Accepting multiple conditions in psychiatry: From comorbidity to multimorbidity.

The concept of multimorbidity in psychiatry refers to the coexistence of multiple health conditions without conceptualizing a central disorder referring to a patient-centered approach that views every diagnosis equally. It emphasizes a shift from focusing on an index disorder to considering interrelated symptoms crucial in psychiatry due to frequent multimorbidity patterns. In clinical practice, multimorbidity guides patient-centered care helping to address the holistic needs of patients and challenging the organization of mental health care. In research, multimorbidity reshapes study outcomes and promotes the development of patient-reported outcome questionnaires, also posing ethical challenges and advocating for the inclusion of multimorbid patients in personalized interventions. Finally, multimorbidity in psychiatry has public health implications aligning with the socioecological systems perspective. This notion aims to improve prognosis, care, and health costs while impacting global mortality and challenging the conceptualization and organization of psychiatric care.

[EMERGINCaRE, the horizon scanning system for anticancer drugs of the French National Cancer Institute]. / EMERGINCaRE, le dispositif d'horizon scanning dédié aux médicaments anticancéreux développé par l'Institut national du cancer.

INTRODUCTION: In a context of intensive clinical development and innovation in oncology, the French National Cancer Institute has developed a horizon scanning focused on emerging anticancer drugs since 2019. This tool aims to provide further insight to national authorities responsible of the access to medicines and policymakers. METHODS: EMERGINCaRE is based on an annual cycle initiated by the identification of clinical developments of interest from a database, one to three years prior European marketing authorization. Clinical developments are ranked and prioritized using a scoring approach. Scores are based on public information about developments collected by the Institute and on the evaluation carried out by clinicians who were asked to analyse and identify the most impacting drugs. A national steering committee prioritizes several high-score developments each year. RESULTS: Seventy-five developments were analysed during the 2023 cycle. Among these developments, 50 are related to drugs for solid tumors and 25 for hematological malignancies. At the end of this cycle, six developments, including two concerning Advanced Therapy Medicinal Products, were prioritized. Half of these prioritized developments evaluate a drug for a poor prognosis cancer. DISCUSSION: Among the developments evaluated with a high clinical impact score, some drugs were finally approved for the clinical situation concerned. As first public Horizon Scanning in France, the methodology of EMERGINCaRE has been refined and deadlines have been optimized to provide annually the information generated by this system to interested public institutions.

[Impact of a program encouraging prevention in primary care on a daily and opportunistic basis]. / Impact d'un programme encourageant la prévention en soins primaires au quotidien et de façon opportuniste.

In France, clinical preventive practices are still underdeveloped and formalized, notably due to a lack of guidelines, despite the fact that a proactive and systematic prevention and health promotion strategy involving all healthcare professionals seems essential. The P3C program aims to encourage preventive clinical practices among healthcare professionals, and thus contribute to the emergence of a common culture of prevention.

Monitoring Food Affordability: Reliability and Validity of an Online Nutritious Food Basket.

Purpose: This study aimed to assess the reliability and validity of an online approach to monitoring food affordability in Ontario using the updated Ontario Nutritious Food Basket (ONFB).Methods: The ONFB was priced online in 12 large multi-chain grocery stores to test intra-/inter-rater reliability using percent agreement and intra-class correlations (ICCs). Then, the ONFB was priced in-store and online in 28 stores to estimate food price differences using paired t-tests and Pearson's correlation for all (n =1708) and matched items (same product/brand and purchase unit) (n = 1134).Results: Intra-/inter-rater agreement was high (95.4%/81.6%; ICC = 0.972, F = 69.9, p < 0.001). On average, in-store prices were less than $0.02 lower than online prices. There were no significant differences between mean in-store and online prices for all items (t = 0.504 p = 0.614). The mean price was almost perfectly correlated between in-store and online (fully matched: R = 0.993 p < 0.001; all items: R = 0.967 p < 0.001). Online monthly ONFB estimates for a family of four were strongly correlated (R = 0.937 p < 0.001) with estimates calculated using in-store data.Conclusions: Online pricing is a reliable and valid approach to food costing in Ontario that contributes to modernizing the monitoring of food affordability in Canada and abroad.

