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Introduction The profile of nursing home (NH) residents has changed over the past decade with more dependency, more severe chronic diseases and more treatments prescribed. For residents, the major consequence is the higher risk of unplanned hospitalization. French guidelines recommend the development of interactive telemedicine (InT) in NHs in order to improve access to care, and to decrease the rate of avoidable unplanned hospitalizations. Methods and analysis: The aim of this study is to analyze the impact of an InT protocol delivered in NHs on the rate of unplanned hospitalizations, and on the quality of life at work and the organizational conditions of effectiveness of telemedicine in NHs. We will perform a mixed methods study combining a cluster non-randomized controlled trial in two matched parallel arms (telemedicine group and control group) and qualitative analysis of the evolution of organizational and professional contexts in NHs. Ethics and dissemination: The study protocol was approved and sponsored by the French Ministry of Health. The study received ethical approval from the Bordeaux University Hospital Institutional Review Board. We will communicate the final results to the public via conferences and results will also be submitted for publication in international peer-reviewed scientific journals. Trial registration number NCT03486977

Background: The most common reasons why adults use e-cigarettes are to stop or reduce tobacco smoking. However, it is unclear if this reason is evenly distributed between young and older adults. Objectives: describe the motivations for e-cigarette use amongst young adults aged 18–25 and compare the reasons for using e-cigarettes of people who currently or formerly used tobacco products to those who had never smoked tobacco prior e-cigarette use. Methods: PubMed®, Scopus®, Cochrane Library®, SocINDEX®, PsycARTICLES®, Psychology and Behavioral Sciences Collection® and PsycINFO® databases were used. English written articles were screened up to March 2018. Depending on study design, quality was assessed using The STROBE or RATS checklists. Results: Six articles were included in the review, all with a moderate quality of evidence. Independently of smoking status, curiosity was the most frequently reported reason for initiating the use of e-cigarettes in young adults. Reasons for continuing to use e-cigarettes were various. The continued use of e-cigarettes could be either a means to replicate smoking habits, or a way for a different and personalized use of nicotine by inhalation. Conclusions: Reasons for using e-cigarettes in young adults are varied and are not limited to stopping smoking.

International audience; Objective : To study acceptance rate and factors influencing acceptance of the switch from originator etanercept (Enbrel©) to biosimilar etanercept (SB4, Bénépali©) in patients with rheumatic disease.Methods : Patients with a well-controlled rheumatic disease consulting in our rheumatology department were offered the switch for SB4. After oral and written information concerning biosimilar, free choice to accept the switch was left to the patients. The main outcome was primary switch acceptance rate defined by switch acceptance during the initial consult. Real switch adherence, socio-cultural factors and beliefs influencing switch acceptance rate were retrieved during a telephonic interview at distance from the consultation.Results : Fifty-two patients were eligible for the switch: 32 (62%) with spondyloarthritis and 20 (38%) with rheumatoid arthritis. The primary acceptance rate was 92% (48/52). Patients refusing the switch were more likely to report a bad opinion on generic drugs (100% vs 11%, p

