Long-term dentoskeletal side effects of mandibular advancement therapy in patients with obstructive sleep apnea: data from the Pays de la Loire sleep cohort.

OBJECTIVES: Mandibular advancement devices (MADs) are the main therapeutic alternative to continuous positive airway pressure for obstructive sleep apnea. Our aim was to evaluate the long-term dentoskeletal side effects of MADs and to identify the predictive factors for these side effects. MATERIALS AND METHODS: Patients from the Pays de la Loire cohort treated with a custom-made MAD for at least 1 year were included in this retrospective study. Digital cephalometric analyses were performed at baseline and at follow-up. RESULTS: We included a total of 117 patients, treated with a MAD for a median [interquartile range] of 4.6 [2.6-6.6] years. The main significant side effects were a decrease in overbite (- 0.5 ± 1 mm), overjet (- 0.7 ± 1 mm) and maxillary incisor inclination (- 2.5 ± 2.8°) and an increase in mandibular incisor inclination (+ 2.2 ± 2.7°). Subjective side effects were not linked to the observed dentoskeletal changes. Current smokers were at higher risk of overjet modifications. A pre-existing anterior open-bite was associated with a greater decrease in overbite. Treatment duration was associated with a more pronounced mandibular incisor proclination. Propulsion was negatively associated with maxillary incisor retroclination. CONCLUSIONS: Long-term dentoskeletal side effects were mainly moderate dental side effects. Some predictive factors were shown to be associated with more pronounced changes. Subjective side effects did not appear to be reliable tools to detect dentoskeletal side effects. CLINICAL RELEVANCE: Regular follow-up with clinical examination and regular radiographs is mandatory. The predictive factors could be of interest for a better selection of patients and to individualize follow-up.

Welding and the risk of head and neck cancer: the ICARE study.

OBJECTIVE: To investigate the association between occupational exposure to welding and the risk of head and neck cancer in a large French population-based case-control study, the Investigation of occupational and environmental CAuses of REspiratory cancers study. METHODS: Analyses were restricted to men (2703 controls and 1588 cases of squamous-cell carcinoma of the oral cavity, oropharynx, hypopharynx and larynx). Welding activity and potential confounders were assessed by detailed questionnaires. ORs and CIs (95% CI) were estimated by unconditional logistic regression, adjusted for age, area of residence, tobacco smoking, alcohol consumption and occupational exposure to asbestos. RESULTS: Welding was associated with an increased risk of head and neck cancer overall (OR=1.31, 95% CI 1.03 to 1.67). The association was strongest for laryngeal cancer (OR=1.66, 95% CI 1.15 to 2.38) and the risk increased with the cumulative duration (p-trend <0.01) and the weighted duration (p-trend <0.01) of welding. A cumulative duration and a weighted duration of welding of more than 10 years were also associated with a significantly increased risk of oral cancer (OR=1.82, 95% CI 1.09 to 3.04; OR=2.10, 95% CI 0.99 to 4.45, respectively). A long duration of arc welding was associated with laryngeal cancer, whereas a long duration of spot welding was associated with oral cancer. Welding was not associated with the risk of oropharyngeal and hypopharyngeal cancer. CONCLUSION: Our findings suggest that welding and several welding-related tasks increase the risk of laryngeal cancer and to a lesser extent oral cancer.

A cohort study of banana plantation workers in the French West Indies: first mortality analysis (2000-2015).

Chlordecone, an organochlorine insecticide, was widely used in the French West Indies banana plantations. We set up a cohort of banana plantation workers who worked between 1973 and 1993, the period of authorized use of chlordecone. Vital status and causes of death were collected from French national registries. Workers were followed up from 1 January 2000 to 31 December 2015. Cause-specific mortality in the cohort was compared to that of the general population of the French West Indies by computing standardized mortality ratios (SMRs). A total of 11,112 workers (149,526 person-years, 77% men) were included in the mortality analysis, and 3647 deaths occurred over the study period. There was a slight deficit in all-cause mortality, which was statistically significant in men (SMR = 0.93, 95% CI 0.89-0.96), but not in women (SMR = 0.96, 95% CI 0.89-1.04). All-cancer mortality did not differ significantly from that of the general population (men: SMR = 0.96, 95% CI 0.90-1.03; women: SMR = 1.04, 95% CI 0.89-1.21). Significant excesses of deaths were observed for stomach cancer in women (SMR = 1.94, 95% CI 1.24-2.89) and pancreatic cancer in women farm owners (SMR = 2.31, 95% CI 1.06-4.39). Mortality from prostate cancer was similar to that of the general population in the whole cohort (SMR = 1.00; 95% CI 0.89-1.13) and non-significantly elevated among farm workers (SMR = 1.10, 95% CI 0.87-1.36). Non-significant increases in mortality were also observed for lung cancer in women, leukemia in men, and non-Hodgkin lymphoma in both genders.

