RESUMO
BACKGROUND: In 2005, following the first cancer plan of the national health authorities, a general cancer registry was established in northern France, in a territory designated as a "zone in proximity to the city of Lille" (ZPL). The aim of the present work was to evaluate the completeness of the registry's first year of incident cancer registration (2005) and to compare the observed cancer incidence in the "ZPL" with the estimated incidence in France. METHODS: Completeness was assessed using the average number of sources per case, the percentage of histological verification and a method of independent case ascertainment (mortality/incidence ratio). A direct standardization on the world population was used to calculate the ZPL/France ratios of standardized incidence rates. Analyses were conducted for 21 cancer sites. RESULTS: In 2005, 3635 cases of invasive cancer were recorded by the registry. The average number of sources per case was 2.7 and histological proof was available for 91.4% of cases. Mortality/incidence ratios showed satisfactory completeness of the data for men for most cancer sites. For women however, for cancer sites for which the number of cases was low, data will have to be confirmed during the subsequent years of observation. A lack of completeness was found for cutaneous melanoma. In men, an overincidence was identified for cancers of lip-mouth-pharynx, larynx, esophagus, lung, liver, bladder, kidney and colon-rectum. In women, an overincidence has been identified for cancers of lip-mouth-pharynx, liver, bladder, colon-rectum, corpus uteri and ovaries. CONCLUSION: The first year of incidence validated at the "Registre général des cancers de Lille et de sa région" shows a completeness of records with regards to studied criteria. The comparison with national data shows an overincidence of cancers related to tobacco and alcohol consumption in the geographical area covered by the registry. The incidence of lip-mouth-pharynx cancer in men is the highest of all French registries.
Assuntos
Neoplasias/epidemiologia , Saúde Pública/estatística & dados numéricos , Sistema de Registros , Feminino , França , Humanos , Incidência , Masculino , Prontuários MédicosRESUMO
The evolution of pleural cancers and malignant pleural mesothelioma incidence in France between 1980 and 2005 was analysed using data derived from the French network of cancer registries (FRANCIM) and the French National Mesothelioma Surveillance Program (PNSM). Mesothelioma proportions in pleural cancers were calculated by diagnosis year in the 1980-2000 period. Our results suggest that the incidences of pleural cancer and mesothelioma levelled off in French men since 2000 and continued to increase in French women. A decrease of the annual pleural cancer incidence average in men was noticed (-3.4% of annual rate of change) between 2000 and 2005. The proportion of pleural cancers that were mesothelioma was unchanged between 1980 and 2003 with an average of 86%. The age standardised incidence rate of pleural mesothelioma remained relatively stable between 1998 and 2005 with a slight falling trend. For women, the age standardised incidence rate of pleural cancers and mesothelioma increased during the period 1998-2005. Additionally, the proportion of pleural cancers that were mesothelioma increased during the same period of time. Finally, the increased trend observed in the incidence of pleural mesothelioma and cancers in women is credibly due to their under diagnosis in the 1980-1997 period. The comparison between the French incidence and the American and British ones shows that the decreasing trend in incidence of mesothelioma and pleural cancers in French men since 2000 is potentially associated with a lower amphibole consumption and by the implementation of safety regulations at work from 1977.
