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Background: Subgroups of precarious populations such as homeless people are more exposed to infection and at higher risk of developing severe forms of COVID-19 compared to the general population. Many of the recommended prevention measures, such as social distancing and self-isolation, are not feasible for a population living in shelters characterised by physical proximity and a high population density. The objective of the study was to describe SARS-CoV-2 infection prevalence in homeless shelters in Brussels (Belgium), and to identify risk factors and infection control practices associated with SARS-CoV-2 positivity rates. Methods: A total of 1994 adults were tested by quantitative PCR tests in 52 shelters in Brussels (Belgium) between April and June, 2020, in collaboration with Doctors of the World. SARS-CoV-2 prevalence is here described site by site, and we identify risk factors associated with SARS-CoV-2 positivity rates. We also investigate associations between seropositivity and reported symptoms. Results: We found an overall prevalence of 4.6% for the period, and a cluster of high rates of SARS-CoV-2 positivity (20–30% in two shelters). Among homeless people, being under 40 years of age (OR (CI95%) 2.3 (1.2–4.4), p = 0.02), having access to urgent medical care (AMU) (OR(CI95%): 2.4 (1.4–4.4)], p = 0.02), and sharing a room with someone who tested positive (OR(CI95%): 5.3 (2.9–9.9), p<0.0001) were factors associated with SARS-CoV-2 positivity rates. 93% of those who tested positive were asymptomatic. Conclusion: This study shows high rates of SARS-COV-2 infection positive tests in some shelters, with a high proportion of asymptomatic cases. The survey reveals how important testing and isolation measures are, together with actions taken by medical and social workers during the outbreak. [ABSTRACT FROM AUTHOR]

Deviance theory introduces a behavioural view on constructive and destructive deviance to explain how an individual's intent can harm or improve organisational well-being. However, to our knowledge, no scale exists that evaluates the personal orientation aspect of deviance and normativity. This article discusses the creation of the Norm and Deviance-Seeking Personal Orientation Scale (NDPOS). To create this scale, we studied the psychometric properties of the instrument using data from French workers. NDPOS exploratory analysis indicated a 12-item scale composed of four factors: normative conformity, normative rule adequacy, deviant performance seeking, and deviant proactivity seeking. Confirmatory factor analysis corroborated the factorial structure in four sub-scales. Convergent and discriminant validity indicated that deviant dimensions were positively related to expressing voice, cognitive flexibility, and deviant behaviours, whereas normativity dimensions were negatively or not related to these behaviours. Furthermore, opposite relations between the conformity construct and the four factors were observed. Practical implications and suggestions for the development of future research on constructive deviance theory are discussed. [ABSTRACT FROM AUTHOR]

The present study sought to translate and adapt the Learning Potential of the Workplace Scale (LPW) into the Italian language and assess its psychometric properties. A sample of 729 workers was recruited from 3 different organizations located in Italy. Three studies tested the psychometric validity of the Italian version. The first tested the LPW's structure and validity by performing confirmatory factor analyses and calculating the scale's reliabilities. The second tested LPW's convergent and divergent validities through correlation analyses. The relationship between the LPW's dimensions, HR training practices, and organizational tradition climate were investigated. Lastly, the third study analyzed the scale construct validity by using structural equation modeling. The relationship of challenging tasks and task feedback with LPW dimensions was observed. Results indicated that the Italian version was reliable, with similar psychometric properties of the original scale and, therefore, a valid instrument for assessing the learning potential of the workplace. [ABSTRACT FROM AUTHOR]

France and South Korea have implemented voucher programs to counter energy poverty. In contrast to goods that traditional voucher programs target, the market structure that dominates energy supply is the oligopoly. In this paper, we study the price impact of vouchers in this market structure. We first state conditions on demand elasticities that make the choice of vouchers consistent with the regulator's objective of eliminating energy poverty. We then model a game between energy suppliers and the regulator, where suppliers maximize profit while the regulator ensures that no consumer spends more than a given share of income on energy. From a benchmark case without vouchers, we show that vouchers reduce the energy price under simultaneous decision making or when the regulator moves first. However, the price impact of vouchers is ambiguous if firms move first. This scenario's price is above the price of the simultaneous decision scenario's price. [ABSTRACT FROM AUTHOR]

