Les médecins de demain

[fre] Les médecins de demain . Depuis trente ans, le corps médical, comme l'ensemble des professions de santé, a connu une forte croissance. Dans le même temps, le développement économique et celui de la protection sociale ont permis une nette augmentation du recours aux soins. Dès la fin des années soixante, des mesures ont été prises pour réguler le nombre de médecins à former, puis pour maîtriser les dépenses de santé. . La décélération de la croissance du nombre de médecins s'observe dès 1978. D'ici à 2040, elle provoquerait des changements importants dans cette profession : . ment, nette féminisation, surtout parmi les généralistes. La proportion d'un spécialiste sur deux médecins, atteinte récemment, devrait se maintenir, mais les spécialités évolueraient différemment les unes des autres. Enfin, le nombre de médecins progresserait de moins en moins vite et diminuerait à partir de 201 0, sous l'hypothèse d'un redressement progressif, du numerus clausus. . Ces changements structurels du corps médical modifieraient ses capacités de production d'actes. De ce fait, dès le début du siècle prochain, l'adéquation de l'offre de soins à la demande se poserait dans un contexte nouveau. [eng] Tomorrow's Doctors . The medical profession, like all the health professions, has grown considerably over the last thirty years. At the same time, economic development and improvements in social security have led to a sharp increase in the demand for treatment. Starting in the late 1960s, measures were taken to regulate the number of doctors trained and then to curb health expenditure. . A slowdown in the growth of the number of doctors was observed as of 1978. By 2040, it will have prompted substantial changes in the profession: aging and a sharp rise in the number of women, especially among general practitioners. The recently attained proportion of one specialist for every two doctors should remain steady, but the group of specialists itself will probably become more diverse. Lastly, based on the hypothesis of a gradual return of restricted-intake measures, growth in the number of doctors should slow down more and more to a state of decrease as of 2010. . These structural changes in the medical profession should alter its capacities to provide medical treatment. Consequently, the match between treatment supply and demand should appear in a new context as of the beginning of the 21st century. [ger] Die Arzte von morgen . In den letzten dreiBig Jahren ist die Zahl der Ârzte wie auch all derjeniger, die am Gesundheitswesen beteiligt sind, stark angestiegen. Im gleichen Zeitraum hat die Entwicklung der Wirtschaft wie auch der sozialen Sicherung eine wesentlich grô3ere Inanspruchnahme von Gesundheitsleistungen ermôglicht. Bereits Ende der sechziger Jahre sind deshalb MaBnahmen getroffen worden, um die Zahl der Medizinstudenten zu beschrânken und die Gesundheitsausgaben unter Kontrolle zu bringen. . Seit 1 978 lâBt sich eine Verlangsamung des Anstiegs der Ârztezahl beobachten, die voraussichtlich bis zum Jahre 2040 erhebliche Verànderungen in diesem Berufszweig bewirken wird: Ùberalterung, deutliche Feminisierung, . insbesondere bei den praktischen Àrzten. An dem vor kurzem erreichten Verhâltnis von einem Facharzt zu zwei praktischen Ârzten wird sich sicherlich nichts ândern; die einzelnen Fachrichtungen werden sich jedoch unterschiedlich entwickeln. Unter der Annahme einer schrittweisen Wiederherstellung des Numerus Clausus wird die Ârztezahl schlieBlich immer weniger rasch ansteigen und ab dem Jahre 2010 sogar abnehmen. . Dieser strukturelle Wandel in der Ârzteschaft wùrde auch bei der medizinischen Versorgung Ànderungen zur Folge haben; denn bereits zu Beginn des kommenden Jahrhunderts mul3 die Entsprechung zwischen Leistungs- angebot und nachfrage in einem vôllig neuen Kontext gesehen werden. [spa] Los médicos de mahana . Desde hace unos treinta anos, el cuerpo medico, como la totalidad de las profesiones sanitarias, se va beneficiando de un fuerte crecimiento. Al mismo tiempo, el desarrollo econômico y el de la protecciôn social han permitido un évidente aumento del recurso a cuidados. Desde fines de los sesenta, se vienen tomando medidas que regulen el numéro de médicos por formar, y que permitan dominar el gasto sanitario. . La deseleracion del crecimiento del numéro de médicos se registra desde 1 978. Hasta el 2040, tal vez provoque cambios importantes en dicha profesiôn : envejecimiento, fuerte femenizaciôn, sobre todo entre los generalistas. La . proporciôn de un especialista de cada dos médicos, registrada hace poco, deberfa de mantenerse, pero las especialidades evolucionarian de manera diferente entre si. En fin, el numéro de médicos progresarfa a un ritmo cada vez mâs lento e iria disminuyendo a partir del 2010, siguiendo la hipôtesis de una recuperaciôn progresiva del numéros clausus. . Estos cambios estructurales del cuerpo médico modificaria sus capacidades de producciôn de actos. De hecho, ya a principios del proximo siglo, la adecuaciôn de la oferta de cuidados a la demanda se presentarfa en otro contexto.

