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International audience; Aromatic similarity is often mentioned by culinary experts and Sommeliers as a basic principle for matching food and beverages. The aim of this study was to investigate how this pairing principle modulates consumers’ judgment of pairings. Two kinds of beverage-food pairing were considered: syrup based lemon soft drink paired with aromatized dairy product (experiment 1) and beer flavoured with either lemon or smoky aroma paired with savoury verrines (experiment 2). In each experiment the flavoured drinks were associated with food flavoured with either the same aroma or another one, leading to two contrasting levels of aromatic similarity. We hypothesized that aromatic similarity would increase the liking of the pairing by increasing perceived harmony and homogeneity and decreasing complexity. Pairings were assessed by a group of about 50 participants in a within experimental design. Experiment 1 confirmed our hypotheses. The pair that shared an aroma was preferred over the pair with different aromas. Aromatic similarity also increased the pairing’s perceived harmony and homogeneity and decreased the pairing’s complexity. Experiment 2 also supported our hypothesis but to a lesser extent. For lemon beer pairings, aromatic similarity induced an increase in harmony and homogeneity but did not affect complexity. In contrast, for smoky beer pairings, aromatic similarity did not affect harmony or homogeneity but induced a decrease in complexity. Moreover no effect or only a marginal effect was observed on liking. We suggest a model that could account for these results in which aromatic similarity would impact liking of the pair by modulating collative properties, specifically harmony and complexity, of the food-beverage pairing.

Resume Contexte La violence est un probleme frequent dans les services de psychiatrie. Le niveau de violence du lieu de vie des patients n’a pas ete etudie comme une variable explicative de la violence intra-hospitaliere. Methode Nous avons mene une etude prospective dans 9 villes francaises tres contrastees du point de vue de leur niveau de violence. Les sujets eligibles etaient des patients hospitalises sous contrainte pour troubles psychotiques, dans une des unites de psychiatrie de chaque ville concernee. Au cours de leur hospitalisation, tout type de comportement agressif etait recueilli par l’Overt Aggression Scale (OAS). Resultats De juin 2010 a mai 2011, 95 patients ont ete inclus. Soixante-dix-neuf pour cent des patients ont montre un comportement violent au cours de leur hospitalisation. La violence des patients etait significativement liee : au sexe masculin, aux antecedents de violence agis par le patient, a l’abus de substances autre que la nicotine, a la presence d’un episode maniaque ou mixte, a l’intensite de la symptomatologie mesuree par la Brief Psychiatric Rating Scale (BPRS), au degre d’insight et au taux de violence a la personne des villes correspondant au secteur du patient. Dans une analyse multivariee, les seuls facteurs significativement lies a la violence des patients etaient l’abus de substance, la severite des symptomes psychotiques et le taux de violence des villes. Conclusion Cette etude suggere que la violence dans l’environnement de vie des patients est associee a une augmentation du risque de passage a l’acte violent au cours de leur hospitalisation.

Background: Dietary choices in out-of-home eating are key for individual as well as for public health. These dietary choices are caused by a wide array of determinants, one of which is automatic decision-making. Nudging is attracting considerable interest due to its understanding and application of heuristic biases among consumers. The aim of this study is to test and compare three nudges in promoting vegetable consumption among test persons in a food lab-based experiment. Methods: The initial sample consisted of 88 participants recruited in Copenhagen, Denmark. Each study participant was randomly assigned to one of the three experiments: priming, default and perceived variety. The priming arm of the experiment consisted of creating a leafy environment with green plants and an odour of herbs. In the default arm of the experiment, the salad was pre-portioned into a bowl containing 200g of vegetables. The third experiment divided the pre-mixed salad into each of its components, to increase the visual variety of vegetables, yet not providing an actual increase in items. Each individual was partaking twice thus serving as her/his own control, randomly assigned to start with control or experimental setting. Results: The default experiment successfully increased the energy intake from vegetables among the study participants (124 kcal vs. 90 kcal in control, pConclusions: Considerable progress has been made with regard to understanding the use of nudging in promoting a healthier meal composition, including increasing vegetable intake. This study suggests that the nature of a nudge-based intervention can have different effects, whether it is increasing intake of healthy components, or limiting intake of unhealthy meal components. This work has demonstrated that consumer behaviour can be influenced without restricting or providing incentives for behaviour change. The present findings have promising application to the foodservice sector.

International audience; Objectives: The main goal of this study was to investigate and compare the neural substrate of two children's profiles of high intelligence quotient (HIQ). Methods: Two groups of HIQ children were included with either a homogeneous (Hom-HIQ: n = 20) or a heterogeneous IQ profile (Het-HIQ: n = 24) as defined by a significant difference between verbal comprehension index and perceptual reasoning index. Diffusion tensor imaging was used to assess white matter (WM) microstructure while tract-based spatial statistics (TBSS) analysis was performed to detect and localize WM regional differences in fractional anisotropy (FA), mean diffusivity, axial (AD), and radial diffusivities. Quantitative measurements were performed on 48 regions and 21 fiber-bundles of WM. Results: Hom-HIQ children presented higher FA than Het-HIQ children in widespread WM regions including central structures, and associative intra-hemispheric WM fasciculi. AD was also greater in numerous WM regions of Total-HIQ, Hom-HIQ, and Het-HIQ groups when compared to the Control group. Hom-HIQ and Het-HIQ groups also differed by their hemispheric lateralization in AD differences compared to Controls. Het-HIQ and Hom-HIQ groups showed a lateralization ratio (left/right) of 1.38 and 0.78, respectively. Conclusions: These findings suggest that both inter- and intra-hemispheric WM integrity are enhanced in HIQ children and that neural substrate differs between Hom-HIQ and Het-HIQ. The left hemispheric lateralization of Het-HIQ children is concordant with their higher verbal index while the relative right hemispheric lateralization of Hom-HIQ children is concordant with their global brain processing and adaptation capacities as evidenced by their homogeneous IQ.

International audience; Introduction: Data show the relevance of a comprehensive approach to health promotion to support children in developing health skills. Health-promoting holistic interventional researches are complex. The Alliance for health aims to enact and assess the impact of a comprehensive approach to health promotion at the school and community levels. This is an intersectoral project involving regional education authorities, regional public health agency, local policy makers, researchers, and local health promotion operators.Methods: This project involves 101 French primary schools and 97 associated municipalities in the AURA region randomly selected in an intervention and control groups. From September 2019 to June 2022, the intervention was implemented in the intervention group. Primary school teachers were provided training, support, and resources to develop a health-promoting environment in school according to the Health-Promoting Schools framework. Meanwhile, school deputies and territorial agents involved in extracurricular activities were provided training, support, and resources in the same aim. Intersectoral working sessions were promoted. From September 2022 to June 2023, the intervention is implemented in the control group. Quantitative and qualitative data regarding indicators and processes were collected to evaluate the intervention in both groups before implementation, in spring 2021 and spring 2022. This abstract focuses on implementation outcomes based on semi-structured interviews conducted in Spring 2022.Results: Our sample included 11 district pedagogical advisors, 10 school principals, 9 school deputies, 2 extracurricular agents, 1 person in charge of after-school programs and 1 health promotion project manager. Schools’ perspective. Identified facilitators were constant and available referral, institutional support and dedicated time, aim and issues clear from the beginning, support from the community, multi-school training sessions, contextualized support. Barriers were COVID-pandemic, lack of community support, lack of time. Community perspective. Identified facilitators were health promotion perceived legitimacy, collective motivation, regular and effective working sessions. Barriers were perceived methodological incompetence, administrative burden, lack of time.Conclusions: Collective work dynamics, practices’ exchanges, health promotion professional identity are essential implementation components. Lack of time is perceived as a structural barrier. Communities pointed out perceived legitimacy and competences as corner-stones of their engagement. These interesting outcomes are to be confronted to data collected in the control group in spring 2023.

