Latest database descriptions

1. Provide epidemiological surveillance of congenital defects in the Parisian population, with the objective of an alert faced with any teratogens from the environment (e.g.: medication, industrial accident), and this, on a local, national and international scale. In the event of an abnormal change in the frequency of a defect, additional investigations are conducted, with a search for special risk factors, and also recording or recruiting bias that can result in a false alarm.
2. Assess in the population the impact of the health initiatives:
- Evaluating the prenatal screening of malformations is a basic objective of the registry,
and this even more so as this screening has developed substantially in France since the
1980s.
- Evaluating preventive initiatives is also important, and especially that of the impact of the primary prevention policy of neural tube defects by periconceptional folic acid supplementation, implemented in France starting in the year 2000.
3. Conduct studies in collaboration with specialized clinical services, in particular for assessing in the population the future of children who carry certain incapacitating malformations.
4. Contribute to etiological research, in particular within the framework of collaborative and multi-center studies. This can entail case/control studies or cohorts set up for particular research questions.

Register objectives in terms of public health (monitoring, assessment)
These concern two different methods: descriptive epidemiology and assessment of healthcare practices.
The objective of the first method is health monitoring of B and C viral infections:
- study of the detection rates of B and C viral serologies and of their trends over time,
- study of the contamination method trends over time,
- study of diagnostic techniques (systematic screening, diagnostic approach if biological anomalies or symptoms detected),
- assessment of the impact of the change in the B viral vaccination campaign in 1998 on the incidence of acute hepatitis B.
In the field of healthcare practice, our objectives are:
- study of the arrangements for treating hepatitis B and C in the population in general,
- assessment of the impact of consensus conferences and national recommendations of good clinical practice,
- analysis of care sectors.
Register's objectives in terms of research
- Study of the natural history of hepatitis B and C in the cohort formed: causes of death, risk of complications.
- Anthropological studies to understand what is hampering the treatment of hepatitis C sufferers and study of the determinants of the diagnosis and care proposal for immigrants suffering from hepatitis B

Identify, in a cohort of major depressive disorder patients starting a treatment with any antidepressant to be followed for 6 months in a outpatient psychiatric setting, the predictive factors of an evolution of their family, social and professional disability and to establish a typology of patients according to their evolutive profile at 6 months after treatment initiation.

General objective: These studies will allow us: - to prospectively determine the impact of different alcoholic and/or metabolic cirrhosis complications and to investigate factors associated with the onset of each event (CHC, decompensation, death), so as to construct and validate predictive scoring. These results will allow the assessment of different levels of risk in order to adapt clinical treatment. The large number of patients should determine whether there are differences concerning the impact of complications and predictive factors according to cirrhosis aetiology. - to identify predictive factors concerning the onset of clinical complications from prospectively gathered biological samples (serum, plasma, DNA), and to evaluate their relevance regarding known factors for viral cirrhosis. This research will benefit from recent advances in biology, particularly in the field of genomics and proteomics. The identification of new factors could improve predictive factors and provide avenues for basic research through nested studies. - to assess the impact of different treatments (alcohol withdrawal, management of diabetes, arterial hypertension, weight loss, etc.) concerning clinical complications and to determine possible treatment modifications which could result in this. The efficacy and safety of these treatments will also be evaluated using a large population receiving treatment under real life conditions. Secondary objective: These studies may use the prospective cohort database along with collected samples, allowing for an optimal use of resources. However, they must include a specific component that requires independent organisation and financing, and that only involves a portion of the included population. Relevant areas are quite diverse (immunology, genetics, metabolism, diabetes, cardiology, imaging, biostatistics, quality of life, pharmacology, health economics, etc.). Some of these studies will be achievable in the short-term.