[Transmission of death certificates to CepiDc-Inserm related to suspicious deaths, in France, since 2000]. / Transmission des certificats de décès au CépiDc-Inserm en cas de mort suspecte en France, depuis 2000.

BACKGROUND: The purpose of this study is to assess variability in death certificates' transmission related to suspicious deaths. METHODS: The medical part of death certificates of suspicious deaths (violent or sudden deaths, unknown or ill-defined causes of death) were examined. We studied the frequency of suspicious deaths, in France, for deaths aged under 65, from 2000 to 2013, searching for temporal (2000-2013) and spatial correlations between unknown causes of death and other suspicious causes, and report of an autopsy. These results were compared with external data. RESULTS: Standardized proportion of deaths by unknown cause more than doubled during the study period (from 3.4 to 7.5%). The spatial correlation was strongly negative between standardized proportions of unknown causes of death and violent deaths (ICC=-0.80). Report of autopsy varied with cause of suspicious death and estimated zone of the forensic institute. The distribution was consistently distributed with external data, except for homicides. CONCLUSION: Information transmission to CépiDc-Inserm needs to be improved in case of suspicious death, in particularly from forensic institutes. This study emphasizes the urgent need for a complementary form to the death certificate.

The economic burden of urinary tract infections in women visiting general practices in France: a cross-sectional survey.

BACKGROUND: Urinary tract infections (UTIs) are among the most common bacterial infections. Despite this burden, there are few studies of the costs of UTIs. The objective of this study was to determine the costs of UTIs in women over 18 years of age who visit general practitioners in France. METHODS: The direct and indirect costs of clinical UTIs were estimated from societal, French National Health Insurance and patient perspectives. The study population was derived from a national cross-sectional survey entitled the Drug-Resistant Urinary Tract Infection (Druti). The Druti included every woman over 18 years of age who presented with symptoms of UTI and was conducted in France in 2012 and 2013 to estimate the annual incidence of UTIs due to antibiotic-resistant Enterobacteriaceae in women visiting general practitioners (GPs) for suspected UTIs. RESULTS: Of the 538 women included in Druti, 460 were followed over 8 weeks and included in the cost analysis. The mean age of the women was 46 years old. The median cost of care for one episode of a suspected UTI was €38, and the mean cost was €70. The annual societal cost was €58 million, and €29 million of this was reimbursed by the French National Health Insurance system. In 25 % of the cases, the suspected UTIs were associated with negative urine cultures. The societal cost of these suspected UTIs with negative urine cultures was €13.5 million. No significant difference was found between the costs of the UTIs due to antibiotic-resistant E. coli and those due to wild E. coli (p = 0.63). CONCLUSION: In the current context in which the care costs are continually increasing, the results of this study suggests that it is possible to decrease the cost of UTIs by reducing the costs of suspected UTIs and unnecessary treatments, as well as limiting the use of non-recommended tests.

[Impact of endocrine disrupting chemicals on birth outcomes]. / Effets des perturbateurs endocriniens sur les marqueurs de la périnatalité

BACKGROUND: Endocrine disruptors are ubiquitous chemicals contaminants in the environment, wildlife, and humans. Their adverse effects on reproduction are well-documented. There is growing evidence that they can contribute to the current emergence of chronic diseases. OBJECTIVES: Our aim is to assess the relationships between endocrine disruptors and the neonatal health outcomes. METHODS: Two persons have independently reviewed Medline and Toxline databases about the following pollutants: bisphenol A, phthalates, parabens, brominated flame retardants and perfluorinated compounds. Only the human epidemiological studies, in general population with an abstract available, published between 2007 January the 1st and 2011 December the 31st, were analysed. The quality of each study was assessed with the Strobe score. RESULTS: Twenty-five out of 680 studies were included in the analysis. All pollutants were widely detected in maternal and new borns samples. Most of the studies have shown associations between bisphenol A, brominated flame retardants and perfluorinated compounds and lower birth weight. The effects on gestational age were less documented and have shown no clear connection. Results for phthalates were more ambiguous. Only one non-instructive study was found on parabens. DISCUSSION: Due to the inherent methological bias on endocrine disruptors research, further additional studies on environmental health must be investigated. It seems necessary to adopt preventive health measures first for vulnerable population.