International audience; Background & objective: Supporting children in developing health skills goes, according to research, through a comprehensive approach to health promotion. The Alliance for health project aims to enact and assess the impact of a comprehensive approach to health promotion at the school and community levels. This intersectoral project involves regional education authorities, regional public health agency, local policy makers, researchers, and local health promotion operators.Methods: This project involved 48 French primary schools and 47 associated municipalities in the AURA region randomly selected. From September 2019 to June 2022, the intervention was implemented. Primary school teachers were provided training, support, and resources to develop a health-promoting environment in school according to the Health-Promoting Schools framework. Meanwhile, school deputies and territorial agents involved in extracurricular activities were provided training, support, and resources in the same aim. Intersectoral working sessions were promoted.To analyze implementation outcomes, semi-structured interviews were conducted in Spring 2022.Results: This qualitative study included 11 district pedagogical advisors, 10 school principals, 9 school deputies, 2 extracurricular agents, 1 person in charge of after-school programs and 1 health promotion project manager. Schools’ perspective. Identified facilitators were a constant and available referral, institutional support and dedicated time, clear aim and issues from the beginning, community support, multi-school training sessions, contextualized support. Barriers were COVID-pandemic, lack of community support, lack of time. Community perspective. Identified facilitators were health promotion perceived legitimacy, collective motivation, regular and effective working sessions. Barriers were perceived methodological incompetence, administrative burden, lack of time.Conclusions: Collective work dynamics, practices’ exchanges, health promotion professional identity are essential implementation components. Lack of time is perceived as a structural barrier. Communities pointed out perceived legitimacy and competences as corner-stones of their engagement.

International audience

International audience; Introduction: Despite various efforts to improve human papillomavirus (HPV) vaccine coverage in France, it has always been lower than in most other high-income countries. The health authorities launched in 2018 the national PrevHPV research programme to (1) co-develop with stakeholders and (2) evaluate the impact of a multicomponent complex intervention aimed at improving HPV vaccine coverage amongst French adolescents.Objective: To describe the development process of the PrevHPV intervention using the GUIDance for rEporting of intervention Development framework as a guide.Methods: To develop the intervention, we used findings from (1) published evidence on effective strategies to improve vaccination uptake and on theoretical frameworks of health behaviour change; (2) primary data on target populations' knowledge, beliefs, attitudes, preferences, behaviours and practices as well as the facilitators and barriers to HPV vaccination collected as part of the PrevHPV Programme and (3) the advice of working groups involving stakeholders in a participatory approach. We paid attention to developing an intervention that would maximise reach, adoption, implementation and maintenance in real-world contexts.Results: We co-developed three components: (1) adolescents' and parents' education and motivation using eHealth tools (web conferences, videos, and a serious video game) and participatory learning at school; (2) general practitioners' e-learning training on HPV using motivational interviewing techniques and provision of a decision aid tool and (3) easier access to vaccination through vaccination days organised on participating middle schools' premises to propose free of charge initiation of the HPV vaccination.Conclusion: We co-developed a multicomponent intervention that addresses a range of barriers and enablers of HPV vaccination. The next step is to build on the results of its evaluation to refine it before scaling it up if proven efficient. If so, it will add to the small number of multicomponent interventions aimed at improving HPV vaccination worldwide.Patient or Public Contribution: The public (adolescents, their parents, school staff and health professionals) participated in the needs assessment using a mixed methods approach. The public was also involved in the components' development process to generate ideas about potential activities/tools, critically revise the successive versions of the tools and provide advice about the intervention practicalities, feasibility and maintenance.

Background We hypothesized that monitoring the volume of activity and overall performance indicators is not sufficient to understand the underlying differences between emergency departments. We aimed to understand the underlying common characteristics of emergency departments and map their typology in order to propose adaptive solutions, that would take into account territorial specificities and manage existing resources. Methods We applied a multifactorial analysis based on input data at three levels; 1) the health care available in the area surrounding the emergency departments, 2) the level of medical technicality of the hospitals and 3) the profile of emergency department visits. Results We included 73 emergency departments in this study, representing 93.6% of the emergency departments in our region and seven groups were retained. The smallest group (n = 5) included both public and private structures with low volumes of activity. These medical structures were associated with the shortest length of stay and one of the lowest hospitalisation rates. The largest group (n = 21) included only public structures in peri-urban areas, which were associated with the highest rate of hospitalization in the region. The surrounding population was representative of the regional population, but the patients were older. Conclusions This approach represents a systemic response to target the organisational needs and constraints, propose appropriate solutions and adjust the financial resources allocated to hospitals. Future policies to improve care delivery may benefit from stratifying solutions and performance objectives depending on these groups.

Background: Capacity building and community-level participation are important to enhance the efficiency and sustainability of health promotion programmes, as well as to promote empowerment and decision-making power. However, stakeholders’ participation in the design and implementation of health promotion projects often involves the provision of information and consultation rather than partnership or citizen control, especially in school settings. Co-creation could be a means to support higher levels of participation, yet its definition remains unclear. A further challenge relates to the methods needed to promote participation. Examining what co-creation represents for health promoters could help in both of these respects. Objectives and goals: This study explored how school health promotion professionals perceived and defined co-creation to gain insight into how to encourage co-creation processes in school-based health promotion. Methods: Qualitative data including documents and illustrations were collected during creative thinking activities undertaken with school health promotion professionals. All data collected were transcribed and analysed using a three-stage screening process. Results: Co-creation is a multi-dimensional construct. Based on our findings, it is a voluntary-based process of bottom-up collaboration informed by values of diversity, mutual trust, openness, autonomy, freedom, respect and shared expertise, responsibility and decision-making. Co-creation can result in out-of-the-box, new or improved tailored health-promoting practices and projects, which address a co-defined need, for the benefit of all members of the group. Conclusion: Co-creation is timely and key in school health promotion practices. Further research is needed into the specific competences needed to promote co-creation, as well as the methods used to evaluate achievements and added value of co-creation at different levels of implementation.

Background Some cancers such as sarcomas (bone and soft tissue sarcomas) and adenoid cystic carcinomas are considered as radioresistant to low linear energy transfer radiation (including photons and protons) and may therefore beneficiate from a carbon ion therapy. Despite encouraging results obtained in phase I/II trials compared to historical data with photons, the spread of carbon ions has been limited mainly because of the absence of randomized medical data. The French health authorities stressed the importance of having randomized data for carbon ion therapy. Methods The ETOILE study is a multicenter prospective randomized phase III trial comparing carbon ion therapy to either advanced photon or proton radiotherapy for inoperable or macroscopically incompletely resected (R2) radioresistant cancers including sarcomas and adenoid cystic carcinomas. In the experimental arm, carbon ion therapy will be performed at the National Center for Oncological Hadrontherapy (CNAO) in Pavia, Italy. In the control arm, photon or proton radiotherapy will be carried out in referent centers in France. The primary endpoint is progression-free survival (PFS). Secondary endpoints are overall survival and local control, toxicity profile, and quality of life. In addition, a prospective health-economic study and a radiobiological analysis will be conducted. To demonstrate an absolute improvement in the 5-year PFS rate of 20% in favor of carbon ion therapy, 250 patients have to be included in the study. Discussion So far, no clinical study of phase III has demonstrated the superiority of carbon ion therapy compared to conventional radiotherapy, including proton therapy, for the treatment of radioresistant tumors. Trial registration ClinicalTrials.gov identifier: NCT02838602. Date of registration: July 20, 2016. The posted information will be updated as needed to reflect protocol amendments and study progress.

