Showing papers in "Revue D Epidemiologie Et De Sante Publique in 2013"
TL;DR: There needs to be a cross-government commitment to action on social determinants of health, and the knowledge synthesised in this report suggests that there is much that can be done at the practical level.
Abstract: Closing the Gap in a Generation, the final report of the Commission on Social Determinants of Health (CSDH) proposed that inequities in power, money and resources were responsible for much of the inequalities in health within and between countries. A toxic combination of poor policies and programmes, unfair economic arrangements and bad governance led to inequalities in the conditions of daily life: the circumstances in which people are born, grow, live, work, and age. Our message is that there needs to be a cross-government commitment to action on social determinants of health. With this commitment, the knowledge synthesised in our report suggests that there is much that can be done at the practical level.
69 citations
TL;DR: The majority of effective interventions minister to people already suffering from psychological disorders, but health promotion initiatives prior to situations of psychological disorders also deserve to be considered, in particular the implementation of services for the isolated elderly.
Abstract: Aim This review focuses on interventions to prevent suicide. It excludes psychotherapy evaluations and pharmaceutical clinical trials. The aim of this article is to provide useful input to the reflection on and the development of actions for professionals who may be concerned by suicide prevention. Method This research is based on 41 published evaluation studies presenting results on at least one of the three following outcomes: completed suicides, suicide attempts, and suicidal ideations. These studies have been classified into seven categories of preventive action. Results According to data from the literature selected for our analysis, the three most efficient categories of intervention seem to be the limitation of access to lethal means, the preservation of contact with the patients hospitalized for a suicide attempt after hospitalization, and the implementation of emergency call centers. The four other categories of intervention examined in this study — the training of general practitioners, the reorganization of care, programs in schools, and information campaigns — have not yet shown sufficient proof of their efficacy. Nevertheless, these interventions, under certain conditions, can also contribute significantly to the prevention of suicide. Conclusion The majority of effective interventions minister to people already suffering from psychological disorders, but health promotion initiatives prior to situations of psychological disorders also deserve to be considered, in particular the implementation of services for the isolated elderly.
47 citations
TL;DR: Gathering scientific evidence on the relationships between the environments, mobility/transportation, and health should allow public health and urban planning decision makers to better take into account the individual and environmental barriers to the adoption of active transportation and to define innovative intervention strategies addressing obesogenic environments to reduce disparities in excess weight.
Abstract: While public policies seek to promote active transportation, there is a lack of information on the social and environmental factors associated with the adoption of active transportation modes. Moreover, despite the consensus on the importance of identifying obesogenic environmental factors, most published studies only take into account residential neighborhoods in the definition of exposures. There are at least three major reasons for incorporating daily mobility in public health research: (i) to identify specific population groups, including socially disadvantaged populations, who experience mobility or spatial accessibility deficits; (ii) to study the environmental determinants of transportation habits and investigate the complex relationships between transportation (as a source of physical activity, pollutants, and accidents) and physical activity and health; and (iii) to improve the assessment of spatial accessibility to resources and exposure to environmental hazards by accounting for daily trajectories for a better understanding of their health effects. There is urgent need to develop novel methods to better assess daily mobility. The RECORD Study relies on (i) an electronic survey of regular mobility to assess the chronic exposure to environmental conditions over a relatively long period, and (ii) Global Positioning System tracking to evaluate precisely acute environmental exposures over a much shorter period. The present article argues that future research should combine these two approaches. Gathering scientific evidence on the relationships between the environments, mobility/transportation, and health should allow public health and urban planning decision makers to better take into account the individual and environmental barriers to the adoption of active transportation and to define innovative intervention strategies addressing obesogenic environments to reduce disparities in excess weight. # 2013 Elsevier Masson SAS. All rights reserved.
37 citations
Journal Article•
TL;DR: In this article, the authors analyse the effect of recours on the fertility status of femmes in France and evaluate the politiques de sante sexuelle et reproductive. But, they focus mainly on the caracteristiques sociales, demographiques, and contraceptives des femmes contribue a eclairer la signification sociale that recouvre cette pratique and a evaluer les politiques.
Abstract: Position du probleme Le nombre de femmes ayant recours plusieurs fois a l'IVG ne cesse de s'accroitre depuis 1975 en France comme dans de nombreux pays ou la contraception est d'un acces facile. L'analyse du recours dit \" repete \" a l'IVG au fil du temps et selon les caracteristiques sociales, demographiques et contraceptives des femmes contribue a eclairer la signification sociale que recouvre cette pratique et a evaluer les politiques de sante sexuelle et reproductive. Methodes L'analyse porte sur les bulletins statistiques d'IVG de 1990 a 2007 et sur les donnees de l'enquete nationale sur le recours a l'IVG en France, collectees aupres d'un echantillon aleatoire de 7 067 femmes en France metropolitaine. Les methodes usuelles d'analyse uni et multivariee ont ete utilisees. Resultats L'augmentation du recours repete a l'IVG est observee dans toutes les categories de la population mais plus marquee chez les femmes de moins de 30 ans, chez celles qui vivent seules et les etudiantes. Les femmes se presentant pour une deuxieme IVG declarent plus que les autres avoir utilise une methode de contraception au moment ou elles se sont trouvees enceintes. Conclusion L'augmentation du recours multiple a l'IVG au fil du temps traduit avant tout l'allongement de la periode entre le premier rapport sexuel et le premier enfant. Le fait d'avoir plusieurs IVG renvoie aux difficultes de gerer un parcours contraceptif sans failles dans le cadre de trajectoires affectives et sexuelles de plus en plus diversifiees.
