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This paper describes the reported distribution of AIDS cases in each country reporting 25 cases or more by November 20, 1997, by age and sex, as well as by assumed mode of transmission. These data come from surveillance systems of varying quality and must be interpreted with care when used for international comparisons, for the proportion of AIDS cases reported ranges from 10% in some countries to more than 90% in others. Moreover, AIDS develops rather late in the natural history of the disease and most people currently living with HIV infection have not yet developed AIDS. People who have developed AIDS are largely those who were initially infected with HIV up to a decade ago. The AIDS data presented in this paper therefore represent HIV transmission which occurred years ago. There is also considerable variation in the speed of progression from HIV to AIDS between children and adults, between those receiving treatment and those without treatment, and between different regions of the world. Finally, there is considerable variation in the way in which the data have been reported by countries.

Introduction Several regions in Canada have recently experienced sharp increases in opioid overdoses and related hospitalizations and deaths. This paper describes opioid-related mortality and disability from opioid use disorder in Canada from 1990 to 2014 using data from the Global Burden of Disease (GBD) study. Methods We used data from the GBD study to describe temporal trends (1990–2014) in opioid-related mortality and disability from opioid use disorder using common metrics: disability-adjusted life years (DALY), deaths, years of life lost (YLL) and years lived with disability (YLD). We also compared age-standardized YLL and DALY rates per 100 000 population between Canada, the USA and other regions. Results The age-standardized opioid-related DALY rate in Canada was 355.5 per 100 000 population in 2014, which was higher than the global rate of 193.2, but lower than the rate of 767.9 in the United States. Between 1990 and 2014, the age-standardized opioid-related YLL rate in Canada increased by 142.2%, while globally this rate decreased by 10.1%. In comparison with YLL, YLD accounted for a larger proportion of the overall opioid-related burden across all age groups. Health loss was greater for males than females, and highest among those aged 25 to 29 years. Conclusion The health burden associated with opioid-related mortality and disability from opioid use disorder in Canada is significant and has increased dramatically from 1990 to 2014. These data point to a need for public health action including enhanced monitoring of a range of opioid-related harms.

