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regarding research took a turn from traditional debates on public health research. Louise Potvin referred to it clearly: ‘The Ottawa Charter identifies values and principles that place the population’s emancipation and participation as equally important processes to research findings. We believe … that these principles and values are becoming the parameters for effectiveness of action.’ We cannot just concentrate on traditional approaches, based on the classical biomedical model, to organize health services and programmes. Jacqueline Descarpentries suggests in her article on public health education interventions that intervention is based on ‘the social and historical realities that have been determined by states’ traditions, and national, global, economic, political and cultural factors, to construct the social conditions for health education.’ A key point of the debate concerns the place of epidemiology in health promotion reflection and research. In this regard, Louise Potvin shed light on the discussion: ‘The methodological discourse is largely dominated by epidemiology. In the public health conceptual universe, health promotion is restrained to justifying its research procedures based on epidemiology’s criteria’, but epidemiology’s methodological paradigm ‘is hardly compatible with the emancipation principles and values of the Ottawa Charter.’ As a consequence, she says, there are two ways to ensure the rigour of health promotion evaluation studies: on the one hand, as part of the epidemiology paradigm, by driving analysis on the basis of a strict definition of the evaluator’s range of control; and on the other hand, by moving away from the paradigm and implementing disciplines that aim to establish processes of social transformation.

Un punto de partida conceptual y metodologico: la Carta de Ottawa El texto de este documento fundador de la salud publica moderna fue una referencia constante ya fuera de manera explicita o implicita. A partir de ahi, las preguntas sobre las necesidades de la investigacion tomaban un cariz del que carecen los debates tradicionales sobre la investigacion en materia de salud publica. Louise Potvin lo expreso claramente: “...la carta de Ottawa identifica valores y principios que consideran que la emancipacion y la participacion de las poblaciones es un proceso tan importante como los resultados perseguidos. Creemos (...) que estos principios y valores se convierten en parametros para evaluar la eficacia de la accion.” Por consiguiente, no podemos contentarnos con los enfoques habituales, muy calcados, sin duda, del modelo biomedico clasico de la organizacion de los servicios y de los programas de salud. Jacqueline Descarpentries situa su investigacion sobre la intervencion educativa de salud publica en base a que dicha intervencion constituye “una realidad social e historica estrechamente ligada a las tradiciones, a las condiciones nacionales, mundiales, economicas y culturales de los Estados en los que (esta) se desarrolla”. Un punto clave del debate se refiere al lugar que ocupa la epidemiologia en la reflexion y en la investigacion sobre la promocion de la salud. De nuevo, Louise Potvin clarifica el debate: “...el discurso metodologico esta muy dominado por la epidemiologia. Por estar ubicada en el universo conceptual y discursivo de la salud publica, la promocion de la salud se ve obligada a

La charte d'Ottawa sur la promotion de la santé date de 1986. Elle constitue un des textes fondamentaux de la santé publique moderne et suggère un capsus de méthodes particulièrement adaptée à la lutte contre les excès de la mondialisation économique et ses effets sur la santé. Cet article propose de relire ce texte fondateur, d'en débattre, de le critiquer, de le commenter, d'en triturer le contenu pour en faciliter l'adaptation aux mouvances sociales, culturelles, institutionnelles, d'en rechercher la modernité, de le confronter à l'expérience qu'il a permis d'acquérir et de mesurer les changements qu'il a pu engendrer. (Promot Educ 2008; Supp (1): 8-13)

une constante reference explicite ou implicite. Des lors les questions sur les besoins de recherche prenaient une tournure que n’ont pas les debats traditionnels sur la recherche en sante publique. Louise POTVIN l’a clairement exprime: “... La Charte d’Ottawa identifie des valeurs et des principes qui placent l’emancipation et la participation des populations comme un processus aussi important que les resultats recherches. Nous croyons (...) que ces principes et valeurs deviennent des parametres de l’efficacite de l’action”. On ne peut alors plus se contenter des approches habituelles, tres calquees, il faut bien le dire, sur le modele biomedical classique de l’organisation des services et des programmes de sante. Jacqueline DESCARPENTRIES situe sa recherche sur l’intervention educative en sante publique comme sous-tendue par le fait que cette intervention constitue “une realite sociale et historique etroitement liee aux traditions, aux conditions nationales, mondiales, economiques et culturelles des Etats dans lesquels (elle) s’est developpe(e)”. Un point clef du debat concerne la place de l’epidemiologie dans la reflexion et la recherche en promotion de la sante. La encore, Louise POTVIN eclaire la scene des discussions: “...le discours methodologique est largement domine par l’epidemiologie. Situee dans l’univers conceptuel et discursif de la sante publique, la promotion de la sante se trouve astreinte a justifier ses procedures de recherche en fonction des criteres de l’epidemiologie”, mais le paradigme methodologique de la recherche en epidemiologie “est peu compatible avec les principes et valeurs d’emancipation qui sous-tendent la Charte d’Ottawa”. En consequence, ditelle, il existe deux voies pour assurer la rigueur des etudes evaluatives en promotion de la sante. L’une, a l’interieur du paradigme idemiologique

A 547 jours du troisième millénaire, le bilan social de l'humanité ne suscite pas d'enthousiasme. Et pourtant, les dernières cinquante années avaient d'abord permis l'espoir d'une prospérité durable, d'un développement économique du tiers-monde, et d'une relative égalité sociale à l'intérieur des pays et d'une nation à l'autre.

