The Radial Propagation of Heat in Strongly Driven Non-Equilibrium Fusion Plasmas.

Heat transport is studied in strongly heated fusion plasmas, far from thermodynamic equilibrium. The radial propagation of perturbations is studied using a technique based on the transfer entropy. Three different magnetic confinement devices are studied, and similar results are obtained. "Minor transport barriers" are detected that tend to form near rational magnetic surfaces, thought to be associated with zonal flows. Occasionally, heat transport "jumps" over these barriers, and this "jumping" behavior seems to increase in intensity when the heating power is raised, suggesting an explanation for the ubiquitous phenomenon of "power degradation" observed in magnetically confined plasmas. Reinterpreting the analysis results in terms of a continuous time random walk, "fast" and "slow" transport channels can be discerned. The cited results can partially be understood in the framework of a resistive Magneto-HydroDynamic model. The picture that emerges shows that plasma self-organization and competing transport mechanisms are essential ingredients for a fuller understanding of heat transport in fusion plasmas.

Parkinson disease male-to-female ratios increase with age: French nationwide study and meta-analysis.

BACKGROUND: Parkinson's disease (PD) is 1.5 times more frequent in men than women. Whether age modifies this ratio is unclear. We examined whether male-to-female (M-F) ratios change with age through a French nationwide prevalence/incidence study (2010) and a meta-analysis of incidence studies. METHODS: We used French national drug claims databases to identify PD cases using a validated algorithm. We computed M-F prevalence/incidence ratios overall and by age using Poisson regression. Ratios were regressed on age to estimate their annual change. We identified all PD incidence studies with age/sex-specific data, and performed a meta-analysis of M-F ratios. RESULTS: On the basis of 149 672 prevalent (50% women) and 25 438 incident (49% women) cases, age-standardised rates were higher in men (prevalence=2.865/1000; incidence=0.490/1000 person-years) than women (prevalence=1.934/1000; incidence=0.328/1000 person-years). The overall M-F ratio was 1.48 for prevalence and 1.49 for incidence. Prevalence and incidence M-F ratios increased by 0.05 and 0.14, respectively, per 10 years of age. Incidence was similar in men and women under 50 years (M-F ratio <1.2, p>0.20), and over 1.6 (p<0.001) times higher in men than women above 80 years (p trend <0.001). A meta-analysis of 22 incidence studies (14 126 cases, 46% women) confirmed that M- F ratios increased with age (0.26 per 10 years, p trend=0.005). CONCLUSIONS: Age-increasing M-F ratios suggest that PD aetiology changes with age. Sex-related risk/protective factors may play a different role across the continuum of age at onset. This finding may inform aetiological PD research.

Population-based analysis of invasive fungal infections, France, 2001-2010.

To determine the epidemiology and trends of invasive fungal infections (IFIs) in France, we analyzed incidence, risk factors, and in-hospital death rates related to the most frequent IFIs registered in the national hospital discharge database during 2001-2010. The identified 35,876 IFI cases included candidemia (43.4%), Pneumocystis jirovecii pneumonia (26.1%), invasive aspergillosis (IA, 23.9%), cryptococcosis (5.2%), and mucormycosis (1.5%). The overall incidence was 5.9/100,000 cases/year and the mortality rate was 27.6%; both increased over the period (+1.5%, +2.9%/year, respectively). Incidences substantially increased for candidemia, IA, and mucormycosis. Pneumocystis jirovecii pneumonia incidence decreased among AIDS patients (-14.3%/year) but increased in non-HIV-infected patients (+13.3%/year). Candidemia and IA incidence was increased among patients with hematologic malignancies (>+4%/year) and those with chronic renal failure (>+10%/year). In-hospital deaths substantially increased in some groups, e.g., in those with hematologic malignancies. IFIs occur among a broad spectrum of non-HIV-infected patients and should be a major public health priority.

Estimates of home and leisure injuries treated in emergency departments in the adult population living in metropolitan France: a model-assisted approach.

BACKGROUND: Home and leisure injuries (HLIs) are currently a major public health concern, because of their frequency, associated consequences, and considerable medical costs. As in many other countries in Europe, in France the population coverage of the surveillance system of HLIs is low. In this study, a model-assisted approach is developed to estimate the incidence rates of HLIs in adults treated in emergency departments (EDs) in metropolitan France between 2004 and 2008. METHODS: Using a sample of the hospitals participating in the French ED-based surveillance system, a generalized linear mixed model was applied, which describes the relationship between the numbers of ED visits for HLIs and the sex and age of the patients on the basis of the number of injury-related stays recorded by the hospitals. Statistics on hospital stays were provided by the French hospital discharge databases in the participating hospitals. The same statistics were available at the national level, which made it possible to extrapolate national incidence estimates. RESULTS: Over the 2004-2008 period, the estimated incidence rate of HLIs age-standardized on the European population aged 15 years and over was 48.7 per 1,000 person-years (95% confidence interval: 39.4-58.0), and displayed little variability over time. This rate corresponded to an average of 2.5 million emergency hospital visits each year due to an HLI in people aged over 15 in France. CONCLUSIONS: The method made it possible to use medico-administrative datasets available nationwide to provide informative estimates despite the small number of participating EDs. The consequences and costs generated by hospital emergency visits can sometimes be onerous, and these estimated rates confirm the scale of the problem and the need to continue investing in preventive actions.

