Sante Publique最新文献

{"title":"Rédaction d’un modèle de directives anticipées approprié pour les femmes atteintes d’un cancer du sein : méthode Delphi.","authors":"Bernard Frèche, Axelle Martinet, Yaritza Carneiro, Marc Besnier, Élodie Poupin","doi":"10.3917/spub.262.0203","DOIUrl":"10.3917/spub.262.0203","url":null,"abstract":"<p><strong>Introduction: </strong>Breast cancer, the most common cancer in women, also affects young women. Advance directives allow individuals to express their end-of-life wishes, but they are often poorly drafted. General practitioners report significant difficulties in discussing end-of-life issues.</p><p><strong>Purpose: </strong>This study aims to propose a model of advance directives that facilitates dialogue between physicians and breast cancer patients.</p><p><strong>Methods: </strong>The model was developed through a Delphi consensus among 21 experts. The Delphi process consisted of three rounds. The panel of experts consisted of health care professionals working with breast cancer patients, a doctor of sociology, the deputy director of the National Center for Palliative Care and End-of-Life Care, and a former cancer patient who is president of an association. The resulting model integrates patients' moral values, care preferences, and social environment in a more personalized manner.</p><p><strong>Results: </strong>The first round lasted three weeks. Of 29 questions, 20 were rated relevant by over 70% of experts. The second round lasted four weeks, during which nine reworded questions were addressed, and eight were validated. The final question was validated in the third round. All experts participated in all three rounds.</p><p><strong>Conclusion: </strong>The proposed model serves as a tool to foster more effective communication between physicians and patients, aiming to faithfully reflect patients' wishes regarding end-of-life care.</p>","PeriodicalId":49575,"journal":{"name":"Sante Publique","volume":"38 2","pages":"203-215"},"PeriodicalIF":0.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147989624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autohypnose et santé mentale des étudiants en odontologie : étude prospective.","authors":"Mathilde Mialon, Emma Sturaro, Thibault Canceill, Mathieu Marty, Géromine Fournier, Franck Diemer","doi":"10.3917/spub.262.0065","DOIUrl":"10.3917/spub.262.0065","url":null,"abstract":"<p><strong>Objective: </strong>This prospective study examined changes in the mental health of dental students in Toulouse during the 2021&amp;#8211;2022 academic year and the impact of optional self-hypnosis training.</p><p><strong>Method: </strong>The entire second-year cohort (n = 103) was included on the basis of voluntary participation. The 27 participants who completed the training and the 76 non-participants formed two groups. Data were collected using two questionnaires administered in the first and second semesters. These included measures of mental health using PHQ-9 (depression) and GAD-7 (anxiety) scores, sociodemographic information, and assessments of stress and motivation.</p><p><strong>Results: </strong>Overall stress decreased significantly between semesters, particularly stress related to lectures, practical work, and examinations. Overall depression and anxiety scores improved modestly. The self-hypnosis group had higher baseline scores, likely due to over-representation of women and students from the License track. Despite these quantitative findings, 68% of self-hypnosis participants reported perceived benefits and provided positive feedback on the experience.</p><p><strong>Conclusion: </strong>These findings highlight the need for future research with long-term follow-up to more precisely evaluate the effectiveness of self-hypnosis and other wellbeing interventions in this demanding university course.</p>","PeriodicalId":49575,"journal":{"name":"Sante Publique","volume":"38 2","pages":"65-76"},"PeriodicalIF":0.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147989843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Boire.","authors":"E Gnansia","doi":"10.3917/spub.261.0219","DOIUrl":"https://doi.org/10.3917/spub.261.0219","url":null,"abstract":"","PeriodicalId":49575,"journal":{"name":"Sante Publique","volume":"38 1","pages":"219-220"},"PeriodicalIF":0.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Freins d’accès aux services de santé en Polynésie française : approche qualitative.","authors":"Lauriane Dos Santos, Alice Servy","doi":"10.3917/spub.261.0157","DOIUrl":"https://doi.org/10.3917/spub.261.0157","url":null,"abstract":"<p><strong>Introduction: </strong>Accessibility to biomedical services is a complex challenge in French Polynesia. The territorial configuration of multiple dispersed islands, combined with the centralization of specialized care pathways in Tahiti, or beyond, entails mobility that can be constraining and exacerbate inequalities in access.