[Carers and the policy for autonomy].

Long-time invisible, the role of informal carers in providing assistance to elderly patients losing their autonomy is gaining recognition. A policy in favour of carers coordinated with that aimed at the people being cared for is necessary, but it is struggling to establish itself in France. Some progress can however be seen with the French bill on adapting society to the ageing of the population.

[Coordination of support to general practitioners to facilitate the patient's care pathway].

Background: In France, the referring GP is responsible for coordination of the patient's care pathway, but GPs appear to have few resources to achieve this task A general practitioner support network (Arespa) was developed in the Franche-Comté region (Arespa)for complex patients.

Objective: To analyse the functioning and effects, of this network on the GP's practices.

Methods: Qualitative research.

[Avoidable hospitalizations: the sole responsibility of primary care?].

Background: Avoidable hospitalizations are used as a performance indicator of primary care in many countries. We investigate here the validity and usefulness of this measure both at a global scale and for the French healthcare system.

Methods: A scoping study was performed to take a critical look at this concept.

Advancing primary care in france and the United States: parallel opportunities and barriers.

Primary care has been identified as key to improving health care delivery systems across the globe. France and the United States have been ranked low on scales of primary care orientation. However, each nation has developed significant approaches to structuring primary care and organizing primary care-focused systems.

Performance scores in general practice: a comparison between the clinical versus medication-based approach to identify target populations.

Context: From one country to another, the pay-for-performance mechanisms differ on one significant point: the identification of target populations, that is, populations which serve as a basis for calculating the indicators. The aim of this study was to compare clinical versus medication-based identification of populations of patients with diabetes and hypertension over the age of 50 (for men) or 60 (for women), and any consequences this may have on the calculation of P4P indicators.

Methods: A comparative, retrospective, observational study was carried out with clinical and prescription data from a panel of general practitioners (GPs), the Observatory of General Medicine (OMG) for the year 2007.

Ethical issues raised by the introduction of payment for performance in France.

Context: In France, a new payment for performance (P4P) scheme for primary care physicians was introduced in 2009 through the 'Contract for Improving Individual Practice' programme. Its objective was to reduce healthcare expenditures while enhancing improvement in guidelines' observance. Nevertheless, in all countries where the scheme was implemented, it raised several concerns in the domain of professional ethics.

The preferred doctor scheme: a political reading of a French experiment of gate-keeping.

Objectives: Since 2006 France experiences an innovative version of Gate-keeping which aims at regulating access to outpatient specialist care. We describe the reform's initial objectives, the political pathway which lead to the implementation of a reshaped reform and discuss the first outcomes after 1 year implementation. In the conclusion, we try to catch a glimpse for future steps of the reform.

[How to build the legitimacy of patient and consumer participation in health issues?].

Initially introduced by Juppé in 1996, the legislative reforms of January 2nd and March 4th 2002 legally enacted new forms of consumer representation and participation in the development of the health system. However, it appears that while this new role which was created to ensure legitimate participation has been recognised by law in theory, it has not necessarily received the same recognition and incorporation in practice at the grass roots level. As a result, it is now essential to think about practical methods of representation in order to sustain local legitimacy of consumers and patients on the ground and construct it from the bottom-up.

[Benchmarks for evaluating health care networks].

The implementation of health care networks is accompanied by a certain number of changes in professional practices. At the heart of the economic, organisational, and political stakes, new questions are posed, especially in terms of evaluation. It is true that no matter what the level of evaluation, it is essential today to rely on the support of existing information systems to develop methodologies and to better describe the produced effects, in economic terms and health outcomes, but also from a more qualitative point of view, in terms of public satisfaction and benefits to clients.

[Risk factors, diseases and health care acceptance in perinatology: a predictive model of hospital use].

Background: The goal of our study was to develop a predictive model of resource use for pregnancy and perinatal care based on the knowledge of the distribution of risk factors in a given population of pregnant women.

