Who self-medicates? Results from structural equation modeling in the Greater Paris area, France.

OBJECTIVES: Our study aimed to describe the prevalence of self-medication among the Paris adult population and to identify the factors associated with self-medication. MATERIALS AND METHODS: This cross-sectional study was based on data collected from the SIRS cohort (a French acronym for "Health, inequalities and social ruptures") in 2005 in the Paris metropolitan area using a face-to-face administration questionnaire among a representative sample of 3,023 French-speaking adults. Structural equation models were used to investigate the factors associated with self-medication in the overall population and according to income. RESULTS: The prevalence of self-medication in the past four weeks was 53.5% in the Paris metropolitan area. Seven factors were directly associated with self-medication in the structural equation model. Self-medication was found more common among women, young people, in active employment or student, with a high income, but also among people with a health information seeking behavior, with a high daily mobility, and/or with a history of unmet healthcare needs due to economic reasons. When looking at these coefficients according to income, the association between self-medication and daily mobility appeared stronger in the bottom quartile of income whereas it was no longer significant in the rest of the survey population. CONCLUSION: Self-medication is a frequent practice in the Paris metropolitan area. This study confirms the role of some factors found to be associated with self-medication in the literature such as age or gender and draws attention to other factors rarely explored such as daily mobility, especially among people with a low income, or health information seeking behavior.

[Inequity of compensation trajectories for victims of medical injuries. A survey in the French out-of-court settlement mechanism]. / Inégalités dans les parcours d'indemnisation des victimes d'accidents médicaux. Une enquête au sein du dispositif français de règlement amiable.

BACKGROUND: In France little is known about either the characteristics of people who take legal action because they believe themselves to be victims of harm caused by medical activity, or about their complaint trajectory. The law of 4th March 2002 created an out-of-court settlement mechanism which aims to reduce inequitable access to compensation experienced by victims faced with legal procedures that are both lengthy and costly. This mechanism now occupies a central position among the avenues of recourse available to patients and their families. METHODS: The study relates to the exhaustive database of 18,258 requests for compensation filed with the out-of-court settlement mechanism between 2003 and 2009. It takes 4 series of variables into account: (1) the characteristics of the people concerned by the request, (2) the recourse practices, (3) the result of the requests, (4) the characteristics of the commissions with whom they dealt. Univariate and multivariate analyses were performed, in particular to find factors relating to the different responses given to the requests. RESULTS: Of the requests filed with the out-of-court settlement mechanism, 34.5% led to compensation being awarded, 30.7% were deemed inadmissible and 34.8% were rejected on the basis of expert opinions. The risk of inadmissibility was greater when the victim was a woman, undeceased, or a minor aged between 1 and 17; it bore no relation to standard of living. Recourse to a lawyer (24%) depended on various characteristics, in particular the age and vital status of the victim. It is associated to the decrease of the risk of inadmissibility and to the increase of the chances of receiving compensation. There were significant differences in the ways requests were processed (depending on where they were filed), in the time it took to examine the case, and in the tendency to reject requests before or after expert medical opinion. CONCLUSION: This study offers the first ever description of the population of patients and families who accessed the out-of-court settlement mechanism for medical claims in France. It looks at how, within the mechanism, the diversity of practices impacts inequity and experiences during the compensation process.

[Migration, health and access to care in Mayotte Island in 2007: lessons learned from a representative survey]. / Migration, santé et recours aux soins à Mayotte en 2007: enseignements d'une enquête représentative en population générale.

BACKGROUND: Mayotte Island, located in the Indian Ocean, is a French overseas departmental community with certain specificities: recent development of sanitary institutions, significant immigration, free access to care for legal residents but with co-payments for irregular residents, the absence of many of the social benefits which exist in mainland France and poor or non-existent health information systems. We report here the first population-based survey describing the links between health, migration and healthcare utilization in this territory. METHODS: Cross sectional population-based study using a three-stage random sample (geographic areas, households, individuals). In all, 2105 individuals were interviewed either in French, Shimaore or Kibushi (response rate=96%), using a questionnaire adapted to the context of Mayotte Island after a preliminary qualitative survey. Descriptive analyses and logistic regression models were performed. RESULTS: Foreigners make up 40% of the Mayotte population (total 186,452 inhabitants), of which one-quarter are children born in Mayotte and 80% have no regular residence status. The median length of residence of migrant foreigners is 10 years. Foreigners represent a majority of the female population, of the 20 to 35 years old population and of the urban areas. Main determinants for migration were economical (50%) or family-related (26%). Health was stated as a cause of migration by 11% of migrants. The social situation of foreigners is more precarious and their perceived health poorer than those of the French. Their access to care is also perceived as more difficult. We did not observe any notable difference in terms of frequency of healthcare attendance over the last 12 months between the two groups, but foreigners have consulted less often private GPs and more often traditional practitioners than French. CONCLUSION: In this overseas French island, the migrant population is numerous and resident for a long time. Their main motivations to immigrate are economic and family-related. They report hurdles to healthcare related with their precarious living conditions, including their illegal residence status.

