Showing papers in "Revue D Epidemiologie Et De Sante Publique in 1995"

[Preliminary analysis of the psychometric properties of the French version of an international questionnaire measuring the quality of life: the MOS SF-36 (version 1.1)].

Abstract: The International Quality of Life Assessment (IQOLA) Project is a 4 year project initiated in 1991 to translate and adapt the Medical Outcome Study Short Form 36 item Health Survey (SF-36) in at least 15 countries. This paper reports on the preliminary psychometric assessment of the SF-36 in French (version 1.1). The validation data come from two studies: a phase IV study of 121 patients with arthritis and a phase IV study of 159 patients with angina. In both cases, the patients were surveyed using the SF-36 and a disease specific module. The main objective of this analysis was to determine how well the scaling assumptions (summated rating or Likert type scaling construction) of the SF-36 were satisfied. Item convergent validity was supported as items-scale correlation range from 0.47-0.87. Item discriminant validity was supported as all items were more correlated with their hypothesised scales than with scales measuring other concepts. Our data support the assumption that the items measuring the same concept had approximately equal variance. Items in a given scale contained about the same proportion of information about the concept being measured, as most items of any given dimension had approximately the same correlation with that dimension. The Cronbach alpha coefficient ranged between 0.79 and 0.95. The correlation between two scales was less than the reliability coefficient for those scales, and these correlations adjusted for attenuation were less than 1. These preliminary results are encouraging. They indicate that the items are linearly related to the underlying concept being measured.(ABSTRACT TRUNCATED AT 250 WORDS)

[Epidemiology of falls and fall-related injuries in the aged].

Abstract: Approximately one third of elderly persons over the age of 65 who live in the community fall each year. About 5% of falls result in a fracture, and 5 to 10% of them result in other serious injuries requiring medical care. Even in the absence of serious physical injury, falls may have severe psychological consequences leading to an accelerated decline in functional capacities. Several epidemiological studies have identified the main intrinsic risk factors for fall. These include advanced age, female sex, impaired balance, gait abnormalities, reduced muscular strength, cognitive deficiencies, impaired visual acuity and use of sedative-hypnotic medications. The results of recent epidemiological studies comparing falls with serious physical injuries to falls without injuries suggest that, besides bone mass, the speed and effectiveness of protective reflexes may greatly influence the risk of trauma after a fall. Contrary to what may be believed, the frequency of falls and fall-related trauma is also high in active and healthy subjects. However, the cause of falls are clearly different for persons of varying age, health status and level of mobility. Several authors have tried to define different types of falls according to the predominance of intrinsic or extrinsic factors in fall aetiology. This approach may allow to identify different risk factors or combinations of risk factors according to the type of falls or to the characteristics of fallers.

Appropriateness of admissions and hospitalization days in an acute-care teaching hospital.

Abstract: A cross-sectional study was made of the appropriateness of admissions and hospitalization days in an high-technology, acute-care teaching hospital. This 952-bed institution with 31 hospital services is a reference center for the metropolitan area of Barcelona. A systematic random sampling (1:11) of the registers of hospital discharges was carried out during the months of January, February and March 1991 (n = 7,142) excluding discharges from the pediatric, obstetrics and psychiatric departments. A retrospective analysis was made of 639 patients' medical records using the Appropriateness Evaluation Protocol (AEP). The rate of inappropriate hospital admissions was 9.1% (58/639) (95% confidence interval: 6.9-11.5). Inappropriate admissions were primarily attributable to hospitalizations for diagnostic and/or therapeutic services that could have been rendered on an ambulatory basis (70.7% of cases). Overall 29.2% of hospitalization days (1,963/6,731) were inappropriate (95% confidence interval: 28.1-30.3). Inappropriate admissions to hospital, an optimizable health care planning and a conservative physician's attitude (postponed discharge) were the most frequent reasons for unnecessary days of care. The interrater reliability in the use AEP criteria for appropriateness of admission showed a kappa index of 0.5 and that for appropriateness of hospitalization days 0.67. In summary, instruments, such as the AEP protocol, that allow us to determine which patients can be attended at other levels of the health care system and which levels are the most appropriate, are key elements in improving the appropriateness of hospital use in public health care systems.

Misuse of pressurized metered dose inhalers by asthmatic patients treated in French private practice.

