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Introduction. Physical activity is the key component of a student's healthy lifestyle, which is a fundamental factor contributing to academic success. The importance of physical activities during the study period is determined particularly by the student's working regime, which is often characterized by a sedentary lifestyle, reduced mobility and constant working position. Material and methods. A cross-sectional epidemiological study (2017-2018) was carried out. The study sample consisted of 783 students, including 430 students from the Republic of Moldova and 353 students from France. The data collection was performed by using a questionnaire that was completed by each study participant online, in electronic form. Results. The mean body mass index (kg/m2) of students from Chisinau was 21.5±0.10 (ranging between 16.16 and 34.72) and of students from Rouen - 22.65±0.22 (15.75-43.76) (p

Contexte et problématique : La pandémie de Covid-19 a déclenché des mesures urgentes sans précédent dans le monde et entraîné le confinement de plus de la moitié de la planète. Des populations ont été et restent fragiles et vulnérables. Les facultés de médecine gèrent au mieux cette période inédite et doivent anticiper et préparer l’avenir en tenant compte de cette nouvelle réalité, et se préparer à la gestion de nouvelles crises sanitaires. Exégèse : La santé mondiale, discipline émergente, est fondée sur une approche transnationale des problèmes de santé, une caractéristique de la pandémie Covid-19, tout en prenant en compte l’ensemble des déterminants environnementaux et sociaux de la santé (au-delà du système de soins). L’enseignement de la santé mondiale, intégré à la formation médicale, contribuera à mieux préparer les professionnels de santé à répondre aux besoins des populations confrontées aux crises sanitaires. Conclusion : Un des premiers enseignements de la pandémie Covid-19 est la nécessité de développer rapidement des filières de formation structurées, multidisciplinaires en santé mondiale pour les étudiants en santé.

Chronic obstructive pulmonary disease (COPD), the most common chronic respiratory disease, is expected to become the third leading cause of death worldwide in 2020. A prospective cohort study conducted in 2017 and 2018 aimed to identify factors associated with inhaler treatment adherence in patients with COPD in Cairo (Egypt). Physicians collected data regarding patient deaths, treatment-related adverse events, and patients’ social support (no support, patient, support by spouse, children, and siblings) from their patients with COPD. The reason for treatment discontinuation was categorized as per patient decision or per physician decision. Adherence was categorized as treatment continued or treatment stopped. Patients who decided to stop treatment were considered non-adherent to COPD therapy. A total of 1311 patients as well as 98 physicians and 205 pharmacists were included. Pharmacists and social support (spouse, children/siblings) were identified as key positive factors in patients’ decisions to adhere to their prescribed COPD treatment regimens. A total of 631 patients (48.1%) stopped the treatment, including 170 (27.0%) due to patient decision and 55 (8.7%) deceased. After Cox model analysis, a low number of patients (6–19) attended by the pharmacist was a significant predictive factor (hazard ratio [HR] = 1.40, 95% confidence interval [CI] = 1.03–1.91, p = 0.03) for deciding to stop treatment. A wife or husband (HR = 0.85, 95% CI = 0.72–1.02, p = 0.07) as well as children or brother/sister (HR = 0.77, 95% CI = 0.57–1.04, p = 0.08) provided a positive effect for continued treatment. Pharmacists are well positioned to play a role as an essential public health resource that can help improve adherence as well as social support that should be considered as an important component to improve adherence to long-term therapy in COPD as well as other chronic non-communicable diseases in low- and middle-income countries.

Higher-education students face substantial risks for developing depressive symptoms during the COVID-19 pandemic or experiencing exacerbated pre-existing depressive symptoms. This study uses data from the COVID-19 International Student Well-Being Study, which collected data through a non-representative convenience sample in 125 higher-education institutions (HEI) across 26 high- and middle-income countries (N: 20,103) during the first wave of the COVID-19 pandemic. It describes the prevalence of depressive symptoms in higher-education students. We find substantial cross-national variation in depressive symptoms, with lowest mean levels established in the Nordic countries and France, while highest mean levels of depressive symptoms were found in Turkey, South Africa, Spain and the USA. Elevated risk for depressive symptoms was found in female students, students with fewer social support resources and in a more disadvantaged socioeconomic position, and students with a migrant background. COVID-19 related stressors, such as reduced social contact, increased financial insecurity, and academic stress explained a relatively larger proportion of the variance in depressive symptoms compared to non-COVID-19 related stressors. This finding shows that not the pandemic itself, but rather the secondary effects of the pandemic relate to students' mental health. Our results enable HEIs to be better equipped to target groups that are particularly at risk during a pandemic.

International audience; An online cross-sectional study was conducted in May 2021 to identify factors, such as changes in food choices, lifestyle, risk and protective behavior, mental health, and social demographics, on eating disorders (ED) among students of a French university. Students were invited to fill out an online questionnaire. ED were identified using the French version of the five-item “Sick, Control, One stone, Fat, Food” (SCOFF) questionnaire. The Expali™-validated algorithmic tool, combining SCOFF and body mass index, was used to screen EDs into four diagnostic categories: bulimic ED, hyperphagic ED, restrictive ED and other ED. A total of 3508 students filled the online questionnaire, 67.3% female, mean age 20.7 years (SD = 2.3). The prevalence of ED was 51.6% in women and 31.9% in men (p < 0.0001). Lower food security scores were associated with a higher risk for all ED categories. Depression and academic stress due to COVID-19 were associated with ED regardless of category. Regarding health behaviors, a high adherence to the National nutrition recommendation was a protective factor for the risk of bulimic ED, hyperphagic ED and restrictive ED. A lower frequency of moderate and vigorous physical activity was associated with a higher risk of hyperphagic ED. Our study has shown a high screening of ED among the students of a French university fourteen months after the beginning of the COVID-19 pandemic. By disrupting academic learning, jobs and social life, the COVID-19 pandemic could have exacerbated existing ED or contributed to the onset of new ED.

