Publications by authors named "Beatrice Trombert"

39 Publications

Sleep quality and sleep disturbances among volunteer and professional French firefighters: FIRESLEEP study.

Sleep Med 2021 Feb 2;80:228-235. Epub 2021 Feb 2.

Clinical and Exercise Physiology, EA 4607 SNA EPIS, University Hospital and Jean Monnet University, PRES Lyon, 42023 Saint-Etienne, France. Electronic address:

Background: Although insufficient sleep among firefighters reduces work efficiency and increases the risk of injury, little is known about the sleep quality of French firefighters in the Loire department. The aim of the FIRESLEEP study was to evaluate sleep quality and sleep disturbances among professional and voluntary French firefighters.

Methods: A cross-sectional observational study was conducted between November 2018 and May 2019. Firefighters were invited to complete a questionnaire on a secure platform including clinical questions and validated questionnaires (Pittsburgh Sleep Quality Index [PSQI], Epworth sleepiness scale [ESS], Insomnia Severity Index [ISI] and the STOP-Bang score) during their periodic medical examination.

Results: 193 firefighters were included in this study, of which 29% were of professional status and 71% were volunteer firefighters. Among them, 26.9% had poor sleep quality, 27.7% showed excessive daytime sleepiness (EDS), 18.8% reported moderate-to-severe symptoms of insomnia, and 1.6% had moderate-to-high risk of obstructive sleep apnea. Subgroup analysis revealed that professional firefighters had poorer sleep quality and higher sleep disturbances than volunteer firefighters. The independent risk factors associated with poor sleep quality were known sleep disorder, treated anxiety/depression, night calls, and insomnia symptoms. Moreover, the independent risk factors associated with EDS were short sleep duration, taking a nap, and insomnia symptoms; while older age was a protective factor for EDS.

Conclusions: Poor sleep quality and sleep disturbances are highly frequent in French firefighters and underdiagnosed. Prevention through education and systematic screening could limit the impact of sleep disturbances on firefighters' global health.
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http://dx.doi.org/10.1016/j.sleep.2021.01.041DOI Listing
February 2021

Prevalence of cardiovascular risk factors in a population of French firefighters.

Arch Environ Occup Health 2021 16;76(1):45-51. Epub 2020 Jun 16.

Department of Occupational Health, University Hospital, Saint-Priest-en-Jarez cedex, France.

Firefighters' activities increase the risk of sudden cardiac events. The main objective of this study was to describe the Loire firefighters' cardiovascular risk factors according to their cardiovascular risk and to their professional status. A retrospective study of the entire population of firefighters of the Loire department was conducted. Risk factors derived from the data collected during the occupational health follow-up medical examinations were described and the cardiovascular risk was assessed for 417 firefighters. The most frequent cardiovascular risk factors were: overweight and obesity (62.1%), high blood pressure (27.8%) and active smoking (16,1%). There were no significant differences between career firefighters and volunteers. The prevalence of risk factors for cardiovascular diseases is less than in the general population. Obesity remains the most common risk factor, especially among firefighters with high cardiovascular risk.
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http://dx.doi.org/10.1080/19338244.2020.1779017DOI Listing
June 2020

Immediate Benefit of Art on Pain and Well-Being in Community-Dwelling Patients with Mild Alzheimer's.

Am J Alzheimers Dis Other Demen 2020 Jan-Dec;35:1533317519859202. Epub 2019 Jul 9.

Neurology Unit, CM2R, University Hospital of Saint-Etienne, Saint-Etienne, France.

Objective: The present report aims to evaluate whether singing intervention can bring an immediate benefit that is greater than the one provided by painting intervention on pain and well-being.

Methods: Fifty-nine mild patients with Alzheimer disease were randomized to a 12-week singing (n = 31) or painting group (n = 28). In the present analysis, the immediate evolution of pain and well-being was compared across sessions between the 2 groups using mixed-effects models.

Results: We observed a significant improvement in well-being for both singing and painting groups immediately after sessions, compared to the assessment before the sessions. We did not observe this improvement across the sessions for pain intensity measurement.

Discussion: Our results revealed that both painting and singing interventions provide an immediate benefit on the patients' well-being.
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http://dx.doi.org/10.1177/1533317519859202DOI Listing
December 2020

A prospective, randomized study evaluating the pain felt during intrauterine device insertion by the direct technique vs conventional technique.

J Gynecol Obstet Hum Reprod 2019 Nov 9;48(9):719-725. Epub 2019 May 9.

Gynecology and Obstetrics Department, Saint-Etienne University Hospital Center, North Hospital, avenue Albert Raimond, 42270 Saint Priest en Jarez, France; INSERM, SAINBIOSE, U1059, Vascular Dysfunction and Hemostasis, Jean-Monnet University of Saint-Etienne, CIC1408, 42055 Saint-Etienne, France. Electronic address:

Objective: To assess the value of the direct insertion technique compared to the conventional insertion technique in reducing the pain experienced during placement of an intrauterine device (IUD).

Methods: A prospective, controlled, randomized, single-blind trial was conducted in women eligible for IUD insertion. Participants were randomized into two groups: "conventional placement" and "direct placement". The primary endpoint was the percentage of women reporting pain scored as ≥ 4 on the Numerical Verbal Rating Scale (NVRS) at IUD release. Secondary endpoints comprised the number of immediate incidents (insertion failure, vasovagal reaction, and IUD expulsion), the correct positioning of the IUD, checked by ultrasound, the occurrence of incidents within the week following IUD insertion, and the operators' evaluation of the procedure.

