French Data Research Articles

Olaparib First-Line Maintenance Monotherapy in BRCA-Mutated Epithelial Ovarian Cancer: Descriptive Analysis of the First French Real-World Data Study.

Olaparib, a poly(ADP-ribose) polymerase inhibitor, was approved by the European Commission in June 2019, following the results of the SOLO-1/GOG 3004 trial as maintenance monotherapy in adult patients with BRCA-mutated epithelial ovarian cancer. This study aimed to provide a descriptive analysis of the first real-world data from patients with BRCA-mutated ovarian cancer who received olaparib as first-line maintenance monotherapy in the French cohort Temporary Authorisation for Use (Autorisation Temporaire d'Utilisation de cohorte, ATUc) programme from 11 March, 2019 to 16 January, 2020. Eligible patients were aged 18 years and over with confirmed epithelial ovarian, primary peritoneal or Fallopian tube cancer and a deleterious or suspected deleterious germline or somatic BRCA 1/2 mutation. Patients were in complete or partial clinical response at the end of first-line platinum-based chemotherapy. Olaparib maintenance therapy was initiated within 8 weeks of the patients' last dose of chemotherapy. Real-world data were collected through treatment access request forms completed by physicians. Clinical and safety data were collected monthly until the end of the ATUc programme. A total of 107 centres in metropolitan France and the French Overseas Departments and Territories requested the inclusion for 238 patients, of whom 194 received maintenance olaparib. In total, 87.6% of the primary tumour locations were ovary, the most common histology was high-grade serous (93.0%) and the most common International Federation of Gynaecology and Obstetrics (Fédération Internationale de Gynécologie et d'Obstétrique) stage was IIIC (56.8%). BRCA testing was performed in routine practice, prior to inclusion into the ATUc programme. All patients had a BRCA mutation: 52.5% had a somatic mutation, 38.4% had a germinal mutation and 9.1% had germinal and somatic mutations. Twenty-four (12%) patients experienced serious adverse drug reactions at the last safety follow-up (17 February, 2020). The most common were anaemia (12 [6%] patients), neutropenia (3 [2%] patients) and thrombocytopenia (3 [2%] patients). The rapid enrolment into the ATUc programme highlighted the strong unmet need for patients with ovarian cancer and a BRCA mutation in first-line maintenance treatment. Olaparib was well tolerated and no new safety signals were observed in this real-world patient population.

Characteristics and outcomes of COVID-19 patients with COPD from the United States, South Korea, and Europe

Background: Characterization studies of COVID-19 patients with chronic obstructive pulmonary disease (COPD) are limited in size and scope. The aim of the study is to provide a large-scale characterization of COVID-19 patients with COPD. Methods: We included thirteen databases contributing data from January-June 2020 from North America (US), Europe and Asia. We defined two cohorts of patients with COVID-19 namely a ‘diagnosed’ and ‘hospitalized’ cohort. We followed patients from COVID-19 index date to 30 days or death. We performed descriptive analysis and reported the frequency of characteristics and outcomes among COPD patients with COVID-19. Results: The study included 934,778 patients in the diagnosed COVID-19 cohort and 177,201 in the hospitalized COVID-19 cohort. Observed COPD prevalence in the diagnosed cohort ranged from 3.8% (95%CI 3.5-4.1%) in French data to 22.7% (95%CI 22.4-23.0) in US data, and from 1.9% (95%CI 1.6-2.2) in South Korean to 44.0% (95%CI 43.1-45.0) in US data, in the hospitalized cohorts. COPD patients in the hospitalized cohort had greater comorbidity than those in the diagnosed cohort, including hypertension, heart disease, diabetes and obesity. Mortality was higher in COPD patients in the hospitalized cohort and ranged from 7.6% (95%CI 6.9-8.4) to 32.2% (95%CI 28.0-36.7) across databases. ARDS, acute renal failure, cardiac arrhythmia and sepsis were the most common outcomes among hospitalized COPD patients. Conclusion: COPD patients with COVID-19 have high levels of COVID-19-associated comorbidities and poor COVID-19 outcomes. Further research is required to identify patients with COPD at high risk of worse outcomes.

