Search

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.

Introduction: The ANRS 14058 Ganymede study aims to determine the proportion post-migration HIV-seroconversion in a sample of HIV-positive men having sex with men (MSM) born outside of France and receiving medical care in Paris region (Île-de-France). The study, based on a self-questionnaire, is also focused on the life course of these MSM before, during and after the migration process., Purpose of Research: The paper refers to a qualitative exploratory study, taking place as a prerequisite for the Ganymede study, in order to refine its questionnaire. The purpose of these interviews was also to explore the migratory motivations and experiences, the sexual biography, and the health history, of a sample of seropositive MSM born outside of France, and to illustrate the diversity of this epidemiological category., Results: Forteen respondents participated in the interview study. Nine of them have learned of their HIV-positive status after having emigrated to France. None of the respondents mentioned a major barrier to medical care access and HIV follow-up. The obstacles they reported were related to the coverage of medical expenses, due to their possible precarious legal and social situation. These men were exposed to the effects of power relations, leading to discrimination and violence, whose wider impacts on health were weakly evoked., Conclusions: Although the findings of the exploratory study are not to be generalized, they illustrate the health issues of the interviewees, and the wide diversity of their biographies and life courses, emphasizing the impact of gender and class power relations as a source of social and health inequalities, and precariousness. They invite therefore to describe this epidemiological category of "MSM born outside of France" in a more heterogeneous way.

Introduction: In France, “the pill crisis” has brought into question the centrality of oral contraception within the “contraceptive standard”, as well as the drawbacks associated with its use, and is more widely part of a dynamic of raising awareness about medical and gynecological violence, at work since the early 2010s., Purpose of Research: This paper intends to question the medical and gynecological violence faced by women seeking medical attention in order to access what is supposed to be a condition for their emancipation : contraception., Method: As part of a sociological research project on the prescriptions and uses of oral contraception, nearly seventy interviews were conducted with seventeen users of oral contraception and thirty-one health professionals authorized to prescribe contraception. Ninety-five medical and gynecological consultations were also observed, in both public and private medical facilities., Results: The use of oral contraception requires regular medical consultation, increasingly exposing users to the risk of medical and gynecological violence, with lack of consent at its core. The case study of a gynecological consultation, as well as the analysis of interviews and observations, reveal various forms of medical violence, with a focus on the patients’ dependence on the medical profession., Conclusions: The interconnectedness of these different forms of medical and gynecological violence encourages us to consider them as part of a continuum of gender violence. An ethical caring stance makes it possible to guard against these situations.

Introduction: This paper examines whether the development of general medicine as a specialty in France since the mid-2000s has had an impact on medical theses. It analyses the changes resulting from the discipline's autonomatization process, involving an investment in some human and social science methods.Purpose of research: In a diachronic approach, all dissertations defended in a general medicine department in 1999, 2007 and 2015 were analyzed (N = 291). We performed systematic coding of the types of methods used, the areas of research investigated, as well as the supervisors' areas of specialization. We used this coded data to develop a typology of research topics (using a hierarchic classification method based on the coordinates of a principal component analysis)., Results: Over the period under study, we observed a complexification of medical theses, which increasingly addressed multi-dimensional research topics. We also noted the emergence of new types of subjects, dealing with the exercise of the specialty and close to social science concerns (on the practices and dispositions of healthcare actors). Qualitative methods have been used more and more often, as a result of the increase in the number of theses supervised by GPs., Conclusions: The reform of general medicine has impacted the subjects treated and methods used in theses, and sheds light on the dynamics of the emergence of a new health research field.

Social inequalities constitute a major obstacle to the social and economic cohesion of a country, particularly those affecting the health field. In the field of cancer screening, the current situation is that of a social gradient of participation and strong territorial inequalities. This paper reports on the results of two interventional investigations to add incentives to the existing device to provide screening tests for specific populations. A prospective trial with a collective randomization unit was set up from April 2011 to April 2013 in the 3 areas of Northern France (Aisne, Oise and Somme), to assess social workers' help with screening of colorectal cancer (Prado trial). A retrospective study was conducted on the experience of mammobile driving in the area of Orne for several years. The analysis of the results shows that each of these devices is capable of reducing or even erasing social and territorial inequalities at a reasonable cost to society. It also shows that in terms of screening, inequalities can only be reduced if additional devices dedicated to particular populations are added to the national system according to a principle of proportionate universalism.

