Showing papers in "Revue D Epidemiologie Et De Sante Publique in 2014"

Cancer incidence and mortality in France over the 1980-2012 period: solid tumors.

Abstract: Background Cancer incidence and mortality estimates for 19 cancers (among solid tumors) are presented for France between 1980 and 2012. Methods Incidence data were collected from 21 local registries and correspond to invasive cancers diagnosed between 1975 and 2009. Mortality data for the same period were provided by the Institut national de la sante et de la recherche medicale. The national incidence estimates were based on the use of mortality as a correlate of incidence. The observed incidence and mortality data were modeled using an age-period-cohort model. The numbers of incident cases and deaths for 2010–2012 are the result of short-term projections. Results In 2012, the study estimated that 355,000 new cases of cancer (excluding non-melanoma skin cancer) and 148,000 deaths from cancer occurred in France. The incidence trend was not linear over the study period. After a constant increase from 1980 onwards, the incidence of cancer in men declined between 2005 and 2012. This recent decrease is largely related to the reduction in the incidence of prostate cancer. In women, the rates stabilized, mainly due to a change in breast cancer incidence. Mortality from most cancer types declined over the study period. A combined analysis of incidence and mortality by cancer site distinguished cancers with declining incidence and mortality (e.g., stomach) and cancers with increasing incidence and mortality (e.g., lung cancer in women). Some other cancers had rising incidence but declining mortality (e.g., thyroid). Conclusion This study reveals recent changes in cancer incidence trends, particularly regarding breast and prostate cancers.

What do we mean by multimorbidity? An analysis of the literature on multimorbidity measures, associated factors, and impact on health services organization

Abstract: Background Multimorbidity is a consequence of both epidemiological and demographic transition. Unlike comorbidity, it currently has no consensus definition, making it difficult to assess its epidemiological and socioeconomic burden, to organize healthcare services rationally, and to determine the skills needed for patient self-reliance. The aim of this study is to define the spectrum of multimorbidity and to discuss current implications for the organization of care. Methods Two independent readers analyzed the literature indexed in PubMed, Embase, CINAHL, and Scopus. Results The bibliographic search conducted on July 16, 2013, retrieved 2287 articles (670 in PubMed, 666 in Embase, 582 in Scopus, and 369 in CINAHL). Of these, 108 articles were retained. Multimorbidity is designated by a variety of terms, none of them being MeSH terms. There is no single measure of multimorbidity, as this entity is usually studied for its functional or economic impact, rather than its causes. The prevalence varies considerably, depending on the measure used and the population studied. Factors associated with multimorbidity are age, gender, and socioeconomic characteristics of the populations studied. Studies evaluating the organization-of-care are inconclusive or insufficient. Conclusions Multimorbidity serves as an avatar for the fundamental, recurrent problems of modern medicine and the organization-of-care. It may be defined by its causes or its consequences and reflects our concept of both individual health and its collective management. Tools that would allow a more appropriate measurement of this entity are available; we should use them to match medical reality to the needs of patients.

Durée de l’allaitement maternel en France (Epifane 2012)

Abstract: Introduction L’allaitement maternel (AM) exclusif, un des objectifs du Programme national nutrition sante (PNNS), est recommande jusqu’a 6 mois si possible, et au moins jusqu’a 4 mois. A partir des donnees de l’etude Epifane, realisee en 2012, notre objectif est de decrire la pratique de l’AM et sa duree sur un echantillon national de nouveau-nes, suivis pendant un an. Methodes Suite au tirage au sort de 136 maternites en France metropolitaine, des questionnaires ont ete passes aupres des meres, a la maternite et a 1, 4, 8 et 12 mois, pour recueillir des informations en particulier sur leurs pratiques de l’AM. Les courbes de Kaplan-Meier permettent de decrire les taux d’AM au cours de la premiere annee de vie des enfants. Resultats Parmi les 3368 meres incluses en maternite (taux de participation de 81 %), 83 % ont ete suivies jusqu’au premier anniversaire de leur enfant. A la maternite, l’initiation de l’AM concernait 74 % des nourrissons. A un mois, 54 % des nourrissons etaient allaites (partiellement, de facon predominante ou exclusive), 34 % a 4 mois, et 24 % a 6 mois. A l’âge de 1 an, seuls 9 % des enfants etaient encore allaites. Parmi les enfants ayant ete allaites meme un seul jour, la duree mediane d’AM atteignait 15 semaines. Discussion Au regard des recommandations, l’AM reste insuffisant en France. Ces resultats permettront de mieux orienter les actions d’information et les interventions engagees notamment dans le cadre du PNNS pour sa promotion. Des analyses complementaires seront presentees sur les facteurs associes a la duree d’AM.

Séroprévalence de la toxoplasmose chez les femmes enceintes dans la wilaya d’Annaba, Algérie

Abstract: Background The aim of the study was to estimate the seroprevalence and risk factors of toxoplasmosis in pregnant women in the department of Annaba, Algeria. Methods We performed a cross-sectional study with analytical purposes. The study was collaboration between the laboratory of Parasitology-Mycology, Faculty of Medicine of Annaba and Parasite Biology Department at the Pasteur Institute of Algeria. A total of 1028 pregnant women who underwent prenatal diagnosis/visit were included over a period of 4 years from January 2006 to December 2009. Immunoglobulin G and M were assayed, using the microparticle enzyme method. The avidity test was used to determine the date of contamination according to age of pregnancy. Search for the parasite was made by inoculation of the placenta and cord blood in white mice. The study compared mother-to-child serological profiles using Western Blot (WB) IgG and IgM. Direct (not well-cooked meat) and indirect (presence of cat, gardening) indicators were recorded to search for parasite exposure. Results Seroprevalence was 47.8 % (95 % CI: 44.8 to 51.0) and the rate of active toxoplasmosis was 1.1 % (95 % CI 0.6 to 1.8). According to their immune status, this was the first serology for 41 % (CI95 %: 38.0–44.0) of women; 12 % (CI95 %: 10.5–14.6) of primiparous women had only one serology test during their entire pregnancy. Major risk factors were consumption of poorly-cooked meat and exposure to cats. Conclusion Toxoplasmosis during pregnancy is a serious issue and an effective prevention program is needed.

