Orientation professionnelle de travailleurs handicapés présentant une pathologie du rachis (à propos de 174 cas suivis en consultation de pathologie professionnelle)

AIX-MARSEILLE2-BU Méd/Odontol. (130552103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Understanding geographic variations in psychiatric inpatient admission rates: width of the variations and associations with the supply of health and social care in France

Abstract Background Inpatient care accounts for the majority of mental health care costs and is not always beneficial. It can indeed have detrimental consequences if not used appropriately, and is unpopular among patients. As a consequence, its reduction is supported by international recommendations. Varying rates of psychiatric inpatient admissions therefore deserve to draw attention of researchers, clinicians and policy makers alike as such variations can challenge quality, equity and efficiency of care. In this context, our objectives were first to describe variations in psychiatric inpatient admission rates across the whole territory of mainland France, and second to identify their association with characteristics of the supply of care, which can be targeted by dedicated health policies. Methods Our study was carried out in French psychiatric sectors’ catchment areas for the year 2012. Inpatient admission rates per 100,000 adult inhabitants were calculated using data from the national psychiatric discharge database. Their variations were described numerically and graphically. We then carried out a negative binomial regression to identify characteristics of the supply of care (public and private care, health and social care, hospital and community-based care, specialised and non-specialised care) which were associated with these variations while adjusting our analysis for other relevant factors, in particular epidemiological differences. Results Considerable variations in inpatient admission rates were observed between psychiatric sectors’ catchment areas and were widespread on the French territory. Institutional characteristics of the hospital to which each sector was linked (private non-profit status, specialisation in psychiatry and participation to teaching activities and to emergency care) were associated with inpatient admission rates. Similarly, an increase in the availability of community-based private psychiatrists was associated with a decrease in the inpatient admission rate while an increase in the capacity of housing institutions for disabled individuals was associated with an increase in this rate. Conclusions Our results advocate for a homogenous repartition of health and social care for mental disorders in lines with the health needs of the population served. This should apply particularly to community-based private psychiatrists, whose heterogeneity of repartition has often been underscored

The Development of Psychiatric Services Providing an Alternative to Full-Time Hospitalization Is Associated with Shorter Length of Stay in French Public Psychiatry

International recommendations for mental health care have advocated for a reduction in the length of stay (LOS) in full-time hospitalization and the development of alternatives to full-time hospitalizations (AFTH) could facilitate alignment with those recommendations. Our objective was therefore to assess whether the development of AFTH in French psychiatric sectors was associated with a reduction in the LOS in full-time hospitalization. Using data from the French national discharge database of psychiatric care, we computed the LOS of patients admitted for full-time hospitalization. The level of development of AFTH was estimated by the share of human resources allocated to those alternatives in the hospital enrolling the staff of each sector. Multi-level modelling was carried out to adjust the analysis on other factors potentially associated with the LOS (patients’, psychiatric sectors’ and environmental characteristics). We observed considerable variations in the LOS between sectors. Although the majority of these variations resulted from patients’ characteristics, a significant negative association was found between the LOS and the development of AFTH, after adjusting for other factors. Our results provide first evidence of the impact of the development of AFTH on mental health care and will provide a lever for policy makers to further develop these alternatives

Geographic variations in involuntary care and associations with the supply of health and social care: results from a nationwide study

Abstract Background Involuntary psychiatric care remains controversial. Geographic disparities in its use can challenge the appropriateness of the care provided when they do not result from different health needs of the population. These disparities should be reduced through dedicated health policies. However, their association with the supply of health and social care, which could be targeted by such policies, has been insufficiently studied. Our objectives were therefore to describe geographic variations in involuntary admission rates across France and to identify the characteristics of the supply of care which were associated with these variations. Methods Involuntary admission rate per 100,000 adult inhabitants was calculated in French psychiatric sectors’ catchment areas using 2012 data from the national psychiatric discharge database. Its variations were first described numerically and graphically. Several factors potentially associated with these variations were then considered in a negative binomial regression with an offset term accounting for the size of catchment areas. They included characteristics of the supply of care (public and private care, health and social care, hospital and community-based care, specialised and non-specialised care) as well as adjustment factors related to epidemiological characteristics of the population of each sector’s catchment area and its level of urbanization. Such variables were extracted from complementary administrative databases. Supply characteristics associated with geographic variations were identified using a significance level of 0.05. Results Significant variations in involuntary admission rates were observed between psychiatric sectors’ catchment areas with a coefficient of variation close to 80%. These variations were associated with some characteristics of the supply of health and social care in the sectors’ catchment areas. Notably, an increase in the availability of community-based private psychiatrists and the capacity of housing institutions for disabled individuals was associated with a decrease in involuntary admission rates while an increase in the availability of general practitioners was associated with an increase in those rates. Conclusions There is evidence of considerable variations in involuntary admission rates between psychiatric sectors’ catchment areas. Our results provide lines of thoughts to reduce such variations, in particular by supporting an increase in the availability of upstream and downstream care in the community

Additional file 1: of Geographic variations in involuntary care and associations with the supply of health and social care: results from a nationwide study

Description of the different databases used in the study. Table including the name, main content and data compilation method for each database included in the study. (DOCX 17 kb

Harmonia ⁺ and Pandora ⁺: risk screening tools for potentially invasive plants, animals and their pathogens

Given the large number of alien species that may potentially develop into invasives, there is a clear need for robust schemes that allow to screen species for such risks. The Harmonia+ framework presented here brings together 30 questions that refer to distinct components of invasion. Together, they cover the stages of introduction, establishment, spread, and multiple kinds of impacts, viz. referring to the health of the environment (including wild species), cultivated plants, domesticated animals and man. In a complete assessment, input is provided by choosing among predefined ordinal answers and by supplementing these with textual clarification. Uncertainty is covered by indicating levels of confidence. By converting answers into scores, which are then condensed into summary statistics, Harmonia+ allows for quantitative output on stage-specific and general risks. Test assessments on five species emerging in Belgium showed the perceived environmental risks of Procambarus clarkii to be highest (0.72), and that of Threskiornis aethiopicus to be lowest (0.13). Given the considerable parallels that exist between invasive alien species and emerging infectious diseases, we additionally created Pandora, which is a risk analysis scheme for pathogens and parasites. It consists of 13 key questions and has the same structure as Harmonia+. Since diseases play a paramount role in biological invasions, results of Pandora assessments may feed into Harmonia+ through a slightly adapted, host-specific version named Pandora+. Harmonia+, Pandora and Pandora+ may be used both for prioritization purposes and for underpinning detailed risk analyses, and can be consulted online through http://ias.biodiversity.be.SCOPUS: ar.jinfo:eu-repo/semantics/publishe