A longitudinal investigation of structural empowerment profiles among healthcare employees.

PURPOSE: Research on structural empowerment has typically adopted a variable-centered perspective, which is not ideal to study the combined effects of structural empowerment components. This person-centered investigation aims to enhance our knowledge about the configurations, or profiles, of healthcare employees' perceptions of the structural empowerment dimensions present in their workplace (opportunity, information, support, and resources). Furthermore, this study considers the replicability and stability of these profiles over a period of 2 years, and their outcomes (perceived quality of care, and positive and negative affect). DESIGN: Participants completed the same self-reported questionnaires twice, 2 years apart. METHODS: A sample of 633 healthcare employees (including a majority of nurses and nursing assistants) participated. Latent transition analyses were performed. RESULTS: Five profiles were identified: Low Empowerment, High Information, Normative, Moderately High Empowerment, and High Empowerment. Membership into the Normative and Moderately High Empowerment profiles demonstrated a high level of stability over time (79.1% to 83.2%). Membership in the other profiles was either moderately stable (43.5% for the High Empowerment profile) or relatively unstable (19.7% to 20.4% for the Low Empowerment and High Information profiles) over time. More desirable outcomes (i.e., higher positive affect and quality of care, and lower negative affect) were observed in the High Empowerment profile. CONCLUSIONS: These results highlight the benefits of high structural empowerment, in line with prior studies suggesting that structural empowerment can act as a strong organizational resource capable of enhancing the functioning of healthcare professionals. These findings additionally demonstrate that profiles characterized by the highest or lowest levels of structural empowerment were less stable over time than those characterized by more moderate levels. CLINICAL RELEVANCE: From an intervention perspective, organizations and managers should pay special attention to employees perceiving low levels of structural empowerment, as they experience the worst outcomes. In addition, they should try to maintain high levels of structural empowerment within the High Empowerment profile, as this profile is associated with the most desirable consequences. Such attention should be fruitful, considering the instability of the High Empowerment and Low Empowerment profiles over time. REGISTRATION: NCT04010773 on ClinicalTrials.gov (4 July, 2019).

Peer support impact on therapeutic adherence in patients with multiple sclerosis: a mixed-methods pilot trial protocol.

INTRODUCTION: Patient partnership is a key component of patient-centred care. One form of partnership is individual peer support, which can improve patients' quality of life and adherence to treatment. Patient with multiple sclerosis could benefit from this type of support, but such an intervention has not been explored in the literature.We propose in this article a pilot study protocol to assess the feasibility and acceptability of healthcare-integrated individual peer support, and the feasibility of a large-scale efficacy trial. METHODS AND ANALYSIS: The PAIR-SEP study is a mixed-methods pilot clinical trial combining quantitative and qualitative approaches. Sixty patients with relapsing-remitting multiple sclerosis undergoing drug therapy from the Neurology centre of Nantes University Hospital (France) will be randomised on a 1:1 ratio to receive either usual care only or usual care combined with peer support (three individual sessions at 1, 3 and 5 months with a peer helper).We will evaluate clinical outcomes in preparation of the large-scale trial: therapeutic adherence 6 months after baseline, therapeutic compliance, quality of life, anxiety and depression, social support. All dimensions will be assessed using validated health questionnaires at baseline and at 6 months.Intervention's acceptability and feasibility will be evaluated using qualitative methods: undirected interviews with patients from the intervention group and separate focus-groups with the peer helpers the healthcare team. ETHICS AND DISSEMINATION: Ethical approval was obtained from the local ethics committee on 1 October 2022. This study was designed in collaboration with multiple sclerosis peer helpers.The trial findings will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT05519553.

"What makes you well?" Supports of well-being in bipolar disorder. A qualitative study.

