Hospital admissions related to influenza in France during the 2006/2007 epidemic.

BACKGROUND: The data available on hospital admissions related to influenza mostly concern in-patients admitted via the emergency department. Severe cases have been collated by intensive care practitioners since 2009. For this survey, we searched French hospital admission databases to estimate the prevalence rate of hospital admissions related to influenza and to record qualitative data. METHOD: All case studies identified between October 2006 and September 2007 were split into two groups: the first displaying symptoms of clinical influenza and the second suffering from influenza as an associated diagnosis. RESULTS: We collected 6797 hospital admissions, 2126 of which were closely related to clinical influenza. Fifty percent of cases concerned the elderly and young people. Fifty-six hospital deaths were recorded in which influenza was the underlying cause in 21% of the cases (12). When influenza was an associated diagnosis (44/56), cardiovascular or respiratory diseases were the main causes (26/44). CONCLUSION: During the same period (2006-2007), the French Sentinel Surveillance identified only 105 hospital admissions related to influenza. Our survey was therefore more exhaustive and was able to record qualitative data. Inclusion of hospital admissions with an associated diagnosis of influenza is debatable because this decreases specificity. The relationship between the principal diagnosis and all the associated diagnoses is difficult to study, although exclusion of this type of hospitalization could significantly underestimate these figures. Despite certain limitations, French hospital admissions databases should complement French Sentinel Surveillance data.

[Biochemical evaluation of the results of lipid regulating treatment in France]. / Evaluation biologique des résultats du traitement hypolipémiant en France. Etude SPOT.

The objective of the SPOT study (Study of Practice versus Objectives of Treatment) was the biochemical evaluation of the results of long term lipid regulating treatment in France, compared to the objectives defined by AFSSAPS (French regulatory agency for the safety of medical products) in 2000. A random sample of doctors was recruited in 21 French regions by the Regional Health Observation service. To be included in the SPOT study, the patients had to be on lipid regulating medication for at least six months and consent to biochemical evaluation following a consultation. A sample of 641 doctors examined 2,479 patients treated for 7 years on average. These middle aged patients (aged 63 +/- 11 years) were mostly taking statins (72%). They had an average total cholesterol level of 5.41 +/- 1.01 mmol/L (2.10 +/- 0.39 g/L). and LDL of 3.25 +/- 0.93 mmol/L (1.26 +/- 0.36 g/L), reflecting previous results and confirming the stability of their treatment. In primary prevention and in low risk subjects (with less than 2 associated risk factors), the AFSSAPS objectives were achieved in 95% of cases. In secondary prevention or in very high risk subjects (at least 3 associated risk factors 0), 35% of patients had LDL cholesterol greater than 3.4 mmol/L (1.30 g/L). The SPOT study, performed on subjects who had in theory been stabilised with lipid regulating medication, gave two conclusions: cardiovascular prevention with lipid regulating medication is improving in France, and the subjects at greatest risk attain the recommended objectives less often despite the expected benefit of treatment being higher.

[Cost-effectiveness analysis of laparoscopic surgery versus methotrexate: comparison of data recorded in an ectopic pregnancy registry]. / Comparaison coût-effectivité de la coelio-chirurgie versus le traitement médical au méthotrexate à partir du registre des grossesses extra-utérines d'Auvergne.

OBJECTIVES: To compare the cost efficacy ratios of medical therapy (methotrexate - MTX) and laparoscopic surgery for ectopic pregnancy, based on an observational study of effectiveness. MATERIAL AND METHODS: Data were collected by a population register of the Auvergne area. We computed the costs before, during and after hospitalization of women who could be treated either by MTX or laparoscopic surgery. We detailed costs related to the various existing facilities. We considered the entire treatment. RESULTS: One hundred nine cases of ectopic pregnancy were treated by laparoscopic surgery and 46 by MTX. Second-line therapy was required in 3% of women who underwent laparoscopic surgery, and 35% of those given MTX. MTX was found to be less costly (1,342 euros) than laparoscopic surgery (2,113 euros). The efficacy threshold for MTX was 11% (giving a failure rate of 89%). CONCLUSION: MTX is much more cost effective than laparoscopic surgery but the frequent need for second-line treatment must also be assessed.