Prescreening in oncology trials using medical records. Natural language processing applied on lung cancer multidisciplinary team meeting reports.

Defining profiles of patients that could benefit from relevant anti-cancer treatments is essential. An increasing number of specific criteria are necessary to be eligible to specific anti-cancer therapies. This study aimed to develop an automated algorithm able to detect patient and tumor characteristics to reduce the time-consuming prescreening for trial inclusions without delay. Hence, 640 anonymized multidisciplinary team meetings (MTM) reports concerning lung cancers from one French teaching hospital data warehouse between 2018 and 2020 were annotated. To automate the extraction of eight major eligibility criteria, corresponding to 52 classes, regular expressions were implemented. The RegEx's evaluation gave a F1-score of 93% in average, a positive predictive value (precision) of 98% and sensitivity (recall) of 92%. However, in MTM, fill rates variabilities among patient and tumor information remained important (from 31% to 100%). Genetic mutations and rearrangement test results were the least reported characteristics and also the hardest to automatically extract. To ease prescreening in clinical trials, the PreScIOUs study demonstrated the additional value of rule based and machine learning based methods applied on lung cancer MTM reports.

Word Segmentation on Discovered Phone Units With Dynamic Programming and Self-Supervised Scoring

Recent work on unsupervised speech segmentation has used self-supervised models with phone and word segmentation modules that are trained jointly. This paper instead revisits an older approach to word segmentation: bottom-up phone-like unit discovery is performed first, and symbolic word segmentation is then performed on top of the discovered units (without influencing the lower level). To do this, I propose a new unit discovery model, a new symbolic word segmentation model, and then chain the two models to segment speech. Both models use dynamic programming to minimize segment costs from a self-supervised network with an additional duration penalty that encourages longer units. Concretely, for acoustic unit discovery, duration-penalized dynamic programming (DPDP) is used with a contrastive predictive coding model as the scoring network. For word segmentation, DPDP is applied with an autoencoding recurrent neural as the scoring network. The two models are chained in order to segment speech. This approach gives comparable word segmentation results to state-of-the-art joint self-supervised segmentation models on an English benchmark. On French, Mandarin, German and Wolof data, it outperforms previous systems on the ZeroSpeech benchmarks. Analysis shows that the chained DPDP system segments shorter filler words well, but longer words might require some external top-down signal.

Cookies in the Context of the French Data Protection Authority's (CNIL) Google Decision and Turkish Law

Çerezler, internet üzerindeki gezinti üzerinde pozitif ve negatif olmak üzere önemli etkilere sahiptir. Genel olarak web üzerindeki gezinti performansını artırmayı amaçlayan çerezler, aynı zamanda gezinti takibi yaparak hedefli reklamcılık uygulamalarında ya da profilleme faaliyetlerinde de kullanılmaktadır. Bu yüzden çerez uygulamaları, veri koruma hukukunun önemli bir alanını oluştururlar ve AB mevzuatında düzenlenmişlerdir. 2021 yılında Google’ın çerezlerin yönetimine dair yapmış olduğu uygulamalara dair şikayetler, Fransız Veri Koruma Otoritesi (CNIL) tarafından soruşturulmuş ve Google’ın iki şirketine toplam 150 milyon Euro para cezası verilmiştir. Söz konusu karar, çerezlerin nasıl konumlandırılması gerektiğine ve yönetimine dair önemli tespitlere yer vermektedir. Makalemizde söz konusu karar ele alınacak ve karardan yola çıkarak Türk hukukunda çerezlerin düzenlenmesine ilişkin önerilere yer verilecektir.

