Reproducibility of total and regional body composition using dual-energy X-ray absorptiometry in rheumatoid arthritis and ankylosing spondylitis.

Several studies have reported changes in body composition in rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Our study showed that body composition measurements obtained by absorptiometry were highly reproducible in patients suffering from these diseases. This study justifies the use of absorptiometry measurements in longitudinal studies in this population. PURPOSE: Our study aimed to assess the reproducibility of total and regional body composition in patients with rheumatoid arthritis (RA) and with ankylosing spondylitis (AS) and to compare them to healthy subjects. METHODS: The study enrolled 80 subjects including 32 healthy subjects, 31 RA patients, and 17 AS patients. Each subject had two scans in one day under the same standard conditions and none ate nor drunk before being repositioned on the table. The reproducibility was assessed through the coefficient of variation (CV), the least significant change (LSC), the intraclass correlation (ICC), and the smallest significant difference (SDD). RESULTS: Total body composition measurements obtained by dual-energy X-ray absorptiometry (DXA) were highly reproducible, and there was no statistically significant difference between reproducibility in healthy subjects, patients with RA, and patients with AS. For total body fat mass (FM), lean mass (LM), and bone mineral content (BMC) in the total population, CV values were 1.71%, 1.25%, and 1.74%, respectively; ICC values were 0.998, 0.996, and 0.993, respectively; LSC values were 4.88%, 3.7%, and 5.2%, respectively; and SDD values were ± 1.23 Kg, ± 1.47 Kg, and ± 126.0 g, respectively. For regional body FM, LM, and BMC in the total population, CV values in the arms were 8.46%, 4.17%, and 3.79%, respectively; in the legs 6.24%, 3.59%, and 2.04%, respectively, and in the trunk 5.02%, 2.92%, and 5.24%, respectively. CONCLUSION: Total body tissue mass, FM percentage, FM, LM, and BMC measurements obtained by DXA are highly reproducible in RA and AS.

Lung cancer: Incidence and survival in Rabat, Morocco.

BACKGROUND: Lung cancer is the most common cancer worldwide, but epidemiologic data from developing countries are lacking. This article reports lung cancer incidence and survival in Rabat, the capital of Morocco. METHODS: All lung cancer cases diagnosed between 2005 and 2008 were analyzed using data provided by the Rabat Cancer Registry. The standardized rate was reported using age adjustment with respect to the world standard population, and the observed survival rates were calculated using the Kaplan-Meier method. RESULTS: Three hundred fifty-one cases were registered (314 males and 37 females), aged 27-90 years (median, 59 years). The most common pathological type was adenocarcinoma (40.2%) followed by squamous cell carcinoma (31.9%); the majority of cases were diagnosed at stage IV (52%). The age-standardized incidence rate was 25.1 and 2.7 per 100,000 for males and females, respectively, and the overall observed survival rates at 1 and 5 years were 31.7% and 3.4%, respectively. The clinical stage of disease was the only independent predictor of survival. CONCLUSION: The survival rate of lung cancer in Rabat is very poor. This finding explains the need for measures to reduce the prevalence of tobacco and to improve diagnostic and therapeutic facilities for lung cancer.

Age-adjusted incidence rates of hip fractures between 2006 and 2009 in Rabat, Morocco.

