Gender differences in the association between depressive mood and mortality: a 12-year follow-up population-based study.

BACKGROUND: Depressive mood has been associated with all-cause mortality in both men and women. This study aimed at exploring gender differences in the association between depressive mood and specific causes of mortality as well as factors that may account for it, including education, marital status, social support, health behaviors, and chronic diseases. METHODS: A population-based survey including 6043 subjects (2892 men and 3151 women) was conducted in 1996 in the north-east of France with a questionnaire covering education, marital status, social support, health behaviors (smoking status, alcohol consumption, body mass index), and chronic diseases. Depressive mood was measured using the Duke Health Profile questionnaire. Cox regression models were used to examine its association with subsequent natural all-cause mortality, and cardiovascular and cancer mortality. RESULTS: During a follow-up of 12.5 years, 406 men and 303 women died from a natural cause. Adjusting for all covariates, depressive mood predicted natural mortality in both men [Hazard Ratio (HR)=1.30; 95% confidence interval (CI): 1.00-1.69] and women (HR=1.37; 95% CI: 1.06-1.77). However, this association was significant for cardiovascular mortality in men (HR=1.63; 95% CI: 1.00-2.65) whereas it was significant for cancer mortality in women (HR=1.71; 95% CI: 1.11-2.64). LIMITATIONS: Baseline data were self-reported and the response rate was low. DISCUSSION: Preventive strategies aiming at reducing the increased mortality associated with depressive mood should take gender into account. Depressed men may warrant a better screening for cardiovascular risk factors and diseases, whereas depressed women may benefit from better cancer prevention measures.

Boosting disability research in the engineering sciences. The recommendations of the National Observatory for Training, Research and Innovation on Disability (ONFRIH).

In 2005, the National Observatory for Training, Research and Innovation on Disability (ONFRIH) was established by French law (Law 2005-102). The mission of ONFRIH is to provide an overview and recommendations for research, training and prevention in the field of disability. In this paper, the authors, respectively the Chairman and Rapporteur of the ONFRIH Working Group "Research and Innovation", present the Observatory's conclusions reached in its 2009 report about engineering sciences research and innovation. After introducing the ONFRIH and recalling the stakes and working methods, they highlight the current state of French research in this area and their thoughts about innovation chain. They evoke the broad outlines of their working group's analysis of this inventory. They conclude by identifying four action plans that express the Observatory's recommendations and were submitted to the responsible ministers. The four main objectives proposed are: (1) to consolidate disability as a major challenge for engineering sciences applications; (2) to reinforce the cooperation between operators at all levels of research and innovation; (3) to encourage the expression of needs within the research and innovation process, and (4) to facilitate the access of disabled people to technological innovations that promote their autonomy and social inclusion.

Predictive factors of long-term mortality of persons with tetraplegic spinal cord injury: an 11-year French prospective study.

STUDY DESIGN: Longitudinal study with mortality follow-up. OBJECTIVE: Identify predictive factors for long-term mortality following tetraplegic spinal cord injury (TSCI). SETTING: The Tetrafigap survey is a multi-centre epidemiological survey on the long-term outcome of persons with TSCI, initiated in France in 1995 with the participation of 35 rehabilitation centres. METHODS: The mortality follow-up involves 1241 persons with TSCI who were admitted to one of the study rehabilitation units at the initial phase and who completed the initial self-administered questionnaire. There were 226 observed deaths (18.2%) during an 11-year period. Logistic regression methods, with estimates of odds ratios (ORs), incorporating clinical, functional and social participation data were used to determine the factors related to mortality. This was followed by multivariate analysis to determine the best predictive factors for long-term mortality. RESULTS: Risk of death increases significantly with age but not with the time elapsed since the accident. The risk of death is higher in men. Interestingly, clinical variables are not the best predictors of long-term mortality. Instead, the significant effect of poor social participation (being single, infrequent contact with friends) and functional limitations (full assistance required with dressing or eating) persists after adjustment for other variables. CONCLUSION: Once the medical situation becomes more stable, factors related to the long-term mortality of persons with TSCI are not exactly identical to those observed in the short acute-phase and during the first year after the accident. Social participation has a significant effect on mortality.