Does Voracious Behavior favor Efficient Market Hypothesis? Role of Performance Measures

Greed plays an important in the fluctuations of stock prices because investors want profits irrespective of the risk taken by them. This study aims to determine, whether, in times of rising trends in the market, greediness is good for the investor or not. Secondly, investors can get high profits by beating the market or not. The already formed deciles portfolios of listed companies on NYSE, AMEX, and NASDAQ based on size and book to market value are taken from the Kenneth R. French data library from Dec 1994 to Dec 2021. Sharpe, Treynor, and Sortino ratios are used as the measure of the performance of portfolios. Ordinal logistic regression is used to calculate the probability at different benchmark levels to determine, whether the investor gets the profit by beating the market or not. The results show that the investor who used the Sharpe ratio has an average 85% probability of getting a profit of more than 75% of the benchmark of S&P-500 in all periods. Thus, the investors’ greediness is good in the long run if the investor considers total risk and can beat the market. By using the Sortino and Treynor ratio, there is an average 50% probability of achieving the profit up to the benchmark which is S&P-500. This means that the investors are not able to beat the market thus, support the efficient market hypothesis by considering the downside and market risk.

Marriage as insurance: job protection and job insecurity in France

Job insecurity is one of the risks that workers face on the labour market. As with any risk, individuals can choose to insure against it, and we here consider marriage as one potential source of this insurance. The 1999 rise in the French Delalande tax, paid by larger private firms when they laid off workers aged 50 or over, led to an exogenous rise in job insecurity for the uncovered (younger workers) in these larger firms. A difference-in-differences analysis using French panel data reveals that this greater job insecurity for the under-50s led to a significant rise in their probability of marriage, and especially when the partner had greater job security, consistent with marriage providing insurance against labour-market risk.

Wages and corporate social responsibility: entrenchment or ethics?

PurposeIn this article the authors examine how corporate social responsibility (CSR) affects the wage policy of firms. At the first glance, one may think that socially responsible firms want to attract employees via ethical concerns and corporate culture, thereby inducing a negative link between CSR and wages. On the other side, socially responsible firms can be expected to increase wages as social entrenchment strategies.Design/methodology/approachIn order to correct for potential endogeneity bias, the authors employ a simultaneous equation model (SEM) on a French data set that includes 13,186 employees.FindingsThe authors show that CSR has an ambiguous impact on corporate wage policy depending on the type of monetary incentives and employee's occupation considered.Originality/valueThe authors extend prior research on the CSR–wage relationship by distinguishing between different forms of monetary incentives: the base wage, total wage and premium wage. Their results draw attention to the fact that the employees' occupation do matter. The evidence confirms that the effect of CSR on the wage is not to be taken for granted: it is wage form and occupation specific.

Pre-exposure prophylaxis in France: How many MSM are eligible and how much will it cost?

Pre-exposure prophylaxis (PrEP) was definitively authorized in France in 2017 after a two-year probationary period. The fact that the estimated number of MSM eligible for PrEP is still unknown is a barrier to this prevention tool's roll-out at the national level. This study aimed to estimate the number of MSM eligible for PrEP in France, and to evaluate the direct cost of its roll-out. We used data from several sources including the Enquête Rapport au Sexe 2019-ERAS 2019 survey, the 2019 French population census from National Institute of Statistics and Economic Studies (INSEE), and the National Public Health Agency's (Santé Publique France) 2016 health barometer survey. We also used data from previous studies which estimated the proportion of MSM who were sexually active in the 12 months prior to the studies, and HIV prevalence in MSM in France. Furthermore, we used data on PrEP drug costs from the French public drug database and data on medical examinations costs from the IPERGAY study. For 2019, the number of HIV seronegative MSM in France who were sexually active in the previous 12 months was estimated at 398,015. Of these, 142,379 (95%CI: 139,893-145,241) and 104,645 (95%IC: 102311-106979) were eligible for PrEP, based on the Menza score and on official French criteria, respectively. The overall estimated cost of PrEP roll-out in eligible MSM varied between € 317,685,216 and € 545,903,216 for official French criteria, which was higher than the estimated €432,240,851 and €742,753,074 according to the Menza score. Our estimations will enable policy makers to make evidence-based decisions about PrEP roll-out to MSM in France. To accelerate the process, it is important to decentralize PrEP delivery, authorize general practitioners to write prescriptions, and promote this prevention tool through information campaigns.

