Variation of diabetes incidence over time in countries with different incidence levels and socio-economic conditions, and in an age span beyond the childhood years, may give clues for diabetes causes. Materials: Data from prospective type 1 diabetes registers in Sweden and Lithuania in children (0-14 years) and young adults (15-34 and 15-39 years, respectively). Number of infections recorded in health care booklets (117 cases; 270 controls); interview about the dietary intake one-year before the diagnosis and routinely recorded growth data (99 cases; 180 controls). Results: The incidence of type 1 diabetes in Sweden and Lithuania differed most in the younger age groups, 28.9 and 7.5/100,000/year in 0-14-year group, respectively. During 1983-2000 incidence increased in 0-14-year old children in both countries, but the pattern of change differed. During 1983-1998 the incidence increased in Swedish children, but tended to decrease in young adults, with no increase in the age group below 35 years, indicating that the increase of childhood diabetes may be due to a shift towards a younger age at diagnosis. Within a low-incidence country Lithuania there was an urban-rural gradient of incidence, especially in the younger age groups, that seemed to follow poverty distribution: incidence in the 0-39-year group was 7.1, 9.0 and 8.8/100,000/year in rural areas, towns and cities, respectively, p<0.001. Exposure to one or more non-specific infection during the first half-year of life reduced diabetes risk: odds ratios (95%-CI) in 0-14 and 5-14-year groups were (0.60; 0.37-0.98) and (0.47; 0.26-0.87), respectively. Higher energy intake and weight-for-age were independent diabetes risk factors: odds ratios for medium and high levels of energy were 1.33 (0.52-3.42) and 5.23 (1.67-16.38), and for weight-for-age 3.20 (1.30-7.88) and 3.09 (1.16-8.22), respectively. High intake of carbohydrates, disaccharides and sucrose in particular, increased diabetes risk independently of the high intake of energy. Conclusion: Environmental factors associated with socio-economic conditions in childhood may be important for the occurrence of type 1 diabetes. Lack of exposure to microbial antigens early in life, higher intake of energy and more rapid growth may contribute to the increase of childhood-onset diabetes observed in many countries.

Background Screening by cytology has been highly effective in reducing the incidence and mortality from squamous invasive cervical cancer (ICC), but the effectiveness is less established regarding non-squamous ICC and regarding women above screening ages and below 30 years of age. Cervical cancer still occurs despite the presence of an organised screening programme. A substantial proportion of screened women with ICC are reported to have had previous abnormal cytology findings. The significance of negative cytology with limited evaluation is not quite determined, the most effective management of women with low-grade abnormalities is controversial, and evaluation of long-term effect of different treatment methods is limited. Aims To identify possible areas of improvements in the prevention of cervical cancer by evaluating the effectiveness of the Swedish cervical screening programme, and by exploring risk factors for ICC in the cytological screening histories and in the management of women with abnormal cytology findings. Methods The screening histories of all ICC cases in Sweden 1999-2001 (n=1230) and of five population-based control women per case were reviewed, using data from the Swedish Cancer Registry, the national population register, the Swedish national cervical screening quality register, histopathological reports and questionnaires to clinicians. The risk of cervical cancer according to screening histories 0.5-6.5 years before cancer diagnosis was estimated as odds ratios (ORs) in logistic regression models with 95% confidence interval (CI) (Paper I). Risk related to different cytological reports was assessed in women below 67 years of age with cytology (n=572, n=3569) in Paper II. The initial follow-up of women with abnormal or unsatisfactory cytology reports (n=159, n=258) was evaluated in Paper III, and further investigation and treatment of abnormalities (n=143 cases, n=176 controls) in Paper IV. Results The cancer cases were above screening ages (31%), had not been screened according to recommendations (33%), had negative cytology (23%), or had previous positive screening tests (13%). No screening within the recommended interval increased the risk of squamous (OR 2.97, 95% CI 2.51-3.50) as well as non-squamous cancer (OR 1.59, 95% CI 1.20-2.11), and increased the risk in all ages. Negative cytology with partially obscuring factors and unsatisfactory cytology increased the risk of subsequent early stage ICC. All cytological abnormalities increased the risk of ICC, and women with glandular atypia or atypia in cells of uncertain origin carried a particularly high risk (OR 11.69, 95% CI 7.02-19.46). After a low-grade squamous abnormal smear finding, further investigation with biopsy was more effective than repeated cytology (OR 0.46, 95% CI 0.24-0.89). Lack of biopsy increased the risk in women with both low-grade and high-grade squamous abnormalities. Neither repeat cytology, nor biopsy, decreased the risk in women with glandular atypia or atypia in cells of uncertain origin. Treatment decreased the risk, even when the biopsy before treatment was negative or showed low-grade atypia only. Ablative therapy was less effective than excision and laser conisation was the most effective therapy. Conclusions Improved adherence to screening recommendations and including older women at increased risk in the programme would have significant cancer preventive gains. Women with negative cytology with limited evaluation and with unsatisfactory cytology may need further evaluation. Assessment with biopsy should be recommended for women with low-grade as well as high-grade squamous abnormalities. The diagnosing of precancer lesions and the identification of women in need of treatment warrant improvements, in particular in cases of glandular or “other” atypia in cytology. Treatment techniques need further evaluation.