Aim: The aim of this paper is to assess the relationships between psycho-behavioral determinants and quality of life in individuals with age-related hearing loss., Methods: This is a cross-sectional study performed in a French preventive health center, Marseille, France (Institut Régional d'Information et de Prévention de la Sénescence). The patients had a bilateral (mild to moderately severe) age-related hearing loss. Data collected included : sociodemographics, general health information, quality of life (Hearing Handicap Inventory for the Elderly and World Health Organization Quality of Life questionnaire), emotional status (anxiety and mood disorders), emotional intelligence (Trait Emotional Intelligence Questionnaire Short Form), and coping strategies (Brief Coping Orientation to Problems Experienced Scale)., Results: Quality of life was linked to psycho-behavioral factors, such as emotional status, emotional intelligence, and coping strategies., Conclusions: These findings would assist health authorities and clinicians in choosing targeted appropriate interventions to improve quality of life of age related hearing loss individuals.

Maternal and child protection services ("PMI") are French universal services providing prevention and health promotion services to parents and their newborn children up to the age of 6. They specifically offer home visitation services in order to reach families that could not be seen otherwise. This paper presents the results of a national survey describing these home visitation services and their local implantation. Sixty French ?départements? (59%), constituting the territorial unit for the PMI answered the survey. The results point out that family reach remains a challenge for these services. Organizational issues represent the main barrier to implement and deliver home visitation with sufficient reach and quality. The services now provide home visitation based on risk factors, while the universality of services seems to be no longer guaranteed. The number of tasks that the nurses have been charged with can explain these difficulties, as well as the lack of financial and human resources.

Although their design may feature a considerable amount of universalism, prevention strategies often produce results that are socially and/or spatially differentiated. This differentiation process can induce social or territorial gradients of access to and/or effectiveness of prevention and, in turn, worsen health inequalities. This process also accentuates the gap between the principles of certain public policies and their practical implementation, raising the question of the real benefit of these policies for beneficiaries. Although Sir Marmot considers proportionate universalism to be a strategy to tackle health inequalities, the practical modalities of implementation of this principle have been rarely described in the literature until very recently. This pragmatic paper therefore presents a causal analysis of differentiation processes, underlines the need for self-reflexive prevention strategies, and investigates practical implications of proportionate universalism.

Objective: This paper presents the stages of development of an occupational biomechanical exposure matrix and preliminary reliability and validity indicators., Methods: The expertise-based job exposure matrix, called "MADE" (for "difficult physical conditions and job matrix"), was developed from the French and international classification of jobs for 17 biomechanical exposures. Three pairs of investigators independently rate the frequency and intensity of exposure of each job from 0 to 5; discordant scores within pairs (mean difference >20% for each biomechanical exposure considered) were discussed collectively. Reliability was assessed by the difference between the initial ratings, the number of revised jobs, and the correlation between the two classifications (with transcoding). Validity was studied by correlating variables similar to those from existing United States and Danish matrices., Results: The difference between the mean scores of the pairs was considered to be "fair" (less than one point). Of the 51 paired results studied (17 exposures - 3 pairs of investigators), four coefficients were found to be less than 0.6, and 14 were between 0.6 and 0.7. Forty-nine of the 1,169 job categories were reviewed. Correlation coefficients between the initial classification and transcoding were greater than 0.7. Correlation coefficients between the French, United States and Danish MEE variables were fair to good., Conclusion: An expertise-based job exposure matrix with fairly reliable indicators has been developed, opening up the prospects to improve certain some fields of public health, at both national and international levels.

