Socioeconomic and cultural factors associated with pap smear screening among French women living in Réunion Island.

BACKGROUND: Réunion Island is a French overseas territory located in the southern Indian Ocean, with a challenging socioeconomic and multicultural context. Compared to mainland France, Réunion has an overincidence and overmortality of cervical cancer. In order to investigate these two issues, it is important to evaluate the barriers and potential levers to Pap smear screening among female inhabitants of the island. We aimed to identify the specific socio-demographic factors, cultural factors, and living conditions associated with Pap smear screening in Réunion, with a view to increasing uptake. METHODS: We conducted a Knowledge Attitude Behavior and Practices (KABP) survey on cervical cancer screening practices among women aged between 25 and 65 years old living in Réunion Island, selected using random digit dialing sampling. Data were collected using Computer Assistant Telephone Interviews. Weighted chi-squared tests and Student's t-tests were used to compare women who had up-to-date Pap smear screening with women who did not. Weighted logistic models were used to identify the factors associated with not having up-to-date screening. RESULTS: A total of 1000 women were included in the study. Of these, 88.1% had a Pap smear test during the previous three years. Factors independently associated with not being up to date were as follows: aged over 55 (AOR 2.3 [1.2-4.3]), no children (AOR 2.5 [1.4-4.3]), having free universal health coverage (AOR 1.7 [1.1-2.7]), an income per unit consumption lower than 1500€ per month (AOR 2.0 [1.1-3.7]), low health literacy (AOR 2.7 [1.7-4.1]), not consulting a general practitioner in the prior 12 months (AOR 3.6 [2.0-6.5]), and a BMI > 30 (AOR 2.6 [1.5-4.4]). CONCLUSIONS: This is the first large-scale survey focusing on recommended Pap smear screening uptake in Réunion Island. Although self-reported screening incidence was higher than in mainland France, national screening policies must take into account the island's diverse social and cultural characteristics (e.g., an ageing population, low health literacy), while implementing actions to fight against poverty and increase general access to healthcare.

Net survival in colon and rectal cancer by stage according to neoadjuvant treatment. A French population-based study.

AIM: Real-life estimations of survival by stage in colorectal cancer are scanty. We estimated population-based net survival by pathological stage and location, and for rectal cancer by patterns of evolution according to clinical and pathological stage with regard to neoadjuvant therapy. METHOD: Age-standardized net survival was estimated on 19,630 colorectal cancers diagnosed between 2009 and 2015. RESULTS: Five-year net survival was 64 % for colon and 62 % for rectal cancer. The highest absolute difference between colon and rectum was 12 % for stage II women aged 75 (91% vs. 79 %). Among patients with clinical stage III rectal cancer, 67 % no longer had pathological node involvement after neoadjuvant treatment. Survival was similar in clinical stage I, II or III and pathological stage III after neoadjuvant treatment and in pathological stage III without neoadjuvant treatment (between 67 % and 72 %). It ranged between 80 and 82 % in pathological stage II, without neoadjuvant treatment or with clinical stage I, II or III before neoadjuvant treatment. Survival ranged between 93 % and 95 % in pathological stage I, treated with surgery only or with clinical stage II or III before neoadjuvant treatment. CONCLUSION: Prognosis is associated with stage determined on surgical specimens rather than stage at the initial workup.

Human Papillomavirus (HPV) Infections Among Participants Undergoing Chlamydia trachomatis Testing in Reunion Island (RUN-SurV-HPV Study): Protocol for a Prevalence Study.

