[Death certificate: recent changes and instructions for use]. / Certificat de décès : modifications récentes et mode d'emploi.

Death certificate : recent changes and instructions for use. Since January 1, 2018, doctors must write death certificates on new models. The year 2017 saw a number of changes regarding funeral legislation and death reporting, concerning, among other things, the practice of custodial care and the data to be completed, which will be analyzed by the Center for Epidemiology on Medical Causes to produce national mortality statistics. The death certificate may be prepared in electronic format or, failing that, in paper form available from regional health agencies.

Certificat de décès : modifications récentes et mode d'emploi. Depuis le 1er janvier 2018, les médecins doivent rédiger des certificats de décès sur de nouveaux modèles. L'année 2017 a vu apparaître plusieurs changements relatifs à la législation funéraire et à la déclaration des décès, concernant entre autres la pratique des soins de conservation ainsi que les données à renseigner qui seront analysées par le Centre d'épidémiologie sur les causes médicales de décès pour produire les statistiques nationales de mortalité. Le certificat de décès peut être établi sur support électronique ou, à défaut, sur support papier disponible auprès des agences régionales de santé.

[Violence undergone by the general practitioners: Under-reporting of the attacks or of the infringements to their properties]. / Violences subies par les médecins généralistes exerçant en libéral : sous-déclaration des agressions ou des atteintes aux biens.

INTRODUCTION: The main objective of this study was to estimate prevalence on the liberal general practitioners. The secondary objectives are to identify the possible brakes with the declaration in the monitoring observatory for security of the doctors as well as to determine if the feminization of the profession was associated with the situations violence. METHODS: A questionnaire in 5 parts was submitted by telephone to 146 drawn lots liberal general practitioners. It approached the undergone physical and verbal attacks, the infringements on the properties arisen during their career, and the proven feeling of insecurity. RESULTS: The rate of participation was 63% (93/146). In all 171 incidents were reported among which 96 physical and verbal attacks (56%), and 75 infringements on the properties (44%) without difference according to the sex. The main motive for the attacks was the refusal of prescription (44%). Practically, no concerned doctor made declaration for the monitoring observatory for the security of the doctors, for lack of interest for 5 of them or the ignorance of its existence for 10 on 32 practitioners having undergone an aggression after the creation of the monitoring observatory. CONCLUSION: We observed an under-reporting of the attacks or of the infringements on the properties by the doctors victims. Our study did not highlight difference between men and women.

[Physician assessment of aptitude for driving in the European Union]. / Évaluation médicale de l'aptitude à la conduite automobile au sein de l'Union européenne.

Road safety is for several years a major public health issue, given the number of casualties and annual deaths caused by road accidents in France or Europe. European directives of 2006 and 2009 were aimed harmonized community practices for the conduct, including medically. We studied the laws in force in each of the 28 countries of the European Union to make an inventory of the organization on this subject. The results showed that 25 countries introduce, at least once, including 21 medical check regularly. Age is the main factor that motivates control. The frequency of examinations increases with the age of the driver. In other countries, a sworn statement of the absence of pathology is enough. Although a medical examination is mostly carried out systematically, it the content is extremely variable, ranging from a simple vision test to a full review with psycho test. Management of professional secrecy is approached differently in different countries, although predominantly an exemption exists in the event of discovery of the inability of a patient. We note that there is a great diversity in the medical screening modalities unsuited to driving. These systems will be harmonized to comply with the wishes of European directives.

[Role of the medical officer for the assessment of driving ability. Practical aspects, liability and confidentiality]. / Rôle du médecin agréé pour l'évaluation de l'aptitude à la conduite. Aspects pratiques, responsabilité et secret médical.

Every candidate for a driving license or any driver who meets a health problem must, on its own initiative, to submit to a medical examination. The list of approved doctors is available in the prefectures. There is a list of medical conditions that are incompatible with the licensing or involve restrictions on the use of the license. The treating physician is not authorized to carry out the assessment of medical fitness to drive for his own patients. This is the prefect who decides after consulting a licensed physician or medical committee composed of licensed doctors. If it deems medically necessary, the medical consultant outside medical commission may request the person to be summoned before the primary medical committee whose jurisdiction is then substituted for his. Possible advice is: fitness, temporary fitness, fitness subject to the license restrictions on use, or the inability of the candidate or driver to drive vehicles of the requested class. We emphasize the absence of shared secret between the attending physician and the medical officer or the Medical Committee.

[Forensic aspect of acute drunkenness]. / Aspects médico-légaux de l'ivresse éthylique aiguë.

