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P-2056. Modelling the Relative Vaccine Effectiveness of ARCT-154 versus BNT162b2 using Immunogenicity Data
No full textInternational audienceBackground: Vaccination has become an essential weapon in the global battle against COVID-19. While showing high effectiveness against the original Wuhan-Hu-1 strain and early SARS-CoV-2 variants, questions have surfaced regarding the duration of immunity they provide, especially with the emergence of new viral strains. The innovative self-amplifying (SA)mRNA vaccine, ARCT-154, has demonstrated clinical improvements in extending duration of immune response. Our objective was to compare the long-term efficacy of ARCT-154 with BNT162b2 in an adult population by assessing relative vaccine effectiveness (rVE) over time. Methods: rVE was estimated using a two-step approach. First, we used geometric mean titer data (Days 29, 91, and 181 post-vaccination) from a phase 3 double-blind controlled clinical trial comparing the immune response of ARCT-154 and BNT162b2 against Wuhan-Hu-1 and Omicron BA.4/5 in healthy 18–77-year-olds (Japan Registry for Clinical Trials identifier: jRCT2071220080). We then incorporated this information into a published model correlating immunogenicity and efficacy to calculate the rVE of ARCT-154 versus BNT162b2 in symptomatic and severe cases. Results: ARCT-154 exhibited an increasing rVE against symptomatic infection with Wuhan-Hu-1 over time, ranging from 2.11% on Day 29 to 8.51% on Day 181 post-vaccination. rVE against symptomatic Omicron infection was 0% on Day 29 but increased to 13.85% by Day 91 and 20.25% by Day 181. rVE against severe illness ranging from 1% to 4% for Wuhan-Hu-1 and 1% to 13% for Omicron across all measured time points. Conclusion: ARCT-154 showed longer-lasting protection than BNT162b2 against symptomatic and severe COVID-19 for both the original Wuhan-Hu-1 and Omicron BA.4/BA.5 strains
Cancer Risk Among Patients With Multiple Sclerosis
No full textInternational audienceBackground and objectives: Previous literature has been diverging on cancer risk in people with multiple sclerosis (PwMS). Therefore, this study compared the risk of cancer in PwMS and a matched sample from the French general population.Methods: This 10-year nationwide retrospective matched cohort study (2012-2021) used data from the national French administrative health care database (99% coverage of the French population) to determine the time to the first incident cancer. PwMS were identified using their long-term disease (LTD) status, hospitalizations, and multiple sclerosis (MS)-specific drug reimbursements. The control population was matched 4:1 on age, sex, residence, insurance scheme, and cohort entry date. Participants were included if they had no history of cancer in the 3 years before inclusion. Patients with cancer were identified through LTD status, hospitalizations, chemotherapy, radiotherapy, or prostate cancer-specific drug reimbursements. Overall and cancer location-specific hazard ratios (HRs) for the first incident cancer were obtained from Fine and Gray models, and age- and sex-stratified estimates were reported. Participation in cancer screening through the 3 national programs (breast, colorectal, and cervical) were compared between groups.Results: Cancer incidence was 799 per 100,000 person-years (PYs) (n = 8,368) among the 140,649 PwMS and 736 per 100,000 PYs (n = 31,796) among the 562,596 matched controls (70.8% of women; follow-up: 7.6 ± 3.2 years). A small overall risk increase was observed for PwMS (HR 1.06, 95% CI 1.03-1.08), mostly in women (HR 1.08, 95% CI 1.05-1.11). Risk varied by cancer types and was lower for prostate (HR 0.80, 95% CI 0.73-0.88), breast (HR 0.91, 95% CI 0.86-0.95), and colorectal (HR 0.90, 95% CI 0.84-0.97) cancer and higher for bladder (HR 1.71, 95% CI 1.54-1.89), brain (HR 1.68, 95% CI 1.42-1.98), and cervical (HR 1.24, 95% CI 1.12-1.38) cancer in PwMS. Cancer risk was higher in PwMS younger than 55 years (HR 1.20, 95% CI 1.15-1.24) but decreased in PwMS aged 65 years and older (HR 0.89, 95% CI 0.85-0.94). This trend was found in all cancer locations. There were fewer PwMS getting screened than controls (all programs), with a particularly pronounced difference among those aged 65 years and older.Discussion: Cancer risk was slightly increased in PwMS, particularly for urogenital cancers, possibly due to surveillance bias. Risk fluctuated depending on age, perhaps due to varying generational screening practices (i.e., diagnosis neglect in the older PwMS) and risk factors