BACKGROUND: Infection by human papillomavirus (HPV) induces various cancers, mainly cervical cancer but also anal and pharyngeal cancers. Reunion Island is a French department in the Indian Ocean. Due to the history of its settlement, the island's population has a wide variety of origins, and the population's sociodemographic characteristics differ from those of the French mainland. These characteristics make the island's population an original French population in its own right, particularly in terms of health. Cervical cancer incidence and mortality in Reunion Island are 10.4 per 100,000 and 4.4 per 100,000, respectively, both of which are much higher than those in mainland France. There is also a disparity in the prevalence of different HPV types, with types 33 and 52 being overrepresented and type 18 being underrepresented. However, vaccination and screening coverage in Reunion Island is low. It is important to understand the burden of infection and its risk factors in members of the young Reunionese population at risk of HPV infection to promote and evaluate the implementation of future vaccination and screening programs on a larger scale. OBJECTIVE: The RUN-SurV-HPV study will have the following four objectives: (1) to describe the prevalence of HPV genotypes in a population at risk of sexually transmitted infections in Reunion Island; (2) to describe the prevalence of HPV genotypes by anatomical site, gender, and sexuality; (3) to describe the correlates and risk factors for HPV detection; and (4) to examine HPV genotypes between different anatomical sites. METHODS: Cross-sectional analyses of 1200 routine vaginal, anal, pharyngeal, and urinary samples collected between October 2020 to December 2022 from female and male patients aged 16 to 30 years undergoing Chlamydia trachomatis testing at a sexually transmitted infection (STI) testing center at Reunion Island will be performed. The population included 333 women who all had vaginal and pharyngeal swabs, with 80 of them also having had an anal swab. There are 167 men who have sex with men who have had anal and pharyngeal swabs, and 120 men who have sex with women who have had a urine swab only. Results will be correlated with sociodemographic and clinical data collected routinely during the consultations. HPV detection and genotyping will be performed using the Anyplex II HPV28 detection assay (Seegene). RESULTS: The first polymerase chain reactions should begin in November 2023. The first results should be submitted for publication in 2024. CONCLUSIONS: The study will determine HPV prevalence by age, sex, male sexual preference, human immunodeficiency virus status, and STI co-infection. Collecting data from young patients not usually routinely screened for HPV infection will be a simple and reproducible way of better understanding local specificities, encouraging vaccination campaigns in the short-term, and evaluating their effectiveness in the future. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/47379.

Understanding barriers and motivations to papillomavirus vaccination in a middle school in Reunion Island.

BACKGROUND: In Reunion Island, papillomavirus (HPV) vaccination coverage is low. A study encouraging vaccination in middle school showed low rate of participation. The main objective of the study was to understand barriers and motivations to HPV vaccination in populations yet sensitized to its benefits. METHODS: The study focused on population around the intervention school where a health promotion program was conducted during school year 2020-2021. Semi-structured face-to-face interviews among children, children's parents, school staff, general practitioners (GP) and association members were conducted. A qualitative study was adopted using a grounded theory approach to obtain an in-depth understanding of issues pertaining to HPV vaccination. FINDINGS: A total of 19 school staff members, 20 parents of middle school children, 39 children, 5 GPs and 3 association members were interviewed in May 2021. Anti-vaccination attitudes included: fear of serious adverse effects (such as fertility) due to poor knowledge, fear of encouraging sexuality among teenagers, mistrust towards scientists and the pharmaceutical industry and the negative impact from social networks. However, we found that the influence of the school, GP's and 'story-telling' study testimonials were crucial to invert the balance and motivate children's vaccination. INTERPRETATION: Reproductive adverse events related to the HPV vaccine may be strongly perceived amongst our population, either regarding fertility or negative fetal effects; though Reunion island has 5% of pregnancies among teenagers. It is crucial to lift this taboo related to sexuality and encourage dialogue between children and their close social network. This better understanding of barriers and motivations will help us increase the impact of school-based HPV vaccination, which will be introduced in September 2023 in whole France.

[Pediatric medical evacuations from Reunion Island to metropolitan France]. / Évacuations sanitaires pédiatriques en oncologie et en hématologie de l'île de la Réunion vers la France métropolitaine.

BACKGROUND: The only French center for pediatric oncology and hematology outside of the metropolitan territory is in the Indian Ocean, in Saint Denis, on Reunion Island. It welcomes children from Reunion Island but also from Mayotte and neighboring countries. A quarter of them requires a secondary medical transfer to metropolitan France for specific technic care. METHOD: We conducted a retrospective single-center study of all pediatric medical evacuations that occurred between 2015 and 2019 from the pediatric oncology and hematology department of Reunion Island. The purpose of this study is to describe these transfers and the consequences of these care pathways for families and care teams. RESULTS: A total of 189 transfers took place for 105 children: 66 from Reunion Island, 17 from Mayotte and 22 were foreigners. In total, 92 % of the children received the medical care for which they were transferred to metropolitan France. Difficulties were reported: family for 26 % of them, social in 11 % of cases and medical in 10 % of medical records. CONCLUSIONS: This organization allows children in the Indian Ocean to benefit from similar care than metropolitan children. Many difficulties arise in connection with family and societal breakdowns caused by these transfers. These differences and difficulties are important to know to better accompany patients, families and caregivers in this stage of their medical pathways.

