Search

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

OBJECTIVE: Our aim was to analyse the obstacles and eventual motivations of solo GPs for working in group practice. METHODS: A qualitative study using 12 focus groups was carried out in primary care in French-speaking Belgium. The subjects comprised four samples of GPs: 20 GP trainers, 18 GP trainees, 25 women GPs and 25 other GPs. The focus groups were taped and transcribed. Two independent researchers carried out the analysis using the QSR NUD.IST software. RESULTS: The participants (88 GPs) did not share a common definition of group practice-in particular multidisciplinary working-the need for a common pool of patients and shared premises. Their main sources of motivation for eventually setting up a group practice were better quality of life, continuity of care and sharing professional knowledge. The main obstacles were a required agreement between colleagues, the loss of a personal patient-GP relationship, budgetary constraints, and divergent views on group practice and GPs' profession (especially true for the association of GPs from different age groups). CONCLUSION: The current study shows that GPs working solo have divergent views of group practice. However, they clearly perceive advantages to this type of association (e.g. better quality of life and continuity of care). This study also confirms the high level of stress and tiredness felt by GPs and especially senior practitioners.

Objective Analyse the parental behaviours that are recognised as influencing the health of very young children based on family structure (parents separated or not).Design Cross-sectional study.Setting Free preventive medicine consultations in the French Community of Belgium.Participants Examination of 79 701 infants aged 7–11 months as part of a free preventive medicine consultation. The data came from an assessment conducted 7–11 months after birth during which information was collected, namely about the parents’ use of tobacco, the infant’s type of nutrition and adherence to vaccination schedules.Main outcome measures Parental behaviours: smoking, nutrition and compliance with vaccination schedule.Results The percentage of infants whose parents were separated was 6.6%. After adjusting for the cultural and socioeconomic environment as well as for other potential confounders, in the event of separation as compared with non-separated parents, the adjusted ORs (95% CI) were as follows: 1.5 (1.3 to 1.7) for the infant’s exposure to tobacco; 1.3 (1.2 to 1.4) for total lack of exclusive breast feeding; 1.3 (1.1 to 1.4) and 1.2 (1.1 to 1.2) for breast feeding for a duration of less than 3 and 6 months, respectively; 1.2 (1.1 to 1.4) for non-compliance with the vaccination schedule against rotavirus. The duration of exclusive breast feeding was shorter when parents were separated (p, SCOPUS: ar.j, info:eu-repo/semantics/published

Hemifacial spasm is a rare, benign condition that first was described more than a century ago. Symptoms are synkinesis and spasms, for which different hypotheses have been put forward that are detailed in this article. The surgical anatomy of the cerebellopontine angle and of the different offending vessels is reviewed, followed by a histologic description of the root exit zone of the facial nerve with microscopic illustrations. A clear, practical technique for microvascular decompression of the facial nerve is described. This article ends with a report of the results and the complications of microvascular decompression found in the literature.

Load management programs are used by electric utilities to decrease peak consumption. Although they are generally offered simultaneously with regular service, economic models of their allocative efficiency are based on the implicit assumption that they are the only service available. We present a model in which participation to a particular load management program, called self-rationing, is optional. We show that, under a break-even constraint, welfare-maximizing prices involve a subsidy from the self-rationing program to regular service whenever peak demand is less elastic than base demand. If cross-subsidization is precluded, regular service is viable only if there exist transaction costs to participate in the self-rationing program.

Background: Many children are experiencing their parents’ separation and General practitioners (GPs) oftenhave the responsibility to medically follow these young patients.Objectives: The goals were to identify the main difficulties GPs are confronted with when following childrenof separated (or divorced) parents and to find ways to improve the quality of these children’s continuous medicalmonitoring.Methods: Eight focus groups of GPs were organized in 2004 in the French-speaking Community of Belgium.Each meeting focused on couples separated for less than three years, with children aged 0 to 15. The debates wereanalysed with the QSR N5 software. Data saturation was obtained after four focus groups.Results: The viewpoint of GPs is: 1. Divorce affects the working conditions of GPs. 2. Conflicts between theparents cause difficulties for the GP, particularly the fact of being « exploited » by the parents. 3. All GPs do nothave the same attitude towards conflicts between the parents; only some of them will try to « manage » the conflictsto improve the child’s situation. 4. Especially in the case of conflicts, parental separation brings a risk for the child:psychological disorders, physical health problems. 5. The professional attitudes of GPs can have a positive influenceon the child’s development, including direct child-centred communication with the child. 6. Some actions, such asproducing sickness certificates or official reports of neglect, can aggravate these children’s situation, especially inthe case of conflicts between the parents.Discussion: Parental separation could be an independent risk factor for the child’s health by inducing somedifficulties of tracking in primary care medicine. If this is confirmed, in case of a family breakdown, the GP shouldadapt the practice of prevention and care, recognizing young patients as most at risk. In order to confirm the possibleimpact of family status, cohort studies must be conducted either transverse observational targeting unselectedpaediatric populations of different ages, or even better in prospective research. Given the high prevalence of parentalseparation in Belgium, the influence of these situations should be measured in terms of public health., info:eu-repo/semantics/published

