Scientific publications portal of EHESP researchers
Not a member yet
5609 research outputs found
Sort by
Public health and economic benefits of seasonal influenza vaccination in risk groups in France, Italy, Spain and the UK: state of play and perspectives
No full textInternational audienceBackground:Seasonal influenza epidemics have a substantial public health and economic burden, which can be alleviated through vaccination. The World Health Organization (WHO) recommends a 75% vaccination coverage rate (VCR) in: older adults (aged ≥ 65 years), individuals with chronic conditions, pregnant women, children aged 6–24 months and healthcare workers. However, no European country achieves this target in all risk groups. In this study, potential public health and economic benefits achieved by reaching 75% influenza VCR was estimated in risk groups across four European countries: France, Italy, Spain, and the UK. Methods:A static epidemiological model was used to estimate the averted public health and economic burden of increasing the 2021/2022 season VCR to 75%, using the efficacy data of standard-dose quadrivalent influenza vaccine. For each country and risk group, the most recent data on population size, VCR, pre-pandemic influenza epidemiology, direct medical costs and absenteeism were identified through a systematic literature review, supplemented by manual searching. Outcomes were: averted influenza cases, general practitioner (GP) visits, hospitalisations, case fatalities, number of days of work lost, direct medical costs and absenteeism-related costs. Results As of the 2021/2022 season, the UK achieved the highest weighted VCR across risk groups (65%), followed by Spain (47%), France (44%) and Italy (44%). Based on modelling, the 2021/2022 VCR prevented an estimated 1.9 million influenza cases, avoiding 375,200 GP visits, 73,200 hospitalisations and 38,400 deaths. To achieve the WHO 75% VCR target, an additional 24 million at-risk individuals would need to be vaccinated, most of which being older adults and patients with chronic conditions. It was estimated that this could avoid a further 918,200 influenza cases, 332,000 GP visits, 16,300 hospitalisations and 6,300 deaths across the four countries, with older adults accounting for 52% of hospitalisations and 80% of deaths. An additional €84 million in direct medical costs and €79 million in absenteeism costs would be saved in total, with most economic benefits delivered in France. Conclusions:Older adults represent most vaccine-preventable influenza cases and deaths, followed by individuals with chronic conditions. Health authorities should prioritise vaccinating these populations for maximum public health and economic benefits
Hommage à Elisabeta Vergu
No full textCe texte rend hommage à Elisabeta Vergu, directrice de recherche INRAE au sein de l'unité MaIAGE du centre de Jouy en Josas, décédée en mai 2023 à l'âge de 49 ans. Née à Tulcea en Roumanie, elle est arrivée en France en 1992 grâce à une bourse lui permettant de se former à l'INSA de Lyon. Après avoir obtenu son diplôme d'ingénieur en 1997 puis un doctorat en biomathématiques de l'Université Pierre et Marie Curie en 2003, elle a été recrutée à l'INRAE en tant que chargée de recherche en 2005 et y sera promue directrice de recherche en 2018. Le texte retrace ses nombreuses contributions au domaine des mathématiques appliquées à l'épidémiologie (sans prétention d'exhaustivité), tant du point de vue des résultats qu'elle a obtenus au travers d'une cinquantaine d'articles et qui s'inscrivent dans un spectre très large de questions théoriques et d'applications, que du point de vue de son engagement sans faille pour la communauté. Par son enthousiasme communicatif, elle aura permis le rapprochement de chercheuses et chercheurs d'horizons très divers pour répondre à des problématiques pluridisciplinaires d'une indéniable actualité
Politiques de l'attente. Patient•es et puissant•es de la domination temporelle
No full textNational audienceCe numéro s’intéresse à ce qu’il se passe quand il ne se passe (apparemment) rien, dans ces lieux et ces temps où des individus font l’expérience de l’attente. Les contributions réunies ici s’appuient sur une diversité de cas d’étude dans lesquels cette expérience est vécue soit quasi exclusivement par des individus de classes populaires (prison, quartiers populaires, justice des mineurs, filières d’accès au logement social), soit par une population plus hétérogène, mais au sein de laquelle les plus précaires attendent significativement plus que les autres (accès aux soins d’urgence). Ce numéro cherche ainsi à comprendre comment ce rapport particulier au temps façonne les relations entre classes populaires et administrations, et en particulier les rapports ordinaires à l’État" (extrait
AtoG: a simple score to predict complications and death after hip fractures, in line with the comprehensive geriatric assessment
