Objectif.– Dans le cadre du programme de surveillance epidemiologique des troubles musculo-squelettiques mis en place par l’Institut de veille sanitaire, la hernie discale operee (HDO) a ete retenue comme traceur de la pathologie rachidienne. L’objectif est ici de decrire les risques de HDO selon les secteurs d’activite et les categories professionnelles et mesurer leur contribution a la survenue de cette pathologie. Methode.– Une etude a ete menee en population generale a l’aide des donnees du Programme de medicalisation des systemes d’information (PMSI) dans les centres de chirurgie rachidienne de la region des Pays de la Loire. Les cas sont les sujets operes en 2007–2008, âges de 20 a 64 ans et habitant la region : 3150 cas ont ete identifies par le PMSI des centres participants, quel que soit leur âge. Ils ont recu un questionnaire permettant de recueillir leur histoire professionnelle et medicale. Les risques de HDO selon les secteurs d’activite et categories professionnelles ont ete estimes par le risque relatif ajuste sur l’âge (RRa). La contribution des secteurs ou des categories professionnelles a la survenue de la HDO a ete quantifiee par la fraction de risque attribuable dans la population (Frap). Resultats.– Parmi les questionnaires, 1860 ont ete completes (taux de reponse : 66,5 %). Parmi les repondants, 1670 (909 hommes et 761 femmes) etaient eligibles. Quatre-vingt pour cent d’entre eux occupaient un emploi au moment de l’operation. Chez les hommes, la categorie professionnelle presentant le risque le plus eleve etait celle des ouvriers (RRa = 1,5 [1,4–1,8]), notamment des ouvriers qualifies de type industriel ou artisanal ainsi que ceux de la manutention, du magasinage et du transport. La categorie professionnelle pesant le plus dans la survenue de la HDO dans la population etait celle des ouvriers (qui contribuent pour 15 % des cas : Frap = 15 [10–19]). Chez les femmes, un exces de risque etait trouve pour les employees (RRa = 1,3 [1,1–1,5], Frap = 9 [4–15]), surtout les employees civiles et agents de service de la fonction publique, les employees de commerce et les personnels des services directs aux particuliers. Les secteurs d’activite les plus a risque etaient chez les hommes la construction (RRa = 1,6 [1,3–1,9]) et chez les femmes, le transport et l’entreposage, l’hebergement et la restauration, les arts, spectacles et activites recreatives, les activites des menages en tant qu’employeurs. Conclusion.– Cette identification des secteurs et categories professionnelles les plus a risque peut contribuer a l’elaboration de politiques de prevention en milieu de travail.

Currently, the engagement of local communities in Health Impact Assessment is becoming more and more important. A scoping review was performed to take stock of visions, methods and experiences in this field.A combined Scopus and Medline search yielded 100 articles in scientific journals. The final selection consisted of 43 papers, including case studies, evaluation studies, reviews, and opinion papers. After analysis, consultation of four experts was performed to check preliminary study outcomes. A grey literature web search was performed to check and complement the results.Results show that community participation is generally considered a core element in HIA. Views as expressed in the papers concern, firstly, the need for and value of local knowledge, secondly, the adherence to or application of democratic values and, thirdly, empowerment of communities. Three categories of methods are used in relation to community participation, often in combination: methods to facilitate knowledge elicitation, to ensure the inclusion of communities in the HIA process, and to build community capacity to participate in policy development. However, the theoretical or practical underpinning of the choice for specific methods is mostly not presented. The experiences described in the papers mainly focus on the access to local knowledge and its usability as a source of evidence in the HIA process. Described effects of community participation are (improved) relations between communities and local agencies, policy makers and professionals and the empowerment of community members. Although these effects are ascribed to community participation, many papers do not provide support for this conclusion beyond the retrospective perception of participants. Expert consultation and additional analysis of the grey literature supported the results derived from the scientific literature and provided more in-depth knowledge. In the grey literature theoretical frameworks, methods and tools for community participation in HIA were more extensively reported as compared to the scientific literature.We conclude that the visions, methods and experiences concerning community participation show that a participative approach may contribute to better, context specific knowledge. It appears that participative HIA has health promotion potential as it helps develop responsive policies.To accomplish this, HIA should, firstly, be better embedded in broader health promotion programmes. Secondly, the methods and approaches for community participation applied in HIA should be theory-informed and well described. The grey literature offers entry points. Finally, more robust and systematic evaluation and research is needed to assess the impact of HIAs on communities and policies.

Approximately 1 million French-Canadians moved to the United States, mainly between 1865 and 1930, and most settled in neighboring New England. In 1900 almost a fifth of all persons born in French Canada lived in the U.S. These migrants exerted considerable efforts to maintain their language and to replicate their home country institutions, most notably the schooling system, in their new country. For decades, this resistance to assimilation generated considerable attention and concern in the U.S. The concerns are strikingly similar to those often invoked today in discussions of immigration from Hispanic countries, notably Mexico. Mexicans may not be assimilating into mainstream America as European immigrants did. We look at the convergence in the educational attainment of French Canadian immigrants across generations relative to native English-speaking New Englanders and to European Roman Catholic immigrants. The educational attainment of Franco-Americans lagged that of their fellow citizens over a long period of time. By the time of the 2000 Census, they appear to have largely achieved parity. The effects of World War II, especially military service, were very important in speeding up the assimilation process through a variety of related channels: educational attainment, language assimilation, marrying outside the ethnic group, and moving out of New England. Economic assimilation was very gradual because of the persistence of ethnic enclaves.

