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PubMed1984

[Social inequality in deaths in Great Britain and in France].

In this paper data are compared on differential mortality for working men in the United Kingdom and France, for the years 1970-1972 (U.K.) and 1966-1971 (F). Differential mortality in the United Kingdom is described in 'occupational mortality' published by O.P.C.S.; mortality according to 'Catégories socio-professionnelles' has been studied for a large cohort by INSEE (National Institute of Statistics and Economic Studies). The comparison between those two sets of data leads to the following conclusions: social differences in death rates seem to be larger in France than in United Kingdom. the main causes of death responsible for these inequalities differ in the two countries: respiratory diseases are the main cause in U.K.; in France, accidents and alcohol-related death lead to the largest inequalities. We discuss the difficulties of comparison between countries: some of the apparent differences may relate to the fact that, in France, mortality data concerns a cohort followed since 1954, while British data comes from a transversal survey. Another point of difference is the fact that foreigners are not included in the French study. In every country where data exist on the subject, inequalities in health are found. The reasons why these inequalities exist, and what should be done to reduce them, is a matter for discussion. The purpose of this paper is to contribute to the debate, by throwing light on some aspects of the observed differences.

Adolescent↗
PubMed2004

[Acute uncomplicated malaria treatment in children in France in 2002].

CONTEXT AND OBJECTIVES: Imported P. falciparum malaria cases are rising in France reaching 1300 estimated children in 2000. Three years after the publication of therapeutic guidelines, the Groupe de Pédiatrie Tropicale conducted an observational survey in order to describe the practice of acute uncomplicated malaria treatments in children, to identify their limits and to make proposals to improve them. METHODS: A self administrated questionnaire has been proposed to 29 pediatric wards declaring over 10 malaria cases in 2000. Questions were focused on treatment practices and monitoring of children diagnosed with acute uncomplicated malaria in 2002. RESULTS: Twenty-six services, who treated more than 700 children, responded. Twenty-two on 26 services hospitalized systematically malaria cases. Mean duration of hospitalization was 2.2 days (S.D. +/- 0.9). First line treatment was halofantrine in 22 on 26 services and mefloquine in four services. A second halofantrine dose was given systematically at day 7 in three services. No clinical cardiac effects happened. Quinine was used in perfusion only in cases of gastric intolerance. Treatment failure has never been experienced in the 22 services using halofantrine and has been experienced at least once in two on four wards using mefloquine. Relapse occurred at least once in 19 on 22 wards treating with halofantrine. DISCUSSION: Halofantrine with hospitalization is still the leading treatment of acute uncomplicated malaria in children in France. In spite of the absence of clinical cardiac incident, a second cure of halofantrine was not often used, exposing to a high rate of relapse. Mefloquine is three time more used than in 1997, in spite of its digestives side effects that can explain failures of treatment. When done, the systematic clinical and parasitological control confirms failures after mefloquine and the high incidence of relapse after one cure of halofantrine. Only used in case of severity or digestive disorders, quinine is a little less prescribed in acute uncomplicated malaria in 2001 than in 1997. CONCLUSIONS: The limitations of antimalarial drugs used in France in case of acute malaria argue for an improvement of protocols (systematic second reduced dose of halofantrine after day 7, mefloquine associated with antiemetic drug) and a systematic clinical and parasitological monitoring. As alternative, efficient combinations of antimalarial as first line treatment are needed in France.

Adolescent↗
PubMed2006

[Management of acute pyelonephritis in patients older than 3 months: survey conducted in 39 paediatric emergency departments of the Ile de France Region in 2004].

