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Couffignal C, Kolta S, Flamant M, Cazanave C, Haymann JP, Mentré F, Duval X, Leport C, Raffi F, Chêne G, Salamon R, Moatti JP, Pierret J, Spire B, Brun-Vézinet F, Fleury H, Masquelier B, Peytavin G, Garraffo R, Costagliola D, Dellamonica P, Katlama C, Meyer L, Salmon D, Sobel A, Cuzin L, Dupon M, Le Moing V, Marchou B, May T, Morlat P, Rabaud C, Waldner-Combernoux A, Hardel L, Reboud P, Couffin-Cadiergues S, Marchand L, Assuied A, Carrieri P, Habak S, Couturier F, Jadand C, Perrier A, Préau M, Protopopescu C, Schmit J, Chennebault J, Faller J, Magy-Bertrand N, Chirouze C, Humbert P, Longy-Boursier, Neau D, Granier P, Ansart S, Verdon R, Merrien D, Chevojon P, Sobel A, Levy Y, Piroth L, Perronne C, Froguel E, Ceccaldi J, Chidiac C, Grégoire V, Reynes J, Fuzibet JG, Arsac P, Bouvet E, Bricaire F, Monsonego J, Girard P, Guillevin L, Herson S, Molina J, Pialoux G, Sain O, Sellier P, Roblot F, Bani-Sadr F, Michelet C, Lucht F, Debord C, Martin T, De Jaureguiberry J, Bernard L. Nevirapine Use Is Associated with Higher Bone Mineral Density in HIV-1 Positive Subjects on Long-Term Antiretroviral Therapy. AIDS Res Hum Retroviruses 2020; 36:399-405. [PMID: 31891665 DOI: 10.1089/aid.2019.0229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We assessed bone mineral density (BMD) in a cohort of human immunodeficiency virus (HIV)-positive patients after a median of 11 years of combination antiretroviral therapy (cART) and evaluated the respective role of HIV infection and antiretroviral drugs (ARVs). A cross-sectional study of 162 participants (131 male) from the ANRS-C08 cohort was performed with bone dual-energy X-ray absorptiometry (DXA) scans and renal assessment. The window of exposure to ARVs was defined as an exposure of more than six cumulative months during the last 3 years before the DXA evaluation to account for a cumulative exposure that could affect bone remodeling. The association with low BMD (Z-score < -2) was assessed by a multiple logistic regression model. The study population was 50 years (median), hepatitis C virus (HCV) (18%), and hepatitis B virus (HBV) (8%) coinfection with HIV-RNA <50 c/mL in 89%, median CD4 of 619/mm3. Prevalence of low BMD was 18% in males and 6% in females. The factors associated with a Z-score < -2 in males were uric acid renal loss [adjusted odds ratio (aOR): 6.1; 95% confidence interval (CI): 1.2-31.5; p = .03], HCV coinfection (aOR: 4.0; 95% CI: 1.3-12.2; p = .02), and less frequent window of exposure to nevirapine (NVP) (aOR: 0.1; 95% CI: 0.02-0.6; p = .01). For the full study sample, there was a strong positive association between duration of exposure to NVP and lumbar spine Z-score (p = .004). HIV-positive patients exposed to long-term cART have a high incidence of low BMD. Tenofovir disoproxil fumarate and ritonavir-boosted protease inhibitors did not seem to be associated with increased risk of low BMD, whereas NVP exposure appeared to have an independent positive association.
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Affiliation(s)
- Camille Couffignal
- Infection, Antimicrobials, Modeling, Evolution (IAME) UMR 1137, INSERM and Université of Paris, Paris, France
| | - Sami Kolta
- Department of Rheumatology, University Hospital Cochin, Assistance Publique–Hôpitaux de Paris, INSERM UMR-1153, Paris, France
| | - Martin Flamant
- Department of Physiology, University Hospital Bichat, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Charles Cazanave
- Infectious Diseases Department, University Hospital Bordeaux, Bordeaux, France
| | - Jean-Philippe Haymann
- Department of Physiology, University Hospital Tenon, and INSERM UMR_S1155, Paris, France
| | - France Mentré
- Infection, Antimicrobials, Modeling, Evolution (IAME) UMR 1137, INSERM and Université of Paris, Paris, France
| | - Xavier Duval
- Infection, Antimicrobials, Modeling, Evolution (IAME) UMR 1137, INSERM and Université of Paris, Paris, and INSERM CIC1425, Paris, France
| | - Catherine Leport
- Unité COREB (Coordination du Risque Epidémique et Biologique), Assistance Publique–Hôpitaux de Paris, Paris, France
| | - François Raffi
- Infectious Diseases Department, University Hospital Hotel-Dieu, and INSERM CIC 1413, University of Nantes, Nantes, France
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Pradier C, Carrieri P, Bentz L, Spire B, Dellamonica P, Moreau J, Moatti JP. Impact of short-term adherence on virological and immunological success of HAART: a case study among French HIV-infected IDUs. Int J STD AIDS 2016; 12:324-8. [PMID: 11368807 DOI: 10.1258/0956462011923165] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To evaluate the impact of injection drug users (IDUs) adherence on effectiveness of highly active antiretroviral therapy (HAART), repeated measures of plasma viral load and CD4+ counts before HAART initiation and at last visit in the cohort were studied. Data were collected by means of patient's face-to-face and self-administered questionnaires about adherence to HAART during the week prior to the last visit. Of a total of 119 patients treated with HAART, undetectable viral load was obtained for 55 patients (46.2%) (G3); 34 patients (28.6%) (G2) had a viral load decline > 0.5 log copies/ml but still detectable viral load at last visit in the cohort, while 30 patients (25.2%) (G1) had no decline or decline ≤ 0.5 log copies/ml. Proportion of 100% adherent patients was significantly higher in G3 (83.6%) than in G2 (64.7%) and G1 (56.7%). In spite of differences in virological success and adherence, mean increase in CD4+ counts was similar in G3 (123 ± 160 counts/mm3) and G2 (143 ± 147) while no immunological improvement was observed in G1. For the sub-groups of patients whose limited adherence has implied virological failure but did not impede short-term immunological reconstitution following HAART initiation, decision to switch HAART regimens could be delayed until interventions for improving future adherence have been carried out.
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Affiliation(s)
- C Pradier
- CISIH, Hôpital de l'Archet, Nice, France
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Bousquet J, Anto JM, Berkouk K, Gergen P, Antunes JP, Augé P, Camuzat T, Bringer J, Mercier J, Best N, Bourret R, Akdis M, Arshad SH, Bedbrook A, Berr C, Bush A, Cavalli G, Charles MA, Clavel-Chapelon F, Gillman M, Gold DR, Goldberg M, Holloway JW, Iozzo P, Jacquemin S, Jeandel C, Kauffmann F, Keil T, Koppelman GH, Krauss-Etschmann S, Kuh D, Lehmann S, Carlsen KCL, Maier D, Méchali M, Melén E, Moatti JP, Momas I, Nérin P, Postma DS, Ritchie K, Robine JM, Samolinski B, Siroux V, Slagboom PE, Smit HA, Sunyer J, Valenta R, Van de Perre P, Verdier JM, Vrijheid M, Wickman M, Yiallouros P, Zins M. Developmental determinants in non-communicable chronic diseases and ageing. Thorax 2015; 70:595-7. [PMID: 25616486 DOI: 10.1136/thoraxjnl-2014-206304] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 10/24/2014] [Indexed: 11/03/2022]
Abstract
Prenatal and peri-natal events play a fundamental role in health, development of diseases and ageing (Developmental Origins of Health and Disease (DOHaD)). Research on the determinants of active and healthy ageing is a priority to: (i) inform strategies for reducing societal and individual costs of an ageing population and (ii) develop effective novel prevention strategies. It is important to compare the trajectories of respiratory diseases with those of other chronic diseases.
