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This paper analyzes whether repealing net neutrality (NN) improves ordecreases the capacity of a regulator to make internet service providers(ISPs) extend broadband coverage through universal service obligations(USOs). We model a two-sided market where a monopolistic ISP links contentproviders (CPs) to end users with a broadband network of a given bandwidth.A regulator determines whether to submit the ISP to NN or to allow it tosupply paid priority (P) services to CPs. She can also impose a broadbandUSO to the ISP, i.e. she can mandate the broadband market coverage. We show that the greater is the network bandwidth, the more likely the repeal of netneutrality increases ISP profits and social welfare. Regulation can still benecessary, however, as there are bandwidth ranges for which the ISP wouldbenefit from a repeal of NN while such a repeal is detrimental to society. JEL: D21, K23, L12, L51, L96

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., SCOPUS: no.j, info:eu-repo/semantics/published

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 requiresfleshing out three similar principles, namely, beneficence, medical and public health engagement in favour of health equality, and community and individual participation; andadopting 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., SCOPUS: no.j, info:eu-repo/semantics/published

International audience; 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.; La France et la Corée du Sud ont mis en place des programmes des coupons chèques pour lutter contre la précarité énergétique. Contrairement aux biens visés par les programmes de coupons traditionnels, la structure du marché qui prédomine dans l'approvisionnement énergétique est l'oligopole. Dans cet article, nous étudions l'impact prix des coupons dans cette structure de marché. Nous énonçons d'abord les conditions d'élasticité de la demande qui rendent le choix de ces chèques conforme à l'objectif du régulateur d'éliminer la précarité énergétique. Nous modélisons ensuite un jeu entre les fournisseurs d'énergie et le régulateur, où les fournisseurs maximisent le profit tandis que le régulateur s'assure qu'aucun consommateur ne dépense plus qu'une part donnée des revenus sur l'énergie. À partir d'un cas de référence sans chèque, nous montrons que les bons réduisent le prix de l'énergie lors de la prise de décision simultanée ou lorsque le régulateur joue en premier. Cependant, l'impact des coupons sur les prix est ambigu si les entreprises décident des prix en premier. Le prix de ce scénario est supérieur au prix du prix du scénario de décision simultanée.

Contexte : Le Consensus mondial sur la responsabilité sociale (RS) des facultés de médecine a été validé en 2010. L’applicabilité des concepts de RS a été très peu investiguée. But : L’objectif était d’abord d’évaluer la perception des concepts de RS chez les participants et ensuite d’évaluer les actions de RS conduites et celles souhaitées dans les facultés de médecine. Cet article analyse les résultats concernant les actions de RS. Sujets et méthodes : Un auto-questionnaire anonyme en ligne a été adressé à différents acteurs dans 20 facultés francophones de dix pays : doyens et équipes décanales, enseignants, étudiants et acteurs de la société civile. Le questionnaire ouvert identifiait les actions conduites de RS et celles souhaitées. Les occurrences des actions regroupées en thématiques ont été calculées. Elles ont été comparées aux occurrences du Consensus mondial. Les verbatim ont été analysés. Résultats : Au total, 425 participants ont été inclus, dont 41,5 % d’enseignants et 28,0 % d’étudiants. Pour les actions conduites, les principales occurrences retrouvées étaient « enseignements » et « acteurs d’enseignements » ; les principaux verbatim rapportaient la révision des curricula de formation et l’enseignement de la médecine de famille. Quant aux actions souhaitées, les « mesures d’impact des actions de RS », la révision des enseignements pour mieux répondre aux besoins de santé et le développement des stages dans la communauté étaient retrouvés. Conclusion : L’importante participation, notamment des étudiants, confirme l’intérêt, mais aussi l’avancée des concepts de RS dans les facultés des différents pays. De nombreuses innovations sont proposées par les différents acteurs. Des approches adaptées de formation et de stratégies répondant aux attentes des différents acteurs sont à mettre en œuvre.