Efficacité d’une intervention multicomposante en collèges et en soins primaires sur la couverture vaccinale anti-HPV en France : Résultats de l’essai PrevHPV
No full textInternational audienceIntroduction : Malgré l’efficacité et la sécurité du vaccin anti-HPV, la couverture vaccinale (CV) demeure faible dans certains pays, dont la France. Une intervention incluant trois composantes (1-Education et motivation des adolescents et de leurs parents, 2-Formation des médecins généralistes aux HPV et à l’entretien motivationnel, 3-Vaccination gratuite en collège) a été co-développée et évaluée dans neuf régions françaises pendant l’année scolaire 2021-22. L’objectif est de présenter l’effet des composantes sur la CV deux mois après la fin de l’intervention.Matériels et Méthodes : Un essai contrôlé, randomisé, en cluster a été mis en œuvre en utilisant un design de plan factoriel incomplet permettant de comparer 6 groupes bénéficiant de 0, 1, 2 ou 3 des composantes évaluées. La composante ‘vaccination gratuite en collège’ n’a jamais été mise en œuvre sans que les adolescents et parents bénéficient au préalable de la composante ‘Education / motivation’. La randomisation était stratifiée sur la région et sur l’indice de défavorisation des communes. Le critère de jugement principal était la CV (au moins 1 dose) des adolescents de 11-14 ans résidant dans la commune. L’analyse a été conduite en intention de traiter (ITT), puis en tenant compte de la dose d’intervention réellement reçue (DIR). L’effet de l’intervention selon le sexe de l’adolescent, l’indice de défavorisation de la commune et l’accessibilité potentielle aux médecins généralistes de la commune a été étudié.Résultats : Au total, 91 communes ont été incluses et analysées. La CV avant intervention variait de 8,9% à 15,0% selon les communes, et a augmenté de 4,0% à 14,2% deux mois après l’intervention. La vaccination en collèges a significativement augmenté la CV quel que soit le type d’analyse (ITT : +5,5%, IC95% [3,1;7,9]; DIR : +11,3%, IC95% [9,1;13,4]), contrairement à la formation des médecins généralistes dont l’effet n’est significatif qu’en tenant compte de la dose d’intervention (ITT : -1,5%, IC95% [-3,4;0,5] ; DIR : +3,6%, IC95% [0,02;7,1] ), et l’éducation / motivation des adolescents et de leurs parents, mise en œuvre seule, reste non significative (ITT : -0,1%, IC95% [-2,5;2,4] ; DIR : +2,6%, IC95% [-1,7;6,9]). Il n’a pas été mis en évidence de différence selon le sexe de l’adolescent, mais l’effet de la vaccination en collège était plus important dans les communes ayant un faible accès aux médecins généralistes (p=0,007). Conclusion : La vaccination en collège, précédée d’une éducation / motivation des adolescents et de leurs parents, permet d’augmenter la CV anti-HPV, et ce plus particulièrement dans les communes ayant un faible accès aux médecins généralistes. La formation des médecins généralistes permet elle aussi d’augmenter la CV dès lors qu’ils y participent
Multiple sclerosis-related healthcare and disease-modifying drug use before and after a cancer diagnosis
No full textInternational audienc
Feasibility and Acceptability of a Mobile-Assisted Screening and Brief Intervention for Multiple Health Behaviors in Medical Settings
No full textInternational audienceIntroduction: Leveraging every interaction between patients and healthcare professionals constitutes an opportunity to foster behavior change. We developed a mobile Screening and Brief Intervention (mSBI) designed to screen for and intervene with multiple health behaviors, based on a personalized feedback. The objectives of the present study were to assess its feasibility during consultations for chronic conditions, collect users’ opinions, and to investigate patients’ behaviors and intention to change. Methods: Research counselors provided the mSBI to patients from 2 departments at University Hospital. Socio-demographic, behavioral, and acceptability data were collected from patients together with feasibility data from counselors’ reporting. Results: A total of 259 participants were analyzed, aged 