Sante Publique最新文献

{"title":"Pratiques et attitudes concernant la vaccination contre le Papillomavirus : enquête descriptive auprès des sages-femmes de territoires hexagonaux et ultramarins.","authors":"Anne Rousseau, Julia Eïd, Emeline Vedapodagom, Dolorès Pourette, Clémence Schantz","doi":"10.3917/spub.262.0239","DOIUrl":"10.3917/spub.262.0239","url":null,"abstract":"<p><strong>Objective: </strong>To describe midwives&amp;#8217; practices and attitudes regarding HPV vaccination across different regions of France.</p><p><strong>Method: </strong>This descriptive cross-sectional study used an anonymous online questionnaire conducted from October 17, 2022, to February 10, 2023, among independent midwives in the &amp;#206;le-de-France region and two overseas departments: Mayotte and R&amp;#233;union. The questionnaire covered three areas: 1) professional characteristics; 2) practices and opinions on vaccination; 3) barriers to vaccination. Descriptive analyses were performed, and the three regions were compared. Qualitative variables were analyzed using chi-squared or Fisher&amp;#8217;s exact tests, as appropriate, with R software.</p><p><strong>Results: </strong>A total of 206 completed questionnaires were obtained: 123/877 (14%) from &amp;#206;le-de-France, 22/49 (45%) from Mayotte, and 61/162 (38%) from R&amp;#233;union. Our results show that midwives in R&amp;#233;union were significantly less supportive of HPV vaccination (75.4% vs. 89.4% in &amp;#206;le-de-France and 86.4% in Mayotte, p = 0.04), and fewer administered the vaccine (34.4% in R&amp;#233;union vs. 64.2% in &amp;#206;le-de-France and 54.5% in Mayotte, p &amp;lt; 0.001). Reported barriers to vaccination included limited knowledge of their vaccination competence, insufficient promotion and information about the vaccine, and reliance on routine vaccination through general practitioners.</p><p><strong>Conclusions: </strong>Midwives have the potential to play a larger role in HPV vaccination. Given lower support and practice levels in R&amp;#233;union, this region should be prioritized for midwife training and public education on the benefits of vaccination and midwives&amp;#8217; vaccination competencies.</p>","PeriodicalId":49575,"journal":{"name":"Sante Publique","volume":"38 2","pages":"239-246"},"PeriodicalIF":0.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147989254","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":"L’empowerment en santé communautaire : perspectives théoriques et implications pour la promotion du vieillissement en santé.","authors":"Élodie Montaigne","doi":"10.3917/spub.262.0129","DOIUrl":"10.3917/spub.262.0129","url":null,"abstract":"<p><strong>Introduction: </strong>Empowerment is a central concept in public health used to reduce social inequalities in health. However, its multiple conceptualizations reflect divergent theoretical perspectives, raising epistemological tensions and practical challenges.</p><p><strong>Aim: </strong>This critical literature review aims to analyze the main theoretical perspectives on empowerment and identify relevant approaches to promote healthy aging from a community health perspective.</p><p><strong>Methodology: </strong>A targeted search was conducted in the PubMed, CAIRN, and Google Scholar databases using English and French keywords (&amp;#8220;empowerment,&amp;#8221; &amp;#8220;sant&amp;#233; communautaire&amp;#8221; [community health], &amp;#8220;promotion de la sant&amp;#233;&amp;#8221; [health promotion], &amp;#8220;vieillissement en sant&amp;#233;&amp;#8221; [healthy aging]). The included publications provided conceptual, critical, or interdisciplinary analyses relevant to community health and the promotion of healthy aging. To broaden the scope of the analysis, the bibliographic references of the selected publications were also reviewed. An iterative thematic analysis was carried out to identify conceptual trends and practical implications.</p><p><strong>Results: </strong>The analysis highlights the relevance of a multi-scalar approach to empowerment that considers individual, community, and organizational dimensions, as proposed by Ninacs. Such an approach can increase the impact of interventions on social health inequalities. Healthy aging promotion provides a concrete illustration of this dynamic: The empowerment of older adults transforms power relations, redefines professional roles, and fosters the emergence of more equitable and collaborative practices.</p><p><strong>Conclusions: </strong>Empowerment constitutes both a conceptual and practical lever for linking community health and health promotion. By embracing its ideological dimension and drawing on appropriate theoretical approaches, it helps to design fairer, more inclusive, and more meaningful interventions for the populations concerned.</p>","PeriodicalId":49575,"journal":{"name":"Sante Publique","volume":"38 2","pages":"129-139"},"PeriodicalIF":0.