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[Exposition chronique aux nitrates et aux trihalométhanes dans l’eau potable dans la cohorte française CONSTANCES]
No full textInternational audienceTrihalomethanes (THMs) and nitrate are widespread chemicals in drinking water. Chronic exposure has been associated with increased cancer risk despite inconclusive evidence, partly due to the challenges in long-term exposure assessment and potential exposure misclassification. We estimated concentrations of nitrate and THMs in drinking water using a public regulatory monitoring database (SISE-Eaux) for CONSTANCES, a French population-based prospective cohort. We obtained 26,322,366 measurements of drinking water parameters from 2000 to 2020. We excluded missing, implausible and duplicated measurements; we corrected or imputed missing geocodes of sampling locations; we calculated the annual median concentration of nitrate and THMs by surveillance area. To predict missing annual median concentrations, linear mixed models with random intercept using surveillance area as a clustering variable were developed for each region for nitrate and the four THM components (chloroform, chlorodibromomethane, bromodichloromethane and bromoform) separately. Concentrations in the nearest surveillance area from the household were merged per year among 75,462 participants with residential history geocoded for 2000-2020. Estimated concentrations resulting from this approach were compared with measured concentrations in 100 samples collected in Paris, Rennes and Saint-Brieuc in 2021. Median annual concentrations of total THMs and nitrate at study participants’ homes for 2000-2020 were, respectively, 15.7 μg/l (IQR: 15.2) and 15.2 mg/l (IQR: 20.8). Among these, 35% were based on measurements for nitrate (16% for THMs), 44% (46%) were predicted using on linear mixed models, and 21% (38%) were based on distribution unit median values. Conditional R(2) predictive models ranged from 0.71 to 0.91 (median: 0.85) for nitrate, and from 0.48 to 0.80 for THMs (median: 0.68). These concentrations will allow future association analyses with risk of breast and colorectal cancer. Our cleaning process introduced here could be adapted to other large drinking water monitoring data.Les trihalométhanes (THM) et les nitrates sont des produits chimiques très répandus dans l’eau potable. L’exposition chronique a été associée à un risque accru de cancer malgré des preuves non concluantes, en partie à cause des difficultés rencontrées dans l’évaluation de l’exposition à long terme et de la classification erronée de l’exposition potentielle. Nous avons estimé les concentrations de nitrates et de THM dans l’eau potable à partir d’une base de données publique de veille réglementaire (SISE-Eaux) pour CONSTANCES, une cohorte prospective française basée sur la population. Nous avons obtenu 26 322 366 mesures de paramètres de l’eau potable de 2000 à 2020. Nous avons exclu les mesures manquantes, invraisemblables et dupliquées ; nous avons corrigé ou imputé les géocodes manquants des lieux d’échantillonnage ; nous avons calculé la concentration médiane annuelle de nitrates et de THM par zone de surveillance. Pour prédire les concentrations médianes annuelles manquantes, des modèles mixtes linéaires avec interception aléatoire utilisant la zone de surveillance comme variable de regroupement ont été élaborés pour chaque région pour le nitrate et les quatre composants THM (chloroforme, chlorodibromométhane, bromodichlorométhane et bromoforme) séparément. Les concentrations dans la zone de surveillance la plus proche du ménage ont été fusionnées par an parmi 75 462 participants ayant des antécédents résidentiels géocodés pour la période 2000-2020. Les concentrations estimées résultant de cette approche ont été comparées aux concentrations mesurées dans 100 échantillons prélevés à Paris, Rennes et Saint-Brieuc en 2021. Les concentrations annuelles médianes de THM et de nitrate totaux au domicile des participants à l’étude pour la période 2000-2020 étaient respectivement de 15,7 μg/l (IQR : 15,2) et de 15,2 mg/l (IQR : 20,8). Parmi ceux-ci, 35 % étaient basés sur des mesures pour le nitrate (16 % pour les THM), 44 % (46 %) ont été prédits à l’aide de modèles linéaires mixtes et 21 % (38 %) étaient basés sur des valeurs médianes d’unité de distribution. Les modèles prédictifs conditionnels du R2 variaient de 0,71 à 0,91 (médiane : 0,85) pour le nitrate et de 0,48 à 0,80 pour les THM (médiane : 0,68). Ces concentrations permettront de futures analyses d’association avec le risque de cancer du sein et colorectal. Notre processus de nettoyage présenté ici pourrait être adapté à d’autres données importantes de surveillance de l’eau potable