BackgroundDuring university, students face some potentially serious health risks, and their lifestyle can have a direct effect on health and health behaviors later in life. Concurrently, university students are digital natives having easy access to the internet and new technologies. Digital health interventions offer promising new opportunities for health promotion, disease prevention, and care in this specific population. The description of the current use of and opinions on digital health among university students can inform future digital health strategies and interventions within university settings. ObjectiveThe aim of this exploratory study was to report on university students’ use and opinions regarding information and communication technologies for health and well-being, taking into account sociodemographic and self-rated general and mental health correlates. MethodsThis field survey was conducted from March to April 2017. An informed consent form and a paper questionnaire were given to students aged 18 to 24 years in 4 university campuses in Bordeaux, France. The survey was formulated in 3 sections: (1) sociodemographic characteristics and self-rated general and mental health, (2) information about the use of digital health, and (3) opinions about digital health. Data were analyzed using descriptive statistics and tests of independence. ResultsA total of 59.8% (303/507 females) students completed the questionnaire. Concerning digital health use, 34.9% (174/498) had at least 1 health app mostly for physical activity (49.4%, 86/174) and general health monitoring (41.4%, 72/174,), but only 3.9% (20/507) of students had a wearable device. Almost all (94.8%, 450/476) had searched for Web-based health-related information at least once in the last 12 months. The most sought health-related topics were nutrition (68.1%, 324/476); pain and illnesses (64.5%, 307/476); and stress, anxiety, or depression (51.1%, 243/476). Although Wikipedia (79.7%, 357/448) and general health websites (349/448, 77.9%) were the most consulted sources, students considered institutional or official websites as the most credible sources (309/335, 92.2%). There were significant differences in digital health use by gender, field, and year of study. No statistically significant association was found between digital health use and self-rated general and mental health status. Concerning opinions on digital health, although 94.1% (475/505) of students estimated that today’s digital health cannot replace traditional health services and medical consultations, 44.6% (207/464) of students declared that this could be possible in the future, provided that digital health interventions are promoted by institutional or official entities. ConclusionsUniversity students are largely using the internet for health information seeking, but using less mobile health apps and very few wearable devices. Our data suggest that digital health has the potential for improving health and well-being at the university, especially if digital health interventions take into account students’ profiles, interests, and needs.

http://www.ofdt.fr/BDD/publications/docs/epfxelr7.pdf; Qu'est-ce qu'un traitement réussi ? Qu'est-ce qu'un échec ? Ce rapport vise à décrire et comprendre la pratique de la substitution à partir d'une enquête de terrain conduite directement auprès des patients. Cent-vingt personnes substituées par buprénorphine haut dosage ou par méthadone dans des cadres thérapeutiques différents (médecine de ville, hôpital, CSAPA, centre thérapeutique résidentiel) ont été interrogées en 2009 et 2010. Leurs profils sociodémographiques ainsi que les durées de traitements (récentes, intermédiaires ou au long cours) sont variés. De ces parcours émergent différents profils (conformiste, adapté, ritualiste et déviant) entre lesquels les patients peuvent évoluer. Après avoir présenté les caractéristiques de ces figures rencontrées, le rapport s'attache à décrire à travers les témoignages recueillis, les étapes clés pour le patient: l'entrée puis les usages et la gestion quotidienne des traitements, ainsi que la question de la sortie de la substitution.

http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowAbstract&ArtikelNr=331007&Ausgabe=255655&ProduktNr=224233; International audience; Background: Therapeutic communities (TCs) are drug-free residential settings, focused on psychosocial rehabilitation. While TCs are considered an effective method, the bulk of the research evidence is from poorly controlled studies. The goal of this study was to evaluate TC effectiveness in terms of abstinence and to determine if there were predictive factors of abstinence. Methods: The search used Medline up to January 30, 2011 and was based on a systematic review method. Studies on retention in treatment and/or substance use were considered. Results: Of the 321 studies retrieved from Medline, 12 met selection criteria including overall 3,271 participants from 61 TCs. On average, subjects stayed in TC a third of the planned time. The completion rate ranged from 9 to 56%. All studies showed that substance use decreased during TC, but relapse was frequent after TC. Treatment completion was the most predictive factor of abstinence at follow-up. Surprisingly, psychiatric comorbidities did not appear associated with relapse or with dropout. Conclusions: There was a drop in consumption after TC, but long-lasting benefits were uncertain. Further studies are needed in order to compare the efficacy of TC programs and other types of treatment settings for substance-related disorders.

Entre nouveau rôle et héritage professionnel, les cadres de santé se trouvent à un point charnière des forces qui s'exercent sur l'hôpital. Cette situation suscite chez eux un malaise et les place à un carrefour de leur histoire : vont-ils couper les ponts avec leur profession d'origine et abandonner le monde du soin pour celui de la gestion ? Comment les mutations de l'hôpital modifient-elles leur rôle? Comment travaillent-elles l'identité du groupe cadre ?

