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Au-delà des quotas d’emploi de personnes handicapées, la production de handicap au travail. Analyse d’un cloisonnement sectoriel de l’action publique
No full textInternational audienceBasé sur une enquête qualitative auprès de trois établissements de la fonction publique hospitalière, cette communication met en évidence le cloisonnement de l’action publique entre questions d’emploi des personnes handicapées et de santé au travail. Elle se focalise notamment sur la commission de maintien dans l’emploi développée dans l’un des établissements afin de traiter les situations d’agents présentant des problèmes de santé pour montrer l'ignorance des questions de prévention dans le traitement des questions de maintien en emplo
Pre-dialysis care trajectory and post-dialysis survival and transplantation access in patients with end-stage kidney disease
No full textInternational audienceBackground: The pre-dialysis care trajectory impact on post-dialysis outcomes is poorly known. This study assessed survival, access to kidney transplant waiting list and to transplantation after dialysis initiation by taking into account the patients' pre-dialysis care consumption (inpatient and outpatient) and the conditions of dialysis start: initiation context (emergency or planned) and vascular access type (catheter or fistula).Methods: Adults who started dialysis in France in 2015 were included. Clinical data came from the French REIN registry and data on the care trajectory from the French National Health Data system (SNDS). The Cox model was used to assess survival and access to kidney transplantation.Results: We included 8856 patients with a mean age of 68 years. Survival was shorter in patients with emergency or planned dialysis initiation with a catheter compared to patients with planned dialysis with a fistula. The risk of death was lower in patients who were seen by a nephrologist more than once in the 6 months before dialysis than in those who were seen only once. The rate of kidney transplant at 1 year post-dialysis was lower for patients with emergency or planned dialysis initiation with a catheter (respectively, HR = 0.5 [0.4; 0.8] and HR = 0.7 [0.5; 0.9]) compared to patients with planned dialysis start with a fistula. Patients who were seen by a nephrologist more than three times between 0 and 6 months before dialysis start were more likely to access the waiting list 1 and 3 years after dialysis start (respectively, HR = 1.3 [1.1; 1.5] and HR = 1.2 [1.1; 1.4]).Conclusions: Nephrological follow-up in the year before dialysis initiation is associated with better survival and higher probability of access to kidney transplantation. These results emphasize the importance of early patient referral to nephrologists by general practitioners
Déserts médicaux en soins de premier recours : un regard économique
No full textInternational audienceCet article s’intéresse à la dégradation de l’accès aux soins de premiers recours dans certains territoires et les désormais consacrés, bien que pour partie mal nommés, « déserts médicaux ». Après une présentation du contexte, nous porterons notre attention sur les déterminants des inégalités de répartition pour les médecins généralistes, puis nous nous interrogerons, à travers le prisme de la science économique, sur la pertinence des leviers de politiques publiques principalement mobilisées jusqu’à aujourd’hui en France pour répondre à ce défi, et ceux peu ou pas considérés, à l’aune de leurs effets attendus ou observés
2022 French Report Card on Physical Activity and Sedentary Behaviors in Children and Youth: From Continuous Alarming Conclusions to Encouraging Initiatives
No full textInternational audienceBACKGROUND: Scientific evidence and public health reports keep highlighting the continuous and alarming worldwide progression of physical inactivity and sedentary behaviors in children and adolescents. The present paper summarizes findings from the 2022 French Report Card (RC) on physical activity for children and youth and compares them to the 2016, 2018, and 2020 RCs. METHODS: The 2022 edition of the French RC follows the standardized methodology established by the Active Healthy Kids Global Matrix. Ten physical activity indicators have been evaluated and graded based on the best available evidence coming from national surveys, peer-reviewed literature, government and nongovernment reports, and online information. The evaluation was also performed in children and adolescents with disabilities. Indicators were graded from A (high level of evidence) to F (very low level of evidence) or INC for incomplete. RESULTS: The evaluated indicators received the following grades: overall physical activity: D-; organized sport participation and physical activity: C; active play: F; active transportation: C; sedentary behaviors: D-; family and peers: D; physical fitness: C; school: C-; community and the built environment: F; government: B. CONCLUSIONS: While this 2022 French RC shows progression for 7 out of the 10 indicators considered, it also underlines the continuous need for actions at the local, regional, and national levels to develop better surveillance systems and favor a long-term improvement of youth movement behaviors
Structures rétiniennes nerveuses et vasculaires : des biomarqueurs des structures cérébrales ?
