Development of a risk prediction score for screening for HBV, HCV and HIV among migrants in France: results from a multicentre observational study (STRADA study).

OBJECTIVES: Migrants from high HIV, hepatitis B virus (HBV) or hepatitis C virus (HCV) endemicity regions have a great burden of these infections and related diseases in the host countries. This study aimed to assess the predictive capacity of the Test Rapide d'Orientation Diagnostique (TROD) Screen questionnaire for HIV, HBV and HCV infections among migrants arriving in France. DESIGN: An observational and multicentre study was conducted among migrants. A self-questionnaire on demographic characteristics, personal medical history and sexual behaviours was completed. SETTING: The study was conducted in the centres of the French Office for Immigration and Integration (OFII). PARTICIPANTS: Convenience sampling was used to select and recruit adult migrants between January 2017 and March 2020. OUTCOME MEASURES: Participants were tested for HIV, HBV and HCV with rapid tests. For each infection, the test performance was assessed using receiver operating characteristics curves, using area under the curve (AUC) as a measure of accuracy. RESULTS: Among 21 133 regular migrants seen in OFII centres, 15 343 were included in the study. The participants' mean age was 35.6 years (SD±11.1). The prevalence (95% CI) of HBV, HCV and HIV was 2.0% (1.8% to 2.2%), 0.3% (0.2% to 0.4%) and 0.3% (0.2% to 0.4%), respectively. Based on the sensitivity-specificity curve analysis, the cut-off points (95% CI) chosen for the risk score were: 2.5 (2.5 to 7.5) for HBV infection in men; 6.5 (0.5 to 6.5) for HBV infection in women; 9.5 (9.5 to 12.5) for HCV infection; and 10.5 (10.0 to 18.5) for HIV infection. Test performance was highest for HIV (AUC=82.15% (95% CI 74.54% to 87.99%)), followed by that for HBV in men (AUC=79.22%, (95% CI 76.18% to 82.26%)), for HBV in women (AUC=78.83 (95% CI 74.54% to 82.10%)) and that for HCV (AUC=75.95% (95% CI 68.58% to 83.32%)). CONCLUSION: The TROD screen questionnaire showed good overall performance for predicting HIV, HBV and HCV infections among migrants in OFII centres. It could be used to optimise screening for these infections and to propose rapid screening tests to those who are at high risk. TRIAL REGISTRATION NUMBER: NCT02959684.

Représentations sociales de l'incontinence urinaire : une enquête auprès de la population française.

INTRODUCTION: Urinary incontinence is a major public health problem. Although, as a condition, it is well documented in the literature, there is little information on its social representations. The study of its representations could make it possible to improve the way it is handled and the treatment suffers receive. PURPOSE OF THE RESEARCH: The aim of this study was to understand the representations of the general French population on the subject of urinary incontinence. METHODS: This involved carrying out a declarative quantitative study using questionnaires. To do this, 1803 people were surveyed all over France. First, a descriptive statistical analysis was carried out using the participants’ socio-demographic data. Second, a logistic regression-type association was made between the dependent and independent variables. RESULTS: Urinary incontinence elicits a certain level of disgust in the general population. Still a taboo subject, it seems to be of little interest to some members of the population. The condition is also often poorly understood, especially by men, the younger generations, and the inhabitants of urban areas in western France. CONCLUSIONS: This quantitative study helped shed key light on the French population’s perceptions of urinary incontinence and the methods of prevention available. It also helped determine the participant profiles associated with these representations. Going forward, it seems worthwhile to focus on informing and educating these populations on the subject.

L'activité odontologique hospitalière dans l'offre de soins en zone sous-dotée : exemple en Basse-Normandie.

INTRODUCTION: Demand for dental care in Basse-Normandie has been severely affected by the reduced availability of local services. One of the missions of hospital dental services is to respond to these difficulties in accessing care. PURPOSE OF THE RESEARCH: The objective of this study is to determine how hospital activity fits into the local dental care offer. To do this, we compared the activity of the dental service of the Caen hospital with that of private practices. RESULTS: The proportion of young patients, particularly those under fifteen, was greater at the university hospital than in private practice (20.9 percent vs 12.9 percent, p < 1.10 -5). The activity of private practices included a higher proportion of fixed prosthetic care and oral prophylaxis procedures, in contrast to surgical procedures, direct restorative care, and consultations, which account for a higher proportion of hospital activity (10 percent vs 22.5 percent, p < 1.10-5). CONCLUSIONS: The dental service at Caen hospital differs from private practices in Basse-Normandie in that its activity is oriented toward primary care or emergency care. This activity seems to reflect a high individual caries risk, probably associated with social vulnerability. The unit therefore seems to respond to a need for primary care.

