Do both timing and duration of screen use affect sleep patterns in adolescents?

BACKGROUND: Sleep duration has declined in adolescents over the last 30 years and screen use has been identified as a risk factor. Studies have examined the duration of screen use and screen-based activities but have not differentiated between evening and night-time use. METHODS: Cross sectional questionnaire survey of adolescents recruited in schools. Sleep habits on school nights and weekends, symptoms of insomnia and daytime repercussions were recorded using an online questionnaire administered in the classroom setting. Sleep deprivation (<7 hours in bed /night), school night sleep restriction (≥2 hours difference in sleep duration on school nights vs weekends), excessive sleepiness (score >6 on a visual analogue scale), duration of screen use and timing of screen use (evening vs after bedtime) were determined. RESULTS: 2513 students (53.4% female, median age 15 years) were included. 20% were sleep deprived and 41% sleep restricted. A clear dose effect relationship in a model controlling for age, sex, school level and sociodemographic class was seen with all levels of night-time screen use on sleep deprivation and sleep restriction (>2 hours use sleep deprivation OR 5.23[3.03-9.00]. sleep restriction OR 2.05[1.23-3.42]) and > 2 hours evening use (>2 hours use sleep deprivation OR 2.72[2.15-3.44] sleep restriction OR 1.69[1.36-2.11]) but not moderate evening use. All night-time use and > 2 hours evening use increased the risk of insomnia, non refreshing sleep, and affected daytime function (daytime sleepiness, lack of energy and irritability). CONCLUSIONS: Both duration of screen use and timing are associated with adverse effects on sleep and daytime functioning in adolescents. More than 2 hours evening use and all night-time use should be avoided.

Timing in initiating lung cancer treatment after bronchoscopy in France: Study from medico-administrative database.

BACKGROUND: Time-to-treatment of cancer is becoming a serious political and social issue. A greater understanding of the timeframes involved in cancer care is needed to reduce inequalities in access to care caused by delays. OBJECTIVE: To describe time delays in each phase of lung cancer treatment after bronchoscopy. METHOD: Using the international classification of diseases and medical procedures codes, from national hospital discharge database we selected patients newly diagnosed for Lung cancer in 2009-2010 who had undergone treatment. RESULTS: We included 14,596 patients. Median times from bronchoscopy to 1) neo-adjuvant chemotherapy and to surgery in patients with surgical pathway were 34d (Q25=22; Q75=47) and 44d (Q25=26; Q75=82), respectively, 2) chemotherapy and to radiotherapy in patients with non-surgical pathway, were 33d (Q25=22; Q75=49) and 88d (Q25=46; Q75=162) respectively, 3) first treatment irrespective of pathway and treatment combination was 34d (Q25=22; Q75=50). Time to first treatment was significantly higher with age and with the status of the first care center. It was longer in most northern regions and in overseas districts and shorter in southern and eastern regions of the country. CONCLUSION: To our knowledge, this is the first study based on medico-administrative database describing time to first treatment after bronchoscopy in patients suffering from lung cancer in France. It could inform decision-making on guidelines on times to access lung cancer treatment.

Qu'est-ce que la surveillance épidémiologique ?

Public health surveillance: what is it? Public health surveillance aims to describe a population health event to estimate its burden based on its characteristics (incidence, prevalence, survival and mortality) and their evolutions. This monitoring helps to contribute to the definition, implementation, monitoring and evaluation of public health policies. It must also be able to alert with the emergence of unexpected health phenomena. Public health surveillance is based partly on specific and continuous health information systems on populations (such registries), determinants or pathologies that are chosen a priori to monitor. It also relies on the collection of data, often in near real time (such SurSauD) and the construction of indicators a posteriori based on emerging health events and needs, or monitoring priorities. These two approaches are highly complementary. The contribution of these information systems (and of the health professionals who have to fill them out) is essential to the development of public health policies.

La surveillance épidémiologique : qu'est-ce que c'est ? La surveillance épidémiologique a pour objectif de décrire les événements de santé d'une population pour en estimer le fardeau en s'appuyant sur ses caractéristiques (incidence, prévalence, survie et mortalité) et leurs évolutions. Cette surveillance permet de contribuer à la définition, la mise en oeuvre, le suivi et l'évaluation des politiques publiques de santé. Elle doit aussi permettre d'alerter lors de l'émergence de phénomènes de santé inattendus. La surveillance épidémiologique repose d'une part sur des systèmes d'information spécifiques et pérennes (tels les registres), portant sur des populations, des déterminants ou des pathologies que l'on choisit a priori de surveiller, et d'autre part sur la collecte de données, le plus souvent dans un temps proche du réel (tel le système SurSaUD) et sur la construction d'indicateurs a posteriori en fonction des événements émergents et des besoins et priorités de surveillance. Ces deux approches sont très complémentaires. La contribution de ces systèmes d'information (et des professionnels de santé qui sont amenés à les renseigner) est essentielle à l'élaboration des politiques publiques de santé.

