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Biomedical subjects

J F Viel

Publications and source records attributed to J F Viel.

At least 19 recordsLinked to original sources
PubMed2005

Clusters of autochthonous hepatitis A cases in a low endemicity area.

At the University Hospital of Besançon (département of Doubs, France), an unusually high number of patients were hospitalized for hepatitis A during the 1999-2000 period, some of whom had not travelled abroad. This prompted us to conduct an investigation on a population basis and search for clusters of cases possibly related to local sources of contamination. Accordingly, case definition was restricted to autochthonous cases. During the 1999-2002 period, 45 autochthonous cases were classified as possibly originating from local environmental sources. A space-time scan statistic detected one most likely cluster (standardized incidence ratio 20.63, 95% confidence interval 10.6-37.1), consisting of 11 persons (of whom five children had attended the same swimming pool). It remained significant in a sensitivity analysis, strongly supporting the hypothesis of an environmental source of contamination. This study reveals the necessity of regular surveillance for hepatitis A and raises the issue of virological surveys of pool waters.

Adolescent↗
PubMed2005

Increasing trend of childhood type 1 diabetes in Franche-Comté (France): analysis of age and period effects from 1980 to 1998.

AIMS/HYPOTHESIS: A study was conducted by the Franche-Comté Regional Association of Private Practitioners (Union Régionale des Médecins Libéraux de Franche-Comté) to assess trends in childhood-onset Type 1 diabetes in this administrative region of France, between 1980 and 1998. METHODS: Cases of childhood-onset Type 1 diabetes (aged 0-14 years) were retrospectively recorded with the help of general practitioners, private specialists and hospitals in the Franche-Comté and surrounding administrative regions. Incidence rates and trends during the period were analysed using Poisson regression. RESULTS: During the 19-year study period, 308 cases of childhood-onset Type 1 diabetes were identified. The level of case ascertainment was estimated to be 80.6% (95% CI: 74.7, 87.4). The male-to-female sex ratio was 1.03. The World standardised incidence rate was 6.90/100,000. The incidence rate was 6.03 (95% CI: 4.76, 7.53) for children aged 0 to 4 years, 6.45 (95% CI: 5.23, 7.88) for children aged 5-9 years and 8.56 (95% CI: 7.18, 10.13) for those aged 10-14 years. The annual increase rate was 4.9%, continuous and regular, without any deviation. This trend did not differ according to gender or age group. CONCLUSION/INTERPRETATION: These results confirm that the incidence and the increase rate in childhood Type 1 diabetes in France are average compared to in other European countries over an extended period of time. Furthermore, the regular and linear increase in incidence supports the hypothesis of causal environmental factors diffusing over time. The complementary data provided also illustrate the role that private practitioners may play by their implication in epidemiology and public health.

Adolescent↗
PubMed2005

Blood warm reperfusion: a necessary adjunct to heart-valve surgery in low-risk patients?

AIM: The aim of this prospective, randomized study was to determine whether blood warm reperfusion improves myocardial protection provided by cold crystalloid cardioplegia in patients undergoing first-time elective heart-valve surgery, using cardiac troponin I release as the criterion for evaluating the adequacy of myocardial protection. METHODS: Seventy patients with a left ventricular ejection fraction greater than 40% were randomly assigned to 1 of 2 myocardial protection strategies: 1) cold crystalloid cardioplegia with no reperfusion or 2) cold crystalloid cardioplegia followed by 2-minute blood warm reperfusion before aortic unclamping. Cardiac troponin I concentrations were measured in serial venous blood samples drawn immediately prior to cardiopulmonary bypass and after aortic unclamping at 6, 9, 12, and 24 h. RESULTS: Randomization produced 2 equivalent groups. The total amount of cardiac troponin I released (7.17+/- 14.8 mg in the crystalloid cardioplegia with no reperfusion group and 5.82+/-4.66 mg in the crystalloid cardioplegia followed by blood warm reperfusion group) was not different (P > 0.2). Cardiac troponin I concentration did not differ for any sample in either of the 2 groups. The total amount of cardiac troponin I released was higher in patients who required inotropic support (9.14 +/-16.2 mg) than those who did not (4.73+/-4.52 mg; P = 0.009). CONCLUSIONS: Our study shows that adding blood warm reperfusion to cold crystalloid cardioplegia provides no additional myocardial protection in low-risk patients undergoing heart-valve surgery.

