[Alcohol use in young adolescents. A survey in French secondary schools]. / Consommation d'alcool chez les jeunes adolescents : enquête en milieu scolaire.

Among young adolescents, early use of alcohol has been shown to be related to later alcohol use disorders and alcohol-related problems in numerous epidemiologic studies. However, if drinking problems are now well documented in young people, few data are available on alcohol use in children and young adolescents. The purpose of this study was to examine the perceptions and attitudes with respect to alcohol use among young adolescents entering their first year of secondary school (mean age, 11.5 years). Data were collected from the ESPACE program, a preventive program conducted in the educational district of Limoges, France. Of the 2268 respondents with complete data, 73.4% (77.1% in males vs. 69.9% in females; P<0.001) reported having tasted alcohol drinks and 3.7% (4.9% in males vs. 2.6% in females; P=0.004) having experienced drunkenness at least once. Of these adolescents, 5.4% (8.5% in males vs. 2.4% in females, P<0.001) reported consuming alcohol at least once per month, which may be considered as a sort of regular drinking pattern. Taking age, sex, and level of alcohol consumption into account, experience of drunkenness (21.9% in regular users vs. 3.7% in occasional users), tobacco use (25.8% in regular users vs. 12.6% in occasional users and 1.5% in nonusers) and cannabis use (6.0% in regular users vs. 0.9% in occasional users and 0.2% in nonusers) were found to be significantly more frequent in regular alcohol users than in other students (P<0.001). Data analysis also showed that regular alcohol users felt significantly more frequently depressed, lacking self-assurance, dissatisfied with their physical appearance and their way of life, and they felt that they exhibited significantly more impairments in their interactions with parents, peers, and the school environment. Similarly, they were found to have significantly more frequently an inclination for risk behaviors and a significantly more positive view of drinking than other students. These results look almost like those reported in adolescents and young people, and show that the alcohol abuse pattern is drawn early in childhood. They also highlight the value of epidemiologic investigations for planning preventive interventions.

Evaluation of at-home phlebotomy for iron overload: feasibility and satisfaction of patients and healthcare workers.

OBJECTIVE: This study aimed to evaluate at-home phlebotomy and the satisfaction of iron-overload patients and healthcare workers with the procedure. METHODS: Forty-two patients underwent at-home phlebotomy between 2003 and 2006. The phlebotomy was performed by the patient's nurse, who was trained by the private healthcare firm that also took charge of the disposal of the blood products. Data concerning these phlebotomies were collected via telephone interviews with all 42 patients, as well as 35 nurses and 40 primary-care physicians. The Limousin Regional Health Observatory processed the data collection. RESULTS: Ninety percent (38/42) of the patients, 80% (28/35) of the nurses and 67% (27/40) of the primary-care physicians responded. For 80% of the patients, phlebotomy volume and frequency were as prescribed. Patients chose home phlebotomy for personal reasons, or because of the limited availability of French Blood Establishment facilities (68%), or in response to being offered it by their hospital physician (32%). For 81.6% of the patients, at-home phlebotomy was more satisfactory than phlebotomy in hospital or at the French Blood Establishment and, for 84%, the constraints required were fully acceptable. The nurses considered that these homecare procedures were within their area of responsibility (100%), but felt that the remuneration was insufficient (65%). Ninety-six percent of the primary-care physicians said they were correctly informed, but only 40% felt that they were truly committed to the procedure. CONCLUSION: At-home phlebotomy is feasible, less costly than institutional phlebotomy and improves patient comfort.

[Parents' attitudes towards childhood fever. A cross-sectional survey in the Lyon metropolitan area (202 cases)]. / L'attitude des parents face à la fièvre de leurs enfants. Une enquête transversale des résidents de l'agglomération lyonnaise (202 cas).