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Affiliation(s)
- J Bousquet
- University Hospital, Montpellier, France Inserm U 1168, Paris, France Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc Roussillon, Site de Référence de l'EIP on AHA, Montpellier, France MeDALL, Mechanisms of the Development of Allergy, FP7, Amsterdam, Groningen, the Netherlands
| | - J M Anto
- MeDALL, Mechanisms of the Development of Allergy, FP7, Amsterdam, Groningen, the Netherlands Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain Universitat Pompeu Fabra (UPF), Barcelona, Spain CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - K Berkouk
- Deputy Head of Unit for Medical Research and the Challenge of Ageing, DG Research & Innovation, European Commission, Brussels, Belgium
| | - P Gergen
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - J Pinto Antunes
- European Commission, Directorate General for Health and Consumers, Brussels, Belgium
| | - P Augé
- Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc Roussillon, Site de Référence de l'EIP on AHA, Montpellier, France University Montpellier 1, France
| | - T Camuzat
- Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc Roussillon, Site de Référence de l'EIP on AHA, Montpellier, France Région Languedoc Roussillon, France
| | - J Bringer
- Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc Roussillon, Site de Référence de l'EIP on AHA, Montpellier, France Montpellier Medical School, France
| | - J Mercier
- Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc Roussillon, Site de Référence de l'EIP on AHA, Montpellier, France Department of Physiology, Montpellier University Hospital, France University Montpellier 1, France
| | - N Best
- Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc Roussillon, Site de Référence de l'EIP on AHA, Montpellier, France Nimes University Hospital, France
| | - R Bourret
- Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc Roussillon, Site de Référence de l'EIP on AHA, Montpellier, France Montpellier University Hospital, France
| | - M Akdis
- MeDALL, Mechanisms of the Development of Allergy, FP7, Amsterdam, Groningen, the Netherlands Swiss Institute of Allergy and Asthma Research (SIAF), Davos and University of Zurich, Switzerland
| | - S H Arshad
- David Hide Asthma and Allergy Research Centre, Isle of Wight, UK
| | - A Bedbrook
- Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc Roussillon, Site de Référence de l'EIP on AHA, Montpellier, France
| | - C Berr
- Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc Roussillon, Site de Référence de l'EIP on AHA, Montpellier, France Inserm, Research Unit U1061, University Montpellier I, Montpellier, France
| | - A Bush
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College, London, UK
| | - G Cavalli
- Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc Roussillon, Site de Référence de l'EIP on AHA, Montpellier, France Institute of Human Genetics, CNRS, Montpellier, France
| | - M A Charles
- Equipe 10 UMR Inserm-Université Paris-Sud (Centre de recherche en Epidémiologie et Santé des Populations, CESP), Villejuif, France
| | - F Clavel-Chapelon
- Nutrition, Hormones and Women's Health Team, INSERM UMR-S 1018, Paris-South University, Villejuif, France
| | - M Gillman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA
| | - D R Gold
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, and Harvard School of Public Health, UK
| | - M Goldberg
- Population-Based Epidemiological Cohorts, INSERM-UVSQ UMS 011, Villejuif, France
| | - J W Holloway
- Human Development & Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - P Iozzo
- Institute of Clinical Physiology, National Research Council (CNR), Pisa, Italy
| | - S Jacquemin
- Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc Roussillon, Site de Référence de l'EIP on AHA, Montpellier, France Horiba, Montpellier, France
| | - C Jeandel
- Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc Roussillon, Site de Référence de l'EIP on AHA, Montpellier, France Department of Geriatrics, University Hospital, Montpellier, France
| | - F Kauffmann
- MeDALL, Mechanisms of the Development of Allergy, FP7, Amsterdam, Groningen, the Netherlands CESP-Team of Respiratory and Environmental Epidemiology INSERM UMR-S1018, University Paris-Sud, Villejuif, France
| | - T Keil
- MeDALL, Mechanisms of the Development of Allergy, FP7, Amsterdam, Groningen, the Netherlands Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin, Berlin, Germany Institute for Clinical Epidemiology and Biometry, Julius Maximilian University of Wuerzburg, Germany
| | - G H Koppelman
- MeDALL, Mechanisms of the Development of Allergy, FP7, Amsterdam, Groningen, the Netherlands Department of Pediatric Pulmonology and Pediatric Allergology, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen Research Institute for Asthma and COPD, Groningen, The Netherlands
| | - S Krauss-Etschmann
- Comprehensive Pneumology Center, Ludwig Maximilians University and Helmholtz Zentrum Muenchen, Member of the German Research Center for Lung Research, Großhadern, Germany
| | - D Kuh
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - S Lehmann
- Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc Roussillon, Site de Référence de l'EIP on AHA, Montpellier, France Institut de Médecine Régénératrice et de Biothérapie (I.M.R.B.), University Hospital, INSERM U1040, Montpellier, France
| | - K C Lodrup Carlsen
- MeDALL, Mechanisms of the Development of Allergy, FP7, Amsterdam, Groningen, the Netherlands Department of Paediatrics, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - D Maier
- MeDALL, Mechanisms of the Development of Allergy, FP7, Amsterdam, Groningen, the Netherlands Biomax Informatics AG, Planegg, Germany
| | - M Méchali
- Institute of Human Genetics, CNRS, Montpellier, France
| | - E Melén
- MeDALL, Mechanisms of the Development of Allergy, FP7, Amsterdam, Groningen, the Netherlands Institute of Environmental Medicine, Karolinska Institutet and Sachs' Children's Hospital, Stockholm, Sweden
| | - J P Moatti
- Aix-Marseille University (AMU), Research Unit 912 AMU/INSERM/IRD Social and Economic Sciences Applied to Health (SESSTIM), France
| | - I Momas
- MeDALL, Mechanisms of the Development of Allergy, FP7, Amsterdam, Groningen, the Netherlands Department of Public health and biostatistics, Descartes University, Paris, France Municipal Department of social action, childhood, and health, Paris, France
| | - P Nérin
- Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc Roussillon, Site de Référence de l'EIP on AHA, Montpellier, France SATT AxLR, Montpellier, France
| | - D S Postma
- MeDALL, Mechanisms of the Development of Allergy, FP7, Amsterdam, Groningen, the Netherlands Department of Pulmonology, University Medical Center Groningen, University of Groningen, GRIAC Research Institute, Groningen, The Netherlands
| | - K Ritchie
- Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc Roussillon, Site de Référence de l'EIP on AHA, Montpellier, France Inserm U1061 Neuropsychiatry, Montpellier and Faculty of Medicine, Imperial College London, London, UK
| | - J M Robine
- Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc Roussillon, Site de Référence de l'EIP on AHA, Montpellier, France Inserm Research Unit 988, Paris, France Inserm Research Unit 710, Montpellier, France Ecole Pratique des Hautes Etudes (EPHE), Paris, France
| | - B Samolinski
- Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - V Siroux
- MeDALL, Mechanisms of the Development of Allergy, FP7, Amsterdam, Groningen, the Netherlands Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, University Grenoble Alpes, IAB, Grenoble, France Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, INSERM, IAB, Grenoble, France Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, CHU de Grenoble, IAB, Grenoble, France
| | - P E Slagboom
- Section of Molecular Epidemiology, Leiden University Medical Center, Leiden, the Netherlands Consortium for Healthy Aging, Leiden University Medical Center, Leiden, the Netherlands
| | - H A Smit
- MeDALL, Mechanisms of the Development of Allergy, FP7, Amsterdam, Groningen, the Netherlands Julius Center of Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - J Sunyer
- MeDALL, Mechanisms of the Development of Allergy, FP7, Amsterdam, Groningen, the Netherlands Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain Universitat Pompeu Fabra (UPF), Barcelona, Spain CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - R Valenta
- MeDALL, Mechanisms of the Development of Allergy, FP7, Amsterdam, Groningen, the Netherlands Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - P Van de Perre
- University Hospital and INSERM U 1058, Montpellier, France
| | - J M Verdier
- Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc Roussillon, Site de Référence de l'EIP on AHA, Montpellier, France EPHE, Section des Sciences de la Vie et de la Terre, Paris, France UMR S 710, University Montpellier 2, Montpellier, Paris, France Institut Transdisciplinaire d'Etudes du Vieillissement, Montpellier, France
| | - M Vrijheid
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain Universitat Pompeu Fabra (UPF), Barcelona, Spain CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - M Wickman
- MeDALL, Mechanisms of the Development of Allergy, FP7, Amsterdam, Groningen, the Netherlands Institute of Environmental Medicine, Karolinska Institutet and Sachs' Children's Hospital, Stockholm, Sweden
| | - P Yiallouros
- Cyprus International Institute for Environmental & Public Health in Association with Harvard School of Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - M Zins
- Director of Population-Based Epidemiological Cohorts, INSERM-UVSQ UMS 011, Villejuif, France
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Leport C, Zylberman P, Guégan JF, Bricaire F, Cavallo JD, Che D, Eliaszewicz M, Moatti JP. Proceedings of the 2nd seminar on emerging infectious diseases, December 7, 2012 – Current trends and proposals. Rev Epidemiol Sante Publique 2014; 62:153-8. [PMID: 24826393 PMCID: PMC7130560 DOI: 10.1016/j.respe.2013.11.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Loubière S, Rotily M, Durand-Zaleski I, Costagliola D, Moatti JP. L'introduction de la PCR dans le dépistage du virus de l'hépatite C dans les dons de sang : du mésusage du principe de précaution. Med Sci (Paris) 2012. [DOI: 10.4267/10608/1922] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Faucher C, Le Corroller Soriano AG, Esterni B, Vey N, Stoppa AM, Chabannon C, Mohty M, Michallet M, Bay JO, Genre D, Maraninchi D, Viens P, Moatti JP, Blaise D. Randomized study of early hospital discharge following autologous blood SCT: medical outcomes and hospital costs. Bone Marrow Transplant 2011; 47:549-55. [PMID: 21725375 DOI: 10.1038/bmt.2011.126] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We report the first randomized study comparing early hospital discharge with standard hospital-based follow-up after high-dose chemotherapy (HDCT) and PBSCT. Patients aged 18-65 years, with an indication of PBSCT for non-leukemic malignant diseases were randomly assigned between two arms. Arm A consisted of early hospital discharge (HDCT during hospitalization, discharge at day 0, home stay with a caregiver, outpatient clinic follow-up). In arm B patients were followed up as inpatients. In total 131 patients were analyzed (66 in arm A and 65 in arm B). Patient characteristics and hematological reconstitution were comparable between the two groups. In arm A, 26 patients were actually discharged early. Patients in group A spent fewer days in hospital (11 vs 12 days, P=0.006). This strategy resulted in a 6% mean cost reduction per patient when compared with the conventional hospital-based group. The early discharge approach within the French health system, while safe and feasible, is highly dependent on social criteria (caregiver availability and home to hospital distance). It is almost always associated with conventional hospital readmission during the aplasia phase, and limits cost savings when considering the whole population of patients benefiting from HDCT in routine clinical practice.
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Affiliation(s)
- C Faucher
- Institut Paoli-Calmettes-Regional Center for Cancer Research and Treatment, Marseilles, France.
