[Media and public health: example of heat wave during summer 2003]. / Média et santé publique: l'exemple de la canicule pendant l'été 2003 en France.

BACKGROUND: The summer of 2003 was the hottest for France in the last 50 years with record day and nighttime temperatures. INSERM statistics estimated that 14,802 heat-related deaths occurred during August 2003 heat wave in France. In the aftermath of this crisis, we thought that it was useful to analyze how the French media dealt with public health during the period from June 1 to August 31, 2003. The objective was to analyze French coverage of public health information during the August 2003 heat wave. METHODS: Manual and computerized analysis of newspaper and radio reports published from June 1 to August 31, 2003. Articles were obtained by searching the EUROPRESS database. Text analysis was performed using the ALCESTE software package. RESULTS: A total of 1,599 articles were analyzed. Few articles contained warnings about heat exposure and preventive measures. Public health policy was relegated to third place after business and ecology themes. The special problems of the high-risk populations were not mentioned until after the rising death toll was known and emphasis was placed on the implications of the crisis in the political process. The findings of this study show the poor performance of public health policy in France and that media must be given guidance to fulfil its role in providing public health information. CONCLUSION: This crisis discloses the absence of public health culture in France and involves the "social exclusion" related to a breakdown of social cohesion. More cooperation is needed between the media and public health professionals to avoid future heat-wave and other public health crises. France must develop a public health culture to promote involvement of both the community and individuals in public health issues.

Validation of the French 'multidimensional fatigue inventory' (MFI 20).

Fatigue has become an important symptom in research and also for clinical diagnosis and follow up. Many physical illnesses, in particular chronic ones such as cancer, are highly associated with fatigue. Various questionnaires for measuring fatigue have been developed, but currently no validated questionnaire exists in French language. We selected the 'Multidimensional Fatigue Inventory' (MFI) which has been validated in its English version and then translated into French by the designers. This study describes the validation step of the French version of MFI and presents the psychometric properties of this instrument. A sample of 225 patients was divided into three groups 'Tired' (82 subjects), 'Moderately tired' (36) and 'Not tired' (107). The analysis of the structure validity found four dimensions: 'General Fatigue', 'Mental Fatigue', 'Reduced Activities' and 'Motivation'. The convergent validity showed highly significant correlation (P < 0.001) with a visual analogue scale. The French MFI has been able to distinguish patients with different fatigue levels. Cronbach's alpha measurement of the scale and the subscales are good, cronbach alpha > 0.70. The reproducibility and sensitivity to change in patients who were followed up one month later show satisfactory results. This validation study of the French version of MFI shows that this instrument is valid for clinical application and allows different dimensions of fatigue to be assessed which is of particular interest for physicians, especially for cancer carers, where fatigue assessment is an important aspect of the follow up.

[Mandatory notification of HIV infection. Epidemiologic justifications and ethical questioning]. / Déclaration obligatoire de l'infection par le VIH. Justifications épidémiologiques et interrogations éthiques.

Since the appearance in May 1999 of the two decrees on the application of the law relative to the reinforcement of sanitation quality control established in July 1998, the disclosure of HIV infection "irregardless of the stage" has become mandatory. This is the first time that it is imposed that one must declare a serologic diagnosis, that is to say an infection in the asymptomatic stage. The sensitive nature of all of the information available on AIDS provides an explanation for the numerous contradictory reactions linked to this decision. We attempt to organise the arguments brought forth according to two approaches: 1) the epidemiological arguments that justify the compilation of the precise data thought to be necessary for the follow-up of the disease and for the implementation of well-targeted prevention actions; and 2) the ethical reservations concerning such an imposed measurement, as well as the questions related to anonymity and confidentiality.

Comparison of methadone and high dosage buprenorphine users in French care centres.

AIMS: In France, maintenance programmes for opiate users were adopted later than in other countries. Two maintenance treatments are available: methadone is only delivered in specialized centres while high dosage (HD) buprenorphine can be prescribed by all general practitioners and in specialized centres. The aim of this study was to compare the socio-demographic profiles, the practices and drug consumption patterns of the two groups attending specialized centres. METHODOLOGY: The Oppidum Programme (observation of illegal drugs and misuse of psychotropic medications), a multi-centric survey, surveys drug-dependent subjects attending specialized care centres throughout France annually. Data were collected by questionnaire on socio-demographic variables and drug use during the preceding week. RESULTS: During October 1998, 46 centres took part in the survey. The methadone group (n = 424) was older, with a better economic situation; 16% used cocaine regularly. The HD buprenorphine group (n = 616) consumed more heroin (12% vs. 8%) and engaged in more misuse, such as intravenous use, illicit acquisitions or irregular consumption. These practices were more frequent for patients consuming the drug "outwith protocol" or for patients obtaining the drug from a general practitioner. CONCLUSION: Our results suggest that patterns of consumption of methadone and buprenorphine are different in several respects: concomitant use of licit or illicit psychoactive substances, route of administration, and illegal acquisition. They also suggest that the behaviours of maintenance treatment users depend less on the nature of the maintenance drug (methadone or high dosage buprenorphine), than the nature of the delivery and monitoring practices.

