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Rihab B, Lina EH, Noémie ST, Jean S, Marjolaine G. The experience of dry mouth and screening for Sjogren's syndrome by the dentist: patient-reported experiences. BMC Oral Health 2023; 23:1010. [PMID: 38102574 PMCID: PMC10724976 DOI: 10.1186/s12903-023-03727-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 11/30/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND One of the main clinical features of Sjögren's Syndrome is oral dryness, which is associated with an increased risk of oral diseases and a lower oral life quality. Dentists have a key role to play in the Sjögren's Syndrome diagnosis and specific management. In parallel, many patients rely on patient associations, which offer opportunities for members to seek information about their disease and share their experiences. We aimed to evaluate patients experience with dry mouth and the importance of dentists in Sjögren's Syndrome diagnosis and its management. METHODS We carried out a cross-sectional survey in 2020 based on a questionnaire drafted in collaboration with clinicians specializing in Sjögren's Syndrome and patient members of a patient association. The survey consisted of 27 questions divided into the six sections: the patient's profile, their experience with dry mouth and treatments used to manage, characteristics of experienced oral-health problems, effects of dry mouth and its consequences on the quality of life, evaluation of the dentist role in the screening of Sjögren's Syndrome, and its management by the dentist. Recruitment was carried out via the patient association's newsletter, website, and social networks. Sjögren's diagnosis was self-reported. RESULTS One thousand four hundred fifty-eight patients fully responded to the survey. Most respondents were women over 50 and were mainly concerned with primary Sjögren's Syndrome. Overall, 86.97% of respondents reported experiencing frequent or constant dry mouth and 69.01% declared having had oral problems (candidiasis, oral pain, loss or alteration of taste, bad breath, gastro-esophageal reflux). We found a positive correlation between the frequency of dry mouth and each of these disorders and between the frequency of dry mouth and alterations in life quality dimensions. Finally, 74.9% of patients did not report having dry mouth to their dentist prior to being diagnosed with Sjögren's Syndrome and 58% had not been informed about the oral risks associated with it by their dentist and sought information themselves or from their physician. CONCLUSIONS We confirm the significant consequences of dry mouth on oral quality of life, as well as its association with oral health problems. Sjögren's Syndrome screening by dentists should be increased, as well as prevention of the associated oral health risks.
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Affiliation(s)
- Boughanmi Rihab
- Service de Médecine Bucco-Dentaire, AP-HP, Hôpital Charles Foix, Ivry/seine, F-94200, France
- Faculté de Médecine Dentaire, Université de Monastir, LR12ES11, Monastir, 5000, Tunisia
| | - El Houari Lina
- AP-HP, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, CIC-1901, Paris, F75013, France
| | - Simon-Tillaux Noémie
- Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, CIC-1901, Paris, F75013, France
| | - Saide Jean
- Association Française pour les Patients atteints de Gougerot Sjögren et des Syndromes Secs, Paris, F- 75018, France
| | - Gosset Marjolaine
- Service de Médecine Bucco-Dentaire, AP-HP, Hôpital Charles Foix, Ivry/seine, F-94200, France.
- Université Paris Cité, URP 2496, 1 rue Maurice Arnoux, Montrouge, F-92120, France.
- Laboratoire d'Excellence INFLAMEX, Paris, France.
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Jean S, Noe MW, Israel NR, Narsinghani U. Severe gastrointestinal bleed in adolescent with transverse colon dieulafoy lesion: a case report. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00404-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Turcotte AF, Jean S, Morin S, Gagnon C. 128 - Relation dose-réponse entre l'obésité abdominale et le risque de fracture dans une cohorte prospective d'hommes et de femmes du Québec. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.06.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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4
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Bucchia M, Barbarot S, Reumaux H, Piram M, Mahe E, Mallet S, Balguerie X, Phan A, Lacour JP, Decramer S, Hatchuel Y, Jean S, Begon E, Joubert A, Merlin E, Wallach D, Meinzer U, Bourrat E. Age-specific characteristics of neutrophilic dermatoses and neutrophilic diseases in children. J Eur Acad Dermatol Venereol 2019; 33:2179-2187. [PMID: 31166045 DOI: 10.1111/jdv.15730] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 05/08/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Our suggested 'modern' concepts of 'neutrophilic dermatoses' (ND) and 'neutrophilic disease' were based on observations in adult patients and have not been studied in paediatric patients. Only a minority of ND occurs in children, and little is known about age-specific characteristics. OBJECTIVES To describe age-specific characteristics of ND in children and to study whether our suggested 'modern' classification of ND may be applied to children. METHODS We conducted a retrospective multicentre study in a French cohort of 27 paediatric patients diagnosed with pyoderma gangrenosum (PG) or Sweet's syndrome (SS). RESULTS Demographics and distribution of typical/atypical forms were similar in patients diagnosed with PG and SS. Atypical ND were more frequent in infants (90%), when compared to young children (60%) and adolescents (33%). Neutrophilic disease was observed in 17/27 patients and was most frequent in infants. Neutrophilic disease of the upper respiratory tract, as well as cardiac neutrophilic disease, was only observed in infants, whereas other locations were similarly found in infants, young children and adolescents. In infants and young children, ND were associated with a large spectrum of general diseases, whereas in adolescents associations were limited to inflammatory bowel disease and Behçet's disease. CONCLUSIONS Our study describes the concept of ND in paediatric patients and shows that they have some characteristics different from ND occurring in adults. ND occurring in infants can be associated with a large spectrum of general diseases. Occurrence of neutrophilic disease is frequent in children. Thus, ND occurring in young paediatric patients should incite clinicians to schedule complementary explorations in order to search for involvement of other organs and to rule out monogenetic autoinflammatory syndromes.
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Affiliation(s)
- M Bucchia
- Centre Hospitalier Le Mans, Service Urgences pédiatriques, Le Mans, France.,Centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l'enfant (RAISE), Service de pédiatrie générale, Maladies Infectieuses et Médecine Interne, Hôpital Robert Debré, Paris, France
| | - S Barbarot
- Service de Dermatologie, CHU de Nantes - Hôtel Dieu, Nantes, France
| | - H Reumaux
- Service de Pédiatrie et médecine générale, CHRU de Lille, Hôpital Jeanne de Flandre, Lille, France
| | - M Piram
- CHU de Bicêtre, Service de Rhumatologue Pédiatrique, CEREMAIA, Le Kremlin-Bicêtre, France.,CESP, U1018 Inserm, Université Paris-Sud, Le Kremlin-Bicêtre, France
| | - E Mahe
- Service de Dermatologie, Unité de Soutien à la Recherche Clinique, Argenteuil, France
| | - S Mallet
- Service de Dermatologie de l'hôpital de la Timone, Aix-Marseille Université, Marseille, France
| | - X Balguerie
- Clinique Dermatologique, CHU de Rouen, Rouen, France
| | - A Phan
- Service de Néphro-Rhumato-Dermatologie Pédiatrique, Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Bron, France
| | - J-P Lacour
- Service de Dermatologie, Centre Hospitalier Universitaire de Nice, Nice, France
| | - S Decramer
- Centre Hospitalier Universitaire de Toulouse, Service de Néphrologie Médecine Interne Pédiatrique, Hôpital des Enfants, Centre De Référence des Maladies Rénales Rares du Sud Ouest, Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Y Hatchuel
- Service de Pédiatrie, Centre Hospitalier Universitaire de Martinique, Fort de France, France
| | - S Jean
- Service de pédiatrie Centre Hospitalier universitaire de Rennes, Rennes, France
| | - E Begon
- Service de Médecine, Centre Hospitalier René-Dubois, Cergy Pontoise, France
| | - A Joubert
- Service de Dermatologie, CHU de Nantes - Hôtel Dieu, Nantes, France
| | - E Merlin
- CHU Clermont-Ferrand, Pédiatrie Générale Multidisciplinaire, CIC INSERM 1405, Clermont-Ferrand, France
| | - D Wallach
- Médecin (honoraire) des Hôpitaux de Paris, Paris, France
| | - U Meinzer
- Centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l'enfant (RAISE), Service de pédiatrie générale, Maladies Infectieuses et Médecine Interne, Hôpital Robert Debré, Paris, France.,INSERM UMR1149, Université Paris Diderot, Paris, France.,Institut Pasteur, Unité Biologie et génétique de la paroi bactérienne, Paris, France
| | - E Bourrat
- Centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l'enfant (RAISE), Service de pédiatrie générale, Maladies Infectieuses et Médecine Interne, Hôpital Robert Debré, Paris, France.,Service de Dermatologie, Centre Hospitalier Universitaire Saint-Louis, Paris, France
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Jacquin L, Gandar A, Aguirre-Smith M, Perrault A, Hénaff ML, Jong LD, Paris-Palacios S, Laffaille P, Jean S. High temperature aggravates the effects of pesticides in goldfish. Ecotoxicol Environ Saf 2019; 172:255-264. [PMID: 30711860 DOI: 10.1016/j.ecoenv.2019.01.085] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/17/2019] [Accepted: 01/25/2019] [Indexed: 06/09/2023]
Abstract
In human-altered rivers, fish are often conjointly exposed to an increase in water temperature due to global warming and to a contamination by organic pollutants such as pesticides, but their combined effects are still elusive. Thermal and chemical stressors could potentially interact because high temperature increases metabolism and toxicant uptake, and can alter the ability of organisms to set up adequate stress responses and to maintain homeostasis. These combined stressors could thus potentially result in higher level of molecular and cellular damage, and stronger effects on behavior and physiology, but experimental evidence across biological levels is still scarce. In this study, goldfish Carassius auratus were experimentally exposed to an environmentally realistic cocktail of pesticides (S-metolachlor, isoproturon, linuron, atrazine-desethyl, aclonifen, pendimethalin and tebuconazol) commonly found in rivers of South-West of France at low or high dose in two different thermal conditions: a common summer temperature (22 °C) or a high temperature recorded during heat waves (32 °C). Results showed that high temperature alone caused behavioral and physiological changes (increased swimming activity, increased hepatosomatic index, decreased reproductive index) but limited cellular damage. However, high temperature aggravated the effects of pesticides at the molecular and cellular level. Indeed, pesticide exposure resulted in higher genotoxic effects (micronuclei rate) and irreversible cellular damage of the gills and liver (apoptosis, inflammation, necrosis) at 32 °C compared to 22 °C. This suggests potential synergistic effects of climate change and pollution, and highlights the need for multiple stress approaches to better predict the impacts of human activities on aquatic wildlife.
