Propositions pour la prévention et la promotion de la santé bucco-dentaire chez les enfants.

At the last congress of the Association Dentaire Française (ADF) (French Dental Association), the minister of health and prevention, François Braun, stressed the importance he attached to oral health prevention. He also emphasized his desire to roll out and extend prevention campaigns, targeting young people in particular. With this in mind, we are working to lay the political foundations for the mass, free distribution of single-use toothbrushes with fluoride toothpaste in schools. This oral health promotion campaign would aim to debunk any myths or misinformation spread by manufacturers and to encourage a profound cultural change in the way children and their parents learn about oral hygiene. The "cavity-score," which is still under development, could help to reinforce the idea, both among the general public and among healthcare professionals, that oral health is not isolated from the rest of the body, and that this health issue cannot be dealt with in isolation, but in conjunction with all healthcare professionals.

Promouvoir la santé des personnes transgenres et de genre divers au sein des systèmes de santé : une revue systématique de la littérature communautaire.

INTRODUCTION: Transgender and gender diverse people (TGD) represent a large and growing portion of the general population who face individual and systemic barriers in accessing care. The socio-cultural context and lack of organization of care place them in a vulnerable situation and there is a need to develop sustainable health promotion strategies. PURPOSE OF RESEARCH: The aim of this participatory study is to establish an overview of the barriers and opportunities for promoting the health of TGD people. To do so, it relies on the expertise of NGOs and aims to produce a thematic synthesis that will support policy-making. RESULTS: We centralized the resources of 18 French and European organizations and included 25 eligible documents following a quality analysis. 3047 data were extracted and coded, then developed into 5 themes that allowed us to model the actions, barriers and opportunities to improve care for the TGD population. CONCLUSIONS: Health promotion of TGD people focuses on discrimination, care pathways, access to care, transmission of knowledge and research. The main obstacles are the role of medical specialists, pathologization, epistemic injustice and the low political priority of their health issues. The main opportunities will rely on ensuring that decision-making allows for the implementation of a pragmatic and collaborative health policy in this context.

The oral care practices and needs of older adults in nursing homes: Assessment of carers and patients / Pratiques et besoins de soins bucco-dentaires en EHPAD : évaluation des soignants et des patients

Good oral health preservation in nursing homes is hampered by the lack of caregivers, who are often inadequately trained, which has an impact on patients' quality of life. The aim was to assess caregivers' practices and the objective and perceived oral care needs of patients in nursing homes. A cross-sectional survey was conducted between September 15 and November 24, 2021, in three nursing homes in Mayenne (France). A self-administered questionnaire was used to identify oral care practices and caregivers' training needs. The care needs and oral health related quality of life of patients were assessed by a single dental surgeon using the OHAT and the GOHAI questionnaire. Assessments were done with 30.8 percent of caregivers, and 40.0 percent and 36.2 percent of patients for OHAT and GOHAI respectively. Oral cavity and prosthesis examinations were systematically carried out by 4.9 percent and 24.4 percent of caregivers respectively. Fifty percent of the nurses had never performed oral care. A need for practical training was expressed by 75.6 percent of the caregivers. The mean GOHAI and OHAT scores were 56.17 ± 5.69 and 6.01 ± 2.42. These scores were significantly correlated (rho=-0.34; p=0.002). Preventive oral care in nursing homes is necessary to maintain residents' quality of life. Efforts must be made to provide training for caregivers and to simplify oral care procedures for patients.

Le maintien d'une bonne santé orale en EHPAD se heurte au manque de soignants, de surcroît souvent insuffisamment formés, ce qui impacte la qualité de vie des patients. L'objectif était d'évaluer les pratiques des soignants et les besoins en soins oraux des patients objectifs et ressentis en EHPAD. Une enquête transversale a été réalisée du 15 septembre au 24 novembre 2021 dans 3 EHPADs de Mayenne. Un auto-questionnaire a été utilisé pour identifier les pratiques de soins et les besoins de formation des soignants. Les besoins de soins et la qualité de vie en lien avec la santé orale des patients ont été évalués par un seul chirurgien-dentiste à partir de la grille OHAT et du questionnaire GOHAI. Les évaluations ont concerné 30,8% des soignants ainsi que 40,0% et 36,2% des patients pour l'OHAT et le GOHAI. Les examens de la cavité orale et des prothèses dentaires étaient systématiquement réalisés par respectivement 4.9% et 24,4% des soignants. Les soins de bouche n'étaient jamais réalisés par 50,0% des infirmiers. Un besoin de formation pratique était exprimé par 75,6% des soignants. Les scores GOHAI et OHAT moyens étaient de 56,17 ± 5,69 et 6,01 ± 2,42. Ces scores étaient significativement corrélés (rho=-0,34 ; p=0.002). Les actions de prévention orale dans les EHPADs sont nécessaires pour maintenir la qualité de vie des résidents. Des efforts doivent être consentis pour la formation des soignants et la simplification du parcours de soins bucco-dentaires des patients.

