Knowledge of HIV and hepatitis B and C status among people living in extreme poverty in France, in 2012.

OBJECTIVE: "Médecins du Monde" healthcare centers receive individuals living in extremely precarious conditions for primary health care; 94% of these are foreigners. These medical consultations are an opportunity to discuss their serological status and to offer them screening tests. PATIENTS AND METHOD: Two standardized questionnaires were implemented in all healthcare centers in 2000. The medical record covers knowledge of HIV and hepatitis B and C status. RESULTS: 41,033 consultations were given in 2012 in the 20 healthcare centers, for 23,181 patients. Only 29% of the patients knew their hepatitis status and 35% their HIV status. 42% of French patients were unaware of their HIV status compared to 67% of foreign patients. The lack of knowledge of foreign patients' HIV status was more frequent among men and in age classes<20 and>60 years of age. Patients from non-EU Europe, the Middle East, and Asia were significantly more likely to be unaware of their HIV status compared to people from Sub-Saharan Africa and Oceania/America. The rate of foreigners not having undergone screening remained stable, regardless of the duration of residence in France. CONCLUSION: These results highlight the need to develop specific prevention projects among immigrant populations in precarious situations.

A multicentric individually-tailored controlled trial of education and professional support to nursing home staff: research protocol and baseline data of the IQUARE study.

BACKGROUND: Whilst the number of people living in nursing homes (NH) is expected to rise, research on NH quality is scarce. The purpose of this article is to describe the research protocol of the IQUARE study and to present its baseline data. METHODS AND DESIGN: IQUARE is a 18-month multicentric individually-tailored controlled trial of education and professional support to NH staff. The main purposes of IQUARE are to improve the quality of the health care provided in NHs and to reduce the risk of functional decline among residents. Data on internal organisation and residents' health for the 175 participating NHs were recorded by NH staff at baseline. NHs were allocated to either a light intervention group (LIG, n = 90 NHs, totalising 3 258 participants) or a strong intervention group (SIG, n = 85 NHs, totalising 3 017 participants). Intervention for LIG consisted at delivering to NH staff descriptive statistics on indicators of quality regarding their NH and the NHs from their sub-region of health and region; whereas for SIG, NH staff received the same information that LIG, but quality indicators were discussed by a cooperative work (two half-day meetings) between a hospital geriatrician and NH staff. Strategies for overcoming NH's weaknesses were then traced; the efficacy of strategies is evaluated at a 6-month period. RESULTS: Baseline data showed high levels of dependence, comorbidities, psychological disturbances and medication's consumption among NH residents. Large discrepancies among NHs were observed. CONCLUSIONS: IQUARE is one of the largest controlled trials in NHs developed in France. Results from IQUARE may constitute the basis for the development of new work modalities within the French health system, and serve as a model of a feasible research approach in NHs.

[Factors associated with early sexual initiation in girls: French data from the international survey Health Behaviour in School-aged Children (HBSC)/WHO]. / Facteurs associés à une initiation sexuelle précoce chez les filles: données françaises de l'enquête internationale Health Behaviour in School-aged Children (HBSC)/OMS.

OBJECTIVE: Inspite of unquestionable progress, the protection of girls at first sexual intercourse is still not perfect. The main risks are well known (sexually transmitted infections [STIs], unwanted pregnancies, psychological consequences) and seem to be higher in the case of early sexual initiation. The aim of this epidemiological study is to analyse factors associated with early heterosexual intercourse (age 15 or before) among girls, considered as risk factors for pregnancies and STIs. POPULATION AND METHODS: Our data come from the 2002 international survey Health Behaviour in School-aged Children (HBSC)/WHO. The questionnaire is completed anonymously in class and measures health, health behaviours and their contexts among 11-, 13- and 15-year-old students. Only the 15 year-olds are asked about their sexual behaviour. In France, 1264 15-year-old (plus or minus six months) girls have answered the survey. RESULTS: Two hundred and twenty-four girls (17,7 %) state they have already had sexual intercourse. Among these, 88,4 % say that condoms and/or pills were used at last sexual intercourse. Multivariate analysis (n=1159) show that seven variables are significantly and independently linked to a higher frequency of early sexual intercourse: single-parent or reconstructed family, repeated drunkenness, daily smoking, cannabis experimentation, frequent evenings out, negative life appreciation and early menarche. DISCUSSION AND CONCLUSION: Identifying factors associated with early sexual initiation should help professionals to better take care of those high risk adolescent girls.

[Dynamics of interdisciplinary around a health care network: simultaneous programme design and evaluation planning]. / Dynamique interdisciplinaire autour d'un réseau de soins: evaluer et construire en même temps.

This article reports on the evaluation experience of a multiple sclerosis care network in the Midi-Pyrénées region (MIPSEP). It shows how an evaluation team composed of public health doctors and sociologists progressively and naturally evolved from having a purely external observation role towards having a collaborative role actively working with the network's members and partners. A qualitative method was chosen for the data collection through interviews with the network's actors, and the frameworks for reference were constituted from official texts which defined the networks and their missions. Coming from a curative and healing culture, the network's actors were concerned primarily about how to organise themselves in order to better respond to the needs expressed by the patients. The various professional backgrounds and cultures, faced with different perspectives from innovation and confronted with the related difficulties, participated in a collective expertise exercise and collaborated in the construction process. This example supports an open, qualitative, evolutionary evaluation approach which is done in close proximity to the field and work on the ground. The study is timely given the current explosion of debate on evaluation methods. With a great deal of exchange and reflection on suitable tools and indicators as well as the respective roles of researchers, care givers and decision-makers, the results of this study advocate to favour multidisciplinary approaches, including opening up this process to funders and planning authorities rather than over-theorising about it, which only serves to enclose and paralyse a process that, on the contrary, should aim to be more inclusive. This could be a useful way to decompartmentalise and break down existing barriers within the health system.