Information on adolescent health can be obtained from a variety of sources. Medical practitioners can offer little insight on the subject because adolescence is the period of life in which there is the least number of consultations with a doctor and the lowest rate of hospitalization. Such professionals therefore observe and record little on adolescents. Educators youth workers and some social workers with professions focused upon adolescence could offer insight into adolescent health but they are almost never consulted. Parents have hardly more occasion to say anything on the subject. To obtain a better understanding of adolescents health information must be obtained from adolescents themselves. The role of epidemiologists what is known about adolescents and their health what is being learned and what remains to be discovered are discussed.

Hundreds of studies carried out in the past 20 years have worked on youth and adolescent health indicators linked to general morbidity and mortality and to specific pathologies. The majority of research has focused on evaluating the impact of risk behaviours such as tobacco, alcohol and drug use, non-protected sexual intercourse, and unbalanced nutrition on the health of youth. The usefulness of medical care and health education programmes has thus traditionally been evaluated on the basis of their impact on mortality and morbidity. However, these measures have proven insufficient and the necessity to pay more attention to quality, and not only length of life is now apparent. This article focuses on the question of whether the tool for measuring quality of life linked to health, adapted from what now exists for "sick" adolescents, can constitute a new indicator allowing for evaluation of the unknown realm of adolescent health needs. The authors address the concept of measuring the quality of life by providing several of its definitions, noting the difficulties and insufficiencies of their measurement. The authors also wonder why the multiple professionals preoccupied with adolescent health have not yet imagined using a participative approach to developing these measures, i.e. an approach including the adolescents themselves, has not been used. The authors propose that to include adolescents in the development of evaluation tools would ensure that the adolescent's needs for expression and to be heard are fulfilled. The authors also maintain that education, both health and general, should enable individuals to understand what is positive within themselves, and thus develop these aspects to their fullest. It should not force models of behaviour onto individuals or groups. If this approach is taken in developing quality of life indicators for young people, a positive health promotion approach to enabling adolescents can be developed.

Bad dental hygiene in adults is usually the result of bad care during childhood. Within the framework of Health for All, WHO and the International Dental Federation defined global objectives for dental health which allow for monitoring progress in different countries. The most common dental problems, such as dental cavities, can be prevented by simple and inexpensive methods. Dental health is based on dental hygiene, nutrition, fluoride intake and dental service utilisation. Dental health promotion aims to create an environment favourable to the adoption of these healthy behaviours. The principle recommended dental health measures are through fluoridation of water, salt, and milk, a low consumption of sweets, and modification of the amount of sugar in the diet; implementation of monitored dental hygiene activities in schools; the organisation of regular dental services in schools/workplaces; and adopting legislative texts or laws requiring certain measures of prevention. In the past several years, certain African countries have set up national dental health programmes (there were 12 in 1993), However, the implementation of dental health promotion generally doesn't result from a national initiative, but from a regional or local scale. This is largely due to the lack of integration of dental health in activities of education and health promotion in general. Programmes planned at a national level and then implemented at a local level on a multisectoral base have had more success. This article presents examples of dental health promotion activities in several African countries, mainly focusing on programmes aimed at 12-13 year olds in primary school. Programmes from Morocco, Kenya, Madagascar, Cote d'Ivoire, Benin, and Tanzania are briefly presented and show that in Africa, dental health promotion has mostly consisted of the implementation of health education actions and that there are no consistent policies, unlike in other developing countries, for fluoridation of water, salt, and milk. In terms of dental health promotion, WHO recommends the promotion of traditional methods of dental hygiene (such as plants or sticks for cleaning), especially among adolescents living in rural and low income communities. In turn, the identification and promotion of the positive aspects of hygiene and traditional care will allow for the implementation of more culturally acceptable approaches.

Family planning centres can play a more extensive role than simple reproductive health, in particular for adolescents and young adults. They can become true health and counseling centres. In France, state supported family planning centres were officially created in 1972; they had been preceded by initiatives developed by non-profit associations. The centres have both educational and medical functions, in the areas of contraception and fight against sterility; since 1990 they have also integrated STD (sexually transmitted diseases) prevention and treatment into their mandates. Family planning centres offer free consultations to adolescent minors, without requiring adult authorization. Overall, young people under the age of 20 account for 25 to 40% of the family planning centre clientele, although they represent only 16% of the potential user population. Females are more likely to frequent the centres than males: one young women in 10 under 20 consults per year, as opposed to only one young man in 400. This is the case for 3 centres in the north of France, which were the objects of the study presented here. In the centres participating in the study, 80% of the clientele were under 20, with the vast majority being under 128 years of age. The availability of contraceptive devices has evidently reduced the reasons for frequenting the centres. As 1 youth in 4 is not yet sexually active however, the preventive role for these centres is obvious and well recognised by the young people. The study indicated that one adolescent among 17 frequents the centres for either health problems or counseling not necessarily having to do with sexuality; some go merely to find someone to talk to. Reasons for these choices most often cited are the assurance of confidentiality and lack of fees. The availability of counsellors, the possibility to consult alone or in a group the possibility to consult without an appointment, the quality of the reception, and the central location of the centres were also cited as important. What the young people appreciated in the family planning centres is exactly what they seek in general health service centres. It is not surprising, therefore, that they use the family planning centres as primary care structures.