Building an empowerment program to improve the health of patients with severe mental disorders / Exemple de coconstruction d'un programme d'empowerment en faveur de la santé des personnes vivant avec des troubles psychiques

Introduction: Risk factors and cardiovascular diseases are overrepresented in people with severe and persistent mental disorders. A person diagnosed with schizophrenia or bipolar disorder is two to three times more likely to die of cardiovascular disease than the general population. Purpose of research: An empowerment program has been co-created to reduce these health inequalities. It is one part of the COPsyCAT project. The people-centered approach has been used. The participation of the patients, caregivers, and health professionals was decisive. Results: Stakeholders redefined the objectives of the program. The aim is to improve quality of life, rather than reducing cardiovascular risk. Existing tools -that have been evaluated for their usability - were selected to allow for self-directed patient orientation, so that the constraints between psychiatry and primary care could be circumvented. The program is based on the pooling of existing resources in a territory. The individual power of action and the organization of healthy offers are thus designed to reinforce each other. Conclusions: This article concretely describes the steps through to which the COPsyCAT empowerment program was designed, in co-construction by the researchers of the study, the users and user associations and healthcare professionals at based on their experiential knowledge. The feasibility of the program and the appropriation of tools in real situations will soon be evaluated. The measure of the program's effectiveness on cardiovascular risk will come in second time.

Introduction: Au sein de la population présentant des troubles psychiques sévères et persistants, on observe une surreprésentation des facteurs de risque et des pathologies cardiovasculaires. Une personne chez qui un diagnostic de schizophrénie ou de troubles bipolaires a été porté aurait deux à trois fois plus de risque de mourir d'une maladie cardiovasculaire que la population générale. But de l'étude: Dans le cadre du projet « Collaboration patient-soignant pour une meilleure prise en charge des troubles cardiovasculaires des patients souffrant de troubles psychiques au long cours ¼ (COPsyCAT), un programme d'empowerment a été coconstruit pour réduire ces inégalités de santé. La prise en compte de l'expérience et des besoins des patients, de leurs aidants et des professionnels de santé est au cœur de chacune des étapes méthodologiques suivies pour la création du programme. Résultats: Les parties prenantes ont défini le programme comme devant viser l'amélioration de la qualité de vie et non la réduction du risque cardiovasculaire. Des outils ont été sélectionnés selon leur maniabilité pour permettre l'orientation autogérée des patients, de telle sorte que les contraintes inhérentes aux cloisonnements entre psychiatrie et soins primaires soient contournées. Le programme se base sur la mutualisation des ressources existantes sur un territoire. Pouvoir d'agir individuel et construction de contexte favorable à la santé sont ainsi pensés pour se renforcer mutuellement et agir sur des leviers réformateurs. Conclusions: Cet article décrit concrètement les étapes grâce auxquelles le programme d'empowerment COPsyCAT a été conçu, en coconstruction par les chercheurs de l'étude, les usagers et associations d'usagers et les professionnels de santé à partir de leurs savoirs expérientiels. La faisabilité du programme et l'appropriation des outils en situation réelle va être prochainement évaluée. La mesure de l'efficacité du programme sur le risque cardiovasculaire viendra dans un second temps.

The impact of COVID-19 on psychiatric and mental health services in Europe: suffering experienced by professionals.