OBJECTIVE: Subjective experience of people living with bipolar disorder is gaining attention in the field of research. Improving well-being could be as important as symptom remission, but this constitutes a vague concept. This study aimed at exploring the boundaries and the determinants of the well-being of people living with bipolar disorder in a French context. METHODS: Individual semi-structured interviews were conducted with 16 patients by three professionals. Interviews were transcribed and analysed using the thematic analysis method. RESULTS: Various dimensions emerged as contributing to well-being: daily routines, connectedness, regaining a positive identity, and self-awareness for self-management. CONCLUSIONS: In addition to those common to the general population, this study highlighted specific determinants of well-being: the construction of a positive identity through acceptance of the diagnosis, the importance of self-awareness and self-management. They are highly intertwined with those of personal recovery and could help caregivers design interventions that directly target these goals. This study aimed to identify specific components of well-being for people living with bipolar disorder. Understanding the determinants of well-being enable caregivers to design tailored interventions that directly target quality of life and help improve bipolar disorder outcomes.

Improving care safety by characterizing task interruptions during interactions between healthcare professionals: an observational study.

Few studies have investigated interruptions to the work of professionals practicing in inpatient hospitals, and even fewer take account of the functions that make up the system. Safety of care can be improved by considering avoidable interruptions during interactions between managerial and care delivery functions. The present study describes the characteristics of interruptions to the work of professionals working in the inpatient hospital sector, with respect to their typology, frequency, duration, and avoidability in the context of interactions between functions. This direct observational study of interruptions in hospital care was performed in the Pays de la Loire (west coast) area of France. A total of 23 teams (17 institutions) working in medical or surgical specialties (excluding intensive care) were included. Observations were performed between May and September 2019, and lasted seven consecutive hours per team. A pair of observers simultaneously observed the same professional for ∼30 min. Each occupational category was examined. Reported characteristics were: (i) the method and duration of the request, (ii) the location of interrupted and interrupting persons, (iii) the reaction of the interrupted person, (iv) the characteristics of the interrupting person, and (v) the classification of interrupted and interrupting tasks according to their function. An avoidable interruption was defined. Interruptions during interactions between professionals were categorised in terms of their function and avoidability. Descriptive statistical analyses (mean, standard deviation, and distribution) were run. In particular, cross-comparisons were run to highlight avoidability interruptions and interactions between managerial and care delivery functions during the working day, for different professional categories, and for the location of the request. Overall, 286 interrupted professionals were observed and 1929 interruptions were characterised. The majority of interruptions were due to a face-to-face request (58.7%), lasting ≤30 s (72.5%). Professionals engaged in the response in 49.3% of cases. A total of 57.4% of interruptions were avoidable. The average number of interruptions was 10.5 (SD = 3.2) per hour per professional. An analysis of avoidability and interactions between managerial and care delivery functions found that the period between 12:00 and 13:00 was the riskiest in terms of care safety. This study highlighted the characteristics of interruptions to the activity of professionals working in inpatient hospitals. Care teams could focus on making medical and nursing professionals much more aware of the importance of interruptions, and each team could decide how to best-manage interruptions, in the context of their specific working environment.

The experience of caregivers providing therapeutic patient education for people living with bipolar disorder: a qualitative study.

BACKGROUND: Therapeutic patient education (TPE) programs are psycho-educational treatments suggested for all chronic diseases. For several years, these programs have been developing for people living with bipolar disorder. However, to date, only few qualitative studies have explored the experience of caregivers. We wanted to explore the experience of caregivers working in psychiatry as facilitators of a therapeutic education program for people living with bipolar disorder. METHOD: A single-center qualitative study was carried out. We conducted an inductive exploration, examining the content of the discourse produced in a focus group of eight caregivers in therapeutic education. The corpus was transcribed manually and a thematic analysis was conducted by two authors in a blinded fashion before combining. RESULTS: Four dimensions and twenty themes were identified: i) facilitators' pleasant experiences of the TPE sessions with a secure climate and a sense of belonging to a group, ii) being a TPE facilitator with a new horizontal and collaborative posture valuing the experiential knowledge, iii) the role of the TPE sessions with knowledge provision, empowerment and destigmatization, and iv) perceived changes in patients with an appeasement, the awareness of a shared experience, openness to others, a phenomenon of identification to peers and a new commitment. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The observations noted overlap with the elements of the personal recovery well known CHIME framework (Connectedness, Hope, positive Identity, Meaning in life and Empowerment). Therapeutic education is a developing form of psychosocial rehabilitation care: through the mobilization of a new attitude of caring, the facilitation of TPE programs could be a lever for changing the posture of caregivers in favor of supporting the personal recovery of people with bipolar disorder. These results would need to be confirmed by further studies.

