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Assessing the Risk of Relapse After In Vitro Fertilization in Women With Multiple Sclerosis
No full textInternational audienceBackground and objectives: Older studies reported an increased risk of relapse after in vitro fertilization (IVF) in women with multiple sclerosis (MS), which has not been confirmed by more recent works. All these studies had several limitations, such as small sample sizes, absence of a control population, or lack of neurologic validation of the relapses. The aim of this study was to determine the risk of relapse after IVF in women with MS.Methods: This retrospective cohort study included all women with MS who underwent IVF between 2009 and 2019 and a control group of women with MS who did not undergo IVF matched on age, MS duration, number of relapses, and MS-specific treatments in the previous year. Data on MS (disease duration, treatments, and relapses) were from the French MS Registry (OFSEP), whereas data on IVF (number of procedures, stimulation protocol type, and outcomes) were from the French national health insurance database. For this, the 2 databases were linked by indirect matching.Results: In total, 115 women with MS underwent 199 IVF procedures (mean age at first IVF: 33.9 ± 4.0 years; 45.2% had ≥2 IVF procedures), and 175 IVFs (88.0%) could be matched to specific patients. The risk of relapse in the 3 months after index date was the same in both IVF group and control group (0.06 relapse per patient-year), as confirmed also by the before-after analysis in the IVF group (0.06 vs 0.08).Discussion: This study, using a 10-year clinical and administrative dataset, did not find any increased risk of relapse after IVF. The maintenance of disease-modifying therapies until IVF was a determining factor in reducing the risk of relapse
Association between education level and access to disease-modifying treatment in patients with multiple sclerosis in France
No full textThe author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Research grant from Eugène Devic EDMUS Foundation against MS, in partnership with the ARSEP FoundationInternational audienceBackground: We hypothesized that differences in access to disease-modifying treatments (DMTs) could explain the association between socioeconomic status and disability progression in multiple sclerosis (MS). Objective: This study aimed to analyze the association between education level and DMT use in France. Methods: All patients from OFSEP network with MS onset over 1996–2014 and aged ⩾ 25 years at onset were included. Three time-to-event outcomes were investigated using flexible parametric survival regression models: time from MS onset to first DMT (any) and to platform therapy, and time from platform therapy to switch to high-efficacy therapy. Results: Overall, 7563 patients were included (mean follow-up 12.6 ± 5.9 years). The percentages of patients aged less than 40 years at MS onset and who initiated treatment before the age of 40 years were significantly higher in the groups with a higher education level. The time-to-event outcomes showed no major difference in DMT practices according to education level, except for women who had a significantly shorter time to DMT initiation in medium to very high education level groups versus low, at 5 years from MS clinical onset. Conclusion: Our results suggest that the association between education level and MS disability progression does not solely reflect different therapeutic practices, particularly in men
Associations between the Strengths and Difficulties Questionnaire (SDQ) and Tests of Variables of Attention (TOVA) in rural school-aged children in Benin Africa
No full textInternational audienceSub-Sahara Africa (SSA) children are at high-risk neurodevelopmentally due to the prevalence of infectious disease, nutritional deficiencies and compromised caregiving. However, few mental health screening measures are readily available for general use. The Strengths and Difficulties Questionnaire (SDQ) has been used as a mental health screening measure in the SSA, but its psychometric properties are not well understood. Five hundred and sixty-six mothers completed the SDQ for their 6-year-old children in rural Benin north of Cotonou. These were mothers who had been part of a malarial and intestinal parasite treatment program and micronutrient fortification intervention program during pregnancy for these children. Their study children ( N = 519) completed the computerized Tests of Variables of Attention (TOVA-visual) as a performance-based screening assessment of attention deficit and hyperactivity disorders. In evaluating the relationship between the SDQ and TOVA, we controlled for maternal risk factors such as depression, poor socioeconomic status and educational level, along with the child’s schooling status. TOVA measures of impulsivity were significantly related to SDQ emotional and hyperactivity/inattention difficulties. TOVA inattention was related to SDQ emotional difficulties. The triangulation of maternal risk factors (e.g., depression), the SDQ and the TOVA can provide effective screening for mental health issues in SSA children
