Conditions In France Research Articles

The impact of hospital saturation on non-COVID-19 hospital mortality during the pandemic in France: a national population-based cohort study

BackgroundA previous study reported significant excess mortality among non-COVID-19 patients due to disrupted surgical care caused by resource prioritization for COVID-19 cases in France. The primary objective was to investigate if a similar impact occurred for medical conditions and determine the effect of hospital saturation on non-COVID-19 hospital mortality during the first year of the pandemic in France.MethodsWe conducted a nationwide population-based cohort study including all adult patients hospitalized for non-COVID-19 acute medical conditions in France between March 1, 2020 and 31 May, 2020 (1st wave) and September 1, 2020 and December 31, 2020 (2nd wave). Hospital saturation was categorized into four levels based on weekly bed occupancy for COVID-19: no saturation (< 5%), low saturation (> 5% and ≤ 15%), moderate saturation (> 15% and ≤ 30%), and high saturation (> 30%). Multivariate generalized linear model analyzed the association between hospital saturation and mortality with adjustment for age, sex, COVID-19 wave, Charlson Comorbidity Index, case-mix, source of hospital admission, ICU admission, category of hospital and region of residence.ResultsA total of 2,264,871 adult patients were hospitalized for acute medical conditions. In the multivariate analysis, the hospital mortality was significantly higher in low saturated hospitals (adjusted Odds Ratio/aOR = 1.05, 95% CI [1.34–1.07], P < .001), moderate saturated hospitals (aOR = 1.12, 95% CI [1.09–1.14], P < .001), and highly saturated hospitals (aOR = 1.25, 95% CI [1.21–1.30], P < .001) compared to non-saturated hospitals. The proportion of deaths outside ICU was higher in highly saturated hospitals (87%) compared to non-, low- or moderate saturated hospitals (81–84%). The negative impact of hospital saturation on mortality was more pronounced in patients older than 65 years, those with fewer comorbidities (Charlson 1–2 and 3 vs. 0), patients with cancer, nervous and mental diseases, those admitted from home or through the emergency room (compared to transfers from other hospital wards), and those not admitted to the intensive care unit.ConclusionsOur study reveals a noteworthy “dose-effect” relationship: as hospital saturation intensifies, the non-COVID-19 hospital mortality risk also increases. These results raise concerns regarding hospitals’ resilience and patient safety, underscoring the importance of identifying targeted strategies to enhance resilience for the future, particularly for high-risk patients.

First Report of Pinnatoxin-G (PnTX-G) in a Marine-Coastal Area of the Adriatic Sea Associated with the Presence of the Dinoflagellate Vulcanodinium rugosum.

This study reports the first detection of the marine neurotoxin pinnatoxin-G (PnTX-G) in clams collected in the northwestern Adriatic Sea (Italy). It also represents the first report of the potential toxin-producing dinoflagellate, Vulcanodinium rugosum, in Italian seas. This result, from the coasts of the Emilia-Romagna Region, indicates a successful colonization process, reflecting conditions in France where V. rugosum was initially documented. In this case, the concentration of PnTXs was very low, making further sampling necessary to fully understand the extent of the phenomenon. Discussions on the need to obtain more data to support a proper risk assessment and the need to implement a monitoring program that includes emerging marine biotoxins are also included.

Prevalence and burden of chronic cough in France.

