Journal articles on the topic 'Économie de la santé – Cancer – France'
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Bacon, Marie-Hélène, Louise Vandelac, and Sébastien Petrie. "Pesticides: Le Talon d’Achille des politiques alimentaires canadiennes et québécoises." Canadian Food Studies / La Revue canadienne des études sur l'alimentation 5, no. 3 (September 30, 2018): 153–81. http://dx.doi.org/10.15353/cfs-rcea.v5i3.274.
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Comment expliquer que le projet de politique alimentaire du Canada ignore le dossier des pesticides alors que la récente politique bioalimentaire du Québec évoque vaguement la question, mais sans engagements significatifs? Pourquoi évacuer ainsi l’analyse des enjeux et des effets sanitaires et environnementaux préoccupants des pesticides et notamment du glyphosate, premier pesticide au monde, en croissance exponentielle, qui, déclaré cancérogène probable par le Centre international de recherche sur le cancer (CIRC) de l’Organisation mondiale de la santé (OMS) (IARC, 2015), constitue au Canada 56 pour cent des pesticides agricoles et 44 pour cent de ceux du Québec (Santé Canada, 2017a; MDDELCC, 2017)? Presqu’omniprésent dans les champs, les cours d’eau agricoles et dans 30 pour cent des aliments au Canada, le glyphosate est l’objet de vives controverses scientifiques et citoyennes dans le monde entier (Robin, 2008, 2018). En Europe, sa ré-autorisation, suite à deux ans de vives controverses a été limitée à 5 ans. Aux États-Unis, 3,500 victimes d’un lymphome non-hodgkinien attribué au Roundup, premier herbicide à base de glyphosate (HBG) en importance au monde, poursuivent en justice son principal fabricant Monsanto (Gonzague & Michel, 2017) alors qu’en France et en Argentine, des poursuites pour malformations congénitales s’amorcent également contre Monsanto (Foucart, 2018). Cet article examine, dans une approche interdisciplinaire et intersectorielle, les facteurs de la montée en puissance des HBG, leurs principaux effets sur l’environnement et la santé, et les lacunes d’évaluation et d’encadrement des pesticides, contribuant à leur diffusion massive et à leurs effets. Il met aussi en évidence que les projets et politiques alimentaires canadiennes et québécoises, centrés sur le développement de modèles agro-industriels intensifs et technicisés d’exportation soumis à une conception de croissance économique, sont peu compatibles avec les exigences de protection de la biodiversité, de la santé et de la sécurité alimentaire. Or, dans un contexte de globalisation des marchés et d’accords de libre-échange avec l’Europe, plus soucieuse du Principe de Précaution et de droits des consommateurs, la négligence de ces enjeux écologiques et sanitaires risque d’en constituer le talon d’Achille.
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Zimmer, Benjamin. "Enjeux et opportunités de la filière Silver économie : exemple de la France." Angewandte GERONTOLOGIE Appliquée 1, no. 1 (January 2016): 41–42. http://dx.doi.org/10.1024/2297-5160/a000030.
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Récapitulation. La Silver économie rassemble l’ensemble des acteurs producteurs de biens et/ou de services qui répondent aux besoins et aux usages des seniors et de leur entourage. C’est une filière transversale qui regroupe de nombreux secteurs d’activité allant de la santé en passant par la construction, les services, le cosmétique, la communication jusqu’au transport ou les loisirs, etc. et qui vise à créer de la valeur économique, sociale et sociétale. Cette approche économique du vieillissement présente de fortes opportunités de croissance, de production et d’emploi et est affichée comme une filière industrielle prioritaire par les pouvoirs publics.
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Geeraert, Jérémy. "La prise en charge par l’hôpital des populations à la marge du système de santé en France : l’exemple des Permanences d’accès aux soins de santé." Saúde e Sociedade 27, no. 3 (September 2018): 654–69. http://dx.doi.org/10.1590/s0104-12902018180550.
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Résumé Cet article analyse la prise en charge de la pauvreté à l’hôpital public. Il prend l’exemple des Permanences d’accès aux soins de santé (PASS), structure hospitalière qui prend en charge des personnes connaissant des difficultés d’accès aux soins dans le système de santé français. Il s’appuie sur une enquête empirique issue d’un travail de thèse en sociologie. L’enquête mêle observations participantes et entretiens semi-directifs (n=49) et a été réalisée dans 16 PASS différentes. Sur un plan théorique, l’article met en miroir les travaux sur les métamorphoses de la question sociale et une perspective biopolitique d’inspiration foucaldienne. La prise en charge des populations en marge du système de santé par une institution publique (l’hôpital) est considérée comme agissant dans des domaines qui dépassent le strict traitement de la maladie pour entrer dans ceux de la régulation sociale, la protection de la santé publique ou la réalisation de droits humains. Dans le cas des PASS, l’article montre la construction d’une biopolitique de la migration autour d’un bricolage compliqué qui mêle citoyenneté, politiques économiques, politiques de santé publique et accès aux soins. Le mode d’exercice du pouvoir se caractérise par un gouvernement par le bas qui est réalisé par les professionnels de terrain lors des interactions avec les patients et met en scène une économie morale basée sur des représentations de ce qui est bon et mauvais pour la société.
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Charif, A. Ben, A. D. Bouhnik, D. Rey, and J. Mancini. "Santé sexuelle des survivants de cancer en France en 2012." Revue d'Épidémiologie et de Santé Publique 62 (September 2014): S213. http://dx.doi.org/10.1016/j.respe.2014.06.135.
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Demeulemeester, R., N. Savy, P. Grosclaude, M. Mounié, N. Costa, and P. Saint-Pierre. "P072 - Modélisation à base d'agent en économie de la santé: exemple dans le champ du cancer thyroïdien." Revue d'Épidémiologie et de Santé Publique 71 (May 2023): 101715. http://dx.doi.org/10.1016/j.respe.2023.101715.
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Dib, Fadia, Gwenn Menvielle, and Pierre Chauvin. "Tous égaux face aux papillomavirus ? L’infection et la vaccination HPV au prisme des inégalités sociales de santé." Questions de santé publique, no. 38 (November 2019): 1–8. http://dx.doi.org/10.1051/qsp/2019038.
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En France, chez les femmes, les inégalités sociales sont particulièrement marquées pour le cancer du col de l’utérus. La vaccination contre le papillomavirus humain (HPV) est un moyen de prévention efficace, toutefois les taux de couverture demeurent très faibles (autour de 30 %). Ce faible taux est probablement en partie causé par le phénomène d’«hésitation vaccinale» dont les déterminants en France restent mal connus. Les interventions pour lutter contre l’hésitation vaccinale en matière de vaccination HPV et améliorer la couverture vaccinale en France sont nécessairement des interventions complexes. S’il s’agit de réduire les inégalités sociales en matière de vaccination HPV, ces interventions nécessitent de mieux connaître les différents déterminants de cette hésitation vaccinale dans les différents groupes sociaux si on fait l’hypothèse (en l’absence de données empiriques en France), qu’ils sont différents: résistance croissante à la vaccination dans les catégories supérieures, moindre proposition des professionnels dans les catégories défavorisées, difficulté à parler de santé sexuelle dans certaines familles, par exemple. Ces interventions complexes doivent être imaginées en co-construction avec les bénéficiaires (jeunes filles, parents et professionnels de santé). Leur évaluation doit être envisagée dès leur mise en œuvre, être perçue par les acteurs comme un mode d’apprentissage et faire appel à des méthodes mixtes.
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Rosenbaum, Jean, Nicolas Bourdel, Saadi Khochbin, Marina Kvaskoff, Sachiko Matsuzaki, Fatima Mechta-Grigoriou, Nicola Pluchino, Olivier Sandra, and Daniel Vaiman. "Des pistes de réflexion pour la recherche sur l’endométriose en France." médecine/sciences 38, no. 3 (March 2022): 274–79. http://dx.doi.org/10.1051/medsci/2022027.
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L’endométriose est une maladie chronique dans laquelle des lésions ressemblant à du tissu endométrial se retrouvent hors de l’utérus, principalement dans la cavité abdomino-pelvienne. Cette maladie pourrait toucher 10 % des femmes en âge de procréer. Elle est à l’origine d’une importante altération de la qualité de vie et d’un coût majeur pour le système de santé. Peu d’équipes de recherche sont mobilisées sur ce sujet, et la physiopathologie de la maladie reste mal comprise. Nous proposons dans cet article des pistes de réflexion pour la recherche sur l’endométriose en France, fondées notamment sur la mobilisation de communautés scientifiques connexes (notamment celles impliquées dans la recherche sur le cancer, la biologie du développement, l’épigénétique, les neurosciences).
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PIERONNE, P., I. RAGUÉNÈS, S. HERCULE-BOBROFF, B. HERSANT, O. LE GOALLEC, and J. F. LORET. "Recyclage des effluents de lavage de filtration au sein d’une filière de production d’eau potable : un guide professionnel pour faciliter les projets." Techniques Sciences Méthodes 1-2 (February 20, 2023): 51–63. http://dx.doi.org/10.36904/202301051.
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Les usines de production d’eau potable disposent d’un levier d’amélioration de leur empreinte environnementale, via le recyclage interne des effluents de lavage de leurs filtres. Cette pratique, déjà existante en France, diminue les prélèvements dans les ressources en eau, limite les rejets et peut conduire à une économie énergétique. Toutefois, en raison d’éventuels risques sanitaires liés à la qualité de la ressource et au type de traitement, chaque projet de recyclage est considéré comme un cas particulier, et soumis à autorisation spécifique. Le cadre réglementaire du recyclage étant assez général en France, il a fallu le compléter par un cadre sanitaire. Ainsi les acteurs locaux désireux de mettre en place de tels projets et les autorités sanitaires locales chargées d’instruire les dossiers disposent depuis 2017 de lignes directrices publiées par l’Agence nationale de sécurité sanitaire de l’alimentation, de l’environnement et du travail (Anses), qui s’appuient sur des études et retours d’expériences de la Fédération professionnelle des entreprises de l’eau (FP2E). Pour compléter ce document de référence, la FP2E a édité en 2021 un guide destiné à accompagner les maîtres d’ouvrage, les maîtres d’oeuvre, les concepteurs et les opérateurs, dans la conception et la gestion opérationnelle de leurs projets de recyclage. Ce guide, également diffusé aux agences régionales de santé (ARS), synthétise les principales recommandations de l’Anses et illustre de façon concrète leur application pour les grandes configurations de filières rencontrées sur le terrain. Après une brève présentation du guide FP2E, des retours d’expérience de trois services d’eau potable ayant adopté le recyclage d’effluents de lavage sont exposés, avec dans chaque cas une description des motivations et des modalités de mise en oeuvre et une synthèse des principales étapes du projet. Ces exemples montrent que cette pratique, vertueuse pour l’environnement, est suffisamment encadrée pour assurer la sécurité sanitaire. Elle est donc à promouvoir plus largement.
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Fassier, P., L. Zelek, P. Bachmann, M. Touillaud, N. Druesne-Pecollo, V. Partula, S. Hercberg, et al. "Déterminants de la prise de poids après diagnostic de cancer dans la cohorte prospective NutriNet-Santé (France)." Revue d'Épidémiologie et de Santé Publique 64 (September 2016): S182—S183. http://dx.doi.org/10.1016/j.respe.2016.06.030.
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Pouchieu, Camille, Philippine Fassier, Nathalie Druesne-Pecollo, Laurent Zelek, Patrick Bachmann, Marina Touillaud, Isabelle Bairati, et al. "Dietary supplement use among cancer survivors of the NutriNet-Santé cohort study." British Journal of Nutrition 113, no. 8 (March 31, 2015): 1319–29. http://dx.doi.org/10.1017/s0007114515000239.
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Dietary supplements (DS) may influence cancer prognosis. Their use in cancer patients has been described in the United States, but data are largely lacking in Europe and notably in France. The present study's objectives were (1) to assess DS use and its sociodemographic, lifestyle, and dietary correlates in a large sample of French cancer survivors; (2) to evaluate the involvement of physicians in such DS use; and (3) to assess the extent of potentially harmful practices. Data were collected by self-administered web-based questionnaires among participants of the NutriNet-Santé cohort. Data on DS use was available for 1081 cancer survivors. DS users were compared to non-users with unconditional logistic regressions. DS use was reported by 62 % of women and 29 % of men. Vitamins D, B6, C and Mg were the most frequently consumed nutrients. 14 % of cancer survivors initiated DS use after diagnosis. For 35 % of the DS consumed, subjects did not inform their attending physician. DS use was associated with a healthier lifestyle (normal weight, never smoking and better diet) and substantially contributed to nutrient intake. 18 % of DS users had potentially harmful DS use practices, such as the simultaneous use of vitamin E and anticoagulant/antiplatelet agents, the use of β-carotene and smoking or the use of phyto-oestrogens in hormone-dependent cancer patients. The present study suggests that DS use is widespread among cancer survivors, a large amount of that use is performed without any medical supervision and a substantial proportion of that use involves potentially harmful practices. Physicians should be encouraged to more routinely discuss DS use with their cancer patients.
