A multidisciplinary and structured investigation of three suspected clusters of transverse upper limb reduction defects in France.

INTRODUCTION: Between 2019-2021, facing public concern, a scientific expert committee (SEC) reanalysed suspected clusters of transverse upper limb reduction defects (TULRD) in three administrative areas in France, where initial investigations had not identified any risk exposure. We share here the national approach we developed for managing suspicious clusters of the same group of congenital anomalies occurring in several areas. METHODS: The SEC analysed the medical records of TURLD suspected cases and performed spatiotemporal analyses on confirmed cases. If the cluster was statistically significant and included at least three cases, the SEC reviewed exposures obtained from questionnaires, environmental databases, and a survey among farmers living near to cases' homes concerning their plant product use. RESULTS: After case re-ascertainment, no statistically significant cluster was observed in the first administrative areas. In the second area, a cluster of four children born in two nearby towns over two years was confirmed, but as with the initial investigations, no exposure to a known risk factor explaining the number of cases in excess was identified. In the third area, a cluster including just two cases born the same year in the same town was confirmed. DISCUSSION: Our experience highlights that in the event of suspicious clusters occurring in different areas of a country, a coordinated and standardised approach should be preferred.

Self-poisoning by E-cigarette and E-liquids: National Reports to French Poison Control Centers from July 2019 to December 2020: VIGIlance and VAPE: The VIGIVAPE Study.

INTRODUCTION: Exposure to e-cigarette liquids, whether intentional or accidental, might lead to adverse events. This study aimed to describe the prevalence and characteristics of exposures to e-liquids reported to French Poison Control Centers. METHODS: All e-liquids exposure cases reported to French Poison Control Centers from July 1, 2019, to December 31, 2020, were reviewed. Information was collected about the patient's characteristics, exposure circumstances, management and outcome. RESULTS: About 919 cases of exposure to e-liquids were reported. Ages ranged from one month to 89 years, with a mean age of 16.6 ± 18.6 years and a median age of 4 years. The highest number of exposures-50.7%-concerned infants (0-4 years), 3.1% children (5-11 years), 5.9% adolescents (12-17 years), and 40.1% of cases concerned adults. The majority of cases were accidental (95.0%). Intentional exposures (4.9%) were mainly observed in patients older than 12 years of age (P < 0.001). The route of exposure was ingestion in 73.7% of the cases. A total of 455 exposures showed no symptoms or signs related to poisoning. High nicotine concentration in e-liquids was associated with an increase in hospital management (Odds-ratio from 1.77 to 2.60). CONCLUSION: Involuntary exposures to e-liquids occurred more often in children under the age of five, mainly by ingestion. Unlike intentional ingestions, unintentional ingestions rarely resulted in severe adverse events. These findings highlight the importance of ongoing surveillance to prevent such exposures and associated injuries, emphasizing the need for effective regulation of these products.

A multi-country One Health foodborne outbreak simulation exercise: cross-sectoral cooperation, data sharing and communication.

Introduction: The awareness of scientists and policy makers regarding the requirement for an integrated One Health (OH) approach in responding to zoonoses has increased in recent years. However, there remains an overall inertia in relation to the implementation of practical cross-sector collaborations. Foodborne outbreaks of zoonotic diseases continue to affect the European population despite stringent regulations, evidencing the requirement for better 'prevent, detect and response' strategies. Response exercises play an essential role in the improvement of crisis management plans, providing the opportunity to test practical intervention methodologies in a controlled environment. Methods: The One Health European Joint Programme simulation exercise (OHEJP SimEx) aimed at practicing the OH capacity and interoperability across public health, animal health and food safety sectors in a challenging outbreak scenario. The OHEJP SimEx was delivered through a sequence of scripts covering the different stages of a Salmonella outbreak investigation at a national level, involving both the human food chain and the raw pet feed industry. Results: A total of 255 participants from 11 European countries (Belgium, Denmark, Estonia, Finland, France, Italy, Norway, Poland, Portugal, Sweden, the Netherlands) took part in national level two-day exercises during 2022. National evaluations identified common recommendations to countries aiming to improve their OH structure to establish formal communication channels between sectors, implement a common data sharing platform, harmonize laboratory procedures, and reinforce inter-laboratory networks within countries. The large proportion of participants (94%) indicated significant interest in pursuing a OH approach and desire to work more closely with other sectors. Discussion: The OHEJP SimEx outcomes will assist policy makers in implementing a harmonized approach to cross-sector health-related topics, by highlighting the benefits of cooperation, identifying gaps in the current strategies and suggesting actions required to better address foodborne outbreaks. Furthermore, we summarize recommendations for future OH simulation exercises, which are essential to continually test, challenge and improve national OH strategies.

