Pronostic de la démence

A better understanding of the prognosis of dementia could help to provide appropriate care in the disease. At individual level, the need to obtain information on the possible evolution of the disease is caregivers’ prime expectation. At societal level and from a public health point of view, it seems necessary that health policies anticipate needs in care, home care, case managers... The general objective of this thesis was to study the prognosis of dementia to improve the care of patients with Alzheimer's disease or related disorders. We worked from incident cases of dementia of two population-based, long-term cohort studies: Paquid (Personnes Agées QUID) cohort and the Three Cities. First, we studied survival prognosis. Overall, it seems difficult to predict death from only prognostic factors related to dementia. The death in dementia may be linked to dementia itself but also to other factors non-related to dementia and therefore difficult to predict. Secondly, we studied the prognosis of functional abilities. Few literature exists on the functional evolution in dementia. We identified a perfect hierarchy in the sequence of occurrence of total disability in 4 basic activities of daily living: bathing and/or dressing, followed by transferring and/or feeding. From a pragmatic point of view, characterizing the dependency in bathing or dressing is crucial to improve care in dementia. The independent prognosis factors on bathing and dressing disabilities occurrence, adjusted on death risk were: age greater than 80 years at time of diagnosis of dementia, a diagnosis of vascular dementia, disabilities in three or four activities out of the four IADL scale of Lawton and poor or very poor subjective health at time of diagnosis of dementia. Based on this thesis, we have a gained a better knowledge of the evolution of functional abilities in dementia. However, it is difficult to predict the course of the disease; dementia being a multifactorial disease for which there is a very high interindividual variability on the progression of the disease.Mieux connaitre le pronostic de la démence peut aider à anticiper la prise en charge de la maladie. Au niveau individuel, le besoin d’obtenir de l’information sur les évolutions possibles de la maladie est la première attente des aidants. Au niveau sociétal, d’un point de vue santé publique, il semble nécessaire que les politiques de santé puissent anticiper les besoins en matière de prise en charge, d’aide à domicile, de structure d’accueil, d’équipes spécialisées, de gestionnaires de cas pour les cas complexes. L’objectif général de cette thèse était d’étudier le pronostic des sujets atteints de démence pour améliorer la prise en charge des malades atteints de maladie d’Alzheimer ou de syndromes apparentés. Les travaux de cette thèse ont été réalisés à partir des cas incidents de démence de deux cohortes en population : la cohorte Paquid (Personnes Agées QUID) et la cohorte des Trois Cités. Dans une première partie, nous avons étudié le pronostic de la survie. Globalement, il semble difficile de prédire le décès à partir de facteurs pronostiques seulement liés à la démence. Les décès dans la démence peuvent être liés à la démence elle-même mais aussi à d’autres causes non liées à la démence et sont donc difficiles à prédire. Dans une deuxième partie nous nous sommes intéressés au pronostic des capacités fonctionnelles. Peu de littérature existe sur l’évolution et le pronostic des capacités fonctionnelles. Nous avons montré une hiérarchie de l’atteinte des activités de bases de la vie quotidienne chez les sujets déments avec une atteinte dans un premier temps de la toilette ou de l’habillage puis dans un deuxième temps de la locomotion ou de l’alimentation. D’un point du vue pragmatique, étudier le passage vers l’incapacité à la toilette ou à l’habillage a un réel intérêt pour améliorer la prise en charge des patients. Les facteurs pronostiques indépendants de la survenue d’une incapacité à la toilette ou à l’habillage ajustés sur le risque de décès étaient : un âge supérieur à 80 ans au moment du diagnostic de démence, un diagnostic de démence vasculaire, l’atteinte de trois ou quatre activités sur l’échelle des quatre IADL de Lawton et une santé subjective mauvaise ou très mauvaise au moment du diagnostic de démence. Les travaux de cette thèse nous ont permis de mieux connaitre l’évolution des capacités fonctionnelles dans la démence. Toutefois, il est difficile de prédire l’évolution de la maladie, la démence étant une maladie multi-factorielle pour laquelle il existe une variabilité interindividuelle très importante concernant la progression de la maladie

