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Introduction: The objectives of our study were to estimate the prevalence of asthma in adults in France and to study the effects of gender on the associations of asthma with the corpulence and socio-economic characteristics of individuals., Methods: We estimated the prevalence of current asthma (asthma attack in the past 12 months or current treatment for asthma) from data collected at inclusion in the Constances cohort study in 2013-2014. Analyses were performed separately in men and women, using robust Poisson regression for multivariate analysis., Results: Using data from 34,100 participants in the cohort (men: 47.7 %; mean age: 44.6 years), the prevalence of current asthma was estimated to be 5.8 % (5.1 % in men, 6.4 % in women). The risk of asthma was increased in women with high body mass index (BMI) or waist circumference. In men, only a high waist circumference was associated with an increased risk of asthma. An association with low socioeconomic status was observed only among women., Conclusion: The associations of asthma with corpulence and socioeconomic status differed between men and women. Additional analyses should provide a better understanding of the mechanisms responsible for these differences., (Copyright © 2021 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: The prevalence of adult asthma is around 6-7% in France. This disease is multifactorial and is related in particular to occupational factors. Using data from The French Health, Health Care and Insurance Survey (ESPS), this study aimed to describe asthma prevalence in France according to socio-economic status in 2012., Methods: This analysis included the population aged 15 years and over. Current asthma, defined by a declaration of having asthma in the last 12 months, was analyzed according to socio-economic variables available in the ESPS survey., Results: Among the 23,047 subjects interviewed, 12,565 were included in the analysis. Current asthma frequency was 7.4%. Higher risk of asthma was observed in unemployed, non-qualified persons, with a lower income, or having free healthcare insurance. Regarding occupations, in men, trade and commerce employees, personal services employees and administrative employees were associated with a higher level of current asthma prevalence., Conclusions: These results show that subjects with lower socio-economic status are more likely to suffer from asthma. New epidemiological tools in France, including cohorts (Constances, COSET) will be helpful to study more precisely the associations between asthma and occupational factors., (Copyright © 2018 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: Few data on change over time of asthma prevalence in French children are available., Methods: Data from the 2012-2013 national health survey of schoolchildren conducted in a random sample of almost 20,000 children in the last year of nursery school were compared to those which had been collected in 2005-2006 in the same grade level using the same methodology., Results: In the 2012-2013 survey, children had a lifetime prevalence of asthma of 11.0% with 11.8% reporting wheezing in the preceding year. Asthma was more frequent and more often uncontrolled in children from families with low socioeconomic status. Compared to the survey conducted in the same grade level in 2005-2006, the prevalence ratios adjusted for children's gender and obesity, family structure, parental unemployment and region were 1.13 [1.05-1.21] for lifetime asthma and 1.12 [1.05-1.17] for past-year wheezing., Conclusion: In France, the prevalence of asthma in young children increased between 2005 and 2012. The socioeconomic status of children's parents affects both asthma prevalence and control., (Copyright © 2016 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Objective: The study aimed to describe the main characteristics of people treated with long-term oxygen therapy (LTOT) and the trends between 2006 and 2011 for prevalence and incidence., Methods: Data were provided from a sample comprising 1/97 of the permanent beneficiaries of the French health insurance. The sample contains anonymous socio-demographic characteristics and data on health care reimbursements. The analyses were carried out among adults aged 20 years and above who had received benefits on account of LTOT., Results: In 2011, 2.6% of adults were treated with LTOT, corresponding to around 135,000 people. The crude incidence rate was 0.9‰. The prescription of LTOT included LTOT alone (70%), LTOT associated with assisted ventilation (23%) and LTOT associated with continuous positive airway