[Dorsal cutaneous adipofascial flaps of long fingers]. / Les lambeaux cutanés a pédicule adipofascial de la face dorsale des doigts longs.

We report a series with the adipofascio cutaneous flap of the dorsal aspect of long fingers used with an anterograde or retrograde pedicle. Thirty flaps were performed in 29 patients with a mean age of 43 years, 16 cases in emergency and 13 cases secondary for the treatement of traumatic sequelae. The adipofascial pedicle was retrograde for 22 flaps and anterograde for 8 flaps. The donor site was adjacent of the cutaneous defect in 21 cases or at a distance in 9 cases. Transcient veinous congestion was observed in 2 cases. No necrosis was reported. A second surgery of plasty was performed in 1 case for a cutaneous bulk. The quality of the cutaneous coverage gave any functional discomfort and was evaluated very satisfying. These flaps have an important adaptabily of utilization depending on the localisation and the size of the cutaneous defect as well as the quality of its surrounding skin. The homodigital feature of these flaps avoids the disadvantages of the dorsal hand flaps or the heterodigital flaps. Due to their anastomotic vascularisation, these flaps are reliable and therefore can be recommended for the treatment of dorsal cutaneous defects of long fingers less than 2.5 cm.

[Submitting to disease, controlling disease, industrialization and medical technology: the case of tuberculosis]. / Maladie subie, maladie dominée, industrialisation et technologie médicale: le cas de la tuberculose.

This article presents an overview of the research work undertaken in France and Algeria on tuberculosis and the application of tuberculosis treatments. Tuberculosis is one of the best medical pointers to social inequality. The disease is seen here as typical of the links between industrialization and health, with regard to the evolution of the epidemiological model and the influence of innovational+ treatments, based on chemotherapy, on the organization of care for tubercular patients, together with the socio-economic and cultural changes that have affected both French and Algerian society during the twentieth century. The first part of the article shows how the epidemiology of tuberculosis tends to vary in accordance with the dynamic evolution of social relationships as industrialization occurs in each country, and how world-wide epidemiological trends are one of the best medical pointers to the North-South divide. The second part of the article is given over to a study of the way in which the application of tuberculosis treatments in both France and Algeria is a function of the organization of the health system in each country, of the status and power of the medical profession within society, and of the impact of technical innovations on the changing forms of care for tubercular patients in both countries. In France, it can be seen that the structure of the system set up to combat tuberculosis in the inter-war years has tended to remain unchanged, despite the opportunities for re-organization of tuberculosis treatment and for making therapy less onerous which have arisen as the incidence of the disease has dropped and antibiotics have been introduced. This resistance to change seems due primarily to the difficulty of achieving redeployment of medical staff, and the inertia caused by the rigid structure of tuberculosis care within the French socio-medical system.(ABSTRACT TRUNCATED AT 250 WORDS)

A abordagem multidisciplinar na pesquisa de saúde pública: o acidente do trabalho e a segurança ocupacional / Multidisciplinary approach in public health research: the occupational accident and occupational safety

Apresenta-se uma análise crítica das diversas abordagens científicas do acidente do trabalho, particularmente em epidemiologia, ergonomia e sociologia tentando destacar os limites epistemológicos em cada campo respectivo. O acidente do trabalho é, por sua própria natureza, näo somente uma lesäo física mas também um fenômeno econômico, social e legal, que nos permite examinar os problemas apresentados pela necessidade de uma abordagem multidisciplinar na pesquisa de saúde pública

[A multicriteria tool for the analysis of health status indicators of a population. Application to the elaboration of a typology for the use of health indicators]. / Un outil multicritère d'analyse des indicateurs d'état de santé d'une population. Application à l'élaboration d'une typologie de l'utilisation des indicateurs de santé.

The authors have designed a multicriteria framework for the analysis of health indexes in order to provide a tool for the comparison of population health status indexes and to establish a typology of these indexes regarding their use for public health. This framework allows for (a) shedding some light on the conceptualization of health underlying each index, (b) understanding the nature of the phenomenon which are effectively measured, (c) understanding the principles of the construction of the index, (d) giving some details concerning its main properties, (e) and finally understanding its possible uses. Using this multicriteria framework for analyzing and comparing 16 different population health status indexes, the authors suggest some guidelines for choosing an index regarding its future utilization (identification of priorities, resources allocation, evaluation). Finally, the limits of the utilization of health status indexes within the process of decision making in public health are underlined.

[Multidisciplinary approach in public health research. The example of accidents and safety at work]. / La pluridisciplinarité dans la recherche en Santé Publique. L'exemple de l'accident et de la sécurité du travail.

This article critically analyses the various scientific approaches taken to industrial accidents, particularly in epidemiology, ergonomie and sociology, by attempting to outline the epistemological limitations in each respective field. An occupational accident is by its very nature not only a physical injury but also an economic, social and legal phenomenon, which more so than illness, enables us to examine the problems posed by the need for a multidisciplinary approach in Public Health research.