Chronic cough is a common condition that is associated with lower health-related quality of life and greater healthcare resource use. There are limited data on the prevalence, population characteristics and burden of chronic cough in France. This was a cross-sectional study based on responses from French adult residents to the 2020 National Health and Wellness Survey. Respondents with chronic cough were compared to 1:3 propensity score-matched controls without chronic cough. The weighted lifetime and 12-month prevalence of chronic cough were estimated as 7.5% and 4.8%, respectively. Respondents with chronic cough reported significantly worse perceived health than matched controls, with lower mean±sd scores of 46.68±9.28 versus 50.42±8.26 on the physical health component and 40.32±9.87 versus 44.32± 9.69 on the mental health component of the Medical Outcomes Study 12-item Short Form Survey Version 2 survey (p<0.001 for both comparisons). Respondents with chronic cough also had higher rates of moderate-to-severe forms of anxiety (24.4% versus 12.4%) and depression (36.4% versus 20.2%); higher rates of multiple forms of sleep disturbance; greater impairment of work productivity (38.2% versus 25.5%) and other activities (41.8% versus 28.2%; p<0.001 for all comparisons). Respondents with chronic cough also had higher rates of all-cause healthcare resource use including emergency room visits, hospitalisation, and overall and specialist healthcare provider visits compared to controls (p<0.001 for all comparisons). Chronic cough is a common condition in France that is associated with lower health-related quality of life and greater healthcare resource utilisation.

Incidence of mental health diagnoses during the COVID-19 pandemic: a multinational network study.

Population-wide restrictions during the COVID-19 pandemic may create barriers to mental health diagnosis. This study aims to examine changes in the number of incident cases and the incidence rates of mental health diagnoses during the COVID-19 pandemic. By using electronic health records from France, Germany, Italy, South Korea and the UK and claims data from the US, this study conducted interrupted time-series analyses to compare the monthly incident cases and the incidence of depressive disorders, anxiety disorders, alcohol misuse or dependence, substance misuse or dependence, bipolar disorders, personality disorders and psychoses diagnoses before (January 2017 to February 2020) and after (April 2020 to the latest available date of each database [up to November 2021]) the introduction of COVID-related restrictions. A total of 629,712,954 individuals were enrolled across nine databases. Following the introduction of restrictions, an immediate decline was observed in the number of incident cases of all mental health diagnoses in the US (rate ratios (RRs) ranged from 0.005 to 0.677) and in the incidence of all conditions in France, Germany, Italy and the US (RRs ranged from 0.002 to 0.422). In the UK, significant reductions were only observed in common mental illnesses. The number of incident cases and the incidence began to return to or exceed pre-pandemic levels in most countries from mid-2020 through 2021. Healthcare providers should be prepared to deliver service adaptations to mitigate burdens directly or indirectly caused by delays in the diagnosis and treatment of mental health conditions.

Potential Work-related Exposure to SARS-CoV-2 by Standard Occupational Grouping Based on Pre-lockdown Working Conditions in France

This study aims to ascertain occupations potentially at greatest risk of exposure to SARS-CoV-2 based on pre-lockdown working conditions in France. We combined two French population-based surveys documenting workplace exposures to infectious agents, face-to-face contact with the public, and working with colleagues just before the pandemic. Then, for each 87-level standard French occupational grouping, we estimated the number and percentage of the French working population reporting these occupational exposure factors, by gender, using survey weights. As much as 40% (11 million) of all workers reported at least two exposure factors. Most of the workers concerned were in the healthcare sector. However, army/police officers, firefighters, hairdressers, teachers, cultural/sports professionals, and some manual workers were also exposed. Women were overrepresented in certain occupations with potentially higher risks of exposure such as home caregivers, childminders, and hairdressers. Our gender-stratified matrix can be used to assign prelockdown work-related exposures to cohorts implemented during the pandemic.

Perceptions of multiple chronic conditions and coping strategies among migrants from Sub-Saharan Africa living in France with diabetes mellitus and HIV: An interview-based qualitative study.