Epidemiological survey of melanoma in the Auvergne region (France): is there an increased incidence in Auvergne?

To assess the efficiency of melanoma screening and prevention campaigns in the Auvergne region (France), cases of melanoma have been recorded since 1st June 1998. The epidemiological follow-up of melanoma was carried out using two sentinel networks; one involving the pathologists, and the other, the dermatologists of the region. Incidence was calculated using the capture-recapture method, by cross-matching the data supplied by both dermatologists and pathologists. Between June 1st 1998 and December 31st 2000, 363 cases of melanoma were recorded. The crude incidence rate of melanoma per 100,000 person-years was 17.1 for all melanomas and 14.6 for invasive melanomas. These rates of incidence were higher than the estimated national rate of France, and were close to incidences found in countries of Northern Europe. This might be explained by an increase in screening for melanoma, by more precise estimation of the incidence due to the capture-recapture method, or by geographic factors (mountainous area). An answer may be provided by following the variation in time of incidence and thickness of melanomas; the increase in the number of thin (low Breslow index) melanomas corresponding with increased screening.

[The use of exit questionnaires, a survey at 7 hospital centers]. / L'utilisation des questionnaires de sortie, une enquête auprès de 7 centres hospitaliers.

Measuring the satisfaction of hospitalised patients has been mandatory in France since 1996. The most common tool for assessing the level of satisfaction is the use of self-administered questionnaires given to the patient upon his/her release from the hospital. A survey was conducted among seven public hospitals to appraise the development and use of such questionnaires, their results and the way in which these results are taken into account in order to improve the quality of care. The survey's results illustrate that the policy with respect to their construction varies between hospitals, without any evaluation of the validity of the questionnaires produced. In most cases, the questionnaires are passively distributed to the patient at the time of discharge. The response rates are low (ranging from 4 to 18%), and the analysis of the collected questionnaires, to the extent to which it is done, is not necessarily used to improve the quality of care. An appropriate evaluation strategy, one capable of effecting change and improving hospital care, still remains to be established in the hospitals which participated in the survey.

[Prevalence of asthma in children in Auvergne: a safe region?]. / Prévalence de l'asthme chez l'enfant en Auvergne: une région préservée?

UNLABELLED: The aim of our study was to determine the prevalence of asthma in the Auvergne region. PATIENTS AND METHODS: Two thousand and nine pupils from primary (five-six years old) and secondary (14-15 years old) schools were given a questionnaire when attending their compulsory medical examination and asked to return it completed. RESULTS: The response rate was 82%. The prevalence of asthma was 5.6%. There was no difference neither between the two age groups nor between sexes. In contrast, there was a significant difference in prevalence according to whether the child lived in a town (7.3%) or in the countryside (4.6%) (p = 0.01). In the department of the Puy-de-Dôme, this difference was even more distinct, with a prevalence of 10% in urban areas and 4.0% in the countryside (p = 0.001). Twelve percent of the children had experienced wheezing over the previous 12 months. The prevalence of bronchitis was higher in rural areas (17.3%) than in towns (11.8%) but not to a significant degree. Passive smoking significantly increased this risk (18.9% and 14%, p = 0.003). CONCLUSION: The prevalence of asthma in the Auvergne region is low in both age groups compared to other regions in France and to Europe. The difference of prevalence between town and countryside may evidence of the influence of environmental factors.

[School health education: practices and representations of primary school teachers]. / Education à la santé à l'école: pratiques et représentations des enseignants du primaire.

A better understanding of primary school teachers' practices and representations toward health education (HE), and identification of individual or structural resistance as well as the partnership and training needs all constitute important goals in HE research. A quantitative study was conducted between April and December 2001 on a representative sample of the population of primary school teachers (n = 673) in the Auvergne region. The results demonstrate that the majority of teachers declare practicing and implementing HE. The approach is primarily thematic, essentially limited to a few lessons since it is only integrated into a broader project 20% of the time. 30% of teachers work in partnership, mainly with partners in school health; however, parents are rarely involved in HE activities. Parameters which influence the teachers' practices and representations are: (1) prioritizing work within an educational network and an inter-communal pedagogical regrouping, with the advantage that there are a greater number of teachers to do HE in these schools than in others, and (2) receiving initial or in-service training. These results suggest that a policy aiming to generalize the inclusion of HE in French primary schools must develop teacher training as well as support and accompany the collective dynamics within schools.