Results: A total of 60 patients were enrolled. During IUD insertion, 27 women (45.8%) reported an NVRS score ≥ 4, 32.1% in the "direct placement" group and 58.1% in the "conventional placement" group (p = 0.07). The median NVRS pain scores in the "direct placement" and "classic placement" groups were 2 and 4, respectively (p = 0.01). No statistically significant between-group differences were found with regard to the secondary endpoints.

Conclusion: Use of the direct technique reduced the pain experienced during IUD placement. We observed a trend towards a decreased proportion of patients reporting an NVRS pain score ≥ 4 at IUD release with use of the direct technique and the median pain intensity scored on the NVRS was significantly lower in this group. The two techniques did not differ with respect to complications.
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http://dx.doi.org/10.1016/j.jogoh.2019.05.010DOI Listing
November 2019

Volunteer and career French firefighters: Cardiovascular risk factors and cardiovascular risk assessment.

Eur J Prev Cardiol 2020 01 5;27(1):107-109. Epub 2019 Feb 5.

Clinical and Exercise Physiology, EA 4607 SNA EPIS, University Hospital and Jean Monnet University, Saint-Etienne, France.

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http://dx.doi.org/10.1177/2047487319827463DOI Listing
January 2020

[Evaluation of 114 abnormal Pap smear follow-up in ambulatory care.]

Sante Publique 2018 July August;30(4):527-532

Aim: In France, cervical cancer screening has led to a decrease in mortality, though it could be optimized by improving the management of abnormal cytology. The aim was to evaluate the follow-up of women with abnormal Pap smear prescribed by an ambulatory health professional, compared to the ANAES guidelines of 2002.

Method: Quantitative monocentric and retrospective study of 120 women with abnormal Pap smear performed before October 2014 in the French department of the Loire.

Results: 114 abnormal Pap smear follow-ups of women between the ages of 18 and 75 have been analyzed. Cytological abnormalities were spread among 90 ASC-US (79%), 16 LSIL (14%), 6 HSIL (5,3%) and 2 ASC-H (1,7%). Compared to the ANAES guidelines, 52% of follow-ups were incomplete, 24% were comprehensive with too long of a delay, and 24% were guidelines compliant. Women under 29 were more likely to have an incomplete follow-up: OR 0,306 [0,116-0,805].

Conclusion: In our sample, the analysis of the follow-ups of women with abnormal Pap smear has reflected over screening and lack of conformity, eventually allowing the screened lesion to progress towards cancer. A national screening program could help to improve the quality of a follow-up for these women.
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http://dx.doi.org/10.3917/spub.185.0527DOI Listing
February 2019

Volunteer and Career French Firefighters With High Cardiovascular Risk: Epidemiology and Exercise Tests.

J Occup Environ Med 2018 10;60(10):e548-e553

Department of Education and Research in General Practice, Saint-Etienne Jean Monnet University, Saint Priest en Jarez, France (Drs Savall, Charles); SDIS 42, Fire and Rescue Department of Saint Etienne, Saint Etienne cedex, France (Drs Charles, Frey); Public Health, University Hospital, Saint-Priest-en-Jarez cedex, France (Dr Trombert); Department of Occupational Health, University Hospital, Saint-Priest-en-Jarez cedex, France (Drs Fontana, Pelissier); University Lyon 1, University of St Etienne, IFSTTAR, UMRESTTE, UMR-T9405, Saint Etienne, France (Drs Fontana, Pelissier); and Clinical and Exercise Physiology, EA 4607 SNA EPIS, University Hospital and Jean Monnet University, PRES Lyon, Saint-Etienne, France (Drs Savall, Trombert, Barthélémy).

Objective: We aim to identify cardiovascular risk factors in firefighters of Loire (French district) with a high cardiovascular risk and report results of a screening program using exercise tests.

Methods: A retrospective descriptive study was performed in a cohort of 158 career and 400 volunteer firefighters with a high cardiovascular risk who had undergone an exercise test.

Results: Five hundred fifty-eight exercise tests and cardiovascular profiles were analyzed. Prevalence was 18% for high blood pressure, 19% for dyslipidemia, and 48% for overweight. Exercise tests were positive in 91 cases (16.3%): sensitivity, 53%; specificity, 74%. Risk of onset of a predictive event was higher in the high-risk group: odds ratio, 3.2 (95% confidence interval 2.0 to 5.1). There were more events on exercise test in volunteer firefighters.

Conclusion: Prevalence of cardiovascular risk factors in the cohort of firefighters was acceptable in comparison to French general population and other firefighters' cohort. Physical training of volunteer firefighters needs reinforcing.
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http://dx.doi.org/10.1097/JOM.0000000000001426DOI Listing
October 2018

Scrutinizing SNOMED CT's Ability to Reconcile Clinical Language Ambiguities with an Ontology Representation.

Stud Health Technol Inform 2018 ;247:910-914

University of Manchester UK.

An important SNOMED CT use case is to support semantic interoperability between electronic health records and aggregation terminologies such as ICD. From the ongoing alignment exercise between SNOMED CT and the new version of ICD, now in its pre-final form, we studied whether the ambiguity of clinical language as displayed by SNOMED CT synonyms hampers the quality of SNOMED CT axioms following the SNOMED CT "concept model". We measure the rate of synonyms in the semantic misalignment between classes from the chapter on circulatory diseases of the ICD-11 beta version and SNOMED CT concepts with the same description names. Our study confirms that SNOMED CT synonyms are ambiguous and that there is a need to increase the number of SNOMED CT fully defined representations of Fully Specified Names (FSN), and of synonyms independently of their relations.
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June 2018

Personality Modulates the Efficacy of Art Intervention on Chronic Pain in a Population of Patients with Alzheimer's Disease.