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Mesotelioma/epidemiologia , Neoplasias Pleurais/epidemiologia , Feminino , França/epidemiologia , Humanos , Incidência , Masculino , Sistema de RegistrosRESUMO
BACKGROUND: Although clinical trials have demonstrated that adjuvant chemotherapy improves survival for stage-III colon cancer, the benefits remain controversial for stage-II lesions. The objective of the present study was to determine the extent to which adjuvant chemotherapy is used for patients with stage-II and -III colon cancers. METHODS: The study population comprised 1074 patients with stage-II and -III colon cancers diagnosed in 2000 in 12 French administrative districts and recorded in population-based cancer registries. Data were collected using a standardized procedure. RESULTS: Overall, 20.4% of patients with stage II and 61.9% with stage III received adjuvant chemotherapy. Age at diagnosis was the strongest determinant of chemotherapy. Among stage-II patients, those receiving chemotherapy decreased from 57.6% in patients aged
Assuntos
Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/patologia , Neoplasias do Colo/tratamento farmacológico , Neoplasias do Colo/patologia , Adenocarcinoma/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Adjuvante , Neoplasias do Colo/epidemiologia , Feminino , França/epidemiologia , Humanos , Obstrução Intestinal/epidemiologia , Obstrução Intestinal/etiologia , Perfuração Intestinal/epidemiologia , Perfuração Intestinal/etiologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Equipe de Assistência ao Paciente , Sistema de Registros , Estudos de AmostragemRESUMO
INTRODUCTION: Prostate cancer was the most common cancer in men in France in 2005, and the second cause of male death from cancer. In this study, we analyzed clinical characteristics of patients with prostate cancer diagnosed in France in 2001 with a focus on therapeutic management of localized prostate cancers. PATIENTS AND METHODS: A total of 2181 cases of prostate cancer diagnosed in 2001 from 11 French counties covered by a cancer registry were analyzed. A descriptive study of the clinical characteristics of patients was performed. Parameters studied included age, county, TNM stage, PSA value, Gleason score, D'Amico prognostic group, Charlson's comorbidity index and initial treatment modalities. For localized cancers, multivariate logistic regression analysis identified factors associated with radical prostatectomy. RESULTS: The proportion of localized prostate cancer (T1 or T2) was 86.6 %. The use of invasive curative treatment (radical prostatectomy and radiotherapy) was 58.4 % for localized cancers. Significant differences in therapeutic management were found between counties. Radical prostatectomy was associated with age at diagnosis, D'Amico prognostic group and the presence of comorbidities. CONCLUSIONS: Most of prostate cancers diagnosed in France in 2001 were clinically localized and were treated by invasive therapy. The consequences of these practices remain to be determined given the limited evolution of many prostate cancers and the frequency of adverse events related to invasive treatments.
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Prostatectomia , Neoplasias da Próstata/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , França , Humanos , Masculino , Pessoa de Meia-Idade , Prostatectomia/estatística & dados numéricosRESUMO
BACKGROUND: The objective of this study was to provide updated estimates of national trends in cancer incidence and mortality for France for 1980-2005. METHODS: Twenty-five cancer sites were analysed. Incidence data over the 1975-2003 period were collected from 17 registries working at the department level, covering 16% of the French population. Mortality data for 1975-2004 were provided by the Inserm. National incidence estimates were based on the use of mortality as a correlate of incidence, mortality being available at both department and national levels. Observed incidence and mortality data were modelled using an age-cohort approach, including an interaction term. Short-term predictions from that model gave estimates of new cancer cases and cancer deaths in 2005 for France. RESULTS: The number of new cancer cases in 2005 was approximately 320,000. This corresponds to an 89% increase since 1980. Demographic changes were responsible for almost half of that increase. The remainder was largely explained by increases in prostate cancer incidence in men and breast cancer incidence in women. The relative increase in the world age-standardised incidence rate was 39%. The number of deaths from cancer increased from 130,000 to 146,000. This 13% increase was much lower than anticipated on the basis of demographic changes (37%). The relative decrease in the age-standardised mortality rate was 22%. This decrease was steeper over the 2000-2005 period in both men and women. Alcohol-related cancer incidence and mortality continued to decrease in men. The increasing trend of lung cancer incidence and mortality among women continued; this cancer was the second cause of cancer death among women. Breast cancer incidence increased regularly, whereas mortality has decreased slowly since the end of the 1990s. CONCLUSION: This study confirmed the divergence of cancer incidence and mortality trends in France over the 1980-2005 period. This divergence can be explained by the combined effects of a decrease in the incidence of the most aggressive cancers and an increase in the incidence of less aggressive cancers, partly due to changes in medical practices leading to earlier diagnoses.