</p><p><strong>Aim of the study: </strong>In this context, the article seeks to identify the different types of constraints faced by users throughout their care pathways in French Polynesia, based on a qualitative and inductive approach centered on their ordinary experience.</p><p><strong>Results: </strong>The methodological approach we have adopted made it possible to analyze users&amp;#8217; experiences regarding the accessibility of healthcare services and to identify a plurality of constraints, both structural and relational, influencing access to biomedical care. The (sometimes prolonged or repeated) distance from home for therapeutic purposes entails variable costs and constraints for users residing outside the Papeete urban area. They are required to mobilize different private resources (family relationships, economic capital) to offset these constraints and cover needs not supported by the social protection system, particularly in order to access specialized services. Individuals with the least economic and social resources may forgo biomedical care due to the lack of accommodation solutions at the place of treatment or the excessive costs associated with their stay. Family relationships emerge as an important condition for both the use and non-use of healthcare services in French Polynesia, but their role is ambivalent&amp;#8212;sometimes facilitating, sometimes hindering access.</p><p><strong>Conclusions: </strong>Economic resources and family relationships constitute social determinants of access to biomedical services in French Polynesia and may lead users to forego care.</p>","PeriodicalId":49575,"journal":{"name":"Sante Publique","volume":"38 1","pages":"157-166"},"PeriodicalIF":0.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148669688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Profil des dysfonctions sexuelles féminines et de l’insatisfaction sexuelle de couple au Bénin.","authors":"Jean-Baptiste Linsoussi, Nouessewa Fanny Maryline Hounkponou Ahouingnan, Jacques Zinsou Saizonou, Mariane Gloria Koty","doi":"10.3917/spub.261.0189","DOIUrl":"https://doi.org/10.3917/spub.261.0189","url":null,"abstract":"<p><strong>Introduction: </strong>The taboo surrounding sexuality in Benin silences most women experiencing significant difficulties in their sexual and intimate relationships.</p><p><strong>Objective: </strong>To determine the profile of sexual dysfunctions and sexual dissatisfaction within couples among women in Benin.</p><p><strong>Methods: </strong>This descriptive cross-sectional study with an analytical component was conducted from September to December 2022 and included 1,531 women of childbearing age in the municipalities of Djougou, Parakou, Abomey-Calavi, and Porto-Novo in Benin. The Female Sexual Function Index and an adapted version of the Sexual Satisfaction Index were used to assess women&amp;#8217;s sexual dysfunction and their sexual satisfaction within their relationships, respectively. A Chi-square test with a 5% significance level was applied to compare results across the selected municipalities.</p><p><strong>Results: </strong>The exploration of the sexual function among the women surveyed revealed dysfunctions in several domains: pain (99.93%), arousal (83.31%), orgasm (73.02%), satisfaction (69.63%), and desire (66.69%). Overall, 62.18% of women were dissatisfied with their personal sexuality. This dissatisfaction was more prevalent among women surveyed in Parakou (76.33%) than in Porto-Novo (54.70%) (p-value=0.00). Sexual dissatisfaction within couples affected 20.31% of the women surveyed. It was more common among women in the municipality of Abomey-Calavi (37.10%) and less common among those in Parakou (3.99%) (p-value=0.00).</p><p><strong>Conclusion: </strong>Sexual dysfunction was highly prevalent in the study population. However, these sexual difficulties do not necessarily lead to sexual dissatisfaction among women.</p>","PeriodicalId":49575,"journal":{"name":"Sante Publique","volume":"38 1","pages":"189-206"},"PeriodicalIF":0.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Santé orale et grande précarité : analyse des Permanences d’Accès aux Soins de Santé (PASS) bucco-dentaires.","authors":"Chloé Patin, Philippine Coz, Antoine Couatarmanach","doi":"10.3917/spub.261.0137","DOIUrl":"https://doi.org/10.3917/spub.261.0137","url":null,"abstract":"<p><strong>Introduction: </strong>The healthcare system struggles to include people in situations of extreme social precariousness, particularly regarding oral health. The Permanences d&amp;#8217;acc&amp;#232;s aux soins de sant&amp;#233; bucco-dentaires (&amp;#8220;PASS Bucco-dentaires&amp;#8221;&amp;#8212;dental care units dedicated to socially precarious populations) aim to provide care for those most excluded from the healthcare system.</p><p><strong>Aim: </strong>This study sought first to identify all existing &amp;#8220;PASS bucco-dentaires&amp;#8221; structures across mainland France and then to analyze how they operate. Two data collection methods were used: a telephone-administered questionnaire completed by the managers of these units, and an analysis of the available activity reports.