Damage or no damage from traffic: Re-examining marginal cost pricing for rail signalling maintenance

This paper re-examines the implementation of the short run marginal cost (SRMC) pricing principle with respect to rail infrastructure usage and empirically tests if there are rail infrastructure maintenance costs triggered by traffic but not caused by asset damage from traffic. This is important because current EU legislation stipulates that only costs related to infrastructure wear and tear from traffic are eligible for the direct cost-based element of track access charges. An econometric approach is applied to French panel data on signalling maintenance costs. The results show that the SRMC for infrastructure provision of these assets is not only related to asset damage costs caused by traffic, but can also be due to economic factors linked to increased line capacity utilisation: 1) higher cost per maintenance activity, and/or 2) increased preventative maintenance to curb delays. Our work offers an explanation as to why econometric and engineering approaches give different views of rail infrastructure cost variability and suggests that EU legislation on track access pricing may need to be revised.

New CNN-based tool to discriminate anthropogenic from natural low magnitude seismic events

SUMMARY With the deployment of high quality and dense permanent seismic networks over the last 15 yr comes a dramatic increase of data to process. In order to lower the threshold value of magnitudes in a catalogue as much as possible, the issue of discrimination between natural and anthropogenic events is becoming increasingly important. To achieve this discrimination, we propose the use of a convolutional neural network (CNN) trained from spectrograms. We built a database of labelled events detected in metropolitan France between 2020 and 2021 and trained a CNN with three-component 60 s spectrograms ranging frequencies from 1 to 50 Hz. By applying our trained model on independent French data, we reach an accuracy of 98.2 per cent. In order to show the versatility of the approach, this trained model is also applied on different geographical areas, a post-seismic campaign from NW France and data from Utah, and reaches an accuracy of 100.0 and 96.7 per cent, respectively. These tests tend to hypothesize that some features due to explosions compared to earthquakes are widely shared in different geographical places. In a first approach, we propose that it can be due to a contrast in the energy balance between natural and anthopogenic events. Earthquake seismic energies seem to be more continuous as a function of frequency (vertical bands features in a spectrogram) and conversely for explosions (horizontal strips).

Sampling Sexual and Gender Minority Youth With UnACoRN (Understanding Affirming Communities, Relationships, and Networks): Lessons From a Web-Based Survey.

