[Children's respiratory health and air pollution]. / Santé respiratoire des enfants et pollution atmosphérique.

Two surveys--one in children 9-11 living in an industrially polluted area, the other one on younger children in an urban environment--combined the collect of previous health impairments through a standardized questionnaire, clinical examination and respiratory functional testing with automatized air pollution measurement. Results confirmed those of similar surveys, that is the mildness of observed anomalies and the diverging perturbations: clinical symptoms without functional alterations or the reverse. Complementary research is therefore needed, if possible longitudinal.

[Value of the restraint systems for security of children under 10 years in motor vehicles]. / L'intérêt des systèmes de retenue pour la sécurité des enfants de moins de 10 ans à bord des véhicules.

On the basis of two surveys, the authors study the current status of children's restraint in cars, its consequences on the occurrence of accidental injuries and the ways and means of improving safety. The first survey conducted the long 1988 Whit Sunday week-end by the National police, has reviewed 800 accidental injuries, 9% of which concerning 134 children: 23 children only were restrained, and the comparison with the others allows to estimate the value of the protection insured by various systems of child restraint. The second survey, performed with 277 children of the kindergartens of the Vosges Department, has investigated how they travel in their parents' car: 10.1% report that they are always restrained. An educational campaign has somewhat improved the situation; however, due to the lack of support by the parents, it quickly deteriorated. A specific effort is to be done, in France, as it has been in other countries, where pediatricians are cooperating with policymakers in order to improve children's safety in cars.

Pertussis in French adolescents: risk factors and respiratory sequels.

An analysis of the risk factors for pertussis and the possible respiratory sequels was carried out in a sample of 499 children and adolescents aged 10-16 years from the general population in north-eastern France. 44 subjects (8.8%) had pertussis during childhood; and the sex ratio was 1 in these cases. Pertussis was significantly associated with a maternal history of respiratory disease, residence in a rural area and coal heating. In a multiple logistic regression model, a maternal history of respiratory disease was the only significant factor (p = 0.01), the number of siblings being of borderline significance (p = 0.06). No increase in respiratory symptoms or asthma prevalence was found in our subjects who had pertussis during childhood.

Child health care policy and delivery in France.

Medical and social protection of mothers, infants, and children began in France more than a century ago. A number of laws and regulations have improved the system, which is discussed in detail. The discussion includes an overview of health policy, service delivery, and the financing of care. Is the current French system of Maternal and Child Health responsible for the good health of today's children? This question is addressed through selected examples. Finally, failures and short-comings of the system are described, including the persistence of underserved groups, unequal access to care, and other problems. Solutions are feasible, and some are now being implemented.

Unintended injuries in children: the French situation.

The French situation with respect to mortality from unintentional injuries in children is far from satisfactory. International comparison is made difficult by statistical bias, but although excess injury mortality is decreasing in France, rates are higher than in most advanced European countries. Many regulations have been enacted during the past 30 years to reduce the economic and social burden of injuries, but political will is insufficient to establish a consolidated national program and enforcement of existing legislation is inadequate. Evaluation of preventive and educational programs is less than optimal; many attempts have not met basic methodologic requirements. The situation is improving, partly because of growing social concern. New regulations are in preparation, but solution of this major public health problem also demands behavioral change, which is much more difficult to effect than other measures. Greater commitment to research, proper evaluation of sound programs, and enforcement of existing law doubtless would reduce the excess morbidity and mortality resulting from unintended injuries to children.

Postneonatal infectious disease mortality: the French situation.

Mortality caused by infectious and parasitic diseases represents a limited part of all postneonatal deaths in France, which have been stable for the past decade. This component is worthy of careful analysis because it is at least partially preventable. Statistics are presented and interpreted, with discussion on which disorders should be included in assessing the impact of infection on morbidity and mortality. Figures and international rankings change according to the inclusiveness of the definition chosen. There is need for epidemiologic and statistical research to make comparisons of mortality more clear. Morbidity is also important because of high incidence, frequent hospitalization, and a heavy social cost. Policy and services in France that relate to control and treatment of infection are described, as are shortcomings that call for further efforts.

