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Response to comment on “Do we need flexible machine-learning algorithms to assess the effect of long-term exposure to fine particulate matter on mortality?”
No full textAssessing equity in effects of nutritional supplementation for child growth, development, and anemia
No full textInternational audienceAbstract Undernutrition in early childhood causes stunted growth, cognitive delays, and anemia, with effects often magnified among children from the poorest households. Small-quantity lipid-based nutrient supplements (SQ-LNS) are effective in addressing undernutrition and improving child development. As momentum builds to scale up SQ-LNS for children aged 6-24 months in the Global South, a key concern is achieving equity in its distribution and outcomes. We performed equity analysis of individual participant data from 14 randomized controlled trials in nine countries (N=37,707 children) to assess SQ-LNS effects on child growth, development, and anemia across levels of an international wealth index. Benefits of SQ-LNS were consistent across the wealth spectrum, leading to similar improvements in child growth, development, and anemia regardless of wealth. However, such equal benefits of SQ-LNS did not erase large inequities in child growth and development between the poorest and wealthier households
Les politiques de jeunesse
No full textInternational audienceL’enjeu de la jeunesse est inlassablement mis à l’agenda à chaque crise économique ou retournement de la conjoncture, qui nous rappellent que les jeunes sont particulièrement vulnérables, que ce soit en matière de chômage ou de pauvreté notamment.L’État est appelé à mettre en place des politiques publiques pour pallier ces difficultés. Or, ce que l’on appelle les « politiques de jeunesse » sont particulièrement nombreuses, hétérogènes et complexes. Quoi de commun en effet entre le service civique, les sports et loisirs, Parcoursup et le Contrat d’engagement jeune ? Quels sont les enjeux liés aux politiques de jeunesse ? Et comment comprendre le mille-feuille des dispositifs existants ?Tom Chevalier et Patricia Loncle dressent un état des lieux des politiques de jeunesse, éclatées entre des secteurs institutionnels, des échelles d’action publique et des acteurs très différents. Ils s’interrogent non seulement sur les contours et le périmètre de ces politiques, mais aussi sur ses formes, ses modalités de mise en œuvre et ses effets sur les jeunes eux-mêmes
Plant species richness, green spaces, and preterm birth risk in urban areas
No full textInternational audienceBackgroundGrowing evidence suggests that urban biodiversity may influence human health, though this relationship remains incompletely understood. While green spaces have shown beneficial effects on birth outcomes, the specific role of plant species richness has not been investigated in relation to preterm birth (PTB, <37 weeks’ gestation).MethodsUsing Kaiser Permanente Southern California electronic health records (2015–2021), we analyzed 232,452 births to examine associations between plant species richness and PTB. Plant species richness was assessed at the maternal neighborhood level, defined using circular buffers of 1.5 km around maternal residences.ResultsWe found that increased plant species richness was associated with decreased PTB risk (adjusted odds ratio per interquartile range: 0.959, 95 % CI: 0.941, 0.977). The observed association persisted after further adjustment for multiple green space indicators. The proportions of mediation effects attributable to mean temperature during pregnancy ranged from 7.0 % to 7.8 % across plant species diversity indicators. In the subgroup analysis, plant species diversity demonstrated significantly stronger protective associations against PTB among mothers exposed to higher levels of Ozone, high ambient temperatures, and those gave birth during the pandemic period. Conversely, protective associations were more pronounced among mothers with lower NO2 exposure during pregnancy. Notably, the significant relationship between plant species richness and reduced PTB persisted in pandemic-period analyses after adjusting for COVID-19 infection during pregnancy.ConclusionsOur findings highlight a complex interplay of sociodemographic and environmental factors influencing PTB risks and underscore the critical need for public health interventions that consider the unique attributes of urban green space
Le bilan carbone : outil de conformité, de connaissance ou de passage à l’action ? Une étude exploratoire dans les établissements de santé
No full textInternational audienceMalgré le consensus autour de la nécessité de réduire nos émissions de gaz à effet de serre (GES), l’obligation, légale en France depuis 2010 pour les grandes entreprises et organisations publiques, de réaliser un bilan de ces émissions, est loin d’être remplie par toutes, sans que les causes de cette faible conformité soient entièrement claires. Le système de santé est concerné de façon particulière par les enjeux climatiques : d’un côté, ses émissions représentent une part non négligeable des émissions totales du pays, de l’autre, son activité (la demande de soins) est très sensible au réchauffement climatique et une augmentation de cette demande doit donc être anticipée. Face à ce double constat, la décarbonation des organisations de santé apparaît revêtir un enjeu particulier. Pourtant, ces dernières respectent aussi peu l’obligation de réalisation d’un bilan des émissions de GES que les autres organisations.Notre étude exploratoire auprès de cadres gestionnaires et dirigeants d’organisations de santé vise à appréhender la façon dont le bilan carbone est perçu et expérimenté. Elle montre que celui-ci, en cohérence avec la littérature existante, apparaît relativement peu maîtrisé et complexe à mettre en œuvre. Mais elle met aussi en avant les ambiguïtés d’une obligation réglementaire paradoxalement peu incitative, voire « désincitative ». Elle souligne enfin la dimension équivoque de l’outil et la façon dont il peut pâtir du fait d’être perçu comme un outil de connaissance bien plus que comme un outil opérationnel de passage à l’action
