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Manitchoko L, Abrahamowicz M, Tubert-Bitter P, Benichou J, Thiébaut ACM. Comparison of cohort and nested case-control designs for estimating the effect of time-varying drug exposure on the risk of adverse event in the presence of ties. Biom J 2023:e2100384. [PMID: 36846937 DOI: 10.1002/bimj.202100384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 08/12/2022] [Accepted: 10/20/2022] [Indexed: 03/01/2023]
Abstract
Cohort and nested case-control (NCC) designs are frequently used in pharmacoepidemiology to assess the associations of drug exposure that can vary over time with the risk of an adverse event. Although it is typically expected that estimates from NCC analyses are similar to those from the full cohort analysis, with moderate loss of precision, only few studies have actually compared their respective performance for estimating the effects of time-varying exposures (TVE). We used simulations to compare the properties of the resulting estimators of these designs for both time-invariant exposure and TVE. We varied exposure prevalence, proportion of subjects experiencing the event, hazard ratio, and control-to-case ratio and considered matching on confounders. Using both designs, we also estimated the real-world associations of time-invariant ever use of menopausal hormone therapy (MHT) at baseline and updated, time-varying MHT use with breast cancer incidence. In all simulated scenarios, the cohort-based estimates had small relative bias and greater precision than the NCC design. NCC estimates displayed bias to the null that decreased with a greater number of controls per case. This bias markedly increased with higher proportion of events. Bias was seen with Breslow's and Efron's approximations for handling tied event times but was greatly reduced with the exact method or when NCC analyses were matched on confounders. When analyzing the MHT-breast cancer association, differences between the two designs were consistent with simulated data. Once ties were taken correctly into account, NCC estimates were very similar to those of the full cohort analysis.
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Affiliation(s)
- Liliane Manitchoko
- Université Paris-Saclay, UVSQ, Inserm, CESP, High Dimensional Biostatistics for Drug Safety and Genomics, Villejuif, France
| | - Michal Abrahamowicz
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Pascale Tubert-Bitter
- Université Paris-Saclay, UVSQ, Inserm, CESP, High Dimensional Biostatistics for Drug Safety and Genomics, Villejuif, France
| | - Jacques Benichou
- Université Paris-Saclay, UVSQ, Inserm, CESP, High Dimensional Biostatistics for Drug Safety and Genomics, Villejuif, France.,Department of Biostatistics, Rouen University Hospital, Rouen, France
| | - Anne C M Thiébaut
- Université Paris-Saclay, UVSQ, Inserm, CESP, High Dimensional Biostatistics for Drug Safety and Genomics, Villejuif, France
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Dujardin A, Lorent M, Foucher Y, Legendre C, Kerleau C, Brouard S, Giral M. Time-dependent lymphocyte count after transplantation is associated with higher risk of graft failure and death. Kidney Int 2020; 99:1189-1201. [PMID: 32891605 DOI: 10.1016/j.kint.2020.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/11/2020] [Accepted: 08/10/2020] [Indexed: 11/18/2022]
Abstract
The transplantation field requires the identification of specific risk factors associated with the level of immunosuppression. Here, our aim was to analyze the association between the number of circulating lymphocytes, monitored routinely by complete blood cell counts during outpatient visits, and patient and graft survival. In total, 2,999 kidney or combined kidney-pancreas recipients transplanted between 2000 and 2016, from two University hospitals, were enrolled. We investigated the etiological relationship between time-dependent lymphocyte count beyond one year after transplantation and patient and graft survival, viral infection and cancer risk using time-dependent multivariate Cox models. Model 1 considered kidney function at one year and model 2 as time-dependent variable. At the time of inclusion (one year after transplantation), 584 patients (19.4%) had deep lymphopenia (under 750 /mm3) and 1,072 (35.7%) had a normal count (over 1,500 /mm3). A patient with deep lymphopenia at a given follow-up time had significantly higher risks of graft failure, death and viral infection than comparable patients with a normal lymphocyte count at the same time point. Thus, after the first year of transplantation, the occurrence of deep lymphopenia within a patient's follow-up is a risk factor for long-term graft failure, death and viral infection.
