Regional Health Agency Research Articles

Junior doctors: when fresh blood fast-tracks the fight against COVID-19

On 11 March 2020, the WHO declared COVID-19 as a Public Health Emergency of International Concern. In Europe, particularly in France, hospitals were urged to take prompt measures: cancellation of...

Local health contracts as instruments of cross-sectoral collaboration: the French CLoterreS study

Abstract Background Although recognised as essential, the role of local governments in promoting health remains under investigated. Yet their mandate directly impacts living conditions and promotes SDGs. In France, 'local health contracts' (LHCs) mobilise local decision-makers in 4 areas: health promotion, prevention, health care and social care. The CLoterreS study assesses the extent to which LHCs foster health-promoting actions through cross-sectoral collaboration. Methods We conducted 49 semi-structured interviews with staff from all Regional health agencies (RHAs) and local stakeholders. We analysed the action plans of a stratified random sample of 53 LHCs from the 165 signed between 2015 and March 2018. We used a validated multidimensional coding tool based on WHO's Essential Public Health Operations and other consensus documents. Results LHC's contribution to health promotion through cross-sectoral collaboration depends on a mix of factors. Among barriers, the improvement of access to health care is often a primary driver for local elected officials. However, political will and past experience in establishing 'win-win' relationships with other sectors is an advantage, as well as the fact that RHAs generally make LHCs an instrument to coordinate health promotion efforts instead of ad hoc funding of isolated actions. Overall, 73% of LHCs' actions address living conditions, health promotion or primary prevention. LHCs frequently target behavioural determinants such as physical activity or diet (44 out of 53) with an emphasis on individual or interpersonal targets. A few innovative actions situated at the intersection of urban planning, transportation, recreational or food environments illustrate the potential for further cross-sectoral action on living conditions. Conclusions LHCs are vehicles for health promotion. Reinforcing cross-sectoral action implies leadership, resource mobilisation, training and coordination of sectors whose health is not a core priority. Key messages In France, Local health contracts (LHCs) are significantly used for health promotion. Cross-sectoral collaboration in this area implies further capacity building beyond the health care sector at the regional and local levels.

Mapping of the main types of neoplasms among children and adolescents across the regional health agencies from the Rio de Janeiro state, Brazil

Objetivo: Analisar os principais tipos de neoplasia malignas em pacientes de 0 a 19 anos de idade nas regionais de saúde do estado do Rio de Janeiro. Método: Estudo ecológico que analisou as neoplasias mais frequentes através dos dados contidos no Sistema de Informação Hospitalar em 2017. Os dados foram analisados através do cálculo da frequência relativa e medidas de tendências central. O mapeamento foi realizado por meio do TabWin. Resultados: foram observados 2.662 casos de neoplasias malignas na população de 0-19 anos de idade residentes nas regionais de saúde do Estado do Rio de Janeiro, sendo a Metropolitana I a região de maior proporção e a leucemia o tipo de câncer infanto-juvenil mais frequente. Conclusão: apropriação desses dados torna possível concretizar estratégias para a construção de políticas públicas, visando medidas de prevenção, diagnosticas e tratamento vislumbrando maior sobrevida, melhor qualidade de vida e redução da taxa de mortalidade infanto-juvenil.

Distribution of the deaths from childhood and adolescent cancer across the regional health agencies from the Rio de Janeiro State, Brazil

Objective: The study’s main purpose has been to analyze the spatial distribution of deaths from malignant neoplasms in patients aged up to 19 years old across the regional health agencies of Rio de Janeiro State. Methods: This ecological study analyzed the spatial distribution of deaths from January to December 2015 through data of the Sistema de Informações sobre Mortalidade (SIM) [Mortality Information System]. The data were tabulated in Tabnet and analyzed using the R statistical software. Results: Considering the 101 deaths observed, 24 (23.8%) were from central nervous system cancer. The Metropolitan I regional health agency had the highest death rates (63.3%), and Baixada Litorânea had the highest proportion of deaths from leukemia (27.9%). Conclusion: Identifying the most frequent deaths from malignant neoplasms makes it possible to formulate public policies aimed at prevention, diagnostics, and treatment consistent with the local reality.

