[Home and recreational injuries in children under 1year: 10years of experience]. / Accidents de la vie courante chez les enfants âgés de moins d'un an : expérience sur 10 ans.

BACKGROUND: There is little research on the prevalence and characteristics of home and recreational injuries in infants under 12months of age. However, domestic accidents result in an average of 50 infant deaths in France every year. METHODS: A descriptive and retrospective study was conducted, based on data from the permanent investigation on home and recreational injuries in infants under 12months of age (EPAC) published by the Institute for Public Health. Data were collected from 2004 to 2013 in the pediatric emergency department of Le Havre hospital. A global quantitative analysis was carried out, as well as age-group-based analyses (groups of infants of similar age within a specific range of 3months of age). RESULTS: A total of 3708 infants under 1year of age were victims of home and recreational injuries. The incidence of domestic accidents was found to be an average of one case per day (gender ratio, 1.12). Up to 85% of reported injuries were found to occur in the home. Falls were the leading cause of home accidents or injuries (73% of the total number of reported accidents), 7% of which resulted from a fall from stairs. Children frequently suffered from concussion or contusions (65%). The neck and head were affected in 73% of cases. A higher proportion of foreign body injuries occurred after 6months of age (RR=2.9, p<0.001). The number of hospitalizations decreased with age: 21% of accidents occurred before 3 months of age; 7% occurred between 9 and 11 months of age (RR=0.32, p<0.001). Falling from a changing table accounted for 9% of fall-related hospitalizations. CONCLUSIONS: This survey characterized for the first time the occurrence of home and recreational injuries in infants under 12months of age in France.

[Methods of data selection from the French medical information system program for trauma patient's analysis: Burns and traumatic brain injuries]. / Méthodes de sélection des données du PMSI pour l'analyse des victimes de traumatismes : brûlures et lésions cérébrales traumatiques.

BACKGROUND: Data from the French medical information system program in medicine, surgery, obstetrics and dentistry can be adapted in some cases and under certain conditions, to account for hospitalizations for injuries. Two areas have been explored: burn and traumatic brain injury victims. METHODS: An algorithm selecting data from the Medical information system program was established and implemented for several years for the study of burn victims. The methods of selection of stays for traumatic brain injuries, which are the subject of a more recent exploration, are described. RESULTS: Production of results in routine on the hospitalization for burns. Expected production of results on the hospitalization for traumatic brain injuries. CONCLUSION: In both cases, the knowledge obtained from these utilizations of the Medical information system program contributes to epidemiological surveillance and prevention and are useful for health care organization.

[Setting-up an epidemiological monitoring system of mortality by trauma in children under 15 years of age in metropolitan France]. / Mise en place d'un système de surveillance épidémiologique de la mortalité par traumatisme chez les enfants de moins de 15ans en France métropolitaine.

In metropolitan France in 2009, trauma was the leading cause of death among children under 15 years of age: 459 deaths (source CépiDc), with 236 deaths by home and leisure injuries (HLI). These rough mortality data do not describe the circumstances of the trauma responsible for the death. The "Fatal home and leisure injury among children under 15 years old-MAC-15" feasibility study was set up in 2009 in France in the following regions: Île-de-France, Nord-Pas-de-Calais, and Provence-Alpes-Côte d'Azur. The main objective of the survey was to understand exactly how these accidents occurred and determine their risk factors. Its secondary objectives were to test the feasibility and analyze the possibility of extending and/or scaling up the monitoring of these deaths. Case reporting was made through death certificates, contacts with regional health agencies, and media surveillance. A detailed record was completed by the medical certifier. In 2009, 76 HLI-related deaths in under 15-year-old children were identified by the survey in the three regions. The victims were mostly boys. The most common cause of death was drowning, followed by suffocation, falls, and fires. The survey contributed to precisely determining the risk factors of HLIs in children and, most often, to identifying the cause responsible for the fatal accident. The feasibility conclusions of this survey are positive, data collection is effective and practicable, and its quality and exhaustiveness were demonstrated. Implementation of the "detailed analyses of the deaths by trauma among children under 15 years old" survey is proposed. This survey will be extended to all deaths by trauma among children in Metropolitan France.

