Papers by Emmanuel Chirpaz
Médecine et Maladies Infectieuses, 2018
Introduction La vaccination des jeunes filles contre les infections a papillomavirus humains (HPV... more Introduction La vaccination des jeunes filles contre les infections a papillomavirus humains (HPV) est l’une des mesures de prevention du cancer du col de l’uterus chez la femme. Apres son introduction il y a 10 ans en France, le vaccin anti-HPV a une couverture vaccinale qui reste actuellement tres faible. D’autre part, certains departements d’Outre-Mer ont des taux d’incidence et de mortalite du cancer du col de l’uterus nettement plus eleves qu’en France metropolitaine. Le prealable a l’adoption d’un comportement de prevention est d’avoir connaissance de l’existence de ce moyen de prevention. Ainsi, l’objectif de cette etude etait d’identifier les facteurs socio-demo-economiques et culturels associes a la meconnaissance de la vaccination anti-HPV chez 1000 femmes d’un departement d’Outre-Mer multiculturel et aux inegalites sociales importantes. Materiels et methodes Il s’agissait d’une enquete transversale telephonique, menee aupres d’un echantillon de 1000 femmes, âgees de 25 a ...
Revue d'Épidémiologie et de Santé Publique, 2018
Perspectives This study responds to AYAs' needs for support and information regarding physical ac... more Perspectives This study responds to AYAs' needs for support and information regarding physical activity and SPC prevention. To improve the quality of the program and its implementation, a gym room will be built at the hospital, and a therapeutic education program dedicated to AYAs will be developed.
BMC Endocrine Disorders, Dec 13, 2022
Background: Diabetes self-management education is exposed to attrition from services and structur... more Background: Diabetes self-management education is exposed to attrition from services and structured ambulatory care. However, knowledge about factors related to attrition in educational programs remains limited. The context of social vulnerability due to low income may interfere. The aim of this study was to identify the sociodemographic, clinical, psychometric, and lifestyle factors associated with attrition from the ERMIES multicentre randomized parallel controlled trial (RCT) that was interrupted due to the combination of both slow inclusion and high attrition. Methods: The ERMIES trial was performed from 2011 to 2016 on Reunion Island, which is characterized by a multicultural population and high social vulnerability. The original objective of the RCT was to test the efficacy of a2-year structured group self-management education in improving blood glucose in adult patients with nonrecent, insufficiently controlled type 2 diabetes. One hundred participants were randomized to intensive educational intervention maintained over two years (n = 51) versus only initial education (n = 49). Randomization was stratified on two factors: centres (five strata) and antidiabetic treatment (two strata: insulin-treated or not). Sociodemographic, clinical, healthcare access and pathway, psychometric and lifestyle characteristics data were collected at baseline and used to assess determinants of attrition in a particular social context and vulnerability. Attrition and retention rates were measured at each visit during the study. Multiple correspondence analysis and Cox regression were performed to identify variables associated with attrition. Results: The global attrition rate was 26% during the study, with no significant difference between the two arms of randomization (9 dropouts out of 51 patients in the intervention group and 17 out of 49 in the control group). Male gender, multiperson household, low household incomes (< 800 euros), probable depression and history of hospitalization or medical leave at inclusion were associated with a higher risk of attrition from the study in multivariate regression.
Évacuations sanitaires pédiatriques en oncologie et en hématologie de l’île de la Réunion vers la France métropolitaine
Bulletin du Cancer
International Journal of Environmental Research and Public Health
In March 2020, the French government implemented nation-wide measures to reduce social contact an... more In March 2020, the French government implemented nation-wide measures to reduce social contact and slow the progression of the emerging coronavirus responsible for COVID-19, the most significant being a complete home lockdown that lasted 8 weeks. Reunion Island is a French overseas department marked by large social inequalities. We draw the hypothesis that distancing and lockdown measures may have contributed to an increase in the social inequalities in health (SIH) on Reunion Island. The aim of our study was to describe the SIH during lockdown in the Reunionese population. We implemented a cross-sectional telephone survey conducted between 13 May and 22 July 2020, using a retrospective data collection on the lockdown period. A total of 892 adult participants (≥18 years) were recruited in the 114 large Reunionese neighborhoods using the quota method within the national “White Pages” telephone directory. Degraded psychological states, an increase in addictive behaviors, difficulties ...
