Serum persistent organic pollutants and diminished ovarian reserve: a single-exposure and mixture exposure approach from a French case-control study.

STUDY QUESTION: Are persistent organic pollutants (POPs) associated with a diminished ovarian reserve (DOR) in women of reproductive age? SUMMARY ANSWER: Amongst 17 POPs detected in over 20% of serum samples, only p,p'-DDE was significantly associated with an increased risk of DOR, and ß-hexachlorocyclohexane (ß-HCH) was significantly associated with a decreased risk of DOR whilst mixture analyses yielded non-significant associations and did not detect any interactions between POPs. WHAT IS KNOWN ALREADY: Animal studies have shown that several POPs can alter folliculogenesis and increase follicle depletion. However, only a few studies have been conducted in humans, with small sample sizes and inconsistent results. STUDY DESIGN, SIZE, DURATION: Our study included 138 cases and 151 controls from the AROPE case-control study. Study participants were women between 18 and 40 years of age recruited amongst couples consulting for infertility in four fertility centres in western France between 2016 and 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS: Cases of DOR were defined as women with anti-Müllerian hormone (AMH) levels ≤1.1 ng/ml and/or antral follicle count (AFC) <7, and controls were women with AMH levels between 1.1 and 5 ng/ml and AFC ≥ 7, without genital malformations and with a menstrual cycle length between 26 and 35 days. A total of 43 POPs (including 15 organochlorine pesticides, 17 polychlorinated biphenyls, and 9 polybromodiphenylethers) were measured in the serum at inclusion into the study. We conducted logistic regression adjusted for potential confounders using a directed acyclic graph to study the effect of each POP on DOR as single exposures, and used Bayesian kernel machine regression (BKMR) to measure the mixture effect of POPs on DOR. MAIN RESULTS AND THE ROLE OF CHANCE: Of the 43 POPs, 17 were detected in over 20% of the serum samples. In the single-exposure multivariate logistic regressions, p,p'-DDE (median 165.0 IQR 161.0 ng/l in controls) as a continuous exposure was significantly associated with an increased risk of DOR (odds ratio (OR) 1.39, 95% CI 1.10-1.77) and non-significantly associated with an increased risk of DOR for the second and third terciles (OR 1.46, 95% CI 0.74-2.87, and OR 1.72, 95% CI 0.88-3.37, respectively). ß-HCH (median 24.2 IQR 21.5 ng/l in controls) was significantly associated with a decreased risk of DOR when ß-HCH was treated as a continuous exposure (OR 0.63, 95% CI 0.44-0.89) and for the third tercile of exposure (OR 0.43, 95% CI 0.21-0.84) and non-significantly associated with a decreased risk of DOR for the second tercile (OR 0.77, 95% CI 0.42-1.42). All sensitivity analyses confirmed our results. BKMR showed similar associations for single exposures but found no significant associations for the total mixture effect. In addition, the BKMR results did not suggest any interactions between POPs. LIMITATIONS, REASONS FOR CAUTION: Controls were recruited amongst infertile couples and thus may not be representative of all women of reproductive age. However, their POP concentrations were in the same range as in the general French population. WIDER IMPLICATIONS OF THE FINDINGS: This study is the first to examine the associations between serum POPs and DOR. The well-recognized anti-androgenic properties of p,p'-DDE and estrogenic properties of ß-HCH could explain these associations of opposite direction. If these results are replicated elsewhere, this could have an impact on fertility prevention messages and help in understanding the impact of POPs on the female reproductive system. STUDY FUNDING/COMPETING INTEREST(S): This study was funded by the Fondation de France (grant numbers 2014-50537 and 00110196) and the French Biomedicine Agency (2016). None of the authors have any conflicts of interest to declare. TRIAL REGISTRATION NUMBER: N/A.

[Association of air-pollution with acute myocardial infarction: A case-crossover study]. / Association entre pollution atmosphérique et infarctus du myocarde sur base de la méthode cas-croisé.

