Prevalence of lung function impairment in cured pulmonary tuberculosis patients in Cotonou, Benin.

SETTING: National teaching hospital for the management of respiratory diseases, Cotonou, Benin. OBJECTIVE: 1) To estimate the prevalence of lung function impairment (LFI) and associated factors in patients cured of pulmonary tuberculosis (PTB); and 2) to determine the link between human immunodeficiency virus (HIV) infection and LFI occurrence. DESIGN: We performed a cross-sectional study in cured patients with smear-positive TB (PTB+) treated between 2012 and 2015. We recruited two control groups of 70 HIV-infected (HIV+/TB-) and 70 HIV-negative participants without TB (HIV-/TB-). We performed spirometry in all participants to identify LFI (obstructive, restrictive or mixed) and the 6-min walk test (6-MWT) in PTB+ participants. We assessed the factors associated with LFI using logistic regression. RESULTS: Of 4711 subjects with PTB, 241 were contacted and 189 were included. The median age was 37 years; 128 (68.0%) were male. Overall, 85 cured PTB+ patients had LFI (45.0%). Extent of initial radiological lesions, time between symptom onset and treatment, and female sex were independently associated with LFI. Fifty-five (29.1%) cured PTB+ patients had an abnormal 6-MWT; those with LFI had a higher risk of poor exercise tolerance (OR 2.23; interquartile range 1.16-4.30). We did not find any association between HIV infection and LFI. CONCLUSION: LFI is very common in cured PTB+ patients from Benin and significantly impacts exercise tolerance.

[Smoking among journalists in the private and public media in Togo]. / Tabagisme dans les médias publics et privés du Togo.

BACKGROUND: Collaboration with journalists should help to reduce the tobacco epidemic. All over the world, no study assessed the extent of tobacco smoking in the bosom of reporters. OBJECTIVE: To determine the prevalence of tobacco smoking among reporters and to evaluate their attitudes towards tobacco. MATERIALS AND METHODS: A cross-sectional survey using an anonymised questionnaire was conducted among reporters working for both the public and private media in Togo between the 1st May and the 31st June 2005 using the "from door to door" method. Data analysis was performed with Epi-Info 3.3.2. RESULTS: The participation rate was 82.44%. The prevalence of tobacco smoking was 25%. Smoking was more common in men (26.1% versus 19.6%, p=0.03). The average age that subjects had started to smoke was 17.1 years (Range: 6 and 30 years) with all smokers reporting that they smoked tobacco only in the form of cigarettes. 79.3% of smokers thought that they would quit within the next five years. Only 6.2% reporters often talked about smoking while on the microphone. A majority of the reporters approved of anti-smoking initiatives. CONCLUSION: Because of their importance in the diffusion of news, the media must be enrolled in the fight against tobacco.

Health effects of PM10 air pollution in a low-income country: the case of Algiers.

SETTING: Although there are proven risk factors related to air pollution, the prevalent situation in low-income countries is not well known. OBJECTIVE: To quantify the health impacts associated with particulate air pollution in the city of Algiers. DESIGN: Descriptive study to evaluate a health impact assessment (HIA) approach based on a dose-response curve from the literature. A study area was defined around an air quality monitoring site in Algiers. Daily health data were obtained from a network of physicians practising in out-patient health centres. RESULTS: Over the period studied, the number of consultations for respiratory reasons attributable to PM10 exposure was 439, representing 4.5% of all health events observed. Different scenarios were examined, showing that a reduction in ambient levels of PM10 would be accompanied by important public health gains. CONCLUSION: The study allowed us to test the applicability of the HIA approach in a low-income country and to confirm the interest of the approach. Although the estimation of dose-response functions obeys a complex methodology, the HIA is an alternative that constitutes an important decision-making tool.

Medical students and tobacco in 2004: a survey in Sousse, Tunisia.

