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Background: Knowledge about the consequences of electronic cigarette (EC) use on respiratory health is still limited. We aimed to assess whether EC use is associated with the occurrence of asthma symptoms and chronic bronchitis among the French adult population, with a specific focus on never combustible cigarettes (CC) smokers. We further investigated whether the association differed in men and women., Methods: Constances is a population-based cohort of adults aged 18-69 years at inception. We analyzed baseline data collected in 136,276 participants recruited in 2015-2019. Associations of current and former EC use with respiratory symptoms (asthma symptom score and chronic bronchitis) were assessed, controlling for CC smoking, cannabis use, demographics, education and body mass index (BMI)., Results: Increased frequencies of respiratory symptoms were observed in both current and former EC users (for the asthma symptom score, adjusted mean score ratio (aMSR): 1.34 [95 % confidence interval: 1.28-1.41] and 1.39 [1.33-1.45], respectively; for chronic bronchitis, adjusted prevalence ratio (aPR): 1.27 [1.19-1.36] and 1.40 [1.32-1.48], respectively). Among never CC smokers, ever EC use was associated with an increased asthma symptom score in both men and women (aMSR = 1.44 [1.09-1.90] and 1.36 [1.01-1.83], respectively), and with a higher prevalence of chronic bronchitis only in women (aPR = 1.97 [1.27-3.05])., Conclusion: EC use is associated with symptoms of asthma and chronic bronchitis, independently of CC smoking and cannabis use. The fact that these associations are observed among individuals who have never smoked tobacco adds further evidence of the deleterious effects of EC on respiratory health., Competing Interests: Declaration of competing interest There is no conflict of interest., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objectives: Asthma has significant occupational consequences. The objective of our study was to investigate the links between asthma and the career path, taking into account gender and age at asthma onset., Methods: Using cross-sectional data collected at inclusion in the French CONSTANCES cohort in 2013-2014, we studied the links between each career path indicator (number of job periods, total duration of employment, numbers of part-time jobs and work interruptions due to unemployment or health issues, employment status at inclusion) on the one hand, and current asthma and asthma symptom score in the last 12 months on the other hand, as reported by the participants. Multivariate analyses were performed separately for men and women using logistic and negative binomial regression models adjusted for age, smoking status, body mass index and educational level., Results: When the asthma symptom score was used, significant associations were observed with all of the career path indicators studied: a high symptom score was associated with a shorter total duration of employment as well as a greater number of job periods, part-time jobs and work interruptions due to unemployment or health issues. These associations were of similar magnitude in men and women. When current asthma was used, the associations were more pronounced in women for some career path indicators., Conclusion: The career path of asthmatic adults is more often unfavourable than that of those without asthma. Efforts should be made to support people with asthma in the workplace, in order to maintain employment and facilitate the return to work., Competing Interests: Competing interests: MG reports grants or contracts from ANSES., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: Declaration of Competing Interest None.

Background: The burden of undiagnosed obstructive lung disease (OLD) (mainly asthma and chronic obstructive pulmonary disease) is not fully established, and targets for corrective action are yet to be identified. We assessed the underdiagnosis of OLD and its determinants in France., Methods: CONSTANCES is a French population-based cohort of adults aged 18-69 years at inception. We analysed data collected at inclusion in 2013-2014. Undiagnosed OLD was defined as spirometry-confirmed airflow limitation (FEV 1 /FVC < lower limit of normal) without prior diagnosis of asthma, chronic obstructive pulmonary disease, or bronchiectasis. Multivariate analysis was performed with weighted robust Poisson regression models to estimate the adjusted prevalence ratios (aPR) of undiagnosed OLD., Results: Spirometry results were available for 19,398 participants. The prevalence of airflow limitation was 4.6%. Overall, 64.4% of adults with airflow limitation did not report a previous diagnosis of OLD. Individuals with high cumulative tobacco consumption (≥ 10 pack-years) (aPR: 1.72 [1.28-2.32]), without respiratory symptoms (aPR: 1.51 [1.28-1.78]), and with preserved lung function (aPR: 1.21 [1.04-1.41] for a 10-point increase in FEV 1 % predicted) had a higher risk of being undiagnosed. Half of symptomatic individuals with airflow limitation (45% of those with moderate to severe airflow limitation) were undiagnosed with OLD., Conclusion: Underdiagnosis of OLD is very common among French adults, even in patients with respiratory symptoms. Efforts should be made in France to raise awareness about OLD in the general population, improve the detection of respiratory symptoms, and increase the use of spirometry among primary care professionals., (© 2021. The Author(s).)

