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Catherine Quantin

Publications and source records attributed to Catherine Quantin.

16 recordsLinked to original sources
PubMed2026

Long-Term Cardiovascular Impact of Postpartum Treatment After Hypertensive Disorders of Pregnancy: Population-Based Cohort Study.

OBJECTIVE: To assess whether early antihypertensive treatment after Hypertensive Disorders of Pregnancy (HDP) influences subsequent development of cardiovascular complications. DESIGN AND SETTING: Population-based nationwide cohort of health data set in France. POPULATION: 108 906 women with HDP (excluding pre-existing Chronic Hypertension (CH)) who delivered between 2010 and 2014, with 35 878 (33%) receiving at least one antihypertensive treatment in the month after giving birth. METHODS: Traditional Cox model, estimated 10-year cardiovascular risk. Extended Cox Step Function model and Restricted Mean Survival Time evaluated time trends. MAIN OUTCOME MEASURES: New-onset CH, heart failure, coronary, cerebrovascular, peripheral artery diseases and 2 composite events (one including CH, the other excluding it) over 10 years following giving birth. RESULTS: Women receiving early postnatal antihypertensive treatment had a higher long-term risk of complications over 10 years than non-treated women (CH: aHR = 3.067, 95% CI [2.996-3.139]; composite event including CH: aHR = 3.025 [2.956-3.096]; composite event excluding CH: aHR = 1.451 [1.305-1.614]). Treated women had events earlier than non-treated women, presenting a higher risk at the beginning of the postpartum period. The 10-year absolute risk for CH remained high in both groups: 44% for treated women and 18% for non-treated women. CONCLUSION: Our study shows that women receiving early postpartum antihypertensive treatment are at higher long-term cardiovascular risk, with 44% of them having CH within 10 years. Besides, approximately 1 in 5 women non-treated in the postpartum period subsequently developed CH, demonstrating that many high-risk women are not being identified in the peripartum period and may be missing opportunities for timely intervention.

Humans↗
PubMed2006

Unique patient concept: a key choice for European epidemiology.

The French Ministry of Health is setting up the personal medical record (PMR or DMP for Dossier Médical Personnel in French). This innovating tool is highly expected and will be extremely useful for the therapeutic follow-up as well as for epidemiological studies on which public health policies are based. Therefore the currently planned identifying process should prevent any epidemiological use of these data. Numerous scientific organisations have alerted government powers about the threat that this impairment represents, and they wish to promote some secure procedures that exist, which have already proved their efficiency at the national and international level.

Computer Security↗
PubMed2006

The French proposal for a health identification number.

The French ministry of Health is setting up the personal medical record (PMR or DMP for Dossier Medical Personnel in French). This innovating tool is highly expected and will be extremely useful for the therapeutic follow-up as well as for epidemiological studies on which public health policies are based. Therefore the currently planned identifying process should prevent any epidemiological use of these data. Numerous scientific organisations have alerted government powers about the threat that this impairment represents, and they wish to promote some secure procedures that exist, which have already proved their efficiency at the national and international level.

Computer Security↗
PubMed2005

Comparison of Cox's and relative survival models when estimating the effects of prognostic factors on disease-specific mortality: a simulation study under proportional excess hazards.

