Aspects méthodologiques de l'investigation des signalements d'agrégats spatio-temporels de maladies non infectieuses

En France, le signalement de regroupements spatio-temporels de maladies non infectieuses au sein de la population générale est en nette augmentation depuis 2000. La gravité des maladies rapportées (souvent des cancers) et la présence de facteurs de risques potentiels dans l'environnement général génèrent des inquiétudes au sein des populations concernées ainsi qu'une demande pressante de prise en charge. L'analyse de l'historique des investigations d'agrégats spatio-temporels enseigne le peu de réussite dans la recherche d'un facteur étiologique de ces événements, malgré l'engagement fréquent d'importantes ressources. Les raisons principales en sont la fréquence des regroupements aléatoires des maladies ainsi que les biais et difficultés méthodologiques rencontrées lors de l'investigation d'un petit nombre de cas de pathologies souvent différentes et multifactorielles. Afin d'apporter une réponse de santé publique adéquate qui permette, à la fois, de mener l'investigation avec la rigueur scientifique nécessaire et de préserver les ressources publiques, il est proposé d'adopter un protocole spécifique d'investigation. Ce dernier est fondé sur un recueil hiérarchisé d'informations sanitaires et environnementales et sur une analyse progressive de la plausibilité de présence d'un agrégat généré par une exposition commune des populations. Du fait du climat social entourant ces événements, une attention particulière est portée aux relations avec la population

A Robinson characterization of finite PσTP\sigma T-groups

Let $\sigma =\{\sigma_{i} | i\in I\}$ be some partition of the set of all primes $\Bbb{P}$ and let $G$ be a finite group. Then $G$ is said to be $\sigma$-full if $G$ has a Hall $\sigma _{i}$-subgroup for all $i$. A subgroup $A$ of $G$ is said to be $\sigma$-permutable in $G$ provided $G$ is $\sigma$-full and $A$ permutes with all Hall $\sigma _{i}$-subgroups $H$ of $G$ (that is, $AH=HA$) for all $i$. We obtain a characterization of finite groups $G$ in which $\sigma$-permutability is a transitive relation in $G$, that is, if $K$ is a ${\sigma}$-permutable subgroup of $H$ and $H$ is a ${\sigma}$-permutable subgroup of $G$, then $K$ is a ${\sigma}$-permutable subgroup of $G$.Comment: 15 pages. arXiv admin note: text overlap with arXiv:1704.0250

Aspects méthodologiques de l'investigation des signalements d'agrégats spatio-temporels de maladies non infectieuses

En France, le signalement de regroupements spatio-temporels de maladies non infectieuses au sein de la population générale est en nette augmentation depuis 2000. La gravité des maladies rapportées (souvent des cancers) et la présence de facteurs de risques potentiels dans l'environnement général génèrent des inquiétudes au sein des populations concernées ainsi qu'une demande pressante de prise en charge. L'analyse de l'historique des investigations d'agrégats spatio-temporels enseigne le peu de réussite dans la recherche d'un facteur étiologique de ces événements, malgré l'engagement fréquent d'importantes ressources. Les raisons principales en sont la fréquence des regroupements aléatoires des maladies ainsi que les biais et difficultés méthodologiques rencontrées lors de l'investigation d'un petit nombre de cas de pathologies souvent différentes et multifactorielles. Afin d'apporter une réponse de santé publique adéquate qui permette, à la fois, de mener l'investigation avec la rigueur scientifique nécessaire et de préserver les ressources publiques, il est proposé d'adopter un protocole spécifique d'investigation. Ce dernier est fondé sur un recueil hiérarchisé d'informations sanitaires et environnementales et sur une analyse progressive de la plausibilité de présence d'un agrégat généré par une exposition commune des populations. Du fait du climat social entourant ces événements, une attention particulière est portée aux relations avec la population

Aspects méthodologiques de l'investigation des signalements d'agrégats spatio-temporels de maladies non infectieuses

