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P-2055. Modelling the Relative Vaccine Effectiveness of ARCT-154 versus BNT162b2 in Younger and Older Adults
No full textInternational audienceBackground: While vaccines have proved a key tool in protection from COVID-19, the duration of immunity induced by first-generation mRNA vaccines is limited. Self-amplifying mRNA (SA-mRNA) vaccines have clinically shown to both elicit higher antibody responses and increase the duration of response. In this analysis, we evaluate the relative vaccine effectiveness (rVE) over time of a COVID-19 SA-mRNA vaccine (ARCT-154) versus BNT162b2 against the original Wuhan-Hu-1 and Omicron BA.4/BA.5 strains in adults stratified by age group (< 60 years and ≥60 years), using a correlate of protection derived from immunogenicity data. Methods: We used geometric mean titer data collected on Days 29, 91, and 181 post-vaccination from a phase 3 clinical trial comparing the immune response of ARCT-154 and BNT162b2 against Wuhan-Hu-1 and Omicron BA.4/5 in healthy 18–77-year-olds (Japan Registry for Clinical Trials identifier: jRCT2071220080) to estimate a correlate of protection against symptomatic and severe COVID-19. rVE of ARCT-154 versus BNT162b2 was then evaluated for each time point against both endpoints in individuals < 60 years and ≥60 years of age. Results: rVE against symptomatic infection and severe illness increased over time against both Wuhan-Hu-1 and Omicron BA.4/BA.5. In adults < 60 years, rVE against symptomatic infection ranged from 2.57% on Day 29 to 9.19% on Day 181 against Wuhan-Hu-1 and from 4.24% to 26.83% against Omicron BA.4/5. In adults ≥60 years, rVE ranged from 2.77% to 10.99% and 4.58% to 48.02% against the two strains, respectively. rVE against severe illness ranged from 0.30% to 4.65% against Wuhan-Hu-1 and 0.63% to 15.84% against Omicron BA.4/5 in adults < 60 years and from 0.34% to 5.61% and 0.74% to 27.96%, respectively, in adults ≥60 years. Conclusion: ARCT-154 showed longer-lasting protection than BNT162b2 against symptomatic and severe COVID-19, with greatest benefits in adults ≥60 years of age against Omicron BA.4/BA.5
Le rôle des leaders d’opinion dans la dénormalisation du tabac en France : application aux campus sans tabac et aux hausses de taxes
No full textThis doctoral research studies how two categories of opinion leaders (deans of medical faculties in France and journalists in the general press) influence the denormalisation of smoking in France, by analysing their postures and roles in relation to preventive measures recommended by the WHO: tobacco-free campuses (CST) and tobacco tax increases. In France, these two measures are still little or poorly used in tobacco control, and the question of how to mobilise opinion leaders to help implement these effective public health measures has not been sufficiently studied. This doctoral research in social marketing draws on multi-disciplinary theories (psycho-social theories of behavioural change and norms, marketing and management theories on the profiles of opinion leaders and the dissemination of a health innovation - such as smoke-free campuses). The problem of the thesis is as follows: What roles and influence do opinion leaders (deans and journalists) have in the fight against smoking in France, and how do they contribute (or not) to the denormalisation of smoking? Application to the development of smoke-free campuses and the implementation of a taxation policy that is relevant to public health. To answer these questions, a qualitative methodology was used, based on 1/ a systematic review of the literature, 2/ a documentary analysis of the French general press over 20 years and 3/ 31 semi-directive interviews with deans of medical faculties. These 3 studies have been published (or are in progress) in scientific journals and make up the 3 chapters of this thesis. We have shown how opinion leaders who are experts in health and executive directors can support and promote a smoke-free campus. Conversely, we were able to show that information opinion leaders such as journalists could help to disseminate anti-tobacco tax language from the tobacco industry. This research contributes to the theory analysing the positive and negative influence exerted by opinion leaders on a norm and more specifically on the public image of a tobacco control measure and its dissemination, as well as applying the concept of personification to the field of social marketing and tobacco control.Cette recherche doctorale étudie comment deux catégories de leaders d’opinion (les doyens des facultés de médecine en France et les journalistes de la presse généraliste), influencent la dénormalisation du tabagisme en France, ceci en analysant leurs postures et rôles par rapport à des mesures de prévention recommandées par l’OMS : les campus sans tabac (CST) et les hausses de taxe sur le tabac. En France, ces deux mesures sont, encore aujourd’hui, peu ou mal utilisées en contrôle du tabac, et la question de comment mobiliser les leaders d’opinion pour aider à la mise en place de ces mesures efficaces pour la santé publique est insuffisamment étudiée. Cette recherche doctorale en marketing social mobilise des théories pluridisciplinaires (théories