High-Resolution Mass Spectrometry for Human Exposomics: Expanding Chemical Space Coverage
No full textInternational audienceIn the modern "omics" era, measurement of the human exposome is a critical missing link between genetic drivers and disease outcomes. High-resolution mass spectrometry (HRMS), routinely used in proteomics and metabolomics, has emerged as a leading technology to broadly profile chemical exposure agents and related biomolecules for accurate mass measurement, high sensitivity, rapid data acquisition, and increased resolution of chemical space. Non-targeted approaches are increasingly accessible, supporting a shift from conventional hypothesis-driven, quantitation-centric targeted analyses toward data-driven, hypothesis-generating chemical exposome-wide profiling. However, HRMS-based exposomics encounters unique challenges. New analytical and computational infrastructures are needed to expand the analysis coverage through streamlined, scalable, and harmonized workflows and data pipelines that permit longitudinal chemical exposome tracking, retrospective validation, and multi-omics integration for meaningful health-oriented inferences. In this article, we survey the literature on state-of-the-art HRMS-based technologies, review current analytical workflows and informatic pipelines, and provide an up-to-date reference on exposomic approaches for chemists, toxicologists, epidemiologists, care providers, and stakeholders in health sciences and medicine. We propose efforts to benchmark fit-for-purpose platforms for expanding coverage of chemical space, including gas/liquid chromatography-HRMS (GC-HRMS and LC-HRMS), and discuss opportunities, challenges, and strategies to advance the burgeoning field of the exposome
Nouvelle approche de spectrométrie de masse haute résolution multiplexée pour une évaluation exhaustive de l’exposition interne aux pesticides
No full textNational audienc
Youth behavioural responses to regulated alcohol advertising content: results from a mixed-methods study in France
No full textInternational audienceObjectives - The World Health Organization advocates measures regulating alcohol advertising content, as illustrated by the French Évin law. However, how people react to such regulation has been under-investigated. The research reported here has two objectives: to analyze how different advertising contents (regulated or not) affect the persuasion process from attention to behavioural responses, and whether young people are protected; to examine how alcohol warnings perform depending on their salience and the advertising content displayed (regulated or not).Materials and Methods - This study surveyed French people aged 15–30 using a mixed-methods design. In-depth interviews were conducted on 26 respondents to understand how non-regulated (NRA) and regulated (RA) alcohol advertising influence the persuasion process. An experiment on 696 people assessed the influence of RA vs. NRA on intentions to buy and drink alcohol, and whether less vs. more salient warnings displayed in the RA or NRA setting have differential effects on behavioural responses.Results - NRA (vs. RA) had a greater influence on young people’s desire to buy and drink alcohol, which we explain by different psychological processes. NRA appeared to trigger a heuristic process that involves affective reactions (e.g. image, symbolism) and product-oriented responses (e.g. quality), whereas RA appeared to trigger a more systematic process that had less influence. The protective effect of content regulations was strong for the youngest participants but fades as age increases, reaching its limits at age 22 years. Salience of the warnings had no influence on desire to buy and drink alcohol, whatever the ad content.Conclusion - Advertising content regulations need to be implemented to protect young people, particularly the youngest. Our results on alcohol health warnings highlighted that text-only labels similar to those adopted in many countries are ineffective at decreasing young people’s intentions to buy and drink alcohol
Providing parents with HPV vaccine information from a male perspective may render them more inclined to have their daughters vaccinated
