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Contexte: Travailler seul devient difficile, une des réponses actuelle des soins premiers en France est le regroupement des soignants. Ainsi, de nouvelles configurations des soins se développent telles les maisons de santé pluriprofessionnelles. Ces évolutions reconfigurent le travail en collaboration. Si travailler seul est difficile, travailler ensemble n'est pas inné. Hormis quelques expérimentations aucune faculté ou institut ne propose d'enseignement pluriprofessionnel en formation initiale. Proposition et objectifs: Réunir des étudiants en fin de formation se destinant prioritairement aux soins premiers et leur proposer d'apprendre à travailler ensemble. Objectifs: Découvrir les autres professions; faire connaître son champ de compétences; décloisonner les filières; apprendre à échanger; améliorer la coordination; optimiser les parcours de soin; concevoir un projet commun. Méthodes: Au cours de l'année scolaire 2016-2017, réalisation du séminaire constitué de trois sessions de deux jours regroupant différentes filières de la région lilloise: École de sages femmes, Institut de formation en soins infirmiers, Institut de formation en masso kinésithérapie du Nord de la France, Faculté de pharmacie, Faculté de médecine (internes de médecine générale). Pour chaque filière, 10 étudiants sont encadrés par un formateur au moins. Trois piliers sont à la base de la conception: se rencontrer pour se connaître; réfléchir ensemble sur les concepts soignant, santé et maladie; agir ensemble pour construire un projet commun. Les savoirs sont construits et intégrés essentiellement à partir de méthodes interactives telles que: conception et écriture de cartes d'identité par « corporation » afin de prendre conscience des représentations existantes qui impactent le « travailler ensemble »; « speed dating » professionnel pour présenter son métier et ses compétences aux autres afin de pouvoir se rencontrer autrement; « world café », un moment de détente au profit d'une réflexion commune autour d'un café pour partager les motivations à être un soignant; témoignages et débat avec des personnes soignées; construction de jeux de rôle de territoire afin de leur permettre d'élaborer un projet de santé pour une population sur un territoire donné. Résultats: Une évaluation de l'ensemble du séminaire est en cours d'analyse. [ABSTRACT FROM AUTHOR]

Résumé: Le pharmacien d'officine est reconnu comme un acteur de la prévention et de l'éducation thérapeutique. Un projet pédagogique mené dans les officines du Nord-Pas-de-Calais et coordonné par la faculté de pharmacie de Lille avec le réseau Néphronor nous a permis de collecter des données permettant d'évaluer l'intérêt d'une évaluation pharmaceutique officinale de la MRC. Nous rapportons ici le résultat de l'intervention réalisée dans 109 pharmacies d'officine. Les entretiens pharmaceutiques ont concerné 2 populations de patients. Le groupe A concerne des patients se connaissant porteurs d'une IRC (entretien pharmaceutique d'optimisation thérapeutique). Le groupe B regroupe des patients à risque de MRC pour lesquels est proposée une stratégie de dépistage. Ainsi, 354 patients ont été inclus dans le groupe A, majoritairement des femmes (51,2 %), en stade 3 d'IRC, d'âge moyen 73 ans, diabétiques (44 %). Environ 70 % des patients avaient déjà été vus par un néphrologue et 45 % d'entre eux présentaient une bonne adhésion thérapeutique selon le questionnaire de Morisky Green. Par ailleurs, 20 % des patients n'avaient pas de traitement néphroprotecteur en stades 3 et 4 de la MRC et plus de la moitié ne connaissaient pas les situations à risque d'insuffisance rénale aiguë. Le groupe B a inclus 532 patients (âge moyen 70 ans). L'intervention pharmaceutique a permis de dépister 10 % de patients avec un DFG < 60 mL/min/1,73 m2. L'entretien pharmaceutique en officine a permis d'optimiser la prise en charge thérapeutique et l'information des patients IRC, ainsi que le dépistage précoce chez certains patients à risque. Chronic kidney disease (CKD) is a major concern of public health. The pharmacist is known as a health practitioner involved in prevention and therapeutic education. Our study aimed at defining the impact of community pharmacists' interventions for preventing and screening CKD. In our observational prospective study of 5 months conducted in 109 community pharmacy, we included 2 groups of patients: A (therapeutic optimization): CKD patients and B (CKD screening): population at risk. In group A, we included 354 patients, mainly women (51.2%), in stage 3 of CKD, mean age 73 years old, with hypertension alone (40.6%) or associated with diabetes (44%). About 70% of the patients had a follow up by a nephrologist and 45% of them were good adherent according to the Morisky Green self-report. However, approximately 20% of patients did not have nephroprotective treatments in their regimen although they were on stage 3 or 4 CKD patients, and about half of them were not aware of medical situations at risk. Concerning group B, 532 patients were included. The pharmaceutical interventions screened 10 % of patients with a GFR < 60 mL/min/1.73m2. The community pharmacists' interventions helped to optimize the therapeutic management of CKD patients and in the early screening of patients at risk. More studies are needed to extrapolate our observations to a larger population. [ABSTRACT FROM AUTHOR]