</p><p><strong>Results: </strong>Fifty-one &amp;#8220;PASS bucco-dentaires&amp;#8221; were identified and mapped in France. Data were collected for 36 structures (70.5% of all units in mainland France). The results reveal wide diversity in administrative organization, access procedures, patient volume, and scope of care. Most facilities are attached to public hospitals (n=31, 86.1%), serve fewer than 500 patients per year (n=21, 58.3%), and do not provide prosthetic treatments (n=27, 75%).</p><p><strong>Conclusions: </strong>The &amp;#8220;PASS bucco-dentaires&amp;#8221; display heterogeneous organizational models across France. This study provides the first comprehensive overview of their diversity and serves as a basis for reflection on the structuring and development of this healthcare offer.</p>","PeriodicalId":49575,"journal":{"name":"Sante Publique","volume":"38 1","pages":"137-145"},"PeriodicalIF":0.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"État des lieux, en Fédération Wallonie-Bruxelles, de l’implication des patients dans les dispositifs pédagogiques infirmiers.","authors":"Catherine Dans, Isabelle Aujoulat, Franck Manzoni, Isabelle Bragard","doi":"10.3917/spub.261.0147","DOIUrl":"https://doi.org/10.3917/spub.261.0147","url":null,"abstract":"<p><strong>Introduction: </strong>While the importance of involving patients at various levels of healthcare systems is increasingly acknowledged, their participation in the training of healthcare professionals&amp;#8212;particularly nurses&amp;#8212;remains under-documented.</p><p><strong>Aim of the study: </strong>This study aims to explore patient involvement in the training of nurses within non-university higher education institutions in the Wallonia-Brussels Federation (Belgium). The objectives are (i) to describe the forms of patient involvement identified in nursing education programs, and(ii) to understand the conditions that influence this involvement.</p><p><strong>Methodology: </strong>This is an exploratory and descriptive qualitative study based on semi-structured interviews with educators who integrate patients into their teaching practices.</p><p><strong>Results: </strong>Ten out of the 11 institutions offering nursing programs in the Wallonia-Brussels Federation involve patients in 21 educational initiatives. Interviews with 24 educators revealed that, in most cases, patient involvement remains relatively limited. The modes of collaboration and patient training often rely on the intervention of a third party. Although institutional support is generally present, few financial resources are allocated to this type of teaching. The status of patients and the preparation of both patients and educators for collaboration are rarely formalized.</p><p><strong>Conclusion: </strong>Patient involvement in nursing education largely depends on the personal commitment of individual educators. There is a need for further reflection on the resources and training necessary to support effective collaboration between patients and educators.</p>","PeriodicalId":49575,"journal":{"name":"Sante Publique","volume":"38 1","pages":"147-156"},"PeriodicalIF":0.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Répondre par une action territoriale et avec des patients-partenaires à un défi de santé lié aux addictions.","authors":"Alexandre Berkesse, Beryl-Alice Vigy, Loïc Ropars, Anthony Prod'homme, Anthony Violeau","doi":"10.3917/spub.hs1.2026.0181","DOIUrl":"https://doi.org/10.3917/spub.hs1.2026.0181","url":null,"abstract":"<p><strong>Introduction: </strong>In a context in which institutions recommend addressing health challenges through patient engagement, we have chosen to develop and pilot a territorial support unit dedicated to recovery from addiction, in partnership with people directly affected by addictive disorders.</p><p><strong>Method: </strong>To co-design and experiment this unit, strategic hypotheses (regarding criteria for identifying patient partners, methods, etc.) were explicitly formulated to assess their alignment with best practice recommendations and their relevance in practice. To identify and characterize learnings, qualitative interviews were conducted after each support session led by patient partners. In addition, a Socratic dialogue approach was used to foster awareness and articulation of experiential knowledge&amp;#8212;both in supporting service users and in collaboration with professionals.</p><p><strong>Results: </strong>This project led to the development and pilot implementation of a territorial support unit dedicated to addiction recovery pathways, and showed that a pragmatic, iterative approach can effectively address the complexity of territorial health challenges. It also provided an opportunity to identify and articulate experiential knowledge mobilized by patient-partners in supporting peers and engaging with professionals. Finally, analysis of project enabled the identification of five key success factors for implementing a health partnership initiative.