Rhone-Alpes Region Of France Research Articles

Access to treatment among persons with hemophilia: A spatial analysis assessment in the Rhone-Alpes region, France

ObjectivesIn France, only hospital pharmacies can dispense clotting factor concentrates to persons with hemophilia, which limits the access to care for the treatment and the prevention of bleeding episodes. Moreover, the cost of clotting factor concentrates may restrain the maintenance of sufficient stocks in hospital pharmacies. The aim of this study was to investigate the accessibility of clotting factor concentrates to persons with hemophilia in the context of long-term prophylaxis and emergency treatment in the Rhone-Alpes region of France. MethodsA geographic information system was used for evaluating accessibility of clotting factor concentrates. Persons with hemophilia and hospital pharmacies were geolocalized with the use of postal data, and the evaluation of accessibility was based on the road network. ResultsApproximately 72% of the study area was accessible in less than 30 minutes to a hospital pharmacy. Eighty-five percent of persons with hemophilia had access to clotting factor concentrates for prophylactic treatment in less than 20 minutes. Most of them were patients with severe or moderate hemophilia. Regarding emergency doses, factor VIII was accessible in less than 30 minutes in 45.6% of the study area, and factor IX in 30.5%. ConclusionThis study highlights that spatial access to clotting factor concentrates by persons with hemophilia in the Rhône-Alpes region is good for prophylactic treatment but is more uneven for emergency doses.

Being treated in higher volume hospitals leads to longer progression-free survival for epithelial ovarian carcinoma patients in the Rhone-Alpes region of France

BackgroundTo investigate the relationship between hospital volume activities and the survival for Epithelial Ovarian Carcinoma (EOC) patients in France.MethodsThis retrospective study using prospectively implemented databases was conducted on an exhaustive cohort of 267 patients undergoing first-line therapy during 2012 in the Rhone-Alpes Region of France. We compared Progression-Free Survival for Epithelial Ovarian Carcinoma patients receiving first-line therapy in high- (i.e. ≥ 12 cases/year) vs. low-volume hospitals. To control for selection bias, multivariate analysis and propensity scores were used. An adjusted Kaplan-Meier estimator and a univariate Cox model weighted by the propensity score were applied.ResultsPatients treated in the low-volume hospitals had a probability of relapse (including death) that was almost two times (i.e. 1.94) higher than for patients treated in the high-volume hospitals (p < 0.001).ConclusionTo our knowledge, this is the first study conducted in this setting in France. As reported in other countries, there was a significant positive association between greater volume of hospital care for EOC and patient survival. Other factors may also be important such as the quality of the surgical resection.

PCR and PCR-RFLP genotyping of Staphylococcus aureus coagulase gene: convenience compared to pulse-field gel electrophoresis

Staphylococcus aureus belongs to the group of major contagious mastitis pathogens. We aimed to evaluate the usefulness and the convenience of the coagulase (coa) gene polymorphism to type S. aureus from bovine mastitis milk samples. A total of 22 S. aureus strains were collected from bovine cases of mastitis in four veterinary practices in the Rhone-Alpes region of France and were assessed using coagulase gene’s polymerase chain reaction (PCR) followed by AluI PCR-restriction fragment length polymorphism (PCR-RFLP). Coa gene PCR produced six profiles. The AluI PCR-RFLP displayed nine profiles, giving ten combined patterns. Two genotypes accounted for 50 % of the isolates. Although the results showed that cows from the studied regions were infected by S. aureus strains harboring more than one coagulase genotype, only one or two types predominated. Identification based on PCR-RFLP of the coa gene gave the same results than pulse-field gel electrophoresis (PFGE). Identification based on PCR-RFLP of the coa gene has been considered a more simple and accurate typing method for epidemiological investigations of bovine mastitis.