J Alzheimers Dis 2018 ;63(2):617-624

Brain Dynamics and Cognition, Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR 5292, Lyon, France.

Background: Alzheimer's disease (AD) mainly occurs in elderly individuals. Comorbidities and chronic pain are frequent in this population. Previous studies revealed that personality modulates both chronic pain (CP) andADoccurrence and evolution. Moreover, as pain treatments can induce side-effects, non-drugs treatments, such as art interventions, are interesting alternative therapies for decreasing CP in these patients.

Objective: Our aim was to assess the potential role of personality traits on art intervention efficacy for reducing CP in a population of patients with mild AD.

Methods: Design: multicenter randomized controlled trial. Fifty mild AD patients underwent a 12-week art intervention including singing and painting groups. Personality was assessed with the Big Five Inventory before the sessions. CP was measured with Numeric Rating Scale (NRS) [Usual pain (NRS-U) and most Intense pain (NRS-I)], Simple Visual Scale [Usual pain (SVS-U) and most Intense pain (SVS-I)] and Brief Pain Inventory (BPI) before and after the sessions. The influence of personality traits on CP evolution before and after art intervention was assessed with multiple linear regression models.

Results: A positive association was observed between neuroticism and the evolution of three CP measures including NRS-U (B = 0.34, p = 0.01), SVS-U (B = 0.20, p = 0.04), and BPI-U (B = 0.46, p = 0.02) evolution. No significant relationship was observed between neuroticism and NRS-I, SVS-I and BPI-R evolution.

Conclusions: Our findings suggest that neuroticism can decrease the efficacy of group art intervention on pain in patients with mild AD. Individual therapies could be more appropriate for these patients. These results emphasize the interest of taking into account patients' personality before proposing them to participate to a group therapy.
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http://dx.doi.org/10.3233/JAD-170990DOI Listing
June 2019

From a Categorical Structure to a Concept Model: The International Classification of Health Interventions (ICHI).

Stud Health Technol Inform 2017 ;245:1334

INSERM U1142, LIMICS, Paris, France.

The International Classification of Health Interventions (ICHI) alpha2 2016 Section 1 Interventions on Body Systems and Functions is based on ISO 1828 international standard named categorial Structure (CAST). This is not sufficient to represent the meaning of ICD9-CM Volume 3 labels. We propose to modify it by using the SNOMED CT concept model.
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June 2018

Can Musical or Painting Interventions Improve Chronic Pain, Mood, Quality of Life, and Cognition in Patients with Mild Alzheimer's Disease? Evidence from a Randomized Controlled Trial.

J Alzheimers Dis 2017 ;60(2):663-677

Memory Clinical and Research Center of Saint Etienne (CMRR) Neurology Unit, University Hospital of Saint Etienne, Saint Etienne, France.

Background: Among non-pharmacological therapies, musical intervention is often used for patients with Alzheimer's disease (AD) and patients presenting chronic pain. However, their efficacy is still under debate.

Objective: Our aim was to determine the efficacy of choral singing versus painting sessions on chronic pain, mood, quality of life, and cognition in AD patients.

Methods: In this multicenter randomized controlled trial, 59 mild AD patients were randomized to a 12-week singing (SG; n = 31) or painting group (PG; n = 28). Chronic pain, anxiety, depression, and quality of life were assessed before, after, and 1 month after the sessions. Cognitive abilities were assessed before and after interventions. The evolution of these different measures was assessed with mixed linear models. The primary data analysis was by intention-to-treat, and completed by a 'per protocol' approach.

Results: Both singing and painting interventions led to significant pain reduction (Time effect: F = 4.71; p = 0.01), reduced anxiety (Time effect: F = 10.74; p < 0.0001), improved Quality of Life (Time effect: F = 6.79; p = 0.002), improved digit span (F = 12.93; p = 0.001), and inhibitory processes (Time effect: F = 4.93; p = 0.03). Depression was reduced over time in PG only (Time x Group effect: F = 4.53; p = 0.01). Verbal Memory performance remained stable over time in SG, but decreased in PG (Time x group effect: F = 9.29; p = 0.004).

Conclusion: Findings suggest that singing and painting interventions may reduce pain and improve mood, quality of life, and cognition in patients with mild AD, with differential effects of painting for depression and singing for memory performance.
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http://dx.doi.org/10.3233/JAD-170410DOI Listing
April 2018

One-Year Evolution of Behavioral and Psychological Symptoms of Dementia in Patients Initially Hospitalized in Cognitive Behavioral Units: The EVITAL Prospective Cohort.

J Alzheimers Dis 2017 ;57(1):147-155

Memory Clinical and Research Center of Lyon (CMRR), Hospital of Charpennes, University Hospital of Lyon, France.

Background: The 2008-2012 French Alzheimer's Plan has provided hospital Cognitive and Behavioral Units (CBU) to improve the management of patients with productive behavioral and psychological symptoms of dementia (BPSD). Little is known concerning the behavioral outcome of these patients after discharge.

Objective: The present study investigated the long-term evolution of BPSD over one year after CBU discharge.

Methods: The EVITAL cohort included 221 participants admitted to the CBUs of 3 French hospitals. BPSD were collected using the Neuropsychiatric Inventory (NPI) at admission and 3, 6, and 12 months after hospitalization. The global NPI score evolution was assessed using a linear mixed-effect model. A four-factor model of the NPI including behavioral dyscontrol, psychosis, mood, and agitation subscores was also analyzed.

