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Nationwide trends in pediatric hospitalizations for eating disorders in France between 2013 and 2022: a retrospective study using the national health insurance database
No full textInternational audienceBackground: Eating disorders (EDs) are extreme eating behaviors with health consequences that sometimes require hospitalization. The prevalence of these disorders is difficult to estimate but appears to be increasing. The aim of this study was to analyze trends in hospitalizations for eating disorders in pediatric care in France over a ten-year period to determine whether these hospitalizations have increased and to characterize the nature of such changes.Methods: We conducted a retrospective observational study based on the French National Health Insurance Database (SNDS) for patients aged 6-18 years who were hospitalized for an eating disorder. Data were collected for the years 2013, 2017, and 2022. The primary objective was to compare the number and duration of hospitalizations across different years. The secondary objectives include: characteristics of initial stays, characteristics of patients, rehospitalizations and/or death in the year.Results: The study included 9,085 children aged 6 to 18 years who were hospitalized for eating disorders. The incidence doubled, increasing from 0.017% in 2013 to 0.036% in 2022. The duration of stays is generally longer than a few days (15 [5-43] vs 15 [5-50]). The median age was 15 years and showed an increasing trend, with a decreasing proportion of boys. Anorexia nervosa remains predominant with stable proportions, but there was a notable increase in "other eating disorders" between 2013 and 2022. Severe malnutrition increased, affecting more than 23% of patients in 2022, and anxiety disorders doubled, affecting 20.7% of patients in 2022. Emergency admissions rose (from 31% in 2013 to 37% in 2022), with a lower readmission rate. The role of psychiatric services increased, representing 25% of hospitalizations in 2022. All regions of France were affected.Conclusions: This study revealed, between 2013 and 2022, a doubling of hospitalizations for EDs in children without a reduction in stay time. Patients have more anxiety and severe malnutrition. The diagnostic categories are changing, resulting in a more significant expansion of psychiatric services
Hospital Resilience in the Face of Covid-19 in France: A Multilevel Analysis of the Impact of Past Practice Quality on Cancer Surgery Resumption
No full textInternational audienceThe COVID-19 pandemic disrupted routine hospital services, causing a substantial backlog of surgeries in 2020. This study investigates hospital resilience in resuming activities during the pandemic, focusing on the impact of pre-pandemic adoption of enhanced recovery after surgery protocols (ERAS) in digestive cancer surgery. ERAS involves patient-centered care protocols proven to improve care process and outcomes but are not systematically implemented in hospitals. We define hospital resilience as the ability to maintain and resume surgery levels in the second half of 2020 during the pandemic. Using French national hospital data for digestive cancer surgeries, we categorized hospitals by the intensity of their ERAS volume before the pandemic and estimated a multilevel model allowing to control for hospital characteristics and pandemic conditions in the area they are situated.Results show that, all else being equal, hospitals that implemented ERAS before the pandemic absorbed the surgical backlog and recovered their pre-pandemic activity level more quickly. High-volume hospitals and specialized cancer centers were also quicker than other hospitals in resuming surgical operations. The findings highlight the differences in care practices across hospitals and the importance of quality protocols in bolstering hospital resilience during health crises. Beyond improving patient outcomes, widespread adoption of such protocols could enhance healthcare resource utilization and help to mitigate broader economic and environmental pressures
Le devenir des pilotes MAIA Premiers enseignements de l'enquête en ligne et pistes pour la recherche
No full textDans le cadre du plan Alzheimer 2008-2012, un dispositif inédit a été créé sous le nom de MAIA pour « Méthode d'action pour l'intégration des services d'aide et de soins dans le champ de l'autonomie ». Entre 2009 et 2016, plus de 350 MAIA ont été mises en place dans tous les départements français selon des configurations variées mais avec toujours à leur tête des « pilotes » ayant une double mission d'animation territoriale et de management d'équipe. Or, la loi relative à l'organisation et à la transformation du système de santé du 24 juillet 2019 a mis fin à l'existence des MAIA au profit des DAC, ou « Dispositifs d'appui à la coordination des parcours de santé complexes ». Que sont devenu.es les pilotes MAIA ? Les compétences et les missions développées dans le cadre de ce poste ont-elles été réinvesties dans leurs nouvelles fonctions ? Comment ont-iels vécu cette expérience professionnelle, et qu'est-ce que cela nous apprend plus généralement sur ce type de poste de coordonnateur•ice