[Chronic diseases: recent trends, challenges and prospects for change]. / Les maladies chroniques : tendances récentes, enjeux et perspectives d'évolution.

INTRODUCTION: The objectives were to describe available sources for epidemiological surveillance of chronic diseases, recent trends, and underlying phenomena for these changes and to deduce possible scenarios for the future. METHODS: Based on the examples of coronary heart disease, stroke, diabetes, chronic obstructive pulmonary disease (COPD) and lung cancer, the authors describe recent trends in mortality and hospitalizations in the general population. RESULTS: Exceptfor diabetes, the morbidity and mortality of the diseases considered have globally declined over the last decade. However, trends varied according to age and gender and an increase in mortality from myocardial infarction, COPD and lung cancer was observed among women under the age of 55. Overall, decreased morbidity and mortality can be explained by improvements in primary prevention (blood pressure, cholesterol, smoking among men...) and prevention of recurrences and complications. DISCUSSION: It is unclear whether these improvements will continue in the future. Aging, obesity, diabetes and smoking among women should negatively impact the medium-term morbidity and life expectancy (especially disability-free life expectancy). It is still difficult to predict future trends, as other factors could attenuate (electronic cigarettes, bariatric surgery...) or, on the contrary exacerbate (increased social inequalities in times of economic crisis, continued increase in smoking among women, diabetes...) these trends.

Monitoring systems and national surveys on prison health in France and abroad.

BACKGROUND: The implementation of a national monitoring system of prisoners' health is under consideration in France. As information available on this topic is quite scarce, particularly in Europe, a study was performed to identify and describe various prison health monitoring approaches implemented worldwide. METHODS: Data were collected for 15 countries in Oceania, North America and western and northern Europe via official state websites, bibliographical searches and interviews with international prison health representatives. RESULTS: The means and methods implemented to monitor prisoners' health in the studied countries are heterogeneous. Although all countries systematically record mortality data, only four have a monitoring system that covers a wide array of health data: Canada and Belgium routinely collect health data using a systematic, standardized and computerized approach, while the USA and Australia have developed regular repeated nationwide surveys. Some countries have set up monitoring systems restricted to specific health problems, such as infectious diseases (e.g. the UK, Switzerland and Canada) and mental health (e.g. New Zealand and the Netherlands). In other countries, including France, prisoners' health monitoring systems are limited to occasional epidemiological studies covering specific topics, for example, psychiatric disorders, addiction or infectious diseases. However, their one-off nature prevents regular assessment of health prevalence and trends. CONCLUSIONS: This study highlights the diversity of approaches and methods developed to monitor prison health in high-income countries. Analysis of these different situations provides an insight into the feasibility of and requirements for the development of an efficient prison health surveillance system.

[Monitoring system on prison health: feasibility and recommendations]. / Surveillance de la santé des personnes détenues en France: faisabilité et recommandations.

INTRODUCTION: This article presents the results of two studies designed to define the feasibility and framework of the future prison health monitoring system in France. The objective of the first study was to obtain the points of view of professionals involved in prison health and the second study was designed to assess the feasibility of using prisoner's medical files for epidemiological purposes. METHODS: The point of view of various professionals was collected by questionnaire sent to 43 randomly selected prison physicians and by 22 semi-directive interviews. The feasibility study was based on analysis of the medical files of 330 randomly selected prisoners in eleven prisons chosen in order to reflect the diversity of correctional settings and prison populations. Additional interviews were conducted with the medical staff of these prison facilities. RESULTS: There is a consensus on the need to monitor prison health, but there are contrasting views on data collection methods (surveys or routinely collected data]. The feasibility study also showed that the implementation of a prison health monitoring system based on routinely collected data from prisoner's medical records was not feasible at the present time in France. CONCLUSIONS: In the light of these findings, it is recommended to initially develop a monitoring system based on regular nationwide surveys, while pursuing computerization and standardization of health data in prison.

[Perceptions and attitudes regarding noise in urban areas: the example of the Ile-de-France region]. / Perceptions et comportements face au bruit dans les zones urbanisées: 'exemple de l'Ile-de-france.

