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Sexual Behavior in Sexual Minority and Non-Minority Youth from Eight European Countries
No full textInternational audienceSexual minority youth, compared to their heterosexual peers, have a disproportionate burden of sexual risks, but it remains unclear whether such inequalities exist across cultures and countries. We used data from eight European countries participating in the 2018 Health Behaviour in School-aged Children (HBSC) study to analyze sexual behavior in representative samples of adolescents aged 14.5-16.5 years (N = 10,583). Overall, 19.1% of the participants reported that they had had sexual intercourse. Compared to their non-minority peers (those exclusively attracted to opposite-gender partners), sexual minority youth - attracted to same- or both-gender partners - were significantly more likely to report having had sexual intercourse and sex before age 14. Those attracted to both-gender partners had similar odds of having had sexual intercourse, but higher odds of not using condoms, or neither condoms nor contraceptive pill use at last intercourse. Those not attracted to anyone had similar odds of having had sexual intercourse but were more likely to report early sex and not using protection at last intercourse. Adjusting for gender, country and family affluence did not substantially change the pattern of results. In interpreting the findings, the onset of puberty, sexual abuse, stigma management and experimentation with sexual identity should be considered. We discuss the practical, clinical and research implications of the findings
Wildfire Smoke Exposure and Incident Dementia
No full textInternational audienceImportance Long-term exposure to total fine particulate matter (PM 2.5 ) is a recognized dementia risk factor, but less is known about wildfire-generated PM 2.5 , an increasingly common PM 2.5 source. Objective To assess the association between long-term wildfire and nonwildfire PM 2.5 exposure and risk of incident dementia. Design, Setting, and Participants This open cohort study was conducted using January 2008 to December 2019 electronic health record (EHR) data among members of Kaiser Permanente Southern California (KPSC), which serves 4.7 million people across 10 California counties. KPSC members aged 60 years or older were eligible for inclusion. Members were excluded if they did not meet eligibility criteria, if they had a dementia diagnosis before cohort entry, or if EHR data lacked address information. Data analysis was conducted from May 2023 to May 2024. Exposures Three-year rolling mean wildfire and nonwildfire PM 2.5 in member census tracts from January 2006 to December 2019, updated quarterly and estimated via monitoring and remote-sensing data and statistical techniques. Main Outcome and Measures The primary outcome was incident dementia, identified using diagnostic codes in the EHR. Odds of dementia diagnoses associated with 3-year mean wildfire and nonwildfire PM 2.5 exposure were estimated using a discrete-time approach with pooled logistic regression. Models adjusted for age, sex, race and ethnicity (considered as a social construct rather than as a biological determinant), marital status, smoking status, calendar year, and census tract–level poverty and population density. Stratified models assessed effect measure modification by age, sex, race and ethnicity, and census tract–level poverty. Results Among 1.64 million KPSC members aged 60 years or older during the study period, 1 223 107 members were eligible for inclusion in this study. The study population consisted of 644 766 female members (53.0%). In total, 319 521 members identified as Hispanic (26.0%), 601 334 members identified as non-Hispanic White (49.0%), and 80 993 members received a dementia diagnosis during follow-up (6.6%). In adjusted models, a 1-μg/m 3 increase in the 3-year mean of wildfire PM 2.5 exposure was associated with an 18% increase in the odds of dementia diagnosis (odds ratio [OR], 1.18; 95% CI, 1.03-1.34). In comparison, a 1-μg/m 3 increase in nonwildfire PM 2.5 exposure was associated with a 1% increase (OR, 1.01; 95% CI, 1.01-1.02). For wildfire PM 2.5 exposure, associations were stronger among members less than 75 years old upon cohort entry, members from racially minoritized subgroups, and those living in high-poverty vs low-poverty census tracts. Conclusions and Relevance In this cohort study, after adjusting for measured confounders, long-term exposure to wildfire and nonwildfire PM 2.5 over a 3-year period was associated with dementia diagnoses. As the climate changes, interventions focused on reducing wildfire PM 2.5 exposure may reduce dementia diagnoses and related inequities
Exploring sub-threshold food addiction in adult patients with severe obesity: a cross-sectional analysis