[Existing report of the health care of detainees and of the organization of the drug circuit in prisons in France]. / État des lieux de la prise en charge sanitaire des détenus et de l'organisation du circuit médicamenteux en milieu carcéral en France.

Since the healthcare system reform in prisons by the law of 18 January 1994, health care for prisoners has depended on the public hospital service. Since the application of this law, hospital pharmacists have been responsible for the health product circuit in the prison. In order to reassess the overall health care of detainees in prison in 2022, a study is being carried out. This study also aims to carry out an inventory of the organization of the drug circuit in prisons in France. In June 2022, a questionnaire was sent by email to pharmacists in charge of supplying health products to one or more prison health units in France. The response rate to the questionnaire is 34 %. The average number of full-time equivalent (FTE) somatic doctors is 1.25. The average FTE pharmacist and pharmacy technician are respectively 0.4 and 0.96. Prescriptions are computerized in 84 % of cases. Therapeutic education and pharmaceutical interviews are carried out in 24 % and 20 % respectively. This study showed an overall improvement in the care of prisoners and the organization of the medication circuit in France compared to the last study. Pharmacists are more present in prisons. However, clinical pharmacy and health promotion actions are insufficiently deployed.

Changes in suicide-related tweets before and during the COVID-19 pandemic in France: The importance of social media monitoring in public health prediction.

INTRODUCTION: The COVID-19 pandemic impacted mental health, as demonstrated by numerous studies. In recent years, especially during the pandemic, the use of social networks, including Twitter, increased. This suggests that this media could help with mental health monitoring, as attested by previous studies. METHOD: We conducted a multidisciplinary study on French tweets that were posted between January 1, 2019, and December 31, 2021. We selected the tweets via the Twitter API (Application Programming Interface) using five keywords relating to suicide: want to die, suicidal ideation, commit suicide, suicidal, and suicide attempt. A word frequency analysis was performed, and the data were compared with the number of emergency visits for suicidal ideation before and during the COVID-19 pandemic as recorded by the French national suicide observatory. RESULTS: We observed that 189,005 tweets were related to suicide in 2019, 261,993 in 2020 (+38.62% of that observed in 2019), and 301,177 in 2021 (+59.35% of that observed in 2019). We also observed an increase in the number of tweets containing control words in 2020 (+30.07% of that observed in 2019), but in 2021, the number almost fell back to the level of that in 2019 (+5.96% of that observed in 2019). Furthermore, the difference between both ratios (of suicide-related tweets and of tweets containing control words) was most significant during the third lockdown. The change in the number of suicide-related tweets followed a curve that overlapped with the change in the number of emergency visits following suicidal ideations, as reported by the French national suicide observatory. In conclusion, Twitter can be an adequate and reliable tool for screening for suicidal ideation in the general population.

Association between physical activity and health in healthcare professionals : Results from the nationwide AMADEUS survey.

OBJECTIVE: The objective of this study was to assess the prevalence of healthcare professionals engaging in insufficient levels of physical activity (PA) and to identify sociodemographic, professional and health characteristics associated with insufficient PA levels. METHODS: We conducted a nationwide online cross-sectional study targeting healthcare professionals in France from May 2021 to June 2021. Participant recruitment involved outreach through social networks, professional networks, and email invitations. PA levels were assessed using the International Physical Activity Questionnaire (IPAQ), with insufficient PA defined as weekly PA totaling less than 600 mets/week. RESULTS: The study included a total of 10,325 participants, of whom 3939 (38.1%, 95% confidence interval 37.1-39.0%) exhibited insufficient levels of PA. In the multivariable analysis, we identified factors associated with insufficient PA: ages between 35-44 (aOR=1.58, 95%CI [1.21-2.06], p=.001) and 45-54 years (aOR=1.40, 95%CI [1.07-1.83], p =.015), gender (female aOR=1.47, 95%CI [1.12-1.44], p<.001), and professions including health executive (aOR=1.27, 95%CI [1.32-1.64], p<.001), nurse assistant (aOR=1.25, 95%CI [1.07-1.47], p=.006), and physician (aOR=1.18, 95%CI [1.03-1.34], p=.015). Additionally, burnout (aOR=1.32, 95%CI [1.21-1.44], p<.001), tobacco use (aOR=1.33, 95%CI [1.20-1.58], p<.001), being overweight (aOR=1.39, 95%CI [1.28-1.52], p<.001), major depression (aOR=1.44, 95%CI [1.20-1.47], p<.001), and sleep disorders (aOR=1.14, 95%CI [1.05-1.25], p=.002) were associated with insufficient PA. Work night shifts was associated with sufficient PA. CONCLUSION: Our study has revealed a substantial prevalence of healthcare professionals with insufficient PA levels. This prevalence, coupled with various associated health-damaging behaviors and mental health issues, underscores the importance of acknowledging the barriers they encounter in adopting a physically active lifestyle.

