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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: 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. · 0.78 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. · 6.24 Impact Factor
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ABSTRACT: Precarious living conditions now affect a significant number of people in France; new welfare benefits have been introduced and initiatives on the part of the social services made in an attempt to increase access to medical care for this underprivileged section of the population. Professionals in health care and researchers view this economic and social vulnerability and its effect on health in the context of a situation in which need and exclusion are predominating factors. An analysis has been made of the results of two social studies, one on access to medical treatment for persons attending free clinics, and the other on adherence to and compliance with treatment in HIV-infected individuals. The interrelations between disease, precarious living conditions and treatment have been examined. For patients with chronic disease or requiring heavy and/or long-term treatment, we show how these three issues are indissociable, and constitute a unique life profile; and also, when the patient's perceptions of his situation are taken into account how they contribute toward maintaining his sense of identity. An awareness of these interrelations and of the way in which the patient assumes the social management of his disease should be included in the approach to this problem by professional medical practice and in the organisation of medical care not only for this destitute or underprivileged section of society, but for the benefit of the community as a whole.
Médecine et Maladies Infectieuses. 01/2000; 30(S3):205-14.
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ABSTRACT: Paraneoplastic digital ischemia is an uncommon complication of metastatic adenocarcinomas.
Two years after remission of an uterine adenocarcinoma, the patient developed an acrosyndrome involving all four limbs with digital ischemia. Recurrent carcinoma was evidenced by a very high antinuclear antibody titer. Chemotherapy improved the acrosyndrome.
Vasomotor disorders which developed in older subjects with no other signs of autoimmune disorders should suggest a neoplastic origin. Icshemia of the fingers would be caused by vasculitis. An elevated antinuclear antibody titer may be a supplementary argument suggesting a neoplastic etiology.
La Presse Médicale 07/1999; 28(21):1109-11. · 0.67 Impact Factor
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ABSTRACT: In France health insurance coverage is universal (see note at the end of the text), nevertheless some people remain uninsured. In this high-risk population, the lack of insurance coverage contributes to the aggravation of health, by reducing access to medical care. In 1992, the Baudelaire consultation was incorporated into the outpatient clinic of Saint-Antoine hospital (Paris, France), to provide the uninsured with the same access as any other patient--but free of charge--to medical care. Social care was also provided in particular by assisting the uninsured in applying for insurance coverage. Our objectives were to quantify the delay in obtaining insurance coverage and to study whether the sociodemographic characteristics of these patients were associated with inequalities in terms of delays.
All patients attending the consultation for the first time in 1994 were included (n = 623). Because of differences linked to the French social security system, analysis was performed into two groups according to the existence of a prior insurance coverage. Delay in obtaining or recovering insurance coverage was considered as the key variable. The socio-demographic factors linked to the rates of access to insurance coverage were determined using Cox proportional hazards regression models. We also examined the factors linked with the existence of a prior insurance coverage by logistic regression modeling.
Within one year 96% of the patients who had had insurance coverage in the past, and 63% of the patients who had not, were insured. No factor, whether nationality, educational level, socio-professional category, family situation, type of housing, made of income was found to be linked with obtaining or recovering insurance coverage. However, nearly all these factors were related with the existence of prior insurance coverage.
Our approach of systematically providing social care allows 70% of uninsured patients to obtain insurance coverage within one year. This approach probably contributes to an improvement by facilitating access to mainstream health care. Moreover, no difference in delay in obtaining insurance coverage was found associated with sociodemographic characteristics.
Revue d Épidémiologie et de Santé Publique 12/1998; 46(5):361-70. · 0.78 Impact Factor
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ABSTRACT: Pheochromocytoma and primary hyperaldosteronism rarely occur simultaneously. Few cases have been reported in the literature.
A patient explored for hypertension was found to have hypokalemia related to primary hyperaldosteronism. Pathology examination of the ablated adrenal showed a co-existing pheochromocytoma suspected at history taking although urine catecholamines were normal.
Different pathogenic hypothesis have been proposed. Such dual tumors could be a simple coincidence, occur in a particular genetic setting, be related to direct contact between cortical and medullary tissue leading to reactional cortical hyperplasia, pheochromocytoma produced factors stimulating aldosterone synthesis, or factor X, a substance produced by cortical adenomas and favoring growth of the pheochromocytoma.
