Accidents de la voie publique et inégalités sociales de santé à Cotonou en 2021.

Au Bénin, les accidents de la voie publique sont préoccupants et causent des décès et des blessures graves, surtout chez les motocyclistes. Les inégalités sociales de santé aggravent cette situation en affectant davantage les populations défavorisées. L'objectif de notre étude était de montrer que ces accidents suivent un gradient social, et d'orienter les interventions et les politiques visant à réduire les disparités en matière de sécurité routière. Il s'agissait d'une étude transversale, descriptive et analytique qui a porté sur 185 patients hospitalisés pour des lésions consécutives à un accident de la voie publique et en mesure de répondre à un questionnaire. Les données ont été collectées à partir des dossiers médicaux des patients et d'entretiens individuels. L'étude a révélé que les traumatismes de la voie publique étaient fréquents parmi les admissions (24,97 %), avec une prédominance chez les jeunes hommes (70,81 %). Parmi les sujets, 57,84 % des traumatisés avaient un niveau socio-économique bas. Les parties du corps les plus touchées étaient la tête et le cou, et les extrémités des membres. Les fractures étaient les lésions les plus fréquentes (62,70 %). Les accidents impliquant une moto représentaient 83,06 % des cas. La fréquence des fractures était plus élevée dans le groupe des accidentés ayant un niveau socio-économique bas et un niveau d'instruction bas. L'amélioration des conditions socioéconomiques et la promotion de moyens de transport alternatifs sûrs pourraient réduire les accidents de la voie publique et les inégalités sociales de santé. L'État pourrait y jouer un rôle clé.

Comprendre l'adoption et la continuation de l'utilisation du diaphragme Caya au Bénin : une étude à méthodes mixtes.

RésuméLe diaphragme Caya, de taille unique, est une méthode de contraception efficace dans multiples contextes. Pourtant, la recherche sur son acceptabilité, utilisation, et continuation en Afrique de l'Ouest francophone reste limitée. Ce projet pilote a introduit Caya à Cotonou et Bohicon, Bénin pour mieux comprendre comment Caya est utilisé. 225 adoptantes ont participé à une enquête, six mois après avoir choisi la méthode. 30 adoptantes, 15 hommes de la communauté et 15 prestataires ont participé à des entretiens approfondis. L'étude a révélé que les adoptantes choisissent la méthode parce qu'elle était non hormonale et ne provoque pas d'effets secondaires. Six mois après avoir adopté Caya, 76,4 % des adoptantes continuaient à l'utiliser ; celles moins instruites et avec 1 enfant ou plus, étaient plus susceptibles de continuer à utiliser Caya. Cela indique que dans ce contexte, Caya est une méthode acceptable qui ajouterait de la valeur aux autres méthodes contraceptives.

Aging and Mental Health: Collaborating on Research Priorities with Older Adults, Caregivers and Health and Social Care Providers across Canada.

Age-related changes can affect mental health, but aging-focused mental health research is limited. The objective was to identify the top 10 unanswered research questions on aging and mental health according to what matters most to aging Canadians. A steering group of experts-by-experience (e.g., older adults, caregivers, health and social care providers) guided three phases of a modified James Lind Alliance priority-setting partnership: (1) a broad national survey (n = 305) and a rapid literature scan; (2) a follow-up national survey (n = 703); and (3) four online workshops (n = 52) with a nominal group technique. Forty-two unique questions on aging and mental health resulted, of which 18 were determined to be answered by existing evidence. Of the 25 partially and unanswered questions, 10 were ranked as top priority. Findings can be used to prioritize future research, knowledge mobilization, and funding decisions, and to promote and support collaboration between longstanding siloed research and care fields.

COVID-19 in Perspective: A Witness Seminar1.

In June 2023, we brought together leaders who responded to the emergency phase COVID-19 pandemic in Ontario as part of a "Witness Seminar." This approach to studying history was developed by the Institute of Contemporary British History. It has been extensively used in the history of science and medicine by the Wellcome Trust History of Twentieth Century Medicine. A witness seminar provides a collective oral history, in which participants can express diverse perspectives, build on each other's thoughts, and create a documentary record for policy makers and future historians. The published transcript provides an intimate look at how the pandemic played out in the eyes of some of key responders and raises many questions about the history of public health funding and administration in the province of Ontario, the failures in long-term care, and the need to improve pandemic communication. This article documents the success of the pandemic response.

