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Meeting the needs of palliative care patients: general practitioners' survey on the last three months of life.
No full textContext: Evaluating palliative care is challenging. Quality and efficiency indicators are not standardized, especially in primary care.
Objectives: To assess the adequacy of care to the patients’ needs and associated factors, during the last three months of life, for palliative care patients followed up in general practice.
Methods: A quantitative study based on a mortality follow-back survey of general practitioners (GPs), in metropolitan France. From 11.2020 to 11.2021, the GPs included adult patients who died a predictable death and retrospectively rated how well the care provided met with the patient's needs, using a numerical scale. A generalized mixed model of logistic regression was used to examine associations between a positive evaluation and GP, patient, and care characteristics.
Results: Ninety-five GPs reported 295 patients. The median age was 85 years and 54% were women. The most common disease was cancer (41%) and 43% had dementia. Care assessment was mostly positive (76%) . Cancer and hospitalization were negative factors (OR [95%IC]=0.46 [0.25-0.86] and OR=0.51 [0.26-0.98] respectively) . Dementia, psychologist intervention and discussions with the family tended to be associated with positive evaluation but results were not significant due to a lack of statistical power (OR=1.86 [0.98-3.52]; OR=10.5 [2.12-51.8], OR=2.74 [0.99-7.57] respectively) .
Conclusion: In end-of-life, GPs’ evaluation of care adequacy to patient's needs was mostly positive. Indicators for palliative care evaluation, in a patient-centered approach, should consider inequalities due to medical conditions such as dementia and consider all the different possible care settings. Communication, psychosocial and spiritual approaches should be encouraged
L’avortement en Allemagne : une polémique sans fin ?
No full textDès son introduction dans le code pénal allemand de 1871, l’avortement n’a cessé de faire polémique outre-Rhin. Si la controverse n’est pas propre à l’Allemagne, l’objectif de cet article est néanmoins de s’interroger sur les raisons de l’ampleur du débat, qui non seulement n’a pas faibli durant le dernier siècle et demi, mais a même repris ces dernières années en dépit des mesures de libéralisation adoptées depuis 2019. Après un rappel de l’évolution historique, l’article présente la législation de la RFA après 1949, puis les débats qui ont accompagné la nouvelle législation de l’Allemagne unifiée et qui continuent de diviser le pays. Cette approche permet de montrer le rôle majeur de l’héritage historique dans les discussions et dans la législation sur l’avortement en Allemagne, et donc la spécificité du débat sur l’avortement, tandis que d’autres sujets comme le droit à l’autodétermination du genre n’ont pas du tout donné lieu à de telles controverses.
Since its introduction into the Penal Code in 1871, abortion has remained a source of controversy in Germany. While the debate is by no means unique to Germany, the aim of this article is to explore the reasons for the intensity of the discussion, which has not only persisted over the past century and a half, but has even gained renewed momentum in recent years despite the liberalisation measures adopted since 2019. Following a historical overview, the article examines the legislation of the Federal Republic of Germany after 1949, then the debates surrounding the new legislation of unified Germany which continue to divide the country. It highlights the major role of historical legacy in shaping both the discussion and legislation on abortion in Germany, thus underlining the specificity of the abortion debate, whereas other issues, such as the right to gender self-determination have not provoked such controversies
Devenir parent sans vivre en couple : une situation fréquente en outre-mer
No full textLes familles monoparentales sont deux fois plus fréquentes dans les départements et régions d’outre-mer qu’en Hexagone. Elles tiennent très souvent à l’arrivée d’un enfant hors couple. Plus d’un tiers des femmes nées entre 1941 et 1980 ont eu leur premier enfant sans vivre en couple dans les Drom. Ces naissances sont plus précoces, plus fréquentes pour les mères peu diplômées ou issues de milieux défavorisés. Elles sont souvent suivies par d’autres naissances hors couple
Leçons apprises du projet ANRS 12381 PRINCESSE en Côte d’Ivoire
No full textLeçons apprises du projet ANRS 12381 PRINCESSE avec témoignage des paires-éducatrices, des médecins du projet et de l’équipe de recherche
Relations entre voisins : la force des liens faibles
No full textSouvent présentées sous l’angle du déclin ou des conflits, les relations de voisinage sont encore très vivantes. En témoigne la Fête des voisins qui célèbre son vingt-cinquième anniversaire cette année. Mais comment se côtoie-t-on selon les milieux sociaux
Distributing a Sane Beverage? The Social Differentiation of Access to Water in Paris
No full textWater management depends on both the physical and social structures of large cities. In Paris, these elements interacted to limit and constrain access to water for large segments of the population for long periods of time. The very unequal distribution of property in the city is central to understanding water regimes in Paris and their evolution over time. This article analyzes the evolution of water systems in Paris from the mid-nineteenth century to the mid-twentieth century, considering access to water (and its quality) as well as the provision of sewers to remove waste soiled materials. Important social variations in the modalities of access to water within the city persisted for a long time. They were a consequence of choices made in organizing the distribution of water in the city
Spatial Inequalities in the Completeness of Under Five Deaths: Assessing Vital Registration Data in Türkiye
