[Colorectal cancer screening program : Test completion rate and follow-up results after selective mailing of the test kit, based on likelihood of participation]. / Dépistage organisé du cancer colorectal : taux de réalisation du test et résultats du suivi après un envoi postal sélectif du kit de test, basé sur la probabilité de participation.

BACKGROUND: Even though theinterest of a Colorectal-Cancer Screening Program has been amply demonstrated, in French departments the participation rate (PR) seldom reaches 45%. In the absence of mass mailing, a strategy (S-1) consisting in mailing a test kit to people having made a request was implemented in 2015. In 2017, another mailing strategy (S-2), which consisted in sending the test kit only to people likely to take the test, was programmed. This study assesses the respective impact of these two strategies as compared to the standard approach (S-0). METHODS: The study included 254,113 (S-0), 4,130 (S-1) and 10,887 (S-2) people aged 50-74, targeted during the 2016-2017 campaign in Seine-Saint-Denis (France). S-0 persons received a 2nd reminder without a test-kit, while S-1 persons received, at their request, a mailed test kit. Without having made a request, S-2 persons the mailed test kit according to probability of participation (Proba) which was estimated a priori by the ratio between the sum total of index values (frequency of previous participation, date of most recent participation, age) and a theoretical maximum. Completion rates (test/colonoscopy) were compared 18 months after the last S-2 kit was sent. RESULTS: PR was highest in S-1 (S-0: 5.8%, S-1: 74.9%, S-2: 31.3%; p < 0.0001). In S-2, PR rose as Proba increased (Proba: ]0-30%], ]30-50%], ]50-75%], ]75-100%]; PR: 21.1%, 23.3%, 36.2%, 52.8% respectively; p < 0.05). Compared to the ≥70 years age-group, the 50-54 years age-group presented a lower PR in S-1 (65.9% vs. 85.1%; p < 0.05) whereas it presented a higher PR in S-0 (4.3% vs. 7.1%; p < 0.05) and in S-2 (23.2% vs. 54.5%; p < 0.05). All in all, colonoscopy completion rates were highest in S-1 (S-0: 62.2%, S-1: 80.0%, S-2: 65.0%; p < 0.001). CONCLUSION: Test-kit mailing without spontaneous request does not lead to an optimal level of participation, thereby highlighting a need to give thought to new and improved mobilization methods. The relatively pronounced participation of younger persons, who are not favored by present-day testing specifications, underscores the interest of a specific approach addressed to active people, who are less inclined than elderly individuals to regularly consult their attending physicians.

[Record linkage of hospital discharge data and first health certificates: a test in the Val d'Oise]. / Chaînage d'enregistrements de séjours PMSI aux premiers certificats de santé: un test dans le Val d'Oise.

BACKGROUND: Our objective was to test the feasibility of an indirect linkage of data on births from health certificates (HC) with hospital discharge (HD) data. METHODS: The linkage was carried out for live births between April 1st and June 30th, 2011 in six of the nine maternity units in the district of Val d'Oise. The HC and HD had 3284 and 3550 births registered during this period, respectively. Linkage was conducted using variables available in both sources: number of fetuses, baby's birth date, gender, maternity unit of birth, maternal age, municipality of residence, gestational age and birth-weight. Two linkage methods were tested: a deterministic and a semi-deterministic method and a probabilistic approach. The latter method calculates a probability estimate for the strength of the relationship between two linked observations related to the discriminatory power and the error rate of the matched variables. For cases that were linked despite discordance on some of the matching variables, random samples of observations were checked against both HC and HD records to compute rates of false matches. RESULTS: The deterministic and semi-deterministic method linked 92.5% and 85.6% of observations in the HC and HD, respectively. The probabilistic method achieved a linkage rate of 99.6% for HC and 92.7% for HD. Cases only linked by the probabilistic method were more often preterm and had low birth-weight. Cases matched using the probabilistic method only had an error rate of 0.4% with 95% CI [0.2-0.6%]. CONCLUSION: Common items in the HC and HD make it possible to achieve a high rate of linkage. The probabilistic method links more births and, in particular, those at higher risk, and error rates were low.