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Thébaud-Mony, Annie. "Science asservie et invisibilité des cancers professionnels : études de cas dans le secteur minier en France." Articles 72, no. 1 (April 19, 2017): 149–72. http://dx.doi.org/10.7202/1039594ar.
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Depuis plus d’un siècle, l’évolution de la recherche concernant la santé publique, en général, et les risques du travail, en particulier, est largement dominée par les besoins et stratégies des industriels. Ceux-ci interviennent, non seulement dans le financement des études menées, mais aussi dans leur conception, parvenant à faire subsister le doute là où la mise en danger est manifeste. L’un des principaux points d’appui de cette incertitude indéfiniment reconduite réside dans l’invisibilité des pathologies liées au travail, en particulier les cancers professionnels.S’appuyant sur des enquêtes pluridisciplinaires en sciences sociales et sciences de la vie — qui mettent en question le modèle dominant monocausal de compréhension des liens entre cancer et facteurs de risque — la première partie de cet article démontre comment une interprétation réductrice de la causalité du cancer permet cette incertitude indéfiniment reconduite, inscrite dans le « paradigme du doute », tout en faisant obstacle à la connaissance et à la reconnaissance des cancers professionnels. Deux études de cas dans le secteur minier français illustrent ensuite la remise en cause, toujours possible, de la dangerosité de cancérogènes parfaitement identifiés, et le déni de droits à la reconnaissance en maladie professionnelle des travailleurs atteints, les maintenant dans l’invisibilité.Ainsi, le paradigme du doute, qui domine la santé publique, permet-il aux industriels, mais aussi aux acteurs étatiques — aujourd’hui comme hier —, de s’appuyer sur l’incertitude pour envisager favorablement la réouverture de sites miniers dans des régions habitées, sans prise en compte des enjeux sanitaires. L’épidémie de cancer ne cesse de progresser atteignant, en France, une incidence estimée de 385 000 nouveaux cas par an en 2015 (contre 150 000 en 1984). Mais le doute entretenu sur les effets sanitaires de risques industriels, dont les dangers sont pourtant avérés, favorise encore actuellement la poursuite des conditions de production de cancers futurs, en particulier chez les premiers concernés par l’exposition aux cancérogènes, à savoir les travailleurs.
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Boinon, D., C. Charles, L. Fasse, J. Journiac, G. Pallubicki, E. Guerdoux-Ninot, G. Ninot, et al. "Quelle est la place des professionnels de santé dans l’adhésion aux programmes thérapeutiques en ligne de l’insomnie ? Éléments de réflexion issus de l’étude Sleep-4-All-1 et protocole de l’étude Sleep-4-All-2.0." Psycho-Oncologie 16, no. 1 (March 2022): 173–81. http://dx.doi.org/10.3166/pson-2022-0179.
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La thérapie cognitivocomportementale de l’insomnie (TCC-I) demeure difficile d’accès pour les patients atteints de cancer. Sa digitalisation semble une solution prometteuse pour bénéficier au plus grand nombre. La faisabilité d’un programme TCC-I québécois a été démontrée en France, tout en révélant les limites d’un dispositif suivi en autonomie et à distance. L’enjeu reste de mieux comprendre le rôle des professionnels de santé dans l’accompagnement des patients dans ce type de programme. C’est l’objectif de l’étude Sleep-4-All-2.0 dont nous présenterons ici le protocole.
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Schaefer, Ramon, Diego Hernandez, Lorenz Selberg, and Michael Schlander. "Health technology assessment (HTA) in England, France and Germany: what do matched drug pairs tell us about recommendations by national HTA agencies?" Journal of Comparative Effectiveness Research 10, no. 16 (November 2021): 1187–95. http://dx.doi.org/10.2217/cer-2021-0047.
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Aims: To explore health technology assessment (HTA) outcomes of matched drug pairs by national agencies in Germany (Gemeinsamer Bundesausschuss, GBA), France (Haute Autorité de Santé, HAS) and England and Wales (NICE). Methods: We considered published GBA decisions, HAS reports and NICE guidance from January 2011 to June 2018. HTAs of matched pairs were compared overall, and for non-cancer and cancer drugs separately. We further analyzed the role of additional attributes related to cancer therapies. Results: Matched pairs show higher concordance for GBA/HAS than for GBA/NICE and HAS/NICE. Overall, NICE evaluated technologies more favorably than GBA and HAS. GBA appraisals of cancer drugs, however, tended to be more positive than cancer-related recommendations by NICE and HAS. Conclusion: The findings indicate substantial variations in HTAs, although cancer-related outcomes seem to diverge less than non-cancer results.
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Mino, J. C., M. Carton, A. Bredart, M. Milder, and E. Renault-Tessier. "Les deux faces du confinement. Préoccupations et satisfactions des personnes atteintes de cancer pendant le confinement." Psycho-Oncologie 14, no. 4 (December 2020): 164–68. http://dx.doi.org/10.3166/pson-2021-0142.
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Objectif et méthode : Quelle a été l’expérience du confinement (16 mars 2020–11 mai 2020) en France, chez les patients atteints de cancer ? Au travers de questions ouvertes envoyées par messagerie électronique pendant les deux dernières semaines du confinement (27 avril–11 mai 2020), l’enquête BaroCov a étudié, auprès de patients suivis à l’institut Curie, les motifs de préoccupation et de satisfaction. À partir des réponses libres, 12 thématiques de préoccupation et 8 thématiques de satisfaction ont été extraites de manière inductive, à partir desquelles les réponses ont été codées puis analysées statistiquement. Résultats : Deux mille quatre cent soixante-dix-huit patients ont répondu, dont 90 % ont plus de 40 ans et 58,9 % entre 40 et 65 ans. Quatre-vingt-trois pour cent sont des femmes. Cinquante et un pour cent vivent à Paris et en proche banlieue. 61,4 % déclarent être en cours de traitement. Préoccupations : Les préoccupations concernaient la santé chez deux tiers des répondants (63,6 %). Elles avaient rapport avec le cancer chez la moitié (45,5 %), dont 9,8 % sur la poursuite du traitement et 5,7%sur les effets secondaires. La Covid-19 préoccupait un cinquième (18,1 %) des personnes. Un quart des répondants citaient comme thématique soit la vie quotidienne (16,6 %) [ne pas vivre comme d’habitude, l’activité professionnelle, l’argent, le logement, le climat social], soit les proches (12,8 %) [la séparation, leur santé, leur avenir]. Appréciations : Un tiers des répondants (33,7 %) citaient les relations avec les proches et un autre tiers (32 %) les conditions de vie (avec la qualité de vie chez 14,6 %, prendre son temps chez 10 % et la nature chez 7,4 %). Plus de 10 % des personnes (13,5 %) citaient spontanément une thématique liée à la maladie (chez 7,3 %, l’état de santé et chez 6,2 % les soins). La thématique du travail n’apparaissait quasiment pas (2,8 %). Conclusion : Le thème principal cité pendant le confinement n’était pas la Covid-19, mais plutôt les polarités existentielles de la vie face au cancer avec d’un côté la peur et les préoccupations liées à la maladie et de l’autre l’importance de l’entourage et la réévaluation positive de la vie quotidienne.
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El Hasnaoui, A., B. Detournay, N. Demarteau, D. Granados, and B. Standaert. "Évaluation de l'impact en santé publique de la vaccination contre le HPV dans la prévention du cancer du col en France." Revue d'Épidémiologie et de Santé Publique 55, no. 1 (October 2007): S4—S5. http://dx.doi.org/10.1016/j.respe.2007.07.014.
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Martin-Fernandez, Judith, Olivier Aromatario, Ollivier Prigent, Marion Porcherie, Valéry Ridde, and Linda Cambon. "Evaluation of a knowledge translation strategy to improve policymaking and practices in health promotion and disease prevention setting in French regions: TC-REG, a realist study." BMJ Open 11, no. 9 (September 2021): e045936. http://dx.doi.org/10.1136/bmjopen-2020-045936.
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ObjectiveThis paper presents the results of a realist evaluation of a knowledge translation (KT) intervention implemented in the field of health promotion and disease prevention at the local level in France.DesignRealist evaluation study.SettingThe target population comprised decision-makers and field professionals working in prevention and public health services operating in regions of France (ie, ARS (Agence Régionale de Santé: regional health agency), IREPS (Instance Régionale d'Education et de Promotion de la Santé pour tous: regional organisation for health promotion and education) and their partners).ParticipantsThis evaluation was based on data collected from 2 seminars, 82 interviews, 18 observations and 4 focus groups over 18 months.InterventionThe TC-REG intervention aimed to increase the use of evidence in cancer prevention, health promotion and disease prevention across four geographical regions in France. The intervention combined various activities: Supporting access to and adaptation of usable evidence, strengthening professionals’ skills in analysing, adopting and using policy briefs, and facilitating the use of evidence in organisations and processes.ResultsThe collected data was used to define favourable/unfavourable contexts for the use of scientific data and mechanisms to be activated to encourage the use of scientific knowledge. From these raw results eight final refined middle-range theories were defined. Organised around the mechanisms to be activated, these middle-range theories illustrate how to activate knowledge and under what conditions. These analyses provided a basis for the production of seven operational and contextualised recommendations to develop KT to inform regional policymaking regarding health promotion and disease prevention.ConclusionThe results obtained from the analyses led us to formulate two perspectives of an operational nature for the benefit of those involved in prevention and health promotion.
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Samson, E., K. Leuraud, E. Rage, S. Caër-Lorho, S. Ancelet, E. Cléro, S. Bouet, et al. "Bilan de la surveillance épidémiologique des travailleurs du cycle électronucléaire en France." Radioprotection 53, no. 3 (July 2018): 175–84. http://dx.doi.org/10.1051/radiopro/2018026.
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À ce jour, les normes internationales de radioprotection sont essentiellement basées sur les connaissances des effets sanitaires des rayonnements ionisants issues des études de cohortes de survivants des bombardements atomiques d’Hiroshima et de Nagasaki, qui ont subi des irradiations par voie externe à forts débits de doses. Or, les expositions aux rayonnements ionisants survenant en population générale et chez certains travailleurs correspondent généralement à de faibles doses, cumulées de manière prolongée dans le temps. Ces expositions peuvent avoir lieu par irradiation externe mais aussi par contamination interne. Les études épidémiologiques chez les travailleurs du nucléaire permettent notamment de mieux caractériser les effets de ces conditions d’expositions. Elles permettent ainsi d’évaluer l’adéquation des normes de radioprotection pour protéger les travailleurs, mais également la population générale adulte, contre les risques de cancer. Par ailleurs, elles permettent d’aborder de nouveaux questionnements de recherche en radioprotection, comme les potentiels effets non cancéreux. Enfin, ces études fournissent un bilan de santé général des populations de travailleurs du nucléaire. Cet article propose une vue d’ensemble des recherches épidémiologiques menées par l’Institut de Radioprotection et de Sûreté Nucléaire (IRSN) chez les travailleurs du cycle électronucléaire en France. Il dresse également quelques perspectives de développements possibles de ces recherches.
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Simonin, Catherine. "Regulatory developments in the medical devices sector: A long and difficult journey." Regulatory Affairs Watch 5, no. 8 (June 2023): 1. http://dx.doi.org/10.54920/scto.2023.rawatch.8.1.
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Because the development of medical devices, device users, and the devices themselves often cross borders, medical device regulations in Switzerland are closely aligned with those of the European Union. Therefore, the Regulatory Affairs Watch editorial team wanted to hear first-hand from a European stakeholder who has been involved in this matter since the events that triggered the changes to European medical device regulation. In this first Deep Dive article, Catherine Simonin, MD, who is actively engaged in France’s Ligue contre le cancer (LCC, league against cancer) and the overarching national patient organisation France Assos Santé, discusses some of the drivers of regulatory changes for medical devices. The LCC has long been advocating for medical device legislation to focus more on patient safety, and the effects of its advocacy efforts can be seen in the EU’s changing legislative landscape. Using a Q&A format, Catherine Simonin also presents the perspective of patients and patient organisations on the EU’s recent Medical Device Regulation.