Les densités régionales de médecins à l'horizon 2020

Un modèle de projection régionale des densités médicales permet de tracer, « à tendances constantes », un portrait régionalisé de l'implantation des médecins à l'horizon 2020. Avec l'hypothèse du maintien des numerus clausus et des comportements de retrait d'activité actuels, la densité nationale passerait de 3,3 médecins pour mille habitants en 1999 à 2,5 en 2020. Au niveau régional, les différences de variation des populations, de structure par âge des médecins en exercice, du nombre de postes d'internes attribués chaque année à chaque région et des taux de réussite au concours de l'internat ont des résultats variés sur les densités médicales. La mobilité des étudiants à l'issue de leur formation joue également sur le nombre de médecins installés. Si l'ensemble de ces paramètres restait constant, le Languedoc-Roussillon et la région PACA se placeraient en 2020 parmi les régions les moins médicalisées, tandis que la Franche-Comté et le Nord Pas-de-Calais auraient des densités parmi les plus fortes

One-year emergency department visits for children < 18 years of age, associated factors and frequency of primary general practitioner or pediatrician visits before: a French observational study (2018–19)

Abstract Background This study was designed to identify factors associated with at least one emergency department (ED) visit and those associated without consultation by a general practitioner or paediatrician (GPP) before ED visit. Levels of annual consumption of healthcare services as a function of the number of ED visit were reported. Methods This retrospective study focused on children < 18 years of age living in mainland France and followed for one-year after their birth or birthday in 2018. Children were selected from the national health data system, which includes data on healthcare reimbursements, long-term chronic diseases (LTD) eligible for 100% reimbursement, and individual complementary universal insurance (CMUc) status granted to households with a low annual income. Adjusted odds ratios (OR) were estimated using multivariate logistic regression. Results There were 13.211 million children included (94.2% of children; girls 48.8%). At least one annual ED visit was found for 24% (1: 16%, 2: 5%, 3 or more: 3%) and 14% of visits led to hospitalization. Factors significantly associated with at least one ED visit were being a girl (47.1%; OR = 0.92), age < 1 year (9.1%; OR = 2.85), CMUc (22.7%, OR = 1.45), an ED in the commune of residence (33.3%, OR = 1.15), type 1 diabetes (0.25%; OR = 2.4), epilepsy (0.28%; OR = 2.1), and asthma (0.39%; OR = 2.0). At least one annual short stay hospitalisation (SSH) was found for 8.8% children of which 3.4% after an ED visit. A GPP visit the three days before or the day of the ED visit was found for 19% of children (< 1 year: 29%, 14–17 years: 13%). It was 30% when the ED was followed by SSH and 17% when not. Significant factors associated with the absence of a GPP visit were being a girl (OR = 0.9), age (1 year OR = 1.4, 14–17 years OR = 3.5), presence of an ED in the commune of residence (OR = 1.12), epilepsy LTD (OR = 1.1). Conclusion The low level of visits to GPP prior to a visit to the ED and the associated factors are the elements to be taken into account for appropriate policies to limit ED overcrowding. The same applies to factors associated with a visit to the ED, in order to limit daily variations

