Facilities In France Research Articles

Demonstration of industrially-fabricated plutonium disposition MOX

The safe and secure management of civil separated plutonium is a UK government and NDA priority. One potential solution to address this considers the manufacture of a modified version of mixed oxide (MOX) fuel, comprising PuO2 dispersed within a UO2 matrix and doped with a suitable neutron absorbing element to maintain criticality control. As an initial step to understand whether an industrially-relevant, proven MOX fuel fabrication process could offer a potential route to the production of a Pu-disposition matrix based on MOX, a series of Gd-doped UO2 pellets were prepared by Orano at the CDA workshop of the MELOX facility in France. Characterisation was performed to quantify the density, morphology (grain size and porosity), Gd distribution and Gd incorporation mechanism. It was found that the materials produced were highly reproducible and similar in density and morphology, irrespective of the variables investigated, and similar to unirradiated UOX and MOX fuel. Gd was distributed in a similar manner to the distribution of PuO2 in unirradiated MIMAS (MIcronisation of a MASter Blend) MOX fuel and evidence for the existence of a solid solution between Gd2O3 and UO2 was ascertained, which could be viewed as favourable from a GDF post-closure criticality control perspective. The source of the powder had the greatest effect on the final characteristics of the Pu-disposition MOX pellets, due to sintering reactivity; however, these differences were minor. These results are a promising step towards the full-scale manufacture of ceramics suitable for the immobilisation and disposition of separated PuO2 in a GDF, should policy dictate.

Chronic kidney disease–associated pruritus: a comparison of instruments and associations with patient-reported outcomes using an electronic patient-reported outcome survey in Europe

ABSTRACT Background The associations between self-reported chronic kidney disease–associated pruritus (CKD-aP) and patient-reported outcomes (PROs) have been reported using various instruments to assess itch. Data collection via multiple CKD-aP instruments allows the evaluation of different domains and measurements of CKD-aP burden and may help tailor data capture for future research or clinical care. Methods An electronic PRO (ePRO) survey was distributed to European hemodialysis (HD) patients enrolled in the Dialysis Outcomes and Practice Patterns Study (DOPPS) in 2021–23. The DOPPS is an international cohort study that aims to investigate practice patterns and outcomes in HD patients. The ePRO survey included multiple CKD-aP instruments: Average Itch and Worst Itching Intensity Numerical Rating Scales (AI-NRS, WI-NRS) and a Kidney Disease Quality of Life (KDQOL)-36 single question. Linear and logistic regression were used to estimate adjusted associations between CKD-aP instruments and various PROs. Results This analysis included 769 patients who completed the WI-NRS from HD facilities in France, Germany, Italy, Spain, Sweden and the UK. The correlation between WI-NRS and the KDQOL-36 itch question was 0.88 overall and 0.46 among patients at least somewhat bothered by itch. Mean WI-NRS scores stratified by response to the KDQOL-36 itch question were 8.1, 6.4, 4.1 and 3.1 for extremely, very much, moderately and somewhat bothered, respectively. Patients with worse WI-NRS scores reported worse sleep quality, greater fatigue, more depressive symptoms, and lower mental and physical quality of life; these associations were similar to those observed for the KDQOL-36 itch question. Conclusion Correlation between CKD-aP instruments was high overall, but moderate among the subgroup of patients bothered by itch; differences can be partially attributed to the recall period for the KDQOL-36 (4 weeks) vs the AI- and WI-NRS (24 h). The consistent associations of these instruments with poor outcomes underscores the importance to identify and effectively treat HD patients suffering from pruritus.

ADAPTATION OF A COMMERCIALLY AVAILABLE WESTERN BLOT KIT FOR THE DETECTION OF ANTIBODY TO ASPERGILLUS IN PENGUINS IN FRANCE AND THE UNITED STATES.