Aged↗
PubMed2004

Multilevel modelling and malaria: a new method for an old disease.

BACKGROUND: Malaria is influenced by a web of individual and ecological factors, i.e. factors relating to people and relating to environment. For a long time analysing these factors concurrently has raised statistical problems. Multilevel modelling provides a new attractive solution, which is still uncommon in tropical medicine. METHODS: Using an actual data set of 3864 individuals from 38 villages of the Highland Madagascar, a two-level modelling process is presented. Individual malaria parasitaemia is modelled step by step according to age (individual factor), altitude, and DDT indoor house-spraying status (village factors). RESULTS: The hierarchical organization of a data set in levels, fixed and random effects, and cross-level interactions are considered. Accurate estimations of standard errors, impact of unknown or unmeasured variables quantified and accounted for through random effects, are the highlighted advantages of multilevel modelling. CONCLUSION: While not denying the importance of understanding an aetiological chain, the authors recommend an increased use of multilevel modelling, mainly to identify accurately ecological targets for public health policy.

Adolescent↗
PubMed2003

Blood pressure, body mass index and socio-economic status in the urban population of Antananarivo (Madagascar).

In many developing countries and especially those in the Indian Ocean, the prevalences of hypertension and obesity have increased markedly over the past decade. In a community-based study set in Antananarivo, the capital of Madagascar, multi-level modelling has now been used to look for associations between blood pressure or body mass index (BMI) and levels of occupation, education and income, among 773 adults. Many (23%) of the subjects had elevated blood pressure (i.e. over 140/90 mmHg). The prevalence of such elevated blood pressure increased with age - with an odds ratio (OR) of 2.16 and a corresponding 95% confidence interval (CI) of 1.81-2.58 for each 10-year increase - but decreased with educational level (high school: OR=0.74; CI = 0.41-1.31) and income (fourth quartile: OR= 0.66; CI = 0.35-1.27). The BMI data indicated that 18.4% of the subjects were underweight, 6.0% were overweight but not obese and 2.4% were obese. Being overweight was directly associated with level of occupation (management level: OR= 3.49; CI = 1.18-10.29) and income (fourth quartile: OR= 3.55;CI = 1.48-8.50). Despite the trends, underweight and overweight individuals and cases of elevated blood pressure were found to co-exist in all socio-economic classes.

Adolescent↗
PubMed2002

Respiratory morbidity in a population of French dental technicians.

AIMS: To compare wage earner dental technicians with non-exposed salaried subjects for the prevalence of respiratory symptoms and function, and chest x ray abnormalities. METHODS: A total of 134 dental technicians and 131 non-exposed subjects participated. A medical and an occupational questionnaire were filled in to evaluate the prevalence of respiratory symptoms and occupational exposures. Subjects underwent respiratory tests and chest x ray examination. RESULTS: Mean age of the dental technicians was 36.6 years with a mean duration of dental work of 16.5 years. There was a significant risk of cough (day and night) and usual phlegm in dental technicians. Respiratory function parameters were lower in dental technicians with a significant difference between exposed and non-exposed groups for % FVC (forced vital capacity), % FEF(25) (forced mid expiratory flow), and % FEF(50). The prevalence of small opacities increased with age. Small opacities were significantly related to an exposure to asbestos in the past. CONCLUSIONS: Our young population of dental technicians is at risk of respiratory morbidity. They should benefit from adequate technical prevention measures.

