Showing papers in "Revue D Epidemiologie Et De Sante Publique in 2012"

Prevalence of breastfeeding in industrialized countries.

Abstract: Background Given the benefits of breastfeeding (BF), healthcare institutions recommend that a child should be breastfed for the first 6 months of its life. This study provides a review of BF as a function of socioeconomic criteria in various industrialized countries. Methods A review was carried out between 1st January 1998 and 1st March 2009, using Medline and the Public Health Database. The papers were selected independently by two persons, using a methodological grid designed to evaluate the quality of the studies. From 1126 initially selected papers, 26 from 16 different countries were retained for further analysis. Results The prevalence of exclusive BF initiation was the highest in Norway, Denmark, and Japan with, respectively, 99, 98.7, and 98.3%. This prevalence was the lowest in the United Kingdom, the United States, and France with, respectively, 70, 69.5, and 62.6%. Women who breastfeed less were most commonly found to be young, single, from a low socioeconomic group, or with a low level of education. Women from immigrant population groups breastfed more than the native-born population during their pregnancy. Conclusion Knowledge of the sociodemographic distribution of women who breastfeed is essential for the definition of preventive policies, which are needed to reduce health-related social inequalities. An in-depth analysis of existing primary healthcare programs would allow new strategies to be defined.

Attentes et besoins des aidants de personnes souffrant de maladie d'Alzheimer

Abstract: Background Family members of people suffering from Alzheimer's disease play a major role in providing daily life care for their relatives. Compared to non-caregivers, they present increased risks of mortality as well as psychological and physical co-morbidity. Altered relationships between caregivers and medical staff and dissatisfaction with the quality of help provided tend to increase the risk of depression and anxiety disorders among caregivers. The present study aimed at exploring the needs and expectations of family caregivers of patients with Alzheimer's disease who request medical assistance for their relatives. Methods The present analysis is an ancillary study of a large multicentric controlled randomized study designed to assess the efficacy of three non-pharmacological treatments in Alzheimer's disease, in which 645 mild-to-moderate Alzheimer patients were enrolled. Needs and expectations of the caregivers were assessed with a French scale of patient expectations for medical consultation, the echelle d’attentes en matiere de consultations (EAC), completed by caregivers during the inclusion visit. This scale consists in a self-administered 28-item questionnaire concerning four main needs: learning skills to improve daily life management of their relatives; information regarding the disease; improving caregivers’ self-confidence; support to improve communication with their relatives. Results The ten items for which more than 40% of caregivers reported high or very high expectations referred to two main needs: information regarding the disease (treatment, prognosis…) and learning skills in order to improve daily life management of their relative. The predominance of such needs was observed whatever the relationship between the caregiver and the cared relative but seemed to be more pronounced in female spouses and children of patients with Alzheimer's disease. Conclusions Needs and expectations of Alzheimer's disease family caregivers involve two major aspects: first, information regarding the disease (treatment, prognosis…) and second, learning skills for improving daily life management of their relative. These results suggest that among the various available family caregivers support programs, programs providing information, education, and practical advice to improve daily life assistance seem to be adequate.

Prevalence of hypertension and associated risk factors in Benin

Abstract: Background Hypertension is one of the main risk factors of cardiovascular diseases. There has been a lack of data on this risk factor in the general population in Benin. The aim of this study was to determine the prevalence of hypertension and identify the associated risk factors in Benin. Methods A cross-sectional study was conducted from July to August 2008 in Benin's 12 departments. The questionnaire and anthropometric measurements of the World Health Organization STEPWISE survey were used. The sample included 6853 subjects 25–64 years of age, randomly selected by five-stage random sampling. Blood pressure was measured using standard procedures. Data was processed and analyzed using EPI DATA and STATA 9.2 software. Prevalence levels were compared using Pearson's chi 2 and means with the Student t -test. Univariate and multivariate regression analysis, taking the sampling method into account, was used to identify risk factors. Results The sample comprised 49.5% females, the 25- to 34-year-old age group was the largest, and the mean age was 42.7 ± 12.4 years. The prevalence of hypertension was 27.9% [95% CI: 26.3–29.5%], 77.5% of the subjects were unaware of their high blood pressure, and 81.6% had not taken their drugs two weeks before the survey. Prevalence of known hypertension was 6.9%, prevalence of treated hypertension 4.8%, and prevalence of controlled hypertension 1.9%. Age and obesity were significantly associated with hypertension. Department and profession were not associated with hypertension. Conclusion This study showed a high prevalence of hypertension in the general population in Benin. Better management of this risk factor will contribute to reducing morbidity and mortality due to cardiovascular diseases.

A multi-level study of the determinants of mental health service utilization.

Abstract: Background Until now, research has focused on neighbourhood variations in mental health services and their relationships with local attributes, such as healthcare supply and socio-economic deprivation, without controlling for individual characteristics (age, sex, income, or education, for instance). Hence, this study is a major attempt to clarify the role played by individual and local attributes in the utilization of mental health services. The aim of this study was to disentangle individual and neighbourhood effects on mental health service use. Methods In this cross-sectional study, individual-level data on 423 participants with a frequent mental health disorder was recruited from the general population and linked to neighbourhood-level data at the census tract level from the 2006 Canadian Census. Neighbourhood variables included socio-economic deprivation, mean income, residential stability and the proportion of recent immigrants. Individual characteristics included gender, age, marital status, self-rated mental health and the number of diagnoses. Multi-level logistic regression was used to assess the effects of individual and neighbourhood characteristics simultaneously on mental health service use. Results The intraclass correlation coefficient indicated that 12.26% of the variance of mental health service utilization is at the neighbourhood level. Final analysis showed that at the individual level, being female, married, or self-rating mental health less than excellent increased healthcare use. At the neighbourhood level, deprived socio-economic neighbourhood decreased health service use (OR = 0.71, P Conclusions Individual and neighbourhood characteristics determine mental health service utilization. Taking both into consideration allows better targeting of health service policy and planning and enables more accurate needs-based resource allocation. However, future research should continue to investigate the pathway through which neighbourhood affects health service utilization.