Antemortem serodiagnosis of aspergillosis remains challenging in Sphenisciformes. Protein electrophoresis, serology (antibody, antigen) by ELISA, and gliotoxin detection provide variable diagnostic value. In the present study, a commercially available Western blot (WB) validated for use in humans and dolphins was adapted for use with penguin samples. Using the same method and reagents, samples were analyzed from multiple institutions in the United States and one facility in France. This was inclusive of normal juvenile African penguins (Spheniscus demersus, n = 10) and various species of penguins in the United States with confirmed infection (n = 9) as well as 52 samples from Humboldt penguins (Spheniscus humboldti) in France. Cumulative WB scores (based on reactivity to different antigens) were found to be significantly higher in the group of penguins with confirmed infection (p < 0.0001). Significant differences were also observed between the clinically normal penguins in the two populations, with higher scores in the United States (median score 1.0, 95%CI [0-5], min 0, max 11) compared to France (median score 0,95%CI [0-0], min 0, max 5). The utilization of the WB as a diagnostic tool is inconclusive due to the use of samples from varying institutions, environmental background, age, and stages of infection. However, this tool may provide an overview of antigen reactivity in penguins infected with Aspergillus to help design a more robust serology assay and further understand the humoral immune response during infection.

Leukaemia, lymphoma, and multiple myeloma mortality after low-level exposure to ionising radiation in nuclear workers (INWORKS): updated findings from an international cohort study

A major update to the International Nuclear Workers Study (INWORKS) was undertaken to strengthen understanding of associations between low-dose exposure to penetrating forms of ionising radiation and mortality. Here, we report on associations between radiation dose and mortality due to haematological malignancies. We assembled a cohort of 309 932 radiation-monitored workers (269 487 [87%] males and 40 445 [13%] females) employed for at least 1 year by a nuclear facility in France (60 697 workers), the UK (147 872 workers), and the USA (101 363 workers). Workers were individually monitored for external radiation exposure and followed-up from Jan 1, 1944, to Dec 31, 2016, accruing 10·72 million person-years of follow-up. Radiation-mortality associations were quantified in terms of the excess relative rate (ERR) per Gy of radiation dose to red bone marrow for leukaemia excluding chronic lymphocytic leukaemia (CLL), as well as subtypes of leukaemia, myelodysplastic syndromes, non-Hodgkin and Hodgkin lymphomas, and multiple myeloma. Estimates of association were obtained using Poisson regression methods. The association between cumulative dose to red bone marrow, lagged 2 years, and leukaemia (excluding CLL) mortality was well described by a linear model (ERR per Gy 2·68, 90% CI 1·13 to 4·55, n=771) and was not modified by neutron exposure, internal contamination monitoring status, or period of hire. Positive associations were also observed for chronic myeloid leukaemia (9·57, 4·00 to 17·91, n=122) and myelodysplastic syndromes alone (3·19, 0·35 to 7·33, n=163) or combined with acute myeloid leukaemia (1·55, 0·05 to 3·42, n=598). No significant association was observed for acute lymphoblastic leukaemia (4·25, -4·19 to 19·32, n=49) or CLL (0·20, -1·81 to 2·21, n=242). A positive association was observed between radiation dose and multiple myeloma (1·62, 0·06 to 3·64, n=527) whereas minimal evidence of association was observed between radiation dose and non-Hodgkin lymphoma (0·27, -0·61 to 1·39, n=1146) or Hodgkin lymphoma (0·60, -3·64 to 4·83, n=122) mortality. This study reports a positive association between protracted low dose exposure to ionising radiation and mortality due to some haematological malignancies. Given the relatively low doses typically accrued by workers in this study (16 mGy average cumulative red bone marrow dose) the radiation attributable absolute risk of leukaemia mortality in this population is low (one excess death in 10 000 workers over a 35-year period). These results can inform radiation protection standards and will provide input for discussions on the radiation protection system. National Cancer Institute, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Institut de Radioprotection et de Sûreté Nucléaire, Orano, Electricité de France, UK Health Security Agency. For the French translation of the abstract see Supplementary Materials section.

The taboo of sexuality and the desire for parenthood of people with intellectual disabilities living in care facilities in France

How do the support staff and the families of the residents with intellectual disabilities of care facilities in France perceive the latter’s sexual life and desire for parenthood and how is this taken into account in their interactions? Life-history interviews conducted with seven family caregivers and four focus groups using Photolanguage® conducted with the support staff were analyzed using a thematic and a psychodynamic analysis. Both institutional rules and families’ concerns impact the sexual expression of the residents. Their sexual and intimate lives are primarily perceived as an ‘additional problem’. Fearing the reactions of the families, support staff tend to keep residents in the dark about reproductive and sexual health issues These findings reveal an urgent need to change the paradigm in these institutions: a vision of residents as fully-fledged adults who can make choices and who have the right to clear information in their sexual and intimate life.