Shiitake dermatitis: experience of the Poison Control Centre Network in France from 2014 to 2019.

OBJECTIVE: Shiitake mushrooms (Lentinus edodes) are an edible fungus, initially grown in Japan and China that are increasingly marketed in Europe. We previously presented 15 shiitake dermatitis cases reported to Poison Control Centres (PCCs) in France from January 2000 to December 2013. The aim of this study was to describe changes in the number of shiitake dermatitis cases since 2014, and to better describe the clinical characteristics and risk factors of this reaction. CASE SERIES: This observational study is a retrospective review of cases in the French PCCs database between 1 January 2014 and 31 December 2019. Out of 125 shiitake exposures, we identified 59 cases of dermatitis: sex ratio of 1.80 M/F; ages ranging from 19 to 69 years (median: 39 years). Dermatitis occurred after raw or undercooked shiitake consumption (e.g., from the wok, in soup, or on pizza). The rash appeared 1-168 h (median: 48 h) after shiitake ingestion. Linear, erythematous, urticarial papules and plaques developed across the trunk, arms, and legs within a few hours and persisted for 1-40 d (median 10 d). The amount of shiitake eaten (low vs. medium vs. high) significantly increased the duration of dermatitis (median days 4 vs. 7 vs. 15, respectively; p = .007). In all, 38 patients received corticosteroids, antihistamine drugs, or both without demonstrated benefit. All patients made a complete recovery. CONCLUSIONS: The mechanism of shiitake dermatitis is thought to involve lentinan, a heat-labile polysaccharide component. Inadequate cooking clearly seems to be a driver of the occurrence of shiitake dermatitis. This study highlighted a dose-dependent response, suggesting a partial toxic mechanism or a th1-type hypersensitivity mechanism. Treatment is focused on symptom management. Health professionals and the general population should be aware of both the risk associated with inadequately cooked shiitake consumption and the favourable prognosis of this still poorly known toxic dermatitis.

Human poisonings by neurotoxic phycotoxins related to the consumption of shellfish: study of cases registered by the French Poison Control Centres from 2012 to 2019.

CONTEXT: In June 2019, a paralytic shellfish poisoning (PSP) case related to the consumption of mussels contaminated by saxitoxins at a concentration below the regulatory threshold came to the attention of the French Agency for Food, Environmental and Occupational Health and Safety (ANSES). This pointed to probable undetected human cases of poisoning by neurotoxic phycotoxins. METHODS: We conducted a retrospective study of poisoning cases by bivalve shellfish (oysters, mussels and scallops) recorded by the French Poison Control Centres (PCC) from 2012 to 2019. All medical records were reviewed by a toxicologist.Cases that could be related to neurotoxic phycotoxins were selected and described. Diagnosis was based on symptoms compatible with ingestion of contaminated shellfish and on contamination data for the shellfish production area (analysed by the French Research Institute for Exploitation of the Sea, Ifremer), or notifications to the European Rapid Alert System for Food and Feed when the origin of the shellfish was known. RESULTS: Among the 619 shellfish poisoning cases recorded by the PCCs from 2012 to 2019, 22% (n = 134) had reported at least one neurological symptom (headache, dizziness or paraesthesia). Review of medical records for the 134 patients led to suspicion of 14 cases of PSP and one case of amnesic shellfish poisoning. Five patients experienced persistent neurological symptoms. Marine toxins were not tested for in the blood or urine of these patients. CONCLUSION: This retrospective identification of cases strongly suspected of being related to neurotoxic phycotoxins led ANSES, PCCs and Ifremer to develop a specific questionnaire and to recommend actions to take when neurological symptoms related to shellfish consumption are reported to a PCC. Daily monitoring of shellfish poisoning cases registered in the national PCCs database was also implemented in order to rapidly detect any suspicious cases, alert the competent authorities, and warn the general population.

