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Soins et santé publique environnementale
No full textNational audienceThe impact of the environment on health is difficult to detect at the individual level due to the multifactorial nature of the associated pathologies. However, the widespread prevalence of exposure to environmental risk factors makes the environment an important determinant of population health. Its importance will grow with climate change, and the healthcare system will be confronted with this issue. As a significant contributor to change itself, the healthcare system will need to reduce its environmental footprint.L’impact sanitaire de l’environnement est peu facilement décelable au niveau individuel du fait du caractère multifactoriel des pathologies associées. La large prévalence des expositions aux facteurs de risque environnemental fait cependant de l’environnement un déterminant important de la santé des populations. Son importance va croître avec les évolutions climatiques ; le système de soins y sera confronté. Lui-même contributeur notable des changements, il devra réduire son empreinte environnementale
Using generalized random forests to characterize vulnerability to adverse health outcomes following wildfire smoke exposure in California
No full textInternational audienceBackgroundAs the health burden attributable to wildfire activity increases under climate change, it is crucial to determine which subgroups face heightened vulnerability to wildfire smoke. Marginalized communities may experience disproportionate risk from overlapping individual and community vulnerability factors. We leverage recent developments in machine learning methods for high-dimensional settings to construct detailed profiles of California communities disproportionately impacted by wildfire smoke across 27 potential effect modifiers.MethodsWe used daily 2006–2019 data on hospital admissions and emergency department (ED) visits for cardio-respiratory diseases in California. We applied a time-stratified case-crossover study design to analyze the effect of wildfire-specific fine particulate matter (PM2.5) on cardio-respiratory diseases. Then, we investigated heterogeneous effects using a generalized random forest approach, which can handle a large set of individual-level (age, sex, race/ethnicity) and area-level (e.g., poverty level, racial/ethnic segregation) factors to construct vulnerability profiles for each Air Basin, representing areas with similar meteorological and geographic conditions.ResultsA 10 µg/m3 increase in wildfire PM2.5 concentration (2-day moving average) was associated with an increased risk of hospital admissions and ED visits related to respiratory diseases (OR = 1.014, 95 % confidence interval = 1.012–1.016). No association was found for cardiovascular diseases. Associations between exposure to wildfire PM2.5 and respiratory diseases varied strongly by individual- (age, sex, race/ethnicity) and area-level factors (such as A/C prevalence, Black/White dissimilarity index). The importance of these effect modifiers, and vulnerability profiles, changed across Air Basins.ConclusionsMachine learning can characterize the complex heterogeneity in wildfire smoke-related health impacts
Santé environnementale
No full textNational audienceCe chapitre vise à donner au lecteur les clefs d'appropriation de la santé environnementale en tant que champ de production de connaissances des dangers et des risques sanitaires liés à l'environnement, de caractérisation et d'évaluation des impacts sanitaires associés, ainsi que de gestion de ces impacts pour protéger la santé publique. Au regard des précédentes éditions, il faut souligner l'accroissement spectaculaire des connaissances, particulièrement des mécanismes étiologiques par lesquels l'environnement agit sur la santé, et des interactions entre les facteurs environnementaux, le climat et la biodiversité et de leurs effets conjugués sur les impacts sanitaires. Cette évolution est liée aux innovations conceptuelles qui ont conduit au développement d'une recherche interdisciplinaire ouvrant la voie à des approches systémiques de caractérisation des risques, et aux innovations technologiques permettant leur mise en oeuvre. Elle a ainsi conduit à un élargissement et un approfondissement du champ de la santé environnementale mais aussi à sa complexification dont la prise en compte opérationnelle dans l'évaluation des risques et sa traduction dans l'élaboration des politiques publiques de prévention et de contrôle reste en grande partie à construire, alors même que la santé environnementale est aujourd'hui menacée, notamment par les intérêts des grands secteurs d'activité des groupes mondialisés
System-wide use of Patient Reported Outcome Measures (PROMs) in OECD countries: insights from a health policy survey and key informant workshops
No full textInternational audienceObjectivesPatient reported outcome measures (PROMs) can systematically integrate the patient perspective to enhance value-based, people-centred healthcare. This study aims to assess the current systematic use of PROMs data across OECD countries and identify barriers and enablers for system-wide implementation from decision-makers’ perspectives.MethodsA cross-sectional country-level survey was conducted among country officials from 38 OECD member and accession countries, and key partners. Two researchers independently coded survey responses. Analysis of barriers and enablers to implementation was guided by the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework and survey results were validated through two online workshops, with 72 and 81 key informants, respectively.ResultsAmong 38 countries surveyed, 44 PROMs programmes were identified in 21 countries. Main purposes of data collection were quality improvement (95% of the programmes) and quality assurance (55%). The primary users of PROMs data were healthcare professionals (68%), policymakers (59%), and healthcare professional organisations (59%). Programmes more frequently engaged healthcare professionals (93%) than patients (79%). In most programmes (73%), patients could complete PROMs via online platforms, whereas in less than half (39%) PROMs data were embedded into electronic health records. The most reported barriers to implementation included limited staffing capacity, technological challenges and insufficienttraining for both patients and healthcare professionals. ConclusionImproved resource allocation, meaningful stakeholder engagement and embedding PROMs into data infrastructures can contribute to system-wide PROMs implementation