PUFFIn – A user friendly fast interface for calculating and visualizing the dose distribution in materials

This article describes a new graphical user interface that uses the PENELOPE Monte Carlo code to calculate dose distributions in materials. It is named PUFFIn, for the Penelope User-Friendly Fast Interface and was developed as an educational and scoping analysis tool for non-experts in radiation modeling. PUFFIn enables the user to visualize and compare the dose distributions in objects (e.g., sterilized healthcare products) irradiated with cobalt-60 gamma-rays, electron beam (E-beam) or X-rays. From such comparisons, the user can determine the most efficient product and/or packaging designs for any given radiation field – whether for conceptual or existing products and packaging.PUFFIn is distributed in a complete, self-contained package of software, including the PENELOPE radiation transport code, a standard graphics package, and a set of simple exercises. The package is available to any user at no cost and requires a minimal amount of training compared to other similar software. PUFFIn's capabilities are described, as well as validation measurements performed at Texas A&M University E-beam facility and the Aerial E-beam Facility in France.

Analyzing the territorial dimensions of work through a comparative study of waste recovery facilities in France and Brazil.

Waste production and management from residents and collection for sorting are systems heavily dependent on territorial dimensions. Ergonomic research needs to better integrate such territorial determinants to improve work conditions and design sustainable work systems. Through studies in France and Brazil, this paper analyzes the territorial relations that raise work systems' sustainability challenges for materials recovery facilities (MRFs) and waste management in both countries and examines the links between work activity and territory in MRFs. Both studies were based on the principles of activity-oriented ergonomics and used analyses of work activity and sociotechnical systems. The French study focused on interventions conducted over a 42-month period in five MRFs. The Brazilian study was based on a 20-month longitudinal qualitative and quantitative study. In this paper, we argue that territory is a key determining factor in waste production and work. Notably, the consumption patterns of residents and the economic flows within a geographic space determine the waste composition; and the territorially specified public policies, which define technical and social dimensions of waste collection and sorting. However, the territorial dimensions of waste are poorly considered in facility design. Workers' health and sorting system performance are thus affected and negatively compromising plant performance. The territory appears as a blind spot in the design of work systems. One of the challenges is to create interfaces and devices that could help to integrate better human activity and waste territorialized anchorage, in a multilevel organization, from local communities to the global recycling chains.

Sociological Views on Sport Practices in Sports Facilities of Brazzaville, Congo

The aim of this study was to characterize the population frequenting Brazzaville's sports facilities and spaces, and to explore the universe of physical activities practiced and their modalities. A total of 5,492 users took part in the study, which was carried out in four districts of Brazzaville covering about half the city's surface area. Data were collected using a questionnaire based on Chifflet's work on the use of sports facilities in France. The results showed that the spatial distribution of the facilities did not provide an adequate sports offer for users, despite the population's enthusiasm for sports and the demand from a young, active clientele.

Factors associated with better alcohol hand rub in 2020. Results from the French national audit "Pulpe'friction".

The application of alcohol-based hand rub on hands (ABHR) can prevent the transmission of microorganisms. But, in some situations the practices remain perfectible. The aim of this study was to assess the self-reported ABHR practices of healthcare workers (HCWs) and to identify the factors associated with better ABHR compliance. A cross-sectional study was conducted using the French national "Pulpe'friction" audit, from 1st January 2020 to 31st December 2020, in healthcare facilities and social welfare facilities in France. Data were analyzed using descriptive statistics and multivariate logistic regression models. Of the 6769 HCWs, the average ABHR compliance was 75% "before patient contact," 95% "before an invasive technique," 86% "after patient contact," and 79% "after contact with patient surroundings." The main reported barriers were the availability, the discomfort and the harmfulness of the product. The factors significantly associated with a better compliance were the individual importance given to hand hygiene (HH); working in a healthcare facility, except in the situation "before an invasive technique"; medical profession "after patient contact"; paramedical profession "after contact with patient surroundings." These results call for national actions to fight the most reported barriers and raise awareness on the importance of HH, especially before touching the patient.