Lung function in adolescents after uncomplicated whooping cough in childhood.

Ventilatory function (forced vital capacity, forced expiratory volume in one second, forced expiratory flows), static lung volumes, phase III slope and closing volume (single-breath nitrogen washout test) were measured in 499 children and adolescents aged 10-16 yrs from a general population sample in North-East France. A history of whooping cough was given by 44 children (22 of each sex); their results were compared to those of the 455 children (215 girls) with a negative history. The only difference between the two groups was a minimal increase in the residual volume/total lung capacity ratio in cases (19.2 +/- 3.1 vs 18.0 +/- 2.9%). We conclude that uncomplicated whooping cough in early childhood did not lead to significant pulmonary function abnormality in this population of children born after 1967.

[The respiratory health of children and industrial and domestic air pollution]. / Santé respiratoire des enfants et pollution aérienne d'origine industrielle et domestique.

At the request of its inhabitants, an epidemiological survey was conducted among the children of Carling, a particularly polluted industrialized town in the department of the Moselle in North-East France. Contrary to all expectations, no major toxic effect of industrial pollution on the respiratory health of the children was found. There was some correlation between the fact of living in a polluted area and a claimed respiratory morbidity. However, the potentially harmful effect of atmospheric pollution could not be translated in terms of abnormalities of respiratory function. In contrast, a significant effect of the smoking habits of the parents, and particularly of the mothers, on respiratory symptoms and spirographic data of their children was observed.

[Respiratory health of children and atmospheric pollution. I. Respiratory symptoms]. / Santé respiratoire des enfants et pollution atmosphérique. I. Symptômes respiratoires.

The impact on the respiratory system of complex industrial pollution (dust, sulphur dioxide, nitrogen oxides, hydrocarbons) was assessed by an analytical epidemiological study in a population of school children in the northeast of France. The parents of 375 children aged from 9-12 (middle school course 1 and 2) from the polluted zone and 523 children of the same age in a neighboring zone which was not polluted have filled in standardised questionnaires (respiratory symptoms, previous infections and allergies, frequency of infection in infancy; tobacco habits, professional and educational attainments of the parents, domestic environment). In the exposed children the majority of respiratory symptoms were more frequent (e.g., respiratory sounds in the boys, 15.6% against 7.9% p less than 0.01) and the absenteeism from school was more numerous (66.9% against 59.1% p less than 0.01). However, the interpretation of the results had to take into account the existence of confusing factors: parental smoking habits and the use of coal fires increased the prevalence of symptoms in the polluted zone, whereas a less crowded population worked in the inverse direction; likewise the educational level of the parents was higher in the polluted zone. After adjusting for these confusing factors, the frequency of rhinitis and absenteeism from school was significantly higher in exposed children.

[Respiratory health of children and atmospheric pollution. II. Ventilatory function]. / Santé respiratoire des enfants et pollution atmosphérique. II. Fonction ventilatoire.

Respiratory function (forced vital capacity-FVC; forced expired volume in one second-FEV1; maximal mid-expiratory flow-DEMM; peak flow-DP; maximal expiratory flow at 75-50-25% of vital capacity CV-DEMx) was studied in children of comparable age, sex and height (9 to 12 years) in a polluted zone (the exposed group n = 223) and a neighboring non-polluted zone (the control group n = 211) in the north of Lorraine. There was no significant difference in ventilatory function between the two groups. Amongst other factors capable of influencing the ventilatory function in the children we found an influence of parental smoking habits (particularly the mothers) identifiable in the non-exposed zone, above all in boys. A sub-segment analysis identified that in the absence of parental smoking, there was a negative influence of open coal fires. The discordance between the results of the measures of respiratory function and the prevalence of different respiratory symptoms, of acute infections and absenteeism from school, is probably explained by the interference of other factors which were not controlled in this study (e.g., ethnic factors and physical activity) and by the moderate level of the pollution; an over-reporting of respiratory symptoms by parents in the exposed zone could not be excluded.