Introduction: Reduction of social inequalities in health has been one of the main political pillars of Regional Health Agencies in France since their creation in 2009. This paper presents a contextual analysis of the effects on social inequalities in health of a hospital-based health promotion and disease prevention programme in terms of overall health policy and scope., Methods: Qualitative analysis was used to describe the impact on social inequalities in health according to the classification proposed by Diderichsen et al. Carey's framework was used to apply proportionate universalism in order to analyse its action on these inequalities, adopting a contextualised and holistic approach with regard to regional and national public policy. The results showed that the intervention focused on targeted actions, but may have broader applications. The intervention strategy shifts between closing the inequality gap and levelling up the social gradient. However, analysis of this type of intervention using the proportionate universalism framework may lead to a revised view of the effects of the intervention on social inequalities in health., Results: Implementing health-equity focused interventions remains a challenge for each institution, including Regional Health Agencies. However, research on hospital-based preventive interventions highlights contrasting results in terms of social gradient, depending on whether the intervention is considered in isolation or in its broader context., Discussion: This article advocates a contextualised approach to analysing local interventions and their effects on social inequalities in health.

Free access to medicines is an important element in the implementation of health care access policies. Paradoxically, this aspect is rarely addressed in the literature on this subject. The Ville-Evrard psychiatric hospital introduced so-called "poverty prescriptions" allowing free drug dispensing, independently of specific PASS (Permanent Access to Health_ Care) systems. This paper presents the results of a study of all poverty prescriptions issued by the facility in 2011./t provides an analytical description of this system and shows that, despite the absence of strict controls, it was used relatively rarely.

This paper describes a knowledge transfer experiment that has been conducted since September 2012 in Argenteuil (Val d'Oise, France). This experiment is part of an interventional research project called DeCL/C: "Knowledge translation on social and spatial inequalities: a tool to raise local awareness and mobilization to lessen cancer screening participation rate disparities': The project is carried out by health geographers from Paris Ouest University (UPO) and the National Association of Cities for Public Health (Elus, Sante Publique et Territoires, ESPT). It encompasses two main components: intervention designed to implement a knowledge co-production and transfer process among researchers, stakeholders and decision makers at various levels. This knowledge concerns social and spatial determinants of inequalities of access to breast cancer screening programmes in cities. The research is multidisciplinary (geography, sociology, political science, epistemology) and is designed to measure the impact of this knowledge co-production and transfer in terms of actions in the targeted cities (six cities in the Paris region) as well as the reduction of inequalities of access to breast cancer screening programmes. This article, based on knowledge transfer literature and an empirical experiment in Argenteuil, describes the ongoing knowledge transfer process. It also highlights Argenteuil stakeholders' and decision makers' interest in action and research. The analysis of the knowledge co-production, sharing and ownership process by local actors a e both "strategic" and "profound':

This paper reports the action research conducted by a group of nurses working in various hospitals belonging to the Onconord-llede- France (Val d'Oise) network and involved in the setting-up of the paramedical cancer announcement system following the 2005 Cancer plan from the point of view of the sociologist who accompanied them. This analysis of the modalities and difficulties of implementation of the new system allowed these nurses to develop their own self-assessment practice survey. They defined the best conaitions for setting up the announcement visit and also achieved a better understanding of their position. This research also opened up lines of reflection on the new organizational configurations and the consequences on professional autonomy.

Couleurs Santé was a community mobilization program implemented in six areas of Brittany, France. The aim of the program was to develop health education projects in schools and among children and adolescents with a view to promoting the development of psychosocial skills and creating healthy environments. Assessment was an integral part of the program, the main aim being to evaluate the effectiveness of the program and its transferability to other settings. The assessment process was examined in order to determine the impact of the assessment on the program and to assess the influence of stakeholders on the assessment method. This paper provides an overview of the development of the program and the associated assessment process and shows how the assessment process has helped to improve the program. The findings highlight the diversity of local approaches and strategies, underlining the importance of the varying interpretations of the initial framework, the contributions of actors and environmental opportunities and constraints. The study also highlights the importance of considering the context and the expectations of actors for developing a method adapted to the program model and for meeting the needs of users.