Attrition and social vulnerability during 2-year-long structured care in type 2 diabetes, the ERMIES randomized controlled trial.

BACKGROUND: Diabetes self-management education is exposed to attrition from services and structured ambulatory care. However, knowledge about factors related to attrition in educational programs remains limited. The context of social vulnerability due to low income may interfere. The aim of this study was to identify the sociodemographic, clinical, psychometric, and lifestyle factors associated with attrition from the ERMIES multicentre randomized parallel controlled trial (RCT) that was interrupted due to the combination of both slow inclusion and high attrition. METHODS: The ERMIES trial was performed from 2011 to 2016 on Reunion Island, which is characterized by a multicultural population and high social vulnerability. The original objective of the RCT was to test the efficacy of a2-year structured group self-management education in improving blood glucose in adult patients with nonrecent, insufficiently controlled type 2 diabetes. One hundred participants were randomized to intensive educational intervention maintained over two years (n = 51) versus only initial education (n = 49). Randomization was stratified on two factors: centres (five strata) and antidiabetic treatment (two strata: insulin-treated or not). Sociodemographic, clinical, health-care access and pathway, psychometric and lifestyle characteristics data were collected at baseline and used to assess determinants of attrition in a particular social context and vulnerability. Attrition and retention rates were measured at each visit during the study. Multiple correspondence analysis and Cox regression were performed to identify variables associated with attrition. RESULTS: The global attrition rate was 26% during the study, with no significant difference between the two arms of randomization (9 dropouts out of 51 patients in the intervention group and 17 out of 49 in the control group). Male gender, multiperson household, low household incomes (< 800 euros), probable depression and history of hospitalization or medical leave at inclusion were associated with a higher risk of attrition from the study in multivariate regression. CONCLUSIONS: Social context, vulnerability, and health care history were related to attrition in this 2-year longitudinal comparative study of structured care. Considering these potential determinants and biases is of importance in scaling up interventions aimed at the optimization of long-term care in type 2 diabetes mellitus. TRIAL REGISTRATION: ID_RCB number: 2011-A00046-35, Clinicaltrials.gov number: NCT01425866 (Registration date: 30/08/2011). SOURCE OF FUNDING: Ministry of Health, France.

PROM SSCOL-Impact of a Papillomavirus Vaccination Promotion Program in Middle Schools to Raise the Vaccinal Coverage on Reunion Island.

Introduction: On Reunion Island, cervical cancer is the third most common cause of cancer in women. Primary prevention is based on the HPV vaccination, yet coverage rate is low (8.1%). The objective of the study was to evaluate the impact of a health promotion program on the proportion of middle school girls who have completed the HPV vaccination schedule. Material and methods: In this prospective, controlled intervention study of superiority, 12 classes were randomly selected in an intervention school where the promotion program took place, and in a control school where no specific intervention was planned. The program combined: information to students during school classes, information to parents by letter and phone calls, information to general practitioners by letter and video conference call, and the free school-based vaccination (in a "health bus" parked in the schoolyard) with the nonavalent HPV vaccine. Results: In the intervention group, the completion was achieved for 26 girls, which was significantly higher than in the control group (three girls, p < 10−3). The initiated vaccination was also higher in the intervention group (31 girls vs. 6 girls in the control group, p < 10−3). The same results were obtained for the boys as for the full or partial scheme (seven boys vs. 0, p = 0.01; 16 boys vs. 1, p < 10−3, respectively). Conclusions: Implementing a health promotion program and offering the free, school-based vaccination raised the vaccination coverage. These results are promising and may be a stepping stone to expanding this program to the whole Reunion Island and hopefully someday decrease the burden of cervical cancer.

Health Impacts of the COVID-19 Lockdown Measure in a Low Socio-Economic Setting: A Cross-Sectional Study on Reunion Island.

