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#1718 Comparison of healthcare utilization between CKD and non-CKD patients: an observational study in the West region of France
No full textInternational audienceBackground and AimsChronic kidney disease (CKD) affects 8%–10% of the French population, posing considerable problems to healthcare systems due to its high morbidity and resource demands. However, less is known about healthcare utilization patterns among CKD patients compared to non-CKD patients. This study aims to compare healthcare utilization between these groups to identify differences in healthcare needs.MethodThis retrospective observational study included data from all hospitalized patients in several teaching hospitals of the west region of France between January 1, 2015, and December 31, 2018, our study period. Patients’ clinical data were extracted from hospitals’ clinical data warehouses (CDWs) and linked to the National Health Data System (SNDS). The SNDS is a comprehensive database maintained by the French Social Security system that contains all reimbursed outpatient care and inpatient care in France. We identified CKD patients using CDWs’ data. We defined CKD as having an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m² measured at least 90 days apart or a documented CKD diagnosis. Patients were stratified by CKD stages (3, 4, or 5). Non-CKD patients were identified as having eGFR values consistently ≥90 mL/min/1.73 m² within study period. Using the SNDS data, healthcare utilization in 2015 was assessed in terms of inpatient care (nephrology-related and unrelated hospitalizations) and outpatient care (consultations with general practitioners (GP), nephrologists, cardiologists, and endocrinologists). Care utilization rates were calculated by age groups and CKD stages.ResultsWe identified 292,559 non-CKD patients (mean age 53.3 years, 54.7% female) and 26,125 CKD patients (mean age 75.2 years; 36% female). Among those, 53.5% were stage 3, 27% stage 4 and 19.5% stage 5. Hospitalization duration increased with both age and CKD severity, with the longest stays observed in advanced CKD stages (mean duration 7–10 days) among older patients (≥75 years). Nephrology-related hospitalization rates decreased with age beyond 50, while unrelated-nephrology hospitalization rate increased with both age and CKD stages. Patients aged >85 years with stage 5 CKD showed the highest rates of unrelated-nephrology hospitalizations (2000 per 1000 person-years) compared to stage 3 CKD (800) and non-CKD patients (790). Minimal differences in hospitalization rates were observed between non-CKD and stage 3 CKD patients as age increased. GP consultation rates increased with age and CKD severity, peaking in stage 5 patients aged >85 years (over 9000 per 1000 person-years). Nephrologist consultations were mainly observed in stage 5 patients, with higher rates in younger age groups (over 3000 per 1000 person-years for age ≤50). Consultation rates with cardiologists increased with age, peaking in stage 4 CKD among patients aged 75–85 years, at approximately 600 per 1000 person-years. Patients over 85 years old had the lowest consultation rates with endocrinologists, regardless of CKD status.ConclusionThis is the first study in France to compare healthcare utilization between CKD and non-CKD patients. As age increased, CKD patients' rates of nephrologist consultations and related-nephrology hospitalizations decreased, suggesting a shift toward hospitalizations and consultations for comorbidities associated with CKD. Additionally, the results showed that hospitalization rates were similar at older ages, while GP consultation rates were comparable at younger ages between CKD and non-CKD patients. Further analysis will explore gender differences and adherence to French national care guidelines to identify areas of improvement in CKD care
De Alma-Ata à Genève : Le chemin tortueux de la promotion de la santé
No full textInternational audienceCe chapitre retrace l'évolution historique et conceptuelle de la promotion de la santé, depuis la Déclaration d'Alma-Ata en 1978 jusqu'à la conférence de Genève en 2021. Il met en lumière les mutations épidémiologiques, scientifiques et sociétales qui ont conduit à l'émergence de ce champ, en réponse aux limites des approches biomédicales traditionnelles face aux défis de santé contemporains.Le chapitre éclaire les pratiques sociales en montrant comment la promotion de la santé s'est développée comme une approche intégrée visant à agir sur les déterminants sociaux, économiques et environnementaux de la santé. Il souligne le passage d'une vision centrée sur la prévention des maladies à une perspective plus large, axée sur le renforcement des capacités des individus et des communautés à prendre en charge leur santé. Cette évolution reflète une transformation profonde des pratiques en santé publique, passant d'interventions descendantes à des approches participatives et émancipatrices. L’auteur met en évidence l'importance accordée à la justice sociale et à la réduction des inégalités de santé dans le développement de la promotion de la santé. Il montre comment cette approche a cherché à dépasser les limites de l'éducation à la santé traditionnelle, en reconnaissant l'influence des environnements sociaux et physiques sur les comportements de santé. Des initiatives telles que les villes ou écoles promotrices de santé illustrent cette vision écologique et intersectorielle. En termes de partage des savoirs, le chapitre souligne l'apport de la promotion de la santé dans l'intégration de différents types de connaissances. Il montre comment ce champ s'est construit à l'interface entre savoirs scientifiques, expériences communautaires et expertises professionnelles. La promotion de la santé a ainsi contribué à valoriser les savoirs expérientiels et à promouvoir une co-construction des connaissances entre chercheurs, praticiens et populations
