RESUMEN
INTRODUCTION: In Basse-Normandie, the population over 65 years old will expend more rapidly between 2007 and 2042 (+11.6%) than the rest of the French population (+9.2%). The same population of Basse-Normandie will get old in the 15 years to come. The impact of these demographic changes over the activity in the gynecology-obstetrics field is not clearly identified. Although we cannot predict the technical and scientific developments in the next 15 years, we are presenting a model allowing to hypothesize about changes of gynecology and obstetrics according to population's aging. MATERIALS AND METHODS: We have established a projection model for the realizable surgical acts in obstetrics and gynecology in accordance with the aging of the population in Basse-Normandie. The study was realized based on the acts concerning the cesarean sections (C-section), tubal sterilization, hysteroscopy and hysterectomy as well as ovarectomy and breast surgery. For each activity branch, the codes of the Classification commune des actes médicaux (CCAM) were selected and then removed from the Programme médicalisé des systèmes d'information (PMSI) database. We have used and adapted the Omphale model of the National Statistics and Economical Studies Institute and we have applied it for the period of 2009-2025. RESULTS: Our projection model has permeated to show a 5.5% regression of the C-section acts, a 2% incretion of the hysterectomies and hysteroscopies, 7.7% of ovarectomies as well as a 9.8% augmentation of the breast surgeries. However, we predict a 11.8% diminution of the sterilizations by tubal implants. Globally, the activity in obstetrics and gynecology will remain constant with an insignificant augmentation of 46 acts (0.01%). CONCLUSION: In Basse-Normandie, the surgical activity in gynecology-obstetrics will moderately increase in the next 15 years. This constant activity signifies that there is no need to form more residents than the number of practitioner to retire. The interest of this model is that it is applicable at a national level and it permits to confront the demographic data and the projections of different activities.
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Ginecología/estadística & datos numéricos , Obstetricia/estadística & datos numéricos , Crecimiento Demográfico , Francia , Humanos , Modelos Estadísticos , Dinámica PoblacionalRESUMEN
OBJECTIVES: The French population is growing and ageing. In this context, it is important to consider the future of gynecologists and obstetricians in Basse-Normandie. The aim of this study was to perform an overview of the demographics of practitioners and estimate the retirements. We also try to project the need of trainees for the next years. MATERIALS AND METHODS: We conducted a demographic and workload survey among 142 practitioners and 35 trainees. We detailed retirements and arrivals of this population. RESULTS: By 2025, nearly two-thirds of practitioners in 2012 will retire, including 100% of medical gynecologists. Otherwise, there will be a lack of 1 to 2 practitioners per year. We also noted the tendance of feminization (86%) and the wish of a multi-practice in public hospital (86%). CONCLUSION: A reflection about the health planning will be necessary in order to answer the demographics difficulty in the region. We will have to take into account the future retirements and also the specific situations in each area.
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Ginecología , Necesidades y Demandas de Servicios de Salud , Internado y Residencia/estadística & datos numéricos , Obstetricia , Adulto , Anciano , Femenino , Francia/epidemiología , Ginecología/educación , Ginecología/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Obstetricia/educación , Obstetricia/estadística & datos numéricos , Médicos/estadística & datos numéricos , Médicos/provisión & distribución , Embarazo , Jubilación/estadística & datos numéricos , Estudiantes de Medicina/estadística & datos numéricos , Recursos HumanosRESUMEN
OBJECTIVES: The French population is growing and ageing. It is expected to increase by 2.7% by 2020, and the number of individuals over 65 years of age is expected to increase by 3.3 million, a 33% increase, between 2005 and 2020. As the number of vascular surgery procedures is closely associated with the age of a population, it is anticipated that there will be a significant increase in the workload of vascular surgeons. STUDY DESIGN: A model is presented to predict changes in vascular surgery activity according to population ageing, including other parameters that could affect workload evolution. METHODS: Three types of arterial procedures were studied: infrarenal abdominal aortic aneurysm (AAA) surgery, peripheral arterial occlusive disease (PAOD) procedures and carotid artery (CEA) procedures. Data were selected and extracted from the national PMSI (Medical Information System Program) database. Data obtained from 2000 were used to predict data based on an ageing population for 2008. From this model, a weighted index was defined for each group by comparing expected and observed workloads. RESULTS: According to the model, over this 8-year period, there was an overall increase in vascular procedures of 52.2%, with an increase of 89% in PAOD procedures. Between 2000 and 2009, the total increase was 58.0%, with 3.9% for AAA procedures, 101.7% for PAOD procedures and 13.2% for CEA procedures. The weighted model based on an ageing population and corrected by a weighted factor predicted this increase. CONCLUSION: This weighted model is able to predict the workload of vascular surgeons over the coming years. An ageing population and other factors could result in a significant increase in demand for vascular surgical services.
