In mid April 2020, with more than 2.5 billion people in the world following social distancing measures due to COVID-19, governments are considering relaxing lock-down. We combined individual clinical risk predictions with epidemic modelling to examine simulations of isolation and exit policies.Methods: We developed a method to include personalised risk predictions in epidemic models based on data science principles. We extended a standard susceptible-exposed-infected-removed (SEIR) model to account for predictions of severity, defined by the risk of an individual needing intensive care in case of infection. We studied example isolation policies using simulations with the risk-extended epidemic model, using COVID-19 data and estimates in France as of mid April 2020 (4 000 patients in ICU, around 7 250 total ICU beds occupied at the peak of the outbreak, 0.5 percent of patients requiring ICU upon infection). We considered scenarios varying in the discrimination performance of a risk prediction model, in the degree of social distancing, and in the severity rate upon infection. Confidence intervals were obtained using an Approximate Bayesian Computation approach. The framework may be used with other epidemic models, with other risk predictions, and for other epidemic outbreaks.
International audience ; Spatial accessibility to health services is a key factor in terms of public health. Even though some tools are available, establishing accessibility criteria applicable from one geographic scale to another remains difficult. Therefore, we propose a method for creating a health accessibility index applicable on a large geographic scale, based on a methodology that overcomes the limitations of political-administrative divisions and which allows a multi-scalar approach to be implemented. The index highlights, on a national scale, areas of cumulative health disadvantages. This index of accessibility to health care combines accessibility and availability and can be adapted to many geographical scales. As accessibility can be understood in various dimensions, a score could be calculated for various fields such as education and culture. The index can help policymakers to identify under-endowed areas and find optimal locations. In terms of public health, it may be used to understand the mechanisms underlying geographic health disparities.
International audience ; Spatial accessibility to health services is a key factor in terms of public health. Even though some tools are available, establishing accessibility criteria applicable from one geographic scale to another remains difficult. Therefore, we propose a method for creating a health accessibility index applicable on a large geographic scale, based on a methodology that overcomes the limitations of political-administrative divisions and which allows a multi-scalar approach to be implemented. The index highlights, on a national scale, areas of cumulative health disadvantages. This index of accessibility to health care combines accessibility and availability and can be adapted to many geographical scales. As accessibility can be understood in various dimensions, a score could be calculated for various fields such as education and culture. The index can help policymakers to identify under-endowed areas and find optimal locations. In terms of public health, it may be used to understand the mechanisms underlying geographic health disparities.
International audience ; Spatial accessibility to health services is a key factor in terms of public health. Even though some tools are available, establishing accessibility criteria applicable from one geographic scale to another remains difficult. Therefore, we propose a method for creating a health accessibility index applicable on a large geographic scale, based on a methodology that overcomes the limitations of political-administrative divisions and which allows a multi-scalar approach to be implemented. The index highlights, on a national scale, areas of cumulative health disadvantages. This index of accessibility to health care combines accessibility and availability and can be adapted to many geographical scales. As accessibility can be understood in various dimensions, a score could be calculated for various fields such as education and culture. The index can help policymakers to identify under-endowed areas and find optimal locations. In terms of public health, it may be used to understand the mechanisms underlying geographic health disparities.
International audience ; INTRODUCTION:Sexually Transmitted Infections (STIs) have always represented a public health concern in the military, yet most studies rely on self-reports among non-random samples of military populations. In addition, most of the studies exploring STI rates among the military focus on US service members. This paper assesses the prevalence and correlates of STIs in the French military using biomarkers and compares self-reported versus diagnosed STIs.METHODS:Data are drawn from the COSEMIL study, a national sexual health survey conducted in the French military in 2014 and 2015. A random sample of 784 men and 141 women aged 18-57 years completed a self-administered questionnaire and provided biological samples for STI testing. We used logistic regression modeling to identify the correlates of STI diagnosis and self-reports.RESULTS:The prevalence of diagnosed STIs was 4.7% [3.8-5.9], mostly due to Chlamydia trachomatis. This rate was four times higher than the 12 months self-reported rate of 1.1% [0.6-2.3]. Reported STI rates were similar among men and women (1.1% versus 1.8%), but diagnosed STI rates were twice as high among females versus males (10.4% versus 4.1%, p = 0.007). There were significant differences in the determinants of reported versus diagnosed STIs. In particular, age and sexual orientation were associated with reported STIs, but not with diagnosed STIs. Conversely, STI counseling and depression were associated with STI diagnosis but not with STI reports.CONCLUSION:This study underlines the need to use biomarkers in population-based surveys, given the differential and substantial underreporting of STIs. Results also highlight the need for programmatic adaptation to address gender inequalities in STI rates, by developing women's health services in the French military. Addressing such needs not only benefits women but could also serve as a strategy to reduce overall STI rates as most military women have military partners, increasing the risk of internal transmission.
