Generalized pustular psoriasis: A nationwide population-based study using the National Health Data System in France.

BACKGROUND: GPP is a rare, chronic, neutrophilic skin disease, with limited real-world data characterizing patients with flares and the impact of flares on disease progression and morbidity. OBJECTIVE: Describe the clinical characteristics of patients with GPP, comorbidities, disease epidemiology and frequency and severity of flares, and compare patients with GPP with a matched severe psoriasis population. METHODS: In this population-based real-world cohort study an algorithm was developed to identify patients with GPP flares. Three cohorts were identified using the Système National des Données de Santé (SNDS) database covering almost the entire French population; a prevalent cohort (2010-2018), an incident cohort (2012-2015). A severe psoriasis cohort was compared with the GPP incident cohort using propensity score matching. RESULTS: The prevalent and incident cohorts comprised 4195 and 1842 patients, respectively. In both cohorts, mean age was 58 years; 53% were male. Comorbidities were significantly more common in the incident cohort versus matched psoriasis cohort, respectively, including hypertension (44% vs. 26%), ischaemic heart disease (26% vs. 18%) and hyperlipidaemia (25% vs. 15%). In the incident cohort, the flare rate was 0.1 flares/person-year and 0.4 flares/person-year among the 569 out of 1842 patients hospitalized with flares. These patients had a mean (±SD) stay of 11.6 ± 10.4 days; 25% were admitted to the intensive care unit. In 2017, the cumulative incidence and cumulative GPP age-sex standardized prevalence were 7.1 and 45.2 per million, respectively. CONCLUSIONS: Patients with GPP had a distinct comorbidity profile compared to patients with severe psoriasis, and GPP flares were associated with long hospitalizations.

Syndromic Surveillance of Acute Gastroenteritis Using the French Health Insurance Database: Discriminatory Algorithm and Drug Prescription Practices Evaluations.

The French national public health agency (Santé publique France) has used data from the national health insurance reimbursement system (SNDS) to identify medicalised acute gastroenteritis (mAGE) for more than 10 years. This paper presents the method developed to evaluate this system: performance and characteristics of the discriminatory algorithm, portability in mainland and overseas French departments, and verification of the mAGE database updating process. Pharmacy surveys with certified mAGE from 2012 to 2015 were used to characterise mAGE and to estimate the sensitivity and predictive positive value (PPV) of the algorithm. Prescription characteristics from these pharmacy surveys and from 2014 SNDS prescriptions in six mainland and overseas departments were compared. The sensitivity (0.90) and PPV (0.82) did not vary according to the age of the population or year. Prescription characteristics were similar within all studied departments. This confirms that the algorithm can be used in all French departments, for both paediatric and adult populations, with stability and durability over time. The algorithm can identify mAGE cases at a municipal level. The validated system has been implemented in a national waterborne disease outbreaks surveillance system since 2019 with the aim of improving the prevention of infectious disease risk attributable to localised tap water systems.

The mortality impacts of fine particles in France.

INTRODUCTION: Worldwide, air pollution has become a main environmental cause of premature mortality. This burden is largely due to fine particles. Recent cohort studies have confirmed the health risks associated with chronic exposure to PM2.5 for European and French populations. We assessed the mortality impact of PM2.5 in continental France using these new results. METHODS: Based on a meta-analysis of French and European cohorts, we computed a shrunken estimate of PM2.5-mortality relationship for the French population (RR 1.15 [1.05:1.25] for a 10µg/m(3) increase in PM2.5). This RR was applied to PM2.5 annual concentrations estimated at a fine spatial scale, using a classical health impacts assessment method. The health benefits associated with alternative scenarios of improving air quality were computed for 36,219 French municipalities for 2007-2008. RESULTS: 9% of the total mortality in continental France is attributable to anthropogenic PM2.5. This represents >48,000 deaths per year, and 950,000years of life lost per year, more than half occurring in urban areas larger than 100,000 inhabitants. If none of the municipalities exceeded the World Health Organization guideline value for PM2.5 (10µg/m(3)), the total mortality could be decreased by 3%, corresponding to 400,000years of life saved per year. CONCLUSION: Results were consistent with previous estimates of the long-term mortality impacts of fine particles in France. These findings show that further actions to improve air quality in France would substantially improve health.

Association between long-term exposure to air pollution and mortality in France: A 25-year follow-up study.