Impact of the COVID-19 pandemic on induced abortions in France in 2020

No abstract availabl

Phenotype and genotype in Nicolaides-Baraitser syndrome

Nicolaides-Baraitser syndrome (NCBRS) is an intellectual disability (ID)/multiple congenital anomalies syndrome caused by non-truncating mutations in the ATPase region of SMARCA2, which codes for one of the two alternative catalytic subunits of the BAF chromatin remodeling complex. We analyzed 61 molecularly confirmed cases, including all previously reported patients (n = 47) and 14 additional unpublished individuals. NCBRS is clinically and genetically homogeneous. The cardinal features (ID, short stature, microcephaly, typical face, sparse hair, brachydactyly, prominent interphalangeal joints, behavioral problems and seizures), are almost universally present. There is variability however, as ID can range from severe to mild, and sparse hair may be present only in certain age groups. There may be a correlation between the severity of the ID and presence of seizures, absent speech, short stature and microcephaly. SMARCA2 mutations causing NCBRS are likely to act through a dominant-negative effect. There may be some genotype-phenotype correlations (mutations at domain VI with severe ID and seizures; mutations affecting residues Pro883, Leu946, and Ala1201 with mild phenotypes) but numbers are still too small to draw definitive conclusions

Heterozygous missense mutations in SMARCA2 cause Nicolaides-Baraitser syndrome

Nicolaides-Baraitser syndrome (NBS) is characterized by sparse hair, distinctive facial morphology, distal-limb anomalies and intellectual disability. We sequenced the exomes of ten individuals with NBS and identified heterozygous variants in SMARCA2 in eight of them. Extended molecular screening identified nonsynonymous SMARCA2 mutations in 36 of 44 individuals with NBS; these mutations were confirmed to be de novo when parental samples were available. SMARCA2 encodes the core catalytic unit of the SWI/SNF ATP-dependent chromatin remodeling complex that is involved in the regulation of gene transcription. The mutations cluster within sequences that encode ultra-conserved motifs in the catalytic ATPase region of the protein. These alterations likely do not impair SWI/SNF complex assembly but may be associated with disrupted ATPase activity. The identification of SMARCA2 mutations in humans provides insight into the function of the Snf2 helicase family.0info:eu-repo/semantics/publishe

Neonatal mortality disparities by gestational age in European countries

IMPORTANCE There are wide disparities in neonatal mortality rates (NMRs, deaths <28 days of lifeafter live birth per 1000 live births) between countries in Europe, indicating potential for improvement. Comparing country-specific patterns of births and deaths with countries with low mortality rates can facilitate the development of effective intervention strategies. OBJECTIVE To investigate how these disparities are associated with the distribution of gestational age (GA) and GA-specific mortality rates. DESIGN, SETTING, AND PARTICIPANTS This was a cross-sectional study of all live births in 14 participating European countries using routine data compiled by the Euro-Peristat Network. Live births with a GA of 22 weeks or higher from 2015 to 2020 were included. Data were analyzed from May to October 2023. EXPOSURES GA at birth. MAIN OUTCOMES AND MEASURES The study investigated excess neonatal mortality, defined as a rate difference relative to the pooled rate in the 3 countries with the lowest NMRs (Norway, Sweden,and Finland; hereafter termed the top 3). The Kitagawa method was used to divide this excess into the proportion explained by the GA distribution of births and by GA-specific mortality rates. A sensitivity analysis was conducted among births 24 weeks’ GA or greater. RESULTS There were 35 094 neonatal deaths among 15 123 428 live births for an overall NMR of 2.32 per 1000. The pooled NMR in the top 3 was 1.44 per 1000 (1937 of 1 342 528). Excess neonatal mortality compared with the top 3 ranged from 0.17 per 1000 in the Czech Republic to 1.82 per 1000 in Romania. Excess deaths were predominantly concentrated among births less than 28 weeks’ GA (57.6%overall). Full-term births represented 22.7%of the excess deaths in Belgium, 17.8%in France, 40.6%in Romania and 17.3%in the United Kingdom. Heterogeneous patternswere observed when partitioning excess mortality into the proportion associated with the GA distribution vs GA-specific mortality. For example, these proportions were 9.2%and 90.8%in France, 58.4%and 41.6%in the United Kingdom, and 92.9%and 7.1% in Austria, respectively. These associations remained stable after removing births under 24 weeks’ GA in most, but not all, countries. CONCLUSIONS AND RELEVANCE This cohort study of 14 European countries found wide NMR disparities with varying patterns by GA. This knowledge is important for developing effective strategies to reduce neonatal mortality