No full textInternational audienceIntroduction: Proximal Femur Fractures (PFFs) are a significant public health issue and occur in the context of global frailty and aging. Recent literature identifies new patient-related prognostic factors that focus on socioeconomic environment, patient well-being, or nutrition status. Specific scores have been developed, but in most cases, they fail to be in line with the comprehensive geriatric assessment, or don't assess the newly identified prognostic factors, contain multitude collinearities, or are too complex to be used in the daily practice.Hypothesis: A comprehensive score with equal representation of the patient's dimensions does at least as good as the Charlson score (CCI), to predict complications and mortality.Objective: To develop a new comprehensive prognostic score, predicting inpatient complications and mortality up to 5-year after PFF.Material and methods: The patients treated surgically for PFF on a native hip, between 2005 and 2017 were selected from a French national database. The variables were the gender, age, the type of treatment (osteosynthesis or arthroplasty), and the CCI. The outcomes were the medical and surgical complications as inpatient and the mortality (up to 5-year). Variables were grouped into dimensions with similar clinical significance, using a Principal Component Analysis, for instance, bed sores and malnutrition. The dimensions were tested for 90-day mortality and complications, in regressions models. Two scores were derived from the coefficients: SCOREpond (strict ponderation), and SCORE (with loose ponderation: 1 point/ risk factors, -1 point/protective factors). Calibration, discrimination (ROC curves with Area Under Curves AUC), and cross-validation were assessed for SCOREpond, SCORE, and CCI.Results: Analyses were performed on 7756 fractures. The factorial analysis identified seven dimensions: age; brain-related conditions (including dementia): 1738/7756; severe chronic conditions (for instance, organ failures) 914/7756; undernutrition:764/7756; environment, including social issues or housing difficulties: 659/7756; associated trauma: 814/7756; and gender. The seven dimensions were selected for the prognostic score named AtoG (ABCDEFG, standing for Age, Brain, Comorbidities, unDernutrition, Environment, other Fractures, Gender). The median survival rate was 50.8 months 95%IC[49-53]. Anaemia and urologic complications were the most prevalent medical complications (1674/7756, 21%, and 1109/7756, 14.2%). A total of 149/7756 patients (1.9%) developed a mechanical inpatient complication (fractures or dislocations), with a slightly higher risk for arthroplasties. The AUCs were 0.69, 0.68, and 0.67 for AtoGpond, AtoG, and CCI, respectively, for 90-day mortality, and 0.64, 0.63, and 0.56 for complications. Compared to patients with AtoG=0, Hazard Ratios for 90-day mortality were 2.3 95%CI[1.7-2.9], 4.2 95%CI[3.1-5.4], 6 95%CI[4.5-8.1], 8.3 95%CI[6.5-12.9], and 13.7 95%CI[8-24], from AtoG=1 to AtoG>=5, respectively (p <10-4); the 90-day survival decreased by 5%/point, roughly. The sur-risk of mortality associated with AtoG was up to 5-year: HR= 1.51 (95%CI[1.46-1.55], p<10-4). Compared to AtoG=0, from AtoG=1 to AtoG ≥5, the pooled Odd Ratios were 1.14 95%CI[1.06-1.2], 1.53 95%CI[1.4-1.7], 2.17 95%CI[1.9-2.4], 2.9 95%CI[2.4-3.4], and 4.9 95%CI[3.3-7.4] for any complication (p <10-4).Conclusion: AtoG is a multidimensional score in line with the concept of comprehensive geriatric assessment. It had good discrimination and performance in predicting 90-day mortality and complications. Performances were as good as CCI for 90-day mortality, and better than it for the complications.Level of proof: IV; retrospective cohort study
La santé publique : des fonctions, des compétences, des valeurs ? [Editorial]
No full textInternational audienceEtre capable de répondre clairement et succinctement à la question « Et vous, c’est quoi votre métier ? » est un conseil de bon sens applicable à bien des circonstances professionnelles ou privées. Dans le contexte d’une carrière en santé publique cela peut s’avérer être un défi ! Par où commencer… La définition fondatrice énoncée en 1920 par Winslow peut-être ? « La santé publique est la science et l’art de prévenir les maladies, de prolonger la vie et de promouvoir la santé […] grâce aux efforts coordonnés de la société
Innovative analytical methodologies for characterizing chemical exposure with a view to next-generation risk assessment
No full textInternational audienceThe chemical burden on the environment and human population is increasing. Consequently, regulatory risk assessment must keep pace to manage, reduce, and prevent adverse impacts on human and environmental health associated with hazardous chemicals. Surveillance of chemicals of known, emerging, or potential future concern, entering the environment-food-human continuum is needed to document the reality of risks posed by chemicals on ecosystem and human health from a one health perspective, feed into early warning systems and support public policies for exposure mitigation provisions and safe and sustainable by design strategies. The use of less-conventional sampling strategies and integration of full-scan, high-resolution mass spectrometry and effect-directed analysis in environmental and human monitoring programmes have the potential to enhance the screening and identification of a wider range of chemicals of known, emerging or potential future concern. Here, we outline the key needs and recommendations identified within the European Partnership for Assessment of Risks from Chemicals (PARC) project for leveraging these innovative methodologies to support the development of next-generation chemical risk assessment