35 citations
TL;DR: A secondary analysis of epidemiological HRQoL data issued from two national surveys showed the existence of social determinants of HRZoL, and demonstrated that four social indicators are determinant of HRqoL namely living in couple, level of education, occupational status and net income per household, independently of age and gender known effect.
Abstract: The concept of health-related quality of life (HRQoL) considers patient's perspective as an essential component of the health care relationship. HRQoL is often assimilated to a set of existing tools aimed at measuring the perspective of patient, more particularly the consequences of ill-health condition on patient's everyday life. Patients' reports of their health is however diverse, as social factors such as age, gender, professional status are likely to impact on health self-perception and reporting. Social aspects of HRQoL are somehow underexplored. This paper presents a secondary analysis of epidemiological HRQoL data issued from two national surveys (Barometre Sante 2005; Enquete Decennale Sante 2002-2003). The data analysis showed the existence of social determinants of HRQoL. It more specifically demonstrated that four social indicators are determinants of HRQoL namely living in couple, level of education, occupational status and net income per household, independently of age and gender known effect. Social mechanisms governing the impact of social determinants on quality of life could be further explored by adopting a multidisciplinary and mutilevel research approach of HRQoL as well as considering the ability of individuals to engage with social aspect of their health conditions.
34 citations
TL;DR: In this article, the authors analyse the effect of recours on the socio-economic status of femmes in the context of IVG and evaluate the politiques of sante sexuelle and reproductive.
Abstract: Position du probleme Le nombre de femmes ayant recours plusieurs fois a l'IVG ne cesse de s'accroitre depuis 1975 en France comme dans de nombreux pays ou la contraception est d'un acces facile. L'analyse du recours dit " repete " a l'IVG au fil du temps et selon les caracteristiques sociales, demographiques et contraceptives des femmes contribue a eclairer la signification sociale que recouvre cette pratique et a evaluer les politiques de sante sexuelle et reproductive. Methodes L'analyse porte sur les bulletins statistiques d'IVG de 1990 a 2007 et sur les donnees de l'enquete nationale sur le recours a l'IVG en France, collectees aupres d'un echantillon aleatoire de 7 067 femmes en France metropolitaine. Les methodes usuelles d'analyse uni et multivariee ont ete utilisees. Resultats L'augmentation du recours repete a l'IVG est observee dans toutes les categories de la population mais plus marquee chez les femmes de moins de 30 ans, chez celles qui vivent seules et les etudiantes. Les femmes se presentant pour une deuxieme IVG declarent plus que les autres avoir utilise une methode de contraception au moment ou elles se sont trouvees enceintes. Conclusion L'augmentation du recours multiple a l'IVG au fil du temps traduit avant tout l'allongement de la periode entre le premier rapport sexuel et le premier enfant. Le fait d'avoir plusieurs IVG renvoie aux difficultes de gerer un parcours contraceptif sans failles dans le cadre de trajectoires affectives et sexuelles de plus en plus diversifiees.
30 citations
TL;DR: During the last decades, inequalities in health care expenditure have decreased in France with diffusion of complementary insurance, due in particular to the CMU-C implementation in 2000, but they are still significant.
Abstract: Tackling health inequalities is one of the main public health goals, and equity of access to care is a necessary condition to achieve this objective. Analyzing and assessing inequalities in health care use is therefore essential in order to enlighten public health policies. This article proposes a review on inequalities in access to care in France and OECD countries, their causes and their evolution. During the last decades, inequalities in health care expenditure have decreased in France with diffusion of complementary insurance, due in particular to the CMU-C implementation in 2000, but they are still significant. The reduction of inequalities is particularly important for GP use, for which we observe now pro-poor inequities. However, there are persistent and important inequalities in access to specialist care, as well as in preventive care. Therefore, France is still one of the European countries with the highest level of inequities in access to care.
25 citations
TL;DR: The prevalences of HIV and HBsAg in Bukavu are lower than in most major cities in sub-Saharan Africa and the residual risk of viral transmission associated with the serological window is equal to the incidence rate multiplied by the duration of theserological window.