Adolescent↗
PubMed2001

[Evaluation of diagnosis and follow-up in screened children with cystic fibrosis in Normandy].

The neonatal screening programme in Normandy (France) allowed the formation of a homogenous cystic fibrosis (CF) cohort of 150 children diagnosed between 1980 and 1997. At the time of this retrospective study, 11 were deceased, out of which nine had meconium ileus (eight deaths after surgery, one at 5 years of age). Sixty children born between 1980 and 1993 in the Basse-Normandie region were followed up during a mean 80 months following similar protocols. The mean age at diagnosis was 41 days (SD = 27 d) for infants without meconium ileus. The occurrence of Pseudomonas aeruginosa (P. aeruginosa) infection and chronic colonization was studied using a monovariate followed by a multivariate analysis including the following variables: sex; meconium ileus; anthropometric data at birth and at diagnosis; pancreatic insufficiency; radiological data (Brasfield score); microbiology data at diagnosis; and genetic data. P. aeruginosa infection appeared earlier in children with pancreatic insufficiency (OR = 2.2; p < 0.05) or with radiological abnormalities (Brasfield score < 21) at diagnosis (OR = 3.9; p < 0.05). Meconium ileus (OR = 5.3; p < 0.01), pancreatic insufficiency (OR = 3.8; p < 0.01) and Brasfield score < 21 at diagnosis (OR = 5.6; p < 0.001) were prognosis factors for early chronic P. aeruginosa colonization. In CF children without meconium ileus, the major risk factor found through multivariate analysis for earlier infection and for earlier chronic colonization by P. aeruginosa was a diagnosis delay > 40 days (respectively OR = 4.6; p < 0.001 and OR = 10.4; p < 0.005). These results must be compared with the lower Brasfield score at diagnosis in infants diagnosed after 40 days of life (p < 0.01).

Adolescent↗
PubMed2001

Cancer transmission through corneal transplantation.

PURPOSE: A retrospective study to demonstrate the safety of corneas from donors affected by systemic malignancies in a view of keratoplasty. METHODS: Using the data of the cancer registry department in a district of 500,000 residents, we analyzed retrospectively 143 patients followed up in the same region and transplanted between 1987 and 1995. We compared the incidence of cancer in recipients of cornea coming from donors with malignancies with recipients of cornea from donors without malignancies. The rate of cancer in this population was also compared with the incidence of cancer in the general population at the same age. RESULTS: Eleven patients (7%) were excluded from the study, eight of them for the presence of cancer in their medical history before surgery and the three others because of lack of information about their follow-up after surgery. Forty patients received corneas from cancerous donors and 103 from donors without cancer. Six patients developed malignancies between 1 and 4 years after transplantation, and only one of them received a cornea from a donor with a systemic malignancy. This recipient developed a different type of cancer from that of the donor. The five other patients received corneas from donors without systemic malignancies. By comparing theses results, there was no relationship between the occurrence of malignancies and transplantation of corneas from cancerous donors (relative risk = 0.49, 95% confidence interval = 0.01-13.62). CONCLUSION: There was no increased incidence of cancer in our patient population compared with reference population. Based on this study, there is no statistical or clinical evidence to suggest the transmission of cancer from donors with malignancies via corneal transplantation, according to the accepted criteria of donor selection.

Cornea↗
PubMed2001

[Relevance and validity of a new French composite index to measure poverty on a geographical level].

