Intervention In France Research Articles

A Nationwide Analysis in France on Sex Difference and Outcomes Following Carotid Intervention in Asymptomatic Patients.

Objective: The impact of sex on outcomes following carotid endarterectomy (CEA) and carotid artery stenting (CAS) is not fully elucidated. The aim of this study was to analyze the association between sex and outcomes of asymptomatic patients who underwent primary carotid interventions in France. Methods: This nationwide retrospective study was performed using the French National Health Insurance Information System and included asymptomatic patients who underwent primary carotid intervention over a 10-year period (1 January 2013 to 31 August 2023). Symptomatic patients and patients who had peri-operative neurologic events were excluded. The primary endpoints were the occurrence of death and stroke/transient ischaemic attack (TIA) at 30 days, 1 and 5 years after patients' discharge. Results: In total, 115,879 patients were admitted for an index CEA (29.4% women) and 6500 for CAS (29.8% women). In the CEA group, no significant sex-related difference was observed for 30-day mortality; however, women had significantly lower 1-year and 5-year mortality rates compared to men (1.9% vs. 2.6%, p < 0.001 and 7.9% vs. 11.1%, p < 0.001). In the CAS group, women had lower 30-day, 1-year and 5-year mortality (0.6% vs. 1.0%, p = 0.040, 3.8% vs. 4.9%, p = 0.048, and 10.4% vs. 15.0%, p < 0.001). A multivariate analysis showed that sex was not associated with the risk of stroke/TIA and mortality at 30 days (OR 0.84 (95% CI 0.67-1.04) and 1.27 (95% CI 0.98-1.64)). Male sex was associated with a higher risk of 1-year and 5-year mortality (OR 1.24 (95% CI 1.13-1.36) and 1.25 (95% CI 1.18-1.31)), but a lower risk of stroke/TIA than female sex. Conclusions: No significant sex-related difference was observed at 30 days in patients being discharged alive and without peri-operative neurologic events. Male sex was associated with a higher risk of mortality but a lower risk of stroke/TIA at 1 and 5 years.

Energy poverty alleviation by social housing providers: A qualitative investigation of targeted interventions in France, England, and the Netherlands

Decisions made by social housing providers (SHPs) profoundly affect their tenants' energy affordability, a group characterised by above-average energy poverty rates. Concentrated deprivation in this tenure has intensified due to policy-driven ‘residualisation’, compelling SHPs to serve almost exclusively low-income and marginalised households. Despite this, research exploring the potential of SHPs to tackle energy poverty through targeted interventions for their most vulnerable tenants remains sparse. The 2021–2022 energy price crisis offers a unique context to investigate this issue, given its substantial impact on household energy affordability. This study delves into insights of social housing professionals through focus groups conducted in France, England, and the Netherlands. It examines their views on the effectiveness of interventions and assesses their feasibility within the respective institutional contexts. We find that SHPs generally favour retrofit prioritisation and behavioural interventions as effective means of supporting at-risk tenants, whereas alterations in rent setting or housing allocation are considered potentially impactful but often undesirable or impracticable. We identify institutional barriers and lack of data as key obstacles to SHPs' adoption of more targeted interventions. To empower SHPs in tackling energy poverty, housing policy reforms must acknowledge and address the significant impact of energy costs within total housing expenses.

Effects of three prophylactic interventions on French middle-schoolers’ mental health: protocol for a randomized controlled trial