[Antibiotic resistance: a public health priority in which everyone has a role to play!] / L'antibiorésistance : une priorité de santé publique, où chacun a un rôle à jouer !

Preserving the effectiveness of our antibiotics against pathogenic bacteria is a major public health issue, which is why the World Health Organization has made the fight against antibiotic resistance one of its ten priorities. The fight against antibiotic resistance must be implemented at international, national and local levels. Nurses, in close contact with patients, have a fundamental role to play in both pillars of the strategy implemented in France: in the prevention and control of infections, of course, but also in the proper use of antibiotics.

[Recommendations and tools for healthcare professionals]. / Les recommandations à suivre et les outils pour les professionnels de santé.

The recommendations for the general public as well as the tools offered to healthcare professionals for their practices are consistent with the 2022-2025 national strategy for the prevention of infections and antibiotic resistance. They therefore cover both infection prevention and the proper use of antibiotics.

[Republication of: Evaluation of the implementation of the 2021 guidelines of the European Society of Cardiology for heart failure with reduced ejection fraction in patients aged over 75]. / Republication de : Évaluation de la mise en application des recommandations 2021 de la Société Européenne de Cardiologie pour l'insuffisance cardiaque à fraction d'éjection réduite chez les patients âgés de plus de 75 ans.

INTRODUCTION: Heart failure is a frequent pathology with a poor prognosis which mainly concerns elderly patients. The recommandations concerning the pharmagical treatment in heart failure with LVEF are reduced on randomized trials carried out on a young population. The aim of this work is to evaluate their application on a population aged ≥ 75. MATERIALS AND METHODS: This is a retrospective, bicentric cohort, concerning patients hospitalized between September 1, 2021 and March 31, 2023, at the hospital centers of Troyes and Romilly sur Seine. The primary endpoint was a composite endpoint combining rehospitalisation rate or all-cause death rate at 6 months. RESULTS: A group of 81 patients was included in the study. The average number of treatments is associated with a significant reduction in the rate of hospitalisations ord deaths at 6 months (p = 0,005); as it concerns the level of titration, the analysing comparing the "therapeutic inertia" group and the "current titration/maximum tolerated dose" group did not reveal any significant difference (p = 0,169). CONCLUSION: Our study highlighted the potential positive impact of the application of the latest ESC recommendations concerning first-line drug treatment on the rate of rehospitalisation or death from all causes, in patients with heart failure reduced LVEF aged over 75.

[Evaluation of the implementation of the 2021 guidelines of the European Society of Cardiology for heart failure with reduced ejection fraction in patients aged over 75]. / Évaluation de la mise en application des recommandations 2021 de la Société Européenne de Cardiologie pour l'insuffisance cardiaque à fraction d'éjection réduite chez les patients âgés de plus de 75 ans.

INTRODUCTION: Heart failure is a frequent pathology with a poor prognosis which mainly concerns elderly patients. The recommandations concerning the pharmagical treatment in heart failure with LVEF are reduced on randomized trials carried out on a young population. The aim of this work is to evaluate their application on a population aged ≥ 75. MATERIALS AND METHODS: This is a retrospective, bicentric cohort, concerning patients hospitalized between September 1, 2021 and March 31, 2023, at the hospital centers of Troyes and Romilly sur Seine. The primary endpoint was a composite endpoint combining rehospitalisation rate or all-cause death rate at 6 months. RESULTS: A group of 81 patients was included in the study. The average number of treatments is associated with a significant reduction in the rate of hospitalisations ord deaths at 6 months (p = 0,005); as it concerns the level of titration, the analysing comparing the "therapeutic inertia" group and the "current titration/maximum tolerated dose" group did not reveal any significant difference (p = 0,169). CONCLUSION: Our study highlighted the potential positive impact of the application of the latest ESC recommendations concerning first-line drug treatment on the rate of rehospitalisation or death from all causes, in patients with heart failure reduced LVEF aged over 75.

