Helmet use and the risk of neck or cervical spine injury among users of motorized two-wheel vehicles.

OBJECTIVE: To quantify the effects of wearing a helmet on head and facial injury among users of motorized two-wheel vehicles and to determine if helmet use increases the risk of neck and cervical spine injury. DESIGN/METHOD: A population-based study involving injured riders from the Rhône Road Trauma Registry from 1996 to 2005. Victims were only included if they had an injury to a body region other than (or in addition to) the head, face, neck, or cervical spine. Thus, inclusion was not affected by helmet use by the rider. The risk of head, face, neck, and cervical spine injury was assessed, with helmet use as the exposure of interest using logistic regression analyses. Adjusted odds ratios and corresponding confidence intervals were calculated. RESULTS: Helmet use significantly decreased the risk of head and facial injuries. The adjusted odds ratios for non-helmeted riders were 2.43 (95% CI 2.05 to 2.87) and 3.02 (95% CI 2.48 to 3.67), respectively. There was no association between helmet use and the occurrence of neck or cervical spine injuries. The adjusted odds ratios for non-helmeted riders were 0.86 (95% CI 0.60 to 1.23) and 1.04 (95% CI 0.78 to 1.39), respectively. CONCLUSION: Helmets protect users of motorized two-wheel vehicles against head and facial injury without increasing the risk of neck or cervical spine injury.

Limits of the quasi-induced exposure method when compared with the standard case-control design. Application to the estimation of risks associated with driving under the influence of cannabis or alcohol.

The disparities between the quasi-induced exposure (QIE) method and a standard case-control approach with crash responsibility as disease of interest are studied. The 10,748 drivers who had been given compulsory cannabis and alcohol tests subsequent to involvement in a fatal crash in France between 2001 and 2003 were used to compare the two approaches. Odds ratios were assessed using conditional and unconditional logistic regressions. While both approaches found that drivers under the influence of alcohol or cannabis increased the risk of causing a fatal crash, the two approaches are not equivalent. They differ mainly with regards to the driver sample selected. The QIE method results in splitting the overall road safety issue into two sub-studies: a matched case-control study dealing with two-vehicle crashes and a case-control study dealing with single-vehicle crashes but with a specific control group. Using a specific generic term such as "QIE method" should not hide the real underlying epidemiological design. On the contrary, the standard case-control approach studies drivers involved in all type of crashes whatever the distribution of the responsibility in each crash. This method also known as "responsibility analysis" is the most relevant for assessing the overall road safety implications of a driver characteristic.

Road crash involvement and professional status: a prospective study using the French Gazel cohort.

OBJECTIVES: To assess professional status (PS) differences in the risk of road crash involvement (RCI) (irrespective of crash severity), and to examine the underlying mechanism by evaluating the role of exposure to road risk (ERR). METHOD: A total of 15,271 subjects selected from the French GAZEL cohort were studied. A proportional hazard model for recurrent events was used to calculate the relative risks (RR) of RCI associated with PS. The associations between RCI and PS were investigated by adjusting for ERR (kilometers travelled and risk behaviors on the road). RESULTS: In all, 1890 RCI were reported. Managers have greater crude RCI risk than unskilled workers (male, RR=1.30; female, RR=1.44). This difference was no longer statistically significant when adjusting for factors describing the drivers' behaviors. Female managers' risks were also insignificant when adjusted for vehicle kilometers travelled (VKT). Managers seemed at lower risk of injury when involved in a crash. CONCLUSION: Socially advantaged subjects have the greatest RCI risk. Qualitative and quantitative ERR factors explain these disparities. These results highlight the importance to focus on ERR when studying the effect of an individual characteristic on RCI. They also highlight the importance to analyse separately the "RCI" and the "susceptibility to injury".

Modelling the hierarchical structure of road crash data--application to severity analysis.

