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Introduction: The digitalisation of the society has made inevitable the development and use of digital health. In mental health care, the use of digital tools has been questioned, although their capacity to improve accessibility to evidence-based information and tackle stigma has been recognised. The paradox of these virtual tools is that they need to rely on local resources to get used and disseminated. Objectives: To identify the factors from the context that could help or hinder the set-up of an effective intervention in digital mental health. Methods: Between 2018 and 2020, a digital mental health intervention, based on the promotion of StopBlues, a digital tool targeting psychic distress and suicide in in the adult general population, was conducted in 32 willing French localities. In each of the latter, a focal person was designated among the officials to organise the promotion locally and liaise with the research team. Employing interviews and observations, we identified the factors from the context that were favouring or hindering the intervention. Results: The qualitative approach unveiled the existing dynamics between local stakeholders and difficulties faced by the focal persons. It appeared that the pollical context particularly influenced the outcome of the intervention. In parallel, the endorsement by local hospitals and psychiatrists was equally crucial confirming the key role they play when they champion a cause at the forefront. Conclusions: Real-world evaluations using both qualitative and quantitative methods of digital mental health interventions have to be implemented in order to understand how they can help people. If these interventions are in line with the 1986 Ottawa Charter in terms of patient empowerment, they still need to be supported by local stakeholders, both at the pollical and medical levels. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

Background To date, there has been no published comprehensive estimation of costs related to Prader-Willi syndrome (PWS). Our objective was therefore to provide data on the economic burden and health-related quality of life associated with PWS in France in order to raise awareness of the repercussions on individuals suffering from this syndrome and on caregivers as well as on the health and social care systems. Method A retrospective cross-sectional study was carried out on 51 individuals recruited through the French PWS patient association. Data on their demographic characteristics and resource use were obtained from an online questionnaire, and costs were estimated by a bottom-up approach. The EQ-5D-5L health questionnaire was used to measure the health-related quality of life of individuals suffering from PWS and their caregivers. Results The average annual cost of PWS was estimated at €58 890 per individual, with direct healthcare accounting for €42 299, direct non-healthcare formal costs €13 865 and direct non-healthcare informal costs €8459. The main contributors to PWS costs were hospitalisations and social services. Indirect costs resulting from loss of productivity in the labour market was €32 542 for adults suffering from PWS. Mean EQ-5D utility scores were 0.4 for individuals with PWS and 0.7 for caregivers. Conclusions Prader-Willi syndrome represents a major economic burden from a societal perspective and has a significant impact on health-related quality of life both for individuals suffering from PWS and for their caregivers in France. These results underscore the need to develop tailored policies targeted at improving care. Likewise, a larger study collecting a broader range of medical characteristics should be undertaken to achieve more precise estimations. [ABSTRACT FROM AUTHOR]

Background Fragile X syndrome (FXS) is the main hereditary cause of intellectual disability. Although the associated burden appears to be considerable, to date no study has comprehensively assessed the cost incurred because of FXS, including its specific impact on health-related quality of life and the burden on caregivers using standardised quantitative tools. The aim of this article is to provide data in order to increase awareness of the repercussions of FXS on patients and caregivers as well as on the health and social care systems in France. Methods A retrospective cross-sectional study was carried out on 145 patients recruited through Le Goëland X-Fragile and Mosaïques, the French FXS patient associations. Data on their demographic characteristics and resource use were obtained from an online questionnaire, and costs were estimated by a bottom-up approach. The EQ-5D health questionnaire was used to measure patients' and caregivers' health-related quality of life. Perceived burden of care was measured using the Zarit Caregiver Burden Interview. The Barthel index, a non-utility-based assessment, was used to measure patients' level of dependence. Results The annual total direct cost of FXS was estimated at €25 800 per patient. The main contributors were informal care provided by the main caregiver (€10 500) and social services (€8400). Healthcare costs, estimated at €2700, represented only a minor share. Mean EQ-5D utility scores were 0.49 for patients and 0.75 for caregivers. The mean burden for caregivers as measured by the Zarit Caregiver Burden Interview was 39.9. Conclusions Fragile X syndrome requires significant resources that are mainly of a non-medical nature and are higher for children than for adults. Compared with related diseases, it constitutes a particularly high burden for caregivers. Using a bottom-up approach and a wide range of standardised measures, this study underscores the need for greater awareness of the burden of FXS as well as an assessment of new and existing interventions to address it. [ABSTRACT FROM AUTHOR]

