Réflexions sur la médecine du travail en Suisse

International Journal of Public Health - La nouvelle ordonnance fédérale du 23 décembre 1960 relative à la prévention des maladies professionnelles constitue un...     

Évaluation des cinq premières années de gestion de la nutrition parentérale à domicile par un prestataire de services en région Limousin

The French region of Limousin uses since 2003 a health care provider for home parenteral nutrition (HPN). An evaluation of the first five years was performed in a retrospective manner, concerning 494 stays of 375 different patients, aged 60.9 ± 12.7 years, between January 1st, 2003 and December 31, 2007. Concerning the HPN, 77.5% were made for cancer patients, 49.7% had a C Detsky index and the average of Karnovsky index was 73.5. The nutrition used in 84.2% of cases an injection site. The three administrative departments of the region received 77.3% of stays. The comparative analysis showed that age of cancer patients was higher, their Detsky index was worse, their ingesta were lower, and that they died more frequently during their follow-up than patients with digestive non-cancer disease. The small follow-up duration in digestive non-cancer patients could be due to a recruitment in perioperative period for them, or could be linked with their need of only refeeding limited sequences. This activity of HPN with a health care provider was useful, answering to a large number of demands, particularly for cancer patients.     

Quels freins à l’établissement du certificat de décès à domicile ? Enquête auprès de médecins sur le territoire de Normandie

IntroductionDrafting a death certificate is an obligation for any physician called upon to note a death. It has a legal and epidemiological impact. The objective of this study is to highlight the obstacles encountered by professionals when this process takes place in a home setting.MethodA study was carried out by means of a questionnaire sent to doctors in the Normandy region.ResultsOne fifth (20%) of the general practitioners (GPs), 25% of the SAMU practitioners (intervening in mobile emergency throughout the country), 27.3% of SOS doctors (intervening 24 hours a day in the deceased person's home in the absence of a GP) stated that they had at least once refused to establish a death certificate. Only 36.4% of SOS doctors, 62.5% of emergency physicians and 41% of GPs considered the drafting of a death certificate to be one of their mandatory missions. No less than 17% of GPs, 25% of SAMU doctors and 9% of SOS doctors stated that due to lack of time, they were occasionally unable to travel to fill out a death certificate, a factor causing delays that were detrimental, especially for the surviving relatives. We highlighted several other obstacles to the completion of death certificates: the difficulty of completing them accurately without knowledge of the deceased person's history, possible inability of professionals on tight schedules to deal with unforeseen requests and, more rarely, the issues raised by an absence of remuneration.ConclusionOur study highlights major obstacles in the preparation of death certificates, obstacles that should be taken into consideration insofar as they affect the quality of the data collected, and entail ethical challenges.     

Dépistage organisé du cancer colorectal : taux de réalisation du test et résultats du suivi après un envoi postal sélectif du kit de test,basé sur la probabilité de participation

BackgroundEven though theinterest of a Colorectal-Cancer Screening Program has been amply demonstrated, in French departments the participation rate (PR) seldom reaches 45%. In the absence of mass mailing, a strategy (S-1) consisting in mailing a test kit to people having made a request was implemented in 2015. In 2017, another mailing strategy (S-2), which consisted in sending the test kit only to people likely to take the test, was programmed. This study assesses the respective impact of these two strategies as compared to the standard approach (S-0).MethodsThe study included 254,113 (S-0), 4,130 (S-1) and 10,887 (S-2) people aged 50–74, targeted during the 2016–2017 campaign in Seine-Saint-Denis (France). S-0 persons received a 2nd reminder without a test-kit, while S-1 persons received, at their request, a mailed test kit. Without having made a request, S-2 persons the mailed test kit according to probability of participation (Proba) which was estimated a priori by the ratio between the sum total of index values (frequency of previous participation, date of most recent participation, age) and a theoretical maximum. Completion rates (test/colonoscopy) were compared 18 months after the last S-2 kit was sent.ResultsPR was highest in S-1 (S-0: 5.8%, S-1: 74.9%, S-2: 31.3%; p < 0.0001). In S-2, PR rose as Proba increased (Proba: ]0–30%], ]30–50%], ]50–75%], ]75–100%]; PR: 21.1%, 23.3%, 36.2%, 52.8% respectively; p < 0.05). Compared to the ≥70 years age-group, the 50–54 years age-group presented a lower PR in S-1 (65.9% vs. 85.1%; p < 0.05) whereas it presented a higher PR in S-0 (4.3% vs. 7.1%; p < 0.05) and in S-2 (23.2% vs. 54.5%; p < 0.05). All in all, colonoscopy completion rates were highest in S-1 (S-0: 62.2%, S-1: 80.0%, S-2: 65.0%; p < 0.001).ConclusionTest-kit mailing without spontaneous request does not lead to an optimal level of participation, thereby highlighting a need to give thought to new and improved mobilization methods. The relatively pronounced participation of younger persons, who are not favored by present-day testing specifications, underscores the interest of a specific approach addressed to active people, who are less inclined than elderly individuals to regularly consult their attending physicians.