Évaluation du chantier sur la relance de la consommation de fruits par les jeunes : rapport d'étape du programme «Un fruit pour la récré »

National audienc

Évaluation du chantier sur la relance de la consommation de fruits par les jeunes : programme « Un fruit pour la récré »

National audienc

Methodology for assessment of a program to stimulate fruit consumption by young people

International audienc

Evaluation of program to promote fruit with children: interest for action

International audienc

Évaluation du projet "Un Fruit pour la Récré" : rapport final

Dans un contexte de croissance de l'obésité et des maladies chroniques en France, surtout chez les jeunes, le Plan National Nutrition Santé recommande à la population d’augmenter sa consommation de fruits et légumes, car ceux-ci auraient un effet positif dans la prévention de ces maladies. Cependant, il s'avère que les jeunes, en particulier ceux des milieux défavorisés, ont une faible consommation de fruits et légumes. Dans ce cadre, le ministère de l'agriculture et de la pêche travaille depuis 2005 sur des "modèles d'accessibilité aux fruits et légumes" et a proposé un premier chantier en 2008, intitulé "Un fruit pour la récré". Cette opération a consisté à proposer une distribution gratuite et hebdomadaire de fruits aux élèves d'écoles primaires, sur l'année scolaire 2008-2009, dans les communes de France qui le souhaitaient. Ce programme a fait l'objet d'une évaluation concomitante visant à estimer ses impacts sur la consommation alimentaire, les attitudes, les connaissances des enfants et des parents, ainsi que leur satisfaction. Un échantillon a été tiré au sort dans les écoles bénéficiaires et non bénéficiaires afin de mesurer les impacts. Les résultats font apparaître un effet positif du programme, malgré un contexte général de crise économique défavorable à la consommation de fruits. La consommation a diminué dans tous les cas pendant l'année scolaire 2008-2009, mais un peu moins chez les bénéficiaires de l'action. Les impacts sur les perceptions et les connaissances sont positifs et les différents acteurs impliqués (enfants, parents et directeurs d'écoles) se déclarent satisfaits de l'opération. L'étude conclut à la nécessité de poursuivre mais par des actions plus globales que sur la seule distribution de fruits

Impact du programme "un fruit pour la récré" sur la consommation, les attitudes, les connaissances des enfants et leurs parents : synthèse

Un premier programme expérimental de distribution des fruits dans les écoles a été lancé en France en mai 2008. Ce programme a fait l'objet d'une évaluation concomitante visant à estimer ses impacts sur la consommation alimentaire, les attitudes, les connaissances des enfants et des parents, ainsi que leur satisfaction. Un échantillon a été tiré au sort dans les écoles bénéficiaires et non bénéficiaires afin de mesurer les impacts. Les résultats font apparaître un effet positif du programme, malgré un contexte général de crise économique défavorable à la consommation de fruits. La consommation a diminué dans tous les cas pendant l'année scolaire 2008-2009, mais un peu moins chez les bénéficiaires de l'action. Les impacts sur les perceptions et les connaissances sont positifs et les différents acteurs impliqués (enfants, parents et directeurs d'écoles ) se déclarent satisfaits de l'opération. L'étude conclut à la nécessité de poursuivre mais par des actions plus globales que sur la seule distribution de fruits

Effectiveness of a multi-faceted intervention to deprescribe proton pump inhibitors in primary care: protocol for a population-based, pragmatic, cluster-randomized controlled trial