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Affiliation(s)
- L Jacquin
- Laboratoire Evolution & Diversité Biologique EDB, UMR 5174, Université de Toulouse, UPS, CNRS, IRD, Toulouse, France.
| | - A Gandar
- Laboratoire Ecolab, Université de Toulouse, UPS, CNRS, INPT, ENSAT, route de l'Agrobiopole, 31326 Castanet-Tolosan, France
| | - M Aguirre-Smith
- Laboratoire Evolution & Diversité Biologique EDB, UMR 5174, Université de Toulouse, UPS, CNRS, IRD, Toulouse, France; Laboratoire Ecolab, Université de Toulouse, UPS, CNRS, INPT, ENSAT, route de l'Agrobiopole, 31326 Castanet-Tolosan, France
| | - A Perrault
- Laboratoire Ecolab, Université de Toulouse, UPS, CNRS, INPT, ENSAT, route de l'Agrobiopole, 31326 Castanet-Tolosan, France
| | - M Le Hénaff
- Bordeaux Science Agro, 1 cours du Général De Gaulle, CS 40201, 33175 Gradignan, France
| | - L De Jong
- Aix Marseille Université, Avignon Université, CNRS, IRD, IMBE, 3 place Victor Hugo, 13331 Marseille, France
| | - S Paris-Palacios
- UMR-I02 SEBIO Unité Stress Environnementaux et BIOsurveillance des milieux aquatiques, Université de Reims Champagne-Ardenne, Faculté des Sciences, Campus du Moulin de la Housse, BP1039 51687 Reims cedex 2, France
| | - P Laffaille
- Laboratoire Ecolab, Université de Toulouse, UPS, CNRS, INPT, ENSAT, route de l'Agrobiopole, 31326 Castanet-Tolosan, France
| | - S Jean
- Laboratoire Ecolab, Université de Toulouse, UPS, CNRS, INPT, ENSAT, route de l'Agrobiopole, 31326 Castanet-Tolosan, France
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Beaudoin C, Moore L, Gagné M, Bessette L, Ste-Marie LG, Brown JP, Jean S. Performance of predictive tools to identify individuals at risk of non-traumatic fracture: a systematic review, meta-analysis, and meta-regression. Osteoporos Int 2019; 30:721-740. [PMID: 30877348 DOI: 10.1007/s00198-019-04919-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 02/26/2019] [Indexed: 01/28/2023]
Abstract
UNLABELLED There is no consensus on which tool is the most accurate to assess fracture risk. The results of this systematic review suggest that QFracture, Fracture Risk Assessment Tool (FRAX) with BMD, and Garvan with BMD are the tools with the best discriminative ability. More studies assessing the comparative performance of current tools are needed. INTRODUCTION Many tools exist to assess fracture risk. This review aims to determine which tools have the best predictive accuracy to identify individuals at high risk of non-traumatic fracture. METHODS Studies assessing the accuracy of tools for prediction of fracture were searched in MEDLINE, EMBASE, Evidence-Based Medicine Reviews, and Global Health. Studies were eligible if discrimination was assessed in a population independent of the derivation cohort. Meta-analyses and meta-regressions were performed on areas under the ROC curve (AUCs). Gender, mean age, age range, and study quality were used as adjustment variables. RESULTS We identified 53 validation studies assessing the discriminative ability of 14 tools. Given the small number of studies on some tools, only FRAX, Garvan, and QFracture were compared using meta-regression models. In the unadjusted analyses, QFracture had the best discriminative ability to predict hip fracture (AUC = 0.88). In the adjusted analysis, FRAX with BMD (AUC = 0.81) and Garvan with BMD (AUC = 0.79) had the highest AUCs. For prediction of major osteoporotic fracture, QFracture had the best discriminative ability (AUC = 0.77). For prediction of osteoporotic or any fracture, FRAX with BMD and Garvan with BMD had higher discriminative ability than their versions without BMD (FRAX: AUC = 0.72 vs 0.69, Garvan: AUC = 0.72 vs 0.65). A significant amount of heterogeneity was present in the analyses. CONCLUSIONS QFracture, FRAX with BMD, and Garvan with BMD have the highest discriminative performance for predicting fracture. Additional studies in which the performance of current tools is assessed in the same individuals may be performed to confirm this conclusion.
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Affiliation(s)
- C Beaudoin
- Department of Social and Preventive Medicine, Medicine Faculty, Laval University, Ferdinand Vandry Pavillon, 1050 Avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.
- CHU de Québec-Université Laval Research Center, Québec, QC, Canada.
- Bureau d'information et d'études en santé des populations, Institut National de Santé Publique du Québec, 945, Avenue Wolfe, Québec, G1V 5B3, Canada.
| | - L Moore
- Department of Social and Preventive Medicine, Medicine Faculty, Laval University, Ferdinand Vandry Pavillon, 1050 Avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada
- CHU de Québec-Université Laval Research Center, Québec, QC, Canada
| | - M Gagné
- Bureau d'information et d'études en santé des populations, Institut National de Santé Publique du Québec, 945, Avenue Wolfe, Québec, G1V 5B3, Canada
| | - L Bessette
- CHU de Québec-Université Laval Research Center, Québec, QC, Canada
- Department of Medicine, Medicine Faculty, Laval University, Ferdinand Vandry Pavillon, 1050 Avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada
| | - L G Ste-Marie
- Department of Medicine, Medicine Faculty, University of Montréal, Montréal, QC, Canada
| | - J P Brown
- CHU de Québec-Université Laval Research Center, Québec, QC, Canada
- Department of Medicine, Medicine Faculty, Laval University, Ferdinand Vandry Pavillon, 1050 Avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada
| | - S Jean
- Bureau d'information et d'études en santé des populations, Institut National de Santé Publique du Québec, 945, Avenue Wolfe, Québec, G1V 5B3, Canada
- Department of Medicine, Medicine Faculty, Laval University, Ferdinand Vandry Pavillon, 1050 Avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada
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Nassari S, Jean S. A140 AN ATYPICAL NON-CELL AUTONOMOUS REGULATION OF GUT HOMEOSTASIS: THE CONTRIBUTION OF ENTEROCYTES-RELATED AUTOPHAGY. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- S Nassari
- Anatomie et biologie cellulaire, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - S Jean
- Anatomie et biologie cellulaire, Université de Sherbrooke, Sherbrooke, QC, Canada
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LACARRIERE C, Jean S. A81 SBF AND RAB21: TWO AUTOPHAGY REGULATORS INVOLVED IN INTESTINAL STEM CELL DIFFERENTIATION. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C LACARRIERE
- Anatomie et biologie cellulaire, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - S Jean
- Anatomie et biologie cellulaire, Université de Sherbrooke, Sherbrooke, QC, Canada
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Sirois M, Fillion V, Jean S. FRAILTY AND USE OF HEALTH SERVICES IN INJURED SENIORS: A POPULATION-BASED STUDY. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M. Sirois
- Centre d’Excellence sur le Vieillissement de Québec, Québec, Quebec, Canada,
- Université Laval, Québec, Quebec, Canada,
| | - V. Fillion
- Centre d’Excellence sur le Vieillissement de Québec, Québec, Quebec, Canada,
- Institut National de Santé Publique, Québec, Quebec, Canada
| | - S. Jean
- Institut National de Santé Publique, Québec, Quebec, Canada
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Rambaud J, Guilbert J, Guellec I, Jean S, Durandy A, Demoulin M, Amblard A, Carbajal R, Leger PL. [Extracorporeal membrane oxygenation in critically ill neonates and children]. Arch Pediatr 2017; 24:578-586. [PMID: 28416430 DOI: 10.1016/j.arcped.2017.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 01/02/2017] [Accepted: 03/11/2017] [Indexed: 10/19/2022]
Abstract
Extracorporeal membrane oxygenation is used as a last resort during neonatal and pediatric resuscitation in case of refractory circulatory or respiratory failure under maximum conventional therapies. Different types of ECMO can be used depending on the initial failure. The main indications for ECMO are refractory respiratory failure (acute respiratory distress syndrome, status asthmaticus, severe pneumonia, meconium aspiration syndrome, pulmonary hypertension) and refractory circulatory failure (cardiogenic shock, septic shock, refractory cardiac arrest). The main contraindications are a gestational age under 34 weeks or birth weight under 2kg, severe underlying pulmonary disease, severe immune deficiency, a neurodegenerative disease and hereditary disease of hemostasis. Neurological impairment can occur during ECMO (cranial hemorrhage, seizure or stroke). Nosocomial infections and acute kidney injury are also frequent complications of ECMO. The overall survival rate of ECMO is about 60 %. This survival rate can change depending on the initial disease: from 80 % for meconium aspiration syndrome to less than 10 % for out-of-hospital refractory cardiac arrest. Recently, mobile ECMO units have been created. These units are able to perform ECMO out of a referral center for untransportable critically ill patients.
