Introduction: Carotid artery dissection occurs as a result of the split of the vessel wall with the formation of intramural hematoma that leads to narrowing of the lumen and is usually localized in the extracranial internal carotid artery (ICA).

The low birth weight of infants is a major public health problem of unknown cause in Benin. We recruited 4,213 pregnant women from a maternity ward in Cotonou for a prospective study. The women were interviewed and further information was obtained from their maternity records. The women were followed until delivery. We found that 6.9% of the births occurred pre-term and there was intrauterine growth retardation in 10.9% of cases. Multiple regression analysis showed that the risks of giving birth to underweight infants were highest for women who were themselves underweight, who had complications due to bleeding or malaria or had social and psychological risk factors. For these particular women, unwanted pregnancy (ORa = 1.60; CI = 1.30-2.00) and lifting heavy loads (ORa = 1.30; CI = 1.10-1.60) were high risk factors. However, adequate prenatal care (ORa = 0.85; CI = 0.69-0.99) and having given birth before were protective factors, reducing the likelihood of a low birth weight. These results have implications for preventive care, in terms of nutrition during pregnancy and psychosociological factors.

This study aimed to determine whether a relationship exists between smoking and intrauterine growth retardation (IUGR). In the city of Cotonou Benin smoking is becoming increasingly popular and prevalence of IUGR remains high. Data were collected on 4113 women during 1991-92 randomly recruited in prenatal care facilities and followed up until delivery. Results revealed that of 4113 women enrolled in the study 10.9% of pregnancies were compatible with the definition of IUGR and 6.9% ended prematurely. Smoking prevalence was 8% in the study sample. Among smokers the IUGR rate was 4.5%; it was 22% among nonsmokers. Most IUGR women were married between 20 and 34 years old and of low socioeconomic standing. Mothers of IUGR newborns made inadequate use of prenatal services compared with mothers of normal infants. These results indicate a positive association between smoking and IUGR after adjustment and despite a relatively small number of smokers. It has been shown that maternal smoking increases the risk of dependence in female offspring. The fight against smoking may have a beneficial effect on future generations. It would be appropriate in Benin to inform adolescent girls about the dangers of smoking for themselves and for the children they will have.

Background The aetiology of multiple sclerosis (MS) remains poorly understood. Dental amalgams containing mercury have recently been suggested as a possible risk factor for MS.Methods In a case-control study conducted between 1991 and 1994, we interviewed a total of 143 MS patients and 128 controls, to obtain information on socio-demographic characteristics and the number of dental amalgams and the time since installation based on dentists' records.Results Neither the number nor the duration of exposure to amalgams supported an increased risk of MS. After adjustment for age, sex, smoking, and education those who had more than 15 fillings had an odds ratio (OR) of 2.57 (95% CI:0.78-8.54) compared to those who had none; for individuals whose first amalgam was inserted more than 15 years prior to the study, we found an OR of 1.34 (95% CI:0.38-4.72).Conclusions Although a suggestive elevated risk was found for those individuals with a large number of dental amalgams, and for a long period of time, the difference between cases and controls was not statistically significant.

BACKGROUND:It has been suggested that nutrition and food patterns, particularly high consumption of animal fat and low intake of fish products, may play a role in the aetiology of multiple sclerosis (MS).METHODS:The relation between nutritional factors and MS was studied among 197 incident cases and 202 frequency matched controls in metropolitan Montreal during 1992-1995. Dietary information was collected by employing a 164-item food frequency questionnaire in a face-to-face interview.RESULTS:An inverse association was observed between high body mass index (BMI) and the risk of MS, with an odds ratio (OR) of 0.76 (95% confidence interval [CI]: 0.61-0.95), per 5-unit increase in BMI, both sexes combined. In addition, taller women showed a greater risk for MS; the OR per 10 cm increase in height was 1.58 (95% CI: 1.06-2.35). In continuous variable analyses, using the difference between the lowest and highest quartile of intake as a unit, a positive association was observed with energy and animal fat intake. The OR per 897 kcal increase was 2.03 (95% CI: 1.13-3.67) and 1.99 (95% CI: 1.12-3.54) per 33 g of animal fat intake above the baseline. A significant protective effect was observed with other nutrients, including vegetable protein, dietary fibre, cereal fibre, vitamin C, thiamin, riboflavin, calcium, and potassium. Similar trends were seen for males and females when analysed separately. With respect to specific foods (as opposed to nutrients), a higher intake of fruit juices was inversely associated with risk (OR = 0.82; 95% CI: 0.74-0.92). A protective effect was also observed with cereal/breads intake for all cases combined (OR = 0.62; 95% CI: 0.40-0.97) and for fish among women only; pork/hot dogs (OR = 1.24; 95% CI: 1.02-1.51) and sweets/candy (OR = 1.29; 95% CI: 1.07-1.55) were positively associated with risk.CONCLUSION:The study generally supports a protective role for components commonly found in plants (fruit/vegetables and grains) and an increased risk with high energy and animal food intake.

