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The role of instrument constituencies in policy change: the case of primary care reform in France
No full textTitre du Panel : "Mechanisms of Policy Change in Health and Social Care Reform"International audienc
Treated and untreated maternal prenatal mental health difficulties and neurodevelopmental outcomes in early childhood: results from the ELFE cohort
No full textV1 under reviewSubmitted to BJOG: An International Journal of Obstetrics and GynaecologyObjective: To assess the impact of prenatal psychotropic medication use on children’s neurodevelopmental outcomes. Design: Prospective observational study Setting: Maternity clinics Population: ELFE birth cohort (N=18,329) children who were unexposed to maternal mental health difficulties during pregnancy (MHD) (n=15,519), exposed to MHD (n=1,980), or exposed to prenatal psychotropic use (PPU) (n=242) Methods: Mothers reported their MHD and PPU at birth and covariates were collected at birth, two months, and one year postpartum. Inverse probability weighting based on multinomial propensity scores adjusted for a wide range of perinatal, socioeconomic, partner and healthcare system support, and family history confounders. Potential moderation by child sex, maternal education, and migration background was tested. Main Outcomes: Child Autistic traits were evaluated at 2 years using the Modified Checklist for Autism in Toddlers (M-CHAT) and general development at ages 3.5 and 5.5 years was evaluated using the Child Development Inventory (CDI). Results: PPU exposure was not associated with children’s M-CHAT, while MHD Exposure without PPU was significantly associated in both crude and weighted regressions. At 3.5 years, crude models showed lower CDI scores for children of MHD Exposed and PPU-exposed mothers compared with unexposed children, but all associations became non-significant after weighting. No significant effects, across CDI subscales, were observed at age 5.5 years, nor in moderation analyses. E-values suggested results were highly sensitive to residual confounding. Conclusions: We found limited evidence for clinically meaningful associations between prenatal psychotropic medication exposure and early child neurodevelopment after accounting for various maternal, household, socio-economic, and family history confounders
Do French Local Youth Policies Still Fail to Address Gender Issues? Lessons From the RAJE Project
No full textInternational audienceThis article analyses the way in which gender issues are taken into account in the development of youth policies at a local level in France, and more specifically in three rural areas of Brittany. The study is being conducted through the “Recherche-Action, Jeunesses et Engagements” (RAJE) project, which has been running since January 2024. Involving decision-makers, youth workers and young people, it is an interesting field for understanding how gender issues emerge and are integrated on the youth policy agenda. Based on a collective narrative, this article both sheds light and questions the ways in which gendered subjectivities are interwoven with the engagement dynamics studied and experimented within the action-research. We analyze local situations in a reflexive and qualitative way, which allow us to formulate several hypotheses on the brakes and levers on putting gender issues on local policies’ agenda. Our work suggests that the gendered distribution of power in social contexts (both political and professional), the mechanisms of gender assignment, and the reproduction of heteronormative stereotypes are not only avenues of inquiry for our action-research, but also main ethical and political issues
Two-stage interrupted time series analysis with machine learning: evaluating the health effects of the 2018 wildfire smoke event in San Francisco County as a case study
No full textInternational audienceAbstract Randomized controlled trials (RCTs) are considered a key identification strategy for establishing causal relationships between exposures and outcomes. When evaluating the health impacts of extreme weather events, however, RCTs are generally infeasible due to ethical issues, costs, and the lack of a suitable control group. Quasi-experimental designs capitalizing on the timing of natural experiments, such as Interrupted Time Series (ITS), offer a valuable alternative to estimate causal effects when control groups are not available. This paper explores the application of a 2-stage ITS framework that compares traditional autoregressive integrated moving average (ARIMA) models and 2 machine learning algorithms: Neural Network Autoregressive (NNETAR) and Prophet-Extreme Gradient Boosting (XGBoost). As a case study, we assess the impacts of the 2018 wildfire smoke event on respiratory hospitalizations in San Francisco County, CA. We split the data into pre- and postevent periods to train and evaluate the models, perform cross-validation for hyperparameter tuning, and predict hospitalizations under the counterfactual scenario. Data and R code are provided for reproducibility. In the case study, the Prophet-XGBoost shows the best model performance and was used to generate the counterfactual trends. We estimate that the 2018 smoke event resulted in a total of 92 (95% empirical CI, 24-125) excess respiratory hospitalizations (12.5% of the observed hospitalization count during the event period). Our proposed approach offers a powerful tool for assessing the effects of extreme weather events and can be broadly applied to other epidemiological contexts, such as public health policy evaluation
L'engagement des salariés dans la transition écologique : les enseignements de deux enquêtes de terrain en CHU
No full textInternational audienc
It is time to consider the climate crisis in haematology
No full textInternational audienceClimate crisis (CC), pollution and destruction of biodiversity represent a major threat to present and future societies. Global pollution is the single largest cause of environmental deaths, with approximately 9 million premature deaths estimated per year..
