Search

Background: The objective was to describe a possible cancer mortality risk in relation with the occupational exposure within an International study co-ordinated by the International Agency for Research on Cancer., Methods: An epidemiological cohort study was set up to assess the mortality in four French pulp and paper companies. The four cohorts were followed up from January 1st 1968 to December 31st 1992. The causes of death were ascertained by matching with the national file of causes of death., Results: The full cohort consisted in 5,529 men and 876 women. The total numbers of subjects deceased between 1968 and 1992 were respectively 708 and 34. Causes of death could be traced for 98%. The observed mortality was significantly lower than the expected for all causes of deaths (SMR = 0.86) as well for all deaths by cancer (SMR = 0.87). The analysis by departments showed an excess mortality by cancer of the pancreas in the wood preparation department (SMR = 3.14) as well as in the paper production department (SMR = 2.04)., Conclusions: In absence of any prior hypothesis, it is difficult to assign an occupational origin to these observed excesses. The future results of the international study will enable us to interpret these results more precisely.

Several epidemiological studies have demonstrated at the individual level an elevated risk of cardiovascular death for women who have been using oral contraceptives. Nevertheless, there has been no detectable increase in the number of cardiovascular deaths during the last fifteen years in countries where the use of oral contraceptives has become widespread. In this paper, we have tried to analyse this apparent contradiction and to discuss the causal nature of the relationship linking oral-contraceptives and cardiovascular death. For this purpose, we present a bibliographical summary of the relevant studies as well as an analysis of the trend in cardiovascular deaths among women in France from 1968 to 1975.

Background: Many programs which aim to reduce tobacco consumption in young people are carried out in the school environment, addressing a "captive audience" and monitoring the actions over a period of several years. The approaches identified as promising involve putting in place a tobacco prevention program throughout the entire school years incorporated in the school program. Several studies showed that early initiation to psychoactive substances is a strong predictor of addiction. Considering the above points, an intervention trial on tobacco prevention covering the four years of secondary school (±11-15 years old) was implemented in the Essonne area, in France., Method: This study was based on a cluster randomized trial comparing three groups: two intervention groups and a control group. The present paper describes the school children (1st year in six secondary schools) included in the trial. It studies the national representativity of this population, the comparability between the control and intervention groups and the items link to tobacco initiation., Results: When considering tobacco behavior in 2014, the included population was representative of the school children in 1st year of secondary school in France with 11.5% of tobacco initiation and 2.5% of regular smokers. The groups were comparable except for four items (family and friends smoking, only child, sensitive urban areas). With this knowledge on factors linked to smoking behaviors this population can be included in the trial analysis., Conclusion: The study of the included population will help to perform the trial analysis and authorize the transferability of the trial results if positive., (Copyright © 2019 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

Background: Long-term intratracheal ventilated patients need continuous artificial ventilation support. After the acute periods, these patients may benefit from dedicated follow-up in rehabilitation care centers. In this paper, we aimed to study the validity of the data provided by a French diagnosis-related group (DRG) information system., Methods: For a sample of intratracheal ventilated patients in two rehabilitation units, we compared the data provided in the DRG information system with the data available in the medical charts. Furthermore, we asked the medical, nursing and allied health staff to assess the data provided by the French DRG information system., Results: The diagnosis was found accurate for 86% of hospital stays. In the DRG information system, 77% of the medical care, and 39% of the nursing and allied health care were mentioned correctly. Overall, 55% of the nursing and allied health care procedures in the DRG information system were not reported in the medical charts. The healthcare providers estimated that the frequency of the care provided was underestimated in the DRG information system for 30% of the nursing and allied health care., Conclusion: The patients' main characteristics were found correctly reported in the DRG information system. However, the diversity and the frequency of the care provided were underestimated. These underestimates were mainly related to care frequently provided in these patients (for example, urinary catheterization, massages, counseling for relatives)., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Background: Nutrition education is one of the main lines of the French nutrition policy that has been undertaken for several years. The underlying hypothesis of this approach is that knowledge improvement is one of the ways likely to contribute to health-enhancing diet and physical activity. The objective of this paper, based on the 2008 Health and nutrition Barometer, is to examine the associations observed between knowledge and behavior with regard to diet and physical activity., Methods: The 2008 Health and nutrition Barometer is a nationally representative telephone survey conducted on 4714 individuals aged 12-75 years. For six recommendations of the National Nutrition and Health Program (Programme national nutrition santé [PNNS]), multiple logistic models were used to identify associations between knowledge of these recommendations and behavior, among adults aged 18-75 years. For food consumed on the day before the interview, odds ratios were adjusted for sex, age, education level, agglomeration size and region. As bivariate analysis showed that income level was significant for recommended consumption of fish, this variable was introduced among adjustment variables. Similarly, the variable occupation was introduced for physical activity., Results: A positive association between knowledge of recommendations and nutritional behavior on the day before interview was observed for fruit and vegetables (OR=1.7), dairy products (OR=1.6), and starchy food (OR=1.6). The same was observed for consumption of fish during the 15 days before the interview (OR=5.0) and for physical activity during a usual week (OR=1.5) but not for the "meat, seafood and eggs" food group., Conclusion: Eating habits and physical activity are positively associated with knowledge of nutritional recommendations, mainly acquired via nutritional information and educational actions. Nevertheless, the important differences observed for certain dietary groups between knowledge of recommendations and dietary intake emphasizes the need to further support individual-focused initiatives with health-enhancing environmental strategies., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

