[Evaluating population health interventions: The contributions of theory-driven evaluations]. / Évaluer les interventions en santé des populations : les apports de l'évaluation fondée sur la théorie.

Population health intervention research has been characterized by the deployment of scientific methods designed to produce knowledge on policy and program interventions directly or indirectly involving the health sector, and potentially affecting population health. The proposed solutions encompass a multitude of interventions of variable types, scale, focus and implementation, rendering them particularly complex and difficult to understand. This complexity raises major conceptual and methodological issues because in reality, we assess not an intervention, but rather a set of interventional elements interacting with those specific to the context in which they appear. It is the interactions that produce effects, to the extent that it makes little sense to speak of an intervention, and more sense to consider an interventional system defined by the interactions. To grasp the numerous elements brought into play, it behooves us to amalgamate evaluation paradigms and approaches. In a precise context, theory-driven evaluations are of pronounced interest. This article presents the main principles of this type of evaluation by focusing on its capacity to shed light on the stakes involved in intervention/context interplay, and by putting forward conclusions transferable to population health research.

[Describing and disseminating organizational innovation in public health DINOSP ; guide (Description of Organizational Innovations in Public Health)]. / Décrire l'innovation organisationnelle en santé publique pour favoriser sa dissémination ; guide DINOSP (Description des innovations organisationnelles en santé publique).

OBJECTIVES: The transition from experimentation to the scaling up of organizational innovations in public health is arduous. The innovation process requires back-up in view of enhancing the chances of success and generalization. The aim of this article is to present the development of a guide to support the description and analysis of organizational innovations in public health. METHOD: The mobilization of two analysis and description tools, ASTAIRE and TIDIeR, made it possible to select the innovation criteria to be considered for generalization. Collective discussions between actors, decision-makers and researchers and individual interviews with the latter refined and completed the proposed guide, which was reread by experts and tested by project leaders, thereby improving its accuracy and usability. RESULTS: The guide puts forward a two-step approach: i) to describe innovation at two levels: on the one hand, intervention methods, and on the other hand, interventional, population or contextual components corresponding to 27 criteria and ii) to assess the transferability of the innovation by distinguishing its key functions, its formal elements and the margins of maneuver to be maintained. DISCUSSION: The guide presents a modular vision of innovations and leaves room for reflection on its mechanisms. It favors the synchronization of innovations with the existing system and their mutualization. CONCLUSIONS: By putting forward a standardised description of organizational innovations in health and analyzing their effectiveness, the tool can effectively contribute to the development of effective, adaptable and generalizable projects, and thereby contribute to progress in public health.

Impacts et mise en œuvre du service sanitaire des étudiants en santé (SSES) français : étude de cas dans deux académies françaises.

CONTEXTE: Le service sanitaire des étudiants en santé (SSES) est un programme de 2018 de sensibilisation à la promotion de la santé (PS), à destination d'étudiants en santé français. Il comprend un temps de formation et un temps d'action des étudiants sur diverses populations. Il est déployé sur le territoire français sans évaluation préalable. L'étude que nous avons conduite a pour objectifs de i) documenter la perception et le degré d'appropriation des objectifs du SSES par les parties prenantes (étudiants et professionnels encadrants), ii) analyser les interventions réalisées par les étudiants au regard des bonnes pratiques de promotion de la santé (PS). MÉTHODES: Il s'agissait d'une étude de cas qualitative menée dans deux académies de la Région Nouvelle-Aquitaine : Poitiers et Bordeaux. Des entretiens ont été conduits auprès des parties prenantes, ainsi que des observations d'actions menées par les étudiants. RÉSULTATS: Nous avons réalisé 87 entretiens et 18 observations. Les données obtenues montrent que : (i) si les parties prenantes se sont fortement impliquées, les conditions de mise en place étaient difficiles et inégales, (ii) les objectifs se révèlent en décalage avec des enjeux de la prévention dans le système de soins, (iii) les étudiants ont entériné une vision erronée de la PS rationnelle et individualisant les comportements liés à la santé, et (iv) les actions menées contreviennent pour la majorité aux critères de qualité en PS, qu'ils soient pédagogiques, méthodologiques ou éthiques. CONCLUSION: Ces résultats ont été confortés dans l'académie de Normandie. À notre connaissance, aucune autre évaluation de ce type n'est réalisée sur le territoire français. Ceci pose des questions car les impacts observés semblent suffisamment inquiétants pour appeler à une réforme du dispositif, tant sur les objectifs que sur les accompagnements à l'action en PS (ex. sur les déterminants sociaux de la santé).

