Case-control study found that primary language disorders were associated with screen exposure.

AIM: We explored the associations between childhood exposure to screens, including televisions, computers, game consoles, tablets and smartphones and primary language disorders. METHODS: This multi-centre case-control study comprised 167 children aged 3.5-6.5 years, who were born in 2010-2012 and diagnosed with primary language disorders, and 109 matched controls without language disorders. Questionnaires were completed by their parents who were recruited by 16 family doctors and 27 speech and language therapists in the Ille-et-Vilaine region of France. The data were analysed using a multivariate logistic regression model and presented as adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). RESULTS: We found that cases (44.3%) and controls (22.0%) exposed to screens in the morning before nursery or primary school were three times more likely to develop primary language disorders (aOR 3.40, 95% CI 1.60-7.23). When this risk was combined with rarely or never discussing screen content with their parents (aOR 2.14, 95% CI 1.01-4.54) they were six times more likely to have language problems (aOR 5.86, 95% CI 1.44-23.95). CONCLUSION: Being exposed to screens in the morning before school, and rarely or never discussing screen content with parents, meant children were six times more likely to develop primary language disorders.

Vaccination coverage of adolescents: Results of a Defense and Citizenship Day-based survey.

INTRODUCTION: Vaccination coverage among French young adults is not routinely measured. Every French adolescent aged between 16 and 18years must take part in the Defense and Citizenship Day (French acronym JDC). We aimed to assess vaccination coverage among young adults for hepatitis B, group C meningococcus meningitis, human papillomavirus (HPV), and measles. We also aimed to assess the proportion of adolescents who received the pertussis booster between the age of 11 and 13years. METHODS: The survey took place from January 19th to 26th, 2015 at the JDC center of Rennes, France. Vaccination coverage data was collected on site from the adolescents' health records. We collected the number of doses received and the dates of administration for each type of vaccine. A properly vaccinated adolescent was defined as having received the right number of doses according to the vaccination schedule. RESULTS: A total of 467 adolescents attended the JDC Day: 408 (87.4%) had brought their health record or an equivalent document. Vaccination coverage was 92.6% [90.1-95.1] for measles, 34.6% [30-39.2] for group C meningococcus meningitis, 40.7% [35.9-45.5] for hepatitis B, and 30.1% [23.9-36.3] of girls had been vaccinated against HPV. Of all adolescents, 60.1% [55.7-64.9] received a dose of the pertussis vaccine between 11 and 13years of age. CONCLUSION: Our results are similar to those of other data sources. With regard to the difficulty of assessing vaccination coverage in that age group, we believe recruitment bias was minimized due to our study location.

[Childhood cancer incidence in French Brittany, 1991-2005]. / Incidence des cancers de l'enfant en Bretagne entre 1991 et 2005.

BACKGROUND: The aim of this study was to describe childhood cancer incidence in French Brittany from 1991 to 2005, as well as its temporal and geographical variations. METHODS: Childhood cancer incidence was analyzed from the data from the Brittany child tumor registry. Crude rates, world age standardized rates and cumulative rates were estimated for all cancers and for each diagnosis group. Standardized rates were also estimated for each of the four Brittany districts. Poisson regressions were performed to estimate trends in annual rates and to compare incidence rates between 2000-2005 and 1991-1999 periods, and between districts. RESULTS: Between 1991 and 2005, 1176 incident cancer cases were recorded in children younger than 15. Age standardized incidence was 169.5 cases per million of children per year. The most frequent cancers were leukemia (30%), central nervous system tumors (24%), lymphomas (12%) and neuroblastomas (8%). For the period 1991-2005 in Brittany, the risk of cancer diagnosis among children aged less than 15 years was 1/459. No significant increase trend was observed over the 1991-2005 period. There was however a significant or close to significant increase in incidence for lymphomas (RR: 1.38 [95%CI: 1.00-1.93]) and central nervous system tumors (RR: 1.24 [95%CI: 0.99-1.56]) between the 1991-1999 and 2000-2005 periods. A significant decrease trend was observed for renal tumors over the 1991-2005 period (Estimated Annual Percent Change=-7.6%, P=0.02). There was no significant difference of incidence between the four districts of the region. CONCLUSION: For the period studied, childhood cancer incidence in French Brittany was lightly higher than for the whole country. Although increases in lymphomas and central nervous system tumors coincided with increasing use of a standardised data collection system for medical information, the data collected provided no evidence in favor of more complete data collection following implementation of the system.

