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During the first COVID-19 lockdown in France in the spring of 2020, schools were closed and all activities outside the home were suspended. Primary school children who found themselves confined to their homes adapted quite well to the change. They continued with their schoolwork and took advantage of their freedom to spend more time on daily activities. But for parents with low socio-economic status, the lockdown placed strain on family relationships, increased the children’s screen time, disrupted their sleep and their psychological well-being, and made schoolwork more problematic. For children and adults alike, the lockdown produced an increase in inequalities likely to worsen over the medium term., Le premier confinement du printemps 2020 a conduit à la fermeture des écoles et à la suspension des activités hors domicile. Assignés à résidence, les enfants d’école primaire se sont plutôt bien adaptés en continuant à faire leur travail scolaire et, profitant d’un temps libéré, ont pu pratiquer leurs activités quotidiennes plus qu’en temps « normal ». Mais pour les parents de statut socioéconomique modeste, le confinement a dégradé les relations familiales, largement accru le temps passé par les enfants sur les écrans, altéré leur sommeil et leur bien-être psychologique, et rendu plus complexes les apprentissages scolaires. Pour les enfants comme pour les adultes, le confinement a accru des inégalités susceptibles de se creuser à moyen terme

International audience; ELFE is the first French national birth cohort. Its objective is to study determinants of the development, health and socialization of children from birth to adulthood through a multidisciplinary approach. A total of 18 329 children were recruited at birth in a random sample of maternity units in metropolitan France during 25 selected days of 2011 spread over the year. Follow-up in the first 5 years consisted of telephone interviews of both parents of the child at age 2 months and 1 year and 2 years, and of one parent at age 3.5 years; a home visit at age 3.5 years; questionnaires to the child’s physician at age 2 years, the child’s nursery school doctor at age 3 to 4 years, and the child’s nursery schoolteacher at age 4 years. Participation rates at the age 2-month, 1- and 2-year and 3.5-year parental interviews were 92%, 86%, 82% and 80%, espectively, of contacted participants. The main categories of data collected concern: sociodemographic characteristics; family life; parental health, behaviour and life values; child development and health; child school performance, behaviour, and socialization; day care and school; and childhood environmental exposures. The ELFE has an open-data policy after an 18-month exclusivity period following each release of new data. The data-access policy, study protocols, questionnaires and data catalogue can be found online: [https://www.ELFE-france.fr/en/]

Screening programs resulting in the early treatment of patients with congenital hypothyroidism (CH) have successfully improved neurodevelopmental outcome, but little is known about long-term health.The aim of the study was to assess health status, and socioeconomic attainment, for a population-based registry of young adult patients.All 1748 eligible patients diagnosed during the first decade after the introduction of neonatal screening in France were invited to participate in this study at a median age of 23.4 yr. Completed questionnaires were obtained from 1202 of the selected patients. The comparison group included 5817 subjects from the last French Decennial Health Survey.Health indicators including medical conditions, hearing and visual status, sociodemographic characteristics, and quality of life were measured.Patients with CH were significantly more likely than their peers to report associated chronic diseases (5.7 vs. 2.9%), hearing impairment (9.5 vs. 2.5%), visual problems (55.4 vs. 47.9%), and being overweight with a body mass index of at least 25 kg/m(2) (22.8 vs. 15.7%) (P0.0001). Furthermore, fewer patients attained the highest socioeconomic category (14.6 vs. 23.1%) and were in full-time employment (39.9 vs. 44.8%) (P0.0001). They were more likely to still be living with their parents and had a lower health-related quality of life than their healthy peers, particularly for mental dimensions, with a mean difference for the mental summary component of 0.35 SD score (P0.0001). CH severity at diagnosis, treatment adequacy, and the presence of other chronic health conditions were the main determinants of educational achievement and health-related quality of life scores.These findings highlight the need for careful monitoring of neurosensory functioning, weight, and long-term treatment adequacy throughout childhood and adulthood.

