J P Daures

Université de Nîmes, Nismes, Languedoc-Roussillon, France

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Publications (261)808.62 Total impact

  • Annals of the Rheumatic Diseases 06/2015; 74(Suppl 2):430.3-431. DOI:10.1136/annrheumdis-2015-eular.4243 · 10.38 Impact Factor
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    Laurent Bailly · Jean Pierre Daurès · Brigitte Dunais · Christian Pradier
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    ABSTRACT: Cancer incidence and prevalence estimates are necessary to inform health policy, to predict public health impact and to identify etiological factors. Registers have been used to estimate the number of cancer cases. To be reliable and useful, cancer registry data should be complete. Capture-recapture is a method for estimating the number of cases missed, originally developed in ecology to estimate the size of animal populations. Capture recapture methods in cancer epidemiology involve modelling the overlap between lists of individuals using log-linear models. These models rely on assumption of independence of sources and equal catchability between individuals, unlikely to be satisfied in cancer population as severe cases are more likely to be captured than simple cases. To estimate cancer population and completeness of cancer registry, we applied Mth models that rely on parameters that influence capture as time of capture (t) and individual heterogeneity (h) and compared results to the ones obtained with classical log-linear models and sample coverage approach. For three sources collecting breast and colorectal cancer cases (Histopathological cancer registry, hospital Multidisciplinary Team Meetings, and cancer screening programmes), individual heterogeneity is suspected in cancer population due to age, gender, screening history or presence of metastases. Individual heterogeneity is hardly analysed as classical log-linear models usually pool it with between-"list" dependence. We applied Bayesian Model Averaging which can be applied with small sample without asymptotic assumption, contrary to the maximum likelihood estimate procedure. Cancer population estimates were based on the results of the Mh model, with an averaged estimate of 803 cases of breast cancer and 521 cases of colorectal cancer. In the log-linear model, estimates were of 791 cases of breast cancer and 527 cases of colorectal cancer according to the retained models (729 and 481 histological cases, respectively). We applied Mth models and Bayesian population estimation to small sample of a cancer population. Advantage of Mth models applied to cancer datasets, is the ability to explore individual factors associated with capture heterogeneity, as equal capture probability assumption is unlikely. Mth models and Bayesian population estimation are well-suited for capture-recapture in a heterogeneous cancer population.
    BMC Medical Research Methodology 04/2015; 15(1):39. DOI:10.1186/s12874-015-0029-7 · 2.17 Impact Factor
  • J.L. Pujol · A. Coffy · J.P. Mérel · J.P. Daurès
  • Revue d Épidémiologie et de Santé Publique 08/2014; 62:S152-S153. DOI:10.1016/j.respe.2014.05.091 · 0.66 Impact Factor
  • Statistical Modelling 02/2014; 14(1):77-98. DOI:10.1177/1471082X13497642 · 0.79 Impact Factor
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    ABSTRACT: Background Influence of uveitis on clinical, epidemiological and imaging features in patients with inflammatory back pain (IBP) related to spondyloarthritis (SpA) needs to be known. Objectives To determine the prevalence of uveitis in patients with recent IBP suggestive of SpA, and to investigate the influence of uveitis on the overall features of patients presenting with recent IBP. Methods The DESIR cohort is a prospective, multicenter French cohort of patients with early IBP (Calin or Berlin criteria) (>3 months and <3 years of duration) suggestive of SpA according to the investigator, including 708 patients (mean age 33.8 years, 53.8% female, 57.3% HLA B27 positive). Uveitis was defined by an ophthalmological episode diagnosed as uveitis by an ophthalmologist, or a painful red eye episode of at least 48 hours duration and/or necessitating local steroids. Data on the baseline demographic characteristics, functional status and quality of life, imaging features (standard X-Rays, MRI, Ultrasounds), BMD, and blood tests were compared in patients with and without uveitis. Both the date of the first symptom of IBP and the symptoms of uveitis were recorded, as well as the date of the visit. Factors associated with the presence of uveitis were identified both by uni and multivariate analysis (logistic regression). Results The prevalence of uveitis in the DESIR cohort was 8.47% [95%CI 6.58-10.83] (n=60/708 patients). Uveitis occurred after the first symptoms of IBP in 45%, before in 37%, and simultaneously (±1month) in 18% of the cases. Presence of uveitis was significantly associated in univariate analysis with pain in cervical spine, infection preceding (less than 3 months) inflammatory disease, previous diagnosis of inflammatory bowel disease, some dimensions of SF36 (mental and physical health, relation), presence of Achilles enthesitis, elevated leukocyte count, serum creatinin levels, radiological hip involvement, and chronic sacro iliac MRI lesions. Uveitis is not associated with fulfilment of diagnosis criteria, HLA-B27, BASDAI, BASFI, ASDAS, BMD. A stepwise multivariate analysis found an association between uveitis and: pain in cervical spine, infection preceding inflammatory disease, previous diagnosis of inflammatory bowel disease, physical health limitation of SF36 (Table). Conclusions In recent IBP suggestive of SpA, uveitis is associated with some particular rheumatologic and extra rheumatologic features. Our data, and in particular the association with IBD and infection might suggest a role of environmental factors in the incidence of uveitis in SpA. Disclosure of Interest None Declared
