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Understanding changes in welfare state regimes: some considerations
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Kinetic analysis of TCPP emission from fireproofed upholstered furniture under realistic indoor conditions
No full textPre-print : https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4925260.International audienceBetter understanding the characteristics and mechanisms governing the indoor emissions of organophosphorus flame-retardants is important to more accurately estimate the human exposure to these compounds and develop risk management strategies that protect human health. This study provides an analysis of short- and long-term trends in Tris(chloropropyl)phosphate (TCPP) emissions from furniture. It is based on the monitoring over a period of almost one year of TCPP concentrations in indoor air and at the surface of a source material (upholstered furniture made of polyurethane (PU) foam containing TCPP) in two rooms for office use. The emission rate was estimated at 8 µg.m-2.h-1 in average with no decline trend observed after about one year's emission. The released mass of TCPP over one year represented about 0.2 % of the initial content of TCPP in the material (2 % w/w). The source material/air partition coefficient (Kma) and its dependence on temperature appear to be the key parameters which control the emission rate. Kma was estimated at 8 × 107 for a temperature of 23 °C. The temperature dependence of Kma was addressed using the Clausius–Clapeyron relationship and the enthalpy of partitioning between the source material and air, ΔHma (previously estimated at 91 kJ mol−1). This study led to the development of a model providing predictions on the long-term trend in TCPP emission from the source material. The simulations showed that the emission should persist over extended periods (several years) with the same intensity level. This characteristic increases the risks associated with inhalation exposure to TCPP
Seasonally varying effects of improved water, sanitation and handwashing interventions on Giardia infection in Bangladesh
No full textInternational audienceBackground : Giardia is the most common enteric parasite among children in low-resource settings, causing diarrhoea and leading to prolonged infection or asymptomatic carriage. We assessed whether the effect of water, sanitation and handwashing (WSH) interventions on Giardia infection among rural Bangladeshi children varies with seasonal conditions. Methods : We conducted a secondary analysis of the WASH Benefits Bangladesh cluster-randomized trial, with 450 clusters assigned to four arms in a 2×2 factorial design (WSH: WSH, WSH+Nutrition; no WSH: Control, Nutrition). Giardia infection was measured by multiplex real-time PCR in stool samples after two years of intervention. Effects were estimated by marginal treatment and assessed for heterogeneity by season when Giardia was measured. We also assessed heterogeneity by cumulative exposure to dry and monsoon seasons from birth to measurement age to estimate the exposure history of Giardia . Results : Giardia prevalence, measured among 2773 children (median age: 30 months, range: 22-38 months), was higher in the dry seasons (32%) than in the monsoon (21%). The effect of WSH was consistent on the relative (20% reduction) and absolute scales, with slightly greater absolute reduction during the dry season (dry: −6.1%, −10.1% to −2.1%). With increasing dry-season exposure, the period of highest risk, prevalence remained consistently lower in the WSH group, with the largest differences between study groups among children with more than 17 months of dry-season exposure by age over two years. Conclusion : We demonstrate how WSH provides resilience to seasonal variation in infection risk and mitigates climate-driven, seasonally varying Giardia transmission. Key Messages What your research question was We investigated whether the effect of water, sanitation and handwashing (WSH) interventions on Giardia infection among rural Bangladeshi children varies with seasonal conditions. What you found We found that Giardia risk varied seasonally, with improved WSH providing consistent relative and absolute reductions — slightly greater on the absolute scale during the dry season — and larger reductions among children with greater cumulative exposure to dry months, reflecting higher baseline risk and demonstrating how WSH enhances resilience to seasonally varying infection risk. Why it is important Since the dry and monsoon seasonal cycle is extreme in Bangladesh, this study demonstrates how WSH can mitigate seasonally varying Giardia infection risk
Who are the healthcare professionals involved in interprofessional team meetings in French multidisciplinary primary care centres? A quantitative analysis of eight centres
