Évaluer les besoins des femmes enceintes : une étude-pilote du dispositif Ariane.

INTRODUCTION: The organization of perinatal prevention in France is based on a system of universalism. Maternal and child protection services are thus open to all, at the risk of excluding people who do not know where or how to find them. Targeted preventive corrective measures, based on risk factors, correct some of this inequity but create other negative effects. PURPOSE OF RESEARCH: This article presents an innovative social protocol in public health: the Ariane systematic prenatal contact. It is based on the principle of proportionate universalism. Ariane consists of a text message and a phone call at the beginning of pregnancy. Aimed at all pregnant women, it allows information to be transmitted orally on public systems of prevention and support for parents. It also makes it possible to assess the needs of families, along eight axes. METHOD: This article presents the results of the pilot study of this system, conducted in Moselle. In total, 14 midwiwes ant 11 parturients who were contacted during their pregnancy participated in post-project interviews. RESULTS: The results show a very high level of acceptability of the calls by all parties. According to the midwives, Ariane has made it possible to increase the relevance of the identification, making it possible to move from a prevention logic based on criteria to a prevention logic based on the needs of families. The contact was easy, according to both the women and the clinicians. CONCLUSION: Our results show that the Ariane protocol make possible to establish a relationship of trust between the families and the services. Implications for outreach policies are also presented in this article.

[Maternal and child protection services at home. Results from a national study.] / Les interventions à domicile en Protection maternelle et infantile. Résultats d'une étude nationale.

Maternal and child protection services ("PMI") are French universal services providing prevention and health promotion services to parents and their newborn children up to the age of 6. They specifically offer home visitation services in order to reach families that could not be seen otherwise. This paper presents the results of a national survey describing these home visitation services and their local implantation. Sixty French ?départements? (59%), constituting the territorial unit for the PMI answered the survey. The results point out that family reach remains a challenge for these services. Organizational issues represent the main barrier to implement and deliver home visitation with sufficient reach and quality. The services now provide home visitation based on risk factors, while the universality of services seems to be no longer guaranteed. The number of tasks that the nurses have been charged with can explain these difficulties, as well as the lack of financial and human resources.

[Effects of the homecare assistance program on maternal and child protection services.] / Effets du programme d'accompagnement du retour à domicile sur les pratiques des services de protection maternelle et infantile.

In 2010, the French Ministry of Health started the implementation of the "PRADO" process, which constitutes a way to finance two early post-partum home visits by midwives. These two visits occur between the third and twelfth day of the newborn child. However, this PRADO program has come as a supplementary service, while the Maternal and child protection services ("PMI") were already in charge of home visitation in early postpartum up to the child's sixth birthday. Through a qualitative survey, this study aimed at evaluating the effect of the implementation of the PRADO program over the PMI structure and home visitation intervention. The results suggest an important lack of coordination between these services that appear to be in competition with each other, while both financed by public funding. The PMI services expressed their feeling that families were less well served in early postpartum, with these two services.

Social participation, social environment and death ideations in later life.

OBJECTIVE: Few studies on elders' suicide and depression have integrated social and community factors in their explicative models. Most of the studied variables used are focused on individual and based on psychopathological models. The purpose of this study is to investigate the impact of socio-environmental factors on death ideations, using data from the European SHARE cohort. METHOD: Social support components and death ideations have been studied, together with known individual risk factors, within a sample of 11,425 European participants in the SHARE study, aged over 64. The item evaluating death ideations was extracted from the EURO-D12 questionnaire. RESULTS: The high prevalence of death ideations (6.9% for men and 13.0% for women) confirmed that elders' death ideations, as it is known to be linked to suicidal behaviors, is a major public health issue. Bivariate analyses revealed a strong association between community participation and death ideations. This association was no longer significant while adjusting for depressive symptomatology. The logistic model identified that factors significantly associated with death ideations, when adjusted for the other factors were: having multiple depressive symptoms (OR = 1.64 per symptom) being aged, especially over 84 (OR = 1.58), being retired for fewer than five years (OR = 1.46), being widowed (OR = 1.35) and having a long-term illness (OR = 1.28). CONCLUSIONS: Although social and community participation is associated to death ideations, this link becomes non-significant in a regression model taking into account other factors. It is important to notice that depressive symptoms, which are obviously closely related to death ideations, take the greatest part in the association among all associated factors. Our results suggest that, consistently with the literature, while addressing death ideation or suicide prevention, professionals have to consider first the secondary prevention of depressive symptomatology. Strategies targeting social isolation and community participation should be considered as part of primary prevention policies.