Candice Roudier

Association of socioeconomic status with overall overweight and central obesity in men and women: the French Nutrition and Health Survey 2006

BackgroundIdentification of subpopulations at high risk of overweight and obesity is crucial for prevention and management of obesity in different socioeconomic status (SES) categories. The objective of the study was to describe disparities in the prevalence of overweight and obesity across socioeconomic status (SES) groups in 18–74 year-old French adults.MethodsAnalyses were based on a multistage stratified random sample of non-institutionalized adults aged 18–74-years-old from the French Nutrition and Health Survey (ENNS), a cross-sectional national survey carried out in 2006/2007. Collected data included measured anthropometry (weight, height and waist circumference (WC)), demographic and SES data (occupation, education and frequency of holiday trips as a marker of family income). SES factors associated with overweight (BMI ≥ 25) and central obesity (WC above gender-specific references) were identified using multiple logistic regression.ResultsAlmost half (49.3%) of French adults were overweight or obese and 16.9% were obese. In men, the risk of overall overweight or obesity was associated with occupation (p < 0.05), whereas the risk of central obesity was independently associated with occupation (p < 0.05) and frequency of holiday trips (p < 0.01). In women, both overall and central overweight and obesity were independently associated with educational level (respectively p < 10-3 and p < 10-3) and frequency of holiday trips (respectively p < 0.05 and p < 10-3).ConclusionThe prevalence of overweight and obesity was found to be similar to that of several neighbouring western European countries, and lower than the UK and eastern Europe. Risk of being overweight or obese varied across SES groups both in men and women, but associations were different between men and women, indicating differing determinants.

Trends in the quality of care for elderly people with type 2 diabetes: The need for improvements in safety and quality (the 2001 and 2007 ENTRED Surveys)

AIM This study aimed to characterize the sociodemographic data, health status, quality of care and 6-year trends in elderly people with type 2 diabetes. METHODS This study used two French cross-sectional representative surveys of adults of all ages with all types of diabetes (Entred 2001 and 2007), which combined medical claims, and patient and medical provider questionnaires. The 2007 data in patients with type 2 diabetes aged 65 years or over (n=1766) were described and compared with the 2001 data (n=1801). RESULTS Since 2001, obesity has increased (35% in 2007; +7 points since 2001) while written nutritional advice was less often provided (59%; -6 points). Mean HbA(1c) (7.1%; -0.2%), blood pressure (135/76 mmHg; -4/-3 mmHg) and LDL cholesterol (1.04 g/L; -0.21 g/L) declined, while the use of medication increased: at least two OHAs, 34% (+4 points); OHA(s) and insulin combined, 10% (+4 points); antihypertensive treatment, 83% (+4 points); and statins 48% (+26 points). Severe hypoglycaemia remained frequent (10% had an event at least once a year). The overall prevalence of complications increased. Renal complications were not monitored carefully enough (missing value for albuminuria: 42%; -4.5 points), and 46% of those with a glomerular filtration rate less than 60 mL/min/1.73 m² were taking metformin. CONCLUSION Elderly people with type 2 diabetes are receiving better quality of care and have better control of cardiovascular risk factors than before. However, improvement is still required, in particular by performing better screening for complications. In this patient population, it is important to carefully monitor the risks for hypoglycaemia, hypotension, malnutrition and contraindications related to renal function.

