Sophie Pennec

LIPRO 2.0: an application of a dynamic demographic projection model to household structure in the Netherlands.

This publication describes a multidimensional household projection model called LIPRO 2.0. The LIPRO computer program which is included in diskette form with the publication is written in Borlands Turbo Pascal 5.0 and can be run on personal computers or compatibles using MS/DOS. The program requires a mathematical coprocessor a hard disk and a memory of 640 kb. About half of the book is devoted to the methodological and computational aspects of the LIPRO model. Additional chapters present an illustrative application of the model to household structure and social security in the Netherlands.

End-of-life medical decisions in France: a death certificate follow-up survey 5 years after the 2005 act of parliament on patients’ rights and end of life

BackgroundThe “Patients’ Rights and End of Life Care” Act came into force in France in 2005. It allows withholding/withdrawal of life-support treatment, and intensified use of medications that may hasten death through a double effect, as long as hastening death is not the purpose of the decision. It also specifies the requirements of the decision-making process. This study assesses the situation by examining the frequency of end-of-life decisions by patients’ and physicians’ characteristics, and describes the decision-making processes.MethodsWe conducted a nationwide retrospective study of a random sample of adult patients who died in December 2009. Questionnaires were mailed to the physicians who certified/attended these deaths. Cases were weighted to adjust for response rate bias. Bivariate analyses and logistic regressions were performed for each decision.ResultsOf all deaths, 16.9% were sudden deaths with no information about end of life, 12.2% followed a decision to do everything possible to prolong life, and 47.7% followed at least one medical decision that may certainly or probably hasten death: withholding (14.6%) or withdrawal (4.2%) of treatments, intensified use of opioids and/or benzodiazepines (28.1%), use of medications to deliberately hasten death (i.e. not legally authorized) (0.8%), at the patient’s request (0.2%) or not (0.6%). All other variables held constant, cause of death, patients age, doctor’s age and specialty, and place of death, influenced the frequencies of decisions. When a decision was made, 20% of the persons concerned were considered to be competent. The decision was discussed with the patient if competent in 40% (everything done) to 86% (intensification of alleviation of symptoms) of cases. Legal requirements regarding decision-making for incompetent patients were frequently not complied with.ConclusionsThis study shows that end-of-life medical decisions are common in France. Most are in compliance with the 2005 law (similar to some other European countries). Nonetheless, the study revealed cases where not all legal obligations were met or where the decision was totally illegal. There is still a lot to be done through medical education and population awareness-raising to ensure that the decision-making process is compatible with current legislation, the physicians duty of care and the patient’s rights.

La place des familles à quatre générations en France.

Pennec (Sophie). - La importancia de las familias de cuatro generaciones en Francia En el pasado era excepcional que una persona jubilada perteneciera a una familia de 4 generaciones sucesivas. Este tipo de situacion es mucho mas frecuente en la actualidad. El presente estudio pretende estimar la proporcion de mujeres pertenecientes a las cohortes femeninas nacidas entre 1920 y 1950 que viven o viviran en familiad de este tipo desde los 50 aňos hasta su defuncion. Las mujeres nacidas en 1950 tienen una probabilidad clara- mente superior a las nacidas 30 aňos antes de vivir, durante la vejez, en una familia de 4 generaciones. Un 26 % de la mujeres supervivientes de la generacion de 1920 se encontraban, a los 50 aňos, en una situacion familiar de este tipo ; el porcentaje sera del 44 % para las mujeres nacidas en 1950. La construccion de un modelo « simple » permite, en primer lugar, paliar la falta de datos y reconstituir las diferentes generaciones presentes a partir exclusivamente de datos sobre fecundidad y mortalidad. En segundo lugar, el modelo permite separar las influencias de la mortalidad y de la fecundidad en el aumento observado, asi como estimar la composi- cion de la familia y en particular la posicion de la mujer en ella. A traves de este analisis se observa que el aumento futuro del numero de familias de 4 generaciones se debera princi- palmente a los incrementos en la esperanza de vida, y en particular a la presencia mas pro- longada de los padres y al aumento del numero de mujeres que viviran hasta edades avanzadas.

[A new scoring system for the diagnosis of BRCA1/2 associated breast-ovarian cancer predisposition].

Criteria have been proposed for genetic testing of breast and ovarian cancer susceptibility genes BRCA1 and BRCA2. Using simulations, this study evaluates the efficiency (sensitivity, positive predictive value [PPV] and specificity) of the various criteria used in France. The efficiency of the criteria published in 1998, which are largely used, is not optimal. We show that some extensions of these criteria provide an increase in sensitivity with a low decrease in specificity and PPV. The study shows that scoring systems (Manchester, Eisinger) have similar efficiency that may be improved. In this aim, we propose a new scoring system that takes into account unaffected individuals and kinship coefficients between family members. This system increases sensitivity without affecting PPV and specificity. Finally, we propose a two-step procedure with a large screening by the physician for recommending genetic counselling, followed by a more stringent selection by the geneticist for prescribing genetic testing. This procedure would result in an increase of genetic counselling activity but would allow the identification of almost 80% of mutation carriers among affected individuals, with a mutation detection rate of 15% and a specificity of 88%.

