Varicella in French adolescents and adults: individual risk assessment and cost-effectiveness of routine vaccination

Age-specific force of varicella infection, hospitalisation and death rates in non-immune persons were calculated using an age-based mathematical model and national data for France. A cost-effectiveness model was then applied to hypothetical cohorts of persons aged 15-45 years with a negative or uncertain history of varicella. Vaccination strategies with and without prior serotesting, and healthcare payer perspective and societal perspective were considered. A sensitivity analysis was performed. Vaccination prevented more than one third of all varicella-related deaths. With serotesting, compared with no intervention, the cost per case avoided and per year of life saved for subjects aged 15 years were 335 and 55,100 Euro, respectively. When work-loss costs were also included, savings were associated with screening and vaccination of subjects less than 30 years old. Without serotesting, the costs raised markedly, with an almost identical effectiveness, resulting in an unfavourable incremental cost-effectiveness. Based on medical costs, routine serotesting and varicella vaccination for French adolescents and young adults with a negative or uncertain history of varicella affords health benefits at a cost comparable to those of other very expensive therapies considered worthwhile. From the societal perspective, such screening and vaccination might save costs.     

Is pertussis being considered as a cause of persistent cough among adults?

A study was conducted to determine the 1124 French Sentinel network general practitioners ability to consider pertussis as a cause of persistent cough among adults. Pertussis was rarely considered in the differential diagnosis of cough (6%). Factors associated with pertussis being considered included younger age, shorter cough duration, world health organization clinical definition for pertussis, and muscular chest pain.     

Strategies for containing a global influenza pandemic

Mathematical modelling provides useful insight into the geographic and temporal spread of pandemic influenza. It has been recently used to assess the ability to stop a pandemic at a very early stage. Here, we model the global diffusion of pandemic influenza and the impact of available preventive and control measures. We refined a published SEIR deterministic model of disease dynamics within 52 cities interconnected via air transport to simulate the impact of five interventions in a variety of scenarios: vaccination, case isolation, therapeutic and prophylactic antiviral treatment, and air traffic reduction. The impact of these measures was assessed on the spread of a potential pandemic strain profile, with an average attack-rate of 26%, a case-fatality rate of 2.5% and a residual immunity of 25%. Our analysis highlighted the importance of: (1) a global perspective for dealing with pandemic risks; (2) the time factor and, hence, the importance of surveillance systems; (3) the complementary role of available control measures. Results provide general guidance for the issues of concern to public-health decision-makers: when to set up interventions, where, and at which administrative levels.     

Prevalence and management of heart failure in France: national study among general practitioners of the Sentinelles network

BACKGROUND: Epidemiological data on heart failure's epidemiology in France are scarce and mostly hospital based. The present study's objective is to estimate the prevalence of heart failure (HF) and its management, in subjects aged 60 years and older seen by the French general practitioners (GP). METHODS: A standardised questionnaire was mailed to 900 GPs of the Sentinelles network, requiring answers for any patient aged 60 years and more, seen on a randomly assigned single day of year 2002. National census and health insurance data were used to estimate prevalence. RESULTS: 434 GPs answered, reporting data for 1797 patients aged 60 years and more. The 214 patients with HF, aged 79 years on average, had been seen by a cardiologist in 95% of cases. Results of an echocardiography was available for 58% of HF patients. Compared to non-HF patients, patients with HF were significantly more dependent, more frequently requiring home visit of the GP and more frequently hospitalised (p < 0.001, age adjusted). All the 42% HF patients with a reported left ventricle ejection fraction lower than 40% were treated with an angiotensin converting enzyme inhibitor or an angiotensin receptor inhibitor. The prevalence of HF among patients aged 60 years and older was estimated at 11.9% in general practice (95% confidence interval: 10.5-13.5), and at 2.19% (1.9-2.5) in the general population. The prevalence increased with age, over 20% in persons aged 80 years and more. CONCLUSION: HF in patients aged 60 years and more seen in general practice in France is characterised by a high prevalence and medical consumption in terms of required number of hospitalisation and GP's home visit. For the GP, the diagnosis of HF relies on the cardiologist more than on an echocardiography. The therapeutic management seems to fit the actual recommendations.     

Why and how post-mastectomy edema should be quantified in patients with breast cancer

In the present study, we advocate quantifying post-mastectomy edema in patients with breast cancer in millilitres and not in centimetre, contrarily to the usual routine practice. The water displacement and perimetric quantification methods exhibited both excellent reproducibility with an intraclass correlation coefficient > 0.99 and an accuracy coefficient     

Measles : sub optimal situation in France

The French sentinel network created in 1984 consists of general practitioners from the whole mainland, recruited on a voluntary basis. The members of the network follow up the weekly epidemiological surveillance of 10 health indicators (influenza-like     

Cognitive, emotional and behavioral impact of an uncertain outcome after study of BRCA1/2: review of the literature

BackgroundRecent advances in oncogenetics have enabled the development of tests for predisposition to breast and ovarian cancers. Where no mutation has been identified in the BRCA1 or 2 genes, the proband (first person tested in a family with a genetic risk) can receive an uncertain outcome: negative inconclusive or identification of a variant of unknown clinical significance. From the demonstration of such outcomes, their psychological impact has been studied among women concerned.ObjectiveThe purpose of this article is to summarize the results of studies about the impact of delivering an uncertain BRCA1/2 genetic result on emotional (general or cancer specific distress), cognitive (perception of risk) and behavioral (decisions of medical care) reactions of consultants. It is also to identify factors particularly associated with personal or familial medical history that may alter this impact.MethodologyA literature review was conducted from a key word search on the databases PsycINFO and PubMed (breast*, BRCA*, genetic*, familial, mutation, heredit*) crossed with terms related to the psychological impact and mutation status. Included papers are quantitative studies focused on the psychological impact of the uncertain genetic test result, compared to the impact resulting from positive or true negative result, or from test refusal.ResultsThe results of the eight selected articles generally suggest a less emotional distress and a lower perceived risk of predisposition or to develop cancer facing uncertain genetic result compared to positive result. Intentions of breast cancer surveillance are optimal, indicating the absence of “false reassurance”, while demand for prophylactic surgery appears to be less frequent. Nevertheless risk factors of inappropriate psychological reactions may be highlighted as pretest clinical distress, a personal cancer history or multiple family history of cancer.ConclusionCurrent data suggest psychological reactions adapted to the clinical significance of uncertain genetic test results. These findings are preliminary given the small number of studies and their restriction to populations with similar sociocultural characteristics.     

Psychological aspects of cancer Information dedicated to patients and relatives

In response to the evolution of the information-seeking behaviour of patients and concerns from health professionals regarding cancer patient information, the French National Federation of Comprehensive Cancer Centres (FNCLCC) introduced, in 1998, an information and education program dedicated to patients and relatives, the SOR SAVOIR PATIENT program (SSP). The methodology of this program adheres to established quality criteria regarding the elaboration of patient information. Cancer patient information, developed in this program, is based on clinical practice guidelines produced by the FNCLCC and the twenty French cancer centres, the National League against Cancer, The National Cancer Institute, the French Hospital Federation, the National Oncology Federation of Regional and University Hospitals, the French Oncology Federation of General Hospitals, many learned societies, as well as an active participation of patients, former patients and caregivers. The information and dialogue handbook SOR SAVOIR PATIENT Vivre pendant et après un cancer reporting on the psychological aspects of cancer was worked out and published on the Web in 2005. The guide aims to provide cancer patients with support and advice about the psychological impact of the disease. It provides information on the possible personal consequences of the disease and treatments, in every domain: psychological, emotional, interpersonal, familial or professional. Patients are also advised of the emotional challenges associated with cancer, of the support they may expect at every stage of the disease, from diagnosis to treatment, and of psychological outcome after the disease is over. The document also provides healthcare professionals with a valuable, concise source of validated information on the psychological aspects of cancer, thus facilitating communication between carers and patients. Information provided in the present article has been selected from the information and dialogue handbook SOR SAVOIR PATIENT Vivre pendant et après un cancer. The document addresses the issue of the psychological support made available to the patients during and after the disease. The SOR SAVOIR PATIENT guide can be downloaded from the FNCLCC website at: http://www.fnclcc.fr     

Study of partner-related and situational risk factors for symptomatic male urethritis

During the last decade, the incidence of male urethritis stopped declining in France. Risk factors associated with unprotected intercourse have been extensively studied in men who have sex with men, but not in men in general. The purpose of the study was to determine major risk factors for urethritis among men and to describe the sociodemographic and medical characteristics of this population in 2005. We conducted a prospective case-crossover study of sexual behaviors among men with acute urethritis attending at general practitioners or sexually transmitted infection (STI) clinics in France. Each patient filled out a selfcompleted questionnaire focusing on sociodemographic characteristics, and on sexual behaviors for the month before urethritis onset and for the preceding 3 months. The doctor reported medical information on a separate questionnaire. Between January and September 2005, 121 cases of male urethritis, defined as recent-onset pain on micturition and/or purulent or mucoid discharge, were included. Median age was 33 years, 22.3% were MSM, 55.1% were single, and 72.0% had at least high school education. Conditional logistic regression analysis showed that intercourse with only casual partners or with both casual and steady partners (OR = 2.6, CI 95%: 0.8–8.7, and OR = 8.7, CI 95%: 2.7–28.0), as well as inconsistent condom use (OR = 5.8, CI 95%: 1.7–19.2) significantly increased the risk of male urethritis. STI prevention campaigns should continue to focus on consistent condom use and should not neglect men over 30 years of age.