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Improving human papillomavirus vaccination coverage in France: a need to act but not to rush
No full textInternational audienceSuboptimal vaccine uptake is a worldwide public health issue. We need (i) to develop interventional population health research on vaccine uptake and (ii) to ensure better use of the research results by public health authorities before developing and implementing a national strategy
On the importance of assessing stigma in dermatological research
No full textCommentary - Volume 39, Issue
Feasibility and potential effect of a pilot blended digital behavior change intervention promoting sustainable diets over a year
No full textInternational audienceWell-designed effective interventions promoting sustainable diets are urgently needed to benefit both human and planetary health. This study evaluated the feasibility, acceptability, and potential impact of a pilot blended digital intervention aimed at promoting sustainable diets. We conducted a series of ABA n-of-1 trials with baseline, intervention, and follow-up phases over the course of a year, involving twelve participants. The intervention included text messages, and individualized online feedback sessions. Quantitative data on diet composition was collected daily for 15 weeks distributed over the year. Qualitative data was collected through interviews at the end of each phase. Results showed high feasibility and acceptability: 100% retention rate, 75% attendance at all feedback sessions, and an average response rate of 86% to the dietary questionnaires. The intervention had a positive and significant effect on the overall diet composition. Specifically, 92% of the participants significantly increased their daily fruit and vegetable consumption, and 58% significantly reduced their intake of red and processed meat as well as ultra-processed foods. Participants also reported reducing food waste, choosing minimally packaged and in-season foods, and prioritizing fair-sourced food. The study demonstrates the potential of digital interventions to effectively promote sustainable dietary behaviors and offers insights for future large-scale implementations. Upcoming iterations should involve a more diverse population, particularly less motivated individuals and with more diverse socioeconomic status
Prenatal Hemoglobin Concentration and Long-Term Child Neurocognitive Development
No full textInternational audienceAnemia in pregnancy, defined by a hemoglobin level (Hb) of less than 110 g/L, contributes to infant mortality and morbidity in sub-Saharan Africa. Maternal Hb changes physiologically and pathologically during pregnancy. However, the impact of these changes on long-term child neurocognitive function is unknown. This study therefore investigates the association between Hb at specific antenatal care visits and prenatal Hb trajectories during pregnancy and long-term child neurocognitive function. We analyzed data from a prospective cohort study that included 6-year-old singleton children born to women enrolled before 29 weeks of gestation into an antimalarial drug clinical trial. Hemoglobin level was analyzed from venous blood collected at least twice during pregnancy and at delivery. We used group-based trajectory modeling to identify distinct prenatal Hb trajectories. In total, 478 children (75.1% of eligible children) had assessment of cognitive and motor functions at 6 years of age. Three distinct Hb trajectories were identified: persistently anemic (Hb <110 g/L throughout the second and third trimesters), anemic to nonanemic (Hb <110 g/L at second trimester with increasing Hb toward the third trimester to Hb ≥110 g/L), and persistently nonanemic (Hb ≥110 g/L throughout the second and third trimesters). Children of women in the persistently anemic and anemic-to-nonanemic groups had significantly lower neurocognitive scores than children of women in the persistently nonanemic group (β = −6.8, 95% CI: −11.7 to −1.8; and β = −6.3, 95% CI: −10.4 to −2.2, respectively). The study shows that maintaining an elevation of Hb at or above 110 g/L from the second to third trimester of pregnancy may be associated with optimal long-term child neurocognitive function
Étude sur les conditions favorables au télétravail des cadres de santé. Partie 1 : La régulation institutionnelle des conditions du télétravail
No full textNational audienceEn 2022, plus de 25 % des actifs en France télétravaillaient, alors qu'en 2019, le télétravail ne concernait que 3 % des actifs (DARES). Longtemps resté à la marge au sein des établissements de santé, le télétravail est aujourd'hui plébiscité par un nombre important de professionnels hospitaliers. Les cadres de santé, personnels d'encadrement à la frontière du soin et de la gestion, représentent une population pour laquelle le télétravail pourrait devenir une alternative compte tenu de certaines de leurs missions. Dans cette première partie, les auteurs montrent que le déploiement et la réussite de la mise en place du télétravail sont avant tout dépendant de l’implication et du portage par le top management. En effet, la co-construction d’objectifs et de modes de contrôles du télétravail avec la hiérarchie est un élément déterminant pour la réussite de la mise en place du télétravail. Ils présentent quatre dimensions relatives aux conditions de télétravail qui appellent une régulation institutionnelle : 1) la définition d’un sens partagé et positif de la notion de télétravail 2) la prise en compte des enjeux organisationnels et techniques relatifs à l’information et à la communication 3) la délibération sur les enjeux de pouvoirs d’agir et d’autonomie et enfin 4) le soutien à la qualité des liens et du dialogue