OBJECTIVES: To describe the different modalities of ambulatory management of acute pyelonephritis in patients older than 3 months of age in paediatric emergency units of the Ile de France region in 2004. METHODS: Between October 2003 and April 2004, referents of 39 paediatric emergency units of the Ile de France region were questioned through a written questionnaire concerning the management of acute pyelonephritis: in or outpatient modalities, antibiotic regimen (molecule and route of administration), investigations and follow-up. RESULTS: Thirty-one questionnaires (79.5%) were returned and analysed. A written protocol was available in 60% of the units. Outpatient management was performed in 24/31 centres. Young age, poor clinical tolerance, urological abnormalities and social difficulties were the major contra-indications for such management. Ultrasonic echography at diagnosis (within 24 h) was performed in 50% of the units. Antibiotics were started using IV route in 18/24 units (75%) and ceftriaxone and aminoside were respectively prescribed in 100% and 29.4% of the units for a duration of 1 to 5 days before switching to the oral route. Antibiotherapy was started orally in 6 units and cefixime was chosen by 5 of them. Follow-up consultations were scheduled in 100% of the units but with various delay after initiation of the treatment. The total duration of treatment was mostly 10 days and oral prophylactic antibiotherapy was prescribed by 10/24 centres after completion of the treatment. Cystoureterography was systematically realized by 83.3% of the units. CONCLUSIONS: Despite important differences in the management of acute pyelonephritis in Ile-de-France, a majority of the units follows similar therapeutic modalities. In the absence of consensus, new recommendations are necessary concerning the management of pyelonephritis in infants and children in France.

Acute Disease↗
PubMed2006

[Management of intussusception in France in 2004: investigation of the Paediatric Infectious Diseases Group, the French Group of Paediatric Emergency and Reanimation, and the French Society of Paediatric Surgery].

OBJECTIVES: To describe the different pathways of management of intussusception (IS) in infants and children in metropolitan France and to identify paediatric emergency centres that might constitute a surveillance network for IS. MATERIAL AND METHODS: A questionnaire was sent to 273 paediatric emergency centres distributed across France in 2005. Modalities of diagnosis and treatment of IS had to be precised. RESULTS: One hundred and sixty-seven centres (61.2%) responded. The response was given by 131 paediatricians (78.4%) and 36 surgeons (21.6%) working in 38 universitary hospitals (22.7%) and 129 general hospitals (77.2%). The mean number of IS treated in each centre in 2004 was 11+/-13.5 (extr. 0 to 70; median 6). Diagnosis of IS required a collaboration between medical and surgical teams in 51.5% of the centres, but in 40.1% the sole medical team was in charge of the diagnosis. Ultrasonography is used for diagnosis by 98.8% of the centres. Reduction with hydrostatic enema and eventually surgery was performed in the same hospital in 44.3%. Other centres systematically or frequently transferred the patients for reduction, mostly towards universitary hospitals (90%). CONCLUSION: The procedures of IS diagnosis are the same everywhere in France but the pathways of therapeutic management do vary, depending on the availability of surgeons and anaesthetists trained in paediatrics on each site. These disparities will probably change with the implementation of the new plan for sanitary organization in children and adolescents in France. Labellized paediatric emergency centres will gather more surgical patients and could eventually constitute an effective surveillance network for IS.

Acute Disease↗
PubMed2004

High heterogeneity of CFTR mutations and unexpected low incidence of cystic fibrosis in the Mediterranean France.

In this report, we present updated spectrum and frequency of mutations of the CFTR gene that are responsible for cystic fibrosis (CF) in Languedoc-Roussillon (L-R), the southwestern part of France. A total of 75 different mutations were identified by DGGE in 215 families, accounting for 97.6% of CF genes and generating 88 different mutational genotypes. The frequency of p.F508del was 60.23% in L-R versus 67.18% in the whole country and only five other mutations (p.G542X, p.N1303K, p.R334W, c.1717-1G>A, c.711+1G>T) had a frequency higher than 1%. The mutations were scattered over 20 exons or their border. This sample representing only 5.7% of French CF patients contributed to 24% of CFTR mutations reported in France. This is one of the highest molecular allelic heterogeneity reported so far in CF. We also present the result of a neonatal screening program based on a two-tiered approach "IRT/20 mutations/IRT" analysis on blood spots, implemented in France with the aim to improve survival and quality of life of patients diagnosed before clinical onset. This 18-month pilot project showed an unexpected low incidence of CF (1/8885) in South of France, with only six CF children detected among 43,489 neonates born in L-R, and 13 among 125,339 neonates born in Provence-Alpes-Côte-d'Azur (PACA).

Adult↗
PubMed2004

Genotype-phenotype relationship for five CFTR mutations frequently identified in western France.

