Biomedical subjects
M H Bouvier-Colle
Publications and source records attributed to M H Bouvier-Colle.
Maternal deaths and substandard care: the results of a confidential survey in France. Medical Experts Committee.
OBJECTIVE: Confidential enquiries were carried out to attempt to understand why the level of maternal mortality has been high in France. STUDY DESIGN: A descriptive retrospective survey has been carried out. Five administrative regions participated in the survey. All maternal deaths--according to the WHO definition--that occurred in these regions over a period of at least 1 year were studied. A specialist completed a full medical questionnaire for each death. Then a committee of medical experts determined the reasons for the death and whether it might have been avoided. RESULTS: Forty-six deaths were recorded, 39 of which were classified as maternal. Haemorrhages were the leading underlying cause, then embolism and hypertensive diseases. Of the 39 deaths, 17 were determined to have been certainly avoidable, and nine more probably avoidable. More than half of all maternal deaths were related to inappropriate or substandard care. These results are discussed in the light of the British and Dutch experience with confidential enquiries into maternal deaths. CONCLUSION: There is no clear explanation why the French maternal mortality rate is high, but the study points out some malfunctions in health care service.
Autopsies of sudden infant death syndrome--classification and epidemiology.
An enquiry into sudden infant death syndrome (SIDS) in 1987 furnished us with detailed epidemiological data for 281 cases that underwent a thorough post-mortem examination. This analysis uses these data to evaluate the role the autopsy plays in explaining sudden death. The cases were classified into three diagnostic groups: explained causes of death (group 1), unexplained deaths with anomalies (group 2), and no anomaly (group 3). These 281 cases show the three essential features that characterize SIDS: over-representation of males, increased deaths during the second and third months of life, and increased deaths during winter. The autopsy examination revealed that many of these deaths had a medical explanation. Almost half were assigned to group 1. At the time of autopsy, no precise pathology could be diagnosed for 147 deaths; of these, 140 showed histological anomalies. There were only seven sudden deaths for which no abnormal sign was evident at the autopsy. These results are compared with those of similar studies and discussed in connection with three factors: the initial selection of cases, the nature and degree of the investigations, and the possible interpretations of the symptoms uncovered.
[Maternal mortality and birth distribution: a possible explanation of excess mortality in France].
Maternal mortality is higher in France than in most European countries with the same health standards. The analysis of the French rates shows that the changes, between 1975 and 1991, in the birth distribution according to the age of the mothers, explain 14% of all maternal deaths in 1991. The proportion of livebirths from mothers aged 30 years and over has increased from 21% in 1976 to 37% in 1991 in France and only 32% in England and Wales. For the period 1988-1990, crude maternal mortality was 9.4 per 100,000 livebirths in France and 7.4 in England and Wales. Direct standardization removes differences between birth distributions of each country and allows to calculate a standardized mortality rate of 8.6 for the French data. The variation between the crude and the standardized French rates is explained by the fact that 18 of the 210 deaths for the considered period were associated to the older mother's age distribution than in England and Wales.
[Sex-specific differences in mortality after high-titre measles vaccination].
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[Maternal mortality in France. Epidemiology and status of research].
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[Drugs: 10 years of recall from the market].
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[Automation of nominal data in the health field: legislation in France].
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Space time clustering of births in SIDS.
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[Sudden infant death: epidemiology].
Since 1985, in order to understand variations and factors related to the SIDS compared with the other causes of postneonatal deaths, several epidemiological studies have been carried out in France. The main results obtained so far are presented in this paper. The national rate of SIDS in France is estimated at 1.2 per 1,000 live births. The only specific risk factor for SIDS is age (2-4 months), though birthweight, prematurity and the younger age of the mother increase the probability of dying in the same manner as for accidental causes and all other postneonatal deaths. In addition we found discrepancies in the SIDS rates of babies according to the month of birth. The total probability of dying during the postneonatal period is lower in babies born during spring than in babies born during late summer or autumn. No significant differences were found in the DTP IPV immunization rates between SIDS and other causes of death or between SIDS and living controls.
[Risk factors of sudden infant death and of death by accidents. According to a national survey in the total postneonatal death].
BACKGROUND: The incidence of sudden infant death syndrome (SIDS) peaks at 2-4 month of age and during the colder months of the year. Other risk factors such as sex, birth weight, maternal age and multiple pregnancy also seem to be shared by the other causes of death after the neonatal period. POPULATION AND METHODS: A retrospective, exhaustive survey of all deaths of infants aged 28 days-one year was carried out between September 1986 to December 1987. The control group was a representative sample of the live births in France during 1989. The deaths were classified into 3 groups: group I, 1184 SIDS, group II 228 SIDS remaining unexplained after autopsy (out of 315 autopsied SIDS), and group III 83 accidental deaths. The factors studied were: sex, birth weight, maternal age, number of infants born from the pregnancy. The risk factors were measured by Odds Ratios and the variables related to mortality were introduced into a logistic model. RESULTS: Incidence of deaths peaked between the 2nd and the 4th month of age in groups I and II while deaths were evenly distributed throughout the first year in group III. Colder months, male gender, low birthweight, multiple birth and the young age of the mother all increased the risk of death in SIDS (groups I and II) but the same factors were also linked to accidental deaths. CONCLUSION: The results confirm those of earlier reports and raise the question why the risk factors for accidental deaths are similar to those for explained or unexplained SIDS, except for infant age.