Sur la scène des consultations en chiropraxie : une lecture de la relation de soin.

INTRODUCTION: The caregiver-patient relationship has been the subject of numerous studies in the field of medicine, but has received little attention in the context of chiropractic care, particularly in France. PURPOSE OF THE RESEARCH: This ethnographic and sociological study aims to gain a better understanding of the characteristics of the chiropractic relationship in chiropractic care through the observation of consultations followed by interviews with both patients and caregivers. These observations were carried out in the Franco-European Chiropractic Institute’s two outpatient clinics and in three private practices. RESULTS: The data were collected between October 2022 and March 2023. Most of the patients treated their health as an asset to be preserved or even improved, and had a good knowledge of their body as a tool for work and/or sports performance. They turned to chiropractic care to find relief from their pain and a form of care combining technical and interpersonal skills. Chiropractic care is based on manual therapy, combined with a dimension of self-management by the patient. Follow-up of the exercises and advice given by chiropractors varies greatly from patient to patient, from diligent application to non-application, and with everything in between. CONCLUSION: Trust is the foundation of all care, and even more so in manual therapy, because of the way the hands act on the body. To establish a working alliance with the patient, the chiropractor has to adapt his or her professional ethos and accept compromises regarding the treatment plan envisaged. Cooperation between a patient and a chiropractor is based on trust, the negotiation of objectives, and the division of tasks between the two parties.

Déprotection sanitaire des étrangers, de quoi la démission d'Aurélien Rousseau est-elle le nom ?

In late December 2023, the French parliament debated legislation that would endanger access to state medical aid (AME) for seriously ill migrants living undocumented in France. The limits of an over-restrictive approach to health care are well known: poorer access to care, additional burden on public hospitals, and the weakening of the whole system. The risks weigh particularly heavily on migrants living with HIV. Yet we know that the number of HIV-positive diagnoses continues to rise among men who have sex with men and who were born abroad. This situation raises public health concerns and risks undermining the ethical foundations of medicine. The French health minister, Aurélien Rousseau, resigned the day after the bill was passed last December, having repeatedly stated his opposition to measures abolishing or weakening AME. In doing so, he demonstrated his commitment to the humanist foundations of medicine, setting an example for all political leaders.

Critères influençant le choix du premier poste après l'internat de chirurgie orale en France.

INTRODUCTION: The Specialized Diploma in Oral Surgery (Diplôme d’études spécialisées en chirurgie orale) was established in 2011. It gives its holders a unique combination of medical and surgical expertise. As a specialty, oral surgery can be pursued via both medical and dental pathways. However, the criteria guiding students’ choice of first job after residency remain largely unknown. PURPOSE OF THE RESEARCH: The primary objective was to evaluate the factors influencing students’ choice of first job after completing their oral surgery residency. RESULTS: The main geographical factors influencing job choice were the presence of family or friends, a short commute, and the location of the spouse’s place of work. Key practice conditions included access to advanced technical facilities and an operating theater offering general anesthesia. Clinical activities ranged from pre-implant grafts to general oral surgery. The likelihood of pursuing a hospital-based position in the same facility was correlated with the well-being experienced during the residency (p < 0.05) and with the oral surgeons’ medical background (p = 0.001). Significant associations exist between region of origin, internship location, and practice region (p < 0.001; p <0.001). CONCLUSIONS: The main factors influencing the choice of first position after oral surgery residency depend on family-related and technical criteria.

Propositions pour la prévention et la promotion de la santé bucco-dentaire chez les enfants.

At the last congress of the Association Dentaire Française (ADF) (French Dental Association), the minister of health and prevention, François Braun, stressed the importance he attached to oral health prevention. He also emphasized his desire to roll out and extend prevention campaigns, targeting young people in particular. With this in mind, we are working to lay the political foundations for the mass, free distribution of single-use toothbrushes with fluoride toothpaste in schools. This oral health promotion campaign would aim to debunk any myths or misinformation spread by manufacturers and to encourage a profound cultural change in the way children and their parents learn about oral hygiene. The "cavity-score," which is still under development, could help to reinforce the idea, both among the general public and among healthcare professionals, that oral health is not isolated from the rest of the body, and that this health issue cannot be dealt with in isolation, but in conjunction with all healthcare professionals.

