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Preventing a global health care systems collapse through low-tech medicine
No full textInternational audienc
The temporal trend and disparity in short-term health impacts of fine particulate matter in California (2006–2019)
No full textInternational audienceMost epidemiological studies assume that the relationship between short-term air pollution exposure and health outcomes is constant over time, which ignores potential changes in population composition and particulate matter emission sources. Limited studies have assessed changes in the relationship between fine particulate matter (PM2.5) and adverse health outcomes over time, with mixed results. Additionally, there is a need to identify which subgroups are disproportionately impacted over time by PM2.5-related health consequences. Therefore, we aimed to examine whether temporal trends exist in the relationships between daily PM2.5 exposure and circulatory and respiratory acute care utilization in California from 2006 to 2019. We further assessed whether certain subpopulations are more susceptible to PM2.5 exposure by demographic characteristics and extreme wildfire frequency. Daily PM2.5 concentrations estimated from a stacked ensemble model and daily cause-specific acute care utilization and demographic data from the California Department of Health Care Access and Information. We analyzed this relationship using modified two-stage Bayesian hierarchical models, where we first did not consider temporal trends, then stratified by two periods, and finally flexibly considered non-linear changes over time. Increases in circulatory (0.56 %; 95 % credible interval (CI): 0.17 %, 0.96 %) and respiratory acute care utilization risk (2.61 %; 95%CI: 2.29 %, 2.94 %) were found with every 10 μg/m3 increase in PM2.5 on the same day and previous two days. These risks were found to increase over time, where 0.13 % (95%CI: 0.02 %, 0.22 %) and 1.40 % (95%CI: 1.24 %, 1.54 %) increases were identified for circulatory and respiratory acute care utilizations, respectively, from the first (2006-2012) to second period (2013-2019). Differences by age, sex, race/ethnicity, and extreme wildfire frequency were noted. These findings confirm that air pollution guidelines should consider the dynamic nature of epidemiological dose-response and can provide insight for targeted air pollution control and adaptation policies designed to reduce PM2.5 exposure, particularly for the most susceptible subpopulations
A New Framework for Monitoring and Evaluating Health Impact Assessment: Capitalising on a French Case Study with the Literature in Evaluation
No full textInternational audienceHealth impact assessment (HIA) is a prospective approach that aims to identify the potential consequences of policies or projects on health in order to propose measures to make them healthier. Initiated in the late nineties, the approach emerged over ten years ago in France. However, the evaluation of HIA effectiveness remains seldomly practised and its theoretical background should be deepened. The aim of this article is to generate a discussion on how to evaluate HIA effectiveness and contribute to its methodological tooling, drawing on an evaluative experience of multiple French HIAs. Our work is based on an iterative approach between an analysis of the evaluation literature and a critical look at an HIA evaluation. We first carried out the evaluation of three HIAs in 2017-2018, combining a normative approach and qualitative research in order to explore each HIA as a phenomenon in its own context. Two years later, we conducted a self-assessing expertise on this evaluation, supported by an analysis of the literature in the field of public policy evaluation, in order to refine the theoretical framework for evaluating HIA effectiveness and ultimately to enhance professional practice by evaluators. This work led to the production of a logic model that identifies, through three dimensions (context, implementation and governance), the multiple pathways that HIA may take to bring about change. It also seeks to show the interdependence of these pathways towards change and helps identify the key drivers and mechanisms of HIA success. In this respect, it complements existing HIA evaluation models as it can serve both as a generic framework for evaluating HIA effectiveness and as an instrument for monitoring HIA implementation
Within- and between-day variability and reproducibility of urinary glycol ethers metabolites in pregnant women
No full textInternational audienceBACKGROUND AND AIM[|]Glycol ethers (GE) are an oxygenated solvent family widely present in consumer products, including personal care and cleaning products. Several recent studies suggested potential adverse developmental outcomes after prenatal exposure to some GE. They used spot measurements of alkoxy carboxylic acidic metabolites in maternal urinary samples as exposure biomarkers to GE. This study aimed to investigate the within-day and between-day variability of GE urinary metabolite concentrations during pregnancy.[¤]METHOD[|]Thirty pregnant women provided all their entire individual urine mictions for 24 hours, twice during the end of pregnancy (6 weeks apart). Nine urinary GE metabolites were measured in each individual sample and volume-weighted 24h-urine pool, using gas chromatography with detection limit of 0.003 mg/L. Concentrations were standardized by urinary creatinine. Mixed models were used to decompose variability into within-day and between-day variability (ie. within-individual), and between-individual variability. Measurement reproducibility for different sample strategies (1st-morning void, one random void, pool of 3-random-voids, 24h-pool) was assessed using Intraclass Coefficient (ICC).