No full textInternational audienceBackground - Most studies on Food Addiction (FA) used the strict classical diagnosis approach without quantifying sub-threshold symptoms (i.e. uncontrolled/excessive food intake, negative affect, craving, tolerance, withdrawal, and continued use despite harm) nor indicating where they stand on the "three-stage addiction cycle" modeling the transition from substance use to addiction. Objectives - (1) to estimate the proportion of clinically significant episodes of distress/impairment in severely obese patients without FA, and (2) to assess their associations with FA symptoms at the subthreshold level. Methods - The modified Yale Food Addiction Scale 2.0 (mYFAS 2.0) assesses 11 symptoms (diagnostic criteria) plus clinically significant impairment and distress (clinical significance criterion). We used this tool to diagnose FA (≥ 2 criteria plus clinical significance) in adult patients with severe obesity, but included only those below the threshold in the analyses. Demographics, clinical features, and obesity complications were collected. Results - Only 18% of the 192 participants (women = 148, 77.1%; mean age: 43.0 ± 13.2) reported a total absence of FA symptoms, while one in four reported recurrent episodes of clinically significant distress (24%) or impairment (25%) in social, occupational, or other important areas of functioning. The most common recurrent symptoms were first-stage symptoms (binge/intoxication), while second- (withdrawal/negative affect) and third-stage (preoccupation/anticipation) symptoms affected nearly one patient in five for tolerance and craving, and one in ten for withdrawal. In multivariate analysis, impairment was positively related to withdrawal and tolerance, while distress was positively related to failure in role obligations. Conclusion - Many patients with severe obesity experience recurrent episodes of FA symptoms at the subthreshold level. Prospective studies will examine whether these symptoms may play a causal role in symptoms progression toward a full-blown FA and obesity outcomes
Statut Juridique et Qualité des Hôpitaux : Une Décomposition des Différences de Processus et de Résultats
No full textThe effect of hospital ownership status on quality has been extensively examined in the literature, yet no clear consensus has been reached. Using administrative data from 2014 to 2023 for all acute inpatient stays in France, we aim to study difference in quality between hospital ownership taking into account its multidimensional aspect by using process and outcome indicators. For all indicators, quality in public hospitals is lower than privatehospitals. We apply a Oaxaca-Blinder decomposition to explain mean differences in quality between public, private non-profit, and private for-profit hospitals. We find that, both differences in characteristics (structure, case-mix, environment) and their differences in coefficients explain quality differences but the coefficients effect mainly drive quality differences. The structure characteristics that contribute the most to mean quality differences is the level of specialization. Regarding case-mix, the most important characteristics is the comorbidityindex. Finally, for environment characteristics, GP accessibility is a key contributor. However, when considering the relative importance of all factors, the role of environmental factors is minor compared with structure and case-mix characteristics.L’effet du statut de propriété des hôpitaux sur la qualité a été largement étudié dans la littérature, mais aucun consensus clair n’a encore été atteint. À partir de données administratives de 2014 à 2023 couvrant l’ensemble des séjours hospitaliers en soins aigus en France, nous analysons les différences de qualité selon le statut de propriété des hôpitaux, en tenant compte de sa nature multidimensionnelle au moyen d’indicateurs de processus et de résultat. Pour l’ensemble des indicateurs, la qualité observée dans les hôpitaux publics est inférieure à celle des établissements privés.Nous appliquons une décomposition de Oaxaca-Blinder afin d’expliquer les différences moyennes de qualité entre les hôpitaux publics, privés à but non lucratif et privés à but lucratif. Nos résultats montrent que les différences de caractéristiques (structure, case-mix, environnement) ainsi que les différences de coefficients contribuent toutes deux aux écarts de qualité, mais que l’effet des coefficients constitue le principal déterminant de ces écarts. Parmi les caractéristiques structurelles, le niveau de spécialisation est celui qui contribue le plus aux différences moyennes de qualité. S’agissant du case-mix, la caractéristique la plus importante est l’indice de comorbidité. Enfin, parmi les caractéristiques environnementales, l’accessibilité aux médecins généralistes constitue un facteur clé. Cependant, si l’on considère l’importance relative de l’ensemble des facteurs, le rôle des caractéristiques environnementales reste limité par rapport à celui des caractéristiques de structure et de case-mix
