Haut Conseil De Research Articles

Teenagers' sleep and its disruption in the digital era

The "Haut Conseil de la santé publique" has highlighted the possible disturbances in teenagers' sleep linked to the use of screens, particularly when falling asleep. Apart from the significant physiological factors that need to be taken into consideration, fantasy stakes can give meaning to insomnia and hypersomnia observed in teenagers in connection with their use of digital technology.

The Triggers for Internationalization and Quality Enhancement in Higher Education of France

The article analyzes the internationalization strategies and the quality assurance systems of France and Université de Lorraine. It has been found out that the goals, proposed in the national and institutional internationalization strategies, include strengthening policies to improve the reception of international students, young researchers and staff.
 It has been noted that Haut Conseil de l'évaluation de la recherche et de l'enseignement supérieur and Université de Lorraine are partners in the project «Implementation of Education Quality Assurance System via Cooperation of University-Business-Government in Higher Education Institutions» (EDUQAS Project), aiming at improving education quality assurance systems through the development of efficient internal quality standards leading to graduates’ better employability in partner countries.
 Haut Conseil de l'évaluation de la recherche et de l'enseignement supérieur and Commission des Titres d’Ingénieur are authorized to conduct international accreditations of study programs. Université de Lorraine Délégation à l’Aide au Pilotage et à la Qualité promotes a culture of continuous improvement and organizational development based on the tools of quality management and process control.
 It has been noted that participation in EDUQAS Project stimulates further development of QA systems at the national and institutional levels; wider participation of stakeholders in higher education quality enhancement and internationalization; higher education quality monitoring through stakeholders’ surveys; monitoring graduates’ career paths in partner countries.
 The legislative basis, internationalization strategies and quality assurance institutions at the national and institutional levels, networks of stakeholders involved in internationalization and quality assurance processes, participation in the international projects have been identified to be triggers for internationalization and quality enhancement in higher education of France.

The official French guidelines to protect patients with cancer against SARS-CoV-2 infection

On request of the French Health Ministry, the French High Council for Public health (Haut Conseil de Santé Publique [HCSP]) entrusted a representative group of French medical oncologists and radiation oncologists, working across academic and private practice, with the task of preparing guidelines to protect patients with cancer against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, while maintaining the possibility of cancer treatment.

France

Macroprudential policy in France is the joint responsibility with several European institutions. With the operationalization of the EU Capital Requirement Directive and Capital Requirement Regulation (CRD/CRR), the French authorities have implemented, several capital buffers, as well as the liquidity coverage ratio (LCR), based on this framework. In France, Haut conseil de stabilité financière (HCSF) is the macroprudential authority established in accordance with recommendation European Systemic Risk Board (ESRB)/2011/13 and the designated authority established in accordance with Article 136 of CRD and is in charge of activating several measures in the CRD/CRR framework as well has direct responsibilities over several tools outside this framework, for example borrower-based tools.

Vaccination of cancer patients treated with chemotherapy: A survey among general practitioners

ObjectivesDespite specific recommendations issued by the French Public Health Council (Haut Conseil de Santé Publique), the vaccination coverage of patients with cancer or malignant blood disease remains insufficient. The aim of this study was to assess the vaccination of chemotherapy patients by their general practitioner (GP). MethodsA survey was conducted between March and July 2017 in 4 French departments to describe the immunization practices of GPs for their chemotherapy patients and provide solutions to help to increase the vaccination rate. ResultsOf the 1610 GPs who received the questionnaire, 287 (17.8%) returned a usable form; 92.6% were globally pro-vaccine. One third of GPs (37.3%) declared that they vaccinated all their chemotherapy patients. The GPs (n=180) who never or only sometimes vaccinated their chemotherapy patients mainly voiced concerns about not being properly trained (45.6%) and the lack of easily available information on vaccination (35.0%). Three-quarters (n=212; 74%) of the GPs wanted to improve their level of medical knowledge via continuing education (52.4%) or by reading guidelines available on-line (39.6%). GPs suggested that a specific vaccination schedule be included in the letter they receive from the cancer specialist (72.8%) and that patient awareness be increased (50.5%). ConclusionsGPs are in favor of the vaccination of cancer patients. The main obstacles stated are the lack of education and the lack of easily available information. Vaccination coverage could be increased by improving the doctor-to-doctor relation between GPs and cancer specialists.