International audience; Introduction: Therapeutic communities (TCs) were introduced as a means of support for individuals with substance dependence a little over forty years ago and are still a common treatment modality in the world. In France, TCs had a bad press because of sectarian drifts. The French Government Plan to combat illegal drugs, tobacco and alcohol (2004-2008) planned the opening of TCs on an experimental basis. Objective: The objective of this study was to define guidelines for the operation of a TC in the French context, based on the expertise of professionals, 30 months after the opening of experimental TCs. Methods: The Delphi analysis that supports the identification of consensus among experts was used. In the context of this study, the experts were professionals of the TCs. It is the expertise of these professionals that was sought. Results: The consensus of professionals to ensure efficient functioning of a TC have been defined. The inclusion criteria should not be restrictive. A pluridisciplinary team of professionals with similar skills than those in outpatient addiction treatment centers should hold the definition of the treatment program. The TC should follow a democratic model inclusive of residents but with a leading of the professionals. To avoid the risks of sectarism and leadership, the TC should make the choice of openness, transparency and integration into the local community and should offer a somewhat limited place to residents to prevent leardership diversion. Conclusion: It is expected that the consensus reached in this Delphi analysis will evolve over the years of operation of TCs but they are a first basis for implementation of TCs in France.; Cette étude a été financée par l'OFDT, appel à projet octobre 2007 Les Communautés Thérapeutiques : quelle mise en œuvre et pour quels résultats ? La Mission Interministérielle de Lutte contre la Drogue et la Toxicomanie (MILDT) a confié à l'Observatoire Français des Drogues et des Toxicomanies (OFDT) la mise en œuvre d'un mandat d'évaluation des CT. Suite à un appel à projet, le Laboratoire de Psychiatrie - USR CNRS 3413 SANPsy/Université Bordeaux Segalen, Bordeaux, France a été sélectionné pour conduire cette évaluation qui s'est déroulée du 12 mars 2008 au 30 mars 2011. Introduction : Les communautés thérapeutiques (CT) sont des lieux de vie communautaire introduits comme modalité de prise en charge des personnes dépendantes des substances il y a un peu plus de quarante ans et sont encore une modalité de traitement répandue dans le monde. En France, les CT ont mauvaise presse du fait de dérives sectaires. Le Plan Gouvernemental français de lutte contre les drogues illicites, le tabac et l'alcool (2004-2008) a prévu la création de CT à titre expérimental. Objectif : L'objectif de ce travail était de définir les points importants à mettre en place pour le fonctionnement d'une CT dans le contexte français, sur la base de l'expérience de professionnels, 30 mois après l'ouverture des CT au statut expérimental. Méthode : La méthode d'analyse Delphi qui favorise la mise en évidence de consensus entre experts a été utilisée. Dans le contexte de cette étude, l'expertise recherchée était celle des professionnels des CT. Résultats : Des consensus pour s'assurer du bon fonctionnement d'une CT ont pu être définis. L'admission en CT doit être peu restrictive. L'encadrement, l'organisation de la prise en charge, le projet thérapeutique, la sortie de la CT doivent s'appuyer sur les décisions d'une équipe pluridisciplinaire avec des compétences équivalentes à celles d'une équipe de centres de soins spécialisés en addictologie. La prise en charge doit être démocratisée mais non déprofessionnalisée. La prévention des dérives sectaires et économiques est garantie par le choix de l'ouverture, de la transparence et de l'intégration dans le tissu local de la CT et en offrant une place somme toute limitée aux résidents. Perspectives : Il est prévisible que les consensus dégagés lors de cette analyse Delphi évolueront au cours des années de fonctionnement des CT mais ils constituent une première base de mise en place des CT en France.