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The use of hormone replacement therapy (HRT) for menopausal women has been the subject of much controversy in recent years, particularly concerning the carcinologic risks. The purpose of this review is to evaluate the impact of the use of HRT on the risk of gynecological but also extra-gynecological cancers. The effect of the type and the duration of use of HRT in menopausal women will also be discussed. The beneficial impact of HRT on overall mortality is also an element that will be discussed and must be taken into account when evaluating the benefit-risk balance of HRT for menopausal women.
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Neoplasias de la Mama , Neoplasias , Neoplasias de la Mama/terapia , Femenino , Terapia de Reemplazo de Hormonas/efectos adversos , Humanos , Menopausia , Posmenopausia , Medición de RiesgoRESUMEN
BACKGROUND: Malignant ovarian germ cell tumors are rare tumors, affecting young women with a generally favorable prognosis. The French reference network for Rare Malignant Gynecological Tumors (TMRG) aims to improve their management. The purpose of this study is to report clinicopathological features and long-term outcomes, to explore prognostic parameters and to help in considering adjuvant strategy for stage I patients. PATIENTS AND METHODS: Data from patients with MOGCT registered among 13 of the largest centers of the TMRG network were analyzed. We report clinicopathological features, estimated 5-year event-free survival (5y-EFS) and 5-year overall survival (5y-OS) of MOGCT patients. RESULTS: We collected data from 147 patients including 101 (68.7%) FIGO stage I patients. Histology identifies 40 dysgerminomas, 52 immature teratomas, 32 yolk sac tumors, 2 choriocarcinomas and 21 mixed tumors. Surgery was performed in 140 (95.2%) patients and 106 (72.1%) received first line chemotherapy. Twenty-two stage I patients did not receive chemotherapy. Relapse occurred in 24 patients: 13 were exclusively treated with upfront surgery and 11 received surgery and chemotherapy. 5y-EFS was 82% and 5y-OS was 92.4%. Stage I patients who underwent surgery alone had an estimated 5y-EFS of 54.6% and patients receiving adjuvant chemotherapy 94.4% (P < .001). However, no impact on estimated 5y-OS was observed: 96.3% versus 97.8% respectively (P = .62). FIGO stage, complete primary surgery and post-operative alpha fetoprotein level significantly correlated with survival. CONCLUSION: Adjuvant chemotherapy does not seem to improve survival in stage I patients. Active surveillance can be proposed for selected patients with a complete surgical staging.
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Neoplasias de Células Germinales y Embrionarias/terapia , Neoplasias Ováricas/terapia , Espera Vigilante , Adolescente , Adulto , Anciano , Coriocarcinoma/tratamiento farmacológico , Coriocarcinoma/patología , Coriocarcinoma/cirugía , Coriocarcinoma/terapia , Disgerminoma/tratamiento farmacológico , Disgerminoma/patología , Disgerminoma/cirugía , Disgerminoma/terapia , Tumor del Seno Endodérmico/tratamiento farmacológico , Tumor del Seno Endodérmico/patología , Tumor del Seno Endodérmico/cirugía , Tumor del Seno Endodérmico/terapia , Femenino , Humanos , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias de Células Germinales y Embrionarias/tratamiento farmacológico , Neoplasias de Células Germinales y Embrionarias/patología , Neoplasias de Células Germinales y Embrionarias/cirugía , Neoplasias Ováricas/tratamiento farmacológico , Neoplasias Ováricas/patología , Neoplasias Ováricas/cirugía , Pronóstico , Estudios Retrospectivos , Teratoma/tratamiento farmacológico , Teratoma/patología , Teratoma/cirugía , Teratoma/terapia , Adulto JovenRESUMEN
BACKGROUND: Low-grade serous ovarian carcinoma (LGSOC) is a rare disease that accounts for 5% of all ovarian cancers and requires surgical complete debulking. To date, the prognostic value of pelvic and paraaortic lymphadenectomy remains unclear in this population. PATIENTS AND METHODS: This retrospective cohort of patients with a diagnosis of LGSOC was registered in the Tumeurs Malignes Rares Gynécologiques national network, between January 2000 and July 2017, at 25 centers. All LGSOC were confirmed after pathological review and operated by primary debulking surgery (PDS) or interval debulking surgery after neoadjuvant chemotherapy (NACT-IDS). Primary endpoints were overall survival (OS) and progression-free survival (PFS). RESULTS: A total of 126 patients were included, 86.1% were stage III/IV, and 74.6% underwent lymph node dissection (LND). According to the Completeness of Cancer Resection (CCR) score, 83.7% had complete resection. Median OS was 130 months, and median PFS was 41 months. Pelvic and paraaortic LND had no significant impact on OS (p = 0.78) or DFS (p = 0.93), and this was confirmed in subgroups (advanced stages FIGO III/IV, CCR score 0/1 or 2/3, and timing of surgery PDS or NACT-IDS). Histological positive paraaortic lymph nodes had a significant negative impact on PFS in the whole population (HR 2.21, 1.18-4.39, p = 0.02) and in the CC0/CC1 population (HR, 2.28, 1.13-4.59, p = 0.02). CONCLUSIONS: Systematic pelvic and paraaortic LND in patients with LGSOC improved neither overall nor PFS. A prospective trial would be necessary to validate these results but would be difficult to conduct due to the rarity of this disease.