Background: the MyPeBS study is an ongoing randomised controlled trial testing whether a risk-stratified breast cancer screening strategy is non-inferior, or eventually superior, to standard age-based screening at reducing incidence of stage 2 or more cancers. This large European Commission-funded initiative aims to include 85,000 women aged 40 to 70 years, without prior breast cancer and not previously identified at high risk in six countries (Belgium, France, Italy, Israel, Spain, UK). A specific work package within MyPeBS examines psychological, socio-economic and ethical aspects of this new screening strategy. It compares women's reported data and outcomes in both trial arms on the following issues: general anxiety, cancer-related worry, understanding of breast cancer screening strategy and information-seeking behaviour, socio-demographic and economic characteristics, quality of life, risk perception, intention to change health-related behaviours, satisfaction with the trial. Methods: at inclusion, 3-months, 1-year and 4-years, each woman participating in MyPeBS is asked to fill online questionnaires. Descriptive statistics, bivariate analyses, subgroup comparisons and analysis of variations over time will be performed with appropriate tests to assess differences between arms. Multivariate regression models will allow modelling of different patient reported data and outcomes such as comprehension of the information provided, general anxiety or cancer worry, and information seeking behaviour. In addition, a qualitative study (48 semi-structured interviews conducted in France and in the UK with women randomised in the risk-stratified arm), will help further understand participants' acceptability and comprehension of the trial, and their experience of risk assessment. Discussion: beyond the scientific and medical objectives of this clinical study, it is critical to acknowledge the consequences of such a paradigm shift for women. Indeed, introducing a risk-based screening relying on individual biological differences also implies addressing non-biological differences (e.g. social status or health literacy) from an ethical perspective, to ensure equal access to healthcare. The results of the present study will facilitate making recommendations on implementation at the end of the trial to accompany any potential change in screening strategy. MyPeBS project is funded by the European Union’s Horizon 2020 research and innovation programme under grant agreement N°755394 and underwent a full external peer review process at this step. MyPeBS has received funding from the PHRC-K research-funding programme (17–154) for the conduct of the study in France. DPF is supported by the NIHR Biomedical Research Centre in Manchester (IS-BRC-1215–20007). FJG is supported by the NIHR Cambridge Biomedical Research Centre (BRC-1215–20014). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. XC is supported by grants from Instituto de Salud Carlos III FEDER (PI19/00007). MyPeBS is supported by the French health insurance systems (CNAM, MSA, MGEN, CPRPSNCF) for the covering of screening exams extra-costs, and by the Malakoff Humanis social protection group through the financing of the equipment of the recruiting centres with digital tablets to inform women about the study.

International audience; Background Stroke represents a major Public Health issue in industrialized countries because of its frequency and severity. In secondary stroke prevention, treatment efficacy is correlated to medication adherence. However, it remains suboptimal in stroke patients. Community pharmacists, in light of their positioning in the care pathway and proximity to patients, can play an essential role in patient support and improving treatment adherence. However, it is currently unknown whether pharmacists are ready to perform this task. Objective Evaluate knowledge, practices and training needs for community pharmacists in therapeutic stroke management to improve long term care for stroke patients. Setting Community pharmacies in the Rhone Alpes region (France). Method We conducted a cross sectional study via a standardized self-assessment questionnaire consisting of 40 questions divided into three parts. The latter was designed by a multidisciplinary team and distributed electronically to community pharmacists of the Rhône-Alpes region (France). Main outcome measure (a) global knowledge score on the pathology, risk factors and clinical care management, (b) description of the support practices for stroke patients, (c) training needs for pharmacists. Results The 104 participants presented a moderate level of knowledge (global score: 12/20 ± 3). Topics best mastered were: pathophysiology, target blood pressure and place of antiplatelets in the therapeutic strategy. Knowledge items that needed improvement were: warning signs correctly identified by 44% of participants, time delay for thrombolysis for which 14% answered correctly, target glycated hemoglobin levels were correct for 41%, and the 3 recommended antihypertensive drug classes were only identified by 5% of participants. Patient education received from pharmacists concerned dosage (89%), treatment adherence (88%), benefits (66%) and administration modalities of medicines (64%), management of risk factors (75% for diet, 73% for physical activity, 70% for smoking and 53% for alcohol). All pharmacists wanted additional training on risk factors and clinical management guidelines. Conclusion Based on this small study, the fragmented knowledge and varied practices promote the need for further training for pharmacists to optimize support of stroke patients. This study promotes the elaboration of training systems adapted to pharmacists' needs. This will help support the development of a targeted pharmaceutical care approach for stroke patients.

International audience

International audience; Recently, neurocognitive studies have shown that food categorization is sensitive to both the properties of the food stimuli (e.g., calorie content) and the individual characteristics of subjects (e.g., BMI, eating disorders) asked to categorize these stimuli. Furthermore, groups of patients with eating disorders (ED) were described as relying more on moral criteria to form food categories than were control subjects. The present studies built on these seminal articles and aimed to determine whether certain food properties might trigger moral categories preferentially in subjects suffering from ED and in the general population. Using a Go/No-Go Association Task, Study 1 focused on the extent to which food categories are laden with moral attributes in ED patients compared to control subjects. Study 2 was a follow-up with a different design (an Implicit Association Test), another food variable (calorie content), and two non-clinical subgroups (orthorexic and healthy control subjects). Results revealed for the first time implicit associations between food variables cueing for energy density and moral attributes in the general population, the population suffering from anorexia nervosa, and subjects suffering from disordered eating such as orthorexia nervosa. These findings suggest that moralization of food is a pervasive phenomenon that can be measured with methods reputed to be less vulnerable to self-presentation or social desirability biases.

International audience; Aims: There are large differences between emergency medical systems, which may account for variability in outcomes. We seek to compare prehospital organizations, response modes, patient characteristics and outcomes after out-of-hospital cardiac arrest, between France and Canada, and discuss the need for the first European-North American prehospital research network on out-of-hospital cardiac arrest.Methods: Preliminary comparative description of data drawn from two nation-wide, population-based, Utstein-style prospectively implemented registries for out-of-hospital cardiac arrest in France and Canada (France: RéAC, Canada: CanROC), covering approximately 80 million people, and soon to be participating in an international research network in 2020.Results: Since creation, 103,722 cases were included in France and approximately 99,317 in Canada. Data used in this work were drawn from 2011 to 2016, and comprised around 33,688 adult, non-traumatic, treated cases in Canada, and 55,358 in France, leading to estimated incidence rates of 75.3/100,000 inhabitants in France and 83/100,000 in Canada. In both countries, out-of-hospital cardiac arrest predominantly occurred in male patients, in their late sixties, at home, of presumed cardiac aetiology. Bystander cardiopulmonary resuscitation was provided in half of the cases. First assessed cardiac rhythm was shockable in 16% (France) vs. 22% (Canada). Professional resuscitation was attempted in 82% (France) and 60% (Canada). Prehospital organizations and response modes differed in the constitution of responding teams (France: physician-led advanced life support, Canada: trained paramedics), in response time intervals (call to first professional responders' arrival at scene 6.5 min (interquartile range IQR [5.2-8.3]) (Canada) vs. 10 min [7-15] (France)), in on-scene interventions, type of referral at hospital (France: systematic bypass of emergency department, tertiary hospital first, Canada: occasional bypass, mainly closest hospital first), and in outcomes (overall survival at hospital discharge in France: 5% vs. Canada: 11%).Conclusion: Despite similarities in some out-of-hospital cardiac arrest Utstein variables, several differences exist between French and Canadian prehospital systems, and ultimately, between outcomes. The creation of the ReACanROC research network will facilitate the conduction of further analyses to better understand predictors of this variability.

Resume Le marquage cellulaire radioisotopique (MCR) des elements figures du sang est une technique couramment impliquee dans la realisation d’examen diagnostique relevant de la medecine nucleaire ; elle n’a jamais ete definie juridiquement. Cette indetermination juridique est un facteur d’insecurite tant pour les patients que pour les professionnels de sante concernes. L’objectif de ce travail etait d’identifier la nature juridique de la cellule radiomarquee en confrontant ses elements constitutifs aux differentes categories juridiques existantes relevant du droit du vivant et du droit des produits de sante. L’etude conclut qu’en l’etat du droit la cellule sanguine radiomarquee appartient sans conteste a la categorie du medicament par fonction ; plus precisement elle est assimilable a un medicament radiopharmaceutique issu d’un processus de preparation. Afin de renforcer la visibilite et donc la prise en compte par les acteurs des contraintes qui en decoulent, il est propose de creer un regime juridique specifique de la cellule radiomarquee en inscrivant a l’article L. 5121-1 du code de la sante publique une nouvelle categorie appelee : preparation radiopharmaceutique d’elements figures du sang a visee diagnostique. La portee de cette disposition placera mecaniquement la preparation des cellules radiomarquees dans le champ de competence exclusif des radiopharmaciens exercant dans une pharmacie a usage interieur ; autre consequence importante : en rentrant dans le champ d’application des bonnes pratiques de pharmacie hospitaliere et des bonnes pratiques de preparation, le processus de radiomarquage des cellules sanguines beneficiera d’un cadre reglementaire protecteur de la securite des patients.