Collecting perspectives on project prioritisation process in the EU co-funded multinational partnership for the assessment of risks from chemicals (PARC) through focus group discussion
No full textInternational audienceIntroduction: The European Partnership for the Assessment of Risks from Chemicals (PARC) is a 7-year multinational partnership aimed at consolidating and strengthening European Union’s (EU) research and innovation capacity for chemical risk assessment (RA) to protect human health and the environment. It consists of nine work packages (WP) involving more than 200 participating organisations from 29 countries. PARC is currently mapping the most relevant needs in the field of European chemical RA to steer PARC’s future activities in the coming years. The present study aims to gather the perspectives of WP/Task/Project Leaders of PARC to understand their experience during the first prioritisation round of PARC activities and to identify potential points of improvement for future rounds. Methods: Three online 90-min focus group discussion (FGD) sessions were conducted between the 3rd and 9th of May 2023. Each session was attended by 4-5 participants with at least one representative from each PARC WPs 4, 5 and 6 ( n = 13). The sessions were recorded and transcribed, then analysed in NVivo 12 software using thematic analysis. Results: Some important aspects for the prioritisation of activities that were mentioned include: (1) having a transparent prioritisation process even though each WP might need different prioritisation criteria, (2) balancing the fulfilment of short-term regulatory needs and anticipating long-term needs in chemical RA, (3) maintaining alignment and synergy between the WPs and with other relevant EU initiatives to avoid duplication and to ensure continuity of work and (4) making sure that PARC can effectively respond to requests from different PARC stakeholders. Conclusions: The next round of PARC research activity steering process will provide an opportunity to implement the various improvements identified. PARC should utilise the advantage of having stakeholders from different backgrounds (e.g., risk assessors, policymakers, regulatory bodies, academia, etc.) within its consortium and its advising bodies to prioritise projects and activities that will support its overall objectives. These recommendations could also be of interest outside PARC in the context of prioritising research and innovation needs related to chemical RA
A one health approach for integrated vector management monitoring and evaluation
No full textInternational audienceThe French Agency for Food, Environmental and Occupational Health & Safety (Anses) has set up a multidisciplinary working group (WG) to develop an innovative One Health approach for the monitoring and evaluation of an integrated vector management system (IVMS) on a territorial scale. Four existing evaluation guidelines and methods have been combined into a semi-quantitative evaluation approach that takes into account all the dimensions of an integrated process. We propose a set of 34 criteria divided into three sections (obj19ectives and management, implementation, integration) that correspond to the main functional components of an IVMS. Each criterion is assigned a score based on the results of a scoring questionnaire completed by the system's stakeholders, and two graphical outputs are generated using a specific combination of these scores. An overview of the system's performance is provided through a series of pie charts synthesizing the scores for each of the three sections and the corresponding eleven subsections. A radar chart further combines the results according to eight attributes chosen to characterize the qualities of the system. Our approach was tested for the invasive mosquito Aedes albopictus, a main vector of arboviruses, in two French territories with contrasting dengue epidemiology. This approach is intended to be generic and usable in all territories that are at risk of being affected by arboviruses, whether in tropical or temperate regions. Beyond a conventional assessment of the various components of an IVMS, our interdisciplinary and multisectoral approach aims to gain a better understanding of such a system in its environment, its overall functioning and its mechanisms for adapting to contextual change. It also aims to identify avenues for improvement as part of a continuous quality process, and to facilitate comparisons between territories and the cross-fertilization of knowledge between stakeholders
Unequal impact of school-related factors to explain low levels of subjective well-being among students in France, the United Kingdom and Portugal
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Une recherche « désordonnée » et « éthique » à la fois ?: Enjeux méthodologiques et professionnels des enquêtes sur les« vulnérabilités ».