BACKGROUND: The COVID-19 pandemic has not only impacted intensive care units, but all healthcare services generally. This PsyGipo2C project specifically investigates how psychiatry and mental health professionals have been affected by the reorganizations and constraints imposed, which have reshaped their often already difficult working conditions. METHODS: Our research combined quantitative and qualitative methods, surveying and interviewing health professionals of all occupations working in psychiatric and mental health services. A questionnaire was completed by 1241 professionals from 10 European countries, and 13 group interviews were conducted across 5 countries. In addition to this, 31 individual interviews were conducted in Belgium and France. RESULTS: Among the questionnaire respondents, 70.2% felt that their workload had increased, particularly due to their tasks being diversified and due to increased complexity in the provision of care. 48.9% felt that finding a work-life balance had become more difficult, and 59.5% felt their health had been affected by the crisis. The impact of the health crisis nevertheless varied across professions: our data provides insight into how the health measures have had a differential impact on professional tasks and roles across the various categories of occupations, obliging professionals to make various adaptations. The distress incurred has been linked not only to these new constraints in their work, but also to the combination of these with other pressures in their personal lives, which has consequently compromised their well-being and their ability to cope with multiple demands. DISCUSSION: The COVID-19 health crisis has had varying impacts depending on the profession and access to remote work, sometimes leading to conflicts within the teams. The suffering expressed by the professionals was tied to their values and patterns of investment in work. Our research also highlights how these professionals made little use of the psychological supports offered, probably due to a reluctance to acknowledge that their mental health was affected.

Is There a Link between Oropharyngeal Microbiome and Schizophrenia? A Narrative Review.

The study aimed to examine the impact of the oropharyngeal microbiome in the pathophysiology of schizophrenia and to clarify whether there might be a bidirectional link between the oral microbiota and the brain in a context of dysbiosis-related neuroinflammation. We selected nine articles including three systemic reviews with several articles from the same research team. Different themes emerged, which we grouped into 5 distinct parts concerning the oropharyngeal phageome, the oropharyngeal microbiome, the salivary microbiome and periodontal disease potentially associated with schizophrenia, and the impact of drugs on the microbiome and schizophrenia. We pointed out the presence of phageoma in patients suffering from schizophrenia and that periodontal disease reinforces the role of inflammation in the pathophysiology of schizophrenia. Moreover, saliva could be an interesting substrate to characterize the different stages of schizophrenia. However, the few studies we have on the subject are limited in scope, and some of them are the work of a single team. At this stage of knowledge, it is difficult to conclude on the existence of a bidirectional link between the brain and the oral microbiome. Future studies on the subject will clarify these questions that for the moment remain unresolved.

Psychiatric and primary care professionals' suggestions for reducing cardiovascular risks for psychiatric patients / Propositions des professionnels pour réduire le risque cardiovasculaire des patients psychiatriques

INTRODUCTION: Cardiovascular diseases represent one of the major causes of mortality in France and are the main cause of excess mortality in people suffering from long-term mental disorders (LTMD), apart from causes related to suicide. AIM OF THE STUDY: The aim of this article is to identify, from the point of view of primary care and psychiatric professionals, psychiatric users’ expectations and needs in order to help them improve their medical and paramedical management of cardiovascular risk (CVR). METHOD: This is a prospective, multi-centered qualitative study carried out in two phases: An exploratory phase, with individual interviews at the beginning of the study to enable the creation of ad hoc collective interview grids, followed by a proper qualitative study, which is in line with medical anthropology and the sociology of health systems. RESULTS: The 30 psychiatric professionals interviewed agreed on the need for better coordination with out-of-hospital care providers. Even if openness is advocated, there is a reminder of the specificities of psychiatry and the importance of taking these specificities into account in general. The 26 primary care professionals show a desire to learn more about psychiatric disorders, pathologies, and treatments in order to facilitate the management of these patients with specific needs. CONCLUSION: The cross-referencing of these results will allow to propose an appropriate intervention in order to induce convincing effects on the reduction of the CVR in people suffering from LTMD.