Students perceived stress in academic programs: consequences for its management.

Abstract: Background: Academic stress contributes to the deterioration of the students' quality of life. Psychological determinants involved in the stress process, trait anxiety and coping, have been neglected when assessing the role of academic programs in stress. This study aimed at determining whether academic programs are associated with a high level of perceived stress above and beyond potential personal and environmental risk factors, as well as coping strategies. Methods: A cross-sectional survey was conducted in 2009 among third-year medical (total n = 170, participants 88%), dental (n = 63, 94%), psychology (n = 331, 61%) and sports sciences (n = 312, 55%) students in Montpellier (France). The stress level experienced during the last 2 months, trait anxiety and coping strategies were appraised. Substance use, psychological care, and stress triggers were also collected using a self-administered questionnaire. Results: Compared with medicine and after adjusting for gender and age, only the sports program was associated with a lower perceived stress risk: adjusted odds ratio: 0.54 [95% Confidence interval: 0.30; 0.99]. Substantial reductions in perceived stress risks were observed in science students after additional adjustments for non-academic stress triggers, substance use, psychological care (adjusted odds ratio: 0.20 [95% Confidence interval: 0.09; 0.41]), and also for trait anxiety and coping strategies (adjusted odds ratio: 0.23 [95% Confidence interval: 0.10; 0.54]). Compared with medicine and after these additional adjustments, psychology had a significantly lower perceived stress risk (0.34 [0.18; 0.64]; 0.40 [0.19; 0.86], respectively), dentistry had a similar risk (0.82 [0.35; 1.91]; 0.53 [0.20; 1.43], respectively). Conclusion: Sports and psychology programs had a lower perceived stress risk compared with medicine. Personal and environmental risk factors and coping strategies modified the association between academic program and perceived stress. Developing efficient coping strategies in students and improving academic environment could contribute to prevent the potential deleterious consequences of stress.

Characteristics of women using organized or opportunistic breast cancer screening in France. Analysis of the 2006 French Health, Health Care and Insurance Survey

Abstract: Background This study aimed at (i) estimating the 2-year self-reported breast cancer screening coverage rate; and (ii) analyzing the relationships between sociodemographic characteristics and healthcare access of women and breast cancer screening (opportunistic or organized) practices. Methods From a 2006 French health survey, 2056 women aged 50 to 74 years were selected and divided into three groups according to their breast cancer screening practices during the previous 2 years: organized screening, opportunistic screening, or no screening. The three groups were compared according to self-reported sociodemographic status, healthcare access, screening behaviors, and perceived health, using polytomic regression. Results The 2-year self-reported coverage rate was 75.8%. It was high among women aged 50 to 69 years and lower among older women. Questions relating to medical access (i.e. having consulted a GP in the last 12 months, having consulted a gynecologist in the last 12 months, and having had a Pap smear in the last 3 years) were the variables most commonly associated with a recent mammogram. Women having a regular follow-up by a gynecologist or having had cervical cancer screening within the last three years used organized breast cancer screening more often and used opportunistic breast cancer screening even more often than other women. Conclusion The study confirmed the key role of gynecologists and general practitioners in encouraging women to have a mammogram. Awareness among healthcare professionals and women of the benefits of organized breast cancer screening compared to opportunistic screening should be sustained and strengthened.

Six-month outcome of elderly people hospitalized via the emergency department: the SAFES cohort.

Abstract: Background The objective of the study was to identify factors predictive of 6-month institutionalization or mortality in frail elderly patients after acute hospitalization. Methods A prospective cohort of elderly subjects 75 years and older was set up in nine French teaching hospitals. Data obtained from a comprehensive geriatric assessment were used in a Cox model to predict 6-month institutionalization or mortality. Institutionalization was defined as incident admission either to a nursing home or other long-term care facility during the follow-up period. Results Crude institutionalization and death rates after 6 months of follow-up were 18% and 24%, respectively. Independent predictors of institutionalization were: living alone (HR = 1.83; 95% CI = 1.27–2.62) or a higher number of children (HR = 0.86; 95% CI = 0.78–0.96), balance problems (HR = 1.72; 95% CI = 1.19–2.47), malnutrition or risk thereof (HR = 1.93; 95% CI = 1.24–3.01), and dementia syndrome (HR = 1.88; 95% CI = 1.32–2.67). Factors found to be independently related to 6-month mortality were exclusively medical factors: malnutrition or risk thereof (HR = 1.92; 95% CI = 1.17–3.16), delirium (HR = 1.80; 95% CI = 1.24–2.62), and a high level of comorbidity (HR = 1.62; 95% CI = 1.09–2.40). Institutionalization (HR = 1.92; 95% CI = 1.37–2.71) and unplanned readmission (HR = 4.47; 95% CI = 3.16–2.71) within the follow-up period were also found as independent predictors. Conclusion The main factors predictive of 6-month outcome identified in this study are modifiable by global and multidisciplinary interventions. Their early identification and management would make it possible to modify frail elderly subjects’ prognosis favorably.

