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Interroger le médico-social. Regards des sciences sociales
No full textInternational audienceCet ouvrage est destiné aux chercheurs comme aux professionnels. Il propose à la fois un bilan synthétique de la recherche en sciences sociales sur le médico-social, une réflexion d’ensemble sur ses transformations contemporaines et un éclairage sur les grandes questions qui le traversent aujourd’hui. L’ouvrage expose et éclaire de façon pédagogique les débats théoriques et conceptuels en sciences sociales autour d’une série d’enjeux clefs, de l’organisation du travail d’accompagnement à la problématique du care, des transformations des professionnalités aux questions de régulation, de normalisation ou de quantification
A French classification to describe medical deserts: a multi-professional approach based on the first contact with the healthcare system
No full textInternational audienceBackground 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 ones 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, socioeconomic 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' specificities
Cancer and multiple sclerosis: 2023 recommendations from the French Multiple Sclerosis Society
No full textInternational audienceBackground: Epidemiological data reveal that 45% of persons with multiple sclerosis (PwMS) in France are more than 50 years. This population more than 50 is more susceptible to cancer, and this risk may be increased by frequent use of immunosuppressive drugs. Consequently, concerns have arisen about the potential increased risk of cancer in PwMS and how patients should be screened and managed in terms of cancer risk.Objective: To develop evidence-based recommendations to manage the coexistence of cancer and multiple sclerosis (MS).Methods: The French Group for Recommendations in MS collected articles from PubMed and university databases covering the period January 1975 through June 2022. The RAND/UCLA method was employed to achieve formal consensus. MS experts comprehensively reviewed the full-text articles and developed the initial recommendations. A group of multidisciplinary health care specialists then validated the final proposal.Results: Five key questions were addressed, encompassing various topics such as cancer screening before or after initiating a disease-modifying therapy (DMT), appropriate management of MS in the context of cancer, recommended follow-up for cancer in patients receiving a DMT, and the potential reintroduction of a DMT after initial cancer treatment. A strong consensus was reached for all 31 recommendations.Conclusion: These recommendations propose a strategic approach to managing cancer risk in PwMS
The intentions of French health university students to recommend and to receive the HPV vaccine are mainly influenced by vaccine knowledge, confidence in vaccines and personal HPV vaccination
No full textInternational audienceIntroduction: Despite documented effectiveness in preventing several cancers, genital warts and safety of Human Papillomavirus (HPV) vaccine, immunization coverage among French adolescents remains far from the 80 % target. University health students (HS) in France may promote HPV vaccine through a national service (Service Sanitaire des Etudiants en Santé). We aimed to evaluate intentions to recommend the HPV vaccine to friends and relatives, to receive HPV vaccine, and to identify factors associated with these attitudes.Methods: We conducted a cross-sectional survey in five French Universities from October 2019 to February 2020, using a self-administered online questionnaire. We used bivariable and multivariable logistic regression models to identify determinants of behavior around HPV vaccine: (i) individual intention for vaccination, and (ii) vaccine recommendation to friends and relatives.Results: Among the 732 respondents (180 men, 552 women), 305 (41.7%) reported previous HPV vaccination (54.5 % among women), 504 (68.9%) would recommend the HPV vaccine to friends and relatives, 532 (72.7%) respondents would be vaccinated today if it was recommended for them. Intentions to recommend or to receive the HPV vaccine were less frequent in nursing students compared to medical and pharmacy students. After adjustment for demographical factors, HPV vaccine knowledge was associated with intention [aOR 1.30 (95%-confidence interval, 1.15-1.47)] and recommendation [1.26 (1.10-1.45)], respectively. Additionally, adjusting for knowledge about HPV infections, and confidence in vaccines in general was associated with vaccine intention [1.55, (1.30-1.84)] and recommendation [1.52 (1.24-1.86)]. HPV-vaccinated HS were more prone to recommend the HPV vaccine to friends and relatives [10.9 (6.6-17.9)].Conclusion: A majority of HS would accept and/or recommend HPV vaccines. HS with greater knowledge about the HPV vaccine were more prone to recommend it. Strengthening knowledge about HPV and its vaccination is probably necessary before their Involvement in a HPV immunization program
Comment prendre en compte la dimension éco-responsable des produits de santé tout au long de leur cycle de vie?
