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Johann Kuhn,1 Valérie Olié,2 Clémence Grave,2 Yann Le Strat,1 Christophe Bonaldi,1 Pierre Joly1,3 1Data Science Division, French National Public Health Agency, Saint-Maurice, France; 2Department of Chronic Diseases and Injuries, French National Public Health Agency, Saint-Maurice, France; 3Centre Inserm U1219 – Bordeaux Population Health, Université de Bordeaux – ISPED, Bordeaux, FranceCorrespondence: Johann Kuhn, Email johann.kuhn77@gmail.comAim: Myocardial infarction (MI) is a cardiovascular disease caused by necrosis of the myocardium, which places a heavy burden on patients. In France, the proportion of daily smokers remains high, reaching at 25.5% in 2020. We evaluated the impact of smoking reduction scenarios on the projection of MI prevalence, mean age of incident cases and number of MI prevented cases until 2035.Methods and Results: The French government has introduced smoking cessation policies that have led to an annual decrease in smoking prevalence. Based on this annual decline, we implemented three scenarios (SC) simulating an annual decrease in the proportion of smokers aged over 35 (SC1: 1%, ie, natural evolution without intervention, SC2: 2%, SC3: 9.87%) and a fourth scenario (SC4) in which there is a complete discontinuation of smoking from 2024 onwards using MI hospitalization and demographic data, estimations for the proportion of daily smokers between 35 and 95 years and multi-state models. Between 2023 and 2035, MI prevalence increased from 3.18% to 4.23% in males and from 1.00% to 1.46% in females under SC1. MI prevalence was equal to 4.21%, 4.06%, and 3.82% in males and 1.45%, 1.40%, and 1.34% in females in 2035 according to SC2, SC3, and SC4, respectively. Compared with SC1, 0.68% MI cases would be prevented with SC2, 4.52% with SC3 and 10.34% with SC4, with almost half of cases being prevented before 65 years of age. The increase in the mean age of MI incident cases ranged from 3 to 4 years among males and from 1 to 2 years among females.Conclusion: While reducing tobacco use could substantially reduce the number of MI cases prevented, its prevalence would continue to increase due to the ageing population. An integrated prevention strategy that includes the leading cardiovascular risk factors should more efficiently reduce the future burden of MI.Keywords: myocardial infarction, prevalence, burden, projection, tobacco control, smoking prevalence

Background Assessing the risk of subsequent self-harm after hospitalisation for COVID-19 is critical for mental health care planning during and after the pandemic. Aims This study aims to compare the risk of admission to hospital for self-harm within 12 months following a COVID-19 hospitalisation during the first half of 2020, with the risk following hospitalisations for other reasons. Method Using the French administrative healthcare database, logistic regression models were employed to analyse data from patients admitted to hospitals in metropolitan France between January and June 2020. The analysis included adjustments for sociodemographic factors, psychiatric history and the level of care received during the initial hospital stay. Results Of the 96 313 patients hospitalised for COVID-19, 336 (0.35%) were subsequently admitted for self-harm within 12 months, compared to 20 135 (0.72%) of 2 797 775 patients admitted for other reasons. This difference remained significant after adjusting for sociodemographic factors (adjusted odds ratio (aOR) = 0.66, 95% CI: 0.59–0.73), psychiatric disorder history (aOR = 0.65, 95% CI: 0.58–0.73) and the level of care received during the initial hospital stay (aOR = 0.70, 95% CI: 0.63–0.78). History of psychiatric disorders and intensive care were strongly correlated with increased risk, while older age was inversely associated with self-harm admissions. Conclusions Hospitalisation for COVID-19 during the early pandemic was linked to a lower risk of subsequent self-harm than hospitalisation for other reasons. Clinicians should consider psychiatric history and intensive care factors in evaluating the risk of future suicide.

