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Management des organisations de santé: De la théorie à la pratique
No full textInternational audienceLes organisations de santé ont joué un rôle majeur pendant la pandémie. Pourtant, beaucoup qualifient les hôpitaux comme étant en crise.Savons-nous vraiment ce qu’est une organisation de santé ? un hôpital ? un réseau de soins à domicile ? savons-nous gérer et coordonner tous ces services entre eux ? comment faire en sorte que le patient revienne au centre des organisations de santé ? et est-ce nos organisations de santé sont adaptées aux défis de demain : le changement climatique et l’intelligence artificielle ?Autant de questions que cet ouvrage propose d’explorer à travers des théories et des cas d’études actuels prenant le soin de comparaisons avec d’autres pays. De plus aujourd’hui, les livres sur ce sujet ne répondent pas complètement aux besoins des professionnels de santé, ni aux grandes questions sur l’avenir du système de santé. L’ouvrage mettra ainsi l’accent sur des aspects innovants des transformations du système de santé : l’écoresponsabilité des organisations de santé, la place et le rôle du patient expert dans la gestion des parcours et dans la recherche clinique, l’usage de nouvelles technologies pour la coordination des parcours et la réalisation des soins
Politiques sociales et de santé: Comprendre et agir
No full textInternational audienceComprendre les politiques sociales et de santé suppose une vision d’ensemble, à la fois transversale et thématique. C’est ce que propose cet ouvrage, en articulant approches pluridisciplinaires (science politique, santé publique, sociologie, économie…) et savoirs professionnels.Loin d’un simple inventaire juridique, il éclaire les enjeux, les orientations et les acteurs de ces politiques.Cette 4e édition, entièrement actualisée, s’enrichit de chapitres sur la lutte contre les discriminations, la santé au travail ou encore la santé environnementale. Elle conserve la spécificité d’aborder conjointement politiques sociales et de santé, pour mieux en révéler les synergies.Conçu comme un ouvrage de référence, il s’adresse aux étudiants (université, IEP, écoles du travail social, concours de la fonction publique,…), aux enseignants, ainsi qu’à toute personne souhaitant actualiser ou approfondir leurs connaissances
The influence of minerals and cations contents on carbon sequestration in temperate French forests’ soils, and their effects on carbon dynamics
No full textInternational audienceAssociation of organic matter (OM) with mineral phases have been identified as one important process to explain organic carbon sequestration in soil. Associations include cationic bridging between OM and mineral surfaces, OM adsorption on mineral surface, and OM co-precipitation with minerals. Some recent studies underlined the crucial role of poorly crystalline aluminium (Al) and iron (Fe) oxides to sequestrate organic carbon. These findings have been mostly observed so far at a global or continental scale. Moreover, the links between soil mineralogy and geochemistry and carbon are still unclear, given the time span needed to unveil them.The aim of the study is to verify if relationships between geochemical parameters and soil carbon content are still noticeable at the scale of the French European territory, in temperate forests covering a wide range of soil types. Taking advantage of a double inventory of soil organic carbon at a 15-year interval, we further aim to assess if a relationship exists between soil geochemical parameters and C dynamics over a decade. In this forest monitoring network of 102 sites across mainland France (RENECOFOR) three soil depths were analysed at each campaign: 0–10, 10–20, 20–40 cm. The particulate organic carbon (POC) fraction proportion of the 0–10 cm soil depth was known for 53 sites for the second campaign. The mineral-associated organic carbon (MAOC) content could be therefore inferred.The soil carbon content was linked to the oxalate-extractable Al and Fe (Alox and Feox) at each of the three depths. The relation with the MAOC content of the 53 sites subset was also highly positively correlated. The cation content (exchangeable calcium and magnesium, Caex and Mgex) showed a positive effect on carbon content for a subset of the sites. These had a higher pH and were mainly located on alkaline parent rocks. However, the stock change was mainly unaffected by neither minerals nor cation content, or by other soil characteristics
Perceptions of health-related quality of life among heart transplant recipients: a qualitative study [preprint]
