Sante Publique最新文献

{"title":"Le territoire vécu comme outil du diagnostic territorial et objet de connaissances en santé.","authors":"Katerina Kononovich, Charlotte de Fontgalland, Jean-Marc Macé","doi":"10.3917/spub.hs1.2025.0009","DOIUrl":"https://doi.org/10.3917/spub.hs1.2025.0009","url":null,"abstract":"<p><strong>Introduction: </strong>Territorial diagnosis is an essential tool for any institutional decision-maker, provided that the study area aligns with the issue being studied. Based on geographical and managerial analyses, this study aims to demonstrate how consumers' territorial experience in health care contribute to modeling knowledge management of population spatial practices in care consumption.</p><p><strong>Methods: </strong>Using health care consumption data from the SNIIRAM, the lived territories of emergency services are defined by relative majority flows; multivariate analysis methods are then applied to produce a typology of these territories. A qualitative analysis is conducted to adapt the MAIKE organizational knowledge management model to these territories.</p><p><strong>Results: </strong>This study identified 451 areas of emergency services use and developed an 18-class typology grouped into three categories. Group 1 comprises areas close to the national average; Group 2 includes favored areas; and Group 3 covers disadvantaged areas, each showing certain variations within the groups.</p><p><strong>Discussion: </strong>Identifying the territory enables the transformation of tacit knowledge into explicit knowledge through the interactive exchanges among the involved actors. Since users' spatial practices often diverge from theoretical models developed by public bodies, this knowledge is crucial for public authorities in planning care services. Knowledge management thus becomes essential for public organizations to effectively pursue their objectives.</p>","PeriodicalId":49575,"journal":{"name":"Sante Publique","volume":"37 HS1","pages":"9-23"},"PeriodicalIF":0.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087787","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":"Prise en charge de la douleur chronique et réseaux ville-hôpital.","authors":"Yves-Marie Pluchon, Eric Chomette, Marc Sorel, Éric Viel, Alexandre Auday, François Sarkozy","doi":"10.3917/spub.hs1.2025.0155","DOIUrl":"https://doi.org/10.3917/spub.hs1.2025.0155","url":null,"abstract":"<p><strong>Introduction: </strong>In France, pain is the leading cause of medical consultations, and chronic pain affects nearly 12 million people. Its management remains delayed, unequal, and often inadequate, with an average wait time of over three years to access specialized services. This delay is due in part to a lack of training among general practitioners, overly siloed medical expertise, and uneven distribution of specialized centers. These factors lead to diagnostic delays, unequal access to care, and a significant societal cost. Innovative regional models, such as the one implemented in Vendée, offer promising avenues for reorganizing care pathways.</p><p><strong>Methods: </strong>The study is based on an analysis of the chronic pain care network in La Roche-sur-Yon (Vendée), coordinated by Dr. Pluchon. This network, linked to the local hospital group GHT85, includes seven local care sites. The analysis was conducted by a national steering committee composed of three heads of CETDs (Chronic Pain Treatment Centers) from diverse contexts. The methodology included interviews with patients, health care professionals, and hospital management, as well as activity data from the PMSI databases. The objective was to identify key success factors, deployment conditions, and the value created for all stakeholders.</p><p><strong>Results: </strong>Between 2018 and 2022, pain management activity at the La Roche-sur-Yon center increased by 58%, and by 59% across nearby sites, while the patient outflow rate dropped by more than 20%. Centralized coordination, a single point of entry for appointments, advanced consultations, and staff mobility helped reduce wait times (in some cases by a factor of 4), improve distribution of resources, and ease access to specialist care-even for patients in remote areas. The model promotes shared protocols, regular regional multidisciplinary meetings (RCPs), and continuous upskilling of local health care providers.</p><p><strong>Discussion: </strong>This innovative regional model brings multiple benefits: reduced inequalities in access, a local network of expertise, more appropriate treatments, decreased diagnostic delays, and medical-economic gains. It offers a concrete response to the shortage of pain specialists and the need for local follow-up. Its success relies on strong coordination, shared tools, collaborative organization, and professional commitment. The model is now being extended to other regions (Sud Seine-et-Marne, Nîmes) through a national pilot program based on common indicators and a shared data platform. The Vendée network illustrates the potential for nationwide reform in chronic pain management.