Introduction: Les maladies cardio-vasculaires représentent une des causes majeures de mortalité en France. Elles sont la cause principale de surmortalité des personnes souffrant de troubles psychiques au long cours (TPLC) en dehors des causes liées au suicide. But de l'étude: Cet article vise à identifier, selon le point de vue de professionnels de soins primaires et de la psychiatrie, leurs attentes et leurs besoins pour apporter aux usagers de la psychiatrie une meilleur prise en charge médicale et paramédicale du risque cardiovasculaire (RCV). Méthode: Il s'agit d'une étude qualitative prospective et multicentrique réalisée en deux temps : une phase exploratoire, par entretiens individuels en début d'étude afin de permettre la création des grilles d'entretiens collectifs ad hoc, suivie d'une étude qualitative proprement dite, qui s'inscrit dans la lignée de l'anthropologie médicale et de la sociologie des systèmes de santé. Résultats: Les 30 professionnels de la psychiatrie interrogés s'accordent sur la nécessité d'une meilleure coordination avec les soignants en extra hospitalier. Même si une ouverture est prônée, on observe un rappel des spécificités de la psychiatrie et l'importance d'une prise en compte générale de ces spécificités. Les 26 professionnels de soins primaires témoignent d'une volonté de mieux connaître les troubles, pathologies et traitements psychiatriques pour faciliter la prise en charge de ces patients à besoins spécifiques. Conclusion: Le croisement de ces résultats permettra de proposer une intervention appropriée en vue d'induire des effets probants sur la réduction du RCV chez les personnes souffrant de TPLC.

Reducing cardiovascular risk in people living with long-term psychiatric disorders / Réduire le risque cardiovasculaire chez les personnes vivant avec des troubles psychiques

INTRODUCTION: This qualitative study based on focus group study aims to identify experiences, expectations, and representations of people with long-term mental illness and their caregivers regarding cardiovascular disease and its risk factors. The aim of this work is to build a cardiovascular risk reduction program for people affected by long-term mental illness. RESULTS: Four major themes were identified in the corpus: (1) knowledge concerning physical health, (2) barriers to the implementation of better practices, (3) levers towards a healthier life and (4) expectations and needs for a better lifestyle. CONCLUSIONS: This work has provided us with concrete elements for the creation of a cardiovascular risk reduction program for people living with long-term mental illness. The challenges of this program will be to adapt to the needs and expectations of people living with long-term mental illness while facilitating the role of caregivers.

Introduction: Cette étude qualitative, basée sur des Focus Groups, vise à identifier les expériences, attentes et représentations des personnes ayant des troubles psychiques au long cours (TPLC) ainsi que des aidants concernant les maladies cardiovasculaires et leurs facteurs de risque. Le but de ce travail est de construire un programme de réduction du risque cardiovasculaire (CV), destiné aux personnes concernées par ces troubles. Résultats: Quatre thèmes majeurs ont été identifiés dans le corpus : (1) les connaissances et acquis concernant la santé physique, (2) les freins à la mise en place de meilleures pratiques, (3) les leviers vers une vie plus saine et (4) les attentes et besoins pour une meilleure hygiène de vie. Conclusions: Ce travail nous a fourni des éléments concrets pour la création d'un programme de réduction du risque CV pour les personnes vivant avec un TPLC. Les enjeux de ce programme seront de s'adapter aux besoins et aux attentes des personnes vivant avec un TPLC tout en facilitant le rôle des aidants.

Repenser les partenariats entre écoles primaires et secteurs de psychiatrie infanto-juvénile en temps de COVID-19.

INTRODUCTION: On a global scale, bringing together schools and public child psychiatry services is favored to promote the development of early interventions that could improve health trajectories, from prevention to treatment, for children exposed to psychological and psychiatric difficulties. In a public health perspective, contextualizing these practices is essential in order to ensure their sustainability and efficiency. This article sheds light on the stakes of these partnerships and their advantages in responding to the health, social, and economic mark that has been left behind by the crisis accompanying the brutal onset of the Covid-19 epidemic. AIMS: Improving the health care management for children with mental health problems or problems of a psychological nature implies taking into account their environment beyond the therapeutic framework. Interventional research, currently underway, is taking place in several sites in France: primary schools, Medical-psychological centers (CMP), and Local Committees on Mental Health (CLSM). The goal is to provide an inventory and an analysis of the partnership and interventional structures that are most efficient, based on the needs and available resources at each site. This research envisages a diversification and a contextualization of the offer of care, with great concern for equity and therapeutic efficacy, starting from school. RESULTS: More than simple results, our aim is to make suggestions as to how to better accompany the end of confinement and the months to come. The development of partnerships in regions that are strongly marked by social and economic inequalities is a priority in terms of public health and the direction of local policies. These partnerships would contribute to a global strategy of evaluating the needs and the personalized accompaniment of children. Formalizing the intervention with the interface being the school sector will support the school staff in overcoming the health crisis that is affecting their institution. The steady rise of CLSMs will enhance local coordination and collaboration to help the most psychologically vulnerable children and aid their parents, given their situation, to support the development of their children. CONCLUSION: Restoring human and material resources to existing structures, notably in the sector of child psychiatry so that it can accomplish its public service mission seems to be a priority today. Establishing school-CMP-CLSM partnerships can contribute to providing local policy direction in the interest of elaborating individual and collective strategies that can ensure needs-adapted care that is accessible to as many children as possible.