UNLABELLED: This study, characterizing the incidence of hip fracture in the province of Rabat, showed that age- and sex-specific rates remained stable between 2006 and 2009. The demographic projections estimated for Morocco indicate that between 2010 and 2030, the expected annual number of hip fractures would increase about twofold. INTRODUCTION: No data on hip fracture incidence trends exist from Africa. The aim of the study was to determine time trends in hip fracture rates for the province of Rabat and to forecast the number of hip fractures expected in Morocco up to 2030. METHODS: All hip fracture cases registered during the years 2006-2009 were collected at all the public hospitals and private clinics with a trauma unit and/or a permanent orthopedic surgeon across the province. RESULTS: Over the 4-year period, 723 (54.3%) hip fractures were recorded in women and 607 (45.6%) in men. The age- and gender-specific incidence of hip fracture rose steeply with advancing age. Hip fractures occurred later in women 75.0 (10.7) years than in men 73.3 (11.0) years (p=0.014), and its incidence was higher in women than in men [85.9 (95% CI 79.7-92.2) per 100,000 person-years vs. 72.7 (95% CI 66.9-78.5)]. The incidence remained globally stable over the period study, and the linear regression analysis showed no significant statistical difference. For the year 2010, there were 4,327 hip fractures estimated in Morocco (53.3% in women). Assuming no change in the age- and sex-specific incidence of hip fracture from 2010 to 2030, the number of hip fractures in men is expected to increase progressively from 2,019 to 3,961 and from 2,308 to 4,259 in women. CONCLUSION: The age-specific incidence of hip fracture between the years 2006 and 2009 remained stable in Morocco, and the number of expected hip fractures would double between 2010 and 2030.

Moroccan national study on prevalence of mental disorders: a community-based epidemiological study.

OBJECTIVE: The main objective of this study was to assess the prevalence of common mental disorders in the Moroccan general population. METHOD: On a systematic representative randomized sample, the Moroccan Arabic version of the Mini International Neuropsychiatric Interview (MINI) was used to assess the prevalence of mood, anxiety, substance, and alcohol abuse disorders. RESULTS: Among 5498 subjects interviewed, 40.1% had at least one current mental disorder. Current major depressive disorder was the most common (26.5%), and at least one anxiety disorder was found in 37% of the sample. Mental disorders were more frequent among female, urban, divorced, and unemployed subjects. CONCLUSION: Mental disorders are common in the Moroccan general population, particularly mood and anxiety disorders.

Risk factors for hypertension among the adult Moroccan population.

This study used data from the Moroccan national survey in 2000 to identify the principle risk factors for hypertension in a representative sample of the population age 20+ years. The risk of hypertension increased steadily with age and was higher among rural residents (OR = 1.42) and those with diabetes (OR = 1.72). The risk increased with increased body mass index, waist size and hypercholesterolaemia. The risk of hypertension decreased by 36% and 46% respectively for those who walked 30-60 min and > 60 min daily. Consumption of fish and fresh fruits 1+ times per week was associated with a lower risk. Among those with hypertension, only 21.9% were previously diagnosed and 8.8% were under medical treatment.

Prevalence and predictors of white-coat hypertension in a large database of ambulatory blood pressure monitoring.

The objective of this study was to determine both the prevalence of white-coat effect and white-coat hypertension (WCH) and which selected clinical variables were predictors of WCH. A total of 2462 patients underwent ambulatory blood pressure monitoring either in borderline hypertension (group 1) or for assessment of antihypertensive treatment (group 2) or for hypotension (group 3). In the overall population 33.0% of patients showed WCH, 32.8% in group 1 and 37.0% in group 2. In multivariate analysis, sex and grade of hypertension were independent predictors of WCH in groups 1 and 2.

[Factors correlated with left ventricular mass in hypertensive patients]. / Facteurs corrélés à la masse ventriculaire gauche chez un groupe d'hypertendus.

UNLABELLED: Left ventricular hypertrophy (LVH) is an independent risk factor in hypertensive patient. THE AIM: Of our study is to evaluate prospectively the relationship between left ventricular mass and clinical, echocardiographical and ambulatory blood pressure data in hypertensive subjects. METHODS: We studied 88 hypertensive patient who underwent clinical and laboratory investigation, echocardiography and 24 hours ambulatory blood pressure monitoring. Correlations were made between these data and left ventricular mass. RESULTS: Clinical data, which correlated well with left ventricular mass, were duration of hypertension, systolic arterial pressure and pulse arterial pressure. In echocardiography left atrial area and left ventricular dysfunction correlated significatively with left ventricular mass. Data from 24 hours blood pressure monitoring as daytime systolic pressure, nighttimes diastolic pressure, ambulatory systolic pressure and ambulatory pulse pressure. CONCLUSION: In hypertensive patient, left ventricular mass correlated well with left atrial dilation and diastolic left ventricular dysfunction. It also correlated with 24 hours ambulatory blood pressure monitoring data.