No full textEn ligne sur ResearchSquare : https://www.researchsquare.com/article/rs-7086890/v1International audienceAbstract Background: Interprofessional collaboration is crucial for providing high-quality care to patients with complex conditions in primary care. In France, multidisciplinary primary care centres (MPCC) receive funding if they organise at least 6 interprofessional team meetings (ITM) per year to discuss complex patient situations and collectively define care strategies. It remains unclear how ITM have been implemented in France. This study analyses healthcare professionals’ involvement in ITMs within MPCCs. Method: A multicenter retrospective quantitative study in 8 French MPCCs based on the analysis of ITM reports for the period from 2018 to 2019 was conducted. Results: 1733 patients’situations (n=1733 cases) discussed during ITMs were analysed. The 8 MPCCs were heterogeneous in terms of geographical location, creation date, and size (3 MPCCs with >20,000 patients followed by more than 60 professionals and 3 MPCCs with <20 professionals). On average, five healthcare professionals attended each ITM, with huge variations among MPCCs. The nurse-general practitioner (GP) pair was central. At least one GP was present at 89% (n=1469) and nurses at 38.15% (n=630) of ITMs. Participation of other professionals was less frequent and varied according to the MPCC. Physiotherapists were present at 7.8% of ITMs, and other healthcare professionals were present at <6% of ITMs, including pharmacists (3% of ITMs). In some cases, external healthcare professionals, particularly those related to mental health, were also involved in ITMs. Conclusions: Depending on the MPCC, the professionals involved in ITM vary widely, with the nurse-GP pair at the centre. The relative absence of certain professionals needs to be analysed in order to encourage interprofessional working. Trial registration: not applicable
Évaluation de la consommation en psychotropes depuis la pandémie de Covid-19 chez les résidents de sept Ehpad, en Ille-et-Vilaine
No full textInternational audienceThis study aimed to determine the course of psychotropic drugs use since the Covid-19 pandemic onset among nursing homes (NH) residents in Brittany, France. We conducted a retrospective, observational, descriptive study, including 7 NH. We collected the data about antipsychotic, antianxiety, hypnotic and antidepressant drugs dispensed from January 2016 to June 2021, and compared their consumptions over 3 periods (1: January 2016 to December 2019; 2: January to December 2020; 3: January to June 2021) using the unit of measurement DDD. In the whole NH population, no significant changes were found. At a NH level, the results between periods 1 and 2 were very different, depending on the NH. For NH with a single nursing home-employed physician, there was an increase of antipsychotic drugs use between periods 1 and 2, and 1 and 3. During periods 2 and 3, the consumption of antipsychotic drugs was higher for NH with a single nursing home-employed physician. The course of psychotropic drugs use since the onset of the Covid-19 pandemic changed depending on the NH organization. Further studies are needed to identify the factors explaining differences between NH.Introduction :Nous avons analysé l’évolution de la consommation en psychotropes depuis le début de l’épidémie de Covid-19 chez des résidents d’Ehpad en région Bretagne, France.Méthode :Nous avons réalisé une étude rétrospective, observationnelle, descriptive, incluant sept Ehpad hospitaliers. Nous avons recueilli les quantités délivrées en antipsychotiques, anxiolytiques, hypnotiques et antidépresseurs de janvier 2016 à juin 2021, et comparé leurs consommations sur trois périodes (1 : janvier 2016 à décembre 2019 ; 2 : janvier à décembre 2020 ; 3 : janvier à juin 2021) en utilisant l’unité de mesure DDD.Résultats :Tous Ehpad confondus, il n’était pas retrouvé de différences significatives. Les résultats étaient très hétérogènes entre les périodes 1 et 2 selon les Ehpad. Pour les Ehpad avec un seul médecin prescripteur, il existait une augmentation de la consommation en antipsychotiques entre les périodes 1 et 2, et 1 et 3. Durant les périodes 2 et 3, la consommation d’antipsychotiques était plus importante pour les Ehpad avec un seul médecin prescripteur.Conclusion :L’évolution de la consommation en psychotropes depuis le début de la pandémie Covid-19 était très variable d’un Ehpad à l’autre. Des études complémentaires sont nécessaires pour identifier les facteurs expliquant ces différences
Chapitre 5. Les transformations des politiques pour les aveugles en Algérie et en Tunisie (1918-1987)