Infectious risk associated with wastewater reuse: an epidemiological approach applied to the case of Clermont-Ferrand, France.

Wastewater reuse raises the question of health risk and the epidemiological surveys needed. An epidemiological and environmental approach was used to check the security for the exposed populations (surrounding and agricultural population in Clermont-Ferrand. Four information systems were set up: two sentinel systems joining general physicians (15) and pharmacists (7) for the surrounding population and two follow-up surveys among field workers and farmers. Water quality monitoring and a study of aerosols from spray irrigation were performed. No epidemic event was identified with only some case clusters (not related to water exposure) being observed. All the declared cases were benign. The workers' survey underlined a substantial incidence of nettle rashes, itchy skins, sunburns, and cuts. The follow-up study among farmers and their families did not reveal any particular phenomena. The bacteriological quality of treated wastewater throughout conformed with the recommendations of the Superior Council of Public Health of France (1,000 faecal coliforms/100 mL). No faecal bacteria were observed in aerosols with water concentrations equal to 10(3) cfu/100 mL and an exposure time of 20 min. The survey of such an irrigation system, towards potential and actual risks, required the conjunction of different epidemiological information sources and microbiological data.

[Use of a self-administered quality of life questionnaire in a university preventive service]. / Utilisation d'un autoquestionnaire de qualité de vie en service de médecine préventive universitaire.

In France, the student population represents close to two million people covered by the medical and social plan of the Services de Sante Inter-Universitaires (Inter-University Health Services), of which one of the objectives is to improve students' quality of life. This is why it seemed interesting to measure this quality of life in order to identify problems and to propose possible improvements. For this, we used a generic self-administered questionnaire, the SF 36, which allowed for detecting the variations of quality of life in relation to health status. Throughout the 1995-1996 school year, 1301 questionnaires were completed by first year students seen in routine visits or scheduled appointments. The questionnaire was well received. The self-administered questionnaire is a sensitive tool that revealed, among healthy students, statistically significant differences in scores between girls and boys (with girls showing lower scores). This difference is not found in the group of students who came for an appointment for a benign pathology. The causes of these variations remain to be explored.

Hospital morbidity of alcohol use disorders in the center of France.

BACKGROUND: The Auvergne region of central France has the third highest mortality rate in the country for alcohol-related disorders and the highest level of alcohol consumption among young people. METHODS: An exhaustive cross-sectional study of regional hospital morbidity related to alcohol was undertaken on a single day in May 1998, including 9,552 hospital beds. All inpatients age 16 and older in the Departments of Medicine, Surgery, Obstetrics and Gynecology, Psychiatry, and Medium-Stay Services were studied. The aim was to define alcohol-related behavior patterns (by using the Diagnostic and Statistical Manual of Mental Disorders [DSM-IV] criteria of abuse and dependence and the CAGE questionnaire) and to measure the proportion of nonsomatic alcohol-related care dispensed in hospital. RESULTS AND CONCLUSIONS: The prevalence of alcohol use disorders in all wards was 20%. Half of these patients were alcohol dependent, a quarter were diagnosed as alcohol abusers, and a quarter had an alcohol-related problem that was not identified during the stay. Alcohol use disorders were more common in male inpatients (34% vs. 8% in female inpatients) and in certain age groups. One male subject in two and one female subject in five between 34 and 45 years had an alcohol-related problem. Almost 25% of male inpatients studied between the ages of 16 and 20 years had an alcohol-related problem, but only half had been diagnosed previously. Hospital care for alcohol-related health problems was seriously inadequate. On average, 38% of patients diagnosed with an alcohol use disorder received relevant nonsomatic alcohol care, of which 13% were alcohol abusers and 50% were alcohol-dependent patients. SIGNIFICANCE: This exhaustive study demonstrates the degree of alcohol-related morbidity among hospitalized patients, which is particularly high in men, in the Auvergne region of France. The study emphasizes the lack of diagnosis, particularly for the young, and the apparent deficiencies in the hospital management of these patients.