No full textInternational audienceBackground: There is a need to improve knowledge of the health-related quality of life (HRQoL) in the post-heart transplantation (HTx) period and the factors affecting it. This qualitative study aimed to identify the most important domains of HRQoL for heart transplant recipients and the factors that impact it. Methods: This was a qualitative study across 5 geographically diverse large HTx centers in France from July 2022 to January 2023. We gathered a purposive sample of individuals who had undergone HTx. A face-to-face semi-structured interview guide was used for individual interviews. All interviews were audio-recorded and transcribed verbatim. Results:A total of 14 individuals (10 men) were interviewed. The data analysis led to the development of 8 main themes (with sub-themes) that were relevant to participants: HRQoL perception (mental health, physical capacity, symptoms and comorbidities), participants’ experience during the HTx process, immunosuppressive treatments, relationship with the healthcare team, external and internal resources, socio-economic aspects and feelings about the donor. Recipients, spontaneously made connections between these themes. Conclusions:Heart transplant recipients had diverse perceptions of their HRQoL in the post-HTx period. The rich variety of themes identified from the review highlights that recipients have a complex HRQoL profile which is not currently captured by standard HRQoL tools that are commonly employed. These aspects should be taken into account in the clinical follow-up and in the selection of the most appropriate Patient Reported Outcome Measures (PROMs)
Chlordecone in indoor dust and associated human exposure in the French West Indies
No full textChlordecone (CLD) is an organochlorine pesticide with various toxicities, widely used from 1972 to 1993 in the French West Indies lands (FWI, Guadeloupe and Martinique). It can remain in environment leading to indoor contamination by pollutants coming from outside. Therefore, investigating indoor pollutants is necessary due to the potential indoor dust ingestion though hand-to-mouth contact, in particular for children. No chemical analytical methods measure CLD in indoor dust and we propose to investigate its presence in this specific compartment, in Martinique. CLD was analyzed from dust samples taken from homes and schools (n=47). Pressure liquid extraction (PLE) with the most suitable mixture solvent of hexane and ethyl acetate (85:15) allowed to extract CLD from dust followed with gas chromatography coupled to tandem spectrometry (GC/MS/MS) analysis. A sampled mass of 25 mg optimal for analysis.. Concentrations of CLD in indoor dust varied from < 16 to 247 ng/g. Exposure to CLD through indoor dust ingestion was assessed too and does not exceed 1.5% and 0.1%, of the acceptable daily intake, in childrens and adults, respectively. However, this exploratory study was conducted on a very limited number of dust samples, not representative of the French West Indies population.</div
Effects of Multiple Wildfire Smoke Pollutants (PM 2.5 , PM 10 , and Ozone) on Respiratory and Cardiovascular Hospitalizations in California (2006–2019)
No full textInternational audienceAbstract The intensity and frequency of wildfire events in the United States are increasing, with wildfire emissions serving as a major contributor to air pollution, particularly through airborne particulate matter and ground‐level ozone (O 3 ). Wildfire smoke detrimentally impacts human health, and evidence has shown that wildfire fine particulate matter (PM 2.5 ) might be more harmful than other sources of PM 2.5 for respiratory conditions. Epidemiological research on health effects of wildfire smoke has mainly focused on PM 2.5 and there is limited evidence on the impacts of particulate matter less than or equal to 10 μm in aerodynamic diameter (PM 10 ) and O 3 . PM 2.5 , PM 10 , and O 3 might have differential effects on human health based on the source of emissions (smoke vs. non‐smoke air pollution). Here, we first quantified the contribution of wildfires to PM 10 and O 3 concentrations in California, USA for years 2006–2019, using a statistical modeling framework. R 2 for our PM 10 predictive model ranged between 0.68 and 0.78 for prediction using testing and all monitoring sites involved, respectively. Similarly, R 2 values for our ozone predictive model ranged between 0.78 (hold‐out sites) and 0.89 (all sites). Second, we quantified the short‐term impacts of wildfire‐specific PM 10 and O 3 concentrations, along with wildfire‐specific PM 2.5 , on hospital admissions for respiratory and cardiovascular illnesses during three different time periods and at various spatial extents (all California ZIP codes and regional analyses). We found heterogeneous effects of wildfire smoke pollutants on different health outcomes and across different regions and periods considered in our study
Exposition aux substances per- et polyfluoroalkylées (PFAS) et santé cardiométabolique des préadolescents