In this paper, we present the main tools for conception, implementation and analysis of case-cohort surveys. In particular, we describe the classical weighted estimators, the weighted approach recently suggested by Breslow et al. and the multiple imputation approach, an alternative to weighted analysis of case-cohort data. Variance estimators are also described. We show how to obtain the subcohort size. Finally, we mention the functions and procedures available in R, SAS and Stata software and we illustrate their implementation using simulated subcohorts from the PRIME cohort., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Background: Survey non-response rates are important quality indicators. Refusal rates can induce non-response bias in health survey estimates. However, comparisons across surveys highlight inconsistencies in the use of survey outcome categories and in the calculation of response rates. In this paper we discuss the relevance of these indicators and suggest other survey quality indicators., Methods: Outcome rates from two French random-digit dialing (RDD) telephone surveys are compared : the Nicolle survey on infectious diseases of 4112 individuals conducted in 2006, and the HIV knowledge, attitude, belief and practices (KABP) survey of 5071 individuals in 2004. Based on the same protocol, we describe in details the way the two RDD samples were drawn and how non-response rates were estimated., Results: Non-response rates were different: 36% in Nicolle survey and 18% in KABP survey. However, the quantity of telephone numbers required to obtain one interview was higher in the KABP survey: 2.8 telephone numbers versus 2.1 in the Nicolle survey. The participation rates, aggregating together refusals, break-off and non-reachable numbers, were equivalent for the two surveys. This result occurred because of a greater proportion of unreached calls in the KABP surveys, which is not integrated into the non-response rates commonly used., Conclusion: Survey non-response rate is insufficient to estimate the quality of a survey. The need for other indicators has been previously stressed in the literature, notably with the adoption and utilization of the American Association for Public Opinion Research (AAPOR) standard definitions of four indicators. But these indicators are quite complex for evaluating non-response bias between surveys. In addition to the classical refusal rate, two other indicators are proposed in this paper: participation rate (number of complete interviews divided by the number of eligible and of unknown eligibility units) and a liking contact rate (number of unreachable units because of a long absence, break-off or non-answer divided by the number of eligible and of unknown eligibility units). The sum of these three indicators is equal to 100% and thus easier to manipulate when comparing surveys., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Background: The analysis of "professional motivations", mainly through the possible crowding-out effects between extrinsic and intrinsic motivations, has become an issue of great concern in the economic literature. This paper aims at applying this topic to the healthcare professions where the proper scaling up of pay-for-performance (P4P) policies by public authorities is at stake., Methods: We used a panel of 528 self-employed general practitioners in the "Provence-Alpes-Côte d'Azur" region in France to provide an interpersonal statistical decomposition between extrinsic and intrinsic motivations with regard to preventive actions. Then, we applied a Tobit model in order to specify the main explicative variables of the share of intrinsic motivations entering into physicians' total motivations., Results: The relative share of intrinsic motivations was quite high among physicians paid with fixed fees. We found a significant effect of age on intrinsic motivations describing a U-shaped curve which can be interpreted as being the result of a "life cycle of medical motivations" or a generational effect., Conclusion: The cross-sectional nature of the data does not allow us to draw any conclusions concerning the predominance of the generational effect or the "life cycle effect" on the evolution of the relative share of physician's intrinsic motivations. Nevertheless, the U-shaped relation between intrinsic motivations and age questions the suitability of using uniformly P4P mechanisms. The generations or age groups of self-employed physicians who seem to be less responsive to extrinsic motivations are more likely to favour the introduction of other types of payment schemes (capitation or salary systems) or regulation tools such as clinical practice guidelines., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Background: We conducted a mortality study on a cohort of French nuclear workers employed at Electricité de France (EDF). A first cancer mortality analysis had covered the period 1968-1994. This paper presents results from a mortality analysis including nine additional years of follow-up to cover workers employed from 1968 to 2003., Methods: The cohort includes 22393 workers, 97% of whom are males. Employment data were updated using the EDF personnel file. Vital status was ascertained using the French National Registry of Population, and further completed using EDF personnel and pension files. Causes of death were obtained from the National registry of causes of death. Standardised Mortality Ratios (SMR) were computed using national rates as references. Variations of all causes and all cancers SMRs were studied according to demographic and occupational characteristics., Results: At the study end point (31/12/2003), 74% of workers are still in active employment. Only 0.3% of workers are lost to follow-up. The median duration of follow-up is 20 years. Causes are ascertained for 96% of deaths. The total number of deaths is 874, 307 of which are cancer deaths. SMRs for all causes and cancers show a significant deficit compared to the French national mortality. No significant excess was observed for any of the cancer sites studied. Non-significant excesses are observed for pancreatic, pleural, kidney and brain cancer. Significant variations of all causes SMRs according to age at study entry and attained age are observed. Significant variations of all causes and all cancers SMRs according to diploma at employment are observed, with a reduced SMR for a higher level of diploma., Conclusion: There is a significant deficit of mortality compared to the general population, reflecting a strong Healthy Worker Effect. Although nine years of follow-up were added, this cohort is made up of young workers, most of whom are still in active service. Regular updating of the follow up of this cohort is planned, aiming for an occupational health surveillance of workers occupationally exposed to ionizing radiation in France.

Background: For many years in France, premature mortality (i.e., deaths before 65 years old) and avoidable deaths have generally been used to monitor health of the population and help to elaborate policies in this area. This paper aims to examine the utility of another indicator of premature mortality, which makes it possible to take into account the impact of deaths, the expected years of life lost (EYLL)., Methods: Mortality data for France in the years 2000 to 2002 were obtained from the Centre for Epidemiology of the Medical Causes of Death. Premature mortality was defined as death before 65 years of age. For the calculation of EYLL, the mortality norm chosen was French-life expectancy for the years 2001 to 2003. In order to study the spatial distribution of the indicators above defined, standardized ratios were calculated for each administrative area, taking France as the reference population., Results: Irrespective of the gender and indicator considered, ranking of the causes emphasized three major groups of pathological conditions, which are strongly distinguished from the others: cardiovascular diseases, malignant neoplasm and injuries. The ranking of causes varied considerably according to the indicator used. The spatial representation of standardized ratios of expected years of life lost and deaths before 65 showed a strong North-South trend., Conclusion: The concept of premature mortality is difficult to define and discussions persist on the age limit to use for its quantification. The choice of an indicator strongly depends on the use which one wishes to make. The simple analysis of deaths before 65 years currently used to describe premature mortality in France makes it possible to describe its frequency. The use of a summary measure as EYLL allows to quantify the impact of premature mortality by giving different weights to deaths depending on the age of occurrence. EYLL, thus, seems to be an indicator, which is particularly adapted to decision-making in public health, depending on choices and values one wishes to give preference to.

Background: The conditions of use and access to medical records have become an important source of interest in the last decade. In this context, our main objective was to assess the impact of a paper patient-held records, shared with healthcare professionals., Methods: In the particular case of breast cancer management, we identified the expectations of practitioners and patients. Secondly and according to a Delphi method, we defined the content and size of a medical record, which could be held by the patient. Following these preliminary studies, we conducted a randomized controlled trial, comparing patients with usual follow-up to others holding the new record containing essential information for coordination of care., Results: The patient-held record favoured membership and satisfaction of both patients and health professionals. It was used as a communication tool between physicians and patients, but could also cause anxiety to some patients. Patient quality of life, data confidentiality and costs of care remained identical in the two arms. With its benefits for both patients and healthcare professionals, a new concept of medical records was revealed by this study., Conclusion: New models for healthcare organization deeply modify the roles and relationships of all the actors in the healthcare system. Further research on patient-held records is needed to evaluate the full range of its benefits and limits.