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Affiliation(s)
- J Rambaud
- Service de réanimation néonatale et pédiatrique, CHU d'Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Université Pierre et Marie Curie (UPMC), 75005 Paris, France.
| | - J Guilbert
- Service de réanimation néonatale et pédiatrique, CHU d'Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - I Guellec
- Service de réanimation néonatale et pédiatrique, CHU d'Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - S Jean
- Service de réanimation néonatale et pédiatrique, CHU d'Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - A Durandy
- Service de réanimation néonatale et pédiatrique, CHU d'Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Université Pierre et Marie Curie (UPMC), 75005 Paris, France
| | - M Demoulin
- Service de réanimation néonatale et pédiatrique, CHU d'Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Université Pierre et Marie Curie (UPMC), 75005 Paris, France
| | - A Amblard
- Service de réanimation néonatale et pédiatrique, CHU d'Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - R Carbajal
- Service de réanimation néonatale et pédiatrique, CHU d'Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - P-L Leger
- Service de réanimation néonatale et pédiatrique, CHU d'Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Unité Inserm U1141, hôpital Robert-Debré, 75019 Paris, France
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Handrigan GA, Maltais N, Gagné M, Lamontagne P, Hamel D, Teasdale N, Hue O, Corbeil P, Brown JP, Jean S. Sex-specific association between obesity and self-reported falls and injuries among community-dwelling Canadians aged 65 years and older. Osteoporos Int 2017; 28:483-494. [PMID: 27562568 DOI: 10.1007/s00198-016-3745-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 08/15/2016] [Indexed: 01/13/2023]
Abstract
UNLABELLED This study investigated the relationship between body mass index (BMI) and falls among community-dwelling elderly. Results indicate that obesity is associated with increased falls and there appears to be a sex-specific difference with obese men at higher risk of falling. Obesity is identified as a risk factor for falls in men. INTRODUCTION The prevalence of falls, fall-related injuries, and obesity has increased over the last decade. The objectives of this study were to investigate sex-specific association and dose-response relationship between BMI and falls (and related injuries) among community-dwelling elderly. METHODS Our study sample consisted of 15,860 adults aged 65 years or older (6399 men and 9461 women) from the 2008-2009 Canadian Community Health Survey-Healthy Aging (CCHS-HA). Falls, fall-related injuries, and BMI measures were self-reported. For both sex, dose-response curves presenting the relationship between BMI, falls, and fall-related injuries were first examined. Thereafter, multivariate logistic regression analyses were also performed to investigate these relationships after adjustment for potentially confounding variables. RESULTS Of women, 21.7 % reported a fall and 16.9 % of men. The dose-response relationship between BMI and prevalence of falls showed that underweight and obese individuals reported falling more than normal and overweight individuals; this being more apparent in men than women. Finally, the dose relationship between BMI and prevalence of fall-related injuries showed that only obese men seem more likely to have sustained a fall-related injury. Results from the multivariate analysis showed that obesity in men was significantly associated with higher odds of falling odds ratio (OR) 1.33 (1.04-1.70) and was not significantly associated with higher odds of fall-related injuries OR 1.10 (0.66-1.84) over a 12-month period compared to normal weight men. For women, obesity was not significantly associated with higher fall prevalence OR 0.99 (0.79-1.25) and fall-related injuries OR 0.71 (0.51-1.00). CONCLUSION Obesity is associated with self-reported falls, and there appears to be a sex-specific difference in elderly persons.
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Affiliation(s)
- G A Handrigan
- School of Kinesiology and Leisure, Université de Moncton, Moncton, NB, Canada.
| | - N Maltais
- School of Kinesiology and Leisure, Université de Moncton, Moncton, NB, Canada
| | - M Gagné
- Institut National Santé Publique Québec, Québec, QC, Canada
| | - P Lamontagne
- Institut National Santé Publique Québec, Québec, QC, Canada
| | - D Hamel
- Institut National Santé Publique Québec, Québec, QC, Canada
| | - N Teasdale
- Department of Kinesiology, Université Laval, Québec, QC, Canada
| | - O Hue
- Department of Science of Physical Activity, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - P Corbeil
- Department of Kinesiology, Université Laval, Québec, QC, Canada
| | - J P Brown
- Department of Medicine, Université Laval, Québec, QC, Canada
| | - S Jean
- Institut National Santé Publique Québec, Québec, QC, Canada
- Department of Medicine, Université Laval, Québec, QC, Canada
- Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
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12
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Béranger A, Pierron C, de Saint Blanquat L, Jean S, Chappuy H. [Communication, information, and roles of parents in the pediatric intensive care unit: A review article]. Arch Pediatr 2017; 24:265-272. [PMID: 28131555 DOI: 10.1016/j.arcped.2016.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 09/03/2016] [Accepted: 12/04/2016] [Indexed: 10/20/2022]
Abstract
Pediatric intensive care units (PICUs), whose accessibility to parents raises controversy, often operate under their own rules. Patients are under critical and unstable conditions, often in a life-threatening situation. In this context, the communication with the parents and their participation in the unit may be difficult. Information is a legal, deontological, and moral duty for caregivers, confirmed by the parents' needs. But the ability to enforce them is a challenge, and there is a gap between the theory and the reality. The communication between the parents and the physicians starts at the admission of the child with a family conference. According to the Société de réanimation de langue française (SRLF), the effectiveness of the communication is based on three criteria: the patients' comprehension, their satisfaction and their anxiety and depression. It has been shown that comprehension depends on multiple factors, related on the parents, the physicians, and the medical condition of the child. Regarding the parents' participation in the organization of the service, the parents' presence is becoming an important factor. In the PICU, the parents' status has evolved. They become a member of the care team, as a partner. The best interest of the child is always discussed with the parents, as the person knowing the best their child. This partnership gives them a responsibility, which is complementary to the physician's one, but does not substitute it.
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Affiliation(s)
- A Béranger
- Laboratoire d'éthique médicale et médecine légale, université Paris Descartes, 45, rue des Saints-Pères, 75006 Paris, France; Recherche clinique Paris Descartes, hôpital Necker-Enfants-Malades, université Paris Descartes, 149, rue de Sèvres, 75015 Paris, France.
| | - C Pierron
- Réanimation polyvalente pédiatrique, hôpital Robert-Debré, université Paris Diderot, 75019 Paris, France
| | - L de Saint Blanquat
- Réanimation polyvalente pédiatrique, hôpital Necker-Enfants-Malades, université Paris Descartes, 75015 Paris, France
| | - S Jean
- Réanimation polyvalente pédiatrique, hôpital Armand-Trousseau, université Pierre-et-Marie-Curie, 75012 Paris, France
| | - H Chappuy
- EA 7323, urgences pédiatriques, hôpital Armand-Trousseau, université Pierre-et-Marie-Curie, 75012 Paris, France
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Beaudoin C, Jean S, Bessette L, Ste-Marie LG, Moore L, Brown JP. Denosumab compared to other treatments to prevent or treat osteoporosis in individuals at risk of fracture: a systematic review and meta-analysis. Osteoporos Int 2016; 27:2835-2844. [PMID: 27120345 DOI: 10.1007/s00198-016-3607-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 04/10/2016] [Indexed: 12/17/2022]
Abstract
UNLABELLED The aim of this review is to compare the efficacy and safety of denosumab over other treatments for osteoporosis. The results of this study suggest that the safety of denosumab and its efficacy in reducing fractures is not significantly different from bisphosphonates. Denosumab was, however, more effective in increasing bone mineral density. INTRODUCTION This study was conducted to compare the efficacy and safety of denosumab over other pharmacological treatments for osteoporosis in individuals at risk of fracture. METHODS Randomised controlled trials comparing denosumab with another pharmacological treatment for osteoporosis were searched in MEDLINE, EMBASE and CENTRAL. Identified articles were screened by two independent reviewers and assessed for inclusion. Data from included studies were extracted and meta-analyses were conducted using random effects models. RESULTS Nine studies including a total of 4890 postmenopausal women were identified. The follow-up period varied from 12 to 24 months. In all studies except one, the comparator treatment was a bisphosphonate. There was no statistically significant difference between patients receiving denosumab and those receiving a bisphosphonate in terms of fracture risk (RR[95 % CI] = 1.15 [0.84-1.58]), adverse events (RR[95 % CI] = 0.99 [0.96-1.02]) or deaths (OR[95 % CI] = 0.58 [0.12-2.71]). Withdrawals due to adverse events were less frequent in denosumab than in other treatment groups but the difference did not reach statistical significance (OR[95 % CI] = 0.68 [0.45-1.04]). The percent change in bone mineral density at the total hip, lumbar spine, femoral neck and one-third radius was significantly higher in participants who received denosumab (e.g. mean difference [95 % CI] at the total hip: 1.06 [0.86-1.25]). CONCLUSIONS These results suggest that, after 12 to 24 months, the safety and efficacy of denosumab for reducing fracture risk is not significantly different from bisphosphonates despite higher gains in bone mineral density. In a clinical setting, denosumab may demonstrate greater effectiveness.
