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Compound Climate Exposures and Public Health: A Synthesis of Research and Future Directions
No full textInternational audienceCompound climate events involve the intersection of individual climate events that are linked through space, time, or both. Anthropogenic climate change will likely increase the burden of these compound events, which often have synergistic health effects, meaning that the combined effect exceeds the sum of their individual parts. These include multivariate (co-occurring) events such as extreme heat and wildfires as well as temporally compounding (sequential) events such as debris flows after wildfire events. Existing epidemiological evidence has mostly identified synergistic health effects, primarily associated with multivariate compound climate exposures at short timescales. The research, however, is often limited by a lack of information on explicit exposure pathways that link changes in climate to health outcomes and inequalities. We discuss opportunities for public health interventions and methodological considerations for future studies in a compound climate and health framework
Peut-on se passer de la contention psychiatrique ?
No full textEmission de radio - France Inter.La méthode, utilisée en psychiatrie pour immobiliser un patient sans son consentement, suscite de plus en plus d’oppositions. Comment soigner sans entrave à la liberté individuelle ? Les professionnels peuvent-ils abandonner l'usage de la contention
Reconnaissance du beau travail et du bon travail en milieu hospitalier : une étude de la perception des cadres de santé.
No full textInternational audienceThis study explores the recognition of beautiful work in hospital settings, its role in valuing caregiving work, its connection with professional identity, and what distinguishes it from good work. While recognition in hospitals is often associated with compliance with standards and performance evaluation (good work), beautiful work is perceived as a qualitative and subjective accomplishment. This study adopts a qualitative method based on discourse analysis involving 29 healthcare middle managers. The results highlight a distinction between beautiful work, characterised by personal commitment, relational impact, and the aesthetic quality of care, and good work, defined by conformity to institutional standards. Beautiful work is mainly recognised by peers and patients, whereas the hierarchy prioritises measurable criteria. The study contributes to enriching the theory of work recognition by providing a finer distinction between beautiful and good work. For most of the healthcare middle managers interviewed, taking beautiful work into account may strengthen motivation, enhance caregivers’ satisfaction, and help build their professional identity. Recommendations encourage hospital management to integrate this recognition through spaces for sharing and institutionalised systems for valorisation. This research concludes by underlining the need for managerial consideration of this qualitative dimension, which is often overlooked by institutional evaluations focused on performance and compliance with standards.Cette étude explore la reconnaissance du « beau travail » en milieu hospitalier, son rôle dans la valorisation du travail soignant, son articulation avec l'identité professionnelle et ce qui le distingue du bon travail. Alors que la reconnaissance en milieu hospitalier est souvent associée au respect des normes et à l'évaluation de la performance (bon travail), le beau travail est perçu comme une réalisation qualitative et subjective. Cette étude mobilise une méthode qualitative fondée sur l'analyse du discours de 29 cadres de santé. Les résultats mettent en évidence une distinction entre le beau travail, caractérisé par l'engagement personnel, l'impact relationnel et la qualité esthétique du soin, et le bon travail, défini par la conformité aux standards institutionnels. Le beau travail est principalement reconnu par les pairs et les patients, tandis que la hiérarchie privilégie des critères mesurables. L'étude contribue à enrichir la théorie de la reconnaissance du travail en distinguant plus finement beau et bon travail. Pour la plupart des cadres interrogés, la prise en compte du beau travail peut renforcer la motivation, la satisfaction des soignants et contribuer à la construction de leur identité professionnelle. Des recommandations invitent à intégrer cette reconnaissance dans le management hospitalier via des espaces de partage et des dispositifs institutionnalisés de valorisation. Cette recherche conclut à la prise en compte managériale de cette dimension qualitative, souvent occultée par des évaluations institutionnelles centrées sur la performance et la conformité aux normes
Assessing the impact of The Climate Fresk workshop on climate-related attitudes and behavioral intentions in the workplace: study protocol for a randomized controlled trial