BACKGROUND: Cystic fibrosis (CF) is the most common inherited disorder in Caucasian populations, with more than 1000 cystic fibrosis transmembrane conductance regulator (CFTR) mutations presently described. The distribution of the mutations ranges widely between countries and/or ethnic groups. Multicentric studies are usually needed to study the genotype-phenotype correlations. METHODS: Since 1992, the French CF Registry (FCFR) has collected and analyzed data from most of the CF patients regularly seen in CF care centres in France. We compared the mutation distribution of the patients born in western France to that of those born elsewhere in France. Then we extracted the available data for all the compound heterozygotes carrying the DeltaF508 allele and one of the following mutations: DeltaI507, 1078delT, 4005+1G->A, E60X and W846X, and matched a patient homozygous for the DeltaF508 mutation for each of them. RESULTS: Western France appeared to have a specific distribution of some CF mutations. Furthermore, disparities were found regarding the mutation repartition (DeltaI507 in Normandy, 1078delT, 4005+1G->A and W846X in western Brittany). Genotype-phenotype correlations showed a wide heterogeneity. Although variations were found, DeltaI507/DeltaF508, 4005+1G->A/DeltaF508 and 1078delT/DeltaF508 patients appeared to have a similar disease as the DeltaF508/DeltaF508 patients. Although the W846X and E60X mutations should be considered as severe alleles as regards to pancreatic function, they were associated with less severe pulmonary manifestations and, probably, better prognosis. CONCLUSION: The knowledge of the distribution of uncommon CF mutations specific to particular areas and of their associated phenotype makes up an essential tool in the management of local CF patients.

Adolescent↗
PubMed2005

[Morbidity and cost of rotavirus infections in France].

BACKGROUND: Rotavirus is the most common cause of severe diarrhea in children. Morbidity and mortality related to rotavirus infection is not well known in temperate countries in general, and in France in particular. OBJECTIVES: The aim of this study was estimate the morbidity, mortality, and cost related to the rotavirus infection in France, in order to assess the potential impact of a vaccination program. METHODS: A birth cohort was followed until 5 years of age using a decision tree model. Rotavirus infection incidence rates were modeled according to age, seasons, and breast-feeding status. RESULTS: Based on estimates from a decision model, we found that in France, rotavirus infection was responsible for 300,000 annual episodes of acute diarrhea, 138,000 visits to general practitioners, 18,000 hospitalizations, and 9 deaths. The annual direct cost related to rotavirus infection care was estimated at 28 million euros. CONCLUSION: This study demonstrates the high morbidity and cost of care associated with rotavirus infection in France. The decision tree model developed in this study could be used in the future to estimate the potential effectiveness, cost and cost-effectiveness of childhood vaccination strategies using new rotavirus vaccines.

Child, Preschool↗
PubMed2005

Sources, distribution and variability of hydrocarbons and metals in atmospheric deposition in an urban area (Paris, France).

Total atmospheric deposition, i.e., both wet and dry deposition, was sampled during 11 months in the "Ile-de-France" region, France. Monthly fluxes of aliphatic hydrocarbons (AHs), polycyclic aromatic hydrocarbons (PAHs) and heavy metals (HMs) were studied at three representative sites (two urbanised and one semiurban). A combination of spatial and temporal variability of total fluxes and pollutant fingerprints allows a better understanding of atmospheric pollutant dynamics over this region. In the whole studied area, aggregated total atmospheric fluxes of AHs, PAHs and HMs range from 19 to 33 mg m(-2) y(-1), 99 to 161 mug m(-2) y(-1) and 48 to 103 mg m(-2) y(-1), respectively. The highest values are observed in Paris centre, reflecting the importance of the urban centre as a source of pollutants, with a decline in many atmospheric deposits when moving away from urban areas. The seasonal distribution of these pollutants suggests the impact of residential heating on urban atmospheric deposition of hydrocarbons and the increase of dust loads containing HMs during summer. The qualitative study performed on atmospheric deposition data highlights the main sources of pollutants. Aliphatic fingerprints suggest a marked contribution of biogenic inputs to aliphatic contamination in the whole Ile-de-France region and slight petroleum inputs in urban areas. Aromatic fingerprints, characterised by the great predominance of phenanthrene, fluoranthene and pyrene, associated with some specific ratio values, suggest the mixture of petrogenic and pyrolytic contaminations of atmospheric deposition in the whole "Ile-de-France" region. HM distribution shows the presence of anthropogenic sources of Al and Fe in this area and the stationary sources (incinerators and plants) as a significant source of Si, S and Sb in the urban atmosphere. Moreover, a pollutant mix phenomenon, occurring in such an urban atmosphere, shows a significant influence on atmospheric deposition at the semiurban site.