INTRODUCTION: The patient overload in pediatric healthcare facilities is caused in part by parents bringing their children in for consultations for fever. We conducted a survey in the Lyon metropolitan area to improve our understanding of parents' attitudes towards their children's fever. OBJECTIVE: To assess the frequency and characteristics of healthcare utilization and evaluate parents' knowledge and attitudes before consulting. METHODS: A random sample of families with at least one child under 6 years of age and living in the Lyon metropolitan area was surveyed by telephone, according to a closed questionnaire that was answered by the person usually responsible for the child's health. RESULTS: 202 families were questioned: 58.9% defined fever as a temperature over 38 degrees C, and 82% used rectal thermometers to measure temperature. Among 144 parents of children with an episode of fever within the previous 12 months, 73% called a physician during the episode, 44% of them immediately. Working-class parents called more frequently (90%) than parents who were professionals or managers (74%). Most parents (94%) administered medication to the child several times before calling the physician. Paracetamol and ibuprofen were mentioned most often. 93% of fever episodes led to consultations. DISCUSSION: Our results show that 59% of the sample defined fever as a temperature equal to 38 degrees C and that fever episodes lead commonly and quickly to physician visits, but that parents do use physical methods and drugs to reduce fever before calling a physician.

[Evaluation of microbial indicators of health risk related to river swimming places]. / Evaluation des indicateurs microbiens du risque sanitaire lié aux baignades en rivière.

A retrospective follow-up study was conducted among 5,737 tourists in 8 holiday camps, during the 1986 summer, in the Ardèche river basin, in order to study the relationship between the bacteriological water quality and the morbidity that occurred to swimmers. Total morbidity was more frequent among bathers than non-bathers (Risk Ratio = 1.7 [95% confidence interval = 1.4-2.1]); gastro-intestinal illness was the major type of morbidity (RR = 2.8 [1.8-4.4] for "objective gastro-intestinal diseases). After screening for the germs that were best correlated with gastro-intestinal and skin diseases, using simple linear regression, logistic regression models allowed confirmation that fecal streptococci best predicted gastro-intestinal morbidity; it significantly exceeded the risk observed among non-bathers above a concentration of 20 SF/100 ml ("objective" gastro-intestinal morbidity). The relationship with fecal coliforms was less clear. However, they are good indicators of skin diseases risk. These results should help re-evaluation of the current microbiological standards concerning recreational waters.

[Passive smoking respiratory risk. A quantitative synthesis of the literature]. / Tabagisme passif et risque respiratoire. Une synthèse quantitative de la littérature.

Fifty nine scientific papers had been published in english or french literature, by 1988, on the matter of respiratory health effects of environmental tobacco smoke exposure (ETS). Fifteen dealt with lung cancer. An original meta-analytical approach was used in order to assess the consistency of these results, where the quality of the papers contributes to the weighing scheme, along with the traditional precision parameters. Lung cancer studies converge towards a point estimate of the relative risk (RR) near 1.5, contrasting non smokers exposed during a long time to ETS (mostly at home) and non exposed non smokers (95% confidence interval = 1.3-1.6). Important methodological difficulties did not allow, to date, to show consistent dose-effect relationship with duration or intensity of exposure. Chronic infections of lower respiratory tract related to ETS have been frequently observed (RR = 1.3; 1.2-1.4) as well among adults as among children. Wheezing and asthma are likewise more frequent among children exposed to ETS at home (RR = 1.2; 1.1-1.4). A modest, although statistically significant decrease of Forced Expiratory Volume at One Second is associated with passive smoking among children (mean effect = -0.5%). Health risk related to passive smoking are much lower than those caused by active smoking. However, this hazard should not be underlooked, since ETS is universally present in everyday life and since anyone may be exposed, including children, the elderly and those who suffer from chronic respiratory diseases. Many research needs are underscored by this meta-analysis. It remains that the current state of knowledge on health risks associated with passive smoking warrants that strong preventive action, educative or statutory, be promoted.

A controlled evaluation of a homoeopathic preparation in the treatment of influenza-like syndromes.

1. A controlled clinical trial was conducted to assess the effectiveness of a homoeopathic preparation in the treatment of influenza-like syndromes. 2. 237 cases received the test drug and 241 were assigned to placebo. Patients recorded their rectal temperature twice a day, and the presence or absence of five cardinal symptoms (headache, stiffness, lumbar and articular pain, shivers) along with cough, coryza and fatigue. 3. Recovery was defined as a rectal temperature less than 37.5 degrees C and complete resolution of the five cardinal symptoms. 4. The proportion of cases who recovered within 48 h of treatment was greater among the active drug group than among the placebo group (17.1% against 10.3%, P = 0.03). 5. The result cannot be explained given our present state of knowledge, but it calls for further rigorously designed clinical studies.

Epidemiological significance of microbiological pollution criteria for river recreational waters.

