[Health in schools or healthy schools?]. / Santé à l'école ou écoles en santé?

Comparing the existing documentation on the European Network of Health Promoting Schools (ENHPS, in French: REES) and on the French School Health Service, many differences as well as similarities are appearing. In Switzerland, the ENHPS/REES is presently well developed. Facing new attitudinal and behavorial problems in schools, a recent experience in Geneva (Switzerland) includes health promotion as one of its objectives.

[Violence and aggression in adolescents and young adults. Review of the recent literature]. / Violence et agressivité chez les adolescents et les jeunes adultes. Revue critique de la littérature récente.

A highly topical subject, violence, its consequences as well as its causes, deserve more attention on behalf of the public health authorities. On one hand, nowadays, the concepts in this field tend to become more global than before; however, on the other hand the epidemiological, etiological and therapeutic approaches benefit also from considering more limited behavior categories and age groups. In this review of the international literature, the authors focus their attention on intentional (excluding accidents) and interpersonal (excluding self-destructive behavior) violence. They consider by priority adolescents (10 to 19) and young adults (15 to 24). After a general introduction to the theme and the presentation of the relevant concepts and definitions, the authors, as a complement to their earlier publication on violence, develop epidemiological aspects concerning mortality, morbidity and the sources of information about these two topics. Their view is partly a critical one, including considerations on risk factors and risk predictors. The etiological aspects are developed along three axes : biomedical components, mainly of neuro-psychiatric and neurological nature ; family violence ; the broader social environment. The following part is devoted to care and prevention. In the discussion, several of the main issues considered in the conceptual, epidemiological, etiological as well as curative and preventive approaches are brought up again, with a perspective on presenting new proposals for further consideration and developments as well as on broadening the initial debate of the introduction.

[The Lang stereo-test in mass screening of kindergarten students]. / Der Lang-Stereotest in Reihenuntersuchungen in Kindergärten.

During the 1990-91 school year 2856 kindergarten children underwent screening in the Geneva area. Their visual acuity was measured and stereoscopic vision estimated with the Lang test. Positive cases were referred to an ophthalmologist for diagnosis.

Intentional violence among adolescents and young adults: an epidemiological perspective.

Intentional violence consists mainly of non-accidental interpersonal violence and suicidal behaviour; the remaining categories are other violence and/or violence with undeterminted intention [corrected]. In almost all the countries considered in this study, intentional violence is taking on worrying proportions in adolescence (10-19-year-olds) and is on the increase among young adults (15-24-year-olds). The scale of the problem is relatively well known thanks to national mortality rates. The relative proportions of murders and suicides vary considerably from one country to another, though they remain fairly constant over time, whether the diachronic progression of mortality due to intentional violence increases, remains stable or falls in the country concerned; this is true for both sexes and for both the age groups considered (15-19 and 20-24). Nevertheless, in view of the much higher incidence of intentionally violent behaviour that does not result in death, more resources should be allocated to epidemiological studies in that area, especially in terms of quantitative and qualitative methods, where possible in association with interdisciplinary projects. Only with a better knowledge of the risk factors and if possible identification of the predictive factors (in the probabilistic sense of the term) could we devise, conduct and evaluate preventive measures that are better targeted than those used so far, whether the factors are socio-cultural, socioeconomic or psychosocial. This is the justification, especially the ethical justification, of further epidemiological studies of an analytical or even interventional nature, going beyond the descriptive studies that have been made by most researchers to date.

[First treatment demands for drug abuse: and indicator of developmental trends]. / Les premières demandes de traitement pour toxicomanie: un indicateur des tendances évolutives du phénomène.

The county of Geneva, Switzerland, is part of an international multi-city survey under the auspices of the Council of Europe. This survey is designed to use common indicators for assessing and comparing drug misuse and its evolution in participating cities and regions. Its aim is to improve the strategies for controlling drug misuse. The first indicator under study is the "first treatment demand". Its objectives are to evaluate the treatment demand as well as the evolution of drug misuse in terms of patient characteristics, so as to optimise prevention and treatment policies. All treatment demands for drug misuse that meet the study's entry criteria are recorded in a permanent and centralized data bank, through an anonymous encoded form filled in by the treatment centers at the time of the demand. Later demands by the same patient are merged with the precedent ones. In this way, both the totality of treatment demands and the subset of first demands can be analyzed and information about individual trajectories can be collected. The introduction of this indicator is subjected to various problems due first of all to the illicit character of drug misuse. In particular, the necessary measures to guarantee strict confidentiality make it more difficult to obtain reliable data, especially for the merging of different treatment demands by the same patient. This paper reports on the introduction of the indicator in Geneva and its anticipated results.

A tentative epidemiologic approach to suicide prevention in adolescence.

During adolescence (by convention, 10-19 years of age), the global mortality rates are relatively low in most countries. Nevertheless, suicidal mortality rates are usually second (after all accidents) or third (after accidents and homicides), depending on the country. Rates in males are regularly higher than those in females. Owing to the universal absence of a systematic recording of parasuicide cases, morbidity data are obviously much more difficult to get and to analyze properly. Data based on hospital admissions give only approximations. Nevertheless, in this age group, parasuicide is expected to be many times more frequent in females than in males. Epidemiologic studies on relapses as well as parasuicide follow-up are rare. Taking into account the number and heterogeneity of known risk factors, suicidal behavior prediction is based on probability statistics: valuable only for groups ("high-risk profiles"), never for individuals. This is particularly true in adolescence, when so many changes occur rapidly. Preventative measures are to be discussed according to their pertinence in each of the three classic levels of prevention.

[Clinical epidemiology: a new epidemiology?]. / L'épidémiologie clinique: une nouvelle épidémiologie?