No full textInternational audienceL’achat de produits de santé représente environ 50 % des émissions de gaz à effet de serre du système de santé français. Cet enseignement tiré de la publication des travaux du Shift Project en novembre 2021 a été un élément déclencheur au sein du système de santé, accélérant les réflexions et mises en œuvre d’actions visant à réduire les impacts environnementaux du système de santé, avant, pendant et après les soins. Au-delà de l’empreinte carbone, les impacts environnementaux des produits de santé sont divers : eau, air, sols…et ce tout au long de la vie des produits. Nous avons choisi de diviser ce cycle de vie en quatre étapes principales : la recherche et développement et la production; la distribution et l’accès au marché; l’usage; et enfin la gestion de la fin de vie. L’analyse du cadre règlementaire à chaque étape et les initiatives existantes, décrites dans la littérature ou par des acteurs de terrain ont structuré et nourri notre réflexion. Nous avons constaté que la règlementation existante conduit à une lecture exclusivement centrée sur le risque sanitaire, avec peu ou pas de prise en compte du risque environnemental, qui constitue pourtant en lui-même un risque pour la santé. Par ailleurs, la mise en œuvre de certaines actions structurantes au cours des 3 premières étapes du cycle de vie permettrait de simplifier, voire de supprimer la problématique aujourd’hui majeure de la gestion des déchets liée à la fin de vie des produits de santé. C’est dans ce sens que nous produisons 9 recommandations permettant une meilleure prise en compte des impacts environnementaux tout au long de la vie des produits de santé
Communication éclairée, efficacité des messages : fiche 9
No full textInternational audienceUnderstanding the issues surrounding chemical substances, in particular endocrine disrupters, molecules that act in the body by altering the hormonal system. This collective work, divided into 19 factsheets, provides practical tools for identifying these chemicals in everyday life, analysing the most high-risk situations, and taking preventive action to reduce people's exposure to them.Comprendre les enjeux liés aux substances chimiques, en particulier les perturbateurs endocriniens, molécules qui agissent dans le corps en altérant le système hormonal. Cet ouvrage collectif structuré en 19 fiches, propose des outils pratiques permettant de repérer ces substances chimiques dans le quotidien, d’analyser les situations les plus à risque, et d’agir en matière de prévention pour la réduction des expositions de la population
Is Neurodevelopmental Assessment in Early Childhood Predictive of Performance Assessed Later in Childhood and Adolescence in Sub-Saharan Africa? A Systematic Review of the Literature
No full textInternational audienceBackground - Most neurodevelopmental tests used to assess child development in sub-Saharan Africa were developed in western or high-income countries, raising the question of their usefulness with African children.Objective - This systematic review identified and synthesized key findings from studies measuring development in children in Sub-Saharan Africa in early childhood and again at school age, to assess neurocognitive associations longitudinally from infancy through middle childhood.Methods - The study was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method, selecting articles referenced in the PubMed, PsycInfo, and Embase databases using the following inclusion criteria: published between 2000 and 2022, written in French or English, and presenting results dealing with the objective assessment of child’s neurodevelopment. All articles were registered in the Zotero reference manager and analyzed by title, abstract, and full text. Results - Several of the seven selected studies confirmed that attention and working memory in infancy can predict children’s neurocognitive performance, including mathematical ability, at school age. In two of the studies, children with poor mental development at 1 year of age are more likely to present with poorer behavioral development at school age, including learning difficulties in school and risk for grade repetition.Conclusion - Cognitive ability assessed in early childhood is strongly associated with performance at school age in cohorts of African children followed longitudinally. Even with assessments adapted cross-culturally, infants and preschoolers at risk for poor developmental outcomes can be identified to better receive strategic early interventions to enhance their development
Healthcare Resources Utilization and Costs of Adult Patients with Long-COVID managed in the community in France
No full textInternational audienc
European Welfare States
No full texthttps://ehne.fr/en/encyclopedia/themes/material-civilization/working-europe/european-welfare-statesOver the course of the 19th century, public authorities in Europe sought to regulate the consequences of industrialization: rapid urbanization, poverty in working-class households, public-hygiene and security problems. Social and working-class issues were the driving forces behind a transformation in the role of the state, which became responsible for supporting a basic minimum of economic well-being, reducing social tensions and promoting “social citizenship” through legislation and the development of social services. The concept became known as a Welfare State (in English), an État-providence in French and a Sozialstaat in German. That regulatory mission has been interpreted either as an essential complement to capitalism or as a victory on the part of the working-class movement
Un modèle multicritère pour estimer la vulnérabilité des territoires aux impacts des changements climatiques sur la santé
No full textInternational audienceLes impacts des changements climatiques sur la santé sont multiples et de mieux en mieux compris par la communauté scientifique. La vulnérabilité des territoires aux changements climatiques dépend de multiples facteurs de nature climatique, environnementale et socioéconomique. Ces facteurs varient d’un territoire à un autre et conduisent à des différences de vulnérabilités. La réduction de la vulnérabilité est un défi majeur pour les décideurs locaux et nécessite des outils appropriés, fondés sur des données probantes, pour aider à la prise de décision. Ce travail présente le développement méthodologique et l’application d’un modèle multicritère d’aide à la décision, destiné aux décideurs locaux afin d’estimer la vulnérabilité des territoires aux impacts des changements climatiques sur la santé