No full textV1. Preprint not peer reviewedBackground: As the urgency of climate action grows, innovative educational approaches are needed to bridge the gap between knowledge and commitment. The Climate Fresk, a collaborative and gamified workshop based on IPCC reports, has reached millions worldwide, but rigorous evidence on its effectiveness remains limited.Objective: This study protocol describes the first randomized controlled trial assessing the impact of The Climate Fresk on climate-related attitudes and pro-environmental behavioral intentions among workers. Secondary objectives are to examine potential moderating factors, such as socio-demographic characteristics, ecological identity, emotions, facilitator expertise and organisation status, to qualitatively explore participants’ perceptions, motivations, and barriers.Methods: We will conduct a parallel, mixed-method RCT including 1,354 participants recruited from French organizations. Eligible participants will be randomized (1:1) to either the experimental arm (The Climate Fresk, a three-hour interactive workshop) or the control arm (a one-hour lecture-style video). Primary outcomes are climate-related attitudes and pro-environmental behavioral intentions, assessed at baseline (T0) and one week post-intervention (T2). Secondary outcomes include ecological identity, emotions, and prior behaviors. Semi-structured interviews with a subsample of participants (n=20) will be conducted one month later (T3). Quantitative data will be analyzed using linear mixed-effects models, accounting for clustering by facilitator and organization. Qualitative data will undergo thematic analysis.Discussion: This trial will provide the first large-scale, controlled evidence on the effectiveness of The Climate Fresk in shaping attitudes and intentions toward climate action. By integrating quantitative and qualitative insights, and considering moderating factors, it aims to advance understanding of gamified climate education and inform strategies to engage diverse populations in sustainability transitions
COVID-19 vaccine hesitancy and perceived post-vaccination adverse event: Findings from a cross-sectional survey
No full textInternational audienceIntroduction: In Quebec, COVID-19 vaccine uptake among adults was high for the first two doses but decreased for the subsequent booster doses. This study assesses the relationships between attitudes towards vaccination and self-reported experience and severity of adverse events following immunization (AEFIs).Methods: A web survey of Quebec adults who received at least one dose of the COVID-19 vaccine was conducted in September 2023. Participants share their level of vaccine hesitancy before vaccination and their experience with AEFIs after receiving a dose. Participants were asked to note the severity of the symptoms they believed were due to vaccination. Intention to receive other vaccines in the future was questioned. Two coders performed a qualitative content analysis on reported AEFIs (N = 3808). Descriptive and multivariate logistic regression analyses were performed.Results: Among the 8419 vaccinated respondents, 46.7 % reported having experienced AEFIs. Fatigue or malaise (20.7 %), injection site disorder (17.3 %), musculoskeletal pain (11.2 %), headache (11.0 %), and fever (10.6 %) were the most commonly reported, respectively. Respondents who were very hesitant before the COVID-19 vaccine reported more frequently having a severe AEFI compared to those who were not hesitant (25.0 % vs 3.4 % =, p < 0.001). This affirmation stays true when all severity of adverse events are considered (68.7 % vs 36.9 %) (p < 0.001). Younger age (aOR = 0.98), being a female (aOR = 1.31), a higher education level (University degree aOR = 1.56 vs high school or less), being vaccine-hesitant in general (aOR = 1.69 vs non or less hesitant) were significantly associated (p < 0.001) with self-reported AEFIs in multivariate analysis. Self-reported AEFIs that prevented doing activities (aOR = 4.87) and being vaccine-hesitant in general (aOR = 4.94) were significantly associated with reduced intention to receive other vaccines in the future.Conclusion: Vaccine hesitancy could influence self-reported AEFIs and their perceived severity. Transparent and tailored communication explaining AEFIs while emphasizing strategies to mitigate these effects could helpful. Our findings also have implications for pharmacovigilance
Association between mycophenolic acid treatment and infection with specific strains of Pneumocystis jirovecii in solid organ transplant recipients in France and Switzerland: a multicentre, retrospective, cross-sectional study