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Affiliation(s)
- B Ventelou
- GREQAM-CNRS & Regional Center for Disease Control (ORS-PACA), 23 rue S Torrents, F-13006 Marseille, France and, INSERM Research Unit 912, Economic & Social Sciences, Health Systems & Societies, INSERM, Marseille, France
| | - JP Moatti
- University of the Mediterranean, Marseille, France and, INSERM Research Unit 912, Economic & Social Sciences, Health Systems & Societies, INSERM, Marseille, France
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Moatti JP, Dab W, Quenel P, Beltzer N, Pollak M. Social perception of aids in french general public: 1987–1990 Evolution in paris region. Psychol Health 2007; 9:285-296. [DOI: 10.1080/08870449408407487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- J. P. Moatti
- a INSERM Research Unit 357, “Health Economics and Sociology”, Hôpital de Bicêtre
| | - W. Dab
- b National School of Public Health
| | - P. Quenel
- c Center for Disease Control and Epidemiology (ORS) , Paris Region
| | - N. Beltzer
- a INSERM Research Unit 357, “Health Economics and Sociology”, Hôpital de Bicêtre
| | - M. Pollak
- d CNRS-Group of political and moral sociology , Paris
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Carrieri MP, Rey D, Serraino D, Trémolières F, Méchali D, Moatti JP, Spire B. Oral contraception and unprotected sex with occasional partners of women HIV-infected through injection drug use. AIDS Care 2007; 18:795-800. [PMID: 16971290 DOI: 10.1080/09540120500431584] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Among HIV-infected women, unprotected sex with the main sexual partner is common practice. Conversely, studies about condom use with sexual partners of unknown HIV sero-status are sparsely reported. We aimed to assess the impact of oral contraception on unsafe sexual behaviours with occasional partners in women HIV-infected through injection drug use. The analysis focused on 90 women, enrolled in the French cohort MANIF 2000 and reported having engaged in sexual relationships with occasional partners during a 48-month period. Visits where women reported unprotected sex with occasional partners in the prior 6 months were compared to visits where they reported protected sex using a logistic model based on Generalised Estimating Equations. Unprotected sex with occasional partners was independently associated with oral contraception (OR[95%CI] = 3.2[1.4-7.2]), reporting only one occasional partner (OR[95%CI] = 3.1[1.6-6.2]) and antiretroviral treatment receipt. No significant association was found between unprotected sex and CD4 level or plasma viral load. With the growing population of people living with HIV as a chronic infection, the development and evaluation of HIV-prevention interventions tailored toward women remain a public health priority. Risk reduction counselling and interventions are needed to promote either the use of dual contraception or, alternatively, that of female condom.
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Peretti-Watel P, Bendiane MK, Moatti JP. Attitudes toward palliative care, conceptions of euthanasia and opinions about its legalization among French physicians. Soc Sci Med 2005; 60:1781-93. [PMID: 15686809 DOI: 10.1016/j.socscimed.2004.08.037] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We assume that actors of the professionalization process of palliative care make a special effort to demarcate it from euthanasia, and that such an effort has a significant impact on beliefs and attitudes toward euthanasia among the whole medical profession. We investigated concurrently attitudes toward palliative care, conceptions of euthanasia and opinion toward its legalization among a sample of 883 French general practitioners, oncologists and neurologists. We found four contrasted profiles of attitudes toward palliative care, which were closely correlated with being in touch with palliative care providers. Attitudes toward palliative care were closely correlated with beliefs about which medical practices should be labelled euthanasia, and these beliefs were in turn strongly associated with opinions toward euthanasia legalization. Our results suggest that the relationship between palliative care and euthanasia mixes semantic and strategic aspects, beyond cognitive and conative ones.
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Affiliation(s)
- P Peretti-Watel
- Regional Center for Disease Control of South-Eastern France, Marseille, France.
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Peretti-Watel P, Bendiane MK, Obadia Y, Lapiana JM, Galinier A, Pegliasco H, Favre R, Moatti JP. Disclosure of Prognosis to Terminally Ill Patients: Attitudes and Practices Among French Physicians. J Palliat Med 2005; 8:280-90. [PMID: 15890039 DOI: 10.1089/jpm.2005.8.280] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Disclosure of the prognosis to terminally ill patients is a strong prerequisite for integrating the physical, psychological, spiritual, and social aspects of end-of-life care. OBJECTIVE This study aimed to assess French physicians' general attitudes and effective practices (with patients followed up to death recently) toward such disclosure. DESIGN/SUBJECTS We used data from a cross-sectional survey conducted among a national sample of 917 French general practitioners, oncologists, and neurologists. RESULTS A majority of respondents opted for prognosis disclosure only at patients' request, very few opted for systematic disclosure without patient's request, and a significant minority opted for systematic concealment. Concerning deceased patients described by respondents, 44.5% of competent patients were informed of prognosis by their physician, 27.3% were informed by someone else, 9.0% refused to be informed, and 19.2% were simply not informed. Concealment was more frequent for older patients, and physicians involved in a nongovernmental organization (NGO) for patients' support were more likely to disclose the prognosis, even without patient's request. CONCLUSIONS Disclosure of the prognosis to terminally ill patients is still far from systematic in France. Further research is needed to better understand the motivations of French physicians' disclosure practices, which are probably culturally shaped.
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Affiliation(s)
- P Peretti-Watel
- Regional Center for Disease Control of South-Eastern France, 23 rue Stanislas Torrents, 13006 Marseille, France.
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12
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Paraponaris A, Verger P, Desquins B, Villani P, Bouvenot G, Rochaix L, Gourheux JC, Moatti JP. Delivering generics without regulatory incentives? Empirical evidence from French general practitioners about willingness to prescribe international non-proprietary names. Health Policy 2004; 70:23-32. [PMID: 15312707 DOI: 10.1016/j.healthpol.2004.01.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2003] [Accepted: 01/17/2004] [Indexed: 10/26/2022]
Abstract
France presents a unique situation in which the take-off of a generic drug market depends, out of regulatory incentives, on whether physicians choose a prescription method (international non-proprietary names, INN) that can lead to the delivery of these drugs and on whether patients accept them. This paper is aimed at pointing out factors explaining general practitioners' (GPs') willingness to prescribe in INN through data collected from a South-Eastern France representative sample of 600 GPs in March 2002. The main results shed light on the key-role played by GPs' information about drugs and the source which they take it from, by GPs' volume of services and caseloads, and slightly by socio-economic characteristics of patients.
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Affiliation(s)
- A Paraponaris
- Inserm Research Unit 379, Epidemiology and Social Sciences Applied to Medical Innovation, 232 Boulevard Sainte Marguerite, 13273 Marseille Cedex 09, France.
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13
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Ananian P, Houvenaeghel G, Protière C, Rouanet P, Arnaud S, Moatti JP, Tallet A, Braud AC, Julian-Reynier C. Determinants of patients' choice of reconstruction with mastectomy for primary breast cancer. Ann Surg Oncol 2004; 11:762-71. [PMID: 15249342 DOI: 10.1245/aso.2004.11.027] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The aim of the study was to measure women's decisions about breast reconstruction (BR) after mastectomy and to assess the factors contributing to their decisions, in a context involving shared decision-making and maximum patient autonomy. METHODS Women who were about to undergo mastectomy for primary breast cancer were systematically offered choices concerning BR and time of reconstruction (intervention always covered by the French National Insurance System). Self-administered questionnaires were used prior to the operation. RESULTS Among the 181 respondents, 81% opted for BR and 19% for mastectomy alone. In comparison with those who chose mastectomy alone, those opting for BR more frequently recognized the importance of discussing these matters with the surgeon and their partner (adjusted odds ratio [OR(adj)] = 13.45 and 3.59, respectively; P <.05) and realized that their body image was important (OR(adj) = 10.55, P <.01); fears about surgery prevented some of the women from opting for BR (OR(adj) = 0.688, P <.05). Among the women opting for BR, 83% chose immediate breast reconstruction (IBR) and 17% chose delayed breast reconstruction (DBR). The preference for IBR was mainly attributable to the fact that these women had benefited more frequently from doctor-patient discussions (OR(adj) = 3.49, P <.05) but was also attributable to the patients' physical and functional characteristics: they were in a poorer state of health (P <.05). The surgeons predicted their patients' preferences fairly accurately. CONCLUSIONS In a context of maximum autonomy, the great majority of the women chose IBR. The patients' choices were explained mainly by their psychosocial characteristics. The indication for BR should be properly discussed between patients and surgeons before mastectomy.
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Affiliation(s)
- P Ananian
- INSERM U379, Institut Paoli-Calmettes, 232 Boulevard Sainte Marguerite, 13273 Marseille Cedex 9, France
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14
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Julian-Reynier C, Eisinger F, Moatti JP, Sobol H. French physicians' knowledge about hereditary breast/ovarian cancer: the need for continuing vocational training in genetics. Public Health Genomics 2004; 2:165-72. [PMID: 14960837 DOI: 10.1159/000016207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The aim of this study was to determine what medical specialists knew about recent findings in the genetics of breast/ovarian cancer, according to their speciality and the methods they used to keep themselves up to date. METHODS A national random sample of 1,169 surgeons and gynaeco-obstetricians was surveyed using a mailed questionnaire, to which 700 of those contacted responded (60%). RESULTS Two years after it had been identified, BRCA1 was known by only 54% of the practitioners, whereas BRCA2 was known by 49.1% 1 year after it was first identified. The lifetime breast cancer risk of women in the general population was estimated by 37.6% of the participants to be between 6 and 10%, and 35.7% rated the penetrance of a breast cancer mutated gene at between 70 and 90%. After multivariate adjustment, the overall score for knowledge of hereditary breast/ovarian cancer was mainly determined as follows: by the speciality (p < 0.001), since the gynaeco-obstetricians scored the highest and the general surgeons the lowest; by the size of practice (p < 0.001), since a larger practice was associated with a higher score, and by whether or not the participants were accustomed to reading the international literature (p < 0.01). CONCLUSIONS These results show the need for physicians who are not geneticists to acquire further knowledge about cancer genetics. We discuss the role of international reviews in communicating the latest knowledge available in genetics to specialists working in other medical fields.
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15
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Moatti JP, N'Doye I, Hammer SM, Hale P, Kazatchkine M. Antiretroviral treatment for HIV infection in developing countries: an attainable new paradigm. Nat Med 2004; 9:1449-52. [PMID: 14647513 DOI: 10.1038/nm1203-1449] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- J P Moatti
- Université de la Méditerrannée & INSERM Research Unit 379, Marseilles, France 13008.