Shiga toxin–producing Escherichia coli–associated pediatric hemolytic uremic syndrome (STEC-HUS) remains an important public health risk in France. Cases are primarily sporadic, and geographic heterogeneity has been observed in crude incidence rates. We conducted a retrospective study of 1,255 sporadic pediatric STEC-HUS cases reported during 2012–2021 to describe spatiotemporal dynamics and geographic patterns of higher STEC-HUS risk. Annual case notifications ranged from 109 to 163. Most cases (n = 780 [62%]) were in children 5 annual space-time clusters. The results of this study have numerous implications for outbreak detection and investigation and research perspectives to improve knowledge of environmental risk factors associated with geographic disparities in STEC-HUS in France.

Macroalgae (seaweeds) are key primary producers in marine coastal habitats and largely contribute to global ocean carbon fluxes. They also represent attractive renewable feedstock for the production of biofuels, food, feed, and bioactive. Brown algae are seaweeds that produce alginates and fucose containing sulfated polysaccharides in their cell wall and laminarin and mannitol for carbon storage. The availability of genomes of the kelp Saccharina japonica and of the filamentous Ectocarpus sp. paved the way for the biochemical characterization of recombinant enzymes involved in their polysaccharide and carbohydrates synthesis, including, notably, mannitol. Brown algal mannitol biosynthesis starts with the conversion of fructose-6-phospate into mannitol-1-phosphate (mannitol-1P), and this intermediate is hydrolysed by a haloacid dehalogenase phosphatase (M1Pase) to produce mannitol. We report here the biochemical characterization of a second M1Pase in Ectocarpus sp. (EsM1Pase1). Both Ectocarpus M1Pases were redox-sensitive enzymes, with EsM1Pase1 active only in presence of the reducing agent. Such catalytic properties have not been observed for any M1Pases yet. EsM1Pases were specific to mannitol-1-P, in contrast to S. japonica M1Pases that could act on other phosphorylated sugars. Finally, brown algal M1Pases formed two well-supported clades, with possible distinct subcellular localization and physiological role(s) under diverse environmental conditions and/or life cycle stages.

Abstract Background Consultation data from emergency general practitioners known as SOS Médecins and emergency departments (ED) from OSCOUR® network to the French syndromic surveillance system SurSaUD® (Surveillance sanitaire des urgences et décès). These data are aggregated and monitored on a daily basis through groupings of one or more medical symptoms or diagnoses (“syndromic groups” (SG)). The objective of this study was to evaluate, revise and enrich the composition of SGs through a consensus of experts who contributed or have experience in syndromic surveillance. Methods Three rounds of a Delphi survey were organised, involving 15 volunteers from SOS Médecins and 64 ED physicians in the OSCOUR® network as well as 8 international epidemiologists. Thirty-four SOS Médecins and 40 OSCOUR® SGs covering major medical specialities were put to the experts, along with their diagnostic codes and their surveillance objectives. In each round, the experts could retain or reject the codes according to the surveillance objective. The panel could also put forward new diagnostic codes in the 1st round, included in subsequent rounds. Consensus was reached for a code if 80% of participants had chosen to keep it, or less than 20% to reject it. Results A total of 12 SOS Médecins doctors (80%), 30 ED doctors (47%) and 4 international experts (50%) participated in the three rounds. All of the SGs presented to the panel included 102 initial diagnostic codes and 73 additional codes for SOS Médecins, 272 initial diagnostic codes and 204 additional codes for OSCOUR®. At the end of the 3 rounds, 14 SOS Médecins (40%) and 11 OSCOUR® (28%) SGs achieved a consensus to maintain all of their diagnostic codes. Among these, indicators of winter seasonal surveillance (bronchiolitis and gastroenteritis) were included. Conclusion This study involved a panel of national experts with international representation and a good level of involvement throughout the survey. In the absence of a standard definition, the Delphi method has been shown to be useful in defining and validating syndromic surveillance indicators.