Background: Helicobacter pylori (H. pylori) infection is a significant risk factor for peptic ulcer (PU) and gastric cancer (GC). Apart from the virulent CagA genotype of H. pylori environmental and dietary factors influence disease outcomes. There have been no studies addressing these factors in Western India. Hence, we conducted a case control study enrolling PU, GC patients and controls at Pune, India. Methods: Risk factors for PU and H. pylori infection were assessed in participant interview. H. pylori status was assessed from stool by monoclonal antigen detection. To understand treatment effect, we followed 100 H. pylori positive patients. Results: We enrolled 190 PU patients, 125 Controls and 35 GU patients. Prevalence of H. pylori was 61% among symptomatic patients and 45% among controls. H. pylori infection (OR: 1.70, 95% CI: 1.03-2.89), meat (OR: 1.10, 95% CI: 1.02-1.75), fish (OR: 1.05, 95% CI: 1.02-1.89) consumption, and family history of ulcer (OR: 1.20, 95% CI: 1.08-1.60) were risk factors for PU. Consumption of snacks with alcohol (OR: 0.32, 95% CI: 0.13-0.78) and history of anti-parasite treatment (OR: 0.51, 95% CI: 0.30-0.86) were protective factors against PU. Lower socioeconomic status (SES) (OR: 1.10, 95% CI: 1.02-1.39), meat consumption (OR: 2.35, 95% CI: 1.30-4.23), smoking (OR: 2.23, 95% CI: 1.24-4.02), eating restaurant food thrice per week (OR: 3.77, 95% CI: 1.39-10.23) and drinking non-filtered or non-boiled water (OR: 1.05, 95% CI: 1.01-1.23) were risk factors for H. pylori infection. Consumption of chili peppers (OR: 0.20, 95% CI: 0.10-0.37) and concurrent parasite infestation (OR: 0.44, 95% CI: 0.24-0.80) were protective against H. pylori infection. H. pylori infection was eradicated only in 53% (40/75) of treated patients. Conclusion: This study indicates that H. pylori infection is associated PU. Consumption of meat, fish and family history of PU are risk factors for PU. Lower SES, consumption of restaurant food, meat, non filtered water and smoking are risk factors for H. pylori infection. Consumption of chili peppers and concurrent parasite infestation are protective against H. pylori infectionwhile history of anti parasite treatment protects against PU. H. pylori were eradicated only in 53% of patients.

No description available.

Introdução. Fatores de risco para agravos à saúde se alteram no tempo e no espaço. No que diz respeito ao câncer de cabeça e pescoço (CCP), as associações com tabagismo e consumo de bebidas alcoólicas estão bem estabelecidas. Dados da literatura sugerem que os tipos mais prevalentes de tabaco e álcool numa população estão associados a riscos mais elevados de câncer. No Brasil, poucos estudos epidemiológicos investigaram o efeito de distintos tipos de tabaco e álcool no CCP. Objetivo. Mensurar a razão probabilística de risco para CCP por tipos de tabaco e álcool no consumo não exclusivo (uso de mais de um tipo de tabaco ou bebida alcoólica) e consumo exclusivo (uso de apenas um tipo de tabaco ou bebida alcoólica). Métodos. O presente estudo têm origem em três projetos multicêntricos: Latino-Americano, conduzido de 03/1999 a 12/2001; Genoma Clínico do Câncer realizado de 07/2000 a 08/2011; e o Temático Marcadores de Agressividade em Tumores de Cabeça e Pescoço (GENCAPO), conduzido de 07/2011 a 06/2015. Assim, constituiu-se um estudo caso-controle com dados provenientes de hospitais do Estado de São Paulo. Os casos foram diagnosticados com carcinoma espinocelular de cabeça e pescoço, confirmados histologicamente. Os controles, pacientes com outras doenças que não câncer, foram selecionados em alguns dos hospitais de procedência dos casos. Tanto os casos quanto os controles foram entrevistados por meio de questionários com informações sobre características e hábitos, bem como dados sobre educação e história ocupacional. As associações entre as variáveis tipo de tabaco e tipo de bebidas alcoólicas com CCP, foram estimadas pelo odds ratio (OR) e respectivo intervalo de 95% de confiança (IC 95%) via regressão logística não-condicional, ajustados pelas variáveis de confusão: sexo (feminino, masculino), idade (< 50 anos, 50-59 anos e &#8805; 60 anos), escolaridade (superior, intermediário, analfabeto), ocupação (manual qualificado, manual não qualificado e outros), estudos multicêntricos (Latino-Americano, Genoma Clínico do Câncer e GENCAPO), tabagismo (maços-anos total: Nunca fumaram, <20 maços-ano, &#8805; 20 e < 40 maços-anos e &#8805; 40 maços-anos, para ajuste do efeito do álcool) e consumo de etanol total (Nunca beberam, &#8804; 100 Kg, > 100 e &#8804; 900 e > 900 kg, para ajuste do efeito do tabaco). Resultados. Os riscos decorrentes do tabagismo foram mais expressivos para hipofaringe particularmente, no padrão não-exclusivo e consumo &#8805; 40 maços-ano