[Solidarity : new paradigm for health data spaces?] / Solidarité : nouveau paradigme pour les espaces des données de santé ?

At the intersection of health promotion and health data sharing, a normative paradigm is emerging: solidarity. This principle became evident with the European Commission's proposal for the European Health Data Space in 2022, approved by the European Parliament in 2024, and Switzerland's DigiSanté project. This article examines health data spaces beyond traditional legal considerations, exploring the implications of increased reliance on solidarity. Highlighting public and private actors, it analyzes the use of health data for research, health surveillance, and profit. The article emphasizes the need for robust frameworks to balance data use for the common good and mitigate the risks of repression and exploitation.

À l'intersection entre promotion de la santé et partage de données de santé, un paradigme normatif émerge : celui de la solidarité. Ce principe s'est révélé avec la proposition de la Commission européenne pour l'espace européen des données de santé en 2022, approuvée par le Parlement européen en 2024, et le projet DigiSanté en Suisse. Cet article examine les espaces des données de santé au-delà des considérations juridiques traditionnelles, en explorant les implications d'un recours accru à la solidarité. En mettant en lumière les acteurs publics et privés, il analyse l'utilisation des données de santé à des fins de recherche, de surveillance sanitaire et de profit. L'article souligne la nécessité de cadres robustes pour équilibrer l'utilisation des données pour le bien commun et atténuer les risques de répression et d'exploitation.

[i-Leviathan: towards precision public health?] / i-Léviathan : vers une santé publique de précision ?

Hobbes' Leviathan symbolizes state sovereignty. In public health, this concept now extends to the prevention and promotion of health and the fight against non-communicable diseases (NCDs). This article explores the evolution towards an i-Leviathan, utilizing health data for more effective health surveillance. Precision public health, grounded in a personalized law approach, relies on the collection, availability, and use of these health data. This article analyzes the legal challenges of this precision, such as stigmatization, discrimination, and repression. It addresses the balance between public interests and individual freedoms, outlining state measures to monitor, control, and discipline healthy individuals.

Le Léviathan de Hobbes symbolise la souveraineté étatique. En santé publique, ce concept s'étend aujourd'hui à la prévention et la promotion de la santé et à la lutte contre les maladies non transmissibles. Cet article explore l'évolution vers un i-Léviathan, recourant à nos données de santé en vue d'une surveillance sanitaire plus efficace. Une santé publique de précision, ancrée dans une approche de droit personnalisé, dépend de la collecte, de la disponibilité et de l'utilisation de ces données de santé. Cet article analyse les enjeux juridiques de cette précision, tels que la stigmatisation, la discrimination et la répression. Il fait état de la balance entre intérêts publics et libertés individuelles, traçant les démarches étatiques de surveiller, contrôler et discipliner l'individu en bonne santé.

[Solidarity and public health]. / Solidarité et santé publique.

During the COVID-19 pandemic, solidarity has been referred to many occasions to justify the measures imposed on individuals by public authorities. If solidarity benefits from a kind of common understanding, it is no less complex to define it in a consensual way. In addition, recent years have been marked by a strengthening of individual responsibility which contributes to the erosion of the principle of solidarity in our society. The purpose of this contribution is to demonstrate the omnipresence of this principle in the field of public health by means of concrete examples.

Au cours de la pandémie de Covid-19, la solidarité a été évoquée à de multiples reprises pour justifier les mesures imposées aux individus par les autorités publiques. Si elle bénéficie d'une sorte de compréhension commune, il n'en demeure pas moins complexe de la définir de manière consensuelle. En outre, ces dernières années ont été marquées par un renforcement de la responsabilité individuelle qui contribue à l'érosion du principe de solidarité dans notre société. La présente contribution a pour vocation de démontrer l'omniprésence de ce principe dans le domaine de la santé publique au moyen d'exemples concrets.

[Healthy Nudges : what is their potential as a public health tool ?] / Les Healthy Nudges : quel potentiel comme outil de santé publique ?

Faced with the emergence of new pathologies and the prevalence of non-communicable diseases, public policies are using new tools, borrowed from social marketing, to increase the efficiency of their reach: Healthy Nudges. Within the architecture of choice, these nudges invite action to achieve the targeted public health objectives, without constraint. The flexibility of these instruments opens up new fields of intervention at all structural and institutional levels, adapting perfectly to Swiss federalism and supporting existing health policies. Opening the way to precision public health, these instruments of soft state intervention raise legal challenges such as the stigmatization of certain parts of the population and the transparency of state activity.

