Inégalités face à la COVID-19 ­ Profils de territoire.

INTRODUCTION: In the midst of the COVID-19 health crisis, the Regional Health Observatories (RHO) and the National Federation of RHOs have chosen to make available their expertise regarding development and production of health indicators to support local and national public policies available, in order to plan for the lifting of population lockdown measures. PURPOSE OF RESEARCH: To characterize as finely as possible the geographical territories, including overseas territories, using indicators to describe both the population potentially at risk of presenting serious forms of COVID-19 and the demographic and social situations that could favor the circulation of the Sars-Cov-2 virus. RESULTS: 1,250 profile sheets, one for each public establishment of intermunicipal cooperation in the French departments (excluding Mayotte) presenting 34 indicators were produced. A national synthesis including a typology of these territories in seven classes was also produced. CONCLUSION: This work shows the possibility of describing a series of indicators linked to a specific theme systematically and at fine geographical scales. Along with a typology of territories, this tool can contribute with others to the management of a health crisis.

Prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium in asymptomatic patients under 30 years of age screened in a French sexually transmitted infections clinic.

BACKGROUND: An increasing prevalence of sexually transmitted infections (STI) has been noted in France over the past decade. Asymptomatic carriage may be high in patients infected with Chlamydia trachomatis attending free and anonymous screening centres (CDAG) and information, diagnosis and screening centres for STI (CIDDIST). In these centres, systematic C. trachomatis detection is recommended in women ≤25 years and in men ≤30 years. OBJECTIVES: This study aimed at estimating the prevalence of C. trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium in asymptomatic patients younger than 30 years attending a CDAG-CIDDIST. MATERIAL AND METHODS: A free systematic screening for C. trachomatis, N. gonorrhoeae and M. genitalium was offered to asymptomatic subjects under 30 years attending the Montpellier CDAG-CIDDIST from April to August 2009. Pathogens were identified by PCR in first void urine samples. RESULTS: Of the 1381 subjects included (53.8% women and 46.2% men), 105 (42.9% men and 57.1% women) tested positive for C. trachomatis (7.6%, 95% CI [6.3;9.13]); eight (seven men and one woman) tested positive for M. genitalium (0.58% [0.2;1]) of whom two were infected with C. trachomatis ; five (two men and three women) tested positive for N. gonorrhoeae (0.36% [0.1;0.8]) of whom three were infected with C. trachomatis. CONCLUSION: This study confirmed the need for C. trachomatis screening in all patients under 30 years. Our results did not support a systematic screening for N. gonorrhoeae and M. genitalium in urine samples in this kind of facility.

Special education and care services for children, adolescents, and adults with autism spectrum disorders in France: Families' opinion and satisfaction.

This study focused on parents' satisfaction with the special education and care services proposed to their child with autism spectrum disorders (ASD). Data were collected in three regions of France, using a questionnaire designed for the purpose of this study. Among the 530 families contacted, 212 filled in the questionnaire (response rate = 40.8%). Results showed that parents were globally satisfied with providers' involvement and motivation, but they felt they were not involved enough in their child's individualized program, that communication with providers was insufficient and that the services lacked ASD's specific tools and interventions. Among all families interviewed, parents of adolescents were the most unsatisfied and we hypothesized that this could be due to the specific issues regarding developmental changes and concern about the future at this period of life. Congruently with the literature, variables related to parental overall satisfaction were a regular communication with professionals, a specific, regularly updated individual program in which parents are associated, and specialized tools and interventions. The implications of these findings are discussed as well as future directions for clinicians to improve service delivery and allow the persons with ASD and their families to be more involved in the services.

[Waiting times for cancer care in four most frequent cancers in several French regions in 2011 and 2012]. / Délais de prise en charge des quatre cancers les plus fréquents dans plusieurs régions de France en 2011 et 2012.

