Center for Research in Epidemiology and Population Health

Villejuif, France

Center for Research in Epidemiology and Population Health

Villejuif, France
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Senat M.-V.,Center for Research in Epidemiology and Population Health | Porcher R.,French Institute of Health and Medical Research | Deruelle P.,Hopital Jeanne de Flandre | Perrotin F.,Hopital Bretonneau | And 4 more authors.
American Journal of Obstetrics and Gynecology | Year: 2013

Objective: The objective of the study was to evaluate the use of 17 alpha-hydroxyprogesterone caproate (17P) to reduce preterm delivery in women with a twin pregnancy and short cervix. Study Design: This open-label, multicenter, randomized controlled trial included women with a twin pregnancy between 24+0 and 31+6 weeks of gestation who were asymptomatic and had a cervical length of 25 mm or less measured by routine transvaginal ultrasound. Women were randomized to receive (or not) 500 mg of intramuscular 17P, repeated twice weekly until 36 weeks or preterm delivery. The primary outcome was time from randomization to delivery. Analysis was performed according to the intent-to-treat principle. Results: The 17P and control groups did not differ significantly for median [interquartile range] time to delivery: 45 (26-62) and 51 (36-66) days, respectively. However, treatment with 17P was associated with a significant increase in the rate of preterm delivery before 32 weeks. Conclusion: Twice-weekly injections of 17P did not prolong pregnancy significantly in asymptomatic women with a twin pregnancy and short cervix. © 2013 Mosby, Inc.


Naouri D.,Center for Research on Medicine | Bussiere C.,Center for Research in Epidemiology and Population Health | Pelletier-Fleury N.,Center for Research in Epidemiology and Population Health
Archives of Physical Medicine and Rehabilitation | Year: 2016

Objective: To explore the determinants of specialized outpatient care use (general practitioners excluded) in people with disabilities living in institutions. Design: Cross-sectional study. Setting: National health and disability survey. Participants: People (N=2528) living in institutions for adults with cognitive, sensory, and mobility disabilities. Interventions: Not applicable. Main Outcome Measures: We used different measures of disability severity available in the survey: (1) the continuous score of limitations based on a measure we constructed according to self-reported level of difficulty performing 18 tasks without aid; (2) the Katz Index; and (3) the respondent's self-reported perception of functional limitations. Logistic regressions were performed to examine the determinants of the likelihood of having consulted a specialized outpatient care physician or a dentist at least once in the previous year. Results: Of the 2528 individuals, 45% (1141) and 28% (697) had respectively consulted a specialized outpatient care physician or a dentist at least once in the previous year. After adjusting for health care needs, higher functional limitation scores, dependency in all 6 activities of daily living, and self-reported perceptions of severe functional limitations were significantly associated with a lower likelihood of having consulted a specialized outpatient care physician (adjusted odds ratio [AOR], .95 [95% confidence interval (CI), .94-.96]; AOR, .29 [95% CI, .23-.38]; and AOR, .51 [95% CI, .42-.62], respectively) or a dentist (AOR, .95 [95% CI, .94-.96]; AOR, .29 [95% CI, .21-.39]; AOR, .55 [95% CI, .44-.67], respectively) at least once in the previous year. Being a man, reporting a lack of family support, and having a low socioeconomic status also significantly affected specialized outpatient care use. Conclusions: Regardless of the method used to define and measure disability, a high degree of disability negatively affects specialized outpatient care use after adjusting for health care need. Further studies are needed to better understand the reasons why this association between the degree of functional limitation and unmet medical needs is also a reality for people with disabilities living in institutions. © 2016 American Congress of Rehabilitation Medicine.