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16
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Eisinger F, Stoppa-Lyonnet D, Lasset C, Vennin P, Chabal F, Noguès C, Moatti JP, Sobol H, Julian-Reynier C. Comparison of physicians' and cancer prone women's attitudes about breast/ovarian prophylactic surgery. Results from two national surveys. Fam Cancer 2004; 1:157-62. [PMID: 14574172 DOI: 10.1023/a:1021113715998] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Prophylactic surgery is a major issue for breast/ovarian cancer prone women. Bio-clinical data to help in the decision-making are not sufficient. In this context of uncertainty, physicians' and women's attitudes to prophylactic surgery is information of great value. The physicians' attitudes were assessed by a randomised national sample of practitioners involved in breast and ovarian cancer management. The patients' attitudes were appraised with a pre-consultation self- administered questionnaire presented during a one-year period to all women in five cancer genetic clinics chosen, for their representative geographical locations and their activity level. Consent to prophylactic surgery is higher among physicians than among patients (p < 0.0001). Acceptability of mastectomy is lower than that of oophorectomy in both patients and physicians (p < 0.0001 in both groups). In addition, age at which the intervention is proposed to be performed is a key determinant for both mastectomy and oophorectomy acceptability, in both physicians and patients (p < 0.001 for each comparison). Particularly, the age of 40 years seems to be a critical threshold for the acceptability of prophylactic oophorectomy. In contrast, respondents' age at the time of the survey has no significant effect on the acceptability rate. The higher acceptability rate of prophylactic oophorectomy compared to that of mastectomy observed in the physicians' survey is paradoxical because a more substantial medical impact on life expectancy was expected from the latter. Our results indicate that assumed reduced mortality is not the main criterion steering acceptability. It was anticipated that prophylactic mastectomy should be rarely performed in France.
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17
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Peretti-Watel P, Bendiane MK, Obadia Y, Favre R, Lapiana JM, Moatti JP. The prescription of opioid analgesics to terminal cancer patients: impact of physicians' general attitudes and contextual factors. Palliat Support Care 2003; 1:345-52. [PMID: 16594224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
OBJECTIVE This study aimed to examine factors associated with the prescription of opioid analgesics to terminal cancer patients, including physicians' general attitudes toward morphine and contextual factors. METHODS A survey was conducted among a sample of French general practitioners (GPs) and oncologists. Respondents were asked to describe the last three terminally ill patients they had followed up to death. RESULTS Overall, 526 GPs and oncologists (global response rate: 57%) described 1,082 cancer patients, among whom 85.4% received opioid analgesics. Among other significant predictors (patient age, cancer type, family assistance), this prescription was less frequent for female patients followed by male physicians (OR = 0.53), and more frequent for patients followed by physicians trained in palliative care (OR = 2.70). On the other hand, physicians' attitudes toward morphine were not associated with prescription of morphine and other opioid analgesics. SIGNIFICANCE OF RESULTS Although nonprescription of opioid analgesics is only a crude proxy measure for undertreatment of cancer pain, our findings suggest the need to develop training in palliative care in order to standardize practices among GPs and specialists. Our results also highlight the necessity to study pain assessment as an interaction between the physician and the patient, and to consider patients' and physicians' respective genders as a key variable within this interaction.
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Affiliation(s)
- P Peretti-Watel
- Regional Centre for Disease Control of South-Eastern France, Marseilles.
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18
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Brou H, Desgrées-du-Loû A, Souville M, Moatti JP, Msellati P. Prophylactic use of cotrimoxazole against opportunistic infections in HIV-positive patients: knowledge and practices of health care providers in Côte d'Ivoire. AIDS Care 2003; 15:629-37. [PMID: 12959812 DOI: 10.1080/09540120310001595113] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We present here the results of a survey conducted in Côte d'Ivoire, Africa, among healthcare providers, on the knowledge of prophylactic use of cotrimoxazole to prevent opportunistic infections in HIV-infected persons. The survey was conducted in 15 health centres, involved or not in the 'initiative of access to treatment for HIV infected people'. Between December 1999 and March 2000, 145 physicians and 297 other health care providers were interviewed. In the analysis, the health centres were divided into three groups: health centres implicated in the initiative of access to treatment for HIV-infected people with a great deal of caring for HIV-infected people, health centres implicated in this initiative but caring for few HIV-infected people, and health centres not specifically involved in the care of HIV-infected people. Six per cent of physicians and 50% of other health care providers had never heard of cotrimoxazole prophylaxis. The level of information about this prophylaxis is related to the level of HIV-related activities in the health centre. Among health care providers informed, knowledge on the exact terms of prescription of the cotrimoxazole is poor. In conclusion, it appears that the recommendations for primary cotrimoxazole prophylaxis of HIV-infected people did not reach the whole health care provider population. Most physicians are informed but not other health workers, even if the latter are often the only contact of the patient with the healthcentre. The only medical staff correctly informed are the physicians already strongly engaged in the care of HIV-infected people.
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Affiliation(s)
- H Brou
- ENSEA, Abidjan, Côte d'Ivoire.
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19
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Peretti-Watel P, Bendiane MK, Pegliasco H, Lapiana JM, Favre R, Galinier A, Moatti JP. Doctors' opinions on euthanasia, end of life care, and doctor-patient communication: telephone survey in France. BMJ 2003; 327:595-6. [PMID: 12969926 PMCID: PMC194087 DOI: 10.1136/bmj.327.7415.595] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- P Peretti-Watel
- Regional Center for Disease Control of South-Eastern France, 13006 Marseille, France.
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20
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Carrieri MP, Chesney MA, Spire B, Loundou A, Sobel A, Lepeu G, Moatti JP. Failure to maintain adherence to HAART in a cohort of French HIV-positive injecting drug users. Int J Behav Med 2003; 10:1-14. [PMID: 12581944 DOI: 10.1207/s15327558ijbm1001_01] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The study, carried out in the French MANIF 2000 cohort of HIV positive patients contaminated through injecting drug use, assessed the impact of patients' sociodemographic and psychological characteristics, behaviors toward drug abuse, and antiretroviral treatment characteristics on the maintenance of adherence to HAART (highly active antiretroviral therapies). A total of 96 patients (30 men and 66 women), who were initially adherent at their first visit after HAART prescription, were considered for analysis. Among these 96 patients, 22 (22.9%) experienced adherence failure defined as a self-reported, non-adherence behavior at any visit before the 18th month of treatment. Logistic regression showed that lack of a stable relationship, active drug injection, and depression were independently associated with adherence failure. Patients' counseling for facilitating maintenance of adherence to HAART over time should focus on prevention of drug use, provision of social support and consider the potential impact of difficulties with treatment on psychological well-being.
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21
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Arnaud S, Houvenaeghel G, Julian-Reynier C, Protière C, Moatti JP. [Women's preferences for early discharge after conservative breast surgery: feasibility, patient profile and satisfaction]. Ann Chir 2003; 128:26-33. [PMID: 12600325 DOI: 10.1016/s0003-3944(02)00003-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Ours aims were to assess the feasibility of short stay after conservative breast surgery when giving the choice to women, to identify women characteristics associated to short (less than 48 hours) or conventional stay and to confront satisfaction and anxiety of the two groups. METHODS Women were able to choice the length of stay immediately after surgery. Afterwards they completed a questionnaire measuring pain, anxiety and satisfaction. Clinical data concerning surgery were also collected. RESULTS The hospital stay was short for 114 women (75.5%) and conventional for 37 women (24.5%). Length of stay was related to education level (P = 0,021), general health status (ASA score) (P = 0,003), breast pain (P = 0,001), the number of wound drains (P = 0,005), cancer (P = 0,001) and satisfaction about hospitalisation (P = 0,022). Post-surgical morbidity was similar between groups, except prolonged axillary drainage more frequent in conventional stay group. CONCLUSION Women often chose a short stay after breast conservative surgery. This procedure is feasible routinely without heavy complication. Women preference for a short stay is real and could be improved by a better organisation, which ensure the continuity of care between hospital and home, with satisfaction assessment.
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Affiliation(s)
- S Arnaud
- INSERM U379, institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13273 Marseille, France.
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22
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Bouhnik AD, Moatti JP, Vlahov D, Gallais H, Dellamonica P, Obadia Y. Highly active antiretroviral treatment does not increase sexual risk behaviour among French HIV infected injecting drug users. J Epidemiol Community Health 2002; 56:349-53. [PMID: 11964431 PMCID: PMC1732133 DOI: 10.1136/jech.56.5.349] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
STUDY OBJECTIVE This study examined the impact of highly active antiretroviral therapies (HAART) on sexual risk behaviours of HIV infected injecting drug users (IDUs) included in the French MANIF 2000 cohort study. DESIGN Longitudinal analysis including baseline and last follow up characteristics using generalised estimating equations (GEE). SETTING Hospital departments for specialist AIDS care in south eastern France and inner suburbs of Paris. PATIENTS All patients antiretrovial treatment naive, who reported being sexually active at enrollment, and who had at least one follow up visit in the cohort between October 1996 and May 1998 (n=188). MAIN RESULTS Of the 188 HIV infected IDUs who were antiretroviral treatment naive at enrollment, 34 were prescribed HAART during follow up. Proportion of patients who reported at least one episode of unprotected sexual intercourse in the previous six months only significantly decreased in the HAART treated group (from 47.1% to 23.5%, p=0.008, compared with 43.5% to 35.7% in the rest of the sample, p=0.10). GEE multivariate model confirmed that prescription of HAART was associated with reduced sexual risk. CONCLUSIONS The concern that HAART might result in clinical improvement leading to resumption of high risk activities that could inadvertently result in HIV transmission was not supported by these data. Reasons for further reductions in HIV risk with taking HAART remain to be clarified.
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Affiliation(s)
- A-D Bouhnik
- Regional Centre for Disease Control of South-Eastern France (ORS-PACA), Marseilles, France
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23
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Fortanier C, Kuentz M, Sutton L, Milpied N, Michalet M, Macquart-Moulin G, Faucher C, Le Corroller AG, Moatti JP, Blaise D. Healthy sibling donor anxiety and pain during bone marrow or peripheral blood stem cell harvesting for allogeneic transplantation: results of a randomised study. Bone Marrow Transplant 2002; 29:145-9. [PMID: 11850709 DOI: 10.1038/sj.bmt.1703338] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2001] [Accepted: 10/26/2001] [Indexed: 11/08/2022]
Abstract
This study reports the first comparison of healthy donor subjective well-being during two alternative procedures of hematopoietic stem cells harvesting for allogeneic transplantation. Among the 105 donors included between September 1996 and October 1998 in the SFGM French randomised trial aiming to compare allogeneic bone marrow (BM) transplantation and blood cell (BC) transplantation, 64 donors (33 in BC and 31 in BM groups) were relevant for the analysis. They had received a set of self-administered questionnaires to complete during the collection process, aiming to measure anxiety (assessed using the Spielberger's State-Trait Anxiety Inventory) and pain induced by the procedure (evaluated using a visual analogical scale). Results showed that no harvest procedure is free from pain even if none was more painful than the other. Levels of anxiety before the collection procedure were high in both groups and significantly so for BC donors. Although BC collection induces at least similar levels of pain and anxiety as does BM collection, they were of a different kind, and the short-term impact of G-CSF stimulation on the well-being of BC donors has to be taken into account in improving quality of care in the allogeneic setting.