Discretionary Power, Scientific Uncertainty and Right to Life in the Context of the COVID-19 Pandemic: Lessons Learnt from the Administrative Tribunal of Guadeloupe and the French Council of State

Administrative Tribunal of Guadeloupe 28 March 2020, case n° 2000295 (Judge for interim relief); French Council of State 4 April 2020, cases n° 439904, 439905 (Judge for interim relief)Based on the precautionary principle and to protect the right to life under Article L. 521-2 of the French Code of Administrative Justice, the Administrative Tribunal of Guadeloupe (Judge for interim relief) ordered the Regional Health Agency of Guadeloupe and the University Hospital Centre of Guadeloupe to procure 200,000 COVID-19 screening tests corresponding to half of the population of Guadeloupe and to buy the doses necessary for the treatment of the COVID-19 epidemic with hydroxychloroquine and azithromycin for 20,000 patients. On appeal, the French Council of State, by disregarding the application of the precautionary principle and with controversial reasoning concerning the relationship between discretionary power and scientific uncertainty, annulled the decision of the Administrative Tribunal of Guadeloupe.

Comment éviter l'implantation des cycles endémiques d'arboviroses autochtones dans nos régions ?

The establishment of Aedes albopictus, vector of arbovirosis, Dengue, Chikungunya and Zika, as well as the existence of epidemic outbreaks in the French overseas departments, requires to take into account the risk of transmission when treating them in health facilities and at home. A plan for the prevention and control of vector-borne diseases must be implemented within health facilities. Its first part is designed to prepare staff and premises (including the surroundings of the facility) and the second part is devoted to the measures to implement during the care of a suspect patient. As a preventive measure, the establishment should identify and list the various potential breeding sites on the establishment, in order to control them and avoid adult emergence.The organization of user and staff protection is based on the identification of a management system for suspect patients to ensure targeted mosquito control in the premises concerned.These measures should be applied without delay when treating a suspect patient in a health facility. In case of home care, the Regional Health Agency (RHA) is responsible for implementing measures to limit the risk of transmission. In order to monitor any risk of transmission prior to diagnosis, RHA is also responsible for collecting the person's living quarters for the duration of his or her viremia. It should then transmit preventive measures if necessary.

How to select relevant metabolites based on available data for parent molecules: Case of neonicotinoids, carbamates, phenylpyrazoles and organophosphorus compounds in French water resources

The presence of pesticide in water resources is a topical issue in France as in many other countries. Resources can be contaminated by current-used pesticides and their metabolites but also by molecules banned 50 years ago. The number of reported studies on the impact of these substances on human health and environment increases every day. Currently, pesticides and their relevant degradation products are subjected to the European regulation for water intended for human consumption. It sets an individual quality limit of 0.1 μg/L, and another of 0.5 μg/L for the sum of their concentrations. The constant improvement of analytical methods allows laboratories to detect pesticides, at lower and lower concentrations but also more and more metabolites. However, regulation does not provide a national indicative metabolites list to be monitored. Each regional health agency offers their own list based on local agricultural practices and quantities of pesticides sold. This article reports a prioritization method allowing to identify new metabolites to be monitored in water resources, along drinking water treatment plants and in treated water; it describes its application in France in order to anticipate possible non-compliance with raw water and treated water and to provide solutions upstream of changes in sanitary control. This methodology has been developed to rank pesticides and to select the corresponding metabolites by combining three main criteria: use (sale and type of use), toxicity, and environmental fate (based on physical and chemical properties). Prioritization method was applied to four families of pesticides: carbamates, organophosphorus compounds, phenylpyrazoles and neonicotinoids, for which there is a real lack of knowledge as regards the occurrence of their metabolites in metropolitan France. 146 pesticides have been prioritized. The first 50 molecules were considered allowing the identification of 72 metabolites to be monitored in water resources and along drinking water treatment plants.

Movement of St. Louis encephalitis virus in the Western United States, 2014- 2018.