Adolescence is a strategic developmental stage in terms of preventing later difficulties and ensuring good mental health. Prophylactic interventions, which are conducted before the onset, prolongation, or worsening of difficulties, and aim to prevent or reduce symptoms or to promote wellbeing, therefore appear particularly appropriate for adolescents. However, existing prophylactic interventions conducted with adolescents have several weaknesses, including sparse theoretical frameworks, ambivalent evidence of their efficacy, and implementation and dissemination difficulties. In addition, no data are currently available on the effectiveness of such interventions in France. To fill this gap, a four-arm randomized controlled trial will be performed to assess the effectiveness of three prophylactic interventions targeting reactive, proactive and interpersonal adaptation in fourth-grade middle-school students, together with participants’ experience and perception of the interventions. Based on existing knowledge about adolescents, their learning mechanisms, and field constraints, these three interventions have been designed to promote their learning and receptiveness to interventions. Compared with baseline (i.e., before the intervention), we expect to observe a significant decrease in the level of distress (anxiety and depressive symptoms, functional impairment, and psychosocial difficulties) and a significant increase in the level of wellbeing after the intervention, across the three intervention groups, but not in the control group. In addition, we expect to observe post-intervention improvements in the processes targeted by the reactive adaptation intervention (operationalized as coping strategy use and flexibility), those targeted by the proactive adaptation intervention (operationalized as the tendency to engage in committed actions and general self-efficacy), and those targeted by the interpersonal adaptation intervention (operationalized as assertiveness in interactions), but only in the corresponding groups, with no change in any of these processes in the control group. The results of this research will not only enrich our knowledge of the processes involved in adolescents’ distress and wellbeing, but also provide clues as to the best targets for intervention. Moreover, the material for these interventions will be freely available in French on request to the corresponding author, providing access to innovative and fully assessed interventions aimed at promoting adolescents’ mental health in France.This clinical trial is currently being registered under no. 2023-A01973-42 on https://ansm.sante.fr/. This is the first version of the protocol.

Severe postpartum hemorrhage and the risk of adverse maternal outcome: A comparative analysis of two population-based studies in France and the Netherlands

ObjectivesAmong women with severe PPH (sPPH) in France and the Netherlands, we compared incidence of adverse maternal outcome (major obstetric hemorrhage (≥2.5L blood loss) and/or hysterectomy and/or mortality) by mode of delivery. Second, we compared use and timing of resuscitation and transfusion management, second-line uterotonics and uterine-sparing interventions (intra-uterine tamponade, compression sutures, vascular ligation, arterial embolization) by mode of delivery. MethodsSecondary analysis of two population-based studies of women with sPPH in France and the Netherlands. Women were selected by a harmonized definition for sPPH: (total blood loss ≥ 1500 ml) AND (blood transfusion of ≥ 4 units packed red blood cells and/or multicomponent blood transfusion). FindingsIncidence of adverse maternal outcome after vaginal birth was 793/1002, 9.1 % in the Netherlands versus 88/214, 41.1 % in France and 259/342, 76.2% versus 160/270, 59.3% after cesarean. Hemostatic agents such as fibrinogen were administered less frequently (p < 0.001) in the Netherlands (vaginal birth: 83/1002, 8.3% versus 105/2014, 49.5% in France; cesarean: 47/342, 13.7% and 152/270, 55.6%). Second-line uterotonics were started significantly later after PPH-onset in the Netherlands than France (vaginal birth: 46 versus 25 min; cesarean: 45 versus 18 min). Uterine-sparing interventions were less frequently (p < 0.001) applied in the Netherlands after vaginal birth (394/1002,39.3 %, 134/214, 62.6%) and cesarean (133/342, 38.9 % and 155/270, 57.4%), all initiated later after onset of refractory PPH in the Netherlands. InterpretationIncidence of adverse maternal outcome was higher among women with sPPH in the Netherlands than France regardless mode of birth. Possible explanatory mechanisms are earlier and more frequent use of second-line uterotonics and uterine-sparing interventions in France compared to the Netherlands.

Embedded social workers within police organizations: Comparing domestic violence interventions in France and Finland

Embedded social workers within police organizations: Comparing domestic violence interventions in France and Finland

Epidemiology of limb trauma interventions in France: Current state and future projections

