Scientific publications portal of EHESP researchers
Not a member yet
5609 research outputs found
Sort by
Influenza vaccine effectiveness in older adults: study methods, transparency and impacts on public health
No full textInternational audienc
#1778 Effects of comorbidities, social deprivation and sex on the excess mortality of French ESKD patients on dialysis
No full textInternational audienceBackground and Aims: Inequalities in access to care may affect End-stage Kidney Disease (ESKD) patient's overall mortality, i.e. mortality directly or indirectly related to ESRD (excess mortality) as well as mortality related to other causes of death. Previous studies in France have identified sex and comorbidities, especially diabetes and cardiovascular diseases, as factors influencing the overall mortality of ESKD patients, whereas social deprivation was not associated with overall mortality. However, no study has yet examined the impact of these factors on excess mortality in dialysis patients. This study thus aims to quantify the effects of social deprivation, sex and comorbidities on the excess mortality of ESKD patients on dialysis in France. Method: This retrospective observational study included adults aged 18-85 years who started dialysis in France between 2017 and 2019, and were followed up until 31 December 2022. Dialysis patients receiving a transplant were censored. Analyses were based on the excess hazard approach: the overall mortality rate was decomposed into the sum of a mortality rate associated with ESKD (the excess rate) and a mortality rate associated with other causes of death (the expected rate). The latter is usually drawn from mortality tables for the general population stratified by demographic covariates. A model is then fitted in order to estimate the excess mortality hazard: the impact of covariates on this hazard is quantified in terms of excess hazard ratios. In France, mortality tables are provided by the “Institut National de la Statistique et des Études Économiques” and stratified by age, calendar year, sex, and “départements” of residence. However, stratification by level of social deprivation or levels of the Charlson Comorbidity Index is not available, which may bias the excess mortality hazard estimates. To assess the impact of using inadequately stratified life tables on estimating excess hazard, we compared the following models using Akaike's Information Criterion: (i) an excess hazard model using the standard life tables and accounting for the hierarchical structure of the data by including a random intercept for the “département” (M0), (ii) an excess hazard model with a model-based life table correction and with (M1) or without (M2) the random intercept at the “département” level, and (iv) an excess hazard model in which the life table correction is achieved by using an individual frailty term (M3). Results: 29148 dialysis patients were included in the study, 65% of whom were men. Compared to the other regression models, the excess hazard model (M2) was the best model (AIC: M0 = 58936.69; M1 = 58966.94, M2 = 58870.41, M3 = 58908.59). There were no differences in excess mortality by deprivation status {EHR (Q5 versus others) 1.054 [0.992; 1.120]; p value = 0.088}. Excess mortality was higher for women than for men {HER (women versus men) = 1.083 [1.017; 1.154]; P-value = .012}. Excess mortality was higher in patients with comorbidities than in those without, and in those who started dialysis in emergency compared with those who started on a planned basis. Elderly patients on dialysis had a higher excess hazard than younger patients. The ratio between the other cause mortality of French dialysis patients and general population was equal to 2.18[1.95; 2.45]. This means that the other cause mortality of French dialysis patients is 2.18 higher than that of the general population with the same characteristics (Table 1, Fig. 1). Conclusion: Using a methodology allowing to account for the insufficient stratification of population mortality tables, we identified several factors other than sex that might be targeted by public health interventions. For example, improved referral to nephrologists could reduce the impact of emergency dialysis. The extent of these inequalities will be better understood by comparison of these results with those of ESKD patients on dialysis in European countries
Redefining pandemic preparedness: Multidisciplinary insights from the CERP modelling workshop in infectious diseases, workshop report
No full textInternational audienceIn July 2023, the Center of Excellence in Respiratory Pathogens organized a two-day workshop on infectious diseases modelling and the lessons learnt from the Covid-19 pandemic. This report summarizes the rich discussions that occurred during the workshop. The workshop participants discussed multisource data integration and highlighted the benefits of combining traditional surveillance with more novel data sources like mobility data, social media, and wastewater monitoring. Significant advancements were noted in the development of predictive models, with examples from various countries showcasing the use of machine learning and artificial intelligence in detecting and monitoring disease trends. The role of open collaboration between various stakeholders in modelling was stressed, advocating for the continuation of such partnerships beyond the pandemic. A major gap identified was the absence of a common international framework for data sharing, which is crucial for global pandemic preparedness. Overall, the workshop underscored the need for robust, adaptable modelling frameworks and the integration of different data sources and collaboration across sectors, as key elements in enhancing future pandemic response and preparedness
Harmonized quality assurance/quality control provisions to assess completeness and robustness of MS1 data preprocessing for LC-HRMS-based suspect screening and non-targeted analysis
No full textInternational audienceNon-targeted and suspect screening analysis using liquid chromatography coupled to high-resolution mass spectrometry (LC-HRMS) holds great promise to comprehensively characterize complex chemical mixtures. Data preprocessing is a crucial part of the process, however, some limitations are observed: (i) peak-picking and feature extraction might be incomplete, especially for low abundant compounds, and (ii) limited reproducibility has been observed between laboratories and software for detected features and their relative quantification. We first conducted a critical review of existing solutions that could improve the reproducibility of preprocessing for LC-HRMS. Solutions include providing repositories and reporting guidelines, open and modular processing workflows, public benchmark datasets, tools to optimize the data preprocessing and to filter out false positive detections. We then propose harmonized quality assurance/quality control guidelines that would allow to assess the sensitivity of feature detection, reproducibility, integration accuracy, precision, accuracy, and consistency of data preprocessing for human biomonitoring, food and environmental communities
Robert Castel (mars 1933 – mars 2013). Portrait
No full textPortait de Robert Castel pour le Bulletin d'histoire de la sociologi
En France, les personnes handicapées peuvent maintenant choisir de vivre dans un logement en dehors des institutions.