Global prevalence and incidence of traumatic spinal cord injury

BackgroundSpinal cord injury (SCI) is a traumatic event that impacts a patient’s physical, psychological, and social well-being and places substantial financial burden on health care systems. To determine the true impact of SCI, this systematic review aims to summarize literature reporting on either the incidence or prevalence of SCI.MethodsA systematic search was conducted using PubMed, MEDLINE, MEDLINE in process, EMBASE, Cochrane Controlled Trial Register, and Cochrane Database of Systematic Reviews to identify relevant literature published through June 2013. We sought studies that provided regional, provincial/state, or national data on the incidence of SCI or reported estimates of disease prevalence. The level of evidence of each study was rated using a scale that evaluated study design, methodology, sampling bias, and precision of estimates.ResultsThe initial search yielded 5,874 articles, 48 of which met the inclusion criteria. Forty-four studies estimated the incidence of SCI and nine reported the prevalence, with five discussing both. Of the incidence studies, 14 provided figures at a regional, ten at a state or provincial level and 21 at a national level. The prevalence of SCI was highest in the United States of America (906 per million) and lowest in the Rhone-Alpes region, France (250 per million) and Helsinki, Finland (280 per million). With respect to states and provinces in North America, the crude annual incidence of SCI was highest in Alaska (83 per million) and Mississippi (77 per million) and lowest in Alabama (29.4 per million), despite a large percentage of violence injuries (21.2%). Annual incidences were above 50 per million in the Hualien County in Taiwan (56.1 per million), the central Portugal region (58 per million), and Olmsted County in Minnesota (54.8 per million) and were lower than 20 per million in Taipei, Taiwan (14.6 per million), the Rhone-Alpes region in France (12.7 per million), Aragon, Spain (12.1 per million), Southeast Turkey (16.9 per million), and Stockholm, Sweden (19.5 per million). The highest national incidence was 49.1 per million in New Zealand, and the lowest incidences were in Fiji (10.0 per million) and Spain (8.0 per million). The majority of studies showed a high male-to-female ratio and an age of peak incidence of younger than 30 years old. Traffic accidents were typically the most common cause of SCI, followed by falls in the elderly population.ConclusionThis review demonstrates that the incidence, prevalence, and causation of SCI differs between developing and developed countries and suggests that management and preventative strategies need to be tailored to regional trends. The rising aging population in westernized countries also indicates that traumatic SCI secondary to falls may become an increasing public health challenge and that incidence among the elderly may rise with increasing life expectancy.

Mortalité périnatale et qualité des prises en charge au sein du réseau Aurore de 2005 à 2011. Mise en place des réunions de morbi-mortalité au sein du réseau

Evaluate the incidence of perinatal mortality and evaluate the percentage of non optimal care management of fatal pregnancies between 2005 and 2011 in the Rhone-Alpes region in France, by the use of the Aurore network. Evaluate the development of morbi-mortality revues (MMR) in this region. Retrospective study of perinatal mortality in the Aurore network, from 2005 to 2011. Systematic analysis of care management (adapted, non adapted, non evaluable), of each perinatal death that occurred in the Aurore network, by a multidisciplinary committee during regional MMR. The incidence of perinatal mortality has diminished from 2005 to 2011 (8,4‰ vs. 6,4‰, P<0.07) as well as the percentage of non adapted care management (13% vs. 5,6%, P<0.001). An underestimation of irregularities in the fetal heart rate was described in 34% of per partum deaths. The percentage of optimal care management was significantly higher when the obstetrician was in the maternity rather than on call at home (P<0.03) and in type 3 maternities compared to type 1 and 2 maternities (P<0.04). The attendance of the MMR organized in the AURORE network progressed between 2006 and 2011. Since 2005, a decrease in perinatal mortality and in non-adapted care management was observed. More studies are necessary to evaluate the link between the development of MMR in this network and the amelioration of these two indicators.

Multi Hazard Scenarios in the Mendoza/San Juan Provinces, Cuyo Region Argentina

This paper exposes major natural hazards inventory encountered in the two San Juan and Mendoza provinces, such as climatic, seismic, gravitational, and social/anthropic ones. The contrast between the high altitude of the region and low one is addressed in order to manage the inhomogeneity of prevention plans. The international road to Chile is greatly affected by gravitational hazards that proceed in out of run period and commercial traffic interruption, and large economic waste more than people vulnerability, as the urban areas are more affected by seismicity scenarios. But as gravitational hazard is affected by the seismicity it is proposed to analyze some co-hazard effect in a multi-scenarios approach from geology geography and mechanical modelling of events to explore the co-effects on the scenarios. Moreover, some similarities with the Rhone-Alpes region of France are evocated and may be of interest.

1511P - Treatment Patterns in Patients with Metastatic Soft Tissue Sarcoma (STS). Results from an Exhaustive Cohort in Rhone-Alpes Region (France), the EMS (Medical Evaluation of Sarcoma) Study

