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Mosquito-borne disease knowledge, attitudes, and practices amongst the general population in metropolitan France
No full textInternational audienceBackgroundAedes albopictus mosquitoes and the mosquito-borne diseases (MBDs) they transmit are spreading throughout France. Yet, research on the perceptions and behaviors of the French population regarding MBDs remains scarce and outdated.AimTo quantify the knowledge, attitudes, and practices (KAP) regarding MBDs in the metropolitan French population and examine factors influencing MBD protective behavior.MethodsIn November 2023, we conducted a cross-sectional KAP survey among a quasi-representative sample (n = 2,087) of adults aged 18 to 79 living in metropolitan France. We used mixed-effects models to examine factors influencing the frequency and variety of protective behavior separately.ResultsDuring summer, most participants were bitten by mosquitoes in their daily lives (73%) and engaged in protective behavior a few (39%) or several times per week (41%). Mosquito biting frequency was the most influential determinant of protective behavior. Concern of contracting MBDs (cumulative odds ratio [COR] = 1.16; 95% CI: 1.12, 1.21) and experiencing financial difficulties (COR = 1.25; 95% CI: 1.02, 1.54) were determinants of protective behavior frequency. Participants reported engaging in a higher variety of protective behaviors if they had greater concern of contracting MBDs (incidence rate ratio [IRR] = 1.06; CI: 1.04, 1.08), had a higher MBD knowledge (IRR = 1.06; CI: 1.04, 1.08), and had a chronic disease (IRR = 1.05; CI: 1.02, 1.07).ConclusionsConcerns of contracting MBDs and MBD knowledge are modifiable factors that influence the frequency and variety of protective behaviors. KAP studies can inform health campaigns and interventions to prevent MBDs
Association between education level and disability progression in patients with multiple sclerosis in France
No full textInternational audienceBackground: Studies have reported an association between socioeconomic status and disability progression in multiple sclerosis (MS), but findings using the pre-MS individual socioeconomic status are missing. Objective: The objective was to investigate the association between education level and disability progression. Methods: All Observatoire Français de la Sclérose en Plaques (OFSEP) patients with MS clinical onset over 1960–2014, and aged ⩾25 years at MS onset were included. Education level was classified into four categories from low (primary/secondary school) to very high (master/doctoral degree). Time from MS onset to EDSS 4.0 was studied using flexible parametric survival models adjusted for age, period, and center, and stratified by phenotype (relapsing multiple sclerosis (RMS) and primary progressive multiple sclerosis (PPMS)) and sex. Results: A total of 11,586 patients were included (women/men ratio = 2.5; age = 36.7 ± 8.6 years; follow-up duration 16.7 ± 9.3 years; 86.4% RMS). For women with RMS, the risk of reaching the outcome at 5 years was inversely associated with the education level (Hazard Ratio medium: 0.74 (0.63–0.87), high: 0.51 (0.43–0.62), very high: 0.39 (0.30–0.50) vs low). Results were similar for men. In PPMS, the risk was significantly different between the extreme groups (very high vs low) for women (0.45 (0.28–0.75)) and men (0.54 (0.32–0.91)), but no gradient was evident. Conclusion: Our study showed a strong association between education level and disability progression, regardless of sex and phenotype
Multidisciplinary Primary Care Groups (Maisons de Santé Pluriprofessionnelles, MSPs) and the Long Path to Team Practice
No full textInternational audienceLike other member countries of the Organization for Economic Co-operation and Development (OECD), the French healthcare system faces a shortage of general practitioners (GPs), resulting in medically underserved areas and increasing disparities in access to health care. For a long time, solo practice remained the norm among French GPs—who are mainly self-employed—in a poorly structured outpatient sector. However, since 2007, new private coordinated care facilities—known as “Multidisciplinary Primary Care Groups” (Maisons de Santé Pluriprofessionnelles, MSPs, in French)—have emerged. These structures, led by self-employed GPs and supported by the public authorities, have catalyzed significant changes in the organization and financing of outpatient care. Alongside GPs, MSPs integrate nurses and allied healthcare professionals, with the aim of fostering coordinated and preventive care through formal contracts signed with local public authorities. The number of MSPs gradually increased, reaching 2251 by the end of 2022. Studies indicate MSPs have positive impacts on the distribution of primary healthcare providers, the evolution of professional practice with an expansion of the range of public health services offered to patients, the quality of care, and GPs working conditions. However, the dissemination of this model, which involves only 17% of GPs and remains heterogeneous, faces a number of obstacles and competes with other forms of integration
Detecting weak changes in the mean of a class of nonlinear heteroscedastic models