pressure (7%). About 45% of the patients were supported financially in the long-term illness program of the French Social Security because of severe chronic respiratory failure. Between 2006 and 2011, the age-adjusted prevalence rates increased by 2.9% per year in men and by 6.7% per year in women. The age-adjusted incidence rates remained stable in men (+1.6% per year, P=0.45) but increased in women (+4.7% per year, P=0.04). The median survival was 27 months., Conclusion: This analysis of the data demonstrates an increasing burden associated with LTOT in France from 2006 to 2011., (Copyright © 2013 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: Most hospital admissions for asthma exacerbation are avoidable with adequate disease management. The objective of this study was to describe admissions for asthma in children in France using data from the French nationwide hospital database., Methods: We selected admissions having either a main diagnosis of asthma or a main diagnosis of acute respiratory failure (ARF) with asthma as an associated diagnosis, occurring in children (age<15years) between 2002 and 2010 in France (excluding French Guyana)., Results: In 2010, 35,004 asthma admissions and 1381 cases of asthma-related ARF were recorded (crude admission rate, 30.1/10,000 children); the mean length of stay was 2days. The in-hospital lethality rate ranged from 0.01% to 0.03% depending on the year. The annual age-standardized admission rate increased between 2002 and 2010 (+2.5% per year on average in metropolitan France). In 2010, 11.8% of children admitted for asthma or asthma-related ARF were readmitted for asthma or asthma-related ARF at least once within the same calendar year, and 1.3% were readmitted within the week following admission. The proportion of children aged less than 5 years who were readmitted within the same calendar year increased between 2002 and 2010., Conclusion: The increase in admission and readmission rates indicates non-optimal management of asthma in children in France., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Introduction: Few data on regional variations in asthma prevalence are available in France., Methods: The study was carried out during the academic year 2005-2006 in a random sample of around 20,000 children in the last year of nursery school. The lifetime prevalence of asthma and the preceding year prevalences of asthma-like symptoms and treatment for wheezing or asthma attacks were estimated by region., Results: Overall, the lifetime prevalence of asthma was 9.8 % and the past-year prevalence of wheezing was 10.7 %. An increasing trend in prevalence was observed from Eastern to Western France and in overseas territories. The regional variations in past-year prevalence of wheezing remained when adjusting for gender, family structure and the number of siblings. Among children who had wheezed or received a treatment in the past year, 42 % had experienced frequent or severe symptoms., Conclusion: Large regional variations in asthma prevalence among young children in France exist., (Copyright © 2012 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Background: Although the diagnosis and treatment of depressive disorders are important public health issues in adolescents, epidemiological data in this population are scarce., Objective: The aims of this study were to estimate the 12-month prevalence rates of depressive disorders among ninth grade pupils in French schools, and to identify the sociodemographic correlates., Methods: The data were collected through a national cross-sectional study conducted among ninth grade pupils in France in 2003-2004. Depressive disorders were assessed using a self-administered questionnaire derived from the standardised Composite International Diagnosis Interview-Short Form (CIDI-SF)., Results: A total of 7110 teenagers (mean age 15.1 years) were included. Of these, 9.6% (95% CI 8.6-10.6) reported symptoms corresponding to at least one major depressive episode (MDE) over the past 12 months. Three correlates were independently associated with a higher prevalence of 12-month MDE: being a female (adjusted odds ratio 3.0; 95% CI 2.4-3.8), being greater or equal to 16 years old (aOR=2.2; 95% CI 1.0-5.0) and living alone with one's mother (aOR=1.7; 95% CI 1.3-2.4) or with one's mother and her spouse (aORa=1.4; 95% CI 1.0-2.1)., Conclusion: The high prevalence of depressive disorders in French adolescents is thoroughly discussed. The needs for developing mental health surveillance, comprehensive prevention and care programs for this population are crucial., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