Increasing acceptance of a vaccination program for coronavirus disease 2019 in France: A challenge for one of the world's most vaccine-hesitant countries.

France is one of the most vaccine-hesitant countries in the world, including for coronavirus disease 2019 (COVID-19). After 10 months of restrictive measures and media coverage of the dangers of COVID-19, French attitudes towards a vaccine continue to deteriorate. The communication strategies of the government have not helped; in fact, they have made the situation worse. Empirical studies on the national strategy for management of the COVID-19 pandemic in France have shed light on the reasons for vaccine hesitancy. These studies have identified four pillars for the vaccination strategy: i) Communication regarding the importance of herd immunity, ii) making healthcare workers the focus of the vaccination campaign, iii) citizen mobilization and guaranteed consultations, and iv) access to free vaccines without delay. This paper discusses the evidence supporting this strategy.

[Innovative transformation of the health system through a preventive transition]. / L'innovation au service de la transformation du système de santé et du « virage préventif ¼.

Given today's evolution of the healthcare system, organizational transformations, technological developments and major challenges, innovation has taken on primordial importance. In this context and with considerable support, many experimentations have taken place. Unfortunately, few have managed to scale up. What results is a congeries of innovations without a future, possibly avoidable squandering of resources, a number of missed opportunities, and the grim prospect of inventor burnout. As regards prevention, innovation is at the heart of an anticipated "preventive transition" of the health system that has yet to achieve operational status. In this article we attempt to redesign the contours of innovation in health, considering it first and foremost in regard to its social utility. We will go on to explore the limitations of innovative practices that delay the arrival of advances in health. Four types of obstacles appear: faulty evaluation; insufficient dialogue between researchers, stakeholders and decision-makers; lack of visibility and, finally, conceptions and perceptions of innovation characterized by tunnel vision. In the concluding section of this paper, we will present several tracks through which the innovation process could be impelled to drive health system transformation. They consist in: (i) incorporating an evaluative and comprehensive research into innovation processes, (ii) elaborating "bottom-up" approaches giving special consideration to innovations instigated by stakeholders and brought to fruition under real-life conditions, (iii) breaking from standardization by thinking from the outset of the adaptability of innovations and, finally, (iv) tying in the experimental approach with a decision-making process.

Most chilblains observed during the COVID-19 outbreak occur in patients who are negative for COVID-19 on polymerase chain reaction and serology testing.

BACKGROUND: Acral lesions, mainly chilblains, are the most frequently reported cutaneous lesions associated with COVID-19. In more than 80% of patients tested, nasopharyngeal swabs were negative on reverse transcription polymerase chain reaction (RT-PCR) for SARS-CoV-2 when performed, and serology was generally not performed. METHODS: A national survey was launched on 30 March 2020 by the French Society of Dermatology asking physicians to report cases of skin manifestations in patients with suspected or confirmed COVID-19 by using a standardized questionnaire. We report the results for acral manifestations. RESULTS: We collected 311 cases of acral manifestations [58.5% women, median age 25.7 years (range 18-39)]. The most frequent clinical presentation (65%) was typical chilblains. In total, 93 cases (30%) showed clinical suspicion of COVID-19, 67 (22%) had only less specific infectious symptoms and 151 (49%) had no clinical signs preceding or during the course of acral lesions. Histology of skin biopsies was consistent with chilblains. Overall, 12 patients showed significant immunological abnormalities. Of the 150 (48%) patients who were tested, 10 patients were positive. Seven of 121 (6%) RT-PCR-tested patients were positive for SARS-CoV-2, and five of 75 (7%) serology-tested patients had IgG anti-SARS-CoV-2. Tested/untested patients or those with/without confirmed COVID-19 did not differ in age, sex, history or acral lesion clinical characteristics. CONCLUSIONS: The results of this survey do not rule out that SARS-CoV-2 could be directly responsible for some cases of chilblains, but we found no evidence of SARS-CoV-2 infection in the large majority of patients with acral lesions during the COVID-19 lockdown period in France. What is already known about this topic? About 1000 cases of acral lesions, mainly chilblains, were reported during the COVID-19 outbreak. Chilblains were reported to occur in young people within 2 weeks of infectious signs, which were mild when present. Most cases did not have COVID-19 confirmed by reverse transcription polymerase chain reaction (RT-PCR), and few serology results were available. What does this study add? Among 311 patients with acral lesions, mainly chilblains, during the COVID-19 lockdown period in France, the majority of patients tested had no evidence of SARS-CoV-2 infection. Overall, 70 of 75 patients were seronegative for SARS-Cov-2 serology and 114 of 121 patients were negative for SARS-CoV-2 RT-PCR.

