Objective: To assess the role of polymerase chain reaction in defining infectiousness among people infected with hepatitis C virus. Design: Published studies of hepatitis C transmission were examined. Twenty nine studies with identified sources of hepatitis C infection who were tested for presence of hepatitis C RNA by polymerase chain reaction were reviewed, including studies of vertical transmission (n = 21), transmission after transplantation (n = 3), transfusion of blood components (n = 3), and needlestick exposure (n = 2). Subjects: All patients identified in studies. Results: A total of 2022 people who had been exposed to sources positive for antibody to hepatitis C were identified. Among 1148 people exposed to sources positive by polymerase chain reaction 148 cases of transmission occurred compared with no definite case among 874 people exposed to negative sources. Rates of transmission from positive sources were 6.2% for perinatal exposure, 6.1% after needlestick exposure, 78% after solid organ or bone marrow transplantation, and 83% after transfusion of blood components. Other factors influencing risk of vertical transmission were coinfection with HIV and level of hepatitis C viraemia. Conclusions: Negative results by polymerase chain reaction indicate an extremely low probability of transmission of hepatitis C from a person with antibody to hepatitis C.

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This new device allows spectacular dose reduction, consistent with adequate clinical information. Improvements of the prototype will lead to extension of potential indications and industrial development.

DGS MRI allows early detection of epiphyseal ischaemia and accurate analysis of the different revascularisation patterns. These changes are directly related to the prognosis of LCP disease and can aid therapeutic decision making.

Objectives In France, a national pilot population-based screening programme on colorectal cancer was set up in French districts were included, targeting a population of more than five million people. This programme offers biennial screening using the fecal occult blood test (FOBT) to average risk subjects aged between 50 and 74 years. People receive a letter inviting them to consult their GPs, who in turn provide the FOBT. People with a positive test result are proposed a full colonoscopy. The results of the programme's first-round performance indicators are presented. Methods The monitoring centre collected data from GPs and gastroenterologists on follow-up and colonoscopy results for people who were screened positive. Data were transferred to the French Institute for Public Health Surveillance (InVS) for the analysis. Results The overall participation rate for the 19 districts having completed a first screening round reached 42%. The overall positive test rate was 2.7%. In the eight districts with comprehensive follow-up data for the first round, 86% of colonoscopies were completed after a positive test. A total of 1615 people were diagnosed with cancer, and 4612 people with adenoma. The cancer detection rate reached 2.3%, it was higher in men than in women (3.4% versus 1.4%), and increased with age. Forty-three percent of invasive detected cancers were stage I, 24% stage II, 23% had lymph node involvement and 10% presented with distant metastasis. Conclusion These results suggest that indicators are consistent with international references. During 2007 -2008, the programme coverage will be progressively extended, and all 99 French districts should be actively involved in its implementation.

The aim of this study was to analyse the role of women's sociodemographic and healthcare access characteristics according to breast cancer screening practices (organized, individual or no screening). A cross-sectional study was set up in seven French districts using a self-administered postal questionnaire. Randomization was stratified proportionally on age and urban/rural status in each district separately among attendees and nonattendees to the organized breast cancer screening programme (OS). A total of 5638 women aged 50-74 years returned their questionnaires: 1480 in the attendee OS group and 4158 in the nonattendee group. Among them, 3537 declared having undergone a recent mammography outside the organized programme (individual, IS group) and 621 declared never having undergone a mammography or having done so more than 2 years ago (NS group). Analyses showed a gradient between the three groups (IS, OS and NS, respectively) in their association with breast cancer screening practices considering three factors: an increasing gradient was observed for renunciation of basic healthcare for financial reasons, a decreasing gradient in the regular visit to a medical gynaecologist and having had a Pap smear in the last 3 years. Three other variables that showed a decreasing gradient are: living with a partner, current use of hormone replacement therapy and having had a check-up in the last 5 years. In conclusion, the main differences between breast cancer screening practices were largely associated with difficulties in healthcare access, considering regular gynaecological visits in particular.

Objective: To compare the safety, efficacy and management of insulin lispro (LP) with regular human insulin (RH) in young diabetic children treated with continuous subcutaneous insulin infusion (CSII). Study Design: 27 very young diabetic children (age 4.6 ± 2.2 years) treated with CSII participated in an open-label, randomized cross-over multicenter study comparing 2 periods of 16 weeks of CSII with LP or RH. Results: Mean daily basal rate was significantly higher during the LP period (p = 0.04). No differences were seen in changes in HbA1c levels, number of hypoglycemic events, cutaneous infections and catheter occlusions. There was no significant difference between the two treatments for preprandial and postprandial glucose values, although prandial glucose excursions tended to be lower with LP (significant at dinner, p = 0.01). Mean blood glucose levels were significantly higher at 0.00 and 3.00 a.m. during LP therapy (p < 0.05). No episode of ketoacidosis occurred during LP treatment. More parents indicated that LP made their own and the child’s daily life easier (p = 0.02) and preferred LP (p = 0.01). Conclusions: LP in CSII therapy in children is safe, as effective as RH, improved postprandial excursions, met the needs of young children in their daily life well, and gained their parents’ satisfaction and preference. However, a shorter duration of LP resulted in hyperglycemia during the first part of the night, which must be compensated for by increasing nocturnal basal rates during this time.