Sante Publique最新文献

Introduction: Osteosynthesis materials (OSM) are raising concerns among patients and medical staff, influencing attitudes and practices related to their use. Research in sociology and anthropology on these materials is limited, justifying a study of the knowledge, attitudes, and practices (KAP) of users of the surgical department at the Regional Hospital Center (CHR) of Dédougou (Burkina Faso).

Methods: This is a descriptive cross-sectional mixed-methods study. A sample of 310 users was selected for the administration of a digital questionnaire. Semi-structured interviews with 51 individuals explored detailed perceptions and experiences concerning osteosynthesis materials (OSM). The data were analyzed using QDA Miner, with strict adherence to ethical principles.

Results: The majority of users (63%) had heard of OSM, mainly from informal sources, but only 53% understood its advantages and disadvantages. Attitudes were predominantly positive, with 82% willing to use OSM if necessary, although 18% expressed reluctance due to high costs and cultural prejudices. Nearly 29% of users had experienced a fracture, with 50% having been offered OSM. Effective communication between caregivers and patients is crucial to improving the understanding and acceptance of OSM.

Conclusion: The study highlights the need to strengthen communication and education strategies for better understanding of OSM. Efforts should include policies to make OSM financially accessible, integrate cultural concerns into care planning, and improve the training of healthcare professionals.

Introduction: Cutaneous manifestations of HAT are common and often go unrecognized by healthcare providers. The objective of this research was to describe the epidemiological, therapeutic, and progressive aspects of the cutaneous manifestations of HAT.

Patients and methods: This is an ambispective, descriptive, and analytical study of HAT patients presentingcutaneous manifestations, treated and monitored at the center from 01/01/2018 to 12/31/2023. The variables analyzed were epidemiological, clinical, paraclinical, therapeutic, and progressive.

Results: The prevalence of cutaneous signs was 67.9%, and the most represented data were: the age group ≥ 20 years (74.4%) with a sex ratio of 1.31; activities with lower risk of HAT (58.4%), passive patients (55.2%); patients in phase II (99.2%), pruritus (100%) of severe intensity (50%), scratching lesions (78.4%) localized on the thorax (82.6%), upper (75 .5%) and lower (54.1%) limbs, and abdomen (50.9%); therapeutic abstinence (82.4%), and the association of other dermatological diseases (23.2%). The average evolution of skin signs was six months, and on average after two months 96.7% of the patients monitored were completely cured. The factors significantly associated with scratching lesions in multivariate analysis were thoracic location (p: 0.0006), age group from 0 to 19 years (p: 0.03), activities with a higher risk of HAT (p: 0.03), and leukorachia ≥100cel/μl (p: 0.01).

Conclusion: Scraping lesions on the thorax are highly indicative of HAT.

Objective: This study assesses the effectiveness of psychosocial interventions by social workers in the Integrated Units for the Care of Women and Children Victims of Violence (UIPFEVV) in Morocco by examining their impact, as well as the organizational structures and operational processes involved. It also explores institutional and social power dynamics, as well as cultural influences affecting service delivery to better understand the mechanisms of response to domestic violence.

Methods: A qualitative exploratory approach was adopted, including semi-structured interviews with 13 social workers and 10 victims of domestic violence in the Fès-Meknès region. Data were analyzed using inductive thematic analysis, employing the Donabedian Model to evaluate the quality of care and feminist critical theory to examine the institutional and cultural structures of care.

Results: The study identifies five main themes regarding social workers' interventions: improving reception and confidentiality, empathy and interview techniques, balancing administrative and emotional support, challenges in orientation and referral, and gaps in post-intervention follow-up. The results show efforts to create a safe and empathetic environment, but also highlight challenges related to resource allocation, personalized support adaptation, and maintaining a continuous relationship with the victims. The Donabedian Model helped identify strengths and weaknesses in structures and processes, while feminist critical theory revealed systemic imbalances affecting the quality of services.

Conclusions: The study emphasizes the need to adapt interventions to the cultural and personal contexts of victims to enhance service effectiveness. It recommends enhanced professional training, better resource allocation, and the implementation of rigorous follow-up protocols to adequately meet the needs of women victims of domestic violence. These adjustments are essential to ensure continuous and effective support, thus facilitating recovery and well-being for victims, while taking into account the institutional and power dynamics influencing these interventions.

Introduction: The risk of aging in poor health is greater among disadvantaged people, but they benefit less from health prevention actions focused on diet and physical activity.

Purpose of the study: The INVITE research-action aims to [1] develop an active recruitment procedure to encourage older adults identified as disadvantaged to attend diet and physical activity prevention workshops in the French region Provence-Alpes Côte d'Azur (PACA), [2] evaluate the feasibility and acceptability of this procedure, and [3] measure the effective participation in the workshops of the identified older adults.