The HIV/AIDS threat continues in African countries, including the Republic of Benin, during this period of economic crisis which is accentuated by the devaluation of the currency. National statistics from the Ministry of Health indicate a progression of the number of cases seropositive for HIV and the number of cases developing AIDS. Concomitantly, we observe a decrease of the number of teenagers fearing HIV infection and a spread or risky sexual behavior, such as unprotected sex. Despite the weak prevalence of HIV infection in Benin, the increase of the number of cases with AIDS remains a serious social problem. This paper describes the epidemiological pattern of AIDS and its social, demographic and economical implications as they affect the current national program to increase the awareness of the problem. We obtained scientific information on the epidemiological chain of AIDS morbidity from prior research results, data from the disease control centers and interviews with the parents of some patients. Quantitative data was collected from twenty selected disease control centers of the national program against AIDS from 1986 to 1995. We compared these data with data obtained by the WHO from 1986 to 1992 from the neighboring countries of Benin. We observed an exponential growth of the cumulative number of AIDS cases, from one declared case in 1985 to 1,280 cases in 1995, including twenty thousand cases seropositive for HIV in 1991. The majority of cases were people between 20 and 49 years old and were predominantly males. Heterosexual (73%), homosexual (0.8%), and mother to child vertical transmission were the principal modes of transmission registered for carriers of HIV-1, HIV-2, or both. The qualitative study revealed a social situation dominated by verbal violence against infected women, absenteeism at work of the patients' family and, friends and a psychological impact on the children of the patients. An evaluation of the direct costs of AIDS was estimated to be $217,600 (US $) for the 1,280 reported cases. We suggest further reinforcement of the program to raise the awareness of the young people in the urban and rural areas of the country.

The aim of this study was to evaluate the performance of a simple and inexpensive homemade urea test (U-test) to detect Helicobacter pylori in upper digestive tract biopsies. We tested and compared the U-test with three other diagnostic methods: the Clo-test, and culture and pathology in 110 patients randomly chosen at the endoscopy clinic. When using culture and/or pathology as the “gold standard”, H. pylori was found to exist in 54 patients. Pathology was positive in 50 cases (92.5%), culture in 49 (90.7%), the U-test in 45 (83.3%), and the Clo-test in 43 (79.6%). With regard to culture pathology, the sensitivities of the U-test and the Clo-test were 83.3% and 79.5%, respectively. Specificity was 100% for both methods. The κ coefficient calculation between the U-test and the Clo-test was 0.98. The results show that the U-test is a reliable, fast, and inexpensive method for detecting H. pylori in upper gastrointestinal biopsies.

