Joël Coste
Paris Descartes University
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Pediatric Infectious Disease Journal | 1999
Dominique Gendrel; Josette Raymond; Joël Coste; Florence Moulin; Mathie Lorrot; Sylvie Guérin; Sophie Ravilly; Hervé Lefèvre; Catherine Royer; Catherine Lacombe; Pierre Palmer; Claude Bohuon
BACKGROUND Procalcitonin (PCT) concentration increases in bacterial infections but remains low in viral infections and inflammatory diseases. The change is rapid and the molecule is stable, making it a potentially useful marker for distinguishing between bacterial and viral infections. METHODS PCT concentration was determined with an immunoluminometric assay on plasma collected at admission in 360 infants and children hospitalized for bacterial or viral infection. It was compared with C-reactive protein (CRP), interleukin 6 and interferon-alpha measured on the same sample. RESULTS The mean PCT concentration was 46 microg/l (median, 17.8) in 46 children with septicemia or bacterial meningitis. PCT concentration was > 1 microg/l in 44 of 46 in this group and in 59 of 78 children with a localized bacterial infection who had a negative blood culture (sensitivity, 83%). PCT concentration was > 1 microg/l in 16 of 236 children with a viral infection (specificity, 93%). PCT concentration was low in 9 of 10 patients with inflammatory disease and fever. A CRP value > or =20 mg/l was observed in 61 of 236 patients (26%) with viral infection and in 105 of 124 patients (86%) with bacterial infection. IL-6 was > 100 pg/ml in 14% of patients infected with virus and in 53% with bacteria. A secretion of interferon-alpha was found in serum in 77% of viral infected patients and in 8.6% of bacterial infected patients. CONCLUSIONS In this study a PCT value of 1 microg/l or greater had better specificity, sensitivity and predictive value than CRP, interleukin 6 and interferon-alpha in children for distinguishing between viral and bacterial infections. PCT values are higher in invasive bacterial infections, but the cutoff value of 1 microg/l indicates the severity of the disease in localized bacterial infection and helps to decide antibiotic treatment in emergency room. PCT may be useful in an emergency room for differentiation of bacterial vs. viral infections in children and for making decisions about antibiotic treatments.
The Journal of Clinical Endocrinology and Metabolism | 2012
Jean-Claude Carel; Emmanuel Ecosse; Fabienne Landier; Djamila Meguellati-Hakkas; Florentia Kaguelidou; Grégoire Rey; Joël Coste
CONTEXT Little is known about the long-term health of subjects treated with GH in childhood, and Safety and Appropriateness of Growth hormone treatments in Europe (SAGhE) is a study addressing this question. OBJECTIVE The objective of the study was to evaluate the long-term mortality of patients treated with recombinant GH in childhood in France. DESIGN This was a population-based cohort study. SETTING The setting of the study was a French population-based register. PARTICIPANTS A total of 6928 children with idiopathic isolated GH deficiency (n = 5162), neurosecretory dysfunction (n = 534), idiopathic short stature (n = 871), or born short for gestational age (n = 335) who started treatment between 1985 and 1996 participated in the study. Follow-up data on vital status were available in September 2009 for 94.7% of the patients. MAIN OUTCOME MEASURES All-cause and cause-specific mortality was measured in the study. RESULTS All-cause mortality was increased in treated subjects [standardized mortality ratio (SMR) 1.33, 95% confidence interval (CI) 1.08-1.64]. In a multivariate analysis adjusted for height, the use of GH doses greater than 50 μg/kg · d was associated with mortality rates using external and internal references (SMR 2.94, 95% CI 1.22-7.07, hazard ratio 2.79, 95% CI 1.14-6.82). All type cancer-related mortality was not increased. Bone tumor-related mortality was increased (SMR 5.00, 95% CI 1.01-14.63). An increase in mortality due to diseases of the circulatory system (SMR 3.07, 95% CI 1.40-5.83) or subarachnoid or intracerebral hemorrhage (SMR 6.66, 95% CI 1.79-17.05) was observed. CONCLUSIONS Mortality rates were increased in this population of adults treated as children with recombinant GH, particularly in those who had received the highest doses. Specific effects were detected in terms of death due to bone tumors or cerebral hemorrhage but not for all cancers. These results highlight the need for additional studies of long-term mortality and morbidity after GH treatment in childhood.