In many prognostic studies focusing on mortality of persons affected by a particular disease, the cause of death of individual patients is not recorded. In such situations, the conventional survival analytical methods, such as the Cox's proportional hazards regression model, do not allow to discriminate the effects of prognostic factors on disease-specific mortality from their effects on all-causes mortality. In the last decade, the relative survival approach has been proposed to deal with the analyses involving population-based cancer registries, where the problem of missing information on the cause of death is very common. However, some questions regarding the ability of the relative survival methods to accurately discriminate between the two sources of mortality remain open. In order to systematically assess the performance of the relative survival model proposed by Esteve et al., and to quantify its potential advantages over the Cox's model analyses, we carried out a series of simulation experiments, based on the population-based colon cancer registry in the French region of Burgundy. Simulations showed a systematic bias induced by the 'crude' conventional Cox's model analyses when individual causes of death are unknown. In simulations where only about 10 per cent of patients died of causes other than colon cancer, the Cox's model over-estimated the effects of male gender and oldest age category by about 17 and 13 per cent, respectively, with the coverage rate of the 95 per cent CI for the latter estimate as low as 65 per cent. In contrast, the effect of higher cancer stages was under-estimated by 8-28 per cent. In contrast to crude survival, relative survival model largely reduced such problems and handled well even such challenging tasks as separating the opposite effects of the same variable on cancer-related versus other-causes mortality. Specifically, in all the cases discussed above, the relative bias in the estimates from the Esteve et al.'s model was always below 10 per cent, with the coverage rates above 81 per cent.

Aged↗
PubMed2005

Revascularization of the right coronary artery: grafting or percutaneous coronary intervention?

BACKGROUND: The choice of myocardial revascularization strategy for the right coronary artery (RCA) in patients with multivessel disease and chronic stable angina remains controversial. Our aim was to determine the better strategy-hybrid, combining bypass of the left coronary network and percutaneous coronary intervention of the RCA, or exclusively surgical-and if the latter, the best conduit. METHODS: We used decision analysis, a modeling technique, to compare two RCA revascularization strategies: surgical grafting and percutaneous coronary intervention. A review of the English language literature determined the variables for each strategy. All possible outcomes of each strategy were analyzed to determine the baseline strategy yielding the highest expected effectiveness. Sensitivity analysis determined the most relevant elements in the model and indicated threshold values. RESULTS: Arterial grafting of the RCA led to the highest expected effectiveness, respectively 6% and 7% higher than that of percutaneous coronary intervention and the saphenous graft procedure. Of the arteries available-the radial, right gastroepiploic, and right internal thoracic artery-the most effective was the right internal thoracic artery, pedicled for the proximal part of the RCA and free connected as a Y or a T to the pedicled left internal thoracic artery for the distal part of the RCA. Sensitivity analysis showed surgery to be the appropriate strategy when the expected 1-year patency rate of the arterial graft exceeded 80%. CONCLUSIONS: This analysis shows arterial grafting of the RCA to have better outcomes than percutaneous coronary intervention, and the right internal thoracic artery to be the best conduit.

Angioplasty, Balloon, Coronary↗
PubMed2005

Myocardial injury in critically ill patients: relation to increased cardiac troponin I and hospital mortality.

OBJECTIVE: To examine the relationship between myocardial injury, assessed by cardiac troponin I (cTnI) levels, and outcome in selected critically ill patients without acute coronary syndromes or cardiac dysfunction. DESIGN AND SETTING: Prospective, observational study in the emergency ICU of a university teaching hospital. POPULATION: Over a 6-month period, 217 consecutive patients admitted to the ICU were studied. METHODS AND RESULTS: cTnI assays were performed in all patients on admission to the ICU. The incidence of myocardial injury, defined by cTnI level > 0.1 ng/mL, was 32% (69 of 217 patients). Overall mortality was 27% (58 of 217 patients). Patients with myocardial injury had a mortality rate of 51%, compared with only 16% mortality for those without myocardial injury (p < 0.001). The hospital mortality rate was highest among older patients (71 +/- 14% vs 58.5 +/- 20%, p < 0.0001) and patients with higher simplified acute physiology scale (SAPS) II score (62 +/- 25% vs 37 +/- 17%, p < 0.0001). Mechanical ventilation was associated with higher in-hospital death (50% vs 31%, for patients who died in the hospital vs those who were discharged alive; p = 0.03). Elevated blood levels of cTnI were found to be independently associated with hospital mortality, regardless of the presence of SAPS II score and mechanical ventilation, in the logistic regression analysis (odds ratio, 2.09; 95% confidence interval, 1.06 to 4.11; p = 0.01). CONCLUSIONS: This study demonstrates the high frequency of myocardial injury (32%) in critically ill patients without acute coronary syndromes or cardiac dysfunction on admission to ICU. Myocardial injury is an independent determinant of hospital mortality. Assessment of myocardial injury on admission to ICU would make it possible to identify patients at increased risk of death.