Face à l'émergence de nouvelles pathologies et la prévalence des maladies non transmissibles, les politiques publiques utilisent de nouveaux outils, empruntés au marketing social, pour renforcer l'efficience de leur portée : les Healthy Nudges. Au sein de l'architecture du choix, ces coups de pouce invitent au passage à l'action pour atteindre les objectifs de santé publique visés, et ce, sans contrainte. La flexibilité de ces instruments ouvre de nouveaux champs d'intervention à tous niveaux structurels et institutionnels, s'adaptant parfaitement au fédéralisme helvétique et se mettant au support des politiques de santé déjà existantes. Ouvrant la voie vers une santé publique de précision, ces instruments d'intervention étatique douce soulèvent des défis juridiques comme la stigmatisation de certaines parties de la population et la transparence de l'activité étatique.

In dubio pro CPR? The Controversial Status of 'Do Not Resuscitate' Imprints on the Human Body - a Swiss Innovation.

'Do not resuscitate' (DNR) imprints on the human body have recently appeared in medical practice. These non-standard DNR orders (e.g., tattoos, stamps, patches) convey the patient's refusal of resuscitation efforts should he be incapable of doing so. The article focuses on such innovative tools to express one's end-of-life wishes. Switzerland provides a unique example, as 'No Cardio-Pulmonary Resuscitation' stamps and patches have been commercialised. The article discusses the challenging legal questions as to the validity of non-standard DNR orders imprinted on the human body. It analyses the obligation of healthcare providers to honour such orders, either as an advance directive or an expression of an individual's presumed wishes, and withhold treatment. Finally, the article addresses the balancing of interests between the presumed wishes of an unconscious patient and his best interests of being resuscitated and potentially staying alive, a dilemma facing healthcare providers in a medical emergency.

Trajectories of social support in adults with type 2 diabetes: Associations with depressive symptoms and functional disability.

OBJECTIVES: Little is known about temporal trajectories of social support in adults with type 2 diabetes (T2D) and how they are associated with diabetes-related outcomes. This study identified and explored different trajectories of social support in a community sample of adults with T2D, as well as the extent to which different trajectories were prospectively associated with depressive symptoms and functional disability. METHODS: Data came from five annual waves of the Evaluation of Diabetes Treatment study (N = 1077). Social support, depressive symptoms, and functional disability were assessed via self-report. Separate analyses were conducted to examine the associations between social support trajectories, depressive symptoms, and functional disability, adjusting for demographic characteristics, diabetes-related covariates, and baseline depressive symptoms and functional disability. RESULTS: Latent class growth modeling identified four distinct social support trajectories. Trajectory Groups 1 and 2 comprised participants with persistently low and persistently moderate-low social support, respectively. Trajectory Groups 3 and 4 included participants with persistently moderate-high and persistently high social support, respectively. People with persistently low social support reported higher functional disability relative to those with persistently moderate-high and persistently high social support. CONCLUSIONS: The findings of the present study indicate that temporal patterns of social support are a predictor of future functional disability among adults with T2D.

Does Social Support Moderate the Association Among Major Depression, Generalized Anxiety Disorder, and Functional Disability in Adults With Diabetes?

BACKGROUND: Diabetes requires complex self-management routines to prevent the development of functional disability. Relative to people without diabetes, those with diabetes are more likely to have comorbid major depressive disorder (MDD) and generalized anxiety disorder (GAD), which also increase the likelihood of functional disability. Social support is associated with positive health outcomes in people with comorbid diabetes and mental disorders and may serve as a buffer against functional disability, though this possibility has yet to be examined. OBJECTIVES: This study examined whether social support moderates the association between MDD or GAD and functional disability in adults with diabetes. Adults with MDD or GAD were expected to report greater disability than those without MDD or GAD. This association was expected to be stronger in people reporting lower social support relative to those reporting higher social support. METHODS: Data came from the cross-sectional 2012 Canadian Community Health Survey-Mental Health (n = 1764). Diabetes status, social support, and functional disability were assessed via self-report; past-year MDD and GAD were assessed with structured diagnostic interviews. RESULTS: Linear regression analyses, conducted separately for MDD and GAD, indicated main effects of past-year MDD and GAD, such that those with a mental disorder reported greater functional disability than those without a mental disorder. Social support did not moderate the associations between either MDD and functional disability or GAD and functional disability. CONCLUSIONS: In this nationally representative population study, both MDD and GAD predicted greater functional disability in adults with diabetes. Social support, however, did not moderate these associations.

Reach of Supplemental Nutrition Assistance Program-Education (SNAP-Ed) interventions and nutrition and physical activity-related outcomes, California, 2011-2012.

