Showing papers in "Revue D Epidemiologie Et De Sante Publique in 1992"

Jackknife and bootstrap

Abstract: The jackknife and the bootstrap are two non parametric methods which provide estimates- of the bias and the variance of an estimator, without any assumption about its statistical distribution. The jackknife is based on the observation of the estimator for subsamples, generally of size n-1, obtained from the original sample. The bootstrap is based on the observation of the estimator on size n samples drawn from the original sample. The two methods are presented, their principle is illustrated through their application to simple examples and to more complex epidemiological problems.

Prevention of cutaneous melanoma: an epidemiological evaluation of the Swiss campaign.

Abstract: A national information program, focusing on the main recognized risk factors (primary prevention) and on the potential benefits of early detection (secondary prevention) of cutaneous malignant melanoma, was launched in Switzerland in May 1988. The first campaign, based on a pilot study conducted in 1986 in the canton of Basel, was followed by a recall campaign in July 1989. This report describes the organization of this program and presents an assessment of its initial impact. The number of newly diagnosed cases increased more than twofold (+ 116%) in the two months following the launch of the first campaign (May to June 1988). This trend was accompanied by a statistically significant shift of case distribution towards younger ages (< 60 years; p = 0.003), and a non-significant shift was observed towards less advanced lesions (thickness < or = 1.5 mm). The incidence decreased quickly, though in the twelve month period between the two campaigns it remained 21% higher than before the inception of the program. No appreciable effects were detected from the recall campaign and no difference was seen among regions or between sexes.

[Cancer in Japanese migrants to Hawaii: interaction between genes and environment].

Abstract: This paper describes the progressive changes in cancer incidence that have been observed among Japanese after their migration to Hawaii. It reviews descriptive and analytic epidemiologic data suggesting a role for genetic susceptibilities in explaining the high risk of Japanese for colon cancer and their low risk for lung cancer, when compared to Caucasians. Differences in certain pharmacogenetic polymorphisms may explain these risk patterns. This research may lead to a better characterization of cancer risk at the individual level and, consequently, to improved methods of prevention.

Studies of cancer in migrant populations: methods and interpretation.

Abstract: Les auteurs examinent l'interet de l'utilisation des donnees en epidemiologie descriptive (qui n'ont pas ete recueillies afin de tester une hypothese specifique) dans le but d'etudier le risque de cancer chez les populations migrantes. Le lieu de naissance constitue le facteur de risque etudie dans de telles analyses, bien que celles-ci varient considerablement en complexite suivant les informations disponibles concernant d'autres variables explicatives ou l'existence de variables de confusion

Le paludisme urbain côtier à Cotonou (République du Bénin) : étude entomologique

Abstract: A one year entomological was carried out the survey in the coastal town of Cotonou to study the urban transmission of malaria. Three representative areas of Cotonou were chosen. The method adopted concerned night catches on human bait and dissection of A. gambiae s.l. The density of the vector (A. gambiae s.l.) fluctuated with the level of urbanization of the areas the annual aggressivity rates reached 1179 in the town center, 3666 in an the outskirts and 3363 in intermediate areas. Mean sporozoitic index was 1.7% and corresponding annual inoculation rate 46. In center of the town, transmission is seasonal and short, with a very high level. Sporozoitic index is 12% and the corresponding inoculation rate is 1.02. Outside of the town, transmission is seasonal and long: lasting 8 months. Transmission is imperceptible in the middle of the dry season and at the beginning of the long rain season. Malaria transmission into urban areas is generally low but in coastal like zones Cotonou, the intensity may be higher.

Methodological problems of time-related variables in occupational cohort studies.

