Showing papers in "Revue D Epidemiologie Et De Sante Publique in 1994"

Job exposure matrices

Abstract: During the last years, the use of Job Exposure Matrices (JEMs) for the evaluation of past occupational exposures has grown. This approach is described in this paper. The definition of a JEM is provided. The development process of a JEM is discussed. It includes the choice of the job classification system which influences the degree to which the matrix can be used in other studies, the precise definition of exposures and the choice of entries which should provide more information than the oversimplified exposed/non exposed dichotomy. When comparing JEMs and experts' evaluation of exposure, all aspects of both methods have to be looked at and a balance struck between the advantages and shortcomings of each of them. The problem should not be reduced to a single choice between the precision provided by experts, and the cost savings and standardization offered by JEMs. Statistical analysis with a JEM must be adapted to the job classified information it provided. When an appropriate method is used, the loss of power with a JEM compared to experts' evaluation is rather small or even null. Finally, it is important to avoid a systematic opposition between JEMs and expert assessments, as one positive result of their comparison may be the improvement of both methods of exposure evaluation.

Organization and results of drug vigilance in France

Abstract: Pharmacovigilance represents all methods of detection, assessment, information and prevention of adverse drug reactions (ADRs). It mainly involves the post-marketing phase because of the low probability of detecting all possible adverse effects of a drug during pre-marketing development. The most widely used method for pharmacovigilance is spontaneous reporting which is an excellent signal generator but precludes satisfactory calculation of incidence rates. The French Pharmacovigilance System has been set up in 1973; reporting of ADRs has been made mandatory in 1984 for prescribers. This system consists in a network of 30 regional centres under supervision of a coordinating committee at the French Drug Agency. The number of ADR cases received, assessed and recorded by the regional centres is around 10,000 per year; a similar number of cases are reported to the Drug Agency by the pharmaceutical industry. Moreover, Regional Centres work as Drug Information Centres answering more than 23,000 inquiries per year.

[Factors associated with a 1-year development in the functional autonomy of elderly persons living at home].

Abstract: The purpose of the study was to examine the incidence and reversibility of disability among elderly people over one year follow-up and to determine the predictors of functional changes. The population used in this analysis consisted in 1850 subjects aged 65 and over included in the PAQUID cohort and visited again at one year follow-up. Disability was measured by Katz's scale (Activities of Daily Living or ADLs), Lawton's scale (Instrumental Activities of Daily Living or IADLs) and a mobility scale. The one year incidence of the dependency was 5.6% for ADLs, 10.8% for IADLs, and 3.3% for mobility. Being dependent at baseline was associated with an increased risk of one year mortality comprised between 3.3 and 5.3 according to the measurement scale. Recovery back to independence was frequent however, especially for ADLs (44.7%) and mobility (28.9%). Predictors of disability were: age in all scales, vision impairment and Mini Mental State Examination score for IADL and mobility scales, depressive symptomatology for ADLs, female sex and breathlessness for IADLs. Absence of cognitive impairment at baseline was associated with recovery to independence in all scales.

Alcohol consumption among high school students and young athletes in north Italy.

Abstract: Alcohol consumption was assessed among 366 male high school students and 330 young men playing in sports teams. On the average, the athletes drank less wine, beer and spirits than the students and reported fewer drunkenness episodes. The association of alcohol drinking with sporting activity and with some independent variables was estimated by logistic regression techniques, fitting models for ordinal or nominal response variables. Point estimates of the odds ratios and their confidence limits showed: 1) an inverse relationship between alcohol drinking and sporting activity, especially as regards the consumption of spirits; 2) a strong positive relationship of alcohol drinking with both experimental and regular smoking; 3) peer alcohol drinking (best friend's and girlfriend's drinking) was the strongest predictor of the participant's alcohol consumption. Language: en

Cognitive performance and three-year mortality in the PAQUID elderly study.