Int J Environ Res Public Health

In 2015, the International Federation of Gynecology and Obstetrics established the prevention of exposures to environmental reprotoxic substances as a priority for health professionals. However, available information about reproductive hazards is voluminous, dispersed, and complex, and this is a severe limitation for physicians to incorporate the prevention of environmental exposure into standard preventive care. One difficulty frequently cited by physicians is the lack of evidence-based information. The objective of our study was to identify a list of environmental chemical hazards to reproduction. We used lists present in relevant regulations or included in scientific reports or databases to identify reproductive hazards. The reproductive hazards were prioritized according to the strength of evidence concerning their impact on fertility or development of the offspring. We identified 1251 reproductive hazards. Our prioritization approach resulted in a high-priority classification for 462 risk factors belonging to the following eight classes: drugs (n = 206), metals (n = 116), pesticides (n = 38), organic solvents (n = 27), synthesizing and/or processing agents in industrial processes (n = 23), phthalates (n = 13), perfluorinated compounds (n = 13), and other compounds (n = 26). Despite the limitations of this work, the generated lists constitute a useful working basis to put in place innovative environmental preventive measures according to the principle of evidence-based medicine

Biomechanical and organisational constraints of pregnant women at work: definition of exposure levels using a consensus method (Delphi)

OBJECTIVES: To identify the biomechanical and organisational constraints that influence pregnancy outcomes and define the exposure levels at which the risks for pregnancy become significant. SETTING AND PARTICIPANTS: We applied a consensus method (Delphi) consisting of a literature review followed by expert opinions on exposure levels. The group of experts was made up of 12 people from different medical specialities and working in various structures in France. OUTCOME MEASURES: The studied variables were: (1) exposure: night work/shift work, weekly hours at work, lifting of heavy loads, prolonged standing and multiple exposure and (2) pregnancy outcomes: prematurity, low birth weight and spontaneous miscarriages. RESULTS: The consensus method resulted in the following recommendations. The time spent working must not exceed 40 hours/week; in the absence of a consensus on the level of exposure, night and/or shift work must be avoided; prolonged standing must not exceed 3 hours/day; lifting must be limited to carrying loads <11 kg, with a daily load <100 kg; multiple exposure must be avoided, in particular: vibration, night work/shift work, time spent working exceeding 40 hours/week, prolonged standing and lifting of heavy loads. CONCLUSIONS: These results could help the occupational physician to address the question of whether an exposed employee should remain at work, considering her individual characteristics (medical history, family situation, socioeconomic level, etc) in consultation with pregnancy specialists (obstetricians, midwives)

PLoS One

The assessment of residential exposure to agricultural pesticides is a major issue for public health, regulatory and management purposes. In recent years, research into this field has developed considerably. The purpose of this scoping review is to provide an overview of scientific literature characterizing residential exposure to agricultural pesticides and to identify potential gaps in this research area. This work was conducted according to the JBI and PRISMA guidelines. Three databases were consulted. At least two experts selected the eligible studies. Our scoping review enabled us to identify 151 articles published between 1988 and 2019 dealing with the assessment of residential exposure to agricultural pesticides. Of these, 98 (64.9%) were epidemiological studies investigating possible links between pesticide exposure and the onset of adverse health effects, principally cancers and reproductive outcomes. They predominantly used Geographic Information Systems and sometimes surveys or interviews to calculate surrogate exposure metrics, the most common being the amounts of pesticides applied or the surface area of crops around the dwelling. Twenty-six (17.2%) were observational measurement studies conducted to quantify levels of pesticide exposure and identify their possible determinants. These studies assessed exposure by measuring pesticides in biological and environmental matrices, mostly in urines and house dust. Finally, we found only eight publications (5.3%) that quantified the risk to human health due to residential exposure for management purposes, in which exposure was mainly determined using probabilistic models. Pesticide exposure appears to be largely correlated with the spatial organization of agriculture activities in a territory. The determinants and routes of exposure remain to be explored to improve the conduct of epidemiological and risk assessment studies and to help prevent future exposures. Improvement could be expected from small-scale studies combining different methods of exposure assessment

Int J Environ Res Public Health

BACKGROUND: Female surgeons are exposed to physical and mental stressors that differ from those of other specialties. We aimed to assess whether female surgeons are more at risk of pregnancy complications than women in other medical specialties. METHODS: We used a cross-sectional electronic survey of female physicians working in the French Region Nouvelle-Aquitaine who were pregnant between 2013 and 2018. A pregnancy complication was defined as the occurrence of miscarriage, ectopic pregnancy, fetal growth restriction, prematurity, fetal congenital malformation, stillbirth, or medical termination of the pregnancy. Multivariate logistic regression models were used to evaluate the risk of pregnancy complications for female surgeons relative to women practicing in other medical specialties. RESULTS: Among the 270 women included, 52 (19.3%) experienced pregnancy complications and 28 (10.4%) were surgeons. In the multivariate analysis, female surgeons had a higher risk of pregnancy complications: adjusted odds ratio = 3.53, 95% confidence interval [1.27-9.84]. CONCLUSION: Further research is necessary to identify the hazards specifically involved in the practice of surgery to be able to propose preventive actions targeted to female surgeons during their pregnancy