Annals of the Rheumatic Diseases | 2005
Alain Saraux; Francis Guillemin; P. Guggenbuhl; Christian Roux; Patrice Fardellone; E. Le Bihan; Alain Cantagrel; Isabelle Chary-Valckenaere; Lianna Euller-Ziegler; René-Marc Flipo; R. Juvin; J.-M. Behier; Bruno Fautrel; Charles Masson; Joël Coste
Objective: To estimate the prevalence of spondyloarthropathies (SpAs) in France in a multiregional representative sample in the year 2001. Methods: A two stage random sample was constituted in seven areas from the national telephone directory and the next birthday method in each household. Interviewers were patient-members of self help groups trained to administer telephone surveys using a validated questionnaire for detecting inflammatory joint disease. Quality of data collection was controlled periodically. SpA was confirmed by the patient’s rheumatologist or by clinical examination. Prevalence estimates after probability sampling correction were standardised for age and sex (1999 national census). Results: Among the 15 219 anonymous telephone numbers selected, 3.6% were places of work or secondary residences and were excluded. The phone interview participation rate ranged across regions from 55.1 to 69.9%. 3554 men and 5841 women were included in the study. Twenty nine cases of SpA were confirmed. All but one fulfilled ESSG criteria. Mean age was 47 years (range 21–78). The overall prevalence standardised for age and sex was 0.30% (95% confidence interval (CI) 0.17 to 0.46). Prevalence was similar in women (0.29% (95% CI 0.14 to 0.49)) and men (0.31 % (95% CI 0.12 to 0.60)). Geographical analysis by department clustering found no significant differences. The prevalence of SpA was as high as that of rheumatoid arthritis. Conclusion: Prevalence of SpA in France was 0.30% in 2001, with no difference between women and men. Ankylosing spondylitis and psoriatic arthritis were the most common SpA subsets.
Journal of Clinical Epidemiology | 1997
Joël Coste; Francis Guillemin; Jacques Pouchot; Jacques Fermanian
Composite measurement scales (CMSs) have contributed to improving the measurement of complex medical phenomena such as physical and psychological functioning or health-related quality of life. However, their use in patient care and research is often limited by their length and excessive respondent burden. In such situations, short instruments should be made available. Efforts to develop short instruments have largely focused on shortening existing instruments. To investigate the methodology currently used in the shortening of CMS, we assessed 42 studies reported in medical, psychological, and educational journals between 1984 and 1994. A number of methodological and statistical considerations important in the CMS shortening procedure were found to have been ignored or neglected by authors developing short forms from existing CMS. Serious flaws appear mainly to result from inadequate conceptualization of the shortening process, and inappropriate use and excess credit given to statistical techniques used to select items to be retained in short forms. When performed, the assessment of measurement properties of the short form was often inappropriate, and cross validation studies were seldom conducted. We propose recommendations for shortening existing CMS, to help authors and investigators develop and choose, respectively, shortened measurement instruments. These recommendations address the preliminary choice of the original CMS to be shortened, and the two successive phases to be considered in the development of short forms: the shortening process itself, where items are selected, and the validation of the shortened CMS, which should be conducted independently using independent subject samples.