Social distribution of tobacco smoking, alcohol drinking and obesity in the French West Indies.

BACKGROUND: Tobacco smoking, alcohol and obesity are important risk factors for a number of non-communicable diseases. The prevalence of these risk factors differ by socioeconomic group in most populations, but this socially stratified distribution may depend on the social and cultural context. Little information on this topic is currently available in the Caribbean. The aim of this study was to describe the distribution of tobacco smoking, alcohol drinking and obesity by several socioeconomic determinants in the French West Indies (FWI). METHODS: We used data from a cross-sectional health survey conducted in Guadeloupe and Martinique in 2014 in a representative sample of the population aged 15-75 years (n = 4054). All analyses were stratified by gender, and encompassed sample weights, calculated to account for the sampling design and correct for non-response. For each risk factor, we calculated weighted prevalence by income, educational level, occupational class and having hot water at home. Poisson regression models were used to estimate age-adjusted prevalence ratios (PR) and 95% confidence intervals (CI). RESULTS: Current smoking and harmful chronic alcohol use were more common in men than in women (PR = 1.80, 95% CI = 1.55-2.09; PR = 4.53, 95% CI = 3.38-6.09 respectively). On the other hand, the prevalence of obesity was higher in women than in men (PR = 0.67, 95% CI = 0.57-0.79). Higher education, higher occupational class and higher income were associated with lower prevalence of harmful alcohol drinking in men (PR = 0.43, 95% CI = 0.25-0.72; PR = 0.73, 95% CI = 0.53-1.01; PR = 0.72, 95% CI = 0.51-1.03 respectively), but not in women. For tobacco smoking, no variation by socioeconomic status was observed in men whereas the prevalence of current smoking was higher among women with higher occupational class (PR = 1.47, 95% CI = 1.13-1.91) and higher income (PR = 1.50, 95% CI = 1.11-2.03). In women, a lower prevalence of obesity was associated with a higher income (PR = 0.43, 95% CI = 0.33-0.56), a higher occupational class (PR = 0.63, 95% CI = 0.50-0.80), a higher educational level (PR = 0.36, 95% CI = 0.26-0.50) and having hot water at home (PR = 0.65, 95% CI = 0.54-0.80). CONCLUSION: Women of high socio-economic status were significantly more likely to be smokers, whereas alcohol drinking in men and obesity in women were inversely associated with socioeconomic status.

Socioeconomic and healthcare use-related determinants of cervical, breast and colorectal cancer screening practice in the French West Indies.

The aim of this study was to investigate the role of socioeconomic and healthcare use characteristics in the participation in breast, cervical and colorectal cancer screening in the French West Indies. We used data from a national health survey conducted in 2014 in Martinique (n=2026) and Guadeloupe (n=2028). Logistic regressions adjusted for various sociodemographic and morbidity variables were performed. The following determinants were investigated: having hot water at home, having received income support for low-income individuals during the last year, educational level, occupational class, complementary health insurance, healthcare renouncement and visit to the general practitioner (GP) during the last year. Multiple imputations were performed to account for missing values. We observed the following cancer screening rates: 78.1% for cervical cancer, 81.5% for breast cancer and 59.5% (women) and 50.8% (men) for colorectal cancer. Higher cervical cancer screening participation was reported among women with qualified occupation and having visited the GP during the last year and lower participation among women who never worked. Higher screening participation was reported among participants having hot water at home and having visited the GP during the last year for breast and colorectal (men and women) cancer. Unexpectedly, a lower colorectal cancer screening participation was found among women with qualified occupation. We observed social inequalities in participation in cancer screening in the French West Indies, which stresses the need to continue efforts to increase screening rates in this population.