Road crashes have an unquestionably hierarchical crash-car-occupant structure. Multilevel models are used with correlated data, but their application to crash data can be difficult. The number of sub-clusters per cluster is small, with less than two cars per crash and less than two occupants per car, whereas the number of clusters can be high, with several hundred/thousand crashes. Application of the Monte-Carlo method on observed and simulated French road crash data between 1996 and 2000 allows comparing estimations produced by multilevel logistic models (MLM), Generalized Estimating Equation models (GEE) and logistic models (LM). On the strength of a bias study, MLM is the most efficient model while both GEE and LM underestimate parameters and confidence intervals. MLM is used as a marginal model and not as a random-effect model, i.e. only fixed effects are taken into account. Random effects allow adjusting risks on the hierarchical structure, conferring an interpretative advantage to MLM over GEE. Nevertheless, great care is needed for data coding and quite a high number of crashes are necessary in order to avoid problems and errors with estimates and estimate processes. On balance, MLM must be used when the number of vehicles per crash or the number of occupants per vehicle is high, when the LM results are questionable because they are not in line with the literature or finally when the p-values associated to risk measures are close to 5%. In other cases, LM remains a practical analytical tool for modelling crash data.

Sexually transmitted diseases as major causes of ectopic pregnancy: results from a large case-control study in France.

OBJECTIVE: To evaluate the current impact of sexually transmitted diseases (STDs) and their consequences on the occurrence of ectopic pregnancy (EP). DESIGN: Case-control study. SETTING: Fifteen maternity hospitals in the Rhône-Alpes region, France. SUBJECTS: Six hundred twenty-four women with EP diagnosed from October 1988 to December 1991 and 1,247 controls who delivered liveborn children during the same period. MAIN OUTCOME MEASURES: Information on risk factors included behavioral, clinical, and serological indicators of STDs and other known risk factors of EP. RESULTS: Logistic regression identified several indicators of STDs as strong and independent risk factors for EP: previously treated STD without history of salpingitis; history of probably pelvic inflammatory disease (PID) and, especially, history of confirmed PID; previous STDs of the sexual partner; and Chlamydia trachomatis seropositivity. The adjusted attributable fractions of EP for previous symptomatic STDs, symptomatic STDs of the sexual partner, and C. trachomatis seropositivity were 20%, 3.5%, and 25.2%, respectively, giving a total of 43% of EP cases attributable to infectious factors. CONCLUSIONS: Our findings and previous epidemiological and biological evidence suggest that STD is a major cause of EP. The evidence is particularly strong in the case of C. trachomatis infection. An effective way of dramatically reducing the EP rate would be to prevent STD through education programs sensitizing young women to the complications of STD and public health measures promoting the use of protective methods such as condoms.

Exposure to organic solvents during pregnancy and oral clefts: a case-control study.

Prior studies on the relationship between maternal exposure to organic solvents in relation to oral clefts have been inconsistent. We re-examined this relationship in a case-control study conducted in the Rhône-Alpes region of France during the years 1985 to 1989. For each case, we selected two controls without congenital anomalies in the same delivery unit born during the same month. We interviewed each mother within the first five days after delivery about previous reproductive history and exposures during the first two months after conception. If the mother had an occupational activity at that time, we asked her occupational physician to confirm the exposures. We compared maternal exposure to any organic solvent between 200 infants with cleft lip and/or cleft palate and 400 controls and the estimated odds ratio was 1.62 (95% CI 1.04-2.52). Then we compared exposures to nine subgroups of solvents. Only the ratio associated with halogenated aliphatic solvents (4.40, 95% CI 1.41-16.15) was significantly different from unity. Control of potential confounders-sex of child, family history, maternal epilepsy-did not alter this odds ratio estimate.

Comparison of road crashes incidence and severity between some French counties.

Our aim is to compare traffic safety among several counties in France, and explore whether observed differences can be explained by differences in road types distribution and by differences in socio-economic characteristics between counties. Traffic safety is measured by incidence and severity, where incidence is defined by the ratio of counts of injury accidents and exposure, measured by the amount of kilometres driven. Severity is measured by the ratio between fatal and injury accidents. These indexes are analysed in the framework of Generalised Linear Models: counts of injury accidents are analysed with a Negative Binomial regression, which accounts for over-dispersion. Severity being the proportion of fatal accidents among injury accidents corresponds to the probability of a Binomial setting and this is modelled by a logistic regression. This modelling provides an easy way to adjust for covariates such as road type, environment (urban/rural) and evolution over time, and to test their possible interactions. We find that the time trend of each indice (incidence and severity) is the same across counties and across road types. There is a significant interaction between county and road type, meaning that, first, differences in traffic safety between counties are not fully explained by different road type distributions, and second, that the "ranking" of counties in term of incidence or severity varies according to the road type considered, and vice-versa. It was planned to explore global characteristics of the counties (driving and socio-economic data) as possible explanatory factors of differences between counties, but the existence of an interaction of county with road types shows the necessity of collecting and exploring characteristics of the sub-levels of road type within county.