No full textThe retina and the central nervous system are anatomically linked, given their common embryological origin. There are many structural and functional similarities between the retina and brain structures; the retina could be a ‘window’ for viewing brain structures. The retina is much more easily observable than the brain, thanks to non-invasive, fast and inexpensive imaging. At the retinal level, two types of structures can be visualised: neural retina structures (e.g. retinal layers) and retinal vascular parameters. On the one hand, retinal layers can be evaluated non-invasively, quickly and inexpensively via optical coherence tomography (OCT). Retinal vessels, on the other hand, are directly viewable in ocular fundus photography, and the retinal vascular network features can be obtained using semi- automatic software applications or fully automated methods (e.g. artificial intelligence). Recently, new technologies have been developed that allow more detailed assessment of retinal vascular microstructure and retinal vessel walls such an OCT-angiography and adaptive optics. We hypothesise that retinal structure alterations (retinal layers thickness and retinal vascular parameters) may reflect structural and microvascular changes at the brain level, which can be assessed by brain imaging or by clinical signs such as dementia signs. In this thesis, in order to test this hypothesis, we first examined the associations between retinal nerve layer thickness and i) brain volumes, ii) cortical thicknesses iii) and white matter microstructure in a population of healthy young adults. We then analysed the associations between the retinal nerve layer thickness and retinal microvasculature with dementia in elderly subjects from the general population. In the i-Share (Internet-based Students Health and Research Enterprise) cohort of young subjects, our results suggest associations between retinal layers thickness and brain regions, particularly in regions the visual pathway, but also in association tracts that rely different brain areas; these associations were mainly found with markers assessing brain microstructure. In the Three City-Aliénor cohort of elderly people, two studies were carried out in relation to dementia. With regard to retinal layers thickness, we described the evolutionary trajectories of retinal nerve layers thickness preceding dementia diagnosis in individuals with dementia and matched controls. Our results suggest a faster decline in the thickness of the retinal nerve fiber layer (RNFL) in future demented subjects. As for retinal microvasculature, we examined the longitudinal relationship between retinal vascular features and dementia incidence over 10 years. Increased vessel tortuosity and, to a lesser extent, increased venular calibers were associated with dementia risk. We also found some specific associations according to dementia etiology. Overall, our results suggest that retinal imaging could provide information for the study of the brain, whether at the structural level or in relation to dementia. However, further studies are needed to better understand the relationship between these two organs, and to clarify the extent to which retinal structures could represent biomarkers of brain structures and be clinically useful for identifying and preventing dementia risk.La rétine et le système nerveux central sont anatomiquement reliés, en raison de leur origine embryologique commune. Les structures de la rétine pourraient constituer une « fenêtre » pour l’évaluation des structures cérébrales. La rétine est en effet beaucoup plus facilement observable que le cerveau. Au niveau rétinien, deux types de structures peuvent être visualisées : les structures nerveuses, notamment les couches rétiniennes, et la microvasculature rétinienne. Les différentes couches rétiniennes peuvent être évaluées de façon non invasive, rapide et peu coûteuse via la tomographie par cohérence optique (OCT). Les vaisseaux rétiniens quant à eux, sont directement visualisables sur des photos du fond d’œil, et des paramètres du réseau vasculaire rétinien tels que la tortuosité ou la complexité du réseau peuvent être obtenus par des logiciels d'analyse semi-automatique ou grâce à l’utilisation de méthodes d’intelligence artificielle. Récemment, de nouvelles technologies permettant une évaluation plus fine de la microstructure vasculaire rétinienne et de la paroi des vaisseaux rétiniens ont été développées comme l’OCT-angiographie et l’optique adaptative. Nous faisons l’hypothèse que des changements au niveau rétinien (structurels et au niveau vasculaire) pourraient