Background: Since some form of dual clinical/public health practice is desirable, this paper explains why their ethics should be combined to influence medical practice and explores a way to achieve that.Main Text: In our attempt to merge clinical and public health ethics, we empirically compared the individual and collective health consequences of two illustrative lists of medical and public health ethical tenets and discussed their reciprocal relevance to praxis. The studied codes share four principles, namely, 1. respect for individual/collective rights and the patient's autonomy; 2. cultural respect and treatment that upholds the patient's dignity; 3. honestly informed consent; and 4. confidentiality of information. However, they also shed light on the strengths and deficiencies of each other's tenets. Designing a combined clinical and public health code requires fleshing out three similar principles, namely, beneficence, medical and public health engagement in favour of health equality, and community and individual participation; and adopting three stand-alone principles, namely, professional excellence, non-maleficence, and scientific excellence. Finally, we suggest that eco-biopsychosocial and patient-centred care delivery and dual clinical/public health practice should become a doctor's moral obligation. We propose to call ethics based on non-maleficence, beneficence, autonomy, and justice - the values upon which, according to Pellegrino and Thomasma, the others are grounded and that physicians and ethicists use to resolve ethical dilemmas - "neo-Hippocratic". The neo- prefix is justified by the adjunct of a distributive dimension (justice) to traditional Hippocratic ethics.Conclusion: Ethical codes ought to be constantly updated. The above values do not escape the rule. We have formulated them to feed discussions in health services and medical associations. Not only are these values fragmentary and in progress, but they have no universal ambition: they are applicable to the dilemmas of modern Western medicine only, not Ayurvedic or Shamanic medicine, because each professional culture has its own philosophical rationale. Efforts to combine clinical and public health ethics whilst resolving medical dilemmas can reasonably be expected to call upon the physician's professional identity because they are intellectual challenges to be associated with case management. [ABSTRACT FROM AUTHOR]

Background: Ethical medical practice requires managing health services to promote professionalism and secure accessibility to care. Commercially financed and industrially managed services strain the physicians' clinical autonomy and ethics because the industry's profitability depends on commercial, clinical standardisation. Private insurance companies also reduce access to care whilst fragmenting and segmenting health systems. Against this background, given the powerful, symbolic significance of their common voice, physicians' and patients' organisations could effectively leverage together political parties and employers' organisations to promote policies favouring access to professional care.Main Text: To provide a foundation for negotiations between physicians' and patients' organisations, we propose policy principles derived from an analysis of rights-holders and duty-bearers' stakes, i.e., patients, physicians and health professionals, and taxpayers. Their concerns are scrutinised from the standpoints of public health and right to health. Illustrated with post-WWII European policies, these principles are formulated as inputs for tentative action-research. The paper also identifies potential stumbling blocks for collective doctor/patient negotiations based on the authors' personal experience. The patients' concerns are care accessibility, quality, and price. Those of physicians and other professionals are problem-solving capacity, autonomy, intellectual progress, ethics, work environment, and revenue. The majority of taxpayers have an interest in taxes being progressive and public spending on health regressive. Mutual aid associations tend to under-estimate the physician's role in delivering care. Physicians' organisations often disregard the mission of financing care and its impact on healthcare quality.Conclusion: The proposed physicians-patients' alliance could promote policies in tune with professional ethics, prevent European policies' putting industrial concerns above suffering and death, bar care financing from the ambit of international trade treaties, and foster international cooperation policies consistent with the principles that inspire the design of healthcare policies at home and so reduce international migration. To be credible partners in this alliance, physicians' associations should promote a public health culture amongst their members and a team culture in healthcare services. To promote a universal health system, patients' organisations should strive to represent universal health interests rather than those of patients with specific diseases, ethnic groups, or social classes. [ABSTRACT FROM AUTHOR]

