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Opportunities for Making Every Contact Count approaches in workplaces [Editorial]
No full textInternational audienceThere is now evidence that widespread adoption of the Making Every Contact Count (MECC) approach developed in the United Kingdom can have a significant impact on health. Even though there are important reasons explaining why such an approach is scarcely applied in workplaces, MECC might be of interest in some specific cases, such as healthcare settings or large companies. It could be considered, organized and evaluated in such workplaces
Le risque de cancer dans la sclérose en plaques : une étude de cohorte nationale à partir du Système national des données de santé (SNDS), 2012-2021
No full textInternational audienceLa littérature scientifique sur le risque de cancer chez les personnes atteintes de la sclérose en plaques (pSEP) diverge. Actuellement, la société francophone de la sclérose en plaques recommande que les pSEP suivent les pratiques de dépistage de la population générale
Health protective behaviours during the COVID-19 pandemic: Risk adaptation or habituation?
No full textInternational audienceMany epidemiological works show that human behaviours play a fundamental role in the spread of infectious diseases. However, we still do not know much about how people modify their Health Protective Behaviours (HPB), such as hygiene or social distancing measures, over time in response to the health threat during an epidemic. In this study, we examined the role of the epidemiological context in engagement in HPB through two possible mechanisms highlighted by research into decision-making under risk: risk adaptation and risk habituation. These two different mechanisms were assumed to explain to a large extent the temporal variations in the public's responsiveness to the health threat during the COVID-19 pandemic. To test them, we used self-reported data collected through a series of 25 cross-sectional surveys conducted in France among representative samples of the adult population, from March 2020 to September 2021 (N = 50,019). Interestingly, we found that both mechanisms accounted relatively well for the temporal variation in the adoption of social distancing during the pandemic, which is remarkable given their different assumptions about the underlying social cognitive processes involved in response to a health threat. These results suggest that strengthening the incentives to encourage people to maintain health protective behaviours and to counter risk habituation effects is crucial to disease control and prevention over time
Prevalence of occupational co-exposure to biomechanical factors and neurotoxic chemicals in French workers
No full textInternational audienceObjectives -Little is known about occupational co-exposure. The objective was to assess the prevalence of exposure and co-exposure to biomechanical factors and neurotoxic chemicals in French workers in 2017. Methods - Data from the French representative survey SUMER 2017 (SUrveillance Médicale des Expositions aux Risques professionnels) were analyzed. A total of 25 118 workers were included. Exposure to 4 biomechanical factors (manual handling of loads, forceful joint exertion, repetitive movements, and hand-arm transmitted vibrations) and 18 neurotoxic chemicals (n-hexane, perchloroethylene, trichloroethylene, etc.) were assessed using a questionnaire during face-to-face interviews with occupational physicians. Results Among men, 22.9% were exposed to at least one biomechanical factor and 10.2% were exposed to at least one neurotoxic chemical, mainly single exposures. Among women, 10.8% were exposed to at least one biomechanical factor and 3.1% were exposed to at least one neurotoxic chemical, also mainly single exposures. Occupational co-exposure to biomechanical factors and neurotoxic chemicals was observed among 4.8% of men and 0.7% of women. Workers under 30 yr old, blue-collar workers and those working in small companies were more co-exposed than other workers. In men, the prevalence of co-exposure was higher in the construction sector compared to other economic activities. Discussion - This study stresses the importance of considering multiple occupational exposures while the current prevention measures are designed to focus on preventing occupational factors individually
Effectiveness and safety of direct oral anticoagulants versus vitamin K antagonists in patients on chronic dialysis: a nationwide registry study
No full textInternational audienceBackground and hypothesis Clinical trials of direct oral anticoagulants (DOAC) are scarce and inconclusive in patients who are receiving dialysis, for whom DOAC are not labelled in Europe. In a French nationwide registry study of patients on chronic dialysis, we compared the effectiveness and safety of off-label DOAC use vs. approved vitamin K antagonist (VKA). Methods Data on patients on dialysis were extracted from the French Renal Epidemiology and Information Network (REIN) registry and merged with data from the French national healthcare system database (Système National des Données de Santé, SNDS). Patients on dialysis who had initiated treatment with an oral anticoagulant between January 1st, 2012, and December 31st, 2020, were eligible for inclusion. The primary safety outcome was the occurrence of major bleeding events and the primary effectiveness outcome was the occurrence of thrombotic events. Using propensity-score-weighted cause-specific Cox regression, we compared the safety and effectiveness outcomes for DOAC and VKA. Results 8,954 patients received an oral anticoagulant (483 DOAC and 8,471 VKA) for the first time after the initiation of dialysis. Over a median [interquartile range] follow-up period of 1.7 [0.8-3.2] years, 2,567 patients presented a first thromboembolic event and 1,254 patients had a bleeding event. After propensity score adjustment, the risk of a thromboembolic event was significantly lower in patients treated with a DOAC than in patients treated with a VKA (weighted hazard ratio (wHR) [95% confidence interval (CI)]: 0.66 [0.46; 0.94]. A non-significant trend toward a lower risk of major bleeding events was found in DOAC-treated patients, relative to VKA-treated patients (wHR [95%CI]: 0.68 [0.41; 1.12]). The results were consistent across subgroups and in sensitivity analyses. Conclusions In a large group of dialysis patients initiating an oral anticoagulant, the off-label use of DOACs was associated with a significantly lower risk of thromboembolic events and a non-significantly lower risk of bleeding, relative to VKA use. This provides reassurance regarding the off-label use of DOACs in people on dialysis
