[Prescription of physical activity by general practitioners: The Biarritz Côte Basque Sport Santé experience]. / La prescription d'activité physique par le médecin traitant : l'expérience de Biarritz Côte Basque Sport Santé.

INTRODUCTION: Physical inactivity represents a public health challenge because it is associated with an increased risk of chronic disease and premature death. The prescription of physical activity (PA) by general practitioners in the context of sports clubs was used to fight against physical inactivity. METHODS: Since May 2015, the Biarritz Côte Basque Sport Santé (BSS) association has proposed a primary prevention scheme based on physical activity prescribed by a panel of voluntary general practitioners designed for inactive persons with no significant chronic diseases. Participants are referred either directly to a sports club in which they are managed by a trained sports instructor or initially to a BSS sport health educator, who proposes an interview and physical evaluation in order to choose the most appropriate sporting activity. PA (comprising a total of 15 activities) is prescribed for twelve weeks and each participant is evaluated at the end of this period. We report our experience with this programme after the inclusion of 200 individuals. RESULTS: Eighty-six physicians from seventeen sites of the Basque coast area participated in this study. Two hundred persons received a PA prescription (men: 27%, mean age: 54 years, range: 18-80); 20% of them were referred directly to participating sports clubs and 80% were first evaluated by our BSS educator. Aquatic gymnastics was the PA most frequently chosen (23%). The number of affiliated sport clubs increased from seven at the beginning of our project to twenty five at the time of analysis. Twenty-eight sport instructors have now been trained and accredited to manage participants. One hundred and thirty eight subjects have completed the planned twelve-week schedule and have been evaluated: 90% of them continue their sport in the sports club. DISCUSSION: Our experience suggests than general practitioner-based PA referral to well-trained sports club educators is a feasible strategy for managing physically inactive individuals. This protocol comprises an intermediary structure, the BSS unit, which allows evaluation and referral to adapted PA for each participant plus compliance monitoring. However, the long-term efficacy of this programme has yet to be evaluated.

Stabilization of overweight prevalence and improvement of dietary habits in French children between 2004 and 2008.

OBJECTIVE: The objective of the present study was to describe changes in overweight and obesity prevalence and eating habits among 7.5-10.5-year-old children in Aquitaine (France) between 2004 and 2008, and to assess how the programme 'Nutrition, Prevention and Health of children and teenagers in Aquitaine' implemented in 2004 may have impacted these changes. DESIGN: Two cross-sectional studies were conducted in two samples of children: the 'before programme' sample during the school year 2004/2005 and the 'after programme' sample during the school year 2008/2009. Settings Data were collected on gender, age, weight, height, area of residence (rural/urban) and socio-economic status of the school (non-low socio-economic/low socio-economic). Multivariate analyses were used to assess the effect of the regional programme intervention on the evolution of overweight and obesity prevalence and eating habits independently. SUBJECTS: The 'before programme' sample included 1836 children from 163 schools during the school year 2004/2005 and the 'after programme' sample included 3483 children from 210 schools during the school year 2008/2009. RESULTS: After adjustment of the model for age, residential area and socio-economic status of the area of residence, the prevalence of overweight including obesity (OR = 1.05; 95% CI 0.89, 1.23, P = 0.56) and of obesity (OR = 0.99; 95% CI 0.71, 1.39, P = 0.96) was found to have stabilized and eating habits had improved: intake of light afternoon meals had increased (OR = 1.38; 95% CI 1.13, 1.69, P = 0.002) while snacking in the morning (OR = 0.50; 95 % CI 0.45, 0.57, P < 0.001) and nibbling (OR = 0.81; 95% CI 0.70, 0.93, P < 0.001) had decreased. CONCLUSIONS: These results encourage the promotion and implementation of regional and national interventions among children regarding their eating habits in order to stabilize or decrease the prevalence of overweight.

Prevalence and factors associated with overweight and obesity in French primary-school children.