Although diabetes is common among people living with HIV/AIDS (PLWHA), few data exists on how migrants from Sub-Saharan Africa (SSA) experience living with these two coexisting conditions in France. The objective of this study was to analyze perception of polypathology among PLWHA from SSA with type 2 diabetes and identify barriers and facilitators to their self-management. A qualitative study was conducted using semi-structured interviews from November 2019 to April 2020 with participants selected from a cohort of PLWHA and diabetes at Avicenne University Hospital. A total of 12 semi-structured interviews were conducted and analyzed using thematic analysis with inductive approach. Stigma remained a major issue in self-managing HIV, and some participants did not consider themselves as having a polypathology, as HIV has always been considered as a distinct condition. In general, emotion-based resources (e.g spirituality, trust in the medical discourse) and social support were mobilized more than problem-solving resources (e.g perception of medication as life-saving). Participants used the same main resource in self-management of HIV and diabetes, and resources used differed from participant to participant. This study highlighted challenges in self-management of diabetes and HIV in this population and complexity related to the socioeconomic and cultural specificities. Self-management could be more successful if patients and carers move in the same direction, having identified the individual coping resources to reach objectives.

PCR214 Severe Sialorrhea: Patient Journey and Related Costs Reveal Unmet Medical Needs

Severe sialorrhea (drooling) can be observed in up to 60% of children with chronic neurological disorders. As little information is available on the management and costs of patients with severe sialorrhea, this study aimed at better understanding the care pathway and related costs associated with the management of this condition in France.

Deep remission improves the quality of life of patients with Crohn's disease and anoperineal fistula treated with darvadstrocel: results of a French pilot study.

The injection of allogeneic adipose tissue-derived mesenchymal stem cells (MSC) into anal fistulas in patients with Crohn's disease has never been evaluated in "real-life" conditions in France. We prospectively studied the first patients receiving MSC injections at our center and undergoing 12months of follow-up. The primary endpoint was the clinical and radiological response rate. The secondary endpoints were symptomatic efficacy, safety, anal continence, quality of life (Crohn's anal fistula-quality of life scale, CAF-QoL), and predictive factors of success. We included 27 consecutive patients. The complete clinical and radiological response rates at M12 were 51.9% and 50%, respectively. The combined complete clinical-radiological response (deep remission) rate was 34.6%. No major adverse effects or changes in anal continence were reported. The perianal disease activity index decreased from 6.4 to 1.6 (p < 0.001) for all patients. The CAF-QoL score also decreased from 54.0 to 25.5 (p < 0.001). At the end of the study, M12, the CAF-QoL score was significantly lower only in patients with a complete combined clinical-radiological response relative to those without a complete clinical-radiological response (15.0 versus 32.8, p = 0.01). Having a multibranching fistula and infliximab treatment were associated with a combined complete clinical-radiological response. This study confirms reported efficacy data for the injection of MSC for complex anal fistulas in Crohn's disease. It also shows a positive impact on the quality of life of patients, particularly those for whom a combined clinical-radiological response was achieved.

CURRENT TRENDS OF THE WORLD WHEAT MARKET: DEMAND AND SUPPLY

Goal. study of supply and demand for wheat grain on the world market, as well as highlighting the main trends and analysis of projected wheat prices at the end of 2022, taking into account the state of crops and projected yields in major exporting countries. Method. To achieve this goal used a wide range of general and special methods of scientific knowledge: dialectical method, graphic, trend, technical analysis, method of induction and deduction, analysis and synthesis, monographic. Results. The study revealed a downward trend in the supply of wheat on the world food market in the 2022/23 marketing year, which, according to experts, will significantly affect price growth and could cause a global food crisis. The reason for this situation is the decline in wheat production in major exporting countries, government restrictions on exports to some countries, weather conditions in France, the blockade of Black Sea ports by Russian troops in Ukraine. Thus, the dynamics of wheat prices in Ukraine shows that on May 9 the price of wheat fell to UAH 6,000 / t, but on May 16 it increased by UAH 500 / t, and on May 23 it fell below UAH 6,000 / t. In general, the slump in grain prices is very significant and reaches about 30% of the initial price. According to technical analysis, the forecast prices for wheat in December 2022 on the Paris Stock Exchange Euronext may reach 440 euros / ton, and on the Chicago Stock Exchange - up to 1360 c $ / bu. The scientific novelty lies in a comprehensive study of the situation on the world wheat market and highlighting the main trends in its development. The practical significance of the obtained results lies in the technical analysis of the wheat grain market on the two main world exchanges and the formulation of sound conclusions about the current price movement and further trend, support and containment lines.