Background: Revisiting professionalism, both as a medical ideal and educational topic, this paper asks whether, in the rise of artificial intelligence, healthcare commoditisation and environmental challenges, a rationale exists for merging clinical and public health practices. To optimize doctors' impact on community health, clinicians should introduce public health thinking and action into clinical practice, above and beyond controlling nosocomial infections and iatrogenesis. However, in the interest of effectiveness they should do everything possible to personalise care delivery. To solve this paradox, we explore why it is necessary for the boundaries between medicine and public health to be blurred.Main Body: Proceeding sequentially, we derive standards for medical professionalism from care quality criteria, neo-Hippocratic ethics, public health concepts, and policy outcomes. Thereby, we formulate benchmarks for health care management and apply them to policy evaluation. During this process we justify the social, professional - and by implication, non-commercial, non-industrial - mission of healthcare financing and policies. The complexity of ethical, person-centred, biopsychosocial practice requires a human interface between suffering, health risks and their therapeutic solution - and thus legitimises the medical profession's existence. Consequently, the universal human right to healthcare is a right to access professionally delivered care. Its enforcement requires significant updating of the existing medical culture, and not just in respect of the man/machine interface. This will allow physicians to focus on what artificial intelligence cannot do, or not do well. These duties should become the touchstone of their practice, knowledge and ethics. Artificial intelligence must support medical professionalism, not determine it. Because physicians need sufficient autonomy to exercise professional judgement, medical ethics will conflict with attempts to introduce clinical standardisation as a managerial paradigm, which is what happens when industrial-style management is applied to healthcare.Conclusion: Public healthcare financing and policy ought to support medical professionalism, alongside integrated clinical and public health practice, and its management. Publicly-financed health management should actively promote ethics in publicly- oriented services. Commercialised healthcare is antithetical to ethical medical, and to clinical / public health practice integration. To lobby governments effectively, physicians need to appreciate the political economy of care. [ABSTRACT FROM AUTHOR]

Background: Strong relations between medicine and public health have long been advocated. Today, professional medical practice assumes joint clinical/public health objectives: GPs are expected to practice community medicine; Hospital specialists can be involved in disease control and health service organisation; Doctors can teach, coach, evaluate, and coordinate care; Clinicians should interpret protocols with reference to clinical epidemiology. Public health physicians should tailor preventive medicine to individual health risks. This paper is targeted at those practitioners and academics responsible for their teams' professionalism and the accessibility of care, where the authors argue in favour of the epistemological integration of clinical medicine and public health.Main Text: Based on empirical evidence the authors revisit the epistemological border of clinical and public health knowledge to support joint practice. From action-research and cognitive psychology, we derive clinical/public health knowledge categories that require different transmission and discovery techniques. The knowledge needed to support the universal human right to access professional care bridges both clinical and public health concepts, and summons professional ethics to validate medical decisions. To provide a rational framework for teaching and research, we propose the following categories: 'Know-how/practice techniques', corresponding a.o. to behavioural, communication, and manual skills; 'Procedural knowledge' to choose and apply procedures that meet explicit quality criteria; 'Practical knowledge' to design new procedures and inform the design of established procedures in new contexts; and Theoretical knowledge teaches the reasoning and theory of knowledge and the laws of existence and functioning of reality to validate clinical and public health procedures. Even though medical interventions benefit from science, they are, in essence, professional: science cannot standardise eco-biopsychosocial decisions; doctor-patient negotiations; emotional intelligence; manual and behavioural skills; and resolution of ethical conflicts.Conclusion: Because the quality of care utilises the professionals' skill-base but is also affected by their intangible motivations, health systems should individually tailor continuing medical education and treat collective knowledge management as a priority. Teamwork and coaching by those with more experience provide such opportunities. In the future, physicians and health professionals could jointly develop clinical/public health integrated knowledge. To this end, governments should make provision to finance non-clinical activities. [ABSTRACT FROM AUTHOR]

Keywords: Medical professionalism; Medical education; Medical research; Public health; Health management; Health policy EN Medical professionalism Medical education Medical research Public health Health management Health policy 1 5 5 12/09/20 20201209 NES 201209 Medicine in the twenty-first century Imagine that physicians could multiply their impact on people's health and improve community health whilst tailoring the delivery of care to each individual patient. Updating the physician's commitment and medical theory is necessary because dual clinical/public health medical practice is a scientific requirement to optimise the physician's impacts on individual and collective health. They in turn were indebted to Prof. GL Engel, the British and Ugandan doctors and medical officers working at Makerere University in the 1950s and 1960s, Dr. Halfdan Mahler, former Director of WHO, and Professor Debabar Banerji of Jawaharlal Nehru University, Delhi. With a feeling of injustice to the many colleagues that we could not cite, we should like to single out a few field practitioners in healthcare services who shared with us their energy, experience, and thoughts: Doctors and Professors Valérie Alaluf, Bernard Hanson, and Marie-Jeanne Wuidar in Belgium; Lucio Abad and Edgar Rojas in Ecuador; and Abdoulaye Sow in Guinea. [Extracted from the article]

