Teachers can take different approaches to HE. Teachers' representation of HE plays an important role in the development of HE activities: some teachers consider that HE is the mission of the health professionals and the parents. Our expectations of teacher involvement should be realistic, should take into account the representations of their role, the difficulties they encounter, and should be sustained by specific training.
Background: This article proposes a method for analysing the degree of maturity of health-in-all-policies (HiAP) among WHO French Healthy Cities Network (WHO-FHCN) as part of the GREENH-City project. We focused on the creation or enhancement of health-promoting environments, and more specifically, public green spaces. Methods: We conducted a cross-sectional quantitative study guided by the evaluative framework of the HiAP maturity level developed by Storm et al. mixed with a qualitative interpretation. A self-administered questionnaire was sent to elected officials and health department officers in the 85 member cities of the WHO-FHCN in 2017. Subsequently 58 cities were included in the analysis, which was based on a Multiple Correspondence Analysis (MCA) and a Hierarchical Ascending Correspondence (HAC). Results: 32 criteria among a total of 100 were identified and were used to organize the cities into 8 groups which was then reduced to three profiles among the cities: a less advanced HiAP profile, an established HiAP profile and an advanced HiAP profile. This process allows us to identify 4 dimensions that make it possible to evaluate the level of maturity of cities in the HiAP process, namely: (1) the consideration of social inequalities in health and/or health issues in the policies / actions of the sector studied, (2) occasional intersectoral collaboration, i.e. one-off initiatives between the health department and others sectors, (3) the existence of joint projects, i.e. common projects between two or more sectors, (4) the existence of intersectoral bodies, in this case on the theme of urban green spaces including an intersectoral committee and/or working groups. Conclusion: Four dimensionswhich allow to the measurement of the degree of progress in implementing health-all-policies are proposed. With a view to integrating knowledge into public action, this study carried out under real conditions offers a realistic method to evaluate HiAP.
La recomposition hospitalière observable depuis plus de 20 ans en France résulte de décisions prises dans le cadre des politiques de planification et des stratégies adoptées par les établissements. Au-delà de ses conséquences, comment dans un premier temps rendre compte du maillage territorial des établissements de santé ? Pour identifier les facteurs caractérisant la topologie du maillage, les statistiques de test conventionnelles sont inadaptées. Aussi nous proposons dans cet article méthodologique, d’étudier l’utilité des modèles issus de la théorie des graphes pour la modélisation des transferts de patients entre établissements de courts séjours (i.e. Médecine-Chirurgie-Obstétrique, MCO) et établissements de soins de suites et réadaptation (SSR) à partir du Programme de Médicalisation des Systèmes d’Information (PMSI). Les modèles Erdös-Renyi (ER) et les modèles à séquences contraintes sur les degrés ( Constrainted Degree Sequence Model , CDSM) testent la significativité des mesures d’assortativité. Dans notre étude, ils démontrent entre autre la propension des établissements de même statut juridique à échanger des patients entre-eux. Les modèles en blocs permettent de créer des clusters d’établissements sur la base des caractéristiques communes. Dans notre contexte, ils soulignent notamment la dynamique territoriale des échanges entre établissements. Enfin, les modèles à graphes aléatoires exponentiels ( Exponential Random Graph Models ou ERGM) et la mesure d’assortativité mesurent l’influence simultanée de la proximité géographique et des statuts juridiques dans la relation entre les établissements. En conclusion, les méthodes issues de la théorie des graphes offrent des perspectives pour identifier et quantifier l’impact de facteurs pouvant influencer la topologie des relations hospitalières.
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