Health effects of electromagnetic fields and tumors of the central nervous system

Contexte. Au cours du siècle, les expositions aux champs électromagnétiques se sont multipliées avec l'électricité et les moyens de télécommunications. En 2002, les champs électromagnétiques d'extrêmement basse fréquence (CEM-EBF) ont été classés comme possiblement cancérogène pour l'homme, suivis des radiofréquences en 2011. A ce jour, ce rôle cancérigène reste controversé. L'association entre les tumeurs cérébrales (TC) et l'exposition aux champs électromagnétiques a été étudiée dans une étude cas-témoins, CERENAT. Méthodes. Les sujets de plus de 16 ans, résidant dans quatre départements français, avec un diagnostic de TC posé en 2004-2006 ont été inclus, ainsi que 2 témoins appariés par cas. Le calendrier professionnel détaillé et l'utilisation du téléphone portable (TP) ont été recueillis dans un questionnaire standardisé lors d'un entretien en face-à-face afin d'estimer l'exposition aux CEM-EBF (par l'application d'une matrice emploi-exposition), et aux radiofréquences. Résultats. L'étude a inclus 596 cas et 1192 témoins. Aucune association n'a été observée entre l'exposition aux CEM-EBF et les gliomes ou les méningiomes. Pour les neurinomes, le risque augmentait avec l'exposition, non significativement, atteignant un rapport de cotes (RC)=2,7 [0,8-9,0] pour une exposition moyenne sur la vie ≥ 0,2μT. Par ailleurs, l'usage régulier du TP (O/N) n'était pas associé aux TC (RC=1,1 [0,8-1,4]). Cependant, une association significative était observée pour les gliomes chez les plus grands utilisateurs pour une durée cumulée des appels ≥ 896 heures (RC=2,3 [1,4-3,8]). Les risques étaient plus élevés pour les tumeurs temporales, l'utilisation professionnelle et l'utilisation urbaine du téléphone. Conclusion. Nos résultats vont dans le sens des études antérieures, montrant une association entre les tumeurs cérébrales et l'utilisation importante du TP; et l'absence d'association avec l'exposition aux CEM-EBF. Cependant, le lien entre CEM-EBF et neurinomes reste à explorer, de même que le suivi à plus long terme des effets du TP.Context. During the century, exposure to electromagnetic fields have increased with electricity and telecommunications facilities. In 2002, extremely low frequency electromagnetic fields (ELF-EMF) have been classified as possibly carcinogenic to humans, followed by radiofrequencies in 2011. To date, this carcinogenic role remains controversial. We investigated the association between brain tumors and exposure to electromagnetic fields in a case-control study, CERENAT. Methods. Subjects over 16 years, living in four French areas, with a diagnosis of brain tumor in 2004-2006 were included, with 2 matched controls per case. The detailed occupational history and mobile telephone use were collected in a standardized questionnaire during a face- to-face interview to estimate exposure to ELF-EMF (using job-exposure matrix) and to radiofrequencies. Results. The study included 596 cases and 1192 controls. No association was observed between exposure to ELF-EMF and gliomas or meningiomas. For neuromas, the risk increased with exposure, not significantly, reaching an odds ratio (OR)=2.7 [0.8 - 9.0] for a life-long mean exposure ≥ 0.2 μT. Moreover, regular use of mobile phone (Y/ N) was not associated with brain tumor (OR=1.1 [0.8 - 1.4]). However, a significant association was observed for gliomas in the heaviest users when considering a life-long cumulative duration of calls ≥ 896 hours (OR=2.3 [1.4 - 3.8]). Risks were higher for temporal tumors, occupational or urban mobile phone use. Conclusion. Our results are consistent with previous studies showing an association between brain tumors and the extensive use of MP, and no association with exposure to ELF-EMF. However, the association between ELF-EMF and neuromas remains to be explored, as well as the follow of mobile phone effects in the long term

Health effects of electromagnetic fields and tumors of the central nervous system

