J Steinmetz

Institut inter Régional pour la SAnté, Tours, Centre, France

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Publications (73)178.21 Total impact

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    ABSTRACT: To monitor the prevalence of hepatitis B and hepatitis C a cross-sectional survey was conducted in 2004 among French metropolitan residents. A complex sampling design was used to enroll 14,416 adult participants aged 18-80 years. Data collected included demographic and social characteristics and risk factors. Sera were tested for anti-HCV, HCV-RNA, anti-HBc and HBsAg. Data were analyzed with SUDAAN software to provide weighted estimates for the French metropolitan resident population. The overall anti-HCV prevalence was 0.84% (95% CI: 0.65-1.10). Among anti-HCV positive individuals, 57.4% (95% CI: 43.2-70.5) knew their status. Factors associated independently with positive anti-HCV were drug use (intravenous and nasal), blood transfusion before 1992, a history of tattoos, low socioeconomic status, being born in a country where anti-HCV prevalence >2.5%, and age >29 years. The overall anti-HBc prevalence was 7.3% (95%: 6.5-8.2). Independent risk factors for anti-HBc were intravenous drug use, being a man who has sex with men, low socioeconomic status, a stay in a psychiatric facility or facility for the mentally disabled, <12 years of education, being born in a country where HBsAg prevalence >2%, age >29 and male sex. The HCV RNA and HBsAg prevalence were 0.53% (95% CI: 0.40-0.70) and 0.65% (95% CI: 0.45-0.93), respectively. Among HBsAg positive individuals, 44.8% (95% CI: 22.8-69.1) knew their status. Anti-HCV prevalence was close to the 1990s estimates whereas HBsAg prevalence estimate was greater than expected. Screening of hepatitis B and C should be strengthened and should account for social vulnerability.
    Journal of Medical Virology 02/2010; 82(4):546-55. · 2.37 Impact Factor
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    ABSTRACT: Allele frequencies of genetic polymorphisms were compared between supposedly healthy subjects and angiographically proven coronary artery disease patients. The polymorphic candidate loci investigated were the apolipoprotein (apo) B signal peptide and XbaI polymorphisms, the apo E polymorphism and two polymorphisms of lipoprotein lipase (LPL) gene: Hind/III and PvuII. Apo B signal peptide and HindIII/LPL polymorphisms showed significant differences in allele partition between cases and controls; the rare alleles of both polymorphisms were less frequent (p<0.05) in cases. We looked for associations between the polymorphisms and lipid concentration variability in a supposedly healthy population (145 men and 144 women). Apo B signal peptide, apo E and PvulII/LPL polymorphisms seem to influence some lipid metabolism parameters significantly. Apo AI and LpCIII levels were significantly different among apo B signal peptide genotypes: Del homozygotes had the highest concentrations of both variables. The e4 allele of apo E polymorphism was associated with increased concentrations of total cholesterol, LDL cholesterol and apo B. Increased LpAI:AII levels observed in E3 homozygotes (p<0.01) have not previously been reported. LpAI:AII concentration was also influenced by PvuII/LPL polymorphisms.
    Clinical Genetics 06/2008; 50(5):339 - 347. · 4.25 Impact Factor
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    ABSTRACT: To analyze the associations between lifestyle factors and colorectal adenomas or cancers in a population 50-74 years old. The study population underwent colonoscopy after positive fecal occult blood test in Health examination centers of the French general health insurance. The two sets of cases (n= 674 cancers, n=2618 adenomas) were compared with controls (n=5456). Associations between risk of colorectal disease and health data (mainly tobacco and alcohol consumption, physical activity, obesity, and laboratory test results) were analyzed with logistic regression models to estimate odds ratios. The probability of colorectal cancer or adenoma was statistically associated with age (60 years or older in men and women). A significant relation between these diseases was observed with smoking (in both smokers and ex-smokers) and with alcohol consumption, with odds ratios above 1.30. The other risk factors studied were not significantly associated with these colorectal diseases. This result provides still more evidence of the need for actions against these risk behaviors.
