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Improving the decision to switch from first to second-line therapy in multiple sclerosis: a dynamic scoring system
No full textInternational audienceBackground - In relapsing-remitting multiple sclerosis (RRMS), early identification of suboptimal responders can prevent disability progression. Objective - We aimed to develop and validate a dynamic score to guide the early decision to switch from first- to second-line therapy. Methods - Using time-dependent propensity scores (PS) from a French cohort of 12,823 patients with RRMS, we constructed one training and two validation PS-matched cohorts to compare the switched patients to second-line treatment and the maintained patients. We used a frailty Cox model for predicting individual hazard ratios (iHRs). Results - From the validation PS-matched cohort of 348 independent patients with iHR ⩽ 0.69, we reported the 5-year relapse-free survival at 0.14 (95% confidence interval (CI) 0.09-0.22) for the waiting group and 0.40 (95% CI 0.32-0.51) for the switched group. From the validation PS-matched cohort of 518 independent patients with iHR > 0.69, these values were 0.37 (95% CI 0.30-0.46) and 0.44 (95% CI 0.37-0.52), respectively. Conclusions - By using the proposed dynamic score, we estimated that at least one-third of patients could benefit from an earlier switch to prevent relapse
Therapeutic mobility and breast cancer in France: Experiences of African women
No full textInternational audienceWhile breast cancer is the most common cancer globally, not all women have access to quality care. Long considered a disease of high-income countries, low- and middle-income countries are now facing a major public health issue regarding cancer. This is the case in sub-Saharan Africa, where access to quality breast cancer treatment is often lacking. This context leads some women to travel abroad, particularly to France, hoping to save their lives. This article aims to examine the experiences, the social cost and the perceptions associated with therapeutic mobility for breast cancer in France. To this end, this study uses a qualitative method based on nineteen biographical interviews with women from sub-Saharan Africa with breast cancer who have migrated to France seeking for treatment. It shows that these women often face significant difficulties throughout their care and life paths in France. Main issues lay in accessing care, housing insecurity, loneliness, and administrative instability. This reflects how the double biographical disruption, caused by cancer and migration, impact entire disease trajectories, from entry to care to post-breast cancer period. With this research, we suggest extending the concept of social death to the issue of women who have undergone therapeutic mobility for their breast cancer in France. Highlighting the experiences of women who remain almost invisible in the public arena, this article analyses poorly heard realities and shows how social inequalities in health can be found even in reconstructing oneself after breast cancer
How Do Young Adult Drinkers React to Varied Alcohol Warning Formats and Contents? An Exploratory Study in France
No full textInternational audienceResearch on alcohol warnings has increased in the last decade, providing key evidence to governments on warning format and contents. The bulk of this research, however, has been conducted in Anglosphere countries, whereas fewer studies have focused on other countries which have high per capita alcohol consumption, and where the high social acceptability of drinking is liable to affect how people accept and react to prevention measures. Since France has one of the highest per capita alcohol consumption rates in the world according to the World Health Organization (WHO), we therefore explore how young adults in France react to warnings on alcoholic beverage advertisements. We conducted 25 in-depth interviews, in 2017, with 18–25-year-old drinkers in France. Respondents were asked open-ended questions on the perceived impact of various warning contents (i.e., on health risk, social-cost risk, and on short- vs. long-term risk) and formats (text only vs. larger text combined with colored pictograms). Warnings that targeted youth-relevant risks (i.e., road accidents or sexual assault) were considered to be the most meaningful and credible, although warnings communicating longer term risks (i.e., brain, cancer) were also thought to be influential. Less familiar risks, such as marketing manipulation and calorie intake, elicited the most negative reactions. Larger text-and-pictogram warnings were considered to be the most effective format in capturing attention and increasing awareness. Regardless of format and content, however, these warnings were not perceived as effective for decreasing alcohol consumption. © 2023 by the authors
Médiation sociale et prévention : quand le périmètre de l’activité déborde celui de la subordination
No full textInternational audienc
The (De)normalisation of Smoking Among Apprentices: Plurality of Settings, Norms and Vulnerability Levels
