Oskar Bordeaux
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Soc Psychiatry Psychiatr Epidemiol
No full textPURPOSE: In 2019, 31% and 14% of young women and men worldwide - respectively - reported being not engaged in employment, education, or training (NEET), an important indicator of long-term socioeconomic vulnerability. This study examined the developmental pathways leading to NEET status in young adulthood by investigating the association between perinatal adversities and NEET status and the mediating role of adolescent externalizing behaviours. METHODS: Data were from the Québec Longitudinal Study of Child Development (QLSCD, n = 974). Latent class analysis identified four profiles of exposures to 30 perinatal adversities: Low adversity, the reference group; Fetal growth adversity, which includes participants experiencing adversity related to growth problems in utero and after birth; Delivery complications, which includes participants - or their mothers - who experience complications during birth; and Familial adversity, which includes participants who experienced adversity related to their family life. The associations between the perinatal profiles, NEET status - which was self-reported at age 21 years - and the putative mediating role of externalizing behavioural problems (self-reported at ages 15 and 17) were investigated using structural equation modeling. RESULTS: The risk of becoming NEET at age 21 was higher for children who experienced familial (OR = 3.19 [95% CI: 2.31-4.40], p < 0.001) and fetal growth (2.03 [1.11-3.71], p = 0.022) adversity. Externalizing behaviour problems mediated the association between familial adversity and NEET status (1.17 [1.05-1.30], p = 0.004). CONCLUSION: Interventions targeting perinatal risk factors and adolescent mental health can contribute to efforts to prevent NEET status in young adulthood
BMJ Glob Health
Get PDFIntroduction We describe the 24-month incidence of Dolutegravir (DTG)-containing antiretroviral treatment (ART) initiation since its introduction in 2019 in West Africa. Methods We included all patients aged 0-24 years on ART from nine clinics in C & ocirc;te d'Ivoire (n=4), Ghana, Nigeria, Mali, Benin, and Burkina Faso. Baseline varied by clinic and was defined as date of first DTG prescription; patients were followed up until database closure/death/loss to follow-up (LTFU, no visit >= 7 months), whichever came first. We computed the cumulative incidence function for DTG initiation; associated factors were explored in a shared frailty model, accounting for clinic heterogeneity. Results Since 2019, 3350 patients were included; 47.2% were female; 78.9% had been on ART >= 12 months. Median baseline age was 12.5 years (IQR 8.4-15.8). Median follow-up was 14 months (IQR 7-22). The overall cumulative incidence of DTG initiation reached 22.7% (95% CI 21.3 to 24.2) and 56.4% (95% CI 54.4 to 58.4) at 12 and 24 months, respectively. In univariate analyses, those aged 10 years were less likely to initiate DTG compared with males of the same age (adjusted HR among 10-14 years: 0.62, 95% CI 0.54 to 0.72; among >= 15 years: 0.43, 95% CI 0.36 to 0.50), as were those with detectable VL (>50 copies/mL) compared with those in viral suppression (aHR 0.86, 95% CI 0.77 to 0.97) and those on PIs compared with those on non-nucleoside reverse-transcriptase inhibitors (aHR after 12 months of roll-out: 0.75, 95% CI 0.65 to 0.86). Conclusion Paediatric DTG uptake was incomplete and unequitable in west African settings: DTG use was least likely in children = 10 years and those with detectable VL. Maintained monitoring and support of treatment practices is required to better ensure universal and equal uptake
Nephrol Ther
No full textEn 2024, la dialyse connaît des avancées, notamment sur le plan environnemental. La « dialyse verte » se profile comme une priorité avec la réduction de l’empreinte carbone des centres de dialyse (consommation d’eau et de ressources, déplacement des patients). Des stratégies innovantes, comme l’ajustement du débit et de la température du dialysat, ont montré une efficacité similaire à celle de la dialyse standard sur le Kt/V tout en diminuant la consommation d’eau. Une revue Cochrane récente confirme l’équivalence entre la dialyse péritonéale (DP) et l’hémodialyse (HD) en termes de mortalité. L’hémodiafiltration (HDF) revient par ailleurs sur le devant de la scène grâce à l’étude CONVINCE et ses études ancillaires, qui montrent une réduction du risque de mortalité et une amélioration de la qualité de vie. De plus, des