Increase in psychotropic drug deliveries after the Xynthia storm, France, 2010.

INTRODUCTION: During the night of February 27 and the early morning of February 28, 2010, 15 coastal municipalities situated in two French departments, Vendée and Charente-Maritime, were violently stricken by a severe windstorm named "Xynthia." This storm caused the death of 12 individuals in Charente-Maritime and 29 people in Vendée. Houses, agricultural fields, and shellfish companies were severely flooded with seawater. Several thousand people temporarily had to leave their homes. The objective of this study was to estimate the short-term mental health impact of Xynthia, in terms of psychotropic drug delivery, on the resident population of the 15 coastal municipalities severely hit by the flooding. METHODS: The French national health insurance database was used to calculate a daily number of new psychotropic treatments from September 1, 2008 through December 24, 2010. New treatments were calculated for each of the following European Pharmaceutical Marketing Research Association (EphMRA) classes: tranquilizers (N05C), hypnotics (N05B), and antidepressants (N06A). A period of three weeks following the storm was defined as the exposure period. A generalized additive model with a Poisson distribution that allows for over-dispersion was used to analyze the correlation between the Xynthia variable and the number of new psychotropic treatments. RESULTS: With a relative risk (RR) of 1.54 (95% CI, 1.39-1.62) corresponding to an estimate of 409 new deliveries of psychotropic drugs during the three weeks following the storm, this study confirms the importance of the psychological impact of Xynthia. This impact is seen on all three classes of psychotropic drugs studied. The impact is greater for tranquilizers (RR of 1.78; 95% CI, 1.59-1.89) than for hypnotics (RR of 1.53; 95% CI, 1.31-1.67) and antidepressants (RR of 1.26; 95% CI, 1.06-1.40). The RR was higher for females than for males. CONCLUSION: This study shows the importance of the psychological impact of the storm as observed clinically by health workers who intervened in the field during the aftermath of Xynthia. It confirms that administrative databases can be used to show a health impact of a disaster even at a local level. This is one more step in the direction of a comprehensive strategy of collecting information to allow the assessment of the health impact of an extreme event, the detection of vulnerable populations, and the orientation of the short-, mid- and long-term public health response.

National trends in admission for cardiac rehabilitation after a myocardial infarction in France from 2010 to 2014.

BACKGROUND: Follow-up care and rehabilitation services [soins de suite et réadaptation (SSR)], especially cardiac rehabilitation (CR), constitute a key stage for patients who have had an acute myocardial infarction (AMI). AIMS: To study admission to SSR, especially for CR, among patients hospitalized for AMI in France in 2014, and its temporal trend between 2010 and 2014. METHODS: We used the French National Hospital Database to select patients hospitalized with a main diagnosis of AMI (identified by ICD-10 codes I21 to I23) in the first semester of each year from 2010 to 2014. We then searched for rehabilitation admission in the 6 months after the index hospitalization. We calculated age-standardized rates of admission for CR and for other rehabilitation purposes. The average annual percentage change in admission rates was analysed by Poisson regression. RESULTS: In 2014, among the 29,424 patients hospitalized for an AMI in the first 6 months of the year, 10,873 (36.9%) were subsequently admitted to SSR units. More specifically, the age-standardized rate of patients hospitalized in CR units reached 28.4% (n=8380), and was greater among men (29.6%, n=6707) than among women (24.9%, n=1673). Between 2010 and 2014, rates of admission for CR increased by 5.0% per year in men and 6.6% per year in women. We found a great increase in ambulatory CR management, which accounted for half of the admissions for CR in 2014. CONCLUSIONS: Favourable trends in rates of admission for CR were reported in both sexes and at all ages, except the oldest. The increase in ambulatory management contributed to these changes. Despite these trends, rates of admission for CR after AMI remain low.

Syndromic surveillance based on emergency department activity and crude mortality: two examples.