Caractéristiques métrologiques et comparaison de trois outils de repérage de la précarité sociale dans une permanence d’accès aux soins de santé hospitalière à Paris

Abstract: Resume Position du probleme Les outils pour mesurer la precarite sociale au niveau individuel font l’objet d’un interet grandissant. En France, on en recense au moins trois : le score d’Evaluation de la precarite et des inegalites de sante pour les centres d’examen de sante (Epices), le score de Handicap social et l’outil de Pascal et al., developpe a l’hopital de Nantes pour les consultations medicales. Cet article propose une analyse metrologique de ces scores puis une comparaison quantitative en les appliquant a une meme population precaire. Methodes La grille utilisee pour l’evaluation methodologique est celle proposee par Terwee et al., qui etudie la validite du contenu, la coherence interne, la validite contre critere, la validite du construit, la reproductibilite (concordance et fiabilite), la sensibilite au changement, les effets plancher et plafond, et l’interpretabilite. Pour comparer quantitativement ces scores, la population d’etude est celle d’une permanence d’acces aux soins de sante (PASS) de Paris. Le score de Handicap social a ete dispense aux 721 personnes venues consulter pendant un mois consecutif en 2010, puis a ete recode pour permettre le calcul des deux autres scores. Resultats Au niveau methodologique, les trois outils ont assez bien defini la population etudiee. La satisfaction par rapport aux autres criteres de qualite est pour le moins variable. Dans la population d’etude, les prevalences observees avec le score de Handicap social etaient de 3,2 % de patients non precaires (classe 1), 32,7 % de moyennement precaires (classe 2) et 64,7 % de fortement precaires (classe 3). Avec le score Epices, la prevalence variait selon le recodage entre 97,9 % et 100 %, tandis qu’elle se situait entre 83,4 % et 88,1 % avec le score de Pascal. Seul ce dernier mettait en evidence des associations significatives, dans les analyses en sous-groupes, avec le sexe, le niveau d’etude, l’emploi et la nationalite. Conclusion Ces trois outils de reperage de la precarite sociale ont des objectifs, des logiques d’elaboration, des utilisations et des limites differentes. Il convient de les connaitre pour savoir quel score utiliser selon la situation d’etude. Beaucoup reste a faire pour evaluer completement leurs performances metrologiques.

HIV seroprevalence and associated factors among men who have sex with men in Togo

Abstract: Background Limited data are available on HIV infection among vulnerable populations in sub-saharan African countries, especially among men who have sex with men (MSM). The aim of this study was to estimate HIV prevalence and the factors associated with HIV infection among MSM in Togo in 2011. Method A cross-sectional survey was carried out among MSM aged at least 18 years old, living in Togo for at least 3 months. They were recruited through the snowball method in six cities of Togo from November 2011 to January 2012. A survey form was used and an HIV screening test was proposed to the participants. The HIV prevalence was estimated with a 95% confidence interval. Univariate and multivariate analyses were performed to identify factors associated with HIV infection. Results A total of 758 MSM were enrolled in this study, including 498 (67.5%) from Lome, the capital of Togo. The median age was 24 years with an interquartile range of [21–27 years] and 271 MSM (35.7%) were students. The vast majority of MSM were Togolese (90.3%) and 14.6% were married or committed to a woman. HIV testing was accepted by 488 MSM (64.3%) but only 408 (53.8%) finally accepted a blood sample collection. The prevalence of HIV infection was 19.6% [95% confidence interval, 15.9–23.8]. In multivariate analysis, three factors were associated with HIV infection: living in Lome, with an HIV prevalence of 29.8% against 4.3% in the other cities of Togo [adjusted odds ratio (aOR) = 9.68; P Conclusion One MSM out of five was HIV-infected. Intervention programs targeting this vulnerable population are urgently needed, to reduce HIV incidence in Togo.

Approches d’analyse causale en épidémiologie

Abstract: Epidemiological research is mostly based on observational studies. Whether such studies can provide evidence of causation remains discussed. Several causal analysis methods have been developed in epidemiology. This paper aims at presenting an overview of these methods: graphical models, path analysis and its extensions, and models based on the counterfactual approach, with a special emphasis on marginal structural models. Graphical approaches have been developed to allow synthetic representations of supposed causal relationships in a given problem. They serve as qualitative support in the study of causal relationships. The sufficient-component cause model has been developed to deal with the issue of multicausality raised by the emergence of chronic multifactorial diseases. Directed acyclic graphs are mostly used as a visual tool to identify possible confounding sources in a study. Structural equations models, the main extension of path analysis, combine a system of equations and a path diagram, representing a set of possible causal relationships. They allow quantifying direct and indirect effects in a general model in which several relationships can be tested simultaneously. Dynamic path analysis further takes into account the role of time. The counterfactual approach defines causality by comparing the observed event and the counterfactual event (the event that would have been observed if, contrary to the fact, the subject had received a different exposure than the one he actually received). This theoretical approach has shown limits of traditional methods to address some causality questions. In particular, in longitudinal studies, when there is time-varying confounding, classical methods (regressions) may be biased. Marginal structural models have been developed to address this issue. In conclusion, "causal models", though they were developed partly independently, are based on equivalent logical foundations. A crucial step in the application of these models is the formulation of causal hypotheses, which will be a basis for all methodological choices. Beyond this step, statistical analysis tools recently developed offer new possibilities to delineate complex relationships, in particular in life course epidemiology.