Safety culture in French nursing homes: A randomised controlled study to evaluate the effectiveness of a risk management intervention associated with care.

BACKGROUND: French Nursing Homes (NHs) are in the early stages of implementing their Risk Management (RM) approach. A regional structure, which was mandated to provide independent support in RM, designed a training package. OBJECTIVE: To study the impact of the RM training package on safety culture (SC) in NHs and drivers for improvement in SC scores. METHOD AND ANALYSIS: This randomised controlled study targeted French NHs. Inclusion criteria were voluntary participation, no external support provided on the topic of adverse incidents upstream of the project, and the commitment of top management to its implementation. The 61 NHs were randomly allocated to one of two groups: the first benefited from a training package; support was given to the second after the impact measurement. Seven dimensions of SC were measured, at an 18-month interval, using the validated Nursing Home Survey on Patient Safety Culture questionnaire (22 items), which was administered to all of the professionals working in NHs. Eleven variables were captured, relating to the structural profile of the NH, the choices of top management in terms of healthcare safety, and the implementation of the system. Further modelling identified predictive factors for changes in SC scores. RESULTS: 95% of NHs completed both rounds of the questionnaire. The dimension Feedback and communication about incidents (SC = 85.4% before the intervention) significantly improved (+2.8%; p = 0.044). Improvement in the dimension Overall perceptions of resident safety-organizational learning was close to significant (+3.1%; p = 0.075). Drivers for improvement in scores were a pre-existing quality improvement approach, and a steering group that showed RM leadership. CONCLUSIONS: The system appears to have improved several dimensions of SC. Our findings are all the more important given the current crisis in the healthcare sector. TRIAL REGISTRATION: Retrospectively registered as NCT02908373 (September 21, 2016).

Impact of empowering leadership on emotional exhaustion: A controlled interventional study in a large French university hospital complex.

AIM: The aim of this study is to assess the effect of a systemic intervention on the evolution of empowering leadership and emotional exhaustion in a university hospital sub-centre compared to a control sub-centre, both being part of a large French university hospital complex. BACKGROUND: Empowering leadership is a promising strategy for developing hospital team engagement and performance. However, the bureaucratic functioning of large hospitals, characterized by a managerial culture of control and a stratified organization, can be a barrier to empowering leadership. METHODS: The intervention included empowering leadership training, direct field experimentation of empowering leadership and coaching, involving all the sub-centre hierarchical levels for 12 months. Data were collected before and after the intervention. A total of 441 and 310 participants were, respectively, included in the intervention and control sub-centres. RESULTS: Empowering leadership was decreased, and emotional exhaustion was increased in the control sub-centre, while the scores remained stable in the intervention sub-centre. The increased emotional exhaustion in the control sub-centre could partially be explained by the change in empowering leadership. CONCLUSION: In a context of decreased empowering leadership and increased emotional exhaustion, the intervention had a protective effect. Implications for the design of future interventions were discussed. IMPLICATIONS FOR NURSING MANAGEMENT: This study unequivocally showed the benefit of transforming hospital management towards empowering leadership, to prevent increased emotional exhaustion. REGISTRATION NUMBER: This study is registered on ClinicalTrials.gov on 4 July 2019 (NCT04010773).