51 ± 17 years, with a majority of women (53%). The m-SBI averaged 20 min and most patients (92%) could complete the screening with minimal assistance. Medical doctors’ involvement facilitated referral to and uptake of the m-SBI, and limited adverse events. On average, patients adhered to 11 of the 18 guidelines screened. A majority of patients rated the personalized feedback as comprehensible and useful. Nearly half of them intended to change behavior. Conclusions: The m-SBI seems well-accepted and useful, but doctor referral, adapting the screening tool to patients with low health literacy, and app’s ability to send the feedback to patients/doctors are essential for feasibility
Inflammation Chronique et Risque de Cancer de la Prostate : Rôle des Infections, des Calculs, du Gène COX-2 et de leurs Interactions GxE
No full textChronic inflammation has been suggested to contribute to prostate carcinogenesis. Inflammation-related risk factors, such as infections, kidney and gallbladder stones, and genetic susceptibility involving inflammatory genes like COX-2, have been studied, but results are often contradictory or limited. Few studies have considered how these factors impact the aggressiveness of the cancer as well. Objectives: 1) Study the role of infections and calculi in the occurrence of prostate cancer 2) Study the role of COX-2 SNPs and the GxE interaction and Prostate Cancer. Methods: Data from the EPICAP, a population-based case-control study carried out in the department of Herault in France, was used for the analysis of infections and calculi, including 819 cases & 879 controls. Information was collected on the history of these factors along with Gleason scores for various grades of cancer. For genetic analysis, EPICAP provided data on the COX-2 gene, including 732 cases and 783 controls derived from blood or saliva samples, after quality control checks, with 20 SNPs analyzed in total. Results: No significant associations between sexually and non- sexually transmitted infections (STIs) whether bacterial or viral and the risk of prostate cancer. Kidney stones, particularly with a history of pyelonephritis, and gallbladder stones, especially in individuals with hypertriglyceridemia, were associated with an increased risk of prostate cancer. Significant associations were observed between several SNPs in the COX-2 gene and prostate cancer, with the A allele of rs4648261 linked to high-grade cancer. Interactions between COX-2 genetic variations and environmental factors like infections and stones did not significantly influence prostate cancer risk. Conclusion: The findings underscore the significant role of inflammatory processes in prostate carcinogenesis and highlight the need for further research into inflammation- related factors. Investigating the duration of these factors and the effectiveness of treatments is crucial to see how chronic inflammation can impact cancer risk. The genetic results based on a preliminary SNP-by-SNP approach, indicate potential associations that require further investigation to confirm and expand upon these findings. Finally, given the importance of aggressive PC and its associated poor prognosis, future research should specifically explore the genetic and environmental factors influencing it and understand the underlying mechanisms for better preventions strategies and more effective treatments.Introduction : L'inflammation chronique a été suggérée comme un facteur contribuant à la carcinogenèse prostatique. Divers facteurs liés à l’inflammation, tels que les infections, les calculs rénaux et biliaires, ainsi que la susceptibilité génétique impliquant des gènes de l’inflammation comme COX-2, ont été étudiés, mais les résultats restent souvent contradictoires ou limités. Peu d’études ont également examiné l’impact de ces facteurs sur l’agressivité du cancer. Objectifs : 1) Étudier le rôle des infections, 2) des calculs et le cancer de la prostate ; 3) Analyser l'influence des SNPs du gène COX-2 et l’interaction gènes-environnement sur le risque de cancer de la prostate. Méthodes : Les données de l'étude EPICAP, une étude cas- témoins en population menée dans le département de l'Hérault en France, ont été utilisées pour analyser les infections et les calculs, avec 819 cas et 879 témoins. Des informations ont été collectées sur