Social disparities in musculoskeletal disorders and associated mental malaise: findings from a population-based survey in France.

AIMS: Various types of musculoskeletal disorders (MSDs) have comorbid mental disorders, which may in turn have a negative influence on disease course and role impairment, but the contribution of social factors to this type of comorbidity is a much under-researched area. This study investigates whether there is a socially patterned association of MSDs with different dimensions of mental malaise. METHODS: The sample included 3,368 economically active participants aged 18-64 years, randomly selected from the Lorraine region in north-eastern France. Information was provided through a post-mailed questionnaire on fatigue, sadness/depression (Duke questionnaire) and cognitive disability during the last eight days. RESULTS: MSDs were significantly more prevalent in manual workers, clerks and other occupations than in upper and intermediate professionals, and similar occupational disparities were found for cognitive disability, fatigue and sadness/ depression. Stratifying the sample, we found the occupational disparities in cognitive disability to be much stronger among participants suffering from MSDs than among participants not suffering from MSDs, and the occupational disparities in fatigue and sadness/depression to be limited to the subsample of subjects suffering from MSDs. CONCLUSIONS: The findings demonstrate that the association of MSDs with mental malaise is much stronger in the lower occupational groups than in the higher groups. Given that psychological factors are implicated in disease prognosis and in the development of disabilities, awareness of the social dimension of the association and treatment of the comorbid mental disorders could open a promising avenue for reducing social inequalities in disability related to MSDs.

Occupational disparities in accidents and roles of lifestyle factors and disabilities: a population-based study in north-eastern France.

OBJECTIVE: To assess occupational disparities with regard to the occurrence of occupational, traffic, domestic and sports accidents, and the role of factors such as smoking, excessive alcohol consumption, obesity, psychotropic drug intake and disability in mediating these disparities. METHODS: The sample included 3368 economically active subjects aged 18-64 years, selected at random in north-eastern France. Subjects completed a postal questionnaire about sociodemographic and lifestyle information, and recorded the occurrence of accidents by type during the previous 2 years. Data were analysed using a logistic regression model with different sets of independent variables and covariates in order to describe the disparities and investigate the role of personal factors. RESULTS: During the 2 years preceding the survey, 11.8% of men and 5.4% of women had an occupational accident, 3.7% of men and 4.5% of women had a traffic accident, 4.1% of men and 1.5% of women had a domestic accident, and 6.1% of men and 1.9% of women had a sports accident. Personal factors were strongly related to the occurrence of accidents, with different patterns in men compared with women, and according to the type of accident. Men in intermediary occupations, clerks, craftsmen and tradesmen and, to an even greater extent, manual workers and farmers had a much higher occurrence of occupational accidents than men in the upper occupations, while craftsmen and tradesmen had a much higher occurrence of traffic accidents. Manual workers had a lower occurrence of sports accidents. After adjustment for lifestyle factors and disability, estimated odds ratios were reduced slightly but remained significant. Occupational disparities in accidents were virtually non-existent among women. CONCLUSION: Occupational disparities in accidents mainly concern men and are predominantly observed in occupational and traffic accidents. Lifestyle factors do play a role in explaining these disparities, but are fairly limited. Improved work conditions, equipment, health behaviours, safe driving practices and accommodation of people with disabilities are needed to reduce the risk of accidents.

Associations of job, living conditions and lifestyle with occupational injury in working population: a population-based study.

