The CONSTANCES Cohort Biobank: An Open Tool for Research in Epidemiology and Prevention of Diseases.

"General-purpose cohorts" in epidemiology and public health are designed to cover a broad scope of determinants and outcomes, in order to answer several research questions, including those not defined at study inception. In this context, the general objective of the CONSTANCES project is to set up a large population-based cohort that will contribute to the development of epidemiological research by hosting ancillary projects on a wide range of scientific domains, and to provide public health information. CONSTANCES was designed as a randomly selected sample of French adults aged 18-69 years at study inception; 202,045 subjects were included over an 8-year period. At inclusion, the selected participants are invited to attend one of the 24 participating Health Prevention Centers (HPCs) for a comprehensive health examination. The follow-up includes a yearly self-administered questionnaire, and a periodic visit to an HPC. Procedures have been developed to use the national healthcare databases to allow identification and validation of diseases over the follow-up. The biological collection (serum, lithium heparinized plasma, EDTA plasma, urine and buffy coat) began gradually in June 2018. At the end of the inclusions, specimens from 83,000 donors will have been collected. Specimens are collected according to a standardized protocol, identical in all recruitment centers. All operations relating to bio-banking have been entrusted by Inserm to the Integrated Biobank of Luxembourg (IBBL). A quality management system has been put in place. Particular attention has been paid to the traceability of all operations. The nature of the biological samples stored has been deliberately limited due to the economic and organizational constraints of the inclusion centers. Some research works may require specific collection conditions, and can be developed on request for a limited number of subjects and in specially trained centers. The biological specimens that are collected will allow for a large spectrum of biomarkers studies and genetic and epigenetic markers through candidate or agnostic approaches. By linking the extensive data on personal, lifestyle, environmental, occupational and social factors with the biomarker data, the CONSTANCES cohort offers the opportunity to study the interplays between these factors using an integrative approach and state-of-the-art methods.

Seeking care for lower back pain in the French population aged from 30 to 69: the results of the 2002-2003 Décennale Santé survey.

OBJECTIVES: To describe the frequency with which members of the French general population in the 30-to-69 age class sought care for lower back pain (LBP) from various healthcare professionals and to identify associated parameters. MATERIAL AND METHODS: Data were collected in the 2002-2003 Décennale Santé survey, which is representative of ordinary households in continental France. We assessed the frequency with which the 17,792 surveyed individuals sought care for LBP by considering consultations with healthcare professionals in general and consultations with general practitioners and physiotherapists in particular. RESULTS: Among the survey subjects, 4.5% reported that they had sought treatment for LBP from a healthcare professional at least once during the 2-month survey period. The decision to seek care was correlated with the characteristics of the LBP. The duration of the pain was associated with the frequency of all types of consultation studied here. Sociodemographic, economic and occupational risk factors were also involved. Consultation with a physiotherapist was related to income. CONCLUSION: These results from a representative sample of the French general population show that the factors associated with seeking treatment for LBP differ according to the type of healthcare professional consulted.

Automated discrimination of psychotropic drugs in mice via computer vision-based analysis.

We developed an inexpensive computer vision-based method utilizing an algorithm which differentiates drug-induced behavioral alterations. The mice were observed in an open-field arena and their activity was recorded for 100 min. For each animal the first 50 min of observation were regarded as the drug-free period. Each animal was exposed to only one drug and they were injected (i.p.) with either amphetamine or cocaine as the stimulant drugs or morphine or diazepam as the inhibitory agents. The software divided the arena into virtual grids and calculated the number of visits (sojourn counts) to the grids and instantaneous speeds within these grids by analyzing video data. These spatial distributions of sojourn counts and instantaneous speeds were used to construct feature vectors which were fed to the classifier algorithms for the final step of matching the animals and the drugs. The software decided which of the animals were drug-treated at a rate of 96%. The algorithm achieved 92% accuracy in sorting the data according to the increased or decreased activity and then determined which drug was delivered. The method differentiated the type of psychostimulant or inhibitory drugs with a success ratio of 70% and 80%, respectively. This method provides a new way to automatically evaluate and classify drug-induced behaviors in mice.