Integrating and Analysing Occupational Health Data Using a Multi-Ontology Approach
No full textInternational audienceA variety of occupational data are collected by health organisations to investigate workplace exposures encountered by workers in their occupational activities and the potential health effects that may arise. These datasets have diverse characteristics and are not inherently designed to interoperate. However, they contain complementary information, which, when analysed collectively, can provide a broader perspective on high-risk occupational scenarios and inform targeted prevention strategies. The objective of this study is to develop a methodology to integrate and analyse heterogeneous French data. For this, ten French occupational databases, provided by six French institutes were used. An Ontology-Based Data Integration approach was employed, involving the mapping of data sources to a domain-specific ontology, namely the Adapted Occupational Exposure Ontology. Four additional ontologies were utilised: the Occupational Exposure Thesaurus, which categorises occupational exposures and hazards; the International Classification of Diseases, which classifies health disorders and diseases; the French Nomenclature of Activities, which identifies activity sectors in France; and the Professions and Socio-professional Categories, which defines occupational classifications. Data integration is primarily achieved through the concept of the “occupational group”, defined as a group of individuals sharing the same sex, occupation, and activity sector. Two case studies derived from the integrated dataset are presented: (1) a quantitative analysis identifying occupational groups at highest risk and most affected by diseases; and (2) a qualitative analysis evaluating the consistency of exposure and disease-related information. The construction sector was selected for these case studies due to its significance in occupational health research and the availability of substantial, relevant data. This methodological approach structures all the data and enables various analysis methods to be designed and implemented, making it possible to envisage targeted responses to current and emerging occupational health problems using specialised tools and queries
Iron deficiency in pregnancy and its association with blood lead and manganese levels in offspring in Benin, Sub-Saharan Africa
No full textInternational audienceIntroduction: The impact of prenatal iron deficiency (ID) on offspring's blood lead level (BLL) and blood manganese level (BML) in infancy remains poorly understood. This study aimed to assess associations between prenatal ID and BLL/BML in offspring in Benin. We also investigated associations between infant ID and corresponding BLL and BML in infants.Materials and methods: Data on hematological parameters, metal blood concentrations, and socioeconomic status were obtained from a prospective mother-child cohort study in Allada, Benin. Blood samples were collected during pregnancy (n = 501), at delivery (n = 501), and from 12-month-old infants (n = 501) to assess iron deficiency and haemoglobin concentration. Additionally, BML was analyzed for a subset of 12-month-old infants (n = 271), and BLL was determined for the full cohort of 12-month-old infants (n = 501). Associations between ID and metal concentrations were examined using logistic regressions.Results: Prenatal ID and IDA at the first and third antenatal care visit (ANC) were positively associated with infant BLL above 50 μg/L. Infants of mothers with prenatal ID and IDA had higher BLL. Moreover, prenatal ID and IDA at first and second ANC visits were positively associated with higher infant BML. In infancy, infants with ID and IDA had significantly higher BLL as compared to those without ID and IDA. Infant ID and IDA were positively associated with elevated BLL.Conclusion: Elevated BLL and BML in infants were positively associated with ID and/or IDA prenatally during at least one ANC visit, while in infancy, infant ID and IDA were positively associated with elevated BLL only. Infants with ID and IDA showed higher BLL but not BML. This suggests that ID prenatally and during infancy may contribute to high blood lead concentrations in infants, which can lead to neurotoxicity. Treating ID and IDA is critical to prevent toxicity caused by high BLL in infants
Parcours d’accès aux services administratifs pour les personnes handicapées : défis et résultats d’une recherche participative
