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Expérimentation de nouvelles formes de travail et transformation du rapport au travail : le cas des entrepreneurs hybrides
No full textInternational audienceCette recherche est axée sur les trajectoires et expériences de vie d’une population « d’entrepreneurs hybrides » au sein d’une grande entreprise française de transport. Afin de comprendre dans quelle mesure l’expérimentation de cette nouvelle forme de travail et d’emploi transforme le rapport au travail, cette étude privilégie une approche qualitative longitudinale centrée sur 46 entretiens. Analysés à travers le cadre conceptuel des parcours de vie, les résultats présentent les déclencheurs et processus autour de l’hybridation ; ils montrent que le changement de nature ou de forme d’emploi n’est pas gage d’un changement dans le rapport au travail des entrepreneurs hybrides. La contribution de cet article est d’apporter une compréhension nouvelle du phénomène des entrepreneurs hybrides (littérature sur les NWW) et à la GRH par une perception plus processuelle des carrières et des « chocs ». Enfin, cette recherche permet d’alimenter la réflexion des praticiens sur la construction des carrières des individus
Implementation evaluation of a school- and primary care-based multicomponent intervention to improve HPV vaccine coverage: Results from the PrevHPV randomized controlled trial
No full textInternational audienceBackground: Human papillomavirus (HPV) vaccine coverage (VC) remains lower than expected in France. The PrevHPV national research program aimed to codevelop and evaluate an intervention including three components: 'education and motivation' of adolescents in schools, 'at-school vaccination', 'general practitioners (GPs)' training'. This study aimed to evaluate the implementation outcomes of each component, whether they affected effectiveness, and identify factors influencing implementation in schools.Methods: A mixed-method study embedded in a cluster randomized controlled trial in 91 French municipalities (July 2021-June 2022). Quantitative data were collected through activity reports and questionnaires, and qualitative data through focus groups with school staff. The implementation outcomes were fidelity, dose, reach, acceptability and sustainability, as defined in the Medical Research Council guidance for process evaluation of complex interventions and Proctor et al.'s Implementation Outcomes Framework; the effectiveness outcome was HPV VC (≥ 1 dose) two months after the end of the intervention. Qualitative data were analyzed using the Consolidated Framework for Implementation Research.Results: The fidelity, acceptability, and sustainability of all three components among participants who completed the intervention were high. However, the withdrawal of one-third of schools before the trial started and difficulties in mobilizing GPs negatively impacted the dose and reach outcomes. Estimates for the on-treatment analyses of the effectiveness were greater than those for which the dose of intervention received was not considered; 'at-school vaccination' (11.25 percentage points, p < 0.001) and 'GPs'training’ (3.56 percentage points, p = 0.049) increased VC, while ‘education and motivation’ remained nonsignificant.Conclusions: Increasing HPV VC among adolescents could be achieved by combining interventions in both schools and primary care settings. This study provides practical implications for implementing such interventions in real life
Opinion of the French Agency for Food, Environmental and Occupational Health & Safety (ANSES) on the risks to human health associated with the proliferation of Ostreopsis spp. on the Basque coast
No full textN/AInternational audienceIn France, the presence of marine microalgae of the genus Ostreopsis has been identified repeatedly on the Mediterranean coast for several years, whereas on the French Basque coasts its presence is much more recent. In the summers of 2021 and 2022, major Ostreopsis flowering episodes were reported on the Basque coast, resulting in several hundred cases of intoxication among holidaymakers and residents. The main route of human exposure is inhalation of aerosols, although it is not yet known whether the agents responsible for poisoning are Ostreopsis cells, cell debris, known toxins produced by Ostreopsis, or other as yet unidentified compounds. Other routes of exposure (dermal contact, eye contact, ingestion of contaminated water or seafood) are also possible. Poisoning is manifested through various signs and symptoms, occurring within 48 hours of exposure (Neurosensory and neurological, respiratory, dermal and digestive). This document presents the opinion of the French Agency for Food, Environmental and Occupational Health & Safety (ANSES), established from the work of its WATER and ERCA Expert Committees. ANSES received a request from the Directorate General for Health (DGS) and the Directorate General for Food (DGAL) to update knowledge about Ostreopsis that had been reported in the Agency's opinions from 2007 and 2008 (ANSES, 2007 and 2008), and draw up specific recommendations for managing Ostreopsis proliferation on the Basque coast. The literature review conducted as part of this expert appraisal revealed that knowledge about the genus Ostreopsis (diversity, biology, ecology, toxins produced) is still too fragmentary to characterise the hazard and risk to human health. Nevertheless to help local authorities affected by Ostreopsis blooms, Agency proposes a surveillance and quality monitoring strategy based on collaboration between site managers and the regional health agencies (ARSs), applicable to sites currently subject to bathing water quality monitoring and water sports sites that meet the conditions below