Non-Hodgkin's lymphoma: time trends for incidence and survival in Côte-d'Or, France.

BACKGROUND: A generally reported increased incidence of non-Hodgkin's lymphomas (NHL) and a recent evolution in treatment strategies, as well as several clinical trials suggesting improved survival, have prompted this study to evaluate time trends in incidence and prognosis of NHL. METHOD: NHL recorded by the population-based Registry of Hematopoietic Malignancies in Côte-d'Or (France) were considered over three 4-year periods from 1980 to 1992. A multivariate survival analysis was carried out in terms of both crude and relative survivals. RESULTS: Overall incidence, increased over the 12 years considered, by an average of 6.8% per annum (P < 0.05). Only two cases of AIDS-related NHL were registered during this period. NHL incidence has increased slightly more for males than for females, further widening the gap in incidence between the sexes. In terms of histological grade the increase in incidence was more pronounced for low-grade and high-grade NHL than for intermediate-grade NHL. The overall 5-year relative survival rate was 69.3%. In multivariate relative survival analysis, neither sex, age, period of diagnosis nor place of hospitalization were significant prognostic factors. Only place of residence, with RR 2.2 (1.41-3.42) for people living in rural areas compared to urban areas and histological type, according to the working formulation with RR 3.8 (2.22-6.61) for high-grade tumours compared to low-grade tumours, remained informative for prognosis. CONCLUSIONS: Although incidence of NHL has increased in Côte-d'Or, this trend has remained independent of the AIDS epidemic. Contrary to the findings of clinical trials, the patients' survival in this population-based series has not been shown to have improved over the study period.

Interval cancers in a community-based programme of colorectal cancer screening with faecal occult blood test.

Interval cancers represent the major limitation of screening for colorectal cancer with the faecal occult blood test. The aim of this study was to describe the characteristics of interval cancers and the sensitivity of the screening programme in a well-defined French population. During five screening rounds, 398 cancers were diagnosed in those of the population having performed at least one screening test; 57.8% of them were interval cancers. The proportion of interval cancers was higher among cancers of the rectal ampulla (72.2%) than among cancers of other sites (52.9%) (P < 0.001). The proportion of TNM stage I and II were higher among screen-detected cancers (73.8%) than among interval cancers (57.4%). The overall sensitivity of the screening programme was 62.9% within 1 year, and 48.7% within 2 years. An improvement in the sensitivity of the faecal occult blood test for colorectal cancer screening is needed, without an unacceptable loss of specificity.

Participation in faecal occult blood screening for colorectal cancer in a well defined French population: results of five screening rounds from 1988 to 1996.

OBJECTIVE: To evaluate the influence on compliance of demographic variables and of the way of proposing a faecal occult blood test in a colorectal cancer mass screening programme. SETTING: Well defined population in Burgundy (France). METHODS: From 1988 to 1996 five screening rounds were conducted in people aged 45 to 74 on entering the study. The screening test was provided free of charge by primary care physicians over a four month period, then mailed to non-consultants, followed by a potential reminder letter. The whole population was invited to participate in each screening campaign. RESULTS: During the five successive rounds, compliance was 52.8%, 54.0%, 57.3%, 58.3%, and 56.2%. It was higher in women than in men, in those initially aged 50 to 69 than in the extreme age groups, and in urban than in rural areas. Overall, 68.7% of the invited population completed at least one screening test and 37.2% completed the five rounds. Among those who participated once in a screening campaign, between 79.6% and 87.6% participated in the succeeding ones. Compliance was higher when the test was proposed by GPs (varying between 85.2% and 94.0% according to the screening campaign) than when it was sent by post (varying between 26.0% and 33.7%). CONCLUSION: In France, a participation rate of over 50% can be achieved in colorectal cancer screening by means of a faecal occult blood test. To achieve this, primary care physicians have to play an active part in the programme and the test must be mailed to non-consultants.

