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A call for robust evaluations of the impacts of serious games for climate change mitigation: The Climate Fresk as a global case study
No full textInternational audienceSerious games and gamified workshops are increasingly used in sustainability education, yet their actual cognitive, emotional, attitudinal, and behavioral impacts remain under-evaluated. The Climate Fresk is a widely implemented example, with over two million participants in more than 150 countries. Designed to raise climate awareness through collaborative learning and emotional engagement, its growing popularity contrasts with the limited scientific assessment of its effectiveness. This perspective paper uses The Climate Fresk as a case study to examine the broader challenges of evaluating serious games in climate education. Drawing on insights from environmental psychology, educational and behavioral sciences, we analyze its potential mechanisms of action, identify key moderating factors, such as participant characteristics, facilitator attributes, and implementation context, and highlight limitations in current evaluation practices. We conclude by outlining a research agenda that emphasizes the need for rigorous, theory-driven experimental designs, including randomized controlled trials focused on relevant psychological determinants of behavior change. Such efforts are essential to establish the evidence base required to improve the effectiveness, reproducibility, and scalability of gamified climate education interventions
Barriers to evidence-based alcohol policies in France: Insights from interviews with parliament members
No full textInternational audienceBackgroundIn France, the evidence-based policies recommended by the World Health Organization SAFER program remain poorly implemented, despite relatively high levels of alcohol consumption and alcohol-related harms. To understand this paradox, we used Kingdon’s Multiple Streams Approach (MSA) as framework to analyze how members of the French parliament perceive alcohol and how alcohol industry and public health actors influence their decision-making.MethodsWe conducted twenty-five interviews with French deputies and senators from different political parties and regions. We built the interview guide following the three MSA streams: problem, policy, and political. We performed a thematic content analysis of the interview data using Nvivo to manage the data.ResultsThe interviewed deputies and senators held ambivalent views on alcohol (problem stream): they acknowledged its health and social harms, but also emphasized its cultural and economic benefits. They supported low-evidence-based alcohol policies (e.g., education and targeted prevention) and showed limited support for Minimum Unit Pricing (MUP) policies (policy stream). Several arguments used by the alcohol industry against MUP emerged, including negative economic effects and illicit trade. The interviewed deputies and senators also reported more frequent interactions with alcohol industry actors than with public health actors (political stream).ConclusionIn line with the MSA streams, our findings suggest that ambivalent framing of alcohol, weak support for evidence-based measures and a wine-favorable political environment may explain the weak alcohol control policies in France. Future research should include additional stakeholders to capture the full set of dynamics that contribute to policy inertia
Urinary Dysfunction Management in Multiple Sclerosis: A Nationwide Real-Life Analysis From the French SNDS Database
No full textInternational audienceAnemia remains a major global public health concern, underscoring the need for innovative nutritional and therapeutic strategies. Indigenous food plants such as Carica papaya (pawpaw) have attracted attention as potential remedies; however, their claimed benefits require rigorous scientific confirmation through well-designed experimental models prior to clinical consideration. This study was designed to formulate and demonstrate a validated, two-stage experimental framework for the systematic assessment of plant-based anti-anemic activity, with C. papaya leaf and seed extracts used as a representative model. Anemia was experimentally induced in Wistar rats using aluminum chloride (AlCl₃) administered orally at 0.5 mg/kg daily for 14 days. The evaluation protocol consisted of two consecutive phases. In Stage 1, crude methanol extracts were screened at graded doses of 100, 300, and 500 mg/kg. Stage 2 focused on the most active extract identified in Stage 1, from which alkaloid and flavonoid fractions were isolated and tested at 75 and 150 mg/kg. Key hematological indices red blood cell count (RBC), hemoglobin concentration (Hb), packed cell volume (PCV), and full blood count were assessed throughout the 14-day treatment period. Administration of AlCl₃ produced marked anemia, evidenced by a decline in RBC from 7.15 to 5.05 × 10¹²/L and a reduction in Hb from 13.65 to 8.55 g/dL in untreated anemic controls. During Stage 1, methanol extracts of C. papaya leaves at 300 and 500 mg/kg demonstrated the strongest hematological recovery, significantly improving RBC, Hb, and PCV values toward normal ranges. In Stage 2, the leaf-derived alkaloid fraction at 150 mg/kg emerged as the most potent intervention, surpassing flavonoid fractions and exhibiting a clear dose-responsive effect. Overall, this work introduces a reliable and reproducible two-stage experimental approach for screening and characterizing plant-derived anti-anemic agents. The results highlight C. papaya leaf methanol extract, particularly its alkaloid fraction, as a promising candidate for anemia management and provide a standardized methodological framework for future studies in this area
Feature Aggregation for Efficient Continual Learning of Complex Facial Expressions
No full textInternational audienceAs artificial intelligence (AI) systems become increasingly embedded in our daily life, the ability to recognize and adapt to human emotions is essential for effective human–computer interaction. Facial expression recognition (FER) provides a primary channel for inferring affective states, but the dynamic and culturally nuanced nature of emotions requires models that can learn continuously without forgetting prior knowledge. In this work, we propose a hybrid framework for FER in a continual learning setting that mitigates catastrophic forgetting. Our approach integrates two complementary modalities: deep convolutional features and facial Action Units (AUs) derived from the Facial Action Coding System (FACS). The combined representation is modelled through Bayesian Gaussian Mixture Models (BGMMs), which provide a lightweight, probabilistic solution that avoids retraining while offering strong discriminative power. Using the Compound Facial Expression of Emotion (CFEE) dataset, we show that our model can first learn basic expressions and then progressively recognize compound expressions. Experiments demonstrate improved accuracy, stronger knowledge retention, and reduced forgetting. This framework contributes to the development of emotionally intelligent AI systems with applications in education, healthcare, and adaptive user interfaces
