Supporting the applicability and transferability of the "Sortir Ensemble & Se Respecter" program in France / Accompagner l'applicabilité et la transférabilité du programme « Sortir Ensemble & Se Respecter ¼ en Frances

INTRODUCTION: The prevention of intimate partner violence (IPV) among young people is a major challenge for public policies. Nevertheless, there are a few prevention programs that have proven effective in France. "Sortir Ensemble & Se Respecter" (SE&SR) is a Swiss adaptation of "Safe Dates," an American intervention program that has reduced violent behavior by young perpetrators and victims of IPV alike. The aim of this article is to analyze the applicability and "potential transferability" of SE&SR in France. METHODS: We described the SE&SR intervention by explaining the intervention theory, the key functions (i.e., the "ingredients" allowing the SE&SR program to work), and we commented on its applicability from a perspective of adapting and transferring it to the French context. We used the ASTAIRE tool and the FIC (key functions, implementation, context) approach. RESULTS: The intervention theory highlighted various factors, acting at the individual level (i.e., beliefs/representations, knowledge, life skills) and at the level of the living environment (i.e., facilities welcoming young people; families; public policies; networks of actors), that can prevent IPV among young people. Ten key functions have been identified, revealing the "skeleton" of the Swiss intervention. We drew on these results to comment on the intervention's applicability, with a view to transferability, specifying the contextual elements to consider before implementing SE&SR in France. CONCLUSION: This study aims to make the process of evaluating applicability, with a view to transferring an evidence-based program to the French context, more accessible.

Introduction: La prévention des violences dans les relations amoureuses (VRA) chez les jeunes est un enjeu fort des politiques publiques. Néanmoins, il existe peu de programmes de prévention ayant fait la preuve de leur efficacité en France. « Sortir Ensemble & Se Respecter ¼ (SE&SR) est une adaptation suisse de « Safe Dates ¼, un programme d'intervention américain qui a montré des résultats en matière de réduction des comportements violents tant du côté des jeunes victimes que des auteurs. L'objectif de cet article est d'analyser l'applicabilité et la « potentielle transférabilité ¼ de SE&SR en France. Méthodes: L'approche adoptée consistait à décrire l'intervention SE&SR en explicitant la théorie d'intervention, les fonctions clés (soit les « ingrédients ¼ permettant que le programme SE&SR fonctionne) et en proposant des commentaires d'applicabilité en vue d'une transférabilité adaptée au contexte français. L'outil ASTAIRE et la démarche FIC ont été utilisés. Résultats: La théorie d'intervention a mis en évidence différents facteurs, agissant au niveau individuel (i.e. connaissances, croyances/représentations, compétences psychosociales) et au niveau des milieux de vie (i.e. structures accueillant les jeunes, familles, politiques publiques/réseaux d'acteurs), qui peuvent prévenir les VRA chez les jeunes. Dix fonctions clés ont été identifiées, dégageant le « squelette ¼ de l'intervention suisse. À la suite de ces résultats, des commentaires d'applicabilité en vue d'une transférabilité ont permis de préciser les éléments de contexte à prendre en compte avant la mise en œuvre de SE&SR en France. Conclusion: Cette étude souhaite rendre accessibles les process d'applicabilité en vue d'une transférabilité d'un programme probant en contexte français.

Emergence of the "e-patient" and "e-caregiver" around a serious game in ETP / Émergence du « e-patient ¼ et du « e-soignant ¼ autour d'un serious game en ETP

