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4.
Sante Publique ; 26(5): 639-45, 2014.
Artigo em Francês | MEDLINE | ID: mdl-25490223

RESUMO

INTRODUCTION: In France, the challenges of replacing departing psychiatrists with a new generation are compounded by an increased demand for psychiatric care, which threatens the accessibility of health care, particularly in rural and semi-rural areas. The objective of this study was to describe the location of psychiatrists trained in the Franche-Comté region, and to analyze the factors associated with establishing their practice in the region, particularly in the most understaffed areas. METHODS: We conducted a retrospective observational study, completed by a qualitative investigation with semi-directive interviews with psychiatrists and psychiatry residents. RESULTS: Between 1994 and 2013, 160 students entered psychiatry residencies in Franche-Comté. As of October 2013, 87 of them were full-time psychiatry practitioners and, 57% of them worked in Franche-Comté. The region of practice was associated with their birthplace (p=0.03). The qualitative investigation showed that, apart from family- and quality of life-related factors (work opportunities for the spouse, family closeness, desire to live in urban areas), opportunities to work in a team, implementation of dynamic and innovative projects and values of the establishment were also considered when choosing a site of practice. CONCLUSION: While the current increase in the number of psychiatry residents may respond, in the long run, to health care demographic problems in Franche-Comté, more specific interventions also seem necessary. Creation of time-shared jobs, facilitating the establishment of psychiatric practices within multidisciplinary clinics, task shifting and telemedicine may allow improvement of the psychiatric care offered in Franche-Comté.


Assuntos
Acesso aos Serviços de Saúde , Internato e Residência/estatística & dados numéricos , Médicos/provisão & distribução , Psiquiatria , Adulto , Feminino , França , Humanos , Masculino , Área de Atuação Profissional , Qualidade de Vida , Estudos Retrospectivos , Serviços de Saúde Rural/organização & administração , Serviços de Saúde Rural/provisão & distribução , Estudantes de Medicina/estatística & dados numéricos , Recursos Humanos , Adulto Jovem
5.
Sante Publique ; 26(4): 433-41, 2014.
Artigo em Francês | MEDLINE | ID: mdl-25380258

RESUMO

INTRODUCTION: The St Claude multidisciplinary health centre in Besançon encouraged the creation of a consumer representatives committee to promote health democracy in primary health care. This project was developed with the help of a local consumers association. This study evaluated the perception and expectations of these fifteen health users/citizens. METHODS: A qualitative study based on individual semistructured interviews was carried out before initiation of the project. RESULTS: The results highlight the motivation and sense of initiative of the participants in this innovative project, who wish to discuss a wide range of topics. These topics were compared to the health centre's health project. Four common themes emerged: maintenance at home for the elderly, management of urgent consultations in the health centfre, prevention and information. These themes were used to guide the formation of this consumer group. The limitations defined by the consumers were also taken into account to ensure durability of the project. This study identified several markers: the original modality of identification of representatives, the themes shared with professionals, the proposed method of structuring activities. DISCUSSION: These preliminary observations and orientations could be used by other organizations to facilitate the creation of a group of consumer representatives.


Assuntos
Equipe de Assistência ao Paciente , Participação do Paciente , Atenção Primária à Saúde , Feminino , França , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino
6.
Sante Publique ; 26(4): 469-74, 2014.
Artigo em Francês | MEDLINE | ID: mdl-25380261

RESUMO

The French "Hospitals, patients, health and territories" law of July 2009 created the Regional Health Project (PRS) to support regional health policy, and requires evaluation of these projects. The construction of these projects, which includes prevention planning, care planning, and medical and social welfare planning, presents an unprecedented complexity in France, where evaluation programmes are still in their infancy. To support future evaluations, the Franche-Comté Regional Health Agency (ARS FC), assisted by the expertise of EFECT Consultants, decided to reconstruct the PRS logic model. This article analyzes the advantages and limitations of this approach. The resulting logic model allows visualization of the strategy adopted to achieve the Franche-Comté PRS ambitions and expected results. The model highlights four main aspects of structural change to the health system, often poorly visible in PRS presentation documents. This model also establishes links with the usual public policy evaluation issues and facilitates their prioritization. This approach also provides a better understanding of the importance of analysis of the programme construction in order to be effective rather than direct analysis of the effects, which constitutes the natural tendency of current practice. The main controversial limit concerns the retrospective design of the PRS framework, both in terms of the reliability of interpretation and adoption by actors not directly involved in this initiative.


Assuntos
Modelos Organizacionais , Avaliação de Programas e Projetos de Saúde/métodos , Programas Médicos Regionais , França , Política de Saúde , Humanos , Regionalização
8.
Pediatr Transplant ; 18(1): 35-41, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24384046

RESUMO

Increased focus on the potential negative side effects of steroid usage in pediatric transplantation has led to steroid minimization or steroid-free transplantation. In this study, we report results after complete steroid avoidance in renal transplantation in the period 1994-2009. We evaluate the effects of complete steroid avoidance on allograft function, BMI, and linear growth. The majority of transplanted children were induced with antithymocyte globulin and immunosuppressed with a calcineurin inhibitor and mycophenolate mofetil. Steroids were given only when rejection occurred or due to comorbidities. Anthropometric data were collected from 65 transplantations in 60 children. Patient survival was 93%; graft survival was 81% after five yr (N = 42) and 63% after 10 yr (N = 16). Acute rejection within the first year of transplantation was 9%. The distribution of the children's BMI before transplantation was normal; the mean BMI-SDS was 0.21 before transplantation, and this value remained stable during the next five yr. Post-transplantation the children demonstrated significant improved growth as the mean height-SDS increased significantly from -1.7 to -1.1. Catch-up growth was most pronounced in the youngest (< six yr). Steroid-free immunosuppression in pediatric renal transplantation is safe and protects against steroid-induced obesity and short stature.


