[Evaluation of measles, mumps and rubella vaccine coverage in 3 year old children in twelve French counties. Time-trends and related factors]. / Evaluation de la couverture vaccinale rougeole-oreillons-rubéole chez les enfants de trois ans dans douze départements français. Evolution temporelle et facteur associés.

BACKGROUND: The aims of our study were to estimate the measle-mumps-rubella (MMR) vaccine coverage in 3 years old children in 12 French countees, to document the evolution between 1997 and 1999 in two groups of 6 countees (pilot group and control group) before and after the implementation of promotion programmes in the pilot group, and to identify factors related to measle-mumps-rubella vaccination. METHODS: Two telephone surveys were carried out in 1997 and 1999 among children randomly selected in the birth rolls of 12 French countees. Parents of 3 years old children were interviewed on measle-mumps-rubella vaccination, knowledge and opinions on vaccinations, utilisation of health care and socio-demographic characteristics. RESULTS: The participation rate was 97% in both surveys. Among the 7382 respondent parents, 98% had immediate access to the child's medical file and could document the vaccine status. The vaccine coverage did not increase significantly between 1997 and 1999 (86.7% versus 87.2%), both in control (89.3% vs. 90.2%) and pilot groups (84.3% vs. 84.3%). A logistic regression model showed that several factors were independently and significantly related to measle-mumps-rubella vaccination (utilisation of homeopathic medicines, mother's age, number of children, physician speciality (general practitioner or pediatrician) and opinion on vaccinations). CONCLUSION: Our study shows that there is a stagnation of vaccine coverage in several French countees, which makes unlikely the national objective of viruses eradication. This epidemiological situation makes very likely outbreaks of measles, mumps and rubella in these countees. National and local pilot programmes did not succeed to promote vaccination in countees with a low measle-mumps-rubella vaccine coverage. Our study identified sub-groups of parents who should be targeted by promotion programmes.

[Characteristics of head trauma in children: epidemiology and a 5-year follow-up]. / Particularités des traumatismes crâniens chez les enfants: épidémiologie et suivi à 5 ans.

BACKGROUND: Accidents are the major cause of morbidity and mortality in children. The aim of this population-based study was to describe characteristics of head injuries leading to hospitalization in children less than 15 years old, in a defined geographic population (Aquitaine: 2.7 millions inhabitants) and the longterm outcome (5-year follow up) of a sample of these patients. PATIENTS AND METHODS: Hospitalized patients, residents of the region, were included in a prospective study during 13 weeks spread over the whole year in 1986 in all emergency services of the region. The follow-up study concerned patients hospitalized in 3 hospitals (a trauma I level center, a pediatric hospital and a general hospital), with a sampling frame taking into account the overall injury severity. Impairments, disabilities and handicaps were assessed with a structured questionnaire five years later and results in children compared with those of adults. RESULT: Annual incidence of hospitalized head injuries in children was 294/100,000 inhabitants. The lethality was 0.3% in hospitalized patients. Ninety-two percent of head injuries were minor. In the youngest patients, the most frequent circumstances were a fall at home. The traffic accidents rate increased with age from 14% to 53% in the 10-14 years old children. Five years later, 104 children were reviewed (83 minor and 21 moderate or severe head injuries). Children complained less often of somatic symptoms than adults. Two children had disabilities in daily life activities, including one whose minor head injury eventually worsened and one after a very severe brain injury. According to the Glasgow Outcome Scale three patients had a poor recovery (2 severe and 1 moderate disability). CONCLUSIONS: Origin and mechanisms of head injuries in childhood were similar than in previous studies. Incidence was higher because of a higher proportion of minor head injuries. Disabilities and poor recovery happened in children with brain lesions or in one children with a minor head injury complicated by a severe anoxia. Anxiety and depression should be better studied in these children.

[Decreasing incidence of HIV infection in intravenous drug users in Aquitaine: 1985-1993]. / Décroissance de l'incidence de l'infection a VIH chez les toxicomanes intraveineux en Aquitaine: 1985-1993.