International audience ; Introduction: Ecological deprivation indices belong to essential instruments for monitoring and understanding health inequalities. Our aim was to develop the SI-EDI, a newly derived European Deprivation Index for Slovenia. We intend to provide researchers and policy-makers in our country with a relevant tool for measuring and reducing the socioeconomic inequalities in health, and even at a broader level. Methods: Data from the European survey on Income and Living Conditions and Slovenian national census for the year 2011 were used in the SI-EDI construction. The concept of relative deprivation was used where deprivation refers to unmet need(s), which is caused by lack of all kinds of resources, not only material. The SI-EDI was constructed for 210 Slovenian municipalities. Its geographical distribution was compared to the distribution of two existing deprivation scores previously applied in health inequality research in Slovenia. Results: There were 36% of adults recognized as deprived in Slovenia in 2011. SI-EDI was calculated using 10 census variables that were associated with individual deprivation. A clear east-to-west gradient was detected with the most deprived municipalities in the eastern part of the country. The two existing deprivation scores correlate significantly with the SI-EDI. Conclusions: A new deprivation index, the SI-EDI, is grounded on the internationally established scientific concept, can be replicated over time and, crucially, provides an account of the socioeconomic and cultural particularities of the Slovenian population. The SI-EDI could be used by the stakeholders and the governmental and nongovernmental sectors in Slovenia, with the goal of better understanding health inequalities in Slovenia. ; Uvod: Kazalniki, ki na ravni izbranih geografskih enot prikazujejo socialno-ekonomsko blagostanje oziroma primanjkljaj prebivalstva, so danes temeljno orodje za preučevanje in razumevanje neenakosti v zdravju. V prispevku predstavljamo SI-EDI, novo razvit kazalnik ...
A public health intervention must improve the health of the population. The intervention can be seen as a set of actions to modify behaviors and beliefs to reduce morbidity and mortality. It is thus similar to a military intervention: the opposing forces must be fought to override the prevailing realm of beliefs and harmful behaviors and to ultimately install long-lasting remedies. In the run-up to the Gulf War in 1990, General Colin Powell, chairman of the Joint Chiefs of Staff, outlined one of the most comprehensive sets of principles in military strategy history 1. This so-called Powell Doctrine is a list of eight questions that must all be answered affirmatively before the US government takes any military action. If any answer to a question is not in the affirmative, the success of the operation may be compromised. We propose an adaptation of the Powell Doctrine applicable for public health interventions.
BACKGROUND: Limited engagement in clinic-based care is affecting the HIV response. We explored the field experiences and perceptions of local health care workers regarding home-based strategies as opportunities to improve the cascade of care of people living with HIV in rural South Africa as part of a Universal Test-and-Treat approach. METHODS: In Hlabisa sub-district, home-based HIV services, including rapid HIV testing and counselling, and support for linkage to and retention in clinic-based HIV care, were implemented by health care workers within the ANRS 12249 Treatment-as-Prevention (TasP) trial. From April to July 2016, we conducted a mixed-methods study among health care workers from the TasP trial and from local government clinics, using self-administrated questionnaires (n = 90 in the TasP trial, n = 56 in government clinics), semi-structured interviews (n = 13 in the TasP trial, n = 5 in government clinics) and three focus group discussions (n = 6-10 health care workers of the TasP trial per group). Descriptive statistics were used for quantitative data and qualitative data were analysed thematically. RESULTS: More than 90% of health care workers assessed home-based testing and support for linkage to care as feasible and acceptable by the population they serve. Many health care workers underlined how home visits could facilitate reaching people who had slipped through the cracks of the clinic-based health care system and encourage them to successfully access care. Health care workers however expressed concerns about the ability of home-based services to answer the HIV care needs of all community members, including people working outside their home during the day or those who fear HIV-related stigmatization. Overall, health care workers encouraged policy-makers to more formally integrate home-based services in the local health system. They promoted reshaping the disease-specific and care-oriented services towards more comprehensive goals. CONCLUSION: Because home-based services allow identification of ...