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Affiliation(s)
- C Beaudoin
- Centre de recherche du CHU de Québec (CHUL), 2705, Boulevard Laurier, Québec, Québec, G1V 4G2, Canada.
- Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, Canada.
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Québec, Canada.
| | - S Jean
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Québec, Canada
- Département de médecine, Faculté de médecine, Université Laval, Québec, Canada
| | - L Bessette
- Centre de recherche du CHU de Québec (CHUL), 2705, Boulevard Laurier, Québec, Québec, G1V 4G2, Canada
- Département de médecine, Faculté de médecine, Université Laval, Québec, Canada
| | - L-G Ste-Marie
- Département de médecine, Faculté de médecine, Université de Montréal, Montréal, Canada
| | - L Moore
- Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, Canada
| | - J P Brown
- Centre de recherche du CHU de Québec (CHUL), 2705, Boulevard Laurier, Québec, Québec, G1V 4G2, Canada
- Département de médecine, Faculté de médecine, Université Laval, Québec, Canada
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Rambaud J, Leger PL, Larroquet M, Amblard A, Lode N, Alix-Seguin L, Demoulin M, Guilbert J, Jean S, Durandy A, Guellec I, Walti H, Carbajal R. Mise en place de la première unité mobile d’assistance circulatoire et respiratoire pédiatrique et néonatale en Île-de-France. Ann Fr Med Urgence 2016. [DOI: 10.1007/s13341-016-0622-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Rambaud J, Léger PL, Larroquet M, Amblard A, Lodé N, Guilbert J, Jean S, Guellec I, Casadevall I, Kessous K, Walti H, Carbajal R. Transportation of children on extracorporeal membrane oxygenation: one-year experience of the first neonatal and paediatric mobile ECMO team in the north of France. Intensive Care Med 2015; 42:940-941. [PMID: 26626061 DOI: 10.1007/s00134-015-4144-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2015] [Indexed: 11/30/2022]
Affiliation(s)
- J Rambaud
- Paediatric Intensive Care Unit, Armand-Trousseau Hospital, APHP, UPMC University, 26 Avenue du Dr Arnold Netter, 75012, Paris, France.
| | - P L Léger
- Paediatric Intensive Care Unit, Armand-Trousseau Hospital, APHP, UPMC University, 26 Avenue du Dr Arnold Netter, 75012, Paris, France
| | - M Larroquet
- Paediatric Surgery, Armand-Trousseau Hospital, APHP, UPMC University, Paris, France
| | - A Amblard
- Paediatric Intensive Care Unit, Armand-Trousseau Hospital, APHP, UPMC University, 26 Avenue du Dr Arnold Netter, 75012, Paris, France
| | - N Lodé
- Emergency Transport Unit, Robert Debré Hospital, Paris, France
| | - J Guilbert
- Paediatric Intensive Care Unit, Armand-Trousseau Hospital, APHP, UPMC University, 26 Avenue du Dr Arnold Netter, 75012, Paris, France
| | - S Jean
- Paediatric Intensive Care Unit, Armand-Trousseau Hospital, APHP, UPMC University, 26 Avenue du Dr Arnold Netter, 75012, Paris, France
| | - I Guellec
- Paediatric Intensive Care Unit, Armand-Trousseau Hospital, APHP, UPMC University, 26 Avenue du Dr Arnold Netter, 75012, Paris, France
| | - I Casadevall
- Emergency Transport Unit, Robert Debré Hospital, Paris, France
| | - K Kessous
- Emergency Transport Unit, Robert Debré Hospital, Paris, France
| | - H Walti
- Paediatric Intensive Care Unit, Armand-Trousseau Hospital, APHP, UPMC University, 26 Avenue du Dr Arnold Netter, 75012, Paris, France
| | - R Carbajal
- Paediatric Intensive Care Unit, Armand-Trousseau Hospital, APHP, UPMC University, 26 Avenue du Dr Arnold Netter, 75012, Paris, France
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Bertrand JA, Jean S, Laberge L, Gagnon C, Mathieu J, Gagnon JF, Richer L. Psychological characteristics of patients with myotonic dystrophy type 1. Acta Neurol Scand 2015; 132:49-58. [PMID: 25496310 DOI: 10.1111/ane.12356] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Myotonic dystrophy type 1 (DM1) is the most common adult-onset muscular dystrophy. It is associated with motor symptoms but patients also display non-motor symptoms such as particular personality traits. Studies have reported mixed results about personality characteristics which may be attributable to small sample sizes, different disease severity of groups studied, and use of different questionnaires or method. This study aimed to describe the psychological characteristics of a large cohort of patients with DM1, to characterize those at risk of developing a psychiatric disorder, and to compare characteristics between two DM1 phenotypes, a mild and more severe adult-onset phenotype. METHODS Two hundred patients with DM1 (152 adult-onset; 48 mild) were asked to complete questionnaires assessing personality traits, psychological symptoms, self-esteem, and suicidal risk. Neurological and neuropsychological assessments were performed to compare personality characteristics to clinical and cognitive measures. RESULTS Patients with DM1 globally showed personality traits and psychological symptoms in the average range compared to normative data, with normal levels of self-esteem and suicidal ideation. However, 27% of patients were found to be at high risk of developing a psychiatric disorder. Moreover, psychological traits differed across phenotypes, with the most severe phenotype tending to show more severe psychological symptoms. The presence of higher phobic anxiety and lower self-esteem was associated with lower education, a higher number of CTG repeats, more severe muscular impairment, and lower cognitive functioning (P < 0.001). CONCLUSIONS Different phenotypes should thus be taken into account in clinical settings for individual management of patients and optimizing therapeutic success.
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Affiliation(s)
- J. A. Bertrand
- Rotman Research Institute; Baycrest Center; Toronto ON Canada
- Université du Québec à Montréal; Montréal QC Canada
| | - S. Jean
- Centre de santé et de services sociaux de Chicoutimi; Chicoutimi QC Canada
| | - L. Laberge
- Université du Québec à Chicoutimi; Chicoutimi QC Canada
- ÉCOBES - Recherche et transfert; Cégep de Jonquière; Jonquière QC Canada
| | - C. Gagnon
- Clinique des maladies neuromusculaires; Centre de santé et de services sociaux de Jonquière; Jonquière QC Canada
- Université de Sherbrooke; Sherbrooke QC Canada
| | - J. Mathieu
- Clinique des maladies neuromusculaires; Centre de santé et de services sociaux de Jonquière; Jonquière QC Canada
- Université de Sherbrooke; Sherbrooke QC Canada
| | - J. F. Gagnon
- Université du Québec à Montréal; Montréal QC Canada
| | - L. Richer
- Université du Québec à Chicoutimi; Chicoutimi QC Canada
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Wipff J, Costantino F, Lemelle I, Pajot C, Duquesne A, Lorrot M, Faye A, Bader-Meunier B, Brochard K, Despert V, Jean S, Grall-Lerosey M, Marot Y, Nouar D, Pagnier A, Quartier P, Job-Deslandre C. A large national cohort of French patients with chronic recurrent multifocal osteitis. Arthritis Rheumatol 2015; 67:1128-37. [PMID: 25545761 DOI: 10.1002/art.39013] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 12/19/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To document more fully the characteristics of chronic recurrent multifocal osteomyelitis (CRMO) in pediatric patients, to collect data on the outcomes and management of the disease, and to define prognostic factors. METHODS One hundred seventy-eight patients were included (123 female patients and 55 male patients), with a mean ± SD age at diagnosis of 10.9 ± 2.9 years. Inclusion criteria were a diagnosis of CRMO, evidence of at least one lesion of osteitis confirmed by imaging, and development of the syndrome before age 18 years. RESULTS Longitudinal clinical and imaging studies revealed that only 12 of 178 CRMO patients (7%) had unifocal lesions at the last medical visit. We were able to apply the clinical chronic nonbacterial osteomyelitis score to 110 of 178 patients (62%), which indicated that bone biopsy could have been avoided in 27 cases (25%). At the last medical visit, disease was in remission in only 73 of 171 patients (43%) (41% receiving therapy) after a mean ± SD of 47.9 ± 38.9 months; 44 of 171 patients (26%) experienced sequelae. Using cluster analysis, the CRMO cohort was separated into 3 homogeneous phenotypes (severe, mild, and intermediate). Patients with the severe phenotype had the worst prognosis. This group was entirely composed of male patients, most of whom had the multifocal form of CRMO and inflammatory syndrome. Patients with the mild phenotype had the best prognosis. This group was primarily composed of female patients with a unifocal form of CRMO and infrequent clavicle involvement and inflammatory syndrome. Patients with the intermediate phenotype had a good prognosis but greater reliance on treatment. This group primarily included female patients with multifocal lesions and inflammatory syndrome. CONCLUSION This is the largest CRMO cohort described in the literature to date. Clinical evolution and imaging investigations confirmed the multifocal pattern of the disease. Three distinct subgroups of CRMO patients were distinguished, with very different prognoses.