Social inequalities in health remain a major problem in France despite recent efforts to improve access to prevention and care. In France, the reduction of inequalities involves many actors, including the Instances régionales d'education et de promotion de la santé (IREPS, the Regional Authorities for Health Education and Promotion). This paper focuses on health education for deaf and hard of hearing youth. The educational team responsible for providing health education among this population has highlighted the dangers of internet use among deaf and hard of hearing youth. The overall objective is to "promote the critical and responsible use of the Internet", focusing in particular on social and technical skills. The project is a long-term intervention based on the active involvement of the educational team and the participating youth. Another objective of the project is to enable participants to contribute to online resources. This has involved using QR codes to create digital resources. The study found high levels of satisfaction among all the participants. These findings provide further evidence of the importance of providing health education to deaf and hard of hearing people.

There have been significant developments in health education over recent years. Focusing on France, the purpose of this paper is to examine the role of health education in reducing social inequalities based on the example of the Atelier santé ville de Cahors (Cahors Health Workshop). The paper addresses the following questions: What are the results and outcomes of the workshop? What kind of health education issues are at stake in the territorial approach to policy-making in an urban context? We examined the methods underlying the health education measures taken in the Cahors Health Workshop, which involve project-based approaches and the promotion of community health. Health education aimed at improving health is central to issues such as listening and speaking, the development of autonomy and the responsibilization of urban actors. Based on a rigorous methodology and the underlying values, health education in the Cahors Health Workshop places local residents, elected representatives and health professionals at the heart of the health care process (from the diagnostic process to the assessment process) and contributes to the reduction of social inequalities in health while facilitating access to information and health care. The goal of health education is to encourage individuals to be responsible for their own health in order to empower them to make informed choices adapted to the demands of their environment.

This paper examines the role of health education in the French Agences régionales de santé (ARS, Regional Health Agencies) in 2012. A survey was conducted among public health managers working in the ARS. Most of the participants reported that health education plays an important role in their agency, notably through their regional health plan and the activities of the organizations responsible for promoting democracy in health care. This is also true of the links with the Institut national de prévention et d'education pour la santé (INPES, the National Institute for Health Prevention and Education) and the network of Instances régionales d'éducation et de promotion de la santé (IREPS, the Regional Authorities for Health Education and Promotion). However, the answers to the open-ended questions and the results of the interviews suggest that these results must be interpreted with caution. The study focuses on a number of factors that must be taken into account when considering the results of the quantitative analysis. These factors include: the subjective (or interpretive) dimension of the term "health education" emphasized by many of the participants (a term involving an emphasis on either health promotion or preventive medicine); the limited emphasis on health education in the ARS (beyond therapeutic patient education) compared to other issues such as health monitoring and security, health care and medico-social problems; the limited resources allocated to health education and the bleak budget outlook; the relationships with the main operators; and the need to develop, promote and apply knowledge of good practice. Finally, the study shows that the role of health education is dependent on individuals' willingness to promote it and, in particular, on the commitment of ARS managers.

Major legislative, structural and organizational changes have had a significant impact on public health in France over the past decade. This paper examines the effects of these changes in terms of the development of health education over the same period. Six significant trends were identified: the development of research in health education, the emphasis on health education as a strategy for reducing health and social inequalities, the emergence of health education as a field of intervention, the emergence of therapeutic patient education, the unprecedented economic difficulties of health education associations, and the changing perception of health education among public health authorities. The embeddedness of health education in health promotion remains vital since it provides the basis for developing the full potential of health education as part of a cross-sector approach, in combination with a range of other strategies aimed at broadening the scope of intervention.