Abstract: Bien que les aerosols-doseurs pressurises soient largement prescrits pour le traitement de l'asthme, des etudes cliniques ont suggere qu'ils sont souvent mal utilises par les patients. Nous avons etudie la frequence et les facteurs de risque de la mauvaise utilisation des aerosols-doseurs pressurises chez des asthmatiques traites en medecine de ville, en France. 264 pneumologues ou generalistes ont rempli un questionnaire pour 3 asthmatiques consecutifs âges de plus de 16 ans et utilisant des aerosols-doseurs, sur les caracteristiques des patients et de la maladie, les techniques appliquees dans l'utilisation des aerosols-doseurs et l'education recue pour cette utilisation. 668 adultes (âge moyen 47,8 ans±18,5, 51.8% d'hommes) et 100 enfants (âge moyen 11,5 ans±2,1, 72,0% de garcons) ont ete inclus. Une technique adequate (inspiration profonde synchronisee avec le declenchement de l'appareil, suivie d'une apnee de 5 secondes) a ete realisee par 33,2% des adultes et 26,0% des enfants; une technique optimale (idem, plus agiter l'appareil avant l'utilisation et declencher une seule fois) a ete realisee par 22,1% des adultes et 20,0% des enfants. Le facteur principal lie a la mauvaise utilisation des aerosols-doseurs etait l'absence d'education pour l'utilisation de l'appareil. Toutefois, seulement 26,5% des adultes et 22,1% des enfants eduques pour l'utilisation appliquaient une technique optimale. La mauvaise utilisation des aerosols-doseurs est un probleme de sante publique et l'education pour cette utilisation n'est pas susceptible de se resoudre. L'utilisation d'appareils de differente nature, tels que les dispositifs declenches par l'inspiration, devrait etre encouragee

Life style and health behavior of southern European and North African immigrants in France

Abstract: A partir d'une enquete nationale francaise, les comportements de prevention et les habitudes de consommation alimentaire, d'alcool et de tabac de trois groupes d'immigres (Italie, Espagne et Portugal, Maghreb) ont ete compares a ceux des Francais. Des odds-ratios ont ete calcules par une regression logistique apres ajustement sur l'âge, la categorie socio-professionnelle et la region de residence. Des comportements differents ont ete observes, notamment, des pratiques de prevention primaire et secondaire moins frequentes, une consommation plus faible en viandes et produits laitiers et plus riche en feculents et en legumes secs, une consommation plus faible en alcool et plus forte de tabac chez les immigres Maghrebins. Les differences observees sont discutees en fonction des autres donnees disponibles en France. Par rapport a d'autres etudes, elles confirment des habitudes alimentaires importees et une perception plus faible des messages preventifs.

Disagreement between hospital medical records and a structured patient interview on the type and date of the first symptom in cancers of the digestive tract.

Abstract: Les dossiers medicaux sont souvent moins fiables que les entretiens de patients en ce qui concerne les signes et les symptomes initiaux du cancer et le procede diagnostique extra-hospitalier. Pourtant, une grande partie de la recherche sur le « retard diagnostique » en cancerologie est basee sur les informations contenues dans les dossiers cliniques. Dans le cadre d'une etude sur le retard diagnostique des cancers du tube digestif, nous avons analyse la concordance sur le type et la date du symptome initial entre le dossier medical hospitalier (DMH) et un entretien structure du patient (ESP). Les dossiers d'un echantillon aleatoire (N = 60) de 183 patients interviewes ont ete etudies. On a considere qu'il y avait concordance sur la date du premier symptome si la difference entre le DMH et le ESP etait de ± 30 jours. Nous avons utilise l'indice Kappa (κ) et la proportion globale d'accord (avec son intervalle de confiance a 95 %). Il y avait accord sur le type du premier symptome dans seulement 61% des cas (κ = 0,50) : 67 % pour le cancer de l'oesophage (κ = 0,49), 60 % pour le cancer de l'estomac (κ = 0,52), et 61 % pour le cancer colorectal (κ = 0,50). Les dossiers ont sous-estime l'occurrence de l'anorexie comme premier symptome et surestime la perte de poids et la dysphagie. La date coincidait pour seulement 56 % des cas, la concordance etant plus faible pour le cancer colorectal. Les dossiers indiquaient que le premier symptome avait eu lieu a une date ulterieure dans 33 % des cas ; globalement, une etude basee sur les DMH aurait sous-estime l'intervalle entre le premier symptome et le diagnostic de 2,2 mois par patient. Pour seulement 40 % il y avait accord total (symptome et date). Des differences significatives peuvent exister entre les dossiers medicaux et ce que les patients rapportent pendant un entretien structure. La qualite de l'information contenue dans les dossiers hospitaliers sur la duree et la nature des