adaptations techniques permettent d’envisager une HDF plus respectueuse de l’environnement. Les stratégies d’anticoagulation évoluent également : la dialyse sans héparine, par dialysat sans calcium et la réinjection asservie à la dialysance ionique, font preuve de leur efficacité. Une grande étude française, basée sur le registre Rein et le Système national de données de santé (SNDS), montre que les anticoagulants oraux directs, en particulier l’apixaban, bien que hors autorisation de mise sur le marché (AMM) en dialyse, offrent des perspectives intéressantes pour réduire le risque thromboembolique. L’inflammation chronique, source majeure de risque cardiovasculaire chez les dialysés, fait l’objet d’essais thérapeutiques ciblant l’IL-6 (clazakizumab), avec des résultats de phase II encourageants. Parallèlement, la gestion du sodium du dialysat est réévaluée : une réduction individualisée permet de mieux contrôler la pression artérielle mais doit être utilisée avec prudence chez certains patients. Enfin, chez les personnes âgées contre-indiquées à la transplantation, l’instauration d’une hémodialyse apporte un bénéfice de survie modeste, parfois au détriment du temps passé à domicile. Les décisions entre la dialyse et le choix de ne pas dialyser (traitement conservateur) doivent donc s’appuyer sur les préférences et la qualité de vie du patient.In 2024, dialysis is experiencing advancements, particularly in environmental sustainability. “Green dialysis” is emerging as a priority, aiming to reduce the carbon footprint of dialysis centers (water and resource consumption, patient transportation). Innovative strategies, such as adjusting dialysate flow rate and temperature, have demonstrated similar effectiveness to standard dialysis in terms of Kt/V while reducing water consumption. A recent Cochrane review confirms the equivalence between peritoneal dialysis (PD) and hemodialysis (HD) in terms of mortality. Additionally, hemodiafiltration (HDF) is regaining attention thanks to the CONVINCE study and its ancillary studies, which show a reduction in mortality risk and an improvement in quality of life. Furthermore, technical adaptations are making HDF more environmentally friendly. Anticoagulation strategies are also evolving: heparin-free dialysis, using calcium-free dialysate and reinjection controlled by ionic dialysance, has proven effective. A large French study based on the Rein registry and the National Health Data System database shows that direct oral anticoagulants, particularly apixaban, although not officially approved for dialysis (off-label use), offer promising prospects for reducing thromboembolic risk. Chronic inflammation, a major cardiovascular risk factor in dialysis patients, is the focus of therapeutic trials targeting IL-6 (clazakizumab), with encouraging phase II results. Meanwhile, dialysate sodium management is being reassessed: individualized reductions can help better control blood pressure but must be used cautiously in certain patients. Finally, in elderly patients contraindicated for transplantation, initiating hemodialysis provides only a modest survival benefit, sometimes at the cost of reduced time spent at home. Decisions between dialysis and conservative management (opting not to dialyze) should therefore be guided by patient preferences and quality of life. En 2024, la dialyse connaît des avancées, notamment sur le plan environnemental. La « dialyse verte » se profile comme une priorité avec la réduction de l’empreinte carbone des centres de dialyse (consommation d’eau et de ressources, déplacement des patients). Des stratégies innovantes, comme l’ajustement du débit et de la température du dialysat, ont montré une efficacité similaire à celle de la dialyse standard sur le Kt/V tout en diminuant la consommation d’eau. Une revue Cochrane récente confirme l’équivalence entre la dialyse péritonéale (DP) et l’hémodialyse (HD) en termes de mortalité. L’hémodiafiltration (HDF) revient par ailleurs sur le devant de la scène grâce à l’étude CONVINCE et ses études ancillaires, qui montrent une réduction du risque de mortalité et une amélioration de la qualité de vie. De plus, des adaptations techniques permettent d’envisager une HDF plus respectueuse de l’environnement. Les stratégies d’anticoagulation évoluent également : la dialyse sans héparine, par dialysat sans calcium et la réinjection asservie à la dialysance ionique, font preuve de leur efficacité. Une grande étude française, basée sur le registre Rein et le Système national de données de santé (SNDS), montre que les anticoagulants oraux directs, en particulier l’apixaban, bien que hors autorisation de mise sur le marché (AMM) en dialyse, offrent des perspectives intéressantes pour réduire le risque thromboembolique. L’inflammation chronique, source majeure de risque cardiovasculaire chez les dialysés, fait l’objet d’essais thérapeutiques ciblant l’IL-6 (clazakizumab), avec des résultats de phase II encourageants. Parallèlement, la gestion du sodium du dialysat est réévaluée : une réduction individualisée permet de mieux contrôler la pression artérielle mais doit être utilisée avec prudence chez certains patients. Enfin, chez les personnes âgées contre-indiquées à la transplantation, l’instauration d’une hémodialyse apporte un bénéfice de survie modeste, parfois au détriment du temps passé à domicile. Les décisions entre la dialyse et le choix de ne pas dialyser (traitement conservateur) doivent donc s’appuyer sur les préférences et la qualité de vie du patient
Eur Child Adolesc Psychiatry
No full textIndividual differences in physical aggression (PA) are largely heritable. However, it remains unclear how genetic propensity for aggression manifests early in life and relates to school-age PA. Preschool externalizing behavior problems (EXT) and adverse experiences are known predictors of school-age PA and also partly heritable. We investigated whether early childhood EXT and adverse experiences mediated the association between polygenic scores and school-age PA. Genotype data collected from 721 participants in the Quebec Longitudinal Study of Child Development (45% males) were used to derive polygenic scores for aggression (PGS) and attention deficit/hyperactivity disorder (PGS). PA was reported annually or biennially on six occasions between ages 6 and 13 by distinct teachers. Mothers reported EXT (PA, hyperactivity, opposition) and adverse experiences (peer difficulties and harsh parenting) on three occasions between ages 3½ and 5. Both PGSs proved significant predictors of school-age PA. However, no early behaviors or adverse experiences mediated the association between PGS and school-age PA. Contrastingly, hyperactivity and opposition each partially mediated the association between PGS and school-age PA. Notably, when both mediators were included in the same model, only hyperactivity remained significant. This study contributes to identifying early manifestations of genetic risk for PA, which may serve as early targets for intervention
BMC Public Health
Get PDFBackgroundThe aim of this study was to analyse the incidence and mortality from various digestive cancer sites and their potential link with pleural plaques, in a French cohort of workers previously occupationally exposed to asbestos.MethodsWe conducted a 10-year follow-up study in 13,481 male subjects, included in the cohort between October 2003 and December 2005, for whom asbestos exposure was assessed by calculation of a cumulative exposure index (CEI) in equivalent fibres.years/mL for each subject. We conducted an incidence study and a mortality study. Complementary analysis was restricted to men who had performed at least one chest CT-scan (N = 4,794). We used a Cox model with age as the time axis variable, adjusted for smoking, time since first exposure (TSFE), CEI to asbestos and the existence of pleural plaques on CT-scan.ResultsIn the incidence study, a significant dose-response relationship was observed between CEI to asbestos and oesophageal cancer (HR 1.03, 95% CI [1.01-1.06]) in the entire cohort after adjustment for TSFE and smoking status. In subjects undergoing CT-scan, a significant association between pleural plaques was observed for oesophageal cancer incidence (HR 2.80, 95% CI [1.09-7.20]) and in the mortality study, multivariate analyses showed a significant dose-effect response between CEI to asbestos and death from oesophageal cancer (HR 1.03, 95% CI [1.00-1.05]) in the entire cohort.ConclusionsThis large-scale study confirms results concerning a likely relationship between asbestos exposure and oesophageal cancer, and the association between this cancer and pleural plaques after adjustment on CEI to asbestos
Arch Clin Neuropsychol