psycho-sociales des changements de comportements et des normes, théories du marketing et du management sur les profils des leaders d’opinion et la diffusion d’une innovation en santé –comme les campus sans tabac). La problématique de la thèse est la suivante : Quels rôles et influence les leaders d’opinion (doyens et journalistes) exercent-ils dans la lutte contre le tabac en France, et comment contribuent-ils (ou non) à la dénormalisation du tabagisme ? Application au développement des campus sans tabac et à la mise en place d’une politique de taxation pertinente pour la santé publique. Pour y répondre, une méthodologie qualitative a été utilisée, basée sur 1/ une revue systématique de la littérature, 2/ une analyse documentaire de la presse généraliste française sur 20 ans et 3/ 31 entretiens semi-directifs auprès de doyens des facultés de médecine. Ces 3 études ont été publiées (ou sont en cours) dans des journaux scientifiques et composent les 3 chapitres de cette thèse. Nous avons montré comment des leaders d’opinion experts en santé et dirigeants exécutifs pouvaient soutenir et porter un campus sans tabac. A l’inverse nous avons pu montrer que des leaders d’opinion de l’information tels que les journalistes pouvaient contribuer à diffuser des éléments de langage anti-taxes sur le tabac issus de l’industrie du tabac. Cette recherche contribue à la théorie analysant l’influence positive et négative exercée par des leaders d’opinion sur une norme et plus précisément sur l’image publique d’une mesure de contrôle du tabac et sa diffusion, ainsi qu’en appliquant le concept de personnification au champ du marketing social et de la lutte contre le tabagisme
Révision de la taxation des boissons sucrées en France : quelles intentions pour quels effets ?
No full textInternational audienceTaxing sugary drinks is a public health measure that has been enacted in a growing number of jurisdictions over the past 15 years. This intervention needs to be evaluated, and its aims clarified. Based on the results of a multidisciplinary research project, in this article we report on the conditions that led to the revision of the taxation of sugar-sweetened beverages in France in 2018. We found an intention to improve the nutritional quality of the beverage offer rather than directly influence consumer behavior. We discuss some of the effects associated with the tax implementation.La taxation des boissons sucrées est, depuis 15 ans, une mesure de santé publique appliquée sur un nombre croissant de territoires. Cette intervention gagne à être évaluée, ce qui implique d’en clarifier les finalités. Basé sur les résultats d’un projet de recherche pluridisciplinaire, cet article analyse les conditions de la révision de la taxation des boissons sucrées en France en 2018. Il met en évidence que l’intention est plutôt de faire évoluer la qualité nutritionnelle de l’offre de boissons que d’influencer directement le comportement des consommateurs. Par ailleurs, il présente quelques effets associés à la mise en oeuvre de la taxe
EPH86 Increased Healthcare Resources Utilization and Costs of Long COVID in Community-Managed Adult Patients in France
No full textInternational audienceObjectives: To compare healthcare resource utilization (HCRU) and direct and indirect costs between patients with previous SARS-CoV-2 infection who developed long-COVID, patients with previous SARS-CoV-2 infection who did not develop long-COVID, and contemporaneous controls without SARS-CoV-2 infection. Methods: We conducted a retrospective cohort study using the electronic records of confirmed and/or probable COVID-19 patients in the primary care setting from The Health Improvement Network (THIN) data between 03/2020 and 08/2023. Long-COVID was defined per World Health Organization (WHO) as suggestive symptoms present ≥3 months following acute SARS-CoV-2 infection. Propensity score matching on age, gender, duration of follow-up, Charlson Comorbidity Index (CCI) and BMI was conducted. Patient characteristics, HCRU and costs of each cohort were summarized. Results: A total of 74,820 patients requesting medical attention were included, 24,940 in each cohort. The mean (SD) age was 51(±17) years with 77% aged <65 years, 63% were female and 30% had a CCI >2. Average follow-up was 17 months. HCRU and costs were the highest in patients with long COVID during the first year following acute infection, with per-patient-per-year cost of €2,223. Comparing those who developed long-COVID vs not, long-COVID patients had the highest costs due to sick leaves (€180 higher), followed by medication use in retail pharmacies (€137 higher) and GP consultations (€55 higher). Comparing those who developed long-COVID vs never infected with acute COVID, long-COVID patients had the highest costs due to retail pharmacy use (€152 higher), followed by sick leaves (€120 higher) and GP consultations (€60 higher). Conclusions: HCRU and costs are higher among patients identified with long COVID following acute infections in France, highlighting the societal burden of long COVID and the importance of long-term management of COVID
Giroux B. (dir.), 2022, Voir, juger, agir. Action catholique, jeunesse et éducation populaire (1945-1975) , Rennes, PUR, coll. « Histoire », 222 p.
