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Eaux, ville et santé : constats, enjeux et solutions
No full textEditorialInternational audienceQu’entend-on par l’eau dans la ville ? Quelle importance pour notre santé ? Dans un environnement urbain toujours plus dense et imperméable, une urbanisation croissante et dans un contexte de changement climatique, l’eau reste indispensable à la vie, son importance pour la santé et le bien-être est indiscutable. L’eau doit être considérée sous toutes ses formes : souterraines, superficielles, pluviales, potables, usées, etc., ainsi que dans tous ses usages et ses bienfaits. Elle est en effet source [...
Climate Change and Respiratory Health: Opportunities to Contribute to Environmental Justice: An Official American Thoracic Society Workshop Report
No full textInternational audienceAdverse environmental exposures worsened by our changing climate threaten respiratory health and exacerbate existing social inequities that further undermine environmental justice (EJ). EJ is the capacity of all people, regardless of sociodemographic characteristics, to minimize harmful exposures and live a healthy life. EJ is achieved through the development, implementation, and enforcement of environmental laws, regulations, and policies. In 2023, an American Thoracic Society workshop convened a group of 39 clinicians, researchers, community advocates, research program administrators, and health policy experts to characterize the respiratory health threats and EJ concerns arising from climate change. The workshop explored four main climate areas through a socioecological and EJ perspective: 1) respiratory health risks, 2) respiratory health impacts in low- and middle-income countries, 3) climate mitigation and adaptation strategies, and 4) priority research infrastructure needs. The workshop committee concluded that climate change can directly and indirectly impair respiratory health and that persistently excluded or marginalized communities (including those in low- and middle-income countries) are disproportionately impacted. These disproportionately impacted communities also lack hazard monitoring and resources to evaluate and advocate for mitigation of adverse environmental exposures. Future respiratory health research must inform mitigation strategies to reduce climate-related emissions from industry to net zero. Researchers, communities, and policymakers require training and support to meaningfully engage with systems-thinking research as well as policy solutions focused on mitigating and adapting to climate change. Finally, the workshop committee recommends a rapid transition away from fossil fuel dependence to a world that provides an equitable allocation of clean transportation options and renewable sources of energy production
Green IT to Reduce Healthcare’s Climate Impact: The French Approach
No full textInternational audienceClimate change poses a significant threat to human health. While the healthcare sector addresses these challenges, it is also a major contributor of greenhouse gas emissions. Although digital health improves care efficiency, it also increases the sector’s carbon footprint. To mitigate this impact, promoting sustainable practices on the path toward digital maturity is crucial. France is committed to reducing the environmental impact of digital health on a national scale. The country has implemented measurement tools and ecoscores to help software developers assess and reduce the ecological footprint of their health solutions, including those of health applications, hospital information systems, and teleconsultation services. Additionally, Green IT initiatives have been launched by public and private hospitals, including eco-responsible purchasing, reusing heat from data centers, utilizing green search engines, saving energy by shutting down unused digital equipment, adopting conservative email practices, and managing the second life and end of life of electronic materials. Political support has facilitated legal and financial measures to create a favorable environment for green innovation and the adoption of environmentally-friendly technologies. By coordinating actions at all levels, France aims to make digital health a model of sustainability while continuing to enhance the quality and accessibility of care for everyone
Circumventing glioblastoma resistance to temozolomide through optimal drug combinations designed by systems pharmacology and machine learning
No full textInternational audienceBackground and Purpose Glioblastoma (GBM), the most frequent and aggressive brain tumour in adults, is associated with a dismal prognostic despite intensive treatment involving surgery, radiotherapy and temozolomide (TMZ)‐based chemotherapy. The initial or acquired resistance of GBM to TMZ appeals for precision medicine approaches to the design of novel efficient combination pharmacotherapies. Such investigation needs to account for the overexpression of the O6‐methylguanine‐DNA methyl‐transferase (MGMT) repair enzyme which is responsible for TMZ resistance in patients. Experimental Approach A comprehensive approach combining quantitative systems pharmacology (QSP) models and machine learning (ML) was undertaken to design TMZ‐based drug combinations circumventing the initial resistance to the alkylating agent. Key Results