Results: Our analysis focused on 148 patients followed up during 12 months and evaluated at each visit. The global NPI score was 48.5 (SD 21.7) at baseline, 28.8 (SD 18.7) at 3-month, 23.2 (SD 16.4) at 6-month and 20.9 (SD 15.9) at 12-month follow-up. The score significantly decreased from baseline to follow-up (F = 109.3 p < 0.0001). Moreover, the decrease was observed for each NPI subscores. The Clinical Dementia Rating (CDR) scale score was significantly linked to the baseline NPI score (t = 2.76, p = 0.009). Conversely, the NPI decline was observed whatever the CDR level.

Conclusion: The present study showed a decrease in the global NPI score and all its subscores during the year following the CBU hospitalization, regardless of the initial CDR score.
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http://dx.doi.org/10.3233/JAD-161023DOI Listing
February 2018

Does the distance between the patient's home and the laboratory influence laboratory monitoring of diabetes?

Sante Publique 2016 Nov;28(5):633-640

Objective: Laboratory tests play an important role in general practice. Access to a clinical laboratory is essential and can potentially influence whether or not these tests are performed. This study assessed the impact of the distance between the patient’s home and the clinical pathology laboratory on laboratory monitoring of diabetes. Methods: This was a retrospective observational study conducted over a period of 3 years on a cohort of diabetic patients from 11 clinical pathology laboratories in the Saint-Etienne region. The primary endpoint was at least three HbA1c, one serum creatinine, one lipid profile and one microalbuminuria over a 12-month period. Statistical analysis was based on the following variables: distance between the patient’s home and the clinical pathology laboratory, patient’s age, their health insurance, type of urban area and the site of blood sampling. Results: Among the 12,773 subjects included, 1,889 (14.8%) complied with the monitoring procedure. The successful monitoring rate decreased by 38% when the distance from the laboratory was more than 5 km (OR 1.38 [1.18 to 1.61]). Monitoring compliance increased with age (OR 0.71 [0.61 to 0.83] for subjects 55-65 years old and 0.61 [0.53 to 0.71] for subjects over 65 years old). However, patients in rural areas and in urban areas with less than 10,000 inhabitants presented better compliance with monitoring than patients living in towns with more than 200,000 inhabitants. Conclusions: Compliance with laboratory monitoring decreased as the distance between the patient’s home and the clinical pathology laboratory increased. These results raise the question of the possible role of home sampling and the availability of other relevant tests required for general practice.
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November 2016

[Automated grouping of terms associated to cardiac valve fibrosis in MedDRA].

Therapie 2016 Dec 21;71(6):541-552. Epub 2016 Jul 21.

UMR_S 1142, Inserm, LIMICS, Sorbonne universités, UPMC université Paris 06, 75006 Paris, France; Service de santé publique et d'information médicale, hôpital nord, centre hospitalier universitaire de Saint-Etienne, 42270 Saint-Etienne, France.

Aim: To propose an alternative approach for building custom groupings of terms that complements the usual approach based on both hierarchical method (selection of reference groupings in medical dictionary for regulatory activities [MedDRA]) and/or textual method (string search), for case reports extraction from a pharmacovigilance database in response to a safety problem. Here we take cardiac valve fibrosis as an example.

Methods: The list of terms obtained by an automated approach, based on querying ontology of adverse drug reactions (OntoADR), a knowledge base defining MedDRA terms through relationships with systematized nomenclature of medicine-clinical terms (SNOMED CT) concepts, was compared with the reference list consisting of 53 preferred terms obtained by hierarchical and textual method. Two queries were performed on OntoADR by using a dedicated software: OntoADR query tools. Both queries excluded congenital diseases, and included a procedure or an auscultation method performed on cardiac valve structures. Query 1 also considered MedDRA terms related to fibrosis, narrowing or calcification of heart valves, and query 2 MedDRA terms described according to one of these four SNOMED CT terms: "Insufficiency", "Valvular sclerosis", "Heart valve calcification" or "Heart valve stenosis".

Results: The reference grouping consisted of 53 MedDRA preferred terms. Our automated method achieved recall of 79% and precision of 100% for query 1 privileging morphological abnormalities, and recall of 100% and precision of 96% for query 2 privileging functional abnormalities.

Conclusion: An alternative approach to MedDRA reference groupings for building custom groupings is feasible for cardiac valve fibrosis. OntoADR is still in development. Its application to other adverse reactions would require significant work for a knowledge engineer to define every MedDRA term, but such definitions could then be queried as many times as necessary by pharmacovigilance professionals.
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http://dx.doi.org/10.1016/j.therap.2016.06.003DOI Listing
December 2016

Histomolecular profiling of pleomorphic, spindle cell, and giant cell carcinoma of the lung for targeted therapies.

Hum Pathol 2016 Mar 2;49:99-106. Epub 2015 Nov 2.

Pathology Department, Saint-Etienne University Hospital, North Hospital, 42055 Saint Étienne CEDEX 2, France.

