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Background Human African trypanosomiasis (HAT) is a neglected tropical disease caused by Trypanosoma brucei gambiense transmitted by tsetse flies in sub-Saharan West Africa. In southern Chad the most active and persistent focus is the Mandoul focus, with 98% of the reported human cases, and where African animal trypanosomosis (AAT) is also present. Recently, a control project to eliminate tsetse flies (Glossina fuscipes fuscipes) in this focus using the sterile insect technique (SIT) was initiated. However, the release of large numbers of sterile males of G. f. fuscipes might result in a potential temporary increase in transmission of trypanosomes since male tsetse flies are also able to transmit the parasite. The objective of this work was therefore to experimentally assess the vector competence of sterile males treated with isometamidium for Trypanosoma brucei brucei. Methods An experimental infection was set up in the laboratory, mimicking field conditions: the same tsetse species that is present in Mandoul was used. A T. b. brucei strain close to T. b. gambiense was used, and the ability of the sterile male tsetse flies fed on blood with and without a trypanocide to acquire and transmit trypanosomes was measured. Results Only 2% of the experimentally infected flies developed an immature infection (midgut) while none of the flies developed a metacyclic infection of T. b. brucei in the salivary glands. We did not observe any effect of the trypanocide used (isometamidium chloride at 100 mg/l) on the development of infection in the flies. Conclusions Our results indicate that sterile males of the tested strain of G. f. fuscipes were unable to cyclically transmit T. b. brucei and might even be refractory to the infection. The data of the research indicate that the risk of cyclical transmission of T. brucei by sterile male G. f. fuscipes of the strain colonized at IAEA for almost 40 years appears to be small. Graphical Abstract

International audience; Despite an increasing acknowledgement of fathers’ involvement in and impact on children’s lives, fathers remain underrepresented in child feeding and childhood obesity prevention research, interventions, and actions. Built on our own experiences with conducting research with fathers and recent evidence on this topic, this Research in Practice article has three aims. It will first substantiate the importance of including and studying fathers in the field of child feeding and childhood obesity prevention based on recent study results. Secondly, the article will present and discuss barriers to fathers' inclusion and participation (why isn't it happening?), among other issues, by drawing on sociological and gender ideological insights. Finally, it will provide recommendations and suggestions related to recruitment, focus and methods that can facilitate fathers’ involvement in future research, interventions, and practice. Taken together, this article aims to provide tools for giving fathers a voice in the field of child nutrition and by doing so, to decrease maternal-only “burden” of care. We hope our experiences and theoretical reflections will inspire and support researchers and practitioners to be as successful as possible in the realm of family care.

Objectives Around 30% of patients with RA have an inadequate response to MTX. We aimed to use routine clinical and biological data to build machine learning models predicting EULAR inadequate response to MTX and to identify simple predictive biomarkers. Methods Models were trained on RA patients fulfilling the 2010 ACR/EULAR criteria from the ESPOIR and Leiden EAC cohorts to predict the EULAR response at 9 months (± 6 months). Several models were compared on the training set using the AUROC. The best model was evaluated on an external validation cohort (tREACH). The model's predictions were explained using Shapley values to extract a biomarker of inadequate response. Results We included 493 therapeutic sequences from ESPOIR, 239 from EAC and 138 from tREACH. The model selected DAS28, Lymphocytes, Creatininemia, Leucocytes, AST, ALT, swollen joint count and corticosteroid co-treatment as predictors. The model reached an AUROC of 0.72 [95% CI (0.63, 0.80)] on the external validation set, where 70% of patients were responders to MTX. Patients predicted as inadequate responders had only 38% [95% CI (20%, 58%)] chance to respond and using the algorithm to decide to initiate MTX would decrease inadequate-response rate from 30% to 23% [95% CI: (17%, 29%)]. A biomarker was identified in patients with moderate or high activity (DAS28 > 3.2): patients with a lymphocyte count superior to 2000 cells/mm3 are significantly less likely to respond. Conclusion Our study highlights the usefulness of machine learning in unveiling subgroups of inadequate responders to MTX to guide new therapeutic strategies. Further work is needed to validate this approach.

International audience; Objectives: To examine the association between high intakes of ultra-processed foods (UPF) and recurrence of depressive symptoms (DepS) in a Western non-Mediterranean country and its contribution to the overall diet-depression relationship.Methods: Analyses were carried out on British participants from the Whitehall II cohort. Present analyses were restricted to white participants N = 4554 (74% men, mean age = 61; SD = 5.9). UPF consumption was estimated from a 127-item food frequency questionnaire using the NOVA classification, and cumulative average of UPF intakes (g/day) over 11 years of exposure (1991/1994–2002/2004) was computed. Recurrent DepS after measurement of UPF was defined as having two or more episodes of DepS (the Center for Epidemiologic Studies Depression Scale (CES-D) score ≥ 16 or antidepressants use) during four phases of follow-up (2002/2004–2015/2016).Results: Over the follow-up, 588 (12.9%) cases of recurrent DepS were observed. After adjusting for socio-demographic factors, health behaviours and health status, participants in top quintile of UPF intakes [mean 33% of total daily intakes in grams] had 31% higher odds of recurrent DepS (odds ratio 1.31; 95% CI 1.04–1.64) compared to participants in the four lowest quintiles of UPF [mean 18.1% of total daily intakes in grams]. Additional analyses showed that associations between adherence to several diet quality measures and recurrent DepS were partially attenuated (17–27%) by UPF intakes.Conclusion: In this British population, high intakes of ultra-processed foods were associated with increased odds of recurrent depressive symptoms and contributed to the overall diet quality-depressive symptoms association.

International audience; Background and Objectives: Some medications require specific medical procedures in the weeks before their start. Such procedures may meet the definition of instrumental variables (IVs). We examined how they may influence treatment effect estimation in propensity score (PS)-adjusted comparative studies, and how to remedy. Study Design and Setting: Different covariate assessment periods (CAPs) did and did not include the month preceding treatment start were used to compute PS in the French claims database (Syt eme National des Donn ees de Sant e-SNDS), and 1:1 match patients with metastatic castration resistant prostate cancer initiating abiraterone acetate or docetaxel. The 36-month survival was assessed. Results: Among 1, 213 docetaxel and 2, 442 abiraterone initiators, the PS distribution resulting from the CAP [-12; 0 months] distinctly separated populations (c 5 0.93; 273 matched pairs). The CAPs [-12;-1 months] identified 765 pairs (c 5 0.81). Strong docetaxel treatment predictors during the month before treatment start were implantable delivery systems (1% vs. 59%), which fulfilled IV conditions. The 36-month survival was not meaningfully different under the [-12; 0 months] CAP but differed by 10% points (38% vs. 28%) after excluding month À1. Conclusion: In the setting of highly predictive pretreatment procedures, excluding the immediate pre-exposure time from the CAP will reduce the risk of including potential IVs in PS models and may reduce bias.

Introduction: A recent meta-analysis shows that women have an increased risk of stroke, but no review has been performed to evaluate differences in drug usage after stroke. The aim of this study was to describe the differences in drug usage after a stroke between men and women, through a systematic review. Material and methods: All observational studies on sex difference in poststroke drug usage published until 20 April 2021 were selected from PubMed and Scopus. Articles were selected and assessed by two independent readers; a third reader resolved disagreements. Data extraction was performed using a standardised reading form; articles quality was assessed using the STROBE guidelines. The study is registered on PROSPERO: CRD42021250256. Results: Of the 604 identified articles, 33 were included. Most of them were published before 2015, and presented methodological limitations. These differentially affected studies with significant and non-significant results, questioning the reliability of inconsistencies. The exploration of sex differences in drug use varied between therapeutic classes (25 articles focussed on thrombolytics, 23 on antithrombotics, 13 on antihypertensive drugs, 9 on lipid-lowering drugs). After stroke women were found less likely to be prescribed antithrombotics in 48% of the corresponding articles concerning this class, and lipid-lowering drugs in 56% of the related ones. The opposite appeared for antihypertensive drugs in 31% of the concerned studies. Discussion/Conclusion: Results inconsistency regarding sex-differences in post-stroke treatment might relate to methodological limitations in non-conclusive studies. Their heterogeneity, and the lack of recent data advocates for the conduct of newer and more comprehensive research in the field as few studies simultaneously considered all involved drug classes.