Le management en santé: Gestion et conduite des organisations de santé
No full text2ème ed.International audienceLe système de santé français est réputé pour son niveau de protection sociale, sa qualité, les compétences de ses professionnels, sa recherche et ses innovations. Néanmoins, certaines menaces le fragilisent : les inégalités territoriales, les pénuries de personnels, des coûts en augmentation constante et des financements limités, alors que les besoins progressent avec, en particulier, le vieillissement de la population. Pérenniser son fonctionnement, faire face aux crises et manager les organisations est un défi quotidien. Maîtriser l’environnement territorial et technique, être apte à conduire le changement, comprendre la sociologie des acteurs, piloter stratégiquement dans le respect du cadre législatif et réglementaire sont les missions du manager en santé. Elles mobilisent des connaissances et compétences parfois difficiles à acquérir.Fruit d’un travail collectif mené par les enseignants ou chargés d’enseignement de l’EHESP, cette deuxième édition propose une synthèse des domaines d’enseignement dispensés auprès de ses différents publics. Abordant des connaissances de base en gestion (finances, ressources humaines, contrôle de gestion, achats…), elle rappelle l’environnement réglementaire spécifique aux établissements et services de santé et analyse le rôle et le jeu des acteurs de terrain, professionnels ou usagers.Ce manuel pédagogique, clair et synthétique, permettra au lecteur, qu’il soit étudiant, élève, professionnel ou dirigeant, d’acquérir les savoirs et les compétences fondamentales au management de la santé
Does vaccination elicit risk compensation? Insights from the COVID-19 pandemic in France
No full textInternational audienceaccination has played a key role in reducing the health burden of COVID-19, however, concern has been raised worldwide regarding risk compensation, a process whereby feelings of security arising from being vaccinated may lead people to reduce their engagement in other protective behaviours. We investigated whether vaccination led to risk compensation and whether this changed over time by conducting a repeated cross-sectional study at seven intervals over the initial months (February to September 2021) of the vaccine rollout in France. Participants (N = 14,003) completed an online survey measuring vaccination status, vaccination intention and engagement in four preventive behaviours: mask wearing, avoidance of physical contact, hand hygiene, and avoiding social gatherings. Risk compensation was measured indirectly by comparing levels of engagement in protective behaviours according to vaccination status, with those unvaccinated but intending to vaccinate serving as a baseline. Risk compensation did not occur systematically and was mostly observed towards the end of the vaccine rollout for two of the four protective behaviours: avoiding social gatherings (in July and September for fully-vaccinated participants (Adjusted Odds Ratio (AOR) =.72, p =.045; AOR =.54, p =.022, respectively) and wearing a mask (those vaccinated with one dose, in September: AOR =.48, p =.029)). Our findings suggest that whilst unlikely to impede the overall effectiveness of public health campaigns, risk compensation nonetheless merits attention when designing informed, targeted public health messages and policy
Staggered interventions with no control groups
No full textInternational audienceThe limitations of the two-way fixed effects for the impact evaluation of interventions that occur at different times for each group have meant that ‘staggered interventions’ have been highlighted in recent years in the econometric literature and, more recently, in epidemiology. Although many alternative strategies (such as staggered difference-in-differences) have been proposed, the focus has predominantly been on scenarios in which one or more control groups are available. However, control groups are often unavailable, due to limitations in the available data or because all units eventually receive the intervention. In this context, interrupted time series (ITS) designs can constitute an appropriate alternative. The extent to which common model specifications for ITS analyses are limited in the case of staggered interventions remains an underexplored area in the methodological literature. In this work, we aim to demonstrate that standard ITS model specifications typically yield biased results for staggered interventions and we propose alternative model specifications that were inspired by recent developments in the difference-in-differences literature to propose adapted analytical strategies
