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Biomedical subjects

F Grémy

Publications and source records attributed to F Grémy.

At least 19 recordsLinked to original sources
PubMed1995

[Predictive values of the usual biologic tests for the detection of human immunodeficiency virus infection. Consequences for screening].

This paper tries to review what is scientifically known about the predictive values of biological tests of HIV infection. The epidemiological situation for that infection is characterized by two facts: the very high values of sensitivity and specificity which are close to unity; the prevalence of seropositivity which is on average--at least in western countries--, very low (except for some small specific groups). Under those conditions, Negative Predictive Values are always very close to unity, and the percentage of false negative tests is extremely low. Things are quite different for Positive Predictive Value, which varies very rapidly with very small shifts or uncertainties about specificity and prevalence. In the case when prevalence is very low (general population screening) and at the same time specificity is not excellent (that means < 0.99 or even < 0.995), Positive Predictive Value is very poor and the proportion of false positive tests rather important. Indeed the analysis of scientific literature, using the method of "best synthesis evidence", reveals numerous discrepancies as to the value of specificity among different tests. Figures vary a lot from one study to another. It is not obvious which screening strategies are concerned by the results, which finally entail a strong statistical uncertainty. Finally, the figures published in the literature are given by high standard laboratories. One may fear the tests realized in routine laboratories are less reliable. As a conclusion, let us say that despite their very good quality, the biological tests, when used separately, should not be trusted without strong previous criticism when applied to samples of the general population. Any biological screening should be preceded by a clinical examination, including a precise inquiry, in order to detect people at risk, that means with a high prior probability. Clinical dialogue has moreover another great interest: it allows health consulting and education, and calls for personal responsibility for both seropositive and negative subjects. It is the best choice of method to reach a high preventive effectiveness.

HIV Infections↗
PubMed1994

Relative importance of risk factors in bladder carcinogenesis: some new results about Mediterranean habits.

In the Mediterranean region of France where bladder cancer mortality and incidence are high, a case-control study with 219 male incident cases and 794 randomized, male population-controls was carried out in 1987-89 to investigate bladder cancer risk factors and more specifically, regional factors. A stepwise logistic regression was applied to the data. This investigation confirms the role of tobacco and of certain occupational exposures in bladder carcinogenesis. There was a significant dose-response relationship with lifelong coffee drinking and alcohol consumption; however the risk estimates were only significantly elevated for the heaviest drinkers. The intake of saccharin was not associated with risk of bladder cancer. Infrequent consumption of carrots, spinach, and marrows conferred an increased risk, suggesting a protective effect of vitamin A. Finally, this investigation results in some new hypotheses. The study of residences and birthplaces has revealed a lower risk for those who have lived in a non-Mediterranean area and a higher risk for those born in a Mediterranean area. These features might be explained by some Mediterranean dietary habits, such as a high consumption of spices (odds ratio = 3.64, 95 percent confidence interval = 2.21-5.98).

Age Factors↗
PubMed1993

[Risk factors in bladder cancer. A case-control study in the department of Hérault, France].

The excess of morbidity and mortality for cancers of the bladder in the french department of Hérault (South of France, on the side of the Mediterranean Sea) justified the implementation of a new epidemiologic study. A case-control study was designed, including 219 cases, 196 hospital-controls and 794 population controls. The collected information concerned profession, habits, behaviour (smoking, alcohol and coffee drinking), places of living, since childhood. The study confirms the role of tobacco, with a highly significant dose-effect, for total consumption, daily dose, and duration of consumption (p < 10(-4)). The classical risk of coffee is confirmed, but it seems not to be due to quantity of caffeine, but to the mouldered form of coffee. As far as alcohol is concerned, the sole risk is due to anisis beverages. When one considers the role of either tobacco, or coffee, or alcohol, the risk is strongly increased (p < 0.02) when exposure begins very early in life (childhood or teen age). But the effect does not depend on the beginning-of-exposure age, when the latter is posterior to teen age (p > 0.95). One may indeed think that the carcinogenic action of these factors concerns mainly the induction phase of the disease. Finally, when place of birth and place of living were considered, a North to South increasing effect was strongly suggested by the study.

Case-Control Studies↗
PubMed1991

Morpho-semantic analysis and translation of medical compound terms.

This paper describes an automatic procedure for morphosemantic analysis and translation of compound medical terms. This analysis is of interest for the automatic indexation of medical discharge reports and summaries. Since words with the suffix -osis may have many different semantic interpretations, such -osis forms are taken as examples for a general method that avoids the difficulties in interpreting medical terms as reported in other studies.

Algorithms↗
PubMed1989

Crisis of meaning and medical informatics education: a burden and/or a relief?

Starting with the quotation by Paul Ricoeur: Man needs love indeed; he needs justice still more; but most of all he needs meaning, this paper states that in this present situation medical education does not prepare students to deal with human needs, neither their own nor those of their patients. This is due to the almost exclusive devotion to hard sciences, contaminated by unscientific ideological drift, which tends to negate subjectivity and to suppress any significance of human destiny. Although medical informatics, by definition, eliminates meaning and knowledge, it can - if properly used as a complement and not as a competitor of human intelligence - help to renovate medical education, introduce true humanistic dimensions, and restore the element of human subjectivity.

Artificial Intelligence↗
PubMed1979

[Health indexes and "sanimetry": conceptual aspects of recent research on the measurement of a population's state of health (author's transl)].

The major health indexes based on the classical concepts of mortality and morbidity are reviewed while emphasizing their limitations: underestimation of health problems socio-economic impact, inadequacy for the evaluation of certain main objectives of health care delivery systems, purely negative measurement of health. This paper investigates the recent attempts to improve these aspects: extension of the concept of morbidity by the introduction of disability measurements and the development of a "positive health" concept. Finally, a discussion is presented of the major health indexes whose development is based on the use of these concepts and the main conceptual, methodological problems they give rise to.

Delivery of Health Care↗
PubMed1978

[Validation of paternity in a father-mother-child trio, by the use of genetic markers. Description of a program to aid in the decision. Determination of the optimal sequence of examinations].

The knowledge of human polymorphism provides aid to the decision for the diagnosis parenthood. This work gives an algorithm of paternity diagnosis on a (presumed father, mother, child) triplet: the program verifies the logical relationships and calculates several indices used to estimate the likelihood of non-exclusion. We propose to attach greater importance to a neglected index: the percentage of subjects for which the paternity is excluded for the doublet (Mother, Child). Finally, we determine the most efficient and most economical sequence for the sequential use of genetic markers.

Alleles↗