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Affiliation(s)
- Amaury Dujardin
- CRTI UMR 1064, Inserm, Université de Nantes, ITUN, CHU Nantes, RTRS Centaure, Nantes, France; Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Marine Lorent
- Centre Hospitalier Universitaire de Nantes, Nantes, France; Inserm UMR 1246-SPHERE, Université de Nantes, Université de Tours, Nantes, France
| | - Yohann Foucher
- Centre Hospitalier Universitaire de Nantes, Nantes, France; Inserm UMR 1246-SPHERE, Université de Nantes, Université de Tours, Nantes, France
| | - Christophe Legendre
- Kidney Transplant Center, Necker University Hospital, APHP, RTRS Centaure, Paris Descartes and Sorbonne Paris Cité Universities, Paris, France
| | | | - Sophie Brouard
- CRTI UMR 1064, Inserm, Université de Nantes, ITUN, CHU Nantes, RTRS Centaure, Nantes, France; Centre Hospitalier Universitaire de Nantes, Nantes, France.
| | - Magali Giral
- CRTI UMR 1064, Inserm, Université de Nantes, ITUN, CHU Nantes, RTRS Centaure, Nantes, France; Centre Hospitalier Universitaire de Nantes, Nantes, France; Centre d'Investigation Clinique en Biothérapie, Labex IGO, Nantes, France
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Thillard EM, Gautier S, Babykina E, Carton L, Amad A, Bouzillé G, Beuscart JB, Ficheur G, Chazard E. Psychiatric Adverse Events Associated With Infliximab: A Cohort Study From the French Nationwide Discharge Abstract Database. Front Pharmacol 2020; 11:513. [PMID: 32390850 PMCID: PMC7188945 DOI: 10.3389/fphar.2020.00513] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/01/2020] [Indexed: 01/18/2023] Open
Abstract
Introduction Infliximab (IFX) was the first anti-tumor necrosis factor (TNFα) antibody to be used in the treatment of severe chronic inflammatory diseases, such as Crohn’s disease and rheumatoid arthritis. A number of serious adverse drug reactions are known to be associated with IFX use; they include infections, malignancies, and injection site reactions. Although a few case reports have described potential psychiatric adverse events (including suicide attempts and manic episodes), the latter are barely mentioned in IFX’s summary of product characteristics. The objective of the present retrospective study was to detect potential psychiatric adverse events associated with IFX treatment by analyzing a national discharge abstract database. Materials and Methods We performed an historical cohort study by analyzing data from the French national hospital discharge abstract database (PMSI) between 2008 and 2014. All patients admitted with one of the five diseases treated with IFX were included. Results Of the 325,319 patients included in the study, 7,600 had been treated with IFX. The proportion of hospital admissions for one or more psychiatric events was higher among IFX-exposed patients (750 out of 7,600; 9.87%) than among non-exposed patients (17,456 out of 317,719; 5.49%). After taking account of potential confounders in the cohort as a whole, a semi-parametric Cox regression analysis gave an overall hazard ratio (HR) [95% confidence interval] (CI) of 4.5 [3.95; 5.13] for a hospital admission with a psychiatric adverse event during treatment with IFX. The HR (95%CI) for a depressive disorder was 4.97 (7.35; 6.68). Even higher risks were observed for certain pairs of adverse events and underlying pathologies: psychotic disorders in patients treated for ulcerative colitis (HR = 5.43 [2.01; 14.6]), manic episodes in patients treated for severe psoriasis (HR = 12.6 [4.65; 34.2]), and suicide attempts in patients treated for rheumatoid arthritis (HR = 4.45 [1.11; 17.9]). Discussion The present retrospective, observational study confirmed that IFX treatment is associated with an elevated risk of psychiatric adverse events. Depending on the disease treated, physicians should be aware of these potential adverse events.