Potential role of environmental and domestic exposure to tremolite in pleural cancer in New Caledonia

Abstract: Une etude precedente sur les cancers respiratoires en Nouvelle Caledonie (1978-1987) a mis en evidence un risque eleve de cancer de la plevre dans ce territoire francais du Pacifique Sud et a permis la decouverte d'une pollution environnementale. Dans certains villages, les habitants fabriquent, a partir d'une roche trouvee dans l'environnement proche, un badigeon dont ils recouvrent les murs de leurs habitations. L'analyse d'echantillons de materiaux a montre qu'il s'agissait essentiellement d'amiante de type tremolite. Des niveaux eleves de fibres de tremolite ont ete trouves dans des echantillons d'air preleves dans ces villages et dans des echantillons biologiques preleves sur des patients atteints de cancer pulmonaire ou de mesotheliome ; les concentrations peuvent atteindre des niveaux de 78 000 fibres par litre d'air et 44 millions de fibres par gramme de tissu sec. En dehors de l'habitat, l'exposition environnementale aux fibres de tremolite pourrait concerner certaines activites professionnelles. Une etude cas-temoins, actuellement en cours, permettra d'estimer les risques de cancer respiratoire associes a l'exposition a la tremolite.

The role of cooked food mutagens as possible etiological agents in human cancer. A critical appraisal of recent epidemiological investigations.

Abstract: The paper reviews the epidemiological studies that investigate the relationships between dietary protein intake and the risk of some cancer and that have been published since 1980. A comparison of these reports is complicated because of many confounding factors that could obscure the conclusions (e.g. choice of controls) and because it is difficult to distinguish the consumption of fat from that of animal proteins. The 75 examined publications deal with the influence of food intake on different cancers: colo-rectal (42), stomach (8), breast (7), ovarian (4), endometrium (3), prostate (4), pancreas (2), urothelium (1), bladder (2), brain (1), lymphoma (1). From these studies in parallel with information from other sources, it is concluded that pyrolysis products generated by heat treatment of protein-rich food could be responsible factors for, at least, colo-rectal cancer.

QALYS or not QALYS: that is the question?

Abstract: The article discusses the proposal of some health economists to use the "cost per QALY (quality-adjusted-life year)" ratio as an universal indicator for economic assessment of medical interventions, in the so-called "cost-utility" analyses. Authors argue that QALYs are not a straightforward application of expected utility theory, which is the standard economic model of individual behaviours toward risk and uncertainty. Indeed, QALYs are compatible with economic utility theory only if individuals' preferences regarding health states satisfy certain very restrictive properties: utility independence between length of life and quality of life, constancy of the proportional trade-off between quality of life and length of life, risk neutrality towards health states, constancy through time of the utility associated with each health state. Aggregation of individual QALYs to obtain an indicator for patient groups at the societal level also raises complex equity problems. Last but not least, from the epistemological point of view, QALYs are based on the hypothesis that health interventions only affect the health of the individual and not any other aspects of his well-being. The authors conclude that the "cost per QALY" approach should be abandoned in order to avoid ambiguities that could impede the development of health economics in the medical field.

Education program for general practitioners on breast and cervical cancer screening: a randomized trial. PRE.SA.GF Collaborative Group.

Abstract: Cette etude avait pour objectif d'evaluer l'influence d'un programme de formation des medecins generalistes sur leur comportement en prescription de depistage des cancers du sein et du col de l'uterus et de montrer la faisabilite de leur participation aux programmes de depistage. Les 3 laboratoires de cytologie et 19 parmi les 20 cabinets de radiologie dans le departement de la Haute-Savoie ont accepte de participer a ce travail. Les cabinets de medecine generale ont ete alloues de facon aleatoire soit au groupe intervention (seminaire d'une journee sur le depistage des cancers du sein et du col de l'uterus) soit au groupe controle (n = 139 par groupe). Toutes les prescriptions de tests de depistage durant l'annee suivante ont ete notes a partir des registres des laboratoires de cytologie et des cabinets de radiologie. Aucune difference significative n'a ete retrouvee entre le groupe intervention et le groupe controle concernant le nombre de mammographies prescrites, avec des moyennes respectives de 19,3 et 15,2 par cabinet de medecine generale. Cependant, le groupe intervention a prescrit significativement plus de mammographies chez les femmes de plus de 50 ans (p = 0,038). Inversement, moins de frottis cervicaux ont ete prescrits par le groupe intervention (moyenne par cabinet 40,5 et 46,1 pour le groupe controle). Un nombre significativement plus eleve de cabinets du groupe intervention n'a prescrit aucun frottis cervical (p = 0,007). Cette etude montre qu'il est possible d'influencer la participation des medecins generalistes aux programmes de depistage, mais qu'il faut attirer l'attention sur messages car des effets negatifs peuvent en resulter.