Abstract: In studies of long-term health effects of occupational exposures it is important that the time patterns of the study exposure and of the relevant confounders should be taken into account in the analysis. The time-related confounders that have been most frequently considered include age at risk, calendar period, duration of employment, length of follow-up, and employment status (active or retired). These factors are related to the healthy worker effect which is more pronounced among active workers, and declines with length of follow-up. Thus, these time-related factors are potential confounders in occupational cohort studies (and in nested case-control studies). It is therefore advisable to routinely control for length of follow-up and employment status, in addition to the usual confounding factors of age at risk and calendar period. However, it should be stressed that this approach will minimise, but not eliminate, confounding due to the healthy worker effect. In particular, direct control for employment status is inadvisable if this constitutes an intermediate variable in the pathway between exposure and disease, and more complex analytical procedures are necessary in such situations. It is also important that the principle exposure under study should also be analyzed in a time-related manner, taking account of the likely induction and latency periods, and the relative etiological importance of exposure intensity, exposure duration and cumulative exposure. The simplest approach is to analyse the cumulative exposure in a time-related manner, and this may suffice when the aim is merely to consider whether or not there is an effect of exposure. However, once it has been provisionally assumed that an effect exists, attention then shifts to understanding the nature of the effect. In this context, the temporal pattern of exposure and outcome can be considered by examining the effects of exposures in specific time windows while controlling for time-related confounders, and for the effects of exposures in other time windows. A more sophisticated approach is direct fitting of a theoretical model of carcinogenesis, such as the Armitage-Doll or Moolgavkar models. However, it should be emphasized that occupational cohort studies only rarely have sufficient numbers, and data of sufficient quality, to permit meaningful conclusions to be drawn from more sophisticated analyses of this type.

[Sleep disorders and use of psychotropic drugs in 6-year-old children].

Abstract: Cette etude prospective, realisee sur deux ans, a pour objectif la determination des facteurs de surconsommation de medicaments psychotropes par l'enfant de 6 ans scolarise dans le departement du Bas-Rhin. L'analyse prend en compte l'environnement familial de l'enfant, la phase post-scolaire, le sommeil de l'enfant, la localisation geographique et les medicaments consommes. L'enfant est examine par les medecins scolaires en presence des parents lors de la consultation obligatoire a l'entree en cours preparatoire. L'etude est exhaustive

Urbanisation et transition nutritionnelle en Afrique Sub-Saharienne : les exemples du Congo et du Sénégal

Abstract: To evaluate the impact of urban life-style on nutritional status, body mass index (BMI) of mothers and indices of malnutrition of preschool children were calculated in four representative surveys in two rural areas and two main cities of Western and Central Africa. Mean BMIs were similar in both urban settings and were significantly higher than those of rural mothers. Distributions shifted significantly towards values over 25 kgs/m2 in towns, although, values lower than 18.5 were still present. Therefore chronic energy deficiency, largely prevalent in many rural areas of Africa, remains important in cities, where obesity also appears to have become a public health concern. Wasting was rare in young urban children, but the prevalence of stunting, although lower, indicates the persistence of nutritional deficiencies. This situation of nutritional transition generates a double burden to already limited health finances and requires an appropriate educational policy.

[Anti-influenza vaccination for active persons (25-64 years): a cost-benefit study].

Abstract: This paper is a specific cost-benefit study concerning 25-64 years people flu vaccination. For this active population the vaccination rate is only 12% and the cost of absenteeism is potentially high. To make the balance between prevention costs and (direct and indirect) avoided costs by the vaccine, we use a basic case with mean value parameters as: efficacy rate of vaccine, impact of epidemics, size of vaccinated population, immunization length and compensation rate of the so-called production losses. These parameters are then supposed to vary in a sensitivity analysis. In any case net benefit of vaccination appears, which size varies mainly in relation to epidemics and vaccinated population extents. But improvements are to be achieved for giving more precise values to "real" efficacy rate of vaccination and effective economic impact of absenteeism on production.

[Diabetes mellitus and pancreatic cancer: a case-control study in greater Montreal, Quebec, Canada].

