J Lebas

Unité Inserm U1077, Caen, Lower Normandy, France

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Publications (77)182.18 Total impact

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    ABSTRACT: Introduction La prévalence de la dépression en France est deux fois plus élevée dans les milieux sociaux les plus défavorisés. Les conséquences des per-ceptions de cette pathologie sur les recours aux soins sont connues mais on sait peu de choses sur les facteurs associés à l'absence de recours aux soins. Objectif Déterminer les raisons de non consultation en soins primaires lors d'un épisode dépressif chez les patients précaires. Méthodes Enquête qualitative suivie d'une étude statistique transversale auprès de patients consultant en PASS en 2010. Des régressions logistiques ont analysé les caractéristiques associées à l'absence de consultation. Résultats L'analyse qualitative a permis de définir quatre thèmes concernant les motifs de non recours au médecin traitant lors d'un épisode dépressif : la perception de la dépression, de ses traitements, le soutien de l'entourage, et la relation médecin malade. L'analyse statistique montre que seuls 52,8 % des déprimés en ont parlé à leur médecin. Les hommes, les personnes de nationalité étrangère, et celles avec une assurance maladie incomplète en parlant signifi-cativement moins fréquemment. La perception péjorative de la maladie et de ses traitements sont les principaux freins à la consultation. La relation méde-cin malade est le motif le moins fréquemment cité, mais près de la moitié des patients pense que leur médecin ne serait pas attentif à ce problème ; ce dernier point étant particulièrement cité par les hommes et les étrangers. Discussion Vus sa prévalence et les freins observés pour consulter, la recherche d'une dépression devrait être plus systématique dans les patientèles précaires. Mot clé Dépression Déclaration d'intérêts Les auteurs n'ont pas transmis de déclaration de conflits d'intérêts.
    VIe Congrès International d’Épidémiologie ADELF-EPITER, Nice; 09/2014
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    ABSTRACT: Inequality in health care is a growing problem, leading to the development of different tools for the assessment of individual deprivation. In France, three tools are mainly used: Epices (which stands for "score for the evaluation of social deprivation and health inequities among the centers for medical examination"), a score called "Handicap social" and a screening tool built for medical consultations by Pascal et al. at Nantes' hospital. The purpose of this study was to make a metrological assessment of those tools and a quantitative comparison by using them on a single deprived population.
    Revue d Épidémiologie et de Santé Publique 08/2014; 62(4):237-47. · 0.69 Impact Factor
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    ABSTRACT: In the context of the French National Health Service, a free access to healthcare facilities (the PASS: "permanence d'accès aux soins de santé") has been implanted in 2000 for patients without health insurance or those dealing with financial hardship. There is few data about socio-demographic characteristics of the patients using these services. The objective of this study was to provide descriptive data about socio-demographic characteristics and motivation of those patients who use these clinics.
    La Revue de Médecine Interne 08/2014; · 0.90 Impact Factor
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    ABSTRACT: Few data exist on the health status and heath care 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.
    Journal of Immigrant and Minority Health 08/2014; · 1.16 Impact Factor
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    ABSTRACT: Background Inequality in health care is a growing problem, leading to the development of different tools for the assessment of individual deprivation. In France, three tools are mainly used: Epices (which stands for “score for the evaluation of social deprivation and health inequities among the centers for medical examination”), a score called “Handicap social” and a screening tool built for medical consultations by Pascal et al. at Nantes’ hospital. The purpose of this study was to make a metrological assessment of those tools and a quantitative comparison by using them on a single deprived population. Methods In order to assess the metrological properties of the three scores, we used the quality criteria published by Terwee et al. which are: content validity, internal consistency, criterion validity, construct validity, reproducibility (agreement and reliability), responsiveness, floor and ceiling effects and interpretability. For the comparison, we used data from the patients who had attended a free hospital outpatient clinic dedicated to socially deprived people in Paris, during one month in 2010. The “Handicap social” survey was first filled in by the 721 outpatients before being recoded to allow the comparison with the other scores. Results While the population of interest was quite well defined by all three scores, other quality criteria were less satisfactory. For this outpatient population, the “Handicap social” score classed 3.2% as non-deprived (class 1), 32.7% as socially deprived (class 2) and 64.7% as very deprived (class 3). With the Epices score, the rates of deprivation varied from 97.9% to 100% depending on the way the score was estimated. For the Pascal score, rates ranged from 83.4% to 88.1%. On a subgroup level, only the Pascal score showed statistically significant associations with gender, occupation, education and origin. Conclusion These three scores have very different goal and meanings. They are not interchangeable. Users should be aware of their advantages and disadvantages in order to use them wisely. Much remains to be done to fully assess their metrological performances.