Abstract: The aim of this study was to investigate the issue of whether low cognitive performance is an independent predictor of mortality in non demented elderly individuals. From an initial population sample of 2792 individuals aged 65 years and over living in Gironde (PAQUID cohort), we selected a sub-sample of 2149 individuals who had no major physical or cognitive disabilities at entry in the study. Among these 2149 individuals, 179 (8.3%) died during the three first years of follow-up. Mortality rates increased strongly with age and were significantly related with educational level, gender, smoking and presence of chronic diseases or regular use of more than 4 medications at baseline examination. Cognitive functions at entry in the study had been assessed by a battery of 6 psychometric tests. The 6 test results were analysed independently and also combined in an overall measure of cognitive functioning. Computation of mortality rates in each quartile of the 6 test scores showed a clear overall pattern of increased mortality with decreased scores. Multivariate logistic regression confirmed that subjects scoring in the lowest quartiles had the highest mortality rates, after adjustment on age, gender, educational level and other possible confounders. Odds-ratio was equal to 3.5 (95% CI: 1.5-7.9) in subjects with the lowest overall cognitive performance compared to the highest performers.

[The framework Prospective Payment Information Systems: bias, sources of errors and consequences].

Abstract: This paper reviews: 1) the biases linked to the definition method of the Diagnosis Related Groups (DRG), and the biases due to the implicit hospital model of the French programme medicalizing hospital information system (PMSI) which limit its use in hospital management; 2) the sources of errors met in use in the different kinds of data networks when collecting administrative data from medical discharge abstracts, which can induce mistakes in patient hospitalization counts and in the representation of medical units contribution to patients care; 3) the sources of errors in collecting medical informations from medical discharge abstracts can make the patient hospitalizations classified in DRG unrepresentative or uninterpretable; 4) the problems linked to the interpretation of the indicators estimated from the DRGs in hospital management and financial allocation.

The relation between antenatal care and birth weight.

Abstract: The relation between gestational age at first antenatal visit and infant's birth weight was investigated in a cohort study of 846 primiparas living in the City of Dundee, Scotland, whose first antenatal visit was between 1 May 1985 and 30 April 1986. The earlier in pregnancy the first antenatal visit the greater the infants' birth weights tended to be (p < 0.01). The relation was independent of gestational age at birth, mother's age and height, social class, tobacco and alcohol consumption and the child's sex. The result supports similar findings elsewhere, but is more robust in that, in contrast to other studies, all birth weights were measured on a single electronic scale and the effects of maternal tobacco and alcohol consumption on birth weight were taken into account in the analysis. The mechanism of the effect remains to be determined but needs to be identified as it may indicate possible preventive measures for the benefit of future children.

[Integration of patients' preferences in individual and collective health choices].

Abstract: The objectives of contemporary medicine are basically to attenuate the consequences of chronic diseases and to improve the quality of life of the patient. All medical disciplines tend now to elicit therapeutic protocols directly from the general appreciation of the patients. The community is trying to obtain a transnosographic indicator which would allow the effects of its strategic choices between different areas of the health care system to be measured, taking into account the implications on the quality of life of the population. Individual preferences are now at the center of the decision-making process. Different experimental methods are being used to reveal them. Psychometricians use direct observation of a subject's reactions in a particular pathological situation: patients are asked to arrange the intensity of the impacts on bipolar numeric scales, but an actual metrical measure is not yet available. Traditionally, economists believe that in a market, only the consumer's choices enable us to estimate his level of satisfaction. In the health care field, where market mechanisms are not fully operational, they tend to extract the patients preferences through forced choices between hypothetical health states. A real metrical measure is thus obtained. The objective of this article is to exhibit these two methods: psychometric and economic, and to show how they have been implemented in French field research to obtain quality adjusted life years indicators: QALY's.