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Affiliation(s)
- Eve-Marie Thillard
- Univ. Lille, CHU Lille, ULR 2694, CERIM, Public Health Department, Lille, France
| | - Sophie Gautier
- Univ. Lille, Inserm, CHU Lille, UMR-S1172, Center for Pharmacovigilance, Lille, France
| | - Evgeniya Babykina
- Univ. Lille, CHU Lille, ULR 2694, CERIM, Public Health Department, Lille, France
| | - Louise Carton
- Univ. Lille, Inserm, CHU Lille, UMR_S1172, Medical Pharmacology Department, Lille, France
| | - Ali Amad
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Guillaume Bouzillé
- University of Rennes, Inserm, CHU Rennes, UMR 1099 - LTSI, Rennes, France
| | | | - Grégoire Ficheur
- Univ. Lille, CHU Lille, ULR 2694, CERIM, Public Health Department, Lille, France
| | - Emmanuel Chazard
- Univ. Lille, CHU Lille, ULR 2694, CERIM, Public Health Department, Lille, France
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Sesé L, Nunes H, Cottin V, Sanyal S, Didier M, Carton Z, Israel-Biet D, Crestani B, Cadranel J, Wallaert B, Tazi A, Maître B, Prévot G, Marchand-Adam S, Guillot-Dudoret S, Nardi A, Dury S, Giraud V, Gondouin A, Juvin K, Borie R, Wislez M, Valeyre D, Annesi-Maesano I. Role of atmospheric pollution on the natural history of idiopathic pulmonary fibrosis. Thorax 2017; 73:145-150. [PMID: 28798214 DOI: 10.1136/thoraxjnl-2017-209967] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 06/23/2017] [Accepted: 07/24/2017] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Idiopathic pulmonary fibrosis (IPF) has an unpredictable course corresponding to various profiles: stability, physiological disease progression and rapid decline. A minority of patients experience acute exacerbations (AEs). A recent study suggested that ozone and nitrogen dioxide might contribute to the occurrence of AE. We hypothesised that outdoor air pollution might influence the natural history of IPF. METHODS Patients were selected from the French cohort COhorte FIbrose (COFI), a national multicentre longitudinal prospective cohort of IPF (n=192). Air pollutant levels were assigned to each patient from the air quality monitoring station closest to the patient's geocoded residence. Cox proportional hazards model was used to evaluate the impact of air pollution on AE, disease progression and death. RESULTS Onset of AEs was significantly associated with an increased mean level of ozone in the six preceding weeks, with an HR of 1.47 (95% CI 1.13 to 1.92) per 10 µg/m3 (p=0.005). Cumulative levels of exposure to particulate matter PM10 and PM2.5 were above WHO recommendations in 34% and 100% of patients, respectively. Mortality was significantly associated with increased levels of exposure to PM10 (HR=2.01, 95% CI 1.07 to 3.77) per 10 µg/m3 (p=0.03), and PM2.5 (HR=7.93, 95% CI 2.93 to 21.33) per 10 µg/m3 (p<0.001). CONCLUSION This study suggests that air pollution has a negative impact on IPF outcomes, corroborating the role of ozone on AEs and establishing, for the first time, the potential role of long-term exposure to PM10 and PM2.5 on overall mortality.
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Affiliation(s)
- Lucile Sesé
- EPAR, Université Pierre et Marie, Paris, France.,Service de Pneumologie, AP-HP, Hôpital Avicenne, Bobigny, France.,Université Paris, Bobigny, France
| | - Hilario Nunes
- Service de Pneumologie, AP-HP, Hôpital Avicenne, Bobigny, France.,Université Paris, Bobigny, France
| | - Vincent Cottin
- Service de Pneumologie, Hôpital Louis Pradel, Lyon, France
| | | | - Morgane Didier
- Service de Pneumologie, AP-HP, Hôpital Avicenne, Bobigny, France.,Université Paris, Bobigny, France
| | - Zohra Carton
- Service de Pneumologie, AP-HP, Hôpital Avicenne, Bobigny, France
| | | | - Bruno Crestani
- Service de Pneumologie, AP-HP, Hôpital Bichat, Paris, France
| | | | - Benoit Wallaert
- Service de Pneumologie, Hôpital Albert Calmette, Lille, France
| | - Abdellatif Tazi
- Service de Pneumologie, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Bernard Maître
- Service de Pneumologie, AP-HP, Hôpital Henri-Mondor, Créteil, France
| | - Grégoire Prévot
- Service de Pneumologie, Hôpital Larrey, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Sylvain Marchand-Adam
- Service de Pneumologie, Hôpital Bretonneau Centre Hospitalier Universitaire de Tours, Paris, France
| | - Stéphanie Guillot-Dudoret
- Service de Pneumologie, Hôpital Pontchaillou, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Annelyse Nardi
- Service de Pneumologie, Nouvel Hôpital Civil, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Sandra Dury
