[How are palliative care needs estimated in short-stay establishments? Apropos of an experience in Côte d'Or]. / Comment estimer les besoins en soins palliatifs dans les établissements de court séjour? A propos d'une expérience en Côte d'Or.

The evaluation of needs and means concerning the care of patients in palliative treatment is among the problems seen as priority by the High Committee for Public Health. We have thus tried to characterise, in a specific health sector, the patients receiving palliative care in short-stay establishments in order to evaluate their care needs. We carried out an exhaustive descriptive survey among all public and private short-stay establishments in the Côte d'Or region. Of the 2116 patients in the hospital on the day of the survey, roughly 30% were considered as eligible for palliative care (patients suffering from serious, chronic and progressive illnesses). The average age of these patients is 63.9 years (standard deviation 19.7). They mainly suffer from tumours (50%), circulatory pathologies (15%), mental illness (7%), or neurological illnesses (6%). Among the patients that may need palliative care, 38% say they feel pain despite treatment with pain-killers among 25.3% of them. The personnel providing care is insufficiently trained in palliative care or in pain, as only a maximum of 18% of nurses and 5% of doctors in short-stay establishments have been trained in these areas.

[Psychiatric hospitalizations after the June 27 1990 Law in a French department]. / Les hospitalisations psychiatriques depuis la loi du 27 juin 1990 dans un département français.

The law, edicted on the 27th june 1990, has introduced in France the without consent hospitalization, to replace the law of 30th june 1838 which was composed of confinements or psychiatric placings. On of the both new types of a without consent admission, called "by a third person request" hospitalization (HDT) containing a procedure called "usual" and another one called "situation emergency", appeared to us more and more used in our practice, particularly the "situation emergency" HDT. Therefore we compared on three periods, one before the law, the two others ones 3 and 6 years after it, the different types of psychiatric admissions in all of the seven psychiatric sectors of a french department. All the hospitalization's forms increase with the chronologic time in Côte d'Or. We notice too in this department an important increase of the HDT, but especially in the "situation emergency" ones, and this, with a statistically revealing way compared to the other types of admission. If this phenomena wasn't purely localized, which only the departmental commissions of psychiatric hospitalization, created by the 1990's law, can reveal by proceeding to an expected assessment of the law consequences, the legislator should fastly take this evolution into account.

[Renal replacement therapy for chronic renal failure patients in the Languedoc-Roussillon region in 1994]. / Les insuffisants rénaux chroniques en traitement de suppléance dans la région Languedoc-Roussillon en 1994.

BACKGROUND: Unbiased and reliable data are presently required for health planning concerning end stage renal diseases (ESRD) in Languedoc-Roussillon region of France. METHODS: A comprehensive retrospective study has been carried out on patients with ESRD in 1994 in this area. Information was collected from medical and social documents by physicians. The present report describes the management of patients and their demographic and epidemiologic characteristics. Multiple correspondence analysis was carried out to estimate to what extent mode of renal replacement therapy is determined by patient characteristics. RESULTS: An incidence of 11.4 for new cases of renal replacement therapy was found per 100,000 inhabitants. This represents an increase of 4.8% in the total number of patients. The patients were found to be elderly (25% being over 72 years) and to present with multiple pathologies (32.5% severe cardiac pathology; 20.7% arteritis of the lower limbs; 15.1% diabetes; 11.2% manifesting malignant tumors). Only 57.5% received dialysis within a hospital setting; 30.1% received dialysis at home; 13% perform autodialysis; 1.2% were being trained for home dialysis in December. The renal transplantation rate was 5.5%. No significant relationship was found between choice of therapy and age, renal disease, comorbidities and place of dwelling. CONCLUSIONS: This study demonstrates the great variety in the modes of treatment used, the facilities provided and the evolutive trend, which together make programming planning difficult.

[Increase in the prevalence of obesity among children aged 4-5 years in a French district between 1988 and 1993]. / Accroissement de la prévalence de l'obésité chez les enfants de 4-5 ans dans un département français entre 1988 et 1993.

Two cross-sectional studies were performed on probabilistic samples in the Hérault "département"--respectively in 1987-1988 on children born in 1983 and in 1992-1993 on children born in 1988--to measure the evolution of the prevalence of obesity. A greater proportion of high weight for height (Z score of 1.0 and more, international reference population) has been observed in comparison with the first year. A major increase in the prevalence of obesity (setting a Z score of 2 as limit) has been recorded between the two periods (odds ratio = 2.51 (1.57 to 4.02)). It cannot be explained by structural changes of the population as regards factors known to be associated with obesity (urbanization, mother's occupation, family composition, social status, unemployment, distribution according to the country of origin). The possible influence of changes in the way of life is discussed in relation with the literature. This first representative sample study confirms--at least for the district studied--the findings in various populations, suggesting that the prevalence of obesity is increasing in France. The causes of this phenomenon remain to be defined.