Le projet de mise en place d’une cohorte pluridisciplinaire de 20 000 enfants suivis depuis la naissance jusqu’à l’âge adulte a été lancé en France en 2005. Il résulte de préoccupations de diverses instances publiques – notamment dans le domaine de l’environnement – comme de chercheurs de disciplines variées. L’aboutissement en a été la constitution de la cohorte Elfe, Étude longitudinale française depuis l’enfance, dont le démarrage est prévu en mars/avril 2011. Les auteurs retracent la genèse du projet. La démarche s’est voulue résolument pluridisciplinaire, et un grand nombre d’équipes de recherche ont été associées à l’élaboration du projet, en proposant des questions de recherche dans trois grands domaines : sciences sociales, santé et relations entre santé et environnement. Pour bénéficier au maximum de la puissance de la Life course approach, les observations seront fréquentes (annuelles pendant les premières années). Une place importante est faite aux pères, qui jouent un rôle croissant dans l’éducation et la socialisation des enfants. L’échantillon sera représentatif des naissances de l’année 2011 sur l’ensemble du territoire de France métropolitaine. La grande quantité d’informations collectées et leur caractère très personnel exigent une prudence particulière dans la constitution et la gestion des fichiers pour laquelle une procédure originale est mise en œuvre. Les résultats du suivi d’une cohorte pilote lancée en 2007 sont aussi présentés. Ils concernent plusieurs centaines de familles, dont les enfants ont maintenant 3 ans.

Background Low-back pain is a major public health concern because of its socioeconomic burden, especially for chronic forms. The purpose of this study was to analyse the associations between low-back pain and occupational and personal factors, with a special focus on interactions between age and occupational exposures. Methods The study population comprised a sample of 3958 and 4526 working women and men aged 30 to 59 derived from a national health survey (2002–2003 EDS). Low-back pain was assessed using the French version of the Nordic questionnaire. Weight, height and smoking status were obtained through interview at home. Occupational exposures were self-assessed. The associations between low-back pain for more than 30 days in the previous year and occupational and personal factors were assessed using logistic models. An interaction between age and each occupational exposure was studied. Results In the multivariate models, age was the only personal factor significantly associated with low-back pain for both genders. The other personal factors studied were significantly associated with low-back pain for women only. Handling heavy loads and awkward postures at work were strongly associated with low-back pain for both genders (respectively OR = 1.80 [1.46–2.23] and OR = 1.65 [1.34–2.03] for men, and OR = 1.65 [1.32–2.06] and OR = 1.28 [1.04–1.59] for women). A high level of psychological demands at work and a low level of decision latitude were also associated with low-back pain for both genders (respectively OR = 1.22 [1.03–1.46] and OR = 1.32 [1.11–1.57] for men, and OR = 1.31 [1.10–1.56] and OR = 1.27 [1.06–1.51] for women). Only the interaction between age and awkward postures for men was borderline significant. Conclusion This study showed strong associations between occupational exposures and persistent/recurrent low-back pain in a general working population in France. Targeting these exposures in prevention programs could be useful.

International audience; OBJECTIVES: To describe the frequency with which members of the French general population in the 30-to-69 age class sought care for lower back pain (LBP) from various healthcare professionals and to identify associated parameters. MATERIAL AND METHODS: Data were collected in the 2002-2003 Décennale Santé survey, which is representative of ordinary households in continental France. We assessed the frequency with which the 17,792 surveyed individuals sought care for LBP by considering consultations with healthcare professionals in general and consultations with general practitioners and physiotherapists in particular. RESULTS: Among the survey subjects, 4.5% reported that they had sought treatment for LBP from a healthcare professional at least once during the 2-month survey period. The decision to seek care was correlated with the characteristics of the LBP. The duration of the pain was associated with the frequency of all types of consultation studied here. Sociodemographic, economic and occupational risk factors were also involved. Consultation with a physiotherapist was related to income. CONCLUSION: These results from a representative sample of the French general population show that the factors associated with seeking treatment for LBP differ according to the type of healthcare professional consulted.

