Front Public Health

BACKGROUND: Sheltered homeless families suffer from deleterious living conditions such as housing instability (i.e., moving from one shelter to another) that could be an additional barrier to healthcare utilization. Few studies have specifically examined perinatal health in homeless mothers and their utilization of prenatal healthcare. This study aimed to identify social determinants such as living conditions (i.e., housing instability) associated with inadequate prenatal care utilization (PCU) in sheltered homeless mothers in the Greater Paris area in France. METHODS: The homeless children and families cross-sectional survey [ENFAMS: (Enfants et familles sans logement)] was performed on a random representative sample of homeless families living in shelters in the greater Paris area in 2013. Following French guidelines, PCU was deemed inadequate if one or more of the following criteria was met: attending fewer than 50% of recommended prenatal visits, PCU initiation after the first trimester of pregnancy, and fewer than three ultrasounds during the entire pregnancy. Families were interviewed in 17 languages by trained peer interviewers in face-to-face interviews. Structural equation modeling was used to identify factors associated with inadequate PCU and to estimate correlations between them. RESULTS: This study analyzed data on 121 homeless sheltered mothers who had at least one child less than one year old. They were socially disadvantaged and most were born outside France. One in five (19.3%) had inadequate PCU. Associated factors were socio-demographic characteristics (young age, primiparous), health status (dissatisfaction with self-perceived general health), and living conditions (housing instability in the second and third trimesters). CONCLUSION: It is essential to reduce housing instability to help sheltered mothers to benefit from social, territorial and medical support and healthcare utilization. Housing stability for pregnant sheltered homeless mothers should be a priority to ensure better PCU and guarantee the newborn's health as much as possible

Demographic, socioeconomic, and sociocultural factors associated with any breastfeeding in homeless mothers

In high‐income countries, breastfeeding has been shown to be positively associated with socioeconomic position. However, less is known about breastfeeding practices and their associated factors among extremely disadvantaged populations. We aimed to assess the associations of cultural origins and socioeconomic factors with any breastfeeding initiation and duration in homeless families. We analyzed data from 456 children aged 6 months to 5 years from the cross‐sectional ENFAMS survey, conducted in 2013 among a random sample of homeless families in shelters in the Greater Paris area. Data were collected by bilingual interviewers in 17 languages. Four nested multivariable robust Poisson regression models were run in a hierarchical framework to determine the factors associated with breastfeeding initiation and with any breastfeeding for 6 months or more. Most of the children (86.0%) had previously been or were currently being breastfed at the time of the survey; 58.9% were fed with breast milk ≥6 months. A higher maternal age and African origin were positively associated with breastfeeding ≥6 months, although the relation to the region of origin was moderated by education level. Migration to escape war, unrest or other violence and the child's birth in France were inversely associated with breastfeeding ≥6 months. Any breastfeeding by these homeless mothers seems influenced predominantly by their cultural origin and complicated by a difficult migration trajectory. The possible influence of poor material circumstances and cumulative hardship should encourage interventions targeted at homeless mothers that emphasize social/family support with a commitment to improving the family's living conditions

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

In search of care in a precarious context. Ethnographic tracking of pregnant women in Île-de-France