Nouveau système de score pour le diagnostic des prédispositions aux cancers du sein et de l’ovaire associées à BRCA1/2

Criteria have been proposed for genetic testing of breast and ovarian cancer susceptibility genes BRCA1 and BRCA2. Using simulations, this study evaluates the efficiency (sensitivity, positive predictive value [PPV] and specificity) of the various criteria used in France. The efficiency of the criteria published in 1998, which are largely used, is not optimal. We show that some extensions of these criteria provide an increase in sensitivity with a low decrease in specificity and PPV. The study shows that scoring systems (Manchester, Eisinger) have similar efficiency that may be improved. In this aim, we propose a new scoring system that takes into account unaffected individuals and kinship coefficients between family members. This system increases sensitivity without affecting PPV and specificity. Finally, we propose a two-step procedure with a large screening by the physician for recommending genetic counselling, followed by a more stringent selection by the geneticist for prescribing genetic testing. This procedure would result in an increase of genetic counselling activity but would allow the identification of almost 80% of mutation carriers among affected individuals, with a mutation detection rate of 15% and a specificity of 88%.

Trajectories of care home residents during the last month of life: the case of France

ABSTRACT This paper examines some demographic and medical factors associated with the likelihood of residing in a care home during the last month of life for persons aged 70 and over in France and, if so, of remaining in the care home throughout or being transferred to hospital. The data are from the Fin de vie en France (End of Life in France) survey undertaken in 2010. During the last month of life, very old people are more likely to be living in a care home but are not less likely to be transferred to hospital. Medical conditions and residential trajectories are closely related. People with dementia or mental disorders are more likely to live in a care home and, if so, to stay there until they die. Compared to care homes, a more technical and medication-based approach is taken in hospitals and care home residents who are transferred to hospital more often receive medication while those remaining in care homes more often receive support from a psychologist. In hospitals as in care homes, few older persons had recourse to advance directives and hospice programmes were not widespread. Promoting these two factors may help to increase the quality of end of life and facilitate an ethical approach to end-of-life care.

A new scoring system in cancer genetics: application to criteria for BRCA1 and BRCA2 mutation screening

Background In hereditary forms of cancer due to mutations of genes such as BRCA1 and BRCA2, methods have been proposed to predict the presence of a mutation in a family. Methods Relying on carriage probability computation is the most predictive, but scores are a good proxy and avoid using computer software. An empirical method, the Manchester scoring system, has been elaborated for BRCA1 and BRCA2 mutation identification. We propose a general scoring system based on a transformation of the carriage probability. Up to an approximation, the transformed carriage probability becomes an additive score. We applied this new scoring system to the diagnosis of BRCA1-associated and BRCA2-associated breast–ovarian cancer predisposition. Using simulations, its performance was evaluated and compared with that of the Manchester scoring system and of the exact probability. Finally, the score system was used on a sample of 4563 families screened for BRCA1 and BRCA2 mutations. Results The performance of the new scoring system was superior to the Manchester scoring system, but the probability computation remained the most predictive. The better performance of the new scoring system was attributed to accounting for unaffected family members and for the degree of kinship of relatives with the proband. Conclusions The new scoring system has a theoretical basis and may be applied to any cancer family syndrome and, more generally, to any disease with monogenic subentities, in which the causal gene mutations have been identified. It will be easily modified when additional predictive factors are found.

Physician-assisted deaths in France: Results from a nationwide survey

La Presse Medicale - In Press.Proof corrected by the author Available online since jeudi 4 juin 2015

Le passage à la retraite d'une génération féminine : une projection par simulation individuelle

Pennec (Sophie). - El paso a la jubilacion de una generacion femenina: una proyeccion por simulation individual. Este trabajo se basa en la descripcion del futuro familiar y economico probable de una generacion en el horizonte 2020-2040, concretamente la de mujeres nacidas entre 1938 y 1942. Se trata de estimar el grado de aislamiento de estas mujeres durante la ultima parte de su ciclo de vida (presencia o no de conyuge o de hijos). El estudio trata tambien de la si- tuacion financiera de las mujeres de estas generaciones: esta situacion no esta unicamente condicionada por los derechos propios adquiridos por estas mujeres y sus posibles conyuges a lo largo de la vida profesional, sino tambien por el fenomeno de aislamiento simulado an- teriormente, la viudedad acarreando evidentemente una modificacion de los recursos. Estas simulaciones, realizadas a partir de datos individuates procedentes de la En- cuesta Familias de 1982, son aun exploratorias, pero muestran en que medida este tipo de trabajos puede contribuir a clarificar el debate sobre los sistemas de proteccion social.

Immigrant-born workers and quality early childhood education and care in the Northern Territory, Australia

Abstract This paper focuses on the growing immigrant-born population of early childhood education and care (ECEC) workers in the Northern Territory of Australia, who represent a committed but poorly understood group within this workforce. The recent reforms to the ECEC workforce in Australia aim to achieve high-quality ECEC services by (a) growing this workforce size to meet the demand for services; (b) meeting the higher educator-to-children ratios; and (c) raising the overall level of qualifications of ECEC workers. By combining the statistical data in an innovative way, this paper shows that even when the growing numbers in this group are combined with newly qualified, immigrant-born and Australian-born entrants, the total number of workers may still be too small to fully implement recent reforms. It concludes by identifying data quality issues and future research directions that would help inform and develop a new strategy for the Northern Territory ECEC workforce.