Introduction: The advent of e-health has an impact on many areas of health care practice, including TPE. The impact of the introduction of information and communication technologies (ICTs) in health care, such as serious games, remains largely unexplored in the field of e-TPE. Purpose of the Research: To ask patients and health care professionals about the use of a serious game, in order to clarify the impact of these technologies on health care practices and on the relationship between caregiver and patient, as well as their advantages and limitations. Method: A qualitative study based on the grounded theory approach, using semi-structured interviews with six health care professionals and six patients using the DRAGO© serious game, a smartphone application designed to improve compliance with allergy treatment. A lexicometric analysis was carried out, with classification by theme and sub-theme, followed by a statistical breakdown of verbatims according to whether they expressed a favorable or unfavorable opinion. Results: 64% of professionals surveyed are in favor of digital innovations in health care, and 67% of patients. Health care professionals have reservations about their patients' eligibility for these new technologies. In both categories, the ethical issues surrounding the emergence of e-health are positively echoed, with 69% of health care professionals and up to 83% of patients in favor. Both categories are more reserved about the impact of ICTs on the health care relationship. Conclusion: Health care professionals and patients alike consider the presence of ICTs in TPE to be "acceptable," although they remain vigilant about the impact they can have on the health care relationship. These developments imply a necessary change in the practices of health care professionals, leading them to think about and encourage the emergence of the profile of tomorrow's e-caregiver working with e-patients.

Introduction: L'avènement de la e-santé vient impacter de nombreux domaines dans la pratique soignante dont l'Éducation Thérapeutique du Patient (ETP). L'incidence de l'introduction de Technologies de l'Information et de la Communication (TIC) en santé de type serious game reste peu étudiée dans le domaine de l'e-ETP. But de l'étude: Questionner des patients ainsi que des professionnels de santé autour de l'usage d'un serious game afin de préciser l'incidence de ces technologies sur les pratiques soignantes, sur la relation soignant-soigné ainsi que leurs intérêts et leurs limites. Méthode: Étude qualitative selon l'approche par théorisation ancrée au travers d'entretiens semi-directifs menés auprès de 6 professionnels de santé et 6 patients usagers du serious game DRAGO©, application sur smartphone visant à renforcer l'observance du traitement contre les allergies. Réalisation d'une analyse lexicométrique avec classement par thématiques et sous-thématiques puis répartition statistique des verbatims selon qu'ils portent une opinion favorable ou défavorable. Résultats: Les professionnels interrogés sont favorables à 64 % au sujet des innovations numériques en santé et les patients à 67 %. Les professionnels de santé émettent des réserves quant à l'éligibilité de leur patientèle à ces nouvelles technologies. Dans les deux catégories de populations, les questionnements éthiques autour de l'émergence de l'e-santé trouvent un écho positif à raison de 69 % d'avis favorables pour les professionnels de santés et jusqu'à 83 % pour les patients. Les deux catégories sont plus réservées quant à l'incidence des TIC sur la relation de soin. Conclusion: Professionnels de santé comme patients estiment comme « acceptable ¼ la présence de TIC en ETP, bien qu'ils restent vigilants sur l'incidence qu'ils peuvent avoir sur la relation de soin. Ces évolutions impliquent un nécessaire changement de pratiques des professionnels de santé amenant à penser et favoriser l'éclosion du profil du e-soignant de demain exerçant auprès de e-patient.

Parental Attachment, Self-Esteem, Social Problem-Solving, Intimate Partner Violence Victimization in Emerging Adulthood.

Emerging adults can experience conflicts with their dating partner, leading to intimate partner violence (IPV). In order to understand the vulnerability factors involved in IPV victimization, the current study explored a serial multiple mediation model to determine the links between parental attachment (to the father and mother), self-esteem, and social problem solving (SPS) on the three forms of IPV (psychological, physical and sexual). Based on an online survey, 756 emerging adults (84.8% women, mean age = 23.52) completed self-report questionnaires related to parental attachment, self-esteem, SPS (avoidance and impulsive/carelessness style), and IPV during the past year. The study design was cross-sectional and data were analyzed through partial least structural equation modeling (PLS-SEM) technique. The findings did not support serial multiple mediation model, as the indirect effects of the two specific mediation models were not significant. However, the total indirect effects were significant, indicating a cascade effect chain of events between the variables; insecure parental attachment was related to lower self-esteem, which was associated with poor SPS skills (especially impulsive/carelessness style), which in turn was associated with both psychological and physical violence victimization. The implications of the findings for promoting the life skills of emerging adults, such as problem solving or self-esteem, to enable them to handle their relationship conflicts are discussed.