Aim: Poor adherence to chronic disease therapy is a critical global problem that negatively effects the long-term therapy for chronic diseases, resulting in negative population health and economic effects. The WHO multidimensional model proposed a systems-based approach for improving adherence to chronic disease therapy. Patients & methods: In the current study, the WHO five-dimension framework was used to evaluate factors among, chronic-disease patients in the United Arab Emirates. Results: We show that patient’s understanding of disease, involvement in treatment decision, age more than 40 years, time spent with physician and fear of how patients were perceived by others were the most predictive factors associated with a high ability to self-manage a chronic disease. Conclusion: Sociocultural factors have an indirect impact on disease self-management.

Background University students are subject to stress due to academic pressure, empowerment and transition from adolescence to adulthood. This young population may have a higher risk of functional disorders as eating disorders (ED) and irritable bowel syndrome (IBS). Our objective was to determine the prevalence of ED, IBS and both and the associated behaviours. Methods A cross sectional study was conducted in Rouen University (France). Participating students filled an anonymous self-questionnaire with items on socio-demographics, depression (Duke score), stress (Cohen score), emotional exhaustion (Maslach Inventory), insomnia (Insomnia Severity Index), cyberaddiction (Internet Addiction Test), ED (SCOFF-F test) and IBS (Rome III). Results This study included 731 students (male/female ratio = 0.43). The prevalences of ED, IBS and co-existing ED-IBS were respectively 16.7%, 7.8% and 2.7%. ED and IBS were more common in female students. Depression, stress, emotional exhaustion, insomnia and cyberaddiction were significantly associated with ED and IBS or both. Students with ED had a higher risk of having IBS (Adjusted Odds Ratio (AOR) = 2.42, 95% CI: 1.30–4.51), and conversely students with IBS had a higher risk of having ED (AOR = 2.46, 95% CI: 1.32–4.55) and were more likely to be in the third year of academic study or above (AOR = 2.95, 95% CI: 1.50–5.76). Conclusion Students (female especially) suffer from ED and IBS, with a significant risk of co-existing ED-IBS. ED and IBS are related to multiple mental health symptoms, which could lead to negative academic consequences. Screening, using simple and quick tests as SCOFF questionnaire and ROME IV criteria (update of ROME III in 2016), is essential in this population of university students.

Contexte : Le Consensus mondial sur la responsabilité sociale (RS) des facultés de médecine a été validé en 2010. L’applicabilité des concepts de RS a été très peu investiguée. But : L’objectif était d’abord d’évaluer la perception des concepts de RS chez les participants et ensuite d’évaluer les actions de RS conduites et celles souhaitées dans les facultés de médecine. Cet article analyse les résultats concernant les actions de RS. Sujets et méthodes : Un auto-questionnaire anonyme en ligne a été adressé à différents acteurs dans 20 facultés francophones de dix pays : doyens et équipes décanales, enseignants, étudiants et acteurs de la société civile. Le questionnaire ouvert identifiait les actions conduites de RS et celles souhaitées. Les occurrences des actions regroupées en thématiques ont été calculées. Elles ont été comparées aux occurrences du Consensus mondial. Les verbatim ont été analysés. Résultats : Au total, 425 participants ont été inclus, dont 41,5 % d’enseignants et 28,0 % d’étudiants. Pour les actions conduites, les principales occurrences retrouvées étaient « enseignements » et « acteurs d’enseignements » ; les principaux verbatim rapportaient la révision des curricula de formation et l’enseignement de la médecine de famille. Quant aux actions souhaitées, les « mesures d’impact des actions de RS », la révision des enseignements pour mieux répondre aux besoins de santé et le développement des stages dans la communauté étaient retrouvés. Conclusion : L’importante participation, notamment des étudiants, confirme l’intérêt, mais aussi l’avancée des concepts de RS dans les facultés des différents pays. De nombreuses innovations sont proposées par les différents acteurs. Des approches adaptées de formation et de stratégies répondant aux attentes des différents acteurs sont à mettre en œuvre.

International audience; This cross-sectional study aimed to determine the use of neuroenhancers, the motivations and factors associated with their use in French and Romanian university students. Students from two universities in France (Rouen and Opal Coast University) and one in Romania (Cluj-Napoca) were asked to complete a self-administered anonymous questionnaire, either online or on paper, about the use of three different categories of substance: Prescription drugs (methylphenidate, modafinil, and beta-blockers), drugs of abuse (alcohol, cannabis, cocaine, and amphetamines), and soft enhancers (coffee, vitamins, caffeine tablets, and energy drinks). In total, 1110 students were included: The users were 2.2% for prescription drugs, 4.3% for drugs of abuse, and 55.0% for soft enhancers. Students used neuroenhancement to stay awake for study (69.3%), to improve concentration (55.5%), to decrease stress (40.9%), and to improve memory (39.6%). Neuroenhancement was considered to meet expectations by 74.4% of users. The factors associated with the use of drugs of abuse were frequent binge drinking (Adjusted Odds Ratio—AOR: 6.49 [95% CI: 2.53–16.6]), smoking (AOR: 5.50 [95% CI: 2.98–10.14]), having a student job (AOR: 2.42 [95% CI 1.13–5.17]), and being male (AOR: 2.23 [95% CI:1.21–4.11]). No significant associations with eating disorders were detected for any of the three categories of substances. University students reported neuroenhancement with prescription drugs, drugs of abuse, and mainly soft enhancers. These substances were used mainly to increase the waking hours. Educational programs in universities seem to be required in order to increase student awareness of the problems caused by neuroenhancements, and to decrease the associated risks by changing students’ attitudes and beliefs.

