[Prescribed and dispensed in the third trimester of pregnancy drugs: What practices and risks?]. / Médicaments prescrits et dispensés au cours du troisième trimestre de grossesse : quelles pratiques et quels risques ?

OBJECTIVE: The aim of the study was to describe the prescribing of drugs to pregnant women during the third trimester of pregnancy. PATIENTS AND METHODS: The retrospective analysis is interested by pregnant women from August 2009 to April 2011, living in Franche-Comté. The used data are recorded in the database of the French Health Insurance Service. Drugs prescribing were analyzed and classified according to three categories: drugs that are contraindicated, not recommended drugs and drugs that are used. This classification is based on two databases: the Summaries of Product Characteristics of Vidal 2010 and data from the National Security Agency of Medicines. The potential exposure of patients was pointed out. RESULTS: On 15,027 patients, 80% had a prescription. Six percent of prescriptions containing drugs not recommended and 1% drugs that contraindicated. Therapeutic classes identified are analgesics, anti-infective drugs and medicines supplementing with vitamins and minerals. Contraindicated drugs (10%) are NSAIDs, rubella vaccine, cyclins and ACE inhibitors and ARBs. Approximately 2.7% of women were potentially exposed to these drugs. DISCUSSION AND CONCLUSION: Despite the recommendations of the ANSM, some drugs that are contraindicated are prescribed for pregnant women in their third trimester of pregnancy. In the absence of studies, the decision must be made on a case by case basis by assessing the risk-benefit ratio. Particular care is to bring about the drugs taken in self-medication. Information and advice are key steps to avoid incidents.

[Assessment of 10 years of memory consultations in the Franche-Comté: Description and analysis of the RAPID regional database]. / Bilan de 10ans de consultations mémoire en Franche-Comté: description et analyse de la base de données RAPID.

The aim of this study was to evaluate the impact, on a regional scale (Franche-Comté), of 3 National Alzheimer care plans, particularly concerning the development of the offer of care management by clinicians as well as the panel of diagnoses concerned. Data on sociodemographic, neuropsychological and diagnostic characteristics were retrieved from the RAPID regional database between 1st January 2003 and 31st December 2012. These analyses focused exclusively on patients who had an initial consultation (n=12,017) during the same period. The existence of a previously established health network capable of carrying out governmental health plans has produced an effective interface between regional administrative structures responsible for the implementation of these plans and health professionals responsible for carrying out them out. This network study, the use of a battery of tests and a common software database have enabled the development of patient care management throughout the Franche-Comté region. It also showed the diversification of diagnoses mentioned over the past years as well as changes in clinical practices on how to address the issue of cognitive impairment.

[Pilot campaign to promote vaccination: description preliminary results of a regional French program]. / Une campagne pilote de promotion de la vaccination: description et premiers résultats d'un programme régional.

CONTEXT AND OBJECTIVE: In 2003, the Franche-Comté decided to launch an innovating program, with the support of many national partners. The objective was to improve the vaccine coverage of Franche-Comté population. DESCRIPTION OF THE INTERVENTION: It consisted in organizing every year (for three years) a week of vaccination with the active assistance of community healthcare professionals (doctors, pharmacists, etc.) and to develop complementary activities during the year: media campaign, visits to all local physicians, training, written data (posters, booklets, etc.), implementing an exhibition. RESULTS: This program is not yet finished. However, the first results (after two years) are very encouraging. Several types of evaluation were carried out: 1) PROCESS: inquiry with physicians; 2) IMPACT: follow-up of vaccine refunding evolution. The notoriety of the program seems important with physicians. They declared having changed their vaccination behavior with their patients. After the vaccination week, the number of vaccines refunded in the next 2 months (compared to the same reference period in 2003) increased by 10% in 2005, after a first increase of 5% in 2004. DISCUSSION/CONCLUSION: The initial analysis confirms that the impact of "a vaccination week" seems to reinforce regional vaccine coverage. Moreover, WHO Europe and the French Health Ministry have decided to extend this program to the national level in 2007.

[Adolescent mental health: perception and support from adults in the school setting]. / Santé mentale des jeunes: perception et prise en charge par les adultes des établissements scolaires.

OBJECTIVE: To compare young people's and adult's perceptions of certain mental health issues in order to be able to propose solutions targeting the improvement of the current situation. METHOD: A school nurse, a chief education counselor and homeroom teacher (3 people per establishment) from 15 schools in the Doubs county were questioned using semi-directed interviews. The schools were all junior high schools or preparatory schools for students aged between 15 and 18 who were studying to take the baccalaureat examination. The data were compared with those of the Health Barometer (a national representative sample of young people attending school in France). RESULTS: Adults have a different perception of health in general and mental health in particular compared to that of young people. There is a perceptible gap between certain adults on the one hand, given their motivation, investment and wish be of help to young people, and on the other hand, young people's perception of it. It seems that for everyone questioned, the school nurse is a uniquely, important contact person. She is in a considerably favourable position for listening and providing assistance on difficult questions like suicidal thoughts, depression, and problems linked to sexuality or contraception.