No full textInternational audienceThis chapter focuses on North Africa, where blindness has long been a category with a particular social status. Since the twelfth century, some blind people had the opportunity to integrate into Koranic schools and mosques, and become reciters of the Koran at ceremonies, or become Imam. Thanks to this, a small minority of blind people were able to rise socially, and differentiate themselves from the majority, who had to rely on begging, family assistance, or community solidarity. This chapter addresses the gap on this topic in academic literature by analyzing and comparing the policies of assistance to the blind in two North African countries during the twentieth century: Algeria and Tunisia, during the colonial and post-independence period. It also examines the circulation of experts, ideas, and materials between these two countries, where since colonial times the authorities chose to divide government work by creating a sector of public action specifically dedicated to the blind. The chapter discusses the public action that included the creation of an administrative agency responsible for the issue, the allocation of specific social and economic benefits, and the funding of educational or vocational training institutions
Ethnographie de la santé orale en établissement de santé mentale
No full textPeople hospitalized in psychiatric wards suffer from poor oral health compared to the general population. This study aimed to analyze the causes and consequences of this deterioration in a mental health facility in western France.An ethnographic study was conducted. It was based on three months of observation of daily life in two inpatient units, nearly a year of observation of a dental consultation within the facility, and a corpus of 24 interviews conducted with a variety of stakeholders (caregivers, dentists and patients).The analysis highlighted the prevalence of factors (hygiene, diet, tobacco use, etc.) that are detrimental to oral health, as well as the barriers faced by caregivers in promoting oral health. The benefits and limitations of dental consultations in accessing and providing care for patients were also analyzed. Finally, as part of an analysis of the "moral economy" of oral health in psychiatry, the ethical tensions faced by stakeholders were investigated. Placed in the current context of psychiatry in France, care relationships in oral health confront professionals with dilemmas related to the promotion of patient autonomy but also to the ways of allocating the resources at their disposal.This work ultimately highlights the importance of collective approaches between different healthprofessionals and patients to promote oral health in psychiatry.Les personnes hospitalisées en psychiatrie souffrent d'une santé orale dégradée par rapport à la population générale. Cette étude visait à analyser les causes et les conséquences de cette dégradation au sein d'un établissement de santé mentale de l'ouest de la France.Une enquête ethnographique a été mise en œuvre. Elle s'appuyait sur l'observation de la vie quotidienne durant trois mois au sein de deux unités d'hospitalisation, sur l'observation du fonctionnement d'une consultation dentaire au sein de l'établissement pendant près d'un an, et sur un corpus de 24 entretiens conduits avec une diversité d'acteurs (soignants, chirurgiens-dentistes et patients).L'analyse a permis de mettre en évidence la prégnance de facteurs (hygiène, alimentation, consommation de tabac…) défavorables à la santé orale, mais aussi les freins auxquels étaient confrontés les soignants dans la promotion de cette santé orale. Ont été également analysés les intérêts et les limites de la consultation dentaire dans l'accès aux soins et leur réalisation chez les patients. Enfin, dans le cadre d'une analyse de "l'économie morale" de la santé orale en psychiatrie, les tensions éthiques auxquelles sont confrontés les acteurs ont été investiguées.Replacées dans le contexte actuel de la psychiatrie en France, les relations de soins en matière de santé orale confrontent les professionnels à des dilemmes liés à la promotion de l'autonomie des patients mais également aux manières d'allouer les ressources dont ils disposent.Ce travail met finalement en évidence l'importance des approches collectives entre les différents professionnels de santé et les patients pour promouvoir la santé orale en psychiatrie
Comportement préventif des patients atteints de cancer en France et son évolution durant la pandémie de COVID-19