Évolution de la mortalité par accident de la vie courante en France métropolitaine, 2000–2008

Abstract: Résumé / Abstract Introduction – L’objectif de ce travail était de mesurer et de caractériser les décès par accident de la vie courante (AcVC) en France de 2000 à 2008. Méthodes – Les résultats ont été établis à partir d’une liste « accidents » issue des causes externes de traumatismes de la Classification inter nationale des maladies, 10ème révision, et exprimés en effectifs, en taux bruts et en taux standardisés sur l’âge. Résultats – En 2008, il y a eu 19 703 décès par AcVC en France métropolitaine (taux standardisé de 25,1/100 000). Une surmortalité masculine a été retrouvée, de 32,7/100 000 chez les hommes vs. 18,9/100 000 chez les femmes, soit un rapport hommes/femmes de 1,7. Les deux tiers des décès par AcVC sont survenus chez les 75 ans et plus. Les chutes (11,3/100 000), les suffocations (3,8/100 000), les noyades (1,5/100 000), les intoxications (2,0/100 000) et les accidents par le feu (0,7/100 000) ont été les principales causes de décès par AcVC. Entre 2000 et 2008, le taux de mortalité par AcVC a diminué de 2,8% par an. Cette diminution, variable selon les types d’AcVC, a été observée surtout chez les moins de 15 ans (-5,7% par an). Sur les trois dernières années, les effectifs de décès par AcVC ont augmenté : +2,8% de 2006 (18 549) à 2007 (19 061 décès), et +3,4% de 2007 à 2008. Cette augmentation s’explique uniquement par l’évolution démographique (plus de personnes âgées) : en effet les taux de mortalité standardisés sont restés stables, autour de 25/100 000. Conclusion – Les AcVC restent une cause importante de décès en France. De nombreux décès pourraient être évités par des mesures de prévention et de réglementation adaptées.. Fatal home and leisure injuries in Metropolitan France, 2000-2008 Introduction – The aim of this study was to measure and characterize deaths due to home and leisure injuries (HLI) in France from 2000 to 2008. Methods – The results were drawn from a list of causes of deaths using the external causes of injury codes of the International Classification of Diseases, 10th Revision (ICD-10) expressed in numbers, crude death rates, and ageadjusted death rates. Results – In 2008, 19,703 deaths due to HLIs occurred in Metropolitan France (age adjusted death rate 25.1/100,000). The age-adjusted death rate was 1.7 times higher for males than for females (32.7/100,000 versus 18.9/100,000). Two third of home and leisure injuries related deaths occurred in persons aged 75 or over. Falls (11.3/100,000), suffocations (3.8/100,000), drowning (1.5/100,000), poisonings (2.0/100,000), and fire accidents (0.7/100,000) were the leading causes of home and leisure injuries-related deaths. The home and leisure injuries death rate decreased by 2.8% per year over the period 2000 to 2008. This decrease, depending on the type of home and leisure injuries, was highest among people under 15 years of age (-5.7% per year). The number of home and leisure injuries-related deaths increased over the last three years: +2.8% between 2006 (18,549) and 2007 (19,061 deaths), and +3.4% between 2007 and 2008. This increase is explains only by demographic changes (more elderly persons), as the age-adjusted death rates remained stable at around 25/100,000. Conclusion – Home and leisure injuries remain a significant cause of death in France. A great number of those deaths could be avoided with adapted prevention and regulation measures. Mots clés /

Determinants of patient satisfaction regarding pain care.

Abstract: Background The management of pain in hospitalized patients remains a major public hospital priority. It has been the object of three French national programs since 1999. The purpose of this study was to reassess pain prevalence, pain intensity and patient perception of its management ten years after the first national program and to determine the factors related to the patient satisfaction with efforts to decrease pain intensity. Methods A 1-day cross-sectional survey in a university hospital. Results Pain prevalence was 59%. Pain intensity varied according to the medical department with lower intensity in surgery and obstetrics than medicine departments. Eighty-one percent of patients were satisfied with their pain management. Patient satisfaction was higher when doctors and nurses were heavily involved in the process of pain relief (OR = 6.6; 95% CI 3.8, 11.4), and when their pain had decreased (OR = 2.9; 1.7, 5.0). The magnitude of decrease in pain were higher when the medical team was involved (OR = 1.9; 95% IC 1.1, 3.3) and pain intensity was measured (OR = 1.6; 1.0, 2.4). Perceptions of doctor and nurse involvement in the patient's care was higher when pain intensity was measured (OR = 6.0; 3.4, 10.5), an immediate treatment offered (OR = 3.5; 2.0, 6.2), encouragement to ask for an analgesic was provided (OR = 2.0; 1.1, 3.5) and for patients with acute pain (OR = 2.2; 1.0, 4.7). Conclusions This study identifies the factors related to patient satisfaction with pain management and the magnitude of the decrease in pain which should allow further efforts to improve the management of pain and reduce its intensity in hospital inpatients.