OBJECTIVES: To assess the roles of job demands, living conditions and lifestyle in occupational injury. METHODS: The sample included 2,888 workers, aged > or =15 years, randomly selected from the north-eastern France. The subjects completed a mailed questionnaire. Data were analyzed with adjusted odds ratios (ORa) computed with the logistic model. RESULTS: In total, 9.2% of workers had an injury during the previous 2 years. The high job demands: tasks at height, handling objects, pneumatic tools, other vibrating hand tools, work in adverse climate, physical workload, vibrating platform, machine tools, cold, heat, awkward posture, noise, hammer, and pace had crude odds ratios between 1.81 and 5.25 for injury. A strong exposure-response relationship was found between the cumulated job demands (CJD, defined by their number) and injury: OR 1.88 (95% CI 1.23-2.87) for CJD1, 4.39 (2.98-4.46) for CJD2-3, and 9.93 (6.70-14.7) for CJD > or = 4, versus CJD0. These ORs decreased to 1.68, 3.70, and 7.15 respectively, when adjusted for sex, age, and living conditions/lifestyle confounders; and to 1.54, 2.99, and 5.45 respectively when also adjusted for job category. The following factors had significant ORa: age <30 years (1.54, 1.12-2.12), male (1.64, 1.18-2.30), smoking (1.60, 1.22-2.10), musculoskeletal disorders (1.54, 1.17-2.04), and frequent drug use for fatigue (2.03, 1.17-3.53). The workmen, farmers/craftsmen/tradesmen, and foremen had a 5.7-8.7-fold while the clerks and technicians a 2.7-3.6-fold higher risk compared with upper class. The risk associated with CJD was twofold higher among the workers aged > or =40 or with frequent drug use for fatigue compared with the others. Obesity had ORa 2.05 (1.11-3.78) among the subjects aged > or =40, and excess alcohol use had ORa 2.44 (1.26-4.72) among those free of disease. CONCLUSIONS: This study identified a wide range of job demands and living conditions/lifestyle which predicted injury. Preventive measures should be conducted to reduce job demands and to help workers to be aware of the risk and to improve their living conditions/lifestyle.

Frequency of low back pain among men and women aged 30 to 64 years in France. Results of two national surveys.

INTRODUCTION: In France, most studies of low back pain (LBP) have been carried out among workers or patients. Until very recently, the frequency of LBP in the general population was not known, because National Health Surveys did not include questions on LBP. OBJECTIVE: To estimate the prevalence of LBP in the French population aged 30 to 64 years. MATERIALS AND METHODS: The main data were from the National Health Survey 2002-2003 (n=14,248). LBP was assessed by an accompanying self-administered questionnaire asking details about duration of LBP in the previous 12 months. Weights were used to estimate the prevalence of LBP in the French population, with two definitions of LBP. Additional results dealing with chronic LBP, from another national survey (Handicap, Disability and Dependence), are also briefly presented. RESULTS: More than half of the French population in this age group experienced LBP at least one day in the previous 12 months (LBP1), with 17% experiencing LBP for more than 30 days in the previous 12 months (LBP30); prevalence differed between men and women and that of LBP30 increased with age. DISCUSSION-CONCLUSION: The prevalence of LBP as assessed by the National Health Survey is similar to that found in countries other than France. These estimates can be used as a reference for surveys in specific populations, provided that comparable methodologies are used.

Rehabilitation of spinal cord injury in France: a nationwide multicentre study of incidence and regional disparities.

