Building a transitional care checklist in rheumatology: A Delphi-like survey

Objectives

To design a transitional care checklist to be used by and facilitate the work of health professionals in providing transitional care for children with a chronic rheumatologic disease and their families.

Expected impact of a public health intervention in the presence of synergistic risk factors

ObjectiveElaborate and test a method to extrapolate the population attributable fraction (benefit of an intervention to reduce the exposure of a given population to a given risk factor) to another population allowing for effects of synergistic factors.Study Design and SettingUsing data from the Systolic Hypertension in the Elderly Program, the present study investigated the impact of a reduction of blood pressure on the occurrence of stroke accounting for the age of the targeted population.ResultsA reduction of blood pressure in populations differing by their age distributions showed that the preventable proportion of strokes increased with age. A 20-mm Hg reduction of blood pressure in a population with mean age 60 years was associated with a 14% reduction of strokes and 18% in a population with mean age 70 years. The difference between these two proportions can be interpreted as the proportion of cases due to the synergistic actions of age and high blood pressure on the occurrence of stroke.ConclusionThe presented example illustrates how the method may be used by public health practitioners to transpose the potential benefits of interventions estimated in a study population to other populations with different exposures to synergistic risk factors.     

Défaillance de la relation à l’objet primaire et altération de l’enveloppe psychique chez l’adolescente obèse

This article is offering a discussion on the links between developmental obesity, constitution of the psychic life and of its envelopes but also about the first object relationship. A clinical presentation of a teenager will allow a better understanding of how the mothers of these teenagers can be in suffering and so, since the birth of their child. These in-secure precocious relations for the baby are both going to inscribe in the body as well as the psyche by an alteration of the psychological envelope translating a defect of contain. A better comprehension of the stakes and the genesis of the developmental obesity is the crucial question of today according to the pressure coming from the high sphere of health authorities. Public and political authorities ask for health care establishments of the “compulsory” losses of weight. But the loss of weight cannot be obtained without psychological care in parallel. Certain obese girls cannot psychically separate their family circle influence from their polyphagic symptom. Indeed, the return at home is often followed by a weighty resumption. The fragility of their psychological containing, the psychological and corporal failures linked to a dysfunction of the first object relation do not facilitate this work of separation as well as the process of autonomy and of individuation. Then, the sustainable loss of weight at the obese teenager cannot happen if it is not accompanied in parallel with a work of psychological care among the relationship with the first object, the constitution of her corporeal and psychological envelope.     

MISS questionnaire in French version: a good tool for children and parents to assess methotrexate intolerance

The aim of this study was to assess the relevance for children and parents to use the French-validated version of the methotrexate intolerance severity score (MISS), a measure of methotrexate intolerance for children suffering from juvenile idiopathic arthritis. The French-version MISS was developed following the “Guidelines for the process of cross-cultural adaptation of self-report measures.” The new version was tested in families of children with juvenile idiopathic arthritis who completed the questionnaire twice at a 2-week interval. Item correlations, Cronbach’s alpha, and kappa coefficients were computed to evaluate acceptability, internal consistency, and reproducibility. A culturally acceptable version to French was obtained. A total of 71 individuals were included from May 2015 to November 2015. The results show very good acceptability: good response rate (80%), few missing data (<1%) and good understanding of parents and children. The inter-item, dimension-item, and inter-dimension correlations were satisfactory (except for “vomiting” items–other items correlation). Cronbach’s alpha coefficient was well higher than the usually recommended value of 0.6. The results of validity of internal and external consistencies were satisfactory. We also found good agreement between the test-retest for every family. The empirical discriminative cut-off point of 3 showed a sensitivity of 86% and a specificity of 83%. The MISS questionnaire is quick to complete, easy to use. It can be completed by children or their parents with no significant difference. This validated French-version MISS can help study prevalence and risk factors of methotrexate intolerance, better detect this intolerance, and provide better support for patients on long-term treatment.     

Panorama des maladies auto-inflammatoires

Monogenic auto-inflammatory diseases are characterized by genetic abnormalities coding for proteins involved in innate immunity. They were initially described in mirror with auto-immune diseases because of the absence of circulating autoantibodies. Their main feature is the presence of peripheral blood inflammation in crisis without infection. The best-known auto-inflammatory diseases are mediated by interleukines that consisted in the 4 following diseases familial Mediterranean fever, cryopyrinopathies, TNFRSF1A-related intermittent fever, and mevalonate kinase deficiency. Since 10 years, many other diseases have been discovered, especially thanks to the progress in genetics. In this review, we propose the actual panorama of the main known auto-inflammatory diseases. Some of them are recurrent fevers with crisis and remission; some others evaluate more chronically; some are associated with immunodeficiency. From a physiopathological point of view, we can separate diseases mediated by interleukine-1 and diseases mediated by interferon. Then some polygenic inflammatory diseases will be shortly described: Still disease, Schnitzler syndrome, aseptic abscesses syndrome. The diagnosis of auto-inflammatory disease is largely based on anamnesis, the presence of peripheral inflammation during attacks and genetic analysis, which are more and more performant.     

