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Two surveys separated by almost a decade reveal the inexorable decline in sleep time in teens: Results of the National survey of middle and high schools in adolescents on health and substances (EnCLASS 2018), and the evolution since 2010
No full textInternational audiencePurpose We investigated total sleep time (TST) and sleep paradigms during schooldays and leisure days in teenagers, and compared the findings to results from 8 years before. Methods The EnCLASS epidemiological survey is a representative sample of thousands of French middle and high schoolers. Specific sleep questions allowed us to assess TST, sleep debt, too short sleep, and screen use. Sleep debt as was defined as a difference between the total sleep time (TST) during schooldays (TSTS) non-schooldays (weekends or vacations; TSTN) of over 2 hours. Too short sleep was assesses when TSTS was < 7 hours. We detailed results of the 2018 bivariable analysis and adjusted by sex, age, class level, academic delay and socio-economic level, allowing us to compare the 2018 and 2010 results. Results TST decreases constantly from the beginning of middle school (MS) to the end of high school (HS). In 2018, 26.7% of middle and 43.7% of high schoolers were in “sleep debt”. Additionally, 13.8% of middle and 29% of high schoolers reported too short sleep (less than 7 hours) on schooldays (vs. 7.8% in middle and 25.1% in high school in 2010). In 8 years, the TSTS of middle schoolers decreases by an average of 20 minutes of sleep per night on weekdays, dropping from 8 h 35 min to 8 h 14 min. Regarding screens at bedtime, an increase of 36.8 points was observed on schooldays in MS between 6 th and 9 th grade, with 13.9% more in HS, in 12 th grade. This included 40.6% of middle and 60.6% of high schoolers using internet before sleep on schooldays. Conclusion Faced with this trend, teachers and parents need to take preventive action to avoid an inexorable decline in teenagers’ sleep
Financer le virage préventif à l’hôpital : enjeux et réalités
No full textNational audiencePlusieurs rapports publiés ces dernières années invitent les établissements de santé à s’investir de plus en plus dans la prévention. Pourtant, en France, le système de financement de l’hôpital est majoritairement structuré autour du curatif. Comment alors accompagner des actions de prévention portées par les établissements de santé
Évaluation des politiques de campus sans tabac : analyse de leurs effets et des processus sous-jacents influençant les connaissances, attitudes et comportements des usagers
No full textThis thesis evaluates smoke-free university campus policies (SFCs), where smoking and vaping are prohibited across the entire campus. These policies include smoking cessation support, communication initiatives, and measures to enforce the ban.The research question of this thesis is as follows: What is the impact of SFCs, and how do their various components produce effects on users’ knowledge, attitudes, and behaviours? To address this question, three studies were conducted: 1/ a systematic literature review to identify the effects of SFCs; 2/ a qualitative study (interviews, observations, documentary analysis) to analyse the processes through which this policy produces its effects; and 3/ a mixed-methods study to explore the barriers and motivations influencing the use of cessation services onthe EHESP School of Public Health smoke-free campus. The results show that SFCs are effective public health measures, that help to denormalise smoking and change users’ behaviours, particularly among students (smoking reduction or cessation, prevention of initiation), while improving the health and quality of life of all campus users (reduced exposure to second-hand smoke, improved air quality, etc.). By providing a logic model and a theory of change that explore the transformations generated by SFCs to produce their effects, this research highlights the key processes for transferring these policies to other institutions. Finally, the results offer practical tools for public health actors and decision-makers to implement, adapt, and evaluate such policies.Cette thèse évalue les politiques de campus universitaires sans tabac (CST), où fumer et vapoter est interdit sur tout le campus. Ces politiques s’accompagnent des aides à l’arrêt du tabac, des actions de communication et des mesures pour faire respecter l’interdiction. La problématique de la thèse est : Quel est l’impact des CST et comment leurs composantes produisent-elles des