First Nations/Métis populations develop diabetes earlier and at higher rates than other Canadians. The Canadian diabetes risk questionnaire (CANRISK) was developed as a diabetes screening tool for Canadians aged 40 years or over. The primary aim of this paper is to assess the effectiveness of the existing CANRISK tool and risk scores in detecting dysglycemia in First Nations/Métis participants, including among those under the age of 40. A secondary aim was to determine whether alternative waist circumference (WC) and body mass index (BMI) cut-off points improved the predictive ability of logistic regression models using CANRISK variables to predict dysglycemia.Information from a self-administered CANRISK questionnaire, anthropometric measurements, and results of a standard oral glucose tolerance test (OGTT) were collected from First Nations and Métis participants (n = 1479). Sensitivity and specificity of CANRISK scores using published risk score cut-off points were calculated. Logistic regression was conducted with alternative ethnicity-specific BMI and WC cut-off points to predict dysglycemia using CANRISK variables.Compared with OGTT results, using a CANRISK score cut-off point of 33, the sensitivity and specificity of CANRISK was 68% and 63% among individuals aged 40 or over; it was 27% and 87%, respectively among those under 40. Using a lower cut-off point of 21, the sensitivity for individuals under 40 improved to 77% with a specificity of 44%. Though specificity at this threshold was low, the higher level of sensitivity reflects the importance of the identification of high risk individuals in this population. Despite altered cut-off points of BMI and WC, logistic regression models demonstrated similar predictive ability.CANRISK functioned well as a preliminary step for diabetes screening in a broad age range of First Nations and Métis in Canada, with an adjusted CANRISK cutoff point for individuals under 40, and with no incremental improvement from using alternative BMI/WC cut-off points.Le diabète touche en plus grande proportion et à un plus jeune âge la population des Premières Nations et des Métis que le reste de la population canadienne. Cet article vise principalement à évaluer l’efficacité et les scores de risque de CANRISK (Questionnaire canadien sur le risque de diabète, un outil de dépistage du diabète destiné aux Canadiens de 40 ans et plus) pour détecter la dysglycémie chez les participants issus des Premières Nations et d’origine métisse en incluant les moins de 40 ans. L’objectif secondaire de cette étude est de déterminer si une modification des seuils relatifs au tour de taille (TT) et à l’indice de masse corporelle (IMC) améliore la valeur prédictive de modèles de régression logistique lorsque les variables du questionnaire CANRISK sont utilisées pour prédire la dysglycémie.Nous avons recueilli auprès de 1479 participants métis et des Premières Nations des données provenant d’un questionnaire CANRISK autoadministré, de mesures anthropométriques et de résultats d’épreuve standard d’hyperglycémie provoquée par voie orale (HGPO). Nous avons calculé la sensibilité et la spécificité des scores CANRISK en appliquant les seuils usuels de classification des risques. Une régression logistique a été effectuée en utilisant des seuils tenant compte de l’origine ethnique pour l’IMC et le TT pour prédire la dysglycémie à l’aide des variables CANRISK.Appliqué aux résultats de l’épreuve d’HGPO, le score seuil CANRISK à 33 points a conduit à une sensibilité et une spécificité de l’outil CANRISK de respectivement 68 % et 63 % chez les 40 ans et plus, et de respectivement 27 % et 87 % chez les moins de 40 ans. L’utilisation d’un seuil inférieur, à 21 points, a fait monter à 77 % la sensibilité chez les moins de 40 ans, avec une spécificité de 44 %. Malgré la faible spécificité correspondant à ce seuil, l’augmentation de la sensibilité montre son importance à identifier les personnes à risque au sein de cette population. Après modification des seuils d’IMC et de TT, les modèles de régression logistique ont présenté une valeur prédictive comparable.L’utilisation du questionnaire CANRISK s’est révélée efficace comme première étape de dépistage du diabète chez les membres des Premières Nations et les Métis d’un large éventail d’âge au Canada, dans la mesure où le seuil CANRISK a été adapté aux moins de 40 ans, et sans que l’on constate d’amélioration différentielle en modifiant les seuils d’IMC et de TT.

In adolescents and young adults (AYA), cancers are rare but represent the third significant cause of death. The aim of this paper was to investigate epidemiological data and pathways of care of AYA in France. During the 2000-2008 period, overall age-standardized incidence rates (ASR) were 254.1/10

Deliberate self-poisoning is a serious problem in Morocco, including in the Souss-Massa-Drâa region. However, our understanding of the problem of suicidal poisoning remains limited.This paper aims to describe the characteristics of patients, toxic substances and poisoning and to identify the risk factors influencing patient outcomes.A retrospective study was conducted of all cases of deliberate self-poisoning recorded between 1981 and 2007 by the Centre Anti-Poison et de Pharmacovigilance du Maroc.1,130 cases of self-poisoning were identified. The mean age was 25 ± 10.1 years and the sex ratio was 0.4. Paraphenylenediamine was the most common cause of death (48 deaths), followed by hydrochloric acid (15 deaths). A close relationship was found between progression to healing and female adolescents and between progression to death and men in other age groups. The study also found that patients who used paraphenylenediamine were twelve times more likely to die (CI95%: 7.4%-19.2%) than those who used other substances. Patients with respiratory and cardiovascular conditions had a relative risk of 9.8 (CI95%: 6.3%-16%) and 3.6 (CI95%: 2.3%-5.7%). Of the 937 cases with known outcome, 89 died (9.5%).