The concept of "clinical epidemiology" is well established in the New World; indeed most of the quotations and works cited in this paper come from the United States and Canada. On the other hand, the concept seems to remain controversial in most countries in the Old World. From an exploration of the interface between the approaches used by epidemiologists on the one hand, and clinicians (including psychiatrists) on the other, this paper discusses aspects of the relationship between "conventional" and "clinical" epidemiology; in particular questions are raised as to whether these are part of the same continuum or whether they are separated by a gulf. At present, answers to such questions depend on subjective positions as well as on objective criteria. In order to reach a consensus on these questions, further concertation especially among epidemiologists, will be needed.

[Food habits of today's adolescents: epidemiological and psychosocial aspects]. / Comportements alimentaires des adolescents d'aujourd'hui: aspects épidémiologiques et psychosociaux.

Adolescence is a period of life often characterized by inconsistent, experimental and risky behaviour. The study of alimentary habits of adolescents is of particular importance since these determine whether nutritional needs will be met. Whereas an epidemiologic approach seeks to determine the number, the role, and the weight of the multiple determinants of these behaviours, a psycho-social approach leads to the consideration of factors much more difficult to quantify. This paper is based on a local pilot study covering 161 male and female apprentices 15 to 21 years of age, as well as on data available from the recent literature. First, a review of common behaviours such as skipping meals, snacking between meals, and concerning food preferences and aversions is presented. We then review in greater depth two recent publications. The first concerns the attraction that soft drinks have for young people and its consequences for micronutrient balance. The second illustrates the relationship between self-body image and various adolescent attitudes and habits involving caloric restriction. Overall, it appears that data currently available to epidemiologists and "preventologists" concerning adolescent feeding behaviour would not allow them either to reassure those pessimists or worry those optimists whose opposing views on the subject appeared in publications prior to the 1980s. Indeed, there have been but few longitudinal studies of the kind which could let one confirm which subgroups of adolescents are truly at risk of particular health problems as a result of specific types of feeding behaviour.

Development of health activities in Switzerland.

A survey in five Swiss cantons has indicated several kinds of difficulty that will have to be overcome if strategies for the prevention of illness and the promotion of health are to be satisfactorily developed and implemented.

Multivariate analysis of dietary patterns in 939 Swiss adults: sociodemographic parameters and alcohol consumption profiles.

A dietary survey of 939 Swiss adults, randomly selected from the population of Geneva and its surrounding communities, was performed according to the history method. A factor analysis, using average weekly intakes for 33 food variables, reveals three principal components of the diet: satiating capacity, healthfulness and culinary complexity. These characteristics, together with the energy content of the diet, were analysed for differences according to sex, age, relative weight index, birthplace, marital status and occupation. All of these sociodemographic variables influence some dimension of dietary habits. Alcohol consumption is positively associated with satiating, protein rich diets, but energy intake from foods does not significantly differ between various groups of abstainers and drinkers. Although the energy contribution of alcoholic beverages is globally additive, we suggest that cultural and societal norms may modulate the relationship of alcohol and diet.

[A plan for a randomized evaluation study for improving the memory of the aged]. / Plan d'une étude d'évaluation randomisée de l'entraînement de la mémoire chez les personnes âgées.

The training is realised through exercises carried out during courses and at home. The effectiveness of this training is assessed by psychometric tests (before/after) and a questionnaire for self evaluation (after). An equal number of subjects to be trained and controls are selected among 100 or so voluntary participants.

[Need for professional expertise in institutions and public health services in 4 cantons and Tessin. Hypothesis--objectives--implementation]. / Enquête sur les besoins en matière d'expertise professionnelle dans les services et institutions de la santé de quatre cantons romands et du Tessin. Hypothèse--objectifs--déroulement.

This survey consists in a process of "collaborative reflection" between consultants from a university department of public health and health authorities in five cantons. The goal of this effort is to identify, within a common framework, known and suspected health problems, risk factors, preventive measures as well as priority research needs in these areas. This information is used to determine the need for an increased access to public health experts at the level of the cantons and gives some indication as to the characteristics required of such experts. Since participants in the survey are also responsible for promotion and implementation of concrete actions for prevention, it is anticipated that this project will result in a number of initiatives focused on the problem which have been identified. The methodology used was inspired by methods previously described for problem identification and program planning, such as the Delphi technique, but was adapted in an original way to the particular needs of this survey. In the first phase, interviews with persons responsible for key health administrations and institutions in each canton are conducted in order to identify the maximum number of salient facts, problems and unresolved questions. In a second phase results and problem statements are consolidated, fed back to all participants and, through repeated contacts, completed, redefined and ranked in order of importance. Although the survey is still ongoing, it has already led to the identification of a number of health problems, possible risk factors and research priorities which had hitherto not been formally identified, and to one concrete program aimed at improving preventive intervention.(ABSTRACT TRUNCATED AT 250 WORDS)

[Risk-taking behavior and accidents in adolescence in developed countries]. / Comportement de prise de risque et accidents à l'adolescence dans les pays développés.

Injuries due to accidents are the primary cause of fatalities among adolescents. Between the ages of 10 and 19, mortality caused by accidents augments significantly, and there is an excess of male mortality, increasing with age. This mortality has remained virtually unchanged over the past 25 years, except for a small narrowing of rate differences by sex. Traffic accidents, particularly those involving motorcycles, are the leading cause of accident fatalities. Though not easily assessed, morbidity due to accidents is probably very high, especially among males. Sports accidents are the most frequent. Adolescents appear to be particularly exposed to some risks, but also tend to be careless about safety. Risk-taking is a source of rewards: pleasure, self-affirmation, sense of independence; but it is described by some authors as self-destructiveness, death from accidents reflecting suicidal tendencies. Paradoxical results of prevention have been observed in this age group.