Santé, comportements de santé et violence parmi les immigrants. Rôle des facteurs socioéconomiques chez les adolescents

in Les Déterminants de la santé (2014)

Etudier les problèmes relatifs à la santé (usage de substances, état de santé, symptômes dépressifs, violence physique/verbale et abus sexuel subis, et implication dans la violence) des immigrés européens ... [more ▼]

Etudier les problèmes relatifs à la santé (usage de substances, état de santé, symptômes dépressifs, violence physique/verbale et abus sexuel subis, et implication dans la violence) des immigrés européens et non-européens et le rôle des difficultés socioéconomiques, relationnelles et scolaires. Les problèmes relatifs à la santé sont plus fréquents chez les immigrés européens et non-européens que les français. Ils sont fortement expliqués par les difficultés socioéconomiques, relationnelles et scolaires. Contexte. Cette enquête transversale a été réalisée sur 1559 adolescents des collèges dans le nord-est de la France. Elle est basée sur un auto-questionnaire, rempli en classe sous la surveillance de l’équipe de recherche, concernant le sexe, l’âge, la nationalité, les caractéristiques socioéconomiques (structure familiale, faible éducation parentale (<bac), profession du père et revenu familial insuffisant), consommation durant les 30 derniers jours d’alcool, tabac, cannabis, drogues dures, faible performance scolaire (note moyenne du dernier trimestre < 10/20), mauvais état de santé et faibles relations sociales (échelle de qualité de vie de l’OMS, WHOOoL-Bref), symptômes dépressifs (mesure de Kandel, score>90ème percentile), violence physique/verbales subie, agression sexuelle subie, et implication dans la violence. Les données sont analysées par les modèles de régression logistiques. Résultats. Les problèmes sont fréquents : usage d’alcool (35,2%), tabac (11,2%), cannabis (5,6)%, drogues dures (2,8%), mauvais état de santé (25,8%), symptômes dépressifs (13,3%), être victime de violence physique/verbale (16,2%) ou d’abus sexuel (3,7%) et implication dans la violence (14,6%). Comparés aux français, les immigrés ont un risque accru pour : usage de tabac (odds ratio ajusté sur le sexe et l’âge 2,04), cannabis (2,33), drogues dures (4,18), mauvais état de santé (1,89), violence subie (1,84) et implication dans la violence (1,77). Les situations socioéconomiques expliquaient respectivement 25%, 9%, 13%, 30%, 12% et 39% de ces risques. L’ajout de relations sociales et de la performance scolaire expliquait respectivement 43%, 20%, 29%, 53%, 24% et 61% des risques. Ces problèmes et les contributions des cofacteurs diffèrent beaucoup entre les immigrés européens et non-européens. Conclusions. Les problèmes relatifs à la santé sont plus fréquents chez les immigrés européens et non-européens que les français. Ils sont fortement expliqués par les difficultés socioéconomiques, relationnelles et scolaires. La prévention pour leur intégration sociale devrait traiter ces problèmes. [less ▲]

Opiate- and Cocaine-Related Fatal Overdoses in Luxembourg from 1985 to 2011: A study on Gender differences

in European Addiction Research (2014), 20

We analyzed gender differences in national Fatal OverDose (FOD) cases related to opiates and cocaine use between 1985 and 2011 (n=340). Methods Cross-examination of national data from law enforcement and ... [more ▼]

We analyzed gender differences in national Fatal OverDose (FOD) cases related to opiates and cocaine use between 1985 and 2011 (n=340). Methods Cross-examination of national data from law enforcement and drug use surveillance sources and of forensic evidence. Bi-variate and logistic regression analysis of male/female differences according to socio-demographics, forensic evidence and drug use trajectories. Results The burden of deaths caused by FOD on the general national mortality was higher for men (PMR/100 = 0.55) compared with women (PMR/100 = 0.34). Compared with their male peers, women were younger at the time of death (t=3.274; p=.001) and showed shorter drug use careers (t=2.228; p=.028). Heroin use was recorded more frequently in first drug offences of female victims [AOR=6.59 (95% CI 2.97–14.63)] and according to forensic evidence, psychotropic prescription drugs were detected to a higher degree in females [AOR=2.019 (95% CI 1.065–3.827)]. Conclusion The time window between the onset of illicit drug use and its fatal outcome revealed to be shorter for women versus men included in our study. Early intervention in female drug users, routine involvement of first line general health care providers and increased attention to poly and psychotropic prescription drugs’ use might contribute to prevent premature drug-related death and reduce gendered specificities. [less ▲]