Impact of Long-Term Cumulative Exposure to Wildfire Smoke PM2.5 on Cardiovascular Hospital Admissions Among Older Adults in the United States
No full textInternational audienceBackground: As wildfires intensify in a warming climate, prolonged exposure to smoke-derived fine particulate matter (PM2.5) poses significant health risks. However, the cardiovascular impacts of long-term cumulative exposure to smoke PM2.5 remain understudied.Objectives: This study sought to investigate associations between long-term cumulative exposure to wildfire smoke PM2.5 and first cardiovascular disease (CVD) hospitalizations among U.S. Medicare beneficiaries and to assess potential effect modification by sociodemographic factors.Methods: This population-based cohort study analyzed 65.2 million Medicare beneficiaries (aged ≥65 years) across the contiguous United States from 2017 to 2022. Wildfire smoke PM2.5 was estimated with the use of a spatiotemporal model at 10 × 10 km resolution and assigned to beneficiaries' residential ZIP codes. We applied quasi-Poisson regressions to estimate relative risks (RRs) and 95% CIs of CVD hospitalizations for each decile of wildfire smoke PM2.5 concentrations, using exposures below the 1st percentile (0.08 μg/m3) as reference.Results: Three-year average wildfire smoke PM2.5 was significantly associated with increased CVD hospitalization risk. We observed a nonlinear pattern peaking at moderate exposure levels (wildfire smoke PM2.5 concentrations between 0.26 and 0.32 μg/m3) for overall CVD (RR: 1.04; 95% CI: 1.03-1.05), ischemic heart disease (RR: 1.07; 95% CI: 1.06-1.09), and arrhythmias (RR: 1.06; 95% CI: 1.04-1.07). Cerebrovascular hospitalizations showed an increasing trend across exposure levels. Beneficiaries of lower socioeconomic status were potentially more vulnerable.Conclusions: Long-term cumulative wildfire smoke PM2.5 exposure is associated with elevated CVD hospitalization risk, varying by exposure levels and individual characteristics. These findings underscore the need for targeted public health strategies to mitigate cardiovascular risks among older adults with the occurrence of wildfires
Validation d'une méthodologie de prélèvement et d'analyse du plomb dans les poussières des espaces publics extérieurs.
No full textInternational audienceThis study focuses on the development and validation of a method for sampling and analysing lead in outdoor settled dust, in order to express the results as dust loading concentrations and mass concentrations. It aims to assess the health risks for children exposed in outdoor public spaces, a population particularly vulnerable to lead poisoning.L'étude porte sur la mise au point et la validation d'une méthode de prélèvement et d'analyse du plomb dans les poussières sédimentées extérieures, afin d'exprimer le résultat à la fois en concentration surfacique et en concentration massique. Elle vise à pouvoir évaluer le risque sanitaire pour les enfants exposés dans les espaces publics extérieurs, population cible du risque d'intoxication au plomb
Assessing psychological distress among medical students: a systematic review and meta-analysis of tools available
No full textInternational audienceIntroduction: Medical students are reported to experience high rates of psychological distress, including depression, anxiety, stress, and suicide. However, there is no consensus on the tools used to detect these symptoms. This systematic review aims to explore the various tools available for assessing distress in medical students.Materials and methods: A systematic literature review was conducted following an established protocol. Articles were included if they addressed anxiety, stress, or psychological distress in medical students and used validated assessment tools translated into English. A meta-analysis was also conducted on the prevalence of stress and anxiety.Results: One hundred twenty-one articles were included, identifying 22 different tools. The Depression, Anxiety and Stress Scale was the most commonly used tool (21.7%), followed by the General Health Questionnaire and the Perceived Stress Scale (14.7%). Only two of the identified tools, the Medical Student Stressor Questionnaire (5.4%) and the Perceived Medical School Stress (3.9%), were specifically designed for medical students. The meta-analysis revealed a stress prevalence of 47.5% and an anxiety prevalence of 44.6%.Conclusion: There are multiple tools available for assessing psychological distress that are already widely used. The use of a specific questionnaire may not be necessary for this population, as tools designed for the general population can also be used for this specific group. However, specific questionnaires may provide a more accurate indication of the causal factors that require action
Reconstructing healthcare networks from patient transfer data: a systematic review
No full textInternational audienceAbstract Healthcare facilities are interconnected via patient transfers, facilitating pathogen spread. We systematically reviewed studies reconstructing patient-sharing networks. We searched PubMed, Scopus and IEEE Xplore up to October, 2025, identifying articles that presented networks of at least three healthcare facilities or units connected by observed patient transfers, excluding those restricted to specific patient groups. 79 articles were included from 5,721 screened, describing 50 distinct networks published across diverse disciplines. Overall confidence in study findings, assessed through a modified QuADS tool, was good. Most networks were reconstructed in Europe and North America. Nursing homes and rehabilitation centers were rarely included, and few studies used temporal network approaches. Although most articles computed descriptive statistics and network metrics, only 27 (34%) developed mathematical models of pathogen transmission. Overall, this review highlights the value of patient-sharing networks for understanding and controlling pathogen spread, while emphasizing the need for broader facility inclusion and more temporal modeling
Mass medical evacuations to decrease the intensive care burden: results from the TRANSCOV cohort study.