    La Presse Médicale 10/2007; 36(9 Pt 1):1174-82. · 0.87 Impact Factor
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    ABSTRACT: The improvement of the consistency of gamma-glutamyltransferase (GGT) activity results among different assays after calibration with a common material was estimated. We evaluated if this harmonization could lead to reference limits common to different routine methods. Seven laboratories measured GGT activity using their own routine analytical system both according to the manufacturer's recommendation and after calibration with a multi-enzyme calibrator [value assigned by the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) reference procedure]. All samples were re-measured using the IFCC reference procedure. Two groups of subjects were selected in each laboratory: a group of healthy men aged 18-25 years without long-term medication and with alcohol consumption less than 44 g/day and a group of subjects with elevated GGT activity. The day-to-day coefficients of variation were less than 2.9% in each laboratory. The means obtained in the group of healthy subjects without common calibration (range of the means 16-23 U/L) were significantly different from those obtained by the IFCC procedure in five laboratories. After calibration, the means remained significantly different from the IFCC procedure results in only one laboratory. For three calibrated methods, the slope values of linear regression vs. the IFCC procedure were not different from the value 1. The results obtained with these three methods for healthy subjects (n=117) were gathered and reference limits were calculated. These were 11-49 U/L (2.5th-97.5th percentiles). The calibration also improved the consistency of elevated results when compared to the IFCC procedure. The common calibration improved the level of consistency between different routine methods. It permitted to define common reference limits which are quite similar to those proposed by the IFCC. This approach should lead to a real benefit in terms of prevention, screening, diagnosis, therapeutic monitoring and for epidemiological studies.
    Clinical Chemistry and Laboratory Medicine 02/2007; 45(10):1373-80. · 3.01 Impact Factor
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    ABSTRACT: Objectif Cette étude cas-témoin analyse les relations entre le cancer ou l'adénome colorectal et les facteurs concernant le mode de vie dans une population âgée de 50 à 74 ans. Méthode La population étudiée a eu une coloscopie à la suite d'un Hémoccult® positif réalisé dans le cadre du dépistage organisé du cancer colorectal dans les Centres d'examens de santé de l'Assurance maladie. Les 674 sujets ayant un cancer colorectal et les 2 618 sujets ayant un adénome ont été comparés à 5 456 sujets témoins n'ayant pas d'anomalie à la coloscopie. Les relations entre le risque de pathologie et les données de santé – concernant principalement la consommation de tabac, d'alcool, l'activité physique, les données morphologiques et les résultats biologiques (glycémie, cholestérolémie, triglycéridémie, numération leucocytaire) – ont été analysées dans un modèle de régression logistique permettant d'estimer les Odds ratio (OR). Résultats La probabilité d'avoir un cancer colorectal ou un adénome augmentait avec l'âge à partir de 60 ans chez les hommes et les femmes. Elle était associée de façon très significative à la consommation de tabac, même ancienne, et à la consommation quotidienne d'alcool avec des OR > 1,30. Les autres facteurs de risque étudiés n'étaient pas statistiquement associés de façon constante aux pathologies colorectales considérées. Conclusion Ces résultats apportent un argument supplémentaire pour renforcer les actions d'éducation à la santé sur ces comportements à risque.
    La Presse Médicale. 01/2007; 36(9):1174–1182.
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    ABSTRACT: Objectives The aim of this study was to describe the results of colorectal cancer screening performed in the Health Examination Centers of the French general health insurance system. Methods The population consisted of 1 262 833 subjects (52.6% men) aged 50 to 74 years old who attended periodic health consultations from 1998 to 2003 in 89 Health Examination Centers in France. Subjects with increased risk for colorectal cancer and subjects with a positive fecal occult blood test (Hemoccult II®) were invited to undergo colonoscopy. Subsequent follow-up and diagnostic data were collected. Results Prior screening practices for colorectal cancer (recent colonoscopy or fecal occult blood test, local screening campaign) were noted in 18% of the subjects attending Health Examination Center consultations. High risk for colorectal cancer (familial or personal factor) without ongoing surveillance or prior screening was observed in 3% of the study population. A fecal occult blood test was proposed to 79% of the population and of them, 89% effectively performed the test: 3.2% of tests were positive. A follow-up protocol was initiated for 63,357 subjects. A colonic exploration was performed in 69% of high-risk subjects and enabled detection of cancer in 85 and adenomas in 1683. A colonic exploration was performed in 88% of subjects with a positive fecal occult blood test and enabled detection of 674 cancers (positive predictive value of fecal occult blood test (PPV) = 4.7%) including 174 Dukes A, and 2618 adenomas (PPV = 18%) including 776 adenomas measuring more than 10 mm (PPV = 5.4%). Conclusion This study confirms the importance of implementing organized screening practices within Health Examination Centers before undertaking a generalized screen campaign targeting the entire French population.