Validation of a French health-related quality of life instrument for adolescents: the VSP-A.

The French Health Ministry, stating the limits of traditional indicators to take into account the different aspects of adolescent health, declared adolescent health status assessment as a priority. Thus a French health-related quality of life (HRQL) generic self-administered indicator was developed on the adolescent's viewpoint for healthy and ill adolescents of 11-17: the VSP-A, Vécu et Santé Perçue de l'Adolescent, intended to be used as a discriminative, predictive and evaluative instrument. This paper reports the validation study of the 40-item VSP-A including 2941 adolescents. Six dimension scores were computed: psychological well-being, energy, friends, parents, leisure, school, as well as an index. Content and construct validity were confirmed. Factorial validity was shown. As expected, scale scores were significantly associated with a one-item global well-being visual analogue scale (r = 0.53; p < 0.001) and with a self-esteem score (r = 0.62; p < 0.001). On the VSP-A index, girls and older adolescents were found to have the lowest scores. The VSP-A is reliable in terms of internal consistency (Cronbach's alpha = 0.83) and test-retest results (r = 0.69; p < 0.001). The ability of VSP-A, filled in less than 15 min, was shown to discriminate between ill and healthy adolescents, and to predict an impairment of their health status. The next phase of the research involves testing in various populations and more specifically in populations with diverse acute and chronical health conditions, so as to refine the content of the instrument and to add much to what is known about the sensitivity to changes of the VSP-A scores in patients who are under treatment.

[The drama of blood contamination in France. An approach to public health]. / Le drame du sang contaminé en France. Une approche de santé publique.

The tragic HIV contamination of hemophilics and transfusion recipients between 1980 and 1985 in France led to low court proceeding the same events. In addition, last June a state minister was arraigned for not recalling transfused patients before 1985. This involves later events and announces other court actions. France is the only country where these dramatic events have take on the dimension of a major political scandal. Based on the scientific elements (reactions and articles in the international medical literature) and an analysis of the decisions made by France, a chronological examination of the disease and the risks for hemophiliacs and transfusion recipients offers helpful insight into possible options for reducing these risks. The interval between these the court proceeding allows time for further thought focusing on a serious deviation of public health in France.

AIDS talks for adolescents.

The authors discuss how to conduct information sessions on AIDS prevention for adolescents on the basis of experience gained in Marseilles secondary schools. Precautionary messages have to be conveyed without encouraging irrational fear and intolerance.

PIP: In November 1994, France's Ministry of Education mandated that third- and fourth-year secondary school students receive at least 2 hours of sex education per year. Since the beginning of such education, most requests for information on AIDS have come from third-year students, generally aged 14-15 years, and some of whom are sexually active. Sex education should be given to all students, with no one excused from attendance due to parental objections. Sex practices and homosexuality must be discussed in detail in AIDS education in order to make students aware of how HIV can be transmitted and how it is not transmitted. Students should be made aware of the risks associated with sexual activity and IV drug use, and strongly urged to take precautions. In addition, the stages of HIV infection should be explained and attention given to transmission routes and high-risk practices, with focus given to the main elements which need to be learned and understood. While not exaggerating high school students' risk of contracting HIV, the educator and facilitator of discussion must also try to convey the seriousness of HIV infection should it occur. Moreover, a tolerance of differences in sexual orientation should be encouraged and all questions posed by students answered with neither ambivalence nor embarrassment, even though some questions may be highly specific and even repugnant.

Mass screening programs for breast cancer in France--average values of assessment criteria.

Breast cancer is the most common cancer in women worldwide. Many studies have been performed worldwide to assess the effectiveness of screening in terms of reduced mortality due to breast cancer. Since the end of 1989, 10 breast cancer mass screening programs using mammography have been carried out in France under the sponsorship of the National Fund for Health Prevention, Education, and Information (FNPEIS) from the National Health Insurance of Salaried Workers (CNAMTS). These 10 campaigns, which are on a district scale, are organized according to variable methods and are assessed using a common procedure. Four groups of criteria are measured in this procedure, which investigates the impact, quality, effectiveness, and costs of screening programs. The average and extreme values of each criterion as calculated from the campaigns are presented in this paper. In order to enlighten the judgment on the French results, a comparison with the international standards in force and with the results of foreign screening programs is proposed.

[Mass screening programs for breast cancer in France. Comparative evaluation]. / Les programmes de dépistage de masse du cancer du sein en France. Evaluation comparative.

