62 research outputs found
Early cardiovascular events in women with a history of gestational diabetes mellitus
International audienceBackground: The effect of gestational diabetes mellitus (GDM) on cardiovascular diseases (CVD) is not assessed within the first 10 years postpartum, regardless of subsequent diabetes. The aim of this study was to determine the risk of CVD events related to GDM within 7 years of postpartum.Methods: This nationwide population-based study of deliveries in 2007 and 2008 with a follow-up of 7 years was based on data from the French medico-administrative database. Two groups were formed: women with a history of GDM and women without GDM or previous diabetes. CVD included angina pectoris, myocardial infarction, stroke, heart bypass surgery, coronary angioplasty, carotid endarterectomy and fibrinolysis. Hypertensive disease was assessed separately. Determinants studied included age, obesity, subsequent diabetes mellitus and hypertensive diseases during pregnancy. Adjusted odds ratios for outcomes were calculated using multiple logistic regressions.Results: The hospital database recorded 1,518,990 deliveries in 2007 and 2008. Among these, 62,958 women had a history of GDM. After adjusting for age, DM, obesity and hypertensive disorders in pregnancy, GDM was significantly associated with a higher risk of CVD (adjusted Odds Ratio aOR = 1.25 [1.09-1.43]). Considering each variable in a separate model, GDM was associated with angina pectoris (aOR = 1.68 [1.29-2.20]), myocardial infarction (aOR = 1.92 [1.36-2.71]) and hypertension (aOR = 2.72 [2.58-2.88]) but not with stroke.Conclusions: A history of GDM was identified as a risk factor of CVD, especially coronary vascular diseases, within the 7 years postpartum. A lifestyle changes from postpartum onwards can be recommended and supported
Influence of exposure to noise and air pollution in urban areas on the occurrence of adverse pregnancy outcomes
La grossesse constitue une pĂ©riode de vulnĂ©rabilitĂ© oĂč la survenue de complications et dâissues dĂ©favorables de la grossesse (CIDG) peut avoir des consĂ©quences majeures sur le devenir de la mĂšre et/ou du nouveau-nĂ©. De multiples facteurs en sont Ă lâorigine. Cependant, il reste encore une part non expliquĂ©e de CIDG, pour laquelle lâenvironnement est suspectĂ© de jouer un rĂŽle.Ce travail de thĂšse est inclus dans le programme PreCEE (Pregnancy Combined Environmental Exposure) et a pour objectif dâĂ©tudier lâinfluence des expositions environnementales aux pollutions sonore et atmosphĂ©rique sur la survenue de CIDG, plus particuliĂšrement de troubles de la croissance fĆtale et de troubles hypertensifs de la grossesse. Ont Ă©tĂ© incluses toutes les grossesses de femmes majeures rĂ©sidant Ă Besançon ou dans lâunitĂ© urbaine de Dijon et ayant accouchĂ© au CHU de Besançon ou au CHU Dijon-Bourgogne entre 2005 et 2009, soit plus de 10 000 grossesses. Les caractĂ©ristiques socio-dĂ©mographiques, mĂ©dicales et mĂ©dico-obstĂ©tricales ont Ă©tĂ© recueillies Ă partir des dossiers obstĂ©tricaux informatisĂ©s et papier. Les niveaux dâexposition au bruit et Ă la pollution atmosphĂ©rique (dioxyde dâazote (NO2) et particules fines (PM10)) ont Ă©tĂ© modĂ©lisĂ©s au domicile de la mĂšre selon des fenĂȘtres spatiales et temporelles diffĂ©rentes.Les rĂ©sultats montrent que lâexposition au bruit nâest pas associĂ©e Ă la survenue de troubles hypertensifs de la grossesse ou de troubles de la croissance foetale, chez les grossesses uniques. Lâexposition aux PM10 est associĂ©e Ă la survenue de troubles de la croissance fĆtale chez les grossesses uniques. Cette association nâest