OBJECTIVE: To determine the prevalence of, and identify associated factors with, overweight and obesity in two samples of French children. DESIGN: We conducted two cross-sectional studies among two samples of children. Weight status, eating behaviour, sedentary activity, physical activity and parents' socio-economic status (SES) were collected using questionnaires filled by doctors during school health check-ups. Overweight and obesity were defined according to the age- and sex-specific BMI cut-off points of the International Obesity Taskforce. Multivariate analysis (logistic regression) was used to identify independent factors associated with overweight including obesity and obesity alone. SETTING: Aquitaine region (south-west France). SUBJECTS: Analyses were conducted among children aged 5-7 years (n 4048) and 7-11 years (n 3619). RESULTS: Overweight prevalence was 9·5 % including 2·2 % of obesity in 5-7-year-old children and 15·6 % including 2·9 % of obesity in 7-11-year-old children. In both samples, overweight and obesity prevalence were higher in children whose parents had low or medium SES (P < 0·05). Factors associated significantly (P < 0·05) and independently with higher overweight or obesity prevalence were female gender, low or medium parental SES, never or sometimes having breakfast, never eating at the school canteen, never having a morning snack, never or sometimes having a light afternoon meal and having high sedentary activity. CONCLUSIONS: Our data confirm that low SES, absence of breakfast and high sedentary activity are associated with a higher risk of being overweight or obese, but also highlight original potential protective factors such as eating at the canteen and high meal frequency.

Evolution of overweight prevalence among 5-6-year-old children according to socio-economic status.

AIM: To assess time trends in overweight and obesity prevalence among 5-6-year-old children of Bordeaux city (France) over seven school years from 2004-2005 to 2010-2011. METHODS: For each year, all 5-6-year-old children from 63 of the 69 schools of Bordeaux were included: 2005, 2100, 2010, 1952, 2040, 2017 and 2111 subjects, respectively. Weight and height were collected by school doctors, and weight status was defined according to the age- and sex-specific body mass index cut-off points of the International Obesity Task Force (IOTF) for obesity and to the French age- and gender-specific child cut-off (close to the IOTF cut-off) for overweight including obesity. RESULTS: From 2004-2005 to 2010-2011, an overall decrease was observed in overweight including obesity (from 8.9% to 5.2%, p < 0.001) and obesity prevalences (from 2.8% to 1.4%, p = 0.046). Similar results were observed in non-low socio-economic status (SES) areas (p < 0.001), whereas the prevalence did not vary significantly in low-SES areas (p > 0.05). CONCLUSION: Overweight prevalence has decreased between 2004 and 2011 in 5-6-year-old children from Bordeaux. However, the gap between low and non-low-SES areas has persisted during these years.

Assessment of nasal septoplasty using NOSE and RhinoQoL questionnaires.

The objective was to assess outcomes of nasal septoplasty without turbinectomy using validated subjective instruments and to correlate results with patient satisfaction. The prospective observational study was conducted in a tertiary referral center. The method included the use of NOSE and RhinoQoL questionnaires to assess patients before and 6 months after Cottle septoplasty without turbinectomy. Patient satisfaction was measured on a visual analog scale. Data were compared by the non-parametric Wilcoxon test. Minimal Clinically Important Differences (MCIDs) were calculated. Correlations between post-operative scores and patient satisfaction were assessed using the Spearman test. Univariate analysis was performed to assess predictors of improvement. One hundred patients were enrolled. Their mean age was 43.4 years and 28% had allergic rhinitis. There was a highly significant improvement in each score at 6 months (p < 0.00001). The MCID for the NOSE was comprised between 5 and 7.5, whereas the mean change was 35.2 points. They ranged from 3.8 to 6.1 for RhinoQoL scores, whereas mean changes were comprised between 12.6 and 20.9. Allergic rhinitis was a predictive factor of less improvement (NOSE p = 0.04-RhinoQoL p = 0.0001). Mean patient satisfaction was 8.2 ± 1.8. Post-operative NOSE and RhinoQoL frequency scores were moderately correlated (r = 0.380; r = 0.356, respectively) whereas bothersomeness and impact scores were highly correlated with patient satisfaction (r = 0.459; r = 0.443, p < 0.00001, respectively). This study shows that the NOSE and RhinoQoL questionnaires can be used in English- and French-speaking populations to perform pre- and post-therapeutic assessment. These validated instruments show that septoplasty without turbinectomy allows management of nasal obstruction and its burden.

Healthcare itinerary of women undergoing an abortion according to their vulnerability.