We provide an efficiency justi cation for the imposition of the uniform pricing constraint in universal service obligations (USO), where USO are de fined as a set of constraints imposed on fi rms belonging to a network industry. Besides the uniform pricing (UP) constraint, which is an obligation to serve all consumers at an identical price, constraints considered are the coverage constraint (CC), an obligation imposed to one of the firms to serve a given segment of the market, as well as the license constraint (LC), a minimum or a maximum coverage restriction imposed on entrants. We show that adding the UP constraint to both a CC and a LC brings an increase in welfare. Our contribution comes from the full recognition of the role of a LC in well-designed USO and we illustrate this role with the particular case of linear demand.

Analysis of interruptible service mechanisms has focused on the efficiency losses due to the absence of complete contingent contracts. There exists a second type of inefficiency which, to a large extent, has been ignored. It originates from the fact that the relative order, or ranking, of consumers' willingness to pay for a given quantity generally varies throughout the contract period. A more general model of electricity demand allowing for changes in the order of consumer willingness to pay for a given quantity is presented. Under such demand conditions, the use of a two-stage rationing mechanism is proposed. Rationing plans which maximize expected aggregate surplus are established in the first stage. The second stage consists in a market for allocation rights to be operated once the states of nature are revealed. Allocations under this two-stage mechanism are shown to be Pareto-superior to existing rationing plans. Directions for future research are discussed.

In a recent issue of this Journal, Woo (1990) suggests a mechanism to improve on a pricing scheme initially proposed by Panzar and Sibley (1978). In this paper, we analyze Woo's mechanism. Woo claims that by activating rationing fuses only when total demand reaches system capacity, the problem of untimely curtailments is avoided. We show that this is trueonly if all consumers reach their subscribed capacity at the same temperature, which will not occur in general, and clarify the implications of this assumption on Woo's improvement of the Panzar-Sibley scheme. A slightly more complex self-rationing mechanism, which addresses the problems that we point out, is suggested.

A universal service obligation (USO) that imposes ubiquity and uniform pricing constraints generally creates strategic links among markets served by the universal service provider (USP). In this paper, we show that adding a unit subsidy in the compensation scheme of a USO helps to counteract the inefficiencies that result from these strategic links. Welfare obtained under different implementations of the USO depends on whether use of the unit subsidy is limited or not. In this respect, franchise bidding for the USO, where firms submit bids for lump-sum subsidies, is welfare-dominated by the exogenous choice of the USP and by pay-or-play regulation. Similarly, the second-best allocation can be attained through the endogenous choice of the USP’s geographic area of monopoly, provided the unit subsidy instrument is available.

The many surveys about information usages in academic environment tend to rest on the model of the generational digital divide, according to which the academic world is impacted from outside by the "digital natives" usages. As a consequence, they tend to evaluate students information practices according to the distance from the "good practices" as conceived by the mediators. A non-normative evaluation mode, based on efficiency, could give a better view on the diversity and inventivity of the strategies. Such an evaluation implies a new understanding of those information retrieval. Through three lines of questioning (knowledge of ressources, critical appropriation of interfaces, reassumption of subjectivity) we give a sketch for a new paradigm, that of a "fuzzy search" wich associates mastering the tools according to the relevance criteria with serendipity as implying the trained aptitude to greet the unexpected.; Les enquêtes sur les pratiques informationnelles en milieu universitaire tendent à reposer sur le modèle de la fracture numérique générationnelle, où le milieu universitaire est impacté de l'extérieur par les usages des digital natives, et à évaluer les pratiques des étudiants selon leur écart avec ce que les médiateurs estiment les "bonnes pratiques". Un mode d'évaluation non normatif mais basé sur l'efficience des stratégies de recherche permettrait de rendre mieux compte de leur diversité voire de leur inventivité. Une telle évaluation suppose une nouvelle compréhension de ces stratégies. A travers trois axes de questionnement (connaissance des ressources, appropriation critique des interfaces, réassomption de la subjectivité des pratiques) nous esquissons un nouveau paradigme d'une "recherche floue" qui associe la maîtrise des outils selon le critère de la relevance à la sérendipité en tant qu'elle suppose l'aptitude à accueillir l'inattendu