BMJ Open

OBJECTIVE: To evaluate the effect of air pollution, from oocyte retrieval to embryo transfer, on the results of in vitro fertilisation (IVF) in terms of clinical pregnancy rates, at two fertility centres, from 2013 to 2019. DESIGN: Exploratory retrospective cohort study. SETTING: This retrospective cohort study was performed in the Reproductive Biology Department of Bordeaux University Hospital localised in Bordeaux, France and the Jean Villar Fertility Center localised in Bruges, France. PARTICIPANTS: This study included 10 763 IVF attempts occurring between January 2013 and December 2019, 2194 of which resulted in a clinical pregnancy. PRIMARY AND SECONDARY OUTCOME MEASURES: The outcome of the IVF attempt was recorded as the presence or absence of a clinical pregnancy; exposure to air pollution was assessed by calculating the cumulative exposure of suspended particulate matter, fine particulate matter, black carbon, nitrogen dioxide and ozone (O(3)), over the period from oocyte retrieval to embryo transfer, together with secondary exposure due to the presence of the biomass boiler room, which was installed in 2016, close to the Bordeaux University Hospital laboratory. The association between air pollution and IVF outcome was evaluated by a random-effects logistic regression analysis. RESULTS: We found negative associations between cumulative O(3) exposure and clinical pregnancy rate (OR=0.92, 95% CI = (0.86 to 0.98)), and between biomass boiler room exposure and clinical pregnancy rate (OR=0.75, 95% CI = (0.61 to 0.91)), after adjustment for potential confounders. CONCLUSION: Air pollution could have a negative effect on assisted reproductive technology results and therefore precautions should be taken to minimise the impact of outdoor air on embryo culture

Interstitial Lung Abnormalities Detected by CT in Asbestos-Exposed Subjects Are More Likely Associated to Age

OBJECTIVE: the aim of this study was to evaluate the association between interstitial lung abnormalities, asbestos exposure and age in a population of retired workers previously occupationally exposed to asbestos. METHODS: previously occupationally exposed former workers to asbestos eligible for a survey conducted between 2003 and 2005 in four regions of France, underwent chest CT examinations and pulmonary function testing. Industrial hygienists evaluated asbestos exposure and calculated for each subject a cumulative exposure index (CEI) to asbestos. Smoking status information was also collected in this second round of screening. Expert radiologists performed blinded independent double reading of chest CT-scans and classified interstitial lung abnormalities into: no abnormality, minor interstitial findings, interstitial findings inconsistent with UIP, possible or definite UIP. In addition, emphysema was assessed visually (none, minor: emphysema 50% of the lung). Logistic regression models adjusted for age and smoking were used to assess the relationship between interstitial lung abnormalities and occupational asbestos exposure. RESULTS: the study population consisted of 2157 male subjects. Interstitial lung abnormalities were present in 365 (16.7%) and emphysema in 444 (20.4%). Significant positive association was found between definite or possible UIP pattern and age (OR adjusted =1.08 (95% CI: 1.02-1.13)). No association was found between interstitial abnormalities and CEI or the level of asbestos exposure. CONCLUSION: presence of interstitial abnormalities at HRCT was associated to aging but not to cumulative exposure index in this cohort of former workers previously occupationally exposed to asbestos

Deep Learning for the Automatic Quantification of Pleural Plaques in Asbestos-Exposed Subjects

OBJECTIVE: This study aimed to develop and validate an automated artificial intelligence (AI)-driven quantification of pleural plaques in a population of retired workers previously occupationally exposed to asbestos. METHODS: CT scans of former workers previously occupationally exposed to asbestos who participated in the multicenter APEXS (Asbestos PostExposure Survey) study were collected retrospectively between 2010 and 2017 during the second and the third rounds of the survey. A hundred and forty-one participants with pleural plaques identified by expert radiologists at the 2nd and the 3rd CT screenings were included. Maximum Intensity Projection (MIP) with 5 mm thickness was used to reduce the number of CT slices for manual delineation. A Deep Learning AI algorithm using 2D-convolutional neural networks was trained with 8280 images from 138 CT scans of 69 participants for the semantic labeling of Pleural Plaques (PP). In all, 2160 CT images from 36 CT scans of 18 participants were used for AI testing versus ground-truth labels (GT). The clinical validity of the method was evaluated longitudinally in 54 participants with pleural plaques. RESULTS: The concordance correlation coefficient (CCC) between AI-driven and GT was almost perfect (>0.98) for the volume extent of both PP and calcified PP. The 2D pixel similarity overlap of AI versus GT was good (DICE = 0.63) for PP, whether they were calcified or not, and very good (DICE = 0.82) for calcified PP. A longitudinal comparison of the volumetric extent of PP showed a significant increase in PP volumes (p < 0.001) between the 2nd and the 3rd CT screenings with an average delay of 5 years. CONCLUSIONS: AI allows a fully automated volumetric quantification of pleural plaques showing volumetric progression of PP over a five-year period. The reproducible PP volume evaluation may enable further investigations for the comprehension of the unclear relationships between pleural plaques and both respiratory function and occurrence of thoracic malignancy