International audience ; INTRODUCTION:Sexually Transmitted Infections (STIs) have always represented a public health concern in the military, yet most studies rely on self-reports among non-random samples of military populations. In addition, most of the studies exploring STI rates among the military focus on US service members. This paper assesses the prevalence and correlates of STIs in the French military using biomarkers and compares self-reported versus diagnosed STIs.METHODS:Data are drawn from the COSEMIL study, a national sexual health survey conducted in the French military in 2014 and 2015. A random sample of 784 men and 141 women aged 18-57 years completed a self-administered questionnaire and provided biological samples for STI testing. We used logistic regression modeling to identify the correlates of STI diagnosis and self-reports.RESULTS:The prevalence of diagnosed STIs was 4.7% [3.8-5.9], mostly due to Chlamydia trachomatis. This rate was four times higher than the 12 months self-reported rate of 1.1% [0.6-2.3]. Reported STI rates were similar among men and women (1.1% versus 1.8%), but diagnosed STI rates were twice as high among females versus males (10.4% versus 4.1%, p = 0.007). There were significant differences in the determinants of reported versus diagnosed STIs. In particular, age and sexual orientation were associated with reported STIs, but not with diagnosed STIs. Conversely, STI counseling and depression were associated with STI diagnosis but not with STI reports.CONCLUSION:This study underlines the need to use biomarkers in population-based surveys, given the differential and substantial underreporting of STIs. Results also highlight the need for programmatic adaptation to address gender inequalities in STI rates, by developing women's health services in the French military. Addressing such needs not only benefits women but could also serve as a strategy to reduce overall STI rates as most military women have military partners, increasing the risk of internal transmission.
International audience ; Background: Suicide within the Amerindian community of Camopi (1741 inhabitants) in French Guiana has been an increasing problem widely reported in the media leading the French Government to mandate a parliamentary mission to investigate the matter. The purpose of the study was to describe this phenomenon and identify factors associated with suicide attempts.Methods:A retrospective observational study was conducted from the health centers' medical records. All suicideattempts and suicides committed between 2008 and 2015 by Amerindians living in Camopi and Trois Sauts werecompiled. Contextual factors and suicide representations were also analyzed.Results:During the study period, the annual attempted suicide rate and the suicide rate were higher in the last 3years. The overall annual rate was equal to 6.9/1741 or 396 per 100, 000 inhabitants for attempted suicide and 172per 100,000 inhabitants for suicide, which is more than 10 times higher than the suicide rate in mainland France.The mortality rate was 30.4% versus 8.2% in mainland France. The 10–20 year-old age group represented 70% ofsuicide deaths. There was no significant difference between genders. A recent death and interpersonal conflictwere the main stressful life events reported by respondents (55 and 52%, respectively). Alcohol addiction (30% ofthe respondents) was associated with suicide attempts under the influence of alcohol (p= 0.03). Repetition ofsuicide attempts was associated with cannabis consumption (p= 0.03). Depression was reported among 45% of therespondents. A third of respondents reported having been abused during their childhood. Over half of respondentsreported that their suicide attempt was motivated by a spirit (58%).Conclusions:Despite limitations due to the small population size and limited time frame, this is the first study todescribe the epidemiology of suicide among Amerindians living in Camopi. In contrast with other French territories,the suicide rate was very high, the sex ratio was balanced and ...
International audience ; Introduction: Ecological deprivation indices belong to essential instruments for monitoring and understanding health inequalities. Our aim was to develop the SI-EDI, a newly derived European Deprivation Index for Slovenia. We intend to provide researchers and policy-makers in our country with a relevant tool for measuring and reducing the socioeconomic inequalities in health, and even at a broader level. Methods: Data from the European survey on Income and Living Conditions and Slovenian national census for the year 2011 were used in the SI-EDI construction. The concept of relative deprivation was used where deprivation refers to unmet need(s), which is caused by lack of all kinds of resources, not only material. The SI-EDI was constructed for 210 Slovenian municipalities. Its geographical distribution was compared to the distribution of two existing deprivation scores previously applied in health inequality research in Slovenia. Results: There were 36% of adults recognized as deprived in Slovenia in 2011. SI-EDI was calculated using 10 census variables that were associated with individual deprivation. A clear east-to-west gradient was detected with the most deprived municipalities in the eastern part of the country. The two existing deprivation scores correlate significantly with the SI-EDI. Conclusions: A new