International audience; L'incidence et la mortalité des cancers sont sous l’influence d’une palette de déterminants de la santé, rendant pertinente une approche de prévention orientée vers ces derniers. Cependant, les recherches interventionnelles intégrées portant sur les milieux, notamment l’école et les communes, sont peu nombreuses.L’expérimentation ALLIANCE est une recherche interventionnelle, complexe, multi-partenariale, visant à développer des environnements favorables à la santé autour des enfants scolarisés à l’école primaire. Trois objectifs ont été définis : (1) développer les actions de promotion de la santé portées par les enseignants auprès des élèves, (2) développer un environnement favorable à la santé dans les écoles primaires, (3) développer un environnement favorable à la santé dans les municipalités.Sur le Cantal, l’Isère, la Loire, et le Rhône, 101 écoles et leurs 97 communes ont été sélectionnées aléatoirement dans le groupe intervention et le groupe témoin.L’intervention consiste en trois dispositifs : Formation, Accompagnement, Ressources, déployés depuis septembre 2019 dans le groupe intervention. Le groupe témoin est parallèlement observé et bénéficiera des stratégies d'intervention à partir de septembre 2022.Une évaluation réaliste est en cours et aboutira en 2023. Dans cette optique, des données quantitatives et qualitatives concernant les indicateurs (élèves, enseignants) et les processus (écoles, territoires) sont collectées dans les deux groupes d’écoles et de communes depuis septembre 2019 jusqu’à juin 2022.Les dispositifs d’intervention, Formation, Accompagnement, Ressources, déployés auprès des écoles et des municipalités seront décrits dans le cadre de cette communication ainsi que les processus d’implémentation adoptés pour les déployer.

International audience

(1) Background: The Vaccine Coverage Rate of influenza remains low and omnichannel efforts are required to improve it. The objective was to evaluate the feasibility and outcomes of a QR Code nudging system in outpatient departments. (2) Methods: The study was performed in 6 departments ensuring ambulatory activities in a French university Hospital between November and December 2021. By scanning QR codes, users accessed anonymously to the ELEFIGHT® web app, which provides medical information on influenza and invites them to initiate a discussion about influenza prevention with their physicians during the consultation. (3) Results: 351 people made 529 scans with an average reading time of 1 min and 4 s and a conversion rate of 32%, i.e., people willing to engage in a discussion. (4) Conclusions: The study suggests that direct access to medical information through QR codes in hospitals might help nudge people to raise their awareness and trigger their action on influenza prevention.

The fast spread of COVID-19 is related to the highly infectious nature of SARS-CoV-2. The disease is suggested to be transmitted through saliva droplets and nasal discharge. The saliva quantification of SARS-CoV-2 in real-time PCR from asymptomatic or mild COVID-19 adults has not been fully documented. This study analyzed the relationship between salivary viral load on demographics and clinical characteristics including symptoms, co-morbidities in 160 adults diagnosed as COVID-19 positive patients recruited between September and December 2020 in four French centers. Median initial viral load was 4.12 log10 copies/mL (IQR 2.95–5.16; range 0–10.19 log10 copies/mL). 68.6% of adults had no viral load detected. A median load reduction of 23% was observed between 0–2 days and 3–5 days, and of 11% between 3–5 days and 6–9 days for the delay from onset of symptoms to saliva sampling. No significant median difference between no-symptoms vs. symptoms patients was observed. Charge was consistently similar for the majority of the clinical symptoms excepted for headache with a median load value of 3.78 log10 copies/mL [1.95–4.58] (P < 0.003). SARS-CoV-2 RNA viral load was associated with headache and gastro-intestinal symptoms. The study found no statistically significant difference in viral loads between age groups, sex, or presence de co-morbidity. Our data suggest that oral cavity is an important site for SARS-CoV-2 infection and implicate saliva as a potential route of SARS-CoV-2 transmission.

Article first published online: 15 November 2021, Purpose: The aim was to identify the competencies professionals need to promote co-creation engagement within communities. Design/methodology/approach: Co-creation could contribute to building community capacity to promote health. Professional development is key to support co-creative practices. Participants were professionals in a position to promote co-creation processes in health-promoting welfare settings across Denmark, Portugal, France and United Kingdom. An overarching unstructured topic guide was used within interviews, focus groups, questionnaires and creative activities. Findings: The need to develop competencies to promote co-creation was high across all countries. Creating a common understanding of co-creation and the processes involved to increase inclusivity, engagement and shared understanding was also necessary. Competencies included: How to run co-creation from the beginning of the process right through to evaluation, using feedback and communication throughout using an open action-oriented approach; initiating a perspective change and committing to the transformation of co-creation into a real-life process. Practical implications: Overall, learning about underlying principles, process initiation, implementation and facilitation of co-creation were areas identified to be included within a co-creation training programme. This can be applied through the framework of enabling change, advocating for co-creative processes, mediating through partnership, communication, leadership, assessment, planning, implementation, evaluation and research, ethical values and knowledge of co-creative processes. Originality/value: This study provides novel findings on the competencies needed for health promoting professionals to embed co-creative processes within their practice, and the key concerns that professionals with a position to mediate co-creation have in transferring the abstract term of co-creation into a real-world practice., This work was financially supported by Portuguese national funds through the FCT (Foundation for Science and Technology) within the framework of the CIEC (Research Center for Child Studies, University of Minho) projects under the references UIDB/00317/2020 and UIDP/00317/2020.

S U M M A R Y Background The European Society of Clinical Nutrition and Metabolism (ESPEN) has developed a consensus definition of malnutrition. This study aimed to determine the prevalence of malnutrition according to the ESPEN definition in otherwise healthy community-dwelling older women and to explore its value for predicting long-term mortality in this population. Methods This prospective population-based cohort study included 181 women (age ≥75 years) from a subsample of the EPIDemiologie de l'OSteoporose (EPIDOS) study participants from Toulouse. Inclusion criteria were the availability of the data on variables required to apply the ESPEN definition and survival after 7 years of follow-up. Primary outcome was mortality at 12-year follow-up; main covariates were malnutrition assessment according to the ESPEN consensus and its components (unintentional weight loss, BMI, and FFMI). Body composition was assessed by dual-energy X-ray absorptiometry at baseline and at 7-year follow-up. Kaplan-Meier survival curves and adjusted Cox regressions were performed. Analysis was adjusted for age, hypertension, diabetes mellitus, and coronary heart disease as potential confounders. Results Complete data were available for 179 of the 181 women in the EPIDOS-Toulouse cohort (83.1 ± 2.2 years) and 13 (7.3%) fulfilled the ESPEN definition for malnutrition at 7-year follow-up. Malnutrition was associated with increased risk of mortality (adjusted HR = 4.4 [95%CI: 1.7–11.3]). Among the ESPEN components, only BMI was associated with increased mortality (adjusted HR=0.6 [95%CI: 0.4–0.9]). Conclusions Although malnutrition prevalence according to the ESPEN definition was relatively low (7.3%) in this sample of otherwise healthy community-dwelling older French women, malnutrition was associated with 4.4-fold higher mortality risk at 12-year follow-up.

Simple Summary Apical periodontitis often manifests as a chronic and asymptomatic disease. The formation of chronic apical periodontitis lesion (CAPL) occurs due an imbalance between microorganisms in a root canal system and a host’s immune response. The pro-inflammatory characteristic of periapical granulomas has been established; increased IL-1β, IL-6 and TNF-α has been documented. In humans over 65 years of age, the immune system becomes more fragile, including a persistent inflammatory response, making them more susceptible to reactivation of latent viruses, bacterial and viral pathogens, autoimmune diseases, opportunistic infections and neoplasms. The question of this study is as follows: in aging adults, do chronic apical periodontitis lesions as biomarkers have a risk effect on the immunoexpression of pro-inflammatory cytokines (IL-1β, IL-6 and TNF-α) compared to adults? The results demonstrated that the pro-inflammatory cytokines IL-1β, IL-6 and TNFα showed higher expression in the CAPL of the elderly than in the adult control group, thus suggesting that aging could be considered a modifier of periradicular disease. However, although aging is not the main cause for the development of CAPL, it seems to be able to influence its evolution. However, further elaborate research studies/analyses to elucidate the reasons and consequences of inflammation in the elderly are recommended. Abstract Persistent inflammatory responses in the elderly may act as modifiers on the progression and repair of chronic apical periodontitis lesions (CAPLs). While the involvement of IL-1β, IL-6 and TNF-α in inflammatory responses and, particularly, in CAPL has been documented, their expression in elderly patients needs to be further characterized. Therefore, the purpose of this study was to evaluate and compare the expressions of pro-inflammatory cytokines in CAPL from elderly individuals with young/middle-aged individuals. Thirty CAPL (15 cysts and 15 granulomas) from elderly patients (>60 years) and 30 CAPL (15 cysts and 15 granuloma) from young/middle-aged individuals (20–56 years) were selected. Immunohistochemical reactions were performed against IL-1β, IL-6 and TNF-α. The slides were subdivided into five high-magnification fields and analyzed. The number of positive stains was evaluated for each antibody. There was no significant difference between the cytokines when the cysts and granuloma were compared in the two groups. In the young/middle-aged, only IL-1β showed a difference and was significantly higher in granulomas (p = 0.019). CAPL pro-inflammatory cytokine levels in the elderly were significantly higher than in young/middle-aged individuals (p < 0.05). The pro-inflammatory cytokines IL-1β, IL-6 and TNF-α were significantly higher in CAPL in the elderly compared with the young/middle-aged group. Further elaborate research studies/analyses to elucidate the reasons for and consequences of inflammation in the elderly are recommended.