Specifics of the institutional mechanism for assessing the scientific research effectiveness in France: Evolution and current state

The article is devoted to the analysis of the specifics institutional mechanism assessment for the scientific research effectiveness in France, where national dirigiste traditions are clearly manifested. Despite a series of cardinal reforms of recent decades in the field of management of the field of R&amp;D and higher education, France continues to operate a centralized model of the organization of assessment, where the decisive positions are held by the highest bodies of state administrative power in the person of specialized unified national services for the assessment of R&amp;D and higher education (HCERES and etc.). The author tried to show the originality of these institutions and the main problems they faced, as well as to understand the reasons for their viability. The research focuses on the analysis of the methods and criteria used by them for evaluating scientific activities. Particular attention is paid to quantitative assessments of scientific research based on bibliometric indicators (“impact factor”, etc.), as well as on the basis of efficiency and profitability criteria. During the analysis of the advantages and disadvantages of using quantitative assessment indicators, it was found that in the conditions of France, an assessment based on bibliometric tools over the past 20 years has gradually turning into a tool for centralized management of research organizations, research teams and individual scientists.

Optimized cultivar deployment improves the efficiency and stability of sunflower crop production at national scale.

Crop simulation helps to analyze environmental impacts on crops and provides year-independent context information. This information is of major importance when deciding which cultivar to choose at sowing time. Plant breeding programs design new crop cultivars which, while developed for distinct populations of environments, are nevertheless grown over large areas during their time in the market. Over its cultivation area, the crop is exposed to highly diverse stress patterns caused by climatic uncertainty and multiple management options, which often leads to decreased expected crop performance. In this study, we aim to assess how finer spatial management of genetic resources could reduce the yield variance explained by genotype × environment interactions in a set of cropping environments and ultimately improve the efficiency and stability of crop production. We used modeling and simulation to predict the crop performance resulting from the interaction between cultivar growth and development, climate and soil conditions, and management practices. We designed a computational experiment that evaluated the performance of a collection of commercial sunflower cultivars in a realistic population of cropping conditions in France, built from extensive agricultural surveys. Distinct farming locations sharing similar simulated abiotic stress patterns were clustered together to specify environment types. We then used optimization methods to search for cultivars × environments combinations leading to increased yield expectations. Results showed that a single cultivar choice adapted to the most frequent environment-type in the population is a robust strategy. However, the relevance of cultivar recommendations to specific locations was gradually increasing with the knowledge of pedo-climatic conditions. We argue that this approach while being operational on current genetic material could act synergistically with plant breeding as more diverse material could enable access to cultivars with distinctive traits, more adapted to specific conditions.

Oil content, fatty acid and phytosterol compositions of chia seeds cultivated under organic conditions in France

Chia (Salvia hispanica L.) is a candidate to be included in European diet due to its seed oil content and composition. Its cultivation in Europe has been assessed in several European countries by introducing genotypes from Latin America. The cultivar Oruro (released by Panam Company, France) was used in this study and cultivated at two locations of southern West of France (Lavaur and Samatan). The aims of this study were to investigate the oil content and composition of chia seeds cultivated in two locations under organic conditions in southern West of France. As expected, location factor affected oil content. Moreover, this factor affected also fatty acid, sterols and tocopherols content and composition. Lavaur presented higher oil content than Samatan. This later location presented higher temperature during grain filling period. Polyunsaturated fatty acids were more represented at Lavaur than at Samatan. Saturated and monounsaturated fatty acids showed the opposite trends. Sterols and tocopherols were more accumulated in chia seeds at Lavaur. These results showed that all quality traits of chia seed cultivated in France were affected by climatic conditions prevailing in location of cultivation.

Trends in exposures to physically demanding working conditions in France in 2003, 2010 and 2017.

