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Perceptions of Health-Related Quality of Life Among Heart Transplant Recipients: A Qualitative Study
No full textInternational audienceBackground: There is a need to improve knowledge of the health-related quality of life (HRQoL) in the post-heart transplantation (HTx) period and the factors affecting it. This qualitative study aimed to identify the most important domains of HRQoL for heart transplant recipients and the factors that impact it.Methods: This was a qualitative study across 5 geographically diverse large HTx centers in France from July 2022 to January 2023. We gathered a purposive sample of individuals who had undergone HTx. A face-to-face semi-structured interview guide was used for individual interviews. All interviews were audio-recorded and transcribed verbatim.Results: A total of 14 individuals (10 men) were interviewed. The data analysis led to the development of 8 main themes (with sub-themes) that were relevant to participants: HRQoL perception (mental health, physical capacity, symptoms and comorbidities), participants' experience during the HTx process, immunosuppressive treatments, relationship with the healthcare team, external and internal resources, socio-economic aspects and feelings about the donor. Recipients, spontaneously made connections between these themes.Conclusions: Heart transplant recipients had diverse perceptions of their HRQoL in the post-HTx period. The rich variety of themes identified from the review highlights that recipients have a complex HRQoL profile which is not currently captured by standard HRQoL tools that are commonly employed. These aspects should be taken into account in the clinical follow-up and in the selection of the most appropriate Patient Reported Outcome Measures (PROMs)
#2288 Survival and care trajectory of kidney graft patients after age 65: Let's look at the cardiovascular comorbidities rather than age
No full textInternational audienceBackground and AimsThe latest French recommendations (HAS 2015) suggest offering renal transplantation as a replacement therapy up to the age of 85, in the hope of improving the survival and quality of life of eligible stage V chronic kidney failure patients. Nevertheless, renal transplantation remains a major procedure, with a significant risk of complication or death for these elderly patients.MethodThe aim of our study is to identify risk factors for one-year mortality after renal transplantation and complications requiring hospitalization by cross-referencing data from the REIN registry and the SNDS (Système National des Données de Santé) in patients starting replacement therapy after the age of 65.ResultsBetween 01/01/2017 and 31/12/2018 10642 patients aged 65 to 85 started renal replacement therapy, 807 were transplanted before 31/12/2020 and followed up until 31/12/2021, after a median time on the waiting list of 9.3 month. Among them, 71 patients died during the first year of transplantation. Age was not associated with a higher risk of death as diabetes or donor type. Only the number of cardiovascular comorbidities was significantly associated (HR 3.6 CI 1.4–9.4 p :0.008), i.e. a 3.6-fold higher risk of death when patients had 3 cardiovascular comorbidities vs. none. Age was also not associated with a longer length of hospital stay at the time of transplantation, or with an increased risk of early re-hospitalization within 30 days. Looking more specifically into cardiovascular comorbidities, we found that having been hospitalized for a peripheral vascular condition within the two years prior to being placed on the transplant waiting list was associated with an increased risk of mortality in the year following the transplant, all other factors being equal (HR 2.14 CI 1.08–4.27 p : 0.029).ConclusionMortality in the first year after kidney transplantation in elderly patients seems to be mainly related to pre-transplant cardiovascular comorbidities, especially peripheral vascular condition with need of hospitalization and not to patient age. Nor does age seem to increase the length of hospital stay or the risk of early re-hospitalization, which would impact on these patients' quality of life. The official age is therefore not a reliable marker for not referring patients for transplantation, but enhanced cardiovascular monitoring to detect vascular conditions as early as possible during chronic kidney disease is likely important
PERIGENOMED-CLINICS 1—the first study on feasibility, acceptability and psychosocial impact of PERIGENOMED: a pilot project aimed at providing initial concrete evidence on the relevance of panel-based genome sequencing for newborn screening (NBS) in France
No full textInternational audienceIntroduction: International pilot projects focusing on next-generation sequencing in newborn screening (NBS), that is, genomic NBS (gNBS), have been established thanks to continuous therapeutic progress and the massive development of new genetic technologies with rapidly decreasing costs. Given the highly encouraging results of the French SeDeN project regarding anticipated acceptability among professionals and parents, it is now appropriate to launch a similar pilot project in France, in collaboration with other international initiatives under the International Consortium on Newborn Sequencing framework.Methods and analysis: PERIGENOMED is a large-scale project designed to provide the first concrete evidence on the relevance of gNBS in France. It includes two clinical trials. We present here the design chosen for the first clinical trial (PERIGENOMED-CLINICS 1). PERIGENOMED-CLINICS 1 aims to assess the feasibility, real-world acceptability, psychosocial impact and organisational pathways of panel-based genomic newborn screening in France, involving 2500 participants. Solo-GS targeting two lists of gene-disease dyads responsible for treatable (list 1; 400 genes, 171 diseases/group of diseases) or actionable (list 2 optional; 407 genes, 218 diseases/group of diseases) rare and severe early-onset diseases will be proposed in five health institutions. Ancillary social and impact studies will also be included.Ethics and dissemination: All study procedures have been reviewed and approved by relevant French ethics committees and regulatory authorities (CPP Est II-2024-A02224-43, 1 January 2025). Results of the project will be disseminated through peer-reviewed publications, national and international conferences, and public engagement initiatives, in coordination with stakeholders.Trial registration number: NCT06875089