Background: This paper discusses the ethical aspects of a large research program in virology, conducted since 1994 and which has evolved in parallel with the elaboration of bioethics laws in France. This research, which involved the collection of a considerable amount of epidemiological data in the field, focused on epidemiological determinants (mother to child transmission, genetic susceptibility/resistance) of the human oncogenic retrovirus human T cell lymphotropic virus type 1 (HTLV-1). Data were collected from a specific population (Noirs Marrons) living in remote areas in French Guiana (South America). This ethnic group of African descent is highly endemic for HTLV-1 and associated adult T cell leukemia/lymphoma. The population has lived for two centuries on either side of the Maroni river, which constitutes the frontier between French Guiana and Surinam. The low socioeconomic and education levels of a large part of this population are mainly explained by a recent housing/residence fixation on the French side of the Maroni river. It is also linked to significant immigration from Surinam due to the civil war, which lasted for five years in the late 1990s, in this country. Conducting epidemiological surveys in this peculiar context illustrates the limitations of the available current legal framework in France for such studies. Indeed, several important ethical issues arose concerning not only individual and population benefits, but also specificities of the given information and of the informed consent. Another question concerns individual information feed-back in such a context of persistent viral infection, with a very low disease incidence, in a population with a relatively low education level. The goal of this work was mainly to report several of the ethical issues encountered and to discuss possible ways of achieving better information deliver and consent procedures in such a context. Indeed, these procedures should include new ideas and regulations promoting a real partnership, in order to conduct long-term epidemiological studies in populations with a low education level.

Background: This paper is aimed at investigating the extents to which illness modifies labour supply and employment conditions of people with chronic diseases (defined as severe diseases giving rise to 100% coverage of health expenditures by the Sickness Fund)., Methods: It is based on the data of 35073 individuals interviewed in the 2002-2003 French Decennial Health Survey, reporting their health, health care consumption and socioeconomic characteristics, and collected by the French National Institute of Statistics and Economic Studies. Models have been estimated with logistic strategies., Results: Participation in labour market appears, all other things being equal, to be less important for people with chronic diseases. Chronic diseases are more deleterious for blue collar than for white collars workers. The probability to have a part-time job is raised by 60% for people with chronic diseases (100% for men, 50% for women). Suffering from chronic diseases raises the probability to have a desired part-time job rather than a full-time job by 80% (170% for men, 60% for women) and the probability to have an undesired part-time job rather than a full-time job by 50% (30% for men, 50% for women). For the elderly (50-65 years), chronic diseases multiply by three the probability to be out-of-work (and not retired), by two the probability to be retired and by 1.5 the probability to be unemployed compared to being employed., Conclusion: The consequences of chronic diseases on the workplace are not negligible, creating new social inequalities that the French social protection system does not seem to be able to completely cover.

Background: Little information is available on temporal trend in socioeconomic inequalities in cause of death mortality in France. The aim of this paper was to study educational differences in mortality in France by cause of death and their temporal trend., Methods: We used a representative sample of 1% of the French population and compared four periods (1968-1974, 1975-1981, 1982-1988, 1990-1996). Causes of death were obtained by direct linkage with the French national death registry. Education was measured at the beginning of each period, and educational disparities in mortality were studied among men and women aged 30-64 at the beginning of each period. Analyses were conducted for all deaths and for the following causes of death: all cancers, lung cancer (among men), upper aerodigestive tract cancers (among men), breast cancer (among women), colorectal cancer, other cancers, cardiovascular diseases, ischaemic heart diseases, cerebrovascular diseases, other cardiovascular diseases, external causes, other causes of death. Socioeconomic inequalities were quantified with relative risks and relative indices of inequality. The relative indices of inequality measures socioeconomic inequalities across the population and can be interpreted as the ratio of mortality rates of those with the lowest to those with the highest socioeconomic status., Results: Analyses showed an increase in educational differences in all cause mortality among men (the relative indices of inequality increased from 1.96 to 2.77 from the first to the last period) and among women (the relative indices of inequality increased from 1.87 to 2.53). Socioeconomic inequalities increased for all cause of death studied among women, and for cancer and cardiovascular diseases among men. The contribution of cancer mortality to difference in overall mortality between the lowest and the highest levels of education increased strongly over the whole study period, especially among women., Conclusion: This study shows that large socioeconomic inequalities in mortality are observed in France, and that they increase over time among men and women.

Background: In France, a harm-reduction policy was implemented in the late 1980s with the aim of reducing the prevalence of HIV and hepatitis C virus infection among drug users. The ANRS-Coquelicot survey was designed to measure the prevalence of HIV and HCV infection among drug users, and to examine determinants of at-risk behaviors., Methods: In 2002, information was collected from 166 drug users recruited in all types of services specializing in drug use and harm reduction in Marseille, France. Self-reported HIV and HCV serostatus was compared with the results of serological tests done on capillary blood collected on filter paper., Results: The self-reported and biologically documented prevalence rates of HIV infection were identical (22 %). In contrast, the self-reported prevalence of HCV infection was 52 %, while the biologically documented prevalence was 73 %. Overall, 30 % of HCV-infected drug users were unaware of their status. Forty-four per cent of drug users under 30 years of age were HCV-seropositive, suggesting that they had been infected early during drug use., Conclusion: The harm-reduction policy seems to have had a marked impact on HIV transmission among drug users, but a much more limited impact on HCV transmission.

Since the mid-1990s, hepatitis C virus (HCV) transmission through blood transfusion has become very rare in western countries. Better understanding of the current modes of transmission is needed. However, risk factors have been mainly estimated on prevalent HCV infections. In this paper we describe the methods of the main case-control studies and their contribution to the knowledge on modes of HCV transmission. We also report the results of a case-control study of incident HCV infections recently carried out in France which confirms the continuing major role of IV drug use and suggests that transmission related to invasive care remained a potential source of new HCV infection between 1995 and 2001.

