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Background: In France, advance directives are favourably perceived by most of the population, although the drafting rate is low. This ambivalence is challenging because advance directives are meant to promote the autonomy and freedom of choice of patients. The purpose of this study was to analyse the content of advance directives written by patients suffering from malignant haemopathies to better understand how patients put them into practice. These could be relevant as early as the initial diagnosis of haematological malignancies because of the uncertain course of the disease., Methods: This was a multicentre, qualitative, descriptive study. The advance directives written by patients with malignant haemopathies treated in one of the six French hospital departments were included in the study from 01/06/2008 to 15/04/2016. A thematic analysis of the advance directives was performed by two researchers: a senior haematologist and a research assistant., Results: The median age of the patients was 69. Most were women (sex ratio: 0.59), living as a couple (57%), with lymphoid pathologies (66%), who were still alive two years after the instructions were written (63%) and had nominated a health care proxy (88.6%). Free texts (62.9%) were richer in content than pre-defined forms. The advance directives were used in three ways: for a purely legal purpose, to focus on medical treatments or actions, or to communicate a message to the family. Three main themes emerged: (1) refusal of medical treatment (100%), in which patients express refusal of life-sustaining care (97.1%). The actual treatments or the moment when they should be limited or stopped were not always mentioned in detail. (2) A desire for effective pain relief to avoid suffering (57.1%) and (3) messages for their family (34.3%), such as funeral arrangements (17.1%) and messages of love or trust (14.3%)., Conclusions: Patients who write advance directives are not necessarily at the end of their lives. Their content mainly conveys treatment wishes, although patients also use them to pass on personal messages to their close family. This emerging role of advance directives to communicate messages within the family should be valued, even if it is not their original purpose.

We evaluate the introduction of various forms of antihypertensive treatments in France with a distribution-sensitive cost-benefit analysis. Compared to traditional cost-benefit analysis, we implement distributional weighting based on equivalent incomes, a new concept of individual well-being that does respect individual preferences but is not subjectively welfarist. Individual preferences are estimated on the basis of a contingent valuation question, introduced into a representative survey of the French population. Compared to traditional cost-effectiveness analysis in health technology assessment, we show that it is feasible to go beyond a narrow evaluation of health outcomes while still fully exploiting the sophistication of medical information. Sensitivity analysis illustrates the relevancy of this richer welfare framework, the importance of the distinction between an ex ante and an ex post approach, and the need to consider distributional effects in a broader institutional setting., (Copyright © 2017 John Wiley & Sons, Ltd.)

The proportion of unsanitary housing in French overseas departments is much higher than in mainland France. Reunion Island is no exception to this fact. Between 80 and 90% of housing in Reunion Island was built by squatters with no legal claim or deed to the property. This has resulted in uncontrolled urban sprawl with living conditions reminiscent of those in developing countries. The absence of adequate drainage systems for sewage and rain water and the lack of properly organized garbage disposal that characterizes these sprawl areas constitutes a particularly favorable breeding ground for vector-borne diseases, especially chikungunya. Thus, implementing measures to control this type of settlement and to relocate of people out of existing sprawl areas constitutes a significant tool to control this epidemiological risk. Up to now, public officials have shown a clear reluctance to intervene in sprawl areas despite good knowledge of their location. On June 26th of this year, a law containing provisions relative to the control of urban sprawl and unsanitary housing in overseas departments and territories will come into effect. This law should provide public officials with the legal basis that has up until now been lacking to take action. Persistence in the "wait-and-see" attitude could lead to condemnation by French or European courts.