St. Louis encephalitis virus (SLEV) is a flavivirus that circulates in an enzootic cycle between birds and mosquitoes and can also infect humans to cause febrile disease and sometimes encephalitis. Although SLEV is endemic to the United States, no activity was detected in California during the years 2004 through 2014, despite continuous surveillance in mosquitoes and sentinel chickens. In 2015, SLEV-positive mosquito pools were detected in Maricopa County, Arizona, concurrent with an outbreak of human SLEV disease. SLEV-positive mosquito pools were also detected in southeastern California and Nevada in summer 2015. From 2016 to 2018, SLEV was detected in mosquito pools throughout southern and central California, Oregon, Idaho, and Texas. To understand genetic relatedness and geographic dispersal of SLEV in the western United States since 2015, we sequenced four historical genomes (3 from California and 1 from Louisiana) and 26 contemporary SLEV genomes from mosquito pools from locations across the western US. Bayesian phylogeographic approaches were then applied to map the recent spread of SLEV. Three routes of SLEV dispersal in the western United States were identified: Arizona to southern California, Arizona to Central California, and Arizona to all locations east of the Sierra Nevada mountains. Given the topography of the Western United States, these routes may have been limited by mountain ranges that influence the movement of avian reservoirs and mosquito vectors, which probably represents the primary mechanism of SLEV dispersal. Our analysis detected repeated SLEV introductions from Arizona into southern California and limited evidence of year-to-year persistence of genomes of the same ancestry. By contrast, genetic tracing suggests that all SLEV activity since 2015 in central California is the result of a single persistent SLEV introduction. The identification of natural barriers that influence SLEV dispersal enhances our understanding of arbovirus ecology in the western United States and may also support regional public health agencies in implementing more targeted vector mitigation efforts to protect their communities more effectively.

Analysis of vaccine losses by temperature changes in a Health Region from Minas Gerais State, Brazil

Introduction: Immunobiologicals are of great importance for the prevention and eradication of diseases. However, the lack of maintenance of the cold chain generates several problems related to losses of these substances, burdening an important amount of public resources. Objective: To analyze vaccine losses in a Health Region (Região Ampliada de Saúde Oeste) of Minas Gerais State in Brazil. Methods: This is a descriptive study, based on secondary data obtained through forms used by the regional health agency (Superintendência Regional de Saúde, SRS), to register losses of immunobiologicals due to temperature changes. Forms from February 2016 through January 2018 were analyzed. The data was organized and validated by double typing. Results: Vaccine losses were caused by lack of electrical energy (40.83%), followed by equipment failure (36.67%), and professional error (10%). As a consequence, 17,229 bottles of vaccines (65.78%) were discarded, corresponding to 111,145 doses. The financial loss was R$ 604,340.31. Conclusion: Losses of vaccines due to temperature changes were relevant in the studied region, damaging the budget for the local health network. Therefore, it is suggested that measures to minimize these losses should be adopted.

Non-compulsory outpatient care programmes: two clinical illustrations

The act of 5 July 2011 pertaining to the rights and the protection of persons under psychiatric care presents the possibility for compulsory care, without the need for full hospitalisation. Patients can be cared for through partial hospitalisation (day hospital and part-time therapeutic clinic) or in a medical-psychological centre. Treatments and all care are detailed in a care programme. This programme is sent, like all certificates, to the regional health agency and the prefecture in the case of psychiatric care by decision of the State representative, or to the hospital director for psychiatric care at the request of a third party. We propose two clinical vignettes.

Sport participation moderates association between bullying and depressive symptoms in Italian adolescents