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Paix, Adrien, Hosni Popotte, Christine Lévy, Adrianna Perez, Thierry Bouillet, Laurent Zelek, and Boris Duchemann. "Nomadisme des patients traités par radiothérapie en Île-de-France : notre système de santé a-t-il autant d’argent à gaspiller ?" Bulletin du Cancer 107, no. 11 (November 2020): 1129–37. http://dx.doi.org/10.1016/j.bulcan.2020.09.003.
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Veziant, Julie, Karine Poirot, Caroline Chevarin, Lucie Cassagnes, Pierre Sauvanet, Benoit Chassaing, Frederic Robin, et al. "Prognostic value of a combination of innovative factors (gut microbiota, sarcopenia, obesity, metabolic syndrome) to predict surgical/oncologic outcomes following surgery for sporadic colorectal cancer: a prospective cohort study protocol (METABIOTE)." BMJ Open 10, no. 1 (January 2020): e031472. http://dx.doi.org/10.1136/bmjopen-2019-031472.
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IntroductionColorectal cancer (CRC) is still associated with poor prognosis, especially in patients with advanced disease. Development of new prognostic tools replacing or supplementing those routinely used is definitely needed, with the aim to optimise and personalise treatment strategies. Gut microbiota composition and body composition profile (obesity, sarcopenia and metabolic syndrome) have recently been reported separately as new relevant prognostic factors for postoperative surgical and oncologic outcomes following CRC surgery. However interactions that exist between these factors have been poorly studied. The purpose of this translational prospective cohort study (METABIOTE) is to investigate potential interactions between gut microbiota, body composition profile and postoperative outcomes and recurrence in patients undergoing surgery for non-metastatic sporadic CRC.Methods and analysisThis single-centre project aims to prospectively enrol 300 consecutive patients undergoing surgery for non-metastatic sporadic CRC at the University Hospital of Clermont-Ferrand, France for the identification of specific microbial signatures (from tumour, colonic mucosa and stools samples) associated with particular metabolic profiles that could impact postoperative morbidity and oncologic outcomes, using microbiological, molecular and imaging approaches. The primary outcome is the 5-year overall survival (OS). Other outcomes are 5-year CRC-related OS, 5-year disease-free survival, 30-day postoperative morbidity, 90-day postoperative mortality and length of hospital stay.Ethics and disseminationThis study protocol was reviewed and approved by an independent French regional review board (n°2018-A00352-53, ‘Comité de Protection des Personnes Ile de France VII’ on 4 July 2018, declared to the competent French authority (‘Agence Nationale de Sécurité du Médicament et des produits de santé’, France), and registered on the Clinical Trials web-based platform (NCT 03843905). Oral and written informed consent will be obtained from each included patient. Study results will be reported to the scientific community at conferences and in peer-reviewed scientific journals.Trial registration numberNCT03843905..
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Lafarge, Jean-Charles, Denis-Jean David, and Cédric Carbonneil. "OP270 Why The Haute Autorité de Santé Rejects the Widespread Use Of “Mini-Bypass”/One Anastomosis Gastric Bypass For Obesity In France." International Journal of Technology Assessment in Health Care 36, S1 (December 2020): 4. http://dx.doi.org/10.1017/s0266462320000975.
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IntroductionOne anastomosis gastric bypass (OAGB) has become a widespread technique over the last few years in France, without any prior assessment and despite existing controversies among bariatric surgeons. An older bypass technique for treating obesity, the Roux-en-Y gastric bypass (RYGB), is available and reimbursed, having been assessed and approved for use in 2005. In 2019, the French Haute Autorité de Santé (HAS) assessed OAGB for the treatment of severe and massive obesity. This assessment, the first in the world, was undertaken for OAGBs carried out with a 200- or 150-centimeter biliopancreatic-limb (BP-limb) length.MethodsA systematic review (SR) of the literature and consultation of a working group consisting of both healthcare professionals (clinician and surgeons) and patients were carried out. The primary aim of our assessment was to determine whether the OAGB technique can replace RYGB. The efficacy and safety profile of OAGB was compared with RYGB in adult patients with massive, severe obesity. Complications and postoperative follow up specific to OAGB were identified.ResultsThe three selected randomized controlled trials (RCTs) could not confirm the superiority or the non-inferiority of OAGB, compared with RYGB, on the selected efficacy endpoints of weight loss, resolution of comorbidities, and quality of life. Adverse events reported for OAGB included severe nutritional complications and bile reflux that could potentially lead to lower esophageal cancer. In one RCT, the frequency of serious adverse events in the OAGB group was almost two times higher than in the RYGB group.ConclusionsHAS considered that OAGB carried out with a longer (200 centimeter) BP-limb is not a validated technique for the surgical treatment of massive, severe obesity. Thus, it cannot be considered an alternative to RYGB. There were insufficient data available on OAGB performed with a 150-centimeter BP-limb. Thus, HAS recommended undertaking a multicenter RCT to assess the efficacy and safety of OAGB. Patients who have already undergone OAGB should receive the same follow up as patients who have received RYGB, including close monitoring for nutritional complications and lower esophageal cancer and an endoscopic examination five years after surgery.
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Chouaid, C., H. Berard, V. Westeel, M. Rotarski, M. Grivaux, H. Finnern, J. Eriksson, and K. Le Lay. "Qualité de vie et utilités de santé dans la prise en charge du cancer du poumon non à petites cellules en France (Étude LUCEOR 2)." Revue des Maladies Respiratoires 30 (January 2013): A23. http://dx.doi.org/10.1016/j.rmr.2012.10.076.
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Dieng, MM, NF Kane Ba, N. Ben Amor, EHA Baldé, A. Dem, PM Gaye, and L. Kochbati. "C116: Toxicité cutanée tardive après radiothérapie hypo-fractionnée des cancers du sein post-mastectomie : A propos de 40 cas." African Journal of Oncology 2, no. 1 Supplement (March 1, 2022): S48. http://dx.doi.org/10.54266/ajo.2.1s.c116.veof2707.
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INTRODUCTION : Le cancer du sein est le premier cancer chez la femme dans le monde et pose un véritable problème de santé publique. La radiothérapie externe qui est un traitement locorégional est indiqué dans la majorité des cas, diminue le taux de rechute locale et améliore la survie globale. On note un intérêt croissant pour les schémas hypo-fractionnés qui présentent un triple avantage : économie du système de santé et gain de temps pour les patientes et libération du temps de machine permettant de réduire le délai de prise en charge. Cependant, ils peuvent se compliquer d’effets secondaires à type de toxicité cutanée. MATERIELS ET METHODES : Il s’agit d’une étude rétrospective portant sur des patientes atteintes d’un cancer du sein traité par mastectomie et radiothérapie hypo-fractionnée au CHU Abderrahman Mami de l’Ariana (Tunisie), sélectionnées sur une période de deux ans entre Janvier 2018 et Décembre 2020. RESULTATS : Nous avons retenu 40 patientes. L'âge moyen était de 51,07 ans avec un minimum de 30 ans et un maximum de 76 ans. Le délai moyen l’apparition des premiers symptômes et la date de la première consultation était de 2,5 mois avec des extrêmes d’un à 12 mois. La circonstance de découverte était dominée par l’autopalpation (67,5%), le reste était le dépistage et la découverte fortuite. Histologiquement, il y avait une nette prédominance du CCI (85%), les grades SBRII et III ont concerné 93% des tumeurs. Le type Lum B était majoritaire (80%). Les emboles vasculaires étaient positifs chez 58% des patientes. L'envahissement ganglionnaire était chez 60% des cas. La mammographie était faite chez 100% des cas. L'IRM indiquée sauf contre-indication, était faite chez six patientes, soit 15%. La TDM TAP était faite chez 100% des patientes. La TDM cérébrale était faite chez 100% des patients. La scintigraphie osseuse était faite chez 100% des patientes. Le stade T2 était majoritaire, représente 77,5% suivis par les stades T1(12,5%) et T3(10%). La mastectomie type Patey associée au curage axillaire était réalisée chez toutes les patientes (100%). La chimiothérapie adjuvante était réalisée chez 85% des cas, trois patientes ne l’avaient pas reçu selon l’état général (7,5%). L’hormonothérapie était réalisée chez 90% des cas. La thérapie ciblée était indiquée chez 30% des cas. La radiothérapie hypo-fractionnée était réalisée chez toutes les patientes avec une dose de 40,05 Gy, pendant trois semaines. La tolérance de la radiothérapie était globalement bonne, aucune toxicité cutanée aigue >2 n’avait été notée. La toxicité cutanée tardive était bonne, aucune toxicité cutanée >2 n’avait été notée. Quatre localisations métastatiques du cancer du sein ont été détectées (10% des cas). La survie sans métastase était de 100% a deux ans. La survie sans récidive locale était de 93,3% à 24 mois et de 75,7 % à 36 mois et la survie sans récidive médiane était de 42,7%. CONCLUSION : La radiothérapie hypo-fractionnée n’augmente pas la toxicité cutanée tardive.
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Pandolfi, Fanny, Didier Guillemot, Laurence Watier, and Christian Brun-Buisson. "Trends in bacterial sepsis incidence and mortality in France between 2015 and 2019 based on National Health Data System (Système National des données de Santé (SNDS)): a retrospective observational study." BMJ Open 12, no. 5 (May 2022): e058205. http://dx.doi.org/10.1136/bmjopen-2021-058205.
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ObjectiveThis study aims to provide a case definition of sepsis of presumed bacterial aetiology based on 10th revision of the International Classification of Diseases (ICD-10) codes, to assess trends in sepsis incidence and mortality between 2015 and 2019 in France, and to describe the characteristics of affected patients and hospital stays.DesignNationwide, population-based, retrospective observational study.SettingMetropolitan France between 2015 and 2019.ParticipantsBetween 2015 and 2019, 1 224 433 patients with sepsis of presumed bacterial aetiology were selected from the French National Hospital Discharge Database (Programme de Médicalisation des Systèmes d’Information) and were identified from corresponding ICD-10 codes for explicit sepsis or implicit sepsis.Main outcomes measuresAnnual overall and age-specific and gender-specific incidence and 95% CI, as well as trends in sepsis incidence and mortality, were estimated. Comorbidities, length of hospital stay and outcomes were described.ResultsThe sex-standardised and age-standardised incidence per 100 000 (95% CI) increased from 357 (356.0 to 359.0) in 2015 to 403 (401.9 to 405.0) in 2019 and remained higher for males compared with females. Children under 1 year and patients over 75 years consistently had the highest incidence. The most common comorbidities were cancer and chronic heart failure. The median hospital length of stay was 12 days. Most patients came from home, but only half returned home after their hospital stay and approximately 15% were discharged to long-term care. In-hospital mortality was about 25% and declined along the study period.ConclusionsMedico-administrative databases can be used to provide nationwide estimates of the in-hospital burden of bacterial sepsis. The results confirm the high burden of sepsis in France. These data should be complemented by estimating the additional burden associated with fungal and viral infections during the COVID-19 pandemic.
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Kudjawu, Y., C. Le Bihan-Benjamin, C. Brouard, S. Leclerc, A. Cohen-Akenine, and H. Fontaine. "Fréquence des hépatites virales chroniques associées au cancer primitif du foie diagnostiqué en France en 2017 : étude à partir du Système national des données de santé." Revue d'Épidémiologie et de Santé Publique 68 (March 2020): S9—S10. http://dx.doi.org/10.1016/j.respe.2020.01.018.
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Blom Fily, Astrid, Laurent Mortier, Isabelle Kachaner, Nicolas Meyer, Mahtab Samimi, Laura Luciani, Capucine Cahuzac, et al. "Avelumab as second-line or later (2L+) treatment in patients (pts) with metastatic Merkel cell carcinoma (mMCC): Analysis of real-world outcomes in France using the CARADERM registry and the French national healthcare database." Journal of Clinical Oncology 41, no. 16_suppl (June 1, 2023): 9537. http://dx.doi.org/10.1200/jco.2023.41.16_suppl.9537.