No full textInternational audienceObjectivesSeveral high-income countries have implemented a gender-neutral vaccination program against human papillomavirus (HPV) infections. The impact of a gender-neutral program (GNP) on parental intention to vaccinate their daughters has not been studied, especially in countries with low HPV vaccine coverage among girlsPatients and methodsIn July 2019, before a GNP was implemented in France (2021), the French National Cancer Institute (INCa) conducted a survey on HPV vaccine acceptance among parents of children aged 11–19 years living in France. In the sample of girls’ parents (n = 1424 parents, 1726 girls), we investigated whether parents who declared no initial intention to have their daughter(s) vaccinated changed their minds after reading information including a male perspective on HPV consisting in description of HPV-related disease among men and in ascertainment of the fact that in some countries, the HPV vaccine is recommended for boys, after which they were once again asked about their intentions “if the vaccine were recommended to boys and girls alike”.ResultsAs regards 295 (25.7 %) of the 1147 unvaccinated girls, their parents declared no intention to have them vaccinated, while 509 (44.4 %) were not sure. Among the parents of the 804 girls whose parents had not intended to have them vaccinated, 134 (16.7 %) changed their minds after reading about HPV among men. Fathers were more likely than mothers to change their minds, and finally intend to have their daughters vaccinated (adjusted relative risk, 1.74 [95 % confidence interval, 1.20,2.54]).ConclusionsThese results suggest that parents, and fathers in particular, could be more motivated to have their daughters vaccinated against HPV if the information with which they were provided included a male perspective and a recommendation of vaccination for boys as well as girls
#989 Fund and incentivize multidisciplinary CKD care: what can we learn from the French CKD bundled payment program?
No full textInternational audienceBackground and Aims - Multidisciplinary care (MDC) is crucial to slow down the progression of Chronic Kidney Disease (CKD) and prevent or post-pone kidney replacement therapy. To incentivize the development of that care, France launched a nationwide bundled payment program (CKD-BP) targeted to patients with CKD G4 and G5. In this study, we review the implementation of the program, 3 years into its launch. Method - First, using the CKD-BP program data collected by participating facilities, we described the characteristics and trajectories of patients enrolled from 2020 through 2022. Second, from exploratory interviews with medical and management staff, we performed a thematic analysis to identify the obstacles encountered during implementation and the changes introduced by the program. Results - Since 2020, 157,863 patients were reported by 408 facilities (median age 75 y-o, 40% women, 77% G4). Missing data frequencies were high for comorbidities. Each year, around 4200 dialysis start (5% of patients) and 2600 deaths (3% of patients) were reported. On average, 47% and 40% of patients visited nurses and dietitians at least once a year respectively. From 22 interviews across 7 facilities, we identified challenges of implementation: adapting information systems, gathering the support of facility management and organizing the care in a context of workforce shortage, specifically nurses. Despite those challenges, facilities welcomed positively the new model, notably with increased time between nurses and patients and affirmation of dietitian's role. Conclusion - We estimate the exhaustiveness of the CKD-BP program at 40% of all French patients with G5 CKD (around 4,600 dialysis start reported in 2021, compared to 11,000 from the national exhaustive REIN registry data). The results of this study suggest that interventions to accompany facilities in adapting their information systems are a priority to ensure efficient allocation of medical time and quality of the data. The results also suggest the need for increased flexibility regarding what professional is considered in the CKD-BP program, beyond nurses and dietitians. These challenges remain to be addressed in order to complete a successful shift from fee-for-service to assessable value-based care for CKD in France
WCN24-739 Impact of dialysis modality on patients' life plans: inclus-dial, a survey for independent patients
No full textInternational audienc
Prevalence of chronic kidney disease in France: methodological considerations and pitfalls with the use of Health claims databases
