[Using cancer case identification algorithms in medico-administrative databases: Literature review and first results from the REDSIAM Tumors group based on breast, colon, and lung cancer]. / Recherche d'algorithmes d'identification des cancers dans les bases médico-administratives : premiers résultats des travaux du groupe REDSIAM Tumeurs sur les cancers du sein, du côlon-rectum et du poumon.

BACKGROUND: The development and use of healthcare databases accentuates the need for dedicated tools, including validated selection algorithms of cancer diseased patients. As part of the development of the French National Health Insurance System data network REDSIAM, the tumor taskforce established an inventory of national and internal published algorithms in the field of cancer. This work aims to facilitate the choice of a best-suited algorithm. METHOD: A non-systematic literature search was conducted for various cancers. Results are presented for lung, breast, colon, and rectum. Medline, Scopus, the French Database in Public Health, Google Scholar, and the summaries of the main French journals in oncology and public health were searched for publications until August 2016. An extraction grid adapted to oncology was constructed and used for the extraction process. RESULTS: A total of 18 publications were selected for lung cancer, 18 for breast cancer, and 12 for colorectal cancer. Validation studies of algorithms are scarce. When information is available, the performance and choice of an algorithm are dependent on the context, purpose, and location of the planned study. Accounting for cancer disease specificity, the proposed extraction chart is more detailed than the generic chart developed for other REDSIAM taskforces, but remains easily usable in practice. CONCLUSIONS: This study illustrates the complexity of cancer detection through sole reliance on healthcare databases and the lack of validated algorithms specifically designed for this purpose. Studies that standardize and facilitate validation of these algorithms should be developed and promoted.

[Epidemiologic picture of one-year-pediatric anesthesia in France]. / Photographie épidémiologique d'une année d'anesthésie pédiatrique en France.

INTRODUCTION: Nowadays, the epidemiological data on French pediatric anesthesia is limited. The purpose of this study was to perform an "epidemiological picture" of this activity. MATERIAL AND METHOD: From the national Program Information System Medicalization, we have identified the institutions of France performing more than 50 anesthesia by year in children under 15 years in 2008 and noted the demographic data, types of institutions, hospital stay and surgeries. RESULTS: Seven hundred and eighty-nine thousands and two hundred anesthetic procedures have performed during 648,018 hospital stays in 929 institutions. A percentage of 68.4% of children were between 3 and 15 years old, 26.7% between 1 and 3 years, 4.1% between 1 year and 1 month and 0.8% less than one month, including 62% of boys and 38% of girls. A percentage of 53.6% of hospital stays were realized in private institutions, 20.9% in University Hospitals (UH), and 20.4% in General hospitals (GH), mainly in day-case surgery (60%), 15.2% in stay of 24h and 24.8% in full hospital stay (FHS). The main surgeries were ENT (29%), digestive (21%), orthopedic (14%), urology (12%) and plastics (9%). Children less than 1 year old were managed by University Hospital and during FHS. Older children were managed in private institution and during day-case surgery. CONCLUSION: Over 50% of stays with anesthesia were performed in private institution and during day-case surgery. Controversially, the management of children younger than 1 year was mainly in University Hospital.

Measuring agreement for ordered ratings in 3 x 3 tables.

OBJECTIVES: When two raters consider a qualitative variable ordered according to three categories, the qualitative agreement is commonly assessed with a symmetrically weighted kappa statistic. However, these statistics can present paradoxes, since they may be insensitive to variations of either complete agreements or disagreements. METHODS: Agreement may be summarized by the relative amounts of complete agreements, partial and maximal disagreements beyond chance. Fixing the marginal totals and the trace, we computed symmetrically weighted kappa statistics and we developed a new statistic for qualitative agreements. Data sets from the literature were used to illustrate the methods. RESULTS: We show that agreement may be better assessed with the unweighted kappa index, kappa(c), and a new statistic zeta, which assesses the excess of maximal disagreements with respect to the partial ones, and does not depend on a particular weighting system. When zeta is equal to zero, maximal and partial disagreements beyond chance are equal. With its estimated large sample variance, we compared the values of two contingency tables. CONCLUSIONS: The (kappa(c), zeta) pair is sensitive to variations in agreements and/or disagreements and enables locating the difference between two qualitative agreements. The qualitative agreement is better with increasing values of kappa(c) and zeta.

Enhanced cytokine mRNA levels in attack-free patients with familial Mediterranean fever.