No full textThis thesis explores the impact of per- and polyfluoroalkyl substances (PFAS) on children's cardiometabolic and liver health, using data from the PELAGIE mother–child cohort. Three studies were conducted using clinical data collected at age 12, considering PFAS exposure during two key windows: the prenatal and peripubertal periods. A wide range of biomarkers was analyzed, including anthropometric, lipid, glycemic, hormonal, and hepatic indicators. The results highlight sex-specific and puberty-dependent associations, with more favorable metabolic profiles linked to prenatal PFAS exposure among post-menarche girls, and less favorable profiles observed in prepubertal boys and pre-menarche girls. The third study revealed that the liver may be a key target of PFAS, with distinct effects by sex. These findings emphasize the importance of considering both developmental timing and sex in evaluating the health impacts of early-life environmental exposures.Cette thèse s’intéresse aux effets des substances per- et polyfluoroalkylées (PFAS) sur la santé cardiométabolique des enfants, à partir de la cohorte mère-enfant PELAGIE. Trois études ont été menées à partir de données cliniques recueillies à l’âge de 12 ans, combinant des mesures d’exposition aux PFAS à deux périodes sensibles : la période prénatale et la période péripubertaire. L’analyse porte sur un large panel d’indicateurs cardiométaboliques et hépatiques : données anthropométriques, marqueurs lipidiques, glycémiques, hormonaux et enzymes hépatiques. Les résultats révèlent des associations différenciées selon le sexe, le statut pubertaire et le moment de l’exposition. Chez les filles post-ménarche, certaines expositions prénatales sont associées à des profils métaboliques plus favorables, tandis que des profils plus défavorables sont observés chez les filles préménarches et les garçons prépubères. Enfin, l’étude hépatique met en évidence une sensibilité particulière du foie aux PFAS, avec des réponses divergentes selon le sexe. Ces travaux soulignent l'importance d’étudier les effets des expositions environnementales précoces sur la santé des enfants, en tenant compte du moment de l’exposition et des caractéristiques développementales
Time to Care : Reimagining the homecare model
No full textThe theme for EHMA 2025 : Taking action to improve health for all.International audienceContext: In a context of persistent challenges facing the homecare sector which include staff shortages, poor working conditions and undervaluation of care work, a French association inspired by the Dutch Buurtzorg model has implemented a new homecare approach for nurses. Buurtzorg-France homecare nurses working in self-managed teams have experimented an hourly payment scheme, replacing the current fee-for-service (FFS). Using Joan Tronto's care ethics framework, this study investigates how this innovative organizational model reshapes nursing practices and patient outcomes. The study focuses on the interplay between organizational values, payment reform and nurses' professional autonomy to assess how structural incentives facilitate the practice of holistic care. We explore how the model supports and encourages holistic care by cultivating a favourable working environment that recognizes the value of caregiving.Methods: A longitudinal qualitative study was conducted between 2017 and 2023 to examine the French adaptation of the Buurtzorg model. 63 semi-structured interviews and 185 hours of shadowing and observation of homecare nurses were conducted capturing caregiving activities, team dynamics and patient interactions. Interviews were transcribed and analysed using thematic analysis in NVivo, followed by a secondary analysis based on Tronto's framework to identify caregiving phases and alignments with ethical values. Data triangulation ensured reliability and a comprehensive understanding. We obtained informed verbal consent, maintained anonymity and assigned pseudonyms.Results: The results reveal a "virtuous cycle of caring," driven by incentives resonating with nurses’ ethical values and enabled by the hourly payment scheme. Previously constrained by the fee for service payment limitations, nurses were now empowered to provide relational, preventative and holistic care. Observations demonstrated enhanced patient autonomy, improved continuity of care and meaningful rapport-building. Nurses reported increased job satisfaction due to reduced time pressure and an alignment with their professional ethics. Organizational support including an assigned coach, continuing education, a performant IT system and teamwork facilitation further contributed to improving their work-life quality. As the hourly payment scheme is generalized, we raise attention to the fact that the success of this payment reform depends on its integration within the Buurtzorg organizational model. Our results underscore the importance of nurturing a values-driven care ecosystem to sustain improvements in care quality and workforce retention.Discussion: This study highlights the role of an organizational structure focused on work-life quality and an hourly payment scheme to improve nurse job satisfaction and address the undervaluation of care work. By aligning the payment model with nurses’ ethical values, Buurtzorg-France fosters relational caregiving, accountability and patient-centred practices. Placing the spotlight on autonomy, teamwork and holistic care allows nurses to practice with integrity while enhancing patient outcomes and reducing systemic inefficiencies. However, scaling this model nationally will necessitate safeguarding its foundational principles because financial incentives alone will be insufficient. The payment scheme must be accompanied by a supportive organizational model and ecosystem that legitimizes caregiving as an essential societal contribution. This study therefore seeks to contribute to a broader discourse on the societal value of caring, urging policymakers to embed care ethics in healthcare reforms
