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The effect of school-based interventions on HPV vaccine-related knowledge, attitudes, and practices among adolescents in France: Secondary results from the PrevHPV trial
No full textInternational audienceBackground: In France, HPV vaccine uptake among adolescents remains a public health concern. Therefore, we examined changes in French adolescents' knowledge, attitudes, and practices (KAP) following exposure to HPV-vaccination-related interventions.Methods: Our cluster-randomized trial applied an incomplete factorial design to allocate three intervention components (in-school education, free in-school vaccination, and general practitioner [GP] trainings) into six arms, randomly assigned to 91 French municipalities. Adolescents' (N = 2758; typically aged 13-14) self-reported HPV-vaccine-related KAP was assessed via online questionnaires at baseline and follow-up. Using logistic regression, we estimated the decomposed effects of each intervention component on favorable responses to individual KAP items. Each model adjusted for the baseline level of the outcome. We conducted subgroup analyses of the effect of the education component.Results: Adolescents who received in-school education, compared to those who did not, provided improved responses on all knowledge items at follow-up. They also reported more favorable attitudes, which included the perceived benefit-risk balance (OR = 1.6 [95 %-CI, 1.2-2.0]) and judging reduced onward transmission as important (1.5 [1.1-2.1]). In-school education increased the likelihood of having HPV-vaccine-related discussions with friends (1.8 [1.2-2.6]). In-school vaccination increased adolescents' likelihood of knowing that friends are vaccinated (3.1 [2.2-4.2]), and perceived accessibility (2.2 [1.5-3.2]). Perceived difficulties in accessing clear vaccine information increased specifically among multilingual adolescents (0.5 [0.2-0.9]).Conclusion: Free in-school HPV vaccination significantly increases perceived ease of access to HPV vaccination for students who are already motivated to get vaccinated, and in-school education and motivation improves students' HPV vaccine-related knowledge and attitudes and can encourage them to get vaccinated. Thus, when offered together over the course of multiple academic years, we would expect to see increased vaccine uptake as adolescents become both more amenable toward vaccination and perceive easier access. Educational material needs tailoring for families from different linguistic and cultural backgrounds
Changes in activity spaces, life spaces, and exposures to physical activity-promoting environments among women with overweight or obesity
No full textInternational audienceUnderstanding factors associated with successful adherence and maintenance of weight loss interventions is important to potentially increase efficacy. Activity spaces and environmental exposures are two understudied factors that may be associated with intervention adherence and outcomes. Women with overweight or obesity (n = 498) from two weight loss intervention studies, Reach for Health and Metabolic, Exercise, and Nutrition at University of California San Diego, wore accelerometer and Global Positioning System (GPS) devices for 1 week at baseline and at 6-month follow up. Changes in activity spaces and time spent in three life space domains (Home, Neighborhood, and Beyond Neighborhood) were assessed at the two timepoints for total time and the subset of time in physical activity (PA). Relationships between repeated GPS-measured exposure to PA promoting environments (walkability; recreation; and greenness) were assessed with linear mixed effects models with an interaction between intervention and timepoint. There was no significant change in the average total or PA-related activity space size. There was no significant change in the amount of total time spent in life space domains by intervention group. However, for PA time in life spaces, the Intervention group increased percent of PA time in the Neighborhood (1.49 %-1.71 %; p = 0.011) and Beyond Neighborhood domains (from 5.85 %-6.60 %; p < 0.0001), whereas PA time at Home was not significantly different (p = 0.755). For the mixed effects models with PA-related time, being in the Intervention group was associated with (-0.06, 95 % CI: -0.19, -0.07; p < 0.01) less exposure to walkability and this was attenuated at time 2, compared to controls. Results suggest that PA-focused interventions did not increase the size of participants' total and PA-related activity spaces but were associated with a higher percent of PA-related time outside of the home. There were not consistent associations between the Intervention group and increased exposure to PA-supportive environments
Glossaire de promotion de la santé : 40 notions pour améliorer la santé, le bien-être et l'équité
No full textNational audienceLa promotion de la santé vise à améliorer la santé, le bien-être et l’équité dans nos sociétés. Face aux défis actuels (climat, solidarité, accessibilité des services), elle agit sur les déterminants de la santé et favorise une approche démocratique des politiques publiques pour réduire les inégalités. Bien que de plus en plus présente dans l’espace public, cette notion suscite débats et questions sur ses concepts, recherches et pratiques. Ce glossaire propose 40 termes clés pour comprendre et appliquer les principes de la promotion de la santé. (extrait 4ème couv.
