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ELENGA N, RO V, MAFEMA MISSINDU J, THOMAS BOIZAN N, VAZ T, LUCARELLI A, ARMOUDON-FLERET MÉ, BUENDÉ S. [Sickle cell disease in French Guiana: assessing 30 years of neonatal screening (1992-2021)]. MEDECINE TROPICALE ET SANTE INTERNATIONALE 2024; 4:mtsi.v4i1.2024.488. [PMID: 38846113 PMCID: PMC11151905 DOI: 10.48327/mtsi.v4i1.2024.488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 01/31/2024] [Indexed: 06/09/2024]
Abstract
Background Sickle cell disease is one of the most common genetic diseases in France. In French Guiana, neonatal screening was introduced in 1992, at the same time as other screening programs for childhood diseases. The aim of this study is to describe the organization of newborn screening for sickle cell disease in French Guiana. Materials and methods We used several data sources: data collected from hospital records since 2005, activity reports from the national neonatal screening program and data from screening campaigns organized by the Drepaguyane association between 2010 and 2021 on 1,300 subjects. Blood samples from newborns are collected by capillary or venous sampling and absorbed on blotting paper (Guthrie) at the same time as those for other neonatal screenings. The dried papers are sent to the inter-regional laboratory in Lille, for further processing. In Saint-Laurent-du-Maroni, in order to reduce the proportion of people lost to follow-up, a double screening is carried out and the results are returned before discharge from the maternity hospital. All data were entered into an anonymous Excel file. The data were analyzed using STATA software. Results Among the 175,593 screened neonates between 1992 and 2021, screening detected 823 infants with sickle cell disease and 17,950 heterozygotes. Sickle cell genotypes include 493 SS (60%), 302 SC (37%) and 28 S-Beta-thalassemia (3%). The incidence of sickle cell disease was 1/213, 95% CI [1/236-1/204], and that of heterozygotes 1/10, IC 95% [1/12-1/8]. The majority of these children (52%) were from the Maroni region. The delay between screening and test results was 7 days. Only pathological results (homozygous, heterozygous) were communicated to parents and/or the attending physician by post. These data confirm the upward trend in the number of children screened for sickle cell disease in French Guiana. Data from screening campaigns organized by the Drepaguyane association have enabled to describe the distribution of the various abnormal hemoglobin fractions, and to confirm that HbS is more frequent in Western French Guiana. In Cayenne, in 2021, the active file comprised 699 patients, including 266 children under 18 years old. Discussion and conclusion This study provides valuable data on 30 years of neonatal screening for sickle cell disease in French Guiana, and on the evolution of sickle cell disease patients. It confirms that French Guiana is the French territory with the highest incidence of sickle cell disease. This incidence continues to rise over time. The study reveals the improvement in the organization of sickle cell disease management in French Guiana between 1992, when screening was introduced, and the present day. It highlights the role of patient associations in the fight against this disease, by organizing awareness and screening campaigns. These data will be used to guide public health policies in the pursuit of improved care and primary prevention.
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Affiliation(s)
- Narcisse ELENGA
- Service de médecine et chirurgie pédiatrique, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Vathanaksambath RO
- Service de médecine et chirurgie pédiatrique, Centre hospitalier de Cayenne, Cayenne, Guyane
| | | | | | - Tania VAZ
- Centre intégré de drépanocytose, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Aude LUCARELLI
- Centre intégré de drépanocytose, Centre hospitalier de Cayenne, Cayenne, Guyane
| | | | - Solange BUENDÉ
- Service de néonatologie, Centre hospitalier de l'Ouest guyanais Franck Joly, Saint-Laurent-du-Maroni, Guyane
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Brun-Rambaud G, Alcouffe L, Tareau MA, Adenis A, Vignier N. Access to health care for migrants in French Guiana in 2022: a qualitative study of health care system actors. Front Public Health 2023; 11:1185341. [PMID: 37920590 PMCID: PMC10619762 DOI: 10.3389/fpubh.2023.1185341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 09/22/2023] [Indexed: 11/04/2023] Open
Abstract
Background Access to health care is a major public health issue. The social determinants of health have a role in accessing health care and in meeting the health needs of populations. With 281 million international migrants around the world, population movements are another major issue. Migrants are particularly exposed to precariousness during their migratory journey and after their settlement. These vulnerabilities may have deleterious effects on their health status and on their social conditions. In French Guiana, 36% of the population is of foreign origin. The objective of this study is to explore the barriers and the facilitators to accessing health care for migrants in French Guiana in 2022, from the perspective of health care professionals, social workers and local NGO actors. Methods This research is an exploratory qualitative study based on the experiential knowledge of health care professionals, social workers and local NGO actors in French Guiana. 25 semi-structured interviews were conducted with these professionals and actors between April and June 2022, using an interview guide to explore their practices, representations and beliefs of access to health care and accompaniment of migrants in their patient journey. The interviews were transcribed and analyzed using the thematic analysis method. Results A total of 25 health care professionals, social workers and local NGO actors were included in the study. Participants highlighted that migrants are exposed to many factors hindering their access to health care in French Guiana (administrative complexity, language barriers, financial barriers, mobility issues, etc.). With the situations of great precariousness and the inadequacies of the public authorities, associative support (social, health and legal accompaniment process provided by NGOs and associations) has an important role in providing close support to migrants. Moreover, health mediation supports migrants in their social and health care journey to lead them toward empowerment. Health mediators contribute to promote a better understanding between professionals and migrants. Conclusion In French Guiana, associative support and health mediation promote access to health care and social accompaniment for migrants. This article highlights the issues surrounding access to health care, associative support and health mediation in the Guianese context, which is marked by significant socio-cultural diversity and precariousness. Considering the benefits of associative support and health mediation, as well as social inequalities in health, is essential for health care professionals, social workers, local NGO actors, associations, public health authorities and political decision-makers to initiate concrete and suitable actions in favor of access to health care and social support for migrants in French Guiana.
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Affiliation(s)
- Gabriel Brun-Rambaud
- Centre d'Investigation Clinique Antilles Guyane, Inserm CIC 1424, COREVIH Guyane, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Leslie Alcouffe
- Centre d'Investigation Clinique Antilles Guyane, Inserm CIC 1424, COREVIH Guyane, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Marc-Alexandre Tareau
- Centre d'Investigation Clinique Antilles Guyane, Inserm CIC 1424, COREVIH Guyane, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Antoine Adenis
- Centre d'Investigation Clinique Antilles Guyane, Inserm CIC 1424, COREVIH Guyane, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Nicolas Vignier
- Centre d'Investigation Clinique Antilles Guyane, Inserm CIC 1424, COREVIH Guyane, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Hôpital Jean Verdier, AP-HP, UFR SMBH, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Université Sorbonne Paris Nord, Bobigny, France
- IAME, Inserm UMR 1137, Université Sorbonne Paris Nord, Université Paris Cité, Paris, France
- Institut Convergences et Migrations, Health and Policy Departments, Aubervilliers, France
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Bonifay T, Le Turnier P, Epelboin Y, Carvalho L, De Thoisy B, Djossou F, Duchemin JB, Dussart P, Enfissi A, Lavergne A, Mutricy R, Nacher M, Rabier S, Talaga S, Talarmin A, Rousset D, Epelboin L. Review on Main Arboviruses Circulating on French Guiana, An Ultra-Peripheric European Region in South America. Viruses 2023; 15:1268. [PMID: 37376570 PMCID: PMC10302420 DOI: 10.3390/v15061268] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
French Guiana (FG), a French overseas territory in South America, is susceptible to tropical diseases, including arboviruses. The tropical climate supports the proliferation and establishment of vectors, making it difficult to control transmission. In the last ten years, FG has experienced large outbreaks of imported arboviruses such as Chikungunya and Zika, as well as endemic arboviruses such as dengue, Yellow fever, and Oropouche virus. Epidemiological surveillance is challenging due to the differing distributions and behaviors of vectors. This article aims to summarize the current knowledge of these arboviruses in FG and discuss the challenges of arbovirus emergence and reemergence. Effective control measures are hampered by the nonspecific clinical presentation of these diseases, as well as the Aedes aegypti mosquito's resistance to insecticides. Despite the high seroprevalence of certain viruses, the possibility of new epidemics cannot be ruled out. Therefore, active epidemiological surveillance is needed to identify potential outbreaks, and an adequate sentinel surveillance system and broad virological diagnostic panel are being developed in FG to improve disease management.
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Affiliation(s)
- Timothee Bonifay
- Centre d’Investigation Clinique Antilles-Guyane, Inserm 1424, Centre Hospitalier de Cayenne, 97306 Cayenne, French Guiana, France; (T.B.); (P.L.T.)
| | - Paul Le Turnier
- Centre d’Investigation Clinique Antilles-Guyane, Inserm 1424, Centre Hospitalier de Cayenne, 97306 Cayenne, French Guiana, France; (T.B.); (P.L.T.)