Periodic surveys of sexual and gender minority (SGM) populations are essential for monitoring and investigating health inequities. Recent legislative efforts to ban so-called conversion therapy make it necessary to adapt youth surveys to reach a wider range of SGM populations, including those <18 years of age and those who may not adopt an explicit two-spirit, lesbian, gay, bisexual, transgender, and queer (2S/LGBTQ) identity. We aimed to share our experiences in recruiting SGM youth through multiple in-person and online channels and to share lessons learned for future researchers. The Understanding Affirming Communities, Relationships, and Networks (UnACoRN) web-based survey collected anonymous data in English and French from 9679 mostly SGM respondents in the United States and Canada. Respondents were recruited from March 2022 to August 2022 using word-of-mouth referrals, leaflet distribution, bus advertisements, and paid and unpaid campaigns on social media and a pornography website. We analyzed the metadata provided by these and other online resources we used for recruitment (eg, Bitly and Qualtrics) and describe the campaign's effectiveness by recruitment venue based on calculating the cost per completed survey and other secondary metrics. Most participants were recruited through Meta (13,741/16,533, 83.1%), mainly through Instagram; 88.96% (visitors: 14,888/18,179) of our sample reached the survey through paid advertisements. Overall, the cost per survey was lower for Meta than Pornhub or the bus advertisements. Similarly, the proportion of visitors who started the survey was higher for Meta (8492/18,179, 46.7%) than Pornhub (58/18,179, 1.02%). Our subsample of 7037 residents of Canada had a similar geographic distribution to the general population, with an average absolute difference in proportion by province or territory of 1.4% compared to the Canadian census. Our US subsample included 2521 participants from all US states and the District of Columbia. A total of CAD $8571.58 (the currency exchange rate was US $1=CAD $1.25) was spent across 4 paid recruitment channels (Facebook, Instagram, PornHub, and bus advertisements). The most cost-effective tool of recruitment was Instagram, with an average cost per completed survey of CAD $1.48. UnACoRN recruited nearly 10,000 SGM youth in the United States and Canada, and the cost per survey was CAD $1.48. Researchers using online recruitment strategies should be aware of the differences in campaign management each website or social media platform offers and be prepared to engage with their framing (content selection and delivery) to correct any imbalances derived from it. Those who focus on SGM populations should consider how 2S/LGBTQ-oriented campaigns might deter participation from cisgender or heterosexual people or SGM people not identifying as 2S/LGBTQ, if relevant to their research design. Finally, those with limited resources may select fewer venues with lower cost per completed survey or that appeal more to their specific audience, if needed.

Legislators in the crossfire: Strategic non-voting and the effect of transparency

When committee members care about their reputation with a principal, making their choices transparent affects the outcome. In Parliaments, legislators care about their reputation with several principals, namely their constituents and Party leaders. It is thus unclear in which direction votes will move when they become observable, and moreover legislators may prefer to opt out of voting entirely in order to avoid conflict. This paper first uses French voting data to show that reputational concerns drive the decision to participate in a vote: in order to avoid blame legislators are less likely to vote when there is disagreement between the constituents and the Party. Second, making legislators’ votes public increases their incentive to use voting for reputation-building, and, therefore, the distortion in group decision-making. The French transparency reform of 2014 provides a quasi-natural setting for a Difference-in-Differences analysis. Greater transparency led to less participation, as legislators preferred not to take sides.

Consequences of SARS-CoV-2 pandemic on urological surgery in France: a nationwide analysis of the healthcare system database

The SARS-CoV-2 outbreak overwhelmed the healthcare systems worldwide. Saturation of hospitals and the risk of contagion led to a reduction in the care of other diseases.ObjectiveTo determine the impact of...

Où se fait l'activité de rythmologie interventionnelle en France et quelle est son évolution ?

IntroductionInterventional rhythmology activity (electrophysiology and pacing) has progressed in France during the last decade. The objective of this article was to assess the distribution of this activity depending on the type of centre (public, university or non-university, private). As the French government issued a new regulation regarding rhythmology activity in 2022, the impact of this regulation on activity distribution has been evaluated. MethodologyAll French data activity can be evaluated after accessing to a national database called PMSI [Programme de médicalisation des systèmes d'information]. Based on data collected in year 2019, the level of activity of the different centres, and the impact of the new criteria of the French regulation regarding rhythmology activity have been analysed. ResultsAbout 180,000 arrhythmias interventions have been done in France in 2019 in 377 centres. According to the new criteria of the French regulation, only 76% responded to level A (diagnostic electrophysiology, single- and dual-chamber pacing), 52% for level B (A+ right atrial ablation, implantable automatic defibrillator, cardiac resynchronisation therapy) and 54% for level C (B + left atrial and ventricular ablation). ConclusionsThis work showed that approximately a quarter of the centres do not meet criteria for level A activity, and approximately half of them for levels B and C. The priority will be to reinforce existing centres before allowing new centres to perform arrhythmias management activity in France.