Sustained excess all-cause mortality post COVID-19 in 21 countries: an ecological investigation
No full textInternational audienceAbstract Background Despite widespread vaccination efforts, significant excess mortality continued in various countries following the COVID-19 pandemic. This study aims to estimate excess mortality during 2022 in 21 countries and regions, and to examine the relationship of governmental control measures and vaccination rates with excess mortality during 2021–2 at an ecological level. Methods Excess mortality for 2022 was estimated by analysing weekly mortality data from January 2020 to December 2022 across 21 countries and regions participating in the C-MOR consortium. This was achieved by comparing the observed age-standardized mortality rates per 100 000 population to a baseline derived from historical data (2015–19). Governmental control measures and vaccination efforts were investigated for their association with weekly excess mortality during 2021–2 in multilevel models with country as a random effect. Results All 21 countries experienced excess mortality in 2022, ranging from 8.6 (Peru) to 116.2 (Georgia) per 100 000 population, noting that rates were not directly comparable across countries. Many countries had higher excess mortality in 2022 compared with previous years. Mauritius showed a significant excess mortality for the first time in 2022. The proportion of COVID-19 deaths relative to total deaths decreased in 2022 for most countries, except Australia. Governmental control measures and vaccinations were associated with reduced excess mortality in 2021 and 2022, respectively. Conclusion The study reveals sustained excess mortality throughout 2022. Excess deaths were mainly non-COVID-19-related, likely due to displaced mortality or to broader long-term impacts of the pandemic response. Governmental control policies and vaccination efforts were associated with lower excess mortality. These findings provide critical insights into pandemic mortality dynamics and emphasize the need for continued vigilance and adaptive public health strategies
14. Stratégies d'ajustement des ressources et expérimentation du travail compressé en 4 jours en EHPAD
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DataPOST : analyse de données de polyexpositions et de santé des travailleurs
No full textWorkers face several occupational risk factors related to their occupation. These exposures, whether sequential or simultaneous, can interact and potentially modify their health effects, a common phenomenon known as multiple exposure. However, knowledge on this subject remains limited. Combining several databases appears to be a solution for better representing the complexity of work situations involving multiple exposures by using complementarity information.This project aims to develop and apply a cross-analytical methodology using ten French occupational health databases to guide research on preventing occupational multiple exposures. It is structured around three main axes: (1) documentation, to gather essential information for understanding the topic, as the health effects of multiple exposures and database characteristics; (2) designing a methodology to integrate heterogeneous data via a reference ontology and prior harmonisation; and (3) applying it through four case studies with different levels of analysis.This methodological approach provides a promising framework to analyse the complexity of multiple exposures situations and opens new perspectives for their prevention. It highlights the need to take into account differences between genders and occupations, to improve data and epidemiological studies, and to explore innovative strategies to advance prevention toward a more inclusive and realistic approach to workers’ health.Les travailleurs sont exposés à divers facteurs de risque, liés à leur métier. Ces expositions, successives ou simultanées, peuvent interagir, et potentiellement modifier leurs effets sur la santé, un phénomène fréquent appelé polyexposition. Pourtant, les connaissances sur ce sujet restent limitées. L’exploitation conjointe de plusieurs bases de données apparaît comme une solution pour mieux représenter la complexité des situations de travail avec polyexposition par utilisation d’informations complémentaires.Ce projet vise à développer et appliquer une méthodologie d’analyse croisée de dix bases de données françaises en santé au travail afin d’orienter la recherche sur la prévention des polyexpositions professionnelles. Il s’articule en trois grands axes : (1) la documentation, pour rassembler les informations nécessaires à la compréhension du sujet comme les effets des polyexpositions professionnelles sur la santé ou encore les caractéristiques des bases de données utilisées ; (2) la conception d’une méthodologie intégrant des données hétérogènes via une ontologie de référence et une harmonisation préalable ; (3) l’application de cette méthodologie à travers quatre études de cas proposant différents niveaux d’analyse.Cette approche méthodologique constitue un cadre prometteur pour analyser la complexité des situations de travail et ouvre des perspectives pour la prévention des polyexpositions, en soulignant la nécessité de prise en compte des différences entre les sexes et les métiers, d’enrichir les données et les études épidémiologiques, et d’explorer des stratégies innovantes pour faire évoluer les pratiques vers une approche plus globale et réaliste de la santé au travail