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Procedimientos Quirúrgicos de Citorreducción , Neoplasias Ováricas , Quimioterapia Adyuvante , Femenino , Humanos , Escisión del Ganglio Linfático , Terapia Neoadyuvante , Estadificación de Neoplasias , Neoplasias Ováricas/tratamiento farmacológico , Neoplasias Ováricas/patología , Neoplasias Ováricas/cirugía , Estudios RetrospectivosRESUMEN
BACKGROUND: Human experimental pain models provide an important translational link between pre-clinical models and clinical pain. Using topical capsaicin and continuous heat application, the novel capsaicin/heat ongoing pain (CHOP) model induces long-lasting experimental pain of which the perceived intensity can be individually adjusted. METHODS: In the CHOP model, capsaicin or control cream is applied to a 10 × 10 cm skin area and a heating pad is applied over the area after cream removal. Two experiments in healthy participants were performed for model characterization. In Experiment 1, a constant temperature was applied for 60 min; in Experiment 2, temperature was adjusted to maintain a constant perceived intensity for 60 min. RESULTS: Experiment 1: across participants, constant temperature induced initial habituation followed by an increase in sensation back to baseline. Cluster analysis revealed that half the participants sensitized to the constant temperature, while the other half did not. The degree of sensitization was related to the baseline pain unpleasantness, relative to pain intensity. Experiment 2: constant perceived intensity was achieved in the painful and a non-painful control condition. The two conditions did not differ regarding possibly confounding variables, including blood pressure, heart rate, inflammation or physiological stress as measured by surrogate markers. Secondary allodynia and hyperalgesia were reported more following painful compared to control stimulation. Sensitizers as determined in Experiment 1 were also more pain sensitive in Experiment 2. CONCLUSION: The CHOP model reproduces some aspects of clinical pain, such as longer duration, sensitization, secondary allodynia and hyperalgesia. SIGNIFICANCE: Here we demonstrate a novel pain model that can be applied for up to an hour without tissue damage. The CHOP model allows for investigation of primary and secondary hyperalgesia as well as top-down influences on sensitization, thereby providing an experimental model that can be used to assess clinically-oriented questions.
