[Prevalence of asthma among adults in France, data from the Constances cohort study]. / Prévalence de l'asthme chez l'adulte en France, données de la cohorte Constances.

INTRODUCTION: The objectives of our study were to estimate the prevalence of asthma in adults in France and to study the effects of gender on the associations of asthma with the corpulence and socio-economic characteristics of individuals. METHODS: We estimated the prevalence of current asthma (asthma attack in the past 12 months or current treatment for asthma) from data collected at inclusion in the Constances cohort study in 2013-2014. Analyses were performed separately in men and women, using robust Poisson regression for multivariate analysis. RESULTS: Using data from 34,100 participants in the cohort (men: 47.7 %; mean age: 44.6 years), the prevalence of current asthma was estimated to be 5.8 % (5.1 % in men, 6.4 % in women). The risk of asthma was increased in women with high body mass index (BMI) or waist circumference. In men, only a high waist circumference was associated with an increased risk of asthma. An association with low socioeconomic status was observed only among women. CONCLUSION: The associations of asthma with corpulence and socioeconomic status differed between men and women. Additional analyses should provide a better understanding of the mechanisms responsible for these differences.

Percepción de familia entre mujeres embarazadas del norte de Portugal / Perception of family among pregnant women in the north of Portugal / Perceção da familia nas mulheres grávidas no norte de Portugal / Perception de famille chez les femmes enceintes dans le nord du Portugal

Resumen Objetivo: Analizarlas diferentes formas de construir la referencia de "ser una familia" en distintos ámbitos rurales y urbanos, a partir de las razones que hay detrás de la decisión de tener hijos. Materiales y métodos: Estudio cualitativo diseñado y analizado a partir del estudio de casos de diferentes áreas de salud del norte de Portugal. La metodología implicó la realización de entrevistas semi-estructuradas a 50 mujeres embarazadas en busca de sus significados recurriendo para ello al análisis de contenido. Resultados: Se identificó la categoría que denominamos "Modelo de referencia familiar", en la cual se señalan dos subcategorías: el sueño sobre la construcción de una nueva familia y el sueño hecho realidad. Estos resultados hacen coincidir la idea de las aspiraciones (ideal inicial, antes de quedar embarazada) y la de las representaciones (ideal abstracto). Los resultados apuntan a unos ideales orientados a la familia y pero muestran una disminución en el número de hijos por mujer consecuencia también de un cálculo en el cual son ponderados los costos asociados con esta decisión. Conclusiónes: Del universo de las aspiraciones, se impone la evocación del deseo de tener hijos, pues fueron realmente pocas las encuestadas que diseñaron un proyecto de vida sin hijos. Sin embargo, vemos una disonancia entre las aspiraciones iniciales y la nueva realidad. Se concluye que existe un proceso de elección entre tener o no hijos, así como la transición a la parentalidad como proyecto conyugal.

Abstract Objective: To analyze the different ways of 'being a family' and that predomínate in different social contexts ranging from rural to urban spaces based on the reasons that support the decision to have children. Materials and methods: A qualitative study was designed and analyzed using case studies of different health areas of northern Portugal. The methodology used was based on semi-structured interviews with 50 pregnant women. It was done a content analysis of interviews. Results: Based on the stories obtained through interviews, we identified the category "reference model of family ", in which two subcategories listed was identified: "the dream of building a new family" and "the dream come true". These results match the idea of aspirations (initial ideal) and representations (abstract ideal). The results suggest a family oriented by ideals and show a decrease in the number of children per woman. This is the result of a perception of the associated costs of this decision. Conclusions: From the universe of aspirations centered in the desire for children, only a few women prefer a life without children. However, we identified a dissonance between the initial aspirations and the practices. It is concluded that there is a process of choice between having children, as well as the transition to parenthood as a conjugal project.

Resumo Objectivo: Analisar os diferentes modos de «ser familia¼ e que predominam em contextos sociais que vão desde a ruralidade até a urbanidade tendo por base as razões que sustentam a decisão de ter descendência. Materiais e métodos: Estudo qualitativo com base em estudo de casos em diferentes centros de saúde no norte de Portugal. A metodologia envolveu a realização de entrevistas semiestruturadas a 50 mulheres grávidas. Para analisar os dados recorreu-se a análise de conteúdo. Resultados: Com base nos relatos obtidos identificou-se a categoria "Modelo de referencia familiar", que identifica duas subcategorias: A construção da nova familia: o sonho e o sonho tornado realidade. Estes resultados correspondem as aspirações de ideia (ideal inicial, antes de engravidar) e as representações (ideal abstracto). Conclusões: Os resultados apontam para um ideal de familia orientado para os dois filhos e demonstram uma diminução do número de filhos por mulher. A diminução do número de filhos é também o resultado de um cálculo onde são ponderados os custos associados a esta decisão. Do universo das aspirações impõe-se a evocação da vontade de ter filhos. Foram realmente poucas as inquiridas que traçaram um projeto de vida sem filhos. Todavia verificamos uma dissonancia entre as aspirações iniciais e por conseguinte com as práticas.

