Phenomena Conflict, Anxiety, and Depression for Cancer Survivor One Year and After Have Therapy in General Hospital

Introduction. Psychosocial distress emerges in cancer disease. This research explores experience of conflict, anxiety, and depression in one year cancer survivor. Methods. Data were collected through in-depth semi structured interviews with fifteen participants when seeking treatment at a public hospital in Bandung. Result. There nine themes emerge: anxiety about cancer\u27s spread and recurrence, changing relationships with a partner, \u27labeling\u27 from oneself and others, physical discomfort along treatment, psychological discomfort along treatment, self-concept, religious/spiritual, hiding diagnose and complain, and deficit information about cancer. But, four themes among were not characterized with conflict, anxiety, and depression. Conflict, anxiety, and depression impact condition of the client cancer. Discussion. Experience of conflict, anxiety, and depression became the basis for the development of management system service and provision of facilities for integrated mental health nursing therapy

Assessing the impact of exposome on the course of chronic obstructive pulmonary disease and cystc fibrosis:The REMEDIA European Project Approach

International audienceBecause of the direct interaction of lungs with the environment, respiratory diseases are among the leading causes of environment-related deaths in the world. Chronic obstructive pulmonary disease (COPD) and cystic fibrosis (CF) are two highly debilitating diseases that are of particular interest in the context of environmental studies; they both are characterized by a similar progressive loss of lung function with small bronchi alterations, and a high phenotypic variability of unknown origin, which prevents a good therapeutic efficacy. In the last years, there has been an evolution in the apprehension of the study of diseases going from a restricted "one exposure, one disease" approach to a broader concept with other associating factors, the exposome. The overall objective of the REMEDIA project is to extend the understanding of the contribution of the exposome to COPD and CF diseases. To achieve our aim, we will (1) exploit data from existing cohorts and population registries to create a unified global database gathering phenotype and exposome information; (2) develop a flexible individual sensor device combining environmental and biomarker toolkits; (3) use a versatile atmospheric simulation chamber to simulate the health effects of complex exposomes; (4) use machine learning supervised analyses and causal inference models to identify relevant risk factors; and (5) develop econometric and cost-effectiveness models to assess the costs, performance, and cost-effectiveness of a selection of prevention strategies. The results will be used to develop guidelines to better predict disease risks and constitute the elements of the REMEDIA toolbox. The multidisciplinary approach carried out by the REMEDIA European project should represent a major breakthrough in reducing the morbidity and mortality associated with COPD and CF diseases

Value of 18-F-FDG PET/CT and CT in the Diagnosis of Indeterminate Adrenal Masses

The purpose of this paper was to study the value of 18-FDG PET/CT and reassess the value of CT for the characterization of indeterminate adrenal masses. 66 patients with 67 indeterminate adrenal masses were included in our study. CT/MRI images and 18F-FDG PET/CT data were evaluated blindly for tumor morphology, enhancement features, apparent diffusion coefficient values, maximum standardized uptake values, and adrenal-to-liver maxSUV ratio. The study population comprised pathologically confirmed 16 adenomas, 19 metastases, and 32 adrenocortical carcinomas. Macroscopic fat was observed in 62.5% of the atypical adenomas at CT but not in malignant masses. On 18F-FDG PET/CT, SUVmax and adrenal-to-liver maxSUV ratio were significantly lower in adenomas than in malignant tumors. An SUVmax value of less than 3.7 or an adrenal-to-liver maxSUV ratio of less than 1.29 is highly predictive of benignity

Cognitive decline in Huntington's disease in the Digitalized Arithmetic Task (DAT)