Risk factors in prematurity and intrauterine growth retardation in Burkina Faso

Abstract: A case-control study to investigate determinants of preterm delivery and intrauterine growth retardation (IUGR) in Bobo-Dioulasso, Burkina Faso, was conducted between December 1991 and November 1992 A total of 581 cases were recruited, 281 preterm infants with birthweight < 2500 g and 300 term infants with birthweight < 2500 g 578 infants born at term with birthweights of 2500 g or more were recruited as controls Logistic regression analyses identified three factors linked independently to both preterm delivery and IUGR: maternal illness during the pregnancy, nulliparity and failure to attend three antenatal consultations In addition, primiparity and a maternal weight < 50 kg were associated with an increased risk of preterm delivery Other factors associated with increased risk of IUGR were maternal height less than or equal to 155 cm, mid-upper arm circumference < 24 cm, and female sex of the infant Improvements in the pre-pregnancy weight of women and in antenatal care focused on nulli- and primiparous women might in this population, reduce substantially the incidence of preterm delivery and IUGR

Interaction between dietary pattern and alcohol intake on the risk of liver cirrhosis. The Provincial Group for the Study of Chronic Liver Disease

Abstract: In order to assess the inter-relationship between nutritional intake and alcohol consumption on the risk of liver cirrhosis we performed a hospital-based retrospective case-control study. We enrolled 115 cases admitted to hospital for liver decompensation at their first diagnosis of liver cirrhosis and 167 hospital controls without evidence of liver disease admitted for acute diseases unrelated to alcohol intake. Daily alcohol intake and average nutrient intake were measured throughout the patient's life, using a reproducible questionnaire. No dose-effect relationship was found between nutrient intake and risk of cirrhosis using classical association statistical methods. We then corrected the intake of each nutrient for the total caloric intake and this energy-adjusted nutrient intake was used in a logistic regression model together with alcohol intake, viral B and C hepatitis markers, age and gender. Using this approach, carbohydrates intake were shown to have a protective effect on the risk of cirrhosis, whereas saturated lipid intake had a significant multiplicative effect on the risk associated with alcohol consumption. By comparison with the teetotalers category who had an average daily intake of saturated fatty acids lower than 40.3 g (reference category; OR = 1), drinkers of more than 100 g ethanol per day showed ORs ranging from 14.2 (95% confidence interval 2.0-101.0) for consumers of less than 40.3 g fatty acid per day, to 39.0 (95% confidence interval 5.0-305.1) for consumers of more than 40.4 g fatty acid per day. In conclusion we give additional evidence on the relationship between diet and risk of cirrhosis, whereby saturated lipid intake multiplies the risk associated with alcohol intake. However, caution should be used to interpret such results, since they seem to suggest that diet but not a particular nutrient can modify the effect of alcohol on the risk of cirrhosis. The present lack of agreement on the mechanisms and the nutrients involved in the pathogenesis of alcoholic liver injury should stimulate wider epidemiological studies using modern nutritional techniques.

Clinical and psychological classification of non-specific low-back pain. A new study in primary care practice.