In recent years international policies have aimed to stimulate the use of information and communication technologies (ICT) in the field of health care. Belgium has also been affected by these developments and, for example, health electronic regional networks ("HNs") are established. Thanks to a qualitative case study we have explored the implementation of such innovations (HN) to better understand how health professionals collaborate through the HN and how the HN affect their relationships. Within the HNs studied a common good unites the actors: the continuity of care for a better quality of care. However behind this objective of continuity of care other individual motivations emerge. Some controversies need also to be resolved in order to achieve cooperative relationships. HNs have notably to take national developments into account. These developments raise the question of the control of medical knowledge and medical practice. Professional issues, and not only practical changes, are involved in these innovations.

The body distribution of i. v. doxorubicin depends mainly on the physicochemical characteristics of the molecule. However, entrapment of that cytostatic drug inside polyalkylcyanoacrylate nanoparticles has been shown to modify its distribution profoundly in the mouse. Polyisohexylcyanoacrylate nanoparticles loaded with [14C]-doxorubicin were studied in comparison with free drug, with emphasis on their distribution pattern in mouse tissue after i. v. administration. An autoradiographic study showed that most of the radioactivity was found in the reticuloendothelial system as soon as a few minutes after i. v. administration of the doxorubicin-loaded nanoparticles. Quantitative determinations by liquid scintillation counting in fresh tissue (spleen, heart, kidneys, liver, lungs, bone marrow) and blood samples confirmed these observations. When the drug was linked to nanoparticles, doxorubicin blood clearance was reduced during the first few minutes after administration, whereas heart and kidney concentrations were substantially decreased. Assays of doxorubicin and doxorubicinol by a specific HPLC analytical method gave results very similar to those obtained by scintillation counting.

This paper (i) highlights the role that unit subsidies can play in the compensation scheme of a Universal Service Obligation (USO), and (ii) shows that welfare may be reduced when regulation requires accounting separation of network activities for vertically integrated USO providers. This suggests that accounting separation should be avoided when a USO is implemented.

This paper takes into account adverse selection in the implementation of universal service obligations (USOs) for a network industry with no bypass. USOs are characterized by a coverage constraint imposed on the network’s owner. We develop fully the model for a welfare maximizing coverage constraint and explain how to adapt it for a full coverage (ubiquity) constraint. We use a market without USO as a benchmark case. We show that, because of information rents, a sufficiently high shadow cost of public funds can lead to a lower coverage with the USO than without it when firms turn out to be relatively inefficient. If the regulator is able to determine the industry structure by issuing licences to operate, the optimal number of firms reflects a trade-off between allocative efficiency and the industry capacity to finance internally the USO. The shadow cost of public funds then plays a dual role as it determines the terms of this efficiency funding trade-off in addition to the terms of the traditionnal efficiency rent trade-off.

Background To determine if detection of coronary artery calcifications in patients with Kawasaki disease may serve as a noninvasive predictor of future coronary artery events. Methods A prospective, cohort pilot study that included 18 patients with Kawasaki disease >1 year from the acute disease was performed including 9 patients with coronary abnormalities during the acute illness (Group 1) and 9 without coronary abnormalities (Group 2). Patients were classified by echocardiography as having none, resolved, or residual coronary artery abnormalities. Electron beam computed tomography (EBCT) scans were completed using the Agatson coronary calcium scoring system. Intermediate follow-up was performed 2.5 years after EBCT to determine if clinically significant coronary artery events (myocardial infarction or sudden death) had occurred. Results Late echocardiographic abnormalities corresponded with the early echocardiographic abnormalities in 5 of 9 patients (P = .029) in Group 1. The late echocardiographic abnormalities significantly correlated with detection of calcifications by EBCT in 4 of 5 patients (95% CI 28%-99%). One patient with residual coronary abnormalities and coronary artery calcifications with the highest calcium score subsequently had a sudden death. Detection of coronary artery calcifications may be predictive of sudden death (P = .056). No residual echocardiographic abnormalities, coronary artery calcifications, or coronary artery events occurred in Group 2 patients. Conclusions Patients with Kawasaki disease with residual coronary abnormalities show EBCT evidence of coronary artery calcifications. Detection of coronary artery calcifications may be useful for risk stratification in the long-term management of patients with Kawasaki disease.