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Fine Particulate Matter, Its Constituents, and Spontaneous Preterm Birth
No full textInternational audienceImportance The associations of exposure to fine particulate matter (PM 2.5 ) and its constituents with spontaneous preterm birth (sPTB) remain understudied. Identifying subpopulations at increased risk characterized by socioeconomic status and other environmental factors is critical for targeted interventions. Objective To examine associations of PM 2.5 and its constituents with sPTB. Design, Setting, and Participants This population-based retrospective cohort study was conducted from 2008 to 2018 within a large integrated health care system, Kaiser Permanente Southern California. Singleton live births with recorded residential information of pregnant individuals during pregnancy were included. Data were analyzed from December 2023 to March 2024. Exposures Daily total PM 2.5 concentrations and monthly data on 5 PM 2.5 constituents (sulfate, nitrate, ammonium, organic matter, and black carbon) in California were assessed, and mean exposures to these pollutants during pregnancy and by trimester were calculated. Exposures to total green space, trees, low-lying vegetation, and grass were estimated using street view images. Wildfire-related exposure was measured by the mean concentration of wildfire-specific PM 2.5 during pregnancy. Additionally, the mean exposure to daily maximum temperature during pregnancy was calculated. Main Outcomes and Measures The primary outcome was sPTB identified through a natural language processing algorithm. Discrete-time survival models were used to estimate associations of total PM 2.5 concentration and its 5 constituents with sPTB. Interaction terms were used to examine the effect modification by race and ethnicity, educational attainment, household income, and exposures to green space, wildfire smoke, and temperature. Results Among 409 037 births (mean [SD] age of mothers at delivery, 30.3 [5.8] years), there were positive associations of PM 2.5 , black carbon, nitrate, and sulfate with sPTB. Adjusted odds ratios (aORs) per IQR increase were 1.15 (95% CI, 1.12-1.18; P &lt; .001) for PM 2.5 (IQR, 2.76 μg/m 3 ), 1.15 (95% CI, 1.11-1.20; P &lt; .001) for black carbon (IQR, 1.05 μg/m 3 ), 1.09 (95% CI, 1.06-1.13; P &lt; .001) for nitrate (IQR, 0.93 μg/m 3 ), and 1.06 (95% CI, 1.03-1.09; P &lt; .001) for sulfate (IQR, 0.40 μg/m 3 ) over the entire pregnancy. The second trimester was the most susceptible window; for example, aORs for total PM 2.5 concentration were 1.07 (95% CI, 1.05-1.09; P &lt; .001) in the first, 1.10 (95% CI, 1.08-1.12; P &lt; .001) in the second, and 1.09 (95% CI, 1.07-1.11; P &lt; .001) in the third trimester. Significantly higher aORs were observed among individuals with lower educational attainment (eg, less than college: aOR, 1.16; 95% CI, 1.12-1.21 vs college [≥4 years]: aOR, 1.10; 95% CI, 1.06-1.14; P = .03) or income (&lt;50th percentile: aOR, 1.17; 95% CI, 1.14-1.21 vs ≥50th percentile: aOR, 1.12; 95% CI, 1.09-1.16; P = .02) or who were exposed to limited green space (&lt;50th percentile: aOR, 1.19; 95% CI, 1.15-1.23 vs ≥50th percentile: aOR, 1.12; 95% CI, 1.09-1.15; P = .003), more wildfire smoke (≥50th percentile: aOR, 1.19; 95% CI, 1.16-1.23 vs &lt;50th percentile: aOR, 1.13; 95% CI, 1.09-1.16; P = .009), or extreme heat (aOR, 1.51; 95% CI, 1.42-1.59 vs mild temperature: aOR, 1.11; 95% CI, 1.09-1.14; P &lt; .001). Conclusions and Relevance In this study, exposures to PM 2.5 and specific PM 2.5 constituents during pregnancy were associated with increased odds of sPTB. Socioeconomic status and other environmental exposures modified this association
Evaluating the Implementation of the Liaison and Support System (LEA) at André Grégoire CHI: A Model for Integrating Obstetric Care in Vulnerable Populations
No full textIntroduction:The maternal mortality rate is a key health status indicator. Maternal health is largely impacted by social inequalities in health. Seine-Saint-Denis is the most unequal department in the Ilede-France region. The André Grégoire Intercommunal Hospital Center (CHI) is a reference point in the field of obstetric care as well as in the identification and support of vulnerable pregnant women who live in this department. Within this context, the Maternity Unit created the midwife career representative system or Liaison and Support project (LEA) financed by the Regional Health Agency. The goal of this research paper is to assess the implementation of this LEA project in the André Grégoire CHI. Methodology:We chose to use a qualitative study to assess the LEA project. We turned to an inductive qualitative approach using a constructivist paradigm. We used semi-structured interviews with open-ended questions. The patients who were selected had given birth in the André Grégoire CHI. We also plan to follow up with the patients after their hospitalization. We also conducted interviews with professionals in the Maternity Unit.Results: A total of 36 interviews was conducted with 16 patients and 20 health care professionals. The age of the mothers ranged from 19 to 38. All the patients had health insurance. The patients who were interviewed acknowledged the quality of care they received in the Maternity Department. Social support is a positive condition in the treatment system of women. However, the COVID 19 crisis led to difficulties