Associations between quality of life and socioeconomic factors, functional impairments and dissatisfaction with received information and home-care services among survivors living at home two years after stroke onset

in BMC Neurology (2014), 14

Quality of life (QoL) assessment is important when monitoring over time the recovery of stroke-survivors living at home. This study explores the associations between QoL and socioeconomic factors ... [more ▼]

Quality of life (QoL) assessment is important when monitoring over time the recovery of stroke-survivors living at home. This study explores the associations between QoL and socioeconomic factors, functional impairments and self-reported dissatisfaction with received information and home-care services among survivors two years after stroke onset. This problem remains partially addressed though optimal information and services may improve survivors' QoL. Methods Stroke-survivors admitted to all hospitals in Luxembourg 18 months or more previously were identified using the only care-expenditure-reimbursement national system database. The clinical diagnosis was confirmed. Ninety four patients aged 65 years and living at home were interviewed to gather socioeconomic characteristics, functional impairments, dissatisfaction with information and home-care services, and QoL (using the Newcastle Stroke-Specific QoL, newsqol) assessing 11 domains. Data were analyzed using multiple linear regression models. Results About 50% of survivors had low education and lower income. Functional impairments were common: sensory (45%), motor (35%), memory (32%), language (31%), and vision (20%). Survivors with education (<12th grade) or lower income had low values for most newsqol domains (sex-age-adjusted regression coefficient saRC, i.e. mean difference, between -23 and -8). Patients who were working had better values for pain, mental feelings and sleep domains than did retired people (saRC between -3.9 and 4.2). Various functional impairments were associated with markedly low values of nearly all domains (saRC between -33.5 and -7.5) and motor, language, memory and sensory impairments had the highest impact. The survivors' perceived QoL was markedly low, especially for the domains of interpersonal relationship, sleep, cognition, mental feelings, and pain. Various QoL domains were strongly related to dissatisfaction with information about stroke and its consequences/changes over time, accuracy of information obtained, help received, coordination between services, and the possibility of receiving help when necessary (saRC reaching -30). Conclusions Stroke-survivors had major alterations in QoL that reflected depressive symptoms, which should be appropriately treated. These findings may help with the development of public policies aiming at improving QoL among stroke survivors. The newsqol could be used routinely to measure the recovery of survivors over time and their needs in terms of information, help and care services [less ▲]

First-year at university: the effect of academic employability skills and physical quality of life on students’ well-being.

in Work: A Journal of Prevention, Assessment, and Rehabilitation (2014), 49

With increasing access at European universities, supporting and promoting the high education, students’ mental well-being and generic employability capacities have become priorities, but their respective ... [more ▼]

With increasing access at European universities, supporting and promoting the high education, students’ mental well-being and generic employability capacities have become priorities, but their respective influences, after an adaptation period of seven months, remain unclear. <br />OBJECTIVE: To analyse the relationships between students’ well-being and self-perceived academic employability skills, and other social and environmental factors. METHODS: 321 freshmen students at the end of their first year completed an online questionnaire. Two instruments were used to assess well-being: the General Health Questionnaire (GHQ-12), which explores psychological suffering, and the psychological quality of life subdomain of the Whoqol-bref. RESULTS: Psychological Whoqol-bref scores are linked to the academic employability skills (AES) items of drafting, critical spirit, problem-solving, teamwork, and supervision/direction of others, and has positive effects on AES score and on the following Whoqol-bref domains: physical, social relationships and environmental. Although three of six psychological Whoqol-bref items (ability to concentrate, satisfaction with self, negative feelings) are correlated with GHQ-12 items (sleeping, decision-making, feeling under strain, problem-solving, depression, self-confidence, thinking about self, feeling happy). GHQ-12 score is negatively linked with Whoqol-bref physical. CONCLUSIONS: For better quality of life, and improved employability skills, innovative activities should be developed to ascertain the sustainable academic's abilities of students. [less ▲]

Socioeconomic inequalities in fatal opiate and cocaine related overdoses: Transgenerational baggage versus individual attainments

in European Health Psychologist (2014)

Background. To determine socioeconomic inequalities in opiates and cocaine related Fatal OverDose (FOD) cases and their implications in terms of preventive measures. Methods. Cross-examination of law ... [more ▼]