Formation of N–O–H bearing species in HNO3 and H2O icy samples by heavy-ion irradiation: an infrared spectroscopic study

This article investigates the radiolysis of a mixture of nitric acid with water (HNO3:H2O) at 16 K in high-vacuum (residual pressure < 10−6 mbar). A nitric acid-water ice film was exposed to 40 MeV 58Ni11+ ion beam in a heavy ion accelerator facility in France. For this astrochemically- and atmospherically-relevant ice mixture of nitric acid and water, we analyze the possible formation and destruction processes of N–O bearing species, thus providing spectroscopic data in the infrared (IR) region for theoretical, laboratory and observational future studies. The irradiation synthetized 18 species which were posteriorly examined by infrared spectroscopy: N2O, NH3, NO, NO2 and H x N y O z molecules, such as hidroxylamine (NH2OH), nitrous acid (HONO) as well as other species with bonding N–O, N–H and H–O–N converting surface-adsorbed nitrogen oxides into astrochemically active NO x . The interaction of HNO3 and H2O originates H–N–O molecular complexes, which were investigated as particular cases of the hydrogen-bonded species formed by a more electronegative atom (N or O) interacts intra or intermolecularly with a donor atom (N or O) and observed in the interstellar medium with higher quantities or great abundances. The HNO3 and H2O destruction cross sections have been determined to be 8.5 × 10−13 and 1.2 × 10−13 cm2, respectively, for the mentioned experimental conditions.

Correlates of Stimulant Use among People Who Use Heroin Undergoing Treatment in Out-Patient Facilities in France, 2010–2020

Background: Polydrug use has been implicated in driving a “fourth wave” of the overdose crisis in North America, specifically through concurrent use of stimulants and opioids, especially fentanyl. In France, however, heroin has historically been and remains the easiest-to-access opioid, accounting for most drug treatment demand. Whether similar polydrug use is increasing in Western Europe remains understudied, despite severe health implications and potential inadequate public health responses. Methods: We take advantage of a nation-wide dataset containing information on all patients serviced in treatment centers in France from 2010 to 2020. We conduct Poisson regression to determine the main predictors of stimulant use among people who use heroin (PWUH) and opioids (PWUO) generally. Results: Heroin remains the primary opioid within drug treatment in France. A decreasing number of out-patients seeking treatment for heroin use has been accompanied by an increasing trend of stimulant use over time, most commonly with powder cocaine. Our results suggest a significant increase of crack cocaine use among the most vulnerable PWUH. Concurrent use of stimulants among PWUH was positively associated with use of alcohol, cannabis, unprescribed psychotropics and hallucinogens, and negatively with tobacco. Similar results were found for all in-treatment PWUO. Conclusions: Our results uncover heterogeneity in the profiles of PWUH that should be fully acknowledged to ensure better efficiency in substance use clinical practices and policy, while simultaneously drawing attention to trends in concurrent opioid-stimulant use outside North America. We advocate for an extension of the generalized risk framework and its implementation in prevention programs.

Sleep timing, workplace well-being and mental health in healthcare workers

IntroductionHealthcare workers face an elevated risk of burnout, sleep disorders, and mental health issues, potentially stemming from the misalignment of their circadian rhythm due to nonstandard work schedules. This cross-sectional survey aims to examine the connections between sleep timing, workplace well-being (including burnout and absenteeism), and mental health outcomes (specifically depression and poor sleep) in healthcare workers. Additionally, the survey takes into account individual and professional factors, as well as the interaction with work schedules. MethodsThe study encompasses 4,971 healthcare workers from both public and private healthcare facilities in France, including nurses, nursing assistants, and physicians recruited during the third wave of the COVID-19 pandemic. The Maslach Burnout Inventory assesses burnout, the Center for Epidemiologic Studies Depression Scale measures depression, and the Pittsburgh Sleep Quality Index evaluates poor sleep. Sleep timing is categorized into morning, neutral, and evening timing, referred to as midsleep. Multivariate logistic regression analysis is conducted to explore the relationships between sleep timing and burnout, depression, and poor sleep, while adjusting for various factors. ResultsThe findings reveal that 56.5% of participants experience burnout, 29.8% report depression, and 64.5% report poor sleep. Nurses and nursing assistants exhibit a higher prevalence of poor sleep. Morning sleep timing is associated with burnout among those with fixed schedules and with depression among those with shift schedules. Among physicians, both morning and evening sleep timing are associated with depression, while morning sleep timing is linked to poor sleep across all subgroups. InterpretationThis study suggests that the misalignment between healthcare workers' internal circadian rhythm and their work schedules may contribute to an increased risk of burnout, depression, and poor sleep. Occupational health services and policymakers should recognize the potential for enhancing workplace well-being and mental health outcomes by enabling healthcare workers to maintain sleep schedules that accommodate their needs.