No full textInternational audienceBackground: In a context of overwhelming demand, mass transfers between intensive care units (ICU) were organized in France during the first COVID-19 epidemic wave (spring 2020). According to early reports, transferred patients experienced a 3-to-4-fold lower ICU case fatality. It is not known whether this difference stems only from the selection of healthier patients for transfer.Research question: Is the 28-day ICU case fatality of transferred patients different from that of matched control (not transferred) patients?Study design and methods: Multicenter retrospective cohort study that included 285 transferred patients, and 667 control (not transferred) patients admitted simultaneously (± 2 days) to the same "origin" ICU and alive five days after the transfer date. The 28-day ICU case fatality and clinical events during ICU stay were compared in transferred and control patients.Results: At ICU admission, age, COVID-19 severity, comorbidities and Simplified Acute Physiology Score II (SAPS II) were similar, but transferred patients were lighter (81 versus 89 kg, p<0.0001) and more autonomous than the matched control patients (64.5 versus 55.0%, p=0.01). Case fatality was approximately 7-fold lower in transferred patients (adjusted incidence rate ratio = 0.14 [95% CI: 0.10-0.19]). ICU stay was longer and delirium, psychiatric disorders and neuromuscular blockade exposure were more frequent in transferred patients than controls. Conversely, acute kidney injury was more frequent in controls (51.5 versus 37.7%, p<0.0001).Interpretation: Although the selection of healthier patients likely contributed to better survival, removal from an overcrowded care environment probably also explains the large survival benefit associated with transfer. By reducing workload, mass transfers might have also benefited patients who remained in origin ICUs. Organizing mass transfers as early as possible may be an appropriate strategy for mitigating the impact of an overwhelming intensive care demand
Socio-demographic, provider-related and attitudinal determinants towards HPV vaccination in a French Caribbean territory
No full textSince introduction of Human Papillomavirus Vaccination (HPVV) in the French Caribbean in 2007, complete-schedule vaccine coverage at age 15 years among girls has remained below 25%, while national and international recommendations target at least 60%. We explored the parental socio-demographic, provider-related and attitudinal determinants of HPVV awareness, uptake and intention in Guadeloupe.Material and methodsWe conducted a cross-sectional survey among parents of adolescents enrolled in public and private middle schools in Guadeloupe in June 2023, using an online questionnaire sent out by schools. We developed separate multivariable logistic regression models predicting HPVV awareness, uptake and intention according to socio-demographic characteristics, HPVV offer by the general practitioner and attitudes towards HPVV.Results : A total of 306 parents completed the online survey questionnaire. Among them, 85.3% were aware of HPVV and 25.4% reported a child vaccinated with at least one dose of HPV vaccine. HPVV awareness was associated with parental educational attainment (OR=2.8;95%CI:[1.2-6.6]). HPVV uptake was associated with the child’s sex (for female, OR=3.6;95%CI:[2.0-6.5]). This latter association was mediated by medical HPVV offer, which itself was a strong determinant of uptake (OR=28.8;95%CI:[11.2-73.7]). Among parents aware of HPVV reporting an unvaccinated child, 27.0% intended vaccination. The only significant determinant for this was having received a medical offer of HPVV (HPVV (OR= 2.3;95%CI:[1.1-4.8]). Believing that the child was too young to be vaccinated was stongly associated with both vaccine uptake (OR=0.1;95%CI:[0.1–0.2]) and intention (OR=0.2;95%CI:[0.1–0.9]).Discussion and conclusions : These results suggest that public intervention through medical offer of HPVV holds a central place in HPVV uptake and intention among parents in Guadeloupe. This finding emphasizes the need for communication on the benefits and risks of HPVV and incentives to GPs to fully get involved in HPVV promotion, possibly with programmatic support from school-based campaigns promoting early vaccination