[Demography of psychiatrists and attractiveness factors: the example of Franche-Comté]. / Démographie des psychiatres et facteurs d'attractivité?: l'exemple de la Franche-Comté

INTRODUCTION: In France, the challenges of replacing departing psychiatrists with a new generation are compounded by an increased demand for psychiatric care, which threatens the accessibility of health care, particularly in rural and semi-rural areas. The objective of this study was to describe the location of psychiatrists trained in the Franche-Comté region, and to analyze the factors associated with establishing their practice in the region, particularly in the most understaffed areas. METHODS: We conducted a retrospective observational study, completed by a qualitative investigation with semi-directive interviews with psychiatrists and psychiatry residents. RESULTS: Between 1994 and 2013, 160 students entered psychiatry residencies in Franche-Comté. As of October 2013, 87 of them were full-time psychiatry practitioners and, 57% of them worked in Franche-Comté. The region of practice was associated with their birthplace (p=0.03). The qualitative investigation showed that, apart from family- and quality of life-related factors (work opportunities for the spouse, family closeness, desire to live in urban areas), opportunities to work in a team, implementation of dynamic and innovative projects and values of the establishment were also considered when choosing a site of practice. CONCLUSION: While the current increase in the number of psychiatry residents may respond, in the long run, to health care demographic problems in Franche-Comté, more specific interventions also seem necessary. Creation of time-shared jobs, facilitating the establishment of psychiatric practices within multidisciplinary clinics, task shifting and telemedicine may allow improvement of the psychiatric care offered in Franche-Comté.

[A comprehensive professional evaluation of the program Obesity in French Polynesia]. / Evaluation professionnelle compréhensive du programme Obésité en Polynésie Française.

A professional evaluation of the program of the fight against obesity set up by the French Polynesian Health Board for a five-year period was carried out in 2001. A comprehensive evaluation was favoured so that adjustments could be better established. Its principle is based on qualitative analysis of the speech of the 27 actors belonging to all levels of intervention and decision in the program. It aims to highlight the convergences and the deviations between what the program produced on the socio-cultural environment and their institutional or professional references. Semi-directive interviews were carried out. The results highlighted a state of uncertainty in the management of human, financial and material resources linked to the political context--awarding the necessary means for implementing the program remains unpredictable. A lack of human resources, problems of collaborating with other sectors, shortcoming skills, and structures around a methodology and forecast indicators were identified. The objectives (media campaigns, improvement in medical practice, and adaptation of a healthy and balanced food environment) were partially carried out. After a year and a half, the most remarkable result is finally that obesity problem is recognised as a public health priority by the population, professionals and decision-makers.