pas modifiĂ©e par la prise en compte de lâexposition au bruit. Enfin, chez les grossesses multiples, lâexposition au NO2 est associĂ©e Ă la survenue de troubles de la croissance fĆtale.Pregnancy is a period of vulnerability where the occurrence of adverse pregnancy outcomes (APO) can have major consequences on the future of the mother and/or the newborn. Multiple factors are responsible for this. However, there is still an unexplained part of APO, for which the environment is suspected to play a role.This PhD thesis is included in the PreCEE (Pregnancy Combined Environmental Exposure) program and aimed to study the influence of environmental exposures to noise and air pollution on the occurrence of APO, more particularly on fetal growth disorders and hypertensive disorders of pregnancy (HDP). All pregnancies of adult women living in Besançon or in the urban unit of Dijon and who gave birth to the Besançon University Hospital or the Dijon-Burgundy University Hospital between 2005 and 2009 were included, i.e. more than 10,000 pregnancies. The socio-demographic, medical and medico-obstetrical characteristics were collected from computerized and paper obstetric records. The levels of exposure to noise and air pollution (nitrogen dioxide (NO2) and fine particles (PM10)) were modeled at the mother's home according to several spatial and temporal windows.Results show that noise exposure is not associated with the occurrence of HDP or fetal growth disorders in single pregnancies. Exposure to PM10 is associated with fetal growth disorders. This association is not changed by taking noise exposure into account. Finally, in multiple pregnancies, exposure to NO2 is associated with fetal growth disorders
Influence de lâexposition au bruit et Ă la pollution de lâair en milieu urbain sur la survenue de complications et dâissues dĂ©favorables de la grossesse
Pregnancy is a period of vulnerability where the occurrence of adverse pregnancy outcomes (APO) can have major consequences on the future of the mother and/or the newborn. Multiple factors are responsible for this. However, there is still an unexplained part of APO, for which the environment is suspected to play a role.This PhD thesis is included in the PreCEE (Pregnancy Combined Environmental Exposure) program and aimed to study the influence of environmental exposures to noise and air pollution on the occurrence of APO, more particularly on fetal growth disorders and hypertensive disorders of pregnancy (HDP). All pregnancies of adult women living in Besançon or in the urban unit of Dijon and who gave birth to the Besançon University Hospital or the Dijon-Burgundy University Hospital between 2005 and 2009 were included, i.e. more than 10,000 pregnancies. The socio-demographic, medical and medico-obstetrical characteristics were collected from computerized and paper obstetric records. The levels of exposure to noise and air pollution (nitrogen dioxide (NO2) and fine particles (PM10)) were modeled at the mother's home according to several spatial and temporal windows.Results show that noise exposure is not associated with the occurrence of HDP or fetal growth disorders in single pregnancies. Exposure to PM10 is associated with fetal growth disorders. This association is not changed by taking noise exposure into account. Finally, in multiple pregnancies, exposure to NO2 is associated with fetal growth disorders.La grossesse constitue une pĂ©riode de vulnĂ©rabilitĂ© oĂč la survenue de complications et dâissues dĂ©favorables de la grossesse (CIDG) peut avoir des consĂ©quences majeures sur le devenir de la mĂšre et/ou du nouveau-nĂ©. De