Abstract: L'objectif de cette etude etait d'evaluer la diversite clinique des patients lombalgiques et de tesrer la validite d'une classification clinique et psychologique des lombalgies precedemment developpee. Nous avons etudie la population des patients consultant, pour une lombalgie, les medecins generalistes du Reseau d'Epidemiologie de la Societe Francaise de Rhumatologie en octobre et novembre 1991. Les 262 patients constituant l'echantillon etudie ont ete evalues par un examen clinique rachidien standardise et par l'autoquestionnaire GHQ-28, recemment valide en francais. 99 patients (38%) presentaient un trouble psychologique selon le GHQ-28. Certains symptomes et signes cliniques etaient plus souvent observes chez les patients presentant un trouble psychologique: douleur declenchee et aggravee par des facteurs psychologiques et les changements de climat, douleur diffuse a composante nocturne perma nente, dysesthesies lombaires, points douloureux rachidiens non systematisables. Les analyses descriptives multivariees (analyse des correspondances et classifications automatiques) ont retrouve la classification des lombalgies (et des lombalgiques) en 4 classes principales - selon la presentation clinique et la presence de troubles psychologiques - mise en evidence dans une etude precedente. Bien que cette etude soit transversale et essentiellement descriptive, la frequence des troubles psychologiques chez les patients lombalgiques (ainsi que la possible implication de ces troubles dans la genese et l'entretien de certains tableaux douloureux) suggere l'interet d'une prise en charge adaptee, tant diagnostique que therapeutique chez ces sujets

Hospital discharge planning and length of hospital stay in elderly patients admitted through the emergency department

Abstract: A prospective study was organized in two teaching hospitals in Paris, including 426 elderly patients aged 75 and more, who had been hospitalized through the medical emergency department. The goal of the study was to assess the influence of difficulties of orientation at discharge on the length of stay, independently of other risk factors. The mean length of stay was 18.3 +/- 15.4 days. Orientation at discharge toward a social or a nursing care institution was associated with a 12 days longer mean length of stay than a home discharge. A longer length of stay was also associated with: a strictly social problem at admission, the diagnoses of dementia, confusion, social problem, fall or general health impairment, a short or long-term fatal prognosis, a poor mental status, refusal of home discharge as expressed by the referent person. Multivariate analysis showed that discharge toward a social or a nursing care institution was the first explanatory factor, explaining 12% of variance. These results suggest that the hospital discharge management has a major influence on the elderly length of hospital stay. Therefore, an interdisciplinary care management, including social and geriatric evaluation as soon as the patient is admitted at the emergency department, should be evaluated, in order to avoid problems of orientation that may occur at discharge.

Prevalence of non-insulin dependent diabetes as perceived by general practitioners in France.

Abstract: A representative, random sample of French general practitioners, reported the number of diabetic patients they treated in their practices. The resulting NIDDM prevalence rate for France was 1.71% (SE +/- 0.03), compatible with the rates found in other studies. Prevalence rates for NIDDM were also calculated by region and a multivariate covariance model was used to correlate the prevalence with known risk factors. The three significant factors were: the quantity of wine consumed, the female/male sex ratio of people over 45 years of age, both positively correlated, and the consumption of animal fats, which was negatively correlated with NIDDM prevalence.

[Occupational exposure and malignant hemopathies: a case-control study in Lyon (France)].

Abstract: Une etude epidemiologique cas-temoins a ete realisee a Lyon, dans le but de rechercher l'existence d'expositions professionnelles associees a un risque d'hemopathies malignes. Nous avons ainsi recueilli l'histoire professionnelle de 118 cas (52 lymphomes non hodgkiniens, 48 leucemies aigues myeloides, 18 leucemies autres). Chaque cas etait apparie a un temoin de meme sexe, meme âge, meme origine ethnique, hospitalise dans le meme hopital, atteint de pathologie non cancereuse. Une equipe d'experts, associant des chimistes et des medecins du travail a analyse de facon systematique et en aveugle tous les dossiers a partir d'une liste de 320 expositions. L'analyse statistique a utilise la methode de Mantel-Haenszel. Apres ajustement les odds-ratio sont augmentes pour les malades atteints de lymphomes non hodgkiniens et pour ceux exposes aux essences minerales (OR=14,86; IC 95%: 2,76-80,0), aux poussieres de mine (3,91; 0,94-15,95), aux alcalis (2,90; 1,09-7,68) et aux encres (OR=2,47; 1,09-5,17); pour les encres, une relation dose-effet et duree d'exposition-effet a ete observee. Parmi les malades atteints de leucemie aigue myeloide, un exces apparait pour les composes de l'arsenic (3,02; 090-10,13) et de plomb (3,70; 1,09-13,44). Deux activites industrielles sont les plus frequemment retrouvees chez les cas: l'agroalimentaire (14 cas/5 temoins) et les travaux d'infrastructure (12 cas/0 temoin). Certaines professions sont plus frequentes chez les cas: le bobinage dans l'industrie textile (6 cas/0 temoin), les professions du verre (8 cas/1 temoin) et les manutentionnaires (10 cas/4 temoins)

