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Une approche multiprofessionnelle de l'accessibilité aux soins de premier recours : des configurations territoriales très diverses
No full textIRDES - DOCUMENTS DE TRAVAIL : DT n° 93Background. Increasing inequalities in accessibility to primary care has generated medical deserts. Identifying them is key to target the geographic areas where action is needed. An extensive definition of primary care has been promoted by the World Health Organization: a first level of contact with the health system, which involves the co-presence of different categories of health professionals alongside the general practitioner for the diagnosis and treatment of patients. Previous analyses have focused mainly on a single type of provider while this study proposes an integrated approach including various providers to define medical deserts in primary care.Method. Our empirical approach focuses on the first point of contact with the health system: general practitioners, proximity primary care providers (nurses, physiotherapists, pharmacies, laboratories, and radiologists), and emergency services. A multiple analysis approach was performed, to classify French municipalities using the information on the evolution and needs of health care accessibility, combining a principal component analysis and a hierarchical ascending classification.Results. Two clusters of medical deserts were identified with low accessibility to all healthcare professionals, socio-economic disadvantages, and a decrease in care supply. In other clusters, accessibility difficulties only concern a part of the health supply considered, which raises concern for the efficiency of primary care for optimal healthcare pathways. Even for clusters with better accessibility, issues were identified, such as a decrease and high needs of health care supply, revealing potential future difficulties.Conclusion. This work proposes a multi-professional and multi-dimensional approach to medical deserts based mainly on an extensive definition of primary care that shows the relevance of the co-presence of various healthcare professionals. The classification also makes it possible to identify areas with future problems of accessibility and its potential consequences. This framework could be easily applied to other countries according to their available data and their health systems’ specificitiesContexte. Les médecins généralistes libéraux sont inégalement répartis sur le territoire avec pour conséquence des espaces mieux dotés quand d'autres apparaissent sous-dotés et sont couramment appelés des « déserts médicaux ». Cette situation est exacerbée par la baisse de l'offre de médecins généralistes disponible et qui va encore durer jusqu'à la fin de la décennie. Dans le même temps, l'accessibilité à d'autres professions de santé de premier recours (infirmières et masseurs-kinésithérapeutes, par exemple) s'améliore.Le premier recours avec le système de santé implique la coprésence de différentes catégories de professionnels de santé aux côtés du médecin généraliste pour le diagnostic et le traitement des patients. Si la littérature sur les inégalités spatiales d'accessibilité est étoffée, les approches mesurant l'accessibilité à plusieurs professionnels de santé sont plus rares.Objectif. Il s'agit ici de renouveler la description de l'accessibilité aux soins de premier recours à partir d'une approche pluriprofessionnelle tenant compte du médecin généraliste, de ses partenaires du quotidien (infirmiers, kinésithérapeutes, pharmacies), de ceux servant d'appui au diagnostic (laboratoires et radiologues) et des services d'urgence.Méthode. Pour classer les communes françaises selon leur niveau, évolution et besoins en matière d'accessibilité aux soins, nous avons procédé en trois étapes. Des scores ont été créés par groupes de professionnels de santé et par grandes dimensions. Puis nous avons effectué une Analyse en composantes principales (ACP) suivie d'une Classification ascendante hiérarchique (CAH) sur ces scores.Résultats. Deux classes de communes cumulent faible accessibilité aux soins, forts désavantages socio-économiques, et, pour l'une, baisse de l'offre de soins. Dans d'autres classes, la faible accessibilité aux soins ne concerne qu'une partie de l'offre considérée, ce qui questionne l'efficacité des soins primaires pour optimiser les parcours de soins. Enfin, dans des classes mieux dotées en matière d'accessibilité, d'autres problématiques d'évolution de l'offre et de besoins persistent
Exploring the relationship between experience of vaccine adverse events and vaccine hesitancy: A scoping review
No full textInternational audienceFear of side effects is the main motive for vaccine refusal. However, before the COVID-19 pandemic, little attention had been paid to the actual experience of adverse events and its relationship with vaccine hesitancy. This scoping review aimed to analyze the impact of VH on EAE and vice versa. We reviewed 55 articles. Most of the studies focused on COVID-19 vaccination and employed cross-sectional surveys with self-reported indicators. These studies identified significant correlations between EAE and VH. Social cognitive models shed some light on the influence of EAE on VH, while the converse is usually explained by the nocebo effect that predominately accounts for the converse. This emerging research field is hampered by significant inconsistencies in theoretical explanations, assessments of the relationship, and measurements of these two phenomena. A more comprehensive consideration of individual experience, both objective and subjective, would help develop more effective vaccine communication strategies and improve pharmacological surveillance
Perceptions and Attitudes of Drinking Water Supply Systems Staff Towards Climate Change Adaptation for Drinking Water Quality Management
