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Falls in older people are a major public health problem due to associated morbidity and mortality. Their origin is most often multifactorial.The objective of the present study, called ChuPaDom, was to identify patterns or profiles of home fallers (HF) - understood here as people who fall in their place of residence - among a sample of persons aged 65 and over who were hospitalized after a fall, and to study their association with falling-induced injuries using data from the ChuPAdom study.Multiple correspondence analysis and Hierarchical Clustering on Principal Components were performed. Multivariate logistic regression was used to test for associations between HF profiles and injuries.The sample comprised 1467 patients (69% female, average age = 84.5 years). Five profiles were identified: youngest seniors who took risks and fell from a raised height, youngest seniors with specific health problems who fell down a stairs, autonomous seniors who fell because they lost their balance or fell from their own height, dependent seniors who fell during low-intensity activities, very old seniors for whom missing data were frequent. Fractures were more frequent among the first profile than the last two profiles constituted with more dependent individuals (p 0.001).These results highlight the heterogeneity of the circumstances in which older people fall. A greater understanding of these circumstances is needed to implement targeted prevention actions.

Regular physical activity and sport have many health benefits but they can also result in injury, which can be quite severe. Data recorded from 2004 to 2013 in an Haute-Savoie emergency department for the home and leisure injuries survey (EPAC) were analyzed in order to describe the characteristics of sport related injuries in an area particularly attractive for winter and air sports. A total of 43,505 sport related injuries were recorded: team sports (30%), winter sports (25%) and cycling (23%) accounted for the most accidents. Men were more at risk than women (sex ratio = 2.3), and the age group 10-14 years were mostly injured (21% of all injuries). Overall, falls were the most frequent mechanism of injury. Climbing, winter sports and air sports led to the most hospitalizations. The risk of hospitalization following a sport related injury was higher in men, when age increased and when the place of residence was located outside Haute-Savoie. Complementary surveys are necessary to estimate the impact on injury incidence of the use of protective equipment (helmet, gloves), the level of sporting proficiency, level of supervision, or whether or not the victim was a member of a sport club.

Every year in France dog bites lead to several thousand visits to emergency departments and numerous hospital admissions.This study aims to describe the sequelae 16 months after dog bites.Following an initial epidemiological study on the severity of 485 dog bites carried out in 8 hospital emergency departments between May 1, 2009, and June 30, 2010, a second study investigating sequelae 16 months after the bite was conducted among 298 patients between September 2010 and December 2011. Data concerning patients' sequelae were collected by telephone or email.Almost half of respondents (47%) reported sequelae; of those patients, most of these reports were aesthetic (9/10). There were more sequelae when the bite was located in the head region or the lower limbs. Sequelae were more frequent among women, when the weight of the biting dog was higher, and when the initial severity of the bite was greater. On the other hand, the link between the patient and the dog, the sex of the dog, the type of aggression, and the age of the patient (15 years or ≥ 15 years) had no impact on the occurrence of sequelae. One patient in 7 still experienced pain 16 months after the bite; women were more likely to experience pain at that timepoint. No articles on dog bite sequelae were found in the literature.The dissemination of these results among professionals (veterinarians and doctors) and the general population will contribute to making dog owners more aware of the risk of bites and the means of avoiding them.