BACKGROUND: A number of disease conditions are influenced by deprivation. Geographical measurement of deprivation can provide an independent contribution to individual measures by accounting for the social context. Such a geographical approach, based on deprivation indices, is classical in Great Britain but scarcely used in France. The objective of this work was to build and validate an index readily usable in French municipalities and cantons. METHODS: Socioeconomic data (unemployment, occupations, housing specifications, income, etc.) were derived from the 1990 census of municipalities and cantons in the Doubs departement. A new index was built by principal components analysis on the municipality data. The validity of the new index was checked and tested for correlations with British deprivation indices. RESULTS: Principal components analysis on municipality data identified four components (explaining 76% of the variance). Only the first component (CP1 explaining 42% of the variance) was retained. Content validity (wide choice of potential deprivation items, correlation between items and CP1: 0.52 to 0.96) and construct validity (CP1 socially relevant; Cronbach's alpha=0.91; correlation between CP1 and three out of four British indices ranging from 0.73 to 0.88) were sufficient. Analysis on canton data supported that on municipality data. CONCLUSION: The validation of the new index being satisfactory, the user will have to make a choice. The new index, CP1, is closer to the local background and was derived from data from a French departement. It is therefore better adapted to more descriptive approaches such as health care planning. To examine the relationship between deprivation and health with a more etiological approach, the British indices (anteriority, international comparisons) would be more appropriate, but CP1, once validated in various health problem situations, should be most useful for French studies.

Analysis of Variance↗
PubMed2000

Soft-tissue sarcoma and non-Hodgkin's lymphoma clusters around a municipal solid waste incinerator with high dioxin emission levels.

Overall evidence from epidemiologic studies in the workplace suggests that dioxin is a human carcinogen, but whether low doses affect the general population remains to be determined. The authors examined the spatial distribution of soft-tissue sarcomas and non-Hodgkin's lymphomas around a French municipal solid waste incinerator with high emission levels of dioxin (16.3 ng international toxic equivalency factor/m3). Not consistently associated with dioxin exposure,-Hodgkin's disease served as the control cancer category. Clusters were identified from 1980 to 1995 in the area ("département') of Doubs by applying a spatial scan statistic to 26 electoral wards. The most likely and highly significant clusters found were identical for soft-tissue sarcomas and non-Hodgkin's lymphomas and included the area around the municipal solid waste incinerator; standardized incidence ratios were 1.44 (observed number of cases = 45, focused test p value = 0.004) and 1.27 (observed number of cases = 286, focused test p value = 0.00003), respectively. Conversely, Hodgkin's disease exhibited no specific spatial distribution. Confounding by socioeconomic status, urbanization, or patterns of medical referral seemed unlikely to explain the clusters. Although consistent, these findings should be confirmed by further investigation (e.g., a case-control study in which dioxins are measured in biologic tissues) before clusters of soft-tissue sarcoma and non-Hodgkin's lymphoma are ascribed to dioxin released by the municipal solid waste incinerator.

Dioxins↗
PubMed2000

Prospective validation of a diagnosis model as an aid to therapeutic decision-making in acute meningitis.

The aim of this study was to validate a diagnosis model that provides pABM, the probability of bacterial versus viral meningitis, based on four parameters collected at the time of first lumbar tap: cerebrospinal fluid protein level, cerebrospinal fluid polymorphonuclear cell count, blood glucose level, and leucocyte count. The model was evaluated prospectively as an aid to therapeutic decision-making in 109 consecutive patients with acute meningitis and negative cerebrospinal fluid Gram stain. In each case pABM was computed before a therapeutic decision and three diagnoses were established successively: (i) clinical evaluation, i.e. before pABM computation (bacterial meningitis, viral meningitis, or meningitis of undetermined origin); (ii) computation of pABM (viral meningitis if pABM< 0.1, bacterial meningitis otherwise); and (iii) determination of definitive diagnosis (bacterial meningitis: positive cerebrospinal fluid culture; viral meningitis: negative cerebrospinal fluid culture, no other aetiology and no treatment; meningitis of undetermined origin: cases fitting neither of the first two diagnoses). The computed diagnosis was viral meningitis in 78 of the 80 cases diagnosed definitively as viral meningitis, and bacterial meningitis in four of the five cases diagnosed definitively as bacterial meningitis. Negative and positive predictive values and accuracy of the model were 98.7%, 66.7%, and 96.5%, respectively. The clinical diagnosis was undetermined in 22 cases, 15 of which were diagnosed definitively as viral cases; in all of these 15 cases, the computed diagnosis was viral meningitis, leading the physician to refrain from starting antibiotics in all of them. The results confirm that the model evaluated is reliable and aids in the identification of patients in whom antibiotics can be safely avoided.