refléter des changements structurels et de microvascularisation au niveau cérébral ; ces atteintes cérébrales peuvent être évaluées grâce à l'imagerie cérébrale ou par les signes cliniques qu'elles entrainent, comme la survenue d'une démence. Dans cette thèse, afin de tester cette hypothèse, nous avons dans un premier temps examiné les associations entre l’épaisseur des couches nerveuses rétiniennes et i) les volumes cérébraux, ii) les épaisseurs corticales, iii) et la microstructure de la substance blanche dans une population de jeunes adultes sans pathologie connue. Ensuite, nous avons analysé les associations entre l’épaisseur des couches nerveuses rétiniennes d'une part et la microvasculature rétinienne d'autre part avec la démence chez des sujets âgés de la population générale. Dans la cohorte i-Share (Internet-based Students Health and Research Enterprise), constituée de sujets jeunes, nos résultats suggèrent des associations entre l’épaisseur des couches nerveuses rétiniennes et les structures cérébrales, notamment au niveau des voies visuelles, mais aussi dans des aires d’association entre différentes zones cérébrales ; ces associations ont surtout été retrouvées avec des marqueurs évaluant la microstructure de la substance blanche cérébrale. Dans la cohorte de Trois Cités Bordeaux-Aliénor, constituée de personnes âgées, deux études ont été menées pour évaluer les liens avec la démence. Concernant les couches nerveuses rétiniennes, nous avons décrit les trajectoires évolutives de l’épaisseur de ces couches chez des futurs déments et des témoins appariés, mettant en évidence un déclin plus important de l’épaisseur de la couche des fibres nerveuses rétiniennes (RNFL) chez les futurs déments. Concernant la microvasculature rétinienne, nous avons analysé si des paramètres rétiniens mesurés initialement étaient associés à la survenue d'une démence dans les 10 années suivantes. Nos résultats suggèrent qu'une plus grande tortuosité des vaisseaux et dans un moindre degré une augmentation des calibres des veinules étaient associées à la survenue d'une démence, avec des associations spécifiques pour certaines étiologies de démence. Ainsi, dans l’ensemble, nos résultats suggèrent que l’imagerie rétinienne pourrait fournir des informations pour l’étude du cerveau, que ce soit au niveau des structures cérébrales ou en lien avec la démence. Cependant, des études supplémentaires sont nécessaires afin de mieux comprendre les relations entre ces deux organes, et afin de préciser dans quelle mesure les structures rétiniennes pourraient représenter des biomarqueurs des structures cérébrales et être utiles sur le plan clinique (…)
Scannotation: A Suspect Screening Tool for the Rapid Pre-Annotation of the Human LC-HRMS-Based Chemical Exposome
No full textInternational audienceIn an increasingly chemically polluted environment, rapidly characterizing the human chemical exposome (i.e., chemical mixtures accumulating in humans) at the population scale is critical to understand its impact on health. High-resolution mass spectrometry (HRMS) profiling of complex biological matrices can theoretically provide a comprehensive picture of chemical exposures. However, annotating the detected chemical features, particularly low-abundant ones, remains a significant obstacle to implementing such approaches at a large scale. We present Scannotation (https://github.com/scannotation/Scannotation_software), an automated and user-friendly suspect screening tool for the rapid pre-annotation of HRMS preprocessed data sets. This software tool combines several MS1 chemical predictors, i.e., m/z, experimental and predicted retention times, isotopic patterns, and neutral loss patterns, to score the proximity between features and suspects, thus efficiently prioritizing tentative annotations to verify. Scannotation and MS-DIAL4 were used to annotate blood serum samples of 75 Breton adolescents. Scannotation's combination of MS1-based chemical predictors allowed us to annotate 89 chemically diverse environmental compounds with high confidence (confirmed by MS2 when available). These compounds included 62% of emerging molecules, for which no toxicological or human biomonitoring data are reported in the literature. The complementarity observed with MS-DIAL4 results demonstrates the relevance of Scannotation for the efficient pre-annotation of large-scale exposomics data sets
Use of interviewer-administered telephone surveys during infectious disease outbreaks, epidemics and pandemics: a scoping review