Diversité microbienne des zones de baignade : le cas de la baignade urbaine de METZ
No full textInternational audienceIn the context of climate change and increasing urbanization, urban water bodies are being reconsidered for recreational use, such as swimming. This study, part of the URB-Bain project, assesses the challenges of reintroducing swimming in urban waters, using the city of Metz as an example. It investigates sanitary risks and microbial diversity in urban rivers, focusing on spatial and temporal variability. Two sampling campaigns were conducted: one in September 2022, with 20 samples from five sites, and another during the summer of 2023, with eight-day sampling at five locations. The study measured sanitary parameters and analysed microbial diversity using metagenomics. The results show significant variations in the concentrations of sanitary parameters, influenced by local and meteorological factors, underlining the importance of regular and appropriate monitoring to ensure public safety. Additionally, whereas no spatial patterned were observed for microbial diversity, it followed a clear temporal variation possibly linked to physico-chemical and hydrometeorological parameters. Although no direct link has been established between water sanitation and microbial diversity, the study highlights the opportunities and obstacles in using metagenomics to study microbial diversity in freshwater.Dans le contexte du changement climatique et d'urbanisation croissante, les plans d'eau et rivières urbains sont reconsidérés pour des usages récréatifs, tel que la baignade. Ce travail réalisé dans le cadre du projet URB-Bain, évalue les défis de la réintroduction de la baignade dans les eaux urbaines, en prenant la ville de Metz comme exemple. Elle examine les risques sanitaires et la diversité microbienne dans les rivières urbaines, en se concentrant sur la variabilité spatiale et temporelle. Deux campagnes de prélèvements ont été menées : l'une en septembre 2022, avec 20 échantillons prélevés en amont et dans le site de baignade pressenti, et l'autre pendant l'été 2023, avec des prélèvements sur huit jours dans cinq points différents. L'étude a étudié les paramètres sanitaires et analysé la diversité microbienne en utilisant la métagénomique. Les résultats montrent des variations significatives dans les concentrations des paramètres sanitaires, influencées par des facteurs locaux et météorologiques, soulignant l'importance d'une surveillance renforcée pour garantir la sécurité des baigneurs. De plus, aucune tendance spatiale n'a été observée pour la diversité microbienne. A l’inverse, une variation temporelle claire a été notée, possiblement liée à des paramètres physico-chimiques et hydrométéorologiques. Bien qu'aucun lien direct n'ait été établi entre la qualité sanitaire de l'eau et la diversité microbienne, l'étude met en avant les opportunités et les obstacles liés à l'utilisation de la métagénomique pour étudier la diversité microbienne dans les eaux douces
All-cause healthcare resource utilization and costs among community-managed adults with long-COVID in France, 2020-2023
No full textInternational audienceBackground: The clinical and economic burden of long COVID is poorly understood. We aim to assess all-cause healthcare resource utilization (HCRU) and costs in the primary care setting among adults with long COVID in France.Methods: A retrospective cohort study using the electronic healthcare records (EHRs) of confirmed and/or probable COVID-19 patients from The Health Improvement Network (THIN) data between March 2020 and December 2022 was conducted. Long COVID was identified per World Health Organization (WHO) definition as suggestive symptoms present ≥3 months following acute SARS-CoV-2 infection. Patients' characteristics, HCRU, direct healthcare and indirect costs (National Health Insurance-based prices) were summarized. Costs between patients with previous SARS-CoV-2 infection who developed long COVID, patients with previous SARS-CoV-2 infection who did not develop long COVID (COVID only), and contemporaneous controls without SARS-CoV-2 infection were compared (Non-COVID).Results: Long COVID developed among 30,122 (11.6%) adults; mean (SD) age was 50 (17) years, 63.6% were female and 27.5% had a Charlson Comorbidity Index score >2. During the post-infection follow-up (mean = 13 months), 97.3% of patients had general practitioner consultations (GP) and 62.4% had nursing care. Costs were highest during the first post-diagnosis year with per patient per year costs of €2,443 (total cost of €52 million), including costs for GP (€208) and specialist (€170) consultations, outpatient procedures (€413), retail pharmacy use (€595), biological testing (€147), and medical device usage (€172). Patients with long COVID had additional costs of €163 and €176 when compared to patients in the COVID only and Non-COVID cohorts, respectively.Limitations: Since the THIN database is generated from GP EHRs, there is the possibility of measurement/documentation errors and missing values which could compromise the validity and accuracy of certain results.Conclusion: Long COVID was associated with non-negligible HCRU, direct and indirect costs to the French healthcare system. These findings reinforce the importance of optimizing long-term resource allocation for patients infected with SARS-CoV-2
