French Departments Research Articles

In-hospital Prognostic Value of TAPSE/sPAP in Patients Hospitalized for Acute Heart Failure

Abstract Background Tricuspid annular plane systolic excursion over systolic pulmonary artery pressure (TAPSE/sPAP) assessed by echocardiography appears to be a good noninvasive approach for right ventricular to pulmonary artery coupling assessment. Yet, the in-hospital prognostic value of TAPSE/sPAP in patients hospitalized for acute heart failure (AHF) has never been explored. Purpose To assess TAPSE/sPAP prognostic value among patients hospitalized for AHF. Methods All consecutive major patients hospitalized for AHF across 39 French cardiology department, with TAPSE/sPAP measured by echocardiography within the 24 first hours of hospitalization were included in this prospective study. The primary outcome was in-hospital major cardiac adverse events (MACEs) defined as all-cause death, resuscitated cardiac arrest or cardiogenic shock. Results Three hundred and thirty-three patients with both AHF and TAPSE/sPAP measurement were included (mean age 68±14 years, 70% of male, 40% HFpEF, 18% HFmrEF, 42% HFrEF). In-hospital MACEs occurred in 50 (15%) of the patients. Using receiver operating characteristics curves analysis, the best threshold for in-hospital MACEs was 0.40 mm/mmHg. Patients with TAPSE/sPAP <0.40 mm/mmHg had more frequently atrial fibrillation (p=0.024), chronic kidney disease (p=0.001), higher NTproBNP level (p<0.001), and worse left and right ventricular function (p<0.01). TAPSE/sPAP <0.40 mm/mmHg was independently associated with in-hospital MACEs, even after adjustment with comorbidities (OR=3.75, 95%CI[1.87-7.93], p<0.001), clinical severity (OR=2.80, 95%CI[1.36-5.95], p=0.006), or using a propensity matched population analysis (OR=2.98, 95%CI[1.53-6.12], p=0.002, figure 1). Finally, TAPSE/sPAP showed incremental prognostic value for in-hospital MACEs over traditional risk factors, including left ventricular ejection fraction (figure 2). Conclusion Emphasizing the prognostic value of TAPSE/sPAP <0.40 mm/mmHg for in-hospital MACEs, over traditional risk factors, these results suggest embedding this parameter into clinical decision-making and risk stratification in patients hospitalized for AHF.

Childminder knowledge of shaken baby syndrome and the role played by childminders in prevention: An observational study in France

BackgroundShaken baby syndrome (SBS) triggers negative short- and long-term outcomes. In France, registered childminders are the principal source of daycare. They may encounter SBS imparted by caregivers or simply excessive infant crying. The aim of the study was to explore childminder knowledge on SBS, the source of information, the responses to infant crying, how childminders perceived their roles in terms of caregiver SBS prevention, and the factors associated with a good knowledge of SBS. MethodsThe participants were registered childminders working in the French department of Gironde who had email accounts. This observational study employed an anonymous online questionnaire distributed by the maternal and child health services unit of the Gironde department over 5 weeks from 16 September 2021. Data on childminder characteristics, knowledge on SBS, responses to infant crying, and perceptions of their roles in SBS prevention were collected. The knowledge score ranged from 0 (all wrong answers) to 30 (all correct answers). ResultsA total of 779 registered childminders participated; 43.9 % had learnt about SBS during their initial training and 75 % before (other training) or after initial training. The median knowledge score was 19/30 (interquartile range [16; 21]). A higher educational level, previous other professional experience, training on SBS, and responsibility for few children were associated with higher scores. Ten reported that they did not advise caregivers who complained of infant crying. ConclusionChildminders require training on SBS and SBS prevention.

Human Papillomavirus (HPV) Infections Among Participants Undergoing Chlamydia trachomatis Testing in Reunion Island (RUN-SurV-HPV Study): Protocol for a Prevalence Study.