Alcohol consumption in itself is not forbidden in France. Two situations are reprehended by the law: public drunkenness - where only the behavior is sanctioned and not the alcohol level - and driving with a level of alcohol superior to 0.5g per liter. The management of a severe state of drunkenness - even though frequent - is on the one hand poorly managed and on the other hands badly mastered by doctors. The management of drunken patients lies essentially in a strong monitoring of the possible complications. The inherent question of the returning-back-home for a drunken patient should be approached according to the state of consciousness rather than the alcohol rate in the blood. No matter what the rate is, the authorization to release a patient depends on the preservation of his judgmental capacities. If those are altered, the doctor can then decide to keep - even against his will - the patient temporarily and until he has recovered his discernment. Patients still keep their right to refuse any medical treatment. Indeed, the law does not provide any answer concerning the particular issue of the refusal of medical care by the patient, especially in case of a severe alcoholic intoxicated state that let the patient incapable to express his will and to understand the range of the given information. There is no legal measure that can able a doctor to firmly forbid a drunk patient to be released and to take the wheel. Doctors have to try to dissuade them by proposing other alternatives but they cannot physically oppose themselves to the patient decision. However, proofs that the doctor tried his best to convince the patient not to drive while under the influence of alcohol can be demanded. Doctors have the duty to inform patients on every risk that alcohol can bring while driving but do not have any measure of pressure.

Finding a balance between patients' rights, responsibilities and obligations.

Patients' rights have developed over recent decades in many countries, resulting in improved access to high quality medical care. The alliance between patients and physicians is a moral obligation, backed up by patient rights. Poor patient compliance with medical recommendations constitutes a public health issue, illustrating the difficulty of obliging patients to comply with treatment. The legal recognition of patients' responsibilities is defined in a few legislative and regulatory texts, but is primarily based on jurisprudence. Patients, who despite being fully aware and informed about the risks adopt a behaviour that is harmful to their health, tend to be considered as being irresponsible. This judicial approach raises a number of questions, as it fails to take into account the complexity of the human factors involved in a behaviour with either positive or negative health effects.

The precautionary principle: is it safe.

The precautionary principle is generally acknowledged to be a powerful tool for protecting health but it was originally invoked by policy makers for dealing with environmental issues. In the 1990s, the principle was incorporated into many legislative and regulatory texts in international law. One can consider that the precautionary principle has turned into "precautionism" necessary to prove to the people, taking account of risk in decisions. There is now a risk that these abuses will deprive the principle of its meaning and value. When pushed to its limits, the precautionary principle can even be dangerous when applied to the healthcare field. This is why a critical analysis of the principle is necessary. Through the literature, it sometimes seems to deviate somehow from the essence of the precautionary principle as it is commonly used in relation to health. We believe that educational work is necessary to familiarize professionals, policy makers and public opinion of the precautionary principle and avoid confusion. We propose a critical analysis of the use and misuse of the precautionary principle.

[Possession of weapon and hunting license: the role of the physician]. / Détention d'armes et permis de chasser: rôle du médecin.

In France, the physician can inform the prefect that a patient, detaining weapon and followed for a pathology (psychiatric notably), is dangerous. Then, it comes back to the prefect to appreciate the appropriate measurements to take, notably to order the delivery of weapon and ammunitions. In France, the doctor can be solicited to establish the necessary medical certficates during requests of approval or acquisition and having guns for hunting and sports shooting, or to obtain the licence of hunting. The acquisition and the possession of certain weapon cannot be granted if the applicant is a protected person over 18, was or is hospitalized, without his consent, owing to mental disturbances or, is in a physical or psychical state apparently incompatible with the possession of weapon. But it appears that the access to this information by the prefects is made difficult by the absence of files centralizing these data. Question settles to institute an automated national file of hospitalizations under pressure, which could be consulted prior to the deliverance or the approval of possession of weapon for hunting and as sports shooting. In our opinion, this should be made, in a strictly supervised manner, through a sworn doctor, systematically solicited as part of the licence of hunting and licence of shooting, to liberate the family practitioners of an expertise role.

[Effectiveness of histopathologic examination in a series of 400 forensic autopsies]. / Intérêt de l'analyse anatomopathologique dans une série de 400 autopsies médicolégales.

OBJECTIVES: To assess the usefulness of histopathologic examination in forensic autopsies. MATERIAL AND METHODS: All consecutive pathological reports and slides from forensic autopsies performed in our department since 2006 have been reviewed. RESULTS: Four hundred forensic necropsies were reviewed. In only 150 cases (38%), pathologists had data about manner of death and gross autopsy findings. Major diagnoses, related to death, and unsuspected by forensic pathologists, were discovered in 83 cases (21%): in 48 cases (12%) gross examination of the heart, lungs and liver showed gross diagnoses missed by the forensic pathologists, and in only 35 cases (9%) microscopic examination revealed a major unsuspected diagnosis (in brain, heart, lungs, liver, kidney and pancreas specimens). In 213 cases (53%), histopathologic examination confirmed gross autopsy findings and allowed to date some wounds. In 104 cases (26%), microscopic examination was not contributory. CONCLUSION: Microscopic examination revealed major diagnoses in less than 10% of forensic autopsies. Its effectiveness is limited for homicides and suicides. Systematic microscopic examination of numerous organs is often useless and should be limited to cases with no anatomic causes of death. Our study emphasizes the need for a better communication between forensic pathologists and histopathologists, and for a better training of some forensic pathologists for gross examination.

[Practical questions around individual with a pacemaker or an implantable cardioverter defibrillator]. / Patients implantés d'un stimulateur cardiaque: questions pratiques.