Human exposure to larvae of processionary moths in France: study of symptomatic cases registered by the French poison control centres between 2012 and 2019.

CONTEXT: Contact with the setae of larvae (caterpillars) of pine or oak processionary moths could induce urticarial or allergic reactions in humans. These species are present in France and presently expanding towards highly populated areas due to climate change and/or human-mediated translocations. We aimed to describe the symptomatic cases of exposure to processionary larvae in France. METHODS: We conducted a retrospective study of symptomatic cases of exposure to processionary larvae registered by the French poison control centres between 1 January 2012 and 31 July 2019. We reviewed all medical records coded with the agent "larvae". RESULTS: Of the 1274 included cases, 59% and 27% corresponded to pine and oak processionary larvae, respectively; the 14% remaining cases concerned unspecified processionary larvae. While the annual number of cases due to pine processionary larvae fluctuated during the study period, cases associated with oak processionary larvae increased steadily. Most of the annual cases occurred between January and May for pine processionary larvae, and April and August for oak processionary larvae (with a peak in March or June, respectively). Among the 1022 cases for which information was available, the sex ratio was 1.2 and the median age was 11 years old. Skin symptoms were reported by 96,3% of the cases, such as pruritus or urticaria. The severity was mild in 96.3% of cases, moderate in 3.5%, and severe in 0.2% (two cases). Ocular or oral exposures led more frequently to severe symptoms than dermal ones (respectively 31% and 18% vs. 2% of cases, p < 10-3). CONCLUSION: Since processionary moth larvae exposure is a growing health concern, which can cause severe injuries particularly after ocular or oral exposures, the population, and the professionals should be informed of existing recommendations to avoid exposure and measures to be taken after being exposed.

Methadone poisonings: a seven-year retrospective study of the French poison center network focusing on suicide attempts vs. misuses.

Methadone has been prescribed in France as opioid substitution therapy as a syrup formulation since 1995 and as capsules since 2008. Following two publications showing on a national scale the high risk of methadone poisoning in children and the lack of difference in poisoning severity between both methadone formulations, French health authorities chose to benefit from the experience acquired by the network of French poison centres concerning poisoning by this substitution medication. The aim of this study was to identify and compare the main circumstances of methadone exposure collected by a poison centre on a national scale over a period of 7 years. Retrospective descriptive study of cases of methadone exposure was compiled by the network of French poison centres between 15 October 2010 and 15 October 2017. Analysis of 1415 files revealed two major circumstances: 47% misuse and 41% suicide attempts. Severity scores evaluated according to the PSS were higher for misuse than for suicidal behaviour, despite the supposed ingested dose being statistically higher in the latter. The results also confirmed the lack of significant difference in methadone exposure between both of the formulations (syrup and capsules). This series of methadone exposure on a national scale is one of the largest compiled series in international medical literature. On the one hand, it highlights the severity of methadone poisoning (in suicidal behaviour and even more so in misuse behaviour), and on the other hand, it confirms that the capsule formulation does not seem to represent a higher risk than the syrup formulation.

Human exposure to banned pesticides reported to the French Poison Control Centers: 2012-2016.