Background People with substance use disorder, and pregnant women especially, are subject to a lot of stigmas, which can prevent optimal accessibility and quality of care. In this survey, we investigated attitudes of final year medical students regarding substance use during pregnancy and identified the factors that influence these attitudes. Method This cross-sectional study was conducted in 2019 and 2020 in Belgium using the short version of the “Substance Abuse Attitude Survey” questionnaire. We focused on two items regarding punishment of substance use during pregnancy. We analysed the concordance between these two, their correlation with other items (e.g. stereotyping, morality, forced withdrawal, low treatment optimism) and the association between respondents’ opinion on punishment and their sociodemographic data. Results The response rate was 65.2% (370/567 online and face-to face questionnaires). 19.2% of respondents were in favour of punishment for alcohol use (n = 353) and 15.1% for drug use (n = 356) during pregnancy. The agreement analysis between the two items showed that 14.3% of students were in favour of punishing both pregnant women who use drugs and those using alcohol. Respondents tended to be more in favour of punishment if they were male students, older, their mothers’ had a lower education level or had no personal or family history of substance use. Attitudes appeared to be more punitive among students with limited contact with people with substance use disorder (i.e. none or limited to hospital). Students intending to specialise in internal medicine were more in favour of punishment of women whereas none of those intending to specialise in psychiatry were in favour. Conclusion Our study shows that about 20% of surveyed medical students favoured punishing substance-using pregnant women. Awareness and training work seems to be necessary to ensure adequate care and support for this already vulnerable population.

Early pregnancies are often linked to precarious situations. Even if Belgium has seen a decrease in teenage pregnancies, in the former mining region of the Hainaut there are still twice as many births to young women under 20 compared to the national rate. Colfontaine is one of the poorest cities in Belgium. Last year, one of the local high schools counted 10 pregnant teenagers out of 450 students. Médecins du Monde was already present in the city at the time with a mobile health clinic called the Médibus. In response, we carried out a mapping of the local sexual and reproductive health actors. The lack of accessibility to social and health structures capable of welcoming teenagers anonymously and free of charge quickly emerged as a problem, the nearest family planning center being located 30 minutes away by bus. In September 2019, in partnership with 5 local health actors, we decided to reshape the Médibus into the Adobus in order to offer family planning consultations, health promotion and harm reduction activities at the high school once a week. In addition to offering health information services, we also aim to detect teenagers experiencing vulnerable situations such as addiction, violence, gender issues and refer them to appropriate services. Halfway through the project, we met 430 teenagers in 14 afternoons. The most common reasons for consultation (N = 310) were questions related to contraception for 29% and to sexually transmitted infections for 24,5%. 70,9% of teenagers received condoms and 13 girls were tested for pregnancy. One girl received a morning-after pill. 3 teenagers with addiction problems and 17 victims of violence were detected. The teams referred 18 teenagers to other services. The success of this outreach project confirms the need for information regarding sexual and reproductive health for teenagers living in precarious situations as well as the need to develop reachable and affordable sexual and reproductive health services in semi-rural areas. Key messages Outreach is an efficient approach to respond to teenagers’ needs in poor semi-rural areas. Outreach facilitated the detection of early pregnancies, addiction and violence issues among teenagers.

In vielen Bereichen des Maschinenbaus und der Automobilindustrie werden immer kleinere und leistungsfähigere Antriebslösungen benötigt. Dabei sind die Belastbarkeit, die Baugröße, der Wirkungsgrad und die akustischen Eigenschaften die Hauptkriterien eines Antriebs. Aufgrund der Anforderungen an Drehmoment und Drehzahl werden kleine Antriebe häufig mit einem Untersetzungsgetriebe ausgestattet. Ein in Kooperation mit der imk automotive GmbH entwickeltes Getriebe ist auf diese Anforderungen ausgelegt und wird im folgenden Artikel beschrieben. Ein erster Prototyp wurde hergestellt und mit einem Prüfstand getestet, um Verbesserungspotential aufzudecken. Zusätzlich zur Messung des Wirkungsgrades wird eine Fast Fourier Transformation der gemessenen Signale durchgeführt, um Abweichungsquellen zu identifizieren., In many areas of mechanical engineering and the automotive industry, ever smaller and more powerful drive solutions are required. The main criteria of a drive are the load capacity, size, efficiency and acoustic properties. Due to the torque and speed requirements, small drives are often equipped with a reduction gear. A gearbox developed in cooperation with imk automotive GmbH is designed to meet these requirements and is described in the following article. A first prototype has been produced and tested with a test bench to detect potential for improvement. In addition to measuring the efficiency, a Fast Fourier Transformation of the measured signals is performed to identify sources of deviation., IFToMM D-A-CH Konferenz, vol. 2020Sechste IFToMM D-A-CH Konferenz 2020: 27./28. Februar 2020, Campus Technik Lienz