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Affiliation(s)
- C Fortanier
- INSERM U379 'Epidemiology and social sciences applied to medical innovation', Marseille, France
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24
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Duran S, Savès M, Spire B, Cailleton V, Sobel A, Carrieri P, Salmon D, Moatti JP, Leport C. Failure to maintain long-term adherence to highly active antiretroviral therapy: the role of lipodystrophy. AIDS 2001; 15:2441-4. [PMID: 11740195 DOI: 10.1097/00002030-200112070-00012] [Citation(s) in RCA: 224] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In a sample of 277 patients included in the French APROCO cohort study who were initially adherent at follow-up visit 4 months after initiation of a protease inhibitor-containing regimen, 76.4% self-reported at least one lipodystrophy-related symptom and 30.0% failed to maintain adherence behaviour 20 months after enrolment. After multiple adjustment for other related factors, such as younger age, alcohol consumption and poor housing conditions, the number of self-reported lipodystrophy symptoms was independently associated with adherence failure.
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Affiliation(s)
- S Duran
- INSERM U379, Marseille, France
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25
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Rotily M, Prudhomme J, Pardal MS, Hariga F, Iandolo E, Papadourakis A, Moatti JP. [Knowledge and attitudes of prison staff towards HIV/AIDS: a European study]. Sante Publique 2001; 13:325-38. [PMID: 11963530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
The goal of this European pilot study was to evaluate the knowledge, attitudes and beliefs of prison staff from five countries towards HIV infection and to identify factors related to the potential discrimination of HIV-positive inmates. The survey revealed that the levels of knowledge with regard to HIV transmission and the degrees of tolerance varied significantly between prisons. A large proportion of staff overestimated the prevalence of HIV in their prison and feared being contaminated. The willingness of the staff to know the inmates' HIV seropositive status was negatively correlated to their level of tolerance; however, it was positively correlated to their knowledge of the modes of HIV transmission. This study underlines the necessity to improve HIV/AIDS prevention policy for prison staff in order to strengthen good practice in terms of managing the risk of contamination and hindering discrimination.
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Affiliation(s)
- M Rotily
- Inserm U379 23, rue Stanislas Torrents 13006 Marseille, France
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26
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Carrieri P, Cailleton V, Le Moing V, Spire B, Dellamonica P, Bouvet E, Raffi F, Journot V, Moatti JP. The dynamic of adherence to highly active antiretroviral therapy: results from the French National APROCO cohort. J Acquir Immune Defic Syndr 2001; 28:232-9. [PMID: 11694829 DOI: 10.1097/00042560-200111010-00005] [Citation(s) in RCA: 140] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Our objective was to describe the evolution of adherence to highly active antiretroviral therapy (HAART) over a 20-month period and its relationship with virologic success. METHODS Self-reported adherence, clinical, and virologic data were collected 4 (M4), 12 (M12), and 20 (M20) months after initiation of a protease inhibitor-containing regimen in the French APROCO cohort. At each visit, patients were classified as nonadherent, moderately, or highly adherent, and HIV plasma RNA was determined. RESULTS Among the 762 patients who were regularly followed until M20, the 436 patients who answered to all questionnaires, including adherence measurement, were selected for the analysis. The proportion of highly adherent patients was 55.7%, 62.2%, and 60.3% at M4, M12, and M20, respectively. A total of 137 patients (31.4%) was "always," 225 (51.6%) "sometimes," and 74 (17.0%) "never" "highly adherent" during follow-up. After multiple adjustment for known baseline predictors, virologic success after 20 months of HAART was more likely achieved in patients who were always (odds ratio [OR] 95% confidence interval [CI], 3.02 [1.64-5.58]) or sometimes (OR [95% CI], 2.15 [1.24-3.74]) "highly adherent." CONCLUSION Adherence behavior is a dynamic process. Continued adherence was associated with better response to therapy and should be encouraged to reduce the risk of virologic failure.
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Affiliation(s)
- P Carrieri
- INSERM U379, Marseille; INSERM U330, Bordeaux; Faculté X-Bichat, Paris, France
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27
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Andréo C, Bouhnik AD, Soletti J, Bertholon DR, Moatti JP, Rossert H, Spire B. [Non-compliance in HIV-infected patients, supported by a community association]. Sante Publique 2001; 13:249-62. [PMID: 11826844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
OBJECTIVE To identify the factors linked to non-adherence to antiretroviral therapy in HIV-infected patients among the readership of REMAIDES, the AIDES association's medical information journal; AIDES is the principal organisation involved in the fight against AIDS in France. METHOD A cross-cutting survey by questionnaire targeting the readers of REMAIDES. People who answered at least two independent questions as never forgetting or suspending their treatment were considered as adherents. RESULTS Among the 1556 patients having responded to the survey, 888 (57%) are classified as adherents. The factors associated with non-adherence are as follows: young age, minimal financial resources, alcohol consumption, a lack of perceiving the treatment's effectiveness, absence of impact on anticipation of the future or emotional life, difficulties as far as in keeping up the medications or the treatment's integration into daily life, the impossibility of stopping the treatment, a duration of treatment > 2 years, hepatitis C co-infection and problematic side effects. Non-adherence is explained by the negative real-life experience of the person throughout the treatment. Interventions which aim to accompany patients under multiple therapies are preferable in order to improve adherence and increase the probability of successful treatment.
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Affiliation(s)
- C Andréo
- Association AIDES, 14 rue Scandicci, Tour ESSOR, 93508 Pantin, France
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28
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Corroller AG, Fortanier C, Faucher C, Blaise D, Moatti JP. [Economic evaluation of blood stem-cells autologous transplantation]. Bull Cancer 2001; 88:893-9. [PMID: 11604363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Economic evaluation of autologous peripheral blood stem cell (PBSC) transplantation certainly played a role in the very fast substitution from bone marrow to BC autograft. Economic evaluation is still ongoing about the optimization of the procedure by assessing the cost-effectiveness ratio of each new improvement of the technique. Among these improvements we present the administration of high dose CD34+ cells, the delayed administration of G-CSF and the outpatient management of post-graft follow-up. It is still very rare in the field of health economics to notice such an early and ongoing economic evaluation of an innovation.
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Affiliation(s)
- A G Corroller
- Economistes, Inserm 1. Institut Paoli-Calmettes, 232, bd Sainte-Marguerite, 13273 Marseille
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Julian-Reynier CM, Bouchard LJ, Evans DG, Eisinger FA, Foulkes WD, Kerr B, Blancquaert IR, Moatti JP, Sobol HH. Women's attitudes toward preventive strategies for hereditary breast or ovarian carcinoma differ from one country to another: differences among English, French, and Canadian women. Cancer 2001; 92:959-68. [PMID: 11550171 DOI: 10.1002/1097-0142(20010815)92:4<959::aid-cncr1406>3.0.co;2-v] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The authors investigated the acceptability to women of the preventive strategies available for dealing with hereditary breast/ovarian carcinoma in France, the United Kingdom, and Canada, countries selected because of their cultural differences. The authors aimed to discover the existence of specific factors that may affect acceptability of these preventative measures. METHODS A cross-sectional, multicenter survey was conducted in Marseilles, France (n = 141), in Manchester, England (n = 130), and in Montreal, Quebec (n = 84). All of the women attending cancer genetic clinics for the first time because of a family history of breast-ovarian carcinoma completed a self-administered questionnaire before their clinic consultation. RESULTS Variations in responses to different preventative options presented on the questionnaire were seen within the sample of patients considered as a whole. The highest levels of acceptability were obtained for mammographic screening (87%) and chemoprevention (58%). In contrast, prophylactic oophorectomy and prophylactic mastectomy were thought to be acceptable at an early age (before 35 years), an age associated with the highest prophylactic efficacy, by only 19% and 16% of the respondents, respectively. After multivariate adjustment, the statistical data showed that the British respondents were more in favor of oophorectomy (P < 0.0001) and more in favor of chemoprevention than the French (P < 0.001) and the Canadian respondents (P < 0.001). The British (overall adjusted response [OR(adj)] = 3.9; P < 0.001) and Canadian respondents (OR(adj) = 3; P < 0.01) were more in favor of prophylactic mastectomy than the French. The cumulated acceptability of mammography before the age of 40 years was found to be greater in the French (OR(adj) = 2.8; P < 0.01) and Canadian (OR(adj) = 3.1; P < 0.05) samples than in the British sample. CONCLUSION These results demonstrated the existence of international variations in the acceptability of the preventive strategies available for women at risk for hereditary breast/ovarian carcinoma. Therefore, these results suggested that when establishing medical recommendations or planning public health interventions, physicians must integrate the population's perception of advantages and drawbacks with the patient's individual decision making.
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Affiliation(s)
- C M Julian-Reynier
- INSERM U379, Epidemiology and Social Sciences Applied to Medical Innovation, Paoli-Calmettes Institute, 232 Boulevard Sainte Marguerite, 13273 Marseilles cedex 9, France.