Poor sleep is associated with work environment among 10,087 French healthcare workers: Results from a nationwide survey

Poor sleep is a prevalent issue among healthcare workers and can have detrimental effects on their health. Various individual and professional factors, including the work environment, may contribute to poor sleep. However, only a limited number of studies have examined the simultaneous influence of these factors. Hence, we conducted a nationwide survey among graduated healthcare workers in both public and private healthcare facilities in France. The aim was to analyze the association between poor sleep, assessed using the Pittsburgh Sleep Quality Index (>5), and the work environment, evaluated using the Job Content Questionnaire. The study encompassed 10,087 healthcare workers, among whom 6,540 (64.8%) reported experiencing poor sleep. Nurses, health executives, nursing assistants, and other allied healthcare professionals were more likely to experience poor sleep compared to physicians. Through multivariate regression analysis, we identified several aspects of the work environment associated with an increased likelihood of poor sleep. These factors included high speed and quantity of work, high complexity and intensity, high fragmentation and unpredictability, limited decision-making latitude, underutilization of skills, lack of emotional support from colleagues, and sustained workplace bullying. These findings highlight the significance of considering the work environment in addressing sleep issues among healthcare professionals.

Radiological characterization for the disposal of a decommissioned LHC external beam dump at CERN

During the last Long Shutdown, a scheduled maintenance period between physics runs, the two Large Hadron Collider (LHC) beam dumps were replaced with upgraded spares modules. It was then decided to conduct an in-house autopsy and a post-irradiation examination of the removed dumps to extract information essential for the 3rd LHC physics run and to aid the design of new generations of beam dumps able to cope with future upgrades of the LHC. The need for a postmortem analysis of the dump cores opened the opportunity to combine the autopsy with processes required for the disposal of the dumps as radioactive waste at a dedicated disposal facility in France. This had a direct impact in terms of overall optimization of the interventions (postmortem analysis and prepackaging) to be performed on the dump as well as in terms of minimizing of the radiological risk (ALARA), by reducing the exposure of the personnel by combining two interventions in one. The characterization of the dump as radioactive waste was performed by means of state-of-the-art Monte Carlo and analytical techniques verified experimentally via a series of dedicated radiochemical (using liquid scintillation) analyses, conducted in-house and in external specialized laboratories. Based on these results, the dumps will be disposed of as intermediate–medium-level (FMA-VC) waste at the ANDRA CSA repository in France.

Health-promoting work schedules among nurses and nurse assistants in France: results from nationwide AMADEUS survey

BackgroundThe study aimed to investigate the relationship between different work schedules and self-reported working conditions and health risk behaviours among nurses and nurse assistants (NNA) in France. It hypothesized that work schedules, particularly long shifts, could impact work-life balance, workload, stress levels, burnout, and smoking habits. NNA had the option to work either with a 7-hour schedule, 5 days per week, or with long work schedules consisting of ten to twelve-hour shifts, three days per week. These schedules could potentially influence various aspects of their professional lives.MethodsThe survey followed the guidelines of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement and was administered to NNA working in public and private national healthcare facilities in France. The researchers used the Job Content Questionnaire to assess the work environment and the French version of the 22-item Maslach Burnout Inventory (MBI) scale to measure burnout.ResultsA total of 3,133 NNA participated in the study, including 2,369 nurses (75.6%) and 764 nurse assistants (24.4%). Among them, 1,811 individuals (57.8%) followed a 7-hour work schedule, while 1,322 individuals (42.2%) had a long work schedule. Multivariate analyses revealed that NNA working with long schedules reported higher psychological demands, more frequent burnout, a higher number of daily smoked cigarettes, and greater coffee consumption. These findings were independent of other factors such as sector of employment, type of healthcare facility, job status, work schedules, night shifts, department specialty, age, and family responsibilities.ConclusionsWhile some NNA may choose long schedules to have more days off, those working with these schedules experience greater work-related burdens and engage in worse health risk behaviours as a coping mechanism. It emphasizes the importance of considering health-promoting work schedules to address the high psychological demands and burnout experienced by NNA with long schedules. Implementing changes in work schedules could potentially improve the overall well-being and job satisfaction of these healthcare professionals.

