Prévention des grossesses non prévues chez les jeunes en France : pour une double protection des premiers rapports sexuels ?

BackgroundDespite the expanded range of contraceptive options and the fact that the first acts of intercourse are well protected, abortion rates among young women in France have increased in the last 15 years. These contraceptive failures could result from the lower effectiveness of the condom compared with the pill, and/or the occurrence of contraceptive gaps when switching from the condom to the pill. Adding to the existing literature, this paper explores the conditions by which women and men discontinue using the condom.MethodsThe study sample was comprised of 1552 men and 1849 women under the age of 30, who participated in the National Survey on Sexual Health in France. Respondents answered questions on contraceptive use, duration of condom use, condom discontinuation and the switch to another method of contraception at the time of condom discontinuation in the context of their first and last sexual relationships.ResultsCondoms, used by a large majority of respondents during the first acts of intercourse, were rapidly discontinued in favor of other methods, particular the pill, for continuing relationships. However, one in ten respondents (women and men alike) had unprotected intercourse after condom discontinuation, when condom use was discontinued in the first trimester of their relationship. Abortions were more frequent among respondents who reported they did not use a condom at the start of a relationship or among women who did not switch to another form of contraception after discontinuing condom use.ConclusionWhile condoms are widely used during the first acts of intercourse, the rising abortion rates among young people suggests frequent contraceptive failures, which partly result from unprotected intercourse following condom discontinuation. These results question the dichotomy between HIV campaigns based on condom use and campaigns to reduce unintended pregnancies, which promote use of other forms of contraception, such as the pill. To reduce the incidence of unprotected intercourse, it would be important to promote the use of condoms at sexual debut, both as a contraceptive and preventive method against STIs, and provide counseling about all available contraceptive options, including the use of emergency contraception as a backup option in case of errors of use of the condom.     

Les soins ordonnés par la Justice en France : principes des procédures et place du médecin

BackgroundPenaly ordered care constitutes a type of legal penalty and a form of special care, linking health and legal environments, and as such is a difficult exercise for the various parties involved.MethodsThis article is based on a comprehensive study of medical and legal literature on the subject.ResultsEach of the measures presented has a legal basis, procedures for implementation and different application fields. According to the measure, the caregiver has a defined role in the organization of care and flexibility in dealing with specific legal authorities. Doctors are often uncertain of their rights and duties in this type of care.ConclusionPenaly ordered care requires cooperation between two professional bodies with different ethical and professional requirements. Beyond this first difficulty, it appears that these measures are also complicated by the many pieces of legislation published recently, stressing the political will of the ever-expanding scope of ordered care, despite the lack of means downstream, sometimes to the detriment of their effectiveness.     

La planification des médecins en Europe : une revue de la littérature des modèles de projection

Background

Healthcare is a labor-intensive sector in which half of the expenses are dedicated to human resources. Therefore, policy makers, at national and internal levels, attend to the number of practicing professionals and the skill mix. This paper aims to analyze the European forecasting model for supply and demand of physicians.

Les accidents en France : évolution et facteurs associés

BackgroundWhatever the type of injury considered, prevention requires an improvement in health services’ awareness of risk factors. The Health Barometer is a general population survey conducted in France since 1992 to contribute to surveillance in this field. The survey's statistical power and the numerous health topics included in the questionnaire provide accurate information for healthcare professionals and decision-makers.MethodsThe Health Barometer 2010 was a nationwide telephone survey of 9110 persons representative of the 15–85-year-old population. One part of the questionnaire detailed injuries which had occurred during the past year. The numerous variables recorded enabled application of logistic regression models to explore risk factors related to different types of injury by age group. The findings were compared with the Health Barometer 2005 data to search for temporal trends of injury prevalence.ResultsThe data analysis showed that 10.3 % of the 15–85-year-olds reported an injury during the past year. This rate was higher than recorded in 2005; the increase was mainly due to domestic accidents and injuries occurring during recreational activities. Both type of injury and risk factors exhibited age-related variability. Domestic accidents and injuries occurring during recreational activities predominated in the older population and were associated with physical or mental health problems (chronic disease, diability, sleep disorders). For younger people, injuries were related to cannabis use, drunkedness, and insufficient sleep. Risk factors were also depended on type of injury: occupational accident-related injuries were linked with social disadvantage (manual worker population) whereas sports injuries were more common in the socially advantaged population.ConclusionThis survey confirms established knowledge and highlights, at different stages of life, new risk factors that contribute to injuries in France. These findings should be helpful for the development of adapted injury prevention programs, by providing a better understanding of the characteristic features of this major public health issue.     

Faut-il une prise en charge spécifique des migrants infectés par le VIH en France ?

Immigrants living in France account for one third of new cases of infection and are a target population for prevention. Care givers should adapt their management practice, taking into account this population's specificities which are not restricted to cultural differences but include major socioeconomic factors. In addition to training on alien rights and basic sociocultural knowledge, care-givers (especially clinicians) must spend more time with the patient (especially at the beginning of the relationship) and accept sharing the "medical power" with other people with a better knowledge of other aspects of the patients' life in addition to the medical one. As in other chronic diseases, mediation is one of the available tools with evident benefits for any patient. Assuming compliance is the same for migrants as for other patients, using this mediation will warrant therapeutic success.     

Quels facteurs influencent la pratique du dépistage des cancers féminins en France ?

BackgroundThe two aims of the study were, first to estimate the declared two-year coverage of breast cancer and cervical cancer screenings, and second to determine the main factors influencing female cancer screening behaviors.MethodsThree groups of women from the 2003 French decennial health interview survey were analyzed: 3378 women aged 50–74 years who answered the question on mammography use, 7912 women aged 25–65 years who answered the question on Pap-smear use, and 2528 women aged 50-65 years who answered both questions.ResultsThe declared coverage of breast cancer screening was 71.2%, the declared coverage of cervical cancer screening was 76.3%. Almost 18% of women declared having undergone neither a mammography nor a Pap-smear in the last two years. The main factor linked to a more frequent practice of one or both cancer screenings (breast or cervix) was to have undergone recently the other screening. The other factors linked to mammography use were mainly healthcare and practitioner access variables. Those linked to Pap-smear use were mainly socioeconomic and socio-demographic variables, healthcare and practitioner access variables being also linked. The main factors linked to having undergone none of these two screenings were of financial nature, particularly household income and home ownership.ConclusionThe study showed that it is appropriate to communicate on both screenings at the same time since they have a positive effect each other. Finally, practitioners continue to play a central role in collecting information on cancer screenings and encouraging screening in women not regularly screened.     

Tous les acides gras saturés ont-ils le même effet métabolique ?

Saturated fatty acids (SFA), widely found in food, participate in the development of certain metabolic abnormalities such as insulin resistance or atherosclerosis. However, all SFA have different metabolic fate. For example, palmitic acid (which consists of 50 % of palm oil versus a maximum of 17 % for other oils such as peanut oil), unlike other SFA as stearic acid, is a potent inhibitor of intracellular insulin pathways in some tissues such as skeletal muscle. This SFA is also considered as a pro-inflammatory SFA because it activates the inflammatory response in different cell types, such as the adipocyte, particularly during the postprandial period. The postprandial inflammation also seems to be exacerbated in obese patients because of the ability of adipose tissue to produce cytokines. Finally, this class of fatty acids is likely involved in the development of atherosclerosis because it causes increased plasma concentration of LDL-cholesterol. Taken as a whole, the current overconsumption of SFA, especially palmitic acid, is a key player in the expansion of certain metabolic diseases such as cardiovascular disease or metabolic syndrome.