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This paper explores how a new French law incorporating a new conceptualization of disability formulated at the international level by the WHO is appropriated at the local level by multidisciplinary teams of professionals in charge of the assessment of disability. Drawing on social representations theory, its concept of cognitive polyphasia and its conceptualization of legal innovation, the paper specifically examines how the teams deal with the tensions between the old and the new models of disability and how the group dynamic is associated with how they do this: by hybridization of old and new models, by selective prevalence according to context, or by displacement of one model. Focus groups with the teams (n = 65 from 10 groups), analysed with indicators of interaction, bring evidence of the three forms. They show how different groups, by drawing differently, depending on their relational dynamics, from a variety of meaning systems circulating at the cultural level, reach different decisions that may lead to different practices in the local implementation of the same laws. We finish by discussing how social representations theory, linking the cultural/global and the interactional/local levels, can enhance our understanding of how socio‐psychological processes intervening in the appropriation of legal innovations may produce different practical implementations of the same new laws. [ABSTRACT FROM AUTHOR]

Copyright of Developmental Medicine & Child Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Developmental Medicine & Child Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

We argue that the long-term care (LTC) policy reform in France results from a long-lasting evolution process that began in the 1980s and has led to the so-called ‘French compromise’. This combines elements of different types of a fragmented care system including health insurance schemes, domiciliary and residential social care providers, tax deductions and an important private insurance sector, not to mention the crucial contribution of informal caregivers in families. This article concentrates on policies in both the public and the private sectors, as well as their overall cost. We focus on the core of the LTC policy, namely the creation and then the reforms of the cash-for-care allowance (Allocation personnalisée à l'autonomie). The evolution of the policy process concluded, after the 2007 Presidential election, with the announcement of a new direction, which has not been implemented yet, but which has raised professional and social concerns. Evidence from France suggests that LTC reform can only take place from a new compromise between three poles of protection: the family, the market and the state. [ABSTRACT FROM AUTHOR]

This paper studies medical spending in France from three perspectives: concentration, persistence, and evolution before death. We use claims data from a representative sample of over 500,000 individuals covered by the National Health insurance scheme, from 2008 to 2013. These data contain individual-level information (gender, age, date of death), some clinical information and detailed information on each medical treatment (inpatient, outpatient, drugs). Medical spending in France is highly concentrated. In 2013, 10 per cent of the population accounted for 62 per cent of all health care spending. In addition, the concentration of medical expenditure increased between 2008 and 2013. The concentration of insurance reimbursement, however, is even greater, indicating that French social health insurance redistributes income from the healthy to the unhealthy. The serial correlation of health care expenditures appears relatively high between adjacent years, but not surprisingly decreases over time. Decedents have high medical expenditures - on average, eight times those of survivors - and resources devoted to health care in the last three years of life represent, on average, 22 per cent of lifetime medical spending. Decedents' expenditures decrease with age after 55 years old. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives Differences in the performance of medical care may be due to variation in the introduction and diffusion of medical innovations. The objective of this paper is to compare seven European countries ( United Kingdom, the Netherlands, West Germany, France, Spain, Estonia and Sweden) with regard to the year of introduction of six specific pharmaceutical innovations (antiretroviral drugs, cimetidine, tamoxifen, cisplatin, oxalaplatin and cyclosporin) that may have had important population health impacts. Methods We collected information on introduction and further diffusion of drugs using searches in the national and international literature, and questionnaires to national informants. We combined various sources of information, both official years of registration and other indicators of introduction (clinical trials, guidelines, evaluation reports, sales statistics). Results and conclusions The total length of the period between first and last introduction varied between 8 years for antiretroviral drugs and 22 years for cisplatin. Introduction in Estonia was generally delayed until the 1990s. The average time lags were smallest in France (2.2 years), United Kingdom (2.8 years) and the Netherlands (3.5 years). Similar rank orders were seen for year of registration suggesting that introduction lags are not only explained by differences in the process of registration. We discuss possible reasons for these between-country differences and implications for the evaluation of medical care. [ABSTRACT FROM AUTHOR]