Food addiction severity is associated with decreased functional connectivity and responses to palatable food pictures in brain areas involved in emotion and cognitive control
No full textInternational audienceBackground & AimsPatients with obesity frequently report impulsivity or loss control of food intake, reflecting the dysfunction of brain regions involved in reward and cognitive control processing related to food addiction (FA). Functional magnetic resonance imaging (fMRI) may help to identify the cognitive processes underlying FA. In patients with obesity, we aimed at identifying (i) fMRI specific responses in brain regions involved in hedonic and motivational processes (striatum), and cognitive control (e.g. prefrontal cortex) according to FA severity; (ii) whether FA severity is related to anxiety and/or depression symptoms.MethodsIn this prospective, observational, monocentric study, forty women with moderate or severe obesity were recruited. FA was diagnosed with the Yale Food Addiction Scale (YFAS) 2.0. Binge Eating Scale (BES), and Hospital Anxiety and Depression Scale (HADS) was also completed. One fMRI session that included fMRI and resting-state fMRI (rsfMRI) assessed brain responses to palatable food images and functional connectivity. Statistical analysis included general linear model analysis and multivariate parametric statistics.ResultsTwenty-three (57.5%) of the 40 included patients suffered from FA; Mean (± standard deviation) age, 36.6±8.6 yr; Body mass index, 39.2±2.9. In the food task condition, both low and high appetizing images activated similar brain regions, and FA severity was associated with reduced activation in the dorsal striatum and pre-central gyrus for high appetizing images (cluster: pFWE<0.05 family-wise error correction; peak: p<0.001 uncorrected). In the resting-state condition, FA severity correlated negatively with functional connectivity (FC) between several brain regions, such as the anterior cingulate cortex and left accumbens, and positively with FC between the left amygdala and hippocampus (cluster/connection: pFDR<0.05, false discovery rate correction). FA severity was associated to higher binge eating, but not anxiety and depression symptoms.ConclusionBrain profiles of patients with obesity are related to FA severity. FA severity is associated with impaired cortico-striatal functional connectivity between brain regions involved in motivation, decision-making and inhibitory control. Interindividual variability in brain responses suggests that dedicated therapeutic strategies might be helpful for obese patients with FA
Data linkage between the French multiple sclerosis cohort (OFSEP) and the French national health insurance database (SNDS)
No full textInternational audienceBackground: Linking disease registries to nationwide healthcare administrative databases increases the research opportunities. Recent guidelines emphasize the need of transparency in this process.Objective: Our aims were to describe the process of record linkage between the French multiple sclerosis (MS) cohort (OFSEP) and the national health insurance database (SNDS) and to evaluate the linkage quality.Methods: As no unique identifier was available in the two databases, the OFSEP-SNDS data linkage was performed by indirect matching using the following sixteen patient variables to create a unique key: sex, dates of birth and death, of visits to a neurologist, of MS-related hospitalizations, of MRI, and use of disease-modifying therapies. Three indicators were computed to assess the linkage quality.Results: Among the 52,034 eligible patients in the OFSEP registry, 42,603 (81.9%) were matched with patients in the SNDS database, with good overall quality (robustness=3.19; this is the number of linkage variables that can be removed without losing the uniqueness of the linked pair; 87.8% of common information). Comparison of the linked and unlinked populations revealed no major selection bias regarding age and sex distributions.Conclusion: The successful linkage of more than 40,000 patients with MS broadens the research perspectives by allowing access to a wide range of clinical and administrative data (e.g., comorbidities, care pathways) over a long mean disease duration (> 15 years)