Utilisation des données du programme de médicalisation des systèmes d’information (PMSI) dans les études épidémiologiques : application à la Cohorte Enfant Scanner

Abstract: Background The “Cohorte Enfant Scanner”, a study designed to investigate the risk of radiation-induced cancer after childhood exposure to CT (computed tomography) examinations, used clinical information contained in the “programme de medicalisation des systemes d’information” (PMSI) database, the French hospital activities national program based upon diagnosis related groups (DRG). However, the quality and adequacy of the data for the specific needs of the study should be verified. The aim of our work was to estimate the percentage of the cohort's children identified in the PMSI database and to develop an algorithm to individualize the children with a cancer or a disease at risk of cancer from medical diagnoses provided by the DRGs database. Methods Of the 1519 children from the “Cohorte Enfant Scanner”, who had had a CT scan in the radiology department of a university hospital in 2002, a cross linkage was performed with the DRGs database. All hospitalizations over the period 2002–2009 were taken into account. An algorithm was constructed for the items “cancer” and “disease at risk for cancer” on a sample of 150 children. The algorithm was then tested on the entire population. Results Overall, 74% of our population was identified in the DRGs database. The algorithm individualized cancer diagnoses with 91% sensitivity (95% confidence interval [95%CI]: 86%; 97%) and 98% specificity (95%CI: 97%; 99%) and 86% positive predictive value (95%CI: 80%; 93%). For the diagnosis of disease at risk for cancer, the sensitivity, specificity and positive predictive value were respectively 91% (95%CI: 84%; 98%), 94% (95%CI: 92%; 95%) and 52% (95%CI: 43%; 61%). Conclusion The DRG database identified with excellent sensitivity and specificity children with diagnoses of cancer or disease at risk for cancer. Hence, potential confounding factors related to the disease of the child can be taken into account for analyses performed with the cohort.

Estimating the burden of mucormycosis infections in France (2005-2007) through a capture-recapture method on laboratory and administrative data.

Abstract: Background Mucormycoses are rare but severe fungal infections whose incidence is increasing, particularly in immunosuppressed and diabetic patients. Following a retrospective study on the characteristics and outcomes of cases who were identified through two sources of information, we carried out a capture-recapture method to estimate the actual burden of the disease in France, 2005–2007. Methods An administrative dataset from the national hospital discharge system and a laboratory dataset from the National Reference Centre for Mycoses and Antifungals were combined to identify patients from 2005 to 2007. We applied capture-recapture equations to estimate the number of cases missed by both sources and to assess the advantages of each dataset, especially in terms of sensitivity. Results There were 94 mucormycosis cases included in the study: 30 and 31 in each respective source and 33 common to both. Capture-recapture showed that 28 cases were missed (expected total: 122 cases, CI95: 102–142). Each dataset had a sensitivity value below 53%. The merged set yielded a 77% sensitivity (66%–92%). Conclusion This study highlights the importance of combining available sources when analysing rare infectious diseases. The proportion of 23% missed cases might seem acceptable given the scarcity of the disease, for which further knowledge is needed. However this proportion could decrease in the future, through the sensitization of clinicians, pathologists and mycologists together with the improving quality of discharge datasets.

Le programme de médicalisation du système d’information (PMSI) – processus de production des données, validité et sources d’erreurs dans le domaine de la morbidité maternelle sévère

Abstract: Background The organization of obstetric care in France brings all women in contact with the hospital system. Thus, hospital discharge data from the Program of Medicalization of the Information System (PMSI) constitute a potentially valuable source of information, particularly regarding rare events such as severe maternal morbidity. These data cover a large population but their quality has not been assessed in that field. Our objectives were to study the processes of production and the validity of PMSI data related to severe maternal morbidity. Methods The study was conducted in four French tertiary teaching hospitals (Caen, Cochin [AP–HP, Paris], Grenoble and Lille). First, the organization of each step of the medical information process -production, formatting, verification and processing- was detailed in each center with a standardized form. Second, the validation study was based on the comparison of data related to severe maternal morbid events in the PMSI from these centers for 2006 and 2007, with the content of medical records which constituted the gold standard. Indicators of sensitivities and positive predictive values of PMSI were calculated. Results The processes of PMSI data production showed major differences between the four centers. In hospital discharge data, diagnoses (eclampsia and pulmonary embolism) had a high proportion of false-positives (68%). Inversely, procedures (four procedures for management of severe haemorrhage) had less than 1% of false-positives, but a low sensitivity with 37% false-negatives which could be corrected in 95%. Regarding intensive care provision, all indicators of hospital data quality were very high. In addition, the validity of hospital data in centers 1 and 2 was higher for all events. Conclusion The heterogeneity of the process of PMSI data production is associated with a variable quality of these data. Intensive care provision can be used in the PMSI, as well as procedures after correction. For diagnoses, the quality of the PMSI data is better in centers having both computerized medical records and steps for verification of medical information.

Do perinatal guidelines have an impact on obstetric practices

Abstract: Background The publication of several sets of French guidelines was unfortunately not accompanied by planned assessment of their impact on practices. The goal of this study was to assess the impact of eight French perinatal guidelines on actual obstetric practices. Methods Historical cohort setting in France: the Audipog database of 299,412 pregnancies from 1994 to 2006, from which we extracted a sub-sample by randomLy selecting from each participating maternity ward all births occurring during a single month of each year (n = 107,450 pregnancies). The main outcome measure was the incidence of pertinent perinatal indicators related to these guidelines. These included site of delivery for low-birth-weight infants (1998), caesarean delivery (2000), preterm delivery (2002), breastfeeding (2002), smoking and pregnancy (2004), immediate postpartum hemorrhages (2004), early discharge after delivery (2004) and episiotomies (2005). Standardised rates, before and after the year of each guideline, were compared using a Chi2 test. Results The percentage of children weighing less than 1500 g at birth born in Level III hospitals increased through 1999 but dropped subsequently, without ever returning to the 1994 level (P 0.05). Exclusive breastfeeding at discharge from the maternity ward has increased slowly (P Conclusions Globally, the impact on actual practices of clinical practice guidelines, except the guideline concerning the active management of the third stage of labour, was low. Most of the changes observed in practices began before the pertinent guideline was published.