Predicting ship resistance with high accuracy is essential to reduce fuel consumption. Of the two currently available methods, extrapolation from models-scale using towing tank results shows high levels of uncertainty, and while computational fluid dynamics is a promising option to reduce this uncertainty, recent full-scale simulations show persistently high errors. Another way to reduce the uncertainty is to understand the scale effects and devise strategies to account of them. In this paper, we explore the scale effects on ship trim and sinkage through numerical simulations using viscous and linear scaling with three different turbulence models. We demonstrate that the scale effect on sinkage can be neglected. However, between Re = 106 and Re = 108, depending on the turbulence model, scale effects on the trim moment range from 15% to 27%, and differences in pressure coefficient on the hull can be observed between the different Reynolds numbers, especially around the aft of the ship of between 23.6% and 32.5%. [ABSTRACT FROM AUTHOR]

Abstract Background Evidence-based policy-making to reduce perinatal health inequalities requires an accurate measure of social disparities. We aimed to evaluate the relevance of two municipality-level deprivation indices (DIs), the French-Deprivation-Index (FDep) and the French-European-Deprivation-Index (FEDI) in perinatal health through two key perinatal outcomes: preterm birth (PTB) and small-for-gestational-age (SGA). Methods We used two data sources: The French National Perinatal Surveys (NPS) and the French national health data system (SNDS). Using the former, we compared the gradients of the associations between individual socioeconomic characteristics (educational level and income) and “PTB and SGA” and associations between municipality-level DIs (Q1:least deprived; Q5:most deprived) and “PTB and SGA”. Using the SNDS, we then studied the association between each component of the two DIs (census data, 2015) and “PTB and SGA”. Adjusted odds ratios (aOR) were estimated using multilevel logistic regression with random intercept at the municipality level. Results In the NPS (N = 26,238), PTB and SGA were associated with two individual socioeconomic characteristics: maternal educational level (≤ lower secondary school vs. ≥ Bachelor’s degree or equivalent, PTB: aOR = 1.43 [1.22–1.68], SGA: (1.31 [1.61–1.49]) and household income ( 1 person per room) houses (1.63 [1.15–2.32]) with PTB only, and unskilled farm workers with SGA only (1.52 [1.29–1.79]). Conclusion Some components of FDep and FEDI were less relevant than others for capturing ecological inequalities in PTB and SGA. Results varied for each DI and perinatal outcome studied. These findings highlight the importance of testing DI relevance prior to examining perinatal health inequalities, and suggest the need to develop DIs that are suitable for pregnant women.

Johann Kuhn,1 Valérie Olié,2 Clémence Grave,2 Yann Le Strat,1 Christophe Bonaldi,1 Pierre Joly3 1Department of Support, Data Processing and Analysis, French National Public Health Agency, Saint-Maurice, France; 2Department of Chronic Diseases and Injuries, French National Public Health Agency, Saint-Maurice, France; 3Centre Inserm U1219 – Bordeaux Population Health, Université de Bordeaux - ISPED, Bordeaux, FranceCorrespondence: Johann Kuhn, Department of Support, Data Processing and Analysis, French National Public Health Agency, 12 rue du Val d’Osne, Saint-Maurice, 94410, France, Tel/Fax +33 1 71 80 15 44, Email johann.kuhn@santepubliquefrance.frPurpose: In France, myocardial infarction (MI) was the second leading cause of years of life lost in 2019. Estimating the burden of MI in future years could help policymakers and other actors anticipate care and prevention needs and guide them in public health decision-making.Materials and Methods: Using data from the French hospital discharge database from 2007 to 2015 (n = 519,400), demographic data, and an illness-death model, we projected incidence, prevalence, number of prevalent cases and mean age of incident MI cases in France. The methodology took into account the age-cohort effect on MI incidence, mortality of healthy and diseased subjects, and the time since disease onset.Results: Projections highlighted an increase in MI prevalence in men between 2015 and 2035 from 2.52% (95% uncertainty interval (UI): [2.48– 2.56]) in 2015 to 4.02% ([3.92– 4.12]) in 2035, and from 0.85% ([0.83– 0.87]) to 1.44% ([1.38– 1.50]) in women. This corresponds to an increase of 365,000 cases between 2015 and 2035 (+81.1%) for men and 146,000 cases for women (+88.0%). The difference in the mean age of incident cases between men and women decreased from 9.52 in 2015 to 5.49 years in 2035.Conclusion: Our projections forecast an increase in MI prevalence between 2015 and 2035 in men and women, especially in relatively younger women. Using statistical models such as ours can help assess the impact of prevention campaigns for the main cardiovascular disease risk factors on the future MI prevalence.Keywords: myocardial infarction, projection, burden, prevalence, incidence, age-period-cohort model