Introduction:the low coverage of specialized mental health services and the shortage of human resources for mental health are enormous challenges for the health care system in Africa. The integration of mental health support into primary health care is a substantial and feasible complementary intervention to specialized services. We collected and analyzed data from 5 Health Care Centers (HCC) that had integrated this care package in Guinea. Methods: we conducted a descriptive study of new cases of mental health issues between 2012 and 2017. The reasons for consultations and diagnoses were identified and analyzed on the basis of consultation registries and individual medical records. Results: a total of 4.995 patients with mental health problems received consultations (2.8% of general consultations; 0.5 -7.7% according to the centers). The average age of patients was 27,9 years (± 16.1). The most common reasons for consultations were: insomnia 44.4% (n = 2081), seizures 39% (n = 1827), behavioral disorders 31.9% (n = 1263) and hallucinations 26.1% (n = 1224). The most common diagnoses were: epilepsy 36.8% (n = 1773) and psychotic disorders 33.5% (n = 1613). Eighty eight point four per cent (n = 4418) of patients received medical treatment, most often combined with psychological support. Conclusion: this study highlights that in the Guinean context, where access to specialized mental health care is very limited, patients with mental ill, even with severe medical conditions, can be followed up in the health centers by non-specialized but trained mental health professionals. [ABSTRACT FROM AUTHOR]

Context: The Global Consensus on Social Accountability (SA) of the Faculties of Medicine was validated in 2010. The applicability of SA concepts is very little investigated. Goal: The objective was to evaluate actions on SA conducted and those expected in the schools of medicine. Subjects and methods: An anonymous online self-questionnaire was addressed to different actors in 20 French-speaking schools of medicine in 10 countries: deans and decanal teams, teachers, students and civil society actors. The open-questionnaire identified the SA actions conducted and those expected in a next future. The occurrences of actions aggregated into themes were calculated. They have been compared to the occurrences of the Global Consensus. The verbatim has been analyzed. Results: A total of 425 participants were included, including 41.5% teachers and 28.0% students. For the actions conducted, the main occurrences found were "lessons learned" and "teaching actors"; the main reports referred to the revision of training curricula and the teaching of family medicine. As for the actions expected, the "measures of impact of the SA actions conducted", the revision of the lessons to better answer the needs of health and the development of the internships in the community were found. Verbatim were analyzed. Conclusion: The important participation, especially of the students, confirms the interest, but also the progress of the concepts of SA in the faculties of the different countries. Many innovations are proposed by the different actors. Appropriate training approaches and strategies that meet the expectations of the actors should be implemented. [ABSTRACT FROM AUTHOR]

Context and objective: The overall objective of the francophone international action research project on social accountability (SA) was to experiment and assess the relevance and implementation of a quality approach based on SA principles and to demonstrate its usefulness as a preferred strategy to improve the health system. Description: On November 1st, 2015, 56 medical schools in 18 French-speaking countries joined the action research project. In the first phase, the opinions and perceptions of various stakeholders were measured. Results indicated that work on SA awareness should continue among stakeholders. High student involvement demonstrated a strong interest in SA concepts. Medical schools chose different themes in experimenting practical SA interventions: faculty-territory agreement, first-line care, training adaptation and vulnerable populations. Results: The decision of medical schools to work on a common theme in the same country demonstrated strong national dynamics. In Tunisia and Haiti, the 4 faculties partnered and worked on a common theme. In Madagascar, the 6 medical schools embarked on a promising national partnership. Conclusion: The experience of the SA action research project by medical schools is singular in the French-speaking world. Because of the range of commitments, the project clearly illustrates the possibility of implementing practical SA actions in academic institutions, communities and countries. [ABSTRACT FROM AUTHOR]