- Service de Pneumologie, Hôpital Maison Blanche, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Violaine Giraud
- Service de Pneumologie, AP-HP, Hôpital Ambroise Paré, Boulogne, France
| | - Anne Gondouin
- Service de Pneumologie, Hôpital Jean Minjoz, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Karine Juvin
- Service de Pneumologie, AP-HP, Hôpital HEGP, Paris, France
| | - Raphael Borie
- Service de Pneumologie, AP-HP, Hôpital Bichat, Paris, France
| | - Marie Wislez
- Service de Pneumologie, AP-HP, Hôpital Tenon, Paris, France
| | - Dominique Valeyre
- Service de Pneumologie, AP-HP, Hôpital Avicenne, Bobigny, France.,Université Paris, Bobigny, France
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Characteristics and consequences of medical care interruptions in HIV-infected patients in France. Epidemiol Infect 2016; 144:2363-70. [PMID: 27033595 DOI: 10.1017/s0950268816000625] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
To describe the consequences of medical care interruptions (MCIs) we selected patients with at least two medical encounters between January 2006 and June 2013 in the Dat'AIDS cohort. Patients with any time interval >15 months between two visits were defined as having a MCI, as opposed to uninterrupted follow-up (UFU). Patients' characteristics at the time of HIV diagnosis and at the censoring date were compared between groups. Cox proportional hazards models were built to assess the role of interruptions on survival (total and AIDS-free). Of 11 116 patients, 824 had at least one MCI. These patients were younger at the time of HIV diagnosis (30 vs. 33 years, P < 0·0001). MCI was less frequent in men having sex with men vs. heterosexual patients [odds ratio (OR) 0·81, 95% confidence interval (CI) 0·69-0·96)], and a centre effect was described. MCI was independently associated with AIDS (OR 2·54, 95% CI 2·10-3·09) and death (OR 2·65, 95% CI 1·94-3·61). At the censoring date, 52·2% of patients with at least one MCI had viral load below detection vs. 85·3% of the UFU group (P < 0·0001). In conclusion, MCIs were associated with patients' survival and with the proportion of viral loads below detection in our cohort, compromising individual and collective treatment benefits.
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Legendre G, Ringa V, Panjo H, Zins M, Fritel X. Incidence and remission of urinary incontinence at midlife: a cohort study. BJOG 2014; 122:816-824. [PMID: 25056001 DOI: 10.1111/1471-0528.12990] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Urinary incontinence (UI) is often considered to be an age-related disease that develops gradually as women grow older. Much remains to be learnt about factors that promote its incidence or its remission. Our objective was to assess its incidence and risk factors. DESIGN Longitudinal cohort study. SETTING French GAZEL cohort. POPULATION A cohort of 4127 middle-aged women (aged 47-52 years at baseline) over an 18-year period (1990-2008). METHODS UI was defined as 'difficulty retaining urine'. The question was asked at baseline and repeated every 3 years over an 18-year period. Two groups (UI incidence and remission) were analysed according to status at baseline (continent or incontinent). A multivariable analysis (Cox model) was used to estimate the risk factors for UI incidence and remission. MAIN OUTCOME MEASURES Annual incidence and remission rates and risk factors for UI incidence and remission. RESULTS The annual incidence and remission rates for UI were 3.3% and 6.2%, respectively. High educational level (hazard ratio [HR] = 1.28; 95% confidence interval [95% CI] = 1.05-1.55), parity, i.e. at least one baby versus no baby (HR = 1.64; 95% CI = 1.19-2.27), menopause (HR = 5.44; 95% CI = 4.47-6.63), weight gain, i.e. for each kilogram change in weight (HR = 1.00; 95% CI = 1.00-1.02), onset of depressive symptoms (HR = 1.31; 95% CI = 1.09-1.57) and impairment in health-related quality of life incidence (social isolation dimension [HR = 1.29; 95% CI = 1.04-1.60] and energy dimension [HR = 1.41; 95% CI = 1.17-1.70]) were associated with an increased probability of UI. The factors associated with persistent UI were age (HR = 0.58; 95% CI = 0.55-0.61), weight gain (HR = 0.99; 95% CI = 0.98-0.99) and transition to menopausal status (HR = 1.54; 95% CI = 1.19-1.99). CONCLUSIONS Our study suggests that, in our population of middle-aged women, age, menopause, weight gain, onset of depression and impaired health-related quality of life may promote UI.