    Annals of the Rheumatic Diseases 01/2014; 71(Suppl 3):561-561. DOI:10.1136/annrheumdis-2012-eular.3211 · 10.38 Impact Factor
  • Y.- M. Pers · S. Lacombe · S. Fabre · J.- P. Daures · J. Rouviere · J. Sany
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    ABSTRACT: Background Network PR-LR is designed to improve the management of patients with rheumatoid arthritis (RA) in the Languedoc Roussillon (France). It conducts training activities, information for patients and health professionals on rheumatoid arthritis. It now has 1,263 patients. There is an anonymized medical records and computerized for each patient which allows regular monitoring. Objectives Compare the consumption of medical procedures between patients in or those outside to the network system. Methods To study the data from RA patients, we asked to the regional health insurance company (RHIC) a list of patients with medical and economic information usable. We gave the health insurance list of patient care within the network. The RHIC has extracted about two years (June 2009-July 2011) a database containing anonymised patient outside the network PR-LR. Once we got the information from the RHIC, we analyzed several criteria: per diem reimbursement, visits to the doctor, number of visits to specialists, many acts of biology and radiology. Other criteria have not yet been exploited due to lack of data: type of treatment (use of corticosteroids, NSAIDs, DMARDs or biological agents), number of hospitalizations, surgical procedures. For comparison of common variables, we used a Chi2 test. Results Over the period studied, we obtained 5936 non-network patients versus 465 patients in the network and living in the Languedoc Roussillon. Non-network patients (N=5936) were a mean age of 61.86 years (SD 15.18), duration symptoms RA of 6 years (SD 3.8). There are 1631 men and 4305 women. The sex male/female ratio is 0.37. Patients Network (N=465) had a mean age of 62.49 years (SD 14.71), an unknown length of RA. There are 99 men and 306 women. The sex male/female ratio is 0.27. There is a significant difference between the 2 groups. In the Network patients group, we observed: Conclusions This study has many limitations but shows for the first time a benefit of a network of care on the treatment of RA patients. Better monitoring through the computer interface allows us a better tight control of the patient and a profit on medical consumption shown by the decrease in visits to the doctor, acts of x-rays and the number of per diem reimbursement. Disclosure of Interest None Declared
    Annals of the Rheumatic Diseases 01/2014; 71(Suppl 3):717-717. DOI:10.1136/annrheumdis-2012-eular.1388 · 10.38 Impact Factor
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    ABSTRACT: To investigate if patients with early RA with persistent moderate disease activity during the first year after diagnosis have a worse 3-5 year outcome than those who achieve sustained clinical remission within the first year, in a daily life setting. The ESPOIR cohort included patients with early arthritis of <6 months' duration. Treatment was the standard of care. We had 5-year follow-up data for 573 patients. This study compared patients who had persistent moderate disease activity (Disease Activity Score in 28 joints (DAS28)>3.2 and ≤5.1) at both the 6- and 12-month visits, with those who were in sustained DAS28 remission. The primary outcome was radiographic progression at the 36-month visit. Secondary endpoints were clinical remission (DAS28 score, Simplified Disease Activity Index, ACR/EULAR criteria), Health Assessment Questionnaire-Disability Index (HAQ-DI) and number of missed workdays at months 36 and 60. A Fisher exact test was used to compare categorical variables, and the Kruskal-Wallis test for quantitative variables. Logistic regression analysis was used to determine predictors of outcome. Patients were aged 48.1±12.5 years and their duration of symptoms was 103.2±52.1 days. Mean baseline DAS28 was 5.1±1.3. Persistent moderate disease activity (107 patients) rather than sustained remission (155 patients) during the first year was associated with increased radiographic disease progression at 3 years (OR=1.99 (95% CI 1.01 to 3.79)), increased HAQ-DI at 3 and 5 years (5.23 (2.81 to 9.73) and 4.10 (2.16 to 7.80), respectively), a 7-11 times smaller chance of achieving clinical remission and a five times greater number of missed workdays. Patients with early RA with persistent moderate disease activity during the first year had a worse outcome than patients who achieved sustained clinical remission. Persistent moderate disease activity affects long-term structure, remission rate and functional and work disability. Such patients may benefit from intensive treatment.
