[An evaluation of a patient education programme for children with asthma at a French teaching hospital ("l'espace du souffle", Nantes) (2002-2003)]. / Programme d'éducation thérapeutique collective pour l'enfant asthmatique à Nantes.

A program of patient education was set up at the CHU of Nantes, for groups of children with asthma in 1997. The aim of this study is to realize a formative evaluation to corelate with some effects. This study was proposed to 99 families with asthmatic children. A written questionnaire, was administered to the parents and children, exploring their satisfaction with the programme, their general knowledge and know-how, biomedical parameters. The observation focused on skills and day-to-day life with the illness. The study was completed by 21 families. The majority of the children, aged 7 to 11 years old, had asthma that needed treatment. All of the parents and children were satisfied with their visit to "l'espace du souffle". They all declared having increased their general knowledge and know-how and biomedical parameters did better. They did, however, feel that they did not know enough about how to recognise precursory symptoms of an attack, about how to practise a sport or how to use "corticoids". They also could not control their personal fear during an attack. During the oral questionnaire a general feeling of stress and worry was clearly noticeable in the parents feeling, that did not appear in the written questionnaire. This patient education program appears to be beneficial. Furthermore, this evaluation highlights some subjects that pass unseen during current individual consultations.

["Evaluating health workshops": the experience of health education committees in the Pays de la Loire region]. / "Qu'est-ce qu'un atelier santé"? L'expérience des Comités d'Education pour la Santé des Pays de la Loire.

The five health promotion and education committees (CODES) from the Pays de la Loire region are carrying out health promotion projects involving socially disadvantaged people. These projects are referred to as ateliers santé (literally meaning "health workshops"). These interventions are conducted over a series of participatory sessions, which creates a more supportive structure to guide people with difficulties assisting them to better recognise and formulate their health needs, as they are normally part of a population group which is neither accustomed to expressing their health needs nor to being heard on this subject. At present little is known about these projects; therefore the Inter-regional and departmental health education committee from Nantes chose to carry out an evaluation of 7 of the 47 existing "workshops". Each one of the seven interventions required an average of 31 hours of preparation. Overall, there were 9 sessions organised with 8 to 9 participants, each lasting for the duration of 2.5 hours, held over a period of 32 weeks. At the end of each session, 85% of the participants claimed that there were satisfied. When questioned six months after the end of their "workshop", half of the 37 participants reported that their perceived health status was a little or much better after having taken part in the process. The evaluation demonstrates that a more clear definition of the operational objectives is necessary in order to promote increased input from the participants and to clarify the intentions of the project team towards a population group which needs a means by which it can enter into this critical debate. The process appears to be in accordance with the criteria and goals of health promotion: negotiation of the content, participation of members of the target audience throughout various stages of the project, and adjustment of the size and scale of the project being to involve a small total number of participants in order to favour effective follow up. Although evaluating the effectiveness and impact of such interventions is difficult and complicated by complex methodological questions, these "workshops" seem to have been greatly appreciated both by those who requested them and those who participated in them, with encouraging results having been witnessed in the lives of certain participants, which all serves as an incentive to pursue this kind of project.

[Study of an HIV positive, tropical origin population in a refugee center in France]. / Etude d'une population d'origine tropicale, VIH positive, dans un centre de réfugiés en France.

The study describes HIV positive refugee patients, who were seen over a 3 years period at COMEDE, a dispensary for foreign nationals. COMEDE offered a HIV test to every patient, and it followed up on the disease and its prevention. Out of 5,234 tests, 328 were positive (6.3%). Less than 5% of the patients refused the test. All the patients returned for the result; 88.4% were African and 11.3% Haitian. The mean age was 31.5 years. The male/female sex ratio was 1.28. In this study, 94.5% of the HIV patients were HIV1, 3% HIV2 and 2.5% carried both strains; 78% were asymptomatic, 7% had ARC and 12.5% had AIDS. The prevalence of tuberculosis was high (10.6%), especially for AIDS patients (65%); Treponematosis prevalence was 13% and toxoplasmosis was 62.8%; 40% had intestinal parasites. 36.4% of the women became pregnant during the study; 41% of the pregnancies were terminated, while 27% went full term. The proportion of missing patients after 6 months was high (57%) because of numerous factors which prevented them from returning. This study shows the importance of proposing a HIV test to this immigrant population, although follow-up is difficult, due to social and economic factors.

[Left ventricular hypertrophy in patients with hypertension. A comparative study between black Africans and white Europeans]. / L'hypertrophie ventriculaire gauche chez l'hypertendu. Une étude comparative entre des sujets Noirs africains et Blancs européens.

