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Développement et mise en œuvre d’une approche innovante de criblage à grande échelle pour une caractérisation étendue de l’exposition humaine aux pesticides [Poster 26 – S5-P26]
No full textInternational audienceL’exposition chimique aux pesticides est un sujet de préoccupation majeure en santé.Actuellement, l’analyse de cette exposition chimique est effectuée de manière plus ou moins directe,par exemple via des questionnaires ou en quantifiant un nombre restreint de substances dans desmatrices biologiques, sang ou urine (méthodes ciblées de biosurveillance). Ces approches sontinsuffisantes pour prendre en compte la complexité et la totalité des expositions auxquelles lesindividus sont exposés. L’objectif de ce projet est de développer un nouveau workflow analytiquemultiplexe en associant trois techniques analytiques complémentaires (HILIC-LC-HRMS ; LC-ESI-HRMS; GC-HRMS) et des outils bio-informatiques innovants permettant de caractériser à large échelle,l’exposition interne de l’homme aux pesticides. L’approche utilisée est celle du « profilage desuspects » en utilisant des données acquises en spectrométrie de masse haute résolution afin decribler plusieurs milliers de marqueurs provenant de produits phytosanitaires, leurs métabolites(phase I et II) ou produits de dégradation. Une librairie de marqueurs de plus de 200 pesticides et deleurs métabolites (i.e., via Biotransformer) a été élaborée pour couvrir une large gamme de propriétésphysicochimiques (logKow : (-4.71;8.38) ; MM/g.mol (72;720). Les données LC-ESI-HRMS présentéesont été pré-traitées par Galaxy (XCMS) et le profilage de suspect grâce à l’outil Scannotation et MS-DIAL4. Cette approche multiple permettra de caractériser et de complémenter les donnéesd’exposition liées à l’usage de pesticides et de tester leurs relations avec des paramètres de santé afind’identifier des substances délétères pour la santé humaine
Du “faire pour” au “faire avec” les usagers : comment développer le partenariat en santé dans les soins primaires ?
No full textInternational audienceLe partenariat en santé est une relation de coopération basée sur la complémentarité des savoirs entre le patient et les professionnels, qui favorise l’autodétermination du premier. Cet article mobilise le cadre du modèle de Montréal appliqué aux soins primaires ainsi que les fruits d’un travail de recherche ayant permis d’identifier les facteurs clés de succès d’une démarche d’intégration de patients partenaires en maison de santé pluriprofessionnelle
Comprehensive characterization of European house dust contaminants: Concentrations and profiles, geographical variability, and implications for chemical regulation and health risk
No full textInternational audienceThis study investigated the concentration profiles and geographical variability of contaminants in house dust across Europe. A collaborative trial (CT) was organized by the NORMAN network using pooled dust and advanced chromatographic and mass spectrometric techniques combined with suspect screening and non-target screening (NTS). Over 1200 anthropogenic compounds were tentatively identified. Additionally, seventy-five individual samples were subjected to target analysis and NTS. The median concentrations of most contaminants varied <3-fold across Europe, and the contaminant profile of European dust was similar to that of North American dust, which was investigated in a previous CT. This similarity may be attributed to the use of similar consumer articles and building materials throughout the developed world. Multivariate data analysis revealed geographical trends in contaminant distribution, with north-south gradients across Europe. Geographical trends were more frequently found for compounds with rapid release (pharmaceuticals, personal care products, fragrances, pesticides, biocides) and smoke-related compounds. The concentrations of chlorinated paraffins, polycyclic aromatic hydrocarbons (PAHs), perfluorinated alkyl substances and stimulants generally increased from north to south, whereas the biocides levels decreased from north to south. Despite widespread presence of in-use contaminants in dusts, some of the highest risks come from compounds that have been restricted for decades or more. These include di(2-ethylhexyl) phthalate (DEHP), polychlorinated biphenyl (PCB) 118 and polybrominated diphenyl ethers 47, 99, and 153. DEHP remains the most abundant contaminant in European house dust, while the other compounds are classified as persistent organic pollutants (POPs). Moreover, there is a striking lack of reliable toxicity data, particularly for emerging compounds. For instance, although acceptable daily intakes (ADIs) were examined for 202 compounds, only 46 had consensus-based ADI values. The results highlight the need for proactive measures to prevent hazardous chemicals from entering the market and for careful selection of substitute chemicals, when such are needed, to avoid regrettable substitutions