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: Obstructive sleep apnea (OSA) is a frequent condition. In the absence of treatment, OSA is associated with a higher risk of traffic accidents and a large variety of diseases. The objectives of this study were to describe the characteristics of patients treated for OSA in France and assess the time trends in treatment., Methods: The French National Health Data System is an individual database with data on all healthcare reimbursements for the entire French population. Based on this database, we included all patients aged 20 years or over who were treated with continuous positive airway pressure (CPAP) or mandibular advancement splint (MAS) between 2009 and 2018. Negative binomial models, adjusted for age, were used to assess time trends in treatment prevalence and incidence rates., Results: In 2017, 2.3% of French adults aged ≥20 years were treated with CPAP (men: 3.3%; women: 1.3%). The highest prevalence was observed in people aged 70-74 years (5.0%). From 2009 to 2018, the annual prevalence of CPAP increased 3-fold and the annual incidence 1.9-fold. During the same period, the rate of patients reimbursed for MAS (first prescription or renewal) was multiplied by 7.6. The proportion of patients treated with CPAP in 2017 who were no longer treated in the subsequent year was 6.9%., Discussion: The sharp increase in the incidence of OSA treatment probably reflects a better recognition of the disease in France. However, the prevalence of OSA treatment remains lower than expected based on the international literature. Further studies are needed to identify the obstacles to an optimal management of individuals with OSA in France., Competing Interests: Dr Damien Léger declares that in the past 5 years, he has been a consultant or investigator in studies sponsored by Actellion, Agence Spatiale Européenne, Bioprojet, iSommeil, Jazz, Vanda, Merck, Philips, Rythm, Sanofi, Vitalaire, and Resmed. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Background: The high prevalence of smoking among French women since the 1970s has been reflected over the past decade by a strong impact on the health of women. This paper describes age and gender differences in France of the impact of smoking on morbidity and mortality trends since the 2000s., Methods: Smoking prevalence trends were based on estimates from national surveys from 1974 to 2017. Lung cancer incidence were estimated from 2002-12 cancer registry data. Morbidity data for chronic obstructive pulmonary disease (COPD) exacerbation and myocardial infarction were assessed through hospital admissions data, 2002-15. For each disease, number of deaths between 2000 and 2014 came from the national database on medical causes of death. The tobacco-attributable mortality (all causes) was obtained using a population-attributable fraction methodology., Results: The incidence of lung cancer and COPD increased by 72% and 100%, respectively, among women between 2002 and 2015. For myocardial infarction before the age of 65, the incidence increased by 50% between 2002 and 2015 in women vs. 16% in men and the highest increase was observed in women of 45-64-year-olds. Mortality from lung cancer and COPD increased by 71% and 3%, respectively, among women. The estimated number of women who died as a result of smoking has more than doubled between 2000 and 2014 (7% vs. 3% of all deaths)., Conclusions: The increase in the prevalence of smoking among women has a major impact on the morbidity and mortality of tobacco-related diseases in women and will continue to increase for a number of years., (© The Author(s) 2019. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

[This corrects the article DOI: 10.1371/journal.pone.0196711.].

Objective: Different phenotypes of wheezing have been described to date but not in early life. We aim to describe wheezing phenotypes between the ages of two months and one year, and assess risk factors associated with these wheezing phenotypes in a large birth cohort., Methods: We studied 18,041 infants from the ELFE (French Longitudinal Study of Children) birth cohort. Parents reported wheezing and respiratory symptoms at two and 12 months, and answered a complete questionnaire (exposure during pregnancy, parental allergy)., Results: Children with no symptoms (controls) accounted for 77.2%, 2.1% had had wheezing at two months but no wheezing at one year (intermittent), 2.4% had persistent wheezing, while 18.3% had incident wheezing at one year. Comparing persistent wheezing to controls showed that having one sibling (ORa = 2.19) or 2 siblings (ORa = 2.23) compared to none, nocturnal cough (OR = 5.2), respiratory distress (OR = 4.1) and excess bronchial secretions (OR = 3.47) at two months, reflux in the child at 2 months (OR = 1.55), maternal history of asthma (OR = 1.46) and maternal smoking during pregnancy (OR = 1.57) were significantly associated with persistent wheezing. These same factors, along with cutaneous rash in the child at 2 months (OR = 1.13) and paternal history of asthma (OR = 1.32) were significantly associated with increased odds of incident wheezing. Having one sibling (ORa = 1.9) compared to none, nocturnal cough at 2 months (OR = 1.76) and excess bronchial secretions at 2 months (OR = 1.65) were significantly associated with persistent compared to intermittent wheezing., Conclusion: Respiratory symptoms (cough, respiratory distress, and excessive bronchial secretion) were significantly associated with a high risk of persistent wheezing at one year. Smoking exposure during pregnancy was also a risk factor for persistent and incident wheezing.

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.)