INTRODUCTION: Long-term exposure to air pollution (AP) has been shown to have an impact on mortality in numerous countries, but since 2005 no data exists for France. OBJECTIVES: We analyzed the association between long-term exposure to air pollution and mortality at the individual level in a large French cohort followed from 1989 to 2013. METHODS: The study sample consisted of 20,327 adults working at the French national electricity and gas company EDF-GDF. Annual exposure to PM10, PM10­2.5, PM2.5, NO2, O3, SO2, and benzene was assessed for the place of residence of participants using a chemistry-transport model and taking residential history into account. Hazard ratios were estimated using a Cox proportional-hazards regression model, adjusted for selected individual and contextual risk factors. Hazard ratios were computed for an interquartile range (IQR) increase in air pollutant concentrations. RESULTS: The cohort recorded 1967 non-accidental deaths. Long-term exposures to b aseline PM2.5, PM10-25, NO2 and benzene were associated with an increase in non-accidental mortality (Hazard Ratio, HR = 1.09; 95% CI: 0.99, 1.20 per 5.9 µg/m3, PM10-25; HR=1.09; 95% CI: 1.04, 1.15 per 2.2 µg/m3, NO2: HR=1.14; 95% CI: 0.99, 1.31 per 19.3 µg/m3 and benzene: HR=1.10; 95% CI: 1.00, 1.22 per 1.7 µg/m3).The strongest association was found for PM10: HR = 1.14; 95% CI: 1.05, 1.25 per 7.8 µg/m3. PM10, PM10-25 and SO2 were associated with non-accidental mortality when using time varying exposure. No significant associations were observed between air pollution and cardiovascular and respiratory mortality. CONCLUSION: Long-term exposure to fine particles, nitrogen dioxide, sulfur dioxide and benzene is associated with an increased risk of non-accidental mortality in France. Our results strengthen existing evidence that outdoor air pollution is a significant environmental risk factor for mortality. Due to the limited sample size and the nature of our study (occupational), further investigations are needed in France with a larger representative population sample.

Indoor air quality, ventilation and respiratory health in elderly residents living in nursing homes in Europe.

Few data exist on respiratory effects of indoor air quality and comfort parameters in the elderly. In the context of the GERIE study, we investigated for the first time the relationships of these factors to respiratory morbidity among elderly people permanently living in nursing homes in seven European countries. 600 elderly people from 50 nursing homes underwent a medical examination and completed a standardised questionnaire. Air quality and comfort parameters were objectively assessed in situ in the nursing home. Mean concentrations of air pollutants did not exceed the existing standards. Forced expiratory volume in 1 s/forced vital capacity ratio was highly significantly related to elevated levels of particles with a 50% cut-off aerodynamic diameter of <0.1 µm (PM0.1) (adjusted OR 8.16, 95% CI 2.24-29.3) and nitrogen dioxide (aOR 3.74, 95% CI 1.06-13.1). Excess risks for usual breathlessness and cough were found with elevated PM10 (aOR 1.53 (95% CI 1.15-2.07) and aOR 1.73 (95% CI 1.17-10.3), respectively) and nitrogen dioxide (aOR 1.58 (95% CI 1.15-2.20) and aOR 1.56 (95% CI 1.03-2.41), respectively). Excess risks for wheeze in the past year were found with PM0.1 (aOR 2.82, 95% CI 1.15-7.02) and for chronic obstructive pulmonary disease and exhaled carbon monoxide with formaldehyde (aOR 3.49 (95% CI 1.17-10.3) and aOR 1.25 (95% CI 1.02-1.55), respectively). Breathlessness and cough were associated with higher carbon dioxide. Relative humidity was inversely related to wheeze in the past year and usual cough. Elderly subjects aged ≥80 years were at higher risk. Pollutant effects were more pronounced in the case of poor ventilation. Even at low levels, indoor air quality affected respiratory health in elderly people permanently living in nursing homes, with frailty increasing with age. The effects were modulated by ventilation.

Indoor air pollution and respiratory health in the elderly.

Data on respiratory effects of indoor air pollution in elderly are scanty. The purpose of this review is to summarize current knowledge on adverse respiratory effects of indoor air pollution in individuals aged over 65 years, by presenting existing epidemiological evidence. Using MEDLINE database through PubMed, we identified relevant publications published between 1991 and 2011 in English on respiratory health effects of indoor air pollution in elderly (>65 years). A total of 61 studies were found and after application of the inclusion criteria: (i) epidemiologic studies published in English in peer-reviewed journals between January 1991 and December 2011, (ii) study population with age over or equal 65 years, and (iii) outcome of respiratory symptoms and disease with the exclusion of lung cancer, 33 relevant publications were selected. Most of them showed significant relationships between exposure to major indoor air pollutants and various short-term and long-term respiratory health outcomes such as wheezing, breathlessness, cough, phlegm, asthma, COPD, lung cancer and more rarely lung function decline. The most consistent relationship is found between chronic obstructive pulmonary disease (COPD) and environmental tobacco smoke (ETS). Further studies in the elderly population are needed in order to define causal relationships between exposures to indoor air pollution and underlying mechanisms in this sub-population.