OBJECTIVE: To assess the behaviour, knowledge and attitudes towards smoking among medical students in Sousse, Tunisia. DESIGN: A cross-sectional survey in classroom settings using a self-administered questionnaire was conducted at the School of Medicine during September 2004. RESULTS: The numbers of students who entered the first and the fifth years of medical training at the University of Sousse in 2004 and completed the questionnaire were respectively 120 and 110. The population age ranged from 18 to 21 years (mean 19 +/- 0.62 years) in first year students and from 22 to 30 years (mean 23 +/- 1.38 years) in fifth year students. The prevalence of daily smoking (both sexes combined) was 4.5% among first year students and 16.7% among final year students. The prevalence of daily smoking according to sex was 29.6% among boys and 0.7% among girls. Over 90% of students thought smoking was harmful to health, but there was considerable underestimation of its causal role in a number of diseases, notably coronary heart disease, bladder cancer and peripheral vascular disease. There were important defects in both knowledge and motivation regarding counselling patients to stop smoking. CONCLUSIONS: The results of this study may provide baseline data to develop an anti-smoking programme in the university.

HIV infection and tobacco smoking behaviour: prospects for prevention? ANRS CO3 Aquitaine Cohort, 2002.

OBJECTIVE: To provide up-to-date and covariate-specific estimates on tobacco smoking prevalence in a representative cohort of French human immunodeficiency virus (HIV) 1 infected patients in 2002. DESIGN: We conducted a cross-sectional analysis of the Aquitaine Cohort of HIV-infected patients. A logistic regression model was used to estimate associations between regular tobacco smoking and sex, age, HIV transmission categories, duration and immuno-virological status of HIV infection and duration of antiretroviral therapy. Smoking prevalence estimates were compared with the general French population values after stratification on age and sex. RESULTS: Among 2036 patients included in the analysis, 51% were regular smokers (95%CI 49-53). Smoking prevalence was significantly higher with younger age (OR 1.7 among those < or = 45 years of age), among injecting drug users (OR 4.3), among those whose infection was not controlled (OR 1.2) and those whose HIV infection had been diagnosed for > or = 5 years (OR 1.5). The main difference with the general population was the peak smoking prevalence among HIV-positive patients infected through injecting drug use. CONCLUSIONS: HIV-infected patients are highly exposed to tobacco smoking, which is implicated in multiple conditions occurring in the course of HIV infection. Adapted smoking cessation programmes should become one of the priorities of the medical care of HIV-infected individuals.

[Measuring levels of professionally-related stress in taxi drivers in Fes, Morocco]. / Mesure du stress professionnel des chauffeurs de taxi a Fès, Maroc.

Professional stress is a harmful physical and emotional reaction that can occur when tension exists between the requirements imposed on a person and the level of control that person may, or may not, have on the fulfillment of these requirements (essentially tension between what one is expected to achieve and what one can realistically achieve). At present, traffic accidents are considered to be a major social problem in Morocco. The authors aim to describe stress levels in taxi drivers and to study potential associated factors, in particular the risk of having an accident while driving. A questionnaire was administered in a cross sectional survey to a sample of 338 taxi drivers working in the city of Fes, Morocco. Stress was evaluated by using a standardized scale developed by the French National Institute of Research and Safety (INRS). It allows for the intensity of stress to be quantified according to a set of seven scores. According to the INRS scale, 46.3% of the taxi drivers could be considered as stressed. Moodiness and blood pressure problems were specifically identified as indicators of stress in this population. These results should incite interest in developing prevention measures in order to reduce or eliminate sources of stress at work in order to decrease the number of traffic accidents related to stress, and hence to improve the taxi drivers' working conditions.

Twenty five year mortality and air pollution: results from the French PAARC survey.

AIMS AND METHODS: Long term effects of air pollution on mortality were studied in 14,284 adults who resided in 24 areas from seven French cities when enrolled in the PAARC survey (air pollution and chronic respiratory diseases) in 1974. Daily measurements of sulphur dioxide, total suspended particles, black smoke, nitrogen dioxide, and nitric oxide were made in 24 areas for three years (1974-76). Cox proportional hazards models controlling for individual confounders (smoking, educational level, body mass index, occupational exposure) were applied, and frailty models used to take into account spatial correlation. Indicators of air pollution were the mean concentration. RESULTS: Models were run before and after exclusion of six area monitors influenced by local traffic (NO/NO2 >3 in ppb). After exclusion of these areas, analyses showed that adjusted risk ratios (95% CI) for TSP, BS, NO2, and NO for non-accidental mortality were 1.05 (1.02 to 1.08), 1.07 (1.03 to 1.10), 1.14 (1.03 to 1.25), and 1.11 (1.05 to 1.17) for 10 microg/m3 respectively. Consistent patterns for lung cancer and cardiopulmonary causes were observed. CONCLUSIONS: Urban air pollution assessed in the 1970s was associated with increased mortality over 25 years in France.

