Scientific publications portal of EHESP researchers
Not a member yet
5609 research outputs found
Sort by
Residential Segregation and Lung Cancer Risk in African American Adults
No full textInternational audienceImportance: Although structural racism as manifested by residential segregation is a documented root cause of race-based disparities in lung cancer survival and care, its impact on lung cancer development remains underexplored.Objective: To examine the association between residential segregation and lung cancer incidence and to identify modifiable factors mediating this association.Design, setting, and participants: This cohort study used data from the Southern Community Cohort Study (SCCS), which enrolled African American and non-Hispanic White participants who had no cancer at enrollment. The SCCS recruited participants from community health centers and random sampling from 12 southeastern states. Follow-up occurred between March 2002 to December 2019. Analysis was performed from April 2022 to March 2025.Exposures: Residential segregation, measured by the isolation index using 2010 census block group data, was linked to participants' baseline address.Main outcomes and measures: Incident lung cancer cases were identified via state cancer registries and the National Death Index (December 31, 2016, to December 31, 2019, depending on the state). Parametric g-computation estimated cumulative lung cancer risk under hypothetical interventions reducing residential segregation. Mediation analyses utilized inverse propensity weighting and marginal structural models to assess potential mediating pathways.Results: The cohort comprised 71 634 participants (median [IQR] age, 50 [45-57] years; 42 032 [58.7%] female; 50 898 [71.1%] African American and 20 736 [28.9%] non-Hispanic White) enrolled between 2002 and 2009. All hypothetical scenarios of lowering the isolation index were associated with lower 17-year culminative incidence of lung cancer among African American individuals but not among non-Hispanic White individuals. Approximately 24.7% (95% CI, 17.1%-36.6%) of the association between residential segregation and lung cancer risk in African American participants was mediated by menthol smoking, 13.1% (95% CI, 3.2%-25.4%) by exposure to particulate matter with a diameter of 2.5 μm or less, 4.7% (95% CI, 1.3%-9.6%) by secondhand smoke exposure at home, and 4.6% (95% CI, 2.1%-7.7%) by education.Conclusions and relevance: In this cohort study of non-Hispanic White and African American individuals, lower residential segregation was significantly associated with decreased lung cancer risk for African American individuals but not their non-Hispanic White counterparts. Mediation analysis identified mentholated smoking use and air pollution exposure as 2 major pathways between residential segregation and lung cancer incidence among African American adults. These findings suggest that lung cancer development reduction efforts should include policies with targetable segregation metrics and initiatives that lower exposure to documented mediators
Factors Associated With Prostate Cancer Screening Adherence Among Retired Men in Togo, 2023
No full textInternational audienceProstate cancer is the leading male cancer in sub-Saharan Africa, with 74,878 (17.4%) new cases and 32,390 (11.6%) deaths in 2022. In Togo, the total number of prostate cancers was 726 in 2021. Screening methods are readily available in Togo. However, prostate cancer is still detected at a late stage. This study aimed to determine the factors associated with adherence to prostate cancer screening among retired men in Togo, 2023, using the Health Belief Model. A national descriptive and analytical exploratory cross-sectional study was carried out from March 1 to May 31, 2023. A total of 288 retirees were included. Overall, 54.9% of retirees perceived their vulnerability to prostate cancer, 54.9% perceived its severity, 52.4% perceived barriers to screening, 50.3% perceived benefits from screening, 53.1% perceived their self-efficacy for screening, and 55.2% perceived cues to action. A total of 83% of retirees agreed to undergo prostate cancer screening. The absence of a history of chronic pathology (adjust odds ratio [aOR] = 3.0, 95% CI [1.4, 6.2], p = .010), frequency of annual medical consultation (aOR = 0.3, 95% CI [0.1, 0.8], p = .020), perceived obstacles (aOR = 0.4, 95% CI [0.2, 0.9], p = .029) and perceived cues to action (aOR = 5.1, 95% CI [1.9, 15.1], p = .002) are significantly associated with adherence to prostate cancer screening. This study reported a high level of adherence to prostate cancer screening among retirees. It demonstrated that the absence of a history of chronic pathology, frequency of annual medical consultation, perceived barriers, and perceived incentive to action were significantly associated with adherence to prostate cancer screening
Exploring boundary conditions of sustained physical activity: implications for theory and practice.