Annals of the Rheumatic Diseases | 2005
Francis Guillemin; Alain Saraux; P. Guggenbuhl; Christian Roux; Patrice Fardellone; E. Le Bihan; Alain Cantagrel; Isabelle Chary-Valckenaere; Lianna Euller-Ziegler; René-Marc Flipo; R. Juvin; J.-M. Behier; Bruno Fautrel; Charles Masson; Joël Coste
Background: Prevalence estimates of rheumatoid arthritis (RA) vary across Europe. Recent estimates in southern European countries showed a lower prevalence than in northern countries. Objectives: To estimate the prevalence of RA in France in a multiregional representative sample in the year 2001. Methods: A two stage random sample was constituted in seven areas (20 counties) from the national telephone directory of households and by the next birthday method in each household. Patient-interviewers, member of self help groups, were trained to administer telephone surveys using a validated questionnaire for case detection of inflammatory rheumatism, and conducted the survey under quality control. All suspected cases of RA were confirmed by their rheumatologist or by clinical examination. Prevalence estimates after probability sampling correction were standardised for age and sex (national census 1999). Results: An average response rate of 64.7% (two stages combined) led to a total of 9395 respondents. Standardised prevalence was 0.31% (95% confidence interval 0.18 to 0.48) for RA, 0.51% in women and 0.09% in men, with a higher age-specific prevalence in the 65–74 year age band. A geographical analysis of county clustering showed significant variation across the country. Conclusion: This national multiregional cooperative study demonstrates the usefulness of working in association with patients of self help groups. It showed a similar prevalence of RA to that of the spondyloarthropathies estimated concomitantly during the survey. It provides a reliable basis for definition of population targets for healthcare delivery and drug treatments.
Arthritis & Rheumatism | 2000
Séverine Guillaume; Anne-Marie Prieur; Joël Coste; Chantal Job-Deslandre
OBJECTIVE To describe the long-term outcome and determine predictors of severity among patients with oligoarticular-onset juvenile idiopathic arthritis (JIA). METHODS In a longitudinal study, 207 patients with oligoarticular-onset JIA who were referred between 1988 and 1998 were evaluated. At disease onset, selected clinical and laboratory data were collected as independent variables. A polyarticular disease course, joint erosion, uveitis, and remission were assessed as dependent variables. Longitudinal analyses were performed with the Kaplan-Meier method, and multivariate analysis with the Cox model. RESULTS After 6 years of followup, the probability of a polyarticular course of disease was 50%, joint erosion was 35%, uveitis was 30%, and remission was 23% in these patients. Joint erosion was strongly associated with a polyarticular course. A high erythrocyte sedimentation rate (ESR) as well as involvement of more than 1 joint or involvement of an upper limb at disease onset were predictors of disease extension. A high ESR was also a strong predictor of a destructive course, and a family history of psoriasis was predictive of uveitis occurrence. No predictive factor for remission could be identified. CONCLUSION Oligoarticular-onset JIA is a severe disease with frequent complications. Factors predictive of severity in oligoarticular-onset JIA were identified. This could allow early identification of high-risk patient subgroups, warranting a more aggressive therapeutic approach.
BMJ | 2003
Joël Coste; Béatrix Cochand-Priollet; Patricia de Cremoux; Catherine Le Galès; Isabelle Cartier; Vincent Molinié; Sylvain Labbé; Marie-Cécile Vacher-Lavenu; Philippe Vielh
Abstract Objectives: To compare the sensitivity, specificity, and interobserver reliability of conventional cervical smear tests, monolayer cytology, and human papillomavirus testing for screening for cervical cancer. Design: Cross sectional study in which the three techniques were performed simultaneously with a reference standard (colposcopy and histology). Setting: Public university and private practices in France, with complete independence from the suppliers. Participants: 828 women referred for colposcopy because of previously detected cytological abnormalities and 1757 women attending for routine smears. Main outcome measures: Clinical readings and optimised interpretation (two blind readings followed, if necessary, by consensus). Sensitivity, specificity, and weighted κ computed for various thresholds of abnormalities. Results: Conventional cervical smear tests were more often satisfactory (91% v 87%) according to the Bethesda system, more reliable (weighted κ 0.70 v 0.57), and had consistently better sensitivity and specificity than monolayer cytology. These findings applied to clinical readings and optimised interpretations, low and high grade lesions, and populations with low and high incidence