Increasing access to fertility preservation for women with breast cancer: protocol for a stepped-wedge cluster randomized trial in France.

BACKGROUND: With the increase in the number of long-term survivors, interest is shifting from cancer survival to life and quality of life after cancer. These include consequences of long-term side effects of treatment, such as gonadotoxicity. Fertility preservation is becoming increasingly important in cancer management. International recommendations agree on the need to inform patients prior to treatments about the risk of fertility impairment and refer them to specialized centers to discuss fertility preservation. However, the literature reveals suboptimal access to fertility preservation on an international scale, and particularly in France, making information for patients and oncologists a potential lever for action. Our overall goal is to improve access to fertility preservation consultations for women with breast cancer through the development and evaluation of a combined intervention targeting the access and diffusion of information for these patients and brief training for oncologists. METHODS: Firstly, we will improve existing information tools and create brief training content for oncologists using a qualitative, iterative, user-centred and participatory approach (objective 1). We will then use these tools in a combined intervention to conduct a stepped-wedge cluster randomized trial (objective 2) including 750 women aged 18 to 40 newly treated with chemotherapy for breast cancer at one of the 6 participating centers. As the primary outcome of the trial will be the access to fertility preservation counselling before and after using the combined intervention (brochures and brief training for oncologists), we will compare the rate of fertility preservation consultations between the usual care and intervention phases using linear regression models. Finally, we will analyse our approach using a context-sensitive implementation analysis and provide key elements for transferability to other contexts in France (objective 3). DISCUSSION: We expect to observe an increase in access to fertility preservation consultations as a result of the combined intervention. Particular attention will be paid to the effect of this intervention on socially disadvantaged women, who are known to be at greater risk of inappropriate treatment. The user-centred design principles and participatory approaches used to optimize the acceptability, usability and feasibility of the combined intervention will likely enhance its impact, diffusion and sustainability. TRIAL REGISTRATION: Registry: ClinicalTrials.gov. TRIAL REGISTRATION NUMBER: NCT05989776. Date of registration: 7th September 2023. URL: https://classic. CLINICALTRIALS: gov/ct2/show/NCT05989776 . PROTOCOL VERSION: Manuscript based on study protocol version 2.0, 21st may 2023.

« C'est pas la pilule qui ouvre la porte du frigo ! ¼. Violences médicales et gynécologiques en consultation de contraception.

INTRODUCTION: In France, “the pill crisis” has brought into question the centrality of oral contraception within the “contraceptive standard”, as well as the drawbacks associated with its use, and is more widely part of a dynamic of raising awareness about medical and gynecological violence, at work since the early 2010s. PURPOSE OF RESEARCH: This paper intends to question the medical and gynecological violence faced by women seeking medical attention in order to access what is supposed to be a condition for their emancipation : contraception. METHOD: As part of a sociological research project on the prescriptions and uses of oral contraception, nearly seventy interviews were conducted with seventeen users of oral contraception and thirty-one health professionals authorized to prescribe contraception. Ninety-five medical and gynecological consultations were also observed, in both public and private medical facilities. RESULTS: The use of oral contraception requires regular medical consultation, increasingly exposing users to the risk of medical and gynecological violence, with lack of consent at its core. The case study of a gynecological consultation, as well as the analysis of interviews and observations, reveal various forms of medical violence, with a focus on the patients’ dependence on the medical profession. CONCLUSIONS: The interconnectedness of these different forms of medical and gynecological violence encourages us to consider them as part of a continuum of gender violence. An ethical caring stance makes it possible to guard against these situations.

Epidaure Market-Effectiveness and transferability of a school-based intervention to improve healthy and sustainable food choices by schoolchildren: Protocol of a randomized controlled trial and qualitative study.

CONTEXT: At least 40% of cancers are linked to environmental or behavioral factors, and dietary behavior appears to be a major lever. Epidaure Market is a prevention initiative developed using a method for co-constructing health promotion initiatives and prevention programs that stratifies evidence from the scientific literature and combines it with experiential knowledge (DEVA, TPB, BCT). It promotes a sustainable diet (i.e., healthy, ecological and ethical nutrition) among 5th and 4th grade students during the crucial period of adolescence, when these behaviors are often far from the recommendations. METHOD: The protocol implemented was carried out in 72 middle school classes in the Montpellier and Dijon academies. The intervention included teaching sessions and a virtual supermarket game, integrated into the school curriculum and delivered by science teachers. Effectiveness is tested in a cluster randomized controlled trial with 3 evaluation times (pre- and post-intervention and 1 follow-up). The study also includes an implementation assessment, with process analysis and implementation elements, as well as a transferability assessment based on key functions (FIC model and Astaire grid). EXPECTED OUTCOMES: The study is still underway within the school. The primary expected outcome is a positive influence on the motives underlying food choices to move towards a sustainable diet. Secondary expectations involve changes in variables such as self-efficacy and perceived social norms, as well as an increase in knowledge about healthy eating. We also expect the qualitative approaches to provide information on the deployment process in the new territories. DISCUSSION: The study aims not only to demonstrate the effectiveness of Epidaure Market, but also to identify the optimal conditions for its nationwide implementation in France's middle schools. Ultimately, the initiative aims to help reduce the incidence of cancer by promoting healthier eating habits among teenagers.

Pour une santé publique en faveur d'une justice épistémique.

La santé publique s'oriente de plus en plus vers l'étude des structures oppressives (telles que le racisme, le sexisme, ou le validisme) et de leur influence sur le marché de l'emploi, les systèmes éducatifs et judiciaires, et l'accès aux systèmes de santé de qualité. Ce commentaire vise à proposer une réflexion sur la manière dont ces structures influencent également la façon de faire de la santé publique. À travers le concept d'injustice épistémique, qui décrit le fait que l'organisation sociale influence la possibilité de connaître et de faire valoir sa connaissance dans une société donnée, nous montrons qu'en tant qu'acteur.rice de santé publique, nous pouvons reproduire et renforcer des injustices sociales. Les injustices épistémiques sont la plupart du temps le fruit de structures et de pratiques quotidiennes. Il est nécessaire de développer l'utilisation d'outils permettant de favoriser la réflexivité pour faciliter la mise en perspective des injustices et des privilèges.