BackgroundA high rate of bullying episodes has been reported in Italian schools, as well as its association with psychopathology in adolescents. However, information regarding moderators of this interaction are still lacking. This study explored whether gender, exercise frequency, and sport participation exerted a protective effect on the association between bullying and depressive symptoms in Italian students. MethodsResearchers obtained data from 4,829 Italian youth ages 13 to 21 using the self-report Epidemiologia dell'Infortunistica Stradale survey (EDIT) developed by the Regional Health Agency of Tuscany, Italy. Three structural equation models were run to assess moderators of the association between bullying and depressive symptoms. Moderators examined in the models included gender, exercise frequency, and sport participation. ResultsThe association between bullying and depressive symptoms was stronger for females (B=0.95, SE=0.04, p< .001) than for males (B=0.45, SE=0.00, p< .001) and for students who did not play sports (B=0.74, SE=0.09, p< .001) than for those who played sports (B=0.61, SE=0.06, p< .001). Females may be more affected by the depressive effects of bullying than males. ConclusionsParticipation in sports buffers against the effects of bullying and may prove a helpful strategy for increasing exercise, positive peer interactions, and mood in adolescents. LimitationsThe cross-sectional nature of the study, the possible role of BMI as a confounding factor and the use of a not widely used measure of depression.

Dimension Reduction and Analysis of a 10-Year Physicochemical and Biological Water Database Applied to Water Resources Intended for Human Consumption in the Provence-Alpes-Côte d’Azur Region, France

The SISE-Eaux database of water intended for human consumption, archived by the French Regional Health Agency (ARS) since 1990, is a rich source of information. However, more or less regular monitoring over almost 30 years and the multiplication of parameters lead to a sparse matrix (observations × parameters) and a large dimension of the hyperspace of data. These characteristics make it difficult to exploit this database for a synthetic mapping of water quality, and to identify of the processes responsible for its diversity in a complex geological context and anthropized environment. A 10-year period (2006–2016) was selected from the Provence-Alpes- Côte d’Azur region database (PACA, southeastern France). We extracted 5,295 water samples, each with 15 parameters. A treatment by principal component analysis (PCA) followed with orthomax rotation allows for identifying and ranking six principal components (PCs) totaling 75% of the initial information. The association of the parameters with the principal components, and the regional distribution of the PCs make it possible to identify water-rock interactions, bacteriological contamination, redox processes and arsenic occurrence as the main sources of variability. However, the results also highlight a decrease of useful information, a constraint linked to the vast size and diversity of the study area. The development of a relevant tool for the protecting and managing of water resources will require identifying of subsets based on functional landscape units or the grouping of groundwater bodies.

Results of the 2017 inspection campaign of French phase I/II research sites in Île-de-France following the BIA 10-2474 accident: Medical vs. regulatory relevance

Following the serious adverse events that occurred in January 2016 during the BIA10-2474 First-in-Human study, the French Ministry of Health asked the Regional Health Agencies to inspect operations at all research sites conducting phase I/II clinical trials of experimental drugs. The aim of this study was to assess the medical relevance of the inspections made in Île-de-France (Paris region) in 2017. All 30 sites of Île-de-France region fully authorized to perform phase I/II trials were inspected by a public health physician and a public health pharmacist. Their reported list of observations was submitted to three physicians with longstanding experience of early pharmacology studies performed in academic or private research facilities. These physicians were asked to adjudicate each observation according to their perceived medical importance regarding safety. Adjudications were first performed separately and disagreements were later settled during a final adjudication meeting. At least one disagreement occurred initially among the 3 adjudicators for 84 of the 120 observations (70%) reported by the inspectors. Following reconciliation, the 3 physicians agreed that 20% of the observations were likely to have potentially serious medical consequences. These observations mainly concerned the management of emergencies and of serious adverse events and the continuity of care. Maintenance of on-site inspections periodically carried out by regulatory authorities granting authorisations to perform phase I/II trials are justified. However, the medical relevance of these inspections can be improved with more emphasis on factors affecting the safety of research participants than on administrative or purely regulatory issues.

Positioning the medico-social sector as a stakeholder in digital transformation

In the Île-de-France region, the medico-social sector is implementing a project to develop digital tools ininstitutions. With the support of the regional health agency, this project will lead to the selection of publishers by the end of 2019 who will offer the institutions business tools tailored to their needs, secure and interoperable to be part of the e-track programme.

