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Faire naître: Ce que le capitalisme fait à la maternité
No full textInternational audienceLa maternité est un lieu politique. Au-delà des violences gynéco-obstétricales et du pouvoir accaparant du corps médical, Clélia Gasquet-Blanchard démontre que cette emprise n’est ni une fatalité ni un simple effet de la casse de l’hôpital public, et que la médicalisation excessive de la naissance a précisément rendu possible le démantèlement du service public de la maternité.En retraçant l’histoire de la dépossession des savoirs et des solidarités entre femmes, elle renverse notre regard sur l’accouchement, sa marchandisation et les puissantes dynamiques de ségrégation sociale et raciale qui l’entourent.Cet essai appelle à réinventer des liens émancipateurs dans les salles d’accouchement comme hors des murs de l’hôpital afin que la naissance devienne un espace d’autonomie, de savoir partagé et de véritable justice reproductive
The Joint Effects of Extreme Heat and Wildfire Smoke on Paediatric Acute Care Utilisation
No full textInternational audienceBackground As climate change worsens, instances of combined extreme heat and wildfire smoke events are becoming more frequent. Despite their increased vulnerability, investigations on the joint effect of wildfire smoke and extreme heat on children's health are limited. Objective To investigate the joint effects of extreme heat and wildfire smoke on paediatric acute care utilisation (ACU) in California from 2006 to 2019. Methods In this case‐crossover analysis, we assembled a time‐series dataset of warm seasons, (May–September) for 1772 ZIP Code Tabulation Areas (ZCTA) in California from 2006 to 2019 to evaluate daily ACUs in the paediatric population (0–19 years). For wildfire smoke, we identified ZCTA‐days exposed using a previously developed time‐series dataset. For extreme heat, we calculated the daily ZCTA‐specific maximum heat index. There were four exposure types: exposed to extreme heat alone, exposed to wildfire smoke alone, exposed to both events simultaneously (compound event) and not exposed to either event. We quantified the synergistic effects by comparing a child's exposures on the day when an ACU occurred to the child's exposure during control days. Results We found 1100–105,788 ZCTA‐days where exposure to both extreme heat and wildfire smoke events occurred across eight combinations of event definitions. The relative excess risk due to interaction (RERI) ranged up to 0.11 (95% confidence interval [CI]: 0.03, 0.19) with thresholds of the 95th percentile for extreme heat and 35 μg/m 3 for wildfire PM 2.5 , indicating a synergistic effect of extreme heat and wildfire smoke on paediatric ACUs. Positive RERIs were consistently observed for infectious enteritis, heat‐related illness, asthma, endocrine nutritional and metabolic disease, and respiratory disease. Conclusion Investigating the synergistic effects of extreme heat and wildfire smoke events in paediatric populations is necessary to develop effective health protection strategies
Is short-term exposure to low and high ambient temperatures associated with an increased risk of sudden unexpected death in infancy? A case-crossover study in France (2015-2022)
No full textInternational audienceBackgroundSudden unexpected death in infancy (SUDI) is a leading cause of infant mortality. Although ambient temperature affects many health outcomes, evidence on its association with SUDI remains limited. We examined short-term effects of high and low temperatures on SUDI in France.MethodsWe performed a time-stratified case-crossover study including lag periods up to six days before death. Conditional logistic regression models assessed associations with both binary temperature indicators (based on percentiles) and continuous metrics using a distributed lag nonlinear model (DLNM). Effect modification by season, sex, social deprivation, urban or rural residence, age at death, and sleeping position was examined.ResultsWe included 1078 SUDI cases in France from 2015 to 2022. Results suggested an increased risk with heat on days close to death. Estimates were imprecise due to the limited sample size, leading to wide confidence intervals for several associations. However, we observed a linear association between temperature and SUDI during summer, particularly for minimum temperature in the last week of life (OR: 1.16, 1.07-1.26). DLNM analyses suggested similar patterns, with elevated risk for minimum temperatures above 15 °C and below 0 °C, though these estimates remain uncertainty.ConclusionsShort-term exposure to both high and low temperatures showed patterns of association with SUDI, with particularly notable effects of heat during summer. Although statistical support for many trends was limited, the alignment of these signals with previous studies suggests that preventive measures to reduce temperature-related risks for infants may be considered, particularly in the context of rising temperatures
School toilet use and avoidance: a systematic review of barriers, facilitators, and impact on child and adolescent health