Background Efficient cognitive tasks sensitive to longitudinal deterioration in small cohorts of Huntington’s disease (HD) patients are lacking in HD research. We thus developed and assessed the digitized arithmetic task (DAT), which combines inner language and executive functions in approximately 4 minutes. Methods We assessed the psychometric properties of DAT in three languages, across four European sites, in 77 early-stage HD patients (age: 52 ± 11 years; 27 females), and 57 controls (age: 50 ± 10, 31 females). Forty-eight HD patients and 34 controls were followed up to one year with 96 participants who underwent MRI brain imaging (HD patients = 46) at baseline and 50 participants (HD patients = 22) at one year. Linear mixed models and Pearson correlations were used to assess associations with clinical assessment. Results At baseline, HD patients were less accurate (p = 0.0002) with increased response time (p<0.0001) when compared to DAT in controls. Test-retest reliability in HD patients ranged from good to excellent for response time (range: 0.63–0.79) and from questionable to acceptable for accuracy (range: r = 0.52–0.69). Only DAT, the Mattis Dementia Rating Scale, the Symbol Digit Modalities Test, and Total Functional Capacity scores were able to detect a decline within a one-year follow-up in HD patients (all p< 0.05). In contrast with all the other cognitive tasks, DAT correlated with striatal atrophy over time (p = 0.037) but not with motor impairment. Conclusions DAT is fast, reliable, motor-free, applicable in several languages, and able to unmask cognitive decline correlated with striatal atrophy in small cohorts of HD patients. This likely makes it a useful endpoint in future trials for HD and other neurodegenerative diseases

Experiences and lessons learned from 29 HPV vaccination programs implemented in 19 low and middle-income countries, 2009-2014

BACKGROUND: Cervical cancer is the greatest cause of age-weighted years of life lost in the developing world. Human papillomavirus (HPV) infection is associated with a high proportion of cervical cancers, and HPV vaccination may help to reduce the incidence of cancer. The aim of the study was to identify barriers, obstacles, and strategies and to analyze key concerns and lessons learned with respect to the implementation of HPV vaccination program in low- and middle-income countries. METHODS: The Gardasil Access Program (GAP) is a donation program established to enable organizations and institutions in eligible low-resource countries to gain operational experience designing and implementing HPV vaccination programs. This study used an online survey to capture the experiences and insights of program managers participating in the GAP. Different factors related to HPV vaccination program management were collected. A mixed-method approach enabled the presentation of both quantitative measurements and qualitative insights. RESULTS: Twenty-nine programs implemented by 23 institutions in 19 low- and middle-income countries were included. Twenty programs managers (97.7 %) reported that their institution implemented sensitization strategies about vaccination prior to the launch of vaccination campaign. The most frequently reported obstacles to HPV vaccination by the program managers were erroneous perceptions of population related to the vaccine’s safety and efficacy. Reaching and maintaining follow-up with target populations were identified as challenges. Insufficient infrastructure and human resources financing and the vaccine delivery method were identified as significant health system barriers. Coupling HPV vaccination with other health interventions for mothers of targeted girls helped to increase vaccination and cervical cancer screening. The majority of program managers reported that their programs had a positive impact on national HPV vaccination policy. The majority of institutions had national and international partners that provided support for human resources, technical assistance, and training and financial support for health professionals. CONCLUSION: Local organizations and institutions can implement successful HPV vaccination campaigns. Adequate and adapted planning and resources that support information sharing, sensitization, and mobilization are essential for such success. These results can inform the development of programs and policies related to HPV vaccination in low- and middle-income countries

ERS: A simple scoring system to predict early recurrence after surgical resection for hepatocellular carcinoma.

peer reviewed[en] BACKGROUND: Surgical resection (SR) is a potentially curative treatment of hepatocellular carcinoma (HCC) hampered by high rates of recurrence. New drugs are tested in the adjuvant setting, but standardised risk stratification tools of HCC recurrence are lacking. OBJECTIVES: To develop and validate a simple scoring system to predict 2-year recurrence after SR for HCC. METHODS: 2359 treatment-naïve patients who underwent SR for HCC in 17 centres in Europe and Asia between 2004 and 2017 were divided into a development (DS; n = 1558) and validation set (VS; n = 801) by random sampling of participating centres. The Early Recurrence Score (ERS) was generated using variables associated with 2-year recurrence in the DS and validated in the VS. RESULTS: Variables associated with 2-year recurrence in the DS were (with associated points) alpha-fetoprotein (100: 3), size of largest nodule (≥40 mm: 1), multifocality (yes: 2), satellite nodules (yes: 2), vascular invasion (yes: 1) and surgical margin (positive R1: 2). The sum of points provided a score ranging from 0 to 11, allowing stratification into four levels of 2-year recurrence risk (Wolbers' C-indices 66.8% DS and 68.4% VS), with excellent calibration according to risk categories. Wolber's and Harrell's C-indices apparent values were systematically higher for ERS when compared to Early Recurrence After Surgery for Liver tumour post-operative model to predict time to early recurrence or recurrence-free survival. CONCLUSIONS: ERS is a user-friendly staging system identifying four levels of early recurrence risk after SR and a robust tool to design personalised surveillance strategies and adjuvant therapy trials