The project to construct a multidisciplinary study cohort of 20,000 children to be monitored from birth to adulthood was launched in France in 2005. It was designed to address the concerns of various public bodies, especially those concerned with the environment, and researchers from a variety of disciplines. The result was the formation of the Elfe (Étude longitudinale française depuis l?enfance) longitudinal cohort of children, scheduled to commence in March/April 2011. The authors describe the origins of the project. The approach was deliberately intended to be multidisciplinary, and a large number of research teams were associated in designing the project, suggesting research questions in three major fields: social sciences, health and the links between health and the environment. To make the most of the life course approach, observations will be frequent (annually during the early years). A major place is given to fathers, who play an increasing role in children?s upbringing and socialization. The sample will be representative of births in 2011 throughout metropolitan France. The vast quantity of information to be collected and its highly personal nature require particular caution in the creation and management of data files, for which an innovative procedure will be used. The results of a pilot cohort study launched in 2007 are also presented. They cover several hundred families, whose children are now three years old.

Objectives: In a context where sleep laboratories are overwhelmed by a growing demand to diagnose obstructive sleep apnea syndrome (OSAS), efficient substitutive solutions to in-laboratory polysomnography should be found. To compare the effectiveness and costs of home unattended polysomnography (Hpsg) and telemonitored polysomnography (TMpsg), a cost minimization study was performed.Methods: In a crossover trial, 99 patients underwent on two consecutive nights TMpsg and Hpsg according to a randomized order. A legibility recording criterion was retained to measure effectiveness. A microcosting study of TMpsg and Hpsg was performed. The risks to adopt home strategy or telemonitored strategy, according to different scenario chosen to reach the diagnosis in case of failure of Hpsg or TMpsg, were analyzed.Results: The recording was considered to be ineffective in 11.2% of TMpsg (95% CI, 4.9–17.4) and in 23.4% (95% CI, 19.12–27.68) of Hpsg. The effectiveness differential was 12.2% (95% CI, 1.8–22.6) (p = .02). Assuming that in case of failure PSGs would be re-realized in the same condition to reach the diagnosis, then TMpsg could be selected if Hc/TMc (cost of Hpsg/cost of TMpsg) > 0.97; Hpsg could be selected if Hc/TMc < 0.76. If 0.76 ≤ Hc/TMc ≤ 0.97, the choice of TMpsg would be ambiguous. TMc was estimated to be $244, while Hc was $153 (Hc/TMc = 0.63).Conclusion: Unless some specific geographical situations generate significant transport costs, the implementation of a strategy based on unattended polysomnography at home is cost-saving compared to a telemonitoring strategy.

This article deals with the choice of the appropriate protocols for the early economic evaluation of information and communication technologies, equivalence trial versus pragmatic trial. The reasoning put forward here is based on a concrete interrogation relative to polysomnography (PSG), a key diagnostic test for sleep apnoea syndrome (SAS). Is PSG under tele-surveillance more efficient than ambulatory PSG to diagnose SAS? After analyzing and discussing both advantages and limits of these two kinds of trial, we showed that one or the other can be used to obtain appropriate results. But in this particular example, we concluded that a pragmatic trial should be preferred, knowing that it requires a smaller sample of patients along with a narrower range of uncertainty concerning the evaluation of costs.

Telemedecine has been talked about for more than 20 years, without it entering daily use with any success. Based on transaction costs economics, the present analysis of the exchange relationships between health care producers highlights certain characteristics of the current technical and legislative context, which leads to transaction costs. It also demonstrates that the introduction of telemedicine shifts the costs associated with agents' opportunism from patients to health-care producers themselves. All these costs may be considered nowadays to thwart the use of telemedicine. It is argued here that the Public Authorities and professionals of health care could act upon telemedicine in two fields: (1) intervention in the institutional environment aims notably at better defining the property rights of telemedicine, and so constitutes an unavoidable means of encouraging health-care producers to invest in new technology; and (2) implementation of organisational forms and mechanisms susceptible to regulating such telemedical relationships between health care producers-given the present institutional environment-constitutes an essential means for overcoming the immediate barriers blocking the diffusion of telemedicine.