OBJECTIVE: The objective of this study was to compare clinical and ultrasonographic findings in 20 consecutive hypertensive Black Africans, with those of 20 hypertensive White Europeans matched for age in order to study modifications of left ventricular (VG) geometry. METHOD: 20 consecutive Black men (B), recently emigrated from Africa and applying for asylum, referred for HT, were assessed by measuring systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse pressure (PP), body mass index (BMI), echocardiography with measurement of the end-diastolic thickness of the septum, posterior wall (Epp), LV diameter (DTD), calculation of the LV mass index (LVMI) according to the Penn convention and the thickness/radius ratio (t/r). These subjects were matched for age with 20 consecutive European White men (W) sent to the echocardiography laboratory for assessment of HT, in whom the same parameters were measured. RESULTS: The mean age was 41.6 +/- 9.2 (B) vs 42.1 +/- 8.8 years (W) (NS). The BMI was 26.3 +/- 3.2 (B) vs 27.3 +/- 3.4 (W) (NS). SBP was 175 +/- 24 (B) vs 156 +/- 15 mmHg (W) (p < 0.01). DBP was 108 +/- 13 (B) vs 94 +/- 9 mmHg (W) (p < 0.01). PP was 67 +/- 20 (B) vs 63 +/- 10 mmHg (W) (NS). LVMI was 131 +/- 43 (B) vs 91 +/- 19 g/m2 (W) (p = 0.001). The t/r ratio was 0.48 +/- 0.08 (B) vs 0.38 +/- 0.07 (W) (p < 0.001). DTD was 47.1 +/- 3.9 (B) vs 48.6 +/- 4.4 mm (W) (NS). Epp was 11.2 +/- 1.9 (B) vs 9.1 +/- 1.4 mm (W) (p < 0.001). A poor correlation was observed between SBP and LVMI (r = 0.23, p = 0.17), and between SBP and t/r (r = 0.21, p = 0.21). CONCLUSION: Compared to a age-matched population of European hypertensive patients with similar morphology, our homogeneous group of recently emigrated patients was characterized by a greater severity of HT and the presence of concentric left ventricular hypertrophy. The marked difference in socio-economic status and access to care of these two populations must be stressed.

[Arterial hypertension in black Africans. Clinical and echographic study in 50 patients]. / Hypertension artérielle du noir Africain. Etude clinique et échographique chez 50 sujets.

OBJECTIVES: Clinical and electrocardiographic and echocardiographic data were collected in 50 black Africans with hypertension to study modifications in left ventricular geometry. METHODS: Thirty men and 20 women with hypertension (mean age 40.9 +/- 10.2 years) who had recently immigrated from Africa were included in the study. Parameters recorded were: systolic and diastolic pressures, body mass index (BMI = weight/height2); ECG; echocardiography (36 patients): end diastolic septal and posterior wall thickness, left ventricle diameter, left ventricle mass (LVM) and relative wall thickness. RESULTS: Systolic and diastolic pressures and BMI were 169 +/- 24 mmHg, 105 +/- 14 mmHg and 26.7 +/- 3.9 kg/m2). LVM was 129 +/- 41 g/m2 (Normal < 134 g/m2) in men and 113 +/- 35 g/m2 (Normal = 110 g/m2) in women. Concentric remodeling was found in 8 patients (LVM = normal, relative wall thickness > or = 0.45), concentric left ventricle hypertrophy in 10 (LVM > normal, relative wall thickness > or = 0.45), excentric left ventricular hypertrophy in 6 (LVM > normal, relative wall thickness < 0.45), asymmetric septal hypertrophy in 4 and normal echocardiogram in 8. There was a negative correlation between age and end diastolic left ventricle diameter (r = -0.34, p < 0.05) and age and end systolic ventricle diameter (r = -0.74, p < 0.05). There was a positive correlation between body surface and septal thickness (r = 0.34, p < 0.05), posterior wall thickness (r = 0.56, relative wall p < 0.001), and relative wall thickness (r = 0.45, p = 0.05). CONCLUSION: This population of young subjects with hypertension showed a high prevalence of modifications in left ventricular geometry with predominant concentric modeling with (8/36) and without (10/36) left ventricle hypertrophy.

[Blind treatment or treatment oriented to intestinal parasitoses in a Parisian health center for refugees]. / Traitement à l'aveugle ou traitement orienté des parasitoses intestinales dans un centre parisien de soins pour exilés.

The Comede health care center for political refugees received 4,414 first arrivals from 70 African, Asian and South American countries in 1989. Many arrived from areas where intestinal parasitic infections are endemic, and where infections by nematodes (Ancyclostoma duodenale, Necator americanus, Ascaris lumbricoides, Trichuris trichiura, Strongyloides stercoralis), trematodes (Schistosoma hematobium, Schistosoma stercoralis) and protozoa (Entamoeba coli) cause significant morbidity. The question that arises is whether we should screen stools and urine only in the case of African refugees, or treat all refugees empirically (mass treatment program). We carried out a retrospective study of 1,425 patients seen for the first time in the Comede from August 1, 1989 to December 31, 1989. Three-quarters of the subjects were men and the mean age was 29 years. 63.2% of the subjects were from 28 African countries, 18.6% from 8 Asian countries, 10% from 5 South American countries and the West Indies, and 6.4% from 4 countries of the Mediterranean basin. 4 countries of the Mediterranean basin. All the subjects were asked to provide stool and urine specimens at the Paris City Laboratory, which were examined using the merthiolate iodo formol direct methods, two concentration methods (MIF and Kato) and Baermann's technique. Patients with infestations were prescribed appropriate treatment at a second visit, compliance with which was good (86%). The prevalence of intestinal parasite infections was 60%. Albendazole was given to 44% of patients, while 45% of African patients were given praziquantel and 2.7% tinidazole.(ABSTRACT TRUNCATED AT 250 WORDS)