[Diffusion of information on medical causes of death: interview procedures and costs].
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Cause of Death↗
Biomedical subjects
F Hatton
Publications and source records attributed to F Hatton.
[Space-time clustering of sudden infant death in France from 1981 to 1986].
In tempered countries, higher sudden infant death rates are observed during winters, which is in favor of an infectious factor in the etiology. According to the geographic regions, the rates of SIDS are showing a downward gradient from the north of France to the south. In an attempt to assess the infectious hypothesis, we carried out a research about space-time clusters of Sudden infant deaths. The Knox's méthode was used with data of the medical causes of death registered in France from 1981-82 to 1985-86, by areas. Clusters were found in several regions, but they are moving from one year to another. The interpretation of these findings remains difficult because of the large number of tests.
Cause of Death↗
The epidemiology of head trauma in Aquitaine (France), 1986: a community-based study of hospital admissions and deaths.
This paper reports the findings of a study of head trauma conducted over a one-year period within a defined region with a population of 2.7 million (Aquitaine, France). It includes cases resulting in death prior to hospitalization or requiring hospitalization. During the one-year period, 391 deaths and 8549 hospital admissions due to head trauma occurred, yielding an annual estimate of 8940 head-injured people. The immediate case-fatality rate was 4.4%. Among non-fatal cases, 80% were mild, 11% moderate and 9% severe. The overall annual incidence was 281/100,000 in both sexes (384 and 185/100,000 in males and females respectively). The annual death rate was 22/100,000 (33 and 12, respectively). Patterns of incidence by age and sex were in general agreement with earlier studies. The main causes of head trauma were traffic accidents (60%) and falls (33%). One-third of hospitalized patients had no injury other than the head trauma. The most frequently associated injuries were those involving extremities, whereas the most severe were those involving the abdomen. The Injury Severity Score (ISS) ranged from 4 to 66, with a mean of 9 and a median of 5. At the eighth day following injury, 25% of hospital-treated patients were still hospitalized and 2% had died. The outcome correlated well with the ISS.
Accidental Falls↗
Sudden infant death and immunization: an extensive epidemiological approach to the problem in France--winter 1986.
In March 1986 five sudden infant deaths were reported, following the diphtheria-tetanus toxoids-pertussis and inactivated poliomyelitis virus (DTP-IPV) immunization of the infants concerned. An epidemiological study was carried out in order to investigate the possibility of a relationship between this immunization and sudden infant death syndrome (SIDS). A detailed examination of the five cases had been carried out by a doctor. An exhaustive survey of all postneonatal deaths occurring between January and March 1986 was conducted and also a matched case-control survey. No significant differences were found in the immunization rates between SIDS and other causes of death, nor between SIDS and living controls. These results are compared with the results from previously published studies on the topic.
Autopsy↗
Incidence, causes and severity of injuries in Aquitaine, France: a community-based study of hospital admissions and deaths.
This paper reports the results of a study of injuries conducted during a one-year period within a defined geographic population of 2.7 million persons (Aquitaine, France). Cases were defined as unintentional or intentional injuries, either resulting in immediate death before reaching hospital or requiring hospital admission. During the one-year period, 1,181 deaths were registered and 8,190 hospital admissions occurred during the sample periods. The three leading causes of injury were falls (40 per cent), traffic accidents (27 per cent), and poisonings (15 per cent). The overall incidence of injuries was 136 per 10,000 person years. Incidence by sex and age was assessed for the main external causes. The ratios of nonfatal to fatal cases were calculated by sex and age and by external cause. The origin of the injury was suicide in 14 per cent of cases and assault or homicide in 3 per cent. The severity of injuries, assessed using an automatic computation of the Injury Severity Score (ISS), ranged from 1 to 66 with a mean of 6.9. Substantial variations of ISS were observed according to external cause. At the 8th day following admission, 31 per cent of hospital-treated patients were still hospitalized and 0.8 per cent had died in hospital. The outcome correlated well with the ISS.