International audience; Neglecting oral hygiene in adolescents negatively affects dental caries and periodontal diseases, in addition to social and emotional well-being. Thus, the TikTok platform (ByteDance, Beijing, China)as a social media could be a powerful channel to provide health-related information and educational content. This study aims to assess the quality of the TikTok videos corresponding to #oralhealtheducation. Sixty-nine videos were identified. Three oral health professionals (OHP), three health education professionals (HEP), and ten of TikTok’s target audience watched and evaluated the videos from a qualitative questionnaire. OHP detected false or incorrect information in 11.6% (8/69) of the videos. At least two HEPs reported being unable to detect this type of content or whether the video met dental ethics standards in both the videos. Disagreement was observed among the professionals themselves. The evaluation indicated that TikTok’s target audience was satisfied with the products viewed with an average score of >2.5, unlike the professionals, whose average score was

Background Surgical treatment of osteochondral lesions of the talus (OLT) is warranted if medical treatments fail, achieving good results in around 85% of cases. Numerous classification systems, based on all possible imaging modalities (radiography, MRI, CT scan, scintigraphy, and CT arthrography), have been proposed to guide surgical treatments, but none has proven to be superior. A recent study demonstrated the prognostic value of CT arthrography by accurately describing the subchondral bone plate. A systematic review of the literature has brought new criteria to predict good outcome following bone marrow stimulation surgical techniques: lesions should measure less than 1 centimeter in size and 5 millimeters in depth. Based on these data, we are proposing a new simple, 3-stage CT arthrographic classification system of OLT. Materials and methods After a brief overview of the classification, 60 CT-arthrographies of ankles with OLT were organized according to this new CT arthrographic classification system by four surgeons (two juniors and two seniors). Two imaging assessments were performed one month apart. Statistical analysis was performed using the Fleiss’ kappa coefficient to determine the inter- and intraobserver agreement. Results An excellent inter- and intraobserver agreement was found with overall Fleiss’ kappa coefficients of 0.897 and 0.847, respectively. Conclusion The results of our study showed an excellent inter- and intraobserver agreement for this new CT arthrographic classification system of OLT. The principal advantage of this new classification system, based on the latest data in the literature, is its ability to easily distinguish lesions that are more amenable to bone marrow stimulation techniques. Level of evidence II.

International audience; Objectives: To determine if commercially available mouthwash with b-cyclodextrin and citrox (bio- flavonoids) (CDCM) could decrease the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) salivary viral load.Methods: In this randomized controlled trial, severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) PCR-positive patients aged 18e85 years with asymptomatic to mild coronavirus disease 2019 (COVID-19) symptoms for

Background Colorectal cancer (CRC) is a leading cause of cancer burden worldwide. In France, it is the second most common cause of cancer death after lung cancer. Systematic uptake of CRC screening can improve survival rates. However, people with limited health literacy (HL) and lower socioeconomic position rarely participate. Our aim is to assess the impact of an intervention combining HL and CRC screening training for general practitioners (GPs) with a pictorial brochure and video targeting eligible patients, to increase CRC screening and other secondary outcomes, after 1 year, in several underserved geographic areas in France. Methods We will use a two-arm multicentric randomized controlled cluster trial with 32 GPs primarily serving underserved populations across four regions in France with 1024 patients recruited. GPs practicing in underserved areas (identified using the European Deprivation Index) will be block-randomized to: 1) a combined intervention (HL and CRC training + brochure and video for eligible patients), or 2) usual care. Patients will be included if they are between 50 and 74 years old, eligible for CRC screening, and present to recruited GPs. The primary outcome is CRC screening uptake after 1 year. Secondary outcomes include increasing knowledge and patient activation. After trial recruitment, we will conduct semi-structured interviews with up to 24 GPs (up to 8 in each region) and up to 48 patients (6 to 12 per region) based on data saturation. We will explore strategies that promote the intervention’s sustained use and rapid implementation using Normalization Process Theory. We will follow a community-based participatory research approach throughout the trial. For the analyses, we will adopt a regression framework for all quantitative data. We will also use exploratory mediation analyses. We will analyze all qualitative data using a framework analysis guided by Normalization Process Theory. Discussion Limited HL and its impact on the general population is a growing public health and policy challenge worldwide. It has received limited attention in France. A combined HL intervention could reduce disparities in CRC screening, increase screening rates among the most vulnerable populations, and increase knowledge and activation (beneficial in the context of repeated screening). Trial registration Registry: ClinicalTrials.gov. Trial registration number: 2020-A01687-32. Date of registration: 17th November 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11565-3.

International audience; Pre-eclampsia (PE), a pregnancy-specific hypertensive disorder, characterized by the development of placental endothelial dysfunction, remains a major source of maternal and perinatal morbidity and mortality, especially in low- and middle-income settings. Periodontal disorders duringpregnancy, and particularly periodontal pathogens, may be related to the risk of PE. Standard oral hygiene methods, based mainly on the joint use of toothbrushes and interdental brushes, reduce periodontal inflammatory risk and modulate the dysbiosis of the oral microbiome. The aim of this trial is to compare the PE outcomes in high-risk pregnant women receiving oral prophylactic measures to a control group. This trial is designed as a two-arm, parallel, cluster randomized controlled trial with the antenatal obstetric clinic as the unit of randomization and an allocation ratio of 1:1. Thepregnant women will be included at 3 months of pregnancy and will be followed throughout the pregnancy. The primary outcome measure will be the incidence of PE from a baseline during the pregnancy. Secondary outcomes measures will include changes from the baseline in quantificationof the pathogenic bacterial load of the interdental microbiota, the severity scores of periodontal indicators, and the incidence of adverse perinatal outcomes. This trial should demonstrate that the implementation of daily oral hygiene reduces oral dysbiosis, the incidence of periodontal disease,and the risk of PE.

Background In the recent decades, the number of apps promoting health behaviors and health-related strategies and interventions has increased alongside the number of smartphone users. Nevertheless, the validity process for measuring and reporting app quality remains unsatisfactory for health professionals and end users and represents a public health concern. The Mobile Application Rating Scale (MARS) is a tool validated and widely used in the scientific literature to evaluate and compare mHealth app functionalities. However, MARS is not adapted to the French culture nor to the language. Objective This study aims to translate, adapt, and validate the equivalent French version of MARS (ie, MARS-F). Methods The original MARS was first translated to French by two independent bilingual scientists, and their common version was blind back-translated twice by two native English speakers, culminating in a final well-established MARS-F. Its comprehensibility was then evaluated by 6 individuals (3 researchers and 3 nonacademics), and the final MARS-F version was created. Two bilingual raters independently completed the evaluation of 63 apps using MARS and MARS-F. Interrater reliability was assessed using intraclass correlation coefficients. In addition, internal consistency and validity of both scales were assessed. Mokken scale analysis was used to investigate the scalability of both MARS and MARS-F. Results MARS-F had a good alignment with the original MARS, with properties comparable between the two scales. The correlation coefficients (r) between the corresponding dimensions of MARS and MARS-F ranged from 0.97 to 0.99. The internal consistencies of the MARS-F dimensions engagement (ω=0.79), functionality (ω=0.79), esthetics (ω=0.78), and information quality (ω=0.61) were acceptable and that for the overall MARS score (ω=0.86) was good. Mokken scale analysis revealed a strong scalability for MARS (Loevinger H=0.37) and a good scalability for MARS-F (H=0.35). Conclusions MARS-F is a valid tool, and it would serve as a crucial aid for researchers, health care professionals, public health authorities, and interested third parties, to assess the quality of mHealth apps in French-speaking countries.