BACKGROUND: A large number of studies have demonstrated an association between ambient air pollutant exposures and acute myocardial infarctions (AMI). Case-crossover methods are frequently used for analyzing the acute health effects of air pollution. Nevertheless, only a few studies controlled for potential confounders like other air pollutants and temperature. METHODS: The defined geographic entity for the collection of acute myocardial infarctions was composed of 15 municipalities in Charleroi. Charleroi is a relatively highly polluted region in Wallonia, the South of Belgium. The analyses presented hereafter concern patients in the 25-74 years age range over time from 1999 to 2009. Ambient concentrations of PM10, O3, NO2, CO and temperature were available from stationary monitors during this time period. A time-stratified case-crossover approach was applied. Season stratified analysis and analysis matching for environmental confounders were also performed. RESULTS: A total of 3303 AMIs were analyzed during the study period. For the entire year, O3 was significantly associated with AMI, OR=1.028 (CI95%: 1.003-1.054). The highest associations (for a 10 µg.m(-3) rise in pollutant levels) between air pollution and myocardial infarction were observed for PM10 and O3 during the warm period, OR=1.086 (CI95%: 1.020-1.151) and 1.064 (CI95%: 1.024-1.105), respectively. Matching cases and controls for temperature produced weaker association between O3 and AMI (OR=1.003, CI95%: 0.974-1.032). In contrast, this matching had no effect on the association between PM10 and AMI. The adjustment for NO2 concentration decreased the association between PM10 and AMI. CONCLUSIONS: The results of this study reinforce the evidence of the short-term effects of air pollution on acute myocardial infarction, especially during the warm season. This also suggests that the case-crossover method is a suitable tool in studying the association between acute events and air pollution. Controlling for potential environmental confounding effects is also feasible with this method.

The organisation of universal newborn hearing screening in the Wallonia-Brussels Federation.

OBJECTIVE: A universal newborn hearing screening programme based on the voluntary participation of maternity hospitals has been implemented in the Wallonia-Brussels Federation since November 2006. This paper presents the results of this programme and its evolution since its implementation (2007-2011). METHOD: Two-step screening by automated otoacoustic emissions is performed on newborns without risk factors for hearing loss and, if abnormal responses or risk factor(s) are found, auditory brainstem response audiometry is performed. Descriptive analyses of the eligible population, coverage rates and prevalence of hearing loss were presented by year of birth (2007-2011) and globally. RESULTS: Over five years, the first screening test coverage rate increased to almost 95%, 2.4% of the newborns without risk factors were referred for auditory brainstem response audiometry and 42.6% of the newborns referred were lost to followup. Of the newborns with risk factor(s) for hearing loss, 6.3% were not tested, 87.4% had normal bilateral hearing and 3.7% were lost to follow-up. Between 2007 and 2011, hearing impairment was reported in 3.18 per thousand newborns eligible for the programme, whatever the kind of hearing loss. CONCLUSIONS: Like many other countries and areas, the Wallonia-Brussels Federation has implemented a universal newborn hearing screening programme. The results of this programme evolved favourably during the period 2007-2011, even if some efforts had to be made to improve the follow-up of the referred newborns and data quality.

Simple adaptations to the Templeton model for IVF outcome prediction make it current and clinically useful.

STUDY QUESTION: What is the validity of the Templeton model (TM) in predicting live birth (LB) for a couple starting an IVF/ICSI cycle? SUMMARY ANSWER: A centre-specific model based on the original predictors of the TM may reach a sufficient level of accuracy to be used in every day practice, with a few simple adaptations. WHAT IS KNOWN AND WHAT THIS PAPER ADDS: The TM seems the best predictive model of LB in IVF. However, previous validations of the TM suggest a lack of discrimination and calibration which means that it is not used in regular practice. We confirm this finding, and argue that such results are predictable, and essentially due to a strong centre effect. We provide evidence that the TM constitutes a useful reference reflecting a high proportion of the patient-mix effect since the parameters of the model remain invariant among centres, but also across various cultures, countries and types of hospitals. The only difference was the intercept value, interpreted as the measurement of the global performance of one centre, in particular, for a population of reference. STUDY DESIGN: The validity of the TM was tested by a retrospective analysis all IVF/ICSI cycles (n = 12 901) in our centre since 2000. PARTICIPANTS, SETTING AND METHODS: All IVF/ICSI cycles were included in the analysis. The model discrimination was evaluated by C-statistics, calculated as the area under the curve of an ROC curve. The TM was then adjusted for our data and additional variables were assessed. MAIN RESULTS AND THE ROLE OF CHANCE: Poor calibration and discrimination (C = 0.64) was observed in conformity with previous external validations. Fitting the TM to our centre constituted the first substantial improvement in prediction accuracy of discrimination (C = 0.69) and calibration. We identified an important linear time trend effect and the added value of three other predictors (FSH, smoking habits and BMI) that significantly improved the model (C = 0.71). BIAS, CONFOUNDING AND OTHER REASONS FOR CAUTION: Bias due to missing data handling was assessed through sensitivity analyses. GENERALIZABILITY TO OTHER POPULATIONS: Neither the TM nor any other models based on some centres are directly applicable to other centres. However, the TM constitutes a useful basis to build an accurate centre-specific model. STUDY FUNDING/COMPETING INTEREST(S): There were no commercial relationships (i.e. consultancies, patent-licensing agreements) that might pose a conflict of interest in connection with the submitted manuscript. The objective of this research was not directed toward any treatment effects.