Assuntos
Neoplasias/epidemiologia , Feminino , França/epidemiologia , Humanos , Incidência , Masculino , Sistema de RegistrosRESUMO
We present the main results of the first population-based cancers survival study gathering all French registry data. Survival data on 205,562 cancer cases diagnosed between 01/01/1989 and 31/12/1997 were analysed. Relative survival was estimated using an excess rate model. The evolution of the excess mortality rate over the follow-up period was graphed. The analysis emphasised the effect of age at diagnosis and its variation with time after diagnosis. For breast and prostate cancers, the age-standardised five-year relative survivals were 84% and 77%, respectively. The corresponding results in men and women were 56% versus 58% for colorectal cancer and 12% versus 16% for lung cancer. For some cancer sites, the excess mortality rate decreased to low values by five years after diagnosis. For most cancer sites, age at diagnosis was a negative prognostic factor but this effect was often limited to the first year after diagnosis.
Assuntos
Neoplasias/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Métodos Epidemiológicos , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros/estatística & dados numéricosRESUMO
In collaboration with 62 population-based cancer registries contributing to the Automated Childhood Cancer Information System (ACCIS), we built a database to study incidence and survival of children and adolescents with cancer in Europe. We describe the methods and evaluate the quality and internal comparability of the database, by geographical region, period of registration, type of registry and other characteristics. Data on 88,465 childhood and 15,369 adolescent tumours registered during 1978-1997 were available. Geographical differences in incidence are caused partly by differences in definition of eligible cases. The observed increase in incidence rates cannot be explained by biases due to the selection of datasets for analyses, and only partially by the registration of non-malignant or multiple primary tumours. Part of the observed differences in survival between the regions may be due to variable completeness of follow-up, but most is probably explained by resource availability and organisation of care. Further standardisation of data and collection of additional variables are required so that this study may continue to yield valuable results with reliable interpretation.
Assuntos
Bases de Dados Factuais/normas , Neoplasias/epidemiologia , Sistema de Registros/normas , Adolescente , Adulto , Criança , Pré-Escolar , Europa (Continente)/epidemiologia , Humanos , Incidência , Lactente , Recém-Nascido , Reprodutibilidade dos Testes , Análise de SobrevidaRESUMO
BACKGROUND: In France, cancer incidence figures are produced by cancer registries covering only 13.5% to 16% of the whole population of the country. Thus, to produce national figures, estimates have to be computed. Registration disparities between registries concerning tumors of the Central Nervous System (CNS) could have biased these estimates. METHODS: National estimates are based on modelling of the incidence/mortality ratio. The most recent estimations for year 2000 were calculated by the French Cancer Registry Network (FRANCIM) and the department of biostatistics of Lyon University Hospital. Since benign tumors are not recorded in some cancer registries, a new estimate of the incidence of CNS tumors was produced by estimating the number of benign tumors in these registries. RESULTS: In 2000 in France, the number of estimated cases of CNS tumors was 2697 in men and 2602 in women, with incidence rates (World standard) of 7.4 and 6.4 per 100,000 respectively. The incidence increased between 1978 and 2000, on an average by 2.25% per year in men and 3.01% per year in women. However, these estimates do not provide a correct picture of CNS incidence. First of all, pathological diagnoses are not performed in 3.5%-27.5% of the patients with CNS tumors registered in French registries. Second, figures for benign tumors (mainly meningiomas) were provided by only two of nine cancer registries. If benign tumors had been registered by all cancer registries, computed incidence would have increased by 12% for men and 26% for women. CONCLUSION: Incidence of CNS tumors is increasing in France, as in many other countries. To improve comparability with other countries, French cancer registries should also collect data on benign tumors. The discrepancies observed between registries in the proportion of patients without information on histology show differences in diagnostic practices and should be the starting point for a survey on this topic.