Abstract: Background To estimate the residual risk of transmission of HIV and HBV virus by blood transfusion in Bukavu. Methods Retrospective cohort study designed for exploratory purposes, which took place in Bukavu (DR Congo) between January 2001 and December 2005, among 3292 blood donors. The incidences were estimated by survival curves and Cox models. The adjusted relative risks with their confidence interval at 95% were derived from Cox models. The residual risk of viral transmission associated with the serological window is equal to the incidence rate multiplied by the duration of the serological window divided by 365. Results The prevalence among blood donors in Bukavu was 1% for HIV and 3.7% for HbsAg. The number of incident cases observed was seven for HIV and 40 for hepatitis B between 2001 and 2005. The incidence rates obtained were 3.57 for 1000 person-years (0.93/1000–6.23/1000) and 25.4 per 1000 person-years (17.6/1000–33.36/1000), respectively for HIV and hepatitis B. The residual risk was 1/4608 donations for HIV or 0.22 (0.02–0.65) and 1/257 donations for HBV or 3.90 (1.20–9.96). Also there were more seroconversions among family blood donors than in volunteer donors. The risk of seroconversion in family donors compared to volunteer donors adjusted for age, sex and residence was 7.09 (3.75–13.39) for HIV and 4.03 (2.63–6.20) for HBsAg. The same result was observed with the survival curves. Conclusion The prevalences of HIV and HBsAg in Bukavu are lower than in most major cities in sub-Saharan Africa. Residual risks are especially important for hepatitis B.
24 citations
TL;DR: Evaluated coverage and compliance rates of human papillomavirus vaccines in Picardy appear to be low and health authorities in PicardY should provide communication and action campaigns to improve these results.
Abstract: Background In France, the human papillomavirus vaccine is routinely recommended for 14-year-old females and a “catch-up” vaccination should be offered to female adolescents who are between 15 and 23 years of age Currently, few studies are available on the coverage rates in France The aim of this study was to evaluate the coverage of the human papillomavirus vaccine and compliance with the vaccination scheme in Picardy, between 2009 and 2010, and to analyze the socioeconomic factors possibly influencing this coverage Methods We selected a female population that was affiliated with the national health insurance organization, living in the Picardy region of France, and aged between 14 and 23 years on 31st December 2010 Results The coverage rate in the study population with at least one dose of vaccine was 168% A complete vaccination scheme (three doses) was observed in less than 389% of them, so only 65% of this population had received the complete vaccination Higher rates of coverage and compliance were observed in girls 14 years of age (655%) and if the prescriber was a gynecologist or pediatrician (respectively, 447% and 481%) There is a negative correlation between coverage and compliance and the percentage of single-parent families and immigrant families by canton area of Picardy The economic cost of an inappropriate scheme was 13 million euros for Picardy in 2009 Conclusion Coverage and compliance rates of human papillomavirus vaccines in Picardy appear to be low This study suggests that health authorities in Picardy should provide communication and action campaigns to improve these results
21 citations
TL;DR: It is shown that children have limited exposure to Toxoplasma gondii and that seroprevalence in men and women does not differ for the population aged 45 years and under, and that geographical disparity in prevalence in France is confirmed.
Abstract: Background The only national seroprevalence data currently available on toxoplasmosis in France are from the national perinatal surveys of pregnant women conducted in 1995 and 2003. These surveys are national, exhaustive and cross-sectional studies of all pregnant women who give birth in France during one specified week. These cross-sectional studies, conducted among women of childbearing age (defined as 18 to 45 years), showed a positive correlation between seroprevalence and age, with a significant regional disparity. This study was performed in order to compare the prevalence of toxoplasmosis antibodies in men and women in the 18–45 age group, to confirm regional variations and to estimate the seroprevalence of toxoplasmosis in France for different age groups, particularly among children and among adults aged over 45 years. Methods Serum samples from 2060 subjects were available from a national serum bank that was established in 1997 as part of a European study on vaccine preventable diseases. The sera were tested for IgG antibodies in 2008–2009, by ELISA test, at the laboratory of parasitology-mycology, CHU Grenoble. Results The seroprevalence for the population aged 1–64 years was 55.4%. Seroprevalence did not vary between the sexes, except among those aged over 45 years, where it was higher in men than in women. Toxoplasmosis seroprevalence varied significantly by regions for all ages. It increased with age and we noted a stronger increase in prevalence in adolescents (10–20 years) than in other age groups. Conclusion This study showed that children have limited exposure to Toxoplasma gondii and that seroprevalence in men and women does not differ for the population aged 45 years and under. This study confirms the geographical disparity in prevalence in France that has been found in other studies in women of childbearing age. This disparity cannot be explained by different laboratory techniques, because sera were tested in a single laboratory. The study also raises the possibility of extrapolating seroprevalences from ENP to the general population and thus estimating the seroprevalence in the French population.
20 citations
TL;DR: The CREX can be a useful vehicle for the implementation of a safety culture in medical units and is located in the base level, short loop of risk management and allows direct involvement of care professionals in patient safety.
Abstract: Background An experience feedback committee (CREX, Comite de Retour d'EXperience) is a method which contributes to the management of safety of care in a medical unit. Originally used for security systems of civil aviation, the method has been adapted to health care facilities and successfully implemented in radiotherapy units and in other specialties. Methods We performed a brief review of the literature for studies reporting data on CREX established in hospitals. The review was performed using the main bibliographic databases and Google search results. Results The CREX is designed to analyse incidents reported by professionals. The method includes monthly meetings of a multi-professional committee that reviews the reported incidents, chooses a priority incident and designates a "pilot" responsible for investigating the incident. The investigation of the incident involves a systemic analysis method and a written synthesis presented at the next meeting of the committee. The committee agrees on actions for improvement that are suggested by the analysis and follows their implementation. Systems for the management of health care, including reporting systems, are organized into three levels: the medical unit, the hospital and the country as a triple loop learning process. The CREX is located in the base level, short loop of risk management and allows direct involvement of care professionals in patient safety. Conclusion Safety of care has become a priority of health systems. In this context, the CREX can be a useful vehicle for the implementation of a safety culture in medical units.
