Prévalence de l’autisme et autres troubles envahissants du développement : données des registres français de population. Générations 1995–2002

Aim and background

In France, prevalence data of pervasive developmental disorders in children are rare despite recently dedicated public health plans aimed to improve the knowledge and types of care of these disorders. Within this context, the two French childhood disabilities registers of Haute-Garonne and Isere counties have been asked to provide recent prevalence data on autism spectrum disorders.

Methods

These two population-based registers record all the cases of pervasive developmental disorders in children residing in covered counties in their eighth year of life, after parental approval. Data are actively collected from the medical records available in various data sources. The main data source is the “county house for people with disabilities” i.e. the local authority which determines the orientation for special education and the decision of special allocation for disabled children. Other data sources are “autism resource centres” and psychiatric hospitals. Diagnoses were coded according to the International Classification of Disease (ICD 10). For this analyze, diagnoses selected were typical and atypical autism (F84.0 and F84.1), Asperger disorder (F84.5), other pervasive developmental disorders (F84.8) and pervasive developmental disorders not otherwise specified (F84.9). The data presented here concerned children born between 1995 and 2002. Prevalence rates were calculated for 10 000 children living in their eighth year of life in each counties.

Results

The overall prevalence rate in the eighth year of life over the whole study period was 31.9 per 10,000 children in Haute-Garonne and 34.9 per 10,000 in Isere, with a significant increasing trend between 1995 and 2002 in Haute-Garonne county. The sex-ratio was 3.8 and 3.5 respectively in Haute-Garonne and Isere. In both counties, about half of the children had an associated intellectual deficiency and about one third if only severe impairment (defined by an IQ below 50) was considered. An epilepsy was more often present when an intellectual deficiency was associated.

Conclusion

Data from the two French registers were quite comparable and demonstrated that prevalence rates of pervasive developmental disorders in the eighth year of life were in the lower range of those published in the international literature.     

Quelle place pour les registres de morbidité à l’ère des données massives de santé ?

The recent opening of massive health databases, as well as the development of methods and tools adapted to their data processing, questions the French model of “morbidity registry”. In France in 2019, nearly 61 health registries were operating. As defined by law, these registries identify exhaustively all patients with a given disease in a given territory. Established several decades ago, these registries are part of the French surveillance system that is used for research and evaluation purposes. Since the advent of recent technological progress, large-scale databases are made available to researchers and it is possible with these databases to answer questions initially assigned to the registries. What is the place of such registries in this new context: are they obsolete or still useful? Should they be opposed to the new tools or are they complementary to them, and if so, what is their place in the new French public health ecosystem? The objective of this work was to assess the roles and missions of existing registries and to reflect on their positioning in this new environment. The French model of registry is sometimes questioned because of the complexity of its circuits, requiring a significant amount of human resources. However, the data that constitute them, validated by cross-checking information from several sources, are of very high quality, and make it possible to validate the data in the new databases (National Health Data System (NSDS) or Hospital Data Warehouses). Registries and new databases are in fact complementary, and far from jeopardizing this model, the recent opening of these databases represents an opportunity for registries to modernize their operations and respond to new missions.     

Évaluation départementale des délais de reperfusion des syndromes coronariens aigus avec élévation du segment ST en fonction de la filière de recours aux soins

Introduction

Acute coronary syndrome with ST segment elevation (STEMI) remains a major cause of morbidity and mortality in France, directly correlated with the time management of the patient to achieve reperfusion of the artery as early as possible. But the delay of reperfusion is related to the course that will take the patient to the revascularization.

Methods

To make an observation of departmental practices, we conducted a retrospective monocentric study on the STEMI supported on 4 years in the Departmental Hospital of La Roche-sur-Yon by comparing the time of reperfusion in two groups: patients who used the recommended chain = diRect chain (Call the emergency number–specialist mobile emergency unit–Cardiac intensive care unit or cardiac catheterization laboratory), and patients who used another chain = Long chain.

Results

On 838 patients with STEMI, 356 (42.5%) used the Direct chain. The average time of reperfusion in the Direct chain group is 4.26 hours (±3.12), 6.17 hours (±4.82) in the Long chain group. There is a significant difference between the two groups of 1.9 hours (P < 0.001). Of 186 patients who consulted a general practitioner, 40.3% of patients were not supported by the mobile emergency unit.

Conclusion

These results should lead to improved practices, to carry on continuing medical education with all actors in the chain and patient information to shorten up the time of reperfusion.     

What do registries bring us? The example of acute coronary syndromes

Prospective, randomised trials are the key to evidence-based medicine. They have brought considerable progress to the field of cardiology. They have, however, methodological constraints that result in the inclusion of only a small proportion of patients presenting with a given disease. In contrast, registries include all patients, without any selection, and therefore reflect everyday practice in the "real world". They are the key to epidemiological data, but they can also be used to tackle questions or issues that are unresolved by randomised trials. Both approaches are complementary and should be used to define the optimal management of patients. Lessons derived from registry data in acute coronary syndromes in the recent past in France are presented.