BackgroundTo explore trends in social and occupational inequalities in terms of exposures to physically demanding working conditions for French employees.MethodsOur study assessed data from the French national cross-sectional survey of occupational hazards (SUMER) that was conducted in 2003, 2010 and 2017. Trends in the prevalence of several types of physically demanding working conditions (lifting of heavy loads, awkward postures, vibrations, harmful noise, extreme temperatures, and carcinogenic, mutagenic and reprotoxic agents) were explored. Temporal changes in associations of individual and job characteristics with these factors of hardship at work were examined using multilevel logistic regressions.ResultsWe estimated that 53.5% of French workers from all industries in the private sector and in public hospitals were exposed to at least one of the adverse physical working conditions considered in 2017. While the prevalence of exposure to severe physical constraints increased between 2003 and 2017 (+4.2 pp), the exposure associated with a hazardous physical environment decreased sharply (−6.3 pp). These observed trends did not occur similarly for all workers. Several inequalities in exposure increased over the period, particularly to the detriment of blue-collar workers. The situation of shift workers deteriorated in terms of the exposure to vibrations and awkward postures.ConclusionOur study indicates that more stringent interventions are needed to reduce the prevalence of pronounced physical constraints that contribute to MSDs. Future prevention strategies, in addition to seeking to achieve a general reduction in exposure to all physically demanding working conditions, should aim to reduce disparities that adversely affect vulnerable populations.

Impact of an interactive web tool on patients\u2019 intention to receive COVID-19 vaccination: a before-and-after impact study among patients with chronic conditions in France

ObjectivesIn France, about 30% of the population refuses COVID-19 vaccination outright, and 9 to 40% are hesitant. We developed and evaluated an interactive web tool providing transparent and reliable information on the benefits and risks of COVID-19 vaccination.MethodsThe most recent scientific data at the time of the study were implemented into an interactive web tool offering individualized information on the risks of COVID-19 infection-related events versus vaccination-related serious adverse events. The tool was evaluated during a before-and-after impact study nested in ComPaRe, a French e-cohort of adult patients with chronic conditions. Primary outcome was the proportion of patients intending to receive vaccination after using the tool, among those not intending to receive it at baseline.ResultsBetween January 8 and 14, 2021, we enrolled 3152 patients in the study [mean age 55.2 (SD: 16.9), 52.9% women and 63% with ≥ 2 chronic conditions]. Before consulting the tool, 961 (30.5%) refused to be vaccinated until further data on efficacy/safety was obtained and 239 (7.5%) outright refused vaccination. Among these 1200 patients, 96 (8.0%, number needed to treat: 12.5) changed their mind after consulting the tool and would subsequently accept vaccination.ConclusionsOur interactive web tool represents a scalable method to help increase the intent to receive COVID-19 vaccination among patients with chronic conditions and address vaccine hesitancy. Since April 2021, our tool has been embedded on the official webpage of the French Government for COVID-19 information.

Chronic diseases, health conditions and risk of COVID-19-related hospitalization and in-hospital mortality during the first wave of the epidemic in France: a cohort study of 66 million people.