Impact du statut socioéconomique sur la gravité du diagnostic initial de cancer du sein

Abstract: Background This study aimed to evaluate the potential impact of social inequalities on stage at diagnosis and long-term outcome of breast cancer patients attending the Institut Curie in Paris (France). Methods The study population included 14,610 breast cancer patients diagnosed and treated in the Institut Curie between 1981 and 2001. The socioeconomic status was determined from district of residence, median income for town of residence corrected by the consumption unit and body mass index. Logistic regression models adjusted on socioeconomic factors were used to evaluate clinical and pathologic features at diagnosis. Overall survival and distant metastasis were analysed with log-rank tests and Cox proportional hazards regression models. Results Patients living in lower income districts were more likely to be diagnosed with breast tumors size greater than 20 mm (P = 0.01). Residents of high-income urban areas (> 15,770 €) exhibited a significant overall survival and distant metastasis advantage (respectively HR = 0.93 [0.86–0.99]; P = 0.02 and HR = 0.91 [0.85–0.98]; P = 0.01). Breast cancer screening with mammography was independent of district of residence (P = 0.61) or income (P = 0.14). After adjusting for age at diagnosis and period, the risk of having breast cancer with unfavorable prognostic factors such as tumor size greater than 20 mm decreased with 1000 € increase in district income (OR = 0.986 [0.98–0.99]; P Conclusion Despite the limitations of the study (aggregate data used to assess socioeconomic status, non representative cohort of French women), we observed that poorer breast cancer prognosis with advanced disease diagnosis and increased risk of breast cancer mortality was related to low socioeconomic status.

Effets chroniques des pesticides sur le système nerveux central : état des connaissances épidémiologiques

Abstract: Background Given the neurotoxic properties of pesticides, suggested by experimental results and clinical observations, many epidemiological studies have investigated neurological effects following acute or chronic exposure to pesticides. This review provides an overview of current knowledge about pesticide effects on the central nervous system: neurodegenerative diseases (Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis), cognitive disorders, and psychiatric disorders (mood disorders, anxiety, depression and suicide). Results Parkinson's disease, the most widely studied in relation with pesticide exposure, particularly with insecticides and herbicides, was observed to be a risk factor of the disease. Evidence is scarce for Alzheimer's disease and amyotrophic lateral sclerosis, but quite consistent. Cognitive and psychiatric disorders were often observed in relation with organophosphate insecticide exposure. Cognitive disorders were found associated with acute and chronic exposures, and psychiatric disorders mostly with poisonings. These epidemiologic studies were limited by a lack of detailed and reliable exposure assessment. The role of genetic susceptibilities has been recently observed, but must be further investigated.

Vaccination against seasonal flu in Switzerland: The indecision of pregnant women encouraged by healthcare professionals.

Abstract: Background The recommendation for seasonal flu immunization from the second trimester of pregnancy, adopted in summer 2010 in Switzerland, is situated within a social context characterized by reluctance toward some vaccinations, a relatively low vaccination coverage against flu in the general population, and still heated debates fuelled by vaccination campaigns organized around the A(H1N1)pdm09 flu pandemic in winter 2009 to 2010. This study examines Swiss pregnant women's representations of the risks associated with seasonal flu and its vaccination. Methods Semi-structured interviews were conducted with 29 women, while in the maternity unit in March 2011, 3 to 5 days after giving birth. The interviews addressed the risks associated with flu, modes of protection, motivations for, and obstacles to vaccination. Results The interviewees did not show major preoccupations regarding seasonal flu and they tended to distance themselves from the at-risk status. They did not directly challenge seasonal flu immunization; however, they were reluctant to do it. Their attitudes were supported by their personal experience and the experience of their social networks. Healthcare professionals, particularly medical doctors, gave very little direction, or even did not raise the issue with them. Conclusions Between the rather moderate positions of those who are against vaccination and those who support it, an intermediate grey zone, characterized by hesitation, was observed. Furthermore, the indecision of pregnant women is reinforced by doubts among the persons they are close to and also among the professionals they met during their pregnancy.

Les facteurs de risque de la mortalité périnatale dans la ville de Lubumbashi en République démocratique du Congo

Abstract: Background The aim of this study is to establish factors explaining perinatal death rates in the city of Lubumbashi. Methods We have carried out a case controlled study in the maternity ward of Jason Sendwe hospital. Perinatal death cases have been compared to those of surviving newborn children among parturient women in the course of 2008. Sociodemographic characteristics, maternal morbidity, children's typical features, have been studied as independent variables. Their effect on perinatal mortality has been assessed using an adjusted odds ratio value at a 5% confidence interval and a logistic regression model. Results In total, we considered 2279 births (mother and child pairs) for our study. Among these were 415 perinatal mortality cases and 1864 control cases. After adjustment for several parameters, household chores (AOR = 1.8; 95% IC = 1.2–2.9), multiple pregnancies (AOR = 1.9; 95% IC = 1.2–2.9), malaria (AOR = 1.4; 95% IC = 1.1–1.8), primiparity (AOR = 1.7; 95% IC = 1.3–2.4), stillbirth (AOR = 5.2; 95% IC = 2.5–11.0) and prematurity (AOR = 2.9; 95% IC = 1.5–5.5) in previous pregnancies, onset of antepartum ferver (AOR = 3.0; 95% IC = 1.2–7.3) and antepartum hemorrhage (AOR = 6.8; 95% IC = 3.1–15.0), lack of fetal motions near delivering time, dystocias (AOR = 2.0; 95% IC = 1.3–3.0), low birthweight (AOR = 15.7; 95% IC = 11.2–22.0), very low birthweight (AOR = 49.0; 95% IC = 28.6–85.1) and foetal macrosomia (AOR = 3.5; 95% IC = 1.8–7.0) were the main factors explaining perinatal mortality. Conclusion Perinatal mortality in Lubumbashi remains associated with several avoidable factors. Basic and emergency obstetrical-neonatal care (B-EMONC) should be improved. Significant efforts should be made in this direction. Perinatal audits should be established for a good heath care quality follow-up. Obstetrical care should be offered as a continuum in order to facilitate communication between the different caregivers.