IPV in emerging adults shows specific dynamics, different from those of adults. Understanding the interactions of vulnerability factors of these IPV, particularly among victims, is important for developing prevention programs based on evidence. Using a new multiple mediation approach, this study explores the interactions between parental attachment, self-esteem, problem solving and IPV victimization. It highlights the need to act on life skills such as problem solving or self-esteem to prevent IPV victimization.

Dysfunctional Attitudes, Sociotropy-Autonomy, and Intimate Partner Violence Victimization in Emerging Adulthood.

Understanding the dynamics and vulnerability factors involved in intimate partner violence (IPV) victimization among emerging adults is important in order to better prevent it from happening. The current study aimed to investigate the relationships among dysfunctional attitudes, sociotropy-autonomy, and types of IPV victimization (i.e., psychological, physical, and sexual) and severity (i.e., minor or severe) in emerging adulthood. Through an online survey, 929 emerging adults (84.6% women, mean age = 23.61) completed self-report questionnaires related to variables explored. When checking for childhood abuse, dysfunctional attitudes, sociotropy, and autonomy were related to IPV victimization for at least one type of violence and one scale of severity. The regression models show that independence from others and importance given to others are related to greater severe and minor physical violence, respectively. Attraction to loneliness seemed related to lesser minor psychological violence, whilst valorization of freedom of movement and action were related to greater minor sexual violence. The capacity to oppose others seemed related to greater severe sexual violence. These different cognitive and social characteristics may be associated with poorer social skills, thus making emerging adults more vulnerable to IPV victimization. The preventive and clinical implications are discussed.

Self-Esteem, Social Problem Solving and Intimate Partner Violence Victimization in Emerging Adulthood.

Although there are many studies examining the psychosocial vulnerability factors of intimate partner violence (IPV) victimization in emerging adulthood, little is known about the life skills that may be involved, such as social problem solving (SPS) and self-esteem. The aim of the current study is to explore the relationships between SPS, self-esteem, and types (i.e., psychological, physical and sexual) and severity of IPV victimization in emerging adulthood. Based on a French online survey, 929 emerging adults (84.6% of whom were women with a mean age of 23.6) completed self-report questionnaires related to SPS (problem orientations and problem-solving styles), self-esteem and IPV victimization. The results showed that positive SPS skills and higher self-esteem were associated with lower severity of IPV. Multivariate analyses showed that the most associated factors of severe forms of IPV were avoidant and impulsive/carelessness styles. Minor sexual violence was positively associated with lower self-esteem and rational problem-solving skills, while minor psychological victimization was related to avoidant style. Upon completion of this study, it can be said that conflicts which escalate into IPV may be associated with dysfunctional conflict resolution styles, highlighting the importance of interventions that promote the development of life skills in order to prevent IPV.

Understanding Inequalities in the Uptake of Supportive Care to Improve Practices in the Cancer Care Continuum.

(1) Background: While inequalities in the prevalence of cancer, access to care, and survival have been well documented, less research has focused on inequalities in the uptake of supportive oncology care. Given its contribution to improving the quality of life of people affected by cancer, access to such care is a major public health issue. The present study focuses on the access and uptake of those supportive oncology care services. (2) Methods: This study is based on qualitative research methodology, using a thematic analysis tree on NVivo© analysis software. First, an exploratory survey was conducted with users of oncology services, and professionals from these services and supportive oncology care. Then, individual interviews were conducted in June 2022 among people who are currently being treated or have been treated for cancer. (3) Results: The experiences of the 33 respondents revealed that significant variations in the uptake of supportive oncology care are underpinned by identifiable disparities in their healthcare pathways: in their assimilation of information, difficulties in accessing oncology care, personal reluctance and motivations, perceived needs and benefits, and use of other medicines. (4) Conclusion: This study aims to gain some insight into disparities in the uptake of supportive care in the Centre-Val de Loire region (France). Thus, it provides a better understanding of the complex ways in which these inequalities in supportive oncology care uptake are constructed.

The impact of COVID-19 on psychiatric and mental health services in Europe: suffering experienced by professionals.