Introduction: Hospitalizations for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) are increasing in France. AECOPD are associated with impaired health status and increased health care costs., Methods: Using data from the French national health insurance information system, we studied mortality, readmissions and lung function testing after discharge among adults hospitalized for AECOPD in 2013., Results: The cumulative probabilities of death and readmission for EACOPD were 21% and 31% respectively. The survival was better among women, even after taking into account the other risk factors (age, previous hospitalization for AECOPD, comorbidities, exacerbation severity). In multivariate analysis, the risk of readmission was increased among men and people living in socially disadvantaged areas. A lung function testing was performed in 34% within 3 months after discharge. Female gender, advanced age, comorbidities and living in a disadvantaged area were associated with a lower frequency of lung function testing., Conclusions: Women had a better prognosis than men after AECOPD hospitalization. The frequency of lung function testing after discharge remained low, particularly among women and people living in disadvantaged areas., (Copyright © 2016 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: Asthma remains poorly studied in homeless children. We sought to estimate the prevalence of asthma-like symptoms (ALS) and to identify the factors associated with ALS and healthcare service utilisation., Materials and Methods: A cross-sectional survey of a random sample of sheltered homeless families was conducted by interviewing 801 parents of children (0-12 years) in 17 languages. ALS were defined as wheezing or night cough without fever during the previous year. Poisson regression models with robust error variance were used to compute prevalence ratios (PR) for factors associated with ALS and healthcare service utilisation for ALS., Results: The prevalence of ALS among the children was 19.9%. Poor housing sanitation was significantly associated with ALS, as being born in the European Union. Most of the children with ALS had used healthcare services (85.4%). The main barriers to accessing such services were having lived in France for less than 49 months, having difficulties in French and living in poor housing conditions., Conclusion: ALS prevalence seemed lower than in the general child population, possibly because of the children's origins. Environmental factors associated with ALS point to the need to improve the indoor environment of family shelters. The relatively high rate of healthcare service utilisation should not overshadow existing barriers.

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.)

Objectives: Climate change may be considered as a key factor for environmental change, exposure to health risks and pathogens, consequently impairing the state of health among populations. Efficient health surveillance systems are required to support adaptation to climate change. However, despite a growing awareness, the public health surveillance sector has had very little involvement in the drafting of adaptation plans. This paper proposes a method to raise awareness about climate change in the public health community, to identify possible health risks and to assess the needs for reinforced health surveillance systems., Methods: A working group was set up comprising surveillance experts in the following fields: environmental health; chronic diseases and; infectious diseases. Their goal was to define common objectives, to propose a framework for risk analysis, and to apply it to relevant health risks in France., Results: The framework created helped to organize available information on climate-sensitive health risks, making a distinction between three main determinants as follows: (1) environment; (2) individual and social behaviours; and (3) demography and health status. The process is illustrated using two examples: heatwaves and airborne allergens., Conclusion: Health surveillance systems can be used to trigger early warning systems, to create databases which improve scientific knowledge about the health impacts of climate change, to identify and prioritize needs for intervention and adaptation measures, and to evaluate these measures. Adaptation requires public health professionals to consider climate change as a concrete input parameter in their studies and to create partnerships with professionals from other disciplines., (Copyright © 2012 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Objective: To determine the prevalence of symptoms evocative of obstructive sleep apnea (SE-OSA) and the magnitude of obstructive sleep apnea (OSA) underdiagnosis., Methods: We used data from a cross-sectional survey conducted in 2008 in a representative sample of the French general population. Data were collected through interviews and self-administrated questionnaires and were complete for 12,203 adults (≥16 years old). SE-OSA was defined by snoring almost every night plus witnessed apneas or excessive daytime sleepiness (Epworth sleepiness scale score>10)., Results: The prevalence of SE-OSA was 4.9% (95% CI: 4.5-5.3), and that of self-reported OSA diagnosis was 2.4% (2.1-2.7). The prevalence of SE-OSA was 8% among people with hypertension and 11% among obese people. A previous sleep monitoring session was reported by 2.7% (2.4-3.0) of the participants and by 15.1% of people with SE-OSA. This latter proportion increased with age (24% in people with SE-OSA aged 60 years or over) and was higher in obese people (26%) and in those with chronic diseases (27% among people with hypertension)., Conclusion: The prevalence of SE-OSA is high in France and OSA remains underdiagnosed, even in people with obesity or hypertension. Further efforts are needed to improve the diagnosis of OSA., (Copyright © 2012 Elsevier B.V. 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.)