Occupational prestige trajectory and the risk of lung and head and neck cancer among men and women in France.

OBJECTIVES: This study aimed at investigating the associations between occupational prestige trajectories and lung and head and neck (HN) cancer risk and to assess to what extent smoking, alcohol drinking, and occupational exposures contribute to these associations. METHODS: Using data from the ICARE case-control study (controls (2676 men/715 women), lung cancers (2019 men/558 women), HN cancers (1793 men/305 women), we defined occupational prestige trajectories using group-based modeling of longitudinal data. We conducted logistic regression models. RESULTS: Among men, a gradient was observed from the downward "low to very low" trajectory to the stable very high trajectory. The associations were reduced when adjusting for tobacco and alcohol consumption and occupational exposures. Among women, when compared to the stable high trajectory, there was an increased cancer risk in all trajectories. The associations remained globally unchanged or even increased after adjustment for tobacco and alcohol consumption and did not change when adjusting for occupational exposures. The ORs were smaller for lung than for HN cancers in men. CONCLUSIONS: Occupational prestige trajectory is strongly associated with lung and HN cancer risk in men and women.

Disparities in cancer incidence by area-level socioeconomic status in the French West Indies.

PURPOSE: Social inequalities in cancer incidence and mortality have been reported in France, but no data are available for the French overseas territories. Our objective was to explore the association between cancer incidence and the socioeconomic level of the residence area in the French West Indies. METHODS: Cancer incidence data were obtained from the cancer registries of Guadeloupe and Martinique (2009-2010). To assess socioeconomic status, we developed a specific index of social deprivation from census data at a small area level. We used Bayesian methods to evaluate the association between cancer incidence and the deprivation index, for all cancers combined and for the major cancer sites. RESULTS: There was no clear association between area-based deprivation and the incidence of all cancers combined. In men, higher area deprivation was associated with a higher incidence of prostate cancer (relative risk (RR) 1.25, 95% credible interval (CI) 1.04-1.49; RR 1.08, CI 0.91-1.29 in the categories of intermediate and high deprivation, respectively, compared to low deprivation), but was not associated with respiratory cancer. Women living in the most deprived areas had a higher incidence of stomach (RR 1.77, CI 1.12-2.89), breast (RR 1.15, CI 0.90-1.45), and cervical (RR 1.13, CI 0.63-2.01) cancers and a lower incidence of respiratory cancer (RR 0.65, CI 0.38-1.11). CONCLUSION: These first results in the French West Indies suggest specific patterns for some cancer sites that need to be further investigated.

Assessment of sedentary behaviors and transport-related activities by questionnaire: a validation study.

BACKGROUND: Comprehensive assessment of sedentary behavior (SB) and physical activity (PA), including transport-related activities (TRA), is required to design innovative PA promotion strategies. There are few validated instruments that simultaneously assess the different components of human movement according to their context of practice (e.g. work, transport, leisure). We examined test-retest reliability and validity of the Sedentary, Transportation and Activity Questionnaire (STAQ), a newly developed questionnaire dedicated to assessing context-specific SB, TRA and PA. METHODS: Ninety six subjects (51 women) kept a contextualized activity-logbook and wore a hip accelerometer (Actigraph GT3X + (TM)) for a 7-day or 14-day period, at the end of which they completed the STAQ. Activity-energy expenditure was measured in a subgroup of 45 subjects using the double labeled water (DLW) method. Test-retest reliability was assessed using intra-class-coefficients (ICC) in a subgroup of 32 subjects who filled the questionnaire twice one month apart. Accelerometry was annotated using the logbook to obtain total and context-specific objective estimates of SB. Spearman correlations, Bland-Altman plots and ICC were used to analyze validity with logbook, accelerometry and DLW data validity criteria. RESULTS: Test-retest reliability was fair for total sitting time (ICC = 0.52), good to excellent for work sitting time (ICC = 0.71), transport-related walking (ICC = 0.61) and car use (ICC = 0.67), and leisure screen-related SB (ICC = 0.64-0.79), but poor for total sitting time during leisure and transport-related contexts. For validity, compared to accelerometry, significant correlations were found for STAQ estimates of total (r = 0.54) and context-specific sitting times with stronger correlations for work sitting time (r = 0.88), and screen times (TV/DVD viewing: r = 0.46; other screens: r = 0.42) than for transport (r = 0.35) or leisure-related sitting-times (r = 0.19). Compared to contextualized logbook, STAQ estimates of TRA was higher for car (r = 0.65) than for active transport (r = 0.41). The questionnaire generally overestimated work- and leisure-related SB and sitting times, while it underestimated total and transport-related sitting times. CONCLUSIONS: The STAQ showed acceptable reliability and a good ranking validity for assessment of context-specific SB and TRA. This instrument appears as a useful tool to study SB, TRA and PA in context in adults.