Noise is the subject of increasing attention for the French, especially in highly urbanized areas where its sources are multiple. In this context, this article aims to gain a better understanding of the how the specificities of the Ile-de-France region influence perceptions, attitudes and expectations of its inhabitants with respect to noise. The article is based on the regional use of results extracted from the national Environmental Health Barometer 2007 study by the INPES, the French National Institute for Prevention and Health Education. First and foremost, noise is perceived as a source of discomfort and inconvenience, in particular in Ile-de-France, while the related consequences of noise exposure for health were of secondary importance and not necessarily influenced by the degree of urbanization. The preoccupation with noise was much more important in the Ile-de-France region than in the rest of the country. Furthermore, a significant proportion of young people, particularly the Paris region, are exposed to high noise levels during their leisure time. These results are useful to better understand the expectations and needs of Parisians in terms of policies needed for information and education, prevention and reduction of noise.

[Estimating emergency hospital admissions to gauge short-term effects of air pollution: evaluation of health data quality]. / Estimation des hospitalisations en urgence pour mesurer les effets à court terme de la pollution atmosphérique : qualité des données issues du PMSI.

The study of the short-term effects and health impact of air pollution is carrier out by the ERPURS regional surveillance program which utilizes hospitalization data obtained from the French hospital information system (PMSI) to determine these links. This system does not permit the distinction between emergency hospital admissions from scheduled ones, which cannot be related to short term changes in air pollution levels. This study examines how scheduled admissions affect the quality of the health indicators used to estimate air pollution effects. This indicator is compared to three new emergency hospitalisation indicators reconstructed based on data from the public hospitals in Paris, partly from the PMSI data and partly with data from an on-line emergency network that regroups all of the computerized emergency services. According to the pathology, scheduled admissions present a difficulty which affects the capacity to highlight the weakest risks with any precision.

[The contributions of local authorities to regional public health policy]. / Apports des collectivités territoriates franciliennes à la politique régionale de santé publique.

Local authorities in France are key players in shaping public health policy by their action on the determinants of health and through their actions aimed at specific population groups. Since the public health act of 9 August 2004 establishing the first regional public health plans, their level of involvement and role continues to grow as coordinators, funders and project managers within the greater Paris metropolitan region. Their active participation in regional policy to improve population health and reduce inequalities in health has led to a better organization of the public health programs implemented (in terms of visibility, dialogue, coordination, transparency, and better awareness of context and integration of local issues). Their participation is also a source of innovation resulting in the proposal and use of new approaches (such as the development of health surveillance and observation for advising the local decision-making process). Within the current context of the "Hospitals, patients, health and territories" bill, which entrusts the governance of regional health policy to a specific agency, the role given to local authorities in this new organizational structure must be clearly defined to take into account all of their existing and potential contributions to public health policy.

Sensitivity analysis in summary measure of population health in France.

BACKGROUND: The aim of this study is to provide estimates of the French burden of disease, using the WHO Global Burden of Disease methodology and to perform sensitivity analysis on different set of mortality data. METHODS: The burden of disease is measured by disability-adjusted life years (DALYs) that take into account both mortality and morbidity data. Results were obtained using French mortality data for the years 2000 and 2001 and morbidity data estimated by WHO for France. Sensitivity analyses were conducted using different mortality data sets and various life tables as mortality norms. Calculations were also performed with and without discounting and age-weighting. RESULTS: In France, the annual burden of disease was about 12.4 million DALYs. Depending on the mortality data set and the choice of social values used for calculation, results could be quite different. The use of WHO estimates for mortality resulted in an underestimation of 2.6% of total DALYs with respect to French data. Changes of the mortality norm imply changes in the number of years of life lost (YLLs), whereas the use of discounting and age-weighting mainly modifies the ranking of diseases. CONCLUSION: DALYs constitute a summary measure of population health, which is a powerful tool for the grading of health problems, allowing to compare fatal and non-fatal diseases. Nevertheless, the validity of results obtained depends primarily on the validity of the input data. Collecting morbidity data (mainly incidence) at the national level is hence an important step in order to assess more accurately the specific burden of diseases in France.

[Early screening and brief intervention among excessive alcohol users: mobilizing general practitioners in an efficient way]. / Repérage précoce et intervention brève auprès des consommateurs excessifs d'alcool. Etude de trois méthodes de promotion du repérage précoce et de l'intervention brève.