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Capsaicina , Calor , Hiperalgesia/fisiopatología , Dolor/fisiopatología , Piel/fisiopatología , Adolescente , Adulto , Femenino , Voluntarios Sanos , Humanos , Hiperalgesia/inducido químicamente , Masculino , Dolor/inducido químicamente , Dimensión del Dolor , Sensación , Adulto JovenAsunto(s)
Trastornos Mentales/diagnóstico , Trastornos Mentales/epidemiología , Migrantes/psicología , Migrantes/estadística & datos numéricos , Viaje/psicología , Adolescente , Adulto , Bélgica/epidemiología , Trastorno de Personalidad Compulsiva/complicaciones , Trastorno de Personalidad Compulsiva/diagnóstico , Trastorno de Personalidad Compulsiva/epidemiología , Delirio/complicaciones , Delirio/diagnóstico , Delirio/epidemiología , Exposición a la Violencia/psicología , Exposición a la Violencia/estadística & datos numéricos , Femenino , Humanos , Masculino , Salud Mental , Persona de Mediana Edad , Agitación Psicomotora/complicaciones , Agitación Psicomotora/diagnóstico , Agitación Psicomotora/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Esquizofrenia/diagnóstico , Esquizofrenia/epidemiología , Esquizofrenia/etiología , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/etiología , Viaje/estadística & datos numéricos , Enfermedad Relacionada con los Viajes , Adulto JovenRESUMEN
The Canadian Partnership Against Cancer was created in 2007 by the federal government to accelerate cancer control across Canada. Its OncoSim microsimulation model platform, which consists of a suite of specific cancer models, was conceived as a tool to augment conventional resources for population-level policy- and decision-making. The Canadian Partnership Against Cancer manages the OncoSim program, with funding from Health Canada and model development by Statistics Canada. Microsimulation modelling allows for the detailed capture of population heterogeneity and health and demographic history over time. Extensive data from multiple Canadian sources were used as inputs or to validate the model. OncoSim has been validated through expert consultation; assessments of face validity, internal validity, and external validity; and model fit against observed data. The platform comprises three in-depth cancer models (lung, colorectal, cervical), with another in-depth model (breast) and a generalized model (25 cancers) being in development. Unique among models of its class, OncoSim is available online for public sector use free of charge. Users can customize input values and output display, and extensive user support is provided. OncoSim has been used to support decision-making at the national and jurisdictional levels. Although simulation studies are generally not included in hierarchies of evidence, they are integral to informing cancer control policy when clinical studies are not feasible. OncoSim can evaluate complex intervention scenarios for multiple cancers. Canadian decision-makers thus have a powerful tool to assess the costs, benefits, cost-effectiveness, and budgetary effects of cancer control interventions when faced with difficult choices for improvements in population health and resource allocation.
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BACKGROUND: In Canada, discussion about changing from cytology to human papillomavirus (hpv) dna testing for primary screening in cervical cancer is ongoing. However, the Canadian Task Force on Preventive Health Care has not yet made a recommendation, concluding that the evidence is insufficient. METHODS: We used the cervical cancer and hpv transmission models of the Cancer Risk Management Model to study the health and economic outcomes of primary cytology compared with hpv dna testing in 14 screening scenarios with varying screening modalities and intervals. Projected cervical cancer cases, deaths, colposcopies, screens, costs, and incremental cost-effectiveness were evaluated. We performed sensitivity analyses for hpv dna test costs. RESULTS: Compared with triennial cytology from age 25, 5-yearly hpv dna screening alone from age 30 resulted in equivalent incident cases and deaths, but 55% (82,000) fewer colposcopies and 43% (1,195,000) fewer screens. At hpv dna screening intervals of 3 years, whether alone or in an age-based sequence with cytology, screening costs are greater, but at intervals of more than 5 years, they are lower. Scenarios on the cost-effectiveness frontier were hpv dna testing alone every 10, 7.5, 5, or 3 years, and triennial cytology starting at age 21 or 25 when combined with hpv dna testing every 3 years. CONCLUSIONS: Changing from cytology to hpv dna testing as the primary screening test for cervical cancer would be an acceptable strategy in Canada with respect to incidence, mortality, screening and diagnostic test volumes.
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PURPOSE: The aim of the study was to assess the diagnostic value of physical examination, radiologic explorations and percutaneous procedures of the breast in the exploration of a non-inflammatory palpable mass, in order to propose guidelines. METHOD: A systematic literature review was conducted in the Medline and Cochrane library databases. International guidelines in French and English language were also consulted until April 30th 2015. RESULTS: Physical examination of a non-inflammatory palpable breast mass is not sufficient to eliminate a breast cancer (LE2). Mammography alone has a sensitivity between 70 and 95% for the diagnosis of breast cancer (LE3). Echography alone has a sensitivity of 98 to 100% for the diagnosis of breast cancer (LE2). The core needle biopsy has a better sensitivity and specificity than the fine-needle aspiration for breast cancer diagnosis (LE2). The association of mammography and 2D echography presents excellent sensitivity and negative predictive value (close to 100 %) to exclude a breast cancer (LE3). A double evaluation using mammography and echography is recommended in the exploration of a non-inflammatory palpable breast mass (grade B).