OR 36,1 (IC95%11,1-117,6); para orofaringe, laringe e cavidade oral, os riscos foram, respectivamente: OR 16,1 (IC95%10,4-24,9); OR 14,2 (IC95% 9,6-21,0); OR 7,4 (IC95% 5,6-10,0). Na condição de consumo exclusivo, para a mesma categoria &#8805; 40 maços-ano para cigarro industrializado, os riscos foram discretamente menos intensos: OR 31,9 (IC95% 9,7-104,3); OR 15,4 (IC95% 9,9-24,0); OR 13,1 (IC95% 8,8-19,5) OR 7,1 (IC95% 5,3-9,6), respectivamente, para hipofaringe, orofaringe, laringe e cavidade oral. No consumo de álcool, foram observadas maiores associações de CCP com as bebidas destiladas. Na condição de consumo exclusivo, para orofaringe o nível de consumo de destilados &#8805; 2000 Kg induziu OR 39,1 (IC 95% 12,7-121,8) em comparação aos que nunca beberam. O uso simultâneo de tabaco e álcool fez aumentar sensivelmente o risco de CCP: OR 10,5 (IC95% 8,5-13,0). Conclusões. Entre os tabagistas com o padrão não-exclusivo de consumo, os maiores riscos foram observados para hipofaringe. Entre os consumidores de bebidas alcoólicas, os destilados conferiram maiores riscos nos dois padrões de consumo. No consumo de cerveja e vinho, as diferenças na intensidade das associações com CCP tornaram-se evidentes apenas nas categorias de maior consumo. / Introduction. Risk factors for health problems change over time and space. With regard to head and neck cancer (HNC), associations with smoking and alcohol consumption are well established. Literature data suggest that the most prevalent types of tobacco and alcohol in a population are associated with higher risks of cancer. In Brazil, few epidemiological studies have investigated the effect of different types of tobacco and alcohol on HNC. Objectives. Measure the probabilistic risks for HNC by tobacco and alcohol types in non-exclusive consumption (use of more than one type of tobacco or alcoholic beverage) and exclusive consumption (use of only one type of tobacco or alcoholic beverage). Methods. The present study has origin from three multicentric projects: Latin American, conducted from 03/1999 to 12/2001; Clinical Genome of Cancer performed from 07/2000 to 08/2011; and the Thematic Markers of Aggression in Head and Neck Tumors (GENCAPO), conducted from 07/2011 to 06/2015. Thus, it is a case-control study with data from hospitals in the State of São Paulo. The cases were diagnosed with squamous cell carcinoma of the head and neck, histologically confirmed. The controls, patients with diseases other than cancer, were selected in some of the hospitals where the cases originated. Both cases and controls were interviewed through questionnaires with information on characteristics and habits, as well as data on education and occupational history. Associations between the variables tobacco type and type of alcoholic beverages with HNC were estimated by the odds ratio (OR) and respective 95% confidence interval (CI 95%) through non-conditional logistic regression adjusted for confounding variables: sex (female, male), age (<50 years, 50-59 years and &#8805; 60 years), schooling (upper, intermediate and illiterate), occupation (qualified manual, unqualified manual and others), multicenter studies, smoking (Never smoked, <20 pack-years, &#8805; 20 and <40 pack-years and &#8805; 40 pack-years, to adjust the effect of alcohol) and total ethanol (Never drank, &#8804; 100 kg,> 100 and &#8804; 900 and > 900 kg, to adjust the effect of tobacco). Results. The risks due to smoking were more significant for the hypopharynx, particularly, in the non-exclusive pattern and consumption &#8805; 40 packs per year OR 36,1 (95% CI 11,1-117,6); for oropharynx, larynx and oral cavity, the risks were: OR 16,1 (95% CI, 10,4-24,9); OR 14,2 (95% CI 9,6-21,0); OR 7,4 (95% CI 5,6-10,0). In the exclusive consumption condition, for the same category &#8805; 40 packets per year for industrialized cigarettes, the risks were slightly less intense: OR 31,9 (95% CI 9,7-104,3); OR 15,4 (95% CI 9,9-24,0); OR 13,1 (IC95% 8,8-19,5); OR 7,1 (IC95% 5,3-9,6), respectively, for hypopharynx, oropharynx, larynx and oral cavity. In alcohol consumption, higher associations of HNC with distilled beverages were observed. In the exclusive consumption condition, consumption level of distilled &#8805; 2000 kg induced OR 39,1 (95% CI: 12,7-121,8) for oropharynx. Simultaneous use of tobacco and alcohol increased the risk of HNC: OR 10,5 (95% CI 8,5-13,0). Conclusions. Among smokers with the non-exclusive pattern of consumption, the greatest risks were observed for the hypopharynx. Among the consumers of alcoholic beverages, the distilled conferred greater risks in the two patterns of consumption. In beer and wine consumption, differences in intensity of associations with HNC became evident only in the higher consumption categories.