Antimicrobial prescribing practices and factors associated with antimicrobial prescribing in hospitalized COVID-19 patients in Oyo state: A retrospective study
No full textInternational audienceBackground: Proportion of hospitalized COVID-19 patients receiving antimicrobial drug is significantly high despite evidence of low level of actual bacterial co-infection, potentially contributing to poor health outcome and global antimicrobial resistance. Materials and methods: A retrospective study was performed on antimicrobial agents prescribed to adult patients with confirmed COVID-19 admitted across three isolation facilities between 1 March 2020 and 30 April 2021 in Ibadan, Oyo state, Nigeria. From individual records, we evaluated patient demographics, COVID-19 risk factors, diagnostic testing, disease severity and antimicrobial utilization. The primary aim was to determine the prevalence of antimicrobial prescription as well as factors associated with antimicrobial prescribing in hospitalized patients with COVID-19 in Oyo state. Results: In total, 271 patients were included in this study. The median age of the population was 51 years (IQR; 32–62 years). The mean duration of hospital admission was 13 days (IQR: 10–14 days). Majority of participants were symptomatic (81.5%). All participants had a COVID-19 PCR test performed and none had bacterial culture performed. All patients received antimicrobial therapy across the entire cohort. The mean DOT per LOT across cohorts was 1.2 for mild cases, 1.4 for moderate cases and 1.3 for severe cases. Factors associated with the number of antimicrobials per prescription were being single (P = 0.02), being below 60 years of age (P = 0.04), mild COVID-19 symptoms (P < 0.001) and diabetes comorbidity (P = 0.03). Conclusion: Given the high rate of antimicrobial prescription and absence of bacteriological culture analysis in these patients, there is risk of development and spread of antimicrobial resistant. Continuous review of antimicrobial prescription is critical in the management of hospitalized COVID-19 patients
Étudier conjointement l’isolement, la contention mécanique et la contention chimique : étude pilote dans trois établissements psychiatriques français
No full textInternational audiencePsychiatric wards that only exceptionally use isolation and mechanical restraint may be suspected of using "chemical restraint". However, in the case of these services, the hypothesis of a reduction in the general level of restraint can also be formulated. Prior to a comprehensive study to test these hypotheses, the current research aims to assess indicators which define high levels of the use of these measures and a relevant sample. The study was conducted in three facilities with 254 hospitalized patients over a week. Five per cent experienced isolation, 2% mechanical restraint, and 13% received high doses of medication (including "as needed" treatments). These figures are below literature data and national averages. Variances exist among centers, with one showing higher percentages for all three measures. While confirming the feasibility of studying these measures together, the study suggests the need for longer observations and continuous evaluation of prescription practices to better reflect yearly isolation and restraint trends. Future studies should involve more centers and include case studies for a nuanced understanding of administration practices in relation to prescriptions.Les services de psychiatrie qui ne recourent qu’exceptionnellement à l’isolement et la contention mécanique peuvent être soupçonnés de recourir à la « contention chimique ». Cependant, face à ces services, l’hypothèse d’une diminution du niveau général de contrainte peut également être formulée. Préalablement à une recherche d’ampleur visant à tester ces hypothèses, la présente étude vise à tester les indicateurs permettant de définir des hauts niveaux de recours à ces mesures et un échantillon pertinent. L’étude a été déployée dans trois établissements auprès des patients hospitalisés sur une semaine donnée, à savoir 254 patients. Cinq pour cent des patients de l’échantillon ont fait l’objet d’une mesure d’isolement et 2 % d’une mesure de contention. Les