Surgical management of ovarian masses in children and adolescents: experience of an academic institution in France.

PURPOSE: Surgical management of ovarian masses in girls still challenging. The aim of the study is to report an 8-year experience in managing children with ovarian masses, and to demonstrate the advantages and the limitations of laparoscopy for such lesions. METHODS: Data of girls aged less than 18 years operated because of an ovarian mass between January 2015 and February 2023 were retrospectively reviewed. Patients were divided into two groups: group A including children operated by laparoscopy, and Group B of patients who underwent open surgery. RESULTS: Eighty-eight children were enrolled. Laparoscopy was performed in 56 patients (63.6%). Group A patients had smaller tumor size (53.6±38.5 vs. 122.2±75.4 mm, P<0.0001), shorter operative time (50.4±20.3 vs. 71.5±36.5 min, P = 0.004), reduced length of hospital stay (1.4±1.1 vs. 3±2.3 days, P<0.0001), and absence of postoperative complications. Only 3 cases (5.7%) of recurrence were seen exclusively within patients followed for benign tumors during a mean follow-up period of 4.6±3 years. CONCLUSION: Laparoscopy should be done in benign ovarian lesions or/and if a torsion is seen. For tumors at high risk of malignancy, laparoscopy can be performed to establish a clear macroscopic diagnosis, for staging of the disease, and resection of small tumors. Conversion to open surgery is indicated in case of doubt.

Cases of Meningococcal Disease Associated with Travel to Saudi Arabia for Umrah Pilgrimage - United States, United Kingdom, and France, 2024.

Invasive meningococcal disease (IMD), caused by infection with the bacterium Neisseria meningitidis, usually manifests as meningitis or septicemia and can be severe and life-threatening (1). Six serogroups (A, B, C, W, X, and Y) account for most cases (2). N. meningitidis is transmitted person-to-person via respiratory droplets and oropharyngeal secretions. Asymptomatic persons can carry N. meningitidis and transmit the bacteria to others, potentially causing illness among susceptible persons. Outbreaks can occur in conjunction with large gatherings (3,4). Vaccines are available to prevent meningococcal disease. Antibiotic prophylaxis for close contacts of infected persons is critical to preventing secondary cases (2).

Educating patients in a French cancer treatment center: How to ensure therapy safety while reckoning patients' knowledge and power to act.

In this article, we analyse how health professionals educate cancer patients to care for their condition and keep strict control over therapy safety. We study how much room for negotiation is left to patients during medical consultations so resources can still be exchanged. We pay particular attention to the trade of knowledge and powers between patients and doctors (power to act and to express oneself in an imbalanced relationship where knowledge is unequally shared). We opted for a qualitative approach with 41 interviews and several ethnological observations, first of consultations in haematology, then of pre-planned phone calls made to patients during the course of a cancer therapy follow-up scheme. The declared ambition of turning cancer patients into self-responsible patients actually re-enacts well-known procedures of control and knowledge acquisition aimed at narrowing their margin of manoeuvre for the sake of therapy safety. Even if some freedom is conceded, patients remain under the control of their medical hierarchy. Health professionals privilege two methods to keep control over patients and teach them therapy safety procedures. Which method is chosen, and how it is used, is dictated by the relationship between socially-diverse patients and health professionals. In the end, what the patient learns and the amount of control the doctor keeps over this process will depend on the distribution of power and knowledge among them, but asymmetry will always remain.

[Health care organization for 2024 Olympics and Paralympics Games]. / Organisation du système de soins pour les Jeux olympiques et paralympiques 2024.

HEALTH CARE ORGANIZATION FOR 2024 OLYMPICS AND PARALYMPICS GAMES. The 2024 olympic and paralympic Games (JOP 2024) constitute the largest global festive event. While this major international gathering is primarily synonymous with celebrations, health security represents a major challenge for the French healthcare system in a highly tense national and international context. The health security of the JOP 2024 relies on close collaboration between the medical service of the organizer Paris 2024, responsible for care at the Olympic sites, and state services (SAMU, Law Enforcement, Firefighters) providing support in the event of serious health incidents or exceptional health situations (SSE). The projected impact on our healthcare structures (excluding SSE) appears moderate, as a 5% increase in hospital activity and approximately 150 additional daily emergencies are expected during the Olympic period compared to a normal summer season. In the event of a major incident resulting in a large number of casualties, state services will take over the governance of relief efforts by activating the ORSEC-NOVI and ORSAN-AMAVI plans for health response. The preparation of this health coverage involves an unprecedented mobilization of all healthcare stakeholders and is manifested by the organization of exercises at a very brisk pace.

