Scientific publications portal of EHESP researchers
Not a member yet
5609 research outputs found
Sort by
Comparison of High Efficacy Treatment Discontinuation and Continuation among Stable Multiple Sclerosis Patients after 50
No full textInternational audienc
The SCREENPEST project: Development and implementation of an innovative large-scale screening approach for extended characterisation of human exposure to pesticides
No full textInternational audienceThe aim of the SCREENPEST project is to provide a methodology for large-scale characterisation of human internal exposure to pesticides, via a "suspect profiling" approach, using urine. To gain access to this variety of compounds a novel multiplexed approach by profiling a single sample using different analytical platforms is needed
« La monoparentalité a des conséquences négatives sur le bien-être des enfants »?
No full textInternational audienc
Situational Analysis and Obstacles to the Development of Ambulatory Surgery in France and the Barriers to its Development: The Practitioners' Perspective
No full textInternational audienceObjectives: The ambulatory endovascular treatment of peripheral arterial occlusive disease (PAOD) remains marginal in France. In 2019, guidelines were published by the French Society for Vascular and Endovascular Surgery to facilitate this practice. However, the development of ambulatory care remains slow and obstacles persist. The objectives of this study were to give an overview of the ambulatory endovascular treatment of PAOD in France and to identify the barriers to its development, according toMaterial and methods: Between September 2022 and October 2023, the French vascular surgeons (n=654) were approached by the French Society for Vascular and Endovascular Surgery and Vascurisq to answer an online questionnaire on their ambulatory practice of the endovascular treatment of PAOD. The questionnaire, completed on a voluntary basis, focused on the medical and social criteria for selection of patients, the treatment, the follow-up, the number of procedures of performed and the potential barriers.Results: Among the 279 (43%) respondents, 197 (71%) were private surgeons. All of the French regions were represented. 228 surgeons (82%) reported performing endovascular treatment for PAOD in an outpatient setting. 178 surgeons (79%) said that they had not changed their practices because of the ambulatory practice. 172 (75%) used manual compression on an outpatient basis. The patients were on average monitored 4.7±1.5h after the procedure. Social isolation was considered as the main exclusion cause.Conclusion: This study, carried out on almost half of the French vascular surgeons gives an overview of ambulatory practice and of the potential obstacles four years after publication of the guidelines. The medicolegal risks, social isolation and the complexity of the lesions appear as real obstacles to the development of the endovascular treatment of PAOD in an outpatient basis
Norway’s Battery Electric Vehicles and Public Health- Findings From the Literature
No full textInternational audienceThe transportation sector is among the highest contributors to the increase in greenhouse gas emissions in European nations, with private cars emerging as the primary source. Although reducing emissions presents a formidable challenge, the emergence of battery electric vehicles (BEVs) offers a promising and sustainable avenue toward achieving zero greenhouse gases within the transportation infrastructure. Since the 1990s, the Norwegian parliament has fervently supported this transition, leveraging public awareness campaigns and a range of financial incentives for its users nationwide. The widespread utilization of BEVs promises substantial health benefits, including ensuring cleaner air for all citizens regardless of their socioeconomic status and fostering improvements in public health outcomes. This transition potentially curtails hundreds of thousands of annual deaths attributed to climate change, enhances the quality of life, bolsters civilian productivity, and fuels economic and population growth. The adoption of BEVs offers a myriad of advantages, including reduced health risks and premature mortality, as well as a quieter environment with diminished noise pollution. Nonetheless, the integration of BEVs necessitates robust road infrastructure with considerable maintenance costs, alongside limitations on driving range for users. Concerns arise regarding potential particle emissions from BEV tire wear due to the increased weight of batteries compared to conventional vehicles. Rapid acceleration capabilities may accelerate tire degradation, contributing to higher particle emissions, of which only 10% to 20% remain suspended in the air, whereas the majority settles on road surfaces, posing a threat to nearby aquatic ecosystems when washed into water bodies and soils. While BEVs hold promise for valuable benefits, successful policy creation and implementation require a detailed awareness of their limitations and challenges to ensure a comprehensive approach to sustainable mobility and public health improvement. Therefore, more research on the limitations of BEVs can help inform improved tactics for maximizing their benefits while limiting potential disadvantages