Introduction The objective of the present study was to investigate the relationship between sources of household air pollution, respiratory symptoms and lung function. Methods 3039 adults aged from 40 to 65 participated in the 2011–2013 ELISABET cross-sectional survey in northern France. Lung function was measured using spirometry. During a structured interview, respiratory symptoms, household fuels, exposure to moulds, and use of ventilation were recorded on a questionnaire. Results The self-reported presence of mould in at least two rooms (not including the bathroom and the kitchen) was associated with a 2.5% lower predicted forced expiratory volume in 1 s (95% confidence interval, −4.7 to −0.29; p-trend <0.05) and a higher risk of wheezing (p-trend < 0.001). Visible condensation was associated with wheezing (p < .05) and chronic cough (p < .05). There were no significant associations with the type of household fuel or inadequate ventilation/aeration. Similar results were found when the analyses were restricted to participants without known respiratory disease. Conclusion Our results suggest that the presence of mould (known to be associated with more severe asthma symptoms) could also have an impact on respiratory symptoms and lung function in the general population and in populations without known respiratory disease. [ABSTRACT FROM AUTHOR]

Geographical variations in cardiovascular disease rates have been linked to individual air pollutants. Investigating the relation between cardiovascular disease and exposure to a complex mixture of air pollutants requires holistic approaches. We assessed the relationship between exposure to multiple air pollutants and the incidence of coronary heart disease (CHD) in a general population sample. We collected data in the Lille MONICA registry (2008–2011) on 3268 incident cases (age range: 35–74). Based on 20 indicators, we derived a composite environmental score (SEnv) for cumulative exposure to air pollution. Poisson regression models were used to analyse associations between CHD rates on one hand and SEnv and each single indicator on the other (considered in tertiles, where T3 is the most contaminated). We adjusted models for age, sex, area-level social deprivation, and neighbourhood spatial structure. The incidence of CHD was a spatially heterogeneous (p =0.006). There was a significant positive association between SEnv and CHD incidence (trend p =0.0151). The relative risks [95%CI] of CHD were 1.08 [0.98–1.18] and 1.16 [1.04–1.29] for the 2nd and 3rd tertile of SEnv exposure. In the single pollutant analysis, PM 10 , NO 2 , cadmium, copper, nickel, and palladium were significantly associated with CHD rates. Multiple air pollution was associated with an increased risk of CHD. Single pollutants reflecting road traffic pollution were the most strongly associated with CHD. Our present results are consistent with the literature data on the impact of road traffic on the CHD risk in urban areas. Unlabelled Image • A small area level geographic analysis from a coronary heart disease (CHD) registry • Long-term exposure to heavy metals assessed by lichen biomonitoring • Proposed a composite air pollution index (SENV) for multiple exposure • Found associations between SENV and CHD incidence • Exposure to multiple low-dose air pollutants may increase cardiovascular risks [ABSTRACT FROM AUTHOR]