Infection by human papillomavirus (HPV) induces various cancers, mainly cervical cancer but also anal and pharyngeal cancers. Reunion Island is a French department in the Indian Ocean. Due to the history of its settlement, the island's population has a wide variety of origins, and the population's sociodemographic characteristics differ from those of the French mainland. These characteristics make the island's population an original French population in its own right, particularly in terms of health. Cervical cancer incidence and mortality in Reunion Island are 10.4 per 100,000 and 4.4 per 100,000, respectively, both of which are much higher than those in mainland France. There is also a disparity in the prevalence of different HPV types, with types 33 and 52 being overrepresented and type 18 being underrepresented. However, vaccination and screening coverage in Reunion Island is low. It is important to understand the burden of infection and its risk factors in members of the young Reunionese population at risk of HPV infection to promote and evaluate the implementation of future vaccination and screening programs on a larger scale. The RUN-SurV-HPV study will have the following four objectives: (1) to describe the prevalence of HPV genotypes in a population at risk of sexually transmitted infections in Reunion Island; (2) to describe the prevalence of HPV genotypes by anatomical site, gender, and sexuality; (3) to describe the correlates and risk factors for HPV detection; and (4) to examine HPV genotypes between different anatomical sites. Cross-sectional analyses of 1200 routine vaginal, anal, pharyngeal, and urinary samples collected between October 2020 to December 2022 from female and male patients aged 16 to 30 years undergoing Chlamydia trachomatis testing at a sexually transmitted infection (STI) testing center at Reunion Island will be performed. The population included 333 women who all had vaginal and pharyngeal swabs, with 80 of them also having had an anal swab. There are 167 men who have sex with men who have had anal and pharyngeal swabs, and 120 men who have sex with women who have had a urine swab only. Results will be correlated with sociodemographic and clinical data collected routinely during the consultations. HPV detection and genotyping will be performed using the Anyplex II HPV28 detection assay (Seegene). The first polymerase chain reactions should begin in November 2023. The first results should be submitted for publication in 2024. The study will determine HPV prevalence by age, sex, male sexual preference, human immunodeficiency virus status, and STI co-infection. Collecting data from young patients not usually routinely screened for HPV infection will be a simple and reproducible way of better understanding local specificities, encouraging vaccination campaigns in the short-term, and evaluating their effectiveness in the future. DERR1-10.2196/47379.

Artificial light at night and breast cancer risk: The findings from CECILE study (France)

Abstract Background Environmental exposure to artificial light at night (LAN) has become ubiquitous in modern societies. Experimental and epidemiological studies suggested that LAN exposure disrupts circadian rhythm, inhibits melatonin production, and increases the risk of breast cancer. Objectives We aimed to assess the association of exposure to outdoor LAN with breast cancer risk, along with possible effect modifications of this association. Methods We used data from a population-based case-control study, including 1185 incident breast cancer cases and 1282 healthy controls enrolled in 2005-2007 from two French departments- Côte d’Or and Ille-et-Vilaine. Data for outdoor LAN exposure was obtained using radiance-calibrated images from Defense Meteorological Satellite Program (DMSP) for 1995-2006. Exposure was assessed for 10 years before inclusion in the study by cross-referencing the DMSP images and the geocoded locations of residences in ArcGIS. Logistic regression was used to obtain odds ratios (OR) and 95% confidence intervals (CI) for the association, adjusting for sociodemographic factors, urbanization, reproductive factors, lifestyle-related factors, night shift work, and air pollution. Results The overall OR for breast cancer per 1 interquartile range (IQR) increase in LAN exposure (159.9 nW/cm2/sr) was 0.98 (95% CI: 0.81-1.17). Subgroup analyses showed slightly higher ORs in post-menopausal women (OR: 1.15; 95% CI: 0.97-1.37) and a stronger association for HER2-positive breast tumors (OR: 1.55; 95% CI: 1.03-2.31). Conclusions We did not find any overall association between outdoor LAN and breast cancer; however, possible associations in certain subgroups were indicated. The strength of this study was the use of calibrated satellite images for exposure assessment and the consideration of a large set of potential confounders. Further large-scale studies using improved exposure assessment methods, including blue light and indoor exposure measurement, are required. Key messages • Light pollution is growing as the newest form of environmental pollution in modern society, potentially affecting health. • More studies are required to explore and ascertain its public health impact.