Opening the black box of hospitalizations in French high-secure psychiatric forensic units

IntroductionBasic epidemiological data are rare concerning the activity of specialized forensic psychiatric facilities in France. Here, we investigated the activity of the ten (640 beds) French “units for difficult patients” (unités pour malades difficiles [UMDs]). MethodWe used the Programme de médicalisation des systèmes d’information (PMSI) database to describe the characteristics and evolution of psychiatric hospitalisations in UMDs between 2012 and 2021, as well as the age, sex, and principal diagnoses of the patients hospitalized in these facilities. ResultsBetween 2012 and 2021, 4857 patients were hospitalized in UMDs (6082 stays). Among them, 897 (18.5%) had more than one stay. The number of admissions ranged from a minimum of 434 to a maximum of 632 per year. The number of discharges ranged from a minimum of 473 to a maximum of 609 per year. The mean length of stay was 13.5 (SD: 22.64) months with a median of 7.3 months (IQR: 4.0–14.4). Among the 6082 stays, 5721 (94.1%) involved male patients. The median age was 33 (IQR: 26–41) years. The most frequent principal psychiatric diagnoses were psychotic disorders and personality disorders. ConclusionThe number of individuals hospitalized in specialized forensic psychiatric facilities has been stable for 10 years in France and remains lower than in most European countries.

PLAID-Care : une recherche sur le moindre recours à la coercition en France

The use of coercion is a common practice in psychiatry despite its deleterious effects and insufficient evidence of benefits. It is so deeply rooted that the mention of establishments that make little use of it arouses a form of incredulity. However, the history of psychiatry and the international literature provide numerous examples of a psychiatry that is hardly coercive and numerous experiences of a reduction in the use of seclusion and/or restraint in psychiatric facilities. Today, in France, there are also less coercive establishments, which, for example, do not use mechanical restraint, have all their units open, or have reduced their use of seclusion and restraint. With regard to the stated policy objectives of reducing the use of coercion, it is surprising that most of these facilities receive little attention. PLAID-Care research aims to contribute to the visibility and analysis of these institutions and the factors involved in the reduced use of coercion. While these factors have already been identified in the international literature, the research is based on the multiplication of disciplinary perspectives (nursing, sociology, anthropology, geography) and the mobilization of a multi-level analytical framework that allows us to embrace their multiplicity and better understand their articulation. The originality of the research also lies in its historical dimension, which allows us to understand, on the scale of an institution, how a policy and practices aiming at the least recourse emerge and are consolidated. The project timeline is divided in three tasks: firstly, an inventory of “low-coercion” facilities in France; secondly, we will select and research four traditionally “low-coercion” facilities in France; thirdly we will focus on recently emerged “low-coercion” practices. PLAID-Care aims to revitalize French research on this theme which to date has been relatively lagging behind the numerous international studies. It will bring together and articulate the knowledge, tools and forms of organization and collaboration that contribute to making a policy of lesser use of coercion operational.

Assessing the implementation and effectiveness of early integrated palliative care in long-term care facilities in France: an interventional mixed-methods study protocol

BackgroundMajority of residents in long-term care facilities (LTCF) have limited and delayed access to palliative care even though many suffer from incurable chronic illnesses that will likely require the provision of palliative care. We present the study protocol of “PADI-Palli”, an intervention aims to advance early integrated palliative care into standard care delivered in LTCF. This study will assess the effectiveness of early integrated palliative care on palliative care accessibility for older persons in LTCF, and identify the key factors for the successful implementation of early integrated palliative care and its sustainability in the LTCF context.MethodsThis multicentre interventional study utilises a pragmatic research design with a convergent parallel mixed-methods approach. The qualitative study will use a case study design and the quantitative study will use a stepped wedge cluster randomised trial. In total, 21 participating LTCF from three French regions will be randomly allocated to one of seven clusters. The clusters will cross over from the usual care to the active intervention condition over the course of the study. The primary outcome relates to the accurate identification of palliative care needs and early access to palliative care for LTCF residents. Secondary outcomes are quality of care, quality of life for residents and their families, and quality of life at work for professionals. Measurements will be performed before and after the intervention. Implementation and evaluation of PADI-Palli intervention is grounded in the Consolidated Framework for Implementation Research.DiscussionExisting evidence demonstrates that early integrated palliative care in cancer care leads to a significant improvement in patient outcomes and processes of care. Little is known, however, about early integrated palliative care in the context of LTCF for older persons. This study has the potential to fill this gap in the literature by providing evidence on the effectiveness of early integrated palliative care for older persons in LTCF. Moreover, this study will provide a better understanding of the relevant contextual elements that facilitate or hinder early integrated palliative care implementation and transferability. If proven effective, this intervention can be scaled to other care settings in which older persons require palliative care.Trial registrationClinicalTrials.gov ID: NCT04708002; National registration: ID-RCB number: 2020-A01832-37.