</p><p><strong>Discussion: </strong>The key success factors identified in this project align with current national recommendations on patient engagement. Moreover, the findings open up new avenues for research, particularly regarding the articulation and integration of professionals&amp;#8217; experiential knowledge with that of patient-partners, the impact of patient-partners on recovery outcomes, and the transferability of this model to other health challenges.</p><p><strong>Conclusion: </strong>Through its territorial anchoring and the high level of engagement of patient-partners throughout the project&amp;#8211;from framing the territorial challenge to co-authoring this article&amp;#8212;this work represents an encouraging experience for health democracy. Beyond the success of this pilot project, which has since secured financial support, this article highlights how such partnership-based initiatives can foster collective empowerment, transform professional practices, and accelerate the professionalization pathways of the patient-partners involved.</p>","PeriodicalId":49575,"journal":{"name":"Sante Publique","volume":"38 HS1","pages":"181-199"},"PeriodicalIF":0.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Santé mentale des minorités sexuelles et de genre : les initiatives communautaires au cœur de la réponse de santé publique.","authors":"Leceo Havard, Rose Babin MacKenzie, Sasha Géhin, François Berdougo, Laszlo Blanquart, Bruno Brive, Max Cressent, Timothée Delescluse, France Frigot, Noémie Pillas, Giovanna Rincon, Gabriel Girard","doi":"10.3917/spub.hs1.2026.0011","DOIUrl":"https://doi.org/10.3917/spub.hs1.2026.0011","url":null,"abstract":"<p><p>This article aims to highlight the scope of community-led interventions in LGBTQI+ mental health promotion, and to emphasize the importance of analyzing tensions between community health and public health policies. Sexual and gender minorities represent populations that are particularly vulnerable to psychological distress, while simultaneously being hesitant to seek out healthcare services due to fears of stigma or inadequate support. Faced with this reality, LGBTQI+ communities have historically come together to develop community-led peer support tools tailored to their specific needs, despite limited material resources and a hostile international political context. By operating at the forefront of these challenges, they serve as essential intermediaries in identifying mental health issues among LGBTQI+ populations, establishing foundational solutions, and driving systemic improvements through partnerships with healthcare professionals and institutions. However, the vulnerability of grassroots organizations can lead to exhaustion and burnout among its actors, who often lack formal training in mental health matters. The article concludes that public mental health policies must actively incorporate and financially support LGBTQI+ community- led interventions to develop culturally appropriate and socially equitable responses, as these local initiatives represent a critical gateway to public mental healthcare services.</p>","PeriodicalId":49575,"journal":{"name":"Sante Publique","volume":"38 HS1","pages":"11-15"},"PeriodicalIF":0.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Santé mentale publique à la française : les CLSM, figures pionnières d’une gouvernance territoriale participative.","authors":"Ozgür Bilal, Sarah Blanzat, Anaëlle Couillet, Morgane Froux, Aurélia Taprest","doi":"10.3917/spub.hs1.2026.0099","DOIUrl":"https://doi.org/10.3917/spub.hs1.2026.0099","url":null,"abstract":"<p><strong>Introduction: </strong>Local Mental Health Councils (CLSMs) offer a concrete and sustainable example of what public mental health, conceived as a common good, could look like. At the intersection of psychiatry, public health, and health democracy, they embody an intersectoral, territorially grounded, and participatory approach to mental health.</p><p><strong>Methods: </strong>Drawing on a review of their origins, an analysis of policy documents, and empirical examples from Parisian CLSM&amp;#8212;complemented by insights from other regions&amp;#8212;this article proposes viewing CLSMs as empirical and imperfect agents of public mental health in practice. Far from being homogeneous, these mechanisms reflect both local specificities and the effects of the absence of a normative framework.</p><p><strong>Results: </strong>This contribution highlights the structural tensions that hinder their consolidation, particularly with regard to institutional recognition, the sustainability of resources, and the effective participation of people with lived experience.</p><p><strong>Discussion: </strong>Finally, it opens a discussion on the political, organizational, and ethical conditions required for a truly shared territorial governance of mental health.</p>","PeriodicalId":49575,"journal":{"name":"Sante Publique","volume":"38 HS1","pages":"99-104"},"PeriodicalIF":0.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}