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Although it is a major issue, the health of children and adolescents in care is still mainly explored on the basis of information provided by adults in French studies. This study therefore aims to make up for the lack of studies integrating the young people’s own point of view and to explore certain aspects of health, as reported by the children and adolescents themselves, by comparing the health of children in care with that of children in the general population. The sample consists of 477 children in care (versus 23,672 who are not). The data were collected through a cross-sectional survey conducted by UNICEF France between October 2020 and March 2022 among 25,300 children and adolescents aged 6 to 18 who responded to a paper or online self-administered questionnaire. The main results of this study confirm the existing findings concerning the much greater health care needs of children and adolescents placed outside their homes (foster families, children’s homes) compared to their peers. In particular, they underline greater psychological suffering linked to their life histories, health risk practices, sexual violence, and suicidal risk. The discussion addresses the complexity of the issues associated with their health and underlines the importance of taking into account the child’s own point of view.

Objectives: Although access to abortion is a national priority in France, there is little documented evidence that it is actually respected. In the Grand Est region, the 2021–2023 plan for access to abortion includes a review of family planning practices and health care provision, to update the 2019 report. It raises the question of access to abortion in all its dimensions, and aims to implement improvement actions best suited to the region’s problems.

Method: An online questionnaire was sent to hospitals, local perinatal centers, sexual health centers, and independent professionals with presumed family planning activity. Of those who responded, only those with actual family planning activity were included.

Results: The five-day deadline for the first appointment recommended by the HAS can be met by 73% of those surveyed. During pre- or post-abortion consultations, a psychosocial interview is offered to 92% of patients, and the detection of violence to 97%. Although 14 hospitals (38%) have extended their abortion access time to 16 weeks of amenorrhea, the number of facilities handling abortions beyond 13 weeks of amenorrhea has fallen since 2019. In primary care, 70% of private practitioners and 61% of sexual health centers offer abortions up to 9 weeks of amenorrhea.

Conclusions: Access to abortion has weakened in the Grand Est region between 2019 and 2023. New laws and regulations could be a lever for improvement, provided that the professionals involved are given the means.

Introduction: Benefiting from the disability pension implies morbid (physical and psychological) and social (fall in income) implications for the person. It also has economic consequences for society, with increasing expenses since 2011 (+4.9% on average per year). Investing in preventive actions against the loss of the ability to work should limit these consequences, but it requires targeting people at risk. The development of artificial intelligence opens up prospects in this regard.

Purpose of the research: To target, using supervised machine learning methods, those people with a high probability of becoming eligible for the disability pension over the course of the year based on their socio-demographic and medical characteristics (pathologies, work stoppages, drugs taken, and medical procedures).

Method: Among the beneficiaries of the French public welfare system aged 20–64 in 2017, we compared the socio-demographic and medical characteristics between 2014 and 2016 of those who received a disability pension in 2017 and not before, and those who did not receive a disability pension from 2014 to 2017. The determination of the boundary between these two groups was tested using logistic regression, decision trees, random forests, naive Bayes classifiers, and support vector machines. The models’ performance was compared with respect to accuracy, precision, sensitivity, specificity, and AUC (area under the curve). Finally, the predictive power of each factor was measured by AUC too.

Results: The boosted logistic regression had the best performance for three of the five criteria, but low sensitivity. The best sensitivity was obtained with the support vector machines, with an accuracy close to that of the boosted logistic regression, but a lower precision and specificity. Random forests offered the best discriminatory ability. The naive Bayes classifier had the worst performance. The most predictive factors in becoming eligible for the disability pension were having 30 days or more off sick in 2014, 2015, and 2016 and being aged 55 to 64.

Conclusion: Supervised learning methods have appeared relevant for identifying people with the highest probability of becoming eligible for the disability pension and, more broadly, for steering public and social policies.

Introduction: In response to the COVID-19 pandemic, France was under lockdown for the first time from March 17 to May 10, 2020.

Purpose of the research: The aim of this work is to study the impact of lockdown on outpatients’ visits to the hospital pharmacy to collect chronic medication, in order to highlight the pharmaceutical classes concerned and to assess whether a decrease in medication adherence could be observed.

Method: Retrospectively, using hospital dispensing traceability software, the dispensing of drugs during the eight weeks of lockdown was compared with that during the two eight-week periods before and after lockdown. Evolutions in the number of medicine lines dispensed and outpatient visits were analyzed over the three time periods, according to pharmaceutical classes. A specific analysis was performed between drugs only available at the hospital pharmacy and drugs available at both the community and hospital pharmacy.

Results: During lockdown, 67% of patients still came regularly, but a significant decrease in the average number of lines dispensed was observed. 15% of regular patients limited their visits during this period. Patients taking drugs available at both the community and hospital pharmacy were significantly more impacted than those taking drugs that could only be dispensed at the hospital pharmacy. On the other hand, age is not a factor associated with the restriction of visits.

Conclusions: Lockdown affected the visits to the hospital pharmacy of at least one in ten regular outpatients. Sending hospital drugs to community pharmacies and the help of home health care providers limited therapeutic disruptions.

