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#1364 Association between sex and hospitalisation during the period prior to kidney transplantation in France
No full textInternational audienceBackground and AimsThe process to kidney transplantation involves several interactions between the patient and the healthcare system. Several events occur along the way, including consultations with general practitioners and specialists, and hospitalisations. Previous studies in France have shown that the use of healthcare is not the same for men and women before and after dialysis starting. However, no study has yet investigated the use of care in terms of hospitalisation prior to kidney transplantation among men and women. The aim of this study was to assess the association between sex and hospitalisation during the period before kidney transplantation, considering patient's characteristics.MethodData were extracted from the REIN registry, which gathered information on patients undergoing kidney replacement therapy in France. This database was linked to the national healthcare consumption database (SNDS) containing information on 98% of the French population. All patients transplanted between 2015 and 2019 and aged over 18 years were included. Our outcomes of interest were the total number of hospitalisations lasting more than 24 hours in the five years before kidney transplantation, excluding stays for dialysis and transplantation. A Poisson regression model adjusted for comorbidities and socio-demographic characteristics was used. A significance level of 5% was considered. The results of the model were presented as adjusted incident rate ratios (aIRR) with their confidence intervals (CI).ResultsWe included a total of 12 872 kidney transplanted recipients. The mean age was 54 years (±14), and 37% were women. The total number of stays was in median four for men and five for women over the five years prior to transplantation. The stays lasted in median two days for men and three days for women. The results of the multivariate analysis showed that, men (compared to women) aIRR: 0.93, 95% CI [0.92–0.95], patients aged over 80 years (compared to under 30) aIRR: 0.93 [0.88–0.99], as well as patients with walking autonomy (compared to non-autonomous) aIRR: 0.76 [0.60–0.97] and patients with a body mass index (BMI) over 30 kg/m² (compared to BMI <18.5) aIRR: 0.84 [0.79–0.90] had a lower risk of being hospitalized during the five year before kidney transplantation. Patients with some co-morbidities, in particular cirrhosis aIRR: 1.82 [1.75–1.90], cancer aIRR: 1.23 [1.16–1.31] and patients with diabetes aIRR: 1.34 [1.32–1.36] were more likely to be hospitalized.ConclusionThis study showed that hospitalisation in the five years prior to kidney transplantation is not homogeneous and that men were less likely to have a more than 24 h hospitalisation compared to women, despite adjusting for comorbidities. Comorbidities increase the risk of hospitalisation. There is a need to characterize these hospitalisations to prevent them
Adsorbable organohalogen parameters : method optimization and seasonal variations in different water matrices
No full textInternational audienc
Qu’est-ce qu’un cancérigène ?Des îlots de connaissances scientifiques dans de profonds océans de controverses :Cas des pesticides inhibiteurs de la succinate déshydrogénase (SDHI)
No full textMaste
La redistribution des médicaments non utilisés : comparaison internationale
No full textInternational audienceThe waste generated globally by unused medicines returned by patients to collection points raises both budgetary and environmental concerns. State practices vary between redistributing these medicines to countries in need and/or underprivileged national populations, and simply destroying them, in line with the WHO’s current stance, which is now opposed to humanitarian donations of medicines.Le gaspillage engendré à l'échelle internationale par les médicaments non utilisés rapportés par les patients dans des points de collecte soulève des interrogations de nature budgétaire mais également de nature environnementale. Les pratiques des États se répartissent entre la redistribution de ces médicaments au profit des pays qui en ont besoin et/ou des populations nationales nécessiteuses, et la destruction pure et simple de ces produits, comme le préconise l'OMS qui est désormais hostile aux dons humanitaires de médicaments
Daily sleep and physical activity from accelerometry in adults: Temporal associations and lag effects
No full textInternational audienceObjectives: Insufficient sleep is linked to various health issues, while physical activity is a protective measure against chronic diseases. Despite the importance of sleep and physical activity for supporting public health, there remains scant research investigating daily and cumulative associations between objectively measured physical activity and sleep. Understanding the associations of physical activity and sleep behaviors over multiple days may inform the efficacy of interventions to synergistically support both behaviors. Method: Data were from the Community of Mine study (N=367 with complete data). Participants wore ActiGraph GT3X+ accelerometers on their wrist and hip for 14days. Sleep was defined as total sleep time (h/night), wakefulness after sleep onset (min), and sleep efficiency (%). Moderate to vigorous physical activity was defined as ≥760 counts per minute. Mixed-effects linear models with distributed lag effects, adjusted for age, Hispanic/Latino ethnicity, body mass index, education, smoking, and residence type, investigated the effect of sleep on prospective moderate to vigorous physical activity (and moderate to vigorous physical activity on prospective sleep): on the same or previous day, 2-day lag, and 3-day lag.Results: An increase in same day, 2-day lag, and 3-day lag moderate to vigorous physical activity was associated with decreased total sleep time. Moderate to vigorous physical activity was not associated with sleep efficiency or wakefulness after sleep onset. An increase in same day and 3-day lag of total sleep time was associated with decreased moderate to vigorous physical activity. An increase in 3-day lag sleep efficiency was associated with decreased moderate to vigorous physical activity. wakefulness after sleep onset was not associated with moderate to vigorous physical activity. Conclusions: These insights contribute to understanding the dynamic interplay between moderate to vigorous physical activity and sleep in adults, highlighting same day and cumulative associations