Emanuel Kulczycki, The Evaluation Game. How Publication Metrics Shape Scholarly Communication: Note de lecture
No full textInternational audienc
GIS and statistics to analyze scale change consequences on medical desert classification in France
No full textInternational audienceBackground Accessibility is a crucial way to overcome geographical restrictions and provides a path for alleviating the medical desert. Less attention has been paid to the choice of spatial unit in the effect of healthcare multi-accessibility. Inside the OASES European program, the France team proposes to create medical desert classification at the municipality level. The contribution of this study is to highlight the consequences of the choice of spatial scale on spatial distribution and the discrepancies between medical desert classifications. Methods Analyses were carried out in metropolitan France and overseas departments, at the commune scale and two other supra-communal scales used by public policies in France. For each spatial unit, a multidimensional and professional classification has been conducted using a three-step method: scores, principal component analysis and clustering. To demonstrate the presence of spatial dependence and to measure homogeneity between classifications joint count autocorrelation indicators and Theil’s indexes were applied. Results Our results present 7 classes of municipalities, and 5 classes of EPCI or living territories according to their level of healthcare accessibility, the dynamic of supply, and the needs of the population. Spatial representation of the classification demonstrates greater variability at the municipality level than other supra scales. Informative contrasted classes at the municipality level disappeared in favor of the middle class in all accessibility at supra scales. The results demonstrate that spatial dependence between areas at the municipality level reduced the scale effect. Conclusions Spatial approaches have become increasingly popular since they enable decision-makers to identify priority areas and allocate resources. Recognizing the instability across various scales is therefore crucial for thinking about the optimal unit of data aggregation when investigating the medical desert. Key messages • Choice of the scale is a mix between public policy decisions and data availability. • Contiguity constraint is a way to reduce the loss of information after aggregation
Implementing Primary Care Reform in France: Bargaining, Policy Adaptation, and the Maisons de Santé Pluriprofessionnelles
No full textInternational audienceContext: The organization of primary care in France has long remained a secondary issue on the political agenda. The government began to address the difficulties of care access and coordination in the 2000s, when a seemingly viable solution emerged from the field: the maisons de santé pluriprofessionnelles (MSPs). In a corporatist system and a predominantly private sector, the government chose an incentive-based contractual policy to encourage providers to join these structures. This article analyzes the implementation of this policy, which depends on private providers’ commitment. Methods: The article offers a comparative case study of six MSPs. Data were collected through semistructured interviews, observation sessions, and document analysis. Findings: First, the article shows that the emergence of MSPs has only been possible thanks to an unprecedented alliance between general practitioners, the state, and the health insurance fund. Second, it argues that MSP policy implementation relies on a complex bargaining process between private providers and public authorities that enables the former to shape it to their local needs. Conclusions: MSP implementation experiences raise questions both about the understanding of medical corporatism in France and the assimilation of policy changes and local variation through policy implementation
Vieillissement des travailleurs indépendants : l'impact des aides sociales sur la consommation de soins
No full textInternational audienceLe Programme d'actions pour une retraite indépendante (Pari), élaboré par le Régime social des indépendants (ex-RSI, désormais intégré au régime général de l'Assurance maladie depuis 2020), vise à favoriser le recours à différentes aides sociales dans une logique de prévention de la perte d'autonomie des travailleurs indépendants, artisans et commerçants âgés de 60 à 79 ans. Déployé en 2015 dans une partie des caisses régionales du RSI, Pari se fonde sur une triple démarche : « ciblée », destinée à identifier les personnes les plus à risque ; « proactive », en sollicitant les personnes pour répondre à un auto-questionnaire portant sur leur situation économique et sociale, et leur état de santé ; et « globale », en proposant une prestation adaptée à partir d'un panier complet d'aides sociales légales et propres au RSI. Mesurer l'impact sur la perte d'autonomie des travailleurs indépendants (le développement de situations de fragilité ou de vulnérabilité et l'apparition de maladies chroniques) est complexe car les effets se déploient à plus long terme et impliquent de nombreux canaux de transmission. En conséquence, l'évaluation ne repose pas sur des résultats en santé, mais sur des indicateurs de processus - le recours aux soins ambulatoires et les dépenses totales de soins associées.En comparant l'évolution des dépenses de soins ambulatoires avant et après la mise en œuvre de Pari entre les régions expérimentatrices et les autres, les résultats indiquent que les aides sociales permettent d'augmenter la demande de soins par un effet revenu des aides financières et par un effet prix qui diminue ou annule les frais à la charge des bénéficiaires. Il apparaît également que le design du programme encourage la consommation de soins, notamment à travers l'initiative d'« aller-vers », mais celle-ci est plus efficace lorsqu'elle est associée à une individualisation de l'offre