    Annals of the rheumatic diseases 01/2014; 74(4). DOI:10.1136/annrheumdis-2013-204178 · 10.38 Impact Factor
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    C Baümler · C Herlin · JP Daures · G Captier
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    C Herlin · C Baümler · JP Daures · G Captier
  • Revue d Épidémiologie et de Santé Publique 09/2012; 60:S70. DOI:10.1016/j.respe.2012.06.095 · 0.66 Impact Factor
  • A. Durand · D. Bourin · F. Borie · C. Castelli · J.-P. Daures · J.-M. Kinowski
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    ABSTRACT: Background Ultracision® and Ligasure® are medical devices used to achieve hemostasis of tissue during their section. In our hospital, Ligasure® applications are stable whereas Ultracision® applications continue to grow. That's why the acquisition of a second Ultracision® generator was requested by the hospital surgeons. Given the high cost, the pharmacy analysed the use of existing generators. The objectives of the study are to verify that Ultracision® and Ligasure® are used according to the predefined indications, that the use of existing generators is optimized, and to perform an economic evaluation. Design The survey was conducted during 6 months in digestive, gynecology and urology surgical unit. Characteristics of the patients, the intervention, and the hospital stay were collected. Economic data were obtained from national economic data and hospital stay related group (GHS). Results Ultracision® was used in 110 interventions and Ligasure® for 83 patients; 85% of the indications corresponded with those validated. Ultracision® and Ligasure® allowed a reduced length of stay, with an increase in revenue respectively of € 877,51 and € 628,75 per patient. Conclusion The study confirmed the compliance to the proper use and the increasing use of pliers. The device's cost is offset by a gain in length of stay. This work has made it possible to justify the acquisition of a second Ultracision® generator.
    06/2012; 47(2):116–122. DOI:10.1016/j.phclin.2011.11.004
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    ABSTRACT: Mastermind-like domain containing 1 (MAMLD1) is a causative gene for the fetal development of male external genitalia. Almost 10% of patients with both severe and non-severe hypospadias exhibit mutations of MAMLD1. The aim of this work was to determine whether polymorphisms of MAMLD1 are a genetic risk factor for hypospadias. This study included 150 hypospadias with a range of severities and 150 controls. Direct sequencing of the MAMLD1 coding exons and their flanking splice sites was performed. In silico secondary and tertiary structure prediction and accessibility of changed amino acids were evaluated using JPred, Netsurf and PHYRE software. Functional studies of the transactivation of haplotypes on Hes3 promoter were performed in vitro using cDNAs of missense variants of MAMLD1. The p.P286S polymorphism was identified in 17/150 patients and 12/150 controls (11.3% vs. 8.0%, p = 0.32). The p.N589S polymorphism was identified in 22/150 patients and 12/150 controls (14.6% vs. 8.0%, p = 0.068). The double polymorphism (S-S haplotype) was present in 16/150 patients and 6/150 controls (10.6% vs. 4.0%, p = 0.044, OR = 2.87, CI from 1.09 to 7.55). The association of polymorphisms consistently revealed a modification in the structure prediction or amino acid accessibility in all three in silico models. The P286S, N589S and P286S + N589S proteins did not exhibit reduced transactivating activity on Hes3 promoter. Polymorphisms of MAMLD1 gene are frequent in patients with hypospadias. Although no change in transactivation was noted on Hes3 promoter, the in silico studies and the significantly increased incidence of the S-S haplotype in hypospadiac patients raise the hypothesis of a particular susceptibility conferred by these variants.