In France, half of hospital admissions for asthma concern children and the rates of hospitalization, decreasing in adults, are stable in children. Most admissions for asthma exacerbation are avoidable with appropriate disease management. The objective of this study was to describe the characteristics of children admitted for asthma. The study was carried out in 14 pediatric units over 1 year. Children aged 3 years and over who were hospitalized for an asthma exacerbation were included. Data from 727 hospitalizations were collected. In 48% of the hospitalizations, children were 3-5 years old. Asthma was undiagnosed at the time of the admission in 27%. Among children with diagnosed asthma, 57% had already been admitted to the hospital for asthma exacerbation, 37% had been admitted to the hospital or emergency department during the last year, and the control of asthma in the previous month was unacceptable in 46%; 11% had received an oral and written self-management action plan. This study underlines the need to strengthen the efforts to encourage improvement of the therapeutic education of asthmatic children in order to decrease the risk of hospitalization for exacerbation of asthma., (Copyright 2010 Elsevier Masson SAS. All rights reserved.)

This paper aims to summarize the most recent data on the descriptive epidemiology of chronic obstructive pulmonary disease (COPD) in France. Data are presented concerning the prevalence, mortality and hospital admissions. The prevalence of COPD is difficult to estimate due to the large degree of under-diagnosis and the difficulty of performing spirometry in population-based epidemiological surveys. The prevalence of chronic bronchitis was estimated at 4%, and the prevalence of COPD was estimated at 5-10%, among adults aged 45 years and older. Data from death certificates, although limited by the accuracy of certification, showed that the annual age-standardised mortality rates from COPD increased between 1979 and 2000 among women but remained stable among men. In 2006, about 16,500 death certificates mentioned COPD, of which 7400 identified it as the underlying cause of death. According to the French national hospital discharge database, the number of admissions related to an exacerbation of COPD ranged from 69,000 to 112,000 in 2006 according to the definition used. The admission rates have increased between 1998 and 2006 and this increase was more pronounced among women than among men. Large regional differences in COPD mortality and hospital admission rates were evident, with the highest rates in Northern and Eastern France and in Brittany., (Copyright 2009 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

This article presents a review of the most recent data on descriptive epidemiology of asthma in France. The latest national surveys show a cumulative prevalence of asthma of more than 10% in children aged 10 years or more and a prevalence of current asthma from 6 to 7% in adults. In 2006, 1038 deaths from asthma were registered (64 deaths among people aged less than 45 years). After the peak observed in the 1980s, mortality from asthma has decreased. The decrease is also observed among children and young adults. According to data from the French discharge database (PMSI), there were 54 130 admissions for asthma (asthma as the principal diagnosis) in 2007. Between 1998 and 2007, the annual rate of admission for asthma decreased. However, no decreasing trend was observed in children and, in adults, admission rates seem to have been stable since 2004. The increase in the rate of admission for acute respiratory failure (ARF) associated with asthma (ARF as the principal diagnosis and asthma as an associated diagnosis) does not compensate for the decrease in the admission rate for asthma that was observed in adults. Data on emergency department visits show evidence of strong seasonal variations in asthma exacerbations., (Copyright 2009 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: Chronic bronchitis is associated with an increased risk of COPD and health-related quality of life (HRQoL) impairment. The objectives of the study were to estimate the prevalence of chronic bronchitis and to describe its relations with quality of life., Methods: The French Health Interview Survey was conducted in 2003 in a representative sample of households. Data were collected during an interviewer's visits to the home. Respiratory symptoms and HRQoL (SF-36) were assessed in 9,050 adults aged 45 years and older using a self-administered questionnaire., Results: The prevalence of chronic bronchitis was estimated at 3.5%. Chronic bronchitis was associated with an impaired physical component summary score after adjusting for sex, age and dyspnoea. It was associated with a reduced mental component summary score (MCS) among men. In women, this association was only significant in the absence of dyspnoea., Conclusion: The prevalence of chronic bronchitis was 3.5% among adults aged 45 years and older. Chronic bronchitis was associated with impairment in health-related quality of life.

Objective: To estimate the prevalence of asthma among children in France., Methods: Data from 3 French national studies were analyzed: the Decennial Health Interview Survey conducted in 2003 among a representative sample of households and 2 surveys conducted among representative samples of schoolchildren from 9(th) grade in 2003-2004 and 5(th) grade in 2004-2005. In the Decennial Health Interview Survey, data on respiratory health were collected using a self-administered questionnaire that was filled in by 1675 children aged 11-14 years living in selected households. For the studies among schoolchildren, 7104 children from 5(th) grade and 7284 from 9(th) grade were interviewed by the school nurse or physician using a standardized questionnaire., Results: The cumulative prevalence of asthma varied from 12.3 to 13.4% depending on the survey and the prevalence of current wheeze (wheezing in the past year) varied from 8.3 to 10.1%. The prevalence of current asthma (current wheeze in a child having already had an asthma attack or treatment for wheezing or asthma in the past year) was nearly 9% in 5(th)-grade and 9(th)-grade schoolchildren. Asthma was not controlled (at least 4 attacks, 1 awakening per week, 1 severe attack, 4 unplanned medical visits, or 1 hospitalization in the past year) in 38.5% of the 598 asthmatic teenagers from 9(th) grade, and 29.2% did not declare any anti-inflammatory drug treatment in the past week in spite of the absence of asthma control., Conclusion: The prevalence of current asthma among children in France is estimated at 9%. Asthma control and treatment remain insufficient. Improving therapeutic and educational management of asthma among children and teenagers is necessary.

