Mainland France Research Articles

Residential proximity to croplands at birth and childhood leukaemia

BackgroundDomestic and parental occupational pesticide exposures are suspected of involvement in the occurrence of childhood acute leukaemia (AL), but the role of exposure to agricultural activities is little known. In a previous ecological study conducted in France, we observed an increase in acute lymphoblastic leukaemia (ALL) incidence rate with increasing viticulture density in the municipalities of residence at diagnosis.ObjectivesThis study aimed to test the hypothesis that residential proximity to croplands at birth increases the risk of childhood AL, with a particular focus on vineyards.MethodsWe identified all the primary AL cases diagnosed before the age of 15 years in the cohorts of children born in the French municipalities between 1990 and 2015. We estimated crop densities in each municipality of residence at birth using agricultural census data, for ten crop types. Variations in standardized incidence ratios (SIR) were evaluated with Poisson regression models, for all AL, ALL and acute myeloid leukaemia (AML), separately.ResultsAmong the 19,809,700 children born and residing in mainland France at birth in 1990–2015, 8,747 AL cases (7,236 ALL and 1,335 AML) were diagnosed over the period. We did not evidence any statistically significant positive association between total crop density or any specific crop density in the municipality of residence at birth and all AL, ALL or AML. Interestingly, we observed a higher ALL incidence rate in the municipalities with the highest viticulture densities (SIR = 1.25 95%CI [1.01–1.54]). Adjusting for the main potential confounders did not change the results.ConclusionOur study does not support the hypothesis that residential proximity to croplands, particularly vineyards, around birth plays a role in childhood leukaemia. The slightly higher ALL incidence rate in children born in the municipalities with the highest viticulture densities may reflect the previously-observed association at diagnosis.

Emergence of a Novel Lineage and Wide Spread of a blaCTX-M-15/IncHI2/ST1 Plasmid among Nosocomial Enterobacter in Guadeloupe.

Between April 2018 and August 2019, a total of 135 strains of Enterobacter cloacae complex (ECC) were randomly collected at the University Hospital Center of Guadeloupe to investigate the structure and diversity of the local bacterial population. These nosocomial isolates were initially identified genetically by the hsp60 typing method, which revealed the clinical relevance of E. xiangfangensis (n = 69). Overall, 57/94 of the third cephalosporin-resistant strains were characterized as extended-spectrum-β-lactamase (ESBL) producers, and their whole-genome was sequenced using Illumina technology to determine the clonal relatedness and diffusion of resistance genes. We found limited genetic diversity among sequence types (STs). ST114 (n = 13), ST1503 (n = 9), ST53 (n = 5) and ST113 (n = 4), which belong to three different Enterobacter species, were the most prevalent among the 57 ESBL producers. The blaCTXM-15 gene was the most prevalent ESBL determinant (56/57) and was in most cases associated with IncHI2/ST1 plasmid replicon carriage (36/57). To fully characterize this predominant blaCTXM-15/IncHI2/ST1 plasmid, four isolates from different lineages were also sequenced using Oxford Nanopore sequencing technology to generate long-reads. Hybrid sequence analyses confirmed the circulation of a well-conserved plasmid among ECC members. In addition, the novel ST1503 and its associated species (ECC taxon 4) were analyzed, in view of its high prevalence in nosocomial infections. These genetic observations confirmed the overall incidence of nosocomial ESBL Enterobacteriaceae infections acquired in this hospital during the study period, which was clearly higher in Guadeloupe (1.59/1000 hospitalization days) than in mainland France (0.52/1,000 hospitalization days). This project revealed issues and future challenges for the management and surveillance of nosocomial and multidrug-resistant Enterobacter in the Caribbean.

Medical and psychological support during the COVID-19 pandemic in Overseas France

France has developed medical and psychological expertise and has equipped all the 15 (french medical service) centres with Medical and Psychological Emergency Units (CUMPs) composed of medical and paramedical teams of referral psychiatrists, psychologists and nurses, reinforced by volunteers (mental health professionals, trained in this discipline). The attacks endured by France heavily called on the services of the teams in mainland France, particularly in Paris in 2015 and Nice in 2016, with reinforcements between teams in mainland France. The COVID-19 pandemic led to the dispatching of teams outside mainland France to overseas territories hard hit by the pandemic, to the point of creating a real health disaster. These situations have been presented to European partners in the framework of the NO-FEAR project. The article relates the human and ethical experience of these teams as well as their preparation.