    Revue d'Épidémiologie et de Santé Publique. 01/2014;
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    ABSTRACT: Purpose In the context of the French National Health Service, a free access to healthcare facilities (the PASS: “permanence d’accès aux soins de santé”) has been implanted in 2000 for patients without health insurance or those dealing with financial hardship. There is few data about socio-demographic characteristics of the patients using these services. The objective of this study was to provide descriptive data about socio-demographic characteristics and motivation of those patients who use these clinics. Methods This descriptive cross-sectional study was conducted between April an May 2008, in 5 PASS clinics from academic tertiary hospitals in Paris. Descriptive data on patient were collected by general practitioners at the end of their consultations. Results This study included 581 patients. The mean age was 42 years, and 65% of patients were males. Only 50.9% declared a salary income and 38.5% had a health insurance. Half of the patients were homeless, and 80% were migrants. The main reasons to visit these health facilities were direct access (no appointment needed), being in financial difficulty and having a medical record in the same hospital. Half of the patients had one chronic disease at least, while only a third of them saw regularly a physician. A total of 834 diseases were found among the 581 patients, including 411 chronic diseases, and 17% of the patients had a psychologic or a psychiatric disorder. Prognosis was divided in three grades: good, low and poor. Almost a half of the patients were considered by the doctor as having a low or a poor prognosis if they would not receive a therapy. Conclusions The findings of this study suggest that the PASS carry out their mission: most of the patients frequenting these facilities live under poor conditions and are in poor health status compared to the patients having access to conventional outpatient services.
    La Revue de Médecine Interne. 01/2014;
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    ABSTRACT: Data on the prevalence of depression and on how a depressive episode prompts the sufferer to seek primary care are not scarce, but the available evidence on the prevalence of depression among immigrants and poor people who frequent general practice facilities is scarce. The Baudelaire Outpatient Clinic at the Saint-Antoine Hospital in Paris provides free medical and social assistance to the poor and/or uninsured. The goal of our study was to estimate the prevalence of depression among these outpatients, to characterize this depressed population, and to analyze its demand for primary care for depressive episodes. From September to December 2010, we conducted a cross-sectional, observational survey among users of the Baudelaire Outpatient Clinic. French-speaking patients attending the clinic between September 15 and December 30, 2010 who agreed to answer a questionnaire administered face-to-face before their consultation were included in the study. The chi-squared test (or Fisher's exact test for small samples) was used for the comparisons of proportions. Logistic regression models were estimated, along with the odds ratios (OR) and their 95% confidence intervals (95% CIs), for the multivariate analysis of factors associated with depression and healthcare-seeking. Models were estimated separately for men and women, since sex was an interaction factor. The statistical analyses were performed using Stata v. 10 software (StataCorp LP, College Station, Texas, USA). Of the 250 patients included (mean age: 45 years), 52.0% were men and 52.4% were immigrants. Close to 40% of them reported having no supplemental health insurance. The estimated prevalence of depression in this population was 56.7%. Depression was more prevalent among the women, immigrants, and people from the poorer socioeconomic groups. Only half of these depressed patients, mostly women, reported having discussed their depression with a physician. French nationality and complete health insurance coverage were associated with more-frequent healthcare-seeking. Few patients reported having been asked about their morale by the physician they consulted, and almost 80% would have liked to be asked about this more often. Depression is a real public health problem, particularly among people from disadvantaged backgrounds, and should be included in their overall management.