No full textInternational audienceBackground: Pneumocystis pneumonia (PCP) case clusters involving solid organ transplant (SOT) recipients have been reported worldwide. Mycophenolic acid, an immunosuppressant used to prevent rejection in SOT recipients that targets the inosine 5 ′ -monophosphate dehydrogenase (IMPDH) protein, has been hypothesised to exert selective pressure on Pneumocystis jirovecii, with the missense mutation G1020A (Ala261Thr) in the impdh gene a possible marker of such selective pressure. The aim of this study was to test the hypothesis that SOT recipients harbour P jirovecii with mutations in the impdh gene and are infected with specific P jirovecii strains.Methods: In this retrospective, multicentre, cross-sectional study of nationally representative, individual-level data, we included SOT recipients, regardless of the organ transplanted, involved or not in a PCP case cluster, and non-SOT recipients (control group) without mycophenolic acid exposure, diagnosed with PCP from 26 French and one Swiss secondary health-care centres. We included patients aged 18 years or older for whom archival P jirovecii DNA extracts were available in sufficient quantity and quality. P jirovecii specimens were characterised using a multilocus sequence typing method including impdh gene analysis. The primary outcome of this study was the detection of the G1020A (Ala261Thr) mutation in the impdh gene. A multivariable logistic regression was done to assess the relation between this mutation and the following variables retrieved from medical records: age, mycophenolic acid exposure at the time of PCP diagnosis, involvement in a PCP case cluster, PCP prophylaxis, and clinical outcome.Findings: 58 SOT recipients (44 treated with mycophenolic acid) and 59 non-SOT recipients (control group; not treated with mycophenolic acid) diagnosed with PCP between Jan 1, 2001, and Dec 31, 2021, were enrolled. The G1020A (Ala261Thr) mutation was detected in P jirovecii specimens from 40 (68⋅9%) SOT recipients (37 treated with mycophenolic acid) and in none of the P jirovecii specimens from the patients in the control group. The multivariable analysis showed that the allele characterised by the G1020A mutation was associated with mycophenolic acid exposure at the time of PCP diagnosis (adjusted odds ratio 73⋅61 [95% CI 17⋅41-455⋅70]; p<0⋅0001) and involvement in a PCP case cluster (12⋅77 [1⋅58-171⋅90]; p=0⋅029), whereas it was not associated with age, PCP prophylaxis, and clinical deterioration. A second missense mutation, G1020T (Ala261Ser) was identified in P jirovecii specimens from three SOT recipients (two treated with mycophenolic acid). Two specific multilocus genotypes (MLG-31 and MLG-34) of P jirovecii associated with Ala261Thr and Ala261Ser substitutions in IMPDH, respectively, were detected only in SOT recipients (38 patients with MLG-31 and three patients with MLG-34).Interpretation SOT recipients in this study were primarily infected with specific P jirovecii strains with mutations in the impdh gene, which might confer a selective advantage as both the G1020A (Ala261Thr) and G1020T (Ala261Ser) are associated with mycophenolic acid resistance in other fungi. Mycophenolic acid selective pressure might explain the maintenance and circulation of these P jirovecii strains within this patient population, and consequently their potential involvement in PCP case clusters
Le bien-être des enfants à l'école: Un problème social
No full textInternational audienceLe bien-être des enfants, en particulier à l’école, est devenu au cours des dernières décennies une question politique et académique majeure, comme en témoigne la forte augmentation des recherches et des politiques publiques en la matière.Le bien-être des enfants à l’école met en lumière et discute les différentes manières dont le bien-être scolaire a été défini et évalué, en dressant un état des lieux à la fois international et interdisciplinaire. L’ouvrage présente des recherches ayant pour point commun de fairedialoguer des perspectives trop souvent opposées dans la littérature : bien-être objectif versus bien-être subjectif ; perspective centrée sur l’adulte versus perspective centrée sur l’enfant ; ou encore analyse des déterminants familiaux versus analyse des déterminants scolaires du bien-être enfantin.L’originalité de l’ouvrage réside dans sa capacité à penser, dans un même mouvement, les multiples dimensions du bien-être des enfants à l’école, et à saisir la manière dont ces différents déterminants s’articulent et se combinent en fonction des contextes (géographiques, sociaux et familiaux) dans lesquels évoluent les enfants
Removing or returning freedom? Views on a nicotine-free generation policy held by young people from aotearoa who use electronic nicotine delivery systems (ENDS)