Energy and macronutrient intakes in Belgium: results from the first National Food Consumption Survey.

Belgium until recently lacked a systematic survey of dietary habits of its inhabitants. The present study evaluated dietary composition in Belgium with respect to energy and macronutrient intakes. Information on food intake was collected using a repeated non-consecutive 24 h recall (2-8 weeks apart) with the validated software package EPIC-SOFT, in combination with a FFQ (self-administered) covering sixty food items. The database of consumed food items was linked to food composition data. Usual macronutrient intake was estimated by the Nusser method. A representative sample of the Belgian population was randomly selected from the national register following a multi-stage procedure. Information on dietary intake was obtained from 3245 subjects aged 15 years and older. Mean energy percentage (E %) of total fat (37.9 E %) and SFA (16.0 E %) was higher than the dietary reference intakes (DRI). Mean E % of total carbohydrates (45.8 E %) was lower than the DRI, while mean E % of mono/disaccharides was 20.3. Total fat and SFA intakes were higher and total carbohydrate and sugar intakes were lower in the older age categories than in the younger age categories. The percentage of energy from SFA intake was lower and that from carbohydrates was higher than that found in an earlier Belgian study. Further efforts are necessary to improve dietary macronutrient intake, taking into account differences in age categories. In addition, it will be important to monitor its changes regularly using trend analyses.

[Cardiovascular disease prevention and health promotion in the French speaking community of Belgium]. / Le cadre de la prévention et de la promotion de la santé cardiovasculaire en communauté française de Belgique.

Cardiovascular diseases remain the first cause of mortality in Belgium and are a priority for the Five-year program of health promotion in the French speaking Community. It is declined in operational programs by priority thematics, including the heart health. With this framework, it appeared necessary to operationalize cardiovascular priorities. A process of systemic and participative planning was set up in order to seek operational strategies and actions, and to cover the whole population and actors concerned with these health problems. The various cardiovascular risk factors, which potentiate one another, are approached together and in a global way. Upstream to the risk factors, social health determinants play an important role in cardiovascular diseases and others diseases like cancers. Tracking cardiovascular risk factors among people 30 to 75 years is also proposed. It makes it possible to identify people at risk and to put forward individual and adapted measures. The plan integrates actions of health promotion (acting on the health determinants and factors which influence them) as well as actions aiming at improving tracking and the accompaniment of the patients in secondary and tertiary prevention. Actions on health determinants and the factors influencing them present moreover the advantage of being often common to many chronic diseases.

[The effect of spiruline during nutritional rehabilitation: systematic review]. / Supplémentation en spiruline dans le cadre de la réhabilitation nutritionnelle: revue systématique.

BACKGROUND: To evaluate the impact of spiruline on nutritional rehabilitation. DATA SOURCES: Systematic search in medical and scientific databases (Medline, Cochrane, Embase) and other specific databases (PhD theses, reports...). METHODS: We selected studies in which spiruline was used as supplementation in malnourished patients, irrespective of the form and dose of spiruline and in controlled trials or not. Two persons made the selection separately. Nutritional status was estimated by anthropometric and biological measures. RESULTS: Thirty-one references were identified and seven studies were retained for this review; three randomized controlled and four non-controlled trials. Spiruline had a positive impact on weight in all studies. In non-controlled trials, the other parameters: arm circumference, height, albumin, prealbumin, protein and hemoglobin improved after spiruline supplementation. For these studies, methodology was the main drawback. None of the studies retained for analysis were double-blinded clinical trials and all involved small samples. Four of them did not have a control group for comparison. CONCLUSION: The impact of spiruline was positive for most of the considered variables. However, the studies taken into account in this review are of poor-methodological quality. A randomized, a large-sized double-blind controlled clinical trial with a longer follow-up should be conducted to improve current knowledge on the potential impact of spiruline on nutritional rehabilitation.

Predictors of past quit attempts and duration of abstinence among cigarette smokers.