Chronic bronchitis (CB) is an indicator of an increased risk of developing COPD, but its symptoms are often underestimated. Demographic and socio-economic conditions might influence its prevalence, reporting and impact. Data from a large epidemiological survey of the French general population were analyzed to determine the burden of CB, the magnitude of under-diagnosis and the influence of age, gender and socio-economic conditions. Altogether, 9050 participants aged 45 years or more provided complete data. The prevalence of symptoms and diagnosis of CB was 3.5% and 3.4%, respectively. CB was associated with impaired health status and activity and, in women, work loss. Among subjects with symptoms of CB, only 28.6% declared a known diagnosis of respiratory disease. Factors associated with symptoms of CB in multivariate analysis were male gender, active smoking, lower income and occupational category: the highest prevalence was observed in manual workers (5.6%) and self-employed subjects (5.2%). The under-diagnosis of CB was more marked in men and subjects of higher socio-economic categories. These results confirm that CB is markedly under-diagnosed in the general population. Socio-economic conditions influence both its prevalence (higher in low categories) and rate of diagnosis (lower in high categories), which should be considered when elaborating prevention and detection campaigns., (Copyright © 2011 Elsevier Ltd. 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.)

Introduction: Most admissions for asthma are preventable. The objective of this study was to describe readmissions for asthma., Methods: We used the nationwide hospital database to identify readmissions for asthma in patients aged two to 44 years recorded in metropolitan France between 2002 and 2005. We selected patients having a main diagnosis of asthma or asthma-related acute respiratory failure. Readmission rates at seven days and one year were estimated using the Kaplan-Meier method., Results: The 1-year readmission rate was 15.0% and varied with age (being higher in patients aged two to four years and 35-44 years) and sex (being higher in females aged ten to 34 years). The 1-year readmission rate increased with index stay length. The 7-day readmission rate was 1.1% and was higher in patients with shorter index hospital stays., Conclusion: The rate of readmission of asthma patients is a relevant indicator for monitoring asthma and, more specifically, the clinical management of the disease. In the future, the accumulation of data from consecutive years and the linkage of admission data to asthma medication claims data can be expected to improve our understanding of severe asthma in France., (Copyright © 2011 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Background: Most hospital admissions for asthma exacerbation are avoidable with adequate disease management., Objectives: The objective of this study was to describe the characteristics of children hospitalized with an asthma exacerbation to identify modifiable factors leading to hospitalization., Methods: The study was conducted in 14 pediatric units and included children 3-17 years of age who were hospitalized for an asthma exacerbation. The present analysis covers 498 children with known asthma. Staff physicians used a standardized questionnaire to collect data. Asthma history came from a parental interview and included usual asthma care, frequency of symptoms and quick-relief medication use in the previous month, frequency of exacerbations and number of unscheduled healthcare visits during the past year, and prior asthma-related hospitalizations., Results: More than half the children had previously been hospitalized for an exacerbation, 42% used continuous inhaled corticosteroids, and 57% had a regular follow-up for asthma. Asthma had been well controlled over the past year for 11%, 12% had experienced exacerbations during the past year but that had been optimally controlled during the previous month, and 11% had recently become poorly controlled (infrequent exacerbations in the previous year and non-optimal control in the previous month). The remaining 327 children (66%) were consistently poorly controlled (non-optimal asthma control in the previous month and frequent exacerbations over the previous year). Among this group, 69% had at least one of the following preventable risk factors for hospitalization: no regular controller therapy (49%), no asthma action plan (40%), or no follow-up for asthma (35%)., Conclusions: Two-thirds of the children with asthma hospitalized for an exacerbation had been consistently poorly controlled during the previous year. They were frequently undertreated and insufficiently educated about asthma. Further efforts are needed to improve asthma treatment and education in France.

Rationale: The association between asthma and anxiety disorders in teenagers is well documented, but data about the association with mood disorders are scarce., Methods: We analyzed data from a cross-sectional study conducted among ninth grade schoolchildren in France in 2003-2004. The teenagers were selected by two-stage sampling and interviewed by school doctors/nurses using a standardized questionnaire including questions about asthma and asthma-like symptoms. They also completed a self-administered questionnaire in which the occurrence of major depressive episodes (MDEs) during the past 12 months was assessed by the Composite International Diagnostic Interview-Short Form., Results: A total of 7000 teenagers (mean age 15.1 years) were included. The prevalence of wheezing in the past 12 months was 10.0% and that of current asthma (wheezing in the past 12 months in children who had already had asthma attacks, or treatment for wheezing or asthma in the past 12 months) was 8.5%. The prevalence of MDE during the past year was 14.2% in teenagers with current asthma versus 9.2% among the others. The association between current asthma and past-year MDE remained significant after adjustment for age, gender, family structure, and the father's employment status. Asthma was uncontrolled (at least four attacks of wheezing, one awakening per week due to wheezing, one severe wheezing, four unplanned medical visits, or one hospitalization for a wheezing attack in the past year) in more than half (58.3%) of asthmatic teenagers with an MDE in the past year versus 35.3% of those without an MDE., Conclusion: Asthma is associated with a higher prevalence of MDE. Among adolescents with asthma, MDE is associated with poorer asthma control. These findings highlight the need for a comprehensive care management of asthma in France that takes the psychological dimension into account.