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Le Moing V, Chêne G, Carrieri MP, Besnier JM, Masquelier B, Salamon R, Bazin C, Moatti JP, Raffi F, Leport C. Clinical, biologic, and behavioral predictors of early immunologic and virologic response in HIV-infected patients initiating protease inhibitors. J Acquir Immune Defic Syndr 2001; 27:372-6. [PMID: 11468425 DOI: 10.1097/00126334-200108010-00007] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Predictors of virologic (plasma HIV RNA viral load [VL] < 500 copies/ml) and immunologic (rise in CD4+ cell count > 50 cells/mm3) response after 4 months of therapy (M4) were studied in 750 HIV-1-infected patients prospectively enrolled at the initiation of a protease inhibitor (PI)-containing regimen. A virologic response was observed in 80% of patients, and an immunologic response was observed in 64%. Sixty-two percent of patients self-reported full adherence to therapy at 1 month of therapy (M1) and M4. In multivariate analysis, a virologic response was more frequent in fully adherent patients (odds ratio [OR] = 2.0; p =.001). An immunologic response was associated with age < 36 years (OR =1.4; p =.03), baseline VL (OR = 1.5 per 1 log10 copies/ml higher; p <.01), decrease in VL at M1 (OR = 1.5 per 1 log10 copies/ml decrease; p <.01), baseline total lymphocyte count (OR = 1.7 per 50% lower; p <.001), and baseline CD4+ cell percentage > or = 20% (OR =1.9; p <.001) but not with adherence to therapy. Full adherence seems to be a major predictor of a virologic response to PI-containing triple therapy. An immunologic response may be possible despite incomplete adherence, at least early in therapy.
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Affiliation(s)
- V Le Moing
- Hôpital Bichat-Claude Bernard, Paris; INSERM U 330, Bordeaux; INSERM U 379, Marseille, France
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31
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Duran S, Solas C, Spire B, Carrieri MP, Fuzibet JG, Costagliola D, Lacarelle B, Moatti JP. 'Do HIV-infected injecting drug users over-report adherence to highly active antiretroviral therapy?' A comparison between patients' self-reports and serum protease inhibitor concentrations in the French Manif 2000 cohort study. AIDS 2001; 15:1075-7. [PMID: 11399998 DOI: 10.1097/00002030-200105250-00024] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- S Duran
- INSERM Research Unit 379, Marseille, France
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32
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Moatti JP, Vlahov D, Feroni I, Perrin V, Obadia Y. Multiple access to sterile syringes for injection drug users: vending machines, needle exchange programs and legal pharmacy sales in Marseille, France. Eur Addict Res 2001; 7:40-5. [PMID: 11316925 DOI: 10.1159/000050713] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE In Marseille, southeastern France, HIV prevention programs for injection drug users (IDUs) simultaneously include access to sterile syringes through needle exchange programs (NEPs), legal pharmacy sales and, since 1996, vending machines that mechanically exchange new syringes for used ones. The purpose of this study was to compare the characteristics of IDUs according to the site where they last obtained new syringes. METHODS During 3 days in September 1997, all IDUs who obtained syringes from 32 pharmacies, four NEPs and three vending machines were offered the opportunity to complete a self-administered questionnaire on demographics, drug use characteristics and program utilization. RESULTS Of 485 individuals approached, the number who completed the questionnaire was 141 in pharmacies, 114 in NEPs and 88 at vending machines (response rate = 70.7%). Compared to NEP users, vending machine users were younger and less likely to be enrolled in a methadone program or to report being HIV infected, but more likely to misuse buprenorphine. They also had lower financial resources and were less likely to be heroin injectors than both pharmacy and NEP users. CONCLUSIONS Our results suggest that vending machines attract a very different group of IDUs than NEPs, and that both programs are useful adjuncts to legal pharmacy sales for covering the needs of IDUs for sterile syringes in a single city. Assessment of the effectiveness and cost-effectiveness of combining such programs for the prevention of HIV and other infectious diseases among IDUs requires further comparative research.
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Affiliation(s)
- J P Moatti
- INSERM Research Unit 379, 'Social Sciences Applied to Medical Innovation', Institut Paoli Calmettes, Marseille, France
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33
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Moatti JP. [Interest in and limitations of economic assessment applied to the evaluation of medical strategies: examples in oncological hematology]. Therapie 2001; 56:135-8. [PMID: 11471364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Using examples of economic assessment of medical innovations in the field of oncology, haematology and safety of blood products, the article shows that most of these innovations follow a law of diminishing returns: increasing levels of resources must be devoted in order to obtain an additional unit of health benefit (such as a life-year saved by a medical intervention). The article argues that, in such a context, cost-benefit analysis, a standard method in public economics, can be a useful tool to determine the 'optimal' level of resources that should be allocated by society for various medical interventions. In some instances, cost-benefit analysis can help to identify barriers to optimal diffusion of medical innovations that are due to inappropriate incentives and constraints in the management of the healthcare system.
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Affiliation(s)
- J P Moatti
- Faculté de Sciences Economique & Gestion, Université de la Méditerranée & Unité INSERM 379, Institut Paoli-Calmettes, 232 Bd Sainte-Marguerite, 13273 Marseille, France
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Abstract
AIMS To evaluate the extent to which the introduction (February 1996) of ambulatory prescriptions of buprenorphine for drug maintenance treatment (DMT) has been associated with its intravenous illicit use by French injecting drug users (IDUs). DESIGN Cross-sectional survey (September 1997), using self-administered questionnaires, in a sample of IDUs recruited at 32 pharmacies, four needle exchange programmes and three syringe vending machines. SETTING Thirty-nine sites where IDUs have access to sterile syringes in the city of Marseille (South-Eastern France). PARTICIPANTS Sample of IDUs attending community pharmacies, vending machines and needle exchange programs to obtain equipment. MEASUREMENT To compare characteristics of IDUs who declared that they only injected buprenorphine in the prior 6 months versus the rest of the sample. FINDINGS Among the 343 respondents (response rate = 70.7%), 33.8% were polydrug users who occasionally injected buprenorphine in parallel to heroin and/or cocaine, while 23.9% only injected buprenorphine in the previous 6 months. IDUs in this latter group were younger, injected more frequently, and were more frequently on buprenorphine DMT, but they were less likely to be HIV-infected and to declare HIV-related injecting risky behaviours. CONCLUSIONS Substantial risk of injecting misuse is associated with large-scale diffusion of buprenorphine DMT. A more stringent regulation for medical dispensation of buprenorphine than the current French general freedom of prescription for all physicians, including general practiioners in ambulatory care, may be necessary in other countries which are considering the diffusion of buprenorphine DMT.
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Affiliation(s)
- Y Obadia
- Regional Center for Disease Control of South-Eastern France (ORS PACA), ORS PACA-INSERM U379, 23 rue Stanislas Torrents, 13006 Marseille, France.
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Messiah A, Loundou AD, Maslin V, Lacarelle B, Moatti JP. Physician recognition of active drug use in HIV-infected patients is lower than validity of patient's self-reported drug use. J Pain Symptom Manage 2001; 21:103-12. [PMID: 11302118 DOI: 10.1016/s0885-3924(00)00248-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A French survey of 325 HIV-infected subjects with a history of injecting drugs allowed us to study the recognition of patients' injection drug use (IDU) by physicians providing HIV-infection care, and to analyze the correlation between patient demographics and incorrect IDU identification. Kappa for concordance of physician's reports of their patient's IDU with patient's declaration was 0.37; concordance was lower among socially vulnerable patients. This contrasted with a nested study of validity of patient's self-report of opioid use: Kappa for patient's declaration of opioid use within the past two days against a biological assay was 0.61, and concordance was higher among socially vulnerable patients. Concordance of physicians' ratings and patients' reports of IDU was not more than fair, even though physicians were knowledgeable about their patient's IDU history. This concordance varied with social status in a way that did not correspond with variations in self-reported opioid use validity, suggesting that identification of active IDU might be partly based on incorrect interpretation of subjective cues.
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Affiliation(s)
- A Messiah
- INSERM Unité Victor Segalen, Bordeaux, France
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36
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Julian-Reynier C, Eisinger F, Moatti JP, Sobol H. Re: Randomized trial of a specialist genetic assessment service for familial breast cancer. J Natl Cancer Inst 2001; 93:158-9. [PMID: 11208894 DOI: 10.1093/jnci/93.2.158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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37
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Duran S, Spire B, Raffi F, Walter V, Bouhour D, Journot V, Cailleton V, Leport C, Moatti JP. Self-reported symptoms after initiation of a protease inhibitor in HIV-infected patients and their impact on adherence to HAART. HIV Clin Trials 2001; 2:38-45. [PMID: 11590513 DOI: 10.1310/r8m7-eq0m-cnpw-39fc] [Citation(s) in RCA: 173] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The purpose of our study was to assess short-term self-reported symptoms in patients who were started on two nucleoside reverse transcriptase inhibitors and one protease inhibitor (PI) in the multicenter APROCO cohort (N = 336) and to assess the influence of these symptoms on adherence. METHOD Adherence and patient's reported symptoms were measured at 1 and 4 months (M) after initiation of highly active antiretroviral therapy (HAART) through self-administered questionnaires. RESULTS Most patients reported at least one symptom (94.0% at M1; 88.0% at M4); fatigue and diarrhea were the most often reported symptoms. Respectively, 81.3% and 75.0% of patients were strictly adherent to HAART during the 4 days prior to M1 and M4 visits. After adjustment for younger age, history of antiretroviral treatment, unstable housing, poor social support, and alcohol consumption, patients who reported a high number of symptoms at M1 were more likely to be nonadherent at M4 (odds ratio per symptom = 1.13; 95% CI = 1.03-1.24). CONCLUSION Patients reporting a high number of symptoms soon after HAART initiation are at higher risk of future nonadherence and could be targeted for interventions to achieve good levels of adherence and to improve treatment outcome.