OBJECTIVE: Despite the widespread awareness of the harms of smoking, millions continue to smoke around the world partly due to the difficulty it takes to quit smoking. Identifying the factors associated with making quit attempts is an essential pillar to reach successful quitting. The purpose of this study is to assess the factors associated with the past quit attempts and their past length of abstinence in a Lebanese sample of cigarette smokers. METHODS: This study was conducted between March 2014 and March 2015, involving 382 patients randomly chosen from 5 outpatient clinics in 5 hospitals in Lebanon. A standardized questionnaire was completed including socio-demographic characteristics, smoking behavior, chronic respiratory symptoms, Fagerstrom scale, Mondor scale, packaging perception, quitting behavior and readiness to quit ladder. RESULTS: Smokers who have chronic allergies (ORa=2.45, p=0.03), those who have ever stopped smoking for at least one month due to the warnings implemented on the packages (ORa=4.6, p<0.0001) and smokers with an intention to quit in 2months (ORa=2.49, p<0.0001) had significantly more past quit attempts. Furthermore, longer quit attempts duration (more than 1month) were significantly associated with low-nicotine dependent smokers (ORa=0.56, p=0.02), higher-motivated smokers (ORa=1.85, p=0.01), people with chronic allergies (ORa=2.07, p=0.02), smokers who have ever stopped smoking for at least one month due to the warnings (ORa=3.72, p<0.0001) and those with an intention to quit in 2months (ORa=1.98, p=0.05). CONCLUSION: The promoters of smoking cessation services should consider these factors when designing comprehensive tobacco control initiatives and in service planning.

[Influence of the age and the level of transmission on the clinical and biological expression of severe malaria in children]. / Influence de l'âge et du niveau de transmission sur l'expression clinique et biologique du paludisme grave de l'enfant.

INTRODUCTION: This study aimed to determine the influence of the age and the level of malaria transmission on the clinical and biological expression of severe malaria in children. METHODS: A prospective descriptive study was conducted in nine referral hospitals in Kinshasa. A total of 1350 children, less than 15years old and hospitalized for severe malaria, were progressively included in the study between January and November 2011. RESULTS: The majority of these children (74.5%) were less than 5years of age. Major syndromes were severe anemia (11.4%), cerebral malaria (27.1%), and respiratory distress (20.5%). Severe anemia and cerebral malaria were associated with the age of the child and not the area transmission. On the other hand, respiratory distress was associated with high malaria transmission areas (P<0.05). After adjustment, these associations were maintained. High malaria lethality was observed in the group of children aged 12-59months (11.6%) and those from areas of high malaria transmission (8.4%). CONCLUSION: The child's age and level of transmission are associated with certain severe types of childhood malaria. Early and appropriate support would reduce the most fatal consequences associated with severe childhood malaria.

[Application of a dietary pattern approach in the Belgium context]. / Application de l'approche globale de l'alimentation dans la population belge.

BACKGROUND: Dietary pattern analysis has recently emerged as a new direction and a complementary approach to study the relationship between diet and morbidity or mortality. At present, two methods have been developed to construct dietary patterns: "a priori" method and "a posteriori" method. OBJECTIVE: This paper presents the two methods and their application based on dietary data from the "Belgium Interuniversity on Nutrition and Health Study". METHODS: A prospective study was conducted (1979-1984) in a sample of 5,225 males and 4,476 females from the Belgian population aged 25 to 74 years at the initial survey and followed for 10 years for all causes and specific mortality. Dietary data was collected by a 24-hour recall and for a sub-sample also by a 7 day-diet record. The "a priori" method was used by calculating an index based on the national dietary guidelines. We used the principal component analysis to identify dietary patterns a posteriori. We conducted a first principal component analysis using the data from the 24-hour recall and a second on the data collected by the 7 day-record. RESULTS: Both of the currently used approaches for extracting dietary patterns have advantages and limitations. We applied first the "a priori" approach by calculating an Index (IAR) which measures the adherence of the sample to the Belgian dietary guidelines. We obtained an index that ranged from 0 to 8, a higher score represented a "healthier diet". The index mean (sd) was 3.7 (+/- 1.2) for the entire sample with a significantly higher IAR for women. Using factor analysis, we identified 8 dietary patterns for men and for women. These were difficult to translate in terms of dietary intake profile. Inversely, with the factors identified with the 7 day record, we could find a "western" dietary profile and a "prudent" profile. CONCLUSION: Dietary pattern analysis offers the opportunity to evaluate the overall quality of the diet. The dietary profiles constructed by the two approaches should be related to morbidity or mortality in order to evaluate their predictive capacity.