BACKGROUND: The COVID-19 pandemic has not only impacted intensive care units, but all healthcare services generally. This PsyGipo2C project specifically investigates how psychiatry and mental health professionals have been affected by the reorganizations and constraints imposed, which have reshaped their often already difficult working conditions. METHODS: Our research combined quantitative and qualitative methods, surveying and interviewing health professionals of all occupations working in psychiatric and mental health services. A questionnaire was completed by 1241 professionals from 10 European countries, and 13 group interviews were conducted across 5 countries. In addition to this, 31 individual interviews were conducted in Belgium and France. RESULTS: Among the questionnaire respondents, 70.2% felt that their workload had increased, particularly due to their tasks being diversified and due to increased complexity in the provision of care. 48.9% felt that finding a work-life balance had become more difficult, and 59.5% felt their health had been affected by the crisis. The impact of the health crisis nevertheless varied across professions: our data provides insight into how the health measures have had a differential impact on professional tasks and roles across the various categories of occupations, obliging professionals to make various adaptations. The distress incurred has been linked not only to these new constraints in their work, but also to the combination of these with other pressures in their personal lives, which has consequently compromised their well-being and their ability to cope with multiple demands. DISCUSSION: The COVID-19 health crisis has had varying impacts depending on the profession and access to remote work, sometimes leading to conflicts within the teams. The suffering expressed by the professionals was tied to their values and patterns of investment in work. Our research also highlights how these professionals made little use of the psychological supports offered, probably due to a reluctance to acknowledge that their mental health was affected.

A Home-Mailed Versus General Practitioner-Delivered Vaginal Self-Sampling Kit for Cervical Cancer Screening: A Cluster Randomized Controlled Trial with a Cost-Effectiveness Analysis.

Objective: We assessed whether general practitioner (GP) delivery of a vaginal self-sampling kit was non-inferior to home-mailed delivery on cervical cancer screening (CCS) participation. Methods: Two hundred and ten French GPs from Indre-et-Loire French department were randomized into two groups, and their unscreened women patients aged 30-65 were included in February-March 2015. In the GP delivery group (n = 105 GPs; 1,806 women), women were sent a reminder letter inviting them to collect a vaginal self-sampling kit at their regular GP's practice. In the home-mailed delivery group (n = 105 GPs; 1,806 women), women were sent a reminder letter with a vaginal self-sampling kit directly at home. The primary outcome was participation in complete CCS within 9 months. A cost-effectiveness analysis was also performed. Results: At 9 months, 14.9% (95% CI: 12.9-16.9) and 27.9% (95% CI: 25.7-30.0) of women in the GP and home-mailed delivery groups participated in complete CCS. The absolute between-group difference was -13.0 percentage points (95% CI: -15.9 to -10.0) in favor of the home-mailed delivery group, crossing the non-inferiority pre-defined non-inferiority margin of 5%. The home-mailed delivery strategy cost 50.81€ more per additional woman screened. Conclusions: The GP delivery was inferior to home-mailed delivery in increasing participation in CCS. Home-mailed delivery of a vaginal self-sampling kit is a cost-effective way to increase CCS in that the additional cost of this strategy seems acceptable. This study is registered at www.Clinicaltrials.gov NCT02255084.

How are patients' preferences for anti-TNF influenced by quality of life? A discrete choice experiment in Crohn's disease patients.

BACKGROUND AND OBJECTIVE: Anti-TNFs have been shown to significantly improve the health-related quality of life (HRQoL) in Crohn's disease (CD) patients. The purpose of this study was to investigate to what extend the patients' preferences for these intravenous (IV) and subcutaneous (SC) treatments differ based on respondents' quality of life. An online discrete choice experiment (DCE) was conducted to understand patient trade-offs in treatment choice. METHODS: Fifty-seven Crohn's disease anti-TNF naïve patients were asked to choose between two different scenarios, considering the following attributes: mode of administration (MODE), total availability for injection (TIME), speed of onset (DELAY), risk of anti-TNF administration despite a contraindication (RISK) and total monthly out-of-pocket expenses (COST). At the same time, patients completed the IBDQ-32 questionnaire. Conditional logit models without and with interaction terms were estimated to evaluate attribute weights. RESULTS: Patients preferred to self-administer SC anti-TNF rather than have a primary care nurse do it, whereas the preference for IV route was negative. After adding interaction terms however, the IV route became preferred for patients with impaired HRQoL, this preference having decreased as HRQoL increased. Surprisingly, patients with impaired HRQoL were less willing to spend more time on treatment, and this effect diminished as HRQoL (overall and in each dimension) became higher. CONCLUSIONS: HRQoL level changed patients' preferences for the anti-TNF treatment. The results suggest the need to optimise the management of IV infusions in the hospital and reinforce the importance of patient-reported outcome measures (PROMS) as a common practice to improve shared medical decision making.

