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Obligation vaccinale des soignants : « Convaincre et expliquer, avant s’il le faut, de contraindre »
No full textInternational audienceThe Covid-19 health crisis has heightened existing tensions over compulsory vaccination for people working in healthcare environments, particularly in a context of intense upheaval in the healthcare system. The French National Advisory Ethics Council for Health and Life Sciences (CCNE) conducted a study on the vaccination strategy for healthcare workers, raising questions of deontological responsibility, ethics and patient solidarity. In the light of this work, the CCNE draws attention to several points: the protection of patients must be seen as a major imperative for caregivers; vaccination must be seen as a preventive tool within the range of available tools; a distinction must be made between the notions of compulsory vaccination in routine periods and compulsory vaccination in times of crisis, so that the tools available can be adapted to both situations; the CCNE recommends that, as far as possible, vaccine recommendations and/or obligations should follow a co-construction process with professional groups and associations representing users; finally, the CCNE calls for a better assessment of the vaccine hesitancy phenomenon, notably through qualitative surveys and polls. This leads to the idea that, as is often the case in prevention, every effort should be made to convince by explaining to encourage trust, before, if necessary, coercing.La crise sanitaire de la Covid-19 a accentué les tensions existantes au sujet de l’obligation vaccinale des personnes travaillant en milieu de soins, qui plus est dans un contexte d’intenses bouleversements du système de santé. Le Comité consultatif national d’éthique pour les sciences de la vie et de la santé (CCNE) a conduit une réflexion sur la stratégie vaccinale auprès des personnes travaillant en milieu de soins, soulevant les questions de la responsabilité déontologique, de l’éthique et de la solidarité à l’égard des patients. À l’issue de ces travaux, le CCNE attire l’attention sur plusieurs points : la protection des patients doit être considérée comme un impératif majeur pour les soignants ; la vaccination doit être envisagée comme un outil de prévention parmi la palette d’outils disponibles ; une distinction entre les notions d’obligation vaccinale en période courante et d’obligation vaccinale en période de crise doit être privilégiée pour que les outils à disposition puissent être adaptés à ces deux situations ; le CCNE préconise que les recommandations et/ou obligations vaccinales suivent autant que possible des processus de co-construction avec les groupes professionnels cibles et les associations représentant les usagers ; enfin, le CCNE appelle à une meilleure évaluation du phénomène d’hésitation vaccinale, notamment par le biais d’enquêtes qualitatives et de sondages. Ceci conduit à l’idée que comme souvent en prévention, tout doit être fait pour essayer de convaincre en expliquant pour favoriser la confiance, avant s’il le faut, de contraindre
Acceptability patterns of hypothetic taxes on different types of foods in France
No full textInternational audienceObjective: To identify patterns of food taxes acceptability among French adults, and to investigate population characteristics associated with them. Design: Cross-sectional data from the NutriNet-Santé e-cohort. Participants completed an ad-hoc web-based questionnaire to test patterns of hypothetical food taxes acceptability (i.e., overall perception combined with reasons for supporting or not) on 8 food types: fatty foods, salty foods, sugary foods, fatty and salty foods, fatty and sugary products, meat products, foods/beverages with unfavorable front-of-pack nutrition label, “ultra-processed foods” (UPF). Sociodemographic and anthropometric characteristics, and dietary intakes (24h-records) were self-reported. Latent class analysis was used to identify patterns of food taxes acceptability. Settings: NutriNet-Santé prospective cohort study. Participants: Adults (n= 27,900) engaged in the French NutriNet-Santé e-cohort. Results: The percentage of participants in favour of taxes ranged from 11.5% for fatty products to 78.0% for ultra-processed foods. Identified patterns were 1) “Support all food taxes” (16.9%), 2) “Support all but meat and fatty products taxes” (28.9%), 3) “Against all but UPF, Nutri-score, and salty products taxes” (26.5%), 4) “Against all food taxes” (8.6%), 5) “No opinion” (19.1%). Pattern 4 had higher proportions of participants with low socioeconomic status, body mass index above 30 kg/m2 and who had consumption of foods targeted by the tax above the median. Conclusion: Results provide strategic information for policy-makers responsible for designing food taxes and may help identify determinants of support for or opposition to food taxes in relation to individual or social characteristics or products taxed
Heat-related mortality in Mexico: A multi-scale spatial analysis of extreme heat effects and municipality-level vulnerability