Contexte. Au cours du siècle, les expositions aux champs électromagnétiques se sont multipliées avec l'électricité et les moyens de télécommunications. En 2002, les champs électromagnétiques d'extrêmement basse fréquence (CEM-EBF) ont été classés comme possiblement cancérogène pour l'homme, suivis des radiofréquences en 2011. A ce jour, ce rôle cancérigène reste controversé. L'association entre les tumeurs cérébrales (TC) et l'exposition aux champs électromagnétiques a été étudiée dans une étude cas-témoins, CERENAT. Méthodes. Les sujets de plus de 16 ans, résidant dans quatre départements français, avec un diagnostic de TC posé en 2004-2006 ont été inclus, ainsi que 2 témoins appariés par cas. Le calendrier professionnel détaillé et l'utilisation du téléphone portable (TP) ont été recueillis dans un questionnaire standardisé lors d'un entretien en face-à-face afin d'estimer l'exposition aux CEM-EBF (par l'application d'une matrice emploi-exposition), et aux radiofréquences. Résultats. L'étude a inclus 596 cas et 1192 témoins. Aucune association n'a été observée entre l'exposition aux CEM-EBF et les gliomes ou les méningiomes. Pour les neurinomes, le risque augmentait avec l'exposition, non significativement, atteignant un rapport de cotes (RC)=2,7 [0,8-9,0] pour une exposition moyenne sur la vie ≥ 0,2μT. Par ailleurs, l'usage régulier du TP (O/N) n'était pas associé aux TC (RC=1,1 [0,8-1,4]). Cependant, une association significative était observée pour les gliomes chez les plus grands utilisateurs pour une durée cumulée des appels ≥ 896 heures (RC=2,3 [1,4-3,8]). Les risques étaient plus élevés pour les tumeurs temporales, l'utilisation professionnelle et l'utilisation urbaine du téléphone. Conclusion. Nos résultats vont dans le sens des études antérieures, montrant une association entre les tumeurs cérébrales et l'utilisation importante du TP; et l'absence d'association avec l'exposition aux CEM-EBF. Cependant, le lien entre CEM-EBF et neurinomes reste à explorer, de même que le suivi à plus long terme des effets du TP.Context. During the century, exposure to electromagnetic fields have increased with electricity and telecommunications facilities. In 2002, extremely low frequency electromagnetic fields (ELF-EMF) have been classified as possibly carcinogenic to humans, followed by radiofrequencies in 2011. To date, this carcinogenic role remains controversial. We investigated the association between brain tumors and exposure to electromagnetic fields in a case-control study, CERENAT. Methods. Subjects over 16 years, living in four French areas, with a diagnosis of brain tumor in 2004-2006 were included, with 2 matched controls per case. The detailed occupational history and mobile telephone use were collected in a standardized questionnaire during a face- to-face interview to estimate exposure to ELF-EMF (using job-exposure matrix) and to radiofrequencies. Results. The study included 596 cases and 1192 controls. No association was observed between exposure to ELF-EMF and gliomas or meningiomas. For neuromas, the risk increased with exposure, not significantly, reaching an odds ratio (OR)=2.7 [0.8 - 9.0] for a life-long mean exposure ≥ 0.2 μT. Moreover, regular use of mobile phone (Y/ N) was not associated with brain tumor (OR=1.1 [0.8 - 1.4]). However, a significant association was observed for gliomas in the heaviest users when considering a life-long cumulative duration of calls ≥ 896 hours (OR=2.3 [1.4 - 3.8]). Risks were higher for temporal tumors, occupational or urban mobile phone use. Conclusion. Our results are consistent with previous studies showing an association between brain tumors and the extensive use of MP, and no association with exposure to ELF-EMF. However, the association between ELF-EMF and neuromas remains to be explored, as well as the follow of mobile phone effects in the long term

Interdisciplinary and differentiated learning of Statistics in an online MPH

International audienceStatistical literacy is necessary for evidence-based public health practice. However, introductory statistics courses can be challenging and stressful for continuing education students. The Master of Public Health program at the University of Bordeaux offers an international open and distance learning program to address the increasing demand for public health education from working professionals who have limited time for training or geographical constraints. To enhance the learning experience, the program has developed problem-based approaches based on epidemiological studies and data by integrating statistics and epidemiology courses. Additionally, the program adapts coding learning objectives to students' skills and career plans by teaching R with two interfaces. While RStudio is recommended for students planning to enter data sciences as it requires more advanced coding skills, R Commander is suitable for students with weak computer skills and those who don’t plan to evolve in data sciences. This strategy has proven to be an effective compromise

Identification des tumeurs incidentes du système nerveux central à partir des données du Programme de médicalisation des systèmes d'information (PMSI) et du registre des tumeurs primitives du système nerveux central de la Gironde

BORDEAUX2-BU Santé (330632101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

RF and ELF electromagnetic field exposure of children in the french ELFE birth cohort