No full textInternational audienceIntroduction: International interest in a smokefree generation policy has grown as more local authorities and governments move to introduce this policy. Young people strongly support this measure, but we know less about how they view a nicotine-free generation policy that includes electronic nicotine delivery systems (ENDS). We addressed this gap by probing adolescents’ views on a birth-year policy that included all nicotine products. Methods: We undertook in-depth interviews with 20 adolescents aged 16–18 who self-assessed as moderately or severely addicted to vaping and lived in Aotearoa New Zealand. In semistructured interviews, we explored participants’ views on a nicotine-free generation, its rationale, implementation and likely impact. We interpreted the data using a reflexive thematic analysis approach. Results: Most participants supported a nicotine-free generation, rejected arguments that ENDS use was a ‘choice’, and called for government leadership to protect them and future generations; a small minority saw the measure as unwarranted interference. Several participants thought compliance would be low, given their experiences of lax age verification practices and the widespread social supply of ENDS, but suggested measures to improve compliance. Conclusions: Although participants thought a nicotine-free generation could impose personal hardship, most privileged the freedom they thought it could bring over the illusory ‘choice’ they currently had. Policy-makers should consider looking beyond a smokefree generation to a nicotine-free generation; alongside this measure, they should implement strong enforcement and provide comprehensive support so young people addicted to nicotine can be empowered to stop using ENDS
From application in the fields to dispersion in the atmosphere: A narrative review on airborne pesticides and their monitoring in France
No full textInternational audiencePesticides, widely used to enhance agricultural productivity, are increasingly monitored and consequently detected in the atmosphere, raising concerns for environmental and human health. This narrative review summarizes current knowledge on the main pathways of atmospheric contamination, namely spray drift, volatilization, and wind erosion, and the key physicochemical, environmental, and operational factors that govern pesticide dispersion. It also evaluates modeling approaches and monitoring initiatives, with a particular focus on France, where recent studies have revealed regional patterns, persistence of banned substances, and the influence of agricultural practices. The review underscores the need for more comprehensive models, integrated monitoring frameworks, and targeted policies to better assess and mitigate airborne pesticide pollution
Disposition des médecins généralistes à déléguer des tâches : les incitations financières peuvent-elles compenser l'aversion au risque ?
No full textInternational audienceBackground: Industries with more motivated workers are more likely to be productive.Motivations is argued to have an impact on risk-taking behaviours. In the healthcare sector, there are at least three agents interacting in the production of health: an Insurer (NHI), professionals and patients. The NHI may want to modify the behaviour of the professionals towards patients by nudging them into delegating tasks to another professional. In the context of decreasing medical density and unequal distribution of General practitioners (GPs), France, as other many countries, has decided to promote vertical integration between healthcare professionals combined with tasks delegation. Yet, the latter can be particularly costly when fee-for-service (FFS) is the dominant payment scheme and raises question concerning the quality of healthcare services provided to patients. The propensity of GPs to delegate tasks depends on their risk-aversion towards patients’ health. In this paper, we study whether financial incentives can alter the negative effect of risk-aversion on GPs’ willingness to delegate tasks. To our knowledge, the literature dealing with the determinants of tasks delegation from GPs to paramedics in the usual context of private practices is relatively scarce, especially in the French case. We contribute tothis literature by studying the impact of GPs’ risk aversion and its interaction with cost sharing due to delegation supported by GPs on their likelihood to delegate tasks to nurses.Methods: Using data from the second French national representative panel of self employed GPs, set up in 2010-2012 by the Ministry of Health (the French DREES), with 2,000 GPs at inclusion, this paper tests whether reducing costs supported by GPs when cooperating with nurses might help increase their preference for tasks shifting. We implement a quasi-experimental design wherein GPs are randomly selected to form three groups of equal size. Each of them was exposed to a different funding scheme when declaring their willingness to delegate tasks to nurses: Fully Funded (FF) by the social security administration, self-funded by GPs’ revenues (Self-Funded, SF) and