Attentes des femmes VIctimes de violences Conjugales envers leur Médecin Généraliste (AVIC-MG), une étude descriptive.

INTRODUCTION: In France, 122 women were killed by their partner or ex-partner in 2021. PURPOSE OF THE RESEARCH: The principal objective of the AVIC-MG study, on women victims of domestic violence and their expectations of their general practitioner, was to observe whether the women in question, who visit specialist facilities for victims of domestic violence, would like to be questioned about domestic violence by their general practitioner (GP). The secondary objective was to describe this population of women and the characteristics of their GP visits during the last twelve months. RESULTS: The study showed that more than 90 percent of these women had consulted a GP in the last twelve months and 65 percent of the mothers in the group had consulted a GP for their child(ren). The majority of these women (82 percent) wanted the GP to ask them about domestic violence. They had gone to the GP for specific reasons: fatigue, pain, psychological suffering (anxiety, sadness, difficulty sleeping). CONCLUSION: The majority of women victims of domestic violence would like primary care practitioners to identify the abuse. Tools are available to help GPs with this complex identification, in particular the DECLICVIOLENCE.FR website.

Signs and symptoms of intimate partner violence in women attending primary care in Europe, North America and Australia: a systematic review and meta-analysis.

BACKGROUND: Intimate partner violence (IPV) is a prevalent yet underdiagnosed health issue, and primary care practitioners are in a unique front-line position to provide care and counsel for the victims. OBJECTIVE: To identify the signs and symptoms of women exposed to IPV who attended primary care, regardless motive of consultation. METHODS: Systematic review and meta-analysis on Cochrane, PubMed, Embase and CINAHL between 1946 and 2020. Eligible studies had to be original quantitative research, on women aged >15 years, attending primary care settings in Europe, North America and Australia and interviewed on their status as victims of IPV and on their signs and symptoms. RESULTS: Of 1791 articles identified, 57 were selected. Associations were found between IPV and signs and symptoms of depression [19 studies: overall odds ratio (OR) = 3.59, 95% confidence interval (CI; 2.7-4.7, I2 = 94.6%)], anxiety [9 studies: overall OR = 2.19, 95% CI (1.75-2.73, I2 = 84%)], gynaecological and/or sexually transmitted infections [6 studies: overall OR = 2.82, 95% CI (2.1-3.8, I2 = 41%)] and combination of somatic symptoms [5 studies: standard mean deviation = 0.795, 95% CI (0.62-0.97, I2 = 0%)]. CONCLUSIONS: Women exposed to IPV may present with clinical symptoms and signs other than bodily injury. Policy implications knowing these symptoms presented by women victims of IPV can help GPs identify and treat them. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018089857.

Perceptions and behaviour of pregnant women in socioeconomic deprivation in rural areas. A qualitative study in France.

BACKGROUND: Socioeconomic deprivation (SED) is a risk factor for complications during pregnancy and childbirth, the impact of which has been studied poorly in rural areas. AIMS: To explore the perceptions and behaviour of women living in SED in a rural area with regard to their pregnancy follow-up. METHODS: A qualitative study using semi-structured individual interviews was carried out in a rural area in central France. To participate, the women had to have an Evaluation of Deprivation and Inequalities in Health Examination Centres deprivation score ≥ 30.17, be living in a rural area and have given birth during the month before the interview. The interviews were analysed using a thematic approach inspired by grounded theory. RESULTS: Seventeen women were interviewed. The difficulties of life in a rural area were linked to geographical remoteness, travel costs, lack of public services, inadequacy of nearby healthcare and social isolation. In all cases, pregnancy was an additional difficulty. The adaptive capability was related to the presence of an efficient family and social network. Most of the time, any increase in the limitations exceeded the ability to adapt and affected the medical follow-up of the pregnancy, although follow-up appointments were rarely abandoned altogether. Perceptions of birth preparation and parenting sessions were often limited to advice on pain management. Due to their affiliation with their rural area or their choice of lifestyle, the women complained only minimally. CONCLUSION: Women often minimize any limitations and implement adaptive techniques that make identification by social and medical services more difficult. PATIENT OR PUBLIC CONTRIBUTION: Eighteen women in SED were contacted by Childhood Medical Protection, midwives and general practitioners practising in rural areas. One woman declined participation and seventeen were interviewed.

Trajectories of antidepressant drugs during pregnancy: A cohort study from a community-based sample.

AIMS: The aim of this study was to monitor the trajectories of antidepressant use during pregnancy and the postpartum period among women chronically treated with antidepressants before their pregnancy, and to assess characteristics associated with each trajectory. METHODS: This cohort study included all pregnant women whose data were included in the General Sample of Beneficiaries (EGB) database affiliated with the French Health Insurance System, from 2009 to 2014. Women were followed up until 6 months after childbirth. Chronic treatment was defined as exposure over the 6-month period preceding pregnancy. A group-based trajectory model (GBMT) was estimated to identify distinctive longitudinal profiles of antidepressant use. RESULTS: Among 760 women chronically treated with antidepressants before their pregnancy, 55.8% stopped their treatment permanently in the first trimester, 20.4% discontinued it for a minimum of 3 months and resumed it postpartum, and 23.8% maintained it throughout pregnancy and postpartum. No sociodemographic or medical characteristics were associated with any trajectory group. Women who maintained treatment presented more frequent obstetric complications and postpartum psychiatric disorders. Among women who interrupted treatment, prescription of benzodiazepines and anxiolytics decreased initially but rose postpartum to a higher level than before pregnancy. CONCLUSIONS: Pregnant women treated with antidepressant require a re-evaluation of psychiatric treatment. It is necessary to pay attention to obstetric complications for severely depressed women. Additionally, as relapse was associated with increased benzodiazepine use, it is important to carefully monitor all women who stop antidepressant treatment during pregnancy.

Screen exposure time of children under 6 years old: a French cross-sectional survey in general practices in the Auvergne-Rhône-Alpes region.

BACKGROUND: The advent of miniature, easy-to-use and accessible multimedia products is leading to screen exposure that begins in early childhood. Overexposure in preschool may lead to adverse effects. The main objective of this study was to determine the average daily time (ADT) spent by children under 6 years of age, followed in general practice, in front of television or interactive screens. METHODS: A cross-sectional survey was conducted in the Auvergne-Rhône-Alpes region among randomly selected General Practitioners (GPs). The average daily screen time (ADST), regardless of the type of device (TVs, computers, tablets, smartphones, video game consoles), of the included children aged 0 to 2 years and 2 to 5 years was calculated from a self-questionnaire completed by the parents. A multivariate Poisson regression model was performed to analyse daily screen time, adjusted by factors selected on their clinical relevance and statistical significance. RESULTS: The 26 participating GPs included 486 parents. They reported an ADST of 26 (± 44) minutes on weekdays and 30 (± 46) minutes on weekends for children under 2 years of age. For children over 2 years of age, the ADST was 66 (± 82) minutes on weekdays and 103 (±91) minutes on weekends. There was an association between the children's average screen time and certain sociodemographic and environmental factors. Children whose parents had higher levels of education, those living in a family without TV screens or those who were well informed about the possible adverse health consequences of overuse of screens had lower average screen time. On the other hand, children of parents who spent more than 2 hours a day in front of screens, were more exposed. CONCLUSIONS: In our survey, the ADST of children under 6 years of age followed in general practice was higher than the current recommendations. GPs can warn parents of preschool children of the effects of overexposure to screens, particularly parents of at-risk children.