No full textInternational audienceWhen it comes to smoking, apprentices are considered a ‘vulnerable’ population. They have been the subject of targeted approaches based on the assumption of common characteristics. In contrast to most public health studies, that assume homogeneity of vulnerable groups, this article, based on Lahire’s ‘theory of the plural individual’, aims to examine inter- and intra-individual variability in relation to tobacco exposure. It is based on a secondary analysis of 30 interviews with apprentices in France on the stigma attached to their use in their different living environments. Our study confirms that the family and the Centre de Formation des Apprentis, as a whole, encourage smoking. It also provides a better understanding of the mechanisms by which inequalities are perpetuated (permissive rules, loans and gifts of cigarettes, spillover effects, lack of incentives to quit). Nevertheless, it allows us to observe that, in some families and in some companies, smoking is denormalised, even stigmatised. Several apprentice profiles emerge: those who are protected from tobacco and seem to be able to quit easily; those who are permanently confronted with it and for whom it is difficult to consider quitting or reducing; and those who are confronted with a plurality of norms, who seem ambivalent and whose consumption varies significantly. These results will allow us to adapt the interventions according to the profile of the apprentices and by including their entourage. In particular, it will be necessary to propose a ‘go-to’ approach that goes beyond the school setting and involves the family and the workplace
The radiologically isolated syndrome: revised diagnostic criteria
No full textInternational audienceThe radiologically isolated syndrome (RIS) was defined in 2009 as the presence of asymptomatic, incidentally identified demyelinating-appearing white matter lesions in the CNS within individuals lacking symptoms typical of multiple sclerosis (MS). The RIS criteria have been validated and predict the transition to symptomatic MS reliably. The performance of RIS criteria that require fewer MRI lesions is unknown. 2009-RIS subjects, by definition, fulfil three to four of four criteria for 2005 dissemination in space (DIS) and subjects fulfilling only one or two lesions in at least one 2017 DIS location were identified within 37 prospective databases. Univariate and multivariate Cox regression models were used to identify predictors of a first clinical event. Performances of different groups were calculated. Seven hundred and forty-seven subjects (72.2% female, mean age 37.7 ± 12.3 years at the index MRI) were included. The mean clinical follow-up time was 46.8 ± 45.4 months. All subjects had focal T2 hyperintensities suggestive of inflammatory demyelination on MRI; 251 (33.6%) fulfilled one or two 2017 DIS criteria (designated as Groups 1 and 2, respectively), and 496 (66.4%) fulfilled three or four 2005 DIS criteria representing 2009-RIS subjects. Group 1 and 2 subjects were younger than the 2009-RIS group and were more likely to develop new T2 lesions over time (P < 0.001). Groups 1 and 2 were similar regarding survival distribution and risk factors for transition to MS. At 5 years, the cumulative probability for a clinical event was 29.0% for Groups 1 and 2 compared to 38.7% for 2009-RIS (P = 0.0241). The presence of spinal cord lesions on the index scan and CSF-restricted oligoclonal bands in Groups 1-2 increased the risk of symptomatic MS evolution at 5 years to 38%, comparable to the risk of development in the 2009-RIS group. The presence of new T2 or gadolinium-enhancing lesions on follow-up scans independently increased the risk of presenting with a clinical event (P < 0.001). The 2009-RIS subjects or Groups 1 and 2 with at least two of the risk factors for a clinical event demonstrated better sensitivity (86.0%), negative predictive value (73.1%), accuracy (59.8%) and area under the curve (60.7%) compared to other criteria studied. This large prospective cohort brings Class I evidence that subjects with fewer lesions than required in the 2009 RIS criteria evolve directly to a first clinical event at a similar rate when additional risk factors are present. Our results provide a rationale for revisions to existing RIS diagnostic criteria
La sociologie face à la maladie d’Alzheimer
No full textInternational audienceFace à la maladie d’Alzheimer, la sociologie s’est montrée, dans les années 2000, particulièrement prolifique. Portés par un contexte dans lequel la maladie d’Alzheimer constituait une préoccupation croissante, encouragés par des financements dédiés, des travaux d’une grande richesse ont vu le jour. Cet ouvrage rend compte de ce « moment Alzheimer » de la sociologie, des regards originaux qu’elle a portés sur la maladie d’Alzheimer et des savoirs qu’elle a produits. Il est organisé en trois grandes parties. La première, « Politiques publiques et initiatives de terrain », interroge les dispositifs mis en place. La deuxième, « Du diagnostic aux derniers temps de la vie. Moments et processus de la maladie d’Alzheimer » retrace les expériences sociales de la maladie des différents acteurs concernés (professionnels, personnes malades, proches). La troisième, « Proches face à la maladie d’Alzheimer », étudie plus précisément ce qui se produit pour les proches aidants
Promouvoir la vaccination HPV en milieu scolaire : une étude mixte explorant les connaissances, représentations et attitudes du personnel scolaire en France
No full textInternational audienceBackgroundHPV vaccine coverage in France remained lower than in most other high-income countries. Within the diagnostic phase of the national PrevHPV program, we carried out a mixed methods study among school staff to assess their knowledge, beliefs and attitudes regarding HPV, HPV vaccine and vaccination in general, and regarding schools’ role in promoting HPV vaccination. MethodsMiddle school nurses, teachers and support staff from four French regions participated between January 2020 and May 2021. We combined: (i) quantitative data from self-administered online questionnaires ( n = 301), analysed using descriptive statistics; and (ii) qualitative data from three focus groups ( n = 14), thematically analysed.ResultsLess than half of respondents knew that HPV can cause genital warts or oral cancers and only 18% that no antiviral treatment exists. Almost 90% of the respondents knew the existence of the HPV vaccine but some misunderstood why it is recommended before the first sexual relationships and for boys; 56% doubted about its safety, especially because they