New public management (NPM) is not only an Anglo-Saxon debate but also a French one, with some of its elements constituting structural components of the French state apparatus. How did it make its way into French hospitals? What core mechanism was at the center of NPM implementation in hospitals? We discuss the redisorganization of the health system under NPM, as it attempted to reassert the central government's power over regions and how it alienated the medical profession. The paper highlights inherent contradictions and other false promises within NPM. It was unable to contained cost, could no enhance accountability or increase civil participation. We then investigate post-NPM reforms in French healthcare. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

There has been an increasing interest in patient satisfaction assessment across nations recently. This paper reports on a cross-cultural comparison of the comprehensive assessment of satisfaction with care (CASC) response scales. We investigated what proportion of patients wanted care improvement for the same level of satisfaction across samples from oncology settings in France, Italy, Poland and Sweden, and whether age, gender, education level and type of items affected the relationships found. The CASC addresses patient's satisfaction with the care received in oncology hospitals. Patients are invited to rate aspects of care and to mention for each of these aspects, whether they would want improvement. One hundred and forty, 395, 186 and 133 consecutive patients were approached in oncology settings from France, Italy, Poland and Sweden, respectively. Across country settings, an increasing percentage of patients wanted care improvement for decreasing levels of satisfaction. However, in France a higher percentage of patients wanted care improvement for high-satisfaction ratings whereas in Poland a lower percentage of patients wanted care improvement for low-satisfaction ratings. Age and education level had a similar effect across countries. Confronting levels of satisfaction with desire for care improvement appeared useful in comprehending the meaning of response choice labels for the CASC across oncology settings from different linguistic and cultural background. Linguistic or socio-cultural differences were suggested for explaining discrepancies between countries. Copyright © 2002 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Introduction In developed countries, the physician-patient relationship is moving from a paternalistic model to new decision-making models that take patient preferences into account. Objectives Our aim was to develop a Decision Board (DB) and to test its acceptability in a French Regional Cancer Centre regarding the decision on whether or not to use chemotherapy after surgery in postmenopausal women with breast cancer. This paper presents the development process for this instrument and reports the pretesting phase, as well as the corresponding results. Methods A working group was created with oncologists, psychologists and economists. Following the first phase, i.e. the development process, a first version of the instrument was presented to health professionals. Their feedback led to important modifications of the instrument. The DB was then presented to experienced patients, which resulted in slight changes. The second phase consisted of pretesting the comprehension, internal and across-time consistency of the DB on healthy volunteers. Results The DB was pretested in a group of 40 healthy volunteers. Eighteen respondents chose chemotherapy and 22 chose not to have chemotherapy. Comprehension rates were very high (≥87.5%). Internal consistency was assessed considering option attitudes based on outcomes and option attitudes based on process. Women shifted their choices in a predictable way. Across-time consistency was appraised using the test-retest method with Visual Analog Scales. The Intraclass Correlation Coefficient was 0.97. Discussion-conclusion Due to cultural differences, the DB developed in our French Cancer Centre is quite different from the DBs previously developed elsewhere. Our instrument showed good comprehension and consistency properties, which are corroborated by the DB literature. Whether our DB is acceptable for patients with breast cancer must still be tested. Patients’ reactions will tell us which type of decision-making model... [ABSTRACT FROM AUTHOR]

Aim: To gather information from nurses and allied health professionals in the French context of the emergence of research in the field so as to inform the development of a new tool: The research in nursing and allied health sciences' Ideas Generator (GénI) capable of sustaining the identification of research ideas from professionals in the field. Background: In many countries, research in nursing and allied health sciences remains underdeveloped. Introduction: Before developing the Ideas Generator tool, it was essential to explore professionals' basis of reference in providing care, then investigate (1) their representation of research in this field of science and (2) their perception of needs for and obstacles to starting a research process. Methods: The qualitative research design used focus groups. The study population included 24 participants naive to research in four hospitals in eastern France (13 nurses and 11 allied health professionals). Thematic analysis was used to analyze the data. The study was reported in compliance with the consolidated criteria for reporting qualitative research criteria. Findings: Professionals used tacit knowledge and their experiences to address care, but the culture of scientific evidence was clearly missing (lack of knowledge of the origin of care guidelines, few bibliographic skills). Participation in a research process could hardly be envisaged without a supervised collaboration with a physician. Research was perceived not to be part of professionals' culture. They self‐censured for lack of methodological competencies. Discussion: Findings underlined some leverage, obstacles, and need to consider to generate a stimulation in the field, especially in countries where such research is still in its infancy. Implication for nursing, health, and education policy: Strengthening the field of nursing and allied health research is essential to extend the skills of nurses and allied health workers and to improve the quality of patient care by taking into account results from the literature. The Ideas Generator tool will be implemented to sustain learning the skills of research through education and training. [ABSTRACT FROM AUTHOR]