Abstract: In a population-based case-control study of dietary risk factors in French Canadians in Montreal, a total of 179 cases and 239 controls were interviewed between 1984 and 1988. It was found that the frequency of diabetes was almost three times higher in cases of pancreatic cancer (16%) than in the controls (6%), with an Odds Ratio (OR) of 2.52 and a Confidence Interval (CI) of 1.04-6.11. Fifty per cent of the pancreatic cancer cases had this disease before the cancer was diagnosed, compared with 71% of the controls at the time of the study. Those aged 50 years and over accounted for 75% of the cases and 71% of the controls (diabetic subjects); 68% of the cases were treated with a combination of diet and oral hypoglycemic agents compared with 86% of the controls. Insulin was used by 32% of the cases and 14% of the controls. These results suggest that diabetes may play a major role in the etiopathogenesis of pancreatic cancer in this urban population. A lot of controversy remains about the precise role of diabetes, and further studies are needed for a better assessment and understanding of the mechanisms of this association.

Electromagnetic fields and cancer risks.

Abstract: Cancer was first associated with exposure to electromagnetic fields (EMF) in 1979 when Wertheimer and Leeper reported that children dying from cancer resided more often in homes believed to be exposed to higher EMF than did healthy control children. The risks were as high as 2.23 (1.56-3.18) 3.09 (1.68-5.71) for all cancers, 2.98 (1.72-5.15) for leukemia and 2.40 (1.08-5.36) for brain cancers. Wire configuration around houses was used as a surrogate for direct EMF exposure measurements. Wertheimer's finding of an association between cancer and wire configuration around houses has been replicated in two recent studies. However, direct measurement of EMF fields in houses of cancer children have not yielded the same results as the wire configuration around houses, thereby jeopardizing the hypothesis of an association between EMF and cancer. To comprehend the putative association between residential exposure to EMF and childhood cancer, one would have to understand what is hidden behind the notion of 'wire configuration' around the house. In parallel with residential studies, scores of studies were conducted among workers occupationally exposed to EMF. What have we learned from these occupational studies? Hypotheses generating and case control studies have revealed the existence of an excess risk of leukemia among electrical workers. Pooled results have estimated the risk for all leukemia to be 1.18 (1.09-1.29) and for acute myeloid leukemia 1.46 (1.27-1.64). An increased risk of leukemia among electrical workers does not necessarily mean that EMF is a causal agent, other chemicals such as benzene, creosote, solvent, could possibly account for it but this has yet to be confirmed.(ABSTRACT TRUNCATED AT 250 WORDS)

Epidemiology and prevalence of seropositivity against Borrelia burgdorferi antigen in La Rioja, Spain.

Abstract: The aim of this study was to acquire a better knowledge of the epidemiology of Lyme disease. A seroepidemiologic study was made by evaluating the different levels of antibodies to Borrelia burgdorferi in a five hundred serum representative sample of a population from the province of La Rioja, Spain. Samples were randomly selected and stratified to take into account sex, age, rural or urban residence, and geographical area. All subjects included in the study were asked to fill out a questionnaire containing this information along with data concerning leisure activities, occupation, contact with animals, tick-bite and antecedent features related to Lyme disease. No statistical differences were found in relation to sex or age. The seroprevalence was very high (31.3%) in mountain areas, where Ixodes ricinus and deer are present. The risk factors associated with seropositivity were forestry and cattle-raising activities, as well as contact with animals. The best titer of antibodies associated with clinical antecedents of Lyme disease and related disorders was 1/256.

Parasitémies à Plasmodium falciparum ou P. malariae chez les porteurs du trait drépanocytaire dans différents biotopes du Bénin

Abstract: The prevalence of malaria and the frequency of gene S were surveyed in two different regions of Benin, savana and coastal lacustrine regions. In both regions, prevalence of malaria was not significantly different between Hb AA people and Hb AS people. Gene S prevalence was not modified by age, excepted for Hb SS which was not found in people upper than 25 years. In holoendemic area, i.e. lacustrine region, means of P. falciparum parasitaemia were significantly lower in Hb AS children than in Hb AA children. Sickle cell trait did not reduce the prevalence of malaria but seemed to decrease the level of parasitaemia.

A randomised 2 x 2 factorial design to evaluate different smoking cessation methods.

Abstract: A study with a 2 x 2 factorial design was performed to evaluate the effectiveness of acupuncture, of nicotine gum and the effect of the association on smoking cessation. After a one-year follow-up period, the success rates were in the same order of magnitude for nicotine gum (active treatment: 10%, placebo: 8%) group and for acupuncture (active treatment: 8%, placebo: 10%) group.

