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Te Velde E.,Erasmus University Rotterdam | Te Velde E.,University Utrecht | Habbema D.,Erasmus University Rotterdam | Leridon H.,INED | And 2 more authors.
Human Reproduction | Year: 2012

Background Postponement of childbearing since the 1970s has led to an increase in permanent involuntarily childlessness. We will address the magnitude of this trend, the effect of IVF/ICSI and the effect on total fertility rate (TFR an often used demographic measure for the level of fertility) in six EU countries.Methods Using a fertility micro-simulation model, we estimate the effect of postponement of first motherhood on permanent involuntary childlessness in six representative European countries since 1970/1985: Sweden, Austria, Czech Republic, The Netherlands, West Germany and Spain. To estimate the effect of IVF/ICSI on this trend, we use data on the Results of all IVF/ICSI cycles performed in The Netherlands in 2003 and 2004. Results Permanent involuntary childlessness approximately doubled since 1970s and rose to ∼4 in the Czech Republic and to ∼7 in Spain with the other countries in between. If all couples entitled to have IVF/ICSI were to be treated, the effect of postponement would almost have been neutralized. However, only a limited proportion of eligible couple are being treated. Without postponement, TFRs would have been between 0.03 and 0.05 higher. Conclusions The effect of postponement on permanent involuntary childlessness is considerable. So far IVF/ICSI only had a slight effect on this trend. The impact of postponement on TFRs is small compared with other demographic trends. © 2012 The Author.


Troude P.,Ined | Troude P.,French Institute of Health and Medical Research | Troude P.,University Paris Diderot | Bailly E.,Ined | And 7 more authors.
Fertility and Sterility | Year: 2012

Objective: To determine the frequency of live births following spontaneous pregnancy (BSP) and to examine their associated factors among couples who have unsuccessfully or successfully experienced fertility treatments. Design: Retrospective cohort. Setting: Eight IVF centers. Patient(s): A total of 2,134 couples who began IVF treatment in the centers in 2000-2002 and were followed up by a postal questionnaire sent 7-9 years after they started treatment in the inclusion center. Intervention(s): None. Main Outcome Measure(s): Rates of BSP and factors associated with BSP. Univariate and multivariate analyses were conducted using logistic regression. Result(s): The BSP rate was 17% (218/1,320) among couples who had previously had a child through medical treatment and 24% (193/814) among couples who had remained childless after treatment. In both groups, the probability of BSP was higher among younger women and increased with a smaller number of IVF attempts. Probability was also higher when the cause of infertility was unexplained. Conclusion(s): Our results should give hope to couples who have been unsuccessfully treated by IVF, especially young couples with unexplained infertility. Nonetheless, it should be remembered that the BSP rates are cumulative rates observed over a long period of time and that these couples have a very low monthly probability of conceiving. © 2012 American Society for Reproductive Medicine, Published by Elsevier Inc.


Rozee Gomez V.,Ined | De La Rochebrochard E.,Ined | De La Rochebrochard E.,French Institute of Health and Medical Research | De La Rochebrochard E.,University Paris - Sud
Human Reproduction | Year: 2013

STUDY QUESTIONWhat are the characteristics, motivation and experience of French patients seeking cross-border reproductive care (CBRC)?SUMMARY ANSWERFrench patients seeking CBRC are same-sex couples, single women who are not eligible for assisted reproduction technologies (ARTs) in France and heterosexual couples seeking oocyte donation due to extremely limited access to this technique in France, while their choice of Greece as a destination is influenced by financial issues.WHAT IS KNOWN ALREADYCBRC is a new, increasing, complex and poorly understood phenomenon. A few studies have investigated UK, German or Italian CBRC patients, but none have specifically investigated French patients although France is one of the top four countries of origin of CBRC patients in Europe.STUDY DESIGN, SIZE, DURATIONA cross-sectional study was carried out in 2010-2012 in three ART centres in Greece, Belgium and Spain in order to investigate French patients treated in these centres. Recruitment was prospective in Greece and Belgium and retrospective in Spain. The overall response rate was 68%, with 128 French patients participating.PARTICIPANTS/ MATERIALS, SETTING, METHODSFrench patients filled in a questionnaire. Information was collected on their socio-economic characteristics and their search for ART treatment in France and in other countries.MAIN RESULTS AND THE ROLE OF CHANCEIn the Belgian centre, 89% of French patients used sperm donation whereas oocyte donation was used by 100% of patients in the Greek centre and 74% of patients in the Spanish centre. The majority (94%) of French patients using sperm donation in Belgium were not legally eligible for access to ART in France as they were same-sex couples or single women, and the main criterion of choice of centre was its geographical proximity (71%). Most of the French patients using oocyte donation in Greece and Spain fulfilled criteria for fully reimbursed oocyte donation treatment in France as they were heterosexual couples (99%) with the woman aged <43 years (65%). For these couples, CBRC was motivated by the extremely limited access to oocyte donation in France. Half of French CBRC patients using oocyte donation in Spain had a low/intermediate occupational level (such as primary school teachers, nurses, administrative officers or sales agents, workers and employees) and this proportion was much higher in Greece (82%, P < 0.01).LIMITATIONS, REASONS FOR CAUTIONLarger and more wide-ranging studies are needed as this study included only 128 patients who may not be representative of all French CBRC patients, especially because the study was carried out only in three ART centres and these too may not be representative.WIDER IMPLICATIONS OF THE FINDINGSCBRC among French patients had been thought to reflect mainly law evasion. This study showed that the reality is much more complex and that CBRC among French patients reflects both law evasion and limited access to oocyte donation in France. It also brings new insight into the characteristics of the patients by suggesting a certain degree of 'democratization' in access to such care. However, the choice of centre seemed related to socio-economic characteristics, in that the Greek centre treated a less advantaged population than the Spanish centre.STUDY FUNDING/COMPETING INTEREST(S)This study was supported by French public research funds, the Institute Emilie du Châtelet from the Ile-de-France Region, the Biomedicine Agency and the Research Institute of Public Health (IReSP). There are no conflicts of interest.TRIAL REGISTRATION NUMBERNot applicable. © 2013 © The Author 2013. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology.