Spatial heterogeneity of the relationships between environmental characteristics and active commuting: towards a locally varying social ecological model.

BACKGROUND: According to the social ecological model of health-related behaviors, it is now well accepted that environmental factors influence habitual physical activity. Most previous studies on physical activity determinants have assumed spatial homogeneity across the study area, i.e. that the association between the environment and physical activity is the same whatever the location. The main novelty of our study was to explore geographical variation in the relationships between active commuting (walking and cycling to/from work) and residential environmental characteristics. METHODS: 4,164 adults from the ongoing Nutrinet-Santé web-cohort, residing in and around Paris, France, were studied using a geographically weighted Poisson regression (GWPR) model. Objective environmental variables, including both the built and the socio-economic characteristics around the place of residence of individuals, were assessed by GIS-based measures. Perceived environmental factors (index including safety, aesthetics, and pollution) were reported by questionnaires. RESULTS: Our results show that the influence of the overall neighborhood environment appeared to be more pronounced in the suburban southern part of the study area (Val-de-Marne) compared to Paris inner city, whereas more complex patterns were found elsewhere. Active commuting was positively associated with the built environment only in the southern and northeastern parts of the study area, whereas positive associations with the socio-economic environment were found only in some specific locations in the southern and northern parts of the study area. Similar local variations were observed for the perceived environmental variables. CONCLUSIONS: These results suggest that: (i) when applied to active commuting, the social ecological conceptual framework should be locally nuanced, and (ii) local rather than global targeting of public health policies might be more efficient in promoting active commuting.

Automatic identification of physical activity types and sedentary behaviors from triaxial accelerometer: laboratory-based calibrations are not enough.

"Objective" methods to monitor physical activity and sedentary patterns in free-living conditions are necessary to further our understanding of their impacts on health. In recent years, many software solutions capable of automatically identifying activity types from portable accelerometry data have been developed, with promising results in controlled conditions, but virtually no reports on field tests. An automatic classification algorithm initially developed using laboratory-acquired data (59 subjects engaging in a set of 24 standardized activities) to discriminate between 8 activity classes (lying, slouching, sitting, standing, walking, running, and cycling) was applied to data collected in the field. Twenty volunteers equipped with a hip-worn triaxial accelerometer performed at their own pace an activity set that included, among others, activities such as walking the streets, running, cycling, and taking the bus. Performances of the laboratory-calibrated classification algorithm were compared with those of an alternative version of the same model including field-collected data in the learning set. Despite good results in laboratory conditions, the performances of the laboratory-calibrated algorithm (assessed by confusion matrices) decreased for several activities when applied to free-living data. Recalibrating the algorithm with data closer to real-life conditions and from an independent group of subjects proved useful, especially for the detection of sedentary behaviors while in transports, thereby improving the detection of overall sitting (sensitivity: laboratory model = 24.9%; recalibrated model = 95.7%). Automatic identification methods should be developed using data acquired in free-living conditions rather than data from standardized laboratory activity sets only, and their limits carefully tested before they are used in field studies.

Estimation of physical activity monitored during the day-to-day life by an autonomous wearable device (SVELTE project).

Physical activity (PA) and the energy expenditure it generates (PAEE) are increasingly shown to have impacts on everybody's health (e.g. development of chronic diseases) and to be key factors in maintaining the physical autonomy of elderlies. The SVELTE project objective was to develop an autonomous actimeter, easily wearable and with several days of autonomy, which could record a subject's physical activity during his/her daily life and estimate the associated energy expenditure. A few prototypes and dedicated algorithms were developed based on laboratory experiments. The identification of physical activity patterns algorithm shows good performances (79% of correct identification), based on a trial in semi-free-living conditions. The assessment of the PAEE computation algorithm is under validation based on a clinical trial.