Bonnet F.,University of Rennes 1 | Disse E.,French Institute of Health and Medical Research | Laville M.,French Institute of Health and Medical Research | Mari A.,Institute of Biomedical Engineering | And 7 more authors.
Diabetologia | Year: 2012

Aims/hypothesis Moderate alcohol consumption is associated with a reduced risk of type 2 diabetes with a stronger effect in women. As the underlying mechanisms remain poorly characterised, we investigated its relationship with insulin resistance, insulin secretion, clearance of insulin and glucagon concentration. Methods One-thousand two-hundred and seventy-six non-diabetic individuals from the RISC (relationship between insulin sensitivity and cardiovascular disease) study without high alcohol consumption were studied; all had a euglycaemic-hyperinsulinaemic clamp and an OGTT with assessment of insulin sensitivity, secretion and clearance.Results Alcohol consumption was positively associated with insulin sensitivity in women (β=0.15, p trend=0.005) and in men (β=0.07, ptrend=0.07) after controlling for age, centre, waist, smoking and physical activity. In women, this association persisted after adjustment for adiponectin but was attenuated after controlling for HDL-cholesterol, suggesting that part of the protection is related to a higher HDL-cholesterol concentration. Higher alcohol consumption was associated with lower basal insulin secretion in women only (β=-0.10, ptrend=0.004) and this association persisted after adjustment for insulin sensitivity. In men, increasing alcohol consumption was associated with enhanced insulin clearance and increased fasting NEFA concentrations, independently of insulin sensitivity. Fasting glucagon decreased with increasing alcohol in women only (abstainers 9.2±4.4; >28 g/week 8.6±4.0; 28-64 g/week 8.1±3.7; <64 g/week 7.5±3.1 pmol/l; p trend=0.01). Conclusions/interpretation Light-to-moderate alcohol consumption was associated in healthy women with enhanced insulin sensitivity, reduced basal insulin secretion rate and lower fasting plasma glucagon concentration, providing consistent mechanisms for the reduced risk of diabetes. © Springer-Verlag 2012.


Rava M.,Center for Research in Epidemiology and Population Health | Rava M.,University Paris - Sud | Smit L.A.M.,Institute for Risk Assessment science IRAS | Nadif R.,Center for Research in Epidemiology and Population Health | Nadif R.,University Paris - Sud
Current Opinion in Allergy and Clinical Immunology | Year: 2015

Purpose of Review: Asthma is a complex disease characterized by an intricate interplay of both heritable and environmental factors. Understanding the mechanisms through which genes and environment interact represents one of the major challenges for pulmonary researchers. This review provides an overview of the recently published literature on gene-environment (G×E) interactions in asthma, with a special focus on the new methodological developments in the postgenomewide association studies (GWAS) era. Recent Findings: Most recent studies on G×E interaction in asthma used a candidate-gene approach. Candidate-gene studies considering exposure to outdoor air pollutants showed significant interactions mainly with variants in the GSTP1 gene on asthma in children. G×E studies on passive and active smoking, including one genomewide interaction study, identified novel genes of susceptibility to asthma and a time-dependent effect of maternal smoking. Other recent studies on asthma found interactions between candidate genes and occupational allergen exposure and several domestic exposures such as endotoxin and gas cooking. New methods were developed to efficiently estimate G×E interaction in GWAS, and a pathway-based strategy to select an enriched gene-set for G×E studies has recently been proposed. Summary: The G×E studies presented in this review offer a good example on how candidate-gene approaches can complement and help in validating GWAS findings. © 2015 Wolters Kluwer Health, Inc. All rights reserved.


Canonico M.,Center for Research in Epidemiology and Population Health | Canonico M.,University Paris - Sud | Plu-Bureau G.,Center for Research in Epidemiology and Population Health | Plu-Bureau G.,University of Paris Descartes | And 2 more authors.
Maturitas | Year: 2011

Hormone therapy (HT) is the most effective treatment for correcting menopausal symptoms after menopause. HT initially consisted of estrogens alone and progestogens were secondly added to estrogens for preventing the risk of endometrial cancer associated to estrogens use. Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, is a major harmful effect of HT. It is now well known that oral and transdermal estrogens are differentially associated with VTE risk but progestogens may be another important determinant of the thrombotic risk among HT users. Both randomized controlled trials and meta-analysis of observational studies suggested that the VTE risk was higher among users of estrogens plus progestogens than among users of estrogens alone. With respect to the different pharmacological classes of progestogens, there is evidence for a deleterious effect of medroxyprogesterone acetate on VTE risk. In addition, observational studies showed that norpregnane derivatives were significantly associated with an increased VTE risk whereas micronized progesterone could be safe with respect to thrombotic risk. The effect of tibolone on VTE risk remains uncertain. In conclusion, progestogens may have differential effects on VTE risk according to the molecules and therefore represent an important potential determinant of the thrombotic risk among postmenopausal women using estrogens. © 2011 Elsevier Ireland Ltd.