COVID-19 and Physical Distancing Measures: Experience of Psychiatric Professionals in Europe.

A The COVID-19 pandemic has had a considerable impact on the organization of psychiatric care. The present study examines how care professionals experienced this period and faced these new constraints weighing on their professional practices. Based on a qualitative research methodology, 13 group interviews with healthcare professionals working in psychiatric wards were conducted in five countries in western Europe. To complement this, 31 individual interviews were carried out in Belgium and France. Public health measures hindered certain therapeutic activities, jeopardized communication, and obliged healthcare professionals to modify and adapt their practices. Confronted with a transformation of their usual roles, healthcare professionals feared a deterioration in the quality of care. Impossible to continue in-person care practices, they resorted to online videoconferencing which went against their idea of care in which the encounter holds an essential place. The lockdown contradicted efforts to co-build care pathways toward readaptation, social reintegration, and recovery, thus reviving the perception of psychiatric hospitalization based on isolation.

Predictors of each quality of life dimension in Crohn's disease patients initiating an anti-TNF treatment: differentiated effects of patient-, disease-, and treatment-related characteristics.

BACKGROUND AND AIMS: In Crohn's disease (CD), a composite therapeutic target was recently recommended, including both objective measurement (endoscopic remission) and Patient-Reported Outcomes (resolution of abdominal pain and normalization of bowel function). All dimensions of health-related quality of life (HRQoL) are impacted: not only bowel symptoms but also systemic symptoms, emotional wellbeing and social function. Thus, understanding the predictors of each HRQoL dimension would improve patient management. However, analysis of these factors has only been found in a few publications, with some limitations. Therefore, this study aimed to explore the evolution of the HRQoL of CD patients during six months after initiation of anti-TNF and to identify its predictors. METHODS: We analyzed data of 56 patients included in a multicenter prospective cohort study (COQC-PIT). HRQoL measures (using IBDQ-32) and data related to patient, disease and treatment characteristics were collected every two months. Generalized estimating equations were used. RESULTS: Overall HRQoL was significantly improved 2 months after anti-TNF initiation, and then stagnated. Patient, disease, and treatment characteristics have differentiated impacts on the overall score and on each dimension of quality of life. Subcutaneous anti-TNF had no significant effect on overall HRQoL, improving only emotional function and bowel symptoms. Concomitant use of corticosteroids and/or immunomodulators impaired almost all dimensions. Having children or working altered bowel symptoms. Disease duration and active smoking negatively impact emotional function and systemic symptoms. CONCLUSIONS: Each HRQoL dimension, not only bowel symptoms, and their influencing factors should therefore be considered in medical decision-making, especially in months following the initiation of a new treatment such as anti-TNF.

What is the impact of blood pressure on neurological symptoms and the risk of ESKD in primary and secondary thrombotic microangiopathies based on clinical presentation: a retrospective study.