International audienceAbstract Background Inappropriately using proton pump inhibitors (PPI) is associated with severe adverse drug reactions and may have major consequences on healthcare costs. Deprescribing (the process by which a healthcare professional supervises the withdrawal of an inappropriate medication, to manage polypharmacy and improve outcomes) should be considered when an inappropriate PPI prescription is identified. Deprescribing interventions directed solely to prescribers have limited efficacy and are rarely targeted to patients. The aim of this trial is to assess the efficacy of a multi-faceted intervention with patients and general practitioners (GPs) to deprescribe PPI. Methods We will conduct a pragmatic , cluster-randomized, population-based, controlled trial in two regions of Western France. GPs with practices with over 100 patients, and their adult patient to whom over 300 defined daily doses (DDD) of PPIs have been dispensed in the year before baseline will be included. A total of 1300 GPs and 33,000 patients will be cluster-randomized by GPs practices. Three arms will be compared: i) a multi-faceted intervention associating a) a patient education brochure about PPI deprescribing sent directly to patients (the brochure was designed using a mixed-methods study), and b) a personalized letter with the Bruyere’s PPI deprescribing algorithm sent to their respective GPs, or ii) a single intervention where only the GPs received the letter and algorithm, or iii) no intervention. The primary outcome will be PPI deprescribing, defined as the proportion of patients achieving at least a 50% decrease in the amount of PPI dispensed to them (DDD/year) at 12 months compared to baseline. Secondary outcomes will include incremental cost-utility ratio (using EQ-5D-5L scale and National Health Insurance’s database), acid rebound (using the Gastroesophageal Reflux Disease Impact Scale), and the patients’ attitudes towards deprescribing (using the French rPATD). Discussion Based on previous trials, we anticipate more than 10% “successful PPI deprescribing” in the multi-faceted intervention compared to the single intervention on GPs and the control arm . The study has been funded through a national grant and will be launched in autumn 2020, for early results by the end of 2022. Trial registration Clinicaltrials.gov NCT04255823 ; first registered on February 5, 2020

Towards outpatient management of tubo-ovarian abscesses?

International audienc

Educ@dom: comparative study of the telemonitoring of patients with type 2 diabetes versus standard monitoring—study protocol for a randomized controlled study

International audienceBackground: The global prevalence of type 2 diabetes is considerable. To avoid or delay its chronic complications, patients with type 2 diabetes should improve blood glucose management by adapting their life style. This involves changing the way in which diabetes is controlled. We believe that, thanks to technological innovations in connected health-monitoring devices, the telemonitoring of type 2 diabetes patients using therapeutic educational tools is likely to help them adapt their treatment and lifestyle habits, and therefore improve blood glucose management.Methods: This is a multicenter, randomized, controlled, prospective study. The primary objective is to compare the efficacy of telemonitoring to standard monitoring in terms of changes in glycated hemoglobin levels (HbA1c) after a 1 year follow-up period. The secondary objectives are clinical (changes in knowledge, physical activity, weight, etc.) and medical-economic. 282 patients are required (141 patients in each group) to satisfy the primary objective. For patients in the intervention group, the device will be given to them for 1 year and then withdrawn during the second year of follow-up.Conclusions: The anticipated benefits of this research are an improvement in blood glucose management in patients with type 2 diabetes by improving their lifestyle whilst rationalizing recourse to consultations in order to reduce the incidence of complications and cost in the long term. If the results of this study show that management of type 2 diabetes by tele monitoring is clinically effective and economical, this device could then be made available to a larger diabetic patient cohort

Key Drivers of Coagulation Factor Use in Von Willebrand Disease During Hospitalization: An Overview of the French BERHLINGO Cohort

International audienceBACKGROUND: Von Willebrand disease (VWD) is the most common inherited bleeding disorder. However, studies of hospitalisation patterns with replacement treatment are scarce. OBJECTIVES: The aim of this study was to investigate the current therapeutic management of VWD and determine the key drivers of coagulation factor uses in patients during hospitalisation. METHODS: Hopscotch-WILL was a multi-centric retrospective study conducted over a 48-month period in any patients with VWD. The data were collected from the BERHLINGO Research Database and the French Hospital database. RESULTS: A total of 988 patients were included; 153 patients (15%) were hospitalised during 293 stays requiring treatment with von Willebrand factor (VWF) concentrates-pure or in association with Factor VIII (FVIII). Their median basal concentrations of VWF and FVIII were significantly lower than in untreated patients: VWF antigen < 30 IU/dL, VWF activity < 20 IU/dL and FVIII:C < 40 IU/dL. The median (interquartile range) concentrate consumption was similar between highly purified VWF or VWF combined with FVIII (72 [110] vs 57 [89] IU/kg/stay, p = 0.154). The use of VWF was highly heterogeneous by VWD type; type 3 had a particularly high impact on VWF consumption in non-surgical situations. The main admissions were for ear/nose/throat, hepato-gastroenterology, and trauma/orthopaedic conditions, besides gynaecological-obstetric causes in women. CONCLUSIONS: The use of VWF concentrates is mostly influenced by low basal levels of VWF and FVIII, but also by VWD type or the cause for hospitalisation. These results could inform future studies of newly released recombinant VWF