[Measuring iron levels relative to the type of milk consumed within a population of 16 to 18 month old French infants]. / Statut martial d'une population d'enfants franciliens âgés de 16 à 18 mois en fonction du type de lait consommé.

The aim of this work was to study the consumption of different kinds of milk by a population of 16-18 month old children, and to compare the iron deficiency prevalence with the type of milk consumed. The study was carried out in 2002, and it involved 588 children who underwent medical check-ups at a social insurance paediatric clinic in Paris. Blood samples were collected from all of the participating children. 55% of the children drank iron-enriched milk, and this percentage increases in children who come from a higher level of socio-economic status and environment. The consumption of iron-enriched milk is a major factor in the protection against iron-deficiency anaemia and depleted iron supplies. The results suggest that much greater efforts are required for improving prevention programmes and initiatives, particularly in socially vulnerable or marginalised populations.

[The interest of cholesterol levels in young children. Study in a population of 4,697 children aged 4]. / Valeur de la cholestérolémie chez l'enfant. Etude sur une population de 4697 enfants de 4 ans.

INTRODUCTION: There is a need to dispose of normal cholesterol levels in young children. In view of the paucity of such data in France, we analysed the results of screening conducted in children. METHOD: We analysed the cholesterol levels of 4697 children, with a mean age of 4.3 years, attending a medical check-up in a Child Health Unit in a National Health Scheme centre in Paris. All the children were recruited consecutively during the year 2002. RESULTS: The mean cholesterol level was of 4.4 mmol/L +/- 0.75. We detected a slight gender-related variation (the mean in girls and boys were of 4.5 +/- 0.76 and 4.4 +/- 0.74 respectively). The 95 percentile in girls and boys were 5.7 and 5.6 mmol/L, respectively. DISCUSSION: For the first time in France, we now have access to data on normal cholesterol levels in a large cohort of 4 year-old children. Screening for hypercholesterolaemia in children provides the opportunity to discuss dietary counselling.

[How are personal child health records completed? A multicentric evaluation study]. / Le carnet de santé de l'enfant est-il informatif? Evaluation dans différentes structures de prévention et de soins.

OBJECTIVE: To evaluate the completeness of personal child health record in France. PATIENTS AND METHODS: Cross-sectional multicentric study, based on child health records analysed and parents' interviews; 1685 children were included: 863 infants aged from 12 to 18 month and 822 children aged from three and a half to four and a half years. RESULTS: One Apgar score was recorded in 96% of cases; the sitting position's acquisition was registered in 91%; the age of walk in 81%. Growth curves were plotted in 64% of cases for weight and in 62% for height in infant's records and 22% of cases for both in older children's records. Ten per cent of the last visit to a physician were not recorded in infants health records, 19% in those of children; as well an hospitalisation for respectively 1,5% and 3,3% and a performed operation for 1,8% and 5,1% respectively. Immunization batches were exhaustively indicated in 68% and 50% of the records. CONCLUSION: Many important data for medical follow-up are missing in the child health records, especially for the oldest children. Physicians and parents should be incited to a better use of the personal record.

[Socioeconomic status and child health: the experience of the Paris Child Health Checkup Center]. / Précarité et santé en pédiatrie: expérience du centre de bilans de santé de l'enfant de Paris.