- Infectious Diseases Department, Centre Hospitalier de Cayenne, 97306 Cayenne, French Guiana, France
| | - Yanouk Epelboin
- Microbiota of Insect Vectors Group, Institut Pasteur de la Guyane, 97300 Cayenne, French Guiana, France
| | - Luisiane Carvalho
- Santé Publique France, Cellule Guyane, 97300 Cayenne, French Guiana, France
| | - Benoit De Thoisy
- Laboratoire des Interactions Virus-Hôtes, Institut Pasteur de la Guyane, 97300 Cayenne, French Guiana, France
| | - Félix Djossou
- Infectious Diseases Department, Centre Hospitalier de Cayenne, 97306 Cayenne, French Guiana, France
| | - Jean-Bernard Duchemin
- Unité d’Entomologie Médicale, Institut Pasteur de la Guyane, 97300 Cayenne, French Guiana, France
| | | | - Antoine Enfissi
- Laboratoire de Virologie, Institut Pasteur de la Guyane, 97300 Cayenne, French Guiana, France
| | - Anne Lavergne
- Laboratoire des Interactions Virus-Hôtes, Institut Pasteur de la Guyane, 97300 Cayenne, French Guiana, France
- Laboratoire de Virologie, Institut Pasteur de la Guyane, 97300 Cayenne, French Guiana, France
| | - Rémi Mutricy
- Emergency Department, Centre Hospitalier de Cayenne, 97306 Cayenne, French Guiana, France
| | - Mathieu Nacher
- Centre d’Investigation Clinique Antilles-Guyane, Inserm 1424, Centre Hospitalier de Cayenne, 97306 Cayenne, French Guiana, France; (T.B.); (P.L.T.)
| | - Sébastien Rabier
- Centre d’Investigation Clinique Antilles-Guyane, Inserm 1424, Centre Hospitalier de Cayenne, 97306 Cayenne, French Guiana, France; (T.B.); (P.L.T.)
| | - Stanislas Talaga
- Unité d’Entomologie Médicale, Institut Pasteur de la Guyane, 97300 Cayenne, French Guiana, France
| | - Antoine Talarmin
- Unité Transmission, Réservoir et Diversité des Pathogènes, Institut Pasteur de Guadeloupe, 97139 Les Abymes, Guadeloupe, France
| | - Dominique Rousset
- Laboratoire de Virologie, Institut Pasteur de la Guyane, 97300 Cayenne, French Guiana, France
| | - Loïc Epelboin
- Centre d’Investigation Clinique Antilles-Guyane, Inserm 1424, Centre Hospitalier de Cayenne, 97306 Cayenne, French Guiana, France; (T.B.); (P.L.T.)
- Infectious Diseases Department, Centre Hospitalier de Cayenne, 97306 Cayenne, French Guiana, France
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Refle JE, Fakhoury J, Burton-Jeangros C, Consoli L, Jackson Y. Impact of legal status regularization on undocumented migrants’ self-reported and mental health in Switzerland. SSM Popul Health 2023; 22:101398. [PMID: 37123558 PMCID: PMC10130692 DOI: 10.1016/j.ssmph.2023.101398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/05/2023] [Accepted: 04/05/2023] [Indexed: 04/08/2023] Open
Abstract
Undocumented migrants face cumulative difficulties like precarious living and working conditions or exclusion from health services that might negatively influence their health. Little is known about the evolution of undocumented migrants' self-reported health (SRH) and mental health after they get documented. This study aims to observe the effect of legal status regularization on SRH and mental health in a cohort of migrants undergoing regularization in Geneva, Switzerland. We evaluate SRH with the first item of the Short Form Survey (SF12) and depression as a proxy of mental health with the PHQ-9 questionnaire over four years among 387 undocumented and newly documented migrants. Using hybrid linear models, our data show that regularization has no direct effect on SRH, but has direct positive effects on mental health in a longitudinal perspective, even when controlling for competing factors. The arrival of the pandemic did not alter these effects. Migrants tend to evaluate their subjective health status more positively than the prevalence of screened depression shows. Those findings point towards better targeted policies that could reduce the burden of depression among undocumented migrants.
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Affiliation(s)
- Jan-Erik Refle
- LIVES, Swiss Centre of Expertise in Life Course Research, University of Geneva, Geneva, Switzerland
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland
| | - Julien Fakhoury
- LIVES, Swiss Centre of Expertise in Life Course Research, University of Geneva, Geneva, Switzerland
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland
| | - Claudine Burton-Jeangros
- LIVES, Swiss Centre of Expertise in Life Course Research, University of Geneva, Geneva, Switzerland
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland
- Institute of Sociological Research, University of Geneva, Geneva, Switzerland
| | - Liala Consoli
- LIVES, Swiss Centre of Expertise in Life Course Research, University of Geneva, Geneva, Switzerland
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland
- Institute of Sociological Research, University of Geneva, Geneva, Switzerland
| | - Yves Jackson
- Division of Primary Care Medicine, Geneva University Hospital and University of Geneva, Geneva, Switzerland
- Corresponding author. Division of Primary Care Medicine, Geneva University Hospital and University of Geneva, Rue Gabrielle Perret Gentil 4, 1211, 14 Geneva, Switzerland.
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De Leo A, D’Adamo G, Morozzi C, Gozzoli C. Taking Care of Forced Migrants Together: Strengths and Weaknesses of Interorganizational Work from the Perspective of Social Workers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1371. [PMID: 36674126 PMCID: PMC9858783 DOI: 10.3390/ijerph20021371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 06/17/2023]
Abstract
The reception and taking care of forced migrants with mental health issues is undoubtedly a very complex task. The literature shows that reception systems are characterized by a high level of fragmentation due to poor collaboration among services that are required to respond to complex and multidimensional needs brought by forced migrants. Starting from the need to deepen what elements support or hinder the implementation of the services' networks for the care and management of forced migrants, qualitative research was conducted within a constructivist paradigm. As the literature reveals a lack of studies considering the perspective of practitioners, we decided to explore the representations of professionals working with migrants in northern Italy in four different service areas (health and psychological well-being, reception, family, and legal areas). A total of 24 professionals (13 F and 11 M) with an average age of 42.4 years were involved in four focus groups according to the four areas. A paper-pencil content analysis was conducted following IPA guidelines. The results show strengths, weaknesses, and elements of improvement for service network implementation. The needs of forced migrants seem to be effectively met only through a service network that takes shape in the interweaving of social, organizational, group, and individual levels.
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Affiliation(s)
- Amalia De Leo
- Department of Psychology, Catholic University, 20123 Milan, Italy
| | - Giulia D’Adamo
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Carlotta Morozzi
- Department of Psychology, Catholic University, 20123 Milan, Italy
| | - Caterina Gozzoli
- Department of Psychology, Catholic University, 20123 Milan, Italy
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Floersheim C, Musso S, Eubanks A, Douine M, Spire B, Sagaon-Teyssier L, Parriault MC, Girard G, Mosnier E. What can lead to late diagnosis of HIV in an illegal gold mining environment? A qualitative study at the French Guiana's border with Brazil. BMJ Open 2022; 12:e061237. [PMID: 36691149 PMCID: PMC9445782 DOI: 10.1136/bmjopen-2022-061237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 08/05/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE The present study aimed to understand what factors can lead to late HIV diagnosis of illegal gold miners at French Guiana's border with Brazil. DESIGN An exploratory qualitative study with in-depth interviews and observations was conducted between November 2019 and February 2020. SETTING The study was conducted in the main medical healthcare service and two non-governmental organisation premises in the Oyapock border region, which is a supply area for illegal gold mining sites. PARTICIPANTS Fifteen people living with HIV diagnosed with CD4 count <350 cells 106/L were interviewed. Seven women and eight men participated; they were between 31 and 79 years old, and the median time since HIV diagnosis was 6 years. Eight had links to illegal gold mining. FINDINGS Three key themes for late HIV diagnosis emerged: (1) the presence of economic and political structural factors which constitute risks for this illegal activity, specifically the repression of gold mining sites by French Armed Forces and the distance from healthcare facilities; (2) representations of the body and health, related to the living conditions of this population; prioritisation of health emergencies and long-term self-medication; and (3) gender roles shaping masculinity and heterosexuality contributing to a perception of not being at risk of HIV and delaying testing. CONCLUSION This study highlights structural, group-based and individual factors that reduce access to HIV testing and healthcare in general for a population of migrant workers in an illegal gold mining area. Faced with harsh living conditions and state repression, these workers develop a vision of health which prioritises the functionality of the body. Associated with gender roles which are partly shaped both by the mining activity and its geographical location, this vision can lead to late HIV diagnosis.
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Affiliation(s)
- Charlotte Floersheim
- Centres Délocalisés de Prévention et de Soins, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Université Paris Cité, IRD, Ceped, Paris, F-75006, France
| | - Sandrine Musso
- Aix Marseille Univ, Centre Norbert Elias, UMR 8562, Marseille, France
| | - August Eubanks
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Maylis Douine
- Centre d'Investigation Clinique Antilles Guyane, INSERM 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Bruno Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Luis Sagaon-Teyssier
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Marie Claire Parriault
- Centre d'Investigation Clinique Antilles Guyane, INSERM 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Gabriel Girard
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Emilie Mosnier
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, Cayenne, French Guiana
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Parent AA, Galindo MS, Lambert Y, Douine M. Combatting malaria disease among gold miners: a qualitative research within the Malakit project. Health Promot Int 2022; 37:6674364. [PMID: 36000529 DOI: 10.1093/heapro/daac058] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Malaria is endemic in French Guiana, in particular, where illegal gold mining activities take place. Gold miners travel from Brazil to remote camps in the Guiana forest to carry out mining activities, exposing themselves to the presumed contamination area. This article presents the results of a qualitative case study of the Malakit project, an intervention where health facilitators offer appropriate training and distribution of self-diagnosis and self-treatment kits to manage an episode of malaria at resting sites on the French Guiana borders. The objectives were: (i) Determine the contextual elements influencing the use of Malakit; (ii) Understand the way gold miners perceive Malakit; (iii) Identify the elements that are favorable and unfavorable to the use of Malakit; (iv4) Identify what can be improved in the project. The data were collected using three methods: on-site observation, semi-structured individual interviews (n = 26), and group interviews (n = 2). The results indicate that Malakit responds to the need for treatment and facilitates access to care. Gold miners say they trust the facilitators and receive accurate explanations, the kit is easy to use and carry, and explanations given are sufficient. Nonetheless, the results lead us to believe that contextual elements influence exposure to numerous risk factors and that malaria among gold miners working illegally in French Guiana is a question of social inequalities in health. Thus, malaria intervention practices such as Malakit cannot be carried out without considering the complexity generated by social inequalities in health.