Air Pollutants↗
PubMed2002

Shell disease in eastern oysters, Crassostrea virginica, reared in France.

Progeny of eastern oyster, Crassostrea virginica, introduced into France in 1992, were reared in IFREMER facilities to test their growth performances. During the summer of 1993, sporadic mass mortalities (80-90%) occurred among C. virginica spat reared in the IFREMER laboratories in La Tremblade (Charente Maritime, France) and Bouin (Vendée, France). Affected oysters presented mantle retraction and deposition of an anomalous conchiolin layer on the inner surface of the shell. The incidence of oysters with gross signs exceeded 80%. No obvious pathogen was identified in soft tissues by histology and transmission electron microscopy (TEM). However, histological examination showed the presence of anomalous basophilic round structures, 0.5-1 microm in diameter, in gill and mantle connective tissues. These extracellular Feulgen-negative structures reacted positively with the von Kossa stain. TEM examination on mantle and gill samples in diseased spat showed that the basophilic bodies consisted of concentric deposits of an amorphous substance interpreted as containing calcium. These observations may indicate that the mineralization process in spat shells was disturbed without exact determination of the cause. Based on the similarities of the gross signs to those reported in juvenile eastern oysters in the United States, we believe that the cause of the mortalities observed in France was probably the Juvenile Oyster Disease. Moreover, we report for the first time the detection of anomalous amorphous structures in gill and mantle connective tissues associated with mortalities and deposition of an anomalous conchioloin layer on the inner shell surface in C. virginica spat.

Animal Diseases↗
PubMed1998

Emergency medicine in France.

The Essonne region of France is situated to the south of Paris. A population of more than 1 million, heavy commercial traffic, and industrial centers mandate first-rate prehospital and hospital emergency medicine. Medical education in France comprises 3 years of basic medical science, followed by 3 years of hospital rotations and a residency of variable length. Emergency medicine is struggling for recognition as a specialty. The ED at the hospital center in Corbeil-Essonnes, France, has 21,000 visits per year, accounting for 30% of hospital admissions. The physical plant is modern and well-organized, with 13 beds. Attention is paid to quality improvement. Prehospital emergency care also receives due attention. A two-tiered system of BLS ambulances run by the fire department and ALS ambulances run by hospitals provide 24-hour emergency coverage. Because of aggressive triage, only 65% of requests for service result in dispatch of an ambulance. Tasks for physicians involved in emergency medicine in France today include further development of firemen's medical skills, development and use of telemedicine, and accreditation of emergency medicine as a recognized specialty.

Ambulances↗
PubMed2005

[Number of training positions in obstetrics and gynecology in France: results from a national survey of trainees].

OBJECTIVES: To evaluate of the actual and optimal number of training positions in obstetrics and gynaecology in France. MATERIAL AND METHODS: Between February and April 2004, we performed a survey of French trainees in obstetrics and gynecology on the available and optimal number of positions for training in their department according to the activity. We also performed a count of the trainees in obstetrics and gynaecology in France. RESULTS: There are 817 trainees in obstetrics and gynaecology in 26 towns in France. They are trained in 177 departments, of which 55 are academic and 122 non-academics. There are 571 positions for training in Obstetrics and Gynaecology: 334 in academic departments and 237 in general non-academic departments. There is therefore 0.7 position per trainee in obstetrics and gynaecology. Trainees estimate that there is a need and a possibility for at least 50 more positions. There is an uneven distribution in trainees between academic departments in Paris and elsewhere in France. CONCLUSION: Trainees consider possible the opening of at least 50 more training positions in obstetrics and gynaecology.

