[Risk factors and perinatal consequences of short interpregnancy interval: a retrospective case-control study]. / Facteurs de risques et conséquences périnatales des grossesses rapprochées : étude cas-témoin rétrospective.

OBJECTIVES: To study the maternal risk factors and perinatal complications of a short interpregnancy interval. PATIENTS AND METHODS: Retrospective case-control study between 2007 and 2009, comparing a group with a short interpregnancy interval (less than 9 months, n=83), and a control group (interval between two pregnancies between 18 and 24 months, n=166). RESULTS: The main risk factor of short interpregnancy interval is to be unemployed (OR=3.2, P<0.001). There is a significant link between lack of prescription contraceptives in postpartum and a short interval between pregnancies (OR=3.4, P<0.001). We also found a higher rate of anemic women during pregnancy (OR=4.9, P=0.001) and postpartum (OR=2.1, P=0.02) in case of short interpregnancy interval. Short interpregnancy interval increases risk of small for gestational age (OR=2.4, P=0.05) and thermoregulation disorders (OR=3.1, P=0.02). CONCLUSION: A low socioeconomic level is a risk factor of short interpregnancy interval. Short interpregnancy interval is at risk of maternal iron deficiency and neonatal complications like low birth weight and hypothermia.

[Access to health care for the destitute]. / Lieux de soins pour les démunis.

An increasing proportion of low income people, in spite of receiving mandatory coverage, cannot afford supplementary insurance, and they cannot afford to advance payment for care which will lately be reimbursed, nor can they afford copayments. The results is that a growing proportion of French population is unable to access common care. Faced with this deteriorating situation, parallel delivery systems of care have been devised at a local level, facilities have been created, and health care providers volunteers to deliver health care to underserved populations. To estimate the extent of the phenomenon, CREDES carried out a specific survey at the national level. First we identified all health care providers or facilities accessible to the underserved. These include traditional providers or facilities, such as private physicians and hospitals which agree to provide "charity care". There are also new facilities created specifically to provide health care to the underserved. The second part of the survey covered the human resources, equipment and services offered at these specific facilities. It revealed the extensive participation by physicians and nursing staff generally on a voluntary basis and the special attention given to the reintegration of the underserved into the standard health care system through assistance with the necessary administrative procedures.