No full textObjective: Sustained physical activity is crucial for health and is often referred to as 'physical activity maintenance.' However, this concept lacks consensus, possibly due limited study of the 'boundary conditions' under which this phenomenon occurs. This gap limits both theoretical development and interventional applications. This study examined the boundary conditions of two operational definitions of physical activity maintenance (activity threshold and timescale) and how their formulation impacts the detection of sustained physical activity phenomena. Methods: We analyzed 352 time series (length=182 days) of moderate-to-vigorous physical activity (MVPA) collected daily with Fitbit from participants in a weight loss intervention. Two activity thresholds were defined based on participants’ baseline intentions and physical activity levels: a) 150 minutes of MVPA/week for participants below this threshold at baseline (subsample BL-Inactive; n=101), and b) current level of MVPA/week for those exceeding 150 minutes of MVPA/week at baseline (subsample BL-Active; n=251). Regression trees were used to examine changes in physical activity trajectories using different boundary definitions of timescales (7, 14, 28, and 56 days). Results: At finer-grained timescales (7 days), physical activity exhibited repeated fluctuations, with sustained activity patterns in 27% of BL-Inactive and 5% of BL-Active participants. At coarser-grained timescales (56 days), activity trajectories were more stable, with sustained activity percentages increasing to 71% and 26%. Conclusions: Varying boundary conditions reveal different ways of conceptualizing sustained physical activity phenomena, leading to plausibly distinct conclusions about behavioral maintenance. These results highlight the importance of carefully studying boundary conditions as critical for robust theory and practice development
CO183 Potential Benefits of Universal Influenza Vaccination on Health Outcomes and Costs in Mexico
No full textInternational audienceObjectivesInfluenza continues to pose a significant public health burden. Although annual vaccination is the most effective preventive strategy, current policies in Mexico target only high-risk groups: children aged 6 to 59 months, adults over 60 years, and individuals with comorbidities, potentially limiting broader population benefits. Universal Influenza Vaccination (UIV), by contrast, includes wider age groups regardless of individual risk. This study evaluated the potential health and economic impact of adopting a UIV approach in Mexico, compared to the current targeted vaccination program.MethodsA retrospective analysis was conducted using an age-stratified dynamic transmission model to simulate the effect of adopting U.S. influenza vaccination coverage rates for age groups not currently included in Mexico’s immunization policy. Epidemiological outcomes were integrated into a health economic model populated with Mexico-specific clinical and cost data. Deterministic and probabilistic sensitivity analyses were performed to assess the robustness of the results.ResultsIn a typical influenza season, the UIV program was estimated to reduce influenza cases by 57.94% (95% CI: 40.56%-71.21%), leading to 57.65% (40.32%-70.93%) fewer medical consultations, 56.23% (39.86%-69.05%) fewer hospitalizations, and a 55.53% (39.42%-68.56%) reduction in influenza-related deaths. Health gains included a 56.11% (40.02%-68.99%) reduction in life-years lost and a 57.32% (40.4%-70.44%) reduction in QALYs lost. Benefits were observed across both targeted and general populations, likely due to indirect protection from broader immunization. The strategy generated cost savings of USD 321.58 million from the third-party payer perspective and USD 389.22 million from the societal perspective.ConclusionsExpanding influenza vaccination coverage through a UIV program in Mexico could substantially reduce disease burden and healthcare costs, offering both direct and indirect health benefits. These findings support the adoption of broader immunization strategies as a cost-saving and life-saving public health intervention
How Do People Who Smoke Respond to Novel Tobacco Pack Warnings? Two Cross-Sectional Studies from Aotearoa New Zealand