No full textInternational audienceDepuis les années 2000, le modèle des droits et de l’autonomie s’est imposé en France. La loi de 2005 pose la base de l’accès aux droits des personnes handicapées en reconnaissant l’accès de tous à l’ensemble de la société. Au niveau international, la convention de l’ONU relative aux droits des personnes handicapées, ratifiée par la France en 2010, promeut les droits et la participation des personnes handicapées. Elle pose dans son article 19 la possibilité de « choisir librement son lieu de vie », c’est-à-dire le type d’habitat mais également sa localisation. Pour autant, en 2023, beaucoup de personnes se trouvent encore en institution par défaut, ou à domicile sans l’accompagnement ni les aménagements nécessaires, et souvent sans possibilité d’investir l’environnement extérieur. Au-delà des discours, la vie à domicile est loin d’être possible pour tous en France. (Introd.
Telemedicine’s Vital Role Amidst Pandemic and Political Turmoil in Myanmar: Lessons from Real-World Experiences
No full textInternational audienceMyanmar faced unprecedented challenges during the tumultuous second wave of COVID-19 in September 2021, compounded by political upheaval following a coup. The healthcare infrastructure was severely compromised, and healthcare professionals faced persecution. This paper explores the pivotal role of telemedicine during these crisis-ridden times, using real-world experiences of patients navigating the dual crises.</div
The epidemiologic case for urban health: conceptualizing and measuring the magnitude of challenges and potential benefits
No full textInternational audienceWe discuss how epidemiology has been and can continue to be used to advance understanding of the links between urban areas and health informed by an existing urban-health conceptual framework. This framework considers urban areas as contexts for health, determinants of health and modifiers of health pathways, and part of a complex system that affects health. We highlight opportunities for descriptive epidemiology to inform the context of urban health, for example, by characterizing the social and physical environments that give rise to health and the actions that change those conditions. We then describe inferential tools for evaluating the impact of group-level actions (e.g., interventions, policies) on urban health, providing some examples, and describing assumptions and challenges. Finally, we discuss opportunities and challenges of applying systems thinking and methods to advance urban health. While different conceptual frames lead to different insights, each perspective demonstrates that urban health is a major and growing challenge. The effectiveness of urban health knowledge, action, and policy as the world continues to urbanize can be informed by applying and expanding upon research and surveillance methods described here.</div
Doctrine de prévention et activité de service : analyse des points de dissonance entre le dispositif de prévention et l’activité de médiation sociale
No full textInternational audienceThe frameworks of thought and action that structure the prevention of occupational risks today form a social apparatus in the sense that Foucault intended. This social apparatus, qualified as a "prevention doctrine", was built according to the classes of industrial situations and is now being questioned by service activities. Based on ergonomic analysis of work and the conduct of prevention projects in a social mediation structure, this article identifies a specific point of the doctrine that is at odds with the activity of mediators: subordination. Indeed, the link between subordination and prevention leads to thinking about the latter in a perimeter and on a model of power far from the real activity of the workers. This article thus provides specific insights into the gap between prevention doctrine and service activities, but also opens up research perspectives through the conceptualization of prevention as a social apparatus.Les cadres de pensée et d’action qui structurent la prévention des risques professionnels forment aujourd’hui un dispositif au sens de Foucault. Ce dispositif, qualifié de « doctrine de prévention », s’est construit en référence aux classes de situations industrielles et se retrouve aujourd’hui remis en question par les activités de service. À partir d’une analyse ergonomique du travail et de la conduite de projet de prévention dans une structure de médiation sociale, cet article cible un point spécifique de la doctrine qui s’inscrit en décalage avec l’activité des médiatrices : la subordination. En effet, le lien qui s’établit entre subordination et prévention amène à penser cette dernière dans un périmètre et sur un modèle du pouvoir éloignés de l’activité réelle des travailleuses. Cet article fournit ainsi des connaissances spécifiques sur l’écart entre la doctrine de prévention et les activités de service, mais ouvre également des perspectives de recherche au travers de la conceptualisation de la prévention en tant que dispositif
Perinatal chemical exposome and micro-sampling: from targeted to non-targeted analysis [Poster 24 – S1-P24]
No full textInternational audienceSeveral chronic diseases and developmental and reproductive disorders are suspected of beingcaused by exposure to chemicals mixtures in utero. It is therefore important to be able to assess thechemical exposome at birth and conduct biomonitoring (HBM) studies for the perinatal period. Micro-sampling techniques, such as dried blood spots (DBS), are innovative because of their non-invasivenature, however, many challenges remain before DBS can be used in HBM studies.The main objective of the thesis project presented here is to develop protocols for DBS sampling andsensitive and robust analytical methods for analysing mixtures of micropollutants from DBS. Followingon from and in parallel with a systematic review of this subject, sample preparation methods are beingdeveloped with a view to quantify PFAS and POPs from DBS, respectively by liquid and gaschromatography mass spectrometry. The problems associated with sampling contamination arecurrently being studied.As a next step, suspect screening and non-targeted analyses using LC-ESI-IMS-HRMS will allow toconsiderably increase the number of exogenous compounds that can be analysed in mixtures. Finally,after studying the comparability of these methods with those used for serum analysis, and setting upstandard operating procedures, the ultimate aim is to be able to apply these methods to the study ofassociations between chemical exposome and health events, as well as comparing exposures betweenmothers and their children, in order to gain a better understanding of the extent to which mixtures ofchemicals we are exposed at birth