TL;DR: In this paper, the authors present their experience over the past 5 years with evaluative research in two public health interventions and show how they conduct evaluations in practice using a pragmatic approach.
Abstract: Forty years ago, Schwartz and Lellouch invented pragmatic clinical trials. Their proposal has not yet been fully espoused. This appears to be the case today also in the domain of public health interventions evaluation, where some still insist on the superiority of experimental methods. Yet evaluations of complex public health interventions are fraught with pitfalls for researchers. Most such interventions take place in natural experimental contexts, where they have no control over the context or the factors that modify implementation and influence the effects. Experimental approaches are, in these cases, not very appropriate, and yet decision makers want to be able to take decisions to improve them. This article presents our experience over the past 5years with evaluative research in two public health interventions. We wish to show how we conduct evaluations in practice using a pragmatic approach. The article is focused on elements that have not, to date, received much attention in the francophone literature: the evaluability assesment and intervention logic, research strategies reinforced particularly by mixed methods and time series, and the analysis of implementation fidelity and mechanisms that foster effectiveness. Because the pragmatic approach to evaluative research stresses the need for good understanding of context and uses reinforced methodological strategies, it allows for rigorous responses to evaluation questions raised by those implementing complex public health interventions. Thus, experimental approaches are not necessarily required to analyze the effectiveness of interventions.
TL;DR: After adjustment for season, children with severe stunting are at a lower risk of high-level malaria parasitemia and the association between PEM indicators and malaria paras itemia is quantified.
Abstract: Background Despite a reduction in the magnitude of endemic malaria reported in recent years, malaria and protein-energy malnutrition (PEM) still remain major causes of morbidity and mortality in sub-Saharan Africa among children under five. The relationship between malaria and malnutrition remains a topic of controversy. We aimed to investigate malaria infection according to nutritional status in a community-based survey. Methods A cohort of 790 children aged 6 to 59 months and residing in eastern Democratic Republic of the Congo was followed-up from April 2009 to March 2010 with monthly visits. Data on nutritional status, morbidity between visits, use of insecticide-treated nets and malaria parasitemia were collected at each visit. The Z scores height for age, weight for age and weight for height were computed using the reference population defined by the WHO in 2006. Thresholds for Z scores were defined at −3 and −2. A binary logistic model of the generalized estimating equation (GEE) was used to quantify the association between PEM indicators and malaria parasitemia. Odds ratio (OR) and their 95% confidence interval (95% CI) were computed. Results After adjustment for season, children with severe stunting (height for age Z score Conclusion Severely stunted children are at a lower risk of high-level malaria parasitemia.
TL;DR: In this article, the authors conducted a systematic search of cohort studies, case-control studies and transversal studies published between 2001 and 2011, combining the MeSH terms "schizophrenia", "psychotic disorders", "homicide", "violence", "substance use disorder", and the TIAB term "alcohol".
Abstract: Background and aim The prevalence of homicide perpetrators with a diagnosis of schizophrenia is 6% in Western countries populations. The relationship between schizophrenia and homicide is complex and cannot be reduced to a simple causal link. The aim of this systematic review was to clarify the role of substance abuse in the commission of murder in people suffering from schizophrenia. Methods A systematic English-French Medline and EMBASE literature search of cohort studies, case-control studies and transversal studies published between January 2001 and December 2011 was performed, combining the MeSH terms “schizophrenia”, “psychotic disorders”, “homicide”, “violence”, “substance use disorder”, and the TIAB term “alcohol”. selection was based on the STROBE and PRISMA checklist for observational studies and systematic and meta-analysis studies, respectively. Results Of the 471 selected studies, eight prospective studies and six systematic reviews and meta-analysis studies met the selection criteria and were included in the final analysis. Homicide committed by a schizophrenic person is associated with socio-demographic (young age, male gender, low socioeconomic status), historical (history of violence against others), contextual (a stressful event in the year prior to the homicide), and clinical risk factors (severe psychotic symptoms, long duration of untreated psychosis, poor adherence to medication). In comparison to the general population, the risk of homicide is increased 8-fold in schizophrenics with a substance abuse disorder (mainly alcohol abuse) and 2-fold in schizophrenics without any comorbidities. A co-diagnosis of substance abuse allows us to divide the violent schizophrenics into “early-starters” and “late-starters” according to the age of onset of their antisocial and violent behavior. The violence of the “early-starters” is unplanned, usually affects an acquaintance and is not necessarily associated with the schizophrenic symptoms. Substance abuse is frequent and plays an important role in the homicide commission. In addition, the risk of reoffending is high. In the “late-starters”, the violence is linked to the psychotic symptoms and is directed to a member of the family. The reoffence risk is low and it depends on the pursuit of care or not. Conclusion Defining subgroups of violent schizophrenic patients would avoid stigmatization and would help to prevent the risk of homicide by offering a multidisciplinary care which would take into account any substance abuse.