    BMC Family Practice 10/2013; 14(1):151. · 1.61 Impact Factor
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    ABSTRACT: Les données sanitaires et sociales sur la population immigrée, en particulier sur celle en situation irrégulière de séjour, sont rares. La policlinique Baudelaire de l’hôpital St Antoine et sa PASS (Permanence d’accès aux soins de santé) reçoivent une majorité de patients migrants dont une grande partie de « sans-papiers ». Les objectifs de notre étude étaient de déterminer l’état sanitaire et social de la patientèle migrante, de comparer les immigrés réguliers et les « sans-papiers » et de déterminer les motifs principaux de migration. Une enquête descriptive transversale auprès de la population immigrée consultant à la policlinique Baudelaire de l’hôpital St Antoine à Paris a été conduite en avril et mai 2009. Au total, 536 patients ont été inclus. La moyenne d’âge de notre échantillon est de 45 ans; 62 % sont des hommes et 49 % sont sans-papiers. La moyenne d’ancienneté d’installation est de 12 ans (19 ans pour ceux en situation régulière et cinq ans pour les « sans-papiers »). Plus de 20 % d’entre eux n’ont pas de couverture sociale. Une majorité (55 %) des patients souffre d’une pathologie chronique. Les plus fréquentes sont l’hypertension (20 %), le diabète de type 2 (12 %), les maladies infectieuses chroniques — VIH, VHB et VHC — (7 %). Les motifs de migration sont majoritairement économiques (39 %), familiaux (19 %) et politiques (17 %). Les raisons de santé viennent au quatrième rang et concernent 9 % des patients. Les maladies chroniques prédominantes chez les migrants sont semblables à celles de la population générale des consultants en soins de santé primaire hormis les maladies infectieuses qui sont plus prévalentes. Les « migrations pour soins » représentent une faible proportion des motifs d’immigration. Pour cette population, les PASS constituent un point d’entrée irremplaçable dans le système de soins.
    Bulletin de la Société de pathologie exotique 05/2012; 105(2).
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    ABSTRACT: Social and health data on the immigrant population remain scarce in France, especially concerning those in irregular situation. The Baudelaire outpatient clinic in Saint- Antoine hospital in Paris (PASS, i.e. specific free medicosocial care for the poor, the uninsured or the undocumented patients) treats a majority of immigrants, a lot of them being in an irregular residence status. The objectives of this study were to describe the social and health status of the immigrant consultants, to compare regular and undocumented migrants and to describe their main reasons for migration. A cross-sectional, descriptive, survey among the immigrant consultants has been performed among this outpatient clinic in April and May 2009. In total, 536 patients were included. Their age mean was 45 years, 62% are male, 49% are in an irregular situation and they have been in France for 12 years in average (19 years for the regular immigrants and 5 years for the undocumented). More than 20% had no health insurance. A majority (55%) of patients were suffering from a chronic disease. The more frequent ones were hypertension (20%), type 2 diabetes (11.6%), chronic infectious diseases - HIV, HBV, HCV - (7%). Reasons for immigration were mostly economical (39%), family (19%) and political (17%). Health reasons were at the 4th rank and concerned 9% of the patients. The main chronic diseases observed among this population are similar to those of the general population of consultants in primary health care, except for the chronic infectious diseases, which are more frequent. Immigration for health reasons represents only a small proportion of all immigration reasons. For this population, free clinics like the one investigated here constitute unique, irreplaceable, access points in the French healthcare system.
    Bulletin de la Société de pathologie exotique 04/2012; 105(2):86-94.
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    ABSTRACT: Few data exist on the health status of the immigrant population in French Guiana. The main objective of this article was to identify differences in its health status in relation to that of the native-born population. A representative, population-based, cross-sectional survey was conducted in 2009 among 1027 adults living in Cayenne and St-Laurent du Maroni. Health status was assessed in terms of self-perceived health, chronic diseases and functional limitations. The migration variables were immigration status, the duration of residence in French Guiana and the country of birth. Logistic regression models were conducted. Immigrants account for 40.5% and 57.8% of the adult population of Cayenne and St-Laurent du Maroni, respectively. Most of them (60.7% and 77.5%, respectively) had been living in French Guiana for more than 10 years. A large proportion were still undocumented or had a precarious legal status. The undocumented immigrants reported the worst health status (OR = 3.18 [1.21-7.84] for self-perceived health, OR = 2.79 [1.22-6.34] for a chronic disease, and OR = 2.17 [1.00-4.70] for a functional limitation). These differences are partially explained by socioeconomic status and psychosocial factors. The country of birth and the duration of residence also had an impact on health indicators. Data on immigrant health are scarce in France, and more generally, immigrant health problems have been largely ignored in public health policies. Immigrant health status is of crucial interest to health policy planners, and it is especially relevant in French Guiana, considering the size of the foreign-born population in that region.