Child health and access to health care in France: Evidence on the role of family income.

Abstract: Background Our paper investigates the relationship between family income and child health in France. We first examine whether there is a significant correlation between family income and child general health, and the evolution of this relationship across childhood years. We then study the role of specific health problems, access to health care, and supplemental health insurance coverage, in the income gradient in general health. We also quantify the role of income in child anthropometric measurements. Whenever possible, we compare our results for France with those obtained for other developed countries. Methods Using data on up to approximately 24,000 French children from the Health, Health Care and Insurance Surveys, we apply econometric techniques to quantify the correlation between household income, child general health, specific health problems, anthropometric characteristics, access to health care, and supplemental insurance coverage. Results There is a positive and significant correlation between family income and child general health in France. The income gradient in child general health is possibly smaller in France than in other developed countries. The gradient in general health is explained by the greater prevalence of specific health problems for low-income children. In addition, income is strongly correlated with anthropometric characteristics. Access to health care, and supplemental health insurance coverage are probably not major determinants of the gradient in general health. Conclusion The relationship between income and health in adulthood has antecedents in childhood. Improving access to health care services for children from low-income families may not be enough to decrease social health inequalities in childhood.

Guide to good practices to ensure privacy protection in secondary use of medical records

Abstract: Guide to good practices to ensure privacy protection in secondary use of medical records C. Riou *, J. Fresson , J.L. Serre , P. Avillach , L. Leneveut , C. Quantin f pour le groupe de travail CIMES, CUESP, CNIM, CCTIRS, CNIL a Departement d’information medicale, CHU de Rennes, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France b Departement d’information medicale, maternite regionale universitaire de Nancy, 54042 Nancy cedex, France c Comite consultatif sur le traitement de l’information en matiere de recherche dans le domaine de la sante, 75231 Paris cedex 05, France d Departement informatique et sante publique, hopital europeen Georges-Pompidou, AP–HP, 75015 Paris, France e Inserm UMR_S 872 eq22, faculte de medecine Rene-Descartes, universite Paris 5, 75006 Paris, France f Service de biostatistiques et informatique medicale, CHU de Dijon, 21079 Dijon cedex, France

Mortalité par accident de la vie courante chez les enfants en France métropolitaine, 2000–2010

Abstract: Introduction Les accidents de la vie courante (AcVC) entrainent de nombreux deces chez les enfants. Ils constituent la premiere cause de mortalite chez les 1–14 ans. L’objectif de ce travail est de suivre l’evolution de ces deces, dont une majorite pourrait etre evitee. Methodes Les donnees de mortalite de la base des certificats de deces (CepiDc) ont ete analysees. Les tendances ont ete modelisees par une regression de Poisson corrigee par une regression binomiale negative. Les taux de variation ont ete ajustes sur l’âge et l’annee. Resultats En 2010, 188 enfants âges de moins de 15 ans sont decedes d’un AcVC. Les garcons etaient plus souvent victimes que les filles (SR = 1,3) ; la cause la plus frequente etait la noyade (55 deces), suivie des incendies (39), des suffocations (34, dont 53 % avant l’âge de 1 an), des chutes (18), des intoxications (5), ainsi que d’autres causes (11 precisees, 26 non precisees). Ces resultats ont ete analyses selon l’âge (moins de 1 an, 1–4, 5–9, 10–14 ans). Les taux standardises de mortalite par AcVC ont diminue de 5,4 % par an (p Discussion Si le nombre et les grandes causes de deces par AcVC chez les enfants sont connus, le descriptif de l’accident ayant conduit au deces n’est pas disponible. La mise en place d’un « recueil detaille » des circonstances de survenue de ces deces accidentels est necessaire a la definition d’axes de prevention cibles.

Hospitalisations potentiellement évitables : une responsabilité des seuls soins de premier recours ?

Abstract: Resume Position du probleme La mesure des hospitalisations potentiellement evitables est utilisee comme un indicateur de performance des systemes de soins primaires dans de nombreux pays. Nous questionnons ici la validite et l’interet de cette mesure de maniere generale et dans le contexte francais en particulier. Methode Une revue ciblee de la litterature a ete effectuee en vue d’une analyse critique du concept. Les differents usages des hospitalisations potentiellement evitables ont deja fait l’objet de deux revues systematiques recentes. Resultats Les taux d’hospitalisations potentiellement evitables semblent bien plus correles aux caracteristiques socio-economiques des patients qu’a l’offre de soins primaires. Les rares travaux recenses en France confirment cette tendance internationale. Plusieurs faiblesses ont ete identifiees dans la construction de cet indicateur : le choix des pathologies considerees comme pouvant etre a l’origine d’hospitalisations potentiellement evitables, leur reperage parmi les codes diagnostiques de motifs d’hospitalisation, la qualite du codage hospitalier, le biais ecologique du recueil des variables explicatives. Des pistes d’amelioration sont proposees. En particulier, nous discutons la possibilite de l’usage de cet indicateur a l’echelle globale du systeme de sante. Conclusion L’utilisation des hospitalisations potentiellement evitables comme indicateur de la performance du systeme de sante serait prematuree en France, a la fois pour des raisons de pertinence et de methodologie.