Assuntos
Neoplasias do Sistema Nervoso Central/epidemiologia , Sistema de Registros/estatística & dados numéricos , Idoso , Neoplasias do Sistema Nervoso Central/mortalidade , Feminino , França/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Taxa de Sobrevida/tendênciasRESUMO
The purpose of this study was to assess possible regional disparities in the management of colon cancer in France. In 1995, 1605 patients with a colon cancer in eight areas covered by a population-based cancer registry were studied. Pre-therapeutic work-up, stage at diagnosis and therapeutic modalities were assessed. There were no differences between areas concerning the resection or the stage at diagnosis. The proportion of patients with a colonoscopy alone varied between 42.7 and 70.4% (P<0.001). The use of both colonoscopy and barium enema was even more heterogeneous (extremes from 11.7 to 40.2%, P<0.001). There were significant differences in the performance of abdominal computed tomography and tumour markers. The number of examined lymph nodes was lower than the recommendation in 47.3% of cases with extremes ranging from 36.9 to 60.9%. Adjuvant chemotherapy was performed on average in 49.4% of cases in stage II (in which it is not recommended) with extremes from 18.8 to 72.5% (P<0.001) and in 79.6% of the cases in stage III (in which it is recommended) with extremes from 63.6 to 94.4% (P=0.08). In conclusion, these results should alert practitioners and health care authorities in order to homogenize practices.
Assuntos
Neoplasias do Colo/diagnóstico , Neoplasias do Colo/terapia , Padrões de Prática Médica/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Idoso , Bário , Quimioterapia Adjuvante , Colonoscopia/estatística & dados numéricos , Terapia Combinada , Enema , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios XRESUMO
The decision to regionalize obstetric services in the Montreal metropolitan area was designed to improve the efficiency of the system. Changes in types of birth between 1981 and 1984 in this area were studied in order to evaluate the effects of this decision on cesarean section rates. Results show a sudden increase in cesarean rates, coinciding with the regionalization decision. Hypotheses put forward are linked to the characteristics of hospitals remaining after this measure, as well as the organisational disturbances which it may have caused.
Assuntos
Planejamento em Saúde , Serviços de Saúde Materna/organização & administração , Cesárea/estatística & dados numéricos , Parto Obstétrico/métodos , Feminino , Humanos , Gravidez , QuebequeRESUMO
During a period of 3 months, 267 children with non severe acute diarrhea (NSAD) were treated by one of four modalities of care: in the private office of a general practitioner (n = 58), or of a paediatrician (n = 109), in a hospital emergency service (n = 62), or as hospital inpatients (n = 38). The socio-economic status and the cost of treatment for each of these children was subsequently assessed. The children admitted to hospital were mainly referred by hospital out-patient departments (47%) and general practitioners (37%) who, unlike paediatricians, care for more socially disadvantaged patients. The main reason for hospitalization was the presence of diarrhea with vomiting (55%). Several measures are proposed to redefine the role of the hospital and to improve cooperation with doctors in office practice, which would reduce both the number of hospitalizations due to NSAD and the length of hospital stay. Since the cost of treating NSAD hospital is 60 time greater than care at home, these measures are economically important.
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Diarreia Infantil/economia , Hospitalização , Medicina , Especialização , Diarreia Infantil/fisiopatologia , Diarreia Infantil/terapia , Medicina de Família e Comunidade , Humanos , Lactente , Tempo de Internação , Fatores SocioeconômicosRESUMO
This article presents the methods and results of two surveys aiming to contribute to the development of partnerships between doctors and teachers in primary school. The first study, carried out with a sample of elementary school teachers, shows the interest they have in health promotion at school, their desire to see national education doctors become involved in health education, and their misunderstanding of the role of national education doctors and nurses, especially in training and participation in school projects. The second study, carried out among a sample of national education doctors, shows their felt sense of "friction" between the individual medical approach within which they were trained and for which they are known and solicited, and the public health approach that they would like to develop. To ameliorate the partnership, the inspector of national education, as the responsible party for educational policies within his district, is the necessary "link" between doctors, school directors and teachers.