BackgroundFrom the beginning of the COVID-19 pandemic, age (most importantly), male gender and various comorbidities were found to be associated with severe forms of COVID-19. However, there was little information provided for an entire country such as France, which was severely affected throughout the epidemic.MethodsIn France, the SNDS, comprising all health insurance reimbursements and benefits, and the PMSI, comprising hospital data, can be used to estimate the risk associated with about fifty diseases or health conditions for hospitalization primarily related to COVID-19 and COVID-19-related deaths. A cohort was constituted comprising all people alive on February 15, 2020. Data were censored at 15 June 2020 for COVID-19-related hospitalization and at 15 July 2020 for death for patients still hospitalized for COVID-19 on 15 June 2020. Cox proportional hazards models were used to estimate hazard ratios (HR) for the associations between each comorbidity (n=47) and the risk of COVID-19-related hospitalization or death. These associations were determined with adjustment for age and gender, and then in models including all variables (adjusted hazard ratios [aHR]).FindingsIn a population of 66,050,090 people, 87,809 people (134 per 100,000) were hospitalized for COVID-19 between February 15, 2020 and June 15, 2020 and a subgroup of 15,661 people (24 per 100,000) died in hospital.A much higher risk was observed with increasing age, reaching a risk of hospitalization for COVID-19 more than five fold higher and a risk of COVID-19-related in-hospital mortality more than 100-fold higher in people aged 85 years and older (absolute risks of 750 and 268 per 100,000, respectively) compared to people aged 40 to 44 years.Men were at higher risk of COVID-19-related hospitalization aHR 1·38 [1·36-1·40]) and COVID-19-related in-hospital mortality (aHR 2·08 [2·01-2·16]) compared to women. Positive associations between social deprivation index and risk of COVID-19 were also observed. Almost all chronic health conditions were positively associated with an increased risk of COVID-19-related hospitalization and in-hospital mortality, with the exception of dyslipidaemia, which was negatively associated. The strongest associations for both COVID-19-related hospitalization and in-hospital mortality were observed in people with Down syndrome (7·0 [6·1-8·1] and 22·9 [17·1-30·7], respectively), mental retardation (3·8 [3·5-4·2] and 7·3 [6·1-8·8], respectively), kidney transplantation (4·6 [4·2-5·0] and 7·1 [6·0-8·4], respectively), lung transplantation (3·5 [2·4-5·3] and 6·2 [2·8-14·0], respectively) end-stage renal disease on dialysis (4·2 [3·9-4·4] and 4·7 [4·2-5·2], respectively) and active lung cancer (2·6 [2·4-2·8] and 4·0 [3·5-4·6], respectively).InterpretationThis national cohort study confirms the associations with most diseases and health conditions in France and provides data on less frequent health conditions, which could be useful particularly to target priority populations during present and future vaccination campaigns.FundingNone

Disparate exposure to physically demanding working conditions in France

BackgroundOur study was aimed at examining disparate exposure to physically demanding working conditions in France, a key objective being to identify the types of employees/jobs requiring high-priority preventive actions. MethodsWe analyzed the data from the 2017 French nationwide cross-sectional survey (SUMER) on occupational hazards to which French employees in various sectors were subjected. The prevalence of several types of physically demanding working conditions (lifting of heavy loads, awkward body postures, vibrations, noise, and extreme temperatures) was explored. Potential associations of individual and job characteristics with these factors of hardship at work were studied by multivariate logistic regression. ResultsIn total, 48% of employees were exposed to at least one physically demanding working condition and 24.8% were exposed to multiple constraints. While managers and intellectual professionals were exposed relatively infrequently to physical constraints, blue-collar workers experienced the highest frequency of exposure. On the one hand, the role of company size depended on the factor of hardship at work considered; on the other hand, employees in large-scale companies were generally less exposed. As expected, employees in the construction industry were the most exposed to physical constraints; that said, our results also show that some activities in the services sector (e.g., personal care, administrative and support services) were quite significantly affected by a wide array of physically demanding working conditions. ConclusionNotwithstanding the establishment in France of Plans de Santé au travail (preventive workplace health and safety plans), occupational risks were found to be high, and above all, they were unevenly distributed among the various socio-professional categories, and strongly contributed to social inequalities in health. Our results identify the types of publics to be designated as high-priority targets for preventive measures aimed at reducing the adverse impacts of physically demanding working conditions and the incidence of associated musculoskeletal disorders.

