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Accessibilité aux soins depuis le déploiement des maisons de santé pluri-professionnelles : une scoping review de la littérature française
No full textInternational audienc
L’impact de la pandémie de Covid-19 sur le suivi des malades rénaux chroniques: étude à partir du Système National des Données de Santé
No full textInternational audienceIntroduction : La pandémie de Covid-19 a mis à l’épreuve la continuité de la prise en charge des pathologies chroniques. L’objectif de cette étude était de mesurer son impact sur le suivi des patients atteints de maladies rénales chroniques (MRC) non suppléées en utilisant le Système National des Données de Santé (SNDS). Méthodes : Un algorithme de repérage de la MRC via la consommation de soins a été appliqué aux données SNDS 2017 et 2019. Les deux cohortes identifiées ont été suivies sur 2 années, découpées en périodes selon la chronologie de la pandémie. Le recours aux soins avec le médecin généraliste (MG) et le néphrologue ont été comparés entre les 2 cohortes.Résultats : Les cohortes de 2017 et 2019 incluaient respectivement 4 866 191 et 5 089 819 individus et ne différaient pas dans leurs caractéristiques (âge médian 68 ans, 59% de femmes). Dans la cohorte 2019, 94,0% et 6,3% des patients avaient eu respectivement au moins une consultation MG et au moins une consultation chez le néphrologue dans la première année de suivi (vs 95,2% et 6,4% pour la cohorte 2017). Au cours de la période aiguë de la pandémie (17 mars -10 mai), la proportion de patients ayant eu au moins une consultation avec le MG a diminué de 21,4% (59,3% dans la cohorte 2017 vs 46,6% dans la cohorte 2019) et de 50% (1,6% vs 0,8%) avec le néphrologue (Tableau 1).Discussion : Notre étude, utilisant des données nationales, montre que malgré une baisse aiguë de consultations au début de la pandémie, la continuité de suivi semble être assurée. Cependant, la survenue des décès et les conditions de démarrage de la dialyse restent à étudier. Des analyses par régions et qui identifient les facteurs associés au recours aux soins sont en cours
What are the effects of smoke-free and tobacco-free university campus policies, and how can they be assessed? A systematic review
No full textInternational audienceObjective : This article looks at the evaluation of smoke-free (SF) and tobacco-free (TF) university campus policies that ban smoking (and often vaping) both indoors and outdoors. To assess the effectiveness of these policies, we performed a systematic literature review to answer the following questions: what is the effect of SF/TF policies on campus users’ behaviors/norms/perceptions around smoking? Are the SF/TF policies an effective measure for reducing smoking among young adults? What methods and indicators can we use to assess the impact of SF/TF campus policies? What is the theoretical model underpinning the influence of SF/TF policies on the behavior of campus users?Methods: The PRISMA method was used. The article selection process included 54 articles published in scientific journals that analyzed the post-implementation impact of SF/TF campus policies. The quality of the selected articles was assessed.Results: Most of the research on SF/TF campus policies has been conducted in the United States using quantitative methodologies. Most of these studies show that SF/TF policies reduce positive beliefs about smoking and its acceptability, influence smoking behavior (reducing smoking initiation and increasing the number of quits and quit attempts), and reduce exposure to passive smoking and pollution from cigarette butts. User acceptability of SF/TF policies is generally high. Limitations of SF/TF campus policies include difficulty for smokers to comply with them, persistence of passive smoking around campuses, and limited uptake of on-campus cessation support services provided to smokers.Discussion: The various mediating and moderating variables identified in the literature have made it possible to propose a model of the potential influence of SF/TF policy on campus users, based on the theory of planned behavior. Based on this review, we provide health professionals and higher education institutions wishing to implement a SF/TF campus policy with a set of indicators that can serve to assess the impact of a SF/TF campus policy (attitudes, acceptability, beliefs, norms, exposure to passive smoking and pollution, changes in smoking behavior).Conclusion: Based on scientific evidence, the implementation of SF/TF campus policies in France is an important measure to help combat smoking in young adults
Le partenariat comme catalyseur de la démocratie en santé : le rôle des tiers dans la mise en place d'un environnement relationnel encapacitant
No full textInternational audienceThe current healthcare ecosystem does not foster democracy in health. Beyond the need to rethink the nature and scope of democratic spaces within it, there is an urgent and priority need to consider how to create relational conditions that enable the effective use of these spaces. The goal is to cultivate empowering cooperative relationships between healthcare users and professionals—relationships of partnership. This article aims to define and illustrate the intermediary work of public actors and structures that are currently contributing to the establishment of this empowering relational environment.L'écosystème actuel de la santé ne favorise pas la démocratie en santé. Au-delà de la nécessité de repenser la nature et l'envergure des espaces démocratiques en son sein, il est urgent et prioritaire de penser l'aménagement des conditions relationnelles permettant d'investir ces espaces de manière à faire émerger des relations de coopération encapacitantes entre les usagers et les professionnels de la santé, c'est-à-dire des relations de partenariat. Cet article vise à définir et illustrer le travail de tiers des acteurs et structures publiques qui contribuent aujourd'hui à la mise en place de cet environnement relationnel encapacitant
QAI-Sport project : characterization of Indoor Air Quality in sports facilities