[Mass screening of colorectal cancer: where are we up to?]. / Le dépistage de masse du cancer colorectal: où en est-on?

Considering the present state of knowledge on the question, only the strategy of screening for intestinal tumours at the asymptomatic stage would seem capable of reducing such a problem as colorectal cancer. Detection of occult blood in stool is currently being evaluated through a mass screening test. Methods used to obtain a high participation rate are now well-defined. In France, to achieve this goal, the test must be proposed by GPs and then mailed to those who do not consult GPs. Four case-control studies and one randomized study conducted among volunteers suggest the efficacy of screening with faecal occult blood testing to reduce mortality from colorectal cancer but they do not indicate effectiveness within a population. Four population-based studies have been set up in Europe (Denmark, England, Sweden and France). Results will be available within one to three years. They should lead to a national screening strategy.

[Informative value of Hemoccult test according to the number of positive slides in mass screening of colorectal cancer]. / Valeur informationnelle du test Hémoccult selon le nombre de fenêtres positives dans le dépistage du cancer colorectal.

Our aim was to study the relationship between the level of positivity of the Hemoccult colorectal cancer screening test and the positive predictive value on one hand, and the characteristics of the screened neoplasms on the other. This study focuses on four successive colorectal cancer screening campaigns in a population of 45,642 subjects born between 1914 and 1943. There were 1 or 2 positive slides in 50.1% of cases, 3 or 4 in 30.7% of cases and 5 or 6 in 19.2% of cases. The positive predictive value was 11.1% for cancer, 17.4% for adenoma > or = at 1 cm and 10.1% for adenoma < 1 cm. For a cancer or adenoma > or = at 1 cm, the positive predictive value varied between 18.6% when there were 1 or 2 positive slides, and 52.5% when there were 5 or 6 positive slides. Dukes A cancers are less likely to have 5 or 6 positive slides than more advanced cancers. On the contrary, neither cancer localisation nor characteristics of adenomas > or = at 1 cm (localisation, size, degree of dysplasia) influenced the number of positive slides. Owing to intermittent colorectal cancer bleeding, it seems necessary to take several successive samples. Two samples per stool over three successive stools seem like a good compromise. The informative value of the test increases with the number of positive slides.

[Health care patterns and colorectal cancers. Study in the population of the Côte d'Or between 1976 and 1990]. / Filières de soins et cancers colorectaux. Etude dans la population de la Côte-d'Or entre 1976 et 1990.

OBJECTIVE: The goal of this study was to analyze the characteristics of colorectal cancer patients associated with the distribution of the incident cases in the health care pattern (public, private and mixed health care options) and to study the development of this distribution over time. METHODS: The study concerned 3,403 cases of colorectal cancer diagnosed in the Côte-d'Or region, France between 1976 and 1990. The relationship between patient characteristics and the type of health care pattern was analyzed using a polychotomous logistic regression model. RESULTS: Data analysis indicates an uneven patient distribution among the public (40.6%), private (47.3%) and mixed (12.1%) sectors. The proportion of patients received in the public sector increased with the age of the patient with a proportional decrease in private and mixed sectors: compared with patients under 65 years cared for in the public sector, the odds ratio characteristic of the private sector was 0.74 for the age group 65-74 and 0.44 for those over 74 years. The odds ratios characteristic of the mixed sector were 0.71 and 0.41 respectively. Cases demonstrating symptoms received care more often in the private sector (48.3%) than in the public (38.7%) or mixed (13%) sectors, whereas those diagnosed in patients with no digestive disorders as well as those diagnosed in emergency situations were mainly cared for in the public sector. Cancers in advanced stages were more often treated in the public sector. In the case of palliative treatment, the patients were more often treated in the public sector than in the private sector or mixed sector. This phenomenon was more marked in the case of symptomatic treatments: with curative treatment taken as the category of reference, the odds ratios associated with symptomatic treatment were 0.38 for the private sector and 0.18 for the mixed sector. Over the period of time examined, there was an increase in the proportion of patients receiving care in the private sector when they lived in the area serviced by Dijon or in areas without a health "structure". Patients residing in areas with a general hospital unchanged over time. Relatively disadvantaged social categories were more often associated with care in the public sector. CONCLUSIONS: This study shows that the characteristics of colorectal cancer patients differ between the public and private sectors. It shows the differences in recruitment of health care structures according to the treatment of those patients. The study provides information useful in conceiving regional schemes of health care organisation.

