Les seins des femmes, au centre du désir des hommes. Regards masculin et féminin

An educational programme in wound healing was developed in France in 1998. The course lasts for 1 year and consists of 100 hours of interactive education including wound-healing principles, management of pressure ulcers, leg ulcers, diabetic foot ulcers, burns and trauma. The programme mixes theoretical and practical issues and results in the award of a diploma that identifies students as having a level of expertise in wound healing. A large component of each student's evaluation is based on a thesis that has been developed by the student during the year. After 6 years of continual development and modification, this educational approach was analysed to evaluate its impact on wound healing in France. More than 500 individuals have been trained by this educational programme, including nurses, physicians, pharmacists, physiotherapists and employees of commercial concerns. In order to evaluate the impact of such a training programme on changing practice in France, a questionnaire was developed and a telephone survey carried out. The results of this survey are reported here and they show that education and training provided undertaking a university diploma has played an important role in the development of wound healing and the subsequent change in practice in France.

INTRODUCTION: A recent paradigm shift indicates that the origin of ovarian high grade papillary serous carcinoma is the fallopian tube. The American College of Obstetricians and Gynecologists and Society of Gynecologic Oncology now recommend prophylactic salpingectomies as a preferred method of sterilization. This study sought to evaluate current practices of sterilization across U.S. Obstetrics and Gynecology (OB/Gyn) residency programs. METHODS: This is an IRB-approved study. An electronic cross-sectional survey of 13 questions was sent to all OB/Gyn program coordinators for distribution to their residents. There are 5,258 filled residency slots in OB/Gyn for the 2016-2017 academic year. RESULTS: Response rate was 6.4%, with even distribution across years. The majority of residents are in an academic setting (64.8%). For patients undergoing post-partum sterilization, 55% of patients were counselled about bilateral salpingectomy and tubal ligation. Postpartum tubal ligation only is offered at 51% of programs. For non-pregnant patients, 40.6% of residents counsel patients about bilateral tubal ligation, hysteroscopic sterilization and bilateral salpingectomy. The most common procedure performed is a bilateral salpingectomy (47.4%), followed by bipolar coagulation (21.8%), spring clips (19.3%), Silicone band method (6.9%) and hysteroscopic sterilization(4.7%). The most common reason cited for performing ligation instead of salpingectomy was perceived increased surgical risk such as bleeding or infection (45.2%). CONCLUSION: Though limited in our response rates, this study has several important implications. Despite recommended practice changes, prophylactic salpingectomy to prevent ovarian cancer has not gained widespread acceptance for either postpartum or interim sterilization. Many patients treated in residency are uninsured or socioeconomically disadvantaged and such procedures may offer a unique opportunity for cancer prevention.

Excision (female genital mutilation) is a very ancient practice whose exact origins are still unknown. The aims of this essay are: 1) To explain the main reasons why some immigrants still perpetrate it on their daughters, also showing how this practice changes with the geographical area and with time; 2) To analyse the legal response to this practice in France, through a qualitative study of the judgements pronounced by the main criminal courts of the country: the Tribunal correctionnel and the Cour d’Assises.

Impact de l’étude LACC. Une enquête de la SFOG

Resilience through policy integration in Europe? Domestic forest policy changes as response to absorb pressure to integrate biodiversity conservation, bioenergy use and climate protection in France, Germany, the Netherlands and Sweden

This article focuses on recent changes in internal trade union organizational practices in France and Germany, drawing on interviews and internal union documents. Whereas the union renewal literature has emphasized the introduction of elements from the action repertoire of social movements into trade unions, this article finds that union officials and leaders are also transferring private sector managerial rhetoric and practices into trade unions. The extent and dynamics of this process termed ‘managerialization’ are discussed, as well as its effects on role definitions of union leaders, officials and members, comparing two trade unions: in France the Fédération Chimie Energie and in Germany the Vereinte Dienstleistungsgewerkschaft. The resulting tensions between trade unionism’s administrative and representative rationalities are highlighted.