Background: Screening cytomegalovirus infection in pregnant women is still controversial in 2004 in France. In this context, we evaluated the interest of such a screening in 2004 in France. This paper was designed to describe trends in CMV prenatal screening practices in 2000-2003 in France., Methods: This retrospective study, describes the prescription of CMV screening in HIV-negative pregnant women giving birth in the private care sector, according to their occupational category and geographical area. Data were provided by the "Caisse d'Assurance-maladie des Travailleurs Indépendants" (independent workers health insurance fund)., Results: The study included 34.347 women, delivering in 2001-2004 (beginning of pregnancy in 2000-2003). The number of pregnant women screened for CMV increased significantly between 2000 (5.8%, 301/5.177), 2001 (11.1%, 1.130/10.139) and 2002 (22.1%, 2.701/12.223), (p<0.001), then was stable in 2003 (22.0%, 1.496/6.808). The percentage of women screened for CMV, at least once during pregnancy, doubled between 2001 and 2002 (p<0.001) in each occupational category and geographical area. It was significantly different between occupational categories (p<0.01), with a higher percentage of women in the self-employed and commercial agent occupational categories than in the craftsman category. There was also a significant difference between geographical areas (p<0.001), with a higher rate in Paris., Conclusion: This study providing baseline information on CMV practices showed: 1- a significant increase in the frequency of CMV screening among pregnant women over the period 2000-2002 with a stabilization in 2003; 2- a similar trend observed in each occupation category and geographical area but with a markedly higher frequency of screening practices in the Paris area and among self-employed women. A study measuring the effect of the 2004 ANAES recommendation suggesting not to screen for CMV during pregnancy should be conducted.

Background: Since 1996, prescribing buprenorphine in high dosage as a drug maintenance treatment has been allowing French general practitioners to undertake drug addicts with a pharmacological support. In France, buprenorphine prescriptions seem to spread over general practitioners (buprenorphine was given to 74,300 patients in 2001). This paper assesses the different factors associated with buprenorphine prescription by general practitioners and with the different degrees of general practitioners' commitment in actually caring drug addicts with the help of buprenorphine., Methods: Two representative samples of private general practitioners, either prescribing buprenorphine (345 over a population of 876) or not prescribing (355 over a population of 1380) have been questioned through a phone interview in the department of South-Eastern France in November and December 2002. Samples have been constituted with the help of a random stratified survey according to sex, age and volume of services (acceptance rate: 65.5%). Survey data have been completed with general practitioners' activity data from Health Insurance and local socioeconomic data from Insee., Results: 37.5% of general practitioners have at least once prescribed buprenorphine during the considered period, but only 26% of the prescribers treated 75% of patients. Prescribers are most often men, younger than 49 years, working in the fixed fees sector and having group practice. They are also most often members of a health care network, trained for drug maintenance treatments and, from an individual point of view, have relatives suffering cancer, or having HIV, or hepatitis C, or who are drug addicts. Low socioeconomic status of the area where GPs exert seems to be particularly associated with general practitioners' prescription of buprenorphine., Conclusion: Data handled in this paper show that supply of substitutive treatments is concentrated among a reduced number of general practitioners and in particularly deprived geographic areas. Workload in deprived areas combined to great professional commitment in maintenance treatment reveals unexpected and unwanted specialisation behaviours by general practitioners, as well as more isolated behaviours by general practitioners who do not ask for particular training program or help by colleagues. These results question the consistency of the general framework of support to general practitioners proposed by health authorities with general practitioners actual practice and needs.

Background: This paper reviews and analyses the main publications concerning health and mortality of the unemployed in France, in order to formulate research orientations for future studies or secondary data analysis., Methods: The conceptual framework was first set up by assembling the different hypotheses concerning the link between health and unemployment (causality versus selection). A review of the different studies was organized by type: health studies based on data from either cross-sectional health surveys at a national or regional scale, or longitudinal surveys, and mortality studies based on data from follow-up of census samples., Results: Those studies confirm the health disadvantage of the unemployed relative to the employed, in terms of self-perceived health, morbidity, health services utilization and mortality. They provide arguments in favor of both the causality and selection hypotheses., Conclusion: The exact nature of the health conditions and causes of death associated with unemployment needs further clarification, as well as the causal pathways.

Background: In France 7,720 people were killed in traffic accidents in 2001, 75% of which were men; the number of injured people is estimated at 153,945, of which 65% were men. The objective of the study is to describe differences between males and females regarding accidents, and to explain the main reasons for these differences., Methods: Analysis is conducted from both national police data (2001) and data from the Rhone medical road accident trauma Register (1996-2001)., Results: The male/female incidence rate is 3.1 for mortality (95% CI: 3.0-3.3) and 1.7 for morbidity (95% CI: 1.7-1.8). Two-wheel motorised vehicle accidents are very specific to males, which explains part of this overrepresentation. The fatality rate and the severe injuries rate among survivors are higher for males. This is true for every main user group (car users, motorised two-wheelers, cyclists, pedestrians) after adjusting for accident circumstances and age of casualties. Males are more severely injured for all body regions and have more often severe after-effects., Conclusions: This paper shows the mechanisms leading to this unfavourable outcome for men. They correspond to differences in the number of trips, in the choice of road transport types, and moreover to differences in risk-taking behaviours. Underlying these behaviours, deep-rooted, strong and rather invariant differences between genders are to be found in the values associated with risk-taking on the road.

Objective: This paper aims to describe and to analyse disparities between men and women for "premature" mortality rates (deaths before 65 year-old). The study is particularly focused on "avoidable" causes of death. These types of deaths are greatly related to risk behaviours such as alcohol abuse, tobacco abuse or dangerous driving. Taking account of these indicators ("premature" and "avoidable" mortality) enables to study health status discrepancies by gender and to characterize specific public health issues in France including high rates of "premature" mortality and risk behaviours., Methods: The analysis is based on exhaustive mortality data from 1980 to 1999 supplied by the Centre for epidemiology of medical causes of death (CepiDc-INSERM). Specific causes of death closely related to risk behaviours are classified as "avoidable": lung and upper airways cancers, cirrhosis, alcoholic psychosis, traffic accidents, aids and suicide. The contribution of these categories in the global male overmortality was assessed according to different demographic and geographic characteristics., Results: Within "premature" mortality, males experience greater burden of "avoidable" mortality (sex-ratio: 4 versus 2). The gender differences are mainly due to injuries and suicides in the younger age groups and to tobacco and alcohol-related cancers (lung and upper airways) in the 45-64 years age group. The recent decline in "premature" mortality sex-ratio is explained by an increase of these two cancers for females. Among european countries, the French male overmortality is especially marked and mainly attributable to "avoidable" causes of death., Conclusion: "Avoidable" and "premature" mortality provide useful tools for the follow-up of health status in France particularly because of high risk behaviours and prevention inadequacy. Reducing gender discrepancies will depend mainly on public health policies in terms of primary prevention.

