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Sans tabac, les campus universitaires respirent mieux, mais les initiatives restent limitées en France
No full texthttps://theconversation.com/sans-tabac-les-campus-universitaires-respirent-mieux-mais-les-initiatives-restent-limitees-en-france-269830Parmi les mesures qui ont fait leurs preuves pour réduire le tabagisme, figure la mise en place de lieux où il est interdit de fumer et de vapoter. C’est le cas des campus universitaires sans tabac. Alors que leur efficacité est démontrée à l’international, ils restent peu développés en France. On fait le point à l’occasion du Mois sans tabac
Evaluating the Impact of the Health Navigator Model on Housing Status Among People Experiencing Homelessness in Four European Countries
No full textInternational audienceBackground: People experiencing homelessness (PEH) face significant health disparities and systemic barriers to healthcare, elevating their risk for cancer and other chronic diseases. To tackle PEHs’ challenges in accessing cancer preventive care, the CANCERLESS project implemented the Health Navigator Model (HNM)—a person-centered intervention that utilizes trained Health Navigators to provide tailored support and facilitate service access. Recognizing housing as a key determinant of health, this analysis assessed changes in housing status associated with participation in the HNM among CANCERLESS participants in Austria, Greece, Spain, and the UK. Methods: This was a secondary analysis of cross-national data collected during a single-arm interventional study. Of 652 enrolled PEH, 277 (42.5%) completed the HNM intervention follow-up and were included in the analysis. Changes in housing status from baseline to follow-up were categorized using the European Typology of Homelessness and Housing Exclusion (ETHOS) and treated as an ordered outcome. Descriptive statistics were complemented by a cumulative link mixed model with a participant random intercept to estimate the association between time (follow-up vs. baseline) and housing transitions among completers, adjusting for age, residence/legal status, and daily smoking. Results: Participants had a mean age of 47.4 (SD 13.8), primarily identified as male (64.1%), reported upper secondary education (33.9%), and were from Western European countries (39.7%), with varying housing situations. Among intervention completers, time (follow-up vs. baseline) was associated with higher odds of being in a higher ETHOS category (OR = 1.49, 95% CI = 1.02–2.20, p = 0.042), consistent with a modest improvement in housing status. Larger estimates were observed among migrants without legal documents (OR = 24.13, 95% CI = 6.41–90.89, p < 0.001), while daily smoking was associated with lower odds (OR = 0.33, 95% CI = 0.11–0.96, p = 0.041); other residence status categories were not statistically significant. Conclusions: Suggesting that tailored, navigation-based models, such as the HNM, may be linked to improved housing stability for PEH, these findings can inform piloting and context-aligned integration of the HNM within public health strategies as an alternative approach to address the complex, interconnected health and social needs of PEH. However, the lack of a comparison group and high attrition limit the results’ conclusiveness, and future evaluations should aim to include assessments of housing-associated contextual factors
Influence of geographical accessibility to specialist and primary care givers on excess mortality of multiple sclerosis patients in France
No full textInternational audienceBackground: Access to healthcare and socioeconomic deprivation are intricately linked. No studies have been led to measure the effect of healthcare accessibility on mortality in patients with MS so far. The objective was to examine the influence of travel time to the expert MS centre and of the accessibility to primary healthcare services on excess mortality in MS.Methods: A retrospective observational cohort study recruited patients from 18 French MS expert centres, with an onset of MS between 1960 and 2015 and a follow-up of up to 30 years. Primary health facility accessibility was measured by the Spatial aCcessibility multiscAlar index. Specialist care accessibility was measured by road travel time to the expert MS centre. Excess death rates (EDR) and excess hazard ratios were studied using additive excess hazard models with multidimensional penalised splines.Results: The study included 33,697 patients. Patients with relapsing-onset MS (R-MS) with a travel time of 40 min had the lowest EDR (Men: 1.2 deaths per 100 person-years (95%CI [0.8;1.8]), women: 0.8 deaths per 100 person-years 95%CI[0.6;1.2]), lower than patients who lived further from the centre. No effect of primary care access was found for patients with R-MS, and no effect of accessibility to primary or specialised care was found for patients with primary progressive MS.Conclusion: This study reveals the impact of travel time to neurologists on excess mortality in patients with R-MS in France. This distance bias association highlights the importance of preventing a potential selection of patients followed in MS expert centres
#1353 Categorical state sequence analysis to identify pre-transplantation care trajectories among chronic kidney disease patients in France