INTRODUÇÃO: O câncer vem apresentando um impacto cada vez maior nas populações em todo o mundo. Apesar de recente queda global na sua incidência, o câncer gástrico ainda é o quinto tipo mais comum. Sua patogênese é multifatorial, envolvendo a interação de fatores genéticos, ambientais e infecciosos. OBJETIVO: Avaliar a associação de tabagismo, consumo de álcool e nível de escolaridade com o desenvolvimento de câncer gástrico. MÉTODOS: Trata-se de um estudo caso-controle de base hospitalar em que foram incluídos pacientes com diagnóstico de adenocarcinoma de estômago confirmado por exame histopatológico sem tratamento prévio para a neoplasia. Posteriormente, os casos foram divididos em subtipos de acordo com a histologia (intestinal e difuso) e localização da lesão (proximal, distal e outras). Os indivíduos do grupo controle foram selecionados entre pacientes admitidos no mesmo hospital, sem história ou suspeita de câncer de estômago, emparelhados por frequência aos casos segundo sexo e idade. Tabagismo foi classificado em maços-ano e consumo de álcool em gramas-ano. RESULTADOS: Foram analisados 240 casos e 499 controles recrutados no período de junho de 2001 a dezembro de 2007. Não frequentaram a escola ou apresentavam ensino fundamental incompleto 94 indivíduos (39,2%) no grupo dos casos e 187 (37,5%) no grupo de controles. Ensino universitário foi atingido por 12 indivíduos (5%) no grupo de casos e por 45 indivíduos (9%) do grupo de controles. Não houve associação de nível de escolaridade com risco de desenvolvimento de câncer de estômago. Tabagismo esteve associado ao risco de câncer gástrico com odds ratio (OR) de 2,25 (IC95%: 1,53-3,31) para ex-tabagistas e de 2,67 (IC95%: 1,72-4,13) para tabagistas atuais. Com relação à localização e tipo histológico, tabagismo foi associado com todos os subtipos de tumores gástricos analisados, com destaque para os tumores proximais que apresentaram OR de 5,38 (IC95%: 2,15-13,45) para consumo superior a 38 maços-ano. Consumo de álcool também esteve associado a risco de desenvolvimento de câncer gástrico em todos os subtipos analisados. Entretanto, esta associação apresentou características distintas do tabagismo. Ex-consumidores de álcool apresentaram risco mais elevado (OR=3,81; IC95%: 2,45-5,91) que consumidores atuais (OR=2,06; IC95%: 1,31-3,26). A análise da interação mostrou que o efeito conjunto de tabagismo e consumo de álcool encontrado foi maior que o esperado, evidenciando interação positiva [?=1,51 (IC 95%: 1,05 - 1,96)]. CONCLUSÕES: Tabagismo e consumo de álcool apresentaram associação com o risco de desenvolvimento de câncer gástrico, com destaque para tabagistas atuais e maior consumo de maços-ano. O consumo associado do tabaco e do álcool aumenta esse risco / BACKGROUND: Cancer has an increasing impact on populations around the world. Despite a recent overall decline in incidence, gastric cancer stills the fifth most common type. Its pathogenesis is multifactorial involving the interaction of genetic, environmental and infectious factors. OBJECTIVES: To evaluate the association of smoking, alcohol consumption and education level with the development of gastric cancer. METHODS: This is a hospital-based case-control study that included patients with gastric adenocarcinoma confirmed by histopathological examination without prior treatment. Subsequently, patients were divided into subtypes according to histology (intestinal and diffuse) and location of the lesion (proximal, distal and others). Control subjects were selected among patients admitted to the same hospital with no history of gastric câncer, and were frequency-matched to cases for age and sex. Smoking was classified in pack-years and alcohol consumption in grams per year. RESULTS: We analyzed 240 cases and 499 controls recruited from June 2001 to December 2007. Not attended school or had incomplete elementary school 94 subjects (39.2%) in the group of cases and 187 (37.5%) in the control group. University education was achieved