TL;DR: This survey confirms established knowledge and highlights, at different stages of life, new risk factors that contribute to injuries in France, which should be helpful for the development of adapted injury prevention programs.
Abstract: Background Whatever the type of injury considered, prevention requires an improvement in health services’ awareness of risk factors. The Health Barometer is a general population survey conducted in France since 1992 to contribute to surveillance in this field. The survey's statistical power and the numerous health topics included in the questionnaire provide accurate information for healthcare professionals and decision-makers. Methods The Health Barometer 2010 was a nationwide telephone survey of 9110 persons representative of the 15–85-year-old population. One part of the questionnaire detailed injuries which had occurred during the past year. The numerous variables recorded enabled application of logistic regression models to explore risk factors related to different types of injury by age group. The findings were compared with the Health Barometer 2005 data to search for temporal trends of injury prevalence. Results The data analysis showed that 10.3 % of the 15–85-year-olds reported an injury during the past year. This rate was higher than recorded in 2005; the increase was mainly due to domestic accidents and injuries occurring during recreational activities. Both type of injury and risk factors exhibited age-related variability. Domestic accidents and injuries occurring during recreational activities predominated in the older population and were associated with physical or mental health problems (chronic disease, diability, sleep disorders). For younger people, injuries were related to cannabis use, drunkedness, and insufficient sleep. Risk factors were also depended on type of injury: occupational accident-related injuries were linked with social disadvantage (manual worker population) whereas sports injuries were more common in the socially advantaged population. Conclusion This survey confirms established knowledge and highlights, at different stages of life, new risk factors that contribute to injuries in France. These findings should be helpful for the development of adapted injury prevention programs, by providing a better understanding of the characteristic features of this major public health issue.
TL;DR: This paper proposes several promising future directions for neighborhood research to address health inequalities, including a need to incorporate life-course concepts, data, and methods, including to model residential histories, neighborhood temporal change and residential mobility, starting early in life.
Abstract: This paper proposes several promising future directions for neighborhood research to address health inequalities. First, there is a need to apply a Geography of Opportunity framework to understand how vast spatial (neighborhood, regional) inequality translates into health inequality. Such a framework highlights inequality that unfolds across an entire region, as well as the continuing significance of race/ethnicity for producing disparities in health and in the social determinants of health. The Geography of Opportunity framework also points to some of the methodological limitations of current neighborhood-health studies, given the structure of neighborhood racial inequality in the US for estimating how important neighborhoods are for producing racial health disparities. Second, there is a need to incorporate life-course concepts, data, and methods, including to model residential histories, neighborhood temporal change and residential mobility, starting early in life. A life-course focus would help inform when in life neighborhoods matter most for health and health inequalities, as well as improve exposure assessment of residential contexts. Third, we must model mechanisms linking neighborhoods and health, including the role of individual and household socioeconomic status. Lastly, we need to more meaningfully integrate social determinants of health, including drawing on policy evaluations that aim to improve neighborhood environments or that aim to expand household neighborhood choice. Doing so would inform how specific modifiable neighborhood exposures stimulated by policy may influence health and health disparities.
TL;DR: Prevalence of TTI markers is high and national strategies for safe blood transfusion have to be strengthened, it is essential to recruit and maintain more volunteer donors, while females should be encouraged to donate blood.
Abstract: Background The study aimed to determine the seroprevalence of transfusion-transmitted infectious (TTI) markers for human immunodeficiency virus (HIV), hepatitis B and C viruses (HBV, HCV) and syphilis among blood donors in Niamey (Niger). The association between seroprevalence of ITT markers and sociodemographic characteristics of blood donors was investigated. Methods A cross-sectional study was conducted in 2010 among 3213 blood donors. Data were collected from a pre-donation questionnaire and from laboratory tests results. Results The male/female ratio was 4/1. Up to 18.1% of donations had at least one positive marker, in which 2.7% presented a positive test for two or more agents. A seroprevalence of 1.62% (95%CI: 1.21–2.12) was associated with HIV, 15.4% (13.9–16.7) with HBV, 1.18% (0.84–1.62) with HCV, and 0.47% (0.26–0.77) for blood samples reacted with RPR test for syphilis. The HIV seroprevalence was two-fold higher in family than in volunteer donors (OR = 2.15, 95%CI: 1.24–3.73). It was also higher in Rhesus D negative donors (OR = 2.40, 95%CI: 1.11–5.17). The hepatitis B surface antigen seroprevalence was significantly higher in males than females (OR = 1.85, 95%CI: 1.39–2.45) and in first time than in regular donors (P Conclusion Prevalence of TTI markers is high and national strategies for safe blood transfusion have to be strengthened. It is essential to recruit and maintain more volunteer donors, while females should be encouraged to donate blood.
TL;DR: This article aims to illustrate the point that primary prevention needs more reflexivity regarding its potential unintended and deleterious side effects, considering the cases of smoking and obesity.