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9537 Background: Avelumab, an anti–PD-L1 antibody, has been approved in multiple countries for the treatment of mMCC based on the results of the pivotal phase 2 JAVELIN Merkel 200 trial (NCT02155647). In pts who received avelumab as 2L+ treatment in the trial (part A), median overall survival (OS) was 12.6 months and median progression-free survival (PFS) was 2.7 months. The French health technology assessment agency requested the collection of real-world data from pts with mMCC from a comprehensive registry; data are reported here. Methods: This retrospective, noninterventional, real-world study evaluated all pts with mMCC in France using combined data from 2 databases: CARADERM (French national database of rare dermatological cancers) and Système National des Données de Santé (SNDS; national healthcare database). For this analysis, eligible pts were diagnosed with mMCC and initiated 2L+ avelumab outside of a clinical trial between August 2016 and December 2019. Pts were followed for 24 months after initiation of avelumab. Probabilistic linkage was performed to identify pts registered in both databases. OS and PFS were analyzed using Kaplan-Meier methodology. Safety data were not collected. Results: A total of 180 pts who received 2L+ avelumab were identified, data were obtained for 112 pts from the CARADERM database and for 68 additional pts after SNDS linkage. Median age at diagnosis was 74.0 years, 66.7% were male, and 98.3% received chemotherapy as first-line treatment. Median follow-up was 13.1 months. 79.5% of CARADERM database pts had discontinued avelumab; the most common reasons specified were progressive disease (36.4%), complete response (17.0%), and death (13.6%). Median OS was 14.6 months (95% CI, 9.9-21.3 months) overall; in CARADERM database pts, median OS was 15.9 months (95% CI, 8.6-28.3 months) vs 13.3 months (95% CI, 6.7-19.1 months) in non-CARADERM database pts. 12- and 24-month OS rates in the overall population were 53.8% (95% CI, 46.2%-60.8%) and 40.5% (95% CI, 33.2%-47.6%), respectively. In CARADERM database pts (data not available in non-CARADERM database pts), median PFS was 3.6 months (95% CI, 2.7-7.5 months), and the objective response rate was 55.3% (95% CI, 45.3%-65.4%), including complete response in 31.9%. Median duration of response was 39.3 months (95% CI, 24.3 months-not estimable). Conclusions: In this real-world study of national data from France, outcomes with avelumab as 2L+ treatment for mMCC were similar to those observed in part A of the JAVELIN Merkel 200 trial. These findings confirm the effectiveness of avelumab in pts with mMCC that have progressed following first-line systemic treatment in routine clinical practice.
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Doutrelant, Philippe, Nicolas Penel, Charlotte Renaudat, Cassandre Von Platen, Marie Paule Lebitasy, Pauline Smis-Papillon, Bruno Hoen, Eric Lartigau, and Yves-Marie Robin. "Very low seroprevalence of sars-cov-2 among health care personnel (HCP) in a French northern comprehensive cancer center at the end of first national containment." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): e13604-e13604. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e13604.
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e13604 Background: To limit SARS-Co-2 transmission in general population, French government had set up a first National containment from March 16, 2020 to June 2, 2020. Furthermore, General Direction of our hospital have implemented and organized physical distancing (telework, teleconsultation, virtual multi-disciplinary board), mask wearing, use of alcoholic ... to limit interpersonal contacts. To assess the impact of this policy, we have carried out a seroprevalence study and identified risk factors for SARS-Co-2 prevalence among HCP in May/June 2020. Methods: This is part of CORSER Study (“Etude séro-épidémiologique du virus SARS-CoV-2 en France d’une Cohorte CORSER-2d de personnels d’établissements de santé »), registered with ClinicalTrials.gov (NCT04325646). Two serological tests were applied in this cohort: S-Flow assay and Luciferase-linked immune-sorbent assay (LuLisa-N test). Results: Between 04 May to 26 June 2020, 392 Osar Lambret Cancer Center employees were included in the present study (about 40% of all staff). The most common jobs were: 92 nurses (23.4%), 80 radiology/radiotherapy manipulators (20.4%), 51 physicians (13.0%), 33 medical interns (8.4%) and 47 administrative staff members (11.9%). There were 98 men (25.0%) and 294 women (75.0%). The mean age was 38.7 (+/- 11.4). There were 7 seropositive cases; the seroprevalence was 1.8% (95%-CI: 0.7-3.6). Among the 7 positive cases, 5 were symptomatic (71.4%). In univariate analysis, factors associated with SARS-Co-2 seroprevalence: symptoms suggesting viral infection within 2 months (OR=5.33), dysgueusia (OR=37.00), anosmia (OR=66.29) and HCP exposed to COVID-19 patient outside work (OR=6.69). Gender, tobacco consumption, O blood group, HCP versus administrative staff, HCP working in different services, HCP providing care to suspected COVID-19 patients, HCP providing high-risk cares were not found to be associated with seropositivity. Of note, we have noticed that BMI≥ 24 kg/m² was associated with seroprevalence (OR=15.45), without biological rational. Conclusions: Our study suggests that strict implementation of protective measures was associated with low SARS-Cov-2 prevalence at the end of first National Containment, including among HCP treating COVID-19+ patients. HCPs seroprevalence seemed lower than seroprevalence of the general population at the same period (4-5%). Clinical trial information: NCT04325646.
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Petit, Thierry, Nawale Hajjaji, Eric-Charles Antoine, Marc-Antoine Benderra, Michel Gozy, Cyril Foa, Jean-Loup Mouysset, et al. "Abstract P2-13-26: Trastuzumab deruxtecan in previously treated HER2-positive metastatic or unresectable breast cancer (BC): First real-life data from the cohort temporary authorization for use (cATU) program in France." Cancer Research 82, no. 4_Supplement (February 15, 2022): P2–13–26—P2–13–26. http://dx.doi.org/10.1158/1538-7445.sabcs21-p2-13-26.
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Abstract Background Trastuzumab deruxtecan (T-DXd) is an antibody-drug conjugate (ADC) composed of an HER2-directed antibody and a topoisomerase I inhibitor covalently linked via a tetrapeptide-based cleavable linker. In DESTINY-Breast01, tolerability and efficacy of T-DXd including overall response rate, progression-free survival, duration of response and overall survival have been demonstrated for HER2-positive metastatic and/or unresectable BC in patients (pts) relapsing after 2 or more anti-HER2-based regimens. In France, rapid and fair access to innovative drugs outside clinical trials, prior to their marketing authorization in a given indication, is granted by the French Health Agency, ANSM (Agence Nationale de Sécurité du Médicament et des Produits de Santé), through cATU program. Here we report first real world evidence data from cATU program in HER2+ BC pts treated with T-DXd. Methods T-DXd 5.4mg/kg was given intravenously in monotherapy every 3 weeks in HER2-positive metastatic and/or unresectable BC pts who had previously received at least 2 lines of anti-HER2 regimens in the metastatic setting. Eligible pts needed to have normal neutrophil count and no left ventricular dysfunction. Pts with active or history of interstitial lung disease (ILD), pneumonitis, severe pulmonary disease were excluded. Clinical, biological and safety data were collected until the end of cATU, as well as treatment response according to RECIST 1.1., dose modification, treatment interruption and discontinuation. Analysis was performed on March 31th, 2021 on the basis of available collected data. Results From September 30th, 2020 to March 31th, 2021, 155 centers requested at least one ATU for a total of 539 adult pts; 468 requests were accepted and 71 were refused as they did not meet eligibility criteria. T-DXd was received by 459 pts with the following characteristics: 99.1% were women, median age was 58 years, 90.4% had a ECOG score of 0-1, 98.9% had initial HER2-positive BC (IHC 3+ or IHC 2+/ISH+), 67% were hormone receptor positive. The main sites of metastases were bones (57.3%), lymph nodes (51.6%), lungs (36.2%), liver (33.1%), brain (28.1%) and cutaneous/subcutaneous (13.9%). Median time between initial diagnosis of primary BC and inclusion was 6.6 years (range: 6.6 months - 33.9 years). 81.7% of pts had previously received radiotherapy and 76.5% underwent surgery. The median number of prior cancer regimens in the metastatic setting was 4 (range: 2-22). 21.1% received 2 prior lines of metastatic treatments, 19.6% received 3 lines and 59.3% received 4 lines or more. 94.8% pts received prior trastuzumab emtansine, and 79.3% had prior pertuzumab. During follow-up, data on tumor assessment were available for 160 pts. Of these, 56.7% had complete or partial response and 12.1% had progression. Of the 459 treated pts, 97 pts (21.1%) experienced ≥ 1 Adverse Drug Reaction (ADR) including 41 pts (8.9%) with ≥ 1 serious ADR. Most frequent ADRs were related to gastrointestinal toxicity (35.4%). During cATU, 17 cases (3.7%) with ILD or considered as ILD were reported but no cases had a fatal outcome (only grade 1 or 2 when reported by physicians). 13 fatal cases were reported (no drug-related deaths, attributed by physician). ADRs leading to T-DXd discontinuation were reported in 4 pts (0.9%). Dose reductions were reported in 17 pts (3.7%) and 21 pts (4.6%) had temporary interruptions. Conclusions We report here the first real world data from the French cATU in HER2-positive BC pts treated by T-DXd. The enrolment of 468 pts in 6 months illustrated the unmet medical need for this population. T-DXd had antitumor activity with a similar response rate to that reported in previous clinical studies. T-DXd was well tolerated and no new safety signals were observed. Citation Format: Thierry Petit, Nawale Hajjaji, Eric-Charles Antoine, Marc-Antoine Benderra, Michel Gozy, Cyril Foa, Jean-Loup Mouysset, Julien Grenier, Mireille Mousseau, Audrey Mailliez, Mahasti Saghatchian, Emma Lachaier, Isabelle Desmoulins, Audrey Hennequin, Patricia Maes, Delphine Loirat, Francesco Ricci, Véronique Diéras, Dominique Berton, Florence Lai Tiong, Luis Teixeira, Nadine Dohollou, Christelle Lévy, Thomas Bachelot, Jean-Yves Pierga. Trastuzumab deruxtecan in previously treated HER2-positive metastatic or unresectable breast cancer (BC): First real-life data from the cohort temporary authorization for use (cATU) program in France [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-13-26.
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Hansen, Dennis Lund, Julien Maquet, Margaux Lafaurie, Sigbjørn Berentsen, Henrik Frederiksen, Guillaume Moulis, and David Gaist. "Increased Risk of Ischemic Stroke Amongst Patients with Primary Autoimmune Hemolytic Anemia in Denmark and France." Blood 138, Supplement 1 (November 5, 2021): 849. http://dx.doi.org/10.1182/blood-2021-151615.
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Abstract Introduction An increased risk of thromboses has been described in patients with autoimmune hemolytic anemia (AIHA), including stroke. Previous studies focused on a broad variety of autoimmune disorders and only adjusted to a limited extent for potential confounders. Further, these studies could not robustly address the relationship of stroke risk with time since AIHA diagnosis. To overcome these shortcomings, we conducted a study of the risk of ischemic stroke amongst patients with primary AIHA in two nationwide cohorts in Denmark and France. Method We identified all patients 15+ years of age diagnosed with primary AIHA in the Danish National Patient Register (1996-2016) and the French health insurance database, Système National des Données de Santé (2012 - 2017). At AIHA diagnosis, patients were age- and sex-matched to comparison cohorts from the general populations in Denmark (1:50) and France (1:5), respectively. Each patient's date of diagnosis was allotted to their corresponding comparisons and marked the start of a 5-year follow-up of the cohorts. We linked data on the cohorts to information from national registers concerning (co)morbidity, vital status and outcomes. Based on this data, we identified comorbidities at baseline (including preexisting cardiovascular and cerebrovascular events (CVD) at diagnosis) and ischemic stroke events during follow-up. We evaluated the absolute risk of ischemic stroke using cumulative incidences, treating death and migration as competing events. Further, the relative risk of ischemic stroke was evaluated using unadjusted cause-specific proportional hazard regression (csHR) and Fine-Gray subdistribution HR (subHR), and subsequently adjusting for CVD event history, atrial fibrillation, diabetes, hypertension, dyslipidemia, history of venous thromboembolism, cancer, and time-varying exposure to antiplatelet, anticoagulant, lipid lowering, and antihypertensive drugs. HRs were estimated both overall for all five years and for the first year after diagnosis for the two countries separately. Hazard ratios for the data from both countries combined were also computed using meta-analysis techniques. Results We included 1,171 (Denmark) and 4,823 (France) patients with primary AIHA and 57,773 (Denmark) and 23,752 (France) comparisons from the general population. During follow-up, 35.1% (Denmark) and 38.3% (France) of patients with AIHA died. Age, gender, and comorbidity distribution as well as mortality was similar in the two countries. Similar differences in the prevalence of previous CVD events were observed between AIHA patients (higher prevalence of CVD) and comparison cohorts in both countries. We identified 29 (Denmark) and 92 (France) ischemic stroke events amongst patients with AIHA, of whom 12 (Denmark) and 57 (France) occurred during the first year after AIHA diagnosis. The cumulative stroke incidences are depicted in the Figure (Panel A: French cohort. Panel B: Danish cohort). Overall, the combined adjusted csHR was 1.3 [1.1; 1.6], and the subHR was 1.0 [0.9; 1.2]. Within the first year from diagnosis, the combined adjusted csHR was 2.3 [1.8; 2.9], and the subHR was 1.7 [1.3; 2.2]. Discussion and conclusion In a combined Danish-French cohort of 5.994 patients with primary AIHA and 81.525 comparisons, we confirm that the risk of ischemic stroke amongst patients with primary AIHA is increased. The risk is highest within the first year after diagnosis with a csHR of 2.3 and a subHR of 1.7. This indicates that although the risk of ischemic stroke is high among patients with primary AIHA compared to the general population, the effect on the cumulative incidence of ischemic stroke is diminished by competing events - especially death. Granular data on treatment was not generally available and our data does not allow us to infer whether the increased risk of ischemic stroke in AIHA derives from the hemolytic process, the treatment or other factors. However, as the risk was highest within the first year and as prior thromboembolic and vascular events were more prevalent amongst patients this could support the hypothesis that free hemoglobin leads to endothelial dysfunction and a procoagulant state that also increases the risk of stroke. Figure 1 Figure 1. Disclosures Hansen: Novartis: Research Funding; Alexion: Research Funding. Berentsen: True North Therapeutics: Consultancy; Sanofi: Consultancy, Honoraria; Janssen-Cilag: Honoraria; Bioverativ: Consultancy, Honoraria; Mundipharma: Research Funding; Apellis Pharmaceuticals: Consultancy, Honoraria; Alexion Pharmaceuticals, Inc: Honoraria. Frederiksen: Novartis: Research Funding; Alexion: Research Funding; Gilead: Research Funding; Abbvie: Research Funding; Janssen Pharmaceuticals: Research Funding. Moulis: Amgen: Membership on an entity's Board of Directors or advisory committees, Research Funding; Argenix: Membership on an entity's Board of Directors or advisory committees; Grifols: Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding; Sobi: Membership on an entity's Board of Directors or advisory committees.