[Epidemiology of tuberculosis in French Brittany: cases notified between 2000 and 2007]. / Épidémiologie de la tuberculose en Bretagne: les cas déclarés entre 2000 et 2007.

The authors studied the reported cases of tuberculosis diseases in Brittany between 2000 and 2007 via the mandatory notification scheme. One thousand nine hundred and seventy-five cases were notified during the study period. The incidence in French Brittany (eight cases per 100,000) was the third highest in France. A statistically significant negative trend was observed later, mainly attributable to a decrease between 2000 and 2001. The mean patient age at notification was 55 in Brittany versus 46 years of age for the rest of France (p<0.001). Eighty per cent of the patients were born in France versus 46% for the rest of the country. The rate of multiresistance to antibiotics was 1.3% versus 4.6% for the rest of France (p<0.001). The estimated completeness of notification was 80% compared to 70% for the whole country. Despite a decrease of tuberculosis incidence in Brittany, the withdrawal of mandatory vaccination suggests strengthening tuberculosis monitoring in the future.

A new knee arthrometer, the GNRB: experience in ACL complete and partial tears.

INTRODUCTION: Clinical diagnosis of anterior cruciate ligament (ACL) tears (Lachman test and Pivot shift test in valgus and internal rotation) is reliable in case of complete ACL tear but reveals elusive in case of partial tears. Quantitative assessment of anterior tibial translation proves to be imprecise, subjective and poorly reproducible especially with the KT-1000 arthrometer. We developed the GNRB, an alternative original anterior knee laxity measurement device. The lower limb is placed in a rigid support with the knee at 0 degrees of rotation, the restraining power being recorded. A 0-250 N thrust force is transmitted by a jack to the upper segment of the calf. This force is only applied in the absence of hamstring muscles contraction. Displacement of the anterior tibial tubercle is recorded using a sensor with a 0.1mm precision. HYPOTHESIS: We hypothesize that this knee laxity measurement device is more reliable and reproducible than other currently available arthrometers. MATERIAL AND METHODS: During a first validation study, the GNRB was compared to the KT-1000 arthrometer, in 20 pairs of healthy knees, measurements being performed by two investigators. Variance analyses were carried out at 134 N. In a second clinical study, 21 complete ACL tears (the notch is devoid of ACL) and 24 partial ACL tears (anterior or posterior bundle tear and cicatricial ACL remnant in continuity) were tested with these arthrometers to exact a differential laxity threshold value between both knees at 250 N. Statistical analysis was subsequently performed using variance and ROC curves analysis. RESULTS: The GNRB arthrometer reveals to be significantly more reproducible than the KT-1000, irrespectively of the tester's experience level. Moreover, unlike the KT-1000, the achieved measurement is independent from the uninvolved side. Reproducibility of laximetry proves to be significantly better with the GNRB than with the KT-1000, wherever the examiner's experience stands and whatever the evaluated side condition could be. When differential laxity threshold value was 3mm in complete ACL tears, sensitivity was 70% and specificity 99% at 134 N. Using a 1.5mm threshold value in ACL partial tears, the arthrometer sensitivity was 80% and specificity was 87% at 134 N. DISCUSSION: Reproducibility of laximetry was significantly better with the GNRB than the KT-1000 device, wherever the examiner's experience stands and whatever the evaluated side-condition could be. The GNRB reports various supplementary advantages compared with other available laximeters. Good control of the investigated limb position in rotation, recording of translation in the absence of hamstring muscles contraction and in direct comparison with the KT-1000: reproducibility, constant pressure, arthrometry improved accuracy and automated measurements recording. The GNRB might be used for diagnosis of partial and complete ACL tears and during follow-up of reconstructed or not ACL tears. LEVEL OF EVIDENCE: type II. Prospective comparative study.

Risk analysis of leukaemia incidence among people living along the Techa River: a nested case-control study.