OBJECTIVE: To describe trends in the incidence of HIV infection diagnosis since 1985 in different at-risk groups in Aquitaine, south-west France. METHODS: We analyzed the data from two regional surveillance systems on HIV infection: the hospital-based system of the Groupe d'Epidémiologie Clinique du SIDA en Aquitaine (GECSA) and the laboratory-based system of the Observatoire Régional de la Santé d'Aquitaine (ORSA). The number of intravenous drug users (IVDUs) in Aquitaine was estimated from two sources: a study performed by the GECSA in IVDUs treatment centers (1990-1991 data) and the annual surveys undertaken by the Ministry of Health (SESI) in all the health facilities and social services of the region from 1988 to 1993. RESULTS: As of December 31st, 1993, 3478 HIV-infected patients had been reported to the GECSA, including 3031 Aquitaine residents. Among those, 1096 were IVDUs without any other at-risk behavior (36.2%), the largest transmission category. The annual incidence of HIV diagnoses has steadily and considerably changed over time for IVDUs: 175 new cases diagnosed in 1985, 218 in 1987, then falling to 38 in 1993. During the same period, there was no marked decrease for homosexuals and the incidence of diagnoses of heterosexually-acquired HIV infections increased. Between 1989 and 1993, the number of HIV tests performed by the laboratories involved in the ORSA surveillance system increased steadily from 80,310 to 176,250 per year, when the number of first positive tests in Aquitaine residents decreased from 744 to 319 per year (-57%). This decrease was greater for IVDUs (-80%) than for the other groups. The survey performed by the GECSA estimated that 990 IVDUs were followed annually by treatment centres in Aquitaine in 1990-1991. This figure was stable and in agreement with the results of the SESI surveys performed throughout the period. CONCLUSION: The incidence of new diagnoses of HIV infection has been decreasing in Aquitaine since 1988, particularly among IVDUs, suggesting that the epidemic is slowing down. It is essential to maintain these systems of epidemiological surveillance as a component of the HIV prevention program.

[Role of regional health observation posts: structure, operation, actions]. / Rôle des observatoires régionaux de la santé: structures, fonctionnements, actions.

The ORS were established at the beginning of 1980's to improve and to promote health informations to help decision makers. The ORS are non-profit making institutions supported by Health Ministry and local authorities. They also conclude contracts with private or public partners. A national federation exist since 1988. The ORS use a lot of scientific technics but have the constant preoccupation to adapt their communication for decision makers and non specialised public. From 1989 to 1994, more than 900 works have been published on a large variety of topics. In 1994, all of the ORS produced a "regional dashboard on health" according to a pattern elaborated by their national federation. In each region, these documents present most of the available indicators on health and social reality. So, the ORS associate local and national points of view.

Posttraumatic disablement: a prospective study of impairment, disability, and handicap.

This study was designed to evaluate both the frequency and the course of impairments, disabilities, and handicaps resulting from trauma. It was conducted in Aquitaine, France, on a sample of 1005 trauma patients (mean ISS, 10.5 +/- 0.3) in which severe trauma (ISS > 25) was rather overrepresented (169 of 1005). A prospective follow-up of disablement according to the WHO classification was based on medical examinations performed 6 and 12 months after the trauma. Of 664 survivors reviewed at 6 months, the findings were cross tabulated with Injury Severity Score (ISS) and age. There was a good relationship between ISS and the mean length of stay in the hospital (r = 0.46; p < 0.001), the duration of rehabilitation, and the time away from work or school. Out of this sample of 1005 patients with rather major injuries, 73% of the survivors suffered from at least one impairment, with a consistently lower frequency in children whatever the severity. At least one disability was encountered in 52.3% of these patients depending on both ISS and age. Handicap was noted in at least 26% of the cases. Between the sixth month and the end of the first year, the minimal handicap regression was 35.8%, whereas the minimal regression of the disability rate was 19.5%. The best improvement was observed essentially in the low ISS categories. Whereas for minor trauma the course of disablement seems to be fixed 1 year after the injury, such is not the case for severe trauma.

Incidence of juvenile type 1 (insulin-dependent) diabetes mellitus in France.

The incidence rate of juvenile Type 1 (insulin-dependent) diabetes in France was reported as the lowest in Europe 13 years ago, but during the recent years increasing rates have been observed in different European countries. A prospective programme has been designed to study the incidence rate of Type 1 diabetes in patients up to 20 years of age in four regions located in the north and south of France (population less than 20 years = 2.31 million inhabitants; 15% of the French population). All cases were independently identified by four specially trained research assistants through hospital admission files, paediatricians, diabetologists and general practitioners. A specific questionnaire was filled out for each newly diagnosed case. Degree of ascertainment was 96% with the data from Sécurité Sociale, the French National Health Insurance. In 1988, 166 cases of juvenile Type 1 diabetes were identified. The incidence rate was 7.17 cases per 10(5) children (95% confidence interval = 6.1-8.2/10(5). The values were not statistically different among the four regions. Age specific incidence rates were as follows: 0-4 years = 3.8; 5-9 years = 8.0; 10-14 years = 9.7 and 15-19 years = 7.3/10(5). Sex ratio was 1.2 (male/female). These data indicate that incidence of juvenile Type 1 diabetes in France was higher in 1988 than previously reported but remains lower than in Northern Europe. This is consistent with the concept of a north to south gradient of the disease.

The epidemiology of head trauma in Aquitaine (France), 1986: a community-based study of hospital admissions and deaths.