Medication, antibiotics, and immunization are three major and cost-effective medical interventions but their use is balanced. Knowledge, attitudes and practices (KAP) are a cornerstone. This retrospective study aims at analyzing KAP related to these concerns among the public service population in order to establish the basis for the implementation of selective preventive actions. From a cross-sectional anonymous online questionnaire-based survey among the insurees of a French mutual organization (Union Prévention Santé pour la Fonction publique, UROPS), 33 questions related to medication, antibiotics and vaccination were extracted to evaluate KAP. New variables were constituted: levels of knowledge, antibiotic misuse, proactive behavior and vaccinophobia. Multiple correspondence analysis was performed to identify respondents’ homogenous groups. In addition, bivariate statistical comparisons were provided and logistic regressions were carried out to identify determinants of these new variables. Public service population (workers and retired) were highly exposed to polymedication (8.7% vs. 24.4%, p < 0.0001), hypnotics overtake (24.3% vs. 18.4%, p < 0.0001), and misuse antibiotics (33.2% vs. 22.6%, p < 0.0001) despite good levels of knowledge. Proportions of vaccinophobia was low (0.8% vs. 1.7%, p < 0.0001). However, workers have different KAP than retired, without shared determinants in the 3 health domains studied. Respondents were proactive (85.8% vs. 81.6%, p < 0.0001), used multiple sources of trustworthy information and seems to be ready for the delegation of health tasks. Thus, preventive actions related to antibiotics and polymedication should be a priority in vaccination education for mutual organizations such as UROPS. Studying their insurees longitudinally could be interesting to highlight the impact of selective prevention on behaviors, through trusted health professionals (general practitioners, pharmacists…).

International audience; Polypharmacy is becoming increasingly common, especially among the elderly. It often has a negative connotation, but is sometimes necessary or even desirable, and needed to categorize polypharmacy as appropriate or inappropriate. The challenge is in ensuring that this is considered appropriate when necessary. We aimed to develop an evidence-based intervention to reduce the risks associated with using a systematic approach, involving key stakeholders in prescribing and dispensing drugs to the elderly in primary care. The purpose of this study is to identify the key components which are perceived as influencing these behaviours. It is a qualitative study of general practitioners (GPS) and community pharmacists involved in the care of the elderly. The main inclusion criterion is the geographic location. Qualitative data will be generated from one-on-one, semi-structured interviews and processed for thematic content analysis. Our approach integrates the patient pathway in primary care. It considers the fact that GP and pharmacist behaviours are far from being independent. This study represents the first step in the process of developing an intervention theory which involves a crossover between data from the literature and the knowledge of experts, allowing us to interrogate hypotheses about the influences and mechanisms associated with prescribing and dispensing drugs to the elderly in primary care.

International audience; Background: Pre-eclampsia, the second most frequent direct source of maternal mortality, is a multisystem gestational disorder characterized by proteinuria and maternal hypertension after the 20th gestational week. Although the causes of pre-eclampsia are still discussed, research has suggested that the placenta has a central place in the pathogenesis of this disease. Moreover, current surveys indicated that periodontal disorders observed during the pregnancy and more particularly, periodontal pathogens could be link to the risk of pre-eclampsia.Objectives: This article aims to review recent studies focusing on periodontal conditions and pathogens associated with pre-eclampsia. Methods: The process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines.Results: Metabolic conditions, immunological changes, fluctuating progesterone and estrogen levels of the pregnant woman induce a dysbiosis of the oral microbiota and contribute to increase inflammation of periodontal tissues. Periodontal pathogens could diffuse through the bloodstream inducing a placenta inflammatory response as well as inflammatory molecules produced in response to periodontopathogens could migrate through the bloodstream leading to a placenta inflammatory response. Also, periodontopathogens can colonize the vaginal microbiota through the gastrointestinal tract or during oro-genital contacts.Conclusion: A cumulative bi-directional relationship between periodontal conditions, pathogens and the pre-eclampsia exists.

International audience; France and Canada prehospital systems and care delivery in out-of-hospital cardiac arrests (OHCAs) show substantial differences. This article aims to describe the rationale, design, implementation and expected research implications of the international, population-based, France-Canada registry for OHCAs, namely ReACanROC, which is built from the merging of two nation-wide, population-based, Utstein-style prospectively implemented registries for OHCAs attended to by emergency medical services. Under the supervision of an international steering committee and research network, the ReACanROC dataset will be used to run in-depth analyses on the differences in organisational, practical and geographic predictors of survival after OHCA between France and Canada. ReACanROC is the first Europe-North America registry ever created to meet this goal. To date, it covers close to 80 million people over the two countries, and includes approximately 200 000 cases over a 10-year period.

Objective The aim of this study was to demonstrate that including a teledentistry consultation in the standard care provided to patients in an eating disorder day hospital could be beneficial, notably for screening for particular pathologies and preventing dental erosion. Methods We included 50 patients from the eating disorders unit of the University Hospital of Montpellier, all of whom underwent a dental examination using asynchronous telemedicine. We recorded the data using teledentistry software for the medical file and an intraoral camera for the clinical videos. Remote diagnosis was performed using the Basic Erosive Wear Examination index. In addition, the participants completed a questionnaire to assess their risk factors for dental pathologies. Results We found dental erosion in 92% of the patients, and 50% had at least one tooth with BEWE 2 or 3 type erosion. Conclusions Despite the fact that there can be wide variety within a group of individuals with similar risk factors, dental telemedicine could promote awareness within this at-risk population, as well as provide personalised prevention advice to each patient. Above all, it would make it possible to treat these patients' lesions at the earliest possible moment, thereby improving their outcomes.

International audience; The aim of this study was to determine whether self-collected pure saliva (SCPS) is comparable to nasopharyngeal (NP) swabs in the quantitative detection of SARS-CoV-2 by RT-PCR in asymptomatic, mild patients with confirmed COVID-19. Thirty-one patients aged from 18 to 85 years were included between 9 June and 11 December 2020. A SCPS sample and a NP sample were taken for each patient. Quantitative PCR was performed to detect SARS-CoV-2 viral load. Results of SCPS vs NP samples testing were compared. Statistical analyses were performed. Viral load was significantly correlated (r = 0.72). The concordance probability was estimated at 73.3%. In symptomatic adults, SCPS performance was similar to that of NP swabs (Percent Agreement = 74.1%; p = 0.11). Thus, the salivary test based on pure oral saliva samples easily obtained by noninvasive techniques has a fair agreement with the nasopharyngeal one in asymptomatic, mild patients with a confirmed diagnosis of COVID-19.

Resume Les offres d’applications mobiles et d’objets connectes se multiplient sur internet, dans les magasins de vente de materiel medical mais aussi dans le reseau de la grande distribution. Ces produits de sante ou de bien-etre n’ont cependant pas tous, un statut juridique bien determine, garant de la securite des utilisateurs, patients ou professionnels de sante. Les objets connectes, sources d’innovation et d’espoir, peuvent devenir des compagnons indispensables pour les patients ou les professionnels de sante ; mal utilises, ils peuvent neanmoins etre a l’origine de dommages corporels.

Objective A large number of digital tools supporting students have emerged over recent years which are encouraged in tutoring. A study conducted at the University of Montpellier (France) among 3rd, 4th, and 5th year dentistry students aimed primarily to identify the type of pedagogical support the students preferred according to their discipline. The secondary aim was to evaluate the student satisfaction after establishing a new pedagogical support. Materials and Methods A total of 165 questionnaires were completed. The main questions concerned pedagogical use of information technology and multimedia tools, choice of dentistry disciplines most justifying their use, and pedagogical gaps in these disciplines. Next, a program of pedagogical videos was developed for the most corresponding discipline. A satisfaction survey was finally conducted. Results Nearly 95.7% of students found online classes and E-learning via the virtual learning environment useful, with the most requested type being video. Demand was stronger in conservative dentistry and endodontics (27%), prosthetics (19%), and periodontology (18%). The most apprehended disciplines were endodontics in the 3rd year, endodontics and prosthetics in the 4th year, and prosthetics in the 5th year. Regarding satisfaction, 100% of students appreciated these videos and 99.4% considered they fulfilled expectations. Conclusion All students requested videos, especially for clinical subjects such as endodontics. With digital technology, our world is experiencing a technological revolution resulting in many daily life changes. With students evolving in a digitally saturated society, our ways of learning and teaching need rethinking. Digital technology can help improve learning effectiveness and develop pedagogical practices more adapted to today's students.