No full textInternational audiencePurposeTo synthesize evidence on school toilet use and avoidance, and to examine associated barriers, facilitators, and health outcomes.MethodsWe conducted a systematic review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines (Moher et al. PLoS Med 6:e1000097, 2009), searching six academic databases and multiple gray literature sources in English and French through June 2025. Eligible studies focused on behavioral, infrastructural, psychological, or social aspects of school toilet use. Data were analyzed qualitatively using thematic synthesis.ResultsWe included 38 studies, representing diverse methodologies and countries. Common barriers to school toilet use included poor cleanliness, lack of privacy, restrictive access policies, and unsafe environments. Adolescents reported heightened concerns about peer surveillance, stigma, and menstruation-related challenges, leading to greater avoidance among older students. Avoidance behaviors were linked to urinary and gastrointestinal disorders, dehydration, psychological distress, and academic difficulties. Girls and LGBTQ+ youth were disproportionately affected by avoidance-related health consequences.ConclusionAdolescence is a critical period during which toilet-related behaviors and vulnerabilities intensify. Addressing barriers to school toilet use requires developmentally appropriate, equity-focused interventions that consider both physical infrastructure and social dynamics. Future research should explore longitudinal outcomes and participatory strategies to improve access and student well-being
Process evaluation of a school-based vaccination intervention to improve HPV vaccine coverage: A mixed-method study embedded in the French PrevHPV cluster randomized controlled trial
No full textInternational audienceBackgroundHuman papillomavirus vaccine coverage (HPV VC) remains suboptimal in many countries. French authorities launched the PrevHPV research program, which included a cluster randomized controlled trial (cRCT) to evaluate the effectiveness of an ‘at-school vaccination’ intervention. Within this trial, we conducted a process evaluation of this intervention, specifically analyzing (i) its implementation, (ii) its mechanisms of impact, and (iii) the contextual factors influencing implementation (facilitators/barriers).MethodWe conducted a mixed-method study embedded in the PrevHPV cRCT (April 2021–April 2022). ‘At-school vaccination’ consisted of vaccination day(s) on school premises where mobile vaccination teams (MVTs) initiated HPV vaccination free of charge for eligible adolescents (i.e., non-vaccinated adolescents aged 11+). Quantitative data were collected through activity reports and self-administered questionnaires of adolescents and school staff. Qualitative data collected through six focus groups with school staff and MVTs were analyzed using thematic analysis.ResultsOf the 31 schools (14,772 adolescents) randomized to implement ‘at-school vaccination’, 12 (39 %) dropped out. Among the participating schools, analysis of implementation showed that 17 % of adolescents returned valid consent forms, of whom 89 % initiated vaccination. MVTs played a central role in implementing vaccination day(s), supported by several school staff (e.g., school nurses, education assistants). Regarding mechanisms of impacts, satisfaction with the vaccination days was high among adolescents and school staff. The intervention generated both positive and negative group effects among adolescents. Contextual factors that facilitated implementation included the preparation of a list of adolescents to be vaccinated and the availability and motivation of school staff. The main barriers related to the management of consent forms and missing health records.ConclusionWe formulated recommendations for implementing at-school vaccination, which may be particularly helpful for the French school HPV vaccination campaigns that were scaled up nationally in 2023. We also discussed potential macro-level improvement strategies, involving modifications to the legislative framework
Standardized Protocol for the Phytochemical Characterization of Carica papaya as a Foundational Tool for Public Health Nutrition Research
No full textInternational audienceBackground: The integration of traditional food plants like Carica papaya (paw paw) into public health nutrition is hindered by inconsistent phytochemical methods, leading to irreproducible data and stalled implementation. Objective: This study aimed to develop and validate a comprehensive, reproducible laboratory protocol for the extraction, fractionation, and quantitative phytochemical analysis of C. papaya leaves and seeds. Methods: A stepwise protocol was developed, encompassing: botanical authentication and optimal drying, sequential methanol extraction, bioactivity-guided fractionation for alkaloids and flavonoids, qualitative screening, and quantitative spectrophotometric assays for key phytochemical classes. The protocol was applied to leaf and seed samples with yield calculations and statistical validation. Results: Methanol extraction yielded 17.51% from leaves and 11.59% from seeds. Fractionation successfully isolated target compounds, with flavonoid yields (7.05–7.96%) exceeding alkaloid yields (2.65–2.97%). Quantitative analysis revealed a phytochemical profile dominated by saponins (1249.83 mg/g in leaves, 723.65 mg/g in seeds), followed by phenolic compounds and alkaloids. Conclusion: This standardized methodology provides an essential toolkit for generating consistent, chemically defined plant extracts. It ensures reproducibility and comparability, supporting the evidence-based development of C. papaya and similar plants as sustainable nutritional resources in public health initiatives addressing malnutrition and dietary deficiencies