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Affiliation(s)
- J Wipff
- Hôpital Cochin, AP-HP, and Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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Blais C, Jean S, Sirois C, Rochette L, Plante C, Larocque I, Doucet M, Ruel G, Simard M, Gamache P, Hamel D, St-Laurent D, Emond V. Quebec Integrated Chronic Disease Surveillance System (QICDSS), an innovative approach. Chronic Dis Inj Can 2014; 34:226-235. [PMID: 25408182] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION With the growing burden of chronic diseases, surveillance will play an essential role in improving their prevention and control. The Institut national de santé publique du Québec has developed an innovative chronic disease surveillance system, the Quebec Integrated Chronic Disease Surveillance System (QICDSS). We discuss the primary features, strengths and limitations of this system in this report. METHODS The QICDSS was created by linking five health administrative databases. Updated annually, it currently covers the period from January 1, 1996, to March 31, 2012. The operational model comprises three steps: (1) extraction and linkage of health administrative data according to specific selection criteria; (2) analysis (validation of case definitions essentially) and production of surveillance measures; and (3) data interpretation, submission and dissemination of information. The QICDSS allows the surveillance of the following chronic diseases: diabetes, cardiovascular diseases, respiratory diseases, osteoporosis, osteoarticular diseases, mental disorders, Alzheimer's disease and related disorders. The system also lends itself to the analysis of multimorbidity and polypharmacy. RESULTS For 2011-2012, the QICDSS contained information on 7 995 963 Quebecers with an average age of 40.8 years. Of these, 95.3% met at least one selection criterion allowing the application of case definitions for chronic disease surveillance. The actual proportion varied with age, from 90.1% for those aged 19 years or less to 99.3% for those aged 65 years or over. CONCLUSION The QICDSS provides a way of producing population-based data on the chronic disease burden, health services and prescription drug uses. The system facilitates the integrated study of several diseases in combination, an approach rarely implemented until now in the context of population surveillance. The QICDSS possesses all the essential features of a surveillance system and supports the dissemination of information to public health decision-makers for future actions.
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Affiliation(s)
- C Blais
- Institut national de santé publique du Québec, Québec, Quebec, Canada; Faculté de pharmacie, Université Laval, Québec, Quebec, Canada
| | - S Jean
- Institut national de santé publique du Québec, Québec, Quebec, Canada; Faculté de médecine, Université Laval, Québec, Quebec, Canada; Département de médecine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - C Sirois
- Institut national de santé publique du Québec, Québec, Quebec, Canada; Département de sciences infirmières, Université du Québec à Rimouski, Lévis, Quebec, Canada
| | - L Rochette
- Institut national de santé publique du Québec, Québec, Quebec, Canada
| | - C Plante
- Institut national de santé publique du Québec, Québec, Quebec, Canada
| | - I Larocque
- Institut national de santé publique du Québec, Québec, Quebec, Canada
| | - M Doucet
- Institut national de santé publique du Québec, Québec, Quebec, Canada; Faculté de médecine, Université Laval, Québec, Quebec, Canada
| | - G Ruel
- Institut national de santé publique du Québec, Québec, Quebec, Canada; Population Research Outcome Studies (PROS), University of Adelaide, Adelaide, South Australia, Australia
| | - M Simard
- Institut national de santé publique du Québec, Québec, Quebec, Canada
| | - P Gamache
- Institut national de santé publique du Québec, Québec, Quebec, Canada
| | - D Hamel
- Institut national de santé publique du Québec, Québec, Quebec, Canada
| | - D St-Laurent
- Institut national de santé publique du Québec, Québec, Quebec, Canada
| | - V Emond
- Institut national de santé publique du Québec, Québec, Quebec, Canada
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Blais C, Jean S, Sirois C, Rochette L, Plante C, Larocque I, Doucet M, Ruel G, Simard M, Gamache P, Hamel D, St-Laurent D, Émond V. Quebec Integrated Chronic Disease Surveillance System (QICDSS), an innovative approach. ACTA ACUST UNITED AC 2014. [DOI: 10.24095/hpcdp.34.4.06] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction
With the growing burden of chronic diseases, surveillance will play an essential role in improving their prevention and control. The Institut national de santé publique du Québec has developed an innovative chronic disease surveillance system, the Quebec Integrated Chronic Disease Surveillance System (QICDSS). We discuss the primary features, strengths and limitations of this system in this report.
Methodology
The QICDSS was created by linking five health administrative databases. Updated annually, it currently covers the period from January 1, 1996, to March 31, 2012. The operational model comprises three steps: (1) extraction and linkage of health administrative data according to specific selection criteria; (2) analysis (validation of case definitions essentially) and production of surveillance measures; and (3) data interpretation, submission and dissemination of information. The QICDSS allows the surveillance of the following chronic diseases: diabetes, cardiovascular diseases, respiratory diseases, osteoporosis, osteoarticular diseases, mental disorders, Alzheimer's disease and related disorders. The system also lends itself to the analysis of multimorbidity and polypharmacy.
Results
For 2011–2012, the QICDSS contained information on 7 995 963 Quebecers with an average age of 40.8 years. Of these, 95.3% met at least one selection criterion allowing the application of case definitions for chronic disease surveillance. The actual proportion varied with age, from 90.1% for those aged 19 years or less to 99.3% for those aged 65 years or over.
Conclusion
The QICDSS provides a way of producing population-based data on the chronic disease burden, health services and prescription drug uses. The system facilitates the integrated study of several diseases in combination, an approach rarely implemented until now in the context of population surveillance. The QICDSS possesses all the essential features of a surveillance system and supports the dissemination of information to public health decision-makers for future actions.
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Affiliation(s)
- C Blais
- Institut national de santé publique du Québec, Québec, Quebec, Canada
- Faculté de pharmacie, Université Laval, Québec, Quebec, Canada
| | - S Jean
- Institut national de santé publique du Québec, Québec, Quebec, Canada
- Faculté de médecine, Université Laval, Québec, Quebec, Canada
- Département de médecine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - C Sirois
- Institut national de santé publique du Québec, Québec, Quebec, Canada
- Département de sciences infirmières, Université du Québec à Rimouski, Lévis, Quebec, Canada
| | - L Rochette
- Institut national de santé publique du Québec, Québec, Quebec, Canada
| | - C Plante
- Institut national de santé publique du Québec, Québec, Quebec, Canada
| | - I Larocque
- Institut national de santé publique du Québec, Québec, Quebec, Canada
| | - M Doucet
- Institut national de santé publique du Québec, Québec, Quebec, Canada
- Faculté de médecine, Université Laval, Québec, Quebec, Canada
| | - G Ruel
- Institut national de santé publique du Québec, Québec, Quebec, Canada
- Population Research Outcome Studies (PROS), University of Adelaide, Adelaide, South Australia, Australia
| | - M Simard
- Institut national de santé publique du Québec, Québec, Quebec, Canada
| | - P Gamache
- Institut national de santé publique du Québec, Québec, Quebec, Canada
| | - D Hamel
- Institut national de santé publique du Québec, Québec, Quebec, Canada
| | - D St-Laurent
- Institut national de santé publique du Québec, Québec, Quebec, Canada
| | - V Émond
- Institut national de santé publique du Québec, Québec, Quebec, Canada
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Beaudoin C, Bessette L, Jean S, Ste-Marie LG, Brown JP. The impact of educational interventions on modifiable risk factors for osteoporosis after a fragility fracture. Osteoporos Int 2014; 25:1821-30. [PMID: 24519745 DOI: 10.1007/s00198-014-2618-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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] [Received: 07/23/2013] [Accepted: 01/08/2014] [Indexed: 10/25/2022]
Abstract
The purpose of this study was to investigate the impact of two educational interventions on the intake of calcium and vitamin D supplements and modifiable risk factors for osteoporosis in women ≥50 years with a fragility fracture (FF). Within 6-8 months of fracture, women were randomized to one of three intervention groups: usual care (UC), written materials (WM), or videocassette and written materials (VC). The written materials for patients and their physician provided information on osteoporosis, FF, and available treatments; written materials for physician were provided through patients. The videocassette presented similar information as the written material, but in greater depth. Twelve months after randomization, the effectiveness of the interventions was assessed. The study cohort consisted of 1,175 women undiagnosed and untreated for osteoporosis. After 12 months, the mean intake of Ca supplements increased by 33, 93, and 91 mg/day for the UC, WM, and VC groups, respectively (p value, WM vs UC = 0.163; VC vs UC = 0.026); the corresponding mean increases for vitamin D were 58, 105, and 118 IU/day (p value, WM vs UC = 0.214; VC vs UC = 0.012). The proportion of women who increased their Ca and vitamin D intake by supplements was similar in all three groups. The intervention had a greater impact in those not taking supplements at randomization and had no impact on modifiable risk factors. In women without diagnosis and treatment for osteoporosis, the interventions seem effective at increasing the amounts of Ca and vitamin D supplements, but not effective at inciting more women to increase their consumption. Therefore, the clinical significance of the impact of the intervention is difficult to evaluate.
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Affiliation(s)
- C Beaudoin
- CHU de Québec Research Centre, 2705, Boulevard Laurier, S-769C, Québec, G1V 4G2, Canada,
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Wipff J, Nouar D, Lemelle I, Pajot C, Duquesne A, Lorrot M, Faye A, Bader-Meunier B, Brochard K, Despert V, Jean S, Grall-Lerosey M, Marot Y, Pagnier A, Quartier P, Deslandre C. FRI0541 Imaging of Chronic Recurrent Multifocal Osteitis: A French National Cohort of 178 Cases. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Wipff J, Nouar D, Lemelle I, Pajot C, Duquesne A, Lorrot M, Faye A, Bader-Meunier B, Brochard K, Despert V, Jean S, Grall-Lerosey M, Marot Y, Pagnier A, Quartier P, Deslandre C. PReS-FINAL-2191: Imaging of chronic recurrent multifocal osteitis: a french national cohort of 178 cases. Pediatr Rheumatol Online J 2013. [PMCID: PMC4044492 DOI: 10.1186/1546-0096-11-s2-o26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Abstract
Introduction
Our purpose was to evaluate changes in fall-related mortality in adults aged 65 years and over in Quebec and to propose a case definition based on all the causes entered on Return of Death forms.