En juin 2023, les chercheuses ont réuni des leaders qui ont répondu à la phase d'urgence de la pandémie de COVID-19 en Ontario dans le cadre d'un « séminaire de témoins ¼. Cette approche visant l'étude de l'histoire a été mise au point par l'Institute of Contemporary British History (institut de l'histoire britannique contemporaine). Elle a été largement utilisée par le Wellcome Trust History of Twentieth Century Medicine (fiducie Wellcome de l'histoire de la médecine du vingtième siècle) en histoire des sciences et de la médecine. Un séminaire de témoins fournit une histoire orale collective, au cours duquel les participants peuvent exprimer divers points de vue, mettre leurs pensées en commun et créer un dossier documentaire pour les décideurs et les futurs historiens. La transcription publiée dresse un portrait intimiste du déroulement de la pandémie aux yeux de certains premiers répondants et soulève de nombreuses questions sur l'histoire du financement et de l'administration de la santé publique dans la province de l'Ontario, ainsi que sur les échecs des soins de longue durée et la nécessité d'améliorer les communications pendant la pandémie. Le présent article rend compte de la réussite de la réponse à la pandémie.

Technologies, professions de santé et réformes publiques : les projets professionnels des techniciens ambulanciers paramédics et des inhalothérapeutes au Québec, 1990-2022.

A blind spot in the history of the healthcare professions is the evolution of "technical" professions, particularly after 1970. However, these professions underwent major changes at the end of the 20th century. We propose two case studies, on Quebec's paramedics and respiratory therapists' professional projects. The projects and strategies of the two groups, which had previously differed, tended to converge after 1995. From then, both groups minimize their relationship with machines and technology. Instead, they claim new tasks focused on clinical evaluation and first-line intervention. Public reforms appear to be shaping this evolution in the political strategies, professional projects and even clinical preferences, of these healthcare professions after 1995.

Un angle mort en histoire des professions de santé est l'évolution des professions à caractère « technique ¼, surtout après 1970. Or, ces métiers se transforment beaucoup à la fin du 20e siècle. Nous proposons deux études de cas, sur les techniciens ambulanciers paramédics et sur les inhalothérapeutes au Québec, basées sur l'analyse des projets professionnels défendus par leurs représentants associatifs. Les projets et les stratégies des deux groupes, qui étaient jusque-là différents, tendent à converger après 1995. À partir de ce moment, les deux groupes minimisent leur relation aux machines et à la technologie. Ils revendiquent plutôt de nouvelles tâches axées sur l'évaluation clinique et l'intervention en première ligne. Nous avançons que ce sont les réformes publiques qui façonnent cette évolution des projets professionnels, des stratégies politiques, et même des préférences cliniques, des professions de la santé après 1995.

[Risk analysis applied to the monitoring of immunosuppressor concentrations in lung transplant recipients]. / Analyse de risques appliquée au suivi des concentrations des immunosuppresseurs chez les patients transplantés pulmonaire.

Mastering and monitoring immunosuppressant concentrations is central to the care of lung transplant patients and involves multiple stakeholders. The objective is to conduct a risk analysis to evaluate the impact of various actions taken. The lung transplantation team was convened to carry out a failure mode effect analysis. The process was divided into stages where different risks were identified. The risk priority number (RPN) (severity, frequency, detectability) and risk level of criticality (frequency, severity) were established before implementation of actions (before 2009) and then after (in 2022) to classify risks according to four levels of criticality. The implemented actions included the establishment of a quality assurance process, computerization of monitoring, and double analysis by a physician/pharmacist pair. Thirty-two risks were identified during the four stages of the process: biological sampling (n=13), reception (n=3), analysis and treatment of levels (n=5), transmission of information/prescriptions to the patient (n=11). The total raw RPN (before 2009) was 839, with 12 major risks. The current total RPN (in 2022) was 452 (a decrease of 46.1%), with 7 major risks identified. The analysis enabled the objective evaluation of the effectiveness of the actions taken. The most secure stage of the process is the reception of residual level results. Efforts should focus on empowering and involving patients, as well as engaging local stakeholders in collaboration with the specialized transplantation team.