Background: After a large increase during the 19th and the 20th century, for two decades the gap in life expectancy between sexes has been reducing in most industrialised countries. In France, where it was specially large, it stopped increasing in the early 1980s and decreased in the most recent years. The paper investigates reasons for these recent trends in France and in the industrialised countries., Methods: Two types of data are used for analysis. Death probabilities from life tables are used for calculating male excess mortality by age and estimating the role of various age groups in life expectancy differences by sex. Sex- and cause-specific mortality rates from INED database for France and from WHO database for other countries are used to assess the part played by various causes of death in the gender gap and its evolution., Results: In France, the stabilisation of the gap is mainly related to the decrease in cardiovascular mortality for men who benefit from the same progress but later than women. In the most recent years, the reduction of the gap is due to the trend reversal of male cancer mortality which is now decreasing, specially because of the reduction of lung cancer mortality. In European countries, taken as examples (England & Wales, Sweden, Switzerland, Italy) cardiovascular mortality is also the main responsible for the decreasing differences. Conversely, in Japan, the gap is still increasing specially for mortality from cancer and respiratory diseases., Conclusions: The recent gap narrowing between male and female life expectancy in France is not a specific case. It does not mean that female health situation is worsening but it is related to an acceleration of progress for males. This reduction will most probably go on in the next years, except if females would enjoy dramatic progression in old age mortality.

Objective: At the end of 2000, certain diseases including leukemia were reported among soldiers who participated in the Balkan and in the Gulf wars. Depleted uranium used during these conflicts was considered as a possible cause. Its radiotoxicity is close to that of natural uranium. This paper reviews the epidemiological knowledge of uranium, the means of exposure and the associated risk of cancer., Methods: The only available epidemiological data concerns nuclear workers exposed to uranium. A review of the international literature is proposed by distinguishing between uranium miners and other workers of the nuclear industry. French studies are described in details., Results: In ionizing radiation epidemiology, contamination by uranium is often cited as a risk factor, but the dose-effect relationship is rarely studied. Retrospective assessment of individual exposure is generally insufficient. Moreover, it is difficult to distinguish between uranium radiotoxicity, its chemical toxicity and the radiotoxicity of its progeny. A causal relation between lung cancer and radon exposure, a gas derived from the decay of uranium, has been demonstrated in epidemiological studies of miners. Among other nuclear workers exposed to uranium, there is a mortality deficit from all causes (healthy worker effect). No cancer site appears systematically in excess compared to the national population; very few studies describe a dose-response relationship., Conclusion: Only studies with a precise reconstruction of doses and sufficient numbers of workers will allow a better assessment of risks associated with uranium exposure at levels encountered in industry or during conflicts using depleted uranium weapons.

Since data from biological material banks are now considered as complementary to epidemiological data, most cohort studies have now integrated them. However, their constitution raises numerous logistical problems. The present paper describes the experience of investigators of an on-going prospective study in France: the E3N study. It reviews several constraints that this team had to face, E3N being a study with no individual benefit for the volunteers.

The French SEROCO and HEMOCO hospital-based cohorts have enrolled and followed HIV-infected patients, before and after the highly active antiretroviral therapy era. Among the objectives in 1988, was explicitly mentioned the constitution of a centralised bank of biological material (serums at enrollment and every 6 months, PBMC at enrollment and every 18 months). This paper details the organisation of the bank and the numerous studies performed from this bank, and presents a few simple decision rules which have been developed with the growing acquired experience.

The Gazel cohort was launched in January 1989 among workers of the French national electricity and gas company to form an open and general purpose epidemiological laboratory. More than 20.000 workers (15.000 men, 5.000 women), aged from 35 to 50 volunteered to participate. One of the objectives of this cohort was the constitution of a bank of biological material aiming to collect and preserve various biological samples (serum, plasma, DNA, etc). This paper details the organisation of the bank and presents a feasability study concerning 2.000 volunteers.

The "SUpplémentation en VItamines et Minéraux AntioXydants" (SU.VI.MAX) study is a randomized double-blind, placebo-controlled, primary-prevention trial designed to test the efficacy of a daily supplementation with antioxidant vitamins and minerals at nutritional doses, in reducing several major health problems in industrialized countries, and especially the main causes of premature death (cancers and cardiovascular diseases). This 8-year cohort study started in 1994 in France; 13,535 eligible subjects (women aged 35 to 60, and men aged 45 to 60) were included in 1994 and will be followed up for 8 years. In this paper are described conditions and practical aspects for the realisation of the biological bank developped on the first sample (1994) and completed in 1996 and 1999. Biological material (buffy coat and plasma samples) are saved and stored at -196 degrees C, -80 degrees C and -20 degrees C for any further tests planned at later date (case-control studies and/or validation of new hypothesis).

Background: Indoor environment can be partly responsible for respiratory health. The aim of this paper is to summarize epidemiological studies dealing with the relations between indoor pollutions and asthma or atopy, to analyze the ways of characterization of the dwellings and to expose health effects of the studied risk factors and results of the confrontation between data issued from questionnaires and from environmental measurements., Methods: Thirty two papers were listed on Medline data base since 1990. These are mainly case-control studies and cross-sectional surveys and most often concern children. The health status is objectively evaluated by medical examinations or indirectly characterized by questionnaires on symptoms. All the studies use a questionnaire to describe indoor environment while some environmental measurements, mostly of biological pollutions, could be realized simultaneously., Results: Some associations between different characteristics of the dwellings and respiratory symptoms are commonly found. Thus, exposure to allergens of the dwellings, environmental tobacco smoke, home dampness or characteristics and cleaning of the bedding increase the prevalence of respiratory symptoms. Residential exposure to chemical pollutants, due to the existence of recent paints are also related to different respiratory symptoms. By contrast, for other indoor risk factors, without standardized evaluation, the impact on respiratory health is inconstant. These factors are sociodemographic environment, heating and cooking installations, use of a humidifier, treatment air system or ventilation system, wall-to-wall carpets or pets at home., Conclusions: On examining this review literature, disparity in description of the indoor environment, depending on the studied pollutants, is pointed out. That is why we advice to use ever validated questionnaires to evaluate environmental tobacco smoke, home dampness and presence of pets, in association with environmental measurements to study indoor sources of allergens. Conversely, to evaluate the home exposure to chemical pollutions poorly studied today, some new questionnaires have to be elaborated and validated with regard to environmental measurements before being used in epidemiological studies.

The four keystones of quantitative risk assessment are hazard identification, exposure assessment, dose-response assessment and risk characterization. This paper considers the different steps of risk assessment and their application to food microbiology. Traditionally, quantitative risk assessment has been viewed simply as a method to estimate risk. However, when we conduct a complete risk assessment including different factors from "farm to fork" it can serve to understand the risk process. Quantitative risk assessment can also provide valuable insights as how to best manage the risk.