</p>","PeriodicalId":49575,"journal":{"name":"Sante Publique","volume":"37 HS1","pages":"155-166"},"PeriodicalIF":0.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087934","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":"Postures communicationnelles des spécialistes en médecine générale dans le dépistage familial du cancer colorectal.","authors":"Griselda Drouet, Fabienne Moreau, Nicolas Palierne, Pierre Ingrand, Aline Delsart, Elisabeth Richard, Isabelle Ingrand","doi":"10.3917/spub.252.0101","DOIUrl":"10.3917/spub.252.0101","url":null,"abstract":"<p><strong>Introduction: </strong>First-degree relatives (FDRs) of patients with colorectal cancer (CRC) or advanced adenoma before the age of 65 (index patients) are at increased risk of CRC, but the guidelines for family screening of FDRs by colonoscopy are poorly followed. The aim of this study was to describe the involvement of primary care physicians (PCPs) with patients (relatives at high risk of colorectal cancer or index patients) and their communicative stance in the context of family screening in relation to the various people involved (other physicians, index patients, and relatives).</p><p><strong>Method: </strong>The study was based on 29 semi-structured telephone interviews with French PCPs of index patients and/or their FDRs. The fully transcribed corpus of interviews was put through linguistic analysis using a lexicometric tool to identify discourse objects based on frequency calculations, and for the purposes of thematic sociological analysis.</p><p><strong>Results: </strong>The analyses showed that family screening is conditioned by communication between PCPs and index patients, whom they encourage to pass on the guidelines to their relatives, and by conversations with doctors from other specialisms, who provide them with precise information about the diagnosis. FDRs have a more \"classic\" relationship with their PCPs, who ask questions in order to ascertain the patient's history and thus direct them toward appropriate screening. The stance of PCPs thus seems to alternate between supervision and reflection, and between consultation and questioning.</p>","PeriodicalId":49575,"journal":{"name":"Sante Publique","volume":"37 2","pages":"101-113"},"PeriodicalIF":0.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477639","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":"Les professionnels de santé assurant le suivi gynécologique en France : différents profils d’activité.","authors":"Thomas Karnycheff, Guillaume Chevillard, Sandrine Voillequin, Quitterie Roquebert","doi":"10.3917/spub.252.0127","DOIUrl":"https://doi.org/10.3917/spub.252.0127","url":null,"abstract":"<p><strong>Introduction: </strong>In France, gynecological care is provided by three types of health professionals: gynecologists, primary care physicians, and midwives. The objective of this study was to describe the gynecological care provided by these different health professionals at the national level.</p><p><strong>Methods: </strong>A descriptive and analytical study of indicators of gynecological care (cervical and vaginal swabs, contraception procedures, and initial contraception and preventive consultations) by gynecologists, primary care physicians, and midwives in private practice in 2022, using data from the French National Health Data System (SNDS) to establish profiles of health professionals using multivariate analysis (principal component analysis and hierarchical clustering).</p><p><strong>Results: </strong>Three gynecologist profiles, five primary care physician profiles, and four midwife profiles were identified based on the intensity of their gynecological care activity and their specialization in certain types of procedures. Professionals with significant gynecological care activity often have a particular focus on private practice, are more frequently female, and belong to younger age groups. The geographical distribution of professionals with significant gynecological care activity varies according to the profession.</p><p><strong>Conclusion: </strong>We demonstrate significant heterogeneity in gynecological care, both between different types of professionals and within the same profession. Understanding gynecological care provision and its dynamics thus requires us to take into account the variety of actors at both the inter- and intra-professional levels.</p>","PeriodicalId":49575,"journal":{"name":"Sante Publique","volume":"37 2","pages":"127-144"},"PeriodicalIF":0.