No full textInternational audienceAbstract Introduction On-pack pictorial warning labels (PWLs) typically feature graphic health risks of smoking. We examined whether expanding the themes featured could increase PWLs’ potential effectiveness. Methods We conducted two online studies: an assessment survey (n = 783) and a discrete choice experiment (DCE) (n = 970) to estimate the impact of price, health, family, and addiction warning themes. Assessment survey respondents rated the likely effect on smoking and quitting-related behaviors of 12 warning images. DCE respondents saw eight sets of four PWLs that combined images and headlines and chose those most likely and least likely to encourage them to think about quitting. Both studies used a PWL featuring a cancerous tongue as a control. Results The assessment survey found images from the health, family, and price themes elicited similar responses to the control, but in some cases were judged more effective. However, all addiction images were significantly less effective than the control. The DCE sample comprised two distinct segments: one responded significantly more strongly to price and family PWLs, while the other was more responsive to a health PWL than to the control. Conclusions PWLs featuring monetary savings, empathetic health messages, and family-oriented benefits can stimulate thoughts of quitting more effectively than a health-oriented PWL designed to arouse fear. Countries introducing or refreshing PWLs should consider more diverse warning themes that provide different motivations to become smoke-free; these are potentially likely to be at least as effective, if not more effective, than graphic health PWLs. Implications PWLs conveying the financial costs of smoking and communicating empathetic health messages and family-oriented risks may stimulate thoughts of quitting more effectively than a control using a health-oriented PWL designed to arouse fear. Priority groups’ differing responses to PWLs support earlier work that recommended complementing health-oriented PWLs with warnings featuring more diverse themes. Countries considering introducing or refreshing tobacco pack warnings should consider developing PWLs that recognize smoking’s impact on well-being in its broader sense, given these appear as effective, if not more effective, than PWLs featuring graphic health images
Quand la formation interroge l’action publique : marges de manœuvre et apprentissage de la transition écologique
No full textInternational audienceL’intégration de la transition écologique dans les politiques de formation continue de la fonction publique ne va pas de soi. En apparence neutres, les dispositifs pédagogiques mobilisés révèlent des tensions structurelles entre volonté de changement et inertie organisationnelle. Cet article montre comment ces formations transverses participent à une transformation plus profonde : celle des représentations collectives de la figure de l’agent public, de ses marges d’initiative et de sa contribution aux enjeux contemporains
Les traductions de la convention des Nations unies relative aux droits des personnes handicapées en France et en Suède
No full textDans revue brochée. ISSN 2260-0965 - ISBN 9782724643459International audienceThere is now a broad consensus that people with disabilities should be included in mainstream society, and in employment in particular. This is reflected in the adoption in 2006 of the United Nations Convention on the Rights of Persons with Disabilities (CRPD), which promotes a new approach to disability based on human rights, as opposed to the previous approach symbo lised by the figure of the specialised institution. However, the CRPD has been translated in various ways. Based on a comparison between France and Sweden, this article looks at these different translations. Highlighting the importance of the institutional arrangements developed in the twen tieth century, it shows that the spread of the inclusion standard has led to a strengthening of the managers of specialised institutions in France, while it has accentuated the activation rationale, which was already very strong in Sweden.L’objectif d’inclusion des personnes handicapées en milieu ordinaire et notamment dans l’emploi fait aujourd’hui l’objet d’un large consensus. Celui-ci se matérialise notamment dans l’adoption en 2006 de la Convention des Nations unies relative aux droits des personnes handicapées (CDPH) qui promeut une nouvelle approche du handicap fondée sur les droits humains, s’opposant à l’approche antérieure symbolisée par la figure de l’institution spécialisée. La CDPH fait toutefois l’objet de traductions diverses. S’appuyant sur une comparaison entre la France et la Suède, cet article s’intéresse précisément à ces différentes traductions. Soulignant l’importance des arrangements institutionnels développés au xxe siècle, il montre que la diffusion de la norme d’inclusion a conduit à un renforcement des gestionnaires d’institutions spécialisées en France tandis qu’elle a accentué la logique d’activation déjà très forte en Suède
