The AflibeRcept use in rEal life study for the treatment of diabetiC macular oedema In the French overseas territories: A 12 months follow-up Study - The RECIF Study

Purpose The incidence and severity of diabetes is particularly high in the French overseas territories (FOT). The RECIF study evaluated real life management of diabetic macular oedema (DME) treated by aflibercept in FOT. Methods A prospective, noncomparative, multicentric, non-interventional, study that evaluated functional and anatomical results of patients treated by aflibercept. Twelve retina specialists working in French Polynesia, La Reunion, Guadeloupe and Martinique participated in the study. Results 67 eyes of 57 patients were followed for 12 months. Average VA gain was 7.8 ETDRS letters. 29.9% of eyes gained at least 15 letters, 6% lost 15 letters or more. 67.2% of eyes achieved visual acuity of 70 letters or better. Average central retinal thickness decrease was 115.3 µm. The mean number of injections during the 1st year of treatment was 4.9. 69% of eyes had a loading dose of at least three-monthly injections. 3 eyes were switched to steroid injections during the follow-up for lack of efficacy. Conclusion This study confirmed the efficacy of intravitreal treatment of DME by aflibercept, in the French overseas territories. This evaluation of real-life management of DME underlines the importance of improvement of patient education and collaboration with referring physicians.

Suicide in French Polynesia: a retrospective analysis based on medicolegal documents and interview with family

Objective To analyse the epidemiological data on suicide in French Polynesia (FP). Methods Data on suicides were collected from the Public Health Direction, Judicial Police Investigations Court of Justice records, the Centre d’Opérations et de Renseignements de la Gendarmerie, patient records for those hospitalized in psychiatry and from psychological autopsies. Results The dataset consisted of 316 suicide cases in FP over 25 years (1992–2016). In FP, suicide was more frequent in men (sex ratio 3.2:1), young people (mean age, 34.4 years) and individuals with previously diagnosed psychiatric disorders (100 of 316; 31.6%) The most common method of suicide was hanging (276 of 316; 87.3%). A history of previous suicide attempts was found in 25 of 56 (44.6%) of suicide cases, when documented. The most common potential triggering factors for suicide were emotional problems. The suicide rates have remained stable during 1992–2016 (mean 10.6/100 000 inhabitants per year), with periods of economic crises increasing suicide rates. Conclusions These results provide valuable information to enable the effective targeting of suicide prevention strategies toward those at high risk. Economic crises had larger impacts in the French overseas territories than mainland France. Given the unprecedented economic impact of the Covid-19 pandemic in FP, there is an urgent need to implement suicide epidemiological surveillance and prevention programmes.

Predictive factors of diagnostic and therapeutic divergence in a nationwide cohort of patients seeking second medical opinion

Objectives The aim of this study was to describe the profile of patients who sought a second medical opinion (SMO) on their therapeutic or diagnostic strategy using nationwide data from a French physician network dedicated to SMOs. Methods An observational cohort study was conducted and the study population consisted of patients residing in France or in the French overseas territories who submitted a request for an SMO through a dedicated platform between January 2016 and October 2020. Patient characteristics were compared between convergent and divergent SMOs. The divergent rate for all patients excluding those with mental diseases were described. Logistic regression was used to estimate the probability of a divergent SMO according to patient characteristics. Results and discussion In total, 1,552 adult patients over several French regions were included. The divergence rate was 32.3 % (n = 502 patients). Gynecological [Odds Ratio (OR) and 95 % CI: 5.176 (3.154 to 8.494)], urological [OR 4.246 (2.053 to 8.782)] and respiratory diseases [OR 3.639 (1.357 to 9.758)] had the highest probability of a divergent SMO. Complex cases were also associated with a significantly higher risk of a divergent opinion [OR 2.78 (2.16 to 3.59)]. Age, sex, region and profession were not found to be predictive of a divergent second opinion. Conclusions Policymakers should encourage new research on patient outcomes such as mortality and hospitalization rates after a SMO. When proven effective, SMO networks will have the potential to benefit from specific public funding or even play a key role in national healthcare quality improvement programs.