    Gastroentérologie Clinique et Biologique 07/2006; 30(s 6–7):832–837. · 1.14 Impact Factor
  • Journal of Hepatology 04/2006; 44. · 9.86 Impact Factor
  • Josiane Steinmetz, Joseph Henny, René Gueguen
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    ABSTRACT: The aim of the present work was to compare in a supposed healthy population of 680 subjects several algorithms for positive selection of urine samples requiring microscopic examination for erythrocytes and leukocytes after screening by automated test-strip measurement and particle counting on a Sysmex UF-50 flow cytometer. Four strategies have been formulated and the sensitivity, specificity, positive predictive value, negative predictive value, false positive rate, false negative rate, and microscopic review rate were measured. The strategy combining test strip analysis and automated counting on all samples, followed by microscopic examination of only discordant samples gave the best results. When the two methods of haematuria screening were in agreement (91% of samples), the false negative rate for microscopy was 1.1%, with a false positive rate of 0.8%, sensitivity of 66% and specificity of 99%, and the results are acceptable without any other examination. When the two methods of haematuria screening were discrepant, visual microscopic analysis was necessary to obtain definitive results. For leukocyturia screening, 80% of results were in agreement by test strip and automatic sediment urinalysis, with only ten results considered as false negatives (1.8%) and four as false positives (0.7%). Agreement was good and the other criteria were good (sensitivity 79%, specificity 99%). On conflicting samples, there was no agreement between methods and microscopic analysis was essential. The benefit of such an algorithm would be optimisation of the workflow without any loss of sensitivity and specificity at the expense of a two-fold increase in cost.
    Clinical Chemistry and Laboratory Medicine 02/2006; 44(4):464-70. · 3.01 Impact Factor
  • Journal of Clinical Virology 01/2006; 36. · 3.29 Impact Factor
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    ABSTRACT: The aim of this study was to describe the results of colorectal cancer screening performed in the Health Examination Centers of the French general health insurance system. The population consisted of 1,262,833 subjects (52.6% men) aged 50 to 74 years old who attended periodic health consultations from 1998 to 2003 in 89 Health Examination Centers in France. Subjects with increased risk for colorectal cancer and subjects with a positive fecal occult blood test (Hemoccult II') were invited to undergo colonoscopy. Subsequent follow-up and diagnostic data were collected. Prior screening practices for colorectal cancer (recent colonoscopy or fecal occult blood test, local screening campaign) were noted in 18% of the subjects attending Health Examination Center consultations. High risk for colorectal cancer (familial or personal factor) without ongoing surveillance or prior screening was observed in 3% of the study population. A fecal occult blood test was proposed to 79% of the population and of them, 89% effectively performed the test: 3.2% of tests were positive. A follow-up protocol was initiated for 63,357 subjects. A colonic exploration was performed in 69% of high-risk subjects and enabled detection of cancer in 85 and adenomas in 1683. A colonic exploration was performed in 88% of subjects with a positive fecal occult blood test and enabled detection of 674 cancers (positive predictive value of fecal occult blood test (PPV)=4.7%) including 174 Dukes A, and 2618 adenomas (PPV=18%) including 776 adenomas measuring more than 10 mm (PPV=5.4%). This study confirms the importance of implementing organized screening practices within Health Examination Centers before undertaking a generalized screen campaign targeting the entire French population.