In March 2020, the French government implemented nation-wide measures to reduce social contact and slow the progression of the emerging coronavirus responsible for COVID-19, the most significant being a complete home lockdown that lasted 8 weeks. Reunion Island is a French overseas department marked by large social inequalities. We draw the hypothesis that distancing and lockdown measures may have contributed to an increase in the social inequalities in health (SIH) on Reunion Island. The aim of our study was to describe the SIH during lockdown in the Reunionese population. We implemented a cross-sectional telephone survey conducted between 13 May and 22 July 2020, using a retrospective data collection on the lockdown period. A total of 892 adult participants (≥18 years) were recruited in the 114 large Reunionese neighborhoods using the quota method within the national "White Pages" telephone directory. Degraded psychological states, an increase in addictive behaviors, difficulties in accessing food, a decrease in physical activity, delayed medical appointments, violence against women, and health problems in children were driven by the socio-economic characteristics of the population, most often to the disadvantage of social groups exposed to poor living conditions. These results suggest that the COVID-19 lockdown contributed to an increase in SIH.

Socioeconomic inequalities in breast cancer survival in Reunion Island: The contribution of stage at diagnosis as a mediator.

INTRODUCTION: Although breast cancer survival has improved in France, it appears that women living in deprived areas are more likely to die from breast cancer. However, no study has yet examined socioeconomic inequalities in breast cancer survival in La Réunion. Our objective was to examine whether socioeconomic inequalities in breast cancer survival exist in Reunion Island and whether stage at diagnosis could partly explain these differences. METHODS: A population-based cohort study of all women on Reunion Island with primary breast cancer diagnosed between 2008 and 2016 was conducted. Each woman was assigned a deprivation index based on her area of residence at diagnosis. Net survival by deprivation group and stage at diagnosis was estimated by the non parametric Pohar Perme method. The role of stage (indirect effect) was assessed using a mediation analysis extended to the relative survival framework. RESULTS: At five years, net survival was significantly lower in women living in the most deprived areas than in women living in the least deprived areas (81 % (95 % CI 77-86) and 91 % (95 % CI 89-94), respectively, p < 0.0001), and mediation analysis showed that the contribution of stage at diagnosis to these survival differences was 43 %. DISCUSSION: Our result shows that although measures to promote earlier diagnosis are important, they would only reduce socioeconomic inequalities in breast cancer survival by 43 %. To further investigate these inequalities, future research should explore the role of unmeasured mediators, such as comorbidities and treatment received, as well as the impact of specific interventions that might address the differences in mediator distribution.

Impact of a Papillomavirus Vaccination Promotion Program in Middle School: Study Protocol for a Cluster Controlled Trial.

BACKGROUND: On Reunion Island, incidence and mortality for uterine cervical cancer is high, yet coverage rate for human papillomavirus (HPV) vaccination is low. OBJECTIVE: The main objective of the study is to evaluate the impact of a health promotion program promoting HPV vaccination on the proportion of middle school girls who complete the full HPV vaccination schedule (2 or 3 doses) by the end of school year. METHODS: This study is a cluster controlled intervention study using a superiority design. A combined health promotion program will be offered containing information to students and parents, training of general practitioners, and free school-based vaccination (in a "health bus"). Children who attend this program will constitute the intervention group and will be compared to children from another middle school who will not attend the program constituting the control group. RESULTS: Recruitment began in October 2020. In the intervention school, of 780 students, 245 were randomly selected in the 12 classes. In the control school, 259 students out of 834 were randomly selected. CONCLUSIONS: In this study, we explore the impact of a health promotion program combining information toward students, parents, and general practitioners with free school-based vaccination. We expect a significantly higher HPV vaccination coverage in the intervention school as compared to the control school, whether it be among girls or boys. The final implication would be an extension of this program in all middle schools on the Island and thus an increase in HPV vaccination coverage. TRIAL REGISTRATION: ClinicalTrials.gov NCT04459221; https://clinicaltrials.gov/ct2/show/NCT04459221. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/35695.

Factors associated with mammography screening among Reunionese women : a cross-sectional study.