In pleomorphic, spindle cell, and giant cell carcinoma (PSCGC) of the lung, we wondered if an integrated diagnosis including morphological and immunohistochemical features could be related to molecular status. We performed immunohistochemistry on 35 PSCGCs against TTF1, napsin A, p40, ALK, ROS1, and c-MET. Mutational status regarding EGFR, KRAS, BRAF, HER2, and PIK3CA genes was established. Of 18 PSCGCs with adenocarcinomatous or "undifferentiated" carcinoma differentiation, 8 were mutated for EGFR (n = 1), KRAS (n = 2), BRAF (n = 1), HER2 (n = 3), and PIK3CA (n = 1). No PSCGC (0/4) with only squamous cell or adenosquamous (0/2) differentiation was mutated. c-MET overexpression was only seen in PSCGC with adenocarcinomatous or undifferentiated component (n = 5) without squamous cell component. ROS1 and ALK were negative. The presence of a "targetable mutation" was correlated to the presence of morphological or immunohistochemical adenocarcinomatous differentiation (P = .0137). Integrated diagnosis of an adenocarcinomatous component in PSCGC could be associated with the presence of targetable gene mutation. Because only PSCGC with adenocarcinomatous or undifferentiated carcinoma harbors mutations, whereas PSCGC with only squamous or adenosquamous differentiation does not in our study, this might represent a prescreening for patients with PSCGC to be tested for molecular targets. Our results emphasize that careful morphological examination and the use of immunohistochemistry might be useful for the selection of PSCGC tested for a mutational target.
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http://dx.doi.org/10.1016/j.humpath.2015.10.006DOI Listing
March 2016

ICHI Categorial Structure: a WHO-FIC Tool for Semantic Interoperability of Procedures Classifications.

Stud Health Technol Inform 2015 ;216:1090

Catholic University of Korea, Korea.

Casemix grouping using procedures classifications has become an important use case for health care terminologies. There are so many different national procedures classifications used for Casemix grouping that it is not possible to agree on a worldwide standard. ICHI (International Classification of Health Interventions) is proposing an approach that standardises only the terminologies' model structure. The poster shows the use of the ICHI alpha to replace ICD9 CM Volume 3 in the UNU-CBG International Casemix grouper.
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March 2016

Cerebral relapsing meningioma: a surgical series with lack of reliability of standard parameters establishing prognosis.

Anticancer Res 2015 Jun;35(6):3559-62

Department of Pathology, University Hospital of Saint Etienne-North Hospital, Saint Étienne, France.

Background/aim: Meningioma is the most frequent meningeal neoplasm, usually without relapse or metastasis. Patient follow-up is challenging, not standardized and is decided in multidisciplinary case discussion. Our aim was to determine the clinical and histological factors influencing the time to relapse.

Patients And Methods: We conducted a single-Center retrospective study on 38 patients with surgically-excised relapsing meningiomas and collected clinical and pathological data.

Results: Our results show that none of the histological factors included in the WHO classification, nor those not included are related to a shorter time to relapse.

Conclusion: In our study, none of the histological, immunohistochemical and clinical parameters evaluated seem to be able to predict the time to relapse in meningioma.
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June 2015

Training program for the management of two obstetric emergencies within a French perinatal care network.

Eur J Obstet Gynecol Reprod Biol 2015 Jun 10;189:101-5. Epub 2015 Apr 10.

Obstetrics and Gynecology Department, Saint Etienne University Hospital, Saint-Priest-en-Jarez, France; Jean Monnet University, Faculty of Medicine, Saint Etienne, France; EA 3065 Thrombosis Research Group, Jean Monnet University, Saint Etienne, France. Electronic address:

Objectives: To evaluate the effectiveness of an interdisciplinary team training program based on simulated scenarios and focusing on two obstetrical emergency situations: shoulder dystocia and complicated breech vaginal delivery (CBVD). These situations are rare, so there are few opportunities for real-life training, yet their competent and efficient management is crucial to minimizing the risks to mother and child.

Study Design: The target population for training comprised the 450 professionals working in the French regional perinatal care network ELENA. An expert committee defined the topics for the training program, selected the simulated scenarios and developed the evaluation grids. The training sessions were conducted by two qualified and experienced professionals in each maternity unit. They comprised a theoretical introduction followed by practical exercises in management of simulated emergency situations by the participant teams, with the aid of a mannequin. Each team completed the exercises twice, their performances being filmed, reviewed and evaluated in each case.

Results: The training sessions took place over 9 months between September 2012 and June 2013. A total of 298 professionals (obstetricians, residents in obstetrics, midwives and nursery nurses) were trained, representing 75% of the staff working in the ELENA perinatal care network. The results showed substantial and significant increases in the overall scores for management of the two emergency situations (from 74.5% to 91.4% for shoulder dystocia [p<0.0001], and from 67.2% to 88.4% [p<0.0001] for CBVD) as well as in the scores for all the specific areas of expertise assessed: safety, know-how, technique, team communication and communication with the patient.

Conclusion: This study demonstrated the value of multidisciplinary team training for obstetric emergencies, encouraging the ELENA perinatal care network to implement an annual training program for its staff. Over and above our experience, the future establishment of a national education program to optimize the management of obstetric emergencies seems to be essential.
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http://dx.doi.org/10.1016/j.ejogrb.2015.03.019DOI Listing
June 2015

OSNA (one-step nucleic acid amplification) sentinel lymph node intraoperative molecular analysis in breast cancer: a cost-benefit analysis.

Med Oncol 2014 Dec 22;31(12):322. Epub 2014 Nov 22.

Department of Gynecological and Oncological Surgery, University Medical Center, Saint Etienne, France.