[The medical records of home health care patients: a complement or alternative to an electronic file?]. / Le dossier de liaison du patient dépendant a domicile: complément ou alternative au dossier electronique?

Home health care services for dependant people involve participation and interventions of professionals from the health care, medico-social and social sectors. In order to ensure quality care, the flow of information must appropriately circulate between all of the various care providers. The establishment of an electronic medical file for these patients is a possible solution which has been proposed to be conducted in next years. A paper medical record is the property of the patient and offers the possibility of an alternative and complementary solution. The electronic file would use the existing available file as a starting point, and without any additional organisational structures being implicated, it allows for better coordination of the health, medical and social activities. An experimental implementation of this in the Franch-Comte region of France demonstrated the advantages and benefits of such a tool based on a logic centered upon the individual and the open sharing of practices between professionals in the medical and social sectors.

Home delivery of an injury prevention kit for children in four French cities: a controlled randomized trial.

OBJECTIVES: Home delivery of counselling and safety devices to prevent child injuries could help parents to adopt safe behaviour. The aim of this study was to test a safety kit designed and used in Quebec (Canada). DESIGN AND SUBJECTS: One hundred families from four towns in the Paris suburbs were visited at home by nurses or doctors when their child reached 6-9 months. Selection criteria were: primipara, medical problem, psychological, and/or socioeconomic difficulties. INTERVENTIONS: During the first visit, 50 families (group 1) received counselling and a kit including preventive devices and pamphlets about indoor injuries and ways to avoid them. The other 50 families (group 2) received counselling but not the kit. A second home visit was made 6-8 weeks later. MAIN OUTCOME MEASURES: The number of safety improvements was calculated 6-8 weeks after a first home visit. Perceived usefulness of the kit was collected from families and from interviewers. RESULTS: Between the first and the second visits, safety improvement was significantly higher in the group with the kit. This was mainly related to the risk of fall (p<0.02), fire and burns (p<0.001), poisoning (p<0.01), and suffocation (p<0.001). For improvement related to devices provided in the kit, the difference between the groups was significant: 64.4% improvement in group 1 versus 41.2% in group 2 (p<0.01). The relative risk (RR) of safety improvement between groups was 1.56 (95% confidence interval (CI) 1.35 to 1.80). Even for improvements not related to the kit the difference remained significant: 31.2% in group 1 versus 20.2% in group 2 (p<0.05); RR = 1.54 (95% CI 1.22 to 1.93). CONCLUSION: Routine home visits by social services offer a good opportunity to tackle child injury prevention. Free delivery of prevention kits and counselling allow families to modify their behaviour and homes so as to reduce risks.

[Evaluation of the effectiveness of an injury prevention kit delivery for toddlers in four French cities]. / Evaluation de l'efficacité de la remise d'une trousse de prévention des accidents domestiques de jeunes enfants: essai d'intervention dans quatre communes des Hauts-de-Seine (France).

BACKGROUND: The home delivery of counseling and devices intended to prevent child injuries could help parents to adopt safe behavior more efficiently. The aim of the present study was to adapt and test in France a safety kit designed and used in Quebec (Canada). The intervention program (kit delivery and counseling) was assessed by measuring 6 to 8 weeks after a first home visit the percentage of safety changes adopted by the families included in the survey, compared with the pre-intervention situation; and by evaluating the satisfaction of families with their participation in the survey, and the satisfaction of nurses with the use of this new tool. POPULATION AND METHOD: One hundred families from 4 towns in the Hauts-de-Seine department in the Paris suburbs (Boulogne, Chaville, Sèvres, Ville d'Avray) were selected by the social services for home visits by nurses or doctors, when their child reached the age of 6 to 9 months. Selection criteria were usually primipara, medical problem, psychological and/or socio-economic difficulties. During the first visit, 49 families (group 1) (1 family lost for follow-up) received the usual informative and preventive counseling, and a kit including preventive devices and pamphlets about indoor injuries and ways of avoiding them. The other 50 families (group 2) received counseling but not the kit. Between 6 and 8 weeks later, a second home visit was paid to all selected families. RESULTS: Between the first and the second visits, the percentage of safety improvement was significantly higher in group 1 (with the kit) than in group 2 (without the kit). This improvement mainly related to the risk of fall (P < 0.02), fire and burns (P < 0.001), poisoning (P < 0.01) and suffocation (P < 0.001). When the analysis was focused on safety improvement related to devices provided in the kit, the difference between the 2 groups was significant: 67.8% of safety improvement in group 1 vs 38.1% in group 2 (P < 0.001). The relative risk (RR) was 1,78 (95% confidence interval (CI): 1,18-2,68). Even for items not related to the devices provided, the difference remained significant: 48.6% in group 1 vs 28.8% in group 2 (P < 0.001); RR =1,31 (95% CI: 1,23-1,40). The perceived usefulness of the kit was discussed in a focus group with all nurses and doctors. On the whole, the judgment was very positive, mainly because the kit facilitated the introduction of the notion of accident prevention in the discussion at home. CONCLUSION: As in the canadian survey, our results indicate that routine home visits by the social services offer a good opportunity to introduce the subject of child injury prevention. Free delivery of prevention kit and simple counseling allow often deprived families to modify their behavior and to arrange their apartments so as to reduce risks.