Adult↗
PubMed2005

Proposal for the creation of a European healthcare identifier.

In France, the European health card was created in June 2004 to increase the quality of healthcare granted to european citizen anywhere in europe and to facilitate the reimbursement of the healthcare costs. The patient identifier included in this card is essentially based on the healthcare insurance number of the patient and does not allow any linkage with his (her) previous health care data if he (she) is affiliated to another national healthcare insurance system when working for a long duration outside France. The purpose of this paper is to present the concept of a personal identifier based on familial components which has been validated by the French authority for personal data protection in the framework of a genetic study. Results issued from the Burgundy perinatal network demonstrate the interest and the faisability of adding a maternal component to the individual component of the new-born to allow Mother/new-born healthcare data linkage after anonymization. The advantage of adding a familial component to the healthcare insurance number is debated. This proposal will permit to link the data of a patient even when residing outside his country in Europe. It will also contribute to establish european public health statistics by matching healthcare data of the patients' records with other administrative data (mortality, social information ..) after anonymisation of these data in accordance with the European directive on data protection.

Computer Security↗
PubMed2004

[Toxoplasmosis seroconversion in pregnant women. The differing attitudes in France].

INTRODUCTION: Since 1992 France has been running a toxoplasmosis prevention program based on the serological detection of infections during pregnancy. In the absence of a consensus, the seroconversions discovered are managed in different ways, varying from one centre to another. OBJECTIVE: To describe the habits of the specialised centres in France and propose means to reduce the heterogeneity. METHODS: A survey using a questionnaire mailed to the centres of parasitology in France specialised in the management of toxoplasmosis seroconversion during pregnancy. RESULTS: All the 30 centres surveyed replied. Five of them do not provide recommendations for treatment and were excluded from analysis. The attitudes of the 25 other centres varied greatly with regard to the indications for therapeutic abortion and amniocentesis, treatment protocols with pyrimethamine and sulfamides, as well as in the frequency of sonographical monitoring. CONCLUSION: In the absence of National guidelines, the management of seroconversions discovered during the prenatal prevention of congenital toxoplasmosis program is left to the discretion of the specialised centre. This results in variations from one town to the next. This heterogeneity underlines the lack of knowledge on the most efficient and acceptable means of preventing and treating congenital toxoplasmosis. In order to improve this situation, the French parasitologists have launched a program of consensual meetings aimed at harmonising the treatment protocols and identifying the points that require further studies.

Adult↗
PubMed2004

Clinical, immunological and virological evolution in patients with CD4 T-cell count above 500/mm3: is there a benefit to treat with highly active antiretroviral therapy (HAART)?

To assess the clinical, immunological and virological evolution in HIV-1 infected patients with CD4 T-cell count above 500/mm3, a historical cohort of 202 untreated and 96 patients treated with HAART was longitudinally studied (median follow-up 36 months). Fourteen untreated and 2 treated patients experienced clinical progression (p = 0.09). The difference between baseline CD4 T-cell count and after 3 years, was -240/mm3 in the untreated group +19/mm3 in the HAART group (p < 10(-3)). A better immunological outcome was significantly associated with a HIV sexual contamination (p = 0.01), HAART (p = 0.01), high baseline CD4 T-cell count (p < 10(-3)) and low baseline HIV viral load (p = 0.01). In the HAART group, the incidence rate of antiretroviral modification due to tolerance difficulties was 0.23+/-0.36/patient year. A sustained undetectable HIV viral load was correlated with a low baseline HIV viral load (p = 0.003) and to be antiretroviral naive (p < 10(-3)). Thus, HAART provide a better immunological outcome in patients with high CD4 T-cell count. However, the CD4 decay slope after 3 years, the risk of therapeutic side-effects and the low risk of clinical progression do not support systematic treatment of those patients.