Frequency of low back pain among men and women aged 30 to 64 years in France. Results of two national surveys.

INTRODUCTION: In France, most studies of low back pain (LBP) have been carried out among workers or patients. Until very recently, the frequency of LBP in the general population was not known, because National Health Surveys did not include questions on LBP. OBJECTIVE: To estimate the prevalence of LBP in the French population aged 30 to 64 years. MATERIALS AND METHODS: The main data were from the National Health Survey 2002-2003 (n=14,248). LBP was assessed by an accompanying self-administered questionnaire asking details about duration of LBP in the previous 12 months. Weights were used to estimate the prevalence of LBP in the French population, with two definitions of LBP. Additional results dealing with chronic LBP, from another national survey (Handicap, Disability and Dependence), are also briefly presented. RESULTS: More than half of the French population in this age group experienced LBP at least one day in the previous 12 months (LBP1), with 17% experiencing LBP for more than 30 days in the previous 12 months (LBP30); prevalence differed between men and women and that of LBP30 increased with age. DISCUSSION-CONCLUSION: The prevalence of LBP as assessed by the National Health Survey is similar to that found in countries other than France. These estimates can be used as a reference for surveys in specific populations, provided that comparable methodologies are used.

[Effectiveness of interventions for low-back-pain sufferers: the return to work criterion]. / Efficacité des interventions s'adressant à des sujets lombalgiques, du point de vue du retour au travail.

BACKGROUND: Return to work is considered as a major effectiveness criterion for interventions dedicated to subacute or chronic low-back-pain sufferers. Moreover, return to work, beyond the economic and social Issues, is regarded more and more as having a therapeutic dimension. This review aims to describe the various interventions which are effective in returning patients to work. METHODS: The presentation is based on existing reviews supplemented by a selection of recent studies. RESULTS: "Cognitive-behavioral therapy", "reassurance" and "back exercises" are some suggested approaches. Some of these techniques are geared specifically towards work. Others, such as "back schools" or "multidisciplinary interventions" combine different approaches. CONCLUSION: Promoting return to work at an appropriate stage (subacute stage) could help low-back-pain sufferers to avoid prolonged disability.

Personal and occupational predictors of sciatica in the GAZEL cohort.

BACKGROUND: The objectives of this prospective study were to investigate personal and occupational predictors of sciatica and to compare the risk factors for sciatica and those for low back pain without sciatica. METHODS: The study analysed data from 841 men, initially free from low back pain, who were followed for 2 years. Subjects were participants in the French GAZEL cohort of employees of the national electricity and gas company. The predictive factors for sciatica and low back pain without sciatica were compared with a polytomous model. RESULTS: Height and driving were predictors only for sciatica, and bending forward and backward at work was a predictor only for low back pain without sciatica. The odds ratio (OR) for sciatica associated with 'height >180 cm' was 3, with a 95% confidence interval (CI) of 1.4-6.5; for driving >2 h daily it was 2 (CI = 0.94-4.10) and for driving >2 h several days a week 2.7 (CI = 1.20-6.10). CONCLUSION: This study confirmed that height and driving are risk factors for sciatica and that sciatica has specific predictors different from those for other types of low back pain. Future studies should consider sciatica separately from these.

[Constitution of a bank of biological material in the French Gazel cohort: logistical and practical aspects]. / Mise en place d'une banque de matériel biologique associée à la cohorte Gazel: aspects logistique et pratique.

The Gazel cohort was launched in January 1989 among workers of the French national electricity and gas company to form an open and general purpose epidemiological laboratory. More than 20.000 workers (15.000 men, 5.000 women), aged from 35 to 50 volunteered to participate. One of the objectives of this cohort was the constitution of a bank of biological material aiming to collect and preserve various biological samples (serum, plasma, DNA, etc). This paper details the organisation of the bank and presents a feasability study concerning 2.000 volunteers.

A real-time approach to detect seal defects in food packages using ultrasonic imaging.