[Rethinking partnerships between primary schools and child psychiatry public health services in times of COVID-19]. / Repenser les partenariats entre écoles primaires et secteurs de psychiatrie infanto-juvénile en temps de COVID-19.

INTRODUCTION: On a global scale, bringing together schools and public child psychiatry services is favored to promote the development of early interventions that could improve health trajectories, from prevention to treatment, for children exposed to psychological and psychiatric difficulties. In a public health perspective, contextualizing these practices is essential in order to ensure their sustainability and efficiency. This article sheds light on the stakes of these partnerships and their advantages in responding to the health, social, and economic mark that has been left behind by the crisis accompanying the brutal onset of the Covid-19 epidemic. AIMS: Improving the health care management for children with mental health problems or problems of a psychological nature implies taking into account their environment beyond the therapeutic framework. Interventional research, currently underway, is taking place in several sites in France: primary schools, Medical-psychological centers (CMP), and Local Committees on Mental Health (CLSM). The goal is to provide an inventory and an analysis of the partnership and interventional structures that are most efficient, based on the needs and available resources at each site. This research envisages a diversification and a contextualization of the offer of care, with great concern for equity and therapeutic efficacy, starting from school. RESULTS: More than simple results, our aim is to make suggestions as to how to better accompany the end of confinement and the months to come. The development of partnerships in regions that are strongly marked by social and economic inequalities is a priority in terms of public health and the direction of local policies. These partnerships would contribute to a global strategy of evaluating the needs and the personalized accompaniment of children. Formalizing the intervention with the interface being the school sector will support the school staff in overcoming the health crisis that is affecting their institution. The steady rise of CLSMs will enhance local coordination and collaboration to help the most psychologically vulnerable children and aid their parents, given their situation, to support the development of their children. CONCLUSION: Restoring human and material resources to existing structures, notably in the sector of child psychiatry so that it can accomplish its public service mission seems to be a priority today. Establishing school-CMP-CLSM partnerships can contribute to providing local policy direction in the interest of elaborating individual and collective strategies that can ensure needs-adapted care that is accessible to as many children as possible.

Démographie des chirurgiens-dentistes en région Centre-Val de Loire : opportunités et perspectives.

The Center Val de Loire region is particularly affected by the shortage of health professionals. The demographics of dentists are not immune to this situation and the retirement of a practitioner has become a real public health issue. For this purpose, bridges were created between the faculties of odontology of Nantes, Clermont-Ferrand and the Faculty of Medicine of Tours, to welcome short cycle students in Center Val de Loire region, to create a link with the liberal practitioners and to allow the students to confront the health issues of this territory.

Consommation de soins dentaires préventifs en région Centre-Val de Loire : une étude rétrospective.

CONTEXT: The demography of dentist-surgeons in the Centre-Val de Loire region is far inferior to the national average and characterized by many territorial inequalities of health. The aim of this study is to provide details concerning the dental hygienic care-seeking consumption habits in this region based on one dental care treatment, dental scaling, which allows for the mechanical elimination of dental plaque in order to prevent periodontal diseases. METHOD: This retrospective study is based on data from several databases of the National Health Insurance Cross-Schemes Information System (Sniiram) for the year 2016, analyzed by the Statistical Institute of Liberal Health Professionals. RESULTS: It can be observed that less scaling treatments have been sought out in this region in comparison with metropolitan France and certain territories which also face difficulties in terms of care treatment offers and scaling treatment inferior to the regional average. Although the care offer is unequally distributed, it seems to have little influence on the number of treatment acts consumed per patient and notably scaling treatments. Inversely, indicators of wealth or poverty do have an impact on treatment consumption HBJD001. CONCLUSION: This study suggests that the consumption of scaling treatment is independent from the dental care offers, but linked to the social gradient of the population. It points to the deficit in the consumption of this treatment in comparison to metropolitan France. The potential role of the HBJD001 treatment as a marker of the trajectory of preventive health care as well as the necessity of the adjustment of the zones determined by the ARS are put forward.