Background In France, a new approach of health promotion re-enforcement was developed in 2919. The purpose is to train health students in health promotion interventions in different communities during two weeks and on a specific thematic, and associating interdisciplinarity partnership between curricula. This national policy is called “national health service” (NHS). The objective was to assess the NHS among medical students Methods A semi-experimental design “before-after” was used. Two anonymous self-questionnaires was completed by medical students (3rd year, preclinical course). A first questionnaire “before” the NHS, the second “after” in April 2019. For comparisons, identical information were collected 'before' and 'after'. Specific information to the two stages were also collected. An additional qualitative study based on same design (”before-after”) with interviews was also conducted. Results A total of 221 students in the “before” stage (exhaustivity: 92.9%) and 206 in the “after” (86.8%) were included. Schools represented more than half of community sites. Before the NHS, 49.5% of the students considered themselves insufficiently trained. Comparisons between the two stages showed, respectively: satisfaction with the health promotion intervention thematic (33.7% vs 53.2%; p = 0.0001), a major interest in the PS approach in the curriculum (21.3% vs 33.6%; p = 0.001), a major desire to integrate PS into future professional practice (33.6% vs 42.4%; p = 0.02), an interest major in the PS approach in interdisciplinarity (45.2% vs 59.8%; p = 0.0001). Conclusions The first edition of the NHS shows promising results, the training ground and the action carried out in cross-professionalism, declared interest in prevention actions and integration of health promotion in professional practice. This health promotion policy includes in the initial training of health students could be a innovative approach for a reinforcement of the French preventive health system. Key messages Innovative health portion intervention: first edition of the French NHS. Longitudinal approaches are needed to measure and assess the potential impact of the NHS.

Background Rouen University Hospital implements a policy of health promotion hospital since 2016. The objective of this study was to evaluate prospectively the impact of physical activity promotion in hospital health workers (HW), using pedometers over a period of six months. Methods Physical activity was measured by electronic pedometers distributed to HW, with the aim to improve their physical activity and to measure it during six months. Online questionnaires collected at different points of follow-up, from inclusion to sixth month (a total of seven points of follow-up). Socio-demographic and characteristics on type of health work were collected as well as the number of steps and the behavior regarding their routine physical activity. Results A total of 680 HW were included in the cohort. The sex ratio M:W was 0.16. The mean age was 41.6 years (SD = 10.7). 44.0% were non-medical caregivers, 32.1% were in administrative section, 14.3% were technical workers and 9.7% were physicians or pharmacists; 53.7% of HW reported doing sport regularly. At inclusion the mean number of daily steps was 8662. The mean progression for all professional profiles between first week and sixth month was of 1082 steps daily, with difference according to position: 1319 in physicians, 1234 in non-medical caregivers, 1106 in administrative workers and 314 in technical workers. In linear regression model, the mean number of progression of daily steps was 964 in physicians, 752 in non-medical caregivers. Conclusions The study shows a significant increase in the number of daily steps measured objectively using an incentive tool, as pedometer during six months of intervention. Further researches are needed to determine if these changes are sustainable over a long period of time Key messages Despite high level of daily steps at baseline, the longitudinal study shows an increase of daily steps over a 6-month period. Such public health intervention is a relevant method to engage people in self-monitoring their physical activity.

Background In Europe, alcohol consumption (AC), especially binge drinking (BD) and behavioural risk factors among students in higher education remain to be investigated. The aim of the study was to assess the evolution of AC, and BD and the behavioural factors associated in university students in four European universities: Chisinau (Ch) in Republic of Moldova, Cluj-Napoca (Cl) in Romania, Miskolc (Ms) in Hungary and Rouen (Ro) in France. Methods In the four countries in 2018, students in higher education completed an anonymous standardized self-questionnaire. The questionnaire collected age, gender (M, W), housing, curricula, smoking, cannabis consumption. Alcohol abuse problems were assessed by ADOSPA test and by AUDIT test.. Frequent BD was determined as a consumption of five or most alcoholic drinks on one occasion at least twice a month. A risk profile of consumers was conducted according to the consumption of alcohol and frequency of BD. Results A total of 3076 students were included, 705 in Ch, 582 in Cl, 534 in Ms and 1255 in Ro. Globally, the sex-ratio was quite similar (M:F=0.45), the mean age was 21.2 (SD = 4.1). In Ro, 83.6% of students consumed alcohol at least 1 per week, 86.4% in Ch, 27.6% in Cl, 43.6% in Ms. The prevalence of frequent BD was 15.9% in Ms and 13.8% in Ro, 11.5% in Ch and 12.6% in Cl. Alcohol hazardous drinking and risk of addiction levels were found in 19.3% of students in Ro, 27.6%, in Ms, 7.4% in Cl and 13,6% in Ch. Regarding patterns of consumption significant difference by gender were found. After multivariate analysis, different risk behaviours were found. Conclusions BD patterns in students were quite similar in the four countries, especially in male students. BD appears as a frequent, whose consequences remain to be investigated. It might be necessary in the future to screen students for potential ED upon entry to the university and also to inform student about the risk of ED and advise them to consult a healthcare professional. Key messages The study showed that alcohol is a central part of students’ lives in France, Hungary, Republic of Moldova and Romania. Specific target populations for public health interventions were identified.