Etude des déterminants géographiques et spatiaux de la qualité de vie liée à la santé en France

BACKGROUND: Wide social and geographical disparities are reported in France for morbidity and mortalityindicators. Less is known regarding the spatial distribution in general population of self-rated health (SRH) andhealth-related quality of life (HRQoL). Improving the knowledge of the contextual determinants of HRQoLwould help towards a better understanding of their meaning and interest in general population when it comes tocompare with classical objective indicators.OBJECTIVES: The objectives were [1] to assess existing spatial disparities of HRQoL in French generalpopulation and to investigate their evolution in time, [2] to determine individual and contextual determinants ofHRQoL and [3] to explore the ecological associations between HRQoL and subsequent mortality five years later.METHODS: Data were drawn from two large representative cross sectional surveys: the Insee Decennial HealthSurvey led in 2003 (N=22 743 [study 1 and 3] ; N= 16 732 [2]) and the Sofres health survey led in 1995(N=3243 [1]).The MOS SF-36 questionnaire was used in both surveys. [1] Fixed effects linear models combinedwith interaction tests were used for assessing time trends. [2] Mixed effects linear models were used for themultilevel analysis, exploring a causal pathway including individual and macrolevel factors (household, urbanunit and region) assessing demographics, socioeconomics, and features related to the notion of areaattractiveness (deindustrialization, net migration rates). [3] Mortality data were drawn from the French nationalstatistics of mortality (CepiDc-Inserm). Negative binomial regression models were performed to identifyecological associations at the region level between HRQoL recorded in 2003 and subsequent mortality (shortterm [2003-2005]; 5-years later [2007-2009]), stratifying on age, gender and specific causes of death.MAIN RESULTS: [1] A significant decrease in HRQoL was observed between 1995 and 2003, affecting allsociodemographic categories and suggesting likely widening disparities in the most fragile categories. [2]Regional HRQoL disparities were found, persisting after adjusting on socioeconomic individual characteristics.Multilevel analysis showed some evidence for mediation involving contextual factors like deindustrialization,net migration rates, voter abstention rate and health-related behaviors. Cross-level interactions were found aswell. [3] Significant ecological associations were identified at the region level between HRQoL and mortalityfive years later, persisting after adjusting on deprivation. Specific relationships were observed after stratifying onage, gender, specific causes of death; the predictive ability of HRQoL for mortality was varying depending onthe mortality period considered for analysis.CONCLUSIONS: Our results highlight the interest in assessing HRQoL at the population level and in exploringthe contextual determinants at play. Systematic inclusion of validated and multidimensional HRQoLquestionnaires should be supported in national surveys, so as to improve our knowledge of long term temporaltrends in HRQoL, to promote an increased use of contextual multilevel analyses using such data, and eventuallyto help better identifying sub-groups at risk and optimizing public health interventions.CONTEXTE : La France est caractérisée par l’existence de fortes disparités