Cette thèse porte sur les processus à l’origine des inégalités sociales de santé, en particulier dans le domaine de la périnatalité. Elle approfondit l'étude des déterminants sociaux de l’accès aux soins des femmes enceintes, et cherche à mieux comprendre la nature précise des mécanismes qui entravent le suivi médical de grossesse. La thèse vise la mise en évidence, dans l’action, des moyens de ces femmes pour accomplir la prise en charge de leur grossesse, et de prendre de front la question de la précarité sans l’imposer en amont comme catégorie analytique.Sa méthode principale, le suivi ethnographique des femmes enceintes, a permis d’étudier de façon longitudinale les mises à l’épreuve d’une prise en charge qui se veut universelle, et de saisir les moments concrets de l’action où les conditions de vie de ces femmes ont modulé leurs parcours de soins. Elle s’appuie également sur des entretiens menés, eux aussi dans la région d’Île-de-France, avec des professionnel.les de la périnatalité et avec une soixantaine de femmes ayant participé à la cohorte épidémiologique PreCARE. Celle-ci a pour objectif principal d’étudier l’impact de la précarité maternelle sur la santé maternelle et périnatale.La thèse analyse l’expérience des personnes enquêtées auprès des institutions, des guichets, et de leurs interactions, autant avec des soignant.e.s que d’autres interlocuteurs. L’analyse est ainsi centrée sur leurs manières d’agir et leurs capacités à s’ajuster à différentes situations associées à leur grossesse, en mobilisant leurs connaissances, compétences et expériences. La question de la précarité n’a pas été imposée a priori comme catégorie prédéfinie, mais elle s’est dessinée progressivement au fil de l’enquête, comme composante déterminante dans les configurations complexes de situations auxquelles devaient faire face les femmes enceintes.La thèse donne à voir l’éloignement des usagères à l’égard des institutions, leurs attentes non comblées et leur perte de chances dans leur suivi médical, par suite de démarches inabouties ou d’absence de proposition de choix. Ne pas se voir proposer de choix a limité leur marge de manœuvre, et pour agir en général. Il s’agit d’une dimension transversale, qui ne peut pas être détachée du caractère déterminant des conditions dans lesquelles les informations sont données aux femmes. En définitive, la distribution sociale du savoir et la restriction de choix et d’action se sont avérés deux aspects essentiels qui viennent définir la place de la précarité dans l’acte de soin, non seulement dans le cadre de la prise en charge périnatale, mais aussi dans les soins de santé en général.This thesis focuses on the processes that are at the origin of social inequalities of health, in particular in the field of perinatal care. It delves into the social determinants of access to health care for pregnant women and aims to improve the understanding the precise nature of the mechanisms that hinder the medical monitoring of pregnancy. The thesis aims to highlight, in action, the resources of these women to obtain medical attention during their pregnancy, and to approach the question of precariousness without previously imposing it as an analytical category.Its main method, the ethnographic tracking of pregnant women, has made it possible to study longitudinally the challenges of supposedly universal health care, and to capture the specific moments of action in which the living conditions of these women have modulated their care trajectories. The thesis obtains its data from interviews conducted in the Île-de-France region, with perinatal professionals and some sixty women who participated in the PreCARE epidemiological cohort. The main objective of this cohort is to study the impact of maternal precariousness on maternal and perinatal health.The thesis analyzes the experience of the subjects studied with the institutions, the counter staff and their interactions, both with health workers and with other interlocutors. The analysis thus focuses on their ways of acting and on their ability to adapt to the different situations associated with their pregnancy, mobilizing their knowledge, skills and experiences. The issue of precariousness has not been imposed a priori as a predefined category, but has gradually emerged in the course of research as a determining component in the complex configurations of situations faced by pregnant women.The thesis shows the distance of the users from the institutions, their unfulfilled expectations and the loss of opportunities in their medical follow-up, as a consequence of unfinished procedures or the absence of proposals to choose from. This absence has made it difficult to enjoy the possibility of choosing, and to act in general. It is a transversal dimension that cannot be separated from the determining character of the conditions in which information is provided to women. In the end, the social distribution of knowledge and the restriction of choice and action have turned out to be two essential aspects that define the place of precariousness in care, not only in perinatal care, but also in health care in general

Les attentes dans la relation d’enquête. Ce qu’elles nous apprennent sur l’objet d’étude

Ce texte propose une réflexion sur la relation d’enquête, issue d’un travail de terrain avec des femmes enceintes rencontrant des difficultés pour se loger. Le suivi ethnographique de ces femmes, réalisé dans la région Île-de-France, a consisté en un accompagnement étroit, parfois aussi de leurs conjoints, durant leurs grossesses et au-delà. Cette méthode a permis d’étudier, de façon longitudinale, les mises à l’épreuve d’une prise en charge médicale qui se veut universelle. Le présent texte porte sur leur consentement, voire leur motivation, à participer à cette démarche ethnographique. Au cours de l’enquête, les attentes des femmes suivies ont pris un sens distinct selon le contexte de leur grossesse et les rôles qu’elles ont attribués à l’ethnographe. Les raisons pour lesquelles ces femmes participent à l’étude suggèrent une privation, quelle que soit sa nature, que la relation d’enquête viendrait combler. On découvre que les attentes des enquêtées constituent une source non négligeable pour la compréhension de la problématique étudiée.This text proposes a reflection about the researcher-participant relationship, resulting from fieldwork with pregnant women experiencing housing difficulties. The ethnographic research tracking these women, carried out in the Île-de-France region, consisted in close follow up, sometimes also for their partners, during their pregnancies and beyond. This method has made possible to study, in a longitudinal way, the challenges of a medical care supposed to be universal. The text focuses on consent, and even motivation, to participate in this ethnographic approach. In the course of the fieldwork, the expectations of the women being followed took on different meanings according to the context of their pregnancy and the roles they assigned to the ethnographer. These women’s reasons for being involved suggest a deprivation, of any kind, that the research relationship would fill. We discover that the participants’ expectations constitute a significant source for understanding the subject studied

Les attentes dans la relation d’enquête. Ce qu’elles nous apprennent sur l’objet d’étude

This text proposes a reflection about the researcher-participant relationship, resulting from fieldwork with pregnant women experiencing housing difficulties. The ethnographic research tracking these women, carried out in the Île-de-France region, consisted in close follow up, sometimes also for their partners, during their pregnancies and beyond. This method has made possible to study, in a longitudinal way, the challenges of a medical care supposed to be universal. The text focuses on consent, and even motivation, to participate in this ethnographic approach. In the course of the fieldwork, the expectations of the women being followed took on different meanings according to the context of their pregnancy and the roles they assigned to the ethnographer. These women’s reasons for being involved suggest a deprivation, of any kind, that the research relationship would fill. We discover that the participants’ expectations constitute a significant source for understanding the subject studied

Accoucher à Melilla. Les pratiques médicales à l’épreuve des « parturientes sans droits » à la frontière hispano-marocaine