Assuntos
Sobrevivência de Enxerto , Transplante de Rim/métodos , Insuficiência Renal/mortalidade , Insuficiência Renal/terapia , Esteroides/efeitos adversos , Adolescente , Antropometria , Soro Antilinfocitário/uso terapêutico , Índice de Massa Corporal , Inibidores de Calcineurina , Criança , Pré-Escolar , Feminino , Taxa de Filtração Glomerular , Humanos , Imunossupressores/uso terapêutico , Lactente , Masculino , Ácido Micofenólico/análogos & derivados , Ácido Micofenólico/uso terapêutico , Obesidade/complicações , Estudos Retrospectivos , Resultado do Tratamento
9.
Sante Publique ; 25(2 Suppl): s101-9, 2013.
Artigo em Francês | MEDLINE | ID: mdl-24313069

RESUMO

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.


Assuntos
Órgãos Governamentais , Educação em Saúde/organização & administração , França , Humanos , Saúde Pública , Inquéritos e Questionários
10.
Sante Publique ; 24(2): 91-2, 2012.
Artigo em Francês | MEDLINE | ID: mdl-22789114
12.
Soins ; (752): 20-3, 2011.
Artigo em Francês | MEDLINE | ID: mdl-21449180

RESUMO

Community health centres are part of a movement to organise primary healthcare promoted by the "Hospital, patients, health and territories" law. These structures are the result of a long process involving health professionals, brought together around a single project. The health centres facilitate new forms of organisation of the healthcare provision such as therapeutic education and new protocols for cooperation between health professionals.


Assuntos
Centros Comunitários de Saúde/organização & administração , Programas Nacionais de Saúde/organização & administração , Atenção Primária à Saúde/organização & administração , França , Humanos , Objetivos Organizacionais
13.
Dan Med Bull ; 57(10): A4197, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21040684

RESUMO

INTRODUCTION: Kidney transplantation is the optimal treatment for many patients with end-stage renal disease (ESRD). Due to shortage of donor kidneys in Denmark, there is a need to expand the possibilities for donation. At the Odense University Hospital (OUH), we have introduced ABO-incompatible kidney transplantation. We used antigenspecific immunoadsorptions to remove blood group antibodies and anti-CD20 antibody (rituximab) to inhibit the antibody production. The aim of introducing the ABO-incompatible kidney transplantation at the OUH was to increase the rate of living donor kidney transplantation without increasing rejection or mortality rates. MATERIAL AND METHODS: Retrospective evaluation. Eleven patients received ABO-incompatible kidney transplantation. The patients were followed for 3-26 months. RESULTS: One patient had an antibody-mediated rejection, one patient suffered T-cell-mediated rejection, and one patient died of myocardial infarction with a functioning graft on the third post-operative day. Both rejections were treated effectively. Among the patients, the average serum creatinine level was 128 micromol/l. CONCLUSION: The rejection and mortality rates for ABO-incompatible kidney transplantation at the OUH are similar to the results from ABO-compatible kidney transplantations performed at the OUH and at other hospitals.


Assuntos
Sistema do Grupo Sanguíneo ABO , Incompatibilidade de Grupos Sanguíneos/imunologia , Falência Renal Crônica/cirurgia , Transplante de Rim/métodos , Adulto , Idoso de 80 Anos ou mais , Anticorpos Monoclonais Murinos/uso terapêutico , Antígenos CD20/imunologia , Incompatibilidade de Grupos Sanguíneos/sangue , Creatinina/sangue , Dinamarca , Feminino , Rejeição de Enxerto , Humanos , Fatores Imunológicos/uso terapêutico , Imunossupressores/uso terapêutico , Falência Renal Crônica/sangue , Falência Renal Crônica/mortalidade , Masculino , Pessoa de Meia-Idade , Ácido Micofenólico/análogos & derivados , Ácido Micofenólico/uso terapêutico , Estudos Retrospectivos , Rituximab , Tacrolimo/uso terapêutico
15.
Sante Publique ; 21 Spec No 1: 5, 2009 Mar 29.
Artigo em Francês | MEDLINE | ID: mdl-20441646
17.
19.
Sante Publique ; 19(4): 303-11, 2007.
Artigo em Francês | MEDLINE | ID: mdl-17933382

RESUMO

Therapeutic patient education (TPE) constitutes a new type of prevention and care being offered in France. This article presents a review of its current organisation and status within the country. The work was carried out based upon a questionnaire targeted towards all of the Regional Social Insurance Registry Unions (URCAM). Nearly all of the regions are supported and served by a regional advisory group which most often times facilitated by a representative from the social health insurance office. The development of TPE is situated and structured, for the most part, within the regional public health policy. Training which is specifically targeted for health professionals remains quite erratic. The hospital continues to play an important role and is a driving force, along with the health care networks, in the development of TPE. The close involvement and participation of the general family practitioner and the organisation of high quality, comprehensive care options (through the dissemination of defined criteria and specifications) are the priority areas for action.


Assuntos
Educação de Pacientes como Assunto/organização & administração , Medicina de Família e Comunidade , França , Pessoal de Saúde , Política de Saúde , Hospitais , Humanos , Educação de Pacientes como Assunto/métodos , Projetos Piloto , Saúde Pública , Previdência Social , Inquéritos e Questionários
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