deprivation index, the SI-EDI, is grounded on the internationally established scientific concept, can be replicated over time and, crucially, provides an account of the socioeconomic and cultural particularities of the Slovenian population. The SI-EDI could be used by the stakeholders and the governmental and nongovernmental sectors in Slovenia, with the goal of better understanding health inequalities in Slovenia. ; Uvod: Kazalniki, ki na ravni izbranih geografskih enot prikazujejo socialno-ekonomsko blagostanje oziroma primanjkljaj prebivalstva, so danes temeljno orodje za preučevanje in razumevanje neenakosti v zdravju. V prispevku predstavljamo SI-EDI, novo razvit kazalnik primanjkljaja na ravni slovenskih občin. SI-EDI je slovenska različica evropskega kazalnika primanjkljaja (European Deprivation Index – EDI), ki ga v javnozdravstvenih raziskavah že uspešno uporabljajo v Franciji, Španiji, Italiji, Angliji in na Portugalskem. Namen raziskave je tudi preveriti veljavnost SI-EDI in ga tako kot ustrezno orodje ponuditi raziskovalcem in odločevalcem. Metode: Za izdelavo SI-EDI smo uporabili podatke za leto 2011 iz dveh virov: (1) podatke slovenske različice Ankete o življenjskih pogojih, ki jo na zahtevo Eurostata na reprezentativnem vzorcu posameznikov letno izvaja nacionalni statistični urad, in (2) podatke iz popisa prebivalstva. Izračun temelji na konceptu relativnega primanjkljaja, ki ga je prvi opisal Townsend, danes pa se v nekoliko prilagojeni obliki uporablja tudi v izračunu kazalnikov primanjkljaja na ravni Evropske unije. V konceptu relativnega primanjkljaja so pomanjkanju podvrženi posamezniki, ki jim ni omogočeno zadovoljevanje različnih vrst potreb, ne samo materialnih. SI-EDI za 210 slovenskih občin smo izračunali po enaki metodi, kot se uporablja za EDI. Njegovo veljavnost smo preizkušali s primerjavo z dvema obstoječima kazalnikoma, ki sta se v slovenskem prostoru v zadnjem obdobju uporabljala v raziskavah in prikazih socialno-ekonomske neenakosti v zdravju po občinah: koeficientom razvitosti občin, ki ga uporablja NIJZ, ter kazalnikom primanjkljaja, ki ga je v dosedanjih analizah bremena raka uporabljala naša raziskovalna skupina. Rezultati: Med štirimi temeljnimi življenjskimi potrebami (dostopnost počitnic, zmožnost ogrevati bivališče, osebnega računalnika in avtomobila), ki so se v raziskavi izkazale za povezane z objektivno ali subjektivno revščino, vsaj ene izmed njih ni zadovoljilo 36 % odraslih. Ti so bili opredeljeni kot prikrajšani na individualni ravni. Njihove lastnosti so bile prenesene na populacijsko raven v agregirani obliki, tako da smo za izračun SI-EDI uporabili 10 ustreznih popisnih spremenljivk. Na zemljevidu SI-EDI po občinah je jasno viden trend večanja socialno-ekonomskega primanjkljaja od zahoda proti vzhodu države. Največje vrednosti SI-EDI imajo področja na skrajnem severovzhodu in jugovzhodu države. Povezava SI-EDI z dvema obstoječima kazalnikoma primanjkljaja je bila statistično značilna. Zaključki: Nov kazalnik primanjkljaja SI-EDI je zasnovan na mednarodno priznanem znanstvenem konceptu, lahko se replicira v času in prostoru, ter kar je najpomembnejše, odraža socialno-ekonomske in kulturne posebnosti populacije. Prepričani smo, da lahko služi kot ustrezno orodje pri razumevanju socialno-ekonomskih razlik v zdravju, zagotovo pa je lahko uporaben tudi drugod, ne samo na javnozdravstvenem področju.
International audience ; INTRODUCTION:Sexually Transmitted Infections (STIs) have always represented a public health concern in the military, yet most studies rely on self-reports among non-random samples of military populations. In addition, most of the studies exploring STI rates among the military focus on US service members. This paper assesses the prevalence and correlates of STIs in the French military using biomarkers and compares self-reported versus diagnosed STIs.METHODS:Data are drawn from the COSEMIL study, a national sexual health survey conducted in the French military in 2014 and 2015. A random sample of 784 men and 141 women aged 18-57 years completed a self-administered questionnaire and provided biological samples for STI testing. We used logistic regression modeling to identify the correlates of STI diagnosis and self-reports.RESULTS:The prevalence of diagnosed STIs was 4.7% [3.8-5.9], mostly due to Chlamydia trachomatis. This rate was four times higher than the 12 months self-reported rate of 1.1% [0.6-2.3]. Reported STI rates were similar among men and women (1.1% versus 1.8%), but diagnosed STI rates were twice as high among females versus males (10.4% versus 4.1%, p = 0.007). There were significant differences in the determinants of reported versus diagnosed STIs. In particular, age and sexual orientation were associated with reported STIs, but not with diagnosed STIs. Conversely, STI counseling and depression were associated with STI diagnosis but not with STI reports.CONCLUSION:This study underlines the need to use biomarkers in population-based surveys, given the differential and substantial underreporting of STIs. Results also highlight the need for programmatic adaptation to address gender inequalities in STI rates, by developing women's health services in the French military. Addressing such needs not only benefits women but could also serve as a strategy to reduce overall STI rates as most military women have military partners, increasing the risk of internal transmission.