Cumulative effective doses delivered by radiographs to preterm infants in a neonatal intensive care unit

OBJECTIVE. We sought to determine the number and distribution of radiographs and the cumulative effective radiograph doses (cED) received by a population of preterm infants (PIs) hospitalized in an NICU. STUDY DESIGN. We reviewed the files of all preterm infants (gestational age: <34 weeks) who were admitted to an NICU during an 18-month period and were discharged alive. A generalized additive model was used to study the relationship between cED and patient characteristics. RESULTS. Four hundred fifty files were analyzed. The median gestational age was 30.1 weeks (range: 24.1–33.9 weeks), and the median birth weight was 1250 g (range: 520–2760 g). The median number of radiographs per infant was 10.6 (range: 0–95), and the median cED was 138 μSv (range: 0–1450 μSv). The cumulative dose exceeded 500 μSv in 7.6% of the cases. Factors that influenced the cumulative effective dose were gestational age, birth weight, care procedures, and clinical adverse events. CONCLUSIONS. Given the potentially life-threatening complications of PIs, cumulative radiograph doses received in the ICU seem low with regard to environmental exposure and international recommendations. Additional studies are needed to evaluate the possible lifetime consequences of exposure to ionizing radiation at this age.

Voluntary Health Registry of French Nationals after the Great East Japan Earthquake, Tsunami, and Fukushima Daiichi Nuclear Power Plant Accident: Methods, Results, Implications, and Feedback

UNLABELLED Introduction The 11th of March 2011, a magnitude 9.0 earthquake struck alongside the north-east coast of Honshu Island, Japan, causing a tsunami and a major nuclear accident. The French Institute for Public Health Surveillance (InVS) set up, within one week after the triple catastrophe, an Internet-based registry for French nationals who were in Japan at the time of the disasters. In this string of disasters, in this context of uncertainties about the nuclear risks, the aim of this registry was to facilitate the: (1) realization of further epidemiologic studies, if needed; and (2) contact of people if a medical follow-up was needed. The purpose of this report was to describe how the health registry was set up, what it was used for, and to discuss further utilization and improvements to health registries after disasters. METHODS The conception of the questionnaire to register French nationals was based on a form developed as part of the Steering Committee for the management of the post-accident phase in the event of nuclear accident or a radiological emergency situation (CODIRPA) work. The questionnaire was available online. RESULTS The main objective was achieved since it was theoretically possible to contact again the 1,089 persons who completed the form. According to the data collected on their space-time budget, to the result of internal contamination measured by the French Institute for Radiological Protection and Nuclear Safety (IRSN) and dosimetric expertise published by the World Health Organization (WHO), it was not suitable to conduct an epidemiologic follow-up of adverse effects of exposure to ionizing radiations among them. However, this registry was used to launch a qualitative study on exposure to stress and psychosocial impact of the Great East Japan Earthquake on French nationals who were in Japan in March 2011. CONCLUSION Setting a registry after a disaster is a very important step in managing the various consequences of a disaster. This experience showed that it is quickly feasible and does not raise adverse side effects in involved people. Motreff Y , Pirard P , Lagrée C , Roudier C , Empereur-Bissonnet P . Voluntary health registry of French nationals after the Great East Japan Earthquake, tsunami, and Fukushima Daiichi Nuclear Power Plant accident: methods, results, implications, and feedback. Prehosp Disaster Med. 2016;31(3):326-329.

Incidence des radiodermites secondaires à un geste de radiologie interventionnelle: Résultat d’une étude de faisabilité auprès des dermatologues français adhérents de la Société française de dermatology

INTRODUCTION Radiodermatitis due to fluoroscopically guided interventional radiology procedures was reported, mostly by dermatologists, several times between 1992 and 2000, but less frequently since 2000. TYPE OF STUDY AND OBJECTIVE: This feasibility study sought to determine whether radiodermatitis secondary to interventional radiology was still occurring recently (2003-2004). METHODS During summer 2004, we sent a questionnaire to the 1450 dermatologists belonging to the French Dermatology Society (société française de dermatologie), asking them to report any cases of radiodermatitis related to fluoroscopically guided interventional radiology between 1 September 2003 and 31 August 2004. RESULTS Responses from 218 dermatologists reported ten cases of radiodermatitis. Median age at diagnosis was 56 years. The procedures involved interventional neuroradiology (n=1), interventional cholangiography (n=1), pacemaker insertion (n=1), and interventional cardiology (n=7). Median time from the fluoroscopic procedure to first symptoms was 2 months and from procedure to radiodermatitis diagnosis 7.5 months. Plastic surgery was necessary for two patients. CONCLUSION Radiodermatitis related to interventional radiology still occurs. We recommend the development of a reporting system for this adverse effect as part of the optimization of interventional radiology practices, including dose reduction.