of abnormalities. Human papillomavirus testing associated with monolayer cytology, whether systematic or for atypical cells of undetermined significance, performed no better than conventional smear tests. Conclusions: Monolayer cytology is less reliable and more likely to give false positive and false negative results than conventional cervical smear tests for screening for cervical cancer. What is already known on this topic New technologies have been developed to improve the detection of cervical cancer and its precursors and reduce the rate of false negative results from conventional cervical smear tests In several countries liquid based monolayer cytology is replacing conventional smear tests, despite controversy about whether these more expensive tests perform better What this study adds Conventional cervical smear testing is superior in terms of low and high grade lesions and in populations with a low or a high incidence of abnormalities Monolayer testing is less reliable and should not replace conventional cervical smear testing
Journal of the American College of Cardiology | 2002
Arnaud Lazarus; Jean Varin; Dominique Babuty; F.rédéric Anselme; Joël Coste; Denis Duboc
OBJECTIVES We hypothesized that pacemaker (PM) implantation in patients with myotonic dystrophy (MD) with a prolonged HV interval, even asymptomatic, may protect them against sudden death related to atrioventricular (AV) block. We sought to prospectively document the true incidence of AV block episodes in this high-risk population and accurately trace, in the long term, by the PM, the occurrence of arrhythmias that may remain undetected during conventional follow-up. BACKGROUND Myotonic dystrophy is associated with a high risk of sudden death, commonly attributed to AV block or ventricular arrhythmias, but cardiac pacing is only recommended as a secondary prevention. METHODS Patients with MD with an HV interval > or =70 ms, even in the absence of related symptoms, prospectively received a cardiac PM, including an algorithm capable of diagnosing episodes of bradycardia and tachyarrhythmias. RESULTS The population consisted of 49 patients (45.5 +/- 8.9 years old) followed for 53.5 +/- 27.2 months. Paroxysmal arrhythmias were recorded in 41 patients (83.7%), consisting of complete AV block (n = 21), sino-atrial block (n = 4), or atrial (n = 25) or ventricular (n = 13) tachyarrhythmias. No patient died of AV block during follow-up, but 10 deaths occurred, 4 of them sudden. An arrhythmic cause could be excluded by postmortem PM interrogation in two cases of typical sudden death. CONCLUSIONS Arrhythmias are common in patients with MD with infrahisian conduction abnormalities. The prophylactic implantation of a pacing system when the HV interval is > or =70 ms seems appropriate. The PM protects the patient against the clinical consequences of paroxysmal profound bradycardia and facilitates the diagnosis and management of frequent paroxysmal tachyarrhythmias.
Arthritis & Rheumatism | 2008
Alfred Mahr; Linda Belarbi; Bertrand Wechsler; Dominique Jeanneret; Robin Dhote; Olivier Fain; François Lhote; Jacky Ramanoelina; Joël Coste; Loïc Guillevin
OBJECTIVE To estimate the prevalence of Behçets disease (BD) in a multiethnic population living in France, with particular focus on disease risk among immigrants. METHODS The study was conducted in a county in the Paris metropolitan area that is home to 1,094,412 adults (ages > or =15 years), of whom 26% are of non-European ancestry. Patients with BD living in this area during 2003 were identified using 3 sources (hospitals, community physicians, and the National Health Insurance database), and diagnoses were verified using the International Study Group criteria. Standardized, year-2003 prevalence rates were computed for the overall population and for each ethnic group. Stratified prevalence rates according to age at immigration to France were calculated to investigate the relationship between age at immigration and BD risk. RESULTS Seventy-nine subjects fulfilled our search criteria. The overall prevalence per 100,000 adults was 7.1 (95% confidence interval [95% CI] 3.5-14.4), and the prevalence for populations of European, North African, and Asian ancestry was 2.4 (95% CI 0.6-7.2), 34.6 (95% CI 24.4-47.5), and 17.5 (95% CI 10.7-27.2), respectively. Within the migrant population of either North African or Asian ancestry, BD prevalences were similar for residents born in France, residents <15 years old at immigration, and residents > or =15 years old at immigration. CONCLUSION Our findings indicate that the prevalence of BD among immigrants of North African or Asian ancestry is significantly higher than that in the European-origin population, and comparable with rates reported from North Africa and Asia. Moreover, our results suggest that BD risk is not related to age at immigration. These findings support the hypothesis that BD has a primarily hereditary basis.