Cardiologists are interested in determining whether the type of hospital pathway followed by a patient is predictive of survival. The study objective was to determine whether accounting for hospital pathways in the selection of prognostic factors of one-year survival after acute myocardial infarction AMI provided a more informative analysis than that obtained by the use of a standard regression tree analysis CART method . Information on AMI was collected for 1095 hospitalized patients over an 18-month period. The construction of pathways followed by patients produced symbolic-valued observations requiring a symbolic regression tree analysis. This analysis was compared with the standard CART analysis using patients as statistical units described by standard data selected TIMI score as the primary predictor variable. For the 1011 84, resp. patients with a lower higher TIMI score, the pathway variable did not appear as a diagnostic variable until the third second stage of the tree construction. For an ecological analysis, again TIMI score was the first predictor variable. However, in a symbolic regression tree analysis using hospital pathways as statistical units, the type of pathway followed was the key predictor variable, showing in particular that pathways involving early admission to cardiology units produced high one-year survival rates.

Les patients trachéoventilés au long cours nécessitent une assistance ventilatoire en continu. En dehors de la phase initiale et des épisodes morbides aigus, ces patients peuvent bénéficier d'une prise en charge spécifique en secteur de soins de suite et de réadaptation (SSR) pour des prises en charge de rééducation, de convalescence ou de répit. Nous avons souhaité étudier la validité des données du PMSI-SSR sur un échantillon de ces patients.Nous avons tout d'abord comparé les données du PMSI-SSR des patients avec les informations contenues dans leur dossier médical (observation médicale et dossiers de soins). Puis, nous avons soumis pour évaluation aux producteurs de soins des établissements étudiés la description des modalités de prise en charge des patients selon le PMSI-SSR.La comparaison des données avec les dossiers des patients a permis de vérifier que l'étiologie et la manifestation morbide principale étaient correctement codées pour 86 % et 94 % des séjours respectivement. Les actes médicaux étaient correctement codés dans 77 % des cas contre 39 % des cas pour les actes de rééducation et réadaptation. Dans 55 % des cas, les actes de rééducation et réadaptation étaient absents des dossiers. Les producteurs de soins ont jugé que pour 30 % des actes de rééducation et réadaptation, le PMSI-SSR sous-estimait la fréquence de réalisation de l'acte. Dans 34 % des cas, des actes de rééducation et réadaptation étaient considérés comme réalisés par les producteurs de soins, mais n'étaient pas codés au sein du PMSI SRR.Tandis que les principales caractéristiques des patients étaient bien reportées dans le recueil PMSI-SSR, la réalisation de nombreux actes de soins était sous-estimée avec un défaut de traçabilité dans le dossier médical. Il s'agissait principalement d'actes réalisés de manière très fréquente chez ces patients trachéoventilés au long cours (par exemple la réalisation de sondages urinaires, de mobilisations articulaires, d'entretiens avec les familles).Long-term intratracheal ventilated patients need continuous artificial ventilation support. After the acute periods, these patients may benefit from dedicated follow-up in rehabilitation care centers. In this paper, we aimed to study the validity of the data provided by a French diagnosis-related group (DRG) information system.For a sample of intratracheal ventilated patients in two rehabilitation units, we compared the data provided in the DRG information system with the data available in the medical charts. Furthermore, we asked the medical, nursing and allied health staff to assess the data provided by the French DRG information system.The diagnosis was found accurate for 86% of hospital stays. In the DRG information system, 77% of the medical care, and 39% of the nursing and allied health care were mentioned correctly. Overall, 55% of the nursing and allied health care procedures in the DRG information system were not reported in the medical charts. The healthcare providers estimated that the frequency of the care provided was underestimated in the DRG information system for 30% of the nursing and allied health care.The patients' main characteristics were found correctly reported in the DRG information system. However, the diversity and the frequency of the care provided were underestimated. These underestimates were mainly related to care frequently provided in these patients (for example, urinary catheterization, massages, counseling for relatives).

La maladie coronaire demeure une des principales causes de mortalité en France. L'épidémiologie des syndromes coronaires aigus (SCA) regroupe l'étude des tendances de la mortalité, de l'incidence et de la létalité. La méthodologie inclut des données de registres des SCA populationnels et hospitaliers. Les taux d'incidence et de mortalité des SCA sont significativement plus hauts dans le nord que dans le sud de la France. Des améliorations significatives de la mortalité et de la létalité hospitalière par SCA ont été enregistrées de 1997 à 2002. Cependant, un ralentissement de la baisse des taux d'incidence des SCA a été notée pendant la même période et en particulier dans le sud de la France. La mort subite continue à être un enjeu majeur de santé publique en raison de la difficulté à mettre en place une politique de prévention efficiente. La gestion de la phase préhospitalière est également une cause importante d'inégalités de santé et mérite une analyse complémentaire de ces disparités. Des données récentes ont montré une nette amélioration des soins en phase aiguë mais les taux relativement élevés d'incidence des SCA souligne l'importance de promouvoir la prévention primaire et le dépistage des lésions athéroscléreuses peu avancées.Coronary artery disease remains a major cause of death in France. Epidemiology of acute coronary syndromes (ACS) encompasses the study of trends of mortality, incidence and case fatality. Methodology includes data from populational and hospital registries of ACS. Incidence and mortality rates of ACS are significantly higher in the North than in the South of France. Significant improvement of ACS mortality and hospital case fatality were registered from 1997 to 2002. However, a slow down in ACS incidence rates was shown during the same period and particularly in the South of France. Sudden death continues to be a major health concern due to problems of prevention. Pre-hospital management is also a major source of health inequalities and this merits further analysis of those disparities. Recent data have shown large improvement in acute coronary care but the relatively high rates of ACS incidence stress the need to promote primary prevention and the screening of minor atherosclerosis lesions.