by 12 subjects (5%) in the case group and 45 subjects (9%) in the control group. There was no association of education level with increased risk of stomach cancer. Smoking was associated with increased risk of gastric cancer with an odds ratio (OR) of 2.25 (95%CI: 1.53-3.31) for former smokers and 2.67 (95%CI: 1.72-4.13) for current smokers. With respect to location and histological type, smoking was associated with all subtypes of gastric tumors analyzed with emphasis on the proximal tumors that had OR of 5.38 (95%CI: 2.15-13.45) for consumption over 38 packs-years. Alcohol consumption was also associated with increases risk of gastric cancer development in all analyzed subtypes. However, this association showed distinct characteristics of smoking. Former drinkers had higher risk (OR=3.81; 95%CI: 2.45-5.91) than current users (OR=2.06; 95%CI: 1.31-3.26). The analysis of the interaction showed that the combined effect of smoking and alcohol consumption was higher than expected, thus showing up a positive interaction [?= 1.51 (95%CI: 1.05-1.96)]. CONCLUSIONS: Smoking and alcohol consumption were associated with the risk of gastric cancer development, especially for current smokers and higher consumption of pack-years. Association of tobacco and alcohol consumption increases this risk

Submitted by Aline Batista (alinehb.ufpel@gmail.com) on 2014-12-03T21:19:41Z No. of bitstreams: 2 Fatores associados a não realização de pré-natal no município de Pelotas, RS.pdf: 1970333 bytes, checksum: b4f214bae0fcf638fdcd1cea56f7d29f (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2014-12-03T21:19:41Z (GMT). No. of bitstreams: 2 Fatores associados a não realização de pré-natal no município de Pelotas, RS.pdf: 1970333 bytes, checksum: b4f214bae0fcf638fdcd1cea56f7d29f (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2013-08-22 / Sem bolsa / Objetivo: Investigar fatores associados a não realização de pré-natal das mulheres com filhos nascidos vivos em 2009 e 2010, residentes no município de Pelotas. Métodos: estudo caso-controle no qual se identificou 179 casos (mulheres que não realizaram o pré-natal) e 537 controles (mulheres com pré-natal) utilizando o banco de dados do Sistema de Informações sobre Nascidos Vivos local. Os controles foram pareados por idade e selecionados de acordo com a região administrativa de moradia do caso. A análise multivariada hierarquizada foi efetivada por meio de Regressão Logística Condicional. Resultados: o modelo ajustado final mostrou associação entre menor escolaridade materna, especialmente ter menos de quatro anos de estudo, ser mulher solteira e multípara com não realização de pré-natal. Conclusões: este estudo aponta indicadores que devem ser considerados na estruturação e implementação de políticas de educação para a saúde reprodutiva, planejamento familiar e rastreamento de gestantes sem pré-natal, assim como indica as regiões do município onde tais estratégias deveriam ser prioritárias. / Objective: To investigate associated factors with lack of prenatal care use of women with live births in 2009 and 2010, residents in the city of Pelotas. Methods: A casecontrol study where they identified 179 cases (women who did not have prenatal care) and 537 controls (women with prenatal) using the Live Births Information System database. The controls were matched by age and selected according to the administrative region's housing case. A hierarchical multivariate analysis was carried out by means of Conditional Logistic Regression. Results: In the final adjusted model showed association no conducting pre-natal the maternal education, especially those having less than four years of study, be unmarried woman and multiparous. Conclusions: This study suggests that indicators should be considered as the implementation of education policies for reproductive health, family planning and tracking of pregnant women without prenatal care, as well as indicates the regions of the county where such strategies should be a priority.

