Physicians train workers' compensation field referees.
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Disability Evaluation↗
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Consanguinity, fertility, reproductive wastage, infant mortality and congenital malformations in Jordan.
OBJECTIVES: Consanguinity is a wide spread practice in Jordan. The objective of this study is to explore the health effects of consanguinity, in particular fertility, reproductive wastage, infant mortality and congenital malformations. METHODS: A stratified 2 stage cluster sample of 1867 married couples, representative of all population groups and all geographic locations of Jordan were randomly selected. A questionnaire was specially designed to explore each of the objectives set for the study and was field tested. A group of field workers were thoroughly trained on the implementation of this instrument. All 1867 couples were interviewed by these field workers and completed questionnaires were reviewed before data entry. Data analysis was carried out using SPSSX statistical package. Significance tests were performed wherever appropriate. RESULTS: The study showed that fertility, as measured by the number of pregnancies, taking into consideration marriage duration, was not affected by consanguinity. Twin pregnancies and abortions did not show any significant difference between consanguineous and non-consanguineous marriages. Consanguineous marriages showed significantly higher rates of still births and infant mortality in general. Within the consanguineous group, female infant mortality rates were significantly higher than those of males. Congenital malformations as reported by mothers of consanguineous marriages were significantly higher than those reported by mothers of non-consanguineous marriages. CONCLUSION: This study showed that consanguinity has a detrimental effect on many aspects of reproductive health.
Abortion, Spontaneous↗
Measurements of year-long exposure to tree nursery workers using multiple pesticides.
A year-long nurseryworker pesticide exposure study was designed to measure and evaluate the exposure occurring to workers who had the potential for simultaneous exposure to multiple pesticides. This four-State study was conducted in five nurseries (four USDA Forest Service and one State) involved in conifer seedling production. Primary comparisons were made among nursery workers in the Pacific northwest and south central United States. Worker exposure was assessed by using patches attached to clothing, handrinse samples and urine excreted from potentially exposed workers. In addition, dislodgeable residue in rinsate from a water wash of pesticide-treated seedlings was also evaluated. Four different groups of field workers, designated as applicators, weeders, scouts and packers, were included. The pesticide absorbed dose, assessed by urine analysis of pesticide metabolites and the deposition of pesticide on patches attached to the clothing of field workers, was monitored as they performed their duties under normal conditions (e.g., typical clothing, pesticide application). Monitoring was performed for the 14 different pesticides which were used in these nurseries. Seven pesticides were studied in more detail using biological monitoring. For these compounds, metabolites known to be excreted in the urine of exposed humans or other mammals were used to estimate the dose of pesticide absorbed by the exposed workers. The highest percentage of positive samples came from dislodgeable residue samples (8.3%) followed by patch samples (3.2%), handrinse (2.9%), and urine samples (1.3%). To summarize the conclusions from the urinary excretion data, 12 of the 73 nursery workers in the study received a low absorbed dose of pesticide. Biological monitoring revealed that three pesticides (benomyl, bifenox and carbaryl) were found in the urine of some of the workers. Of the 3,134 urine samples analyzed there were 42 positive; 11 urine samples were positive for benomyl, while bifenox was responsible for 13 positives and carbaryl accounted for the remaining 18. The 12-week continuous monitoring of urine showed that metabolites of these materials were rapidly excreted; thus, no build-up in the body is anticipated. Margins of Safety (MOS) calculations were made to provide an assessment of the significance of the exposure. Based on the low frequency of positive urine samples in the study, the low levels of metabolites when they were found, their apparent rapid excretion rate and the No Observed Effect Level (NOEL) data, furnished from other sources, nursery worker exposure to pesticides in these conifer nurseries is below health threatening levels.
Adult↗
Determinants of pill failure in rural Bangladesh.
The pill is the most popular family planning method in Bangladesh. However, the failure rate of this method in Matlab, a typical rural area, has been found to be very high. It is estimated that with the current level of failure of the pill and other temporary contraceptives in Matlab, it is unlikely that fertility in Bangladesh will come down to replacement level without a change in contraceptive method mix. It is, therefore, important to know the reasons for the high failure in pill use. Data for this study came from a case-control study in Matlab. A pill failure was considered a case, and no-failure was considered a control. The study included 167 cases and 167 controls. In addition, five focus group discussions were conducted to supplement the data collected from the cases and controls to gain a deeper understanding of pill failure. Results of the analysis of both quantitative and qualitative data suggested that the following were the risk factors for pill failure: no mobility of women, poor knowledge of women about the effectiveness and consequences of drop-out from pill use, weak confidence in the pill, a gap between the use of subsequence pill cycles, delay in starting the pill after menstruation for the first use, not taking any measures consistently for missing the pill, and not following the arrow sign given on the pill cycle. Extensive training of field workers and pill users, covering the reasons for pill failure identified in this study and strong supervision of the work of field workers, is likely to reduce the rate of pill failure in Bangladesh. Also, information, education and communication services for users, and management of side-effects, may be helpful in reducing pill failure.