Poisson regression in epidemiology

Abstract: The goals of Poisson regression are to estimate the effects of risk factors on incidence or mortality rates and to evaluate the dose-response relationship for variables representing quantitative levels of exposure. This statistical model presents, over standardization techniques, several advantages which are recalled here. The Poisson assumption, approximating the exact sampling distribution of rates is discussed. The model equation with internal and external standard rates is introduced, as well as summary measures of fit. Two examples are given: one from a cohort study, the other one from a geographical study, to help in the interpretation of Poisson regression results. Lastly, recent and on-going developments of these models are briefly considered.

Parasitoses intestinales et environnement dans les villes Sahélo-Soudaniennes : l'exemple de Pikine (Sénégal)

Abstract: A survey carried out in Pikine (Senegal) on a sample of 5 groups of children drawn from ecologically representative sections of the town confirms the high prevalence in urban areas of Africa of intestinal infection, especially A. lumbricoides (35.6%), T. trichiura (35.4%), and Giardia (43.7%). The prevalence of A. lumbricoides (35.6%), T. trichiura (35.4%), and Giardia (43.7%). The prevalence of A. lumbricoides and T. trichiura are appreciably higher in the oldest sectors of the town or in those with a better sanitary standard: up to 47.7% for Ascaris and 46% for Trichuris. The use of X2 tests and log-linear analysis demonstrates a significant association between Ascaris and Trichuris. The highest prevalence for Giardia (56.8%) were to be found on the outskirts of the town, where the lowest prevalence of Ascaris (21.7%) and Trichuris (22.9%) were noted; moreover, age-based prevalence for the three parasites vary from one ecological area to another. The relationship between the urbanization process, the variation in environmental factors and intestinal parasitic infection, and the operational implications arising from this geographically-based approach are discussed.

[Prospective Payment Information Systems and epidemiology: a difficult link to establish].

Abstract: Les auteurs rappellent les limites de l'utilisation en epidemiologie des donnees produites en France dans le cadre du Programme de Medicalisation des Systemes d'Information (PMSI) pour la planification sanitaire, l'evaluation medicale et ce qu'ils appellent l'epidemiologie des processus de prise en charge en hospitalisation de court sejour en France. Ils analysent les problemes de description medicale sous quatre angles: exhaustivite, fiabilite, finesse et sequencement. Ils envisagent ensuite les differents biais pouvant affecter l'information sur la morbidite obtenue a partir d'une clientele hospitaliere; les differences loco-regionales de recrutement peuvent s'expliquer par les caracteristiques de la population de reference mais egalement par le degre de disponibilite des equipements et les variations de pratiques de prise en charge

[Hospital transfer of newborn infants in the Loire-Atlantic area (France)].

Abstract: The rate of neonatal referral from the site of birth to a special care centre is generally related to the conditions of the pregnancy and the status of the neonate. The purpose of this study was to investigate other factors affecting referral including obstetric procedures, and equipment and personnel environment. A prospective survey of the neonatal population in 9 maternity hospital in the Loire-Atlantique area in France was conducted. There were, 1.316 births and the referral rate was 10.3% with a range of 1 to 24% depending on the originating hospital. After adjustment for gestational age, multivariate analysis revealed that the medical variables were the main factors affecting referral rate (positive gastric smear, adjusted odds ratio, ORa = 62.6; disease, ORa = 37.7; Apgar score 1 min < 7, ORa = 9.4; monitoring abnormality, ORa = 3.2; coloured amniotic fluid, CORa = 2.7; birthweight, ORa = 0.3). A high risk of referral was observed in only one maternity hospital (ORa = 9.4) related to a poor environment index. This center was in close vicinity to another maternity hospital. In a regional referral programme, high risk neonates should be delivered in maternity hospitals near a special care centre. But, in order to keep the rate of referral, with its adverse effect on the mother-baby relation, low, care for neonates with minor disease or only slightly underweight at birth should be cared for in these centers without referral.

[Psychotropic drug use in adolescence: why more girls? Study of a sample of 12-20-year-old students in Haute-Marne (France)].