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Grignani, Giovanni, Piotr Rutkowski, Celeste Lebbe, Natalie Prinzi, Jean-jaques Grob, Enrica Teresa Tanda, Michele Guida, et al. "545 A phase 2 study of retifanlimab in patients with advanced or metastatic merkel cell carcinoma (MCC) (POD1UM-201)." Journal for ImmunoTherapy of Cancer 9, Suppl 2 (November 2021): A574—A575. http://dx.doi.org/10.1136/jitc-2021-sitc2021.545.
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BackgroundRetifanlimab (INCMGA00012) is a humanized, hinge-stabilized immunoglobulin G4 kappa (IgG4κ), anti-programmed cell death protein (PD)-1 monoclonal antibody with safety and clinical pharmacology that are characteristic for the class. Evaluation of retifanlimab in solid tumors is under investigation in phase 2 and 3 studies. POD1UM-201 is an open-label, single-arm, multicenter, phase 2 study evaluating the efficacy and safety of retifanlimab in patients with chemotherapy-naïve or chemotherapy-refractory advanced/metastatic Merkel cell carcinoma (MCC). Updated results from the chemotherapy-naïve cohort are reported here.MethodsEligible patients were ≥18 years of age, had metastatic or recurrent unresectable loco-regional MCC, Eastern Cooperative Oncology Group performance status ≤1, measurable disease per Response Evaluation Criteria in Solid Tumors (RECIST) v1.1, and had not received prior systemic treatment for MCC. Retifanlimab 500 mg IV every 4 weeks (Q4W) was administered for up to 2 years. The primary endpoint was overall response rate (ORR) assessed by independent central review per RECIST v1.1. Secondary endpoints included duration of response, disease control rate (DCR; defined as proportion of patients with either an objective response or stable disease lasting at least 6 months), progression-free survival, overall survival, safety, and pharmacokinetics.ResultsAs of April 16, 2021, 87 patients with chemotherapy-naïve advanced/metastatic MCC had received retifanlimab. Per protocol, the primary efficacy analyses are based on the first 65 patients assessed. At the data cutoff, 34 of these 65 patients (52.3%) were on treatment; 4 (6.2%) had completed treatment; and 27 (41.5%) had discontinued treatment for reasons including disease progression (18 [27.7%]), adverse event (AE; 7 [10.8%]), death (1 [1.5%]), and physician decision (1 [1.5%]). The ORR in these patients was 46.2% (n=30: complete response, 8 [12.3%]; partial response, 22 [33.8%]). The DCR was 53.8% (n=35). Other secondary efficacy results are not yet mature. Among all treated patients (n=87), 66 (75.9%) had a treatment-emergent AE (TEAE), 25 (28.7%) had a grade ≥3 TEAE, and 12 (13.8%) had a grade ≥3 treatment-related AE. Twenty-three patients (26.4%) had an immune-related AE (irAE), and 8 (9.2%) had a grade ≥3 irAE. Four patients (4.6%) discontinued treatment due to irAEs (peripheral sensorimotor neuropathy, pancreatitis, eosinophilic fasciitis, and polyarthritis [each n=1]). One patient (1.1%) had a grade 3 infusion reaction.ConclusionsThese data from the POD1UM-201 trial show that retifanlimab monotherapy at 500 mg Q4W continues to demonstrate promising clinical activity and safety in patients with advanced/metastatic chemotherapy-naïve MCC. Updated results will be presented at the meeting.AcknowledgementsThe study is sponsored by Incyte Corporation (Wilmington, DE). Statistical support was provided by Xiaohan Xu of Incyte Corporation. Editorial assistance was provided by Matthew Bidgood of Envision Pharma Group (Philadelphia, PA, USA).Trial RegistrationClinicaltrials.gov NCT03599713; EudraCT 2018-001627-39Ethics ApprovalThe study was approved by institutional review boards or independent ethics committees in Canada (McGill University Health Center-Research Ethics Board [MP-37-2019-5103, MEO-37-2019-1616]; Ontario Cancer Research Ethics Board [1728]; Health Research Ethics Board of Alberta – Cancer Committee [HREBA.CC-19-0004, HREBA.CC-19-0020]); Czech Republic (Eticka komise Fakultni nemocnice Kralovske Vinohrady, Eticka komise IKEM a FTNsP, Eticka komise Nemocnice Na Bulovce, Statni ustav pro kontrolu leciv, Eticka komise FN a LF UP Olomouc [169/18MEK24, LEK/04/07/2018, (L-18-85) 8522/23.3.2021, 22.3.2021/9965/EK-Z]); France (Comité de Protection des Personnes Ile de France X [CNRIPH : 18.11.19.49212/Id. 2043]; Agence Nationale de Sécurité du Médicament et des Produits de Santé); Germany (Ethik-Kommission der Medizinischen Fakultaet der Universitaet Duisburg-Essen [18-8371-AF]; Bundesamt fuer Strahlenschutz; Paul-Ehrlich Institute); Hungary (Egeszsegugyi Tudomanyos Tanacs Klinikai Farmakologiai Etikai Bizottsaga [IV/2407-0/2021-EKL, OGYÉI/11697-2/2021]; Orszagos Gyogyszereszeti es Elelmezes-egeszsegugyi Intezet); Italy (Comitato Etico IRCCS Pascale Napoli [116/21 E - 87/18]; Comitato Etico IRCCS di Candiolo [232/2021]; Istituto Tumori Giovanni Paolo II IRCCS Ospedale Oncologico Bari [736/CE]; Comitato Etico Locale per la Sperim. Clin. dei Medicinali dell’Az. Osp.ra Univ.ria Senese di Siena [14107]; Comitato Etico dell’IRCCS Istituto Nazionale per la Ricerca sul Cancro di Genova [389/2018 - 24/05/2021]; Comitato etico degli IRCCS Istituto Europeo di Oncologia e Centro Cardiologico Monzino [IEO 948 - RE3065/IB Edition 7 dated 10Nov2020 (SA7)]; Comitato Etico, Fondazione IRCCS Istituto Nazionale dei Tumori, .c. Medicina Oncologica 1 – Fondazio [INT 01/19]; Comitato Etico IRCCS Istituto Oncologico Veneto di Padova [EM 109/2021]; Comitato Etico dell’IRCCS Istituto Dermopatico dell’Immacolata Ospedale Generale S. Carlo di Roma [550/7]; AIFA – Agenzia Italiana del Farmaco [0040152-01/04/2021-AIFA-AIFA_USC-P]; Comitatao Etico Policlinico di Modena [1017/2018/FARM/AOUMO - EMENDAMENTO SOSTANZIALE IB EDIZIONE 7 DEL 10/11/20 (201800162739-010) (p. 9869/21)]); Poland (Komisja Bioetyczna przy Centrum Onkologii [no. 55/2019]; Office for Registration of Medicinal Products, Medical Devices and Biocidal Products [UR/DBL/D/328/2019]); Spain (CEIC Hospital General Universitario Gregorio Marañon [280/18]; Agencia Española del Medicamento y Productos Sanitarios); Switzerland (Kantonale Ethikkommission Zürich (KEK-Zürich) [2019-00200]; Swissmedic [2019DR2035]); United Kingdom (North East – York Research Ethics Committee [248465]; Medicines and Healthcare products Regulatory Agency; Health Research Authority); United States (Copernicus Group IRB; Western Institutional Review Board [20181738, Work order number -– IQV1-18-309]; Roswell Park Cancer Institute IRB [STUDY00000802/P 75918]; Inova Institutional Review Board, Human Research Protection Program; Stanford IRB Research Compliance Office [48198]; Rush University Medical Center [18072304-IRB01]; University of Miami IRB; Mayo Clinic IRB – Rochester).
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ELSEN, J. M., and J. M. AYNAUD. "Introduction au numéro hors série Encéphalopathies spongiformes transmissibles animales." INRAE Productions Animales 17, HS (December 19, 2004): 5–6. http://dx.doi.org/10.20870/productions-animales.2004.17.hs.3613.
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Les agents des encéphalopathies spongiformes transmissibles (ESST) sont responsables de maladies neurodégénératives fatales chez l’homme (maladie de Creutzfeldt-Jakob, insomnie fatale familiale, syndrome de Gerstmann-Straussler-Scheinker, Kuru) et chez les animaux (tremblante ovine et caprine, encéphalopathie spongiforme bovine, encéphalopathie spongiforme féline, encéphalopathie transmissible du vison, dépérissement chronique des cervidés. L’encéphalopathie spongiforme bovine (ESB) est une maladie nouvelle apparue en 1985 au Royaume-Uni, puis s’est propagée ensuite dans les autres pays européens et en particulier en France (premier cas identifié en 1990). La tremblante des ovins est en revanche connue depuis plus de deux siècles en Europe. Elle se distingue de l’ESB par sa contagiosité et la distribution de la protéine prion pathologique PrPsc dans les tissus périphériques. L’agent de l’ESB est transmissible des bovins à l’homme chez lequel il provoque une forme particulière (variant) de la maladie de Creutzfeldt-Jakob. En revanche, l’agent de la tremblante ovine semble sans danger pour l’homme.
Jusqu’en 1992, date du premier rapport réalisé à la demande du ministre de la recherche, Hubert Curien, par une commission de 9 chercheurs présidée par Dominique Dormont, les recherches poursuivies en France sur les ESST étaient le fait d’un petit réseau informel qui a été à l’origine d’un premier programme de recherches piloté par l’INSERM. L’annonce faite le 20 mars 1996 par les autorités du Royaume-Uni que 10 britanniques venaient de succomber à une variante de la maladie de Creutzfeldt-Jakob liée à l’ESB, entraîne une crise de confiance sans précédent des consommateurs. Interpellée, la communauté scientifique incluant l’INRA est alors brutalement placée devant un ensemble de questions nouvelles qui l’oblige à recentrer sa stratégie en termes d’expertise collective.