Intervention Research In Health Promotion: The Challenges of Transferability of a Youth Nutrition Project

Abstract Recent evidence reports the efficacy of theory-based interventions to promote physical activity (PA) among population (Gourlan et al., 2015). However, despite those encouraging results reported in the scientific literature, few documents currently exists to help professionals in the health and educational domains to implement theory-based interventions (Marcus & Forsyth, 2009). The “Great Live and Move Challenge” (GLMC) is an intervention based on the tenets of the theory of planned behavior (TPB, Ajzen, 1991) which aim to promote PA among 7-11 years old French school-aged children and their parents (Cousson-Gélie et al., 2019). Throughout the GLMC, children are asked to quantify their daily PA level by illustrating each 15 minutes of PA achieved with an “energy cube”. The cluster randomised controlled trial showed the effectiveness of GLMC in 3121 children by significantly increasing the proportion of children doing one hour of physical activity per day. During a two-year follow-up, children answered each year a questionnaire measuring TPB constructs and weekly physical activity practice both at pre- and post-intervention. A subsample of 157 children also wore an accelerometer (i.e., Actigraph GT3X+). Results notably show that the intervention had a positive impact on the proportion of children who comply with physical activity guidelines during the two years of follow-up, with an increase each year. The GLMC is now implemented in 7 French departments and reaches over 24,000 children. Based on these results, we would like to propose an adaptation of the GLMC for adults, by adapting this intervention in the professional environment, in order to maintain the community aspect of the project. After the presentation of the project and its transferability in different spaces, an interactive debate will be organised on the challenges of transferability.

Socioeconomic impact of the COVID-19 crisis and early perceptions of COVID-19 vaccines among immigrant and nonimmigrant people living with HIV followed up in public hospitals in Seine-Saint-Denis, France.

The burden of the first year of the coronavirus disease 2019 (COVID-19) pandemic was greater for vulnerable populations, such as immigrants, people living in disadvantaged urban areas, and people with chronic illnesses whose usual follow-up may have been disrupted. Immigrants receiving care for HIV in Seine-Saint-Denis' hospitals have a combination of such vulnerabilities, while nonimmigrant people living with HIV (PLWHIV) have more heterogeneous vulnerability profiles. The ICOVIH study aimed to compare the socioeconomic effects of the COVID-19 crisis as well as attitudes toward COVID-19 vaccination among immigrant and nonimmigrant PLWHIV. A questionnaire assessed vulnerabilities prior to the COVID-19 epidemic and the impact of the early epidemic on administrative, residential, professional, and financial fields. We surveyed 296 adults living with HIV at four hospitals in Seine-Saint-Denis, the poorest metropolitan French department, between January and May 2021. Administrative barriers affected 9% of French-born versus 26.3% of immigrant participants. Immigrants experienced financial insecurity and hunger more often than nonimmigrant participants (21.8% versus 7.1% and 6.6% versus 3%, respectively). Spontaneous acceptance of vaccination was higher among nonimmigrant than among immigrant participants (56.7% versus 32.1%), while immigrants were more likely to wait for their doctor's recommendation or for their doctor to convince them than their French-born counterparts (34.2% versus 19.6%). The trust-based doctor‒patient relationship established through HIV follow-up appeared to be a determining factor in the high acceptance of the COVID-19 vaccine among immigrant participants.

Improving Children's Mental Health Literacy Through the Cocreation of an Intervention and Scale Validation: Protocol for the CHILD-Mental Health Literacy Research Study.

