[Media and public health: example of heat wave during summer 2003]. / Média et santé publique: l'exemple de la canicule pendant l'été 2003 en France.

BACKGROUND: The summer of 2003 was the hottest for France in the last 50 years with record day and nighttime temperatures. INSERM statistics estimated that 14,802 heat-related deaths occurred during August 2003 heat wave in France. In the aftermath of this crisis, we thought that it was useful to analyze how the French media dealt with public health during the period from June 1 to August 31, 2003. The objective was to analyze French coverage of public health information during the August 2003 heat wave. METHODS: Manual and computerized analysis of newspaper and radio reports published from June 1 to August 31, 2003. Articles were obtained by searching the EUROPRESS database. Text analysis was performed using the ALCESTE software package. RESULTS: A total of 1,599 articles were analyzed. Few articles contained warnings about heat exposure and preventive measures. Public health policy was relegated to third place after business and ecology themes. The special problems of the high-risk populations were not mentioned until after the rising death toll was known and emphasis was placed on the implications of the crisis in the political process. The findings of this study show the poor performance of public health policy in France and that media must be given guidance to fulfil its role in providing public health information. CONCLUSION: This crisis discloses the absence of public health culture in France and involves the "social exclusion" related to a breakdown of social cohesion. More cooperation is needed between the media and public health professionals to avoid future heat-wave and other public health crises. France must develop a public health culture to promote involvement of both the community and individuals in public health issues.

Comparison of methadone and high dosage buprenorphine users in French care centres.

AIMS: In France, maintenance programmes for opiate users were adopted later than in other countries. Two maintenance treatments are available: methadone is only delivered in specialized centres while high dosage (HD) buprenorphine can be prescribed by all general practitioners and in specialized centres. The aim of this study was to compare the socio-demographic profiles, the practices and drug consumption patterns of the two groups attending specialized centres. METHODOLOGY: The Oppidum Programme (observation of illegal drugs and misuse of psychotropic medications), a multi-centric survey, surveys drug-dependent subjects attending specialized care centres throughout France annually. Data were collected by questionnaire on socio-demographic variables and drug use during the preceding week. RESULTS: During October 1998, 46 centres took part in the survey. The methadone group (n = 424) was older, with a better economic situation; 16% used cocaine regularly. The HD buprenorphine group (n = 616) consumed more heroin (12% vs. 8%) and engaged in more misuse, such as intravenous use, illicit acquisitions or irregular consumption. These practices were more frequent for patients consuming the drug "outwith protocol" or for patients obtaining the drug from a general practitioner. CONCLUSION: Our results suggest that patterns of consumption of methadone and buprenorphine are different in several respects: concomitant use of licit or illicit psychoactive substances, route of administration, and illegal acquisition. They also suggest that the behaviours of maintenance treatment users depend less on the nature of the maintenance drug (methadone or high dosage buprenorphine), than the nature of the delivery and monitoring practices.

Incidence, clinical observations and risk factors in the severe form of Mediterranean spotted fever among patients admitted to hospital in Marseilles 1983-1984.

Seven of 142 cases (5%) of Mediterranean spotted fever admitted to hospital in Marseilles in 1983 and 1984 were severe. All of them were confirmed by specific laboratory tests. The disease resembles Rocky Mountain spotted fever with purpuric exanthem, confusion, renal insufficiency, hypoxaemia, thrombocytopenia, hyponatraemia and hypocalcaemia. Two patients died. The predisposing factors for severity were old age, alcoholism, heavy smoking, respiratory insufficiency and glucose-6-phosphate dehydrogenase deficiency.

[Anonymity in epidemiological surveys: study and initiation of a new method]. / L'anonymat dans les enquêtes épidémiologiques: étude et mise en oeuvre d'une nouvelle méthode.

The authors propose a system of registering epidemiological data which ensures strict observation of anonymity. Data are made anonymous at the source: the practitioners who possess the medically confidential information themselves compute the code number creating anonymity through a nonreversible calculation formula: it is impossible to work back from the number to the patient's identity, even if one has the formula and powerful computer resources. This method differs from simple data encoding whose key could either be discovered or revealed: it requires neither keys nor a secret but effects a definitive and irreversible transformation. In compliance with the recommendations of the committee on Ethics, of the French "Ordre des Médecins" and of the Law on Data Processing and Liberties, the method was subjected to a double test for reliability, experimental and theoretical.

[Experience in mass screening of breast cancer with mammography in France]. / Les expériences de dépistage de masse du cancer du sein par mammographie en France. Un protocole commun d'évaluation.