Genre et accidents vasculaires cérébraux à Brazzaville

Abstract: Background The relationship between gender and cerebrovascular disease is controversial. The aim of our study was to evaluate the relationship between gender and vascular risk factors, biological variables and the severity of the neurological deficit in stroke. Methods This cross-sectional study, conducted from March to August 2011 in the department of neurology of the university hospital of Brazzaville which included all patients hospitalized for confirmed stroke. The study variables were: age, sex, vascular risk factors, NIHSS scores and Glasgow, blood pressure, and the biological exams and complications. Statistical analysis was performed on SPSS12. Results Eighty patients were included. The mean age was 62.7 ± 11.2 years, with 58.8% of men. Alcohol intake and smoking were more frequent in men than women respectively P = 0.005 and P = 0.032. Psychosocial stress was more often declared by women than men (P = 0.042). However there was no significant difference in biological variables, the severity of stroke and the occurrence of complications Conclusion Our study suggests that in the Congolese context, gender does not influence significantly most parameters during stroke, but men consume more alcohol and women are exposed to psychosocial stress.

The impact of some behavioral aspects on periodontal disease in a group of Romanian students - an epidemiological survey.

Abstract: Aims To investigate the prevalence of periodontitis in a young population representative for the North-western part of Romania (Transylvania) and to identify possible risk indicators of periodontitis. Methods The study is a cross-sectional epidemiological survey. The subjects were students randomly sampled from three universities in Cluj-Napoca and high school students from the neighboring city of Bistrita. The sample size of the population was calculated. Overall, 623 subjects aged 16–35 years were evaluated, of which 488 were university students and 135 high school students. A structured questionnaire was administrated to collect information on socio-behavioral status and oral hygiene habits. Periodontal data was collected using a full-mouth methodology by trained examiners. A recent introduced case definition was used to pick up periodontitis cases. Results The older the subject, the more frequent toothbrushing, dental visits, and use of interproximal hygiene devices, but also addiction to tobacco and alcohol consumption. The prevalence of periodontitis was 0.96% (n = 6). Half of these subjects (n = 3, 0.48%) were considered to have aggressive periodontitis (AP). Low frequency of toothbrush changing was identified to influence the development of periodontitis. Smoking and lower socioeconomic level did not seem to correlate with periodontal disease in the present study. Conclusions In order to better understand the prevalence of periodontal diseases and identify periodontitis cases as well as to evaluate the impact of specific behavioral factors on the disease development in individual and population levels, further extensive screenings are obviously required. Periodontal prevention programs focusing on oral health behavior are mandatory.

Facteurs prédictifs de la mortalité des patients admis aux urgences médicales des cliniques universitaires de Kinshasa

Abstract: Background: The management of medical emergencies is poorly organized in the Democratic Republic of Congo. In addition, the mortality of patients attending the medical emergency unit of Kinshasa University Hospital is relatively high, with death of patients occurring rather early. To date, factors associated with this mortality have been poorly elucidated. This study aimed to identify predictive factors of all-cause mortality in patients admitted to the medical emergency unit of the Kinshasa University Hospital. Methods: Analytical prospective study of all patients admitted from 15th January to 15th February 2011 in the emergency unit of the internal medicine department of Kinshasa University Hospital (427 patients). Among these patients, 13 were dead at arrival and were excluded from this study. The 414 patients included were followed until discharge from the hospital. Demographic, clinical, biological, diagnostic, therapeutical and evolutive data were collected. Four multivariate logistic regression models were used to identify risk factors associated with mortality. Results: Patients' median age was 40. years (interquartile range, 28-58 years), 54.5% were male, and 15.9% had a life-threatening pathological condition on admission. The overall mortality was 12.3%. According to multivariate analyses, transfer from other health care structures (OR: 3.5; 95% CI: 1.7-7.1), Glasgow Coma Scale score less than 14 on admission (OR: 11.1; 95% CI: 4.7-26.3), high creatinine level (OR: 4.2; 95% CI: 1.8-9.7), presence of cardiovascular (OR: 2.9; 95% CI: 1.5-5.7), renal (OR: 7.4; 95% CI: 3.2-17.3), hematologic and/or respiratory (OR: 6.1; 95% CI: 1.7-21.4) diseases, presence of sepsis and/or meningitis and encephalitis (OR: 5.2; 95% CI: 1.6-17.0) were significantly associated with a high risk of death. However, the Glasgow Coma Scale score less than 14 on admission and renal disease were the only predictive factors of mortality remaining after including demographic, clinical, diagnostic and therapeutical variables in the logistic regression model. Conclusion: Our study showed that transfer from another health care structure, low Glasgow Coma Scale score on admission, high creatinine level, cardiovascular, renal, hematologic and/or respiratory diseases, sepsis and/or meningitis and encephalitis were associated with an increased risk of death in Kinshasa University Hospital patients admitted in the medical emergency unit. © 2013 Elsevier Masson SAS.