socioéconomiques et géographiquesde l’état de santé, le plus souvent objectivées par des indicateurs objectifs de morbidité et de mortalité. Ladistribution territoriale des mesures de santé perçue comme la qualité de vie liée à la santé (QdVLS) reste malconnue en population générale. Une meilleure connaissance de la répartition et des déterminants – en particuliercontextuels - de ces indicateurs subjectifs permettrait de mieux comprendre leur signification par rapport auxindicateurs objectifs et d’apprécier l’intérêt spécifique de leur suivi en population générale.OBJECTIFS : Les objectifs de cette recherche étaient [1] d’étudier l’existence de disparités spatiales de QdVLSdans la population française et d’analyser leur évolution dans le temps, [2] d’étudier les déterminants de laQdVLS à la fois individuels et contextuels dans le cadre d’une analyse multiniveau, et [3] d’évaluer lesassociations écologiques entre QdVLS et mortalité ultérieure à cinq ans d’intervalle.MATERIEL ET METHODES : Les données issues de deux enquêtes transversales nationales représentatives ont étéexploitées : l’enquête Décennale 2003 de l’Insee pour l’ensemble des travaux menés (N=22 743 [1 et 3] ; N=16 732 [2]) et l’enquête Sofres 1995 pour l’analyse de l’évolution temporelle de la QdVLS (N=3 243 [1]). Lequestionnaire utilisé dans les deux enquêtes était le SF-36. [1] Des modèles de régression linéaire multiple àeffets fixes avec recherche d’interactions ont été réalisés pour l’analyse de l’évolution temporelle. [2] L’analysemultiniveau des déterminants contextuels de la QdVLS s’appuyait sur des modèles à effets mixtes, afind’explorer une chaine causale incluant des déterminants aux niveaux individuel, du ménage, de l’unité urbaine etrégional, d’ordre démographique, socioéconomique ou intégrant la notion contextuelle plus complexed’attractivité (taux migratoire, désindustrialisation). [3] Les données de mortalité étaient issues de la statistiquenationale des décès élaborée annuellement par le CépiDc. Des modèles de régression binomiale négative ont étéréalisés pour l’analyse des associations écologiques au niveau régional entre QdVLS en 2003 et mortalitéultérieure (court terme [2003-2005] ; à 5 ans [2007-2009]) et en stratifiant sur le sexe, l’âge et les causesspécifiques de décès.RESULTATS PRINCIPAUX : [1] Une diminution significative de la QdVLS était observée entre 1995 et 2003affectant tous les groupes sociodémographiques et suggérant la possibilité d’un accroissement des disparités pourles catégories les plus fragiles de la population. [2] De fortes disparités régionales de QdVLS étaient retrouvées,persistant après ajustement sur les caractéristiques socioéconomiques individuelles. L’analyse multiniveaupermettait d’identifier des processus de médiation impliquant les variables contextuelles de désindustrialisation,le taux d’accroissement migratoire, le taux d’abstention aux élections, et les comportements liés à la santé. Desinteractions inter-niveaux et intra-régionales étaient identifiées. [3] Des associations écologiques significativesétaient retrouvées au niveau régional entre QdVLS et mortalité à cinq ans d’intervalle, persistant aprèsajustement sur le niveau socioéconomique. Des relations spécifiques étaient observées après stratification surl’âge, le genre, les causes spécifiques de décès ; le caractère prédictif de la QdVLS variait selon le délai plus oumoins court entre mesure de la QdVLS et mortalité

