Developing and Validating an Individual-Level Deprivation Index for Children's Health in France.

BACKGROUND: Deprivation generates many health inequalities. This has to be taken in account to enhance appropriate access to care. This study aimed to develop and validate a pediatric individual-level index measuring deprivation, usable in clinical practice and in public health. METHODS: The French Individual Child Deprivation Index (FrenChILD-Index) was designed in four phases: item generation then reduction using the literature review and expert opinions, and index derivation then validation using a cross-sectional study in two emergency departments. During these last two phases, concordance with a blinded evaluation by an expert enabled us to determine thresholds for two levels of moderate and severe deprivation. RESULTS: The generation and reduction phases retained 13 items. These were administered to 986 children for the derivation and validation phases. In the validation phase, the final 12 items of the FrenChILD-Index showed for moderate deprivation (requiring single specific care for deprived children) a sensitivity of 96.0% [92.6; 98.7] and specificity of 68.3% [65.2; 71.4]. For severe deprivation (requiring a multidisciplinary level of care), the sensitivity was 96.3% [92.7; 100] and specificity was 91.1% [89.2; 92.9]. CONCLUSIONS: The FrenChILD-Index is the first pediatric individual-level index of deprivation validated in Europe. It enables clinical practice to address the social determinants of health and meet public health goals.

Effets d'un programme de développement des compétences psychosociales en milieu scolaire : Le PROgramme de Développement Affectif et Social (PRODAS) : Revue de la littérature.

OBJECTIF: Le Programme de Développement Affectif et Social (PRODAS) est un programme de développement des compétences psychosociales des enfants ou adolescents mis en œuvre depuis 2005 en milieu scolaire par une association française (le Planning familial). L'objectif de cet article était de synthétiser les connaissances sur les effets de ce programme, afin de contribuer à l'étude de sa transférabilité. MÉTHODES: La revue de littérature réalisée a porté sur des études datant de 1970 à 2017. Ont été interrogées les bases de données : ScienceDirect, PsycNET, ERIC, PsycINFO, erudit, ISIDOR, Cochrane. Les mots clés utilisés étaient « Human Development Program ¼ ou « PRODAS ¼. RÉSULTATS: Une amélioration, le plus souvent significative, des compétences émotionnelles et sociales des enfants et des adolescents était rapportée. Une relation de type dose-effet était également suggérée par certains résultats. Peu de données étaient disponibles chez les jeunes enfants (école maternelle) et aucune étude n'explorait les effets du programme à long terme. CONCLUSION: Cette synthèse a permis de mettre en lumière les principaux effets du PRODAS. Toutefois, considérant que ce programme est un des seuls à s'adresser aux enfants dès 4 ans en France, de futures études portant sur des enfants d'écoles maternelles, avec un suivi à long terme, seraient utiles pour compléter les données sur l'efficacité d'un tel programme.

Influence of Socioeconomic Context on the Rehospitalization Rates of Infants Born Preterm.

OBJECTIVE: To investigate the impact of social inequalities on the risk of rehospitalization in the first year after discharge from the neonatal unit in a population of preterm-born children. STUDY DESIGN: Preterm infants were included if they were born between 2006 and 2013 at ≤32 + 6 weeks of gestation and who received follow-up in a French regional medical network with a high level of healthcare. Socioeconomic context was estimated using a neighborhood-based socioeconomic deprivation index. Univariate and logistic regression analyses were used to identify risk factors associated with rehospitalization. RESULTS: For the 2325 children, the mean gestational age was 29 ± 2 weeks and the mean birth weight was 1315 ± 395 g. In the first year, 22% were rehospitalized (n = 589); respiratory diseases were the primary cause (44%). The multiple rehospitalization rate was 18%. Multivariable analysis showed that living in the most deprived neighborhoods (socioeconomic deprivation index of 5) was associated with overall rehospitalization (OR, 2.2; 95% CI, 1.5-3.6; P <.001), and multiple rehospitalizations (OR, 2.5; 95% CI, 1.2-4.9; P <.01); with socioeconomic deprivation index of 1 (least deprived) as reference. Deprivation was associated with all causes of hospitalization. Female sex (P <.001) and living in an urban area (P = .001) were protective factors. CONCLUSIONS: Despite regional routine follow-up for all children, rehospitalization after very preterm birth was higher for children living in deprived neighborhoods. Families' social circumstances need to be considered when evaluating the health consequences of very preterm birth.

Improving access and continuity of care for homeless people: how could general practitioners effectively contribute? Results from a mixed study.

OBJECTIVES: To analyse the views of general practitioners (GPs) about how they can provide care to homeless people (HP) and to explore which measures could influence their views. DESIGN: Mixed-methods design (qualitative -> quantitative (cross-sectional observational) → qualitative). Qualitative data were collected through semistructured interviews and through questionnaires with closed questions. Quantitative data were analysed with descriptive statistical analyses on SPPS; a content analysis was applied on qualitative data. SETTING: Primary care; views of urban GPs working in a deprived area in Marseille were explored by questionnaires and/or semistructured interview. PARTICIPANTS: 19 GPs involved in HP's healthcare were recruited for phase 1 (qualitative); for phase 2 (quantitative), 150 GPs who provide routine healthcare ('standard' GPs) were randomised, 144 met the inclusion criteria and 105 responded to the questionnaire; for phase 3 (qualitative), data were explored on 14 'standard' GPs. RESULTS: In the quantitative phase, 79% of the 105 GPs already treated HP. Most of the difficulties they encountered while treating HP concerned social matters (mean level of perceived difficulties=3.95/5, IC 95 (3.74 to 4.17)), lack of medical information (mn=3.78/5, IC 95 (3.55 to 4.01)) patient's compliance (mn=3.67/5, IC 95 (3.45 to 3.89)), loneliness in practice (mn=3.45/5, IC 95 (3.18 to 3.72)) and time required for the doctor (mn=3.25, IC 95 (3 to 3.5)). From qualitative analysis we understood that maintaining a stable follow-up was a major condition for GPs to contribute effectively to the care of HP. Acting on health system organisation, developing a medical and psychosocial approach with closer relation with social workers and enhancing the collaboration between tailored and non-tailored programmes were also other key answers. CONCLUSIONS: If we adapt the conditions of GPs practice, they could contribute to the improvement of HP's health. These results will enable the construction of a new model of primary care organisation aiming to improve access to healthcare for HP.