Florence Carrouel

Introduction: Care pathways support the coordination and delivery of care, but their optimization requires a better understanding of the factors that influence their organization and evolution. This study aimed to define determinants of care pathways (DCPs) and identify invariant determinants of care pathways (IDCPs). Methods: A qualitative study was conducted using semi-structured interviews with 21 French healthcare professionals, including clinicians, academics, and institutional stakeholders. Data were analyzed thematically in accordance with COREQ guidelines. Results: Two main themes were identified. The first concerned the characteristics of DCPs and comprised three subthemes: their distinction from health determinants (HDs), the relevance of identifying DCPs, and their contribution to care-pathway modeling. Participants characterized HDs as factors influencing individual or population health status, whereas DCPs were described as factors primarily shaping the organization, accessibility, continuity and progression of care. Both may vary and interact over time. The second theme concerned the identification of IDCPs and comprised four categories: health status, systemic and organizational determinants, social and environmental determinants, and individual and psychological determinants. These categories were considered to be systematically present across care pathways, although their specific manifestations and effects varied according to the patient, context and stage of care. Conclusions: IDCPs provide a common analytical framework for analyzing and optimizing CPs. Systematically considering these categories, together with HDs and specific DCPs, may help identify modifiable points of disruption and support the design, evaluation and modeling of more coordinated and patient-centered care.

Background: Oral squamous cell carcinoma (OSCC) has a relatively poor survival, and TNM staging alone offers limited prognostic discrimination. C-reactive protein (CRP) is a non-specific inflammatory marker and is one of the most studied candidate prognostic biomarkers of OSCC, while CYFRA 21-1 and squamous cell carcinoma antigen (SCC-Ag) are tumor-derived keratin proteins reflecting malignant cell turnover, often examined alongside CRP. However, no prior review has synthesized the value of these three markers together in OSCC. Methods: Following the PRISMA 2020 guidelines, PubMed, Embase, and Web of Science were searched for studies reporting an extractable hazard ratio (HR), odds ratio, or comparable association of serum and/or salivary CYFRA 21-1, SCC-Ag, and/or CRP with disease-free survival (DFS), recurrence, or overall survival (OS) in OSCC. HRs were pooled using Knapp–Hartung random-effects models, wherever at least two independent cohorts contributed; salivary CYFRA 21-1 and recurrence were pooled as a standardized mean difference (SMD). Studies reporting only cross-sectional associations with tumor stage, grade, or metastasis and non-independent (same-registry) studies were synthesized descriptively following Synthesis without Meta-analysis (SWiM) guidance. Risk of bias was assessed with QUIPS and certainty of evidence with the GRADE framework. Results: Twenty-eight studies were included (21 quantitative, 7 narrative), representing ~3500 study participants across published cohorts, with some overlap between studies. For OS, two independently pooled single-marker estimates were both non-significant: serum SCC-Ag alone (n = 2, HR 1.43, 95% CI: 0.09–23.14, p = 0.35, I² = 66%) and serum CRP alone (n = 5, HR 1.33, 95% CI: 0.89–1.99, I² = 52%). A further seven non-independent, same-registry studies reporting combined SCC-Ag + CRP or single-marker models ranged from HR 1.82 to 11.11, directionally consistent with the pooled estimates. For DFS, pooled serum CYFRA 21-1 alone gave HR 1.61 (95% CI: 0.39–6.61; p = 0.15, I² = 0%), with six further non-independent or single-study estimates (HR 1.38–4.05) in the same direction. For recurrence, pooled salivary CYFRA 21-1 gave an SMD of Hedges’ g = 0.79 (95% CI: 0.04–1.55; p = 0.048, I² = 0%). All outcomes were rated very low certainty by GRADE. Conclusions: Within the limitations of the study and the small number of contributing studies, salivary CYFRA 21-1 showed some prognostic value for recurrence, while pooled estimates for serum CRP alone, serum SCC-Ag alone, and serum CYFRA 21-1 alone for DFS all trended toward increased risk but did not reach statistical significance. Given the very low evidence certainty, these findings are hypothesis-generating and require further validation in independent, multicenter, prospective cohorts before clinical application.

