Risk for non Hodgkin’s lymphoma in the vicinity of French municipal solid waste incinerators

<p>Abstract</p> <p>Background</p> <p>Dioxin emissions from municipal solid waste incinerators are one of the major sources of dioxins and therefore are an exposure source of public concern. There is growing epidemiologic evidence of an increased risk for non-Hodgkin's lymphoma (NHL) in the vicinity of some municipal solid waste incinerators with high dioxin emission levels. The purpose of this study was to examine this association on a larger population scale.</p> <p>Methods</p> <p>The study area consisted of four French administrative departments, comprising a total of 2270 block groups. NHL cases that had been diagnosed during the period 1990–1999, and were aged 15 years and over, were considered. Each case was assigned a block group by residential address geocoding. Atmospheric Dispersion Model System software was used to estimate immissions in the surroundings of 13 incinerators which operated in the study area. Then, cumulative ground-level dioxin concentrations were calculated for each block group. Poisson multiple regression models, incorporating penalized regression splines to control for covariates and dealing with Poisson overdispersion, were used. Five confounding factors were considered: population density, urbanisation, socio-economic level, airborne traffic pollution, and industrial pollution.</p> <p>Results</p> <p>A total of 3974 NHL incident cases was observed (2147 among males, and 1827 among females) during the 1990–1999 time period. A statistically significant relationship was found at the block group level between risk for NHL and dioxin exposure, with a relative risk (RR) of 1.120 (95% confidence interval [CI] 1.002 – 1.251) for persons living in highly exposed census blocks compared to those living in slightly exposed block groups. Population density appeared positively linked both to risk for NHL and dioxin exposure. Subgroup multivariate analyses per gender yielded a significant RR for females only (RR = 1.178, 95% CI 1.013 – 1.369).</p> <p>Conclusion</p> <p>This study, in line with previous results obtained in the vicinity of the incinerator located in Besançon (France), adds further evidence to the link between NHL incidence and exposure to dioxins emitted by municipal solid waste incinerators. However, the findings of this study cannot be extrapolated to current incinerators, which emit lower amounts of pollutants.</p

Intérêt du PMSI dans l'analyse de l'état de santé d'un territoire (l'exemple de l'Alsace Bossue)

STRASBOURG-Medecine (674822101) / SudocSudocFranceF

Evaluation de l'exposition professionnelle pour l'épidémiologie prospective (propositions de stratégies de mesures)

Dans le cadre de l'épidémiologie professionnelle prospective, notre objectif est de proposer une stratégie optimisée de répartition d'un nombre prédéterminé de mesurages de l'exposition entre différents groupes d'exposition homogènes, caractérisant différentes tâches .Notre méthode a consisté, sur la base de données réelles à simuler l'évolution historique de plusieurs populations industrielles, les différents postes de travail et les tâches exécutées en leur sein, lesquelles sont considérées comme des groupes d'exposition homogène. A partir de ces données l'exposition journalière est simulée pour chaque sujet. Les différentes stratégies de mesurage consistant en un nombre annuel de mesurages pour chacune des tâches ont été simulées de même que l'état de santé à un moment t sous l'hypothèse d'un effet linéaire de l'exposition cumulée. Les critères de comparaison des stratégies consistaient en erreurs quadratiques moyennes sur les estimations de l'exposition cumulée et sur les pentes doses réponses estimées lors d'une étude transversale à l'instant t. La stratégie qui a été retenue comme optimale consiste à répartir annuellement les mesurages proportionnellement à l'estimation de l'erreur type de l'exposition moyenne dans chaque groupe d'exposition. Cette erreur type est estimée en fonction de l'effectif, des résultats des mesurages passés, des durées d'exposition ainsi que d'une idée à priori sur les écarts types géométriques des mesurages dans des groupes d'exposition homogènes. Cette stratégie est applicable en hygiène industrielle, son optimalité demande cependant à être validée dans d'autres circonstances, notamment si l'effet de l'exposition n'est pas cumulatif.LYON1-BU.Sciences (692662101) / SudocSudocFranceF

Congenitally missing teeth and labio-palatal clefts: keep to the left

Objectives: dental anomalies are more frequent for individuals with clefts than for the general population. Our objective is to evaluate the prevalence of dental ageneses in a sampling from Alsace made up of 124 children with clefts (81 boys and 43 girls, average age 12.5 years old). Method: clinical and radiographic exams make it possible to specify the dental formula as well as the type of clefts that are divided into 4 groups: simple Labial Clefts (LC – 12.9%), Labio-Alveolar Clefts (LAC – 4%), Labio-Palatal Clefts (LPC – 49.2%) and Palatal Clefts (PC – 33.9%). Results: 63% of the patients present one or more ageneses mainly involving the maxillary lateral incisors (54%) and the maxillary or mandibular second premolars (32%). The percentage of children with congenitally missing teeth is, in ascending order, minimal in the case of LC (33%), average in the case of PC (54%) and highest in cases of LPC (79%). The frequency of ageneses increases proportionally with the severity of the cleft. The left side is most affected (p < 0.01) regardless of the side of the cleft. Conclusions: dental ageneses are more frequent on the left side, regardless of the side of the cleft. The greater prevalence on the left side could suggest the intervention of overlapping etiopathogenic factors when clefts and dental ageneses are involved