STUDY DESIGN: Multicentre retrospective 1-year survey during 2000. OBJECTIVES: To describe the network of physical medicine and rehabilitation units in France that care for people with traumatic spinal cord injuries (SCI), and secondly, to evaluate the incidence of SCI persons who have postinjury rehabilitation care. SETTING: Every rehabilitation unit involved in rehabilitation of SCI patients in metropolitan France. METHODS: During the first phase of the survey, a questionnaire was used to list the rehabilitation units that treat SCI people among a total of 380 centres. An additional survey was then carried out on a sample of 30 units that did not answer this questionnaire. In the second phase, the units involved were asked about the number of SCI patients received for a first rehabilitation stay during the year 2000 and their demographic and clinical characteristics. The incidence was calculated on the basis of the population census in metropolitan France aged 15 years, above. RESULTS: Of the 275 respondent units, 148 declared that they treat SCI people on a regular or occasional basis. The survey on the sample of 30 randomly selected nonrespondents enabled us to estimate that 10% of the 105 nonrespondent units were concerned. Among the 148 units contributing to the study, 131 identified all the SCI patients received during the year 2000. After a series of adjustments, an extrapolation for all of metropolitan France leads to an annual incidence of 19.4 SCI persons per million inhabitants, or 934 new cases per year. CONCLUSION: This is the first nationwide survey aiming to estimate the incidence of SCI patients in France. The finding is based on the incidence of SCI persons treated in rehabilitation units. It therefore concerns the incidence of patients who will remain severely disabled.

[Prevalence of impairments and social inequalities]. / Prévalence des déficiences et disparités sociales.

BACKGROUND: Population ageing and longer duration of the working career could increase the prevalence of impairments and disabilities whereas there have been few data to help prevention and care. This study aimed at describing the prevalence of various types of impairments and assessing their social inequalities in the Lorraine population (north-eastern France). METHODS: The sample included 6.214 subjects aged 15 or more from 8.000 households randomly selected in the Lorraine population. A mailed questionnaire including socio-demographical characteristics, job, and various types of impairments was used. The data were analysed with the chi2 independence test, the adjusted odds ratio (OR) and the Mantel-Haenszel test. RESULTS: The prevalence of at least one impairment was 30% in both sexes. It varied from about 20% for subjects aged less than 40 years to about 60% for the subjects aged 70 years or more. It was higher in men than in women among the individuals aged more than 50 years (OR adjusted on age: 1.22, 95% CI: 1.04-1.44). The impairments were generally multiple for the subjects aged over 50. The prevalence of at least one impairment was higher for workmen (OR adjusted on age: 2.11, 95% CI: 1.68-2.66), farmers, craftsmen, traders and heads of firms (OR adjusted on age: 1.60, 95% CI: 1.17-2.18) and for employees (OR adjusted on age: 1.62, 95% CI: 1.29-2.03) in comparison with executives, intellectual professionals and teachers. For workmen a higher prevalence was observed for all types of impairments: intellectual and psychological functions, language, hearing, vision, visceral functions, and skeleton and posture. Farmers, craftsmen, traders, heads of firms and employees showed an excess for most types of impairments. Social inequalities were significant for various age groups during their period of occupational activity, but not after retirement. Unemployed people also had an excess of impairments. CONCLUSION: The prevalence of impairments strongly increased with advancing age. Marked inequalities were observed between various socio-occupational categories. Men were more affected than the women over 50 years of age. Impairments represent a health index which is useful for prevention to reduce their causes and consequences.

Disability in adults with hip and knee arthroplasty: a French national community based survey.

OBJECTIVES: To compare levels of disability of people with and without hip and knee arthroplasty in a random national sample. METHODS: In 1999 a screening questionnaire to classify people into groups of increasing probabilities of disability was sent to 417 500 people; response rate 86%. The study population was obtained by a stratified randomisation, with a high sampling rate for the most severely disabled group and a minimum sampling rate for people without daily living restrictions. A computer assisted interview to assess levels of disability, dependence, and handicap was given to 21 760 people; response rate 78%. A weighting factor was applied to obtain estimates representative of the French population. The presence of chronic conditions, impairments, and disability was ascertained from the subjects' reports. RESULTS: The hip and knee arthroplasty group comprised 815 subjects in the sample, indicating an estimated 691 000 subjects (95% confidence interval (CI) 597 000 to 785 000) in the French non-institutionalised population. The prevalence of arthroplasty is estimated at 1.2%. After adjustments for confounding factors, activity limitations were greater among subjects with arthroplasty for the following activities: climbing stairs (odds ratio (OR)=4.0, 95% CI 2.8 to 5.8); walking distance (OR=3.4, 95% CI 2.5 to 4.6 for a walking distance less than 500 m); bending forward (OR=3.2, 95% CI 2.2 to 4.7); cutting toenails (OR=2.8, 95% CI 1.9 to 3.9); carrying (OR=2.6, 95% CI= 1.8 to 3.8); shopping (OR=2.1, 95% CI 1.5 to 2.9). CONCLUSIONS: This study would be useful to policy-makers considering population strategies for managing disabling arthritis.