Risque zoonotique : médecins généralistes et vétérinaires sont-ils prêts à collaborer ?

INTRODUCTION: Zoonotic risk is a major public health concern that should be addressed through close collaboration between veterinarians and physicians. Yet the few studies available in this field highlight the absence of such collaboration and point to organizational and cultural constraints as explanatory factors. None of them have investigated potential psychosocial determinants. METHODS: This qualitative study is a comparative exploration of veterinarians' and physicians' relationship to zoonotic risk and interprofessional collaboration. Individual exploratory interviews were held with fourteen practicing veterinarians and ten general practitioners - all of whom were French. Their different perceptions of zoonotic risk and collaboration were described by means of a thematic analysis. The social representations of each profession with regard to the other were investigated using attitudinal analyses. RESULTS: Collaboration between general practitioners and veterinarians is commonly perceived as non-existent. The main limiting factors on collaboration are: first, greater psychosocial involvement with regard to zoonotic risk among veterinarians than among general practitioners, due to differences in the degree of exposure to these diseases and in the expertise and values regarding the human-nature relationship; second, contrasting assessments of the others' profession (social desirability), evidenced in veterinarians' negative representations of general practitioners who, conversely, deem veterinarians to be particularly competent; and, thirdly, different perceptions of collaboration (social utility), as a keen interest in collaboration is witnessed among veterinarians, whereas general practitioners see it as only moderately useful. CONCLUSION: It is essential to promote places where physicians and veterinarians can meet locally, so that perceptions of zoonotic risk can evolve, particularly among physicians, along with veterinarians' beliefs about and attitudes towards them.

Patients' perspectives of the effects of a group-based therapeutic patient education program for bipolar disorder: a qualitative analysis.

BACKGROUND: Few qualitative studies have explored the impact of group-based psychoeducation programs from the perspective of patients with bipolar disorder, and no studies to date have examined the effects of such programs on patients' personal recovery. The aim of this study was to explore the effects of a group therapeutic education program on the personal recovery of people with bipolar disorder and its determinants. METHODS: Three professionals conducted semistructured interviews with 16 patients who participated in 9 weekly sessions of four separate bipolar therapeutic education programs. The interviews were transcribed verbatim and analyzed inductively by two of the professionals using the thematic analysis method. RESULTS: Three main themes emerged from the interviews: the elements of therapeutic education, the experience of therapeutic education and the changes facilitated by therapeutic education. The changes reported by the participants included the evolution of the patient's relationship with the disorder, improvement in the patient's knowledge of the disorder, improvement in disorder management throughout daily life in general, and development of psycho-social skills and social relationships. CONCLUSIONS: This study provides support for the beneficial impact of group therapeutic education programs on the personal recovery of people with bipolar disorder. These programs improve all dimensions of recovery according to the CHIME model, with connectedness, hope and empowerment being the main dimensions impacted. Our results indicate that therapeutic group education programs can be beneficial for people with bipolar disorder at any point during their experience of the disorder, with the potential exception of periods of thymic decompensation.

Exploring the Personal Recovery Construct in Bipolar Disorders: Definition, Usage and Measurement. A Systematic Review.

Personal recovery from psychiatric disorders is a journey toward a satisfying and hopeful life despite the possible persistence of symptoms. This concept has gained interest and become an increasingly important goal in mental health care programmes. Personal Recovery is well described in the context of severe mental illnesses in general, but little is known about this journey in bipolar disorders and the factors underlying it. A systematic review was conducted according to the PRISMA recommendations, focusing on studies exploring personal recovery in bipolar disorder specifically. The latter have integrated a comprehensive approach to the concept, the existing means of measurement or have explored the levers of recovery in care. Twenty-four articles were selected, including seven qualitative, 12 observational, and five interventional studies. The Bipolar Recovery Questionnaire was the only scale developed de novo from qualitative work with bipolar people. Personal recovery did not correlate very closely with symptomatology. Some elements of personal recovery in bipolar disorder were similar to those in other severe mental illnesses: meaning in life, self-determination, hope, and low self-stigma. Specific levers differed: mental relationships with mood swings, including acceptance and decrease in hypervigilance, and openness to others, including trust and closeness. The studies highlighted the role of caregiver posture and the quality of communication within care, as well as the knowledge gained from peers. The choice to exclude articles not focused on bipolar disorder resulted in the provision of very specific information, and the small number of articles to date may limit the scope of the evidence. New components of personal recovery in bipolar disorder emerged from this review; these components could be taken into account in the construction of care tools, as well as in the caregiving posture. Strengthening skills of openness to others could also be a central target of recovery-focused care.