think there is not enough information on this topic. Schools nurses had greater knowledge than other professionals and claimed that educating pupils about HPV was fully part of their job roles; however, they rarely address this topic due to a lack of knowledge/tools. Professionals (school nurses, teachers and support staff) who participated in the focus groups were unfavourable to offering vaccination at school because of parents’ negative reactions, lack of resources, and perceived uselessness. ConclusionsThese results highlight the need to improve school staff knowledge on HPV. Parents should be involved in intervention promoting HPV vaccination to prevent their potential negative reactions, as feared by school staff. Several barriers should also be addressed before organizing school vaccination programs in France.IntroductionLa couverture vaccinale contre les papillomavirus humains (HPV) en France reste inférieure à celle de la plupart des autres pays développés. Dans le cadre de la phase diagnostique du projet PrevHPV, nous avons mené une étude mixte auprès de professionnels de l’Education Nationale afin d’explorer leurs connaissances, représentations et attitudes vis-à-vis des HPV, du vaccin contre les HPV et de la vaccination en général, ainsi qu’au sujet du rôle du milieu scolaire dans la promotion de la vaccination contre les HPV.MéthodesL’étude a été menée auprès d’infirmières scolaires, d’enseignants et de membres du personnel administratif et d’encadrement de collèges de quatre régions françaises entre janvier 2020 et mai 2021. Nous avons combiné : (i) des données quantitatives collectées via des questionnaires auto-administrés, en ligne (n = 301), analysées à l'aide de statistiques descriptives ; et (ii) des données qualitatives collectées lors de trois focus groups (n = 14), traitées par une analyse thématique de contenu.RésultatsMoins de la moitié des répondants au questionnaire en ligne savaient que les HPV peuvent provoquer des verrues génitales ou des cancers ORL et 18 % seulement qu'il n'existe pas de traitement antiviral contre les HPV. Près de 90 % des répondants connaissaient l'existence du vaccin contre les HPV, mais certains professionnels ne comprenaient pas pourquoi ce vaccin était recommandé avant les premiers rapports sexuels ou pour les garçons ; 56 % doutaient de son innocuité, notamment parce qu'ils pensaient qu'il n'y avait pas assez de recul sur ce vaccin. Les infirmières scolaires avaient de meilleures connaissances que les autres professionnels et reconnaissaient que l'éducation des élèves au sujet des HPV fait partie intégrante de leur mission ; cependant, elles abordaient rarement ce sujet, notamment en raison d'un manque de connaissances et/ou d'outils. Les professionnels (infirmières scolaires, enseignants et personnel administratif/d’encadrement) ayant participé aux focus groups n'étaient pas favorables à l'idée de proposer la vaccination contre les HPV en milieu scolaire, notamment en raison du manque de ressources, de la crainte d’être confrontés à des réactions négatives de la part des parents et car ils n’en percevaient pas l’utilité (la vaccination étant accessible dans d’autres lieux).ConclusionLes résultats de cette étude soulignent la nécessité d'améliorer les connaissances du personnel scolaire sur les HPV et sa vaccination. Les parents devraient être impliqués dans les interventions de promotion de la vaccination contre les HPV afin de prévenir d’éventuelles réactions négatives, comme le craignent les professionnels des collèges. Plusieurs obstacles doivent également être levés avant d'organiser la vaccination en milieu scolaire en France
Près de six millions de malades rénaux chroniques potentiels repérés à partir du Système national des données de santé
No full textInternational audienceIntroductionEn France, si les données concernant le stade terminal de la maladie rénale chroniques (MRC) traitée par dialyse ou greffe rénale sont documentées de longue date, grâce au registre REIN, l’épidémiologie des stades les plus précoces de la maladie et le recours aux soins associé restent méconnus. L'objectif était de repérer une population MRC et décrire ses caractéristiques et son recours aux soins, via le Système national des données de santé (SNDS).MéthodesUn algorithme de repérage, « Renalgo », développé à partir d'avis d'experts du groupe Redsiam-Maladie Rénale a été appliqué aux données SNDS des années 2018, 2019 et 2020 en recherchant médicaments, biologie, actes et diagnostics d'hospitalisation. Des combinaisons de répétitions associant le prescripteur classe les patients avec MRC « certaine » ou « probable ». Les malades en traitement de suppléance ont été exclus. Les caractéristiques des bénéficiaires ont été extraites du SNDS. Le recours aux soins a été décrit pour l'année suivant l'année d'identification.RésultatsAu total en 2018, 5 235 393 bénéficiaires ont été identifiés (5 116 566 en 2019 et 5 890 830 en 2020), soit une prévalence dans la population générale comprise entre 7,6 % et 8,6 %. Parmi-eux, les bénéficiaires identifiés comme « certains » représentaient 15 % du total. Une cohorte de patients MRC identifiés à la fois en 2018, 2019 et 2020 était constituée de 1 591 088 bénéficiaires. Les caractéristiques des malades ne variaient pas selon les années. L’âge médian était de 68 ans (76 ans dans le groupe « certains », 66 ans chez les «probables »). On retrouvait 59 % de femmes (47 % chez les certains). Annuellement, 87 % avaient eu au moins une consultation avec un médecin généraliste et 6 % avec un néphrologue (24 % parmi le groupe « certains »).Discussion/ConclusionCe travail souligne le poids important et l’étendue de la MRC en France. Ces résultats constituent une information de santé publique majeure à destination des acteurs des soins primaires. La validation de cet algorithme via des cohortes est la prochaine étape cruciale