ABSTRACT Background Soft tissues sarcomas (STS) are rare malignant tumors. Few treatments are approved for metastatic STS and an extent off-label drugs use is expected. Based on a prospective study (EMS) of 888 patients newly diagnosed with a sarcoma between March 2005 and Feb 2007 in the Rhone-Alpes region of France, the treatment patterns of patients with metastatic STS were described. Methods 358 patients with subtypes corresponding to subtypes included in the phase III PALETTE trial were identified in the EMS study. Of these patients 19.3% (n = 69) had metastatic STS at diagnosis. Among the patients with localized STS, 26.2% (n = 76/289) had progressed following diagnosis leading to a total of 145 metastatic STS patients in the population. These patients were characterized and followed to determine treatment patterns. Results For first line (1L) metastatic patients, 25.4% (n = 35/138) of patients entered a clinical trial. 68.4% of patients received at least one off-label drug (table 1). Doxorubicin was the most common 1L therapy (63%). In the 2L, 25.8% of patients entered a clinical trial and 51.6% received at least one off-label drug. Doxorubicin was still the most common therapy (29%), but there was no clear standard of care. Median time to relapse was 250, 123 and 110 days, for 1, 2 and 3L. Median treatment free interval (TFI) between 1L and 2L was 89 days and reduced to 30 days between 2L and 3L. Conclusions STS is a rare and heterogeneous disease with a high use of unapproved treatments and short TFIs between two treatment lines. The lack of clear standard of care, particularly in patients receiving 2L therapy demonstrates important medical need for new agents in this therapeutic area Table 1: treatment mainly used at 1st and 2nd metastatic treatment lines, either given alone or in combination. 1st metastatic line 2nd metastatic line Therapeutic option N = 145, MD * = 7 N = 83, MD = 4 Systemic Treatment 95 (68.8%) 62 (78.5%) Drugs administered N = 95 N = 62 Doxorubicin 60 (63.2%) 18 (29.0%) Ifosfamide 28 (29.5%) Fully combined with Doxo 7 (11.3%) 42.8% combiend with Doxo Dacarbazine 18 (18.9%) 2 (3.2% fully combined with Doxo Docetaxel‡ 12 (12.6%) 14 (22.6%) Gemcitabine‡ 12 (12.6%) 14 (22.6%) of which >80% use was Gemcitabine-Docetaxel regimen Trabectedine 7 (7.4%)‡ 8 (12.9%) Ate least 1 off-label drug 65 (68.4%) 35 (56.5%) * MD: Missing Data‡: off-label use in STS treatment Disclosure B. Tehard: GlaxoSmithKline Employee GlaxoSmithKline funded the data analyses leading to resultst mentionned in this abstract. I. Ray-Coquard: Isabelle Ray-Coquard received fees and Grants from GSK GlaxoSmithKline funded the data analyses leading to resultst mentionned in this abstract. N. Ladarre: GlaxoSmithKline Employee GlaxoSmithKline funded the data analyses leading to resultst mentionned in this abstract. S. Manson: GlaxoSmithKline Employee GlaxoSmithKline funded the data analyses leading to resultst mentionned in this abstract. J. Blay: Jean-Yves Blay received fees from GSK GlaxoSmithKline funded the data analyses leading to resultst mentionned in this abstract. All other authors have declared no conflicts of interest.

Contribution of a preliminary socio-anthropological survey to the development of a therapeutic patient education programme for patients receiving oral chemotherapy

Introduction: For a long time patients with cancer receiving chemotherapy were ’captive’, and were considered as passive during the administration of their treatment. The development of oral treatments over the last decade has considerably changed this situation. However, very little is known about the behaviour of the patients and the physicians in this new setting. Our team carried out a social anthropological survey on patients who were autonomous in the management of their oral chemotherapy, before developing a therapeutic patient educational programme. Objectives: The objective of the survey was to identify the mental representations and behaviour of patients and prescribing oncologists. Methods: The survey included 42 patients receiving oral chemotherapy and 10 oncologists from two cancer centres in the Rhone-Alpes region in France between January and March 2007. Different qualitative study methods were used: repeated focus groups and individual face-to-face or telephone interviews. Results and discussion: The results of this survey were used to develop the objectives for a therapeutic educational programme. The way patients managed their oral chemotherapy was found to be linked to their beliefs about the treatment efficacy and toxicity. The structure and contents of the educational sessions were adapted to take into consideration the identified representation.

A prospective epidemiological study of new incident GISTs during two consecutive years in Rhône Alpes region: incidence and molecular distribution of GIST in a European region

Background:Preliminary data indicate that the molecular epidemiology of localised gastrointestinal stromal tumour (GIST) may be different from that of advanced GIST. We sought to investigate the molecular epidemiology of sarcomas, including GIST, in the Rhone-Alpes region in France.Patients and methods:A prospective and exhaustive study in the Rhone-Alpes Region in France to assess the precise incidence of primary sarcomas with systematic centralised pathological review and molecular analysis was conducted for 2 consecutive years.Results:Among 760 patients with a confirmed diagnosis of sarcoma, 131 (17%) had a GIST. The majority of patients had gastric primaries (61%). Mutational analysis could be performed in 106 tumour samples (74%), and 71 (67%) had exon 11 mutations. PDGFRA mutations were found in 16% of cases, which is twice as high as previously reported for advanced GIST.Conclusion:Data indicate that PDGFRA mutations in localised GIST may be twice as high as what was previously reported in patients with advanced disease. This finding may have important consequences for patients offered adjuvant imatinib, although most of these tumours are in the low-risk group.