[Epidemiologic research and road traffic accidentology in Europe]. / Recherche épidémiologique et accidentologie routière en Europe.

Every year there are 1.7 million road casualties on EU roads, of which 46,000 are fatal. With reference to the three main sources of information available (the police, the medical profession, and insurance companies), we have extracted epidemiological results for this important public health issue, taking into account the relevance of this approach in terms of its exhaustiveness and representativity. Finally, referring to different ad hoc etiological and evaluative research, we have put forward some ideas on the possible contribution that epidemiology could make to a better understanding of road traffic accidents. Given that current research is coordinated at an EU level, we have confined our analysis to the 15 member countries of the EU.

[Analysis of biases in epidemiological knowledge of road accidents in France]. / Analyse des biais dans la connaissance épidémiologique des accidents de la route en France.

BACKGROUND: In France, as in many countries, road casualty statistics are mostly based on police reports. It is generally recognized that these data are incomplete but no measurement has been made of the degree of under-reporting and thus of associated biases. This study aims to demonstrate and quantify these biases. METHODS: The study compares, after data linkage, the 10,202 people reported injured or killed in 1996 in the medical road accident victims Register in the Département du Rhône (France), with the 4,572 victims reported by the police during the same year and in the same area. This Département was chosen, as it is the only region in France where these two independent data sources coexist. Two types of possible biases are studied: injury severity classification bias and selection bias induced by underreporting. RESULTS: The study shows that the definition of "serious injury" used by the police exaggerates the severity of the victim's condition in over half the cases. This bias depends on road user group. This bias is maximum for pedestrians: compared to a slightly injured car occupant, a pedestrian with the same injury severity level has significantly more chance to be considered as severely injured (RR=1.78; 95% CI: 1.11-2.87). Conversely, significant selection biases are related to data collection by the police. The multivariate analysis shows that the underreporting of victims increases if no third party is involved (i.e. without any other vehicle or pedestrian), and reduces with injury severity. It also varies by road user group (with the largest underreporting for cyclists). Among the most seriously injured in accidents involving third parties, motor cyclists and car users are the most reported category and pedestrians the least (RR=0.80; 95% CI: 0.70-0.92). Biases in Register selection are much more limited and basically concern underreporting of victims of minor accidents who did not require medical care. CONCLUSIONS: This study confirms and quantifies misleading distortions in police statistics used to assess road accidents. These results concern the relevant indicators to be used to define road safety issues.

[Detection of flat condylomata of the cervix uteri in the Department of Rhône]. / Dépistage des condylomes plans du col utérin dans le département du Rhône.

In France's Rhône Department, the prevalence of cervical condylomas detected through cervical smears was measured in a systematic study. The rate determined was 1.67% of the women examined. This rate declines slightly with age among women up to 50 years of age, and declines more among those over 50. The study shows a higher frequency of cases in spring (May and June) and in autumn (September and October). We found important geographical variations, with overall higher rates in urban zones. However, there were certain notable exceptions (high rates in some rural areas and low rates in some urban zones). This survey will be followed up to examine the variation of this rate in time. The study has formed the basis of new hypotheses which must be verified by subsequent surveys.

[Differences between males and females in traffic accident risk in France]. / Différences entre les hommes et les femmes face au risque routier.