Des données numériques à la valeur dans les établissements de santé : une réflexion stratégique sur le cas des centres hospitaliers universitaires
No full textBig Data (BD) in healthcare is regarded as a potential source of value creation for health systems and organizations. For hospitals, utilizing digital data generated through routine activities has become a strategic imperative. These institutions are encouraged to invest in the development and deployment of dedicated capacities, particularly through the establishment of Health Data Warehouses (CDWs).Do these investments unlock the potential for value creation attributed to Big Data in hospitals? This research addresses this question from a strategic perspective, with a specific focus on academic health centers (AHCs), which are at the forefront of technological innovations in healthcare. We examine how Big Data Analytics (BDA) strategies are defined and deployed within healthcare institutions and identify which approaches most effectively support value creation from established CDWs.Our analysis is structured along three primary axes. First, a scoping review outlines the stages and components in the pathway from digital data to value creation in hospitals. Subsequently, a qualitative study, based on 61 interviews conducted in 5 AHCs, investigates the planning processes underlying BDA strategies that guide investments in CDWs. Finally, a mixed-method study examines the implementation of these strategies and identifies conditions enabling CDWs to achieve their potential.Despite anticipated benefits, a significant gap remains between the theoretical potential of Big Data and the actual value created due to various internal and external constraints affecting BDA strategies in AHCs. To mitigate investment risks, enhance CDWs' capacity to deliver projects, and broaden the value-creation ecosystem beyond the AHC community, our findings encourage exploration of strategic perspectives that complement those currently adopted. We highlight the importance of fostering multi-level alignment within the ecosystem by leveraging the concepts of meta-strategy and meta-organization.Le big data (BD) en santé est présenté comme une source de création de valeur pour les systèmes et organisations de santé. Pour les hôpitaux, exploiter les données numériques générées dans le cadre des activités courantes est devenu un enjeu stratégique. Ceux-ci sont incités à investir dans le développement et le déploiement de capacités dédiées, prenant notamment la forme d’entrepôts de données de santé (EDS).Ces investissements permettent-ils de réaliser le potentiel de création de valeur prêté au big data hospitalier ? Dans cette recherche, nous explorons cette question en adoptant une perspective stratégique, avec un focus particulier sur les centres hospitaliers universitaires (CHU), qui sont à la pointe des innovations technologiques en santé. Nous analysons ainsi comment les stratégies d’analyse du big data (ABD) sont définies et déployées au sein des établissements de santé et quelles approches soutiennent le mieux la création de valeur à partir des EDS créés.Trois axes d’analyse structurent notre approche. Une étude de la portée (scoping review) décrit les étapes et composantes du chemin des données numériques vers la valeur dans les hôpitaux. Ensuite, une étude qualitative, basée sur 61 entretiens dans 5 CHU, examine le processus de planification des stratégies ABD guidant les investissements dans les EDS. Enfin, une étude en méthode mixte explore l’implémentation de ces stratégies, et identifie les conditions permettant aux EDS de réaliser leur potentiel.Malgré les bénéfices attendus, un écart significatif persiste entre le potentiel théorique du big data et la valeur effectivement créée du fait des multiples contraintes internes et externes impactant les stratégies ABD des CHU. Afin de faire baisser le niveau de risques des investissements réalisés, d’augmenter les capacités des EDS à délivrer des projets et d’ouvrir le champ de la création de valeur à un écosystème plus large que la simple communauté des CHU, nos résultats invitent à explorer des perspectives stratégiques complémentaires à celles mises en oeuvre. Nous soulignons l’importance de créer les conditions d’un alignement multi-niveaux au sein de l’écosystème en mobilisant les concepts de méta-stratégie et de méta-organisation
Sex-Related Gap in the Use of Disease-Modifying Therapies in Multiple Sclerosis