The synergistic and mediating effects of ozone on associations between high temperature, heatwaves and mortality in the Greater London area between 2010 and 2018.
No full textInternational audienceThe health impacts of increasing heat exposure are alarming, especially in a climate change era. The role of ozone in the extreme temperature-mortality association remains unclear. We examined the mechanisms through which ozone influences extreme temperature-mortality association in Greater London, UK, from 2010 to 2018. Employing a time-series analysis with generalized linear quasi-Poisson models, we quantified the effects of daily 8-hour maximum ozone concentrations, heatwaves, and extreme temperature on all-cause, respiratory and cardiovascular mortality. Interaction analyses were applied to assess the synergistic effects of ozone and heat-related exposures. A causal mediation analysis was utilized to decompose the total effect of high temperature/heatwave on mortality into direct and indirect effects. The risk of all-cause mortality during the warm season (May to September) increased by 1.3% (95% Confidence Interval (CI): 1.1%, 1.6%) for each 1°C increment in daily mean temperature. Heatwave days (two or more days with unusually high temperatures) were associated with an 8.6% (95% CI:6.9%, 10.4%) increase in all-cause mortality compared to non-heatwave days. These effects were more pronounced for respiratory mortality, i.e. 1.6% (95% CI: 1.0%, 2.2%) increase per 1°C increment in temperature and 9.6% (95% CI: 4.6%, 15.0%) increase during heatwaves. The risk of heat-related mortality increased on high ozone days, and high temperatures amplified the risk of ozone-related mortality. The proportion of the total effect of extreme temperature and heatwaves on all-cause mortality mediated by ozone was 8.5% and 8.8%, respectively. For respiratory mortality and heatwaves, the proportion mediated was 14.9%. Our findings show synergistic effects of ozone and extreme temperature on mortality, as well as mediating effects of ozone in the heat-mortality associations
Prognostic factors of disability progression in multiple sclerosis in real life: the OFSEP-high definition (OFSEP-HD) prospective cohort in France
No full textInternational audiencePurpose: To determine prognostic factors of disability in multiple sclerosis (MS), that is, (1) identify determinants of the dynamics of disability progression; (2) study the effectiveness of disease-modifying treatments (DMTs); (3) merge determinants and DMTs for creating patient-centred prognostic tools and (4) conduct an economic analysis.Participants: Individuals registered in the French Observatoire Français de la Sclérose en Plaques (OFSEP) database were included in this OFSEP-high definition cohort if they had a diagnosis of MS, were ≥15 years old and had an Expanded Disability Status Scale (EDSS) score <7. The outcomes will be assessed annually: (1) time to reach irreversible EDSS scores of 4, 6 and 7; (2) relapses and disease progression; (3) MRI-based progression, patient-reported outcomes, social consequences; and (4) combined outcomes on activity and progression. Clinical and quality-of-life data, MRI results and biological (blood, serum) samples will be collected at each follow-up.Findings to date: A cohort of 2842 individuals, 73.4% women, mean (SD) age of 42.7 (11.6) years, median disease duration of 8.8 years, has been recruited from July 2018 to September 2020. The course of MS was relapsing remitting in 67.7%, secondary progressive in 11.9%. The mean annual relapse rate was 0.98. The disease-modifying treatment received was highly effective therapy in 50.3% and moderately effective therapy in 30.7%.Future plans: The participants will be followed until December 2026. Disease course up to four landmarks will be examined as predictors of disease progression: (1) diagnosis of MS; (2) relapse activity worsening and independent progression; (3) any recent disease activity and (4) any visit with absence of disease activity in the past 5 years. The marginal effectiveness and tolerability of treatments will be assessed. Stratified algorithms will be proposed for medical decision-making. Economic evaluation of disease cost and cost-effectiveness of new DMTs will be conducted from a public payer perspective.Trial registration number: NCT0360345
What it takes to be a customer. The making of care markets in England
No full textInternational audienceOver the past 20 to 30 years, the role of local government in England has shifted from providing care to enabling it (Yeandle, 2016). The Care Act, introduced in 2014, was a major overhaul of the social care system (Hunter et al., 2020) and a further step in the way to entrusting local authorities with the duty to “shape” markets (Care Act 2014). Continuing cuts to local governments’ budgets, however, have challenged the “successful” implementation of the Act (Peckham et al., 2020; Marczak et al., 2022; Burn et al., 2024).I contend that the Care Act is one among several pieces of legislation whose objective is to bring about a care market. Changes made to local governments’ responsibilities tackled the supply side of the market. Although the introduction of cash for care mechanisms (Glendinning, 2012; Locke & West, 2018) turned service users into customers/employers, a whole range of new roles (jobs) is still needed to support the users in their new status of “rational” customers.To explore these new roles, I draw on two types of material. Firstly, I rely on the coding of semi-structured interviews conducted with health and social care professionals in one English local authority. Secondly, I build on the analysis of policy documents from statutory bodies organising the provision of care and support to older adults and people with disabilities