France↗
PubMed2004

[Childhood allergies in Reunion Island: is there any difference with metropolitan France?].

BACKGROUND: The present study had three aims: to estimate for the first time with standardized methodology allowing international comparisons the prevalence and the severity of childhood allergies in Reunion Island, to determine their risk factors and to make a comparison with metropolitan France. METHODS: The same standardized protocol (ISAAC) was used in population-based samples of adolescents recruited in metropolitan France between 1993 and 1994 (n=18555) and in Reunion Island in 2000 (n=2 362). RESULTS: Compared to metropolitans, the adolescents living in Reunion Island suffered significantly more from asthma in the past Year and in life (22 vs 13% and 19 vs 13% respectively). The trend was less clear for allergic rhinitis and eczema since in the case of these manifestations the adolescents reported more symptoms (27 vs 16% et 14 vs 10%, respectively) whereas the metropolitans reported more lifetime diagnostic labels (14 vs 17% et 18 vs 23%, respectively). In Reunion Island, allergies were slightly more severe (1.1 vs 0.8% for severe asthma and 15 vs 2% for eczema). Furthermore, 68% of asthmatics who had severe asthma attacks in the past Year and more than a third of adolescents with severe asthma did not take any asthma medication, which is different from the metropolitan situation. Risk factors for allergies were the same in Reunion Island and in metropolitan France, except the ownership of a pet in the first Year of life, which was not protective against the development of allergies as recently shown in some western countries but was a risk factor. CONCLUSIONS: Asthma and allied diseases are less frequent in metropolitan France than in Reunion Island where management appears to be insufficient. Improvement in prevention and management plans are required in Reunion Island.

Adolescent↗
PubMed2005

[Lung cancer mortality among women in France. Trend analysis and projection between 1975 and 2014, with a bayesian age-cohort model].

BACKGROUND: With 4,500 deaths in year 2000, female lung cancer mortality rates increased by 3% every year over the last two decades in France. This trend, not observed among males, is attributed to the regular increase of female smoking. In order to answer French Health decider's concerns, we estimated the future female lung cancer mortality rates and numbers of deaths for the next fifteen years, in France and its regions. METHODS: Analyses were based on numbers of female deaths from lung cancer observed between 1975 and 1999, and on past and future population estimates for 1975-2014, at national and regional levels. Mortality rates and numbers of deaths in France and its regions by 5-year periods and 5-year age groups were given in the 1975-1999 death certificate data base, and were projected for 2000-2014. The analysis used a bayesian approach of the age-cohort model with auto-regressive constraints on parameters. Estimated mortality rates were standardized on truncated 20-85 + world population. RESULTS: French female lung cancer mortality increased by 3% every year between 1975 and 1999. In period 1995-1999, truncated 20-85 + mortality rates, and number of deaths per year were respectively 11.4 per 100,000 and 4,000. Mortality rates increased in all regions but variations were maximum in Corsica (+ 314%) and minimum in Auvergne (+ 37%). For the whole of France, the estimated truncated 20-85 + standardized rate, was respectively, 14.1 and 22.5 per 100,000 in period 2000-04 and period 2010-14, which represents a 60% increase between these two time periods. At the regional level, the maximum variation was found in Languedoc-Roussillon (107%), the minimum in Nord-Pas-de-Calais (40%). CONCLUSIONS: The bayesian approach of the age-cohort model is increasingly used because it produces stable projections, without having to include other cancer parameters. Nevertheless, it would be interesting to extend this model by incorporating a tobacco consumption component, in order to assess scenarios based on consumption decreases.

Adult↗
PubMed2002

[Anesthesiologists in France. First results of the national survey conducted in 1999 by the French College of Anesthesiologist, The French National Society of Anesthesia and Intensive Care with the scientific support of the National Institute for Demographic Studies].