Description des pratiques des médecins généralistes dans le diagnostic et la prise en charge de la gale commune

Although there is evidence suggesting an epidemiologic increase of scabies in France, few studies have assessed medical practice in terms of diagnosis and treatment. To describe the management of scabies by general practitioners (GPs). A questionnaire was addressed to the 524GPs of the Doubs department in France regarding the management of cases of scabies diagnosed between January and June 2015. The response rate was 57% (n=299). At least one case of scabies was observed by 89% of GPs in the previous six months and more than three cases were diagnosed by 59% of GPs. The main clinical criterion for diagnosis was the specific localization of pruritus (82%). No diagnostic test was used by 94% of GPs other than except direct parasitological examination, which was used by 6%. A systematic examination by a dermatologist was prescribed by 3% of GPs, by 78% of them in the case of diagnostic doubt, and not at all by 19%, even though 66% of GPs' offices were located under 10kilometers from a dermatologist's office. Ivermectin (IVM) alone was prescribed by 38% of GPs, either as a single dose (22%) or as two repeated doses (16%). Topical treatment alone was prescribed by 2% of GPs and the association of IVM and topical treatment was used by 26%, either as a single dose (19%) or as two repeated doses (7%). All household members and any sexual contacts were systematically treated by 77% of GPs, but 9% did not prescribe any treatment. Decontamination advice was given by 100% of GPs. Recurrence of scabies was observed by 25% of GPs despite systematic treatment (93%) of patients' close contacts. Our study confirms the frequency of scabies in general medicine and the interest of GPs in this evaluation of practice. Our data also demonstrate the heterogeneity of management by GPs and the limitations of/poor compliance with national recommendations on scabies proposed by the Haut conseil de santé publique (Public Health Council) in 2012. Our study emphasizes the critical role of GPs in the management of scabies and the need for specific recommendations concerning their practices.

E-cigarettes

Electronic cigarettes (e-cigarettes) are growing in popularity among young smokers in France seeking to reduce tobacco-induced harms without abandoning the small everyday pleasures and social relationships that unfold around smoking. But e-cigarettes raise ideological challenges: The World Health Organization and the French Agency for Safety of Medicine and Health Products ( Agence Nationale de Sécurité du Médicament) have denied e-cigarettes the status of pharmaceutical substitution products in the cessation of smoking, while their possibilities for pleasure are seen as a threat by France’s public health council, the Haut Conseil de Santé Public. This paper discusses how different actors (policy makers, tobacco companies, and users themselves) have embraced this new technology. I argue that e-cigarettes have become a valued form of substitution precisely because they provide occasions for social bonding, gustatory pleasure, and the non-medicalized management of health with endless possibilities for individualized tailoring.

Liberté, égalité, fraternité…santé.

“We are not England, we are not France”, said Hillary Clinton about health-care insurance during a recent US presidential debate. European models of health care have their own history in which redistribution forms the cornerstone of social solidarity. Aiming to guarantee social cohesion, France's Etat Providence is rooted in models of a welfare state that developed in Germany and the UK. Ensuring universal health coverage and financed through payroll taxes, and increasingly through a general social contribution on all types of income, French health insurance is characterised by a strong redistributive scheme that benefits the poorest and the most sick. 1 Haut Conseil de la Santé PubliqueSanté en France: problèmes et politiques. La Documentation Française, Collection Avis et Rapport, Paris2015 Google Scholar Private and public health-care providers coexist in France and patients have the choice to be treated wherever they wish. Patients are reimbursed by the compulsory national insurance with any uncovered costs covered by private companies, half of which are non-profit insurers. This model is widely considered efficient. France was ranked first in WHO's World Health Report on health systems in 2000, although the report also highlighted health inequalities across the country. 2 WHOThe world health report. Health systems: improving performance. World Health Organization, Geneva2000 Google Scholar Achieving universal health coverage in France: policy reforms and the challenge of inequalitiesSince 1945, the provision of health care in France has been grounded in a social conception promoting universalism and equality. The French health-care system is based on compulsory social insurance funded by social contributions, co-administered by workers' and employers' organisations under State control and driven by highly redistributive financial transfers. This system is described frequently as the French model. In this paper, the first in The Lancet's Series on France, we challenge conventional wisdom about health care in France. Full-Text PDF State humanitarian verticalism versus universal health coverage: a century of French international health assistance revisitedThe French contribution to global public health over the past two centuries has been marked by a fundamental tension between two approaches: State-provided universal free health care and what we propose to call State humanitarian verticalism. Both approaches have historical roots in French colonialism and have led to successes and failures that continue until the present day. In this paper, the second in The Lancet's Series on France, we look at how this tension has evolved. During the French colonial period (1890s to 1950s), the Indigenous Medical Assistance structure was supposed to bring metropolitan France's model of universal and free public health care to the colonies, and French State imperial humanitarianism crystallised in vertical programmes inspired by Louis Pasteur, while vying with early private humanitarian activism in health represented by Albert Schweitzer. Full-Text PDF France: a philosophy for healthThe dominance of English as the language of science and, increasingly, global health too often closes the door on the history and experiences of others. In France's case, careful study of the nation's struggle to achieve universal health coverage, together with its distinctive approach to global health, has much to offer those who seek to understand the diversity of paths to achieve better health at home and abroad. The two Lancet Series papers1,2 on France's contribution to health, along with four comments from French or Francophone leaders,3–6 aim to correct this imbalance in the English-language literature on health. Full-Text PDF