Implementing regional “Sport, health and well-being” plans A process of continuous adjustments

The regional health agencies (ARS) and the regional Directorates for Youth, Sports and social cohesion (DRJSCS) must collaborate to define, together, the modalities for the implementation of the &#8220;Sport, Health and Wellness&#8221; plan. Then based on these modalities the actors &#8220;providers of physical and sporting activities, (APS)&#8221; acting as close to the population (local authorities and their groupings, schools, health, Medical-social, health-sector associations, sports, professionals, etc.) are invited to mobilize themselves to concretely deploy the aims of this plan. Based on a perspective of sociology of public action, the survey was built on an approach that helped to identify the&#160;different actors and their stance. 90&#160;semi-directive interviews were conducted with the public and private actors involved in the implementation of this plan. This corpus was amended by a collection of sources targeted at the case studied and by a treatment of the literature in order to reinforce the results. Through the implementation of this plan, the central State promotes collaboration between public and private actors in different sectors. The plurality of interests at hand explains that the articulation of their ways of seeing and doing things remains a particularly complex operation.

How Do Infectious Disease Epidemiologist Positions Increase Public Health Capacity? Results from a Qualitative Study of Local Health Departments.

The purpose of this study was to characterize changes in and impacts on epidemiologic capacity in local health departments after the implementation of a state-funded epidemiologist program using qualitative data. The study used key informant interviews in Texas health departments, which were conducted and inductively analyzed to identify themes. Five predominant themes emerged from interviews on the impact of state-funded epidemiologists on the epidemiology capacity of local health departments. State-funded epidemiologists were seen as increasing overall epidemiology capacity in local health departments. Specifically, they improved timeliness of infectious disease reporting and quality and thoroughness of disease investigations. They also improved community stakeholder relationships with local health departments and communications across local, regional, and state public health agencies. Key informants at all levels described positive effects of the state-funded epidemiologists on disease surveillance. Local epidemiology capacity has increased, and, in turn, Texas public health surveillance capacity has improved at the local, regional, and state levels. Funding programs like this should be considered when public health capacity is low and in need of an increase.

Northern Québec James Bay Cree Regional Health Governance in Support of Community Participation: Honouring the "Butterfly"

Successful responses to the Truth and Reconciliation Commission of Canada's (TRC, 2015) Calls to Action require “joint leadership, trust-building, and transparency” between Canadian public institutions and First Nations. In the area of health and wellness, community participation in priority setting and planning constitutes one important step forward. In 2013, the Québec Cree regional health and social services agency launched a unique wellness planning initiative involving community participation in regional level policy-making. This article reports on a qualitative study conducted with key agency staff, an early component of a broader developmental participatory evaluation. Focusing on contextual challenges to and ways forward on community participation in planning, thematic analysis of 17 semi-structured interviews revealed important nuances between Cree and non-Cree perspectives: These perspectives reflected an empowerment versus a utilitarian view of participation, respectively. Cree Elders consulted on these results highlighted the ontological and epistemological distinction of Cree perspectives, and the importance of bringing these forth. These interpretations point to the relevance of extending cultural safety to institution-level processes bearing on relationships with communities and potentially building capacity for participation.

Prospective study on chronic diseases and healthcare costs for the south of France region, 2016-2028

Abstract Background In France, Health Regional Agencies (HRA) have to elaborate a Public Health Plan for the 5 coming years. For estimating future population health needs and associated costs to adapt the health services on the regional territory, the HRA in southeastern France requested a prospective analysis, based on demographic and epidemiologic scenarios about major chronic diseases, to evaluate future trends. Methods Six chronic diseases were selected: diabetes (1 or 2), cardiovascular diseases, respiratory diseases, cancers, neurological diseases and dementia. We used medico-administrative data from the National health insurance fund, and adapted algorithms to identify people with these diseases. We calculated prevalence rates according to gender and age and used two alternative scenarios (a constant one, and a trend-based one) to estimate the number of people with chronic diseases in 2023 and 2028, starting in 2016. We also estimated future healthcare costs according a constant and a trend-based scenario. Results The algorithms detect reasonable rates of disease compared to official rates available for 2016. Due to demographic (ageing) and/or epidemiologic trends, the number of people with chronic diseases will highly increase during the next ten years in the South of France region. For instance, between 2016 and 2028, there will be from 15% to 20% more people with diabetes. Associated costs will also be higher (+33% between 2016 and 2028), especially those granted to nursing care (+40%). Conclusions Burden of diseases and health expenditures are going to increase in the future. Projections are needed to help policymakers anticipating the required health services adaptation. Medico-administrative database are an invaluable source of data to do so. The next step of this project will consist in estimating those trends for smaller geographical areas. Key messages Data of the French Health Insurance fund can be used to predict future prevalence of chronic diseases and healthcare costs. South of France will face a main increase of people with chronic diseases.