UNLABELLED: Measuring waiting times is a good indicator of quality of cancer care and could reveal inequalities in cancer care access. AIMS: To determine the most representative waiting times in breast, lung, colon and prostate cancer care in several regions of France. To analyze the influence of individual, medical or health care system factors on those waiting times. METHODS: This study was piloted by the French Cancer Institute in partnership with the National Federation of the Regional Health Observatories and was driven by the Regional Oncology Networks and the Regional Health Observatories. In 2011, 2,530 women with breast cancer and 1,945 patient with lung cancer were included in eight regions, and in 2012, 3,248 patients with colon cancer and 4,207 men with prostate cancer were included in 13 regions, two of which were overseas departments. Data were analyzed from multidisciplinary discussion reports and from medical records. RESULTS: The mean time intervals (± standard deviation) for the various components of access to care were as follows in breast cancer: mammography to pathologist diagnosis, 17,7 days (±15,9); diagnosis (or treatment proposal) to surgery, 22,9 days (±13,9). In lung cancer: first suspect medical image to pathologist diagnosis, 21,5 days (±17,6); diagnosis to treatment proposal, 13,5 days (±10,7). In colon cancer: coloscopy to pathologist diagnosis, 4,5 days (±4,1); diagnosis to surgery, 18,9 days (±14,9). In prostate cancer: pathologist diagnosis to treatment proposal, 36,5 days (±26,5); treatment proposal to surgery, 45,2 days (±30,1). Data collection was particularly difficult because of very heterogeneous way in medical records filling by care centers, so the data collection method used in the study could not be used in routine procedures. Waiting times measured in the four cancers had an important variability. In fact, age, circumstance of diagnosis, tumor stage and category of care center had an influence. After considering those different factors, differences between regions remained from range 2 to 4. Those regional differences could be explained by organizational factors but were not explored in our study. In the same way, data on individual factors (social vulnerability, category of employment) were not available to measure their effects on this study. Besides, our results were comparable to those in international publications or national recommendations in other countries. CONCLUSION: These results suggest that waiting times could be good indicators and could reveal inequalities in cancer care access. Measuring them would lead to characterize those inequalities and to propose actions to improve access to cancer care whose impact could be measured.

Cognitive impairment at age 5 years in very preterm infants born following premature rupture of membranes.

OBJECTIVE: To evaluate the relationship between preterm premature rupture of membranes (PPROM) and cognitive impairment in 5-year-old children born very preterm. STUDY DESIGN: The Etude Epidémiologique sur les Petits Ages Gestationnels Study is a population-based cohort of children followed up from birth to age 5 years recruited in 9 French regions in 1997. We analyzed data from singletons born between 24 and 32 weeks gestation categorized into 4 groups according to etiology of prematurity: infants born after PPROM, after idiopathic preterm labor, in a vascular context (Vasc), and to women with other complications (Other). Cognitive development at age 5 years was assessed using the Mental Processing Composite score of the Kaufman-Assessment Battery for Children. RESULTS: Among the 1051 children followed up to age 5 years, the mean Mental Processing Composite score was 93.6 ± 19.7, and 13.3% of the children (140 of 1051) had cognitive impairment. After adjustment for potential confounders, the risk of cognitive impairment among infants in the PPROM group was not significantly different than that in the idiopathic preterm labor group (OR, 1.09; 95% CI, 0.62-1.92) and the Other group (OR, 1.36; 95% CI, 0.75-2.47), but was lower than that in the Vasc group (OR, 1.86; 95% CI, 1.16-2.97). In the PPROM group, the risk of cognitive impairment was greater when the latency period (ie, time from rupture to delivery) was <3 days (OR, 2.32; 95% CI, 1.07-5.02). CONCLUSION: Preterm infants born after PPROM are not at increased risk for cognitive impairment in childhood, but the time between PPROM and birth may influence that risk.

[Prevalence and risk factors of overweight among 5- to 11-year-old schoolchildren in Narbonne, France]. / Prévalence et facteurs de risque de la surcharge pondérale chez les écoliers narbonnais de 5 à 11 ans.

In order to address the increasing prevalence of overweight and obesity in children, the French city of Narbonne recently began monitoring childhood obesity with a view to developing and implementing targeted actions to stabilize the prevalence of overweight. The main purpose of this study was to assess the risk factors for overweight in children. The study was conducted during the 2008-2009 academic year and was based on a sample of 1,476 preschool and primary school children from all public and private schools in Narbonne. The prevalence of overweight and obesity were 14.9% and 3.7%, respectively. The study found that watching television for more than 2 hours a day, short sleep duration (less than 10 hours per night), a low socioeconomic status and parental obesity are risk factors for overweight and obesity in children. The findings suggest that priority actions among poor populations and overweight mothers are required in order to stabilize the prevalence of overweight and obesity in children, including providing advice on healthy eating, fighting against sedentary lifestyles and promoting sleep.

Predictors of cerebral palsy in very preterm infants: the EPIPAGE prospective population-based cohort study.