Objectives: To provide data on the economic burden and health-related quality of life (HRQoL) associated with systemic sclerosis (SSc) in France and to raise awareness of the repercussions of this disease for patients and caregivers and on the health and social care system. Method: A cross-sectional study was carried out on 147 patients recruited through the Association des Sclérodermiques de France (ASF), the French association for SSc patients. Data on the patients’ use of resources were obtained retrospectively from an online questionnaire and costs were estimated by a bottom-up approach. The HRQoL patients and caregivers was assessed with the five-level EURQol-5 Dimension (EQ-5D-5L) health questionnaire. Results: The average annual cost of SSc was estimated at EUR 22 459 per patient. Direct healthcare costs amounted to EUR 8452, direct non-healthcare formal costs to EUR 1606, direct non-healthcare informal costs to EUR 1875, and indirect costs resulting from patients’ absence from the labour market to EUR 10 526. The main contributors to SSc costs were hospitalizations and early retirement. Mean EQ-5D utility scores were 0.49 for patients and 0.66 for caregivers. Conclusions: Although SSc is a rare disease, its economic burden from a societal perspective is substantial and the consequences for HRQoL are significant for both patients and caregivers in France, underscoring the need to develop tailored policies targeted at improving patients’ care and reducing the long-term impact of SSc. [ABSTRACT FROM AUTHOR]

Background and purpose A cost of illness study was undertaken on behalf of the French Ministry of Health to estimate the annual cost of stroke in France with the goal of better understanding the current economic burden so that improved strategies for care may be developed. Methods Using primary data from exhaustive national databases and both top-down and bottom-up approaches, the stroke-related costs for healthcare, nursing care and lost productivity were estimated. Results The total healthcare cost of stroke patients in France in 2007 was €5.3 billion, 92% of which was borne by statutory health insurance. The average cost of incident cases was €16 686 per patient in the first year, while the annual cost of prevalent cases was a little less than half that amount (€8099). Nursing care costs were estimated at €2.4 billion. Lost productivity reached €255.9 million and that income loss for stroke patients was partially compensated by €63.3 million in social benefit payments. Conclusions With healthcare costs representing 3% of total health expenditure in France, stroke constitutes an ongoing burden for the health system and overall economy. Nursing care added nearly half again the amount spent on healthcare, while productivity losses were more limited because nearly 80% of acute incident strokes were in patients over age 65. The high cost of illness underscores the need for improved prevention and interventions to limit the disabling effects of stroke. [ABSTRACT FROM AUTHOR]

Introduction: The unbridled development of eMental health technologies has shown the urgency of building the evidence base by associating mental health professionals. Yet, very little research has been conducted to apparaise the merits of including cities and their local mental health providers in the promotion of eMental Health technologies programs. While more and more cities have locally implemented a health strategic plan and have built a local network of professionals, how do local actors react to the implementation of innovative eMental health community-based programs?. Objectives: Key elements of community-based prevention programs in digital health need to be highlighted and analyzed. Methods: In 2018, 41 French cities volunteered to promote Stop-Blues, a digital health tool aimed at preventing psychological distress. In each city, a local delegatewas responsible for the promotion. Using observations, questionnaires and interviews with the delegates, we analyzed how the promotion of StopBlues® was conducted in each city, in light of the social and political contexts. Results: Over the past year, (83%) of them have organized multiple actions to promote StopBlues®, but with wider variations from one place to another as preexisting community-based collaborations between the different local actors in mental health carewas a facilitating factor. The innovative character of StopBlues® has induced actions, behaviors and measures that were not expected. Conclusions: A good understanding and description of the local social and institutional context in which a public health program (especially mental health) is set up is critical for its evaluation and success. [ABSTRACT FROM AUTHOR]