OBJECTIVE: To explore the factors associated with the uptake of mammography screening in Reunionese women aged 50-65 years. METHODS: This study included all women aged 50 to 65 years participating in a population-based cross-sectional study "FOSFORE". Participants were recruited between March and June 2017 using two sampling frames. The first frame consisted of households with a landline telephone, with or without a mobile line, by first randomly generating a telephone number and then randomly selecting an individual from among all eligible women in the household. The second sampling frame was constituted of women with an exclusive mobile line, who were selected directly if they met the eligibility criteria. Data were weighted for age and socio-professional status to ensure representativeness at the Reunion Island level. Weighted logistic regression was used to calculate odds ratios while adjusting for confounders. RESULTS: 417 women were included in the study; 63.8% were up to date with guidelines on mammography screening and 36.2% were not up to date. Four factors were significantly associated with mammography screening, with an adjusted odds ratio of 2.92 (95% CI 1.51-5.61) for not having an Active Solidarity Income, 1.98 (95% CI 1.22-3.23) for having a regular gynecological follow-up by a physician, 6.53 (95% CI 3.23-13.21) for performing a Pap smear test in the past two years, and 2.07 (95% CI 1.21-3.52) for having an adequate literacy level (HLQ3). CONCLUSION: The findings of this study suggest that higher socio-economic status is an indicator of participation in mammography screening in La Réunion, and future educational and intervention programs should target women in deprived areas.

Survival of adult patients with solid cancer in Reunion Island, 1998-2014.

INTRODUCTION: Population-based cancer survival is a major indicator of effectiveness of cancer management. This study is the first population-based study to estimate the net survival (NS) of adult cancer patients in Reunion Island, a French overseas department with distinctive epidemiological, cultural, and sociodemographic characteristics. METHODS: All adult incident cases (n=23,055) of invasive solid tumors diagnosed between 1998 and 2014 and registered in the Reunion Island Cancer Registry were included in the study. The Pohar-Perme estimator was used to estimate 1-, 3-, 5-, and 10-year NS. RESULTS: 5-year NS ranged from 7% (liver in women) to 97% (thyroid cancer in women) for cancers diagnosed between 2006 and 2014. For the most common cancers, the age-standardized 5-year NS of women was 81% for breast cancer, 58% for colorectal cancer and 62% for cervical cancer. For men, the age-standardized 5-year NS was 85% for prostate cancer, 12% for lung cancer, and 52% for colorectal cancer. Age-standardized 5-year NS increased slightly with the period of diagnosis (from 1998-2005 to 2006-2014) for prostate, breast, head and neck, lung, colorectal (women), and stomach (men) cancers, remained stable for colorectal (men) cancer, and decreased slightly for cervical and stomach (women) cancers. DISCUSSION: Overall, NS was lower in Reunion Island than in mainland France. While the epidemiological, cultural, and sociodemographic characteristics of the Reunionese population likely explain some of the observed differences compared to mainland France, site-specific studies are needed to explore the different determinants of survival in Reunion Island.

Health, illness and cancer in Reunion Island: Health services in a diverse but aging French territory.

The major social, cultural, economic and demographic changes in Reunion Island in the last 70 years have had effects on its population and the evolution of its public health issues. The demographic transition and changes in lifestyle have led to a rapidly aging population with increased needs for care for dependency and chronic illness such as cancers. The aim of this paper is to offer a review of the literature and ongoing research on health and cancer in Reunion Island. It reviews the recent literature on these changes, including the socio-demography of the population, the medical demography and cancer care infrastructure. It highlights the significant social inequalities of the island, and shows its medical demography and healthcare services are close to national averages. It then offers a review of publications on the experiences of health and illness in Reunion Island in a multicultural and postcolonial context, between medical pluralism and biomedicine. It then offers a focus on the epidemiology of three cancers, namely breast, cervical and prostate cancers. It concludes with a review of known ongoing research, and calls for a rapid adaptation of the organization of the medico-social system, in order to face Reunion Island's most pressing healthcare issues: chronic illnesses such as cancers, and dependency.

Vaccination against influenza and pneumococcal infections in patients with autoimmune disorders under biological therapy: Coverage and attitudes in patients and physicians.