No full textInternational audienceBackground and objectives: In women with multiple sclerosis (MS), the therapeutic strategy may be influenced by the anticipation of future pregnancies, leading to underexposure to disease-modifying therapies (DMTs) and highly effective DMTs (HEDMTs) compared with men. We aimed to evaluate potential therapeutic inertia in women with MS and explore its causes.Methods: We performed a retrospective cohort study based on data extracted on June 2023 from the Observatoire Français de la Sclérose en Plaques for all patients with a relapsing-remitting MS onset between 18 and 40 years. The primary outcome was the annual probability of receiving a DMT, accounting for sex, disease severity, and pregnancy/postpartum periods. Secondary outcomes were the annual probability of receiving a HEDMT, each DMT separately, and interaction of the effect of sex with calendar year, patient age, and disease duration. We used a longitudinal logistic model with generalized estimating equations and an inverse-probability-of-censoring weighting.Results: We included 22,657 patients with MS; 16,857 (74.4%) were female, mean (SD) age at onset was 29.0 (6.0) years, and median (interquartile range) follow-up duration was 11.6 (6.6-17.3) years. Women were significantly less likely to receive a DMT (odds ratio [OR] 0.92, 95% CI 0.87-0.97) or a HEDMT (OR 0.80, 95% CI 0.74-0.86). This difference appeared 2 years after disease onset for DMTs and 1 year for HEDMTs, and did not differ significantly according to patient's age. Teriflunomide, sphingosine-1-phosphate receptor modulators, and anti-CD20s were significantly underused in women throughout their entire period of availability; interferons β (IFN-β) and natalizumab were initially less used and then equally after some time; glatiramer acetate and fumarates were first used equally, then more frequently in women. The proportion of treated women, analyzed from the first childbirth of 5,268 women, began to decline 18 months before childbirth, from 42.6% to 27.9% at the estimated time of conception.Discussion: Women with MS were significantly less exposed to DMTs compared with men. Anticipation of pregnancy was probably an important factor underlying this difference, but also sex-specific therapeutic inertia. Neurologists and patients should be educated on the most recent recommendations on the use of DMTs in the context of pregnancy to avoid deleterious therapeutic inertia
Effect of a multicomponent HPV intervention on self-reported HPV vaccine uptake and intention among French adolescents and parents: results from the national, cluster-randomised PrevHPV trial
No full textInternational audienceBackground : Human papillomavirus (HPV) infections cause several cancers, including nearly all cervical cancer cases. While there are safe and effective vaccines, the adolescent HPV vaccine coverage in France is low (<50%). Thus, we studied the effect of municipality-wide interventions to increase HPV vaccine uptake and intention among middle school students. Methods : This cluster-randomised trial used an incomplete factorial design to arrange three components (in-school education, motivation, mobilisation (EMM); in-school vaccination; and local general practitioner (GP) trainings) into six intervention conditions, which were randomly assigned to 91 participating French municipalities. We assessed HPV vaccine status using online self-reported questionnaires that students (typically aged 13–14) and parents completed at baseline and 5-month follow-up. Using adjusted linear regression, we estimated differences in (1) vaccine uptake and (2) uptake and intention to vaccinate, both by randomisation arm and by intervention component. We explored subgroup effects by at-home multilingualism, gender, age and parental education. Results : 2047 of 2664 (74%) students were unvaccinated against HPV at baseline. The 5-month probability of first-dose vaccine uptake in the control group was 0·09 (95% CI 0.06 to 0.11). Vaccine campaigns alone contributed a 24-percentage-point (0.18, 0.30) increase in uptake compared with the control group. EMM was only effective in increasing vaccine uptake among monolingual francophone students, and we detected no effect from GP training. Vaccine campaigns and EMM both increased the combined outcome of vaccine intention and first-dose uptake, but EMM had the same subgroup effect. Questionnaire data from parents (N=236) were sparser but demonstrated similar overall trends. Conclusions : Our results demonstrate that in-school HPV vaccine campaigns effectively increase HPV vaccine uptake among adolescents without exacerbating extant disparities in vaccine uptake. EMM can also be a useful tool to increase HPV vaccine intention but must be improved to bridge disparities in its effectiveness. GP training results were inconclusive
Effets indésirables des vaccins et hésitation vaccinale : une revue exploratoire
No full textInternational audienc
Surrounding residential greenness and mental health: Findings from the French CONSTANCES cohort
No full textInternational audienceThis cross-sectional study assessed the association between surrounding greenness and two mental health outcomes according to degree of urbanization in the French CONSTANCES cohort. We included 114,717 participants. Depression in 2018 was evaluated by Center for Epidemiologic Studies Depression Scale (CES-D, from 0 to 60), and psychological distress in 2019 by General Health Questionnaire-12 (GHQ-12, from 0 to 12). Residential surrounding greenness was quantified by the mean of normalized difference vegetation index (NDVI) within 300m circular buffer around residential address. Adjusted negative binomial models were performed to assess the cross-sectional association between a 0.1 increase in NDVI at 300m and each outcome, separately in rural, peri-urban, urban and Paris areas. Stratified analyses by age and sex, and causal mediation models evaluating the role of physical activity were conducted. In 2018, the median age was 48.5, with 54.5% being women. A 0.1 unit increase of NDVI was associated to lower depressive symptoms in peri-urban areas (incidence rate ratio (IRR)= 0.92; 95% CI: 0.84–1.00) but higher in Paris (1.21; 1.06–1.38), and no associations were found in urban or rural areas. A 0.1 unit NDVI increase was associated to lower GHQ-12 score in peri-urban (IRR: 0.77; 95% CI: 0.64–0.93) and urban areas (IRR: 0.79; 95% CI: 0.65–0.97), with stronger effect size for middle-aged adults in urban areas and men in peri-urban areas. No associations were found in rural or Paris areas. Physical activity showed no mediation role. Surrounding greenness was associated with better mental health in peri-urban and urban but not in rural areas, possibly due to differences in types and uses of greenspaces