Determinants of tuberculosis diagnosis delay in limited resources countries

Abstract: BACKGROUND: Delayed diagnoses of pulmonary tuberculosis contribute to the spread of the epidemic. METHODS: This study aims to identify risk factors associated with patient delay (from symptoms onset to the first visit), health system delay (from the first visit to the tuberculosis treatment initiation) and total delay (sum of the patient and the health system delay) in low income and high tuberculosis burden countries. A systematic literature review has been performed using the keywords: "tuberculosis"; "delay", care seeking"; "health care seeking behavior"; "diagnosis" and "treatment". Only quantitative studies showing delays for pulmonary tuberculosis adult cases were included in this review. RESULTS: Low income, gender, rural life, unemployment, ageing and misunderstanding the microbial cause of tuberculosis are associated with delayed diagnoses. Systemic factors including low health care coverage, patient expenditures and entry into the health system by consulting a traditional healer or a non-skilled professional delay the beginning of tuberculosis treatment. CONCLUSION: Delays can be used as indicators to evaluate tuberculosis control programs. Active case finding in the households of contagious patients can help to diminish diagnostic delays in low-income countries with high endemicity.

Femme enceinte vivant en zone de fluorose endémique au Sénégal et faible poids du nouveau-né à la naissance : étude cas–témoins

Abstract: Background In developing countries, maternal and neonatal mortality is high. Among the causes of death during the neonatal period, low birth weight is crucial. A dose of fluoride beyond 2 mg/L causes enamel damage, possibly affecting the fetus. The aim of this study was to search for an association between dental fluorosis in the mother and low birthweight of the newborn. Methodology This was a case–control study performed in an endemic area in Senegal (Diourbel). It included 108 mothers who gave birth to newborns weighing less than 2500 g (cases) and 216 mothers with newborns weighing greater or equal to 2500 g (controls). Data on socio-demographic, lifestyle, history and pregnancy variables were collected. Those related to water consumption during pregnancy and dental fluorosis (Dean's index) were measured. The data were analyzed by R software. Logistic regression was used to identify associations and the statistical significance level was set to 0.05. Results The proportions of mothers consuming well water were 62% among cases versus 43.5% among controls. The score 4 of Dean's Index was reported for 25.9% of cases versus 6.9% of controls. The water consumed and the modal score of Dean's Index were significantly associated with the occurrence of low birthweight adjusted for gender, consanguinity, anemia and hypertension. Conclusion Low birthweight was associated with pregnant women living in endemic areas. Defluoridation programs and access for pregnant women and children to high quality water are necessary in areas of endemic fluorosis.

Déterminants de l’intention de consommer au moins cinq portions de légumes et de fruits chaque jour chez des jeunes adultes aux études postsecondaires

Abstract: Background Vegetable and fruit consumption helps reduce the occurrence of overweight, obesity, and other chronic diseases. However, only 50% of young adults eat at least five servings of these foods daily. Based on the construct of the Theory of planned behaviour of Ajzen (1991) to which other constructs were added (descriptive norm, perceived regularity of the behaviour and past behaviour), this study aims at identifying the determinants in the intention of young adults in postsecondary education institutions to eat at least five servings of vegetables and fruit daily during the next three months. Methods A sample of 385 students in two CEGEP (junior college institutions) in the Quebec City area participated in this correlation study on a volunteer basis. While attending class, they completed a self-administered questionnaire. Results Hierarchical regression analyses showed that perceived behavioural controls and the perceived weight of facilitating factors and barriers to the behaviour, explained 75% of the intention variance. Another 4% was explained when the perceived regularity of the behaviour, the descriptive norm, and past-behaviour, were added to the analysis. Logistic regression analyses show that individuals presenting weak/strong intention can be differentiated among themselves as to the perception of benefits derived from a daily consumption of vegetables and fruit (such as maintaining good health, eating foods that taste good), and as to facilitating factors/barriers that assist or inhibit such consumption (possessing more information on the nutritional value and taste of vegetables and fruit, or disposing of sufficient time to prepare them). Conclusion To our knowledge, this is the first study done in Quebec using a recognized theoretical model to identify the determinants of the intention to eat at least five servings of vegetables and fruit daily in a sample of young adults in postsecondary education institutions. The results may be helpful in designing the contents of interventions aimed at maintaining and increasing daily consumption of vegetables and fruit by young adults.