    Gastroentérologie Clinique et Biologique 01/2006; 30(6-7):832-7. · 1.14 Impact Factor
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    ABSTRACT: Lipoproteins in human serum and in lipoprotein fractions obtained by sequential ultracentrifugation of serum were analyzed by combining three types of micro two-dimensional electrophoresis (2-DE) technique to obtain systematic information on lipoproteins and apolipoproteins. The samples were first analyzed under non-denaturing conditions of electrophoresis to characterize the physicochemical properties of low-density lipoproteins (LDL) and high-density lipoproteins (HDL) under physiological conditions. The samples were then analyzed, employing isoelectric focusing without denaturants in the first dimension and sodium dodecyl sulfate (SDS) electrophoresis in the second dimension, to study the process of dissociation of lipoproteins to apolipoproteins. The HDL's dissociated into their constituent apolipoproteins, showing that the charge heterogeneity of HDL is caused by the heterogeneous apolipoprotein content. LDL dissociated into apo B-100 and minor components. In the third type of micro 2-DE, employing urea and Nonidet P-40 in the first dimension and SDS in the second dimension, the lipoproteins were dissociated into their apolipoproteins during the steps of sample treatment, to obtain the information on the contnt of apolipoprotein peptides and their genetic alleles. The combined micro 2-DE technique will be useful for the systematic analysis of lipoproteins and apolipoproteins in hypo- and hyperlipoproteinemic patients.
    Electrophoresis 04/2005; 8(7):325 - 330. · 3.26 Impact Factor
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    ABSTRACT: International guidelines emphasize the importance of LDL cholesterol (LDL-C) assay in the care and follow-up of patients with cardiovascular risk. Most studies and common practice use Friedewald's formula for LDL-C calculation. The accuracy of the result depends closely on the precision of the input parameters (total cholesterol, triglycerides (TG) and HDL cholesterol), and discrepancies between calculated LDL-C and measurement by reference methods appear when TG exceed 4.5 mmol/L, or in the presence of abnormal lipoproteins. These restrictions and uncertainties in calculations have prompted the recent development of direct and homogeneous methods that fit all analyzers. A multicenter evaluation of four direct assays of LDL-C (Daiichi, Denka Seiken, Kyowa, Wako) was carried out on 45 serum samples (TG below 3.1 mmol/L) in eight laboratories using different analyzers. For three methods (Daiichi, Kyowa, Wako), the interlaboratory reproducibility was markedly improved relative to that of calculation. A strong correlation was found for all new methods when compared with a beta-quantification assay. Average bias in Denka Seiken assays was greater than Kyowa's and Daiichi's (although less dispersed for the latter) and for Wako all bias were positive. The relationship between bias variations and the lipid parameters of the samples was studied. Three methods, Daiichi, Kyowa and Wako, revealed a significant positive correlation between bias and serum VLDL-C/TG ratio, clearly indicating that cholesterol enrichment of VLDL was a source of variability in these assays. Specificity of the four methods was tested in situation of dyslipidemia by spiking isolated lipoproteins (chylomicrons, VLDL and HDL). This experiment revealed differences in behavior, most evidently upon addition of VLDL. No method was truly specific, but up to 8 mmol/L of TG the variations were acceptable. In the presence of type III hyperlipoproteinemia, however, only the Denka Seiken method was reliable. Linearity up to 20 mmol/L (Daiichi, Denka Seiken) or 14 mmol/L (Kyowa, Wako) of LDL-C allows these tests to be used in main routine cases. New direct assays are an obvious technological advance in terms of analytical performance and conveniency. Their use for the diagnosis and follow-up of hyperlipidemic patients offers an alternative that overcomes the limitations of the Friedewald calculation.
    Annales de biologie clinique 01/2005; 63(1):27-41. · 0.30 Impact Factor
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    ABSTRACT: According to a recent French legislation (1995), retired people who have been exposed to an occupational carcinogen can benefit from a specific post-occupational medical follow-up program, supported by the "Caisse Primaire d'Assurance-Maladie" (CPAM), the French health insurance system. However, only very few people presently take access to this social measure. The ESPACES project developed and evaluated a procedure to identify retirees who have been exposed to asbestos during their career, and to inform them about the post-occupational medical follow-up program. This pilot study was performed within the health centers ("Centres d'examens de santé" (CES)) of the health insurance system in a random sample of men who have retired from the six main French administrative divisions between 1994 to 1996. A probability of exposure to asbestos was attributed through a job exposure matrix. Subjects were interviewed in the CES to validate their exposure data. Retired subjects with confirmed exposure to asbestos were referred to their CPAM, to apply for the medical follow-up. The whole process was evaluated through a comparison with control CPAMs, and simulations were performed to assess its sensitivity and specificity, as well as the total number of persons in France who could potentially benefit. Among the 737 persons classified as exposed by the matrix who came to the CES, the exposure was confirmed for 53.8%, and 143 benefited from the medical follow-up, 17 times more than in a sample of control CPAMs. Based on an annual number of about 250,000 new retirees, simulations showed that a low detection threshold, taking into account the probability and duration of exposure, would yield approximately 25,000 persons coming to the CES, more 6,000 of them benefiting from the follow-up. The proposed detection threshold would allow for a feasible and ethically acceptable generalization, due to the optimization of the false negative and false positive rate.