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Affiliation(s)
- André-Anne Parent
- CReSP and Interactions Research Centre, School of Social Work, Université de Montréal, Québec, Canada
| | | | - Yann Lambert
- Centre hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
| | - Maylis Douine
- Centre hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
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Fakhoury J, Burton-Jeangros C, Consoli L, Duvoisin A, Jackson Y. Association Between Residence Status Regularization and Access to Healthcare for Undocumented Migrants in Switzerland: A Panel Study. Front Public Health 2022; 10:832090. [PMID: 35664122 PMCID: PMC9160788 DOI: 10.3389/fpubh.2022.832090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/11/2022] [Indexed: 11/24/2022] Open
Abstract
Background Switzerland has a universal healthcare system. Yet, undocumented migrants face barriers at different levels that hinder their access to healthcare services. The aim of this study is to assess whether undocumented migrants' healthcare utilization improves with residence status regularization. Methods We used two-wave panel data from the Parchemins study, a study exploring the impact of regularization on undocumented migrants' health in Geneva, Switzerland. First wave data were collected between 2017 and 2018, second wave data between 2019 and 2020. At baseline, the sample consisted of 309 undocumented migrants, recruited after the implementation of a temporary regularization policy in Geneva. We distributed them into two groups according to their residence status 12 months before the second data collection [regularized vs. undocumented (controls)]. Using as dependent variable the number of medical consultations within two distinct 12-months periods (the first before regularization, the second after regularization), we conducted multivariable regression analyses applying hurdle specification to identify factors enhancing healthcare utilization. Then, we estimated first-difference panel models to assess change in healthcare utilization along regularization. Models were adjusted for demographic, economic and health-related factors. Results Of the 309 participants, 68 (22%) were regularized. For the 12 months before regularization, these migrants did not significantly differ in their healthcare utilization from the controls. At this stage, factors increasing the odds of having consulted at least once included being a female (aOR: 2.70; 95% CI: 1.37–5.30) and having access to a general practitioner (aOR: 3.15; 95% CI: 1.62–6.13). The factors associated with the number of consultations apart from underlying health conditions were the equivalent disposable income (aIRR per additional CHF 100.-: 0.98; 95% CI: 0.97–1.00) and having access to a general practitioner (aIRR: 1.45; 95% CI: 1.09–1.92). For the 12 months after regularization, being regularized was not associated with higher odds of having consulted at least once. However, among participants who consulted at least once, regularized ones reported higher counts of medical consultations than controls (3.7 vs. 2.6, p = 0.02), suggesting a positive impact of regularization. Results from the first-difference panel models confirmed that residence status regularization might have driven migrants' healthcare utilization (aβ: 0.90; 95% CI: 0.31-1.77). Conclusions This study supports the hypothesis that residence status regularization is associated with improved healthcare utilization among undocumented migrants. Future research is needed to understand the mechanisms through which regularization improves undocumented migrants' use of healthcare services.
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Affiliation(s)
- Julien Fakhoury
- Swiss National Center of Competence in Research (NCCR) “LIVES – Overcoming Vulnerability: Life Course Perspectives”, University of Geneva, Geneva, Switzerland
- Institute of Sociological Research, University of Geneva, Geneva, Switzerland
- *Correspondence: Julien Fakhoury
| | - Claudine Burton-Jeangros
- Swiss National Center of Competence in Research (NCCR) “LIVES – Overcoming Vulnerability: Life Course Perspectives”, University of Geneva, Geneva, Switzerland
- Institute of Sociological Research, University of Geneva, Geneva, Switzerland
| | - Liala Consoli
- Swiss National Center of Competence in Research (NCCR) “LIVES – Overcoming Vulnerability: Life Course Perspectives”, University of Geneva, Geneva, Switzerland
- Institute of Sociological Research, University of Geneva, Geneva, Switzerland
| | - Aline Duvoisin
- Swiss National Center of Competence in Research (NCCR) “LIVES – Overcoming Vulnerability: Life Course Perspectives”, University of Geneva, Geneva, Switzerland
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland
| | - Yves Jackson
- Geneva University Hospital and University of Geneva, Geneva, Switzerland
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Sabbah N, Massicard M, Mathieu N. Specificities of the Diabetic Population in French Guiana: The Health Barometer Survey. Curr Diabetes Rev 2022; 18:e012821190876. [PMID: 33511949 DOI: 10.2174/1573399817666210129103506] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/11/2020] [Accepted: 12/12/2020] [Indexed: 11/22/2022]
Abstract
AIM This study aims to identify the epidemiological and social characteristics of the diabetic population in French Guiana. BACKGROUND The prevalence of diabetes is very high in the French overseas departments. French Guiana is, however, a very atypical territory, closer in the epidemiological field to Latin America than European and French standards. OBJECTIVE To perform a descriptive analysis of variables related to renouncing medical care, social parameters, and use of healthcare services. METHODS A two-stage random sample of 1390 individuals aged 30 to 75 years was surveyed by telephone, and screening was initially done for diabetic versus non-diabetic individuals. Logistic regression was fitted on the sample to adjust for potential confounding factors. A Kaplan-Meier analysis showed the risk of diabetes as a function of the age of onset. RESULTS The prevalence rate of diabetes was 9.3%, particularly among women, for whom 20% had a history of gestational diabetes. Excess weight and obesity were found in 60% of people with diabetes. The diabetic individuals in French Guiana were younger than those in mainland France, and 30% of people with diabetes were on insulin. They often reported sleep problems, and their health status was described as poor. People with diabetes did not regularly consult a doctor and were very rarely followed up by a specialist. CONCLUSIONS The prevalence rate of diabetes and obesity in French Guiana was one of the highest among the French territories, with specific vulnerabilities requiring to be addressed by local health policies.
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Affiliation(s)
- Nadia Sabbah
- Department of Endocrinology and Metabolic Diseases, Centre Hospitalier de Cayenne, F-97306 Cayenne,French Guiana
| | - Mickael Massicard
- Department of Endocrinology and Metabolic Diseases, Centre Hospitalier de Cayenne, F-97306 Cayenne,French Guiana
| | - Nacher Mathieu
- Clinical Investigation Center Antilles French Guiana (CIC INSERM 1424) Centre Hospitalier de Cayenne, F-97306 Cayenne,French Guiana
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Massicard M, Drak Alsibai K, Nacher M, Sabbah N. Nutritional and Socioeconomic Determinants of Overweight and Obesity in the French Amazon: The Health Barometer Study. Front Endocrinol (Lausanne) 2022; 13:849718. [PMID: 35498399 PMCID: PMC9040446 DOI: 10.3389/fendo.2022.849718] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/04/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES French Guiana is a multicultural overseas territory where obesity is a major public health problem. This study aimed to highlight the nutritional and socioeconomic determinants of overweight and obesity in different populations in French Guiana. METHODS A two-stage random sample of 1390 individuals aged 15 to 75 years was surveyed by telephone, and the participants were initially screened for diabetes. Logistic regression was fitted on the sample to adjust for potential confounding factors. RESULTS Overweight and obesity were found in 54.7% of the respondents, a higher proportion than in mainland France. There was a significant body image discrepancy in our population, with a higher risk of obesity among single women, often immigrants from the non-French Caribbean and South America, unemployed or low education. CONCLUSIONS The main factors associated with obesity were being a precariousness immigrant; there was often a mismatch between body image and overweight/obesity, which is a major obstacle to the improvement of dietary behaviors and lifestyle. This information provides operational clues as to where to act and the necessary adaptations to attempt to modify behaviors in a culturally-adapted manner.
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Affiliation(s)
- Mickael Massicard
- Department of Endocrinology and Metabolic Diseases, Centre Hospitalier André Rosemon, Cayenne, French Guiana
| | - Kinan Drak Alsibai
- Department of Pathology, Cayenne Hospital Center Andrée Rosemon, Cayenne, French Guiana
- Center of Biological Resources (CRB Amazonie), Cayenne Hospital Center Andrée Rosemon, Cayenne, French Guiana
| | - Mathieu Nacher
- Clinical Investigation Center, Centre Hospitalier André Rosemon, University Antilles French Guiana (CIC INSERM 1424), Cayenne, French Guiana
| | - Nadia Sabbah
- Department of Endocrinology and Metabolic Diseases, Centre Hospitalier André Rosemon, Cayenne, French Guiana
- Clinical Investigation Center, Centre Hospitalier André Rosemon, University Antilles French Guiana (CIC INSERM 1424), Cayenne, French Guiana
- *Correspondence: Nadia Sabbah,
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Vietnamese Women Rural Migrants’ Social Vulnerability Under the Lens of Hegemonic Masculinities and Confucianism. JOURNAL OF INTERNATIONAL MIGRATION AND INTEGRATION 2021. [DOI: 10.1007/s12134-021-00916-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Collectif. Oyapock coopération santé : une collaboration transfrontalière pour une meilleure prise en charge du VIH dans le bassin de l’Oyapock. CONFINS 2021. [DOI: 10.4000/confins.39613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Fakhoury J, Burton-Jeangros C, Guessous I, Consoli L, Duvoisin A, Jackson Y. Self-rated health among undocumented and newly regularized migrants in Geneva: a cross-sectional study. BMC Public Health 2021; 21:1198. [PMID: 34162363 PMCID: PMC8220781 DOI: 10.1186/s12889-021-11239-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background In Europe, knowledge about the social determinants of health among undocumented migrants is scarce. The canton of Geneva, Switzerland, implemented in 2017–2018 a pilot public policy aiming at regularizing undocumented migrants. We sought to test for associations between self-rated health, proven eligibility for residence status regularization and social and economic integration. Methods This paper reports data from the first wave of the Parchemins Study, a prospective study whose aim is to investigate the effect of residence status regularization on undocumented migrants’ living conditions and health. The convenience sample included undocumented migrants living in Geneva for at least 3 years. We categorized them into those who were in the process of receiving or had just been granted a residence permit (eligible or newly regularized) and those who had not applied or were ineligible for regularization (undocumented). We conducted multivariate regression analyses to determine factors associated with better self-rated health, i.e., with excellent/very good vs. good/fair/poor self-rated health. Among these factors, measures of integration, social support and economic resources were included. Results Of the 437 participants, 202 (46%) belonged to the eligible or newly regularized group. This group reported better health more frequently than the undocumented group (44.6% versus 28.9%, p-value < .001), but the association was no longer significant after adjustment for social support and economic factors (odds ratio (OR): 1.12; 95% confidence interval (CI): 0.67–1.87). Overall, better health was associated with larger social networks (OR: 1.66; 95% CI: 1.04–2.64). This association remained significant even after adjusting for health-related variables. Conclusion At the onset of the regularization program, access to regularization was not associated with better self-rated health. Policies aiming at favouring undocumented migrants’ inclusion and engagement in social networks may promote better health. Future research should investigate long-term effects of residence status regularization on self-rated health. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11239-0.
