Diagnosing undernutrition children and adults: new French criteria. Why, for what and for whom? A joint statement of the French National Authority for Health and French Federation of Nutrition.

The objective was to establish new diagnostic criteria for undernutrition for the French population, concordant for children aged <18 years and adults aged <70 years, easy to use by health professionals and applicable whatever the situation (in and outpatients). A multi-disciplinary working and a reading group were involved. The procedure was divided into four phases: (1) systematic review and synthesis of the literature; (2) writing of the initial version of the guidelines; (3) reading and (4) finalisation. The literature search included international guidelines, meta-analyses, systematic reviews and randomised control trials from January 2007 to 31 July 2018. A two-step approach was selected: diagnosing undernutrition and then grading its severity. For diagnosis at least one phenotypic criterion associated with at least one aetiologic criterion were required for both children and adults. Phenotypic criteria for children were weight loss, Body Mass Index (BMI) < International Obesity Task Force curve 18·5, weight stagnation, reduction of muscle mass/function; for adults: weight loss, BMI < 18·5 and reduction of muscle mass/function. Aetiological criteria for children and adults were reduction in dietary intake, reduced absorption and hypercatabolism. Phenotypic metrics were used in both children and adults for grading severity (moderate or severe). These new French recommendations integrate the proposals of recent international recommendations combining aetiologic with phenotypic criteria, but for the first time, they are concordant for children and adults. The WHO threshold of 18·5 for BMI was kept as phenotypic criteria because epidemiological data show an increased mortality for that threshold.

Combining the Memory Impairment Screen and the Isaacs Set Test: a practical tool for screening dementias.

OBJECTIVES: To assess the accuracy of combining the Memory Impairment Screen (MIS) with the Isaacs Set Test (IST) in distinguishing subjects with dementia from controls without dementia. DESIGN: The weighted sum of MIS and IST scores was calculated, and the logical "or" rule combination was performed using two different patient and control samples. Combination results were compared with each test used alone and with Mini-Mental State Examination to detect all types of dementias. SETTING: Database of the Regional Network for Diagnostic Aid and Management of Patients with Cognitive Impairment in the Franche-Comté, France, geographical area. PARTICIPANTS: A cohort of 444 patients with Alzheimer's disease, non-Alzheimer's dementia, and reversible dementia and 311 controls. MEASUREMENTS: Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for the combination of these two tests. RESULTS: The weighted sum had overall sensitivities of 0.92 and 0.84 for mild cases, with a specificity of 0.92. The "or" rule had overall sensitivities of 0.92 and 0.89 for mild cases, with a specificity of 0.90. This pairing requires no more than 5 minutes. Its scoring is simple with the "or" rule combination. CONCLUSIONS: The combination of MIS and IST could be a useful tool for screening dementias. The "or" rule combination seems particularly adapted to medical practice.

Rapid screening of cognitive change in patients with questionable dementia using the Memory Impairment Screen and the Isaacs Set Test.

OBJECTIVES: To assess the efficacy of combining the Memory Impairment Screen (MIS) and the Isaacs Set Test (IST) in predicting short-term development of dementia in a group of people with questionable dementia (QD) at baseline. DESIGN: Performances of the weighted sum of MIS and IST and the <> rule were compared with each other and with the Mini-Mental State Examination. SETTING: Database of the Regional Network for Diagnostic Aid and Management of Patients with Cognitive Impairment in the Franche-Comté geographical area in France. PARTICIPANTS: A cohort of 106 patients aged 65 and older with QD were followed up for a mean of 14.9 months (range 6-24 months). MEASUREMENTS: Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for the combination of these two tests. RESULTS: The weighted sum had a sensitivity of 0.74 and a specificity of 0.84. The <> rule (MIS<6 or IST<25) had a sensitivity of 0.74 and a specificity of 0.81. When range values were applied, low scores on the MIS and the IST (MIS<6 and IST<25) led to a high probability of dementia, whereas high scores (MIS>7 and IST>29) suggested a high probability of remaining dementia-free in the study follow-up. CONCLUSION: This quickly performed tool (5 minutes) is simple to use and score. When including cutscores (MIS<6 or IST<25) or range values, this test could be considered a useful screening procedure for all types of dementias.

Negative impact of rurality on lung cancer survival in a population-based study.

INTRODUCTION: Several studies have suggested that rurality is a risk factor for worse prognosis in cancer. METHODS: The study population included the 2268 lung cancer cases collected between 1981 and 1996 in the Doubs Cancer Registry (France). RESULTS: The numbers of patients were 849 (31.8%) in rural areas and 89 (3.3%) in very rural areas. The relative 5-year survival was 15.2% in rural areas and 13.4% in urban areas (p = 0.5), and 2.7% in very rural areas and 14.4% in extended urban areas (p = 0.02). Multivariate analyses of observed and relative survival showed that patients living in very rural areas (p < 0.0001), 65 years of age and older and having small cell carcinoma had a significantly shorter survival. CONCLUSIONS: This study showed that the multidimensional definition of rurality identified a population with unfavorable prognoses.

Short-term associations between air pollution and respiratory drug sales.

STUDY OBJECTIVE: This research was implemented to assess the effect of air pollution on anti-asthmatic, bronchodilator, and cough and cold preparation sales in the city of Rouen (France) based on the Upper Normandy Regional Union of Health Insurance Offices database and the Air Quality Monitoring Network database. DESIGN: An ecological time-series analysis was performed for a period of 2 years (July 1998-June 2000). Generalized additive model yields to relative risks and 95% confidence interval (CI) estimates were also carried out. MAIN RESULTS: The 10-day cumulative effect of a 10-microg/m(3) black smoke increase was significantly associated with a 6.2% (95% CI, 2.4-10.1%) increase in the sales of anti-asthmatics and bronchodilators and to a 9.2% (95% CI, 5.9-12.6%) increase in the sales of cough and cold preparation for children aged under 15 years. The cumulative effect of a 10-microg/m(3) increase in SO(2) was associated with an 11.8% (95% CI, 6.7-17.1%) increase in cough and cold preparation sales for children aged under 15 years. The cumulative effect of 10-microg/m(3) increase in NO(2) was associated with an 13.6% (95% CI, 8-18.3%) increase in cough and cold preparation sales for children under 15 years of age. CONCLUSIONS: The results of this study suggest that an increase in drugs sales was directly related to air pollutant concentration increases in the city of Rouen (France).