Quelles priorités en santé-environnement ? Classement par coûts socio-économiques des déterminants de santé-environnement comme outil d’aide à la décision
No full textInternational audienceContext . The health system has begun to engage in a transition following the imperatives of reducing greenhouse gas emissions and improving efficiency in order to tackle climate change. It is estimated that more than 70% of non -communicable diseases may be due to environmental health determinants. It has been hypothesised that by acting on environmental health determinants through health prevention and promotion, it may be possible to reduce the burden on the health system imposed by diseases linked with the environment, thus supporting its resilience and transition. Objectives . The goal of this study is to conduct an analysis of health risks linked to the environment by identifying environmental health determinants, and prioritising them in terms of their socioeconomic cost, as a means of supporting the transition of the healthcare system and facilitating policy -making. Methods . The scoping review method was used to define the scope of environmental health and determinants it encompasses. After selecting relevant databases, data on the health and environmental impacts of those determinants were collected in an analysis frame. The standardised socioeconomic translation of those impacts makes it possible to prioritise those determinants. Results . The environmental health determinants which have the greatest burden on society are noise (147 B/year), outdoor air quality (130 B/year), and nutrition and physical activity (overweight/obesity: 20.4 B/year and physical inactivity/sedentary lifestyles: 140 B/year). Other environmental challenges with less detail and using other indicators of exposure and mortality are also to be considered, including: - continental flooding as the leading natural risk in terms of exposure and damage; - severe cold and heat episodes as the deadliest climatic events.ContexteLe système de santé a engagé sa transition écologique suivant un impératif de réduction des émissions de gaz à effet de serre et d’efficience face aux défis du changement climatique. Par ailleurs, on estime que plus de 70 % des pathologies non transmissibles seraient dues à des déterminants environnementaux de la santé. L’hypothèse est posée qu’en agissant de façon préventive et promotrice en santé sur ces déterminants, il est possible de réduire le poids des pathologies liées à l’environnement sur le système de santé, et donc d’appuyer sa résilience.ObjectifsLa présente recherche a pour objectif de classer les risques sanitaires liés à l’environnement sous le prisme de déterminants de santé-environnement et de les hiérarchiser en fonction de leurs coûts socio-économiques, dans un but d’appui à la transition et d’aide à la décision.MéthodesLa méthode de l’étude de portée (scoping review) a été utilisée pour définir le périmètre de la santé-environnement et les déterminants que recoupe ce champ. Une fois les bases de données pertinentes sélectionnées, les données relatives aux impacts sanitaires et environnementaux de ces déterminants ont été réunies dans un tableau de synthèse. La traduction socio-économique uniformisée de ces impacts a permis de hiérarchiser ces déterminants.RésultatsLes déterminants de santé-environnement pesant le plus sur la société sont le bruit (147 Md€/an), la qualité de l’air extérieur (130 Md€/an) et la nutrition et l’activité physique (surpoids/obésité : 20,4 Md€/an ; inactivité physique/ sédentarité : 140 Md€/an).De surcroît, d’autres enjeux environnementaux, qui seront ici moins détaillés et utilisant d’autres indicateurs d’expositions et de mortalités, sont à considérer : les inondations continentales comme premier risque naturel en termes d’exposition et de dommages matériels ; les épisodes de grand froid et les vagues de chaleur / canicules comme les événements climatiques extrêmes les plus meurtriers
Healthcare Resources Utilization and Costs of Paediatric Patients with Long-COVID managed in the community in France
No full textInternational audienceOBJECTIVES: The risk of persistent symptoms following SARS-CoV-2 infection is observed, and the burden of long COVID to healthcare system is poorly characterized in this age group. We aimed to assess the healthcare resources utilization (HCRU) and costs associated with community-managed long COVID in children in France.Methods: We conducted a retrospective cohort study using the electronic records of confirmed and/or probable COVID-19 patients in the primary care setting from The Health Improvement Network (THIN) data between 03/2020 and 08/2023. Long-COVID was defined per World Health Organization (WHO) with suggestive symptoms given ≥12 weeks following acute SARS-CoV-2 infection. Patients’ characteristics, HCRU and costs were summarized.Results: A total of 27,537 children were included and 14.1% have long COVID. The mean (SD) age was 9(±5) years old with 26% being aged 6mos-4 yr, 37% aged 5-11 yr and 37% aged 12-17 yr, 49% were female and less than 1% had a Charlson Comorbidity Index (CCI) >2. The average follow-up was 13 months. Most of the patients (96%) had consultations with general practitioners (GPs), followed by nursing care (34%) and pediatrician (15%). HCRU & costs were the highest in the 1st year after long COVID diagnosis with per patient per year cost at €823, including consultations by GP at €187 and specialists at €78, outpatient procedures at €120, treatments at €216, laboratory tests at €52 and medical devices at €55.Conclusions: In children, long COVID poses a nontrivial burden to the FR health system, highlighting the importance of managing pediatric patients in primary care setting after acute infection, reducing the consequences of long COVID