Background: Knowledge on Radiofrequency (RF) and Extremely Low Frequency (ELF) electromagnetic fields (EMF) exposure of children remains scarce, despite their growing use and their potential health effects. There is a need for studies taking into account every source of children exposure, including emerging ones, with longitudinal design to capture changes while growing, from in-utero to the adolescence. Aims: to characterize and follow RF and ELF exposure in children of the French ELFE birth cohort. Methods: 18918 children born in 2011 have been included. RF and ELF exposure will be assessed by questionnaires. Jobs and company activity will be coded with international classifications, and a job-exposure matrix will be applied to assess maternal occupational exposure during pregnancy. Domestic uses (Wi-Fi, cordless phone, mobile phone, electrical appliances, transportation means...) will be collected on questionnaires. Residential exposure will be assessed by using geocoded residential addresses and mapping of EMF sources. An exposure study will be performed in a subgroup of 400 children (when 3 yrs old). Housing and household characteristics and a time-activity diary will be completed, and numerous RF bands and ELF 50Hz will be measured at different places in each room and during 24 h in the living room. Results: questionnaires at birth, 2 months and 1 year of life have been already administered, and follow-up at 2 years is scheduled in 2013. Perspectives: Interactions between EMF and other radiations or chemical exposures will be studied, in relation with health outcomes collected at each follow-up. Other factors influencing children's health and development (social, psychological, medical and familial factors), also collected will allow an accurate assessment of the etiology of health events. Future collaboration with other international birth cohorts to better understand the etiology of rare diseases such as pediatric cancers will be considered

Trends in probabilities of death owing to cancer and owing to other causes in patients with colon cancer

IF 2.014 (2017)International audienceBACKGROUND: It is of interest to both the clinicians and patients to estimate the probability of death owing to cancer in the presence of other causes as time elapses since diagnosis. The objective of this study was to depict for patients diagnosed with colon cancer between 1990 and 2010 in France, the probability of surviving up to 10 years after diagnosis and to disentangle the probability of death owing to cancer from that of death owing to other causes.PATIENTS AND METHODS: Individuals with cancer were described, up to 10 years after diagnosis, as belonging to one of three categories: those who died owing to a cause related to cancer, those who died owing to another cause and those who survived. Net survival, crude probabilities of death related to colon cancer, death related to another cause and survival were estimated by modeling excess mortality hazard.RESULTS: In women of all ages, 5 and 10-year net survival improved over calendar time. The 10-year probability of survival decreased when age increased in both sexes. It was higher in women than in men, and this difference increased with age. Crude probabilities of death related to colon cancer decreased between 1990 and 2010 for men and women, although this was not observed in the eldest men.CONCLUSION: Crude probability of death related to colon cancer is an important indicator for patients and health policy makers. Results of cancer screening should be faced to trends in probability of death related to colorectal cancer

Quality indicators for colorectal cancer surgery and care according to patient-, tumor-, and hospital-related factors

Abstract Background Colorectal cancer (CRC) care has improved considerably, particularly since the implementation of a quality of care program centered on national evidence-based guidelines. Formal quality assessment is however still needed. The aim of this research was to identify factors associated with practice variation in CRC patient care. Methods CRC patients identified from all cancer centers in South-West France were included. We investigated variations in practices (from diagnosis to surgery), and compliance with recommended guidelines for colon and rectal cancer. We identified factors associated with three colon cancer practice variations potentially linked to better survival: examination of ≥12 lymph nodes (LN), non-use and use of adjuvant chemotherapy for stage II and stage III patients, respectively. Results We included 1,206 patients, 825 (68%) with colon and 381 (32%) with rectal cancer, from 53 hospitals. Compliance was high for resection, pathology report, LN examination, and chemotherapy use for stage III patients. In colon cancer, 26% of stage II patients received adjuvant chemotherapy and 71% of stage III patients. 84% of stage US T3T4 rectal cancer patients received pre-operative radiotherapy. In colon cancer, factors associated with examination of ≥12 LNs were: lower ECOG score, advanced stage and larger hospital volume; factors negatively associated were: left sided tumor location and one hospital district. Use of chemotherapy in stage II patients was associated with younger age, advanced stage, emergency setting and care structure (private and location); whereas under-use in stage III patients was associated with advanced age, presence of comorbidities and private hospitals. Conclusions Although some changes in practices may have occurred since this observational study, these findings represent the most recent report on practices in CRC in this region, and offer a useful methodological approach for assessing quality of care. Guideline compliance was high, although some organizational factors such as hospital size or location influence practice variation. These factors should be the focus of any future guideline implementation.</p

Validation and comparison of simple noninvasive indexes for predicting liver fibrosis in HIV-HCV-coinfected patients: ANRS CO3 Aquitaine cohort.: Non invasive fibrosis indexes in HIV-HCV coinfected patients