National alliance against osteoarthritis: A French coalition to research and mobilize against osteoarthritis

Background In France, between 9 and 10 millions of persons suffer from symptoms of osteoarthritis (OA), ie. 17 % of the global population[1]. This disease is the second cause of disability in our country[2] and can be responsible for an important loss of quality of life. In 2002, a socio-economical study(2) showed that, in the last ten years before the study, the number of persons suffering from OA progressed by 54 %, trigerring a 156 % increase in medical costs directly linked to OA. A more recent study[3] established the cost of OA treatment to around 3 billions euros per year. Paradoxically, the two public health objectives connected to OA and defined by the August 9, 2004 Law (objectives #085 and #087) have been left without action or evaluation[4]. Overall, as a public health and medical cost challenge, OA has been largely ignored in our country. Objectives To create a sense of urgency and challenge around this disease, AFLAR, the historical non-profit organization involved in the fight against OA and the only French patient organization dealing with this issue, decided to create the National Alliance against Osteoarthrosis. Methods This National Alliance is composed of various professionnals and institutions involved in OA medical care : patient organizations, medical associations, healthcare professional boards. Starting on november 2011, these experts met and discussed to define National Alliance objectives as well as various actions to be developed. Results National Alliance members agreed on the following objectives : –To bring together all the professionals involved in OA care and to trigger a global mobilization around this underestimated public health issues –To stimulate collective thinking around the challenges linked to OA care –To develop awareness and visibility actions –To disseminate prevention messages, especially regarding the role of physical activity –To identify and relay the needs of people affected by OA –To increase the involvement of local and national governing bodies Four actions have been proposed to reach these objectives : –To fight against misconceptions through educational messages dissemination –To initiate a large online national survey –To launch a web portal which will gather all AFLAR OA-related activities –To develop a regional prevention project Conclusions National Alliance against Osteoarthritis projects synergize efforts from each member’s expertise. Innovative through the diversity of its participants, this Alliance will undoubtedly contribute to amplify our country’s mobilization against OA. References Le Pen C. Les consequences socioeconomiques de l’arthrose en France. La Revue du Rhumatisme 72 (2005) 1326–1330 Fautrel et col. Joint Bone Spine 2005 May ; 72(3) : 235-40 Grange L et coll. : Osteoarthritis in France the cost of ambulatory care in 2010. 2012 World Congress on Osteoarthritis (Barcelone) : 26-29 avril 2012 Rapport du Haut Conseil de Sante publique d’avril 2010 : Objectifs de sante publique Evaluation des objectifs de la loi du 9 aout 2004 – Propositions (p46-47) Disclosure of Interest None Declared

PARE0020 National alliance against osteoarthritis : a french coalition to research and mobilize against osteoarthritis

BackgroundIn France, between 9 and 10 millions of persons suffer from symptoms of osteoarthritis (OA), ie. 17 % of the global population[1]. This disease is the second cause of disability...

La vaccination rotavirus en 2012. Position du Groupe de Pathologie Infectieuse Pédiatrique (GPIP) et de l’Association Française de Pédiatrie Ambulatoire (AFPA)

In 2008 and 2010, the Comité technique des vaccinations and the Haut Conseil de Santé Publique have not recommended generalized vaccination against rotavirus (RV) in France. The Groupe de Pathologie Infectieuse Pédiatrique (GPIP) and the Association Française de Pédiatrie Ambulatoire (AFPA) believes that it is time to reconsider the recommendation. Indeed, on the one hand, answers were made on the presence of circovirus in vaccines and the risk of intussusception, on the other hand, these vaccines are already implemented in vaccination programs in many developing countries or countries with income intermediate and high. Finally, independent studies have demonstrated the effectiveness in countries with widespread vaccinations (without significant genotypic changes of circulating strains). In addition, implementation would have a major impact on our health care system, changes of the epidemic curve of RV infections (delayed and shortened) to prevent the coexistence of different epidemics occurring during the fall and winter. Remains medico-economic evaluation, which is not of the competence and the responsibility of GPIP and AFPA. However, it seems surprising that developing or middle-income countries have been able to generalize this vaccination and that France can't do it.

