Scientific publications portal of EHESP researchers
Not a member yet
5609 research outputs found
Sort by
Preventing Multimorbidity: Moving Beyond the Single Disease Lens
No full textCommentaryInternational audienc
Frais de scolarité, sélection, individualisation des parcours : en Europe, une variété d’expériences étudiantes
No full texthttps://theconversation.comAlors que de plus en plus de jeunes Européens suivent des études supérieures, la manière de gérer cette massification varie beaucoup d’un pays à l’autre. Tom Chevalier, chercheur en science politique, et Patricia Loncle-Moriceau, professeure de sociologie, en dressent un état des lieux dans les Politiques de jeunesse, publiées en juin 2025 aux PUF (« Que sais-je ? »). En voici un extrait permettant de mieux situer la position de la France par rapport à ses voisins
Quantifying the short-term mortality effects of wildfire smoke in Europe: a multicountry epidemiological study in 654 contiguous regions
No full textInternational audienceBackground: Fine particulate matter (PM2·5) from wildfire smoke could be more harmful to human health than that from other sources. Evidence of the short-term association between wildfire-related PM2·5 and mortality in Europe remains sparse, leading to uncertainties in the fire-related PM2·5 mortality burden.Methods: In this retrospective, multicountry epidemiological study, we used the EARLY-ADAPT database to obtain daily mortality records in 654 contiguous subnational regions from 32 European countries, representing a population of 541 million individuals. We combined these data with daily estimates of fire-related and non-fire-related PM2·5 from the System for Integrated Modelling of Atmospheric Composition model during 2004-22. Regional and pooled associations between daily fire-related PM2·5 and all-cause and cause-specific mortality were quantified using quasi-Poisson regression. We compared deaths attributable to fire-related PM2·5 using relative risks (RRs) specific to fire-related PM2·5 versus total PM2·5.Findings: Our study data included 95⸱3 million daily deaths for all-cause mortality, 19⸱5 million daily deaths for cardiovascular mortality, and 3⸱9 million daily deaths for respiratory mortality from Jan 1, 2004, until the latest available year in each country. Pooled cumulative (lags 0-7) RRs associated with a 1 μg per m3 increase in fire-related PM2·5 were 1⸱007 (95% CI 1⸱004-1⸱010) for all-cause mortality, 1⸱009 (1⸱006-1⸱013) for cardiovascular mortality, and 1⸱013 (1⸱008-1⸱019) for respiratory mortality. RRs were larger for fire-related PM2·5 than for non-fire-related PM2·5. Using RRs for total (fire-related and non-fire-related) PM2·5 underestimated the fire-related PM2·5 attributable mortality by 93%.Interpretation: Associations with all-cause and cause-specific mortality were larger for fire-related compared with non-fire-related PM2·5. Assuming wildfire PM2·5 has the same effect as total PM2·5 substantially underestimates the mortality burden of wildfire smoke
Understanding the interplay between epidemiological and social cognitive drivers of behaviour change during the Covid-19 pandemic
No full textInternational audienceSince the COVID-19 pandemic, there is growing evidence that the social epidemiological context may play a crucial role in the adoption of health protective behaviours in response to emerging infectious diseases. Yet, our understanding of how and why these behaviours are influenced by the epidemiological forces remains relatively limited. This repeated, cross-sectional investigation examines the extent to which the association between the socio-epidemiological context and protective behaviour was mediated by a series of common social cognitive factors from leading models of health behaviour during the COVID-19 epidemic in France. Representative samples of the French population completed an online, self-report survey at seventeen intervals (March-November 2020), with approximately 2000 participants in each survey wave. Results indicate that both contextual and social cognitive variables largely drove the adoption of protective behaviours over time. However, social cognitive variables only partially mediated the effect of the epidemiological context on protective behaviour (physical distancing and hygiene measures), suggesting that unknown factors may be operating in addition to those commonly used in these models. These findings highlight the need for future research to consider the epidemiological context, and further possible mediating variables, when modelling determinants of social cognitions and preventive behaviour, and above all, to broaden its focus to include neglected underlying psychological mechanisms involved in the behavioural response to epidemics
Economic Impacts of Initiating Vaccination at 3 Months vs. 6 Months in an Influenza Pandemic in the United States
No full textInternational audienceBackground/Objectives: An influenza pandemic is likely to occur in the coming decades and will be associated with substantial healthcare and financial burdens. In this study, we evaluated the potential economic costs of different vaccination scenarios for the US population in the context of a moderate or severe influenza pandemic. Methods: Economic analysis was performed for initiation of pandemic vaccination from 3 months vs. 6 months in the US after declaration of a pandemic. We evaluated three vaccine effectiveness levels (high, moderate, low) and two pandemic severity levels (moderate and severe). Results: No vaccination would lead to total direct and indirect costs of 823 bn in a severe pandemic. Initiation of vaccination at 3 months would result in cost savings versus no vaccination (excluding vaccine price) of 260–709 bn in a moderate and severe pandemic, respectively, whereas initiation of vaccination at 6 months would result in cost savings of 36–97 bn, respectively. Cost savings of 162 bn would occur in a moderate or severe pandemic, respectively, from use of a low effectiveness vaccine from 3 months instead of a high effectiveness vaccine from 6 months. Conclusions: Rapid initiation of vaccination would have a greater impact than increased vaccine effectiveness in reducing the economic impacts of an influenza pandemic
Engaging education: Boosting HPV vaccination through a serious game
No full textLetter to the EditorInternational audienc
Co-designing a shared digital decision aid for HPV vaccination in French general practice
