Care pathway of asylum seekers in the health care access points following inclusion in the PREMENTADA project: an observational study.

OBJECTIVES: The health service access point (PASS) allows people in precarious situations to benefit from medical and social care. A mobile PASS service was set up in 2020 in Marseille for people seeking asylum (DA). The objective of our study was to describe the care pathways within the PASS for DA. STUDY DESIGN: We led a retrospective observational study of care pathways of the 418 DA included in the PREMENTADA study (ClinicalTrials number: NCT05423782) in the 3 months following their inclusion. METHODS: We conducted a quantitative study, which ran from March 1, 2021, to August 31, 2021, to collect data from mobile and hospital PASS consultations, referrals following PASS consultations or hospitalizations, emergency room visits, hospitalizations, prescription, and dispensing of treatment following PASS consultations or on discharge from hospital, between D0 and M3. RESULTS: A total of 163 (39.0%) patients were lost to follow-up after an initial assessment of their health status. Overall, 74.4% of the patients were followed only by the mobile PASS for a mental health problem, and 57.4% were followed for a somatic problem until they obtained their rights. The mobile PASS referred 43.5% of patients to the hospital PASS for access to various technical facilities: medical imaging, pharmacy (63% of them benefited from the dispensing of health products), biological tests, and so on. The morbidities of the DAs were severe enough to require technical support that the mobile PASS could not provide, but recourse to the emergency department was fairly low (1.6%), testifying to the efficiency of the primary care provided by the mobile PASS. CONCLUSIONS: Our study provides the first data concerning the DA's healthcare pathway in France. Considering the health status of this population and the fact that early management of health problems allows for rationalization of costs, we can ask the question of the future of these patients in the absence of adapted care systems. The PASS and the hospitals to which they are attached will have to adapt their care offer to take into account the DA's specific problems.

Haematological parameters do senesce in the wild: evidence from different populations of a long-lived mammal.

Increasing evidence of senescence has been reported from long-term studies of wild populations. However, most studies have focused on life-history traits like survival, reproduction or body mass, generally from a single intensively monitored population. However, variation in the intensity of senescence across populations, and to a lesser extent between sexes, is still poorly understood. In addition, the pattern of age-specific changes in haematological parameters remains virtually unknown to date for any population of vertebrate living in the wild. Using repeated blood samples collected from known-aged (2-15 years of age) roe deer (Capreolus capreolus) from two populations facing highly different environmental conditions, we filled the gap. In particular, we investigated age-specific changes in haematocrit, albumin and creatinine. We reported clear evidence of senescence in all haematological parameters. Moreover, senescence patterns differed between sexes and populations. The rate of senescence was higher in males than in females for haematocrit with no site difference. On the other hand, the rate of senescence in creatinine was higher at Trois Fontaines than at Chizé with no sex difference. Our findings provide a first demonstration of age-specific declines in haematological parameters in wild populations of large herbivores and show that the process of senescence in vertebrates is not restricted to body mass or fitness components. We also demonstrate that the senescence pattern of haematological parameters is context dependent and varies both between sexes and according to environmental conditions.

Incidence of acute respiratory tract infections (2006-2015) and influenza (2006-2013) among French armed forces.

OBJECTIVES: We aimed to assess the incidence of respiratory tract infections in military settings between 2006 and 2015. PATIENTS AND METHODS: We performed a retrospective epidemiological study of the entire military population from 2006 to 2015. Comprehensive data was collected from all medical centers, operational medical units, naval services, and army training hospitals and provided by the epidemiological surveillance of the armies. RESULTS: The annual average population of the study was 331,394 soldiers. For acute respiratory tract infections (2006-2015), 22,818 cases were reported in metropolitan France, 3,211 cases in French overseas territories, 1,595 cases in the French Navy, and 1,318 cases in external military operations for a total of 28,942 cases. For influenza (2006-2013), 934 cases were reported in metropolitan France, 101 cases in French overseas territories, and 23 cases in external operations, for a total of 1,058 cases. The mean incidence rate of acute respiratory tract infections expressed as case number per 1,000 person-years (PY) was 8.7 PY (95% CI [8.6-8.8]) with an exceptional increased incidence rate in 2009 (25.9 PY, 95% CI [25.4-26.4]). The mean incidence rate of influenza was 0.35 PY (95% CI [0.33-0.37]) with a peak incidence rate of 1.9 PY in 2009. CONCLUSION: Acute respiratory tract infections are at the forefront of infectious episodes in the French armies. Although not necessarily severe, current prevention measures are not enough to reduce the incidence threshold of these infections and need to be improved.

Hospital-based home care for young children newly diagnosed with type 1 diabetes: Assessing expectations and obstacles in families and general practitioners.

AIMS: This study aimed to evaluate whether hospital-based home care was desired by the parents of children diagnosed with type 1 diabetes (T1D) under the age of 5 years and their general practitioners, and to identify the main expectations and obstacles to its implementation. METHODS: This descriptive bicentric study in France was performed between November 2016 and November 2017. Data were collected by interviewing 57 families of children diagnosed with diabetes before the age of 5 years and the corresponding 30 general practitioners. The primary endpoint was the families' or general practitioners' acceptance of home-based care after diagnosis. RESULTS: A high proportion of families and physicians (86% and 93%, respectively) expressed a wish for hospital-based home care, most of whom considered it essential (79% and 87%, respectively). Low-income families were less likely to accept this care pathway (P<0.001). The families' expectations regarding home care were help with social care, the management of emergencies, and return to school. The physicians' main request was improved interprofessional collaboration. CONCLUSION: Hospital-based home care seems to be an acceptable transition after conventional care for children just diagnosed with T1D. Multidisciplinary support, personalized social care, and access to welfare benefits may improve acceptance rates, especially among low-income families.

Immunosenescence patterns differ between populations but not between sexes in a long-lived mammal.

In animals, physiological mechanisms underlying reproductive and actuarial senescence remain poorly understood. Immunosenescence, the decline in the ability to display an efficient immune response with increasing age, is likely to influence both reproductive and actuarial senescence through increased risk of disease. Evidence for such a link has been reported from laboratory animal models but has been poorly investigated in the wild, where variation in resource acquisitions usually drives life-history trade-offs. We investigated immunosenescence patterns over 7 years in both sexes of two contrasting roe deer populations (Capreolus capreolus). We first measured twelve immune markers to obtain a thorough identification of innate and adaptive components of immunity and assessed, from the same individuals, the age-dependent variation observed in parasitic infections. Although the level of innate traits was maintained at old age, the functional innate immune traits declined with increasing age in one of two populations. In both populations, the production of inflammatory markers increased with advancing age. Finally, the adaptive response declined in late adulthood. The increasing parasite burden with age we reported suggests the effective existence of immunosenescence. Age-specific patterns differed between populations but not between sexes, which indicate that habitat quality could shape age-dependent immune phenotype in the wild.

A comparison of the physiological status in parasitized roe deer (Capreolus capreolus) from two different populations.

Studies of the impact of parasites on host performance have mainly focused on body mass, a phenotypic trait that responds relatively slowly to the presence of parasites, and the expectedly faster response of physiological parameters has been mostly overlooked. We filled the gap by measuring the impact of endoparasites on four hematological/biochemical parameters (hematocrit, albumin, creatinine and fructosamine) in two contrasting free-living populations of roe deer. We generally found negative relationships between parasites and physiological parameters. Our findings also indicate little role of host sex on parasite impact and strongest parasite effects on young and senescent hosts.