This paper reports the findings of a study of head trauma conducted over a one-year period within a defined region with a population of 2.7 million (Aquitaine, France). It includes cases resulting in death prior to hospitalization or requiring hospitalization. During the one-year period, 391 deaths and 8549 hospital admissions due to head trauma occurred, yielding an annual estimate of 8940 head-injured people. The immediate case-fatality rate was 4.4%. Among non-fatal cases, 80% were mild, 11% moderate and 9% severe. The overall annual incidence was 281/100,000 in both sexes (384 and 185/100,000 in males and females respectively). The annual death rate was 22/100,000 (33 and 12, respectively). Patterns of incidence by age and sex were in general agreement with earlier studies. The main causes of head trauma were traffic accidents (60%) and falls (33%). One-third of hospitalized patients had no injury other than the head trauma. The most frequently associated injuries were those involving extremities, whereas the most severe were those involving the abdomen. The Injury Severity Score (ISS) ranged from 4 to 66, with a mean of 9 and a median of 5. At the eighth day following injury, 25% of hospital-treated patients were still hospitalized and 2% had died. The outcome correlated well with the ISS.

Epidemiological surveillance of suicides and attempted suicides in Aquitaine, south-west France, using an original computer network of sentinel general practitioners.

To improve the epidemiological study of suicide and attempted suicides in Aquitaine, France, we developed a comprehensive surveillance system based on the input of Sentinel General Practitioners (SGPs). From October 1986 to May 1988, for each case of suicide or attempted suicide, the SGPs reported epidemiological data to our system through a computer network of personal home terminals (Minitels). Data included age, sex, method and result of attempt and antecedents. In an analysis of the relationship between the suicidal method, antecedents and results of suicidal act, the principal findings were a high rate of antecedents of suicide attempts by drug overdoses, hangings and drownings; and no antecedents for attempts by the use of firearms. This may show that the increasing accessibility of firearms is making it more likely that impulsive suicide attempts will be lethal.

[An orodental epidemiologic survey conducted in the school environment in the Great Southwest of France]. / Enquête épidémiologique bucco-dentaire menée en milieu scolaire dans le Grand Sud-Ouest.

Within the framework of a national epidemiological study, a regional study of the oral conditions of a representative survey of 1174 schoolchildren aged 6 to 15 years, was conducted in the south-west Region of France. This Region studied by the Dental School of Bordeaux comprised the departments of Dordogne, Gironde, Landes, Lot-et-Garonne, Pyrénées-Atlantiques, Charente and Charente-Maritime. Only 8.8% of the 15 years old children were caries free. The mean DMFT was 4.3 at age 12 years whereas the mean DMFS at the same age was 6.6. At the age of 15, these indices reached respectively the values of 6.5 and 11.4. The most affected sites were the pits and fissures, followed by the approximal and smooth surfaces (respectively 59.3%, 25.4% and 15.3% at age 15). The plaque index varied only slightly around 0.9, whereas the calculus index increased regularly from 0.0 to 0.4 between the ages of 6 to 15 years. The gingival index, which was 0.1 at age 6, remained stable around 0.3 between 8 and 15 years of age.

Incidence, causes and severity of injuries in Aquitaine, France: a community-based study of hospital admissions and deaths.

This paper reports the results of a study of injuries conducted during a one-year period within a defined geographic population of 2.7 million persons (Aquitaine, France). Cases were defined as unintentional or intentional injuries, either resulting in immediate death before reaching hospital or requiring hospital admission. During the one-year period, 1,181 deaths were registered and 8,190 hospital admissions occurred during the sample periods. The three leading causes of injury were falls (40 per cent), traffic accidents (27 per cent), and poisonings (15 per cent). The overall incidence of injuries was 136 per 10,000 person years. Incidence by sex and age was assessed for the main external causes. The ratios of nonfatal to fatal cases were calculated by sex and age and by external cause. The origin of the injury was suicide in 14 per cent of cases and assault or homicide in 3 per cent. The severity of injuries, assessed using an automatic computation of the Injury Severity Score (ISS), ranged from 1 to 66 with a mean of 6.9. Substantial variations of ISS were observed according to external cause. At the 8th day following admission, 31 per cent of hospital-treated patients were still hospitalized and 0.8 per cent had died in hospital. The outcome correlated well with the ISS.

[Injuries and poisoning caused by various types of activities. Epidemiologic survey on death and hospitalization in Aquitaine]. / Les traumatismes et intoxications par grands domaines d'activité. Enquête épidémiologique sur les décès et les hospitalisations en Aquitaine.