No full textInternational audienceDepuis 2005, en dépit d’une mobilisation accrue d’une rhétorique des droits et de la participation, l’effectivité des droits des personnes handicapées demeure fragile (Revillard, 2020). Malgré des exigences d’accessibilité anciennes, l’accessibilité physique comme numérique demeurent problématiques. En 2024, le CNCPH fait toujours le constat de politiques d’accessibilité reléguées au second plan et dans un contexte de dématérialisation, 60% des démarches administratives en ligne demeurent encore inaccessibles aux personnes handicapées (Défenseur des droits, 2022).À partir d’une recherche participative réalisée par un collectif de recherche de personnes handicapées, de professionnels du secteur médico-social et de chercheuses, nous avons voulu comprendre les effets de l’environnement (obstacles et facilitateurs), sur la réalisation des démarches administratives par des personnes vivant en milieu rural. Cette communication présentera la question de recherche et le cadre théorique interdisciplinaire (sociologie, géographie sociale) basés sur une approche systémique du handicap (OMS, 2001) et de l’accès aux droits (Deville, 2018). Puis, seront analysés les enjeux méthodologiques liés à la démarche participative mobilisée dans le groupe de recherche et lors de l’enquête de terrain auprès de 24 personnes travaillant en ESAT. Enfin, la présentation des résultats sera principalement axée sur les expériences vécues des démarches administratives par les personnes, dans leurs dimensions socio-spatiales.L’analyse montre que la connaissance des personnes enquêtées concernant les services administratifs et leur compréhension des démarches à réaliser sont souvent limitées. Pour autant, elles participent à différents degrés aux démarches et toutes ne sont pas en demande de participation. Les formes de soutien mobilisé sont également variées (représentant légal, professionnel de l’ESAT ou d’un SAVS, aidant familial) et font l’objet de stratégies de la part des travailleurs en fonction des compétences identifiées et supposées de chacun. Par ailleurs, on observe une spécificité de l’inscription spatiale des parcours d’accès aux services administratifs en lien avec la particularité de la participation sociale des personnes. Malgré leurs capacités de mobilité, les déplacements jusqu’aux guichets des administrations comme la CAF et la MDPH sont rares voire inexistants. Les temps dédiés aux démarches sont principalement localisés à l’ESAT et/ou au domicile avec les tuteurs et les travailleurs sociaux qui se déplacent
Determination of chlordecone in indoor dust by GC/MS/MS and associated human exposure in the French West Indies
No full textInternational audienceChlordecone (CLD) is an organochlorine pesticide with various toxicities, widely used from 1972 to 1993 in the French West Indies lands (FWI, Guadeloupe and Martinique). It can remain in environment leading to indoor contamination by pollutants coming from outside. Therefore, investigating indoor pollutants is necessary due to the potential indoor dust ingestion though hand-to-mouth contact, in particular for children. No chemical analytical method measures CLD in indoor dust and we propose to investigate its presence in this specific compartment, in Martinique. CLD was analyzed from dust samples taken from homes and schools (n = 47). We extracted CLD from dust with pressure liquid extraction (PLE) using a suitable mixture solvent of hexane and ethyl acetate (85:15). This was followed with gas chromatography coupled to tandem spectrometry (GC/MS/MS) analysis. A sampled mass of 25 mg was optimal for analysis. Concentrations of CLD in indoor dust varied from < 16-247 ng/g. Exposure to CLD through indoor dust ingestion was also assessed and does not exceed 1.5 % and 0.1 %, of the acceptable daily intake, in children and adults, respectively. However, this exploratory study was conducted on a very limited number of dust samples limiting the generalization to the whole French West Indies population
Efficacité relative en vie réelle du vaccin grippal quadrivalent à haute dose (HD) comparé aux dose standard (SD) chez les personnes âgées de 65 ans et plus en France: analyse agrégée des saisons 2021-22 et 2022-23
No full textInternational audienceIntroduction :Le vaccin grippal haute dose (HD) a été introduit en France pour les personnes âgées de 65 ans et plus à partir de la saison 2021-2022, au cours de laquelle une efficacité vaccinale relative (EVr) de 23,3% (95%CI: 8.4%-35.8%) par rapport aux vaccins standard dose (SD) contre les hospitalisations pour grippe a été rapportée. Nous présentons l'EVr en vie réelle du HD par rapport aux SD sur les hospitalisations pour grippe et/ou pneumonie (P&I) agrégée sur les saisons 2021-22 et 2022-23 chez les 65+.Matériels et méthodes :Deux études de cohorte rétrospectives basées sur le Système National des Données de Santé ont inclus des adultes non institutionnalisés âgés de 65 ans et plus et vaccinés contre la grippe en 2021-2022 et 2022-2023. Les covariables ont été identifiées à partir des codes CIM-10, CCAM, dispensation de médicaments sur les 5 ans précédant. Les hospitalisations ont été identifiées des 14ᵉ jour post-vaccination jusqu'à la fin du suivi. Les vaccinés HD et SD ont été appariés (1:4) sur le score de propension avec une contrainte exacte sur l'âge, le sexe, la semaine de vaccination et la région. Compte tenu de potentilles différences inter-saisons (variations dans la circulation virale, couverture vaccinale et comportements d'accès aux soins), l'EVr