[Alcohol and pregnancy in Lorraine: Study of professional practice and aid to detection]. / Alcool et grossesse en Lorraine: étude des pratiques professionnelles et aide au repérage.

BACKGROUND: Foetal alcohol spectrum disorder (FASD) is the main non-genetic cause of mental disability in children. "The zero alcohol rule" during pregnancy is recommended but no tracking tool is available to perinatal professionals. In order to improve prevention of FASD in Lorraine, the Lorraine Perinatal Network conducted an assessment of current practices by perinatal professionals and proposed a tool to facilitation detection of FASD. MATERIALS AND METHODS: The proposed tool is a self-assessment questionnaire combining the AUDIT-C and T-ACE procedures. One hundred randomly selected professionals and all midwives of the Department of Maternal and Child Health (Meurthe-et-Moselle) were asked about their practices before filling in the self-assessment questionnaire. RESULTS: Midwives (98%) were significantly more involved than doctors (53%) (p < 0.0001). 32% of the professionals interviewed encountered difficulties talking about alcohol and 30% were willing to be trained in this issue. The majority of professionals who tested the tool found it to be appropriate. Pregnant women easily answered the questionnaire. Only 15 women reported drinking alcohol during pregnancy, while the self-administered survey revealed that 38 women required specific monitoring. DISCUSSION: It remains difficult to encourage active participation of professionals, especially doctors, in this field. Professionals expressed the need for an aid to detection of high-risk behaviours. The proposed tool facilitates detection, but there is still room for improvement. CONCLUSION: The Perinatal Network must find new means to mobilize professionals, organize training programmes and improve the tool so that drinking can be systematically discussed during prenatal visits.

["I love my heart": a regional program to reduce cardiovascular risk and health inequalities]. / "Je t'aime mon coeur", un programme régional de réduction des risques cardio-vasculaires ... et des inégalités de santé.

"Je t'aime mon coeur" ("I love you, my heart") is a regional program aimed at reducing cardiovascular risk based on a strategy consistent with the Ottawa Charter. One of the objectives of the program is to reduce health inequalities between the general population and disadvantaged groups with limited access to preventive services. Among disadvantaged groups, access to the program appears to be related to the activities designed specifically for them and, in particular, to the support provided by professionals dedicated to the task. The study also shows that the program has had a positive impact on key determinants of health, including individual factors (knowledge, perceived self-efficacy, self-esteem, etc.) and environmental factors. In addition, the study provides evidence of social mobilization and indicates that the targeted populations have responded positively to the program. There is also evidence of better coordination between professionals from different fields. However, the level of public participation in governance remains low, particularly in the steering committee and the technical committee. Additional resources are needed to promote the emergence of a public group or population actively involved in implementing the program. The participation of the general public in the team behind the project should enable people to become actors in their own right on a par with other stakeholders.