International audience; Background: There is a growing understanding of the role played by ‘neighbourhood’ in influencing health status. Various neighbourhood characteristics—such as socioeconomic environment, availability of amenities, and social cohesion, may be combined—and this could contribute to rising health inequalities. This study aims to combine a data-driven approach with clustering analysis techniques, to investigate neighbourhood characteristics that may explain the geographical distribution of the onset of myocardial infarction (MI) risk.Methods: All MI events in patients aged 35–74 years occurring in the Strasbourg metropolitan area (SMA), from January 1, 2000 to December 31, 2007 were obtained from the Bas-Rhin coronary heart disease register. All cases were geocoded to the census block for the residential address. Each areal unit, characterized by contextual neighbourhood profile, included socioeconomic environment, availability of amenities (including leisure centres, libraries and parks, and transport) and psychosocial environment as well as specific annual rates standardized (per 100,000 inhabitants). A spatial scan statistic implemented in SaTScan was then used to identify statistically significant spatial clusters of high and low risk of MI.Result: MI incidence was non-randomly spatially distributed, with a cluster of high risk of MI in the northern part of the SMA [relative risk (RR) = 1.70, p = 0.001] and a cluster of low risk of MI located in the first and second periphery of SMA (RR 0.04, p value = 0.001). Our findings suggest that the location of low MI risk is characterized by a high socioeconomic level and a low level of access to various amenities; conversely, the location of high MI risk is characterized by a high level of socioeconomic deprivation—despite the fact that inhabitants have good access to the local recreational and leisure infrastructure.Conclusion: Our data-driven approach highlights how the different contextual dimensions were inter-combined in the SMA. Our spatial approach allowed us to identify the neighbourhood characteristics of inhabitants living within a cluster of high versus low MI risk. Therefore, spatial data-driven analyses of routinely-collected data georeferenced by various sources may serve to guide policymakers in defining and promoting targeted actions at fine spatial level.

The objective of this study was to determine the time spent by children (0– 18 years old) in indoor places of leisure and also day-care centers. The sampling scheme was stratified by geographic region and size of town. This study was performed from September 2005 to March 2006. Families were asked to complete a diary by phone on their children's activities during the last week of school and the last week of a vacation period. The time spent in each place was then extrapolated for the winter period. We then evaluated the overall attendance and time (means and quartiles) spent by all of the children, and by those of children attending places. Information was collected on 2780 children. Gymnasiums were frequented the most (52.3% during the winter period) and were the places in which children spend the greatest amount of time (average: 19 min/day). Other places frequented the most included bars/restaurants (46.5%; average: 9 min/day), cinemas/theaters (42.2%; average: 10 min/day), and indoor pools (2...

The airborne contaminant exposure levels experienced by poultry farmers have raised concerns about the possible health hazards associated with them. Thus, a longitudinal project was instituted in France to monitor these exposures in poultry workers and to evaluate the long-term effect on health.Sixty-three workers in two different poultry housing systems were included (33 from floor-based systems and 30 from cage-based systems). Personal dust concentrations (over 2 days) and activity patterns (over 14 days) were collected and then modeled to obtain average long-term estimates. Health data were collected by questionnaire.The mean daily time spent in the cage system was more than 2 hours longer than in the floor system. Two main common tasks accounted for ~70% of this time. Dust concentrations were higher in the floor system than in the cage system. The concentrations for the 14 days of known activity patterns estimated using the statistical model agreed well with the measured values. Several chronic respiratory symptoms were significantly associated with the high levels of long-term exposure estimated by the model. The highest risk was for chronic bronchitis symptoms (4-fold higher for exposures of 0.1 mg/m(3) of respirable dust).The presented modeling strategy can be used to estimate the long-term average personal exposure to respirable dust, and to study the association between dust exposure and chronic respiratory symptoms. This population of workers will be followed-up in subsequent examinations (3 years later) to determine whether the predictive model is valid, and whether long-term dust exposure is related to the incidence of respiratory symptoms and changes in pulmonary functions.