Objective: The authors present an account of the current state of sectorization in France and its development over the last decade. Method: The paper is based on statistics collected by the French Health Ministry and on relevant laws and regulations. Comments by patients, families and professionals are presented. Results: The supply of mental health care is usually satisfactory, and there is a tendency for in-patient units to be converted into day hospitals. There is a large disparity between regions, especially in child and adolescent psychiatry. The 1838 law governing compulsory admissions was revised in 1990, and this revision was the object of a commission of inquiry in 1995. Psychiatric units work on the borders between health and social services and are forging new links between the two. Conclusion: Psychiatric care requires an integrated health and social perspective. In the field of mental health legislation European recommendations are called for. [ABSTRACT FROM AUTHOR]

This paper describes how the categorisation of patients by staff in a French emergency department (ED) leads to the micro-rationing of care. Although ED staff are reluctant to acknowledge it, they refuse to treat many would-be patients at the reception stage, and advise them to go to other care settings (such as general practitioners’ premises or social dispensaries). The study analyses the judgmental categories staff use to decide patients’ eligibility for care, paying particular attention to their clinical, organisational, moral and social dimensions. Staff ration care at the point of service delivery but they soften the harshness of the rationing by making a positive discrimination in favour of those seen to be in real need. Data from observations and interviews are used to analyse the tensions between the different models of ‘local justice’ employed by doctors. [ABSTRACT FROM AUTHOR]

Highlights the presentation of the research paper entitled "Nurses - A Disappearing Species," Marie-Paule Florin, former President of the French Nurses Association, at the Le Touquet-Paris-Plage, France. Contents of the research paper; Problems of the nursing sector commented by Florin in the research paper; Need to create structures of nursing and to integrate present structures with levels in planning.

This paper seeks to analyze the political factors involved in health care delivery in a modern industrial welfare state and to illustrate how the transformation of the French state has affected the policymaking environment surrounding this particular issue. Cultural traditions rooted in the nineteenth century seriously circumscribed the role of the state in defining the conditions of medical practice. Nonetheless, pressures emerging since 1945 for the provision of a wide array of social services have drawn the state into ever closer regulation of the health sector. The economic constraints of the past decade resulted in state-imposed cost-containment policies which accentuated the trend toward politicization of health care. In consequence, and despite the rear-guard defensive tactics of the medical profession, the French state has succeeded in firmly establishing its primacy in this major area of public policy. [ABSTRACT FROM AUTHOR]

This article presents various news items related to nursing. Nurses attending the 19th Congress of the International Council of Nurses in Seoul, Korea, from May 28, 1989 to 2 June, 1989, will try to answer many questions about the future of nursing. Training in Family planning for physicians, nurses, midwives and other health staff appears to be very unsatisfactory in most countries of the World Health Organization's (WHO) European Region, according to a recent report "Training in Family Planning for Health Personnel." The publication based on a WHO meeting held in Paris, France during July 6-11, 1981, has been published by the WHO European Office, Copenhagen.

In this article the author reflects on the sustainable expansion of harm reduction services for drug users in the U.S. He notes that one of the purposes of their paper is asking if it should occur within a separate health care system for drug users or within the mainstream health care system. He cites the concept of harm reduction in the European Union (EU), France, and Australia and states that continued cross-national research on the issue may be helpful.