No full textThe neonatal, infant and under-5 mortality rates are important indicators of child health used by countries to monitor their health policies and for international comparisons. Coverage and completeness of registration systems are critical for the quality of these indicators. However, under registration of deaths is still a major problem today, especially where registration systems are still in the process of being established, particularly in low- and middle-income countries. In the last two decades, Türkiye stands out with its rapidly declining child and infant mortality, as well as its developing VR system. However, the completeness of under-5 deaths in the VR system in Türkiye has not been fully evaluated yet. The fact that the regions in Türkiye that are disadvantaged in terms of early-age mortality are less populated poses the risk of neglecting areas that need more investment and improvement in child mortality and data quality. In this study, we assess the completeness of under-5 deaths at the national and regional levels by using a recently developed model for estimating under-5 mortality by detailed age. We apply this model at both the national and regional levels to assess the completeness of under-5 deaths in the VR system of Türkiye from 2009 to 2022. The results confirm the presence of early death omission in the eastern regions at the beginning of the studied period, for which we propose a correction. The prediction of the model also indicates a strong improvement over time in the completeness of death registration in these regions. This study stresses the importance of revealing regional disadvantages rather than relying on national progress in the completeness of under five deaths, especially in low- and middle-income countries where registration systems are still in the process of being established
« Soyez vigilants ! » les dispositifs numériques de surveillance de quartier. Trajectoires d’engagement municipal, usages sociaux ordinaires et détournements
No full textSi la participation citoyenne à la co-production de l’ordre est devenue un objet sociologique d’intérêt en France ces dernières années, les usages municipaux et citoyens des dispositifs numériques privés de surveillance restent méconnus. Ce sont ces usages que l’article explore à partir d’une enquête qualitative (entretiens, observations, analyse de corpus documentaire) portant sur deux communes situées dans la banlieue et la couronne périurbaine d’une ville d’un peu plus de 100 000 habitants. Si l’engagement municipal dans ces dispositifs relève d’une réaction sociale à des désordres, l’existence de dissensions quant à leur bien-fondé parmi les habitants ne suffit pas à les associer à la décision de leur mise en place. Ces outils numériques font l’objet d’usages multiples et de détournements, mais ils révèlent également une surveillance sélective de certains groupes et favorisent un processus d’étiquetage de la déviance. L’article révèle ainsi les effets ambivalents de ces activités numériques de surveillance
The Impact of HIV Stigma and Discrimination on HIV Testing, Antiretroviral Treatment, and Viral Suppression in Africa: A Pooled Analysis of Population-Based Surveys
No full textBackground: UNAIDS’ Ending AIDS targets include ensuring that <10% of people experience HIV stigma and discrimination. We estimated the effect of HIV stigma and discrimination on the HIV care cascade in eastern, southern, central, and western Africa –regions with the highest HIV burden worldwide.
Methods: Using population-based surveys, we assessed three community-level HIV stigma exposures (continuous): discriminatory attitudes, perceived stigma, and shame of association with people living with HIV (PLHIV). Among PLHIV, we examined individual-level, past-year anticipated or experienced stigma in healthcare settings (binary). Using Poisson regression, we estimated adjusted prevalence ratios (aPR) for the effect of each stigma measure on past-year HIV testing, antiretroviral therapy use (ART), and viral suppression. We used segmented regression with a median breakpoint to model non-linear effects of community-level stigma.
Findings: We identified 124 surveys in 38 countries (2000-2023). Stigma towards PLHIV was high: 51% of participants held discriminatory attitudes, 74% perceived HIV stigma, and 43% reported shame of association. Among PLHIV, 21% had anticipated and 4% experienced stigma. At the community-level, where the prevalence of discriminatory attitudes was above the median, people were less likely to have tested for HIV (aPR=0.88 per 10% increase, 95%CI:0.87-0.88), and PLHIV had lower ART use (aPR=0.96, 95%CI:0.94-0.97) and viral suppression (aPR=0.96, 95%CI:0.95-0.98). Similarly, communities with higher (≥median) shame of association levels had lower testing (aPR=0.97 per 10% increase, 95%CI:0.96-0.98) and viral suppression (aPR=0.98, 95%CI:0.96-1.00). PLHIV who anticipated and/or experienced stigma were 7% (95%CI:4-10%) and 10% (95%CI:6-14%) less likely to be on ART and virally suppressed, respectively, possibly reaching 14% (95%CI:7-21%) and 16% (95%CI:9-23%) when adjusted for selection bias.
Interpretation: HIV stigma and discrimination have measurable, widespread, negative effects on the full cascade of care: HIV testing, treatment, and viral suppression. These effects are most pronounced in communities with the highest levels of stigma
Homo, bi et non binaires : quand les jeunes questionnent l’hétérosexualité
No full textLes personnes s’identifiant aux minorités sexuelles sont de plus en plus nombreuses, en particulier chez les jeunes. L’enquête Envie, représentative des jeunes adultes de 18-29 ans en France hexagonale, montre la grande diversité des identifications, des désirs et des pratiques sexuelles des jeunes. Si l’hétérosexualité hexagonale reste majoritaire, les jeunes femmes s’identifiant comme bisexuelles, pansexuelles ou ayant déjà été attirées par les deux sexes sont de plus en plus nombreuses. Cette diversité est particulièrement visible chez les jeunes non binaires qui représentent un peu moins de 2 % des 18-29 ans