Biological invasions in France: Alarming costs and even more alarming knowledge gaps

The ever-increasing number of introduced species profoundly threatens global biodiversity. While the ecological and evolutionary consequences of invasive alien species are receiving increasing attention, their economic impacts have largely remained understudied, especially in France. Here, we aimed at providing a general overview of the monetary losses (damages caused by) and expenditures (management of) associated with invasive alien species in France. This country has a long history of alien species presence, partly due to its long-standing global trade activities, highly developed tourism, and presence of overseas territories in different regions of the globe, resulting in a conservative minimum of 2,750 introduced and invasive alien species. By synthesizing for the first time the monetary losses and expenditures incurred by invasive alien species in Metropolitan France and French overseas territories, we obtained 1,583 cost records for 98 invasive alien species. We found that they caused a conservative total amount ranging between US$ 1,280 million and 11,535 million in costs over the period 1993–2018. We extrapolated costs for species invading France, for which costs were reported in other countries but not in France, which yielded an additional cost ranging from US$ 151 to 3,030 millions. Damage costs were nearly eight times higher than management expenditure. Insects, and in particular the Asian tiger mosquito Aedes albopictus and the yellow fever mosquito Ae. aegypti, totalled very high economic costs, followed by non-graminoid terrestrial flowering and aquatic plants (Ambrosia artemisiifolia, Ludwigia sp. and Lagarosiphon major). Over 90% of alien species currently recorded in France had no costs reported in the literature, resulting in high biases in taxonomic, regional and activity sector coverages. To conclude, we report alarming costs and even more alarming knowledge gaps. Our results should raise awareness of the importance of biosecurity and biosurveillance in France, and beyond, as well as the crucial need for better reporting and documentation of cost data.

Three new combinations and one lectotypification of fern and lycophyte taxa from the French overseas territories

With the exception of French Guiana and Adélie Land, the French Overseas Territories (FOTs) are islands and their biodiversity is remarkable in many ways. Notably, they harbour numerous unique taxa leading to exceptionally high rates of endemism. Among French endemic plants, 95% occur in the FOTs, accounting for ca. 4000 species of tracheophytes and ‘bryophytes’ (Gargominy et al. 2020).

France's Approaches to Territorial Disputes Settlement

The article explores France's territorial disputes in Europe and beyond (in French overseas territories), as well as disputes settlement approaches adopted by Paris. The author outlines the historical background of the disputes and the motives of France to allocate significant funds in order to maintain high-cost overseas territories, some of them are disputed by regional countries. In Europe France relies on both bilateral mechanisms and EU instruments to settle disputes. The French territorial disagreements with other countries remain more acute overseas. Paris promotes a method of gradual settlement based on the idea that the joint development of disputed areas allows to mitigate contradictions and to create conditions for a long-term territorial settlement. The French overseas Department of Mayotte as a special territorial case is outlined. The Union of the Comoros claims are supported by the UN. The French rationale for retaining Mayotte as part of France despite the UN decision is based on the results of several referendums, when the island's residents voted for this idea.

Increasing prevalence and local transmission of non-B HIV-1 subtypes in the French Antilles and French Guiana between 1995 and 2018

The Caribbean and South American French Overseas Territories (CSAFOT) are the regions most heavily affected by the Human Immunodeficiency Virus type 1 (HIV-1) epidemic in France. Although dominated by HIV-1 subtype B, the detection of non-B subtypes and the great proportion of HIV-positive persons born abroad demonstrated the potential for local spread of non-B subtype strains in CSAFOT. To reconstruct the epidemiologic dynamics of major non-B subtype clusters spreading in CSAFOT, we conducted phylogenetic and evolutionary analyses of 2,523 HIV-1 pol sequences collected from patients living in Martinique, Guadeloupe, and French Guiana from 1995 to 2018. A large variety of HIV-1 non-B subtype strains (eight subtypes, twelve CRFs, and multiple URFs) have been introduced in CSAFOT and their prevalence significantly increases over time in Martinique and Guadeloupe. We identified twelve major transmission networks of non-B subtypes (CRF02_AG and subtypes A3, C, D, and F1) that probably arose in Guadeloupe, Martinique, French Guiana, and mainland France between the late 1970s and the middle 2000s. Phylogeographic analyses support frequent non-B subtype viral transmissions within CSAFOT as well as transatlantic transmission between CSAFOT and mainland France. Domestic transmission networks of non-B subtype variants in CSAFOT comprise both men having sex with men and heterosexual individuals from different age groups. Different HIV-1 non-B subtype variants were sequentially introduced in CSAFOT between the late 1970s and the middle 2000s and are currently spreading through domestic, regional, and/or transatlantic networks of individuals from different age and risk groups.