Public health surveillance and the environment

Abstract: Since the 1970's, in many industrial countries, the awareness of environmental health risks has led to set up information systems in order to assess and monitor concentrations of pollutants in air, water or food. These monitoring systems aim to answer the question: "is the environmental contamination too high?". With this objective, concentrations of pollutants are compared to standards. Up to now, this approach has been favoured and many environmental data have been collected at a local, regional, national or international level. Nevertheless, other approaches are possible as the health surveillance which aims to directly monitor the effects of contaminants on health. More recently, a third approach has been developed which consists in linking environmental monitoring data and health monitoring data. These approaches are not exclusive. All of them aim to produce useful information to help decision-makers in the management of environmental issues. However, the question is "what are the conditions to be achieved for routinely collected data to fulfil the requirements of a real Public Health surveillance system?". The conditions, advantages and limits of these three approaches are discussed.

[Anorexia and bulimia: increasing disorders? A review of the literature on the epidemiology of eating disorders].

Abstract: De plus en plus de cliniciens sont confrontes a des jeunes souffrant d'anorexie ou de boulimie, mais la question d'une reelle augmentation de ces affections reste ouverte: cette revue fait le point sur la litterature epidemiologique publiee ces trente dernieres annees Jusqu'en 1980, les auteurs ont tendance a conclure a une augmentation de l'incidence de l'anorexie a partir d'etudes portant avant tout sur des echantillons medicalises, hospitalises Des 1990, des etudes retrospectives de qualite aboutissent a la conclusion de l'existence d'un syndrome anorexique «complet» dont l'incidence n'aurait pas varie au cours des decennies tout en mettant en evidence l'emergence d'un syndrome anorexique transitoire resolutif, qui serait, lui, plus recent et en augmentation L'incidence du syndrome anorexique, defini selon des criteres stricts, est evalue a 1/100000 habitants dans la population generale et a 20 a 30/100000 habitants chez les jeunes filles de 15 a 35 ou 45 ans En outre, des 1980, grâce a l'apparition d'outils de depistage tels que l'EA T (Eating Attitude Test), de nombreux troubles des conduites alimentaires atypiques, de meme que le syndrome boulimique sont recenses La prevalence de la boulimie varie de 2 a 5% environ dans des populations exposees de femmes de 15 a 45 ans La variabilite des resultats des etudes retenues dans cette revue peut etre en grande partie expliquee par l'heterogeneite des approches epidemiologiques d'une part, par la tendance au deni manfestee par les adolescents souffrant de dysfonctions authentiques d'autre part A l'avenir, il importera de rester prudent dans l'interpretation de donnees touchant a l'anorexie ou a la boulimie: les questionnaires auto-administres permettant avant tout de detecter des conduites deviantes mineures, seul le recours a des entretiens cliniques sera a meme d'assurer le diagnostic d'anorexie ou de boulimie averee

[Motivations of volunteers for participation in an interventional study in the field of nutritional prevention: results of a pilot study of the SU.VI.MAX project].

Abstract: Nous avons cherche a preciser les motivations et les caracteristiques principales de sujets se portant volontaires pour l'etude SU.VI.MAX qui visera a recruter et suivre pendant 8 annees, une cohorte de 15000 volontaires, au niveau national, dans le cadre d'un essai d'intervention nutritionnelle. Un appel pour recruter «1000 volontaires pour aider a tester et a valider les outils de l'etude SU.VI.MAX» a ete lance, dans le cadre d'une campagne de presse de modeste envergure. Au total 15789 sujets repondant aux criteres de selection se sont portes candidats et ont recu un questionnaire a remplir; 10984 questionnaires ont ete retournes correctement remplis (soit 70%) dont 1005 ont ete selectionnes pour etre analyses. L'analyse lexicale des motivations a permis de retenir une typologie organisee autour de 6 classes qui peuvent etre regroupees en deux poles. Le pole des altruistes eclaires correspond a des discours relatifs aux notions de «volontariat-benevolat» (7% des sujets), de souhait de participer a une «cause humanitaire» (9% des sujets) ou aux «progres de la recherche medicale» (27% des sujets). Le pole des volontaires interesses par le theme de l'etude recouvre les classes de discours relatifs aux notions d'interet personnel lie a l'existence d'«antecedents familiaux» (13% des sujets), a des preoccupations pour les «aliments enrichis et les mineraux et/ou les vitamines» (19% des sujets) ou pour les relations entre une »bonne sante et une bonne alimentation» (22% des sujets)

[Screening for lead poisoning in children by measuring lead levels in housing: a study of the Paris region].

