Continuous Monitoring of Transplant Center Performance: Different Options for Different Goals.

BACKGROUND: In France, the need for continuous monitoring of transplant center performance has recently become apparent. Cumulative sum (CUSUM) monitoring of transplantation is already been used to monitor transplant outcomes in the United Kingdom and in the United States. Because CUSUM monitoring can be applied by different methods, the objective was to assess and compare the performance of different CUSUM methods for detecting higher than expected (ie, excessive) graft failure rates. METHODS: Data come from the French transplant registry. Lung and kidney transplants in 2011-2013 constituted the control cohort, and those in 2014-2016 the observed cohort. The performance of CUSUM monitoring, according to center type and predefined control limits, was measured by simulation. The outcome monitored was 3-month graft failure. RESULTS: In a low-volume center with a low failure rate, 3 different types of control limits produced successful detection rates of excessive graft failures of 15%, 62%, and 73% and false alarm rates of 5%, 40%, and 52%, with 3, 1, and 1 excess failures necessary before a signal occurred. In a high-volume center with a high failure rate, successful detection rates were 83%, 93%, and 100% and false alarm rates were 5%, 16%, and 69%, with 6, 13, and 17 excess failures necessary before a signal occurred. CONCLUSIONS: CUSUM performances vary greatly depending on the type of control limit used. A new control limit set to maximize specificity and sensitivity of detection is an appropriate alternative to those commonly used. Continued attention is necessary for centers with characteristics making it difficult to obtain adequate sensitivity or sufficiently prompt response.

Suicide Among Farmers in France: Occupational Factors and Recent Trends.

Numerous studies have found agricultural workers, including farmers, at elevated risk of suicide, and socioeconomic conditions have been suggested as one of the important determinants of this mortality cause. The real agricultural income per worker in Europe increased steadily from 2005 to 2007 and then fell by 1.8% in 2008 and by 11.6% in 2009. This drop was particularly pronounced in France. Repeated cross-sectional studies were conducted to investigate suicide mortality rates among French farmers in 2007-2009. The study population included all French farmers enrolled yearly in the compulsory Agricultural Social Security and Health Insurance (CCMSA). Most of the mean of 500,164 subjects per year were men (68%). National cause-specific mortality rates were used to calculate standardized mortality ratios (SMRs) and associated 95% confidence intervals (95% CIs) for both genders and for each of the 3 years. During the 3-year study period, 2,769 men and 997 women died. Suicide accounted for 417 of the men's (15%) and 68 of the women's (6.8%) deaths. Hanging was the most frequent method of suicide for both. Compared with the general population, the increased rate of suicide deaths among male farmers was 28% in 2008 and 22% in 2009. This increased rate was particularly high among those aged 45-54 years (31%) and 55-64 years (47%) in 2008 (and in the 55-64-year-old group in 2009 (64%). Two specific types of farming activity were associated with increased suicide mortality rates in both 2008 and 2009: dairy cattle farming (SMR = 1.56 [95% CI: 1.09-2.15] and SMR=1.47 [95% CI: 1.01-2.04]) and beef cattle farming (SMR = 2.27 [95% CI: 1.59-3.10] and SMR = 1.57 [95% CI: 1.01-2.27]). These results may be useful for a better understanding of the situation from an epidemiological standpoint and for improving suicide prevention policies in this particular population.

In an occupational health surveillance study, auxiliary data from administrative health and occupational databases effectively corrected for nonresponse.

OBJECTIVES: To show how reweighting can correct for unit nonresponse bias in an occupational health surveillance survey by using data from administrative databases in addition to classic sociodemographic data. STUDY DESIGN AND SETTING: In 2010, about 10,000 workers covered by a French health insurance fund were randomly selected and were sent a postal questionnaire. Simultaneously, auxiliary data from routine health insurance and occupational databases were collected for all these workers. To model the probability of response to the questionnaire, logistic regressions were performed with these auxiliary data to compute weights for correcting unit nonresponse. Corrected prevalences of questionnaire variables were estimated under several assumptions regarding the missing data process. The impact of reweighting was evaluated by a sensitivity analysis. RESULTS: Respondents had more reimbursement claims for medical services than nonrespondents but fewer reimbursements for medical prescriptions or hospitalizations. Salaried workers, workers in service companies, or who had held their job longer than 6 months were more likely to respond. Corrected prevalences after reweighting were slightly different from crude prevalences for some variables but meaningfully different for others. CONCLUSION: Linking health insurance and occupational data effectively corrects for nonresponse bias using reweighting techniques. Sociodemographic variables may be not sufficient to correct for nonresponse.

Depressive symptoms and atypical jobs in France, from the 2003 Decennial health survey.

BACKGROUND: The objective is to study the relations between depressive symptoms and atypical jobs in the working population in France and to determine if these associations might be linked with psychosocial and organizational constraints. METHODS: The data come from the 2003 Decennial health survey and concern 11,895 workers. Depressive symptoms were measured by the CES-D scale. Atypical jobs were defined by employment status (fixed-term or temporary job contract, permanent job contract, self-employed) and by part-time work during working life (involuntary or chosen). Working conditions related to atypical hours and psychosocial factors were also studied. RESULTS: For both sexes, involuntary part-time work was associated with a higher frequency of depressive symptoms, but part-time work by choice was not. Fixed-term contracts were associated with depressive symptoms only in women. All of these associations persisted after adjustment for psychosocial and organizational factors. CONCLUSION: The associations between atypical jobs and depressive symptoms differ for job status according to sex and do not seem to be associated with the worst psychosocial working conditions. The interpretation of these results is nonetheless limited in part by the cross-sectional nature of the survey.