Agénésies dentaires et fentes labio-palatines : priorité à gauche

Objectifs : les anomalies dentaires sont plus fréquentes chez les individus porteurs de fentes que dans la population générale. Notre objectif est d’évaluer la prévalence des agénésies dentaires dans un échantillon alsacien composé de 124 enfants porteurs de fentes (81 garçons et 43 filles, âge moyen 12,5 ans). Méthode : les examens clinique et radiographique permettent de préciser la formule dentaire ainsi que le type de fentes qui sont classées en 4 groupes : Fente Labiale pure (FL - 12.9%), Fente Labio-Alvéolaire (FLA - 4 %), Fente Labio-Palatine (FLP - 49.2 %) et Fente Palatine (FP - 33.9 %). Résultats : 63 % des patients présentent une ou plusieurs agénésies dentaires touchant essentiellement les incisives latérales maxillaires (54 %) et les secondes prémolaires maxillaires ou mandibulaires (32%). Le pourcentage d’enfants avec agénésies est, par ordre croissant, minimal en cas de FL (33%), moyen en cas de FP (54%) et culmine en cas de FLP (79%). La fréquence des agénésies augmente avec la sévérité de la fente. Le côté gauche est le plus atteint (p <0.01) quel que soit le côté de la fente. Conclusions : les agénésies dentaires sont plus fréquentes du côté gauche, quel que soit le côté de la fente. Cette prévalence à gauche pourrait suggérer l’intervention de facteurs étiopathogéniques communs à la survenue des fentes et des agénésies dentaires

Effect of emergency start and central venous catheter on outcomes in incident hemodialysis patients: a prospective observational cohort

International audienceBackground: Unfavorable conditions at hemodialysis inception reduce the survival rate. However, the relative contribution to outcomes of predialysis follow-up, symptoms, emergency start or central venous catheter (CVC) is unknown.Methods: We analyzed the determinants of survival according to dialysis initiation conditions in the nationwide REIN registry, using two methods based either on clinical classification or data mining. We divided patients into four groups according to dialysis initiation (emergency vs planned, symptoms or not, previous follow-up). "Followed planned starters" began dialysis as outpatients and with an arteriovenous fistula (AVF). "Followed symptomatic non-urgent starters" were patients who started earlier because of any non-urgent symptomatic event. "Followed urgent starters" had seen a nephrologist before inception but started dialysis in an emergency condition. "Unknown urgent starters" were patients without any follow-up and who had a CVC at inception.Results: "Followed urgent" starters had the lowest 2-year survival rate (66.8%) compared to "followed planned" (77.3%), "followed symptomatic non urgent" (79.2%), and "unknown urgent" (71.7%). Compared to other groups, the risk of mortality was lower in followed symptomatic non urgent (HR 0.86 95% CI 0.75-0.99) and higher in followed urgent starters (HR 1.05 (95% CI 0.94-1.18). In data mining Classification And Regression Tree regrouping in five categories, the lowest 2-year survival (52.3%) was in over 70-year-old starters with a CVC. The survival was 93.2% in under 57-year-old patients without active cancer, 82.5% in 57-70-year-old individuals without cancer, 72.4% in over 70-year-old patients without CVC and 61.4% in under 70-year-old subjects with cancer. The hazard ratio of data mining categories varied between 2.12 (95% CI 1.73-2.60) in 57-70-year-old subjects without cancer and 4.42 (95% CI 3.64-5.37) in over 70-year-old patients with CVC. Therefore, regrouping incident patients into five data mining categories, identified by age, cancer, and CVC use, could discriminate the 2-year survival in patients starting hemodialysis.Conclusions: Although each classification captured different prognosis information, both analyses showed that starting hemodialysis on a CVC has more dramatic outcomes than emergency start per se

Evaluating the Portability of Rheumatoid Arthritis Phenotyping Algorithms: case study on French EHRs

International audiencePrevious work has successfully used machine learning and natural language processing for the phenotyping of Rheumatoid Arthritis (RA) patients in hospitals within the United States and France. Our goal is to evaluate the adaptability of RA phenotyping algorithms to a new hospital, both at the patient and encounter levels. Two algorithms are adapted and evaluated with a newly developed RA gold standard corpus, including annotations at the encounter level. The adapted algorithms offer comparably good performance for patient-level phenotyping on the new corpus (F1 0.68 to 0.82), but lower performance for encounter-level (F1 0.54). Regarding adaptation feasibility and cost, the first algorithm incurred a heavier adaptation burden because it required manual feature engineering. However, it is less computationally intensive than the second, semi-supervised, algorithm