multiples facteurs en sont Ă lâorigine. Cependant, il reste encore une part non expliquĂ©e de CIDG, pour laquelle lâenvironnement est suspectĂ© de jouer un rĂŽle.Ce travail de thĂšse est inclus dans le programme PreCEE (Pregnancy Combined Environmental Exposure) et a pour objectif dâĂ©tudier lâinfluence des expositions environnementales aux pollutions sonore et atmosphĂ©rique sur la survenue de CIDG, plus particuliĂšrement de troubles de la croissance fĆtale et de troubles hypertensifs de la grossesse. Ont Ă©tĂ© incluses toutes les grossesses de femmes majeures rĂ©sidant Ă Besançon ou dans lâunitĂ© urbaine de Dijon et ayant accouchĂ© au CHU de Besançon ou au CHU Dijon-Bourgogne entre 2005 et 2009, soit plus de 10 000 grossesses. Les caractĂ©ristiques socio-dĂ©mographiques, mĂ©dicales et mĂ©dico-obstĂ©tricales ont Ă©tĂ© recueillies Ă partir des dossiers obstĂ©tricaux informatisĂ©s et papier. Les niveaux dâexposition au bruit et Ă la pollution atmosphĂ©rique (dioxyde dâazote (NO2) et particules fines (PM10)) ont Ă©tĂ© modĂ©lisĂ©s au domicile de la mĂšre selon des fenĂȘtres spatiales et temporelles diffĂ©rentes.Les rĂ©sultats montrent que lâexposition au bruit nâest pas associĂ©e Ă la survenue de troubles hypertensifs de la grossesse ou de troubles de la croissance foetale, chez les grossesses uniques. Lâexposition aux PM10 est associĂ©e Ă la survenue de troubles de la croissance fĆtale chez les grossesses uniques. Cette association nâest pas modifiĂ©e par la prise en compte de lâexposition au bruit. Enfin, chez les grossesses multiples, lâexposition au NO2 est associĂ©e Ă la survenue de troubles de la croissance fĆtale
Influence de lâexposition au bruit et Ă la pollution de lâair en milieu urbain sur la survenue de complications et dâissues dĂ©favorables de la grossesse
Pregnancy is a period of vulnerability where the occurrence of adverse pregnancy outcomes (APO) can have major consequences on the future of the mother and/or the newborn. Multiple factors are responsible for this. However, there is still an unexplained part of APO, for which the environment is suspected to play a role.This PhD thesis is included in the PreCEE (Pregnancy Combined Environmental Exposure) program and aimed to study the influence of environmental exposures to noise and air pollution on the occurrence of APO, more particularly on fetal growth disorders and hypertensive disorders of pregnancy (HDP). All pregnancies of adult women living in Besançon or in the urban unit of Dijon and who gave birth to the Besançon University Hospital or the Dijon-Burgundy University Hospital between 2005 and 2009 were included, i.e. more than 10,000 pregnancies. The socio-demographic, medical and medico-obstetrical characteristics were collected from computerized and paper obstetric records. The levels of exposure to noise and air pollution (nitrogen dioxide (NO2) and fine particles (PM10)) were modeled at the mother's home according to several spatial and temporal windows.Results show that noise exposure is not associated with the occurrence of HDP or fetal growth disorders in single pregnancies. Exposure to PM10 is associated with fetal growth disorders. This association is not changed by taking noise exposure into account. Finally, in multiple pregnancies, exposure to NO2 is associated with fetal growth disorders.La grossesse constitue une pĂ©riode de vulnĂ©rabilitĂ© oĂč la survenue de complications et dâissues dĂ©favorables de la grossesse (CIDG) peut avoir des consĂ©quences majeures sur le devenir de la mĂšre et/ou du nouveau-nĂ©. De multiples facteurs en sont Ă lâorigine. Cependant, il reste encore