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Objectives: We aimed to determine the public health status of an 18th century mountain locality., Methods: We collected data registered in parish death certificates from Arudy, a small village in the French Pyrenees during the period 1741-1800., Results: Two thousand and six hundred and sixty-three cases were studied. About 50% of deaths occurred during the first 10 years of life. There were some particularities in deaths pattern with regards to age categories between males and females and seasonality. A fraction of individuals died at advanced ages (24.1% ≥60 years and of note three cases ≥100 years). The cause of death was reported in only 2.2% of cases (nearly always sudden fatalities). Maternal mortality could not be precisely determined. Throughout this period we identified a series of mortality crises which targeted mostly children and were probably in relation with undocumented epidemics., Conclusions: These data offer some clues about the sanitary situation of an European mountain community during the 18th century., (© 2021 Wiley Periodicals LLC.)

Migration management policies in many states have marginalized significant numbers of individuals on the basis of their precarious residency status, negatively impacting their health. This article looks at how three European states with high levels of contagion – France, Sweden, and the United Kingdom – adapted their migration management policies to the changed circumstances during the Covid 19 pandemic in which there was new pressure for prioritizing population health over other concerns. The analysis compares globally-recognized 'best practices' for migrant health during the pandemic with policies adopted by France, Sweden, and the UK – selected as prominent migrant-hosting states and that experienced high rates of Covid-19. The article draws on supplementary evidence through interviews with civil society organizations working directly with migrants living on the margins of society – what are termed here 'marginalized migrants' (MMs). As the article concludes, the national policies often fell below international 'best practices' such that migration management was often prioritized over population health despite the crisis. The perspective developed in this paper is important for understanding where migration control policies have been prioritized over public health. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to give an overview of emerging issues relating to the management of patients in custody during the COVID-19 outbreak in France. Design/methodology/approach: During custody in France, a medical consultation is provided for any patient who requests it. In the Paris area, this consultation is carried out by a practitioner in forensic medicine, based in a general hospital. Usually, most medical consultations for patients in custody take place directly in police stations. With the COVID-19 outbreak, the authors chose to suspend this activity, asking law enforcement to bring patients directly to their hospitals. Patients presenting with severe infections or indicative symptoms of the severe acute respiratory syndrome Coronavirus 2 infection and a comorbidity are tested for COVID-19. Such patients remain hospitalized until results of the test are received. If the result is positive, they are hospitalized for the length of their custody. If sent to prison, they are transferred to a medical facility in detention. Findings: From the onset of the outbreak, the authors observed increased pressure from law enforcement to obtain medical information. According to the French Code of Medical Ethics, no medical information should be disclosed regarding the authors' patients' medical situations. The authors are also concerned about sending a potentially infected patient back to a police station, to prison or to his/her home. Originality/value: This paper provides a snapshot of issues relating to the management of patients in custody during the COVID-19 outbreak in France. Unfortunately, the current situation in France does not permit a wider range of testing for the specified population in this paper. [ABSTRACT FROM AUTHOR]

The ongoing emergency for refugees is having profound and hidden health consequences for thousands of displaced persons who live in informal ‘makeshift’ camps across Europe. This interdisciplinary paper reports the results of the first environmental health assessment in such a location, in what was Europe’s largest informal refugee camp in 2016, in Calais, northern France. We detail the lack of facilities for sanitation, safe provision of food, water and shelter, demonstrating how conditions fall short of agreed international standards for formal refugee camps. Rather than the notion of migrants being the cause of health problems, this paper critically reveals the hidden materiality of bodily injury caused by poor health conditions, where the camp itself produces harm. Drawing upon theories of biopolitical exclusion, the paper concludes by (i) emphasising the empirical and conceptual themes that tie refugee politics and biologies together and (ii) makes a call for increased attention to makeshift camps as key sites of health exclusion in Europe and beyond. [ABSTRACT FROM PUBLISHER]

INTRODUCTION Tax increases are the most effective but still the least-used tobacco control measure. The tobacco industry (TI) employs lobbying strategies to oppose the implementation of tax policies on its products. Over the past two decades, French tobacco tax policies have been characterized by a relative inconsistency. This research aims to understand why, by analyzing the arguments of French policymakers (MPs and government) between 2000 and 2020 in favor or against tax increases. METHODS To capture parliamentary debates, we performed an advanced term search on the French National Assembly website, using the keyword 'tobacco'. The search returned 5126 available documents out of which 1106 (12.6%, 645 questions, 461 responses) covered price and taxation and were included. They were analyzed using descriptive statistics and thematic content analysis (NVivo) and were compared, when relevant, to arguments raised in the international literature on TI lobbying against taxation increases. RESULTS We found 3176 arguments on tobacco taxation: 77.2% were against tobacco tax increases and 22.7% were in favor of tax policies. Arguments varied depending on the source: 92.4% of MPs' arguments were against tax increases, while 52.1% of arguments from government responses were in favor. The anti-tax arguments were similar to those identified in the international literature that singled out negative economic and social consequences (illicit trade, penalizing tobacconists). Other arguments that were more specific to the French context, highlighted the key economic and social role played by tobacconists in France. Pro-tax arguments highlighted the health, economic and social benefits of tax policies. CONCLUSIONS This is the first French tobacco research on parliamentary documents, although Parliament is a place of direct TI lobbying. It will enable public health actors to better understand the arguments used by the TI in order to counter them in front of MPs, and to better monitor debates in Parliament. [ABSTRACT FROM AUTHOR]

BACKGROUND: There are several characteristics of working in an urban environment that challenge the usual forms of work prescription. OBJECTIVE: This is a case study on the work of gardeners in an urban setting in the north of Paris. This paper develops the notion of territory, which we define as a system that is locally rooted in an open environment through the situated actions of gardeners' work. As the employees do their work in an outside environment, interactions in real-life situations are beyond the control of work organization. City gardeners' work is carried out in a green, living and human environment. METHODS: We conducted detailed open observations in a town's green zones. These were complemented by individual interviews in work situations and by collective interviews within the boundaries of the municipality. RESULTS: We use the notion of territory to highlight the particularity of work within organizations where the work environment cannot be limited to the space inside their walls. The gardeners' work makes it possible to link residents and passers-by (on foot or in vehicles) with the town's green spaces (micro-ecosystems). Their work consists in connecting the different expectations and needs of the various life forms: the human beings (with a variety of lifestyles), as well as the plants, insects and animals. CONCLUSION: The particularities of working in an open environment create complex forms of prescription. The notion of territory, rarely used in ergonomics, proves to be fruitful for considering work in these contexts. [ABSTRACT FROM AUTHOR]