Background and aims. The nutritional disorders are modifiable predisposing factors of the current leading causes of morbidity and premature mortality, such as cardiovascular diseases, diabetes and cancers. An early recognition of appropriate interventions could decrease the burden of medical costs and increase the healthy life expectancy. The aims of our study were the description of nutritional status, its associated factors, and the detection of eating disorders among Romanian medical students of the “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca.Methods. A cross-sectional study was conducted during the 2015-2016 academic year, including medical students from all study years, by an online questionnaire. The statistics, both descriptive and inferential, were calculated using EpiInfo.Results. A total of 222 students from the University Romanian section were included, with a sex-ratio (men:women) of 0.22. The average body mass index of the medical students included was 21.3±3.3 kg/m2, for females it was 20.7±3 kg/m2 and for males 23.9±3.1 kg/m2. For the nutritional disorders such as overweight, the prevalence among males (30%) had a net predominance (p

Les etudiants (en general âges de 18 a 25 ans) ont longtemps ete consideres comme une population privilegiee. C’est pourquoi, contrairement aux moins de 18 ans, les actions mises en place dans le domaine de la sante publique n’en font que rarement une priorite et se sont trop peu attachees a une politique de prevention adaptee aux etudiants. Si la vie etudiante est dans l’esprit de beaucoup de personnes une sorte de « parenthese enchantee », une periode bienheureuse que vivraient des jeunes deconnectes de la realite, certaines enquetes recentes revelent en fait une verite bien plus preoccupante. Les recherches visant a mieux connaitre les conditions de vie, l’etat de sante et les comportements a risque des etudiants se sont developpees ces dernieres annees, aussi bien a l’echelle nationale que regionale. Elles abordent des themes varies (consommation de substances psychoactives, stress, equilibre alimentaire, etc…) et sont un pre-requis indispensable a la mise en place d’actions de prevention adaptees aux besoins et aux demandes des etudiants. Le programme de sante publique, specifiquement destine aux etudiants associent des interventions de promotion de la sante, basees sur un site Inter (wnww.tasanteenunclic.org) et des forum sante conduits sur les campus des universites par des etudiants pairs. Des resultats (1) Equilibre alimentaire : 43 % des etudiants considerent leur alimentation comme desequilibree, 80 % grignotent et 51 % sautent des repas. Seulement 28 % des etudiants de cette meme enquete respectent la recommandation du PNNS pour la consommation de fruits et legumes et 42 % celle pour la consommation de produits. (2) Activite physique : 40 % des etudiants « Campus Sante » n’ont pas une activite physique reguliere, avec une proportion plus elevee chez les filles. (3) Burn out : La prevalence d’un burn out fort etait retrouvee significativement chez les etudiants en medecine (19,0 %) et en droit (18,9 %), faible chez les etudiants en STAPS (10,2 %). (4) Evolution : 2007 et 2015. Le binge drinking et la pratique reguliere d’une activite sportive augmentait significativement chez les etudiants en sante (respectivement, AOR = 1,48 CI95 % = 1,20–1,83 ; AOR = 1,33 CI95 % = 1,11–1,60) ; la consommation reguliere de cannabis a diminue (AOR = 0,32 CI95 % = 0,19–0,54). Il n’y avait pas de changement dans la consommation de tabac. Il est indeniable que les connaissances de prevention des etudiants sur ces differents themes peuvent etre ameliorees, cela constitue un premier pas dans la demarche de mise en œuvre d’une politique de prevention aupres de cette population. Le volet recherche epidemiologique est indispensable pour suivre les evolutions des risques mais aussi identifier de nouveaux comportements de sante a risque.

Introduction La reduction de la prevalence hospitaliere des escarres represente un enjeu de sante publique pour une meilleure qualite de vie des patients et une reduction des couts hospitaliers. Nos objectifs etaient d’estimer la prevalence, la concordance de codage Programme de medicalisation des systemes d’information (PMSI) et le cout de prise en charge des escarres. Materiel et methodes Une etude transversale a ete realisee en fevrier 2018. Tous les patients hospitalises dans le secteur medecine, chirurgie, obstetrique (MCO) ou soins de suite et de readaptation (SSR) un jour donne ont ete inclus. Un questionnaire recueillant des donnees epidemiologiques a ete rempli par les soignants des services concernes. Une verification du remplissage a ete realisee au moment du depot du questionnaire. Une double saisie des questionnaires a ete effectuee, avec un retour au dossier patient en cas de discordance de saisie. Une extraction PMSI a 2 mois a permis de comparer les deux bases de donnees. Le cout global de prise en charge a ete modelise en utilisant l’outil ANAP dedie. Resultats Sur 1664 patients inclus, 11,42 % porteurs d’escarres ont ete identifies, dont 3,3 % avec au moins une escarre acquise a l’hopital ; 6,84 % des patients les plus a risque d’escarre (score de Braden Discussion Le suivi sanitaire de la prevalence des escarres en milieu hospitalier s’associe a un enjeu financier notable, tant en termes de recettes que de depenses. Les erreurs de codage de cette pathologie pourtant frequente dans certains services sous-estiment la charge de travail et le cout represente par les escarres et peut etre a l’origine d’un manque de materiel et de temps infirmier. Notre etude montre que la prise en charge des escarres occasionne pour un centre hospitalo-universitaire un cout journalier (cout de prevention et de prise en charge) de 32 243 €. Conclusion Un travail de sensibilisation et de valorisation reste necessaire aupres des soignants mais egalement des medecins, trop souvent peu concernes par cette pathologie qui est source de complications pour les patients et de consequences economiques pour les services.

Background Eating disorders (ED) and behavioural risk factors among students in higher education remain to be investigated. The aim of the study was to identify the prevalence of ED and the behavioural factors associated with ED in university students in four European universities: Chisinau (Ch) in Republic of Moldava, Cluj-Napoca (CN) in Romania, Miskolc (Ms) in Hungary and Rouen (R) in France. Methods In the four countries, students in higher education completed an anonymous standardized self-questionnaire, from 2016 to 2018. The questionnaire collected age, gender (M, W), housing, curricula, smoking, cannabis consumption, alcohol abuse problems (ADOSPA test), and perceived stress (Cohen score). The Sick, Control, One stone, Fat, Food (SCOFF scale) screening test was used to identify student with ED. Results A total of 3076 students were included, 705 in Ch, 582 in CL, 534 in Ms and 1255 in R. The sex-ratio was M:F=0.31 Ch, 0.30 in CN, 0.44 in Ms and 0.66 in R. The mean age was 21.2 (SD = 3.98) in Ch, 21.2 (SD = 3.2) in CL, 23.8 (SD = 5.1) in Ms and 20.0 (SD = 3.4) in R. The global prevalence of ED was 23.8%. According to the gender, the prevalence of ED in the four universities was 14.7% in M and 38.3% in W in Ch, 21.8% in M and 24.7% in W in CN, 19.7% in M and 21.4% in W in Ms and 16.1% in M and 34.0% in W in R (p < 10-4). After logistic regression, significant positive relation between the positive SCOFF was observed with female gender, alcohol abuse problems and stress level. Conclusions ED prevalence patterns were quite similar in the four countries, with high prevalence of ED, even in men. Associated behavioural risk-factors were quite similar. It might be necessary in the future to screen students for potential ED upon entry to the university and also to inform student about the risk of ED and advise them to consult a healthcare professional. Key messages Our study highlights the high prevalence of eating disorders, with similar behaviours in university students in four countries. Because of the detrimental effects of ED on physical and emotional health, it seems mandatory to set up public health programs (health promotion, prevention).