Objective In greater Paris and its surroundings (as it is in all France), oxygen is home delivered by not-for-profit (NP) associations or profit-making (PM) health organizations. Both are financed by the national health insurance. This dual context and the current economic climate justify an economic evaluation of all respiratory care for patients with COPD receiving long-term oxygen therapy (LTO). This pragmatic approach identifies the variables that have the greatest impact on direct medical costs and estimates the annual cost for respiratory care per COPD patient. Design Retrospective study. Setting Health insurance scheme for self-employed professionals (CANAM). Patients and methods Between July 1985 and March 1994, 234 patients registered in CANAM files began LTO, 24% in the PM sector, 76% in the NP sector, mainly using concentrator (78%), mean age of 74±10 years, male predominance (74%), PaO 2 of 56.2±10.5 mm Hg, FEV 1 /FVC of 43±15%, and 51% having 1 or more severe illness(es) associated. The economic appraisal was performed on a representative sample of 61 patients and measured the total resources consumption for respiratory care per COPD patient and per year (physician visits and tests, drugs, physiotherapy, oxygen therapy, hospitalizations for acute respiratory failure, transport costs). Results A quarter of the patients in each sector did not meet the LTO prescription guidelines (PaO 2 >60 mm Hg). For patients having their oxygen delivered by NP sector, the total ambulatory cost for respiratory care was lower ($4,506 per patient and per year vs $5,399) because they mainly used concentrator, all the other direct ambulatory costs being equal. The total annual cost for respiratory care of a COPD patient receiving LTO amounted to $11,672 (NP and PM sectors merged). Oxygen therapy represented 73% of the total ambulatory cost. In a multiple linear regression model, hospitalization represented the largest share of cost, significantly higher when PaO 2 was 55 mm Hg or less ($2,287 per patient per year vs $8,717). In contrast, none of the covariates (age, sex, PaO 2 , FEV 1 /FVC) influenced at a significant level the total cost of visits, tests, drugs, and physiotherapy, amounting to $1,507. Conclusion As oxygen treatment plays an important role in the variation of costs, further pragmatic studies should help to better understand what are the real motivations to choose one mode of oxygen administration more than another and should determine factors that may lead physicians sometimes not to comply with clinical guidelines.

Background Physical occupational exposure is a risk factor for low back pain in workers but the long term effects of exposure remain unclear. As several countries consider increasing the retirement age, further information on this topic is relevant. This study aimed to describe the prevalence of low back pain among middle aged and aging individuals in the general French population according to physical occupational exposure and retirement status. Methods The study population originated from the French national survey 'Enquête décennale santé 2002'. Low back pain for more than 30 days within the previous twelve months (LBP) was assessed using a French version of the Nordic questionnaire. Occupational exposure was self assessed. Subjects were classified as "exposed" if they were currently or had previously been exposed to handling of heavy loads and/or to tiring postures. The weighted prevalence of LBP was computed separately for men and women, for active (aged 45-59) and retiree (aged 55-74), according to 5-year age group and past/present occupational exposure. Results For active men, the prevalence of LBP was significantly higher in those currently or previously exposed (n = 1051) compared with those never exposed (n = 1183), respectively over 20% versus less than 11%. Among retired men, the prevalence of LBP tended towards equivalence with increasing age among those previously exposed (n = 748) and those unexposed (n = 599). Patterns were quite similar for women with a higher prevalence in exposed active women (n = 741) compared to unexposed (n = 1260): around 25% versus 15%. Similarly, differences between previously exposed (n = 430) and unexposed (n = 489) retired women tended to reduce with age. Conclusion The prevalence of LBP in active workers was associated with occupational exposure. The link with past exposure among retirees decreased with age. These results should be considered for policies dealing with prevention at the workplace and retirement.