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477638","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":"Améliorer la connaissance et la reconnaissance des interventions non médicamenteuses : implications pour la santé publique d’une étude participative et de consensus.","authors":"Grégory Ninot, Emeline Descamps, Ghislaine Achalid, Sébastien Abad, Pierre-Louis Bernard, François Carbonnel, Patrizia Carrieri, Patrizia Dargent-Molina, Fréderic Fiteni, Aude-Marie Foucaut, Alice Guyon, Béatrice Lognos, Nicolas Molinari, Arnaud Legout, Julien Nizard, Michel Nogues, Pierrick Poisbeau, Lise Rochaix, Bruno Falissard","doi":"10.3917/spub.pr2.0078","DOIUrl":"https://doi.org/10.3917/spub.pr2.0078","url":null,"abstract":"<p><strong>Introduction: </strong>In the absence of a consensus on the definition and evaluation of non-pharmacological interventions (NPI)-despite the use of the concept by the World Health Organization, the French Health Authority, the Ministry of Health, and the European Centre for Disease Prevention and Control-this study has co-constructed a consensus-based paradigm aligned with international health research standards. This article outlines its relevance and limitations for public health.</p><p><strong>Method: </strong>Over a two-year period, the study engaged all stakeholders, i.e., more than 1,000 participants. Participatory workshops based on international health research recommendations and experiential knowledge, and consensus sessions were conducted under the guidance of a multidisciplinary committee and with the logistical support of the Non-Pharmacological Intervention Society. These efforts helped to identify the key descriptive and evaluative invariants specific to NPIs. Four phases followed: development, improvement, voting, and consultation.</p><p><strong>Results: </strong>The term NPI refers to prevention or care protocols with a physical, nutritional, or psychosocial focus, targeting a health issue and personalized by a qualified professional. The evaluation framework comprises 77 invariants-14 ethical and 63 methodological-distributed across five types of study: mechanistic, observational, prototypical, interventional, and implementation. The NPIS Model paradigm was endorsed by 31 learned societies and three French health authorities.</p><p><strong>Conclusion: </strong>The term NPI should be reserved for prevention and care protocols that are described, explainable, effective, safe, and implementable. The consensual framework for co-constructed evaluation should promote the transfer of NPIs from research to practice, their interprofessional coordination, contextual adaptation, continuous improvement, training, and, finally, their recognition. This scientific paradigm strengthens the role of public health professionals in developing targeted, efficient, and potentially fundable interventions for at-risk or ill populations. It paves the way for the development of an open registry of intangible health care practices that can be codified, shared, traced, and improved, informed by user feedback. This paradigm does not, however, cover all areas of public health.</p>","PeriodicalId":49575,"journal":{"name":"Sante Publique","volume":"37 3","pages":"113-132"},"PeriodicalIF":0.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240064","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":"Forces et défis des différents modèles de logement permanent avec soutien : perspective des organisations œuvrant dans le secteur au Québec.","authors":"Marie-Josée Fleury, Guy Grenier, Nadia L'Espérance","doi":"10.3917/spub.pr2.0077","DOIUrl":"https://doi.org/10.3917/spub.pr2.0077","url":null,"abstract":"<p><strong>Objectives: </strong>Permanent supportive housing (PSH) is the preferred strategy for eradicating homelessness. This study seeks to outline the specificities of PSH in Montreal (Quebec, Canada), to compare the different models and highlight their respective strengths and challenges.</p><p><strong>Method: </strong>Data was collected in 2023 through 31 organizations from eight governmental bodies or Quebec associations and 23 Montreal PSH resources. A sample of 42 managers and practitioners from the homelessness/housing sector participated by completing an interview and/or a questionnaire. The study used a mixed-methods approach integrating descriptive and content analyses.</p><p><strong>Results: </strong>Community-based PSH was the most prevalent model, although half of the resources offered both community-based and private-sector PSH. A median of 70 residents received support, with only one-third of those being followed at least once a week. Common challenges were mainly linked to funding (e.g., quality affordable housing) or due to the complexity of providing follow-up to residents. Key distinctions were based on whether the housing was contracted in the private sector, and on whether support was available onsite. Challenges specific to private-sector PSH included relationships with landlords, the remoteness of follow-up sites, and resident isolation. Community-based and social PSH faced issues associated with adherence to house rules and resident stigmatization.</p><p><strong>Conclusion: </strong>Findings indicate that increasing the number of resources, the intensity and diversity of support, and expanding relocation options would be beneficial to residents.</p>","PeriodicalId":49575,"journal":{"name":"Sante Publique","volume":"37 3","pages":"87-98"},"PeriodicalIF":0.