Abstract: As part of a cross-sectional survey on adolescent health, psychotropic drug use was investigated by a self-administered questionnaire on school based adolescents aged 12-20 years (N = 3,279). 27.5% of the girls and 13.8% of the boys had taken a psychotropic drug during the 12 previous months. Female overuse was observed for different types of drugs (for distress/anxiety, sleep disturbance...) whether prescribed or not. Increased use with age was more marked for girls (14.3% to 36.2%) than for boys (10.7 to 16.9%). Psychotropic drug use increased with depressiveness, somatic complaints and medical care. A logistic regression analysis showed that female consumption was still slightly higher than that of boys after adjustment on other related factors.

[Prevalence of health problems in the Gazel (EDF-GDF) cohort: regional distribution and disparities].

Abstract: This study deals with regional differences in annual prevalence of 44 declared diseases or clinical disorders in 1989 in GAZEL cohort participants from "Electricite de France-Gaz de France" company. The studied sample consisted of 20,325 people, from 35 to 50 years old, living in France, who answered to a mail questionnaire in 1989. The collected data from one year were analysed. An overall "regional effect" was searched about every listed disease in the questionnaire. For this purpose, a logistic model, controlling for age and sex, was used. For comparing prevalence of a disease in one region with average prevalence, an odds ratio (OR) was calculated: it was defined here as the ratio of disease odd in the region to the average French odd. The regional effect was studied in greater detail for five diseases, making allowance for extra factors of adjustment (tobacco and alcohol consumption, Quetelet index, salary category, number of declared diseases). The regional effect remained significative for four diseases: hypertension with OR from 1.26 to 1.68 in northern regions, and from 0.63 to 0.75 in southeastern ones; osteoarthrosis with OR lower than 1 in western regions (0.60 to 0.79), and larger in the South (1.24 to 1.46); hyperthyroidism, goiter with OR elevated in Midi-Pyrenees (2.91) and Lorraine (1.82) [corrected]; renal stones with OR high in the South (1.85 in Provence Riviera). These results can be compared to known observations about geographical differences in mortality. They also suggest persistence of hazardous areas for some diseases.

[Dynamics of asthma mortality in France: seasonal fluctuations and peak mortality in 1985-87].

Abstract: In the face of an observed increase in asthma mortality since the end of the 70's an analysis of the time series of the deaths for the period 1979-89 was conducted; which shows a peaking of mortality between 1985 and 1987. A different seasonal component of asthma mortality has been identified for the age group 5-34 and over 34 group. For the later, mortality was found to peak during winter and dropping to the lowest point in summer, well synchronised with the mortality due to respiratory infection. For the former, mortality usually peaks during summer and troughs during the winter, independently of the mortality due to respiratory infection. A bimodal repartition of deaths was observed in the age group 5-34 with a main peak in summer (July) and a secondary peak in autumn (October). Modeling of the deaths series by season shows a dramatic rise in mortality during the years 1985, 1986 and 1987 affecting both age groups. During these 3 years, the global over-mortality is 21%. The increase has affected all the seasons allowing for seasonal variations of each age group. Factors responsible for the death seasonality in each age group are discussed. The temporary action of a non-specific factor was proposed to explain the cross-sectional character of the mortality crisis in the population; namely the influenza epidemics during the 1985 and 1986 winters.

Aids-related knowledge and practices in migrant populations: the case of Montrealers of Haitian origin.

Abstract: The objectives of the study were to determine knowledge levels regarding AIDS and its modes of transmission, and to describe sexual behaviour of Montrealers of Haitian origin. A serial cross-sectional study was conducted in three phases between 1987 and 1990. A questionnaire was administered in a face-to-face interview with the exception of the section concerning sexual practices which was self-administered for those respondents who were literate in French. The study was conducted among 775 men and women residing in the metropolitan Montreal region. These individuals were aged 15 to 39, were born in Haiti or had at least one parent born in Haiti. Knowledge levels were high except for misconceptions about HIV transmission through casual contact and mosquito bites. There was a significant association between high risk sexual behaviour and marital status with the odds of having had multiple partners significantly raised for previously married individuals (OR = 5.96, 95% CI = 3.09; 11.50). High risk behaviour was also associated with being under 25 years of age (OR = 2.83, 95% CI = 1.40; 5.74), knowing someone with HIV/AIDS (OR = 1.88, 95% CI = 1.05; 3.37), being male (OR = 6.81, 95% CI = 3.99; 11.60) and earlier year of interview. Montrealers of Haitian origin, with their specific AIDS-related socio-cultural characteristics, constitute a community which is intermediate between their country of origin, Haiti, and their host country, Canada.