Geographic and spatial determinants of health-related quality of life in France

CONTEXTE : La France est caractérisée par l’existence de fortes disparités socioéconomiques et géographiquesde l’état de santé, le plus souvent objectivées par des indicateurs objectifs de morbidité et de mortalité. Ladistribution territoriale des mesures de santé perçue comme la qualité de vie liée à la santé (QdVLS) reste malconnue en population générale. Une meilleure connaissance de la répartition et des déterminants – en particuliercontextuels - de ces indicateurs subjectifs permettrait de mieux comprendre leur signification par rapport auxindicateurs objectifs et d’apprécier l’intérêt spécifique de leur suivi en population générale.OBJECTIFS : Les objectifs de cette recherche étaient [1] d’étudier l’existence de disparités spatiales de QdVLSdans la population française et d’analyser leur évolution dans le temps, [2] d’étudier les déterminants de laQdVLS à la fois individuels et contextuels dans le cadre d’une analyse multiniveau, et [3] d’évaluer lesassociations écologiques entre QdVLS et mortalité ultérieure à cinq ans d’intervalle.MATERIEL ET METHODES : Les données issues de deux enquêtes transversales nationales représentatives ont étéexploitées : l’enquête Décennale 2003 de l’Insee pour l’ensemble des travaux menés (N=22 743 [1 et 3] ; N=16 732 [2]) et l’enquête Sofres 1995 pour l’analyse de l’évolution temporelle de la QdVLS (N=3 243 [1]). Lequestionnaire utilisé dans les deux enquêtes était le SF-36. [1] Des modèles de régression linéaire multiple àeffets fixes avec recherche d’interactions ont été réalisés pour l’analyse de l’évolution temporelle. [2] L’analysemultiniveau des déterminants contextuels de la QdVLS s’appuyait sur des modèles à effets mixtes, afind’explorer une chaine causale incluant des déterminants aux niveaux individuel, du ménage, de l’unité urbaine etrégional, d’ordre démographique, socioéconomique ou intégrant la notion contextuelle plus complexed’attractivité (taux migratoire, désindustrialisation). [3] Les données de mortalité étaient issues de la statistiquenationale des décès élaborée annuellement par le CépiDc. Des modèles de régression binomiale négative ont étéréalisés pour l’analyse des associations écologiques au niveau régional entre QdVLS en 2003 et mortalitéultérieure (court terme [2003-2005] ; à 5 ans [2007-2009]) et en stratifiant sur le sexe, l’âge et les causesspécifiques de décès.RESULTATS PRINCIPAUX : [1] Une diminution significative de la QdVLS était observée entre 1995 et 2003affectant tous les groupes sociodémographiques et suggérant la possibilité d’un accroissement des disparités pourles catégories les plus fragiles de la population. [2] De fortes disparités régionales de QdVLS étaient retrouvées,persistant après ajustement sur les caractéristiques socioéconomiques individuelles. L’analyse multiniveaupermettait d’identifier des processus de médiation impliquant les variables contextuelles de désindustrialisation,le taux d’accroissement migratoire, le taux d’abstention aux élections, et les comportements liés à la santé. Desinteractions inter-niveaux et intra-régionales étaient identifiées. [3] Des associations écologiques significativesétaient retrouvées au niveau régional entre QdVLS et mortalité à cinq ans d’intervalle, persistant aprèsajustement sur le niveau socioéconomique. Des relations spécifiques étaient observées après stratification surl’âge, le genre, les causes spécifiques de décès ; le caractère prédictif de la QdVLS variait selon le délai plus oumoins court entre mesure de la QdVLS et mortalité.BACKGROUND: Wide social and geographical disparities are reported in France for morbidity and mortalityindicators. Less is known regarding the spatial distribution in general population of self-rated health (SRH) andhealth-related quality of life (HRQoL). Improving the knowledge of the contextual determinants of HRQoLwould help towards a better understanding of their meaning and interest in general population when it comes tocompare with classical objective indicators.OBJECTIVES: The objectives were [1] to assess existing spatial disparities of HRQoL in French generalpopulation and to investigate their evolution in time, [2] to determine individual and contextual determinants ofHRQoL and [3] to explore the ecological associations between HRQoL and subsequent mortality five years later.METHODS: Data were drawn from two large representative cross sectional surveys: the Insee Decennial HealthSurvey led in 2003 (N=22 743 [study 1 and 3] ; N= 16 732 [2]) and the Sofres health survey led in 1995(N=3243 [1]).The MOS SF-36 questionnaire was used in both surveys. [1] Fixed effects linear models combinedwith interaction tests were used for assessing time trends. [2] Mixed effects linear models were used for themultilevel analysis, exploring a causal pathway including individual and macrolevel factors (household, urbanunit and region) assessing demographics, socioeconomics, and features related to the notion of areaattractiveness (deindustrialization, net migration rates). [3] Mortality data were drawn from the French nationalstatistics of mortality (CepiDc-Inserm). Negative binomial regression models were performed to identifyecological associations at the region level between HRQoL recorded in 2003 and subsequent mortality (shortterm [2003-2005]; 5-years later [2007-2009]), stratifying on age, gender and specific causes of death.MAIN RESULTS: [1] A significant decrease in HRQoL was observed between 1995 and 2003, affecting allsociodemographic categories and suggesting likely widening disparities in the most fragile categories. [2]Regional HRQoL disparities were found, persisting after adjusting on socioeconomic individual characteristics.Multilevel analysis showed some evidence for mediation involving contextual factors like deindustrialization,net migration rates, voter abstention rate and health-related behaviors. Cross-level interactions were found aswell. [3] Significant ecological associations were identified at the region level between HRQoL and mortalityfive years later, persisting after adjusting on deprivation. Specific relationships were observed after stratifying onage, gender, specific causes of death; the predictive ability of HRQoL for mortality was varying depending onthe mortality period considered for analysis.CONCLUSIONS: Our results highlight the interest in assessing HRQoL at the population level and in exploringthe contextual determinants at play. Systematic inclusion of validated and multidimensional HRQoLquestionnaires should be supported in national surveys, so as to improve our knowledge of long term temporaltrends in HRQoL, to promote an increased use of contextual multilevel analyses using such data, and eventuallyto help better identifying sub-groups at risk and optimizing public health interventions