Height and the prevalence of chronic disease.

Abstract: The relationship of stature with the prevalence of 18 chronic diseases or groups of diseases was analysed using data from the 1983 Italian National Health Survey, based on a sample of 63,859 individuals aged 20 or over randomly selected within strata of geographical area, size of the place of residence and of the household in order to be representative of the Italian population. Rate ratios (RR) were computed using multiple logistic regression, including terms for sex, age, geographical area, education and smoking. For 15 out of 18 diseases or groups of diseases the RR was below unity in the highest quartiles of height, and the inverse trends with stature were significant for 11 (diabetes, RR 0.90 for highest vs lowest quartile; heart disease, RR 0.92; chronic bronchitis and emphysema, RR 0.84; bronchial asthma, RR 0.70; anaemias, RR 0.70; liver cirrhosis, RR 0.62; urolithiasis, RR 0.76; renal insufficiency, RR 0.71; arthritis, RR 0.89; psychiatric and neurological disorders, RR 0.82). None of the diseases considered showed significant direct trends with height, but hypertension (RR 1.09 for the highest vs lowest quartile), haemorrhoids or varices (RR 1.09) and cancers (RR 1.22) tended to be elevated in the highest quartile of height. The generalised inverse relationship between height and prevalence of chronic disease suggests that poorer nutrition in childhood and adolescence is an unfavourable indicator for the subsequent occurrence of several diseases. Major exceptions were hypertension and varices, two conditions highly dependent on the pattern of health care utilization, and cancer.

Epidemiology of occupational reproductive hazards: methodological aspects.

Abstract: Both male and female workers may be exposed to occupational agents which affect their reproductive processes. Reproductive outcomes are important in their own right, for example teratogenic effects and impaired neurological development. In addition, reproductive impairment may indicate germ cell mutation, which has far-reaching implications. Research into reproductive effects is beset with pitfalls. Applying the results of toxicological research may be suggestive, but such extrapolation is very unreliable owing to profound differences in reproductive and/or toxicological mechanisms. Epidemiological data are therefore indispensable. Optimal methods of data collection and study design, comparable with similar studies of other populations, are essential. Otherwise reliable conclusions cannot be drawn, and this is a waste of resources and of the work and cooperation of everyone who participates in the research. In considering study design, the key question is the measurement (or minimally, the accurate description) of exposures, which is more problematic than the ascertainment of reproductive outcome variables. From the viewpoint of exposures, case control studies have the same disadvantage as studies of the general population, that exposures are heterogeneous, and most specific exposures are therefore rare, even in a large study; in addition, measurement is particularly difficult in this situation. Occupationally defined populations have the corresponding advantages of relative homogeneity and availability of data, although even here numerous problems exist, which are well known. Outcomes can be assessed by means of biological or questionnaire-based methods. They are best regarded as complementary, as each has its strengths and weaknesses.(ABSTRACT TRUNCATED AT 250 WORDS)

The cholera epidemic in Ecuador: towards an endemic in Latin America.

Abstract: We present an epidemiological study of the first wave of cholera in Ecuador in 1991. One month after the 7th cholera pandemic hit the Pacific coast of Peru, the disease reached the coast of Ecuador and spread to the rest of the country within a few weeks. One year later, 46,320 cases have been notified, giving an incidence of 481 cases per 100,000 inhabitants. The overall mortality rate has been low (697 deaths, i.e. 1.50%), although there have been large differences between the various provinces: in the Andes (Sierra), for example, rates above 8% have been recorded. The first wave peaked about eight weeks after the first case, with 3400 new cases per week throughout the country. This was followed by a gradual decrease towards a baseline of 250-500 new cases per week. A resurgence was observed in most coastal and Andean provinces from November 1991 onwards. The kinetics of the epidemic are compatible with an endemic implantation of the disease in Ecuador, as is probably the case in the entire intertropical Pacific coast region of Latin America. From the data presented, the latin-american episode of the 7th pandemic starting on the Pacific coast, is characterized by a very high attack rate and a low mortality rate as compared to Africa, and the unexpected involvement of populations living on the high Andean plateaux. It is probable from the results collected in Ecuador that cholera will become endemic in Latin America.

