[Use of a self-administered quality of life questionnaire in a university preventive service]. / Utilisation d'un autoquestionnaire de qualité de vie en service de médecine préventive universitaire.

In France, the student population represents close to two million people covered by the medical and social plan of the Services de Sante Inter-Universitaires (Inter-University Health Services), of which one of the objectives is to improve students' quality of life. This is why it seemed interesting to measure this quality of life in order to identify problems and to propose possible improvements. For this, we used a generic self-administered questionnaire, the SF 36, which allowed for detecting the variations of quality of life in relation to health status. Throughout the 1995-1996 school year, 1301 questionnaires were completed by first year students seen in routine visits or scheduled appointments. The questionnaire was well received. The self-administered questionnaire is a sensitive tool that revealed, among healthy students, statistically significant differences in scores between girls and boys (with girls showing lower scores). This difference is not found in the group of students who came for an appointment for a benign pathology. The causes of these variations remain to be explored.

[Quality of life and multiple sclerosis: validation of the french version of the self-questionnaire (SEP-59)]. / Qualité de vie et sclérose en plaques: validation de la version francophone d'un auto-questionnaire, le SEP-59.

We conducted a prospective study among 166 multiple sclerosis (MS) patients (103 from an university hospital, 63 from a MS rehabilitation center) to assess the properties of the French version of the Multiple Sclerosis Quality Of Life - 54 items (MS QOL-54) which combines the MOS SF36 together with MS specific items. The SF-36 had been translated into French through the IQOLA project. We translated and adapted the MS specific items with the help of three different teams. The translation into French has an addition of five items, because we kept the MS specific items of an earlier unpublished form. Acceptability is excellent with a response rate over 90p.100. Test-retest reliability is good except for the "role limitation-emotional" scale of the SF-36. Construct validity, based on factor analysis, shows no change in the SF-36 internal consistency and the specific items provided their own information. External validity, tested against both medical (Expanded Disability Status Scale, Kurtzke scale, Mini-Mental-State and disease stage) and rehabilitation (Functional Independence Measure) parameters is excellent. The French MS QOL questionnaire contains 59 items including both the SF-36 and the MS QOL-54 items. This will permit international comparisons of MS patients' care and therapy.

Using the Short Form-36 with multiple sclerosis patients in five countries: a cross-cultural comparison.

Questionnaires measuring health-related quality of life are increasingly used in international studies of medical effectiveness. It is important to know if data from these instruments are comparable across countries. We initiated a collaboration among five research groups--from the USA, The Netherlands, Belgium, France, and the UK--in the field of health-related quality of life in multiple sclerosis. All groups used the 36-item Short Form Health Survey. The goal of our study was to make a cross-cultural comparison. In the five countries under study the sample size varied from 50 to 134 patients with multiple sclerosis. The survey was completed by a total of 457 patients, who were heterogeneous in relation to age, duration of illness, severity and type of multiple sclerosis. There appeared to be major differences among the samples in scores on each of the eight scales. These findings may be influenced by differences in method of recruitment, demographic and disease-related characteristics, administration, and cultural factors. After having performed a number of analyses, it appeared that the differences were mainly attributable to sampling effects; however, cultural influences could not be excluded.

[Comparative evaluation of maternity hospitals in Auvergne: from planning to contracting]. / Evaluation comparative des maternités en Auvergne: de la planification à la contractualisation.

Two reforms of public hospitals have been launched by the French government in 1991 and 1996 aimed at lowering costs and increasing the quality of services and ultimately the safety of patients. As concerns maternity hospitals, several new rules have been imposed upon. For example, those who performed less than 300 births a year should be closed. The basic idea was to concentrate technical resources and human skills in middle-size and important hospitals for saving money, and simultaneously, raising the safety level for mothers and babies. However, negative adverse effects fastly appeared: to avoid closure, some small maternity homes tried to convince future mothers not to go to well-equipped hospitals, even if their cases appeared complex and their health at risk. An experience of partnership between maternity hospitals (care providers), the Sickness Insurance Fund (the financing body) and the Administration was carried out in the Auvergne region. It was based on the observation of a large number of indicators concerning the activity of hospitals, the size and quality of their equipment, the satisfaction of their patients ... etc ... for designing the rights and duties of each partner. Instead of planning from the summit, a process of mutually-agreed contract was established.