Evaluation prospective de l'effet des polymorphismes ACE I/D, ATI A/C et PAI-1 4g /5g sur la survie à long terme après angioplastie coronaire transluminale percutanée

Objectifs : La compréhension des mécanismes à l'origine des maladies cardiovasculaires se heurte à la multitude des facteurs génétiques et environnementaux impliqués. Parmi les polymorphismes << candidats , les génotypes ACE UD, AT1 A/C et PAI-1 4g/5g ont été associés à la survenue de coronaropathies de manière discordante selon les études. L'objectif de notre travail était d'évaluer la relation entre mortalité totale ou cardiologique et polymorphismes, chez des patients ayant bénéficié d'une angioplastie coronaire transluminale percutanée (PCI) au CHU de Caen, Basse Normandie. Méthodes : Après analyse univariée des courbes de survie par la méthode de Kaplan-Meier, une analyse multivariée a été réalisée par modèle semi-paramétrique de Cox. Les covariables incluses dans le modèle étaient : âge, sexe, hypercholestérolémie, hypertension artérielle, antécédents familiaux cardiovasculaires, tabac, diabète, antécédents personnels d'angioplastie ou d'infarctus du myocarde, stade CCS, fraction d'éjection du ventricule gauche, traitement par aspirine, statine, bêta-bloquant, inhibiteur de l'enzyme de conversion, antagonistes des récepteurs de l'angiotensine II, inhibiteur calcique. Résultats : Près de mille patients ayant bénéficié d'une angioplastie coronarienne transluminale percutanée ont été suivis pendant 5,7 années en moyenne. Le taux de mortalité globale était de 16,3% et le taux de mortalité cardiologique était de 6,4%. En analyse univariée, le génotype PAI-1 4g/4g était associé à un excès de mortalité. Après ajustement sur les covariables, aucun polymorphisme génétique étudié n'était significativement associé à un excès de risque de mortalité globale ou cardiologique. En considérant le modèle récessif comparant le génotype homozygote supposé délétère aux deux autres formules génotypiques, les risques relatifs ajustés de décès cardiologique étaient de 0,74 [0,38-1,44] pour ACE D/D, 2,07 [0,85-5,08] pour AT1 C/C et 1,58 [0,87-2,88] pour PAI-1 4g/4g. L'analyse des combinaisons génotypiques et des interactions ne retrouvait pas d'association significative avec la mortalité. Conclusion : Notre travail n'a pas retrouvé de relation significative entre la mortalité globale ou cardiologique et les polymorphismes ACE UD, AT1 A/C et PAI-1 4g/5g, chez des patients ayant bénéficié d'une PCI. L'amélioration des techniques de génotypage devrait permettre la découverte de nouveaux polymorphismes plus spécifiques.ROUEN-BU Médecine-Pharmacie (765402102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF