Inhabitants In France Research Articles

Insights from local government managers: Navigating crises through organizational capacities and perceptions

AbstractRecent years have shown that strategic responses to crises by local governments (LGs) depend on the type of crisis, the institutional environment, but also internal capacities and sensemaking processes. However, such relationships have not been tested widely yet. Based on a survey of managers (n = 590) from cities with more than 15,000 inhabitants in France, Germany, Italy, and the United Kingdom, this study explores the role played by specific organizational capacities (critical thinking, bricolage, and financial capacities) and crisis perceptions (valence—i.e., threat vs. opportunity; and controllability) in shaping adaptive or regressive response strategies. Results show that these capacities are associated with how LGs' managers perceive crises and the type of responses adopted. Higher financial capacity, bricolage, and critical thinking are associated with stronger sense of organizational controllability, but they have different relationships with threat and opportunity perceptions. The study confirms the importance of distinguishing valence (threat and opportunity) from controllability perceptions.

Have the Inhabitants of France, Great Britain, Spain, and the US Been Secularized? An Analysis Comparing the Religious Data in These Countries

This paper carries out a comparative analysis of the religious beliefs and practices of residents in France, Spain, the United Kingdom, and the United States of America, using two waves of the World Values Survey. The main objective is to investigate the impact that secularization has had on the religious experience in these countries. More specifically, the prospection is carried out around the Christian creed in its Protestant and Catholic manifestations, understood as the majority beliefs in these countries. To carry out this task, we compiled a series of data distributed around the following categories: Contextualization: The importance of religion within different aspects of life; level of religiosity and membership in religious denominations; the sphere of beliefs: Belief in God, belief in life after death, belief in hell, and belief in heaven; scope of practices; and the nones. Subsequently, we carry out an explanatory-interpretative analysis articulated around four questions or challenges faced by these religious forms in the context of secularization: 1. The crisis of Christianity; 2. the thesis of European exceptionalism; and 3. the rise of the nones. In conclusion, the data analyzed allow us to affirm—with nuances—the following: 1. The existence of a process of dechurching in the heart of Christianity; 2. the confirmation that the European case is exceptional if we compare it with other trends or other cultural programs of secularization; 3. that the area of greatest dechurching is linked to community practice, something that allows this research to adhere to Davie’s thesis, which defines the current religious situation as believing without belonging; and 4. as a consequence of the process of dechurching, there is a rise of a social group without religious adscription: The nones.

Systematic assessment of non-medical use of prescription drugs using doctor-shopping indicators: A nation-wide, repeated cross-sectional study.

The aim of this study was to present the first nation-wide, systematic, repeated assessment of doctor-shopping (i.e. visiting multiple physicians to be prescribed the same drug) during 10years for more than 200 psychoactive prescription drugs in the 67 million inhabitants in France. This was a nation-wide, repeated cross-sectional study. Data are from the French National Health Data System in 2010, 2015 and 2019 for 214 psychoactive prescription drugs (i.e. anaesthetics, analgesics, antiepileptics, anti-Parkinson drugs, psycholeptics, psychoanaleptics, other nervous system drugs and antihistamines for systemic use). The detection and quantification of doctor-shopping relied upon an algorithm that detects overlapping prescriptions from repeated visits to different physicians. We used two doctor-shopping indicators aggregated at population level for each drug dispensed to more than 5000 patients: (i) the quantity doctor-shopped, expressed in defined daily doses (DDD), which measures the total quantity doctor-shopped by the study population for a given drug; and (ii) the proportion doctor-shopped, expressed as a percentage, which standardizes the quantity doctor-shopped according to the use level of the drug. The analyses included approximately 200 million dispensings to approximately 30 million patients each year. Opioids (e.g. buprenorphine, methadone, morphine, oxycodone and fentanyl), benzodiazepines and non-benzodiazepine hypnotics (Z-drugs) (e.g. diazepam, oxazepam, zolpidem and clonazepam) had the highest proportions doctor-shopped during the study period. In most cases, the proportion and the quantity doctor-shopped increased for opioids and decreased for benzodiazepines and Z-drugs. Pregabalin had the sharpest increase in the proportion doctor-shopped (from 0.28 to 1.40%), in parallel with a sharp increase in the quantity doctor-shopped (+843%, from 0.7 to 6.6DDD/100 000 inhabitants/day). Oxycodone had the sharpest increase in the quantity doctor-shopped (+1000%, from 0.1 to 1.1DDD/100 000 inhabitants/day), in parallel with a sharp increase in the proportion doctor-shopped (from 0.71 to 1.41%). Detailed results for all drugs during the study period can be explored interactively at: https://soeiro.gitlab.io/megadose/. In France, doctor-shopping occurs for many drugs from many pharmacological classes, and mainly involves opioid maintenance drugs, some opioids analgesics, some benzodiazepines and Z-drugs and pregabalin.

Electronic petitions in France on the material of Change.org, a non-governmental e-petition platform

The article presents the results of an empirical study on electronic petitions posted on the Change.org French-speaking segment, geographically linked to France. The relevance of the topic is due to the intervention of modern information and communication technologies in political reality and the need for scientific reflection of the consequences of digital changes in political processes. The authors of the article analyse the regional particularities of the online petition activity by the inhabitants of France on the material of 15 887 electronic petitions (January 2015 – October 2017), 570 of which are petitions with the status of “victory” (4 %). The authors note that the European territories of France form three main groups of online petition activity (with low, medium and high petition activity). Residents of France most often relate to social problems (social security, health care and education) in electronic petitions. In addition, Change.org is actively registering electronic petitions on issues related to crime and terrorism, discrimination, the environment, the economy and animal welfare. Electronic petitions about problems of culture, sports and problems of confessional relations are recorded relatively rarely. The greatest response from the recipients of the petition is caused by problems in the social sphere, education and health. The French society, through the prism of activity on the non-governmental Internet resource Change.org, appears as a modern society with post-industrial values, preoccupied with security issues, in an active and relatively productive dialogue with its political and business elite.

«ЧУМА» А. КАМЮ И ПАНДЕМИЯ COVID-19: ЧЕЛОВЕЧЕСТВО ПЕРЕД ЛИЦОМ ЭКЗИСТЕН-ЦИАЛЬНОЙ УГРОЗЫ

The novel of the Nobel Prize winner in literature Albert Camus "The Plague" became one of the most widely read books in Europe during the Covid-19 coronavirus pandemic. A number of researchers consider Camus to be an existentialist writer. Existentialism arises, after two bloody wars, to give answers to questions that concern humanity. Since Albert Camus wrote the novel during the Second World War, he understands the plague not only as a disease, but also as German soldiers, whom the inhabitants of France called the "brown plague" because the invaders wore brown shirts. As the inhabitants of the city of Oran resisted the plague on the pages of the work, so the inhabitants of France fought against Nazism and fascism. A. Camus in the novel "The Plague" describes the quarantine measures that take place in the city of Oran in the 40s of the XX century. The consequences of the epidemic and the behavior of the residents described in the novel have much in common with modern coronavirus realities: the decline of the economy, the growth of the number of unemployed, protests against the quarantine measures introduced; the introduction of curfews, the creation of new medicines, etc. In Russia, as in the pages of the novel, there is a decline in the economy. Thus, during the pandemic in Russia, the number of registered unemployed increased from 1.3 million people to 4.8 million, and the appeal to employment centers for support measures increased from 20% to 80%. Camus in his novel writes about the creation of an anti-plague serum, in Russia, the first in the world, a vaccine against coronavirus infection "Sputnik V" was created. The director of the hotel, described in the work, said that due to the epidemic and quarantine, the tourist business disappeared. According to the World Tourism Organization — tourism at the end of 2020 it has decreased by 77% compared to 2019, which is equivalent to the tourist activity that was recorded in the late 80s. Stray animals were shot in Oran, because they believed that they could be carriers of infection. In China, during the Covid-19 pandemic, pets were thrown out of windows because people believed that they could be the source of Covid-19, and in Denmark, more than 11 million minks were exterminated for the same reasons. The authors of this article attempted to analyze the development of the epidemiological process in the novel and plot the mortality rate from the plague according to the data of the work.

Doctor shopping for methylphenidate as a proxy for misuse and potential abuse in the 67 million inhabitants in France.

Doctor shopping enables subjects to receive more than the prescribed dose out of any medical management, which suggests a search for high doses and makes doctor shopping a relevant proxy for misuse and potential abuse. Therefore, this study aimed to identify and characterize profiles of subjects with doctor-shopping behavior for methylphenidate in the entire French population. This study is a cross-sectional study of doctor-shopping behavior for methylphenidate in France, in 2016, using the Système national des données de santé, and accounting for overlapping prescriptions. Subjects who obtained >840mg by doctor shopping were defined as subjects with heavy doctor-shopping behavior, and subjects who obtained >0mg and ≤840mg by doctor shopping were defined as subjects with light doctor-shopping behavior. A total of 63739 subjects were included, and received 339.6kg of methylphenidate. Among them, 216 (0.3%) subjects had heavy doctor-shopping behavior, and 313 (0.5%) subjects had light doctor-shopping behavior. Compared with subjects with light doctor-shopping behavior, subjects with heavy doctor-shopping behavior were older (64% of 30- to 49-year-old subjects vs. 77% of ≤17-year-old subjects; P<0.001), received more concomitant dispensings of antipsychotics (37% vs. 26%; P=0.008) and opioid maintenance treatments (50% vs. 6%; P<0.001), and had more prescribers (4 [IQR=2-5] vs. 2 [IQR=2-3]; P<0.001). In the French context where prescription and dispensing of methylphenidate are highly regulated and methylphenidate is much less used than in other countries, these results are a warning signal to avoid trivializing methylphenidate in adults.

PCV65 Analysis of Venous Thromboembolism (VTE) Hospital Management from Real-World French Administrative Database

Venous thromboembolism (VTE) is caused by the formation of a thrombus in the bloodstream. VTE includes deep vein thrombosis, which can evolve to embolism if the thrombus breaks off. VTE is a frequent pathology, with an annual incidence of 1 to 2 per 1,000 inhabitants in France and a severe pathology, with a 3-month mortality between 10 and 15%. However very few real-world data are available in France on those patients and their hospital management. A retrospective cross-sectional study was conducted using the French exhaustive National hospital discharge database (PMSI). VTE patients were included between 2014 and 2017 and followed until 2018. The study was conducted for the whole VTE population and on two distinct cohorts: (i) patients with venous thrombosis (I80*, I820 I821, I636, I676, O222, O223, O225, O870, O871 and O873) and (ii) patients with embolism (I26*, I822, I823, I828, I829 and O882). Relevant comorbidities were assessed using also ICD-10 codes. Incidence and prevalence of VTE inpatients were calculated and hospital management and its associated costs were described. In-hospital mortality was assessed using Kaplan-Meier model. The number of VTE patients increased from 133,633 to 143,873 between 2014 and 2017 with more than 90% of incident patients. The prevalence and incident rates were stable at 2 per 1,000 inhabitants. Median age was 71 and 52.7% were female. Median length of first VTE episode was 6 days and a recurrence lasted 2 days. The median delay between first and second episode was 354 days. The burden of VTE reached 238.8M€ in 2017. The 1-year hospital mortality was 5.11%. This study provides a recent and detailed description of VTE patients and their hospital management in France. VTE patients hospital management was found to be associated with a high economic burden, mainly caused by the first hospital stay.

Evolution of doctor shopping for oxycodone in the 67 million inhabitants in France as a proxy for potential misuse or abuse.

This nationwide study aimed to compare use of oxycodone and doctor shopping for oxycodone in 2010 and 2016, and to quantify doctor shopping for oxycodone by sex, age, formulation, and dosage in 2010 and 2016. This study is a cross-sectional comparative analysis of doctor shopping based on all dispensings of oxycodone in France, in 2010 and 2016. Dispensings of oxycodone were extracted from the Système national des données de santé, which covers the 67 million inhabitants in France. Quantification of doctor shopping relies on an algorithm accounting for overlapping prescriptions, which is a proxy for potential misuse or abuse. The number of subjects who received oxycodone increased by 214% from 67,838 subjects in 2010 to 212,753 subjects in 2016, and the number of subjects with doctor-shopping behavior increased by 197%, from 1066 subjects in 2010 to 3163 subjects in 2016. For 30- to 44-year-old men, the total quantity of oxycodone obtained by doctor shopping increased by 391%, from 4582 defined daily doses in 2010 to 22,517 defined daily doses in 2016. By formulation and dosage, the total quantity of oxycodone obtained by doctor shopping increased with the dosage for both immediate-release and extended-release tablets in 2010 and 2016. The widespread extent of doctor shopping and its 3-fold increase in line with population exposure is a strong signal in the French context. These results are another argument to avoid trivializing oxycodone to prevent misuse, potential abuse, and potential oxycodone-related deaths, but it requires caution to prevent compromising effective treatment of pain.

Incidence of Orbital Exenteration: A Nationwide Study in France over the 2006-2017 Period

ABSTRACT Purpose Orbital exenteration is a radical and disfiguring surgery mainly performed for treating orbital malignancies. Recently, several studies found favorable results in terms of overall survival with eye-sparing surgeries combined with targeted therapies and/or radiotherapy. The aim of this study was to assess the incidence of orbital exenteration and its evolution in France between 2006 and 2017. Methods A national observational cohort study was conducted in France between January 2006 and December 2017. Data were collected from the national PMSI (Programme de Médicalisation des Systèmes d’Information) database provided by the CNAM (Caisse Nationale de l’Assurance Maladie). All patients undergoing orbital exenteration over the study period in France were included. Results One thousand and fifty-seven patients were included. The mean annual number of orbital exenterations was 88.1 (63–117), corresponding to a mean incidence of 0.1/100,000 inhabitants/year. A male predominance was noted (n = 626, 59.2%). Exenteration was mainly performed between 75 and 79 years. The underlying etiology was available for 821 patients (77.7%): malignancies were the most common (n = 755; 92.0%) followed by infectious diseases (n = 16; 1.9%). Over the study period, no statistical difference in the mean incidence of orbital exenteration was found (p = .132). Conclusion The mean annual incidence of orbital exenteration was 0.1/100,000 inhabitants in France and was not significantly modified during the study period.

ReACanROC: Towards the creation of a France–Canada research network for out-of-hospital cardiac arrest

AimsThere are large differences between emergency medical systems, which may account for variability in outcomes. We seek to compare prehospital organizations, response modes, patient characteristics and outcomes after out-of-hospital cardiac arrest, between France and Canada, and discuss the need for the first European–North American prehospital research network on out-of-hospital cardiac arrest. MethodsPreliminary comparative description of data drawn from two nation-wide, population-based, Utstein-style prospectively implemented registries for out-of-hospital cardiac arrest in France and Canada (France: RéAC, Canada: CanROC), covering approximately 80 million people, and soon to be participating in an international research network in 2020. ResultsSince creation, 103,722 cases were included in France and approximately 99,317 in Canada. Data used in this work were drawn from 2011 to 2016, and comprised around 33,688 adult, non-traumatic, treated cases in Canada, and 55,358 in France, leading to estimated incidence rates of 75.3/100,000 inhabitants in France and 83/100,000 in Canada. In both countries, out-of-hospital cardiac arrest predominantly occurred in male patients, in their late sixties, at home, of presumed cardiac aetiology. Bystander cardiopulmonary resuscitation was provided in half of the cases. First assessed cardiac rhythm was shockable in 16% (France) vs. 22% (Canada). Professional resuscitation was attempted in 82% (France) and 60% (Canada). Prehospital organizations and response modes differed in the constitution of responding teams (France: physician-led advanced life support, Canada: trained paramedics), in response time intervals (call to first professional responders’ arrival at scene 6.5 min (interquartile range IQR [5.2–8.3]) (Canada) vs. 10 min [7–15] (France)), in on-scene interventions, type of referral at hospital (France: systematic bypass of emergency department, tertiary hospital first, Canada: occasional bypass, mainly closest hospital first), and in outcomes (overall survival at hospital discharge in France: 5% vs. Canada: 11%). ConclusionDespite similarities in some out-of-hospital cardiac arrest Utstein variables, several differences exist between French and Canadian prehospital systems, and ultimately, between outcomes. The creation of the ReACanROC research network will facilitate the conduction of further analyses to better understand predictors of this variability.

Interest of Social Representations Theory to grasp coastal vulnerability and to enhance coastal risk management (Interés de la Teoría de las Representaciones Sociales para entender la vulnerabilidad costera y para mejorar la gestión de los riesgos costeros)

ABSTRACTThis theoretical paper provides a new perspective on coastal vulnerability analysis by combining geography and psycho-social approaches. Most studies on perceptions of coastal risks report that people who are exposed have a low level of perceived vulnerability (they are not anxious), strong place attachment (they love their living place and want to live close to the sea) and are resistant to changes in adaptation strategies (they do not want to move away). For natural scientists and managers, these findings usually appear as paradoxes that enhance vulnerability and lead to these people being labelled ‘irrational’, ‘in denial’, ‘uninformed’ or ‘uneducated’. Based on our long-term studies among coastal inhabitants in France, we believe that using Social Representations Theory (SRT) in this context enables us to go beyond these preconceived and individual-centred ideas towards a more contextualized view. This position extends theoretical risk/vulnerability research and is applicable to coastal risk management.

How to Manage Frail Older Adults in the Community? Proposal of a Health Promotion Program Experienced in a City of 16,638 Inhabitants in France.

Health promotion programs could prevent and delay frailty and functional decline. However, in practice, the planning and establishment of such a program is a challenge for health care providers. We report an experimental model of screening and management for frail elderly conducted in Cugnaux, city of 16,638 inhabitants in France, by the Toulouse Gerontopole and the social care service of the Cugnaux City Hall. A frailty screening self-administered questionnaire (FiND questionnaire) was sent to community-dwelling residents of 70 years old and over of Cugnaux. The completed questionnaires were analyzed and the subjects were classed into three groups: robust, frail, mobility disability, based on their score. Frail subjects and those with mobility disability invited to undergo a frailty assessment in the premises of the town hall realized by a nurse in order to identify the causes of their frailty and propose them a personalized intervention plan (PIP). The FiND questionnaire was sent to the residents of Cugnaux of 70 years old and over (n=2,003). After two mailings, 860 (42.9%) completed questionnaires were received. Mean age of the responders was 79.0 ± 6.2 years and 59.6% women (n= 511). According to the questionnaires analysis, 393 (45.7%) were robust, 212 (24.6%) frail, 240 (27.9%) had a mobility disability and 15 (1.7%) could not be classified due to missing data. 589 (68.5%) subjects accepted to be contacted by the Gerontopole nurse. The assessment by the nurse was proposed to frail subjects and those with mobility disability (n=313). Until 31 December 2016, 136 patients have been evaluated. The mean age was 80.1±5.4 and most patients were women (69.9%). The mean ADL score was 5.8±0.5 and the IADL showed a mean score of 6.9±1.7. According to Fried definition of frailty, 76 patients (55.9%) were pre-frail, and 35 (25.7%) frail. Concerning the frailty domains identified, 75 patients (55.1%) showed the alteration of physical performance, 70 (51.5%) thymic disorders and 46 (33.8%) sensory disorders. Preventive interventions proposed in the PIP were mostly physical interventions (86.8%, n=118) followed by cognitive (61.8%, n=84) and nutritional (39.7%, n=54) interventions. This project shows the feasibility to implement a care model in the community. It permitted a large identification of frail elderly people in the city population, insuring their assessment and clinical follow up to maintain their capacities and referring them to social services.

Hospital incidence and annual rates of hospitalization for venous thromboembolic disease in France and the USA.

Objective The study was designed to describe the hospital incidences and annual hospitalization rates for venous thromboembolic disease by age and sex in France and the United States on the closest possible methodological bases. Methods French statistics are from the PMSI MCO (Programme de médicalisation des système d'information de médecine, chirurgie et obstétrique (French national hospital discharge register)) national database. These are compiled for each calendar year by collating résumé de sortie anonymisé (RSA, anonymous discharge summary) files forwarded and validated by health establishments with admissions in medicine, surgery, obstetrics, and odontology. They are compared to the data issued from the US National Hospital Discharge Survey which is equivalent to the PMSI in France and uses the International Classification of Diseases-9 for encoding the data. These data were published in the Morbidity, Mortality Weekly Report of the Centre for Disease Control. Results In the US, 547,996 hospital stays involve venous thromboembolic diseases, 348,558 deep venous thrombosis (DVT), and 277,549 pulmonary embolism (PE). Of these 78,511, or 14%, include a diagnosis of both DVT and PE. The hospital incidence of venous thromboembolic disease is 1.4%, DVT 0.9%, and PE 0.7%. In France, of the 26,658,228 annual hospital stays, 273,931 include venous thromboembolic disease, 179,286 DVT, and 139,345 PE while 44,700, i.e. 16.3%, include both DVT and PE. The hospital incidence of venous thromboembolic disease is thus 1.0%, DVT 0.6%, and PE 0.5%. The overall annual hospitalization rates for venous thromboembolic disease, DVT, and PE are respectively 274, 179, and 139 per 100,000 inhabitants in France and 239, 146, and 121 per 100,000 inhabitants in the US. Conclusion Venous thromboembolic diseases occur in France and the US in 1% of all hospital stays and are responsible for an annual hospitalization rate that exceeds 200 per 100,000. The scale of these annual incidences should prompt us to question the quality of prevention put in place and/or its efficacy.

許容可能な温度推定方式のフランス一般家庭データによる評価

We evaluate the proposed method that estimates acceptable room temperatures, by French residential data. By distributing HEMS sets to 200 French volunteer families, we have collected data of smart plugs and thermometers from April of 2014 to March of 2015. By applying the proposed method to the French volunteer residential data of winter, we obtain 0.4 degree Celsius reduction on average by comparing the room temperature means to the minimum acceptable temperatures estimated by the proposed method. This result indicates that our proposed method may be useful for inhabitants in France, in addition to those in Japan.

Causes of death in people with chronic HBV infection: A population-based cohort study

Mortality related to hepatitis B virus (HBV) is not well known in developed countries. The aim of this study was to investigate in a population-based cohort the excess risk of death in HBV patients compared with mortality in the general population and to identify risk factors related to all-cause mortality and HBV-related mortality. A specialized population-based registry has recorded data from patients with chronic HBV infection in a population of one million inhabitants in France since 1994. Standardized mortality rates for all-cause death and HBV-related death were calculated. Cumulative mortality rates were calculated using the Kaplan-Meier method. Multivariate analysis was performed using a Cox model. Between 1994 and 2009, 1117 people were diagnosed with chronic HBV infection. Of these 136 (12.2%) died. All-cause mortality was significantly higher in HBV-infected people (standardized mortality ratio (SMR) 1.7 [1.4-2.0]). There was substantial excess mortality due to hepatocellular carcinoma (SMR 15.9 [10-24.1]), non-Hodgkin lymphoma (SMR 8.6 [3.1-18.6]) and liver disease (SMR 10.2 [5.8-16.6]). The cumulative rates for all-cause mortality were 8.6% at 5 years, 12.6% at 10 years and 18.5% at 15 years. The corresponding values for HBV-related mortality were 3.5%, 4.2%, and 5.8%. The multivariate analysis for all-cause mortality and for HBV-related mortality showed that male sex, age over 45 at diagnosis, current alcoholism and nosocomial risk factors were predictors of increased mortality. This study shows increased all-cause mortality in HBsAg-positive patients, with considerable excess mortality due to chronic liver disease, hepatocellular carcinoma and non-Hodgkin lymphoma.

L’empowerment au regard de l’histoire française de la participation des habitants

Thibault Tellier&#8217;s article explores the historical foundations of the participation of inhabitants in France, in the context of urban policies development during the thirty-year boom period following the second world war (known as the &#171;&#160;Trente Glorieuses&#160;&#187;), and the implementation of the &#171;&#160;politique de la Ville&#160;&#187; at the beginning of the 80&#8217;s. He points out that a confusion exists between the terms &#171;&#160;participation&#160;&#187; and &#171;&#160;animation&#160;&#187;, which has caused a profound misunderstandig of empowerment.

Eclipse of Empire? Perceptions of the Western Empire and its Rulers in Late-Medieval France

Posing the ‘deceptively simple question: how did the inhabitants of France in the thirteenth and the first half of the fourteenth century view their world?’, Chris Jones concentrates on how the French kings and educated contemporaries perceived the ‘rulers of the western Empire in a period in which the authority they exercised underwent a dramatic decline’. This is set against the wider issues of ‘conceptions of political structures and the fundamental organization of society’: how was the relationship between the Emperor and contemporary kings, the Empire and individual kingdoms, comprehended? Did views change in the wake of developments following the death of Frederick II? On the one hand, there were continuing claims to universal imperial rule; on the other, there was all too obvious evidence of imperial impotence. Did kings exercise their powers as representatives of the Emperor, or as rulers in their own right? This was the contentious matter of whether a Rex in regno suo was indeed an imperator or sovereign princeps that so exercised thirteenth-century legal minds, especially those of Parisian academics and royal counsellors in France and Naples.

Incidence of gastrointestinal stromal tumors (GISTs) in France: Results of the PROGIST survey conducted among pathologists

10047 Background: GISTs are the most common mesenchymal tumors of the gastrointestinal tract but data on the annual incidence of this tumor is scarce due to previous lack of well-defined pathologic criteria. The aim of this study was to investigate the incidence of GISTs in France and describe the distribution according to age, sex, circumstances of discovery, localization and risk categories. Methods: This prospective epidemiologic study was performed among pathologists who were asked to declare all the cases of GIST over a one year period. All pathology centers (330 centers) in France were proposed to participate and asked to report exhaustively the cases diagnosed from 1 December 2004 to 30 November 2005. Results: 591 cases of GISTs were reported, 535 new cases and 56 cases of relapse. However, some large centers were not able to participate. So, the annual estimated incidence was 12 cases/million inhabitants in France. The main characteristics of the new cases of GIST were as follows: mean age 65 (± 13.2) (range: 16–93) years, 48.6% men and 51.4% women, circumstances of discovery: fortuitous 163 (30.5%), symptomatic 249 (46.5%), unknown 123 (23%). The primary tumor locations were: stomach 341 (63.7 %), small intestine 115 (21.5%), mesentery 35 (6.5%), colon/rectum 17 (3.2%), esophagus 4 (0.7%), unknown 23 (4.3%). 95.3% of GISTs were cKIT (CD117) + and 3.7 % were cKIT -. According to the Fletcher consensus criteria, based on tumor size and mitotic rate, among the 490 localized GISTs 14.7% were considered to be at very low prognostic risk, 25.5% at low-risk, 23.1 % at intermediate risk and 23.1 % at high-risk. For 13.6 % data were missing. Conclusions: This study is providing for the first time an estimation of the annual incidence of GISTs and a description of the characteristics of these tumors in France based on pathology registration. The true incidence may be slightly higher as some large centers were not able to reported their cases. These results are comparable to what has been reported in recent studies in other European countries. No significant financial relationships to disclose.

Prévalence de l’ Helicobacter pylori dans la choriorétinopathie séreuse centrale et l’épithéliopathie rétinienne diffuse : Étude complémentaire

In 2001, Mauget-Faysse et al. found a prevalence of Helicobacter pylori infection of 56.3% in 16 patients with central serous chorioretinopathy (CSC) and diffuse retinal epitheliopathy (DRE). This prevalence was twice that of the French population. This complementary study aimed to verify these results.and method: Between 1996 and 2002, 78 patients living in the southeast of France with CSC/DRE were included in this study. H. pylori infection was assessed by the 13C-urea breath test. Diagnosis was confirmed by fundus biomicroscopy, fluorescein and ICG angiographies and retinal OCT scans (from 2002). Results were analyzed with the Chi2test.Out of 78 patients, there were 60 males (76.9%) and 18 females (23.1%), with a mean age of 53 years (range, 29-80 years); 27 had CSC (34.6%) and 51 had DRE (65.4%). H. pylori infection was detected as positive in 31 patients (39.7%) and negative in 47 (60.3%). Men were detected positive in 43.3% of cases, compared to women detected positive in only 27.8%. The difference in prevalence of H. pylori between the study population (39.7%) and the overall population of 58,419,710 inhabitants of France in 1999 (25.4%) was found statistically highly significant (p = 0.0036).and conclusion: These results may indicate a possible association between H. pylori infection and CSC/DRE manifestations. These data confirm the first results of the 2001 prospective pilot study and also show a higher prevalence of H. pylori infection in men than in women.

Socioeconomic Aspects of Postacute Care for Patients with Brain Infarction in France

Background: In France, the socioeconomic aspects of stroke have never been addressed. Such analyses are essential for health authorities to justify the establishment of new stroke units when resources are low, provided it can be shown that stroke units are effective in reducing both the morbidity and mortality of stroke. Only 6 dedicated stroke services exist for 60 million inhabitants in France. Our aim was to study acute and postacute pathways and to determine the factors that influence destination after discharge, handicap evolution and costs. Methods: In a cohort of 494 consecutive patients with brain infarction, we collected information on medical and socioeconomic variables, handicap and its evolution using the modified Rankin scale and Mini-Mental Status score at the 10th day, 6th month and 18th–40th month. These data were recorded during the initial hospital stay, at the follow-up clinic visit and in a home interview done 18–40 months after discharge by research nurses. We used multiple logistic regression for analyses. Results: The most important factor for not returning home was having a Rankin score greater than 3 with an odds ratio of 41.7 (95% confidence interval 19.2–90.0; p = 0.001). Multivariate analysis showed that when the Rankin score was 0, 1 or 2, the main factors for not returning home were socioeconomic variables and serious medical disorders. When the Rankin score was 4 or 5, the main reason for not being sent for rehabilitation was medical status. After adjustment for the Rankin score, patients who returned home or were transferred to rehabilitation were quite similar regarding socioeconomic and medical variables. Other patients transferred to a geriatric ward, nursing home or new housing were more frequently living alone, 60 years of age or older, had less than 2 children, low level of education, dementia or cancer. Overall, the mean cost was 19,513 Euros over an 18-month period and was mainly driven by the level of the Rankin score (e.g. 10,530 vs. 34,809 Euros for Rankin scores of 0–1 and 4–5, respectively). Conclusion: These data showed that not only handicap level but also socioeconomic variables are important in determining the destination of stroke patients after discharge. They may help health authorities to make decisions to establish new approaches to treat stroke. This study can also serve as a basis for future cost-effectiveness studies of new drugs being evaluated in therapeutic trials or of new management strategies of stroke patients.