Tobacco consumption and cognitive impairment in elderly people. A population-based study.

We examined the relationship between tobacco consumption and Alzheimer's disease (AD), cognitive deficit, and memory performances in elderly community residents of southwestern France. Subjects were considered to have a cognitive deficit if they scored under 24 on the French version of the Mini-Mental State Examination, and poor memory performances if they scored under 8 on the Benton Visual Retention Test. Among the 3770 subjects who gave information about their smoking habits, only 356 (9.5%) were current smokers, 998 (26.5%) were past smokers, and 2416 (64%) were never smokers. Current smokers (odds ratio (OR) = 0.52, P < 0.001) and past smokers (OR = 0.54, P < 0.001) had a lower risk of cognitive deficit than did never smokers. However, this significant relationship disappeared after adjustment for potential confounding factors such as occupational category (OR = 0.91 (not significant) for current smokers and OR = 0.87 (not significant) for past smokers). Similar results were obtained for the risk of AD and of poor memory performances. The apparent protective effect of smoking habits on cognitive abilities could be due to a confounding effect of occupational category.

Smoking habits and attitudes of medical students towards smoking and antismoking campaigns in nine Asian countries. The Tobacco and Health Committee of the International Union Against Tuberculosis and Lung Diseases.

As part of a world survey of the habits, knowledge and attitudes of medical students regarding tobacco we report a study in 15 medical schools from nine Asian countries. Some 1646 first year and 1587 final year students were included, of whom 59% were male. The prevalence of daily smoking in males was 4% in first year and 11% in final year; of occasional smoking 18% and 24% respectively, both with considerable variations between countries. The rates were very low in women. Male exsmokers varied from 3% to 24% in different centres. Overall, 33% of smokers had made a serious attempt to quit; 44% expected to have succeeded within 5 years. Over 80% of non- or exsmokers, but only 60% of smokers, thought smoking was harmful to health. There was gross underestimation of tobacco's causal role in a number of important diseases, e.g. coronary artery disease, peripheral vascular disease, emphysema, bladder cancer and neonatal mortality. There were notable defects both in training and in motivation to counsel smoking patients. There was only partial knowledge of legislative and other measures to discourage smoking, e.g. only 44% of final year students (26% of smokers) thought increased taxation an important measure. In knowledge and attitudes there was little difference between the sexes, but in most aspects smokers had notably lower scores.

The relationship between dyspnoea and main lifetime occupation in the elderly.

PAQUID is a prospective epidemiological study of mental and functional ageing. Based on the data collected during the baseline screening of this cohort, the present paper will examine the relationship between main lifetime occupation and the presence of dyspnoea in a representative sample of 3777 subjects aged > or = 65 years; living at home in the south-west of France. Subjects were considered dyspnoeic if they had a dyspnoea level 3, 4 or 5 according to the Fletcher classification. Occupational categories were determined according to the classification of the French 'Institut National de la Statistique et des Etudes Economiques,' and to the type of occupation for blue-collar workers. The proportion of dyspnoeic subjects varied significantly according to the occupational categories (from 13% for teachers to 37% for farm workers) and to the type of work (from 18% for printing workers to 41% for building workers). When age, sex, weight, smoking history, place of residence, educational level and some concurrent diseases were adjusted for, former farm workers (odds ratio [OR] = 3.3, 95% confidence interval [CI]: 2.0-5.6), farm managers (OR = 2.1, 95% CI: 1.3-3.5), domestic service employees (OR = 1.9, 95% CI: 1.2-3.6) and blue-collar workers (OR = 1.9, 95% CI: 1.3-3.0), had a higher risk of dyspnoea than subjects who used to have an intellectual occupation. The risk was not significant for other professional categories. These results demonstrate the important long-term effect of previous professional activities on respiratory health in the elderly.

Smoking in Mediterranean countries: Europe, North Africa and the Middle-East. Results from a co-operative study.