    Revue d Épidémiologie et de Santé Publique 03/2004; 52(1):7-17. · 0.69 Impact Factor
  • J Steinmetz, J Henny, R Gueguen
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    ABSTRACT: The Sysmex UF-50 is an automated flow cytometer for urine sediments analysis. Interpretation of the results needs establishment of reference limits for the different constituents measured. First of all, we checked precision of measurements and stability of urines during transportation. Then, urine samples from 4 to 95 year old subjects were examined with the UF-50, by visual microscopy and test strips. Distributions of results for erythrocytes, leukocytes, epithelial cells, casts, bacteria and conductivity were described in a sample of 680 subjects (364 men and 316 women), with creatininemia below 140 micromol/L, consuming no drugs and for women without intra uterine device and apart from menstruation period. Then, the results were compared with those obtained in groups selected on microscopic analysis and test strip results. UF-50 sensitivity and specificity were 77.5% and 88% for 15 erythrocytes/microL in reference to microscopic urinalysis, they were 91.3% and 87.3% for 15 leucocytes/microL. The reference sample was defined with negative microscopic results. The upper reference limits (centile 97.5) were 16 red blood cells/microL for men 14.5 for women, 13.5 and 33 leucocytes/microL, 8 and 19 epithelial cells/microL, 1,3 and 0,4 casts/microL, 5 500 et 7 700 bacteria/microL, 36,2 et 34,6 conductivity mS/cm. The Sysmex UF-50 is a suitable analyser for urinary sediments. Reference limits may be different from usual reference limits due to variability in performances of other methods.
    Annales de biologie clinique 01/2004; 62(6):671-80. · 0.30 Impact Factor
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    ABSTRACT: Aim: To assess biennial screening for colorectal cancer in health examination centers (CES) after four years of follow-up in complement to a preliminary publication. Method: We offered a biennial screening test for occult blood in stools (Hemoccult II®) by mail to patients who had had a negative screening test for occult blood two years pre-viously. Patients who had a positive result were then offered the possibility of undergoing further tests. Data on the actual outcomes were obtained from the attending physicians. We offered subsequent biennial screening only to patients who tested negative for occult blood. We enrolled a total of 121,127 patients who had taken part in a first screening test during a health examination (point n° 1). A second test was performed two years later in 1999-2000 in patients who tested negative in the first screening test (n° 2) and a third test in 2001-2002 for those who tested negative in the second screening test (n° 3). Results: The participation rate in the screening tests, compared to the number of subjects included in the initial screening sample, was 58.3 % after four years of follow-up. The participation rate increased from 81.6 % at point n° 2 to 91.7 % at point n° 3. A total of 3.01 % of the tests were positive. Data concerning follow-up from positives tests was available in 64.8 % of the cases. 1,014 patients were diagnosed with adenomas (positive predictive value = 20.2 %); 352 of the adenomas were larger than 10 mm. 276 cancers were detected (positive predictive value = 5.5 %). 53 % of the cancers were discovered following the initial screening test. Conclusion: These results are similar to our preliminary findings and suggest that biennial screening in examination centers is a satisfactory screening method after four years of follow-up with respect to clearly-defined quality criteria.