Although a growing body of evidence suggests that chronic exposure to outdoor air pollution is linked to a decline in lung function, data on flow at low lung volumes that may be more specific of small airway obstruction are still scarce. We aimed to study the associations between residential exposure to air pollution and lung function, with specific focus on small airways obstruction. We assessed 2995 French participants (aged between 40 and 65) in the ELISABET cross-sectional survey. Residential exposures to nitrogen dioxide (NO 2), particulate matter with a diameter <10 μm (PM 10) and sulphur dioxide (SO 2) were assessed. The spirometric parameters were forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and forced expiratory flow between 25% and 75% of FVC (FEF25-75) and at 75% of FVC (FEF75). Coefficients in linear regression models were expressed as the z-score [95% confidence interval] for an increment of 5 μg/m3 in NO 2 and 2 μg/m3 in PM 10 and SO 2. NO 2 was associated with significantly lower values of FEV1 (−0.10 [-0.15;-0.05]), FVC (−0.06 [-0.11;-0.02]), FEV1/FVC (−0.07 [-0.11;-0.03]), FEF25-75 (−0.09 [-0.14;-0.05]) and FEF75 (−0.08 [-0.12;-0.04]). PM 10 was associated with significantly lower values of FEV1 (−0.10 [-0.15;-0.04]), FVC (−0.06 [-0.11;-0.01]), FEV1/FVC (−0.06 [‒0.11;-0.01]), FEF25-75 (−0.08 [-0.13;-0.03]) and FEF75 (−0.08 [-0.12;-0.04]). SO 2 was associated with significantly lower values of FEV1 (−0.09 [-0.16;-0.02]), FEV1/FVC (−0.07 [-0.13;-0.01]), FEF25-75 (−0.09 [-0.15;-0.02]) and FEF75 (−0.08 [-0.14;-0.03]) but not FVC (−0.05 [-0.11; 0.009]). Even though spatial variations in pollutant levels were low, residential exposure to outdoor air pollution was associated with lower lung function, including lower FEF25-75 and FEF75 suggesting small airway obstruction. • We study two cities where pollution levels are below the European Union's limits. • Residential exposure to air pollution was associated to lower lung function. • Data on the possible association with small airway function are still scarce. • Outdoor air pollution was associated with an impairment in small airway function. [ABSTRACT FROM AUTHOR]

Graphical abstract Highlights • Spatial heterogeneity of environmental justice can be mapped at neighborhood scale. • Socio-economic, demographic and environmental determinants could be cumulated. • A matrix combined with radar charts provides a clear picture of these determinants. • A same level of vulnerability can be related to different profiles of determinants. • Composite index emphasises on the biological susceptibility to air pollution. Abstract Differential and not fair exposure to environmental risk factors across socio-demographic groups, called environmental justice (EJ), may contribute to inequalities in health and most often put disadvantaged groups at higher risk for environmental health effects. Main literature has difficulties to consider the potential exposure of populations to different levels of air pollutants. Cumulative and long-term exposures are still seldom considered. We propose a comprehensive EJ methodology to prioritize and characterize neighborhoods which takes into account the cumulative impact of health determinants. For this purpose, the use of environmental biomonitoring is an innovative approach to consider the integrated and long-term exposure to complex air pollution. Cumulative Impact Screening (CIS) methodology was used for two contrasted living areas of France. CIS is based on synthetic and composite index construction. Three scores were attributed to each neighborhood according to a cumulative calculation of key parameters: environmental score (using 3 air biomonitoring parameters: trace elements loads in lichens, lichenic biodiversity and dust deposition on poplar leaves), socioeconomic deprivation score and susceptible population score. Each score can be considered as a dimension of health vulnerability. CIS analysis and maps highlighted the unequal spatial distribution of EJ. After the multi-criteria hierarchization of spatial units, the influence of each dimension was characterized in each neighborhood with radar charts. The study was carried out in two living areas in the north of France: a costal industrial zone, the Dunkerque Urban Community and a densely populated area located at the crossroads of Europe, the European Lille Metropolis. Three neighborhoods of the highest vulnerability level were identified in each area. We highlighted a same level of vulnerability can be related to different profiles of determinants. This multidimensional approach was able to discriminate neighborhoods with a gradient level of vulnerability in each area, despite different environmental, demographic and economic contexts. This cross-use constitutes a preliminary validation in order to assess the replicability of the methodology. This step showed that this approach could be replicated in countries or regions which would have different characteristics: it is both specific to a given context and well suited for different contexts. We demonstrated that environmental biomonitoring is a smart approach to fill the lack of available data on multiple air pollution at the local scale. The tool developed is specific to the territory and transposable and communicant, which facilitate adoption by a variety of community agency and other regulatory stakeholders, and prioritization of public health actions. [ABSTRACT FROM AUTHOR]