SETTING: Although smoking is considered a major public health problem, it remains an important component of social behaviour and economic activity. OBJECTIVE: To provide an initial evaluation, from available data, of the main characteristics of smoking in the Mediterranean region. DESIGN: A questionnaire was sent to a group of correspondents-clinicians or epidemiologists involved in tobacco prevention-in the different countries. RESULTS: The proportion of smokers was quite different in men and women. In the majority of the countries over 45% of men and under 15% of women were smokers. The mean age of initiation of smoking was about 15. In every country mainly manufactured cigarettes were smoked, and the younger population preferred American cigarettes. Doctors and medical students had smoking habits similar to those of the general population. All of the countries included in the study had antismoking legislation, but only some put restrictions on advertising or sponsoring from the tobacco industry. CONCLUSION: To deal with the situation, recommendations have been proposed by a group of IUATLD experts in the different regions. The first of these is the implementation of a co-operative study in order to collect reliable data on smoking. Other recommendations are to set up educational programmes for health professionals to aid them in their smoking prevention activities.

Smoking and eight-year mortality in an elderly cohort.

SETTING: The increasing numbers of elderly people highlight the question of smoking effects in this age group. OBJECTIVE: To investigate whether there is a relationship between smoking and 8-year mortality in a representative elderly cohort aged 65 years and over, residing in the department of Gironde, in the south-west of France. METHODS: Data were collected by a questionnaire administered during home visits. Every death was systematically recorded during the 8-year follow-up. RESULTS: The 2786 (99.8%) subjects included in the study were categorised into current smokers, former smokers and never smokers. Mortality was higher (P < 0.0001) in men (39.6%) than in women (29.4%). In men, the risk of mortality was higher (P = 0.01) among current (44.5%) and former smokers (41.4%) than in never smokers (32.5%). The risks were similar in never smokers and former smokers who had stopped more than 20 years previously. Tobacco consumption in pack-years was higher (P = 0.02) in those people who died during the follow-up period than in those who were still alive. Mortality due to respiratory disease (P = 0.008) and lung cancer (P < 0.0001) was significantly higher in current smokers than in former and never smokers. Adjusting for potential confounding factors, smoking remains significantly associated with mortality both in current (relative risk [RR] = 1.7, P < 0.001) and former smokers (RR = 1.3, P = 0.004). CONCLUSION: These results confirm the consequences of smoking even in the elderly, and raise the question of smoking prevention after 65 years of age.

Air pollution: a new respiratory risk for cities in low-income countries.

Since the major accidents that occurred in the 1960s, air pollution has commonly been considered as a respiratory risk factor whose effects are most often studied in industrialised countries. Our aim is to show that it is now the turn of low- and middle-income countries to take this risk factor into account. After a discussion of the characteristics of air pollution, how it is diffused and the main known health effects (short- and long-term effects), we describe the specific differences between the cities in the North and the South. As a result of late industrialisation, cities in the South are now faced with pollution from industrial sources and urban traffic with polluting vehicles. The case of Algeria and Morocco illustrates this situation and its potential health risks. In order to prevent the health risks of air pollution in the cities of the South, systems for measuring pollution levels and epidemiological surveillance need to be put in place rapidly. This strategy can only work if it is supported by a strong partnership from industrialised countries.

Prevalence of self-reported asthma symptoms in a French elderly sample.

The aim of this study was to estimate the prevalence of reported asthma symptoms in French elderly people according to age, sex and principal lifetime occupation. PAQUID (Personnes Agées QUID) is a cohort of 3777 subjects, aged 65 years and over, living at home in the south-west of France. The aim of PAQUID is to study factors of cerebral and functional ageing. This cross-sectional study took place during the third year of the PAQUID follow-up, and concerned 2406 subjects (63.7% of the initial sample). Two questions were introduced into the PAQUID general questionnaire: "have you ever had asthma?' (cumulative asthma), and "did you have at least one asthma attack in the last 12 months?' (current asthma). Of 2355 subjects, 144 (6.1%) reported asthma history at some point in their life. For 58 (40.3%) subjects, it was in the previous 12 months. In men, the prevalence rate was 7.3% for cumulative asthma and 2.8% for current asthma. In women, rates were 5.2% and 2.2%, respectively. The rates were lower at advanced ages (> 85 years) for both males and females. They were particularly high in former farm workers; 13% reported cumulative asthma and 11% reported at least one asthma attack in the previous 12 months. Farmers appear to have a higher risk of both cumulative [odds ratio (OR): 2.30; 95% confidence interval (CI): 1.00-5.47] and current asthma (OR: 5.35; 95% CI: 1.33-21.50) compared to white collar workers, despite adjustments on age, sex and smoking history. The risk was also significant for manual workers, but only for cumulative asthma.