Vaccination against influenza, measles, pertussis and varicella in workers in healthcare facilities in France: A national cross-sectional study in 2019.

Vaccine recommendations for healthcare workers (HCW) aim to protect them and reduce transmission to susceptible patients. We conducted a national randomised survey in 2019 whose main objectives were to estimate national vaccination coverage (VC) for measles, pertussis, varicella, and influenza in HCW working in healthcare facilities (HCF) in France, and to identify determinants associated with higher VC. We performed a cross-sectional survey of physicians, nurses, midwives and nursing assistants in HCF using a random stratified three-stage sampling design. Data were collected during face-to-face interviews using a tablet computer and complemented with information from the individual HCW vaccination records. We investigated possible determinants of higher VC using univariate and multivariate Poisson regressions and estimated the prevalence ratio (PR). We included 8594 HCW working in 167 HCF. Self-declared VC was 73.3% (CI95%: 71.0-75.5) for measles in HCW with no history of measles (at least one dose), 53.5% (49.9-57.0) for pertussis (booster dose during adulthood), 26.4% (23.0-30.2) for varicella in HCW with no history of varicella (at least one dose) and 34.8% (32.8-37.4) for influenza. Taking into account the history of each disease and related VC, 14.6% and 10.1 % of HCW were susceptible to measles and varicella. VC varied by profession, age group, ward and sex. Higher influenza VC was observed in HCW working in wards where i) there was a staff vaccination contact person (PRa: 1.2, CI95% 1.1-1.4), ii) staff vaccination was organized in the ward (1.4: 1.2-1.6), iii) information on influenza vaccines was provided (1.2: 1.1-1.4), and iv) the ward manager supported the HCW vaccination campaign (1.3: 1.1-1.6). Over a 10-year period, VC for HCW working in HCF improved in France. However, vaccination objectives were not achieved for measles (95%) or influenza (80%). Vaccination efforts should be continued, especially in wards with at-risk patients.

Decoding the Psychiatric Space: Cross Country Comparison of Facilities for Mental Health Service Users.

Normalisation theory made perfect sense at the onset of de-institutionalisation. To map its influence on mental health facilities, research was conducted and began with ten facilities within England (UK) and France, followed by a further two in England and four in New Zealand. A checklist tailored to mental health facilities was used to measure the extent to which the facility looked domestic or institutional. Hence, the mental health checklist architecturally measured domesticity versus institutionalisation in psychiatric architecture. It consisted of 212 features, grouped into three main categories—context and site; building; and space and room—and was based on a pre-existing checklist designed for hostels for those with learning disabilities. The mental health checklist was developed and piloted in Europe and reflected European de-institutionalisation principles. Cross-country comparison revealed that patient acuity was potentially not a determinant of institutional buildings for mental health. Institutional facilities in France were detected, and some of the most domestic facilities were within England, with the most recent sample having a greater tendency towards the more institutional end. Those in New Zealand tended towards the most institutional. Across all 16 facilities, there were very few universal institutional and domestic features, raising the ambiguity of a clearly defined stereotype of facilities for mental health service users. Consequently, the current fluidity of design across and within countries provides a significant opportunity for designers and mental health providers to consider non-institutional design, particularly at the planning stage. The use of the mental health checklist facilitates this debate. Future research in other geographical areas and through further consideration of cultural differences provides further opportunities to extend research in this area, with the potential to enhance and improve the lived experience of users of mental health services.