The aim of the study was to analyze the medical and economic interest of OSNA molecular technique, compared to conventional postoperative histopathologic evaluation for sentinel lymph node exploration in breast cancer patients. This retrospective cost-benefit study was conducted in the French Universitary Hospital of Saint Etienne on patients who received sentinel lymph node exploration between July 1, 2007 and December 31, 2009. Lymph nodes were analyzed by conventional postoperative histological evaluation in group 1 (82 patients) and OSNA in group 2 (86 patients). Costs were analyzed in three different ways: surgery cost, hospitalization cost and histopathologic cost. Average operating time was slightly shorter for group 1 (histology) [71.9 vs. 76.8 min for group 2 (OSNA)]. Time and operating costs were not significantly different (p = 0.293). The average cost of pathological examination was significantly higher in group 2 (35.04 euros per node in group 1 vs. 291.84 euros per node in group 2 p < 10(-3)). The average length of hospital stay was significantly longer in group 1 (5.4 days in group 1 vs. 4.2 days in group 2, p = 0.0065). The total costs were not significantly different between both groups (3,774.6 euros in group 1 vs. 3,393.9 euros in group 2 p = 0.055). The sentinel lymph node analysis with OSNA technique does not lead to higher expenses. It also avoids another surgery for 20% of patients. A prospective multicentric medico-economic study made with a larger effective would probably confirm these results.
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http://dx.doi.org/10.1007/s12032-014-0322-zDOI Listing
December 2014

Morphological and immunohistochemical analysis in ovaries and fallopian tubes of tamoxifen, letrozole and clomiphene-treated rats.

Arch Gynecol Obstet 2014 Sep 12;290(3):553-9. Epub 2014 Apr 12.

Department of Obstetric, Gynecology and Reproductive Medicine, CHU Nord, 42000, St Etienne, France.

Purpose: Ovarian and tubal dysplasia may be precursors to ovarian cancer. The goal of this study was to check whether these histopathological lesions would be found after ovulation induction using tamoxifen, clomiphene citrate and letrozole.

Methods: Seventy-two rats were divided into four groups. In the first group, 24 rats received normal saline. The second group (16 rats) received clomiphene citrate for six cycles. The third group, divided into two sub-groups of eight rats each, were stimulated with tamoxifen for six cycles, with a dosage, respectively, of 0.4 and 0.8 mg/kg/day. In the last group, eight rats received letrozole 0.1 mg/kg/day and eight other rats received letrozole 0.5 mg/kg/day, for six cycles. Once the six cycles had been completed the rats were killed in order to remove ovaries and tubes for histopathological analysis (morphological, p53 and Ki67 immunohistochemical assessment).

Results: Histopathological lesions were found in both ovaries and tubes. The mean ovarian dysplasia score was significantly higher in the tamoxifen group whatever the dosage (p = 0.006 and 0.0002) and in the letrozole group with 0.5 mg/kg/day (p = 0.0002) compared with the control group. The mean tubal dysplasia score was significantly higher in all groups that received drug treatment compared with the control group, whatever the dosage used. The proliferation index (Ki67) was significantly higher in the tamoxifen and letrozole groups while no significant difference was found for apoptosis marker p53.

Conclusions: Ovulation induction may induce histopathological abnormalities in ovaries and tubes with a different immunohistochemical profile in comparison with salpingo-oophorectomies for genetic risk.
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http://dx.doi.org/10.1007/s00404-014-3234-4DOI Listing
September 2014

Metabolic syndrome is associated with poor memory and executive performance in elderly community residents: the PROOF study.

Am J Geriatr Psychiatry 2014 Nov 25;22(11):1096-104. Epub 2014 Jan 25.

EA SNA-EPIS, PRES Lyon, Saint Etienne, France; Clinical and Exercise Physiology Laboratory, University Hospital of Saint-Etienne, Saint Etienne, France.

Objective: Aging is associated with a loss of cognitive performance and an increasing occurrence of cardiovascular events. Moreover, cardiovascular risk factors are linked to cognitive impairment and dementia. Whereas individual components of metabolic syndrome (Met S) have been reported to be linked to cognitive decline and dementia, there are very few studies on Met S as a whole. The present study aims to assess the relationship between Met S and its components and cognitive functioning in a cohort of elderly non-demented community residents.

Design: Population-based cohort study (PROOF study). Cross-sectional analysis.

Participants: Dementia-free community-dwellers aged 65.

Measures: The PROOF participants underwent an extensive neuropsychological battery at baseline. Summary cognitive measures including memory, attention, and executive performance were created by converting the individual test results to Z scores and computing the average scores within each domain. Each of the three cognitive scores was individually compared between groups as a function of Met S. The cognitive scores and the covariates which were significant in univariate analyses were then included in logistic regression models.

Results: A significant association was observed between the presence of metabolic syndrome, poor memory, and executive function even after adjusting for confounding factors (memory: odds ratio: 1.77, p = 0.008; executive functions: odds ratio: 1.91, p = 0.002).

Conclusions: Our study showed that in a sample of elderly community dwellers, Met S was associated with poor memory and executive performance. These results underline the importance of detecting and managing metabolic syndrome components to prevent cognitive impairment and dementia.
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http://dx.doi.org/10.1016/j.jagp.2014.01.005DOI Listing
November 2014

[The impact of a general practitioner training program on the colorectal cancer screening participation rate].

Sante Publique 2013 Nov-Dec;25(6):775-83

Aim: Colorectal cancer mortality in France in 2011 was 13.8/100,000 men and 8.2/100,000 women. As participation in mass screening remains insufficient, training was proposed to general practitioners in the Drôme-Ardèche departments. The objective of this study was to assess the impact of this training after one year.

Methods: This study compared a group of trained volunteers with the other general practitioners in the two departments. The participation rate was measured in patients aged 50 to 74 years examined during the year following the training programme. The participation rate was then assessed on the total population of patients aged 50 to 74 seen by each practitioner, and the practitioner's degree of conviction (tests performed / test kits delivered) and the clarity of instructions (interpretable tests / tests performed) were assessed.