No full textInternational audienceBackground and AimsKidney transplantation is the best renal replacement therapy for eligible patients. There are several trajectories leading to kidney transplantation including various transitions between different states. Few studies have attempted to describe these trajectories. The aim of this study is to describe the care trajectories of chronic kidney disease patients prior to kidney transplantation as well as patients’ characteristics associated to them.MethodData were extracted from the REIN registry. All patients aged 18 years and over who underwent a kidney transplantation between 2015 and 2019 in France were included. Information on their comorbidities and dialysis modalities five years prior to transplantation was extracted. The care trajectory was defined as a sequence of states including a state without replacement therapy, dialysis modalities (self-dialysis, home dialysis, peritoneal dialysis, facility-based hemodialysis), waitlisting, follow-up of previous kidney transplantation and kidney transplantation. A state sequence analysis using an Optimal Matching approach followed by an ascending hierarchical classification was used to classify patients in “groups” regarding their care trajectories. A binary logistic regression was performed to study patients’ characteristics associated with the “trajectory group” with early access to kidney transplantation.ResultsA total of 14 426 patients were included in the study, 37% of whom were women. The median age was 55 years, interquartile range [44–66]. Sequence analysis identified 6322 distinct sequences. Hierarchical ascending classification using the Wald method identified four “groups” of care trajectories (Fig. 1). “Trajectory group 1” includes 8114 individuals (56.2% of all, 37% of women, median age 53.0-year-old) and is characterised by early transplantation and short time on dialysis before transplantation. ”Trajectory group 2” includes 1 905 individuals (13.2% of all, 35% of women, median age 56.6-year-old) and is characterised by patients who have mainly been on self-dialysis in the five years prior to transplantation. “Trajectory group 3” included 1210 individuals (8.4% of all, 37% of women, median age 59.7-year-old) and consisted mainly of patients who were on facility-based hemodialysis during the five years prior to kidney transplantation. ”Trajectory group 4” included 3197 individuals (22.2% of all, 38% of women, median age 58.9-year-old) and consisted of patients who had been on facility-based haemodialysis or self-dialysis for approximately three years prior to kidney transplantation (Fig. 2).Multivariate logistic regression found that, the existence of a comorbidity, in particular cancer aOR: 0.4 CI 95% [0.3–0.5], diabetes aOR: 0.8 [0.7–0.9], a psychiatric disorder aOR: 0.4 [0.3 - 0.6] but also older age group compared with less than 40 years, aOR40-59 years: 0.6 [0.5–0.7], aOR60-69 years: 0.4 [0.3–0.45], aOR70-79 years: 0.4 [0.38–0.5], were associated with a lower probability of being in “trajectory group 1”, the trajectory group with early access to kidney transplantation. However, patients with cirrhosis aOR: 1.4 [1.1–1.8] or those who were autonomous aOR: 1.8 [1.2–3.3] were more likely to be in “trajectory group 1”. There is no sex effect aOR: 1.02 [0.95–1.10]. The patient's region of residence is significantly associated with the trajectory group 1.ConclusionThis study identified 4 care trajectory groups prior to kidney transplantation. Half of the patients had a care trajectory marked by an early access to kidney transplantation, probably patients who were well followed up and for whom the recommendations on access to transplant have been successfully observed (Trajectory group 1). There was no sex effect on being in this first group. Patients with cirrhosis were more likely to have the “trajectory group 1” maybe because of the existence of dual kidney and liver transplantation in France from which they can benefit with priority. Further studies are needed to evaluate how pre-transplant trajectory might affect post-transplant outcomes
8. Mieux gérer la coordination des parcours complexes des patients
No full textInternational audienceLa coordination des parcours – ou plutôt l’absence de coordination – est un enjeu essentiel d’efficience, de qualité et de sécurité des soins, notamment pour les patients atteints de pathologies complexes. Y répondre exige aux décideurs politiques et aux manageurs de développer des réponses à plusieurs niveaux du système de santé (micro, méso, macro). L’une des réponses consiste, depuis plus de vingt ans, à développer des métiers (souvent infirmiers) dédiés à la coordination. Plusieurs travaux de recherches en santé proposent de définir leur mission ou d’évaluer leurs résultats sur des indicateurs de performance des organisations de santé (finance, qualité sécurité des soins…). Toutefois, ces travaux donnent peu d’éléments concrets pour accompagner les manageurs, qui sont chargés de les mettre en œuvre dans l’organisation du travail. Le cadre APANCO, récemment développé pour saisir l’organisation du travail en oncologie, offre la possibilité d’une analyse détaillée des activités réalisées par les acteurs de la coordination en situation réelle. Il éclaire la manière dont l’organisation détermine le développement des activités de coordination et offre des leviers concrets aux manageurs pour faciliter leur implantation
#1444 Persistent effects of territorial and gender inequalities on the care trajectory of dialysis patients: access to transplantation and CKD-related mortality before and after transplantation
No full textInternational audienceBackground and Aims Different factors influencing chronic kidney disease (CKD) patients’ outcomes have been identified in the literature, such as gender, smoking, socioeconomic status, and various comorbidities (cancer, diabetes, cardiovascular disease, respiratory disease, physical disability and hepatic disease). The outcomes of interest include access to renal transplantation, and mortality related to CKD (excess mortality) for dialyzed patients and for those who received a renal transplant. Yet little information is available on the association between territorial inequalities, and these outcomes. Our work aims to study the association between département of residence and the aforementioned factors with different outcomes of dialyzed patients. Method We conducted an observational longitudinal cohort study using national REIN registry, including 29,281 CKD patients aged 18–85 who started dialysis between 2017 and 2019 in France, with follow-up until 31st of December 2022. Among them, 6,329 patients were transplanted. We conducted a complete case analysis using flexible multi-level multi-state relative survival modelling allowing for a frailty term to account for patients clustering by department and to simultaneously examine transplant access, excess mortality in dialysis and excess mortality after transplantation. Results Conclusion We were able to identify persistent effects of territorial and gender inequalities on the outcomes of dialysis patients’ care trajectory. Having identified areas with better and worse outcomes might allow to calibrate the care plans in dialysis patients, and for example plan interventions focused specifically on the areas with lower access to transplant. Similarly, helping CKD-patients stop smoking might be interesting since smoking is associated with a lower access to transplantation and a higher excess mortality in dialysis. For CKD patients with comorbidities, better coordination of care between nephrologists and other specialists could improve patient outcomes. This study will be extended to the full dataset after imputation process, due to high proportion of missing data