effets sur les connaissances, attitudes et comportements des usagers ?Pour y répondre, trois études ont été menées : 1/ une revue systématique de la littérature pour identifier les effets des CST, 2/ une étude qualitative (entretiens, observations, analyse documentaire) pour analyser les processus par lesquels cette politique produit ses effets, et 3/ une étude mixte pour étudier les freins et motivations à l’utilisation des dispositifs d’aide sur le CST de l’EHESP. Les résultats de cetterecherche montrent que les CST sont des mesures pertinentes de santé publique, qui aident à dénormaliser le tabagisme et à modifier les comportements des usagers, en particulier des étudiants (réduction ou arrêt du tabac, prévention de l’initiation), tout en améliorant la santé et la qualité de vie de l’ensemble des usagers sur les campus (réduction du tabagisme passif, meilleure qualité de l’air respiré, etc.). En proposant un modèle logique et une théorie du changement qui explorent les transformations générées par les CST pour produire leurs effets, nous mettons en lumière les processus clés pour leur transférabilité à d'autres institutions. Enfin, nos résultats fournissent aux acteurs de la santé publique et aux décideurs des outils pratiques pour mettre en place, adapter et évaluer ces politiques
Application des nouvelles approches SS/NTS pour la caractérisation des expositions aux pesticides à l’échelle nationale : le projet Ecophyto II SCREENPEST
No full textInternational audienc
QAI * -Sport project: Indoor air quality in sports facilities - Characterization of exposure to emerging VOCs and SVOCs and to micro-organisms
No full textInternational audienceThis paper aims in presenting the objectives and the scientific approach of the QAI-sport project, funded by ADEME (French Agency for Ecological Transition). The project proposes to characterize exposure to volatile organic compounds (VOCs), semi-volatile organic compounds (SVOCs) and microbiological contaminants (molds, viruses and bacteria) by studying ten sports facilities for different activities (martial arts, weight-lifting, motricity in preschools). Initially, non-targeted analyses of these agents will be carried out under occupied and unoccupied conditions, with particular attention paid to emerging pollutants. An in-depth study, carried out on a selection of 3 rooms, will then allow to study the sources and distribution of contaminants (VOCs, SVOCs and micro-organisms) between the gaseous and particulate phases of the air, sedimented dust and the surfaces of materials. Due to the COVID-19 pandemic, the project will also include specific research into Sars-CoV-2. Exposure to biocides used against this virus will also be assessed. For SVOCs, the data obtained will be integrated into a model to predict the behavior of these pollutants in indoor environments. Finally, a study of the migration of VOCs and SVOCs in sweat and synthetic saliva will complete the results for a comprehensive and detailed assessment of exposure routes to these compounds
Heatwaves and Home Births: Understanding the Impact of Extreme Heat on Place of Delivery in India
No full textInternational audienceAbstract We investigate the effect of extreme heat on home births in India, proposing that such extreme weather events may impede access to health facilities for childbirth. Utilizing geocoded data from the 2019–2021 Demographic and Health Survey for India, we identified the place of delivery of 208,368 births as home versus health facility. We incorporated maximum values for gridded wet‐bulb globe temperatures (WBGT max ) and dry‐bulb temperatures (DBT max ) corresponding to delivery dates and maternal residences. We defined context‐specific extreme heat events using several percentile‐based thresholds (between 80th and 95th) over varying durations (1–5 days). We used Generalized Estimating Equations (GEE) with inverse probability of treatment weighting, incorporating socioeconomic factors and state‐level fixed effects, and adjusted for seasonality. We tested for effect‐measure‐modification by socio‐economic factors (e.g., caste, wealth), healthcare access factors (e.g., rural/urban place of residence, difficultly in accessing healthcare), and contextual factors (e.g., long‐term mean temperature, prevalence of institutional delivery). Both WBGT max and DBT max ‐based heatwave exposures were associated with increased likelihood of home births, with WBGT exposures demonstrating an earlier onset of significant associations at lower percentile thresholds while DBT showed stronger associations at higher thresholds and longer durations. Effect modification analyses revealed heightened impacts in warmer regions, states not designated as high‐focus under the Janani Suraksha Yojana program, and non‐Hindu populations. We find that extreme heat may compromise delivery at health facilities in India. Findings call for improved health system preparedness via early warning systems and advanced resource allocation to mitigate some of these effects