In 2008, 30 active substances from plant protection products were banned from marketing in France. Nevertheless, the French Poison Control Centers continue to see cases of poisoning caused by these active substances that are no longer approved. The aim of this study was to describe the characteristics of the reported cases in mainland France and in overseas French territories, over the period 2012-2016. A total of 408 cases of human exposure were reported during the study period. The most commonly reported substances were dichlorvos (24.8%, n = 108), paraquat (23.8%, n = 97), aldicarb (14.7%, n = 60), diuron (9.6%, n = 39), dinocap (5.1%, n = 21), methomyl (4.2%, n = 17), carbofuran (3.9%, n = 16), anthraquinone (2.9%, n = 12) and carbendazim (2.7%, n = 11). The number of cases of intoxication dropped sharply between 2012 (n = 119) and 2016 (n = 47), except in the overseas French territories. Among the 72 serious cases (severe or life-threatening or with a fatal outcome), the most common substances involved were paraquat (n = 34), aldicarb (n = 24) and carbofuran (n = 7). This study suggests persistent use of carbamate insecticides, the existence of illegal imports of dichlorvos or paraquat-based products, and the use of certain banned fungicides in the professional agricultural sector. Information and collection campaigns are therefore essential after the withdrawal of marketing authorization for the plant protection products.

Urinary incontinence in French women: prevalence, risk factors, and impact on quality of life.

BACKGROUND: The lack of epidemiologic data on the prevalence of female urinary incontinence (UI) attending general practitioners (GPs) in France led us to conduct a cross-sectional study in our country. OBJECTIVES: To determine the prevalence of UI and to assess its impact on the quality of life (QoL). DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study of women aged >18 yr was conducted by attending GPs between June 2007 and July 2007. MEASUREMENTS: The main outcome measures were urinary symptoms, functional impairment, International Consultation on Incontinence Questionnaire-Short Form score, and medical care seeking. RESULTS AND LIMITATIONS: Overall, 241 GPs enrolled 2183 women seen during 1 d. The prevalence of UI was 26.8% (n=584) and increased with age, body mass index (BMI), and number of children delivered (p<0.0001). Among women with UI, 496 were included in a cross-sectional survey: 45.2% (n=224) had stress UI, 42.1% (n=209) had mixed UI, and 10.9% (n=53) had urge UI, while 2% (n=10) had UI of indeterminate type. Overall, 288 of 496 women (51.8%) stated that UI had a negative impact on their QoL; this effect remained mostly mild or moderate, and only 197 of 496 women (39.7%) had asked for medical help. Longer duration of symptoms, higher frequency of comorbid urinary symptoms, and altered QoL were most frequent among women with mixed UI (p<0.001). Misclassification may have occurred because the diagnosis of UI was based on self-reported data rather than on clinical or urodynamic examinations. CONCLUSIONS: UI symptoms were found in almost one in four women attending GPs. Clinical and functional UI impairment were associated with age, BMI, and parity. UI caused distress to women, but only those who were severely affected sought help. The results emphasize the need for policy development for UI prevention and management in France.

French colorectal cancer screening pilot programme: results of the first round.

OBJECTIVES: In France, a national pilot population-based screening programme on colorectal cancer was set up in 2002. In 2006, 23 French districts were included, targeting a population of more than five million people. This programme offers biennial screening using the fecal occult blood test (FOBT) to average risk subjects aged between 50 and 74 years. People receive a letter inviting them to consult their GPs, who in turn provide the FOBT. People with a positive test result are proposed a full colonoscopy. The results of the programme's first-round performance indicators are presented. METHODS: The monitoring centre collected data from GPs and gastroenterologists on follow-up and colonoscopy results for people who were screened positive. Data were transferred to the French Institute for Public Health Surveillance (InVS) for the analysis. RESULTS: The overall participation rate for the 19 districts having completed a first screening round reached 42%. The overall positive test rate was 2.7%. In the eight districts with comprehensive follow-up data for the first round, 86% of colonoscopies were completed after a positive test. A total of 1615 people were diagnosed with cancer, and 4612 people with adenoma. The cancer detection rate reached 2.3/1000 [corrected] it was higher in men than in women (3.4/1000 [corrected] versus 1.4/1000) [corrected] and increased with age. Forty-three percent of invasive detected cancers were stage I, 24% stage II, 23% had lymph node involvement and 10% presented with distant metastasis. CONCLUSION: These results suggest that indicators are consistent with international references. During 2007-2008, the programme coverage will be progressively extended, and all 99 French districts should be actively involved in its implementation.