Adult↗
PubMed2004

Long-term ocular prognosis in 327 children with congenital toxoplasmosis.

OBJECTIVE: Retinochoroiditis is the most frequent consequence of congenital toxoplasmosis. Early diagnosis and treatment are believed to reduce the risk of visual impairment. We report on the clinical evolution of ocular lesions and final visual function in a prospective cohort of congenitally infected children who were identified during monthly maternal prenatal screening. METHODS: The study included 327 congenitally infected children who were monitored for up to 14 years at the Croix Rousse Hospital in Lyon, France. Data on date of maternal infection; time and type of therapy; antenatal, neonatal, and postnatal work-ups; and ocular status were analyzed. RESULTS: All mothers but 52 had been treated. Pyrimethamine and sulfadiazine was given in utero to 38% of children and after birth to 72% of newborns. Fansidar was given for an average duration of 337 days in all but 2 children. After a median follow-up of 6 years, 79 (24%) children had at least 1 retinochoroidal lesion. In 23 (29%) of them, at least 1 new event had been diagnosed up to 10 years after detection of the first lesions: reactivation of an existing lesion (1 case), new lesion in a previously healthy location (19 cases), or both (3 cases). Fifty-five children had lesions in 1 eye; of the 45 children for whom final visual acuity data were available, 31 (69%) had normal vision. Twenty-four children had lesions in both eyes; of the 21 for whom final visual acuity data were available, 11 had normal vision in both eyes. None had bilateral visual impairment. CONCLUSIONS: Clinicians, parents, and elder children with congenital infection should be informed that late-onset retinal lesions and relapse can occur many years after birth but that the overall ocular prognosis of congenital toxoplasmosis is satisfactory when infection is identified early and treated accordingly.

Adolescent↗
PubMed2004

A peculiar aspect of patients' safety: the discriminating power of identifiers for record linkage.

Today, one of the main stake of the interfaced health information systems or networks is to be able to gather the different parts of the medical record of a patient without any risk to mix them with those of one other patient. This objective could appear easy to reach but only in theory because in practice many name are misspelled or erroneous and a great attention has to be paid to define what is the best identifier to link medical record. As a linkage using less informative identifiers could lead to linkage errors, it is essential to quantify the information associated to each identifier. The aim of this study was to estimate the discriminating power of different identifiers susceptible to be used in a record linkage process. This work showed the interest of three identifiers when linking data concerning a same patient using an automatic procedure based on the method proposed by Jaro; the date of birth, the first and the last names seemed to be the more appropriate identifiers. Including a poorly discriminating identifier like gender did not improve the results. Moreover, adding a second christian name, often missing, increased linkage errors. On the contrary, it seemed that using a phonetic treatment adapted to the French language could improve the results of linkage in comparison to the Soundex. However, whatever, the method used it seems necessary to improve the quality of identifier collection as it could greatly influence linkage results.

Humans↗
PubMed2003

A relative survival regression model using B-spline functions to model non-proportional hazards.

Relative survival, a method for assessing prognostic factors for disease-specific mortality in unselected populations, is frequently used in population-based studies. However, most relative survival models assume that the effects of covariates on disease-specific mortality conform with the proportional hazards hypothesis, which may not hold in some long-term studies. To accommodate variation over time of a predictor's effect on disease-specific mortality, we developed a new relative survival regression model using B-splines to model the hazard ratio as a flexible function of time, without having to specify a particular functional form. Our method also allows for testing the hypotheses of hazards proportionality and no association on disease-specific hazard. Accuracy of estimation and inference were evaluated in simulations. The method is illustrated by an analysis of a population-based study of colon cancer.

Aged↗
PubMed2003

Management of the second episode of spontaneous pneumothorax: a decision analysis.