Risk factors associated with higher scores in internalizing and externalizing behaviors in Chilean preschoolers.

Early detection of behavioral disorders in children is necessary for intervention. Available data show a high prevalence of child and adolescent psychiatric disorders in Chile (22.5%), but behavioral problems in younger children have not been evaluated. This work assesses behavioral disorders in preschoolers and their association with sociodemographic variables of the family and the child. The data was collected during the impact assessment of the Biopsychosocial Development Support Program "Chile Crece Contigo", using a multistage and representative random sample of 1377 preschoolers, aged between 30 and 48 months, who attended public health services. Homes were visited to apply a questionnaire and the Child Behavior Checklist (CBCL, 1.5-5 years). Results: Multivariable regression model for total raw scores shows that child's age, the number of chronic diseases in the child, and history of exposure to mother's alcohol consumption in pregnancy, remain significant when adjusted for all variables included (R2 of 17.8% and η2 of .19 (95% CI: .14-.22)). In externalizing and internalizing explanatory models, child's chronic diseases and a higher score of authoritarian beliefs about parenting show the two largest effect sizes. These results add to the evidence of urgent problems in preschool mental health.

La temprana detección de trastornos de comportamiento en los niños es necesaria para la intervención. La información disponible muestra una alta prevalencia de trastornos siquiátricos de niños y adolescentes en Chile (22.5%), pero no se han evaluado los problemas de comportamiento en niños más pequeños. Este trabajo evalúa trastornos de comportamiento en niños de edad prescolar y su asociación con variables sociodemográficas de la familia y del niño. La información se recogió durante la evaluación del impacto del Programa de Apoyo al Desarrollo Biosicosocial "Chile Crece Contigo," usando un grupo muestra de multiniveles representativo de 1,377 niños prescolares, de entre 30 y 48 meses de edad, quienes recibían servicios de salud pública. Se visitaron las casas para dar un cuestionario y la Lista de Comprobación del Comportamiento del Niño (CGCL, 1.5-5 años). Resultados: El modelo de regresión de variables múltiples para el total de la puntuación en bruto muestra que la edad del niño, el número de enfermedades crónicas en el niño, así como el historial de exposición al consumo de alcohol por parte de la madre durante el embarazo permanecen siendo significativos cuando se les ajusta para todas las variables incluidas (R2 de 17.8% y η2 de 0.19 (95% CI 0.14 a 0.22)). En los modelos explicativos de externalización e internalización, las enfermedades crónicas del niño y un más alto puntaje de creencias autoritarias acerca de la crianza demuestran ser las dos con la magnitud de efectos más extensa. Estos resultados contribuyen aun más a la evidencia sobre los problemas urgentes en la salud mental prescolar.

La détection précoce de troubles du comportement chez les enfants est nécessaire afin d'intervenir. Les données disponibles font état d'une forte prévalence de troubles psychiatrique de l'enfant et de l'adolescent au Chili (22,5%) mais les problèmes de comportement chez les plus jeunes enfants ne sont pas évalués. Ce travail évalue les troubles du comportement chez des enfants d'âge préscolaire et leur lien aux variables sociodémographiques de la famille et de l'enfant. Les données ont été recueillies durant l'évaluation de l'impact du programme de Soutien au Développement Biopsychosocial « Chile Crece Contigo ¼, en utilisant un échantillon aléatoire à plusieurs degrés et représentatif de 1 377 enfants d'âge préscolaire, âgés de 30 à 48 mois, qui participaient à des services de santé publique. Les domiciles ont été visités pour appliquer un questionnaire et la Checklist de Comportement de l'Enfant (CBCL, 1,5-5 ans). Résultats: Le modèle de régression multivariable pour les scores bruts totaux montre que l'âge de l'enfant, le nombre de maladies chroniques chez l'enfant et le passé d'exposition à la consommation d'alcool de la mère durant la grossesse restent importants après l'ajustement pour toutes le variables inclues (R2 de 17,8% and η2 de 0,19 (95% CI 0.14 à 0.22)). Dans les modèles explicatifs externalisant et internalisant les maladies chroniques de l'enfant et un score élevé de croyances autoritaire sur le parentage font preuves des plus grands effets de taille. Ces résultats s'ajoutent aux preuves sur les problèmes urgents de santé mentale préscolaire.