En France, le signalement de regroupements spatio-temporels de maladies non infectieuses au sein de la population générale est en nette augmentation depuis 2000. La gravité des maladies rapportées (souvent des cancers) et la présence de facteurs de risques potentiels dans l'environnement général génèrent des inquiétudes au sein des populations concernées ainsi qu'une demande pressante de prise en charge. L'analyse de l'historique des investigations d'agrégats spatio-temporels enseigne le peu de réussite dans la recherche d'un facteur étiologique de ces événements, malgré l'engagement fréquent d'importantes ressources. Les raisons principales en sont la fréquence des regroupements aléatoires des maladies ainsi que les biais et difficultés méthodologiques rencontrées lors de l'investigation d'un petit nombre de cas de pathologies souvent différentes et multifactorielles. Afin d'apporter une réponse de santé publique adéquate qui permette, à la fois, de mener l'investigation avec la rigueur scientifique nécessaire et de préserver les ressources publiques, il est proposé d'adopter un protocole spécifique d'investigation. Ce dernier est fondé sur un recueil hiérarchisé d'informations sanitaires et environnementales et sur une analyse progressive de la plausibilité de présence d'un agrégat généré par une exposition commune des populations. Du fait du climat social entourant ces événements, une attention particulière est portée aux relations avec la population

Prenatal exposure to organophosphate pesticides and autism spectrum disorders in 11-year-old children in the French PELAGIE cohort

International audienceBackground: Organophosphate (OP) pesticides act by inhibiting acetylcholinesterase activity at synaptic junctions and have already been linked with deleterious effects on neurodevelopment, including autism spectrum disorders (ASD).Objectives: To investigate the association of prenatal exposure to OP pesticides with traits related to ASD in 11-year-old children.Methods: The "Childhood Autism Spectrum Test" (CAST) parent questionnaire was used to screen for autistic traits in 792 children from the French PELAGIE cohort. Prenatal maternal urine samples were collected 80%), terbufos and its metabolites least often (<10%). No association with ASD was found for DAP, terbufos or its metabolites. Incidence rate ratios (IRRs) increased with maternal urinary diazinon concentrations, from 1.11 (95% CI: 0.87-1.42) to 1.17 (95% CI: 0.94-1.46). Higher CAST scores were statistically significantly associated with the maternal urine samples in which chlorpyrifos or two of its metabolites (chlorpyrifos-oxon and 3,5,6-trichloro-2-pyridinol) were detected. The IRR for exposure to chlorpyrifos or chlorpyrifos-oxon was 1.27 (95%CI: 1.05-1.52) among all children, and 1.39 (95%CI: 1.07-1.82) among boys.Conclusion: These findings suggest an increase in autistic traits among 11-year-old children in association with prenatal maternal exposure to chlorpyrifos and possibly diazinon. These associations were previously suspected in the literature, in particular for chlorpyrifos. Further work establishing the causal mechanisms behind these risk association is needed

Assessing the Risk of Relapse Requiring Corticosteroids After In Vitro Fertilization in Women With Multiple Sclerosis

International audienceBackground and Objectives: Several studies have shown an increased risk of relapse after In Vitro Fertilization (IVF) in women with Multiple Sclerosis (MS), especially when a GnRH agonists stimulation protocol was used. Our objective was to investigate the risk of relapse after IVF in women with multiple sclerosis, overall and according to stimulation protocol (GnRH agonists vs antagonists), using data from the French national health insurance database. Methods: This retrospective cohort study included all women with MS who have benefited from IVF between January 1, 2010 and December 31, 2015 in France. Three-month exposed periods after IVF were compared to unexposed periods before IVF, each woman being her own control. Four outcomes were considered: annualized relapse rate (ARR), proportion of IVF with relapse, difference in the number of relapse “after – before” and the delay from IVF to the first relapse. Relapses were identified by an algorithm based on MS-related hospital admissions and use of corticosteroid therapy. Stimulation protocols and disease-modifying therapies (DMT) were identified using drugs claims. Zero-inflated Poisson regression models adjusted for age at IVF and presence of DMT were used. A random effect on the woman was included because women may have multiple IVF procedures. Subgroup analyses by stimulation protocol and IVF outcome (pregnancy or failure) were conducted. Results: A total of 225 women accounting for 338 IVF were included (mean age at first IVF 34.6 ± 4.5 years; 36% of women had at least two IVF during the period). No increase in the risk of relapse after IVF was found overall (before vs. after IVF: respectively 0.20 vs. 0.18 relapse per patient-year; resp. 7.7% vs. 7.1% of IVF with women having at least one relapse) and in subgroups. A lower ARR before and after IVF was observed among women who remained treated until IVF. Discussion: The maintenance of DMT until IVF appeared to be a determining factor in reducing the risk of relapse. Women with MS should be reassured as we did not show an increased risk of relapse requiring use of corticosteroids therapy after IVF neither with GnRH agonists nor with GnRH antagonists