E-bikes and travel behaviour change: systematic review of experimental studies with meta-analyses
No full textInternational audienceTransitioning from private cars to active modes of transport is key to reducing transport related greenhouse gases emissions and promoting physical activity. Electrically assisted bicycles, often referred to as e-bikes, play a pivotal role in facilitating this shift. However, the environmental and health benefits of e-bikes depend on the modes they substitute, with the highest benefits obtained when private cars are replaced. This systematic review and meta-analysis targets quasi-experimental (i.e. pre–post measures of travel behaviours without control group) and experimental (i.e. pre–post measures of travel behaviours with control groups) studies assessing the impact of acquiring an e-bike on overall travel behaviour changes expressed in both distances and mode share (in % of kilometres travelled). Ten studies, all conducted in Northern Europe, were included. Results from the narrative synthesis and meta-analysis show that: (i) when participants have access to an e-bike, either through a free loan programme or a purchase, they engage in e-cycling; the meta-analysis reveals a significant difference of 5 km travelled daily after the interventions between participants that got access to an e-bike compared to those from control groups with no e-bikes, reflecting a substantial increase of 26% in e-bike mode share; (ii) e-bikes can substitute for all other modes of transport, but car use appears to be the most affected in both the systematic review and meta-analyses difference (2.4 km fewer travelled per day by car between the intervention and control groups at follow-up, reflecting to a 10% decrease in car mode share); (iii) baseline travel behaviours may influence modal shift, with e-bikes substituting for the most prevalent means of transport in baseline. E-bikes have the potential to be a reliable and competitive alternative to cars in a healthier and more sustainable transport system and our study brings new empirical evidence to support this claim
Prévalence de l’automédication chez les transplantés rénaux : une étude transversale monocentrique
No full textInternational audienceImportance Vitamin D deficiency is a risk factor for multiple sclerosis (MS) and is associated with the risk of disease activity, but data on the benefits of supplementation are conflicting. Objective To evaluate the efficacy of high-dose cholecalciferol as monotherapy in reducing disease activity in patients with clinically isolated syndrome (CIS) typical for MS. Design, Setting, and Participants The D-Lay MS trial was a parallel, double-blind, randomized placebo-controlled clinical trial in 36 MS centers in France. Patients were enrolled from July 2013 to December 2020 (final follow-up on January 18, 2023). Untreated patients with CIS aged 18 to 55 years with CIS duration less than 90 days, serum vitamin D concentration less than 100 nmol/L, and diagnostic magnetic resonance imaging (MRI) meeting 2010 criteria for dissemination in space or 2 or more lesions and presence of oligoclonal bands were recruited. Intervention Patients were randomized 1:1 to receive oral cholecalciferol 100 000 IU (n = 163) or placebo (n = 153) every 2 weeks for 24 months. Main Outcomes and Measures The primary outcome measure was disease activity, defined as occurrence of a relapse and/or MRI activity (new and/or contrast-enhancing lesions) over 24 months of follow-up, also analyzed as separate secondary outcomes. Results Of the 316 participants enrolled and randomized (median [IQR] age, 34 [28-42] years; 70% women), the primary analysis included 303 patients (95.9%) who took at least 1 dose of the study drug and 288 (91.1%) ultimately completed the 24-month trial. Disease activity was observed in 94 patients (60.3%) in the vitamin D group and 109 patients (74.1%) in the placebo group (hazard ratio [HR], 0.66 [95% CI, 0.50-0.87]; P = .004), and median time to disease activity was longer in the vitamin D group (432 vs 224 days; log-rank P = .003). All 3 secondary MRI outcomes reported significant differences favoring the vitamin D group vs the placebo group: MRI activity (89 patients [57.1%] vs 96 patients [65.3%]; HR, 0.71 [95% CI, 0.53-0.95]; P = .02), new lesions (72 patients [46.2%] vs 87 patients [59.2%]; HR, 0.61 [95% CI, 0.44-0.84]; P = .003), and contrast-enhancing lesions (29 patients [18.6%] vs 50 patients [34.0%]; HR, 0.47 [95% CI, 0.30-0.75]; P = .001). All 10 secondary clinical outcomes showed no significant difference, including relapse, which occurred in 28 patients (17.9%) in the vitamin D group vs 32 (21.8%) in the placebo group (HR, 0.69 [95% CI, 0.42-1.16]; P = .16). Results were similar in a subset of 247 patients meeting updated 2017 diagnostic criteria for relapsing-remitting MS at treatment initiation. Severe adverse events occurred in 17 patients in the vitamin D group and 13 in the placebo group, none of which were related to cholecalciferol. Conclusions and Relevance Oral cholecalciferol 100 000 IU every 2 weeks significantly reduced disease activity in CIS and early relapsing-remitting MS. These results warrant further investigation, including the potential role of pulse high-dose vitamin D as add-on therapy. Trial Registration ClinicalTrials.gov Identifier: NCT0181716