Adult↗
The relationships between biomechanical and postural stresses, musculoskeletal injury rates, and perceived body discomfort experienced by industrial workers: a field study.
A combination of archival, subjective, and observational field data collection methods were used to investigate the relationship between biomechanical and postural stresses, and the resulting physical strain experienced by industrial workers of a packaging plant. Assessment of physical strain was based on the number and incidence rate of Occupational Safety and Health Administration (OSHA)-reportable injuries that were recorded over a period of 27 months, and based on the self-reported ratings of perceived body discomfort. Both the biomechanical and postural stresses correlated with the musculoskeletal injury rate. The results illustrate the usefulness of postural and biomechanical analyses for assessing the risk of injury in industry.
Adult↗
[STATUS OF THE ACHROMATIC VISUAL FIELD IN WORKERS EXPOSED TO IONIZING RADIATION].
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Brain Diseases↗
Association between nutritional status, cell-mediated immune status and acute lower respiratory infections in Bangladeshi children.
OBJECTIVE: To investigate the association between nutritional status, cell-mediated immune status and the incidence of acute lower respiratory infections (ALRI). DESIGN: Community-based longitudinal study. SETTING: Three villages in rural Bangladesh at Matlab. SUBJECT: 696 children aged 0-59 months were followed up for a year. METHODS: Trained field workers visited all children every fourth day and collected morbidity data for the preceding three days by recall. To determine the type and severity of respiratory infections, the field workers physically examined each child reporting a cough. Anthropometric status was determined monthly and cell-mediated immune status by skin tests was assessed at the beginning of the study and thereafter every 3 months. RESULTS: The incidence of ALRI was 23 episodes per 100 child-years. A total of 73-78% of the children were below -2 z score weight for age, 15-30% were below - 2 z score weight for height, and 68-76% were below -2 z score height for age. In logistic regression models, malnutrition as assessed by weight-for-height status [odds ratio (OR) 0.66, 95% confidence interval (CI) 0.45-0.96, P = 0.03] or weight-for-age status (OR 0.64, 95% CI 0.45-0.92, P = 0.02) was significant predictor of ALRI. Anergic children had a higher risk of ALRI which approached to be statistically significant (OR 1.81, 95% CI 0.92-3.55, P = 0.08). CONCLUSIONS: Improvement of nutritional and cell-mediated immune status in rural Bangladeshi children should reduce the incidence of ALRI.
Acute Disease↗
Acute respiratory infections in children: a community-based longitudinal study in rural Bangladesh.
A community-based logitudinal study conducted in Matlab, a rural area in Bangladesh, investigated acute respiratory infections (ARI) among children. A cohort of 696 children under 5 years of age was followed for 1 year yielding 183,865 child-days of observation. Trained field workers visited the study children every fourth day. Data on symptoms suggesting ARI, such as fever, cough, and nasal discharge, were collected for the preceding 3 days by recall. To determine the type and severity of ARI, the field workers conducted physical examinations (temperature, rate of respiration, and chest indrawing) of children reporting cough and/or fever. The overall incidence of ARI was 5.5 episodes per child-year observed; the prevalence was 35.4 per hundred days observed. Most of the episodes (96 per cent) were upper respiratory infections (URI). The incidence of acute lower respiratory infections (ALRI) was 0.23 per child per year. The incidence of URI was highest in 18-23-month-old children, followed by infants 6-11 months old. The highest incidence of ALRI was observed in 0-5-month-old infants followed by 12-17-month-old children. Among 559 children who were followed for 6 months or longer, about 9 per cent did not suffer any URI episode and about 16 per cent suffered one or more ALRI episodes. About 46 per cent of URI and 65 per cent of ALRI episodes lasted 15 days or more. The incidence rates of URI were higher during the monsoon and pre-winter periods, and that of ALRI at the end of the monsoon and during the pre-winter periods. Sociodemographic variables were not associated with the incidence of URI or ALRI. The study documents ARI to be a major cause of morbidity among rural Bangladeshi children.