No full textBACKGROUND: End-stage chronic kidney disease (CKD) is a significant concern for older adults and is often associated with cognitive impairment (CI). The origin of this CI is multifactorial, involving vascular and metabolic factors. Additionally, renal treatments, including dialysis, may affect cognition. This study aimed to assess the neuropsychological profiles of these patients and understand the effects of dialysis treatment. METHODS: We conducted an observational retrospective study including older adults with end-stage CKD attending for kidney transplantation (KT). Comprehensive neuropsychological assessments were conducted. Composite cognitive scores were computed. Multivariate regression models were used to assess associations between cognition and dialysis status. RESULTS: We included 223 patients (151 treated with dialysis, 72 with conservative management), mean age of 73.5 ± 3.4. We observed a high prevalence of CI, around 30% for global cognition and affecting all neuropsychological domains. Patients treated with dialysis exhibited lower cognitive performance compared to those not undergoing dialysis, particularly in episodic (p = .031) and working memory (p = .024). CONCLUSION: This study confirms the high prevalence of CI in end-stage CKD, with dialysis being associated with worse episodic and working memory compared to non-dialyzed participants. Future investigations are needed to track the long-term cognitive trajectory of patients on the KT waiting list and post-transplantation. TRIAL REGISTRATION: Retrospectively registered, no 22-808 on July 7th, 2022, CNIL register number 22-5808
Lancet
Get PDFBACKGROUND: Direct oral anticoagulants (DOACs) reduce the rate of thromboembolism in patients with atrial fibrillation but the benefits and risks in survivors of intracerebral haemorrhage are uncertain. We aimed to determine whether DOACs reduce the risk of ischaemic stroke without substantially increasing the risk of recurrent intracerebral haemorrhage. METHODS: PRESTIGE-AF is a multicentre, open-label, randomised, phase 3 trial conducted at 75 hospitals in six European countries. Eligible patients were aged 18 years or older with spontaneous intracerebral haemorrhage, atrial fibrillation, an indication for anticoagulation, and a score of 4 or less on the modified Rankin Scale. Patients were randomly assigned (1:1) to a DOAC or no anticoagulation, stratified by intracerebral haemorrhage location and sex. Only the events adjudication committee was masked to treatment allocation. The coprimary endpoints were first ischaemic stroke and first recurrent intracerebral haemorrhage. Hierarchical testing for superiority and non-inferiority, respectively, was performed in the intention-to-treat population. The margin to establish non-inferiority regarding intracerebral haemorrhage was less than 1·735. The safety analysis was done in the intention-to-treat population. The trial is registered with ClinicalTrials.gov, NCT03996772, and is complete. FINDINGS: Between May 31, 2019, and Nov 30, 2023, 319 participants were enrolled and 158 were randomly assigned to the DOAC group and 161 to the no anticoagulant group. Patients' median age was 79 years (IQR 73-83). 113 (35%) of 319 patients were female and 206 (65%) were male. Median follow-up was 1·4 years (IQR 0·7-2·3). First ischaemic stroke occurred less frequently in the DOAC group than in the no anticoagulant group (hazard ratio [HR] 0·05 [95% CI 0·01-0·36]; log-rank p<0·0001). The rate of all ischaemic stroke events was 0·83 (95% CI 0·14-2·57) per 100 patient-years in the DOAC group versus 8·60 (5·43-12·80) per 100 patient-years in the no anticoagulant group. For first recurrent intracerebral haemorrhage, the DOAC group did not meet the prespecified HR for the non-inferiority margin of less than 1·735 (HR 10·89 [90% CI 1·95-60·72]; p=0·96). The event rate of all intracerebral haemorrhage was 5·00 (95% CI 2·68-8·39) per 100 patient-years in the DOAC group versus 0·82 (0·14-2·53) per 100 patient years in the no anticoagulant group. Serious adverse events occurred in 70 (44%) of 158 patients in the DOAC group and 89 (55%) of 161 patients in the no anticoagulant group. 16 (10%) patients in the DOAC group and 21 (13%) patients in the no anticoagulant group died. No patients died in the placebo group. INTERPRETATION: DOACs effectively prevent ischaemic strokes in survivors of intracerebral haemorrhage with atrial fibrillation but a part of this benefit is offset by a substantially increased risk of recurrent intracerebral haemorrhage. To optimise stroke prevention in these vulnerable patients, further evidence from ongoing trials and a meta-analysis of randomised data is needed, as well as the evaluation of safer medical or mechanical alternatives for selected patients. FUNDING: European Commission
La filière méthanisation au défi de sa démocratisation. Quelle participation pour quels publics ?