Engagement communautaire et prise en compte de la détresse psychologique, de la peur et de la stigmatisation dans la surveillance et la gestion des épidémies de la maladie à virus Ebola dans l'approche « Une seule santé ¼ en République démocratique du Congo.

INTRODUCTION ET OBJECTIF: Une réponse efficace aux crises sanitaires telle la maladie à virus Ebola (MVE) nécessite l'engagement des communautés. Cette étude explore les enjeux psychosociaux influant sur la réponse des communautés congolaises aux épidémies de MVE, et comment la détresse et la résilience communautaire s'intègrent dans l'approche « Une seule santé ¼ selon les perceptions des communautés. MÉTHODES: Cette étude de cas qualitative inclut des entretiens individuels (n = 36) avec des informateurs clés et trois groupes de discussion avec des participants (n = 28) issus de diverses associations locales, Cette étude de cas qualitative menée au Nord-Kivu inclut. Le cadre MATCH de l'engagement communautaire, adapté, structure l'analyse thématique. RÉSULTATS: Les participants ont tous reconnu le vécu douloureux - la peur, le rejet, la stigmatisation - des communautés et des professionnels de santé, et le rôle crucial des communautés dans la réponse aux épidémies. Ils ont souligné l'importance d'impliquer ces communautés dans l'élaboration et la mise en œuvre des stratégies pour éviter l'« Ebola business ¼. Les perceptions face à la maladie des différentes catégories de participants sont influencées par des croyances, les rôles sociaux et des considérations religieuses. Concernant l'approche « Une seule santé ¼, les participants ont reconnu la nécessité d'impliquer toutes les couches sociales de la communauté. CONCLUSION: Un modèle innovant de gestion des épidémies et urgences de santé publique intègre les essentiels de l'engagement communautaire dont la détresse psychologique.

Real-World Outcomes of Incurable Cancer Patients Treated with Unlisted Anticancer Treatments in an Academic Center in Quebec, Canada.

Medical oncology is a rapidly evolving field, with new medications being discovered yearly, contributing to increased survival rates. However, accessing drugs in a timely manner can be challenging. In Quebec, Canada, a physician can prescribe an unlisted anticancer treatment through a regulated pathway under exceptional circumstances. We conducted a quality improvement study describing the outcomes of incurable cancer patients receiving unlisted anticancer therapy at the Jewish General Hospital between 2018 and 2019. Though our study did not include a comparator arm, unlisted anticancer therapies were associated with interesting median progression-free survival (11 months) and overall survival (25 months). Moreover, a large proportion of treatments, 44%, were subsequently reimbursed in the province of Quebec. Given the delay in anticancer drug reimbursement, this pathway is essential for timely access to oncology drugs. Such 'special access' programs will likely become increasingly important as precision medicine becomes the standard of practice.

[Diabetes complications and sexual health: Addressing them without taboos]. / Complications du diabète et santé sexuelle : les aborder sans tabous.

In France, 1.5 million women live with diabetes. This chronic metabolic disease disrupts every aspect of the lives of sufferers, right down to the most intimate. The impact of diabetes on women's sexuality is less well documented than for men. Yet a holistic approach to the management of the disease is essential to provide quality care.

[Physical activity and diabetes: Where, when, how and with whom?] / Activité physique et diabète : où, quand, comment et avec qui ?

Today, physical activity is one of the most effective preventive and health-promoting factors for people with diabetes. Understanding the issues involved and how to implement it will help you to support patients in maintaining this practice.

[The contribution of social networks using the example of type 1 diabetes]. / Apport des réseaux sociaux à partir de l'exemple du diabète de type 1.

Type 1 diabetes has an impact not only on physical health, but also on social life, family life and psychological balance. Social networks play a decisive role, alongside associations, in helping patients to adopt the "other pace of life" implied by the disease. Beyond health, the skills needed to enable patients to achieve personal fulfillment are beyond the scope of healthcare professionals. Peer communities are an invaluable contribution to building this life with diabetes.

[Diabetes, loved ones: Constraints, support, shared experiences]. / Le diabète et les proches, entre contraintes, soutien et vécus en commun.