OBJECTIVES: Fears related to the future of anaesthesia manpower in France have led the French College of Anaesthesiologists (Cfar) and the French Society of Anaesthesia and Intensive Care (Sfar), in scientific partnership with the National Institute for Demographic Studies (Ined), to set-up a national survey among French anaesthetists (MAR) practicing in France, to describe their demographic evolution and to analyse their professional activities. METHODS: The survey was based on a personal questionnaire, filled by each individual, approved by the National Commission on Informatics and Freedoms (CNIL). The survey was conducted in November 1998, in the 1484 hospitals, public (590) and private (894) where anaesthetics are performed, under the control of local and regional referents. RESULTS: The anaesthesiologists positions count gave a total of 9741 positions shared between 5694 in public practice (58%), 3569 in private practice (37%) and 478 in private hospitals taking part to the national health service-PSPH (5%). The evaluation of the number of anaesthesiologists from the number of positions has made necessary a methodology of rectification of the survey to take in account the lack of response and the multiple sites of activity. The survey allows an evaluation of around 8876 physicians practising anaesthesia and intensive care in France at the beginning of 1999, among them 216 overseas. This census is in concordance with the count made by the Medical Council--Ordre des médecins--which published a number of 8716 anaesthesiologists in France, and 234 overseas, at the 1st January 1999, corresponding to a total of 8950. The annual demographic growth has felt from 9% per year, before 1989, to reach the level zero, in 1999. The masculinisation of the speciality is growing with a proportion of 35.7% of females, as well as ageing, the overage of age increasing from 42.8 in 1989 to 45.9 years in 1999. The pyramid of ages does not correspond to a growing population but to ageing people due to a decrease of the youngest classes. The medical density of 14.75 anaesthesiologists for 100,000 inhabitants in 1999, compared to 12.9 in 1989, is slightly above the European average, but the geographic distribution is very unequal between north and south, the large cities, centre of a university hospital, and the smaller one even if a reduction of differences is observed. The study and the analysis of professional activities bring important data to take in account side of demographic evolution. CONCLUSION: The demographic evolution must integrate non-only the reduction of the entries in the speciality, of the retirements, but also the sociological evolutions linked to the working time reduction. The solutions face to the promised shortcut of manpower consist of a reorganisation of the structures, a new definition of tasks and managements, without the possibility to avoid and adjustment of the anaesthesiologists population.

Adult↗
PubMed2005

[Selective cyclooxygenase-2 inhibitors. A population-based analysis of use in France over a three-year period and comparison with randomised clinical trials].

OBJECTIVES: The use of selective cyclooxygenase-2 (COX-2) inhibitors is highly controversial today, mainly because of doubts about cardiovascular tolerance. Few studies have assessed the use of these drugs in daily clinical practice. This study aims to assess the changes in their use in daily practice in France and to compare it with their use in randomized clinical trials. METHODS: The French National Health Insurance Fund AMPI database of self-employed workers in non-agricultural occupations was used to obtain the following information: patients requesting reimbursement for celecoxib and rofecoxib between November 2000 and October 2003, morbidity assessed by enrollment on the lists of chronic diseases for which care is fully (100%) reimbursed, pregnancy (assessed by the payment of physicians' or hospital fees for delivery or by maternity benefits), and concomitant drugs (by claims for reimbursement). We compared these patients with those in randomized clinical trials (RCT) of celecoxib or rofecoxib published in either English or French before November 2003; we focused on their demographic characteristics, morbidity, pregnancy and concomitant drug use. RESULTS: Use of COX-2 inhibitors in France did not vary over the study period, except for patients' mean age (range: 64.2-62.9 years), proportion of women (56.7%-54.7%) and use of gastroprotective drugs (18.2%-28.4%). The mean age of patients in our study was 10 years older than that of RCT patients, and the proportion of women in our study was 15% lower. The percentage of women who took these drugs while pregnant was 0.02% in our study and 0.09% in the RCT. The percentage of patients with long-term chronic disorders overall was higher in our study than in the RCT, and the percentage for all specific long-term diseases except rheumatoid arthritis was also higher (for example, more patients had cardiovascular diseases or diabetes in our study [15%] than in the RCT [6%]). Patients in our study also used concomitant drugs from 9 of the 14 principal Anatomical Therapeutic Chemical classification groups more frequently than RCT patients: for cardiovascular drugs, for example, the figures were 55% and 5%, respectively. CONCLUSION: The demographic characteristics, prevalence of chronic morbidity and use of concomitant drugs among COX-2 inhibitor users in France varied little over the three years after marketing approval. Compared with RCT patients, these users were less often female, were older and more often had cardiovascular diseases. Cardiovascular events occurring among COX-2 inhibitor users in France should be evaluated.

