Des pratiques à risque favorisant la survenue d'abcès cutanés chez les personnes qui injectent des substances : résultats de l’étude ANRS-OUTSIDER

IntroductionCutaneous abscesses are a common complication of intravenous substance use. Although these skin and soft tissue infections represent one of the main causes of emergency room visits and hospitalizations in people who inject drugs (PWID), data on their prevalence and causes are scarce. The present study was part of the larger ANRS-OUTSIDER project and aimed to study the factors associated with skin abscesses in PWID, focusing in particular on the different stages of injection.MethodAnalyses were based on data of the 164 persons who regularly injected psychoactive substances participating in the French ANRS-OUTSIDER project. A face-to-face questionnaire collected data on sociodemographics, substance use, injection practices, and experience of skin abscesses in the previous six months. Factors associated with skin abscesses were studied using a logistic regression model.ResultsOf the 140 participants for whom abscess data were recorded at inclusion, 35% reported having a skin abscess in the previous six months. Factors associated with skin abscesses were: benefiting from universal health coverage (PUMA/CMU/AME) (Odd ratio (OR) = 0.28, confidence interval (CI) à 95%=0.08–0.99), finding the vein to inject by touch (OR=3.44, 95% CI=1.41–8.43) and licking the needle before injection (OR=5.16, 95% CI=1.10–24.30).ConclusionOur results highlight that skin abscesses were very frequent among the complications observed in our sample of French PWID, and that certain injection practices fostered their occurrence. These data will provide stakeholders with useful information to improve prevention and harm reduction messages for PWID.     

Disparités géographiques d’évolution d’incidence des cancers de la thyroïde par taille entre 1983 et 2000 en France

BackgroundThe aim of this investigation was to study geographic time trends of thyroid cancer incidence according to tumor size in France, 1983 to 2000.MethodsIncidence data were provided from six French registries over the period 1983–2000 covering seven administrative districts. Five tumor size groups were distinguished: < 10 mm, 10–20 mm, 20–40 mm, > 40 mm and unknown size. Papillary cancers diagnosed in women were analyzed according to tumor size in each geographic area. World age standardized rates were calculated and annual percent change rates were estimated for each tumor size group in each geographic area. Loglinear Poisson regression models were used to study geographic discrepancies in time trends incidences.ResultsThe six French registries included 2222 papillary thyroid cancers in women between 1983 et 2000. Thyroid cancer incidence was increasing in the six geographic areas. Geographical variations in time trends incidence between registries reflected geographical variations in time trends incidence of small sized tumors (less than 10 mm).ConclusionWide geographic variations in thyroid cancer incidence were noticed for small size tumors, which may be correlated with geographic variations in medical practices.     

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.     

La prévention des maladies cardiovasculaires et des cancers dès l’école primaire : « Être & Savoir,l’école de la santé », évaluation d’une intervention sur 2207 enfants

BackgroundAn assessment of the primary school prevention program “To be and to behave, the health school” was necessary to pursue the activity and enable the development of health education at school.Methods“To be and to behave, the health school” is a health education program designed for primary school pupils in the Auvergne region in France whose targets are primary prevention of cardiovascular diseases and cancers. The program involves a three steps sequence: delivery of a teaching kit, intervention of a health bus, health olympiads. The health assessment focused on resources allocated (program content and functioning of tools created for the program), processes employed (number of schools voluntarily participating and number of pupils who effectively participated with the olympiads of the “health” bus), immediate impact (short-term knowledge acquired by pupils, by class, before the bus arrived and during the olympiads).ResultsThe program involved the participation of 28 schools, 90 classes and 2,137 children. The tools conceived were well adapted. Knowledge scores achieved in the different domains of the program fields progressed significantly for participating classes (p < 10^?5) except for smoking where pupils’ knowledge was already good (baseline score = 14.42/20). This progression in knowledge was better in participating schools than in control schools (p < 0.05).ConclusionThe program “To be and to behave” has enabled pupils to progress in their health knowledge. The present results are currently being considered for continuing the program.     

Apport de la téléconsultation et de l’isolement des cas symptomatiques dans la maîtrise de l’épidémie COVID-19 au sein d’une base militaire

BackgroundThe first wave of COVID-19 swept over France during the first quarter of 2020, leading to saturation of the health care system. We wished to study, in a French military medical unit assisting one of the country's largest armed forces populations, the impact of teleconsultation and the systematic isolation of all possible, probable and confirmed cases of COVID-19.MethodsThis is a retrospective study carried out from March 9 to May 31, 2020 on the basis of our activity register. The variables collected included type of medical consultation procedure, occupational status, classification of cases and date of onset of first symptoms. We have paralleled our activity with that of SOS Médecins and the emergency departments of the Île-de-France region.Results/discussionDuring this period, 1719 episodes of care (teleconsultations or physical consultations) were recorded, of which 91% (n = 1561) were linked to COVID-19. We identified 598 “suspected” (possible and probable) and confirmed cases. “Isolated” teleconsultations (not followed by a face-to-face medical consultation, sample taking or necessitating the dispatch of prompt assistance) represented 86% of episodes of care (n = 1482). Comparison of our activity and the number of new cases with the databases of SOS Médecins and the Île-de-France emergency services suggests that our isolation strategy was timely and effective.ConclusionThe contribution of teleconsultation was substantial and reassuring. Teleconsultation makes it possible to absorb a large volume of patients, is easy to implement, and entails no nosocomial risk. Isolation of infected patients should be a priority during an outbreak. Once it has become a priority to rapidly bring an epidemic under control, this attitude must be extended to all symptomatic patients.