A QSP model representing TMZ cellular pharmacokinetics‐pharmacodynamics and dysregulated pathways in GBM was developed and validated using multi‐type time‐ and dose‐resolved datasets, available in control or MGMT‐overexpressing cells. In silico drug screening and subsequent experimental validation identified a strategy to re‐sensitise TMZ‐resistant cells consisting in combining TMZ with inhibitors of the base excision repair and of homologous recombination. Using ML, functional signatures of response to such optimal multi‐agent therapy were derived to assist decision‐making in patients. Conclusion and Implications We successfully demonstrated the relevance of combined QSP and ML to design efficient drug combinations re‐sensitising glioblastoma cells initially resistant to TMZ. The developed framework may further serve to identify personalised therapies and administration schedules by extending it to account for additional patient‐specific altered pathways and whole‐body features
Coopération régionale en santé sur la planification familiale dans l’archipel des Comores
No full textInternational audienceCette communication mobilise le cadre analytique de la justice reproductive, qui englobe à la fois le droit de ne pas avoir d’enfant, celui d’en avoir, et celui d’élever ses enfants dans un environnement sûr. Au sein de l’archipel des Comores, la planification familiale, l’accès différencié à l’IVG et aux techniques d’assistance médicale à la procréation (AMP) interrogent l’offre en santé reproductive, décrite dans le cadre de cette communication.Les données présentées ont été collectées lors d’une mission réalisée à l’automne 2024 pour le compte de l’Agence Régionale de Santé de l’île dans le cadre de la coopération régionale en santé avec l’Union des Comores. Dans ce contexte, un terrain de deux mois a été réalisé à Mayotte et un autre de quinze jours en Union des Comores. Cette communication s’appuie sur les enquêtes statistiques des territoires en présence ainsi que des entretiens réalisés auprès d’acteurs institutionnels et associatifs du champ de la santé sexuelle et reproductive, analysés à l’aide du logiciel NVivo. L’objectif de cette communication était de présenter les pratiques contraceptives différenciées, les enjeux d’accès à l’IVG et les conditions d’accès à l’AMP sur ces territoires, dans une perspective comparative.Les résultats montrent une forte disparité à l’échelle de l’archipel entre Mayotte et l’Union des Comores. En matière de contraception, Mayotte bénéficie d’un cadre d’accès élargi, tandis qu’en Union des Comores l’accès reste légalement restreint aux couples mariés, avec des ruptures fréquentes de stocks et des besoins non satisfaits élevés. Concernant l’IVG, l’Union des Comores applique une interdiction stricte de cet acte. Certaines femmes adoptent des pratiques clandestines ou optent pour une mobilité vers Mayotte, où l’IVG est légale mais socialement stigmatisée. L’accès à l’AMP, quant à lui, illustre une asymétrie inverse: Mayotte ne dispose pas d’offre locale, poussant les couples à effectuer des mobilités reproductives vers La Réunion ou l’hexagone, tandis qu’une clinique privée vient d’ouvrir sur l’île d’Nzouani (Anjouan), ciblant les seuls couples mariés hétérosexuels pouvant en payer le coût.Ces résultats révèlent une fragmentation de l’offre de santé reproductive à l’échelle de l’archipel, mettant en évidence des injustices structurelles pesant sur les populations les plus vulnérables. Le propos visait à défendre la nécessité de promouvoir une justice reproductive effective, impliquant de déconstruire les représentations homogénéisantes, de renforcer l’éducation à la santé sexuelle et de développer une coopération régionale capable d’assurer un accès équitable aux droits reproductifs des populations en présence dans l’archipel
Expérience utilisateur de chambres d’hôpital innovantes pour les patients âgés : le projet HospiSenior
No full textInternational audienceThe hospital environment plays a crucial role in patient recovery. Traditional hospital rooms are not fully adapted to the specific needs of older patients who face higher risks of falls, delirium, and functional decline, leading to decreased comfort, autonomy, and safety. The HospiSenior project was designed to address these issues by developing innovative, user-centered hospital rooms tailored to older patients. This study aimed to evaluate the user experience (UX) of the HospiSenior rooms among older patients, caregivers, and healthcare professionals across five university hospitals in France. A multicentric, non-interventional, descriptive study was conducted between January 2021 and January 2024. Participants included hospitalized older patients, their informal caregivers, and healthcare professionals. UX was assessed using the AttrakDiff and meCUE questionnaires, measuring global UX (UXg) and specific UX (UXs) for 14 key innovations implemented in the rooms. Safety perception was evaluated using the QUEST 2.0 scale. A total of 100 participants were enrolled. Overall, UX scores were positive, particularly among caregivers and professionals, with higher ratings for pragmatic quality and attractiveness. However, older patients reported lower UX scores, indicating usability challenges. High adoption rates were observed for the inclined bed position, sliding pocket door, and