Combined Prognostic Value of Age at Onset and Socioeconomic Status for Long-term Survival in Breast Cancer
No full textInternational audienc
Strengthening the use of regulatory policy measures for prevention of NCDs in Europe through the JA PreventNCD project
No full textInternational audienceAims: The Joint Action project on Cancer and other Non-communicable Diseases (NCDs) prevention, Action on Health Determinants, includes a dedicated workstream on structural and population-level interventions. The overarching objective of this workstream is to strengthen the compliance, coherence, implementation and enforcement of evidence-based regulatory measures that support governmental efforts to reduce the burden of NCDs. Methods: The workstream adopts a multi-method approach, informed by existing academic literature and previous European studies. Key methodologies include policy mapping, evidence reviews, behavioural assessments, policy impact modelling, and pilot testing. Governmental alcohol and tobacco policies will be evaluated using comparative policy scales, while the health and economic impacts of health taxation policies will be projected through and microsimulation modelling. Nutrient profile modelling and food composition databases will be developed to inform strategies for food reformulation. The effectiveness of labelling interventions will be examined. Tools for monitoring digital marketing exposure will be developed, and the impact of environmental policy impact will be assessed. Expected results: The workstream is expected to deliver comprehensive policy analyses, demonstrate the potential impact of health taxation, propose harmonized nutrient profiling frameworks, assess the effectiveness of food and alcohol labelling practices and contribute to the development of cross-national structures for public food procurement. Additionally, it will provide guidance on the implementation of effective measures and evaluate divergences in national policy approaches across Europe. Conclusions: The workstream will generate actionable evidence and documentation to inform and support public policy processes, thereby contributing to reductions in the burden of preventable disease across the region
Marketing social, déterminants commerciaux de la santé et prévention des addictions
No full textInternational audienceLe marketing social, né aux États-Unis il y a environ cinquante ans, s’est développé en France depuis les années 2000. Il s’inspire des techniques du marketing commercial mobilisé par les entreprises pour mettre en place des programmes de prévention. De nombreuses recherches ont montré son efficacité pour modifier les comportements dans divers contextes, dont les addictions
Childhood and Adolescent Environmental Risk Factors for Multiple Sclerosis: A Systematic Review With Meta‐Analysis
No full textInternational audienceBackground: We aimed to provide updated evidence from the current literature regarding pediatric environmental factors associated with the risk of developing multiple sclerosis (MS).Methods: Articles were searched in PubMed, SciVerse ScienceDirect, and Web of Science. We included all clinical studies assessing the occurrence of MS at any age in association with the exposure to any environmental risk factor during childhood or adolescence. The main outcome was the occurrence of MS. The quality assessment was performed with the critical appraisal checklist for case-control studies. Pooled unadjusted effect sizes (OR) were calculated and reported with a 95% CI from random-effects meta-analysis.Results: The review included 87 studies conducted across 20 countries. The studies analyzed diverse environmental risk factors, including infections, vaccinations, tobacco exposure, body mass index, and other pediatric exposures. EBV infection showed a significant positive association with MS risk (ES = 2.38, 95% CI = 1.80-3.15). Breastfeeding showed limited protective associations, and various adverse social experiences like bullying and sexual abuse were linked to increased MS risk. Active smoking during childhood/adolescence and obesity during these periods were associated with higher MS risk, while normal body mass index was protective. Antibiotic and chemical exposures, as well as vitamin D deficiency, were linked to higher MS risk. The review highlighted substantial heterogeneity and identified publication bias in studies on infections and vaccinations.Conclusions: Environmental risk factors for MS are important during childhood and adolescence. The first 20 years are a key window for prevention and should be seen as an opportunity
Régulations de la contrainte en psychiatrie : vers une transformation des pratiques ?
No full textInternational audienceÀ partir de plusieurs recherches sur le recours à la contrainte en psychiatrie, dont une recherche doctorale sur les pratiques de contrainte, leur inscription dans des organisations et des cultures de soin et leurs régulations sociales, légales, professionnelles (Moreau, 2015), et une recherche collective PLAID-Care sur les établissements et services ayant un moindre recours à la contrainte (Saetta et al., 2023), ce chapitre reviendra sur les formes de régulations de la contrainte en France (I). Il s’agira notamment, après avoir souligné leur construction socio-historique (II), de s’interroger sur l’efficacité de ces régulations au regard de la persistance voire de l’augmentation du recours à la contrainte (III), avant d’évoquer des pistes de régulations qui ne soient pas centrées sur le seul moment où se pose la question de la contrainte, impliquant une prise en compte élargie des espaces-temps du soin et de la parole des personnes concernées (IV)