Accueil et suivi des personnes en demande de transition en soins de premiers recours : retour sur plus de dix ans d'expérience.

Ten years ago, trans-gender people were looking for respectful and safe accompaniment. It was in this context of difficulty in finding answers that the Maison Dispersée de Santé de Lille began to set up a support service. The approach was immediately anchored in the gender transition pathway within primary care medicine, i.e. in access to local care. Caregivers and users, we build together our practice of health and care by meeting, debating, listening and sharing individual and collective expertise. Thus, we have gradually built a rigorous and non-rigid framework of a global, bio-psycho-social accompaniment that takes into account experiential learning. This framework must take into account the health of each individual in order to propose, follow and adapt a hormone replacement treatment. It allows for the accompaniment of physical changes, possible pre-existing psychological suffering or that which appears during the transition, as well as the upheaval of one's place in society. People with gender variations need medical support because they are part of a social reality that leads to this demand. The prevalence of transidentity has long been underestimated and this need has also been underestimated. Our experience of more than ten years of accompanying transitions of women and men in this context shows the feasibility of transitions in primary care within the French system of care and medico social support.

Effect of a postpartum prescription for pertussis vaccine: a before-and-after study.

BACKGROUND: Among the strategies to encourage pregnant women to be vaccinated against pertussis in the postpartum period, that of giving them a prescription has been evaluated only sparsely. OBJECTIVE: To measure the effect of giving women who are not immunized against pertussis a prescription for the vaccine at discharge from the maternity unit. MATERIAL AND METHODS: Single-center before-and-after study (2011: before; 2015: after). All women received both oral and written information about vaccination against pertussis. During the after period, they were also specifically asked their immunization status during pregnancy. Those currently unimmunized received a written prescription for it at discharge. RESULTS: Among the women unimmunized at delivery, the percentage who were vaccinated postpartum climbed from 17 to 42% between 2011 and 2015 (p < 0.001), while the percentage of their unimmunized partners who were vaccinated remained stable (27 and 29%, p = 0.74). During this time, the percentage of women immunized against pertussis at the beginning of pregnancy rose from 32 to 52% (p < 0.001). Finally, the percentage of all women protected against this disease postpartum climbed from 44 to 72% between these two periods (p < 0.001). CONCLUSIONS: In the postpartum period, giving a prescription for pertussis vaccine to women unimmunized is accompanied by a significant elevation in their vaccination rate. Nevertheless, this rate remains low and better strategies have to be implemented.