STUDY QUESTION How do the different forms of regulation and public financing of IVF affect utilization in otherwise similar European welfare state systems? SUMMARY ANSWER Countries with more liberal social eligibility regulations had higher levels of IVF utilization, which diminished as the countries' policies became more restrictive. WHAT IS KNOWN ALREADY Europe is a world leader in the development and utilization of IVF, yet surveillance reveals significant differences in uptake among countries which have adopted different approaches to the regulation and and public financing of IVF. STUDY DESIGN, SIZE, DURATION A descriptive and comparative analysis of legal restrictions on access to IVF in 13 of the EU15 countries that affirmatively regulate and publicly finance IVF. PARTICIPANTS/MATERIALS, SETTING, METHODS Using 2009 data from the European Society of Human Reproduction and Embryology study of regulatory frameworks in Europe and additional legislative research, we examined and described restrictions on access to IVF in terms of general eligibility, public financing and the scope of available services. Multiple correspondence analysis was used to identify patterns of regulation and groups of countries with similar regulatory patterns and to explore the effects on utilization of IVF, using data from the most recent European and international IVF monitoring reports. MAIN RESULTS AND THE ROLE OF CHANCE Regulations based on social characteristics of treatment seekers who are not applicable to other medical treatments, including relationship status and sexual orientation, appear to have the greatest impact on utilization. Countries with the most generous public financing schemes tend to restrict access to covered IVF to a greater degree. However, no link could be established between IVF utilization and the manner in which coverage was regulated or the level of public financing. LIMITATIONS, REASONS FOR CAUTION Owing to the lack of data regarding the actual level of public versus private financing of IVF it is impossible to draw conclusions regarding equity of access. Moreover, the regulatory and utilization data were not completely temporally matched in what can be a quickly changing regulatory landscape. WIDER IMPLICATIONS OF THE FINDINGS Whether motivated by cost, eligility restrictions or the availability of particular services, cross-border treatment seeking is driven by regulatory policies, underscoring the extra-territorial implications of in-country political decisions regarding access to IVF. STUDY FUNDING/COMPETING INTEREST(S) There was no funding source for this study. The authors have no conflicts of interest to declare. [ABSTRACT FROM AUTHOR]

Introduction. – Asthma, the most frequent chronic disease in childhood, is often treated by a continuous preventive treatment associated to the treatment of attacks.This therapeutic scheme fits well with educative skills. The Robert Debré’s asthma school has been created in December 1999. Two nurses specialized in child asthma education are working in the school, helped by the pediatric pulmonologists. Children 6-year-old or more, that are treated in the hospital for asthma may be sent to the asthma school for education. They receive individual or collective education for cognitive, psycho-affective and sensory-motor targets related to asthma.Aim of the study. – To evaluate the outcome of educative action in childhood asthma and to study hospitalizations costs.Methods. – Subjects: children who received education for the first time in the year 2000 or 2001 and in whom exhaustive computerized data were available were eligible for the study. Methods: retrospective and comparative study one-year-before/one-year-after the first educational intervention, assessed by comparison of the numbers of scheduled medical consultations and hospitalizations (and their cost).Results. – Sixty-six children were studied. We registered a significant increase of scheduled medical consultations (177 vs. 223; P < 0.03), and a very significant decrease of hospitalizations for asthma attacks (32 vs. 11; P < 0.001) without influence of the number of educational interventions and with a 52% decrease in costs (84 788 vs. 40 073 euros; P < 0.03).Conclusion. – Asthmatic children education is a useful tool to improve medical follow-up and to decrease hospitalizations number. In a two-year survey, the decrease of cost in a group of 66 children is 44 715 euros. [Copyright &y& Elsevier]

Introduction: In France about 10,000 suicides/year are recorded. General practitioners (GPs) have an important role in prevention, with consultation rates between 20% and 76% the day preceding suicide. StopBlues is an application/website for primary prevention of suicide in the general population. Its promotion was supported by municipalities and involved GPs. Objectives: To evaluate how the involvement of GPs in the promotion of StopBlues had an impact on its utilization. Methods: StopBlues was promoted in 25 French municipalities randomly assigned to a 'basic' promotion group organized by municipalities only or an 'intensified' promotion group that also includes promotion in GPs' waiting rooms. StopBlues users were asked how they found out about StopBlues. After two years, an ad hoc questionnaire was sent to all GPs (N=2,111). Results: StopBlues users from those municipalities (N=885) were 16% to learn about StopBlues from GPs, 93% of them living in municipalities with 'intensified' promotion. In the 'basic' group, where no GPs have heard about StopBlues, 15% would like to know more about it/will have a look at it and 8% will use it and recommend it to colleagues. Half of GPs from the 'intensified' group had heard about the program, with 24% who recommended StopBlues to some patients. 21% of GPs agreed that they will use it and recommend it to colleagues. Conclusions: Involving GPs in the use of e-health tools is of major interest to improve their utilization. Our results show that GPs are in need of those in dealing with patients with psychological pain/distress. [ABSTRACT FROM AUTHOR]

