Les patients atteints de mono-traumatisme à un membre doivent consulter un médecin de première ligne qui assurera la prise en charge initiale et référera au besoin le patient vers un orthopédiste. L‟objectif principal de cette étude est de décrire ce mécanisme de référence envers un Service d‟orthopédie affilié à un Centre de traumatologie Niveau 1. La collecte de données concernant l‟accès aux soins spécialisés et la qualité des soins primaires a été faite lors de la visite en orthopédie. Nous avons étudié 166 patients consécutifs référés en orthopédie sur une période de 4 mois. Avant leur référence en orthopédie, 23 % des patients ont dû consulter 2 médecins de première ligne ou plus pour leur blessure. Le temps entre la consultation en première ligne et la visite en orthopédie (68 heures) dépasse le temps compris entre le traumatisme et l‟accès au généraliste (21 heures). Parmi les cas jugés urgents, 36 % n‟ont pas été vus dans les temps recommandés. La qualité des soins de première ligne fut sous-optimale chez 49 % des patients concernant l‟analgésie, l‟immobilisation et/ou l‟aide à la marche. Les facteurs associés à une diminution d‟accès en orthopédie et/ou une qualité de soins inférieure sont : tabagisme, jeune âge, habiter loin de l‟hôpital, consulter initialement une clinique privée, avoir une blessure au membre inférieur ou des tissus mous et une faible sévérité de la blessure selon le patient. Ces résultats démontrent qu‟il faut mieux cibler l‟enseignement relié aux mono-traumatismes envers les médecins de première ligne afin d‟améliorer le système de référence. / Patients with isolated traumatic limb injuries usually consult primary care for first line treatment. The primary care physician will often refer the patient to an orthopaedic surgeon when needed. The research objective was to study the referral mechanism to an Orthopaedic Service in a Level 1 Trauma Center for patients with an isolated limb injury. Access to specialized care and quality of primary care are used to describe the referral mechanism. We studied 166 consecutives patients referred to orthopaedic surgery over a 4 months period. Before the orthopaedic visit, 23 % had seen 2 or more doctors for their injury. The time between the first primary care visit and the orthopaedic evaluation was greater (68 hours) then the interval between the injury and the visit with primary care (21 hours). Among the cases that were considered urgent, 36 % had not been seen within the recommended delay. Quality of initial care was judged sub optimal for 49 % of patients in terms of immobilization, analgesia and/or walking aids. Factors associated with decreased access or quality of care are: smoking, younger age, living far from the hospital, consulting first in a private clinic, lower limb or soft tissue injury and a patient‟s low self-perception of severity. These results underline the necessity of targeting primary care education and improving the referral mechanism for patients with isolated limb injuries.

No description available.

Human trafficking has become an international issue of significant importance; it is the largest and most profitable organised crime after drugs and arms trafficking. Particular concern has recently been raised due to the Brexit potential ramifications on Human trafficking. There is a risk that the EU directive 2011/36 will be repealed as a result of Brexit. Accordingly, it has been questioned whether the UK national efforts and legislation concerning human trafficking are comprehensive and sufficient enough without the strengthening support of the EU and especially the EU directive 2011/36. Thus, this thesis aimed to determine the impact Brexit will have on human trafficking in the UK by investigating if there will be "gaps" in the UK national legislation on human trafficking.  A comparative content analysis was conducted to analyse the UK national legislation on human trafficking, The Modern Slavery Act 2015 (MSA 2015). The Modern Slavery Act was compared with the EU directive 2011/36 to determine how the legislation differed. The method and analysis were conducted on both a latent and manifest level which means it both described the definitions and analysed how the definitions could be interpreted, hence how it affects reality. Based on what has commonly been argued the main reasons behind human trafficking in Europe, the content analysis focused on the definitions of human trafficking, prostitution and protection of migrant victims. Prostitution and migrations are frequently claimed to be the main reasons behind human trafficking in Europe.  Due to the risk of the EU directive 2011/36 being repealed, the result of the thesis exhibits the need for the UK to update their national legislation. The MSA 2015 needs to become coherent with international agreements and strengthen the protection of victims of human trafficking. Due to the gendered nature of human trafficking, this research addressed human trafficking from a feminist perspective by applying the "dominance theory" and the "sameness theory". The feminist theories helped analyse and investigate the issue of human trafficking and the potential ramifications of Brexit. Applying the ideas illustrated the patriarchal structures surrounding human trafficking and within the MSA 2015.