No full textInternational audienceThe first objective of this study was to evaluate the perceptions, attitudes, and behaviors of Drinking Water System (DWS) staff in relation to climate change (CC) impacts and adaptation in their roles and responsibilities for managing water quality from the source to the consumer’s tap. The second objective was to explore the determinants or causes attributed to current practices in the use of decision support systems (DSSs) in the context of CC adaptation and drinking water. 316 public servants (staff) from 263 drinking water utilities of Canadian municipalities answered an online questionnaire and subsequently 10 of them participated in focus groups based on a discussion guide developed to follow up on the results of the questionnaire. Results indicate that only 32% of DWSs staff perceive CC adaptation as a priority and most of the focus groups participants admitted practicing it in a curative form whereas prevention would be more beneficial to them. The main challenges they face (especially small municipalities) are related to a lack of manpower and financial capacity. Our results also suggest a need for DWS staff to be introduced to different DSSs that respond to existing concerns. DWSs staff have a lot to gain by adopting DSS tools for CC adaptation. The next step of this study will be to implement a participative process based on hypothetical scenarios to identify levers and barriers to the adoption and use of DSSs in DWSs
"En France, les personnes handicapées peuvent maintenant choisir de vivre dans un logement en dehors des institutions"
No full textInternational audienc
Applying a two-stage generalized synthetic control approach to quantify the heterogeneous health effects of extreme weather events: A 2018 large wildfire in California event as a case study
No full textInternational audienceExtreme weather events, including wildfires, are becoming more intense, frequent, and expansive due to climate change, thus increasing negative health outcomes. However, such effects can vary across space, time, and population subgroups, requiring methods that can handle multiple exposed units, account for time-varying confounding, and capture heterogeneous treatment effects. In this article, we proposed an approach based on staggered generalized synthetic control methods to study heterogeneous health effects, using the 2018 California wildfire season as a case study. This study aimed to estimate the effects of the November 2018 California wildfires, one of the state’s deadliest and most destructive wildfire seasons, on respiratory and circulatory health, document heterogeneity in health impacts, and investigate drivers of this heterogeneity. We applied a two-stage generalized synthetic control method to compare health outcomes in exposed (from 8 November to 5 December 2018) versus unexposed counties and used random-effects meta-regression to evaluate the effect modification of county-level socioeconomic variables on the observed health effects of the November 2018 wildfires. We observed an increase in respiratory hospitalizations for most exposed counties when compared with unexposed counties, with significant increases in Fresno, San Francisco, San Joaquin, San Mateo, and Santa Clara counties. No effect on circulatory hospitalizations was observed. County-level sociodemographic characteristics seem to not modulate the effects of wildfire smoke on respiratory hospitalizations. This novel two-stage framework can be applied in broader settings to understand spatially and temporally compounded health impacts of climate hazards. We provide codes in R for reproducibility and replication purposes
Mesure et démesure des soins critiques ou comment réanimer en Anthropocène ? [Editorial]
No full textInternational audienceLes soins critiques sont un enfant de l’époque de l’Anthropocène. Ils sont le fruit, d’une part de connaissances théoriques acquises dans les années 1750-1900 et dont l’origine remonte à une transformation des relations entre l’Homme et la Nature au 17° siècle, et d’autre part de l’arrivée d’un monde d’abondance matérielle à partir de la grande accélération des années 1950. Ce développement des soins critiques au sein d’un imaginaire où l’amélioration continue des performances était vue comme étant à la fois possible et intrinsèquement bénéfique a entrainé une forme de démesure, d’impression de pouvoir toujours repousser les limites de la vie. Mais en parallèle, la proximité de la mort, l’invasivité des soins prodigués et le caractère limité des lits ont aiguisé le sens de la juste mesure et de la prudence des professionnels des soins critiques. Ainsi les réanimateurs, habitués à cette tension entre mesure et démesure, ont tout pour être à l’avant-garde des évolutions éthiques que nous imposent le monde de l’Anthropocène, un monde fait de fluctuations écologiques, économiques, sanitaires et géopolitiques, un monde qui requiert de privilégier la robustesse à la performance
Communicating on Vaccine Benefit-Risk Ratios: A Discrete-Choice Experiment among Health Care Professionals and the General Population in France
No full textInternational audienceBackground: We explored preferences around the benefit-risk ratio (BRR) of vaccination among the general adult population and health care sector workers (HCSWs). We estimated preference weights and expected vaccine uptake for different BRR levels for a vaccine recommended during an infectious disease emergence. In addition, we explored how far qualitative information about disease severity, epidemiological context, and indirect protection interacts with these preferences.Methodology: This was a cross-sectional study, using a self-administered online questionnaire containing a single-profile discrete choice experiment among HCSWs and the general population in France (quasi-representative sample). The questionnaire was available from January 12 to April 27, 2023, for HCSWs and from April 17 to May 3, 2023, for the general population. BRR is represented as the number of vaccine-prevented disease events for 1 event related to a vaccine