Accidental Falls↗
[Injuries and poisoning caused by various types of activities. Epidemiologic survey on death and hospitalization in Aquitaine].
From the data of a survey conducted in 1986 within the French area of Aquitaine and based on a representative sample of injuries having led to immediate death or hospitalization, different types of injuries were compared. Domestic and recreational accidents constituted the leading cause (41%) of injuries, followed by traffic accidents (28%) and suicides (13%). The overall ratio of immediate deaths to hospitalizations was 1 to 30 (1 to 10 for suicides, 1 to 20 for traffic accidents and 1 to 80 for domestic accidents). The overall annual incidence was 131 per 10,000 (respectively 20, 34 and 53 for suicides, traffic accidents and domestic accidents). The incidence by sex, age and type of accident was assessed. Among hospitalizations, about 3/4 of domestic and school accidents were falls; 45% of work accidents were cutting-piercing or being struck by an object, and 40% were falls; 90% of attempted suicides were poisonings. Using the Injury Severity Score (ISS), severity of injuries was the highest in traffic accidents. Traffic accidents also led to the highest hospital mortality within eight days (1.6%).
Accidents↗
Sudden infant death syndrome and diphtheria/tetanus toxoid/pertussis/poliomyelitis immunisation.
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Diphtheria Toxoid↗
Prediction of outcome of anaesthesia in patients over 40 years: a multifactorial risk index.
The prediction of outcome of anaesthesia in patients over 40 years of age was assessed using a multifactorial index based on current preoperative factors recorded prospectively. The study was conducted using a representative sample of anaesthetizations (except for cardiac surgery) including 517 cases with major complication (occurring during or within 24 hours of anaesthesia) and a one in fifty random sample comprising 1538 cases without complication. A split sample approach was adopted and a logistic regression model was applied to two subsets of similar size. Four preoperative factors were significantly associated with the occurrence of complications: ASA physical status, age, surgical procedure (major/minor) and type (elective/emergency). Goodness-of-fit of the model was assessed using another sample of 332 cases with complication and a different subset of 987 cases without complication. The model fitted the data well (p = 0.15).
Age Factors↗
The implications of a national study of risk of anaesthesia.
In order to set up measures to improve safety in anesthesia, the French Ministry of Health charged the Institut National de la Santé et de la Recherche Médicale (I.N.S.E.R.M.) with conducting an epidemiological survey of complications associated with anaesthesia. A prospective survey was carried out from 1978 to 1982 in a representative sample of 198,103 anaesthesias performed in 460 public and private institutions randomly selected throughout the country. There were 268 major complications associated with anaesthesia occurring during or within 24 hours after anaesthesia (incidence 1.35 per 1000), among these 67 were followed by death and 16 by coma. The incidence of deaths and comas totally attributable to anaesthesia was one per 7924. Half of the deaths and comas totally attributable to anaesthesia were from post-anaesthetic respiratory depression which could be directly linked to a dramatic lack of recovery rooms. The extension of the study to all institutions revealed that 25% of teaching hospitals, 43% of non-teaching hospitals and 20% of private clinics did not have a recovery room available. A total number of 12,000 recovery beds was estimated to be necessary in France; 40% being currently available leaving 60% to be created.
Anesthesia↗
Complications related to anaesthesia in infants and children. A prospective survey of 40240 anaesthetics.
A prospective survey of anaesthesia-related mortality and morbidity in infants and children was carried out in a representative sample of anaesthetics performed in 440 institutions chosen at random in France. A total of 40240 anaesthetics were administered to patients younger than 15 yr, 2103 (5%) involving infants (younger than 1 yr). Twenty-seven major complications related to anaesthesia occurred during or within 24 h of the anaesthesia--an incidence of 0.7 per 1000 anaesthetics. Nine, of which four were associated with cardiac arrest, were observed in infants, whereas in children there were 18 complications of which eight were associated with cardiac arrest, one with fatal outcome. The risk of complications was significantly higher (P less than 0.001) in infants (4.3 per 1000) than in children (0.5 per 1000). Accidents observed in infants mainly occurred during maintenance of anaesthesia and were the result of respiratory failure. In children, circulatory failure was as frequent as respiratory failure and complications were observed almost equally during induction and maintenance and on recovery. The rate of complications increased significantly with the ASA score and the number of co-existing diseases. The incidence was also higher when a previous history of anaesthesia was present, when the procedure was an emergency, and when the duration of preoperative fasting was less than 8 h.