The purpose of this paper is to describe the epidemiological profile ofnp pagenum="196"/acute pesticide poisoning in children (APP) treated by the Moroccan Poison Control Center (CAPM) and to analyze death cases in order to determine factors predictive of severity.the study is based on a retrospective study of all cases of APP collected by the CAPM over a period of eighteen years (January 1990 to December 2008). Univariate analysis was performed to identify risk factors.2,672 cases of childhood poisoning by pesticide were collected. The mean age was 5.6 ± 4.57 years. The sex ratio was 1.12. The cause of poisoning was accidental in 87.1% of cases, followed by attempted suicide (12.1%). Organophosphates were the most frequent poison (50.7%), followed by alpha-chloralose (26.5%). The case fatality rate was 3.3%. Mortality was attributed to organophosphates in 30 cases, followed by inorganic derivatives (7 cases) and carbamates (6 cases). A univariate analysis comparing survivors and groups who died showed that rural origin (p = 0.04), voluntary circumstances (p = 0.001), and the type of chemical class of pesticide (plt; 0.001) significantly influence fatal poisoning.Acute pesticide poisoning among children is a reality in Morocco. Preventive measures may be needed.

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).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.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.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.

The objective of this paper is the study of a health indicator allowing surveillance and evaluation of the overall health of the Paris population, and providing information to help prioritize possible choices among preventive and curative actions. Moreover, comparison between results obtained for Paris with a global health indicator, "Disability-adjusted life years" (DALYs) and available bibliographical data will enable clarifying some points about summary measures of health.The method used is that of the Global Burden of Disease. It allows a ranking of diseases using an indicator called DALYs. This indicator integrates mortality and morbidity components by summing expected years of life lost due to premature mortality and calculated years of healthy life lost. DALYs were calculated using local mortality data and published regional disabilities tables from the World Health Organisation (WHO).There were a total of 242 061 DALYs for Paris for the year 1999. The six leading specific causes are: alcoholic psychosis and dependence (accounting for 6.5% of the total), lung cancers (5.7%), ischaemic hearth disease (4.8%), depression (4.4%), dementias (4.2%), and arthritis (3.9%). Men contributed the majority of DALYs for the first three. For four of the six leading causes, the majority of DALYs came from years lived with disability, rather than mortality. Only for lung cancer and ischaemic hearth disease was the majority of DALYs from years of life lost by mortality.The results for Paris are used to illustrate how DALYs can illuminate debates about public health priorities. Such data can inform the population about health condition and provide decision makers with global health indicators. The next step will be to estimate the DALYs from local morbidity data when available, and compare these results to those based on the World Health Organisation tables, which are not sensitive to local results other than those due to mortality. Future steps include further evaluation and development of this method for surveillance, assessment and evaluation of public health actions. However, some of the results obtained with this indicator underline the limits of this kind of analysis.

This paper describes the trends in tobacco sales and smoking prevalence in the Tunisian population, estimates the consequences of smoking on mortality of this population, and discusses anti-tobacco actions: educational actions, legislative measures and price increases. Sales Data were collected from the Tunisia tobacco company. Smoking prevalence data from surveys, conducted by several institutes, and numbers of deaths by causes have been estimated from WHO for the year 1998. Tobacco sales increased from 4.96 g per adult per day in 1981, to 6.3 g, in 1993, then decreased widely. The proportion of smokers was 30% in 1996. 55% among men versus 5.6% among women. Among 17 to 24 years old young adults, the proportion of smokers was 29.2% in 1994 (50% among men versus 3.9%, among women). Mortality attributable to tobacco in Tunisia has been estimated to 6430 deaths in 1997 (5580 among men versus 850 among women). These deaths represent 22% of the total male deaths and 4% of the female ones. Anti-tobacco measures have been reinforced by the enactment of anti-tobacco law. Proportion of young smokers remaining elevated, it is expected that consequences of the tobacco addiction in Tunisia, in term of mortality, will be even heavier in the next two decades, if efficient anti-tobacco actions are not implemented.

Testicular cancer is the most common malignancy in young men and its incidence is increasing. The overall rate of cure can exceed 90% when management is optimal. Ultrasonography for diagnosis and thoraco-abdominal CT for staging are the optimal imaging modalities. In this paper we analyze technical parameters as well as findings and the strategy of examinations in testicular neoplasm.

Normal aging is accompanied by functional decline with a loss of independence in activities of daily living. In many cases, after acute medical events, such a functional decline is observed, for which rehabilitation therapies are indicated. However, uncommon types of functional decline are also seen, without trigger event, having a particuliar clinical course: some of these are described in this paper, ranging from the "failure to thrive" to the dramatic "slipping syndrome".

