Investigating and Improving Access to Reproductive Healthcare for Vulnerable Migrant Women in France

Background: Homelessness and housing instability in the host countries are central features of the experience of migration to the EU. Although migrant women across the EU encounter obstacles in accessing healthcare services, little is known on the health and access to healthcare services for unstably housed migrant women. The DSAFHIR project aims to better describe the risks faced by migrant women in situations of administrative and social vulnerability, to analyze the barriers to access healthcare and to test specific health interventions. Methods: The DSAFHIR project consists of a two-wave mixed-method survey and the implementation of two tailored sexual health interventions. 474 migrant women aged 18 to 77 years housed in social hotels were surveyed at inclusion. After the implementation of sexual health interventions, respondents were contacted for the follow-up survey (n=284). Discussion: The project provides needed data on migrant women’s health and healthcare access, including non-French speakers. It allows to draw lessons on feasibility and acceptability of quantitative and qualitative surveys on this hard-to-reach population. A high response rate in both waves of the survey (84% and 85%) suggests good acceptability. The attrition is comparable to other migrant longitudinal surveys (60% of the original sample completed the follow-up survey, or 40% of attrition), suggesting that relying on cell phones is possible for follow-up even in contexts of housing instability

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

Male gonadal dose of ionizing radiation delivered during X-ray examinations and monthly probability of pregnancy: a population-based retrospective study

BACKGROUND: Male gonadal exposure to ionizing radiation may disrupt spermatogenesis, but its influence on the fecundity of couples has been rarely studied. We aimed to characterize the influence of male gonadal dose of ionizing radiation delivered during radiodiagnostic on the monthly probability of pregnancy. METHODS: We recruited a random sample of women who retrospectively described 1110 periods of unprotected intercourse beginning between 1985 and 1999 and leading either to a live birth or to no pregnancy; their duration was censored after 13 months. The male partner answered a telephone questionnaire on radiodiagnostic examinations. We assigned a mean gonadal dose to each type of radiodiagnostic examination. We defined male dose for each period of unprotected intercourse as the sum of the gonadal doses of the X-ray examinations experienced between 18 years of age and the date of discontinuation of contraception. Time to pregnancy was analysed using a discrete Cox model with random effect allowing to estimate hazard ratios of pregnancy. RESULTS: After adjustment for female factors likely to influence fecundity, there was no evidence of an association between male dose and the probability of pregnancy (test of homogeneity, p = 0.55). When compared to couples with a male gonadal dose between 0.01 and 0.20 milligrays (n = 321 periods of unprotected intercourse), couples with a gonadal dose above 10 milligrays had a hazard ratio of pregnancy of 1.44 (95% confidence interval, 0.73–2.86, n = 31). CONCLUSION: Our study provides no evidence of a long-term detrimental effect of male gonadal dose of ionizing radiation delivered during radiodiagnostic on the monthly probability of pregnancy during the year following discontinuation of contraceptive use. Classification errors due to the retrospective assessment of male gonadal exposure may have limited the statistical power of our study

La prévention en France, 2004 : Éléments de réflexion

La prévention est un domaine de l’activité sanitaire insuffisamment développé en France. À l’interface de nombreux domaines, c’est une discipline complexe qui doit à la fois reposer sur des bases scientifiques rigoureuses et prendre en compte des aspects sociaux et économiques parfois divergents.Prevention has been underdeveloped in the public health arena, at least in France. It is a complex discipline, relying both on strong scientific methodology as well as social and economical considerations, which may be sometimes a source of conflicts

La prévention en France, 2004

La prévention est un domaine de l’activité sanitaire insuffisamment développé en France. À l’interface de nombreux domaines, c’est une discipline complexe qui doit à la fois reposer sur des bases scientifiques rigoureuses et prendre en compte des aspects sociaux et économiques parfois divergents