Familial Mediterranean fever (FMF) is a recessively inherited inflammatory disorder, characterized by recurrent attacks of fever and serositis. Screening of mutations in the causing gene (MEFV) now allows accurate diagnosis of FMF among other inflammatory conditions. It is well documented that secreted levels of some pro-inflammatory cytokines are elevated in FMF. Here, we investigated cytokine expression at the transcriptional level, in patients that could be genetically ascertained. We have measured the transcript abundance of tumor necrosis factor alpha, interleukin-1beta, interleukin-6 and interleukin-8, in circulating leukocytes and shown that these were more elevated in attack-free FMF patients than in controls (P=0.01, P=0.008, P=0.02, P=0.001 respectively). There was no significant difference according to MEFV genotype or colchicine treatment. Our results suggest that cytokine transcriptional pathways are misregulated in attack-free FMF patients, and further supports the hypothesis that these patients have subclinical inflammation between attacks.

[Family socioeconomic deprivation and vulnerability in the pediatric emergency room: evaluation and management]. / Précarité et vulnérabilité familiale aux urgences pédiatriques: évaluation et prise en charge.

OBJECTIVE: The aim of this study was to evaluate the importance of socioeconomic deprivation and other forms of vulnerability in families attending the pediatric emergency unit (PEU). It was based on a five-level classification of family types and an analysis of responses provided by the French healthcare system. METHOD: The prospective study involved 150 families admitted to the PEU on the basis of open-response interviews that analyzed demographic and socio-economic characteristics, motivations for consultation, the child's quality of life, family problems experienced by the parents, and their support network. RESULTS: Five categories of families were defined as follows: complete destitution necessitating immediate social measures (0.7%); acknowledged and well-managed economic deprivation (13.3%), unacknowledged and/or complex economic deprivation with a significant deterioration in the quality of life (22.2%), familial psychological vulnerability without economic deprivation (30.4%), and families without any apparent problems (33.7%). Consultation at the PEU appears to be a multifactorial phenomenon motivated by socioeconomic, psychological and cultural factors. This phenomenon is connected with the present-day imbalance in the healthcare system, which does not adequately respond to the needs of vulnerable families. CONCLUSION: This survey contributes to the current reflection on the integration of psychosocial factors in child healthcare at both the hospital and local community level. The method described herein has determined the factors of vulnerability and the risks of economic deprivation. It can contribute to the development of improved communication and cooperation between practitioners, the hospital and local social workers.

Complex allele [-102T>A+S549R(T>G)] is associated with milder forms of cystic fibrosis than allele S549R(T>G) alone.

We recently reported a novel complex allele in the cystic fibrosis transmembrane regulator (CFTR) gene, combining a sequence change in the minimal CFTR promoter (-102T>A) and a missense mutation in exon 11 [S549R(T>G)]. Here we compare the main clinical features of six patients with cystic fibrosis (CF) carrying the complex allele [-102T>A+S549R(T>G)] with those of 16 CF patients homozygous for mutation S549R(T>G) alone. Age at diagnosis was higher, and current age was significantly higher (P=0.0032) in the group with the complex allele, compared with the S549R/S549R group. Although the proportion of patients with lung colonization was similar in both groups, the age at onset was significantly higher in the group with the complex allele (P=0.0022). Patients with the complex allele also had significantly lower sweat test chloride values (P=0.0028) and better overall clinical scores (P=0.004). None of the 22 patients reported in this study had meconium ileus. All 16 patients homozygous for S549R(T>G), however, were pancreatic insufficient, as compared with 50% of patients carrying the complex allele (P=0.013). Moreover, the unique patient homozygous for [-102T>A+S549R(T>G)] presented with a mild disease at 34 years of age. These observations strongly suggest that the sequence change (-102T>A) in the CFTR minimal promoter could attenuate the severe clinical phenotype associated with mutation S549R(T>G).

Herault breast screening programme: results after 30 months of a mobile French schedule.

Breast screening in the Herault Department (France) has been carried out since July 1990. As with other French programmes, it is a population-based screen, whose main features are related to its organization in that: (a) it is performed by a specific unit (the 'Institut Montpelliérain d'Imagerie Medico-Biologique'); and (b) the group of women targeted is those aged 40-70 years. The two-view mammography is performed every 2 years in mobile units. This paper presents the results after 30 months: 26,026 participants were screened from a target population of 52,617 women, giving a participation rate of 49%. The recall rate and the biopsy rate observed were 7% and 1.5%, respectively. The predictive positive value was 8.4% for a positive test while it was 35% for the biopsy; the values increased with age. 137 cancers were observed giving a detection rate of 5.3%, of which 82% were in situ. Small (< or = to 10 mm) tumours represented 41.5%, and 71.5% of the cancers were node negative. The surgical treatment was conservative for 66% of them.