bathroom lighting (100%), while the mirror-window (10%) and connected room system (9%) were the least used features. Safety perceptions were generally positive, though concerns were noted for automatic lighting. HospiSenior rooms improve UX for older patients, caregivers, and professionals, yet some innovations require further adaptation for optimal usability. Future research should explore the long-term clinical impact of these design features, with the ongoing Hospisenior clinical trial (NCT06098534) expected to provide further insights.Le projet HospiSenior visait à développer des chambres hospitalières innovantes et adaptées aux besoins des patients âgés, souvent confrontés à un risque accru de chutes, de déclin fonctionnel et cognitif. Cette étude a évalué l’expérience utilisateur (UX) des chambres HospiSenior parmi les patients âgés hospitalisés, leurs aidants et les professionnels de santé dans cinq hôpitaux universitaires en France, entre janvier 2021 et janvier 2024. Un total de 100 participants a été inclus, et l’UX a été mesurée à l’aide des questionnaires AttrakDiff et meCUE. Les résultats ont montré des scores UX globalement positifs, particulièrement parmi les aidants et les professionnels, mais les patients âgés ont rapporté des difficultés d’utilisation, notamment avec certaines innovations comme le miroir-fenêtre et le système de chambre connectée. L’adoption des caractéristiques telles que le lit incliné et l’éclairage de la salle de bain a été élevée. Les perceptions de sécurité étaient généralement positives, bien que des préoccupations aient été exprimées concernant l’éclairage automatique. Cette étude suggère que les chambres HospiSenior améliorent l’UX pour les patients âgés, mais que certaines innovations nécessitent des ajustements pour une utilisation optimale. Des recherches futures devraient explorer l’impact clinique à long terme de ces aménagements
France, love it but leave it: The silent flight of French muslims
No full textInternational audienceTheir names are Mohamed, Samira, sometimes Matthieu or Sophie. They were born and bred in many parts of France and are highly qualified, but they have decided to go and live in London, New York, Montreal, Brussels, Geneva or Dubai. Many were discriminated against on the French job market, or stigmatised because they have the wrong religion or wrong-sounding names. Whether devout Muslims or not, they felt unloved and unwanted in France, and they find outside of France a sense of peace and fulfilment their native country would not give them. Outside of France they enjoy a 'right to indifference' they just couldn't find in their native country.This book, based on original research, sheds new light on the silent, never-talked-about flight abroad of French Muslims. It unpacks their motivations, their experiences in France and abroad, and their sense of Frenchness, fraught with bitterness as well as with gratitude. This book isn't just about an unreported brain-drain: it is also about the deleterious effects of Islamophobia in a country that balks at using the very concept. And it is about an urgent challenge that most countries with Muslim minorities need to confront
Two and a half decades of United States wildfire burn zone disaster data, 2000-2025
No full textInternational audienceGrowing wildfire frequency and urban development expanding into fire-prone areas have heightened wildfire risk for wildland-urban interface (WUI) communities. When burn zones come near or cross into communities, the heat, flames, and smoke can harm human health-directly or via psychosocial stressors-to the point of becoming a disaster. We harmonized six wildfire datasets to create the first U.S.-wide spatial dataset of wildfire burn zone disasters. Our criteria for a wildfire burn zone disaster were wildfires that burned near a community (≥96 people per km2 or met WUI criterion) and resulted in ≥1 civilian fatality, ≥1 destroyed structure, or received federal disaster declaration. We identified 6,212 U.S. wildfire burn zone disasters between 2000-2025. The annual number of these disasters ranged between 61 in 2001 and 570 in 2011 (median = 217), with an increasing trend over the study period. California had the highest number of wildfire burn zone disasters (n = 878, 14.1%). These data may inform demographic, economic, and population health research, as well as policymaking and resource allocation
Vers une santé plus soutenable pour et avec les infirmiers
No full textNational audienceEcological crises threaten human health, while healthcare systems exacerbate these problems by generating significant emissions, particularly through the purchase of medical goods. To reduce their impact without compromising the quality of care, it is essential to transform practices. Healthcare workers, particularly nurses, are key players in this transition. Their role must be recognized, supported, and strengthened.Les crises écologiques menacent la santé humaine, tandis que les systèmes de santé aggravent ces problèmes en générant d’importantes émissions, notamment par l’achat de biens médicaux. Pour réduire leur impact sans compromettre la qualité des soins, il est essentiel de transformer les pratiques. Les soignants, en particulier les infirmières, sont des acteurs clés de cette transition. Leur rôle doit être reconnu, soutenu et renforcé