Cancer in sub-Saharan Africa in 2020: a review of current estimates of the national burden, data gaps, and future needs
The Lancet Oncology
Vaccines
Introduction: On Reunion Island, cervical cancer is the third most common cause of cancer in wome... more Introduction: On Reunion Island, cervical cancer is the third most common cause of cancer in women. Primary prevention is based on the HPV vaccination, yet coverage rate is low (8.1%). The objective of the study was to evaluate the impact of a health promotion program on the proportion of middle school girls who have completed the HPV vaccination schedule. Material and methods: In this prospective, controlled intervention study of superiority, 12 classes were randomly selected in an intervention school where the promotion program took place, and in a control school where no specific intervention was planned. The program combined: information to students during school classes, information to parents by letter and phone calls, information to general practitioners by letter and video conference call, and the free school-based vaccination (in a “health bus” parked in the schoolyard) with the nonavalent HPV vaccine. Results: In the intervention group, the completion was achieved for 26 g...
Socioeconomic inequalities in breast cancer survival in Reunion Island: The contribution of stage at diagnosis as a mediator
Cancer Epidemiology
Factors associated with mammography screening among Reunionese women : a cross-sectional study
Revue d'Épidémiologie et de Santé Publique
Le Cancer De La Prostate De 1982 a 1996 (Evolution De L'Incidence et De La Mortalite Dans 5 Departements Francais Couverts Par Un Registre De Population)
GRENOBLE1-BU Médecine pharm. (385162101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF
Survival of adult patients with solid cancer in Reunion Island, 1998–2014
Bulletin du Cancer, 2022
INTRODUCTION Population-based cancer survival is a major indicator of effectiveness of cancer man... more INTRODUCTION Population-based cancer survival is a major indicator of effectiveness of cancer management. This study is the first population-based study to estimate the net survival (NS) of adult cancer patients in Reunion Island, a French overseas department with distinctive epidemiological, cultural, and sociodemographic characteristics. METHODS All adult incident cases (n=23,055) of invasive solid tumors diagnosed between 1998 and 2014 and registered in the Reunion Island Cancer Registry were included in the study. The Pohar-Perme estimator was used to estimate 1-, 3-, 5-, and 10-year NS. RESULTS 5-year NS ranged from 7% (liver in women) to 97% (thyroid cancer in women) for cancers diagnosed between 2006 and 2014. For the most common cancers, the age-standardized 5-year NS of women was 81% for breast cancer, 58% for colorectal cancer and 62% for cervical cancer. For men, the age-standardized 5-year NS was 85% for prostate cancer, 12% for lung cancer, and 52% for colorectal cancer. Age-standardized 5-year NS increased slightly with the period of diagnosis (from 1998-2005 to 2006-2014) for prostate, breast, head and neck, lung, colorectal (women), and stomach (men) cancers, remained stable for colorectal (men) cancer, and decreased slightly for cervical and stomach (women) cancers. DISCUSSION Overall, NS was lower in Reunion Island than in mainland France. While the epidemiological, cultural, and sociodemographic characteristics of the Reunionese population likely explain some of the observed differences compared to mainland France, site-specific studies are needed to explore the different determinants of survival in Reunion Island.
Health, illness and cancer in Reunion Island: Health services in a diverse but aging French territory
Bulletin du Cancer, 2022
The major social, cultural, economic and demographic changes in Reunion Island in the last 70 yea... more The major social, cultural, economic and demographic changes in Reunion Island in the last 70 years have had effects on its population and the evolution of its public health issues. The demographic transition and changes in lifestyle have led to a rapidly aging population with increased needs for care for dependency and chronic illness such as cancers. The aim of this paper is to offer a review of the literature and ongoing research on health and cancer in Reunion Island. It reviews the recent literature on these changes, including the socio-demography of the population, the medical demography and cancer care infrastructure. It highlights the significant social inequalities of the island, and shows its medical demography and healthcare services are close to national averages. It then offers a review of publications on the experiences of health and illness in Reunion Island in a multicultural and postcolonial context, between medical pluralism and biomedicine. It then offers a focus on the epidemiology of three cancers, namely breast, cervical and prostate cancers. It concludes with a review of known ongoing research, and calls for a rapid adaptation of the organization of the medico-social system, in order to face Reunion Island's most pressing healthcare issues: chronic illnesses such as cancers, and dependency.
Le cancer de la prostate dans les départements de l'Isère et du Tarn entre 1985 et 1995 : évolution des indications thérapeutiques
Bulletin Du Cancer, 1998
L'objectif de ce travail est de decrire l'evolution des pratiques therapeutiques du carci... more L'objectif de ce travail est de decrire l'evolution des pratiques therapeutiques du carcinome de la prostate dans les departements du Tarn et de l'Isere au cours de la periode 1985-1995. Les dossiers de sujets porteurs d'un carcinome de la prostate diagnostique entre 1985 et 1995 dans les departements de l'Isere et du Tarn ont ete etudies retrospectivement. Un tirage au sort stratifie sur l'annee de diagnostic et le departement a abouti a l'inclusion de 871 sujets. Les pratiques therapeutiques du cancer de la prostate ont evolue de maniere importante entre 1985 et 1989. Les prostatectomies radicales se sont developpees fortement a compter de 1986 alors que le taux des radiotherapies est reste stable. Cette evolution s'est faite au detriment des traitements dit « non curatifs » avec diminution du taux des traitements hormono-suppresseurs. Elle s'explique par le diagnostic a un stade plus precoce de ces carcinomes grâce a l'important developpeme...