Problématique. L’étiologie du cancer pancréatique est encore peu caractérisée, notamment quant au rôle des expositions environnementales modifiables. L’objectif de cette étude est d’examiner si les expositions chimiques dans les milieux de travail sont des facteurs de risques pour ce cancer le plus souvent mortel. Méthodes. Une étude cas-témoin populationnelle à Montréal incluant 19 types de cancer a été réalisée entre 1979 et 1985. Pour chaque participant, un historique de travail détaillé a été obtenu ainsi que des données sur des variables sociodémographiques et des habitudes de vie. Les antécédents de travail ont été examinés par des chimistes et hygiénistes de travail afin de déterminer le statut d’exposition de chaque participant pour environ 300 substances d’intérêt. Pour ce rapport, les 116 cas participants de cancer pancréatique ont été comparés avec les autres cas de cancers et des témoins populationnelles. Des analyses préliminaires ont été effectuées pour repérer les substances qui démontraient des indices d’association avec le cancer du pancréas. Celles-ci, en plus des substances qui sont réputées être associées avec le cancer du pancréas dans la littérature, ont été retenues pour des analyses statistiques plus approfondies. Pour chaque substance, deux catégories d’exposition ont été établies : « exposé » et « substantiellement exposé ». Les ratios de cotes entre le cancer pancréatique et chaque substance ont été estimés par régression logistique tout en contrôlant pour des facteurs de confusion possibles. Des analyses semblables ont été réalisées pour des catégories industrielles et occupationnelles. Résultats. Parmi toutes les expositions étudiées, la majorité d’entre eux n’ont pas démontré une association avec le cancer du pancréas. Cependant, des associations positives ont été repérées pour quelques substances, notamment pour les produits de combustion du charbon (RC 2,6, IC 95 % [1,3- 5,3]), la suie (RC 3,4, IC 95 % [1,3-8,6]), les cires et agents de polissage (RC 2,7, 95 % [1,1-4,1]), les produits de nettoyage (RC 1,9, IC 95 % [1,1-3,2]) et pour la catégorie des concierges et nettoyeurs (RC 2,8, IC 95 % [1,5-5,1]). Conclusion. Malgré que plusieurs des associations observées dans cette étude ne sont pas suffisamment appuyées directement par la littérature existante, nos résultats représentent une ressource utile pour diriger les futurs projets de recherche et notamment pour les éventuelles méta- analyses. / Background. Pancreatic cancer is a fatal disease in most cases. Unfortunately, little is known about the etiology of pancreatic cancer and whether modifiable environmental chemical exposures may play an important role. The purpose of this study is to explore whether chemical exposures in the workplace may be risk factors for pancreatic cancer. Methods. A population-based case-control study including 19 types of cancer was conducted in Montreal between 1979 and 1985. Detailed occupational histories were obtained from all subjects as well as information on several socio-demographic and lifestyle variables. Occupational histories were assessed by industrial hygienists and chemists to determine whether exposure had occurred to any of nearly 300 substances from a checklist. For this report, the participating 116 pancreatic cancer cases were compared with other cancer controls and population controls. Preliminary analyses were conducted to identify agents from the checklist showing evidence of an association with pancreatic cancer. These were selected for more in-depth statistical analyses together with agents reported in the literature as being potentially associated with pancreatic cancer. For each agent, “any” and “substantial” exposure metrics were defined. Unconditional logistic regression methods were used to estimate odds ratios between pancreatic cancer and each of the selected exposures while controlling for potential confounders. Similar analyses were conducted for occupation and industry groups. Results. Of all the exposures assessed, the majority did not reveal an association with pancreatic cancer. However, suggestive positive associations were found for several agents including coal combustion products (OR 2.6, 95% CI [1.3-5.3]), soot (OR 3.4, 95% [1.3-8.6]), waxes and polishes (OR 2.7, 95% [1.1-4.1]), cleaning agents (OR 1.9, 95% [1.1-3.2]) and for the occupational category “janitors and cleaners” (OR 2.8, 95% CI [1.5-5.1]). Conclusion. For most of the agents revealing an association with pancreatic cancer in our study, there is a paucity of direct evidence published by other authors to corroborate our findings. However, parallels can be made with previously observed excesses in occupational groups making our findings useful for guiding future research efforts, notably for meta-analyses, to uncover the specific chemical exposures that may account for these excesses.