Bangladesh↗
Natural Nashers: a programme of dental health education for adolescents in schools.
This research set out to recognize and overcome the difficulties and doubts in designing, testing and disseminating a dental health education programme for adolescents, as part of their school curriculum. After extensive pilot work, large-scale field trials were mounted of Natural Nashers for 13-14-year-old pupils in school. These trials ran among 6700 pupils in 45 largely urban, mixed sex, state comprehensive schools in England and Scotland. A quasi-experimental control group design was used and evaluation was carried out at the levels of process (teachers' questionnaires, pupils worksheets, field-workers' reports) and outcome (pupils' pre- and post-questionnaires, worksheets, plaque and gingival scores), among a random subsample (n = 1900) divided between study (n = 1300) and control (n = 600). Eighty-three teachers completed a questionnaire and 330 field workers' reports were analysed. Two hundred and fifty pupils were further examined after a minimum of 6 months. Significant improvements in plaque and gingival scores, knowledge and attitudes compared to control pupils were noted. Gains in the areas of knowledge and attitudes were the largest of any recorded in similar trials in Europe. Process data showed that in the experimental schools, improved oral hygiene was correlated with teachers who were enthusiastic and used a cooperative style. Results from the teachers' questionnaire showed that the programme was very well received and educationally suitable.
Adolescent↗
Occupational exposure to agricultural chemicals: effect on the activities of some enzymes in the blood of farm workers.
OBJECTIVE: To determine the effect of different durations of exposure to agricultural chemicals on the activities of the blood enzymes delta-aminolevulinic acid dehydratase (ALAD), superoxide dismutase (SOD), and cholinesterase (ChE) in tobacco field workers. METHODS: For this preliminary investigation, 8 volunteers (all smoked tobacco) who were working on a small tobacco farm were monitored over a period of 2 years along with a comparable urban unexposed group (n = 4). During the growing season between 1994 and 1996, dermal and respiratory exposure were determined and blood samples were drawn after the following durations of field work: (1) preexposure (0 DAY); (2) after 1 day of field work (1 DAY) - workers reentered fields at 24 h after spraying of acephate and maleic hydrazide; (3) after 30 days of field work (postspraying; 30 DAYS); and (4) Postexposure - no tobacco production. Standard analytical methods were used. RESULTS: Activity of ALAD was depressed by 30% after 1 DAY and there was no further decrease in ALAD activity after 30 DAYS of field work. SOD activity, in contrast, declined by 29% and 50% after 1 DAY and 30 DAYS, respectively, as compared with 0-DAY activity and that of the urban control, which was similar to 0-DAY activity (P< or =0.05). Plasma ChE activity declined by 19% after both 1 and 30 DAYS of exposure/field work. The activities of all three enzymes were restored to urban control or preexposure levels during postexposure. Plasma Cd levels were high in the samples taken after 30 DAYS as compared with the preexposure levels. Respiratory nicotine exposure was highest after 30 DAYS of field work. CONCLUSION: This preliminary study suggests that erythrocyte SOD is a sensitive indicator of exposure to agricultural chemicals in tobacco field workers.
Adult↗
Subacute poisoning with phosalone, an organophosphate insecticide.
An illness characterized by weakness, dizziness, and gastrointestinal symtoms was identified among a crew of 30 migrant field-workers employed by a grape grower in Madera County, California, during August 1987. The onset of symptoms occurred between August 24 and August 30 and a median of 9 days from the date of first employment. The first crew member sought medical treatment on August 26, and 10 crew members were admitted to hospital between August 27 and August 30. For most workers, gastrointestinal and constitutional symptoms resolved shortly after admission, but 4 patients had episodes of severe sinus bradycardia persisting for several days. On the day of admission, transient atrioventricular dissociation developed in 2 persons. Interviews with 16 crew members not admitted to the hospital identified only 1 additional worker ill with gastrointestinal symptoms, but all 16 had moderate to severe inhibition of both plasma and red blood cell cholinesterase. Four other workers who were tested but not interviewed also had cholinesterase depression. The crew had had exposure since August 19 to the organophosphate insecticide phosalone, which was last applied to the vineyard on July 21, or 29 days earlier. Although this is the first report unequivocally linking phosalone to field-worker poisoning, the delayed onset and nonspecific nature of the symptoms associated with subacute poisoning may have hindered the recognition of previous similar episodes.