ContextThe distributions and projections of trauma, treated according to the anatomical region, have not been studied in France. The objectives of this study were to obtain French epidemiological data specific to trauma procedures in orthopedic surgery, as well as to establish a statistical trend on the evolution of medical and surgical procedures resulting from this, since 2013 and over the years to come. Our hypothesis was that an increasing trend in trauma procedures since 2013 exists, with an epidemiological forecast of a continuing increase over 50 years, mainly in the context of the management of osteoporotic fractures related to the ageing French population. Material and methodsWe conducted a retrospective study using national data to obtain completion of procedures between the start of 2013 and the end of 2021. ResultsFrom 2013 to 2021, we noted a total of 5,216,567 procedures related to orthopedic traumatology for an average of 579,618 procedures per year. We noted an overall increase in all procedures, continuing from 2013 to 2019, with an average annual increase of 1.125%. The most commonly performed procedure was osteosynthesis, with an average of 276,989 procedures per year. This was followed by wound sutures with an average of 185,023 procedures, orthopedic reductions of fractures and/or dislocations at an average of 62,960, then arthroplasties with 25,425 procedures per year, musculotendinous ruptures were 19,755 procedures per year, surgical reductions of fractures and/or dislocations represented 6920 procedures per year, and fasciotomies with 2848 procedures. From 2013 to 2021, there was an annual average of 276,989 osteosynthesis procedures. Open osteosynthesis, with an average of 146,547 procedures per year, represented 55% of osteosynthesis procedures. Fractures of the proximal end of the femur represented 79,549 procedures on average per year, including 46,621 (58%) involving the trochanter, while 32,852 (41%) were of the femoral neck. Wrist fractures accounted for an annual average of 55,300. Hand fractures represented an annual average of 38,444, of which 52.2% were closed (17,778). On average, 1000 fractures per year involved the carpus without scaphoid involvement, and 2177 scaphoid fractures. Ankle fractures represented 37,951 procedures on average per year, including 74% of the malleolar complex (28,199). Leg fractures represented 17,613 procedures per year, 58% tibial diaphysis (10,091), 41% tibial plateau (6,857). The strengths of this study are the exhaustiveness of the data, presenting all the Common Classification of Medical Procedures (CCAM) chosen during the defined period. ConclusionThis study allowed us to establish, to our knowledge, the first epidemiological database of French orthopedic traumatology. Level of evidenceIV; epidemiological descriptive study.

Adoption of a multicomponent intervention to improve HPV vaccination in France: a mixed methods study

Abstract Background HPV vaccine coverage (VC) in France has always been lower than in most high-income countries. As part of the PrevHPV project, we developed and evaluated a school-based multicomponent intervention to improve HPV VC among French adolescents. We assessed the adoption of the PrevHPV intervention among secondary schools and its associated factors. Methods We carried out a pragmatic cluster randomized controlled trial (April 2021-June 2022) in 14/25 French school districts. The cluster was the municipality. Municipalities were eligible if there was only one secondary school and most inhabitants aged 11-14 years attended this school. We then contacted the head of the school to ask him/her to participate in the study. Based on the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework, we described municipalities’ exclusions, schools participation and associated factors (Chi2, t-tests). We also used qualitative data from six focus groups with participating school staff to explore facilitators and barriers to adoption at the school level. Results Compared to non-eligible municipalities (n = 2658), eligible ones (n = 1205) were smaller, less urban and deprived, with lower accessibility to general practitioners. Out of 346 randomly selected municipalities, 91 (26%) accepted to participate. Participating schools were smaller and located in more deprived municipalities than non-participating ones. During the trial, 31/91 (34%) schools discontinued intervention; we did not identify any characteristic associated with discontinuation. Qualitative data showed that several contextual factors can influence adoption at the school-level: human resources (school staff availability, turnover and attitudes towards vaccination, especially for school nurses); material (e.g. computer equipment) and financial resources; parents’ attitudes towards vaccination. Conclusions These results can guide policy making on school-based HPV vaccine promotion in France and Europe. Key messages • The PrevHPV project is supported by the French health authorities and conducted by a multidisciplinary consortium to tackle a long-lasting public health concern in France. • Should the intervention prove effective, these results are expected to help stakeholders scale-up the school-based PrevHPV intervention in France and other European countries.