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Affiliation(s)
- Julien Fakhoury
- Swiss NCCR Lives, University of Geneva, Geneva, Switzerland. .,Centre interfacultaire de gerontologie et d'etudes des vulnerabilites (CIGEV), University of Geneva, Geneva, Switzerland.
| | | | - Idris Guessous
- Division of Primary Care Medicine, Geneva University Hospital and University of Geneva, Geneva, Switzerland
| | - Liala Consoli
- Swiss NCCR Lives, University of Geneva, Geneva, Switzerland.,Centre interfacultaire de gerontologie et d'etudes des vulnerabilites (CIGEV), University of Geneva, Geneva, Switzerland
| | - Aline Duvoisin
- Swiss NCCR Lives, University of Geneva, Geneva, Switzerland.,Centre interfacultaire de gerontologie et d'etudes des vulnerabilites (CIGEV), University of Geneva, Geneva, Switzerland
| | - Yves Jackson
- Division of Primary Care Medicine, Geneva University Hospital and University of Geneva, Geneva, Switzerland
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Sabbah N, Carles G, Demar M, Nacher M. Diabetes in French Guiana, adapting national standards of therapeutic education and care to the amazonian challenge. World J Diabetes 2021; 12:98-107. [PMID: 33594330 PMCID: PMC7839167 DOI: 10.4239/wjd.v12.i2.98] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/25/2020] [Accepted: 12/02/2020] [Indexed: 02/06/2023] Open
Abstract
French Guiana is a territory located more than 7000 km from France. It is also the largest French territory, with almost 84000 km2 and 90% of it is covered by forest. Some municipalities are isolated due to the scarcity of transportation and the poor road infrastructure. The population is extremely diverse ethnically and culturally, and includes more than thirty ethnic groups. Immigration is high because it is one of the richest countries in the area bordering northern Brazil, Suriname, Guyana, and as a result of socio-economic crises in some other countries such as Haiti, and it has permeable natural borders. Diabetes and obesity, are emerging issues, with double the prevalence of Mainland France, whereas infectious diseases, such as HIV, take second place. Therapeutic and educational management are challenging because they require the adaptation of tools and treatments to the mul-ticulturalism and precariousness often encountered in these populations. The French and European recommendations are unsuited to the needs of the territory and must take into account the epidemiological, sociological and cultural parameters of these populations in order to provide appropriate and graded management of diabetes in the French Amazon.
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Affiliation(s)
- Nadia Sabbah
- Endocrinology Diabetology Nutrition, Centre Hospitalier Andree Rosemon, Cayenne 97300, French Guiana
| | - Gabriel Carles
- Department of Obstetrics and Gynaecology, Centre Hospitalier Franck Joly, St Laurent Du Maroni 97320, French Guiana
| | - Magalie Demar
- Department of Laboratory, University of French Guiana, Cayenne 97300, French Guiana
| | - Mathieu Nacher
- Department of Medicine, COREVIH Centre Hospitalier Andree Rosemon, Cayenne 97300, French Guiana
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Sudre C, Duplan H, Bukasakakamba J, Nacher M, Peyre-Costa P, Sabbah N. Diabetes Care in French Guiana: The Gap Between National Guidelines and Reality. Front Endocrinol (Lausanne) 2021; 12:789391. [PMID: 34917037 PMCID: PMC8670498 DOI: 10.3389/fendo.2021.789391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/30/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION French Guiana is a multicultural overseas territory in the Amazon, where precariousness and difficulties in access to care are widespread. The prevalence of diabetes is double that of other French departments, and cardiovascular morbidity and mortality is high. The objective of the study was to analyze the biological, clinical and therapeutic follow-up of patients with diabetes mellitus using exhaustive data and to correlate it with national and European recommendations. MATERIAL AND METHODS Using the national health insurance data, 9079 and 10075 patients with diabetes mellitus were analyzed in 2018 and 2019, respectively. We analyzed antidiabetic treatments, medical, dental, and podiatric consultations, examinations prescribed as part of the annual follow-up, and home nursing care. RESULTS There was a significant increase over one year in the number of patients (+10%) with diabetes, mainly women (60%), and 31% were under 54 years of age, with a disparity depending on the area of the territory, the most isolated having less access to screening. Less than 56% of patients had HbA1c measurements twice a year, less than 43% had an annual renal check-up, only 19% had an ophthalmic check-up at least every two years, less than 25% had an annual dental check-up, and less than 4% had an annual follow-up with the podiatrist. CONCLUSIONS Substandard diabetes monitoring is a major problem likely to increase morbidity and mortality. Adapting health care to the specificities of the territory is crucial, notably by formalizing the delegation of care to advanced practice nurse and non-healthcare professionals in precarious or geographically isolated areas.
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Affiliation(s)
- Christine Sudre
- Regional Office of the Medical Service and Directorate of Risk Management Coordination of French Guiana, Cayenne, French Guiana
| | - Hélène Duplan
- Regional Office of the Medical Service and Directorate of Risk Management Coordination of French Guiana, Cayenne, French Guiana
| | - John Bukasakakamba
- Department of Endocrinology and Metabolic Diseases, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Mathieu Nacher
- Clinical Investigation Center, West Indies, French Guiana (INSERM CIC 14 24), Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Pascale Peyre-Costa
- Regional Office of the Medical Service and Directorate of Risk Management Coordination of French Guiana, Cayenne, French Guiana
| | - Nadia Sabbah
- Department of Endocrinology and Metabolic Diseases, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
- Clinical Investigation Center, West Indies, French Guiana (INSERM CIC 14 24), Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
- *Correspondence: Nadia Sabbah,
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Tortelli A, Perquier F, Melchior M, Lair F, Encatassamy F, Masson C, K’ourio H, Gourevitch R, Mercuel A. Mental Health and Service Use of Migrants in Contact with the Public Psychiatry System in Paris. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249397. [PMID: 33333905 PMCID: PMC7765309 DOI: 10.3390/ijerph17249397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 05/05/2023]
Abstract
BACKGROUND Migrants, and particularly asylum seekers, are at increased risk of psychiatric disorders in comparison with natives. At the same time, inequalities in access to mental health care are observed. METHODS In order to evaluate whether the Parisian public psychiatric system is optimally structured to meet the needs of this population, we examined data on mental health and service use considering three different levels: the global system treatment level, a psychiatric reception center, and mobile teams specializing in access to psychiatric care for asylum seekers. RESULTS We found higher treatment rates among migrants than among natives (p < 0.001) but inequalities in pathways to care: more mandatory admissions (OR = 1.36, 95% CI: 1.02-1.80) and fewer specialized consultations (OR = 0.56, 95% CI: 0.38-0.81). We observed a mismatch between increased need and provision of care among migrants without stable housing or seeking asylum. CONCLUSIONS Inequalities in the provision of care for migrants are observed in the Parisian public psychiatric system, particularly for those experiencing poor social and economic conditions. There is a need to facilitate access to mental health care and develop more tailored interventions to reduce discontinuity of care.
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Affiliation(s)
- Andrea Tortelli
- Pôle Psychiatrie Précarité, Groupe Hospitalier Universitaire Paris Psychiatrie & Neurosciences, 75014 Paris, France; (F.L.); (C.M.); (A.M.)
- Pierre Louis Institute for Epidemiology and Public Health (IPLESP/INSERM UMR_S 1136), 75012 Paris, France;
- Institut des Migrations, 75013 Paris, France
- Correspondence:
| | - Florence Perquier
- Departement d’Epidémiologie, Groupe Hospitalier Universitaire Paris Psychiatrie & Neurosciences, 75014 Paris, France;
| | - Maria Melchior
- Pierre Louis Institute for Epidemiology and Public Health (IPLESP/INSERM UMR_S 1136), 75012 Paris, France;
- Institut des Migrations, 75013 Paris, France
| | - François Lair
- Pôle Psychiatrie Précarité, Groupe Hospitalier Universitaire Paris Psychiatrie & Neurosciences, 75014 Paris, France; (F.L.); (C.M.); (A.M.)
| | - Fabien Encatassamy
- CPOA: Centre Psychiatrique d’Orientation et d’Accueil, Hôpital Sainte-Anne, Groupe Hospitalier Universitaire Paris Psychiatrie & Neurosciences-1, rue Cabanis, F-75014 Paris, France; (F.E.); (H.K.); (R.G.)
| | - Chloé Masson
- Pôle Psychiatrie Précarité, Groupe Hospitalier Universitaire Paris Psychiatrie & Neurosciences, 75014 Paris, France; (F.L.); (C.M.); (A.M.)
| | - Hélène K’ourio
- CPOA: Centre Psychiatrique d’Orientation et d’Accueil, Hôpital Sainte-Anne, Groupe Hospitalier Universitaire Paris Psychiatrie & Neurosciences-1, rue Cabanis, F-75014 Paris, France; (F.E.); (H.K.); (R.G.)
| | - Raphaël Gourevitch
- CPOA: Centre Psychiatrique d’Orientation et d’Accueil, Hôpital Sainte-Anne, Groupe Hospitalier Universitaire Paris Psychiatrie & Neurosciences-1, rue Cabanis, F-75014 Paris, France; (F.E.); (H.K.); (R.G.)
| | - Alain Mercuel
- Pôle Psychiatrie Précarité, Groupe Hospitalier Universitaire Paris Psychiatrie & Neurosciences, 75014 Paris, France; (F.L.); (C.M.); (A.M.)