Aim: The goal of this paper is to analyze the COVID-19 policies of 10 European countries, including Sweden, Finland, Norway, Italy, France, Germany, Poland, Belgium, the Netherlands, and Hungary, with a time-series policy analysis tool. Subject and methods: The results of the COVID-19 policy analysis are based on a single time-series indicator, or daily population mortality rate: the number of COVID-19 daily cumulative deaths divided by the population in millions. The lower the score, the better the policy. Although many experts believe that the COVID-19 policy outcome analysis is premature, time series analysis is an excellent analysis that can provide information on the progress and transition of policy outcomes. In other words, the proposed time series analysis tool allows policymakers to identify and quantify when mistakes were made during the on-going COVID-19 pandemic. Results: The COVID-19 policy analysis discovered many useful facts. Sweden failed due to the herd immunity approach. Hungary made a fundamental mistake in COVID-19 tactics. Countries such as Sweden, Hungary, Belgium, and Poland showed time-series changes that differed from the others. Conclusion: Public health interventions can play a key role in mitigating the COVID-19 pandemic. The proposed policy analysis tool, hiscovid demonstrated the effectiveness of the time-series score behavior for discovering when policymakers made mistakes. [ABSTRACT FROM AUTHOR]

Aim: In this paper, we report on a study investigating the involvement of primary care providers in French local health contracts., Background: Worldwide actions are carried out to improve collaboration between primary care and public health to strengthen primary healthcare and consequently community health. In France, the local health contract is an instrument mobilising local stakeholders from different sectors to join in their actions to improve the health of the population., Methods: We developed an instrument to analyse the frequency and nature of involvement of primary care providers in 428 action plans extracted from a sample of 17 contracts (one per French region). The number of primary care actions were counted, and thematic analyses were conducted to identify the nature and level of involvement of the professionals., Findings: Primary care providers were involved in 20.1% (n = 86) of the action plans and were mostly described as a target of the action rather than leaders or partners. Within those action plans, 76.7% (n = 66) of these action plans aimed to improve access to care for local communities; an issue that appears as the main driver of collaboration between public health and primary care actors.

Evidence is accumulating of the negative impact of the COVID‐19 pandemic and related public health measures on mental health. In this emergent field, there has been little research into the role of risk perception on depressive symptoms and the contribution of health‐care resources to model risk perception and mental health. The aim of this paper is to describe the relationship between individual‐level perception of risk and depression, controlling for a set of confounders and for country‐level heterogeneity. A cross‐sectional and observational online survey was conducted using a non‐probability snowball sampling technique. We use data on 11,340 respondents, living in six European countries (Italy, Sweden, United Kingdom, France, Poland, Czech Republic) who completed survey questionnaires during the first months of the pandemic. We used a fixed‐effect approach, which included individual and macro‐level variables. The findings suggest that a high proportion of people suffering from depression and heightened risk perception is positively associated with reporting depressive symptoms, even if this relationship varies significantly between countries. Moreover, the association is moderated by contextual factors including health‐care expenditure as a percentage of Gross Domestic Product, hospital beds for acute care, and number of medical specialists per head of population. Investment in health care offers a concrete means of protecting the mental health of a population living under pandemic restrictions. [ABSTRACT FROM AUTHOR]

Many countries have introduced health impact assessment (HIA) at the national, regional, or local levels. In France and in Québec, there is increasing interest in using HIA to inform decision-makers and influence policies, programs, and projects. This paper aims to compare HIA implementation models in two regions: Nouvelle-Aquitaine (France) and Montérégie (Québec, Canada) using a case study methodology. The objective is to gain a better understanding of the similarities and differences in the approaches used to achieve the operationalization of HIA. The methodological approach involves four steps: (1) design of an analytical framework based on the literature; (2) exchanges within the research team and review of documents concerning the two implementation strategies under study; (3) development of the case studies based on the proposed framework; and (4) cross-comparison analysis of the case studies. The findings show that the two regions share certain similarities, including the strong commitment and political will of the public health organizations involved and a well-established culture of engaging in intersectoral action with municipal partners. Differences mainly concern their different approaches to implementing HIAs in accordance with the regional policies and the organizational and administrative contexts in place. This study identifies potential avenues for supporting the practice of HIA at the municipal level.

INTRODUCTION We describe the vaping and smoking habits of French adolescents aged 15-16 years in the Loire department with a view to assess the impact of e-cigarette experimentation and use on their smoking behavior. METHODS This quantitative, cross-sectional, single-center and observational study conducted from January to July 2019 targeted 6622 students aged 15-16 years attending public high school in the Loire department, France. RESULTS A total of 4937 (74.6%) adolescents were included. Of these, 73.2% were non-vapers and 72.2% non-smokers; 66.0% of adolescents were non-vapers and nonsmokers. Slightly less than half of adolescents had experimented with e-cigarettes (44.6%), more than half of whom (26.8%) continued to use vaping products, with 6.02% vaping daily. Likewise, a little less than half of adolescents had experimented with smoked tobacco (42.4%), more than half of whom (27.8%) continued to use smoking products, with 10.3% smoking daily. Vapers and smokers (20.6%) tended to begin with the use of smoked tobacco and to progress to the dual use of vaping and smoked tobacco products. Vaping had a positive effect, as 71.8% of vapers who smoked tobacco before initiating vaping stopped or reduced smoking following their progression to this double use. More than half of tobacco users are daily users while this daily use affects only 1/3 boys and 1/6 girls for vape. Finally, nearly 80.7% of adolescents who had never smoked before vaping did not smoke at the time of the study. CONCLUSIONS Our data suggest that vaping has a rather marginal impact on smoking initiation among French adolescents aged 15-16 years in the Loire department. They therefore neither confirm nor completely disprove the gateway effect theory, relating to use of tobacco subsequent to vaping. [ABSTRACT FROM AUTHOR]