AIM: The aim of this study was to assess the independent role of cerebral lesions on ultrasound scan, and several other neonatal and obstetric factors, as potential predictors of cerebral palsy (CP) in a large population-based cohort of very preterm infants. METHOD: As part of EPIPAGE, a population-based prospective cohort study, perinatal data and outcome at 5 years of age were recorded for 1812 infants born before 33 weeks of gestation in nine regions of France in 1997. RESULTS: The study group comprised 942 males (52%) and 870 females with a mean gestational age of 30 weeks (SD 2 wks; range 24-32 wks) and a mean birthweight of 1367 g (SD 393 g; range 450-2645 g). CP was diagnosed at 5 years of age in 159 infants (prevalence 9%; 95% confidence interval [CI] 7-10%), 97 males and 62 females, with a mean gestational age of 29 weeks (SD 2 wks; range 24-32 wks) and a mean birthweight of 1305 g (SD 386 g; range 500-2480 g). Among this group, 67% walked without aid, 14% walked with aid, and 19% were unable to walk. Spastic, ataxic, and dyskinetic CP accounted for 89%, 7%, and 4% of cases respectively. The prevalence of CP was 61% among infants with cystic periventricular leukomalacia, 50% in infants with intraparenchymal haemorrhage, 8% in infants with grade I intraventricular haemorrhage, and 4% in infants without a detectable cerebral lesion. After controlling for cerebral lesions and obstetric and neonatal factors, only male sex (odds ratio [OR] 1.52; 95% CI 1.03-2.25) and preterm premature rupture of membranes or preterm labour (OR 1.72; 95% CI 0.95-3.14) were predictors of the development of CP in very preterm infants. INTERPRETATION: Cerebral lesions were the most important predictor of CP in very preterm infants. In addition, infant sex and preterm premature rupture of membranes or preterm labour were also independent predictors of CP.

Health indicators in the European regions--ISARE II.

BACKGROUND: Most comparisons of health data in Europe take place at the national level. However, there is increased interest in looking at health data at a sub-national level. This is because of the increased importance in many European countries, of regions and devolved powers to them. This study aimed to establish the availability of health data at a regional level and to construct an experimental database. METHODS: Using a network of country correspondents, data were collected on a series of topics from all the regions of that country. In addition, a supplementary list of data was collected from one region of each country. RESULTS: Out of the then 15 Member States of the European Union (EU), 14 countries participated in the study. Thirteen countries were able to supply data. Where data were available, using the criteria we developed, these were of relatively good quality. Data on mortality was most readily available, but data on the important public health topics such as obesity was much more difficult to obtain, and absent in many cases. CONCLUSIONS: It is possible to construct a database and a resultant set of indicators for relevant sub-national areas of Member States in the EU. This is not likely to be achieved through current routine data collection systems unless significant changes are made to the data collection processes such as those undertaken by Eurostat. There is, also, an urgent need to introduce comprehensive sub-national data collections on important public health topics such as obesity and smoking.

Are maternal hypertension and small-for-gestational age risk factors for severe intraventricular hemorrhage and cystic periventricular leukomalacia? Results of the EPIPAGE cohort study.

OBJECTIVE: The purpose of this study was to examine the relationships between different causes of preterm delivery (eg, maternal hypertension, small-for-gestational age [SGA], other) and cerebral damage (eg, cystic periventricular leukomalacia [c-PVL], grade III intraventricular hemorrhage [IVH], and intra-parenchymal hemorrhage [IPH]). STUDY DESIGN: This study included 1902 very preterm singletons who were transferred to neonatal intensive care units in 9 French regions. We used logistic regression models to compare the risk of cerebral injury associated with maternal hypertension, SGA, and all other causes of preterm delivery. RESULTS: We found that the risk of c-PVL and grade III IVH was higher in infants born after preterm premature rupture of membranes (PPROM) with short latency or idiopathic preterm labor than in infants born to hypertensive mothers. We show that SGA and antepartum maternal hemorrhage significantly increase the risk of IPH. CONCLUSION: Our results show that infants born to hypertensive mothers have a lower risk of cerebral injuries than infants born following idiopathic preterm labor and PPROM because they are less exposed to prenatal infection.

Mild extrapyramidal signs and functional impairment in ageing.

BACKGROUND: Little is known about the clinical significance of mild extrapyramidal signs (EPS) in elderly individuals. We investigated whether EPS are associated with functional impairment in older people with cognitive decline. METHODS: A sub-group of 105 participants from the EUGERIA Study of Cognitive Ageing without Parkinson's disease or dementia, but with informant evidence of cognitive decline, were followed across three years and underwent neurological examination and assessment of mental health, cognition and functional capacity. RESULTS: 28.6% had at least one EPS (resting tremor, muscular rigidity or akinesia, of which rigidity was the most frequent). EPS presence was significantly associated with functional impairment after controlling for age and cognitive impairment (AAMI), although the association was reduced to borderline significance after further adjustment for depression and psychotropic medication use. There was evidence of colinearity between EPS and depression, possibly suggesting similar underlying mechanisms. CONCLUSIONS: There is an association between mild EPS and functional impairment in older persons with evidence of cognitive decline, but free of dementia or Parkinson's disease.