l’historique de ces facteurs, ainsi que sur les scores de Gleason pour différents grades de cancer. Pour l'analyse génétique, les données sur le gène COX-2 provenant des 732 cas et 783 témoins ayant des données obtenues à partir d'échantillons de sang ou de salive, ont été utilisées après contrôle qualité, avec un total de 20 SNPs analysés. Résultats : Aucune association significative n’a été observée entre les infections sexuellement ou non sexuellement transmissibles (bactériennes ou virales) et le risque de cancer de la prostate. Les calculs rénaux, en particulier en présence d'un antécédent de pyélonéphrite, et les calculs biliaires, notamment chez les individus avec une hypertriglycéridémie, ont été associés à un risque accru de cancer de la prostate. Des associations significatives ont été observées entre plusieurs SNPs du gène COX-2 et le cancer de la prostate, avec l'allèle A du rs4648261 lié aux cancers de haut grade. Les interactions entre les variations génétiques du COX-2 et les facteurs environnementaux comme les infections et les calculs n'ont pas eu d'influence significative sur le risque de cancer de la prostate. Conclusion : Ces résultats soulignent le rôle important des processus inflammatoires dans la carcinogenèse prostatique et mettent en lumière la nécessité de poursuivre les recherches sur les facteurs liés à l'inflammation. Il est important d'étudier la durée d'exposition à ces facteurs et l'efficacité des traitements pour mieux comprendre l’impact de l’inflammation chronique sur le risque de cancer. Les résultats génétiques, basés sur une approche préliminaire par SNP, suggèrent des associations potentielles qui nécessitent des recherches supplémentaires pour être confirmées et approfondies. Enfin, étant donné l'importance du cancer de la prostate agressif et son pronostic souvent défavorable, il est essentiel que les futures recherches se concentrent sur les facteurs génétiques et environnementaux qui l'influencent, afin de mieux comprendre les mécanismes sous-jacents et d'élaborer des stratégies de prévention et de traitement plus efficaces
Parking and Public Health
No full textInternational audiencePurpose of review - Parking is a ubiquitous feature of the built environment, but its implications for public health are under-examined. This narrative review synthesizes literature to describe pathways through which parking may affect population health. Recent findings - We begin by contextualizing the issue, outlining key terminology, the sheer scale of land dedicated to parking, and the historical factors that led to this dominant land use. Next, we delineate four pathways linking parking with public health: 1) Promoting driving and car dependency, affecting air pollution, greenhouse-gas emissions, physical activity, traffic-related injuries and fatalities, and accessibility; 2) Creating impervious surfaces, with consequences for urban heat, flooding, water pollution, and green space; 3) Affecting housing affordability and associated health outcomes of this social determinant; and 4) Design, construction, and maintenance, the health impacts of which include on-street parking's positive and negative impacts on safety for all roadway users, air-quality effects of parking's construction and maintenance, and the potential for green parking lots to mitigate some health consequences of impervious surfaces. While evidence supports each pathway, additional empirical research is needed to evaluate impacts of parking on public-health outcomes. As a dominant feature of the built environment with many health implications, parking warrants attention by public-health research and practice
“Emotional stress is more detrimental than the virus itself”: A qualitative study to understand HIV testing and pre‐exposure prophylaxis (PrEP) use among internal migrant men in South Africa