ORGANISATION DU SYSTÈME DE SOINS POUR LES JEUX OLYMPIQUES ET PARALYMPIQUES 2024. Les Jeux olympiques et paralympiques 2024 (JOP 2024) constituent le plus important événement festif mondial. Si ce grand rassemblement international se veut avant tout synonyme de fête, la sécurité sanitaire représente un enjeu majeur pour le système de soins français, dans un contexte national et international en tension majeure. La sécurité sanitaire des JOP 2024 relève d'une étroite collaboration entre le service médical de l'organisateur Paris 2024, responsable des soins sur les sites olympiques, et les services de l'État (Samu, forces de l'ordre, sapeurs-pompiers) venant en soutien en cas d'événements sanitaires graves ou en cas de situation sanitaire exceptionnelle. La prévision de l'impact sur les structures sanitaires (en dehors de situation sanitaire exceptionnelle) semble modérée, puisque l'on attend une augmentation de 5 % de l'activité hospitalière et environ 150 urgences journalières de plus pendant la période olympique par rapport à une saison estivale normale. En cas d'événement majeur générant un grand nombre de victimes, les services de l'État prendront la gouvernance des secours par le déclenchement des plans ORSECNOVI et ORSAN-AMAVI pour la valence sanitaire. La préparation de cette couverture sanitaire fait appel à une mobilisation sans précédent de tous les acteurs de santé et se concrétise par l'organisation d'exercices à un r ythme très soutenu.

[Pollution attributable mortality]. / Mortalité attribuable à la pollution.

POLLUTION ATTRIBUTABLE MORTALITY. Pollution is estimated to be responsible for 9 million premature deaths per year in the world. For each cause of death with a risk increased by a pollutant, the number of deaths attributable to it is computed by comparison with the number of deaths expected under a reference pollution level, which is 10 µg/m3 for ambient particulate matter pollution. Only 8% of the deaths attributable to pollution occur in high income countries, because of the large effects of water and indoor air pollution (caused by traditional cooking methods) in low and middle-income countries. In France, by this method, one estimates that 13.200 deaths a year are attributable to ambient particulate matter pollution and 1.100 to ozone. Santé publique France, which has concluded that 48.000 deaths a year were attributable to air pollution in France, overvalues the risk by a factor of nearly 4 by overestimating the risks associated with air pollution and taking a utopian reference scenario.

MORTALITÉ ATTRIBUABLE À LA POLLUTION. On estime que la pollution est responsable de 9 millions de décès prématurés par an dans le monde. Pour chaque cause de décès dont le risque est augmenté par la pollution, un nombre de décès attribuable à la pollution est calculé par comparaison avec le nombre attendu pour un niveau de pollution de référence qui est de 10 µg/m3 pour la pollution particulaire de l'air extérieur. Seulement 8 % des décès attribuables à la pollution surviennent dans les pays à revenu élevé (effets importants des pollutions de l'eau et de l'air intérieur par des modes de cuisson traditionnels dans les pays à revenus bas ou moyens). En France, par cette méthode, on estime que 13 200 décès par an sont liés à la pollution particulaire de l'air extérieur et 1 100 à l'ozone. Santé publique France, qui conclut que 48 000 décès par an sont attribuables à la pollution de l'air en France, surévalue donc le risque d'un facteur proche de 4 en surestimant l'effet de la pollution et en prenant une pollution de référence utopique.

[Occupational medicine in France: the current situation in 2024]. / Médecine du travail en France, état des lieux en 2024.

OCCUPATIONAL MEDICINE IN France : THE CURRENT SITUATION IN 2024. Occupational medicine has evolved since its creation in 1946. Occupational medicine services have become Occupational health services (OHS) and medical examination in nowadays only a part of their missions, which include helping the employers to perform risk assessment, patients to stay at work, and implementing health promotion in the workplaces in order to prevent disabilities. To fulfill those missions, OHS can rely on health specialists (occupational physicians and nurses) but also on a wide range of competencies, from toxicologists to ergonomists, and from psychologists to occupational hygiene specialists, all gathered in multidisciplinary teams, leaded by the occupational physician. Optimizing cooperation between general practitioners and occupational health physicians is still needed to improve the worker journey, to facilitate his ability to return to work and to ameliorate his long-term health follow-up according to his previous occupational exposures.