Though the government pledged to cut the public deficit from 7.7% of the gross domestic product in 2010 to 3% by 2013, thereby responding to EU Normative power, health expenditures continue to rise, because public demands are higher and more social problems are handled in the health care setting. With French budget deficit threatening France's credit rating, novel instruments were needed. These included corporate management recipes (e.g., pay for performance contracts, patient volume targets, and management by objectives), new compensation mechanisms (e.g., activity‐based accounting and a nationwide scale of health care costs) and far‐reaching laws (e.g., the 2009 HPST bill). Our approach investigates some critical elements of the French health care system. We focus on primary (e.g., family physicians and General Practitioners) and secondary (e.g., hospital and specialty) care. We explore how policies such as the standardization of health services, the regrouping of health policy decisions within the larger Regional Health Agencies, affected citizens' engagement and physicians' autonomy. A French welfare elite pursued a hybrid strategy, regulating quasi‐markets of care providers in a postcompetitive government, while creating supportive conditions for a vibrant private hospital sector. Reforms also emphasized evidenced‐based policy, outputs‐rather than outcome‐measurement, and performance evaluation in a bid to streamline the delivery of health services. [ABSTRACT FROM AUTHOR]

Background: Temporal ecological studies have shown that outdoor moulds are associated with severe asthma exacerbations, as emergency department visits or hospitalisations. The aim of this was to assess the associations between daily sales of short‐acting β2‐agonists (SABA), a specific and frequent treatment for control of mild asthma exacerbations in children and young adults, and outdoor mould concentrations in the central France area over a 5 year period. Methods: The relationship between daily changes in mould (25 species) concentrations and daily SABA sales within a population of patients aged 6 to 39 years in a middle‐size town of central France (approximately 127,000) was obtained from social security database and analysed with generalized additive models, taking into account confounding factors (air pollution, weather conditions, pollen counts and trend). Results: Daily SABA sales (mean, SD) rose from 17.3 (9.7) in 2010 to 22.7 (12) in 2015. The relative risk (RR [95% CI]) of SABA sales associated with an interquartile increase in mould concentration was significant in the whole population for Alternaria 1.06 [1.002–1.12]. When the influence of age and sex was accounted for, the relationship was significant only in 6–12 years old males for Alternaria 1.21 [1.04–1.41] and Aspergillus –Penicillium 1.08 [1.04–1.12]. Conclusions: Daily SABA sales are positively associated with Alternaria spores in the general population of children and young adults. The association between daily SABA sales and temporal changes to Alternaria and Aspergillus –Penicillium in male children indicate that outdoor moulds contribute to asthma morbidity. [ABSTRACT FROM AUTHOR]

Addictovigilance is a health vigilance dedicated to the survey of medicinal or illicit psychoactive substance use disorders (SUDs). France is the only European country to have a vigilance system specifically dedicated to substances with an abuse/addiction potential. The French Addictovigilance system is organized in a network of regional tertiary centres (called Abuse and Dependence Monitoring Centres, CEIP‐Addictovigilance) and works in close collaboration with Regional and National health authorities. Because of the essential and unavoidable nature of their practice in the French Healthcare system, general practitioners (GPs) are key actors to identify and track Addictovigilance signals. They have been involved in several of the pharmacoepidemiological surveys implemented by the French Addictovigilance Network (FAN). Now, they increasingly participate in clinical research projects and studies. In this article, interactions between GPs and the FAN are illustrated with two examples: patients on opioid substitution treatment and patients on opioid analgesics. Collaborations between GPs and the FAN could be further potentiated. In particular, more effective communication on psychoactive SUDs including abuse/addiction is necessary to optimize the implementation of preventive measures for patients on psychoactive substances medications, and to improve the attitudes of GPs and more widely health professionals in the management of any psychoactive user suffering from SUDs. In addition, both adapted training and improved collaborative research could contribute to the optimization (safety, quality) of professional practices. [ABSTRACT FROM AUTHOR]

Nursing historians well understand the importance of' history in furthering the understanding of' nursing practice, the profession, and the healthcare and social systems in which nursing takes place. These are all important issues for readers of nursing inquiry. One of the most important functions a historical perspective performs is to shatter the historical illusion that the problems and challenges faced by contemporary nurses, patients and healthcare providers are solely by-products of' the here and now. The struggle for control of nursing practice and negotiations over the elastic boundaries of' nursing knowledge, skill and work have formed the basis of heated battles since at least the rise of the "clinic" in eighteenth-century France.