La mise en place à cette occasion, du comité interministériel d’experts sur les ESST animé par Dominique Dormont (et auquel 8 chercheurs INRA participaient) a été un facteur très important dans la mobilisation de la communauté scientifique française et en particulier de l’INRA (voir à ce sujet l’analyse critique du fonctionnement de ce comité interministériel faite par Jacqueline Estades et Elisabeth Rémy dans l’ouvrage « l’expertise en pratique : les risques liés à la vache folle et aux rayonnements ionisants », 249 pages, L’Harmattan éditeur, Novembre 2003). Depuis 1993, les chercheurs INRA du département de génétique animale réfléchissaient aux conditions de développement de projets de recherche nouveaux sur les maladies à prions et en particulier sur la tremblante ovine qui sévissait de façon spectaculaire dans un troupeau ovin expérimental (domaine INRA de Langlade). Les chercheurs concernés de ce département ont eu un rôle moteur dans la mobilisation ultérieure des autres départements.
En effet, à partir de l’automne 1996, des chercheurs INRA appartenant à 6 départements de recherche différents (génétique animale, santé animale, physiologie animale, transformation des produits animaux, hydrobiologie et faune sauvage, économie et sociologie rurale) ont décidé de s’engager dans des projets de recherche centrés sur les maladies à prions. Cet intense effort de mobilisation s’est accompli essentiellement par mobilité thématique (et non pas à la faveur de recrutements nouveaux), ce qui a représenté pour chacun des chercheurs engagés un effort personnel de remise en cause l’obligeant à repartir de zéro dans un domaine totalement nouveau, en abandonnant des recherches où chacun avait acquis un positionnement national et international.
Cette mobilisation collective importante a été favorisée par trois facteurs différents :
- l’exceptionnelle demande sociétale résultant d’une crise de confiance sans précédent touchant à la fois le consommateur et le citoyen,
- l’ensemble des nombreuses questions nouvelles posées par la problématique « prions » qui a profondément excité la curiosité et l’intérêt des chercheurs de disciplines différentes,
- et, enfin, la mise en place rapide de nouveaux moyens financiers, à la faveur d’une série d’appels d’offres successifs (INRA en interne, interministériels, GIS Prions, Union Européenne) qui ont exercé un effet incitatif puissant.
Dans ce contexte nouveau, les objectifs prioritaires de l‘INRA ont été les suivants :
- tout d’abord, créer les conditions optimales pour la mise au point des différents outils indispensables au développement des recherches sur les ESST :
. les souris transgéniques pour les infections expérimentales,. les lignées de cultures cellulaires pour la propagation in vitro du prion,. les anticorps monoclonaux anti protéine prion (PrP),. les techniques immunocytohistochimiques pour identifier la protéine prion pathogène PrPsc dans les tissus infectés,. les méthodes de génotypage à grande échelle du gène PrP chez les ovins,. les approches épidémiologiques adaptées,. et surtout toute la logistique appropriée pour la manipulation des prions en toute sécurité au laboratoire et dans les animaleries (souris et gros animaux).
- parallèlement, organiser des instances nouvelles pour la coordination (comité d’action incitative programmée, bureau permanent des recherches ESST) et l’animation scientifique interdisciplinaire (séminaires réguliers) de façon à assurer les meilleures conditions pour favoriser les échanges entre les équipes et la cohérence des projets entre eux.
- et, enfin, mettre en place des moyens nouveaux en termes de ressources humaines (redéploiements, recrutements).
Plus d’une vingtaine d’équipes INRA se sont engagées depuis 1996. A partir des nouveaux outils mis à disposition des différentes équipes, les recherches se développent et les résultats obtenus ont été présentés et discutés lors des séminaires organisés en 1998, 2000 et 2003. Ces résultats ont été valorisés par un nombre important de publications et ont été concrétisés au niveau des applications par la mise au point de tests rapides de diagnostic des ESST (contribution au test Biorad pour l’ESB, convention avec l’Institut Pourquier pour la tremblante ovine) ainsi que par un plan ambitieux de contrôle génétique et d’éradication de la tremblante dans les troupeaux ovins français. Dans le domaine de la biosécurité du retraitement des farines animales, un brevet a été pris en mars 2004.
A l’issue du dernier séminaire, la direction scientifique Animal et Produits Animaux a décidé de valoriser l’ensemble des résultats obtenus et des connaissances en découlant, par la réalisation de ce numéro hors-série. L’objectif était de présenter au plus grand nombre l’ensemble des avancées scientifiques et des axes de recherche actuels sur les prions, menés dans les différentes disciplines.
Ce numéro hors-série de la revue « Productions Animales » comprend 7 chapitres structurés autour des questions nouvelles que les chercheurs se sont attachés à résoudre : les animaux modèles, la caractérisation des souches et la nature de l’agent, la protéine prion cellulaire, la pathogénie des ESST, la variabilité de la résistance aux ESST et enfin l’épidémiologie et la lutte contre les ESST. En outre à la fin du numéro, figurent des annexes présentant successivement : la liste des publications scientifiques réalisées à partir des résultats obtenus, la liste des séminaires scientifiques organisés en interne, et enfin la liste des 18 projets scientifiques européens dans le domaine des ESST, impliquant des équipes INRA comme coordinateur ou comme partenaire, illustrant ainsi leur positionnement international.
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Chevalier, K., M. Genin, T. Petit Jean, J. Avouac, R. M. Flipo, S. Georgin-Lavialle, S. El Mahou, et al. "AB1131 IDENTIFICATION OF FACTORS ASSOCIATED WITH THE OCCURRENCE OF SEVERE FORMS OF COVID-19 INFECTION IN PATIENTS WITH AUTOIMMUNE/INFLAMMATORY RHEUMATIC DISEASES." Annals of the Rheumatic Diseases 81, Suppl 1 (May 23, 2022): 1682.2–1683. http://dx.doi.org/10.1136/annrheumdis-2022-eular.3245.
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BackgroundPatients with autoimmune/inflammatory rheumatic diseases (AIRD) were suspected to be an at-risk population of severe COVID-19. However, whether this higher risk is linked to the disease or to its treatment is difficult to determine.ObjectivesTo identify, among AIRD patients, factors associated with occurrence of moderate-to-severe COVID19 infection and to evaluate if having an AIRD was associated with an increased risk of severe form of COVID19 infection (defined by hospitalization in ICU or death), compared to general population.MethodsData source: The “Entrepôt des Données de Santé (EDS)” collect data from electronic health records of all patients hospitalized or followed in the AP-HP (39 hospitals in Paris area, France). The French RMD COVID19 cohort is a national multi-center cohort that included patients with confirmed AIRD and diagnosed with COVID-19. All AIRD patients diagnosed with COVID-19 before September 2020 from both cohorts were included.-We Identified factors associated with severe COVID-19 was made in a combined analysis of the 2 cohorts.-Then, we compared COVID-19 infection severity in the EDS-COVID database in AIRD patients and controls, by a propensity score (PS)-matched case-control (1:4) studyResultsAmong 1213 patients (334 in EDS and 879 in RMD cohort), 195 (16.1%) experienced a severe COVID19. In multivariate analysis, greater age, history of interstitial lung disease, arterial hypertension, obesity, sarcoidosis, vasculitis, auto-inflammatory disease and treatment with corticosteroids or rituximab were associated with severe COVID-19 (Table 1).Table 1.AIRD patient’s characteristics associated with severity of COVID-19Patients with mild or moderate infectionPatients with severe infectionOR ajustés 95%CIp-value(N = 1018)(N = 195)Patients characteristics Age55.9 (16.7%)70.3 (14.3%)1.05 [1.03;1.07]<0.001 Gender: Female695 (68.3%)105 (54.1%)0.59 [0.38;0.94]0.025 Interstitial pneumonia38 (3.7%)20 (10.3%)2.94 [1.34;6.34]0.008 Obesity143 (17.8%)38 (27.7%)2.09 [1.26;3.43]0.004 Hypertension268 (26.3%)114 (58.5%)1.81 [1.13;2.89]0.013Underlying Disease: Chronic inflammatory arthritis618 (60.8%)72 (36.9%)Ref. Auto-inflammatory disease29 (2.9%)5 (2.6%)3.91 [1.2;11.32]0.025 Other29 (2.9%)4 (2.1%)0.35 [0.06;1.41]0.15 Connectivitis190 (18.7%)34 (17.4%)1.13 [0.62;2.01]0.69 Sarcoidosis40 (3.9%)24 (12.3%)5.19 [2.15;12.3]<0.001 Vasculitis111 (10.9%)56 (28.7%)1.8 [1.02;3.16]0.044Treatments Corticosteroid318 (31.2%)117 (60.0%)2.47 [1.58;3.87]<0.001 Leflunomide44 (4.3%)2 (1.0%)0.13 [0;0.97]0.045 Rituximab37 (3.7%)22 (11.5%)4.05 [1.96;8.27]<0.001Not significant in multivariate analysisCOPD, Asthma, Coronary heart diseases, stroke, diabetes, smoking, cancer, non-steroidal anti-inflammatory drugs, colchicine, hydroxychloroquine, methotrexate, salazopyrine, mycophenolate mofetil, azathioprine, intravenous immunoglobulins, anti-TNFα, anti-IL1, -IL6, -IL17, Abatacept, JAK inhibitorAmong 35741 COVID-19 patients in EDS, 316 with AIRD were compared to 1264 PS-matched controls. Severe form occurred in 118 (37,3%) AIRD cases and 384 (30.4%) controls (Adjusted OR (aOR) for severe form= 1.43 [1.1;1.9], p=0,01). In analysis restricted to rheumatoid arthritis (RA) and spondylarthritis (SpA), no increased risk of severe form (aOR=1.11 [0.68;1.81]) form or death (aOR=1.00 [0.55;1.81]) was observed.ConclusionIn this multicenter study we confirmed that AIRD patients treated with rituximab or corticosteroids were at increased risk of severe COVID-19, as were those with vasculitis, auto-inflammatory disease, and sarcoidosis. Also, when compared to controls from the same cohort of hospitalized patients, AIRD patients had, overall, an increased risk of severe COVID-19, increased risk not observed in an analysis restricted to patients with RA or SpA.AcknowledgementsFAI2R /SFR/SNFMI/SOFREMIP/CRI/IMIDIATE consortium and contributorsPatricia MartelAll clinicians/physicians implicated in COVID-19 patient care in APHP hospital and generated EDS patient dataDisclosure of InterestsNone declared
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Thebaud-Mony, Annie. "PRECARIZAÇÃO SOCIAL DO TRABALHO E RESISTÊNCIAS PARA A (RE)CONQUISTA DOS DIREITOS DOS TRABALHADORES NA FRANÇA." Caderno CRH 24, no. 1 (February 1, 2012). http://dx.doi.org/10.9771/ccrh.v24i1.19217.
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Este artigo apresenta, inicialmente, algumas grandes etapas históricas da conquista dos direitos de trabalhadores na França, sublinhando o que levou a um real reconhecimento oficial dos direitos em matéria de luta para a melhoria das condições de trabalho. No decorrer dos anos 1970, quando a “flexibilidade” se tornou a palavra de ordem da reestruturação das empresas, duas leis questionam a proibição da intermediação de mão de obra, instaurando um processo estrutural de precarização do trabalho e do emprego, que alterou não somente a segurança econômica dos assalariados como o conjunto dos direitos associados ao contrato de trabalho. Esse processo desmonta, em grande parte, o direito à saúde dos trabalhadores nos locais de trabalho, a exemplo dos cânceres profissionais, como revela pesquisa permanente realizada em uma região parisiense, junto a pacientes acometidos de câncer. Novas redes de resistência, no mais das vezes internacionais e constituídas numa base cidadã, organizam-se, entretanto, em torno dos desafios de saúde, tal como é tratado na conclusão. PALAVRAS-CHAVE: precarização, cânceres profissionais, direitos, resistências, França. PRECARIZATION OF LABOR AND RESISTANCES TO (RE)GAIN WORKERS’ RIGHTS IN FRANCE Annie Thebaud-Mony This paper initially presents some major historical stages of the conquest of workers’rights in France, emphasizing what led to a real official recognition of the rights in the fight to improve working conditions. During the seventies, when “flexibility” became the watchword of corporate restructuring, two laws questioning the banning of intermediation of labor and establishing a structural process of precarization of labor and employment, that changed not only the workers’ economic security as the set of rights associated with the employment contract. This process unravels, in great part, the right to health of workers in the workplace, such as professional cancers, as reveals research a permanent research made in a parisian region, with patients suffering from cancer. New networks of resistance, most often internationally established and constituted on a citizenship basis organize themselves, however, about the health challenges, as addressed in the conclusion. Keywords: precariousness, professional cancers, rights, resistances, France. LA PRÉCARISATION SOCIALE DU TRAVAIL ET LES RÉSISTANCES POUR (RE) CONQUÉRIR LES DROITS DES TRAVAILLEURS EN FRANCE Annie Thebaud-Mony Cet article présente tout d’abord quelques grandes étapes historiques de la conquête des droits des travailleurs en France et met en évidence ce qui a conduit à une véritable reconnaissance officielle des droits dans la lutte pour l’amélioration des conditions de travail. Au cours des années 70, quand la “flexibilité” est devenue le mot d’ordre pour la restructuration des entreprises, deux lois remettent en question l’interdiction de l’intermédiation de la maind’œuvre qui a implanté un processus structurel de précarisation du travail et de l’emploi et qui a modifié non seulement la sécurité économique des salariés mais aussi l’ensemble des droits liés au contrat de travail. Ce processus démantèle en grande partie le droit à la santé des travailleurs sur leur lieu de travail, à l’exemple des cancers professionnels que révèle une enquête permanente faite en région parisienne auprès de patients atteints d’un cancer. Cependant de nouveaux réseaux de résistance, le plus souvent internationaux et constitués sur une base citoyenne, s’organisent face aux défis concernant la santé, comme démontré dans la conclusion. MOTS-CLÉS: précarisation, cancers professionnels, droits, résistances, France. Publicação Online do Caderno CRH: http://www.cadernocrh.ufba.br Publicação Online do Caderno CRH no Scielo: http://www.scielo.br/ccrh
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Liber, Mélanie, and Bertrand Ridremont. "Le vétérinaire face aux nouveaux défis de la filière porcine." Bulletin de l'Académie vétérinaire de France 175 (2022). http://dx.doi.org/10.3406/bavf.2022.70986.