Knowledge of the spatial distribution of diseases provides useful information in etiologic research and in implementation of preventive activities in community health. Spatial autocorrelation analysis is one of the various methods that enables to determine spatial clustering of diseases. This method has not been applied to lung, stomach and colon cancer in Québec. These cancers are frequent and are associated with environmental factors. The objectives of the study are to determine spatial distribution of incidence rates of these cancer sites by sex and to help generate etiologic hypotheses. Community health departments (CHDs) of residence are considered as risk markers since their population and environment may be related to the selected cancer sites. Data were obtained from Québec Cancer Registry. Rates were standardized by the direct method. Autocorrelation analysis was done through BW coefficient and Moran's coefficient I for correlograms. Results of standardized rates were compared to those of non standardized rates. Rates yielded the same results for the BW coefficient. Conversely, results were quite different for the correlograms. This implies that results from standardized rates should be kept since the age structure of CHD populations are different. Important variation in the level of spatial autocorrelation was found among the six sex-specific cancer sites. For male lung cancer and male stomach cancer first-order neighbouring CHDs showed similar incidence rates according to a geographic gradient. Female lung cancer exhibited spatial autocorrelation. Absence of spatial autocorrelation for colon cancer suggests that CHD is not the appropriate scale for study of this cancer and allows use of conventional epidemiologic methods. These results are discussed in relation to current etiologic hypotheses.(ABSTRACT TRUNCATED AT 250 WORDS)

In Benin, as in other African countries, low birthweight infants is a major health problem with poorly understood causes. In a case-control study of 2114 mothers recruited before discharge from the "Lagune" maternity ward at Cotonou, we examined the relationship between spontaneous abortion and low birthweight infants in women who delivered between 15 June 1990 and 20 July 1991. Information was obtained by interview then on the basis of hospital files. The results indicated that there was no association between spontaneous abortion and premature birth: OR = 1.00 (95% CI = 0.61-1.56). Likewise, the relationship between a past history of spontaneous abortion and intrauterine growth retardation was not significant: OR = 1.19 (95% CI = 0.83-1.71). Adjustment with characteristics of the mothers did not improve the correlations. It is concluded that there is no relationship between a past history of spontaneous abortion and low birthweight.

Les études sur la distribution spatiale des maladies fournissent des informations précieuses à la recherche épidémiologique et à la mise en oeuvre de mesures préventives en santé communautaire. Parmi les diverses méthodes utilisées dans ce type d'étude figure l'autocorrélation spatiale. Son intérêt est de délimiter des configurations de regroupement spatial des maladies dans les unités territoriales. Au Québec, cette méthode n'a pas été appliquée aux cancers du poumon, de l'estomac et du côlon. Ces cancers sont fréquents et sont associés à des facteurs environnementaux. L'objectif de ce travail est de mettre en évidence la distribution spatiale des taux d'incidence de ces cancers par sexe au niveau des départements de santé communautaire (DSC) et d'aider à générer des hypothèses. Le DSC de résidence est considéré comme un marqueur de risque cancérigène à cause des caractéristiques liées à la population et à l'environnement. Les données proviennent du Fichier des tumeurs du Québec et couvrent la période 1984–1988. Les taux ont été standardisés par la méthode directe. L'analyse de l'autocorrélation a été faite par le coefficient BW et par le I de Moran pour les corrélogrammes. Les résultats des taux standardisés ont été comparés à ceux des taux non standardisés. Les taux produisent les mêmes résultats pour le coefficient BW. Les résultats sont par contre très différents pour les corrélogrammes. Cela implique que l'on devrait retenir les résultats des taux standardisés, eu égard aux compositions par âge différentes de la population des DSC. Les variations du niveau d'autocorrélation spatiale entre les six sièges anatomiques ont été importantes. Pour les cancers du poumon et de l'estomac chez les hommes, les DSC voisins montrent des taux d'incidence semblables selon un gradient géographique. Une autocorrélation a été également obtenue pour le cancer du poumon chez la femme. L'absence d'autocorrélation spatiale pour le cancer du côlon suggère que le DSC ne constitue pas l'échelle appropriée pour l'étude de ce cancer, ce qui autorise l'utilisation des méthodes épidémiologiques habituelles. Ces résultats sont discutés à lumière des hypothèses étiologiques actuelles. Des études ultérieures sont nécessaires pour le cancer du poumon et de l'estomac.

