[The measure of the quality of life of adolescents: a new evaluation tool of their health needs for a new educational approach?]. / La mesure de la qualité de vie des adolescents: un nouvel outil d'évaluation de leurs besoins de santé pour une nouvelle approche éducative?

Hundreds of studies carried out in the past 20 years have worked on youth and adolescent health indicators linked to general morbidity and mortality and to specific pathologies. The majority of research has focused on evaluating the impact of risk behaviours such as tobacco, alcohol and drug use, non-protected sexual intercourse, and unbalanced nutrition on the health of youth. The usefulness of medical care and health education programmes has thus traditionally been evaluated on the basis of their impact on mortality and morbidity. However, these measures have proven insufficient and the necessity to pay more attention to quality, and not only length of life is now apparent. This article focuses on the question of whether the tool for measuring quality of life linked to health, adapted from what now exists for "sick" adolescents, can constitute a new indicator allowing for evaluation of the unknown realm of adolescent health needs. The authors address the concept of measuring the quality of life by providing several of its definitions, noting the difficulties and insufficiencies of their measurement. The authors also wonder why the multiple professionals preoccupied with adolescent health have not yet imagined using a participative approach to developing these measures, i.e. an approach including the adolescents themselves, has not been used. The authors propose that to include adolescents in the development of evaluation tools would ensure that the adolescent's needs for expression and to be heard are fulfilled. The authors also maintain that education, both health and general, should enable individuals to understand what is positive within themselves, and thus develop these aspects to their fullest. It should not force models of behaviour onto individuals or groups. If this approach is taken in developing quality of life indicators for young people, a positive health promotion approach to enabling adolescents can be developed.

[Cost-effectiveness analysis of the treatment of chronic hepatitis C]. / Analyse coût-efficacité du traitement de l'hépatite chronique C.

OBJECTIVES: Chronic active hepatitis C is an important public health issue because of its prevalence, evolution, and overall cost. Treatment by recombinant alpha-interferon is both expensive and exacting and its effectiveness is limited. We report the results of a cost-effectiveness analysis of alpha-interferon treatment in patients with chronic active hepatitis C. METHODS: Direct medical costs of caring for patients with chronic active hepatitis C and its complications, based on treatment or no treatment, were assessed with retrospective data collected from the files of 137 hospital patients. Seventy-seven patients were treated with alpha-interferon between 1988 and 1994. The overall costs of caring for chronic active hepatitis C patients, without treatment or with alpha-interferon treatment (3 millions units three times a week) for 6 months (strategy A), 12 months (strategy B), or 12 months but discontinuing treatment when there was no response (strategy C), was reported and compared to the respective effectiveness of each. RESULTS: With an actualization rate of 5%, the real overall cost of caring for a chronic active hepatitis C patient was 143290 FF. Considering the contraindication rate (15%), the treatment acceptance (85%), the response rate to treatment (50%), and the prolonged response rate (25 to 30%), treating patients with strategy A induced a real overall cost of caring to 140731 FF to avoid 0.11 cases of cirrhosis, to 150277 FF to avoid 0.13 cases of cirrhosis with strategy B, and to 136947 FF to avoid 0.13 cases of cirrhosis with strategy C. CONCLUSION: Alpha-interferon treatment in patients with chronic active hepatitis C provides a long-term saving compared to cases which receive no treatment. Strategy C was the most cost-effective, inducing the reduction of both the number of cases of cirrhosis and the cost of care.