No full textInternational audienceIn the context of the COVID-19 epidemic, adopting preventive behavior could be defined as complying with recommendations issued by public health authorities. The aim of this study was to investigate heterogeneity of preventive behavior changes over time among cancer patients (CPs) during outbreak.Methods: The PAPESCO-19 study is a multicenter prospective cohort including 893 CPs from French comprehensive cancer centers (June 2020- June 2021). During the one-year follow-up, CPs completed questionnaires on socio-demographics, lifestyle and COVID-19-related history. Biological and clinical data were collected from medical records. We used the R package lcmm to determine the different classes of preventive behavior trajectories in CPs.Results: Between June 2020 and April 2022, over two-thirds of CPs reported wearing a mask during all outings. Only one class of preventive behavior was identified. Female CPs, those on sick leave, CPs unable to work due to health reasons and those spending most of the day at home, showed more preventive behavior. CPs with two or more children were less likely to adopt preventive behavior.Conclusions: No patient clinical characteristics were associated with preventive behavior.IntroductionLors de l’épidémie de COVID-19, les Français ont été fortement incités à appliquer des gestes barrières et des mesures de prévention individuelles afin d'endiguer la propagation du virus. Dans ce contexte, l'adoption d'un comportement préventif peut être définie comme le respect de ces mesures, et varie selon le profil socio-démographique et les conditions de vie selon l'enquête nationale CoviPrev. Bien qu'alors considérés comme des personnes à risque de développer des formes graves de COVID-19, on peut s'attendre également à des comportements préventifs variés chez les patients atteints de cancer. L'objectif de cette étude est d’étudier le comportement préventif des patients atteints de cancer, ainsi que son évolution pendant l’épidémie.MéthodesL’étude PAPESCO-19 est une cohorte prospective multicentrique ayant inclus 893 patients atteints de cancer de quatre centres de Lutte contre le cancer français (Angers, Clermont-Ferrand, Nancy et Nantes) entre juin 2020 et juin 2021. Les participants répondaient à des questionnaires tous les trois mois pendant une année. Afin de modéliser l'hétérogénéité des profils de comportement préventif et de tracer les trajectoires de ces profils, nous avons utilisé le package R lcmm.RésultatsUn seul profil de comportement préventif a été identifié chez ces patients. De plus, les femmes et les patients en arrêt maladie ou ne travaillant pas pour des raisons de santé, et les patients restant au domicile la plupart de la journée, avaient tendance à plus respecter les mesures barrière, tandis que les patients ayant deux enfants ou plus étaient moins enclin à adopter un comportement préventif.ConclusionNos résultats montrent que la population de patients atteints de cancer est une population homogène, suggérant qu’être traité pour un cancer pourrait encourager les gens à adopter un comportement préventif en matière de santé. Cependant, aucune caractéristique clinique du patient n'était associée au comportement préventif
Publish or Perish – do French hospitals disclose their greenhouse gas emissions for vertical differentiation?
No full textInternational audienceFrench legislation requires large and medium-sized hospitals to publicly report their greenhouse gas (GHG) emissions. Yet, many hospitals fail to comply with this regulation, while others report voluntarily. The organizational drivers behind this behavior remain underexplored. This study examines whether hospitals disclose their GHG emissions aspart of a broader strategy to differentiate themselves—similar to how they report patient satisfaction scores to signal quality. We explore whether carbon reporting is used as a vertical differentiation strategy in the French healthcare system. We used a mixed-methods approach. First, we analyzed national administrative data to test whether reporting GHG emissions is associated with reporting patient satisfaction scores. Second, we conducted semi-structured interviews with hospital managers to understand the motivations behind emissions reporting. Quantitatively, we found no significant association between the two types of reporting. Hospitals do not appear to use GHG emissions disclosure and patient satisfaction scores as part of the same signaling strategy. Qualitative findings confirmedthat GHG reporting is primarily driven by internal factors such as executive leadership, process improvement, and organizational values, rather than external differentiation or patient demand. Carbon reporting in French hospitals is not currently used as a differentiation strategy. Stronger regulatory enforcement is needed to ensure compliance. Inaddition, hospitals require support—through methodological guidance, training, and the development of dedicated sustainability roles—to integrate environmental performance into their management systems and contribute meaningfully to healthcare decarbonization