Results: Thirty-five general practitioners attended the training programme in Spring 2011. The number of tests performed in this group of trained GPs was 0.29 per target patient examined (vs 0.17 among the 604 practitioners who did not attend the training programme) with a significant difference (p < 0.0001). The number of tests performed on the total patient population aged 50 to 74 was 0.24 per patient (vs 0.14) with p < 0.001. The conviction index was 0.85 (vs 0.90) with p < 0.0008 and the clarity of instructions index was 0.94 (vs 0.93) (p not significant).

Conclusion: The training programme had a limited impact on participation in colorectal cancer screening, but trained practitioners nevertheless distributed more test kits and more tests were performed.
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April 2014

Evaluation of automated term groupings for detecting anaphylactic shock signals for drugs.

AMIA Annu Symp Proc 2012 3;2012:882-90. Epub 2012 Nov 3.

INSERM U872, Eq. 20, Paris, France.

Signal detection in pharmacovigilance should take into account all terms related to a medical concept rather than a single term. We built an OWL-DL file with formal definitions of MedDRA and SNOMED-CT concepts and performed two queries, Query 1 and 2, to retrieve narrow and broad terms within the Standard MedDRA Query (SMQ) related to 'anaphylactic shock' and the terms from the High Level Term (HLT) grouping related to 'anaphylaxis'. We compared values of the EB05 (EBGM) statistical test for disproportionality with 50 active ingredients randomly selected in the public version of the FDA pharmacovigilance database. Coefficient of correlation was R(2) = 1.00 between Query 1 and HLT; R(2) = 0.98 between Query 1 and SMQ narrow; R(2) = 0.89 between Query 2 and SMQ Narrow+Broad. Generating automated groupings of terms for signal detection is feasible but requires additional efforts in modeling MedDRA terms in order to improve precision and recall of these groupings.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3540466PMC
July 2013

Method for mapping the French CCAM terminology to the UMLS metathesaurus.

Stud Health Technol Inform 2012 ;180:164-8

Department of Public Health, CHU University of Saint Etienne, France.

The French coding system of surgical procedures, the Classification Commune des Actes Médicaux (CCAM), is used in France for DRG databases and fee for services payment. Mapping between CCAM and other clinical procedures terminologies by the means of UMLS metathesaurus is essential in order to increase semantic interoperability between different healthcare terminologies and between different case mix systems. In a previous work the CISMeF team used an automatic approach to map CCAM descriptors to the French part of the UMLS metathesaurus. In another way for the French funded research project InterSTIS, we performed a mapping using MetaMap based on the top level semantic structure descriptors of anatomy and action of CCAM translated from French to English. This paper aims to present this new approach and to compare the results with the previous one. The combination of both approaches significantly improved the coverage of the mapping to 68 % for both descriptors and 95 % for at least one descriptor.
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January 2013

Joint use of epidemiological and hospital medico-administrative data to estimate prevalence. Application to French data on breast cancer.

Cancer Epidemiol 2012 Apr 26;36(2):116-21. Epub 2011 Dec 26.

Registre des Cancers de l'Isère, Grenoble, France.

Background: Estimate complete, limited-duration, and hospital prevalence of breast cancer in a French Département covered by a population-based cancer registry and in whole France using complementary information sources.

Methods: Incidence data from a cancer registry, national incidence estimations for France, mortality data, and hospital medico-administrative data were used to estimate the three prevalence indices. The methods included a modelling of epidemiological data and a specific process of data extraction from medico-administrative databases.

Results: Limited-duration prevalence at 33 years was a proxy for complete prevalence only in patients aged less than 70 years. In 2007 and in women older than 15 years, the limited-duration prevalence at 33 years rate per 100,000 women was estimated at 2372 for Département Isère and 2354 for whole France. The latter rate corresponded to 613,000 women. The highest rate corresponded to women aged 65-74 years (6161 per 100,000 in whole France). About one third of the 33-year limited-duration prevalence cases were diagnosed five years before and about one fourth were hospitalized for breast-cancer-related care (i.e., hospital prevalence). In 2007, the rate of hospitalized women was 557 per 100,000 in whole France. Among the 120,310 women hospitalized for breast-cancer-related care in 2007, about 13% were diagnosed before 2004.

Conclusion: Limited-duration prevalence (long- and short-term), and hospital prevalence are complementary indices of cancer prevalence. Their efficient direct or indirect estimations are essential to reflect the burden of the disease and forecast median- and long-term medical, economic, and social patient needs, especially after the initial treatment.
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http://dx.doi.org/10.1016/j.canep.2011.12.001DOI Listing
April 2012

A Suitable Approach to Estimate Cancer Incidence in Area without Cancer Registry.

J Cancer Epidemiol 2011 8;2011:418968. Epub 2011 Mar 8.

Registre des Cancers de l'Isère, 38240 Meylan, France.

Objective. Use of cancer cases from registries and PMSI claims database to estimate Département-specific incidence of four major cancers. Methods. Case extraction used principal diagnosis then surgery codes. PMSI cases/registry cases ratios for 2004 were modelled then Département-specific incidence for 2007 estimated using these ratios and 2007 PMSI cases. Results. For 2007, only colon-rectum and breast cancer estimations were satisfactorily validated for infranational incidence not ovary and kidney cancers. For breast, the estimated national incidence was 50,578 cases and the incidence rate 98.6 cases per 100,000 person per year. For colon-rectum, incidence was 21,172 in men versus 18,327 in women and the incidence rate 38 per 100,000 versus 24.8. For ovary, the estimated incidence was 4,637 and the rate 8.6 per 100,000. For kidney, incidence was 6,775 in men versus 3,273 in women and the rate 13.3 per 100.000 versus 5.2. Conclusion. Incidence estimation using PMSI patient identifiers proved encouraging though still dependent on the assumption of uniform cancer treatments and coding.
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http://dx.doi.org/10.1155/2011/418968DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3065037PMC
July 2011

Level of physical activity at the age of 65 predicts successful aging seven years later: the PROOF study.