[Injuries in France: trends and risk factors]. / Les accidents en France : évolution et facteurs associés.

BACKGROUND: Whatever the type of injury considered, prevention requires an improvement in health services' awareness of risk factors. The Health Barometer is a general population survey conducted in France since 1992 to contribute to surveillance in this field. The survey's statistical power and the numerous health topics included in the questionnaire provide accurate information for healthcare professionals and decision-makers. METHODS: The Health Barometer 2010 was a nationwide telephone survey of 9110 persons representative of the 15-85-year-old population. One part of the questionnaire detailed injuries which had occurred during the past year. The numerous variables recorded enabled application of logistic regression models to explore risk factors related to different types of injury by age group. The findings were compared with the Health Barometer 2005 data to search for temporal trends of injury prevalence. RESULTS: The data analysis showed that 10.3% of the 15-85-year-olds reported an injury during the past year. This rate was higher than recorded in 2005; the increase was mainly due to domestic accidents and injuries occurring during recreational activities. Both type of injury and risk factors exhibited age-related variability. Domestic accidents and injuries occurring during recreational activities predominated in the older population and were associated with physical or mental health problems (chronic disease, diability, sleep disorders). For younger people, injuries were related to cannabis use, drunkedness, and insufficient sleep. Risk factors were also depended on type of injury: occupational accident-related injuries were linked with social disadvantage (manual worker population) whereas sports injuries were more common in the socially advantaged population. CONCLUSION: This survey confirms established knowledge and highlights, at different stages of life, new risk factors that contribute to injuries in France. These findings should be helpful for the development of adapted injury prevention programs, by providing a better understanding of the characteristic features of this major public health issue.

[Epidemiology of accidental falls from heights among children, Paris Region, May to September 2005]. / Epidémiologie des chutes accidentelles de grande hauteur chez les enfants en île-de-France entre mai et septembre 2005.

SUMMARY: A survey conducted between May and September 2005 in the Paris Region collected 67 cases of accidental "falls from heights" among the children under the age of 15. Most of the injured children were under the age of 6 (72%), the majority were boys (72%). More than half of the children's families were from extra-European origin, mostly from Sub-Saharan Africa. In 32% of the cases, the fall occurred as the opening had a protection. A piece of furniture was in place beneath the window or was disposed by the child in 55% of the cases; 33% of the children climbed the parapet or the opening. In third of the falls, there was an adult present with the child in the room. Seven children died (10%) and eight (12%) had sequelae. The risk of fall due to the lack of surveillance is not enough known by adults. It is therefore recommended to organise prevention campaigns. To prevent falls, one should revise the regulations for building the parapet and the mechanisms for opening the windows.

[Epidemiologic survey of infants hospitalized for bronchiolitis. Survey conducted by the ERBUS medical network]. / Surveillance épidémiologique hospitalière de la bronchiolite du nourrisson par le réseau ERBUS.

BACKGROUND: Acute infant bronchiolitis is a frequent seasonal disease which peaks in December. It often requires hospital care in Paris and in its surroundings. The exceptional bronchiolitis epidemic of December 1991 brought about a temporary saturation of hospital bed space at the Assistance Publique-Hôpitaux de Paris (AP-HP). Hereafter, in order to organize care more efficiently, an epidemiological observation network called ERBUS was set up. METHODS: Thanks to daily reports of emergency pediatric admissions through the Minitel network, it has been possible to get real time information on the course of the past five epidemics in each of the 11 AP-HP hospitals with pediatric emergency units. RESULTS: Globally the results point to a similar situation every year: approximately 60% boys, 35% babies under 6 months; the ratio of very young patients who are admitted to hospital is multiplied by 1.5 at the mid-point of and at the end of the epidemic compared with the beginning; 70% of the babies under 3 months are admitted to hospital. The ratio of patients who come and are admitted to hospital has been on the decrease every year since 1991: globally from 36.8% down to 28.6% in five years (from 75.1% down to 65.3% among babies under 3 months). The rhythm and intensity of the epidemic have risen sharply: in five years, the number of patients has increased by 119% and that of patients admitted to hospital by 69%, while the epidemic peaks are earlier and higher. CONCLUSION: These statistics have actually been used to allocate additional resources in AP-HP hospitals during the epidemics. To avoid the saturation of bed space in the future, ambulatory care of patients not admitted to hospital should be favored.