No full textInternational audienceUnderstanding effects of extreme heat across diverse settings is critical as social determinants play an important role in modifying heat-related risks. We apply a multi-scale analysis to understand spatial variation in the effects of heat across Mexico and explore factors that are explaining heterogeneity. Daily all-cause mortality was collected from the Mexican Secretary of Health and municipality-specific extreme heat events were estimated using population-weighted temperatures from 1998 to 2019 using Daymet and WorldPop datasets. We analyzed the association between single-day extreme heat events defined at the 99th percentile of the same-day maximum temperature and mortality, and seven heat threshold metrics based on relative and absolute scales were considered as sensitivity analyses. A time-stratified case-crossover was applied to evaluate heat impacts across 32 states in Mexico. A within-community matched design with Bayesian Hierarchical model explored effects across 2456 municipalities. A random-effects meta-regression was applied to understand which municipality-level socio-demographic characteristics such as education, age and housing predicted observed spatial heterogeneity. Extreme heat increased the odds of mortality overall, and this was consistent across extreme heat thresholds. At the state level, extreme heat events showed highest impact on mortality in Tabasco [OR: 1.23, 95% CI: 1.17, 1.30]. The municipality-level spatial analysis showed substantial differences across regions with highest effects observed along the eastern, southwestern and Sonora coasts. Municipalities with older populations, higher marginalization, lower education, and poorer housing conditions were more vulnerable to heat effects. Understanding the differential risks of extreme heat events at varying scales is important to prioritize at-risk populations in action plans and policies to reduce their burden
Is home where the heat is? comparing residence-based with mobility-based measures of heat exposure in San Diego, California
No full textInternational audienceBackground: Heat can vary spatially within an urban area. Individual-level heat exposure may thus depend on an individual's day-to-day travel patterns (also called mobility patterns or activity space), yet heat exposure is commonly measured based on place of residence.Objective: In this study, we compared measures assessing exposure to two heat indicators using place of residence with those defined considering participants' day-to-day mobility patterns.Methods: Participants (n = 599; aged 35-80 years old [mean =59 years]) from San Diego County, California wore a GPS device to measure their day-to-day travel over 14-day intervals between 2014-10-17 and 2017-10-06. We measured exposure to two heat indicators (land-surface temperature [LST] and air temperature) using an approach considering their mobility patterns and an approach considering only their place of residence. We compared participant mean and maximum exposure values from each method for each indicator.Results: The overall mobility-based mean LST exposure (34.7 °C) was almost equivalent to the corresponding residence-based mean (34.8 °C; mean difference in means = -0.09 °C). Similarly, the mean difference between the overall mobility-based mean air temperature exposure (19.2 °C) and the corresponding residence-based mean (19.2 °C) was negligible (-0.02 °C). Meaningful differences emerged, however, when comparing maximums, particularly for LST. The mean mobility-based maximum LST was 40.3 °C compared with a mean residence-based maximum of 35.8 °C, a difference of 4.51 °C. The difference in maximums was considerably smaller for air temperature (mean = 0.40 °C; SD = 1.41 °C) but nevertheless greater than the corresponding difference in means.Impact: As the climate warms, assessment of heat exposure both at and away from home is important for understanding its health impacts. We compared two approaches to estimate exposure to two heat measures (land surface temperature and air temperature). The first approach only considered exposure at home, and the second considered day-to-day travel. Considering the average exposure estimated by each approach, the results were almost identical. Considering the maximum exposure experienced (specific definition in text), the differences between the two approaches were more considerable, especially for land surface temperature
Coordinating healthcare pathway: Sociology of collective action in the field of physical activity for health
No full textThe theme for EHMA 2025 : Taking action to improve health for all.International audienceContext: Since 2019, the French government has been implementing a new coordination structure, the maison sport-santé (literally, it means physical activity for health center). This public policy is aimed at people who are not practicing enough physical activity and at patients suffering from chronic illness. Beneficiaries are offered a personalized program designed to help them re-engage in physical activity over a long term period. The maison sport-santé is designed to interact and coordinate sports, social and health organisations and professionals, to offer a global and integrated health approach to users.Method: A qualitative approach was adopted to investigate the issues involved in coordinating physical activity pathway, and thus coordinating social actors from the field of sports, health and social. The aim of this work is to analyse a public policy through a micro-level perspective, in order to gain a detailed understanding of its practical implementation. Furhermore, it studies the way in which the maison sport-santé develop strategies to create cooperation and coordination based on an integrated and personalized health pathway for the user. Over a two-year period, non-participant observations and 34 semi-structured interviews were conducted. Three monographs of different structures were also carried out. Analysis of meeting reports and official documents contextualised