Background. To determine socioeconomic inequalities in opiates and cocaine related Fatal OverDose (FOD) cases and their implications in terms of preventive measures. Methods. Cross-examination of law enforcement and healthcare data sources and of forensic evidence in a nested case-control study design. FOD cases were individually matched with 4 controls, according to sex, year of birth, drug administration route and duration of drug use. 272 cases vs. 1,056 controls were compared through conditional logistic regression. Findings. Being professionally active [OR=0.662 (95% CI 0.446–0.985)], reporting salary as main income source [OR=0.417 (95% CI 0.258–0.674)], and education attainment higher than primary school [OR=0.501 (95% CI 0.344-0.729)] revealed to be protective factors, whereas parental professional status was not associated to FOD. Discussion. Compared to their peers, drug users with lower socioeconomic profiles show increased odds of FOD. However, actual and self-referred socioeconomic characteristics of drug users, impacting on daily life quality, such as educational attainment, employment and revenue, appeared to be more predictive of FOD than transgenerational factors such as the parental socioeconomic status. Thus, motivational interventions aimed at socio-professional reintegration should be given due attention in dedicated harm prevention policies. [less ▲]

Déconstruction du processus cumulatif et d’amplification des souffrances :les effets d’une dérive…

in Les Déterminants de la santé (2014)

A partir du discours de professionnels de proximité qui côtoient au quotidien les souffrances psychiques de leurs clients, nos objectifs ont été d’analyser les principaux problèmes de santé mentale et les ... [more ▼]

A partir du discours de professionnels de proximité qui côtoient au quotidien les souffrances psychiques de leurs clients, nos objectifs ont été d’analyser les principaux problèmes de santé mentale et les facteurs psychosociaux qui contribuent à l’émergence des souffrances, et participent à leur maintien ou leur développement, et de déterminer leurs besoins et les actions qui pourraient être entreprises pour y répondre. Notre problématique s’inscrit une compréhension des processus présents dans la construction et la reconstruction des souffrances des clients des services sociaux et de santé. Comme aucune information n’existe sur l’accès aux soins en milieu rural, notre étude a tenté d’aborder les mécanismes de la souffrance décrits par les professionnels de proximité. Notre approche a été guidée par les questions suivantes: si la souffrance résulte d’une vision de l’individu sur sa propre existence, quelles valeurs entrent en jeu ? Si la souffrance est appréhendée comme la résultante d’une conduite particulière, dans quelle mesure est-elle aussi un produit social ? Quelles sont les interventions qui couvriraient les besoins de cette clientèle ? Quelles sont les actions qui les amèneraient à acquérir des capacités personnelles et des capabilités sociales pour s’opposer aux effets des souffrances ? Comment lorsque les souffrances interagissent de concert dans des contextes qui leur sont propices, mènent-elles les personnes aux dérives d’un état psychique qui se détériore ? La liste des professionnels de première ligne travaillant auprès de personnes âgées de 18 à 65 ans issues des communes rurales a été établie avec l’aide du comité de pilotage du RE.SO.NORD (REseau du centre SOcial de la région du NORD). Un entretien semi-structuré d’une durée de plus d’une heure a été mené en face à face. A partir des retranscriptions des discours des professionnels, une analyse de contenu a été menée. Les professionnels de proximité ayant participé à l’enquête (sept médecins généralistes, trois psychiatres, neuf assistants sociaux, trois psychologues et sept travailleurs sociaux ; moyenne d’âge 42 ans, dont les femmes sont légèrement plus nombreuses) décrivent les effets d’une dérive en montrant comment les mécanismes en jeu produisent des processus d’amplification des problèmes neuropsychiatriques et d’accumulation des facteurs psychosociaux, et comment ces souffrances peuvent aboutir à des états de santé mentale critiques. Dans cette logique de gradation, les problèmes de santé mentale viennent s’agréger à un ensemble de comportements délétères. Cette gradation illustre un état que les clients atteignent lorsque les sphères intime et sociale se dégradent de concert. Elle représente cet état au cours duquel les personnes semblent avoir comme perdu face à leurs souffrances et ne parviennent plus à s’en relever. Car la di fficulté majeure rencontrée par leurs clients ne réside pas tant dans l’existence avérée d’une souffrance, mais dans l’incapacité à la surmonter. La souffrance dite « émotionnelle » désigne le caractère privé de l’existence et concerne les aspects tels que les comportements liés à l’addiction, aux troubles neuropsychiatriques et psychologiques, aux anxiétés existentielles profondes, et aux conséquences que ces problèmes engendrent sur le bien-être mental via les maladies mentales, font ici sens au regard d’une souffrance, à tout le moins personnelle. La détresse d’ordre psychique agit alors comme le révélateur de la souffrance vécue lorsque la sphère intime de leur existence se dégrade. Quant à a souffrance dite « sociale » est le résultat de l’angoisse perçue quant à la dégradation de leur qualité de vie. Elle se réfère aux conditions psychologiques de vie ainsi qu’aux conditions matérielles de l’e xistence telles que le travail, le logement, le revenu, autant de facteurs qui, lorsque leur pérennité devient incertaine, et affecte la satisfaction à l’égard de la vie des personnes et de son entourage. La mise en avant d’une interaction résultant du choc des sphères émotionnelle et sociale montre qu’un problème survient rarement seul. La question qui demeure, est celle de comprendre si la présence simultanée de divers problèmes découle d’un effet en cascade, du glissement d’un problème vers un autre ou de la présence de facteurs de risque communs à l’apparition de cette souffrance. Dans la mesure où les souffrances sont multiples et s’interpénètrent, les observations des professionnels ont tenté de mettre au jour l’attention particulière qu’il est nécessaire de porter au développement conjoint des diverses trajectoires problématiques, et de leurs comorbidités. Les pistes d’action vers lesquels aboutissent nos résultats s’inscrivent dans les objectifs [less ▲]

