Thomas L.,University Hospital |
Najioullah F.,University Hospital |
Besnier F.,University Hospital |
Valentino R.,University Hospital |
And 24 more authors.
American Journal of Tropical Medicine and Hygiene | Year: 2014
During the last decade Martinique experienced four dengue epidemics, each characterized by the predominance of 1 or 2 serotypes. In this retrospective database analysis, we investigated the relationship between dengue serotype and disease severity. Data on dengue were collected from 715 patients (male/female ratio 0.87), 14 to 91 years of age (median 35 years) examined in the adult emergency department between 2005 and 2010. In this series, DENV-4 infections more frequently had a milder clinical presentation. The DENV-2 infections were most often secondary infections admitted at the critical phase of dengue illness with signs of plasma leakage. The DENV-1 infections were disabling, particularly in females, and most often led to disease of intermediate severity, without overt plasma leakage. These data were consistent with there being differences in virulence between serotypes, regardless of the host's immune status. However, secondary DENV-2 infections showed an increased risk of plasma leakage. Copyright © 2014 by The American Society of Tropical Medicine and Hygiene.
Saunders L.,Coordination Center for Nosocomial Infection Control |
Saunders L.,University of Sfax |
Perennec-Olivier M.,Coordination Center for Nosocomial Infection Control |
Jarno P.,Coordination Center for Nosocomial Infection Control |
And 6 more authors.
PLoS ONE | Year: 2014
Background: Surgical site infection (SSI) surveillance is a key factor in the elaboration of strategies to reduce SSI occurrence and in providing surgeons with appropriate data feedback (risk indicators, clinical prediction rule). Aim: To improve the predictive performance of an individual-based SSI risk model by considering a multilevel hierarchical structure. Patients and Methods: Data were collected anonymously by the French SSI active surveillance system in 2011. An SSI diagnosis was made by the surgical teams and infection control practitioners following standardized criteria. A random 20% sample comprising 151 hospitals, 502 wards and 62280 patients was used. Three-level (patient, ward, hospital) hierarchical logistic regression models were initially performed. Parameters were estimated using the simulation-based Markov Chain Monte Carlo procedure. Results: A total of 623 SSI were diagnosed (1%). The hospital level was discarded from the analysis as it did not contribute to variability of SSI occurrence (p = 0.32). Established individual risk factors (patient history, surgical procedure and hospitalization characteristics) were identified. A significant heterogeneity in SSI occurrence between wards was found (median odds ratio [MOR] 3.59, 95% credibility interval [CI] 3.03 to 4.33) after adjusting for patient-level variables. The effects of the follow-up duration varied between wards (p<10-9), with an increased heterogeneity when follow-up was <15 days (MOR 6.92, 95% CI 5.31 to 9.07]). The final two-level model significantly improved the discriminative accuracy compared to the single level reference model (p<10-9), with an area under the ROC curve of 0.84. Conclusion: This study sheds new light on the respective contribution of patient-, ward- and hospital-levels to SSI occurrence and demonstrates the significant impact of the ward level over and above risk factors present at patient level (i.e., independently from patient case-mix). © 2014 Saunders et al.
Peneau S.,University of Paris 13 |
Peneau S.,French Institute of Health and Medical Research |
Peneau S.,National Health Research Institute |
Peneau S.,French National Conservatory of Arts and Crafts |
And 12 more authors.
Journal of Pediatrics | Year: 2014
Objective To examine the association between breastfeeding and adult body fatness, adjusting for nutritional intake in early childhood. Study design Nutritional intakes of 73 healthy infants born in 1984 who participated in the 2-decade-long Longitudinal Study of Nutrition and Growth in Children (Etude Longitudinale Alimentation Nutrition Croissance des Enfants [ELANCE]) were estimated at age 10 months and again at age 2 years. Breastfeeding was defined as any breastfeeding, including partial breastfeeding, regardless of duration. At age 20 years, weight, height, subscapular skinfold thickness (SF), and fat mass (assessed via bioelectrical impedance analysis) were measured. Results In this sample, 64% of the children had been breastfed. In linear regression models adjusted for mother's body mass index and father's profession, breastfeeding was not associated with any of the body fat measurements at 20 years (all P >.05). After adding nutritional intake variables (total energy and % energy from nutrients) to the models, breastfeeding became significantly associated with lower SF at 20 years. In particular, breastfed subjects had significantly lower % SF at 20 years after adjustment for energy and % fat intakes at 2 years of age, (β = -28.25% SF; 95% CI, -50.28% to -6.21%; P =.013) or when adjusting for energy and % carbohydrates at 2 years of age (β = -28.27% SF; 95% CI, -50.64% to -5.90%; P =.014). Conclusion Breastfeeding was not associated with adult body fatness taking into account the usual confounding factors. However, after also adjusting for nutritional intake covariates, a protective effect of breastfeeding emerged. Early nutrition needs to be taken into account when examining the long-term health effects of breastfeeding. © 2014 Elsevier Inc. All rights reserved.