Incidence et facteurs associés à la césarienne primaire au Bénin (Afrique).

Abstract: Among 3225 deliveries in two Cotonou public maternity units, 244 primary cesarean section were observed during July 1988 to December 1989. Primary cesarean section incidence varied according to indications, maternal parity and maternity care units. Foetal distress (65.9%), malpresentation and cephalopelvic disproportion (22.1%) were the dominant organic risk factors for the primary cesarean section. Multivariate stepwise logistic regression technique indicated that the most important indications for the practice in Cotonou were mainly organic risk factors, maternal height and parity as well as repeating stillborn history. Practician experiences (OR = 6.6) and foetal distress (OR = 9.3) in the decision making process were highly associated to cesarean section and differed between maternity units. Authors provided some suggestion for improving the practice of cesarean section in Cotonou and in Benin.

An epidemic of tuberculosis in an elementary school, Sanremo, Italy, 1993.

Abstract: In late 1992, three cases of tuberculosis were identified in school children attending a small elementary school in Sanremo, Italy. In order to identify further cases and determine the source, an epidemiologic investigation was undertaken. Tine test and X rays were performed on all students and school personnel. A total of 80% of the 59 students in the school had positive tine test reactions, as did 100% of the 12 teachers. All but one of the positive students had converted since last tested, as had the nine teachers who had been previously negative. The source of the outbreak was a teacher who had been in direct classroom contact with two of the five classes and had worked closely with the rest in building of a Christmas creche for the school. This outbreak suggests that increasing attention should be paid to school as potential foci for the spread of tuberculosis and that greater attention be paid to teacher screening, particularly in areas of higher tuberculosis prevalence.

[Effects of an educational campaign on cardiovascular risk factors in a French town (Epernon, study town). Methods and preliminary results: prevalence and level of risk factors].

Abstract: The authors report the methods and preliminary findings of a study scheduled to last 5 years, which aims to evaluate cardiovascular risk factor changes in response to an education program. The population sample consisted of 961 subjects, from Epernon itself (the study town) and from two control towns. The assessment criteria were reported at the beginning of the study and then again after 2 and 5 years. They consisted of an analysis of medical events and of biomedical and dietary data and a detailed analysis of behavior with regard to health and socio-economic variables. Preliminary data show that the samples were similar in Epernon and the control towns and also comparable to some French epidemiological data. There is a striking difference between the percentage of subjects aware of their blood pressure (65.5%) and blood cholesterol (13.4%) levels.

[Mother-child transmission of hepatitis B virus in the Tunisian Sahel].

Abstract: In order to assess the importance of mother-child transmission of the hepatitis B virus (HBV) in the Tunisian Sahel, 81 HBsAg-positive mothers have been selected at delivery in a representative sample of 1940 who delivered in maternities of this region. Each HBsAg-positive mother was matched for age and parity particularly with two HBsAg-negative mothers. Children born to these 66 HBsAg+ and 120 HBsAg- mothers were traced at 28 months and tested by ELISA for HBV serologic markers (HBsAg, anti-HBs and anti-HBc). The distribution of these markers was significantly different according to the maternal status for HBsAg. The overall prevalence rate of HBV markers was higher in children born to HBsAg+ mothers as compared to children born to HBsAg- mothers (33.3% vs 13.3%, OR = 2.5, 95% CI:1.4-4.2). For HBsAg, the figures were 27.3% and 9.2% respectively (OR = 2.9, 95% CI: 1.5-5.9). Given the prevalence rate of HBsAg in mothers (4.2%), the role of mother-child transmission in the spread of HBV infection and the intensity and precocity of horizontal transmission, systemic vaccination against HBV at birth should be recommended in the Tunisian Sahel in the context of the EPI. However this decision should take into account, in terms of cost/efficacy ratio, the other public health problems concerning this area.