    Revue médicale de l'assurance maladie. 01/2004;
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    ABSTRACT: Position du problèmeLa réglementation française permet aux inactifs qui ont été exposés à une substance cancérogène dans leur vie professionnelle de bénéficier d’un suivi médical post-professionnel pris en charge par leur Caisse Primaire d’Assurance-Maladie (CPAM). Actuellement, très peu de personnes concernées bénéficient de cette mesure. Le projet ESPACES propose et évalue une méthode de repérage des retraités qui auraient été exposés professionnellement à l’amiante afin de les informer de leurs droits à ce suivi.MéthodesCette étude pilote a été réalisée dans les Centres d’Examens de Santé (CES) de la Sécurité sociale de six départements, sur un échantillon d’hommes retraités dans les années 1994-96 tirés au sort. La probabilité d’exposition à l’amiante a été évaluée grâce à une matrice emplois-exposition. Des entretiens de validation ont été réalisés dans les CES. Les retraités dont l’exposition a été confirmée ont été adressés pour une demande de prise en charge de suivi médical. Une évaluation de la procédure a été réalisée par comparaison avec des CPAM témoins, et des simulations ont permis d’évaluer la sensibilité et la spécificité de la procédure, ainsi que les effectifs potentiellement concernés.RésultatsParmi les 737 sujets classés exposés part la matrice et qui sont venus à l’entretien, 53,8 % ont vu leur exposition confirmée. Au total, 143 sujets ont été pris en charge, soit une proportion 17 fois supérieure à celle des CPAM témoins. Les simulations montrent que pour environ 250 000 nouveaux retraités chaque année, l’adoption d’un seuil bas de détection (prenant en compte la probabilité et la durée d’exposition) amènerait environ 25 000 personnes dans les CES, dont plus de 6 000 seraient pris en charge.ConclusionUne généralisation de la procédure qui aurait pour effet de réduire les inégalités d’information des personnes ayant été exposées à l’amiante a été proposée aux responsables de la Sécurité sociale. Le seuil de dépistage proposé permet une généralisation réalisable et éthiquement acceptable, en optimisant le nombre de faux positifs et de faux négatifs.Background According to a recent French legislation (1995), retired people who have been exposed to an occupational carcinogen can benefit from a specific post-occupational medical follow-up program, supported by the “Caisse Primaire d’Assurance-Maladie” (CPAM), the French health insurance system. However, only very few people presently take access to this social measure. The ESPACES project developed and evaluated a procedure to identify retirees who have been exposed to asbestos during their career, and to inform them about the post-occupational medical follow-up program.Methods This pilot study was performed within the health centers (“Centres d’examens de santé” (CES)) of the health insurance system in a random sample of men who have retired from the six main French administrative divisions between 1994 to 1996. A probability of exposure to asbestos was attributed through a job exposure matrix. Subjects were interviewed in the CES to validate their exposure data. Retired subjects with confirmed exposure to asbestos were referred to their CPAM, to apply for the medical follow-up. The whole process was evaluated through a comparison with control CPAMs, and simulations were performed to assess its sensitivity and specificity, as well as the total number of persons in France who could potentially benefit.ResultsAmong the 737 persons classified as exposed by the matrix who came to the CES, the exposure was confirmed for 53.8%, and 143 benefited from the medical follow-up, 17 times more than in a sample of control CPAMs. Based on an annual number of about 250,000 new retirees, simulations showed that a low detection threshold, taking into account the probability and duration of exposure, would yield approximately 25,000 persons coming to the CES, more 6,000 of them benefiting from the follow-up.Conclusion The proposed detection threshold would allow for a feasible and ethically acceptable generalization, due to the optimization of the false negative and false positive rate.
    Revue d'Épidémiologie et de Santé Publique. 01/2004; 52(1):7-17.
  • Revue D Epidemiologie Et De Sante Publique - REV EPIDEMIOL SANTE PUBL. 01/2004; 52:74-74.
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    ABSTRACT: To present the first assessment of the two-yearly faecal occult blood test used to screen patients attending health care centres for examinations. Method The Hemoccult II test was proposed by correspondence to 26 530 subjects aged 52-74 years, having exhibited a negative test during their periodical check-up 2 years before. The test was performed by 20 590 subjects and the corrected participation rate, taking into account unjustified sending, was of 83.1%. The positivity rate was 3.5%. In the 519 colonoscopies performed (71% of positive Hemoccult II), 23 cancers and 91 adenomas (31 larger than 1 cm) were observed (positive predictive value=22%). In 213 subjects, the information on the follow-up of the positive Hemoccult II were unavailable or unexploitable (lost to follow-up, coloscopy refused, inappropriate examinations). These results show that the two-yearly screening for colorectal cancer in an informed population after a periodical check-up results in a good participation rate. The follow-up rate of positive subjects, fundamental for the assessment of the program, is lower than during the regular check-up but remains relatively satisfactory.
