Factors associated with regular cervical cancer screening.

OBJECTIVE: To identify the factors associated with regular cervical screening (CS) in the French female population. METHODS: Face-to-face interviews with 5354 randomly selected French women were carried out in this population-based, observational, cross-sectional study. The variables found significant by univariate analysis were entered in a stepwise analysis. A multivariate logistic model constructed with these variables permitted to identify which were significantly related to women undergoing regular CS. RESULTS: A significant relationship was found between regular CS and previous screening for HIV infection, being professionally active, fear of cervical cancer, level of education, and having had a gynecologic check-up in the past 5 years. CONCLUSION: Since the study sample was known to be representative of the female adult population, most of our observations may have important public health implications in France, where information on HPV infection and its possible consequences need to be improved.

[Prevention of human papillomavirus (HPV)-induced infections: access of adolescent girls to health care. A population-based, cross-sectional observational study]. / Prévention des infections à papillomavirus humains (HPV): accès des jeunes filles aux circuits de soins. Etude observationnelle transversale en population générale féminine.

INTRODUCTION: The human papillomavirus (HPV) is the most common cause of sexually transmitted infections worldwide, and its prevalence is highest among young women aged 17-25 years. It is the principal risk factor for cervical cancer. Systematic vaccination of adolescent girls should significantly reduce the incidence of this disease and its related mortality. AIM: One of the objectives of the Enjeux study, a population-based survey, was to identify the place of young girls within the French health care system to help assess the optimal conditions for implementing anti-HPV vaccination. METHODS: Data came from 5354 interviews of women aged 18-70 years, 320 of whom provided information about daughters aged 11-14 years and 406 about daughters aged 15-17 years. Among the latter, 318 were also interviewed and 294 completed a self-administered questionnaire. RESULTS: The results showed that sexual activity was reported by approximately one third of the girls aged 15-17 years. At-risk behaviors in these girls included insufficient contraception (only 51% use condoms). Data on the medical management of the population of 11-17 year-old girls indicate that they have access to - and are integrated into - the health care system, with frequent medical visits. They see the general practitioner (GP) most frequently, followed by the school doctor. The frequency of general practice visits is similar in both age groups; more than 50% of the girls visit their GP more than twice a year. Vaccination is a frequent reason for these visits; gynecologic reasons are less frequent. CONCLUSION: The results of this survey underline the central place of the GP in the health management of young girls aged 11 to 17 years.

Risk of malaria among French adult travellers.

BACKGROUND: Imported malaria remains an important, but often unrecognised, health problem in Europe. Little information exists on the incidence of imported malaria with respect to exposure. This study aimed to estimate the incidence of malaria in a cohort of travellers with respect to protection measures. METHOD: In all 13,017 participants enrolled in a French general population cohort (SU.VI.MAX cohort) and followed-up over 8 years were investigated. All participants received a retrospective questionnaire about travel to malaria-endemic countries relating to countries visited, duration of stay, use of protection measures and chemoprophylaxis. Malaria cases was confirmed from medical records. RESULTS: Data were obtained for 752 individuals who made 1,393 trips to malaria-endemic areas. This sample was predominantly middle-class and high-risk groups such as migrants were not represented. Mechanical protection was used in 589 trips (42.3%) and chemoprophylaxis in 1,017 trips (73.0%). This was appropriate for the zone in 615 trips (44.0%) and adequate compliance was reported in the case of 497 trips (35.6%). Appropriate chemoprophylaxis and physical protection measures were used in 21.7% of the trips. Six laboratory-confirmed cases of imported malaria yielded an estimated incidence density of 148 cases/month of exposure/10,000 travellers. In five cases, appropriate protection measures had not been taken. CONCLUSION: Appropriate chemoprophylaxis and physical protection measures against malaria infection are used by less than one-quarter of a sample of predominantly middle-class travellers from France to endemic areas. More intense education measures need to be implemented to reduce the risk of imported malaria.

Seroprevalence of varicella in the French population.