Assuntos
Relações Interprofissionais , Medicina/organização & administração , Serviços de Saúde Escolar/organização & administração , Especialização , Ensino/organização & administração , Atitude , Coleta de Dados , França , Promoção da Saúde , Humanos , Papel do Médico , Desenvolvimento de ProgramasRESUMO
Background. The aim of the study was to assess the accuracy of the colorectal-cancer incidence estimated from administrative data. Methods. We selected potential incident colorectal-cancer cases in 2004-2005 French administrative data, using two alternative algorithms. The first was based only on diagnostic and procedure codes, whereas the second considered the past history of the patient. Results of both methods were assessed against two corresponding local cancer registries, acting as "gold standards." We then constructed a multivariable regression model to estimate the corrected total number of incident colorectal-cancer cases from the whole national administrative database. Results. The first algorithm provided an estimated local incidence very close to that given by the regional registries (646 versus 645 incident cases) and had good sensitivity and positive predictive values (about 75% for both). The second algorithm overestimated the incidence by about 50% and had a poor positive predictive value of about 60%. The estimation of national incidence obtained by the first algorithm differed from that observed in 14 registries by only 2.34%. Conclusion. This study shows the usefulness of administrative databases for countries with no national cancer registry and suggests a method for correcting the estimates provided by these data.
RESUMO
INTRODUCTION: This study aimed at modelling the effect of organized breast cancer screening on mortality in France. It combined results from a Markov model for breast cancer progression, to predict number of cases by node status, and from relative survival analyses, to predict deaths. The method estimated the relative risk of mortality at 8 years, in women aged 50-69, between a population screened every two years and a reference population. METHODS: Analyses concerned cases diagnosed between 1990 and 1996, with a follow-up up to 2004 for the vital status. Markov models analysed data from 3 screening programs (300,000 mammographies) and took into account opportunistic screening among participants to avoid bias in parameter's estimates. We used survival data from cancers in the general population (n=918, 7 cancer registries) and from screened cancers (n=565, 3 cancer registries), after excluding a subgroup of screened cases with a particularly high survival. Sensitivity analyses were performed. RESULTS: Markov model main analysis lacked of fit in two out of three districts. Fit was improved in stratified analyses by age or district, though some lack of fit persisted in two districts. Assuming 10% or 20% overdiagnosed screened cancers, mortality reduction was estimated as 23% (95% CI: 4, 38%) and 19% (CI: -3, 35%) respectively. Results were highly sensitive to the exclusion in the screened cancers survival analysis. Conversely, RR estimates varied moderately according to the Markov model parameters used (stratified by age or district). CONCLUSION: The study aimed at estimating the effect of screening in a screened population compared to an unscreened control group. Such a control group does not exist in France, and we used a general population contaminated by opportunistic screening to provide a conservative estimate. Conservative choices were systematically adopted to avoid favourable estimates. A selection bias might however affect the estimates, though it should be moderate because extreme social classes are under-represented among participants. This modelling provided broad estimates for the effect of organized biennial screening in France in the early nineteen-nineties. Results will be strengthened with longer follow-up.