Among 3225 deliveries in two Cotonou public maternity units, 244 primary cesarean section were observed during July 1988 to December 1989. Primary cesarean section incidence varied according to indications, maternal parity and maternity care units. Foetal distress (65.9%), malpresentation and cephalopelvic disproportion (22.1%) were the dominant organic risk factors for the primary cesarean section. Multivariate stepwise logistic regression technique indicated that the most important indications for the practice in Cotonou were mainly organic risk factors, maternal height and parity as well as repeating stillborn history. Practician experiences (OR = 6.6) and foetal distress (OR = 9.3) in the decision making process were highly associated to cesarean section and differed between maternity units. Authors provided some suggestion for improving the practice of cesarean section in Cotonou and in Bénin.

Among 3225 deliveries in two Cotonou public maternity units, 244 primary cesarean section were observed during July 1988 to December 1989. Primary cesarean section incidence varied according to indications, maternal parity and maternity care units. Foetal distress (65.9%), malpresentation and cephalopelvic disproportion (22.1%) were the dominant organic risk factors for the primary cesarean section. Multivariate stepwise logistic regression technique indicated that the most important indications for the practice in Cotonou were mainly organic risk factors, maternal height and parity as well as repeating stillborn history. Practician experiences (OR = 6.6) and foetal distress (OR = 9.3) in the decision making process were highly associated to cesarean section and differed between maternity units. Authors provided some suggestion for improving the practice of cesarean section in Cotonou and in Benin.

Among 3225 deliveries in two Cotonou public maternity units, 244 primary cesarean section were observed during July 1988 to December 1989. Primary cesarean section incidence varied according to indications, maternal parity and maternity care units. Foetal distress (65.9 %), malpresentation and cephalopelvic disproportion (22.1 %) were the dominant organic risk factors for the primary cesarean section. Multivariate stepwise logistic regression technique indicated that the most important indications for the practice in Cotonou were mainly organic risk factors, maternal height and parity as well as repeating stillborn history. Practician experiences (OR = 6.6) and foetal distress (OR = 9.3) in the decision making process were highly associated to cesarean section and differed between maternity units. Authors provided some suggestion for improving the practice of cesarean section in Cotonou and in Benin.

A population-based echotomographic (ECT) and serological survey of hydatidosis was carried out in a high risk community located in Central Tunisia. 1434 subjects over 5 years of age (93.3% of the population in this age range) underwent an abdominal echotomography (ECT) and a serological test (ELISA with confirmation by counterelectrophoresis). The ECT prevalence rate was 3.5% and increased with age reaching 7.7% in the over 39 years age group. Most subjects (96.0%) had liver cyst(s). The serological prevalence rate was 2.9%. A strong agreement was found between ECT and serological results (Kappa test = 0.449). Taking ECT as a reference, the relative specificity and sensitivity of serology were 99.3 and 62.0 respectively. Most ECT positive seronegative subjects had calcified cysts. These results confirm the presence of highly endemic foci of hydatidosis in Central Tunisia, show a good agreement between serological and ECT results at a population level and demonstrate the high feasibility of ECT as a screening technique.

La prévalence de la maladie de Parkinson au Québec était de 84/100000 en 1985. Des études ont démontré une fluctuation importante dans la distribution régionale et évoqué des liens à des facteurs environnementaux. Nous avons voulu vérifier l'existence de ces liens, plus spéifiquement avec 3 métaux: le fer, ;e manganèse et l'aluminium. L'estimation de l'exposition environnementale à ces trois métaux et le risque qui en découle, ont 'eté évalués grâce à l'épinette rouge utilisée comme bio-indicateur. Les concentrations de métaux dans les arbres ont permis d'estimer les risques temporles pour chaque ville du territoire étudié. Ces risques, combinés à l'historique de résidence, ont permis de comparer l'exposition des parkinsoniens à celle des non-parkinsoniens. Il en ressort que l'exposition environnementale de ces deux groupes n'est significativement différente.