the interviews and observations.Results: Although the maison sport-santé are tasked with coordinating the physical activity pathway, it turns out that they are more cooperating with their partners on small projects rather than fully coordinating all the social actors. As a result, these structures have difficulty gaining recognition as the legitimate central organisation in the field of physical activity for health. They face numerous professional struggles and organisational conflicts. The maison sport-santé produce a narrative based on the common good and service user to encourage cooperation between social actors, to regulate conflicts and the work of their service providers. This form of coordination directly calls into question the organisation of work in the field of health and its components, i.e. the social sector and physical activity. The budgetary and human resources constraints faced by the maison sport-santé vary according to their social network and the support they receive from local policies.Discussion: This study analyses the local implementing of a public health measure through the perspective of meanings produced by local actors and of collective action. It brings some insights about the local implementation of a people-centred policy. If this research focused on the main social actors of the public policy (the local government, the maison sport-santé and their partners), it would be interesting to extend the analysis to all social actors in the ecological systems (professional associations, sports federations, etc.). In addition, the analysis of the actions organised around the maisons sport-santé reveals trends in the way public health policies are governed. It would be useful to develop an analysis of the transfer of a public service to local, sometimes private organisations. These points of improvement are currently being pursued as part of a thesis within the EHESP doctoral network in public health
Breaking new ground in tobacco control: student reactions to France’s first smoke-free campus
No full textInternational audienceBackground: The World Health Organization recommends adopting smoke-free campuses (SFCs), and in 2024, the European Council has urged Member States to implement smoke-free policies on educational premises. However, unlike North America, Australia and New-Zealand, Europe has been slow to adopt SFCs. In France, the EHESP School of Public Health became the first SFC in 2018. This research assessed students' support for this SFC policy since its implementation and examined associated factors.Methods: An online cross-sectional study was conducted annually from 2018 to 2025. The dependent variable was students' support for the SFC policy, measured using a four-point Likert scale ranging from strong opposition to strong support. Explanatory variables included tobacco use behaviors, knowledge of tobacco's dangers, and sociodemographic characteristics. An ordered logit regression model was applied to account for the ordinal nature of the outcome variable. Explanatory variables were introduced sequentially to evaluate their incremental contribution.Results: The sample comprised 2,532 students with a 56.97% overall response rate. Support for the SFC policy was nearly universal (96.7% - 91.4% among students who smoked), exceeding levels reported outside Europe. Smoking status, demographic factors, and time were significantly associated with it. Current smoking or vaping, or ever smoking were negatively associated with support. Support increased between 2018 and 2025. Being a woman, an aspiring public servant, or older in age positively influenced it. Knowledge of tobacco's dangers showed no significant association with support.Conclusions: Most research on SFC policies has been conducted in settings with low smoking prevalence where SFCs are typical. Our study is the first to assess support in a country where SFC policies were not yet widespread. The high level of support observed should encourage the broader implementation of SFCs in France and across other European countries
Commentary on Dennett et al .: When heat and the opioid epidemic collide ‐ implications for climate‐resilient public health strategies
No full textCommentaryInternational audienc
Long-term exposure to wildfire smoke and mortality: Heterogeneous effects by exposure metric and across subpopulations
No full textInternational audienceWildfire smoke, once rare, is a hazard that populations across the globe are increasingly exposed to repeatedly. Evidence of acute health effects of wildfire particulate matter (PM(2.5)) is growing, but less is known about long-term effects related to repeated exposures. Using a cohort of 1,250,083 Kaiser Permanente Southern California members aged ≥60, we estimated the association between all-cause mortality and 3-y exposure to five different census tract-level wildfire smoke metrics (mean daily wildfire-specific PM(2.5), mean daily wildfire-specific PM(2.5) during the peak wildfire week, number of days with daily wildfire-specific PM(2.5) > 0 μg/m(3), number of weeks with average wildfire-specific PM(2.5) > 5 μg/m(3), and number of smoke waves). We applied a discrete-time approach with pooled logistic regressions, adjusting for sex, age, race and ethnicity, marital status, smoking status, requiring an interpreter, calendar year, and census tract-level poverty and population density. When comparing those highly exposed (95th percentile) to those minimally exposed (5th percentile), we found an increased odds of mortality across all five wildfire smoke metrics. Mean daily wildfire PM(2.5) was the metric most strongly associated with mortality (odds ratio: 1.07; 95% CI: 1.05, 1.09). We observed greater vulnerability to the long-term effects of smoke for individuals under age 75, or with Black or Other racial/ethnic identity, or living in a census tract with higher poverty. Identifying the most harmful long-term wildfire smoke metric and most-at-risk populations can help focus attention for developing effective adaptation strategies in a changing climate