Environmental risk factors for multiple sclerosis: a comprehensive systematic review and meta-analysis
No full textInternational audienceBackground and Objectives: Multiple sclerosis (MS) is a demyelinating disease of the central nervous system. Its etiology may involve both genetic and environmental factors, including vitamin D levels, body mass index, infections, and smoking. This is the first comprehensive systematic review with meta-analysis that synthesizes and explore the role of many environmental risk factors in the etiology of MS.Methods A systematic search of MEDLINE, SciVerse ScienceDirect and Web of Science were conducted for any original peer-reviewed article that included adult subjects diagnosed with and without MS that were exposed to any environmental risk factor. We did not set any time restrictions. Data were extracted and the quality assessment was performed with the Critical Appraisal Checklist for Case Control Studies. All the information was synthesized qualitatively and quantitatively (meta-analysis). We used the random-effects model based on the binomial distribution to calculate the pooled effects sizes (ES) regarding the risk of developing MS according to each potential risk factor.Results One-hundred thirty-two publications met all the eligibility criteria and were included in the review. Overall, 109,626 people with MS and 16,724,390 controls from 38 countries were included in the review. A total of 42 environmental risk factors were investigated as potential risk factors for MS. Among the various statistically significant associations, the pooled ES revealed a direct association between serological evidence of contact with EBV (ES = 1.96, 95% CI = 1.53–2.51), herpes virus type 6 (HHV-6) (ES = 2.84, 95% CI = 2.08–3.89) and varicella-zoster virus (ES = 1.33, 95% CI = 1.08–1.63) and the occurrence of MS. Similarly, smoking was associated with a greater likelihood of having MS (ES = 1.43, 95% CI = 1.27–1.61). Vitamin D levels at any time were negatively associated with the proportion of cases of MS and had a moderate pooled ES (g = – 0.48, 95% CI = – 0.88–0.09). Adult BMI was not associated with MS. Discussion: This review furnishes a broad and detailed overview of the potential environmental risk factors associated with MS. Our findings hold notable implications for public health policies, clinical practices, and the focus of future research
Learning from the implementation phase of the new French capitation payment model for chronic kidney disease care: a qualitative study
No full textInternational audienceAbstract Background France introduced a new payment model for care providers of patients with Chronic Kidney Disease (CKD) Grades 4 and 5: the CKD-Capitation Payment model. The model aims to financially incentivise multidisciplinary care for patients. We performed a qualitative study among participating providers to identify obstacles and facilitators of the model implementation as well as the initial benefits and potential policy improvements. Methods From March to July 2023, we collected data through semi-structured interviews with medical and managerial staff of facilities participating in the new model in France. We purposely selected a sample of facilities based on ownership status and CKD-Capitation Payment model activity data, including the number of patients reported. We performed a thematic analysis of the interview transcripts. Results We interviewed 22 staff from 14 facilities. Interviews revealed that adapting the information systems to the model requirements was a major obstacle to implementation, undermining efficient medical time allocation and data quality. Securing facility management support and organising the care amid workforce shortages were additional obstacles. Despite these challenges, staff reported positively on the model, noting the increased time spent by nurses with patients and the assertion of dietitians’ role. Interviewees reported the need for greater flexibility in visit requirements to better align with patient needs. Conclusions This study demonstrates how the new capitation payment model introduced in France can enable multidisciplinary and coordinated care for patients with CKD. However, supporting facilities in adopting interoperable information systems and increasing the flexibility of the model appear essential for long-term adoption. Graphical abstrac