BACKGROUND: Patients under biological therapy for auto-immune disease are considered immunosuppressed and several recent recommendations highlight the need for vaccination against influenza and pneumococcal infections. The aims of this study were to evaluate influenza and pneumococcal vaccine coverage among patients receiving biological therapy and identify factors associated with vaccine uptake within this population. METHODS: A retrospective cross-sectional study was performed in adult patients attending hospitals for an auto-immune/inflammatory disease and treated with biological therapy. Vaccine uptake was evidenced from patient's medical records or from their pharmacist's records. Questionnaires about attitudes and knowledge regarding vaccinations were administered to patients and their physicians. Multivariable logistic regression was used to determine factors significantly associated with influenza and pneumococcal vaccine receipt. RESULTS: A total of 208 patients were included: 52% female and mean age 50.6 (± 14.7) years. Among them 173 completed the questionnaire while 72 physicians replied. Underlying inflammatory diseases were rheumatisms (46%), bowel diseases (31%) and skin diseases (23%). Vaccine uptake was 28% for influenza, 48% for pneumococcus and 22% received both vaccines. Main factors associated to positive uptake were receiving a prescription from a physician, as well as having a good knowledge of vaccines. Factors limiting vaccination were a negative attitude toward vaccines in general, and belonging to the group of inflammatory bowel diseases. CONCLUSIONS: Vaccine coverage for influenza and pneumococcal infections are low in the patients under biologics for auto-immune/inflammatory disease. Health policies should reinforce information and promotion of these vaccines among these patients but also the prescribers.

Impact of management on mortality in patients with invasive cervical cancer in Reunion Island.

OBJECTIVE: In Reunion Island, the standardized mortality rate for cervical cancer is 4.8/100,000 women, twice higher than in Metropolitan France. For locally advanced disease, the standard of care includes a treatment by brachytherapy. Nevertheless, brachytherapy was not available on the Island before 2016. The objective of this study was to assess the impact of the management of patients with invasive cervical cancer on mortality in Reunion. METHODS: We have identified all the women hospitalized in one of the health care centers of the Island diagnosed with invasive cervical cancer between 01/01/2010 and 31/12/2015. The guidelines of the French Society of Gynecological Oncology (FSGO) were considered as the reference to evaluate professional practices. The characteristics that had an influence on global survival after log-rank test were included in a multivariate analysis according to the Cox Model. RESULTS: Retrospective analysis identified 303 women meeting inclusion criteria. The assessment of professional practices showed that the decisions on 11.6% of the patients discussed during multidisciplinary meetings, were not applied, consequentially leading to a decrease in survival (p=0.001). A total of 156 patients (51.5%) were administered a treatment in accordance with the guidelines of the FSGO and had a better survival, even after multivariate analysis (HR 2.53 [CI 95% 1.55-4.14], p<10-3). Nonconformity was associated with the lack of access to brachytherapy on the Island. Women on the Island presented low rates of screening tests (cover rates 53.2%). CONCLUSION: The absence of treatment in accordance with the guidelines and decisions taken during multidisciplinary meetings and the absence of brachytherapy were associated to a higher mortality among patients with invasive cervical cancer in Reunion Island. We hope that the implementation of brachytherapy in Reunion will address these deficiencies.

Follow-up at two years of age and early predictors of non-compliance in a cohort of very preterm infants.

AIM: To examine the rates of follow-up at two years of age and perinatal factors associated with non-compliance in an observational population-based cohort of very preterm children enrolled in a routine follow-up program. METHOD: Data review of infants born between 2008 and 2012 in the Observatoire de La Grande Prématurité, Reunion Island cohort. All singletons born alive before 33weeks of gestational age and resident on the island at two years of age were included. Patients were considered compliant if they were timely evaluated between 20-28months of age, or non-compliant if they were not evaluated or evaluated after 28months of age. RESULTS: Of the 802 survivors (mean gestational age of 30.3±2.0months, mean birthweight of 1364±396g), 468 (58.4%) were examined between 20-28months, 119 (14.8%) after 28months of age, and 215 (26.8%) were never evaluated, respectively. In multivariate analysis, factors associated with non-compliance were higher parity (>2), past history of preterm delivery, maternal diabetes (preexisting or gestational), appropriate for gestational status, and centre of birth. CONCLUSION: Sustainable follow-up of vulnerable neonates remains a challenge in clinical practice. Early predictors of non-compliance can be used to define individualized and local follow-up strategies in these infants at high risk for developmental disabilities.

Disease-Free Survival after Simultaneous or Delayed Resection of Synchronous Colorectal Liver Metastasis and Primary Cancer.