An updated assessment of past and future warming over France based on a regional observational constraint

Abstract. Building on CMIP6 climate simulations, updated global and regional observations, and recently introduced statistical methods, we provide an updated assessment of past and future warming over France. Following the IPCC AR6 and recent global-scale studies, we combine model results with observations to constrain climate change at the regional scale. Over mainland France, the forced warming in 2020 with respect to 1900–1930 is assessed to be 1.66 [1.41 to 1.90] ∘C, i.e., in the upper range of the CMIP6 estimates, and is almost entirely human-induced. A refined view of the seasonality of this past warming is provided through updated daily climate normals. Projected warming in response to an intermediate emission scenario is assessed to be 3.8 ∘C (2.9 to 4.8 ∘C) in 2100 and rises up to 6.7 [5.2 to 8.2] ∘C in a very high emission scenario, i.e., substantially higher than in previous ensembles of global and regional simulations. Winter warming and summer warming are expected to be about 15 % lower than and 30 % higher than the annual mean warming, respectively, for all scenarios and time periods. This work highlights the importance of combining various lines of evidence, including model and observed data, to deliver the most reliable climate information. This refined regional assessment can feed adaptation planning for a range of activities and provides additional rationale for urgent climate action. Code is made available to facilitate replication over other areas or political entities.

Pathological significance of GLUT-1 expression in breast cancer cells in diabetic and obese patients: The French Guiana study

The prevalence of obesity and type 2 diabetes is higher in French Guiana compared to mainland France. These metabolic disorders are associated with an increased risk of cancer. One of the factors involved is hyperinsulinemia that promotes the action of glucose transporter 1 (GLUT-1). The objective of this study is to characterize the expression of GLUT-1 in breast cancers cells in diabetic and obese patients compared to those who are not and to describe the clinical and histological prognostic factors of breast cancer in this population. We conducted a monocentric study between 2014 and 2020. Patients were classified into three groups: diabetes, obesity, and control group. The GLUT-1 expression was assessed by immunohistochemistry. In total, 199 patients were included in this study. The median age was 53.5 years, and the median tumor size was 2.8 cm. Luminal A was the most frequent molecular type (58.1%), followed by the triple-negative type (19.9%). The breast cancer in our population was characterized by a younger age at diagnosis, more aggressive molecular types, and larger tumor size. Thus, we suggest the advancement of the age of breast cancer screening in this territory. Overexpression of GLUT-1 was observed in 60.4% of cases and in all carcinoma in situ lesions. GLUT-1 overexpression was associated with more aggressive cancers. This overexpression is correlated with high histological grade, high proliferation index, and aggressive molecular types. Our study found no difference in GLUT-1 expression between the diabetic or obese patients and the control group.

Note on Psila helvetica Shatalkin & Merz, 2010: a new rust fly (Diptera: Psilidae) for mainland France, with key to French species and male genitalia illustration

Note on Psila helvetica Shatalkin & Merz, 2010: a new rust fly (Diptera: Psilidae) for mainland France, with key to French species and male genitalia illustration

Lost in transformation: comparative analysis of healthcare provision dynamics within urban systems of European Russia and France

ABSTRACT Since the 1990s, many countries have implemented healthcare reforms underlined by New Public Management principles and technological transformations. Although studies have examined these reforms from different viewpoints, the spatial implications of healthcare reforms have received limited attention. Scholarship focused predominantly on regional variations of healthcare provision overlooking the sharp contrasts between cities where most healthcare facilities are de facto located. Addressing this research gap, we investigate the long-term dynamics of healthcare provision on the urban level, tracing the differences (if any) between cities of different sizes and administrative statuses. The study adopts a comparative approach. We draw our data from two countries: France and Russia (mainland France and European Russia). Findings indicate that, despite some variations, healthcare reforms in both countries follow similar paths, resulting in fewer hospital beds that have been partially replaced by places in day hospitals. At the same time, we also observe diverging country-specific trends in terms of redistribution of healthcare provision. In France, some cities completely lost their hospital equipment but those cities that remained equipped tend to a uniform distribution. In European Russia, on the contrary, all cities remain equipped but there is a drastic polarization depending on size and administrative status.