Annals of Internal Medicine | 1997
Jacques Pouchot; Anne Grasland; Carole Collet; Joël Coste; John M. Esdaile; P. Vinceneux
The tuberculin skin test has many potential sources of error and variability. Standardization of the tuberculin reagent and the meaning of the test results have been considered in some detail [1, 2], but little attention has been paid to the reading itself [3-10]. Measurement of the induration, however, is one of the most important potential sources of error. If the customary technique of palpation is used, the margins of the induration may be difficult to define. The alternative ballpoint-pen method, although advocated as more reliable than palpation [3], has not been discussed in official statements on tuberculosis [1, 2]. We investigated the reliability of the ballpoint-pen technique and compared this technique with the palpation method. Methods Patients and Procedures Patients and health care personnel who were in an internal medicine department and needed a tuberculin skin test were invited to participate. Persons who had received bacille CalmetteGurin vaccine were enrolled preferentially. Ninety-six persons who provided informed consent ultimately participated in the study. Tuberculin Skin Tests and Measurement Methods Ten units of tuberculin from Pasteur Merieux, Lyon, France (corresponding to the recommended 5 IU of purified protein derivative tuberculin), were injected intradermally on the volar surface of the forearm (Mantoux technique) [11]. Readings were done on the third day after the test was administered, and the diameter of induration was measured along the long axis of the forearm. Two experienced investigators each independently did three measurements. The first two measurements were taken with a blinded caliper using the ballpoint-pen technique [3]. With this technique, a medium-point ballpoint pen is used to draw a line starting 1 to 2 cm away from the skin reaction and moving toward its center. When the pen reaches the margin of the induration, an increased resistance to further movement is felt and the pen is lifted. The procedure is repeated on the opposite side of the skin reaction. The distance between the ends of the opposing lines at the margins of the induration is measured. In our study, the lines were erased and the measurement process was repeated. The lines were then erased again, and the third measurement was done by palpation [2]. To reproduce the usual conditions of testing, we used a flexible ruler. The data were collected during eight sessions; 11 to 14 participants were tested per session. To reduce the chance that an observer would remember previous readings, three things were done. First, the results of measures that were obtained with the blinded caliper were recorded by a third investigator. Second, the first ballpoint-pen measure was done for all participants at each session, then the second ballpoint-pen measure, and then the palpation measure. Third, before the second and third readings, the third investigator verified that no minor landmarks persisted. Statistical Analysis To analyze the reliability of quantitative data, we used statistical methods that have been described elsewhere [12]. Intraclass correlation coefficients and their 95% CIs were computed using SAS soft-ware (SAS Institute, Cary, North Carolina) [13]. Induration diameters were used to classify skin reactions as positive or negative according to the 5-, 10-, and 15-mm cutoff points that have been recommended as indicating positivity in various situations [2]. Reliability was then assessed with coefficients [14]. We also used a graphical analysis that focuses on the mean and the variation in the differences between repeated measurements [15]. Mean differences and the SD of the differences were calculated. An area of imprecision that was determined on the basis of the SD of the differences was placed around the arbitrarily chosen 10-mm cutoff value (10 mm 1.96 SD). If a first measurement fell within this area, particularly at or about the cutoff value, the likelihood that the second measurement would be sufficiently different to change the result of the tuberculin skin test from negative to positive (or vice versa) was high. Conversely, such reclassification would occur in only 5% of the cases that had values outside this area. Results Because of the study design, only 27 participants (28%) did not react to the tuberculin skin test. Reliability of the Ballpoint-Pen Technique Intraobserver Reliability In persons who had no response to the tuberculin skin test, the intraobserver reliability was perfect (intraclass correlation coefficient = 1.0). Intraclass correlation coefficients were high for both observers and decreased only slightly after the nonresponders were excluded. The coefficients also suggested good intraobserver reliability but were lower with the 10- and 15-mm cutoff values than with the 5-mm cutoff value (Table 1). Table 1. Reliability Study of the Ballpoint-Pen and Palpation Methods of Induration Measurement for the Tuberculin