O49 État de santé et prise en charge des adultes diabétiques de type 1 : quelles évolutions entre Entred 2001 et 2007 ?

Objectif Decrire le risque vasculaire, les complications et la qualite des soins des adultes diabetiques de type 1 en France metropolitaine et leurs evolutions entre 2001 et 2007. Materiels et methodes Pour Entred 2007, un tirage au sort a selectionne 8 926 adultes diabetiques rembourses d’au moins 3 antidiabetiques au cours des 12 derniers mois. Pour 48%, un questionnaire patient (QP) et pour 28% un questionnaire medecin (QM) ont ete recueillis ; 5,6% avaient un diabete de type 1 (DT1) (n = 275 avec QP et n = 183 avec QM). Les analyses ont ete ponderees sur le plan de sondage et la non-reponse aux questionnaires. Les donnees d’Entred 2007 ont ete comparees a celles de 2001(n=235). Resultats L’âge moyen etait de 42 ans et le DT1 evoluait depuis 17 ans en moyenne. Surpoids et obesite avaient progresse (30% en 2007, +3 points depuis 2001 ; et 13%, +4 pts) alors que les consultations dietetiques avaient diminue (35%, - 3 pts), un tabagisme etait rapporte par 39% des personnes (+3 pts). Une HbA1c > 8% etait rapportee par les medecins pour 40% des patients (- 2 pts), une pression arterielle 140/80 mm Hg pour 10% (- 13 pts) et un cholesterol-LDL 1,3 g/l pour 14% (- 3 pts). La frequence des complications declarees par les patients etait stable (angor ou infarctus du myocarde : 7% ; traitement ophtalmologique par laser : 24%). La frequence des traitements anti-hypertenseurs restait stable (33%), et celle des traitements hypolipemiants augmentait (28%, +10 pts) au profit des prescriptions de statines. Au total, 41% avaient ete hospitalises (- 7 pts) ; 28% avaient consulte un endocrinologue (+7 pts) et 18% un cardiologue (- 4 pts), 35% (+8 pts) avaient beneficie de 3 dosages d’HbA1c et 54% (+7 pts) d’un dosage des lipides, en secteur liberal dans l’annee. Discussion La prise en charge des adultes DT1 s’est amelioree entre 2001 et 2007, mais est encore insuffisante. Le controle glycemique, lipidique et surtout tensionnel est meilleur, mais l’equilibre glycemique reste difficile a atteindre, temoignant d’un risque eleve de complications micro et macrovasculaires. Le tabagisme concerne toujours plus d’un tiers des personnes, et surpoids et obesite progressent, atteignant 43%. Ces facteurs de risque macrovasculaires comportementaux constituent 2 cibles d’intervention majeures accessibles a une demarche educative.

P4 Les complications rénales du diabète : dépistage, prise en charge médicale et tendances 2001–2007, selon les études Entred