[Incidence of autopsies in France. Consequence on the estimation of sudden death rate according to regions. Results from an epidemiologic survey on postneonatal mortality].
In order to assess the actual rate of sudden infant death in France, an epidemiological survey was carried out. All the deaths of the postneonatal period were investigated from September 1986 to December 1987. The parents of the babies and the certifying physicians were involved in the survey, the results of the post mortem investigations were recorded. That material showed a low rate of necropsies among the sudden infant deaths (31% at the national level) and wide variations in the rates between the French regions (from 55 to 7%). Nevertheless the results of the autopsies as well as the clinical aspects allowed to calculate the unexplained sudden infant death rates by region according to the Beckwith's definition. These rates are ranging from 0.8 to 1.9 per thousand live births (mean 1.3).
Reasons for the underreporting of maternal mortality in France, as indicated by a survey of all deaths among women of childbearing age.
Although maternal mortality is higher in France than in other European countries, hospital data prove that maternal deaths are underestimated. To assess the degree of underestimation and investigate the reasons for it, a retrospective survey was carried out among the certifying doctors of the 3045 deaths that occurred among women aged 15-44 years, from December 1988 to March 1989. Doctors were asked for information on the obstetric condition of the women and their health before death. Some 88.2% of those approached responded. Sociodemographic information was obtained from the French national record of causes of death. Although doctors reported gravid puerperal conditions on 41 death certificates, only 24 deaths were classified in the maternal mortality category of the International Classification of Diseases. The other 17 deaths were classified elsewhere. The present survey permitted the identification of 27 additional deaths of which 16 were considered as having obstetric causes. Of the 68 deaths in pregnant or puerperal women which occurred during the survey period, 54 were classified as having obstetric causes. No sociodemographic differences were found between the deaths registered in the national record and the newly identified maternal deaths. All deaths occurring during or after parturition were reported to the national record, but most of the deaths from abortion were identified from the survey. The discussion deals with the misclassification of maternal deaths and the difficulty of determining the underlying cause of deaths involving complex diseases or uncertain pathogenesis.
[Causes and risk factors in post-neonatal mortality in France in 1987 according to a national survey].
A stagnation in postneonatal mortality (28 days-1 year) is reported in France as in other similar countries. More than fifty per cent of these deaths are registered under the sudden infant death syndrome, a cause which is classified in the symptoms and ill-defined conditions chapter of the International Classification of Diseases. To establish the actual rate of sudden infant death syndrome (SIDS) it was necessary to carry out a specific retrospective survey. All postneonatal deaths (3917) registered in France from September 1986 to December 1987 were studied by means of questionnaires sent to the certifying doctor and to the families. The sudden infant death rate is estimated at 1.2 per 1,000 and the risk factors of the total postneonatal deaths are birthweight, prematurity, transfer into neonatal care unit, and age of the mother.
[Maternal mortality in France. Frequency and reasons for its under-estimation in the statistics of medical cause of death. Group of Experts on Maternal Mortality].
All deaths of women of reproductive age notified in France over four months were the subject of an enquiry carried out through the post to the doctors who had written the certificates of death. The objective was to try to evaluate the true maternal mortality on a national scale. This enquiry was carried out on 4,102 female deaths and showed that 68 of these (1.6%) were in pregnant or puerperal women. 45 of these deaths were classified as maternal which was twice the number that showed up on the official statistics of the causes of death. On one hand the under notification--due to failure to realise that the patient was pregnant at the time of certification, and on the other hand the under registration because of the complexity of the pathological states explain this under estimation. The frequency of maternal mortality has been evaluated at 18 per 100,000 live births and 60% of these deaths are considered as due to a direct obstetric cause. The most frequent causes are embolisms, then haemorrhages and hypertension of pregnancy.
[Suicide mortality in Aquitaine 1986-1988].
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[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.
"Avoidable" mortality and health services: a review of aggregate data studies.
STUDY OBJECTIVE: The aim of the study was to review published work reporting mortality from conditions amenable to medical intervention and compare the methods used and the results obtained. SOURCE MATERIAL: Two types of analysis were examined: (1) analyses of time trends, relating decline in mortality from amenable conditions to improvements in medical care (3 papers); (2) analyses of geographical variation, either between or within countries, in which mortality was related to the availability of health care resources and to other factors (8 papers). RESULTS: Time-trend studies have in general shown that mortality from amenable causes has declined faster over the past decades than most other causes of death. Studies of geographical variation have shown that mortality from amenable causes is consistently associated with socioeconomic factors, and that the association with the provision of health care resources is rather weak and inconsistent. CONCLUSIONS: (1) The low levels of mortality from amenable causes which presently prevail in industrialised countries are likely to reflect, at least in part, the increased effectiveness of health services; (2) geographical variation in mortality from amenable causes has not yet been shown to reflect differences in effectiveness of health services; and (3) if geographical variation in avoidable mortality does reflect such differences, they must arise from circumstances other than the level of supply, for example from more specific aspects of health care delivery, and are probably closely related to socioeconomic circumstances. In depth studies at the individual level are now more likely to produce information about factors limiting the effectiveness of health services than further studies of aggregate data.