Recent public health crises have shown the need for readily available information allowing proper management by decision-makers. One way of obtaining early information is to involve data providers who already record routine data for their own use. We describe here the results of a pilot network carried out by the InVS (Institut national de veille sanitaire) which gathered data available in real time from hospital emergency departments and register offices. Emergency departments data were registered from patients' computerised medical files. Mortality data were received from the national institute of statistics (Insee). Data were transmitted automatically on a daily basis. Influenza data from outbreaks in 2004/05 and 2005/06 were compared with data from the sentinel network for the same periods. Environmental health data were compared with meteorological temperatures recorded in Paris between June and August 2006. A mortality analysis was conducted on a weekly basis. Correlation between influenza data from emergency departments and data from Sentiweb (sentinel network) was significant (p<0.001) for both outbreaks. In 2005 and 2006, the outbreaks were described similarly by both sources with identification of the start of the outbreaks by both systems during the same weeks. As for data related to heat, a significant correlation was observed between some diagnoses and temperature increases. For both types of phenomena, mortality increased significantly with one to two weeks lag. To our knowledge, this is the first time that a study using real time morbidity and mortality data is conducted. These initial results show how these data complement each other and how their simultaneous analysis in real time makes it possible to quickly measure the impact of a phenomenon.

Effect of rehabilitation setting on dependence following stroke: an analysis of the French inpatient database.

BACKGROUND: In France in 2009, patients admitted to Multidisciplinary Inpatient Rehabilitation for stroke were sent to a neurological rehabilitation center (NRC) or a general or geriatric rehabilitation (GRC) service. OBJECTIVE: To describe the functional outcome of stroke patients admitted for rehabilitation in France in 2009, both globally and as a function of the rehabilitation setting (GRC or NRC). METHODS: Data from the French Hospital Discharge Diagnosis databases for 2009 were included. Two logistic regression models were used to analyze factors related to improvement in dependence score and discharge home. Odds ratios (ORs) were also calculated. RESULTS: Among the 83 505 survivors of acute stroke in 2009, 28 201 were admitted for rehabilitation (33.8%). Of these, 19 553 went to GRC (69%) and 8648 to NRC (31%). On average, patients admitted to GRC were older (78.6 years vs 66.4 years), P < .001). At the start of rehabilitation, 50% of NRC patients and 56% of GRC patients were heavily dependent, but level of dependence was similar within each age-group. Rehabilitation in NRC lead to a greater probability of functional improvement (OR = 1.75, P < .001) and home discharge (OR = 1.61, P < .001) after adjustment for gender, age, Charlson's comorbidity index, initial level of dependence, type of stroke, and total length of stay. CONCLUSION: This study confirms, on a national level, the functional benefit of specialized rehabilitation in NRC. These results should be useful in the improvement of care pathways, organization of rehabilitation, and discharge planning.

[Acute and post-acute hospitalizations for stroke in France: recent improvements (2007-2009)]. / Évolutions de la prise en charge hospitalière des accidents vasculaires cérébraux en court séjour et en soins de suite et de réadaptation entre 2007 et 2009 en France.

OBJECTIVES: The objectives of this study were to assess the main characteristics of acute and post-acute care for transient ischemic attack (TIA) and stroke, based on the French national hospitalization databases and their evolutions from 2007 through 2009. METHODS: Hospitalizations with a main diagnosis of stroke were first selected in the 2007, 2008 and 2009 French hospital discharge databases (PMSI-MCO). They were then linked in the corresponding national databases of post-acute hospitalization records (PA), through the common anonymous patient number used in every hospitalization database. RESULTS: In France, 138,601 acute hospitalizations were registered in 2009, 31,674 TIA and 106,927 strokes, of which 91% were in public hospitals. The mean length of stay was 6.4 days for TIA and 12.7 days for stroke. Stroke hospitalization in stroke unit increased from 9.7% in 2007 to 25.9% in 2009 and acute care in hospital having a stroke unit, from 22.9% to 47.4%. A third of stroke patients hospitalized in acute care in 2009 (and not deceased), were linked in the post-acute-care database: 10.4% were in rehabilitations facilities (RF) and 23.4%, in post-acute nursing facilities (PAN), versus respectively 7.5% and 24% in 2007. DISCUSSION: French national hospitalization databases are exhaustive (acute care) or quasi-exhaustive (post-acute care) and can be linked with a good reliability. However, their validity depends on coding accuracy. In this respect, stroke unit hospitalization might be underreported. CONCLUSION: The French national hospital databases showed consistent improvements in stroke care in recent years. At the acute phase, there was an increase in stroke care in both stroke unit and hospital with stroke unit, due to the development of stroke care in France. Furthermore, the proportion of stroke patient discharged in rehabilitation facilities increased from 7.5% to 10.4%.

Population and risk group uptake of H1N1 influenza vaccine in mainland France 2009-2010: results of a national vaccination campaign.

A mass vaccination campaign against influenza A/H1N1 was launched in France in October 2009. Vaccination was offered free of charge to the entire population according to a pre-defined order of priority. Demographic data and data on vaccinations given were recorded in a dedicated database. We analysed vaccine uptake by age, sex and region in the overall population and in certain risk groups, including pregnant women. Overall vaccine uptake was 8% and varied by age-group and sex. Vaccine uptake in pregnant women was 22.7%. These low uptakes may reflect controversies around the vaccine and vaccination policy and have important implications for future pandemic vaccination strategies.