[Health information technology: current use and challenges for primary healthcare services]. / Réalités et défis pour l'organisation du système de santé de premier recours.

Health information technology is developing rapidly, due to a profusion of actors and support from public policies. It generates new uses and functions, for both patients and professional users, thereby suggesting a "digital revolution" is coming. Nevertheless, e-Health's development meets with a particularly complex healthcare system, especially when it comes to primary care services. This situation creates four types of challenges. Firstly, an organizational challenge, meaning e-Health implementation needs to take into account the organization in which it intends to integrate. Secondly, a social and territorial concern, as the burden of inequalities is one of healthcare system's major issues. The third challenge is about economics, as we need to search for new methods for globally apprehending e-Health's business model and long-term sustainability. Lastly, the fourth challenge relates to new technical and legal issues.

Attitudes associated with behavioral predictors of serious road traffic crashes: results from the GAZEL cohort.

OBJECTIVES: To test the hypothesis that behavioral predictors of serious road traffic crashes (RTC) are correlated with unfavorable attitudes towards traffic safety. DESIGN: Prospective and cross-sectional cohort study. SETTING: France PARTICIPANTS: 13,447 of the 19,894 living members of the GAZEL cohort, workers and recent retirees of a French national utility company followed up since 1989. MAIN OUTCOMES MEASURES: Driving behavior and attitudes towards traffic safety in 2001 by questionnaire. Serious RTCs were recorded over the subsequent 3 years using the cohort annual questionnaire. Behavioral predictors of serious RTCs were assessed using generalized linear Poisson regression models with time-dependent covariates. Factor scores extracted from the first four attitudinal factors of principal component analysis were saved and then regressed on behavioral predictors as independent variables. RESULTS: After controlling for potential confounders, the best predictors of serious RTCs were: "exceeding speed limits on rural roads", "risky use of cellular phone", and "sleepy driving". The adjusted rate ratio ranged from 1.47 to 2.16. Predictors of contravention of the highway code (the first two predictors) were found to be strongly associated with negative attitudes towards "enforcement" and "speed limitations" with an adjusted odds ratio ranging from 1.31 to 2.02. CONCLUSION: Our study supports the view that individuals with a high propensity for driving behaviors associated with an increased risk of RTCs were more likely to have negative attitudes towards traffic safety. Changing drivers' negative or distorted opinions of traffic "enforcement" as well as "speed limitations" and "alcohol prohibition on roads" could improve their compliance with road traffic rules.