État de santé et suivi bucco-dentaire selon le statut diabétique : exploitation de l’enquête ESPS 2008

Abstract: Resume Position du probleme Le diabete mal controle entraine des complications severes comme la maladie parodontale, affection orale entrainant la perte des dents. Les diabetiques beneficient en France d’une prise en charge a 100 % des soins lies a leur diabete, dans la limite des tarifs conventionnels de l’assurance maladie. On observe des inegalites sociales en sante orale et face au diabete. L’objectif de ce travail est d’etudier les caracteristiques sociales associees a l’etat de sante et au recours aux soins dentaires des personnes diabetiques a partir de l’enquete sante protection sociale (ESPS) 2008 et de les comparer a celles des personnes non diabetiques. Methodes L’enquete ESPS est une enquete representative en population generale. En 2008, les donnees de sante et de recours aux soins provenaient d’un auto-questionnaire propose a tous les membres des menages de 16 ans ou plus. Cette etude a ete restreinte aux personnes âgees de 35 ans et plus ayant renseigne leur auto-questionnaire sante (n = 8961). Le diabete etait defini par sa declaration ou par la prise d’un hypoglycemiant. L’etat de sante orale etait estime par la perception de sa sante dentaire et le nombre de dents absentes non remplacees. Le recours aux soins etait mesure par la declaration d’une visite dans les 2 ans chez le dentiste. Resultats Le taux de participation etait de 74,1 %. La prevalence du diabete etait de 7,2 % (648). Les personnes diabetiques avaient un moins bon etat dentaire (42,7 % vs 26,5 % – OR = 1,22, IC 95 % = [1,01–1,47]). Les facteurs sociaux etaient associes a l’etat de sante dentaire et celui des personnes precaires etait plus degrade. L’effet du niveau de precarite sur la sante dentaire etait equivalent pour les diabetiques et non-diabetiques. Le recours a un dentiste concernait 73,4 % des personnes : les personnes diabetiques consultaient moins que les personnes non diabetiques (61,5 % vs 74,4 %), mais cette difference n’etait pas significative (OR = 0,86, IC 95 % = [0,72–1,04]). Les personnes precaires recouraient moins, y compris les diabetiques. L’effet du niveau de precarite sur le recours etait equivalent dans les deux populations, diabetiques ou non diabetiques. Conclusion Cette etude pose la question du suivi dentaire des diabetiques, particulierement pour les populations vulnerables, malgre une prise en charge des soins facilitee.

Les déterminants de la survie des patients vivant avec le VIH sous thérapie antirétrovirale dans la ville de Goma, RD-Congo

Abstract: Resume Objectif Identifier les determinants de la survie chez les patients VIH sous antiretroviraux. Methode Une etude a ete menee sur une cohorte retrospective de 844 personnes vivant avec le VIH mises sous therapie antiretrovirale dans deux hopitaux de la ville de Goma au cours de la periode allant du 1 er janvier 2004 au 15 decembre 2012. La methode de Kaplan-Meier a ete utilisee pour decrire la probabilite de survie depuis l’inclusion dans la cohorte. Le test du Log-rank a permis de comparer les courbes de survie en fonction des determinants observes. Le modele de regression de Cox a permis d’identifier les determinants de la survie apres induction de traitement. Resultats La duree mediane de suivi des malades a ete estimee a 3,56 ans (intervalle interquartile : 2,22–5,39). Le taux de mortalite etait de 40 deces pour 1000 personnes-annees (IC95 % : 33,1–47,5) a la date de point. Le sexe masculin (RR : 2,56 ; IC95 % : 1,66–3,93), le stade clinique tres avance de la maladie (stade IV) (RR : 2,12 ; IC95 % : 1,15–3,90), le taux de CD4 bas (CD4 Conclusion Une initiation therapeutique au stade precoce de la maladie avec utilisation de molecules moins toxiques, ainsi qu’une intensification de la surveillance des patients, particulierement ceux de sexe masculin, sont recommandees.

Couverture par le vaccin de la grippe saisonnière des médecins généralistes et de leurs patients. Enquête de pratique auprès de médecins généralistes français après la campagne de vaccination 2011–2012

Abstract: Background In France, vaccination coverage against seasonal influenza for risk groups was inadequate: 55.2% of people aged 65 and older, and 33% of the16–64 year group with chronic targeted disorders were vaccinated in March 2012. Three quarters of general practitioners were vaccinated. Our objective was to estimate the influence of the vaccination status of general practitioners on vaccine coverage of their patients at risk. Methods A questionnaire was sent in March 2012 to a sample of 500 general practitioners. Their professional characteristics, vaccination status against seasonal influenza and the determinants of these vaccinations were collected and compared to the vaccine coverage of their patients obtained from the French healthcare fund. Results Self-reported vaccination coverage of the 225 general practitioners respondents was 81.3%. There was a positive correlation with age greater than 50 years, high activity level, rural practice and the absence of particular mode of exercise. The doctors wanted to be vaccinated to protect themselves and protect their patients or their family. Of the 42 doctors unvaccinated, 42.5% feared the side effects of the vaccine, 40% considered influenza to be a benign illness and 32.5% considered low risk of catching or spreading it. The vaccination rate for patients aged 65 and older was 62.3% among 147 doctors vaccinated versus 58.3% in unvaccinated 31 physicians (P Conclusion This study shows a positive association between the reported vaccination of general practitioners and effective influenza vaccination of their patients aged 65 years and older. This result is less clear for patients with chronic targeted disorders. All this findings argue in favor of promoting seasonal influenza vaccination among general practitioners.