Assuntos
Neoplasias da Mama/diagnóstico , Neoplasias da Mama/mortalidade , Mamografia/métodos , Cadeias de Markov , Programas de Rastreamento/métodos , Idoso , Progressão da Doença , Feminino , Seguimentos , França/epidemiologia , Humanos , Pessoa de Meia-Idade , Sistema de Registros , Viés de Seleção , Análise de Sobrevida , Fatores de TempoRESUMO
Survival data on female invasive breast cancer with 9-year follow-up from five French cancer registries were analysed by logistic regression for prognostic factors of cancer stage. The Kaplan-Meier method and log-rank test were used to estimate and compare the overall survival probability at 5 and 7 years, and at the endpoint. The Cox regression model was used for multivariate analysis. County of residence, age group, occupational status, mammographic surveillance, gynaecological prevention consultations and the diagnosis mammography, whether within a screening framework or not, were independent prognostic factors of survival. Moreover, for the same age group, and only for cancers T2 and/or N+ (whether 1, 2 or 3) and M0, the prognosis was significantly better when the diagnosis mammography was done within the framework of screening. Socio-economic and surveillance characteristics are independent prognostic factors of both breast cancer stage at diagnosis and of survival. Screening mammography is an independent prognostic factor of survival.
Assuntos
Neoplasias da Mama/mortalidade , Carcinoma Ductal de Mama/mortalidade , Fatores Socioeconômicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/patologia , Feminino , Seguimentos , Humanos , Mamografia , Programas de Rastreamento , Pessoa de Meia-Idade , Vigilância da População , Taxa de Sobrevida , População BrancaRESUMO
BACKGROUND: Dermatofibrosarcoma protuberans (DFSP) is a rare malignant tumour of the skin, with an estimated incidence of 0.8 to five cases per 1 million people per year. OBJECTIVE: To study epidemiological, immunohistochemical and clinical features, delay in diagnosis, type of treatment and outcome of DFSP from 1982 to 2002. METHODS: Using data from the population-based cancer registry, 66 patients with pathologically proved DFSP were included (fibrosarcomatous DFSP were excluded). Each patient lived in one of the four departments of Franche-Comté (overall population of 1 million people) at the time of diagnosis. The main data sources came from public and private pathology laboratories and medical records. The rules of the International Agency for Research on Cancer were applied. RESULTS: The estimated incidence of DFSP in Franche-Comté was about three new cases per 1 million people per year. Male patients were affected 1.2 times as often as female patients were. The trunk (45%) followed by the proximal extremities (38%) were the most frequent locations. DFSP occurred mainly in young adults between 20 and 39 years of age. Mean age at diagnosis was 43 years, and the mean delay in diagnosis was 10.08 years. Our 66 patients initially underwent a radical local excision. Among them, 27% experienced one or more local recurrences during 9.6 years of follow-up. There was one regional lymph node recurrence without visceral metastases. These recurrences were significantly related to the initial peripheral resection margins. We observed a local recurrence rate of 47% for margins less than 3 cm, vs. only 7% for margins ranging from 3 to 5 cm [P=0.004; OR=0.229 (95%, CI=0.103-0.510)]. The mean time to a first local recurrence was 2.65 years. Nevertheless, there was no death due to the DFSP course at the end of the follow-up, and the final outcome was favourable. CONCLUSION: Our study emphasizes the importance of wide local excision with margins of at least 3 cm in order to prevent local recurrence. However, the recent development of inhibitors of signal transduction by the PDGFB pathway should soon modify the surgical strategy, which is often too mutilating.
Assuntos
Dermatofibrossarcoma/epidemiologia , Dermatofibrossarcoma/patologia , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/patologia , Adolescente , Adulto , Distribuição por Idade , Criança , Pré-Escolar , Dermatofibrossarcoma/cirurgia , Feminino , Seguimentos , França/epidemiologia , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/prevenção & controle , Sistema de Registros/estatística & dados numéricos , Distribuição por Sexo , Neoplasias Cutâneas/cirurgiaRESUMO
Using a multilevel Cox model, the association between socioeconomic and geographical aggregate variables and survival was investigated in 81 268 patients with digestive tract cancer diagnosed in the years 1980-1997 and registered in 12 registries in the French Network of Cancer Registries. This association differed according to cancer site: it was clear for colon (relative risk (RR)=1.10 (1.04-1.16), 1.10 (1.04-1.16) and 1.14 (1.05-1.23), respectively, for distances to nearest reference cancer care centre between 10 and 30, 30 and 50 and more than 90 km, in comparison with distance of less than 10 km; P-trend=0.003) and rectal cancer (RR=1.09 (1.03-1.15), RR=1.08 (1.02-1.14) and RR=1.12 (1.05-1.19), respectively, for distances between 10 and 30 km, 30 and 50 km and 50 and 70 km, P-trend=0.024) (n=28 010 and n=18 080, respectively) but was not significant for gall bladder and biliary tract cancer (n=2893) or small intestine cancer (n=1038). Even though the influence of socioeconomic status on prognosis is modest compared to clinical prognostic factors such as histology or stage at diagnosis, socioeconomic deprivation and distance to nearest cancer centre need to be considered as potential survival predictors in digestive tract cancer.