How do mobile health applications support behaviour changes? A scoping review of mobile health applications relating to physical activity and eating behaviours.

OBJECTIVE: The objective of this review was to analyse how researchers conducting studies about mobile health applications (MHApps) effectiveness assess the conditions of this effectiveness. STUDY DESIGN: A scoping review according to PRIMSA-ScR checklist. METHODS: We conducted a scoping review of efficacy/effectiveness conditions in high internal validity studies assessing the efficacy of MHApps in changing physical activity behaviours and eating habits. We used the PubMed, Web of Science, SPORTDiscus and PsycINFO databases and processed the review according to the O'Malley and PRISMA-ScR recommendations. We selected studies with high internal validity methodologies (randomised controlled trials, quasi-experimental studies, systematic reviews and meta-analyses), dealing with dietary and/or physical activity behaviours; covering primary, secondary or tertiary prevention and dealing with behaviour change (uptake, maintenance). We excluded articles on MHApps relating to high-level sport and telemedicine. The process for selecting studies followed a set protocol with two authors who independently appraised the studies. RESULTS: Twenty-two articles were finally selected and analysed. We noted that the mechanisms and techniques to support behaviour changes were poorly reported and studied. There was no explanation of how these MHApps work and how they could be transferred or not. Indeed, the main efficacy conditions reported by authors refer to practical aspects of the tools. Moreover, the issue of social inequalities was essentially reduced to access to the technology (the shrinking access divide), and literacy was poorly studied, even though it is an important consideration in digital prevention. All in all, even when they dealt with behaviours, the evaluations were tool-focused rather than intervention-focused and did not allow a comprehensive assessment of MHApps. CONCLUSION: To understand the added value of MHApps in supporting behaviour changes, it seems important to draw on the paradigms relating to health technology assessment considering the characteristics of the technologies and on the evaluation of complex interventions considering the characteristics of prevention. This combined approach may help to clarify how these patient-focused MHApps work and is a condition for improved assessment of MHApps in terms of effectiveness, transferability and scalability.

[Primary and secondary prevention of cancer in women: How can awareness be improved? A literature review]. / Prévention primaire et secondaire des cancers féminins : comment améliorer la sensibilisation des femmes ? Une revue de la littérature.

BACKGROUND: Cancer in women is a major public health concern especially since primary and secondary prevention can reduce mortality. Institutional interventions could play an important role by working directly with healthcare providers. Thus, the objective of this literature review is to draw up an inventory of the interventions proposed to promote the prevention of breast and cervical cancer and to analyze their feasibility or applicability in the French institutional context. METHODS: The literature review was conducted on Cairn, Cochrane, PubMed and ScienceDirect databases with relevant keywords. RESULTS: Forty articles were selected. Interventions focusing on breast and cervical cancer have been quite similar. The format is usually a written document presenting a personalized letter inviting the recipient to participate in a screening program. Paper or call reminders are pivotal tools. Educational groups involving a few sessions, as well as individual education, are particularly important to increase women's knowledge about lesser known prevention behaviors (ex. breast self-examination). CONCLUSION: This work points out concrete ways to establish relevant actions for secondary prevention of cancer in women. A personalized approach (ex., sending personalized letters) appears to be a relevant lever to incite women to participate.

Study protocol for a pragmatic randomised controlled trial evaluating efficacy of a smoking cessation e-'Tabac Info Service': ee-TIS trial.

INTRODUCTION: A French national smoking cessation service, Tabac Info Service, has been developed to provide an adapted quitline and a web and mobile application involving personalised contacts (eg, questionnaires, advice, activities, messages) to support smoking cessation. This paper presents the study protocol of the evaluation of the application (e-intervention Tabac Info Service (e-TIS)). The primary objective is to assess the efficacy of e-TIS. The secondary objectives are to (1) describe efficacy variations with regard to users' characteristics, (2) analyse mechanisms and contextual conditions of e-TIS efficacy. METHODS AND ANALYSES: The study design is a two-arm pragmatic randomised controlled trial including a process evaluation with at least 3000 participants randomised to the intervention or to the control arm (current practices). Inclusion criteria are: aged 18 years or over, current smoker, having completed the online consent forms, possessing a mobile phone with android or apple systems and using mobile applications, wanting to stop smoking sooner or later. The primary outcome is the point prevalence abstinence of 7 days at 6 months later. Data will be analysed in intention to treat (primary) and per protocol analyses. A logistic regression will be carried out to estimate an OR (95% CI) for efficacy. A multivariate multilevel analysis will explore the influence on results of patients' characteristics (sex, age, education and socioprofessional levels, dependency, motivation, quit experiences) and contextual factors, conditions of use, behaviour change techniques. ETHICS AND DISSEMINATION: The study protocol was reviewed by the ethical and deontological institutional review board of the French Institute for Public Health Surveillance on 18 April 2016. The findings of this study will allow us to characterise the efficacy of e-TIS and conditions of its efficacy. These findings will be disseminated through peer-reviewed articles. TRIAL REGISTRATION NUMBER: NCT02841683; Pre-results.