R-phycoerythrin (R-PE) can be enzymatically extracted from red seaweeds such as Palmaria palmata. This pigment has numerous applications and is notably known as an antioxidant, antitumoral or anti-inflammatory agent. Enzymes secreted by P. palmata associated fungal strains were assumed to be efficient and adapted for R-PE extraction from this macroalga. The aim of the present study was to quantify both xylanolytic and cellulolytic activities of enzymatic extracts obtained from six Palmaria palmata derived fungal strains. Degradation of P. palmata biomass by fungal enzymatic extracts was also investigated, focused on soluble protein and R-PE extraction. Enzymatic extracts were obtained by solid state fermentation. Macroalgal degradation abilities were evaluated by measuring reducing sugar release using DNS assays. Soluble proteins and R-PE recovery yields were evaluated through bicinchoninic acid and spectrophotometric assays, respectively. Various enzymatic activities were obtained according to fungal isolates up to 978 U/mL for xylanase and 50 U/mL for cellulase. Enzymatic extract allowed high degrading abilities, with four of the six fungal strains assessed exhibiting at least equal results as the commercial enzymes for the reducing sugar release. Similarly, all six strains allowed the same soluble protein extraction yield and four of them led to an improvement of R-PE extraction. R-PE extraction from P. palamata using marine fungal enzymes appeared particularly promising. To the best of our knowledge, this study is the first on the use of enzymes of P. palmata associated fungi in the degradation of its own biomass for biomolecules recovery.

Summary: Background: A rapid increase in incidence of the SARS-CoV-2 Omicron variant (sub-lineage BA.1) occurred in France in December 2021, while the Delta variant was prevailing since July 2021. We aimed to determine whether the risk of a severe hospital event following symptomatic SARS-CoV-2 infection differs for Omicron versus Delta. Methods: We conducted a retrospective cohort study to compare severe hospital events (admission to intensive care unit or death) between Omicron and Delta symptomatic cases matched according to week of virological diagnosis and age. The analysis was adjusted for age, sex, vaccination status, presence of comorbidities and region of residence, using Cox proportional hazards model. Findings: Between 06/12/2021–28/01/2022, 184 364 cases were included, of which 931 had a severe hospital event (822 Delta, 109 Omicron). The risk of severe event was lower among Omicron versus Delta cases; the difference in severity between the two variants decreased with age (adjusted Hazard Ratio (aHR)=0·13 95%CI: 0·08–0·20 among 40–64 years, aHR=0·50 95%CI: 0·26–0.98 among 80+ years). The risk of severe event increased with the presence of comorbidities (for very-high-risk comorbidity, aHR=4·15 95%CI: 2·86–6·01 among 40–64 years) and in males (aHR=2·28 95%CI: 1·82–2·85among 40–64 years) and was higher in unvaccinated compared to primo-vaccinated (aHR=7·29 95%CI: 5·58–9·54 among 40–64 years). A booster dose reduced the risk of severe hospital event in 80+ years infected with Omicron (aHR=0·29; 95%CI: 0·12–0·69). Interpretation: This study confirms the lower severity of Omicron compared to Delta. However, the difference in disease severity is less marked in the elderly. Further studies are needed to better understand the interactions between age and severity of variants. Funding: The study was performed as part of routine work at Public Health France.