Epidemiology of the Microsporidium Nosema ceranae in Four Mediterranean Countries.

Simple SummaryNosema ceranae is a highly prevalent intracellular parasite of honey bees’ midgut worldwide. There is a lack of studies addressing the influence of climatic and beekeeping factors on the dynamics of its infection. A long-term study has been carried out in six apiaries in four Mediterranean countries (France, Israel, Portugal, and Spain), monitoring a total of 103 colonies. The lowest prevalence of infection was observed in mainland France, while the highest percentage of infected honey bees per colony was detected in Israel. The location and beekeeping management were shown to influence the infection levels. The percentage of infected honey bees negatively affected the colony strength in the apiaries located in Spain and mainland Portugal, whereas queen replacement had a positive effect on these same apiaries, reducing infection levels. The highest colony losses occurred in mainland France, which had the lowest levels of N. ceranae. It was followed by Spain, an apiary with high levels of N. ceranae, so no correlation between infection and mortality could be established. These results suggest that complementary studies on interactions with other pathogens and honey bee genetics are needed in order to develop management strategies for its control.Nosema ceranae is a highly prevalent intracellular parasite of honey bees’ midgut worldwide. This Microsporidium was monitored during a long-term study to evaluate the infection at apiary and intra-colony levels in six apiaries in four Mediterranean countries (France, Israel, Portugal, and Spain). Parameters on colony strength, honey production, beekeeping management, and climate were also recorded. Except for São Miguel (Azores, Portugal), all apiaries were positive for N. ceranae, with the lowest prevalence in mainland France and the highest intra-colony infection in Israel. A negative correlation between intra-colony infection and colony strength was observed in Spain and mainland Portugal. In these two apiaries, the queen replacement also influenced the infection levels. The highest colony losses occurred in mainland France and Spain, although they did not correlate with the Nosema infection levels, as parasitism was low in France and high in Spain. These results suggest that both the effects and the level of N. ceranae infection depends on location and beekeeping conditions. Further studies on host-parasite coevolution, and perhaps the interactions with other pathogens and the role of honey bee genetics, could assist in understanding the difference between nosemosis disease and infection, to develop appropriate strategies for its control.

Location dynamics of general practitioners in France

BackgroundFor several years now, the socio-political context in France has widened the territorial divide between metropolitan France and peripheral France. Access to healthcare is part of this divide, which harms small and medium-sized towns as well as rural fringes. This article focuses on these geographic dynamics in access to healthcare, with a focus on self-employed general practitioners (GPs), who are essential links in the care pathway as referring physicians. MethodsThis paper uses data from French public statistics from 2007 to 2017 to build spatial panels and to highlight the territorial factors that explain the dynamics of the locations of GPs. ResultsOver the period under review, the density of GPs has decreased and territorial disparity has increased. There is no trend towards a worsening of this isolation of either the periphery or deprived cantons with regard to the density of GPs in these areas. However, we note a clear trend towards the grouping together of different types of care within cantons, leading to a tendency towards the polarization of the healthcare supply in the territories of mainland France, which implies another type of geographical difficulty. ConclusionThe increase in territorial disparities in accessibility to GPs does not really seem to correspond to the classical divides in France, but rather raises the issue of intra-metropolis and intra-periphery disparities.

Ecologisation, territorialisation and participation: A mining narrative in times of ecological crisis.

