Migration experiences, life conditions, and drug use practices of Russian-speaking drug users who live in Paris: a mixed-method analysis from the ANRS-Coquelicot study.

BACKGROUND: After the collapse of the Soviet Union at the beginning of the 1990s, people who inject drugs spiked in Eastern Europe. Facing local repression and an array of factors encouraging emigration, some users have migrated to France. This population now make up to a third of the patient list of some harm reduction services in Paris. This article aims to present original data on the sociodemographic profiles of these users, on their migration trajectory, their life conditions, and on the evolution of their drug use practices since arriving in Paris. METHODS: Data were collected as part of the ANRS-Coquelicot Survey, an HIV and HCV seroprevalence study among French-speaking people who use drugs. A sub-sample of Russian-speaking drug users who had relocated from Eastern Europe to live in Paris completed a quantitative questionnaire (N = 150) and a qualitative semi-structured interview (N = 20). The survey aimed to describe participants' backgrounds, and a thematic analysis of interviews was conducted to explore participants' migration histories, their life conditions in Paris, and their drug use practices before and after arriving in France. RESULTS: This study highlights the great vulnerability of the participating population, often following a loss of social status after migrating to France. Another important finding is that participants had better access to harm reduction tools and reduced their risk of exposure to HIV and HCV infections linked to needle sharing. Although 60% said they had already shared a syringe in their lifetime (49.9% of them in their home country), the proportions shrank to 13.9% after they arrived in France and to 9.3% in the month before the study, a proportion that is lower than among French-speaking people who use drugs. CONCLUSIONS: Our main findings on the profiles and behaviors of the study population lead us to make two recommendations: to offer stronger global care to these users in Paris and to reform drug policy in their home countries by integrating it into a public health approach.

Recourir à la pédopsychiatrie publique : étude dans six centres de soins parisiens.

INTRODUCTION: According to the French National Institute of Health and Medical Research (INSERM), 12% of children and youth living in France (one in eight) suffer from mental disorders. However, the conditions for this population to use mental health services remain poorly explored.Purpose of research: Our aim was to provide a double-statistical and discursive-perspective on the orientation of this population towards public child psychiatry centers (socio-demographic profile, actors who made the requests, reasons for first consultations, difficulties and disorders qualification by parents…). METHODS: This article is based on a quantitative and qualitative survey conducted in 6 public health centers in Paris: two Medical-Psychological Centers (CMP), two Medico-Psycho-Pedagogical Centres (CMPP), a Part-Time Therapeutic Reception Center (CATTP) and a Psychiatric Day Hospital (HJ). Overall, 581 first call forms and 73 patient files were analyzed (representing 654 children) and supplemented with illustrative interview excerpts from 59 family cases. RESULTS: Beyond descriptive elements (gender, age, school level, socio-family context, conditions of access to the centers, etc.), this study stressed the high vulnerability of some families, the range of reasons given for initial follow-up as well as the key role of educational institutions in screening and referring the population to mental health care. CONCLUSIONS: These results open up interesting insights into the early implementation of preventive measures and offer many research opportunities.

The cost of treating high blood pressure in general practice in France.

In this study, the cost of having high blood pressure treated by French general practitioners was estimated, using an analysis of the computerized records for 28,015 patients with either hypertension or history of hypertension over three years. Costs due to visits, drugs, and complementary tests were included. The average annual cost of treatment was 597 euros (SD 377 euros). The annual average cost of drugs was 447 euros, and antihypertensive drugs 258 euros. The average annual cost of patients who were controlled throughout the period was 537 euros, patients who were normalized cost 595 euros, and patients who deteriorated cost 612 euros.

Determinants of resource utilization in four palliative care units.

OBJECTIVE: To assess resources mobilized per day and per patient receiving palliative care (PC) and to explain the observed cost variability. STUDY SETTING: We conducted a prospective study in four French PC units. STUDY DESIGN/DATA COLLECTION: For each patient, socio-demographic and medical data were collected (using a case-report form developed specifically for this purpose) and a daily cost for the provision of care was estimated. Three methods were used to analyse causal relationships. The first method was to ask the PC staff, individually and in group meetings, their own perception of the relationship between daily costs and the other variables; the remaining two methods used the data collected in the prospective study: correlational analysis and segmentation. The database contained 140 hospitalization sequences. PRINCIPAL FINDINGS: The daily cost per patient was, on average, Euro 434 (standard deviation: Euro 73) and ranged from Euro 301 to Euro 667. Beyond differences in resources between PC units in this study, six variables were predictive of higher costs: degree of anxiety of patients and/or their families; proximity of death; extreme dependence; ENT cancer; relatively young age of the patient; and provision of certain procedures (drip, syringe driver, aspiration, oxygen therapy). CONCLUSIONS: These elements suggest using, not a single rate to finance this type of care, but modifying this tariff according to the characteristics of the patients. They raise the question about the criteria to be used if such a step were to be taken.

Developing an operational typology of patients hospitalised in palliative care units.

The objective of this study was to develop an operational typology of patients hospitalised in palliative care units (PC units) and to characterize these populations. Prospective data were collected in four PC units over three-week periods, generating a sample of 139 cases. Five classes of patient were identified and described via a factorial analysis and a classification: metastatic cancers requiring significant psychological attention, terminally ill patients, ENT cancers, neurological diseases and elderly patients. A more detailed study revealed differences between metastatic cancers, younger patients, very dependent patients and the other patients. We present the sociodemographic, clinical and cost per patient profiles of each class of patient. Having access to a broader sample of PC units and of patients would allow for a more complete typology.