Background Graduate education is associated with many life changes and stressful events for students, potentially causing depression, anxiety and stress. Prevalence of these disorders and potential associated factors are not clearly identified. Methods A cross-sectional study was conducted among university students in France. The students filled out a self-questionnaire recording depression anxiety and stress with the DASS21. High” and “very High” intensity symptoms were grouped into “presence” of depression, anxiety and stress and “moderate” “light” “normal” were grouped into “absence” of depression, anxiety and stress. Curriculum, perceived academic pressure, financial difficulties, smoking, binge drinking and eating disorders were also recording. Results A total of 1,202 students were included of which 17.8% were healthcare students. The sex ratio (M:F) was of 0.42 with a mean age of 20.0 years. Prevalence of depression, anxiety and stress were respectively 16.4%, 26.4% and 16.0%. After multivariate analysis, female gender was associated with presence of stress (AOR=1,41 IC 95% [1,03-1,93]). High level of perceived academic pressure (AOR=2,13 [1,61-2,82], 2,05 [1,57-2,68], 2,35 [1,72-3,22]) financial difficulties (AOR=1,33 [1,03-1,73], 1,54 [1,19-1,99], 1,37 [1,04-1,82]) and eating disorders (AOR=2,46 [1,83-3,31], 2,36 [1,75-3,19], 2,21 [1,63-23]) were associated with presence of depression, anxiety and stress. Binge drinking (AOR=1,48 [1,05-2,09]) and smoking (AOR=1,46 [1,01-2,13]) were associated with anxiety. Conclusions These results show prevalence of depressive, anxiety and stress symptoms among students. Poor mental health is related to academic and financial difficulties, and is associated especially with eating disorders. There is a pressing need to prioritize mental health of college students through the national public health policies. Additional studies are needed to better understand the relationships between these different factors. Key messages There is a significant prevalence of depression, anxiety and stress symptoms among Rouen students. Depression, anxiety and stress symptoms among students are associated with high level of perceived academic pressure, financial difficulties and presence of eating disorders.

Background Attention is needed on students as high levels of substance use are often part of the university experience. The aim of the study is to identify the trend of tobacco smoking and binge drinking among university students (US) of Belgium, France and the Netherlands over a 9 years period. Methods Three repeated cross-sectional studies in US were performed in 2009-10, 2012-13 and 2016-17 in university of Antwerp (Belgium), Amsterdam (the Netherlands) and Rouen (France). US between 18 and 25 voluntarily filled out a self-administered anonymous questionnaire. The socio-demographic characteristics (age, gender, curriculum, job and accommodation) of the US were collected. Tobacco smoking and binge drinking in the previous 12 months were also collected. The trend test of Cochran-Armitage was used for comparisons. Results In 2010, 1388 US were included in Antwerp, 1907 in Amsterdam, and 1137 in Rouen. In 2013, 1665 US were included in Antwerp, 3590 in Amsterdam, and 1488 in Rouen. In 2016, 2347 US were included in Antwerp, 4157 in Amsterdam, and 1011 in Rouen. Female gender was 63.4% in Antwerp, 68.7% in Amsterdam and 65.4% in Rouen. The prevalence of tobacco smoking was respectively in 2010, 2013 and 2016: in Antwerp: 31.0%, 33.5% and 27.6% (p = 0.008); in Amsterdam: 13.7%, 16.5% and 17.0% (p = 0.003); in Rouen: 21.3%, 23.7% and 23.5% (p = 0.21). The prevalence of binge drinking (more than once a month) was respectively in 2010, 2013 and 2016: in Antwerp: 16.2%, 12.3% and 16.7% (p = 0.30); in Amsterdam: 26.5%, 27.4% and 26.5% (p = 0.82); in Rouen: 8.6%, 16.6% and 7.1% (p = 0.44). Conclusions Risk behaviours as tobacco smoking and binge drinking in US show a different prevalence according to country. Tobacco smoking decreases in two countries and frequent binge drinking did not change during the 9 years period. Further analyses need to be conducted taking into account the curriculum and the socio-demographic characteristics. Key messages Risk behaviours as tobacco smoking and binge drinking in university students show a different prevalence according to the European country. Binge drinking does not worsen for 9 years among university students.