Hepatitis B and C continue to be major public health problems in France, particularly among migrants. The fact of being born in hepatitis B and C-endemic countries or of being a long-term resident of these countries are common risk factors, especially in the case of hepatitis B. Screening for both types of infection remains low among migrants. The main purpose of this study was to examine perceptions of the risk of viral hepatitis B and C in migrants among health professionals in Côte-d'Or (Burgundy, France) and to understand the factors promoting or hindering screening. The paper presents the results of a qualitative study based on face-to-face interviews with 23 healthcare providers and 8 social workers. The participating health professionals were interviewed about their involvement in the fight against hepatitis B and C and their perceptions of the risk of infection among migrants. The interviews conducted with social workers focused mostly on the conditions of social and health support provided to migrants. The study found that hepatitis B and C screening among migrants was associated with HIV screening. Screening was found to be associated with formalities relating to the legal and administrative status of migrants, the type of accommodation or housing, health professionals' knowledge of the risk factors associated with the epidemiological and social/health context in the countries of origin, and their own involvement in humanitarian aid. Migrants seeking political asylum and living in reception centers were found to be more likely to undergo screening. The findings suggest that awareness of the importance of systematic screening for hepatitis B and C in migrants from hepatitis B and C-endemic areas needs to be promoted among social workers and health professionals, as recommended by the National Prevention and Control Program (2009-2012).

At the end of the 1970s, the term "community health" was hugely popular in the field of health and welfare in many countries throughout the world. Mainly inspired by American and Latin American sources, the concept was based on a participatory and multidisciplinary approach to preventive and curative health services. What is the current state of community health? The objective of this study was to examine the socio-historical development of community health over the last 40 years. The paper begins by presenting a conceptual framework defining community health and public health as two distinct domains in the field of health and welfare. The study found that depending on the setting, the historical period and the ability of actors to promote their views, the space occupied by the two domains and the relationships between them tend to vary, as shown by a comparative analysis between France and Québec from the 1970s to the 2010s. Based on the results of this study, the expression ?doing community health' appears to refer to a precise set of?practices based on certain approaches and methods implemented by actors in specific areas of intervention. Depending on the time and place, the actions and practices of the?concerned actors will determine the extent to which they are incorporated into the institutional context of public interventions.

The purpose of this paper is to map out the Therapeutic Patient Education activities of health centers in the Lorraine region of France in the months leading up to the promulgation of the HPST law (reform of the French Public Hospital system) defining and regulating TPE. A self-administered survey and interviews were conducted to identify the educational activities offered by the program (structure, training of professionals, links with general practitioners, etc.) and to quantify them (number of patients, classes, etc.). All health centers in Lorraine were contacted (193 centers in total). 93 centers responded and 48?reported TPE activities, with 131 functional TPE courses (or structured activities) and 40 projects. An analysis based on 8 quality criteria was carried out. The study found that 49 centers met at least 6 quality criteria and were close to the required quality standards. The study also found that the geographical distribution of TPE provision is unbalanced. The number of TPE beneficiaries in a given semester varies between 0 and 24 patients per 1,000 inhabitants (according to the health area), which amounts to 5% of chronically ill people in the Lorraine region.

This paper describes a highly unusual hospital unit that combines somatic and psychiatric approaches under the generic heading of a Medico-Psycho-Social Unit (MPSU) established at Angers University Hospital since 1996. The paper examines the value of a mixed approach while highlighting its limitations. The interest of the MPSU is that it provides a multidisciplinary, somatic and psychiatric approach on the same site. The joint expertise of medical and paramedical staff is required in cases where the assessment of the consultation-liaison services is not sufficient and in complex situations requiring the resources of an intensive care unit and specific medical and surgical specialties. Based on an established partnership and joint service provision, this type of unit is relatively uncommon both in France and abroad. However, the prevalence of somatic and organic comorbidity suggests that MPSUs are an innovative solution for the challenges of this type of care. Two clinical cases will be used as examples.

Unlabelled: The purpose of health surveillance is to contribute to health planning, information and prevention. Surveillance involves repeated data collections based on epidemiological studies and follow-up of data collected from medical-administrative databases. This paper provides an overview of mental health surveillance in France and examines the relevance and limitations of the collected data., Method: The prevalence of major depressive episodes (MDE) in the general population was recently examined in seven studies. Among these studies, the Health Barometers involved two data collections at a five-year interval using the same method. Mortality and hospitalization data are important for suicide and suicide attempt (SA) surveillance. Health insurance databases provide key information about psychotropic drug use and serious psychiatric illnesses defined as long-term., Results: The prevalence of 12‑month MDE remained stable at 7.8% between 2005 and 2010. Mortality data show a suicide rate of 16 per 100,000 inhabitants. Hospital data show that the rate of hospitalization for SAs is approximately ten times that of suicide. Data from emergency wards indicate that approximately 220,000 SAs are admitted to hospital emergency services every year. Currently, depressive disorders are the primary reason for new admissions under the ALD23., Discussion: A comparison of data from different sources is required to provide a basis for mental health surveillance in France and to help identify those populations that need to be targeted as a matter of priority by prevention measures.

