Biomedical subjects

D Zmirou

Publications and source records attributed to D Zmirou.

64 records · Page 4Linked to original sources

PubMed1988

Comparison of bacterial indicators and sampling programs for drinking water systems.

A total of 48 French villages were selected for a survey of water quality from February 1983 to June 1984 as part of an epidemiological study conducted in the rural area of the Rhône-Alpes region. Water samples were collected and analyzed on a weekly basis in each village. Bacteriological analysis of each water sample included enumeration of standard plate count bacteria, total and thermotolerant coliforms, and fecal streptococci. The water quality regulations are examined as to the analysis frequency, the volume of samples, and the relationship between the various bacterial indicators. Analyzing 300-ml, instead of 100-ml, samples tends to generate better information on single water samples. However, if many samples are analyzed over time from the same community, the value of using large volumes of water samples is diminished. The comparisons between bacterial indicators showed that the information obtained from the various indicators was very similar. However, fecal streptococci had a better predictive value of a negative test than coliforms with respect to the French standards.

Bacteria↗

PubMed1988

A controlled evaluation of a health education programme for pregnant women in rural areas.

A controlled evaluation of health education for pregnant women was implemented from 1983 to 1985 in the French north alpine rural area with a quasi-experimental design. Altogether 116 villages (88,983 inhabitants) constituted the pilot zone where the programme took place. This was matched with a control zone of 114 villages (78,800 inhabitants) where routine antenatal surveillance was not changed. The programme involved a large group of health and social workers and institutions and several educational devices. There was a total of 3143 births to the study women during the programme. In all the 45 maternity clinics of the region the mothers were questioned as to their pregnancy history and delivery outcome. The programme succeeded in increasing, in the pilot zone, the proportion of women who benefited from a monthly antenatal visit, whereas no positive trend was shown in the control zones, even when controlling for some identified potential confounders (age and distance to health care providers). Similarly, women in the pilot zone were more likely to attend delivery preparation sessions than women in the control zone. However, many conditions revealed no differential modification in the two study zones. Perinatal morbidity is lower in the north alpine rural area than in the whole country. These results favour further development of social policies for pregnancy and of prenatal care, complemented by better information and training for health and social workers; they also favour better information as to medical monitoring, hygiene, and social rights related to pregnancy.

Female↗

PubMed1988

[A network of epidemiological information in community medicine practice: methodological principles of the VENUS Program].

Implementation of epidemiological studies involving the participation of large networks of ambulatory care physicians requires prior resolution of the methodological dilemma between a "volunteer sentinel doctors" approach and one based on sampling techniques. A study of the VENUS program (concerning Sexually Transmitted Diseases) illustrates this latter approach for which formulae are proposed for estimating the rate of incidence in the population. Methodological implications of this technique are commented upon, and the complementary indications for the two techniques for gathering information on ambulatory morbidity are discussed.

Ambulatory Care↗

PubMed1988

[Birth in the rural area: an evaluation of prevention of perinatal risk in rural areas].

A study was designed and implemented between 1983 and 1985 in order to evaluate the effectiveness of a personalized health education program designed for pregnant women in the specific context of rural areas. The action succeeded in increasing the proportion of women benefiting from a monthly antenatal surveillance but many other results underline the limitations of such prevention programs that would be restricted to the information of the general public and health professionals. Perinatal morbidity in the north-alpine rural area ranks very favourably compared to the regional or national figures.

Evaluation Studies as Topic↗

PubMed1987

A follow-up study of gastro-intestinal diseases related to bacteriologically substandard drinking water.

In a prospective follow-up study conducted in 52 French alpine villages, one weekly water sample was taken in each village provided with untreated ground water and analyzed as to the presence of four indicator bacteria: total plate count, total coliforms, thermotolerant (fecal) coliforms, and fecal streptococci. Cases of acute gastro-intestinal disease (AGID) occurring among 29,272 inhabitants were reported through physicians, pharmacists, and primary school teachers. A loglinear model identified fecal streptococcus (FS) as the best predictor; the presence of fecal coliforms enhanced the effect of FS. The total bacteria count and the total coliforms had no independent contributions. A threshold analysis suggested that any level of indicator bacteria above zero was associated with an excess of AGID.

Child↗

PubMed1986

[Longitudinal study of the risks related to the consumption of water not conforming to bacteriological norms].

A prospective follow-up study lasting 18 months in 1983-1984 was conducted in 50 villages in order to assess the risk related to the consumption of drinking water which did not meet the bacteriology standards. 119 physicians, 52 pharmacists and 118 primary-school teachers enumerated the cases of acute gastro-intestinal diseases observed among a population of 29,272 inhabitants. A weekly water sample was analysed in each village as to the presence of four indicator germs of fecal contamination: total plate count, total coliforms, fecal coliforms (thermotolerant) and fecal streptococci. 1,950 cases of acute gastro-intestinal diseases were registered by the physicians and pharmacists during a population experience of 1,873,303 persons-weeks, i.e. an incidence density of 1.06 X 10(-3) cases per person-week. The risk notified by the school teachers among children aged 7 to 11 was higher: 16.3 X 10(-3) cases per child-week. The villages were classified in 3 groups, according to the proportion of substandard samples: "good", "intermediate", and "bad" categories. The relative risk contrasting the "bad" and "good" villages was 3.5 for the cases notified by the physicians and the pharmacists among the general population (95% confidence interval = 2.5-4.8); it was 1.7 for the cases reported by the teachers among the children (95% confidence interval = 1.5-1.9). This concordant difference was very significant but not constant across the 18 months of the survey. The authors conclude that the bacteriology standards are a relevant indicator of a health hazard.