What is the level of safety culture in French nursing homes? The EHPAGE study.

BACKGROUND: French nursing homes (NHs) are in the early stages of implementing their risk management approach. The latter includes the development of a safety culture (SC) among professionals. A training package to support NHs in implementing a risk management strategy has been designed by QualiREL Santé, a regional body that provides support in quality and risk management. The aim is to improve SC. No data are available about the level of SC in French NHs. This study evaluates the level of SC and identifies predictors of SC scores in NHs that will subsequently benefit from the training package. METHOD: The study was proposed to NHs who are members of QualiREL Santé in 2 French departments. Inclusion criteria were voluntary participation, the commitment of top management to benefit from the training package, and the absence of previous risk management support provided by QualiREL Santé. The NHSOPS-F questionnaire (22 items measuring 7 dimensions of SC) was administered to professionals between January and March 2016. 14 variables related to the structural profile of the NHs and the strategic choices of top management in terms of healthcare safety were recorded. Scores for 7 dimensions were calculated for all of the included NHs. Further modelling identified predictive factors. RESULTS: 58 NHs were included. The response rate for the NHSOPS-F (n = 1946 professionals) was 64% (Q1-Q3 = [49.4;79.0]). Staffing was the least-developed dimension (11.8%), while scores were highest for Feedback and communication about incidents (84.8%). Being attached to a public hospital was associated with poorer perceptions of SC, notably for the dimension "Overall perceptions of resident safety and organizational learning" (ß = - 19.59;p-value< 0.001). A less-developed SC was also significantly linked to existing Quality initiatives. CONCLUSIONS: Overall, French NHs must prioritise issues of staffing, teamwork and compliance with procedures. The role of human factors within teams should be exploited by top management. Our initial findings will help to adapt improvement approaches and are particularly relevant to local and national policies during the ongoing pandemic.

Assessing the Acceptability and Feasibility of a Web-Based Screening for Psychoactive Substance Users Among a French Sample of University Students and Workers: Mixed Methods Prospective Study.

BACKGROUND: Early detection in the prevention of addictive behaviors remains a complex question in practice for most first-line health care workers (HCWs). Several prevention measures have successfully included a screening stage followed by a brief intervention in case of risk-related use or referral to an addiction center for problematic use. Whereas early detection is highly recommended by the World Health Organization, it is not usually performed in practice. OBJECTIVE: The aim of this study was to assess the acceptability and feasibility of a web-based app, called Pulsio Santé, for health service users and first-line prevention HCW and to carry out an exhaustive process of early detection of psychoactive substance use behaviors. METHODS: A mixed methods prospective study was conducted in 2 departments: HCWs from the regional occupational health department and from the university department of preventive medicine dedicated to students were invited to participate. Participants 18 years or older who had been seen in 2017 by a HCW from one of the departments were eligible. The study procedure comprised 5 phases: (1) inclusion of the participants after a face-to-face consultation with an HCW; (2) reception of a text message by participants on their smartphone or by email; (3) self-assessment by participants regarding their substance use with the Pulsio Santé app; (4) if participants agreed, transfer of the results to the HCW; and (5) if participants declined, a message to invite them to get in touch with their general practitioner should the assessment detect a risk. Several feasibility and acceptability criteria were assessed by an analysis of a focus group with the HCW that explored 4 themes (usefulness and advantages, problems and limitations, possible improvements, and finally, integration into routine practice). RESULTS: A total of 1474 people were asked to participate, with 42 HCWs being involved. The percentage of people who agreed to receive a text message or an email, which was considered as the first level of acceptability, was 79.17% (1167/1474). The percentage of participants who clicked on the self-assessment link, considered as the second level of acceptability, was 60.24% (703/1167). The percentage of participants who completed their self-evaluation entirely, which was considered as the first level of feasibility, was 76.24% (536/703). The percentage of participants who shared the results of their evaluation with the HCWs, considered as the second level of feasibility, was 79.48% (426/536). The qualitative study showed that there were obstacles on the side of HCWs in carrying out the recommended interventions for people at risk based on their online screening, such as previous training or adaptations in accordance with specific populations. CONCLUSIONS: Quantitative results showed good acceptability and feasibility of the Pulsio Santé app by users and HCWs. There is a need for further studies more directly focused on the limitations highlighted by the qualitative results.