Large quantities of radioactive materials released over time from the Mayak nuclear weapons facility caused significant internal and external exposure for people living along the banks of the Techa River (Southern Urals, Russia). We conducted a nested case-control study in the Extended Techa River Cohort to determine whether the risk of leukaemia incidence increased with protracted exposure to ionising radiation or with other non-radiation risk factors. The study included 83 cases identified over 47 years of follow-up and 415 controls matched for sex, age at diagnosis, age (within a 5 year age group), and date of initial residence in the riverside area. External and internal doses have been calculated using the Techa River Dosimetry System 1996 (TRDS96). Conditional logistic regression was used to calculate odds ratios per Gray (OR/Gy) and 95% confidence intervals (95% CI). After excluding cases of chronic lymphoid leukaemia, the OR/Gy of total, external, and internal doses were 4.6 (95% CI: 1.7-12.3), 7.2 (95%CI: 1.7-30.0) and 5.4 (95%CI: 1.1-27.2), respectively. A history of solid tumour, either malignant or benign, before the leukaemia diagnosis was associated with a 2.5-fold increase in the leukaemia risk (95% CI: 1.1-5.9). Even though the analysis of confounders was less useful than expected because of missing data, multivariate analyses that took the exposure dose into account confirmed the association between leukaemia incidence and tumour history.

The congenital anomalies registry in Belarus: a tool for assessing the public health impact of the Chernobyl accident.

A national population-based malformation registry (BNR) has been in operation since 1979 in Belarus, one of the countries most heavily exposed to the contamination from the Chernobyl accident of 26 April 1986. We describe its methodology and its compliance with established criteria, evaluate the completeness of its reporting, and analyze the data collected in four administrative regions with contrasting contamination levels from 1983 through 1999. Nine easily diagnosed malformations have been monitored since 1983. Reporting completeness exceeds 85% for all periods and all regions. In all periods, the prevalence at birth of these malformations was lower in the most contaminated regions and showed a similar positive time trend in areas of low and high contamination. We conclude that the BNR is a reliable tool for studying the possible effects on congenital malformations caused by the Chernobyl accident. Although the trend we observed may be explained by better ascertainment and prenatal diagnosis, a real increase cannot be ruled out.

Relationship between migraine, blood pressure and carotid thickness. A population-based study in the elderly.

The relationship between migraine and blood pressure is controversial. We studied the association between migraine and blood pressure in a population-based sample of elderly patients. Participants were 1373 subjects 59-71 years of age. Lifetime migraine was diagnosed according to the International Headache Society criteria by a headache specialist. Blood pressure was measured as well as the carotid intima-media thickness (IMT) which is a good marker of the long-term exposure to high blood pressure. Migraine during life was diagnosed in 140 participants. Mean systolic blood pressure was lower in subjects with migraine than in those without headache (128 mmHg vs. 137 mmHg). There was a significant trend of decreasing frequency of migraine with increasing blood pressure and also with increasing IMT. In this study, migraine was associated with lower levels of blood pressure and with smaller values of carotid wall thickness.

Lay versus expert interviewers for the diagnosis of migraine in a large sample of elderly people.

OBJECTIVE: To determine the agreement between lay interviewers and experts in the diagnosis of migraine by questionnaire. SUBJECTS: A population based sample of 1188 individuals aged 64 to 73 years. METHODS: Participants who declared that they had recurrent headaches (n = 238) answered a structured questionnaire by lay interviewers with special training in migraine. A migraine expert subsequently interviewed all the headache sufferers using the same questionnaire. Migraine was defined according to the International Headache Society criteria. RESULTS: In comparison with the expert, the diagnosis derived by the lay interviewers had high values for specificity (97%) and positive predictive value (86%), and a low sensitivity (50%) and negative predictive value (57%). Agreement between the expert and the lay interviewers was low, with a kappa value of 0.36 (95% confidence interval 0.26 to 0.47). The most serious discrepancies concerned the duration of attacks, the worsening of headaches by physical activity, the presence of nausea or vomiting, and the unilaterality of headaches. As a result, the lifetime prevalence of migraine headaches was greatly underestimated by lay interviewers (6.5%) in comparison with the expert (11.1%). CONCLUSIONS: A low level of agreement between lay interviewers and a headache expert in the diagnosis of migraine headaches by structured questionnaire may result in a substantial underestimation of migraine prevalence.

[Analysis of an apparent cluster of Crohn's disease cases in Indre-et-Loire, France (1990-1999)]. / Etude d'un agrégat apparent de maladies de Crohn en Indre-et-Loire, 1990-1999.