Probing velocity: novel approach for assessment of inflamed periodontal attachment.

Little is known about the biophysical characteristics of the dento-gingival junction in response to the development or resolution of inflammation. The Toronto automated periodontal probe (TAPP) provides an estimate of the biophysical integrity of the dento-gingival junction by measuring intrapocket probing velocity. Presence or absence of a plateau in displacement versus time plots were used to perform dichotomous analyses as a function of established parameters of inflammation. Plateaus were operationally defined as a 3 standard deviation reduction in the slope of the displacement versus time plot (probing velocity) and hence the plateau represents an increased resistance of the probe tip at the dento-gingival junction. The aim of the study was to measure the relationship between post-treatment reductions of gingival inflammation and the probability of plateau formation as measured by the TAPP. Twenty-nine subjects exhibiting gingival inflammation were provided with periodontal therapy consisting of subgingival scaling and root planing. Over a 2-month sampling period, 6 sites from each subject were monitored and these sites exhibited wide variations of inflammation. Logistic regression revealed a significant relationship between the probability of plateau formation and treatment (P = 0.002), plaque index (P = 0.002), the increased severity levels of gingival index (P > 0.05), or bleeding index (P > 0.05). The probability of plateau formation decreased with higher levels of crevicular fluid flow but there was no dependence of plateau formation on probing depth (P > 0.55). These data indicate a direct relationship between improved measures of clinical health and increased resistance to probe penetration near the base of the pocket.(ABSTRACT TRUNCATED AT 250 WORDS)

Assessment of disability and handicap associated with dyspnoea in elderly subjects.

In a sample of 2792 community dwellers, aged 65 and over, randomly selected in an administrative area of southwestern France, eight items of the functional assessment scales had an independent association with dyspnoea, adjusting for age, visual or hearing impairments, depressive symptomatology, and cognitive impairment. These eight items included: two activities of daily living (dressing and continence), two instrumental activities of daily living (shopping and use of transportation), three Rosow items (walking half a mile, climbing stairs, and doing heavy housework), and a mobility scale. Disability increased with breathlessness grade in each of these items, but with different patterns, suggesting a hierarchical relationship between some Rosow, IADL and ADL items for the association of dyspnoea with disability.

[Attitudes of French cardiologists towards smoking]. / Les cardiologues français face au tabagisme.

The object of this study was to evaluate the attitudes and opinions of French cardiologists towards smoking. A postal enquiry was performed with the aid of the French Society of Cardiology and the French Federation of Cardiology in 1993 using a questionnaire developed by the World Health Organisation and the International Union against Tuberculosis and Respiratory Diseases (IUATRD). Seven hundred and thirty cardiologists replied (34% of the study population). The average age was 47 +/- 9 years; 84% were male. The prevalence of smoking was 27% (14% daily smokers and 13% occasional smokers); 47% were former smokers and 26% had never smoked. The proportion of physicians who had never smoked was higher in the younger age groups (29 to 45 years) than in the older age groups (33% versus 21% in the over 45). Forty-two per cent of daily smokers had tried seriously to stop smoking at least once but only 16% hoped to stop smoking in the following 5 years. Young cardiologists were more aware of the cardiovascular and respiratory diseases related to tobacco consumption. Only 64% of cardiologists (54% of daily smokers) systematically warned a smoker if the patient had no tobacco-related illness or did not ask about smoking systematically. Forty-seven per cent of those who replied stated that they were underinformed about the methods of helping patients to stop smoking. The authors conclude that fewer French cardiologists smoke than their general practitioner counterparts (14% of daily smokers versus 21%). They have a better understanding of the respiratory and cardiovascular risks of tobacco consumption but seem to be insufficiently prepared to help their patients to stop smoking. In addition, their personal behaviour with regards to smoking influences their attitude towards patients who smoke.