The microbial integrity of many types of flexible food packages depends on a zero defect level in the fused seam seal. Human inspection for defects in these seals is marginal at best, and secondary incubation protocols are often used to spot packages with compromised integrity before releasing product for sale. A new type of inspection method has been developed and is being evaluated for robustness. The purpose of the study was to evaluate a new raster scanning geometry to simulate continuous motion, online ultrasonic inspection of the seal region in flexible food package seals. A principal engineering tradeoff of scanning inspection systems is between increased line speed that results from decreased spatial sampling (less acquired data to process) and decreased image quality. The previously developed pulse-echo Backscattered Amplitude Integral (BAI) mode imaging technique is used to form ultrasound images using the new scanning geometry. At an ultrasonic frequency of 22.9 MHz, 38- and 50-microm-diameter air-filled channel defects in all-plastic transparent trilaminate are evaluated. The contrast-to-noise ratio (CNR) of the processed BAI-mode image is used to quantify image quality as a function of spatial sampling. Results show seal defects (38- and 50-microm diameter) are still detectable for undersampled conditions, although image quality degrades as spatial sampling decreases. Further, it is concluded that the raster scanning geometry is feasible for online inspection.

Individual and occupational determinants of low back pain according to various definitions of low back pain.

OBJECTIVES: To test associations between non-specific low back pain and several risk factors when definitions of low back pain vary. DESIGN/SETTING/PARTICIPANTS: A cross sectional study was set up in 1991, 725 workers from four occupational sectors answered a self administrated questionnaire including the Nordic questionnaire and questions about intensity of pain and individual and occupational factors. MAIN RESULTS: Prevalence of low back pain varied from 8% to 45% according to the definition used. Psychosomatic problems, bending or carrying loads were often associated to low back pain, whereas other risk factors were related to some specific dimensions of the disorder. CONCLUSIONS: Risk factors of low back pain vary with the definition. This could explain inconsistencies found in literature reviews. To be able to compare data, it seems important to be precise what definition is used and to use comparable questionnaires.

High contrast ultrasound images of defects in food package seals.

Previous work to detect defects in food packaging seals using pulse-echo ultrasound inspired the backscattered amplitude integral (BAI) imaging technique, which could reliably identify channels with diameters 38 microm or larger at a center frequency of 17.3 MHz (lambda=86 microm). The current study presents two new processing techniques that more reliably reveal smaller channels ( approximately 6 microm in diameter). The RF sampling technique (RFS) displays a single, time-gated, pressure value from the received (not envelope-detected) RF waveform at each transducer position. The RF correlation technique (RFC) calculates the correlation coefficients of the RF signals with a reference signal that does not pass through a channel. The correlation coefficient can be calculated for the entire RF signal (RFCE) or over a short segment of the RF signal (RFCS). The performance of these imaging methods for detecting channel defects is investigated for plastic and aluminum foil trilaminate films with 6, 10, 15, 38, and 50 microm channels filled with water or air. Data are collected with a focused ultrasound transducer (17.3 MHz, 6.35 mm in diameter, f/2, 173 microm -6 dB pulse-echo lateral beamwidth at the focus) scanned over a rectangular grid, keeping the package in the focus. Performance is measured using detection rates, image contrast, and contrast-to-noise ratio (CNR). Both RFS and RFCS have improved detection rates relative to BAI for channels 15 microm or smaller. The RFCS technique is the most effective at smoothing the background, leading to the greatest CNR improvements.

Parametric modeling in food package defect imaging.

A novel approach in food package defect detection is proposed based on system identification theory, in which the channel defect detection problem can be regarded as the conventional system identification problem, i.e., estimation of the system impulse response based on the input-output sequence using parametric and nonparametric models. The well-known parametric model ARX has been investigated in this paper. The data are collected with a focused ultrasound transducer (17.3 MHz, 6.35-mm diameter, f/2, 173 microm -6 dB pulse-echo lateral beam width at the focus) scanned over a rectangular grid, keeping the packages in the focus. Performance is measured in terms of detection rate, image contrast, and contrast-to-noise ratio. The results using the ARX model are compared with previous image formation techniques and also compared with the non-parametric method, i.e., spectral analysis. The results show that the ARX model has the comparable detection rate as RFCS and higher detection rate than BAI and RFS (except 6-microm air-filled channel in plastic trilaminate film) for channel in plastic trilaminate film. The ARX model has achieved the moderate contrast enhancement and ranks second in contrast-to-noise ratio enhancement among the compared techniques. The ARX model has a low detection rate for channel defects in aluminum trilaminate film, which shows that its performance is material-dependent. Finally, the parametric method, ARX model demonstrates better performance than the non-parametric method, spectral analysis for food package defect detection.