Longitudinal assessment of nitrate and trihalomethanes in drinking-water and breast cancer in the CONSTANCES cohort: a prospective population-based study in France
No full textInternational audienceNitrate and trihalomethanes (THMs) in drinking water are widespread and potential human carcinogens. We evaluated the association between time-varying exposure to nitrate and THMs in drinking water and female breast cancer (BC) among adults from CONSTANCES, a large French population-based prospective cohort. Our analysis included 26,669 women (18.5–72.5 years old) enrolled in 2012–2020, followed until 2021, with information on residential history, type of water consumed, type of filter used, and bathing and showering frequency. We used water quality data for 2004–2020 from the drinking surveillance national database (SISE-Eaux). Annual median concentrations of nitrate, chloroform, chlorodibromomethane, bromodichloromethane, and bromoform at the participants’ residential addresses were estimated. Waterborne ingested exposure was estimated considering type of water, filter used, and liters/day consumed. Estimated exposure in showers and baths combined residential concentrations with showers/baths duration and frequency. Incident BC cases were ascertained in the French national health data system (SNDS) for 2012–2021. Extended Cox models with attained age as time-scale and time-varying weighted average exposures, adjusted for individual and area-level covariables, were used to estimate hazard ratios (HR) and confidence intervals (CI) by exposure tertiles. Average age at enrolment was 49.3 years, and median exposure window was 13 years. Median follow-up was 5 years (153,742 person-years), resulting in 437 new BC diagnoses. Median residential nitrate, brominated (Br)-THMs and chloroform concentrations were, respectively, 15.8 mg/L, 14.2 μg/L, and 2.7 μg/L. HR (95 %CI) of BC associated with waterborne ingested nitrate (mg/day) for the second (>4.8–15.1) and third tertile (>15.1) compared to the first (≤4.8) were 1.35 (1.01–1.81) and 1.51 (1.10–2.07), respectively. Residential THM concentrations were not associated with BC, however HR (95 %CI) of BC for showering and bathing Br-THMs exposure (μg/L × min/day) was 1.18 (0.84–1.64) for the third (>125) vs. first tertile (≤51.5). Findings suggest that ingested nitrate could be a risk factor of B
Nephrologists’ perception of the French national guidelines in nephrology
No full textInternational audienceIn France, the “Haute Autorité de Santé” (HAS), an independent public scientific authority, regularly publishes guidelines targeted to healthcare professionals. As their implementation is left to the healthcare professionals’ discretion, their perception could influence their application. The aim of this study was to assess the nephrologists’ perception of the HAS guidelines on nephrology in general and on the access to the kidney transplant waiting list. We used a mixed methods approach with an exploratory design combining analysis of qualitative and quantitative data. Nephrologists practicing in France were included. We collected qualitative data in face-to-face semi-structured interviews and identified the main themes through an inductive thematic analysis. We collected quantitative data through an online questionnaire designed based on the qualitative findings. The analysis of interviews with 45 nephrologists (22 women) identified three main themes: (i) nephrologists’ knowledge and sources of information on HAS guidelines in nephrology; (ii) their perception of these guidelines and relevance to medical practice; (iii) age limit to access the kidney transplant waiting list in the 2015 guidelines. The quantitative analysis included 126 nephrologists (47.6% women), among whom 84.1% had already heard about these guidelines. Respectively, 85.8% and 80.2% found the guidelines “clear” and “complete”. Overall, the quantitative data confirmed the qualitative findings. This study shows how nephrologists perceive the HAS guidelines. This will inform discussions on how to make these guidelines more accessible to nephrologists. New studies could be carried out to better quantify and qualify the effect of these guideline
Communicating scientific evidence: drugs for Alzheimer's disease as a case study
No full textInternational audienceThis paper reviews the scientific evidence on new anti-amyloid monoclonal antibodies for treating Alzheimer's disease as a case study for improving scientific evidence communication. We introduce five guidelines condensed from the biomedical evidence literature but adapted to the short format of science communication in e.g., journal opinion pieces and newspaper articles. Given the major importance and recent confusion regarding the discussed drugs, with certain disagreements seen e.g., between FDA and EMA, the suggested guidelines may be useful to clinicians discussing with their patients and to scientists communicating the evidence in balance. More generally, we hope that the guidelines may help us to improve communication of scientific evidence on complex topics in opinion pieces in the scientific literature, in advocacy, and in media appearances