Introduction Cette analyse vise a estimer la prevalence, le depistage et la prise en charge medicale des complications renales du diabete de type 2 en France metropolitaine en 2007, ainsi que leurs determinants et evolutions de 2001 a 2007. Patients et Methodes Pour Entred 2007, un tirage au sort a selectionne 8 926 personnes diabetiques remboursees d’au moins 3 antidiabetiques au cours des 12 derniers mois. Des questionnaires patient (n = 3 894 diabetiques de type 2) et medecin (n = 2 232) ont ete recueillis. Les analyses ont ete ponderees sur plan de sondage et non-reponse aux questionnaires. Les determinants d’une prise en charge appropriee ont ete analyses par regression logistique. En les restreignant a des populations comparables, les donnees 2007 (n = 1 941) ont ete comparees a celle d’Entred 2001 (n = 1 553). Resultats Le debit de filtration glomerulaire etait inferieur a 60 ml/min/1,73 m2 chez 19 % des diabetiques de type 2 (âge moyen 69 ans), et 16 % avaient une albuminurie anormale. La prevalence de la maladie renale chronique etait estimee au moins a 29 % (femmes 32 % ; hommes 26 %) et les stades 1, 2, 3, 4 et 5 a respectivement 3 %, 6 %, 18 %, 1 % et 0 % (34 % normaux et 38 % manquants). Plus de deux tiers (68 %) des personnes avec maladie renale chronique beneficiaient d’un traitement par IEC/ARA II (+ 16 points depuis 2001). Un tiers (34 %) disposait d’un suivi medical adequat (dosage de microalbuminurie, +5 points ; creatinemie, +4 points ; et 3 dosages d’HbA1c annuels, +11 points). Les facteurs lies a l’existence d’un traitement par IEC/ARA etaient l’âge = 65 ans, le surpoids ou obesite, une pression arterielle elevee, la pratique d’un dosage annuel d’albuminurie ou de creatinemie. Les facteurs lies au suivi medical adequat etaient la prise en charge a 100 % pour affection de longue duree, au moins 12 consultations en medecine generale, un suivi effectue par un medecin specialiste ou âge de 50 ans au plus. Conclusion Bien que des ameliorations soient survenues depuis 2001, le depistage, le suivi et le traitement des complications renales du diabete restent insuffisants et les complications renales frequentes.

P98 Consommations alimentaires des adultes diabétiques âgés de 18 à 74 ans en France métropolitaine. Étude nationale nutrition santé, 2006-2007

Introduction Cette analyse a pour objectif principal de decrire les consommations alimentaires des personnes diabetiques adultes vivant en France metropolitaine. Materiels et methodes L’Etude nationale nutrition sante a ete realisee en 2006-2007 pour decrire la situation nutritionnelle des adultes de 18 a 74 ans vivant en France metropolitaine. Elle a porte sur un echantillon national obtenu par un sondage aleatoire stratifie a 3 degres. Les consommations alimentaires ont ete recueillies a partir de 3 rappels des 24 heures, realises par telephone, sur une periode de 15 jours. Poids et taille ont ete mesures. Le diabete diagnostique a ete reporte par auto-questionnaire (diabete auto-declare ou traitement par antidiabetique oral ou insuline). Au total, 2 413 adultes etaient concernes par cette analyse, parmi lesquels 86 etaient diabetiques. Resultats Parmi les personnes ayant un diabete diagnostique, 30 % (dont 70 % etaient obeses) etaient considerees comme sous-declarant de leurs consommations alimentaires et ont ete exclus des analyses alimentaires. Les apports energetiques totaux sans alcool (AESA) des personnes diabetiques etaient en moyenne de 2 126 kcal/j chez les hommes et 1 530 kcal/j chez les femmes pour un indice de masse corporelle moyen respectif de 30,3 et 32,0 kg/m 2 . Les AESA se repartissaient en moyenne en 43 % d’apports en glucides totaux (dont 71 g/j de glucides simples), 38 % en lipides totaux et 19 % en proteines. Par rapport aux non diabetiques, les personnes diabetiques avaient une consommation plus reduite en glucides simples, compensee par une plus grande consommation de glucides complexes et de lipides totaux. Discussion La description des consommations alimentaires des personnes diabetiques repose sur un effectif faible, parmi lequel la sous-declaration est frequente, ce qui complique l’interpretation. Conclusion Cette etude permet de decrire les consommations alimentaires des personnes diabetiques, leur adequation aux recommandations, et de les comparer a celles de la population generale. Des efforts restent necessaires afin de limiter les apports en lipides totaux dans la population diabetique.