The Tetrafigap Survey on the long-term outcome of tetraplegic spinal cord injured persons: Part III. Medical complications and associated factors.

STUDY DESIGN: To study the short- and long-term medical complications encountered in tetraplegic spinal cord injured persons (TSCI) and to give prominence to both the medical and socio-economic factors with which they are respectively associated. METHODS: The Tetrafigap Study is a multicentre epidemiological survey carried out using self-administered questionnaires studying the global long-term outcome of TSCI patients after the initial phase of rehabilitation. RESULTS: The data for 1668 patients were analyzed. The rate of rehospitalizations was 74.4% with on average three stays per patient and as reported causes, in descending order: urinary complications, systematic follow-up, pressure sores, respiratory complications, contractures, bowel complications, pains and secondary fractures of the lower limbs. At the time of the survey, 84.7% of patients mentioned awkward contractures, 73.8% pains, 55.9% embarrassing urinary leakage and 14.1% pressure sores. With regard to persons suffering from complete motor lesion, urinary complications and pressure sores were more frequently reported, whereas for persons suffering from incomplete motor lesions, awkward contractures and pains were more frequent. In the elderly, pains were more often mentioned, and pressure sores and pain were also the most common in patients coming from lower socio-professional status. Contractures and pain decreased with time. All these complications but pressure sores and pain are statistically interrelated. CONCLUSION: The medical complications of spinal cord injured persons are frequent, they are linked to biological, psychological and environmental factors, and are interrelated. Therefore, seeking mid- and long-term risk factors must be given priority in order to better adapt attempts at increasing secondary prevention.

Subjective well-being and severe motor impairments: the Tetrafigap survey on the long-term outcome of tetraplegic spinal cord injured persons.

The purpose of the research described in this article is to study the effects of severe motor impairments on a person's well-being, by attempting to throw light upon the inconsistencies found in the previous literature, which are due to problems of a conceptual and methodological nature. The data were gathered during the Tetrafigap survey on the long-term outcome of tetraplegic persons in France. This survey involved 1668 tetraplegic spinal cord injured people. We examine the relationships between the overall assessment of well-being as expressed by the people interviewed, and a range of clinical, social and psycho-social factors. A progressive approach, along with the use of adjustments via linear regressions, has allowed us to identify certain confounding factors, and to analyse the respective effects of the different types of variables studied. Thus current age, the age at which the impairment occurred and having or not having a professional activity do not have any direct links with the assessment of well-being, whereas the existence of pain and the subjective assessment of one's own independence and of the severity of one's disability are predictive factors. The functional independence indicators are only linked to well-being when they relate to situations in which the dependence creates embarrassment due to socio-cultural taboos. The loss of autonomy only affects well-being in as much as it imposes limits to social activity, whether they be relational or occupational. Living as a couple is a negative predictive factor if the couple were together prior to the impairment occurring. The overall results demonstrate the importance of moving beyond any conception of the impact of the impairments on well-being that is too exclusively focused on the individual, and of integrating the socio-cultural meanings of handicap situations and the dynamics of the interactions which take place therein.

[Survival of tetraplegic spinal cord injured persons after the first admission of a rehabilitation center and prognosis factors: a multicenter study of 697 subjects in French centers]. / La survie des blessés médullaires tétraplégiques après la première entrée en centre de rééducation et ses facteurs pronostiques.