Abstract: Screening programs for lead poisoning in France rely usually on the preliminary identification of risk factors among children seen in Maternal and Child Health (MCH) clinics. To assess the potential relevance of screening strategies based on the quantification of exposure to lead in housing, we estimated first the prevalence of exposure to lead in a representative sample of older buildings, then the prevalence of lead poisoning among children living in those buildings where high levels of lead had been found. Exposure to lead was measured in dust and paint samples collected in hallways and other collective areas of the buildings. Venous blood samples were collected from the children aged 10 months to 6 years residing in buildings where lead exceeded 1.5 g/kg in paint samples or 1000 micrograms/m2 in dust samples. Paint and dust samples were collected in 137 buildings: 74% presented high dust and/or paint lead contents. Blood samples were collected from 145 out of a total of 189 children residing in these buildings: blood lead levels (PbB) were higher than or equal to 10 micrograms/dl for 65% of these children; 29% were higher than or equal to 15 micrograms/dl, 16% higher than or equal to 20 micrograms/dl. Out of 42 children with PbB > or = 15 micrograms/dl, 21 had not been previously identified through the screening program conducted in local MCH clinics. Clinic-based and environment-based screening appeared to be complementary. It seems thus justified to develop screening strategies based on the assessment of exposure to lead in the environment.

A methodological review of specific techniques of time series analysis in epidemiology and public health

Abstract: L'analyse des variations temporelles d'indicateurs de sante peut contribuer a l'amelioration des connaissances en epidemiologie et en sante publique. Dans ce cadre il est necessaire d'utiliser des modeles et des methodes statistiques propres aux series chronologiques. Une approche classique, developpee par Box & Jenkins, est tout d'abord presentee ainsi que les outils necessaires a l'identification des modeles. Deux generalisations de cette approche sont aussi decrites. Pour etudier les liens entre deux series, on peut faire appel a la regression avec erreurs autocorrelees, tandis que pour evaluer l'effet d'une intervention, on utilise les modeles d'intervention. Cet article presente les concepts de base de telles analyses sous une forme condensee pour encourager l'utilisation de ces methodes

[Depressive symptoms in elderly persons: comparison between rural and urban populations].

Abstract: The aim of this article is to compare the prevalence of depressive symptoms and its correlates in an urban and a rural sample of 2797 persons of age 65 and over living in Southwest France. The crude prevalence rate of elevated depressive symptomatology, evaluated by the Center of Epidemiological Studies Depression (CESD) scale was 14.1% and 13.9% respectively in the rural and the urban area. After adjusting for potential confounders, the risk of elevated depressive symptoms is slightly higher in the urban area (p = 0.09). Factors found to be associated with the level of depression are the same in the rural and the urban area, and the magnitude of the effects is comparable. These results are compared with those of other studies and the observed differences are discussed.

Mortality due to bronchopulmonary cancers in workers of 2 foundries

Abstract: A mortality study was carried out in two factories producing stainless steel in order to assess lung cancer risk among workers employed in coke oven, blast and open hearth furnaces, foundry, electric furnace, hot and cold rolling mills and pickling areas. Occupational exposures of interest were chromium compounds, nickel compounds, polycyclic aromatic hydrocarbons (PAH), silica and asbestos. All male workers having at least one year of employment between 01.01.1960 and 31.12.1990 were followed up for mortality. The vital status was assessed from birth place registries. Complete job histories since date of first employment were abstracted from the company files. The smoking habits of 50% of the cohort members were known from medical records. The observed number of deaths (obs) were compared with the expected ones based on regional rates with adjustment for age, sex and calendar time (Standardized Mortality Ratio, SMR). The cohorts included 6324 (factory 1) and 5270 (factory 2) workers. The overall mortality did not differ markedly from that expected in both factories: SMR = 0.95 (obs = 1540, p = 0.05) in factory 1 and SMR = 1.06 (obs = 916, non-significant) in factory 2. SMRs for lung cancer did not differ from unity, respectively 0.99 (obs = 105) and 1.00 (obs = 54), in whole cohorts. Non-significant lung cancer excesses were observed among workers of some workshops where exposures of interest might have occurred: coke oven (SMR = 2.04), blast furnace (SMR = 1.36), open hearth furnace (SMR = 1.75), hot rolling mills (SMR = 1.29). These processes, however, are no longer involved in the study factories. Furthermore, no lung cancer excess was observed among workers employed in current workshops: electric furnaces and cold rolling mills.