Aim: Since 1999, the development of more than 100 “Maisons des Adolescents” (MDAs) has enabled young persons to gain access to specific care in integrated youth‐friendly facilities in France. To contribute to the development and standardization of international youth‐friendly health care services, this review provides insight into the French MDA facilities. Methods: This socio‐historical analysis includes a systematic review of articles referring to the MDAs (selection through title and/or abstract), ministry reports and newspaper articles, from 1999 to 2018. Results: If the various medical programmes of MDAs depend on the priorities of local teams rather as well as on official regulations, all MDAs offer the following essential services: a “Health and Prevention Space” open daily; multidisciplinary consultations; a mobile team visiting youth hospitalized in medical units; a mobile team able to meet adolescents at their homes; an open centre for art workshops; refresher and remedial courses for school work; network meetings and parent support groups. The MDAs from the start addressed an age group (young people aged 11‐21 years) rather than an illness. They thus provide primary prevention for adolescents according to the World Health Organization definition of health as “a state of complete physical, mental and social well‐being.” This medical and political movement was shaped by the epistemological background of its first leaders. Conclusion: Although more cohort studies to evaluate their early interventions would be useful, the success of the MDA network is already widely acknowledged by users, professionals and policy makers. [ABSTRACT FROM AUTHOR]

Abstract: This article reconstructs the socio‐historical processes that have led to the formal inclusion and marginalization of “irregular migrants” in the French public health insurance system and the parallel legal production of exclusion of a share of this group. It interrogates the binary inclusion/exclusion in the field of healthcare linking it to the logic of sovereignty and governmentality in a stratified society. It shows how these processes have led to unequal health practices and increased obstacles to accessing health insurance and healthcare providers, and, consequently, has resulted in the exclusion of a share of this group from the regular healthcare system. These two levels of discrimination are illustrated using empirical research on departments in French public hospitals that have been designed to enable access to care for individuals without insurance (Permanence d'accès aux soins de santé, or PASS: health care access units). [ABSTRACT FROM AUTHOR]

Public value appears to be reborn out of the ashes of earlier failed new public management (NPM)-driven policies in health care. It advocates greater consultation of the civic society and autonomy of public managers in decision-making. In France, the 2009 Hospital, Patient, Health, and Territory law recentralized the health system and strengthened the central government to restore consistency in policy implementation and address earlier NPM shortcomings. The 2014 Health Project heralds a phase of policy hybridization that not only preserves earlier NPM tools but also seeks to reaffirm the role of the public and the medical profession in the governance of the health system. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

High blood pressure in pregnancy remains, by its complications, the leading cause of morbidity as well as maternal and fetal mortality. The frequency (5-10% of pregnancies) and the potential severity of this disease, for both mother and child, encourage to standardize and to optimize our medical practices. If the short-term complications for the mother and child are well known, long-term ones for the mother are beginning to be better identified. The onset of hypertension during pregnancy disrupts the classic organization of health care and requires the intervention of the general practitioner and/or an obstetrician, a gynecologist, a midwife, a cardiologist, a nephrologist. There is not always a care coordinator, and decisions are sometimes taken with delay. This is what drove the French Society of Hypertension, in partnership with the French National College of Gynecologists-Obstetricians, to develop a consensus proposing easy-to-use guidelines. Educating women and all health professionals to hypertension and its management, in line with current scientific data, is one of the major challenges of this consensus. [ABSTRACT FROM AUTHOR]

We evaluated the cost-effectiveness and the budget impact of new DAA-based regimen use in France. A Markov model simulated chronic hepatitis C ( CHC) treatment interventions with IFN-based and IFN-free regimens at stage of fibrosis ≥F3, ≥F2 or regardless of fibrosis stage, and treatment either with the least or the most expensive combination. It estimated quality-adjusted life years ( QALYs) and incremental cost-effectiveness ratios ( ICERs). It also assessed the budget impact over 5 years of treating all CHC-screened patients, regardless of fibrosis, assuming ≤20 000 patients treated/year and priority to ≥F3. Sensitivity analyses were also conducted. For genotypes (G) 1-4, the initiation of IFN-free regardless of fibrosis was a cost-effective strategy compared to prior standard of care ( SOC) initiated at stage F2: €40 400-88 300/ QALY gained in G1; similar results were obtained for patients infected with G4. Considering G2-3, the most cost-effective strategy was IFN-based regimens regardless of fibrosis compared to prior SOC initiated at stage F2: €21 300 and €19 400/ QALY gained, respectively; the strategy with IFN-free regimens being more effective but not cost-effective at current costs. The budget impact of treating all CHC-screened patients over 5 years would range between 3.5 and 7.2 billion €, depending on whether one considers the least or the most expensive combination of new DAAs and whether one treats G2-3 with IFN-based or IFN-free new DAAs. In France, treatment initiation with new DDAs regardless of fibrosis stage is cost-effective, but would add 3.5-7.2 billion € to an already overburdened medical care system. [ABSTRACT FROM AUTHOR]