[Prevalence of cancer, health care and daily life assistance in people aged 75 or over living in the Tarn area (France)]. / Prévalence du cancer, recours aux soins et aide dans la vie quotidienne chez les personnes âgées de 75 ans et plus dans le Tarn (France).

The association between cancer and dependence was estimated using a cross-sectional study among persons 75 years of age or-older in Tarn county (area with a cancer registry recognized by the National Committee of Registries). A representative random sample stratified on age, sex, and size of district, was drawn using the electoral registers. Each person randomly selected answered the questions of a surveyor about previous history of cancer, aid in daily life activities and use of health care. Among 5,161, the questionnaire was filled for 3,368 persons (participation: 65.3%). Only 2.3% declared a past history of cancer (cancers diagnosed before 1982 and cancers of the skin excluded). After verification 12.6% of the men and 5.2% of the women in the sample were found in the registry. This result shows a very high tendency for people not to declare their disease. From 75 years of age, 1 man among 8, and 1 woman among 20 suffer or have suffered from a cancer during the last 12 years. Only a weak association between prevalence of cancer and aid in daily life activities could be found, probably explained by the important polymorbidity existing in this age group. The persons who suffered from cancer, are not more often confined in bed or in old people's home. Regarding use of health care, they see a nurse or their general practitioner more frequently, they have been operated or admitted in the hospital more frequently than persons without a past history of cancer. Persons with a past history of ear-nose-throat cancer differ from other cancers by needing more aid to go out of their home, and by taking medical advice more frequently. Except for the ear-nose-throat cases, cancer (aside from the acute stage) does not generate more dependence or hinder the quality of survival, in comparison to those of people of the same age.

Prevalence of cancer in the elderly: discrepancies between self-reported and registry data.

Data on self-reported cancer by a sample of 3349 elderly persons in the south-west of France were validated against registry data in the same region: only 21% of the persons on the cancer registry reported occurrence of cancer. Breast cancer was found to be most frequently accurately reported.

[The quality of voter registration lists and participation factors during a community survey of elderly people]. / Qualité des listes électorales et facteurs de participation lors d'une enquête communautaire auprès de personnes âgées.

Electoral registers are often used to randomly select persons for epidemiological surveys. The importance and the different types of inaccurate informations found in these lists were studied during a survey among an elderly population of 5,161 persons aged 75 and over in Tarn area. Information was found to be inaccurate in 13.7% of the cases (people who have died 3%, moved out of the area 10.5%, inaccurate date of birth 0.2%), this increased with age and with size of the parish. The overall participation was 65.3%. The corrected participation (with exclusion of inaccurate information) was 75.7% and was higher in rural parishes and where the help of local organizations of elderlies was available.

[Respiratory symptoms in schoolchildren in Toulouse. Influence of atmospheric pollution]. / Symptômes respiratoires chez les enfants d'âge scolaire à Toulouse. Influence de la pollution atmosphérique.

In order to get a better knowledge on respiratory illnesses of children in Toulouse, and to evaluate the influence of air pollution, 1,000 children between 8 and 11 years of age, living in five different areas of the city were observed during one year (March 1985-March 1986), together with the measure of twenty pollutants. A questionnaire was used to assess the history of respiratory diseases and the chronic respiratory pathology. According to the areas, no difference appeared, other than the frequent cough which is more important in an area with lower social income (p less than 0.01). The acute respiratory illnesses, as noted during the year of observation, had a different pattern according to the areas (p less than 0.0001). Amongst the five pollutants used for the analytic study through the cross-correlations, four: nitrogen monoxide and dioxide, black fumes, and ammonia particulate derivatives are related to the respiratory diseases.

Prospective study of restriction of activity in old people after falls.

The levels of activity of two populations of fall victims (at home and in an institution) were studied before and then 6 months after an apparently minor fall, in comparison with a control group. The fall victims had a lower level of activity than the controls. They walked less indoors, and found it more difficult to get out. These differences may be considered predictive factors for falls. It was also found that the falls resulted in a restriction of activity and appear to be a factor that aggravates and accelerates the effects of ageing.

[Disabilities, subjective health and mortality after a 3-year follow-up of a rural aged population]. / Incapacités, santé subjective et mortalité à 3 ans dans une population rurale âgée.

This study examines risk factors for mortality on a three years follow-up, in a sample of 645 subjects 60 years and over, living in a rural area in Haute-Garonne. Basic data were collected by interview in a transversal survey in 1982 and three years later 68 persons had died. The assessment of relative risk factors illustrates the important role of disabilities (RR = 5.3), of self-evaluation of health, and of degree of enthusiasm for life; but there is no statistical relationship between mortality and social support, or number of diseases. A discriminant analysis, indicates that disabilities and subjective assessment of health seem to be independent predictors of mortality. A "mortality risk indicator" including nine components, can identify people who have a high risk of dying within three years, with a sensitivity of 77% and specificity of 78%.