France↗

PubMed1985

[Clinical trial of an antipneumococcal vaccine in elderly subjects living in institutions].

Pneumococcal vaccine effectiveness was assessed in a randomized trial among 1,686 old people (mean age: 74, standard deviation: 4 years) living in 24 geriatric hospitals and 26 homes for the aged in our district; 937 were vaccinated with Merck-Sharp and Dohme pneumococcal vaccine (14 serotypes). The 749 others composed the reference group. This study was performed during 2 years, since December 1980. Both groups were randomized after a two-criteria stratification: by clinical risk assessed before the study, and by type of homes for the aged. Forty pneumonias were diagnosed, with 13 proved pneumococcal etiology. The incidence of pneumonia was significantly reduced in the vaccinated group (p less than 10(-4) but the mortality rate was not modified. We concluded in favor of the effectiveness of pneumococcal vaccine: etiological fraction 77.1% (51.2%-89.3% confidence limits, 95% risk) in the population we studied. The incidence of pneumococcal-proved pneumonia was not significantly reduced.

Aged↗

PubMed1984

[Epidemiologic study of the health effects of atmospheric waste from an industrial and household refuse incineration plant].

This article describes a 1981 study of the health effects of air pollution caused by incineration of industrial and household wastes. The study lasted 2 months and took place in a village of France's Isère department. A retrospective comparison was made of the consumption of medicines for respiratory problems over a 2-year period among 3 matched groups of residents. The groups represented 3 areas of the village situated, respectively, at 200 meters, 1 kilometer and 2 kilometers from the incinerator (the relative distance from the incinerator being used as an indicator of degree of exposure). The consumption of medicines was determined by analyzing Social Security forms filed by the residents after each purchase. The study revealed a strong heterogeneity in the consumption of medicines among the 3 groups: the variances in the number of medicines prescribed decrease significantly (p less than 1%, Bartlett test) as the distance of the residents' homes from the incinerator increases. The authors attribute this fact to the presence, in the group most directly exposed to the pollution, of subjects most affected by the respiratory effects of the polluted air. The mean levels of consumption of medicines (non parametric test) did not reveal any significant differences, though they ranged from 1 to 2.4. With these results in hand, the public health authorities fixed new norms for the operation of the incinerator.

Adolescent↗

PubMedDate not supplied

Relationships between nitrogen dioxide personal exposure and ambient air monitoring measurements among children in three French metropolitan areas: VESTA study.

In epidemiological studies, investigators have routinely used ambient air concentrations, measured by air-quality monitoring networks, to assess exposure of subjects. When there is great spatial variability of ambient air concentrations or when there are specific indoor exposures, this approach may yield substantial exposure misclassification and distort the associations between exposure and the health endpoints of interest. In 3 French metropolitan areas, the cross-sectional relationships between 48 hr of nitrogen dioxide personal exposure of 73 children and the corresponding 48-hr background ambient air concentrations were analyzed. The crude correlation between ambient air concentrations and personal exposures was poor in all cities (r2 = .009 for Grenoble, r2 = .04 for Toulouse, and r2 = .02 for Paris). These correlations were improved when the authors took into account other ambient air or indoor air sources of nitrogen dioxide emissions (the corresponding multiple linear regression, r2, increased to .43 in Grenoble, .50 in Toulouse, and .37 in Paris). The main variables that explained personal exposures were an index of traffic intensity and proximity and use of a gas cooker at home. The results of this study confirm that ambient air-monitoring site measurements are poor predictors of personal exposure. Investigators should carefully characterize the proximity of roads occupied by dense traffic to the home/school as well as indoor sources of nitric oxide emissions; both of these careful characterizations will assist researchers in the prediction of personal exposure in epidemiological studies.

Adolescent↗

PubMedDate not supplied

Short-term health effects of an industrial toxic waste landfill: a retrospective follow-up study in Montchanin, France.

A retrospective follow-up study was conducted in 1990 to assess the short-term health impacts of an industrial waste landfill. The site, located since 1979 in a French town of 6,000 inhabitants (about 100 m from the nearest houses) released volatile organic compounds (VOCs) into the air and provoked intense health concern in the community. The landfill was subsequently closed in 1988. Subjects were 694 inhabitants residing in three different parts of town. Individual exposure was estimated, using a dispersion model of volatile air pollutants and accommodated the daily activity patterns of each individual within the area under investigation. Surrogate morbidity data were derived from measurement of the consumption of drugs prescribed for specific therapeutic categories over a 3-y period (18 mo before and 18 mo after the site was closed). Although differences were not statistically significant, the most exposed subjects had been prescribed more drugs for diseases possibly linked to emissions from the site before it closed than the least exposed individuals. There was a suggestion of a slight trend in the consumption of drugs for ear, nose, and throat and pulmonary ailments with individual exposure levels. These results, and the review of toxicological data for some of the VOCs released by the dump, support the decision to close the site.

Environmental Exposure↗