Aotearoa New Zealand’s ‘endgame’ legislation: a critical analysis of the parliamentary repeal debate using an adapted policy dystopia model approach
No full textInternational audienceIntroduction In February 2024, Aotearoa New Zealand’s newly elected coalition Government repealed policies to reduce the addictiveness, availability and accessibility of smoked tobacco. The repeal lacked a robust rationale, was contrary to public opinion, and passed under urgency, a process that bypasses external review. To inform international endgame policy development and implementation, we critically reviewed arguments presented during the repeal debate. Methods We analysed the verbatim parliamentary debate (Hansard) using an approach modelled on the Policy Dystopia Model, a framework developed to critique tobacco companies’ discursive strategies. We identified and reviewed counter-arguments alleging anti-democratic processes would increase health, economic and social inequities, and then classified these claims in relation to equity and democratic rights. Results Coalition arguments described structural policies as unnecessary and proposed returning to individually focused measures, such as smoking cessation support. Coalition party members claimed the repealed measures would have promoted illicit trade and retail crime, and reduced public safety and freedom, arguments favoured by tobacco companies. Opposition members’ arguments alleged antidemocratic processes breached constitutional obligations to Aotearoa’s Indigenous Peoples, and predicted socially and economically regressive outcomes would follow the repeal. Conclusions Coalition arguments presented dystopic outcomes while Opposition arguments highlighted process flaws that threatened democracy and equity. Researchers and advocates should continue to document the weak and contradictory empirical support for tobacco companies’ arguments. However, future activities should expose tobacco companies’ connections with politicians, demand stronger compliance with the Framework Convention on Tobacco Control and promote strong lobbying regulations
Quelles conditions pour une contribution des situations d’exercices physiques au travail à la prévention des TMS ? : approche ergonomique au travers d’une étude de cas multiples dans le BTP
No full textThis thesis based on an activity-based approach in ergonomics examines the pertinence of physical exercises sessions at work (warm-ups, muscular awakenings, stretching) as a means of preventing musculoskeletal disorders (MSDs) in the construction industry. Despite the fact that these practices are developing, their effectiveness is still discussed (Claudon et al., 2018).By implementing a multiple case study (Yin, 2009) we analyse these sessions as work situations in their own right. Thus, the activity of the facilitators, the organisation of the sessions, the perception of the companions and the integration of these actions into an overall prevention strategy are at the centre of the analysis.Based on the literature and an initial exploratory case study,an framework for analysis was developed.The results from six construction sites reveal a diversity of practices, a lack of leadership skills, divergent objectives between stakeholders and a lack of coordination with work organisation. The intervention on one of the cases shows that co-construction of these work situations increases their effectiveness, by integrating them into an overall prevention approach (Caroly et al., 2008).This work proposes to analyse and to conceive these physical exercise sessions as any other work situation, and to consider them as an entrance point towards a prevention of MSDs which is meant to be larger, extending over the individual dimension, by taking into account the organisation of the work and the participation of the stakeholders.Cette thèse en ergonomie de l’activité interroge la pertinence des séances d’exercices physiques au travail (échauffements, réveils musculaires, étirements) comme levier de prévention des troubles musculosquelettiques (TMS) dans le secteur du bâtiment et des travaux publics (BTP). Bien que ces pratiques se développent, leur efficacité reste discutée (Claudon et al., 2018).En mettant en oeuvre une étude de cas multiples (Yin, 2009) nous analysons ces séances comme des situations de travail à part entière. Ainsi, l’activité des animateurs, l’organisation des séances, la perception des compagnons et l’intégration de ces actions dans une stratégie de prévention globale sont au coeur de l’analyse.A partir de la littérature et d’un premier cas exploratoire, un cadre d’analyse a été conçu.Celui-ci repose sur onze conditions de mise en oeuvre de séances d’exercices physiques au travail.Les résultats issus de six chantiers de gros oeuvre révèlent une hétérogénéité des pratiques, un manque de compétences d’animation, des objectifs divergents entre acteurs et une faible articulation avec l’organisation du travail. L’intervention sur l’un des cas montre qu’une co-construction de ces situations de travail améliore leur efficacité, en les intégrant dans une démarche globale de prévention (Caroly et al., 2008).Ce travail propose d’analyser et de concevoir ces séances d’exercice physique comme toute situation de travail et les positionne comme point d’entrée vers une prévention des TMS qui se veut plus large, dépassant la seule dimension individuelle, en prenant en compte l’organisation du travail et participation des acteurs