hautes doses ont concerné 13 % des patients (en comptant les traitements si besoin) et 9 % des patients (en les excluant). Ces données sont inférieures aux données de la littérature et aux moyennes nationales. Des différences apparaissent cependant entre les centres, l’un d’eux affichant, pour les trois mesures des pourcentages plus élevés que les deux autres. Cette étude confirme la faisabilité d’étudier conjointement les trois mesures, la pertinence des indicateurs utilisés et les possibilités d’extraction des données. Cependant, la semaine étudiée ne paraissant pas le reflet de ce qui s’observe sur l’ensemble de l’année en matière d’isolement et de contention, il serait opportun de multiplier les semaines d’observation, voire d’évaluer en continu les pratiques de prescription. Les futures études devront aussi inclure un nombre plus important de centres et inclure également des études de cas, permettant d’approcher plus finement les pratiques d’administration en rapport avec celles de prescriptions
#Bartender: portrayals of popular alcohol influencer’s videos on TikTok©
No full textInternational audienceBackground - Despite widespread use of the short-video social media platform TikTok © , limited research investigates how alcohol is portrayed on the platform. Previous research suggests that a driver of alcohol content on TikTok © , in part, comes from bartenders demonstrating how to make drinks. This study aims to explore the characterizing patterns of how bartender influencers on TikTok © feature and incorporate alcohol in their videos. Methods - We identified the global top 15 most followed bartenders on TikTok © in 2021 (cumulative 29.7 million subscribers) and the videos they posted in November and December 2021, the period just before Christmas and New Year, when alcohol tends to be more marketed than in other periods. The videos were coded based on five criteria: (1) the presence of alcohol or not; (2) alcohol categories; (3); alcohol brand(s) if visible; (4) the presence of candies and other sweet products; (5) presence of cues that refer to young people’s interests. Results - In total, we identified 345 videos, which received 270,325,600 views in total, with an average of 18,021,707 views per video. Among these 345 videos, 92% (n = 317) displayed alcohol in their cocktail recipes (249,275,600 views, with an average of 786,358 views). The most common types of alcohol present in videos were liquor, vodka, rum, and whiskey, all of which are high-ABV beverages. 73% (n = 230) displayed or mentioned an alcohol brand. 17% (n = 55) associated alcohol with sweet products such as different types of candy (53,957,900 views, with an average of 981,053 views per video). 13% (n = 43) contained cues appealing to young people (e.g., cartoons, characters) (15,763,300 views, with an average of 366,588 views per video). Conclusions - Our findings suggest a large presence of positively framed alcohol content posted by popular bartenders on TikTok © . As exposure to digital marketing is related to an increase in alcohol consumption, particularly among young people, regulations are needed to protect the public from alcohol-related harms
Effectiveness of a School- and Primary Care-Based HPV Vaccination Intervention: The PrevHPV Cluster Randomized Trial
No full textInternational audienceImportance - The human papillomavirus (HPV) vaccine is safe and effective, yet vaccination coverage remains below public health objectives in many countries. Objective - To examine the effectiveness of a 3-component intervention on HPV vaccination coverage among adolescents aged 11 to 14 years 2 months after the intervention ended, each component being applied alone or in combination. Design, Setting, and Participants - A cluster randomized trial with incomplete factorial design (PrevHPV) was conducted between July 1, 2021, and April 30, 2022, in French municipalities receiving 0, 1, 2, or 3 components of the intervention. Randomization was stratified by school district and municipalities’ socioeconomic level. Analyses were carried out on 11- to 14-year-old adolescents living in all participating municipalities, regardless of what had been implemented. Intervention - The PrevHPV intervention had 3 components: (1) educating and motivating 11- to 14-year-old adolescents in middle schools, along with their parents; (2) training general practitioners (GPs) on up-to-date HPV information and motivational interviewing techniques; and (3) free HPV vaccination at school. Main Outcomes and Measures - The primary outcome was HPV vaccination coverage (≥1 dose) 2 months after the