Étude exploratoire de la mise en place de l’Early Start Denver Model en France

BackgroundThe Early Start Denver model is one of the interventions recommended by the French High Authority on Health since 2012 for the very early care of children with Autism Spectrum Disorders. This program, developed in the United States, has shown the best evidence of effectiveness in an intensive form of delivery that is difficult to generalize to other culturally different contexts. Consequently, its implementation in the French health care system has required some adaptations that have not yet been evaluated. After a summary of the method's features and the results of studies of its effectiveness, this first retrospective descriptive observational study aims to characterize the implementation and practice of this intervention in France. In doing so, it also aims to better understand the potential obstacles to the implementation of early intervention and thus propose avenues for improvement. Material and methodA census of French units offering the Denver model was conducted from June to October 2020. A questionnaire sent to the participating units made it possible to explore different dimensions: first, the characteristics of these units, including their composition. Secondly, their integration into the care network and the children's care pathway. Practice and delivery modalities were also assessed. Finally, the objective was to highlight the difficulties that the teams may have faced when implementing the model. The data were collected in Microsoft Excel® software in order to perform a descriptive statistical analysis. ResultsIn total, 92% of the units surveyed participated in the study and returned the questionnaire. Our results highlight a significant heterogeneity in the deployment of the Denver method at the national level and underline the limit of resources available in the territory, particularly in its intensive delivery form. ConclusionFurther research is still needed to study the feasibility and effectiveness of ESDM interventions deployed in the specific context of the French healthcare system. In addition, significant work remains to be done to establish rapid and identifiable pathways for early intervention in young children with ASD.

Perception de différentes dimensions de la psychiatrie par les agents de police : étude sur 191 policiers parisiens

IntroductionPsychiatric pathologies are widespread in the general population and rank third among the most frequent pathologies in the world, according to the World Health Organization, affecting nearly one in four people over their lifetime. Police officers in France are often required to intervene with people suffering from psychiatric disorders when they are involved in disturbances to public order. However, despite the frequency of these interventions in France, only a few specific training courses in psychiatry are made available to police officers. There has not been any research conducted in France on this subject. The objective of our study was to explore the perception of different dimensions of psychiatry (symptoms, treatments, prevalence, and dangerousness) by the Parisian police through an exploratory study. MethodA self-administered questionnaire was sent to Parisian police officers through an internal mailing list. The questionnaire was comprised of 25 questions divided into five sub-sections. The first section of the questionnaire concerned the demographic and professional characteristics of the participants (age, gender, rank, and years of experience). The second section explored the exposure (personal and professional) of police officers to psychiatry. The third and fourth sections were devoted to questions about training in psychiatry and their perception of the different dimensions of psychiatry. The last section of the questionnaire was dedicated to any comments regarding the questionnaire. ResultsOne hundred and ninety-one Parisian police officers – 106 men (56%) and 83 women (43%) – responded to the questionnaire and many of them reported frequent exposure to psychiatry (two-thirds say they are involved at least once a month with patients suffering from psychiatric disorders). The most frequently encountered problems were delusional ideas, agitation, suicide attempts or suicides, behavioral problems related to substance abuse, and hallucinations. We generally found benevolent attitudes on the part of the police. The police officers questioned evoked: mistrust (94.7%), empathy (46.8%), fear (37.4%), incomprehension (32.9%), and a negative judgment (8.4%), and 84% of the police officers reported an increased risk of using force during interventions involving people with psychiatric disorders. These results can be partly explained by the impairment of discernment found in people with decompensated psychiatric disorders, communication difficulties between police and patients, and the lack of training in the management or recognition of such symptoms. In addition, the majority of the participants reported feeling insufficiently trained in psychiatry and were in favor of the implementation of specific training courses either during their studies or as an element in their professional career: three-quarters of the police officers questioned never had any training in psychiatry during their studies or since taking up their post, and 80% of the police officers said they were inadequately trained to evaluate and deal with situations involving psychiatric disorders. The police officers largely favored specific training: 82.7% of them would like to be more trained in psychiatry during their studies or on the job, thus underlining a desire to be better prepared for these interventions. ConclusionThis study is, to our knowledge, the first of its kind in France on this subject. Several results are consistent with those of international scientific literature and highlight the frequent exposure of Parisian police officers to people with psychiatric disorders and the officers’ mostly benevolent, understanding, and non-stigmatizing attitudes. Nevertheless, police officers remain insufficiently trained in psychiatry, and this lack of training can be the source of communication difficulties, mistrust, or fear and thus increase the risk of the use of force. The majority of the study participants favor implementing these training courses, particularly with respect to the management of agitation and behavioral disorders, which are the symptoms most frequently encountered during these interventions. This study remains exploratory but could inform future work, mainly in implementing and evaluating specific psychiatric training for police officers.