International audience ; Background: Suicide within the Amerindian community of Camopi (1741 inhabitants) in French Guiana has been an increasing problem widely reported in the media leading the French Government to mandate a parliamentary mission to investigate the matter. The purpose of the study was to describe this phenomenon and identify factors associated with suicide attempts.Methods:A retrospective observational study was conducted from the health centers' medical records. All suicideattempts and suicides committed between 2008 and 2015 by Amerindians living in Camopi and Trois Sauts werecompiled. Contextual factors and suicide representations were also analyzed.Results:During the study period, the annual attempted suicide rate and the suicide rate were higher in the last 3years. The overall annual rate was equal to 6.9/1741 or 396 per 100, 000 inhabitants for attempted suicide and 172per 100,000 inhabitants for suicide, which is more than 10 times higher than the suicide rate in mainland France.The mortality rate was 30.4% versus 8.2% in mainland France. The 10–20 year-old age group represented 70% ofsuicide deaths. There was no significant difference between genders. A recent death and interpersonal conflictwere the main stressful life events reported by respondents (55 and 52%, respectively). Alcohol addiction (30% ofthe respondents) was associated with suicide attempts under the influence of alcohol (p= 0.03). Repetition ofsuicide attempts was associated with cannabis consumption (p= 0.03). Depression was reported among 45% of therespondents. A third of respondents reported having been abused during their childhood. Over half of respondentsreported that their suicide attempt was motivated by a spirit (58%).Conclusions:Despite limitations due to the small population size and limited time frame, this is the first study todescribe the epidemiology of suicide among Amerindians living in Camopi. In contrast with other French territories,the suicide rate was very high, the sex ratio was balanced and younger age groups were most affected
A public health intervention must improve the health of the population. The intervention can be seen as a set of actions to modify behaviors and beliefs to reduce morbidity and mortality. It is thus similar to a military intervention: the opposing forces must be fought to override the prevailing realm of beliefs and harmful behaviors and to ultimately install long-lasting remedies. In the run-up to the Gulf War in 1990, General Colin Powell, chairman of the Joint Chiefs of Staff, outlined one of the most comprehensive sets of principles in military strategy history 1. This so-called Powell Doctrine is a list of eight questions that must all be answered affirmatively before the US government takes any military action. If any answer to a question is not in the affirmative, the success of the operation may be compromised. We propose an adaptation of the Powell Doctrine applicable for public health interventions.
International audience ; INTRODUCTION:Sexually Transmitted Infections (STIs) have always represented a public health concern in the military, yet most studies rely on self-reports among non-random samples of military populations. In addition, most of the studies exploring STI rates among the military focus on US service members. This paper assesses the prevalence and correlates of STIs in the French military using biomarkers and compares self-reported versus diagnosed STIs.METHODS:Data are drawn from the COSEMIL study, a national sexual health survey conducted in the French military in 2014 and 2015. A random sample of 784 men and 141 women aged 18-57 years completed a self-administered questionnaire and provided biological samples for STI testing. We used logistic regression modeling to identify the correlates of STI diagnosis and self-reports.RESULTS:The prevalence of diagnosed STIs was 4.7% [3.8-5.9], mostly due to Chlamydia trachomatis. This rate was four times higher than the 12 months self-reported rate of 1.1% [0.6-2.3]. Reported STI rates were similar among men and women (1.1% versus 1.8%), but diagnosed STI rates were twice as high among females versus males (10.4% versus 4.1%, p = 0.007). There were significant differences in the determinants of reported versus diagnosed STIs. In particular, age and sexual orientation were associated with reported STIs, but not with diagnosed STIs. Conversely, STI counseling and depression were associated with STI diagnosis but not with STI reports.CONCLUSION:This study underlines the need to use biomarkers in population-based surveys, given the differential and substantial underreporting of STIs. Results also highlight the need for programmatic adaptation to address gender inequalities in STI rates, by developing women's health services in the French military. Addressing such needs not only benefits women but could also serve as a strategy to reduce overall STI rates as most military women have military partners, increasing the risk of internal transmission.