Because of its sector-based organization and extra-hospital care, public psychiatry has a unique position in healthcare. This paper describes the tools and procedures used to analyze and allocate the resources of the "Centre Hospitalier Alpes-Isère", a hospital serving a catchment population of 530,000 adults. A consensus-based approach was used to validate the selected indicators and included the participation of a geographer. Five levels of resource allocation were identified and classified using a decision tree. At each level, the relevant authorities and criteria were identified as key components of the decision-making process. This paper describes the first three levels of care provision. Focusing on adult care, a comparative assessment of the resources allocated to general psychiatric care and specialist care was conducted, in addition to a comparative assessment of the resources allocated to each of the hospital's four local centers. Geographical accessibility to extramural facilities was also assessed. A study of the characteristics of each general psychiatry clinic revealed significant disparities. The paper highlights several issues: the poor knowledge of psychiatric epidemiological data relating to the population within the catchment area, the difficulty of assessing non-consolidated data or indicators from multiple sources, and the limited and partial nature of geographical data for characterizing and evaluating health care in the hospital's peripheral clinics. Several studies are currently underway to assess the operational effectiveness of the tools and procedures used to analyze and allocate resources.

The level of cooperation between legal and healthcare professionals in psychiatry has increased significantly as a result of the greater emphasis on safety and security and the increasing tendency to place mental disorders in a judicial or legal context. As a result of the many new laws that have been passed since 1998, psychiatrists are increasingly required "to treat criminal recidivism and prevent violent behavior". These issues have been highlighted by the scientific, medical and legal community, though without ever resulting in any action by the public authorities. Based on an examination of the care provided to a prisoner before, during and after incarceration, this study suggests that despite the existing regulatory framework and the abundance of data on the provision of care (including psychiatric care), a comprehensive review of the current system is required. To what extent is care management effective and consistent? Are the stated economic objectives achievable? This paper argues that in a prison context the range of healthcare options needs to be clearly defined and laid out in order to provide mental health patients and mental health professionals with a realistic vision of care provision.

A significant number of seriously ill patients die in French emergency departments. A qualitative study of the care of end of life patients in two emergency departments in teaching hospitals was conducted to analyze the work of practitioners. Organizational and funding constraints exert a significant influence on the quality of care, which in some cases may become inconsistent and cause tensions among staff. These issues are largely the result of contradictions between the temporal characteristics of some deaths and work organization. This paper offers a number of suggestions for improving the care of end of life patients in emergency departments.

The aim of this paper is to carry out a survey and comparative analysis of social representations of physical activity and fruit and vegetables in a sample of young, adult and elderly subjects. Four "urban" areas and four "rural" areas were selected for the purposes of the investigation. The samples used to assess social representations of fruit and vegetables and physical activity included 132 and 153 participants respectively. Verbal association was used and a factorial correspondence analysis was applied to the data. The prevention messages delivered as part of the second national program of nutrition and health were integrated by adult participants. A very limited awareness of the benefits of eating fruit and vegetable was observed in the young population. This study underlines the importance of implementing regular measures for the purposes of qualitative local evaluations that consider the specific characteristics of every age group in order to assess the psychological impact of prevention campaigns.