A Remote Adapted Physical Activity Intervention for Women With Breast Cancer and Severe Depressive or Anxiety Symptoms: Series of N-of-1 Trials With Ecological Momentary Assessment
No full textInternational audienceBackground: Women with breast cancer live with the burden of the disease, its treatment, and the psychosocial consequences of illness, often contributing to the experience of psychological distress. At this end, physical activity (PA) is an evidence-based strategy to decrease depressive and anxiety symptoms. However, no study has yet investigated how those psychological symptoms fluctuate and vary during a PA intervention at the individual level, especially for individuals with severe psychological distress. Thus, the aim of the present study was to examine the short-term effects of a 12-week remote PA intervention on daily level of depressive and anxiety symptoms among women with breast cancer and severe depressive or anxiety symptoms. Method: A N-of-1 study followed an ABA' design was conducted. Each A phase (2-week) represents pre-and post-intervention phase and B phase (12-week) represents the intervention phase. For the whole 16 weeks, participants received a daily prompt to report their depressive and anxiety levels. The intervention combined two to three (un)supervised remote PA sessions per week coupled with weekly text messages. Results: Sixteen participants completed the intervention. A significant decrease of depressive and anxiety symptoms was found for nine and seven participants, respectively. Different temporal patterns of depressive and anxiety were observed during and after the intervention. Interestingly, the impact of PA intervention was generally not immediate and gradual. Conclusion: This study supports the utility of remote PA intervention to improve depressive and anxiety symptoms in women with breast cancer and poor mental health
Modelling the Impact on Greenhouse Gas Emissions From Using a High Dose Compared With a Standard Dose Influenza Vaccine in Adults Aged 65 Years and Older in France
No full textAbstract Background: The healthcare system accounts for 8% of total carbon dioxide emissions in France. Vaccines are proven to mitigate the burden of infectious diseases and reduce healthcare utilization. This study aimed to assess the environmental impact on the French healthcare system of using a high-dose (HD) influenza vaccine instead of a standard-dose (SD), by modelling greenhouse gas (GHG) emissions in the care pathway for 65+ in France. Methods: A model was developed applying GHG emission factors to avoided health outcomes through HD instead of SD vaccination, considering the increased GHG emissions from vaccine production. Outcomes from a health economic model populated with French epidemiological data were used, estimating avoided influenza-related primary care visits, emergency visits, and hospitalizations for the HD vaccine based on superior vaccine efficacy (24.2% higher for the HD vaccine than the SD vaccine). A vaccination coverage rate of 60% was used as a baseline and 75% as an exploratory scenario in line with World Health Organization (WHO) targets. Two hospitalization approaches were considered: 1/ based on influenza hospitalizations and 2/ including cardio-respiratory complications triggered by influenza. Emissions factors from France were used for hospitalizations, while UK data were adjusted and used for primary care visits and emergency visits. Results: During an average season, if 60% of older adults were vaccinated with HD instead of SD, 5.0 kilotons of carbon dioxide equivalent (kt CO 2 eq) could be avoided per year considering hospitalizations for influenza, and 32.2 kt CO 2 eq when cardio-respiratory complications are included. At the 75% WHO target, from 6.2 to 40.2 kt CO 2 eq would be avoided. Avoided hospitalizations represented up to 95% of the avoided carbon emissions. The higher GHG emissions from HD vaccine production were compensated by avoided GHG emissions from prevented health outcomes in the approach for influenza hospitalizations, and the intervention exceeded the carbon-efficiency threshold when including cardio-respiratory complications. Conclusions: Despite a higher carbon footprint from vaccine production, the use of an HD vaccine rather than an SD vaccine reduced GHG emissions throughout the care pathway and is therefore at least carbon efficient while delivering tangible public health benefits for 65+