BACKGROUND/AIMS: The purpose of our study was to compare disease-free survival in patients with synchronous colorectal liver metastasis who underwent delayed hepatic resection or simultaneous resection. METHODOLOGY: All patients who underwent a curative resection of synchronous colorectal liver metastasis between 2000 and 2006 in our tertiary care referral centre were retrospectively included in our study. Patients who underwent the first stage of a two-stage hepatectomy during the primary resection were included in the delayed resection group. Disease-free survival was studied using a Kaplan-Meier method. Prognostic factors for disease-free and overall survival were determined by multivariate analysis using Cox models. RESULTS: One hundred and five patients underwent 85 delayed resections and 20 simultaneous resections. Three and five-year disease-free survival did not differ significantly between simultaneous (50% and 40%) and delayed (65% and 34%) resection groups (P = 0.47). Preoperative carcinoembryonic antigen (HR = 2.05, 95% CI, 1.07-3.92) and presence of extra-hepatic metastasis (HR = 2.85, 95% CI, 1.08-7.54) were independent prognostic factors for disease-free survival. Three and five-year overall survival did not differ either (23% and 23%; 24% and 20%, P = 0.13). CONCLUSIONS: Simultaneous resection of synchronous colorectal liver metastasis and primitive cancer does not appear to impair long-term disease-free survival.

Compliance with guidelines on antibiotic prophylaxis in total hip replacement surgery: results of a retrospective study of 416 patients in a teaching hospital.

OBJECTIVE: To assess compliance of anesthesiologist practices in antibiotic prophylaxis during total hip replacement (THR) surgery with the French Society of Anesthesiology and Intensive Care consensus-based guidelines. DESIGN: Retrospective review of medical records. Compliance of anesthesiologist practices with the guidelines was assessed according to antibiotic prophylaxis use, antimicrobial agent, dosage of first injection, time from first dose to incision, and total duration of antibiotic prophylaxis. SETTING: Orthopedic surgery wards in a 2,200-bed French teaching hospital. PATIENTS: A random sample of 416 patients undergoing THR from January 1999 to December 2000. RESULTS: Three hundred eighty-six (93%) of the sampled medical records were usable. Antibiotic prophylaxis was used for 366 (95%) of the patients. Total duration of prophylaxis did not exceed 48 hours in 98% (359 of 366) of the patients. Drug selection complied with national guidelines in 259 (71%) of the patients. Dosage and timing of the first injection were appropriate in 98% (290 of 296) and 80% (236 of 296) of the patients, respectively, who received one of the recommended antibiotics. Overall, 53% (203 of 386) of the patients met all five criteria. In multivariate analysis, there was a significant anesthesiologist effect on overall compliance with the guidelines (likelihood ratio chi-square with 9 degrees of freedom, 25.7; P < .01). Undergoing surgery during 2000 was the only patient characteristic associated with an increased rate of appropriate practices (adjusted OR, 1.56; CI95 1.02-2.38). CONCLUSION: The overall compliance rate should be improved by disseminating the guidelines and the results of this study following audit and feedback.

Incidence and mortality trends for prostate cancer in 5 French areas from 1982 to 1996.

After an increase in the 1980s, incidence and mortality for prostate cancer in North America or England and Wales started to decrease in the early 1990s. The reasons for this evolution are widely debated, notably the importance of early detection. This study describes trends of prostate cancer incidence and mortality in 5 areas in France, where practices of early detection for this cancer are widely used. The 5 French administrative areas, covered by a population-based registry, have a total population of approximately 1,700,000 men. Incidence data from these registries were studied for the period 1982-1995, and mortality data were provided by the Institut National de la Santé et de la Recherche Médicale (INSERM) for the period 1982-1996. Age-Period-Cohort models by Poisson regression were created to characterize these trends. Between 1982 and 1995, 14,699 cases of prostate cancer were registered by the 5 registries under consideration. After a little intensification of the increase in 1987, undoubtedly due to early detection (notably using Prostate-Specific Antigen), the trend of the incidence seems to reverse from 1993. Mortality increased monotonically from 1982-1990 by an average of 1.8% per year, before decreasing annually by an average of 3.3% until 1996. Poisson regressions indicated a period effect on both incidence and mortality data; a small, but significant, cohort effect exists for incidence evolution, showing that elements such as etiologic factors may have an influence. Until results of randomized studies on mass screening are available, the question of individual screening remains; improved knowledge of risk factors could be interesting.