No full textInternational audienceBackground - Health policy-making require careful assessment of chronic kidney disease (CKD) epidemiology to develop efficient and cost-effective care strategies. The aim of the present study was to use the RENALGO-EXPERT algorithm to estimate the global prevalence of CKD in France. Methods - An expert group developed the RENALGO-EXPERT algorithm based on healthcare consumption. This algorithm has been applied to the French National Health claims database (SNDS), where no biological test findings are available to estimate a national CKD prevalence for the years 2018-2021. The CONSTANCES cohort (+219 000 adults aged 18-69 with one CKD-EPI eGFR) was used to discuss the limit of using health claims data. Results - Between 2018 and 2021, the estimated prevalence in the SNDS increased from 8.1% to 10.5%. The RENALGO-EXPERT algorithm identified 4.5% of the volunteers in the CONSTANCES as CKD. The RENALGO-EXPERT algorithm had a positive predictive value of 6.2% and negative predictive value of 99.1% to detect an eGFR 90) had been diagnosed with kidney disease during hospitalization, and the other half based on healthcare consumption suggestive of a 'high-risk' profile; 95% of the 1661 false negatives (ALGO-, eGFR < 60) had an eGFR between 45 and 60 ml/min, half had medication and two-thirds had biological exams possibly linked to CKD. Half of them had a hospital stay during the period but none had a diagnosis of kidney disease. Conclusions - Our result is in accordance with other estimations of CKD prevalence in the general population. Analysis of diverging cases (FP and FN) suggests using health claims data have inherent limitations. Such an algorithm can identify patients whose care pathway is close to the usual and specific CKD pathways. It does not identify patients who have not been diagnosed or whose care is inappropriate or at early stage with stable GFR
Barriers and facilitators to the HPV vaccine: a multicenter qualitative study of French general practitioners
No full textInternational audienceBackgroundIn France, human papillomavirus (HPV) vaccination coverage is low, with only 30.7% of 17-year-old girls having received a complete HPV vaccination schedule in 2020.AimThe aim of this study is to determine the perspective and behaviors of general practitioners (GPs) regarding HPV vaccination with their patients and to identify if a reluctance is observed.Design and SettingThis qualitative study is based on semi-directed individual interviews conducted between December 2019 and December 2020. A representative sample of GPs with various profiles was included from four French regions.MethodA purposive sampling method was employed, and interviews continued until data saturation was reached. The analysis was based on grounded theory.ResultsTwenty-six GPs aged 29–66 years were interviewed. The measures taken by the French health authorities (lowering the target age, reimbursing the vaccine, extending the target population to boys) were perceived as facilitators. Reported barriers included organizational challenges due to low attendance of adolescents, and relational barriers primarily due to parental vaccine hesitancy. Physicians had to address fears regarding perceived risks and concerns about sexuality associated with HPV vaccination, which were linked to the socio-cultural characteristics of families. Physicians developed strategies including mobilizing scientific knowledge, empowering families by promoting health through prevention, repetition of vaccination proposals, personal experience, and relationship. Different practices were identified according to three GP typologies: effective, convinced but unpersuasive, and reluctant physicians.ConclusionBased on these results, specific interventions, including communication techniques, especially for hesitant or unpersuasive physicians, are needed to enable GPs to become more effective
Médicaments, santé : comment fonctionnent les politiques européennes ?
No full texthttps://theconversation.comLa pandémie de Covid-19 avait remis le sujet de la santé au cœur des préoccupations européennes. Mais l’actualité internationale, et en particulier le conflit ukrainien, a changé la donne. Pour preuve, le 1er février 2024, les dirigeants européens ont décidé de réduire de près de 20 % le principal programme de financement de la santé (EU4Health – « L’UE pour la santé », adopté en réaction à la pandémie). Dans le même temps, ils choisissaient de redéployer, dans le budget 2021-2027, 10,6 milliards d’euros provenant de différents programmes afin de financer un plan d’aide à l’Ukraine. Ce qui fait dire à certain que la montagne des déclarations post-Covid a accouché d’une souris… Est-il vrai que rien n’a changé ? Actuellement, quelles sont les prérogatives de l’Europe en matière de santé ? Les réponses de Gaël Coron, professeur à l’École des hautes études en santé publique (EHESP) et spécialiste de l’Europe