Adolescent↗
PubMed2006

[Epidemiology of tuberculosis in France].

Tuberculosis causes an ever-increasing public health burden throughout the world and is one of the World Health Organization's top priorities. In France, the incidence of tuberculosis has been stable at around 10 cases per 100 000 inhabitants per year since 1997. In 2004, the incidence rate in 2004 was 9.2 per 100 000, with substantial geographic disparities: the Ile-de-France region (including Paris and its suburbs) accounted for more than 40% of all reported cases (20.8 per 100 000). Incidence rates of tuberculosis vary according to the geographic origin: in France, this rate is highest among people from sub-Saharan Africa (incidence rate: 166.7 per 100.000 compared with 5.0 per 100.000 for those born in France). Pulmonary tuberculosis is the disease form most commonly observed (71.5% of cases). Among those cases, 76.9% were laboratory-confirmed in 2004. National guidelines to improve case management and disease control were updated in 2003 and 2005. Funding must be made available to reinforce tuberculosis surveillance and to conduct public health initiatives targeted at the populations most at risk.

Adolescent↗
PubMed2001

Incidence of Reye's syndrome in France: a hospital-based survey.

At the time of the study no information was available in France about the incidence of Reye's Syndrome (RS) and no warnings about RS and aspirin. The objective was to evaluate the incidence of RS in France by a hospital-based study. For a period of 1 year from November 1995 to November 1996, all French paediatric departments were required to report any child under 15 years with unexplained noninflammatory encephalopathy (i.e., CDC consciousness level stage I or deeper with normal CSF) and a threefold (or greater) increase in serum aminotransferase and/or ammonia. All suspected cases were classified by a panel of experts as probable RS or excluded RS. In 10% of randomly selected paediatric departments we checked that every suspected case had been reported. Forty-six suspected cases were reported during the year of the survey, of which 14 were classified as RS. Five of these 14 cases had a metabolic disorder. Nine children were definitively diagnosed as having RS (i.e., an estimated incidence of RS of 0.79/1,000,000 children, i.e., below 15/year). Eight children had been exposed to aspirin, four to aspirin alone and four to aspirin and acetaminophen. On the basis of these results the incidence of RS in France in 1996-1997 was not substantially different from that of countries where warning labels were already in use, but it was higher than in the US after 1994. This was probably due to the reduction in aspirin prescription in France because of warnings in Europe and the US and also because many cases of RS are now identified as metabolic disease. On the basis of these results and because the relationship between aspirin and RS has already been proved, public and professional warnings concerning RS on aspirin-containing products in cases of varicella and viral febrile illness have been adopted by the French Drugs Agency.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2003

[Imported malaria in children in France].

UNLABELLED: Among the European countries, France is the most affected by imported malaria. The aim of this study was to take stock of the situation of imported malaria in children in France. METHODS: Attacks of malaria in children less than 15-year-old which have been notified to Centre National de Référence des Maladies d'Importation (CNRMI) were reviewed retrospectively between 1995 and 1997 and 1995 and 1998 for severe malaria. RESULTS: Over a period of 3 years, 1256 malaria attacks were notified in children including 90.9% without signs of severity. The mean age was 7 years. Sex ratio was 1.19. About 44.5% were French. Most of the cases were acquired in Africa. Plasmodium falciparum was involved in 79.2% of the cases. About 61.8% of children have been under prophylaxis but only 37.9% admit good compliance. Chemoprophylaxis was frequently inadequate. Halofantrine was prescribed for 76% of these children. Over a 4-year period, 51 children were notified as severe malaria attacks. Among them, 17 had severe malaria as defined by the World Health Organisation criteria. Most of these patients (73%) were treated by quinine by intravenous route. Two children died. CONCLUSION: Paediatric malaria is not rare in France. Only the improvement of prophylaxis could decrease the incidence of malaria in France.

Adolescent↗