La Presse Médicale 10/1998; 27(25):1272-4. · 0.67 Impact Factor
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ABSTRACT: In France, the entire population theoretically has access to health coverage, but in fact a section of the poorest population does not. Institutions have therefore been set up to provide medical care for the destitute. The objectives of this study were to describe the social characteristics of the HIV-positive destitute population attending an out-patient clinic providing free health care for the destitute in a Paris University Hospital, to compare their clinical-epidemiological characteristics with those of non-destitute HIV-positive patients, and to evaluate the quality of their care. We performed a historical prospective study wherein a cohort of 115 HIV-positive destitute patients (defined as having no health coverage at their first consultation) was compared with a control cohort of 183 HIV-positive non-destitute patients attending the same clinic. Ninety-five per cent of the destitute patients had no stable employment, 32% had no source of income, 75% had no permanent residence and 27% were i.v. drug abusers. Fifty-nine per cent were foreigners, most of whom had legal residence papers and had been in France for more than 3 years. When comparing the control and the destitute groups, the latter had a three times greater risk of developing tuberculosis (RH = 3.2, CI 95% = [1.1-9.4]). Medical compliance, access to antiretroviral treatment and hospitalization were identical in both groups. No difference was observed in terms of occurrence of a new AIDS-related disease during follow-up when full-blown AIDS before entry, CD4 count at entry and transmission group were taken into account in multivariate analysis. From the moment that destitute patients attended this adapted medico-social facility, their access to care was the same as, if not better than, that of the other patients. The development of out-patient medico-social facilities for HIV-positive destitute patients must be a public health priority even for those countries theoretically providing generalized health coverage.
AIDS Care 09/1997; 9(4):451-9. · 1.60 Impact Factor
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The Lancet 09/1996; 348(9025):480. · 38.28 Impact Factor
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ABSTRACT: The slip test is a non-invasive way to objectively evaluate the extent of scleroderma by measuring the "slipping" of the skin over an underlying bone. The results obtained in 30 scleroderma patients and 60 controls (178 tests due to multiple measurements) were analyzed to determine which test sites show a significant difference between patients and controls (Student's t-test) and which sites are the most discriminating for the diagnosis of the disease (multivariate analysis). Patient values were clearly distinct from those of controls. The best sites (defined by p < 0.05) were: the mandible, the second and first phalanges of the middle finger, the hands, the forearms, the epicondyles, the sternum, the iliac crests, the patellae, the tibias (the upper and lower fourths) and the feet; in all, 23 sites to which can be added the opening of the mouth (measurement of the maximal interlabial distance), which proved to be a reliable parameter. Multiple regression analysis yielded an equation that identified patients with scleroderma based on 4 variables (right forearm, right iliac crest, sternum and right rib). The slip test is thus the first reproducible quantitative test able to confirm and quantify clinical impressions in scleroderma. It is entirely able to objectively monitor the evolution of the disease under treatment. Nevertheless, complementary studies are needed to verify whether the slip test, which can be performed in 20 minutes during an office visit, can be used advantageously in the routine clinical evaluation of scleroderma.
Annales de medecine interne 02/1992; 143(8):510-4.
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Annales de medecine interne 02/1991; 142(3):227-8.
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Journal of acquired immune deficiency syndromes 02/1991; 4(6):641-3.
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Annales de medecine interne 02/1991; 142(1):63-4.
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The Lancet 08/1990; 336(8708):179. · 38.28 Impact Factor
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Annales de medecine interne 02/1990; 141(2):193-4.
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ABSTRACT: Two cases are reported of atypical relapses of pneumocystosis in AIDS patients treated with aerosol pentamidine for 14 and 22 months. These pneumopathies are unusual because of their pitted aspect and recurrent spontaneous pneumothoraxes in spite of repeated drainage. They are difficult to diagnose because bronchoalveolar lavage fluid is negative for Pneumocystis carinii, despite their presence in lung biopsies. Histological lesions vary, being granulomatous, necrotizing and invasive, with involvement of the pleura and lymph nodes. Although a highly effective therapy against P. carinii pneumonia, aerosol pentamidine may play a role in these atypical episodes: either by causing bronchial obstructions beyond which the pneumocytotic lesions cannot be reached by lavage and become necrotic, or by favoring the extrapulmonary spread of P. carinii.
Annales de medecine interne 02/1990; 141(2):179-82.
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Annales de medecine interne 02/1990; 141(2):187-92.
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ABSTRACT: Pulmonary toxoplasmosis in AIDS is rare. Its frequency is estimated to be between 0.2 and 3.7% but is probably underestimated; however, it is lower than that of neurotoxoplasmosis and is rarely identified prior to autopsy. We describe herein 3 cases diagnosed in living patients. The clinical presentation is usually severe interstitial pneumonitis, occurring in profoundly immunodeficient patients. Toxoplasma gondii, the infectious agent, must always be sought in the bronchoalveolar lavage of such patients and is sometimes associated with other opportunistic infectious agents, such as Pneumocystis carinii.
Annales de medecine interne 02/1990; 141(5):469-71.
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La Presse Médicale 12/1988; 17(40):2142. · 0.67 Impact Factor