Considering social inequalities in health in COVID-19 response: insights from a French case study.

The COVID-19 pandemic highlighted the impact of social inequalities in health (SIH). Various studies have shown significant inequalities in mortality and morbidity associated with COVID-19 and the influence of social determinants of health. The objective of this qualitative case study was to analyze the consideration of SIH in the design of two key COVID-19 prevention and control interventions in France: testing and contact tracing. Interviews were conducted with 36 key informants involved in the design of the intervention and/or the government response to the pandemic as well as relevant documents (n = 15) were reviewed. We applied data triangulation and a hybrid deductive and inductive analysis to analyze the data. Findings revealed the divergent understandings and perspectives about SIH, as well as the challenges associated with consideration for these at the beginning stages of the pandemic. Despite a shared concern for SIH between the participants, an epidemiological frame of reference dominated the design of the intervention. It resulted in a model in which consideration for SIH appeared as a complement, with a clinical goal of the intervention: breaking the chain of COVID-19 transmission. Although the COVID-19 health crisis highlighted the importance of SIH, it did not appear to be an opportunity to further their consideration in response efforts. This article provides original insights into consideration for SIH in the design of testing and contact-tracing interventions based upon a qualitative investigation.

Development of a health-promoting sports club's intervention in France applying participatory action research.

The recognition of sports clubs (SC) as health-promoting settings is increasing, as well as the number of health promotion (HP) interventions implemented in this setting. However, minimal understanding of their development process and the persistent gap between theoretical knowledge and real-life practice is a major limitation to their implementation. This article describes a participatory research approach, implicating 29 stakeholders in sports and HP (6 HP researchers, 9 HP professionals, 6 representatives from regional and national sports organizations and 8 representatives from SC), leading to the co-construction of a health-promoting SC intervention. Stakeholders were mobilized through four stages: (i) analysis of effective programs, (ii) co-construction workshops, (iii) evaluation of relevance and acceptability, and (iv) beta-testing of a massive open online course (MOOC). A qualitative analysis was carried out on data collected through notetaking, recordings, transcripts, email exchanges and produced documents. This work led to the development of an HP intervention, including an MOOC, as well as a seven-step SC-tailored program. The convergence of theoretical knowledge and contextual real-life practice made it possible to respond to the specific needs and implementation problems encountered by SC actors and to develop acceptable strategies and tools.

Conditions for the Successful Integration of an eHealth Tool "StopBlues" Into Community-Based Interventions in France: Results From a Multiple Correspondence Analysis.

BackgroundFor over a decade, digital health has held promise for enabling broader access to health information, education, and services for the general population at a lower cost. However, recent studies have shown mixed results leading to a certain disappointment regarding the benefits of eHealth technologies. In this context, community-based health promotion represents an interesting and efficient conceptual framework that could help increase the adoption of digital health solutions and facilitate their evaluation.ObjectiveTo understand how the local implementation of the promotion of an eHealth tool, StopBlues (SB), aimed at preventing psychological distress and suicide, varied according to local contexts and if the implementation was related to the use of the tool.MethodsThe study was nested within a cluster-randomized controlled trial that was conducted to evaluate the effectiveness of the promotion, with before and after observation (NCT03565562). Data from questionnaires, observations, and institutional sources were collected in 27 localities where SB was implemented. A multiple correspondence analysis was performed to assess the relations between context, type of implementation and promotion, and use of the tool.ResultsThree distinct promotion patterns emerged according to the profiles of the localities that were associated with specific SB utilization rates. From highest to lowest utilization rates, they are listed as follows: the privileged urban localities, investing in health that implemented a high-intensity and digital promotion, demonstrating a greater capacity to take ownership of the project; the urban, but less privileged localities that, in spite of having relatively little experience in health policy implementation, managed to implement a traditional and high-intensity promotion; and the rural localities, with little experience in addressing health issues, that implemented low-intensity promotion but could not overcome the challenges associated with their local context.ConclusionsThese findings indicate the substantial influence of local context on the reception of digital tools. The urban and socioeconomic status profiles of the localities, along with their investment and pre-existing experience in health, appear to be critical for shaping the promotion and implementation of eHealth tools in terms of intensity and use of digital communication. The more digital channels used, the higher the utilization rates, ultimately leading to the overall success of the intervention.International Registered Report Identifier (IRRID)RR2-10.1186/s13063-020-04464-2