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Jolivet A, Agostini C, Manca MF, Carod JF, Launay JF, Brunet J, Brignon J, Carles G, Perotti F. [The public health department of the Western French Guiana Hospital: a 5-year return of experience]. SANTE PUBLIQUE 2020; 32:199-210. [PMID: 32989949 DOI: 10.3917/spub.202.0199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION The western French Guiana hospital (Chog) is atypical. The creation of a public health department (PSP) is the result of a willingness of the institution to respond to public health issues on its territory. The main objective of this article is to identify the levers and impediments for the development of public health activities within this hospital, after five years of implementation. METHOD This article was based on the analysis of documents produced within the PSP, the institution and at the regional level (2013-2018), and on interviews conducted in 2017 with PSP professionals, and chiefs of other departments of the Chog (N = 16). RESULTS The added value of the PSP is based on the pooling of human resources and technical skills, the coexistence of clinical activities, prevention, research, teaching and international cooperation with Suriname, and the development of multidisciplinary and evaluative approaches. The lack of a set of public health objectives in the establishment project, the lack of place for these activities in its new hospital, and the difficult mobilization of financial resources, however, limit the prospects. CONCLUSION This analysis has shown difficulties in developing public health activities within this hospital, in an overseas territory with nonetheless multiple and complex needs. The authors invite politics and health authorities to value, and develop these activities, conditions necessary for the positioning of the hospital as an actor of the “turn in prevention”.
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Manca MF, Rochat-Stettler L, Carod JF, Agostini C, Jolivet A. High prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae in Western French Guiana. Braz J Infect Dis 2020; 24:256-260. [PMID: 32442426 PMCID: PMC9392076 DOI: 10.1016/j.bjid.2020.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/19/2020] [Accepted: 04/23/2020] [Indexed: 11/08/2022] Open
Abstract
The purpose of this study was to estimate the prevalence of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections in western French Guiana and to analyze associated factors with both infections. A retrospective study was conducted in a sexually transmitted infections clinic in 2017. Women (n = 338) were tested by real-time polymerase chain reaction for vaginal, anal and throat CT and NG infections. Men (n = 192) were evaluated using urine specimens. Socio-demographic and sexual behaviour data were collected by nurses with a structured questionnaire. The prevalence of CT and NG infections among women were 24.3% and 13.3%, respectively, and 12.0% and 7.3% among men. Women aged under 25 years had a higher risk of CT and NG infections than women aged 35 years or more. Another risk factor for CT infection was low educational level, and occasional unprotected sex for NG infection. CT and NG infections were associated with reporting symptoms among men. Very high prevalences of CT and NG infections among women and men were found, which suggest that a large-scale screening strategy should be implemented in French Guiana.
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Affiliation(s)
- Maria-Francesca Manca
- Western French Guiana Hospital Center Franck-Joly, Department of Public Health, Saint-Laurent du Maroni, French Guiana
| | - Laurence Rochat-Stettler
- Western French Guiana Hospital Center Franck-Joly, Department of Medicine, Saint-Laurent du Maroni, French Guiana
| | - Jean-François Carod
- Western French Guiana Hospital Center Franck-Joly, Department of Medical Biology, Saint-Laurent du Maroni, French Guiana
| | - Camille Agostini
- Western French Guiana Hospital Center Franck-Joly, Department of Public Health, Saint-Laurent du Maroni, French Guiana
| | - Anne Jolivet
- Western French Guiana Hospital Center Franck-Joly, Department of Public Health, Saint-Laurent du Maroni, French Guiana; INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et Santé Publique (IPLESP), Equipe de Recherche en Epidémiologie Sociale (ERES), Paris, France.
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Nacher M, Deungoue S, Brousse P, Adenis A, Couppié P, Sobesky M. [The interplay between isolation and precariousness, and hospitalization duration in French Guiana]. Rev Epidemiol Sante Publique 2020; 68:125-132. [PMID: 32035728 DOI: 10.1016/j.respe.2019.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 09/03/2019] [Accepted: 09/19/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND French Guiana faces singular health challenges: poverty, isolation, structural lag, difficulties in attracting health professionals. Hospital stays exceed the recommended durations. The present study aimed to model the impact of precariousness and geographic isolation on the hospital duration performance indicator and to recalculate the indicator after incrementing severity by 1 unit when patients were socially precarious. METHODS Cayenne hospital data for 2017 were used to model the hospital duration performance indicator (IP-DMS) using quantile regression to study the impact of geographic and social explanatory variables. This indicator was computed hypothesizing a 1 unit increment of severity for precarious patients and by excluding patients from isolated regions. RESULTS Most excess hospitalization days were linked to precariousness: the sojourns of precarious patients represented 47% of activity but generated 71% of excess days in hospital. Quantile regression models showed that after adjustment for potential confounders, patients from western French Guiana and Eastern French Guiana, precarious patients and the interactions terms between residence location and precariousness were significantly associated with IP-DMS increases. Recalculating the IP-DMSafter exclusion of patients from the interior and after increasing severity by 1 notch if the patient was precarious led to IP-DMS levels close to 1. CONCLUSION The results show the nonlinear relationship between the IP-DMS and geographical isolation, poverty, and their interaction. These contextual variables must be taken into account when choosing the target IP-DMS value for French Guiana, which conditions funding and number of hospital beds allowed in a context of rapid demographic growth.
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Affiliation(s)
- M Nacher
- SD -CIC Inserm 1424, centre hospitalier de Cayenne, rue des Flamboyants, 97300 Cayenne, Guyane.
| | - S Deungoue
- SD -CIC Inserm 1424, centre hospitalier de Cayenne, rue des Flamboyants, 97300 Cayenne, Guyane
| | - P Brousse
- Département des centres délocalisés de prévention et de soins, centre hospitalier de Cayenne, Guyane
| | - A Adenis
- SD -CIC Inserm 1424, centre hospitalier de Cayenne, rue des Flamboyants, 97300 Cayenne, Guyane
| | - P Couppié
- Service de dermato-vénéréologie, centre hospitalier de Cayenne, Guyane
| | - M Sobesky
- Département d'information médicale, centre hospitalier de Cayenne, Guyane
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Combes SJB, Simonnot N, Azzedine F, Aznague A, Chauvin P. Self-Perceived Health among Migrants Seen in Médecins du Monde Free Clinics in Europe: Impact of Length of Stay and Wealth of Country of Origin on Migrants' Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16244878. [PMID: 31817068 PMCID: PMC6950051 DOI: 10.3390/ijerph16244878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 11/29/2019] [Accepted: 11/30/2019] [Indexed: 11/16/2022]
Abstract
Health of migrants is a widely studied topic. It has been argued that migrant health may deteriorate over time. Though migrants are a “hard to reach” population in survey data, this paper builds on a unique dataset provided by Médecins du Monde from five countries. We study self-perceived health (SPH) in connection with socio-economic and demographic factors and length of stay. Results differ for men and women. Compared to other documented migrants, asylum seekers have a 50–70% greater chance of having worse health. Migrants with better living conditions have a 57–78% chance of being in better health. Male migrants with a job have between a 82–116% chance of being in good health. The probability for women from poorer countries to have a better physical SPH after three months of residing in the host country is six-fold that of women from richer countries. This paper contributes widely to the knowledge of health of migrants. Contrary to other evidence, health of women migrants from poorer countries tends to improve with length of stay.
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Affiliation(s)
- Simon Jean-Baptiste Combes
- Univ Rennes, EHESP, CNRS, ARENES–UMR 6051, 35000 Rennes, France; (F.A.); (A.A.)
- French Collaborative Institute on Migration, 93322 Aubervilliers, France
- Correspondence:
| | - Nathalie Simonnot
- Médecins du Monde–Doctors of the World, International Network, 75018 Paris, France;
| | - Fabienne Azzedine
- Univ Rennes, EHESP, CNRS, ARENES–UMR 6051, 35000 Rennes, France; (F.A.); (A.A.)
- French Collaborative Institute on Migration, 93322 Aubervilliers, France
| | - Abdessamad Aznague
- Univ Rennes, EHESP, CNRS, ARENES–UMR 6051, 35000 Rennes, France; (F.A.); (A.A.)
| | - Pierre Chauvin
- Department of Social Epidemiology, Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP), 75012 Paris, France;
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Renouncing care in French Guiana: the national health barometer survey. BMC Health Serv Res 2019; 19:99. [PMID: 30728033 PMCID: PMC6366016 DOI: 10.1186/s12913-019-3895-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 01/11/2019] [Indexed: 12/18/2022] Open
Abstract
Background In French Guiana, health inequalities are patent for a broad range of pathologies for all age groups. The objective of the present study was to quantify the proportion of the population that had renounced care in the past year, to study predictive factors, and to compare results with other French territories. Methods A two-stage random sample of 2015 individuals aged 15 to 75 years was surveyed by telephone. A descriptive analysis of variables relative to renouncing care, use of health care, screening, and vaccination was initially performed. Multivariate analysis was then used to determine variables associated with renouncing care for financial reasons and renouncing for reasons linked to time were directly estimated using a Poisson model on weighted data. Variables with a significance level < 0.2 in the bivariate analysis were included in the full multivariate model. Results In French Guiana, during the past 12 months, 30.9% of surveyed persons renounced care whatever the type for financial reasons. Results of the multivariate analysis showed that gender, perceived financial situation, perceived health and complementary insurance status were independent predictive factors of care renouncement for financial reasons. Overall, 24% of the surveyed population declared having renounced to care for time-related motives. The independent predictors for time-related renouncing were different than those for renouncing care for financial reasons: a higher education level and a poor perceived health were independently associated with time-related renouncement; retired persons and students were found to renounce care less frequently than persons with a job. Conclusions Renouncing for financial reasons, a major target of the 2016 health law, represented a public health problem in French Guiana. Renouncing for lack of time was an important motive for renouncing, which is aggravated by the insufficient number of health professionals, but may benefit from organizational solutions. There are avenues for improvement of health for the most vulnerable: promote health, act on risk factors, and facilitate the readability and accessibility of the health system. Recent reforms to stabilize health insurance may however have some adverse consequences for migrants.