Subchronic Exposure to Regulated Trihalomethanes and Haloacetic Acids: Do We Need to Refine Our Exposure Assessment? A Full-Scale Case Study in a Canadian Municipality
No full textInternational audienceRegulated disinfection byproducts (e.g., trihalomethanes and haloacetic acids) in drinking water networks fluctuate spatially and temporally, depending on water sources and treatment practices with higher concentrations during the summer. Trihalomethanes and haloacetic acids monitoring is based on yearly averages of quarterly measurements with maximum acceptable concentrations where extensive monitoring of disinfection byproducts is not required during those months. Because of concerns that exposures of a short duration could result in adverse reproductive and developmental outcomes, it is vital to study the temporal and spatial variations in exposure within complex systems such as networks. This paper uses an extensive data set in a network to study how domestic exposure may vary across the network and influence potential health risk estimation for key lifestages such as infants, toddlers, and adults. According to this study, the patterns and levels of subchronic exposure to those compounds vary spatially in the network. Subchronic hazard quotients to chloroform were also investigated and were below one, indicating that levels of exposure are less than the dose that may trigger toxicity for the selected end point. The information provided may assist public health authorities in evaluating the influence of DBP peaks on exposure and subchronic hazard quotients as well as in identifying areas of a distribution system with higher subchronic risks than others
Analysis of healthcare utilization before the diagnosis of radiologically isolated syndrome
No full textInternational audienceBackground: Previous studies have shown that people with multiple sclerosis (MS) had frequent healthcare visits up to 10 years before being diagnosed but with no information from magnetic resonance imaging (MRI) scans of the connection with the radiologically isolated syndrome (RIS).Objective: To analyze healthcare use 3 years before the RIS diagnosis.Methods: We examined healthcare usage before the first scan in RIS cases from 2010 to 2019. RIS subjects were identified from the French National MS observatory and compared to the general population (matched 10:1) and MS patients (matched 4:1).Results: Among 482 RIS individuals, 223 (46.3%) were not linked to the healthcare resources database. The remaining RIS individuals (53.7%) had higher healthcare usage before their RIS diagnosis for issues related to neurology visits, headaches (odds ratio (OR): 3.34, confidence interval (CI): [2.00-5.57], p < 0.0001), and the use of anti-migraine drugs (OR: 2.61, CI: [1.37-4.99], p = 0.004) compared to MS.Conclusion: Only about half of RIS patients had MS-selected healthcare resources, which allowed for data linkage. Those who did seek care before their RIS diagnosis were most commonly known for other neurological comorbidities. These findings do not support the idea of a systemic prodrome before RIS diagnosis
Pourquoi la vaccination rencontre-t-elle tant de scepticisme ?
No full texthttps://theconversation.comMalgré leur efficacité, les vaccins continuent à alimenter la défiance d’une partie des populations, pour diverses raisons. Sensibilisation des publics, lutte contre les fake news, obligation vaccinale… comment assurer le succès des campagnes de vaccination
Exposome factors associated with multi-morbidity in older adults: a discovery-based cross-sectional analysis in the Longitudinal Aging Study Amsterdam
No full textInternational audienceAbstract Ageing populations and longer life expectancies challenge healthcare systems due to rising noncommunicable diseases (NCDs) and multi-morbidity. Designing healthier living environments may reduce population risks of NCD onset, but knowledge is needed on environmental factors related to NCDs in older adults. We therefore examined associations between residential neighbourhood built, physico-chemical, and sociodemographic environmental factors and NCD prevalence in the Netherlands among older adults. Cross-sectional data from 1578 older adults from the Longitudinal Aging Study Amsterdam (2008–09) were matched with environmental data from the Dutch Geoscience and Health Cohort Consortium (GECCO). Multivariable logistic regression analyses were conducted to assess the odds of having a single NCD versus no NCD and multi-morbidity versus no NCD, adjusted for sociodemographic factors. Participants had a mean age of 73.2 years, 55% were female, and 77% reported at least one NCD. Multi-morbidity was more common in women, who were also older and had lower education and income. Higher green space density within 500 m was significantly associated with lower odds of single NCD [odds ratio (OR): 0.52, 95% confidence interval (CI): 0.33–0.83]. A higher number of cars in a household also showed lower odds of single NCD (OR: 0.14, 95% CI: 0.04–0.55). No significant associations were observed for physico-chemical exposures. Results were consistent in sensitivity analyses. The findings underscore the need for urban planning and policies that support healthy ageing while embracing a longevity-ready perspective, accounting for the built, physico-chemical, and sociodemographic environments across the life-course