Abstract: In France, as in many countries, tackling social inequalities in health is a public health priority. However, primary prevention may sometimes contribute to increase such inequalities. This article aims to illustrate this point, considering the cases of smoking and obesity. The implicit hypotheses of prevention regarding its targets are discussed, as well as its stigmatization effects. On the one hand, prevention can increase the social differentiation of risky behaviors, as it is more effective among wealthier and more educated people. On the other hand, prevention policies intending to increase either the financial or the symbolic cost of risky behaviors may also increase social inequalities. Primary prevention needs more reflexivity regarding its potential unintended and deleterious side effects.
SIDI1
TL;DR: The results reflect the importance of monitoring the nutritional status on both individual and collective levels and the need to develop strategies for prevention, diagnosis and early treatment before the problem becomes more widespread.
Abstract: Background Childhood obesity is a phenomenon of growing concern today because of its rapid growth worldwide. The aim of our study was to estimate the prevalence of overweight and obesity among school age children in Marrakech. Methods We conducted a cross-sectional study of a random sample of 1418 schoolchildren aged 8–15 years in the public sector in Marrakech in May 2011. Trained physicians measured the weight and size of respondents. The body mass index (BMI) was calculated for each child. Overweight was assessed by comparing BMI with World Health Organization (WHO) and International Obesity Task Force (IOTF) references. Statistical analysis was performed using SPSS version 16.0 and using a macro of WHO Anthro for SPSS. Results The mean age was 10.8 ± 1.6 years. The sex ratio (girl/boy) was 1. The prevalence of overweight and obesity were 8 % (95 % CI [6.7, 9.6]) and 3 % (95 % CI [2.2, 4.1] based on WHO reference. This prevalence were respectively 12.2 % (95 % IC [10.5; 14.0]) and 5.4 % (95 % IC [4.3; 6.7]) using the IOTF reference. Conclusion In the absence of national data, our results reflect the importance of the phenomenon in our context, hence the importance of monitoring the nutritional status on both individual and collective levels and the need to develop strategies for prevention, diagnosis and early treatment before the problem becomes more widespread.
TL;DR: La repartition des maternites en France s’est modifiee entre 2001 et 2010, même si elles sont desormais moins nombreuses mais mieux equipees.
Abstract: La repartition des maternites en France s’est modifiee entre 2001 et 2010. Elles sont desormais moins nombreuses mais mieux equipees.
TL;DR: Eating habits and physical activity are positively associated with knowledge of nutritional recommendations, mainly acquired via nutritional information and educational actions, which emphasizes the need to further support individual-focused initiatives with health-enhancing environmental strategies.
Abstract: Background Nutrition education is one of the main lines of the French nutrition policy that has been undertaken for several years. The underlying hypothesis of this approach is that knowledge improvement is one of the ways likely to contribute to health-enhancing diet and physical activity. The objective of this paper, based on the 2008 Health and nutrition Barometer, is to examine the associations observed between knowledge and behavior with regard to diet and physical activity. Methods The 2008 Health and nutrition Barometer is a nationally representative telephone survey conducted on 4714 individuals aged 12–75 years. For six recommendations of the National Nutrition and Health Program ( Programme national nutrition sante [PNNS]), multiple logistic models were used to identify associations between knowledge of these recommendations and behavior, among adults aged 18–75 years. For food consumed on the day before the interview, odds ratios were adjusted for sex, age, education level, agglomeration size and region. As bivariate analysis showed that income level was significant for recommended consumption of fish, this variable was introduced among adjustment variables. Similarly, the variable occupation was introduced for physical activity. Results A positive association between knowledge of recommendations and nutritional behavior on the day before interview was observed for fruit and vegetables (OR = 1.7), dairy products (OR = 1.6), and starchy food (OR = 1.6). The same was observed for consumption of fish during the 15 days before the interview (OR = 5.0) and for physical activity during a usual week (OR = 1.5) but not for the “meat, seafood and eggs” food group. Conclusion Eating habits and physical activity are positively associated with knowledge of nutritional recommendations, mainly acquired via nutritional information and educational actions. Nevertheless, the important differences observed for certain dietary groups between knowledge of recommendations and dietary intake emphasizes the need to further support individual-focused initiatives with health-enhancing environmental strategies.
TL;DR: In this article, Bobo-Dioulasso et al. investigated the effect of the family on the soins/soutiens multiformes in Afrique subsaharienne, and found that a priori, les repondants font croire qu’il n’y a pas de besoins fonctionnels des personnes âgees not couverts par la famille.