International audienceBACKGROUND: Although an increasing number of noninvasive fibrosis markers are available in HCV-monoinfected patients, data on the performance of these tests in HIV-HCV-coinfected patients are lacking. OBJECTIVE: To assess the diagnostic performance for predicting hepatic fibrosis stage of four simple and inexpensive noninvasive indexes (FIB-4, APRI, Forns, and platelet count) in HIV-HCV-coinfected patients. METHODS: Two hundred consecutive HIV-HCV-coinfected patients from the ANRS-CO3 Aquitaine cohort who underwent liver biopsy were studied. Fibrosis stage was assessed according to Metavir scoring system by a single pathologist unaware of the data of the patients. Diagnostic performances were assessed by measuring the areas under the receiver operating characteristic curves (AUROC) and the percentage of patients correctly identified (PCI). RESULTS: For predicting significant fibrosis (F > or = 2), APRI, Forns index, and FIB-4 had AUROCS of 0.77, 0.75, and 0.79, with 39%, 25%, and 70% of PCI, respectively. For predicting severe fibrosis (F > or = 3), FIB-4 had AUROC of 0.77 with 56% of PCI. For predicting cirrhosis (F4), FIB-4, APRI, and platelet count had AUROCs of 0.80, 0.79, and 0.78, with 59%, 60%, and 76% of PCI, respectively. Overall, diagnostic performances of the different indexes did not differ significantly for both significant fibrosis and cirrhosis. CONCLUSION: The use of these noninvasive indexes could save liver biopsies in up to 56-76% of cases for the prediction of severe fibrosis-cirrhosis. However, given the high percentage of misclassified cases for significant fibrosis, such indexes do not appear currently suitable for use in clinical practice in HIV-HCV-coinfected patients

Quality indicators for colorectal cancer surgery and care according to patient-, tumor-, and hospitalrelated factors.

International audienceABSTRACT: Background and methods: Colorectal cancer (CRC) care has considerably improved considerably, particularly since the implementation of a quality of care program centered around national evidence-based guidelines. Formal quality assessmentevaluation of the quality of care is however still needed. The aim of this research was to identify factors associated with practice variation in CRC patient care. CRC patients identified from all cancer centers in South-West France were included. We investigated variations in practices (from diagnosis to surgery), and compliance with recommended guidelines for colon and rectal cancer. We identified factors associated with three colon cancer practice variations potentially linked to better survival: examination of [greater than or equal to]12 lymph nodes (LN), non-use and use of adjuvant chemotherapy for stage II and stage III patients, respectively. RESULTS: We included 1,206 patients, 825 (68%) with colon and 381 (32%) with rectal cancer, from 53 hospitals. For major practices cCompliance was high for (resection, pathology report, LN examination, and chemotherapy use for stage III patients. In). For colon cancer, patients, 26% of stage II patients received adjuvant chemotherapy and 71% of stage III patients. 84% of stage US T3T4 rectal cancer patients received pre-operative radiotherapy. In For colon cancer patients, factors associated with examination of <=12 LNs were: lower ECOG score, advanced stage and larger hospital volume; factors negatively associated were: left sided tumor location and one hospital district. Use of chemotherapy in stage II patients was associated with younger age, advanced stage, emergency setting and care structure (private and location); whereas under-use in stage III patients was associated with advanced age, presence of comorbidities and private hospitals. Limitations and conclusions: Although some changes in practices may have occurred since this observational study, these findings represent the most recent report on practices in CRC in this region, and offer a useful methodological approach for assessing quality of care. Guideline compliance was high, although several practice variations were highlighted in particular based on some organizational factors such as hospital size or location influence practice variation. These factors should be the focus of any future guideline implementation

Mobile phone use and brain tumours in the CERENAT case-control study

International audienceThe carcinogenic effect of radiofrequency electromagnetic fields in humans remains controversial. However, it has been suggested that they could be involved in the aetiology of some types of brain tumours.Objectives: The objective was to analyse the association between mobile phone exposure and primary central nervous system tumours (gliomas and meningiomas) in adults.Methods: CERENAT is a multicenter case-control study carried out in four areas in France in 2004-2006. Data about mobile phone use were collected through a detailed questionnaire delivered in a face-to-face manner. Conditional logistic regression for matched sets was used to estimate adjusted ORs and 95% CIs.Results: A total of 253 gliomas, 194 meningiomas and 892 matched controls selected from the local electoral rolls were analysed. No association with brain tumours was observed when comparing regular mobile phone users with non-users (OR=1.24; 95% CI 0.86 to 1.77 for gliomas, OR=0.90; 95% CI 0.61 to 1.34 for meningiomas). However, the positive association was statistically significant in the heaviest users when considering life-long cumulative duration (≥896 h, OR=2.89; 95% CI 1.41 to 5.93 for gliomas; OR=2.57; 95% CI 1.02 to 6.44 for meningiomas) and number of calls for gliomas (≥18,360 calls, OR=2.10, 95% CI 1.03 to 4.31). Risks were higher for gliomas, temporal tumours, occupational and urban mobile phone use.Conclusions: These additional data support previous findings concerning a possible association between heavy mobile phone use and brain tumours