Abstract Introduction A growing body of evidence suggests that long-term exposure to air pollutants like nitrogen oxides (NO x) and particulate matter (PM) is associated with the prevalence and incidence of type 2 diabetes mellitus. Serum glucose and glycosylated hemoglobin (HbA1c) levels are biomarkers of glucose homeostasis. Data on the association between glucose homeostasis biomarkers and air pollution are scarce. HbA1c and fasting blood glucose (FBG) concentrations have been linked to PM and NO 2 exposure in Taiwan, where mean pollution levels are 3 to 7 times higher than the guideline maximum annual mean values of 40 μg/m3 (for NO 2) and 20 μg/m3 (for PM10) set by the World Health Organization (WHO). However, this association is not consistently reported at lower levels of pollution. The objective of the present study was to investigate the relationships between long-term exposure to air pollution at the place of residence, diabetes biomarkers, and prevalent diabetes in two cities with relatively low level of pollution. Methods Data were recorded for 2895 adults (aged 40 to 65) having participated in the 2011–2013 ELISABET cross-sectional survey of the Lille and Dunkirk urban areas in northern France. Using multiple logistic and generalized linear regression models, we analyzed the associations between individual exposure to pollution on one hand and HbA1c, FBG and prevalent diabetes mellitus (DM) on the other. An atmospheric dispersion modelling system was used to assess annual exposure at the place of residence to coarse particulate matter (PM10), NO 2 , and sulfur dioxide (SO 2). Results The median pollutant levels were 21.96 μg/m3 for NO 2 , 26.75 μg/m3 for PM10, and 3.07 μg/m3 for SO 2. A 2 μg/m3 increment in PM10 was associated with an HbA1c increment [95% confidence interval] of 0.044% [0.021; 0.067]. This association was still statistically significant after adjustment for the neighborhood's characteristics. A 5 μg/m3 increment in NO 2 was associated with an HbA1c increment of 0.031% [0.010; 0.053]. Associations between DM or FBG and air pollution did not achieve statistical significance. Conclusion Our study of a middle-aged, urban population evidenced an association between elevated HbA1c levels and long-term exposure to PM10 and NO 2 pollution levels that were relatively low but close to the WHO's guideline maximum values. Highlights • There is debate as to whether air pollution is a risk factor for diabetes mellitus. • Few studies have focused on diabetes biomarkers. • Annual exposure to PM10 and NO 2 at the place of residence was associated with HbA1c. • Associations were observed for relatively low levels of exposure. • Effect sizes were consistent with those observed in areas with more contrasting pollutant levels. [ABSTRACT FROM AUTHOR]