OBJECTIVE: The purpose of this work was to comparatively assess the results of mass screening programs for breast cancer implemented in six French departments in 1986, within the scope of the National Fund for Health Prevention, Education and Information of the National Health Insurance Office of Salaried Workers. MATERIAL AND METHODS: The data collected by the screening centres were analyzed by ten assessment teams that were independent from the program promotion staff, all using the same evaluation form. A complementary population study performed in eight French districts then, allowed assessing the frequency of self-referred screening (mammography performed out of program). RESULTS: The rate of participation in screening programs, in relation to the invited population, ranged from 21 to 48%, according to the district (36% in average). This low participation was probably related to the extent of self-referred screening. In fact, 19 to 40% of women, according to the district, had previously had a screening mammographic coverage: rate was around 68% in women aged 50 to 69 years. Positive findings with mammography ranged from 4.5 to 15.8% (10.1% in average), while intervention rates ranged from 0.7 to 1.6% and detection rates from 3.8 to 6.2%. The ratio between benign tumors and cancers ranged from 0.7 to 2.1 according to the district. In order to enlighten the judgement on French results, we propose a comparison with the international standards in force. CONCLUSION: The various experiences with breast cancer screening in France show that this screening is technically feasible on the basis of existing medical structures. However, some criteria are still below the expected values, especially if compared with international standards. This result is probably accounted for by the high rate self-referred screening before age 40 in France. In these conditions, the question is whether extending breast cancer screening programs in France is an appropriate course of action.

[Observation of illicit or misused psychotropic drugs (O.P.P.I.D.U.M.): five years of surveillance of products consumed by drug addicts at Marseille]. / Observation des produits psychotropes illicites ou détournés de leur utilisation médicamenteuse (O.P.P.I.D.U.M.): cinq ans de surveillance des produits consommés par les toxicomanes à Marseille.

The aim of O.P.P.I.D.U.M. is the survey of products used by drug addicts. A five year survey, based on regular pools, has provided interesting results. 1,283 patients (80 per cent men, about 27 years old, 1/4 employed) used 2,241 drugs. The most frequent was heroin, followed by benzodiazepines, cannabis and cocaine. Flunitrazepam was the most commonly misused product, taken by users who started consumption earlier, with a higher rate of unemployment and imprisonment. Cocaine was as often taken intravenously as by sniffing, and most often used before imprisonment. Ecstasy (M.D.M.A.) has appeared recently. Codeine taken alone was used by subjects older than the heroin users, more frequently employed and virtually never prison inmates: this suggests the existence of an unofficial detoxication and substitution process. Confidence of clinicians needs anonymity of the records and return of information. Such a campaign is about to be launched.

[Corticotropic adenoma in slow adrenal insufficiency]. / Adénome corticotrope au cours d'une insuffisance surrénale lente.

This case report deals with an insulin-dependent diabetic patient suffering peripheral adrenal insufficiency who, after 12 years of substitutive treatment exhibited resistance to mineralo- and gluco-corticoids with relapse of melanodermia and plasma ACTH levels higher than 1500 pg/ml despite increasing doses. A corticotrop macroadenoma was diagnosed by MR imaging and functional tests and confirmed by surgical excision followed by disappearance of resistance. Pre-operative functional investigation show autonomisation of the adenoma but with some partial persisting regulation. This case report draws attention to this rare either complication or association which can occur in peripheral adrenal insufficiency.

[Experience in mass screening of breast cancer with mammography in France]. / Les expériences de dépistage de masse du cancer du sein par mammographie en France. Un protocole commun d'évaluation.

In the framework of the National Fund for Prevention, Health Education and Information, the setting-up in France, on an experimental basis, of mass breast cancer screening programs by mammography in ten departments leads to suggest a common protocol for the evaluation of these programs, before an eventual generalization to the whole country. These programs are based on common principles: local screening based on existing medical facilities, single view mammography with double reading. However, the screening organisation is different in each department according to the target population, the screening interval, the mode of invitation, the methods for arranging double reading, etc. The purpose of this article is to report on the work of the evaluation group of the ten programs, and to propose a methodology for comparing the screening experiences in order to measure the role of the organisation methods. It gives definitions and modes of calculations for the evaluation criteria in four fields: impact, quality, efficacy and cost (with details about the feasibility of data collection) and proposes a reflection on analysis techniques in order to develop an optimum mass screening strategy.

[A surveillance method for products used by drug addicts examined in emergency units]. / Essai de mise au point d'une méthode de surveillance des produits utilisés par les toxicomanes consultant dans les services d'accueil.

Products used in a toxicomaniac way are in rapid change, and different from different area. Users too have to be better known. Authors present a simple survey method of these products, based on sample use. First results seem to be correct. These method may be used, associated with others, in a network as those existent for many years in the United States.