Immune Tolerance Induction With a Recombinant Factor VIII Fc in Haemophilia A: Data From a Chart Review Study
No full textInternational audienceObjective: To report data from an ITI chart review study (NCT03951103) for first-time and rescue ITI with recombinant factor VIII Fc fusion protein (rFVIIIFc) in persons with haemophilia A.Methods: Retrospective and prospective real-world data are reported from a non-interventional, multicentre study of patients who had been or were currently being treated with rFVIIIFc ITI. ITI treatment outcome (defined by investigators) and regimens are reported.Results: Forty-one patients from 16 sites were included. First-time ITI was used in 24 patients; 16 had an ITI outcome at study end. Thirteen patients (81.3%) had ITI success, and three had failure. Median (range) rFVIIIFc consumption was 300 (61-2800) IU/kg/week, and most (70.8%) used ≤ 300 IU/kg/week. The vast majority of patients (87.5%) received less than daily ITI. Rescue ITI was used in 17 patients; 16 had an ITI outcome at study end. Eight patients (50.0%) had ITI success/partial success, seven had failure, and one withdrew early. Median (range) rFVIIIFc consumption was 536 (98-1435) IU/kg/week; 35.3% used ≤ 300 IU/kg/week and 52.9% used > 500 IU/kg/week. Most patients (64.7%) received daily ITI.Conclusion: ITI with rFVIIIFc is likely to be successful in first-time ITI patients and is an effective option for those who have previously experienced ITI failure.Trial registration: ClinicalTrials.gov identifier: NCT03951103
How Do Neurocognitive Tests Relate to Reported Child Difficulties at 6 Years of Age in Benin?
No full textInternational audienceObjective: The aim of this study was to examine the relationship between children's difficulties perceived by parents in the Ten Questions questionnaire (TQ) and children's assessments by the Kaufman Assessment Battery for Children, Second Edition (KABC-II) and the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2).Methods: The study was carried out in the district of Allada, a semi-rural area of Benin, involving a cohort of 562 6-year-old children. A response was considered positive if the parent reported a difficulty for their child compared to other children.Results: The proportion of TQ-reported difficulties was 34.2%. More difficulties were reported by parents when their child had lower scores on the KABC-II (p < 0.001) and on the BOT-2 (p < 0.01). Greater family wealth, higher maternal education, and better child school attendance were associated with higher KABC-II Mental Processing Index (MPI) scores, higher BOT-2 scores, and fewer reported difficulties on the TQ. The likelihood of parents reporting difficulties was ˃60% when KABC-II MPI scores were low. When considering the KABC-II as the gold standard to define mild delays (mean minus 1 SD), the TQ demonstrated a sensitivity of 51.0% and specificity of 69.4%, which increased to 58% and 72%, respectively, when children attended school.Conclusion: Objective assessments of children's abilities were associated with parents' perceived difficulties. In a low-resource rural setting in sub-Saharan Africa, the TQ is a useful tool for screening neurodevelopmental difficulties, particularly for children attending school
The role of standardized management practices in improving quality of care: Evidence from healthcare chains
No full textThe theme for EHMA 2025 : Taking action to improve health for all.International audienceQuality of care is of paramount importance for private sector hospitals to differentiate their supply of care. Amongst the debated strategies to achieve this goal is the sharing of managerial practices (Bloom & Sadun, 2014; McConnell et al., 2013). In fact, healthcare organizations worldwide have largely engaged in cooperation and networking behaviours during the last decades, mainly through mergers. As such, networks owned by private-equity funds now dominate healthcare industries in most developed countries. They rely on standardized management practices across their facilities in order to improve their efficiency. These include standardizing the use of medical consumables between facilities and centralising their purchasing, optimizing the use of staff and premises, as well as developing centralized ancillary services and amenities (e.g., private rooms, premium catering, internet access) that generate additional revenues.Although hospital mergers are often driven by the goal of rationalizing resources and reducing costs (Craig et al., 2021; Schmitt, 2017), their impact on quality of care remains debated. A recent systematic review by Mariani et al. (2022) highlights that mergers produce mixed results in terms of quality of care. Moreover, whilst the role of standardized managerial practices has been largely overlooked, healthcare networks have been the subject of growing criticisms. These networks frequently rely on leveraged buyouts (LBOs) to finance external growth, pushing them to prioritize rapid profitability in newly acquired facilities. This financial pressure can sometimes compromise the quality of care provided. For example, in 2022, France’s leading nursing-home group, ORPEA, faced a major scandal when managerial practices, designed and enforced by the network’s top management, were linked to mistreatment of residents across its facilities.Our research