Geographical Ambulatory Endovascular Revascularisation Disparities in France From 2015 to 2019

Despite efficiency and safety evidence, ambulatory endovascular revascularisation for lower extremity arterial disease (LEAD) accounted for only 5% of interventions in France in 2016. Such a low rate suggests temporal and geographical space disparities. The aim of this study was to describe the space-time development of ambulatory endovascular revascularisation for LEAD in France and to investigate the contributions of healthcare services and population characteristics as potential determinants. A retrospective study of discharge data from French hospitals that performed endovascular procedures for LEAD between 2015 and 2019 was conducted. Space-time analyses with Moran's Index, zero inflated Poisson regression, and clustering approaches were applied. Spatial clusters were compared on the basis of healthcare services and population characteristics (including poverty and single man household as proxies of social isolation). Between 2015 and 2019, the number of ambulatory interventions tripled (1 104 vs.3 130). Of the 86 French departments, the proportion with >5% of ambulatory interventions increased from 10.7% to 28.7% over the study period. In 2019, ambulatory activity in French departments ranged from 0% to 39%. This change was accompanied by a northwest to northeast spatial trend. The clusters of 27 departments with substantial ambulatory activity differed from the others notably by the mortality rate of lower limb arterial thromboembolic diseases in males (OR 3.15, 95% CI 1.2-8.1), the proportion of single man households of age ≥75 (OR 0.37, 95% CI 0.2-0.8), and the poverty rate of people aged 50-59 years (OR 0.69, 95% CI 0.5-0.9). The development of ambulatory interventions for LEAD in France is encouraging but heterogeneous. Some determinants of this evolution are clearly population based, with a positive impact of needs to take care of the burden of LEAD but negative effects of social isolation and poverty. Research should be conducted to overcome some patient constraints such as isolation.

Social Status of Researchers And Professional Practices in the Field of Research Aimed at Social Intervention in France

During a governmental mission to France in March of 1988 the author evaluated the effects of the status and professional practices of researchers on their work in the field of ‘social research’. This type of research is largely financed by sectorial ministeries and private associations formed under the provisions of the law of 1901. I examined the sociopolitical and scientific milieu of knowledge production in this field of study. Such research on social aspects of health, social problems and income security raises fundemental epistemological questions regarding its legitimacy, specificity, scientific validity, and applicability. A traditional theoretical orientation in social science research, lack of interest in funding this type of research at the CNRS (Centre National de la Recherche scientifique) and scientific ministries, and the precarious status of young researchers all characterize this new field of study and also constrain its development. However a new momentum is under way, due to recent initiatives by the Mission de Recherche et d’Experimentation (MIRE), the Ministère des affaires sociales et de l’emploi, and to political lobbying by public bodies and private organizations with the goal of revitalizing social research aimed at finding concrete and innovative solutions to contemporary problems through the application of research.