La Fédération nationale des comités d'éducation pour la santé (FNES) rassemble en France 110 comités départementaux et régionaux d'éducation pour la santé, structures associatives (“associations sans but lucratif” en droit français) travaillant en réseau et ayant notamment en commun: 1. l'approche « généraliste » de la santé, celle-ci étant considérée comme un tout, ce qui n'exclut pas des approches thématiques (par exemple maladies cardio-vasculaires, addictions, santé des personnes âgées, sécurité routière, etc.); 2. l'approche « globale » de la santé, ne dissociant pas santé physique et santé mentale, considérant l'ensemble des déterminants de la santé, intégrant la prévention des maladies et la promotion du développement harmonieux et du bien-être des personnes et des groupes; 3. l'approche de santé publique qui concerne tous les secteurs de l'activité sociale, dont le système de soins dans ses dimensions à la fois curative et préventive; 4. La référence au concept de la promotion de la santé tel que défini par la charte d'Ottawa. La recherche constitue un objectif de développement pour la FNES, qui vient de recruter dans son équipe permanente un “délégué aux affaires scientifiques et à la prospective”. Le développement technique de la FNES s'articule autour d'axes de travail (démarche d'asssurance de qualité, exploration de champs nouveaux de la promotion de la santé…) qui nécessitent de s'appuyer sur une dynamique de recherche propre et sur la prise en compte des acquis des recherches menées ailleurs. Les coopérations europénnes paraissent fondamentales à ce titre, et la FNES est heureuse d'être associée à la réflexion et aux efforts déployés dans ce sens au Grand Duché du Luxembourg. (Promot Educ 2008; Supp(1): 71-72)

The First International Conference on Health Promotion (Ottawa 1996) consolidated and developed the interest of Latin American countries in the amelioration of the health of their populations. Initiatives such as the International Conference for Health Promotion in Columbia in 1992 and the adoption in 1993 of the Caribbean Charter for Health Promotion show the efforts that have been carried out by different American countries to work toward the principles of the Ottawa Charter and to adapt them to their realities. This article focuses on the state of health of adolescents in Latin America as well as different actions that have been, and continue to be, carried out. The authors first discuss the peer approach to health education, which has been used in many health promotion actions throughout Latin America because of its effectiveness. Often in developing countries, the oldest children care for the younger ones. This approach therefore provides a way to reach not only peers of the adolescent involved, but also other youth in his/her entourage. Also, the participation of youth in health education allows them to develop relations with adults outside of their families, to improve their self-perceptions and to acquire a sense of responsibility and belonging within a social group. Examples from several countries are provided by the authors. What the authors call "classic" approaches to health promotion and education are also still used in many countries of Latin America and many of these programmes are concerned with sexual education and managing adolescent parenthood. Also, programmes using in approach specific to problems such as alcoholism, drug abuse, and violence have been developed in many countries. Finally, training programmes for health personnel focusing on the specific health needs of adolescents have been developed in Brazil, Peru, Costa Rica, and Uruguay for a large range of health professionals (psychologists, social workers, etc.). In conclusion, the authors state that although there is an increasing number of health promotion actions for adolescents in Latin America, there is still much work to be done. One of the elements that is priority for managing the health of adolescents is the integral approach of the adolescent, considering the psychological, social, and environmental factors that influence his/her well-being. Multi-disciplinary and intersectoral approaches are also considered as important, as is the participation of adolescents in the development and implementation of actions concerning them.

This study analyzes 39 malpractice suits based on suicide attempts of hospital patients in Quebec between the years 1968 and 1977. Both the age and sex of the victims, as well as the pathology involved, the site of occurrence, the technique used and the foreseeability of the event are examined. The study discusses the two main criteria that are used by the courts to determine liability for such occurrences, that is the foreseeability of the attempt and the possibility of its prevention. This is followed by an outline of the different factors that are considered by the courts in determining liability, such as the nature of the illness, the behavior of the patient, the site of hospitalization and the type of surveillance prescribed and exercised. This analysis illustrates the difficulty in predicting the behavior of suicidal patients. In addition, as demonstrated, it is often impossible to prevent these patients from committing suicide. In conclusion, it is important to recognize the difficulties facing those who do decide to sue, difficulties stemming from the requirement of proving fault on the part of the doctor or the hospital staff in either not foreseeing the event or in not prescribing appropriate measures so as to prevent its occurrence.