Résumé: Une approche participative a été promue par Santé publique France pour étudier la santé des populations exposées à l'incendie des usines Lubrizol et NL Logistique en septembre 2019. Elle vise à partir des questions que se posent les parties prenantes et à les associer à la construction de l'enquête et à l'analyse des résultats. Dans cet article, la personne en charge de la coordination de cette approche présente les critères à partir desquels le rôle des parties prenantes s'est élaboré, ainsi que sa façon d'appréhender la participation. The French Public Health Agency promoted a participatory approach to study the health of populations exposed to the fire in the Lubrizol and NL Logistique plants in September 2019. Based on the preoccupations of stakeholders, it involves them in the construction of the survey and the analysis of the results. In this paper, the coordinator of this approach presents the criteria used to define the role of the stakeholders and his approach to participation as a process. [ABSTRACT FROM AUTHOR]

Background: Syndromic surveillance provides public health intelligence to aid in early warning and monitoring of public health impacts (e.g. seasonal influenza), or reassurance when an impact has not occurred. Using information collected during routine patient care, syndromic surveillance can be based on signs/symptoms/preliminary diagnoses. This approach makes syndromic surveillance much timelier than surveillance requiring laboratory confirmed diagnoses. The provision of healthcare services and patient access to them varies globally. However, emergency departments (EDs) exist worldwide, providing unscheduled urgent care to people in acute need. This provision of care makes ED syndromic surveillance (EDSyS) a potentially valuable tool for public health surveillance internationally. The objective of this study was to identify and describe the key characteristics of EDSyS systems that have been established and used globally.Methods: We systematically reviewed studies published in peer review journals and presented at International Society of Infectious Disease Surveillance conferences (up to and including 2017) to identify EDSyS systems which have been created and used for public health purposes. Search criteria developed to identify "emergency department" and "syndromic surveillance" were applied to NICE healthcare, Global Health and Scopus databases.Results: In total, 559 studies were identified as eligible for inclusion in the review, comprising 136 journal articles and 423 conference abstracts/papers. From these studies we identified 115 EDSyS systems in 15 different countries/territories across North America, Europe, Asia and Australasia. Systems ranged from local surveillance based on a single ED, to comprehensive national systems. National EDSyS systems were identified in 8 countries/territories: 2 reported inclusion of ≥85% of ED visits nationally (France and Taiwan).Conclusions: EDSyS provides a valuable tool for the identification and monitoring of trends in severe illness. Technological advances, particularly in the emergency care patient record, have enabled the evolution of EDSyS over time. EDSyS reporting has become closer to 'real-time', with automated, secure electronic extraction and analysis possible on a daily, or more frequent basis. The dissemination of methods employed and evidence of successful application to public health practice should be encouraged to support learning from best practice, enabling future improvement, harmonisation and collaboration between systems in future.Prospero Number: CRD42017069150 . [ABSTRACT FROM AUTHOR]

Context Until the last decade of the 20th century, France had no equivalent to the US Food and Drug Administration. In this paper we describe and interpret the complex series of events that led to the passage by the French Parliament in December 1992 of a law incorporating such an agency, the Agence du Médicament (literally, 'medicines agency'). The broad aim of this project was to learn how public health policy change comes about by detailed analysis of a specific instance. More specifically, we aimed to better understand the circumstances under which public health crisis leads to significant public health policy reform. Methods This paper is based on detailed analysis of primary documents (eg, archived French health ministry papers, recorded parliamentary debates, government reports, newspaper articles) and oral history interviews covering a period from 1988 to 1993. Thematic analysis of these materials was initially grounded in theories of organizational change, moving to constructs that emerged from the data themselves. Findings Policy entrepreneurs positioned to frame adverse events and seize opportunities are key to public health policy reform. However, whether these entrepreneurs will have the requisite institutional power is contingent both on political structure and on the power of competing institutional actors. Health crises may catalyze institutional reform, but our analysis suggests that whether reform occurs, or even whether adverse episodes are labeled as crises, is highly contingent on circumstances of history, political structure, and political ideology and is extremely difficult to predict or control. Conclusions Actors positioned to shape public health policy need to have a detailed understanding of the circumstances that facilitate or impede policy reform. Health crises are now more often global than not. Comparative, theoretically grounded, cross-national research that looks in detail at how different countries respond to similar health crises would be extremely valuable in informing both policymakers and researchers. [ABSTRACT FROM AUTHOR]

Aim: This paper describes the situation regarding COVID‐19 emergency in France as of early May 2020, the main policies to fight this virus, and the roles and responsibilities of nurses regarding their work at this time, as well as the challenges facing the profession. Background: Europe continues to be affected by the COVID‐19 pandemic. At the time of writing France was the fourth country with the highest number of detected cases and cumulative deaths. Sources of evidence: Websites of the World Health Organization, French Government, French Agency of Public Health, French National Council of Nurses and ClinicalTrials.gov database, as well as the experiences of the authors. Discussion: The history of the development of the pandemic in France helps explain the establishment of the state of health emergency and containment of the population. Many decisions made had undesirable repercussions, particularly in terms of intra‐family violence, mental health disorders and the renunciation of care. Hospitals and primary care services, with significant investment by nurses, played a key role in the care of persons with and without COVID‐19. Conclusion: France has suffered a very high toll in terms of COVID‐19 morbidity and mortality, and effects on its people, health systems and health professionals, including nurses. Implications for nursing practice: Nurses are recognized for their social usefulness in France. However, it is important to consider the collateral effects of this crisis on nurses and nursing and to integrate the health emergency nursing skills established during the pandemic into the standard field of nursing competence. Implications for nursing policy: The nursing profession has expectations of a reflection on and revision of nursing skills as well as of its valorization in the French healthcare system, notably carried out by the French National Council Order of Nurses. [ABSTRACT FROM AUTHOR]