Manufacturing controversy: “reverse racism” as backlash to antiracist interventions in France

PurposeThe purpose of this paper is to shed some light on the paradoxes of mainstream French anti- racism regarding Islamophobia. The authors focus on the driving role played by French republican values in the recurring inability of anti-racist activism, and anti-islamophobia in particular, to act upon the structural character of racism in France.Design/methodology/approachThe authors’ analysis draws on a longitudinal and qualitative investigation of the “Sud-Education 93” controversy (SE93). The authors use the analytical framework provided by controversy studies in order to focus on the aftermath, in the public sphere, of the organisation by a French labour union of a minority-only workshop designed to provide teachers with a space for expression and purposeful guidance, in order to face Islamophobia and racism issues within French public schools. The authors collected an exhaustive set of data about the comments, criticisms and debates that emerged in the public sphere as a reaction to the workshop. The authors drew on situational analysis methodology, providing controversy analysts with several power-mapping techniques, in order to conduct a discursive analysis of the statements and claims made by the protagonists of the controversy.FindingsFirst, the authors’ insights point out that French Islamophobia relies on the myth of the universal republican citizen that acts as a context-specific form of colour-blindism. Second, the authors shed light on the discursive and relational mechanisms that characterise the denial of Islamophobia undertaken by political actors who use “reverse racism” arguments as a form of backlash, i.e. a strategy of “fragility” (DiAngelo, 2018) consisting in maintaining artificially a never-ending controversy over Islamophobia. Finally, the authors discuss the role played by these strategies of fragility in the recurring rejection of anti-islamophobia activism in France and the limitations and prospects they embody for future forms of anti-racist strategies.Research limitations/implicationsThe Latourian perspective adopted in the paper focuses on the implications of the controversy over Islamophobia within the public sphere. The authors’ fieldwork suggests, however, that the internal dynamics of minority-only organisations embodies sites and répertoires of micro-contestation capable of bypassing on the short run, and perhaps overthrowing, the power of French hypocrisy about anti-racism and the backlash processes the authors observed in the public sphere.Originality/valueThe authors’ contribution lies in the in-depth analysis of “reverse racism” rhetorics as a strategy of fragility and its implications in terms of colour-blindism and backlash.

The State of Animal- Assisted Interventions in France: Is the IAHAIO Model Relevant?

The State of Animal- Assisted Interventions in France: Is the IAHAIO Model Relevant?

A biofeedback-enhanced therapeutic exercise video game intervention for young people with cerebral palsy: Arandomized single-case experimental design feasibility study.

Movement-controlled video games have potential to promote home-based practice of therapy activities. The success of therapy gaming interventions depends on the quality of the technology used and the presence of effective support structures. This study assesses the feasibility of a novel intervention that combines a co-created gaming technology integrating evidence-based biofeedback and solution-focused coaching (SFC) strategies to support therapy engagement and efficacy at home. Following feasibility and single-case reporting standards (CONSORT and SCRIBE), this was a non-blind, randomized, multiple-baseline, AB, design. Nineteen (19) young people with cerebral palsy (8-18 years old) completed the 4-week home-based intervention in France and Canada. Participant motivations, personalized practice goals, and relevance of the intervention to daily activities were discussed in a Solution Focused Coaching-style conversation pre-, post-intervention and during weekly check-ins. Participants controlled a video game by completing therapeutic gestures (wrist extension, pinching) detected via electromyography and inertial sensors on the forearm (Myo Armband and custom software). Process feasibility success criteria for recruitment response, completion and adherence rates, and frequency of technical issues were established a priori. Scientific feasibility, effect size estimates and variance were determined for Body Function outcome measures: active wrist extension, grip strength and Box and Blocks Test; and for Activities and Participation measures: Assisting Hand Assessment (AHA), Canadian Occupational Performance Measure (COPM) and Self-Reported Experiences of Activity Settings (SEAS). Recruitment response (31%) and assessment completion (84%) rates were good and 74% of participants reached self-identified practice goals. As 17% of technical issues required external support to resolve, the intervention was graded as feasible with modifications. No adverse events were reported. Moderate effects were observed in Body Function measures (active wrist extension: SMD = 1.82, 95%CI = 0.85-2.78; Grip Strength: SMD = 0.63, 95%CI = 0.65-1.91; Box and Blocks: Hedge's g = 0.58, 95%CI = -0.11-1.27) and small-moderate effects in Activities and Participation measures (AHA: Hedge's g = 0.29, 95%CI = -0.39-0.97, COPM: r = 0.60, 95%CI = 0.13-0.82, SEAS: r = 0.24, 95%CI = -0.25-0.61). A definitive RCT to investigate the effectiveness of this novel intervention is warranted. Combining SFC-style coaching with high-quality biofeedback may positively engage youth in home rehabilitation to complement traditional therapy. ClinicalTrials.gov, U.S. National Library of Medicine: NCT03677193.