Exposure to interparental violence and psychosocial maladjustment in the adult life course: advocacy for early prevention.

BACKGROUND: Early family-level and social-level stressors are both assumed to be the components of two main path models explaining the association between exposure to interparental violence in childhood and its long-term consequences on mental health explored through life-course epidemiological studies. AIMS: To investigate the association between exposure to interparental violence in childhood and mental health outcomes in adulthood when taking into account early family and social stressors. METHODS: A retrospective French cohort study of 3023 adults representative of the general population in the Paris metropolitan area was conducted in 2005 through at-home, face-to-face interviews. The outcomes measures were current depression and lifetime suicide attempt, intimate partner violence, violence against children and alcohol dependence. RESULTS: The adults exposed to interparental violence during childhood had a higher risk of psychosocial maladjustment. After adjusting for family- and social-level stressors in childhood, this risk was, respectively, 1.44 (95% CI 1.03 to 2.00) for depression, 3.17 (1.75 to 5.73) for conjugal violence, 4.75 (1.60 to 14.14) for child maltreatment and 1.75 (1.19 to 2.57) for alcohol dependence. CONCLUSIONS: The adult consequences of parental violence in childhood-and this independently of the other forms of domestic violence and the related psychosocial risks-should lead to intensifying the prevention of and screening for this form of maltreatment of children.

[Internet and health: lessons learned from the French national survey on households living conditions in 2005]. / Internet et santé: les enseignements de l'enquête permanente sur les conditions de vie des ménages, France, 2005.

BACKGROUND: The Internet is a major source of information for the general public in the field of health. However despite ever-increasing connection rates, a digital divide persists in the industrialised countries. The objective of this study was to assess the determinants involved in Internet access and then in Internet use for health information seeking. METHODS: This study is based on a cross-sectional survey of a representative random sample of French inhabitants: the Enquête permanente sur les conditions de vie des ménages conducted by Insee in 2005, which included a specific investigation on information and communication technology. RESULTS: Fifty-two percent of the French adult population had Internet access, and 28.5% of the Internet users had previously searched for medical information during the month before the survey. A first level of socioeconomic divide has been shown in Internet access: poor socioeconomic status, health problems. In terms of health information seeking among Internet users, the divide was not socioeconomic but more related to gender, the health care system utilization, and the diversified use of the Internet. CONCLUSION: In a public health perspective, this study suggests that promoting Internet access and utilization is still necessary in order to make it a widely used tool for prevention and health promotion.

[The access to care of underserved populations: a research among free clinics patients in the Paris area]. / Le recours aux soins des personnes en situation précaire: une recherche auprès de consultants de centres de soins gratuits en région parisienne.

BACKGROUND: Over the last decade, the increasing number of people experiencing difficult social conditions--especially in urban areas--has led to the implementation of free (health and social care) clinics for uninsured and/or poor people. METHODS: In this paper, we give some results of multidisciplinary (sociological and epidemiological) research conducted among patients attending five of these free clinics in the Paris area. RESULTS: The statistical and qualitative analyses revealed the diversity of the studied population, as well as the conditions in which these consultants attended such clinics, what kind of services and help they used and, furthermore, what kind of social ties were strengthened. CONCLUSION: These results lead us to discuss our present knowledge of the determinants of the utilization of the healthcare system, not only among vulnerable people, but perhaps also amongst the general population.

[Migration and knowledge of AIDS in the rural Cameroon environment: comparison between men and women]. / Migration et connaissance du SIDA en milieu rural camerounais: comparaison hommes-femmes]

PIP: Individual interviews conducted during 1992-93 with 772 women 14-49 years old and 637 men 18-55 years old in 5 villages of Kadey Department in eastern Cameroon, where AIDS seroprevalence has been increasing rapidly, were the basis for this analysis of the relationship between migration and knowledge of AIDS. The 5 villages were of varying size, ethnic composition, religion, economic structure, and migratory pattern. 3/4 of both men and women had migrated for at least 6 months at some time, but the men migrated more frequently and were more likely to migrate to an urban area. 53% of men and 31% of women had spent at least 6 months in an urban area. 85% of men but only 68% of women knew about AIDS. 62% of men and 51% of women had correct knowledge of AIDS transmission. 33% of men and 16% of women knew about the protective role of condoms. Bivariate and multivariate analysis indicate that migration, differences between men and women, and interactions between the 2 types of variables are determinants of knowledge about AIDS. Multivariate analysis was used to study the relative influence of having or not having migrated, migrating to an urban or to a rural area, and number of migrations on knowledge of AIDS for men and women. Knowledge of the existence of AIDS was significantly affected by urban migration and by the interaction between sex and having migrated. A man who had migrated had almost 4 times the probability of knowing about AIDS as a woman who had never migrated. None of the factors concerning migration history or sex had a significant influence on correct knowledge of AIDS transmission. Migration increased both correct and erroneous knowledge of transmission. The fact of being a man tripled the probability of knowing about the protective role of condoms, while having migrated several times or having migrated to urban areas nearly doubled the probability.^ieng