Children's mental health is a public health priority, with 1 in 5 European children younger than 12 years having a behavioral, developmental, or psychological disorder. Mental health literacy (MHL) is a modifiable determinant of mental health, promoting psychological well-being and reducing mental health problems. Despite its significance, no interventions or scales currently exist for increasing and measuring MHL in this population. This study has dual objectives: (1) cocreating and evaluating an intervention on children's MHL, and (2) developing and validating a scale that measures children's MHL. Our study focuses on children aged 9-11 years attending primary school classes in various settings, including urban and rural areas, and priority education zones within a French department. Using a participatory research approach, we will conduct workshops involving children, parents, teachers, and 1 artist to cocreate an intervention comprising multiple tools (eg, a pedagogical kit and videos). This intervention will undergo initial evaluation in 4 classes through observations, interviews, and satisfaction questionnaires to assess its viability. Concurrently, the artist will collaborate with children to create the initial version of the CHILD-MHL scale, which will then be administered to 300 children. Psychometric analyses will validate the scale. Subsequently, we will conduct a cluster randomized controlled trial involving a minimum of 20 classes, using the CHILD-MHL scale scores as the primary end point to evaluate the intervention's efficacy. Additional interviews will complement this mixed methods evaluation. Both the intervention and the scale are grounded in the Child-Focused MHL model. The first tool of the intervention is the pedagogical kit Le Jardin du Dedans, supported by the public organization Psycom Santé Mentale Info and endorsed by UNICEF (United Nations Children's Fund) France. The second tool is a handbook by the Pan American Health Organization and the World Health Organization, which is addressed to teachers to sensitize them to children's mental health problems. The third is a 5-page supplementary leaflet produced by the nongovernmental organization The Ink Link, which teaches children the notion of MHL. Finally, we produced 56 items of the MHL Scale and listed existing education policies for children's mental health. After its robust evaluation, the intervention could be extended to several schools in France. The scale will be the first in the world to measure children's MHL. It will be used not only to evaluate interventions but also to provide data for decision makers to include MHL in all educational policies. Both the intervention and the scale could be translated into other languages. PRR1-10.2196/51096.

Carbon footprint of general practice: Retrospective case study of GP offices in a rural department of France

ContextThe medical sector has a significant impact on greenhouse gas emissions which, in turn, impacts global health. In the context of the climate emergency, measures should be adopted to reduce greenhouse gas emissions from the health care sector. So far, few regulations have been implemented for general practice facilities, despite the fact that the potential impact of general practice is large, due to the size of this sector. This study seeks to establish the carbon footprint of general practices in a rural French department, and to identify the main vectors of CO2 emissions. Materials and MethodsThree general practitioners’ offices located in Lot-et-Garonne agreed to participate in this study. This retrospective study extrapolated the carbon footprint of the practices during 2020 using the ADEME BEGES method and Life Cycle Assessment. We collected data and accounting reports directly from practices regarding different potential CO2 emission sources (electricity, water, transport, waste, digital activities, stationery, and medical equipment). ResultsMedical practices emitted an average of 39.8t of CO2 equivalent in 2020, i.e. 1.5 kg of CO2eq per consultation. Transportation was the main vector of emissions with 95 % of the total (83 % via patient transportation and 12 % via physician transportation), followed by medical equipment (3 %), electricity consumption (1.1 %), office supplies (0.7 %), digital activities (0.1 %), then water and waste (both, < 0.1 %). ConclusionGeneral Practice generates a significant amount of CO2 and, therefore, requires specific actions to be implemented to reduce its impact on the environment.

A current overview of the pharmacological composition of "La Chimique" consumed in Mayotte: Preliminary results of the CHASSE-MAREE protocol.