[Superficial cancer of the stomach: evolution of their characteristics over a 20 year period in one population]. / Les cancers superficiels de l'estomac: évolution de leurs caractéristiques sur une période de 20 ans dans une population.

OBJECTIVES: The aim of this study was to analyse the incidence, treatment and prognosis of early gastric cancer in a population-based series and to draw a picture of time trends. METHODS: Over a 20-year period (1976-1995), 80 early gastric cancers were diagnosed in the Côte-d'Or area (493,000 residents). Incidence rates were calculated by sex, age groups and 5-year periods. Prognostic factors were determined using the Kaplan-Meier method and the Cox model. RESULTS: Age-standardized incidence rates were 0.8/100,000 in men and 0.3/100,000 in women. Incidence increased slightly over time (NS) and their proportion among gastric cancers increased from 3.4% (1976-1980) to 7.9% (1991-1995) (P < 0.01). Among these cancers, 25 were intramucosal (31.3%), 55 were submucosal (68.8%) and 8 had lymph node metastases (10.0%). Overall 21 patients (24.1%) had already been treated for a peptic ulcer. The 5-year crude survival rate was 63.1% and the corresponding net survival rate was 86.3%. Lymph node metastases, location, sex and cancer extension and age were independent prognostic factors. CONCLUSIONS: Though it is on the increase, the proportion of early gastric cancers remains low among gastric cancers. This study confirms the importance of performing a gastroscopy with biopsy upon each bout of ulcer and that the prognosis is lower than suggested by hospital based series.

[Adjuvant chemotherapy for colon adenocarcinoma in the county of Côte-d'Or]. / Chimiothérapie adjuvante pour adénocarcinome colique dans le département de la Côte-d'Or.

OBJECTIVES: The aim of this study was to assess the use of adjuvant chemotherapy in colon adenocarcinomas on a population basis and determine which factors could modulate its prescription. METHODS: The influence of time of diagnosis, age, sex, place of residence, health care pattern, tumor location and number of metastatic lymph nodes was investigated from the 1988 to 1995 data from the Registry of Digestive Cancers in Côte-d'Or (France). Each independent variable was given an odds-ratio (OR). RESULTS: An adjuvant chemotherapy was performed for 0.9% of 231 Dukes'A cancers, 3.8% of 367 Dukes'B and 16.7% of 264 Dukes'C. For the latter, the prescription of adjuvant chemotherapy was influenced by time of diagnosis (from 1.3% in 1988-89 to 35.8% in 1994-95; OR = 228 for period 1994-95 compared with the first period), age (the proportion of treated patients under 75 years of age has increased from 2.2% in 1988-89 to 57.9% in 1994-95; OR = 30.1 for patients younger than 75 years compared with older ones) and health care pattern (OR = 0.21 for treatment in non university hospitals and 0.06 in the private sector compared with university hospitals. CONCLUSION: In spite of an increasing proportion of patients treated by adjuvant chemotherapy for Dukes'C colon cancers, this treatment of proved effectiveness has not yet reached its full development.

[Performance of the Hemoccult test in the screening of colorectal cancer and adenoma. Results of 5 screening campaigns in Saône-et-Loire]. / Performances du test Hemoccult dans le dépistage des cancers et des adénomes colorectaux. Résultats de cinq campagnes de dépistage en Saône-et-Loire.