Depressive symptoms and employment status among Belgian adolescents.

Abstract: The association of employment status and depressive symptoms was assessed by means of the Center for Epidemiological Studies-Depression (CES-D) scale in a population of 898 male and female subjects aged 16 to 21. The unemployed subjects (N=300) scored significantly higher on depressive symptoms than did the students (N=300) or the employed workers (N=298) even when gender was controlled. Although the quantity of depressive symptoms differed, the nature of the symptoms experienced was similar in the three groups. Affective symptoms were more common than symptoms in somatic or interpersonal areas, suggesting that in adolescence and young adulthood there is a high degree of affective disturbance. We conclude that primary unemployment is associated with a substantial degree of depressive morbidity.

Economic analysis of neonatal screening for drepanocytosis in metropolitan France

Abstract: There is indisputable evidence that mortality and morbidity can be significantly reduced by programmes that screen newborns for sickle cell disease. But in the French epidemiological context, national decision regarding generalization of local screening programmes to all newborns must take into account economic considerations as at-risk populations represent, in most geographic areas, a few percent of the total population. Targeted screening can be considered but raises ethical and practical issues. In order to compare alternative screening strategies, a cost-effectiveness analysis has been performed. The analysis is based on a screening programme of newborns conducted in the south-eastern suburb of Paris. Strategies have been defined in terms of laboratory procedures (isoelectrofocalisation, electrophoresis on citrate agar, high pressure liquid chromatography, BIORAD technique,...) and methods for blood collection (dried paper, micro-tube). An evaluation of all the necessary costs have been performed for each strategy in the biochemistry laboratory in charge of the neonatal programme. Costs have been estimated from detailed observation of physical quantities of capital and labour involved in each case. Evolution of unit and marginal costs according to the level of annual production has been assessed. Effectiveness has been measured in terms of number of sickle cell cases detected. Screening of at-risk babies in Paris region would permit detection of 80 to 215 babies each year at a unit cost per case found varying from 1 to 2,800 US$ (according to hypothesis of prevalence). When compared with other programmes of prevention, results of selected screening of newborns in whole metropolitan France suggest that this action might be discussed by public health authorities.

Respiratory symptoms and function of coal miners presenting radiological pulmonary abnormalities

Abstract: Respiratory symptoms and lung function of 80 coal workers suspected of pneumoconiosis (pulmonary X-rays classified 0/1 or 1/0 according to International Labour Organisation classification) who worked for at least 10 years at face work (Ts) were studied in comparison with two control groups matched by age (+/- 2 years), height (+/- 5 cm), weight (+/- 10 kg) and smoking habits: the Tn group constituted by 80 coal workers who worked for at least 10 years at face work with normal pulmonary X-rays, and the HTn group constituted by 80 underground miners who worked mainly out of face work with normal pulmonary X-rays. The frequencies of cough, expectoration, chronic bronchitis or dyspnoea were significantly higher in Ts group than in the two others. The one-second forced expiratory volume to vital capacity ratio (FEV1/VC) was lower, closing volume to vital capacity (CV/VC) or to total lung capacity ratios (CV/TLC) were higher in Ts group than in the control groups. Unexpectedly, vital capacity (VC), one-second forced expiratory volume (FEV1), total lung capacity (TLC), compliance, diffusing capacity (DLCO) referred to alveolar volume (VA) were higher. In Ts group, the small rounded opacities were noted in the top part of the lung (56.9%), the irregular ones were distributed on the entire lung (65.5%). There were no relation between the category of small opacities and respiratory symptoms or lung function.