Association between health-related quality of life and being an immigrant among adolescents, and the role of socioeconomic and health-related difficulties

in International Journal of Environmental Research and Public Health (2014), 10(1),

To develop satisfactorily, adolescents require a good health-related quality of life (QOL, including physical health, psychological health, social relationships and living environment). However, for ... [more ▼]

To develop satisfactorily, adolescents require a good health-related quality of life (QOL, including physical health, psychological health, social relationships and living environment). However, for poorly understood reasons, it is often lacking, especially among immigrants with lower family and socioeconomic resources. This study assessed health-related QOL of European and non-European immigrant adolescents and the contributions of socioeconomic difficulties, unhealthy behaviors, and violence. It included 1,559 middle-school adolescents from north-eastern France (mean age 13.5, SD 1.3; 1451 French adolescents, 54 European immigrants and 54 non-European immigrants), who completed a self-administered questionnaire including sex, age, socioeconomic characteristics (family structure, parents’ education, occupation, and income), unhealthy behaviors (uses of tobacco/alcohol/cannabis/hard drugs, obesity, and involvement in violence), having sustained violence, sexual abuse, and the four QOL domains measured with the World Health Organization’s WHOQOL-BREF (poor: score<25PthP percentile). Data were analyzed using logistic regression models. Poor physical health, psychological health, social relationships, and living environment affected more European immigrants (26% to 35%) and non-European immigrants (43% to 54%) than French adolescents (21% to 26%). European immigrants had a higher risk of poor physical health and living environment (gender-age-adjusted odds ratio 2.00 and 1.88, respectively) while non-European immigrants had a higher risk for all poor physical health, psychological health, social relationships, and living environment (3.41, 2.07, 3.25, and 3.79, respectively). Between 20% and 58% of these risks were explained by socioeconomic difficulties, parts of which overlapped with unhealthy behaviors and violence. The associations between the two sets of covariates greatly differed among French adolescents and immigrants. Poor QOL was more common among European and non-European immigrants due to socioeconomic difficulties and associated unhealthy behaviors and violence. The different risk patterns observed between French adolescents and immigrants may help prevention. [less ▲]

Opiate and cocaine related Fatal Overdoses in Luxembourg from 1985 to 2011: a time-stratified

in Health Issues and Populations in Health Promotion (2013)

To describe trends in the national prevalence of fatal overdose (FOD) cases related to opiates and cocaine use between 1985 and 2011. To analyse male/female differences in FOD victims according to various ... [more ▼]

To describe trends in the national prevalence of fatal overdose (FOD) cases related to opiates and cocaine use between 1985 and 2011. To analyse male/female differences in FOD victims according to various time periods. Methods. A triangulation approach was chosen to cross-examining data from national law enforcement sources, the national drug use surveillance system (RELIS) and of forensic and toxicological evidence. Data have been stratified according to 3 time periods covering each 9 successive years in order to increase the visibility of long term variations and trends. Statistical analysis of male/female differences according to socio-demographic and forensic data as well as drug use trajectories was performed. Results. National FOD prevalence has been decreasing from the beginning of this century to reach a historically low rate of 1.71 cases/100,000 inhabitants in 2011. The burden of deaths caused by FOD on the general national mortality showed to be higher for men compared with women. Furthermore, the pathways towards a FOD revealed to be different for male and female victims referred to various aspects including age of decedents, criminal records, drug use trajectories, drug use patterns and the involvement of psychotropic prescription drugs. Conclusions. The time window for intervention between the onset of drug use and its potential fatal outcome might be shorter for women compared with men. Further research should address dynamics between socio-economic status of victims and various cultural components to assess their possible impact on drug overdose induced mortality. Early intervention in female drug users and increased attention to poly and psychotropic prescription drugs use should be considered in health promotion programmes and relevant research outcomes routinely provided to first line general health care providers to accelerate access to appropriate treatment if required and eventually contribute to prevent premature death and reduce gender inequalities. [less ▲]