Evaluation of the efficacy of PREVENIR (PREVention ENvIronment Reproduction) platforms on urinary markers of chemical exposure in pregnant women: protocol for an unblinded randomised clinical trial (PREVENIR-G)
No full textInternational audienceIntroduction It has been reported that pregnant women used more cosmetics daily than non-pregnant women. Phenoxyacetic acid is the main metabolite of phenoxyethanol, the most frequent preservative in cosmetics used in Europe, previously associated with reproductive effects (longer time to conception, endocrine disruptors in newborns and poorer verbal comprehension in children). In France, specialised platforms (PREVention ENvIronment Reproduction (PREVENIR)) in university hospital maternity wards are dedicated to evaluating environmental and occupational exposures in patients with pregnancy-related pathologies and supporting targeted prevention efforts. These platforms are composed of occupational health physicians, obstetrician-gynaecologists, midwives, occupational health nurses, and occupational health and environmental engineers. To assess the efficacy of these platforms, we developed a randomised clinical trial, the protocol for which is presented in this paper. The primary objective of the PREVENIR-G Study is to compare the change in urinary phenoxyacetic acid concentrations from baseline to 3 months postintervention between an intervention group and a control group. To date, the intervention has been integrated into routine care in certain facilities; however, its efficacy remains unproven. It is therefore essential to assess the relevance of this intervention, considering both its potential benefits and any adverse effects, such as increased stress or anxiety. Methods and analysis This study is an unblinded, randomised clinical superiority trial with two parallel groups (intervention vs no intervention) in four university maternity hospitals in France. We will include 300 pregnant women (aged 18 years or older) who are under 24 weeks of gestation (150 per group) referred to the participating PREVENIR platforms for management. The intervention will consist of clinical prevention management through the PREVENIR platforms, involving a consultation with an environmental health expert for an assessment of environmental and occupational exposures. During the consultation, targeted prevention messages will be provided based on identified exposures. The no intervention comparator will be a waiting-list control group. At the inclusion visit, patients will receive urine collection vials for samples to be collected at baseline and again at 3 months. Urine samples will be collected twice in a single day, on three separate days, during the collection week at home. In the week following the urine collection period, only participants in the intervention group will engage with the PREVENIR platforms. The primary outcome will be the difference in the urinary phenoxyacetic acid concentration between baseline and 3 months postintervention, compared between the intervention and control groups. Ethics and dissemination The study has been approved by the hospital ethics committee (CCP Ouest 2, no. 2023-A00941-44). All participants will provide written informed consent. Results will be shared through presentations and publications
Biochemical Foundations of Insecticide Resistance in Culex Mosquitoes from Minna, Nigeria: A Focus on Glutathione-S-Transferase and Protein Dynamics
No full textInternational audienceThe escalating challenge of insecticide resistance among mosquito populations presents a substantial obstacle to managing disease vectors across sub-Saharan Africa. This research delves into the biochemical foundations of this resistance in Culex mosquitoes collected from Minna, Nigeria, paying specific attention to shifts in protein levels and the activity of the detoxification enzyme glutathione-S-transferase (GST) after exposure to standard insecticides. Larvae gathered from the field were reared to adulthood and then subjected to standardized susceptibility tests using six different insecticides. We then used spectrophotometric techniques to compare the total protein concentration and GST enzyme activity between mosquitoes that survived the exposure (resistant) and those that died (susceptible). Our findings revealed that mosquitoes which survived insecticide exposure displayed a marked increase in GST activity, especially following contact with pyrethroid-based insecticides. Conversely, higher protein concentrations were consistently observed in the deceased mosquitoes, which may indicate that oxidative stress and associated protein damage are factors in their mortality. The pronounced rise in GST activity among the survivors strongly suggests that an enhanced capacity for detoxification is a critical mechanism enabling resistance in these Culex populations. This study underscores the value of biochemical markers in tracking resistance and offers crucial baseline information for guiding insecticide resistance management strategies in Nigeria. We recommend that ongoing surveillance of enzyme activity be incorporated into vector control initiatives to help design more effective interventions and prolong the usefulness of existing insecticides