International audience; Introduction: With recent higher awareness of the necessity of improving healthcare workers' well-being, we aimed to overview systematic reviews dealing with interventions on well-being, occupa-tional health, and aging of healthcare workers. Methods: From three databases (PubMed, Embase, and Web of Science), a scoping review of systematic reviews was carried out to determine current knowledge on interventions focused on the well-being or aging of healthcare workers. Only systematic reviews were considered, with appropriate extraction and quality evaluation. Results: Of the total of 445 references identified, 10 systematic reviews were included, mostly published since 2019. Nurses were the most frequent targets of interventions, and mental health was the main outcome described. The overall level of quality was also heterogenous, with high to low-quality reviews. Conclusions: Workers' mental health well-being was the major outcome targeted by intervention, with varying level of evidence. Further studies are needed with integrative approaches on global health and life course perspectives, with a focus on the plurality of settings, worker types, and women. (c) 2022 THE AUTHORS. Published by Elsevier BV on behalf of Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency. This is an open access article under the CC BY -NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Purpose Upstream social marketers advocate implementing effective public policies to protect vulnerable populations from the impacts of advertising harmful products. This study aims to explore how alcohol ad content restrictions (as practised in some countries where ads may only convey factual information and objective properties of alcohol products) versus non-regulated advertising affect consumers’ product perceptions, attitude towards the ad and desire to drink. This study also examines how such restrictions influence the noticeability of text health warnings in ads (signalling alcohol-related risks) depending on their prominence. Design/methodology/approach A multi-method study was used to increase the validity of results. An online quantitative survey (n = 348) and an eye-tracking study (n = 184) were conducted on young French people (15–30). The eye-tracking method is particularly relevant for objectively measuring visual attention. Findings Results show that content restrictions on alcohol advertising reduce ad appeal and desire to drink. A more prominent format enhanced attentional processing of the text warning, whereas none of the tested ad contents influenced its noticeability. Practical implications This study assesses scientific evidence of the effect on alcohol ad content regulations adopted by some countries and provides arguments for upstream social marketers to inform and influence policymakers. Originality/value To the best of the authors’ knowledge, this is the first multi-method study that assesses the effect of regulated vs non-regulated alcohol ads in terms of persuasion and of text warning visibility.

In repaired tetralogy of Fallot (TOF), little is known about characteristics of patients with rapid ventricular tachycardia (VT). Also, whether patients with a first episode of nonrapid VT may subsequently develop rapid VT or ventricular fibrillation (VF) has not been addressed.The objectives of this study were to compare patients with rapid VT/VF with those with nonrapid VT and to assess the evolution of VT cycle lengths (VTCLs) overtime.Data were analyzed from a nationwide registry including all patients with TOF and implantable cardioverter-defibrillator (ICD) since 2000. Patients with ≥1 VT episode with VTCL ≤250 ms (240 beats/min) formed the rapid VT/VF group.Of 144 patients (mean age 42.0 ± 12.7 years; 104 [72%] men), 61 (42%) had at least 1 VT/VF episode, including 28 patients with rapid VT/VF (46%), during a median follow-up of 6.3 years (interquartile range 2.2-10.3 years). Compared with patients in the nonrapid VT group, those in the rapid VT/VF group were significantly younger at ICD implantation (35.2 ± 12.6 years vs 41.5 ± 11.2 years; P = .04), had more frequently a history of cardiac arrest (8 [29%] vs 2 [6%]; P = .02), less frequently a history of atrial arrhythmia (11 [42%] vs 22 [69%]; P = .004), and higher right ventricular ejection fraction (43.3% ± 10.3% vs 36.6% ± 11.2%; P = .04). The median VTCL of VT/VF episodes was 325 ms (interquartile range 235-429 ms). None of the patients with a first documented nonrapid VT episode had rapid VT/VF during follow-up.Patients with TOF and rapid VT/VF had distinct clinical characteristics. The relatively low variation of VTCL over time suggests a room for catheter ablation without a backup ICD in selected patients with well-tolerated VT.Clinicaltrials.gov identifier: NCT03837574.

Background: Recently, common genetic risk factors for intracranial aneurysm (IA) and aneurysmal subarachnoid hemorrhage (ASAH) were found to explain a large amount of disease heritability and therefore have potential to be used for genetic risk prediction. We constructed a genetic risk score to (1) predict ASAH incidence and IA presence (combined set of unruptured IA and ASAH) and (2) assess its association with patient characteristics. Methods: A genetic risk score incorporating genetic association data for IA and 17 traits related to IA (so-called metaGRS) was created using 1161 IA cases and 407 392 controls from the UK Biobank population study. The metaGRS was validated in combination with risk factors blood pressure, sex, and smoking in 828 IA cases and 68 568 controls from the Nordic HUNT population study. Furthermore, we assessed association between the metaGRS and patient characteristics in a cohort of 5560 IA patients. Results: Per SD increase of metaGRS, the hazard ratio for ASAH incidence was 1.34 (95% CI, 1.20–1.51) and the odds ratio for IA presence 1.09 (95% CI, 1.01–1.18). Upon including the metaGRS on top of clinical risk factors, the concordance index to predict ASAH hazard increased from 0.63 (95% CI, 0.59–0.67) to 0.65 (95% CI, 0.62–0.69), while prediction of IA presence did not improve. The metaGRS was statistically significantly associated with age at ASAH (β=−4.82×10 −3 per year [95% CI, −6.49×10 −3 to −3.14×10 −3 ]; P =1.82×10 −8 ), and location of IA at the internal carotid artery (odds ratio=0.92 [95% CI, 0.86–0.98]; P =0.0041). Conclusions: The metaGRS was predictive of ASAH incidence, although with limited added value over clinical risk factors. The metaGRS was not predictive of IA presence. Therefore, we do not recommend using this metaGRS in daily clinical care. Genetic risk does partly explain the clinical heterogeneity of IA warranting prioritization of clinical heterogeneity in future genetic prediction studies of IA and ASAH.

International audience; Objective: To review studies conducted on the costs of dementia in low- and middle-income countries (LMICs), describe their methodology and summarize costsestimates.Methods: We conducted a systematic review, searching in bibliographic databases in health, economics and social sciences, and main grey literature resources. Publications were evaluated by two independent investigators, conflict discussed, and the final decision taken by a third investigator. We included all studies presenting costs of any aspect of dementia care.Results: Overall, 6,843 title and abstract, then 74 full texts articles evaluated. Finally, 15 single studies were included. Those were from only 9 out of the 156 LMICs: China (6); Brazil (2); and one from Argentina, Colombia, Iran, Peru, Romania, Thailand and Turkey. No study was from Africa. Studies focused mainly on Alzheimer’s disease. Studies investigated all three categories of cost-of-illness i.e., medical, social and informal care costs, but items, data collection and definitions in each category were highly variable. Dementia costs tend to increase with the severity of the disease with greater medical costs in the mild stage and higher social and informal care costs in the moderate and severe stages. Costs estimates varied widely: from $327.4 to $1,266.3 for annual medical costs, from $112.4 to $5,575.0 for social costs; and costs from $324.0 to $10,031.1 for informal care. Overall, dementia care cost up to $19,101 per year for a single patient, usually at the charge of families.Conclusion: Limited studies have been conducted on dementia costs in LMICs, with none so far in Africa. It appears urgent to provide accurate evidence of the disease burden in the region to guide public health policies.

Several countries are expanding their paternity leave policies, which can have positive effects on parental mental health. We examined whether 2 weeks of paid paternity leave are associated with post-partum depression in mothers and fathers at 2 months after the birth of their child.We used data from the Etude Longitudinale Française depuis l'Enfance (ELFE) cohort study. Participating mothers gave birth in 2011 in a representative sample of 320 maternity hospitals in mainland France. Inclusion criteria were single or twin livebirths born after at least 33 weeks' gestation; mother's age at least 18 years; no plans to leave metropolitan France within 3 years. Mothers were interviewed face-to-face shortly after the child's birth. Fathers and mothers were both interviewed by telephone 2 months after the child's birth, reporting whether the father had the right to paternity leave and if yes, if he had taken or intended to take it. We used the Edinburgh Postnatal Depression Scale to assess post-partum depression among fathers and mothers at 2 months. Logistic regression models, using survey-weighted data and adjusted for confounders using inverse probability weights, yielded odds ratios (ORs).We included 10 975 fathers and 13 075 mothers with reported information on paternity leave and post-partum depression at 2 months in the statistical analyses. Fathers had a median age of 32·6 years (IQR 36·9-22·6) and mothers had a median age of 30·5 years (34·0-27·1) at the time of the ELFE child's birth. The prevalence of depression in fathers according to paternity leave status was 4·5% among those who used paternity leave, 4·8% among those who intended to use paternity leave, and 5·7% among those who did not use paternity leave. For mothers, the prevalence of post-partum depression was 16·1% among those whose partner used paternity leave, 15·1% among those whose partner intended to use paternity leave, and 15·3% among those whose partner did not use paternity leave. Fathers who took paternity leave had reduced odds of post-partum depression (OR 0·74 [95% CI 0·70-0·78]) as did fathers who intended to take paternity leave (0·76 [0·70-0·82]) compared with fathers who did not take paternity leave. However, we did not find such beneficial effects for mothers whose partners took (1·13 [1·05-1·20]) or intended to take paternity leave (1·02 [0·96-1·08]).Taking and intending to take 2-weeks' paid paternity leave was associated with a reduced likelihood of reporting post-partum depression in fathers. However, offering 2-weeks' paternity leave might place mothers at a greater risk of post-partum depression, suggesting that optimal length and timing of the leave, among other factors, need further investigation.The French National Research Agency.