The Role of occupational activities and Work environment in occupational injury and interplay of personal factors in various age groups among Indian and French coalminers.

in International Journal of Occupational Medicine and Environmental Health (2013), 26(6), 910-929

The role of occupational hazards in occupational injury may be mediated by individual factors across various age groups. This study assessed the role of occupational hazards as well as contribution of ... [more ▼]

The role of occupational hazards in occupational injury may be mediated by individual factors across various age groups. This study assessed the role of occupational hazards as well as contribution of individual factors to injuries among Indian and French coalminers. Material and Methods. We conducted a case-control study on 245 injured workers and on 330 controls without any injuries from Indian coal mines using face-to-face interviews, and a retrospective study on 516 French coalminers using a self-administered questionnaire including potential occupational and personal factors. Data were analyzed using logistic models. Results. The annual rate of injuries was 5.5% for Indian coalminers and 14.9% for the French ones. Logistic model including all occupational factors showed that major injury causes were: hand-tools, material handling, machines, and environment/work-geological/strata conditions among Indian miners (adjusted odds-ratios 2.01 to 3.30) and biomechanical exposure score among French miners (adjusted odds-ratio 3.01 for score the 1–4, 3.47 for the score 5–7, and 7.26 for score ≥ 8, vs. score 0). Personal factors among Indian and French coalminers reduced/exacerbated the roles of various occupational hazards to a different extent depending on workers’ age. Conclusion. We conclude that injury roles of occupational hazards were reduced or exacerbated by personal factors depending on workers’ age in both populations. This knowledge is useful when designing prevention which should definitely consider workers’ age. [less ▲]

Two years post-stroke: the effects of dissatisfaction with services and quality of information on patients’ quality of life in Luxembourg

in Best Investissements for Health (2013)

Stroke is the second cause of death and helps from socio-medical services and information are crucial for promoting post-stroke patient’s quality of life. We analysed the impact of dissatisfaction with ... [more ▼]

Stroke is the second cause of death and helps from socio-medical services and information are crucial for promoting post-stroke patient’s quality of life. We analysed the impact of dissatisfaction with these services and information on post-stroke patient’s quality of life taking into account socioeconomic factors and functional impairments, which remains little documented. Methods: All 2-year post-stroke patients admitted to all hospitals in Luxembourg were identified using the only care-expenditure-reimbursement national system database. Clinical diagnosis of cerebrovascular disease was confirmed. Ninety four patients living at home (mean age 65.5) were face-to-face interviewed to gather socioeconomic characteristics (sex, age, nationality, family structure, education, occupation, income and residence place) and to measure quality of life (using the Newcastle Stroke-Specific Quality of Life measure, noted Newsqol (assessing mobility, self-care, pain, cognition, vision, communication, feelings, relationships, emotion, sleep and fatigue) and dissatisfaction with various services and information. Data were analysed using multiple regression models. Results: Most functional impairments impacted multiple Newsqol dimensions. Language impairment related to most Newsqol dimensions (mobility, self-care, cognition, vision, communication, feelings, relationships, sleep and fatigue); memory impairment to pain, cognition, feeling, emotion, and sleep; motor impairment to mobility, self-care, pain, feeling and fatigue; visual impairment to relationships in addition to vision; sensory impairment to pain, communication, emotion and sleep. Controlling for all socioeconomic factors and functional impairments evidenced that dissatisfactions with helps and information about helps from community services were strongly associated with all Newsqol dimensions including mainly self-care, communication, mental feeling, relationships, emotion and sleep. Lack of information about stroke was associated with relationships and sleep. Conclusion: Improving help services and information about helps and cerebrovascular disease in chronic phase should highly impact patients’ quality of life. It is important to promote patient-centred care focusing on information need, financial need, and medical, technical and personal aids. [less ▲]