Résumé Objectif: Analyser les différentes formes de «etre famille¼ qui prédominent dans des contextes sociaux allant du rural a la vie urbaine ayant pour motifs la décision d'avoir des enfants. Matériaux et méthodes: Étude qualitative basée sur des études de cas dans des centres de santé primaires dans le nord du Portugal. La méthodologie se base sur des entrevues semi-structurées a 50 femmes enceintes. Pour analyser les données, on a utilisé l'analyse des contenus.. Résultats: Basé sur les données, on a identifié la catégorie «Modele de famille¼, qui identifie deux sous-catégories: la construction de la nouvelle famille : le reve et le reve devenu réalité. Ces résultats correspondent aux aspirations de l'idée (idéal, avant la grossesse) et représentations (idéal abstrait). Les résultats pointent vers un idéal de famille orienté vers les enfants et montrent une diminution du nombre d'enfants par femme qui est également la conséquence de facteurs socioéconomiques qui influencent cette décision. L'univers des aspirations permet l'évocation du désir d'avoir des enfants. Conclusions: On a eu tres peu de femmes qui désirent une vie sans enfant. Cependant, nous voyons une dissonance entre les aspirations initiales (idéal) et les représentations (idéal abstrait). On conclut qu'il existe un choix entre avoir enfants, bien comme la transition vers la parentalité en tant que projet conjugal.

[Observational study of a social device for women in precarious situations during pregnancy and post-partum]. / Étude observationnelle d'un dispositif d'aide aux femmes en situation de précarité pendant la grossesse et le post-partum.

OBJECTIVES: To assess the impact of the Regional experimental accompanying nutrition and breast-feeding for pregnant women (PRENAP) 75 social device on the duration of postpartum hospitalization and breast-feeding for pregnant women in precarious situation. METHODS: A retrospective observational study took place between November 2013 and May 2015 in a type III Parisian maternity. Comparison of sociodemographic, perinatal and postpartum characteristics of women in precarious situations (no stable housing and no social care or universal medical coverage or state medical aid) was done according to whether they were included in the system PRENAP or not. RESULTS: Over the study period, 344 (4.6%) women in precarious situations gave birth in this maternity. Among these women, the women included in the PRENAP system were more frequently in a very unfavorable social situation than those who were not included. The inclusion in the PRENAP device did not reduce the hospitalization in post-partum. Breast-feeding was chosen more frequently by the women included in the PRENAP device. CONCLUSION: The PRENAP device seems to favor the use of breast-feeding, but is not associated with a diminution of the hospitalization time in post-partum. This social device, which seems to be beneficial in terms of social and medical support for women in precarious situations, deserves to be evaluated prospectively.

[Trends in social inequities in diabetes care in the Provence-Alpes-Côte-d'Azur region of France between 2008 and 2011]. / Évolution des inégalités sociales de suivi du diabète en région Provence-Alpes-Côte-d'Azur entre 2008 et 2011.

BACKGROUND: Social inequities in healthcare are known to exist for the management of many chronic diseases in France, including diabetes. The recession that began in 2008 has led to increased income disparities but has it also exacerbated health inequities. The aim of this study was to describe trends in inequities in diabetes-related healthcare between 2008 and 2011 in the PACA region (Provence-Alpes-Côte-d'Azur). METHODS: This analysis used two sources of data: the regional national health insurance fund (PACA region) reimbursement database and the socio-demographic databases of the national statistics office (INSEE) for four full years (2008 to 2011). It included individuals who had been reimbursed for three purchases of oral diabetes drugs during the previous year and assessed the association between the median household income (weighted by number and age of household members) of each patient's municipality of residence and seven indicators of diabetes monitoring and care. Using adjusted mixed logistic models, including an interaction term between time (number of years) and the median household income of the municipality, we examined the performance of the indicators for each year. RESULTS: The total number of patients with diabetes in the 941 municipalities of the PACA region varied by year from 142,055 to 164,929. Models showed that living in a town with a high or intermediate household income was significantly associated with better performance of the seven indicators and that the interaction term was significant for six of them. The effect of the municipal median income decreased significantly between 2008 and 2011 for five indicators: HbA1c, LDL-cholesterol, microalbuminuria, ophthalmoscopy and diabetes specialist visit. CONCLUSION: Social inequities in diabetes-related healthcare persisted between 2008 and 2011 but appeared to be decreasing, despite the recession.

Prognostic factors after hospitalization for COPD exacerbation.

INTRODUCTION: Hospitalizations for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) are increasing in France. AECOPD are associated with impaired health status and increased health care costs. METHODS: Using data from the French national health insurance information system, we studied mortality, readmissions and lung function testing after discharge among adults hospitalized for AECOPD in 2013. RESULTS: The cumulative probabilities of death and readmission for EACOPD were 21% and 31% respectively. The survival was better among women, even after taking into account the other risk factors (age, previous hospitalization for AECOPD, comorbidities, exacerbation severity). In multivariate analysis, the risk of readmission was increased among men and people living in socially disadvantaged areas. A lung function testing was performed in 34% within 3 months after discharge. Female gender, advanced age, comorbidities and living in a disadvantaged area were associated with a lower frequency of lung function testing. CONCLUSIONS: Women had a better prognosis than men after AECOPD hospitalization. The frequency of lung function testing after discharge remained low, particularly among women and people living in disadvantaged areas.