No full textLes cahiers de doléances de l’Orne et du Finistère (2018-2019). Matérialité des cahiers, conditions d’énonciation et de participation. Note de recherche ANR Gilets jaunes
No full textLa démarche de l'enquête restituée dans cette note de recherche s'inscrit dans la continuité des études sur les doléances à l'échelle départementale. En s'appuyant sur une analyse quantitative des doléances recueillies dans l'Orne et le Finistère, ainsi que sur une enquête qualitative de terrain réalisées dans le cadre d'un stage (ANR GILETSJAUNES), cette note apporte un éclairage sur les conditions de production de ces cahiers ainsi que sur les conditions d'énonciation propres aux contributeurs et contributrices, avec un accent mis sur le rapport des Gilets jaunes à ces cahiers.Les Gilets jaunes : approches pluridisciplinaires des mobilisations et politisations populaire
Nephrol Dial Transplant
No full textBACKGROUND AND HYPOTHESIS: Knowledge regarding access to first kidney transplantation (KT) and subsequent KT in patients commencing kidney replacement therapy (KRT) in childhood is limited. METHODS: Using European Renal Association (ERA) Registry data, we investigated European patients who started KRT below 20 years of age between 1978 and 2019. Access and determinants to first, second and third KT were assessed using multivariable Cox regression. RESULTS: 12 623, 4077, and 1186 patients were included while awaiting first, second and third KT, at median ages of 13.8 (IQR: 7.5-17.4), 20.9 (IQR: 16.5-26.1) and 26.6 (IQR: 20.3-32.8) years, respectively. During the study period, overall access was 87.8%, 72.7% and 60.5% for first, second and third KT, respectively, and median time to each KT was 0.9 (IQR: 0.2-2.1), 1.9 (0.6-4.5) and 2.6 (IQR: 1.0-5.3) years. Younger age at KRT initiation (aHR 0-4 vs. 10-14 years: 0.54; 95%CI: 0.51-0.57) and female sex (HR: 0.94; 95%CI: 0.90-0.98) were associated with lower access to first KT. KT candidates between 15-19 years had lower access to first and second KT (aHR: 0.69; 95%CI: 0.66-0.73, and aHR: 0.70; 95%CI: 0.61-0.81) compared to 10-14 year-olds. Compared to CAKUT, glomerulonephritis patients had lower access to KT (aHR: 0.75; 95%CI: 0.71-0.80 for first, aHR: 0.89; 95%CI: 0.81-0.98 for second and aHR: 0.80; 95%CI: 0.66-0.97 for third KT). Similarly, patients with primary renal diseases with high risk of recurrence, had lower chances of receiving a first and second KT (aHR: 0.80; 95%CI: 0.76-0.85 for first, aHR: 0.86; 95%CI: 0.78-0.95 for second KT). Access to re-transplantation was also higher with prior pre-emptive KT and previous graft survival exceeding five years. CONCLUSION: Our study highlights KT access disparities particularly for females, the youngest recipients, high-risk age (15-19 years), and diseases with recurrence risk. Notably, pre-emptive transplants and enduring previous grafts offer advantages regarding re-transplantation