International audience; BACKGROUND: Prenatal lead exposure is known to have neurotoxic effects on the developing fetus, while some viral infections may have a tropism for the central nervous system. Our objective was to study whether the effects of prenatal lead exposure on infant development and behaviors at 18 months of age are modified by the occurrence of a maternal infection to Zika virus (ZIKV) during pregnancy. METHODS: During the ZIKV epidemic in Guadeloupe in 2016 a cohort of pregnant women was set up. Blood samples (pregnancy, childbirth and cord) (n = 297) enabled us to measure blood lead levels aimed to determine prenatal lead exposure and the likelihood of maternal infection during pregnancy (ZIKV status + vs -). The 18 months "Ages and Stages Questionnaire" (ASQ) was used to generate scores for global development, fine and gross motor skills, communication, problem solving, and personal-social skills. The questions from a longitudinal cohort study conducted in Canada (Québec) were used to generate hyperactivity, opposition, inattention and physical aggression scores. Associations were tested by multivariate linear regressions. RESULTS: Prenatal lead exposure was associated with delays in neurodevelopment at 18 months, reflected by lower scores in ASQ totals, and in the fine motor and problem-solving domains. Some of these associations appeared to be sex-specific, observed almost exclusively in boys (ASQ total, fine motor and personal-social scores). Prenatal lead exposure was not associated with behavioral scores. ZIKV infection during pregnancy was associated with a lower fine motor ASQ score, and higher scores for hyperactivity, opposition and physical aggression. Significant interaction between prenatal lead exposure and ZIKV status was observed with a lower personal-social score in ZIKV (-) only, and for hyperactivity and inattention scores, though some of these interactions (ASQ personal-social score, inattention score) were no longer significant when children with microcephaly were excluded from the analyses. DISCUSSION/CONCLUSION: Our study confirms previous findings of associations between prenatal exposure to lead at low levels and adverse neurodevelopmental outcomes during infancy and the particular vulnerability of boys. It suggests associations between ZIKV infection during pregnancy and adverse effects on a number of neurodevelopmental functions (fine motor function) and behaviors (opposition, hyperactivity), that need to be confirmed at later age. There is no strong evidence of interaction between ZIKV infection and lead exposure but both prenatal risk factors may affect fine motor function.

International audience; BackgroundComplementary therapy in oncology aims to help patients better cope with the illness and side effects (SEs) of cancer treatments that affect their quality of life (QOL). This study aimed to assess the benefits of homeopathic treatment on the health-related QOL (HRQOL) of patients with non-metastatic breast cancer (BC) prescribed in post-surgical complementary therapy.Patients and methodsAn extraction from the French nationwide healthcare database targeted all patients who underwent mastectomy for newly diagnosed BC between 2012 and 2013. HRQOL was proxied by the quantity of medication used to palliate the SEs of cancer treatments.ResultsA total of 98,009 patients were included (mean age: 61 ± 13 years). Homeopathy was used in 11%, 26% and 22% of patients respectively during the 7–12 months before surgery, the 6 months before, and 6 months after. Thereafter, the use remained stable at 15% for 4 years. Six months after surgery, there was a significant overall decrease (RR = 0.88, confidence interval (CI)95 = 0.87–0.89) in the dispensing of medication associated with SEs in patients treated with ≥ 3 dispensing of homeopathy compared to none. The decrease appeared to be greater for immunostimulants (RR = 0.79, (CI)95 = 0.74–0.84), corticosteroids (RR = 0.82, (CI)95 = 0.79–0.85), and antidiarrheals (RR = 0.83, (CI)95 = 0.77–0.88).ConclusionThe study showed an increasing use of homeopathy in patients with BC following diagnosis. This use was maintained after surgery and seemed to play a role in helping patients to better tolerate the SEs of cancer treatments.Micro-abstractThis study evaluated the benefits of homeopathy on the quality of life (QOL) of patients with non-metastatic breast cancer (BC). There is an increasing use of homeopathy in patients with BC after diagnosis, leading to an overall decrease in medications that palliate the side effects of cancer treatment. This may indicate that QOL is improved in patients with BC who use homeopathy.

Droits auteurs: https://www.ifac2023.org/archives/001/202211/IFAC2023_2ndCFP_20221115.pdf; International audience; We revisit the problem of minimizing the epidemic final size in the SIR model through social distancing. In the existing literature, this problem has been considered by imposing a priori interval structure on the time period during which interventions are enforced. We show that when considering the more general class of controls with an L1 constraint on the confinement effort to reduce the infection rate, the support of the optimal control is still a single time interval. In other words, for the problem of minimizing the epidemic final size in the SIR model through social distancing, there is no benefit in splitting interventions on several disjoint time periods. The techniques we deploy here are different than what has been proposed in the literature, and could be potentially applied to other problems.

Background Workplace absenteeism increases significantly during influenza epidemics. Sick leave records may facilitate more timely detection of influenza outbreaks, as trends in increased sick leave may precede alerts issued by sentinel surveillance systems by days or weeks. Sick leave data have not been comprehensively evaluated in comparison to traditional surveillance methods. The aim of this paper is to study the performance and the feasibility of using a detection system based on sick leave data to detect influenza outbreaks. Methods Sick leave records were extracted from private French health insurance data, covering on average 209,932 companies per year across a wide range of sizes and sectors. We used linear regression to estimate the weekly number of new sick leave spells between 2016 and 2017 in 12 French regions, adjusting for trend, seasonality and worker leaves on historical data from 2010 to 2015. Outbreaks were detected using a 95%-prediction interval. This method was compared to results from the French Sentinelles network, a gold-standard primary care surveillance system currently in place. Results Using sick leave data, we detected 92% of reported influenza outbreaks between 2016 and 2017, on average 5.88 weeks prior to outbreak peaks. Compared to the existing Sentinelles model, our method had high sensitivity (89%) and positive predictive value (86%), and detected outbreaks on average 2.5 weeks earlier. Conclusion Sick leave surveillance could be a sensitive, specific and timely tool for detection of influenza outbreaks.

International audience; Background: The specific compounds that make ambient fine particulate matter (PM2.5) carcinogen remain poorly identified. Some metals contribute to ambient PM2.5 and possibly to its adverse effects. But the challenge of assessing exposure to airborne metals limits epidemiological studies.Objective: To analyze the relationships between several airborne metals and risk of cancer in a large population.Methods: We estimated the individual exposure to 12 airborne metals of ∼ 12,000 semi-urban and rural participants of the French population-based Gazel cohort using moss biomonitoring data from a 20-year national program. We used principal component analyses (PCA) to derive groups of metals, and focused on six single carcinogenic or toxic metals (arsenic, cadmium, chromium, lead, nickel, and vanadium). We used extended Cox models with attained age as time-scale and time-varying weighted average exposures, adjusted for individual and area-level covariables, to analyze the association between each exposure and all-site combined, bladder, lung, breast, and prostate cancer incidence.Results: We identified 2,401 cases of all-site cancer between 2001 and 2015. Over the follow-up, median exposures varied from 0.22 (interquartile range (IQR): 0.18-0.28) to 8.68 (IQR: 6.62-11.79) µg.g-1 of dried moss for cadmium and lead, respectively. The PCA yielded three groups identified as "anthropogenic", "crustal", and "marine". Models yielded positive associations between most single and groups of metal and all-site cancer, with e.g. hazard ratios of 1.08 (95% CI: 1.03, 1.13) for cadmium or 1.06 (95% CI: 1.02,1.10) for lead, per interquartile range increase. These findings were consistent across supplementary analyses, albeit attenuated when accounting for total PM2.5. Regarding specific site cancers, we estimated positive associations mostly for bladder, and generally with large confidence intervals.Conclusion: Most single and groups of airborne metals, except vanadium, were associated with risk of cancer. These findings may help identify sources or components of PM2.5 that may be involved in its carcinogenicity.

International audience; Aims: To evaluate the effectiveness of a French mass-media campaign in raising knowledge of both long-term alcohol-related harms (LTH) and low-risk drinking guidelines (LRDG), as well as in lowering alcohol consumption.Design: An 8-month longitudinal survey from February to October 2019, with three waves of on-line data collection (T0 before the campaign, T1 just after it ended and T2 6 months after it ended).Setting: France.Participants: A total of 2538 adult drinkers (aged 18-75 years).Measurements: The main outcomes' variables were LTH knowledge (cancer, hypertension, brain haemorrhage), LRDG knowledge (two guidelines: 'maximum of two drinks a day' and 'minimum of 2 days without alcohol per week'), intention to reduce alcohol consumption and self-declared consumption with respect to the French LRDG. At T1, exposure to the campaign was measured using self-reported campaign recall.Findings: In T1, we observed significant positive interactions between exposure group based on campaign recall and survey waves on knowledge of (i) the 'maximum two drinks a day' guideline [adjusted odds ratio (aOR) = 1.32, 95% confidence interval (CI) = 1.08-1.62, P = 0.008], (ii) brain haemorrhage (aOR = 1.80, 95% CI = 1.44-2.25, P < 0.001) and (iii) hypertension (aOR = 1.41, 95% CI = 1.09-1.81, P = 0.008) risks. Campaign exposure was also associated with a significant decrease in at-risk drinking in women (aOR = 0.67, 95% CI = 0.50-0.88, P = 0.004). No significant interaction was observed at T1 for the knowledge of the 'minimum of 2 days without alcohol a week' guideline, or of cancer risk. At T2, no significant interaction was observed for the main outcomes' variables.Conclusions: There appears to be an association between exposure to a 2019 French mass-media campaign to raise knowledge of long-term alcohol-related harms and low-risk drinking guidelines and reduce alcohol consumption and (i) improved knowledge of the 'maximum two drinks per day guideline', (ii) knowledge of the risks of hypertension and brain haemorrhage and (iii) a reduction in the proportion of people exceeding low-risk drinking guidelines (in the general population only). These associations were only observed over the short term and, in some cases, only for certain segments of the population.