No full textInternational audienceWe study a likelihood ratio test for detecting multiple weak changes in the mean of a class of CHARN models. The locally asymptotically normal (LAN) structure of the family of likelihoods under study is established. It results that the test is asymptotically optimal, and an explicit form of its asymptotic local power is given as a function of the candidates change locations and change magnitudes. Strategies for weak change-points detection and their locations estimates are described. The estimates are obtained as the time indices maximizing an estimate of the local power. A simulation study shows the good performance of our methods compared to some existing approaches. These methods are also applied to three sets of real data
Environmental justice issues in drinking water contaminant exposure in a European context
No full textInternational audiencePrevious studies have documented ethnic and sociodemographic disparities in exposure to drinking water (DW) contaminants. A majority were conducted in the U.S., with fewer studies conducted in other regions. This research aims to assess available evidence regarding environmental justice (EJ) issues in Europe, identify contaminants and potential drivers.A Scoping Review was conducted, exploring the existing European studies from 1990 to 2022. The review encompasses types of DW contaminants studied in relation to EJ, research designs, and potential drivers contributing to inequalities in exposure to specific contaminants. In addition, a case study was conducted in Ille-et-Vilaine, France, focusing on contaminants identified in the review and using a national monitoring database. Inequalities in contaminants' exposure were assessed using a composite deprivation index, FDep, at the census tract level (IRIS) applied in multilevel models and geographically weighted regression models, accounting for the rural-urban heterogeneity.Results show a limited number of primary studies focusing on EJ and DW contaminants exposure in Europe (n = 16). Various chemical contaminants such as nitrates, trihalomethanes (THMs), heavy metals, fluoride and pesticides have been assessed. Case study findings suggest some association between FDep and contaminants, with a different level of correlation depending on the contaminant. THMs show a negative correlation with deprivation, while lead displays a positive correlation related to the FDep. Disparities in exposure were also found according to the spatial scale of analysis. In rural areas, higher deprivation levels were associated with higher levels of nitrate (OR: 1.47; 95%CI: 1.02, 2.15) and lower level of fluoride (OR: 0.16; 95%CI: 0.07, 0.30) or THMs (OR: 0.73; 95%CI: 0.55, 0.98) in tap water.This study emphasizes the need for comprehensive research on EJ and DW contaminants exposure on a larger scale. Understanding complex interactions between contaminant distribution, socioeconomic factors, and exposure is essential for addressing EJ in drinking water
Are psychological attitudes towards vaccination an expression of personality? A cross-sectional study on COVID-19 vaccination in France
No full textInternational audienceBackground: The capacity of the 7C model's psychological antecedents, which include confidence in vaccines, complacency, convenience, calculation, collective responsibility, confidence in the wider system, and social conformism, to explain variance in COVID-19 vaccine intentions and behaviours has been documented. However, it remains unclear whether the attitudes represented by the 7C psychological antecedents are specific to vaccination or if they are, in fact, an expression of underlying personality traits.Methods: From February to June 2022, French adults completed self-administered questionnaires assessing COVID-19 vaccination history, the 7C antecedents, and personality traits ("ComCor" and "Cognitiv" studies). Vaccination behaviours were studied through three outcomes: at-least-one-dose vaccination status by 2022 (N = 49,019), up-to-date vaccination status (N = 46,566), and uptake speed of first dose (N = 25,998). Personality traits were evaluated using the French version of the Big Five Inventory (BFI-Fr). Multivariable logistic regressions and Cox models predicting vaccine behaviours were run with the 7C antecedents, both with and without personality traits.Results: Among the 49,019 participants, 95.0% reported receipt of at least one dose and 89.8% were up to date with recommendations. All 7C antecedents were significantly associated with the outcomes. The inclusion of personality traits did not substantially alter the effect estimates of the association between the 7C antecedents and vaccination behaviours, with differences between effect sizes of models with and without personality traits being < 5%.Conclusions: Our results suggest that the 7C psychological antecedents of vaccination are not the mere expression of personality and that their impact on vaccine behaviours is independent of personality traits. As such, the 7C antecedents may be modifiable by appropriate information and vaccine promotion. Trial registration: The "ComCor" study received ethical approval by the Comité de Protection des Personnes Sud Ouest et Outre Mer 1 on 21/09/2020. The addition of the "Cognitiv" questionnaire received ethical approval by the Comité de Protection des Personnes Sud Ouest et Outre Mer 1 on 01/02/2022. The data protection authority Commission Nationale de l'Informatique et des Libertés (CNIL) authorised the processing of data on 21/10/2020. The study is registered with ClinicalTrials.gov under the identifier NCT04607941
Vers une approche systémique de la santé à l’école : travailler les conditions et leviers de déploiement