Resume Introduction La polyarthrite rhumatoide presente un faible niveau d’adhesion medicamenteuse. A l’etranger, le pharmacien de ville a un impact positif sur l’adhesion des patients dans plusieurs pathologies chroniques. En France, les missions des pharmaciens d’officine se developpent avec la mise en place d’entretiens pharmaceutiques. Objectif Evaluer les perceptions des pharmaciens de ville sur l’interet et la faisabilite d’entretiens pharmaceutiques dans la polyarthrite rhumatoide. Methode Des entretiens semi-diriges ont ete realises entre aout et octobre 2017, aupres de pharmaciens de ville de la region Auvergne-Rhone-Alpes. L’analyse inductive du verbatim des entretiens a ete effectuee par deux personnes independantes. Resultats Les 15 entretiens ont souligne des difficultes de recrutement des patients pour les entretiens actuellement possibles a l’officine, la complexite de l’organisation et des modalites de financement, une faiblesse du lien ville-hopital. Neanmoins les pharmaciens etaient motives pour elargir le dispositif a d’autres pathologies. Concernant des entretiens dans la polyarthrite rhumatoide, les pharmaciens les verraient sous forme d’entretiens structures, preferentiellement a l’officine, en lien, voire « prescrits » par les medecins pour une pluriprofessionnalite et un partage d’information optimaux. Une formation prealable ainsi qu’un financement de ces entretiens devront etre envisages pour motiver les pharmaciens a cette activite. Conclusion Cette etude a permis d’aborder avec les pharmaciens de ville leurs attentes et besoins pour elargir le dispositif d’entretiens pharmaceutiques dans la polyarthrite rhumatoide. Ces resultats devront etre pris en compte pour construire un modele d’entretiens d’accompagnement des patients dans la polyarthrite rhumatoide qui puisse s’integrer dans l’exercice officinal.

International audience; In France, around 25% of the estimated number of people living with HIV are migrants, of whom three quarters are from sub-Saharan Africa (SSA). Our objective was to determine factors associated with virological rebound (VR) at the occasion of a transient stay to the country of origin. HIV-positive migrants from SSA participating to the ANRS-VIHVO adherence study between 2006 and 2009, on effective ART with controlled pre-travel HIV-1 plasma viral load (VL), were included. Outcome was VR, defined as VL ≥ 50 copies/ml at the post-travel visit during the week following the return to France. Among 237 persons (61.6% female, median age 41 years (IQR, 35–47), median time on ART 4.2 years (IQR, 2.2–7.1), 27 (11.4%) experienced VR. The main purpose of the travel was to visit family and median time spent abroad was 5.3 weeks (IQR, 4.1–8.8). The travel was extended longer than anticipated by at least 1 week in 42 individuals (17.7%). In multivariable logistic model, risk factors for VR were male sex [adjusted OR (aOR) 5.1; 95% CI 1.6–16.2)], no employment in France (aOR 2.0; 1.2–3.5), self-reported non-adherence during the trip (aOR 14.9; 4.9–45.9) and PI-containing regimen (aOR 4.6; 1.2–17.6). In another analysis not including self-reported adherence, traveling during Ramadan while respecting the fast (aOR 3.3; 1.2–9.6) and extension of the stay (aOR 3.0; 1.1–7.8) were associated with VR. Virological rebound was partly explained by structural barriers to adherence such as extension of the travel and inadequate management of Ramadan fasting. Individuals’ journeys should be carefully planned with health care providers.

Mobile health apps can contribute to increased quality of individual oral hygiene behaviors. This study provides an overview and an evaluation of quality of oral-hygiene-related mobile apps currently available in Google Play Store and the French Apple App. A shortlist of nine apps was assessed by 10 oral health professionals using the Mobile App Rating Scale. Intraclass correlation was used to evaluate interrater agreement. Best quality scores were obtained by Oral-B (3.4 ± 0.97), Colgate Connect (3.20 ± 0.63), and Preventeeth (3.10 ± 1.1) and worst ones by Mimizaur se brosse les dents (1.80 ± 0.79) and Kolibree (2.30 ± 0.82). The subjective quality scores ranged from 2.62 ± 0.61 (Oral-B) to 1.5 ± 0.61 (MSD). Specificity of the content ranged from 3.46 ± 0.84 (Preventeeth) to 1.78 ± 0.47 (Mimizaur se brosse les dents). Thus, even if oral health professionals positively evaluated the quality of oral-hygiene-related mobile apps, they are less assertive concerning their impact on the user’s knowledge, attitudes, and intentions to change, as well as the likelihood of actual change in the oral hygiene behavior. Further investigations are needed to assess whether information from these apps is consistent with oral hygiene recommendations and to determine the long-term impacts of these apps.

International audience

International audience; Background: Adults with cardiovascular diseases were disproportionately associated with a significantly increased risk of a severe form of COVID-19 and all-cause mortality.Objective: The aim of this study was to report the associated symptoms for COVID-19 cases, to estimate the proportion of contacts and to describe the clinical signs and behaviors among individuals with/without myocardial infarction history among cases and contacts.Methods: A two-week cross-sectional telephone survey was conducted during the first lock-down period in France, from 2020 May 4th to 15th. A total of 668 households participated representing 703 individuals with pre-existing cardiovascular disease in the past two years and 849 individuals without myocardial infarction history.Results: High rates of compliance with health measures were self-reported, regardless of age or risk factors. Four confirmed COVID-19 cases were registered from four different households. Based on deductive assumptions, 9.73% were identified as contacts of whom 71.52% were asymptomatic. Among individuals with myocardial infarction history, two were COVID-19 cases, and the estimated proportion of contacts was 8.68% of whom 68.85% were asymptomatic. The cases and contacts presented different symptoms, with more respiratory signs.Conclusions: The telephone survey could be a relevant tool for reporting the number of contacts on a limited period and territory, based on the presence of associated symptoms and COVID-19 cases in the households. This study advanced our knowledge to better prepare for future crises.

Forensic dentistry is the branch of forensic science concerned with the study of teeth and jaws. To facilitate the work of experts, new comparative identification tools are emerging, with digital techniques such as the intra-oral camera, which are revolutionising current techniques in forensic dentistry. Objective The aim of this study is to evaluate the diagnostic quality of the post-mortem odontogram carried out remotely via a video of the oral cavity using an intra-oral camera. The gold standard is the post-mortem odontogram obtained via the standard identification technique during the clinical examination. Materials and methods 25 deceased patients were included in the study and the data were collected in the Forensic Medicine and Thanatology Department at the University Hospital of Montpellier. The protocol was divided into three stages: the gold standard consultation, the recording of videos with the Soprocare® camera, and the remote analysis of the images obtained. The gold standard consultation and the remote analysis were carried out by two separate dental surgeons responsible for completing a clinical file, used to establish the odontogram of the deceased patient. Results The study was carried out on 25 deceased subjects, between 13 May and 12 June 2019. Our sample was composed of 68% men and 32% women. A sensitivity threshold of 0.97 was observed for the performance of the odontogram, i.e., for all the teeth actually present in the mouth for all subjects in the study, 97% of them were identified with the videos taken using the intraoral camera. The examination with the intra-oral camera demonstrated a good diagnostic performance in the detection of missing teeth with a PPV of 97.9% and a NPV of 98.2%. Practitioner became more skilled at recording the videos with the intra-oral camera. One can therefore note an ease in the handling of this digital tool, which gradually improved with the number of subjects included in the study Conclusions The Soprocare® intraoral camera has an acceptable diagnostic validity in establishing the odontogram of the deceased. It enables fundamental elements to be detected with optimal efficiency. However, several points still need to be improved, in order to make the use of the camera during data collection as easy and efficient as possible.