Aims: Insufficient physical activity (PA) is one of the largest public health challenges of our time and requires a multisectoral public-health response. PA recommendations state that all children and adolescents should accumulate at least 60 minutes of moderate-to-vigorous PA (MVPA) daily and carry out vigorous PA (VPA) three times weekly. While participation in sports club activities is known to enhance the probability of reaching the recommended overall PA level, less is known about the contribution of sports club participation to VPA, and few cross-national comparisons have been carried out. The purpose of this paper is to study whether participation in sports club activities is associated with meeting the overall PA and VPA recommendations among children and adolescents across six European countries, namely Belgium (Flanders), Czech Republic, Finland, France, Ireland and Sweden. Methods: Analyses were carried out on existing self-reported national data sets using descriptive statistics and logistic regression. Results: Results indicate that approximately two-thirds of children and adolescents take part in sports club activities in the given countries. Sports club participants were more likely to meet the overall PA recommendations (OR 2.4–6.4) and VPA recommendation (OR 2.8–5.0) than non-participants. Conclusions: The extent to which overall PA and/or VPA is gained through sports club participation versus other settings needs to be further studied. Nonetheless, it can be argued that sports clubs have an important position in PA promotion for younger populations. [ABSTRACT FROM AUTHOR]

The article provides updates on issues related to the European Public Health Association (EUPHA) as of October 2019. Topics covered include opportunity of the World Health Organization to renew its vision for health in Europe beyond 2020, a white paper published by the European Commission in March 2017 setting out five possible paths for the future of Europe, and EUPHA's statement on what European political parties are stating on health.

This paper seeks to contribute to a more nuanced discourse on vaccination policy. Current polarization between either mandatory and entirely voluntary is misleading, as virtually all immunization programs feature a combination of instruments that comprise mandatory and voluntary elements. We develop this argument by presenting five case studies from the European Union (EU). By systematically acknowledging the nuances of political and institutional varieties, we build the case for reframing the terms of the debate in the EU and beyond. [ABSTRACT FROM AUTHOR]

Résumé: En France, les assurés sociaux de la CPAM ont droit à un examen périodique de santé (EPS) réalisé au centre d'examen de santé. Il est orienté vers la prévention, quelles que soient les maladies préexistantes de l'assuré, la lutte contre la précarité et les inégalités d'accès aux soins. Les médecins généralistes (MG) estiment intervenir fréquemment en matière de prévention. Aux termes d'une enquête quantitative transversale descriptive observationnelle par questionnaire papier anonyme, réalisée de février à mai 2018, auprès de 240 MG libéraux de la Loire, les MG semblent favorables à un EPS adapté à une population qui leur semble devoir être ciblée différemment. Une meilleure collaboration entre MG et centres d'examens de santé préalablement et au décours de l'EPS pourrait être envisagée. In France, social security contributors are entitled to a periodic health examination (PHE) carried out at the health examination center (HEC). The PHE is oriented towards prevention whatever pre-existing illnesses, the fight against precariousness and inequalities in access to care. General practitioners (GPs) consider that they frequently intervene in the field of prevention. According to a quantitative cross-sectional descriptive observational survey by anonymous paper questionnaire, conducted from February to May 2018, among 240 liberal GPs in the Loire district, GPs seem to favour a PHE adapted to a population that they feel should be targeted differently. It would be interesting to better understand this point of view. Better collaboration between MG and HEC before and during the PHE could be envisaged. [ABSTRACT FROM AUTHOR]

This paper offers some insights on the European regulatory situation with respect to raw materials used in production of gene, cell and tissue therapy products, including advanced therapy medicinal products. By focusing on the existing EU and French rules, the purpose of this paper is to review the content and scope of the measures restricting their placing on the market and/or use, the legal implications and hence key challenges ahead. Also known under the specific term "ancillary products" in France, raw materials are subject to a fragmented regulatory environment that could indirectly hinder innovation in this rapidly evolving area. Taking account of contamination risk that could originate from such materials, the question as to whether it is necessary to assure their quality and safety by means of one or various regulatory instrument(s) does not arise. Nevertheless, it is vital that, in a sector as innovative as this one, an appropriate and more predictable regulatory regime applies in Europe, which requires undertaking a constructive work aimed at harmonising the rules in relation to production of and trade in raw materials intended to be used for advanced therapies while ensuring the EU objective of public health protection: a work already in progress. [ABSTRACT FROM AUTHOR]

There has been a long tradition of psychoanalysis in the community in France. The first psychoanalysts working in public institutions did so in places such as the network of the Offices publics d'Hygiène sociale (OPHS), initially intended to treat tuberculosis, infant mortality, etc., after the Second World War. The introduction of psychiatric care in the community mobilized a genuine interpenetration of psychoanalysis and psychiatry. In 1953, the SPP founded the Centre de Consultations et de Traitements Psychanalytiques, and in 1955 Victor Smirnoff created a children's centre. In 1958, Philippe Paumelle created the Association de Santé mentale du 13ème arrondissement de Paris (ASM 13), a pilot project, implemented in 1960 as "district psychiatry", which is France's national policy of community psychiatry. In the consultation centres of these psychiatric districts, called centres médico-psychologiques (CMP), psychotherapy is provided by clinical psychologists, who are largely psychoanalytic in orientation. In 1972, Pierre Marty and Michel Fain created what would become the Institut de Psychosomatique in 1978. In 1974, ASM 13 created its own Centre de psychanalyse with Jean and Évelyne Kestemberg, specialising in psychotic and borderline pathologies. The activities and theoretical contributions of these psychoanalytic public centres are presented in this paper, with attention to: the distinction between treatment and consultation; the introduction of a new approach to psychosomatics; the description of a psychotic relation to the object as fetish; the research about free treatment and its implications. Currently, the situation of psychoanalysis in France is divided between the medical authorities who reject psychoanalysis in the name of evidence-based medicine, and the persistence of psychoanalysis in both public and private practice. More generally, it appears that the central issue at stake is the conception of the 'psychic human being' and psychic causality in Western societies. [ABSTRACT FROM AUTHOR]

Bed bugs are pervasive global pests that have reemerged in the last 20 years as a significant public health concern, especially in densely populated urban areas. Beyond financial losses, expenses, inconvenience, and psychological distress, bed bug infestations often necessitate chemical management, posing poisoning risks to those with an infestation. The French Poison Control Centers recorded 1056 cases of exposure to bed bug insecticide products between 1999 and 2021. This study followed cases over 2007–2021, with a notable surge in reports of adverse reactions from 2016 onwards. Data revealed an increased recurrent misuse of insecticides, including substances banned or not approved for this use. Our findings underscore the growing public reliance on chemical insecticides for home bed bug management. With this is the concern of increased poisoning risks, and potential long-term health consequences from non-professional efforts by the public to manage bed bugs in their homes. This escalating trend emphasizes the need for safer and more sustainable pest management strategies in urban environments. [ABSTRACT FROM AUTHOR]