No full textInternational audienceIndoor air quality in sports facilities is still poorly studied compared to that of housing and other public buildings. One objective of the QAI-Sport project consisted in providing an overview of the organic chemicals and microbiological composition in air of 10 sports halls having different activities: dojos, motricity rooms and weight rooms. Targeted and non-targeted analytical approaches were applied to provide the broadest possible screening of VOCs, SVOCs and microbiological contaminants in indoor air and settled dusts (for SVOCs) with a focus on emerging pollutants. Two sampling campaigns were performed in unoccupied and occupied rooms to assess the impact of sporting activity on IAQ.For VOCs, active sampling using various supports was applied: Carbograph 4 cartridge, 2,4-dinitrophenylhydrazine cartridge for carbonyls and bubbling solution for carboxylic acids. Analyses were carried out by ATD-GC-MS, HPLC-UV and ion chromatography, respectively. Indoor air SVOCs were sampled on cartridge containing polyurethane foam and quartz filter to determine the total concentration (gas + suspended particles) of about forty compounds. Samples were analyzed by GC/MS/MS after pressurized solvent extraction (PLE). Settled dust were collected by vacuum cleaner in occupied rooms and sieved to 100 μm before PLE and GC/MS/MS analysis. For microbiological contaminants, air was sampled by cyclonic collector in liquid medium and analyzed by culture (bacteria and molds identification) and molecular biology (PCR) for viruses, including Sars-Cov-2.About 50 VOCs were identified and quantified. Composition and concentrations are globally close to those of other indoor environments, with a predominance of carbonyls, especially hexanal. However, some specific and emerging compounds (like benzothiazole, decamethylcyclopentasiloxane and 1-(2-methoxy-1-methyl ethoxy)-2-propanol)) were highlighted. Acetone and 6-methyl-5-hepten-one, emitted by human body, were identified as occupancy tracers. SVOCs are mainly phthalates (DiBP, DBP in air, DEHP, DiNP in dust), organophosphate flame retardants (TCPP in air, EHDPP, TPP in dust) and PAHs (Fluorene, phenanthrene in air, pyrene in dust) which concentrations are particularly high in one weight room’s dust, probably issued from a recycled rubber flooring. Microbiological contamination is similar to residential ones and Sars-CoV-2 was not detected. The project will further consist in identifying pollutants’ sources, understanding their partitioning indoors and assessing exposure
Accidents du travail : pourquoi demeurent-ils encore aussi peu visibles ?
No full texthttps://theconversation.comDepuis 1996, on commémore chaque année dans le monde et en France, les personnes décédées en lien avec leur travail ou activité professionnelle. Partout sur la planète, manifestations, reportages et interviews mettent en avant, le 28 avril, les drames de celles et ceux qui « perdent leur vie à la gagner ». À l’échelle mondiale, l’Organisation internationale du travail estime le nombre de décès liés au travail à près de deux millions chaque année
Biocide and other semi-volatile organic compounds in settled indoor dust of CRESPI daycare centers and implication for public health
No full textInternational audienceThis study investigates the presence of biocides and other semi-volatile organic compounds (SVOCs) used in cleaning products in the settled dust of daycare centers and discuss their health impact through ingestion by young children. In Paris metropolitan area, 106 daycares area were investigated between 2019‐2022. Fifteen substances were analyzed in settled indoor dust by gas chromatography-tandem mass spectrometry. Detection rates ranged from 5 to 100%. Galaxolide and benzophenone showed highest median concentration: respectively 884 ng/g and 819 ng/g. The daily intakes (DI) of each chemical through settled dust ingestion were estimated and compared to those from food, inhalation, and dermal contact reported in the literature. Daily intakes from settled dust for musks, triclosan, geraniol, benzophenone, 2-phenylphenol, bifenthrin, and 4-n-nonylphenol were lower than those reported in the literature for other countries. The proportion of dust ingestion to total DI was negligible, except for benzophenone (DI=34%) for children aged 3 to 11 months. The DIs were well below the respective toxicological reference values for isothiazolinones, 4-tert-butylphenol, chlorocresol, and diclosan.Our results suggest that exposure to these biocides and the other SVOCs, taken individually, by dust ingestion in daycares, is not a major public health concern. However, benzophenone, presumed carcinogen for humans, may require further investigation because of its presence in several daycares
Health Outcomes Related to Multiple Exposures in Occupational Settings: A Review
No full textInternational audienceIndividuals are constantly exposed to hazardous factors that can affect their health, the hazards encountered in the workplace can lead to the development of occupational diseases. Risk mitigation measures help to reduce the risks, but they are often designed without consideration of interactions between occupational exposures. Therefore, there is a need for research and it resulted in international research plans and programmes. The aim of this scoping review is to provide an overview of the scientific results related to the link between multiple occupational exposures and human health outcomes. Sixty-three articles were reviewed. Research articles were included only if they mentioned: several combined exposures, the direct characterisation of each exposure, and exposure/health outcome associations. Seven activity sectors were identified: ‘extraction and energy production and distribution’, ‘health care’, ‘banks, public administration and defence’, ‘chemical production’, ‘manufacturing industry’, ‘agriculture and food industry’ and ‘transport and logistics’. Six multiple exposures scenarios were identified: chemical (n = 35), chemical/physical-biomechanical (n = 22), chemical/psychosocial-organisational (n = 6), physical-biomechanical (n = 9), physical-biomechanical/psychosocial-organisational (n = 13), and psychosocial-organisational (n = 12). The health problems identified concern nervous, mental, respiratory, musculoskeletal, auditory and other systems. Eighty-eight of 97 (91%) multiple exposure/health problem associations were reported to be statistically significant. Twenty studies (32%) provided specific risk prevention advice for multiple exposures. Prevention aimed at reducing risks to workers' health is still underdeveloped, further research is needed to improve prevention methods. No study was related to biological risk, and some other multiple exposures known to have health effects were not identified as well. This highlights the need for more multiple exposures research
Habiter avec une maladie respiratoire chronique : les dynamiques territoriales du Care dans le cas de la mucoviscidose.
