The burden of road traffic accidents in a French Departement: the description of the injuries and recent changes

International audienceBACKGROUND: A significant reduction in road traffic accidents has been observed since prevention measures were introduced by the French public authorities in 2002. The goals of this study are to describe the burden of road traffic accidents in a French Departement, and to identify changes if any between the periods 1997-2001 and 2002-2006 on the basis of the disability adjusted life years (DALY). METHODS: Years of lost life (YLL) and years lived with disability (YLD) were calculated for two periods using the mortality and incidence data in the Rhone Departement Registry of Road Traffic Accident Casualties. RESULTS: YLD and YLL that are related to road traffic accidents are at their maximum value between 15 and 24 years of age. For men, intracranial fractures and intracranial injuries dominate, and for women it is spinal cord injuries that account for highest rates of YLD. A reduction in the rates of YLL and YLD has been observed for both genders and all age groups between 1997-2001 and 2002-2006. CONCLUSION: The reduction in DALY between the two periods is explained both by the reduction in the number of fatalities and injuries but also by an increase in the age at which they occur

Pertinence et conditions de production d'un indicateur estimant la charge de morbidité (Utilisation des années de vie sur l'incapacité pour décrire la santé en France)

LE KREMLIN-B.- PARIS 11-BU Méd (940432101) / SudocSudocFranceF

Impact of migration origin on individual protection strategies against sexual transmission of HIV in Paris metropolitan area, SIRS cohort study, France.

International audienceThe impact of migration and country or region of origin on sexual behaviours and prevention of the sexual transmission of HIV has been scarcely studied in France. The objective of this study was to evaluate if and how individual attitudes of prevention towards HIV infection are different according to country or region of origins in Paris area, France. 3006 individuals were interviewed in the Paris metropolitan area in 2010. Outcome variables were (i) the intention of the individual to protect oneself against HIV, and (ii) the adoption of a condom-based approach for protection against HIV. To explore factors associated with these outcomes, we constructed multivariate logistic regression models, first taking into account only demographic variables -including country of origin-, then successively adding socioeconomic variables and variables related to sexual behaviour and HIV perception and prevention behaviour. French and foreign people who have origins in Sub-Saharan Africa declared more intentions to protect themselves than French people with French parents (in foreign men, aOR = 3.43 [1.66-7.13]; in foreign women, aOR = 2.94 [1.65-5.23]), but did not declare more recourse to a condom-based approach for protection against HIV (in foreign men, aOR = 1.38 [0.38-4.93]; in foreign women, aOR = 0.93 [0.40-2.18]). Conversely, foreign women and French women from foreign origin, especially from Maghreb (Northern Africa), reported less intention of protection than French women with French parents. These results underline the importance of taking culture and origins of target populations into consideration when designing information, education and communication about HIV and sexually transmitted diseases. These results also draw attention to fractions of the general population that could escape from prevention messages

Gender, socioeconomic status, migration origin and neighbourhood of residence are barriers to HIV testing in the Paris metropolitan area.

International audienceIn France, numerous HIV patients still discover their HIV status as a result of AIDS-related symptoms. We investigated factors related to the absence of any HIV testing in men and women separately, using the data from the SIRS cohort, which includes 3023 households representative of the Paris metropolitan area in 2005. The failure to use HIV testing services was studied in relation to individual socioeconomic and demographic factors as well as some psychosocial characteristics. The effect of the characteristics of the residential neighbourhood was also analysed using multilevel models. In multivariate analysis, the factors associated with no history of HIV testing in women were an age >44, the absence of any pregnancy during the previous 15 years , a low education level, unemployment, to have had no or only one steady relationship in one's lifetime, to have a religious affiliation and to live in a poor neighbourhood. In men, factors were age 44, to have had no or only one steady relationship during one's lifetime, to have a religious affiliation and to perceive oneself as being at low risk of HIV infection An association according to the 'migration origin' was observed among men: foreigners and French men born to (at least) one foreign parent were more likely not to have been tested than French men born to two French parents. We conclude that gender, social and territorial differences exist in HIV testing among people living in the Paris area. More systematic proposals of HIV test in primary care would be an effective policy to overcome these persistent social stratifications

Which adults in the Paris metropolitan area have never been tested for HIV? A 2010 multilevel, cross-sectional, population-based study.