Parkinson's disease (PD) has been proposed to result from the interaction of aging and environment in susceptible individuals. The prevalence of PD in Quebec was 84 per 100 000 in 1985. The regional variation observed has been linked with several environmental factors. We intended to verify the existence of a relation between the development of PD with exposure to 3 metal pollutants: Fe, Mn, and Al. The choice of these metals rests on their potential presence in the environment caused by the industrial activity in the region studied, and on the fact that it theoretically favors the prevalence of the illness. Environmental exposure to these metals and the resulting risks were evaluated using red spruce as a bio-indicator. The metal concentrations in tree rings were determined by neutron activation analysis. These concentrations permitted a temporal estimation of contamination in each of the territories studied, from 1938 to 1987. The risk of environmental exposure was assumed to be proportional to the concentration of the metal. The calculated risks combined with the history of residence allowed a comparison between parkinsonians and controls. It appeared that environmental exposure to the metals was not significantly different between those two groups.

La prévalence de la maladie de Parkinson au Québec était de 84/100000 en 1985. Des études ont démontré une fluctuation importante dans la distribution régionale et évoqué des liens à des facteurs environnementaux. Nous avons voulu vérifier l'existence de ces liens, plus spéifiquement avec 3 métaux: le fer, ;e manganèse et l'aluminium. L'estimation de l'exposition environnementale à ces trois métaux et le risque qui en découle, ont 'eté évalués grâce à l'épinette rouge utilisée comme bio-indicateur. Les concentrations de métaux dans les arbres ont permis d'estimer les risques temporles pour chaque ville du territoire étudié. Ces risques, combinés à l'historique de résidence, ont permis de comparer l'exposition des parkinsoniens à celle des non-parkinsoniens. Il en ressort que l'exposition environnementale de ces deux groupes n'est significativement différente.Parkinson's disease (PD) has been proposed to result from the interaction of aging and environment in susceptible individuals. The prevalence of PD in Quebec was 84 per 100 000 in 1985. The regional variation observed has been linked with several environmental factors. We intended to verify the existence of a relation between the development of PD with exposure to 3 metal pollutants: Fe, Mn, and Al. The choice of these metals rests on their potential presence in the environment caused by the industrial activity in the region studied, and on the fact that it theoretically favors the prevalence of the illness. Environmental exposure to these metals and the resulting risks were evaluated using red spruce as a bio-indicator. The metal concentrations in tree rings were determined by neutron activation analysis. These concentrations permitted a temporal estimation of contamination in each of the territories studied, from 1938 to 1987. The risk of environmental exposure was assumed to be proportional to the concentration of the metal. The calculated risks combined with the history of residence allowed a comparison between parkinsonians and controls. It appeared that environmental exposure to the metals was not significantly different between those two groups.

ABSTRACT:We examined the role of the environment in the development of Parkinson's disease (PD). A group of 42 parkinsonians have been compared with a group of 84 matched controls. The epidemiological study (1987-1989) covered the territory of the Community Health Department of Valleyfield, in southern Quebec (Canada). Odds ratio adjusted for age and sex were calculated for seven environmental factors. A decreased risk for PD was associated with residence in rural areas (OR: 0.31; p ≤ 0.05) and residence near industry or mining (OR: 0.15; p ≤ 0.05). An increased risk for PD seems to be associated with occupational exposure to the three metals Mn, Fe and Al (OR: 2.28; p = 0.07) especially when the duration of exposure is longer than 30 years (OR: 13.64; p ≤ 0.05). Other environmental factors not found to be associated with PD were: pesticides manipulation, farm work, industrial work and well water consumption.

We examined the role of the environment in the development of Parkinson's disease (PD). A group of 42 parkinsonians have been compared with a group of 84 matched controls. The epidemiological study (1987-1989) covered the territory of the Community Health Department of Valleyfield, in southern Quebec (Canada). Odds ratio adjusted for age and sex were calculated for seven environmental factors. A decreased risk for PD was associated with residence in rural areas (OR: 0.31; p less than or equal to 0.05) and residence near industry or mining (OR: 0.15; p less than or equal to 0.05). An increased risk for PD seems to be associated with occupational exposure to the three metals Mn, Fe and Al (OR: 2.28; p = 0.07) especially when the duration of exposure is longer than 30 years (OR: 13.64; p less than or equal to 0.05). Other environmental factors not found to be associated with PD were: pesticides manipulation, farm work, industrial work and well water consumption.