Health needs and public health functions addressed in scientific publications in Francophone sub-Saharan Africa.

OBJECTIVE: To describe the reporting of public health research in Francophone sub-Saharan Africa (FSA). STUDY DESIGN: A bibliometric research study of scientific public health publications in FSA, which includes 24 countries and approximately 260 million people. METHODS: Two researchers analysed original articles published in 2007 in the medical or social sciences fields and indexed in Scopus. At least one co-author of articles had to be based in FSA. The analysis focused on research field, public health function (WHO classification), FSA country author's affiliation, language, journal type and global burden of disease (WHO classification). RESULTS: Of 1047 articles retrieved by the search, 212 were from the public health field. The number of articles per country varied from 0 to 36. Public health functions examined were health service research (24.5%), health monitoring (27.4%), prevention (15%) and legislation (0.5%). The distribution of health needs described in the articles was close to that of the WHO data for Africa for 2004: infectious and parasitic diseases (70% vs 54%), maternal and perinatal conditions (15% vs 17%), non-communicable diseases (15.6% vs 21%), and injuries (0.5% vs 8%). CONCLUSION: The areas reported in published articles from sub-Saharan Africa reflect the health needs distribution in Africa; however, the number of publications is low, particularly for prevention. In light of the current focus on evidence-based public health, this study questions whether the international scientific community adequately considers the expertise and perspectives of African researchers and professionals.

[Reflections and perspectives on evidence-based health promotion in the French environment]. / Réflexions et perspectives concernant l'evidence-based health promotion dans le contexte français.

In France, current structuring of preventive and health promotion policies has created a context favoring evidence-based actions. Yet, in health promotion and health education, interventions are very much setting dependent, potentially compromising this type of approach to health promotion. Thus, in an attempt to inform participants in health promotion in the French setting of ongoing international debates on the topic, we present the main limitations developed in literature, highlighting recent work responding to the challenge. Our analysis is focused on three points: the issue of the level of intervention and indicators to assess efficacy and effectiveness of health promotion interventions; the issue of research methodologies, their capacity to demonstrate efficacy and effectiveness of health promotion interventions and the transferability of their outcomes; the issue of the external validity of studies, and in particular the information necessary for understanding complex mechanisms of intervention. On the basis of this analysis, and with the aim of improving evidence-based health promotion practices, we propose practical perspectives in the French environment for policymakers, local practitioners and researchers. To conclude, we link this issue with the concept of knowledge transfer, which is developed in other countries.

[Eruptive pseudoangiomatosis in an adult renal transplant recipient]. / Pseudo-angiomatose éruptive chez un adulte transplanté rénal.

BACKGROUND: In 1969, Cherry et al. described four children with acute onset angioma-like papules with spontaneous regression during an acute viral infection. Similar cases, called eruptive pseudoangiomatosis, have been reported since and considered to be a viral exanthema. We observed a similar eruption in a 48-year-old male kidney transplant recipient. CASE REPORT: One month after kidney transplantation, the patient rapidly developed macules and papules on the trunk. He had unexplained fever 15 days before the eruption. A biopsy specimen revealed dermal blood vessels surrounded by lymphoid infiltrate. Serology tests were unable to identify any virus. The lesions resolved spontaneously within 15 days. DISCUSSION: In our patient, eruptive pseudoangiomatosis was diagnosed on the basis of the clinical and histological features and the disease course. This case demonstrates that the entity is not limited to children. Further cases should be studied to determine the precise pathogenics of this uncommon entity.

A low-salt medical water reduces irritancy of retinoic acid in facial acne.