International audienceDespite the widespread offer of free HIV testing in France, the proportion of people who have never been tested remains high. The objective of this study was to identify, in men and women separately, the various factors independently associated with no lifetime HIV testing. We used multilevel logistic regression models on data from the SIRS cohort, which included 3006 French-speaking adults as a representative sample of the adult population in the Paris metropolitan area in 2010. The lifetime absence of any HIV testing was studied in relation to individual demographic and socioeconomic factors, psychosocial characteristics, sexual biographies, HIV prevention behaviors, attitudes towards people living with HIV/AIDS (PLWHA), and certain neighborhood characteristics. In 2010, in the Paris area, men were less likely to have been tested for HIV at least once during their lifetime than women. In multivariate analysis, in both sexes, never having been tested was significantly associated with an age younger or older than the middle-age group (30-44 years), a low education level, a low self-perception of HIV risk, not knowing any PLWHA, a low lifetime number of couple relationships, and the absence of any history of STIs. In women, other associated factors were not having a child < 20 years of age, not having additional health insurance, having had no or only one sexual partner in the previous 5 years, living in a cohabiting couple or having no relationship at the time of the survey, and a feeling of belonging to a community. Men with specific health insurance for low-income individuals were less likely to have never been tested, and those with a high stigma score towards PLWHA were more likely to be never-testers. Our study also found neighborhood differences in the likelihood of men never having been tested, which was, at least partially, explained by the neighborhood proportion of immigrants. In contrast, in women, no contextual variable was significantly associated with never-testing for HIV after adjustment for individual characteristics. Studies such as this one can help target people who have never been tested in the context of recommendations for universal HIV screening in primary care

Chronic air pollution and social deprivation as modifiers of the association between high temperature and daily mortality.

International audienceBACKGROUND: Heat and air pollution are both associated with increases in mortality. However, the interactive effect of temperature and air pollution on mortality remains unsettled. Similarly, the relationship between air pollution, air temperature, and social deprivation has never been explored. METHODS: We used daily mortality data from 2004 to 2009, daily mean temperature variables and relative humidity, for Paris, France. Estimates of chronic exposure to air pollution and social deprivation at a small spatial scale were calculated and split into three strata. We developed a stratified Poisson regression models to assess daily temperature and mortality associations, and tested the heterogeneity of the regression coefficients of the different strata. Deaths due to ambient temperature were calculated from attributable fractions and mortality rates were estimated. RESULTS: We found that chronic air pollution exposure and social deprivation are effect modifiers of the association between daily temperature and mortality. We found a potential interactive effect between social deprivation and chronic exposure with regards to air pollution in the mortality-temperature relationship. CONCLUSION: Our results may have implications in considering chronically polluted areas as vulnerable in heat action plans and in the long-term measures to reduce the burden of heat stress especially in the context of climate change

Chronic air pollution and social deprivation as modifiers of the association between high temperature and daily mortality. Environ. Health 2014

Abstract Background: Heat and air pollution are both associated with increases in mortality. However, the interactive effect of temperature and air pollution on mortality remains unsettled. Similarly, the relationship between air pollution, air temperature, and social deprivation has never been explored. Methods: We used daily mortality data from 2004 to 2009, daily mean temperature variables and relative humidity, for Paris, France. Estimates of chronic exposure to air pollution and social deprivation at a small spatial scale were calculated and split into three strata. We developed a stratified Poisson regression models to assess daily temperature and mortality associations, and tested the heterogeneity of the regression coefficients of the different strata. Deaths due to ambient temperature were calculated from attributable fractions and mortality rates were estimated