Mayotte Island, a French department located in the Mozambique Channel, has for several years been faced with the consumption of "La Chimique" (LC), reputed (but extremely poorly documented) to be a mixture of tobacco and synthetic cannabinoid receptor agonists (SCRAs). One of the objectives of the CHASSE-MAREE protocol is to assess the composition and heterogeneity of LC products through successive LC sample collection campaigns among users. Currently underway, we present here the first analytical results (samples collected in 2022). Between September and December 2022, 80 samples were collected throughout the island over three periods: 70 in the usual form of LC (small folded papers containing a plant-like sample, mostly tobacco), 6 powders, and 4 cigarettes. Analysis was performed using liquid chromatography with high-resolution mass spectrometry. The detected substances (number of detections) included SCRAs (MDMB-4en-PINACA [35], ADB-FUBIATA [25], MDMB-INACA [16], ADB-BUTINACA [15], AFUBIATA [11], 4F-MDMD-BICA [7], CH-PIATA [14], 5C-APINACA [3], BZO-HEXOXIZID [2], and 4F-ABINACA [1]), nicotine (68), tetrahydrocannabinol (THC), cannabinol (CBN), and cannabidiol (CBD) (2), medications (amantadine [11], cyamemazine [6], and acetaminophen [3]), and a designer benzodiazepine (bromazolam [4]). The SCRAs currently in use are varied, and the market for "cooks" (those who prepare LC) is dispersed according to where and when samples are collected. These preliminary results will be supplemented by analysis of samples collected in the first half of 2023 and by an improved description of the current panorama of consumption of LC in Mayotte (mapping, effects felt and dependence, etc.).

Exposure to outdoor artificial light at night and breast cancer risk: a population-based case-control study in two French departments (the CECILE study)

BackgroundExposure to outdoor artificial light at night (LAN) disrupts circadian rhythms and is suspected of increasing the risk of breast cancer. To date, this is an understudied aspect of environmental pollution. In this study, we sought to assess the specific role of exposure to outdoor artificial light at night in breast cancer, independently of air pollution-related effects.MethodsData from a French population-based case-control study, including 1,185 incident breast cancer cases and 1,282 controls enrolled in 2005–2007, were used. Outdoor LAN exposure data were obtained using radiance-calibrated images from the Defense Meteorological Satellite Program (DMSP) for 1995–2006 by cross-referencing the DMSP images and the geocoded locations of residences in ArcGIS. The odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were obtained using logistic regression adjusting for multiple potential confounders, including air pollution.ResultsThe OR for overall breast cancer unadjusted for air pollution per interquartile range increase in LAN exposure was 1.05 (95% CI: 0.92–1.20). The OR decreased to 0.98 (95% CI: 0.81–1.17) after adjustment for ambient NO2 levels. Subgroup analyses showed slightly higher ORs in postmenopausal women (OR per IQR increase: 1.07; 95% CI: 0.85–1.35) and a positive association for HER2-positive breast tumors (OR: 1.55; 95% CI: 1.03–2.31).ConclusionOur results do not provide evidence that outdoor LAN exposure is associated with increased risk of breast cancer. However, an association was suggested for the HER2-positive subtype of breast cancer. Further large-scale studies with more precise exposure assessment methods, including blue light and indoor exposure measurements, and considering environmental exposures correlated with LAN exposure such as air pollution, are needed.

Decision-making process of withholding or withdrawing life-sustaining treatments in French emergency departments during COVID-19 outbreak.

Decision-making process of withholding or withdrawing life-sustaining treatments in French emergency departments during COVID-19 outbreak.