Flamant C.,University of Nantes | Tich S.N.T.,University of Angers | de la Rochebrochard E.,Ined | de la Rochebrochard E.,National Health Research Institute | And 4 more authors.
PLoS ONE | Year: 2011

Our goals were to (1) validate the parental Ages and Stages Questionnaires (ASQ) as a screening tool for psychomotor development among a cohort of ex-premature infants reaching 2 years, and (2) analyse the influence of parental socio-economic status and maternal education on the efficacy of the questionnaire. A regional population of 703 very preterm infants (<35 weeks gestational age) born between 2003 and 2006 were evaluated at 2 years by their parents who completed the ASQ, by a pediatric clinical examination, and by the revised Brunet Lezine psychometric test with establishment of a DQ score. Detailed information regarding parental socio-economic status was available for 419 infants. At 2 years corrected age, 630 infants (89.6%) had an optimal neuromotor examination. Overall ASQ scores for predicting a DQ score ≤85 produced an area under the receiver operator curve value of 0.85 (95% Confidence Interval:0.82-0.87). An ASQ cut-off score of ≤220 had optimal discriminatory power for identifying a DQ score ≤85 with a sensitivity of 0.85 (95%CI:0.75-0.91), a specificity of 0.72 (95%CI:0.69-0.75), a positive likelihood ratio of 3, and a negative likelihood ratio of 0.21. The median value for ASQ was not significantly associated with socio-economic level or maternal education. ASQ is an easy and reliable tool regardless of the socio-economic status of the family to predict normal neurologic outcome in ex-premature infants at 2 years of age. ASQ may be beneficial with a low-cost impact to some follow-up programs, and helps to establish a genuine sense of parental involvement. © 2011 Flamant et al.


Gobillon L.,INED | Wolff F.-C.,University of Nantes
Urban Studies | Year: 2011

In this paper, a study is made of the mobility and housing choices of the elderly when retiring, using household data collected in France. From a theoretical viewpoint, individuals are likely to decrease their housing quantity because of an income loss when retiring, but they may also increase it to benefit from more housing comfort for leisure. Using the 1992 Trois Générations survey, it is first shown that housing mobility at retirement is substantial in France, with a variety of self-reported motives. Then, using the 1994-2001 French Europanel survey, evidence is found of both upsizing and downsizing for mobile recent retirees. In many cases, housing adjustments lead to a correction of the initial disequilibrium between the number of rooms and the number of occupants. However, a significant proportion of mobile recent retirees improve the quality of their dwelling. © 2011 Urban Studies Journal Limited.


PubMed | University of British Columbia, Anses and Ined
Type: | Journal: International journal of methods in psychiatric research | Year: 2016

Our aims are to describe and explain the structure of the Cannabis Abuse Screening Test (CAST) across countries. Standard statistical analyses fail to describe and explain several variables simultaneously while taking account of the group structure of individuals. The 2011 European School Survey Project on Alcohol and other Drugs (ESPAD): 5204 last-year cannabis users aged 15-16 from 13 European countries. Multigroup principal component analysis (mgPCA) and multigroup partial least squares (mgPLS). MgPCA shows that the CAST has a two-dimensional structure (frequency of use/problems and non-recreational use/dependency symptoms). All the countries present a good concordance with the common structure, except Kosovo, Lichtenstein and Romania. MgPLS shows that three explanative variables (in a total of eight) are mainly related with the CAST (the frequencies of cannabis use in the last 12months and in the last 30days and the age at first cannabis use) while Kosovo, Lichtenstein and Romania also present specificities. The CAST structure appears stable in the 13 countries except for Kosovo, Lichtenstein and Romania that also show specific relationships between the CAST variables and their determinants.