No full textInternational audienceL’expérience des comités d’éthique est désormais solidement documentée par les chercheurs et chercheuses en sciences sociales qui soumettent leurs protocoles de recherche à ces institutions. Le développement de ces instances n’a pas manqué d’interroger nos disciplines quant aux enjeux de standardisation des méthodes, d’autonomie professionnelle ou encore d’accès au terrain. Mais si elles doivent fonder leur décision sur des critères communs, ces instances s’inscrivent dans des contextes culturels et organisationnels diversifiés qui ne sont pas sans affecter les enjeux éthiques, méthodologiques et professionnels de la recherche. En nous appuyant sur nos expériences d’enquête au sein des projets AURELIA et PRESPOL, consacrés à des objets de recherche similaires déployés au sein d’espaces nationaux distincts (France, Angleterre, Canada, Suède), nous proposons précisément de revenir sur les enjeux soulevés par le recours à ces comités.Nous interrogeons tout d’abord la place des procédures d’éthique ainsi que les statuts des comités d’éthique. Cette réflexion interroge aussi bien les enjeux de légitimité et d’autonomie professionnelle que ceux relatifs au contrôle de l’accès au terrain. À partir des commentaires des comités d’éthique, nous réinterrogeons ensuite la notion d’éthique d’enquête auprès de personnes vulnérables. Nous distinguons « questions mal formulées », « questions stimulantes » et « questions non posées », ce qui nous amènera à appréhender la recherche en elle-même comme activité sociale. Enfin, nous interrogeons les contraintes imposées à la recherche qualitative en sciences sociales et leurs implications dans la réalisation concrète de nos terrains de recherche
Understanding political perceptions of tobacco policies and stakeholders in France: A qualitative study with parliamentarians
No full textInternational audienceCharacterized by persistently high smoking prevalence, France nonetheless faces difficulties in implementing coherent and sustained tobacco control measures. To understand what sustains this situation, we explored how French parliamentarians perceive tobacco, tobacco control policies (with a focus on taxation), and the stakeholders they believe should inform policy decisions
Competencies in the ethical practice of public health
No full textInternational audienceAbstract Background The ethical practice of public health is guided by the articulation of ethical principles in a code and competencies to be demonstrated by individuals or embodied by institutions. Methods To update competencies listed since the first full list published by the American Public Health Leadership Society in 2004, we search the published literature with terms related to ethics, competencies, education, and public health. Results We identified 84 articles meeting the search criteria. Only five presented specific competencies for public health ethics. Several of these were overly general. The most specific competencies related to particular areas of public health. Discussion There has been little progress in describing public health ethics competencies since 2004, with the exception of particular areas of public health. To be meaningful, competency frameworks must be specific and measurable. But to be useful, they must not be overly specific and burdensome in number. The authors recommend that institutions and countries promoting the ethical practice of public health through codes and competencies share their questions and solutions informally and transparently in a community of learning
Real-world persistence with sacubitril/valsartan in patients with heart failure in France: A claims database study
No full textInternational audienceBackground. – Information on treatment persistence and tolerability of sacubitril/valsartan (S/V) in elderly patients with heart failure (HF) is limited.Aims. – To evaluate treatment persistence, adherence and safety-related events in patients with HF treated with S/V, and to compare outcomes in subgroups of patients younger and older than 75 years.Methods. – This observational study was performed using the French national healthcare claims database. All patients who started S/V between April 2015 and December 2020 were eligible and were followed until 31 December 2020 or death. All deliveries of medication were documented. Persistence was defined as the interval between the first delivery and permanent discontinuation. Adherence was defined as the proportion of days covered (PDC). Adverse events of special interest (AESIs) were hospitalizations for hypotension, acute renal failure, hyperkalaemia or angioedema. All-cause mortality was documented.Results. – A total of 104,910 patients were enrolled, including 44,743 (42.6%) aged ≥ 75 years. Median (interquartile range [IQR]) follow-up duration was 18.1 (8.5–30.1) months. Twelve-month persistence rates (95% confidence intervals) were 83.0% (82.7–83.2) overall, 86.0% (85.7–86.3) in patients aged < 75 years and 78.7% (78.3–79.1) in patients aged ≥ 75 years. The median (IQR) PDC was 0.90 (0.82–0.96), with no significant difference between the two age groups. Hospitalizations with AESIs were documented in 20,624 patients (19.7%), were more frequent in patients aged ≥ 75 years (22.8%) than in younger patients (17.3%) and were associated with concomitant discontinuation of S/V in 3408 patients (3.2%; < 75 years: 2.3%; ≥ 75 years: 4.0%).Conclusions. – S/V can be considered a suitable treatment option for patients aged ≥ 75 years with HF