Background: Seasonal influenza epidemics have a substantial public health and economic burden, which can be alleviated through vaccination. The World Health Organization (WHO) recommends a 75% vaccination coverage rate (VCR) in: older adults (aged ≥ 65 years), individuals with chronic conditions, pregnant women, children aged 6–24 months and healthcare workers. However, no European country achieves this target in all risk groups. In this study, potential public health and economic benefits achieved by reaching 75% influenza VCR was estimated in risk groups across four European countries: France, Italy, Spain, and the UK. Methods: A static epidemiological model was used to estimate the averted public health and economic burden of increasing the 2021/2022 season VCR to 75%, using the efficacy data of standard-dose quadrivalent influenza vaccine. For each country and risk group, the most recent data on population size, VCR, pre-pandemic influenza epidemiology, direct medical costs and absenteeism were identified through a systematic literature review, supplemented by manual searching. Outcomes were: averted influenza cases, general practitioner (GP) visits, hospitalisations, case fatalities, number of days of work lost, direct medical costs and absenteeism-related costs. Results: As of the 2021/2022 season, the UK achieved the highest weighted VCR across risk groups (65%), followed by Spain (47%), France (44%) and Italy (44%). Based on modelling, the 2021/2022 VCR prevented an estimated 1.9 million influenza cases, avoiding 375,200 GP visits, 73,200 hospitalisations and 38,400 deaths. To achieve the WHO 75% VCR target, an additional 24 million at-risk individuals would need to be vaccinated, most of which being older adults and patients with chronic conditions. It was estimated that this could avoid a further 918,200 influenza cases, 332,000 GP visits, 16,300 hospitalisations and 6,300 deaths across the four countries, with older adults accounting for 52% of hospitalisations and 80% of deaths. An additional €84 million in direct medical costs and €79 million in absenteeism costs would be saved in total, with most economic benefits delivered in France. Conclusions: Older adults represent most vaccine-preventable influenza cases and deaths, followed by individuals with chronic conditions. Health authorities should prioritise vaccinating these populations for maximum public health and economic benefits. [ABSTRACT FROM AUTHOR]

Purpose – Hospital at Home (HAH) is a concept slowly expanding over time. At first this type of organization was used to accomplish low-technical tasks. The main objective was to increase bed availability in hospitals for new patients. Nowadays, HAH structures are able to undertake more technical complex care such as (but not limited to) end-of-life care, chemotherapy and rehabilitation. The purpose of this paper is to propose a new methodology to make an unbiased economic comparison between HAH structures and traditional hospitalization. Design/methodology/approach – This article accomplishes two main objectives: in the first part the authors propose a comprehensive literature review dealing with the comparison between traditional hospital and home care structures from an economic standpoint, showing that results are highly dependent on initial conditions of the study (patient health state, territory settings, bio-medical parameters); in the second part the authors propose an unbiased economic comparison approach between health care provided in traditional hospital and home care network using formal modelling with Petri nets and discrete event simulation. As an example for the comparison a multi-session treatment is proposed. Various scenarios are tested to ensure that results will be maintained even if initial conditions change. Relevant performance indicators used for comparison are economic costs from the point of view of the insurance and economic costs related to the consumption of resources. Findings – It is found that HAHS can be used to control and improve patients flow on hospitals. Decisions about offering a multi-session treatments at home must be taken, not only because of economic impacts on hospitals, but also because it follows strategic goals of the organization. This decision must be issued following a strategic analysis. Some important questions are: How should newly available beds be used in the hospital? Which territories will be covered? What is the best logistic strategy for delivering the medicines? Originality/value – Comparing HAH with traditional hospitalization can provide useful information to healthcare authorities when deciding to create, or not, new HAH structures. [ABSTRACT FROM AUTHOR]

Purpose - This paper aims to characterize the French public hospitals (FPHs) according to their strategic behaviour. Until recently, FPHs used to ignore strategic issues, for their mission was clearly defined by regulating authorities and their activities were quasi-automatically funded by the latter. This situation fundamentally changed as the environment of all ‘health care providers’ became more demanding FPHs have now to engage in a strategic process. The paper seeks to focus on the content of FPHs' strategies, and compare our results with standard findings of the strategic management literature, notably the strategic behaviour typologies established by Miles and Snow and Zaleznik and Kets de Vries. Design/methodology/approach - A three-stage empirical approach is conducted, mixing qualitative and quantitative methods. The measurement stage, based on a questionnaire survey realized with the support of a professional union, gathered the answers of 276 FPHs' decision-makers, representing 51 per cent of the target population. This stage allows the formation of classes among these respondents, according to the environmental, organisational, and strategic features they describe. Findings - The results are globally consistent with Miles and Snow's and Zaleznik and Kets de Vries' typologies. This is noteworthy since they were obtained in a different context and with different methodological approaches. Research limitations/implications - This article tackles the issue of the universality of the strategic process. Practical implications - Finally, implications for policy makers and hospitals' managers are drawn from the study. Originality/value - Whit mostly differentiates the paper' results from the standard typologies is that FPHs can be separated according to the alliances criterion. [ABSTRACT FROM AUTHOR]

Background: Physical inactivity is widely recognized as one of the leading causes of mortality, and transport accounts for a large part of people's daily physical activity. This study develops a simulation approach to evaluate the impact of the Ile-de-France Urban Mobility Plan (2010-2020) on physical activity, under the hypothesis that the intended transport mode shifts are realized. Methods: Based on the Global Transport Survey (2010, n = 21,332) and on the RECORD GPS Study (2012-2013, n =229) from the French capital region of Paris (Ile-de-France), a simulation method was designed and tested. The simulation method used accelerometer data and random forest models to predict the impact of the transport mode shifts anticipated in the Mobility Plan on transport-related moderate-to-vigorous physical activity (T-MVPA). The transport mode shifts include less private motorized trips in favor of more public transport, walking, and biking trips. Results: The simulation model indicated a mean predicted increase of 2 min per day of T-MVPA, in case the intended transport mode shifts in the Ile-de-France Urban Mobility Plan were realized. The positive effect of the transport mode shifts on T-MVPA would, however, be larger for people with a higher level of education. This heterogeneity in the positive effect would further increase the existing inequality in transport-related physical activity by educational level. Conclusions: The method presented in this paper showed a significant increase in transport-related physical activity in case the intended mode shifts in the Ile-de-France Urban Mobility Plan were realized. This simulation method could be applied on other important health outcomes, such as exposure to noise or air pollution, making it a useful tool to anticipate the health impact of transport interventions or policies. [ABSTRACT FROM AUTHOR]