Methods: Data recorded in Outcome of Pregnancy Certificates (CIG) from 11 voluntary maternities of the district of Seine-Saint-Denis allowed us to identify those pathologies that were predictive of premature births and prenatal hospitalization of mothers. We built a classification of disease states and of risk level.

[-Anesthesia and analgesia practice patterns in French obstetrical patients-].

Objective: To assess the rate of epidural analgesia (EA) for parturition and the techniques of anaesthesia for Caesarean section (CS).

Study Design: Retrospective study.

Patients: A series of 84,235 deliveries.

[Type of birth center and conditions of transfer of neonates under 1500 g or gestational age under 33 weeks].

Background: Perinatal care's organization has been widely discussed in France during this last decade. Until now, transfer of high-risk neonates from their birth maternity to a pediatric unit using mobile vehicles led by specialized teams is encouraged in this country.

Population And Methods: Retrospective analysis of the type of maternities of birth for a population of 717 newborns, weighing less than 1,500 g and/or of gestational age under 33 weeks, extracted from a sample of 84,279 births in 1991.

[Cesarean sections in France: impact of organizational factors on different utilization rates].

In this study, we analysed the potential impact of organizational factors to explain the variation of cesarean sections' rates. We used a retrospective sample of 84,372 deliveries and two subsamples of low risk deliveries for cesarean sections. We determined different organisational factors that included: juridical and financial status of maternities, their architecture, the type of on-call for obstetricians, pediatrists and anesthetists, the annual number of deliveries and the level of pediatric staff and equipments of the maternities.

[Analysis of delivery facilities and conditions in 1991 in mothers of infants with birth weights below 1500 grams and/or gestational age under 33 weeks].

Aims: To identify maternities (in terms of level of activity and linkage with pediatric services) where, in 1991, mothers gave birth to infants of gestational age less than 33 weeks and/or with birth weight under 1500 g. To analyse factors linked to the probability of choosing a particular maternity as place of delivery for this population and measure the impact of maternal transferts on the rates of deliveries. To estimate the number of neonate transferts which could be avoided with simple recommendations.

[Coding problems in medical information in the framework of the medicalization of the hospital information system].

The authors review the difficulties presented by the description of medical data, on the basis of the french experience with the programme to medicalize the hospital information system. They explain the different steps in preparing a hospital discharge abstract, and the difficulties presented by each one. They particularly stress the phase of hierarchization in choosing the principal diagnosis.

Measles-specific lymphocyte reactivity and serum antibody in subjects with different measles histories.

Measles hemagglutination-inhibiting (HAI) antibody titers and measles-specific lymphocyte reactivity were studied in subjects who had previously received killed measles vaccine and had been recently reimmunized with live vaccine--persons who previously had atypical measles, subjects with multiple immunizations with live vaccine, adults with a history of measles, and persons with primary measles immunization. Twelve to 18 months after revaccination of former recipients of killed vaccine, all 31 subjects had measles HAI antibody titers greater than or equal to 10 and only three had lymphocyte stimulation indices (LSI) greater than 2.8.

Revaccination of previous recipients of killed measles vaccine: clinical and immunologic studies.

Clinical and immunologic studies were performed in association with revaccination with live measles vaccine in 75 adolescents 11 to 14 years after immunization with killed measles vaccine. Ten subjects had local pain with swelling or erythema or both at the injection site; in three, the local reactions were severe and disturbing systemic complaints were also noted. These marked reactions were more common in subjects in whom the interval between the last dose of killed vaccine and the dose of live vaccine of the primary immunization series was less than or equal to 2 months, in subjects with prevaccination serum HAI antibody titers of less than or equal to 5, and in subjects with high measles antigen specific lymphocyte stimulation ratios.

Nervous complications of exanthem subitum.

For many years it was generally believed that all convulsions associated with exanthem subitum were febrile in origin. More recently several investigators have suggested that the causative agent of this disease has a selective action on brain tissue aside from the effect of high temperature. In support of this concept are a variety of neurological manifestations sometimes observed during the course of exanthem subitum.