Adolescent↗
[Relationship between the development of the health status and the activity of the health care system in developed countries].
The question of the relationship between the evolution of health status and the activity of health care system in developed countries is treated frequently through epidemiological studies. However, there are numerous methodological difficulties linked to this type of investigation and it is not possible to give a certain answer to this question. Particular difficulties concern the choice of indicators (indicators of health status and indicators of health care system). This choice may influence largely the outcome of the results. If general mortality has tended to decline over the last thirty years, some causes of death have progressed and many studies show an increase of the level of morbidity and disabilities declared in the population and an increase of social disparities in health status. The analysis concerning the role of health care systems, in order to explain this evolution, does not lead to a single conclusion. Some works show the positive effect of the activity of health care systems (especially for infant mortality). According to other authors, the growth of chronic diseases must be considered as the negative aspect of the success obtained in the struggle against mortality. But above all, interpretation of results needs a continuous reference to methodologies used and it is only on this condition that such data may be useful for public health decisions.
Aged↗
[Sudden infant death in France during the winter of 1986].
From the statistics of the medical causes of deaths and the results of a retrospective survey carried out among the physicians who certified the deaths, an analysis of post-neonatal mortality during winter of 1986 was undertaken in order to know if the relative part of the sudden infant death syndrome (SIDS) had increased during that winter. It appeared that the deaths attributed to SIDS can be distinguished from deaths of other causes for several factors (place of death, former status of the baby). However, the low number of post mortem examinations performed does not allow in all the declared cases to assess SIDS as internationally defined. However, it is shown that sudden mortality was not higher during this special winter and that immunizations were not more frequently related to this cause than to other causes of death.
France↗
[Digestive surgery in France. A national epidemiologic survey (1978-1982)].
An epidemiological survey, carried out from 1978 to 1982 in 460 public and private institutions randomly selected from all parts of France, provided an assessment of the activity performed in digestive surgery. The sample included 37,967 patients, yielding an annual estimation of 700,000 patients operated on in the entire country. Digestive surgery was the first surgical domain (20 p. 100 of the entire surgical activity); 51.5 p. 100 of the patients were males and 53 p. 100 were under 35 yr of age. The annual incidence of these operations was 1.3 per 100 population. The first reason for operation was appendicitis (43 p. 100), followed by hernia (17.2 p. 100), gallbladder and biliary tract (10 p. 100), and anal diseases (7.7 p. 100). Digestive cancers led to 32,000 operations each year, with a majority of colonic cancers (40 p. 100). Except for appendectomy and operations on the gallbladder and biliary tract, most procedures were more frequent in males, especially operations on the stomach and esophagus. Incidences of appendectomy, cholecystectomy, inguinal hernia repair and operations for digestive cancers were assessed by sex and age. Incidence of appendectomy was 3 to 4 times greater than in other countries. Intraoperative and immediate postoperative (less than 24 h) mortality was higher for digestive operations (4.7 p. 1000) than for surgery as a whole (2 p. 1000). It increased with age and was higher in males.
Adolescent↗
Asthma mortality in France.