Acute Disease↗
PubMed2000

Preoperative quality of life as a predictive factor of 3-year survival after open heart operations.

BACKGROUND: The aim of this prospective study was twofold: to determine the evolution of quality of life in heart surgery patients through the first 3 postoperative years using the Nottingham Health Profile questionnaire and to determine whether preoperative quality of life influences 3-year survival. METHODS: From January to July 1994, 215 patients underwent elective open heart operation in our department. Patients filled in the Nottingham Health Profile questionnaire five times: preoperatively, postoperatively at month 3, and at each anniversary of their operation for 3 years. The evolution of quality of life scores through time were compared using analysis of covariance with repeated measures. Analysis of 3-year survival prognostic factors was achieved using the Cox proportional hazards model. RESULTS: Quality of life scores varied through time, but not significantly. Multivariate analysis showed two independent risk factors to influence 3-year survival: dyspnea class (III-IV versus I-II, relative risk = 2.80, 95% confidence interval = 1.2 to 6.5) and the energy section of the Nottingham Health Profile questionnaire (relative risk = 1.02 by unit, 95% confidence interval = 1.01 to 1.03). CONCLUSIONS: Our study shows quality of life scores to be stable for the first 3 years after operation and the preoperative energy score to be predictive of 3-year survival.

Aged↗
PubMed2000

Intermediate lukewarm (20 degrees c) antegrade intermittent blood cardioplegia compared with cold and warm blood cardioplegia.

BACKGROUND: In the field of intermittent antegrade blood cardioplegia, 3 levels of temperature are commonly used: (1) cold (8 degrees C); (2) tepid (29 degrees C); and (3) warm (37 degrees C). Given the 21 degrees C spread and the metabolic changes that can occur between cold (8 degrees C) and tepid (29 degrees C) cardioplegia, we thought it worthwhile to test a temperature halfway between the cold and tepid levels. The aim of this study was to test the quality of myocardial protection provided by intermediate lukewarm (20 degrees C) cardioplegia by comparing it with cold and warm cardioplegia. Protection was assessed by measuring cardiac troponin I release. METHODS: One hundred thirty-five patients undergoing coronary artery bypass grafting were enrolled in a prospective randomized trial comparing cold (8 degrees C), intermediate lukewarm (20 degrees C), and warm (37 degrees C) antegrade intermittent blood cardioplegia. Cardiac troponin I concentrations were measured in serial venous blood samples. RESULTS: The total amount of cardiac troponin I released was significantly higher in the cold group (4.7 +/- 2.3 microg) than in the intermediate lukewarm (3.4 +/- 2.0 microg) or the warm (3.1 +/- 2.7 microg) groups. The cardiac troponin I concentration was significantly higher at hour 6 in the intermediate lukewarm group (1. 23 +/- 0.55 microg/L) than in the warm group (0.89 +/- 0.50 microg/L). CONCLUSIONS: Intermittent antegrade intermediate lukewarm blood cardioplegia is appropriate and clinically safe. Cardiac troponin I release suggests that intermediate lukewarm cardioplegia is better than cold cardioplegia but less effective than warm cardioplegia in low-risk patients. We therefore recommend the use of warm cardioplegia in low-risk patients.

Aged↗
PubMed2000

Deprived areas and attendance to screening of cervix uteri cancer in a French region.