    Journal of pediatric urology 12/2011; 7(6):585-91. DOI:10.1016/j.jpurol.2011.09.005 · 1.41 Impact Factor
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    ABSTRACT: To study the contribution of routine viral screening tests in patients with early rheumatoid arthritis (RA) or a potential for progressing to RA. Eight hundred thirteen patients with swelling of at least 2 joints for at least 6 weeks and a symptom duration of less than 6 months in the ESPOIR cohort were screened for parvovirus B19 (IgG and IgM anti-parvovirus B19 antibodies), hepatitis B virus (HBV; hepatitis B surface antigen), hepatitis C virus (HCV; anti-HCV antibodies), and human immunodeficiency virus (HIV; anti-HIV-1 and -2 antibodies). Parvovirus B19 testing was performed in 806 patients and showed longstanding immunity in 574 (71.2%) and no antibodies in 223 (27.7%). Among the 9 remaining patients (7 IgG positive/IgM positive, 1 IgG negative/IgM positive, and 1 IgG indeterminate/IgM positive), only 2 (0.25%; 95% confidence interval [95% CI] 0-0.99%) had a positive polymerase chain reaction test for parvovirus B19; these patients (women ages 34 and 40 years) had no extraarticular signs. HIV seroprevalence was 0.12% (n = 1 of 813; 95% CI 0.01-0.8%) and HCV seroprevalence was 0.86% (n = 7 of 808, 95% CI 0.38-1.86%). HCV-related arthritis was diagnosed in 4 patients (0.5%). HCV-seropositive patients had significantly higher transaminase levels than the other patients (P = 0.001), with no significant differences for the other laboratory data. HBV seroprevalence was 0.12% (n = 1 of 808; 95% CI 0.01-0.8%); the positive HBV status was known before study inclusion, and the patient had no diagnosis of HBV-related arthritis. Finally, routine viral testing identified 2 patients with parvovirus B19 infection and 3 with HBV infection (0.6%; 95% CI 0.2-1.5%). Cost was €85.05 per patient (total €68,720). Routine serologic testing did not contribute substantially to the diagnosis in this context.
    11/2011; 63(11):1565-70. DOI:10.1002/acr.20576
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    ABSTRACT: Over the past decades, an increasing trend in male external genital malformations such as cryptorchidism and hypospadias has led to the suspicion that environmental chemicals are detrimental to male fetal sexual development. Several environmental pollutants, including organochlorine pesticides, polychlorinated biphenyls, bisphenol A, phthalates, dioxins and furans have estrogenic and anti-androgenic activity and are thus considered as endocrine-disrupting chemicals (EDCs). Since male sex differentiation is critically dependent on the normal production and action of androgens during fetal life, EDCs may be able to alter normal male sex differentiation. The objective of this study was to determine the incidence of external genital malformations in a population of full-term newborn males in southern France. We also performed a case-control study to identify the risk factors for male external genital malformations, with a focus on parental occupational exposure to EDCs. Over a 16-month period, 1615 full-term newborn males with a birth weight above 2500 g were registered on a level-1 maternity ward, and the same pediatrician systematically examined 1442 of them (89%) for cryptorchidism, hypospadias and micropenis. For every male newborn with genital malformation, we enrolled nearly two males matched for age, parity and term. All parents of the case and control newborns were interviewed about pregnancy aspects, personal characteristics, lifestyle and their occupational exposure to EDCs using a detailed questionnaire. RESULTS We report 39 cases of genital malformation (2.70%), with 18 cases of cryptorchidism (1.25%), 14 of hypospadias (0.97%), 5 of micropenis (0.35%) and 2 of 46,XY disorders of sexual differentiation (DSD; 0.14%). We observed a significant relationship between newborn cryptorchidism, hypospadias or micropenis and parental occupational exposure to pesticides [odds ratio (OR) = 4.41; 95% confidence interval (95% CI), 1.21-16.00]. Familial clustering for male external genital malformations (OR = 7.25; 95% CI, 0.70-74.30) and medications taken by mothers during pregnancy (OR = 5.87; 95% CI, 0.93-37.00) were associated with the risk of cryptorchidism, hypospadias and micropenis, although the association was not statistically significant. Although the causes of male genital malformation are multifactorial, our data support the hypothesis that prenatal contamination by pesticides may be a potential risk factor for newborn male external genital malformation and it should thus be routinely investigated in all undervirilized newborn males.