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Neoplasias de la Mama/diagnóstico , Guías de Práctica Clínica como Asunto , Neoplasias de la Mama/diagnóstico por imagen , Femenino , Humanos , Radiografía , UltrasonografíaRESUMEN
Breast sonography is required with mammogram to explore clinical breast mass (grade B), colored unipore breast nipple discharge (grade C), or mastitis (grade C). Bi-RADS system is recommended to describe and classify breast-imaging abnormalities. For breast abscess, a percutaneous biopsy is recommended in case of mass or persistent symptoms (grade C). For mastodynia, when breast imaging is normal, no MRI neither breast biopsy is recommended (grade C). Percutaneous biopsy is recommended for BI-RADS 4-5 mass (grade B). For persistent erythematous breast nipple or atypical eczema lesion, a nipple biopsy is recommended (grade C). For distortion and asymmetry, a vacuum core needle biopsy is recommended because of the risk of underestimation by simple core needle biopsy (grade C). For BI-RADS 4-5 microcalcifications without ultrasound signal, a vacuum core needle biopsy of at least 11 gauges is recommended (grade B); in the absence of microcalcifications on radiograph carrots, additional samples are recommended (grade B). For atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ, flat epithelial with atypia, radial scar, mucocele with atypia, surgical excision is commonly recommended (grade C). Expectant management is feasible after multidisciplinary concertation. For these lesions, when excision is not in sano, no new excision is recommended except for pleomorphic or with necrosis CLIS (grade C). For grade 1 phyllode tumour, in sano surgical resection is recommended; for grade 2 phyllode, 10-mm margins are recommended (grade C). For breast papillary without atypia, complete disappearance of the radiologic signal is recommended (grade C). For breast papillary with atypia, complete surgical excision is recommended (grade C).
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Enfermedades de la Mama/diagnóstico , Enfermedades de la Mama/terapia , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/terapia , Guías de Práctica Clínica como Asunto , Femenino , HumanosRESUMEN
BACKGROUND: Several screening methods for colorectal cancer (crc) are available, and some have been shown by randomized trials to be effective. In the present study, we used a well-developed population health simulation model to compare the risks and benefits of a variety of screening scenarios. Tests considered were the fecal occult blood test (fobt), the fecal immunochemical test (fit), flexible sigmoidoscopy, and colonoscopy. Outcomes considered included years of life gained, crc cases and deaths prevented, and direct health system costs. METHODS: A natural history model of crc was implemented and calibrated to specified targets within the framework of the Cancer Risk Management Model (crmm) from the Canadian Partnership Against Cancer. The crmm-crc permits users to enter their own parameter values or to use program-specified base values. For each of 23 screening scenarios, we used the crmm-crc to run 10 million replicate simulations. RESULTS: Using base parameter values and some user-specified values in the crmm-crc, and comparing our screening scenarios with no screening, all screening scenarios were found to reduce the incidence of and mortality from crc. The fobt was the least effective test; it was not associated with lower net cost. Colonoscopy screening was the most effective test; it had net costs comparable to those for several other strategies considered, but required more than 3 times the colonoscopy resources needed by other approaches. After colonoscopy, strategies based on the fit were predicted to be the most effective. In sensitivity analyses performed for the fobt and fit screening strategies, fobt parameter values associated with high-sensitivity formulations were associated with a substantial increase in test effectiveness. The fit was more cost-effective at the 50 ng/mL threshold than at the 100 ng/mL threshold. CONCLUSIONS: The crmm-crc provides a sophisticated and flexible environment in which to evaluate crc control options. All screening scenarios considered in this study effectively reduced crc mortality, although sensitivity analyses demonstrated some uncertainty in the magnitude of the improvements. Where possible, local data should be used to reduce uncertainty in the parameters.