The HIV/AIDS threat continues in African countries, including the Republic of Benin, during this period of economic crisis which is accentuated by the devaluation of the currency. National statistics from the Ministry of Health indicate a progression of the number of cases seropositive for HIV and the number of cases developing AIDS. Concomitantly, we observe a decrease of the number of teenagers fearing HIV infection and a spread or risky sexual behavior, such as unprotected sex. Despite the weak prevalence of HIV infection in Benin, the increase of the number of cases with AIDS remains a serious social problem. This paper describes the epidemiological pattern of AIDS and its social, demographic and economical implications as they affect the current national program to increase the awareness of the problem. We obtained scientific information on the epidemiological chain of AIDS morbidity from prior research results, data from the disease control centers and interviews with the parents of some patients. Quantitative data was collected from twenty selected disease control centers of the national program against AIDS from 1986 to 1995. We compared these data with data obtained by the WHO from 1986 to 1992 from the neighboring countries of Benin. We observed an exponential growth of the cumulative number of AIDS cases, from one declared case in 1985 to 1,280 cases in 1995, including twenty thousand cases seropositive for HIV in 1991. The majority of cases were people between 20 and 49 years old and were predominantly males. Heterosexual (73%), homosexual (0.8%), and mother to child vertical transmission were the principal modes of transmission registered for carriers of HIV-1, HIV-2, or both. The qualitative study revealed a social situation dominated by verbal violence against infected women, absenteeism at work of the patients' family and, friends and a psychological impact on the children of the patients. An evaluation of the direct costs of AIDS was estimated to be $217,600 (US $) for the 1,280 reported cases. We suggest further reinforcement of the program to raise the awareness of the young people in the urban and rural areas of the country.

The first part of this review on event-related potentials (ERPs) in children summarizes the role of ERPs in the study of normal cognitive development. The ERPs vary both as a function of the age of the child and also as a function of the cognitive processes that are required by the tasks. Topographical studies allow one to identify cortical regions involved in specific cognitive processes, and monitor their age-related changes. The second part of this paper reviews two examples of abnormal cognitive development (attention deficit hyperactivity disorder and childhood autism) where the ERPs allow a better understanding of the dysfunction underlying the observed cognitive disorders.

Fracture of the neck of the femur (or hip fracture) is an important cause of mortality and morbidity among the elderly, and contributes significantly to health care costs. This paper examines recent Canadian trends in mortality and hospital morbidity attributable to this condition. Age-standardized rates for deaths, hospital admissions and hospital days at ages 55 and over are presented, and average annual percentage changes are estimated for each of these statistics using logarithmic regression. Changing trends in surgical procedures used to treat femoral fractures are also examined and linked with mean lengths of hospital stays. Between 1972 and 1990, deaths due to femoral fractures declined an average 2.3% annually for women and 1.2% for men. Hospital admissions dropped 0.1% for women and remained stable for men, while hospital days fell by 2.9% and 1.9% respectively. Beginning in 1977 there was a marked reduction in the proportion of admissions due to femoral fractures for which no surgical intervention was recorded and a corresponding increase in the proportion of fractures treated surgically by open reduction. Changes over the past two decades in the surgical treatment of patients with fracture of the neck of the femur may have reduced the hospital care burden. It is not possible from the available data to determine whether changes in treatment have also contributed to the observed reduction in mortality due to hip fracture. Neither can this downward trend be attributed to a fall in the condition's incidence, given observed hospital admission rates. Programs to prevent osteoporosis, falls, and injuries from falls are needed to complement improvements in surgical procedures.

The paper present the functional and anatomic results obtained in 376 retinal detachment operations done in the Ophthalmological Clinic from Cluj-Napoca. The following types of operations were done: cerclage Arruga, scleral indentation, surface diathermy, laser photocoagulation. The retrospective study revealed percentages of 73.41% the anatomic reapplication and 50% in functional recovery. The negative influencing factors of the prognosis were: aphakia, large and old retinal detachments, macular region affectation.