INTRODUCTION: This study combined information on the interventions of the US Department of Agriculture's Supplemental Nutrition Assistance Program-Education with 5,927 interview responses from the California Health Interview Survey to investigate associations between levels of intervention reach in low-income census tracts in California and self-reported physical activity and consumption of fruits and vegetables, fast food, and sugar-sweetened beverages. METHODS: We determined 4 levels of intervention reach (low reach, moderate reach, high reach, and no intervention) across 1,273 program-eligible census tracts from data on actual and eligible number of intervention participants. The locations of California Health Interview Survey respondents were geocoded and linked with program data. Regression analyses included measures for sex, age, race/ethnicity, and education. RESULTS: Adults and children from high-reach census tracts reported eating more fruits and vegetables than adults and children from no-intervention census tracts. Adults from census tracts with low, moderate, or high levels of reach reported eating fast food less often than adults from no-intervention census tracts. Teenagers from low-reach census tracts reported more physical activity than teenagers in no-intervention census tracts. CONCLUSION: The greatest concentration of Supplemental Nutrition Assistance Program-Education interventions was associated with adults and children eating more fruits and vegetables and adults eating fast food less frequently. These findings demonstrate the potential impact of such interventions as implemented by numerous organizations with diverse populations; these interventions can play an important role in addressing the obesity epidemic in the United States. Limitations of this study include the absence of measures of exposure to the intervention at the individual level and low statistical power for the teenager sample.

Alcohol consumption, depressive symptoms, and the incidence of diabetes-related complications.

BACKGROUND: Heavy alcohol consumption in individuals with type 2 diabetes mellitus (T2DM) is related to increased risks of diabetes-related micro- and macrovascular complications. Depressive symptoms may be relevant to this relationship, because high depressive symptoms are associated with an increased risk of complications. This study investigated whether the interaction between depressive symptoms and alcohol frequency was positively related to the development of neuropathy, retinopathy, nephropathy, and coronary artery disease (CAD), such that those with high depressive symptoms and high alcohol frequency will be at increased risk of complications. METHODS: Data were from five waves of the Evaluation of Diabetes Treatment annual survey including 1413 adults with T2DM in Quebec. Data on alcohol frequency (number of drinking occasions), depressive symptoms, and complications were collected annually. The development of each complication was investigated using multiple logistic regression analysis with generalized estimating equations. RESULTS: After adjusting for sociodemographic, lifestyle, and diabetes-related covariates, the interaction between alcohol frequency and depressive symptoms was positively related to the incidence of neuropathy and CAD, such that those with high depressive symptoms who drank the most frequently had the highest risk of neuropathy (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.00-1.04; P = 0.04) and CAD (OR 1.02, 95% CI 1.00-1.04; P = 0.04). This interaction was not significantly related to retinopathy or nephropathy. CONCLUSION: Individuals with high depressive symptoms and high alcohol frequency may have a particularly high risk of neuropathy and CAD. Future prevention efforts should examine both alcohol frequency and depressive symptoms when evaluating the risk of complications.

State incentives to promote organ donation: honoring the principles of reciprocity and solidarity inherent in the gift relationship.

Organ transplantation saves the lives of thousands of patients worldwide every year. However, a chronic organ shortage overshadows this success. We define the organ shortage as a public health problem due to its serious consequences on patients and society. This definition raises the question of the state's role in transplantation medicine. It leads us to formulate a public policy promoting organ donation through state incentives, ie regulatory instruments to reward individuals' willingness to donate. Incentives allow the state to express gratitude for the solidary act of the donor toward the recipient and society. In an original approach, we integrate sociological findings as to the act of donation-the concept of reciprocity most importantly-into the core attributes of such a public policy. Addressing regulatory design questions, we present incentives such as allocation priority, tax benefits, health insurance discounts, and coverage of funeral costs. We also examine the unique non-financial incentive successfully implemented in Israel. We then discuss the legal and ethical framework in which state incentives have to operate, concluding that normative constraints can be addressed through law reform. Finally, we focus on aspects neglected so far in public information campaigns and discuss the interaction between state policy and public opinion.

Chronic Umbilical Discharge: An unusual presentation of endometriosis.

Umbilical endometriosis is an important differential diagnosis of any umbilical lesion. A 35-year-old type 2 diabetic woman presented with intermittent umbilical discharge which failed to respond to various antibiotics. An ultrasound scan and MRI scan failed to show any obvious abnormality. The umbilicus was excised and histology confirmed endometriosis. Surgical excision provides a definitive diagnosis and curative treatment for isolated endometriosis.