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A literature review was carried out of the health impacts of incineration, landfill, composting, landspreading sewage sludge and sewage discharges. A protocol for making judgements about the strength and reliability of the evidence was applied using an algorithm with defined criteria. Possible judgements were “convincing”, “probable”, “possible” or “insufficient”. The review found that the evidence linking any adverse health outcomes with incineration, landfill or landspreading sewage sludge was “insufficient” to claim a causal association. The evidence is “insufficient” to link residence near a centralised composting facility with adverse health outcomes but it is “possible” that working at a centralised composting facility causes health problems. Working in sewage treatment plants “probably” causes gastrointestinal tract problems, headache, fatigue and airways symptoms. The only “convincing” evidence is that gastrointestinal symptoms result from bathing in sewage contaminated recreational waters.

To assess the appropriateness of hospitalisation days, a cross‐section study was conducted in a French university hospital. Concerning both medical and surgical wards, three days were randomly chosen from April to June 2001. A total of 2,180 hospitalisation days were evaluated in accordance with the French appropriateness evaluation protocol (AEPf) with 10.9 per cent in medicine and 7 per cent in surgery judged as inappropriate. The delay tool was used to identify the causes of inappropriate days. The first cause of delay (68 per cent) was the unavailability of outside care (UOC), respectively 83.2 per cent and 61.4 per cent in surgical and medical services. The UOC was more pronounced for patients living in Caen (34 per cent) which represented only 20 per cent of hospitalised patients in the university hospital of their city. These results allow for suggestions for services to improve organisation and bring arguments for better health care.