The authors review the new provisions from the law of 25 February 2008 on security measures on retention for safety and on reporting of criminal irresponsibility related to mental disorder. In doing so, they aim to bring a medical perspective to the discussion. Issued after a long process of reflection which began in 2005 with the report from the Health Justice Committee, the law provides for the possibility of keeping offenders considered dangerous detained after the end of the term of their sentence. It also amends the reporting procedure for excluding criminal responsibility due to mental disorder. The concept of dangerousness, as the foundational definition of security measures, is discussed and the difficulties of its evaluation are outlined. Finally, the paper attempts to clarify the role of the psychiatrist in this new schema and to reaffirm the principles of care.

Conflicts of interest between the food industry and public decision makers have increasingly multiplied over the last few years, especially within the context of implementing the French National Nutrition Programme. This paper describes the rhetoric and the strategies developed by the private sector in order to counter the law's implementation and enforcement based on a concrete example, namely, the removal of vending machines from schools. After having evoked possibilities of developing new partnerships as suggested by national and international health authorities, it reaffirms the right and the duty of the State to regulate within the framework of a health promotion policy, an approach which integrates the necessary open democratic public debate between the different sectors.

Home health care services for dependant people involve participation and interventions of professionals from the health care, medico-social and social sectors. In order to ensure quality care, the flow of information must appropriately circulate between all of the various care providers. The establishment of an electronic medical file for these patients is a possible solution which has been proposed to be conducted in next years. A paper medical record is the property of the patient and offers the possibility of an alternative and complementary solution. The electronic file would use the existing available file as a starting point, and without any additional organisational structures being implicated, it allows for better coordination of the health, medical and social activities. An experimental implementation of this in the Franch-Comte region of France demonstrated the advantages and benefits of such a tool based on a logic centered upon the individual and the open sharing of practices between professionals in the medical and social sectors.

A national study on the prevalence of excessive alcohol consumption behaviour was undertaken throughout France. The results presented in this paper are those from Lower-Normandy. Two surveys were carried out: one among patients of general practitioners, and another among those in hospitals. The following data were specifically examined: the CAGE test score, the use of alcohol, the level of dependence, the conclusion of the care provider and the patient's profile. The results show that the frequency of excessive alcohol consumption in Lower-Normandy remains slightly higher than the national average. However, a significant reduction, which has been confirmed by the decrease in mortality rates, has been obtained within the last two decades. But nevertheless, the fight must continue and with on-going determination, and this aspect must rely more heavily upon general practitioners.

In the period from March to July 2003, the French and international press published a great deal of information and news about the first occurrence of the global SARS epidemic, due to its threat on numerous developed or lesser developed countries. The author collected all of the available French daily newspapers, dating from March 17 to July 31, 2003, and in particular every edition of the five national papers relaying any information on the epidemic covered on the front page. The review and study of these papers' headlines highlight the intense media coverage given in the French press primarily from April to May 2003, accompanied by an evolution of the themes being tackled above all which concerned the world-wide alert from WHO which originally comprised the countries of the East (mainly China) as well as Canada, European countries (including France) and finally whose scale reached that of global proportions. Due to this situation, certain countries adopted more drastic protective measures.

This paper describes the results of a national study of the 70 french cardiac surgery units. This study was required by the ministry of health in order to prepare the planning process of cardiac surgery in France. Results concerning the year 1994 show important regional variations of resources among the country. The number of interventions has increased three fold in 15 years (from 13,000 to 38,000 a year). The share of the different indications are constant (coronaropathy: 53%; valvulopathy: 36%; congenital: 8%). Patient flows across french regions represent 15% of the interventions. Regional intervention rates per capita range from 45 to more than 80 for 100,000 inhabitants. French cardiac surgery is, in fact, organized at a multiregional level and the regional intervention rates are not correlated with mortality or demographic rates.

During September 1994, the french press and the foreign one have published abundant news about the plague which broke out in India and also because of the threat of an epidemic towards the others EC countries. From September 24th to October 9th, 1994, the author has collected the whole available daily papers in particular all editions of the eight national papers and foreign daily ones stating the information hitting the headlines. The review of these papers has shown an intensive media coverage in the french press overall from September 28th to October 1st, 1994, accompanied by an evolution of concerned items which is first of all a completely indian problem whose scale is finally threatening over the world. Due to this situation, some countries have taken measures of extreme protection.