Background: Acute exacerbations of chronic obstructive pulmonary disease (AE-COPD) necessitating hospital admission have a major impact on patient outcome and management costs. We examined temporal trends in AE-COPD-related hospital admissions in France between 1998 and 2007., Methods: Data were obtained from the French national hospital discharge database for patients aged at least 25 years. AE-COPD was identified with both a "narrow" and a "broad" definition, according to the position (primary or associated) of diagnoses, in order to ensure robustness., Results: In 2007, among adults aged 25 years or more, the crude AE-COPD-related admission rates were 23/10000 in men and 10/10000 in women using the narrow definition. Using the broad definition, these rates were respectively 38 and 16/10000. With the narrow definition, the annual number of AE-COPD-related admissions increased by 38% between 1998 and 2007, while in-hospital lethality decreased from 7.6% to 6.0%. The proportion of male patients decreased from 72% to 68%. Similar trends were found using the broad definition. The age-standardized AE-COPD-related admission rate increased by 4.4% per year in women and by 1.6% per year in men with the narrow definition, and by respectively 3.8% and 1.2% with the broad definition. A strong seasonal pattern of admissions for AE-COPD was found, matching that of general practitioners visits for influenza-like illness., Conclusion: Hospitalization rates for AE-COPD have increased in France in recent years, especially among women. By contrast, AE-COPD-related in-hospital lethality has decreased., (Copyright © 2010 Elsevier Ltd. 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.

Mortality from asthma has decreased in many countries since the 1990s. Mortality statistics are usually based only on the underlying cause of death. The objectives of this study were to describe the characteristics of deaths and the trends in asthma-related mortality using multiple-cause analysis. Data were obtained from the French Centre of Epidemiology on Medical Causes of Death. Because ICD-10 was implemented in 2000, the analysis covers the period 2000-2005. In 2004-2005, asthma was the underlying cause of 42% of deaths with certificates mentioning asthma. The age-standardised rates of death from asthma decreased from 2000 through 2005 (-12% and -11%/year in the 1-44 and 45-64 age groups, respectively). The decline for all deaths with asthma was less pronounced (-9%/year in the 1-44 age group and -8%/year in the 45-64). Among adults aged 65 or older, the decrease in asthma-related mortality was higher in men (-12%/year for underlying cause, -9% for multiple-cause) than women (-5% and -3%, respectively). Since 2002, age-standardised rates of asthma-related mortality have been higher in women than men. In people aged 1-44 years, in-hospital deaths have declined between 2000 and 2005 while the proportion of non-hospital deaths increased from 53% to 67%. Regardless of the definition used, the age-standardised rate of asthma-related deaths decreased from 2000 to 2005, and the faster decline for underlying cause than for multiple-cause mortality argues for a real decline in mortality attributable to asthma. Using multiple cause-of-death analysis provides additional information for asthma mortality surveillance.

Background: Several studies have investigated the association between pollen exposure and asthma emergency admissions, but only 2 have investigated the effect of airborne allergens on consultations for rhinitis or conjunctivitis and none has used drug consumption as the health indicator., Objective: To analyze the short-term association between pollen exposure and antiallergic drug consumption in the urban area of Clermont-Ferrand, France, taking into account the potentially confounding effect of air pollution and meteorological factors., Methods: We used the French health insurance database to select all individuals from the Clermont-Ferrand urban area having benefited from reimbursement for antiallergic treatment from January 1, 2000, through December 31, 2001, and from January 1, 2003, through December 31, 2004. An episode of treated allergic rhinitis, rhinosinusitus, or conjunctivitis (ARC) was defined as the association of an oral antihistamine and a local antiallergic drug on the same prescription. The relations between daily changes in pollen concentrations and daily changes in the number of treated ARC cases were analyzed using a Poisson regression model with penalized spline functions., Results: The risk of treated ARC associated with an interquartile increase in pollen concentration increased significantly for Poaceae (5%, P < .001), Fraxinus (7%, P < .001), Betula (7%, P < .001), and Corylus (2%, P < .02). This increase was significant in all age groups for Poaceae and Fraxinus pollen and in people younger than 65 years for Betula pollen. The effect was mainly concentrated on the present day, except for Poaceae pollens, for which the risk remained significantly (P < .001) increased until 3 days lag time., Conclusions: This study showed a significant increase in treated ARC cases related to Poaceae, Fraxinus, and Betula. Specific risks are difficult to evaluate for species that share the same pollination period. Time-series studies based on drug consumption are useful to highlight and to supervise pollen-related diseases requiring ambulatory care.