[Illness-based payment to hospitals: the French experience].

Abstract: Since 1991, the French government is experiencing case based prospective payment mechanisms for public and for profit private hospitals. The experiments are the final objective of a program launched in 1982 to implement Diagnosis Related Groups (DRG) in France. Experiments are described and discussed. The relevance of the DRG classification is questioned, as well as the potential incentives embedded in the payment scheme. In the public sector, a case based prospective budgeting method is tested, to re-allocate resources according to case mix and relative costs. In the for profit sector, a prospective payment per case is designed, with price and volume adjustment inside a global cap of expenses. The experiments are a first step towards the unification of payment methods in both sectors. But important differences still remain, dealing with the scope of the payment method and the rate-setting basis. All expenditures will be covered in the public sector, physician fees are excluded in the private sector. The rates are based on actual cost in the public sector, on actual bills for the private sector.

Le risque nosocomial

Abstract: Le risque nosocomial, apres avoir ete longtemps neglige, redevient un sujet preoccupant en raison de circonstances favorables a sa recrudescence et d'une visibilite mediatique et juridique nouvelle. Il presente quatre dimensions: le risque clinique est le plus evident, il concerne les malades hospitalises et, de plus en plus, les personnels hospitaliers; le risque economique, malgre des difficultes d'appreciation, occupe au sein des budgets hospitaliers une place insoupconnee; le risque juridique, souligne par une evolution recente de la jurisprudence; enfin, le risque ethique lie aux comportements, parfois induits chez les soignants, en rapport avec le risque professionnel

Management of drug addicts (heroin addicts) by general practitioners

Abstract: A telephone survey has been undertaken in a random sample of 150 General Practitioners (GPs) in four regions of France. 25% refused to answer. The study showed that drug addiction (use of heroin) is a serious issue for many of these physicians: 15% follow more than 20 drug addicts per year and only 12% see none; extrapolating the mean number of drug addicts followed yearly (9.4 per GP) to all GPs in the four regions (26,000, that is to say half of all french GPs) give an "active file" of 250,000 drugs addicts per year. Only 15% if the GPs feel they are educated for the management of drug addicts, although 70% say they prescribe medication such as hypnotics and anxiolytics (97%), the most cited being Tranxene 50 (Chlorazepate 50 mg), antalgics (84%), morphinic or morphine-like drugs (49%), mainly Temgesic, and at last antidepressants and neuroleptics (39%). GPs suffer from being isolated in their practices, as contacts with collegues or institutions specialized in drug addiction are few. If one third of the GPs wish an active participation in the management of drug addicts, and one third wish at least to "do something", they are all much ambiguous in their attitudes toward drug addiction. Their behaviors vary from medical pride to anxiety and even fear. They all mention a lot of practical problems with respect to reputation, practice, lack of time... Unanimous wishes concern opportuneness of setting up continuous medical education on this topic, of working out guidelines for prescription, of improving relationships with other institutions.

Manganese in drinking water and its contribution to human exposure

Abstract: Methylcyclopentadienyl manganese tricarbonyl (MMT) has been used in Canada since 1976 as an additive in unleaded gasoline. The combustion of MMT leads to the emission of Mn oxides to the environment and may represent a potential risk to public health. It therefore seems important to assess the associated Mn exposure. The present study is part of a broader research program on total human exposure to Mn and aims specifically at assessing the level of exposure to Mn and other metals via drinking water. A comparative study was performed between two groups of workers (garage mechanics and blue collar workers of the University of Montreal) differentiated by their exposure to inhaled Mn. For Pb, Cu and Zn in residential tap water, significant differences were observed between the first sample and the one taken after one minute of flow. A significant difference was also found between the two groups of workers (combined flow time) for Mn, Cu and Ca. The Mn contribution from water is estimated to be 1% of the total dose from ingested food. This low exposure may become important (17%) for persons drinking well water, especially if we consider interactions between metals following multimedia exposure.