Companies wishing to invest in the French underground market today must consider several orders of change compared to the 1990–2000 period, ranging from the ecological transition agenda, to the failure of the national “mining renewal” policy, the rise of the local scale in natural resources governance, to the growing critique of mining practices. What influence does this new configuration have on the territorial strategy and narrative of mining companies in mainland France? This research is based on a case study: an exploration project of gaseous resources (helium, carbon dioxide and related gases) conducted in France by a junior mining company. In order to promote local acceptance of its future activities, the company puts forward a “green” communication raising the question of a more integrated relationship between industry, territory and environment. Does it translate a new consideration to “the territory” or is it a mere communication strategy, or both?

Lack of pediatricians in sociomedical units (PASS) in France

In France, units called “Healthcare Access Centers” (Permanences d'Accès aux Soins de Santé; PASS) improve access to the healthcare system for deprived outpatients in hospitals. This study aimed to describe child care in PASS in mainland France in 2019. PASS receive a growing number of children: 23.9% of all newly admitted patients. However, only 6.6% of children receiving care were seen by pediatricians. Social deprivation would receive better attention in pediatric care through the close partnership between PASS and pediatricians or through the direct intervention of the latter in PASS. This improvement also starts with the implementation of wide screening for social vulnerability during the routine medical follow-up of children.

Faecal carriage of multidrug-resistant bacteria and associated risk factors: results from a point prevalence study.

Since 2003, incidences of carbapenemase-producing Gram-negative bacilli (CP-GNB) and vancomycin-resistant Enterococcus faecium (VRE) have steadily increased in France. We therefore conducted a point prevalence study to estimate carriage rates of CP-GNB, VRE and ESBL-producing Enterobacterales (ESBL-PE) and associated risk factors. Between September 2019 and January 2020, all inpatients hospitalized on a given day in 11 teaching hospitals in the Paris urban area were eligible. Patient interviews and rectal swab screening results were recorded by dedicated nurses. The swabs were plated onto selective chromogenic media and processed using the GeneXpert® system. Of 2396 patients, 364 (15.2%) yielded at least one multiresistant bacterial isolate, including 29 CP-GNB carriers (1.2%), 13 VRE carriers (0.5%) and 338 ESBL-PE carriers (14%). In 15 patients (4.4% of ESBL-PE carriers and 36.6% of CP-GNB/VRE carriers), concomitant CP-GNB/VRE and ESBL-PE carriage was observed. In 7/29 CP-GNB and 7/13 VRE carriers, carbapenemase production and vanA in the screening samples was only detected with Xpert® tests. The OXA-48 gene was predominant in 13/34 CP-GNB isolates from 29 carriers. From the 338 ESBL-PE carriers, 372 isolates were recovered, mainly Escherichia coli (61.2%). Among 379 children, 1.1% carried a CP-GNB/VRE strain, and 12.4% carried an ESBL strain. Previous hospitalization outside mainland France, previous antimicrobial treatment and previous ESBL-PE carriage were the main risk factors associated with CP-GNB and/or VRE carriage. The low CP-GNB and VRE prevalence likely reflects the French policy to limit intrahospital spread of CP-GNB and VRE strains.

Hepatitis B, C, and delta in the general population in Mayotte: hepatitis B as a major public health concern