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.

Background: A study was undertaken of deaths with an underlying or associated cause of chronic obstructive pulmonary disease (COPD), and trends in COPD mortality from 1979 to 2002 in France were analysed., Methods: Data were obtained from the Centre of Epidemiology on the Medical Causes of Death (CépiDc) for individuals aged 45 years and over. Owing to implementation of ICD-10 in 2000 for recording causes of death, two separate periods were analysed (1979-99 and 2000-2)., Results: In 2000-2, COPD was the underlying cause of 1.4% of deaths (deaths from COPD) and was mentioned on the death certificate in 3.0% (deaths with COPD). The other main underlying causes in these cases were cardiovascular diseases (32.0%) and cancers (24.5%). In 1979-99, age standardised rates of death with COPD remained stable in men (-0.01%/year) and increased in women (+1.7%/year). The mean annual rates of death with COPD per 100 000 were 84 for men and 19 for women in 2000-2., Conclusion: Multiple cause analysis improved the estimate of COPD related mortality. In 1979-99, COPD related mortality rates in France were stable in men but increased in women. Implementation of ICD-10 in 2000 introduced substantial discontinuities in mortality trends.

To quantify the impact of foodborne diseases on health, and set priorities for data collection, prevention and control of these diseases, we compiled and analyzed information from surveillance systems and other sources on the morbidity and mortality due to foodborne infectious diseases in mainland France in the last decade of the 20th century. Illness due to 13 bacteria, two viruses, and eight parasites were studied. The number of foodborne infections, hospitalizations, and deaths were estimated from multiple data sources. For each agent, several estimates were derived from the different sources. Estimates were ranked according to their plausibility, based on an assessment of the validity of the data source, and are presented as a "plausible interval" consisting of a low and high estimate. We estimate that these pathogens caused 10,200-17,800 hospitalizations per year. Salmonella is the most frequent cause (5,700-10,200 cases), followed by Campylobacter (2,600-3,500 cases) and Listeria (304 cases). Toxoplasmosis accounts for the majority of hospitalizations (426 cases) attributable to the studied parasitic infections. The number of deaths related to foodborne infection was estimated between 228 and 691. Bacterial pathogens account for the majority (191 to 652) of deaths of which 92 to 535 are attributable to salmonellosis, ranking as the first cause of death, and 78 to listeriosis, the second cause. Salmonella, Campylobacter, and Listeria are the main causes of severe foodborne illness in France. For several pathogens, data are insufficient to derive exact estimates of the disease burden. Nevertheless, it has been possible to derive plausible estimates for the majority, and to rank them according to their impact on public health.

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.

Objectives: to investigate blood markers of oxidative stress, and enzymatic and non-enzymatic antioxidants in normally nourished elderly people with Alzheimer's disease., Design: case-control study., Subjects: twenty patients with Alzheimer's disease and 23 elderly control subjects, living at home, free from disease and not undergoing any treatment known to have a strong influence on blood oxidative stress markers or antioxidant defence systems., Methods: we performed a nutritional evaluation, including anthropometric and biological measures and a 3-day dietary record. We determined concentrations of antioxidant vitamins (alpha-tocopherol, retinol) and malondialdehyde in plasma and erythrocytes. We also measured erythrocyte enzymatic activities of glutathione peroxidase and copper-zinc superoxide dismutase., Results: the two groups were similar in age, body mass index, dietary record and serum albumin concentration. After adjustment for age, sex and cardiovascular co-morbidity, mean plasma concentration of alpha-tocopherol was lower in those with Alzheimer disease than in control subjects (15+/-3.5 mg/l compared with 18.2+/-3.5; P=0.002), as was the mean plasma concentration of retinol (0.54+/-0.2 mg/l vs 0.7+/-0.2; P=0.014). The mean concentration of free plasma malondialdehyde was higher in those with Alzheimer's disease (0.70+/-0.2 mmol/l vs 0.5+/-0.1; P=0.036). In Alzheimer disease patients, free plasma malondialdehyde concentrations were inversely correlated with levels of alpha-tocopherol (P=0.002) and retinol (P=0.025). Erythrocyte levels of vitamins and enzymatic activities were similar in the two groups., Conclusion: lower plasma concentrations of alpha-tocopherol and retinol in normally nourished elderly patients with Alzheimer's disease than in controls could suggest that these antioxidant vitamins had been consumed as a result of excessive production of free radicals.