Context: Worldwide, French-speaking faculties of medicine (139) are conscious of their obligations and fully committed with respect to social accountability in order to optimally respond to the needs of populations they are mandated to serve. In 2012, they launched an international action research project on social accountability. After a few years of work, they recently put together a strategic plan for 2015-2020 to confirm their commitments, coordinate their action in an optimal way, improve the thoroughness of action follow-up and improve its impact. Analysis: The plan is based on three specific intervention axes: impact, accreditation, partnerships/collaborations. They are supported in three transversal support areas: advocacy/training/expertise, dissemination/leadership, organization/resources. The objectives of each axis as well as a series of priority actions for 2015-2017 are presented. Conclusion: The strategic plan reaffirms the commitment of the French-speaking faculties of medicine regarding social accountability in the coming years. [ABSTRACT FROM AUTHOR]

Background: In Western countries, many children are affected by the separation of their parents. Our main objective was to assess the possible impact of parental separation family structure on certain aspects of somatic health in low-age children. Methods: We conducted a cross-sectional study based on data collected in the framework of free preventive medicine consultations in the French Community of Belgium. The data was derived from assessments conducted, between 2006 and 2012, on children 7 to 11 months after birth during which information of 79701 infants was collected regarding the risk of sudden infant death, psychomotor development, and development in terms of height and weight. The main outcome measures were: episode of risk of sudden infant death, polysomnography, home monitoring, psychomotor development, and body mass index. Results: The parents of 6.6% of the infants were separated. We established multivariable models, based on the presence or absence of confounders. The adjusted ORs (95% CI) of symptoms perceived as frightening, notably at night, of a prescription for a polysomnography, of an abnormal polysomnography result, and of follow-up by home monitoring were thus respectively 1.3 (1.1-1.6), 1.1 (0.9-1.3), 1.8 (1.3-2.4), and 1.3 (1.1-1.6). The adjusted ORs (95% CI) for psychomotor delay and for a body mass index above the 97th percentile were respectively 1.3 (1.0-1.6) and 1.2 (1.1-1.3) in the event of separation. Conclusions: This study confirms the possibility that not living with both parents is an independent risk factor for the somatic health and psychomotor development of infants. This observation should be verified because it would have a major impact on the actions of family doctors and other first-line healthcare providers, in particular with regard to information and targeted prevention. [ABSTRACT FROM AUTHOR]

Contexte : Un projet de recherche-action, dont l'objectif est d'expérimenter et d'évaluer la mise en œuvre d'une démarche de responsabilité sociale (RS), puis de démontrer l'utilité comme une stratégie de choix pour améliorer l'impact sur la santé, a été lancé en 2012. La phase 1 du projet est d'étudier la perception des facultés de médecine, de ses membres et de ses partenaires. Objectifs : - Présenter les résultats de la perception de la RS des facultés de médecine par différents acteurs ; - Proposer des actions pour améliorer l'appropriation de la démarche de RS. Méthodes : La phase 1 a débuté en novembre 2012. Tous les acteurs et partenaires (équipe décanale, enseignants, étudiants, société civile, autorités de santé) des facultés participantes ont été invités à répondre à un questionnaire en ligne sur leur perception (échelle de Lickert) de la réalité de la mise en œuvre des axes de RS dans leur contexte. Le questionnaire anonyme comprend deux sections : une portant sur les 10 axes et les sous-axes du Consensus mondial sur la responsabilité sociale, l'autre sur les caractéristiques socioprofessionnelles des répondants. Résultats : 28 facultés de médecine francophones réparties dans 14 pays se sont engagées dans le projet. La première phase s'achèvera en mars 2013. Les résultats seront présentés et discutés lors de la réunion du groupe des 28 facultés en avril 2013 à Tlemcen (Algérie). Les résultats seront utiles pour la préparation de la phase 2 : définition de normes et indicateurs, puis leur expérimentation dans le contexte facultaire. Les premières réunions de lancement dans les facultés ont montré l'appropriation effective des équipes décanales et des étudiants dans la concrétisation du projet. Conclusion : Une meilleure connaissance de la RS par différents acteurs permettra de mieux définir une démarche qualité des facultés et d'améliorer leurs actions pour mieux répondre aux problèmes prioritaires de santé publique. Le projet francophone contribue à la dynamique des facultés dans les pays et les régions. [ABSTRACT FROM AUTHOR]