Inégalité de détresse psychologique entre les hommes et les femmes en emploi : vulnérabilité ou expression genrée du stress?

IntroductionThis study aims to compare the vulnerability hypothesis and the expression hypothesis to explain a greater level of psychological distress among working women than among working men.MethodThe two hypotheses were contrasted by integrating work stressors, family stressors, work-family conflicts and psychosocial resources. The conceptual models were tested by using multilevel path analyses on 2026 employees in Quebec (Canada) based in 63 work establishments.ResultsResults partially supported both hypotheses. According to the vulnerability hypothesis, single parenting, child-related problems and self-esteem were indirectly involved in the variation of psychological distress among women through family-to-work, otherwise known as work-family conflict. According to the expression hypothesis, although family-to-work conflict was closely associated with more psychological distress among women, this stressor was also closely associated with higher at-risk alcohol consumption among men. Couple-related problems and a sense of control likewise played a role in the expression mechanism through family-to-work conflict.ConclusionThese results underline the importance of considering that gender contributes to mental health inequalities through multiple mechanisms. They also call for a distinction between the two directions of work-family conflict as gendered mediators.     

Déterminants de la rage humaine au Maroc : variabilité génétique,qualité du vaccin ou prise en charge insuffisante

Objectives: The authors wanted to determine the cause of a recent upsurge of rabies cases in Morocco.Results: Serum levels of anti-rabies antibodies were superior to 0.5 IU/ml in all vaccinated persons tested after exposure. Assessing the efficacy of rabies vaccines and sera administered to people exposed to rabies showed that the quality of products was good. Sequence comparisons between circulating wild rabies virus and vaccine strains allowed us to show that rabies virus strains circulating in Morocco were related to Group 1 ‘Africa’, genetically identical to strains used as vaccine seed worldwide. Assessing the quality of management indicated that death from rabies could be due to inadequate prophylaxis.Conclusion: Our study clearly demonstrated that death from rabies was not related to genetic variability of circulating viruses, failure of the vaccination, or to poor quality of vaccines and sera, but rather to insufficient and inadequate therapeutic management.     

Activité physique,nutrition et obésité

This review presents the various benefits of physical activity in obese patients and proposes a therapeutic strategy to include this important element in overall obesity management. Physical activity counseling includes structured endurance and resistance exercise training, promotion of lifestyle physical activity as well as limitation of sedentary behavior. The favorable effects of physical activity in obesity management are many but of varying importance. Weight maintenance after weight loss is considered the main benefit but requires higher volume of exercise than recommended for health maintenance in the general population. Other substantial benefits concern maintenance of body composition and improvement of obesity-related comorbidities, especially cardiometabolic complications. Programs and benefits of physical activity in the specific situation of weight loss after bariatric surgery need further research. Following a therapeutic education process aiming at sustained behavior modification, the goals for physical activity counseling need to be tailored to individual situations and barriers (physical/physiological, personal, environmental) should be carefully considered. Specific physical activity programs, when initiated in the health care sector, benefit from the input of physical activity educators. Maintenance of programs over time requires collaboration with stakeholders such as physical activity associations, sports clubs and obese patients organizations.     

Santé et instabilité professionnelle : résultats issus des centres d’examens de santé de l’assurance-maladie

BackgroundJob insecurity has increased over the last 30 years. Socioeconomic changes have led to various insecure employment categories, including fixed term employment, part time employment and government sponsored jobs. This study was aimed at investigating relationships between employment status and health.MethodsThe study population was composed of 767 184 people, aged 26 to 59 years, examined between 2003 and 2005 in the Health Examination Centers of the French General Health Insurance. Employment status was defined using insecure employment (combining permanent/fixed-term contracts and part-time/full time), government sponsored jobs and duration of unemployment (from < 6 months to ≥ 3 years). Health indicators were poor perceived health, smoking, lack of gynecological follow-up, obesity, untreated caries and high blood pressure. Data were analysed by logistic regression (odds ratios [OR]) adjusted on age, occupational social class and education level, the reference category being permanent full time contracts (OR = 1).ResultsSignificant level-dependent relations with health were observed between non permanent versus permanent employments, part time versus full time. Most OR of unemployed people were higher than those of having employment and increased with duration of unemployment. For example, for poor perceived health in men, OR ranged between 1.00 and 1.68 (95%CI 1.57–1.78) according to job insecurity categories, and between 1.75 (95%CI 1.67–1.83) and 2.80 (95%CI 2.72–2.89) according to duration of unemployment. For obesity in women, OR increased from 1.00 to 1.48 (95%CI 1.37–1.60) in active women and from 1.35 (95%CI 1.27–1.44) to 1.77 (95%CI 1.70–1.84) in unemployed.ConclusionsThis study showed quantitative relationships between job insecurity, unemployment and health. In particular, workers having government-sponsored jobs and long-time unemployed people were at high risk of health problems.     