MÉDECINE DU TRAVAIL EN FRANCE, ÉTAT DES LIEUX EN 2024. La médecine du travail a peu à peu évolué, depuis sa création en 1946. Les services médicaux du travail sont devenus des services de prévention et de santé au travail, et le suivi de santé ne représente désormais qu'une partie de leur activité. L'aide à l'évaluation des risques, le maintien en emploi, les actions de promotion de la santé dans une perspective de prévention de la désinsertion professionnelle ont pris une place grandissante. Cela s'est accompagné d'une évolution des compétences au sein de ces services. Outre la compétence santé représentée par le binôme médecin-infirmier, des ergonomes, psychologues et toxicologues sont désormais présents ; ils interviennent en prévention des risques professionnels et constituent des équipes pluridisciplinaires, animées et coordonnées par le médecin du travail. Une meilleure collaboration entre médecin du travail et médecin traitant reste nécessaire pour améliorer le parcours du travailleur, son maintien en emploi et son suivi de santé au long cours en fonction de ses expositions professionnelles passées.

[Specific aspects of medico-social protection in French public services]. / Aspects spécifiques de la protection médico-sociale en fonctions publiques.

SPECIFIC ASPECTS OF MEDICO-SOCIAL PROTECTION IN FRENCH PUBLIC SERVICES. Civil servants in the three French civil services (State, hospital and local governments) benefit from specific medical and social protection, unique to their status. This protection is very different from that of private sector workers under the French general social security regime, with specific participants and instances (licensed doctors and "conseils médicaux") and specific sick leave depending on the pathology of the civil servant, in particular long-term sick leave ("congés de longue maladie"), long-term leave ("congés de longue durée") and leave for temporary disability attributable to the service. Therapeutic part-time leave also has specific conditions for granting and renewal. Finally, civil servants benefit from specific measures for returning to and remaining in employment, particularly in the context of professional reclassification.

ASPECTS SPÉCIFIQUES DE LA PROTECTION MÉDICO-SOCIALE EN FONCTIONS PUBLIQUES. Les fonctionnaires des trois fonctions publiques (d'État, hospitalière et territoriale) bénéficient d'une protection médico-sociale spécifique, propre à leur statut. Celle-ci est très différente de celle des travailleurs du secteur privé dépendant du régime général de la Sécurité sociale : intervenants et instances spécifiques (médecins agréés et conseils médicaux) ; congés de maladie particuliers en fonction de la pathologie du fonctionnaire, notamment les congés de longue maladie, les congés de longue durée et les congés pour invalidité temporaire imputable au service. Le temps partiel thérapeutique a également des conditions d'octroi et de renouvellement dédiées. Enfin, les fonctionnaires bénéficient de mesures pour le retour et le maintien en emploi qui leur sont propres, notamment dans le cadre du reclassement professionnel.

COVID-19 profiles in general practice: a latent class analysis.

BACKGROUND: General practitioners (GPs) were on the front line of the COVID-19 outbreak. Identifying clinical profiles in COVID-19 might improve patient care and enable closer monitoring of at-risk profiles. OBJECTIVES: To identify COVID-19 profiles in a population of adult primary care patients, and to determine whether the profiles were associated with negative outcomes and persistent symptoms. DESIGN, SETTING AND PARTICIPANTS: In a prospective multicentre study, 44 GPs from multiprofessional primary care practices in the Paris area of France recruited 340 consecutive adult patients (median age: 47 years) with a confirmed diagnosis of COVID-19 during the first two waves of the epidemic. METHOD AND OUTCOME: A latent class (LC) analysis with 11 indicators (clinical signs and symptoms) was performed. The resulting profiles were characterised by a 3-month composite outcome (COVID-19-related hospital admission and/or death) and persistent symptoms three and 6 months after inclusion. RESULTS: We identified six profiles: 'paucisymptomatic' (LC1, 9%), 'anosmia and/or ageusia' (LC2, 12.9%), 'influenza-like syndrome with anosmia and ageusia' (LC3, 15.5%), 'influenza-like syndrome without anosmia or ageusia' (LC4, 24.5%), 'influenza-like syndrome with respiratory impairment' (LC5) and a 'complete form' (LC6, 17.7%). At 3 months, 7.4% of the patients were hospitalised (with higher rates in LC5), and 18% had persistent symptoms (with higher rates in LC5 and LC6). At 6 months, 6.4% of the patients had persistent symptoms, with no differences between LCs. CONCLUSION: Our findings might help GPs to identify patients at risk of persistent COVID-19 symptoms and hospital admission and then set up procedures for closer monitoring.