Changes in cycling practices in France during the Covid-19 pandemic. An illusory reduction in inequalities

To understand, through the study of telerehabilitation introduction, whether telerehabilitation in physical therapy ('masso-kinésithérapie') represents a lasting change in professional practices in France. A triangulation of different qualitative methodologies was used, including eight semi-structured interviews, an observation of a telerehabilitation session and a participant and retrospective observation. A specific interview guide was developed for the interviews and another specific guide was developed for the telerehabilitation session observation to analyse this session. All semi-structured interviews were transcribed, and an in-depth thematic analysis based on grounded theory was performed. Three key themes emerged from our analysis. Firstly, physiotherapists quickly adopted telerehabilitation due to the widespread use of digital technologies and perceived clinical benefits. Secondly, they adapted their care delivery methods, transitioning from in-person to digital formats, and engaged in self-learning and peer support. These changes led to modifications in workspaces and communication practices, fostering closer relationships between physiotherapists and patients. Lastly, the implementation of telerehabilitation faces challenges, including technical difficulties, the lack of physical contact, and an unfavourable implementation context. Our results provide key elements to focus on for telerehabilitation implementation in physical therapy and professions for which professional practice is strongly associated with hands-on interventions.

Although free online machine translation (FOMT) is widely used by L2 students, the use of these tools in the context of L2 learning seems to remain controversial among teachers. The goal of this study is to compare high school teachers’ beliefs about FOMT with high school students’ practices in France. A survey was first conducted to gain access to teachers’ attitudes toward the use of FOMT in the classroom (n = 126), and learners’ practices were observed through video screen capture of a writing activity (n = 49). The use of Google Translate was studied as a cognitive process, and a comparative analysis of the texts produced with or without Google Translate was also carried out. The results contradict some of the teachers’ beliefs, as some videos show traces of cognitive activities (evaluation and revision) when learners use Google Translate. The analyses also confirm that the quality of the texts written with the help of Google Translate is better in terms of accuracy and complexity than when pre-intermediate learners do not use this tool.

INTRODUCTION: In the age of evidence-based medicine, physicians are expected to adapt quickly to changing recommendations. The Society of Gynecologic Oncology (SGO) released a practice statement in November 2013 recommending providers consider performing salpingectomy concurrently with other pelvic surgeries for prevention of epithelial ovarian cancers. This study evaluates practice changes from tubal ligation to salpingectomy for surgical sterilization at an academic center following these recommendations. METHODS: This IRB approved, retrospective cohort study evaluated interval surgical sterilization procedures performed in an academic medical center between 1/1/2012 and 12/31/2018. Descriptive statistics compared rates of salpingectomy with tubal ligation before and after 1/1/2014, as well as annually. A multivariable regression model was fit to the data to adjust for potential confounding differences between populations. RESULTS: 243 surgical sterilization procedures were performed during the study time period. Salpingectomy accounted for 0/64 (0%) prior to the recommendation release and 86/168 (51.19%) after the release, (P<.0001). Rate of salpingectomies increased annually: 3/31 (9.7%) in 2014, 9/35 (20.5%) in 2015, 16/32 (50.0%) in 2016, 22/23 (95.7%) in 2017, 36/38 (94.7%) in 2018, (P<.0001). Adjusting for potentially clinically relevant differences in the populations, the only other variable associated with type of sterilization was insurance, (P=.0279). Mean surgical duration was 8.5 minutes longer after the recommendation release, (P=.0019). There were no differences in blood loss, intraoperative or postoperative complications. CONCLUSION: Significant practice change in sterilization method from tubal ligation to salpingectomy occurred immediately following the SGO recommendations, however complete adoption of these recommendations (defined as 95% of procedures) took 4 years to achieve.

Epithelial ovarian cancer is the most common cause of mortality from gynecologic malignancy, and most of epithelial cancers are of serous type. The site of origin of pelvic high-grade serous carcinoma has been the subject of debate for 60 years. This paper reviews the evidence that pelvic serous carcinoma originates from the fallopian tube mucosa and puts forward a theory that inflammation in the tube, caused by menstrual cytokines or infection, is critical to the genesis of these tumors. Other risk factors for pelvic serous carcinoma will be reviewed, including oral contraceptive use, parity, infertility, and tubal ligation.Studies were identified for this review by searching the English language literature in the MEDLINE database between the years 1995 and 2007 using the following keywords: fallopian tube neoplasia, ovarian serous adenocarcinoma, pregnancy, oral contraceptive, infertility, pelvic inflammatory disease, cytokines, menstruation, and tubal ligation, followed by an extensive review of bibliographies from articles found through the search.The clinical implications of this theory are discussed, and a change in surgical practice is recommended, with salpingectomy at the time of simple hysterectomy. This theory also has implications for the development of new methods of screening for pelvic serous carcinomas, as there are no screening methods that are currently available to find this form of cancer in an early stage. Inflammatory markers could be detected in the vagina from the fallopian tube indicating possible chronic inflammation and a risk factor for mutagenesis leading to serous carcinoma.