Chad has one of the highest maternal and infant mortality rates in the world. Efforts to reduce these rates have led to the introduction of fee exemption and community involvement initiatives to further encourage the use of health services. Despite the introduction of these initiatives, inequalities in access to and use of health facilities persist. The aim of this study is to understand why and how the same action, implemented in a quasi-homogeneous way, produced contrasting results in different health centers. A multiple, contrasting case study was used to analyze the outcomes of pediatrics consultations and deliveries in four health centers in the Bénoye and Beinamar districts. Data were collected through individual interviews (n=26) and focus groups (n=22) with women beneficiaries, community health workers, and health care providers. The qualitative software QDA Miner was used to process the data. The study revealed that the organizational and managerial capacities of the providers and community actors would explain the heterogeneity of the results observed. Contextual factors such as the remoteness of services or the impassability and dangerousness of roads accentuated the disparities in the results observed. The results of this study show that human and contextual factors would explain the heterogeneity of the observed effects.

Introduction: Seasonal malaria chemoprevention (SMC) by mass administration of sulfadoxine pyrimethamine + amodiaquine (SPAQ) reduces the burden of malaria in children aged 3–59 months. The occurrence of adverse drug reaction (ADR) may affect the success of this intervention. There are few studies of SMC adverse event surveillance in sub-Saharan Africa, particularly in Burkina Faso, a highly endemic country. Our main objective was to characterize the ADRs reported during SMC campaigns in Burkina Faso. Secondly, we evaluated the performance of the pharmacovigilance integrated into the SMC program in order to support safe administration of SMC.

Method: This was a retrospective descriptive study of SMC individual case safety reports recorded in VigiBase® in Burkina Faso from 2014 to 2021. We used the P-method for the analysis of preventable serious adverse drug reactions and WHO criteria for assessing the performance of pharmacovigilance integrated into the SMC program.

Results: A total of 1,105 SMC individual case safety reports were registered in VigiBase® for 23,311,453 doses of SPAQ given between 2014 and 2021. No pharmacovigilance signal was detected. The number of serious cases was 101, of which 23 (22.8%) were preventable. In 38.1% of children, the occurrence of ADRs led to discontinuation of SMC treatment. Vomiting was the most frequently reported adverse drug reaction (48.0%). The proportion of children whose treatment was discontinued due to vomiting was 42.7%, while the proportion of treatment discontinuation for other ADRs was 32.8% (p = 0.01). The SMC program contributed at 46.2% to the national pharmacovigilance database. The reporting rate was 0.03 per 1,000 exposed children in 2021. The median completeness score of the ICSRs was 0.7 (IQR: 0.5–0.7), and the median time to register the ICSRs in VigiBase® was 204 (IQR: 143–333) days.

Conclusions: Post-drug administration vomiting may interfere with the purpose of SMC. Measures to manage this adverse drug reaction should be taken to improve the success of the SMC program. Based on the information on reporting time and reporting rate, spontaneous reporting should be supported by active surveillance, including cohort event monitoring, in Burkina Faso.

This article offers an analytical synthesis of international trends in public policies to regulate tobacco in the first quarter of the twenty-first century. It begins with a review of the densification of the repertoire of public action and the affirmation of a strategy that consists of encircling tobacco (designated as an enemy) and attacking it through a variety of material and symbolic tactics. Tobacco regulation is a constantly dynamic process, due to the intensity of the exchanges of blows between protagonists: these agonistic interactions are reflected in framing struggles that lead to a diversification of tobacco qualifications. Tobacco is thus framed as a health issue, but also as an environmental problem and a challenge for social justice. Finally, the article shows how, at the end of a quarter-century of diverse mobilizations, the gradual formulation of a paradigm shift is taking shape, in which the objective of public action is no longer simply to control tobacco, but to eliminate it as a commodity.

Heated tobacco (HT), a new tobacco product, is presented by the tobacco industry as an effective and safe alternative to cigarettes. Even if the quantities of harmful compounds emitted by HT are lower than those found in cigarette smoke, this reduction in exposure cannot be equated with a reduction in risk. No study has provided evidence that switching from cigarettes to HT reduces the risk of tobacco-related diseases. HT cannot be considered as a cigarette cessation product and was even designed as a product to initiate or return to tobacco consumption. To promote this product, the tobacco industry essentially exploits the concept of harm reduction and, as such, tries in its commercial communication to create confusion between HT and electronic cigarettes, despite these two products having nothing in common. This promotion is based, on the one hand, on the data of internal studies in contradiction with those of independent studies, and, on the other, illegally, on social networks and communication in contradiction with the statements of regulation authorities. HT is a new lure offered by the tobacco industry, intended to maintain its profits in a world that is moving away from “traditional” cigarettes. It should be strictly advised against for both non-smokers and smokers.

The prevalence and severity of smoking are particularly high in populations in precarious situations and make smoking an essential determinant of social inequalities in health, due to its particularly catastrophic impact on the health of these populations. The general reduction in smoking, less significant in disadvantaged populations, contributes to further increasing these inequalities, and smoking tends to be concentrated in the most vulnerable populations. The relationships between tobacco and precariousness are examined by identifying, based on a review of the literature, the main common factors of vulnerability: stress and social adversity, self-stigma, a low feeling of self-efficacy, the social function of tobacco use, the ambivalence of demands, associated addictions, the severity of tobacco dependence, distance from support and care systems, etc. Specific attention is paid to certain particular conditions: mental health disorders, addictions (other than tobacco), inadequate housing, detention, migration. On this basis, courses of action are proposed to improve access to care and its effectiveness for the people concerned. Emphasis is placed on the mobilization of professionals who often tend to neglect issues of smoking in view of the immediate severity of the problems at the origin of the demands of the people received. A support offer for harm reduction (vaping in particular) seems particularly suited to often-ambivalent demands. The importance of networking and the involvement of CSAPAs/CAARUDs is also underlined. At the systemic level, all of this must be accompanied by political advocacy to reduce these inequalities and social determinants of health.