One-year predictive factors for various aspects of neck disorders.

STUDY DESIGN: A longitudinal epidemiologic study conducted over 12 months among active workers in different occupations. The study was primarily designed to evaluate intervention for prevention of low back and other spinal disorders. OBJECTIVE: To determine factors that predict incidence, recurrence, and persistence of neck disorders (ND), taking into account various dimensions of ND. SUMMARY OF BACKGROUND DATA: Neck pain is often supposed to have essentially the same risk factors as back pain; however, there is comparatively little data relevant to this issue. Moreover, there is a lack of prospective studies that take into account a diversity of predictive factors. METHODS: The Nordic questionnaire for the analysis of musculoskeletal symptoms was completed twice at a 12-month interval by 568 workers. Predictive factors were studied with logistic models for four dimensions of ND from the second questionnaire: 1) any ND in the past 6 months; 2) ND for more than 30 days; 3) treatment for ND; and 4) visit to a health care professional for ND. The predictive factors were obtained from the first questionnaire and included gender, age, occupational group, level of psychological distress and psychosomatic problems, and ND at baseline. RESULTS: Female gender and older age were predictors of ND. Headaches or pain in the head, psychological distress, and psychosomatic problems were predictors for all dimensions of ND. These effects were observed for both incidence and persistence of ND. CONCLUSIONS: The results emphasize the role of psychosomatic and psychological factors in the occurrence and course of ND for various dimensions of the disorder.

[Social problems encountered during prenatal care in a Paris maternity ward]. / Problèmes sociaux rencontrés lors du suivi prénatal dans une maternité parisienne.

In 1993, about 2,600 children are born in Robert Debré Hospital (RDH), a hospital specialized in pediatrics and obstetrics located in Paris. One hundred and seventy nine of the mothers contacted the hospital social service during pregnancy. The main goal of this study was to describe the social problems encountered by these women and the solutions proposed by the social service of RDH. The second aim was to describe the socio-demographic profile and medical problems of this population. At first contact, 45% of the women had no social coverage, and only 18% had a steady job. Most social problems were related to administrative procedures. Financial and housing problems were more difficult to solve in this context. These figures reflect the growing problem of precarity, with its consequences. A hospital social service is not the right place to solve these very complex problems. The most worrisome point is that the living conditions of newborn children are often unknown after delivery.

Channel defect detection in food packages using integrated backscatter ultrasound imaging.

Hermetically-sealed flexible food packages require very effective seal integrity testing to extend the shelf stability of thermally processed food. The initial goal of this study was to estimate the detection limits of laboratory-generated channels which simulate defects in food packages using pulse-echo ultrasonic imaging techniques. Packages with well characterized (via transmission optical microscopy) laboratory-generated channels that simulate defects with diameters between 9 and 325 microm in the seal plane traversing the major axis of the heat seal were generated in heat-sealed microwavable retort-pouch plastic film (trilaminate). Pulse-echo techniques in the 13-17 MHz center frequency range were investigated. The samples were examined with a conventional B-mode imaging technique, which was found to be inadequate for subwavelength imaging of the types of typical channel defects found in shelf-stable food packages. Based on conventional B-mode image features, a new goal of this study was established to develop and evaluate an imaging technique which would exhibit subwavelength imaging capabilities. The new imaging technique called backscattered amplitude integral (BAI) is introduced here. It was observed that BAI-mode imaging has the ability for subwavelength detection of channel defects, e.g., detection of a 10-microm diameter channel defect at a center frequency of 13.1 MHz (lambda=182 microm).