[Disturbed eating behavior and suicide thoughts among adolescents: results of a national telephone survey ]. / Conduites alimentaires perturbées et pensées suicidaires chez les adolescents: résultats d'une enquête nationale par téléphone.

The objective of this paper is to study the relation between the disturbed eating behaviours and the suicidal thoughts. In the Young People Health Barometer 97/98, 13.3% of the adolescents interviewed stated that they have "quite often" or "very often" overeaten and experienced difficulty in stopping themselves in the last 12 months. 1.0% have voluntarily vomited, 4.8% are afraid of starting to eat for fear of not being able to stop themselves, 5.6% eat in secret. Moreover, 10.3% say that they have had thoughts about suicide in the last 12 months. Percentage of suicidal thoughts increases notably with the number of declared disturbed eating behaviours. The adjusted odd ratio on sex and age for having had thoughts about suicide, comparing those declaring at least one of these eating behaviours to those declaring none of these behaviours, is 2.9.

[Evaluation of measles, mumps and rubella vaccine coverage in 3 year old children in twelve French counties. Time-trends and related factors]. / Evaluation de la couverture vaccinale rougeole-oreillons-rubéole chez les enfants de trois ans dans douze départements français. Evolution temporelle et facteur associés.

BACKGROUND: The aims of our study were to estimate the measle-mumps-rubella (MMR) vaccine coverage in 3 years old children in 12 French countees, to document the evolution between 1997 and 1999 in two groups of 6 countees (pilot group and control group) before and after the implementation of promotion programmes in the pilot group, and to identify factors related to measle-mumps-rubella vaccination. METHODS: Two telephone surveys were carried out in 1997 and 1999 among children randomly selected in the birth rolls of 12 French countees. Parents of 3 years old children were interviewed on measle-mumps-rubella vaccination, knowledge and opinions on vaccinations, utilisation of health care and socio-demographic characteristics. RESULTS: The participation rate was 97% in both surveys. Among the 7382 respondent parents, 98% had immediate access to the child's medical file and could document the vaccine status. The vaccine coverage did not increase significantly between 1997 and 1999 (86.7% versus 87.2%), both in control (89.3% vs. 90.2%) and pilot groups (84.3% vs. 84.3%). A logistic regression model showed that several factors were independently and significantly related to measle-mumps-rubella vaccination (utilisation of homeopathic medicines, mother's age, number of children, physician speciality (general practitioner or pediatrician) and opinion on vaccinations). CONCLUSION: Our study shows that there is a stagnation of vaccine coverage in several French countees, which makes unlikely the national objective of viruses eradication. This epidemiological situation makes very likely outbreaks of measles, mumps and rubella in these countees. National and local pilot programmes did not succeed to promote vaccination in countees with a low measle-mumps-rubella vaccine coverage. Our study identified sub-groups of parents who should be targeted by promotion programmes.

[Smoking prevention in France from 1997 to 1999]. / La prévention du tabagisme en France au cours des années 1997/1999.

The years following the adoption of the Veil law (passed in 1977) were not characterised by substantial results in terms of a reduction in tobacco consumption. In 1991, the Evin law marked an important step in the regeneration and structuring of the fight against this substance. It is within this see-sawing context of smoking behaviour that a three-year (1997-1999) plan was supported and implemented by the French National Social Security and the French Committee for Health Education. The central theme was to help people to quit. During this same time period, the consensus conference (1997) as well as the announcement of a governmental plan (1999) came about to consolidate and magnify these directions. The observance of the change in tobacco consumption permits one to acknowledge that the Evin law and its measures for assistance had a positive impact during the early 1990s. On the other hand, this impact seems to have been on the whole "blunted" throughout the second half of the decade. The main hypothesis to explain this stagnation is that the increase in the price of tobacco was less sensitive and that the measures aimed at enforcing this law were less often applied, whereas at the very same time the commitment of the actors involved in the fight against smoking was strong. This assessment permits one to: 1) confirm the fact that in public health, health promotion actions are effective when they are jointly associated with initiatives that are coercive (the law and its application) and educational, the development of the environment and the improvement of care; and 2) remember the importance of truly applying the clauses of the Evin law and perhaps eventually adding to them.