une part non expliquĂ©e de CIDG, pour laquelle lâenvironnement est suspectĂ© de jouer un rĂŽle.Ce travail de thĂšse est inclus dans le programme PreCEE (Pregnancy Combined Environmental Exposure) et a pour objectif dâĂ©tudier lâinfluence des expositions environnementales aux pollutions sonore et atmosphĂ©rique sur la survenue de CIDG, plus particuliĂšrement de troubles de la croissance fĆtale et de troubles hypertensifs de la grossesse. Ont Ă©tĂ© incluses toutes les grossesses de femmes majeures rĂ©sidant Ă Besançon ou dans lâunitĂ© urbaine de Dijon et ayant accouchĂ© au CHU de Besançon ou au CHU Dijon-Bourgogne entre 2005 et 2009, soit plus de 10 000 grossesses. Les caractĂ©ristiques socio-dĂ©mographiques, mĂ©dicales et mĂ©dico-obstĂ©tricales ont Ă©tĂ© recueillies Ă partir des dossiers obstĂ©tricaux informatisĂ©s et papier. Les niveaux dâexposition au bruit et Ă la pollution atmosphĂ©rique (dioxyde dâazote (NO2) et particules fines (PM10)) ont Ă©tĂ© modĂ©lisĂ©s au domicile de la mĂšre selon des fenĂȘtres spatiales et temporelles diffĂ©rentes.Les rĂ©sultats montrent que lâexposition au bruit nâest pas associĂ©e Ă la survenue de troubles hypertensifs de la grossesse ou de troubles de la croissance foetale, chez les grossesses uniques. Lâexposition aux PM10 est associĂ©e Ă la survenue de troubles de la croissance fĆtale chez les grossesses uniques. Cette association nâest pas modifiĂ©e par la prise en compte de lâexposition au bruit. Enfin, chez les grossesses multiples, lâexposition au NO2 est associĂ©e Ă la survenue de troubles de la croissance fĆtale
Validation de la version française du questionnaire spécifique du cancer de la prostate EPIC (expanded prostate cancer index composite) chez des sujets issus de la population générale (étude QaliPro)
BESANCON-BU MĂ©decine pharmacie (250562102) / SudocSudocFranceF
Is an activity volume threshold really realistic for lung cancer resection?
IF 1.804 (2017)International audienceBackground:We analyzed volume as a continuous variable to estimate threshold, which is a methodology rarely seen in the literature. The objective of this work was to assess hospital volume for lung cancer (LC) surgery and to establish the associated threshold for acceptable in-hospital mortality (IHM). Data was obtained from the French national medico-administrative database.Methods:From January 2005 to December 2016, data from 108,571 patients operated for LC in France were collected from the national administrative database. To estimate the volume threshold, hierarchical logistic regression models were developed.Results:The crude IHM rate was 5.2% in low volume centers and 3.5% in high volume centers (P<0.0001). Centers performing more than 70 LC surgeries per year reduced the risk of postoperative death by 35% [adjusted odds ratio (OR): 0.65; 95% confidence interval (CI): 0.5-0.84]. Among the 4 models, the use of fractional polynomial of the volume had the lowest Akaike's information criterion (AIC) index. The threshold volume was reached once a hospital's annual volume reached 70 patients (95% CI, 40-85). In our analyses, the proportion of patients who were admitted in hospitals with an annual volume that was less than identified threshold were 34% of patients operated for LC. A hospital with an annual volume of 10 patients for lung resection, increasing the annual volume by 60 procedures would be associated with a 31% reduction in the odds of death within 30 days.Conclusions:From the medico-administrative database, we have been able to estimate a minimum volume threshold that may be useful to help regionalize thoracic surgery centers