Background: Mental distress represents a major public health challenge worldwide, affecting work ability, productivity, and social functioning. Public-sector employees face high psychosocial demands, but data on their mental health literacy and supportive behaviors remain scarce. Mental Health First Aid (MHFA) aims to improve knowledge, attitudes, and behaviors (KAB) toward psychological distress among nonspecialists, but evidence among civil servants and on skill retention over time is limited. Objective: This study aimed (1) to determine KAB related to psychological distress among French civil servants, (2) to examine associations between KAB scores and MHFA training exposure, and (3) to explore gradients according to time since training as an indirect indicator of potential retention of MHFA-related competencies. Methods: A nationwide cross-sectional survey was conducted in November 2025 among French civil servants. Participants completed an online questionnaire adapted from a published instrument. The 3 dimension scores were normalized to a 0-40 scale, yielding a total KAB score of 0-120, categorized as inadequate (0-70), marginal (71-88), or adequate (89-120). Multivariable linear regression models identified factors associated with KAB outcomes, adjusting for sociodemographic and professional variables. Results: Among 338,560 eligible civil servants invited by email, 6526 (1.93%) initiated the questionnaire, and 4679 (1.38% of those invited) fully completed it and were included in the analysis. Participants were predominantly women (3022/4679, 64.59%), aged 40-69 years (4317/4679, 92.26%), and belonged to professional category A (2207/4679, 47.17%). The mean total KAB score was 82.88 (SD 19.14; 95% CI 82.33-83.43), corresponding to a marginal level. Mean subscores were 31.31 (SD 5.26; 95% CI 31.16-31.46) for knowledge, 29.72 (SD 11.52; 95% CI 29.39-30.05) for attitudes, and 21.86 (SD 7.96; 95% CI 21.63-22.09) for behaviors. MHFA-trained participants (545/4679, 11.65%) obtained significantly higher total KAB scores than untrained participants (mean 95.56, SD 14.17; 95% CI 94.37-96.75 vs mean 81.21, SD 19.09; 95% CI 80.63-81.79; P<.001), with higher scores for knowledge (mean 33.31, SD 5.26 vs mean 31.04, SD 5.35), attitudes (mean 34.35, SD 8.81 vs mean 29.10, SD 11.70), and behaviors (mean 27.87, SD 6.13 vs mean 21.06, SD 7.84; all P<.001). Among MHFA-trained participants, scores decreased over time (12 months; P<.001), but remained higher than in untrained individuals even beyond 12 months after training. In adjusted models, MHFA training was strongly associated with higher KAB scores (β=14.63 for 12 months; all P<.001). Lower scores were observed in professional categories B and C and among men. Conclusions: Mental health literacy and supportive behaviors among French civil servants remain heterogeneous and, on average, marginal. MHFA training is associated with substantially higher KAB scores, even beyond 12 months, supporting its role as a public health literacy intervention in occupational settings. Declining scores over time supports reinforcement strategies to sustain competencies.

Despite significant biomedical advances in the prevention of mother-to-child transmission (MTCT) of HIV, residual transmission and suboptimal maternal outcomes persist across Europe. The challenge is no longer primarily virological but structural: aggregated ART coverage indicators mask important discontinuities across the perinatal care pathway. This scoping review maps evidence on clinical and psychosocial dimensions of the perinatal HIV pathway among adult women living with HIV (WLHIV) in Europe, and identifies key gaps in their integration across the continuum of care. Following PRISMA-ScR guidelines, five databases were searched for studies published between 2010 and 2026. Of 1881 records identified, 109 met inclusion criteria. Findings were synthesized thematically using an inductively developed framework spanning preconception through long-term postpartum outcomes. MTCT rates declined from approximately 1–1.2% in the mid-2000s to below 0.5% in recent data, and vaginal delivery rates increased markedly with sustained viral suppression. However, persistent inequalities remain among younger women, migrants, and those with histories of injecting drug use. Stigma, migration-related vulnerability, mental health difficulties, constrained disclosure, and socioeconomic insecurity shape engagement with care, influencing treatment continuity, retention, and virological outcomes, particularly during the postpartum period. Equitable perinatal HIV outcomes require integrated care models that combine clinical HIV and obstetric services with mental health support, social needs screening, and migration-sensitive services to address the structural conditions shaping care trajectories. A substantial proportion of WLHIV in Europe originate from high-prevalence regions, making perinatal HIV in this context a direct interface between global infectious disease burden and migration health. Addressing care in European settings therefore contributes to broader global health equity goals in HIV elimination. The protocol was pre-registered on Open Science Framework with registration number: 10.17605/OSF.IO/9BZGY.

