La santé des enfants en France : un enjeu négligé ?

INTRODUCTION: As part of the National Health Strategy, the High Council for Public Health (HCSP) was tasked with leading a reflection on a “comprehensive and concerted child health policy”. Policy-making requires relevant knowledge and statistical benchmarks. It therefore seemed useful to examine the French statistical system and active research topics. This assessment is expected to provide a current portrait of the priorities and implicit health choices for the children. It also aims to reveal insufficiently explored aspects of children’s health. METHODS: The inventory of this system was carried out on the basis of several methods, hearings, work of two documentalists, and analysis of the published and grey literature. RESULTS: The emphasis is on pathologies, medical prevention and behaviors conceived primarily as individual. The idea that the health of tomorrow’s adults is built up behind this apparent good health and its inequalities does not appear, or only marginally. The elements on affective, cognitive or relational development are not sufficiently analyzed, for lack of data. The living conditions of children, especially poverty and violence in all its forms, are not sufficiently considered as health issues. Research is developing today with a hospital-centric vision, without a real strategy of research on children’s health. DISCUSSION: Given the dispersion of data, publishing a summary report on children’s health on a regular basis is essential, as enriching the system with data on the environment, poverty and psychomotor, psychosocial and cognitive development. There is an urgent need to develop research on children’s health and to define a research strategy that does not exist today.

Clinical Characteristics Are Similar across Type A and B Influenza Virus Infections.

BACKGROUND: Studies that aimed at comparing the clinical presentation of influenza patients across virus types and subtypes/lineages found divergent results, but this was never investigated using data collected over several years in a countrywide, primary care practitioners-based influenza surveillance system. METHODS: The IBVD (Influenza B in Vircases Database) study collected information on signs and symptoms at disease onset from laboratory-confirmed influenza patients of any age who consulted a sentinel practitioner in France. We compared the clinical presentation of influenza patients across age groups (0-4, 5-14, 15-64 and 65+ years), virus types (A, B) and subtypes/lineages (A(H3N2), pandemic A(H1N1), B Victoria, B Yamagata). RESULTS: Overall, 14,423 influenza cases (23.9% of which were influenza B) were included between 2003-2004 and 2012-2013. Influenza A and B accounted for over 50% of total influenza cases during eight and two seasons, respectively. There were minor differences in the distribution of signs and symptoms across influenza virus types and subtypes/lineages. Compared to patients aged 0-4 years, those aged 5-14 years were more likely to have been infected with type B viruses (OR 2.15, 95% CI 1.87-2.47) while those aged 15-64 years were less likely (OR 0.83, 95% CI 0.73-0.96). Males and influenza patients diagnosed during the epidemic period were less likely to be infected with type B viruses. CONCLUSIONS: Despite differences in age distribution, the clinical illness produced by the different influenza virus types and subtypes is indistinguishable among patients that consult a general practitioner for acute respiratory infections.

Assessment of the use of hypolipidemic agents (HAs), mainly statins, in elderly subjects aged 80 years and more in Burgundy: analysis of 13,211 patients.

Only few studies have investigated the use of HA in elderly subjects and there are no data in very elderly subjects. We assessed the prescription of HA and analyzed the relationship between such prescriptions and frailty markers among persons aged 80 and more in an observational study. We recorded the prescriptions for 13,211 patients aged 80-109 years and affiliated to the "Mutualité-Sociale-Agricole (MSA)" of Burgundy over a 1-month period. The prescription of a HA among all included patients, and the existence of serious long-term disease(s) (LTD), polypharmacy or a prescription of cardiovascular drugs among patients receiving a HA were recorder. Among the 13,211 patients, 3412 aged 80-98 years were treated with an HA. The main HA were statins (70.4%), and fibrates were used in 27.3% of cases. Of these 3412 patients, 2250 had one or several LTD mainly coronaropathy, hypertension, diabetes mellitus or peripheral artery disease. The mean number of drugs per prescription was 6.37. Among subjects treated with HA, 40% also received antiplatelets, 35.6% ß-blockers and 30% inhibitors of the renin-angiotensin system. For 99% of the patients, the prescription of HA was a renewal. Prescribers were mainly general practitioners (96.8%). Statins are the most widely prescribed HA even among very elderly subjects. However, after 80 years the prescription of HA, mainly statins, decreases with aging. This could be explained by polypathology, polypharmacy and the deterioration in metabolic functions which are markers of frailty. This study should encourage research into the use of statins in very elderly subjects.