Background: It is now widely accepted that social and physical environment participate in shaping health. While mortality is used to guide public health policies and is considered as a synthetic measure of population health, few studies deals with the contextual features potentially associated with mortality in a representative sample of an entire country. This paper investigates the possible role of area deprivation (FDep99) and travel time to health care on French cause-specific mortality in a proper multilevel setting.Methods: The study population was a 1% sample representative of the French population aged from 30 to 79 years in 1990 and followed up until 2007. A frailty Cox model was used to measure individual, contextual effects and spatial variances for several causes of death. The chosen contextual scale was the Zone d'Emploi of 1994 (348 units) which delimits the daily commute of people. The geographical accessibility to health care score was constructed with principal component analysis, using 40 variables of hospital specialties and health practitioners' travel time.Results: The outcomes highlight a positive and significant association between area deprivation and mortality for all causes (HR = 1.24), cancers, cerebrovascular diseases, ischemic heart diseases, and preventable and amenable diseases (HR from 1.14 to 1.29). These contextual associations exhibit no substantial differences by sex except for premature ischemic heart diseases mortality which was much greater in women. Unexpectedly, mortality decreased as the time to reach health care resources increased. Only geographical disparities in cerebrovascular and ischemic heart diseases mortality were explained by compositional and contextual effects.Discussion: The findings suggest the presence of confounding factors in the association between mortality and travel time to health care, possibly owing to population density and health-selected migration. Although the spatial scale considered to define the context of residence was relatively large, the associations with area deprivation were strong in comparison to the existing literature and significant for almost all the causes of deaths investigated.Conclusion: The broad spectrum of diseases associated with area deprivation and individual education support the idea of a need for a global health policy targeting both individual and territories to reduce social and socio-spatial inequalities. [ABSTRACT FROM AUTHOR]

Disparities in breast cancer screening are often explained by socioeconomic factors, although a growing body of papers show that risk preference, time orientation and perceptions may explain mammography use. The aim of this paper is to estimate the relative contribution of socioeconomic factors, risk preference, time orientation and perceptions to disparities in breast cancer screening regularity. These determinants are elicited in an experimental laboratory from 178 women aged between 50 and 75 years in France in 2013. The results reveal that risk aversion accounts for 30% of the variance in screening regularity, which is greater than that attributable to socioeconomic determinants (20%), perceptions (11.5%) or time orientation (2%). These results suggest that further investigation on the relationship between risk aversion and screening behaviors is needed to design more comprehensive public health interventions. [ABSTRACT FROM AUTHOR]

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Rationale: Public health and preventive medicine (PHPM) has been recognized internationally as a physician specialty, but national parallels and differences exist between training contexts. This paper reviews PHPM training and employment in Canada, France, Italy, Japan, the United Kingdom, and the USA. Methods: Information gathered from relevant accreditation bodies and literature searches was used to create descriptive profiles of national training demographics and structure and a narrative outlining trends and challenges facing the specialty. Results: Notable similarities and differences exist between national contexts. Key themes were differences in training strategies and practice scope, specialty stakeholders, certification structure, and funding. Recognition challenges faced the specialty across all six countries. Other challenges included unclear competencies and training strategies and a need for PHPM specialists to highlight their role in combating population health threats. Additional differences existed between comparator countries on the structure of training, funding sources for training programs, availability of training posts, and linkages with other physician specialties. Conclusion: Highlighting these themes is a first step to fostering training collaborations between PHPM specialist physicians to augment transnational action on global public health challenges and also supports PHPM physician educators with innovative solutions from abroad that might address domestic specialty challenges. [ABSTRACT FROM AUTHOR]

In France the desire to expand public health developed mainly because of the hygienist movement which prevailed in the 19th century. This paper aims to show how medical doctors committed themselves deeply at the Chambre des députés and Sénat with the objective of creating the legislation to control sanitary standards which was written between 1870 and 1914.

Background: Health literacy (HL) has become a subject of major interest in public health worldwide. It is known to be linked to self-efficacy in care use and to global health status, and a non-negligible frequency of problematic or inadequate levels of HL in populations worldwide is reported. As this has yet to be evaluated in France, the present study aimed to evaluate the HL level of patients in a French emergency department (ED). Methods: We conducted a descriptive, cross-sectional observational, single center study in the ED of the Lyon Sud hospital (Hospices civils de Lyon, Lyon, France). The primary endpoint was the HL level of the patients determined according to the score obtained using the 16-item European Health Literacy Survey Questionnaire. The secondary endpoint was the identification of sociodemographic factors associated with the HL level. Results: A total of 189 patients were included for analysis. 10% (95% CI [3%; 17%]) of the patients had an inadequate HL, 38% (95% CI [31%; 45%]) had a problematic HL, and 53% (95% CI [46%; 61%] had an adequate HL. In multivariate analysis, age and perceived health status were independent predictors of the HL level; OR =0.82 (95% CI [0.69; 0.97]; p=0.026) for a 10-year increase in age, and OR =1.84 (95% CI [1.22; 2.82]; p=0.004]). Conclusions: The HL level of the patients in the ED studied herein was similar to that found in the population of France and other European countries and was influenced by age and perceived health status, which are both associated with care needs. It may be therefore interesting to explore in future studies how taking into consideration HL in the general population may lead to a better self-efficacy in care and optimize the use of the healthcare system. [ABSTRACT FROM AUTHOR]

Neural tube defects are neurological conditions affecting one in 1000 fetuses in France each year. If a fetus is affected, there is a 90% chance that the pregnancy will be terminated. Increasing folic acid intake to 400μg per day 2months before and 2months after conception reduces prevalence rates by at least 40%. In 2005, France introduced a social marketing campaign seeking to increase the intake of folic acid by to-be-pregnant and pregnant women through information provision. This paper sets up a quasi-experimental setting to measure the impact of the French social marketing campaign on availability and preferences for folic acid. I combine detailed scanner data on grocery purchases with a dataset on macronutrients and micronutrients. The identification strategy exploits the variation in the usefulness of folic acid information between households: households that are pregnant or want to conceive a child use it, while those that are not pregnant do not. Results suggest evidence of a positive impact of the information campaign on folic acid household availability and preferences. A value per statistical neural tube defects case is found to be of at least 12 million. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The article offers information on the 27th edition of the Oncology Nursing Meetings (RIO), scheduled for March 16, 2024, at the new venue, Palais des congrès, porte Maillot, in Paris. The program, curated by the scientific and organizational committee (CSO), will revolve around current themes conducive to learning, featuring diverse formats for exchanges and sharing, including round tables, calls for papers and posters, symposiums, etc.