Background: Most hospital admissions with asthma are avoidable. The objective of the analysis was to describe hospital readmissions for asthma., Methods: Using data from the French hospital information system, admissions for asthma or for acute respiratory failure associated with asthma that occurred in 2-44 years-old patients between 2002 and 2005 in France (excluding French overseas departments) were analysed. Readmission rates at 7 days and at 1 year were estimated using the Kaplan-Meier method., Results: The risk of readmission at 1 year was 15.0%. It varied according to age (higher in 2-4 year and 35-44 years-old patients) and sex (higher in 10-34 years-old females) and increased with the length of stay of the index admission. The risk of readmission at 7 days was 1.1% and was higher for the shortest lengths of stay., Conclusion: Readmissions for asthma are pertinent indicators for the monitoring of asthma, especially the clinical management of the disease. Using data from an increasing number of years, together with linkage of hospital admissions and asthma drug reimbursement data, should allow a better understanding of severe asthma in France.

Background: As the quality of asthma care influences hospital admission rates, we described hospitalizations for asthma and studied trends in admission rates in France from 1998 to 2002., Methods: Using data from the French hospital information system, admissions for asthma were defined by the J45 or J46 codes (ICD-10) as primary diagnosis, and admissions for acute respiratory failure (ARF) associated with asthma by the J96.0 code as primary diagnosis and the J45 or J46 codes as an associated diagnosis. Annual rates of admission adjusted for age and sex were calculated., Results: During the study period, the adjusted asthma admission rate decreased by 5% per year (from 10.8/10,000 in 1998 to 8.6/10,000 in 2002). A significant decrease was observed in children aged 10-14 years (-5%/year) and in older people (from -7%/year in 15-19 years old to -9%/year in people aged 50 years or more), whereas no significant decrease was seen in youngest children (-2%/year in children aged 0-1 or 5-9 years, +0.1%/year in those aged 2-4 years). Although not statistically significant, an increase in admission rate for ARF associated with asthma was observed (+5%/year)., Conclusion: Admission rates for asthma decreased between 1998 and 2002 in people aged 10 years and older. However, changes in coding practices or admission policies cannot be excluded and the extent to which the observed trends reflect changes in preventive care among patients with asthma remains to be assessed.

A heat wave of exceptional intensity occurred in France in August 2003, 2003 was the warmest of the last 53 years in terms of minimal, maximal and average temperatures, and in terms of duration. In addition, high temperatures and sunshine, causing the emission of pollutants, significantly increased the atmospheric ozone level. Some epidemiological studies were rapidly implemented during the month of August in order to asses the health impact of this heat wave. Excess mortality was estimated at about 14 800 additional deaths. This is equivalent to a total mortality increase of 60% between August 1st and 20th, 2003 (Inserm survey). Almost the whole country was concerned by this excess-mortality, even in locations where the number of very hot days remained low. Excess-mortality clearly increased with the duration of extreme temperatures. These studies also described the features of heat-related deaths. They showed that the death toll was at its highest among seniors and suggested that less autonomous or disabled or mentally ill people were more vulnerable. So, they provided essential information for the setting up of an early warning system in conjunction with emergency departments. The public health impact of the Summer 2003 heat wave in various European countries was also assessed. Different heat waves in term of intensity had occurred at different times in many countries with each time deaths in excess. But, it does seem that France was the most affected country. However, implementation of standardized methods of data collection through all countries is necessary to afford further comparisons. Collaborative studies will be conducted in this way. After theses first descriptive studies, further etiologic studies on risk factors and heat-related deaths were launched and are now in progress. Considering the health impact of the heat wave, national health authorities decided to launch an Heat Wave National Plan including a provisional Heat Watch Warning System (HWWS) for 2004. Developed in collaboration with Metéo France, this HWWS is based upon an analysis of historical daily mortality data and meteorological indicators in 14 French cities in order to define the best indicators and triggers. The public health impact of the heat wave of August 2003 was major. This exceptional event raises questions about anticipating phenomena which are difficult to predict. The collaborative efforts which were developed and the group of actions and studies which were implemented in a context of emergency are now useful for the setting up of early warning strategies and thus efficient prevention.