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La France est le 3ème pays producteur de porcs de l’Union Européenne, avec une forte régionalisation de cette production (Grand Ouest). Le modèle d’élevage prédominant est le type « naisseur-engraisseur ». La filière porcine doit relever un certain nombre d’enjeux et répondre à des défis sociétaux croissants : baisse du recours aux antibiotiques et lutte contre l’antibiorésistance, renforcement de la biosécurité, prise en compte croissante du bien-être animal, développement de la médecine de précision avec des outils connectés, respect de l’environnement, attrait du métier d’éleveur. On compte environ 100 à 120 vétérinaires déclarant une activité significative, partielle ou totale, en production porcine. La première mission du vétérinaire spécialisé est le suivi sanitaire des élevages. Face aux enjeux sociétaux actuels, le vétérinaire doit être capable d’accompagner l’éleveur vers des évolutions ou transitions en termes de bien-être animal, biosécurité, prévention, utilisation des données d’élevage et des outils numériques pour contribuer aussi au bien-être de l’éleveur et à la santé économique de l’élevage. Mots-clés : porc, naisseur-engraisseur, vétérinaire, suivi sanitaire, bien-être animal, biosécurité, prévention, économie.
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Ménoret, Marie. "Le risque de cancer du sein en France : un mode unique de prévention." 39, no. 1 (January 8, 2008): 145–60. http://dx.doi.org/10.7202/016936ar.
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Résumé Cet article porte sur l’élaboration du risque de cancer du sein en France et sur ses conséquences sociales. Il s’appuie sur des données historiques et sociologiques pour tracer l’évolution de sa prévention, de la fin du xixe siècle aux tests contemporains de prédisposition génétique. Il montre que la détection précoce s’est imposée comme la technique d’excellence de prévention du cancer du sein, dans un monde où les thérapeutiques évoluent peu en matière de guérison, d’une part, et dans lequel les discours alternatifs n’ont eu que très peu d’audience auprès des publics concernés, d’autre part. Basée exclusivement sur le dépistage, l’entreprise française de prévention du cancer du sein a progressivement transformé des personnes en bonne santé en patientes asymptomatiques — dans un processus de médicalisation du risque — et des populations ciblées de femmes en population à risque — dans un processus de naturalisation du même risque. L’entreprise de surveillance qui organise cette situation est l’oeuvre d’une autonomie médicale qui légitime un « faute de mieux », en l’absence de remède efficace.
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Porte, M., M. D. Harmel, L. Pernice, M. Misserey, C. Adam, J. Sondey, and L. Pallier. "Improving participation of detained men in organised screening of colorectal cancer in Toulon." European Journal of Public Health 29, Supplement_4 (November 1, 2019). http://dx.doi.org/10.1093/eurpub/ckz186.212.
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Abstract In France, organised screening for colorectal cancer was set up in 2008. Participation rate was assessed in March 2014 at the prison of Toulon / La Farlède. On the 100 detained men aged 50-74 years old concerned by screening, only 3.9 % were screened. A project aiming at improving participation in screening while addressing specific difficulties related to prison settings (lack of privacy in cells, low socioeconomic and education status of the population, stronger exposition to risk factors for colorectal cancer) was launched in 2015 and has been yearly conducted since then. How to improve colorectal cancer screening in a prison setting? How to organise a sustainable screening program? What proximity guidance should be provided to foster participation? The program that was developed mainly consisted in awareness sessions and proximity guidance to testing. Among the 330 detained men targeted between 2015 and 2018, 165 men performed an immunologic test (57.9%) and 45 were excluded for medical reasons. Colonoscopy was performed for 10 of the 13 men with a positive result and lesions were detected for 9 men. Among them, one cancer, 6 high-risk polyps and 2 low-risk polyps were found. Those findings exceeded expected numbers. Despite a small population sample, data revealed the benefit of the project in comparison with other participation rates: only 33.5% in France and 29.3% in the Var department (estimates for 2016-17 by Santé Publique France). Furthermore, we achieved a participation rate compliant with European recommendations establishing 45% as a minimum target. The success of our program relied on the synergy between health prevention professionals screening organisers and prison medical staff. Strong involvement of each team constituted a real leverage for project to ensure effective proximity guidance for detained persons leading them to get screened. Key messages Awareness program adapted to prison improved participation in colorectal cancer organised screening. Proximity guidance helped to detect cancer and to improve medical care of detained persons.
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Lucas, E., A. Guillet, C. Bonaldi, C. Caserio-Schönemann, and Y. Le Strat. "Géodes: the health indicators web portal of the French Public Health Agency." European Journal of Public Health 29, Supplement_4 (November 1, 2019). http://dx.doi.org/10.1093/eurpub/ckz186.643.
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Abstract Background Santé publique France, the French Public Health Agency, produce numerous health indicators (diseases or health determinants) from many different data sources (specific or unspecific surveillance systems, epidemiological and behavioural surveys, administrative databases). In order to improve visibility and accessibility of these indicators, a web portal “Géodes” was created. Methods Géodes was built with Géoclip Air© developped by a French start-up. This ergonomic tool allows to explore the geographical dimension of health indicators through interactive maps along with graphs and tables. In addition, Géodes is designed to explore the temporal dimension of indicators produced yearly or weekly through dynamic maps or time series. All indicators are linked to an explanatory sheets. Description, sources, precisions or limits of interpretation are discribed. It is also easy to present indicators in interactive tables, exportable in different formats such as Excel spreadsheets. Results Since February 1st 2019, Géodes is available online without any access restriction (https://geodes.santepubliquefrance.fr). Over 300 health indicators are provided related to infectious and chronic diseases, occupational and environmental health, behaviours, emergency departement attendances, etc. An indicator is either a number of cases, a proportion or an incidence rate. Most indicators are stratified by categories such as sex or age group. It is possible to represent two indicators on a single map, e.g. the smoking prevalence and the standardised rate of lung cancer. Conclusions The days following the opening to the public, the site recorded up to 10,000 connections per day. In routine, the site knows up to 200 visits per day, up to 3,000 in case of quoting aparticular indicator in the media. These figures show that this health data observatory meet a real need. Key messages A web portal of health indicators created by Santé Publique France is now available. More than 300 health indicators are integrated in the portal. Indicators can be visualized through interactive maps, tables and time series and their values are easily exportable and communicable.
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Berjaoui, Roxane, Christele Gautier, and Nathalie Joannard. "P01-06 Physical activity and non communicable diseases in France." European Journal of Public Health 32, Supplement_2 (August 27, 2022). http://dx.doi.org/10.1093/eurpub/ckac095.006.
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Abstract France, as a Member State of WHO Europe, plays a major role in the European strategy on physical activity, nutrition and health within a global framework for the fight against non-communicable diseases. France has adopted a National Sport Health Strategy for 2019-2024 intended to promote sports and physical activities (SPA) as a fully-fledged determinant of health and well-being lifelong. It is consistent with other strategies or plans implemented by other ministerial departments. The four axes of the NSHS are: 1/Promoting health and well-being through physical activity and sports, 2/Developing the offer of and participation in adapted physical actvities for therapeutic purposes and prevention of loss of autonomy; 3/Better protecting sports people’s health and improving safety of activities whatever their intensity; 4/Improving and disseminating knowledge on the impacts on physical condition and health of engaging in sports and physical activities. One of the key measure of the NSHS is indexing of “Maisons Sport Santé”, Health Sport-Houses (HSH) aimed at receiving and orientating all those wishing to engage in, develop or resume sport or physical activities for health or wellbeing reasons, whatever their age, state of health or frailty. Following 3 calls for projects, 436 HSH have been recognized since 2019 and cover almost whole French territory. HSH can be integrated within an association, a hospital, a sports establishment or as digital platforms. A particular attention is paid to people with highly sedentary lifestyles and those with limited autonomy. People with chronic or long-term diseases (cancer, diabetes, heart disease, asthma, Alzheimer etc.) to whom physical activities adapted to their limitations have been prescribed are also priority targets. “Month of Sport and Physical Activities” is a large-scale communication campaign to promote the benefits of sport and physical activities to a wide range of population. The aim is to spread recommendations on SPA and the fight against sedentary behavior, to make SPA accessible to everyone and to encourage people and make them aware of the possibilities to practice in their daily life. Another goal is to give visibility to current actions in this area, to enable French people carry out an analysis of their physical condition and to spur them to (re) start a physical activity training.
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Veziris, Nicolas, Claire Andréjak, Stéphane Bouée, Corinne Emery, Marko Obradovic, and Raphaël Chiron. "Non-tuberculous mycobacterial pulmonary diseases in France: an 8 years nationwide study." BMC Infectious Diseases 21, no. 1 (November 17, 2021). http://dx.doi.org/10.1186/s12879-021-06825-x.
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Abstract Background The objective of the study was to describe the epidemiology, management and cost of non-tuberculous mycobacteria pulmonary disease (NTM-PD) in France. Methods A retrospective analysis was performed using the SNDS (“Système national des données de santé”) database over 2010–2017. Patients with NTM-PD were identified based on the ICD10 codes during hospitalizations and/or specific antibiotics treatment regimens. The study population was matched (age, sex and region) to a control group (1:3) without NTM-PD. Results 5628 patients with NTM-PD (men: 52.9%, mean age = 60.9 years) were identified over the study period and 1433 (25.5%) were treated with antibiotics. The proportion of patients still receiving treatment at 6 and 12 months was 40% and 22%, respectively. The prevalence of NTM-PD was estimated at 5.92 per 100,000 inhabitants and the incidence rate of NTM-PD remained stable over time between 1.025/100,000 in 2010 and 1.096/100,000 in 2017. Patients with NTM-PD had more co-morbidities compared to controls: corticoids (57.3% vs. 33.8%), chronic lower respiratory disease (34.4% vs. 2.7%), other infectious pneumonia (24.4% vs. 1.4%), malnutrition (based on hospitalization with the ICD-10 code reported during a hospital stay as a main or secondary diagnosis) (22.0% vs. 2.0%), history of tuberculosis (14.1% vs. 0.1%), HIV (8.7% vs. 0.2%), lung cancer and lung graft (5.7% vs. 0.4%), cystic fibrosis (3.2% vs. 0.0%), gastro-esophageal reflux disease (2.9% vs. 0.9%) and bone marrow transplant (1.3% vs. 0.0%) (p < 0.0001). The mean Charlson comorbidity index score was 1.6 (vs. 0.2 for controls; p < 0.0001). NTM-PD was independently associated with an increased mortality rate with a hazard ratio of 2.8 (95% CI: 2.53; 3.11). Mortality was lower for patients treated with antibiotics compared to untreated patients (HR = 0.772 (95% CI [0.628; 0.949]). Annual total expenses the year following the infection in a societal perspective were € 24,083 (SD: 29,358) in NTM-PD subjects vs. € 3402 (SD: 8575) in controls (p < 0.0001). Main driver of the total expense for NTM-PD patients was hospital expense (> 50% of the total expense). Conclusion Patients with NTM-PD in France were shown to have many comorbidities, their mortality risk is high and mainly driven by NTM-PD, and their management costly. Only a minority of patients got treated with antibiotics and of those patients treated, many stopped their therapy prematurely. These results underline the high burden associated with NTM-PD and the need for improvement of NTM-PD management in France.