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147989860","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":"L’infertilité : un défi de santé publique et de société.","authors":"Alexandre Vallée, Jean-Marc Ayoubi","doi":"10.3917/spub.262.0033","DOIUrl":"10.3917/spub.262.0033","url":null,"abstract":"<p><p>Infertility currently affects nearly one in six couples, representing more than 3.3&amp;#160;million people in France. Infertility now occurs in an unprecedented demographic context, marked by a rapid decline in fertility: the total fertility rate has fallen from 1.87 children per woman in 2019 to 1.56 in 2025, while the annual number of births has reached its lowest level since the post&amp;#8211;Second World War period, resulting in a natural population decrease. This trend gives infertility major strategic significance for public health and social cohesion. Far from being a purely individual medical problem, infertility arises from multiple, closely interrelated determinants, including biological, environmental, socioeconomic, and behavioral factors. Age remains a central determinant, with a marked decline in female fertility from the age of 30 onward and a gradual deterioration in sperm quality in men after 40. The increasing postponement of parenthood, driven by longer educational trajectories, job insecurity, high housing costs, and limited access to childcare, further exacerbates these biological vulnerabilities. In parallel, exposure to endocrine-disrupting chemicals, common conditions such as endometriosis, polycystic ovary syndrome, and diabetes, as well as behaviors including smoking, physical inactivity, and obesity, significantly contribute to subfertility. Current care pathways remain unequal and insufficiently adapted, particularly for individuals undergoing assisted reproductive technologies. A structured national strategy based on prevention, research, and equal access to care is therefore urgently needed.</p>","PeriodicalId":49575,"journal":{"name":"Sante Publique","volume":"38 2","pages":"33-39"},"PeriodicalIF":0.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147989783","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":"L’action associative face au diabète au Maroc : le cas de l’association El Amel à Fès.","authors":"Mohammed Ameziane, Zouhair Belamfedel Alaoui","doi":"10.3917/spub.261.0207","DOIUrl":"https://doi.org/10.3917/spub.261.0207","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetes represents a growing public health challenge in Morocco, particularly among socially vulnerable populations who face significant barriers to healthcare within an overstretched public system. In this context, patient associations play a decisive role in care and support.</p><p><strong>Methods: </strong>This study examines the action of the El Amel association, based in Fez, to assess its contribution to reducing social health inequalities related to diabetes. A qualitative, exploratory design was conducted between January and April 2021, involving nineteen semi-structured interviews with patients, association leaders and healthcare providers. Thematic analysis identified six major dimensions of the association&amp;#8217;s action.</p><p><strong>Findings: </strong>Findings highlight El Amel as a central community actor, perceived as more effective and credible than public services due to its responsiveness and patient-centered approach. Its activities have expanded to functions traditionally carried out by the state, including glycemic monitoring, medicine distribution, and specialized consultations). Its quasi-free service policy enhances access to care and reduces inequalities, although the financial sustainability of the model remains fragile. The association is also solicited for needs beyond the medical field, positioning itself as a crucial social anchor, at times operating on the margins of legality to meet patients&amp;#8217; needs.</p><p><strong>Discussion: </strong>Ultimately, the experience of El Amel demonstrates the capacity of patient associations to transform diabetes care in contexts of vulnerability by strengthening patient autonomy and creating new forms of solidarity. Institutional recognition and integration into public health policies appear essential to ensure equitable and sustainable care for people living with diabetes in Morocco.</p>","PeriodicalId":49575,"journal":{"name":"Sante Publique","volume":"38 1","pages":"207-218"},"PeriodicalIF":0.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671084","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":"Facteurs influençant l’utilisation et la non-utilisation de soins de sage-femme dans la région de Québec, Canada : une étude qualitative des trajectoires de soins selon une perspective parentale.","authors":"Maude Vézina, Stéphanie Maltais","doi":"10.3917/spub.261.0167","DOIUrl":"https://doi.org/10.3917/spub.261.0167","url":null,"abstract":"<p><strong>Introduction: </strong>In Canada, healthcare delivery models for perinatal care vary among provinces and territories, following a shared-care approach that allows women to choose their preferred healthcare provider. Globally, research aims to understand the factors influencing the choice of healthcare providers and birth settings during the perinatal period, including ideological, cultural, sociodemographic, and healthcare-related variables.</p><p><strong>Objectives: </strong>This study explores these factors by examining the perspectives of parents in the Quebec region (Canada) regarding their decision on whether to use midwifery care for perinatal services. A qualitative case study approach was adopted, with data collected in 2021 through 25 interviews.</p><p><strong>Results: </strong>The findings led to the development of an updated conceptual model, building upon Thiessen et al.&amp;#8217;s previous model (2016) to incorporate two new dimensions: the healthcare context and knowledge and information regarding the perinatal period. This revised model, comprising seven main categories, provides a structured framework for understanding the factors influencing the use or non-use of midwifery care in the Quebec region and serves as a basis for future research in this area.