No full textInternational audienceWhen a child suffers from a chronic respiratory disease, his parents question their ways of dwelling. They want to protect their child from the common risks inside and outside their home. They seek to adapt their living environment to take care of his respiratory health. The article analyses the residential path of Joshua’s family, a young boy with cystic fibrosis. It shows why his parents have chosen to live in Brittany. It highlights the various qualities that make a region an attractive place to live and care for a sick child. It underlines the need for a balance between the characteristics of the environment (such as climate), a suitable healthcare offer, and the society’s sensitivity and commitment to dealing with a rare disease like cystic fibrosis.L’article propose une réflexion sur les facteurs susceptibles de rendre un territoire attractif pour les malades respiratoires chroniques dans le but de préserver au mieux leur état de santé. Dans cet objectif, il présente une analyse des dynamiques territoriales du care dans le cas de la mucoviscidose
Voie d'accouchement dans les pays à revenu faible et intermédiaire : facteurs non cliniques influençant la prise de décision
No full textOver the past three decades, there has been a significant global increase in caesarean section rates without clear benefits for maternal health. The aim of this thesis, carried out as part of an international project (Argentina, Burkina Faso, Thailand and Vietnam), is to better understand the non-clinical factors leading to the increase in caesarean section rates in the study hospitals, in order to inform the implementation of effective interventions to reverse the trend in these hospitals. Using data from a cross-sectional survey among women who had just given birth in the 32 hospitals participating in the project, we assessed the maternal factors, especially women's preference, and the organisational factors that influence the use of caesarean sections within a population of low-risk women. Employing several multilevel logistic regression models and propensity score analysis, we evaluated the associations between these factors and the mode of delivery. Our findings reveal that women's preference for caesarean section is associated with an increased likelihood of undergoing this procedure. Although such preferences are relatively low within hospitals, they are more prevalent among nulliparous women, often rooted in apprehension towards pain and childbirth. Additionally, high caesarean section rates are driven by organizational norms and healthcare professionals' excessive workload. These findings suggest the need to support women and their preferences, strengthen human and physical resources in delivery rooms and optimise the organisation of care provided to pregnant women.Les taux mondiaux de césariennes ont considérablement augmenté au cours des 30 dernières années, sans bénéfices évidents pour la santé maternelle. L'objectif de cette thèse, réalisée au sein d'un projet international (Argentine, Burkina Faso, Thaïlande et Vietnam), était de mieux comprendre les facteurs maternels et organisationnels non cliniques conduisant à l'augmentation des taux de césarienne dans les hôpitaux d'étude, pour informer la mise en oeuvre d'interventions efficaces afin d'inverser la tendance dans ces hôpitaux. A partir des données d'une enquête transversale menée auprès de femmes venant d'accoucher dans les 32 hôpitaux participants au projet, nous avons évalué les facteurs maternels, en particulier la préférence des femmes, et les facteurs organisationnels qui influencent le recours à la césarienne dans une population de femmes à bas risque. Plusieurs modèles de régression logistiques multi-niveaux et une analyse par score de propension ont été mobilisées pour mesurer les associations entre les facteurs étudiés et la voie d'accouchement. Les résultats montrent que la préférence des femmes pour la césarienne augmente leur probabilité d'accoucher par césarienne. Cette préférence reste faible dans les hôpitaux mais plus fréquente chez les femmes nullipares et basée sur la peur de la douleur et de l'accouchement. Enfin, des normes organisationnelles et la charge de travail excessive des professionnels de santé contribuent à la pratique excessive de la césarienne. Ces résultats suggèrent le besoin de soutenir les femmes et leurs préférences, de renforcer les ressources humaines et physiques dans les salles d'accouchement et d'optimiser l'organisation des soins dispensés aux femmes enceintes