attempts to clarify the link between standardization of managerial practices via network integration and quality of care by examining: whether network integration improves quality of care (H1), whether network integration fosters the standardization of managerial practices (H1a), and whether standardized managerial practices improve quality of care (H1b). To do so, we design a mixed empirical study on the French private hospital sector, where networks hold most of the market. Firstly, we rely on data from the French National Health Data System (SNDS) to examine how being integrated to a network may impact quality of care (e.g., hospital occupancy rates, readmission rates, average length of stay) through a Difference-in-Differences (DiD) method. Then, we rely on a series of qualitative semi-directive interviews with professionals from hospital networks (e.g., Head of Quality and Risk Management, Head of Information Systems, Head of Purchasing) or managers from merged hospitals to explain the role of management practices standardization in improving quality of care
Exploring boundary conditions of physical activity maintenance: A secondary analysis of time-series data from a weight-loss intervention
No full textInternational audienceObjective: A key concept in health psychology is behavioral maintenance. However, previous research has struggled to establish shared conceptualizations and operational definitions. This study aimed to contribute to this debate by examining whether a simple conceptual proposition of physical activity maintenance as 'the performance of physical activity according to an intended target threshold over a specific period of observation' can be empirically supported, and under which boundary conditions. Specifically, we explored different formulations of two boundary conditions: activity threshold and timescale of change.Methods: We analyzed 350 time series (length = 182 days) of moderate-to-vigorous physical activity (MVPA) collected daily with Fitbit from participants in a weight loss intervention. All participants reported an intention to engage in at least 150 min of MVPA per week over the following six months. Activity thresholds were defined based on each participant's baseline MVPA. Generalized Additive Models were used to model individual trajectories across varying timescales (7, 14, 28, and 56 days).Results: At short timescales (7-14 days) trajectories crossed the threshold frequently, indicating high variability. At longer timescales (28-56 days) trajectories were more stable, with participants tending to stay either above or below their threshold, aligning with our target conceptualization of maintenance. Relaxing the threshold by 10-20% relatively increased the proportion of participants classified as maintainers, though maintenance remained uncommon for participants with higher thresholds.Conclusions: Our findings provide initial evidence on which boundary conditions support detecting physical activity maintenance as conceptually defined. These results underscore the importance of systematically testing boundary conditions to advance understanding of behavioral maintenance.Trial registration: ClinicalTrials.gov identifier: NCT03907462
#134 The evolution of consultation practices with general practitioners and nephrologists for patients with CKD before and after the COVID-19 pandemic in France
No full textInternational audienceBackground and AimsThe COVID-19 pandemic led to concerns about disruptions in the care of chronic diseases, including chronic kidney disease (CKD). The aim of this study was to assess the immediate and short-term consequence of the COVID-19 pandemic on consultation practices for patients with CKD who did not have kidney replacement therapy in France.MethodWe used the French National Health Data System (SNDS) that contains healthcare data of the whole French population. A validated algorithm was applied within the SNDS to identify two cohorts of patients: i) a 2019 cohort including individuals exposed to the COVID-19 pandemic and ii) a 2017 cohort including individuals unexposed to the pandemic. We followed these cohorts for 2 years and divided the follow-up in eight periods according to the lockdown periods in France during the pandemic. The percentage of patients who had at least one GP and nephrologist consultations in each period was compared between cohorts. For each period, the sum of person-time alive was calculated and used as denominator in order to neutralize the effect of death.ResultsWe identified 4,866,096 and 5,089,706 individuals with CKD in 2017 and 2019, respectively. The characteristics of individuals were similar (mean age = 62 years in the 2017 cohort and 63 years in the 2019 cohort). In the 2019 cohort, 94 % had at least one consultation (in-person or teleconsultation) with a GP and 6.3 % had at least one consultation with a nephrologist during the first year of follow-up (vs 95.2% and 6.4% in the 2017 cohort). Teleconsultations did compensate a deficit of in-person GP and nephrologist consultations throughout the acute periods of the pandemic in 2020 and 2021 (40.5% of patients in the 2019 cohort had at least one GP consultation in-person and 52.5% an in-person or tele-consultation during the period of the first lockdown). The analyses stratified by age and sex did not show differences in GP or nephrologist consultation rates between cohorts.ConclusionIn France, outpatient healthcare use remained stable for individuals with CKD during the 2 years following the COVID-19 pandemic, with minimal changes in consultation rates with GPs and nephrologists. Indeed, thanks to teleconsultations, the yearly proportion of patients with at least one consultation with a GP or nephrologist did not change much between cohorts