OBJECTIVES: The aim of this population-based study was to specify the positivity rate, the positive predictive value of Hemoccult test as well as the characteristics of the cancers and adenomas screened during the successive colorectal cancer screening campaigns. METHODS: This study focused on five colorectal cancer mass screening campaigns by Hemoccult test carried out between 1988 and 1996. The test was offered every two years to a cohort of subjects born between 1914 and 1943 and living in some districts of the Saône-et-Loire administrative area. RESULTS: The positivity rate of the test was higher in the first campaign (2.1%) than in the subsequent ones (mean 1.3%). It was also higher in males than in females and it increased with age. After a positive test, 85.4% of the subjects had a colonic exploration. The exploration rate was higher when the test was offered by general practitioners (88.0%) than when it was mailed (77.8%) (P < 0.01). Through this test, cancer was detected in 168 patients, and one adenoma or more in 414 patients. The positive predictive value was 11.4% for cancer, 17.1% for adenoma > or = 1 cm and 11.1 for adenoma < 1 cm. It was higher in males than in females and it increased with age. Depending on the campaigns, 35.9% to 47.3% of the subjects explored after a positive test had a cancer or an adenoma. The screened cancers or adenomas were more often localized in the sigmoid or the rectum. Three quarters of screened cancers were stage I or II (TNM classification). All together, 82.7% of cancers were treated with surgical resection for cure and 10.1% with endoscopic resection. CONCLUSIONS: This work confirms the feasibility of carrying out regular colorectal cancer screening campaigns, through which a few subjects can be selected for undergoing colonic explorations. These latter can detect a cancer or adenoma in 40% of cases.

[Mass screening for colorectal cancer]. / Le dépistage de masse du cancer colorectal.

Considering the present state of knowledge, only the strategy of screening for intestinal tumours at the asymptomatic stage could reduce such a problem as colorectal cancer. Data from case-control studies provide evidence of the efficacy of screening by rigid proctosigmoidoscopy. But compliance with such a strategy is not known. The effectiveness of screening by sigmoidoscopy has yet to be demonstrated. A European controlled study of flexible sigmoidoscopy in association with the Hemoccult test versus the Hemoccult test alone has been set up. Evaluation by a randomized screening trial with a single flexible sigmoidoscopic examination at age 55 to 60 years has also been suggested. Case-control studies and a randomized study conducted among volunteers demonstrate that it is possible to reduce mortality from colorectal cancer in people who accept screening with faecal occult blood testing, using the Hemocult test. Four population-based studies have been set up in Europe (in England, Denmark, France and Sweden). They are based on a biannual Hemoccult test. Compliance in the test group ranges between 55% and 65% in the first screening campaign and remains high in the following screening campaigns. In France, to achieve this goal, the test must be proposed by GPs and then mailed to those who do not consult GPs. Reliable mortality data will be available within 1 to 3 years. The results of the European trials must be awaited to know if screening biennually is effective in reducing colorectal cancer mortality.

[Health care pattern of the initial course of treatment of breast cancer in the French Department of Côte-d'Or from 1982 to 1992]. / Filières de soins du traitement initial du cancer du sein en Côte-d'Or de 1982 à 1992.

PURPOSE: The aim of this study was to describe the implication of the different health care structures in the treatment of breast cancer. METHODS: In Côte-d'Or, from 1982 to 1992, there were 2432 cases of breast cancer. Surgery came first as treatment for 93% of the patients, radiotherapy came second (77%). The department is subdivided in several geographic areas (ZPIU):--Dijon, equipped with university hospital (UH) and with private hospitals (PH),--cities with general hospitals (GH)--and areas without hospitals. Demographic, geographic and clinical variables were studied in order to explain the patient distribution between the various hospitals. RESULTS: 52% of the cases were operated in PH, 37% in UH and 11% in GH. The main users of the GH were women who lived nearby. Age over 75 was associated with a treatment in GH. Women with clinical signs of severity were twice as often operated in UH rather than PH. Post-operative radiotherapy was done in 95% of the cases in the same structure where surgery was done. CONCLUSION: No matter how popular university and private hospitals were in our regional capital, general hospitals played a proximity role.