A randomized trial of survey participation in a national random sample of general practitioners and gynecologists in France

Abstract: Background Healthcare professionals play a critical role in women's choice of contraceptive methods. However, national surveys on sexual and reproductive health (SRH) among physicians are rare and present low participation rates. We conducted a randomized trial to test for the effectiveness of three interventions to improve survey participation of private physicians delivering reproductive health services in France. Methods The study comprised a national random sample of 500 general practitioners and 500 gynecologists working in private offices. All received a postal invitation to participate either by completing a paper, phone or online questionnaire. Physicians were randomly assigned to six groups to test for the effect of three interventions: a non-monetary incentive in the form of a scientific book, telephone contact, and the possibility of completing the questionnaire by phone. Results Overall, 362 questionnaires were collected (26 online, 2 by phone) and 58 physicians were ineligible. The completion rate increased from 26.7% in physicians who received no intervention to 42.7% in those who received the book and a phone call. The phone call increased the completion rate by 11% percentage points ( P = 0.01), while the book had no significant effect. Results from multivariate logistic regressions also indicate that gynecologists (OR = 1.6) and female physicians (OR = 1.5) were more likely to participate than others. Conclusion The results suggest that phone calls substantially increase participation of physicians in sexual and reproductive health surveys but have little impact on sampling distortion. Differentials in response rates by physicians’ characteristics should be considered in future SRH studies among physicians.

Impact de la modification d’avis du Haut Conseil de la santé publique (HCSP) sur le taux de prescription des vaccins papillomavirus humains en région Midi-Pyrénées

Abstract: Resume Position du probleme Deux vaccins coexistent en France en prevention de l’infection par papillomavirus. Le 17 decembre 2010, le Haut Conseil de la sante publique a modifie son avis sur le Cervarix®, ne justifiant plus l’utilisation preferentielle du Gardasil®. Cet avis a ete publie le 25 janvier 2011. Notre travail souhaitait rechercher un impact de cette modification d’avis sur le taux de delivrance du Cervarix® par rapport au Gardasil®. Methode Nous avons realise une etude ecologique des remboursements de vaccins antipapillomavirus a partir des donnees de la Caisse nationale d’assurance maladie tous regimes confondus a l’echelon de la region Midi-Pyrenees 12 mois avant et apres le 25 janvier 2011. Les variables qualitatives ont ete comparees par des tests du Chi2, les variables quantitatives ont ete comparees par le test t de Student. Resultats Nous retrouvons une variation statistiquement significative (p Discussion Les medecins ont modifie leur prescription suite a la modification des recommandations montrant l’importance de ces avis dans la decision therapeutique. La vitesse de diffusion aupres des medecins de cette information a surement ete favorisee par l’implication des firmes pharmaceutiques dans les reseaux de formation medicale continue et par la visite medicale directe.

Effets de la contamination chronique à l'uranium sur la mortalité Bilan d'une étude-pilote chez les travailleurs de l'industrie nucléaire en France

Abstract: Background This article presents the mortality data compiled among a cohort of workers at risk of internal uranium exposure and discusses the extent to which this exposure might differentiate them from other nuclear workers. Methods The cohort consisted of 2897 Areva-NC-Pierrelatte plant workers, followed from 1st January 1968 through 31st December 2006 (79,892 person-years). Mortality was compared with that of the French population, by calculating Standardized Mortality Ratios (SMR) and 95 % confidence intervals (CI 95 % ). External radiation exposure was reconstructed using external dosimetry archives. Internal uranium exposure was assessed using a plant-specific job-exposure-matrix, considering six types of uranium compounds according to their nature (natural and reprocessed uranium [RPU] and solubility [fast-F, moderate-M, and slow-S]). Exposure-effect analyses were performed for causes of death known to be related to external radiation exposure (all cancers and circulatory system diseases) and cancer of uranium target-organs (lung and hematopoietic and lymphatic tissues, HLT). Results A significant deficit of mortality from all causes (SMR = 0.58; CI 95 % [0.53–0.63]), all cancers (SMR = 0.72; CI 95 % [0.63–0.82]) and smoking related cancers was observed. Non-significant 30 %-higher increase of mortality was observed for cancer of pleura (SMR = 2.32; CI 95 % [0.75–5.41]), rectum and HLT, notably non-Hodgkin's lymphoma (SMR = 1.38; CI 95 % [0.63–2.61]) and chronic lymphoid leukemia (SMR = 2.36; CI 95 % [0.64–6.03]). No exposure-effect relationship was found with external radiation cumulative dose. A significant exposure-effect relationship was observed for slowly soluble uranium, particularly RPU, which was associated with an increase in mortality risk reaching 8 to 16 % per unit of cumulative exposure score and 10 to 15 % per year of exposure duration. Conclusion The Areva-NC-Pierrelatte workers cohort presents a non-significant over-mortality from HLT cancers, notably of lymphoid origin, unrelated to external radiation exposure. The pilot study suggests an association between mortality from the HLT and lung cancers and exposure to slowly soluble RPU compounds. The results of this study should be investigated further in more powerful studies, with a dose-response analysis based on individual assessment of uranium absorbed dose to uranium-target organs.

Algerian medical teachers' research output and its determinants during the 2000-2009 decade.