[Epidemiologic aspects of respiratory aging: contribution of the PAQUID survey]. / Aspects épidémiologiques du vieillissement respiratoire: apport de l'enquête PAQUID.

BACKGROUND: Respiratory ageing raises for the epidemiologists many questions still unsolved by clinical and physiological approaches: prevalence of chronic respiratory diseases, consequences on autonomy, risk factors. This paper aims to provide some responses based on a wide sample of elderly people: the PAQUID cohort. METHOD: PAQUID is a cohort of 3777 dwellers representative of the population aged 65 and over in two administrative areas of south-western France. The study is based on general variables as well as specific variables identifying dyspnea, asthma, chronic bronchitis and their risk factors. Disability was measured using specific scales. Mortality is registered during the follow-up. RESULTS: Twenty-five percent of subjects had a dyspnea for minor efforts (level 3 and over). There was a significant relationship between dyspnea and disability levels for basic and instrumental activities of daily living. Mortality rate was significantly associated to dyspnea level of the subjects at inclusion in the cohort, especially in men, even taking into account other mortality related risk factors (sex, smoking, occupation). 6.1% of the subjects reported symptoms of asthma. But only 2.5% reported symptoms in the twelve last months. The follow-up has shown new asthma cases among symptom-free subjects at the beginning of the survey. Previous occupation especially agricultural (pesticides exposition), and industrial activity, smoking and allergy may be considered as the main respiratory risk factors. CONCLUSION: These data provide more knowledge of some aspects of respiratory ageing. The results allowed to evaluate associated morbidity, to determine risk factors and to measure its impact on disability and mortality. Such information may be useful for prevention of respiratory related disability.

[Transmission of tuberculosis in Gironde: epidemiologic investigation by genomic analysis of Mycobacterium tuberculosis]. / Transmission de la tuberculose en Gironde : approche épidémiologique par l'analyse génomique du Mycobacterium tuberculosis.

BACKGROUND: Over the past few years, epidemiologic surveys of tuberculosis have been strengthened by new biologic technology, in particularly using RFLP (Restriction Fragment Length Polymorphism). This technique, which identifies Mycobacterium tuberculosis patterns, has allowed to study thoroughly tuberculosis bacilli transmission and pathogenesis. First applied on tuberculosis epidemics in at risk groups, RFLP has now an interest in the epidemiologic molecular survey of urbans populations. The aim of this study is to identify, in a French department, the proportion of clustering cases of tuberculosis, suspected of recent contamination. METHODS: An active surveillance of tuberculosis allows to record systematically the cases of tuberculosis-disease in Gironde. All M. tuberculosis isolates from the patients reported in this surveillance system were processed through IS6110 based RFLP analysis. Patients were interviewed face to face before this analysis, using a standardised data collection instrument. RESULTS: 102 patients were included in 1997; the RFLP analysis of all available strains identifies a high degree of polymorphism with 71 unique patterns; twelve groups with clustering patterns were found, grouping two (nine clusters), three (two clusters) and seven patients (one cluster) each. Those cases suspected of recent transmission were younger (age<60 years) and lived in poorer conditions. Epidemiologic links were confirmed in only 35% of the 31 patients clustered. CONCLUSION: This community survey analysis has allowed to identify at risk groups for tuberculosis transmission and to strengthen tuberculosis control in Gironde.

Determinants of chronic bronchitis prevalence in an elderly sample from south-west of France.

This paper attempts to estimate by means of a cross-sectional study in subjects aged 65 yrs and over the determinants of the prevalence of chronic bronchitis according to age, gender, smoking history, educational level, former occupation and associated morbidity. Data were examined from the third year of a cohort (Personnes àgêes QUID (PAQUID)) and concerned 2,406 subjects. Identification of chronic bronchitis was based on a direct question asking for the presence of phlegm on most days during at least 3 months per year for at least the two previous years. Of the sample, 13% reported chronic bronchitis (20% of males, and 8% of females). A multivariate analysis was performed and showed that chronic bronchitis was linked to sex, smoking history and professional category. Independent of these factors, asthma history and digitalic drug therapy were also closely associated to chronic bronchitis. These results underline the long-term effect of smoking and occupation on chronic bronchitis, and also illustrate the strong association with asthma and cardiac morbidity over 65 yrs of age.