An individual with a pacemaker can ask his GP for information about potential problems associated with the device. Should a pacemaker continue to be used by end-of-life patients? Should a pacemaker be stopped in a limited care situation? What precautions should be taken when treating a patient with a pacemaker? Pacemakers and implantable defibrillators are sensitive to electromagnetic interference (EMI). Medically, MRIs are theoretically contraindicated, even though examinations could be performed without a major problem, and special precautions should be taken when using an electrosurgical cutter or radiotherapy. In case of death, a doctor or embalmer must remove the patient's pacemaker due to its risk of explosion during cremation. Doctors who sign cremation forms have a legal obligation to provide such information. It may affect an employee's ability to work. Are there some professions that are not well suited for individuals with a pacemaker?

[Identifying psychoactive substance use among new prison detainees]. / Repérage des détenus admis en maison d'arrêt ayant des consommations de substances psychoactives.

Consumption of psychoactive substances is widespread among prison detainees. This represents not only a public health problem but also a barrier to rehabilitation. Too few resources are devoted to this issue in France. We conducted a pilot study of psychoactive substance use among new prison entrants, in order to guide their therapeutic management. Tobacco, alcohol, cannabis, opiates and medicinal drugs were used daily by respectively 81%, 29%, 23%, 14% and l3% of study participants. Brief interventions targeted users of tobacco (92%), alcohol (25%), cannabis (65%), cocaine (67%) and opiates (56%)? These results encourage us to systematically identify substance use among new detainees in order to offer optimal support aimed and to facilitate their rehabilitation. Given the lack of specialized care, brief interventions may be an interesting option but they must be adapted to the specificities of this population.

Obesity surgery: French medico-legal aspects.

The demand for bariatric surgery is expected to increase. It is a procedure that carries a high surgical risk, and a risk of postoperative complications due to the pathologies associated with obesity. Obesity surgery is not classified as plastic surgery, but may subsequently lead to plastic surgery-type operations. Malpractices in the field of obesity surgery are most frequently at the pre-operative stage. In the absence of any fault, a patient may obtain indemnification by "national solidarity". Physicians and surgeons have an obligation to be able to prove that they informed their patients properly.

[Public health law in practice: violence and health in Picardy]. / De la loi de santé publique à l'expérimentation "Violence et santé" en Picardie.

Violence is too often considered an inevitable part of human existence. Physical, psychological and behavioural trauma has an impact not only on the health of the individual but also on the healthcare system. Largely perceived as a social problem, violence is also a public health issue. Promoted by the World Health Organisation and developed in France by Prof Henrion, the National Authority for Health and the mission led by Dr. Tursz, the public health dimension of "Violence and health" is now better defined. The Public Health law of 2004 provided for a national plan on "Violence and Health". After an initial action study, we developed a tool to coordinate public actions in this field. The group "For health, against violence in Picardy" was created to implement expert recommendations by building knowledge, promoting training and networking, and developing services to support and guide victims of violence.

["Violence and health": an autopsy of a public health plan]. / "Violence et santé", autopsie d'un plan de santé publique.

The law provides for an evaluation and a five-year review of the French Public Health Act. Among its five strategic plans, the law of August 9, 2004 provided for a "national plan to limit the health impact of violence, risk behavior and addictive behavior." Under the impetus of the World Health Organization's World Report on Violence and Health in 2000, a rich reflection was conducted in France on this issue establishing some key axes for implementation. Although we can link several actions related to this field within the framework of specific policies since 2004 (road violence, addictions, violence against women, etc.), we note that a plan on violence and health has not emerged. The lack of enforcement and application of this part of the law raises questions about the quality of the law as well as the in the role and place for the theme "violence and health" in an upcoming law.

[The gift of the body to science]. / Le don du corps à la science.

We detailed the practical methods of gift of the body and the functioning of the centers of gift of the body in France. The gift of the body is an ignored step, lacking a clear legal framework, which explains partly the disparities of operation noted within the various centers concerned. The doctors must be able to inform the patients and their families about the methods of the gift of the body.

[Compensation of victims of nosocomial or post-transfusion hepatitis C virus infection]. / Indemnisation des hépatites C d'origine nosocomiale ou transfusionnelle.

The purpose of this review is to inform physicians about the procedures for compensation of victims of nosocomial or post-transfusion hepatitis C virus infection. The different procedures are described in reference to the legislation and regulations. According to the law dated March 4, 2002 if Hepatitis C is contracted during care, in a private or public hospital, the hospital (and not the physician) is responsible for the damages resulting from the nosocomial infection, except if evidence of another cause is provided. For post-transfusion hepatitis C, the patient must show that a transfusion took place prior to the diagnosis of hepatitis C. The patient must also prove that there were no other sources of infection. The French Institute of Blood can sometimes not be held responsible by proving that none of the donors of the transfused blood were infected with the hepatitis C virus. This is a no fault system. Different examples of litigation show the important role of physicians, who must be aware of the main points of the procedures to better understand what is entailed by the medical certificates which the victim may request and also to provide him with any other steps to be taken to obtain compensation.