Although effective medications are available for the treatment of acne, tolerance problems may preclude adequate treatment regimens such as topical retinoic acid, and reduce patient compliance. The present study was conducted to evaluate whether a medical water (Avène) in conjunction with retinoic acid may improve local tolerance in acne. A controlled, open, randomised, multicentric study was completed after 28 days of treatment in 69 acne patients, 34 applying a retinoic acid preparation alone, and 35 applying retinoic acid in association with the water spray used ad libitum. Topical retinoic acid treatment induced prominent signs of irritation in both groups. However, a statistically significant reduction between the two treatment groups could be demonstrated on scaling at all assessment visits (p< or =0.02, Wilcoxon test). No significant water effect on erythema, burning and itching was shown during the treatment period. The overall tolerance assessed by the investigator was significantly improved with the water (p = 0.04, Wilcoxon). Taken together, water with a low mineral content appears to be a promising adjunctive treatment for improving the tolerance of topical retinoids in acne.

[Mucinous carcinoma of the prostate: critical review of Elbadawi's criteria]. / Carcinoma mucinoso de la próstata: revisión crítica de los criterios de Elbadawi.

OBJECTIVES: We present our experience on prostatic mucinous adenocarcinoma and at once we practice an actualization and a critical review of Elbadawi's criteria. METHODS: After reviewing 206 prostatic carcinomas diagnosed in our hospital, we describe one case that fulfill criteria for being considered a prostatic mucinous adenocarcinoma. We also carry out a wide literature review trying to define anew the including criteria of this tumour by the light of modern knowledge and technology. CONCLUSIONS: We think that for accepting a tumour as a prostatic mucinous adenocarcinoma, this have to fulfill the following criteria: 1. "More than 25% of a significative tumoral sample is mucinous pattern and present, single or clustered, tumour cells floating in immunohistochemically probed, acidic and neutral, mucin lakes". 2. "Tumour is Gleason 3-4 cribiform pattern with direct transition to colloid areas and usually coexist with classic adenocarcinoma but papillary growth patterns should be excluded. Tumour may contain a moderate proportion of signet-ring cells". 3. "Immunohistochemical staining for PSA have to be strongly positive in both, cribiform and mucinous, areas". 4. "Those PSA nonreactive, or only focally positive, mucinous adenocarcinomas, could be labeled as prostatic only when local or distant mucinous carcinomas are ruled out".

Carcinoma mucinoso de la próstata:revisión crítica de los criterios de Elbadawi / Prostatic mucinous carcinoma: critical review of Elbadawi's criteria

OBJETIVOS: Presentar nuestra experiencia sobre el adenocarcinoma mucinoso de la próstata (AMP) a la vez que se realiza una actualización y una revisión crítica de los criterios de Elbadawi. MÉTODOS: Tras revisar 206 carcinomas prostáticos diagnosticados en nuestro servicio, describimos un caso que cumple los criterios para ser considerado un AMP. Realizamos además una amplia revisión de la literatura intentando redefinir dichos criterios de inclusión a la luz de los conocimientos y tecnologías actuales. CONCLUSIONES: Pensamos que para aceptar que un tumor es un AMP, este debería cumplir los siguientes criterios: 1. "Más del 25 por ciento de una muestra tumoral significativa es de tipo mucinoso y presenta células tumorales, sueltas o en racimos, dentro de lagos de mucinas ácidas y neutras demostradas por inmunohistoquímica".2. "El tumor tiene un patrón cribiforme Gleason 3-4 con transición más o menos directa hacia áreas coloides y usualmente coexiste con adenocarcinoma clásico pero descartándose los patrones de crecimiento papilar. El tumor puede contener células en anillo de sello en proporción moderada".3. "Ambas áreas, cribiforme y mucinosa, deben teñirse intensamente con PSA y/o PSAP".4. "Aquellos adenocarcinomas mucinosos que no se tiñen con el PSA, o sólo son focalmente positivos, podrán eti-quetarse como prostáticos sólo si se excluye de forma inequívoca la presencia de tumores mucinosos locales o distantes" (AU)

A case of dyskeratosis congenita associated with impaired DNA repair as shown by the comet assay.

An 18-year old boy with dyskeratosis congenita is presented. To examine the DNA metabolism of our patient, we applied the comet assay, a simple, quick and sensitive method that so far has not been used in this disease. After exposure to UVB, cells originating from the patient present abnormal DNA repair localized in the late step. We consider that such repair deficiency could be related to susceptibility to cancer. The comet assay seems to be a good procedure to investigate dyskeratosis congenita or other genodermatoses.