OBJECTIVES: To examine the relationship between deprivation and attendance to cervical cancer screening. METHODS: Three deprivation indices (Carstairs, UnderPrivileged Area, Department of Environment) were calculated for women aged 25-65 attending a 1993-95 cervical cancer screening program (Doubs "département", France), with 594 municipalities as statistical units. Weighted multivariate linear regressions were performed, with attendance rate as the dependent variable, and the three deprivation indices in turn as independent variables along with women's mean age, average net income, density of (para)medical amenities, density of population and proportion of women. RESULTS: Per municipality women were numbered 1-29,822 (mean 210). In multivariate models, the three deprivation indices were negatively linked to attendance rate, and so were mean age of women and density of population. Average net income, proportion of women, and density of (para)medical amenities (nurses, laboratories, ambulances, physicians, dentists) were positively associated with attendance rate. CONCLUSIONS: In early stages, cervical cancer screening programs should account for populations living in deprived areas, through focused health promotion efforts and easier access to screening facilities.

Adult↗
PubMed2000

Perceived health status in patients over 70 before and after open-heart operations.

AIM: to evaluate improvement and predictors of improvement in patients' perceived health status after cardiac surgery in older patients. METHODS: three hundred and seventy-seven patients from three different departments of cardiac surgery completed the Nottingham Health Profile questionnaire before and 1 and 2 years after open-heart surgery. We analysed pre- and postoperative data and pre- and postoperative Nottingham Health Profile scores. RESULTS: the mean age was 74+/-3 years. The comparison between pre- and postoperative scores showed an improvement in all but the social isolation section. Logistic regression showed that the predictors of patients who became worse after surgery were (i) in the energy section: age over 75 [odds ratio (OR) = 1.8, 95% confidence interval (CI) = 1.02-3.2], coronary artery disease (OR = 2.4, 95% CI = 1.04-3.6) and postoperative events (OR = 1.9, 95% CI = 1.01-3.7); (ii) in the physical mobility section: diabetes mellitus (OR = 2.4, 95% CI = 1.2-4.7); and (iii) in the social isolation section: physical mobility impairment (OR = 3.4, 95% CI = 1.3-8.7). CONCLUSIONS: cardiac surgery improves perceived health status in patients over 70. This improvement is better for those undergoing aortic valve replacement than for those undergoing coronary artery bypass surgery. Comparison with reference scores for a standard population shows that, even when successful, cardiac surgery results in fatigue and persistent sleep disturbance in older patients.

Aged↗
PubMed1999

Comparative effects of low and high doses of clomipramine and placebo in panic disorder: a double-blind controlled study. French University Antidepressant Group.

This study was designed to explore the dose-response relationship for clomipramine in patients with panic disorder, with or without agoraphobia. After 1 week of single-blind placebo pretreatment, 180 such patients were assigned to a multicentre placebo-controlled comparison of the effects of high and low doses of clomipramine, and were followed up for 8 weeks. In alleviating anxiety and panic disorder, both clomipramine doses were more efficacious than placebo for panic disorder and, to a lesser degree, for phobia. The lower dose was better tolerated and at least as effective as the higher dose, sometimes more so. These results indicate the clinically important possibility that low-dose clomipramine is effective and well tolerated.

Adolescent↗
PubMed1999

Water vole (Arvicola terrestris scherman) density as risk factor for human alveolar echinococcosis.

Concern is growing in Europe about alveolar echinococcosis (AE) with the increase in grassland rodent and red fox populations, intermediate and definitive hosts for Echinococcus multilocularis, respectively. The objective of this study was to assess the influence of rodent densities on human AE distribution. Spatial Poisson regression analyses were performed with geomorphologic features, landscape composition, climatic characteristics, and water vole density as independent variables. The outcome consisted of AE cases diagnosed over the period 1980-1992. High vole density yielded a 10-fold risk (relative risk [RR] = 10.34, 95% confidence interval [CI] = 2.78-38.39), and the first plateau (400-700 m altitude) compared with the plain (200-400 m) was associated with a large increase in risk (RR = 7.10, 95% CI = 1.30-38.63). These results confirm that human AE is strongly influenced by the densities of arvicolid species. Foxes feeding almost exclusively on grassland rodents when the latter expand could mediate this relation.

Altitude↗