BackgroundLocated in southwestern Indian Ocean, Mayotte is a French territory, with a very specific demographic, social and health context. To date, epidemiological data on infections by hepatitis B (HBV), C (HCV), and delta (HDV) viruses in Mayotte have been sparse. We aimed to estimate, in the 15–69-year-old general population living in Mayotte, the prevalence of infections by hepatitis B (HBV), C (HCV), and delta (HDV) viruses and the distribution of HBV status: current infection with positive HBs antigen (Ag); resolved infection with positive HBc antibodies and negative HBsAg; immunisation by vaccination with only positive HBs antibodies; and no infection/no immunisation with negative markers. We also described the characteristics of infected people and assessed the determinants of lifetime HBV infection.MethodsThe Unono Wa Maore survey, implemented in a random sample of the general population in 2018–2019, consisted of an at-home collection of epidemiological data and venous blood samples. Detection of hepatitis B, C, and delta serological and molecular markers was performed.ResultsAmong 5207 eligible people, 4643 responded to the questionnaire (89.2%), with 2917 being tested for HBV and HCV (62.8%). Estimated HBV status was as follows: current infection 3.0% (95% confidence interval [CI]: 2.3–3.9%) (n = 76); resolved infection 27.8% (95% CI: 25.8–29.9); immunisation by vaccination 27.7% (95% CI: 25.9–29.7); and no infection/no immunisation 41.5% (95% CI: 39.3–43.7). One participant was positive for HDV antibodies (Ab) (0.65%) with a negative HDV-RNA viral load. The risk of lifetime HBV infection was higher in men (adjusted prevalence ratio (aPR): 1.55, 95% CI: 1.29–1.89); in people aged 30–49 years (aPR: 3.83, 95% CI: 1.49–9.81) or 50–69 years (aPR: 4.52, 95% CI: 1.77–11.53) compared to those under 20; in individuals who reported no condom use during their first sexual intercourse (aPR: 1.46, 95% CI: 1.01–2.14); and in those living in Dembeni-Mamoudzou (aPR: 1.40, 95% CI: 1.09–1.80) compared to the West-Centre of Mayotte. Finally, six individuals were positive for HCV antibodies (0.21%), including three positive for HCV RNA.ConclusionsMayotte is an area of intermediate endemicity for HBV and low endemicity for HCV and HDV. With a prevalence of HBsAg 10 times higher than in mainland France, a high proportion of people susceptible to HBV infection, and a demographic, health, and social context that may favour its transmission, hepatitis B is a major public health concern in Mayotte.

Cross-sectional comparisons of dietary indexes underlying nutrition labels: nutri-score, Canadian 'high in' labels and Diabetes Canada Clinical Practices (DCCP).

To assess the cross-sectional association between dietary indexes (DI) that underlie, respectively, the Nutri-score (NS), the proposed Canadian 'High In' Symbol (CHIL) and the Diabetes Canada Clinical Practice Guidelines (DCCP) with food consumption, nutrient intakes and metabolic markers. 1836 adults (18-74years) participating in the representative ESTEBAN study, conducted in mainland France in 2014-2016, were included in the analysis. Food consumption was assessed with three repeated 24h dietary recalls. Anthropometric measurements and biomarkers of metabolic risk (cholesterol-total, LDL (Low Density Lipoprotein), HDL (High Density Lipoprotein)-triglycerides, glucose) were obtained through a clinical examination and fasting blood draw. The DI were assessed for their association with food consumption, dietary intakes and metabolic biomarkers as quintiles and continuous variables using multi-adjusted linear regression. Heathier diets were assigned to lower scores. Correlations between scores ranged from + 0.62 between CHIL-DI and NS-DI to + 0.75 between NS-DI and DCCP-DI. All DIs discriminated individuals according to the nutritional quality of their diets through food consumption and nutrient intakes (healthier diets were associated with lower intakes of energy, added sugars and saturated fat; and with higher intakes of fiber, vitamins and minerals). NS-DI was associated with blood glucose (adjusted mean in Q1 = 5 vs. Q5 = 5.46mmol/dl, ptrend = 0.001) and DCCP-DI was associated with BMI (Q1 = 24.8kg/m2 vs. Q5 = 25.8kg/m2, ptrend = 0.025), while CHIL showed no significant association with any anthropometric measures or biomarkers. This study provides elements supporting the validity of the nutrient profiling systems underlying front-of-package nutrition labellings (FOPLs) to characterize the healthiness of diets.

Sociodemographic and behavioural factors of adherence to the no-screen guideline for toddlers among parents from the French nationwide Elfe birth cohort

