[Evaluation of diagnostic or screening procedures].
Explore the source record for details and available documents.
Humans↗
Biomedical subjects
W Dab
Publications and source records attributed to W Dab.
Sensitivity, specificity and predictive values of health service based indicators for the surveillance of influenza A epidemics.
BACKGROUND: The Regional Influenza Surveillance Group (GROG) is a French surveillance network set up in 1984. It collects virological specimens and health service based indicators on a weekly basis. Our aim was to assess the predictive value of the health service based indicators for the detection of influenza A epidemics. METHODS: Virological data were used as a gold standard for defining the epidemics. For each health service based indicator, a statistical threshold was used as a test for the identification of epidemic weeks. Finally, an epidemiological criterion was defined in order to improve the specificity and the speed of detection of outbreaks. RESULTS: Health service based indicators have a positive predictive value of around 0.80. They also advance the detection of outbreaks by between 1 and 4 weeks. CONCLUSIONS: These indicators are easy to collect and are useful for the surveillance of influenza epidemics. Such a system is the prerequisite for the rational use of preventive tools.
Disease Outbreaks↗
Health effects of attending a public swimming pool: follow up of a cohort of pupils in Paris.
OBJECTIVES: This study aimed to determine the health effects of attending a well-kept school swimming pool maintained according to French public health regulations. METHODS: This prospective month long study was carried out on a randomised sample of pupils aged 5 to 18 years who attended a private French school with two swimming pools. The children surveyed, helped by their parents, had to fill in questionnaires about their bathing habits and symptoms during the survey period. Inspections of the pool complex were made and these included physicochemical and bacteriological analyses of the pools' water. PARTICIPATION: The response rates achieved were 70% at primary and middle school levels but only 25% in the high school pupils. Because of this older teenagers were excluded from the final analysis (of 246 children). RESULTS: Compared with non-bathers, bathers experienced fatigue and eye irritation significantly more often (p < 0.001). The eyes were red (38% of bathers) and/or watery (16%) after swimming but this resolved spontaneously within 24 hours. Bathing behaviour (bath duration, head immersion, wearing swimming goggles) did not affect these incidence rates noticeably. There were no differences between bathers and non-bathers with regard to other symptoms, especially otolaryngological ones. This survey does not allow definite conclusions to be made about verrucas because 22% of non-bathers were exempted from swimming because of verrucas that they might have caught previously in a pool. CONCLUSIONS: Except for verrucas, the methodology was adequate and daily self reporting of symptoms was feasible. This college largely recruits pupils from higher social classes and is not therefore representative of schools in Paris.
Adolescent↗
[Urban atmospheric pollution and mortality: analysis of epidemiological studies published between 1980 and 1991].
This paper analyses 14 epidemiologic investigations (published from January 1980 to September 1991) about the relationship between urban air pollution and mortality. Air pollution indicators and mortality indicators are examined. Methods to analyse the relationships between these two kinds of indicators are classified according as they bring "qualitative information" trying to answer the question: "is there any relationship between air pollution and mortality?" or according as they try to quantify this relationship. Results are presented by author. Confounding factors and means to take them into account are described. This paper ends by a discussion about interest and limits of these studies. It emphasizes the importance of the collaboration between metrologists of urban air pollution and epidemiologists.
Air Pollutants↗
Impact on the general public of media campaigns against AIDS: a French evaluation.
The article presents the results of the first national survey in a representative sample of the French population of 18 years of age and over (n = 1000; March 1990) about knowledge, attitudes, beliefs and practices toward HIV infection. It focuses on the impact of the media campaigns about AIDS and condom promotion that were initiated since April 1987 by French public health authorities. A total of 53.2% of respondents were able to correctly quote at least one of the slogans of the campaigns and 48.4% felt they have been personally influenced by the campaigns. Respectively 25.4%, 12.1%, and 11.2% declared that the campaigns have made them more concerned of individual risk of HIV infection and prompted them to condom use and HIV testing. Among heterosexually active respondents, 16.9% declared condom use in the past 12 months, age, marital status, level of education, HIV testing and self-acknowledgement of influence of campaigns being the main factors related to condom use in multidimensional analysis. Respondents who recognise having been influenced by campaigns are less likely to believe in HIV transmission through casual contact and to express discriminatory attitudes toward HIV carriers but more likely to support HIV mandatory screening for the general population. The difficulties to properly evaluate media campaigns for AIDS prevention are discussed as well as the complex trade-offs that general public information has to face between promotion of both individual behavioural change and societal support and empathy for HIV carriers and persons with AIDS.
Acquired Immunodeficiency Syndrome↗
Study of civilian victims of terrorist attacks (France 1982-1987).