Results: The INVITE procedure was co-developed by researchers, social workers, and older adults. It includes six steps: identification, invitation letter, telephone contact, home visit, phone call confirmation, and welcome session during the workshop. A pre-test phase made it possible to identify the barriers facing older adults and their motivations at each step, and thus to improve the procedure. The evaluation phase of the effective participation showed that, for 9 workshops, 47 home visits were carried out and 11 older adults participated in the workshops.

Conclusion: The INVITE procedure is well received and makes it possible to reach out to disadvantaged older adults and bring them to prevention workshops. Since the prevention workshops promote social diversity, this procedure could be an effective lever to avoid widening social inequalities in health. A larger-scale deployment would help to better characterize participants' sociodemographic profiles and to evaluate costs.

Introduction: First-degree relatives (FDRs) of patients with colorectal cancer (CRC) or advanced adenoma before the age of 65 (index patients) are at increased risk of CRC, but the guidelines for family screening of FDRs by colonoscopy are poorly followed. The aim of this study was to describe the involvement of primary care physicians (PCPs) with patients (relatives at high risk of colorectal cancer or index patients) and their communicative stance in the context of family screening in relation to the various people involved (other physicians, index patients, and relatives).

Method: The study was based on 29 semi-structured telephone interviews with French PCPs of index patients and/or their FDRs. The fully transcribed corpus of interviews was put through linguistic analysis using a lexicometric tool to identify discourse objects based on frequency calculations, and for the purposes of thematic sociological analysis.

Results: The analyses showed that family screening is conditioned by communication between PCPs and index patients, whom they encourage to pass on the guidelines to their relatives, and by conversations with doctors from other specialisms, who provide them with precise information about the diagnosis. FDRs have a more "classic" relationship with their PCPs, who ask questions in order to ascertain the patient's history and thus direct them toward appropriate screening. The stance of PCPs thus seems to alternate between supervision and reflection, and between consultation and questioning.

Introduction: In France, gynecological care is provided by three types of health professionals: gynecologists, primary care physicians, and midwives. The objective of this study was to describe the gynecological care provided by these different health professionals at the national level.

Methods: A descriptive and analytical study of indicators of gynecological care (cervical and vaginal swabs, contraception procedures, and initial contraception and preventive consultations) by gynecologists, primary care physicians, and midwives in private practice in 2022, using data from the French National Health Data System (SNDS) to establish profiles of health professionals using multivariate analysis (principal component analysis and hierarchical clustering).

Results: Three gynecologist profiles, five primary care physician profiles, and four midwife profiles were identified based on the intensity of their gynecological care activity and their specialization in certain types of procedures. Professionals with significant gynecological care activity often have a particular focus on private practice, are more frequently female, and belong to younger age groups. The geographical distribution of professionals with significant gynecological care activity varies according to the profession.

Conclusion: We demonstrate significant heterogeneity in gynecological care, both between different types of professionals and within the same profession. Understanding gynecological care provision and its dynamics thus requires us to take into account the variety of actors at both the inter- and intra-professional levels.

Introduction: In the absence of a consensus on the definition and evaluation of non-pharmacological interventions (NPI)-despite the use of the concept by the World Health Organization, the French Health Authority, the Ministry of Health, and the European Centre for Disease Prevention and Control-this study has co-constructed a consensus-based paradigm aligned with international health research standards. This article outlines its relevance and limitations for public health.

Method: Over a two-year period, the study engaged all stakeholders, i.e., more than 1,000 participants. Participatory workshops based on international health research recommendations and experiential knowledge, and consensus sessions were conducted under the guidance of a multidisciplinary committee and with the logistical support of the Non-Pharmacological Intervention Society. These efforts helped to identify the key descriptive and evaluative invariants specific to NPIs. Four phases followed: development, improvement, voting, and consultation.

Results: The term NPI refers to prevention or care protocols with a physical, nutritional, or psychosocial focus, targeting a health issue and personalized by a qualified professional. The evaluation framework comprises 77 invariants-14 ethical and 63 methodological-distributed across five types of study: mechanistic, observational, prototypical, interventional, and implementation. The NPIS Model paradigm was endorsed by 31 learned societies and three French health authorities.