BackgroundExcessive screen time in infancy and childhood has been associated with consequences on children’s development and health. International guidelines call for no screen time before age 2 years, whereas in France, the most prominent guidelines recommend no screen before age 3 years. However, data are lacking on parental adherence to the no-screen guideline for toddlers and factors of adherence in France. Using data from the French nationwide Elfe birth cohort, we estimated adherence to the no-screen guideline at age 2 years and examined related factors, including sociodemographic characteristics, parental leisure activities and screen time.MethodsIn 2011, 18,329 newborns and their parents were enrolled in 349 randomly selected maternity units across mainland France. At age 2 years, screen exposure of 13,117 toddlers was reported by parents in phone interviews. Data on sociodemographic characteristics, parental leisure activities and screen time were collected from both parents. Three patterns of parental leisure activities were derived by principal component analysis: literate (e.g.,reading), screen-based, and physical/artistic activities. Multivariable logistic regression models were used to examine the associations of sociodemographic characteristics, parental leisure activities and parental screen time with adherence to the no-screen guideline for toddlers.ResultsOverall, 1809/13,117 (13.5%) families adhered to the no-screen guideline for toddlers. Adherence was reduced with maternal age < 40 years, low parental education, single-parent household and parental migration status. After adjusting for sociodemographic characteristics, adherence to the guideline was positively associated with a parental literate activity pattern (mothers: odds ratio [95% confidence interval]: 1.15 [1.08, 1.22]); fathers: 1.15 [1.07, 1.23]) and negatively with a screen-based activity pattern (mothers: 0.73 [0.69, 0.77]; fathers: 0.81 [0.76, 0.87]). With each additional hour of parental screen time, mothers and fathers were less likely to adhere to the guideline (mothers: adjusted odds ratio 0.80 [0.77, 0.83]; fathers: 0.88 [0.85, 0.91]).ConclusionsAdherence to the no-screen guideline for toddlers in France was low. Parental leisure activities and parental screen time are major factors of adherence to the no-screen guideline and could be considered in targeted public health interventions.

Public perception of the tax on sweetened beverages in France.

To assess in 2021 the acceptance and perception of the French tax on sweetened beverages, following its revision in 2018, and factors associated with a higher level of acceptance. A cross-sectional survey within the NutriNet-Santé cohort study. Participants were invited to complete a self-reported questionnaire in March 2021. Weighting was applied to the sample to allow inferences on the French population. Individual characteristics associated with support for the tax were investigated using logistic regression modelling. NutriNet-Santé prospective cohort study. Adults engaged in the NutriNet-Santé cohort, aged 18 years or older (n 28 344), living in mainland France. Almost two-thirds (63·4 %) of the participants were aware of the existence of a tax on sweetened beverages, although less than a quarter had specific knowledge regarding its design and the 2018 revision. In turn, 64·7 % of participants expressed a favourable opinion towards the taxation scheme. This proportion was higher if tax revenues were used to finance health-related measures (respectively 68·8 % of favourable opinion if used to finance a reduction in prices of healthy products and 76·4 % if used to finance the healthcare system). Multivariable analyses showed that support towards the tax varied among subgroups of the population. Groups who tended to be less financially affected by the measure and those who perceived sugar-sweetened beverages as having detrimental effects were more likely to support the tax. The revised French sugar-sweetened beverage tax appeared to be favourably received and perceived by the public.

Underuse of primary healthcare in France during the COVID-19 epidemic in 2020 according to individual characteristics: a national observational study

BackgroundThe organization of healthcare systems changed significantly during the COVID-19 pandemic. The impact on the use of primary care during various key periods in 2020 has been little studied.MethodsUsing individual data from the national health database, we compared the numbers of people with at least one consultation, deaths, the total number of consultations for the population of mainland France (64.3 million) and the mean number of consultations per person (differentiating between teleconsultations and consultations in person) between 2019 and 2020. We performed analyses by week, by lockdown period (March 17 to May 10, and October 30 to December 14 [less strict]), and for the entire year. Analyses were stratified for age, sex, deprivation index, epidemic level, and disease.ResultsDuring the first lockdown, 26% of the population consulted a general practitioner (GP) at least once (-34% relative to 2019), 7.4% consulted a nurse (-28%), 1.6% a physiotherapist (-80%), and 5% a dentist (-95%). For specialists, consultations were down 82% for ophthalmologists and 37% for psychiatrists. The deficit was smaller for specialties making significant use of teleconsultations. During the second lockdown, the number of consultations was close to that in 2019, except for GPs (-7%), pediatricians (-8%), and nurses (+ 39%). Nurses had already seen a smaller increase in weekly consultations during the summer, following their authorization to perform COVID-19 screening tests. The decrease in the annual number of consultations was largest for dentists (-17%), physiotherapists (-14%), and many specialists (approximately 10%). The mean number of consultations per person was slightly lower for the various specialties, particularly for nurses (15.1 vs. 18.6). The decrease in the number of consultations was largest for children and adolescents (GPs: -10%, dentists: -13%). A smaller decrease was observed for patients with chronic diseases and with increasing age. There were 9% excess deaths, mostly in individuals over 60 years of age.ConclusionsThere was a marked decrease in primary care consultations in France, especially during the first lockdown, despite strong teleconsultation activity, with differences according to age and healthcare profession. The impact of this decrease in care on morbidity and mortality merits further investigation.