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Affiliation(s)
- S Duran
- INSERM U379, Marseille, Paris, France
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38
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Rey D, Bendiane MK, Moatti JP, Wellings K, Danziger R, MacDowall W. Post-exposure prophylaxis after occupational and non-occupational exposures to HIV: an overview of the policies implemented in 27 European countries. AIDS Care 2000; 12:695-701. [PMID: 11177447 DOI: 10.1080/09540120020014228] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this survey, which was part of an English-French project supported by the Commission of the European Communities, was to compare access to HIV post-exposure prophylaxis (PEP) in the occupational and non-occupational contexts in 27 European countries. A protocol was designed in May 1998 in collaboration with all country consultants. Data were collected at country level by each consultant through interviews, review of local and national recommendations and results of national or local surveys. The final comparative analysis was carried out from the individual country reports and a review of the literature. The large majority of European countries have detailed procedures regarding occupational PEP: 20/27 have produced national guidelines, three have adopted the US CDC recommendations and only four have no official recommendations. Although no standard protocol exists, the more common one is a four-week implementation of a triple combination therapy. In the context of non-occupational exposure to HIV, only five countries have guidelines with specific recommendations and one country has adopted the CDC recommendations. In the majority of cases (13 countries), PEP is never recommended but is only available in a few circumstances, sometimes with major limitations. In the last eight countries, such PEP is not currently available. Although the estimations of HIV transmission risks in occupational and non-occupational contexts are really comparables, easy access to PEP after accidental sexual or blood exposures is not guaranteed for the general population in the majority of European countries.
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Affiliation(s)
- D Rey
- Regional Center for Disease Control of South Eastern France, ORS PACA, Marseille, France.
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39
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Landman R, Moatti JP, Perrin V, Huard P. Variability of attitudes toward early initiation of HAART for HIV infection: a study of French prescribing physicians. AIDS Care 2000; 12:711-6. [PMID: 11177449 DOI: 10.1080/09540120020014246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study assessed prescribing physicians' attitudes toward early initiation of HAART, three months after the dissemination of the first French official treatment guideline. Telephone interviews have been made in a national random sample of physicians with full- or part-time practice in hospital departments delivering care for HIV-infected patients. Questionnaires included hypothetical clinical cases. Logistic regression compared characteristics of respondents according to attitudes toward HAART. Among the 483 respondents (response rate = 87.0%), agreement was high with official recommendations to systematically initiate HAART with protease inhibitors (PIs) for patients with CD4+ cell counts < or = 300/mm3, following a diagnosis of acute primary HIV infection, or for HIV sexual risk post-exposure prophylaxis. Confronted with a case of a naive asymptomatic patient with stable 450 CD4+/mm3, 34.6% would prescribe HAART with PIs in any case, and 29.8% only if the patient has plasma viral load < or = 10,000 HIV RNA copies/ml. The remaining 35.6% would not prescribe PIs and were older, had limited activity in HIV care and expressed more interest in alternative medicines. To avoid a confusing impact of variability of clinical attitudes toward uncertainties associated with antiretroviral treatments among HIV-infected patients, shared decision-making between patient and physician should be promoted for initiation of HAART.
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Affiliation(s)
- R Landman
- Department of Infectious and Tropical Diseases, Hôpital Bichat-Claude Bernard, Paris, France
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40
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Escaffre N, Morin M, Bouhnik AD, Fuzibet JG, Gastaut JA, Obadia Y, Moatti JP. Injecting drug users' adherence to HIV antiretroviral treatments: physicians' beliefs. AIDS Care 2000; 12:723-30. [PMID: 11177451 DOI: 10.1080/09540120020014264] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This paper investigates physicians' judgements about adherence to antiretroviral treatment (ART) among patients who have been HIV-infected through injecting drug use (IDU). Comparisons were made between data collected from physicians at enrollment (January 1996 to January 1998) of a prospective cohort study (MANIF 2000) and self-declarations of 196 HIV-infected injecting drug users (IDUs) who have been prescribed ART. The likelihood of being perceived as 'adherent' by physicians was higher for women, patients of 30 years of age or older, with biological markers indicative of a healthier status, and who were perceived as 'free of injecting behaviour' and not in drug maintenance treatment. Although the proportion of non-adherent patients was similar in physicians' assessment (26.0%) and patients' self-declarations (27.0%), a strong discordance occurred: 60.4% of patients self-reporting non-adherence to ART (80.0% for those receiving a protease inhibitor) were classified as adherent by their prescribing physicians. The study suggests that a priori judgements based on clinical experience but also on social stereotypes interfere with physicians' assessment, and that physicians' decisions to initiate complex treatment regimens may further induce optimistic biases and an underestimation of the problems faced by IDU patients to adequately adhere to them.
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Affiliation(s)
- N Escaffre
- INSERM Research Unit 379 'Epidemiology and Social Sciences Applied to Medical Innovation', Institut Paoli Calmettes, Marseille
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Julian-Reynier C, Evers-Kiebooms G, Evans G, Zoeteweij M, Moatti JP, Watson M. Congress report of the Sixth International Meeting on Psychosocial Aspects of Hereditary Breast/Ovarian Cancer Genetic Testing. Psychooncology 2000; 9:549-51. [PMID: 11180590 DOI: 10.1002/1099-1611(200011/12)9:6<549::aid-pon468>3.0.co;2-r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Loubière S, Rotily M, Moatti JP. [Medico-economic assessment of the therapeutic management of patients with hepatitis C]. Gastroenterol Clin Biol 2000; 24:1047-51. [PMID: 11139674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
OBJECTIVES To present a review of the literature on the economic assessment of health care for hepatitis C virus infected patients. METHODS The identification of articles was based on Medline. A scale was used to compare the methodology and results of the economic evaluations. RESULTS The results emphasize the shortage of studies in the field of hepatitis C, and the inadequacy of epidemiological, clinical and economic data on hepatitis C virus infection, as well as of clinical research from an economic perspective. CONCLUSION To implement an efficient screening and health care policy, health care decision makers need criteria to evaluate the efficiency of treatment strategies for hepatitis C. Economic analyses could provide important information for the social debate on hepatitis treatment.
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Affiliation(s)
- S Loubière
- INSERM U 379, Epidémiologie et Sciences Sociales Appliquées à l'Innovation Médicale, Marseille
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Rotily M, Delorme C, Galinier A, Escaffre N, Moatti JP. [HIV risk behavior in prison and factors associated with reincarceration of injection drug users]. Presse Med 2000; 29:1549-56. [PMID: 11072370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
OBJECTIVES The aim of this study was to estimate the frequency of risk behavior for HIV transmission in prison and to identify the factors associated with reincarceration. PATIENTS AND METHODS An epidemiologic study was carried out in the penitentiary center of Marseilles between December 1995 and March 1997. Five hundred and seventy-four prisoners answered an anonymous voluntary questionnaire managed by independent interviewers. RESULTS Among the 574 prisoners, 133 (23%) reported they had injected drugs (intravenous drug users, IDU) including 71 (53%) who had injected drugs during the three months preceding incarceration. Seven percent of the IDU received opiate substitutes before their imprisonment. Nine prisoners of the 120 who have responded to the question (7.5%: 3.7-14.2 95% CI) stated they had injected drugs during the first three months of incarceration. Multivariate analysis showed that reincarceration was significantly more frequent among men, HIV-infected and unemployed prisoners, and prisoners not receiving opiate substitutes at the time of their imprisonment. DISCUSSION This study show that risk behaviors of HIV and hepatitis virus transmission are frequent among intravenous drug users, including during their incarceration. The relationship between opiate substitution treatment and reincarceration deserves to be studied further on larger samples in order to better evaluate its impact on social rehabilitation of drug addicts. This data also underline the need to strengthen prevention programs in prisons and the importance of social and health policies targeted on drug users especially opiate substitution programs.
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Affiliation(s)
- M Rotily
- Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, INSERM U379, Marseille.
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Reynaud-Maurupt C, Carrieri MP, Gastaud JA, Pradier C, Obadia Y, Moatti JP. Impact of drug maintenance treatment on injection practices among French HIV-infected IDUs. The MANIF 2000 Study Group. AIDS Care 2000; 12:461-70. [PMID: 11091779 DOI: 10.1080/09540120050123864] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Drug maintenance treatment (DMT) has only been recently introduced in France (methadone programmes in March 1995, buprenorphine prescriptions in ambulatory medicine in February 1996) in relation to risk reduction policies for HIV infection among intravenous drug users (IDUs). Impact of DMT was assessed in the period of inclusion (October 1995-December 1997) of a French cohort of patients HIV infected through intravenous drug use the MANIF 2000 study). Among the 429 patients, 48.2% were ex-IDUs, 20.3% were active users not in DMT and 31.5% were in DMT. A majority (73.3%) of patients in DMT had persisted in their injection behaviours and their social and psychological characteristics were similar to those of active users not in DMT. Among the 186 active IDUs, those in DMT were more likely to have injected cocaine (42.4%) and buprenorphine or methadone (21.3%) than those who were not (respectively 27.6% and 2.4%), and 23.6% declared direct needle-sharing behaviours during the prior six months. Among younger IDUs (< or = 33 years of age) (n = 100), needle-sharing was associated with polydrug use and cocaine injection but was not significantly reduced by participation in DMT. These results suggest the need for taking into account differences between type of HIV-infected drug users and developing appropriate multidrug maintenance treatment programmes, which may imply adaptations of current dosages of methadone and buprenorphine.
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Abstract
This paper is an introduction to the various contributions in this special issue of Social Science & Medicine which are an attempt to synthesise the main debates of the 2nd European Conference on Social and Behavioural Research on AIDS held in Paris, in January 1998. The paper discusses how the recent advent of highly active antiretroviral therapies (HAART) and new trends in the epidemic (its concentration in the socially most vulnerable groups and countries) have affected the research agenda of European social and behavioural sciences (SBS) in HIV/AIDS. Questions which had already been thoroughly studied by SBS (like determinants of HIV-related risk behaviours, or impact of gender and socio-economic inequities as well as discrimination on the diffusion of HIV) will have to be "revisited" in light of these recent changes. New issues (such as risk behaviours among already infected patients. impact of therapeutic advances on psychosocial and daily life management of their disease by people living with HIV/AIDS, adherence to treatment, or "normalisation" of AIDS public policies) will have to be strongly and quickly dealt with, in order for SSB to keep the pace with the rapid evolution of the epidemic and of the societal responses to it. Finally, the paper argues that to face these challenges, new theoretical and methodological advances will have to go beyond the classical oppositions in internal debates among SSB between individualistic and holistic approaches, or between radical criticism of the existing state of the world and practical involvement in public health decision-making.