Short term respiratory health effects of ambient air pollution: results of the APHEA project in Paris.

STUDY OBJECTIVE: To quantify the short term respiratory health effects of ambient air pollution in the Paris area. DESIGN: Time series analysis of daily pollution levels using Poisson regression. SETTING: Paris, 1987-92. MEASUREMENTS AND MAIN RESULTS: Air pollution was monitored by measurement of black smoke (BS) (15 monitoring stations), sulphur dioxide (SO2), nitrogen dioxide (NO2), particulate matter less than 13 microns in diameter (PM13), and ozone (O3) (4 stations). Daily mortality and general admissions to public hospitals due to respiratory causes were considered. The statistical analysis was based on a time series procedure using linear regression modelling followed by a Poisson regression. Meterological variables, epidemics of influenza A and B, and strikes of medical staff were included in the models. The mean daily concentration of PM13 and daily 1 hour maximum of SO2 significantly affected daily mortality from respiratory causes. An increase in the concentration of PM13 of 100 micrograms/m3 above its 5th centile value increased the risk of respiratory death by 17%. PM13 and BS were also associated with hospital admissions due to all respiratory diseases (4.1% increased risk when the BS level exceeded its 5th centile value by 100 micrograms/m3). SO2 levels consistently influenced hospital admissions for all respiratory diseases, chronic obstructive pulmonary disease, and asthma. Asthma was also correlated with NO2 levels. CONCLUSIONS: These results indicate that even though the relative risk is weak in areas with low levels of pollution, ambient air pollution, and especially particulate matter and SO2, nonetheless require attention because of the number of people exposed and the existence of high risk groups.

[Epidemiology of Crohn disease in Public Assistance-Hospitals in Paris. Data of hospitalizations 1981-1992]. / Epidémiologie de la maladie de Crohn à l'Assistance Publique-Hôpitaux de Paris. Données d'hospitalisation 1981-1992.

OBJECTIVES: The aim of this study was to describe the epidemiological features of hospitalizations for Crohn's disease in Public Hospitals of Paris ("Assistance Publique-Hôpitaux de Paris") between 1981 and 1992. METHODS: Data concerning hospital stays were obtained from the OTARIE file, containing for each hospitalization descriptive data about the patient (including sex, birth date and locality, residence locality) and the hospital (including the identity of hospital department, the route of admission into the department and discharge from the department, the main medical diagnosis). RESULTS: There was a 2.5-fold increase of the number of hospital stays for Crohn's disease from the beginning to the end of the study period. Concomitantly, the women/men sex-ratio increased from 0.99 to 1.39. The rate of hospital stays lasting less than 24 hours increased at the end of the study period, reaching 10.6% in 1992. Among the patients born out of the area of Paris, there was a significantly higher proportion of patients native from the North of France. CONCLUSION: The prominent epidemiological features concerning the hospital stays for Crohn's disease in Public Hospitals of Paris between 1981 and 1992 were: a) a 2.5-fold increase of the number of patients hospitalized per year between 1981 and 1992; b) a concomitant increase of the sex-ratio in favour of women; c) the existence of a significant higher proportion of patients originary from the North of France.

[An analysis of the organization, profile of the clientele and pathologies managed in the urology division of the Public Assistance-Hospital of Paris. A 15-day cross-sectional survey of 10 services]. / Analyse de l'organisation, du profil de clientèle et des pathologies prises en charge en consultation d'urologie à l'Assistance Publique-Hôpitaux de Paris. Enquête transversale de 15 jours dans 10 services.