Precariousness, Diabetes Control and Complications in French Guiana

AimsThe social parameters of an individual impact the incidence of cardiovascular diseases. French Guiana, an overseas French territory with a lower standard of living than France, has a prevalence of diabetes mellitus that is twice that of mainland France. In this context we aimed to study the relation between precariousness, diabetes complications and glycemic control.MethodsA multicenter prospective cohort was initiated since May 2019. 1243 patients were included and their outcomes and history were compared between the precarious and non-precarious based on their EPICES score, a score that measures social isolation and precariousness.Results73.3% of the sample was considered precarious. Retinopathy was significantly more frequent among the deprived. There were no significant differences for other macro or microvascular complications.There was a significant difference in Glycated Haemoglobin between the precarious and non-precarious groups (8.3% (67 mmol/l) vs 8.8% (73mmol/l)). After adjusting for potential confounders, precariousness was no longer associated with poor glycemic control; the independent factors significantly associated with poor glycemic control were: not being fluent in French, having creole or portugese as mother language, and not having any insurance.ConclusionsPrecariousness is a risk factor for retinal complications in patients with diabetes mellitus in French Guiana. In this chronic disease, the universal healthcare system alleviates health inequalities for many, but not all, diabetic complications.Translation and cultural mediation may further reduce health inequalities in this multicultural territory where a substantial proportion of the population is not fluent in French.

Vichy's Mass Firing of Women Teachers of Colour in the French Caribbean and its Consequences1

AbstractThis article examines the application to Martinique and Guadeloupe of Vichy's sexist law of 11 October 1940, relating to the employment of women and its impact on female teachers. We argue that Vichy showed greater zeal in applying the new regime's patriarchal law on women's work in the Caribbean than in mainland France. We examine in detail the 11 October 1940 law and the modalities of its application in the metropole and in the Caribbean, its manipulation by various actors and the arguments mobilized over the course of its promulgation in a West Indian context. Next, we consider to what degree female Caribbean teachers were impacted by these measures and analyse some of the underlying causes for their dismissal. We highlight the broader social and administrative transformations into which this particular purge fitted. Finally, we underscore the agency of fired schoolteachers as well as their resilience.

Unearthing BUMIDOM: the state-organized migration of French Caribbeans to mainland France (1963-1982) as portrayed in recent audiovisual productions

ABSTRACT This article explores four recent audiovisual productions that bring to light the state-organized mass migration of French West Indians from Martinique and Guadeloupe to mainland France through BUMIDOM (Bureau pour le développement des migrations dans les départements d’outre-mer) during the 1960s and 1970s. Vehemently criticized at the time—some observers even comparing it to the slave trade—BUMIDOM ended up being largely obfuscated from the collective national memory. Each in its own way, the four productions—two documentaries, Bumidom—Des Français venus d’Outre-mer (2011) and L’Avenir est ailleurs (2007), as well as the fictional TV mini series Le Rêve français (2018) and the feature film Le Gang des Antillais (2016)—unearth the humiliation experienced by the Martinicans and Guadeloupeans handled by BUMIDOM and how it enhanced their feeling of being perceived as not entirely French. After examining the productions, the article concludes by discussing them in relation to the concept of creoleness—as advocated by Jean Bernabé, Patrick Chamoiseau and Raphaël Confiant in Éloge de la créolité (1989)—and the ‘desire for conviviality’: to what extent can an excavation of a painful and contentious past be helpful in that respect?