Background/Aims: In France, geographic access to medical care may affect the diagnosis of hepatitis C. The aims of this study were to compare the detection rates of hepatitis C in urban and rural areas after adjusting...Background/Aims: In France, geographic access to medical care may affect the diagnosis of hepatitis C. The aims of this study were to compare the detection rates of hepatitis C in urban and rural areas after adjusting for distance to medical care, and evaluating the impact of the place of residence on patients’ clinical characteristics. Methods: Between 1994 and 2001, 1938 newly detected cases were recorded in a French population of 1,005,817 inhabitants. Age and sex-adjusted detection rates for 105 inhabitants were estimated for urban and rural areas and for classes of distance to the nearest practitioner. Results: Detection rates were lower in rural than in urban areas [14.1, (95CI: 12.5- 15.7) versus 24.7 (95CI: 23.5- 26.0)] and decreased as the distance to the general practitioner increased [27.0 (95CI: 25.5- 28.4) versus 13.7 (95CI: 12.1- 15.3) for a cutoff value of 1.5 km]. In multivariate analyses, detection rates were only influenced by the distance to general practitioner. Hepatocellular carcinoma at diagnosis was more frequent among rural than among urban patients (adjusted OR=2.28,95CI: 0.97- 5.39, P=0.059). Conclusions: A poorer geographic access to care explained the lower detection of hepatitis C in rural areas. Hepatocellular carcinoma was more frequent in rural patients. It may result from later detection and/or involvement of environmental factors on hepatocarcinogenesis.展开更多
Objectives The objective of this prospective study was to determine whether sociological and/or alcohol related behavioral factors could be predictive of relapse after orthotopic liver transplantation for alcoholic li...Objectives The objective of this prospective study was to determine whether sociological and/or alcohol related behavioral factors could be predictive of relapse after orthotopic liver transplantation for alcoholic liver disease. Methods Fiftyfive liver transplanted patients out of a series of 120 alcoholic cirrhotic patients were enrolled in a randomized prospective study. This study was initially designed to compare the 2 year survival in intent to transplant patients versus in intent to use conventional treatment patients. For all patients, an identical questionnaire was completed at inclusion, and every 3 months for 5 years to collect data on alcohol related behavior factors. Results Fifty one patients fulfilled the criteria for the study. The mean follow up was 35.7 months (range: 1-86). Rate of alcohol relapse was 11%at one year and 30%at 2 years. Alcohol intake above 140 g a week was declared by 11%and 22%of patients at one and 2 years, respectively. The only variable leading to a significantly lower rate of relapse was abstinence for 6 months or more before liver transplantation (23%vs 79%, P = 0.0003). This variable was also significant for patients whose alcohol intake was greater than 140 g per week (P = 0.003) (adjusted relative risk =5.5; 95%CI = 1.3-24.5; P = 0.02). Multivariate analysis (Cox model) showed that abstinence for 6 months or more before liver transplantation was the unique predictive variable. Conclusion In this prospective study of 51 patients transplanted for alcoholic liver disease, abstinence before liver transplantation was the only predictive factor of alcohol relapse after liver transplantation.展开更多
文摘Background/Aims: In France, geographic access to medical care may affect the diagnosis of hepatitis C. The aims of this study were to compare the detection rates of hepatitis C in urban and rural areas after adjusting for distance to medical care, and evaluating the impact of the place of residence on patients’ clinical characteristics. Methods: Between 1994 and 2001, 1938 newly detected cases were recorded in a French population of 1,005,817 inhabitants. Age and sex-adjusted detection rates for 105 inhabitants were estimated for urban and rural areas and for classes of distance to the nearest practitioner. Results: Detection rates were lower in rural than in urban areas [14.1, (95CI: 12.5- 15.7) versus 24.7 (95CI: 23.5- 26.0)] and decreased as the distance to the general practitioner increased [27.0 (95CI: 25.5- 28.4) versus 13.7 (95CI: 12.1- 15.3) for a cutoff value of 1.5 km]. In multivariate analyses, detection rates were only influenced by the distance to general practitioner. Hepatocellular carcinoma at diagnosis was more frequent among rural than among urban patients (adjusted OR=2.28,95CI: 0.97- 5.39, P=0.059). Conclusions: A poorer geographic access to care explained the lower detection of hepatitis C in rural areas. Hepatocellular carcinoma was more frequent in rural patients. It may result from later detection and/or involvement of environmental factors on hepatocarcinogenesis.
文摘Objectives The objective of this prospective study was to determine whether sociological and/or alcohol related behavioral factors could be predictive of relapse after orthotopic liver transplantation for alcoholic liver disease. Methods Fiftyfive liver transplanted patients out of a series of 120 alcoholic cirrhotic patients were enrolled in a randomized prospective study. This study was initially designed to compare the 2 year survival in intent to transplant patients versus in intent to use conventional treatment patients. For all patients, an identical questionnaire was completed at inclusion, and every 3 months for 5 years to collect data on alcohol related behavior factors. Results Fifty one patients fulfilled the criteria for the study. The mean follow up was 35.7 months (range: 1-86). Rate of alcohol relapse was 11%at one year and 30%at 2 years. Alcohol intake above 140 g a week was declared by 11%and 22%of patients at one and 2 years, respectively. The only variable leading to a significantly lower rate of relapse was abstinence for 6 months or more before liver transplantation (23%vs 79%, P = 0.0003). This variable was also significant for patients whose alcohol intake was greater than 140 g per week (P = 0.003) (adjusted relative risk =5.5; 95%CI = 1.3-24.5; P = 0.02). Multivariate analysis (Cox model) showed that abstinence for 6 months or more before liver transplantation was the unique predictive variable. Conclusion In this prospective study of 51 patients transplanted for alcoholic liver disease, abstinence before liver transplantation was the only predictive factor of alcohol relapse after liver transplantation.