en vie réelle agrégée sur les deux saisons a été estimée via une méta-analyse à effets aléatoires en utilisant des modèles linéaires mixtes généralisés. L'hétérogénéité a été évaluée par le test Q de Cochran.Résultats :En 2021-2022, 431 643 personnes ont reçu le HD et 7 401 210 un SD. En 2022-2023, 976 211 ont reçu le HD et 6 938 087 un SD. L'EVr du HD vs SD contre les hospitalisations pour grippe agrégée sur les deux saisons a été estimée à 26,0 % (IC95%: 20,0; 33,0). Les rVE agrégées contre les hospitalisations non spécifiques de la grippe (PI ou pneumonie) ne montraient pas de différence significative. Le test d'hétérogénéité était non significatif.Conclusion :Ce résultat, cohérent avec les études contrôlées randomisées et les estimations des deux saisons séparées, renforce le bénéfice du HD dans la réduction des hospitalisations pour grippe par rapport au SD en conditions réelles. L'utilisation du vaccin HD, adapté à la population âgée, pourrait contribuer à réduire le fardeau lié aux infections respiratoires
Cost of Carbon in the Total Cost of a Healthcare Procedure: Example of Micro-Costing Study in a French Setting
No full textInternational audienceBackground: Economic evaluation aims to compare the costs and results of health strategies to inform public decision making. Although sometimes suggested, until now no national evaluation agency has recommended formally incorporating the cost of greenhouse gas (GHG) emissions generated by health interventions into the estimation of healthcare costs.Objective: The objective of this study was to test and discuss the feasibility of estimating and including the contribution of GHG emissions cost to the total cost of a surgical intervention, with the example of robot-assisted total knee arthroplasty (RTA), using a micro-costing approach.Methods: The study was conducted in June 2022 at the William Morey Hospital (France). Data regarding all of the resources (labor, medical equipment, consumables), as well as energy consumption, staff commuting and waste treatment were collected and valued from the hospital point of view. Greenhouse gas emissions were valued using a cost-effectiveness approach. Several sensitivity analyses were performed.Results: The mean cost per patient of an RTA was estimated to be €4755.65, of which €152.64 (3.21 %) would be attributable to GHG emissions. The contribution of GHG emissions in the overall cost of a health intervention was highly dependent on the convention used for the price of carbon.Conclusion: Despite persistent theoretical and practical challenges, adding the estimation of GHG emission costs in the economic evaluation of health interventions may provide institutional decision makers with information that allows them to allocate the public healthcare resources more efficiently
Associations between prenatal exposure to PFAS and cardiometabolic health in preadolescents
No full textInternational audienceIntroduction: While a number of studies have examined the effects of prenatal exposure to per- and polyfluoroalkyl substances (PFAS) on childhood obesity, the results reported have been inconsistent and few studies have integrated biological markers. The aim of this study was to investigate the associations between prenatal exposure to PFAS and cardiometabolic health parameters at age 12, taking pubertal stage into consideration.Method: This study included 394 mother-child pairs enrolled in the PELAGIE mother-child cohort (France). Nine PFAS were measured in umbilical cord blood, and the children attended a clinical examination at age 12. Anthropometry, blood metabolic markers, and blood pressure were measured and used to build an internal cardiometabolic score. Linear regression and Quantile G-computation models were used to evaluate individual and mixture PFAS effects, adjusting for confounders and stratifying by sex and pubertal stage.Results: No statistically significant association was observed between prenatal exposure to PFAS and cardiometabolic score at age 12. In post-menarche girls, perfluorohexane sulfonate (PFHxS) and perfluorodecanoic acid (PFDA) were statistically significantly associated with a decrease in a number of adiposity parameters (e.g., Body mass index z-score: beta [95%CI] = -0.37 [-0.67; -0.07]), as well as a decrease in low-density lipoproteins (LDL) and leptin levels. Similar results were observed with PFAS mixture, with statistically significantly decreased tricipital skinfolds (beta [95%CI] = -1.30 [(-2.54;-0.06)]). Isolated associations, including higher systolic blood pressure, changes in cholesterol levels, and lower adiponectin levels were observed in specific subgroups.Conclusion: There is no clear evidence of an association between prenatal exposure to PFAS and the cardiometabolic health at earlier stage of pubertal development. However, inverse associations between PFAS and anthropometric measures have been observed in post-menarche girls. While the literature on this topic is scarce in pre-adolescents, these results suggest the importance of considering sex and pubertal stage in these associations