Rejuvenation Res 2011 Apr 31;14(2):215-21. Epub 2011 Mar 31.

Equipe d'Accueil Système Nerveux Autonome, Epidémiologie, Physiologie, Exercice, Santé (SNA-EPIS), PRES Lyon, Université Jean Monnet, Hôpital Universitaire, Saint-Étienne, France.

Background: Physical activity has a pleiotropic effect and is a significant factor in successful aging. This study aims to quantify the relationship between the physical activity of a 65-year-old cohort and the level of life satisfaction and self-rated health 7 years later.

Methods: A total of 988 questionnaires were sent by mail to a representative sample of healthy pensioners. Life satisfaction and health status were estimated on two visual analogical scales in answer to the following questions: (1) How would you estimate your state of health? and (2) Are you generally satisfied with your life? The level of physical activity was estimated using a questionnaire which enabled us to calculate: (1) Daily energy expenditure (DEE), (2) physical activity energy expenditure (PAEE), (3) daily energy expenditure higher than 5 metabolic equivalents (METs) (DEQisa), (4) Activity index (PAEE/DEE), (5) VO(2) peak.

Results: In all, 686 responses were validated. The average age was 72.9 ± 1.2 years old with 59.5% of women (n = 408). Amongst the sample, 98.8% (n = 676) lived in their own homes and 25.2% (n = 172) lived alone. Mean DEE was 10.365 ± 1.964  kJ/24  h, mean PAEE was 4.479 ± 1.170  kJ/24  h, mean activity index was 0.42 ± 0.05, and mean estimated oxygen uptake (VO(2)) peak was 22.5 ± 1.6  mL/min per kg. Activity index and VO(2) peak were the variables most significantly correlated with self-rated health (p = 0.0032 and p = 0.0011, respectively) and life satisfaction (p = 0.0117 and p = 0.0053).

Conclusions: Energy spent in activity and VO(2) peak estimated from DEE, measured at the age of 65, appear to be strong predictors of well-being 7 years later.
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http://dx.doi.org/10.1089/rej.2010.1101DOI Listing
April 2011

Evaluation of the CCAM Hierarchy and Semi Structured Code for Retrieving Relevant Procedures in a Hospital Case Mix Database.

AMIA Annu Symp Proc 2010 Nov 13;2010:61-5. Epub 2010 Nov 13.

Department of Public Health and Medical Informatics, CHU Université Jean-Monnet, Saint Etienne, France;

In France, clinical procedures are coded with the French procedures classification (Classification Commune des Actes Médicaux, CCAM) and recorded in every hospital. CCAM uses hierarchical semi-structured codes which describe procedures (topography, action, access mode and/or technique). This amount of information could be analyzed and used for clinical and medico-economic evaluation. But relevant and practical data searches are difficult. In this paper we present a use case about searching for endoscopic activities in a case mix database to evaluate the relevance of the hierarchical organization and semi structured codes of CCAM in order to retrieve data already coded using this controlled vocabulary. Precision was 0.79 and recall 0.84 in the hierarchical search whereas precision was 0.94 and recall was 0.81 using part of the code related to access mode and/or technique. We discuss a revision of the CCAM by the use of an existing modeling (from the GALEN project) and better knowledge representation for each procedure.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3041456PMC
November 2010

Primary central nervous system lymphoma: immunohistochemical profile and prognostic significance.

Neuropathology 2010 Jun 18;30(3):232-40. Epub 2009 Nov 18.

Department of Pathology, Centre, Hospitalier Universitaire de Saint-Etienne, Saint Etienne 42055 Cedex 2, France.

Primary central nervous system lymphoma (PCNSL) is a rare subtype of non-Hodgkin lymphoma (NHL) with extranodal location affecting only the CNS, meninges and eye, without visceral or lymph node involvement. Its incidence has increased sharply over the past three decades, especially in immunocompetent subjects. Most PCNSL cases are diffuse large B-cell lymphomas (DLBCLs). However, it differs from nodal DLBCL in that it has a worse prognosis. DLBCLs are a heterogeneous entity and according to new genomic discoveries, classifications into prognostic subgroups have been embarked upon. Two prognostic algorithms were then prepared using a panel of immunohistochemical markers (CD10, Bcl6, MUM1/IRF-4, and Bcl2), thus categorizing DLBCL into two subgroups, GCB (germinal centre B-cell-like) or non-GCB, and into Group 1 or Group 2. Our goal is to apply both of these two sub-classifications to 39 PCNSLs, in order to assess their usefulness and prognostic relevance. 74.3% of our PCNSLs were of a non-GCB phenotype, corresponding to an activated postgerminal origin. They were evenly distributed across G1 and G2. Two- and 5-year overall survival rates were 34.8% and 19.6%, respectively. Younger age (<65) and a therapeutic combination of chemotherapy and radiotherapy significantly improved our patients' survival rates. The other clinical or biological markers tested had no prognostic impact. The two classifications did not reveal any significant survival difference. The recent discovery of a specific "transcriptional signature" of PCNSL, marking them out of DLBCL could account for the irrelevance of such prognostic classifications to PCNSL.
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http://dx.doi.org/10.1111/j.1440-1789.2009.01074.xDOI Listing
June 2010