    Human Reproduction 08/2011; 26(11):3155-62. DOI:10.1093/humrep/der283 · 4.59 Impact Factor
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    ABSTRACT: Cancer population studies require reliable and complete baseline data, which should theoretically be available by collecting histopathology records. The completeness of such a collection was evaluated using capture-recapture analysis based on three data sources concerning breast and colorectal cancers over an identical period and within the same geographical area. The total number of breast and colon cancer cases was estimated using capture-recapture analysis based on the number of cases which were common or not between sources recording screened, diagnosed and treated cancers in the French Alpes Maritimes district. The estimated total number of new cases of breast cancer diagnosed among Alpes Maritimes residents women aged 50-75 was 791 (95% CI: 784-797) in 2008. Of these 791 cases, 729 were identified through histopathology records, thus amounting to 92.2% completeness (95% CI: 91.5-93.0%). The total estimated number of new cases of colorectal cancer diagnosed among Alpes Maritimes residents aged 50-75 was 527 (95% CI: 517-536). Of these 527 cases, 481 were identified through histopathology records, thus amounting to 91.3% completeness (95% CI: 89.7-93.0%). The estimated completeness of cancer records collected from histopathology laboratories was higher than 90% for new cases of breast and colorectal cancer within the age range concerned by the screening programme. A verified and validated histopathology data collection may be useful for cancer population studies.
    08/2011; 35(6):e62-8. DOI:10.1016/j.canep.2011.05.017
  • A Mahamat · K Brooker · J P Daures · I M Gould
    The Journal of hospital infection 07/2011; 78(3):243-5. DOI:10.1016/j.jhin.2011.03.005 · 2.78 Impact Factor
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    G Mouterde · C Lukas · I Logeart · R M Flipo · N Rincheval · J P Daurès · B Combe
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    ABSTRACT: To determine predictors of short-term radiographic progression in an inception cohort of patients with early arthritis. Patients presenting with synovitis of at least two joints for 6 weeks to 6 months were included in the Etude et Suivi des POlyarthrites Indifferenciées Récentes (ESPOIR) cohort. Univariate analysis was used to determine the relationship between baseline variables and radiographic outcome (assessed by the modified total Sharp score (mTSS)) after 6 and 12 months. Stepwise multiple logistic regression was used to select independent predictive factors. The sensitivity and specificity of rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA) at baseline in discriminating between erosive and non-erosive disease were determined by receiver operating characteristic (ROC) curves. From data available for 736 patients, radiographic progression at 6 months was independently predicted by baseline ACPA, human leucocyte antigen (HLA)-DRB1*01 and/or 04 genes, erythrocyte sedimentation rate and mTSS. Interestingly, the season of onset of the first symptoms was associated with the severity of early arthritis (OR 1.66, 95% CI 1.07 to 2.59, in winter and spring vs summer and autumn). Univariate analysis revealed similar results for season at 12 months (OR 1.68, 95% CI 1.20 to 2.37). The peak of the ROC curves for radiographic outcome occurred with ACPA and RF values similar to the cut-offs provided by manufacturers. The authors found the onset of arthritis symptoms during winter or spring associated with greater radiographic progression at 6 months for patients with early arthritis. These data could reinforce the role of environmental factors in the development and outcome of rheumatoid arthritis.
    Annals of the rheumatic diseases 07/2011; 70(7):1251-6. DOI:10.1136/ard.2010.144402 · 10.38 Impact Factor
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    ABSTRACT: Education of patients with chronic hepatitis C has been proposed to increase response to therapy with peginterferon and ribavirin. We performed a prospective study to determine the effects of systematic consultation by a nurse on patient adherence and the efficacy of therapy. We analyzed data from 244 patients who received either systematic consultation after each medical visit from a nurse who used a standard evaluation grid and provided information about the disease and treatment (group A [GrA], n = 123) or the conventional clinical follow-up procedure (group B [GrB], n = 121). Treatment lasted 24 to 48 weeks. Characteristics of each group were similar at baseline, including prior treatment (42.6% in GrA and 36.0% in GrB). Overall, GrA had significantly better adherence to treatment than GrB (74.0% vs 62.8%), especially among patients who received 48 weeks of treatment (69.7% vs 53.2%; P < .03). Significantly more patients in GrA had a sustained virologic response, compared with GrB overall (38.2% vs 24.8%; P < .02), as well as treatment-naive patients (47.1% vs 30.3%; P < .05), and those with genotypes 1, 4, or 5 infections (31.6% vs 13.3%; P < .007). There were no differences between GrA and GrB in response of patients with genotypes 2 or 3 infections or advanced fibrosis. Prognostic factors for a sustained virologic response (based on bivariate and multivariate analyses) were virologic response at week 12 (odds ratio [OR], 1.9; P < .0001), genotypes 2 or 3 (OR, 2.9; P < .0001), therapeutic education (OR, 2.5; P < .02), and lack of previous treatment (OR, 2.3; P < .005). Therapeutic education by a specialized nurse increases the response of patients with hepatitis C to therapy, particularly in difficult-to-treat patients.
    Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 06/2011; 9(9):781-5. DOI:10.1016/j.cgh.2011.05.022 · 6.53 Impact Factor
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    ABSTRACT: Most clinical guidelines recommend that AIDS-free, HIV-infected persons with CD4 cell counts below 0.350 × 10(9) cells/L initiate combined antiretroviral therapy (cART), but the optimal CD4 cell count at which cART should be initiated remains a matter of debate. To identify the optimal CD4 cell count at which cART should be initiated. Prospective observational data from the HIV-CAUSAL Collaboration and dynamic marginal structural models were used to compare cART initiation strategies for CD4 thresholds between 0.200 and 0.500 × 10(9) cells/L. HIV clinics in Europe and the Veterans Health Administration system in the United States. 20, 971 HIV-infected, therapy-naive persons with baseline CD4 cell counts at or above 0.500 × 10(9) cells/L and no previous AIDS-defining illnesses, of whom 8392 had a CD4 cell count that decreased into the range of 0.200 to 0.499 × 10(9) cells/L and were included in the analysis. Hazard ratios and survival proportions for all-cause mortality and a combined end point of AIDS-defining illness or death. Compared with initiating cART at the CD4 cell count threshold of 0.500 × 10(9) cells/L, the mortality hazard ratio was 1.01 (95% CI, 0.84 to 1.22) for the 0.350 threshold and 1.20 (CI, 0.97 to 1.48) for the 0.200 threshold. The corresponding hazard ratios were 1.38 (CI, 1.23 to 1.56) and 1.90 (CI, 1.67 to 2.15), respectively, for the combined end point of AIDS-defining illness or death. Limitations: CD4 cell count at cART initiation was not randomized. Residual confounding may exist. Initiation of cART at a threshold CD4 count of 0.500 × 10(9) cells/L increases AIDS-free survival. However, mortality did not vary substantially with the use of CD4 thresholds between 0.300 and 0.500 × 10(9) cells/L.
    Annals of internal medicine 04/2011; 154(8):509-15. DOI:10.1059/0003-4819-154-8-201104190-00001 · 16.10 Impact Factor

Publication Stats

5k Citations
808.62 Total Impact Points

Institutions

  • 1996–2014
    • Université de Nîmes
      Nismes, Languedoc-Roussillon, France
  • 1989–2011
    • Institut de Recherche en Cancerologie de Montpellier
      Montpelhièr, Languedoc-Roussillon, France
  • 2008–2009
    • Université Montpellier 2 Sciences et Techniques
      Montpelhièr, Languedoc-Roussillon, France
    • Novartis
      Bâle, Basel-City, Switzerland
  • 1999–2009
    • Institut Universitaire de France
      Lutetia Parisorum, Île-de-France, France
    • Unité Inserm U1077
      Caen, Lower Normandy, France
  • 2007–2008
    • Université de Montpellier 1
      Montpelhièr, Languedoc-Roussillon, France
  • 2006
    • Centre Hospitalier Universitaire de Clermont-Ferrand
      Clermont, Auvergne, France
  • 1990–2001
    • Centre Hospitalier Universitaire de Montpellier
      • Department of Epidemiology, Biostatistics and Medical Information
      Montpelhièr, Languedoc-Roussillon, France
  • 1996–1997
    • Centre Hospitalier Régional Universitaire de Nîmes
      Nismes, Languedoc-Roussillon, France
  • 1994
    • Centre Hospitalier Régional et Universitaire de Besançon
      Becoinson, Franche-Comté, France
  • 1992
    • Observatoire Régional de la Santé Ile-de-France
      Lutetia Parisorum, Île-de-France, France