Pour une santé publique en faveur d'une justice épistémique.

La santé publique s'oriente de plus en plus vers l'étude des structures oppressives (telles que le racisme, le sexisme, ou le validisme) et de leur influence sur le marché de l'emploi, les systèmes éducatifs et judiciaires, et l'accès aux systèmes de santé de qualité. Ce commentaire vise à proposer une réflexion sur la manière dont ces structures influencent également la façon de faire de la santé publique. À travers le concept d'injustice épistémique, qui décrit le fait que l'organisation sociale influence la possibilité de connaître et de faire valoir sa connaissance dans une société donnée, nous montrons qu'en tant qu'acteur.rice de santé publique, nous pouvons reproduire et renforcer des injustices sociales. Les injustices épistémiques sont la plupart du temps le fruit de structures et de pratiques quotidiennes. Il est nécessaire de développer l'utilisation d'outils permettant de favoriser la réflexivité pour faciliter la mise en perspective des injustices et des privilèges.

"My Biggest Fear Is She'll Die Alone": Care Partner Perspectives of Institutional COVID-19 Visitor Restrictions in Ontario, Canada.

In March 2020, the Government of Ontario, Canada implemented public health measures, including visitor restrictions in institutional care settings, to protect vulnerable populations, including older adults (> 65 years), against COVID-19 infection. Prior research has shown that visitor restrictions can negatively influence older adults' physical and mental health and can cause increased stress and anxiety for care partners. This study explores the experiences of care partners separated from the person they care for because of institutional visitor restrictions during the COVID-19 pandemic. We interviewed 14 care partners between the ages of 50 and 89; 11 were female. The main themes that emerged were changing public health and infection prevention and control policies, shifting care partner roles as a result of visitor restrictions, resident isolation and deterioration from the care partner perspective, communication challenges, and reflections on the impacts of visitor restrictions. Findings may be used to inform future health policy and system reforms.

[Emotional distress and trauma at the threshold of death: health issues and levers for action]. / Pénibilité émotionnelle et trauma au seuil de la mort : enjeux de santé et leviers d'action.

The emotional load and the confrontation with the end of life and death that health professionals regularly endure are occupational health and public health issues. Understanding their deleterious effects on the health of caregivers is only a first step, which must be followed by the identification of the various levers of action that can be mobilized.

[Does aspirin have a place in primary cardiovascular prevention by the polypill ? Simulation study on a realistic virtual population]. / L'aspirine a-t-elle une place dans la prévention cardiovasculaire primaire par la polypill ? Étude de simulation sur une population virtuelle réaliste.

BACKGROUND: The polypill strategy could become widely accepted in cardiovascular prevention due to reduced costs and its simplicity, which promote compliance. Aspirin is often included as a component of the polypill for primary prevention, but three powerful recent trials failed to show any favorable net benefit even in high-risk subgroups. Our objective is to estimate the net benefit associated with aspirin in primary cardiovascular prevention. METHODS: We simulated the impact of different polypill compositions combining pravastatin, ramipril, hydrochlorothiazide, with or without aspirin, on a realistic French virtual population between 35 and 65 years old. We assessed how this impact on myocardial infarction and stroke varied according to gender, diabetes, and arterial hypertension. We identified the subgroup of individuals whose specific benefit from aspirin was greater than twice the risk of serious bleeding it induced. RESULTS: The absolute benefit associated with aspirin was reduced by co-prescriptions. No subgroup of women benefited from aspirin, and the subgroup of women with a clear net benefit represented 128 women out of 529,421. Men at high risk of cardiovascular death, or with diabetes and hypertension, had a benefit from aspirin exceeding the risk of bleeding induced, but this risk represented more than half of the benefit. No subgroup analyzed did show a benefit greater than twice the risk of bleeding. The proportion of men whose expected benefit from aspirin was greater than twice the risk of bleeding represented 3% of all men. An optimal polypill strategy in primary prevention between the ages of 35 and 65, combining three drugs but not aspirin, can hope to save two out of three strokes and more than one out of two myocardial infarctions. It would prevent a major cardiovascular accident every 16 to 193 individuals treated according to the subgroups considered. CONCLUSION: Until proven otherwise, aspirin has only a limited place in individuals between 35 and 65 years without a cardiovascular history. We showed how simulating therapeutic strategies on a realistic virtual population could be used for best applying available evidence.