In-hospital mortality following lung cancer resection: nationwide administrative database
IF 8.332International audienceOur aim was to determine the effect of a national strategy for quality improvement in cancer management (the "Plan Cancer") according to time period and to assess the influence of type and volume of hospital activity on in-hospital mortality (IHM) within a large national cohort of patients operated on for lung cancer.From January 2005 to December 2013, 76 235 patients were included in the French Administrative Database. Patient characteristics, hospital volume of activity and hospital type were analysed over three periods: 2005-2007, 2008-2010 and 2011-2013.Global crude IHM was 3.9%: 4.3% during 2005-2007, 4% during 2008-2010 and 3.5% during 2011-2013 (p43 resections per year (adjusted (a) OR 1.48, 95% CI 1.197-1.834). The risk of death was lower in the period 2011-2013 than in the period 2008-2010 (aOR 0.841, 95% CI 0.764-0.926). Adjustment variables (age, sex, Charlson score and type of resection) were significantly linked to IHM, whereas the type of hospital was not.The French national strategy for quality improvement seems to have induced a significant decrease in IHM
Chirurgie combinée de la cataracte et endophtalmie postopératoire aiguë en France de 2005 à 2014
National audienceIntroduction : Lâobjectif de cette Ă©tude Ă©tait dâanalyser lâassociation entre chirurgie de la cataracte combinĂ©e avec des interventions chirurgicales de traitement du glaucome, vitrĂ©orĂ©tiniennes ou cornĂ©ennes et la survenue dâune (EPOA), de 2005 à 2014 en France. MĂ©thodes : Les procĂ©dures de chirurgie de la cataracte par phacoĂ©mulsification et/ou de traitement du glaucome, vitrĂ©orĂ©tiniennes ou cornĂ©ennes ont Ă©tĂ© repĂ©rĂ©es par les codes correspondant de la classification commune des actes mĂ©dicaux (CCAM) dans le programme de mĂ©dicalisation des systĂšmes dâinformation (PMSI) du 1er janvier 2005 au 31 dĂ©cembre 2014. LâEPOA Ă©tait dĂ©finie par la prĂ©sence dâun diagnostic dâendophtalmie lors dâune hospitalisation survenant dans les 42 jours postopĂ©ratoire. Lâassociation entre EPOA et chirurgie de la cataracte combinĂ©e a Ă©tĂ© estimĂ©e par des ratios de taux dâincidence (IRR) bruts et ajustĂ©s, estimĂ©s Ă lâaide de rĂ©gressions de Poisson. RĂ©sultats : De 2005 à 2014, ont Ă©tĂ© identifiĂ©es 6 260 477 procĂ©dures de chirurgie de la cataracte par phacoĂ©mulsification seule et 115 468 phacoĂ©mulsifications combinĂ©es avec des interventions chirurgicales de traitement du glaucome, vitrĂ©orĂ©tiniennes ou cornĂ©ennes. La frĂ©quence de survenue dâune EPOA aprĂšs une chirurgie de la cataracte combinĂ©e Ă©tait de 0,149 %. La chirurgie de la cataracte combinĂ©e Ă©tait plus Ă risque dâEPOA que la chirurgie de la cataracte seule avec un ratio de taux dâincidence ajustĂ© (IRR) Ă 1,38 ; IC 95 % = [1,11â1,70] ; p = 0,0054. Par rapport Ă la chirurgie de cataracte seule, les procĂ©dures chirurgicales vitrĂ©orĂ©tiniennes sans tamponnade Ă©taient associĂ©es Ă une frĂ©quence plus Ă©levĂ©e dâEPOA (IRR = 2,95 [2,59â3,36] ; p < 10â3) alors que les procĂ©dures de traitement du glaucome de type sclĂ©rectomies profondes Ă©taient associĂ©es Ă une frĂ©quence plus faible dâEPOA (IRR = 0,48 [0,30â0,76] ; p < 10â3), aprĂšs ajustement notamment sur le type dâintervention combinĂ©e ou non. Discussion/Conclusion : LâaccĂšs Ă une base de donnĂ©es nationale nous a permis de mettre en Ă©vidence une association entre chirurgie combinĂ©e de cataracte et EPOA. La survenue dâune EPOA Ă©tait associĂ©e au type de chirurgie pratiquĂ©e
Is an activity volume threshold really realistic for lung cancer resection?