Methods
The analysis covers deaths between 1981 and 2009 recorded in the Quebec vital statistics data.
Results
While the number of fall-related deaths increased between 1981 and 2009, the adjusted falls-related mortality rate remained relatively stable. Since the early 2000s, this stability has masked opposing trends. The mortality rate associated with certified falls (W00–W19) has increased while the rate for presumed falls (exposure to an unspecified factor causing a fracture) has decreased.
Conclusion
For fall surveillance, analyses using indicators from the vital statistics data should include both certified falls and presumed falls. In addition, a possible shift in the coding of fall-related deaths toward secondary causes should be taken into account.
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Affiliation(s)
- M Gagné
- Institut national de santé publique du Québec, Québec, Quebec, Canada
| | - Y Robitaille
- Institut national de santé publique du Québec, Québec, Quebec, Canada
| | - S Jean
- Institut national de santé publique du Québec, Québec, Quebec, Canada
| | - P-A Perron
- Bureau du coroner en chef du Québec, Québec, Quebec, Canada
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Gagné M, Robitaille Y, Jean S, Perron PA. Changes in fall-related mortality in older adults in Quebec, 1981-2009. Chronic Dis Inj Can 2013; 33:226-235. [PMID: 23987219] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Our purpose was to evaluate changes in fall-related mortality in adults aged 65 years and over in Quebec and to propose a case definition based on all the causes entered on Return of Death forms. METHODS The analysis covers deaths between 1981 and 2009 recorded in the Quebec vital statistics data. RESULTS While the number of fall-related deaths increased between 1981 and 2009, the adjusted falls-related mortality rate remained relatively stable. Since the early 2000s, this stability has masked opposing trends. The mortality rate associated with certified falls (W00-W19) has increased while the rate for presumed falls (exposure to an unspecified factor causing a fracture) has decreased. CONCLUSION For fall surveillance, analyses using indicators from the vital statistics data should include both certified falls and presumed falls. In addition, a possible shift in the coding of fall-related deaths toward secondary causes should be taken into account.
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Affiliation(s)
- M Gagné
- Institut national de santé publique du Québec, Québec, Quebec, Canada.
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Haley N, Lambert G, Jean S, Frappier JY, Otis J, Roy E. 1135 – Mental health distress and alcohol misuse associated with prevalence of sexually transmitted infections among adolescents in care. Eur Psychiatry 2013. [DOI: 10.1016/s0924-9338(13)76234-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Jean S, Candas B, Belzile É, Morin S, Bessette L, Brown JP. Utilisation des données administratives : validation d’un algorithme en surveillance de l’ostéoporose. Rev Epidemiol Sante Publique 2012. [DOI: 10.1016/j.respe.2012.06.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Jean S, Candas B, Belzile É, Morin S, Bessette L, Brown JP. Appariement des données administratives pour l’estimation de l’utilisation des ressources médicales. Rev Epidemiol Sante Publique 2012. [DOI: 10.1016/j.respe.2012.06.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Haley N, Lambert G, Jean S, Tremblay C, Frappier J, Otis J, Roy E. Sexual Heath of Adolescents in Quebec Youth Protection Centers. Paediatr Child Health 2012. [DOI: 10.1093/pch/17.suppl_a.17ab] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Jean S, Despert V, Bridoux L. Arthrite juvénile idiopathique (AJI) et maladies inflammatoires chroniques intestinales (MICI). Arch Pediatr 2012. [DOI: 10.1016/j.arcped.2012.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bessette L, Jean S, Lapointe-Garant MP, Belzile EL, Davison KS, Ste-Marie LG, Brown JP. Direct medical costs attributable to peripheral fractures in Canadian post-menopausal women. Osteoporos Int 2012; 23:1757-68. [PMID: 21927921 DOI: 10.1007/s00198-011-1785-9] [Citation(s) in RCA: 24] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 07/27/2011] [Indexed: 10/17/2022]
Abstract
UNLABELLED This study determined the cost of treating fractures at osteoporotic sites (except spine fractures) for the year following fracture. While the average cost of treating a hip fracture was the highest of all fractures ($46,664 CAD per fracture), treating other fractures also accounted for significant expenditures ($5,253 to $10,410 CAD per fracture). INTRODUCTION This study aims to determine the mean direct medical cost of treating fractures at peripheral osteoporotic sites in the year post-fracture (through 2 years post-hip fracture). METHODS Health administrative databases from the province of Quebec, Canada were used to estimate the cost of treating peripheral fractures at osteoporotic sites for the year following fracture (through 2 years for hip fractures). Included in costs analyses were physician claims, emergency and outpatient clinic costs, hospitalization costs, and subsequent costs for treatment of complications. RESULTS A total of 15,827 patients (mean age 72 years) who suffered one fracture at an osteoporotic site had data for analyses. Hip/femur fractures had the highest rate of hospital stays related to fracture (91%) and the highest rate of hospital stays associated with a post-fracture complication (8%). In the year following fracture, the mean (SD) costs (2009 Canadian dollars) of treating acute fractures and post-fracture complications were: hip/femur fracture $46,664 ($43,198), wrist fracture $5,253 ($18,982), and fractures at other peripheral sites $10,410 ($27,641). The average (SD) cost of treating post-fracture complications at the hip/femur in the second year post-fracture was $1,698 ($12,462). Hospitalizations associated with the fracture accounted for 88% of the total cost of fracture treatment. CONCLUSIONS The treatment of hip fractures accounts for a significant proportion of the costs associated with the treatment of peripheral osteoporotic fractures. Interventions to reduce the incidence of fractures, particularly hip fractures, would result in significant cost savings to the health care system and would preserve quality of life in many patients.
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Affiliation(s)
- L Bessette
- Department of Medicine, CHUL Research Centre, Laval University, 2705, Laurier boulevard, Room S-763, Quebec City, QC, GIV 4G2, Canada.
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Wipff J, Dumitrescu MA, Lorrot M, Kettani S, Faye A, Lacassagne S, Bader-Meunier B, Mouy R, Wouters C, Desjonquères M, Jean S, Despert V, Duquesne A, Quartier P, Job-Deslandre C. Création d’une cohorte française d’ostéites chroniques multifocales récidivantes : premiers résultats. Arch Pediatr 2012. [DOI: 10.1016/j.arcped.2012.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Jean S, Candas B, Belzile É, Morin S, Bessette L, Dodin S, Brown JP. Algorithms can be used to identify fragility fracture cases in physician-claims databases. Osteoporos Int 2012; 23:483-501. [PMID: 21336492 DOI: 10.1007/s00198-011-1559-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [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] [Received: 10/20/2010] [Accepted: 01/10/2011] [Indexed: 01/06/2023]
Abstract
SUMMARY Physician-billing claims databases can be used to determine the incidence of fractures in the community. This study tested three algorithms designed to accurately and reliably identify fractures from a physician-billing claims database and concluded that they were useful for identifying all types of fractures, except vertebral, sacral, and coccyx fractures. INTRODUCTION To develop and validate algorithms that identify fracture events from a physician-billing claims database (PCDs). METHODS Three algorithms were developed using physician's specialty, diagnostic, and medical service codes used in a PCD from the province of Quebec. Algorithm validity was assessed via calculation of positive predictive values (PPV; via verification of a sample of algorithm-identified cases with hospitalization files) and sensitivities (via cross-referencing respective algorithm-identified fracture cases with a well-characterized fracture cohort). RESULTS PPV and sensitivity varied across fracture sites. For most fracture sites, the PPV with algorithm 3 was higher than with algorithms 1 or 2. Except for knee fracture, the PPVs ranged from 0.81 to 0.96. Sensitivities were low at the vertebral, sacral, and coccyx sites (0.40-0.50), but high at all other fracture sites. For 95% of fractures, the fracture site identified by algorithm agreed with the fracture site from patients' medical records. Fracture dates identified by algorithm were within 2 days of the actual fracture date in 88% of fracture cases. Among cases identified by algorithm 3 to have had an open reduction (N = 461), 95% underwent surgery according to their respective medical charts. CONCLUSION Algorithms using PCDs are accurate and reliable for identifying incident fractures associated with osteoporosis-related fracture sites. The identification of these fractures in the community is important for helping to estimate the burden associated with osteoporosis and the utility of programs designed to reduce the rates of fragility fracture.
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Affiliation(s)
- S Jean
- National Institute of Public Health of Québec, 945, Wolfe Avenue, Quebec, QC G1V 5B3, Canada.