BACKGROUND: In France 7,720 people were killed in traffic accidents in 2001, 75% of which were men; the number of injured people is estimated at 153,945, of which 65% were men. The objective of the study is to describe differences between males and females regarding accidents, and to explain the main reasons for these differences. METHODS: Analysis is conducted from both national police data (2001) and data from the Rhone medical road accident trauma Register (1996-2001). RESULTS: The male/female incidence rate is 3.1 for mortality (95% CI: 3.0-3.3) and 1.7 for morbidity (95% CI: 1.7-1.8). Two-wheel motorised vehicle accidents are very specific to males, which explains part of this overrepresentation. The fatality rate and the severe injuries rate among survivors are higher for males. This is true for every main user group (car users, motorised two-wheelers, cyclists, pedestrians) after adjusting for accident circumstances and age of casualties. Males are more severely injured for all body regions and have more often severe after-effects. CONCLUSIONS: This paper shows the mechanisms leading to this unfavourable outcome for men. They correspond to differences in the number of trips, in the choice of road transport types, and moreover to differences in risk-taking behaviours. Underlying these behaviours, deep-rooted, strong and rather invariant differences between genders are to be found in the values associated with risk-taking on the road.

[Behavior of men and women with respect to procreation]. / Comportement des hommes et des femmes face à la procréation.

A specific survey was carried out on a sample of men and women of childbearing age to study their attitudes towards parenthood and to analyse psycho-social aspects which may have an effect thereon. The analysis took into account; the children number, woman's age, socio-economic status and occupational activity. Whatever the factor studied, it was constantly observed that the demand for an additional child (in particular the third child) was expressed more often by men than by women.

[Risk factors for condylomata. A case control study]. / Facteurs de risque de condylomes. Etude cas-témoins.

The present study involves 214 patients whose cervical smear showed signs of human papilloma virus infection (HPV), matched with 1042 controls. We demonstrate increasing odds ratio with the total number of sexual partners since first sexual intercourse (p less than 0.0001). Moreover the cases have more often changed partners in the year preceding the diagnosis (odds ratio 2.6 p less than 0.0001). Their male partners more often have occupations that expose them to "extra-conjugal adventures" (p = 0.0005). Using a logistic regression analysis we demonstrate the independence of the masculine and feminine risk factors. After adjustment for age, reason for consulting and marital status the following factors are related to HPV infection: new partner, total number of sexual partners since first sexual intercourse and partner's occupation.

[Fetal growth from the AUDIPOG study. II. Application for the diagnosis of intrauterine growth retardation]. / Croissance foetale à partir de l'étude AUDIPOG. II. Application au diagnostic de retard de croissance intra-utérin.

The identification of intrauterine growth retarded infants remains a problem. It is useful to distinguish between small for date which uses the reference of a statistical birthweight limit and intrauterine growth retardation. A study comprising nearly 100,000 births from many French regions allowed a definition of the limits of birthweights taking into account gestational age, sex, birth rank, maternal height and pregravid maternal weight. This new approach distinguished two groups of newborns, the "constitutionaly small" and those who are newly called "growth retarded". The validity of this new classification is discussed.

[New limitations on birth weight for the diagnosis of intrauterine growth retardation]. / Nouvelles limites de poids de naissance pour le diagnostic de retard de croissance intra-utérin.

It is quite strange that hypotrophism is evaluated from old growth curves, established in a distant country, at relatively high altitudes. From 20,000 cases of births in three regions of France, center, north and south, the authors establish the new mean from which they draw interesting conclusions.

[Facial expression of the vertical dimension before and after orthognathic surgery]. / La mimique du sens vertical avant et après chirurgie orthognathique.