THE DISCOMFORT OF THE JULY MONARCHY WITH DAUMIER’S GARGANTUA

Gargantua, a lithograph created by Honoré Daumier in 1831, portrayed the French king Louis-Philippe as a gluttonous giant who devours the labor of his people while sitting in a toilet-like throne, and attacked the king’s person and his government with a satirical manner. Apart from its portrayal of the king as a social cannibal, Gargantua also had a scatological humor by representing the king in defecating. For this reason, this lithograph was by no means tolerated by the July Monarchy that struggled to control over the press by censorship throughout its reign. In this research paper that aims to study the meanings and reasons behind Daumier’s portrayal of king Louis-Philippe as a ravenous giant in Gargantua, it will be discussed why this caricature, which the government both censored and sentenced Daumier to imprisonment and fine penalty, discomforted the king and his government so much. In this context, it will be briefly reviewed the political, economic and social conditions in France before and after the 1830 July Revolution in order to get a better understanding on the political atmosphere during the time when Daumier started to draw satirical caricatures for the journal, La Caricature. Later, it will be discussed Gargantua’s literary references, its implications to king Louis-Philippe and his government, the domestic politics in 1831, and the impact of lithography on increasing power of the press in France. Keywords: Honoré Daumier, Gargantua, lithography, political caricature, printmaking

1978 – 2018, Os 40 anos da primeira experiência de aplicação da cartografia geomorfológica francesa de detalhe na zona tropical úmida brasileira: histórico, princípios da legenda, mudanças e sua difusão no país

A cartografia geomorfológica francesa de detalhe (RCP.77) foi aplicada pioneira-mente no Brasil em 1978, ano em que foram publicadas as cartas geomorfológicas do Vale do Rio do Peixe em Marília – SP (1:100.000), São Pedro – SP (1:50.000) e Carste de Lagoa Santa – MG (1:50.000) e a Carta do Modelado e das Formações Superficiais do Médio Vale do Rio Parateí – SP (1:25.000). Caracterizada pelo detalhamento na representação das formas, inclusive nos mapas de escala média, essa legenda é dividida em itens morfogenéticos, os quais associam o relevo aos processos responsáveis pela sua formação. Muitas adaptações têm sido realizadas na legenda desde 1978, em função dos objetivos dos trabalhos, dos materiais disponíveis para a realização das pesquisas e das condições climáticas da zona tropical úmida brasileira, bastante diferentes daquelas do território francês, onde a legenda foi idealizada. Infelizmente, a difusão desta legenda no Brasil ficou restrita aos pesquisadores que passaram pelo Laboratório de Pedologia, ou por pessoas influenciadas por eles. Isso se deu provavelmente pela dificuldade de leitura e elaboração desses mapas, pouca disponibilidade de bases cartográficas e fotografias aéreas de escala média e grande necessárias à realização desses mapeamentos, falta de estudos detalhados sobre a gênese das formas e concorrência com outras legendas de aplicação mais simples. As novas técnicas de sensoriamento remoto e de estudos das formações superficiais abrem novas possibilidades para o uso da legenda.

Changes in the Intensity and Hardships of Hospital Work in France (1998-2013)

This paper looks at the evolution of working conditions in France’s hospital sector over the fifteen years to 2013. The issue is important in view of the extensive reforms undertaken in the sector since the early 1990s, which have led to profound reorganizations. We start by reviewing the state of knowledge and data of working conditions in hospitals. In the light of the last three editions of France’s Working Conditions survey (enquête Conditions de travail), we then look at the changes in the pace of work and in the different forms of hardship at work that occurred in French hospitals between 1998 and 2013. We then compare these with observations for other sectors. Finally, we analyze, ceteris paribus, the current specificities of the hospital sector in terms of exposure to work pace, staggered schedules, physical hardships and a worsening working environment. We observe that there was an acceleration in work pace faced by hospital staff in the period studied. This was accompanied by a slight alleviation of physical hardships. However, working conditions in hospitals remain particularly stressful.

For a better management of the psychic suffering of exiles

Most people seen by Doctors of the World are foreign nationals exposed to extreme social and administrative precariousness.The violence of their journeys and the reception conditions in France have harmful consequencesfor their psychological health.