Psychosocial and Organizational Processes and Determinants of Health Care Workers' (HCW) Health at Work in French Public EHPAD (Assisted Living Residences): A Qualitative Approach Using Grounded Theory.

In a context marked by negative health indicators that make structural aspects more salient, this paper aimed at understanding and explaining the processes and determinants at work that positively and negatively interfere with the professionals' health in the French public nursing home environment. To this purpose, the qualitative approach by grounded theory was chosen. In total, 90 semi-structured interviews were recorded and 43 were transcribed; in addition, 10 observations of 46 participations in meetings and working groups were carried out in four public service and hospital establishments. Our results indicate that the role of health workers, its definition, and its execution are fundamental to the understanding of their health at work. Two protective and constructive processes are involved in the maintenance and development of the professionals' health in this work, with considerable confrontations with death and suffering: individual and collective control of emotional and cognitive commitment, and the development of resources for formation, information, and cooperation. Nonetheless, they are jeopardized when a lasting imbalance is generated between the work's demands and the available resources. This leads to a loss spiral in organizational, inter-individual, and individual resources that makes it difficult to sustain work.

Decreasing patient-reported burden of treatment: A systematic review of quantitative interventional studies.

OBJECTIVES: To describe and analyse studies aiming at quantitatively assessing the impact of interventions on patient-reported burden of treatment as an outcome (primary or secondary). METHODS: The aim of the search strategy was to identify all publications describing a medical intervention intended to reduce patient-reported burden of treatment in adult patients with long-term conditions, from January 1, 2008 to July 15, 2019. Four databases (Medline, PsycINFO, the "Trials" section of the Cochrane-Library, and OpenGrey) were searched in English, French, Spanish, Italian and Portuguese. Each identified article was reviewed and the risk of bias was assessed using a tool adapted from the Cochrane Collaboration recommendations. RESULTS: Of 641 articles retrieved, 11 were included in this review. There were nine randomized controlled trials, one non-randomized controlled trial, and one before-and-after study. The sample sizes ranged from 55 to 1,546 patients. Eight out of the eleven studies reported significant positive outcomes of the studied interventions. Reducing dosing frequency, improving background therapy, offering home care or providing easier-to-use medical devices were associated with positive outcomes. CONCLUSIONS: Only a few studies have specifically focused on decreasing the subjective burden of treatment. Small trials conducted in patients with a single specific disorder have reported positive outcomes. However, a large, high-quality study assessing the impact of a change in care process in patients with multiple morbidities did not show such results. Further studies are needed to implement this aspect of patient-centred care.

Risk of seropositivity to Coxiella burnetii in humans living in areas with endemically infected cattle: No way for specific prevention.