OBJECTIVE: The program "Boire moins, c'est mieux" (BMCM--"The less alcohol, the better") initiated by the ANPAA offered 550 general practitioners (GPs) in 2003 to follow training courses so as to perform "early screening and brief intervention" (ESBI) in general practice. Phone calls to the medical offices, a financial compensation offer and a media campaign in the immediate environment of general practitioners were used. The study aimed at assessing the respective efficiency of these three methods. METHOD: Mailing was the control mobilization method. Phone calls were used in addition to mailing for one GP out of two, according to a previous draw. Financial compensation (2 + for each questionnaire filled out, and 10 + for each BI delivered) was used when GPs were invited a second time to attend the training. Community-based mobilization only occurred in the site in Saint-Quentin-en-Yvelines (France). The primary endpoint was the actual participation to the training evenings. The secondary endpoints were the registration to trainings and the ESBI activity following the training. RESULTS: Phone calls enabled to multiple by 7 the number of participants attending training sessions, as compared to the impact of mailing only (p < 10-7); phone calls had no proper impact on ESBI activity following the training. Financial compensation had a powerful impact on the level of ESBI activities (p = 10-4); however, announcing it had no effect on registrations and barely modified the impact of phone calls. The proportion of the population benefiting from a screening action doubled in the site where a community-based action occurred (p < 10-7). CONCLUSION: A mere phone call was particularly efficient in increasing the number of trained GPs. Financial incentive led to an activity level very close to systematic screening. Community-based approach increased significantly the proportion of the screened population.

Risk denial about smoking hazards and readiness to quit among French smokers: an exploratory study.

In most developed countries, a significant part of the population is still smoking despite comprehensive tobacco control policies. Among other reasons, many smokers may endorse self-exempting beliefs that help them to deny the smoking hazards for themselves. We investigated the relationship between smokers' risk denial and their readiness to quit making use of a French cross-sectional survey conducted in the Paris Ile-de-France Region (N=939 smokers). Self-exempting beliefs were quite widespread among participants and two of them were significant predictors of a low readiness to quit: considering that one's cigarette consumption is too low to be harmful and believing that one's way of smoking can protect from smoking-related diseases. Future tobacco control messages and interventions should specifically address these self-exempting beliefs that reduce smokers' cognitive dissonance and then inhibit their willingness to quit.

Air pollution and doctors' house calls for respiratory diseases in the Greater Paris area (2000-3).

This study describes the short-term relationships between the daily levels of PM10, PM2.5, NO2 and the number of doctors' house calls for asthma, upper respiratory diseases (URD) and lower respiratory diseases (LRD) in Greater Paris for the years 2000-3. Doctors' house calls are a relevant health indicator for the study of short-term health effects of air pollution. Indeed, it is potentially more sensitive than indicators such as general hospital admissions due to the severity of diseases motivating the call. In this study, time-series analysis was used. The daily numbers of doctor's house calls were adjusted for time trends, seasonal factors, day of the week, influenza, weather and pollen. Up to 15 days of lag between exposure and health effects was considered using distributed lag models. A total of about 1,760,000 doctors' house calls for all causes occurred during the study period, among which 8027 were for asthma, 52,928 for LRD and 74,845 for URD. No significant increase in risk was found between air pollution and doctors' house calls for asthma. No significant association was found between NO2 and doctors' house calls. An increase of 10 microg/m3 in the mean levels of PM10 and PM2.5 encountered during the 3 previous days was associated with an increase of 3% (0.8% and 5.3%) and 5.9% (2.9% and 9.0%) in the number of doctor's house calls for URD and LRD, respectively. Considering up to 15 days between exposure and health outcomes, effects persist until 4 days after exposure and then decrease progressively. No morbidity displacement was observed. This study shows a significant heath effect of ambient particles (PM2.5 and PM10). When compared to the RRs obtained for mortality or hospital admissions in the same area, the values of the RRs obtained in this study confirm the higher sensibility of doctor's house calls for respiratory diseases as a health indicator.

HIV risk and condom use in the adult heterosexual population in France between 1992 and 2001: return to the starting point?

OBJECTIVE: The aim of this paper is to measure changes in protection behaviours from 1992 to 2001, in assessing trends in condom use over time in the heterosexual adult population. DESIGN: These changes are measured through repeated AIDS KABP surveys comparing, over time, condom use during the 12 months prior to the surveys and condom use at first sexual intercourse before and after the beginning of the AIDS epidemic. METHOD: National telephone surveys were conducted in 1992, 1994, 1998 and 2001. A total sample of 7026 heterosexual individuals, aged 18-54 years, was obtained. RESULTS: Two temporal phases are highlighted in condom use. The first shows an increase in both condom use at first sexual intercourse from 1985 to 1998, and in condom use during the 12 months prior to the surveys between 1992 and 1998, suggesting that sexual health promotion messages may have increased HIV/AIDS preventive behaviours. The second phase shows a decrease in condom use. Compared with 1998, condom use at first sexual intercourse in the 2001 survey still remains high; however, condom use in the 12 months prior to the survey is clearly decreasing, particularly among those with multiple sexual partners during the past 12 months. CONCLUSIONS: Reasons for this relapse in condom use in the general population include changes in social and individual representation due to the introduction of highly active antiretroviral therapy, the difficulties in sustaining long-term preventive behaviours, and a high level of awareness in the population and/or the decrease of large HIV prevention campaigns.