for the patients during the post-partum period. The Hospital Center is also recognized for its obstetric care by the midwives. The main challenges to implementing the LEA project were the lack of communication and the competition that we observed. The lack of human and financial resources also has a negative impact on the quality of work life. The LEA project has the potential to reduce the workload -including administrative-of the midwives. Finally, the cityhospital link still needs to be created.Discussion: A managerial role is key if the LEA project is to succeed. The implementation of communication strategies in the Maternity Department is required. The merging of the LEA project and the Unit of Personalized support (UAP) is considered as a viable cooperation strategy. This merging would prevent redundancy. A communication campaign with independent midwives will also be necessary. A quantitative study is proposed in a second analysis. However, the financial situation of the CHI might prevent it from implementing this project. Conclusion:The implementation of the midwife career representative system could improve the treatment system of patients, provided: the relay to the hospital is guaranteed and the communication with the city is effective. The proposed LEA project should ensure the managerial and the coordination of care aspects so that patients can enjoy a continuity of care after leaving the hospital.</div
P1-7 - Vécu des femmes et des hommes en dialyse vis-à-vis de la maladie rénale chronique et leur perception de la greffe rénale : une étude qualitative (France)
No full textInternational audienceIntroduction :Le parcours d'accès à la greffe rénale commence par l'acceptation du patient d’être greffé après une discussion avec le néphrologue. La perception de la maladie et de la greffe rénale par le patient pourrait influencer l'acceptation d’être greffé. En mettant un accent particulier sur les différences homme-femme, cette étude qualitative vise à décrire le vécu des patients vis-à-vis de la maladie rénale ainsi que leurs perceptions de la greffe. Méthode : Les données ont été collectées par entretiens semi-directifs auprès de 60 hommes et 60 femmes ayant démarré la dialyse en 2021 et 45 néphrologues en Bretagne, Île-de-France et Normandie. Une analyse thématique inductive a été effectuée pour identifier les principaux déterminants. Résultats :Six grands thèmes ont été identifiés et répartis sous deux axes. L'axe 1 com- porte les thèmes relatifs à l'expérience des patients avec leur maladie : le fardeau de la maladie rénale chronique, la dialyse comme traitement contraignant, le rôle des proches dans la gestion de la maladie, les facteurs facilitateurs de l'acceptation de la maladie. L'axe 2 comporte des thèmes en lien avec les perceptions de la greffe rénale : la représentation faite de la greffe ou encore la provenance du greffon (donneur vivant ou décédé) comme déterminant de l'acceptation de la greffe et. Concernant les particularités liées au genre, l'impact psychologique de la maladie et le refus d'un greffon issu d'un donneur vivant étaient retrouvés essentiellement chez les femmes. Conclusion : Cette étude montre que le vécu de la maladie varie d'un patient à un autre et que les femmes en expriment plus fréquemment l'impact psychologique. Les expériences passées du patient ou de son entourage vis-à-vis de la maladie en générale et de la greffe en particulier, ainsi que les liens du patient avec sa famille, apparaissent comme des déterminants significatifs de l'acceptation d'un greffon
The diversity of researchers’ roles in sustainability science: the influence of project characteristics
No full textInternational audienceDespite recent studies of researchers’ roles in sustainability science, understanding the factors that influence them is a complex challenge. To address this lack of knowledge, we conducted a self-reflexive analysis involving 11 researchers from Rennes, France, who self-reflected on 12 projects conducted in north-western France over the past 15 years. This study investigates the roles of researchers in sustainability science projects by clustering these projects based on their characteristics and by evaluating the roles researchers assumed within each cluster. Four clusters were identified, ranging from academic research with minimal stakeholder involvement to highly interdisciplinary and transdisciplinary projects with significant stakeholder engagement. Researchers adopted multiple and dynamic roles, influenced by project characteristics but not deterministically. The role of transdisciplinary dialogue facilitator was frequently filled by intermediaries rather than researchers, highlighting a skills gap or a misalignment with traditional metrics of research performance. Self-reflection was significant in managing complex interdisciplinary and transdisciplinary projects, especially in clusters dealing with real-world problems and stakeholder interactions. The methodology, based on qualitative interviews and project clustering, proved effective and suggests that future research should include broader data collection and explore individual factors about mindset and motivation which influence researchers’ roles. These findings emphasise the need for better support and recognition of diverse roles in academic evaluation and suggest the potential benefits of specialised intermediaries in transdisciplinary research