Skin Test The top panel of Figure 1 shows the difference between the two readings for each participant that were done by the first observer (range, 6.8 to +3.5 mm) plotted against the corresponding mean for each participant. The level of intraobserver reliability was evaluated by determining the 95% CI ( 2.68 to +2.96 mm) within which most of the differences were seen. This means that 5% of the time, the second measure of the test results done by using the ballpoint-pen method would be at least 2.7 mm less than or 3.0 mm more than the first one. This lack of reliability could lead to the reclassification of a negative tuberculin skin test result as positive or vice versa. Figure 1. Top. Middle. Bottom. As shown in the top panel of Figure 1, an area of imprecision that straddles the cutoff value (7.2 to 12.8 mm for a 10-mm cutoff value) was generated using the SD of the differences. Test results for 8 of the 69 patients (12%) were reclassified. The first measurement for 30 of the 69 patients (43.5%) fell within this area of imprecision; 7 of those 30 patients (23.3%) were among the 8 patients whose test results were reclassified. Interobserver Reliability Agreement between observers, estimated by using the intraclass correlation and coefficients, was high (Table 1). The first ballpoint-pen measures made by the two observers were used for these analyses. Differences between first measures done by the two observers were between 5.1 and +7.3 mm (Figure 1, middle). The 95% CI of the differences was 3.39 to +3.69 mm; this means that 5% of the time, the result of a second tuberculin skin test measurement by another investigator would be at least 3.4 mm more than or 3.7 mm less than that of a first investigator. As in the top panel of Figure 1, an area of imprecision (6.5 to 13.5 mm) is shown in the middle panel of Figure 1; this area is slightly broader than that calculated for intraobserver reliability. Test results for 8 of the 69 patients (12%) were reclassified. The first measurement for 40 of the 69 patients (58%) fell within this area of imprecision; 7 of those 40 patients (17.5%) were among the 8 patients whose results were reclassified. Reliability of the Palpation Technique Except for the coefficients at the 15-mm cutoff, assessment of agreement between observers showed that all reliability coefficients obtained with the palpation technique were slightly lower than those obtained with the ballpoint-pen method (Table 1). The 95% CI of the differences between the measures of the two observers was 4.6 to +5.2 mm (Figure 1, bottom). This resulted in a much broader area of imprecision for the readings (5.1 to 14.9 mm). Test results were reclassified for 12 of the 69 patients (17.4%). The first measure of 43 of the 69 patients (62.3%) fell within this area of imprecision, and the 12 patients whose test results were reclassified were among those 43 (27.9%). Agreement between Ballpoint-Pen and Palpation Methods Although all the intraclass correlation coefficients were high, the coefficients that were produced after persons with no response to the test were excluded suggested only moderate to good reliability (Table 1). The 95% CIs of the differences between the first ballpoint-pen and the palpation measures were 3.0 to +4.1 mm for readings taken by the first observer and 2.5 to +3.9 mm for readings taken by the second observer. The areas of imprecision for the measurements were from 6.4 to 13.6 mm for readings taken by the first observer and 6.8 to 13.2 mm for readings taken by the second observer. Reclassification occurred in 8 of 69 patients (12%) for both observers. Discussion In our study, the ballpoint-pen technique was reliable, as evaluated by global reliability coefficients. However, the graphical analysis provided a more meaningful representation of the level of variation. Intraobserver reliability may be the most important factor for such diagnostic tests as the tuberculin skin test, which are usually done by only one examiner for any given patient. Lack of reliability may lead to the frequent reclassification of results, particularly if readings are at or about the cutoff values. Reliability coefficients were slightly higher for the ballpoint-pen technique than for the palpation method. In addition, the 95% CI of the differences of the measures taken by the two observers was 38% broader for the palpation method than for the ballpoint-pen technique; this could result in more frequent misclassification. Only one study [10] has addressed the interobserver reliability of the ballpoint-pen technique. That study relied on simple correlation coefficients to determine reliability. Reanalysis of the data from that study provided a coefficient of 0.74 (using a cutoff point of 10 mm). Previous studies of the reliability of the palpation method [5, 6, 10] have also been restricted primarily to the assessment of interobserver agreement and have provided conflicting results. Recalculation from the data of one large survey of six studies on tuberculin skin testing [4] gave