The project to construct a multidisciplinary study cohort of 20,000 children to be monitored from birth to adulthood was launched in France in 2005. It was designed to address the concerns of various public bodies, especially those concerned with the environment, and researchers from a variety of disciplines. The result was the formation of the Elfe (Etude longitudinale francaise depuis l'enfance) longitudinal cohort of children, scheduled to commence in March/April 2011. The authors describe the origins of the project. The approach was deliberately intended to be multidisciplinary, and a large number of research teams were associated in designing the project, suggesting research questions in three major fields: social sciences, health and the links between health and the environment. To make the most of the life course approach, observations will be frequent (annually during the early years). A major place is given to fathers, who play an increasing role in children's upbringing and socialization. The sample will be representative of births in 2011 throughout metropolitan France. The vast quantity of information to be collected and its highly personal nature require particular caution in the creation and management of data files, for which an innovative procedure will be used. The results of a pilot cohort study launched in 2007 are also presented. They cover several hundred families, whose children are now three years old. Abstract: Le projet de mise en place d'une cohorte pluridisciplinaire de 20 000 enfants suivis depuis la naissance jusqu'a l'âge adulte a ete lance en France en 2005. Il resulte de preoccupations de diverses instances publiques - notamment dans le domaine de l'environnement - comme de chercheurs de disciplines variees. L'aboutissement en a ete la constitution de la cohorte Elfe, Etude longitudinale francaise depuis l'enfance, dont le demarrage est prevu en mars/avril 2011. Les auteurs retracent la genese du projet. La demarche s'est voulue resolument pluridisciplinaire, et un grand nombre d'equipes de recherche ont ete associees a l'elaboration du projet, en proposant des questions de recherche dans trois grands domaines : sciences sociales, sante et relations entre sante et environnement. Pour beneficier au maximum de la puissance de la Life course approach , les observations seront frequentes (annuelles pendant les premieres annees). Une place importante est faite aux peres, qui jouent un role croissant dans l'education et la socialisation des enfants. L'echantillon sera representatif des naissances de l'annee 2011 sur l'ensemble du territoire de France metropolitaine. La grande quantite d'informations collectees et leur caractere tres personnel exigent une prudence particuliere dans la constitution et la gestion des fichiers pour laquelle une procedure originale est mise en œuvre. Les resultats du suivi d'une cohorte pilote lancee en 2007 sont aussi presentes. Ils concernent plusieurs centaines de familles, dont les enfants ont maintenant 3 ans. Abstract: En 2005, Francia lanzo un proyecto de cohorte pluridisciplinario comprendiendo 20 000 ninos, con un seguimiento desde el nacimiento hasta la edad adulta. Este proyecto fue el fruto de preocupaciones de diversas instancias publicas - particularmente en el sector del medio ambiente - asi como de investigadores de varias disciplinas. El resultado de ello ha sido la constitucion de la cohorte Elfe, Estudio longitudinal frances desde la infancia, cuyo comienzo esta previsto para marzo/abril de 2011. Los autores de este articulo describen la genesis del proyecto. El proceso ha sido voluntariamente pluridisciplinario, y un gran numero de equipos de investigacion han sido asociados a su elaboracion, proponiendo objetivos en tres grandes campos de investigacion : ciencias sociales, salud y relaciones entre salud y medio ambiente. Para beneficiar al maximo de las ventajas de la Life course approach , las observaciones se haran a un ritmo frecuente (anual durante los primeros anos). Una atencion particular se presta al padre, que desempena un papel creciente en la educacion y la socializacion del nino. La muestra sera representativa de los nacimientos del ano 2011 sobre el conjunto del territorio. La gran cantidad de informaciones recogidas y su caracter personal exigen una prudencia particular en la constitucion y la gestion de los ficheros, para las cuales se aplica un procedimiento original. Se presentan tambien aqui los resultados de una cohorte-piloto lanzada en 2007, que concierne varios centenares de familias cuyos ninos tienen ahora tres anos.

International audience; PURPOSE: To investigate the pathways from level of education to low back pain (LBP) in the adult population, especially concerning the role of physical working constraints, and personal factors (overweight, tobacco consumption, and tallness). METHODS: The study population consisted of 15,534 subjects from the National Health Survey, with data on LBP, level of education, personal factors, and physical working constraints. Logistic models for LBP (pain more than 30 days during the previous 12 months) were compared in order to check the consistency of the data with specific causal pathways. RESULTS: Low back pain was strongly associated with level of education. This association was almost completely explained if present or past exposure to tiring work postures and handling of heavy loads were taken into account. For men, the OR for "no diploma", adjusted only for age, was 1.75; it was 1.02 after additional adjustment on physical work factors. Personal factors played also a role, especially overweight for women. Among them, the OR associated with a body mass index = 27 or more was 1.58 after adjustment on all the other factors. CONCLUSIONS: In this national population the main pathways from education to LBP were through occupational exposure and lifestyle factors.