Les pneumonies sont la première cause de mortalité par maladie infectieuse dans le monde chez les enfants. Les objectifs étaient d'identifier les causes microbiologiques des pneumonies communautaires chez les enfants de moins de 5 ans dans les pays émergents et en développement et les déterminants associés à leur sévérité en termes d'hypoxémie à l'admission et de mortalité. Une étude cas-témoins multicentrique hospitalière a été menée par le réseau GABRIEL dans 9 sites des pays suivants : Cambodge, Chine, Haïti, Inde (2 sites), Madagascar, Mali, Mongolie et Paraguay. Les cas étaient des enfants hospitalisés, âgés de 2 à 60 mois et atteints de pneumonie radiologiquement confirmée ; un témoin par cas du même centre, sans signe évocateur de pneumonie était recherché. Un appariement fréquentiste sur la période et la classe d'âge était effectué. Des prélèvements respiratoires ont été réalisés chez tous les sujets pour identifier 19 virus, 5 bactéries et les sérotypes de Streptococcus pneumoniae par biologie moléculaire. Pour les cas, des prélèvements supplémentaires de sang et de liquide pleural étaient effectués. Les étiologies des pneumonies ont été estimées par le calcul de la fraction attribuable populationnelle après régression logistique multivariée. Les facteurs associés à l'hypoxémie à l'admission - déterminés chez les patients atteints de pneumonie - ont été identifiés par régression logistique multivariée ; les facteurs associés à la mortalité hospitalière à 14 jours ont été quantifiés par modèle de Cox bivarié. Parmi les 888 cas et 870 témoins analysés, les agents causaux des pneumonies après analyse multivariée étaient par ordre décroissant de fréquence : S. pneumoniae, respiratory syncytial virus (RSV), rhinovirus, human metapneumovirus (hMPV), parainfluenza virus 1, 3 et 4, influenzavirus A et B et Mycoplasma pneumoniae. La fraction attribuable ajustée était de 42,2% (intervalle de confiance [IC] à 95% : 35,5-48,2%) pour S. pneumoniae, de 18,2% (IC à 95% : 17,4-19,0%) pour RSV et de 11,2% (IC à 95% : 7,5-14,7%) pour rhinovirus. Une importante hétérogénéité des étiologies entre pays a été identifiée. Parmi les 405 cas de pneumonie analysés pour l'étude de la gravité, 17,3% étaient hypoxémiques. La détection d'hMPV ou de RSV au niveau respiratoire était indépendamment associée à un risque accru d'hypoxémie (odds ratio ajusté [ORa]=2,4 ; IC à 95% : 1,0-5,8 et ORa=2,5 ; IC à 95% : 1,1-5,3, respectivement). La détection de S. pneumoniae dans le sang (hazard ratio brut [HRb]=4,6 ; IC95% : 1,5-14,0), un dosage de procalcitonine ≥50 ng/ml (HRb=22,4 ; IC à 95% : 7,3-68,5) et l'hypoxémie à l'admission (HRb=4,8, IC à 95% : 1.6-14.4) étaient prédictifs de surmortalité hospitalière ; ces associations subsistaient après ajustement sur l'âge, la période, le centre, la séropositivité HIV ou le statut nutritionnel. La majorité des pneumonies chez les enfants de moins de 5 ans dans les pays en développement peut être attribuée à S. pneumoniae, RSV, rhinovirus et hMPV. Les pneumonies hypoxémiantes chez les enfants sont liées à hMPV et RSV alors que les pneumonies liées à S. pneumoniae sont associées à un risque accru de décès. Ces résultats permettent d'identifier des priorités de prévention vaccinales et non-vaccinales / Pneumonia is the leading cause of death from infectious diseases in children worldwide. The objectives were to identify the etiologies of community-acquired pneumonia in children under 5 years in emerging and developing countries and the determinants associated with severity in terms of hypoxemia at admission and mortality. A hospital-based multicenter casecontrol study was conducted at 9 sites in the following countries: Cambodia, China, Haiti, India (2 sites), Madagascar, Mali, Mongolia and Paraguay. Cases were hospitalized children aged between 2 and 60 months, with radiologically confirmed pneumonia; a control was a patient from the same center, without any sign suggesting pneumonia. A frequentist matching by period and age category was made. Respiratory samples were taken from all subjects to identify 19 viruses, 5 bacteria and Streptococcus pneumoniae serotypes by molecular biology. For cases only, additional blood samples and pleural fluid were performed. The etiologies of pneumonia were estimated by calculating the population-attributable fraction after multivariate logistic regression. The factors associated with hypoxemia at admission were identified in patients with pneumonia by multivariate logistic regression; factors associated with 14-day in-hospital mortality were quantified by bivariate Cox model. Among the 888 cases and 870 controls analyzed, the causative agents of pneumonia after multivariate analysis migth be: Streptococcus pneumoniae, respiratory syncytial virus (RSV), rhinovirus, human metapneumovirus (hMPV), parainfluenza virus 1, 3 and 4, influenzavirus A and B, and Mycoplasma pneumoniae. The adjusted attributable fraction was 42.2% (95% confidence interval [CI]: 35.5-48.2%) for S. pneumoniae, 18.2% (95% CI: 17.4-19.0%) for RSV and 11.2% (95% CI: 7.5-14.7%) for rhinovirus. A significant heterogeneity in etiologies between countries was identified. Among the 405 pneumonia cases analyzed for the study of gravity, 17.3% were hypoxemic. Detection of hMPV or RSV from respiratory samples were independently associated with an increased risk of hypoxemia (adjusted odds ratio [aOR]=2.4, 95% CI: 1.0-5.8; aOR=2.5, 95% CI: 1.1-5.3, respectively). Detection of S. pneumoniae from blood (crude hazard ratio [cHR]=4.6, 95% CI: 1.5- 14.0), procalcitonin ≥50 ng/ml (cHR=22.4, 95 %: 7.3-68.5) and hypoxemia (cHR=4.8, 95% CI: 1.6- 14.4) were predictive of higher hospital mortality; these associations were consistent after adjusting for age, period, center, HIV or nutritional status. The majority of pneumonia in children under 5 years of age in developing countries might be attributable to S. pneumoniae, RSV, rhinovirus and hMPV. Hypoxemic pneumonia in children were related to RSV and hMPV infection while S. pneumoniae-related pneumonia was associated with an increased risk of death. These findings might guide future vaccinal or non vaccinal policies

