[Children's medical records, HIV and confidentiality: practices and attitudes of physicians and families]. / Carnet de santé de l'enfant, VIH et confidentialité: pratiques et attitudes des médecins et des familles.

The aim of this study is to describe the attitudes and practices of doctors and families regarding the use of the individual child health journal, especially by exploring the contradictions between the validity and confidentiality of its content, in particular with respect to HIV infection. In order to accomplish this, both doctors (N = 380) and families (N = 242) were questioned, most of them living and working in Seine-Saint-Denis, the metropolitan district with the third highest prevalence rate of HIV. The findings indicate that: most families are not always prepared to make sure that the confidential use of the child's health journal is maintained, and even less so those affected by HIV; doctors refrain from recording certain psychological and even medical data in the child health journal for fear of the information's misuse within the social sphere; doctors as well as families expressed their preoccupations concerning the confidentiality of the child health journal, essentially with respect to its content and how it is used in various contexts. A number of possibilities are proposed by the study's participants: establish a vaccination record separate from the child health journal, educate parents on how to maintain its confidential use and train the health workers to this end.

[Prevalence of dental caries in children before and after a prevention program in Seine-Saint-Denis]. / Prévalence de la carie dentaire chez l'enfant avant et après un programme de prévention en Seine-Saint-Denis.

BACKGROUND: The Seine-Saint-Denis Council planned in 1984 a prevention strategy program among schoolchildren which consisted in a health educational campaign and fluoridation therapy. The purpose of this paper was to present the evolution of dental caries among 11-year-old children from a low-income country after 8 years of prevention and to discuss further orientations in prevention. METHODS: Two cross-sectional surveys were conducted in 1984 and 1992 on, respectively, 1,907 and 2,771 schoolchildren attending primary schools of the department. The DMF index, summing up the total number of decayed, missing or filled permanent teeth was used to assess dentition status. RESULTS: The DMF index ranged from 3.38 in 1984 to 1.99 in 1992, a 41% decrease. This decrease was associated with a change of the distribution in DMF, the percentage of caries-free children increasing from 19% to 42% after 8 years. 83% of the decayed teeth were first molars. In 1992, only 24% of children received comprehensive care. In both surveys, the prevalence of dental caries was related to socio-economic status. CONCLUSIONS: Prevention strategy in this low-income county, led to improved dental health among children. However, the study design did not allow for evaluation of the impact of preventive measures on the evolution of dental caries prevalence. The community program contributed to improved dental health in most children even if it could not prevent the development of dental caries in very low-income children with severely decayed teeth and no access to dental care. Further steps in order to improve prevention, including use of sealants among these children, are under evaluation.

Modelling the 1985 influenza epidemic in France.

The Rvachev-Baroyan-Longini model is a space-time predictive model of the spread of influenza epidemics. It has been applied to 128 cities of the USSR, and more recently, to forecasting the spread of the pandemic of 1968-1969 throughout 52 large cities. It is a deterministic, mass-action, space and time continuous model. The model has been applied to the simulation of the influenza epidemic of 1984-1985 in the 22 French Metropolitan districts and results are presented. Estimates of the parameters of the model were made using the French Communicable Diseases Network data. These parameters are the contact rate, a, (estimate = 0.55) which is the number of people with whom an infectious individual will make contact daily sufficient to pass infection and the infectious period, 1/b, estimated as 2.49 days. The mean annual railroad passenger traffic from district i to district j varies from 0 to 1,991,000 persons depending on the districts. The computer spread of the epidemic is presented on weekly maps. Results are also presented on district charts, giving the size of district epidemics and the time of peak of the epidemic. The precision of the computer fittings was judged satisfactory by the calculated size of peak differing from the real one by less than 100 per cent, in 17 out of 18 districts, and by the calculated time of peak differing from the observed by less than two weeks in 14 out of 18 districts. Although precision could be improved with more detailed information about passenger traffic, the French use of the model has been satisfactory.

[Attitude of French general physicians to surveillance of transmissible diseases]. / Attitude de médecins généralistes français face à la surveillance des maladies transmissibles.

A survey was conducted among 450 French general practitioners in order to learn the attitude of GPs concerning the surveillance of communicable diseases. From a list of 15 such diseases, 406 respondents indicated those they considered important for surveillance. Viral hepatitis was the first choice, being considered important for surveillance by 68% of the practitioners. Also, 48% believe that surveillance of influenza is important. The proportions remain the same whatever the age or the region of the practitioners. The homogeneity of the answers underscores the feasibility of having a reliable national system of surveillance for these diseases. Tuberculosis and sexually transmitted diseases other than syphilis (which shares second place with influenza) and measles (in fourth place), diminish importantly among the GPs' selections as their age rises, thus calling our attention to the role experience plays in the choices and, very probably, to the nature of their clientele. Neither prevalence nor the gravity of diseases appears to have been the only factor governing choices; on the other hand, the complexity of the disease and the utility of surveillance appear to be decisive factors in their choices. Hence, those who report having seen at least one case of a disease during the previous year are more numerous in citing the disease as important for surveillance.

A computer network for the surveillance of communicable diseases: the French experiment.

The description and first results of the French Communicable diseases Network are reported. The network, initiated in November 1984, currently includes the National Department of Health, the local health offices and various clinical, biological, and epidemiological partners. Surveillance of influenza, viral hepatitis, acute urethritis, measles, and mumps is based upon reports from sentinel general practitioners throughout France who are equipped with terminals and can communicate their data on a 24-hour basis. The network distributes electronic bulletins summarizing the surveillance data, the regional statistics concerning other diseases, and epidemiological and administrative news. Electronic mail is used for data validation and enhances communication between the parties of the network.