Abstract Background Adult deprived patients consume more healthcare resources than others, particularly in terms of increased length of stay (LOS) and costs. Very few pediatric studies have focused on LOS, although the effect of deprivation could be greater in children due to the vulnerability of this population. Our objective was to compare LOS between deprived and nondeprived children hospitalized for acute infectious diseases in two university-affiliated pediatric departments located in a low-income area of northern Paris. Methods We performed a prospective observational multicenter study in two university-affiliated hospitals, Hôpital Robert-Debré and Hôpital Jean-Verdier. All the patients under 15 years of age admitted to the general pediatric department for pneumonia, bronchiolitis, gastroenteritis, or pyelonephritis between 20 October 2016 and 20 March 2017 were included. Deprivation was assessed with an individual questionnaire and score (EPICES). Endpoints included length of stay, costs, and readmission rates at 15 days in each quintile of deprivation. Multivariate regression assessed the association between deprivation and each endpoint. Results A total of 556 patients were included in the study and 540 were analyzed. Sixty percent were boys and the mean age was 9 months ± 18. Bronchiolitis was the most frequent diagnosis (67.8%). Fifty-six percent of patients were considered to be deprived based on the EPICES questionnaire. Mean LOS was 4.6 ± 3.5 days and we found no significant difference in LOS between the different deprivation quintiles (P = 0.83). Multivariate regression did not show an association between LOS and deprivation. Conclusion There was no difference between deprived and nondeprived patients in terms of LOS. Deprivation may therefore impact hospitals in other ways such as admission rates. The impact of deprivation during hospitalization for chronic diseases should also be investigated. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to estimate the commitment to mental health research by the European Union (EU) through the 7th framework (FP7) and the competitiveness and innovation (CIP) programmes during the 2007-2013 period. Methods: Research projects dedicated or partially related to mental health were identified using keywords in the CORDIS database that inventories all FP7 and CIP research projects. We then contacted projects' principal investigators to access the budget breakdown by country and performed an imputation of the distribution of funding between countries based on projects' and participants' characteristics where information was missing. Results: Among the 25 783 research projects funded by the FP7 and the CIP, 215 (0.8%) were specifically dedicated to mental health and 170 (0.7%) were partially related to mental health. They received €607.1 million representing 1.4% of FP7 total funding. Within the FP7- HEALTH subprogramme, the projects represented 5.2% of funding. Important variations appeared across EU countries both for raw funding, which varied between €0 and €77M, and for funding per 100 inhabitants, which varied between €0 and €293. Conclusion: EU funding of mental health research does not match the burden incurred by mental disorders and must be increased in the next framework programme. [ABSTRACT FROM AUTHOR]

Stigma and social exclusion related to mental health are of substantial public health importance for Europe. As part of ROAMER (ROAdmap for MEntal health Research in Europe), we used systematic mapping techniques to describe the current state of research on stigma and social exclusion across Europe. Findings demonstrate growing interest in this field between 2007 and 2012. Most studies were descriptive (60%), focused on adults of working age (60%) and were performed in Northwest Europe--primarily in the UK (32%), Finland (8%), Sweden (8%) and Germany (7%). In terms of mental health characteristics, the largest proportion of studies investigated general mental health (20%), common mental disorders (16%), schizophrenia (16%) or depression (14%). There is a paucity of research looking at mechanisms to reduce stigma and promote social inclusion, or at factors that might promote resilience or protect against stigma/social exclusion across the life course. Evidence is also limited in relation to evaluations of interventions. Increasing incentives for cross-country research collaborations, especially with new EU Member States and collaboration across European professional organizations and disciplines, could improve understanding of the range of underpinning social and cultural factors which promote inclusion or contribute toward lower levels of stigma, especially during times of hardship. [ABSTRACT FROM AUTHOR]