International audience; Introduction: Fetal growth restricted fetuses are less likely to receive evidence-based care; a previous work demonstrated an improvement in neonatal prognosis when fetuses with intrauterine growth restriction (IUGR) received minimum evidence based-care.Objective: The objective of the study was to evaluate the impact of a standardized healthcare pathway on the implementation of the recommended clinical practice in the antenatal management of IUGR fetuses, in comparison to a traditional pathway. The quality of the implementation of practice has been defined whether or not minimum evidence-based care (MEC), defined according to the recommendations of the French college of gynecologists and obstetricians (CNGOF), has been implemented.Study design: From a historical cohort of 31,052 children, born at the Femme Mère Enfant Hospital (Lyon, France) between January 1st, 2011 and December 31st, 2017, we selected the population of IUGR fetuses. We compared the rate of MEC between the IUGR fetuses followed-up in the traditional healthcare pathway versus the IUGR fetuses followed-up in a standardized healthcare pathway between 2015 and 2017.Results: A total of 245 IUGR were tracked between 2015 and 2017. Over this period, 120 fetuses were followed within the traditional pathway and 125 within the IUGR pathway. The standardized pathway resulted in a higher rate of MEC (86,4%) when compared to IUGR fetuses followed-up in the traditional pathway (27,5% (OR* 20 (95 % CI 10.0-39.7). Among early-onset IUGR: 31 % received MEC in the traditional pathway versus 83 % in the standardized pathway (p

International audience; Background: Digital communication technologies are playing an important role in the health communication strategies of governments and public health authorities during the COVID-19 pandemic. The internet and social media have become important sources of health-related information on COVID-19 and on protective behaviors. In addition, the COVID-19 infodemic is spreading faster than the coronavirus itself, which interferes with governmental health-related communication efforts. This jeopardizes national public health containment strategies. Therefore, digital health literacy is a key competence to navigate web-based COVID-19-related information and service environments. Objective: This study aimed to investigate university students' digital health literacy and web-based information-seeking behaviors during the early stages of the COVID-19 pandemic in Germany.Methods: A cross-sectional study among 14,916 university students aged ≥18 years from 130 universities across all 16 federal states of Germany was conducted using a web-based survey. Along with sociodemographic characteristics (sex, age, subjective social status), the measures included five subscales from the Digital Health Literacy Instrument (DHLI), which was adapted to the specific context of the COVID-19 pandemic. Web-based information-seeking behavior was investigated by examining the web-based sources used by university students and the topics that the students searched for in connection with COVID-19. Data were analyzed using univariate and bivariate analyses.Results: Across digital health literacy dimensions, the greatest difficulties could be found for assessing the reliability of health-related information (5964/14,103, 42.3%) and the ability to determine whether the information was written with a commercial interest (5489/14,097, 38.9%). Moreover, the respondents indicated that they most frequently have problems finding the information they are looking for (4282/14,098, 30.4%). When stratified according to sociodemographic characteristics, significant differences were found, with female university students reporting a lower DHLI for the dimensions of "information searching" and "evaluating reliability." Search engines, news portals, and websites of public bodies were most often used by the respondents as sources to search for information on COVID-19 and related issues. Female students were found to use social media and health portals more

Ocrelizumab is the first approved drug for primary progressive multiple sclerosis. Following appraisal by health technology assessment (HTA) bodies, this medicine has not been widely covered across European countries. We have compared the HTA process in England and France.We undertook an analysis of relevant documents that were published by the two HTA bodies. We analyzed patients' availability of Ocrelizumab at the different stages of the process.We identified differences in the assessment, one being the use of a different population of the pivotal trial, which has resulted in the consideration of distinct clinical effectiveness estimates. Ocrelizumab became available earlier in France as part of an early access program. However, rapid access was discontinued for newly eligible patients following an opinion concluding that Ocrelizumab yielded no additional benefit over placebo. This opinion was not compatible with the criteria allowing reimbursement in France.In England, there was no early access program and following an appraisal that included cost-effectiveness evaluation combined with pricing agreements, medicine was finally recommended. In conclusion, differences in the HTA process may result in appreciable differences in timing and outcome from marketing authorization to the adoption of newly licensed drugs.

Nutrition is recognized as an essential component in the prevention of a number of chronic diseases, including periodontal disease. Based on these considerations, a better understanding is required regarding how the diet, and more particularly the intake of macronutrients and micronutrients, could impact the potential relationship between nutrition and periodontal diseases, periodontal diseases and chronic diseases, nutrition and chronic diseases. To overcome this complexity, an up-to-date literature review on the nutriments related to periodontal and chronic diseases was performed. High-sugar, high-saturated fat, low-polyols, low-fiber and low-polyunsaturated-fat intake causes an increased risk of periodontal diseases. This pattern of nutrients is classically found in the Western diet, which is considered as an &lsquo, unhealthy&rsquo, diet that causes cardiovascular diseases, diabetes and cancers. Conversely, low-sugar, high-fiber and high-omega-6-to-omega-3 fatty acid ratio intake reduces the risk of periodontal diseases. The Mediterranean, DASH, vegetarian and Okinawa diets that correspond to these nutritional intakes are considered as &lsquo, healthy&rsquo, diets, reducing this risk of cardiovascular diseases, diabetes and cancers. The role of micronutrients, such as vitamin D, E, K and magnesium, remains unclear, while others, such as vitamin A, B, C, calcium, zinc and polyphenols have been shown to prevent PDs. Some evidence suggests that probiotics and prebiotics could promote periodontal health. Periodontal and chronic diseases share, with a time delay, nutrition as a risk factor. Thus, any change in periodontal health should be considered as a warning signal to control the dietary quality of patients and thus reduce the risk of developing chronic diseases later on.

International audience; In this paper, we tackle the problem of quantifying the closeness of a newly observed curve to a given sample of random functions, supposed to have been sampled from the same distribution. We define a probabilistic criterion for such a purpose, based on the marginal density functions of an underlying random process. For practical applications, a class of estimators based on the aggregation of multivariate density estimators is introduced and proved to be consistent. We illustrate the effectiveness of our estimators, as well as the practical usefulness of the proposed criterion, by applying our method to a dataset of real aircraft trajectories.

Karen Beny,1,2 Benjamin du Sartz de Vigneulles,1 Valerie Chamouard,3,4 Ronald Guilloux,5 Valérie Gay,6 Claude Negrier,3 Claude Dussart1,2 1EA 4129 Laboratory P2S (Health Systemic Process), University of Lyon, University Claude Bernard Lyon 1, Lyon, France; 2Central Pharmacy, Hospices Civils de Lyon, Lyon, France; 3Reference center on hemophilia and other constitutional hemorrhagic diseases, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France; 4Pharmacy, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France; 5Laboratory S2HEP, University of Lyon, University Claude Bernard Lyon 1, Lyon, France; 6Hemophilia Care Center, Centre hospitalier Métropole Savoie, Chambéry, FranceCorrespondence: Karen BenyCentral Pharmacy, Hospices Civils de Lyon, 57 rue Francisque Darcieux, CS 60004, 69563 Saint Genis Laval Cedex, Lyon, FranceTel +33 4 78 86 66 92Fax +33 4 72 67 88 74Email karen.beny@chu-lyon.frBackground: New therapies provide a favorable evolution in the care management of persons with hemophilia. However, the impact of these new therapies on patient care organization remains to be determined. A qualitative study will be implemented to analyze patients’ perception regarding the impact of innovation on the organization of their care management. Secondary objectives will include refining specific factors related to persons with hemophilia (barriers or facilitators, especially the place of treatment) to consider within an organizational impact analysis.Patients and Methods: Semi-structured individual interviews will be conducted via videoconferencing or by phone by two researchers using an interview guide. Participants will be recruited from the Rhône-Alpes region, in France. Physicians from two hemophilia treatment centers will identify eligible patients. Moreover, a call for volunteers will be launched by the Rhône-Alpes committee of the French hemophilia association. Interviews will be conducted with adult patients, adolescent patients or parents of a minor with hemophilia regularly treated prophylactically or on demand. Data analysis will be performed with NVivo® software. Each interview will be analyzed by two researchers using an inductive content analytic method.Discussion: The INNOVHEMO study is an original study analyzing the way patients perceive the impact of an innovation on their care management organization. The resulting patient-specific factors, identified as barriers or facilitators, will need to be integrated into a more comprehensive analysis of the impact of innovation on care management organization.Keywords: therapeutic innovation, hemophilia, care pathway, qualitative research, organizational aspect, patient experience data