Improving breast and colorectal screening uptake in France. One map to target intervention areas
No full textInternational audienceAbstract Background Most intervention areas for improving cancer screening uptake are in deprived neighbourhoods. However, in recent years, determinants and attitudes to screening have evolved, and new perspectives are needed in understanding cancer screening practices. It is therefore necessary to develop simple, effective and reproducible strategies for identifying intervention areas. Using one map, the aim is to investigate spatially and temporally breast and colorectal cancer screening in France from 2015-2016 to 2021-2022. Methods Uptake in breast (BS) and colorectal (CS) cancer screening at the census block level was generated by the regional cancer screening centre for women aged 50 to 74, residing in the Rhône department (mostly rural but including the urban Lyon metropolitan area). We used spatial analysis to create a map highlighting groups of hotspots, identifying their direction of propagation between 2015-2019 and 2020-2022. Results The results reveal interesting areas for intervention with differences and similarities in uptake of the two screenings. For CS, there was a 5-pt increase in uptake between the two periods (2015-2019: 33% and 2020-2022: 38%), whereas for BS the uptake remained stagnant around 49% on average in the metropolitan area. The map highlights 49 urban census blocks with consistently lower uptake rates in both screenings (39.2% for BS, 23.7% for CS) than the overall average. Conversely, some census blocks have consistently lower uptake rates on one screening but not on the other (CS or BS). Conclusions This work may inform the breast and colorectal locally screening trend and inform policymakers to develop tailored prevention strategies. These analyses are easily reproducible at different times and spaces, and they have the potential for evaluation and comparison of screening uptake. Key messages • Maps may inform policymakers to develop tailored prevention strategies. • Investigate spatially and temporally breast and colorectal cancer screening reveal interesting areas for interventions
Impact of a shared medical decision-making aid on patient decisional conflict regarding human papillomavirus vaccination: a mixed-methods study
No full textInternational audienceIntroduction: Human papillomaviruses (HPVs) cause several vaccine-preventable cancers, including cervical cancer. In France, HPV vaccination coverage remains low. Decision aids (DAs) can help individuals make informed health choices. This study assessed the impact of an online DA (SOSHPV) on decisional conflict and vaccination intention, and explored user perceptions in real-life contexts.Methods: A convergent mixed-methods design was used (November 2023-June 2024). The quantitative component included a pre-post questionnaire assessing knowledge, vaccination intention, and decisional conflict. The qualitative component involved semistructured interviews with a subsample of users, analyzed using grounded theory.Results: Among 943 website visitors, 187 participants (54 males, 12 adolescents) completed the presurvey, and 44 (12 males, 6 adolescents) completed both assessments. Over half (54%) were young parents using the tool to support HPV vaccination decisions for their child. Post-intervention, knowledge improved (P < 0.001), and decisional conflict decreased (P < 0.001). Vaccination intention shifted: 55%-75% in favor and 32%-18% undecided (P < 0.001). Qualitative analysis (n = 12) revealed three themes: social ambivalence around vaccination, the DA as a support for informed choices, and its role in enhancing communication with healthcare providers.Discussion: This study showed a reduction in decisional conflict and increased vaccination intention. These findings suggest that DAs may play an important role in addressing vaccine hesitancy and supporting value-aligned choices in real-world settings.Conclusion: This study highlights the potential of an online DA to improve vaccine acceptance by reducing decisional conflict and enhancing dialog. Further research is needed to assess its large-scale impact on vaccine uptake
13. De la satisfaction à l'expérience: évaluer le service perçu par les patients
No full textNational audienceComprendre l’expérience du patient constitue un enjeu clé en management de la santé. Dans un contexte de complexification des prises en charge, cette compréhension permet d’adapter les réponses aux besoins de plus en plus personnalisés des patients. Aujourd’hui, les évaluations dont disposent les managers se limitent principalement à des indicateurs de satisfaction, au mieux à quelques données agrégées sur l’expérience des patients, qui ne traduisent pas la spécificité des vécus individuels. Les portails en lignes permettent aux patients de partager leur expérience au grand public au niveau granulaire, donc très détaillé, mais restent très controversés sur la forme et sur leur usage. Pour améliorer les prises en charge personnalisées en santé, on propose ici de s’inspirer du customer journey dans le secteur marchand. Centrée sur des données d’expérience recueillies en situation, cette approche vise à retracer la trajectoire d’un patient par ses points de contact avec l’organisation (chaque point de contact constitue un espace d’investigation). Elle éclaire d’emblée les enjeux de management et permet d’identifier des pistes d’amélioration