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Dinámica Poblacional/tendencias , Procedimientos Quirúrgicos Vasculares , Carga de Trabajo/estadística & datos numéricos , Adolescente , Adulto , Anciano , Aneurisma de la Aorta Abdominal/cirugía , Arteriopatías Oclusivas/cirugía , Enfermedades de las Arterias Carótidas/cirugía , Bases de Datos Factuales , Francia , Humanos , Persona de Mediana Edad , Modelos Estadísticos , Enfermedad Arterial Periférica/cirugía , Recursos Humanos , Adulto JovenRESUMEN
BACKGROUND: Following community concern regarding potential health effects associated with odors of a wastewater treatment plant, a descriptive epidemiological study was conducted to assess the complaints and the health status of the community and to identify potentially more susceptible groups. METHODS: Questionnaires were administered by telephone to nearly 3.000 subjects, randomly selected in the 8 nearby towns, using a geographical Information System. Residents of three areas were compared, according to the distance from the site: 0-1.5 km (high exposed group), 1.5-3 km (moderate exposed group) and 3-4.5 km (low exposed group). Questions measured demographic characteristics, concerns, perceived environmental risk and health effects (symptoms in the past 1 month and in the past 1 year). Multivariate logistic models study the relationships of complaints and health effects, with area and susceptibility factors. RESULTS: Two thousand eight hundred and sixty seven eligible adults participated in an interview. Taking in account confounding factors, population of high and moderate exposed groups reported more odor complaints than the low exposed group, with adjusted odds ratio (OR) of 4.73 (CI95%: 3.63-6.14) and 2.06 (CI95%: 1.59-2.66) respectively. But these 2 groups did not report more frequent health effects compared to the low exposed group. Several health effects were significantly more frequent in persons with self-reported chemical intolerance and in persons considering malodor in terms of health threat. In this last sub-group of population, rhinitis were significantly more frequent in the high exposed group compared to low exposed group, whereas respiratory infections and asthma attacks showed the same non significant patterns. CONCLUSION: If 24,2% of the total sample complaints from odors of the site, this study did not show a higher frequency of health effects in people living near the site (high exposed group). But 2 susceptible groups (with a higher frequency of symptoms potentially related to odors) were identified: persons with self-reported chemical intolerance, among those, many allergic and asthmatic subjects, and persons considering malodor in terms of health threat.
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Exposición a Riesgos Ambientales/efectos adversos , Estado de Salud , Odorantes , Eliminación de Residuos , Adolescente , Adulto , Anciano , Asma/epidemiología , Asma/etiología , Actitud Frente a la Salud , Niño , Preescolar , Factores de Confusión Epidemiológicos , Estudios Epidemiológicos , Femenino , Francia/epidemiología , Agua Dulce , Sistemas de Información Geográfica , Humanos , Hipersensibilidad/epidemiología , Hipersensibilidad/etiología , Lactante , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Características de la Residencia , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/etiología , Rinitis/epidemiología , Rinitis/etiología , Factores de Riesgo , Encuestas y CuestionariosRESUMEN
The prevalence of infection in local communities has been used as the basis for the country-wide repartition of onchocerciasis in Cameroon, following the principles for rapid epidemiological mapping of onchocerciasis (REMO) developed by the World Health Organization. The levels of endemicity were evaluated in 349 villages by rapid epidemiological assessment (REA), a method based on the examination of nodules in males aged > or = 20 years. An onchocerciasis map was then drawn from the epidemiological data which had been collected previously, from clinico-parasitological surveys based on the examination of skin snips, and the results of the REA surveys. The REMO surveys allowed the main onchocerciasis foci in Cameroon to be accurately delineated, and several small endemic areas which had never been reported before to be identified. The total 'at risk' population (i.e. those for which ivermectin treatment should be considered as urgent or highly desirable) was estimated by combining the epidemiological results and the demographical data available from an administrative census. Those at risk were estimated to number 3.5 million, representing about 50% of the total rural population in Cameroon.
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Enfermedades Endémicas , Oncocercosis/epidemiología , Adulto , Camerún/epidemiología , Métodos Epidemiológicos , Humanos , Masculino , Prevalencia , Prohibitinas , Medición de RiesgoRESUMEN
A study aimed at determining individual factors associated with participation in community treatment with ivermectin was conducted in a village hyperendemic for onchocerciasis in northern Cameroon. The respective influences of sex, age, place of residence, distance between the compound and the dosing point, compound size, and participation in treatment by authoritative individuals in the compound was evaluated using univariate and multivariate analysis. Participation in treatment was closely associated with the attitude of the compound heads. Participation of compound heads in treatment increased as the household size increased, and as the distance to the distribution point diminished. This may be explained by the fact that getting information on health programmes is easier in large households whose members are involved in various social activities, and in compounds located near the village centre. Staff involved in health education should take this issue into account, and try to ensure circulation of information particularly to those living in small or remote compounds.
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Antinematodos/uso terapéutico , Ivermectina/uso terapéutico , Oncocercosis/tratamiento farmacológico , Participación del Paciente , Adolescente , Adulto , Distribución por Edad , Camerún , Niño , Preescolar , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Distribución por SexoRESUMEN
A rapid and cheap method for mapping the endemicity levels of onchocerciasis in both forest and savanna areas, where the vectors are members of the Simulium damnosum complex, is described. The selection of the study communities is based on a general understanding of the vectors' ecology and biassed towards those at highest risk of onchocerciasis, although there must be adequate geographical coverage. In a case study in Cameroon, prevalences were determined, using the non-invasive nodule palpation technique, in samples, each of 30-50 adult males, from 49 villages in six study areas in Cameroon. The method proved effective in the rapid mapping of onchocerciasis distribution in all areas studied, in which the distribution patterns varied from the classical linear to diffuse, and in one area with an anomalous distribution. The method should prove of value in the design of national onchocerciasis control programmes.