half-funded by both the social security administration and GPs revenues (Half-Funded, HF). We estimate the effect of financial incentives, risk aversion and their interaction on GPs’ willingness to delegate tasks to nurses using a probit model controlling for age, gender, rural/urban area, GP density. Results: We find that, first, GPs are more likely to favour tasks delegation when they share a lower proportion of the cost of working with nurses. Second, GPs who are more risk averse in patients’ health are less likely to delegate tasks to nurses. Third, the interaction between financial incentives and risk-aversion (for patient health) does not significantly impact GPs’ likelihood to delegate tasks to nurses. Conclusion: This study shows that financial incentives cannot bypass the negative impact of GPs’ risk-aversion on their propensity to tasks shifting. Enhancing tasks delegation should not only rely on financial incentives, which could reveal to be not efficient.Contexte : Les secteurs d’activité où les travailleurs sont les plus motivés sont les plus susceptibles d’être productifs. On estime que les motivations ont un impact sur les comportements à risque. Dans le secteur de la santé, au moins trois agents interagissent dans la production dela santé : un assureur (l’assurance maladie), les professionnels et les patients. L’assurancemaladie peut vouloir modifier le comportement des professionnels envers les patients en les incitant à déléguer des tâches à un autre professionnel. Dans un contexte de diminution de ladensité médicale et d’inégale répartition des médecins généralistes (MG), la France, comme de nombreux autres pays, a décidé de promouvoir l’intégration verticale entre professionnelsde santé combinée à la délégation de tâches. Or, cette dernière peut être particulièrementcoûteuse lorsque le paiement à l’acte (FFS) est le système de paiement dominant et soulèvedes questions concernant la qualité des services de santé fournis aux patients. La propension des MG à déléguer des tâches dépend de leur aversion au risque envers la santé des patients.Dans cet article, nous étudions si les incitations financières peuvent modifier l’effet négatifde l’aversion au risque sur la volonté des MG à déléguer des tâches. À notre connaissance,la littérature traitant des déterminants de la délégation de tâches des MG aux paramédicaux dans le contexte habituel des cabinets libéraux est relativement rare, en particulier dans le casfrançais. Nous contribuons à cette littérature en étudiant l’impact de l’aversion au risque des MG et son interaction avec le partage des coûts dû à la délégation soutenue par les MG sur leur probabilité de déléguer des tâches aux infirmières. Méthodes : À partir des données du deuxième panel national représentatif de médecins généralistes libéraux français, mis en place en 2010-2012 par le ministère de la Santé (la DREES),avec 2 000 MG à l’inclusion, cet article teste si la réduction des coûts supportés par les MG lorsde la coopération avec les infirmières pourrait contribuer à accroître leur préférence pour la délégation de tâches. Nous mettons en oeuvre un dispositif quasi-expérimental dans lequel les MG sont sélectionnés aléatoirement pour former trois groupes de taille égale. Chacun d’entre eux a été exposé à un système de financement différent lors de la déclaration de sa volontéde déléguer des tâches aux infirmières : entièrement financé (FF) par l’administration de lasécurité sociale, autofinancé par les revenus des médecins généralistes (SF) et à moitié financé par l’administration de la sécurité sociale et les revenus des médecins généralistes (HF). Nous estimons l’effet des incitations financières, de l’aversion au risque et de leur interaction sur lavolonté des médecins généralistes de déléguer des tâches aux infirmières en utilisant un modèle probit contrôlant l’âge, le sexe, la zone rurale/urbaine, la densité de médecins généralistes. Résultats : Nous constatons que, premièrement, les médecins généralistes sont plus susceptibles de favoriser la délégation de tâches lorsqu’ils partagent une proportion plus faible du coût de travail avec les infirmières. Deuxièmement, les médecins généralistes qui sont plusréticents au risque pour la santé des patients sont moins susceptibles de déléguer des tâches aux infirmières. Troisièmement, l’interaction entre les incitations financières et l’aversion au risque (pour la santé des patients) n’a pas d’impact significatif sur la probabilité des médecins généralistes de déléguer des tâches aux infirmières.Conclusion : Cette étude montre que les incitations financières ne peuvent pas contournerl’impact négatif de l’aversion au risque des médecins généralistes sur leur propension à déléguer des tâches. L’amélioration de la délégation de tâches ne devrait pas s’appuyer uniquement sur des incitations financières, qui pourraient s’avérer inefficaces