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BACKGROUND: Cystocele is a frequent and invalidating type of genital prolapse in woman. Sacropexy using synthetic mesh is considered the surgical gold standard, and the laparoscopic approach has supplanted the open abdominal route because it offers the same anatomical results with a lower morbidity. The use of mesh through the vaginal route may have many advantages: easiness to perform, shorter operative time and recovery, but may increase morbidity. In France, both laparoscopic sacropexy and vaginal mesh are commonly used to treat cystoceles. The French Haute Autorité de santé (HAS) has highlighted the lack of evaluation of safety assessment for vaginal meshes. METHOD/DESIGN: The main objective of the study is to compare the morbidity of laparoscopic sacropexy with vaginal mesh for cystocele repair. The primary endpoint will be the rate of surgical complications greater or equal to grade 2 of the Clavien-Dindo classification at 1-year follow-up. The secondary aims are to compare the functional results in the medium term (sexuality, urinary and bowel symptoms, pain), the impact on quality of life as well as anatomical results. PROSPERE is a randomized controlled trial conducted in 12 participating French hospitals. 262 patients, aged 45 to 75years old, with cystocele greater or equal to stage 2 of the POP-Q classification (isolated or not) will be included. Exclusion criterias are a previous surgical POP repair, and inability or contra-indication to one or the other technique. We have designed this study to answer the question of the choice between laparoscopic sacropexy and vaginal mesh for the treatment of cystocele. The PROSPERE trial aims to help better determine the indications for one or the other of these techniques, which are currently based on subjective choices or school attitudes. This is the reason why competent authorities have asked for such studies.
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Cistocele/cirugía , Procedimientos Quirúrgicos Ginecológicos/métodos , Laparoscopía , Mallas Quirúrgicas , Prolapso Uterino/cirugía , Anciano , Cistocele/complicaciones , Femenino , Procedimientos Quirúrgicos Ginecológicos/instrumentación , Humanos , Histerectomía/métodos , Laparoscopía/métodos , Persona de Mediana Edad , Prótesis e Implantes , Procedimientos de Cirugía Plástica/instrumentación , Procedimientos de Cirugía Plástica/métodos , Incontinencia Urinaria/etiología , Incontinencia Urinaria/cirugía , Prolapso Uterino/etiología , Vagina/cirugíaRESUMEN
Renal failure due to ischemic injury is a common denominator of various clinical situations in critically ill patients. This study was designed to characterize the TPSO/Cholesterol synthesis and cell division pathways in response to different levels of ischemia. Porcine kidneys were subjected to either 60 min-warm ischemia (WI) or auto-transplanted after cold storage for 24 h at 4°C (CS), or both conditions (WI+CS), pathway activation and function were evaluated at 3 h, 3 and 7 days after reperfusion. CS combined to WI affects renal functions indicating a high degree of injury. During the first week of reperfusion, renal levels of free and esterified cholesterol, major cellular components, increased in CS group with an attenuated production when WI was associated. CS and WI+CS groups exhibited an elevated expression of cell cycle induction markers such as PCNA and stathmin. TSPO expression was highest in groups with the lowest injury, and correlated with kidney outcome, revealing its potential for diagnosis.
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Lesión Renal Aguda/fisiopatología , Riñón/fisiopatología , Regeneración , Lesión Renal Aguda/metabolismo , Animales , Ésteres del Colesterol/biosíntesis , Frío , Expresión Génica , Tasa de Filtración Glomerular , Riñón/irrigación sanguínea , Riñón/metabolismo , Trasplante de Riñón , Antígeno Nuclear de Célula en Proliferación/genética , Antígeno Nuclear de Célula en Proliferación/metabolismo , Receptores de GABA/genética , Receptores de GABA/metabolismo , Daño por Reperfusión/metabolismo , Daño por Reperfusión/fisiopatología , Estatmina/genética , Estatmina/metabolismo , PorcinosAsunto(s)
Aorta Abdominal/cirugía , Carcinoma/cirugía , Laparoscopía/métodos , Escisión del Ganglio Linfático/métodos , Neoplasias del Cuello Uterino/cirugía , Aorta Abdominal/patología , Carcinoma/patología , Femenino , Humanos , Laparoscopía/efectos adversos , Escisión del Ganglio Linfático/efectos adversos , Metástasis Linfática , Estadificación de Neoplasias , Cuerpos Paraaórticos , Pronóstico , Resultado del Tratamiento , Neoplasias del Cuello Uterino/patologíaRESUMEN
Prolapse commonly coexists with lower urinary tract dysfunction. If symptomatic stress urinary incontinence is often described by patients with low stage pelvic organ prolapse, obstructive symptoms are common in patients with stage 3 or 4 prolapse. Positive preoperative reduction testing in stress continent women planning prolapse repair is associated with a higher risk for postoperative leakage and clearly identify a high risk population. To date it has not been proven that urodynamic testing may provide more precise data than physical examination to advocate an additional stress urinary surgery at the time of prolapse repair. A systematic prophylactic Burch colposuspension significantly reduces the risk of postoperative SUI. In patients with occult SUI, a concomitant TVT at the time of vaginal prolapse surgery significantly reduces the risk of postoperative SUI. In patients without leakage during reduction testing, there is no evidence for performing a concurrent TVT.
