[The "Wellbeing" project: To more reliably identify and support pregnant women with psychological or social vulnerabilities]. / Projet Bien-être : vers un meilleur repérage et accompagnement des femmes présentant des vulnérabilités psychologiques ou sociales.

The perinatal period is one of the most critical periods in the life cycle. The health of the mother and child are strongly and permanently influenced by events occurring during pregnancy, delivery or early infancy. In psychological terms, nearly 10% of women reported poor self-rated mental health during pregnancy. Moreover, sociodemographic characteristics indicative of social disadvantage are associated with a higher risk of poor self-rated mental health. 81.3% of these women did not consult a healthcare professional for psychological problems. The well-being project is designed to optimise the care of pregnant women with psychological or socioeconomic vulnerabilities and to assess the value of an early prenatal interview.

Systematic review and meta-analysis of randomized controlled trials evaluating primary care-based interventions to promote breastfeeding in low-income women.

BACKGROUND: Given the benefits of breastfeeding (BF), health care institutions recommend that a child should be breastfed for the first 6 months of its life. However, differences between social groups as regards BF behaviour are very prevalent. OBJECTIVES: To identify effective programmes that can be implemented by GPs to promote BF in low-income women. METHODS: A review of the literature was based on the Medline, Cochrane and Public Health databases (1985-2009), using index terms relating to BF, general medicine and social inequalities in health. Randomized controlled trials were included in our analysis. Two people independently selected which studies would be used by rating the quality of the articles. The results of these studies were presented in raw form and in terms of a pooled relative risk. RESULTS: We analysed 10 studies (of the 343 articles originally selected) involving a population of 1445 'mother and child' pairs. The studies that assessed ways of encouraging the initiation of any form of BF showed that educational programmes are effective [relative risk (RR) for starting BF, 1.46, 95% confidence interval (CI): 1.03-2.08]. As regards the studies that involved ways to encourage mothers to continue BF, the programmes used showed significant success rates after 3-month postpartum (RR: 1.15, 95% CI: 1.01-1.30). The successful programmes usually involved multiple 'short' follow-up appointments (<20 to 30 minutes). CONCLUSIONS: Educational programmes delivered in the context of ongoing personal contact with a health professional are effective in promoting BF in low-income women.

How French general practitioners adapt their care to patients with social difficulties?

OBJECTIVE: Several studies have shown the role of the primary care system in access to care and in reducing social inequalities in health. The objective of this study was to describe the practices of general practitioners (GPs) in taking into account the social environment of their patient, and the ways they adapted to social difficulties. DESIGN: Qualitative study comprising interviews and focus groups. SETTING: French primary care settings. PARTICIPANTS: Twenty semistructured interviews and two focus groups were conducted with 33 GPs. Sessions were audio recorded, transcribed verbatim and analysed using thematic analysis. The reporting of findings was guided by consolidated criteria for reporting qualitative research. RESULT: This study identified adaptations at three levels: in the individual management of patients (alert system, full involvement in prevention, better communication, prioritised additional examinations, financial facilities, help in administrative tasks), in the collective management of patients in an office (consultation without appointment, pay-for-performance indicators, medical staffs, multidisciplinary protocols, medical practice in group, medical student), and in the community management (patients description, cooperation with associations, public health sector and politics). CONCLUSION: In France, GPs can take into account the social determinants of health in practice through simple or more complex actions.

[Low-income patients: Perception and determinants among medical students]. / Patients bénéficiaires de la CMU complémentaire : perceptions des étudiants en médecine et facteurs influençant ces perceptions.

INTRODUCTION: In France, more than 4 million people benefit from the universal complementary health insurance coverage (CMUc). Approved by many doctors, CMUc remains discussed by a part of the medical profession. What is the perception of general medical practice students regarding patients receiving CMUc and what are the determinants influencing it? METHODS: A cross-sectional study was carried out by providing final year interns in general medicine with a self-administered questionnaire. The primary assessment criterion was the perception of the interns regarding patients receiving CMUc, classified into three categories: positive, negative or neutral. After a description of the sample, statistical analysis included multivariate logistic polytomous regression models developed with the SAS 9.1 software. RESULTS: A total of 57.1% (200) of the third year interns of Île-de-France in 2009-2010 responded to the questionnaire. Forty-two percent of students had a "neutral" perception of the patients receiving CMUc, 41% a "positive" one and 17% a "negative" one. Influencing factors were: the perception of the first encounter, the gender of the intern, the type of practice that he intended to take up and the experience he had of patients receiving CMUc. In multivariate analysis, a positive impression of the first encounter significantly increased the probability of having a positive future perception compared to a negative impression of the first encounter (OR=16,19 [2,37-110,48]). DISCUSSION: To improve these perceptions, the main proposals are increased contacts with underprivileged populations and the close supervision of the students by their course tutors.