Adolescent↗
The Yoruba farm market as a communication channel in guinea worm disease surveillance.
Disease eradication programmes are by definition time bound and require strategies that facilitate timely intervention. Surveillance, which undergirds eradication, also requires timely strategies. Finding such strategies is especially challenging when the target disease is endemic in remote areas, e.g. guinea worm disease, the focus of this study. A strategy of market based surveillance was pilot tested in Ifeloju Local Government Area (LGA) of Oyo State, Nigeria. The project goal was to design a surveillance system that both fit into the natural communication network of rural people, and also enlisted their active involvement. Ethnographic research methods were employed to learn about market location, structure, catchment area and attendance pattern. Four larger farm markets (serving 164 hamlets with 17,000 population) were chosen. Each hamlet was visited and a volunteer 'reporter' was recruited. Reporters were trained on case recognition and detection, first aid and prevention, with a sensitivity to distinguishing indigenous and clinical perceptions of guinea worm. The market cycle was based on the traditional four-day week. Field workers visited every second market 16 times between October 1990 and February 1991. The reporter was expected to identify correctly the first case of the season and thus label the village as endemic for the season. Reporters gave oral reports, and positive indications were followed up within 48 hr by field workers, who verified the case and administered first aid. All hamlets were visited once a month to verify negative reports. Reporter attendance was monitored. Those who had a formal role in the market, e.g. sales agents, had better attendance than ordinary farmers who came only to sell their own produce. Knowledge of market structure and attender roles offers a guide for adapting this surveillance approach to other cultural systems and health issues.
Adolescent↗
Methods to recruit hard-to-reach groups: comparing two chain referral sampling methods of recruiting injecting drug users across nine studies in Russia and Estonia.
Evidence suggests rapid diffusion of injecting drug use and associated outbreaks of HIV among injecting drug users (IDUs) in the Russian Federation and Eastern Europe. There remains a need for research among non-treatment and community-recruited samples of IDUs to better estimate the dynamics of HIV transmission and to improve treatment and health services access. We compare two sampling methodologies "respondent-driven sampling" (RDS) and chain referral sampling using "indigenous field workers" (IFS) to investigate the relative effectiveness of RDS to reach more marginal and hard-to-reach groups and perhaps to include those with the riskiest behaviour around HIV transmission. We evaluate the relative efficiency of RDS to recruit a lower cost sample in comparison to IFS. We also provide a theoretical comparison of the two approaches. We draw upon nine community-recruited surveys of IDUs undertaken in the Russian Federation and Estonia between 2001 and 2005 that used either IFS or RDS. Sampling effects on the demographic composition and injecting risk behaviours of the samples generated are compared using multivariate analysis. Our findings suggest that RDS does not appear to recruit more marginalised sections of the IDU community nor those engaging in riskier injecting behaviours in comparison with IFS. RDS appears to have practical advantages over IFS in the implementation of fieldwork in terms of greater recruitment efficiency and safety of field workers, but at a greater cost. Further research is needed to assess how the practicalities of implementing RDS in the field compromises the requirements mandated by the theoretical guidelines of RDS for adjusting the sample estimates to obtain estimates of the wider IDU population.
Data Collection↗
The Model Family Planning Project in Isfahan, Iran.
In the 1972-74 Isfahan Model Family Planning Project, which grew out of previous family planning projects in Isfahan, contraceptive education and services were provided by private doctors, family planning clinics, health centers, nurses, midwives, full-time field-workers, functionaries, and the mass media on a comprehensive and integrated basis. The percent of married women aged 15-44 using modern methods rose from 6 percent to 21 percent by the end of the project period. Continuation rates for the pill and IUD were comparable to those in other, more urban programs. Field-workers proved to be more effective in recruiting new acceptors than health workers and functionaries; mass media and relatives played indirect roles.
Adolescent↗
Birth asphyxia in a rural community of north India.
A community-based inquiry was conducted in a rural area of north India to estimate extent of the problem of birth asphyxia. Births and neonatal deaths were recorded in 54 villages. Trained field workers contacted birth attendants/family members within 15 days after the birth, and recorded the symptoms and signs related to birth asphyxia on a pre-coded questionnaire. Detailed descriptive history of birth events in chronological order was recorded in cases suspected to be asphyxiated or stillborn. Two pediatricians reviewed the case histories independently to assign the diagnosis. Out of the 1977 recorded livebirths, field workers suspected 53 babies to be asphyxiated, 39 of these were diagnosed as asphyxiated, four as not asphyxiated by both the experts, and 10 were considered as asphyxiated by one of the experts. Prevalence of birth asphyxia was estimated to be at least 2 per cent (39/1977). Case fatality in these cases was 74 per cent. The verbal diagnosis method adopted in this study can be used to compare the prevalence of asphyxia in community studies.