Pregnancy in women with multiple sclerosis in France from 2010 to 2015: Incidence, outcomes, and exposure to disease-modifying therapies

International audienceBackground: Multiple sclerosis (MS) is usually diagnosed between 20-40 years old, when women often plan to have children. Objective: Our objectives were to estimate pregnancy incidence rates in women with multiple sclerosis (MS), and to describe the use of disease-modifying therapies (DMTs) before conception and during pregnancy, and pregnancy outcomes. Methods: This retrospective cohort study included all 15- to 49-year-old women with MS in the French national health insurance database over 2010–2015. A pregnancy was exposed if a DMT reimbursement claim occurred during pregnancy or in the 14 preceding days. We used zero-inflated negative binomial (ZINB) regression models to estimate incidence rates and ordinal and multinomial regression models to estimate DMT exposure and pregnancy outcomes. Results: The pregnancy incidence rate was 4.5 per 100 person-years. The probability of having a DMT-exposed pregnancy increased from 0.22 in 2010 to 0.30 in 2015. The probability of live birth was 0.72 (95% CI = 0.70–0.74) for exposed pregnancies (varied considerably among DMTs), 0.77 (95% CI = 0.76–0.79) without treatment, and 0.81 (95% CI = 0.79–0.83) if treatment was stopped within the previous year. Conclusion: In this population-based study, we showed an increase of exposed pregnancies over time, beta-interferon and glatiramer acetate being the most used DMTs and associated with the highest probabilities of live birth. Interrupted exposed pregnancies may reflect undesired pregnancies or fear of an adverse outcome, while recent DMT stop probably reflects pregnancy planning

Prenatal exposure to persistent organic pollutants and molar-incisor hypomineralization among 12-year-old children in the French mother-child cohort PELAGIE

International audienceBACKGROUND: Exceptional episodes of exposure to high levels of persistent organic pollutants have already been associated with developmental defects of enamel among children, but knowledge is still scarce concerning the contribution of background levels of environmental contamination. METHODS: Children of the French PELAGIE mother-child cohort were followed from birth, with collection of medical data and cord blood samples that were used to measure polychlorinated biphenyls (PCBs), organochlorine pesticides (OCs), and perfluorinated alkyl substances (PFASs). At 12 years of age, molar-incisor hypomineralization (MIH) and other enamel defects (EDs) were recorded for 498 children. Associations were studied using logistic regression models adjusted for potential prenatal confounders. RESULTS: An increasing log-concentration of β-HCH was associated with a reduced risk of MIH and EDs (OR = 0.55; 95% CI, 0.32-0.95, and OR = 0.65; 95% CI, 0.43-0.98, respectively). Among girls, intermediate levels of p,p’-DDE were associated with a reduced risk of MIH. Among boys, we observed an increased risk of EDs in association with intermediate levels of PCB 138, PCB 153, PCB 187, and an increased risk of MIH with intermediate levels of PFOA and PFOS. CONCLUSIONS: Two OCs were associated with a reduced risk of dental defects, whereas the associations between PCBs and PFASs and EDs or MIH were generally close to null or sex-specific, with an increased risk of dental defects in boys. These results suggest that POPs could impact amelogenesis. Replication of this study is required and the possible underlying mechanisms need to be explored