[Maternal mortality and birth distribution: a possible explanation of excess mortality in France].

Abstract: Maternal mortality is higher in France than in most European countries with the same health standards. The analysis of the French rates shows that the changes, between 1975 and 1991, in the birth distribution according to the age of the mothers, explain 14% of all maternal deaths in 1991. The proportion of livebirths from mothers aged 30 years and over has increased from 21% in 1976 to 37% in 1991 in France and only 32% in England and Wales. For the period 1988-1990, crude maternal mortality was 9.4 per 100,000 livebirths in France and 7.4 in England and Wales. Direct standardization removes differences between birth distributions of each country and allows to calculate a standardized mortality rate of 8.6 for the French data. The variation between the crude and the standardized French rates is explained by the fact that 18 of the 210 deaths for the considered period were associated to the older mother's age distribution than in England and Wales.

[Epidemiologic research on the environment and health: some methodologic aspects].

Abstract: Les recherches epidemiologiques sur l'environnement et la sante s'interessent aux facteurs physiques, chimiques ou biologiques dont la presence - ou au contraire l'absence relative - dans les milieux entrant en contact avec l'homme (air, eau, sols, aliments...) peut nuire a sa sante. Certains risques «majeurs» d'origine environnementale sont bien etablis. Cependant, dans bon nombre de situations les expositions de l'environnement sont associees a des risques relatifs «faibles». Ceci n'exclut pas que ces expositions puissent avoir un impact important sur la morbidite, car leur prevalence peut etre elevee. Par contre, cela complique leur etude tant du point de vue des imprecisions statistiques que de celui de la prise en compte des differentes sources de biais. L'augmentation de la taille des etudes est essentielle, elle ne suffit cependant pas a etablir une distinction claire entre «risques relatifs dilues» et «faibles risques relatifs». Pour avancer dans cette distinction et mieux connaitre les risques d'origine environnementale, les solutions classiques de l'epidemiologie - bien definir et mesurer les expositions, les atteintes a la sante et les tiers facteurs - gardent toute leur valeur : 1) identifier et quantifier les sources d'exposition de l'environnement, etudier la distribution de l'exposition des individus et ses determinants, prendre en compte l'ensemble de l'histoire personnelle d'exposition et integrer de facon appropriee la variabilite temporelle a court terme des expositions, accorder une attention particuliere a la definition et a la mesure de la nature et de l'intensite des expositions ; 2) s'interesser a la nature des interactions entre les agents physiques, chimiques ou biologiques de l'environnement et l'organisme pour proposer des marqueurs biologiques specifiquement associes aux expositions aux differents stades du processus pathogene (exposition aux organes ou structures cibles, atteintes precoces, atteintes specifiques) ; 3) identifier des caracteristiques personnelles constitutionnelles ou acquises susceptibles d'interagir avec les expositions environnementales au cours du processus pathogene. Si rien ne garantit que ces differentes approches permettront a coup sur d'avancer dans la distinction entre «faibles risques relatifs» et «risques relatifs dilues», tout conduit a penser qu'en les ignorant, les epidemiologistes qui s'interessent a l'environnement auront du mal a sortir de la zone d'incertitude des «faibles risques».

Recent trends in incidence of cervical cancer in several regions of south-western Europe

Abstract: In recent decades, most Western countries have experienced a decline in the incidence of invasive cervical cancer. More recently, a reversal of this trend has been noted in young women, especially in anglo-saxon countries. These trends have been attributed to the beneficial results of cervical cancer screening on the one hand, to the widespread increase of high risk sexual behaviors on the other. Recent trends in Latin European countries have not previously been studied. Time trends of incidence data from 10 regions of South-Western Europe (Geneva, Vaud, Calvados, Doubs, Bas-Rhin, Isere, Ragusa, Varese, Zaragoza and Navarra) were analysed by means of log-linear models. The data were provided for various periods of time between 1970 and 1990. The mean incidence rate varies threefold between Navarra where rates are the lowest to Calvados where they are the highest. The overall decrease rate is of the order of -3% per year but rate changes differ by age group. The reduction seems to concern mostly middle aged women. A definite trend could not be determined among younger women due to low case numbers. Thus, the hypothesis of a rising incidence in young women cannot be confirmed at this time.