A cross-sectional study was carried out in ten urology departments over a two-week period. Three categories of data were collected concerning socio-economic status and epidemiological profiles and management of the patients. The results are presented with comparative analysis of performance of the clinics, and the epidemiological data are analysed with reference to the inpatient case mix.

[Hospitalization for HIV infection in public hospitals in Paris. Recent evolution (1988-1990) and short-term projections (1991-2)]. / L'hospitalisation pour infection par VIH dans les hôpitaux de Paris. Evolution récente (1988-1990) et projections à court terme (1991-1992).

Acute-care hospitalization of subjects infected with HIV in Parisian public hospitals (Assistance Publique-Hôpitaux de Paris) increased by 10% between 1988 and 1990, while outpatient day-care rose by 73%. During this time, the percentage of patients coming from the Paris suburbs rose from 30 to 35%. The average length of stay increased from 14.2 to 14.9 days during the same period, and hospital stays lasting longer than 30 days (9.2%) accounted for 39.2% of all hospitalizations. Forecasts for 1991 and 1992 show acute-care hospitalization rising from 25 to 30% and outpatient care increasing from 45 to 94%, depending upon the hypothesis considered.

[Hospitalization of foreign residents living abroad at the Assistance Publique--hospitals of Paris (1981-1988)]. / Hospitalisation des étrangers résidant à l'étranger à l'Assistance Publique--hôpitaux de Paris (1981-1988).

In 1988, 10,386 foreign patients living abroad were hospitalized in the public Hospitals of "Assistance Publique" in Paris. Specific statistical methods starting from an anonymous file of patients, made it possible to study these hospital stays in terms of patients for each year between 1981 and 1988. Several factors are described: the various origins of the hospitalized patients; the overall decrease in the number of hospitalized patients during the period taken into account, with a detailed analysis for certain nationalities; the comparatively higher rate of tumors and cardiovascular diseases; the distribution of patients by diseases and by geographical origin. These data are in keeping with those of a recent survey on morbidity carried out by the Department of Health.

[Endocrinology in Paris Public Assistance hospitals. Development of hospitalization activity from 1981 to 1990]. / L'endocrinologie à l'Assistance Publique-Hôpitaux de Paris. Evolution de l'activité d'hospitalisation de 1981 à 1990.

An analysis of data of thirteen endocrinology wards gives an overview of hospital activity and epidemiological profiles for a ten-years period. The decrease of the A.L.O.S., the extra-regional recruitment and the shift of in-patient care toward day care show the development of specialization of this discipline.

Results of a comparative study of in-patient satisfaction in eight hospitals in the Paris region.

Using the method of self-administered questionnaires, patient satisfaction was measured in eight hospitals for both in-patient stays and out-patient visits, excluding emergency departments for which this method is not appropriate. According to the size of the ward, the in-patient satisfaction was assessed for a period of time, ranging from one to three months in order to obtain 110 questionnaires; for outpatients, the satisfaction was assessed for one week. On the whole, the study showed high satisfaction with the care provided by physicians and nurses (81% and 74% of patients were "very satisfied"), satisfaction with cleanliness and comfort (respectively 64% and 61%), and low satisfaction for quietness and for the time schedule and the quality of meals (respectively 48%, 52% and 40%). As far as comparisons between hospitals and between wards within a given specialty were made, a major result of the study was to point out the very great range of dispersion of satisfaction scores. For example, if the mean value of the satisfaction about comfort is 61% of patients "very satisfied", the extreme values for the set of eight hospitals are 35% and 70%. Another example may be given in general surgery specialty: if the mean value of the satisfaction for medical care is 78%, the extreme values for the set of seven wards are 68% and 86%. These results make clear that however encouraging the scores may be, the evidence of the variability is a powerful incentive to organize corrective actions.