IF 1.804 (2017)International audienceBackground:We analyzed volume as a continuous variable to estimate threshold, which is a methodology rarely seen in the literature. The objective of this work was to assess hospital volume for lung cancer (LC) surgery and to establish the associated threshold for acceptable in-hospital mortality (IHM). Data was obtained from the French national medico-administrative database.Methods:From January 2005 to December 2016, data from 108,571 patients operated for LC in France were collected from the national administrative database. To estimate the volume threshold, hierarchical logistic regression models were developed.Results:The crude IHM rate was 5.2% in low volume centers and 3.5% in high volume centers (P<0.0001). Centers performing more than 70 LC surgeries per year reduced the risk of postoperative death by 35% [adjusted odds ratio (OR): 0.65; 95% confidence interval (CI): 0.5-0.84]. Among the 4 models, the use of fractional polynomial of the volume had the lowest Akaike's information criterion (AIC) index. The threshold volume was reached once a hospital's annual volume reached 70 patients (95% CI, 40-85). In our analyses, the proportion of patients who were admitted in hospitals with an annual volume that was less than identified threshold were 34% of patients operated for LC. A hospital with an annual volume of 10 patients for lung resection, increasing the annual volume by 60 procedures would be associated with a 31% reduction in the odds of death within 30 days.Conclusions:From the medico-administrative database, we have been able to estimate a minimum volume threshold that may be useful to help regionalize thoracic surgery centers
Incidence des procédures de chirurgie du glaucome en France de 2005 à 2014
National audienceIntroduction Cette Ă©tude a pour objectif de dĂ©crire lâincidence des diffĂ©rentes procĂ©dures chirurgicales de traitement du glaucome en France mĂ©tropolitaine et dans les dĂ©partements dâoutre-mer (DOM) entre 2005 et 2014. MĂ©thodes Tous les patients hospitalisĂ©s pour une chirurgie du glaucome et rĂ©sidant en France mĂ©tropolitaine et dans les DOM entre le 1er janvier 2005 et le 31 dĂ©cembre 2014 ont Ă©tĂ© identifiĂ©s Ă partir de la base nationale du PMSI. Les sĂ©jours de chirurgie de glaucome Ă©taient repĂ©rĂ©s par les codes correspondant dans la classification commune des actes mĂ©dicaux (CCAM). Le dĂ©nominateur des taux dâincidence a Ă©tĂ© obtenu dans les donnĂ©es du recensement de lâinstitut national de la statistique et des Ă©tudes Ă©conomiques (Insee) pour chaque annĂ©e. Les taux dâincidence ont Ă©tĂ© standardisĂ©s sur la population française. RĂ©sultats Lâincidence de la chirurgie du glaucome Ă©tait de 30 procĂ©dures pour 100 000 habitants entre 2005 et 2014, diminuant lĂ©gĂšrement sur la pĂ©riode dâĂ©tude (taux standardisĂ© sur la population française). On a observĂ© des variations dans le temps de lâincidence des diffĂ©rents types de procĂ©dures. Par exemple, le taux dâincidence annuel de trabĂ©culectomies a lĂ©gĂšrement diminuĂ© au cours de la pĂ©riode dâĂ©tude passant de 15,6 en 2005 Ă 12,1 procĂ©dures pour 100 000 habitants en 2014. Ensuite, le taux dâincidence des sclĂ©rectomies profondes a doublĂ© entre 2005 et 2006 passant de 5,3 Ă 10,4 procĂ©dures pour 100 000 habitants, puis a diminuĂ© rĂ©guliĂšrement pour arriver Ă 7,8 procĂ©dures pour 100 000 habitants en 2014. Enfin, le taux dâincidence des procĂ©dures de drainage de lâhumeur aqueuse a augmentĂ© sur la pĂ©riode passant de 0,24 en 2005 Ă 0,95 procĂ©dures pour 100 000 habitants en 2014. Discussion/Conclusion La base nationale du PMSI permet de dĂ©crire les tendances de la chirurgie du glaucome sur une pĂ©riode de 10 ans. On observe une diminution de la pratique des trabĂ©culectomies au profit dâautres procĂ©dures telles que la sclĂ©rectomie profonde et les procĂ©dures de drainage de lâhumeur aqueuse
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