École Nationale de Management et de l'Administration de la Santé

Objetivo: Verificar a situação epidemiológica da leptospirose na cidade de Maceió-Alagoas durante os anos de 2021 e 2022. Método: Trata-se de um estudo ecológico dos casos registrados no Sistema de Informação de Agravos de Notificação (SINAN), no período de 2021 e 2022. Os dados foram organizados segundo características sociodemográficas, clínicas e epidemiológicas e analisados por meio de medidas absolutas e relativas. Resultados: Foi verificado que o sexo masculino (83,02%), a faixa etária de 20 a 39 anos (33,96%), a raça-cor parda e/ou preta (100,00%) e os indivíduos com fundamental incompleto (28,30%) foram os mais acometidos pela doença. Com relação às características clínicas, verificou-se maior proporção de sinais de baixa gravidade (96,23%), hospitalização (94,34%), diagnóstico por critério laboratorial (58,49%) e desfecho de cura (80,39%). Quanto às características epidemiológicas, a maioria dos casos tiveram contato com água e/ou lama de enchente (70,80%), justificando a maior proporção de casos no ano de 2022, período de inundações na cidade de Maceió. Conclusão: A situação epidemiológica da leptospirose em Maceió no período de 2021 e 2022 apresentou características sociodemográficas, clínicas e epidemiológicas condizentes com a literatura e reforçam a necessidade da adoção de estratégias específicas, principalmente, em áreas de inundações, buscando priorizar a redução do risco de infecção e a eficácia no tratamento precoce dos acometidos pela doença.

In sub-Saharan African countries, out-of-pocket payments can be a major barrier to accessing appropriate healthcare services. Community-based health insurance (CBHI) has emerged as a context-appropriate risk-pooling mechanism to provide some financial protection to populations without access to formal health insurance. The aim of this rapid review was to examine the peer-reviewed literature on the impact of CBHI on the use of healthcare services as well as its capacity to improve equity in the use of healthcare between different socio-economic groups. A systematic search of three electronic databases (Pubmed, Cochrane Library and Littérature en Santé) was performed. Data were extracted on scheme and study characteristics, as well as the impact of the schemes on relevant outcomes. Sixteen publications met the inclusion criteria, studying schemes from seven different countries. They provide strong evidence that community-based health insurance can contribute to improving access to outpatient care and weak evidence that they improve access to inpatient care. There was low evidence on their capacity to improve equity in access to healthcare among insured members. In the absence of sufficient public spending for healthcare, such schemes may be able to provide some valuable benefits for communities with limited access to primary-level care in sub-Saharan Africa. The overall high risk of bias of the studies and the wide existing variety of insurance arrangements suggest caution in generalizing these results. These findings need to be validated and further developed by rigorous studies.

Objectif : Cette étude examine si les prescripteurs ont respecté la recommandation de la Haute Autorité de Santé de 2011 concernant la limitation des prescriptions de médicaments spécifiques à la maladie d’Alzheimer (MA) et si le respect de cette recommandation dépend du genre du patient. Design de l’étude : L’échantillon est composé de données trimestrielles de l’EGB de 2010 à 2013 (16 trimestres) pour des individus vivant à domicile et âgés de 65 ans et plus en 2010. Méthodes : La probabilité de consommer des médicaments spécifiques à la MA est estimée à partir d’un modèle de panel à effets fixes permettant de capturer l’hétérogénéité individuelle invariante dans le temps. Les variables explicatives variant dans le temps ont été incluses dans le modèle pour contrôler des variations d’état de santé et de remboursement. Les estimations ont été réalisées séparément pour les hommes et les femmes. Résultats : Une différence de tendance dans la probabilité de consommer des médicaments spécifiques à la MA entre les patients hommes et femmes est observée après la diffusion de la recommandation de la HAS en 2011 : cette probabilité décroit chez les femmes alors qu’elle reste stable chez les hommes. Conclusions : Notre cas d’étude complète la littérature sur l’influence des agences d’évaluation des technologies de santé sur les pratiques médicales. Les politiques de santé publique pour la prise en charge des patients atteints de la MA devraient prendre en compte les différences de genre des patients. De futures recherches devrait étudier comment mettre en place des thérapies et des politiques de prévention prenant en compte les différences de genre entre patients et leurs effets.