International audience; The healthcare burden of cardiovascular diseases remains a major issue worldwide. Understanding the underlying mechanisms and improving identification of people with a higher risk profile of systemic vascular disease through noninvasive examinations is crucial. In ophthalmology, retinal vascular network imaging is simple and noninvasive and can provide in vivo information of the microstructure and vascular health. For more than 10 years, different research teams have been working on developing software to enable automatic analysis of the retinal vascular network from different imaging techniques (retinal fundus photographs, OCT angiography, adaptive optics, etc.) and to provide a description of the geometric characteristics of its arterial and venous components. Thus, the structure of retinal vessels could be considered a witness of the systemic vascular status. A new approach called "oculomics" using retinal image datasets and artificial intelligence algorithms recently increased the interest in retinal microvascular biomarkers. Despite the large volume of associated research, the role of retinal biomarkers in the screening, monitoring, or prediction of systemic vascular disease remains uncertain. A PubMed search was conducted until August 2022 and yielded relevant peer-reviewed articles based on a set of inclusion criteria. This literature review is intended to summarize the state of the art in oculomics and cardiovascular disease research.

International audience; BACKGROUND: Occupational blood and body fluid exposures (OBBFEs) are one of the biological risks run by health professionals, especially in hospitals. OBJECTIVE: The objectives of this study were to assess the occurrence and reporting of occupational blood and body fluid exposures (OBBFEs) in university hospital medical staff and to investigate factors associated to declared OBBFE and factors associated to reported OBBFE. METHODS: A self-administered questionnaire has been e-mailed to all junior and senior medical staff in four university hospital centers in one administrative region of France in 2017. RESULTS: 292 of the 1,228 respondents declared at least one OBBFE. More than two-thirds (70.2%) were under-reporters and more than half (53.8%) non-reporters. Younger subjects, surgical specialties and other associated work accidents were risk factors for OBBFE. Considering the reporting procedure too complex was a risk factor for underreporting. CONCLUSIONS: Underreporting by hospital medical staff was a persistent phenomenon, with a high rate. The OBBFE reporting procedure needs rethinking.

International audience; En ayant recours à des outils et méthodes de cartographie de réseau et d’analyse sémantique, cet article explore comment la revue Sciences Sociales et Santé s’inscrit dans l’espace des sciences sociales de la santé, et plus largement des sciences sociales. À partir d’un corpus d’articles publiés dans Sciences Sociales et Santé entre 1994 et 2021, l’article identifie, d’une part, les horizons disciplinaires qui alimentent la production de la revue depuis 30 ans et met en relief, d’autre part, des thématiques de prédilection présentes ou passées et leur prévalence relative. Ces analyses confirment et prolongent celles réalisées à l’occasion des précédents numéros anniversaires de la revue. L’analyse thématique des trente dernières années de production de la revue montre qu’elle est restée fidèle au cœur de son projet : rendre compte – via un regard pluridisciplinaire – des multiples débats portant sur la santé et ses enjeux de société.

International audience; Plan : - Vers un modèle de santé de plus en plus intégré- Enquêter sur les centres de santé et les permanences d’accès aux soins- L’importance de l’échelon territorial local dans l’analyse- Politiques publiques de santé : l’enjeu de la « responsabilité populationnelle »- Le défi de l’intégration sociale

International audience; BACKGROUND: The diverse and complex variations in the possible forms of health-work interactions are constantly reconfigured over the course of a person’s career. OBJECTIVES: The aims of this study were: 1) assess the scope of the individual changes in working conditions; 2) examine conjoint changes in working conditions; 3) examine the links between these changes and back pain and fatigue. METHOD: Analyses were conducted using data from the French observatory EVREST. The variations for each individual (close to 8,000 in total) were studied by comparing data for each individual obtained at two dates at least four years apart within the period between 2010 and 2017. RESULTS: The frequency of the studied constraints was often similar at two dates (T1 and T2), but significantly higher for repetitive movements, working additional hours and interruptions which disrupt the work. The variations in physical constraints, intensity of work and lack of agency scores between the two timepoints are two-by-two positively correlated. Finally, respondents in the higher tertiles for any of these working condition scores at T2 had a higher probability of back pain or fatigue, compared to individuals in the lower tertiles at both timepoints. Being in a higher tertile at both dates corresponded to the highest odds-ratios for health complaints. CONCLUSION: From a “sustainability” perspective, these findings support treating this diversity of seniority in a profession and past experience at the same time as major decisions on production are made, rather than dealing with it as an afterthought.

International audience; BackgroundLocal governments are well-positioned to promote healthy behaviours and environments. In France, since 2009, this role can be reinforced by signature of a Local Health Contract with the Regional Health Agency. This multi-year scheme includes an action plan which may cover four areas: health promotion, disease prevention, health care and long-term care. Although approximately 400 Local Health Contracts had been signed by 2018, we found only sparse evidence on the context in which they were formulated and the contents of their action plans. Based on the international literature, the CLoterreS study aimed to develop an instrument characterizing the contracts’ action plans, with a specific focus on prevention and health promotion. This paper presents an assessment and application of the CLoterreS instrument.MethodsThe instrument was developed and applied in five steps: 1) development of the contextual and thematic variables; 2) pre-testing of a coding chart and its coding guide; 3) consultation with practitioners; 4) assessment of inter-rater agreement; and 5) application of the instrument to a nationally-stratified random sample of 53 contracts.ResultsWhile inter-rater agreement by type of variables was satisfactory (κ > 0.7), some variables had to be discarded due to lack of information or insufficient agreement. The analysis indicates that most of the 53 contracts studied were signed in urban areas, on the scale of a single town or a syndicate of municipalities. The action plans are clearly focused on life circumstances, health promotion and protection or primary prevention of diseases, insofar as, on average, 73% of the contracts’ action forms address at least one of these topics. The proportion of action forms dealing with at least one topic in secondary or tertiary prevention, long-term care or the organisation of health care and services is nevertheless substantial (43%). Illustrations of actions are presented.ConclusionBuilding on internationally recognized evidence-based practice, the CLoterreS instrument has proven useful in characterizing health promotion action plans at the local level. Its use by practitioners could foster a broader vision of the scope of actions that can be implemented through a Local Health Contract and in conjunction with other local prevention and access-to-care schemes.; ContexteLes collectivités locales sont bien placées pour promouvoir des comportements et des environnements favorables à la santé. En France, depuis 2009, ce rôle peut être renforcé par la signature d'un Contrat local de santé (CLS) avec l'Agence régionale de santé. Ce dispositif pluriannuel inclut un plan d'action pouvant aborder quatre domaines : promotion de la santé, prévention des maladies, soins, accompagnement médico-social. Malgré environ 400 CLS recensés en 2018, les connaissances sur leur contexte d’élaboration et le contenu de leurs plans d'action restent limitées. En s'appuyant sur la littérature internationale, l’étude CLoterreS visait à développer un outil permettant de caractériser les CLS selon leurs plans d'action, notamment en matière de prévention et de promotion de la santé. Dans cet article nous présentons une évaluation et une application de l'outil CLoterreS.MéthodeL'outil a été développé et appliqué en cinq étapes : 1) le développement de variables contextuelles et thématiques ; 2) le prétest de la grille de codage et de son guide ; 3) la consultation de professionnels ; 4) un test d'accord inter-juges ; et 5) l'application et l'utilisation de l'outil à partir d'un échantillon aléatoire stratifié à l’échelle nationale de 53 CLS.RésultatsLe test d'accord inter-juges par type de variable était satisfaisant (κ > 0,7), mais certaines variables ont dû être écartées par manque d'information ou faute d'accord suffisant. L'analyse indique que la plupart des 53 CLS étudiés ont été signés en milieu urbain, à l’échelle d'une municipalité ou d'une intercommunalité. Les plans d'action sont clairement orientés vers les circonstances de vie, la promotion et la protection de la santé ou la prévention primaire des maladies, dans la mesure où, en moyenne, 73 % des fiches action abordent au moins un thème relevant de ce domaine. La proportion de fiches action abordant au moins un thème relevant de la prévention secondaire ou tertiaire, de l'accompagnement médico-social ou de l'organisation de soins et services de santé est néanmoins substantielle (43 %). Des exemples d'action sont présentés.ConclusionS'appuyant sur des pratiques probantes reconnues à l’échelle internationale, l'outil CLoterreS s'est avéré utile pour caractériser des plans d'action en promotion de la santé au niveau local. Son utilisation par des professionnels pourrait encourager une vision plus large de la diversité d'actions pouvant être mises en œuvre dans un CLS et en lien avec d'autres dispositifs locaux de prévention et d'accès aux soins.