Abstract: Position du probleme : En Afrique subsaharienne, la forte implication de la famille dans les soins/soutiens multiformes aux personnes âgees fait souvent croire qu’elle assure tout ou presque tout a ces personnes. Nous avons voulu explorer cette perception en documentant les besoins non couverts de personnes âgees vivant a Bobo-Dioulasso. Methodes : Il s’agit d’une etude longitudinale aupres de 58 personnes dont 15 personnes âgees et 43 aidants issus de 15 familles a Bobo-Dioulasso. Outre l’observation reguliere de ces familles pendant une annee, un entretien individuel approfondi a ete realise avec chaque participant au debut et a la fin de l’etude. Les donnees ont ete analysees a l’aide du logiciel QSR Nvivo 8. Resultats : A priori, les repondants font croire qu’il n’y a pas de besoins fonctionnels des personnes âgees non couverts par la famille. Cependant, l’alimentation, le premier et le principal besoin fonctionnel des personnes âgees, n’est pas qualitativement satisfait par la famille, de meme que d’autres besoins materiels ou sanitaires. La qualite des soins/soutiens sociaux, des soins biomedicaux et des soutiens communautaires est insuffisante lorsque ces soins/soutiens sont fournis. La famille demande de nombreux services gratuits ou subventionnes aux structures publiques ou communautaires alors qu’ils ne sont pas actuellement disponibles. Discussion : Dans un contexte de pauvrete generalisee, il est difficile a chaque acteur du systeme social de maintien des personnes âgees en autonomie fonctionnelle de fournir des services/soutiens de qualite optimale. Une synergie d’action reduirait les besoins fonctionnels non couverts des personnes âgees.
TL;DR: The implementation of non-linear decompositions suggests that health care use inequalities between French and immigrant populations are for the most part attributable to differences in the distribution of observable characteristics between both populations.
Abstract: A partir des donnees de l’Enquete sur la sante et la protection sociale (ESPS) realisee en 2006 et 2008, cette etude s’interesse aux disparites de recours aux soins entre la population immigree et la population francaise. Nous cherchons a mettre en evidence les mecanismes qui generent les inegalites de recours aux soins liees a l’immigration en utilisant des techniques de decomposition non lineaire. Les resultats des estimations montrent que les immigres presentent, a besoins de sante equivalents, un plus faible recours aux medecins generalistes et specialistes que la population francaise. L’application des techniques de decomposition non lineaire revele que la majeure partie du differentiel de recours aux soins entre les immigres et les Francais est liee a une difference de distribution des caracteristiques observables entre les deux populations. En particulier, les inegalites de recours aux generalistes semblent etre en premier lieu expliquees par la plus faible couverture sante des immigres, tandis que leur niveau d’etudes et de revenu sont les principaux facteurs generant les inegalites de recours aux specialistes.
TL;DR: Several factors were significantly associated with a low uptake of Pap smear screening among women with no limited access to healthcare, and considering these factors may help to refine messages aimed at cervical cancer prevention.
Abstract: Background To help prevent cervical cancer, three yearly opportunistic Pap smear screening is recommended in France for women aged 25–65 years. Pap smear screening coverage varies with age and socioeconomic level. The aim of this cross-sectional study was to identify factors associated with a low uptake of Pap smear screening among women with no limited access to healthcare. Methods We analyzed data from women aged 25–65 living in the Rhone-Alpes region who completed a self-administered questionnaire given to them by general practitioners between June and August 2008. The questionnaire covered knowledge about cervical cancer and its prevention as well as the women's history of Pap smear screening and other health-related behaviors. The relationship between low uptake of Pap smear screening – defined as not having had the test within the past 3 years – and a range of possible contributing factors was investigated using logistic regression. Results Of 1186 women with an intact uterus who completed the questionnaire, 89.1% said they had had a Pap smear within the past 3 years. On multivariate analysis, the 10.9% who had not were significantly more likely to live alone (1.76 [1.13–2.74]), to have no children (2.17 [1.31–3.62]), to have never used contraception (5.35 [2.98–9.62]), to have less knowledge about Pap smear screening (3.40 [1.55–7.49]), and to be unvaccinated against hepatitis B (0.55 [0.35–0.87]). Conclusion Despite high overall compliance with Pap smear screening recommendations among women who consulted general practitioners, several factors were significantly associated with a low uptake of the service. Considering these factors may help to refine messages aimed at cervical cancer prevention.
TL;DR: The results suggest that population health is dependent on the distribution of social as well as economic resources along the dimensions predicted by a capabilities model and governments should be attentive to the impact of policy on the Distribution of social, aswell as economic, resources.
Abstract: Background The objective of this study is to outline a capabilities approach to the social determinants of population health and to compare its explanatory power and implications for public policy-making with psychosocial approaches. Methods A model linking the structures of economic and social relations to health outcomes is developed and logistic methods used to confirm its base validity for a representative sample of 16,488 citizens in 19 developed democracies drawn from the World Values Surveys of 1990 and 2005. Self-reported health is the dependent variable. Age, gender, education, employment status, self-mastery, income, autonomy at work, ties to family and friends, subjective social status, associational memberships and sense of national belonging are considered. Results At baseline, risk ratios reflecting movement from the 25th to 75th percentile in the distribution of the variable indicate that increases in income reduce the likelihood of poor health (0.78; 0.73–0.82) as does higher autonomy at work (0.90; 0.85–0.94) but so does access to social resources reflected in ties to family and friends (0.89; 0.86–0.92), associational memberships (0.93; 0.89–0.98), subjective social status (0.77; 0.54–0.90) while the absence of feelings of national belonging increases the likelihood of poor health (1.14; 1.06–1.23). Conclusion The results suggest that population health is dependent on the distribution of social as well as economic resources along the dimensions predicted by a capabilities model. Governments should be attentive to the impact of policy on the distribution of social, as well as economic, resources.
