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Background In this study, we aim to measure and compare the frequency of reported denial of care in sub-Saharan African migrants living in the Paris area, according to their HIV and HBV status and social and migration characteristics. Methods The ANRS-PARCOURS study is a life-event survey conducted in 2012-13 in healthcare facilities in the Paris area, among three groups of sub-Saharan migrants recruited in primary care centres (N = 760; reference group), in dedicated centres for HIV care (N = 922; HIV group) and in centres for chronic hepatitis B care (N = 777; CHB group). Characteristics associated with refusal of care since arrival in France were identified using a logistic regression model. Results Compared to the reference group (6%, P < 0.001), the reported refusal of care was twice as high in the HIV group (12%) and the CHB group (10%). In the multivariate analysis, men and women living with HIV were at greater risk of being denied care (aOR = 2.20[1.14-4.25] and 2.24[1.25-4.01]). Women covered by the specific health insurance (HI) for precarious or undocumented migrants were also at higher risk (aOR = 2.07[1.10-3.89] and 2.69[1.18-6.10], respectively). The risk was also increased in men who remained for at least one year without permit of residence or without HI and among those who were threatened in their country. Conclusion Refusals to provide healthcare are frequent and deleterious situations especially for migrants living with HIV. Health decision makers, public insurance bodies and health professional councils must address this issue to improve equity in the healthcare system.

International audience; OBJECTIVE: RA and axial SpA have an important impact on patients' lives. The objective of this study was to explore the reporting of different aspects of that impact in publications, with a focus on differences between diseases and over time. METHODS: A systematic literature review retrieved all articles reporting on the life impact of RA or axial radiographic SpA in adults published within the last 10 years and issued from European research. The data were classified into physical impact (including pain, functional assessment and fatigue), psychological impact (including psychological distress and coping) and social impact (including relationships, family and social life). The number of articles published over time was analysed by linear regression. RESULTS: In all, 1352 abstracts were screened and 149 publications (40 056 patients) were analysed: 129 articles (86.5%) concerned RA and 16 (10.7%) concerned axial SpA. The mean number of articles reporting on the physical aspects of impact was 11.4 (s.d. 4.8) per 2-year period, but increased more than 2-fold (from 7 articles in 2001-3 to 15 in 2010-11), in particular due to recent publications on fatigue, whereas the number of articles on psychological aspects [mean 12.4 (s.d. 4.0)] decreased markedly after 2006. Publications reporting on social aspects [mean 8.2 (s.d. 4.1)] remained globally stable. CONCLUSION: In the era of biologics, there is an interest in the patient-perceived life impact of RA and axial SpA in the European literature, but the impact of RA has been the subject of greater exploration. There are clearly trends over time in the reporting of impact.

Background: The social inequalities in health have endured or even worsened comparatively throughout different social groups since the 1990s. Our objective was to identify the individual characteristics (socio-economic status, living conditions, individuals' social integration, health beliefs, expectations and representation and psychological characteristics) statistically associated with the fact of stating (or not) that healthcare had been forgone because of cost. Methods: In this cross-sectional, multi-centre study we randomly selected a study sample from five underprivileged areas in the Paris region. A multiple logistic regression model was used to calculate the odds ratios (OR) and 95% confidence interval (CI). The validity of the model was assessed by goodness-of-fit tests (Pearson and deviance) and by the study of 100 bootstrap samples. Results: After making adjustments for numerous individual socio-economic and health characteristics, we observed a higher occurrence of reported forgone healthcare among people who have had financial worries during adulthood [ORyes/no=5.47 (1.44−20.75)], a life-course experience of physical, sexual or psychological abuse [ORyes/no=2.86 (1.40−5.84)]; who have experienced childhood difficulties [OR1/never difficulties=5.28 (1.81−15.39), OR2−4/never=7.62 (2.69−21.57), OR>4/never=8.57 (2.39−30.80)]; who have expressed a low degree of sickness orientation [ORlow/high=2.62 (1.33−5.14)], a high worry/concern about health [ORhigh/low=2.71 (1.33−5.50)] and a low self-esteem [ORmedium/high=8.28 (1.44−47.64), ORlow/high=16.44 (2.81−96.24)]. Conclusion: Aside from purely financial hurdles, other factors play a role in the non-use of healthcare services. Health policies mainly promoting equal financial access to healthcare have little chance of abating health inequalities.

Background: Both the predictors for tobacco use and the determinants of the amounts of tobacco consumed by smokers should be taken into account when designing prevention programmes. Methods: Using a sample of 12,948 individuals representative of the French population in 1999, multilevel models were used to carry out a comparative investigation for the predictors of tobacco use and the determinants of the amount of tobacco consumed by smokers. Results: At the individual level, a combination of risks (higher risk of smoking and larger amounts of tobacco consumed by smokers) was found for males, for individuals with a low level of education and for divorcees. At the level of the area of residence, both the risk of smoking (odds ratio 1.07, 95% confidence interval: 1.01–1.12 for an increase by one standard deviation) and the amount of tobacco consumed among smokers (percentage variation +4%, 95% confidence interval: 0% – +8%) increased with the gross domestic product per capita. Conclusion: This study justifies the combined use, in such analyses, of consumption levels for smokers in addition to the risk of smoking, in order to identify the profiles with the highest risk. It was possible to identify various groups with both a high risk of tobacco use and a high level of consumption among smokers, on the basis of individual (male, divorced or less educated) and environmental (living in a high GDP area) factors. The prevention efforts should thus be focused on such groups. Received 10 October 2002. Accepted 4 December 2002.

Background The existence of a social gradient regarding the prevalence of depression is widely documented. A link between traumatic life events during childhood (TLEC) and depression in adulthood is also admitted but no French study has ever confirmed that it can be modulated by the social status of individuals. Our goal was to figure out whether the combination of TLEC and depression in adulthood was similar, or not, in various social groups. Methods Conducted in 2010, the third wave of the …

Background Smear test and mammography are medically indicated for the prevention of cervical and breast cancers, respectively. While higher rates of cancer among homeless women persist, little is known about the cancer screening (CS) prevalence and correlates among this population in France. Moreover, in Paris area, the number of sheltered families has tripled in the last ten years. The objective of this study was to identify the factors associated with the lack of participation in screening for breast …

Background. The attitude of general practitioners (GPs) to public health surveillance is not well documented, even though they furnish essential information, in particular for sentinel surveillance among the general population. Methods. The attitude of 560 French GPs to the surveillance of 17 communicable diseases was researched. Half the GPs had previous experience in public health surveillance and the other half did not. Their motivation for belonging to a public health surveillance network and some of their demographic characteristics were also investigated. Their attitude was compared with an obiective evaluation of public health surveillance priorities, based on 10 criteria. Results. Primarily, GPs are interested in the surveillance of uncommon and serious diseases (HIV infection, tuberculosis, meningitis), and/or preventable ones (viral hepatitis, flu' syndrome, measles, sexually transmitted diseases), which coincides with the choices made by public health decision makers. The age of the GPs, their type of practice (urban/rural), and their participation (or not) in a surveillance network modify their priorities: in general the GPs' perception of the risks to which their patients may be exposed influences their choice of which diseases should be subject to surveillance in general medicine