Background Traumatic brain injuries (TBI) result most often from injuries which could have been avoided through preventive measures. They have very costly human and financial consequences. To contribute to the epidemiological surveillance of TBI, the objective of this project was to analyse hospitalizations for TBI in France. Methods Each hospitalisation results in a report containing information on the diagnosis, the treatment, the health condition upon discharge, etc. This database, called the Programme for the Medicalization of Information Systems (PMSI), is comprehensive. The main hospital diagnosis (MD) and associated diagnosis (AD) are coded in the International Classification of Diseases, 10 th Revision (ICD10). The selections were made from different ICD10 code lists used in the literature: “Intracranial injury” (S06 codes) always selected for TBI analysis; “Fracture of vault of skull, etc.” (S02.0, S02.1, S02.3, S07.1) often retained (OR); “Fracture of skull and facial bones, etc.” (S02.7, S02.8, S02.9, S07.0, S07.8, S07.9, S09.7, S09.8, S09.9) sometimes retained (SR). The selection must be made on all diagnoses (MD and AD), since the TBI can be coded as an AD in case of multiple injuries. Results In 2013, there were 134,546 hospitalizations with at least one diagnosis coded as S06, 8,292 additional hospitalizations coded as OR, and 6,821 hospitalizations coded as SR, representing a total of 149,659 hospitalizations. The fact of adding to the selection of S06 codes hospitalizations with OR codes or hospitalizations with OR and SR codes results in an increasing number of hospitalizations: 6.2% and 11.2% respectively. Conclusions The analysis of hospitalizations for TBI should not be limited to S06 codes because they produce too many false negatives. The analysis of false positives and negatives associated with the addition of OR or OR + SR codes requires the use of a gold standard to conclude on the best selection and estimate hospital morbidity due to TBI.

Background The literature and the knowledge regarding home and leisure injury (HLI) are far wider than it used to be a couple of decades ago. Different types of epidemiological surveillance have been carried out: cross-sectional, population, cohort studies. Nevertheless, little is known about detailed circumstances of those injuries. Methods The French HLI permanent survey started in France in 1986 in a dozen of hospital emergency services and is fully standardised since 2004. All patients admitted for HLI are included and detailed information is collected: where, when, how, who, what product is involved as well as the chronology of the injury and the care given. Results In France, like in other countries, several systems provide epidemiological indicators to describe HLI: incidence in population, consumption of health care services, and people at risk. However, when a specific injury needs to be more documented, such as button battery ingestion, trampoline injuries, wasp stings, barbecue burns, traumatic sport injuries, elderly falls, etc., the only system able to provide solid answers in France is the HLI permanent survey, which records around 120 000 annual injuries. The strength of the survey is the robustness guaranteed by the annual quality analysis and evaluations making the figures reliable and allowing time series analysis. Incidence rates can be estimated thanks to sophisticated models. Conclusions For prevention purposes, there are increasing demands about HLI from the Ministry of Health, organisations, and associations. The HLI permanent survey is a key tool to improve knowledge about incidence, severity, preventability, and contributes to the diminution of those injuries through specific prevention initiatives and regulations.

Background The frequency of falls among the elderly and their severity represent a major public health issue, whether in terms of deaths, functional or psychological sequelae, and cost. In France, the proportion of elderly people aged 65 years and more represent 18% of the population (12.2 million). Life expectancy at birth is 79.2 years for men and 85.4 years for women. In metropolitan France in 2011, 9,412 deaths due to falls were reported, of which 90% in people aged 65 years old and more with a sex-ratio equal to 0.6. It is necessary to further explore their risk factors for the implementation of effective preventive actions. Methods Patients to be included in the study should be aged 65 years or more, suffering from an accidental fall at home resulting in hospitalisation. Prospective data collection will start in 2016 during six months in several French hospitals emergency services. Standardised questionnaires will collect the circumstances of the falls, socio-economic and demographic status, and health and home characteristics of the patients. A follow-up study will be carried out one year after the fall to evaluate sequelae. Results This study aims at identifying the circumstances of accidental falls at home among the elderly and establishing profiles of fallers with the help of factorial analyses. The second part of the study will analyse the consequences of the falls one year later: recurrent falls, type of sequelae and disability, quality of life, depending on the initial severity of the fall and the profile of the faller. Conclusions This study will contribute to the implementation of adapted preventive measures thanks to the profiles established.