Diabetes is a pathology that has major consequences not only for those who suffer from it, but also for those around them. Relatives can play different roles in this respect, depending on the type of relationship they have with the person with diabetes. The onset of the disease is likely to modify pre-established roles within social groups such as the family sphere, with the possibility of strengthening ties, but also of damaging them.

French national helpline "stop" for minor-attracted persons: First findings.

OBJECTIVES: Preventing minor-attracted persons from acting on their impulses is a significant public health concern. To address this, the STOP telephone helpline was established nationwide in France in January 2021. This service acts as a bridge, connecting callers with their nearest CRIAVS (resource centers for professionals working with sex offenders) where they can speak with a healthcare professional who can guide them toward appropriate care if needed. Our study is a detailed look at the STOP service's activity from January 1st, 2021, to December 31st, 2022, covering a span of 24 months. METHOD: We developed a structured approach to collecting data for analysis. Data were extracted from the centralized database of the STOP service, allowing for the collection of quantitative variables and qualitative variables. RESULTS: Over the study period, there were 5442 calls made to the service. After filtering out calls that were unsuccessful or too short (mostly under 5minutes), we analyzed 369 records. Among these, 79.1% were first-time callers, with 73.3% of them admitting to being attracted to children, a group which predominantly consisted of men. Notably, 46.7% of callers expressing an attraction to children were referred to further care. In total, 72.6% of callers learned about the service through media channels. CONCLUSION: Analysis revealed that the STOP service was primarily utilized by the intended audience-minor-attracted persons. The gradual decline in call volume over time and the reliance on media for awareness highlight the importance of widespread publicity. The findings from our study, spanning twenty-four months of the STOP service's operation, highlight the value of having such a platform available to facilitate access to mental health support for minor-attracted persons. They emphasize the need for increased communication efforts to promote the STOP service and call for further data analysis to enhance its effectiveness.

Bias related to overweight and obesity among French psychiatrists: Results of a national survey.

BACKGROUND: According to people with a higher weight, physicians are the second most stigmatizing group related to excess weight. As a result of these weight-related biases, the therapeutic relationship with the patient and the quality of care would be negatively affected. In addition, this stigma could negatively impact the clinical practice related to higher weight and avoidance of care. OBJECTIVES: The objective of this study was to assess the stigma of overweight and obesity among psychiatric residents and psychiatrists in France. Specifically, the study aimed to assess factors that may influence weight-related bias among psychiatrists, to explore the relevance of visual assessment of body mass index, and to determine how they this feature is integrated into their practice. METHOD: An online questionnaire including sociodemographic items, the Fat Phobia Scale, the Beliefs About Obese Persons Scale, the Body Shape Scales, and questions about their clinical practice was distributed via national professional mailing lists and social networks. RESULTS: The survey was answered by 271 seniors or residents in psychiatry. The results indicated a moderate level of weight-related bias among psychiatrists as assessed by the Fat Phobia Scale which was higher in residents than in senior psychiatrists. Over a third of the respondents had no material to assess their patient's weight, and two thirds did not systematically assess overweight or obesity. Finally, the results demonstrate that psychiatrists failed to accurately evaluate overweight or obesity based on male or female silhouettes. CONCLUSION: It appears that measures should be taken to raise awareness among psychiatrists of the stigmatization of individuals living with a higher weight, as well as to enhance the quality of weight gain care in psychiatry.

[The nurse consultant in remote medical monitoring: an innovative, patient-centered approach]. / L'infirmière "conseil" en télésurveillance médicale : une approche innovante centrée sur le patient.

Telemedical monitoring of heart failure patients is revolutionizing the traditional approach to care, thanks to the crucial role played by nurse consultants. Based on two years' experience in a telemonitoring unit, where the practice model is outside the conventional nursing context, we aim to highlight this innovative method, which is helping to improve the care and benefits of patients with chronic pathologies. This patient-centered approach offers holistic, individualized care through personalized remote monitoring, fostering a relationship of trust and encouraging patient autonomy.

[Stress profile of veterinarians in Switzerland: Young + female + employed = stressed?] / Belastungsprofil von Tierärzt*innen in der Schweiz: Jung + weiblich + angestellt = gestresst?