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Incontinencia Urinaria de Esfuerzo/complicaciones , Prolapso Uterino/complicaciones , Femenino , Humanos , Guías de Práctica Clínica como Asunto , Incontinencia Urinaria de Esfuerzo/diagnóstico , Incontinencia Urinaria de Esfuerzo/terapia , Prolapso Uterino/diagnóstico , Prolapso Uterino/terapiaRESUMEN
Virilizing ovarian tumors are rare and can occur at any age. In postmenopausal women, they commonly present with signs of masculinization. These tumors should be suspected in any patient with virilization and high testosterone levels (>1ng/mL). Tumor localization is sometimes difficult. These tumors are usually benign; surgical resection is the accepted treatment. Masculinizing consequences of hormonal secretions may be managed by cosmetologic treatments which should not be overlooked.
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Tumor de Células de Leydig/cirugía , Neoplasias Ováricas/cirugía , Posmenopausia , Virilismo/etiología , Anciano , Anciano de 80 o más Años , Alopecia/etiología , Femenino , Humanos , Tumor de Células de Leydig/sangre , Tumor de Células de Leydig/diagnóstico , Persona de Mediana Edad , Neoplasias Ováricas/sangre , Neoplasias Ováricas/diagnóstico , Ovariectomía , Testosterona/sangre , Resultado del Tratamiento , Virilismo/sangreRESUMEN
This article describes the application of in vivo 13C-nuclear magnetic resonance (NMR) spectroscopy and gas chromatography (GC)-combustion-isotope ratio mass spectrometry to the study of brain uptake and metabolism of polyunsaturated fatty acids in the suckling rat model. NMR spectroscopy is uniquely suited to the non-invasive detection of nonradioactive metabolites in living animals. We applied this approach to the noninvasive detection of 13C-arachidonate in brain and liver of living suckling rats but found that technical limitations in our model, mainly poor signal-to-noise, largely prevent useful results at this time. However, in a tracer study using simultaneous doses of 13C-gamma-linolenate and 13C-arachidonate, 13C-NMR of tissue lipid extracts quantitatively demonstrated a 10-fold greater (liver) or 17-fold greater (brain) accumulation of pre-formed vs newly synthesized arachidonate. GC-combustion-isotope ratio mass spectrometry was used to trace the utilization of [U-13C]-alpha-linolenate into three products in the brain: docosahexaenoate, cholesterol, and palmitate. The rationale was that although alpha-linolenate is used in de novo lipogenesis, the quantitative importance of this pathway is unknown. Our results in the suckling rat show that 2-13% of carbon from [U-13C]-alpha-linolenate appearing in brain lipids is in docosahexaenoate while the rest is in brain lipids synthesized de novo. Overall, these results indicate that the suckling rat brain prefers pre-formed to newly synthesized arachidonate and that alpha-linolenate is readily utilized in brain lipid synthesis. These methods are suited to comparative studies of the metabolism of polyunsaturates and they support previous observations that the metabolism of some polyunsaturates such as alpha-linolenate extends well beyond the traditional desaturation-chain elongation pathway.