Death audits and reviews for reducing maternal, perinatal and child mortality.

© 2018 The Cochrane Collaboration. This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the impact and cost-effectiveness of different types of death review in reducing maternal, perinatal and child mortality.

Individual and process factors influencing user’s satisfaction with Housing First services

Abstract Objectives Housing First models aim to give homeless with severe drugs and mental health problems a permanent home and assertive care team support. Concern persists that user satisfaction and retention rate are key values in the evaluation of such inclusive-care programs, to secure good outcomes. The aims of this study were 1) to explore user’s satisfaction with Housing First services, and 2) to determine individual or contextual factors influencing user’s satisfaction. Methods Based on the French Un Chez Soi d’Abord sample, we analysed data from homeless people with severe mental problems assigned to the Housing First and followed during 3 years. Measures included team tracking frequency, service users’ needs, and a Client Satisfaction Questionnaire (CSQ-8). Generalized estimating equations were used with a random effect for site to identify relevant baseline confounders for the CSQ score. Results At 36-month follow-up, 131 HF participants completed the services user’s needs and CSQ-8 questionnaires. 94% were still housed. Respondents reported needs from the HF team for managing housing (74%), administrative assistance (63%) and mental illness (43%). The mean total CSQ-8 score was 25.6 (SD = 5.2) out of 32. Four predictors of a higher CSQ score were: higher frequency of visits (regression coefficients 8.2), lower user’s education (-2.2), ever been a tenant (1.4), and suffering of schizophrenia disorder (0.9) (p&amp;lt;.001). Conclusions The users’ perception of the quality of HF services appears to be high. Our results underscore the interaction of individual and process factors influencing user satisfaction. These findings suggested that HF intervention in France is a promising strategy for high quality of services to homeless people with mental illness. Key messages He users’ perception of the quality of Housing First services appears to be high. Housing First intervention in France is a promising strategy for high quality of services to homeless people with mental illness.

Development of an evidence-based reference framework for care coordination interventions in France

Abstract Background Today, the high variability of practices, the lack of common definitions and underlying concepts increases the existing difficulty to standardise, to replicate, to transpose and to assess the coordinated care. This heterogeneity makes very difficult the evaluation of performance of care coordination. The aim of the first phase of Epock study is to develop a theoretical framework for care coordination interventions in the French health system that can be used for description, implementation and evaluation of care coordination intervention in any clinical situation. Methods A review of systematic reviews on care coordination interventions was conducted to identify relevant models and constitutive elements of the expected reference framework for care coordination intervention. These elements resulting from the literature review have been grouped by themes, prioritised and selected by a structured consensus method (Nominal Group Technique). Results Four dimensions of care coordination were identified: (a) Underlying conceptual models; (b) Care organization, care and facilitation activities; (c) Actors and tools; and (d) Effects classified according to WHO’s quality of care dimensions. Among these dimensions, 4 to 28 elements have been selected to build the reference components of care coordination in France. Conclusions This first reference framework for care coordination interventions in France will be used during the Epock project phase 2 as a basis for comparing practices observed in oncology. This framework could be used as of now for: practice by helping to develop job descriptions and training programmes for future care coordination professionals; piloting to measure care coordination (by developing indicators for care coordination); and research, to evaluate the impact of care coordination interventions. Key messages Epock is a challenging French national research project for the development of an evidence-based reference framework for cancer care coordination interventions considered as a complex intervention. Epock will provide key elements for cancer care coordination intervention effective implementations and for designing further medico-economic evaluation of cancer care coordination intervention impact.