side effect. Results are reported in 4 groups: general population sample, non-HCSWs, non-university-degree HCSWs, and university-degree HCSWs.Results: Among the 1,869 participants, 1,038 (55.5%) varied their vaccine decision among the different vaccine scenarios. Hypothetical vaccine acceptance among university-degree HCSWs increased when the vaccination BRR was 100:1, while non-university-degree HCSWs and non-HCSWs were more sensitive to qualitative information about the vaccine BRR than quantitative indicators. Among participants in the general population sample with varied decisions, expected acceptance increased by 40% sample if disease risk was high. Among serial vaccine nondemanders, high disease risk decreased their certitude to refuse hypothetical vaccination.Conclusion: Our results suggest that only university-degree HCSWs are sensitive to the notion of BRR, but not the general public. Given that previous research found speaking about BRR might reduce vaccine acceptance, this notion should be avoided in vaccine promotion.Highlights: The notion of benefit-risk ratio (BRR) of vaccination appears to be taken into account in vaccine decisions by university-degree HCSWs, but not by the general public. Mentioning a favorable BRR could imply that the vaccine is not safe and reduce vaccine motivation.Mentioning qualitative attributes of BRR surrounding disease frequency and severity, and indirect protection effects, strongly affected theoretical vaccine decisions in all participants, irrespective of professional categories.Expected vaccine acceptance increased by 40% among the general population sample if disease risk was presented as high, and expected vaccine coverage exceeded 50% in scenarios with high disease risk.Among those refusing vaccination in all vaccine scenarios, only a high risk of developing the disease decreased their certitude to refuse vaccination. This further underlines the importance of disease risk perception on vaccine decision making, including among persons who a priori are unlikely to accept vaccination
Les territoires de la protection des jeunes majeurs : disparité et inégalités
No full textQue devient un jeune protégé par l’aide sociale à l’enfance lorsqu’il atteint 18 ans ? Derrière la promesse d’un « contrat jeune majeur » censé assurer la continuité du soutien jusqu’à 21 ans, la réalité se révèle profondément inégale. D’un département à l’autre, les chances d’obtenir ou de renouveler une aide varient largement.Cette recherche, conduite à la croisée du droit et des sciences sociales, plonge au coeur de ces disparités territoriales. À partir d’enquêtes menées dans trois départements aux pratiques contrastées, elle interroge la manière dont les politiques publiques locales façonnent les parcours des jeunes majeurs et traduisent le principe d’égalité de protection. L’analyse des textes juridiques, des contentieux et d’une quarantaine de situations individuelles permet d’observer comment les règles nationales se réécrivent au niveau local, sous l’effet des moyens disponibles, des cultures professionnelles et des jeux d’acteurs.Au fil des entretiens avec éducateurs, responsables de service, élus et jeunes concernés, se dessine une géographie sociale de la protection, où l’accès au droit dépend autant de la trajectoire du jeune que de la doctrine implicite de son territoire.Le rapport met en lumière la coexistence d’un « socle commun » de principes et de pratiques, et de multiples écarts dans leur mise en œuvre, notamment entre jeunes français et jeunes étrangers. Il révèle également les tensions d’un système où la protection devient un « droit-devoir », conditionné à la participation du jeune. Au-delà du cas des « jeunes majeurs », il éclaire ainsi la manière dont les politiques sociales françaises dessinent leurs frontières entre droit, mérite et vulnérabilité
Principles of public health ethics and a tool for ethical reflection for professionals in a world of turmoil
No full textInternational audienceBackground Since the original publication of the Seven Principles of Public Health Ethics, the world has gone through a global pandemic. Rising nationalism, and political tensions have become increasingly heated. In other words, we are in a state of turmoil. This paper aims to restate the principles for the current context and introduces a practical tool for public health professionals to apply to guide ethical reflection. Methods The seven-principle approach is reviewed in light of feedback received personally, at academic events and from the literature over the last more than ten years. Two revised original tools specifying the principles are integrated into one. Results The case for explicit and transparent public health ethics is made, followed by an overview of important philosophical ethical theories. Then, each revised principle is explained and one practical tool for ethical decision-making is presented. Conclusions The authors suggest that this tool can contribute to improving public health decision making by laying out a clear and simple framework for ethical decision-making, which is helpful to contribute to public trust and reasonable public health practice in a world of turmoil
Des participations héroïsées. Le handicap dans les séries télévisées pour enfants France, 1993-2008
No full text187 illustrations en couleurInternational audienceComment le handicap est-il mis en scène dans les dessins animés pour enfants ?C’est une question à laquelle ce livre tente de répondre à travers une ethnographie des mondes sociaux virtuels. En analysant des séries animées télévisées françaises (Les Pastagums, Atout 5, Foot2Rue, Les Minijusticiers, Titeuf, Bali, Milo), cette recherche décrypte les situations dans lesquelles se retrouvent les personnages identifiés : situations de handicap et situations de participation. Au regard des mondes sociaux actuels, les formes d’héroïsations observées sont interprétées comme autant de traces figées d’une injonction normative de performance