Background: In Reunion Island, incidence and mortality for uterine cervical cancer is high, yet c... more Background: In Reunion Island, incidence and mortality for uterine cervical cancer is high, yet coverage rate for HPV vaccination is low. The main objective of the study is to evaluate, the impact of a health promotion program, promoting HPV vaccination, on the proportion of middle school girls who complete the full HPV vaccination schedule (2 or 3 doses) by the end of school year.Methods: This study is a cluster controlled intervention study using a superiority design. A combined health promotion program will be offered, containing: information to students and parents, training of general practitioners and free school-based vaccination (in a "health bus"). Children who will benefit from this program will constitute the intervention group, and will be compared to children from another middle school who will not benefit from any program, constituting the control group.Discussion: Our hypotheses were as follow : Clear and appropriate information for the target population as ...
First results of radiotherapy after hyperbaric oxygenation with temozolomide for high-grade gliomas
Journal of Clinical Oncology, 2012
2048 Background: The outcome of patients with high-grade gliomas remains poor despite modern ther... more 2048 Background: The outcome of patients with high-grade gliomas remains poor despite modern therapeutic arsenal. The objective of this study was to assess the feasibility and efficacy of radiotherapy (RT) given immediately after hyperbaric oxygenation (HBO) with Stupp protocol. Methods: All patients with histologically confirmed high-grade gliomas from 2008 till 2011 coveraged at GHSR hospital were enrolled. Patients underwent Stupp protocol consisting in 60 Gy RT with a daily dose of 2 Gy for 5 days per week administrated immediately after HBO. Temozolomide (TMZ) was administrated at the daily dose 75 mg/m², 7 days per week followed by 6 cycles of TMZ 150 to 200 mg/m² for 5 days each 28 day-cycle. HBO schedule was approximately 15 min of compression with air, 60 min of 100% oxygen inhalation and 10 min of decompression with oxygen. Results: A total of 21 patients were diagnosed and histologically confirmed high grade gliomas. Five were excluded because of HBO contraindications. Tw...
European Journal of Cancer, 2018
HAL is a multidisciplinary open access archive for the deposit and dissemination of scientific re... more HAL is a multidisciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers. L'archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés.
European Journal of Internal Medicine, 2019
HAL is a multidisciplinary open access archive for the deposit and dissemination of scientific re... more HAL is a multidisciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers. L'archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés. Distributed under a Creative Commons Attribution-NonCommercial| 4.0 International License
European journal of obstetrics, gynecology, and reproductive biology, Jan 15, 2017
In Reunion Island, the standardized mortality rate for cervical cancer is 4.8/100,000 women, twic... more In Reunion Island, the standardized mortality rate for cervical cancer is 4.8/100,000 women, twice higher than in Metropolitan France. For locally advanced disease, the standard of care includes a treatment by brachytherapy. Nevertheless, brachytherapy was not available on the Island before 2016. The objective of this study was to assess the impact of the management of patients with invasive cervical cancer on mortality in Reunion. We have identified all the women hospitalized in one of the health care centers of the Island diagnosed with invasive cervical cancer between 01/01/2010 and 31/12/2015. The guidelines of the French Society of Gynecological Oncology (FSGO) were considered as the reference to evaluate professional practices. The characteristics that had an influence on global survival after log-rank test were included in a multivariate analysis according to the Cox Model. Retrospective analysis identified 303 women meeting inclusion criteria. The assessment of professional ...
Early human development, Jan 22, 2017
To examine the rates of follow-up at two years of age and perinatal factors associated with non-c... more To examine the rates of follow-up at two years of age and perinatal factors associated with non-compliance in an observational population-based cohort of very preterm children enrolled in a routine follow-up program. Data review of infants born between 2008 and 2012 in the Observatoire de La Grande Prématurité, Reunion Island cohort. All singletons born alive before 33weeks of gestational age and resident on the island at two years of age were included. Patients were considered compliant if they were timely evaluated between 20-28months of age, or non-compliant if they were not evaluated or evaluated after 28months of age. Of the 802 survivors (mean gestational age of 30.3±2.0months, mean birthweight of 1364±396g), 468 (58.4%) were examined between 20-28months, 119 (14.8%) after 28months of age, and 215 (26.8%) were never evaluated, respectively. In multivariate analysis, factors associated with non-compliance were higher parity (>2), past history of preterm delivery, maternal di...
La Revue de Médecine Interne, 2016
Uploads
Papers by Emmanuel Chirpaz