The novel phosphorylated pyrrolidine diethyl(2-methylpyrrolidin-2-yl)phosphonate (DEPMPH) was evaluated as a (31)P NMR probe of the pH changes associated with ischemia/reperfusion of rat isolated hearts and livers. In vitro titration curves indicated that DEPMPH exhibited a 4-fold larger amplitude of chemical shift variation than inorganic phosphate yielding an enhanced NMR sensitivity in the pH range of 5.0-7.5 that allowed us to assess pH variations of less than 0.1 pH units. At the non-toxic concentration of 5 mm, DEPMPH distributed into external and cytosolic compartments in both normoxic organs, as assessed by the appearance of two resonance peaks. An additional peak was observed in normoxic and ischemic livers, assigned to DEPMPH in acidic vesicles (pH 5.3-5.6). During severe myocardial ischemia, a third peak corresponding to DEPMPH located in ventricular and atrial cavities appeared (pH 6.9). Mass spectrometry and NMR analyses of perchloric extracts showed that no significant metabolism of DEPMPH occurred in the ischemic liver. Reperfusion with plain buffer resulted in a rapid washout of DEPMPH from both organs. It was concluded that the highly pH-sensitive DEPMPH could be of great interest in noninvasive ex vivo studies of pH gradients that may be involved in many pathological processes.

Objectives: Because most HIV-infected women are of reproductive age, we investigated whether their reproduction planning was affected by their HIV diagnosis., Design: The European women study is a prospective, multicentre cohort of 485 HIV-infected women with a known interval of seroconversion., Methods: The incidence of pregnancy was measured with person-time methods. Generalized estimating equation analysis was used to determine risk factors for pregnancy and pregnancy outcomes., Results: In 449 women, the age-adjusted incidence of pregnancies decreased from 8.6 before HIV diagnosis to 8.2 and 6.0 per 100 person-years in 0-4 and over 4 years after HIV diagnosis, respectively (P = 0.14). The proportion of induced abortions increased from 42% before to 53% after HIV diagnosis (P < 0.05). The risk of spontaneous abortion did not increase as a result of HIV infection. Since 1995, the proportion of births increased (P = 0.009), whereas that of induced abortions decreased (P = 0.01) compared with earlier years. An increased risk of pregnancy after HIV diagnosis was found in northern and central European women compared with southern European women; there was a lower risk in single women than in women with a steady partner. Of all pregnant women, single women, women between 15 and 25 years of age, and women with multiple partners were at increased risk for induced abortion both before and after HIV diagnosis., Conclusion: The incidence of pregnancy decreased with HIV disease progression. Pregnancies after HIV diagnosis appear to be related largely to social and cultural attitudes. The number of induced abortions was high before HIV diagnosis and it significantly increases thereafter.

Objectives: To assess the impact of HIV-related immunodeficiency and antiretroviral treatment on the occurrence and evolution of abnormal Papanicolaou tests., Study Design: Cohort of 485 HIV-infected women with a known date of infection, enrolled during May 1993-April 1998 in 23 centres (gynaecology, infectious disease or STD clinics, or drug treatment centres) in 12 European countries; in 21 centres, follow-up was performed every 6 months (median follow-up: 2 years)., Methods: Human papillomavirus (HPV) was detected at inclusion by Southern blot and PCR. The prevalence of squamous intraepithelial lesions (SIL), the incidence of SIL and regression from low-grade SIL were studied according to CD4 count after controlling for HPV detection results., Results: Compared with women with CD4 cell counts > 500 x 10(6)/l, women with CD4 cell counts < 200 x 10(6)/l had a twofold increase in both prevalence and incidence of SIL and in non-regression from untreated low-grade SIL; in addition, these women had a lower response rate to treatment of high-grade cervical intraepithelial neoplasia. The increase in SIL incidence associated with a low CD4 cell count was significant in women not receiving antiretroviral treatment (relative risk, CD4 cell count 200-499 x 10(6)/l, 1.9; CD4 cell count < 200 x 10(6)/l, 2.9; CD4 cell count > 500 x 10(6)/l, reference), whereas it was less marked and not statistically significant in treated women., Conclusions: Severe HIV-related immunodeficiency strongly increases the risk of occurrence of SIL; antiretroviral treatment may reduce this risk, probably by restoring or at least preserving immune function.

Objectives: To investigate the prevalence and incidence of sexually transmitted infections (STI) in HIV-infected women in relation to time from infection and sexual behaviour., Design: The European study on the natural history of HIV infection in women is a prospective cohort study of 487 HIV-infected women with a known interval of seroconversion from 12 European countries., Methods: Incidence was measured with person-time methods. Generalized estimating equations analysis was used to determine risk factors for STI., Results: At entry, 15% of the women were diagnosed with at least one acute STI (chlamydial infection, trichomoniasis or gonorrhoea), 10% with at least one other STI (genital warts or genital ulcerations) and 13% with vaginal candidiasis. Although frequently diagnosed during follow-up, the occurrence of acute STI and vaginal candidiasis decreased, whereas the occurrence of other STI increased with ongoing time from HIV infection. Furthermore, women with a history of prostitution [relative risk (RR), 2.00; 95% confidence interval (95% CI), 1.20-3.33] and women with irregular condom use (RR, 7.74; 95% CI, 3.52-17.0) were at higher risk for an acute STI., Conclusions: Although STI diagnoses were frequent, the occurrence of acute STI declined with time from infection which might be explained by changed sexual behaviour over time. The occurrence of other STI increased with time from HIV infection, presumably due to reactivation as a result of immunosuppression.