Abstract Background A public health student service was set up by the French government in 2018 with the aim of increasing awareness of primary health promotion among the 47,000 students of medicine and other health professions. It is an annual program involving community-based actions on nutrition, physical activity, addiction or sexuality. Our objective was to evaluate its implementation at local level and the different experiences of the stakeholders. Methods A quasi-experimental study using process evaluation was performed in a Faculty of Medicine in Paris. Quantitative and qualitative data were collected from medical students who carried out preventive health actions, in the institutions in which the actions took place and from a subsample of beneficiaries. Results One hundred and eight actions were carried out by 341 students in 23 educational or social institutions, mostly high schools (n = 12, 52%). Two thirds of the students did not feel sufficiently prepared to deliver preventive health interventions (65.7%, 224/341); however the beneficiaries found that the interventions were good (278/280, 99,2%). Nineteen (83%) of the host institutions agreed to welcome health service students again, of which 9 required some modifications. For students, the reporting of a satisfactory health service experience was associated with the reporting of skills or knowledge acquisition (p

Abstract Introduction Although COVID-19 has been associated with psychiatric symptoms in patients, no study to date has examined the risk of hospitalization for psychiatric disorders after hospitalization for this disease. Objective We aimed to compare the proportions of hospitalizations for psychiatric disorders in the 12 months following either hospitalization for COVID-19 or hospitalization for another reason in the adult general population in France during the first wave of the current pandemic. Methods We conducted a retrospective longitudinal nationwide study based on the national French administrative healthcare database. Results Among the 2,894,088 adults hospitalized, 96,313 (3.32%) were admitted for COVID-19. The proportion of patients subsequently hospitalized for a psychiatric disorder was higher for COVID-19 patients (11.09 vs. 9.24%, OR = 1.20 95%CI 1.18–1.23). Multivariable analyses provided similar results for a psychiatric disorder of any type and for psychotic and anxiety disorders (respectively, aOR = 1.06 95%CI 1.04–1.09, aOR = 1.09 95%CI 1.02–1.17, and aOR = 1.11 95%CI 1.08–1.14). Initial hospitalization for COVID-19 in intensive care units and psychiatric history were associated with a greater risk of subsequent hospitalization for any psychiatric disorder than initial hospitalization for another reason. Discussion Compared with hospitalizations for other reasons, hospitalizations for COVID-19 during the first wave of the pandemic in France were associated with a higher risk of hospitalization for a psychiatric disorder during the 12 months following initial discharge. This finding should encourage clinicians to increase the monitoring and assessment of psychiatric symptoms after hospital discharge for COVID-19, and to propose post-hospital care, especially for those treated in intensive care.

Objectives We aimed to assess the level of prior SARS-CoV-2 infection in socially deprived neighbourhoods after the first wave of the pandemic, and to identify factors associated with seropositivity.Design A cross-sectional study.Setting Three socially deprived neighbourhoods of the city of Perpignan, in the south of France, where large settled Roma communities live.Participants People aged 6 years old or over, living in the study area. 700 people were included in the study using two-stage stratified sampling design.Interventions The study included a questionnaire and SARS-CoV-2 antibody testing by the Roche Elecsys immunoassay between 29 June and 17 July 2020.Primary and secondary outcome measures SARS-CoV-2 antibody seroprevalence was estimated from weighted data. Associated factors and reported symptoms were investigated using univariable and multivariable logistic regressions.Results The seroprevalence of anti-SARS-CoV-2 antibodies was 35.4% (95% CI 30.2% to 41.0%). People aged 15–64 years old had increased odds of being seropositive than those aged 65 years or over. Obese people had higher odds of being seropositive (adjusted OR (aOR)=2.0, 95% CI 1.1 to 3.8). The odds of being seropositive were higher in households with clinical COVID-19 cases (one case: aOR=2.5, 95% CI 1.3 to 5.0; several cases: aOR=6.9, 95% CI 3.1 to 15.2). In the neighbourhood with the highest measured seroprevalence, people living in a dwelling with one to two rooms had higher odds of being seropositive than those living in a four-room house (aOR=2.8, 95% CI 1.2 to 6.3). Working during the lockdown was associated with lower odds of being seropositive (aOR=0.2, 95% CI 0.03 to 1.0).Conclusion Transmission of SARS-COV-2 in this vulnerable population was very high during the COVID-19 pandemic’s first wave. Our results highlight the need to strengthen and adapt preventive measures taking into account all social determinants of health, especially housing conditions.