From the data of a survey conducted in 1986 within the French area of Aquitaine and based on a representative sample of injuries having led to immediate death or hospitalization, different types of injuries were compared. Domestic and recreational accidents constituted the leading cause (41%) of injuries, followed by traffic accidents (28%) and suicides (13%). The overall ratio of immediate deaths to hospitalizations was 1 to 30 (1 to 10 for suicides, 1 to 20 for traffic accidents and 1 to 80 for domestic accidents). The overall annual incidence was 131 per 10,000 (respectively 20, 34 and 53 for suicides, traffic accidents and domestic accidents). The incidence by sex, age and type of accident was assessed. Among hospitalizations, about 3/4 of domestic and school accidents were falls; 45% of work accidents were cutting-piercing or being struck by an object, and 40% were falls; 90% of attempted suicides were poisonings. Using the Injury Severity Score (ISS), severity of injuries was the highest in traffic accidents. Traffic accidents also led to the highest hospital mortality within eight days (1.6%).

[Cardiovascular mortality in industrial and developing countries (author's transl)]. / La mortalité cardio-vasculaire dans les pays industrialisés et dans les pays en développement.

In developing countries when causes of death are registered cardiovascular mortality levels revealed themselves surprising. For instance, they appear to be more important in Tebessa (Algeria) during 1974-1975, Mauritius (1973-1976) or Egypt (1971-1973) than in france, United States or Sweden before the age of 45 and very near after this age. These results are consistent with the mortality patterns by causes of death proposed by Preston according to life expectancy at birth. Before the age of 45, rheumatic heart diseases can explain this overmortality. After this age the recent observations in the Third-World, especially in Africa, show that cardiomyopathy, cardiomegaly and principally hypertension are widely spread to-day. On the other hand, ischemic heart diseases are still rare. For many authors, cardiovascular diseases are increasing in Africa because ways of life in developing and developed countries are becoming identical. In fact, this trend could be a little artificial. Formerly indeed, disparity in population age structures and mortality differences for all other causes were not enough taken into account.

PIP: The authors analyze trends in cardiovascular mortality in developed and developing countries between 1973 and 1976. Factors contributing to higher mortality in developing countries are examined. The relationship between the increase in heart disease mortality and the age structure of the population, life style, and mortality differences for all other causes is studied (SUMMARY IN ENG)

[Higher rural mortality or lower urban mortality in France? (author's transl)]. / Surmortalité rurale ou sous-mortalité urbaine en France?

Examination of crude and standardized rates, life expectancies and death probabilities by age shows an excess of mortality for males and females in little towns (less than 10 000 inhabitants) and on the other hand a lower mortality in parisian area. One aspect of the problem--relation between mortality and urbanisation (localities size)--is not the same with the sexes. For males, there is a lower mortality in rural area, on the contrary, for females, mortality is decreasing while the size of the locality is increasing. It would be possible to explain this results by parameters closely connected with urbanisation, such as socio-economic groups, marital status, health system. A next research will take this parameters and medical causes into account.

PIP: The authors examine mortality in France according to urban and rural area. They consider crude and standardized death rates, life expectancies, and death probabilities by age. The relationship between mortality and factors including urbanization, socioeconomic and marital status, and availabiliy of health services is analyzed (SUMMARY IN ENG)

[Contraception and liberal medical acts. The results of a national enquiry carried out by INSERM 1974-1975 (author's transl)]. / Contraception et activité médicale libérale. Résultats de l'enquête nationale INSERM 1974-1975.

The authors examined the part taken by contraception in a liberal practice in France arising out of a national enquiry on liberal medicine in France which was conducted by INSERM in 1975 and which was concerned with the medical activity of a random sample of 1150 doctors carrying out 2 100 total acts. They particularly analysed how these acts were distributed between general practitioners and gynaecologists. It is estimated that in 1975 there were 4.6 million medical liberal acts for contraception in women between 15 and 44 years of age, which worked out at about 1 per person every 8 to 9 months. General practitioners performed about 55 per cent of these acts. The geographical situation (whether it is urban or rural) is the main determinant of the choice of general practitioner or gynaecologist and not the age of the women or their professional activity. Certainly from the point of view of doctors contraception plays an important part in the activity of gynaecologists (20 to 25 per cent of their acts) whereas it remains a weak part of the activity of general practitioners (approximately 1 act every 2 or 3 days). Gynaecologists are inversely busy according to the amount of contraception they practise, but one must consider that there is a balance between contraceptive acts and obstetrical acts. As far as general practitioners are concerned, on the other hand, the year they qualify is the most important, since the younger doctors give up more time for this kind of activity than the older ones.

[The adolescent today. Medical and demographic questions (author's transl)]. / L'adolescent aujourd'hui. Aspects démographiques et médicaux.

Medical and demographic aspects of adolescence are described. These include: statistics concerning medical causes of death, data obtained in special medical or social communicaties, especially hospital morbidity and chronic disease statistics; lastly, the results of sample surveys, such as that concerning morbidity breakdown in general practice. All these data can serve as a basis for an intelligent approach to the medical problems of adolescence.