[Population health intervention research, health technology assessment, health services research and intervention implementation research: Convergences and singularities]. / Recherche interventionnelle en santé des populations, évaluation des technologies de santé, recherche sur les services de santé et recherche sur la mise en œuvre des interventions : convergences et particularités.

In public health, intervention is an object of research and evaluation which, over time, has given rise to numerous approaches. The first part of the article proposes to reposition intervention research in population health and intervention evaluation on a continuum. Although the former has a more cognitive objective and the latter a more pragmatic objective, they are not mutually exclusive. The distinction between these two practices is based on the predominance of the following characteristics: the objectives pursued, the scope of the investigations, the regulatory constraints, the financing obtained, the ethical approaches taken, and the deliverables established. The second part of the article offers a glance different fields and approaches within the continuum between these two poles: Health Technology Assessment, Health Services Research and Implementation Research. While all of them have the study of health interventions at their core, but each has developed through specialisation in one or the other type of intervention, in a particular scope or context, in certain evaluation questions, or in specific approaches. all as gateways to the study of public health intervention, these different approaches are by no means mutually exclusive.

Revisiting the Do-Live-Well Health Promotion Framework: A Citation Content Analysis.

Background. The Do-Live-Well (DLW) framework was first published in 2015 and aimed to fill a theoretical gap in the health promotion literature related to the links between occupational patterns and health. However, the extent of uptake and use of the framework since publication is unknown. Purpose. To explore and reflect on the adoption and application of DLW in the literature. Method. Citation content analysis of two seminal DLW publications was conducted from 2015 to November 2022 across six databases. Findings. Seventeen citations directly applied DLW to inform research (n = 10), practice (n = 5) and knowledge translation (n = 2). Implications. The findings highlight uptake of the framework in a range of settings, and how it can inform an occupation-based understanding of health and well-being. Ongoing knowledge dissemination, development of practice tools, and research to update evidence and examine relevance are needed to further advance the utility and application of the framework.

Barriers in psychiatrists' mind to active smoking cessation promotion in severe psychiatric disorders.

BACKGROUND: Promoting the cessation of smoking in mental healthcare is a priority of international health organizations as it is the most cost-effective intervention in psychiatry. AIM: To explore the representations of psychiatrists on their role in active smoking cessation prevention in severe psychiatric disorders. METHODS: Psychiatrists and residents in psychiatry were recruited at a national level by professional mailings. RESULTS: One thousand four hundred and sixty participants were included in the study, and only 46% reported actively promoting smoking cessation. In multivariate analyses, participants aged<35years were more likely to promote cessation of tobacco smoking, as well as the two thirds who believe that psychiatry is a systemic discipline with complex interactions between brain, body and mind. Almost two thirds of those promoting tobacco cessation reported lacking time to combine psychiatric and physical examination during one session. The psychiatrists who reported not promoting tobacco smoking cessation also reported never dealing with physical health in case of the absence of a general practitioner and thinking that physical examination may have a negative impact on the therapeutic relationship. Almost all (96%) reported promoting the need for a general practitioner for their patients. We found no significant difference between the public and private sectors (P>0.05). INTERPRETATION: Young psychiatrists are more prone than their elders to promote smoking cessation but report lacking time to include it in their daily practice. Promotion of tobacco smoking cessation should be included in the components for quality evaluation for mental health services and specific sessions dedicated to this intervention.