Abstract: Background Publications are the primary output of scientific research. We conducted a national study to quantify Algerian medical teachers’ research output and identify its determinants during the 2000–2009 decade. Methods The American Medline database and the French Pascal database were used. A publication was eligible only if the lead author was an Algerian medical teacher (in medicine, pharmacy, or dentistry) working in Algeria. The same questionnaire was completed by cases (teachers who were first authors of an original article during the study period) and randomly selected controls. Logistic regression analysis was used to identify factors related to research output. Results A total of 79 original articles (42.2% of publications) were retrieved, a quarter of which were listed in Pascal alone. The publication rate was 2.6 original articles per 1000 teachers per year. The journals that published these original articles had a median impact factor of 0.83. The ability to publish an original article was 4.3 times higher if the teacher had undergone training in biostatistics and/or epidemiology (adjusted odds ratio [aOR] = 4.31, 95% confidence interval [CI]: 1.79–10.38). A promotion evaluation grid that did not encourage writing (aOR = 3.44, 95% CI: 1.42–8.33), a doctoral thesis, seniority, foreign collaboration, and English language proficiency were found to be associated with publication output. Conclusions Algerian medical teachers’ research output was particularly low. Replacing the current promotion grid with a grid that promotes writing, developing abilities to read and write articles and developing English language proficiency are likely to improve this situation.

Justifications nosologiques et fonctionnelles des arrêts maladie : une étude transversale dans le Rhône

Abstract: Background Although sick leave has significant medical and economic stakes, justifications for sick leave are poorly known in France. Our objective was to describe the medical justifications for sick leave, in nosological, functional and contextual terms. Methods Cross-sectional study, based on 1,143 sick leave certificates collected by the Health Insurance Fund of the Rhone district in February 2011. The medical justifications for sick leave were classified and coded in nosological terms according to the International Classification of Primary Care (ICPC-2) and in functional and contextual terms according to the “AT-CIF questionnaire”, derived from the International Classification of Functioning (ICF). Results Among the 1,073 sick leaves containing a medical justification (93.9%), 757 (70.5%) could be classified only according to the ICPC-2 and 316 (29.5%) according to both the ICPC-2 and the AT-CIF questionnaires. The health problems most frequently reported in sick leave justifications concerned, in order of decreasing frequency: respiratory (26.9%), psychological (13.7%), or digestive (12.1%) systems; general problems (10.7%); pregnancy (3.5%); the neurological system (2.9%). Furthermore, 346 functional deficiencies, five restrictions of activity and one environmental barrier were identified. Conclusion Sick leave certificates almost always provide justifications for sick leave in nosological terms, but in less than one third of certificates provide information in functional or contextual terms. Training practitioners to make functional and contextual assessments may allow them to more optimally decide on the indication and the duration of sick leave, and facilitate communication around the patient.

[Sources of information on suicide attempts in the Nord - Pas-de-Calais (France). Contributions and limitations].

Abstract: Resume Position du probleme Les indicateurs permanents de sante mentale sont rares en France et les conduites suicidaires ne sont souvent apprehendees qu’a partir de la mortalite par suicide. Methodes L’interet epidemiologique et les limites methodologiques de quatre bases de donnees medico-administratives, sur lesquelles etait possible une extraction portant sur les tentatives de suicide, ont ete etudies dans la region Nord - Pas-de-Calais (France) : les appels telephoniques au Samu pour tentative de suicide (2009 a 2011), les accueils en service d’urgences hospitalieres avec diagnostic de tentative de suicide (2012), les hospitalisations en medecine-chirurgie pour tentative de suicide (2009 a 2011) et les prises en charge psychiatriques avec diagnostic de tentative de suicide (2011). Resultats Un Samu sur deux, cinq services d’urgences sur 30, et la totalite des services de medecine-chirurgie et de psychiatrie ont transmis des donnees utilisables. Dans les deux dernieres sources, un identifiant anonyme unique a permis une statistique au niveau de l’individu ; alors que dans les deux premieres sources, elle ne porte que sur les gestes suicidaires. En 2011, le taux d’appels pour tentative de suicide pour 100 000 habitants s’elevait a 304 alors que le taux d’hospitalisation avec ce diagnostic etait de 275. Les taux les plus eleves se situaient entre 20 et 49 ans chez les hommes ; avant 20 ans et entre 40 et 49 ans chez les femmes. On note une grande homogeneite des sources quant a l’âge moyen (entre 37,8 et 38,5 ans) et le sexe (55,0 % a 57,6 % de femmes). En 2011, le nombre de patients avec un diagnostic de tentative de suicide suivis en psychiatrie etait 2,6 fois plus faible que le nombre de personnes hospitalisees en medecine-chirurgie pour tentative de suicide (3563 vs 9327). Conclusion La permanence du recueil et la grande quantite d’informations enregistrees plaident pour l’utilisation de ces bases medico-administratives dans le cadre de la definition et de l’evaluation des politiques de sante mentale. L’augmentation de la participation des Samu et des services des urgences, ainsi que du codage du caractere suicidaire des intoxications par quelques services manifestement sous-declarants, doit cependant etre obtenue pour l’amelioration de ce systeme d’information multi-sources.