Effectiveness of Mois sans tabac 2016, a French social marketing campaign against smoking

Abstract Background In October 2016, Santé publique France, the National Public Health Agency, launched a social marketing campaign aiming at triggering quit attempts among smokers: “Mois sans tabac”, inspired by the English ’Stoptober’. This campaign sets smokers the objective of being smokefree for one month, in November. It combines a national mass-media communication with provision of cessation help services (quitline, website, mobile application, self-help kit) and local actions, in connection with the health regional agencies. The study aims at evaluating the effectiveness of this intervention. Methods The effectiveness evaluation is based on a specific analysis of the 2017 Health Barometer, a random survey representative of the population living in metropolitan France conducted between January and July 2017 on a sample of 25,319 individuals aged 18-75 years-old. The participation rate was 48.5%. Multivariate logistic regressions allowed testing the association between recall of the campaign and quit attempts (QA) in the last quarter of 2016, adjusted for sociodemographic confounders (N = 6,341). Respondents who attempted to quit were contacted at one-year for a follow-up. Results Nearly one in six daily smokers (15.9% [14.9-17.1]) reported making a 24-hour QA in the last quarter of 2016, and 18.4% [15.5-21.3] of them reported that it was related to Mois sans tabac, which represents approximately 380,000 QA [310,000-440,000] related to the operation. Among smokers who made a QA, 31% have been abstinent for at least 30 days [27%-34%] and 18% [15%-21%] reported they did not smoke anymore in 2017. Recall of Mois sans tabac was associated with QA in the last quarter of 2016 (aOR=1.3 [1.1-1.6], p &amp;lt; 0.01) and with cessation in 2017 (aOR=2.4 [1.4-4.2], p &amp;lt; 0.01), and odds-ratios increased with frequency of exposure and number of sources of information. Conclusions These results show that the first edition of Mois sans tabac was successful in triggering quit attempts among smokers. Key messages Mass-media campaigns for smoking cessation, combined with provision of help services and local actions, can be effective for triggering quit attempts. Importing foreign social marketing programs can be effective.

Mapping of early intervention programs for psychosis in France in 2018

Abstract Early intervention programs (EIP) have been developed in many countries (United States, Europe, Canada) and are now widely considered effective in the treatment of early psychosis. In France, current national policies in the field of mental health promote the development of early intervention but France has not yet met national standards of care for EIP. A recent report from the London School of Economics (2016) even mentioned the delay of France in this area, referring to only one EIP in the country. A preliminary investigation conducted in 2017 showed a strong dynamic with many ongoing projects which led us to renew this investigation in 2018. This was a two-phase study. First, an inventory was achieved through a bottom-up approach and many contacts across the country which may either provide this kind of care or know of such initiatives: psychiatrists, healthcare facilities or Health Regional Agencies. Then, an online declarative survey was administered covering structure of attachment, dedicated team, funding, targeted population, activity in 2017, difficulties and prospects. Between May and October 2018, 69 EIP were identified in France: 35 were operational and 34 were being established or beginners. The 35 identified operational programs were located throughout the country with a few disparities. Half of the programs had been existing for 2 years (17/35). All programs operated with multidisciplinary teams, including at least one psychiatrist and with a mean of 5.9 dedicated full-time equivalents workers. Half of the programs offered case management (48.6%). Most programs were not as a specific setting and had mixed activities, including chronic patients with schizophrenia and most programs offered an integration of ambulatory follow-up in the living environment for some patients (77.1%). A real dynamic has been launched in France. This study will help to improve visibility of programs and to harmonize and ensure a high level of care. Key messages This study shows that a real dynamic has been launched in France. This study shows a need for teams to harmonize and standardize practices of care.