Background: Work-related stress and burnout syndromes are unfortunately common comorbidities found in health professionals. However, burnout syndrome has only been partly and episodically assessed for community pharmacists whereas these professionals are exposed to patients’ demands and difficulties every day. Prevalence of burnout, associated comorbidities and coping strategies were assessed in pharmacy teams (pharmacists and pharmacy technicians) in French community pharmacies. Methods: This online survey was performed by emails sent to all French community pharmacies over 3 months. The survey assessed the prevalence of burnout (Maslach Burnout Inventory—MBI—questionnaire), anxiety, depression and strategies for coping with work-related stress. Results: Of the 1,339 questionnaires received, 1,322 were completed and useable for the analysis. Burnout syndrome was detected in 56.2% of respondents and 10.5% of them presented severe burnout syndrome. Severe burnout syndrome was significantly associated with men, large urban areas and the number of hours worked. Depression and anxiety were found in 15.7% and 42.4% of respondents, respectively. These co-morbidities were significantly associated with severe burnout syndrome. Higher MBI scores were significantly associated with medical consultations and medicinal drug use. Conversely, respondents suffering from burnout syndrome declared they resorted less to non-medical strategies to manage their work-related stress (leisure, psychotherapy, holidays and time off). Conclusion: This study demonstrated that community pharmacists and pharmacy technicians presented high prevalence of burnout syndrome, such as many healthcare professionals. Unfortunately, burnout syndrome was associated with several comorbidities (anxiety, depression and alcohol abuse) and the consumption of health resources. The psychological suffering of these healthcare professionals underlines the necessity to deploy a strategy to detect and manage burnout in community pharmacy. [ABSTRACT FROM AUTHOR]

Environmental inequalities are based on the proximity of socio-economically disadvantaged populations to sources of environmental and public health risks, and have recently been extended to environmental contamination. We evaluated such inequalities using a novel approach, at the scale of neighbourhoods in the industrial area of Dunkerque, France, by associating an index of social disadvantage with environmental biomonitoring measurements. A Localised Disadvantage Index (LDI), which characterises the socio-economic status of populations at a neighbourhood level, was developed using an eco-sociological approach. The burdens of 18 trace elements (TE) were recently determined using samples of epiphytic lichens, collected within the study zone. A mean value of TE burden was modelled for each neighbourhood and an integrated index (Mean Impregnation Ratio, MIR) was generated to assess the level of multi-metallic contamination. LDI mapping reveals socio-economic disparities. The neighbourhoods situated near to factories are the most disadvantaged. Environmental maps reveal high contaminations in the vicinity of the industrial zones. The LDI is significantly correlated with the MIR, and with 16 of 18 TE. Significant differences in the level of contamination are observed between high- and low-deprived neighbourhoods. Our results uncover the presence of environmental inequalities. The most disadvantaged populations live in a strongly contaminated environment. We have pioneered the use of biomonitoring data and an integrated index of contamination for the prospection of environmental inequalities. [ABSTRACT FROM AUTHOR]

Background: Strong geographic variations in the incidence of end-stage renal disease (ESRD) are observed in developed countries. The reasons for these variations are unknown. They may reflect regional inequalities in the population's sociodemographic characteristics, related diseases, or medical practice patterns. In France, at the district level, the highest incidence rates have been found in the Nord-Pas-de-Calais region. This area, with a high population density and homogeneous healthcare provision, represents a geographic situation which is quite suitable for the study, over small areas, of spatial disparities in the incidence of ESRD, together with their correlation with a deprivation index and other risk factors. Methods: The Renal Epidemiology and Information Network is a national registry, which lists all ESRD patients in France. All cases included in the Nord-Pas-de-Calais registry between 2005 and 2011 were extracted. Adjusted and smoothed standardized incidence ratio (SIR) was calculated for each of the 170 cantons, thanks to a hierarchical Bayesian model. The correlation between ESRD incidence and deprivation was assessed using the quintiles of Townsend index. Relative risk (RR) and credible intervals (CI) were estimated for each quintile. Results: Significant spatial disparities in ESRD incidence were found within the Nord-Pas-de-Calais region. The sex- and age-adjusted, smoothed SIRs varied from 0.66 to 1.64. Although no correlation is found with diabetic or vascular nephropathy, the smoothed SIRs are correlated with the Townsend index (RR: 1.18, 95% CI [1.00–1.34] for Q2; 1.28, 95% CI [1.11–1.47] for Q3; 1.30, 95% CI [1.14–1.51] for Q4; 1.44, 95% CI [1.32–1.74] for Q5). Conclusion: For the first time at this aggregation level in France, this study reveals significant geographic differences in ESRD incidence. Unlike the time of renal replacement care, deprivation is certainly a determinant in this phenomenon. This association is probably independent of the patients' financial ability to gain access to healthcare. [ABSTRACT FROM AUTHOR]