Q fever, a zoonotic disease caused by Coxiella burnetii, is endemic among cattle in Western France. However, studies assessing the risk of human infection in such areas are lacking to date, while they may provide information about key specific preventive actions which could be advised to the human populations living with or close to cattle. Therefore, we conducted a cross-sectional study in two departments of Western France during the 2017/18 winter in order to explore possible risk factors for seropositivity among two distinct populations, i) an occupational risk group, that is, the cattle farmers, and ii) the general adult population (approached by blood donors). Sera were collected in 176 cattle farmers and 347 blood donors respectively, and tested for phase I and II antibodies using an indirect immunofluorescence antibody assay. Each participant was asked to fill in a questionnaire containing socio-demographic characteristics, occupational and non-occupational risk exposure. Identified risk factors were: in the general population, working in contact with ruminants, comparatively to any other activity (OR = 4.41; 95% CI: [1.59-6.55]); among farmers, managing an itself infected cattle herd (OR = 3.20; 95% CI: [1.59-6.55]). No other controllable risk factor (lifestyle, outdoor activities, proximity to pets and livestock animals, occupational practices) was here evidenced. In areas with endemically infected cattle, human exposure to Coxiella burnetii is to some extent unavoidable. This strengthens the need for physicians' awareness of the symptoms of Q fever and the appropriateness of general biosecurity measures, especially among at-risk groups living there.

Contours et organisations des activités de santé publique au sein des centres hospitaliers universitaires français.

PURPOSE OF RESEARCH: This study, conducted at the initiative of the French academic college of public health, aimed to describe, from the point of view of public health physicians, the outlines and organization of public health activities within French university hospitals. In the first half of 2018, a survey was sent to physicians in charge of public health specialties and to chiefs of public health divisions from the 41 French university hospitals. The survey was supplemented by 10 telephone interviews. RESULTS: Among the 33 hospitals from which we received answers, 28 had a division that encompassed the majority of public health activities, usually combined with other disciplines (occupational medicine, pharmacy…). The existence of a public health division improved the visibility of this specialty and allowed to leverage its strengths. Epidemiology, biostatistics and health information were the most represented activities. Several public health activities were shared with other divisions and directions (healthcare quality and safety, infection control, etc.), due, in part, to a lack of public health physicians. Most respondents cited health promotion, health economics and big data analytics as activities that need to be developed in their institution. CONCLUSION: While most institutions have an identified public health division, their organizations are still heterogeneous and constantly evolving. Despite several difficulties, hospital public health activities are more diversified than before, but need the collaboration of extra hospital public health departments to progress.

Local characteristics associated with higher prevalence of ESBL-producing Escherichia coli in community-acquired urinary tract infections: an observational, cross-sectional study.

OBJECTIVES: The prevalence of ESBL-producing Escherichia coli (ESBL-E. coli) in community-acquired urinary tract infections (UTI) has been increasing worldwide since 2000, but with large geographical variations. The aim of this study was to determine whether the ESBL-E. coli rate in urine samples from individuals with community-acquired UTI was associated with the local socio-economic, environmental, agricultural and healthcare characteristics. METHODS: This was a cross-sectional study in western France using data on antibiotic susceptibility of E. coli isolated from urine samples of individuals with community-acquired UTI analysed in non-hospital laboratories from 2015 to 2017. The ESBL-E. coli rate was calculated for each laboratory. Data on socio-economic characteristics, human antibiotic consumption, hospital bed density, animal farming density and percentage of agricultural land and surface water were retrieved at the municipality level and aggregated by study area. Their association with ESBL-E. coli prevalence was quantified using multivariate linear regression models with a backward selection. RESULTS: From 358 291 E. coli isolates from urine samples tested in 92 laboratories, the mean ESBL-E. coli prevalence for the study period was 3.30%. In an adjusted model, the ESBL-E. coli rate was significantly (P < 0.05) and positively associated with the local percentage of people >65 years old, third-generation cephalosporin use (DDD/1000 inhabitants), number of hospital beds/km2, poultry density, pig density and percentage of agricultural land. Lower deprivation was associated with a higher ESBL-E. coli rate. CONCLUSIONS: Several anthropogenic factors (primary care, hospitals and animal farming) are associated with the local ESBL-E. coli rate in community-acquired UTI. These results could contribute to improve risk management, including identification of at-risk patient groups.