Hiérarchisation des médicaments vétérinaires susceptibles de contaminer les eaux destinées à la consommation humaine en Bretagne
No full textInternational audienceThe continuous use of veterinary pharmaceuticals can represent diffuse and pseudo-persistent pollution in the environment. This is confirmed by the fact that veterinary pharmaceutical residues (VPRs) have been quantified in natural waters at concentrations ranging from ng/L to μg/L, thanks to improvements in analytical methods. In order to perform a monitoring study in Brittany, a region subject to high husbandry pressure, a ranking of veterinary pharmaceutical residues was carried out to select the veterinary pharmaceuticals that would be the most likely to reach the aquatic environment. A preliminary list of 70 veterinary drugs was considered based on the results of interviews conducted with veterinarians during the REMEDES project and on the results of the study of the Regional Health and Environment Plan Working Group 2. The ranking methodology developed aims to reflect the potential of VPRs to enter natural waters. Criticality groups have been established on the basis of three criteria: 1) the potential for entry into the environment, divided into animal targets, route of administration and veterinary practices in Brittany; 2) the mobility of molecules from soil to water; and 3) the persistence of compounds in natural waters. Metabolites were integrated when relevant. Fifty-four compounds out of the 70 studied were classified according to this methodology. Establishing a ranking method is currently a complex task for VPRs. There is still a significant lack of experimental data conducted under homogeneous conditions on the environmental fate of these compounds. Some families have been studied in depth, such as antibiotics like sulfonamides and tetracycline families, but data in the literature is scarce for others, such as antiparasitic drugs and anticoccidians, despite the fact that these veterinary drugs are widely used in breeding areas such as Brittany.L’utilisation continue de médicaments vétérinaires peut représenter une pollution diffuse et pseudo-persistante dans l’environnement. Ceci est confirmé par le fait que des résidus de médicaments vétérinaires (RMV) ont été quantifiés dans les eaux naturelles à des concentrations allant du ng/L au μg/L, grâce aux progrès des méthodes analytiques. Afin de réaliser une étude de suivi en Bretagne, région soumise à une forte pression d’élevage, une priorisation des médicaments vétérinaires a été réalisée pour sélectionner les médicaments vétérinaires les plus susceptibles d’atteindre le milieu aquatique. Une liste préliminaire composée de 70 médicaments vétérinaires, basée sur des enquêtes d’usage chez les vétérinaires (Projet REMEDES) et les résultats d’un Groupe de travail du Plan régional santé environnement 2 (GDT PRSE 2), ont été considérés. La méthodologie de hiérarchisation développée a pour objectif de refléter le potentiel d’entrée dans les eaux naturelles des RMV étudiés. Des groupes de criticités ont été établis sur la base de trois critères : 1) le potentiel d’entrée dans l’environnement, décomposé en fonction des cibles animales, de la voie d’administration et des pratiques vétérinaires en Bretagne ; 2) la mobilité des molécules du sol vers l’eau ; 3) la persistance des composés dans les eaux naturelles. D’autre part, les métabolites ont été intégrés quand cela était pertinent.Sur les 70 étudiés, 54 composés ont pu être hiérarchisés par cette méthodologie. L’établissement d’une méthode de priorisation est, à ce jour, une tâche complexe. Il y a encore un manque notable de données expérimentales menées en conditions homogènes sur le devenir environnemental de ces composés. Certaines familles ont fait l’objet d’études approfondies, comme les antibiotiques, dont les sulfonamides ou les tétracyclines, mais les données de la littérature sont rares pour d’autres familles comme les antiparasitaires ou les anticoccidiens. Pourtant, ces médicaments vétérinaires sont largement utilisés dans les zones d’élevage en Bretagne
Mieux intégrer les professionnels de santé réfugiés, dans l’intérêt de tous
No full texthttps://theconversation.com/mieux-integrer-les-professionnels-de-sante-refugies-dans-linteret-de-tous-249971Depuis le 5 mars, près de 300 praticiens à diplôme hors Union européenne (Padhue) exerçant en France ont entamé une grève de la faim pour demander leur régularisation. Si leur situation commence à être médiatisée, celle des soignants accueillis en France avec le statut de réfugié est encore moins connue, et probablement encore moins enviable. Explications
Testing for the zero‐altered Poisson distribution with positive data
No full textInternational audienceThis article proposes three new goodness‐of‐fit tests for the zero‐altered Poisson distribution, or equivalently for the positive Poisson distribution, based on positive data, that is, data truncated at 0, whose test statistic is built using a characterization of this law. It is shown that the proposed tests are consistent against any fixed alternative and that the parametric bootstrap method can accurately approximate their null distributions. The power of these tests is investigated through a large simulation study, where it is also compared with some existing tests, showing a very competitive behavior. Several applications to real datasets illustrate the usefulness of the tests