The 2008-2012 French Alzheimer plan has proposed measures to improve care for dementia patients in a more personalized and graduate approach owing to patients and caregivers needs. A key measure of the plan is the nationwide implementation of the MAIA (French acronym for Maison pour l'Autonomie et l'Intégration des malades d'Alzheimer). The main goal is to implement a process of integration through a network of partners involved in elderly care, assistance, or support. The MAIA model comprises tools and mechanisms necessary to improve the integrated care process; in particular, case management for elderly in complex situations. The purpose of this paper is to describe the main measures from the national plan that aim to improve care for dementia patients with an emphasis on the MAIA measure. We summarize initial results of case management activity in one MAIA in the South West of France and we present two vignettes of cases benefiting from case management in order to demonstrate the nature of intervention. The French Alzheimer plan has promoted several non-pharmacological strategies for dementia patients. Implementation of both integrated care and case management represent a challenging perspective for the elderly and health professionals.

Purpose: The purpose of this paper is to give an overview of management of the COVID-19 epidemic in a French immigration detention center. Design/methodology/approach: During containment in France because of COVID-19, the judicial authorities had to deal with the risk of contamination within immigration detention centers (IDC). In the Paris IDC, which can usually receive up to 240 individuals, measures have been taken to limit the risk of contamination by releasing individuals without prior judicial conviction and testing the others by a nasal swab. Findings: The test was done for all the present individuals (48), except two who refused. Eight tests (17.4%) were positive and only one was symptomatic. Individuals testing positive for COVID-19 were transferred into COVID-centers specially created during this health crisis. Originality/value: Management of the COVID-19 epidemic in this French IDC illustrates the necessity of good cooperation between judicial authorities and medical teams in charge of those centers and the difficulty of balancing public health actions with state security. [ABSTRACT FROM AUTHOR]

Early evidence shows mixed effects of the COVID-19 pandemic on births in Europe. This research note compares pre-pandemic trends in the general fertility rate (GFR) at the regional level in the four European countries with the largest populations--France, Germany, Italy, and Spain--with those observed after the onset of the pandemic. It also explores the relationship between changes in GFR during the pandemic and factors such as COVID-19-related deaths, changes in labour market characteristics, and shifts in the population at risk of poverty following the pandemic's onset. We collected regional data on monthly births from January 2018 to December 2021 from national statistical offices, with additional data from Eurostat. Our analysis included two sets of regressions. First, regional-level fixed effects linear regression models for monthly GFRs were run separately for each country to estimate the effects of three pandemic periods for each region. The resulting coefficients of the pandemic periods were then integrated into a weighted linear regression as the dependent variable, including regional factors such as changes in labour market characteristics, risk of poverty, and excess mortality as regressors. The results highlight within-country variations in birth rate changes following the pandemic, with a particular association between declining birth rates and increased youth unemployment. [ABSTRACT FROM AUTHOR]

Introduction: Prolonged Hospital Length of Stay (PLOS) is an indicator of deteriorated efficiency in Quality of Care. One goal of public health management is to reduce PLOS by identifying its most relevant predictors. The objective of this study is to explore Machine Learning (ML) models that best predict PLOS. Methods: Our dataset was collected from the French Medico-Administrative database (PMSI) as a retrospective cohort study of all discharges in the year 2015 from a large university hospital in France (APHM). The study outcomes were LOS transformed into a binary variable (long vs. short LOS) according to the 90th percentile (14 days). Logistic regression (LR), classification and regression trees (CART), random forest (RF), gradient boosting (GB) and neural networks (NN) were applied to the collected data. The predictive performance of the models was evaluated using the area under the ROC curve (AUC). Results: Our analysis included 73,182 hospitalizations, of which 7,341 (10.0%) led to PLOS. The GB classifier was the most performant model with the highest AUC (0.810), superior to all the other models (all p-values <0.0001). The performance of the RF, GB and NN models (AUC ranged from 0.808 to 0.810) was superior to that of the LR model (AUC = 0.795); all p-values <0.0001. In contrast, LR was superior to CART (AUC = 0.786), p < 0.0001. The variable most predictive of the PLOS was the destination of the patient after hospitalization to other institutions. The typical clinical profile of these patients (17.5% of the sample) was the elderly patient, admitted in emergency, for a trauma, a neurological or a cardiovascular pathology, more often institutionalized, with more comorbidities notably mental health problems, dementia and hemiplegia. Discussion: The integration of ML, particularly the GB algorithm, may be useful for health-care professionals and bed managers to better identify patients at risk of PLOS. These findings underscore the need to strengthen hospitals through targeted allocation to meet the needs of an aging population. [ABSTRACT FROM AUTHOR]

Aims: Recent studies have suggested increased rates of depression in healthcare workers (HCWs), with direct impact on care quality and productivity. The objective was to determine the proportion of HCWs adequately treated for their major depression in a nationwide survey, the proportion of lifestyle risk factors for depression, and to determine if working in psychiatry department or professional status may modulate these outcomes. Design: The method followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement guidelines. A survey comprising the Center for Epidemiologic Studies‐Depression Scale was sent to public and private national healthcare facilities. Results: Overall, 10,325 participants were recruited; 3438 (33.3%) [95% confidence interval 32.4–34.2] met likely diagnostic criteria for clinical depression. Almost 80% of them declared that they had a history of major depressive episode. However, only approximately 23% of them were treated with antidepressants and approximately 13% had a psychiatric follow‐up. Depressed HCWs working in psychiatry departments received slightly better care for their depression, but they also consumed more anxiolytics and hypnotics and had more risk factors for depression (including smoking and hazardous drinking). We found specificities according to professions, physicians reported higher rates of hazardous drinking while nurses, nurse assistants, and health executives had higher rates of smoking and twice as much obesity as physicians. Conclusion: Disseminating tools to detect major depression, programs destigmatizing depression and antidepressants, promoting physical activity, weight loss, tobacco cessation and reduced alcohol consumption are promising strategies to improve the care of major depression in HCWs. Relevance to clinical practice: Reducing depression in healthcare workers is necessary to improve the quality of care, to limit burnout, medical errors, absenteeism and turn‐over and globally to improve the wellbeing at work. [ABSTRACT FROM AUTHOR]