Incidence, criticality and typology of care-related adverse events in nursing homes based on initial epidemiological characteristics and possible prevention measures in France.

Knowledge of care-related adverse events in nursing homes in France is limited. An observational descriptive study was conducted in 25 nursing homes over a period of two weeks between 2016 and 2017. This study aimed to describe types of care-related adverse events and to assess their severity, the frequency with which they occurred, and their criticality. Eighty-six types of care-related adverse events, associated with 13 risk areas, were identified (31 of which were identified by an investigating physician). Of these types of events, 11 corresponded to an unacceptable level of criticality, and 13 were categorised as warranting surveillance. Efforts in nursing homes should focus on the different types of care-related adverse event: loss of or damage to a medical device, failure to administer medication, failure to coordinate between different establishments, shortfalls in planning and continuity of care, shortfalls in the information system, loss of or damage to laundry items, and unauthorised exit from the premises. Broad recommendations on preventing adverse events and improving nursing homes should be the subject of future study.

Risk Factors of Extended-Spectrum Beta-Lactamases-Producing Escherichia coli Community Acquired Urinary Tract Infections: A Systematic Review.

PURPOSE: The prevalence of extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-EC) has been increasing worldwide since the early 2000s. E. coli is found in 70-90% of community-acquired urinary tract infections (CA-UTIs). We performed a systematic literature review to determine the risk factors for CA-UTI caused by ESBL-EC. METHODS: We searched the MEDLINE, Cochrane Library, Embase and Web of Science databases without language or date restriction up to March 2019. Two independent reviewers selected studies with quantified risk factors for CA-UTI due to ESBL-EC, and assessed their quality using the Newcastle-Ottawa Scale. RESULTS: Among the 5,597 studies identified, 16 observational studies (n=12,138 patients) met the eligibility criteria. The included studies were performed in various countries, and 14/16 were published after 2012. The most relevant risk factors for CA-UTI due to ESBL-EC identified were prior use of antibiotics (odds ratio (OR) from 2.2 to 21.4), previous hospitalization (OR: 1.7 to 3.9), and UTI history (OR: 1.3 to 3.8). Two risk factors were related to environmental contamination: travelling abroad, and swimming in freshwater. CONCLUSION: Our findings could allow adapting empiric antibiotic treatments according to the patient profile. Further studies are needed to quantify the relationships between CA-UTI due to ESBL-EC and the environment.

[Incidence, criticality and typology of care-related adverse event in nursing homes: first French epidemiological characteristics and prevention perspectives]. / Incidence, criticité et typologie des évènements indésirables en Ehpad : premières caractéristiques épidémiologiques françaises et perspectives de prévention.

Knowledge in France on the subject of care-related adverse events in the nursing home sector is sparse. An observational descriptive study was conducted in 25 nursing homes over a period of 2 weeks over periods of two weeks between 2016 and 2017. It aimed to describe the types of care-related adverse event, and to assess their seriousness, frequency of occurrence, and criticality. Eighty-six types of care-related adverse event belonging to 13 risk domains were identified (31 by the investigating physician). Among these types of event, 11 corresponded to an unacceptable level of criticality, and 13 were categorised as warranting surveillance. Efforts in nursing homes should focus on the various types of care-related adverse event: loss of or damage to a medical device; failure to administer a medication; failure to coordinate between structures; shortfalls in planning and care continuity; shortfalls in the information system; loss of or damage to laundry items; unplanned escapade. Recommendations on the main lines of prevention and improvement in nursing homes should be the subject of future study.