This article analyzes differential care in perinatal health based on an ethnographic survey carried out on the Spanish-Moroccan border of Melilla. The geopolitical context brings together conditions conducive to processes of social categorization and inequalities of health care, especially for those considered non-legitimate to benefit from health care services in the city. Discourses on the harm caused by the arrival of pregnant Moroccan women without any medical follow-up describe an institution that lacks the necessary tools to deal with the vicissitudes of its situation. Two years of fieldwork in the enclave’s maternity hospital highlighted the tensions between local and central authorities, which reflect medical practices that would be inconceivable in any other context. Foreign women giving birth here is experienced as a threat, just like those of Melillan women who share a common characteristic with them: ethnicity. Discrimination in medical practices is a way of defending the institution and the "Spanishness" of the enclave, while reinforcing the vulnerability of some of the professionals and users

Table_1_Social determinants of inadequate prenatal care utilization in sheltered homeless mothers in the Greater Paris area in France.DOCX

BackgroundSheltered homeless families suffer from deleterious living conditions such as housing instability (i.e., moving from one shelter to another) that could be an additional barrier to healthcare utilization. Few studies have specifically examined perinatal health in homeless mothers and their utilization of prenatal healthcare. This study aimed to identify social determinants such as living conditions (i.e., housing instability) associated with inadequate prenatal care utilization (PCU) in sheltered homeless mothers in the Greater Paris area in France.MethodsThe homeless children and families cross-sectional survey [ENFAMS: (Enfants et familles sans logement)] was performed on a random representative sample of homeless families living in shelters in the greater Paris area in 2013. Following French guidelines, PCU was deemed inadequate if one or more of the following criteria was met: attending fewer than 50% of recommended prenatal visits, PCU initiation after the first trimester of pregnancy, and fewer than three ultrasounds during the entire pregnancy. Families were interviewed in 17 languages by trained peer interviewers in face-to-face interviews. Structural equation modeling was used to identify factors associated with inadequate PCU and to estimate correlations between them.ResultsThis study analyzed data on 121 homeless sheltered mothers who had at least one child less than one year old. They were socially disadvantaged and most were born outside France. One in five (19.3%) had inadequate PCU. Associated factors were socio-demographic characteristics (young age, primiparous), health status (dissatisfaction with self-perceived general health), and living conditions (housing instability in the second and third trimesters).ConclusionIt is essential to reduce housing instability to help sheltered mothers to benefit from social, territorial and medical support and healthcare utilization. Housing stability for pregnant sheltered homeless mothers should be a priority to ensure better PCU and guarantee the newborn's health as much as possible.</p

10 ans d'A&S

Anthropologie & Santé a 10 ans. C'est pour nous l'occasion de rappeler l'histoire et les valeurs de la revue, d’expliciter son fonctionnement et son modèle économique. Nous avons également voulu donner à ce numéro de transition une dimension récréative, affranchie de la rigueur et des codes académiques des revues scientifiques auxquels nous sommes attachées. Ce numéro accueille donc d’autres formes d’écriture de l’anthropologie ou des textes qui abordent des fragments d’expérience de la recherche plus rarement décrits ou analysés dans les articles scientifiques. Leur facture laisse plus de place à la métaphore, à la poésie, à l’humour et à la narration – sans toutefois se départir de la précision des concepts. Anthropologie & Santé is 10 years old. This anniversary is an opportunity for us to recall the journal's history and values, to explain its functioning and its economic model. We also wanted to give this transitional issue a recreational dimension, freed from the rigor and academic codes of the scientific journals to which we are attached. This issue therefore welcomes other forms of writing in anthropology, or texts dealing with fragments of research experience that are more rarely described or analysed in scientific papers. Their writing forms leave room for metaphor, poetry, humour and narratives

Promoción turística sostenible de la reserva de la biosfera Tajo-Tejo Internacional

Convocatoria proyectos de innovación de Extremadura 2020/2021Se describe un proyecto llevado acabo por varios centros educativos ubicados en la zona de la Reserva de la Biosfera Tajo-Tejo Internacional (RBTTI) que pretendía contribuir a la transformación sostenible del entorno mediante su conocimiento y promoción, implementando las competencias digital, social y ciudadana y la cultura emprendedora mediante metodologías activas como el aprendizaje servicio. Entre los objetivos principales del proyecto destacan: dar a conocer las implicaciones de la RBTTI; diseñar una campaña de promoción de la RBTTI mediante trípticos y vídeos promocionales; conocer la Reserva a través de las principales vías pecuarias y caminos que comunican los pueblos; descubrir los principales elementos socioculturales, históricos y tradicionales de la Reserva; valorar la importancia del territorio para conservar la biodiversidad: paisajes, ecosistemas, fauna y flora representativa; relacionar la trashumancia y las vías pecuarias como rasgos identificativos de la Reserva, vinculándolo con la historia y rasgos culturales de los pueblos y valorar el emprendimiento y la iniciativa personal, el asosiacionismo y creación de redes de cooperación en y entre pueblos como motor de desarrolloExtremaduraES