[Assessment of the outcome of anorexia nervosa: construction of a self-administered questionnaire based on the patients' perception]. / Evaluation du devenir de l'anorexie mentale: construction d'un autoquestionnaire basé sur la perception des patientes (étude préliminaire).

INTRODUCTION: Our working hypothesis is that a better insight into the outcome of patients suffering from anorexia nervosa should contribute to preventing relapses and further complications and assessing treatment efficiency. Through anorexia nervosa, the patients express the difficulty they have to view themselves as specific subjects. OBJECTIVE: The current classic outcome evaluation is based on the study of objective events, which only partially reflect the reality of the patients' outcome at a subjective level. The objective of this study was to set up a new assessing instrument of the outcome of patients suffering from anorexia nervosa, essentially based on the patients' perception of their experience. METHOD: The methodology used has been based on: (1) the conduct by the main investigator of unstructured interviews using "free association", with the help of an interview guide. The anorexia nervosa patients were recruited among those who were hospitalized on an isolation contract, or among outpatients under a psychiatrist/psychoanalyst's supervision, aged over 25 years old so that they may have started their reproductive life. The study included 30 patients; (2) the analysis of the interview contents backed by preexisting hypotheses and by new ones suggested by the expression of the patients' perception, so as to set up an inventory of new themes; (3) the construction of a self-administered questionnaire starting from the development of each theme into several questions taking up the patients' own words and offering 4 possible answers (disagree completely, disagree, agree, quite agree). RESULTS: The analysis of the interviews contents has led to the development of 11 themes. The self-administered questionnaire includes a total of 124 items stemming from the development of each theme into between 9 and 16 items that were mixed in the version submitted to patients. DISCUSSION: This original interpretation of the outcome of the patients through their experience provides a better understanding of their relation to desire and pleasure, and consequently of the evolution of their subjectivity. By integrating several aspects of the disease expression, our instrument constitutes an alternative to the combination of several non-specific tools in anorexia nervosa. It thus avoids the atomization of the pathology and respects the specificity of its structure. The analysis of the disease function in the emergence of their subjectivity rather than the static observation of its symptoms has led to the development of new themes. CONCLUSION: The validation of this new methodological approach of the follow-up of anorexia nervosa based on the patients' perception of the evolution of their disease, aside from anthropometrical or physiological parameters, will have to be tested on a new population of patients. A quantitative score will be developed in association with the self-administered questionnaire. Its use in further epidemiological studies will enable a scientific assessment of the patients' outcome, and better prevent further complications and relapses, by screening patients with a pejorative risk. The ultimate aim is to improve these patients' care.

The term breech presentation: Neonatal results and obstetric practices in France.

OBJECTIVE: Compare neonatal complications according to the planned mode of delivery and according to whether the women gave birth at a maternity unit that applied "consensus" guidelines. STUDY DESIGN: The study used the database of the AUDIPOG Sentinel Network (n=71,919 pregnancies between 1994 and 2000). The principal outcome was a composite variable that included neonatal morbidity and mortality. A survey of obstetric practices was sent to 175 maternity units belonging to the network. Consensus guidelines were defined from the survey responses and taken into account in the database analysis. RESULTS: Neonatal complications did not differ between the group of women with term babies in breech presentation for whom vaginal delivery was planned and those for whom an elective caesarean was planned (adjusted OR=1.33; 95% CI: 0.63-2.80). The survey allowed us to define a set of six criteria for deciding on mode of delivery; it established a consensus, followed by 42% of the maternity units in the study. The rate of neonatal complications among the women with planned vaginal delivery was lower for those giving birth in units that applied the consensus guidelines than among those in the other units: adjusted OR=0.27 (95% CI: 0.09-0.85). CONCLUSION: The risk of neonatal morbidity according to planned mode of delivery for term breech babies was lower for those giving birth in units that applied the consensus guidelines than among those in the other units.

[Twin delivery: a survey of French obstetrical policies]. / Accouchement des grossesses gémellaires: enquête sur les politiques des maternités françaises.