Bilan de la surveillance épidémiologique renforcée du chikungunya et de la dengue. Saison 2013. France métropolitaine

Abstract: Introduction Le moustique Aedes albopictus, vecteur de la dengue et du chikungunya est present dans le sud de la France metropolitaine depuis 2004. Afin de prevenir et d’evaluer le risque de transmission autochtone, une surveillance entomologique et epidemiologique renforcee est mise en place chaque annee dans sa zone d’implantation et a sa periode d’activite, du 1er mai au 30 novembre. Elle permet de mettre en œuvre rapidement des mesures de lutte anti-vectorielle autour des cas viremiques, potentiellement a l’origine de transmission autochtone. Methode Ce dispositif repose sur le signalement des cas suspects importes (revenant d’une zone de circulation active de ces virus) et complete la declaration obligatoire des cas confirmes. Resultats Dans les 17 departements concernes en 2013, 430 signalements ont ete recenses. Parmi eux, 190 cas importes ont ete confirmes, 2 de chikungunya et 188 de dengue. Un cas autochtone de dengue a ete investigue en PACA. Un quart des cas a ete confirme en septembre, periode ou le vecteur est le plus actif. La majorite des cas residaient en region PACA (41 %) et Rhone-Alpes (26 %). La plupart (86 %) etaient en periode viremique dans la zone. Globalement l’enquete entomologique a detecte la presence d’Aedes albopictus adultes pour 10 % des cas. En region PACA, ce pourcentage etait de 32 %. Conclusion En 2013, la majorite des cas importes etaient viremiques dans la zone de presence du vecteur et au moment ou il etait le plus actif. Cela confirme le risque de transmission autochtone et rappelle que cette surveillance est essentielle pour prevenir et limiter ce risque.

Chaînage d’enregistrements de séjours PMSI aux premiers certificats de santé : un test dans le Val d’Oise

Abstract: Resume Position du probleme Tester la faisabilite d’un chainage indirect des bases du premier certificat de sante (PCS) et du Programme de medicalisation du systeme d’information (PMSI). Methodes Le chainage est realise pour les naissances vivantes ayant eu lieu entre le 1 er avril et le 30 juin 2011, dans six des neuf maternites du Val d’Oise. Le PMSI et les PCS denombrent respectivement 3550 et 3284 naissances. Le chainage a ete effectue a partir de variables communes : le nombre de fœtus, la date de naissance du bebe, le sexe, l’etablissement de naissance, l’âge de la mere, le code geographique de domicile, le terme et le poids de naissance. Deux methodes de chainage ont ete testees : une methode deterministe et semi-deterministe et une methode probabiliste. Cette derniere methode consistait a calculer un poids pour estimer la force du lien de deux observations chainees a partir de probabilites traduisant le pouvoir discriminant et le taux d’erreur de remplissage de chaque variable. Parmi les cas chaines ayant au moins une discordance pour une des variables de chainage, des echantillons ont ete tires au sort pour verifier les identites dans le PMSI et le PCS afin de calculer un taux d’erreur de chainage. Resultats La methode deterministe et semi-deterministe a chaine 92,5 % des PCS et 85,6 % des sejours PMSI. La methode probabiliste a permis d’atteindre un taux de chainage de 99,6 % des PCS et de 92,7 % des sejours PMSI. Les observations chainees uniquement par la methode probabiliste etaient des naissances plus souvent prematurees et d’enfants de faible poids. Le taux d’erreur du chainage probabiliste chez les singletons etait de 0,4 % avec un IC95 % [0,2–0,6 %]. Conclusion Les donnees disponibles dans le PMSI et les PCS ont permis de chainer un tres grand nombre d’observations. La methode probabiliste apporte un gain supplementaire dans le chainage de cas a risque, avec un taux d’erreur faible.

Dépistage organisé du cancer du sein en France : pour une optimisation de l’information

Abstract: Background Based on international and national recommendations, organized breast cancer screening in France raises questions of medical ethics built around the key concepts of individual autonomy and public health policy. Because of the evolving knowledge, professionals and institutions involved in the program must review the ethical values associated with this medical practice. Methods The ethical aspects of organized breast cancer screening were studied. In response to newly acquired knowledge highlighted by a review of texts governing this practice in France, proposals for changes resulting from reflections of a working group coordinated by the National Cancer Institute are presented. Results Ethical issues raised by screening must find expression in the general principles of the program's organization: acceptability of screening, efficiency, adverse effects, equity of access, free care…, but also at different stages of the procedure: information delivery, first and second invitations, refusal of further diagnostic investigation… Conclusion A better match between breast cancer screening and recently developed knowledge requires optimal information delivery to women targeted by the program as well as a stronger role for the referring healthcare professional.

Quelle définition et taxonomie utiliser pour un recueil d’événements indésirables associés aux soins primaires en France ?

Abstract: Background There is no widely accepted definition of incident for primary care doctors in France and no taxonomic classification system for epidemiological use. In preparation for a future epidemiological study on primary care incidents in France (the ESPRIT study), this work was designed to identify the definitions and taxonomic classifications used internationally along with the usual methods and results in terms of frequency in the literature. The goal was to determine a French definition and taxonomy. Design Systematic review of the literature and consensus methods. Method An exhaustive search of epidemiological surveys was performed. A structured grid was used. After having identified the definitions used in the literature, a definition was chosen using the focus groups method. Taxonomies identified in the literature were classified by relationship, architecture, code number, and number of studies published. Subsequently, a consensus among experts, who independently tested these taxonomies on six incidents, was reached for choosing the most appropriate for epidemiological data collection (little information on a large number of cases). Results Twenty-four papers reporting 17 studies were selected among 139 articles. Five definitions and eight taxonomies were found. The chosen definition of incident was based on the WHO definition “A patient safety incident is an event or circumstance that could have resulted, or did result, in harm to a patient, and whose wish it is not repeated again”. The test of incidents resulted in the choice of the TAPS version of the International Taxonomy of Medical Error in Primary Care for a reproducible and internationally recognized codification and the tempos method for its current use in French general practice. Discussion The definitions, taxonomies, data collection characteristics and frequency of incidents results in the international literature on incidents in primary care are key components for the preparation of an epidemiological survey on incidents in primary care.