Vulnérabilité du territoire littoral guyanais aux maladies infectieuses à transmission vectorielle : esquisses de problématiques et perspectives de recherches pluridisciplinaires

Vulnerability is a concept increasingly mobilized for understanding the emergence of situations of risk regardless of their nature (Beck, Glatron, 2009; Bogardi, 2004, D'Ercole, 1991; D'Ercole et al., 1994; Fabiani, Theys 1987; Fabiani, 2010, Leone 2007, Leone, Vinet, 2007, Pierrat, 2011). The use of vulnerability for the knowledge of conditions for the emergence risk of vector-borne diseases (VBD) opens a way for systemic and multidisciplinary analysis of risk that exceeds the knowledge of traditional social criteria such as age, gender, social class or level of income taken into account in epidemiological studies. If since the beginning of the nineteenth century, the anglo-aaxon work on the risks of VBD (Cohen, 2000; Daszack et al., 2000 and 2001; Hong, Lee, 2005; Midley, Thuiller, 2005, Plowright et al., 2008 ) take into account the vulnerability assessment, however the France lags behind the Haut Conseil de la santé publique wishes to catch up (Leport and Guégan, 2011). The study of territorial vulnerability of French Guiana to VBD opens new possibilities of action for the management of health risks.

Vaccinations : élaboration des recommandations et de leur évolution en France

French guidelines for immunization are elaborated by a permanent advisory committee (Comité technique des vaccinations), which is part of the Public Health Council. This committee is composed of 20 experts from the different medical specialties involved in the immunization process, who are appointed for 3 years by the French Ministry of Health. Other members, without voting power, represent de different agencies, affiliated to the health minister, other ministers and different institutions. All members have to declare and update their potential conflicts of interests. The committee establishes official guidelines concerning topics submitted from the National Health Care Authorities, industrial firms awarded marketing approval for a new vaccine, or in the event of a modification concerning a previous registration. The advisory committee can also decide itself to establish official guidelines on a given topic. A submission usually leads to the creation of a specific working group assigned the task of preparing a report and an advice project. The project is proposed for committee vote and subsequently validated by the Commission for Transmissible Diseases of the Superior Public Health Authority (Haut Conseil de la santé publique). The committee guidelines stipulate whether the vaccine should be recommended or not, the target population (universal or limited to a selected population) and the immunization schedule. The committee's advice statement may also mention the need for a specific survey of the impact of the vaccination on epidemiology, as well as a broader survey related to its safety. Usually, when a vaccine is recommended, the Transparency Commission of the Haute Autorité de santé and the economic committee on drugs decide on its reimbursement by the public health care fund. The guidelines become part of the immunization schedule, which is updated annually and published in the Official Bulletin of the Minister of Health and in the Bulletin épidémiologique hebdomadaire.

Actualité sur la prise en charge du paludisme de l’enfant en France

France is the most important country out for imported malaria. Malaria epidemiological data managed by the malaria national reference center shows that the malaria of children concerns migrant who travel in Africa during summer to visit family. Preventing and treatment recommendations are formerly published by “Haut conseil de la santé publique”. Revision 2007 of the 1999 consensus conference about management and prevention of imported Plasmodium falciparum malaria were published in February 2008. This article presents the actuality of these recommendations for clinical pratice.

SOME RECENT DEVELOPMENTS IN AFRICAN CHRISTIANITY

IN THE LATE 1 980S, at the time of the end of the cold war, Africa experienced the beginning of a second liberation, as the peoples of Africa tried to throw off the political systems that had come to serve them so badly. The struggle was not the same everywhere, but one of its common features was the significant role played by the churches. In Francophone Africa, the struggle took a particular form; citizens' groups forced the dictators to convene a national conference, at which a wide range of groups debated the nation's future. The dictators, vulnerable and deserted by their previously supportive Western backers, had to give way, at least in the short term. One of the remarkable features of these conferences was the way in which Catholic Bishops were asked to preside over them. In Benin, Mgr Isidore de Sousa, Archbishop of Cotonou, presided over the national conference, then as president of the Haut Conseil de la Republique overseeing the transition process, was the highest authority in the land for the thirteen months leading up to elections. In Gabon it was Mgr Basile Mve Engone, Bishop of Oyem. In Togo, Mgr Sanouko Kpodzro, Bishop of Atakpame, presided over the process. In the Congo, Mgr Ernest Kombo, the country's first Jesuit and Bishop of Owando, presided over the three month long national conference and then the entire transitional process. In Zaire, Mgr Laurent Monsengwo Pasinya, Archbishop of Kisangani, was elected in 1991 to preside over the national conference attempting to halt Zaire's decline into anarchy.1 In many other countries, the churches' role was just as significant, though it took different forms. For years, in Kenya, the most articulate criticism of President Moi came from individual Anglican Bishops, and later from the National Council of Churches of Kenya. In Malawi, ie whole process of opposition to President Banda's rule was begun by the 1992 Lenten pastoral of the Catholic Bishops. In Madagascar, the Council of Churches was the core of the 'Forces Vives' that led to the ousting of President Ratsiraka in 1992. And in Zambia the churches were among the most prominent local bodies involved in the transition