Construire aujourd’hui le laboratoire de biologie médicale durable de demain
No full textInternational audienceIn the face of climate emergency, medical biology laboratories (MBLs) must reconcile diagnostic performance, innovation, and environmental sustainability. Playing a crucial role in patient diagnosis and follow-up, MBLs have a significant ecological footprint due to their high energy consumption, extensive use of plastics, and substantial waste production, including hazardous materials classified as carcinogenic, mutagenic, reprotoxic, or radioactive. Still with the goal of continuing to contribute to patient care activities and improving the quality of care, this article provides an overview of concrete strategies and perspectives for reducing the ecological footprint of medical biology MBLs. Through practical examples and evidence-based recommendations, we aim to raise awareness among medical biologists and equip them with the necessary tools to integrate ecological transition into their daily practices.Face au dérèglement climatique, les laboratoires de biologie médicale (LBM) sont confrontés à la nécessité de réconcilier performance diagnostique, innovation et durabilité environnementale. Les LBM, qui jouent un rôle crucial dans le diagnostic et le suivi des patients, génèrent une empreinte écologique significative due à leur consommation énergétique, à l’utilisation massive de ressources et à la production importante de déchets (plastiques, biologiques, chimiques…) dont certains sont classés cancérogènes, mutagènes, reprotoxiques et radioactifs. Toujours avec l’objectif de continuer à participer activement à l’amélioration de la qualité de soins des patients, cet article propose un état des lieux des stratégies concrètes et perspectives de réduction de l’empreinte écologique des LBM. À travers des exemples pratiques et des recommandations fondées, nous visons à sensibiliser les biologistes médicaux sans les culpabiliser et à identifier des stratégies pour engager une transition écologique dans leurs pratiques quotidiennes
Integration of the exposome concept into health risk assessments: a challenge for health safety agencies
No full textInternational audienceThe exposome is a concept that aims to study the environmental factors to which individuals are exposed during their lifetime and the role of these factors in the development of chronic diseases. Since the concept emerged in 2005, new data, methods, and tools have been generated by the scientific community to assess the different components of the exposome and their impacts on human health. Currently, one of the main challenges is accounting for the diversity and complexity of exposures and their effects on health in risk assessment, which might be accomplished by integrating the exposome into this process. To this end, a working group was constituted by Anses to develop a strategy to integrate the exposome concept in risk assessment and more generally in the work produced by health safety agencies. We present the principal challenges to be addressed by considering 8 themes covering relevant aspects of the exposome and we made recommendations for each theme: 1) characterization of the exposome in epidemiological surveys; 2) exposome data; 3) risk assessment of chemical mixtures; 4) aggregation of multiple sources and routes of exposure; 5) dynamics of the exposure in the context of time, space, and social factors; 6) establishment of reference values; 7) multiple factors in risk, benefit and health impact assessment; and 8) eco-exposome. Then, we propose practical recommendations with short-, medium-, and longterm time scales to progressively operationalize the exposome into risk assessments implemented by health safety agencies. We also discuss how providing broader exposome input into risk assessment can support risk regulators to incorporate exposome input into risk management
To See Nature: A Window of Opportunity to Decrease the Risk of Depression and Anxiety
No full textInternational audienceWe re-examined the associations between nature views and depression and anxiety specificall
The evolution of consultation practices with general practitioners and nephrologists for patients with chronic kidney disease before and after the COVID-19 pandemic in France