Introduction la faible couverture des services spécialisés et la pénurie en ressources humaines en santé mentale représentent d´immenses défis pour les systèmes de santé en Afrique. L'intégration de la santé mentale dans les soins de santé primaires constitue un complément substantiel et faisable aux services spécialisés. Cette étude rassemble et analyse les données générées dans 5 Centres de santé (CS) ayant intégrés ce paquet de soins en Guinée. Méthodes l'étude descriptive porte sur les nouveaux cas de santé mentale entre 2012 et 2017. Les motifs de consultations et les diagnostics posés ont été répertoriés et analysés sur la base des registres de consultation et des dossiers médicaux individuels. Résultats au total 4995 patients ont consulté pour un problème de santé mentale, ce qui représente 2,8% des consultations générales (de 0,5 à 7,7% selon les centres). La moyenne d'âge des patients était de 27,9 ans (± 16,1). Les motifs de consultations les plus fréquents étaient les insomnies: 44,4% (n = 2081), les crises convulsives: 39% (n = 1827), les troubles du comportement: 31,9% (n = 1263) et les hallucinations: 26,1% (n = 1224). Les diagnostics les plus fréquemment posés étaient l'épilepsie : 36,8% (n = 1773) et les troubles psychotiques: 33,5% (n = 1613). 88,4% (n = 4418) des patients ont reçu un traitement médicamenteux, le plus souvent combiné avec un soutien psychologique. Conclusion l´étude montre que dans le contexte guinéen où l´accès aux soins spécialisés en santé mentale est très limité, les malades mentaux, même atteints de pathologies lourdes, peuvent être suivis dans des Centres de santé par un personnel non spécialiste mais formé en santé mentale.

The concept of quaternary prevention, resulting from a reflection on the doctor-patient relationship, is presented as a renewal of the age-old ethical requirement: first, a doctor must do no harm; second, the doctor must control himself/herself. The origin of the concept, its endorsement by the World Organization of Family Doctors (WONCA) and the European Union of General Practitioners (UEMO), its dissemination, and the debates to which it has given rise, are presented by a panel of authors from 10 countries. This collective text deals more specifically with: the bioethics of prevention, the importance of teaching Quaternary prevention and factual medicine, the social and political implications of the concept of quaternary prevention, and its anthropological dimensions. El concepto de prevención cuaternaria, resultante de una reflexión sobre la relación médico-paciente, se presenta como una renovación del antiguo requisito ético: primero, un médico no debe hacer daño; segundo, el médico debe controlarse a sí mismo. El origen del concepto, su respaldo por parte de la Organización Mundial de Médicos de Familia (WONCA) y la Unión Europea de Médicos Generales (UEMO), su difusión, y los debates a los que ha dado lugar, son presentados por un panel de autores de 10 países. Este texto colectivo trata más específicamente de: la bioética de la prevención, la importancia de la enseñanza de la prevención cuaternaria y la medicina práctica, las implicaciones sociales y políticas del concepto de prevención cuaternaria y sus dimensiones antropológicas. O conceito de prevenção quaternária, resultante de uma reflexão sobre a relação médico-paciente, é apresentado como uma renovação da antiga exigência ética: primeiro, o médico não deve causar nenhum dano; segundo, o médico deve se controlar. A origem do conceito, o seu endosso pela Organização Mundial de Médicos de Família (WONCA) e a União Europeia de Médicos de Clínica Geral (UEMO), a sua divulgação e os debates a que deu origem, são apresentados por um painel de autores de 10 países. Este artigo baseia-se na bioética da prevenção, na importância do ensino da prevenção quaternária e na medicina factual, nas implicações sociais e políticas do conceito de prevenção quaternária e nas suas dimensões antropológicas.

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., info:eu-repo/semantics/published

For interdisciplinarity between physics and mathematics to take its proper place in secondary schools, its value must be demonstrated and used during the future teacher’s university education. We have observed from examples and surveys, however, that an ever-widening gulf is emerging between degree courses in mathematics and physics. This article therefore develops comparative approaches to some common concepts to demonstrate their complementarities from the angle of the relation between mechanics and analysis. The example of the differential, which is described as an obstacle to the “mathematization” of physics (Karam et al. 2015), is used to transform it into a tool to aid conceptualization, offering a dual approach to the concepts and their applications. This should enable students to have a better understanding that is related to their specific curriculum.

Background: In Western countries, many children are affected by the separation of their parents. The study's main objective was to analyse the parental behaviours potentially influential for preschool children's health by family structure (parents together or separated). Methods: We conducted a cross-sectional study based on data collected from examinations as part of free preventive medical consultations in the French Community of Belgium. During the assessment of 30,769 infants aged 28 to 32 months, information was collected on the parents' use of tobacco, brushing of the infant's teeth, being monitored by a dentist, and receiving vision screening. The chi2 test was applied and the odds ratios were derived to compare the two groups of children (exposed/not exposed to parental separation). Multivariate logistic regression analyses were used to adjust the effect of exposure. Results: Nearly one in ten (9.8%) did not live with both parents under the same roof. Taking into account the social and cultural environment and other potential confounders at our disposal, we found that in the event of parental separation, behaviours differ in comparison with situations where parents live together; the adjusted odds ratios (ORs) (95% confidence interval) for the infant's exposure to tobacco, absence of teeth brushing, lack of monitoring by a dentist and absence of visual screening, were respectively 1.7 (1.2-2.0), 1.1 (0.9-1.2), 1.3 (1.1-1.6), 1.2 (1.1-1.2), and 1.2 (1.1-1.4). Conclusions: This study confirms the suspicion that parental separation is an independent risk factor for parental behaviours that negatively influence the infant's health. If these results are confirmed, this it could affect the work of the family doctors and paediatricians, especially in terms of family support and information to parents., SCOPUS: ar.j, info:eu-repo/semantics/published