Are breast cancer screening practices associated with sociodemographic status and healthcare access? Analysis of a French cross-sectional study.

The aim of this study was to analyse the role of women's sociodemographic and healthcare access characteristics according to breast cancer screening practices (organized, individual or no screening). A cross-sectional study was set up in seven French districts using a self-administered postal questionnaire. Randomization was stratified proportionally on age and urban/rural status in each district separately among attendees and nonattendees to the organized breast cancer screening programme (OS). A total of 5638 women aged 50-74 years returned their questionnaires: 1480 in the attendee OS group and 4158 in the nonattendee group. Among them, 3537 declared having undergone a recent mammography outside the organized programme (individual, IS group) and 621 declared never having undergone a mammography or having done so more than 2 years ago (NS group). Analyses showed a gradient between the three groups (IS, OS and NS, respectively) in their association with breast cancer screening practices considering three factors: an increasing gradient was observed for renunciation of basic healthcare for financial reasons, a decreasing gradient in the regular visit to a medical gynaecologist and having had a Pap smear in the last 3 years. Three other variables that showed a decreasing gradient are: living with a partner, current use of hormone replacement therapy and having had a check-up in the last 5 years. In conclusion, the main differences between breast cancer screening practices were largely associated with difficulties in healthcare access, considering regular gynaecological visits in particular.

Lung cancer mortality in France. Trend analysis and projection between 1975 and 2012, using a Bayesian age-period-cohort model.

INTRODUCTION: Lung cancer is currently the most common cancer in the world and as such is an important public health concern. One of the main challenges is to foresee the evolution of trends in lung cancer mortality rates in order to anticipate the future burden of this disease as well as to plan the supply of adequate health care. The aim of this study is to propose a quantification of future lung cancer mortality rates by gender in France until the year 2012. METHODS: Lung cancer mortality data in France (1978-2002) were extracted from the National Statistics of Death and analyzed by 5-year age-groups and periods, using a Bayesian age-period-cohort model. DISCUSSION: Between 1978 and 2002, female lung cancer mortality rate rises by 3.3%year(-1). For men, a slow increase is observed until 1988-1992 followed by a declining trend. In 1998-2002, age-standardized mortality rates were, respectively, 45.5 and 7.6 per 100000 for males and for females. By 2008-2012 these figures would reach 40.8 (95% credibility interval (CI): 32.7, 50.0) and 12.1 (CI: 11.7, 12.6) per 100000, respectively, which represents among women a 4.7% annual increase (CI: 4.5, 5.0). RESULTS: Our results highlight the relevance of pursuing public health measures in order to cope more actively with tobacco smoking in the prevention strategy against lung cancer specifically among women.

[Non-insulin treated diabetes: relationship between disease management and quality of care. The Entred study, 2001]. / Diabète non insulino-traité: lien entre l'existence d'une prise en charge pour affection de longue durée et la qualité du suivi médical. Données entred 2001.