Background The Elfe Cohort (French Longitudinal Study of Childhood), consisting of more than 18,000 children recruited in 2011 in French maternity hospitals, aims at better understanding child development, particularly in terms of health and social relations. This cohort will describe familial and environmental risk factors of injuries occurring in children, and analyse the long term outcome of casualties and the prognostic factors for the occurrence of sequelae. Methods The study focused on 15,869 children included in the Elfe Cohort for whom data were collected at birth and at two months of life. Information was available on the child’ socio-cultural context, health, conditions of birth, place of residence, as well as traumatic events in the first two months. Results During the first two months of life, 73 cases seeking healthcare due to an injury were recorded: 54 consultations and 19 hospitalizations. Head injury was reported in 55 cases. The victims were mostly boys and single children. The socio-demographic characteristics of families were mixed: more precarious and smaller dwellings, parents usually more inactive, mostly French mothers and higher median income. The victims were more likely to sometimes sleep with their parents; they were less often premature (2% vs. 5%); their mothers were less likely to have consumed alcohol during pregnancy (1% vs 4%). Conclusions These preliminary results will be followed by a detailed description of injuries occurring at 1 year, 2 years of age and beyond, based on the children’s growth. The casualties’ outcome will be analysed and compared to that of the non-injured. The implications depending on the severity will be compared with data from other surveys. Among data sources on injuries in France (medical administrative bases, population surveys, thematic surveys), the Elfe cohort is the only one that can identify the outcome of injured children.

Background Every year in France, dog bites result in several thousand admissions in emergency departments and numerous hospitalizations. The purpose of this survey was to identify severity factors and sequelae due to dog bites. Methods An epidemiological study about the severity of 485 dog bites was carried out in eight hospital emergency departments between 2009 and 2010; a study investigating sequelae 16 months after the bite was conducted among 298 of the 485 patients. Patients and dogs characteristics were collected by caregivers and veterinarians, 16-month sequelae were asked to patients by questionnaire. Multivariate regression analyses were conducted to explore severity and sequelae risk factors. Results In children, bites were more frequent in the head and neck, but lesions were more severe in adults. The bites were more numerous and more serious when the victim knew the biting dog. No association was found between the severity of the bite and the type of biting dog. Almost half of respondents (47%) reported sequelae; most of them were aesthetic (91%). There were more sequelae when the bite was located at the head or inferior limbs; the sequelae were more frequent among women, when the weight of the biting dog was higher, and when the initial severity of the bite was higher. The link between the victim and the dog, the sex of the dog, the type of aggression, as well as the age of the victim, had no impact on the occurrence of sequelae. One patient out of seven was still having pain 16 months after the bite, women more often than men. Conclusions Numerous patients still suffer 16 months after a dog bite, articles providing this type of results were not found in the literature. Dissemination of these results among professionals (physicians and veterinarians) and the general public should contribute to make dog owners aware of the risk of bite and the means to avoid them.

International audience; OBJECTIVE: Endpoints used for the evaluation of immunogenicity in vaccine trials are often the proportion of individuals with immune response or geometric means of antibody concentrations for each serotype. When a vaccine includes several types of the same species, we illustrate how an endpoint combining all responses may improve clinical relevance and statistical power. STUDY DESIGN AND SETTINGS: The motivating example was the ANRS 114 Pneumovac trial where the effect of two vaccine strategies against Streptococcus pneumoniae was assessed in adults infected by the Human Immunodeficiency Virus. The power associated with several endpoints was calculated in the example and in simulations. A new endpoint based on four ordered levels is formulated and analyzed by using a proportional odds model. RESULTS AND CONCLUSION: The analysis of this new endpoint led to an odds ratio allowing detection of improvement and detriment. In the simulation study, this endpoint was associated with the largest statistical power by increasing the amount of information used as compared with usual endpoints. We recommend this new endpoint formulation in the formal development of a new vaccination regimen, whenever applicable.