Asphyxia Neonatorum↗
Substantial reduction in severe diarrheal morbidity by daily zinc supplementation in young north Indian children.
OBJECTIVE: To evaluate the impact of 4 months of daily zinc supplementation on the incidence of severe and recurrent diarrhea in children 6 to 30 months of age. METHODS: A double-blind, randomized, placebo-controlled trial was conducted on children who were identified by a door-to-door survey to be aged 6 to 30 months and residing in the urban slum of Dakshinpuri, New Delhi. They were randomized to receive daily zinc gluconate (elemental zinc 10 mg to infants and 20 mg to older children) or placebo. A field attendant administered the syrup daily at home for 4 months except on Sundays, when the mother did so. One bottle that contained 250 mL was kept in the child's home and replaced monthly. Field workers visited households every seventh day during the 4-month follow-up period. At each visit, information was obtained for the previous 7 days on history of fever, number and consistency of stools, and presence of cough. When the child was ill, illness characteristics and treatment seeking outside the home were determined. If the child had diarrhea or vomiting, then dehydration was assessed. At household visits, 2 packets of oral rehydration salts were given when a child had diarrhea. Children who visited the study clinic spontaneously for illness or were referred by the field workers were treated according to the standard national program guidelines. Antibiotics were advised only for diarrhea with bloody stools or for associated illnesses. For using generalized estimating equations for longitudinal analysis of a recurring event such as diarrhea, the follow-up data for each child was divided into 17 child-periods of 7 days each and presence or absence of an incident episode of diarrhea or severe diarrhea within each 7-day period was coded. This method of analysis does not assume independence of events and therefore prevents underestimation of variance that results because of correlation of morbidity within the same child. A logistic generalized estimating equations model with exchangeable correlation covariance-variance matrix was then used to estimate the effect size. RESULTS: Zinc or placebo doses were administered on 88.8% and 91.2%, respectively, of study days during the 4 months of follow-up. There was a small but significant increase in the average number of days with vomiting in the zinc group (4.3 [standard deviation (SD): 5.8] vs 2.6 [SD 3.9] days; difference in means: 1.7 [95% confidence interval (CI): 1.3-2.1] days). At the baseline, mean plasma zinc was 62.0 microg/dL (SD: 14.3 microg/dL) in the zinc and 62.0 microg/dL (SD: 11.2 microg/dL) in the placebo group; 45.8% and 42%, respectively, had low plasma zinc levels below 60 microg/dL. At the end of the study, plasma zinc levels were substantially higher in the zinc group (ratio of geometric means: 1.94 [95% CI: 1.86-2.03]) and the proportion with low plasma zinc was lower (difference in proportions: -46.7% [95% CI: -41.8% to -51.4%]). The incidence of diarrhea during follow-up was lower in the zinc-supplemented as compared with the placebo group (odds ratio [OR]: 0.88; 95% CI: 0.82-0.95). The beneficial impact of zinc was greater on the incidence of diarrhea with progressively increasing duration: episodes of diarrhea that lasted 1 to 6 days (OR: 0.92; 95% CI: 0.85-1.00), 7 to 13 days (OR: 0.79; 95% CI: 0.65-0.95), and > or =14 days (OR: 0.69; 95% CI: 0.48-0.98). The impact was also greater on the incidence of episodes with progressively higher stool frequency: 3 to 5 stools per day (OR: 0.90; 95% CI: 0.83-0.98), 6 to 9 stools per day (OR: 0.87; 95% CI: 0.77-0.98), and > or =10 per day (OR: 0.77; 95% CI: 0.63-0.94). In the zinc group, significantly more children experienced no diarrheal episode during the study period (risk ratio [RR]: 1.22; 95% CI: 1.02-1.44). Furthermore, substantially fewer children (RR: 0.51; 95% CI: 0.36-0.73) experienced recurrent diarrhea, defined as >6 diarrheal episodes in the follow-up period as compared with children in the placebo group. The number of children who were hospitalized for any cause tended to be lower in the zinc group, but the difference was not statistically significant (1.79% vs 2.43%; RR: 0.74; 95% CI: 0.43-1.27). The baseline mean plasma copper (microg/dL) was similar in the 2 groups (difference in means: 1.6; 95% CI: -2.9 to 6.1). The end study plasma copper levels were significantly lower in the zinc group (difference in means: -15.5; 95% CI: -19.9 to - 11.1). CONCLUSIONS: Zinc supplementation substantially reduced the incidence of severe and prolonged diarrhea, the 2 important determinants of diarrhea-related mortality and malnutrition. This intervention also substantially reduced the proportion of children who experienced recurrent diarrhea. Prompt measures to improve zinc status of deficient populations are warranted. The potential approaches to achieve this goal include food fortification, dietary diversification, cultivation of plants that are zinc dense or have a decreased concentration of zinc absorption inhibitors, and supplementation of selected groups of children. Future studies should assess the impact of increased zinc intakes on childhood mortality in developing countries. For facilitating intervention, there is a need to obtain reliable estimates of zinc deficiency, particularly in developing countries. The functional consequences of the effect of various doses of zinc on plasma copper levels merits additional study.