Differential Effect of Targeted Temperature Management Between 32 °C and 36 °C Following Cardiac Arrest According to Initial Severity of Illness: Insights From Two International Data Sets

Recent guidelines have emphasized actively avoiding fever to improve outcomes in patients who are comatose following resuscitation from cardiac arrest (ie, out-of-hospital cardiac arrest). However, whether targeted temperature management between 32 °C and 36 °C (TTM32-36) can improve neurologic outcome in some patients remains debated. Is there an association between the use of TTM32-36 and outcome according to severity assessed at ICU admission using a previously derived risk score? Data prospectively collected in the Sudden Death Expertise Center (SDEC) registry (France) between May 2011 and December 2017 and in the Resuscitation Outcomes Consortium Continuous Chest Compressions (ROC-CCC) trial (United States and Canada) between June 2011 and May 2015 were used for this study. Severity at ICU admission was assessed through a modified version of the Cardiac Arrest Hospital Prognosis (mCAHP) score, divided into tertiles of severity. The study explored associations between TTM32-36 and favorable neurologic status at hospital discharge by using multiple logistic regression as well as in tertiles of severity for each data set. A total of 2,723 patients were analyzed in the SDEC data set and 4,202 patients in the ROC-CCC data set. A favorable neurologic status at hospital discharge occurred in 728 (27%) patients in the French data set and in 1,239 (29%) patients in the North American data set. Among the French data set, TTM32-36 was independently associated with better neurologic outcome in the tertile of patients with low (adjusted OR, 1.63; 95%CI, 1.15-2.30; P= .006) and high (adjusted OR, 1.94; 95%CI, 1.06-3.54; P= .030) severity according to mCAHP at ICU admission. Similar results were observed in the North American data set (adjusted ORs of 1.36 [95%CI, 1.05-1.75; P= .020] and 2.42 [95%CI, 1.38-4.24; P= .002], respectively). No association was observed between TTM32-36 and outcome in the moderate groups of the two data sets. TTM32-36 was significantly associated with a better outcome in patients with low and high severity at ICU admission assessed according to the mCAHP score. Further studies are needed to evaluate individualized temperature control following out-of-hospital cardiac arrest.

Are we socially equally at risk of smoking during the COVID-19 pandemic? French data from 2009-2021

Abstract Background Since 2020, the COVID-19 pandemic has greatly affected people including a significant increase in mental health difficulties. Cigarette smoking is found to be strongly associated with mental health conditions, which is why the pandemic might have influenced the secular decline in smoking rates observed over recent years. Persons belonging to socioeconomically disadvantaged groups may be particularly affected, both because the pandemic is found to exacerbate existing social inequalities and because this group was more likely to smoke before the pandemic. We examined the prevalence of smoking in a French cohort study, focusing on differences between educational attainment. In addition, we examined the association between educational level and interpersonal changes in tobacco consumption from 2018 to 2021. Methods The TEMPO cohort study included 1785 French adults followed between 1991 and 2021. With four assessments of smoking status available before and two after the onset of COVID-19, we estimated the smoking prevalence over time stratified by highest obtained diploma. We studied interpersonal change in smoking status between 2018 and 2021 among 148 smokers, using multinomial logistic regression. Results The prevalence of smokers was higher among those with low educational attainment compared with those with higher diploma at all timepoints. The difference between the two groups increased from 2020 to 2021 (4.8% to 9.4%). Smokers with high educational level were more likely to decrease their tobacco consumption from 2018-2021 compared to low educated smokers (aOR=2.72 [1.26;5.89]). Conclusions Current findings showed a widening of the socioeconomic gap over time in smoking rates, which emphasizes the vulnerability of persons with low educational attainment to smoking, also during the pandemic. Key messages • The existing gap in smoking prevalence between lower and higher diploma groups has increased from 2020 to 2021, which may be a consequence of the COVID-19 pandemic. • From 2018 to 2021, people with high school as highest qualification were less likely to decrease their tobacco use compared to higher educated people.