OBJECTIVES: To describe obstetrical policy variations concerning the delivery management in the case of twins, at term. PATIENTS AND METHODS: A mail survey was undertaken among the medical supervisors of the maternity wards belonging to the AUDIPOG Network (N=170). RESULTS: The participating rate was 73.35%. 124 answers were analysed. Elective caesarean was realized by 0.8% of participants for diamniotic twins and by 57% of cases for monamniotic twins An elective caesarean is planned for respectively 74% of answers if first (J1) and second twin (J2) are in a breech presentation, 81% if J1 is in breech and J2 in cephalic presentation, and 68% if J1 is in breech and J2 in transverse presentation. Delivery with J1 in breech and J2 in cephalic presentation had a higher risk than a delivery of a single breech at term. When J1 and J2 had a breech presentation 73% of participants thought that this delivery is more difficult than a delivery of a single breech at term. However, they were only 17.5% to consider that a delivery of twin with J1 in cephalic and J2 in breech presentation had a higher risk than a single breech delivery. DISCUSSION AND CONCLUSION: Medical policy variations are not extensive except for X-ray pelvimetry and the presence for the delivery of one paediatrician and one anaesthesiologist. An elective caesarean policy for twins is infrequent in France.

Role of a 10-Gy boost in the conservative treatment of early breast cancer: results of a randomized clinical trial in Lyon, France.

PURPOSE: To define the role of a 10-Gy boost to the primary tumor in the conservative treatment of early infiltrating breast carcinoma treated by limited surgery and radiotherapy. PATIENTS AND METHODS: Between 1986 and 1992, 1,024 women with early breast carcinoma (< or = 3 cm in diameter) were treated by local excision, axillary dissection, and conventional 50-Gy irradiation given in 20 fractions over 5 weeks and then randomly assigned to receive either no further treatment or a boost of 10 Gy by electrons to the tumor bed. The median follow-up time was 3.3 years as of September 1994. The occurrence of telangiectasia was reported, and the patients were asked to evaluate the cosmetic result. RESULTS: At 5 years, 10 patients of 521 who had received the boost (Kaplan-Meier estimate of local relapse rate, 3.6%) and 20 of 503 who had received no further treatment (Kaplan-Meier estimate of local relapse rate, 4.5%) had developed a local recurrence (P = .044). After adjustment for the main prognostic variables, the relative risk was still significantly lower for the boost group (0.3; range, 0.12 to 0.95). The boost group had a higher rate of grade 1 and 2 telangiectasia (12.4% v 5.9%), but no difference was seen between the two treatment arms in the self-assessment score for the cosmetic result. CONCLUSION: Delivery of a boost of 10 Gy to the tumor bed after 50 Gy to the whole breast following limited surgery significantly reduces the risk of early local recurrence, with no serious deterioration in the cosmetic result. Additional follow-up evaluation will be required to assess the long-term results.

Effect of a mediterranean type of diet on the rate of cardiovascular complications in patients with coronary artery disease. Insights into the cardioprotective effect of certain nutriments.

OBJECTIVES: We sought to describe the various cardiovascular complications that occurred in the Lyon Diet Heart Study (a secondary prevention trial testing the protective effects of a Mediterranean type of diet), to analyze their relations with the associated drug treatments and to gain insights into the possible mechanisms underlying the beneficial effects of certain nutriments. BACKGROUND: Dietary habits are implicated in coronary heart disease, and the traditional Mediterranean diet is thought to be cardioprotective. However, the exact mechanisms of this protection are unknown. METHODS: A total of 605 patients (303 control subjects and 302 study patients) were studied over a mean period of 27 months. Major primary end points (cardiovascular death and nonfatal acute myocardial infarction), secondary end points (including unstable angina, stroke, heart failure and embolisms) and minor end points (stable angina, need for myocardial revascularization, postangioplasty restenosis and thrombophlebitis) were analyzed separately and in combination. RESULTS: When major primary and secondary end points were combined, there were 59 events in control subjects and 14 events in the study patients, showing a risk reduction of 76% (p < 0.0001). When these end points were combined with the minor end points, there were 104 events in control subjects and 68 events in the study patients, giving a risk reduction of 37% (p < 0.005). By observational analysis, only aspirin among the medications appeared to be significantly protective (risk ratio after adjustment for prognosis factors 0.45; 95% confidence interval 0.25 to 0.80). CONCLUSIONS: These data show a protective effect of the Mediterranean diet. However, the risk reduction varied depending on the type of end point considered. Our hypothesis is that different pathogenetic mechanisms were responsible for the development of the various complications. It is likely that certain nutriments characteristic of the Mediterranean diet (omega-3 fatty acids, oleic acid antioxidant vitamins) have specific cardioprotective effects.