Higher prevalence of breathlessness in elderly exposed to indoor aldehydes and VOCs in a representative sample of French dwellings.

The purpose of this study was to explore respiratory health effects of indoor exposures to aldehydes and volatile organic compounds (VOCs) in elderly living in a population-based representative sample of French dwellings and to compare them to the rest of the occupants of the dwellings. Twenty VOCs were objectively measured in 490 main dwellings. The respiratory conditions were assessed through a standardized questionnaire in 1012 inhabitants aged over 15 years, 144 of whom were aged over 65 years. Generalized estimating equations (GEE) were used to model the relationship between respiratory health outcomes and air pollutants concentrations using the median value of the distribution to define elevated exposure. Similar levels of indoor air pollutants were found in elderly and others. However, associations between breathlessness and living in dwellings with elevated concentrations of toluene and o-xylene respectively were statistically significant in elderly but not in the rest of the population (adjusted odds ratios (AOR(95% confidence interval) = 3.36(1.13, 9.98) and 2.85(1.06, 7.68) in elderly vs. 0.91(0.59, 1.39) and 0.79( 0.47, 1.34) in the others respectively). A more pronounced effect of n-decane on past year breathlessness was observed in case of poor ventilation in the dwellings. Our results showed a higher risk of breathlessness in elderly exposed to indoor air pollution than in the rest of the exposed population. Further investigations are needed to confirm whether this is related to frailty in elderly.

Long-term outcomes following single-bundle transtibial arthroscopic posterior cruciate ligament reconstruction.

PURPOSE: Posterior cruciate ligament (PCL) injury has a reported incidence of 3-20 %. PCL reconstruction is aimed at reducing onset of premature articular degeneration and improving function. Numerous operative techniques have been described with varying degrees of result consistency. METHODS: We evaluated 15 patients treated for isolated primary posterior cruciate ligament injury with a mean follow-up of 4.1 years (range one to nine). Post-reconstruction clinical assessment included the Lysholm and Tegner knee scoring scale, international knee documentation committee (IKDC) ligament evaluation, and KT2000 arthrometer assessment. RESULTS: On the Lysholm knee score 11 patients (73 %) had excellent results, three patients (20 %) had good results and one patient (7 %) had a poor result. On the Tegner activity score the majority of patients scored 7-8 with a return to high level sports. At the final follow-up, the post-reconstruction IKDC score was normal or nearly normal (A and B) in 14 (93 %) patients, and abnormal (C) in one (7 %) patient. According to KT-2000 arthrometer measurements at final follow-up review, 11 patients (73 %) were rated as normal (A, 0-2 mm), and four patients (27 %) as nearly normal (B, 3-5 mm). These results were independent of age, mechanism of injury, time elapsed to surgical reconstruction, and length of follow-up. CONCLUSIONS: Despite being a technically demanding procedure, the outcomes reported in this study show that single bundle transtibial arthroscopic PCL repair using four strands hamstring autograft provides satisfactory and consistent functional outcomes.

Bronchitis-like symptoms and proximity air pollution in French elderly.

BACKGROUND: Our aim was to explore the association between respiratory health and proximity air quality in elderly. METHODS: The prevalence of respiratory conditions was linked in 2104 individuals aged > or =65 years recruited in Bordeaux (3C Study) to home address concentrations of NO2, CO, SO2, fine particles (PM(10)), VOCs and benzene, estimated through a dispersion model combining data on background air pollution, traffic characteristics, and conditions of topographical and meteorological dispersion of air pollutants. RESULTS: Mean [minimum; maximum] values of the annual concentrations (microg/m(3)) of proximity air pollutants were respectively: 28 [18; 72.2] for NO2, 420 [350; 1337] for CO, 7.5[5; 13.7] for SO2, 23.1 [19; 51] for PM(10), 8.1 [0.01; 116.6] for VOCs and 1.8 [1.5; 6.9] for benzene. Using a binary logistic regression model, PM(10) were significantly associated with usual cough (Odds-Ratio=1.33 (95% confidence interval: 1.00-1.77) for exposed compared to non-exposed) and SO(2) with usual cough (1.55 (1.16-2.08)) and phlegm (1.45 (1.04-2.01)). We found a 10% and a 23% increase in usual cough for a 10microg/m(3) increment in PM(10) and a 1microg/m(3) increment in SO2 respectively, and a 23% increase in usual phlegm for a 1microg/m(3) increase in SO2. A sensitivity analysis showed similar results when considering 3-year proximity pollution. A more pronounced effect of SO2 and PM(10) on usual cough and phlegm was observed in woman. CONCLUSIONS: Our assessment of exposure to proximity air pollution has shown an increased prevalence of bronchitis-like symptoms in elderly living in areas polluted by SO2 and PM(10).