Breast Cancer Screening in Women With Multiple Sclerosis: A Mixed‐Methods Study
No full textInternational audienceABSTRACT Background There is little information on breast cancer screening (BCS) practices in women with multiple sclerosis (WwMS). Objective To assess and compare BCS rates in WwMS and in the general population and identify barriers and facilitators. Methods In a 2012–2020 cohort study, we identified 47,166 WwMS without a history of cancer and matched them (up to 1:4) to 184,124 controls from the French national medico‐administrative database. Mammography rates were compared according to age, city‐level socio‐economic status, period, and DMT use. We used logistic and negative binomial models to identify factors associated with BCS adherence in WwMS. We also carried out semistructured interviews with 20 WwMS and analyzed them using the empirically inductive method. Results Compared with controls, fewer WwMS underwent BCS at least once (69.9% vs. 76.7%, p < 0.001) and had a lower biennial mammography rate (0.55 vs. 0.63; p < 0.001). Rate differences increased with age. Once stratified on DMT, age‐standardized rates only differed in the non‐treated group (0.51 vs. 0.64; p < 0.001). Factors associated with lower mammography rates in WwMS were city‐level socio‐economic status (mostdeprived vs. least deprived; IRR 0.88 95% CI [0.86–0.91]), long MS duration (16–25 years: 0.91 [0.89–0.94]; ref: ≤ 5) and hospitalization (MS‐related: 0.85 [0.82–0.88]; non‐MS‐related: 0.92 [0.89–0.94]). However, DMT use was associated with higher mammography rates (high efficacy: 1.17 [1.14–1.21]; moderate efficacy: 1.18 [1.16–1.20]). Barriers were physical disability and feeling of excessive medicalization. Facilitators were disability‐accessible care and perception of BCS as a routine procedure. Conclusion BCS among WwMS is suboptimal, especially among those not treated by DMT, and needs to be improved
Pratiques d’usage, d’automédication et d’autorégulation chez les personnes utilisatrices de cannabis dans le contexte français : une étude par méthodes mixtes
No full textThe French prohibitive policies on cannabis did not prevent the ever-increasing use of this psychoactive substance in the general population over the past decades. In addition, modes of use and available products are broadening, with persistent uncertainty about the quality of products on the market. In a context of controversy surrounding cannabis (e.g., the medical use, the legal status, etc.), new public health strategies are required in order to reduce the health and psychosocial harms associated with cannabis use, according to the needs of concerned people. The main objective of this research work is to describe and to understand the practices of adult people who regularly use cannabis in France. In particular, the objectives are to explore the profiles and motivations associated with cannabis self-medication and with cannabis supply, as well as the perceptions of risks and benefits of cannabis use and the strategies employed for self-regulating cannabis consumption in daily life. This research work is based on a mixed-methods design which triangulate quantitative data from 3 separate online questionnaire surveys (CANNAVID 1, N=4279; CANNAVID 2, N=574; CANNABRIS, N=230) with qualitative data from 21 semi-structured interviews of regular users of cannabis aged between 18 and 68 years old. The questionnaire surveys were conducted according to the community-health participatory research principles. Results highlight some “expert” profiles of cannabis users, who claim having a “responsible” use and/or “therapeutic” use of cannabis. Indeed, many participants purposely adopted some consumption strategies to maintain, or even to improve, their physical, mental and social functioning in their daily lives. These strategies deal with social and temporal contexts of consumption, with the form and the quality of products, with the source of supply and with modes of administration. Moreover, these strategies are adopted differentially according to age, gender, education, health status and housing conditions. Finally, the results underscore the possibility of non-problematic trajectories of cannabis use, or even positive trajectories. Public health policies and interventions could therefore aim to strengthen the skills, knowledge and autonomy of people using cannabis. In addition, they could foster safer cannabis supplies by providing alternatives to the unregulated market and by controlling the quality of products on the cannabis market.Malgré les politiques de répression de l’offre et de la demande, la prévalence de l’usage du cannabis a continué d’augmenter dans la population française au cours des dernières décennies. De plus, les modes d’usages et les produits disponibles continuent de se diversifier, avec une incertitude persistante quant à la qualité des produits en circulation. Dans un contexte de controverses autour du cannabis (par exemple, vis-à-vis de l’usage médical ou de son statut juridique), il est nécessaire de proposer de nouvelles stratégies de santé publique adaptées aux besoins des personnes concernées, notamment afin de réduire les risques sanitaires et psychosociaux associés au cannabis. L’objectif global de ces travaux de thèse est de décrire