The medical and psychological consequences of terrorism were assessed through an epidemiologic survey of 254 survivors of terrorist attacks (TA) that occurred in public places in France between 1982 and 1987 (20 bombings and 1 machine-gun attack). Physical lesions were typical of bombings (blast syndrome, burn, coma), but amputations were rare. Post-traumatic stress disorder (PTSD) was present in 10.5% of uninjured victims, 8.3% of moderately injured and 30.7% of severely injured ones. Major depression was found in 13.3% of all victims, with no difference according to the level of the injury. Prevalence rates were not different in males and females, nor did they vary with age of the victim. The prevalence of PTSD was not associated with the delay between TA and questionnaire completion. These findings suggest the need for including psychiatric assistance in the initial care of TA victims, especially severely injured ones.
Adult↗
A new influenza surveillance system in France: the Ile-de-France "GROG". 2. Validity of indicators (1984-1989).
The evaluation of the validity of the GROG's indicators is based on the first five years of activity, four of which being epidemic ones. A virological criterion for identifying epidemics is used as the gold standard. For each non-specific indicator, the ratio of epidemic weeks to non-epidemic weeks is outlined. Therefore we can define four epidemic situations in relation with the strains circulating and the non-specific indicators. Influenza A epidemics, which are known as a mortality problem can also be described according to its impact upon morbidity. As a result, it is possible to set up a sensitive and specific surveillance system for early detection of influenza epidemics. This objective is achieved by combining both the weekly collection of virological data as well as the collection of other available indicators either in routine practice or as provided by a network of sentinel practitioners. Such detection can pave the way for an improvement in preventive measures against the harmful effects on health of influenza epidemics.
Antiviral Agents↗
[Declared utilization of prophylactics. Results of a KABP survey in Ile-de-France--1990].
Explore the source record for details and available documents.
Acquired Immunodeficiency Syndrome↗
A new influenza surveillance system in France: the Ile-de-France "GROG". 1. Principles and methodology.
The aims of influenza surveillance have changed over the years. The early detection of epidemics is essential for practical decisions on vaccine development, strategy of vaccine prophylaxis, chemoprophylaxis or chemotherapy. A new surveillance system is presented which combines the classical specific data related to the isolations, direct detection of virus as well as serological findings, with non-specific indices. The rationale for definition and elaboration of such indices is discussed: selected parameters deal with medical activity of a panel of sentinel doctors (general practitioners and pediatricians), notifications of diagnosed acute respiratory viral infections, measure of emergency doctors activity, absence from work (as seen by physicians, insurance agencies or industrial personnel), selected drug prescription and consumption, hospital admissions. The sentinel physicians also cooperate in taking samples from cases, thereby extending the field of specific surveillance since they have contact with standard cases of the disease and not only hospitalized patients. A weekly comparison of time variations of specific and non-specific indices should permit a reliable evaluation of the epidemic situation and therefore be of great help for practical decisions. The system has operated since 1984, and the initial hypothesis of the sensitivity of some of the indices has already been verified.
Disease Outbreaks↗
Modifications of sexual behaviour related to AIDS: a survey in Paris region.
A survey on the effects of AIDS upon sexual behaviour has been carried out, in December 1987, in a representative sample (n = 900) of the population of 18 years of age and over of the Paris region. Among the sexually active population, 13.8% have been tested for HIV at least once in 1987, 10.7% denied some opportunity of sexual intercourse during the last 6 months of 1987 because of fear of AIDS, and 11.8% declared regular utilization of condoms. 53.4% of condom users are new users since the last 6 months, and, 46.6% of all condom users are mainly motivated by fear of AIDS. Multivariate analysis shows that being single, declaring multiple sexual partners and having being tested for HIV are the main predictors for use of condoms, suggesting adoption of a rather coherent preventive behaviour in a significant fraction of the sexually 'at risk' population.
Acquired Immunodeficiency Syndrome↗
Misconceptions about transmission of AIDS and attitudes toward prevention in the French general public.
A survey of the social perception of AIDS and its prevention was carried out in December 1987 in a representative sample of the adult population of the Paris region (France). A significant part of the general public still holds misconceptions about transmission by casual contact and blood donation. Misbeliefs about modes of transmission clearly encourage individuals' willingness to stigmatize AIDS patients and to support the most coercive measures of prevention (such as quarantine). Advertizing efforts to promote use of condoms, sexual education in schools, and systematic HIV screening for pregnant women are the only measures which create a broad consensus independently of sociocultural differences. Socioeconomic status and even religious or political beliefs strongly influence public opinions toward other preventive measures.
Acquired Immunodeficiency Syndrome↗
[Social acceptability of screening for HIV seropositivity in pregnant women. An inquiry in the Paris region].
Current debate about screening strategies for HIV during pregnancy is not limited to clinical and epidemiologic arguments; ethical and social concerns about the risk of stigmatization against HIV carriers are also taken into account. Therefore, data on public perception of AIDS and attitudes toward preventive measures against the disease can be of interest. In December 1987, a survey was carried out, through personal interview, in a representative sample (900 individuals selected by the quota method) of the 10.5 million inhabitants 18 years of age and over, in the Paris region. 9.8% of the women declared having been tested for HIV, at least once, during 1987, and 20% of these tests were part of prenatal care. Mandatory screening for HIV among pregnant women is supported by 78.6% of the respondents while only 64% support screening during premarital examinations and a minority (37.8%) is in favour of mandatory screening for the whole population. 48.5% of respondents share the misperception that transmission from mother to fetus always happens, and 70% think that women who are HIV carriers should renounce pregnancy: willingness to support mandatory screening for pregnant women is significantly higher among individuals who share these two beliefs.