Dépistage de la dépression chez une population âgée vivant à domicile. Intérêt de la « Mini-Geriatric Depression Scale »

Abstract: Background Depression is the most usual mental disorder in the elderly, but underdiagnosed and undertreated. Its prevalence is variable. Symptoms of depression present in the elderly can be masked and difficult to recognize. The purpose of this study was to examine prevalence and risk factors for depression in elderly living in their home. Methods A cross-sectional study of randomly selected homes in randomly selected geographical islets was carried out Monastir City (Tunisia). Questionnaire-based interviews were conducted among the elderly aged more than 65 years living in their home. Depression symptoms were assessed using a Mini-Geriatric Depression Scale. The relationship between the risk of depression and sociodemographic and health-related variables was studied using logistic regression. Results Out of 598 (female 66 %, mean (SD) age 72.3 (7.4) years) elderly persons interviewed, 136 (22.7 %) were screened to have a Mini-Geriatric Depression Scale more than or equal to 1. Multiple logistic regression analysis revealed that the following were significant (P Conclusion This study suggests that the risk of depression is a common psychiatric disorder in elderly living in their home, and underlines the usefulness of the Mini-Geriatric Depression Scale to detect the risk of depression in the elderly. This clinical approach should be encouraged in all medical practices to improve the prognosis of depression in the elderly.

Prescriptions médicamenteuses potentiellement inadaptées chez les personnes âgées : une étude en Provence-Alpes-Côte d’Azur à partir des données de remboursements de l’Assurance maladie

Abstract: Background This study conducted in the region of Provence-Alpes-Cote d’Azur (PACA) sought to assess the feasibility of constructing and using indicators of potentially inappropriate prescriptions for the elderly from health insurance reimbursement data. We present and discuss different indicators of inappropriate prescriptions for people aged 70 years or older (at-risk prescriptions, dangerous or at-risk coprescriptions, absence of necessary coprescriptions) and reports their prevalence in PACA. Methods The indicators were constructed from the French list of inappropriate prescriptions, national agency guidelines, and the advice of experts in the field. The indicators selected were applied to the databases of the PACA Salaried Workers’ Health Insurance Fund for 2008 for all recipients aged 70 years or older and compared according to age, sex, chronic disease status, and, after standardization for age and sex, according to district of residence. Results In January 2009, 500,904 recipients aged 70 years or older were identified in the data base of the Salaried Workers’ Health Insurance Fund, 60.8% of whom were women and 52.1% of whom had approved coverage for a chronic disease. The potentially inappropriate prescriptions most frequently observed here, in decreasing order, were: prescription of an NSAID without the coprescription of gastric protection (28.1%); long-term benzodiazepine treatment (21.5%); prescription of long half-life benzodiazepine (14.9%), and long-term treatment with NSAIDs (11.6%). Overall, the prevalence of each increased significantly with age and was higher among women and people with chronic diseases. Significant variations were also observed between the different districts of PACA. Conclusion Our results confirm that a substantial proportion of elderly people receive potentially inappropriate prescriptions. They also suggest that health insurance reimbursement data could be used in some prescription domains for monitoring trends in the potentially inappropriate prescriptions in the populations of various territories, provided that specific limitations are considered.

[Health risk assessment of traffic-related air pollution near busy roads].

Abstract: Background Although ambient urban air pollution has well-established health effects, epidemiology faces many difficulties in estimating the risks due to exposure to traffic pollutants near busy roads. This review aims to summarize how exposure to traffic-related air pollution near busy roads is assessed in epidemiological studies and main findings regarding health effects. Method After presenting the specificity of emissions due to traffic road, this review identifies the key methods and main results found in epidemiologic studies seeking to measure the influence of exposure to nearby traffic on health published over the past decade. Results The characterization and measurement of population exposure to traffic pollution faces many difficulties. Thus, epidemiological studies have used two broad categories of surrogates to assess exposure: direct measures of traffic itself such as distance of the residence to the nearest road and traffic volume and modeled concentrations of pollutant surrogates. Studies that implemented these methods showed that people living near heavy traffic road or exposed to near-road air pollution tend to report more health outcomes. Discussion Traffic-related air pollution near busy roads is the subject of increasing attention, and tends to be better characterized. However, its health impacts remain difficult to grasp, especially because of the vast diversity of approaches used in epidemiological studies. Greater consistency in the protocols would be desirable to provide better understanding of the health issue of traffic in urban areas and thus to better implement policies to protect those most at risk.

Imprisonment, alcohol dependence and risk of delusional disorder: A cross-sectional study

Abstract: Background Compared to the general population, an excess of psychotic illnesses, major depression and dependence disorders among prisoners has been reported. However, the impact of prison on detainees’ psychopathology has rarely been studied. Objective To determine the mental disorders liable to develop or regress on entry into prison and over time. Method Two samples of French prisoners detained in local prisons were interviewed using the same methodology. The first sample consisted of 267 new arrivals. The second was a random sample of 450 prisoners. Diagnoses were assessed using a thorough methodology: each prisoner was interviewed for approximately 2 hours by two clinicians. One of the clinicians used a structured clinical interview, which generates DSM IV diagnoses (MINI plus v 5.0); the second completed the procedure with an open clinical interview. The final DSM IV diagnoses were obtained as a consensus between the two approaches. Multilevel logistic regressions were used to take into account potential confounders. Results Prevalence rates of mental disorders were substantially higher in prison even for the sample of newcomers (major depression disorder: 24.7%, substance dependence: 17.6% and schizophrenia: 4.1%). Alcohol dependence disorder was significantly more frequent in the sample of newcomers (OR 1.84 [1.01–3.51]). No significant difference was evidenced between samples for substance dependence disorder. Psychotic disorders were significantly less frequent at entry into prison, particularly delusional disorder (OR 0.29 [0.08–0.98]). Conclusion This study shows the contrasted potential effects of prison on psychopathology: alcohol dependence disorders were significantly more frequent for the newcomers, while the frequency of delusional disorders was lower. This evidence is arguing in favour of the validity of the old concept: prison psychosis. Moreover, prisoners should receive relevant help from clinicians to cope with these disorders.