et comprendre les pratiques d’usage chez les personnes adultes consommant régulièrement du cannabis en France. Plus précisément, les objectifs sont d’explorer les profils et les motivations vis-à-vis des pratiques d’automédication et des pratiques d’approvisionnement, ainsi que les perceptions des bénéfices et risques associées aux usages du cannabis et les stratégies mises en place pour réguler ses consommations dans la vie quotidienne. Ces travaux de thèse reposent sur une méthodologie mixte articulant des données quantitatives, issues de trois enquêtes transversales par questionnaire (CANNAVID 1, N=4279 ; CANNAVID 2, N=574 ; CANNABRIS, N=230) conduites par Internet en collaboration avec des associations de santé communautaire, et des données qualitatives issues de 21 entretiens semi-directifs menés auprès de personnes entre 18 et 68 ans qui utilisent régulièrement le cannabis. Les résultats montrent ainsi des profils d’usager·ères « expert·es », socialement intégré·es, qui revendiquent des « usages responsables » et/ou des usages « thérapeutiques ». En effet, de nombreuses personnes consommatrices de cannabis adaptent volontairement leurs pratiques d’usage dans le but de préserver, voire d’améliorer, leur fonctionnement physique, mental et social dans leur vie quotidienne. Les stratégies mises en place tiennent compte des contextes de consommation, de la forme et de la qualité des produits, de la source d’approvisionnement et des modes de consommation. Enfin, ces stratégies ne sont pas mises en place de la même manière selon l’âge, le genre, le niveau d’éducation, l’état de santé et les conditions de logement des personnes. Finalement, ces résultats soulignent la possibilité de trajectoires non-problématiques d’usage du cannabis, voire de trajectoires positives. Les politiques et interventions de santé publique pourraient ainsi viser à renforcer les compétences, les connaissances et l’autonomie des personnes utilisatrices de cannabis. Elles pourraient également permettre des pratiques d’approvisionnement plus sécures, notamment en proposant des alternatives au marché illégale ou en contrôlant la qualité des produits sur le marché du cannabis
Dynamics of a Prey-Predator Model: Untangling the Role of Fear-Induced Allee Effect, Prey Refuge, and Group Defense
No full textInternational audienceEcological systems often exhibit complex dynamics due to interactions between predator and prey species, which can be influenced by both direct predation and indirect effects like fear and population thresholds. We introduce a predator–prey model that incorporates non-consumptive effects such as the Allee effect, group defense, and prey refuge. These non-consumptive effects are triggered by predator fear, along with a predator-taxis sensitivity parameter. We explore interactions between fear and defense mechanisms. Our ODE model’s comprehensive mathematical analysis addresses the positivity and boundedness of solutions, species extinction, and the existence and stability of equilibria, including various local bifurcations. We present a one-parameter bifurcation analysis focusing on the Allee parameter and predator-taxis sensitivity. This analysis reveals multiple interior equilibrium points with varying stability, occurrences of saddle-node, transcritical, and Hopf bifurcations, as well as instances of bistability and tristability. We find that a strong Allee effect initially supports species coexistence through tristability. However, beyond a certain threshold, the Allee parameter leads to unsustainable coexistence. Similarly, initial predator sensitivity may encourage coexistence through multiple stable states, but excessive sensitivity makes coexistence infeasible. The outcomes — ranging from complete extinction to predator extinction — depend critically on initial population densities. Further, we delve into the spatial dynamics of the associated reaction–diffusion prey–predator interaction model that incorporates cross-diffusion effects. We establish conditions for stability and Turing instability, validate through numerical simulations. These simulations reveal diverse spatial patterns such as irregular mixtures of spots, and cluster of spots like patterns that underscore the influence of time iteration, cross-diffusion coefficients and the Allee threshold on spatial density distribution of species
Modeling the impact of early vaccination in an influenza pandemic in the United States
No full textInternational audienceWe modeled the impact of initiating one-dose influenza vaccination at 3 months vs 6 months after declaration of a pandemic over a 1-year timeframe in the US population. Three vaccine effectiveness (VE) and two pandemic severity levels were considered, using an epidemic curve based on typical seasonal influenza epidemics. Vaccination from 3 months with a high, moderate, or low effectiveness vaccine would prevent ~95%, 84%, or 38% deaths post-vaccination, respectively, compared with 21%, 18%, and 8%, respectively following vaccination at 6 months, irrespective of pandemic severity. While the pandemic curve would not be flattened from vaccination from 6 months, a moderate/high effectiveness vaccine could flatten the curve if administered from 3 months. Overall, speed of initiating a vaccination campaign is more important than VE in reducing the health impacts of an influenza pandemic. Preparedness strategies may be able to minimize future pandemic impacts by prioritizing rapid vaccine roll-out