[A caregiver-person with schizophrenia partnership to improve oral health education] / Un partenariat patients schizophrènes-soignants pour conduire un programme d'éducation en santé orale.

INTRODUCTION: Poor oral health in persons with schizophrenia is a major public health issue affecting 600,000 people in France. The aim of this article was to present the different stages in the development of a specific oral health educational program for persons with schizophrenia. It takes into account experimental knowledge of these persons and presents the results of the feasibility study. PATIENTS AND METHOD: The focus group method was applied to a group of health professionals and users to highlight an exploratory corpus in order to develop an oral health educational program. An expert group including persons with schizophrenia among others validated the fields and tools of this program. A feasibility study was then conducted in a control group of 7 persons with schizophrenia. RESULTS: Altogether, 26 persons participated in this feasibility study. The main fields investigated by the expert group aimed to promote personal responsibility for one's health, to improve access to the healthcare system and to promote the global management of health. The feasibility study showed the ability of this program to change persons with schizophrenia representations and knowledge of this health problem. Most educational tools were considered relevant. CONCLUSION: An oral health educational program was built as part of a caregiver-persons with schizophrenia partnership and showed its feasibility. A multicentric randomized trial is currently ongoing to assess the efficacy of this program with a high level of proof.

[Dentistry demographics of Center Val de Loire region: Opportunities and prospects]. / Démographie des chirurgiens-dentistes en région Centre-Val de Loire : opportunités et perspectives.

The Center Val de Loire region is particularly affected by the shortage of health professionals. The demographics of dentists are not immune to this situation and the retirement of a practitioner has become a real public health issue. For this purpose, bridges were created between the faculties of odontology of Nantes, Clermont-Ferrand and the Faculty of Medicine of Tours, to welcome short cycle students in Center Val de Loire region, to create a link with the liberal practitioners and to allow the students to confront the health issues of this territory.

Psychometric characteristics of the "General Oral Health Assessment Index (GOHAI) ¼ in a French representative sample of patients with schizophrenia.

BACKGROUND: The "General Oral Health Assessment Index" (GOHAI) was widely used in clinical or epidemiological studies worldwide, as it was available for use in different languages. Therefore, the aim of this study was to evaluate the psychometric characteristics of the GOHAI in a representative sample of patients with schizophrenia. METHODS: A total of 90 schizophrenic patients (in-patients and out-patients) were recruited from the participants of the "buccodor study" (NCT02167724) between March and September 2015. They were selected using a random stratified sampling method according to their age, sex, or residential area (urban/rural area). GOHAI validity (construct, predictive, concurrent and known group validity) and internal consistency (reliability) were tested. Test-retest reliability was evaluated in 32 subjects. RESULTS: The mean age was 47.34 (SD = 12.17). Internal consistency indicated excellent agreement, with a Cronbach's α value of 0.82 and average inter-item correlation of 0.65. Intraclass correlation coefficients for test-retest reliability with 95% confidence intervals were not significantly different (p > 0.05). Construct validity was supported by three factor that accounted for 60.94% of the variance observed. Predictive validity was corroborated as statistically significant differences were observed between a high GOHAI score, which was associated with self-perceived satisfaction with oral health, lower age and high frequency of toothbrushing. Concurrent validity was corroborated as statistically significant relationships were observed between the GOHAI scores and most objective measures of dental status. For known group validity, they was no significant difference of the mean GOHAI score between out or in-patients (p > 0.05). CONCLUSION: Acceptable psychometric characteristics of the GOHAI could help caregivers to develop ways to improve the Oral Health related Quality Of Life of schizophrenic patients. TRIAL REGISTRATION: Clinical Trials Gov NCT02167724 . Date registered 17 June, 2014.