Varraso R.,Center for Research in Epidemiology and Population Health | Varraso R.,University Paris - Sud | Barr R.G.,Columbia University | Willett W.C.,Harvard University | And 3 more authors.
American Journal of Clinical Nutrition | Year: 2015

Background: Despite mechanistic data that linked fish and omega-3 (n-3) PUFAs with lower risk of chronic obstructive pulmonary disease (COPD), epidemiologic data remain scarce. Fish and n-3 PUFAs are an important component of the prudent dietary pattern that is thought to be protective in the onset of COPD. Objective: We examined the role of fish and PUFA intakes on risk of developing COPD while taking into account the overall dietary pattern. Design: We investigated the objective in 120,175 women and men from the Nurses' Health Study and Health Professionals Follow-Up Study. Over the study period (1984-2000), there were 889 cases of newly diagnosed COPD. Cumulative average intakes of fish, eicosapentaenoic acid, docosahexaenoic acid, n-3 PUFAs, n-6 PUFAs, and the n-3:n-6 ratio were calculated from repeated food-frequency questionnaires. Because fish is a food group included in the prudent pattern, we derived a new prudent pattern without the contribution from fish, and we termed this pattern the "modified prudent" pattern. We performed multivariable Cox proportional hazards models. Results: Before the dietary pattern was taken into account, and with 14 factors controlled for, we showed that more-frequent fish intake (≤4 servings/wk) was inversely associated with risk of COPD [adjusted pooled HR for the highest intake compared with the lowest intake (<1 serving/wk): 0.71; 95% CI: 0.54, 0.94]. After additional adjustment for the dietary pattern (modified prudent and Western patterns), the association was NS (0.84; 95% CI: 0.63, 1.13). No significant associations were shown between PUFA intakes and risk of COPD. Conclusion: Although COPD-prevention efforts should continue to focus on smoking cessation, these prospective findings support the importance of promoting a healthy diet in multi-interventional programs to prevent COPD instead of focusing on changes in an isolated food or nutrient. © 2015 American Society for Nutrition.


Moreau C.,Family and Reproductive Health | Moreau C.,Center for Research in Epidemiology and Population Health | Moreau C.,National Institute of Demographic Studies | Bohet A.,Center for Research in Epidemiology and Population Health | And 5 more authors.
Fertility and Sterility | Year: 2013

Objective: To investigate trends and determinants in the use of long-acting reversible contraceptives (LARCs), including intrauterine devices and implants, over the last decade among young women in France. Design: Data drawn from three cross-sectional national probability surveys. Setting: Not applicable. Patient(s): A total of 1,204 women, ages 15 to 29, who are at potential risk of an unintended pregnancy in 2000; 1,921 in 2005; and 1,281 in 2010. Intervention(s): None. Main Outcome Measure(s): Logistic regression models were used to explore trends in LARC use since 2000 and to examine determinants of LARC use in 2010. Result(s): A minority of women were using LARC methods, with a significant increase between 2000 and 2010, from 4.6% to 6.4%. The odds of LARC use in 2010 were higher among women 20 to 29 years, parous women, women with a history of unintended pregnancy, women in difficult financial situations, smokers, and women in the care of a gynecologist. Conclusion(s): This study shows that little progress has been made in LARC use among young women in France, despite these methods being widely available and reimbursed by the national health system. Copyright © 2013 American Society for Reproductive Medicine, Published by Elsevier Inc.