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Sardadvar S. How Migrant Status Affects Health beyond Socioeconomic Status: Evidence from Austria. INTERNATIONAL MIGRATION REVIEW 2018. [DOI: 10.1111/imre.12108] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The debate on health inequalities usually focuses on the interplay between socioeconomic status (SES) and health, where it is widely accepted that the former influences the latter. However, little is known on whether the influence of SES on health is sufficient to explain the observed lower health statuses among various migrant groups in European countries. This paper presents a model that integrates the influences of SES and migrant status on health and tests its implications empirically for Austria. Several ordered logit regressions are performed, whose results show that particular migrant groups are disadvantaged with respect to health. In addition, the overall influence of migrant status on health is considerably stronger for women than for men, while health status of men is influenced by interactions between migrant status and occupational status.
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Egmann G, Tattevin P, Palancade R, Nacher M. Prehospital Emergencies in Illegal Gold Mining Sites in French Guiana. Wilderness Environ Med 2018; 29:72-77. [PMID: 29336958 DOI: 10.1016/j.wem.2017.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 09/10/2017] [Accepted: 09/19/2017] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Illegal gold mining is flourishing in French Guiana, existing outside the law due to both the high cost of gold mining permits and the challenges of law enforcement within the Amazon forest. We report the characteristics of, and the medical responses to, medical emergencies in illegal gold mining sites. METHODS We performed a retrospective study of all medical emergencies reported from illegal gold mining sites to the centralized call office of SAMU 973 from 1998 through 2000 and from 2008 through 2010. According to the national health care system, any medical emergency within the territory is handled by the prehospital emergency medical service (SAMU 973), irrespective of the patients' legal status. Data were extracted from the SAMU 973 notebook registry (1998-2000) or the SAMU 973 computerized database (2008-2010) and werre collected using a standardized questionnaire. RESULTS Of 71,932 calls for medical emergencies in French Guiana during the study periods, 340 (0.5%) originated from illegal gold mining sites. Of these, 196 (58%) led to medical evacuation by helicopter, whereas the overall rate of evacuation by helicopter after placing a call to SAMU 973 was only 4% (3020/71,932; P<0.0001 for comparison with illegal gold mining sites). Medical emergencies were classified as illness (48%, mostly infectious), trauma (44%, mostly weapon wounds), and miscellaneous (8%). CONCLUSIONS Medical emergencies at illegal gold mining sites in the Amazon forest mostly include infectious diseases, followed by trauma, and often require medical evacuation by helicopter. Our study suggests that implementation of preventive medicine within gold mining sites, irrespective of their legal status, could be cost-effective and reduce morbidity.
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Affiliation(s)
- Gérald Egmann
- SAMU 97.3, Centre Hospitalier Andrée Rosemon, Cayenne, France (Dr Egmann)
| | - Pierre Tattevin
- Maladies Infectieuses et Réanimation Médicale, Centre Hospitalier Universitaire Pontchaillou, Rennes, France (Dr Palancade).
| | - Renaud Palancade
- SAMU 31, Centre Hospitalier Universitaire Purpan, Toulouse, France (Dr Palancade)
| | - Matthieu Nacher
- Centre d'investigation clinique-Epidemiologie Clinique Antilles-Guyane, INSERM CIE 802,Université Antilles-Guyane, EA 3593, Cayenne, France (Dr Nacher)
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Douine M, Mosnier E, Le Hingrat Q, Charpentier C, Corlin F, Hureau L, Adenis A, Lazrek Y, Niemetsky F, Aucouturier AL, Demar M, Musset L, Nacher M. Illegal gold miners in French Guiana: a neglected population with poor health. BMC Public Health 2017; 18:23. [PMID: 28716015 PMCID: PMC5513330 DOI: 10.1186/s12889-017-4557-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 06/30/2017] [Indexed: 11/17/2022] Open
Abstract
Background In French Guiana, a French overseas territory in South America, 6 to 10 thousands undocumented persons work illegally in gold mining sites in the Amazonian forest. Precarious life conditions lead to poor health but few data exist on the health status of illegal gold miners in French Guiana. The objective of this article was to describe the sociodemographic and health status of this vulnerable population. Method A prospective cross-sectional survey was conducted in 2015 on gold mine supply sites at the border between French Guiana and Suriname. Health status was assessed through medical examination, past medical history, haemoglobin concentration, and HIV and malaria testing. A questionnaire was used to collect data about the migration itinerary and life conditions on mining sites. Results Among the 421 adults included in the study, 93.8% (395/421) were Brazilian, mainly from Maranhão (55.7%, 220/395), the poorest Brazilian state. The sex ratio was 2.4. Overall, 48% of persons never went to school or beyond the primary level. The median time spent in gold mining was quite long (10 years), with a high turn-over. One third of the surveyed population (37.1%, 156/421) had high blood pressure, and only two had a medical follow-up. Most persons had experienced malaria (89.3%, 376/421). They declared frequent arboviroses and digestive disorders. Active leishmaniasis was observed in 8.3% of gold miners. Among women, 28.5% were anemic. Concerning HIV, 36.6% (154/421) of persons, mainly men, never got tested before and 6 were tested positive, which represented an HIV prevalence of 1.43% (95%CI =0.29–2.5). Conclusion These findings support the hypothesis that mining in remote areas is linked to several specific illnesses. Theoretically, gold miners would be presumed to start their economical migration to French Guiana as a healthy group. However, their strenuous working and living conditions there lead to poor health caused by infectious and non infectious diseases. This description of their health status is precious for health policy planners in French Guiana given the importance of controlling communicable disease, and the severity and range of specific illnesses acquired by this neglected population. Trial registration Clinical trial registration PRS N° NCT02903706. Retrospectively registered 09/13/2016.
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Affiliation(s)
- Maylis Douine
- Centre d'Investigation Clinique Antilles-Guyane (Inserm 1424), Cayenne Hospital, Av des Flamboyant, BP 6006, 97306 cedex, Cayenne, French Guiana, France. .,Epidemiology of Tropical Parasitoses, EA 3593, Université de Guyane, Cayenne, French Guiana, France.
| | - Emilie Mosnier
- Epidemiology of Tropical Parasitoses, EA 3593, Université de Guyane, Cayenne, French Guiana, France.,Centres Délocalisés de Prévention et de Soins, Cayenne Hospital, Cayenne, French Guiana, France
| | - Quentin Le Hingrat
- INSERM UMR1137, IAME Université Paris Diderot Sorbonne Paris Cité, AP-HP, Laboratoire de Virologie, Hôpital Bichat-Claude Bernard, Paris, France
| | - Charlotte Charpentier
- INSERM UMR1137, IAME Université Paris Diderot Sorbonne Paris Cité, AP-HP, Laboratoire de Virologie, Hôpital Bichat-Claude Bernard, Paris, France
| | - Florine Corlin
- Centre d'Investigation Clinique Antilles-Guyane (Inserm 1424), Cayenne Hospital, Av des Flamboyant, BP 6006, 97306 cedex, Cayenne, French Guiana, France
| | - Louise Hureau
- Centre d'Investigation Clinique Antilles-Guyane (Inserm 1424), Cayenne Hospital, Av des Flamboyant, BP 6006, 97306 cedex, Cayenne, French Guiana, France
| | - Antoine Adenis
- Centre d'Investigation Clinique Antilles-Guyane (Inserm 1424), Cayenne Hospital, Av des Flamboyant, BP 6006, 97306 cedex, Cayenne, French Guiana, France.,Epidemiology of Tropical Parasitoses, EA 3593, Université de Guyane, Cayenne, French Guiana, France
| | - Yassamine Lazrek
- Laboratoire de parasitologie, WHO Collaborating Center for Surveillance of Anti-Malarial Drug Resistance, Centre National de Référence du paludisme, Institut Pasteur de la Guyane, Cayenne, French Guiana, France
| | - Florence Niemetsky
- Centres Délocalisés de Prévention et de Soins, Cayenne Hospital, Cayenne, French Guiana, France
| | - Anne-Laure Aucouturier
- Centre d'Investigation Clinique Antilles-Guyane (Inserm 1424), Cayenne Hospital, Av des Flamboyant, BP 6006, 97306 cedex, Cayenne, French Guiana, France.,Centres Délocalisés de Prévention et de Soins, Cayenne Hospital, Cayenne, French Guiana, France
| | - Magalie Demar
- Academic Laboratory of Parasitology - Mycology, Cayenne Hospital, Cayenne, French Guiana, France
| | - Lise Musset
- Laboratoire de parasitologie, WHO Collaborating Center for Surveillance of Anti-Malarial Drug Resistance, Centre National de Référence du paludisme, Institut Pasteur de la Guyane, Cayenne, French Guiana, France
| | - Mathieu Nacher
- Centre d'Investigation Clinique Antilles-Guyane (Inserm 1424), Cayenne Hospital, Av des Flamboyant, BP 6006, 97306 cedex, Cayenne, French Guiana, France.,Epidemiology of Tropical Parasitoses, EA 3593, Université de Guyane, Cayenne, French Guiana, France
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Jaries R, Vantilcke V, Clevenbergh P, Adoissi J, Boukhari R, Misslin C, Nacher M, Vreden S, Jolivet A. Population movements and the HIV cascade in recently diagnosed patients at the French Guiana -Suriname border. AIDS Care 2017; 29:1448-1452. [PMID: 28278570 DOI: 10.1080/09540121.2017.1291899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Border areas are particular "hot spots" generating high levels of HIV vulnerability and facing great challenges to control epidemics. The objective of this study is to describe the sociodemographic, clinical and biological profiles of newly HIV diagnosed people at the French Guiana - Suriname border, to construct an HIV care cascade and compare it with the Surinamese one. HIV-patients aged over 15 years newly diagnosed in western French Guiana in 2011 and 2012 were included in a retrospective cohort study. Patients were identified using different sources (n = 121). The male-to-female ratio was 0.8, 85% of the patients were of foreign origin, 72% were undocumented migrants, 21% were living in Suriname and 48% had baseline CD4 cell counts <200 cells/mm3. After one year, 34% were lost to follow-up, 54% received treatment, 34% had controlled viremia and 6% died. We observed a disappointing HIV cascade, like that of Suriname, requiring to develop a coordinated healthcare offer on both sides of the border. Targeted efforts through a bi-national collaboration are needed to address the specific issues of cross-border patients to reach the 90*3 UNAIDS's diagnosis, link to care and treatment targets and better control the local epidemic.