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240169","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":"La décolonisation de la santé publique en Bolivie ou la fragmentation de tout un secteur.","authors":"Amélie Aubert Plard","doi":"10.3917/spub.251.0043","DOIUrl":"https://doi.org/10.3917/spub.251.0043","url":null,"abstract":"<p><strong>Introduction: </strong>During its first ten years (2006-2016), the government of Evo Morales led Bolivia through a wave of reforms aimed at establishing a popular nationalism, free from what it calls \"Western imperialism.\"</p><p><strong>Purpose of the study: </strong>This article analyzes the implementation of the decolonization process, particularly in the reproductive health sector. It highlights the effects generated on those involved and the mechanisms of appropriation and/or rejection. To do this, it focuses on three measures: the My Health program, the professionalization of traditional midwives, and the cultural adaptation of delivery rooms.</p><p><strong>Results: </strong>While the deployment of the My Health program is developing community medicine that is appreciated by users, it is also giving rise to deep rivalries among healthcare professionals and decision-makers alike. Furthermore, when it comes to intercultural childbirth, the study reveals a lack of both supply and demand.</p><p><strong>Conclusion: </strong>Far from reforming it structurally, the decolonization process seems to have caused a deep ideological and organizational split within the health sector. The new measures have been implemented in the form of additional, competing programs, which has caused difficulties regarding their acceptance and integration within the established healthcare system. What's more, while in its discourse the government rejects Western colonization, in practice it remains heavily dependent on international aid.</p>","PeriodicalId":49575,"journal":{"name":"Sante Publique","volume":"37 1","pages":"43-51"},"PeriodicalIF":0.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129185","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":"Étude des conditions d’émergence d’une politique intersectorielle de promotion de la santé à l’échelon du territoire néocalédonien : fenêtre d’opportunité pour la santé à l’École.","authors":"Carmella Rebouillat, Pierre-Christophe Pantz, Didier Jourdan","doi":"10.3917/spub.hs1.2025.0037","DOIUrl":"https://doi.org/10.3917/spub.hs1.2025.0037","url":null,"abstract":"<p><strong>Introduction: </strong>Health promotion is a set of intersectoral actions aimed at improving the health of all individuals and at reducing health inequalities. Public health research faces the challenge of identifying the conditions necessary to develop health promotion policies at the territorial level.</p><p><strong>Method: </strong>To identify the conditions for the development of such a policy, we studied the case of the intersectoral health promotion policy in schools in New Caledonia. Drawing on the Kingdon model adapted to public health by Ridde et al., we conducted a detailed analysis of the context, actors, and mechanisms that enabled the publication of regulatory texts and financial commitments.</p><p><strong>Results: </strong>We noted a surge in the number of political entrepreneurs in the health and education sectors. These key actors have made health in schools a \"problem\" in the political sense of the term. Support from the health agency and its partners enabled credible solutions to be proposed, which, moreover, were acceptable to the institutions, in a political context conducive to reaching consensus among members of government who come from different political backgrounds.</p><p><strong>Discussion: </strong>A window of opportunity was opened in 2016 with the convergence of three key elements: awareness of the existence of a problem, solutions and a favorable political context, and the mobilization of political actors supported by experts who were able to substantiate the political project.</p>","PeriodicalId":49575,"journal":{"name":"Sante Publique","volume":"37 HS1","pages":"37-46"},"PeriodicalIF":0.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087868","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":"Une approche collective de la santé au cœur des territoires ruraux et insulaires de Bretagne : le savoir-faire communautaire des <i>Semeurs de Santé</i>.","authors":"Camille Astier, Hélène Denoual, Claire Cornelissen, Collectif Les Semeurs De Santé, Marie Rénée Guevel","doi":"10.3917/spub.hs1.2025.0065","DOIUrl":"https://doi.org/10.3917/spub.hs1.2025.0065","url":null,"abstract":"","PeriodicalId":49575,"journal":{"name":"Sante Publique","volume":"37 HS1","pages":"65-74"},"PeriodicalIF":0.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087920","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":"Éditorial.","authors":"Moustapha Dramé, Philippe Quénel","doi":"10.3917/spub.hs2.2025.0001","DOIUrl":"https://doi.org/10.3917/spub.hs2.2025.0001","url":null,"abstract":"","PeriodicalId":49575,"journal":{"name":"Sante Publique","volume":"37 HS2","pages":"1"},"PeriodicalIF":0.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145662552","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}