Territorial health inequalities in breast cancer mortality across France from 1968 to 2017
No full textInternational audienceBackground: Territorial health inequalities are of growing concern in countries with universal health systems. From 2003, three successive national cancer plans were launched in France, aiming to improve prevention and treatment. Regions in France are responsible for strategic and financial management of healthcare within their boundaries, which, until 2016, included up to 8 departments. In this study, we analyze the evolution of between and within-region territorial inequalities in breast cancer mortality over 50 years. Methods: We used direct and indirect standardization to analyze trends in breast cancer mortality for women aged 25 to 74 years between 1968 and 2017 in each department of metropolitan France. We analyzed the evolution of relative inequalities over time using standard errors of age-adjusted rates. We used multilevel Poisson regression to estimate how much the regional level contributed to territorial variation. Results: Over the period 1968 to 1992, breast cancer standardized mortality ratios (SMRs) increased (+16%) while relative territorial inequalities decreased (-21%). After 1997, SMRs decreased (-23%) but territorial inequalities remained unchanged. In 18 out of 22 regions, inequalities were lower at the end than at the start of the study period. Period proved to be the most important determinant of variation in mortality. However, multilevel models also suggested that the regional level explained most of the remaining variation in each period (from 50% to over 80%). Conclusions: Over the study period in most French regions, breast cancer mortality has decreased, and so have relative inequalities. Nevertheless, there is evidence that regions have performed differently. The proportion of variation explained by the regional level suggests the continued relevance of the health system on breast cancer mortality. Key messages: Territorial inequality in breast cancer mortality has decreased in France over the 1968-2017 period. In most regions, disparities between departments have decreased
Experience of Chronic Kidney Disease and Perceptions of Transplantation by Sex
No full textInternational audienceImportance: The pathway to kidney transplantation (KT) begins with the patient's acceptance of this surgical procedure after discussion with the nephrologist. The patients' perceptions of the disease and of KT may influence their willingness to undergo transplantation.Objective: To describe patients' experiences of kidney disease and their perceptions of KT and the nephrologists' perceptions of the patient experience.Design, setting, and participants: This qualitative study collected data through semistructured interviews with patients with chronic kidney disease and nephrologists in the Bretagne, Île-de-France and Normandie regions, France. Researchers involved in the study in each region purposely selected 99 patients with chronic kidney disease who initiated dialysis in 2021, based on their age, sex, dialysis facility ownership, and also 45 nephrologists, based on their sex and years of experience. Data analysis was performed from January to October 2023.Main outcomes and measures: Themes were identified using inductive thematic analysis. Specific characteristics of men and women as well as the nephrologist's views for each theme were described.Results: This study included 42 men and 57 women (56 [57%] aged 60 years or older) who started dialysis in 2021 and 45 nephrologists (23 women and 22 men). Six major themes were identified: (1) burden of chronic kidney disease on patients and their families, (2) health care professional-patient relationship and other factors that modulate chronic kidney disease acceptance, (3) dialysis perceived as a restrictive treatment, (4) patients' representation of the kidney graft, (5) role of past experiences in KT perception, and (6) dualistic perception of KT. In some cases, women and nephrologists indicated that women's perceptions and experiences were different than men's; for example, the disease's psychological impact and the living donor KT refusal were mainly reported by 8 women.Conclusions and relevance: Patients' past experience of chronic kidney disease in general and of KT in particular, as well as their relationship with their family and nephrologist, were substantial determinants of KT perception in this qualitative study. Targeted policies on these different factors might help to improve access to KT, and more research is needed to understand whether there are sex-based disparities