Background: The development of maintenance treatment for subjects with addictive behavior is an important public health issue. As such, the social effectiveness of maintenance products must be examined from an economical and social point of view. This paper aims at presenting the financial costs involved in the use of Subutex, a product commercialized since 1996., Methods: A complete typology of costs related to drug addiction and its consequences was set up. Some of these costs were estimated on the basis of data drawn from the literature. The cost of Subutex use for maintenance treatment was assessed and compared with the financial stakes including the potential reduction of the economic and social cost of drug addiction., Results: Monthly treatment cost of Subutex was 1252 FrF per drug abuser on maintenance treatment. By extrapolation, for a population of 40,000 drug abusers, the direct medical cost of Subutex during a course of maintenance treatment with general practitioner follow-up was estimated at 600 millions FrF. US data sources were applied to France to assess the cost of illnesses attributable to drug addiction. The cost reached 4.8 billions FrF. The cost of delinquency associated with drug addiction, which mostly concerns money laundered to purchase substances was an estimated 6.4 billions FrF. Finally, the cost of public anti-drug abuse programs was nearly 4.7 billions FrF. Thus, the direct cost of drug addiction consequences reached 15.6 billions FrF. This cost should be compared with the annual cost of Subutex for public organizations which was an estimated 600 millions FrF., Conclusions: The "profit" threshold of maintenance treatment with Subutex in terms of direct costs is very low. A decrease of only 4% of the costs associated with drug addiction would make it possible to balance the financial budget for the community. Our analysis does not take into acount absolutely all the public health and safety aspects involved in the use of Subutex. It does however provide a useful assessment of the financial aspects of the question and justification for this therapeutic strategy from a budgetary point of view.

This paper deals with the main security services of data protection: integrity, authentication, nonrepudiation and confidentiality. It describes the different tools which may be used to achieve these security objectives: encryption, digital signature, access controls, integrity control, audit and certification. The French legislation concerning encryption has been recently updated in order to simplify the use of encryption techniques for personal data security. This legislation describes different authorization or reporting procedures according to the type of the request (application, equipment, import or export of encryption techniques) and the security level required.

Background: The Seine-Saint-Denis Council planned in 1984 a prevention strategy program among schoolchildren which consisted in a health educational campaign and fluoridation therapy. The purpose of this paper was to present the evolution of dental caries among 11-year-old children from a low-income country after 8 years of prevention and to discuss further orientations in prevention., Methods: Two cross-sectional surveys were conducted in 1984 and 1992 on, respectively, 1,907 and 2,771 schoolchildren attending primary schools of the department. The DMF index, summing up the total number of decayed, missing or filled permanent teeth was used to assess dentition status., Results: The DMF index ranged from 3.38 in 1984 to 1.99 in 1992, a 41% decrease. This decrease was associated with a change of the distribution in DMF, the percentage of caries-free children increasing from 19% to 42% after 8 years. 83% of the decayed teeth were first molars. In 1992, only 24% of children received comprehensive care. In both surveys, the prevalence of dental caries was related to socio-economic status., Conclusions: Prevention strategy in this low-income county, led to improved dental health among children. However, the study design did not allow for evaluation of the impact of preventive measures on the evolution of dental caries prevalence. The community program contributed to improved dental health in most children even if it could not prevent the development of dental caries in very low-income children with severely decayed teeth and no access to dental care. Further steps in order to improve prevention, including use of sealants among these children, are under evaluation.

Background: This paper proposes a method to take smoking into account in occupational cohort studies when a lung cancer excess is observed and no information on smoking is available., Methods: The model consists in assessing the proportion of smokers in the study cohort on the basis of (i) the relative risk observed for lung cancer (P1), and (ii) relative risks due to other smoking related diseases (P2). If P1 is higher than P2, it is concluded that the observed lung cancer excess is unlikely to be due to smoking., Results: The model was applied to nine epidemiological studies, of which five showed a lung cancer excess (ranged between 1.12 et 1.32). The P2 proportions of four of these five studies ranged between 0.29 and 0.46, and were lower than P1 that ranged between 0.57 and 0.69. These differences reached statistical significance. These results suggest that occupational lung cancer risks might have existed. The model was validated by applying to cohorts without lung cancer excess and to cohorts of smokers and non smokers. The robustness was assessed using different values of the basic parameters: proportion of smokers in the general population and risks due to smoking for smoking related diseases., Conclusion: This model is an assessment of the relative importance of smoking and occupational factors in occupational cohort studies, in the absence of information on smoking.

Background: The risk associated with smoking has been studied for a long time in fertility epidemiology. This paper reviews the association between smoking and ectopic pregnancy (EP) using results collected in our previous studies. It provides arguments for a causal interpretation of this association., Methods: Data came from three case-control studies performed between 1988 and 1996 and from the register of ectopic pregnancies in Auvergne (France) from 1992 to 1995. The methods are those classically used in the analysis of case-control studies., Results: The risk of EP increased significantly with smoking (p < 0.01): the adjusted OR are 1.5 for 1-9 cigarettes a day, 2.0 for 10-19 cigarettes a day, and 2.5 for more than 20 cigarettes a day. The attributable risk of smoking ranged between 17% and 32% according to the study. Similarly, the risk of EP recurrence increased significantly with smoking (p < 0.02): after adjustment, OR = 1.3 for 1-9 cigarettes a day, OR = 1.5 for 10-19 cigarettes a day, and OR = 1.7 for more than 20 cigarettes a day. Finally, smoking was associated with the site of EP., Conclusions: Thus there is a large body of arguments towards a causal relationship between smoking and EP. This provides additional arguments to persuade women to stop or to reduce smoking, especially hypofertile women.