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Affiliation(s)
- G Legendre
- CESP-INSERM, U1018, Equipe 7, Genre, Santé Sexuelle et Reproductive, Université Paris Sud, Le Kremlin-Bicêtre Cedex, France; Service de Gynécologie-Obstétrique, Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Le Kremlin Bicêtre Cedex, France; Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire d'Angers, Angers Cedex, France
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Rolland Y, Cantet C, Barreto PDS, Cesari M, Abellan van Kan G, Vellas B. Predictors of decline in walking ability in community-dwelling Alzheimer's disease patients: Results from the 4-years prospective REAL.FR study. ALZHEIMERS RESEARCH & THERAPY 2014; 5:52. [PMID: 24517197 PMCID: PMC3978928 DOI: 10.1186/alzrt216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 10/15/2013] [Indexed: 11/11/2022]
Abstract
Introduction The aim of this study was to explore the predictors of decline in walking ability in patients with Alzheimer’s disease (AD). Methods The prospective REseau surla maladie ALzheimer FRançais (REAL.FR) study enrolled six hundred eighty four community-dwelling AD subjects (71.20% women; mean age 77.84 Standard Deviation, SD, 6.82 years, Mini-Mental State Examination 20.02, SD 4.23). Decline in walking ability was defined as the first loss of 0.5 points or more in the walking ability item of the Activities of Daily Living scale (ADL), where higher score means greater independence, during the four-years of follow-up. Demographic characteristics, co-morbidities, and level of education were reported at baseline. Disability, caregiver burden, cognitive and nutritional status, body mass index, balance, behavioral and psychological symptoms of dementia, medication, hospitalization, institutionalization and death were reported every six months during the four years. Cox survival analyses were performed to assess the independent factors associated with decline in walking ability. Results The mean incident decline in walking ability was 12.76% per year (95% Confidence Interval (CI) 10.86 to 14.66). After adjustment for confounders, the risk of decline in walking ability was independently associated with older age (Relative Risk, RR = 1.05 (95% CI 1.02 to 1.08)), time from diagnosis of dementia (RR = 1.16 (1.01 to 1.33)), painful osteoarthritis (RR = 1.84 (1.19 to 2.85)), hospitalization for fracture of the lower limb (RR = 6.35 (3.02 to 13.37)), higher baseline ADL score (RR = 0.49 (0.43 to 0.56)), and the use of acetylcholinesterase inhibitors (RR = 0.52 (0.28 to 0.96)). Conclusions The risk of decline in walking ability is predicted by older age, increased dementia severity, poor functional score, and orthopedic factors and seems to be prevented by the use of acetylcholinesterase inhibitors medication.
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Affiliation(s)
- Yves Rolland
- INSERM, U1027, F-31073 Toulouse, France ; University of Toulouse III, F-31073 Toulouse, France ; Gerontopole, Toulouse University Hospital, Toulouse, France ; Service de Médecine Interne et de Gérontologie Clinique, Pavillon Junot, 170 avenue de Casselardit. Hôpital La Grave-Casselardit, Toulouse, France
| | - Christelle Cantet
- INSERM, U1027, F-31073 Toulouse, France ; University of Toulouse III, F-31073 Toulouse, France ; Gerontopole, Toulouse University Hospital, Toulouse, France
| | | | - Matteo Cesari
- INSERM, U1027, F-31073 Toulouse, France ; University of Toulouse III, F-31073 Toulouse, France ; Gerontopole, Toulouse University Hospital, Toulouse, France
| | - Gabor Abellan van Kan
- INSERM, U1027, F-31073 Toulouse, France ; University of Toulouse III, F-31073 Toulouse, France ; Gerontopole, Toulouse University Hospital, Toulouse, France
| | - Bruno Vellas
- INSERM, U1027, F-31073 Toulouse, France ; University of Toulouse III, F-31073 Toulouse, France ; Gerontopole, Toulouse University Hospital, Toulouse, France
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Sourdet S, Abellan Van Kan G, Soto ME, Houles M, Cantet C, Nourhashemi F, Vellas B, Pahor M, Rolland Y. Prognosis of an Abnormal One-Leg Balance in Community-Dwelling Patients With Alzheimer’s Disease: A 2-Year Prospective Study in 686 Patients of the REAL.FR Study. J Am Med Dir Assoc 2012; 13:407.e1-6. [DOI: 10.1016/j.jamda.2011.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 11/09/2011] [Accepted: 11/15/2011] [Indexed: 12/20/2022]