TL;DR: In this paper, the authors investigated the causal nature and the pathways underlying the causal relationship between the presence of various chronic conditions and employment outcomes including decreased workforce participation, early retirement, work limitations, sickness absence from work or low access/return to work.
Abstract: Background Differential consequences of ill health according to individuals’ position on the social scale may constitute an important pathway underlying social health inequalities. In the current context, chronic diseases have major consequences on employment. These consequences may play a substantial role in the process of social health inequalities. Understanding the employment consequences of chronic diseases and their socially differentiated nature constitutes a critical field of research for the comprehension and the reduction of social health inequalities. Discussion In the past decades, studies in various countries have provided evidence of an association between the presence of various chronic conditions and employment outcomes including decreased workforce participation, early retirement, work limitations, sickness absence from work or low access/return to work. However, available data leave unanswered important questions regarding the causal nature and the pathways underlying this association. In addition, only few studies have focused on social inequalities in the employment consequences of specific health conditions. Though, such studies appear essential in order to thoroughly investigate the pathways underlying such inequalities. These pathways deserve to be investigated in future researches. Such researches, in addition to their contribution to a better understanding of social health inequalities, potentially have important public health implications.
TL;DR: Barriers and facilitating factors linked to the implementation of integrated care were identified at several levels: leadership; collaboration between services and clinicians; and funding and policy making.
Abstract: Background Better integration of healthcare is the focus of many current reforms in Western countries. The goal is to reduce fragmentation of health and social care delivery for patients with chronic diseases. In France, Alzheimer autonomy integration experimentations (Maison Autonomie Integration Alzheimer [MAIA]) were introduced as part of the 2008–2012 National Alzheimer Plan. To date, implementation of such organizations remains challenging. It is thus paramount to identify factors obstructing, and on the contrary facilitating, implementation of integrated care. Methods After an in-depth literature review of qualitative studies published from January 1995 to December 2010. We selected 10 qualitative studies on health care professionals’ perceptions of barriers and facilitators to the implementation of integrated care. Results Barriers and facilitating factors linked to the implementation of integrated care were identified at several levels: leadership; collaboration between services and clinicians; and funding and policy making. The operative strategy applied to change care delivery and the role of the leading pilot are key elements during the implementation phase. Conclusion Strong leadership and active involvement of a broad spectrum of professionals from clinical practitioners to healthcare managers is crucial for a successful implementation of integrated care services.
TL;DR: There appears to be an uncoupling effect dissociating these activities from the sensation of hunger and thus energy intake, and children and adolescents seem to increase their energy intake during and after such activities without any alteration of their subjective appetite.
Abstract: Sedentary behavior has progressed with modern society, generating very low levels of energy expenditure and subsequent body weight disorders (obesity). There is also evidence that the absence of physical activity associated with short sleep time and watching television or playing video games leads to poor eating habits and favors high-energy intake. These findings have generally been reported in adults, with a few studies including data on children and adolescents. This brief review summarizes the current literature regarding the impact of such activities on food consumption and eating behavior in children and adolescents. There appears to be an uncoupling effect dissociating these activities from the sensation of hunger and thus energy intake. Children and adolescents seem to increase their energy intake during and after such activities without any alteration of their subjective appetite. In addition to considering the impact of sedentary behavior and physical activity level, future public health recommendations should also focus on associated nutritional adaptations (energy balance).
TL;DR: In this paper, the authors used the Peer Pressure Inventory (PPI) to assess the effect of peer pressure on substance use, sexual behavior and juvenile delinquency in young Swiss men.
Abstract: BACKGROUND: Peer pressure is regarded as an important determinant of substance use, sexual behavior and juvenile delinquency. However, few peer pressure scales are validated, especially in French or German. Little is known about the factor structure of such scales or the kind of scale needed: some scales takes into account both peer pressure to do and peer pressure not to do, while others consider only peer pressure to do. The aim of the present study was to adapt French and German versions of the Peer Pressure Inventory, which is one of the most widely used scales in this field. We considered its factor structure and concurrent validity. METHODS: Five thousand eight hundred and sixty-seven young Swiss men filled in a questionnaire on peer pressure, substance use, and other variables (conformity, involvement) in a cohort study. RESULTS: We identified a four-factor structure, with the three factors of the initial Peer Pressure Inventory (involvement, conformity, misconduct) and adding a new one (relationship with girls). A non-valued scale (from no peer pressure to peer pressure to do only) showed stronger psychometric qualities than a valued scale (from peer pressure not to do to peer pressure to do). Concurrent validity was also good. Each behavior or attitude was significantly associated with peer pressure. CONCLUSION: Peer pressure seems to be a multidimensional concept. In this study, peer pressure to do showed the strongest influence on participants. Indeed, peer pressure not to do did not add anything useful. Only peer pressure to do affected young Swiss men's behaviors and attitudes and was reliable. Language: fr