Contexte et objectif : L’objectif general du projet de recherche-action international francophone sur la responsabilite sociale des facultes de medecine a ete d’experimenter et d’evaluer la pertinence, l’applicabilite et la mise en œuvre d’une demarche de qualite inspiree des principes de responsabilite sociale (RS) et d’en demontrer l’utilite comme une strategie de choix pour ameliorer la sante. Description : Au 1er novembre 2015, 56 facultes de medecine dans 18 pays francophones ont adhere au projet de recherche-action. La phase d’evaluation de la perception des differents acteurs a montre que la sensibilisation devait etre poursuivie aupres des acteurs « intra muros » et « extra-muros ». La participation forte des etudiants signe un vif interet de ces derniers pour la RS. Des experimentations d’actions pragmatiques de RS ont ete choisies par les facultes : le contrat faculte-territoire, la premiere ligne de sante, l’adaptation de la formation et les populations vulnerables. Resultats : Le regroupement de facultes dans un meme pays montre une dynamique nationale forte, une mutualisation des projets d’intervention et une visibilite accentuee. En Tunisie et en Haiti, les quatre facultes nationales sont partenaires du projet autour d’une thematique commune. Les six facultes de medecine de Madagascar se sont engagees dans un partenariat national prometteur. Conclusion : L’experience du projet de recherche action sur la RS des facultes de medecine est une experience d’envergure originale dans le monde francophone. En raison de la diversite des engagements, le projet illustre de maniere evidente la possibilite d’engager des actions pragmatiques de RS a l’echelle d’une communaute, d’une institution academique ou d’un pays.

Contexte : Les facultes de medecine francophones au niveau mondial (139), conscientes de leurs obligations, s’engagent pleinement envers leur responsabilite sociale avec l’objectif de repondre au mieux aux besoins des populations qu’elles ont le mandat de servir. En 2012, elles ont mis sur pied un projet international de recherche-action sur la responsabilite sociale. Apres quelques annees de travaux, elles ont recemment elabore un plan strategique pour la periode 2015-2020 pour confirmer leurs engagements, mieux coordonner les actions, en faire un suivi plus rigoureux et en augmenter l’impact. Exegese : Le plan se fonde sur trois axes specifiques d’intervention : l’impact, l’accreditation, les partenariats/collaborations. Ceux-ci sont renforces par trois axes transversaux de soutien : plaidoyer/formation/expertise, dissemination/leadership, organisation/ressources. Les objectifs de chacun des axes ainsi qu’une serie d’actions prioritaires pour la periode 2015-2017 sont presentes. Conclusion : Ce plan strategique confirme l’engagement concret des facultes de medecine francophones envers leur responsabilite sociale pour les prochaines annees.

International audience; Equity is often invoked as a possible justification for the imposition of universal service obligations (USOs). However, no previous analysis supports a formal link between equity and USO. In this paper, we describe the extent to which the im- position of USOs in oligopolistic network industries can meet the objectives of an inequality-averse regulator. We show that USOs can be used for equity purposes provided that the regulator is able to control the competitive structure of the industry. We also show that the uniform pricing constraint, which is an obligation to offer the same price conditions to all consumers, is welfare-enhancing but rather surprisingly, it does not necessarily improve equity.

Background: In Western countries, many children are affected by the separation of their parents. Our mainobjective was to assess the possible impact of parental separation family structure on certain aspects of somatichealth in low-age children.Methods: We conducted a cross-sectional study based on data collected in the framework of free preventivemedicine 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 wascollected regarding the risk of sudden infant death, psychomotor development, and development in terms ofheight 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 thepresence or absence of confounders. The adjusted ORs (95% CI) of symptoms perceived as frightening, notably atnight, of a prescription for a polysomnography, of an abnormal polysomnography result, and of follow-up by homemonitoring 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 thesomatic health and psychomotor development of infants. This observation should be verified because it would have amajor impact on the actions of family doctors and other first-line healthcare providers, in particular with regard toinformation and targeted prevention., SCOPUS: ar.j, info:eu-repo/semantics/published