Acute Disease↗
Effectiveness and efficacy of zinc for the treatment of acute diarrhea in young children.
UNLABELLED: Intervention trials have shown that zinc is efficacious in treating acute diarrhea in children of developing countries. In a randomized, placebo-controlled trial, we assessed the effectiveness and efficacy of giving 3 Recommended Daily Allowances of elemental zinc to 6- to 35-month-old children with acute diarrhea. METHODS: Seventeen hundred ninety-two cases of acute diarrhea in Nepalese children were randomized to 4 study groups. Three groups were blinded and the children supplemented daily by field workers with placebo syrup, zinc syrup, or zinc syrup and a massive dose of vitamin A at enrollment. The fourth group was open and the caretaker gave the children zinc syrup daily. Day-wise information on morbidity was obtained by household visits every fifth day. RESULTS: The relative hazards for termination of diarrhea were 26% (95% confidence interval [CI]: 8%, 46%), 21% (95% CI: 4%, 38%), and 19% (95% CI: 2%, 40%) higher in the zinc, zinc-vitamin A, and zinc-caretaker groups, respectively, than in the placebo group. The relative risks of prolonged diarrhea (duration >7 days) in these groups were 0.57 (95% CI: 0.38, 0.86), 0.53 (95% CI: 0.35, 0.81), and 0.55 (0.37, 0.84); zinc accordingly reduced the risk of prolonged diarrhea with 43% to 47%. Five percent and 5.1% of all syrup administrations were followed by regurgitation in the zinc and zinc-vitamin A group, respectively, whereas this occurred after only 1.3% of placebo administrations. Vomiting during diarrhea was also more common in children receiving zinc. CONCLUSIONS: Three Recommended Daily Allowances of zinc given daily by caretakers or by field workers substantially reduced the duration of diarrhea. The effect of zinc was not dependent on or enhanced by concomitant vitamin A administration.
Acute Disease↗
[Living conditions of prostitutes: consequences for the prevention of HIV infection].
Since 1990, several community-based interventions have been set up for populations of prostitutes in France with the principal objective of preventing HIV infection in prostitutes and their sexual partners. Field workers have suggested that extremely precarious living conditions are a major obstacle for the diffusion of prevention messages. A multidisciplinary working group thus set up a study in order to determine which living conditions could affect the adoption of behaviour at low risk for HIV infection. In May 1995, six of the seven teams conducting prevention actions among prostitutes in France used a short standardised questionnaire to collect information including type of housing, health insurance cover, physical aggressions, drug use. It was planned to collect data from all persons attending the drop-in centres. A total of 355 questionnaires were completed (sampling was exhaustive for 3 of the 6 teams). The population comprised women, men and transvestites. The median age was 28 years. Only 39% (135/348) of the subjects had access to health insurance. Approximately 50% (160/324) of the persons lived in precarious accommodation (hotel or no fixed address) and 33% (119/355) had been victims of physical aggressions during the 5 months preceding the study. Transvestites and young people had the most precarious living conditions. Despite the limits of this study due to the difficulty in carrying out a survey in this very marginalised population, the unique information collected may enable community health action strategies to be suitably adapted. In particular, it is important to improve partnership between field workers and existing social and health services, to improve access to better accommodation, health care and physical security while disseminating prevention messages and distributing condoms.
Adolescent↗