Background University students tend to find it difficult to ask for help especially when it comes to health issues. The objective of the study was to determine the health issues of general practitioner and the reasons of primary care foregone in university students. Methods A cross sectional study was conducted in 2018 in Normandy university students (France). The socio demographic characteristics of the university students were collected. The primary care seeking during the previous 12 months were assessed by the consultation to the general practitioner and categorized: acute physical issues (stomach aches, cough ...), chronic physical issues (asthma, diabetes...), mental health issues (stress, anxiety...) and preventive medicine (vaccine, certificate...). The foregone of primary care during the previous 12 months and the barriers to accessing primary health-care-seeking were also collected. Results 1179 university students (58.0% of women, age mean 20.4 years) were included. Frequency of health issues in the last 12 months were preventive issues (57.2%), acute physical issues (52.2%), chronic physical issues (16.7%) and psychological issues (18.4%). The foregone of primary care of the university students was reported by 20.5% of university students. The three main barriers reported by these students to accessing primary health-care-seeking behaviour were self-treatment (60.6%), lake of time (64.7%) and financial barriers (25.4%). Logistic regression showed that the foregone of primary care was positively associated with being female students AOR=1.69 CI95% (1.21-2.36), grant holder AOR=1.52 CI95% (1.10-2.02), and living in rented accommodation AOR=1.47 CI95% (1.03-2.02). Conclusions Half of university students consult the general practitioner for physical concerns and one fifth for psychological disorders. However with 20% of primary care foregone by university students, the access of primary care in the targeted population could be improved. Key messages One fifth of university students foregoes to primary care. Female students, grant holder and living in accommodation are the risk factors of foregone of primary care.

Objective In this international study, the prevalence of Eating disorders (EDs) was determined among university students and identified associated demographic and behavioral factors predicting disorders using data from three European countries. Methods The survey was conducted in Hungary, Poland, and Ukraine in 2018. Registered full-time students completed an online anonymous questionnaire. Students provided data about socioeconomic characteristics, body mass index (BMI), EDs, physical fitness and sport practice, psychological distress (stress, anxiety, depression), life orientation, alcohol, tobacco, and cannabis use. Data were analyzed using SPSS 24.0 software. Results From the 1965 returned questionnaires 1950 were analyzed, because of the missing data (67.3% female, mean age of the total participant’s 21.40 ± 3.83 years old). EDs were observed in 26.3% of students. In logistic regression, EDs were predicted by female sex, higher BMI, single marital status, elevated psychological distress and limited access to health care. Conclusion EDs are relatively common in university students especially in females. Students with higher distress and BMI, limited access to health care and living without partner are at risk for EDs. This result highlights the need for a public health approach. Universities are the last chance where students can be screened in an organized setting and offer interventions early when treatment is likely to be most effective.

In the 21st century, public health is not only about fighting infectious diseases, but also contributing to a "multidimensional" well-being of people (health promotion, non-communicable diseases, the role of citizens and people in the health system etc.). Six themes of public health, issues of the 21st century will be addressed. Climate change is already aggravating already existing health risks, heat waves, natural disasters, recrudescence of infectious diseases. Big data is the collection and management of databases characterized by a large volume, a wide variety of data types from various sources and a high speed of generation. Big data permits a better prevention and management of disease in patients, the development of diagnostic support systems and the personalization of treatments. Big data raises important ethical questions. Health literacy includes the abilities of people to assess and critique and appropriate health information. Implementing actions to achieve higher levels of health literacy in populations remains a crucial issue. Since the 2000s, migration flows of health professionals have increased mainly in the "south-north" direction. India is the country with the most doctors outside its borders. The USA and the UK receive 80% of foreign doctors worldwide. Ways have been identified to try to regulate the migratory phenomena of health professionals around the world. The mobilization of citizen, health system users and patient associations is a strong societal characteristic over the last 30 years. In a near future, phenomena will combine to increase the need for accompaniment of patient or citizen to protect health, such increase of the prevalence of chronic diseases, reinforcement of care trajectories, medico-social care pathways, and importance of health determinants. Interventional research in public health is very recent. It is based on experimentation and on the capitalization of field innovations and uses a wide range of scientific disciplines, methods and tools. It is an interesting tool in the arsenal of public health research. It is essential today to be able to identify the multiple challenges that health systems will face in the coming years, to anticipate changes, and to explore possible futures.

Aim: The objective was to investigate factors influencing patients’ willingness to pay (WTP) and physician’s views on the cost of therapy for two contrasted chronic diseases, chronic heart failure and psoriasis. Methods: A cross-sectional survey was conducted in ten developing countries, using a stated WTP contingent valuation method. Multivariate analyses were performed by linear regression. Results: Independent factors influencing patient WTP were income (+0.04 $PPP [purchasing power parity] in WTP per $PPP in monthly income; p Conclusion: Disease-specific factors may affect WTP for treatment that should be accounted for to support effective public health programs in developing countries.

BackgroundOn the population level, the association of age and other sociodemographic factors with eating disorders (ED) is unclear.MethodsWe used cross-sectional data from the French general population-based NutriNet-Santé e-cohort (n=49 603 adults; 76.3% women; mean age=50.4±14.6 years). ED were evaluated in 2014 with the 5-item SCOFF screening questionnaire and the Expali algorithmic tool. Likely cases of restrictive, bulimic, hyperphagic and other ED were the dependent variables. Age, marital status, education, occupation, physical activity and smoking were the independent variables. Associations were estimated via gender-stratified multivariable polytomous logistic regression.ResultsAmong women, age displayed inverse linear associations with both restrictive and bulimic ED, underscoring 18–25 years as the most vulnerable period (adjusted OR=3.37, 95% CI: 2.24 to 5.08 for restrictive ED; adjusted OR=2.98, 95% CI: 2.37 to 3.74 for bulimic ED, respectively). A similar association was observed in men regarding bulimic ED. In women, age was not associated with hyperphagic ED for which living alone, low education, low physical activity, being a homemaker/disabled/unemployed/retired, a manual worker or a former/current smoker had increased importance. In men, 18–39 years emerged as the least vulnerable period regarding hyperphagic ED (adjusted OR=0.74, 95% CI: 0.56 to 0.99). Across gender, having postsecondary education had significant inverse associations with all except restrictive ED, whereas being a student had a significant positive association with restrictive ED.ConclusionsThe findings support gender-specific associations of age with four ED subtypes and could inform future prevention initiatives targeting specific ED among specific age groups.Trial registration numberNCT03335644; Pre-results.