No full textInternational audienceINTRODUCTION: During the COVID-19 crisis, researchers had to collect data remotely. Telephone surveys and interviews can quickly gather data from a distance without heavy expense. Although interviewer-administered telephone surveys (IATS) can accommodate the needs of international public health research, the literature on their use during infectious disease outbreaks is scarce. This scoping review aimed to map the characteristics of IATS during infectious disease outbreaks. METHODS: IATS conducted principally during infectious disease outbreaks and answered by informants at least 18 years old were searched from PubMed and EBSCO. There was a manual addition of relevant documents identified during an initial search. Overall trends were reported using different groupings, including WHO regions, and study details were compared before and during the COVID-19 pandemic. RESULTS: 70 IATS published between 2003 and 2022 were identified. 57.1% were conducted during the COVID-19 pandemic. Among 30 IATS conducted before the COVID-19 pandemic in the world, only 3.3% were carried out in low-income and middle-income countries (LMICs). This percentage of studies in LMICs out of all the IATS rose to 32.5% during the pandemic. The share of qualitative studies grew from 6.7% before the COVID-19 outbreak to 32.5% during the outbreak. IATS performed during the COVID-19 pandemic focused on more diverse, specific population groups, such as patients and healthcare professionals. Mobile phones are increasingly used for IATS over time. CONCLUSION: IATS are used globally with high frequency in the Western Pacific Region and high-income countries. Technical and financial challenges continue to exist, and assessments of inclusiveness and representativeness should be carefully conducted. A lack of details related to methods was observed, and this scoping review urges researchers using this data collection method in the future to specify how they executed IATS for better use and more efficient deployment
(Re)-discovering rivers benefits in the City: a One Health approach
No full text16th European Public Health Conference 2023 Our Food, Our Health, Our Earth: A Sustainable Future for Humanity Dublin, Ireland 8–11 November 2023International audienceIn the context of climate change and increasing urbanization, urban bathing is emerging in France and elsewhere, thus bringing us to question how we can maximize the benefits for the health of populations and minimize the risks. The multidisciplinary URB-bain project studies the feasibility of bringing bathing back to the urban environment. In a One Health approach, it combines 1/ the study of health risks associated with the chemical and microbiological analyses quality of the water of two potential bathing sites (Metz, France) and 2/ a socio-historical and political approach to the use of urban bathing in France, Europe, and Canada. This paper will present the first results of axis 2. Two types of qualitative data were collected: semi-structured interviews and documentation. Interviews were conducted with technicians, decision-makers, and NGOs. Eighteen interviews were performed (10 in Metz, France, 3 in Paris, and 5 in Quebec, Canada), recorded, transcribed, and analyzed (N'Vivo 12©). Other sites were documented (Copenhagen, Berlin). The causality model between urban bathing and health developed within the framework of the project and the principles for operationalizing the One Health concept (collaboration, coordination, communication, capacity building) guided the analysis. Documentation analysis showed a renewed interest in urban bathing in France since the 1990s, culminating in 2017 in Paris with the opening of a pool in the Canal de la Villette under pressure from citizens and motivated by the hosting of the Olympic Games in 2024. In France, health considerations focused on regulatory issues based on bacteriological quality for the institutions. The water bodies’ ecological and chemical status is neither a concern nor a One-health approach. Social accessibility and gender equity in the public space are important issues. The analysis of the interviews, still in progress, will help to put the initial results into perspective with the other sites studied. Key messages • Urban bathing is a public health issue in a context of climate change. • Urban bathing is a one-health issue
Assessing the risk of relapse after in vitro fertilization in women with multiple sclerosis
No full textInternational audienc
Pandemics and the tourism industry: who is in control?
No full textInternational audienceThe UN World Tourism Organization (UNWTO) has the authority to adapt WHO recommendations on pandemic control