No full textInternational audienceIntroduction: South Africa has one of the highest rates of internal migration on the continent, largely comprised of men seeking labour in urban centres. South African men who move within the country (internal migrants) are at higher risk than non‐migrant men of acquiring HIV yet are less likely to test or use pre‐exposure prophylaxis (PrEP). However, little is known about the mechanisms that link internal migration and challenges engaging in HIV services. Methods: We recruited 30 internal migrant men (born outside Gauteng Province) during August 2022 for in‐depth qualitative interviews at two sites in Johannesburg (Gauteng) where migrants may gather, a factories workplace and a homeless shelter. Interviewers used open‐ended questions, based in the Theory of Triadic Influence, to explore experiences and challenges with HIV testing and/or PrEP. A mixed deductive inductive content analytic approach was used to review data and explain why participants may or may not use these services. Results: Migrant men come to Johannesburg to find work, but unreliable income, daily stress and time constraints limit their availability to seek health services. While awareness of HIV testing is high, the fear of a positive diagnosis often overshadows the benefits. In addition, many men lack knowledge about the opportunity for PrEP should they test negative, though they express interest in the medication after learning about it. Additionally, these men struggle with adjusting to urban life, lack of social support and fear of potential stigma. Finally, the necessity to prioritize work combined with long wait times at clinics further restricts their access to HIV services. Despite these challenges, Johannesburg also presents opportunities for HIV services for migrant men, such as greater anonymity and availability of HIV information and services in the city as compared to their rural homes of origin. Conclusions: Bringing HIV services to migrant men at community sites may ease the burden of accessing these services. Including PrEP counselling and services alongside HIV testing may further encourage men to test, particularly if integrated into counselling for livelihood and coping strategies, as well as support for navigating health services in Johannesburg
Coordination et mobilisation des acteurs dans les Contrats locaux de santé : étude dans deux régions
No full textInternational audienceContexte : Le renforcement des capacités locales d’action sur les déterminants sociaux de la santé est essentiel à l’amélioration des conditions de vie des populations. En raison du large spectre d’actions attribuables aux contrats locaux de santé (CLS), ceux-ci constituent des dispositifs susceptibles de jouer ce rôle. Or, peu d’études ont été menées permettant d’établir cette contribution des CLS pour la santé des populations et ce qui favorise la mobilisation des acteurs locaux au sein du dispositif. Nous présentons les résultats d’une étude sur ces deux aspects. Méthodes : L’enquête qualitative a été réalisée dans deux régions. Un premier volet portait sur l’analyse des actions d’un échantillon de contrats (n=12) à l’aide de l’outil CLoterreS permettant de catégoriser les mesures décrites dans le plan d’action. Des entretiens menés avec des acteurs locaux (n= 28) ont permis d’identifier les retombées du CLS en matière de prévention, promotion de la santé et santé environnement. Le second volet a consisté en la conduite d’entretiens semi-directifs (n = 25) auprès des porteurs d’action de CLS échantillonnés (n = 12). Une grille d’analyse a ensuite été appliquée couvrant les questions d’implication des acteurs, de gouvernance, de rôles et de bénéfices/coûts perçus à la participation au CLS. Résultats : Le CLS favorise l’émergence d’actions nouvelles sur les territoires susceptibles de se déployer au-delà des frontières administratives des communes. Il soutient l’expansion d’actions sur les déterminants de santé autres que le soin. Il contribue aussi à l’évolution d’actions existantes mono-objectif vers des actions apportant plusieurs solutions. L’émergence d’actions non prévues dans le contrat témoigne de sa capacité d’adaptation à l’actualité du territoire. Initialement, c'est majoritairement la recherche de financements qui incite les structures à rejoindre les CLS et porter des actions. Certains y voient un instrument permettant d’améliorer la reconnaissance, la légitimité, la visibilité de leurs actions auprès des élus locaux. Le CLS impulse une dynamique partenariale en renforçant l'interconnaissance et offre aux acteurs un soutien méthodologique. Discussions : Le CLS apparaît bien un outil de renforcement de l’action locale en santé. Nous évoquons ses points de fragilité et l’importance de mieux caractériser et valoriser les métiers de la coordination