Épidémiologie des gastroentérites à rotavirus chez les enfants âgés de moins de cinq ans en Tunisie – Résultats de la surveillance sentinelle hospitalière 2009 à 2011

Abstract: Background Rotavirus is the major cause of severe acute gastroenteritis among young children. The objectives of this study were to assess the epidemiology, clinical and virological features of community-acquired rotavirus acute gastroenteritis, in children under 5 years of age, hospitalized in Tunisia. Methods A multicenter prospective observational study was conducted from April 2009 to March 2011, in 11 sentinel pediatric departments. Clinical data and stool samples were collected for all children under 5 years, admitted for acute gastroenteritis. Rotavirus was detected by Elisa immunoassay test and genotyped for G and P by semi-nested multiplex RT-PCR. Result A total of 621 children were enrolled in this study. Rotavirus was detected in 30.3% of cases (95% CI [26.7–33.9]). The estimated incidence rate of rotavirus acute gastroenteritis was 11 cases/100,000 child-years (95% CI [9.43–12.57]). This infection affected predominantly children aged under 24 months, and occurred mainly in winter (55.3%). Vomiting, fever and dehydration were observed in 79.6%, 69.5% and 57% respectively. Genotype analysis identified four G types (G1, G2, G3 and G4) and 4 P types (P[4], P[6], P[8] and P[9]). The most common G/P combination was G3P[8] (24.4%), followed by G4P[8] (13.3%) and G1P[8] (6.5%). Conclusion These results highlight the frequency and potential severity of rotavirus acute gastroenteritis in pediatric hospital settings. The present study could provide a sufficient database to make a decision related to the introduction of rotavirus vaccine in Tunisian national immunization program.

Consumption of psychoactive substances among 535 women entering a Lyon prison (France) between June 2004 and December 2008

Abstract: Background In France, recent data on the consumption of psychoactive substances (PASs) among women entering prison are virtually nonexistent. The objective of this study was to describe the characteristics of female entrants at Montluc prison in Lyon (France) and to estimate their PAS consumption. Methods Between June 1, 2004 and December 31, 2008, of 841 women entering the Lyon correctional facility, 535 had an entrance interview, conducted by a nurse, during which a questionnaire was systematically proposed; 306 detainees did not have this interview and could not be included in the study because of an immediate transfer to another prison or emergency hospitalization. Socioeconomic and incarceration characteristics, PAS consumption, as well as consumption level (occasional, regular, abusive or dependence) and psychological distress of the 535 interviewed detainees were systematically noted. This psychological distress was defined by the presence in the entrant talks or behavior suggesting clinical symptoms such as anxiety, depression, delusion, delirium, and mood or behavior disorders. Descriptive analysis was undertaken with the Chi 2 test and Fisher's exact test for differences between the proportions observed. Results The average age of the 534 responding detainees was 31.5 years; 59.2% had had no ongoing professional activity in the 12 months prior to incarceration, and 21.6% had already been imprisoned before; 37.5% of the entrants reported dependence on tobacco and 13.7% on alcohol; 6.6% reported regular, abusive use or dependence on cannabis, 20.4% on psychotropic medications, and 7.7% on other drugs (heroin, cocaine, synthetic drugs) in the 6 months preceding their incarceration; 39.2% of the consumers at risk reported using at least two substances; 7.1% of detainees were on opioid substitution treatment. A multiple correspondence factor analysis was used to note specific characteristics of three groups of PAS consumers. Conclusions More frequent among young women detainees, overall PAS consumption was quite close to that of male entrants, was greater than in the general female population, and was very often accompanied by psychological distress. Effective screening upon entry into detention should be carried out so that female consumers can be offered psychological and/or psychiatric care adapted to a prison environment.

Éléments d’exhaustivité et résultats pour la première année d’enregistrement du Registre général des cancers de Lille et de sa région

Abstract: Background In 2005, following the first cancer plan of the national health authorities, a general cancer registry was established in northern France, in a territory designated as a “zone in proximity to the city of Lille” (ZPL). The aim of the present work was to evaluate the completeness of the registry's first year of incident cancer registration (2005) and to compare the observed cancer incidence in the “ZPL” with the estimated incidence in France. Methods Completeness was assessed using the average number of sources per case, the percentage of histological verification and a method of independent case ascertainment (mortality/incidence ratio). A direct standardization on the world population was used to calculate the ZPL/France ratios of standardized incidence rates. Analyses were conducted for 21 cancer sites. Results In 2005, 3635 cases of invasive cancer were recorded by the registry. The average number of sources per case was 2.7 and histological proof was available for 91.4% of cases. Mortality/incidence ratios showed satisfactory completeness of the data for men for most cancer sites. For women however, for cancer sites for which the number of cases was low, data will have to be confirmed during the subsequent years of observation. A lack of completeness was found for cutaneous melanoma. In men, an overincidence was identified for cancers of lip-mouth-pharynx, larynx, esophagus, lung, liver, bladder, kidney and colon-rectum. In women, an overincidence has been identified for cancers of lip-mouth-pharynx, liver, bladder, colon-rectum, corpus uteri and ovaries. Conclusion The first year of incidence validated at the “Registre general des cancers de Lille et de sa region” shows a completeness of records with regards to studied criteria. The comparison with national data shows an overincidence of cancers related to tobacco and alcohol consumption in the geographical area covered by the registry. The incidence of lip-mouth-pharynx cancer in men is the highest of all French registries.