Objectives: To assess the potential contribution of improving the nutritional quality of processed foods on individuals' nutritional intake and food supply. This paper also discusses the means to encourage firms to implement these reformulations, particularly in public/private partnerships., Study Design: The French Observatory of Food Quality was created by the Government for the quantification and follow-up of food reformulation by the food industry. This nutritional composition database on branded products was matched with two consumption databases: TNS Kantar Worldpanel, which provides details on quantities bought and food expenditures; and INCA 2, an individuals' food consumption survey completed by the French Food Safety Agency. Three food groups were considered: breakfast cereals (355 items in 2008), biscuits and pastries (1805 items in 2008), and bread-based products (620 items in 2009)., Methods: First, the variability in nutrient composition within food categories was determined, which made it possible to consider several food composition modification scenarios within each category. The formulation of the food items with the lowest nutritional quality was modified to three different levels to improve the overall level of quality in a given category. Second, the quantities of sugars, fat, fibre and sodium delivered to the French market through breakfast cereals, biscuits, pastries and bread-based products were calculated for each scenario. Finally, the distribution of individuals' nutrient consumption from the three food groups among the French population was assessed., Results: These scenarios generated important improvements of 1-22% (increase in the amount of fibre or decrease in the amounts of sugars, fat and sodium delivered to the market), depending on the scenario, the food group and the nutrient considered. Improvement of the products with the lowest nutritional quality would also lead to significant variation in individuals' nutrient consumption for the average adult and child consumers of the three groups (range 4.2-18.8%, depending on the scenario, the food group and the nutrient considered)., Conclusion: Encouraging the reformulation of foods, especially for products with the lowest nutritional quality in each category of processed foods, is a worthy target for health policy makers. The methodology presented in this paper provides information for negotiations between policy makers and firms to quantify commitments in terms of their potential impacts on individuals' nutrient intake, and to check that the firms' commitments are actually met., (Copyright © 2011 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Famed owing to his research works about fats and colours, the chemist M.-E. Chevreul was also greatly interested in public health. He expressed himself on this matter especially as member then chairman of the Advisory Committee of Crafts et Factories: set of laws on insanitary factories to be reconsidered, choices of processes which do not affect workers' health. He has relations with old pupils of the Polytechnics School: so he was at the beginning of Charles Freycinet's brilliant career. He read papers to the French Agricultural Society and Sciences Academy and was a juror of the academic committees of insanitary crafts.

FSPH is based on the foundations of the 45-year-old National School of Public Health Administration (ENSP), located in Rennes (Brittany) on a 22-acre campus. The annual budget is 55 milion euros, which is only partly adequate for FSPH missions and objectives. What is currently needed, in addition to ENSP is a high-level academic establishment. It has been argued that France lacks the research resources and funding necessary to hold a leading international position in public health research and expertise. About 85% of international scientific papers published by French teams in the field of public health are produced by Inserm (the French equivalent of NIH) and university hospitals, which are mainly located in Paris. It is proposed to initially network and reinforce existing forces, in close collaboration with top-level institutions in the French capital. This series of three papers proposes to establish a dynamic in two domains: (i) risk analysis and regulation, and (ii) prevention and screening in public health. FSPH will be grounded on scientific excellence, French-English bilingual training, openness to Europe and North America, worldwide notoriety, and collaboration with top-flight academic and research institutions, hospitals, and the private sector.

Objective: The current challenges of cultural diversity necessitate effective methods for training professionals in health, as well as other sectors, to work with the phenomenon of culture. This paper presents an overview of a semiotic-based approach to training in this regard., Methods: Recent publications by Anti Randviir in semiotics on the textual nature of cultural phenomena and by Annabel Levesque on the healthcare issues of Western, French-speaking Canadians provide the methodological frame and basic cultural reference for the overview., Results: The anthropological definition of culture as a 'semiotic', or universe of meaning, offers interdisciplinary common ground for designing practical approaches to cultural analysis, intercultural communication and creativity training. This definition is consistent with convergent findings and research practice in social and cognitive psychology, administrative science, philosophy, ethnography, linguistics and semiotics., Conclusions: Cultural performances such as narrative constitute an effective methodological tool for interdisciplinary data gathering and for analysis of all kinds of cultures: organizational, family, ethnic, regional, transborder, etc. When combined with a functionalist and systemic approach to the study of culture, semiotic approaches to narrative analysis provide useful principles for decoding cultural modes of communication and for designing meaningful change based on cultural specificity.

A heatwave in 2003 caused 15,000 deaths in France. This article examines the impact of the public health crisis on French public management, considering how government actors across various state institutions, including central and decentralized tiers of public administration, have been engaged in reform. It studies how these actors in the post-crisis reform process established responsibility and drew lessons. The paper shows that solidarity was used discursively in a game of political blameshifting and experimentation. It also points to the politics behind the framing of crisis enquiries. [ABSTRACT FROM PUBLISHER]

The medical community has long regarded obesity and overweight as serious health risks, and popular culture reflects these concerns. A focus on body weight reduction motivates many contemporary exercise and diet practices, especially among women. Yet, there is significant evidence that those risks have been exaggerated, that weight loss regimens may be more detrimental to health than moderate obesity, and that pressure to be thin leads to disordered eating and unhealthy lifestyle choices. This paper examines the problematic manners in which some national health policies regard the problems of overweight and obesity. It contends that concepts of aesthetics, grounded in 19th-century beliefs about the body, guide clinicians to emphasize measurement of the body in health assessment at potential cost to individual wellness.

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.