Prenatal exposure to glycol ethers and visual contrast sensitivity in 6-year-old children in the PELAGIE mother-child cohort

International audienceBACKGROUND: Maternal occupational exposure to organic solvents during pregnancy has been associated with decreased visual function in offspring. Glycol ethers (GEs) belong to oxygenated solvents and are widely used both in occupational and domestic contexts. OBJECTIVES: We aimed to assess associations between prenatal GEs exposure and contrast sensitivity in children. METHODS: Six GE alkoxy carboxylic acidic metabolites (methoxyacetic acid [MAA], ethoxyacetic acid [EAA], ethoxyethoxyacetic acid [EEAA], butoxyacetic acid [BAA], phenoxyacetic acid [PhAA], and 2-methoxypropionic acid [2-MPA]) were measured in first morning void urine samples collected from 220 early-pregnancy women, in the mother-child PELAGIE cohort (France). Trained investigators administered the Functional Acuity Contrast Test (FACT) to the 6-year-old children, providing scores for 5 spatial frequencies (1.5-18 cycles per degree (cpd)). We standardized biomarker urinary concentrations on urine sampling conditions. Values below the LOD were imputed based on log-normal distribution, generating five datasets for multiple imputation. Linear regression models were adjusted for potential confounders. RESULTS: GE metabolites were detected in 70-98% of maternal urine samples. Phenoxyacetic acid (PhAA) had the highest median concentration (0.33 mg/L), and 2-methoxypropionic acid (2-MPA) the lowest (0.01 mg/L). Children with higher prenatal PhAA concentrations had poorer FACT scores at various spatial frequencies (fourth vs. first quartile: β(18cpd) = -0.90 (95% confidence interval CI = -1.64, -0.16), β(12cpd) = -0.92 (95%CI = -1.55, -0.29) and β(1.5cpd) = -0.69 (95%CI = -1.19, -0.20)). The 2-MPA log-scale concentration was negatively associated with the FACT score at the 3-cpd stimulus. DISCUSSION: PhAA is the metabolite of ethylene glycol monophenyl ether present in many cosmetics. 2-MPA is the metabolite of an isomer of propylene glycol methyl ether commonly present in household and industrial cleaning products. Although evidence of biological plausibility is lacking, the study suggests adverse impact of ubiquitous prenatal exposure to some GE on visual functioning among children

Seasonal influenza vaccination coverage and its determinants among nursing homes personnel in western France

Abstract Background Influenza-associated deaths is an important risk for the elderly in nursing homes (NHs) worldwide. Vaccination coverage among residents is high but poorly effective due to immunosenescence. Hence, vaccination of personnel is an efficient way to protect residents. Our objective was to quantify the seasonal influenza vaccination (IV) coverage among NH for elderly workers and identify its determinants in France. Methods We conducted a cross-sectional study in March 2016 in a randomized sample of NHs of the Ille-et-Vilaine department of Brittany, in western France. A standardized questionnaire was administered to a randomized sample of NH workers for face-to-face interviews. General data about the establishment was also collected. Results Among the 33 NHs surveyed, IV coverage for the 2015–2016 season among permanent workers was estimated at 20% (95% Confidence Interval (CI) 15.3%–26.4%) ranging from 0% to 69% depending on the establishments surveyed. Moreover, IV was associated with having previously experienced a “severe” influenza episode in the past (Prevalence Ratio 1.48, 95% CI 1.01–2.17), and varied by professional categories (p < 0.004) with better coverage among administrative staff. Better knowledge about influenza prevention tools was also correlated (p < 0.001) with a higher IV coverage. Individual perceptions of vaccination benefits had a significant influence on the IV coverage (p < 0.001). Although IV coverage did not reach a high rate, our study showed that personnel considered themselves sufficiently informed about IV. Conclusions IV coverage remains low in the NH worker population in Ille-et-Vilaine and also possibly in France. Strong variations of IV coverage among NHs suggest that management and working environment play an important role. To overcome vaccine “hesitancy”, specific communication tools may be required to be adapted to the various NH professionals to improve influenza prevention