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Le Port A, Cottrell G, Martin-Prevel Y, Migot-Nabias F, Cot M, Garcia A. First malaria infections in a cohort of infants in Benin: biological, environmental and genetic determinants. Description of the study site, population methods and preliminary results. BMJ Open 2012; 2:e000342. [PMID: 22403339 PMCID: PMC3298838 DOI: 10.1136/bmjopen-2011-000342] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 02/06/2012] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Malaria infection of the placenta during pregnancy was found to be associated with infant susceptibility to malaria. Other factors such as the intensity of malaria transmission and the nutritional status of the child might also play a role, which has not been adequately taken into account in previous studies. The aim of this study was to assess precisely the parts played by environmental, nutritional and biological determinants in first malaria infections, with a special interest in the role of placental infection. The objective of this paper is not to present final results but to outline the rationale of the study, to describe the methods used and to report baseline data. DESIGN A cohort of infants followed with a parasitological (symptomatic and asymptomatic parasitaemia) and nutritional follow-up from birth to 18 months. Ecological, entomological and behavioural data were collected along the duration of the study. SETTING A rural area in Benin with two seasonal peaks in malaria transmission. PARTICIPANTS 656 infants of women willing to participate in the study, giving birth in one of the three maternity clinics and living in one of the nine villages of the study area. PRIMARY OUTCOME MEASURES The time and frequency of first malaria parasitaemias in infants, according to Plasmodium falciparum infection of the placenta. RESULTS 11% of mothers had a malaria-infected placenta at delivery. Mosquito catches made every 6 weeks in the area showed an average annual P falciparum entomological inoculation rate of 15.5, with important time and space variations depending on villages. Similarly, the distribution of rainfalls, maximal during the two rainy seasons, was heterogeneous over the area. CONCLUSIONS Considering the multidisciplinary approach of all factors potentially influencing the malaria status of newborn babies, this study should bring evidence on the implication of placental malaria in the occurrence of first malaria infections in infants.
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Affiliation(s)
- Agnès Le Port
- Institut de Recherche pour le Développement (IRD), UMR216, Mère et Enfant Face aux Infections Tropicales, Paris, France
- Faculté de Pharmacie, Université Paris Descartes, Paris, France
| | - Gilles Cottrell
- Faculté de Pharmacie, Université Paris Descartes, Paris, France
- Institut de Recherche pour le Développement (IRD), UMR216, Mère et Enfant Face aux Infections Tropicales, Cotonou, Benin
| | - Yves Martin-Prevel
- IRD, UMR204 IRD/Montpellier1/Montpellier2/SupAgro, Prévention des Malnutritions et des Pathologies Associées (NUTRIPASS), Montpellier, France
| | - Florence Migot-Nabias
- Institut de Recherche pour le Développement (IRD), UMR216, Mère et Enfant Face aux Infections Tropicales, Paris, France
- Faculté de Pharmacie, Université Paris Descartes, Paris, France
| | - Michel Cot
- Institut de Recherche pour le Développement (IRD), UMR216, Mère et Enfant Face aux Infections Tropicales, Paris, France
- Faculté de Pharmacie, Université Paris Descartes, Paris, France
| | - André Garcia
- Institut de Recherche pour le Développement (IRD), UMR216, Mère et Enfant Face aux Infections Tropicales, Paris, France
- Faculté de Pharmacie, Université Paris Descartes, Paris, France
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Relationship between home hazards and falling among community-dwelling seniors using home-care services. Rev Epidemiol Sante Publique 2010; 58:3-11. [DOI: 10.1016/j.respe.2009.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Revised: 09/22/2009] [Accepted: 10/19/2009] [Indexed: 11/18/2022] Open
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