BACKGROUND: The impact of blood pressure on neurological symptoms and risk of end-stage kidney disease (ESKD) is unknown in primary and secondary thrombotic microangiopathies (TMAs). METHODS: We measured baseline systolic (SBP) and diastolic (DBP) BP in consecutive 563 patients with adjudicated primary and secondary TMAs, and assessed its association with the risk of ESKD. RESULTS: Normal BP, grade 1, 2 and 3 hypertension were present in 243 (43.1%), 132 (23.4%), 101 (17.9%) and 88 (15.6%), respectively. Significant BP differences were noted in relation to the cause of TMA: highest BP values were found in patients with atypical hemolytic-uremic syndrome (aHUS), pregnancy, transplantation and auto-immune-related TMAs. Normal BP or grade 1 hypertension was found in 17/18 (94.4%) patients with thrombotic thrombocytopenic patients (only 1/18 (5.6%) had a SBP value>150 mmHg). In contrast, BP values could not differentiate isolated "essential" malignant hypertension (MH) from MH associated with aHUS (isolated MH (n=15): BP (median (IQR)): 220 (182-249)/132 (101-150) mmHg; MH with aHUS (n=5): BP: 223 (196-245)/131 (111-144) mmHg). The risk of vigilance disturbances (6.9%, 15.0%, 25.0%, respectively), epileptic seizures (1.5%, 4.0%, 12.5%, respectively) and posterior reversible encephalopathy syndrome (0.76%, 2.97%, 6.82%, respectively) increased with increasing baseline BP values from grade 1 to grade 3 hypertension. ESKD occurred in 35/563 (6.2%) patients (1.23%, 2.27%, 11.9% and 19.3% of patients with normal BP, grade 1, 2 and 3 hypertension, respectively). As compared to patients with normal BP (<120/139 mmHg), grade 1, grade 2 and grade 3 hypertension were associated with a greater risk of ESKD in univariate (OR: 1.91 [0.83-4.40], 13.2 [3.56-48.9] and 34.8 [9.31-130], respectively) and multivariate (OR: 0.89 [0.30-2.69], 7.00 [1.57-31.3] and 19.7 [4.53-85.2], respectively) analyses. The association between BP and the risk of ESRD was unchanged after adjustment on eculizumab use (OR: 3.46 [1.41-8.49], 17.7 [4.44-70.0] and 70.6 [8.61-579], respectively). Patients with MH, regardless of its cause, had a greater risk of ESKD (OR: 26.4 [10.0-69.8] vs other patients). CONCLUSIONS: Baseline BP differs in primary and secondary TMAs. High BP reduces the neurological tolerance of TMAs and is a powerful independent risk factor of ESKD, even after adjustment on TMA's cause.

International professional practices in mental health, organization of psychiatric care, and COVID-19: A survey protocol.

OBJECTIVE: Our project aims to provide: an overview of the impact of the COVID-19 pandemic on the field of mental health professionals in 23 countries;a model of recommendations for good practice and proposals for methods and digital tools to improve the well-being at work of mental health professionals and the quality of services offered during crisis and post-crisis periods;an in-depth ethics review of the assessment of the use of numerical tools for psychiatry professionals and patient support, including teleconsulting. METHODS: This is a large international survey conducted among 2,000 mental health professionals in 23 countries over a 12-month period. This survey will be based on 30 individual interviews and 20 focus group sessions, and a digital questionnaire will be sent online to 2,000 professionals based on the criteria of gender, age, professional experience, psychiatric specialty, context of work in psychiatry, and geographical location. Regarding the development of telepsychiatry during the COVID-19 pandemic, a pilot study on the use of digital tools will be carried out on 100 clients of psychiatry professionals in France and Belgium. DISCUSSION-CONCLUSION: This study will contribute to the co-construction of an international organization and monitoring system that takes into account psychiatric health professionals as major resources to fight against the COVID-19 pandemic and to develop efficient processes for preparing and anticipating crises by reducing psychosocial risks as much as possible. This project also aims to design tools for remote medicine and to develop the use of numerical tools for monitoring and supporting professionals and helping professionals to build the conditions for satisfactory operational work during crises and post-crisis situations, using adapted organizational methods. Our ongoing research should support professionals in the search for existing concrete solutions to cope with emergency work situations while maintaining an optimal quality of life.

Infection in Patients with Suspected Thrombotic Microangiopathy Based on Clinical Presentation.