Background: Respiratory ageing raises for the epidemiologists many questions still unsolved by clinical and physiological approaches: prevalence of chronic respiratory diseases, consequences on autonomy, risk factors. This paper aims to provide some responses based on a wide sample of elderly people: the PAQUID cohort., Method: PAQUID is a cohort of 3777 dwellers representative of the population aged 65 and over in two administrative areas of south-western France. The study is based on general variables as well as specific variables identifying dyspnea, asthma, chronic bronchitis and their risk factors. Disability was measured using specific scales. Mortality is registered during the follow-up., Results: Twenty-five percent of subjects had a dyspnea for minor efforts (level 3 and over). There was a significant relationship between dyspnea and disability levels for basic and instrumental activities of daily living. Mortality rate was significantly associated to dyspnea level of the subjects at inclusion in the cohort, especially in men, even taking into account other mortality related risk factors (sex, smoking, occupation). 6.1% of the subjects reported symptoms of asthma. But only 2.5% reported symptoms in the twelve last months. The follow-up has shown new asthma cases among symptom-free subjects at the beginning of the survey. Previous occupation especially agricultural (pesticides exposition), and industrial activity, smoking and allergy may be considered as the main respiratory risk factors., Conclusion: These data provide more knowledge of some aspects of respiratory ageing. The results allowed to evaluate associated morbidity, to determine risk factors and to measure its impact on disability and mortality. Such information may be useful for prevention of respiratory related disability.

A longitudinal survey was carried out in three maternity units in France in 1993-1994. At the first contact, within the four days following the delivery, 761 women were included in the survey with a face-to-face interview. The second and the third contacts took place five and twelve months after the birth. These contacts were postal questionnaires at home, with a first mail followed by three reminders, if necessary. This paper analyses the response rate to a postal survey and the efficiency of repeated mails in the context of a research about women's health after childbirth. The characteristics of non responders and those of late responders are compared with initial stage responders. Twelve months after the birth, 57% of the women had returned the questionnaire after the first mail and 86% after all the mailings. Non responders were younger and were more often in unfavorable family or social conditions than responders. The late responders had more often a non French nationality, they reported more often psychotropic drugs consumption and wished for this pregnancy less often than the initial stage responders. For some characteristics as educational level, employment or financial concerns late responders had an intermediate position between the initial stage responders and the non responders. Repeated mailings strongly improve the final response rate. Nevertheless non responders remain a particular group that is imperfectly represented by the late responders.

This paper gives an overview of linking methods of personal data computed in different files as registers and administrative or medical records. Epidemiological and demographic examples are studied, then the successive steps of record linkage are described:definition and choice of identifiants, searching and comparing pairs of records to determine whether they should be linked. A special mention is made to probability matching and methods optimizing the matching procedures. The discussion envisages the advantages of record linkage:better use of health statistics, new types of epidemiologic studies. The ethical problems and the need for evaluation are also discussed.

In order to provide greater safety in blood transfusions, public health authorities have imposed the use of screening tests. The purpose of this paper is to estimate the cost-effectiveness ratios of the screening test used in France. Four risks were studied: HIV, HBV, HCV and HTLV. Two efficiency measures were used: cost per positive blood donation detected and cost per case of prevented infection transmission. Moreover, for HTLV alone, the efficiency was estimated by the cost per prevented pathology. Data concerning the costs were provided by the French Blood Agency; those concerning the results of the screening campaigns were provided by the official health authorities, the other data used in the calculations were drawn either from the French Blood Agency data or from a review of international literature. Results gave information about the expenditure devoted to the screening of virologic risks associated with blood transfusion in France (250 million francs per year for the four viruses studied). They stressed the differences in screening efficiency according to the test studied (the cost by prevented seroconversion varied from 31,795 francs for HBV, 72,180 francs for HCV, 676,596 francs for HIV to 6,137,346 francs for HTLV screening test in the base case) and especially the very low efficiency of the systematic screening of the HTLV virus (from 34 to 307 million francs per prevented leukemia).

In this paper, we analyze the factors related to the allocation of home help services, a main component for maintaining elderly at home. The study is based on a random sample of 889 people aged 65 and over, living at home in the areas of Lunel and Pézenas (Hérault, France). The factors taken into account were disabilities, income, social support, and subjective health assessed through the Nottingham Health Profile (NHP). A logistic model allowed to bring out the factors related to the delivery of home help services. Positive statistical correlations were found for age (OR = 1.6 per 10-year age groups), disabilities for instrumental activities of daily living (OR = 3.8) and for the notion of mobility assessed through the NHP (OR = 3.3); negative statistical correlations were found for the level of income (OR = 0.3), as well as for disabilities for activities of daily living (physical dependency) (OR = 0.5). These results show that the main criterion for allocating home help services is not severe disability and that subjective aspects play an important part. Accordingly, current practices should be modified to obtain a better targeting of home help services for disabled elderly at home.

This paper describes the trends observed in the treatment of myocardial infarction within the three French MONICA registers between 1985 and 1991. Data, collected according to the WHO-MONICA Protocol, relate to the initial care of patients and the treatment they were prescribed. In this study 2974 cases are included. The time delays before hospitalization do not change in spite of an increasing use of mobile emergency care units. In all three centers there is a strong progression of thrombolysis, increasing from 12% to 41% in Strasbourg, from 21% to 47% in Toulouse and from 31% to 35% in Lille. Antiplatelet drugs rise from 11% to 76% in Strasbourg, from 39% to 85% in Toulouse and from 33% to 76% in Lille. Beta-blockers also progress in the three centers. Prescription of anticoagulants, nitrates and antiarrythmics is constant. In contrast calcium blockers are less prescribed. Duration of hospital stay is much longer in Strasbourg. In Toulouse the resort to coronary angiography (96%) and to angioplasty (51%) is much more frequent than in the two other centers. Similar trends in the three regions reflect the results of the secondary prevention trials conducted in the last years. Differences concern mainly treatments and procedures that were less studied before 1991. It will be interesting to study the trends in the following years in order to estimate the influence of the trials on the homogeneity of practice in the three centers.

The International Quality of Life Assessment (IQOLA) Project is a 4 year project initiated in 1991 to translate and adapt the Medical Outcome Study Short Form 36 item Health Survey (SF-36) in at least 15 countries. This paper reports on the preliminary psychometric assessment of the SF-36 in French (version 1.1). The validation data come from two studies: a phase IV study of 121 patients with arthritis and a phase IV study of 159 patients with angina. In both cases, the patients were surveyed using the SF-36 and a disease specific module. The main objective of this analysis was to determine how well the scaling assumptions (summated rating or Likert type scaling construction) of the SF-36 were satisfied. Item convergent validity was supported as items-scale correlation range from 0.47-0.87. Item discriminant validity was supported as all items were more correlated with their hypothesised scales than with scales measuring other concepts. Our data support the assumption that the items measuring the same concept had approximately equal variance. Items in a given scale contained about the same proportion of information about the concept being measured, as most items of any given dimension had approximately the same correlation with that dimension. The Cronbach alpha coefficient ranged between 0.79 and 0.95. The correlation between two scales was less than the reliability coefficient for those scales, and these correlations adjusted for attenuation were less than 1. These preliminary results are encouraging. They indicate that the items are linearly related to the underlying concept being measured.(ABSTRACT TRUNCATED AT 250 WORDS)