Mediterranean dietary pattern in a randomized trial: prolonged survival and possible reduced cancer rate.

BACKGROUND: The Mediterranean dietary pattern is thought to reduce the risk of cancer in addition to being cardioprotective. However, no trial has been conducted so far to prove this belief. METHODS: We compared overall survival and newly diagnosed cancer rate among 605 patients with coronary heart disease randomized in the Lyon Diet Heart Study and following either a cardioprotective Mediterranean-type diet or a control diet close to the step 1 American Heart Association prudent diet. RESULTS: During a follow-up of 4 years, there were a total of 38 deaths (24 in controls vs 14 in the experimental group), including 25 cardiac deaths (19 vs 6) and 7 cancer deaths (4 vs 3), and 24 cancers (17 vs 7). Exclusion of early cancer diagnoses (within the first 24 months after entry into the trial) left a total of 14 cancers (12 vs 2). After adjustment for age, sex, smoking, leukocyte count, cholesterol level, and aspirin use, the reduction of risk in experimental subjects compared with control subjects was 56% (P=.03) for total deaths, 61% (P=.05) for cancers, and 56% (P=.01) for the combination of deaths and cancers. The intakes of fruits, vegetables, and cereals were significantly higher in experimental subjects, providing larger amounts of fiber and vitamin C (P<.05). The intakes of cholesterol and saturated and polyunsaturated fats were lower and those of oleic acid and omega-3 fatty acids were higher (P<.001) in experimental subjects. Plasma levels of vitamins C and E (P<.05) and omega-3 fatty acids (P<.001), measured 2 months after randomization, were higher and those of omega-6 fatty acids were lower (P<.001) in experimental subjects. CONCLUSIONS: This randomized trial suggests that patients following a cardioprotective Mediterranean diet have a prolonged survival and may also be protected against cancer. Further studies are warranted to confirm the data and to explore the role of the different lipids and fatty acids in this protection.

[Early postpartum hospital discharge in France]. / Sortie précoce dans le post-partum: état des lieux en France.

BACKGROUND: Early postpartum discharge is a recent practice in France and for which there are few national data. METHODS: The Sentinel AUDIPOG network was used to describe the practice of postpartum early discharge (< 3 days in case of vaginal delivery and < 5 days in case of caesarean section) from 1994 till 2002, after standardization on the distribution according to the type of hospital and the region (n = 128232). Secondarily, the prognostic medical factors of an early postpartum hospital discharge were researched, in univariate analysis and logistic regression analysis, of the births of 2001-2002. RESULTS: Early postpartum discharges concerned 3% of the deliveries in 1997 and 7% in 2002. Eearly postpartum discharge was more frequent in the level II and III obstetric facilities, in non- university hospitals, in facilities with more than 1 500 deliveries a year, in urban hospitals and in Paris and the surrounding area. The women leaving early in the postpartum were more often multiparas, with no pregnancy pathology, with a single pregnancy, without postpartum hemorrhage, and a child > 2500 g without risk of infection. At present, 40% of vaginal delivery and 25% of caesarean section primiparas and 55% of vaginal delivery and 30% of caesarean section multiparas could be discharged early. CONCLUSION: The reduction of the postpartum hospital stay is inevitable but it is advisable to take care that the women who are discharged are medically fit for discharge.

Perinatal care regionalization and acceptability by professionals in France.

BACKGROUND: For twenty years, most of industrial countries developed recommendations on regionalization of perinatal care. Perinatal regionalization is particularly aimed at improving morbidity and mortality outcomes of low birth weight newborns by transferring pregnant women to the maternity units having a medical or neonatal environment suited to the risks incurred by mothers or babies. Perinatal regionalization cannot be effective without being well accepted by the majority of professionals. The objectives of this study were then to identify professionals'expectations and objections to perinatal regionalisation and to compare them from a professional group to another one. METHODS: Professionals of 3 French perinatal networks were under consideration: the Rhône, the Auvergne and the Gard-Lozère networks. The study included two stages: 1) a psychosociological qualitative study, based on professionals'interviews, aimed at identifying main concerns of professionals and developing a questionnaire; then 2) an epidemiological quantitative study, using this questionnaire within French networks. In the questionnaire, 8 dimensions explored the professionals'views: constraints related to regulation aspects and to the setting up of maternity units care levels, risk of loss of professionals' competence and prestige, consequences on medical practices, on inter-professional relationship, on work organization and financial aspects, and related to the new role of 'private practice'professionals, legal consequences. RESULTS: The response rate of the epidemiological study was 80%. The results permitted to construct 8 dimension scores describing the reasons of poor acceptability of regionalization. After taking into account the age, the sex, the network and the juridical status of the institution, the study revealed a significant poorer acceptability of regionalization by most of medical specialty groups (anesthetists, obstetricians, midwives and "private practice" professionals) compared with neonatologists, or by "private" professionals (professionals working in private clinics and "private practice" professionals) compared with professionals working in university or community hospitals. The study described also network setting up conditions related to its functioning. CONCLUSION: By identifying clearly professionals 'objections and expectations, this study should facilitate improvement in the organization of studied perinatal networks.