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Abstract
This article shows that policies aimed at reducing risks of infectious agents transmissible through blood unfortunately follow a law of 'diminishing returns': increasing marginal costs have to be devoted for limited reductions in the risks of contamination through blood donations. Therefore, the economic cost-effectiveness analysis is appropriate to identify screening strategies which may minimize costs to reach a certain level of safety. Moreover, economic analysis can contribute to public debates about the level of residual risk that society is willing to accept. Empirical results from French studies about screening for hepatitis C virus (HCV) in individuals who have received blood transfusions and in blood donations are presented to illustrate these points.
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Affiliation(s)
- J P Moatti
- Inserm U 379, Institut Paoli-Calmettes, Marseille, France
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Moatti JP, Spire B, Duran S. [A review of socio-behavioural studies on adherence to antiretroviral treatments: beyond biomedical models?]. Rev Epidemiol Sante Publique 2000; 48:182-97. [PMID: 10804427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
This paper, based on a review of the literature of socio-behavioural research in this field, shows how the AIDS epidemic has renewed traditional approaches to patients behaviour toward medical treatment by substituting the notion of adherence for the traditional one of compliance. It shows how this issue of patients adherence has come to the forefront of HIV care with the recent diffusion of highly active antiretroviral therapeutics (HAART), because inadequate adherence has profound implications for the individual and public heath effectiveness of these therapeutic advances. The paper argues that two alternatives, and indeed conflicting, approaches to adherence to treatment in HIV infection however persist. The aim of the first approach remains to predict and correct non-adherent behaviour in certain patients and sometimes suggests that such predictions may provide justification for denying individuals treatment. This 'predictive' approach focuses on identification of individual barriers to 'good' adherence and calls on social science research to help improve the 'acceptability' of prescribed regimens for patients. An alternative 'empathic' approach focuses more on encouraging and supporting all HIV-infected patients medically eligible for HAART to devise appropriate individualised plans that can facilitate management of their treatment in their daily life. This latter approach more willingly learns from social science research which recognises the patient's subjective experience of illness as a central concern. In the future, the respective contributions of these two alternative approaches will have to be judged on the basis of their capacity to analyse both the factors which influence HIV-infected patients' initial adherence to antiretroviral treatment and those, potentially quite different, which interfere with adherence on the long term. They will also be judged for their capacity to inspire effective psychological and socio-behavioural interventions aimed at facilitating patients adherence.
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Affiliation(s)
- J P Moatti
- INSERM U379, 232 Boulevard Sainte Marguerite, 13009 Marseille, France
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Julian-Reynier C, Eisinger F, Moatti JP, Sobol H. Physicians' attitudes towards mammography and prophylactic surgery for hereditary breast/ovarian cancer risk and subsequently published guidelines. Eur J Hum Genet 2000; 8:204-8. [PMID: 10780786 DOI: 10.1038/sj.ejhg.5200418] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
After a BRCA mutation has been identified in the context of hereditary breast/ovarian cancer (HBOC), mammographic screening and prophylactic surgery are two of the main options available to those responsible for the clinical management of healthy women. The aim of this study was to describe the attitudes of specialists towards the clinical management of women with an HBOC risk: this information was collected prior to the publication of the recent French guidelines. A random national sample of 1169 French surgeons, gynaecologists and obstetricians was surveyed using a mailed questionnaire, to which 700 of these physicians (60%) responded. When dealing with a BRCA mutated woman, 88.6% of the respondents said they would recommend mammographic screening, but only 27.1% would recommend that it should be carried out annually from the age of 30 years onwards, as recommended in the French guidelines; 10.9% would find it acceptable to propose prophylactic mastectomy from the age of 30 years, and 22.9% would find it acceptable to propose prophylactic oophorectomy from the age of 35 years. The specialists who agreed with recommending breast/ovarian cancer genetic testing also had more positive attitudes towards prophylactic mastectomy (adj OR = 3.4, 95% CI = 1.4-8.2), as did those who had previously recommended prophylactic mastectomy when gene testing was not yet available (adj OR = 2.06, 95% CI = 1.23-3.44). The respondents' attitudes towards prophylactic oophorectomy and mastectomy were significantly associated (adj OR = 3.9; 95% CI = 2.3-6.5). Previous recommendation of prophylactic mastectomy was associated (P < 0.01) with a higher level of knowledge of breast/ovarian cancer genetics and with medical practice in this field. French physicians' attitudes towards mammographic screening and prophylactic surgery were not in complete agreement with the subsequently published French guidelines, the impact of which has now to be considered. Constantly evolving knowledge about the efficacy of preventive intervention will give practitioners new elements to integrate into their counselling.
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Blaise D, Kuentz M, Fortanier C, Bourhis JH, Milpied N, Sutton L, Jouet JP, Attal M, Bordigoni P, Cahn JY, Boiron JM, Schuller MP, Moatti JP, Michallet M. Randomized trial of bone marrow versus lenograstim-primed blood cell allogeneic transplantation in patients with early-stage leukemia: a report from the Société Française de Greffe de Moelle. J Clin Oncol 2000; 18:537-46. [PMID: 10653869 DOI: 10.1200/jco.2000.18.3.537] [Citation(s) in RCA: 305] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To compare hematologic recovery in patients receiving allogeneic blood cell transplantation (BCT) with those receiving allogeneic bone marrow transplantation (BMT). PATIENTS AND METHODS One hundred eleven patients with leukemia in the early stages and with HLA-matched sibling donors were randomized in this study. One hundred one underwent transplantation. Standard procedures for collection and transplantation were used. Patients did not receive prophylactic granulocyte colony-stimulating factor after undergoing transplantation. In addition to clinical end points being established, a prospective and comparative economic evaluation of the first 6 months after transplantation was performed. RESULTS Groups were balanced for patient, donor, and transplant characteristics. Blood cell collection led to the collection of a higher number of CD34(+) and CD3(+) cells than did bone marrow collection (P < 10(-6)) without reported side effects for the donor. Patients in the BCT group reached platelet counts of 25 and 50 x 10(9) platelets/L 8 and 11 days earlier than did the BMT group (P < 10(-4) and P < 10(-5)), respectively. This resulted in fewer platelet transfusions during the first 180 days after transplantation (P =.002) for the former group. The time to reach neutrophil counts of 0.5 and 1 x 10(9) neutrophils/L was 6 and 7 days shorter, respectively, in the BCT group than in the BMT group (P < 10(-5)). This quicker hematologic recovery was associated with a shorter length of hospitalization and a decrease in total cost of procedure during the first 6 months. CONCLUSION This study establishes that allogeneic BCT results in quicker hematologic recovery but is associated with a higher occurrence of chronic graft-versus-host disease.
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MESH Headings
- Acute Disease
- Adjuvants, Immunologic/therapeutic use
- Adult
- Bone Marrow Transplantation/economics
- Bone Marrow Transplantation/immunology
- Bone Marrow Transplantation/methods
- Female
- Granulocyte Colony-Stimulating Factor/therapeutic use
- Hematopoietic Stem Cell Transplantation/economics
- Hematopoietic Stem Cell Transplantation/methods
- Humans
- Lenograstim
- Leukemia/blood
- Leukemia/immunology
- Leukemia/therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/blood
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/immunology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Leukemia, Myeloid/blood
- Leukemia, Myeloid/immunology
- Leukemia, Myeloid/therapy
- Male
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/blood
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/immunology
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy
- Prognosis
- Prospective Studies
- Recombinant Proteins/therapeutic use
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Affiliation(s)
- D Blaise
- Société Française de Greffe de Moelle, Lyon, France.
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Macquart-Moulin G, Viens P, Palangié T, Bouscary ML, Delozier T, Roché H, Janvier M, Fabbro M, Moatti JP. High-dose sequential chemotherapy with recombinant granulocyte colony-stimulating factor and repeated stem-cell support for inflammatory breast cancer patients: does impact on quality of life jeopardize feasibility and acceptability of treatment? J Clin Oncol 2000; 18:754-64. [PMID: 10673516 DOI: 10.1200/jco.2000.18.4.754] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This study was designed to investigate the quality of life (QOL) of patients enrolled onto the High-Dose Chemotherapy for Breast Cancer Study Group trial (PEGASE 02), a French pilot multicenter trial of the treatment of inflammatory breast cancer (IBC) aimed at evaluating (1) toxicity and feasibility of sequential high-dose chemotherapy (HDC) with recombinant human granulocyte colony-stimulating factor (filgrastim) and stem-cell support and (2) response to HDC in terms of pathologic response and survival. PATIENTS AND METHODS QOL measures were performed at inclusion and four times subsequently up to 1 year using an ad hoc side-effect questionnaire (19 physical symptoms) and the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire (EORTC QLQ-C30). RESULTS Of the 95 patients entered, the overall QOL questionnaire completion compliance was 75.6%. During cycle 3 of HDC, the number of symptoms was high (mean +/- SD QOL score, 10 +/- 3), with fatigue, hair loss, appetite loss, nausea, change in taste, vomiting, fever, and weight loss reported by more than 60% of patients. Toxicity and distress associated with HDC were reflected in the decline of four EORTC QLQ-C30 scores: global QOL (P =.001), and physical, role, and social functioning (P <.001 for all statistics). However, QOL deterioration disappeared after treatment completion, except for physical functioning (P =.025). One year after inclusion, most QOL scores returned to baseline, and both emotional functioning and global QOL scores were even higher than baseline (P =.030 and P =.009, respectively). CONCLUSION If it is confirmed that improvements in pathologic response rates with HDC effectively translate into increased probabilities of survival for IBC patients, adoption of such treatment as PEGASE 02 will not involve crucial choices between length of life and QOL and should not be delayed for QOL arguments.
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Affiliation(s)
- G Macquart-Moulin
- National Institute of Health and Medical Research Unit 379, Institut Paoli-Calmettes, Marseilles, France.
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