No full textCommentaireInternational audienceL’école constitue un déterminant majeur de la santé des enfants, des adolescents, mais également, en tant qu’environnement de travail, des professionnels qui la fréquentent. La littérature internationale montre tout l’intérêt d’aller vers une approche socio-écologique du milieu de vie scolaire, considérant les liens et les interactions inextricables des différents déterminants contribuant à la réussite scolaire et à la santé des élèves à court, moyen et long termes, ainsi qu’au bien-être des adultes encadrants, enseignants et familles. En France, la mise en œuvre de cette approche constitue un changement de paradigme, passant d’une approche centrée sur le dépistage systématique de pathologies et la transmission d’informations à une approche systémique, considérant l’école dans toute sa complexité. Dans cette perspective, ce commentaire s’intéresse au niveau macro des politiques publiques, au niveau méso des établissements scolaires et au niveau micro des personnes fréquentant ces établissements
La campagne « 1, 2, 3 bass » : interroger le rôle de l’État dans la régulation des corps reproductifs à Mayotte
No full textInternational audienceCette communication interroge l’histoire du gouvernement des corps reproductifs à Mayotte, territoire insulaire de l’océan Indien. À la suite de l’indépendance de l’Union des Comores en 1975 et du maintien de Mayotte dans le giron français, la croissance démographique de l’île est rapidement devenue un enjeu prioritaire des politiques publiques, donnant lieu à des campagnes d’espacement puis de limitation des naissances. Parmi celles-ci, la campagne « 1, 2, 3 bass » – du shimaoré « 1, 2, 3 ça suffit » – a fait l’objet d’un mémoire de recherche en sciences sociales, qui est l’objet de cette communication
Understanding how smoke-free campus initiatives influence user behaviours: a logic model associated with this policy
No full textThe theme for EHMA 2025 : Taking action to improve health for all.International audienceContext: Smoke-free campuses (SFC) prohibit smoking and vaping on all university grounds and for all users. They include activities such as support for smoking cessation. While studies have demonstrated their effectiveness in reducing smoking prevalence, passive smoking, and denormalising tobacco use, little has been said on the way SFC activities generate their transformations. We report on a theory-based process evaluation identifying the transformation leading to the SFC expected outcomes. These transformations are represented by a logic model, which provides a visual representation of the relationships between the resources, activities, outcomes, and impacts of the SFC, along with the underlying assumptions.Methods: We conducted a retrospective qualitative study on the first SFC implemented in France by the EHESP School of Public Health. Guided by Mayne's (2017) theory of change framework, which includes ten dimensions of an impact pathway (e.g., activities; reach/reaction of the campus users; changes in capacity including knowledge, attitudes, skills, aspirations, and opportunities; change in behaviour, and well-being), we uncovered the causal model and hypotheses underpinning the effect of this SFC. Our dataset included 128 internal documents (e.g., minutes of meetings, administrative documents of the EHESP), semi-structured interviews with stakeholders (n=15) involved in the development and implementation of the SFC, and direct non-participant observations of the programme activities on campus and smoking practices (n=20 hours). Content analysis was conducted using NVivo© version 14.Results: While the objectives of the EHESP SFC are similar to the ones documented in the literature (i.e. to influence the behaviours of smokers, former smokers, and non-smokers, and improving the quality of life and well-being on campus), we found that this SFC is also driven by the goals of enhancing the institution's reputation as a public health leader and to encourage the dissemination of SFC policies across France through former employees and students trained at the school.According to the interviewees in this research, to achieve these goals, activities such as communication, student ambassadors, and cessation support for smokers inform users about the smoking ban and elicit positive reactions, such as acceptability of the SFC and its perceived utility. These reactions are expected to facilitate capacity changes, including increased awareness among smokers about their dependence, support for the policy, and motivation to quit, while improving stress management and acceptance of non-smoking norms, which are associated to behavioural change (reduce or quit smoking).The functioning of the SFC is based on key assumptions: the availability and use of cessation support services, the denormalization of tobacco use through reduced visibility of smoking on campus, the perceived costs in time and steps in reaching the smoking shelters, and the active involvement of all users in ensuring compliance with the SFC policy.Discussion: This research identifies some of the transformations that activities of the EHESP’s SFC can generate in students and staff in order to fulfil its outcomes. However, its findings have limited external validity as they focus only on the EHESP SFC. Further research, especially quantitative studies, is needed to test the proposed model and confirm the findings. Understanding how a SFC brings about these changes is crucial for expanding the model and adapting it to other universities or environments such as smoke-free hospitals and healthcare settings
Partie I. Concepts, enjeux et contexte des directives anticipées psychiatriques. Chapitre 5. Perspective juridique
No full textInternational audienceLes directives anticipées se situent à l'intersection entre le droit à l'autodétermination et la protection des personnes vulnérables