International audience; AIM: Drug shortage is a growing global health issue. The aim of the study was to evaluate the consequences of drug shortages on patient safety based on data recorded in the French Pharmacovigilance Database. METHODS: All cases involving drug shortages reported from 1985 to the end of 2019 were extracted from the database. RESULTS: Following the selection process, 462 cases were included. The number of cases increased significantly from 2004 to 2019. Cases mainly involved drugs from the nervous system (22.1%, CI95[17.5;27.0]), the cardiovascular system (16.4%, CI95[11.9;21.4]), and anti-infectives for systemic use (14.3%, CI95[9.7;19.2]) ATC classes. Most of the cases reported an adverse drug reaction (ADR) belonging to the SOC nervous system (21%, CI95[18;24]), skin and subcutaneous (14%, CI95[11;17]), general (13%, CI95[10;17]), and gastrointestinal (8%, CI95[5;11]) disorders. Disease worsening was observed in 15.9% of the cases, mostly related to a lack of efficacy of the replacement drug. Half of the cases were considered as serious. Evolution was favourable in 79.4% of the cases. Death and/or life-threatening situations were reported in 5.8% of the cases. Medication errors (ME) were identified in 51 cases (11%), mostly occurring at the administration step and involving a human factor. CONCLUSION: This study emphasises the clinical impact of drug shortage in terms of ADRs, ME and inefficiency. These observations underline the importance of a global health policy programme to limit the occurrence of drug shortages and to reinforce the information provided to patients and health care professionals in this context to limit risk.

Background: Venous thromboembolism (VTE) is a life-threatening vascular event with environmental and genetic determinants. Recent VTE genome-wide association studies (GWAS) meta-analyses involved nearly 30 000 VTE cases and identified up to 40 genetic loci associated with VTE risk, including loci not previously suspected to play a role in hemostasis. The aim of our research was to expand discovery of new genetic loci associated with VTE by using cross-ancestry genomic resources. Methods: We present new cross-ancestry meta-analyzed GWAS results involving up to 81 669 VTE cases from 30 studies, with replication of novel loci in independent populations and loci characterization through in silico genomic interrogations. Results: In our genetic discovery effort that included 55 330 participants with VTE (47 822 European, 6320 African, and 1188 Hispanic ancestry), we identified 48 novel associations, of which 34 were replicated after correction for multiple testing. In our combined discovery-replication analysis (81 669 VTE participants) and ancestry-stratified meta-analyses (European, African, and Hispanic), we identified another 44 novel associations, which are new candidate VTE-associated loci requiring replication. In total, across all GWAS meta-analyses, we identified 135 independent genomic loci significantly associated with VTE risk. A genetic risk score of the significantly associated loci in Europeans identified a 6-fold increase in risk for those in the top 1% of scores compared with those with average scores. We also identified 31 novel transcript associations in transcriptome-wide association studies and 8 novel candidate genes with protein quantitative-trait locus Mendelian randomization analyses. In silico interrogations of hemostasis and hematology traits and a large phenome-wide association analysis of the 135 GWAS loci provided insights to biological pathways contributing to VTE, with some loci contributing to VTE through well-characterized coagulation pathways and others providing new data on the role of hematology traits, particularly platelet function. Many of the replicated loci are outside of known or currently hypothesized pathways to thrombosis. Conclusions: Our cross-ancestry GWAS meta-analyses identified new loci associated with VTE. These findings highlight new pathways to thrombosis and provide novel molecules that may be useful in the development of improved antithrombosis treatments.

International audience; Premiers enseignements de la crise sanitaire, Covid-19, estimation du R(t), algorithme, cartes animées, épistémologie, Covid-19, estimation of R(t), algorithms, animated maps, epistemology. "Comme nombre de chercheurs, nous avons mis nos savoirs au service de la lutte contre la Covid-19. Dès février 2020, nous avons produit des graphiques quotidiens afin de comparer l’évolution de la pandémie selon les pays. Nous avons aussi fédéré un réseau scientifique qui élaborait et documentait des analyses pertinentes.Ensuite, nous avons conçu un outil qui estime au mieux le taux de reproduction de la pandémie dans les pays du monde et dans les départements français, en n’utilisant que le nombre des infections quotidiennes observées dans chaque territoire. Disposant de données de qualité limitée, notre modèle s’est focalisé sur la correction des erreurs, via des méthodes dites de « problèmes inverses ». Bien qu’il ne permette d’estimer que le taux de reproduction du jour, notre outil permet une évaluation de tendance à court terme.Enfin, pour analyser au mieux l’évolution spatiale et temporelle de la pandémie, nous avons réalisé une carte animée et interactive intégrant la production de graphiques permettant la comparaison entre deux pays. Nous concluons cet article en abordant quelques pistes épistémologiques."

International audience; Like in many countries, the French health authorities are pinning their hopes on vaccination to stop the spread of the COVID-19 pandemic. However, this requires the public to get the vaccine. Based on six COCONEL surveys carried out during and after the lockdown among the general French adult population, which aimed to explore life conditions during this period and individual perceptions of the situation, this paper aims to investigate the acceptability of a putative vaccine against COVID-19 among the French population, and more specifically to compare attitudes among the elderly, who are more vulnerable to the disease, with those of younger people. Out of the 8,036 respondents, 27.5% declared that they would refuse the vaccine if it were available. Among the age groups of particular interest, 29.2% of people aged 18–64 said they would refuse the vaccine, compared to 12.4% of respondents aged 65 or over. For both groups, this refusal rate fluctuated depending on the date of the survey, gender, household composition, level of household income, and uptake of the last flu vaccine. In conclusion, more attention should be paid to elderly people, as they were more likely to report hostility toward vaccination in general. Finally, considering that several vaccines are now available, further studies should be done to study vaccine uptake in relation to the vaccine offered.; La campagne vaccinale contre la COVID-19 est une priorité sanitaire. Toutefois, l’adhésion de la population française à cette vaccination est un élément clé de sa réussite. À la lumière de six enquêtes COCONEL réalisées en population générale adulte pendant et après le confinement dans l’objectif de documenter les conditions de vie des Français pendant cette période ainsi que leur perception des mesures mises en place par les autorités, cet article propose d’analyser l’intention de se faire vacciner des Français à l’égard d’une vaccination contre la COVID-19, selon l’âge. Plus spécifiquement, l’intention des personnes âgées de 65 ans et plus, particulièrement vulnérables face à cette maladie, comparativement aux personnes plus jeunes. Parmi les 8 036 répondants, 27,5 % refuseraient ce vaccin s’il était disponible ; 29,2 % des 18-64 ans contre 12,4 % des 65 ans et plus. Quel que soit l’âge, ce refus de vaccination varie selon la date d’enquête, mais aussi selon le genre, la composition du foyer, le niveau de revenus, ainsi que la pratique vaccinale antérieure contre la grippe saisonnière. En conclusion, une attention particulière devra être portée aux personnes âgées de 65 ans et plus qui sont plus enclines à manifester une hostilité à la vaccination en général. Enfin, la mise sur le marché de différents vaccins devrait encourager à poursuivre les analyses de l’adhésion vaccinale au regard du vaccin proposé.

Coronavirus disease 2019 (Covid-19) is a global diastrophic disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Covid-19 leads to inflammatory, immunological, and oxidative changes, by which SARS-CoV-2 leads to endothelial dysfunction (ED), acute lung injury (ALI), acute respiratory distress syndrome (ARDS), and multi-organ failure (MOF). Despite evidence illustrating that some drugs and vaccines effectively manage and prevent Covid-19, complementary herbal medicines are urgently needed to control this pandemic disease. One of the most used herbal medicines is berberine (BBR), which has anti-inflammatory, antioxidant, antiviral, and immune-regulatory effects; thus, BBR may be a prospective candidate against SARS-CoV-2 infection. This review found that BBR has anti-SARS-CoV-2 effects with mitigation of associated inflammatory changes. BBR also reduces the risk of ALI/ARDS in Covid-19 patients by inhibiting the release of pro-inflammatory cytokines and inflammatory signaling pathways. In conclusion, BBR has potent anti-inflammatory, antioxidant, and antiviral effects. Therefore, it can be utilized as a possible anti-SARS-CoV-2 agent. BBR inhibits the proliferation of SARS-CoV-2 and attenuates the associated inflammatory disorders linked by the activation of inflammatory signaling pathways. Indeed, BBR can alleviate ALI/ARDS in patients with severe Covid-19. In this sense, clinical trials and prospective studies are suggested to illustrate the potential role of BBR in treating Covid-19.

International audience; Medical Informatics brings methods and solutions that could support reducing healthcare's ecological footprint. Initial frameworks for Green Medical Informatics solutions are available, however these do not address organizational and human factors. Including these factors in evaluation or analysis of (technical) interventions aimed at making healthcare more sustainable, is essential for improving usability as well as effectiveness of these interventions. Interviews with healthcare professionals from Dutch hospitals led to preliminary insights into which organizational and human factors impact the implementation and adoption of sustainable solutions. Results indicate that forming multidisciplinary teams is considered an important factor for realizing intended outcomes in terms of reducing carbon emissions and waste. Some other key factors mentioned are formalizing tasks, allocating budget and time, creating awareness and changing protocols to promote sustainable diagnosis and treatment procedures.