Cretan Mediterranean diet for prevention of coronary heart disease.

As a result of the Seven Countries Study, the Mediterranean diet has been popularized as a healthy diet. Nevertheless, it has not replaced the prudent diet commonly prescribed to coronary patients. Recently, we completed a secondary, randomized, prospective prevention trial in 605 patients recovering from myocardial infarction in which we compared an adaptation of the Cretan Mediterranean diet with the usual prescribed diet. After a mean follow-up period of 27 mo, recurrent myocardial infarction, all cardiovascular events, and cardiac and total death were significantly decreased by > 70% in the group consuming the Mediterranean diet. These protective effects were not related to serum concentrations of total, low-density-lipoprotein (LDL), or high-density-lipoprotein (HDL) cholesterol. In contrast, protective effects were related to changes observed in plasma fatty acids: an increase in n-3 fatty acids and oleic acid and a decrease in linoleic acid that resulted from higher intakes of linolenic and oleic acids, but lower intakes of saturated fatty acids and linoleic acid. In addition, higher plasma concentrations of antioxidant vitamins C and E were observed. We conclude that a Cretan Mediterranean diet adapted to a Western population protected against coronary heart disease much more efficiently than did the prudent diet. Thus, it appears that the favorable life expectancy of the Cretans could be largely due to their diet.

Enzyme-linked immunosorbent assay for anti-histone antibodies and their presence in systemic lupus erythematosus sera.

We describe an enzyme-linked immunosorbent assay (ELISA) with adsorption of histones (total and fractions) on glass beads and saturation of excess sites with sheep serum. The anti-histone antibodies are detected with peroxidase conjugate and developed with Trinder's reagent which has great stability. This very sensitive method detects anti-histone antibodies in 53% of SLE patients and in virtually no other diseases. Positive reactions are observed only with total histones and fractions H1 and H2b.

Control of bias in dietary trial to prevent coronary recurrences: The Lyon Diet Heart Study.

BACKGROUND AND OBJECTIVES: A major limitation of dietary trials is that double blind design is not feasible. These trials are therefore prone to biases. The Lyon diet heart study is a single-blind secondary prevention trial to test the hypothesis that a Mediterranean-type of diet may prevent recurrences after a first myocardial infarction. A surprising 73% reduction of the risk of new major cardiac events was observed in the experimental group. For this reason, it is important to describe the methods used in the trial. We now report our techniques to randomize the patients, to change their diet and to control for possible bias, in particular any investigator or attending physician bias. DESIGN: In this dietary trial, a specific design was used to recruit and randomize the patients without informing them and their physicians that they were participating in a comparative trial. The attending physician bias was evaluated by studying drug usage and the investigator bias by constructing a questionnaire from which specific scores were used to evaluate (1) how the patients appreciated their participation in the study and (2) whether this participation resulted in significant changes in their way of living. SUBJECTS: 605 survivors of a first myocardial infarction were randomized into either a control or a Mediterranean group. RESULTS: The two randomized groups were similar for all the variables of prognosis. Drug usage was not significantly different between groups, suggesting that there was no major attending physician bias. Analyses of the appreciation scores and of the change score did not detect any significant investigator bias. CONCLUSIONS: Although the study cannot be completely shielded from minor biases, the data presented here provide evidence that the dietary modifications per se were protective, not other (including psychosocial) changes resulting from the participation to the trial.

Birth ponderal index and body mass index reference curves in a large population.