Objectifs : Les objectifs etaient de determiner la prevalence de l’activite physique (AP), de caracteriser les profils d’AP et d’identifier les comportements a risque associes a une AP dans la population etudiante. Methodes : En 2014, une etude epidemiologique transversale a ete conduite dans les universites de Rouen et du Littoral et la Cote d’Opale. Un auto-questionnaire anonyme a collecte des informations sur l’âge, le sexe, les consommations d’alcool, le risque de trouble de comportement alimentaire (TCA). La pratique d’une AP a ete evaluee par la pratique sportive et la duree. Trois categories ont ete definies : aucune AP declaree, AP moderee (0,5 a 3 heures/semaine) et une AP intense (> 3 heures/ semaine). Resultats : Au total, 2787 etudiants ont ete inclus. Le sexe ratio H/F etait de 0,56 et l’âge moyen de 21,0 ans (ecart-type = 3,5) ; 41,8 % ne pratiquaient aucune AP, 28,4 % une AP moderee et 19,8 % une AP intense. La prevalence de la consommation d’alcool au moins une fois par semaine etait de 14,6 % chez les etudiants sans AP, 20,2 % chez les etudiants avec une AP moderee et de 24,4 % chez les etudiants avec une AP intense. Les facteurs independamment associes a la pratique d’une AP intense etaient les femmes (ORA = 0,28, IC a 95 % = 0,18-0,43 ; p < 10-4), etre fumeur (ORA = 0,54, IC a 95 % = 0,36-0,81 ; p = 0,003), avoir un risque de TCA (ORA = 0,95, IC a 95 % = 0,51-0,91 ; p = 0,02) et le niveau de stress (ORA = 0,91, IC a 95 % = 0,85-0,96 ; p = 0,001). Conclusion : Plus de 40 % des etudiants ne pratiquent aucune AP regulierement. Les resultats montrent la necessite d’avoir une meilleure comprehension pour elaborer des strategies d’intervention adaptees aux populations jeunes, prenant en compte de nouvelles approches de sante publique.

International audience

Introduction et but de l’etude Les troubles du comportement alimentaire (TCA), tels que l’anorexie mentale, la boulimie et l’hyperphagie, sont des pathologies chroniques associees a une morbidite et une surmortalite importantes, et ont des consequences psychosociales graves. Or, les donnees sur les prevalences des TCA en France sont anciennes, rarement en population generale, et elles necessitent d’etre actualisees. A travers une large etude epidemiologique d’observation, l’objectif etait de mesurer les prevalences actuelles et d’identifier les determinants sociodemographiques des TCA chez les adultes francais. Materiel et methodes Il s’agit d’une etude ancillaire conduite dans le cadre de la cohorte NutriNet-Sante (lancee en 2009). Cette cohorte porte sur des volontaires de plus de 18 ans, recrutes par des campagnes multimedia grand public et inclus sur le site Internet https://www.etude-nutrinet-sante.fr . Le questionnaire SCOFF (compose de 5 questions a reponse binaire), lance en juin 2014, a permis d’identifier les personnes a risque de TCA. Parmi les 51 077 individus ayant repondu au questionnaire, nous avons selectionne un echantillon de 49 603 pour lesquels l’ensemble des donnees sociodemographiques, anthropometriques, et de mode de vie ont ete collectees. Des analyses transversales ont ete realisees, a l’aide de modeles logistiques multivaries ainsi que l’algorithme Expali TM (en cours de validation) qui permet le classement des TCA en 4 grandes categories diagnostiques : restrictifs, boulimiques, hyperphagiques et autres. Resultats et analyse statistique Au total, 6 925 (14 %) individus etaient a risque de TCA, (16 % chez les femmes, 8 % chez les hommes). Les troubles hyperphagiques etaient les plus frequents (52,6 %), suivis par les troubles boulimiques (26,2 %), et ensuite par les troubles restrictifs (7,2 %). Dans les deux sexes, le fait de vivre seul(e), d’etre etudiant(e), d’etre en surpoids ou obese, et d’etre ancien fumeur etaient significativement associes aux TCA ; en revanche, le fait d’avoir un diplome eleve etait inversement associe aux TCA. Chez les femmes, les prevalences des troubles restrictifs ou boulimiques diminuaient apres l’âge de 45 ans, tandis que chez les hommes les prevalences des troubles boulimiques et hyperphagiques montraient une legere augmentation a partir de cet âge. Conclusion Ces resultats permettent d’actualiser les donnees sur les prevalences des TCA en France, meme si cet echantillon pourrait etre sujet d’un biais de selection. Neanmoins, les prevalences des TCA retrouvees dans la cohorte NutriNet-Sante sont proches de celles estimees par des etudes de synthese. Dans l’avenir, les recherches longitudinales completeront ces travaux et serviront a orienter le developpement des strategies de sante publique. L’elaboration d’un programme de prevention des TCA bases sur Internet pourrait etre envisagee.

International audience; BackgroundEating disorders are particularly frequent in young adults, college students included. However eating disorders among European healthcare students are not well known. The objectives were to identify the prevalence of eating disorder (ED) among healthcare students and the associated factors.MethodsA cross-sectional study was conducted in France (Rouen, West opal coast and Lille), in Romania (Cluj-Napoca), and in Moldavia (Chisinau). An anonymous self-questionnaire collected age, gender, year of study, depression, anxiety and stress (DASS 21), estimated academic level, smoking and eating disorder (SCOFF test). A clinical algorithm (Expali™) identified the four Broad Categories of ED (hyperphagic, bulimic, anorexic and other ED) derived from DSM-5 with the combine of answers to SCOFF test and body mass index.ResultsIn total, 1273 healthcare students were included (434 in France, 270 in Moldavia and 569 in Romania). Sex ratio (M:F) was 0.30 and the mean of age 20.2 [standard deviation (SD) = 1.32]. The body mass index were 13.1% of underweight and 14.4% of overweight/obese without difference between the countries (P = 0.34). The prevalence of ED was 19.6% in France, 35.6% in Moldavia and 24.2% in Romania (P < 0.0001). Bulimic disorder was the main ED (42.2%) following by hyperphagic disorders (32.6%), anorexic disorders (10.9%) and other ED (14.3%) with difference between the 3 countries (P = 0.004). After logistic regression, the associated factors with ED were: gender [female AOR = 2.0; 95% CI (1.3–3.1)], year of study [first year AOR = 2.0; 95% CI (1.3–2.9)], depression [AOR = 1.8; 95% CI (1.3–2.5)], anxiety [AOR = 1.6; 95% CI (1.1–2.2)] and country [Moldavia AOR = 2.1; 95% CI (1.4–3.0)].ConclusionOur study provides different prevalence of ED among healthcare students in three European countries. The categories of ED were also different according the country. Individual as well as institutional interventions should be targeted university students with the help an easy and quick screening test such as the SCOFF questionnaire, especially in the first year of study.