In the framework of the National Fund for Prevention, Health Education and Information, the setting-up in France, on an experimental basis, of mass breast cancer screening programs by mammography in ten departments leads to suggest a common protocol for the evaluation of these programs, before an eventual generalization to the whole country. These programs are based on common principles: local screening based on existing medical facilities, single view mammography with double reading. However, the screening organisation is different in each department according to the target population, the screening interval, the mode of invitation, the methods for arranging double reading, etc. The purpose of this article is to report on the work of the evaluation group of the ten programs, and to propose a methodology for comparing the screening experiences in order to measure the role of the organisation methods. It gives definitions and modes of calculations for the evaluation criteria in four fields: impact, quality, efficacy and cost (with details about the feasibility of data collection) and proposes a reflection on analysis techniques in order to develop an optimum mass screening strategy.

[A surveillance method for products used by drug addicts examined in emergency units]. / Essai de mise au point d'une méthode de surveillance des produits utilisés par les toxicomanes consultant dans les services d'accueil.

Products used in a toxicomaniac way are in rapid change, and different from different area. Users too have to be better known. Authors present a simple survey method of these products, based on sample use. First results seem to be correct. These method may be used, associated with others, in a network as those existent for many years in the United States.

[Observation of illicit or misused psychotropic drugs (O.P.P.I.D.U.M.): five years of surveillance of products consumed by drug addicts at Marseille]. / Observation des produits psychotropes illicites ou détournés de leur utilisation médicamenteuse (O.P.P.I.D.U.M.): cinq ans de surveillance des produits consommés par les toxicomanes à Marseille.

The aim of O.P.P.I.D.U.M. is the survey of products used by drug addicts. A five year survey, based on regular pools, has provided interesting results. 1,283 patients (80 per cent men, about 27 years old, 1/4 employed) used 2,241 drugs. The most frequent was heroin, followed by benzodiazepines, cannabis and cocaine. Flunitrazepam was the most commonly misused product, taken by users who started consumption earlier, with a higher rate of unemployment and imprisonment. Cocaine was as often taken intravenously as by sniffing, and most often used before imprisonment. Ecstasy (M.D.M.A.) has appeared recently. Codeine taken alone was used by subjects older than the heroin users, more frequently employed and virtually never prison inmates: this suggests the existence of an unofficial detoxication and substitution process. Confidence of clinicians needs anonymity of the records and return of information. Such a campaign is about to be launched.

[Treatment of Grave's disease by radio iodine. Observation of 277 patients (author's transl)]. / Le traitement de la maladie de Basedow par l'iode radio-actif. Surveillance de 277 patients de l à 23 ans.

277 patients treated by radio iodine for Graves' disease were observed during a one to twenty three years period. 24 % relapse, always during the first three years. Hypothyroidism is ineluctable : 20 % from the first year and 3,4 % more each year. Goiter increases the delay for hypothyroidism occurrence. There is no linkage between hypothyroidism and radio iodine dose. Radio iodine does not cure graves' disease but give a "non hypo-non hyper" status, before secondary hypothyroidism.

[Action of 5-hydroxytryptophan on serum thyreostimulin and prolactin in primary hypothyroidism (author's transl)]. / Action du 5 hydroxytryptophane sur les taux plasmatiques de thyréostimuline et de prolactine dans l'hypothyroïdie primitive et chez le sujet normal.

Orally 5 HTP has significantly decreased serum TSH level in eight patients with primary non treated hypothyroidism, but not in five normal subjects. Serum T4 et T3 levels did not change and serum PRL did not increase in the two groups. These results indicate a possible inhibitory action of 5 HT on TSH regulation. Action of 5 HT on PRL has not been defined here.

[Corticotropic adenoma in slow adrenal insufficiency]. / Adénome corticotrope au cours d'une insuffisance surrénale lente.

This case report deals with an insulin-dependent diabetic patient suffering peripheral adrenal insufficiency who, after 12 years of substitutive treatment exhibited resistance to mineralo- and gluco-corticoids with relapse of melanodermia and plasma ACTH levels higher than 1500 pg/ml despite increasing doses. A corticotrop macroadenoma was diagnosed by MR imaging and functional tests and confirmed by surgical excision followed by disappearance of resistance. Pre-operative functional investigation show autonomisation of the adenoma but with some partial persisting regulation. This case report draws attention to this rare either complication or association which can occur in peripheral adrenal insufficiency.

[Mass screening programs for breast cancer in France. Comparative evaluation]. / Les programmes de dépistage de masse du cancer du sein en France. Evaluation comparative.