[Risk factors in cardiovascular diseases in a semi-urban community of the Tunisian Sahel].

Abstract: Cardiovascular diseases are the leading cause of mortality in the western countries at the same time they are beginning to appear with increasing frequency in developing countries An epidemiologic study was carried out at Kalaa Kebira (Sousse-Tunisia) to determine the prevalence of the different risk factors of cardiovascular diseases The study was performed on a representative sample of 555 adults of 20 years and more (response rate of 76%) There was a high proportion of adult males smokers (66%) The prevalence of hypertension varied from 15% to 25%, those of diabetes was 65% An hypercholesterolemia greater than 62 mmole/l was observed for 12% of the sample and obesity for 20%

[Morbidity and severity of malaria attacks in carriers of sickle-cell trait].

Abstract: The authors made a survey in a permanent high Plasmodium falciparum transmission area to compare frequency and severity of malaria attacks in children belonging to different haemoglobin types before 15 years; 291 young out-patients of the local infirmary and 467 outpatients of the hospital were examined. Diagnosis of malaria was inferred from clinical and parasitological criteria and subsequent evolution of the disease. Pathogenic threshold of parasitaemia was similar in all haemoglobin type groups of children and was about 3,000 parasite-infected red cells per mm3. Malaria was diagnosed more often among HbAA patients, than among other patients. Mortality rate in AA haemoglobin children was higher than 3% whereas in sickle cell trait carriers no death could be certainly attributed to malaria. The S gene rate was significantly weaker (p < 0.05) in subjects attacked by Malaria (5%) than in all other groups of children. In the endemic malaria areas the susceptibility of S gene carriers appears to be lesser than in AA haemoglobin children and could explain the paradoxically lower rate of mortality in this group.

Determinants of perinatal and infant mortality in Italy

Abstract: Determinants of stillbirths, perinatal and infant mortality in Italy have been analyzed using information collected routinely by the Italian Central Institute of Statistics on more than 2,400,000 births and 33,000 infant deaths in the period 1980-1983. Individual records included data on maternal (i.e. age, education, obstetric history) and fetal characteristics (sex, birth weight, gestational week at birth). The Italian stillbirth, perinatal and infant (1st-365th day of life) mortality rates in the period considered were respectively 7.7/1000 births, 16.4/1000 births and 13.5/1000 livebirths. Perinatal and infant mortality was extremely elevated in the very-low-birth-weight category. About 90% of liverbirths weighing less than 1000 g died within the first year of life, but this fell to about 45% in babies weighing 1000-1499 g. Among other factors, stillbirth, perinatal and infant mortality rates were elevated among males, born to older women and in higher birth rank and multiple pregnancies. These findings persisted, although less markedly, after adjustment for weight. Mortality rates were about 50-70% higher in less educated women. This finding was not markedly changed after adjustment for birth weight and maternal age, suggesting that socio-economic factors are per se important determinants of perinatal and infant mortality in Italy.

Epidemiological surveillance of nursery school children in the Hérault for the evaluation of maternal and infant health and welfare services

Abstract: A random sample of 4-5 years old children born in the same year was taken from the infant schools of the Herault (France) and examined by pediatricians during a systematic check carried out by the Mother and Child Protection Department of the Health Service This gave and estimation of the prevalence of the most widespread health problems: language, motricity, eyesight, hearing, obesity and asthma Differences according to social and familial factors were found for language and motricity problems, as well as for access to preventive care

How much benefit could be obtained from cardiovascular disease intervention programs

Abstract: To estimate the potential benefits of cardiovascular disease intervention programs in Spain, we have computed cardiovascular population mortality fractions and deaths attributable to the main risk factors by using relative risks from international studies and Spanish prevalence and mortality data (subjects of both sexes, aged 25-64). As many as 71% of the cardiovascular deaths studied in men and 44% in women might be delayed every year in Spain if it were possible to eliminate the current exposure of the population to smoking, obesity, sedentariness, hypertension and hypercholesterolemia. With the eradication of tobacco exposure 31% of coronary deaths and 16% of stroke deaths in men (7% in both cases for women) might be avoided. Similar actions on sedentariness, hypertension and hypercholesterolemia might delay 17% and 29%, 13% and 13%, and 9% and 11% of deaths, respectively, in males (figures generally somewhat higher in females). These figures would be moderately lower if reductions in the prevalence of these factors are considered realistically. These results may encourage the implementation of strategies against cardiovascular diseases in countries with risk factor prevalence similar to that of Spain.