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Affiliation(s)
- Raphael Jaries
- a Department of Public Health , Centre Hospitalier de l'Ouest Guyanais , Saint-Laurent du Maroni , French Guiana
| | - Vincent Vantilcke
- a Department of Public Health , Centre Hospitalier de l'Ouest Guyanais , Saint-Laurent du Maroni , French Guiana
| | - Philippe Clevenbergh
- c Department of Medicine , Centre Hospitalier de l'Ouest Guyanais , Saint-Laurent du Maroni , French Guiana
| | - Jocelyne Adoissi
- a Department of Public Health , Centre Hospitalier de l'Ouest Guyanais , Saint-Laurent du Maroni , French Guiana
| | - Rachida Boukhari
- b Department of Clinical Biology , Centre Hospitalier de l'Ouest Guyanais , Saint-Laurent du Maroni , French Guiana
| | - Caroline Misslin
- c Department of Medicine , Centre Hospitalier de l'Ouest Guyanais , Saint-Laurent du Maroni , French Guiana
| | - Mathieu Nacher
- d Centre d'Investigation Clinique Antilles-Guyane, INSERM 1424, Centre Hospitalier Andrée Rosemon , Cayenne , French Guiana
| | - Stephen Vreden
- e Department of Medicine , Academic Hospital , Paramaribo , Suriname
| | - Anne Jolivet
- a Department of Public Health , Centre Hospitalier de l'Ouest Guyanais , Saint-Laurent du Maroni , French Guiana.,f Department of Social Epidemiology , Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136) , Paris , France
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Jolivet A, Cadot E, Angénieux O, Florence S, Lesieur S, Lebas J, Chauvin P. Use of an emergency department in Saint-Laurent du Maroni, French guiana: does being undocumented make a difference? J Immigr Minor Health 2016; 16:586-94. [PMID: 24077834 DOI: 10.1007/s10903-013-9919-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Few data exist on the health status and heathcare utilization of the undocumented migrants in France. Data are particularly scarce in French overseas territories where this population is numerous. We aimed to describe the characteristics of undocumented patients who use the emergency department of Saint-Laurent du Maroni Hospital(SLMH) in French Guiana, and to identify factors associated with their subsequent hospitalization. In a random sample of 177 patients, we used logistic regression models to test the mediational role of health-care system utilization and medical characteristics at admission in the association between residency status and hospitalization.More than a quarter of patients (27.7 %) were undocumented migrants, who were subsequently hospitalized more often than the others [OR 3.11, 95 % CI (1.32–7.34)]. More-severe symptoms at admission, a poorer access to health insurance, a greater distance between their home and SLMH, and poorer French language skills partially explained this higher hospitalization rate. Despite the fact that France has instituted a specific insurance program for the undocumented, an increasing number of barriers to accessing health care is being reported for these people. Our results suggest that these obstacles have some impacts in the utilization of hospital care.
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Gueneuc A, Carles G, Lemonnier M, Dallah F, Jolivet A, Dreyfus M. Hématome rétroplacentaire : terrain et facteurs pronostiques revisités à propos d’une série de 171 cas en Guyane francaise. ACTA ACUST UNITED AC 2016; 45:300-6. [DOI: 10.1016/j.jgyn.2015.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 03/21/2015] [Accepted: 04/01/2015] [Indexed: 10/23/2022]
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Valmy L, Gontier B, Parriault MC, Van Melle A, Pavlovsky T, Basurko C, Grenier C, Douine M, Adenis A, Nacher M. Prevalence and predictive factors for renouncing medical care in poor populations of Cayenne, French Guiana. BMC Health Serv Res 2016; 16:34. [PMID: 26822003 PMCID: PMC4731954 DOI: 10.1186/s12913-016-1284-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 01/22/2016] [Indexed: 01/01/2023] Open
Abstract
Background Access to health care is a global public problem. In French Guiana, there exists social inequalities which are specially marked amongst immigrants who make up a third of the population. Health care inequalities are prevalent. The objective of this study was to determine factors associated with why health care amongst the poor population of Cayenne was renounced. The study was cross sectional. It focused on knowledge, attitudes, practices and beliefs of the population living in poor neighborhoods of the Cayenne area. Methods Populations coming at the Red Cross mobile screening unit in poor urban areas of Cayenne were surveyed from July 2013 to June 2014. Structured questionnaires consisted of 93 questions. Written informed consent was requested at the beginning of the questionnaire. The predictors for renouncing medical care were determined using logistic regression models and tree analysis. Results Twenty percent of persons had renounced care. Logistic regression showed that renouncement of health care was negatively associated with having no regular physician Adjusted Odds Ratio (AOR) = 0.43 (95 % CI = 0.24–0.79) and positively associated with being embarrassed to ask certain questions AOR = 6.81 (95 % CI = 3.98–11.65) and having been previously refused health care by a doctor AOR = 3.08 (95 % CI = 1.43–6.65). Tree analysis also showed that three of these variables were linked to renouncement, with feeling shy to ask certain questions as the first branching. Conclusion Although most people felt it was easy to see a doctor, one in five had renounced health care. The variables identified by the models suggest vulnerable persons generally had previous negative encounters with the health system and felt unwanted or non eligible for healthcare. Health care mediation and welcoming staff may be simple solutions to the above problems which were underscored in our observations.
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Affiliation(s)
- Larissa Valmy
- Centre d'Investigation Clinique Antilles-Guyane, Inserm 1424, Centre Hospitalier Andrée Rosemon, Av. des Flamboyants, 97306, Cayenne cedex, France.
| | - Barbara Gontier
- Centre d'Investigation Clinique Antilles-Guyane, Inserm 1424, Centre Hospitalier Andrée Rosemon, Av. des Flamboyants, 97306, Cayenne cedex, France
| | - Marie Claire Parriault
- Centre d'Investigation Clinique Antilles-Guyane, Inserm 1424, Centre Hospitalier Andrée Rosemon, Av. des Flamboyants, 97306, Cayenne cedex, France
| | - Astrid Van Melle
- Centre d'Investigation Clinique Antilles-Guyane, Inserm 1424, Centre Hospitalier Andrée Rosemon, Av. des Flamboyants, 97306, Cayenne cedex, France
| | - Thomas Pavlovsky
- Emergency Department, Centre Hospitalier Andrée Rosemon, Av. des Flamboyants, 97306, Cayenne cedex, France
| | - Célia Basurko
- Centre d'Investigation Clinique Antilles-Guyane, Inserm 1424, Centre Hospitalier Andrée Rosemon, Av. des Flamboyants, 97306, Cayenne cedex, France
| | - Claire Grenier
- Croix Rouge Française, Centre de Prévention Santé, 25 rue Docteur Roland Barrat, 97300, Cayenne, France
| | - Maylis Douine
- Centre d'Investigation Clinique Antilles-Guyane, Inserm 1424, Centre Hospitalier Andrée Rosemon, Av. des Flamboyants, 97306, Cayenne cedex, France
| | - Antoine Adenis
- Centre d'Investigation Clinique Antilles-Guyane, Inserm 1424, Centre Hospitalier Andrée Rosemon, Av. des Flamboyants, 97306, Cayenne cedex, France
| | - Mathieu Nacher
- Centre d'Investigation Clinique Antilles-Guyane, Inserm 1424, Centre Hospitalier Andrée Rosemon, Av. des Flamboyants, 97306, Cayenne cedex, France
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Ronda E, Briones-Vozmediano E, Galon T, García AM, Benavides FG, Agudelo-Suárez AA. A qualitative exploration of the impact of the economic recession in Spain on working, living and health conditions: reflections based on immigrant workers' experiences. Health Expect 2015; 19:416-26. [PMID: 25846581 DOI: 10.1111/hex.12365] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND This study aimed to analyse how immigrant workers in Spain experienced changes in their working and employment conditions brought about Spain's economic recession and the impact of these changes on their living conditions and health status. METHOD We conducted a grounded theory study. Data were obtained through six focus group discussions with immigrant workers (n = 44) from Colombia, Ecuador and Morocco, and two individual interviews with key informants from Romania living in Spain, selected by theoretical sample. RESULTS Three categories related to the crisis emerged--previous labour experiences, employment consequences and individual consequences--that show how immigrant workers in Spain (i) understand the change in employment and working conditions conditioned by their experiences in the period prior to the crisis, and (ii) experienced the deterioration in their quality of life and health as consequences of the worsening of employment and working conditions during times of economic recession. CONCLUSION The negative impact of the financial crisis on immigrant workers may increase their social vulnerability, potentially leading to the failure of their migratory project and a return to their home countries. Policy makers should take measures to minimize the negative impact of economic crisis on the occupational health of migrant workers in order to strengthen social protection and promote health and well-being.