OBJECTIVE: The purpose of this work was to comparatively assess the results of mass screening programs for breast cancer implemented in six French departments in 1986, within the scope of the National Fund for Health Prevention, Education and Information of the National Health Insurance Office of Salaried Workers. MATERIAL AND METHODS: The data collected by the screening centres were analyzed by ten assessment teams that were independent from the program promotion staff, all using the same evaluation form. A complementary population study performed in eight French districts then, allowed assessing the frequency of self-referred screening (mammography performed out of program). RESULTS: The rate of participation in screening programs, in relation to the invited population, ranged from 21 to 48%, according to the district (36% in average). This low participation was probably related to the extent of self-referred screening. In fact, 19 to 40% of women, according to the district, had previously had a screening mammographic coverage: rate was around 68% in women aged 50 to 69 years. Positive findings with mammography ranged from 4.5 to 15.8% (10.1% in average), while intervention rates ranged from 0.7 to 1.6% and detection rates from 3.8 to 6.2%. The ratio between benign tumors and cancers ranged from 0.7 to 2.1 according to the district. In order to enlighten the judgement on French results, we propose a comparison with the international standards in force. CONCLUSION: The various experiences with breast cancer screening in France show that this screening is technically feasible on the basis of existing medical structures. However, some criteria are still below the expected values, especially if compared with international standards. This result is probably accounted for by the high rate self-referred screening before age 40 in France. In these conditions, the question is whether extending breast cancer screening programs in France is an appropriate course of action.

[The drama of blood contamination in France. An approach to public health]. / Le drame du sang contaminé en France. Une approche de santé publique.

The tragic HIV contamination of hemophilics and transfusion recipients between 1980 and 1985 in France led to low court proceeding the same events. In addition, last June a state minister was arraigned for not recalling transfused patients before 1985. This involves later events and announces other court actions. France is the only country where these dramatic events have take on the dimension of a major political scandal. Based on the scientific elements (reactions and articles in the international medical literature) and an analysis of the decisions made by France, a chronological examination of the disease and the risks for hemophiliacs and transfusion recipients offers helpful insight into possible options for reducing these risks. The interval between these the court proceeding allows time for further thought focusing on a serious deviation of public health in France.

[PROTIS, an expert system applied to the treatment of non-insulin-dependent diabetes. Evaluation of its efficacy]. / PROTIS, un système expert appliqué au traitement du diabète non insulino-dépendant. Evaluation de son efficacité.

PROTIS is an expert system devised to help general practitioners in the treatment of diabetes. It provides weighted results in ranking order from the most indicated to the most contra-indicated treatment. The reliability of PROTIS was tested comparatively by asking the system and two diabetologists involved in its design to analyze 250 clinical cases. The therapeutic advice given by PROTIS was considered satisfactory in 91.2% of the cases and erroneous, though without vital consequences, in 4.4%. The system was unable to propose any treatment in 4.4% of the cases. Most errors or non-responses could be corrected. This evaluation showed that PROTIS faithfully reproduces the reasoning of diabetologists and could serve as an example of what an expert system could do for the general practitioner.

[Evolution of campaigns against malaria from 1897 to the present]. / Evolution des campagnes de lutte contre le paludisme de 1897 à nos jours.

The knowledge of more precise epidemiological data, the use of new drugs, the application of better adapted measures against the anopheles mosquitoes have given hope for the elimination of malaria. Successes have been obtained at least in certain latitudes; however, in intertropical regions the problem often remains without a final solution. The stages of this persistent fight carried on for 90 years are recalled with their alternating successes and failures.

[Mandatory notification of HIV infection. Epidemiologic justifications and ethical questioning]. / Déclaration obligatoire de l'infection par le VIH. Justifications épidémiologiques et interrogations éthiques.

Since the appearance in May 1999 of the two decrees on the application of the law relative to the reinforcement of sanitation quality control established in July 1998, the disclosure of HIV infection "irregardless of the stage" has become mandatory. This is the first time that it is imposed that one must declare a serologic diagnosis, that is to say an infection in the asymptomatic stage. The sensitive nature of all of the information available on AIDS provides an explanation for the numerous contradictory reactions linked to this decision. We attempt to organise the arguments brought forth according to two approaches: 1) the epidemiological arguments that justify the compilation of the precise data thought to be necessary for the follow-up of the disease and for the implementation of well-targeted prevention actions; and 2) the ethical reservations concerning such an imposed measurement, as well as the questions related to anonymity and confidentiality.