The effects of fatty acids (FA)-carrier, egg-lecithin liposomes (LIPO) as alternative to BSA, on ATP, glycogen and glucose contents in isolated perfused liver of fed rats were non-invasively studied using 31P/13C nuclear magnetic resonance (NMR). Oxidative phosphorylation was studied in isolated mitochondria from the same liver consecutively to the NMR experiments. ATP content decreased slowly and ATP turnover was similar during the perfusion with saline solution (KHB) or LIPO. However, LIPO induced an enhancement of respiratory control ratio in isolated mitochondria. Tissue glycogen and glucose content decreased when FA (linoleate or linolenate) were perfused with defatted BSA (3%) or LIPO (600 mg/l) whereas glucose excretion level was unchanged and lactate excretion tended to increase, reflecting changes in the cytosolic redox state and/or an enhancement of glycolysis. Addition of FA (0.5 or 1.5 mM) to LIPO caused a dramatic fall in liver ATP, a mitochondrial uncoupling and an impairment of the phosphorylation activity. Perfusion with FA (1.5 mM) carried by BSA significantly increased the ATP degradation without change of mitochondrial function. Owing to the higher affinity of BSA than LIPO for FA, these latter could be more easily released from complex LIPO-FA, increasing their uncoupling effect. Hence, the FA concentrations have to be largely decreased from the above currently used concentrations to avoid this effect. It will then be possible to minimize the effector action of FA and to study their more specific metabolic function as fuel. It was concluded that LIPO were appropriate carriers to study the different metabolic effects of FA.

The spin trap 5-(diethoxyphosphoryl)-5-methyl-1-pyrroline N-oxide (DEPMPO) is an improved ESR probe to assess superoxide (O2*-) formation in the postischemic heart. We recently found that DEPMPO pretreatment improves recovery of cardiac function with the concomitant inhibition of postischemic O2*- production. By perfusing diethyl methylphosphonate MeP(O)(OEt)2 to ischemic-reperfused isolated rat hearts, we provide hemodynamic evidence that this preservation, which exerts during ischemia, is in fact specific to the phosphonate group. Using 31P NMR on intact rat hearts, it was also found that the "phosphonate effect" of DEPMPO is related to the preservation of ATP levels during ischemia, when compared to 5,5-dimethyl-1-pyrroline N-oxide. This mechanism may be a means of reducing the potency of cardiac tissue to produce O2*- during reperfusion.

In healthy individuals, glycogen recovery after a strong depletion is known to be rapid and insulin independent during the initial phase, and subsequently, slow and insulin dependent. Free fatty acids (FFAs) as a putative source of insulin resistance (IR) could thus impair glycogen recovery during the second period. Using in vivo 13C nuclear magnetic resonance (NMR), we studied the effect of long-chain triglyceride emulsion on gastrocnemius glycogen resynthesis during a 3-h recovery period after 90 min of moderate exercise consisting of plantar flexion on overnight-fasted healthy men (n = 8). In separate experiments, each subject was infused with 10% Ivelip (0.015 ml x kg(-1) x min(-1)) or 10% glycerol (0.13 mg x kg(-1) x min(-1)). NMR spectra were acquired before and at the end of the exercise and during the recovery period. Whole-body glucose and lipid oxidation rates (indirect calorimetry), plasma insulin, C-peptide, glucose, lactate, beta-hydroxybutyrate, triglycerides, and FFAs were determined. Glycogen consumption was 47.6 +/- 4.5% (glycerol) and 49.7 +/- 4.8% (Ivelip) of the initial glycogen. An acquired IR in the Ivelip group was significant at the onset of the recovery period by homeostasis model assessment (P = 0.002). Glycogen resynthesis in the glycerol group appeared faster during the 1st h than during the subsequent 2nd h of the postexercise period. The glycogen resynthesis level was significantly lower in the Ivelip group than in the glycerol group during the recovery period (P = 0.04 during the 1st h and P = 0.001 during the next 2 h). During the recovery, plasma lactate and whole-body oxidation rates were similar in the two groups, whereas glycemia was significantly higher in the Ivelip group. A decreased cellular uptake of glucose as a substrate for glycogenosynthesis, rather than a competition between oxidation of carbohydrate and FFA, is discussed.