BACKGROUND: Four cases of Crohn disease (CD) were diagnosed between 1990 and 1997 in children living in the same area in the Indre-et-Loire district (county A). The local population raised the hypothesis that an environmental source could be responsible for these cases. An investigation was carried out to assess the excess of cases and to identify their possible determinants. METHODS: A case was defined as any new case of CD (European definition) that occurred between 1989 and 1998 in county A or in the adjacent county of the Vienne district. Case finding was done by contacting all hospital services, pediatricians and gastro-enterologists in the 2 districts. A Standardized Incidence Rate (SIR) was calculated for sex and age in adults and children using data from the Inflammatory Bowel Registry of northern France. Statistical significance was assessed by a test taking into account small samples. A descriptive study was carried out among pediatric cases. RESULTS: Four pediatric cases and four adults were identified, all from county A. The SIR in adults was 0,45 (95% Confidence Interval [95% CI: 0.12-1.15). In children, the global SIR was 8,51 (95% CI: 2.29-21.79) and 19,05 (95% CI: 5.12-48.70) in county A. The descriptive study did not identify any exposure leading to a possible hypothesis concerning the origin of the cases. CONCLUSION: This study has shown that the incidence of CD among children of the area was greater than observed in France and has permitted to establish a close relationship with the affected families, to implement a social approach to the problem and to limit rumors. It illustrates the interest of a systematic stepwise approach, which takes into consideration the anxiety of the local community. Cluster investigation should be integrated as part of the public health agencies activities. However, in most cases, despite an excess risk, results do not allow to conclude in terms of etiology.

Prises de risques lors de la premiere injection intraveineuse de drogue.

Aims. - The objectives of the study were to describe the circumstances surrounding the intiation of intravenous drug use, the role of the introducer and to evaluate intravenous drug users risk behaviors at the first injection of drug. Design.- In 1997, we conducted a cross-sectional survey using a structured questionnaire concerning the initiation process into intravenous drug abuse. IDUs were interviewed in four treatment drug abuse and psychosocial centers in Paris and in one prison. Participants.- Of the 152 consecutive IDUs interviewed, 143 completed the questionnaire, 83 were male. Findings. - The mean age at first opiate use and at first injection were 19 years (SD: 4.3) and 20 years (SD: 4.3). At first injection, heroin was the main used drug (91%), the subject was with others persons (91%), asked himself for injection (70%) albeit had not planned this injection (40%). The subject injected at a friend's home (31%). The introducer was an IDU (93%), mean age 23.4 (SD: 5.2). He or she was a friend (61%) or a sexual partner (14%). The preparation of the first injection and the injection were made by the introducer in 72% and 74% of cases. The injecting equipment had been borrowed (22%) from an IDU whose HIV status and HCV status were unknown in 83% and 85% of cases. Conclusion. - Our study shows novel results about the first injection, they are of prime importance for harm reduction. The introducer plays a major role in preventing risk-behavior at the first injection and for education about safe injecting practices.

[Risks incurred by the first intravenous drug injection]. / Prises de risques lors de la première injection intraveineuse de drogue.

AIMS: The objectives of the study were to describe the circumstances surrounding the initiation of intravenous drug use, the role of the introducer and to evaluate intravenous drug users risk behaviors at the first injection of drug. DESIGN: In 1997, we conducted a cross-sectional survey using a structured questionnaire concerning the initiation process into intravenous drug abuse. IDUs were interviewed in four treatment drug abuse and psychosocial centers in Paris and in one prison. PARTICIPANTS: Of the 152 consecutive IDUs interviewed, 143 completed the questionnaire, 83 were male. FINDINGS: The mean age at first opiate use and at first injection were 19 years (SD: 4.3) and 20 years (SD: 4.3). At first injection, heroin was the main used drug (91%), the subject was with others persons (91%), asked himself for injection (70%) albeit had not planned this injection (40%). The subject injected at a friend's home (31%). The introducer was an IDU (93%), mean age 23.4 (SD: 5.2). He or she was a friend (61%) or a sexual partner (14%). The preparation of the first injection and the injection were made by the introducer in 72 % and 74 % of cases. The injecting equipment had been borrowed (22%) from an IDU whose HIV status and HCV status were unknown in 83 % and 85 % of cases. CONCLUSION: Our study shows novel results about the first injection, they are of prime importance for harm reduction. The introducer plays a major role in preventing risk-behavior at the first injection and for education about safe injecting practices.