Time and spatial trends of operated cryptorchidism in France and environmental hypotheses: a nationwide study from 2002 to 2014.

STUDY QUESTION: Is there an evolution in the risk of operated cryptorchidism in France and does local geographical environment appear as an important trigger for this defect? SUMMARY ANSWER: We observed an increase of the risk of operated cryptorchidism in boys under the age of 7 years during the period 2002-2014 and a strong spatial heterogeneity, with the detection of spatial clusters suggesting environmental factors. WHAT IS KNOWN ALREADY: Epidemiologic data on cryptorchidism are scarce and its etiology is poorly understood. As part of the testicular dysgenesis syndrome, cryptorchidism is suspected to be a male genital developmental disorder caused by endocrine disruptor chemical (EDC) exposure during the prenatal period. STUDY DESIGN, SIZE, DURATION: This was a retrospective and descriptive study using data from the French national hospital discharge database, in the 2002-2014 study period. We built an indicator to reflect incident cases of operated cryptorchidism in boys under the age of 7 years in metropolitan France, with an algorithm using specific codes for diseases (ICD-10 codes) and surgical acts (CCAM codes). PARTICIPANTS/MATERIALS, SETTING, METHODS: The study population was composed of 89 382 new cases of operated cases of cryptorchidism in boys under the age of 7 years. We estimated the temporal evolution of the incidence rate. We fitted a spatial disease-mapping model to describe the risk of cryptorchidism at the postcode scale. We used Kulldorff's spatial scan statistic and Tango's flexibly shaped spatial scan statistic to identify spatial clusters. MAIN RESULTS AND THE ROLE OF CHANCE: The estimated increase in the incidence of operated cryptorchidism from 2002 to 2014 was equal to 36.4% (30.8%; 42.1%). Cryptorchidism displayed spatial heterogeneity and 24 clusters (P < 0.0001) were detected. The main cluster was localized in a former coal mining and metallurgic area in northern France, currently an industrial area. The cluster analysis suggests the role of shared socio-economic and environmental factors that may be geographically determined and intertwined. The industrial activities identified in the clusters are potentially the source of persistent environmental pollution by metals, dioxins and polychlorinated biphenyls. LIMITATIONS, REASONS FOR CAUTION: The indicator we used reflects operated cases of cryptorchidism, with an under-evaluation of the health problem. We cannot exclude a possible role of the evolution and local differences in surgical practices in the observed trends. Our inclusion of boys under 7 years of age minimized the biases related to differences in practices according to age. Regarding the environmental hypothesis, this is an exploratory study and should be considered as a hypothesis-generating process for future research studies. WIDER IMPLICATIONS OF THE FINDINGS: To our knowledge, this is the first descriptive study to address nationwide trends of operated cryptorchidism with detection of spatial clusters, with a very large sample allowing great statistical power. Our results generate plausible environmental hypotheses, which need to be further tested. STUDY FUNDING/COMPETING INTEREST(S): This study was entirely funded by Santé publique France, the French National Public Health Agency. All authors declare they have no actual or potential competing financial interest. TRIAL REGISTRATION NUMBER: N/A.

[Algorithms based on medico-administrative data in the field of endocrine, nutritional and metabolic diseases, especially diabetes]. / Algorithmes basés sur les données médico-administratives dans le champ des maladies endocriniennes, nutritionnelles et métaboliques, et en particulier du diabète.

BACKGROUND: Medico-administrative databases represent a very interesting source of information in the field of endocrine, nutritional and metabolic diseases. The objective of this article is to describe the early works of the Redsiam working group in this field. METHODS: Algorithms developed in France in the field of diabetes, the treatment of dyslipidemia, precocious puberty, and bariatric surgery based on the National Inter-schema Information System on Health Insurance (SNIIRAM) data were identified and described. RESULTS: Three algorithms for identifying people with diabetes are available in France. These algorithms are based either on full insurance coverage for diabetes or on claims of diabetes treatments, or on the combination of these two methods associated with hospitalizations related to diabetes. Each of these algorithms has a different purpose, and the choice should depend on the goal of the study. Algorithms for identifying people treated for dyslipidemia or precocious puberty or who underwent bariatric surgery are also available. CONCLUSION: Early work from the Redsiam working group in the field of endocrine, nutritional and metabolic diseases produced an inventory of existing algorithms in France, linked with their goals, together with a presentation of their limitations and advantages, providing useful information for the scientific community. This work will continue with discussions about algorithms on the incidence of diabetes in children, thyroidectomy for thyroid nodules, hypothyroidism, hypoparathyroidism, and amyloidosis.

[Epidemiology of accidental falls from heights among children, Paris Region, May to September 2005]. / Epidémiologie des chutes accidentelles de grande hauteur chez les enfants en île-de-France entre mai et septembre 2005.

SUMMARY: A survey conducted between May and September 2005 in the Paris Region collected 67 cases of accidental "falls from heights" among the children under the age of 15. Most of the injured children were under the age of 6 (72%), the majority were boys (72%). More than half of the children's families were from extra-European origin, mostly from Sub-Saharan Africa. In 32% of the cases, the fall occurred as the opening had a protection. A piece of furniture was in place beneath the window or was disposed by the child in 55% of the cases; 33% of the children climbed the parapet or the opening. In third of the falls, there was an adult present with the child in the room. Seven children died (10%) and eight (12%) had sequelae. The risk of fall due to the lack of surveillance is not enough known by adults. It is therefore recommended to organise prevention campaigns. To prevent falls, one should revise the regulations for building the parapet and the mechanisms for opening the windows.