A rapid and easy PCR-RFLP method for genotyping Serratia marcescens strains isolated in different hospital outbreaks and patient environments in the Lyon area, France

A new genotyping method for Serratia marcescens is described. This method uses the flagellin gene as target for polymerase chain reaction amplification and Alu I restriction fragment length polymorphism. The strains tested belonged to 13 different hospital clusters of S. marcescens isolated between 1983 and 1988, concerning outbreaks and/or patient environments in different hospital units in Lyon and the Rhone-Alpes region of France. Initially, the classification had been performed by marcescinotyping. These strains were then tested by ribotyping and genotyping of the flagellin gene. Genotyping showed similar classification to ribotyping. The genotyping method is the easiest technique, as reproducible as ribotyping, and with almost the same ability to discriminate different strains. It does not need expensive equipment, is more rapid, and is less labor intensive than ribotyping. With this method, all strains of S. marcescens including sporadic isolates could be amplified and typed. Antibiotic sensitivity determination was found to be a useful complementary and confirmation test for all these typing methods.

Health effects costs of particulate air pollution.

We conducted a cross-sectional study in December 1994 in three metropolitan areas of the Rhone-Alpes region in France (Lyon, Grenoble, and Chambéry; total number of inhabitants = 970,000) to assess the medical costs resulting from exposure to particulate air pollution. Probability samples of the general population (508 families, 1265 subjects) and of the physicians (395) and 13 hospital respiratory care and emergency units in the study area provided data on the prevalence of respiratory disorders and on medical care usage. Measurements from air-quality monitoring networks were used to ascribe a fraction of the respiratory morbidity to the ambient air particle concentrations present during the study period, on the basis of attributable risk estimates drawn from recent meta-analyses. The medical care usage and absenteeism related to respiratory disorders were converted into direct and indirect medical and social costs by use of a "cost of illness" approach. These costs were extrapolated to annual costs of disease attributable to particulate pollution in 1994, using daily values of air pollution. The average particulate concentrations during the study period were moderate (39, 41, and 10 micrograms/m3 in the three cities), yielding attributable fractions that ranged between 0.6% and 13.8% according to the health condition and to the city. Three hundred ninety-five subjects reported respiratory symptoms (prevalence, 31.2%) during the study period; 1182 patients visited a doctor and 158 used hospital services. The extrapolated annual estimates of the attributable cost of respiratory diseases for a population of 1 million range between 79 and 135 million French francs (FF) (20th and 80th percentiles of the cost distribution, after a Monte Carlo simulation, respectively; 50th percentile, 107 x 10(6) FF [16.3 x 10(6) Euros]). Over-the counter drug consumption represents the largest cost item (approximately 44% of total costs), followed by wage losses (38%). Hospital expenditures amount to a low percentage of total costs (about 5%) because most respiratory disorders do not require hospital care. Mortality was not considered in this study. Most of these costs occur at relatively low levels of air pollution (67% of the total annual costs are incurred during days with particle concentrations lower than 50 micrograms/m3). Such substantial figures are useful for assessing the social impacts of air pollution and for evaluating the cost efficiency of abatement policies.

Surveillance of community-acquired viral infections due to respiratory viruses in Rhone-Alpes (France) during winter 1994 to 1995.

Nasal swab from patients with acute flu-like illness were evaluated for the presence of respiratory viruses in the Rhone-Alpes region of France from 1 October 1994 through 2 May 1995. The relative frequencies and seasonal distributions of the specific viruses were assessed. In addition, virus type was correlated with specific clinical signs and symptoms. During the study, 962 samples were collected by 75 medical practitioners participating in the Groupe Regional d'Observation de la Grippe surveillance network. One or more viruses were detected from 348 samples (36.1%), including 108 respiratory syncytial virus (RSV), 64 influenza virus A type H3N2, 47 influenza virus B, 64 coronavirus, 35 rhinovirus, 22 adenovirus, 5 enterovirus, and 3 parainfluenza-fluenza strains. There were 16 mixed infections. RSV infections peaked in the early winter, and influenza viruses A and B infections peaked during the late winter and early spring. There were two peaks of coronavirus infections (late fall and late winter). Other viruses were detected at lower levels throughout the study period. Patients from whom adenovirus was isolated were significantly more likely to have a fever of > 39.5 degrees C than were patients with other detectable viruses (P < 0.001). Furthermore, there was a significant correlation between influenza and cough (P < 0.01) and RSV and bronchiolitis (P < .001). Thus, the current study defined the overall and relative frequencies of respiratory virus detection from nasal swab specimens in patients with an acute flu-like illness in the Rhone-Alpes region of France during a 7-month period. Correlation with clinical signs and symptoms and provisional conclusions regarding seasonality were also determined.