Adult↗
[Reception of adolescents at an intersector dispensary. Retrospective study of 5 years of operation].
The study of some characteristics (clinical and sociodemographic) of a population of adolescent clients and the modes of reception and therapeutic modalities which have been proposed for them introduces a discussion on: the contributions and the limits of so-called informal modes of reception and assigning to treatment, as well as the value of taking into consideration the ways the adolescents relate to their environment; the necessity for rapid agreement and the diversity of the observed evolutions which justify both the need for adequate identification of immediate movement and for a dynamic perspective; and, after considering the adequacy of the gathered information for our way of thinking and practicing, the pertinence of an epidemiological evaluation and its utility for clinicians.
Adolescent↗
[Absenteeism as a predictor of severe morbidity. A double case-control study (myocardial infarction and industrial accident) in a large company of the Quebec Province].
Are absenteeism indicators usefull as predictor of serious morbidity in a working population? To seek an answer was the objective of a double case-control study carried out in a large company (17000 workers) of Quebec Province. In the first study, 64 cases of myocardial infarction (incidence density = 1.66% +/- 0.35) were compared with 64 controls matched for sex, age and type of work. In the second one, 142 cases of labor accident were compared with 142 controls sampled in a similar way. Absenteeism frequency and length were analysed during the period of 6 to 12 years prior to the onset of the health problem. Ratios were calculated on an individual basis for all causes of absence and for sick leave; they were adjusted for length of service. A four classes interval scale was used for the comparison. An excess of absence length exists in the two studies. The excess is not significant for the myocardial infarction cases (+ 33%, with a statistical power = 51%). It is significant for the labor accident cases (+ 52%, p less than 0.01). The corresponding odds ratio calculated in reference to the lowest absence group were 2.4 (0.9-6.6) and 2.7 (1.5-4.9). The cumulative absence length can be considered as a predictor of serious disease. A conceptual framework of the relationship between absence and natural disease history is presented. The epidemiological approach to the phenomenon of absence is certainly usefull in spite of the controversy underlined by the social sciences.
Absenteeism↗
A frame-work to co-ordinate research and preventive action.
We are presenting here an integrated decision-making algorithm for preventive action and research in public health (DAP). We reformulated several of the main stages of the elaboration of a community health programme as sets of questions or decisional nodi which lead to a decisional algorithm. The eight main stages of the DAP are the following: (1) detecting a problem, (2) is the significance of the problem well known?, (3) is our understanding of the problem sufficient for action to be initiated?, (4) defining operational objectives, (5) do we have an action strategy?, (6) are effective means available?, (7) action, (8) evaluation. We have found a place for research in six of the eight stages of the process: stages 1, 2, 3, 5, 6, 8. Some operational consequences of this categorisation and the place of research at each stage are discussed. We conclude that decision-making as to the relevance of research, must be subject to some degree of social input.
Community Health Services↗
Proposals for a prevention policy: an analysis of the French report.
We present here and criticize the "Proposals for a Prevention Policy" drawn up by a multidisciplinary commission in France during 1982. The Report provides original elements at three conceptual levels: (i) a socio-economic model of causality of disease with a temporal, a probabilistic and a polyfactorial dimension; (ii) a social point of view brought to the concepts of health, prevention and health promotion; (iii) general principles for preventive intervention at a population level, including a breaking with the "victim-blaming" ideology. In this Report, work is always at the very center of the analysis developed by the commission. Practically, proposals are concerning work and environment on the one hand and structures and functional of public health services on the other hand. They may appear somewhat unrealistic or not clearly detailed. But one should understand that the commission essentially proposes an attitude of active involvement on the part of social actors rather than a list of concrete proposals. Undoubtedly, this French Report poses and discusses questions which are of interest even outside of the French context.
France↗
[A multicriteria tool for the analysis of health status indicators of a population. Application to the elaboration of a typology for the use of health indicators].
The authors have designed a multicriteria framework for the analysis of health indexes in order to provide a tool for the comparison of population health status indexes and to establish a typology of these indexes regarding their use for public health. This framework allows for (a) shedding some light on the conceptualization of health underlying each index, (b) understanding the nature of the phenomenon which are effectively measured, (c) understanding the principles of the construction of the index, (d) giving some details concerning its main properties, (e) and finally understanding its possible uses. Using this multicriteria framework for analyzing and comparing 16 different population health status indexes, the authors suggest some guidelines for choosing an index regarding its future utilization (identification of priorities, resources allocation, evaluation). Finally, the limits of the utilization of health status indexes within the process of decision making in public health are underlined.
Health Status Indicators↗
[Community health departments and the Occupational Health and Safety Act].
Explore the source record for details and available documents.
Accidents, Occupational↗