Contacts between general practitioners and migrants without a residence permit and the use of "urgent" medical care.

AIMS: To examine the extent to which general practitioners (GPs) are consulted by migrants without a residence permit (MRP), their use of the government sponsored reimbursement system and the difficulties encountered therewith. To study what hurdles the care recipients (MRP) experience in using healthcare and the reimbursement system. METHODS: A written survey of GPs in the Brussels Capital region and semi-structured interviews with MRP in the same area. Bivariate analysis of the GP data (two-sided independent t-test, two-sided Fisher's exact test). Recording, transcription, coding and categorizing of MRP interviews. RESULTS: Overall GP response rate was 71%. The average number of MRP contacts per month was 1.1 for all, representing 0.26% of all GP contacts. GPs working in community health centres (CHC) 4.4 MRP per month (p=0.042). The mean probability that the GP will not use the reimbursement programme is 0.66--there is less non-use in CHC (p=0.042). The main barrier for GPs is insufficient knowledge of the system, followed by its complex and time consuming paperwork. Barriers experienced by MRP include fear of deportation, lack of funds, insufficient healthcare related knowledge and communication barriers. CONCLUSIONS: Primary care is an active channel in healthcare for MRP, with CHC taking the lead. With the reimbursement system, there should hardly be financial barriers to access the healthcare system. However, due to the high probability of non-use (0.66), this system cannot substantially contribute to lowering financial barriers. The complexity of the system prevents it from being used properly and leads to undesirable alternatives.

Individual cancer risk as a function of current age and risk profile.

Behavioural changes are an important partner in the fight against cancer (primary prevention or the choice to participate in secondary prevention). To make such behavioural changes, people need to have a correct assessment of their own risk, which is often underestimated or overestimated. These risk estimates depend, among others, on the calculation method that is used. Currently, the method that is used most often is 'indirect cumulative risk' (ICR). We discuss several drawbacks of using ICR in individual counselling and therefore use an alternative method. In this alternative (life table method) we calculated 10-year risks for a whole range of cancers as a function of the current age and risk profile, while taking into account other causes of death. These estimates can easily be used to give an individualized assessment of the risk of cancer. Regardless of the risk estimation method used, the risk needs to be broken down for 'risk factors'. If only the risk for an average person of the population is given, this means a small overestimation for the non-risk group, but a significant underestimation for the at-risk group. When we compare the life table risk as a function of risk factors to the more commonly used ICR, large differences are found, especially in prostate, breast and lung carcinomas. The life table method, although it has certain limitations, has advantages over the ICR method for individual counselling. To our knowledge this is the first overview in which 10-year risks as a function of the current risk profile are given for multiple cancers. The calculated risks are primarily intended to better inform people who are considering preventive measures. For example, for a 40-year-old woman without familial risk who is considering the pros and cons of breast cancer mammographic screening, it is more interesting to know that she has a 0.7% chance of getting breast cancer in the next 5 years, rather than being told that 11% of women get breast cancer during their lives (ICR 0-74). Current smokers can now be given absolute risk reduction estimates of smoking cessation. To keep the life table risk estimates up to date, they must be repeated every couple of years, using up-to-date incidence and mortality data.