[Children hospitalized with severe malaria in Kinshasa (Democratic Republic of the Congo): Household characteristics and factors associated with mortality]. / Caractéristiques des ménages des enfants hospitalisés pour paludisme grave et facteurs associés à la létalité palustre à Kinshasa (République démocratique du Congo).

BACKGROUND: Malaria is a major health problem in tropical Africa. In DRC, little is known about the characteristics of households of children with severe malaria or the factors associated with its lethality, especially relative to hospital status. METHODS: This study of 9 hospitals of the city-province of Kinshasa studied 1350 children younger than 15 years and hospitalized for severe malaria from January to November 2011. RESULTS: More than three quarters of children admitted to public (state) and church hospitals were from poor households and with uneducated mothers (P < 0.001). The case-fatality rate (5.9% of all children) differed according to hospital status: 5.3% in state hospitals, 8.4% in private hospitals, and 4.0% in the faith-based hospitals (P < 0.001). The risk of death was significantly associated with circulatory collapse (odds ratio, OR = 10.3), number of associated syndromes >2 (OR = 3.5), z-score of weight-for-age ≤-2 (OR = 3.5), delay in seeking medical care (OR = 4.9), body temperature ≥40°C (OR = 2.9), respiratory distress (OR = 1.9) and home rental (versus ownership) a tenant (OR = 2.8), and anorexia was a protective factor (odds ratio = 0.5). CONCLUSION: Severe cases of malaria are rife in poor households and periurban residential areas. Orienting prevention, control, and care- according to the vulnerability of affected households and providing early treatment are imperative if we are to reduce mortality from malaria.

Trends in Belgian premature avoidable deaths over a 20 year period.

STUDY OBJECTIVES: To analyse over a 20 year period the level and trends in the "EC avoidable death indicators". DESIGN: The Years of Potential Life Lost (YPLL) method applied to curative and preventive avoidable mortality indicators in Belgium for four successive five year periods, countrywide as well as by district, separately for women and men. Ratios of YPLL rates (age standardised) describe changes between 1974-78 and 1990-94. SETTING: Belgium for the periods 1974-78, 1980-84, 1985-89, 1990-94. PARTICIPANTS: All avoidable death cases aged 1-64. MAIN RESULTS: Ratio of YPLL rates indicated a more favourable development between 1974-78 and 1990-94 in the EC avoidable indicators than in all causes premature mortality. The EC avoidable mortality indicators have been assigned to two categories, curative indicators and preventive indicators. The best ratio of YPLL rates was found in curative indicators for men but the largest gains in YPLL rates over the periods come from the "preventive indicators" in men. For women, malignant neoplasm of the breast rose to the first ranked in 1985-1989 and 1990-1994, where it contributed to more years of YPLL loss than motor vehicle accidents, and malignant neoplasm of the trachea, bronchus and lung had risen to the fifth ranked since 1985-89. The order of the top causes for men did not change between 1974 and 1994, except for cirrhosis of liver, which rose from the fifth to the fourth rank. In the particular case of one "preventive indicator", malignant neoplasm of the trachea, bronchus and lung, the regional analysis of time trend between 1974-78 and 1990-94 showed more districts with a favourable development for both men and women in the Flemish region than in Wallonia. CONCLUSION: The YPLL method combined with the avoidable mortality indicators enabled us to compare the changes of curative and preventive EC avoidable indicators between 1974-78 and 1990-94. In the case of malignant neoplasm of the trachea, bronchus and lung, which is of major concern to the health promotion policies, changes over the periods have widened a "north/south" health contrast.

Do social class differentials in health and health behaviors exist in young people (15-to-24-year-olds) in Belgium?

BACKGROUND: Socio-economic differentials in health are a reality in adults but their postulated persistence throughout the life-course is a subject of discussion. METHODS: Given the real socio-economic inequalities in the health of the adult population in Belgium, we used the 1997 national health survey data to measure these inequalities in the population between the ages of 15 and 24 years, inclusive. Concentration indices were calculated for three health-related variables, namely, subjective health, smoking, and drinking, in connection with various socio-economic indicators specific to the individual and/or the household (occupation, education, income, poverty, socio-economic insecurity). RESULTS: These concentration indices confirmed the existence of socio-economic differentials in the health of these 15-to-24-year-olds in Belgium. The data showed that a "poor health" status for subjective health and smoking was more frequent in the most disadvantaged socio-economic groups and for daily drinking more frequent in the better-off socio-economic groups. CONCLUSIONS: We found a relative diversity in the magnitudes of the inequalities measured depending on the parameters used for their quantification. However, there was an overlapping convergence and reproducibility of the patterns in the general directions of the inequality measurements, as follows: the results for a given indicator were remarkably consistent, regardless of the socio-economic variable studied. This consistency argues in favour of the confirmation of socio-economic class differentials in health in 15- to 24-year-olds in Belgium.