Hair of the herd: cattle hair as a sentinel for human exposure to pesticides
No full textInternational audienceVarious contaminants such as pesticides, antiparasitic for animal care and biocides within buildings are used on dairy farms, many of which are suspected of being reprotoxic, neurotoxic, immunotoxic, or endocrine-disrupting[1]. This study aims to assess whether cattle hair can serve as a proxy for characterizing the chemical exposome of female dairy farm workers in France, through a non-targeted (NTA)/suspect screening (SS) analysis based on high-resolution mass spectrometry (HRMS)[2]. A method for detecting a broad panel of compounds in cattle hair using liquid chromatography-tandem mass spectrometry with electrospray ionization (UHPLC-ESI-HRMS) is under development to ensure sensitivity and robustness of the NTA/SS approaches. Cattle hair was sampled at the forehead (cowlick) from five different species (prim'holstein, normande, montbéliarde, pied rouge and jersiaise) and underwent washing, grinding, solvent extraction and evaporation, before analysis. Statistical analyses will also be performed to evaluate the effect of race and the washing procedure on cattle hair. The expected results will provide insights into how cow breed influences contaminant levels in hair, on the importance of a washing step before analysis to remove fecal residues, and the pertinence of non-targeted analysis for keratinous matrices. Finally, relative quantification of the detected compounds in cattle hair compared to human concentration levels from the literature, will be performed. This study will assess whether cattle hair can serve as a reliable indicator of the chemical exposome of female farm workers, and hence potentially be used as a matrix for occupational exposure. [1]Baldi, I.; Cordier, S.; Coumoul, X.; Elbaz, A.; Gamet-Payrastre, L.; Lebailly, P.; Multigner, L.; Rahmani, R.; Spinosi, J. Pesticides: Effets sur la santé; Rapport de recherche; Institut national de la santé et de la recherche médicale(INSERM): Paris, 2013; p 1014.[2]Chaker, J.; Gilles, E.; Léger, T.; Jégou, B.; David, A. From Metabolomics to HRMS-Based Exposomics: Adapting Peak Picking and Developing Scoring for MS1 Suspect Screening. Anal. Chem. 2021, 93 (3), 1792–1800. https://doi.org/10.1021/acs.analchem.0c04660
Rendre visibles les nappes : croisement entre modélisation hydrogéologique et perceptions sociales du risque
No full textNational audienceDans le contexte du changement climatique, les inondations par remontée de nappe représentent un risque encore peu visible, peu compris, et insuffisamment intégré aux politiques territoriales d’adaptation. Le programme de recherche pluridisciplinaire Rivages Normands 2100 propose d’en explorer les dimensions à la fois géoscientifiques et socio-politiques, en croisant modélisation hydrogéologique et recherche sociologique. Il s’intéresse à la manière dont ces risques modélisés sont perçus, représentés et discutés par les acteurs locaux (élus, techniciens et gestionnaires) et avec les scientifiques.Cet aléa échappe aux perceptions immédiates des risques environnementaux et met à l’épreuve les représentations cartographiques classiques. Contrairement aux submersions marines ou à l’érosion côtière ou aux débordements des cours d’eau, les remontées de nappes sont diffuses, invisibles et difficilement spatialement circonscrites. Si les cartes issues des modèles intègrent des paramètres complexes et des incertitudes climatiques, les acteurs locaux eux s’appuient sur des repères empiriques et concrets, fondés sur leur vécu du territoire. Cet écart entre abstraction scientifique et perception sociale constitue un obstacle à l’appropriation des connaissances, accentué par la faible acceptabilité de l’incertitude dans le débat public.Les dispositifs participatifs mis en œuvre (ateliers cartographiques, entretiens, réunions publiques) ont permis d’interroger ces perceptions et de créer des espaces de traduction entre savoirs experts et savoirs situés. Ces échanges révèlent comment les cartes et les modèles ne sont pas seulement des outils techniques, mais aussi des objets médiateurs, catalyseurs de controverses ou supports de négociation entre les différentes perceptions du risque. La confrontation entre savoirs scientifiques, décisions politiques et expériences locales montre comment les connaissances sur le risque environnemental se discutent et se construisent dans des rapports de pouvoir inégaux. Cette communication propose une lecture interdisciplinaire de la médiation autour d’un risque hydrologique, en mobilisant à la fois les sciences de la Terre et la sociologie de l’environnement. Elle met en lumière les conditions sociales, cognitives et politiques de circulation des savoirs sur les eaux souterraines, en insistant sur la nécessité de formes coopératives et réflexives de gouvernance du risque