To estimate geographical variations of child immunisation at the regional level in Senegal, to identify individual and contextual factors that could explain these regional discrepancies, and to measure their effects.
Data come from the 2015, 2016 and 2017 Senegalese Demographic and Health Survey, a national survey targeting women aged 15-49, with a questionnaire focusing on health and reproductive issues including their children\'s immunisation status. We restricted the analysis to children aged 12-23 months (n = 4955) and conducted a multilevel logistic regression to assess individual and contextual factors associated with complete immunisation coverage.
The complete immunisation coverage rate of children was estimated at 68% and ranged from 41% in the region of Kedougou to 83% in the region of Dakar. The inter-regional variance was significantly different from zero (P = 0.006) in the empty multilevel model. It decreased by more than half (57 %) after adjusting for individual factors but remained significantly different from zero (P = 0.010). Regional variations of complete immunisation rates drastically decreased and were no longer statistically significant (P = 0.343) after adjusting for the following regional factors: population density, density of hospitals, literacy rate and proportion of health facilities with an antenatal care service.
Regarding health policies designed to improve childhood immunisation and to reduce related inequalities, our results highlight the need to take into account both individual and contextual factors, with a focus on rural and deprived areas where children are at higher risk of incomplete immunisation.
Estimer les variations géographiques de la vaccination des enfants au niveau régional au Sénégal, identifier les facteurs individuels et contextuels qui pourraient expliquer ces écarts régionaux et mesurer leurs effets. MÉTHODES: Les données proviennent de l\'enquête démographique et la santé du Sénégal de 2015, 2016 et 2017, une enquête nationale ciblant les femmes âgées de 15 à 49 ans, avec un questionnaire axé sur les problèmes de santé et de reproduction, y compris le statut vaccinal de leurs enfants. Nous avons limité l\'analyse aux enfants âgés de 12 à 23 mois (n = 4.955) et avons effectué une régression logistique à plusieurs niveaux pour évaluer les facteurs individuels et contextuels associés à une couverture vaccinale complète. RÉSULTATS: Le taux de couverture vaccinale complète des enfants était estimé à 68% et variait de 41% dans la région de Kédougou à 83% dans la région de Dakar. La variance interrégionale était significativement différente de zéro (P = 0,006) dans le modèle vide à plusieurs niveaux. Il diminuait de plus de la moitié (57%) après ajustement pour les facteurs individuels mais est restait significativement différent de zéro (P = 0,010). Les variations régionales des taux de vaccination complète ont considérablement diminué et n\'étaient plus statistiquement significatives (P = 0,343) après ajustement pour les facteurs régionaux suivants: densité de population, densité des hôpitaux, taux d\'alphabétisation et proportion d\'établissements de santé disposant d\'un service de soins prénatals.
En ce qui concerne les politiques de santé conçues pour améliorer la vaccination des enfants et réduire les inégalités associées, nos résultats soulignent la nécessité de prendre en compte les facteurs individuels et contextuels, en mettant l\'accent sur les zones rurales et défavorisées où les enfants sont plus à risque de vaccination incomplète.

BACKGROUND: The prevalence of adult asthma is around 6-7% in France. This disease is multifactorial and is related in particular to occupational factors. Using data from The French Health, Health Care and Insurance Survey (ESPS), this study aimed to describe asthma prevalence in France according to socio-economic status in 2012.
METHODS: This analysis included the population aged 15 years and over. Current asthma, defined by a declaration of having asthma in the last 12 months, was analyzed according to socio-economic variables available in the ESPS survey.
RESULTS: Among the 23,047 subjects interviewed, 12,565 were included in the analysis. Current asthma frequency was 7.4%. Higher risk of asthma was observed in unemployed, non-qualified persons, with a lower income, or having free healthcare insurance. Regarding occupations, in men, trade and commerce employees, personal services employees and administrative employees were associated with a higher level of current asthma prevalence.
CONCLUSIONS: These results show that subjects with lower socio-economic status are more likely to suffer from asthma. New epidemiological tools in France, including cohorts (Constances, COSET) will be helpful to study more precisely the associations between asthma and occupational factors.

OBJECTIVE: To identify the socioeconomic and psychosocial impacts of clinical treatment decisions for advanced unilateral intraocular retinoblastoma.
METHODS: Retrospective observational case series.
METHODS:
METHODS: institutional study at Alexandria Main University Hospital.
METHODS: records of 66 unilateral retinoblastoma cases treated from May 2005 to May 2013 were retrospectively reviewed. Sixty cases were eligible (International Intraocular Retinoblastoma Classification [IIRC] group C, D or E).
METHODS: two treatment groups were compared: enucleation vs. salvage treatment. Salvage treatment eyes were further subdivided based on IIRC group. Six socioeconomic parameters (financial burden, financial impact, psychological, social, medical and tumor impacts) were scored. Parameter scores ranged from 0 to 3, for overall score range 0 (no adverse impact) to 18 (severe adverse impact).
METHODS: derived Socioeconomic scores were correlated with treatment and outcomes.
RESULTS: The enucleation group (28 eyes) had a median overall Socioeconomic score of 4/18, significantly lower than the salvage treatment group (32 eyes), median score 11/18 (P<0.01). Socioeconomic score varied with IIRC group. Attempted eye salvage failed in 25 children, due to uncontrolled tumor (44%) and socioeconomic impact of cumulative therapies (56%). Treatment duration and Socioeconomic score were higher for the 5 children in the salvage treatment group who developed metastatic disease compared to those without metastasis (P<0.01).
CONCLUSIONS: The socioeconomic and psychosocial impacts of attempted ocular salvage for unilateral intraocular retinoblastoma are severe, in comparison to primary enucleation. Primary enucleation is a good treatment for unilateral retinoblastoma.