Rev Epidemiol Sante
-
Rev Epidemiol Sante · Oct 2003
Review[Urban particulate air pollution: from epidemiology to health impact in public health].
Major air pollution accidents which occurred in the 1950s led to public awareness of the health hazards involved. Since that period, levels of air pollution have decreased, but several studies conducted in North America and Europe indicate that particulate air pollution is linked to increased cardiorespiratory morbidity and mortality. Despite this evidence, several questions were raised concerning the interpretation of the results (threshold effect, harvesting effect and biological plausibility). ⋯ Some causality criteria are more important than others, but they all support the causal nature of the relationship between air pollution and health, and thus justify the feasibility of health impact assessment calculations. Recent studies on relative risk assessment show that even if the risk linked to worsening air quality is low, public health consequences are high. Such information must be made accessible to policy makers and the population in general so that, together with the public health workers, they can all contribute to improving air quality and health in their communities.
-
Rev Epidemiol Sante · Oct 2003
Comparative Study[Causes of death in a cohort of EDF-GDF employees: comparison between occupational medicine and official statistics data].
In an epidemiological study, medical causes of death may be obtained from different sources. In a study on French gas and electricity company (EDF-GDF) workers, they were obtained from the national INSERM database. Additionally, the causes collected by the EDF-GDF occupational physicians were available for a subset of 1,330 deaths, which occurred between 1989 and 1994. The data from the two sources were compared with each other, in order to assess whether they were globally equivalent, and the potential impact of their differences on the results of epidemiological analyses. ⋯ Causes of death recorded in the INSERM and EDF-GDF physicians databases are very different. Therefore, using the national mortality rates computed by INSERM with the EDF-GDF physicians causes of death to calculate SMRs is not valid, and it is observed that they may be very different from those computed with INSERM data. In a general way, it should be better to use the INSERM database, which is a common source, in order to generate results comparable with other studies. However, this database has its own limitations, and it may be better, in particular situations and for internal analyses, to use another source if it seems to be a better one.
-
Rev Epidemiol Sante · Apr 2003
[I will quit tomorrow... Statistical portrayals of "dissonant smokers''].
This article aims to profile dissonant smokers (smokers who want to quit) from various viewpoints: smoking habits, reasons to quit, methods of quitting, health and socio-economic status. ⋯ The variety of dissonant smokers profiles underlines the need to diversify action against tobacco. Moreover, we have to pay attention to the impact of recent fear-arousing media campaigns. They certainly increase awareness of smoking-related health damages. Nevertheless, concerning addicted smokers who already want to quit but are affected by poor health and social handicaps, such campaigns may only increase psychological distress.
-
Rev Epidemiol Sante · Feb 2003
[Iron supplementation associated with malaria prevention among pregnant women in Abidjan].
Despite the demonstrated efficacy of iron supplements and malaria prevention, the effectiveness of antenatal care programs for prevention of anaemia (haemoglobin rate<11 g/dL) in pregnant women is low in West Africa. Apart from the issue of availability and despite low cost, the major reason evoked is the lack of motivation of pregnant women and health care professionals. In this study, iron supplements and malaria prophylactics were provided free of charge during pregnancy. The treatment was proposed at the first antenatal visit, with the objective of not interfering with routine practice of birth attendants and women in latter antenatal visits. ⋯ It is therefore important to reinforce the availability of treatments to prevent anaemia in pregnant women due to their demonstrated efficiency as a part of routine antenatal activities.
-
Rev Epidemiol Sante · Dec 2002
Comparative Study[Quality of medical database to valorize the DRG model by ISA cost indicators].
The use of the French version of the DRG model is focused on cost allocation, based on the case-mix system and the use a weight called ISA (Synthetic Index of Activity) for each DRG. However, this administrative database is becoming more and more used by both researchers and health policy makers for health planning and benchmarking. In France, data abstraction and coding of medical records is done by physicians. The objective of this study was to determine the accuracy of a database of the discharge summaries used for DRGs and to compare consequences of inappropriate coding on budget estimation and risk adjustment. ⋯ Discharge summaries used in the French DRGs system consistently underestimate the presence of comorbid conditions, which has direct implications for policy-makers comparing performance between hospital units. Both clinical practitioners and policy makers should be aware of this bias when assessing patient's quality of care or performing health planning through discharge summaries.