First identification of Cryptosporidium parvum virus 1 (CSpV1) in various subtypes of Cryptosporidium parvum from diarrheic calves, lambs and goat kids from France

Cryptosporidium spp. remain a major cause of waterborne diarrhea and illness in developing countries and represent a significant burden to farmers worldwide. Cryptosporidium parvum virus 1 (CSpV1), of the genus Cryspovirus, was first reported to be present in the cytoplasm of C. parvum in 1997. Full-length genome sequences have been obtained from C. parvum from Iowa (Iowa), Kansas (KSU) and China. We aimed at characterizing the genome of CSpV1 from France and used sequence analysis from Cryptosporidium isolates to explore whether CSpV1 genome diversity varies over time, with geographical sampling location, C. parvum genetic diversity, or ruminant host species. A total of 123 fecal samples of cattle, sheep and goats were collected from 17 different French departments (57 diseased animal fecal samples and 66 healthy animal fecal samples). Subtyping analysis of the C. parvum isolates revealed the presence of two zoonotic subtype families IIa and IId. Sequence analysis of CSpV1 revealed that all CSpV1 from France, regardless of the subtype of C. parvum (IIaA15G2R1, IIaA17G2R1 and IIdA18G1R1) are more closely related to CSpV1 from Turkey, and cluster on a distinct branch from CSpV1 collected from C. parvum subtype IIaA15G2R1 from Asia and North America. We also found that samples collected on a given year or successive years in a given location are more likely to host the same subtype of C. parvum and the same CSpV1 strain. Yet, there is no distinct clustering of CSpV1 per French department or ruminants, probably due to trade, and transmission of C. parvum among host species. Our results point towards (i) a close association between CSpV1 movement and C. parvum movement, (ii) recent migrations of C. parvum among distantly located departments and (iii) incidental transmission of C. parvum between ruminants. All together, these results provide insightful information regarding CSpV1 evolution and suggest the virus might be used as an epidemiological tracer for C. parvum. Future studies need to investigate CSpV1’s role in C. parvum virulence and on subtype ability to infect different species.

Efficacy and management of tocilizumab in polymyalgia rheumatica: results of a multicentre retrospective observational study.

The efficacy of anti-IL-6 receptors such as tocilizumab (TCZ) was demonstrated in patients with PMR in two recent randomized controlled trials. The objective of this multicentre retrospective study was to assess the efficacy of TCZ in PMR patients requiring glucocorticoid (GC)-sparing treatment, as well as different strategies for TCZ withdrawal. We conducted a multicentre study in French tertiary healthcare departments for patients with PMR. PMR patients receiving off-label TCZ between 2015 and 2022 were included. The primary endpoint was the proportion of patients tapering to GCs ≤5 mg/day 6 months after the first TCZ infusion. The secondary endpoints were the proportion in whom GC was discontinued during follow-up, and the proportion of patients in whom TCZ was discontinued. Fifty-three PMR patients were included. Thirty-one patients suffered from active PMR despite conventional synthetic DMARDs. GCs were ≤5 mg/day in 77% of the patients (95% CI 36-89) at 6 months, and in 97% of the patients at 12 months. Six and 12 months after the first TCZ infusion, the proportions of GC-free patients were 22.5% (95% CI 12.7-37.8) and 58.3% (95% CI 43.2-74.1), respectively. Among TCZ withdrawal strategies, TCZ infusion spacing and TCZ dose reduction were more successful (success in 87% and 79% of attempts, respectively) than TCZ discontinuation (success in 52% of attempts; P = 0.012 and P = 0.039, respectively). In GC-dependent PMR patients, treatment with TCZ led to a drastic decrease in GC dose and remission of PMR. TCZ dose reduction or TCZ infusion spacing are good options to consider in TCZ withdrawal.

Le gallium-68, de la production à la gestion des déchets

For nearly 8 years, the use of 68Ga (gallium-68) PET imaging has been growing steadily, with the marketing authorisation for [68Ga]Ga-Édotréotide (Somakit®) and compassionate access to [68Ga]Ga-PSMA-11 in French nuclear medicine departments. In the very near future, the needs in 68Ga will probably be increased by commercialization of a PSMA-11 kit which will facilitate [68Ga]Ga-PSMA-11 access. 68Ga is obtained from a 68Ge (germanium-68)/68Ga (gallium-68) generator, but cyclotron production is envisaged by European medical cyclotrons. As a result, a rapid evolution of equipment and premises needed is observed. In this article, we propose to review the various stages in the use of 68Ga, from production to disposal, according to latest regulation evolutions.