INTRODUCTION: We studied the relationship between 100% medical fee coverage for chronic disease and quality of care in people with type 2 diabetes treated with oral hypoglycaemic agents (OHA) only, in France. METHODS: For the Entred study, 10,000 adults who received reimbursements for a delivery of OHA or insulin were randomly sampled from the database of the major national medical insurance system in 2001. For these 10,000 people, we extracted all medical consumption from the 2001 database and mailed a medical questionnaire; another questionnaire was mailed to their medical provider. We restricted the analysis to people with type 2 diabetes, treated with OHA only, with no annual visit to an endocrinologist (n = 1167), and to a sub-group with no complication reported by their medical provider (n = 525). RESULTS: 71% of people benefited from a waiver of co-payment due to a chronic disease (100% medical fee coverage for a list of 30 diseases including diabetes). People with 100% coverage were more likely to be women, older, with a longer duration of the disease, more often on several OHA and a drug for cardiovascular disease, and had a higher level of HbA1c. In multivariate analyses, 100% fee coverage was linked with a higher frequency of three HbA1c measurements (OR = 2,5 [1,6-4,0]), one electrocardiogram (1,9 [1,2-3,1]) and one podiatric visit (2,2 [1,1-4,3]) in 2001 in people without complications. No association was found with one measurement of albuminuria, creatininemia, lipids, and ophtalmological, dental or dietitian visit. CONCLUSIONS: In 2001, a significant relationship was found between 100% medical fee coverage on a better quality of care for people with diabetes on OHA at an early stage of the disease. Several explanations are further discussed.

Special management of insulin lispro in continuous subcutaneous insulin infusion in young diabetic children: a randomized cross-over study.

OBJECTIVE: To compare the safety, efficacy and management of insulin lispro (LP) with regular human insulin (RH) in young diabetic children treated with continuous subcutaneous insulin infusion (CSII). STUDY DESIGN: 27 very young diabetic children (age 4.6 +/- 2.2 years) treated with CSII participated in an open-label, randomized cross-over multicenter study comparing 2 periods of 16 weeks of CSII with LP or RH. RESULTS: Mean daily basal rate was significantly higher during the LP period (p = 0.04). No differences were seen in changes in HbA1c levels, number of hypoglycemic events, cutaneous infections and catheter occlusions. There was no significant difference between the two treatments for preprandial and postprandial glucose values, although prandial glucose excursions tended to be lower with LP (significant at dinner, p = 0.01). Mean blood glucose levels were significantly higher at 0.00 and 3.00 a.m. during LP therapy (p < 0.05). No episode of ketoacidosis occurred during LP treatment. More parents indicated that LP made their own and the child's daily life easier (p = 0.02) and preferred LP (p = 0.01). CONCLUSIONS: LP in CSII therapy in children is safe, as effective as RH, improved postprandial excursions, met the needs of young children in their daily life well, and gained their parents' satisfaction and preference. However, a shorter duration of LP resulted in hyperglycemia during the first part of the night, which must be compensated for by increasing nocturnal basal rates during this time.

Femoral head vascularisation in Legg-Calvé-Perthes disease: comparison of dynamic gadolinium-enhanced subtraction MRI with bone scintigraphy.

BACKGROUND: It has been reported that MRI using a dynamic gadolinium-enhanced subtraction technique can allow the early identification of ischaemia and the pattern of revascularisation in Legg-Calvé-Perthes (LCP) disease with increased spatial and contrast resolution. Therefore, dynamic gadolinium-enhanced subtraction (DGS) MRI may be a possible non-ionising substitute for bone scintigraphy. OBJECTIVE: The purpose of this prospective study was to compare DGS MRI and bone scintigraphy in the assessment of femoral head perfusion in LCP disease. MATERIALS AND METHODS: Twenty-six DGS MR images and bone scintigraphies of 25 hips in 23 children were obtained at different stages of LCP disease; three stage I, 12 stage II, six stage III and five stage IV (Waldenström classification). The extent of necrosis, epiphyseal revascularisation pathways (lateral pillar, medial pillar, and/or transphyseal perfusion) and metaphyseal changes were analysed. RESULTS: Total agreement between both techniques was noted in the depiction of epiphyseal necrosis (kappa=1), and metaphyseal abnormalities (kappa=0.9). DGS MRI demonstrated better revascularisation in the lateral (kappa=0.62) and medial pillars (kappa=0.52). The presence of basal transphyseal reperfusion was more conspicuous with MRI. CONCLUSIONS: DGS MRI allows early detection of epiphyseal ischaemia and accurate analysis of the different revascularisation patterns. These changes are directly related to the prognosis of LCP disease and can aid therapeutic decision making.