Legleye S.,INED | Legleye S.,French Institute of Health and Medical Research | Legleye S.,University of Paris Descartes | Kraus L.,Ift Institute For Therapieforschung | And 4 more authors.
European Addiction Research | Year: 2012

The present study aims at validating the Cannabis Abuse Screening Test (CAST) in a clinical sample of adolescent and young adult cannabis users seeking treatment. Applying a classical test theory approach using DSM-IV diagnoses as gold standard, two versions of the CAST questionnaire are compared. The sample consisted of 140 subjects aged 15-26 years (mean 18.9) recruited from two cannabis treatment centers. Gold standard diagnoses were assessed using the Adolescent Diagnostic Interview-Light. Internal structure and consistency of the CAST were assessed by principal component analysis and Cronbach's α. Optimal thresholds were defined using receiver operating characteristic analysis. Both the binary and the full test version revealed unidimensional structures with moderate to satisfactory internal consistency (α = 0.66 and 0.73). Screening properties were unsatisfactory when the CAST was compared against cannabis dependence. With regard to cannabis use disorders, both test versions yielded comparable and good sensitivity and specificity at cut-off 3 (binary: 92.2%, 66.7%) and 6 (full: 93.0%, 66.7%). Overall, the full CAST may be used for screening cannabis use disorders in clinical settings. Further research may use validation methods that do without gold standard. Copyright © 2012 S. Karger AG.


Apolloni A.,Ecole Normale Superieure de Lyon | Gargiulo F.,INED
Advances in Complex Systems | Year: 2011

Axelrod's model describes the dissemination of a set of cultural traits in a society constituted by individual agents. In a social context, nevertheless, individual choices toward a specific attitude are also at the basis of the formation of communities, groups and parties. The membership in a group changes completely the behavior of single agents who start acting according to a social identity. Groups act and interact among them as single entities, but still conserve an internal dynamics. We show that, under certain conditions of social dynamics, the introduction of group dynamics in a cultural dissemination process avoids the flattening of the culture into a single entity and preserves the multiplicity of cultural attitudes. We also consider diffusion processes on this dynamical background, showing the conditions under which information as well as innovation can spread through the population in a scenario where the groups' choices determine the social structure. © 2011 World Scientific Publishing Company.


Bajos N.,French Institute of Health and Medical Research | Prioux F.,Ined | Moreau C.,French Institute of Health and Medical Research
Revue d'Epidemiologie et de Sante Publique | Year: 2013

Background: The number of women resorting to abortion several times has increase continuously in France since 1975, similar to the situation in many countries where contraception is widely available and used. The analysis of time trends in so-called "repeat" abortion across social, demographic and contraceptive characteristics can be helpful in capturing the social meaning of this practice and informing policies for sexual and reproductive health. Methods: The present analysis was based on statistical reports of abortions performed in France from 1990 to 2007 and on data from the National Survey of Abortion Patients, a representative sample of 7067 women undergoing an abortion in France. Chi2 and logistic regression models were used for the statistical analysis. Results: Increase in "repeated" abortion was seen across all groups of the population but was greater in women under 30, women who live alone and students. Women presenting for a second abortion were more likely to report the pregnancy followed a contraceptive failure than women presenting for an abortion for the first time. Conclusion: The trend for an increasing use of multiple abortions over time occurs primarily because of longer time between first intercourse and first child. Having several abortions is an expression of the difficulties women have in managing daily contraceptive use in the context of more diversified emotional and sexual trajectories. Position du problème: Le nombre de femmes ayant recours plusieurs fois à l'interruption volontaire de grossesse (IVG) ne cesse de s'accroître depuis 1975en France comme dans de nombreux pays où la contraception est d'un accès facile. L'analyse du recours dit «répété« à l'IVG au fil du temps et selon les caractéristiques sociales, démographiques et contraceptives des femmes contribue à éclairer la signification sociale que recouvre cette pratique et à évaluer les politiques de santé sexuelle et reproductive. Méthodes: L'analyse porte sur les bulletins statistiques d'IVG de 1990à 2007et sur les données de l'enquête nationale sur le recours à l'IVG en France, collectées par la Direction de la recherche, des études, de l'évaluation et des statistiques (Drees) auprès d'un échantillon aléatoire de 7067femmes en France métropolitaine. Les méthodes usuelles d'analyse uni- et multivariée ont été utilisées. Résultats: L'augmentation du recours répété à l'IVG est observée dans toutes les catégories de la population mais plus marquée chez les femmes âgées de moins de 30. ans, chez celles qui vivent seules et les étudiantes. Les femmes se présentant pour une deuxième IVG déclarent plus que les autres avoir utilisé une méthode de contraception au moment où elles se sont trouvées enceintes. Conclusion: L'augmentation du recours multiple à l'IVG au fil du temps traduit avant tout l'allongement de la période entre le premier rapport sexuel et le premier enfant. Le fait d'avoir plusieurs IVG renvoie aux difficultés de gérer un parcours contraceptif sans failles dans le cadre de trajectoires affectives et sexuelles de plus en plus diversifiées. © 2013 Elsevier Masson SAS.


Leridon H.,INED
Medecine Therapeutique Medecine de la Reproduction, Gynecologie et Endocrinologie | Year: 2013

This paper deals with the possible outcome of human reproductive processes in a relatively near future.

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