Les comportements de prévention du Sida : prévalence et facteurs favorisants

Ducot (Béatrice), Spira (Alfred) - Preventive behaviour of AIDS : prevalence and conducive factors Prevention of sexually transmitted diseases and AIDS may be achieved by several different strategies : selection or reduction in the number of sexual partners, relinquishing certain sexual practices, and using condoms. 36 per cent of heterosexual men and 30 per ent of heterosexual women, who had had at least two different sexual partners during the last five years, and who were questioned in the ACSF survey claim that they had altered their behaviour, since AIDS entered into the picture. The most frequently mentioned changes are greater selectiveness and reduction in the number of sexual partners. Persons most likely to have changed their behaviour are those who do not live as a couple, those who have had a large number of partners in the past, and those who admit having suffered from a sexuality transmitted disease. Apart from those who have only had a single faithful (or perceived to be faithful) sexual partner, 15 per cent of men and 8 per cent of women with a single partner and 17 per cent of men and 5 per cent of women in multipartnerships say that they used condoms systematically during the last 12 months. Factors conducive to that type of the protection include the type of the new, or occasional partner and the recency of the relation. Finally, it seems, that having one or several confidants with whom very private matters can be discussed, makes people more conscious of the risk of infection and stimulates preventive behaviour.Ducot (Béatrice), Spira (Alfred). - Les comportements de prévention du Sida : prévalence et facteurs favorisants En matière de prévention des MST et du Sida, plusieurs stratégies peuvent être adoptées : sélection et diminution du nombre des partenaires sexuels, abandon de certaines pratiques, utilisation du préservatif lors des rapports. Parmi les sujets hétérosexuels interrogés lors de l'enquête ACSF, 36% des hommes et 30% des femmes ayant eu au moins 2 partenaires sexuels différents dans les 5 dernières années déclarent avoir « changé leur comportement depuis qu'on parle du Sida». Les changements les plus fréquemment cités sont une sélection et une diminution du nombre de partenaires. Les personnes les plus susceptibles d'avoir ainsi changé leur comportement sont les sujets ne vivant pas en couple, ayant eu un nombre élevé de partenaires et celles déclarant avoir déjà eu une MST. En ce qui concerne les douze derniers mois, si on exclut les personnes n'ayant eu qu'un seul partenaire conjoint fidèle ou ressenti comme tel, 15% des hommes et 8% des femmes monopartenaires, 17% des hommes et 5 % des femmes multipartenaires déclarent avoir utilisé de façon systématique un préservatif durant cette période. Les facteurs favorisant une telle protection sont le type de partenaire nouveau ou occasionnel et le caractère récent de la relation. Enfin, il semble que le fait d'avoir un ou plusieurs confidents avec le(s)quel(s) on parle de choses intimes favorise la prise de conscience du risque de contamination et l'adoption de comportement de prévention.Ducot (Béatrice), Spira (Alfred). - Comportamientos de prevención del Sida : preva- lencia y factores favorecedores En materia de prevención de enfermedades sexualmente transmisibles y del Sida se pueden adoptar varias estrategias : selección y disminución del numero de parejas, abando- no de ciertas prácticas, utilización del preservativo. Entre los individuos heterosexuales en- cuestados para ACSF, el 36 % de los hombres y el 30 % de las mujeres que habian tenido al menos dos parejas distintas durante los últimos cinco afios declaran haber « cambiado su comportamiento desde que se habla del Sida». Los cambios que se citan con más frecuencia son una selección y una disminución del numero de parejas. Las personas más susceptibles de haber cambiado de comportamiento son aquellas que no viven en pareja, con un numero elevado de parejas y las que declaran haber tenido anteriormente una enfermedad sexualmente transmisible. En cuanto al comportamiento durante los doce meses anteriores a la en- cuesta, si se excluyen las personas que declaran haber tenido una sola pareja supuesta о realmente fiel, un 15 % de los hombres y un 8 % de las mujeres con una sola pareja durante el periodo, y un 17 % de los hombres y un 5 % de mujeres con más de una pareja declaran haber utilizado el preservativo de forma sistemática. Algunos de los factores que favorecen la protección son el tipo de pareja, nueva u ocasional, y el carácter reciente de la relación. Finalmente, el hecho de tener uno o más confidentes con los cuales se comparten problemas fntimos favorece la concienciación del riesgo de infección y la adopción de un comportamiento preventivo.Ducot Béatrice, Spira Alfred. Les comportements de prévention du Sida : prévalence et facteurs favorisants. In: Population, 48ᵉ année, n°5, 1993. Sexualité et sciences sociales : les apports d'une enquête, sous la direction de Michel Bozon et Henri Leridon. pp. 1479-1503

Santé reproductive de l'homme en France (méthodologie d'étude et variations géographiques)

LE KREMLIN-B.- PARIS 11-BU Méd (940432101) / SudocPARIS-BIUP (751062107) / SudocSudocFranceF

Canicule et surmortalité à Paris en août 2003

The excess mortality related to the August 2003 heat-wave occurred with different intensity according to places: it was more important in Île-de-France and in the Centre region that in other areas of France. Its impact was more massive in urban environment than in the rural communes. In Paris, the expression of the excess mortality was clearly exacerbated with an increase of almost 190% of mortality between 1st and August 20th 2003 compared to the previous years. However, this extra-mortality did not occur in a homogeneous way in the city. The analysis of the space disparities of mortality in the city was led on the deaths domiciled according to two levels of aggregation, the districts (20) and the quarters (80). It rests, in other, on the cartography of simple indicators of mortality (standardized ratio of mortality) and of excess mortality. The determination of the factors of social risks (socio-demographic and socio-economic characteristics of the population) and contextual (temperature, pollution) is based on the construction of a Poisson regression model. In 2003 a space structure of mortality very different from that of the previous years review was highlighted: it is characterized by a pole of excess mortality in the south of the city. This shift of mortality is the result of a narrow intrication between socio-economic factors and other factors, such as the levels of pollution or the intra-urban variations of temperature. Beyond the dramatic dimension of this without precedent event, the study puts forward the social and economic precariousness of a part of the old population in the capital. This study thus stresses in a strong way the importance of the links between various dimensions (medical, social and contextual) of a health phenomenon