Contexte : Les inégalités sociales de santé représentent un problème de santé publique considérable. Dans le cadre du cancer du sein, la précarité est associée au pronostic. En effet, une relation entre précarité géographique et stade au diagnostic a été établie dans la littérature. Cependant, à ce jour, aucune étude n'a encore analysé l'association de ce dernier à la précarité individuelle.Objectifs : Les objectifs de ce travail de recherche sont (1) d'estimer le risque de cancer du sein de stade avancé associé à la précarité individuelle, (2) d'étudier l'impact des facteurs pouvant modifier ce risque, (3) d'évaluer la robustesse de l'association face au choix de la mesure de précarité.Population et méthode : Les données sont issues d'une étude cas-témoins. Les Cas et les Témoins de l'étude ont été recrutés parmi les patientes de l'Hérault atteintes de cancers du sein invasifs diagnostiqués entre 2011 et 2012. Les Cas correspondent aux patientes présentant un cancer du sein de mauvais pronostic (taille de tumeur supérieure à 5cm, ou atteinte ganglionnaire ou atteinte métastatique) et les Témoins aux patientes présentant des cancers de bon pronostic (taille de tumeur inférieure à 5cm et aucune atteinte ganglionnaire et aucune atteinte métastatique). Au total 604 patientes ont été incluses : 173 Cas et 431 Témoins. L'exposition à la précarité a été recueillie par un questionnaire standardisé.Résultats : Les patientes précaires ont, toutes variables égales par ailleurs, 2 fois plus de risque d'avoir un cancer de stade avancé comparée aux patientes non précaires. La précarité n'est associée à aucun autre facteur biologique (grade SBR, types histologique et moléculaire). Chez les patientes asymptomatiques (diagnostiquées suite à un dépistage) les patientes précaires ont plus de risque d'avoir des cancers de stade avancé. Chez les femmes avec un antécédent familial de cancer du sein tout comme chez les femmes vivant dans une zone géographique favorisée, les patientes précaires et non-précaires ont le même risque de cancer de stade avancé. Comparé aux autres mesures de l'environnement socio-économique (classe sociale, précarité géographique…), le score EPICES semble la méthode de mesure la plus adaptée pour étudier l'association entre précarité et stade au diagnostic.Conclusion : Nos résultats suggèrent que les écarts observés entre les patientes précaires et les patientes non-précaire semblent être plutôt liés à retard au diagnostic plutôt qu'à des différences biologiques entre les tumeurs. Ce retard au diagnostic semble dépendre de composantes individuelles mais aussi collectives. De plus, une meilleure connaissance du cancer du sein pourrait permettre de réduire les barrières supplémentaires vécues par les précaires. / Context: Socio-economic inequalities in health represent a significant public health problem. In the breast cancer context, socio-economic deprivation is associated with prognosis. Indeed, a relationship between area-based deprivation and diagnostic stages was already described in the international literature. However, the association between individual deprivation and diagnostic stages was not study so far.Objectives: Our aim was to (1) estimate the risk of advanced breast cancer associated with individual socio-economic deprivation, (2) study the impact of modifying factors, (3) evaluate the strength of this association according to the method used to measure deprivation.Population and methods: Data were collected from a Case-Control study. Cases and Controls were recruited among invasive breast cancer patients diagnosed between 2011 and 2012 in the Hérault. Cases were defined as patients with poor prognosis breast cancer (with tumor size over 5cm, or with lymph node involvement, or with metastasis). Controls were defined as patients with good prognosis breast cancer (with tumor size under 5cm, and without lymph node involvement, and without metastasis). A total number of 604 patients were included: 173 Cases and 431 Controls. The exposition to deprivation was measured by a standardized questionnaire.Results: Deprived patients, with all other variables remaining constant, have a two-fold risk of having advanced breast cancer compared to non-deprived patients. Deprivation was not associated with the other biological factors (SBR grade, histologic and molecular type). Among asymptomatic patients (diagnosed after a mammographic screening), deprived patients have a higher risk of advanced breast cancer. Among women with family history of breast cancer so as women living in affluent geographic areas, deprived and non-deprived patients have the same risk of advanced breast cancer. Compared to other measures of socio-economic environment (social class, area-based deprivation…), EPICES score seems to be the most adapted method to study the association between deprivation and breast cancer diagnostic stages.Conclusion: Our results suggest that the gap observed between deprived and non-deprived patients seem to be associated with delayed diagnosis more than biological differences between tumors. This delayed diagnosis seems depend on individual and geographic components. Moreover, a better knowledge of breast cancer could allow a reduction of the barrier experienced by deprived women.