[Autopsy practices in cases of sudden infant death syndrome in the French-speaking community of Belgium and comparison with other European countries]. / Pratiques d'autopsie en cas de mort subite du nourrisson en Communauté francophone de Belgique et comparaison avec différents pays européens.

This work summarises the current difficulties encountered in performing autopsies in cases of sudden unexplained infant deaths in Belgium. Over the last few years, the incidence of postneonatal deaths in most European countries has significantly decreased, probably due to prevention campaigns. However, there are still many difficulties encountered in systematically including autopsies in the general strategy for managing this public health problem. The analysis of autopsy practices in Belgium in cases of unexplained infants' deaths and their comparison with other European countries' practices give us the opportunity to propose changes in order to improve policies and the overall understanding of these unexplained deaths.

[Severe oligospermia with normal FSH. Comparison between radioimmunologically and immunoradiometrically determined levels of LH]. / Oligospermies sévères à FSH normale. Comparaison entre les dosages radio-immunologiques et immuno-radiométriques de la LH.

We have noted in a group of oligospermic patients with normal FSH levels and normal sized testes that there can be a significant drop in the LH levels estimated by IRMA, compared with a control group of fertile men. On the other hand, there is no correlation between IRMA and RIA levels of LH in oligospermic men when there is such a correlation in the control group. As oligospermia is usually testicular in origin preliminary results suggest that there may be a disturbance of gonadotrophin secretion in one type of oligospermia and we intend to continue this preliminary study.

[Pregnancy in the diabetic woman. Incidence of malformations, of macrosomia, update on obstetrical management]. / La grossesse de la femme diabétique. Incidence des malformations, de la macrosomie, mise à jour sur la conduite obstétricale.

Perinatal mortality for infants born to diabetic mothers has dropped in the years from the 1950's when it was 20% to less than 3% by the end of the 1980's. In spite of this considerable reduction which is due to careful observation and multidisciplinary management in this type of pregnancy, the congenital malformation rate is 4 times greater than with the general population (3%) and the rate of spontaneous abortions is double (13%). The caesarean section rate is 5 times higher (18%). In bringing out a retrospective study we have attempted to analyse the endocrinological and obstetrical features of the cases.

[Acute adrenal gland decompensation in the immediate postpartum]. / Décompensation surrénalienne aiguë dans le post-partum immédiat.

We report the case of acute adrenal gland failure which occurred one hour after cesarian section for the delivery of a child after 31 weeks of amenorrhoea. The clinical picture of the mother was immediately severe and was dominated by neurological features: profound coma with a bilateral Babinski's sign. The laboratory tests however only revealed severe hypoglycaemia among the classical signs of adrenal gland failure. It was extremely difficult to correct the blood glucose level without concomitant administration of corticosteroids.

[Chronic Chagas cardiomyopathy: methods for identifying groups at risk and/or risk behaviors]. / La cardiopathie chagasique chronique: propositions méthodologiques pour l'identification des groupes et/ou des comportements a risque.

Chagas' disease is still in 1992 a true problem of Public Health in several countries of South America. Almost 1/3 of the infested patients will develop a heart complications particularly lethal: the Chagas' chronic cardiopathy. The existing drugs do not cope with this Public Health problem. Such a lack of therapy enlarged because of the success of vectors control, has based the main strategies for the years to come, i.e. eradication of the insects of Triatoma. infestans group. So, there is a great risk to look upon the patients already infested and threatened with acute heart complication. Many factors have an influence on the occurrence of such a complication. Therefore, identification of groups or behaviours at risk should lead to an adapted strategy to take care of the patients already infested by Trypanosoma Cruzi. The authors propose a methodology which taking into consideration all "may be risk factors", eases a graded conceptual model. This model will be certainly useful in identifying some pertinent parameters, in elaborating or accepting some data collection technology, in data analysis, as well as in setting up some operational research projects.