The dynamic analysis of faces of the patients asking for a restoration for an aesthetic injury with a combined orthodontical-surgical treatment requires, besides a static morphological study: with photographs an cephalometric tracings; the study of their facial expression. In order to find out a method of classification of the units of expressive facial behavior, the mobility of the face is studied through the coding of the facial activity by P. EKMAN and W. FRIESEN i.e. the F.A.C.S.: Facial Action Coding System: From the video-recordings of faces and their photographic versions obtained after a pause on the video recorder, these authors have improvised a technic based on the visual observation of the anatomical basis of the movement in connection with facial expression and their description through minimal anatomical action units or A.U. These minimal units of behaviour combine to form mimics. Thanks to the F.A.C.S., the facial mimic of 18 patients before and after orthognatic surgery, and of six samples without dentofacial deformations has been studied. 18,844 AU have been observed, among 6,278 mimics made all together, with 604 different types. A classification of the mimics made by everyone and repeated in time has enabled us to establish a king of "norm" related to expression, allowing us some comparisons with expression of deformed patients. On one hand, for all of the patients examined, we have observed the mimics of the patients after surgery were more identical to the mimics of the samples. On the other hand, some differences have been distinguished concerning the changes of expressivity after surgery depending on the type of morphology before surgery: thus, rather a normal activity of the shrinking of the orbicularis oris has been observed, as well as the buccinator, among the open bites that had been operated on; and the activity of the uppe lip deriving from the "levator Labu Superious Caput infra orbitalis" has become more normal, and rather a normal activity of the lower lip deriving from mentalis, among the operated deep-bites. These results are akin to the clinical observations and suggest that the F.A.C.S. will be able to provide a coding for the study of facial expression.

Prematurity and occupational activity during pregnancy.

The aim of this study was to determine the elements of fatigue in occupations which constitute possible risk factors for the course of a pregnancy, and, in particular, that could cause premature birth. In 1977-1978, a total of 3437 women in France were surveyed after giving birth in two maternity hospitals. One hospital was located in Lyon (a large city) and the other in Haguenau (a small town). Among 1928 working women, it was found that certain occupational categories are more prone to risk of prematurity than others. The authors carried out an analytical breakdown of the job into its diverse components which led them to define five sources of fatigue and to construct an index capable of detecting the strenuous working conditions. There is a significant relationship between the prematurity rate and the number of high fatigue scores observed in the job. When the number of scores varies from 0 to 5 the rate of premature births increases from 2.3% to 11.1%. This relationship remains significant after controlling for confounding factors.

Sociodemographic characteristics and intentions for further births in France.

PIP: The purpose of this study, which interviewed 356 couples of childbearing age in the Lyon region of France, was to analyze the different attitudes of men and women towards parenthood, and to identify the social and personal characteristics which may modify these attitudes. The 2 groups in the study, the 183 couples who wanted an additional child and the 127 who did not, were compared in relation to socioeconomic status, woman's work status, woman's age at 1st birth, and absence of a child of each sex. (46 couples with conflicting intentions were excluded.) The couples intending to have further children on average had significantly fewer children, were younger, and less frequently had a child of each sex. The other factors were statiscally insignificant. The fertility rate of couples not wanting more children was above the replacement rate of 2.6. The rate for couples intending to have another child was comparable at 2.4, except that the average 5 year age differences between the 2 groups was higher than the usual interval between 2 births, reinforcing the trend toward a model family of 2 or 3 children and greater intervals between consecutive births.^ieng

[Contraceptive methods and women's age]. / Pratiques contraceptives et age des femmes.

PIP: 1582 women aged 15-44 in the area of Lyon, France, were interviewed by a psychologist in 1981-82 concerning their attitudes to contraceptives. Many women were more approving or tolerant of specific contraceptive methods for other women than for themselves. 72% approved of sterilization for other women but only 55% stated they would consider it for themselves. 88% of respondents stated they had ever used contraception, with the proportion increasing by age from 55% of those under 20 years old to 95% of those over 30. Among the 1392 women having ever used a contraceptive method, 14% said they did not like any method. 70% liked the pill, 60% liked the OC, and 25-35% liked various periodic abstinence methods. Attitudes toward different methods varied by age. Use of methods also varied by age. The most recent method used within the past year varied from 68% of women under 20 to 32% over 35 for the pill, from under 7% for women 20-29 to 20% for women 30-35 for the IUD, from about 11% of all women to 14% among women aged 30-34 for natural and mechanical methods, and from 3.5% of women 30-34 to 15% of those over 35 for female sterilization. Use of IUDs and OCs declined with parity but increased for women living alone or in consensual unions. Use of OCs and IUDs was lowest among women in households headed by workers in low level jobs. Within each parity, marital status, age, or employment group, use of OCs and IUDs declined with age. The decline in use of IUDs and OCs by age when number of children, marital status, and socioprofessional category were controlled was confirmed by regression analysis.^ieng