Trente ans d'évolution de la santé des adolescents
No full textOver the past 30 years, adolescents’ physical and mental health has steadily declined, mirroring poorer fitness, reduced sleep, more sedentary lifestyles (driven largely by screen use), and diets increasingly dominated by ultra-processed and fast foods. This trend is shaped by broader factors such as repeated health, social, and political crises, climate change, and is further amplified by social and regional inequalities.Health policies have often struggled to anticipate or address adolescents’ specific needs. Yet, there are encouraging signs: deaths from accidents and suicides have fallen, smoking, drug use, and early pregnancies have decreased, while sports participation and youth engagement in climate issues have grown. To reverse negative health trends and prevent the early onset of chronic diseases, an adolescent-centered strategy is urgently needed—one designed with young people themselves and aligned with broader child health policies. This strategy should be holistic and cross-sectoral, taking into account the full rhythm of adolescents’ daily lives and creating supportive environments for their well-being, with schools, families, leisure activities, and above all adolescents themselves actively involvedAu cours des 30 dernières années, la santé physique et mentale des adolescents n'a cessé de se dégrader, reflétant une moins bonne condition physique, un sommeil réduit, une sédentarité accrue (principalement due à l'utilisation des écrans) et une alimentation de plus en plus dominée par les aliments ultra-transformés et la restauration rapide. Cette tendance est influencée par des facteurs plus vastes tels que les crises sanitaires, sociales et politiques répétées, le changement climatique, et est amplifiée par les inégalités sociales et régionales.Les politiques de santé ont souvent peiné à anticiper ou à répondre aux besoins spécifiques des adolescents. Pourtant, des signes encourageants apparaissent : les décès par accident et par suicide ont diminué, le tabagisme, la consommation de drogues et les grossesses précoces ont diminué, tandis que la pratique sportive et l'engagement des jeunes sur les questions climatiques ont augmenté. Pour inverser les tendances négatives en matière de santé et prévenir l'apparition précoce de maladies chroniques, une stratégie centrée sur les adolescents est urgente, conçue avec les jeunes eux-mêmes et qui s’articule avec les politiques de santé infantile. Cette stratégie doit être holistique et intersectorielle, prenant en compte l'ensemble du rythme de vie quotidien des adolescents et créer des environnements favorables à leur bien-être, avec les écoles, les familles, les activités de loisirs et surtout les adolescents eux-mêmes activement impliqué
Logement et handicap : quels leviers pour faciliter la participation sociale
No full text5ème ed.International audienceEn France, sous l'influence des mouvements internationaux, les politiques du handicap ont adopté une approche par les droits axée sur la citoyenneté, l'inclusion et la participation sociale. Celle-ci est pensée dans différents domaines de la vie quotidienne, principalement la scolarité pour les enfants et le travail pour les adultes. L'accès à la vie associative, l'engagement citoyen et politique, ou encore les relations sociales lui sont aussi associés. En revanche, le logement est peu étudié en tant que support à la participation sociale des personnes handicapées : bien qu'il en constitue le socle, il reste considéré comme relevant de la sphère privée et de l'intime. (extrait de l'introduction
La recherche est une démarche, l’expérience est singulière et l’expertise est collective…
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Setting public health guidelines for chemicals in indoor settled dust. First achievements and steps to come: the case of lead
No full textInternational audienceHealth based guidelines for environmental concentrations of chemicals are designed to prevent harmful chemical exposures. However, none exists for indoor settled dust, despite its ingestion being a documented pathway of exposure, for certain chemicals. The objective of this paper is to present the derivation of a health-based indoor settled dust guideline (ISDG) for lead. The guideline was developed to protect a specific fraction of the most vulnerable population against the most sensitive effect, taking into account other exposure pathways. It is calculated from a toxicological reference value, body weight, and the mass of ingested dust. The most vulnerable population is young children, and the corresponding critical effect is a loss of IQ points, with a toxicity reference value of 0.5 µg.kgbw-1.d-1. Assuming that 80% of the exposure for the most affected individuals comes from dust ingestion, the ISDG for protecting 90, 95 or 95% of young children are 43, 33 and 20 µg.gdust-1, respectively. These values are consistently lower than the concentrations that would trigger lead poisoning screening. The main uncertainties lie in the estimations of the amount of ingested dust. This ISDG could contribute to environmental management efforts to prevent or reduce lead exposures