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Bessette L, Davison KS, Jean S, Roy S, Ste-Marie LG, Brown JP. The impact of two educational interventions on osteoporosis diagnosis and treatment after fragility fracture: a population-based randomized controlled trial. Osteoporos Int 2011; 22:2963-72. [PMID: 21311871 DOI: 10.1007/s00198-011-1533-1] [Citation(s) in RCA: 26] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 12/20/2010] [Indexed: 10/18/2022]
Abstract
UNLABELLED This study assessed whether osteoporosis diagnosis and treatment after an osteoporotic fracture can be increased by providing osteoporosis reading material to patients and family doctors or by watching a videocassette about osteoporosis. Educating patients about osteoporosis had little impact on whether a woman received an osteoporosis diagnosis or treatment. INTRODUCTION The purpose of this study was to investigate the impact of two education-based interventions on osteoporosis diagnosis and treatment in women ≥ 50 years of age after fragility fracture. METHODS Six to eight months after fracture, women were randomized into three groups: (1) control, (2) written materials, or (3) videocassette and written materials. Written materials for both the patient and physician detailed osteoporosis, fragility fracture, and available treatments; written materials for physicians were provided through patients. The educational videocassette presented similar information as the written material, but in greater depth. Rates of osteoporosis diagnosis and treatment following intervention were compared among groups using survival analysis methods. Statistical significance was set at p < 0.0167. RESULTS At randomization, 1,174 women were without osteoporosis diagnosis and treatment, and after follow-up, 12% of the control group, 15% of the written materials group (p = 0.073), and 16% (p = 0.036) of the videocassette and written materials group were diagnosed with osteoporosis (statistical comparisons to control). Treatment rates were 8% for the control group, 12% for the written materials group (p = 0.052), and 11% for the videocassette and written materials group (p = 0.157). At randomization, 1,314 women were without treatment and after follow-up therapy was initiated in 10% of the control group, 13% of the written materials group (p = 0.107), and 13% of the videocassette and written materials group (p = 0.238). CONCLUSIONS The educational interventions assessed in this trial were not satisfactory to increase osteoporosis diagnosis or treatment in recently fractured women to a clinically meaningful degree.
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Affiliation(s)
- L Bessette
- Department of Medicine, CHUL Research Centre, Laval University, Quebec City, PQ, Canada.
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Lambert G, Haley N, Jean S, Tremblay C, Frappier JY, Otis J, Roy E. P1-S2.29 Risky sexual practices among youth in Quebec Care Centers. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Polard T, Jean S, Gauthier L, Laplanche C, Merlina G, Sánchez-Pérez JM, Pinelli E. Mutagenic impact on fish of runoff events in agricultural areas in south-west France. Aquat Toxicol 2011; 101:126-134. [PMID: 20970859 DOI: 10.1016/j.aquatox.2010.09.014] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Revised: 09/15/2010] [Accepted: 09/20/2010] [Indexed: 05/30/2023]
Abstract
When heavy rainfall follows herbicide application, the intense surface runoff causes stream water contamination. Aquatic organisms are then briefly exposed to a complex mixture of contaminants. The aim of the present study is to investigate the genotoxic impact of such events on fish. A model fish, the Crucian carp (Carassius carassius) was exposed in controlled conditions, for 4 days, to water sampled daily in the Save River (France). The watershed of this stream is representative of agricultural areas in south-west France. Three hydrological conditions were compared: basal flow, winter flood, and spring flood. Chemical analysis of the water samples confirmed the higher contamination of the spring flood water, mainly explained by a peak of metolachlor. Genotoxicity was evaluated by micronucleus (MN) test and comet assay in peripheral erythrocytes. A significant increase in DNA breakdowns compared to controls was detected by the comet assay for all conditions. Exposure to spring flood water resulted in the highest damage induction. Moreover, induced chromosomal damage was only detected in this condition. In addition, fish were exposed, for 4 days, to an experimental mixture of 5 herbicides representative of the spring flood water contamination. Fish exhibited moderate DNA damage induction and no significant chromosomal damage. The mutagenicity induced by field-collected water is then suspected to be the result of numerous interactions between contaminants themselves and environmental factors, stressing the use of realistic exposure conditions. The results revealed a mutagenic impact of water contamination during the spring flood, emphasizing the need to consider these transient events in water quality monitoring programs.
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Affiliation(s)
- T Polard
- Université de Toulouse, INPT, UPS, ECOLAB (Laboratoire Ecologie Fonctionnelle), Ecole Nationale Supérieure Agronomique de Toulouse (ENSAT), Castanet Tolosan, France
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Polard T, Jean S, Merlina G, Laplanche C, Pinelli E, Gauthier L. Giemsa versus acridine orange staining in the fish micronucleus assay and validation for use in water quality monitoring. Ecotoxicol Environ Saf 2011; 74:144-149. [PMID: 20828819 DOI: 10.1016/j.ecoenv.2010.08.005] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 11/26/2009] [Revised: 07/29/2010] [Accepted: 08/01/2010] [Indexed: 05/29/2023]
Abstract
This study concerns a comparative analysis of the acridine orange and Giemsa staining procedures for the fish erythrocyte micronucleus assay. The goal was to optimize the assay in the context of field water monitoring. Fish (Carassius carassius) were exposed to a reference genotoxic agent, cyclophosphamide monohydrate 5 mg l(-1) for 2, 4, and 6 days before testing. Slides from each individual were scored using the two procedures. The results show that the assay was more sensitive when acridine orange was used. When slides were Giemsa stained, the presence of ambiguous artefacts, leading to false positives and increasing random variance, reduced the contrast between exposed and control samples. Acridine Orange staining was then applied in the context of water quality monitoring. Fish were exposed for 4 days to water sampled in two hydrological contexts: basal flow and spring flood. The results show that exposure to spring flood water in an agricultural stream can induce mutagenicity.
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Affiliation(s)
- T Polard
- Université de Toulouse; INP-ENSAT, Avenue de l'Agrobiopôle, 31326 Castanet-Tolosan, France
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Gagnon C, Chouinard M, Laberge L, Veillette S, Bégin P, Breton R, Jean S, Brisson D, Gaudet D, Mathieu J. Health supervision and anticipatory guidance in adult myotonic dystrophy type 1. Neuromuscul Disord 2010; 20:847-51. [DOI: 10.1016/j.nmd.2010.08.006] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 08/25/2010] [Accepted: 08/26/2010] [Indexed: 11/30/2022]
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Laberge L, Prévost C, Perron M, Mathieu J, Auclair J, Gaudreault M, Richer L, Jean S, Veillette S. Clinical and genetic knowledge and attitudes of patients with myotonic dystrophy type 1. Public Health Genomics 2010; 13:424-30. [PMID: 20689257 DOI: 10.1159/000316238] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Accepted: 06/03/2010] [Indexed: 11/19/2022] Open
Abstract
AIMS The goal was to assess clinical and genetic knowledge and attitudes in patients affected by myotonic dystrophy type 1 (DM1). METHODS Two hundred patients with molecular confirmation of the diagnosis of DM1 completed a multi-choice questionnaire. DM1 patients' knowledge and views were compared to clinically normal DM1 noncarriers (n = 264) and controls (n = 1,474). RESULTS Knowledge of the DM1 mode of inheritance was better in noncarriers than in patients (p < 0.001). Noncarriers were more aware than DM1 patients of the common clinical characteristics of DM1 such as limitations in physical activities and problems related to employment, schooling, activities of daily living, parenthood, peer relationships, and personality (p < 0.001). Compared to controls, DM1 patients felt less informed about the availability of clinical genetic services (p < 0.05) and new genetic technologies (p < 0.001). Among patients, logistic regression revealed that each additional year of education (p < 0.05) and each additional 100 CTG repeats (p < 0.01), respectively, increased and decreased the odds of knowing the DM1 mode of inheritance by about 23% and 18% respectively, independently of age, age at onset of symptoms, gender, severity of muscular impairment, and intellectual quotient. CONCLUSIONS DM1 patients' genetic knowledge is significantly dependent of the level of education and the number of CTG repeats. Healthcare providers should be aware of this situation in order to adjust counselling and education accordingly.
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Affiliation(s)
- L Laberge
- ÉCOBES Recherche et Transfert, Cégep de Jonquière, Saguenay, Qué., Canada.
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Leslie WD, O'Donnell S, Lagacé C, Walsh P, Bancej C, Jean S, Siminoski K, Kaiser S, Kendler DL, Jaglal S. Population-based Canadian hip fracture rates with international comparisons. Osteoporos Int 2010; 21:1317-22. [PMID: 19802507 PMCID: PMC5101056 DOI: 10.1007/s00198-009-1080-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Accepted: 09/09/2009] [Indexed: 10/20/2022]
Abstract
SUMMARY We identified hospitalizations throughout Canada during 2000-2005 in which the most responsible diagnosis was a proximal femoral fracture. Use of the US fracture risk assessment tool (FRAX) would be inappropriate for Canada as it would overestimate fracture risk in Canadian women and older men. INTRODUCTION It is recommended that the WHO fracture risk assessment tool should be calibrated to the target population. METHODS We identified hospitalizations for women and men throughout Canada during the study period 2000-2005 in which the most responsible diagnosis was a proximal femoral fracture (147,982 hip fractures). Age-standardized hip fracture rates were compared between Canadian provinces, and national rates were compared with those reported for the USA and Germany. RESULTS There were relatively small differences in hip fracture rates between provinces, and most did not differ appreciably from the Canadian average. Hip fracture rates for women in Canada in 2001 were substantially lower than in the USA (population-weighted rate ratio 0.70) and were also lower than in Germany for 2004 (population-weighted rate ratio 0.74). CONCLUSIONS Overall hip fracture rates for Canadian women were found to be substantially lower than those for the USA and Germany. This study underscores the importance of assessing country-specific fracture patterns prior to adopting an existing FRAX tool.
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Affiliation(s)
- W D Leslie
- Faculty of Medicine, Department of Medicine (C5121), University of Manitoba, 409 Tache Avenue, Winnipeg, Manitoba, R2H 2A6, Canada.