Iszatt N.,Norwegian Institute of Public Health |
Stigum H.,Norwegian Institute of Public Health |
Verner M.-A.,University of Montreal |
White R.A.,Norwegian Institute of Public Health |
And 19 more authors.
Environmental Health Perspectives | Year: 2015
Background: Infant exposure to persistent organic pollutants (POPs) may contribute to obesity. However, many studies so far have been small, focused on transplacental exposure, used an inappropriate measure to assess postnatal exposure through breastfeeding if any, or did not discern between prenatal and postnatal effects. oBjectives: We investigated prenatal and postnatal exposure to POPs and infant growth (a predictor of obesity). Methods: We pooled data from seven European birth cohorts with biomarker concentrations of polychlorinated biphenyl 153 (PCB-153) (n = 2,487), and p,p´-dichlorodiphenyldichloroethylene (p,p´-DDE) (n = 1,864), estimating prenatal and postnatal POPs exposure using a validated pharmaco kinetic model. Growth was change in weight-for-age z-score between birth and 24 months. Per compound, multilevel models were ftted with either POPs total exposure from conception to 24 months or prenatal or postnatal exposure. results: We found a significant increase in growth associated with p,p´-DDE, seemingly due to prenatal exposure (per interquartile increase in exposure, adjusted β = 0.12; 95% CI: 0.03, 0.22). Due to heterogeneity across cohorts, this estimate cannot be considered precise, but does indicate that an association with infant growth is present on average. In contrast, a significant decrease in growth was associated with postnatal PCB-153 exposure (β = –0.10; 95% CI: –0.19, –0.01). conclusion: To our knowledge, this is the largest study to date of POPs exposure and infant growth, and it contains state-of-the-art exposure modeling. Prenatal p,p´-DDE was associated with increased infant growth, and postnatal PCB-153 with decreased growth at European exposure levels. © 2015, Public Health Services, US Dept of Health and Human Services. All Rights Reserved.
Caron A.,Institute for Public Health Surveillance |
Clement G.,Institute for Public Health Surveillance |
Heyman C.,Institute for Public Health Surveillance |
Aernout E.,Institute for Public Health Surveillance |
Le Tertre A.,French Institute for Public Health Surveillance
Studies in Health Technology and Informatics | Year: 2015
Introduction. Incompleteness of epidemiological databases is a major drawback when it comes to analyzing data. We conceived an epidemiological study to assess the association between newborn thyroid function and the exposure to perchlorates found in the tap water of the mother's home. Only 9% of newborn's exposure to perchlorate was known. The aim of our study was to design, test and evaluate an original method for imputing perchlorate exposure of newborns based on their maternity of birth. Methods. In a first database, an exhaustive collection of newborn's thyroid function measured during a systematic neonatal screening was collected. In this database the municipality of residence of the newborn's mother was only available for 2012. Between 2004 and 2011, the closest data available was the municipality of the maternity of birth. Exposure was assessed using a second database which contained the perchlorate levels for each municipality. We computed the catchment area of every maternity ward based on the French nationwide exhaustive database of inpatient stay. Municipality, and consequently perchlorate exposure, was imputed by a weighted draw in the catchment area. Missing values for remaining covariates were imputed by chained equation. A linear mixture model was computed on each imputed dataset. We compared odds ratios (ORs) and 95% confidence intervals (95% CI) estimated on real versus imputed 2012 data. The same model was then carried out for the whole imputed database. Results. The ORs estimated on 36,695 observations by our multiple imputation method are comparable to the real 2012 data. On the 394,979 observations of the whole database, the ORs remain stable but the 95% CI tighten considerably. Discussion. The model estimates computed on imputed data are similar to those calculated on real data. The main advantage of multiple imputation is to provide unbiased estimate of the ORs while maintaining their variances. Thus, our method will be used to increase the statistical power of future studies by including all 394,979 newborns. © 2015 European Federation for Medical Informatics (EFMI).