BACKGROUND AND OBJECTIVES: In contrast to shigatoxin-associated Escherichia coli (STEC) causing hemolytic uremic syndrome, STEC-unrelated infections associated with thrombotic microangiopathy are less characterized. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Our retrospective study in a four-hospital institution of 530 consecutive patients with adjudicated thrombotic microangiopathies during the 2009-2016 period studied STEC-unrelated infections' epidemiology and major outcomes (death, acute dialysis, and major cardiovascular events). RESULTS: STEC-unrelated infection was present in 145 of 530 (27%) patients, thrombotic microangiopathies without infection were present in 350 of 530 (66%) patients, and STEC causing hemolytic and uremic syndrome was present in 35 of 530 (7%) patients. They (versus thrombotic microangiopathy without infection) were associated with age >60 years (36% versus 18%), men (53% versus 27%), altered consciousness (32% versus 11%), mean BP <65 mm Hg (21% versus 4%), lower hemoglobin and platelet count, and AKI (72% versus 49%). They were associated with more than one pathogen in 36 of 145 (25%) patients (either isolated [14%] or combined [86%] to other causes of thrombotic microangiopathy); however, no significant clinical or biologic differences were noted between the two groups. They were more frequently due to bacteria (enterobacteria [41%], Staphylococcus aureus [11%], and Streptococcus pneumonia [3%]) than viruses (Epstein-Barr [20%], cytomegalovirus [18%], influenza [3%], hepatitis C [1%], HIV [1%], and rotavirus [1%]). STEC-unrelated infections were independent risk factors for in-hospital death (odds ratio, 2.22; 95% confidence interval, 1.18 to 4.29), major cardiovascular event (odds ratio, 3.43; 95% confidence interval, 1.82 to 6.69), and acute dialysis (odds ratio, 3.48; 95% confidence interval, 1.78 to 7.03). Bacteria (versus other pathogens), and among bacteria, enterobacteria, presence of more than one bacteria, and E. coli without shigatoxin were risk factors for acute dialysis. CONCLUSIONS: Infections are frequent thrombotic microangiopathy triggers or causes, and they are mostly unrelated to STEC. Infections convey a higher risk of death and major complications. The most frequent pathogens were enterobacteria, S. aureus, Epstein-Barr virus, and cytomegalovirus. PODCAST: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2021_09_07_CJN17511120.mp3.

Relevance of Adopting a Hybrid Strategy Mixing Single-Use and Reusable Ureteroscopes for Stones Management: An Economic Study to Support the Best Strategy.

Endoscopic procedures such as ureteroscopy (URS) have seen a recent increase in single-use devices. Despite all the advantages provided by disposable ureteroscopes (sURSs), their cost effectiveness remains questionable, leading most teams to use a hybrid strategy combining reusable (rURS) and disposable devices. Our study aimed to create an economic model that estimated the cut-off value of rURS procedures needed to support the profitability of a hybrid strategy (HS) for ureteroscopy. We used a budget impact analysis (BIA) model that estimated the financial impact of an HS compared to 100% sURS use. The model included hospital volume, sterilization costs and the private or public status of the institution. Although the hybrid strategy generally remains the best economic and clinical option, a predictive BIA model is recommended for the decision-making. We found that the minimal optimal proportion of rURS procedures in an HS was mainly impacted by the activity volume and overall number of sterilization procedures. Private and public institutions must consider these variables and models in order to adapt their HS and remain profitable.

Positioning Digital Tracing Applications in the Management of the COVID-19 Pandemic in France.

To combat the COVID-19 pandemic, many European countries have developed a public health strategy involving the use of digital contact tracing (DCT) applications to improve timely tracking and contact tracing of COVID-19 cases. France's independent COVID-19 Control and Society Connection Council (CCL) was established by law in May 2020 to issue advice and recommendations on the national epidemic digital systems. In this paper, we present the recommendations by the CCL, with the objective to increase the uptake and utility of French DCT applications. As the country's most vulnerable population has been subjected to greater virus exposure, a stronger impact of the lockdown, and less access to preventive and health care services, the CCL is particularly aware of health inequalities. The French DCT app TousAntiCovid had been downloaded by 13.6 million users (ie, 20% of the French population) in March 2021. To promote the use of DCT apps, the CCL has recommended that communication about the app's individual and collective objectives be increased. The CCL has also recommended the introduction of clear, simple, accessible, incentivizing, noncoercive information within the digital tools. In addition, the CCL has recommended improving public health policies to address the needs of the underprivileged. The CCL calls for promoting population empowerment with the use of digital tools, improving public health culture for decision-makers dealing with health determinants, taking social considerations into account, and incorporating community participation.