International audience; Qualifiée d’« urgence de santé publique de portée internationale » par l’OMS en août 2014, l’épidémie à virus Ebola, en raison de sa diffusion rapide longtemps hors de contrôle et d’un potentiel létal élevé, a généré un désastre sanitaire de grande ampleur. L’épidémie a comptabilisé plus de 11 000 décès pour 28 421 cas déclarés, et entraîné d’autres décès, indirects et non comptabilisés, du fait du chaos dans lequel les structures de santé étaient plongées. En première ligne, le corps des professionnels de santé a été durement affecté, avec plus de 400 décès. L’épidémie a particulièrement sévi en Guinée, au Libéria et en Sierra Léone, pays parmi les plus pauvres d’Afrique de l’Ouest et fortement déstabilisés par des crises politiques récentes. Dans une moindre mesure, elle a affecté le Nigéria, le Mali et plus marginalement le Sénégal. (Intro.)

International audience; Si quelques problématiques spécifiques au bâtiment sont très anciennes (peintures au plomb, amiante), la pollution intérieure ou, de façon plus positive, la qualité des environnements intérieurs s’est invitée dans l’arène scientifique puis le débat public depuis les années 1970. Du fait notamment de la prise de conscience du temps passé dans des environnements intérieurs et donc de l’importance de ces environnements en termes d’exposition, de nombreux travaux ont été menés pour améliorer les connaissances et définir des mesures de gestion et de prévention.

International audience; L’évaluation des risques décrite dans ce chapitre, au sens de Risk Assessment défini en 1983 par le National Research Council (NRC, 1983) est une analyse scientifique basée sur le recueil de données et la modélisation. Ses résultats sont des expressions qualitatives ou quantitatives de l’intensité et de la vraisemblance de dommages, causés par une exposition. L’évaluation s’effectue au niveau populationnel, car il ne s’agit pas de prédictions individuelles. Elle est la première composante de l’analyse des risques, qui comprend également la gestion et la communication des risques (OMS, 2021). Cet outil mobilise et organise les connaissances existantes pour aider à la décision publique, répondre à une question spécifique, guider la mise en œuvre de politiques publiques, ou la mise en place de réglementations protectrices de la santé.Si ce chapitre traite des composés chimiques, les concepts, principes et étapes de la démarche s’appliquent aussi aux risques physiques et biologiques. Après une présentation de ses objectifs, ce chapitre abordera les raisons d’être et les concepts de la démarche d’évaluation des risques sanitaires, puis en détaillera les étapes : formulation du problème, identification des dangers, établissement de la relation dose-réponse, évaluation des expositions et enfin caractérisation des risques et des incertitudes.

International audience; Introduction Livestock farming and its negative impacts are increasingly criticized by society; its evolution toward more sustainable systems is therefore a key aspect of the transition of agro-food systems. It is necessary to rethink livestock systems' research and innovation processes and develop innovative solutions. Including citizens, non-professionals of the sector, who are less influenced by the current organization of the agricultural sector could be an opportunity to generate innovative solutions, but they have been kept away from research and innovation processes so far. Methods In this context, we implemented a co-design process involving researchers, livestock professionals, and citizens in a participatory research project aiming at producing knowledge and developing innovative solutions for the future mountain dairy systems. For this, we have adapted the KCP design method known to promote the exploration of innovative solutions, support the agro-ecological transition, and build a common horizon. Results The analysis of this collective dynamic and its outputs allowed us to highlight the positive contribution of citizens during the design process, even if they are not livestock experts. The citizens participated in the formulation of new knowledge by questioning the researchers and livestock professionals and were less influenced by the current system. This contributed to the exploration of original and varied solutions for livestock farming systems. Discussion This experimentation offers perspectives for including citizens in agro-food systems research and innovation process. It also opens up interesting perspectives for the fields of citizen science and co-design research.

International audience; L’épisode de choléra à Londres en 1849 lors duquel John Snow fut le premier à mettre en évidence un agrégat de cas autour d’un point d’eau contaminé est l’un des premiers jalons de la surveillance en hygiène environnementale (Astagneau et Ancelle, 2011). L’histoire de la surveillance s’inscrit d’abord dans la gestion des contacts des personnes ayant des maladies transmissibles graves (peste, typhus, variole, fièvre jaune, etc.) (Thacker et Birkhead, 2008). Ces maladies étaient associées à des éclosions rapides et à des taux de mortalité élevés. L’un des objectifs de la surveillance était alors de détecter précocement les cas pour les isoler et prévenir la propagation des maladies. À partir des années 1940, le docteur Langmuir et ses collègues ont développé une nouvelle vision de la surveillance en s’intéressant à l’incidence des maladies dans une population donnée plutôt qu’aux cas (le nombre absolu sans dénominateur), permettant ainsi la formalisation du concept de « surveillance sanitaire » (Langmuir, 1963).Depuis, l’adoption d’une vision holistique de la santé incluant les déterminants de santé que sont les facteurs personnels, sociaux, économiques et environnementaux a permis l’émergence de la surveillance dans d’autres sphères que celles des maladies transmissibles, comme les maladies chroniques d’origine environnementale ou encore différents événements de santé (accidents domestiques, tentatives de suicide…). Ce chapitre fait un tour d’horizon de la surveillance en santé environnementale, en présente les principaux concepts et l’illustre par des études de cas.

International audience; The DetecIP project aims to implement multifactorial dynamic rules within a computerized decision support system (CDSS) for pharmaceutical analysis of orders to reduce the rate and severity of iatrogenic hyperkalemia and acute kidney injury. However, understanding the impact of this intervention (if any) requires that the way in which it influences the work systems and processes also be studied. This study presents the preliminary results of the analysis of the work contexts in which these rules will be implemented. A series of semi-structured interviews exploring the dimensions of the systems engineering initiative for patient safety (SEIPS) were conducted with healthcare professionals involved in the prevention and management of iatrogenic risks in five hospital units. Data were analyzed to identify current barriers and facilitators to the prevention and management of iatrogenic risks. Preliminary results from a geriatric unit and a cardiology unit reveal that, despite overall similarities in work processes, differences in the availability and location of physicians and clinical pharmacists influence how iatrogenic risks are managed. These contextual differences could influence the impact of the new CDSS rules once implemented.

International audience; 23.1. Le milieu de travail : un déterminant majeur de la santé 23.2. Lésions professionnelles et indicateurs de santé 23.3. Principaux facteurs de risque pour les travailleurs 23.3.1. Agents chimiques 23.3.2. Agents biologiques 23.3.3. Agents physiques 23.3.4. Contraintes du travail associées aux troubles musculo-squelettiques (TMS) 23.3.5. Organisation du travail 23.4. Prévention et gestion du risque professionnel 23.4.1. Interventions en santé au travail 23.4.2. Surveillance des milieux de travail 23.4.3. Surveillance médicale individuelle 23.4.4. Surveillance épidémiologique 23.5. Perspectives

International audience; Appropriate costing and economic modeling are major factors for the successful scale-up of health interventions. Various cost functions are currently being used to estimate costs of health interventions at scale in low- and middle-income countries (LMICs) potentially resulting in disparate cost projections. The aim of this study is to gain understanding of current methods used and provide guidance to inform the use of cost functions that is fit for purpose. We reviewed seven databases covering the economic and global health literature to identify studies reporting a quantitative analysis of costs informing the projected scale-up of a health intervention in LMICs between 2003 and 2019. Of the 8725 articles identified, 40 met the inclusion criteria. We classified studies according to the type of cost functions applied-accounting or econometric-and described the intended use of cost projections. Based on these findings, we developed new mathematical notations and cost function frameworks for the analysis of healthcare costs at scale in LMICs setting. These notations estimate variable returns to scale in cost projection methods, which is currently ignored in most studies. The frameworks help to balance simplicity versus accuracy and increase the overall transparency in reporting of methods.

Research topic: One Health Surveillance in Practice: Experiences of Integration among Human Health, Animal Health, Environmental Health, and Food Safety Sectors; International audience; Introduction The awareness of scientists and policy makers regarding the requirement for an integrated One Health (OH) approach in responding to zoonoses has increased in recent years. However, there remains an overall inertia in relation to the implementation of practical cross-sector collaborations. Foodborne outbreaks of zoonotic diseases continue to affect the European population despite stringent regulations, evidencing the requirement for better ‘prevent, detect and response’ strategies. Response exercises play an essential role in the improvement of crisis management plans, providing the opportunity to test practical intervention methodologies in a controlled environment. Methods The One Health European Joint Programme simulation exercise (OHEJP SimEx) aimed at practicing the OH capacity and interoperability across public health, animal health and food safety sectors in a challenging outbreak scenario. The OHEJP SimEx was delivered through a sequence of scripts covering the different stages of a Salmonella outbreak investigation at a national level, involving both the human food chain and the raw pet feed industry. Results A total of 255 participants from 11 European countries (Belgium, Denmark, Estonia, Finland, France, Italy, Norway, Poland, Portugal, Sweden, the Netherlands) took part in national level two-day exercises during 2022. National evaluations identified common recommendations to countries aiming to improve their OH structure to establish formal communication channels between sectors, implement a common data sharing platform, harmonize laboratory procedures, and reinforce inter-laboratory networks within countries. The large proportion of participants (94%) indicated significant interest in pursuing a OH approach and desire to work more closely with other sectors. Discussion The OHEJP SimEx outcomes will assist policy makers in implementing a harmonized approach to cross-sector health-related topics, by highlighting the benefits of cooperation, identifying gaps in the current strategies and suggesting actions required to better address foodborne outbreaks. Furthermore, we summarize recommendations for future OH simulation exercises, which are essential to continually test, challenge and improve national OH strategies.