</p><p><strong>Conclusion: </strong>This study aimed to explore factors influencing the use or non-use of midwifery care in Quebec. Various factors were identified, including parents&amp;#8217; medical history, parity, previous pregnancy experiences, education, childbirth ideologies, environmental and emotional considerations, social influences, and the impact of choice, knowledge, and information regarding the perinatal period, as well as the public health context.</p>","PeriodicalId":49575,"journal":{"name":"Sante Publique","volume":"38 1","pages":"167-181"},"PeriodicalIF":0.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671184","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":"Vers un partenariat avec les familles en santé mentale infantile : recherche-action collaborative en CMPP.","authors":"Camille Augustin, Vera Ivanaj, Fabienne Ligier","doi":"10.3917/spub.261.0183","DOIUrl":"https://doi.org/10.3917/spub.261.0183","url":null,"abstract":"<p><strong>Introduction: </strong>In France, care pathways in child mental health remain complex and difficult to navigate for families, despite political efforts to strengthen outpatient support. Often mobilized as &amp;#8220;resources,&amp;#8221; families are still rarely recognized as full partners in the care process.</p><p><strong>Objectives and method: </strong>This collaborative action research, conducted in a CMPP (centre m&amp;#233;dico-psycho-p&amp;#233;dagogique; center for medical, psychological, and educational care) located in a rural area, aimed to better understand the obstacles experienced by families and to co-construct with them concrete proposals to improve their support. The study adopted a qualitative approach based on two components: fifteen semi-structured interviews with parents, complemented by twenty-five interviews with CMPP professionals; followed by a participatory workshop with three volunteer mothers over six working sessions.</p><p><strong>Results: </strong>The analysis highlighted several facilitating factors, including caring professional attitudes, holistic support, and associative assistance. It also revealed persistent barriers such as diagnostic delay, administrative overload, a lack of accessible information, social isolation, and the invisibilization of the parental role. The workshops led to concrete proposals: a simplified welcome booklet, peer-support caf&amp;#233;s, parental support groups, video capsules for professional training, and a partnership ethical charter. Some of these initiatives will be piloted from September 2025 with institutional support.</p><p><strong>Discussion: </strong>Based on the &amp;#8220;Montreal model&amp;#8221; of patient engagement, this study demonstrates that recognizing parental experiential knowledge shifts professional practices toward genuine co-production of care pathways.</p><p><strong>Conclusion: </strong>This work opens up concrete prospects for transformation in other medico-social structures seeking to strengthen family participation.</p>","PeriodicalId":49575,"journal":{"name":"Sante Publique","volume":"38 1","pages":"183-187"},"PeriodicalIF":0.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671198","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":"Représentations des professionnels des EHPAD à l’égard des soins palliatifs : <i>étude qualitative multisite</i>.","authors":"Emmanuel Bagaragaza, Benoite Umubyeyi, Danièle Leboul","doi":"10.3917/spub.262.0175","DOIUrl":"10.3917/spub.262.0175","url":null,"abstract":"<p><strong>Introduction: </strong>Early integration of a palliative care approach into the care of dependent older adults constitutes a public health concern owing to multiple factors.</p><p><strong>Study aim: </strong>To explore the perceptions of nursing home professionals toward palliative care in order to understand how these perceptions influence the adoption of a palliative care approach in residents&amp;#8217; care.</p><p><strong>Methods: </strong>We conducted a qualitative study using a multiple case study approach. Semi-structured interviews and focus group discussions were held with professionals from 21 nursing homes. Data were analyzed using a thematic content analysis approach.</p><p><strong>Results: </strong>A total of 68 individual interviews and nine focus groups involving 67 professionals were conducted. The findings revealed shared perceptions of palliative care across settings and professional categories. Professionals structure palliative care around the umbrella term of accompagnement, which encompasses multiple goals and incorporates diverse practices. The majority of professionals associate palliative care with the terminal phase of an incurable illness and the end of life, and consider it to be reserved for the expertise of specialized teams. Such perceptions hinder the appropriation of the palliative care approach and delay its adoption in residents&amp;#8217; care.</p><p><strong>Conclusion: </strong>To ensure optimal integration of a palliative care approach within nursing home residents&amp;#8217; care, strong strategies aimed at improving perceptions and attitudes at individual, clinical, and organizational levels are required. These strategies should focus on co-creating an organizational culture that values palliative care as an approach that is integrated in a timely manner throughout the continuum of care to meet residents&amp;#8217; needs.</p>","PeriodicalId":49575,"journal":{"name":"Sante Publique","volume":"38 2","pages":"175-187"},"PeriodicalIF":0.