[Evaluation of trisomy 21 risk by serial determination of chorionic gonadotrophin hormone and alpha-fetoprotein: results of a national pilot study]. / Evaluation du risque de trisomie 21 par dosage sérique de l'hormone gonadotrophique chorionique et de l'alpha-foetoprotéine: résultats de l'enquête pilote nationale.

Previous studies, as early as 1984, have demonstrated the efficiency of maternal serum markers to screen for Down syndrome. These markers were AFP, hCG, oestriol and beta-1-glycoprotein. A pilot study was initiated in France in 1990 to evaluate these markers. It lasted from May 1990 until April 1991. 22,410 pregnancies were monitored in total, and 19,407 for women between 30 and 37 years of age. The pregnancy outcome was known for 20,151 cases (86.6%). Sensitivity and predictive value of the test was calculated on 17,362 dosages which outcome was known. The sensitivity based on hCG only was 59.4% (38/64) for trisomy 21 and positive predictive value 1.65% (38/2,307). This test is a better marker than maternal age. In the pilot study it induced a 13.2% rate of amniocentesis. If the risk was calculated using both hCG and AFP results, the performances of the test were better. At equal rate of amniocentesis, the double test increases the sensitivity (+9.5% at risk 1/200, +7% at risk 1/250, +14.4% at risk (1/350). The strategy of double dosages decreases the number of amniocentesis for a given sensitivity rate. This decrease is more spectacular for high levels of sensitivity. This pilot study confirms already published results. Maternal serum markers are the best tools, combined with maternal age to evaluate the risk of trisomy 21.

Impact on the general public of media campaigns against AIDS: a French evaluation.

The article presents the results of the first national survey in a representative sample of the French population of 18 years of age and over (n = 1000; March 1990) about knowledge, attitudes, beliefs and practices toward HIV infection. It focuses on the impact of the media campaigns about AIDS and condom promotion that were initiated since April 1987 by French public health authorities. A total of 53.2% of respondents were able to correctly quote at least one of the slogans of the campaigns and 48.4% felt they have been personally influenced by the campaigns. Respectively 25.4%, 12.1%, and 11.2% declared that the campaigns have made them more concerned of individual risk of HIV infection and prompted them to condom use and HIV testing. Among heterosexually active respondents, 16.9% declared condom use in the past 12 months, age, marital status, level of education, HIV testing and self-acknowledgement of influence of campaigns being the main factors related to condom use in multidimensional analysis. Respondents who recognise having been influenced by campaigns are less likely to believe in HIV transmission through casual contact and to express discriminatory attitudes toward HIV carriers but more likely to support HIV mandatory screening for the general population. The difficulties to properly evaluate media campaigns for AIDS prevention are discussed as well as the complex trade-offs that general public information has to face between promotion of both individual behavioural change and societal support and empathy for HIV carriers and persons with AIDS.