International audience; Background: Air pollution triggers asthma attacks hours to days after exposure. It remains unclear whether socioeconomic deprivation modulates these effects. Investigation of these interactions requires adequate statistical power, obtainable by using either a sufficient number of observations or very sensitive indicators of asthma attacks. Using a small-area temporal ecologic approach, we studied the short-term relations between ambient air pollution and sales of short-acting beta-agonist (SABA) drugs, a frequent and specific treatment for control of asthma attacks in children and young adults, and then tested the influence of deprivation on these relations.Methods: The study took place in Strasbourg, France in 2004. Health insurance funds provided data on 15,121 SABA sales for patients aged 0 to 39 years. Deprivation was estimated by small geographic areas using an index constructed from census data. Daily average ambient concentrations of particulate matter (particles with an aerodynamic diameter < 10 microm [PM(10)]), nitrogen dioxide (NO(2)), and ozone (O(3)) were modeled on a small-area level. Adjusted case-crossover models were used for statistical analysis.Results: Increased of 10 microg/m(3) in ambient PM(10), NO(2), and O(3) concentrations were associated, respectively, with increases of 7.5% (95% confidence interval [CI], 4 to 11.2%), 8.4% (95% CI, 5 to 11.9%), and 1% (95% CI, - 0.3 to 2.2%) in SABA sales. Deprivation had no influence on these relations.Conclusion: The associations observed are consistent with those reported by studies focusing on SABA use. Similar studies in other settings should confirm whether the lack of interaction with deprivation is due to specific local conditions.

International audience

Nucleoside reverse transcriptase inhibitors (NRTIs) differ in the type and severity of adverse effects resulting from mitochondrial abnormalities. mtDNA in peripheral blood mononuclear cells (PBMCs) was measured during the first 12 months of different NRTIs combinations and its association with clinical lipodystrophy was estimated. Extended follow-up of a randomized trial, ALBI-ANRS 070, including antiretroviral naive patients was conducted. Total DNA was extracted from available cryopreserved PBMCs at baseline and months 6 and 12. Nuclear and mitochondrial genes were amplified using a real-time PCR assay. Clinical lipodystrophy was assessed 30 months after randomization using a standardized questionnaire. A logistic regression analysis assessed the value of mtDNA to predict lipodystrophy. Mean mtDNA level (copies/cell) significantly decreased from 5847 at baseline to 3176 at month 12 (p0.0001). In the zidovudine + lamivudine (ZDV + 3TC) arm (n = 37), the mean mtDNA was 6098, 6807, and 3725 copies/cell for baseline, month 6, and month 12, respectively. In the stavudine + didanosine (d4T + ddI) arm (n = 40), the mean values were 5616, 5731, and 2648 copies/cell, respectively. The proportion of patients in the lowest quartile of mtDNA (1421 copies/cell) at month 12 was higher in 18 patients with lipodystrophy (44%) than in 28 without lipodystrophy (7%) (p = 0.008). At 12 months, a larger reduction of mtDNA from baseline was observed in those started on the d4T + ddI arm. Furthermore, a low mtDNA level at month 12 was associated with the subsequent development of lipodystrophy. This marker may be of value for the early prevention of lipodystrophy in treated HIV-infected patients.

Health socioeconomic gradients are well documented in developed countries, but incompletely explained. A portion of these health inequalities may be explained by environmental exposures. The objective of PAISARC is to explore the relations between socioeconomic status, air pollution exposure and two selected health outcomes?asthma exacerbations and myocardial infarction?at the level of a small area. The study design is ecological, using data available from the national census, with the residential block (French IRIS, 2000 people on average, National Institute of Statistics?INSEE) as the statistical unit. The setting is the Greater Strasbourg metropolitan area (450?000 inhabitants) in eastern France. We first constructed a socioeconomic status index, using 1999 national census data and principal component analysis at the resolution of these census blocks. Air pollution data were then modeled at the same resolution on an hourly basis for the entire study period (2000?2005). Health data were obtained from various sources (local emergency networks, the local population-based coronary heart disease registry, health insurance funds) according to the health outcome. We present here the initial results and discuss the methodological approaches best suited for the forthcoming steps of our project.