(1) Background: Opioid use disorder (OUD) is a complex condition that can require long-term treatment. Pharmacological therapy for OUD involves treatment with opioid agonists (OMT) tailored to individual profiles. The aim of our study in daily clinical practice was to compare the profiles of patients treated with methadone (MTD) and those using buprenorphine (BHD or BHD-naloxone-NX). (2) Methods: A cross-sectional multicentre study explored the psychological, somatic and social profiles of patients with Opioid Use Disorder (OUD) following Opioid Maintenance Treatment (BHD, BHD/NX, or MTD). Descriptive and comparative analyses were performed (3) Results: 257 patients were included, a majority were men using heroin. 68% (178) were on MTD, 32% (79) were on BHD. Patients with MTD were significantly more likely to report socio-affective damage, and more likely to be younger and not to report oral or sublingual use as the main route for heroin or non-medical opioids (4) Conclusions: In daily clinical practice, regarding OUD damage, only socio-affective damage was significantly more prevalent among patients on MTD than among those on BHD in the multivariate model. Age and route of administration also differed, and our results could raise the issue of the type of OMT prescribed in case of non-medical use of prescribed opioids. These hypothesis should be confirmed in larger studies.

The development of the space industry in the Republic of Kazakhstan is acquiring particular significance in the context of rapid digitalization, increasing dependence on advanced telecommunication solutions, and intensifying international competition in the field of high technologies. President Kassym-Jomart Tokayev has repeatedly emphasized the need to shift from fundamental scientific developments to applied research and the commercialization of space technologies as a key element of modern state policy. The implementation of national projects such as «KazSat-2», «KazSat-3» and the planned «KazSat-3R» satellite demonstrates the Republic of Kazakhstan’s determination to ensure independence in satellite communications, expand the range of digital services, reduce reliance on foreign operators, and simultaneously create an economically sustainable model of revenue generation through the commercial use of space infrastructure. This study is devoted to the legal analysis of public procurement procedures applied in the implementation of the «KazSat-3R» project, considering its strategic importance and technological complexity. Particular attention is given to the provisions of the new Law «On Public Procurement» which came into force on January 1, 2025. An important element of the research is a comparative legal analysis of international practices in France and Germany, where flexible approaches are applied in procurement for strategic sectors. These instruments help to strike a balance between ensuring competitiveness and the need to implement complex projects in the space sector. The study examines institutional and regulatory barriers that arise in practice when attempting to engage foreign contractors - such as the absence of financial indicators in domestic sustainability assessment systems, as well as the inability to participate in procurement without a Kazakhstan Business Identification Number (BIN). Based on the analysis, the paper proposes specific measures to improve legislation aimed at eliminating legal barriers to the implementation of high-tech projects. These include the development of sector-specific procurement standards, the introduction of flexible procedures, and the formalization of mechanisms for the participation of foreign suppliers based on international evaluation criteria.

The European water governance took a decisive turn with the formulation of the Water Framework Directive (WFD), which demands the restoration of all water bodies that did not achieve sufficient ecological status. Urban rivers are particularly impaired by human activities and their restorations are motivated by multiple ecological and societal drivers, such as requirements of laws and legislation, and citizen needs for a better quality of life. In this study we investigated the relative influence of socio-political and socio-cultural drivers on urban river restorations by comparing projects of different policy contexts and cultural norms to cross-fertilize knowledge. A database of 75 projects in French and German major cities was compiled to apply (a) a comparative statistical analysis of main project features, i.e., motivation, goals, measures, morphological status, and project date; and (b) a qualitative textual analysis on project descriptions and titles. The results showed that despite a powerful European directive, urban river restoration projects still keep national specificities. The WFD drives with more intensity German, rather than French, urban river restoration. This study showed the limits of macro-level governance and the influence of microlevel governance driven by societal aspects such as nature perception and relationships between humans and rivers.

Sustainable Anesthesia