Spondylodiscitis via enterospinal fistula after promontofixation.

Spondylodiscitis on enterospinal fistula after promontofixation. A case report and other spondylodiscitis etiologies.

[The history of lymphatic filarlasis control programme in French Polynesia: lessons from a 50 years effort]. / Histoire de la lutte contre la filariose lymphatique en Polynésie française: leçons de 50 années d'efforts.

With a mean prevalence of microfilariaemia superior to 15% in the four archipelagos of the territory French Polynesia was confronted with a huge public health problem of Wuchereria bancrofti - associated filarias during the 50s. Supported by a strong US sponsoring, a large scale control campaign based on diethylcarbamazine (DEC) distribution was launched and led to the method of spaced doses (the most useful protocol being one annual DEC dose). Progressively applied to the whole Polynesian population since 1974, this very innovative programme had generated the idea of a possible eradication of the parasitosis. Meanwhile at laboratory level important progress in Immunology (mainly the validation of rapid diagnosis tests detecting a specific antigenemia) and later in Molecular Biology (with the main application being the follow-up of the infection status of the vector Aedes polynesiensis) questioned this optimistic concept (one lesson given by the study of Maupiti island, considered as a 0% reference island for a long time). More recently a regional WHO-sponsorized control programme, called PacELF, has for main objective the elimination of lymphatic filariasis as a public health problem in the South Pacific region near 2010. This objective argues for using a (DEC and albendazole) drug combination cumulating micro- and macro-filaricid activities. The dream of a lymphatic filariasis free Pacific is coming back again.

Epidemiological transition and geographical discontinuities: the case of cardiovascular mortality in French Polynesia.

The need to maintain the unity of geography justifies the use of every possible approach to the study of spatial discontinuities. The geography of health can be enriched by studying and applying routine methods of regional geography. To achieve this aim, the use of epidemiological transition theory, involving its transposition from the domain of time to space, is proposed. This requires careful analysis of sources of data not commonly used in geography and emphasizes links between health, environment and development. French Polynesia constitutes a prime study area for such an approach, especially because of its multiple contrasts in geographic scale and levels of development between the different archipelagoes and even within individual islands. To demonstrate the utility of this approach, cardiovascular mortality is studied at different geographic scales. Results are displayed as health spatiograms which show the discontinuities of human geography in French Polynesia at different scales. The results appear to constitute synthetic indicators of socio-spatial disparities and permit the geography of health to contribute not only to the measurement of regional health conditions but also to the matters of global human geography.

[Geographic aspects of mortality in French Polynesia]. / Aspects géographiques de la mortalité en Polynesie française.

The fast pace of social and economic changes which have occurred in French Polynesia over the last 30 years, have made this territory a choice ground for studying trends in mortality by revealing a fast and outstanding epidemiological transition. However, the breakdown of the population in small scattered human groups raises the statistical problem of measuring mortality. The crude mortality rate has decreased steadily from 17.5/1000 in 1945-1949 to 5.3/1000 over the last five years. However, the various infant mortality rate, in spite of their decline, is still exceeding those of Metropolitan France. The contrasted trends in the causes of mortality provides a means to classify French Polynesia in the group of small fast developing countries but still ranks it far behind its 'reference models' such as Metropolitan France or the developed countries in the South Pacific, Australia and New Zealand. Moreover, there are significant regional disparities which still exist between Tahiti and the outlying archipelagoes, mainly among causes of death. As a whole, distant islands remain significantly more affected by deaths resulting from infectious and parasitic diseases, in line with the model of epidemiological transition, where as the islands of Tahiti with 70% of the total population appears as a place of cumulation of infectious and degenerative diseases, in particular of overloading and cultural problems. The centre/periphery opposition between a metropolitan country and an overseas territory repeats itself at the local level between urban and rural environments.

[Health problems in an insular territory: the EVASANS in French Polynesia]. / Problèmes de santé dans un territoire insulaire: les EVASANS en Polynésie Française.

During the past three decades, French Polynesia has experienced a tremendous economic boom: GDP has multiplied by 30 in thirty years, whereas the population has only doubled in size. Health resources may nowadays be compared to those of a developed country. But as the "territory" is composed of a large number of islands, the availability of services is very uneven. The "Iles sous le Vent" are well staffed and well equipped, but other islands are under privileged. The small population of several small islands does not justify the permanent presence of a medical doctor. In this context, a system of health air-lifting was established. The system is classified into three groups: non-emergencies (scheduled for a later date), emergencies (immediate airlifting), and extreme emergencies (immediate airlifting with a doctor on board). Patients are airlifted to another island in the "territory" (mainly to Papeete, Tahiti), to New Zealand, or to France. The cost of this system (known as EVASANS) is extremely high. It raises the issue of improving local health care facilities and of promoting preventive medicine.

The epidemiological transition in an overseas territory: disease mapping in French Polynesia.

During the last 200 years in French Polynesia the people have experienced several dramatic changes in the pathological scene. First the discovery of Tahiti and the surrounding islands at the end of the eighteenth century caused the spread of diseases previously unknown, usually in the form of epidemic outbreaks. In contrast, from the 1860s to soon after the end of the Second World War, health amelioration in French Polynesia was slowly occurring. This constituted a first epidemiological transition in which infectious disease mortality was sharply reduced. The distribution of vaccines, hygiene education and legislation stemmed the long period of some 100 years of demographic disaster and at last the population was able to increase. However for a long time infectious or parasitic diseases remained the main causes of morbidity and mortality. Only from the end of the 1950s has the situation evolved to the present state where morbidity and mortality of the circulatory system and cancer are similar in prevalence to industrialized countries. Diachronistic mapping of some of the most noteworthy diseases is presented to illustrate this last and most important phase of the epidemiological transition.

Relations between health levels, services and demand in French Polynesia.

During the course of the last 30 years, the pathological landscape of French Polynesia has undergone major changes. All health indicators attest to the fact that the overall level of health has improved. A sickness regime typical of a developed country now coexists with a pathology of a less developed country. The latter remains a matter of concern. There is a general health over-servicing in French Polynesia, but especially Tahiti itself contrasts with the modest means of the surrounding islands. For example 91% of private doctors in French Polynesia practice in Tahiti's city area. Medical utilization has been risen with the level of services offered more than pro rata to population increase. This is a consequence of the sudden development of a modern lifestyle in a marginal territory. Examples make clear that medical facility coverage is widespread and that a system of free public health care has been developed both among the population of Tahiti and also of the surrounding islands.