    BMC Public Health 01/2012; 12:53. · 2.08 Impact Factor
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    The Lancet 11/2010; 376(9755):1827-8. · 39.21 Impact Factor
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    ABSTRACT: Mayotte Island, located in the Indian Ocean, is a French overseas departmental community with certain specificities: recent development of sanitary institutions, significant immigration, free access to care for legal residents but with co-payments for irregular residents, the absence of many of the social benefits which exist in mainland France and poor or non-existent health information systems. We report here the first population-based survey describing the links between health, migration and healthcare utilization in this territory. Cross sectional population-based study using a three-stage random sample (geographic areas, households, individuals). In all, 2105 individuals were interviewed either in French, Shimaore or Kibushi (response rate=96%), using a questionnaire adapted to the context of Mayotte Island after a preliminary qualitative survey. Descriptive analyses and logistic regression models were performed. Foreigners make up 40% of the Mayotte population (total 186,452 inhabitants), of which one-quarter are children born in Mayotte and 80% have no regular residence status. The median length of residence of migrant foreigners is 10 years. Foreigners represent a majority of the female population, of the 20 to 35 years old population and of the urban areas. Main determinants for migration were economical (50%) or family-related (26%). Health was stated as a cause of migration by 11% of migrants. The social situation of foreigners is more precarious and their perceived health poorer than those of the French. Their access to care is also perceived as more difficult. We did not observe any notable difference in terms of frequency of healthcare attendance over the last 12 months between the two groups, but foreigners have consulted less often private GPs and more often traditional practitioners than French. In this overseas French island, the migrant population is numerous and resident for a long time. Their main motivations to immigrate are economic and family-related. They report hurdles to healthcare related with their precarious living conditions, including their illegal residence status.
    Revue d Épidémiologie et de Santé Publique 08/2010; 58(4):237-44. · 0.69 Impact Factor
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    59ème Congrès français de médecine interne, Ajaccio; 06/2009
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    ABSTRACT: Background Mayotte Island, located in the Indian Ocean, is a French overseas departmental community with certain specificities: recent development of sanitary institutions, significant immigration, free access to care for legal residents but with co-payments for irregular residents, the absence of many of the social benefits which exist in mainland France and poor or non-existent health information systems. We report here the first population-based survey describing the links between health, migration and healthcare utilization in this territory.Methods Cross sectional population-based study using a three-stage random sample (geographic areas, households, individuals). In all, 2105 individuals were interviewed either in French, Shimaore or Kibushi (response rate = 96%), using a questionnaire adapted to the context of Mayotte Island after a preliminary qualitative survey. Descriptive analyses and logistic regression models were performed.ResultsForeigners make up 40% of the Mayotte population (total 186,452 inhabitants), of which one-quarter are children born in Mayotte and 80% have no regular residence status. The median length of residence of migrant foreigners is 10 years. Foreigners represent a majority of the female population, of the 20 to 35 years old population and of the urban areas. Main determinants for migration were economical (50%) or family-related (26%). Health was stated as a cause of migration by 11% of migrants. The social situation of foreigners is more precarious and their perceived health poorer than those of the French. Their access to care is also perceived as more difficult. We did not observe any notable difference in terms of frequency of healthcare attendance over the last 12 months between the two groups, but foreigners have consulted less often private GPs and more often traditional practitioners than French.ConclusionIn this overseas French island, the migrant population is numerous and resident for a long time. Their main motivations to immigrate are economic and family-related. They report hurdles to healthcare related with their precarious living conditions, including their illegal residence status.RésuméPosition du problèmeMayotte est une collectivité départementale française de l’Océan Indien qui conjugue de nombreuses spécificités : développement sanitaire récent, pression migratoire importante, accès aux soins gratuit pour les résidents légaux et payant pour les