International audience; INTRODUCTION: In France, most studies of low back pain (LBP) have been carried out among workers or patients. Until very recently, the frequency of LBP in the general population was not known, because National Health Surveys did not include questions on LBP. OBJECTIVE: To estimate the prevalence of LBP in the French population aged 30 to 64 years. MATERIALS AND METHODS: The main data were from the National Health Survey 2002-2003 (n=14,248). LBP was assessed by an accompanying self-administered questionnaire asking details about duration of LBP in the previous 12 months. Weights were used to estimate the prevalence of LBP in the French population, with two definitions of LBP. Additional results dealing with chronic LBP, from another national survey (Handicap, Disability and Dependence), are also briefly presented. RESULTS: More than half of the French population in this age group experienced LBP at least one day in the previous 12 months (LBP1), with 17% experiencing LBP for more than 30 days in the previous 12 months (LBP30); prevalence differed between men and women and that of LBP30 increased with age. DISCUSSION-CONCLUSION: The prevalence of LBP as assessed by the National Health Survey is similar to that found in countries other than France. These estimates can be used as a reference for surveys in specific populations, provided that comparable methodologies are used.

Background The person trade-off (PTO) is a technique for eliciting preferences for resource allocation across patient groups. In principle PTO responses should satisfy a requirement of multiplicative transitivity, i.e. that if people consider treatment of 1 in state A to be equivalent to treating 10 in state B, and 1 in state B to be equivalent to 10 in state C, then they should find 1 in state A equivalent to 100 in state C. Earlier studies addressing labelled diseases (specific diagnoses), have shown multiplicative intransitivity of the PTO responses. Our purpose was to test multiplicative transitivity in the case of health states described with the EuroQol instrument only and to find a possible framing effect such as the number of persons in the reference intervention. Methods Forty-four master degree students were asked to fill in a questionnaire addressing four chronic health states. Their task consisted in (1). ranking the states by severity, (2). valuing each of them by the means of the time trade-off, and (3). doing the PTO for all the 10 possible pairwise combinations of the four chronic states plus a fatal one. In a subsequent questionnaire the number of persons in the reference intervention in the PTO was increased from 10 to 100. Multiplicative transitivity was studied in subjects who demonstrated a willingness to trade off and consistency in ranking individual values. Results None of the 39 subjects included satisfied a minimum multiplicative transitivity requirement in PTO responses. Internal consistency was not improved when the PTO involved health states close to each other in terms of severity, nor when the prevention of death was not the reference intervention. For the 22 subjects having answered both types of questionnaire, increasing the number of persons in the reference intervention did not improve multiplicative transitivity. Conclusions The PTO holds promise as a useful method for determining social preferences for priority setting, inasmuch as it captures distributive concerns that individual utility techniques such as the time trade-off do not address. But the lack of multiplicative transitivity in PTO responses is unsatisfactory, and ways to reduce this problem need to be explored.

Information and communication technology (ICT) is not yet integrated into current medical practice and frequently, organizational patterns of health care production are held responsible for this situation. However, and quite paradoxically, measures recently taken in France indicate that a preferential role is granted to ICT in order to promote the development of healthcare networks. In this context, one should carefully examine which factors, other than organizational ones, can explain the very slow diffusion of telemedicine. Actually, medical assessment of telemedicine is very seldom and the medical community is unable to appreciate the extent that this technology would modify the quality of care provided. Furthermore, and as a consequence of the former, there is no economic evaluation of telemedicine applications and its effects, in terms of productivity, remain virtual. In this article, based on an early evaluation of telemonitored polysomnography to diagnose sleep apnea syndrome, we show that it is possible, even at an experimental stage, to produce appropriate and convincing clinical results stating the true technological effectiveness (choice of an adequate clinical trial, selection of appropriate endpoints). Specific attention is given to the technical conditions in which the technology is assessed, we also provide most of the data that should be taken into account to foresee the major organizational transformations of the production processes. Our results show that early clinical ad hoc evaluations of telemedicine applications can be conducted promptly, providing strong clinical results and useful data for any forthcoming economic evaluation.