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Rochette, Corinne, Anne Sophie Michallet, Stéphanie Malartre-Sapienza, and Sophie Rodier. "Telephone follow-up of oncology patients: the contribution of the nurse specialist for a Service-Dominant Logic in hospital." BMC Health Services Research 21, no. 1 (June 16, 2021). http://dx.doi.org/10.1186/s12913-021-06552-8.
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Abstract Background The French healthcare system is characterised by a shift towards outpatient care and the desire to develop telemedicine affirmed in the collective commitment “Ma santé 2022” presented by President Macron in 2018. In France, remote patient follow up has recently been developed in the active phase of cancer treatment inspired by the patient navigation approach used in other countries. According to Service-Dominant Logic (S-D L), patients become more active. Their role in co-production of services is strengthened and their behaviours changed. Telephone follow-ups can contribute to modifying the relationship between the patient and the nurse navigators in charge of it, moving logically from a passive attitude from the patient to a more active one. Methods This study was carried out at Léon Bérard, a cancer control unit, in France. It concerned patients treated in an oncohaematology department, who benefited from telephone follow-ups carried out by nurse specialists during the active phase of their treatment. The multidisciplinary research team including social science researchers, physicians and carers developed a research protocol to study this pilot case. Essentially based on a qualitative approach, it was validated by the centre’s management to study this follow-up on patients’ behaviours. The 1st phase of the research, based on 24 semi-structured interviews with patients undergoing treatment undertaken from November 2018 to September 2019, is presented. Results The Telephone follow-up was a positive experience for all patients. The action of the nurse specialist helped to develop certain dimensions of in-role and extra-role behaviour that created value. The patients’ discourse has reported a positive follow-up in its clinical dimensions, its psychological dimensions and an enhanced quality of life. We detected a patient activation through their roles but it remained limited. The telephone follow-up also created a patient dependency. Conclusions The telephone follow-up is a relevant tool for patients undergoing treatment and it deserves to be more widely deployed. It brings comfort and creates a relationship based on trust but at the same time it limits the emancipation of the patient, which is a central element of the S-D logic and its empowerment.
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Xoxi, Entela, Rossella Di Bidino, Serena Leone, Andrea Aiello, and Mariangela Prada. "Value assessment of medicinal products by the Italian Medicines Agency (AIFA) and French National Authority for Health (HAS): Similarities and discrepancies." Frontiers in Medical Technology 4 (September 5, 2022). http://dx.doi.org/10.3389/fmedt.2022.917151.
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The evaluation of pharmaceutical innovation and therapeutic value is an increasingly complex exercise for which different approaches are adopted at the national level, despite the need for standardisation of processes and harmonisation of public health decisions. The objective of our analysis was to compare the approaches of the AIFA (Agenzia Italiana del Farmaco) and the HAS (Haute Autorité de Santé) in assessing the same medicinal products. In Italy, the 1525/2017 AIFA Deliberation introduces a transparent scheme for the evaluation of innovative status (innovative, conditional, not innovative) based on the therapeutic added value (TAV), therapeutic need, and quality of evidence. In contrast, in France, the HAS makes judgements using the effective clinical benefit (Service Médical Rendu) and improvement of effective clinical benefit (Amélioration du Service Médical Rendu, ASMR). This analysis focused on medicinal products evaluated both by the AIFA and by the HAS from July 2017 to September 2021. Similarities between AIFA and HAS evaluations were investigated in terms of the TAV, recognition of innovativeness, and the ASMR. Both total and partial agreements were considered relevant. Therefore, raw agreement, Cohen's kappa (weighted and unweighted), and Bangdiwala's B-statistic were estimated. A total of 102 medicinal products were included in this study. Out of these, 38 (37.2%) were orphan drugs, while 56 (54.9%) had a clinical indication for the treatment of cancer. The AIFA and HAS reached a higher level of agreement on the innovativeness status compared with the TAV. A moderate total agreement emerged in the recognition of innovativeness (k = 0.463, p-value ≤0.0001), and partial agreement was substantial (equal weight k = 0.547, squared k = 0.638), while a lack of agreement resulted in a comparison of the TAV according to the AIFA and the ASMR recognised by the HAS. Indeed, whereas the AIFA determined the TAV to be important, the HAS considered it to be moderate. In addition, whereas the AIFA identified a bias towards a moderate TAV, the HAS identified a bias towards a minor ASMR. A higher level of agreement was reached, both on the TAV and on innovative status, for less critical medical products (non-cancer-related, or non-orphan, or with a standard European Medicines Agency approval). These results underline the importance of implementing European procedures that are more broadly aligned in terms of value definition criteria.
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Andreeva, Valentina, Manon Egnell, Pilar Galan, Gilles Feron, Serge Hercberg, and Chantal Julia. "Association of the nutrient profile system underlying the Nutri-Score front-of-package label with oral health: preliminary evidence from a population-based sample." Proceedings of the Nutrition Society 79, OCE2 (2020). http://dx.doi.org/10.1017/s0029665120000749.
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AbstractThe 2017 implementation in France of the front-of-package nutrition label known as Nutri-Score is a major public health strategy to help individuals make healthier food choices at the point of purchase and thus help reduce chronic disease risk on the population level. The algorithm behind the Nutri-Score is intended to reflect the overall nutritional quality of food and is based on the one developed by the British Food Standards Agency Nutrient Profiling System, following a slight modification (FSAm-NPS) in accordance with French dietary guidelines. Prior research has focused on its association with various physical health outcomes (weight gain, metabolic syndrome, cancer incidence, etc.), yet no studies have explored the link with oral health indicators. We analyzed the cross-sectional association of the FSAm-NPS with oral health in a population-based sample of 33,231 men and women enrolled in the NutriNet-Santé cohort. Oral health (main dependent variable) was assessed in 2016 with the General Oral Health Assessment Index (GOHAI). It consists of 12 items scored on a 5-point Likert scale (maximum score = 60) with lower scores corresponding to poorer oral health with a detrimental impact on quality of life. FSAm-NPS (main independent variable) was calculated on the basis of 3 non-consecutive 24-h dietary records, following established methodology (score range: -15 to + 40, with lower scores corresponding to higher nutritional quality). Age-specific associations (cutoff = 60 y) were explored via multivariable linear regression models. Mean GOHAI score in the sample was 53.8 ± 5.5 (range: 19 to 60) and mean FSAm-NPS was 6.0 ± 2.2 (range: -6.7 to + 15.5). The unadjusted and the age- and sex-adjusted models were significant only in the younger age group (18–59 y). The fully-adjusted model showed modest yet significant associations between overall nutritional quality and oral health in younger and older participants, with the strength of the model being more pronounced in the former compared with the latter age group (F value: 28.5 vs. 6.3, both p < 0.0001). Overall, consuming food with a higher FSAm-NPS score (corresponding to lower nutritional quality) was associated with higher risk of oral health problems. Future longitudinal studies are needed to confirm the observed associations. On the public health policy level, the findings support implementation of the Nutri-Score on pre-packaged food in order to steer consumer choice toward nutritional profiles that are favorable not only for chronic disease prevention but also for oral health.
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Decanter, C., J. Delepine, H. Behal, S. Manier, B. Bruno, M. Barbatti, C. Robin, J. Labreuche, F. Morschhauser, and P. Pigny. "Longitudinal study of AMH variations in 122 Adolescents and Young Adults (AYA) and non-AYA lymphoma patients to evaluate the chemo-induced ovarian toxicity to further personalise fertility preservation counselling." Human Reproduction, August 21, 2021. http://dx.doi.org/10.1093/humrep/deab189.
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Abstract STUDY QUESTION What is the influence of age and chemotherapy regimen on the longitudinal blood anti-Müllerian hormone (AMH) variations in a large series of adolescents and young adult (AYA) (15–24 years old) and non-AYA (25–35 years old) lymphoma patients? SUMMARY ANSWER In case of alkylating regimen treatment, there was a deep and sustained follicular depletion in AYA as well as non-AYA patients; however in both groups, the ovarian toxicity was extremely low in cases of non-alkylating treatments. WHAT IS KNOWN ALREADY AMH is now well-recognised to be a real-time indicator of ovarian follicular depletion and recovery in women treated by chemotherapy. Its longitudinal variations may discriminate between highly and minimally toxic protocols regarding ovarian function. It has been shown, in different cancer types, that age, type of chemotherapy regimen and pre-treatment AMH levels are the main predictors of ovarian recovery. Large studies on longitudinal AMH variations under chemotherapy in lymphoma patients are few but can provide the opportunity to assess the degree of follicle loss at a young age. STUDY DESIGN, SIZE, DURATION This prospective cohort study was conducted in the Fertility Observatory of the Lille University Hospital. Data were collected between 2007 and 2016. Non-Hodgkin or Hodgkin lymphoma patients (n = 122) between 15 and 35 years old were prospectively recruited before commencing chemotherapy. Patients were treated either by a non-alkylating protocol (ABVD group; n = 67) or by an alkylating regimen (alkylating group; n = 55). PARTICIPANTS/MATERIALS, SETTING, METHODS Serial AMH measurements were performed at baseline (AMH0), 15 days after the start of chemotherapy (AMH1), 15 days before the last chemotherapy cycle (AMH2), and at time 3, 6, 9, 12, 18 and 24 months from the end of chemotherapy. The whole study population was divided into two groups according to age: AYA (15–24; n = 65) and non-AYA (25–35; n = 57). All patients received a once monthly GnRH agonist injection during the whole treatment period. A linear mixed model was used to account for the repeated measures of single patients. MAIN RESULTS AND THE ROLE OF CHANCE At baseline, non-AYA patients had higher BMI and lower AMH levels than AYA patients. All AYA and non-AYA patients having received ABVD protocols had regular cycles at 12 months of follow-up. In case of alkylating regimens, amenorrhoea was more frequent in non-AYA patients than in AYA patients at 12 months (37% vs 4%, P = 0.011) and at 24 months (24% vs 4%, P = 0.045). We distinguished a similar depletion phase from AMH0 to AMH2 between ABVD and alkylating groups but significantly different recovery phases from AMH2 to AMH + 24 months. AMH recovery was fast and complete in case of ABVD protocols whatever the age: AMH reached pre-treatment values as soon as the 6th month of follow-up in the AYA group (mean (95% CI) in log AMH M0 vs M6: 3.07 (2.86 to 3.27) vs 3.05 (2.78 to 3.31), P = 1.00) and in the non-AYA group (mean (95% CI) in log AMH M0 vs M6: 2.73 (2.40 to 3.05) vs 2.47 (2.21 to 2.74), P = 1.00). In contrast, no patients from the alkylating group returned to pre-treatment AMH values whatever the age of patients (AYA or non-AYA). Moreover, none of the AMH values post-chemotherapy in the non-AYA group were significantly different from AMH2. Conversely in the AYA group, AMH levels from 6 months (mean (95% CI) in log AMH: 1.79 (1.47 to 2.11), P < 0.001) to 24 months (mean (95% CI) in log AMH: 2.16 (1.80 to 2.52), P ≤ 0.001) were significantly higher than AMH2 (mean (95% CI) in log AMH: 1.13 (0.89 to 1.38)). Considering the whole study population (AYA and non-AYA), pre-treatment AMH levels influenced the pattern of the AMH variation both in alkylating and ABVD protocols (interaction P-value = 0.005 and 0.043, respectively). Likewise, age was significantly associated with the pattern of the recovery phase but only in the alkylating group (interaction P-value =0.001). BMI had no influence on the AMH recovery phase whatever the protocol (interaction P-value = 0.98 in alkylating group, 0.72 in ABVD group). LIMITATIONS, REASONS FOR CAUTION There was a large disparity in subtypes of protocols in the alkylating group. The average duration of chemotherapy for patients treated with alkylating protocols was longer than that for patients treated with ABVD. WIDER IMPLICATIONS OF THE FINDINGS These results make it possible to develop strategies for fertility preservation according to age and type of protocol in a large series of young lymphoma patients. In addition, it was confirmed that young age does not protect against ovarian damage caused by alkylating agents. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by Agence Régionale de Santé Hauts de France and Agence Onco Hauts-de-France who provided finances for AMH dosages (n° DOS/SDES/AR/FIR/2019/282). There are no competing interests. TRIAL REGISTRATION NUMBER DC-2008-642 and CNIL DEC2015-112.