"This article looks at the relationships among immigration, fertility and mortality to explain the changes that have occurred and will continue to occur in the population of the United States. Emphasis centers on the recent past, the present and the first half of the 21st century. It is pointed out that the nation will undergo major changes in its age and ethnic composition in the near future because of the aging of the baby boom generation and the continued high level of immigration from Latin America and Asia.... In the paper's conclusion, alternative policy options are considered." (SUMMARY IN ENG AND SPA)

This paper tries to reconstruct the demographic evolution of China during the past 30 years, in the light of new data recently published by Chinese sources. At the end of 1979 China had a population of 1970 million, a birth rate of 18/1000, a mortality rate of 6/1000, and a growth rate of 12/1000; the Chinese population which was 540 million in 1949, the year of the Liberation, was already 642 million by the end of 1957. The demographic evolution of the past 30 years can be summed up in 5 phases: 1) 1950-57, marked by a natural growth rate of 10-24/1000, due mainly to a significant decrease in mortality; fecundity was about 5 children/woman; 2) 1958-61; very little is known about those years, the period of the "great leap forward"; there was undoubtedly a marked decrease in birth rate due to starvation-caused amenorrhea, and a marked decrease in mortality rate, resulting in a natural growth rate of only 5/1000; 3) 1963-64, with a natural growth rate of 33.5/1000, and mortality decreases again; 4) 1965-70, with a birth rate of 35/1000 and a mortality rate down to 7-8/1000; these are the years of the Cultural Revolution and the demographic problem is underrated in comparison to the political situation; 5) 1970-on; fertility rate is at its lowest, 2.3, and the slogan is "2 children/couple". The characteristics of China's population in 1979 are not very different from those of 1953; 38.5% of the population is in the age group 0-15, and there are 410 million dependent young people as compared to 60 million dependent old people; survival rate is 65.7% and infant mortality has fallen to the level of that in developed countries. The Communist Party made public its directives in 1979: 1 child/couple, reduction of natural growth rate to 5/1000 by 1985 and zero population growth by the year 2000; should these directives become real, China will have a population of 1050 million inhabitants by the year 2000. The level of education in China is still low despite the doubling and tripling of the number of schools at every level; the current reduction in birth rate will show in the classrooms only in about 12 years' time. The active population includes almost the totality of the population over 17, with the majority employed in the agricultural section; the internal gross product has increased 60 times in the past 26 years; still, unemployment exists and it becoming a serious problem. Demographic aging is still much below the level of developed countries. The real problem will become apparent in 1982-93, when the mass of the people born between 1962-73, about 300 million people, will become adults and will be looking for jobs.

This paper explores fertility trends in Belgium from 1950 to 1980, noting that there was a drop in the birthrate from 1969 to 1975, and a slight rise from 1975 to 1980. The size of each successive birth cohort in Belgium declined from 161,000 births in 1964 to 119,000 in 1975. By 1980, however, the number was back to 124,000. The cause of this increase is the interaction of a favorable age structure with a stop in the fall of fertility rates. Despite the fact that since 1973-74 a smaller proportion of couples in each marriage and parity cohort have a birth within a year of their marriage or previous birth, the previous trend toward particularly long intervals (4 or more years) seems to be reversed: a higher proportion of couples are now having these births within the 2nd and 3rd year. The trends have been too weak, however, to bring period fertility back to replacement level especially as the proportion progressing to a 3rd child has been rising only very slowly from the overall-low it reached in 1975. The age structure effect will continue to be favorable until about 1990--the time when the large birth cohort of 1964 reaches the mean age at maternity. Unless fertility starts declining again rather sharply, rather than remaining stable or exhibiting slight increases as has occurred in the most recent marriage and parity cohorts, we can expect further increases in the annual number of births. Fertility is correlated with maternal age, marital status, marriage duration, and birth intervals for primiparas and multiparas. Numerous graphs document the trends. An appendix gives tables of fertility projections by birth cohorts using Jean Bourgeois-Pichat's method of successive extrapolations of cumulative fertility totals. (author's modified)