A file of 100,716 children born between 1984 and 1988 in 22 maternity wards was used to estimate for each week of gestational age and gender, the exponent ß which makes an index Weight/Lengthß independent from length. It varied with gestational age but remained near 3. Therefore, Rohrer's index (Weight/Length3 ) appears as a good approximation to assess neonatal weight as a whole, taking length into account. However, literature suggests that Quetelet's index (Weight/Length2 ) might be a better indicator of fat mass. In both cases, percentile curves take gestational age into account. Curves by gestational age between 32 and 42 weeks of amenorrhea and by gender, for Quetelet's and Rohrer's indices have been plotted. The values vary with gestational age. For example, the tenth percentile of Quetelet's index shifts from 7.8-12.3 kg/m2 in boys and from 7.9-12.2 kg/m2 in girls. Am. J. Hum. Biol. 10:327-340, 1998. © 1998 Wiley-Liss, Inc.

Obsessional symptoms in expectant women and outcome of their pregnancy.

The aim of this investigation was to explore whether, within the scope of personality traits and their modifications during pregnancy, the obsessional dimension may have a protective role against premature birth. In fact, obsessional characterology with its tendency to control may suggest that the women with these traits do not passively experience their pregnancy and may try to control its evolution, at least in their fantasies. Personality dimensions have been recorded using Derogatis' psychological self-administered questionnaire, in which women were asked to assess their level on the Derogatis symptom scale before and during pregnancy. The survey involved 351 women (117 premature and 234 term deliveries) who had both completed the self-administered questionnaire on the 6-month pregnancy visit and answered a specific interview at birth. Our results have shown that the existence of obsessional traits before pregnancy apparently does not have a protective role against premature delivery (odds ratio = 1.40; NS). Conversely, intensified obsessional symptoms during pregnancy are associated with a decreased premature birth rate (odds ratio = 0.44; p < 0.05). These results remain when the presence of obsessional traits before pregnancy is taken into account (adjusted odds ratio = 0.38; p < 0.02). The possibility of a defence reaction to this situation of pregnancy is discussed.

Transvaginal ultrasonography of the uterine cervix in hospitalized women with preterm labor.

OBJECTIVE: The aim of this study was to examine the relation between cervical length and the presence of funneling and the risk of preterm delivery. METHOD: This prospective blind cohort involved 200 hospitalized women with preterm labor in a tertiary care hospital. Women were recruited for a single transvaginal ultrasonography to assess cervical length and presence of funneling. The main outcome measures were: (1) relative risks (RR) and adjusted odds ratios of preterm delivery (<37 weeks' gestation); (2) time interval between the cervical ultrasonography date to 37 weeks' gestation or to-preterm birth. RESULTS: The RR of preterm delivery according to the cervical length (cut-off of <30 mm) was 2.79 (95% CI 1.70--4.59). The RR according to the presence of funneling (cut-off of >5 mm) was 1.39 (95% CI 0.99--1.95). The adjusted odds ratio was 3.92 (95% IC 1.75--8.75) for cervical length and 0.77 (95% CI 0.35--1.67) for funneling. Women with a cervical length of <30 mm had a significantly shorter interval from ultrasonography date up to 37 weeks' gestation than did women with a cervical length of >30 mm (P<0.003). CONCLUSION: Ultrasonographic mensuration of the cervix provides predictive information on the risk of preterm delivery.

[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.

[Which measures are to be taken in the prevention of prematurity in working women?]. / Quelles mesures de prévention de la prématurité en milieu professionnel?

The aim of this study was to determine the best preventive measures for employed pregnant women. Assuming that certain working conditions constitute a risk factor for preterm birth, should we give time off to women whose jobs are strenuous, reduce their weekly hours of work, or lengthen their antenatal maternity leave in an attempt to reduce risk of preterm birth? To answer this question, a survey carried out in 50 factories showed that a reduction of weekly working hours (routinely granted in many factories at present) appears helpful in reducing the preterm birth rate : this is also true for sick leaves granted for fatigue without pathological reason : on the other hand, the lengthening of antenatal maternity leave for fatigue, without medical reason, seems without effect. In the absence of experimental evaluation of preventive measures proposed at the end of this study, we provide a model for evaluating, theoretically, the relationship efficiency/cost/acceptability of such measures. Consequently, instead of lengthening antenatal maternity leave, we suggest prescribing 1 rest week (as sick leave) per month, beginning with the 4th month of pregnancy, for women working in strenuous conditions.

