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Background: Under-diagnosis and under-treatment of childhood asthma were investigated in France using data collected during the 6 Cities Study, the French contribution to the International Study of Asthma and Allergies in Childhood., Methods: 7,781 schoolchildren aged between 9 and 10 years underwent a medical visit including skin prick tests to common allergens and exercise test for Exercise-Induced Asthma (EIA) and their parents filled in a standardized questionnaire on asthma, management, treatment and potential risk factors., Results: 903 children reported asthma (11.6%), 377 without a doctor's diagnosis. Of the 526 participants with a diagnosis of asthma confirmed by a doctor (58.2%), 353 were treated and 76 were not treated during the year preceding the investigation despite their diagnosis. The information on the treatment was missing for the rest of individuals diagnosed with asthma (n = 97). Having a treatment was significantly associated with severe asthma and with the presence of other respiratory and allergic stigmata (atopic eczema, rhinitis, positive skin allergy tests, and EIA). In addition, having a treatment did not correspond to a good control of the disease. Similarly, children with asthma-like symptoms but without doctor-diagnosed asthma had asthma less well controlled than children with diagnosed asthma. They were also more exposed to passive smoking and traffic but had fewer pets. In contrast, diagnosed children reported more frequently a small weight at birth and a preterm birth., Conclusions: In France, childhood asthma is still under-diagnosed and under-treated and environmental factors play a role in these phenomena.

Objective: We compared helical CT angiography and ventilation-perfusion radionuclide lung scanning as initial tests in the diagnosis of acute pulmonary embolism., Subjects and Methods: Two hundred sixteen consecutive patients who were clinically suspected of having acute pulmonary embolism underwent helical CT angiography, ventilation-perfusion radionuclide lung scanning, and Doppler sonography of the veins of the legs. On the basis of concordance of the results for ventilation-perfusion radionuclide lung scanning and helical CT angiography and on the degree of clinical suspicion, certain patients underwent pulmonary angiography. Patients without pulmonary embolism at initial evaluation in whom no treatment was instituted were followed up for at least 3 months to determine the potential recurrence of thromboembolic disease., Results: Of the 216 patients, 37 (17%) were excluded because of insufficient data to assess the initial event. Final diagnosis for the 179 remaining patients was pulmonary embolism in 68 (37.9%) and no pulmonary embolism in 111 (62.0%), based on pulmonary angiography in 23 patients (12.8%) and concordant imaging findings and outcome in the remaining patients. Statistically significant differences (p < 0.05) were found between sensitivity, specificity, positive predictive value, and negative predictive value for helical CT angiography and ventilation-perfusion radionuclide lung scanning (94.1% versus 80.8%; 93.6% versus 73.8%; 95.5% versus 82%; and 96.2% versus 75.9%, respectively). Interobserver agreement was excellent for helical CT angiography (kappa = 0.72) and moderate for ventilation-perfusion radionuclide lung scanning (kappa = 0.22)., Conclusion: Helical CT angiography could replace ventilation-perfusion radionuclide lung scanning as the initial test for screening patients who are clinically suspected of having pulmonary embolism.