OBJECTIVES: To assess the age-specific seroprevalence of varicella in the French population and to explore age-adjusted differences according to gender and geographic region. METHODS: Data were obtained from 1257 randomly selected, frozen serum samples, from subjects 1-30 years of age, that were sent to the Pasteur-Cerba laboratory in November 2003 to January 2004 for the following clinical indications: allergies, respiratory infections, herpes virus infections excluding varicella and endocrinologic tests. IgG concentrations were tested with an indirect enzyme immunoassay. Statistical analyses included use of locally weighted, scatterplot smoothers. RESULTS: Age-specific seroprevalence of varicella increased by >6-fold between 1 and 8 years of age, ie, from 15.0% (95% confidence interval, 8.6-23.5%) for subjects 1-2 years of age to 89.0% (95% confidence interval, 81.0-94.3%) for those 7-8 years of age. The smoothed curve of age-specific seroprevalence suggested that the steepest rate of increase occurred between 1 and 8 years of age, followed by a considerable slowing in the rate of increase, reaching a prevalence of approximately 95% by age 30. Varicella seroprevalence rates were similar for the samples referred for the 4 clinical indications, as follows: allergies, 76.2%; respiratory infections, 74.0%; herpes virus infections excluding varicella, 73.3%; endocrinologic tests, 73.7% (P = 0.84). CONCLUSIONS: Most varicella-zoster virus infections occur during early childhood. Seroprevalence rates reach approximately 50% by 4 years of age and approximately 90% by 8 years. Therefore, the best strategy to reduce the prevalence of wild-type varicella-zoster virus in the French population would be to immunize children 12-18 months of age, as is currently performed in the United States.

Epidemiology of genital herpes simplex virus infections in a community-based sample in France: results of the HERPIMAX study.

OBJECTIVE: The objective of this study was to provide information on the prevalence of herpes simplex infections in the general population in Europe. GOALS: The goals of this study were to determine the prevalence of clinically probable genital herpes and the relationship between serotype and clinical expression in a French community-based sample. STUDY: A total of 4410 subjects chosen at random were serotyped for herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2). Data on symptoms were obtained by questionnaire allowing retrospective diagnosis of clinically probable genital herpes. RESULTS: Questionnaire data and serotype were available for 3192 subjects. Seroprevalences of HSV-1 and HSV-2 were 65.6% and 15.5%, respectively. Prevalence of clinically probable genital herpes was 11.8%, identified in 11.1% of HSV-1-positive subjects and 26.8% of HSV-2-positive subjects, with a lower prevalence in those coinfected with both virus types. CONCLUSIONS: Clinically probable genital herpes was observed in one fourth of subjects with HSV-2 infections and in some subjects with HSV-1 infection. Coinfection with HSV-1 appeared to protect against symptom expression in subjects infected with HSV-2.

Impact of a patient education program on adherence to HIV medication: a randomized clinical trial.

Patients' knowledge of their HIV condition and its treatment, which has been recognized as a factor that influences adherence to antiretroviral therapy, can be improved through educational programs. This prospective, randomized, controlled trial compared an experimental group that participated in an educational program and a control group with standard care. The study evaluated the impact of an educational intervention on adherence to antiretroviral therapy, patients' knowledge, quality of life, and therapeutic response in patients treated with highly active antiretroviral therapy. Three hundred twenty-six patients were analyzed at inclusion. A higher level of adherence was associated with patients who were older, had higher incomes, and did not smoke. CD4 cell count and plasma viral load were correlated with adherence at entry. The educational intervention had an impact on adherence and knowledge in the experimental group at 6 months, which was maintained at 12 and 18 months. A delayed increase in adherence was observed in the control group at 12 months. No significant impact on quality of life was observed over time. The patients' health status improved in 56% of the experimental group subjects and 50% of the control subjects. However, no significant impact was shown on CD4 cell count and plasma viral load. This study shows that an educational intervention improves adherence to antiretroviral regimens and health status and suggests that it should be initiated early in therapy.