Objective Fall-related visits to emergency departments ( EDs) are common among older individuals. We aimed to assess effectiveness of a healthcare intervention program for the management of elderly patients admitted to EDs after a fall. Methods Using a before-after observation method, we investigated ED healthcare staff practices related to fall-related injuries in 2010 (period 1) and 2012 (period 2) in 13 centers participating in the Northern French Alps Emergency Network. Following the identification of initial weaknesses, several information and training tools were introduced between the two periods to improve patient management. All individuals aged 75 years or over who presented to an ED after a fall were included in the study. We reviewed the completeness and quality of medical records during both periods and compared the rate of clinical-paraclinical check-ups performed, geriatric evaluation/assessment in the ED, and the 1-month recurrence of visits to the ED for the same reason. Results During period 1, a total of 2,425 falls were recorded, while 2,684 were reported in period 2. The 2012 medical charts contained significantly more information about risk factors than those of 2010. An electrocardiogram (64% vs. 53%; p < 0.001), biologic check-up (65% vs. 57%; p < 0.001), balance, orthostatic hypotension, and cognitive impairment tests were more often performed in 2012. There was no change in the hospitalization rate, although short-duration hospitalization in the ED was more frequent in 2012. Geriatrists were more often consulted by patients in 2012 (18% vs. 13%; p < 0.001) and more involved in ED evaluation and hospitalization. The intervention program had a beneficial impact on the fall recurrence rate ( n = 29 [3.6%] in period 1 and n = 17 [2.0%] in period 2; odds ratio = 0.52; p = 0.037), which significantly decreased between 2010 and 2012. Conclusions The intervention program was associated with a decrease of fall recurrence. Further efforts should be made in EDs to ensure a sustained level of satisfactory and long-lasting management of the elderly. [ABSTRACT FROM AUTHOR]

General measures of self-rated health are collected routinely in national health surveys and widely used in the analyses of determinants of health and health care utilization. However, these subjective assessments can be influenced by health expectations (contextualized beliefs about health) that may vary systematically across individuals and be associated with their socio-demographic characteristics. Our objective is to contrast the impact of health expectations associated with respondent characteristics (reporting heterogeneity) on self-rated feelings of sadness, lowness or depression obtained from general population samples in France and Vietnam. Based on self ratings and ratings in response to common anchoring vignettes depicting different levels of depression, we used nationally representative data from the World Health Survey conducted in France (2002) and Vietnam (2002-2003) and a modification of the standard probit model to test and adjust for reporting heterogeneity associated with individual characteristics. We find evidence of reporting heterogeneity within France and Vietnam and across the two countries. In particular we find that, when adjusted for reporting heterogeneity, sex is no longer significantly associated with self-rated feelings of sadness, lowness or depression in France. Given the absence of clear biological markers in the definitions of depressive disorders and the substantial impact reporting heterogeneity is shown to have, measures of depressive disorders based on self-reports should be interpreted with caution. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

In response to increasing care needs, the reform or development of long-term care (LTC) systems has become a prominent policy issue in all European countries. Cash-for-care schemes-allowances instead of services provided to dependents-represent a key policy aimed at ensuring choice, fostering family care, developing care markets, and containing costs. A detailed analysis of policy documents and regulations, together with a systematic review of existing studies, was used to investigate the differences among six European countries (Austria, France, Germany, Italy, the Netherlands, and Sweden). The rationale and evolution of their various cash-for-care schemes within the framework of their LTC systems also were explored. While most of the literature present cash-for-care schemes as a common trend in the reforms that began in the 1990s and often treat them separately from the overarching LTC policies, this article argues that the policy context, timing, and specific regulation of the new schemes have created different visions of care and care work that in turn have given rise to distinct LTC configurations. A new typology of long-term care configurations is proposed based on the inclusiveness of the system, the role of cash-for-care schemes and their specific regulations, as well as the views of informal care and the care work that they require. [ABSTRACT FROM AUTHOR]