Comment impliquer le public et les patient(e)s dans la recherche en prévention primaire: Perspectives internationales et leçons tirées du réseau de recherche en prévention primaire des cancers CANCEPT
No full textInternational audienceAbstract Objectives This article explores the methods and benefits of involving patients and the public in primary prevention (PP) cancer research. Through the experience of the CANCEPT PP research network, it aims to clarify practices and propose methodological guidelines for developing interventions tailored to the needs of populations. Methods The Methodological Exchange Group GEM MIXTE, made up of 9 researchers and 9 co-researchers, met monthly (2023–2024, France) in order to define public and patient involvement in PP, take stock of participatory practices among CANCEPT members via a questionnaire (14 researchers, 8 institutions, 22 projects), and develop methodological guidelines in the form of a mind map. The participatory approaches were evaluated using the Public and Patient Engagement Evaluation Tool (PPEET) questionnaire. Results GEM MIXTE has enabled us to clarify the methodology of participatory research in PP and to propose practical guidelines. This work highlights the importance of diversifying the profiles of the co-researchers to enhance the relevance of interventions, while emphasizing the role of the group coordinator in structuring and facilitating exchanges. The PPEET evaluation confirmed that the co-researchers were committed to the objectives, although socio-cultural diversity remains a challenge. Conclusion This work proposes a methodological framework for integrating lived experience into research. The guidelines developed provide tools to inspire other networks to structure their approaches effectively, thereby strengthening citizen participation in public health.Résumé Objectifs Cet article explore les modalités et bénéfices de l’implication des patient(e)s et du public dans la recherche en prévention primaire (PP) des cancers. À travers l’expérience du réseau CANCEPT, il vise à clarifier les pratiques et proposer des repères méthodologiques pour développer des interventions adaptées aux besoins des populations. Méthodes Le Groupe d'Échange Méthodologique GEM MIXTE, composé de 9 chercheur(e)s et de 9 co-chercheures, s’est réuni mensuellement (2023–2024, France) afin de: livrer une définition de l’implication des patient(e)s et du public en PP, faire un état des lieux des pratiques participatives au sein des membres de CANCEPT via un questionnaire (14 chercheur(e)s, 8 institutions, 22 projets), élaborer des repères méthodologiques sous forme de carte mentale. L’évaluation des démarches participatives a été réalisée à l’aide du questionnaire Public and Patient Engagement Evaluation Tool (PPEET). Résultats Le GEM MIXTE a permis de clarifier le cadre méthodologique de la recherche participative en PP et de proposer des repères pratiques. Ces travaux mettent en évidence l’importance de diversifier les profils des co-chercheur(e)s pour enrichir la pertinence des interventions, tout en soulignant le rôle du coordinateur pour structurer et animer les échanges. L’évaluation PPEET a confirmé l’adhésion des co-chercheurs aux objectifs, bien que la diversité socioculturelle reste un défi à relever. Conclusion Ce travail propose un cadre méthodologique pour intégrer les savoirs expérientiels dans la recherche. Les repères élaborés offrent des outils pour inspirer d’autres réseaux à structurer efficacement leurs démarches, renforçant ainsi la participation citoyenne en santé publique
When the Going Gets Tough, the Tough Get Going? Health and Self-employment in Europe
No full textWe provide a comprehensive picture of the change in the health status for the self-employed aged 50 and upwards in Europe. We find that self-employed workers are in better physical health than employees at younger ages, due potentially to a selection effect. We also find a negative effect of self-employment status on objective health, leading to worse physical conditions at older ages, despite a catching-up of healthcare consumption after retirement. The examination of the evolution of the self-employed healthcare consumption enables us to distinguish two components: an intense health restoration effect and a regular one, corresponding to two distinct periods in their life. We interpreted the former effect as the increased probability of the self-employed to be hospitalized during their careers, meaning that the self-employed seek care later or for serious reasons only. The latter effect or the regular restoration effect meaning a greater number of medical visits for the self-employed after retirement which is potentially due to a reduction in the opportunity cost of the use of healthcare resources