[¤]RESULTS[|]In the 530 individual urinary samples collected, 6 GE metabolites were detected in more than 75% samples. For phenoxyacetic acid and 2-methoxyproprionic acid, within-individual variability was lower than between-individual variability (57% and 70% of the total variability, respectively). For these metabolites, high ICC were observed for the 3-random-voids-pool (0.77 and 0.79, respectively) and the 24h-pool (0.69 and 0.76, respectively). For 2-butoxyacetic acid and ethoxyethoxyacetic acid, the within-day variability was high (>40%) and for methoxyacetic acid and 2-butoxyethoxyacetic acid, the within-day and between-day variabilities were similar (25-30%). Their ICC were generally low to moderate (<0.60) whatever the sample collection strategies.[¤]CONCLUSIONS[|]During pregnancy, urinary metabolite concentrations for some GE showed substantial within-day and between-day variability. For others, such as phenoxyacetic acid and 2-methoxyproprionic acid, the collection of 3 random urine samples during a day might offer reproducible exposure measurement.[¤
Assessing the contribution of the chemical exposome to neurodegenerative disease
No full textInternational audienceOver the past few decades, numerous environmental chemicals from solvents to pesticides have been suggested to be involved in the development and progression of neurodegenerative diseases. Most of the evidence has accumulated from occupational or cohort studies in humans or laboratory research in animal models, with a range of chemicals being implicated. What has been missing is a systematic approach analogous to genome-wide association studies, which have identified dozens of genes involved in Alzheimer's disease, Parkinson's disease and other neurodegenerative diseases. Fortunately, it is now possible to study hundreds to thousands of chemical features under the exposome framework. This Perspective explores how advances in mass spectrometry make it possible to generate exposomic data to complement genomic data and thereby better understand neurodegenerative diseases
Politiques d’organisation et dynamiques de coordination: l’exemple du secteur de l’autonomie
No full textInternational audienceDans ce chapitre, Alis Sopadzhiyan analyse les évolutions des politiques du champ de l’autonomie qui, face à la multiplication et à la diversité des organisations qui accompagnent les personnes, tentent de mettre en place de la coordination entre ces organisations, via de nouveaux dispositifs dédiés, et ce à différents niveaux. Si ces politiques de coordination ont d’abord été développées à l’intérieur de politiques sectorielles, plus récemment, elles ont tenté de répondre à des enjeux transversaux à ces politiques. L’autrice décrypte ainsi, pour le lecteur, à partir d’une perspective d’analyse des politiques publiques, la complexité organisationnelle qui caractérise le médico-social, et les tentatives et actions pour réduire cette complexité, ou du moins, l’organiser. Elle nous donne des clés pour problématiser les notions d’organisation et de coordination, et pour analyser des dynamiques de structuration du secteur médico-socia
Attirer et fidéliser les professionnels de santé par la Qualité de Vie et les Conditions de Travail (QVCT) : retour sur diverses expérimentations [Table Ronde]
No full textNational audienceQuels sont les liens entre l’amélioration de la qualité de vie et des conditions de travail (QVCT) et le pouvoir d’attraction des équipes et des établissements de santé ? Échanges sur des expériences inspirantes et questionnantes : les espaces de discussion sur le travail et le télétravail des cadres à l’hôpital, la semaine de 4 jours dans un Ehpad et la démarche participative dans le champ de la santé. L’occasion de se pencher sur la plus-value des chercheurs dans les démarches qui visent à transformer les organisations de travai
L’engagement en ligne des étudiants : une étude exploratoire basée sur la recherche orientée par la conception
No full textInternational audienceL’un des objectifs de la conception des modules en ligne est d’engager les étudiants dans le processus d’apprentissage. Plusieurs travaux de recherche (Casimiro, 2016 ; Oh et Kim, 2016 ; Zhu, 2006) montrent que le niveau d’engagement cognitif avec des ressources en ligne est directement lié aux compétences acquises grâce à ce mode d’apprentissage. Cependant, engager les étudiants en ligne et mesurer cet engagement reste un processus complexe. Par ailleurs, l’un des défis de la recherche est d’identifier une méthodologie appropriée qui permet à la fois aux chercheurs et aux praticiens de développer ou de trouver des stratégies adaptées, de les mettre en place et de tester leur efficacité.L’objectif de cet article est de présenter les résultats d’une recherche sur l’engagement étudiant en ligne dans le cadre de l’approche de Recherche Orientée par la Conception (ROC), qui a été adoptée pour mettre en œuvre un module en ligne ALIVE (Apprentissage en Langues et Interculturalité Via un Environnement numérique) au sein de l’EHESP dans le cadre du projet DESIR (Développement d’un Enseignement Supérieur Innovant à Rennes). Nous cherchons à comprendre : 1). L'impact du ROC sur la conception des cours et sur la pratique professionnelle des chercheurs et des praticiens. 2) Dans quelle mesure le module en ligne proposé, basé sur le modèle itératif de la ROC, favorise l'engagement des étudiants (n = 51). Nos résultats permettent de montrer les limites des outils utilisés pour mesurer l’engagement étudiant et reflètent l’impact de la méthodologie du ROC sur les dynamiques de collaboration chercheurs-praticiens et sur la conception du module
Processus inégalitaires en santé et migrations. Quelle place pour une approche critique de la dimension spatiale des inégalités sociales ?
No full textTextes issus du colloque "Approches critiques de la dimension spatiale des rapports sociaux : débats transdisciplinaires et internationaux" tenu à Caen du 26 au 28 juin 2019.International audienc