The activities of 'expert patients' or 'patient tutors', who help educate their peers, are gaining recognition in the health care system. This study investigates the role played by such patients in therapeutic education programmes organized by caregivers to validate the role of patients in implementing the therapeutic education of haemophilic patients and to define the skills required for such activities. This study employs the consensus methodology recommended by France's National Authority for Health. The working group includes seven caregivers from Hemophiliac Treatment Centers (HTCs) and three patients from the French Association of Hemophiliacs (FAH). The role of patients in haemophilia education is recognized. Patients participating in the education of their peers are referred to as 'patient resources'. A patient resource should be an adult, a volunteer and live in the same region as his peers. Candidates are chosen by the FAH and the HTCs to serve based on their motivation to facilitate the education of other patients as well as on their psychological and pedagogical aptitudes. A patient resource participates in the conception and administration of therapeutic education programmes. He also mediates between the caregivers and the patients. He ensures that the patients understand the material and are able to apply their knowledge in daily life. His activities are governed by professional ethics. Seven categories of skills were defined, permitting the group to determine precisely which skills are required to function as a patient resource. Supervision of the patients is planned to reinforce reflexive practices in the patients. Evolution of the health care system has led patients to become involved in therapeutic education. This phenomenon calls for a framework to be developed and an evaluation of its eventual effects. [ABSTRACT FROM AUTHOR]

Rationale and objectives Analgesia is a recommended practice for pain treatment in prehospital emergency medicine, but all experts note suboptimal pain relief or oligoanalgesia. The increase in the Care Workload (CW) and the Medical Treatment Duration (MTD) linked to analgesia are two explanatory factors, and they are representative of the unavailability of a prehospital team. The unavailability of a team is an opportunity cost which is probably the most important cost within the framework of prehospital emergency. The aim of this study was to analyse the influence of analgesia use on the availability of prehospital emergency teams. Methods This study was a prospective, multicentre cohort study conducted in 10 French Mobile Emergency and Resuscitation Services (MERS) between September 2001 and June 2003. A case–control study was performed including 568 case patients who received analgesia matched with controls based on diagnosis and severity. The pairs were compared for MTD and CW. Results No significant difference between cases and controls was found concerning MTD ( P = 0.134). Conversely, a difference was found for CW ( P < 10−4), with a mean value of 53.7 Project Recherche Nursing (PRN) points for the cases and 45.8 PRN points for the controls. Conclusions This study shows that analgesia generates an additional CW without increasing the MTD, and does not hinder the MERS teams' availability. This economic result should improve adherence to these clinical practice guidelines. Thus, analgesia appears to be a factor of productivity in the current context of economic pressures in terms of the funding of the healthcare system. [ABSTRACT FROM AUTHOR]

Germany, France and the Netherlands all have specific ‘Bismarckian’ health insurance systems, which encounter different and specific problems (and solutions) from those of national health systems. Following a relatively similar trajectory, the three systems have gone through important changes: they now combine universalization through the state and marketization based on regulated competition; they associate more state control (directly or through agencies) and more competition and market mechanisms. Competition between insurers has gained importance in Germany and the Netherlands and the state is reinforcing its controlling capacities in France and Germany. Up to now, continental health insurance systems have remained, however, Bismarckian (they are still mainly financed by social contribution, managed by health insurance funds, they deliver public and private health care, and freedom is still higher than in national health systems), but a new ‘regulatory health care state’ is emerging. Those changes are embedded in the existing institutions since the aim of the reforms is more to change the logic of institutions than to change the institutions themselves. Hence, structural changes occur without revolution in the system. [ABSTRACT FROM AUTHOR]

The article presents a study that examines the evolution of the cultural care program of Soins Culturels in Paris, France. The program of Soins Culturels for the young inpatients states three main aims: to bring life into hospitals; to integrate culture into medical treatment; and to introduce topics for action and reflection.