No full textInternational audienceBackground: Human papillomavirus (HPV) is responsible for the most common sexually transmitted infection in the world and persistent infection of oncogenic types is associated with an increased risk of cancers. This infection could be prevented by vaccination. However, in a time of vaccine hesitancy, the decision to get vaccinated or to have a child vaccinated is the result of a complex process and decision aids are tools that may be of help in this context.Objective: The aim of this article is to present the development of a shared decision aid for HPV vaccination in France, destined to be used during general practice consultations.Methods: In order to develop the shared decision aid, we followed the steps recommended by the International Patient Decision Aids Standard (IPDAS), i.e. scoping and defining the objectives, assembling the steering group, designing (carrying out two focus groups and a narrative review of the literature) and testing in a alpha test phase (carrying out three focus groups and 11 individual interviews). The tool was co-constructed with adolescents, parents and general practitioners.Results: We created an online shared decision aid which included the definition of HPV, epidemiological data, the mode of contamination, the different locations of the disease, the development of cancer, the importance of Pap smears, the effectiveness of the vaccination as well as the possible side effects. The various focus groups as well as individual interviews made it possible to determine the values and expectations of patients and physicians thus improving the decision aid. This development also made it possible to confirm an existing need for this type of tool for both patients and physicians.Conclusions: We have developed a shared decision aid that could help general practitioners communicate about HPV vaccination and get more patients vaccinated. The impact of its use during the consultation will be evaluated on criteria such as the resolution of the decision-making conflict and ultimately on the vaccination coverage, as part of the PrevHPV study
Tabac, alcool et santé publique : quand les intérêts commerciaux bloquent la prévention
No full textTribuneInternational audienceSelon un rapport de l'Organisation mondiale de la santé, environ un quart des décès annuels en Europe par an s'explique par la consommation de produits vendus par 4 secteurs industriels : tabac, alcool, alimentation ultratransformée et énergies fossiles. Depuis quelques décennies, la communauté scientifique alerte sur le rôle de ces "déterminants commerciaux de la Santé" (DCoS) pour expliquer la mauvaise santé de la population, l'augmentation des dépenses de soins associée et le creusement des inégalités sociales. L'objectif de cette tribune est de définir les DCoS et de montrer comment les activités commerciales des industriels du tabac et de l'alcool en France bloquent la prévention. [Extrait
Evaluation de l'implémentation d'interventions en milieu scolaire visant à améliorer la couverture vaccinale HPV en France : résultats d'une étude mixte au sein de l'essai contrôlé randomisé PrevHPV
No full textInternational audienceBackground and objective(s)Human papillomavirus (HPV) vaccine coverage (VC) remains lower than expected in many countries, particularly France. In 2018, the French authorities launched the PrevHPV research program to codevelop school- and primary care-based interventions with stakeholders and evaluate their effectiveness and implementation. The school-based interventions were ‘education and motivation’ and ‘at-school vaccination’. Analyses, without considering the dose of intervention received, showed that only the ‘at-school vaccination’ intervention significantly increased VC at two months. Implementation weaknesses may negatively impact effectiveness; therefore, it is worth having an in-depth understanding of the intervention implementation. This investigation aimed to evaluate the implementation of the school-based interventions of the PrevHPV program.Material and MethodsWe carried out a mixed-method study embedded in the national cluster randomized controlled trial PrevHPV (July 2021-June 2022). The cluster was the municipality (n=91). The ‘education and motivation’ intervention consisted (i) for parents, of a web conference on HPV infection and vaccination; and, (ii) for 8th–9th grade pupils, of two educational group sessions on those topics during school hours, using participatory learning and e-health tools. The ‘at-school vaccination’ intervention consisted of offering free vaccination to all pupils whose parents agreed on school premises. Quantitative data were collected through standardized activity reports and self-administered questionnaires; the implementation outcomes were fidelity, dose, reach, acceptability and sustainability. Qualitative data were collected through semi-structured group interviews with school staff and analyzed using the Consolidated Framework for Implementation Research.ResultsWe found high rates for: fidelity (e.g., 69% of the targeted classes had two sessions and 89% of schools invited all pupils for at-school vaccination); acceptability (e.g., pupils’ attentiveness and participation satisfying in 90% of the sessions, 96% of vaccinated pupils and 78% of school staff satisfied with the organization of vaccination days); and sustainability (e.g., 91% and 76% of participating schools considered conducting sessions and vaccination days the following year, respectively). However, the withdrawal of 1/3 of schools before the trial started and difficulties in mobilizing parents (e.g., <1% of invited parents participated in a web conference) negatively impacted dose and reach. Facilitators of and barriers to the implementation related to the intervention content and format, the characteristics of both the external and internal environment of the school, the numerous stakeholders and individuals involved, and the implementation strategies used. Facilitators included well-designed provided tools, supportive regulations, motivated leaders, and the presence of an external facilitator; barriers included staff workload, financial and material resources.ConclusionSchools can play a significant role in HPV vaccine promotion but are challenging settings for implementation. This study highlights challenges for involving stakeholders (parents, school staff) and the organizational changes this implies. This study has practical implications for implementing such interventions in real life, which is more valuable since HPV vaccination has been offered at school to all French 7th-grade pupils since 2023