13 research outputs found
Increased risk of contralateral breast cancers among overweight and obese women: a time-dependent association
Abstract Breast cancer (BC) survivors are at increased risk of second cancers. Obesity is commonly recognized as a risk factor of BC in postmenopausal period and a prognosis factor in BC regardless of menopausal status. Our aim was to study whether overweight BC survivors were at increased risk of contralateral BC (CBC). Our population was a large cohort of women followed since a first BC without distant spread and/or synchronous CBC. Body mass index (BMI) was assessed at diagnosis time. Binary codings of BMI were used to oppose overweight and obese patients to the others. Survival analyses were used including Cox models. Assumed hypothesis of proportional hazards was explored using graphical methods, Schoenfeld residuals and time-dependant covariates. In case of nonproportional hazards, survival models were computed over time periods. Over 15,000 patients were included in our study. Incidence of CBC was 8. 8 (8.3-9.3)/1000 personyears and increased during follow-up. A significant timedependent association between overweight and CBC was observed. After 10 years of follow-up, we found a significant increased hazard of CBC among patients with a BMI above 25 kg/m 2 : the adjusted hazard ratio was 1.50(1.21-1.86), P = 0.001. After 10 years of follow-up, our study found a poorer prognosis among overweight BC survivors regarding CBC events. While benefits from diet habits and weight control may be expected during the long-term follow-up, they have yet to be established using randomized clinical trials. Keywords Contralateral breast cancer Á Non-proportional hazards Body mass index Á Overweight Á Time-dependent covariate Á Breast cancer prognosis Abbreviations BC Breast cancer BMI Body mass index CBC Contralateral breast cancer HR Hazard rati
State of inequality in diphtheria-tetanus-pertussis immunisation coverage in low-income and middle-income countries: a multicountry study of household health surveys
Background Immunisation programmes have made substantial contributions to lowering the burden of disease in
children, but there is a growing need to ensure that programmes are equity-oriented. We aimed to provide a detailed
update about the state of between-country inequality and within-country economic-related inequality in the delivery
of three doses of the combined diphtheria, tetanus toxoid, and pertussis-containing vaccine (DTP3), with a special
focus on inequalities in high-priority countries.
Methods We used data from the latest available Demographic and Health Surveys and Multiple Indicator Cluster Surveys
done in 51 low-income and middle-income countries. Data for DTP3 coverage were disaggregated by wealth quintile, and
inequality was calculated as diff erence and ratio measures based on coverage in richest (quintile 5) and poorest (quintile 1)
household wealth quintiles. Excess change was calculated for 21 countries with data available at two timepoints spanning
a 10 year period. Further analyses were done for six high-priority countries—ie, those with low national immunisation
coverage and/or high absolute numbers of unvaccinated children. Signifi cance was determined using 95% CIs.
Findings National DTP3 immunisation coverage across the 51 study countries ranged from 32% in Central African
Republic to 98% in Jordan. Within countries, the gap in DTP3 immunisation coverage suggested pro-rich inequality,
with a diff erence of 20 percentage points or more between quintiles 1 and 5 for 20 of 51 countries. In Nigeria, Pakistan,
Laos, Cameroon, and Central African Republic, the diff erence between quintiles 1 and 5 exceeded 40 percentage
points. In 15 of 21 study countries, an increase over time in national coverage of DTP3 immunisation was realised
alongside faster improvements in the poorest quintile than the richest. For example, in Burkina Faso, Cambodia,
Gabon, Mali, and Nepal, the absolute increase in coverage was at least 2·0 percentage points per year, with faster
improvement in the poorest quintile. Substantial economic-related inequality in DTP3 immunisation coverage was
reported in fi ve high-priority study countries (DR Congo, Ethiopia, Indonesia, Nigeria, and Pakistan), but not Uganda.
Interpretation Overall, within-country inequalities in DTP3 immunisation persist, but seem to have narrowed over
the past 10 years. Monitoring economic-related inequalities in immunisation coverage is warranted to reveal where
gaps exist and inform appropriate approaches to reach disadvantaged populations
Critères utilisés par les Groupes Techniques Consultatifs Nationaux pour la Vaccination pour établir des recommandations de politique vaccinale (étude bibliographique et sur questionnaire dans 13 pays)
La vaccination, bien qu étant une des interventions de santé publique les plus efficaces qui soit n est malheureusement toujours pas utilisée aujourd hui au maximum de ses capacités. Pour tenter d inverser cette tendance beaucoup de pays dans le monde se dotent de GTCV, institutions indépendantes en charge d élaborer les recommandations vaccinales propres à chaque contexte. Le présent travail a pour objet de décrire les critères utilisés par les GTCV pour élaborer leurs recommandations. Pour cela, nous avons dans un premier temps effectué une revue de la littérature, puis une enquête auprès de 13 GTCV dans le monde. Nous avons constaté qu assez peu d informations sur le sujet sont publiées dans la littérature. Notre enquête rapporte que les caractéristiques épidémiologiques de la maladie ainsi que les caractéristiques des vaccins sont les critères les plus importants dans la prise de décision. Autre élément essentiel, beaucoup de pays utilisent une méthodologie définie pour élaborer leurs décisions, mais très peu la rendent publique, entretenant probablement un sentiment de manque de transparence. Il serait à nos yeux nécessaire que les institutions internationales se saisissent de cette question et tentent d harmoniser les procédures, voire d élaborer une méthodologie validée qui permettrait à l ensemble des GTCV de gagner en transparence, et aux comités qui s établissent de plus en plus d avoir un référentiel leur permettant de démarre leurs activités dans les meilleures conditionsPARIS12-CRETEIL BU Médecine (940282101) / SudocSudocFranceF
Epidémiologie de la mort encéphalique dans la région Ile de France, enquête prospective Mai - Juin 2000
LE KREMLIN-B.- PARIS 11-BU Méd (940432101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF
Increased risk of contralateral breast cancers among overweight and obese women: a time-dependent association.
International audienceBreast cancer (BC) survivors are at increased risk of second cancers. Obesity is commonly recognized as a risk factor of BC in postmenopausal period and a prognosis factor in BC regardless of menopausal status. Our aim was to study whether overweight BC survivors were at increased risk of contralateral BC (CBC). Our population was a large cohort of women followed since a first BC without distant spread and/or synchronous CBC. Body mass index (BMI) was assessed at diagnosis time. Binary codings of BMI were used to oppose overweight and obese patients to the others. Survival analyses were used including Cox models. Assumed hypothesis of proportional hazards was explored using graphical methods, Schoenfeld residuals and time-dependant covariates. In case of non-proportional hazards, survival models were computed over time periods. Over 15,000 patients were included in our study. Incidence of CBC was 8.8 (8.3-9.3)/1000 person-years and increased during follow-up. A significant time-dependent association between overweight and CBC was observed. After 10 years of follow-up, we found a significant increased hazard of CBC among patients with a BMI above 25 kg/m(2): the adjusted hazard ratio was 1.50(1.21-1.86), P = 0.001. After 10 years of follow-up, our study found a poorer prognosis among overweight BC survivors regarding CBC events. While benefits from diet habits and weight control may be expected during the long-term follow-up, they have yet to be established using randomized clinical trials