Publications by authors named "D Coste"

13 Publications

Post-retirement surveillance of workers exposed to asbestos or wood dust: first results of the French national SPIRALE Program.

Epidemiol Prev 2011 Sep-Dec;35(5-6):315-23

Institut national de la santé et de la recherche médicale (Inserm) U1018, Villejuif, France.

Objectives: In France, 15 000-20 000 cancers attributable to occupational exposure occur each year. These cancers appear most often after the worker has retired. Since 1995, a system of post-retirement medical surveillance (PRMS) has been set up for former workers, but it remains largely underused.

Design: The SPIRALE program is a public health intervention aimed at identifying the former workers having been exposed to asbestos or wood dust during their working life and to propose them a PRMS. Additionally, it is also an epidemiologic research on the longterm effects of occupational exposure.We report the results of first years of the program conducted in 2006-2008, in 13 districts.

Setting And Participants: a self-administered questionnaire was sent to 50 000 newly retired men, to identify potential past occupational carcinogen exposure. For respondents detected as possibly exposed, exposure was assessed in Health Screening Centres and a PRMS was recommended if necessary.

Main Outcome Measures: Participation rate, rate of confirmed exposure, increased rate of PRMS, satisfaction about the program.

Results: The participation rate was 24%. From 12 002 questionnaires analysed, 72% of respondents were identified as possibly exposed: 3%to wood dust, 50%to asbestos and 19%to both exposures. Exposure to asbestos was confirmed for 73.4%, and according to the level of exposure, PRMS was recommended for 47.1%. Wood dust exposure was confirmed for 56.7%. In these districts, PRMS for asbestos increased by 45% and for wood dust by 600%. Additional surveys showed that participants showed a high degree of satisfaction about the program.

Conclusions: The results are positive in terms of detection, information and medical surveillance of exposed workers.
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June 2012

[Pilot data from the Spirale project -- follow-up of occupational respiratory exposures].

Rev Mal Respir 2011 Oct 12;28(8):1000-7. Epub 2011 Oct 12.

Inserm U1018, Epidemiology of Occupational and Social Determinants of Health Centre for Research in Epidemiology and Population Health, 94800 Villejuif, France.

Introduction: The medical follow-up of individuals who have had occupational exposures to potential respiratory hazards is little known and under-utilised. The Spirale program aims to deliver this intervention effectively to all potential beneficiaries.

Methods: Spirale was introduced in two stages; i) identification of occupational exposures to asbestos or wood dust through a postal questionnaire; ii) for those initially identified, confirmation of exposure through attendance at a health centre for examination and further medical follow-up as necessary.

Results: In 2007, Spirale contacted 50,662 men born between 1942 and 1943, living in 13 departments in France. The initial response rate was 24%, rising to 50% after reminders. Seventy-two percent of people were identified as possibly having been exposed; 50% to asbestos, 3% to wood dust and 19% reporting a mixed exposure. Among the 8641 people located, 3843 (44.5%) benefited from an evaluation of their exposure. In total, 73.4% of people had their exposure to asbestos confirmed and in 1751 (64.2%) this was at a level to justify follow-up.

Conclusion: TheSpirale program largely achieved its objective of location and initiation of medical monitoring of people who have been exposed through their work to respiratory carcinogens. It should now be implemented throughout the country.
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October 2011

Genetic discontinuities and disequilibria in recently established populations of the plant pathogenic fungus Mycosphaerella fijiensis.

Mol Ecol 2010 Sep 13;19(18):3909-23. Epub 2010 Aug 13.

CIRAD, UMR BGPI, Campus international de Baillarguet, Montpellier Cedex, France.

Dispersal processes of fungal plant pathogens can be inferred from analysis of spatial genetic structures resulting from recent range expansion. The relative importance of long-distance dispersal (LDD) events vs. gradual dispersal in shaping population structures depends on the geographical scale considered. The fungus Mycosphaerella fijiensis, pathogenic on banana, is an example of a recent worldwide epidemic. Founder effects in this species were detected at both global and continental scale, suggesting stochastic spread of the disease through LDD events. In this study, we analysed the structure of M. fijiensis populations in two recently (∼1979-1980) colonized areas in Costa Rica and Cameroon. Isolates collected in 10-15 sites distributed along a ∼250- to 300- km-long transect in each country were analysed using 19 microsatellite markers. We detected low-to-moderate genetic differentiation among populations in both countries and isolation by distance in Cameroon. Combined with historical data, these observations suggest continuous range expansion at the scale of banana-production area through gradual dispersal of spores. However, both countries displayed specific additional signatures of colonization: a sharp discontinuity in gene frequencies was observed along the Cameroon transect, while the Costa Rican populations seemed not yet to have reached genetic equilibrium. These differences in the genetic characteristics of M. fijiensis populations in two recently colonized areas are discussed in the light of historical data on disease spread and ecological data on landscape features.
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September 2010

Prevalence of hepatitis B and hepatitis C virus infections in France in 2004: social factors are important predictors after adjusting for known risk factors.

J Med Virol 2010 Apr;82(4):546-55

National Institute for Public Health Surveillance, Saint-Maurice, France.

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.
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April 2010

[Evaluation of a fully integrated digital screening mammography program in the Vienne region].

J Radiol 2009 Dec;90(12):1837-42

Service d'Imagerie Médicale du CHU de Poitiers, 2, rue de Milétrie, 86000 Poitiers.

Purpose: To evaluate a fully integrated digital screening mammography program (image acquisition, transfer and over-read).

Materials And Methods: between april 2005 and December 2007, two imaging sites were authorized by the Department of Health to use digital mammography units (Senographe 2000D and 2000DS, GEMS) for screening mammography. the initial interpretation was made on a workstation with accompanying digital films. The images were also transmitted via the internet on the same day for over-read on a workstation. In addition, a over-read was also performed from printed mammographic images using a viewbox. Differences in interpretation and BIRADS classification as well as economical considerations were analyzed between the types of interpretation setups.

Results: A total of 7008 screening mammograms were included. No significant problem was reported with regards to internet image transfers. No significant interpretation difference was noted related to the fully integrated digital imaging process. This technology could generate cost savings estimated in 2007 at 3.793/year (mailing fee).

Conclusion: A fully integrated digital screening mammography program results in improved organisational processes and significant cost reductions without reduced diagnostic accuracy.
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December 2009