Introduction: For more than a decade, digital health has held promise for enabling a much broader population to have access to health information, education and services. However, the increasing number of studies on the subject show mixed results and currently, there is a certain disillusionment regarding its benefits. And yet, the Covid-19 crisis has revealed the importance of developing digitalbased complementary support to existing resources. Objectives: Factors associated with higher utilization rates among the target audience need to be investigated. Methods: In 2018, 41 French cities enrolled in an intervention program aimed at promoting StopBlues®, a digital health tool that helps prevent mental distress and suicide among the general population. After two years of experimentation, a Multiple Correspondence Analysis (MCA) was performed using quantitative and qualitative data collection methods from institutional sources, questionnaires and web analytics tools. Results: Finding trends show that higher utilization rates were associated with the involvement of general practitioners (GPs) in the promotion of StopBlues and the use of digital marketing channels. Context-specific characteristics also played an important role in the adoption of the tool. Conclusions: The local context has a strong influence on how digital tools are locally promoted and accepted. Further research is needed to understand how local actors and specifically GPs can be involved in suicide prevention. More broadly, the challenge today is to ensure acceptance of digital health technology among targeted populations by adapting the digital offer to their needs and promoting the available tools. [ABSTRACT FROM AUTHOR]

Introduction: France's suicide rate is among the highest in Europe, with the young among the more at risk than others. Several European projects have demonstrated the effectiveness of using e-tools in suicide prevention particularly for hard-to-reach populations. Lessons from StopBlues, an e-health tool (application/website) for suicide prevention in the general population developed in 2018 which was promoted by municipalities and general practitioners, shows the necessity to adapt its content for young people. Objectives: The objective is to develop an e-health tool, BlueZberry, for suicide prevention targeting adolescents and young adults with psychological pain by adapting StopBlues and its promotional plan. Methods: The detailed content of BlueZberry and its promotional plan were determined via a literature review and 26 individual and group interviews with experts and youth with StopBlues as a starting part. Results: The literature review and interviews confirmed the need to adapt the tool according to age of the user since the context and source of psychological pain vary rapidly at this time of life. Blue-Zberry consists of three modules for age groups 12-14, 15-17 and 18-25 years with specific graphics andmessages. Its locally organized promotion should include youth hangouts on top of usual places. Conclusions: This adaptation of StopBlues will reach a larger audience by offering a more suitable solution for this vulnerable population. A web-portal will serve as an entry point for both StopBlues and BlueZberry where users will be redirected to one of the tools/modules according to their profile and respective needs. [ABSTRACT FROM AUTHOR]

Objectives: This study explores whether and how self-management support (SMS), a key element of well-coordinated chronic care, is integrated into existing chronic care approaches in 13 European countries [1]. Methodology: An expert review was conducted using a data template informed by the Chronic Care Model [2]. Key informants (researchers and policymakers) from the 13 countries presented a sample of exemplary chronic care approaches and related SMS strategies. This was complemented by interviews with 27 Dutch care professionals investigating SMS implementation in practice. Results: SMS remains relatively underdeveloped in Europe. Country-specific strategies are similar in involved providers (nurses) and settings (primary care), yet differ considerably in mode, format and materials used. SMS focuses mainly on patients medical and behavioral management, and less on emotional management. According to Dutch providers, barriers in financing and medical culture (e.g. length of consultation, patient-doctor communication) hamper implementation of SMS as an integral part of chronic care. Conclusion: While Europe might increasingly be talking the talk of patient participation in chronic care, it appears far from walking the walk. Care professionals experience difficulties in operationalizing SMS in their daily routines. Stronger integration with the health promotion field may help patients and professionals to engage in productive partnerships. [ABSTRACT FROM AUTHOR]

Despite the growing burden of mental disorders and the proven impact of research, there is a scarcity of research in mental health in Europe. In the context of the ROAMER project, intending to develop a roadmap for mental health research in Europe, we aim at mapping available resources in terms of research infrastructure, training and funding so as to identify gaps and formulate recommendations. Our method was twofold. First, as part of a larger survey a consultation survey was circulated within a pilot sample of 111 European mental health researchers. Second, survey results were discussed and complemented with a focus-group-type panel, composed of national and European experts. Based on 55 survey responses and the expert panel, we have identified several key themes in the expert’s opinions. In terms of infrastructure, these include claims about a lack of collaboration and insufficient access to potentially shared resources; poor linkage between research and clinical practice; inadequate dialogue between research and policy-makers; and a lack of interdisciplinarity. In terms of training and capacity building, it emerged that incentives lack to attract and keep researchers within mental health. Concerning research funding, the share of core funding is deemed too low while European and national grant-application procedures appear inefficient and do not cover all fields of research. These results give a preliminary insight in the issues of current mental health research in Europe. After roll-out of the consultation to the entire mental health research community and a second expert panel, final recommendations will be formulated. [Copyright &y& Elsevier]