In environmental health, vulnerability reflecting the cumulative harmful constraints and nuisances to which populations are subjected and resilience defined as the capacity of a territory to cope with health inequalities have been little extensively investigated together with the same importance. Besides the diversity of factors involved, there is no consensual framework to develop composite indices, one recognized methodology to deal with a multifaceted issue. Therefore, this research aims to establish a new transferable approach to assess the spatial heterogeneity of territorial inequalities. This new strategy relies on the simultaneous evaluation of resilience and vulnerability and the joint analysis based on the cross-interpretation of the spatialized composite indices of resilience and vulnerability. A case study was conducted to demonstrate the feasibility of this methodology, using the municipality as a spatial unit of analysis within a region in the north of France. To provide the most holistic description possible of the 3817 studied municipalities, 50 variables related to the economic, environment, policy, health, services and social dimensions were used to develop the composite indices. The vulnerability Index has a median value of 0.151 with an IQR of [0.126–0.180] and the Resilience Index has a median value of 0.341 with an IQR of [0.273–0.401]. The joint analysis was conducted to classify each municipality among four defined typologies: 1687 municipalities (44.2%) belong to the "To monitor" category, 1646 (43.1%) to the "Resilient" category, 329 (8.6%) to the "Have resources" category and 155 (4.1%) to the "Territorial blackspot" category. The methodology herein may be a diagnostic tool to identify and prioritize municipalities that could benefit from the implementation of specifically tailored public health policies. Unlabelled Image • Transdisciplinary research is mandatory for assessing environmental health issues. • Data reuse overcomes the difficulties of data accessibility. • Proposed use of composite indices to assess the accumulation of health determinants • Spatial heterogeneity of resilience and vulnerability can be mapped at local scale. • Joint analysis enables stakeholders to prioritize future public health actions. [ABSTRACT FROM AUTHOR]

• Composite indices contain many variables and selection methods for specific needs. • The absence of a common framework leads to strong subjectivity. • It is possible to harmonize dimension characterization practices. • A framework is provided for selection of relevant variables for composite indices. • An increase in methodological transparency will improve interterritorial comparison. The wide range of factors involved in environmental health and the complexity of interactions between all environmental determinants require the validation of multidimensional approaches. While the development of composite indices is receiving growing attention by scientists and public authorities, the concept continues to lack transposability and robustness partly due to varying conceptualizations and/or methodologies. This review aims to promote harmonizing practices governing the first step of development of composite index, namely identification and characterization of the dimensions and variables that are included in environmental health indices. A review of available literature (more than 1500 studies) was conducted to identify the composite indices developed to assess territorial determinants from an environmental health perspective. This process made it possible to identify 23 spatialized composite indices and to assess a total of 329 variables. This diversity highlights that the absence of a common framework can lead to a strong subjectivity and limit comparisons between different environmental health indices. The specificity and the availability of certain variables would limit the transposability of indices. In light of current knowledge, this review proposes a consolidated methodological framework based on a categorization of variables into dimensions and sub-dimensions related to heath, environment, social, economics, services and policy. To characterize the sub-dimensions, several variables are possible and can be chosen according to the availability and/or accessibility of the data. The adaptation of a composite index to a specific territory or to a specific issue would then be effective through the included variables. This also aims to be transposable to any spatial unit (country, region, census tract). This work is a first step towards a proposal of guidelines designed to provide a consensual framework that could facilitate the exploitation of environmental health indices. This transparency could also increase the understanding and adoption of these tools by public authorities and general public. [ABSTRACT FROM AUTHOR]