UNLABELLED: Data on disadvantaged children's health are rare in France. The objectives of this study were to compare the frequency of various health problems according to socioeconomic status and to determine if socially vulnerable children benefit from health checkups more than others. PATIENTS AND METHODS: This cross-sectional study was conducted in 5,733 children who underwent a health checkup in Paris between September and December 1998. Three groups were defined according to family income estimation and status: socially vulnerable, at risk of vulnerability, and standard. RESULTS: Health status of socially vulnerable children is characterized by a higher prevalence of significant overweight (1.2% versus 0.3% in children at risk of vulnerability and 0.4% in the standard group), iron deficiency (25.7% by age ten months versus 16.2% and 10.4%, respectively), and cavities (20.6% by age four years versus 15.6% and 6.4%, respectively). Ametropia are more frequent in children from socially vulnerable or at risk of vulnerability groups, but not often corrected. These children present more psychomotor disorders than the others. Following checkups, management of observed health problems is identical in the three groups. CONCLUSION: Prevalence of studied troubles is higher in children living in low socioeconomic condition. Following checkups, these children have access to health care services in most cases. Long-term evaluation of the benefit of such health examinations should be performed.

[Estimation of vaccination rates in children of 10 months, 2 years and 4 years of age who underwent a health checkup at the Well Child Clinic in Paris during the year 1997]. / Estimation de la couverture vaccinale chez les enfants de 10 mois, 2 ans et 4 ans, venus consulter en centre de bilan de santé de l'enfant à Paris durant l'année 1997.

UNLABELLED: In France, the vaccination program has changed through the last years. We report a study on immunization rates of children who underwent a complete health checkup at a Well Child Clinic in Paris. We studied three groups of children (children at the ages of 10 months, 2 years and 4 years) regarding types of daycare and medical care. PATIENTS AND METHODS: Nine hundred children who underwent a health checkup between April and June 1997 were included in the study. Data were collected from immunization records and parents' interviews. RESULTS: In 10-month-old children, prevalence rates of immunization against diphtheria, tetanus, poliomyelitis and pertussis (DTPP) and immunization against Haemophilus influenzae type b (Hib) disease were 98% and 96%, respectively. Only 1.7% were immunized against measles. Forty-two percent of children had complete or ongoing immunization against hepatitis B. The vaccination coverage for BCG was 94%. In two-year-old children, boostering for DTPP vaccine had been performed by 90%, more than 90% were immunized against measles and 50% had received at least one shot to prevent hepatitis B. At the age of 4 years, 99% were immunized against DTPP, 78% were immunized against Hib disease, 98% against measles and 48% for hepatitis B. All children were immunized with BCG, and 98% were BCG-controlled (22% had tuberculin intradermal reaction). The highest immunization rates were observed in children who had preventive care in 'Maternal and Infantile Protection Centres.' Immunization rates were not influenced by the type of daycare, except for measles in two-year-old children managed by private pediatricians. CONCLUSION: We observed high immunization rates of children who underwent health checkups. Late immunization against measles and low immunization rates against hepatitis B reflect the difficulties encountered in mobilising physicians and families for these vaccinations.

[Evaluation of the screening strategy for lead poisoning in 1-to-3-year-old children monitored in maternal-child welfare centers in Paris]. / Evaluation de la stratégie de dépistage du saturnisme chez les enfants âgés de 1 à 3 ans, suivis dans les centres de protection maternelle et infantile à Paris.

A procedure for screening for lead poisoning was implemented since 1987 in the maternal and child health centers of 6 Paris "arrondissements". It relies on a screening of the children through environmental and clinical information. Our study aimed at evaluating this procedure and at estimating the prevalence of lead poisoning in the children aged 1 to 3 years old attending free maternal and child health centers in Paris. We did a cross-sectional survey of a sample of 512 children. A questionnaire concerning each child's risk factors was answered by the paediatric nurses of the clinics. Potential lead poisoning cases were detected by capillary determining of free erythrocyte protoporphyrins (FEP). Blood lead level (PbB) was measured in children with FEP > or = 350 micrograms/l. The prevalence rate of lead poisoning was estimated at 1.9% +/- 1.7% for a PbB threshold > or = 250 micrograms/l and at 9.6% +/- 3.5% for a PbB threshold > or = 150 micrograms/l. The detection procedure identified 4 children out of 5 with a PbB > or = 250 micrograms/l and 2 children out of 3 with a PbB > or = 150 micrograms/l.