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Affiliation(s)
- Elena Ronda
- Center for Research in Occupational Health (Cisal), Pompeu Fabra University, Barcelona, Spain.,Public Health Research Group, University of Alicante, Alicante, Spain.,CIBERESP, Madrid, Spain
| | | | - Tanyse Galon
- Department of General and Specialized Nursing, University of São Paulo, Ribeirão Preto, Brazil
| | - Ana M García
- Center for Research in Occupational Health (Cisal), Pompeu Fabra University, Barcelona, Spain.,CIBERESP, Madrid, Spain.,Department of Preventive Medicine and Public Health, Faculty of Social Sciences, University of Valencia, Valencia, Spain
| | - Fernando G Benavides
- Center for Research in Occupational Health (Cisal), Pompeu Fabra University, Barcelona, Spain.,CIBERESP, Madrid, Spain
| | - Andrés A Agudelo-Suárez
- Center for Research in Occupational Health (Cisal), Pompeu Fabra University, Barcelona, Spain.,Public Health Research Group, University of Alicante, Alicante, Spain.,Faculty of Dentistry, University of Antioquia, Medellín, Colombia
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Robert G, Martínez JM, García AM, Benavides FG, Ronda E. From the boom to the crisis: changes in employment conditions of immigrants in Spain and their effects on mental health. Eur J Public Health 2014; 24:404-9. [PMID: 24632339 DOI: 10.1093/eurpub/cku020] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Migrant workers have been one of the groups most affected by the economic crisis. This study evaluates the influence of changes in employment conditions on the incidence of poor mental health of immigrant workers in Spain, after a period of 3 years, in context of economic crisis. METHODS Follow-up survey was conducted at two time points, 2008 and 2011, with a reference population of 318 workers from Colombia, Ecuador, Morocco and Romania residing in Spain. Individuals from this population who reported good mental health in the 2008 survey (n = 214) were interviewed again in 2011 to evaluate their mental health status and the effects of their different employment situations since 2008 by calculating crude and adjusted odds ratios (aORs) for sociodemographic and employment characteristics. FINDINGS There was an increased risk of poor mental health in workers who lost their jobs (aOR = 3.62, 95%CI: 1.64-7.96), whose number of working hours increased (aOR = 2.35, 95%CI: 1.02-5.44), whose monthly income decreased (aOR = 2.75, 95%CI: 1.08-7.00) or who remained within the low-income bracket. This was also the case for people whose legal status (permission for working and residing in Spain) was temporary or permanent compared with those with Spanish nationality (aOR = 3.32, 95%CI: 1.15-9.58) or illegal (aOR = 17.34, 95%CI: 1.96-153.23). In contrast, a decreased risk was observed among those who attained their registration under Spanish Social Security system (aOR = 0.10, 95%CI: 0.02-0.48). CONCLUSION There was an increase in poor mental health among immigrant workers who experienced deterioration in their employment conditions, probably influenced by the economic crisis.
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Affiliation(s)
- Gemma Robert
- 1 CiSAL, Center for Research in Occupational Health, Universitat Pompeu Fabra, Barcelona, Spain
| | - José Miguel Martínez
- 1 CiSAL, Center for Research in Occupational Health, Universitat Pompeu Fabra, Barcelona, Spain2 CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Ana M García
- 1 CiSAL, Center for Research in Occupational Health, Universitat Pompeu Fabra, Barcelona, Spain2 CIBER Epidemiología y Salud Pública (CIBERESP), Spain3 Preventive Medicine and Public Health Department, University of Valencia, Valencia, Spain
| | - Fernando G Benavides
- 1 CiSAL, Center for Research in Occupational Health, Universitat Pompeu Fabra, Barcelona, Spain2 CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Elena Ronda
- 1 CiSAL, Center for Research in Occupational Health, Universitat Pompeu Fabra, Barcelona, Spain2 CIBER Epidemiología y Salud Pública (CIBERESP), Spain4 Preventive Medicine and Public Health Area, University of Alicante, Alicante, Spain
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Fitness for detention in police custody: a practical proposal for improving the format of medical opinion. J Forensic Leg Med 2013; 20:980-5. [PMID: 24237804 DOI: 10.1016/j.jflm.2013.07.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 04/08/2013] [Accepted: 07/22/2013] [Indexed: 11/23/2022]
Abstract
Health issues among arrestees are a worldwide concern for which only local policies have been established. Physicians attending detainees in police custody are expected to decide whether the detainee's health status is compatible with detention in a police station and make any useful observations. A high degree of heterogeneity in the information collected by the physician and transmitted to the police has been observed. We analyzed the content and limitations of available documents and developed a model that could serve as a guide for any attending physician. The document presented here has been used in France on over 50,000 occasions since June 2010. We developed a two-page template consisting of (1) a standard medical certificate to be sent to the authority who requested the doctor's attendance and (2) a confidential medical record, not sent to the requesting authority. We evaluated perceived health by the three global health indicators of the Minimum European Health Module and used DSM IV criteria for the evaluation of addictive disorders. In the case of recent traumatic injuries, the certificate has also included the collection of data on traumatic injuries and the contexts of their occurrence. The proposed certificate achieved several goals, by protecting the interests of the person examined, in case of poor conditions of arrest or detention, protecting doctors in cases of legal proceedings, and allowing epidemiological data to be collected. The certificate may also contribute to an international awareness of medical care for detainees in police custody.
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What are the living conditions and health status of those who don't report their migration status? A population-based study in Chile. BMC Public Health 2012; 12:1013. [PMID: 23170824 PMCID: PMC3537744 DOI: 10.1186/1471-2458-12-1013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 11/14/2012] [Indexed: 11/19/2022] Open
Abstract
Background Undocumented immigrants are likely to be missing from population databases, making it impossible to identify an accurate sampling frame in migration research. No population-based data has been collected in Chile regarding the living conditions and health status of undocumented immigrants. However, the CASEN survey (Caracterizacion Socio- Economica Nacional) asked about migration status in Chile for the first time in 2006 and provides an opportunity to set the base for future analysis of available migration data. We explored the living conditions and health of self-reported immigrants and respondents who preferred not to report their migration status in this survey. Methods Cross-sectional secondary analysis of CASEN survey in Chile in 2006. Outcomes: any disability, illness/accident, hospitalization/surgery, cancer/chronic condition (all binary variables); and the number of medical/emergency attentions received (count variables). Covariates: Demographics (age, sex, marital status, urban/rural, ethnicity), socioeconomic status (education level, employment status and household income), and material standard of living (overcrowding, sanitation, housing quality). Weighted regression models were estimated for each health outcome, crude and adjusted by sets of covariates, in STATA 10.0. Results About 1% of the total sample reported being immigrants and 0.7% preferred not to report their migration status (Migration Status - Missing Values; MS-MV). The MS-MV lived in more deprived conditions and reported a higher rate of health problems than immigrants. Some gender differences were observed by health status among immigrants and the MS-MV but they were not statistically significant. Regressions indicated that age, sex, SES and material factors consistently affected MS-MVs’ chance of presenting poor health and these patterns were different to those found among immigrants. Great heterogeneity in both the MS-MV and the immigrants, as indicated by wide confidence intervals, prevented the identification of other significantly associated covariates. Conclusion This is the first study to look at the living conditions and health of those that preferred not to respond their migration status in Chile. Respondents that do not report their migration status are vulnerable to poor health and may represent undocumented immigrants. Surveys that fail to identify these people are likely to misrepresent the experiences of immigrants and further quantitative and qualitative research is urgently required.
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Cabieses B, Tunstall H, Pickett KE, Gideon J. Understanding differences in access and use of healthcare between international immigrants to Chile and the Chilean-born: a repeated cross-sectional population-based study in Chile. Int J Equity Health 2012; 11:68. [PMID: 23158113 PMCID: PMC3541972 DOI: 10.1186/1475-9276-11-68] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 11/05/2012] [Indexed: 11/17/2022] Open
Abstract
Introduction International evidence indicates consistently lower rates of access and use of healthcare by international immigrants. Factors associated with this phenomenon vary significantly depending on the context. Some research into the health of immigrants has been conducted in Latin America, mostly from a qualitative perspective. This population-based study is the first quantitative study to explore healthcare provision entitlement and use of healthcare services by immigrants in Chile and compare them to the Chilean-born. Methods Data come from the nationally representative CASEN (Socioeconomic characterization of the population in Chile) surveys, conducted in 2006 and 2009. Self-reported immigrants were compared to the Chilean-born, by demographic characteristics (age, sex, urban/rural, household composition, ethnicity), socioeconomic status (SES: education, household income, contractual status), healthcare provision entitlement (public, private, other, none), and use of primary services. Weighted descriptive, stratified and adjusted regression models were used to analyse factors associated with access to and use of healthcare. Results There was an increase in self-reported immigrant status and in household income inequality among immigrants between 2006 and 2009. Over time there was a decrease in the rate of immigrants reporting no healthcare provision and an increase in reporting of private healthcare provision entitlement. Compared to the Chilean-born, immigrants reported higher rates of use of antenatal and gynaecological care, lower use of well-baby care, and no difference in the use of Pap smears or the number of attentions received in the last three months. Immigrants in the bottom income quintile were four times more likely to report no healthcare provision than their equivalent Chilean-born group (with different health needs, i.e. vertical inequity). Disabled immigrants were more likely to have no healthcare provision compared to the disabled Chilean-born (with similar health needs, i.e. horizontal inequity). Factors associated with immigrants’ access to, and use of, healthcare were sex, urban/rural status, education and country of origin. Conclusion There were significant associations between SES, and access to and use of healthcare among immigrants in Chile and a higher prevalence of no health care provision entitlement among poor and disabled immigrants compared to the Chilean-born. Changing associations between access and use of healthcare and SES among immigrants in Chile over time may reflect changes in their socio-demographic composition or in the survey methodology between 2006 and 2009. Resumen
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Affiliation(s)
- Baltica Cabieses
- Faculty of Medicine Universidad del Desarrollo, Avenida Las Condes 12,438 Lo Barnechea, Santiago, Chile.
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Kaoutar B, Mathieu-zahzam L, Lebas J, Chauvin P. La santé des migrants consultant la policlinique Baudelaire de l’hôpital Saint-Antoine à Paris, France. ACTA ACUST UNITED AC 2012; 105:86-94. [DOI: 10.1007/s13149-012-0227-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 02/28/2012] [Indexed: 11/30/2022]
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