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Encéfalo/metabolismo , Ácidos Grasos Insaturados/farmacocinética , Cromatografía de Gases y Espectrometría de Masas/métodos , Espectroscopía de Resonancia Magnética/métodos , Animales , Animales Lactantes , Ácido Araquidónico/farmacocinética , Encéfalo/crecimiento & desarrollo , Isótopos de Carbono/farmacocinética , Colesterol/biosíntesis , Ácidos Docosahexaenoicos/metabolismo , Lípidos/biosíntesis , Hígado/metabolismo , Ácido Palmítico/metabolismo , Ratas , Sensibilidad y Especificidad , Ácido alfa-Linolénico/farmacocinética , Ácido gammalinolénico/farmacocinéticaRESUMEN
A subset of new licensees, namely the ones with suspensions or invalidity periods of at least 90 days are studied. This subpopulation is comprised of 3,550 men and 1,295 women for whom the study file contains age, gender, licensing exam performance, and the dates all police reported crashes for the first three years after licensing. This group is compared with the complementary subpopulation of 53,069 men and 58,464 women. The average injury crash rate per year, not prorated, is 0.057 for men and 0.033 for women, about twice the rate for those without lengthy suspensions. These licensees are older, have lower success rates at licensing exams, and have a longer learning period than the others. Separate logistic-normal regression models for men and for women are estimated for the probability of a collision in a year using the available explanatory variables.
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Accidentes de Tránsito/estadística & datos numéricos , Adolescente , Femenino , Humanos , Concesión de Licencias , Modelos Logísticos , Masculino , Quebec , Medición de RiesgoRESUMEN
OBJECTIVE: The U.S. and some Canadian government agencies have waived commercial license restrictions for some insulin-using diabetic drivers. However, the U.S. Federal Highway Administration is no longer giving waivers. Scientific evidence to support such regulations has been sparse. This article presents detailed analyses of crash risks for users and nonusers of insulin among diabetic truck-permit holders in Québec, Canada. RESEARCH DESIGN AND METHODS: Diabetic truck-permit holders were group-matched by age to a random sample of healthy permit holders. Data on permits, medical conditions, and crashes involving 13,453 permit holder-years in 1987-1990 were extracted from the files of the public insurer for automobile injuries in Québec. Additional health status data were obtained from the provincial public health insurer. A telephone survey was conducted to collect data on driving patterns and exposure. Risk ratios were estimated using negative binomial regression models. RESULTS: Risk ratios for crashes vary by category of diabetes. Permit holders for single-unit trucks (STs) who are diabetic without complications and not using insulin have an increased crash risk of 1.68 when compared with healthy permit holders of the same permit class. When controlling for risk exposure, commercial drivers with an ST permit and the same diabetic condition have an increased risk of 1.76. Insulin use is not associated with higher crash risk. CONCLUSIONS: The increased crash risk for the group with uncomplicated diabetes not using insulin is a new finding. The lack of consistent increases in crash risks among diabetic commercial drivers with complications or who use insulin may be a "healthy worker effect" masking the real risk, because these licensees have a lower participation rate as professional drivers.
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Accidentes de Tránsito/estadística & datos numéricos , Diabetes Mellitus/fisiopatología , Adulto , Anciano , Estudios de Cohortes , Comercio/legislación & jurisprudencia , Complicaciones de la Diabetes , Diabetes Mellitus/tratamiento farmacológico , Estado de Salud , Humanos , Hipoglucemia/inducido químicamente , Hipoglucemia/epidemiología , Hipoglucemia/fisiopatología , Hipoglucemiantes/efectos adversos , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Concesión de Licencias , Persona de Mediana Edad , Quebec , Factores de RiesgoRESUMEN
The question of dental unit waterline contamination now concerns the dental profession on a number of levels and has become part of the landscape in dentistry. Researchers have identified the problem, studied it, and published their results. Official organizations have reacted to the problem by issuing press releases and recommendations. In the mean time, dental companies have jumped into the fray, ensuring a proliferation of products designed to mitigate a problem that certain people feel is imaginary are artificially inflated. Despite the number of publications describing waterline contamination, we still face the challenge of determining whether are picture of the problem is truly accurate. For example, it has become almost customary to use the term contamination when talking about waterlines, even though it is inadequate. In addition, we are moving ahead with water quality standards for dental units at a time when certain fundamental questions remain unanswered. What should we be measuring and what methods should we be using? Do certain disinfection procedures have an opposite effect to the one desired? Finally, the question of health risks linked to the colonization of waterlines has not been adequately addressed by researchers.