INTRODUCTION: The impairment of mental health among veterinary professionals has raised public awareness in recent years. The driving forces include a serious gap in veterinary services - with less available veterinary colleagues, especially in rural areas - and a general lack of veterinary graduates. This article presents the results of our first Swiss survey on psychological well-being in the veterinary profession. Our results are viewed both in the current context and in the context of developments that have already taken place in other medical disciplines. Results indicate higher levels of stress in veterinarians working as clinicians, in female colleagues, in veterinarians of younger age and veterinarians under employment. In the meantime, larger surveys such as the Vétos Entraide (https://vetos-entraide.com) were established in France and projects such as the Happy Vet project (https://happyvetproject.org) were launched in Switzerland for eg. the burnout prevention in the profession. However, the topic of «mental health¼ remains highly relevant in veterinary medicine and requires further research and measures, which should consider the identified predisposing factors, such as age and gender.

INTRODUCTION: L'opinion publique a été sensibilisée ces dernières années à l'altération de la santé mentale des vétérinaires. Les causes de cette situation sont notamment une grave lacune dans les services vétérinaires ­ avec moins de collègues vétérinaires disponibles, en particulier dans les zones rurales ­ et un manque général de diplômés en médecine vétérinaire. Cet article présente les résultats de notre première enquête suisse sur le bien-être psychologique dans la profession vétérinaire. Nos résultats sont examinés à la fois dans le contexte actuel et dans le contexte des développements qui ont déjà eu lieu dans d'autres disciplines médicales. Les résultats indiquent des niveaux de stress plus élevés chez les vétérinaires travaillant comme cliniciens, chez les collègues féminins, chez les vétérinaires plus jeunes et chez les vétérinaires salariés. Entre-temps, des enquêtes de plus grande envergure telles que Vétos Entraide (https://vetos-entraide.com) ont été mises en place en France et des projets tels que le projet Happy Vet (https://happyvetproject.org) ont été lancés en Suisse pour, par exemple, prévenir l'épuisement professionnel. Cependant, le thème de la «santé mentale¼ reste très pertinent en médecine vétérinaire et nécessite des recherches et des mesures supplémentaires, qui devraient prendre en compte les facteurs prédisposants identifiés, tels que l'âge et le sexe.

[Nurturing and growing a community of department heads: Act 2 in haematology]. / Faire vivre et grandir une communauté de chefs de service : acte 2 en hématologie.

In response to the French hospital system crisis and the challenges faced by the heads of departments, we have undertaken an initiative to create a community of heads of haematology departments willing to assist each other. Our inaugural seminar, held in January 2023, established the foundational "core" group of heads of department. Throughout 2023, this emerging community has prospered, offering sustained support to peers. In January 2024, we broadened our community to include other heads of departments, following a second seminar gathering 36 participants. During this event, we took the time to exchange thoughts and reflect on our missions. Building on the experience of guest speakers and employing methods of co-development and co-construction in plenary sessions, small-group workshops, and social gathering, we were able to discover and experience the collective intelligence, creativity, strength, and support stemming from such a group. This peer community of heads of departments stands as a powerful tool for management support, whereby personal experiences nourish and enrich the experience of others. We hope that our initiative will inspire heads of departments from other specialties so that, together, we can better work towards our missions as heads of departments and collaborate on rebuilding the hospital "from the bottom up".

[Effects of a return-to -home assistance programm (PRADO-IC) on the patient journey in a cohort of cardiac heart failure patients]. / Effets du programme d'aide au retour à domicile (PRADO-IC) sur le parcours de soins à un an d'une population de patients insuffisants cardiaques.