Assuntos
Neoplasias do Sistema Digestório/epidemiologia , Neoplasias do Sistema Digestório/mortalidade , Assistência ao Paciente/normas , Idoso , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Sistema de Registros , Fatores Socioeconômicos , Taxa de SobrevidaRESUMO
A study has been undertaken in a unit of pediatric gastroenterology and nutrition. The unit also deals with general pediatric emergencies. The purpose of this study was to calculate the cost of hospitalization and the distribution of the cost between the different components: personnel expenses (medical and non-medical staff), cost of products used (enteral and parenteral nutrition included), cost of medicotechnical intervention. The study was carried out over a period of 28 days and included 117 hospitalized children. Only the expenses directly linked to the patient's care were taken into account. The exact time spent with each patient by every category of staff, the quantity of products and the treatment given had to be carefully recorded. The results reveal the share of the cost which goes to non-medical staff (about 60%), except when pathological cases need frequent and detailed investigations. Once the budget has been determined, department heads are required to play administrative role and this study underlines the process of cost build-up and thus enables a selective intervention in one sector or another of hospital expenses.
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Hospitais de Ensino/economia , Hospitais Universitários/economia , Pediatria/economia , Adolescente , Criança , Pré-Escolar , Alocação de Custos , Nutrição Enteral/economia , França , Hospitalização/economia , Humanos , Lactente , Microcomputadores , Nutrição Parenteral Total/economiaRESUMO
The Rhône-Alpes Auvergne Register allows the monitoring of malformations, in 2 French regions. This monitoring led to the discovery of a cluster of cases of esophageal atresia of the isolated type during the year 1984. Analysis of this cluster showed that it was mainly due to a concentration of cases (7 observed vs 1.78 expected) born in the Ain department, 4 of them being born during the first trimester. Analysis of the cluster was followed by an individual questioning of families. It concerned essentially the environmental conditions of the onset of pregnancy and did not allow to set the hypothesis of a possible risk factor. The authors conclude that either the cluster should be attributed to chance, or the used questionnaire, even if directed towards all directions and seeming quite complete, was not sufficient to allow bringing out an hypothesis.
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Atresia Esofágica/epidemiologia , Anormalidades Múltiplas , Atresia Esofágica/complicações , França , Humanos , Recém-Nascido , Idade Materna , Estudos Retrospectivos , Conglomerados Espaço-TemporaisRESUMO
Seventeen pediatricians and 34 general practitioners (GP) randomly selected in the closest area around Edouard-Herriot hospital (Lyon, France) were questioned regarding socio-economic status of families of infants who were treated for non severe acute diarrhea (loss of weight less than 10% of the initial body weight, no dehydration), and gave a copy of their prescription. During the same period, information was collected on outpatients as well as hospitalized cases of non severe acute diarrhea. Results show that in 3 months, GPs treated approximately 500 cases of non severe acute diarrhea, pediatricians 230 and the hospital 64. Oral rehydration was prescribed in 16% of diarrhea treated by GPs and 50% of those treated by pediatricians. The socio-economic status of families treated by pediatricians differed widely from those treated by GPs as well as those cared for in hospital. Vomiting as an argument for admission was found in 55% of referrals.