Epidemiology of occupational neurobehavioural hazards. Methodological experiences from organic solvent research.

Abstract: Neurobehavioral hazards have been identified since long in occupational health, e.g. lead, mercury, certain solvents, and many others agents. There are reviews and books on "Occupational neurology" or "Prevention of neurotoxic illness in working populations". Many methods have been applied for studies of the central and peripheral nervous systems in humans: registered diagnoses, questionnaire ratings, clinical evaluation, psychometric tests, neurophysiological and neuroradiological methods, cerebrospinal fluid components etc. Some neurological disorders are well defined, while neuropsychiatric syndromes often are less precisely diagnosed. Decreased subclinical test results in exposed groups might predict an increased risk for later, more serious disorders but the longitudinal information on clinical importance is often lacking. Some historical lessons from the epidemiology of occupational neurology will be repeated and a few reflections on the suitability of different diagnostic entities for epidemiological research shall be made. Since the beginning of the 1970s' a number of studies from the Scandinavian countries have demonstrated long-term neurobehavioral effects from working conditions with relatively moderate exposure to organic solvents. Similar findings have been verified in studies from some countries outside Scandinavia while other studies have been inconclusive. Those results have caused considerable controversy and have been discussed at international conferences and in scientific journals. Very different outcomes have been investigated in those solvent studies, however, and most studies have had a cross-sectional design with inherent problems. The exposure has been assessed in different ways, e.g. by years of occupation, hygienic measurements of the present working conditions, biological monitoring, retrospective assessments on qualitative or semi-quantitative scales. Sometimes single solvent exposures have been studied but most of the studies concern mixtures of solvents from aromatic and aliphatic hydrocarbons. As the designs have varied the exposure assessment has been crude and many different outcomes have been studied, it is hardly surprising that the results and the interpretations have differed. The first results from a comprehensive investigation on 135 solvent exposed painters and 71 carpenters as referents, selected from active members of the respective trade union 1965-70 and investigated in the late 80s, will be presented. Clinical, including psychiatric, diagnostic work up and neuropsychological as well as neurophysiological tests have been performed. Psychological test results from military conscripts at age 19 were available for all. The individual exposure history has been carefully assessed.(ABSTRACT TRUNCATED AT 400 WORDS)

[Mortality due to suicide, accidents and undetermined causes in hospitalized mental patients 1968-1982]

Abstract: An analysis of the national statistics on mortality in psychiatric hospitals, covering 14 years from 1968 to 1982, provided rates of deaths by suicides, accidents and ill-defined symptoms (chapters 16 and 17 in the ICD). Death rates among psychiatric inpatients are compared to rates in the general population. For suicide, there is an increase of about 45% in patients under 75, which is higher than for the general population. The evolution for accidents is close to that found in the general population. The death rate by ill-defined symptoms is decreasing. The increase in the rates of deaths by suicide found both in France and in several other countries suggests that the major changes (sectorization policy and use of psychotropic drugs), in the care lead to increased risk of suicide for certain patients due to shortened hospital stays and subsequent intermittent institutional care. Specific modes of death can also be described: senility without mention of psychosis, airway obstruction by false passages, notably in subjects under 55, accidental falls, hangings and drownings are particularly important in the observed over-mortality. Language: fr

Modélisation statistique des variations géographiques en épidémiologie

Abstract: In epidemiology, studies of the geographical variations of mortality or incidence rates for some chronic diseases have often given rise to etiological clues concerning those diseases. In this framework the variables concerned have a spatially autocorrelated structure which has to be taken into account in the statistical analysis. The statistical techniques used to study in the first place the spatial variations of mortality rates and then the joint geographical variations of mortality and exposure indices are reviewed. Emphasis is placed on the importance played by the geographical scale of the analysed data in the modelling process as well as on the interpretation problems of geographical correlation studies.