    La Presse Médicale 11/2003; 32(32):1496-9. · 0.87 Impact Factor
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    ABSTRACT: and Aims: The ESPACES study was intended to identify retirees who may have been, according to their job descriptions, exposed to asbestos during their working lives. As part of this study, we analysed the quality of the occupation and activity sector coding as well as its effect on the subjects' exposure status. The occupation and activity sector for a sample of 450 retired men were coded twice (with the second coder blinded to the first result), according to the international codes for industries (ISIC-1975) and occupations (ISCO-1968). For each series, linking the information about a job episode (dates, ISIC code, ISCO code) with the matrix allowed attribution of a probability of asbestos exposure to each episode and each subject. The asbestos exposure in the two series was compared by the kappa reproducibility coefficient. The analysis concerned 425 questionnaires. There was at least one difference in the code for either activity sector (ISIC) or occupation (ISCO) in half the episodes (50.2%). The exposure status estimated by the job-exposure matrix did not change between the series for 84.7% of the subjects. The kappa coefficient was 0.64 for all questionnaires, 0.70 when the questionnaire was coded twice by the same coder, and 0.62 when coded by two different coders. Despite intra- and inter-differences between coders, the coding of job episodes for the ESPACES study appears satisfactory and hence indicates that the assessment of the subjects' asbestos exposure was assessed without major distortions. This study underlines the usefulness of employing coders specifically trained for this technique.
    Occupational and Environmental Medicine 07/2003; 60(6):438-43. · 3.22 Impact Factor
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    ABSTRACT: Infraclinical hypothyroidism is a recognized entity defined in terms of laboratory results which occurs more readily in women. The appropriateness of thyroid hormone multicentric prospective study initiated in 1997 has established that infraclinical hypothyroidism occurred in about 3% of women over 45 years of age undergoing routine check-ups at eleven health screening centers. Associated clinical signs and laboratory findings were reported. The purpose of the present study was to describe findings in a 3-year follow-up of these women with infraclinical hypothyroidism in order to assess natural history and appropriate care. Ninety-seven women of the 151 women with a TSH level between 4 and 12 mU/l in the 1997 survey were reviewed during the last three months of 2000. Forty-three of them had taken thyroid hormone replacement drugs since 1997. About 44% of the women examined still had infraclinical hypothyroidism or developing hypothyroidism. There was not significant difference between treated (33%) and non-treated (55%) patients. Clinical and biological signs associated with infraclinical hypothyroidism at the initial examination (elevated serum cholesterol, abnormal ECG, eyelid edema, recent weight gain) were unchanged at the second examination, both in treated and not treated women. A logistic model including all these factors demonstrated that the probability of prescription of thyroid hormone replacement therapy increased 5.4-fold when the starting TSH level was above 6 mU/l and 3.2-fold if ECG abnormalities were present. Using a statistical model with anti TPO antibodies, a level above 64 U/l increased the probability of treatment 7-fold, with ECG findings being related to probability of treatment. Age, cholesterol level, use to lipid lowering drugs, presence of eyelid edema or weight gain were not associated with replacement therapy in this model. No consistent conclusion concerning the appropriateness of screening for infraclinical hypothyroidism can be drawn from these three-year follow-up findings. Another examination scheduled for 2003 should provide further precision concerning the natural history of infraclinical hypothyroidism as well as long-term medical practices and therapeutic impact.
    Annales d Endocrinologie 01/2003; 63(6 Pt 1):505-10. · 1.02 Impact Factor

Publication Stats

1k Citations
178.21 Total Impact Points

Institutions

  • 1995
    • Institut inter Régional pour la SAnté
      Tours, Centre, France
  • 1989–1994
    • University of Texas Health Science Center at Houston
      • Graduate School of Biomedical Sciences
      Houston, TX, United States
  • 1990
    • Agence de Médecine Préventive
      Lutetia Parisorum, Île-de-France, France