Dans les etablissements de sante en France et a travers le monde, l’amelioration du travail en equipe est presentee comme une reponse au probleme de la securite des soins. Cette politique est portee par la Haute autorite de sante (HAS) et prend forme dans un programme fournissant divers supports a des equipes volontaires desirant ameliorer leur fonctionnement. L’article saisit la mise en œuvre de ce programme comme un terrain opportun pour etudier comment les professionnels de sante, au sein des services, pratiquent le travail en equipe. Notre analyse repose sur une methodologie qualitative (entretiens, observations) aupres de trois services. Nous avons construit une grille d’analyse a partir du concept de Teaming d’Edmondson (2012), que nous traduisons par faire-equipe. Ce concept identifie cinq dimensions decisives : l’existence de representations partagees du travail, la creation d’un climat de confiance entre membres de l’equipe, la capacite a affronter les echecs pour mieux les surmonter, la capacite a enjamber les frontieres de l’equipe et la production d’un leadership pour articuler ces differentes dimensions. Cette grille permet d’observer comment les professionnels tentent de developper et d’ameliorer de maniere durable leur travail en equipe. Les resultats montrent qu’au-dela de l’enthousiasme initial, faire equipe s’avere laborieux. Les dimensions considerees comme necessaires au travail en equipe ne sont souvent pas presentes. En outre, diverses contraintes d’ordre structurel pointent les limites des politiques d’equipe pensees a l’echelle d’un service.

The search for efficiency and concentration on patient needs and satisfaction are at the topic of current conceptions in terms of the quality and organization of health services. There is indeed a relative consolidation of organizational approaches called Patient-Centered Care (e.g. CCM, DM, case management, population management) for the structured management of patients with chronic diseases and a real desire to implement them in the domain of health. This evolution continues in the management of health systems through New Public Management - NPM. There is a strong pressure on professionals (care professionals and managers) to ensure greater efficiency in terms of activities and greater efficiency in terms of the use of resources. Both developments point to a greater emphasis on personalizing care, differentiating benefits, and taking into account the satisfaction of beneficiaries of public services. However, without being antinomic, the two evolutions underlie divergent and even paradoxical issues and mechanisms.

In order to study social inequalities, indices can be used to summarize the multiple dimensions of the socioeconomic status. As a part of the Equit’Area Project, a public health program focused on social and environmental health inequalities; a statistical procedure to create (neighborhood) socioeconomic indices was developed. This procedure uses successive principal components analyses to select variables and create the index. In order to simplify the application of the procedure for non-specialists, the R package SesIndexCreatoR was created. It allows the creation of the index with all the possible options of the procedure, the classification of the resulting index in categories using several classical methods, the visualization of the results, and the generation of automatic reports.

The concept of integrated services delivery, although dating from the 1990s, has only recently appeared in French public health policy. To clarify the concept and its adaptation to the reality of the French systems of healthcare and social services, the French Society of Geriatrics and Gerontology established an interdisciplinary working group. This article reports that group's findings according to three axes: the definition of integration, the objectives of this organizational approach and the means needed to achieve them. Analysis of the literature indicated that integration is a process that aims to overcome the fragmentation of services for vulnerable people. This process requires a multilevel approach, particularly concerning how to modify public policies and financing systems. Notably, all relevant levels need to develop shared processes, tools, resources, finance, interventions and returns on the latter. Indeed, this sharing is the ultimate proof of evolution towards integration. In the second part of the position paper, its authors have developed arguments that could lead professionals and non-professional caregivers to adopt integrated care as an answer to their aspirations. Policy-maker perspectives and politicians are also analyzed. Bearing in mind that integrated care necessarily will always involve a human component which may find expression during individual case-management; relations between integration and case managements are clarified. Finally, lessons learned from national and international experiments are examined. Results suggest that integrated care must to be accompanied by a local pilot. Results of recent experiments have shown that it is possible to initiate a dynamic towards integrated care in France and hence join the international movement towards adapting our healthcare systems to new challenges.

La Charte de l’Éducation et de la Formation, promulgada en 1999 por el rey Mohamed VI, puso en marcha una ambiciosa reforma del sistema educativo marroquí. En aplicación de sus principios, en el curso 2012-2013 se inaugura una nueva organización en la formación inicial de profesores que supone un cambio de modelo. Conocer cuál ha sido la trayectoria de esta formación en el ámbito de los profesores de español y cuáles son las líneas generales de la reforma que se avecina, son el objetivo de este trabajo, que incluye referencias sobre la evolución de la enseñanza del español en Marruecos. Abstract The Charte de l'Éducation et de la Formation, enacted in 1999 by King Mohamed VI, launched an ambitious reform of the Moroccan educational system. In application of its principles, in the 2012-2013 academic year opens a new organization in the initial training of teachers representing a paradigm shift. Knowing what has been the history of this formation in the area of Spanish teachers and what are the outlines of the reform looming, are the focus of this paper, which includes references to the evolution of teaching Spanish in Morocco.

International audience