Cancer incidence and mortality in France over the period 1980-2005

BACKGROUND: The objective of this study was to provide updated estimates of national trends in cancer incidence and mortality for France for 1980-2005. METHODS: Twenty-five cancer sites were analysed. Incidence data over the 1975-2003 period were collected from 17 registries working at the department level, covering 16% of the French population. Mortality data for 1975-2004 were provided by the Inserm. National incidence estimates were based on the use of mortality as a correlate of incidence, mortality being available at both department and national levels. Observed incidence and mortality data were modelled using an age-cohort approach, including an interaction term. Short-term predictions from that model gave estimates of new cancer cases and cancer deaths in 2005 for France. RESULTS: The number of new cancer cases in 2005 was approximately 320,000. This corresponds to an 89% increase since 1980. Demographic changes were responsible for almost half of that increase. The remainder was largely explained by increases in prostate cancer incidence in men and breast cancer incidence in women. The relative increase in the world age-standardised incidence rate was 39%. The number of deaths from cancer increased from 130,000 to 146,000. This 13% increase was much lower than anticipated on the basis of demographic changes (37%). The relative decrease in the age-standardised mortality rate was 22%. This decrease was steeper over the 2000-2005 period in both men and women. Alcohol-related cancer incidence and mortality continued to decrease in men. The increasing trend of lung cancer incidence and mortality among women continued; this cancer was the second cause of cancer death among women. Breast cancer incidence increased regularly, whereas mortality has decreased slowly since the end of the 1990s. CONCLUSION: This study confirmed the divergence of cancer incidence and mortality trends in France over the 1980-2005 period. This divergence can be explained by the combined effects of a decrease in the incidence of the most aggressive cancers and an increase in the incidence of less aggressive cancers, partly due to changes in medical practices leading to earlier diagnoses.     

Hazard regression model and cure rate model in colon cancer relative survival trends: are they telling the same story?

Hazard regression models and cure rate models can be advantageously used in cancer relative survival analysis. We explored the advantages and limits of these two models in colon cancer and focused on the prognostic impact of the year of diagnosis on survival according to the TNM stage at diagnosis. The analysis concerned 9,998 patients from three French registries. In the hazard regression model, the baseline excess death hazard and the time-dependent effects of covariates were modelled using regression splines. The cure rate model estimated the proportion of ‘cured’ patients and the excess death hazard in ‘non-cured’ patients. The effects of year of diagnosis on these parameters were estimated for each TNM cancer stage. With the hazard regression model, the excess death hazard decreased significantly with more recent years of diagnoses (hazard ratio, HR 0.97 in stage III and 0.98 in stage IV, P < 0.001). In these advanced stages, this favourable effect was limited to the first years of follow-up. With the cure rate model, recent years of diagnoses were significantly associated with longer survivals in ‘non-cured’ patients with advanced stages (HR 0.95 in stage III and 0.97 in stage IV, P < 0.001) but had no significant effect on cure (odds ratio, OR 0.99 in stages III and IV, P > 0.5). The two models were complementary and concordant in estimating colon cancer survival and the effects of covariates. They provided two different points of view of the same phenomenon: recent years of diagnosis had a favourable effect on survival, but not on cure.     

Conditional relative survival of cancer patients and conditional probability of death

BACKGROUND:

Little information is available on the conditional probabilities of death among patients who survive for >5 years after a diagnosis with cancer. The objective of this study was to estimate the conditional probabilities of death for breast cancer, prostate cancer, colorectal cancer, and lung cancer in France.

METHODS:

The study included data from the French Network of Cancer Registries from 205,562 patients aged <75 years who were diagnosed with cancer between 1989 and 1997. The conditional probabilities of death were calculated by using a relative survival regression model in which age was included as a covariate.

RESULTS:

After the first year and until 10 years after diagnosis, the annual probability of death decreased dramatically for colorectal cancer: It was the same in all age groups after 3 years, and it was approximately 1% at 10 years. For prostate cancer, the decrease was not as great, and the conditional probability of death remained higher among younger patients at >4% at 10 years. During the 3 years after diagnosis, the probability of death was greater for older patients with breast cancer; then, it decreased less for younger patients compared with older patients, leading to a greater conditional probability of death among younger patients at 4 years and up to 10 years. The annual probability of death in patients with lung cancer decreased for both sexes but remained substantially higher for men than for women, reaching approximately 8% and 5%, respectively, at 10 years.

CONCLUSIONS:

Further studies would facilitate a better understanding of the observed differences in relative survival within European countries. Cancer 2009. © 2009 American Cancer Society.