BACKGROUND: We surveyed survival and prognosis factors in tetraplegic spinal cord injured persons (TSCI) after their admission to a physical medicine and rehabilitation center. METHODS: This multicenter study included 697 individuals, the entire cohort of patients admitted to three of the principal French centers caring for spinal cord injured persons from 1949 to 1997. The data set was drawn from the medical files and included data on the accident and its complications, social and demographic features, and the characteristics of the spinal injury. Survival data were obtained for all subjects from the official registries of their place of birth. Univariate (Kaplan-Meier) and multivariate (Cox regression) analysis was made to study links between these data and survival. RESULTS: Univariate analysis indicated that the principal variables significantly related to survival were: level of the lesion, age at the time of the accident, the cause of the accident, and the presence of a permanent tracheotomy or a depressive syndrome requiring medical care. Multivariate analysis showed that the risk of dying was 82% lower for persons who did not have a permanent tracheotomy. The risk declined by 92%, 89% and 69% for TSCI aged 20 years or less, 20-39 years and 40-59 years respectively at the time of the accident compared with those aged more than 60 years. This risk was 37% lower for TSCI without depressive syndrome and 52% lower for persons injured at levels C6, C7, C8 compared with those injured at levels C2, C3, C4. CONCLUSION: Multivariate analysis showed that the principal prognosis factors for survival are the presence of a permanent tracheotomy, the age at the time of the accident, the presence of a depressive syndrome and the level of the lesion. No statistical improvement of survival was observed related with time (corresponding to the year of inclusion) but, over the study period, there was an increasing number of spinal cord injured person who survived with high lesions.

The Tetrafigap Survey on the long-term outcome of tetraplegic spinal cord injured persons, part II: Demographic characteristics and initial cause of injury.

OBJECTIVES: After presenting in part I the protocol and the methodology of the Tetrafigap Survey, this article is aimed at investigating demographic characteristics, initial cause of trauma and spinal injury in the French tetraplegic spinal cord injured (TSCI) population. STUDY DESIGN: The Tetrafigap Survey is a multicentre epidemiological survey on the outcome of TSCI people following their first admission to a rehabilitation department or centre. SETTING: The survey was conducted with the participation of 35 French-speaking collaborating centres. METHOD: A self-administered questionnaire was carried out among consenting TSCI patients followed by the centres. 1,668 questionnaires fulfilled all the required criteria for data analysis. RESULTS: The socio-demographic variables (gender, current age and age at the time of accident, duration of disability), circumstances of accident as well as initial spinal cord lesions are reviewed in the body of the text. CONCLUSION: The results from this survey form the first detailed description of the French TSCI population. Whereas demographic data show many similarities with those of previous studies in other countries, some specific differences are highlighted, in particular relating to the type of accident.

Construct validity of the functional independence measure (FIM): questioning the unidimensionality of the scale and the "value" of FIM scores.

The Functional Independence Measure (FIM) is one of the most widely used disability and dependence assessment instruments in rehabilitation medicine. As for other similar scales, the expression of results as a unique score raises an important question. Is it legitimate to consider the object being measured (functional independence) as a unidimensional entity? The answer is of major practical importance in justifying the use of the FIM. Having made a critical analysis of the previous validation procedures, the authors then submitted admission FIM items of 127 consecutive patients admitted in a French rehabilitation unit to different multidimensional statistical methods in order to analyse the structure of the FIM. Their findings demonstrate the multidimensional nature of the phenomenon assessed by the scale. This observation raises the question of the relevant use of the FIM total score, currently too widely applied without sufficient precaution, and suggests that preferably subscores should be used.

Work values: a comparison of non-disabled persons with persons with paraplegia.

