Biomedical subjects
Publications and source records attributed to P Lazar.
A sixteen-year-old black male, distraught over his acne, injected his face via syringe and needle with a topical cream. Within twelve hours, the injected lesions became red and edematous, and later tender. After treatment with oral prednisone and erythromycin, the lesions resolved. This case serves to illustrate the unexpected misuses of cosmetics, in this instance, a patient anxious only to improve his acne problem.
A preterm birth prevention program was instituted in France in the early 1970s. Its effectiveness has been assessed through a perinatal study in Haguenau. A relationship between prenatal care improvement and preterm birth rate decrease was noted, but a causal interpretation cannot be derived from such an observational study. However, some arguments do support this interpretation: no satisfactory alternative explanation (such as biases in pregnancy duration measurement, change in the composition of the population of pregnant women, or secular trend), a plausible causal pattern, and a dose-response relationship between prenatal care and preterm birth rate. The Haguenau study results can be applied to other French regions, but extrapolation to other countries would depend on their social, medical and cultural contexts.
The marketing and use of cosmetics can involve consumers, government regulators, and dermatologists. As practitioners, we should be aware of these interactions and of the role cosmetics play in the lives of our patients, in the marketplace, and in society as a whole.
The aim of the council directive of 29 March 1977 of the European Community (1) is the screening for non-work-related lead exposure levels in the general populations of European (member) countries. In France, such testing was carried out in eight metropolitan areas (having more than 500,000 inhabitants), another eight "critical" areas surrounding industrial emission sources and one area (Vosges) having a high level of lead contamination in the water. In view of the reference values (maximum 35 micrograms/dl in an individual blood sample) adopted by the directive, the situation is most serious in the area where the exposure is due to the lead contamination in the water. Individuals here run a seven times greater risk of exceeding the 35 micrograms/dl blood-lead limit relative to urban populations where the lead comes mostly from vehicle emissions into the atmosphere (i.e. 9.3% of the blood-lead values of the Vosgian sample exceed 35 micrograms/dl; 3.5% for the industrial complexes which deal with lead and 1.4% for the urban zone). While these vehicle exhausts are the subject of much current concern, in perspective, the problem of lead pipe contaminated drinking water appears to be of far greater importance.
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A reduction in preterm births has been observed in Haguenau (Eastern France) during a 12-year intervention study with a program for prevention of preterm deliveries. The Perinatal Study of Haguenau was an observation tool used in a stable population, and it allowed measurement of the way women have progressively responded to the new proposals in prenatal care. It also allowed measurement of the results of the interventions: low birth weight (less than 2,500 g) and preterm birth rates (less than 37 weeks of gestation) among single live births. The total duration of the study was divided into three periods of four years (1971 through 1974, 1975 through 1978, and 1979 through 1982), for which the numbers of single live births are 5,763, 4,957, and 5,919, respectively. For the same periods, the low-birth-weight rates, 4.6%, 4.0%, and 3.8%, respectively, showed a significant decrease (P less than .001). Following a similar pattern, the rates of preterm birth were 5.4%, 4.1%, and 3.7% (a significant reduction with P less than .001). These improvements in pregnancy outcome do not disappear after standardization of mother's age, high blood pressure, or social class distribution. These findings, which concur with the results of others, enhance the hypothesis of a direct relationship between a prevention program and a reduction in preterm birth rates.
All children born between 1971 and 1974 at the Haguenau maternity center (Lower-Rhine department, N.E. France) and attending school in Haguenau were examined by school doctors. The paper shows that there were differences in development of the 3 groups studied: 54 children born before term, 62 born small-for-dates and 1,188 controls. The rapid growth rate observed in the preterm children enabled them to catch up with the controls in physical growth criteria, in contrast to those in the small-for-dates group. Overall, those in the preterm group seemed to enjoy better health than those in the small-for-dates group, but their adaptation to school life was poorer.
The aim of this study was to determine the elements of fatigue in occupations which constitute possible risk factors for the course of a pregnancy, and, in particular, that could cause premature birth. In 1977-1978, a total of 3437 women in France were surveyed after giving birth in two maternity hospitals. One hospital was located in Lyon (a large city) and the other in Haguenau (a small town). Among 1928 working women, it was found that certain occupational categories are more prone to risk of prematurity than others. The authors carried out an analytical breakdown of the job into its diverse components which led them to define five sources of fatigue and to construct an index capable of detecting the strenuous working conditions. There is a significant relationship between the prematurity rate and the number of high fatigue scores observed in the job. When the number of scores varies from 0 to 5 the rate of premature births increases from 2.3% to 11.1%. This relationship remains significant after controlling for confounding factors.
A total of 506 women at moderate risk of preterm delivery were randomly allocated to either cervical cerclage or a control group. Significantly more women in the group allocated to cerclage were admitted to hospital for reasons other than the operation and more received oral tocolytic drugs. There were also more caesarean sections and more preterm deliveries in the women allocated to cerclage although the differences between the two groups were small and not statistically significant.
The maternal risk factors that correlate with small-for-dateness among twins have been analyzed using a sample of 659 twins pairs and a matched sample of singletons. Non-marital status, job involvement, and the previous delivery of a low-birth weight (less than 2,500g) infant present a negative interaction with twinning, as low gestational age-adjusted birth weight does not correlate significantly with these risk factors among twin gestations, while it does among singleton gestations. On the other hand, the effects of parity, habitual maternal weight, smoking during pregnancy, and twinning are additive on gestational age-adjusted birth weight. Indeed, the decrease in adjusted birth weight associated with these risk factors is of the same magnitude among twins and singletons and is statistically significant in both cases. These findings suggest that exposure of twin pregnancies to these latter risk factors, and particularly to smoking during pregnancy, can lead to the delivery of newborns with extremely low birth weights.
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The characteristics of 673 mothers of twins were compared to those of a matched sample of mothers of singletons. Both groups of mothers were interviewed just after delivery, and births in each group were matched for time and place. Of the characteristics studied, the use of oral contraceptives (OC) displayed a significant negative association with dizygotic twinning, with an estimated relative risk of 0.55 (95% confidence limits: 0.39/0.78). Among other maternal trails significantly associated with dizygotic twinning, ony age, parity and weight were possible confounders as far as the relationship between OC use and dizygotic twinning was concerned. Adjustment for these 3 characteristics left this relationship unaltered. These findings are compatible with the existence of the a direct relationship between OC use and a reduction in dizygotic twinning. Review of the available evidence concerning reproductive capacities following OC discontinuation suggests that the higher incidence of chromosomic abnormalities among spontaneous abortuses of OC users or their lower fertility could explain a reduction of dizygotic twinning rate after OC discontinuation. It is concluded that examination of te time and place variations in OC use and dizygotic twinning would help to clarify the nature of their relationship.
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The blood lead levels of 1.877 persons living in 8 large French cities or in their suburbs were measured. Blood lead level varies with sex, age, tobacco, wine consumption and date of construction of the house. The specific effect of each of these variables can be quantified. The slope of the regression of blood lead level on age is approximatively 1 microgram/dl per 14 years. Blood lead level increases by 1 microgram for people living in houses built before 1945. The effect of tobacco and wine consumption is greater among males than females. For males the increase is about 3 microgram/dl between non smokers and heavy smokers whereas for females it is about 2 microgram/dl. Wine effect is about 2 microgram/dl among males and 1 microgram/dl among females. These findings are discussed in terms of differences in lead supply or modifications in the number and condition of red blood cells.
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