Maitrot-Mantelet L.,University of Paris Descartes | Horellou M.H.,University of Paris Descartes | Massiou H.,Lariboisiere Hospital | Conard J.,University of Paris Descartes | And 3 more authors.
Thrombosis Research | Year: 2014

Introduction Migraine, particularly migraine with aura (MA), is associated with a higher risk for ischemic stroke (IS). A procoagulant state may predispose to IS. Whether inherited biological thrombophilia are associated with migraine risk remains controversial. Objective To assess the risk of migraine without or with aura related to inherited biological thrombophilia adjusted for the main potential confounders. Material and Methods A cross-sectional study was conducted in 1456 French women aged 18 to 56 years, referred for biological coagulation check-up because of personal or familial venous thrombosis history. Between April 2007 and December 2008, all women answered a self-administered questionnaire to determine whether they had headache. Results There were 294 (20%) migrainous sufferers (including 71 [5%] with MA), 975 (67%) non migrainous women and 187 (13%) non migrainous headache women. Inherited thrombophilia were detected in 576 (40%) women, including 389 (40%) non migrainous women, 90 (40%) migraine without aura (MWA), 33 (46%) MA women and 64 (34%) non migrainous headache women. Factor V Leiden (FVL) i.e. F5rs6025 or Factor II G20210A (FIIL) i.e. F2rs1799963 mutation was detected in 296 (30%) non migrainous women and in 100 (34%) migrainous women of which 27 had MA. There was a significant association between MA and FVL or FIIL mutations (adjusted OR = 1.76 [95% CI 1.02-3.06] p = 0.04) whereas this association in MWA and in non migrainous headache women was not significant. There was no significant association between migraine and other biological thrombophilia. Conclusion FVL or FIIL mutations were more likely among patients suffering from MA. Whether biological thrombophilia screening should be systematically performed in women suffering from MA remains to be determined. © 2014 Elsevier Ltd. All rights reserved.


Canonico M.,Center for Research in Epidemiology and Population Health | Canonico M.,University Paris - Sud
Menopause | Year: 2014

Objective: Postmenopausal hormone therapy (HT), which consists of exogenous estrogens with or without combined progestogens, remains the most effective treatment of climacteric symptoms. Depending on its characteristics, it may nevertheless increase the risk of venous thromboembolism, and its effects on hemostasis have been studied for several decades. The aim of this review was to summarize current knowledge on the effects of HT on hemostasis, taking into account the route of estrogen administration, the daily dose and chemical structure of estrogens, and the pharmacologic class of progestogens. Methods: Data from randomized controlled trials that included a control group (either placebo or no treatment) were selected, and analysis was conducted on different generations of biomarkers. Results: Overall, studies showed a hemostasis imbalance among oral estrogen users with a decrease in coagulation inhibitors and an increase in markers of activation coagulation, leading to global enhanced thrombin generation. By contrast, transdermal estrogen use was associated with less change in hemostasis variables and did not activate coagulation and fibrinolysis. No clear difference in HT effects on hemostasis was highlighted between daily doses of estrogens, between estrogen compounds, and between pharmacologic classes of progestogens. Conclusions: Changes in hemostasis are in accordance with clinical results showing an increased thrombotic risk with oral - but not transdermal - estrogen use. © 2014 by The North American Menopause Society.


Jeebhay M.F.,University of Cape Town | Ngajilo D.,University of Cape Town | Le Moual N.,Center for Research in Epidemiology and Population Health | Le Moual N.,University Paris - Sud
Current Opinion in Allergy and Clinical Immunology | Year: 2014

PURPOSE OF REVIEW: To identify the similarities and differences between nonwork-related adult-onset and occupational asthma from various literature sources published between 2010 and 2013, with respect to the epidemiology, phenotypic manifestations, and risk factors for the disease. RECENT FINDINGS: The incidence of adult-onset asthma from pooled population studies is estimated to be 3.6 per 1000 person-years in men and 4.6 cases per 1000 person-years in women. In adults with new-onset asthma, occupational asthma is a common asthma phenotype. Work-related factors are estimated to account for up to 25% of adult cases of asthma and occupational asthma comprising about 16% of adult-onset asthma cases. The review finds that nonwork-related adult-onset asthma is a heterogenous entity and that environmental exposure factors (aside from occupational exposures) appear to have a lesser role than host factors when compared with occupational asthma. SUMMARY: Large-scale general population studies are needed to identify the similarities and differences between nonwork-related adult-onset and occupational asthma, which may enable a better understanding of these entities and promote efforts towards holistic management approaches for these asthma phenotypes. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.

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