Le comité de retour d’expérience (CREX) : une méthode pour l’amélioration de la sécurité des soins

BackgroundAn experience feedback committee (CREX, Comité de Retour d’EXpérience) is a method which contributes to the management of safety of care in a medical unit. Originally used for security systems of civil aviation, the method has been adapted to health care facilities and successfully implemented in radiotherapy units and in other specialties.MethodsWe performed a brief review of the literature for studies reporting data on CREX established in hospitals. The review was performed using the main bibliographic databases and Google search results.ResultsThe CREX is designed to analyse incidents reported by professionals. The method includes monthly meetings of a multi-professional committee that reviews the reported incidents, chooses a priority incident and designates a “pilot” responsible for investigating the incident. The investigation of the incident involves a systemic analysis method and a written synthesis presented at the next meeting of the committee. The committee agrees on actions for improvement that are suggested by the analysis and follows their implementation. Systems for the management of health care, including reporting systems, are organized into three levels: the medical unit, the hospital and the country as a triple loop learning process. The CREX is located in the base level, short loop of risk management and allows direct involvement of care professionals in patient safety.ConclusionSafety of care has become a priority of health systems. In this context, the CREX can be a useful vehicle for the implementation of a safety culture in medical units.     

Inégalités sociales,de santé du constat à l’action – Intérêt de la mise en place d’un accompagnement personnalisé pour la réduction des inégalités sociales en cancérologie

The impact of social factors on healthcare inequality is well-recognized in many industrialized countries and involves a wide range of pathological conditions (cardiovascular disease, cancer, etc.). In general, the poorest indicators of health are observed in socially disadvantaged populations. Beyond this observation is the question of actions taken to prevent the formation of social inequality in healthcare. The purpose of this work was to evaluate the potential contribution of an intervention tool called the "patient navigator", used in English-speaking countries and to determine its feasibility in France.     

Où trouver des données pour la pharmacoépidémiologie en France ? Quelques idées

Prior to the conduct of a pharmacoepidemiologic study, it is necessary to obtain the following: 1) A literature review to identify previous studies conducted on the issue of interest; 2) Data on the profiles of use of the drugs of interest (i.e. frequency of exposure, demographic characteristics of users…). In France, there is currently no database, which routinely collects this type of information. In this paper, we provide a list of sources of information on drugs available in France that we have identified. These sources are scattered and highly heterogeneous in terms of available information and access requirements.     

Dépistage des bactériuries à l'admission chez les patients diabétiques : peut-on abandonner les examens cytobactériologiques urinaires systématiques ?

OBJECTIVES AND METHOD: The discordance between test by urine dipstick (nitrites and leucocyte-esterase) and analysis in laboratory, with urinary culture on the same sample was studied in diabetic patients, from October 2000 to May 2002, to eventually stop systematic laboratory test. The dipstick result (Clinitek 20 Bayer) was classified as "possibility of bacteriuria" if one of the two tests was positive. Bacteriuria was considered significant if the laboratory test result gave, at least 10(5) bacteria per mL, (one strain), and at least 10(4) leucocytes. The out point was the dipstick negative predictive value (NPV). RESULTS: The study included 683 patients. The dipstick result was "possibility of bacteriuria" in 153 cases (22.4%). Thirty-nine bacteriuria (5.7%) were reported, including 2 dipstick false negatives. The NPV was 99.6% [IC 95% : 99.1-100]. CONCLUSION: The systematic laboratory tests were stopped.