HIV self-testing (HIVST) empowers individuals by allowing them to decide when and where to test and with whom to share their results. From 2019 to 2022, the ATLAS program distributed ≈ 400 000 HIVST kits in Côte d Ivoire, Mali, and Senegal. It prioritised key populations, including female sex workers and men who have sex with men, and encouraged secondary distribution of HIVST to their partners, peers and clients. To preserve the confidential nature of HIVST, use of kits and HIVST results were not systematically tracked. Therefore, an anonymous phone survey was conducted to estimate HIVST positivity rates and linkage to confirmatory testing and care. This two-step survey involved an initial recruitment phase from March to June 2021 where participants were encouraged via leaflets to call a free phone number and complete a sociobehavioural questionnaire. This was followed by a second phase in September and October 2021, where participants who reported a reactive HIVST result were re-contacted to complete a further questionnaire. Of the 2 615 participants recruited during the first phase, 89.7% reported consistent results (2 visible lines and result interpreted as reactive; one line and interpreted as non-reactive; or no/one line and interpreted as invalid). HIVST positivity rates varied between 2.4% to 9.1% based on calculation methods (i.e. self-interpreted result or reported number of lines, inclusion or exclusion of don t knows and refusals). The second phase saw 78 out of 126 eligible participants complete the questionnaire. Of the 27 who reported a consistent reactive result in the first phase, 15 (56%, 95%CI: 36 to 74%) underwent confirmatory HIV testing, with 12 (80%) confirmed as HIV-positive, all of whom began antiretroviral treatment. The confirmation rate of HIVST results was fast, with 53% doing so within a week and 91% within three months of self-testing. Two-thirds (65%) went to a general public facility, and one-third to a facility dedicated to key populations. The ATLAS HIVST distribution strategy reached people living with HIV in West Africa. Linkage to confirmatory testing remained sub-optimal in these first years of HIVST implementation. However, if confirmed HIV-positive, almost all initiated treatment. HIVST constitutes a relevant complementary tool to existing screening services.

International audience; BackgroundHIV testing is a central element of the strategy to end AIDS epidemic, as status awareness is the entry point to HIV care. In West Africa, only 68% of people living with HIV (PLHIV) were aware of their HIV status in 2019. To address the testing gap, the ATLAS project distributed a total of 400000 self-tests (HIVST) in three West African countries between 2019 and 2022, including 200 000 kits in Côte d’Ivoire. The aim of this study is to assess levels and correlates of knowledge, attitude and practice towards HIV conventional testing (tests other than HIVST) and self-testing after the introduction of HIVST in Cote d’Ivoire.MethodWe conducted the population-based cross-sectional in the Bas-Sassandra District of Côte d’Ivoire, 24 months after HIVST was introduced in the region by ATLAS. ATLAS Household Survey (AHS) used a three-stage stratified sampling approach – 3 of the strata are the 3 departments with ATLAS activities and 1 includes departments with almost none, each further stratified on urban and rural settings. Face-to-face interviews were conducted in a representative a sample of the population aged 15-49. One main objective of the survey was to assess the effect of the ATLAS initiative on HIV testing.Weighed proportions and chi-square tests were used to assess knowledge of, attitude towards and practice of HIV conventional and self testing, comparing male and female on the one hand and departments with and without ATLAS HIVST distribution activities on the other hand. Logistic regressions were used to identified factors associated with knowledge of, attitude towards and practice of HIV conventional and self testing (ongoing analysis).Preliminary resultsA total of 6274 people with median age of 29 were interviewed and completed the questionnaire (3205 males and 3069 females). Most participants were in couple (44% males and 59% females) and have attended school (63% males and 45% females).Despite most participants knowing about HIV-AIDS (97 % Males and 96% females), very few reported having heard about HIVST (11% males and 10% females). However, most participants showed a positive attitude toward HIVST and reported that they would be interested/very interested to use it if freely available for themselves (75% males and 71% females), as well as for their sexual partners. About 18% of females and 10% of males reported having performed at least 1 conventional test in the last 12 months, while 3% of participants had already used a HIVST in the past.ConclusionAlthough knowledge and use of HIVST remain relatively low in the region, participants show a positive attitude toward HIVST, and express willingness to use it if freely available. Next results will tell how the observed results differ between participants living in department with ATLAS HIVST distribution and others, and how significant are the differences. It will also provide an overview of associated factors. This will provide policy makers with tools for potential actions in order to improve HIV testing and advance progress towards UNAIDS targets to achieve 95 % of PLHIV who know their status by 2025.

National audience; La cartographie établie par la Dress (service statistique du ministère de la santé) des sources de la statistique publique rappelle sa richesse et sa diversité. Elle montre aussi en creux la diversité des moyens pour y accéder, et l’absence d’un portail unique pour la diffusion de ces données.Notre présentation vise à expliquer les raisons qui peuvent expliquer cette apparente complexité. Les lois qui protègent les données de santé et les données personnelles, mais aussi les exceptions permettant aux chercheurs d’y accéder, ont en effet entraîné la mise en place de dispositifs différenciés pour leur diffusion. Nous exposerons donc dans un premier temps le cadre légal français, avant de présenter les solutions construites pour ouvrir ces données aux chercheurs.

International audience; Background: Circulation of multidrug-resistant bacteria (MRB) in healthcare facilities is a major public health problem. These settings have been greatly impacted by the Coronavirus Disease 2019 (COVID-19) pandemic, notably due to surges in COVID-19 caseloads and the implementation of infection control measures. We sought to evaluate how such collateral impacts of COVID-19 impacted the nosocomial spread of MRB in an early pandemic context.Methods and findings: We developed a mathematical model in which Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and MRB cocirculate among patients and staff in a theoretical hospital population. Responses to COVID-19 were captured mechanistically via a range of parameters that reflect impacts of SARS-CoV-2 outbreaks on factors relevant for pathogen transmission. COVID-19 responses include both "policy responses" willingly enacted to limit SARS-CoV-2 transmission (e.g., universal masking, patient lockdown, and reinforced hand hygiene) and "caseload responses" unwillingly resulting from surges in COVID-19 caseloads (e.g., abandonment of antibiotic stewardship, disorganization of infection control programmes, and extended length of stay for COVID-19 patients). We conducted 2 main sets of model simulations, in which we quantified impacts of SARS-CoV-2 outbreaks on MRB colonization incidence and antibiotic resistance rates (the share of colonization due to antibiotic-resistant versus antibiotic-sensitive strains). The first set of simulations represents diverse MRB and nosocomial environments, accounting for high levels of heterogeneity across bacterial parameters (e.g., rates of transmission, antibiotic sensitivity, and colonization prevalence among newly admitted patients) and hospital parameters (e.g., rates of interindividual contact, antibiotic exposure, and patient admission/discharge). On average, COVID-19 control policies coincided with MRB prevention, including 28.2% [95% uncertainty interval: 2.5%, 60.2%] fewer incident cases of patient MRB colonization. Conversely, surges in COVID-19 caseloads favoured MRB transmission, resulting in a 13.8% [-3.5%, 77.0%] increase in colonization incidence and a 10.4% [0.2%, 46.9%] increase in antibiotic resistance rates in the absence of concomitant COVID-19 control policies. When COVID-19 policy responses and caseload responses were combined, MRB colonization incidence decreased by 24.2% [-7.8%, 59.3%], while resistance rates increased by 2.9% [-5.4%, 23.2%]. Impacts of COVID-19 responses varied across patients and staff and their respective routes of pathogen acquisition. The second set of simulations was tailored to specific hospital wards and nosocomial bacteria (methicillin-resistant Staphylococcus aureus, extended-spectrum beta-lactamase producing Escherichia coli). Consequences of nosocomial SARS-CoV-2 outbreaks were found to be highly context specific, with impacts depending on the specific ward and bacteria evaluated. In particular, SARS-CoV-2 outbreaks significantly impacted patient MRB colonization only in settings with high underlying risk of bacterial transmission. Yet across settings and species, antibiotic resistance burden was reduced in facilities with timelier implementation of effective COVID-19 control policies.Conclusions: Our model suggests that surges in nosocomial SARS-CoV-2 transmission generate selection for the spread of antibiotic-resistant bacteria. Timely implementation of efficient COVID-19 control measures thus has 2-fold benefits, preventing the transmission of both SARS-CoV-2 and MRB, and highlighting antibiotic resistance control as a collateral benefit of pandemic preparedness.