No full textInternational audienceAbstract Background The COVID-19 pandemic led to concerns about disruptions in the follow-up of chronic diseases, including chronic kidney disease (CKD). Here, we assessed the COVID-19 pandemic impact on healthcare use by patients with CKD in France. Methods We used the French National Health Data System (SDNS) that contains data on outpatient and inpatient healthcare of the whole French population. Using a validated algorithm, we identified two CKD cohorts based on their healthcare utilization: (i) the 2019 cohort (pandemic-exposed) and (ii) the 2017 cohort (comparator). We followed these cohorts for 2 years and compared consultations (in-person and teleconsultation) with a general practitioner (GP) and a nephrologist and all-cause hospitalizations (excluding COVID-19 as primary diagnosis). We stratified comparisons by age group and sex. Results We identified 4,866,096 individuals with CKD in 2017 and 5,089,706 in 2019. During the first year of follow-up, 95.2% and 6.4% of patients in the 2017 cohort had at least one consultation with a GP and with a nephrologist, respectively, versus 94% and 6.3% in the 2019 cohort. Teleconsultations compensated for the reduction of in-person GP and nephrologist consultations throughout the lockdown periods in 2020 and 2021 (40.5% of patients in the 2019 cohort had at least one in-person consultation and 52.5% an in-person or tele-consultation with a GP). Hospitalizations ≥ 24 h decreased in 2020 and 2021 (-10%). Conclusions In France, outpatient care for CKD was maintained during the 2 years following the COVID-19 pandemic, thanks to teleconsultations. The persistently lower inpatient care utilization warrants further investigation. Graphical abstrac
Unpacking the Transformations Activated by Smoke-Free Campuses: A Logic Model of France’s First Initiative
No full textInternational audienceSmoke-free campuses (SFCs) are characterized by a ban on smoking and vaping on all higher education premises (indoor and outdoor spaces) and by the smoking cessation support they provide. Although literature has demonstrated the impact of SFCs on smoking among young adults, little is known about the sequences of transformations they activate, the assumptions on what it takes to work and on the motivations and constraints that inform their development. Drawing from the first SFC implemented in France, we report on an analysis of the expected transformations in smokers and their environment generated by the activities on campus. Guided by Mayne’s logic model template and tapping into three sources of data (i.e., internal documents, semi-structured interviews with people involved in its implementation, and direct nonparticipant observations), we identified the causal model linking the SFC’s activities to its impacts. Our results show that the SFC’s activities aim to impose constraints to discourage tobacco use, reduce environmental triggers to smoking, denormalize smoking, and facilitate access to cessation aids through better information and accessibility. The SFC may also influence campus dynamics by fostering cohesion, the campus’s appeal, and social interactions within the smoking shelters. The policy is also meant to stimulate similar initiatives in other campuses and institutions in the health sector notably through the training of a new generation of managers. The resulting logic model is an essential tool for the transferability of SFC to other environments and can facilitate the identification of indicators for assessing their impacts and effects
Étude de cohorte rétrospective à l'échelle nationale visant à évaluer l'efficacité vaccinale relative du vaccin grippal haute dose par rapport aux vaccins dose standard chez les adultes de plus de 65 ans vivant en communauté en France au cours de la saison 2022-2023. [P11]
No full textInternational audienceIntroductionDans un essai contrôlé randomisé, le vaccin grippal haute dose (HD) a démontré une efficacité vaccinale relative (eVR) supérieure de 24,2% (9,7;36,5%) par rapport aux vaccins à dose standard (SD) pour prévenir la chez les 65+ [1]. Le HD a été introduit en France pour les 65+ à partir de la saison 2021-2022, au cours de laquelle nous avions rapporté une rVE de 23,3% (8.4%-35.8%) contre les hospitalisations pour grippe. Nous présentons ici les résultats de la deuxième saison.MéthodesNous avons mené une étude de cohorte rétrospective à partir du SNDS. Les personnes âgées de 65 ans et plus vivant en communauté et vaccinées contre la grippe au cours de la saison 2022-2023 ont été inclues et suivies depuis la date de vaccination jusqu'au 30 juin 2023/admission en maison de retraite/décès. Les hospitalisations pour grippe et autres causes ont été recueillies à partir de 14 jours après la vaccination. Après un appariement sur score de propension (1:4) avec contrainte exacte sur les groupes d'âge, le sexe, la semaine de vaccination et la région, les ratios de taux d'incidence ont été estimés via modèles de régression.Résultats675 412 individus avec HD ont été appariés à 2 701 648 individus avec SD. Au sein de la cohorte appariée, le HD était associé à une diminution de 27,4 % (19,8%-34,3%) des hospitalisations pour grippe par rapport au SD. Certaines hospitalisations non liées à la grippe étaient légèrement plus fréquentes chez les patients ayant bénéficié de l'HD, ce qui suggère un biais résiduel dû à des facteurs de confusion non mesurés.Discussion/ConclusionCe résultat, cohérent avec la littérature et l'analyse 2021-2022 [2], renforce le niveau de preuve quant au bénéfice du vaccin HD sur la réduction des hospitalisations liées à la grippe par rapport au vaccin SD en vie réelle. L'utilisation d'un vaccin HD adapté à la population des 65 ans et plus pourrait contribuer à réduire le fardeau lié aux infections respiratoires
Portrait de Robert Castel , in Bulletin d'histoire de la sociologie, n°15-16, mars 2025, p. 45-47. Édité par le réseau thématique 49 « Histoire de la sociologie » de l'Association française de sociologie
No full textBulletin d'association savanteOnt participé à ce numéro : Matthieu Béra, professeur à l'Université de Bordeaux. Olivier Bétourné, historien et éditeur, président des Editions du Seuil de 2009 à 2018. Gérard Grosse, agrégé de sciences économiques et sociales. Gérald Houdeville, maître de conférence à l'Université Catholique de l'Ouest. Claude Martin, directeur de recherche émérite au CNRS, École des hautes études en santé publique. Igor Martinache, maître de conférences à l'Université Paris Nanterre. Gérard Mauger, directeur de recherche émérite à l'EHES