A retrospective follow-up study was conducted during the summer of 1986 in the French Ardèche basin in order to assess the relationship between swimming-related morbidity and the bacteriological quality of the recreational water. 5737 tourists in eight holiday camps were questioned as to the occurrence of illness and their bathing habits during the week preceding the interviews. The rate-ratio contrasting swimmers and non-swimmers for total morbidity is 2.1 (1.8-2.4) = 95% confidence interval); gastrointestinal illness is the major type of morbidity and differs significantly between the two groups (RR = 2.4 (1.9-3.0) for total gastrointestinal cases; RR = 2.3 (1.7-3.2) for 'objective' gastrointestinal cases). Faecal streptococci (FS) are best correlated to gastrointestinal morbidity, using direct linear regression models. Faecal coliforms (FC) are not as good predictors of the risk. The concentration of faecal streptococci above which the 'objective' gastrointestinal morbidity among bathers is significantly greater than among non-bathers is 20 FS/100 ml. Swimmers suffer skin ailments much more frequently than non-swimmers (RR = 3.7 (2.4-5.7]; although the relationship may be artefactual, this type of morbidity is well correlated with the concentration of faecal coliforms, aeromonas and pseudomonas. This study provides epidemiological data on which to base microbiological standards for river recreational waters dependent on what might be considered as an 'acceptable' risk.

Comparison of bacterial indicators and sampling programs for drinking water systems.

A total of 48 French villages were selected for a survey of water quality from February 1983 to June 1984 as part of an epidemiological study conducted in the rural area of the Rhône-Alpes region. Water samples were collected and analyzed on a weekly basis in each village. Bacteriological analysis of each water sample included enumeration of standard plate count bacteria, total and thermotolerant coliforms, and fecal streptococci. The water quality regulations are examined as to the analysis frequency, the volume of samples, and the relationship between the various bacterial indicators. Analyzing 300-ml, instead of 100-ml, samples tends to generate better information on single water samples. However, if many samples are analyzed over time from the same community, the value of using large volumes of water samples is diminished. The comparisons between bacterial indicators showed that the information obtained from the various indicators was very similar. However, fecal streptococci had a better predictive value of a negative test than coliforms with respect to the French standards.

A follow-up study of gastro-intestinal diseases related to bacteriologically substandard drinking water.

In a prospective follow-up study conducted in 52 French alpine villages, one weekly water sample was taken in each village provided with untreated ground water and analyzed as to the presence of four indicator bacteria: total plate count, total coliforms, thermotolerant (fecal) coliforms, and fecal streptococci. Cases of acute gastro-intestinal disease (AGID) occurring among 29,272 inhabitants were reported through physicians, pharmacists, and primary school teachers. A loglinear model identified fecal streptococcus (FS) as the best predictor; the presence of fecal coliforms enhanced the effect of FS. The total bacteria count and the total coliforms had no independent contributions. A threshold analysis suggested that any level of indicator bacteria above zero was associated with an excess of AGID.

[Longitudinal study of the risks related to the consumption of water not conforming to bacteriological norms]. / Etude longitudinale des risques liés à la consommation d'eaux non conformes aux normes bactériologiques.

A prospective follow-up study lasting 18 months in 1983-1984 was conducted in 50 villages in order to assess the risk related to the consumption of drinking water which did not meet the bacteriology standards. 119 physicians, 52 pharmacists and 118 primary-school teachers enumerated the cases of acute gastro-intestinal diseases observed among a population of 29,272 inhabitants. A weekly water sample was analysed in each village as to the presence of four indicator germs of fecal contamination: total plate count, total coliforms, fecal coliforms (thermotolerant) and fecal streptococci. 1,950 cases of acute gastro-intestinal diseases were registered by the physicians and pharmacists during a population experience of 1,873,303 persons-weeks, i.e. an incidence density of 1.06 X 10(-3) cases per person-week. The risk notified by the school teachers among children aged 7 to 11 was higher: 16.3 X 10(-3) cases per child-week. The villages were classified in 3 groups, according to the proportion of substandard samples: "good", "intermediate", and "bad" categories. The relative risk contrasting the "bad" and "good" villages was 3.5 for the cases notified by the physicians and the pharmacists among the general population (95% confidence interval = 2.5-4.8); it was 1.7 for the cases reported by the teachers among the children (95% confidence interval = 1.5-1.9). This concordant difference was very significant but not constant across the 18 months of the survey. The authors conclude that the bacteriology standards are a relevant indicator of a health hazard.