[Comparison of two types of behavior and attitude surveys on alcohol, tobacco and illegal drug use]. / Comparaison de 2 modalités d'enquête sur les comportements et attitudes au sujet de l'alcool, du tabac et des drogues illégales.

BACKGROUND: The aim of this study was to compare the results of two types of surveys frequently used in France to monitor alcohol, tobacco and illegal drug consumptions. METHODS: Data from a random sample phone survey (1993 18-75 year old French adults in November and December 1995), a quota sample face-to-face survey (1000 18-75 year old French adults in November 1995) and other sources (sales statistics and other surveys) were compared. RESULTS: Results from the two types of surveys were similar for alcohol and tobacco consumption prevalence. Concerning smoking prevalence, the random survey gave an estimate of 35.5% for the smokers ratio versus 35.2% with the quota sample survey. The daily alcohol consumer percentage was 20.9% and 22.1% respectively with the random and the quota sample surveys. Differences were observed for attitudes and illegal substances consumption: the random sample phone survey estimated at 15.5% people using drug during their life versus 13.9% for the quota sample face-to-face survey. CONCLUSIONS: Quota sampling and face-to-face surveys can be used to monitor alcohol, tobacco consumption and to a lesser extent, drug consumption trends, especially by repeated surveys, instead of random sample phone survey which are more time and money consuming.

[Attitude and behavior of hospital personnel toward smoking]. / Attitudes et comportement du personnel hospitalier face au tabagisme.

Due to a lack of data available at the national level, on smoking behaviour of hospital staff, a survey was carried out in a representative sample of hospitals. This survey, which will be repeated in the future, should enable to evaluate preventive actions at hospital and to measure the implication level of the hospital staff in tobacco prevention. The analysis of data collected among 3082 persons shows that a third of the hospital staff smokes. Among these persons a certain part smoke at their working place, this proportion is varying considerably with the working area in the hospital. The more this area is close to the patient the less is hospital staff smoking. More than one third of the interviewers (37.3%) think that trying to convince people to stop smoking is part of their role: this opinion varies considerably depending on the professional activity in the hospital. In addition a very large majority (81.4%) of the hospital staff considers that it has an exemplary role to play in front of patients. This belief is shared equally by all the different groups of staff. The smoking prevalence among hospital staff is equivalent to that of the general population; this underlines the need and the necessity to realize anti-tobacco campaigns among this health care population. Moreover since the exemplary role they have to play, is very well accepted, preventive actions could rely on a good level of participation.

[Food habits, consumption, and knowledge of a low-income French population]. / Habitudes, consommations et connaissances alimentaires des Français en situation de précarité financière.

Behaviors related to nutrition as well as the eating habits of low-income French people are analyzed from data collected by the Nutrition and Health Barometer of the CFES in 1996. French people with monthly incomes of less than 4000 francs appear to go to fast-food restaurants more often than to other types of restaurant (for leisure or work). They appear to eat their three main meals alone more often, to spend less time over the evening meal, to watch television during their noon and evening meals, to have cheese or another dairy product rather than a main dish, and to limit their evening meal to a single dish. They are less numerous than higher-income people to have the "ideal" breakfast. These economically disavantaged French people do their shopping more often in large of medium-sized supermarkets and more often plan their meals according to the family budget. In terms of food they are more numerous to eat neither fruit nor vegetables; they consume less pork, fish and shellfish, dairy products, alcoholic beverages and especially before-dinner drinks. This study shows that the eating behavior of low-income French people is less in conformity with commonly accepted nutritional recommendations. Likewise, the rate of obesity observed among the women from this households appears high.

[Prospective view concerning organization of breast cancer screening in France]. / Vue prospective sur l'organisation du cancer du sein en France.

Development of an organized cancer screening is today an essential axis of Public Health. Successive sequences are the test, the experience and the generalization. There are three principles for this generalization: 1. transparence with a specific act coding; 2. selectivity to assure the quality at each stage of this process; 3. responsibility on both professionals and policy holder levels. A such organization can only find its reasons in: 1. a legislative text who sets a very strict frame in accordance with regulations with a specific list and therefore differed for the act itself; 2. professionals and structures approved for organized screening acts, covered at 100%. The regional level will certainly be at the center of this system. Three authorities are marked out for playing significant role: the Regional Direction of Sanitary and Social Action, the Regional Union of Sickness Insurance Funds and the Regional Union of Liberal Physicians. If those measures and this organization might improve the quality of screening acts, they would be for the major part ineffective if they don't allow to get back to women who today escape, for the major part, this prevention process. They are essentially persons aged of 55 years old and over and the most deprived public. In this prospect, the general practitioner must play an essential role in a same time to go back to those public and ease an open to a dialogue around screening.