Background: Some neurological manifestations associated with Mycoplasma pneumoniae infection have been reported, such as meningoencephalitis, cerebellitis, aseptic meningitis, polyradiculopathy, transverse myelitis, cranial nerve palsies and myositis., Case Report: Case 1. A 10 year-old boy had an acute pneumonia that was subsequently proven to be due to Mycoplasma pneumoniae infection. This infection was resistant to macrolid administration for 1 week requiring the administration of vibramycin instead. At that time, the patient developed an aseptic meningitis syndrome and a severe cerebellitis. He completely recovered within a few days. Case 2. A boy was admitted because he suffered from polyradiculopathy that had appeared during an acute episode of pneumonia. The neurological involvement extended to cranial nerves, then subsequently completely disappeared. Seroimmunological studies confirmed the Myoplasma pneumoniae infection., Conclusion: The mechanism of these classical but rare neurological manifestations remains unclear.

The authors report on the case of a child with the nephrotic syndrome complicated by thrombosis of superior longitudinal sinus, bilateral massive pulmonary embolism resulting in a sudden death. A dramatic deficiency in factor XII was demonstrated; the pathophysiology and management of such an abnormality are discussed.

After a brief recall of clinical features, an outline of care for children with spinal muscular atrophy or severe neuromyopathies is proposed. With regard to respiration, the aim is to allow pulmonary growth, mainly through preventive ventilation. From the orthopaedic point of view, the main goal is to prevent contractures and kyphoscoliosis. Moreover, several methods of technical assistance can be proposed in order to make everyday life easier and allow familial and social insertion.

An anti-calcaneus carbon fibre orthosis (ACCFO) is an appliance combining a plantar orthosis with an anterior counter-support at the tibia and two side supports, medial and lateral, leaving the posterior aspect of the leg and heel free. It is made of polyethylene and polycarbolactone resin reinforced by a covering of tubular carbon fibres and polymerized epoxy-resin. Fifty-five pairs have been used in 18 children aged from one years and five months to 12 years suffering from a paraplegia at L4-L5 or S1 level due to myelomeningocele. Two children were unable to walk before the use of the ACCFO and 16 walked with various aids. All the children were followed-up with regular muscle and joint assessments and video recordings at their respective day-care hospitals. The orthoses were made by the same supplier. Correction of the calcaneo-valgus was improved in all the cases. Balance in standing was improved in 15 cases, including three children who became able to stand without other aids. This orthosis is well adapted to children suffering from spina bifida. It is well accepted because of its lightness and good skin tolerance and was preferred to earlier appliances in all cases.

A 14 days old neonate presented an occlusion of the right internal carotid artery complicating a Streptococcus B meningitis. We discuss the mechanism of this rare complication of purulent meningitis, usually due to hemophilus influenzae.

The authors report two cases of fulminant hepatitis in children. Coagulopathy was early demonstrated in the two patients. The illness progressed rapidly and the two children died before receiving antiviral treatment. Herpes virus was demonstrated in the hepatocytes by electron microscopy.

Hypomelanosis of Ito is a rare neurocutaneous syndrome and several abnormalities are often associated. Malignant hypertension and polycythemia are very unusual; their occurrence in a 12 year-old girl is not related to any classical etiology and their place in Ito disease is discussed.

Neurological complications of arterial hypertension are analyzed in 31 children (mean age = 9 years). All patients presented a renal or renovascular disease (acute nephritis + hypoplastic dysplasia , transplantation = 58%) for which malignant hypertension was the first symptom in 16%. The mean +/- SD initial blood pressure was 189 +/- 33/113 +/- 25 mm Hg and was preceded by previous symptoms in 1 patient out of 6. Neurological abnormalities consisted in seizures (48%), acute intracranial hypertension (39%), cranial palsy (23%), coma (19%), hemiplegia/paresia (16%), retinal changes (6%) or aphasia (6%). The EEG was abnormal in 50% of the patients, sometimes showing permanent paroxysmal activity. Neuroradiologic investigations revealed hemorrhagic and/or ischemic lesions in 1/5 patients. On follow-up, hypertension disappeared in 41% of the children; a decrease in renal function was noted in 56% of the patients at the last examination; neurological sequellae were present in 40% (EEG anomalies +/- epilepsy, motor deficit, retinal changes, psychomotor delay, cranial palsy) and 1 patient died. The morbidity of malignant hypertension stresses the importance of early diagnosis and treatment (calcium channel blockers) when its prevention is not possible.