Travel Time to Hospital for Childbirth: Comparing Calculated Versus Reported Travel Times in France.

Objectives Timely access to health care is critical in obstetrics. Yet obtaining reliable estimates of travel times to hospital for childbirth poses methodological challenges. We compared two measures of travel time, self-reported and calculated, to assess concordance and to identify determinants of long travel time to hospital for childbirth. Methods Data came from the 2010 French National Perinatal Survey, a national representative sample of births (N = 14 681). We compared both travel time measures by maternal, maternity unit and geographic characteristics in rural, peri-urban and urban areas. Logistic regression models were used to study factors associated with reported and calculated times ≥30 min. Cohen's kappa coefficients were also calculated to estimate the agreement between reported and calculated times according to women's characteristics. Results In urban areas, the proportion of women with travel times ≥30 min was higher when reported rather than calculated times were used (11.0 vs. 3.6%). Longer reported times were associated with non-French nationality [adjusted odds ratio (aOR) 1.3 (95% CI 1.0-1.7)] and inadequate prenatal care [aOR 1.5 (95% CI 1.2-2.0)], but not for calculated times. Concordance between the two measures was higher in peri-urban and rural areas (52.4 vs. 52.3% for rural areas). Delivery in a specialised level 2 or 3 maternity unit was a principal determinant of long reported and measured times in peri-urban and rural areas. Conclusions for Practice The level of agreement between reported and calculated times varies according to geographic context. Poor measurement of travel time in urban areas may mask problems in accessibility.

[Health as an interdisciplinary construction. Example of the dialogue between geography, health and territory]. / La santé, une construction interdisciplinaire. L'exemple du dialogue géographie - santé-territoire.

It is common to confuse health and medicine, but this comparison is far too limited to promote health. Health is related to the living conditions of the individual, from all points of view: food, education, housing, work, travels, health care. Obviously the latter is part of it but is just one link in a long chain. A health condition is the result of a system of multiple interactive components at a given time and in a given place: endogenous factors (physical, biological, genetic) and exogenous ones (political, economic, social and cultural environments, features of the living conditions). The discrepancies are the results of the differentiated combinations of these factors. Some contexts associate a series of health protecting factors whereas others associate factors of vulnerability. There has always been a dialogue between, on the one hand, medicine and, on the other hand, sociology, anthropology and economy. It dates back to antiquity for geography (cf: Hippocrates treatise: on air, water and places) but it disappeared at the time of Pasteur revolution. The 20th century marks the return of geography and in 2009 a French law takes hold of one of its key words "territory". Why? What are the contributions of this discipline? Maps are a strong image of this discipline, which cannot be limited to this production. Geography also contributes to the laws of distance, polarity and flows and to the notions of scale, accessibility, network, basin, space for living, territorial dynamics.... We have here a very good opportunity to establish a dialogue between health and geography. Indeed, the perception of the territorial dimension of health issues is being reinforced both through the reading of epidemics such as SARS and flues and through the discrepancies in the health conditions. This reinforcement is related to the territorialization procedures. In the field of health care planning this discipline provides us, thanks to its tools, with decision-making diagnoses necessary for the promotion of a greater territorial equity. At the time of the implementation of the HPST (Law on Hospital - Patient - Health - Territory) and ARS (Regional Agency for Health) laws and of the debates on the health territories, the emphasis will be put on the French health care system.

[Infectious diseases outbreaks in French overseas territories: when the circumstances are right...]. / Emergence des maladies infectieuses Outre-mer: "tout est affaire de circonstances".

Emerging infectious diseases have become a major preoccupation over the past 30 years, possibly owing to the way in which we treat our environment. The current world situation, with its overcrowding, socio-political instability, and increased mobility, offers extremely favourable circumstances for the emergence and rapid spread of microbial pathogens through human populations. The HIV/AIDS pandemic and its impact on Africa is used to illustrate these risks.

Perinatal health inequalities and accessibility of maternity services in a rural French region: closing maternity units in Burgundy.

Maternity unit closures in France have increased travel time for pregnant women in rural areas. We assessed the impact of travel time to the closest unit on perinatal outcomes and care in Burgundy using multilevel analyses of data on deliveries from 2000 to 2009. A travel time of 30min or more increased risks of fetal heart rate anomalies, meconium-stained amniotic fluid, out-of-hospital births, and pregnancy hospitalizations; a positive but non-significant gradient existed between travel time and perinatal mortality. The effects of long travel distances on perinatal outcomes and care should be factored into closure decisions.