Introduction: Health inequalities among children and adolescents remain a major public health concern, with schools identified as key settings for integrated, context-sensitive interventions. The Explo’Santé program was developed in France to promote life skills and foster health-supportive school environments by targeting school-level determinants, including relational dynamics, organizational processes, and classroom environments. Methods: A longitudinal qualitative study was conducted between 2022 and 2025 across six French districts, based on 36 semi-structured interviews with primary and middle school teachers involved in program implementation. Data were analyzed using thematic analysis to explore perceived environmental changes and contextual mechanisms influencing implementation. Results: Six main themes emerged, including spatial conditions, peer climate, teacher–student relationships, organizational flexibility, pedagogical formats, and institutional embedding. In primary schools, stable classroom environments enabled gradual symbolic and relational transformations, with improved emotional expression, peer interactions, and integration into routine practices. In contrast, middle schools were characterized by organizational fragmentation, reduced temporal and relational continuity, and more heterogeneous student engagement, limiting program integration. Sustainability appeared dependent on contextual alignment, coordination, and institutional support. Conclusion: The findings highlight that school-based health promotion effects are context-dependent and shaped by interactions between develop-mental stage and institutional structure. Sustaining psychosocial gains appears to depend on maintaining relational and organizational continuity across educational stages, as well as on stronger integration of health promotion into formal school structures.

Background: Introduced in 2002, the Essure® implant was promoted as a minimally invasive permanent contraceptive. After widespread use, increasing reports of adverse effects led to its global withdrawal in 2018. This study explores the experiences of women in France who chose Essure®, focusing on their motivations and the factors leading to its removal. Methods: A qualitative descriptive study was conducted in 2024, involving 17 semi‐structured interviews to document participants' clinical pathways, implantation experiences and decision‐making around removal. Interviews were recorded, transcribed verbatim and analysed thematically. The study followed the COREQ checklist and received ethical approval (reference 2024‐04‐04‐005). Results: All participants reported symptom onset following implantation, including chronic joint, muscle and abdominal pain. Complications such as tubal damage, device migration and breakage during removal were also described. Beyond physical symptoms, women experienced psychological distress and social consequences. Many reported inadequate pre‐procedural counselling, particularly regarding the device's composition and potential risks. Participants often encountered insufficient support from healthcare providers when reporting symptoms or requesting removal. Conclusion: The study highlights the broad impact of Essure®, revealing not only physical complications but also emotional and social burdens. Findings underscore the need for comprehensive informed consent, empathetic communication and responsive care in the management of contraceptive device complications. Patient or Public Contribution: Women with lived experience of Essure® implantation and removal were central to this study. They were involved in shaping the research question and informing the design through preliminary interviews, which contributed to refining the interview guide. Participants provided rich, first‐hand narratives through semi‐structured interviews, allowing for an in‐depth understanding of clinical pathways, complications and the psychosocial impact of the device. Recruitment was conducted in collaboration with the RESIST patient association, whose support was instrumental in identifying eligible participants. The study thus reflects patient‐led priorities and experiential knowledge, contributing to the interpretation of findings and the development of patient‐centred recommendations. Their involvement did not end at the preliminary stage. The experiential input from these women was also later mobilised to reorient the interpretation of emerging findings during the thematic analysis, ensuring that analytical categories remained anchored in lived experience.