International audience

Fin 2013, la Guinée est touchée par une épidémie d’Ebola qui prend rapidement une ampleur majeure et se diffuse aux pays voisins. Un processus de Riposte épidémique est instauré par les autorités nationales et les institutions sanitaires internationales afin de contenir et stopper l’épidémie. Des projets de recherche incluant des essais cliniques pour un vaccin efficace et des études sur les conséquences de la maladie sur les sortis-guéris sont rapidement mis en place pendant et après l’épidémie, dont la fin officielle est déclarée en 2016. En février 2021, une résurgence de l’épidémie d’Ebola est officiellement déclarée en Guinée forestière par les autorités nationales. La maladie est identifiée avec l’aide du président par intérim de l’association de survivants d'Ebola en Guinée forestière, qui tient une clinique dans la ville deN’Zérékoré : alors que l’on transporte à l’hôpital une femme atteinte par la maladie, il reconnaît les symptômes du virus Ebola et conseille aux soignants de se protéger et de faire tester la patiente. Le test s’avère positif et le dispositif de Réponse épidémique est lancé par le gouvernement guinéen et ses institutions. La mobilisation des sortis-guéris – qu’elle soit située ou plus large, ponctuelle ou continue – participe ainsi à faire émerger une compétence locale de la surveillance épidémique. Du fait de leurs compétences et connaissances acquises par l’expérience de la maladie, ces derniers constituent des acteurs importants dans la prévention des futures épidémies. Dans ce contexte, le Centre de Recherche et de Formation en Infectiologie de Guinée (CERFIG), déjà à l’initiative de plusieurs projets de recherche avec les sortis-guéris – notamment le projet POSTEBOGUI de 2015 à 2019 sur les conséquences cliniques, immuno-virologiques et psycho-sociales de la maladie, ainsi qu’une recherche anthropologique lors de la résurgence d’Ebola en 2021 en Guinée forestière – propose d’examiner comment et dans quelles conditions les sortis-guéris peuvent mobiliser leurs connaissances afin de devenir des acteurs de la gestion du risque sanitaire et de participer de manière formelle ou informelle à la surveillance épidémique sur le territoire guinéen. Si des programmes sont actuellement mis en œuvre visant à évaluer le risque biologique d’une résurgence à partir des sortis-guéris, le présent rapport analyse les opportunités et conditions de la mobilisation des sortis-guéris dans le système de surveillance épidémique communautaire pour leur expertise.

La gravité des difficultés d'attractivité de l'hôpital public nécessite d'agir rapidement et simultanément sur un ensemble de leviers (réglementaires, financiers, managériaux, organisationnels et de formation) et de transformer en profondeur les relations interprofessionnelles au sein de l'hôpital. Restaurer l'attractivité de l'hôpital public ne peut consister à retourner à un hypothétique âge d'or ; il s'agit d'inventer ensemble les conditions du "bien soigner" au XXIe siècle.

Si la Côte d’Ivoire a ratifié plusieurs textes sur les pesticides, des questions demeurent : ces politiques sont-elles mises en œuvre ? Comment le sont-elles ? Pourquoi ne le sont-elles pas ou le sont-elles partiellement ? Dans ce vaste champ réglementaire, nous nous sommes intéressés à la politique d’agrément des revendeurs de pesticides. Nous cherchons à comprendre les expériences sociales relatives à l’exécution de la politique d’agrément des revendeurs de pesticides, ainsi que les ressorts sociaux de la difficile mise en œuvre de cette politique.La recherche qualitative, à Bouaké et Abidjan, a mobilisé des méthodes comme l’immersion avec tenue d’un journal de terrain ; l’observation et l’entretien ; la capture d’images et la recension de documents. Le recueil des données a été réalisé de novembre 2019 à janvier 2020 puis de février à juin 2021. Il ciblait les revendeurs de pesticides, les firmes agrochimiques et les institutions privées et publiques intervenant dans l’agrément des revendeurs. Le matériau est principalement constitué de 25 entretiens, 103 images et 30 comptes rendus de terrain.Les résultats révèlent que la Côte d’Ivoire dispose d’une procédure effective et de services publics chargés de délivrer des agréments aux revendeurs de pesticides, qui permettent, a minima et très partiellement, d’encadrer la vente des pesticides et de former les revendeurs. La difficile mise en œuvre de cette politique d’agrément s’explique en partie par des entraves institutionnelles et certains imaginaires sur la fiscalité.La mise en œuvre de la politique d’agrément des revendeurs de pesticides impose la prise en compte de la complexité de l’enchevêtrement des logiques des acteurs en interaction dans le processus de commercialisation des pesticides (revendeurs, associations syndicales, structures de formation, ministères de tutelle, etc.).

International audience; Pesticides, pollution de l’air, de l’eau et des aliments, changements climatiques, menaces biologiques, chimiques, radiologiques, épidémies et inégalités environnementales de santé… Les sujets d’inquiétude quant aux conséquences de la dégradation de l’environnement sur notre santé sont nombreux et ont besoin d’être compris et analysés à l’aide des connaissances scientifiques actuelles. Unique dans le paysage éditorial et scientifique francophone, cet ouvrage présente les méthodes et approches de la santé publique environnementale d’aujourd’hui. Cette 2e édition s’enrichit de nouvelles perspectives comme la démarche « Une seule santé », le concept d’exposome, et offre une vision globale des impacts sanitaires des changements climatiques. Présentant les grands défis écologiques et les inégalités socio-environnementales de notre temps, plus de 150 auteurs s’appuient sur les données les plus récentes, établissent des objectifs au gré d’exemples illustrés et d’études de cas en Europe, en Afrique et en Amérique du Nord. Alors que les programmes axés sur la santé publique, la santé environnementale, la santé au travail et les sciences de l’environnement connaissent un engouement sans précédent, cet ouvrage est une référence pour les étudiants, enseignants, chercheurs et professionnels de ces disciplines, ainsi que pour les organisations publiques et associatives dans toute la francophonie. (R.A.)

International audience; Objectives: Pneumococcal immunization is recommended in dialysis patients. We aimed to estimate pneumococcal vaccination coverage among patients who initiate dialysis in France, and its association with mortality. Methods: Data were extracted from two prospective national databases, merged using a deterministic linkage method: renal epidemiology and information network (REIN) registry, which includes all patients on dialysis and kidney transplants recipients in France, and the national health insurance information system (SNIIRAM) which collects individual data on health expenditure reimbursement, including vaccines. We enrolled all patients who initiated chronic dialysis in 2015. Data on health status at dialysis initiation, dialysis modalities, and pneumococcal vaccine prescribed from 2 years before to 1 year after dialysis start were collected. Univariate and multivariate Cox proportional hazard models were used to assess one-year all-cause mortality. Results: Among the 8,294 incident patients included, 1,849 (22.3 %) received at least one pneumococcal vaccine before (n = 542, 6.5 %), or after (n = 1,307, 15.8 %) dialysis start, as follows: 13-valent pneumococcal conjugated vaccine (PCV13) followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23), n = 938 (50.7 %); only PPSV23, n = 650 (35.1 %); or only PCV13, n = 261 (14.1 %). Vaccinated patients were younger (mean, 66.5 ± 14.8 years vs. 69.0 ± 14.9 years, P ≤ 0.001), more likely to suffer from glomerulonephritis (17.0 % vs. 11.0 %, P ≤ 0.001), and less likely to start dialysis in emergency (27.2 % vs. 31.1 %, P = 0.001). On multivariate analysis, patients who received PCV13 and PPSV23, or only PCV13 were less likely to die (respectively, HR = 0.37; 95 %CI 0.28–0.51, and HR = 0.35; 95 %CI 0.19–0.65). Conclusions: Pneumococcal immunization with PCV13 followed by PPSV23, or with PCV13 alone, but not with PPSV23 alone, is independently associated with decreased one year-mortality in patients who start dialysis.

International audience; Introduction: Data show the relevance of a comprehensive approach to health promotion to support children in developing health skills. Health-promoting holistic interventional researches are complex. The Alliance for health aims to enact and assess the impact of a comprehensive approach to health promotion at the school and community levels. This is an intersectoral project involving regional education authorities, regional public health agency, local policy makers, researchers, and local health promotion operators.Methods: This project involves 101 French primary schools and 97 associated municipalities in the AURA region randomly selected in an intervention and control groups. From September 2019 to June 2022, the intervention was implemented in the intervention group. Primary school teachers were provided training, support, and resources to develop a health-promoting environment in school according to the Health-Promoting Schools framework. Meanwhile, school deputies and territorial agents involved in extracurricular activities were provided training, support, and resources in the same aim. Intersectoral working sessions were promoted. From September 2022 to June 2023, the intervention is implemented in the control group. Quantitative and qualitative data regarding indicators and processes were collected to evaluate the intervention in both groups before implementation, in spring 2021 and spring 2022. This abstract focuses on implementation outcomes based on semi-structured interviews conducted in Spring 2022.Results: Our sample included 11 district pedagogical advisors, 10 school principals, 9 school deputies, 2 extracurricular agents, 1 person in charge of after-school programs and 1 health promotion project manager. Schools’ perspective. Identified facilitators were constant and available referral, institutional support and dedicated time, aim and issues clear from the beginning, support from the community, multi-school training sessions, contextualized support. Barriers were COVID-pandemic, lack of community support, lack of time. Community perspective. Identified facilitators were health promotion perceived legitimacy, collective motivation, regular and effective working sessions. Barriers were perceived methodological incompetence, administrative burden, lack of time.Conclusions: Collective work dynamics, practices’ exchanges, health promotion professional identity are essential implementation components. Lack of time is perceived as a structural barrier. Communities pointed out perceived legitimacy and competences as corner-stones of their engagement. These interesting outcomes are to be confronted to data collected in the control group in spring 2023.