Background Despite many economic and political similarities between France and Canada, particularly in their health care systems, there are very significant differences in their systems of medical education. Aim This work aims to highlight the sociohistorical values of each country that explain these differences by comparing the medical education systems of the 2 countries, including medical schools (teachers, funding), key processes (curriculum, student selection) and quality assurance methods. Discussion In France, means and processes are standardised and defined at a national level. France has almost no national system of assessment of medical schools nor of students. By contrast, Canada leaves medical schools free to design their medical curricula, select students and appoint teachers using their own criteria. In order to guarantee the homogeneity and quality of graduates, the medical profession in Canada has created independent national organisations that are responsible for accreditation and certification processes. Each country has a set of founding values that partly explain the choices that have been made. In France these include equality and the right to receive free education. In Canada, these include equity, affirmative action and market-driven tuition. Conclusion Many of the differences are more easily explained by history and national values than by a robust base of evidence. There is a constant tension between a vision of education promoted by medical educators, based on contextually non-specific ideas such as those found in the medical education literature, and the sociopolitical foundations and forces that are unique to each country. If we fail to consider such variables, we are likely to encounter significant resistance when implementing reforms. [ABSTRACT FROM AUTHOR]

OBJECTIVE To assess the bothersomeness and impact on quality of life (QoL) of urinary incontinence in community-dwelling women in France, Germany, Spain and the UK. SUBJECTS AND METHODS A detailed follow-up questionnaire was mailed to 2960 randomly-selected women who had reported symptoms of urinary incontinence in an earlier survey of 29 500 representative households in four European countries. In the second questionnaire, women were asked about the severity of their symptoms, the impact of urinary incontinence on their QoL, and how bothersome their incontinence was. RESULTS A total of 1573 women responded to the follow-up questionnaire, of which >80% reported that their urinary incontinence symptoms were bothersome. The greatest negative effect appeared to be on physical activities, confidence, self-perception and social activities, with a statistically significant correlation between an increase in bothersomeness and an increase in severity of symptoms. Similarly, a negative impact on QoL was associated with an increase in severity of incontinence. The variables: country, urinary incontinence type, severity, age, number of medical conditions and number of leakages had a statistically significant influence on the bother and the validated incontinence QoL (I-QoL) questionnaire scores. CONCLUSION The extent to which women are bothered by their urinary incontinence and report that their symptoms have a negative impact on their QoL is largely subjective. In determining the most appropriate management, physicians should consider the experience of being incontinent as unique to each individual. [ABSTRACT FROM AUTHOR]

Abstract Objective This article looks at how users and doctors in France have rethought the question of shared decision-making in the clinical field of haemophilia following a major crisis – that of the infected blood affair. Design We did a qualitative survey based on semi-structured interviews in three regions of France. Setting and participants The interviews covered 31 clinical doctors of haemophilia and 31 users: 21 adult males with severe haemophilia (21/31), infected (14/21) or not (7/21) with HIV, the infected wife of one of the latter (1/31) and nine parents of young patients with severe haemophilia (9/31), either HIV positive (6/9) or negative (3/9). Results and conclusions The results show the infected blood affair to be a major individual and collective ordeal. It has caused users and doctors to rethink their roles within clinical relationships and to develop new ways of sharing medical decision-making. Prior to the crisis, the dominant model was based upon a distinction between the medical aspect, governed by the doctors, and the psychosocial aspect, which involved the patients and their families. Since the crisis, medicoscientific knowledge has been shared between users and doctors. This general trend nevertheless permits the existence of different patient, family and doctor profiles which in turn correspond to different notions of what a clinical decision should be. Some users remain attached to the idea of complementarity between doctors and patients (new partnership model), whilst others put doctors and patients on an equal footing (negotiation model). On the doctors’ side, whilst some still prefer the initial model for therapeutic decision-making, the majority have reassessed their perceptions and viewpoints. A certain number believe that decisions should be made by both doctor and patient in accordance with scientific procedures (decision-making controlled by scientific standards) or regulatory procedures (decision-making controlled by legal standards). Yet others feel that multiple points of view are acceptable within the decision-making process (decision-making model as interactivity). [ABSTRACT FROM AUTHOR]