BACKGROUND: Many studies indicate that a substantial part of the student population drinks excessively, yet most European universities do not have an alcohol policy. In the absence of an alcohol guideline at universities and the easy access to alcohol sold at the student cafeteria, for instance, this has the potential to place students at risk of overconsumption, which has adverse health consequences.OBJECTIVES: Therefore, our study objectives were to explore and compare university students' experiences and attitudes toward alcohol policy on their campus using a qualitative approach.METHODS: 29 focus group discussions (FGDs) were conducted among students from universities in five European countries: Belgium (4 FGDs), Denmark (6 FGDs), France (5 FGDs), Hungary (6 FGDs), and the Slovak Republic (8 FGDs), with a total number of 189 participants.RESULTS: Across the five European countries, students recognized that alcohol was a big problem on their campuses yet they knew very little, if any, about the rules concerning alcohol on their campus.CONCLUSIONS: Students will not support an on campus alcohol restriction and a policy should therefore focus on prevention initiatives.

Background Artemisinin-based combination therapy (ACT) is recommended as the first-line anti-malarial treatment strategy in sub-Saharan African countries. WHO policy recommends parasitological confirmation by microscopy or rapid diagnostic test (RDT) in all cases of suspected malaria prior to treatment. Gaps remain in understanding the factors that influence patient treatment-seeking behaviour and anti-malarial drug purchase decisions in the private sector. The objective of this study was to identify patient treatment-seeking behaviour in Ghana, Kenya, Nigeria, Tanzania, and Uganda. Methods Face-to-face patient interviews were conducted at a total of 208 randomly selected retail outlets in five countries. At each outlet, exit interviews were conducted with five patients who indicated they had come seeking anti-malarial treatment. The questionnaire was anonymous and standardized in the five countries and collected data on different factors, including socio-demographic characteristics, history of illness, diagnostic practices (i.e. microscopy or RDT), prescription practices and treatment purchase. The price paid for the treatment was also collected from the outlet vendor. Results A total of 994 patients were included from the five countries. Location of malaria diagnosis was significantly different in the five countries. A total of 484 blood diagnostic tests were performed, (72.3% with microscopy and 27.7% with RDT). ACTs were purchased by 72.5% of patients who had undergone blood testing and 86.5% of patients without a blood test, regardless of whether the test result was positive or negative (p

Contexte et objectif : L’objectif general du projet de recherche-action international francophone sur la responsabilite sociale des facultes de medecine a ete d’experimenter et d’evaluer la pertinence, l’applicabilite et la mise en œuvre d’une demarche de qualite inspiree des principes de responsabilite sociale (RS) et d’en demontrer l’utilite comme une strategie de choix pour ameliorer la sante. Description : Au 1er novembre 2015, 56 facultes de medecine dans 18 pays francophones ont adhere au projet de recherche-action. La phase d’evaluation de la perception des differents acteurs a montre que la sensibilisation devait etre poursuivie aupres des acteurs « intra muros » et « extra-muros ». La participation forte des etudiants signe un vif interet de ces derniers pour la RS. Des experimentations d’actions pragmatiques de RS ont ete choisies par les facultes : le contrat faculte-territoire, la premiere ligne de sante, l’adaptation de la formation et les populations vulnerables. Resultats : Le regroupement de facultes dans un meme pays montre une dynamique nationale forte, une mutualisation des projets d’intervention et une visibilite accentuee. En Tunisie et en Haiti, les quatre facultes nationales sont partenaires du projet autour d’une thematique commune. Les six facultes de medecine de Madagascar se sont engagees dans un partenariat national prometteur. Conclusion : L’experience du projet de recherche action sur la RS des facultes de medecine est une experience d’envergure originale dans le monde francophone. En raison de la diversite des engagements, le projet illustre de maniere evidente la possibilite d’engager des actions pragmatiques de RS a l’echelle d’une communaute, d’une institution academique ou d’un pays.

Contexte : Les facultes de medecine francophones au niveau mondial (139), conscientes de leurs obligations, s’engagent pleinement envers leur responsabilite sociale avec l’objectif de repondre au mieux aux besoins des populations qu’elles ont le mandat de servir. En 2012, elles ont mis sur pied un projet international de recherche-action sur la responsabilite sociale. Apres quelques annees de travaux, elles ont recemment elabore un plan strategique pour la periode 2015-2020 pour confirmer leurs engagements, mieux coordonner les actions, en faire un suivi plus rigoureux et en augmenter l’impact. Exegese : Le plan se fonde sur trois axes specifiques d’intervention : l’impact, l’accreditation, les partenariats/collaborations. Ceux-ci sont renforces par trois axes transversaux de soutien : plaidoyer/formation/expertise, dissemination/leadership, organisation/ressources. Les objectifs de chacun des axes ainsi qu’une serie d’actions prioritaires pour la periode 2015-2017 sont presentes. Conclusion : Ce plan strategique confirme l’engagement concret des facultes de medecine francophones envers leur responsabilite sociale pour les prochaines annees.