Exploring the drop in flu cases during the 2020–2021 season: The Italian case study

To explore the 2020-2021 influenza season by describing the case of Italy. FluNet was searched for Italian data on virological samples. French, German, and Spanish data were collected for comparison. InfluNet was used for Italian epidemiological data on influenza-like illness (ILI). Data were extracted for the period from the 42nd week of 2020 to the 16th week of 2021 and for the previous 5-year period. The Containment and Health Index were used to describe the containment measures. Among 6818 samples, 0% were positive in Italy in the 2020-2021 season (28.8% in the previous 5-year period; the percentage change in the total number of tested specimens was -51.3%). In France, Germany, and Spain, the percentage change was -23%, -7%, and -61%, respectively. The Italian ILI incidence remained below the baseline levels (mean 0.0144/100,000 inhabitants; range 0.0085-0.0204). In the previous 5-year period, the mean incidence was 0.041/100,000 inhabitants. With the increase in containment measures, a deflection of ILI incidence was described (P=.015). Despite the reduced number of collected specimens compared to previous seasons and a slight rise in influenza vaccination rates, containment measures represent the most likely factor that helped to reduce cases in the 2020-2021 influenza season in Italy.

Cocooning strategy: Pertussis vaccination coverage rate of parents with a new-born in 2016 and 2017 in France.

The "cocooning" strategy was introduced in 2004 to protect infants too young to be vaccinated against pertussis, by immunizing their parents and close relatives. The study objective was to assess its implementation 12 years after its introduction by estimating the pertussis vaccination coverage rates (VCR) among parents of newborns. Pertussis VCR were estimated among all women who gave birth and men who took paternity leave, in 2016 or 2017, from a 1/97th random sample of French claims data. Two distinct study periods were defined based on current recommendations for the cocooning strategy: the "common practice" and the "parental project" periods. In 2016, the pertussis VCR of women having given birth and men having taken paternity leave was 47.2 and 47.1%, respectively (46.1 and 45.6% in 2017, respectively). About one quarter of vaccinations were performed during the "parental project" period, with the vaccine most frequently reimbursed during the month of childbirth for women (57.1% in 2016 and 49.4% in 2017) and before or during the month the paternity leave began for men (about 78% in both 2016 and 2017). General practitioners were the main prescribers in private practice, even during the "parental project" period. To optimize the protection for infants, the main objective of the cocooning strategy, pertussis immunization coverage of adults and seniors needs to be improved. Moreover, cocooning vaccination linked to a parental project needs to be performed earlier, during pregnancy (for those around the mother) or in immediate post-partum (e.g., during the maternity stay).

Impact of Depsychopathologization of Transgender and Gender Diverse Individuals in ICD-11 on Care Delivery: Looking at Trans Expertise through a Trans Lens.

Depsychopathologization of transgender and gender diverse (TGD) individuals in the eleventh revision of the International Classification of Diseases (ICD-11) called for a shift in care delivery models, based on free and informed consent. Public health policies face epistemic and discriminatory challenges and consensus built on evidence-based data is needed. TGD communities were consulted but did not actively participate in ICD-11 and the following public health debates. There is a need for TGD perspective—both in research and practice. This study draws on a peer-led participatory approach and explores TGD participants’ recommendations based on unexploited French data from ICD-11, in which 72 TGD gave feedback on public policies. Lexicometric analyses were conducted using the ALCESTE method and resulted in a two-step double Descending Hierarchical Classification. Sex, gender, and health consumption were analyzed as secondary variables. The first classification highlighted five main topics: care pathways, training of professionals, access, literacy, and civil status change, developed into 12 targets in the second classification. While sex and gender appeared to have little impact on discourses, recommendations varied according to received care. This study supports the growing scientific consensus of a public health approach to face TGD health challenges and emphasizes TGD individuals’ expertise.