[Relations between blood pressure at 3-4 years of age and body mass at birth: a population-based study]. / Relation entre la pression artérielle à l'âge de 3-4 ans et la corpulence à la naissance: étude en population.

BACKGROUND: To study the association between blood pressure of 3-4 year-old children and birth corpulence estimated from birth ponderal index (body weight/length3), a school based, cross sectional survey was conducted in the Rhône department. METHODS: 1296 randomly selected children were examined at the time of a school medical visit. Physicians abstracted information on pregnancy and measurements at birth from the Child Health Handbook and from parents interview. Systolic and diastolic blood pressure measurements were carried out by using an automated oscillometric device. RESULTS: Multiple linear regression analyses revealed an inverse association between systolic blood pressure and birth ponderal index (converted into Z-score adapted to gestational age), this was obtained after adjustment for current length and for current body mass index (body weight/length2--converted into Z-score), for child emotion and for linked study factors. Such a model provided an assessment of regression coefficient: -0.67 mmHg/birth ponderal index Z-score unit (95% confidence interval: -1.24 to -0.11). So, estimation of systolic blood pressure difference between two 3-4 year-old children, one at -2 SD birth ponderal index and another at +2 SD, was obtained: 2.6 mmHg. No evidence of an association between diastolic blood pressure and birth ponderal index was observed. CONCLUSION: In this large population with a limited range of age, our results show that, at age 3-4 years, systolic blood pressure is higher with lower birth ponderal index, suggesting that thinness at birth might be a risk factor of hypertension in adulthood.

[Video display terminals and pregnancy. Evaluation of risks by consensus. Report of an INSERM working group]. / Travail sur terminal à écran et grossesse. Evaluation des risques par consensus. Rapport d'un groupe de travail de l'INSERM.

INSERM established a working group to evaluate the effects of VDT work on pregnancy outcome. The group examined all available scientific papers concerning radiation emitted by VDTs, animal experimentation, and epidemiological studies. An estimation of risk was made for each outcome (congenital malformations, spontaneous abortion, stillbirth, premature birth, and low birthweight) according to a decisional algorithm, a method that gives preponderance to epidemiological arguments. On this basis, the group was able to show that the use of VDTs poses no increased risk of congenital anomalies, stillbirth, or premature birth. Consensus evaluation of divergent epidemiological results concluded that VDT work is not a risk factor significantly affecting spontaneous abortions. The risk of low birthweight could not be validly assessed.

[Viral hepatitis: incidence and epidemiologic pattern in an urban area (author's transl)]. / Hépatites virales: incidence et caractéristiques épidémiologiques dans une agglomération urbaine.

In order to describe the incidence and the epidemiologic pattern of viral hepatitis (V.H.) in a French urban area, with a special attention to ambulatory cases, an epidemiological information system has been developed during one year. The physicians (sample), the medical laboratories and, at a lesser degree, the hospital care units, have taken part in this work. The incidence rate of ambulatory cares has been estimated 85 cases/10(5) persons (69/110), less than previously assumed. Non-B V.H. remains more frequent (52 cases/10(5) persons), but B.V.H. are rather close to them (33 cases/10(5) persons). Large differences exist between geographic areas, without evident rational. Higher incidence rates characterize children (especially 5-9 years) and migrant people (especially from North Africa): those facts are completely account by very high rates within the subgroup of migrant children (473 and 260 cases/10(5) persons). The reported patterns allows us to point on this high risk characteristic of migrant's children and to assume an important modification in the pattern of local inhabitants V.H. in the region. These trends have to be followed by further studies.

[Risk factors in overweight: a survey among female hospital personnel]. / Facteurs de risque de surcharge pondérale: enquête auprès du personnel féminin hospitalier.

The purpose of this study was to explore the eventual relationship between the working conditions, and overweight women working in hospitals. The sample comprised 594 women working in hospitals in Lyon; 34% of them were overweight which is 10% above the theoretical weight. The rate of overweight hospital staff increased with the woman's age, the number of children and when the social level decreased. The analysis showed that being overweight was more frequent in women working in cleaning staff (56%) and in nursing auxiliaries (36%) than in nurses and administrative staff (24% and 27% respectively). After taking the above personal risk factors into account, this relationship remained the same. However, the night work and the length of service in hospitals are not found to be risk factors, after adjustment for the personal risk factors and type of work. Considering the women who were not overweight at the time of commencing employment, the relationship between being overweight and the type of working conditions in the hospitals disappeared.