Prognosis of dementia

Mieux connaitre le pronostic de la démence peut aider à anticiper la prise en charge de la maladie. Au niveau individuel, le besoin d’obtenir de l’information sur les évolutions possibles de la maladie est la première attente des aidants. Au niveau sociétal, d’un point de vue santé publique, il semble nécessaire que les politiques de santé puissent anticiper les besoins en matière de prise en charge, d’aide à domicile, de structure d’accueil, d’équipes spécialisées, de gestionnaires de cas pour les cas complexes. L’objectif général de cette thèse était d’étudier le pronostic des sujets atteints de démence pour améliorer la prise en charge des malades atteints de maladie d’Alzheimer ou de syndromes apparentés. Les travaux de cette thèse ont été réalisés à partir des cas incidents de démence de deux cohortes en population : la cohorte Paquid (Personnes Agées QUID) et la cohorte des Trois Cités. Dans une première partie, nous avons étudié le pronostic de la survie. Globalement, il semble difficile de prédire le décès à partir de facteurs pronostiques seulement liés à la démence. Les décès dans la démence peuvent être liés à la démence elle-même mais aussi à d’autres causes non liées à la démence et sont donc difficiles à prédire. Dans une deuxième partie nous nous sommes intéressés au pronostic des capacités fonctionnelles. Peu de littérature existe sur l’évolution et le pronostic des capacités fonctionnelles. Nous avons montré une hiérarchie de l’atteinte des activités de bases de la vie quotidienne chez les sujets déments avec une atteinte dans un premier temps de la toilette ou de l’habillage puis dans un deuxième temps de la locomotion ou de l’alimentation. D’un point du vue pragmatique, étudier le passage vers l’incapacité à la toilette ou à l’habillage a un réel intérêt pour améliorer la prise en charge des patients. Les facteurs pronostiques indépendants de la survenue d’une incapacité à la toilette ou à l’habillage ajustés sur le risque de décès étaient : un âge supérieur à 80 ans au moment du diagnostic de démence, un diagnostic de démence vasculaire, l’atteinte de trois ou quatre activités sur l’échelle des quatre IADL de Lawton et une santé subjective mauvaise ou très mauvaise au moment du diagnostic de démence. Les travaux de cette thèse nous ont permis de mieux connaitre l’évolution des capacités fonctionnelles dans la démence. Toutefois, il est difficile de prédire l’évolution de la maladie, la démence étant une maladie multi-factorielle pour laquelle il existe une variabilité interindividuelle très importante concernant la progression de la maladie.A better understanding of the prognosis of dementia could help to provide appropriate care in the disease. At individual level, the need to obtain information on the possible evolution of the disease is caregivers’ prime expectation. At societal level and from a public health point of view, it seems necessary that health policies anticipate needs in care, home care, case managers... The general objective of this thesis was to study the prognosis of dementia to improve the care of patients with Alzheimer's disease or related disorders. We worked from incident cases of dementia of two population-based, long-term cohort studies: Paquid (Personnes Agées QUID) cohort and the Three Cities. First, we studied survival prognosis. Overall, it seems difficult to predict death from only prognostic factors related to dementia. The death in dementia may be linked to dementia itself but also to other factors non-related to dementia and therefore difficult to predict. Secondly, we studied the prognosis of functional abilities. Few literature exists on the functional evolution in dementia. We identified a perfect hierarchy in the sequence of occurrence of total disability in 4 basic activities of daily living: bathing and/or dressing, followed by transferring and/or feeding. From a pragmatic point of view, characterizing the dependency in bathing or dressing is crucial to improve care in dementia. The independent prognosis factors on bathing and dressing disabilities occurrence, adjusted on death risk were: age greater than 80 years at time of diagnosis of dementia, a diagnosis of vascular dementia, disabilities in three or four activities out of the four IADL scale of Lawton and poor or very poor subjective health at time of diagnosis of dementia. Based on this thesis, we have a gained a better knowledge of the evolution of functional abilities in dementia. However, it is difficult to predict the course of the disease; dementia being a multifactorial disease for which there is a very high interindividual variability on the progression of the disease

Reuse of termino-ontological resources and text corpora for building a multilingual domain ontology: An application to Alzheimer’s disease

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