BACKGROUND: Optimal management for patients presenting a second episode of spontaneous pneumothorax remains controversial. The aim of this study was to compare two possible treatment strategies, video-assisted thoracic surgery (VATS) and conservative management, in order to assess which of the two was better adapted for the treatment of the second episode of spontaneous pneumothorax. METHODS: The authors propose a decision analytic model including a cost-effectiveness study to compare two clinical strategies: VATS (reference strategy) and conservative management (alternative strategy). Data were obtained from a Medline search for English language articles and cost estimates were derived from the financial and public health departments of our hospital. The model was analyzed to determine the baseline strategy leading to the highest expected effectiveness and the lowest expected cost. RESULTS: Conservative management offered a slight advantage in expected effectiveness value (99.99 vs 99.93 for VATS). VATS produced the lowest expected cost (4347 vs 7536 for conservative management). The incremental cost-effectiveness ratio was 57,750. Within the ranges tested, the sensitivity analysis presented consistent results in terms of effectiveness and advocated conservative management as the best strategy. In terms of cost, with the exception of length of stay, the sensitivity analysis was insensitive in estimating the different probabilities, and favored VATS over conservative management. CONCLUSIONS: In the management of the second episode of spontaneous pneumothorax, VATS offers substantial savings in cost for only a slight decrease in effectiveness, when compared with conservative management.

Cost-Benefit Analysis↗
PubMedDate not supplied

Which are the best identifiers for record linkage?

As a linkage using less informative identifiers could lead to linkage errors, it is essential to quantify the information associated to each identifier. The aim of this study was to estimate the discriminating power of different identifiers susceptible to be used in a record linkage process. This work showed the interest of three identifiers when linking data concerning a same patient using an automatic procedure based on the method proposed by Jaro; the date of birth, the first and the last names seemed to be the more appropriate identifiers. Including a poorly discriminating identifier like gender did not improve the results. Moreover, adding a second christian name, often missing, increased linkage errors. On the contrary, it seemed that using a phonetic treatment adapted to the French language could improve the results of linkage in comparison to the Soundex. However, whatever, the method used it seems necessary to improve the quality of identifier collection as it could greatly influence linkage results.

Confidentiality↗
PubMedDate not supplied

Acute liver enzyme elevations in HIV-1-infected patients.

BACKGROUND: Acute liver enzyme elevations (ALEE) have been associated with a first-line highly active antiretroviral therapy (HAART) and/or viral hepatitis coinfections in HIV-infected patients. By comparison, the frequency and the risk factors of ALEE in untreated patients and in patients treated with several antiretroviral regimens need to be assessed. PURPOSE: To describe the long-term frequency and the characteristics of ALEE in antiretroviral treated and untreated patients and to define risk factors for ALEE in a retrospective cohort of HIV-1-infected patients. METHOD: An HIV-infected cohort was retrospectively examined. ALEE was defined as levels of alanine amino transferase and/or alkaline phosphatase rising to at least 2.5 times above baseline values. Hazard ratios (HR) for ALEE were estimated using an extension of the Cox proportional model taking into account recurrent events. RESULTS: Out of 239 assessable patients, 12 (5%) were coinfected with hepatitis B virus (HBV) and 34 (14.2%) with hepatitis C virus (HCV). The incidence rate of ALEE was 9.9/100 patients-year and the cumulative incidence was 20.9%. HCV genotype 3 tended to give a higher risk of ALEE. Independent factors for developing ALEE in multivariate logistic regression were HBV (HR = 4.0) and HCV (HR = 3.4) coinfections, antiretroviral therapy (HR = 2.6), CDC stage C (HR = 2.5), and high alkaline phosphatase baseline values (HR = 1.7). CONCLUSION: The occurrence of ALEE is influenced more by the past medical history and the clinical background of the patients than by antiretroviral therapy. These patient-linked variables must be taken into account to avoid unwarranted treatment withdrawal.

Acute Disease↗