There is indisputable evidence that mortality and morbidity can be significantly reduced by programmes that screen newborns for sickle cell disease. But in the French epidemiological context, national decision regarding generalization of local screening programmes to all newborns must take into account economic considerations as at-risk populations represent, in most geographic areas, a few percent of the total population. Targeted screening can be considered but raises ethical and practical issues. In order to compare alternative screening strategies, a cost-effectiveness analysis has been performed. The analysis is based on a screening programme of newborns conducted in the south-eastern suburb of Paris. Strategies have been defined in terms of laboratory procedures (isoelectrofocalisation, electrophoresis on citrate agar, high pressure liquid chromatography, BIORAD technique,...) and methods for blood collection (dried paper, micro-tube). An evaluation of all the necessary costs have been performed for each strategy in the biochemistry laboratory in charge of the neonatal programme. Costs have been estimated from detailed observation of physical quantities of capital and labour involved in each case. Evolution of unit and marginal costs according to the level of annual production has been assessed. Effectiveness has been measured in terms of number of sickle cell cases detected. Screening of at-risk babies in Paris region would permit detection of 80 to 215 babies each year at a unit cost per case found varying from 1 to 2,800 US$ (according to hypothesis of prevalence). When compared with other programmes of prevention, results of selected screening of newborns in whole metropolitan France suggest that this action might be discussed by public health authorities.

This paper analyses 14 epidemiologic investigations (published from January 1980 to September 1991) about the relationship between urban air pollution and mortality. Air pollution indicators and mortality indicators are examined. Methods to analyse the relationships between these two kinds of indicators are classified according as they bring "qualitative information" trying to answer the question: "is there any relationship between air pollution and mortality?" or according as they try to quantify this relationship. Results are presented by author. Confounding factors and means to take them into account are described. This paper ends by a discussion about interest and limits of these studies. It emphasizes the importance of the collaboration between metrologists of urban air pollution and epidemiologists.

This paper is a specific cost-benefit study concerning 25-64 years people flu vaccination. For this active population the vaccination rate is only 12% and the cost of absenteeism is potentially high. To make the balance between prevention costs and (direct and indirect) avoided costs by the vaccine, we use a basic case with mean value parameters as: efficacy rate of vaccine, impact of epidemics, size of vaccinated population, immunization length and compensation rate of the so-called production losses. These parameters are then supposed to vary in a sensitivity analysis. In any case net benefit of vaccination appears, which size varies mainly in relation to epidemics and vaccinated population extents. But improvements are to be achieved for giving more precise values to "real" efficacy rate of vaccination and effective economic impact of absenteeism on production.

Planning home help for geographical areas requires information on disabilities and required needs. This paper proposes a methodology to estimate the amount of help required. The analysis is based on survey data from three French regions: Ile-de-France, Languedoc-Roussillon and Basse-Normandie and from a team of experts. The total need, whether covered by professionals or by the patient's social network is considered for three aspects: Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL) and additional help resulting from home conditions. The required average number of hours per week varies from 49.9 for people confined to bed or chair, to 3.8 for people able to get out of their house without help (group 4). The need for IADL represents 44% of the total need for group 1 and 60% for group 4. Housing conditions generated an additional time representing 3 to 5% of total need, according to the group considered. The methodology allows to identified discrepancies between requirements and help provided by region and by disability group within each region. It appears to be a useful tool in planning home-help.

Rheumatic diseases are very common and their consequences on both the individuals (leading cause of activity limitation between the age of the 18 and 64 years) and on society (socio-economic costs) are considerable. However, the epidemiology of these diseases remains poorly known. In this paper, a review of the epidemiological data for the most frequent rheumatic diseases (including recent advances) is followed by an analysis of the specific obstacles to epidemiological research in the rheumatology field and by a proposal of possible developments.

Any immunization policy involves a given vaccination coverage rate and a related cost of implementation. Moreover, for each vaccination coverage rate, there are associated costs for treating residual morbidity and its human and social consequences. Thus, an overall cost can be determined for each coverage rate, and an optimal policy can be defined. This approach is illustrated in the paper by examining the costs and advantages of a measles vaccination program for France. We first calculate the various costs of the present situation (in which vaccination coverage is close to 0%), and then simulate the cost of total eradication of measles (vaccination coverage = 100%). The results show that the latter policy is to be preferred from every point of view.

A survey of the presence of viruses in wastewater has been conducted during 6 years in 19 treatment plants of the lorraine area. The results presented in this paper show the presence of numerous viral species in the 1938 samples analyzed from 1976 to 1981 and large variations of the annual positivity rate linked to the circulation of enteric viruses in the population. By direct inoculation to cell cultures the search of virus is positive in only 15% of the samples. On the other hand a previous concentration step allows to obtain an increase of positive samples. Taking into account the important aptitudes of polio and non poliovirus to survive in water, the survey of wastewater could be a good indicator of their presence in the population. The isolation of non vaccinal polioviruses confirm the need of the continuation of the vaccination program, but perhaps also a reevaluation of the rule of the living oral vaccine because of the presence of so called "intermediary strains".

This paper presents an evaluation of the demographic impact of mortality by AIDS in the next future years, in France. Future cases are predicted by using a regression technique based on an exponential model. Three demographic indicators are computed: Years of Potential Life Lost (YPLL), Expectancy of Life (EL) and Expectancy of Active Life (EAL) for males. For example, in 1990 AIDS would be responsible of a loss of 0.67 and 0.38 years for EL and EAL respectively. These results would raise AIDS almost to the Accidents level and ahead of Suicide. Moreover, we consider that the estimations presented in this article are rather optimistic, taking into account the fact that there is an increasing proportion of IV drug abusers cases, younger than the other cases.

The many papers about the treatment of tuberculosis published during the last fifteen years show the different stages of the evolution of knowledge in this field. The Register of tubercular patients, steadily brought up to date in the French "département" Bas-Rhin, gives interesting information concerning the evolution of treatment in routine. The nature of chemotherapy shows that the newly acquired knowledge is rapidly applied, whereas the average duration of treatment is regularly shortened but is still longer than the duration recommended by researchers. A greater discrepancy appears in hospitalisation: although the efficacy of domiciliary treatment has been known and proved since the early sixties, the proportion of patients having an entirely domiciliary treatment is still low, and in 1978 over 3 patients out of 4 were hospitalized for 4.4 months on average.