étrangers en situation irrégulière, absence de plusieurs prestations sociales, systèmes d’information sanitaire inexistants. Pour la première fois, une enquête représentative en population générale a permis de décrire les liens entre migration et santé et d’étudier les recours aux soins en fonction de la nationalité.MéthodesEnquête transversale représentative en population générale conduite auprès d’un échantillon aléatoire à trois niveaux (zones géographiques, logements, personnes), comprenant 2105 personnes interrogées en français, shimaore ou kibushi (taux de réponse = 96 %). Le questionnaire a été adapté au contexte de Mayotte par la réalisation d’une enquête qualitative préalable. Des analyses descriptives et des modèles de régression logistique ont été réalisés.RésultatsLes étrangers représentent 40 % de la population (dont un quart d’enfants nés à Mayotte) ; 80 % sont en situation irrégulière alors que l’ancienneté médiane d’installation des immigrés étrangers est de dix ans. Ils sont majoritaires chez les femmes, dans la population entre 20 et 35 ans et dans les zones les plus urbanisées. Les migrations sanitaires apparaissent très minoritaires : 11 % des immigrés déclarent avoir migré ou s’être installés à Mayotte pour raisons de santé tandis que la majorité des motifs de migration sont économiques (50 %) ou familiaux (26 %). La situation sociale des étrangers est plus précaire, leur état de santé ressenti moins bon que les Français et leur accès aux soins est également jugé plus difficile. La fréquence de consultation durant l’année précédente ne diffère pas selon la nationalité contrairement aux modalités de recours aux soins ; les étrangers consultent moins en médecine libérale et plus en médecine traditionnelle.Conclusion Dans ce « territoire frontière » de la République, la population étrangère est nombreuse et installée depuis dix ans en moyenne. Les motifs de migration sont principalement économiques et familiaux. Les étrangers relatent des obstacles dans l’accès aux soins liés à la précarité de leurs conditions de vie et à l’absence de titre de séjour.
    Revue d Épidémiologie et de Santé Publique 09/2008; 56(6). · 0.69 Impact Factor
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    Health in France, 2002, Edited by Haut Comité de la Santé Publique, 06/2003: pages 144-219; John Libbey Eurotext., ISBN: 2-7420-0466-1
  • BMJ (online) 08/2002; 325(7354):44. · 17.22 Impact Factor
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    ABSTRACT: Because of its frequency and impact on women's health, domestic violence is an important public health issue. Psychological and psychosomatic disorders, pathological pregnancies as well as traumatic and gynaecological conditions are the main consequences of such violence, which may arise at a distant term after the events that constitute it. Health professionals, particularly general practitioners, emergency doctors, gynaecologists, obstetricians and midwives are on the frontline in identifying the victims and providing care to them. Therefore, there is a need to make a wide range of specific and relevant information readily available to these professionals and a call to renew their practices and increase partnerships.
    Bulletin de l'Académie nationale de médecine 02/2002; 186(6):949-59; discussion 959-61. · 0.16 Impact Factor
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    ABSTRACT: The impact of early-untreated HIV infection on chronic hepatitis C was determined in a case-control study, aimed at limiting factors associated with the progression of immunodeficiency. HIV-infected patients attending for a medical examination during 1995-1996 were systematically screened for: previous intravenous drug use without other HIV or Hepatitis C virus (HCV) risk factor, CD4 cell count > 200/microl, no AIDS, no antiretroviral treatment, positive anti-HCV antibody, negative hepatitis B surface antigen, abnormal aminotransferase activity. Thirty-eight consecutive eligible HIV-infected patients (cases) were included. Thirty-eight HCV-infected patients without HIV infection whose unique risk factor was intravenous drug use (controls) were paired to cases according to age, sex, and duration of HCV infection. Cases and controls had similar ages, sex ratios, duration of HCV infection, and alcohol intake. They were infected predominantly by genotypes 1 and 3. Viraemia was higher in cases than in controls. METAVIR histological scores of activity and fibrosis in cases versus controls were 2.2 +/- 0.8 versus 1.6 +/- 0.7 (P = 0.0008) and 1.8 +/- 1 versus 1.5 +/- 0.8 (P = 0.06), respectively. The percentage of cirrhosis was higher in cases, without reaching statistical difference. The progression rate of fibrosis was higher in cases. Age at contamination and METAVIR activity score were significantly associated with the progression of fibrosis in cases. Early-untreated HIV infection is associated with higher HCV viraemia and more severe liver injury in intravenous drug users with chronic hepatitis C.
    AIDS 10/2001; 15(15):2011-6. · 6.41 Impact Factor