Air pollution and performances in outdoor sports: a systematic review and meta-analysis of short-terms associations
No full textInternational audienceLaboratory studies suggest that high concentrations of particles matter (diameter<2.5 mm [PM2.5]) and ozone (O3) may reduce sport performances at short term. However, a systematic review of literature examining whether air pollution has an effect on sport performances in real situations is missing.Seven databased were searched for articles which examined the association between particulate (PM2.5, PM10, PMCoarse), gaseous (O3, sulfur dioxide [SO2], nitrogen dioxide [NO2], carbon monoxide [CO], and index (Air Quality Index [AQI]) of air pollutants and sport performances in real context. We included observational studies with objective measures of air pollution and performances. They were categorized into endurance, power/speed, technical performances. Harvest plots were used to summarize the findings and guide narrative synthesis. Risk of bias was also assessed. When appropriate, meta-analyses were completed to evaluate the strength of the associations. Subgroup and sensitivity analyses were also conducted. Over 200 reported associations from 21 articles were examined. Participants were primarily elite athletes. The majority of studies examined football (n = 9), and endurance sports (n = 9). Overall, no evidence supported a negative association between performances and the AQI, PM2.5, and NO2 outdoor concentrations. We found that exposure to O3 was associated with reduced sports performance O3, (d = -0.33, 95%CI: -0.65 –0.02 [all performances]; d = -0.54, 95%CI: -1.02 -0.04) [endurance performances]). An absence of significant association between AQI, PM2.5, or NO2 exposure and sports performance is clearly supported by our systematic review and meta-analyses. Higher O3 concentration could impair sport performances in real context, but the evidence is less consistent. No firm conclusion can be drawn from our work for the short term levels of CO, PM10, or SO2 and their respective association with endurance and technical performances
Quantifying excess mortality attributable to tropical cyclones in South Korea: Insights from a generalized synthetic control approach
No full textInternational audienceEpidemiological evidence related to health impacts attributable to tropical cyclones, typhoons or hurricanes is growing, but evidence from Korea remains limited. Utilizing detailed cyclone routes and cause-specific mortality data in fine administrative unit resolution, this study was conducted to evaluate the effect of multiple cyclones in Korea on excess mortality counts using a natural experiment framework. Administrative unit specific mortality counts (all-cause, non-accidental, and cause-specific) and cyclone (size, moving route, and gale radius) data from 2002 to 2023 were obtained from governmental databases. The timing of each cyclone was treated as a natural experiment and a generalized synthetic control (GSC) analysis coupled with random effects meta-analysis was used to estimate pooled changes in daily average mortality counts over the 2 weeks following cyclone exposure. Stratification analyses according to gender, age group, educational level, and location of death were conducted. Of the 21 cyclones that made landfall on the Korean Peninsula between 2002 and 2023, nine in clearly defined exposed and non-exposed regions were selected for analysis. During the 2 weeks following tropical cyclone exposure, daily average increases of 0.084 (95% confidence interval [CI]: 0.020, 0.148), 0.075 (95% CI: 0.012, 0.137), and 0.007 (95% CI: -0.011, 0.025) in all-cause, non-accidental, and external injury-related mortality counts, respectively, were observed in each cyclone-exposed region when compared to synthetic control. Residents living closer to the route of the cyclone center, elderly individuals, and low-educated populations were more susceptible to the effects of cyclones. An average of 150 excess all-cause deaths were estimated for each tropical cyclone during the 2 weeks post-exposure in Korea. Therefore, it is essential to develop countermeasures to prevent excess mortality from tropical cyclone exposure