CONTEXT: Precariousness is increasing among all populations and especially among women. The access to healthcare is increasingly unequal upon the population and particularly in access to contraception methods or abortion according to their vulnerability level. OBJECTIVE: Our main object is to describe the socio-demographic specifications, the different steps involved in the healthcare itinerary to contraception and abortion, according to the level of social vulnerability for a woman population sample requesting an abortion. The secondary objects are to detect the existence of a difficult healthcare itinerary and to describe the exposure to risky situations or behaviors according to their vulnerability level. METHOD: It is an observational cross-sectional survey to women having recourse to induced abortion in centers providing them, during 3 month in 2014, in the Aquitaine area. The validated tool to evaluate this situation in a psycho-social approach is the "EPICES score". RESULTS: Our sample identifies 49% of women in a precariousness situation. These women are younger and more often less employed. They benefit less often from a regular gynecology follow-up, do not use contraception as often and resort to abortion more often. They relate more often risky behavior for the health, conflict with the partner and psychological, physical violence. CONCLUSION: Special attention should be brought to all women in request of an abortion, for half of them are in a precarious situation and this physical might be a rare occasion of access to healthcare. Violence screening should be systematic and the choice of a long term birth control method should be encouraged.

Dietary behaviors as associated factors for overweight and obesity in a sample of adolescents from Aquitaine, France.

This study aimed to identify dietary behaviors that might be considered as associated factors for overweight or obesity among French adolescents. Forty-nine of the 536 middle and high schools in Aquitaine (southwest of France) were invited to take part in the study. For each school, participating adolescents were selected using stratification by grade. A self-report questionnaire, including information about sex, age, dietary behaviors, physical and sedentary activities, and parental socioeconomic status (SES), was filled in by adolescents during class. Overweight and obesity were defined according to the age- and sex-specific body mass index cutoff points of the International Obesity Task Force. Multivariate analysis (logistic regression) was used to identify independent dietary factors associated with overweight including obesity and obesity alone (adjustment on sex, age, parental SES, and weight status and adolescents' sedentary activity). In addition to parental SES and weight status and adolescents' sedentary activity, some dietary behaviors are also independently and significantly associated with a higher prevalence of overweight including obesity: absence (OR 1.43, 0.91-2.23) or rare (OR 1.57, 1.23-2.01) breakfast intake (p < 0.01) and absence (OR 5.03, 3.19-7.92) or rare (OR 1.90, 1.46-2.47) light afternoon meal intake (p < 0.001). All variables were also significantly and independently associated with obesity alone. This study shows that socioeconomic factors and individual behaviors are associated with overweight or obesity. These results confirm the importance to carry out multifaceted educational actions among adolescents, by promoting physical activity and healthy food choices in order to prevent overweight and promote healthy lifestyle behaviors.

Dietary behaviors as associated factors for overweight and obesity in a sample of adolescents from Aquitaine, France

This study aimed to identify dietary behaviors that might be considered as associated factors for overweight or obesity among French adolescents. Forty-nine of the 536 middle and high schools in Aquitaine (southwest of France) were invited to take part in the study. For each school, participating adolescents were selected using stratification by grade. A self-report questionnaire, including information about sex, age, dietary behaviors, physical and sedentary activities, and parental socioeconomic status (SES), was filled in by adolescents during class. Overweight and obesity were defined according to the age- and sex-specific body mass index cutoff points of the International Obesity Task Force. Multivariate analysis (logistic regression) was used to identify independent dietary factors associated with overweight including obesity and obesity alone (adjustment on sex, age, parental SES, and weight status and adolescents' sedentary activity). In addition to parental SES and weight status and adolescents' sedentary activity, some dietary behaviors are also independently and significantly associated with a higher prevalence of overweight including obesity: absence (OR 1.43, 0.91–2.23) or rare (OR 1.57, 1.23–2.01) breakfast intake (p < 0.01) and absence (OR 5.03, 3.19–7.92) or rare (OR 1.90, 1.46–2.47) light afternoon meal intake (p < 0.001). All variables were also significantly and independently associated with obesity alone. This study shows that socioeconomic factors and individual behaviors are associated with overweight or obesity. These results confirm the importance to carry out multifaceted educational actions among adolescents, by promoting physical activity and healthy food choices in order to prevent overweight and promote healthy lifestyle behaviors (AU)