Conclusion: The term NPI should be reserved for prevention and care protocols that are described, explainable, effective, safe, and implementable. The consensual framework for co-constructed evaluation should promote the transfer of NPIs from research to practice, their interprofessional coordination, contextual adaptation, continuous improvement, training, and, finally, their recognition. This scientific paradigm strengthens the role of public health professionals in developing targeted, efficient, and potentially fundable interventions for at-risk or ill populations. It paves the way for the development of an open registry of intangible health care practices that can be codified, shared, traced, and improved, informed by user feedback. This paradigm does not, however, cover all areas of public health.

Objectives: Permanent supportive housing (PSH) is the preferred strategy for eradicating homelessness. This study seeks to outline the specificities of PSH in Montreal (Quebec, Canada), to compare the different models and highlight their respective strengths and challenges.

Method: Data was collected in 2023 through 31 organizations from eight governmental bodies or Quebec associations and 23 Montreal PSH resources. A sample of 42 managers and practitioners from the homelessness/housing sector participated by completing an interview and/or a questionnaire. The study used a mixed-methods approach integrating descriptive and content analyses.

Results: Community-based PSH was the most prevalent model, although half of the resources offered both community-based and private-sector PSH. A median of 70 residents received support, with only one-third of those being followed at least once a week. Common challenges were mainly linked to funding (e.g., quality affordable housing) or due to the complexity of providing follow-up to residents. Key distinctions were based on whether the housing was contracted in the private sector, and on whether support was available onsite. Challenges specific to private-sector PSH included relationships with landlords, the remoteness of follow-up sites, and resident isolation. Community-based and social PSH faced issues associated with adherence to house rules and resident stigmatization.

Conclusion: Findings indicate that increasing the number of resources, the intensity and diversity of support, and expanding relocation options would be beneficial to residents.

Introduction: Territorial diagnosis is an essential tool for any institutional decision-maker, provided that the study area aligns with the issue being studied. Based on geographical and managerial analyses, this study aims to demonstrate how consumers' territorial experience in health care contribute to modeling knowledge management of population spatial practices in care consumption.

Methods: Using health care consumption data from the SNIIRAM, the lived territories of emergency services are defined by relative majority flows; multivariate analysis methods are then applied to produce a typology of these territories. A qualitative analysis is conducted to adapt the MAIKE organizational knowledge management model to these territories.

Results: This study identified 451 areas of emergency services use and developed an 18-class typology grouped into three categories. Group 1 comprises areas close to the national average; Group 2 includes favored areas; and Group 3 covers disadvantaged areas, each showing certain variations within the groups.

Discussion: Identifying the territory enables the transformation of tacit knowledge into explicit knowledge through the interactive exchanges among the involved actors. Since users' spatial practices often diverge from theoretical models developed by public bodies, this knowledge is crucial for public authorities in planning care services. Knowledge management thus becomes essential for public organizations to effectively pursue their objectives.

Introduction: In France, pain is the leading cause of medical consultations, and chronic pain affects nearly 12 million people. Its management remains delayed, unequal, and often inadequate, with an average wait time of over three years to access specialized services. This delay is due in part to a lack of training among general practitioners, overly siloed medical expertise, and uneven distribution of specialized centers. These factors lead to diagnostic delays, unequal access to care, and a significant societal cost. Innovative regional models, such as the one implemented in Vendée, offer promising avenues for reorganizing care pathways.

Methods: The study is based on an analysis of the chronic pain care network in La Roche-sur-Yon (Vendée), coordinated by Dr. Pluchon. This network, linked to the local hospital group GHT85, includes seven local care sites. The analysis was conducted by a national steering committee composed of three heads of CETDs (Chronic Pain Treatment Centers) from diverse contexts. The methodology included interviews with patients, health care professionals, and hospital management, as well as activity data from the PMSI databases. The objective was to identify key success factors, deployment conditions, and the value created for all stakeholders.

Results: Between 2018 and 2022, pain management activity at the La Roche-sur-Yon center increased by 58%, and by 59% across nearby sites, while the patient outflow rate dropped by more than 20%. Centralized coordination, a single point of entry for appointments, advanced consultations, and staff mobility helped reduce wait times (in some cases by a factor of 4), improve distribution of resources, and ease access to specialist care-even for patients in remote areas. The model promotes shared protocols, regular regional multidisciplinary meetings (RCPs), and continuous upskilling of local health care providers.

Discussion: This innovative regional model brings multiple benefits: reduced inequalities in access, a local network of expertise, more appropriate treatments, decreased diagnostic delays, and medical-economic gains. It offers a concrete response to the shortage of pain specialists and the need for local follow-up. Its success relies on strong coordination, shared tools, collaborative organization, and professional commitment. The model is now being extended to other regions (Sud Seine-et-Marne, Nîmes) through a national pilot program based on common indicators and a shared data platform. The Vendée network illustrates the potential for nationwide reform in chronic pain management.