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Jean S, Adams SF, Facciabene A, Peng X, Coukos G. Rapid, durable restoration of malignant ascites-derived antigen presenting cell immunogenicity by toll-like receptor agonists. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.5094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Bessette L, Jean S, Davison KS, Roy S, Ste-Marie LG, Brown JP. Factors influencing the treatment of osteoporosis following fragility fracture. Osteoporos Int 2009; 20:1911-9. [PMID: 19333675 DOI: 10.1007/s00198-009-0898-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [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] [Received: 11/17/2008] [Accepted: 02/03/2009] [Indexed: 01/06/2023]
Abstract
UNLABELLED Treatment rates of osteoporosis after fracture are very low. Women who suffer a fragility fracture have a greater chance of receiving anti-fracture treatment if they had low bone mineral density (BMD), a fracture at the hip, femur or pelvis, administration of calcium and vitamin D supplements and/or an age > or =60 years. INTRODUCTION This investigation identifies the predictors of osteoporosis treatment 6 to 8 months following fragility fracture in women >50 years of age. METHODS In this prospective cohort study, women were recruited 0 to 16 weeks following fracture and classified as having experienced fragility or traumatic fractures (phase 1). Six to 8 months following fracture, women completed a questionnaire on demographic features, clinical characteristics and risk factors for osteoporosis (phase 2). Osteoporosis treatment was defined as initiating anti-fracture therapy (bisphosphonate, raloxifene, nasal calcitonin and teriparatide) after fracture in those previously untreated. RESULTS Of the 1,273 women completing phase 1, 1,001 (79%) sustained a fragility fracture, and of these women, 738 were untreated for osteoporosis at phase 1 and completed the phase 2 questionnaire. Significant predictors of treatment included BMD result, fracture site, administration of calcium and vitamin D supplements at the time of fracture and age > or =60 years. All other risk factors for osteoporosis, such as fracture history after the age of 40 years, family history of osteoporosis and comorbidities did not significantly influence the treatment rate. CONCLUSIONS Physicians largely based their decision to treat on BMD results and not on the clinical event-fragility fracture.
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Affiliation(s)
- L Bessette
- Department of Medicine, CHUL Research Centre, Laval University, Quebec City, PQ, Canada, GIV 4G2.
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Sankaranarayanan R, James MA, Burtchaell S, Holloway R, Hoyt RH, Mchenry B, Fedewa MM, Penot JP, Jacquot C, Bonet JF, Pochet H, Jean S, Fressonnet R, Penot MP, Weiss A, Abecasis JA, Leal S, Monge J, Fartouce S, Santos JM, Silva A, Costa R, Leao MIP, Mori RF, Giannini G, Costa SPL, Silva KR, Penteado IM, Palka P, Lange A, Donnelly JE, Adsett M, Hayes JR, Stafford WJ, Hirayama Y, Kawamura Y, Sato N, Saito T, Hotta D, Kikuchi K, Ohori K, Hasebe N, Cabrera Bueno F, Alzueta J, Fernandez-Pastor J, Pena-Hernandez JL, Molina-Mora MJ, Barrera A, De Teresa E, Ayala Paredes F, Roux JF, Scazzuso F, Lavallee L, Poirier M, Chaumont J, Iorgulescu C, Vasile A, Dorobantu M, Vatasescu RG, Lefflerova K, Lupinek P, Bytesnik J, Cihak R, Krausova R, Vancura V, Kautzner J, Blich M, Suleiman M, Zeidan Shwiri T, Marai I, Boulos M, Amikam S, Lilli A, Magnacca M, Svetlich C, D'addario S, Baratto MT, Ghidini Ottonelli A, Savino K, Casolo G, Wolber T, On C, Binggeli C, Holzmeister J, Brunckhorst C, Duru F. Poster Session 2: Results (pacing), indications (pacing). Europace 2009. [DOI: 10.1093/europace/euq204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Laberge L, Bégin P, Dauvilliers Y, Beaudry M, Laforte M, Jean S, Mathieu J. A polysomnographic study of daytime sleepiness in myotonic dystrophy type 1. J Neurol Neurosurg Psychiatry 2009; 80:642-6. [PMID: 19211594 DOI: 10.1136/jnnp.2008.165035] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To assess contributors to excessive daytime sleepiness (EDS) in myotonic dystrophy type 1 (DM1), to characterise subjects with sleep-onset REM periods (SOREMPs), and to verify whether self-reported instruments and respiratory function tests can predict multiple sleep latency test (MSLT) and sleep-disordered breathing. METHODS A sample of 43 DM1 patients without selection bias underwent polysomnography (PSG) for two consecutive nights and MSLT, completed a sleep diary and Epworth Sleepiness Scale (ESS), and were assessed for respiratory function and narcolepsy symptoms. RESULTS ESS scores (ES) > or =11 and MSLT mean sleep latency (MSL) < or =8 min were found in 21 (50.0%) and 19 (44.2%) subjects, and either in 30 (69.8%) subjects. ES did not relate to MSL. Subjects with subjective sleepiness (ES> or =11) reported more cataplexy-like and sleep paralysis symptoms, longer habitual sleep times, and higher sleep efficiency and REM sleep per cent than those without. Subjects with objective sleepiness (MSL< or =8 min) had a higher stage 4 sleep per cent. Subjects with > or =2 SOREMPs (25.6%) showed higher muscular impairment, lower MSL, higher ES, and more cataplexy-like symptoms than those with < or =1 SOREMP. Apnoea-hypopnoea index (AHI) > or =5, predominantly obstructive, was found in 37 (86.0%) subjects, and AHI >30 in 12 (27.9%). Neither subjective nor objective sleepiness could be explained by AHI, nor satisfactorily predicted by daytime respiratory abnormalities. CONCLUSIONS DM1 entails frequent EDS but with different phenotypes and distinct mechanisms involved. The high prevalence of daytime sleepiness and severe sleep apnoeas found in this study supports the routine use of clinical sleep interviews, PSG and MSLT in DM1, and emphasises the need for more randomised trials of psychostimulants.
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Affiliation(s)
- L Laberge
- Département des sciences de l'éducation et de psychologie, Université du Québec à Chicoutimi, 555, boul. de l'Université, Chicoutimi, Québec, Canada, G7H 2B1.
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Bouquinet E, Balestra J, Bismuth E, Bruna AL, Gallet S, Harvet G, Jean S, Jousselme C. Maladie chronique et enfance : image du corps, enjeux psychiques et alliance thérapeutique. Arch Pediatr 2008; 15:462-8. [DOI: 10.1016/j.arcped.2008.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Revised: 01/14/2008] [Accepted: 01/15/2008] [Indexed: 10/22/2022]
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Jean S, Cinel I, Dellinger R. Effect of the inspiratory flow pattern on inspiration/expiration transition of lung vibrations in mechanically ventilated patients. Crit Care 2008. [PMCID: PMC4088675 DOI: 10.1186/cc6525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Bessette L, Ste-Marie LG, Jean S, Davison KS, Beaulieu M, Baranci M, Bessant J, Brown JP. The care gap in diagnosis and treatment of women with a fragility fracture. Osteoporos Int 2008; 19:79-86. [PMID: 17641811 DOI: 10.1007/s00198-007-0426-9] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.3] [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] [Received: 03/12/2007] [Accepted: 05/22/2007] [Indexed: 10/23/2022]
Abstract
UNLABELLED In women aged 50 years or more who experienced a fracture, 81% suffered a fragility fracture. Six to eight months after fragility fracture, 79% had either not been investigated for osteoporosis or prescribed anti-fracture therapy. Despite fragility fractures being common in this population osteoporosis is under-diagnosed and under-treated. INTRODUCTION The objective of this study was to evaluate the diagnostic and treatment rates for osteoporosis six months following fragility fracture. METHODS This prospective cohort study was set in the general community from the Province of Quebec, Canada. Women at least 50 years of age who suffered a fracture were recruited during their initial visit to the hospital and had their fracture type classified as either fragility or traumatic. Six-to-eight months after fragility fracture, women were again contacted to evaluate the diagnostic and treatment rates of osteoporosis. RESULTS Of the 2,075 women recruited over a 25 month period 1,688 (81%) sustained a fragility fracture and 387 (19%) sustained a traumatic fracture. Nine hundred and three participants with a fragility fracture were again contacted six-to-eight months after fracture. For the 739 women not on treatment on the recruitment day, only 15.4% initiated pharmacological therapy in the six-to-eight-month period following fracture and 79.0% had either not been investigated for osteoporosis or prescribed anti-fracture treatment. CONCLUSIONS The proportion of fragility fractures to total fractures is higher than previously reported. Despite the availability of diagnostic modalities, effective treatments, and adequate health care assessments, there is a substantial care gap in the management of osteoporosis.
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Affiliation(s)
- L Bessette
- Laval University, Rheumatology and Immunology Research Centre, CHUL Research Centre, Québec, QC, Canada.
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Said W, Jean S, Guenard C, Benseghir T, Duvauferrier R, Marin F. [What is your diagnosis? Giant intraspongiform discal hernia of the L5 vertebral body]. ACTA ACUST UNITED AC 2007; 88:1203-4. [PMID: 17878886 DOI: 10.1016/s0221-0363(07)89936-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Jean S, Cinel I, Tay C, Wang Z, McGinly D. Correlation of lung vibration and airflow. Crit Care 2007. [PMCID: PMC4095257 DOI: 10.1186/cc5363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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