INTRODUCTION: Congestive heart failure (HF) is associated with prolonged and recurrent hospitalizations; the prognosis remains poor a better follow up might be beneficial. PRADO-IC program is provided in order to improve the transition of care. AIM OF THE STUDY: To evaluate PRADO-IC program in term of healthcare consumption and prognosis in a cohort of patients hospitalized for decompensated HF, using the insight of the national data base SNDS (Système National de Données de Santé). METHODS: From September 2016 to September 2018, all patients hospitalized for heart failure at Saint-Joseph Hospital were included in an observational study. The inclusion in the PRADO-IC program was at physician's discretion. Two groups were compared according to the inclusion in PRADO-IC (P group) or not (control group (C)). The primary endpoints were the comparison of one-year mortality and heart failure readmission rate between the two groups. The secondary end points were time to the first contact with a general practitioner (GP), a cardiologist, CHF drugs prescription, and others follow up data. RESULTS: Six hundred and fifteen patients were included, 254 in the P group and 361 in the C group. Patients in the P cohort presented more frequently severity criteria (age, weight, BNP level, arrhythmia, anemia, renal failure). Mortality at one year (n = 47; 18.5% P group vs. n = 65; 16.2% C group, p = 0.87) did not differ in both groups. There was no significant difference in one-year re-hospitalization rate for HF (n = 93, 36.6% in P group vs. n = 133, 26.8% in C group, p = 0.95). Time to the first contact with the GP was shorter in P group (8.00 vs. 18.50 days, p < 0.0001). Time to first hospitalization (69.0 vs. 37.0 days, p = 0.028) and the length of hospitalization (6.0 vs. 4.0 days, p = 0.045) were longer in P group. There was no difference for HF drugs prescription rate between the two groups. CONCLUSION: Our study shows that the PRADO-IC program concerned more severe patients. Despite this, the one-year mortality and the HF readmission rates are similar between the two groups. The follow up is improved in P group.

A Qualitative Exploration of Participant Experiences in the Avoiding Diabetes After Pregnancy Trial in Moms (ADAPT-M).

OBJECTIVES: Gestational diabetes mellitus (GDM), a temporary condition of pregnancy, identifies women at high risk of developing subsequent type 2 diabetes mellitus (T2D). Lifestyle interventions have been shown to reduce the risk of developing T2D after GDM. However, they often have low attendance and adherence rates. The Avoiding Diabetes After Pregnancy Trial in Moms (ADAPT-M) is a 24-week home-based postpartum program aimed at bridging the gap from prenatal care to T2D prevention for women with GDM. Our objective was to explore the experiences of participants who completed the ADAPT-M program, to elicit their perceived benefits and opportunities for improvement. METHODS: This was a qualitative descriptive study wherein we conducted semistructured interviews with 21 women with previous GDM who participated in the ADAPT-M program in Ontario, Canada. Transcripts were analyzed using NVivo software using a conventional content analysis approach. RESULTS: Two themes describing the experience of women who underwent the ADAPT-M lifestyle-based coaching program emerged: 1) the benefits of a supportive relationship between coaches and participants; and 2) a desire for more from the program, including peer support, more customization, and addressing emotional needs. CONCLUSIONS: Our findings support the importance of fostering supportive health-care relationships in T2D prevention programs for postpartum women with a history of GDM. Enhanced customization, emotional support, and opportunities for peer support should be considered in the development of future programming to better meet the needs of participants.

[Development and validation of a tool for the systematic identification of social vulnerabilities in cancer patients: the DEFCO tool]. / Développement et validation d'un outil de dépistage systématique des fragilités sociales des patients atteints de cancer : l'outil DEFCO.

INTRODUCTION: Literature suggests that patients from deprived backgrounds are less likely to adhere to their treatments, continue to expose themselves to risk factors and, as a result, have poorer health outcomes. It is therefore crucial to identify these vulnerable populations early on, in order to provide them with tailored and reinforced care. The primary aim of this research is to construct and validate a systematic screening tool for identifying patients at highest risk of social vulnerability due to deprivation, through the use of psychometric techniques. This tool is intended to be easily used by healthcare professionals, to provide tailored and targeted care throughout the patient's journey. METHOD: This study involves the development and assessment of a screening tool, along with a self-questionnaire and a decision support tool incorporating an artificial neural network. It is a prospective, monocentric, 2-stage psychometric validation study. RESULTS: This study has demonstrated the successful development of the self-questionnaire using psychometric methodology. The tool was found a good performance in screening social vulnerabilities. DISCUSSION: This validated self-questionnaire is an easy-to-use tool, allowing systematic screening for social vulnerabilities for cancer patients. This early identification allows to reinforce patient's pathway in order to avoid disruption. The integration of the tool in an artificial neuron network system allows to automate and disseminate this method of deprived patients' detection, while limiting the workload for the staff.