intervention ended among 11- to 14-year-old adolescents living in participating municipalities, based on the French national reimbursement database and data collected during the trial in groups randomized to implement at-school vaccination. Results - A total of 91 municipalities comprising 30 739 adolescents aged 11 to 14 years (15 876 boys and 14 863 girls) were included and analyzed. Half the municipalities were in the 2 lowest socioeconomic quintiles and access to GPs was poor in more than two-thirds of the municipalities. Thirty-eight of 61 schools (62.3%) implemented actions and 26 of 45 municipalities (57.8%) had at least 1 trained GP. The median vaccination coverage increased by 4.0 percentage points (IQR, 2.0-7.3 percentage points) to 14.2 percentage points (IQR, 9.1-17.3 percentage points) at 2 months. At-school vaccination significantly increased vaccination coverage (5.50 percentage points [95% CI, 3.13-7.88 percentage points]) while no effect was observed for adolescents’ education and motivation (−0.08 percentage points [95% CI, −2.54 to 2.39 percentage points]) and GPs’ training (−1.46 percentage points [95% CI, −3.44 to 0.53 percentage points]). Subgroup analyses found a significant interaction between at-school vaccination and access to GPs, with a higher effect when access was poor (8.62 percentage points [95% CI, 5.37-11.86 percentage points] vs 2.13 percentage points [95% CI, −1.25 to 5.50 percentage points]; P = .007 for interaction). Conclusions and Relevance - In this cluster randomized trial, within the context of the late COVID-19 pandemic period and limited school and GP participation, at-school HPV vaccination significantly increased vaccination coverage. The trial did not show a significant effect for training GPs and education and motivation, although it may be observed after more time has elapsed after the intervention
The relative effectiveness of a high-dose quadrivalent influenza vaccine vs standard-dose quadrivalent influenza vaccines in older adults in France: a retrospective cohort study during the 2021-22 influenza season
No full textBackground - High-dose quadrivalent influenza vaccine (HD-QIV) was introduced during the 2021/22 influenza season in France for adults aged ≥65 years as an alternative to standard-dose quadrivalent influenza vaccines (SD-QIV). This is the first study to estimate the relative vaccine effectiveness (rVE) of HD-QIV versus SD-QIV against influenza-related hospitalizations in France. Methods Community-dwelling individuals aged ≥65 years with reimbursed influenza vaccine claims during the 2021/22 influenza season were included from the French national health insurance database. Individuals were followed up from vaccination day to 30 June 2022, nursing home admission or death date. Baseline socio-demographic and health characteristics were identified from medical records over the 5 previous years. Hospitalizations due to influenza and other causes were recorded from 14 days after vaccination to end of follow-up. HD-QIV and SD-QIV vaccinees were matched using 1:4 propensity score matching with an exact constraint on age group, sex, week of vaccination and region. Incidence rate ratios (IRR) were estimated using zero-inflated Poisson or zero-inflated negative binomial regression models. Results We matched 405,385 (99.9%) HD-QIV to 1,621,540 SD-QIV vaccinees. HD-QIV was associated with a 23.3% (95%CI: 8.4–35.8) lower rate of influenza hospitalizations compared to SD-QIV. Post-matching, we observed higher rates in the HD-QIV group for hospitalizations non-specific to influenza and for negative control outcomes, suggesting residual confounding by indication. Conclusions HD-QIV was associated with lower influenza-related hospitalization rates versus SD-QIV, consistent with existing evidence, in the context of high SARS-CoV-2 circulation in France and likely prioritization of HD-QIV for older/more comorbid individuals
Introduction. Sciences sociales et médico-social : les origines d'un questionnement
No full textInternational audienceCet ouvrage propose des clefs de lecture pour rendre compte des dynamiques et des tensionsqui structurent aujourd’hui le secteur médico-social. Il voudrait rendre accessible à un largepublic le regard que portent les sciences sociales sur une série de questions fondamentalesauxquelles font face ses acteurs. Ces questions portent notamment sur le sens de leurs pratiques,sur les objectifs que celles-ci visent et les contraintes auxquelles elles sont soumises, sur lesfaçons dont ces pratiques sont discutées collectivement ou encore sur les moyens dontdisposent les acteurs