Deaths caused by asthma are now recognized in all western countries, but they were only lately accepted in France because Laennec and Trousseau denied that patients with asthma may die of asthma. The "epidemic" of asthma deaths of the 1960s was not observed. Since 1968, it appears that asthma deaths decreased until 1974 for females and until 1980 for males, and then increased up to 2.9/100,000 in males and 3.6/100,000 for females. In the age group 5 to 34 years, there is a slight increase of deaths caused by asthma with a death rate of 0.35/100,000 in males and 0.39/100,000 in females. The ninth revision of the ICD did not lead to an increase in the number of reported deaths caused by asthma. In Denmark, death rates in the age group 5 to 34 years are similar to those in France, but in Germany they are much greater in number, and a clear increase was noticed. The causes of death of individuals with asthma in France are similar to causes reported in other countries, but deaths caused by specific immunotherapy may be more frequent because asthma is often treated by this form of therapy. Moreover, some deaths were associated with "corticophobia," with many patients preferring to use homeopathy or acupuncture.
Adolescent↗
[Relation between the level of the development of the care system and the level of "preventable" mortality according to department in France].
"Avoidable" mortality may be defined as a selection of causes of death whose occurrence is closely related to medical intervention. We have attempted to relate the variations in mortality from these selected causes to health service input among the 95 French departments. This analysis was controlled for social factors. Firstly we performed independently two factor analysis of the departmental variations in health care variables and in social factors. These studies were carried out with the aim of creating new discriminant and independent variables. Multiple stepwise regressions were then used to analyse the independent and joint associations of these new variables with mortality. The data show principally the considerable weight of social factors in explaining mortality differences. On the contrary, we found very weak relationships between health service input and mortality. However in view of the analysis method, it would appear unjustified to interpret this result in terms of a criticism of the "avoidable" mortality concept.
Adolescent↗
[Injuries requiring anesthesia. An epidemiologic survey].
An epidemiological survey carried out in 460 public and private institutions chosen at random country-wide in France made it possible to study injuries whose treatment had necessitated an anaesthetic. For 1980, the total number of anaesthetics administered for injuries was estimated at 450,600, among which 22% were applied in public teaching hospitals, 40% in non teaching hospitals, and 38% in private institutions. Of the total number of anaesthetics given, 41% were emergencies and 10% were repeat operations. The proportion of anaesthetics applied in treatment of injuries increases in the summertime and on weekends. There was a majority of male patients (61%), the most important group being those 15 to 24 years of age. Among females, the highest proportion of injuries was observed among those between 75 and 84 years of age. Fractures accounted for 58% of the injuries, open wounds for 20%, dislocations, sprains and strains for 10%. The incidence of injuries varied according to sex and age. Those exposed to the highest risk were males between 15 and 24, and females over 75. Incidence rates by sex and age were also assessed for fractures of the skull and face, upper limb, neck of the femur and lower limb.
Adolescent↗
[The role of a cultural factor in the educational practices of mothers of young children].
Through 3 groups of mothers, defined as belonging to 3 different geographical areas which are considered to represent cultural heritage, a series of educational practices towards infant under one year of age was studied. Among factors acting on practices which further the infants' contacts with others and exploration of environment, the usual sociodemographic characteristics play a part which is not greater than the one of the personal mother's dynamic and mostly of the cultural context (geographical area), which occurs as the first variable in a stepwise regression. When the child is 3 years old, durability of the maternal behavior is brought to the fore. The authors discuss the repercussion of these differences on the future of the children belonging to each of these groups.
Child Rearing↗
[Femoral neck fractures after age 65: morbidity, mortality, lethality].
In 1984, in France, 7,916 deaths of persons over 65 yr were due to femoral neck fracture (national statistics of mortality). In the same age group, the annual number of surgical procedures performed for this reason was estimated from a national survey to be 36,300 in 1980. The proportion of deaths and surgical procedures due to this condition increases with age and is always higher in females. The same result is observed concerning the annual incidence of deaths and the incidence of operations (2 p. 1000 in males, 6 p. 1000 in females over 65 yr). Lethality was assessed by relating figures of mortality and surgical morbidity (1 death p. 4.6 operations). It was higher in males (1 death p. 3.5) than in females (1 death p. 4.9). The difference between males and females was more marked in younger age groups (ratio of 3 in the 65-69 yr group) and decreased with age. This excess-lethality in males is partly due to a poorer preoperative condition, and especially to a greater frequency of coexisting respiratory failure.
Aged↗