A number of studies focus on factors that might explain the low level of employment of persons with paraplegia without questioning the social representations connected to work. Being employed is considered a priori as beneficial, constituting an important objective for rehabilitation. However sociologists have recently pointed out that work, as a means of self fulfilment, is a 'constructed' rather than a 'natural' category. The comparisons of the representations of work given by two groups: persons with paraplegia (n = 350), and non-disabled persons (n = 327) show that persons with paraplegia are more likely than non-disabled persons to consider work as a source of personal fulfilment and social recognition and less likely to positively value the fact of not-working. In addition, a demonstrated satisfaction with not working, among persons of working age, is clearly more significant among non-disabled persons than among persons with paraplegia. Among these, some of them who have generally made up their mind about not working declare that they feel satisfied being unoccupied. This satisfaction is explained, in part, by expressed representations of work. The authors suggest a reflection on the place of work in rehabilitation programmes.

The Tetrafigap Survey on the long-term outcome of tetraplegic spinal cord injured individuals: Part I. Protocol and methodology.

The Tetrafigap Survey, a multicentre epidemiological survey on the outcome of tetraplegic spinal cord injured (TSCI) people from their first admission to a Rehabilitation Department or Centre is currently being undertaken in France. The general objective of this survey is to evaluate the situation of the TSCI people and their conditions of life in its medical, psychological and social aspects. This first article is aimed at presenting the protocol and the methodology of this survey. In a second part, yet to be submitted for publication, the preliminary results will be presented. It was first necessary to create a database of the population of TSCI people known to the centres and medical rehabilitation services, removing double entries. The criteria used for inclusion in the study were: a complete or incomplete traumatic cervical cord lesion, including post-surgical complications; age 16 or over at the time of the accident which must have occurred before December 31, 1992. The enquiry consisted of a self-administered questionnaire carried out with surviving tetraplegic people who had given their informed consent for their participation. The questionnaire consecutively covered the following topics: the situation at the time of the accident, the medical evolution between the accident and the end of stay in a rehabilitation unit, their evolution after discharge and the current situation (medical, social, professional and personal). During this first phase, 6082 TSCI people were identified by the collaborating centres. The 603 files of those who had died and 769 double entries were removed. Thus, 4710 questionnaires were sent out. The results of the participation show that 2251 people gave their consent and received questionnaires (340 additional deaths were acknowledged at this step). 163 refused, 869 were lost for follow-up, and 67 were excluded. There was no reply from 1020 people. We received 1830 questionnaires of which 1669 fulfilled all the necessary criteria for data exploitation. Home interviews with people who gave their consent will be carried out in a second phase as well as a study of deaths. A 5-year longitudinal follow-up is scheduled.

French survey of postpolio sequelae. Risk factors study and medical social outcome.

For 10 yr, numerous studies have been conducted to try to explain the further deterioration of the sequelae from a previous, acute poliomyelitis. The different etiologic hypotheses, which have been put forward, have not been confirmed yet. A retrospective study has been completed by mailed questionnaires sent to 360 patients previously affected by acute polio; 248 polio survivors replied. Deterioration, as functional loss especially during walking and exertion, was reported by 77% of our respondents. Among the newly affected cases, 60% have given up or slowed down their socio-professional activities because of these new problems with their health. These functional losses, reported by patients, have been statistically related to several factors: the aging process, weight gain, female predominance and the involvement of abdominal muscles at a previously acute polio stage. The recently affected population has the same degree of disability (measured through the "Functional Independence Measure" (translated in French and self-administered)) as the nonaffected one. This fact suggests that the problems that are being experienced may be partly subjective.

[Removing practices and prevalence of the handicaps in the situation of transportation. Contribution of the 1991-1992 global survey on the removing of inhabitants of the Ile-de-France region]. / Pratiques des déplacements et prévalence des handicaps en situation de transport. L'apport de l'enquête globale 1991-1992 sur le déplacement des habitants de la région Ile-de-France.

The Greater Paris area has 9.5 million population. About 400,000 are, to various extent, in a state of disability. Among the disabled, 17,000 have to move in wheel-chairs. Out of 100 disabled people, 58 suffer from walking difficulties, 20 from eye deficiency and 11 from ear deficiency. Help is mostly required for walking: 58 percent of the disabled population need such a help.