Food Risks and Scares
No full textInternational audienceThough our food may, objectively speaking, be much safer than in the past, incidence of food safety crises has increased in developed societies. Thus the dominant view in the West is paradoxically that food risks are much higher than in the past. Beyond the seeming irrationality of consumers, this entry uses recent literature to examine the anthropological and sociological foundations of contemporary food scares, as well as their evolution throughout history. It also seeks to highlight the main institutional and contextual factors – connected to social change – which tend to amplify experiences of food safety crises. Finally, it reviews the public policies that have been implemented in recent decades in order to restore consumer trust in the safety of their food
#2823 Association between nephrotoxic drugs and the development of chronic kidney disease based on french real-world data
No full textInternational audienceBackground and AimsChronic kidney disease (CKD) is primarily associated with cardiovascular conditions such as hypertension (HTN) and diabetes. However, the impact of nephrotoxic drugs on the development of CKD remains difficult to assess due to multiple factors, including the slow progression of the disease, polypharmacy, particularly in elderly patients, and a lack of data.Given the constant increase in CKD prevalence and the growing trend of polypharmacy, our objective is to explore the iatrogenic impact of nephrotoxic drugs on the onset of CKD using real-world data.MethodThis retrospective study is based on the linkage of hospital data alias PMSI (Program for the Medicalization of Information Systems) and the French National Health Data System (SNDS). The SNDS provides information on outpatient drug consumption, while hospital data include biological test results. These two datasets were matched using common information from the PMSI, such as ICD-10 (International Classification of Diseases) diagnoses and medical procedures.We included non-dialysis adult patients hospitalized between 2015 and 2018 who had at least one creatinine measurement. Patients were categorized based on their renal status: healthy patients (without CKD or acute kidney injury) and patients who developed CKD (normal GFR at least once followed by an ICD-10 diagnosis of CKD or three months of clearance < 60 mL/min/1.73m²). Age and sex were identified, along with other comorbidities influencing CKD, such as HTN, diabetes, dyslipidemia, and obesity, identified using ICD-10 codes and the Anatomical Therapeutic Chemical (ATC) classification of outpatient medications.The nephrotoxic drugs studied included drugs known to induce CKD, such as lithium, antiretrovirals (ARVs), fluindione, tyrosine kinase inhibitors (TKIs), triptans, tolvaptan, proton pump inhibitors (PPIs), and non-steroidal anti-inflammatory drugs (NSAIDs). Drug exposure was assessed in a binary manner (exposed/unexposed) over the year preceding the first clearance measurement for healthy patients and over the year preceding the onset of CKD for patients who developed chronic kidney disease.Comorbidities by renal status were analyzed using logistic regression. Subsequently, the impact of each nephrotoxic drug was assessed using logistic regression adjusted for significant comorbidities, with an alpha risk of 5%.ResultsThe study included 244,937 healthy patients (mean age: 63.5 years, 55% female) and 238,676 patients who developed CKD (mean age: 71.6 years, 40% female).According to the preliminary results, comorbidities were more frequent among patients who developed CKD, including HTN (82%), dyslipidemia (48%), diabetes (25%), and obesity (7%). Age was a significant risk factor for CKD development, with a notably higher risk in patients over 75 years old (OR = 10.31 [95% CI: 9.6-11.1]). The total number of nephrotoxic drugs was a significant factor in renal function decline (OR = 1.1 [95% CI: 1.0–1.1]). Among the studied drugs, those with a significant impact on CKD development included ARV 2 (OR = 5.4 [95% CI: 3.9–7.4]), ARV 1 (OR = 3.2 [95% CI: 2.5–4.1]), TKIs (OR = 2.6 [95% CI: 2.2–3.0]), fluindione (OR = 2.2 [95% CI: 2.1–2.3]), lithium (OR = 1.9 [95% CI: 1.6–2.4]), and PPIs (OR = 1.2 [95% CI: 1.1–1.2]). However, in this study, certain drugs such as NSAIDs and triptans were not significantly associated with CKD development. The complete results of the statistical models are presented in Table 1.ConclusionThanks to full visibility of the patient pathway from outpatient care to hospital settings, we conclude that the significant factors contributing to CKD development include comorbidities such as age, HTN, diabetes, dyslipidemia, and obesity. The nephrotoxic drugs with a significant impact are ARVs, TKIs, lithium, fluindione, and PPIs, which are widely prescribed on a population level. Ongoing studies aim to investigate the relationship between CKD development and drug exposure quantified using the cumulative Defined Daily Dose (DDD), which represents the assumed average maintenance dose per year for a drug used in its primary indication