[Quality of life and multiple sclerosis: validation of the french version of the self-questionnaire (SEP-59)]. / Qualité de vie et sclérose en plaques: validation de la version francophone d'un auto-questionnaire, le SEP-59.

We conducted a prospective study among 166 multiple sclerosis (MS) patients (103 from an university hospital, 63 from a MS rehabilitation center) to assess the properties of the French version of the Multiple Sclerosis Quality Of Life - 54 items (MS QOL-54) which combines the MOS SF36 together with MS specific items. The SF-36 had been translated into French through the IQOLA project. We translated and adapted the MS specific items with the help of three different teams. The translation into French has an addition of five items, because we kept the MS specific items of an earlier unpublished form. Acceptability is excellent with a response rate over 90p.100. Test-retest reliability is good except for the "role limitation-emotional" scale of the SF-36. Construct validity, based on factor analysis, shows no change in the SF-36 internal consistency and the specific items provided their own information. External validity, tested against both medical (Expanded Disability Status Scale, Kurtzke scale, Mini-Mental-State and disease stage) and rehabilitation (Functional Independence Measure) parameters is excellent. The French MS QOL questionnaire contains 59 items including both the SF-36 and the MS QOL-54 items. This will permit international comparisons of MS patients' care and therapy.

[Reserved reception of the general health report of France: an evaluation of the national federal of regional health observatories]. / L'accueil réservé au rapport général sur la santé en France: une evaluation de la fédération nationale des ORS.

At the request of the High Committee for Public Health (HCSP), an evaluation of the reception of its report, "Health in France" was carried out by the National Federation of Regional Health Observatories. Forty semi-directive interviews among actors of the health system from various geographic and professional backgrounds were carried out. It appears that the HCSP is an authority that is not well-known, for the most part. The report itself was mainly distributed by administrative networks; in the majority of cases, only the first part is well-known and was the particular focus of the interviewees. Overall, this document is a work instrument, a global tool, and a reference document. Several improvements are proposed concerning its form, the list of subjects covered, as well as the means of distribution.

[Comparative evaluation of maternity hospitals in Auvergne: from planning to contracting]. / Evaluation comparative des maternités en Auvergne: de la planification à la contractualisation.

Two reforms of public hospitals have been launched by the French government in 1991 and 1996 aimed at lowering costs and increasing the quality of services and ultimately the safety of patients. As concerns maternity hospitals, several new rules have been imposed upon. For example, those who performed less than 300 births a year should be closed. The basic idea was to concentrate technical resources and human skills in middle-size and important hospitals for saving money, and simultaneously, raising the safety level for mothers and babies. However, negative adverse effects fastly appeared: to avoid closure, some small maternity homes tried to convince future mothers not to go to well-equipped hospitals, even if their cases appeared complex and their health at risk. An experience of partnership between maternity hospitals (care providers), the Sickness Insurance Fund (the financing body) and the Administration was carried out in the Auvergne region. It was based on the observation of a large number of indicators concerning the activity of hospitals, the size and quality of their equipment, the satisfaction of their patients ... etc ... for designing the rights and duties of each partner. Instead of planning from the summit, a process of mutually-agreed contract was established.

[Epidemiologic follow-up of subjects taking a cure in thermal spas: apropos of a 2-year experience in Bourboule and Saint-Nectaire]. / Le suivi épidémiologique des curistes dans les stations thermales: à propos de deux ans d'expérience à la Bourboule et à Saint-Nectaire.

We tried to find out if a controlled sentinel system can be used in a hot spring spa to determine the level of incidents encountered by cure takers and to alert in case of epidemiological events. After two years of experiences in two different thermal resorts, we conclude that such systems may operate and may be extended to other hot spring spas. Among the incidents declared, some cannot be explained by a reactivation of the chronic disease justifying the cure and we pointed out the role of places and periods of cure takers' meeting.