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147989670","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":"Impact de la COVID-19 sur les personnes en obésité : enquête dans les CSO (centres spécialisés obésité) de Nouvelle-Aquitaine.","authors":"Arnaud Alessandrin, Blandine Gatta-Cherifi, Maud Monsaingeon-Henry, Xavier Piguel, Helena Mosbah, Pierre Jésus, Laurence Salles, Marielle Toulze, Thibault Bossy, Anastasia Meidani","doi":"10.3917/spub.261.0095","DOIUrl":"10.3917/spub.261.0095","url":null,"abstract":"<p><p>Objective&amp;#160;: In the context of increased hospitalization of obese and overweight individuals during the COVID-19 pandemic, a multidisciplinary team sought to understand the impacts of lockdowns and curfews on patients treated in Specialized Obesity Centers (CSOs) in Nouvelle-Aquitaine, France. Methods&amp;#160;: This study employs a mixed-methods approach (qualitative and quantitative). Results&amp;#160;: It demonstrates disruptions in patients&amp;#8217; healthcare trajectories and statistically reflects the specific experiences of this population. Conclusions&amp;#160;: It offers an analytical perspective on bariatric care and the COVID-19 pandemic.</p>","PeriodicalId":49575,"journal":{"name":"Sante Publique","volume":"38 1","pages":"95-101"},"PeriodicalIF":0.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670964","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":"Vers une approche globale et intégrée des troubles psychiques sévères : enseignements de la littérature.","authors":"Esther Touitou-Burckard, Laurent Boyer, Coralie Gandré","doi":"10.3917/spub.hs1.2026.0129","DOIUrl":"https://doi.org/10.3917/spub.hs1.2026.0129","url":null,"abstract":"<p><strong>Introduction: </strong>This knowledge synthesis aims to identify the main barriers within health systems to the comprehensive care&amp;#8212;including somatic health&amp;#8212;of people with severe mental illness, as well as the organizational responses needed to address them. It offers insights to inform public mental health policies aimed at reducing the health inequalities faced by this population.</p><p><strong>Methods: </strong>This review is based on a narrative synthesis of both quantitative and qualitative literature, with particular attention paid to French research in order to draw conclusions relevant to this national context.</p><p><strong>Results: </strong>People with severe mental illness face barriers at every stage of their care pathways, from primary care to end-of-life services. These difficulties stem in part from a lack of coordination between care sectors and insufficient consideration of the social difficulties experienced by this population. Although integrated care models are being developed to address these issues, in particular within specialized mental health services, their impact remains insufficiently documented in real-life settings and over the long term. Further attention should also be given to service users&amp;#8217; preferences and to coordination between health and social care.</p><p><strong>Conclusion: </strong>An ambitious public mental health policy in France must promote a comprehensive, inclusive, and intersectoral approach to the health of people living with severe mental illness. It should support the development and evaluation of new organizational models that address the needs and expectations of this specific population.</p>","PeriodicalId":49575,"journal":{"name":"Sante Publique","volume":"38 HS1","pages":"129-137"},"PeriodicalIF":0.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867556","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 psychiatrie n’est pas une discipline médicale comme les autres.","authors":"François Gonon","doi":"10.3917/spub.hs1.2026.0229","DOIUrl":"https://doi.org/10.3917/spub.hs1.2026.0229","url":null,"abstract":"<p><p>For most somatic diseases, diagnosis and treatment are guided by biological knowledge. However, psychiatry&amp;#8217;s biological basis is currently limited to a few rare genetic disorders, such as certain forms of autism with intellectual disability. For other mental disorders, no biomarkers have yet been validated to aid diagnosis. Likewise, most psychotropic medications in use were discovered in the 1950s and 1960s through chance observations or are derived from these early molecules. The first part of this article presents doubts expressed by leaders in American psychiatry regarding the ability of neuroscience to reliably inform mental health practices in the foreseeable future. Between these doubts and the promises of spectacular advances widely reported in the media, there is a considerable gap. The second part examines these media misrepresentations, their causes, and their consequences. The third part highlights the specificities of psychiatry, particularly regarding diagnostic practices. Finally, the fourth part discusses primary prevention policies that could help reduce the economic and social costs of mental disorders. While not exhaustive, these include reducing the rate of premature births and teenage motherhood, strengthening educational support for primary school children, limiting children&amp;#8217;s screen time, and reducing income and wealth inequalities. Overall, mental health is not solely a biomedical issue; it is a broader public health concern.</p>","PeriodicalId":49575,"journal":{"name":"Sante Publique","volume":"38 HS1","pages":"229-237"},"PeriodicalIF":0.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867641","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}