[Influence of educational status on a screening test for dementia, the Mini-Mental State Examination].

Abstract: This study aimed to examine the relationships between the educational level and the Mini-Mental State Examination (MMSE) total scores and its different items. In a survey dealing with cerebral aging, the MMSE administered 2,792 subjects aged 65 years and over, who continued to live at home. The total score decreased with age and increased markedly when the educational level rose. The proportion of failures was higher than or equal to 10% for 12 of the 30 MMSE items, including the 5 items designed to measure attention ability (serial subtractions) and the 3 ones exploring delayed memory. Regarding these 12 items, the percentage of failures increased homogeneously with age, but the relationship with educational level was heterogeneous: it was very strong for the calculation items, weaker for the delayed memory items. These results pointed to the complex relationships between MMSE scores and educational level, and suggested a possible bias related to the screening tool in dementia surveys.

[Life style of children and obesity in a population of 5-year-old children].

Abstract: La frequence accrue de l'obesite chez l'enfant, conduit a rechercher des facteurs de risque tres precoces susceptibles de faire l'objet de mesures de prevention. Une etude cas-temoins a ete realisee dans les ecoles des departements du Rhone et de l'Isere, lors de la visite d'entree a l'ecole primaire. 327 enfants obeses et 704 temoins ont participe a l'etude. Les donnees anthropometriques des enfants depuis la naissance ainsi que leur mode de vie ont ete recueillies au cours dune interview aupres des parents

[Anemia at delivery in Lome (Togo): prevalence, risk factors and consequences in newborn infants].

Abstract: A prevalence study was carried out on 125 mothers and their newborns in Lome (Togo): at delivery 48% of the mothers and 30% of the newborns were anaemic according to WHO criteria. Iron deficiency was the major determinant of anaemia in the mothers, as three out of four showed at least one biochemical indicator of iron deficiency. Folate deficiency was detected in 68% of the mothers but did not influence their haematological parameters. Severe iron deficiency in the mothers (serum iron < 7 mumol/l) was associated with a decrease in serum iron in the newborns, thus demonstrating an impaired iron transfer to the fetus. Folate supplementation of the mothers during pregnancy improved their newborn's folate status. A systematic ferro-folic supplementation is needed during pregnancy and would be beneficial to both mothers and newborns. Supplements could be given to women at prenatal care clinics. Attendance in these centers by 98% of pregnant women in Lome allows us to anticipate a good coverage for such an intervention.

Mass sociogenic illness in a youth center.

Abstract: In July, 1989, 63 (42%) of 150 children ages 4-14 years attending an outreach program at a youth center in Florida, but no employees, developed acute and rapidly resolving upper gastrointestinal symptoms 2 to 40 minutes after a prepackaged lunch. All ill children were sent to 3 local hospital emergency departments for evaluation. However, clinical evaluation was normal for all. Of 102 children who ate any prepackaged foods, 48 (47%) became ill compared to 1/19 (5%) for children who did not eat (rate ratio [RR] = 8.9; 95% confidence interval [CI]: 1.3-60.9). No employees ate any of the food items served. Consumption of sandwiches was associated with a moderate increased risk of illness (RR = 1.7, 95% CI: 1.0-2.9). The attack rate did not differ by age, but was greater for girls (39/56, 70%) than for boys (9/46, 20%; [RR = 3.6, 95% CI: 1.9-6.6]). Over 3,000 similar prepackaged meals from the same caterer were served in the same area of Florida that day. An inquiry in the area documented absence of similar symptoms elsewhere. Unopened meal samples tested negative for pesticide residues, heavy metals, staphylococcal toxin, or Bacillus cereus. We diagnosed the outbreak as mass sociogenic illness. Complaints of a bad tasting sandwich by the index case and possible staff anxiety about food poisoning may have contributed to the development of the outbreak.