Anaphylaxis management in a French pediatric emergency department: Lessons from the ANA-PED study.

Anaphylaxis is a serious systemic hypersensitivity reaction that requires immediate recognition and prompt administration of epinephrine/adrenaline. The present study aimed to assess the appropriateness of epinephrine/adrenaline use in children identified as allergic by physicians in the emergency department (ED) at the time of the reaction, and to identify factors that are possibly associated with epinephrine/adrenaline administration, auto-injector prescription, and further referral to an allergist. We performed a retrospective cross-sectional study at the pediatric ED of the University Hospital of Montpellier, France. We included all consecutive children who attended the ED between 2016 and 2020 with an allergy-related diagnosis at discharge. We included 1056 allergy-related visits, including 224 (21.2%) with a diagnosis of anaphylaxis at discharge; only 17.0% of them received an epinephrine/adrenaline injection, and 57.1% consulted an allergist after the acute episode. An auto-injector was prescribed to 63 (28.1%) patients at discharge from the ED. Besides the severity of the clinical presentation, factors associated with a guidelines-based management of the anaphylactic reaction and with an increased administration rate of epinephrine/adrenaline included presence of asthma symptoms and presence of extended skin reactions. Our study underlines persistent gaps in the management of pediatric anaphylaxis in ED, focusing on hereby identified levers. By disseminating current knowledge and guidelines on anaphylaxis and allergies, specialists could work together with emergency physicians to establish effective management algorithms and improve anaphylaxis management and care pathways for children experiencing allergic reactions, especially anaphylaxis. Clinical Trials, number NCT05112367.

Structural identification of weather impacts on crop yields: Disentangling agronomic from adaptation effects

AbstractA large literature has assessed the impacts of climate change on agricultural production by estimating reduced‐form models of crop yields conditionally on weather and individual fixed effects. The estimates obtained are usually interpreted as the weather impacts on yields once farmers have adapted. Yet, few attempts have documented that farmers do adapt to weather, and none have verified that these adjustments actually impact crop yields. Our objective here is to unpack how weather affects agricultural production by developing a structural model that explicitly accounts for both the plants' biophysical and farmers' behavioral responses to weather. Considering adaptation during the growing season through fertilizer and pesticide applications, our approach allows us to distinguish the “direct” weather effects (i.e., the agronomic impacts of weather changes on plant growth per se) from the “indirect” weather effects via farmers' input choices (i.e., the adaptation impacts). We estimate the underlying structural model using farm‐level data from the Meuse French department, which provides details of fertilizer and pesticide uses by crop. We show that the reduced‐form and structural estimates indicate similar weather impacts on crop yields, for a large range of sensitivity analyses. Our structural estimates indicate that the adaptation effects are sizable and that farmers' adjustments reduce projected damage from climate change. In our illustrative case, farmers' adaptation offsets between one‐quarter to two‐thirds of the negative agronomic impacts of future warming on crop yields. Our analyses exhibit that commonly used reduced‐form models of crop yields inherently capture these within‐season behavioral responses to weather.

Anterior Versus Classical Approach During Right Hepatectomy for Hepatocellular Carcinoma: Inverse Propensity Score Weighted Analysis

BackgroundEastern data highlight the oncological benefits of the anterior approach (AA) during right hepatectomy (RH) for hepatocellular carcinoma (HCC). However, to our knowledge, previous western data on this topic are scarce.In this study, the oncological outcomes of AA and classical approach (CA) during RH for HCC were compared. MethodsA retrospective inverse propensity score-weighted fashion (IPTW) case–control study was performed in two French hepatobiliary surgery departments. Overall survival (OS), disease-free survival (DFS), and early recurrence rate (within 2 years after surgery) were analyzed. ResultsSurvival analysis was performed for 114 patients (CA group,60 patients; AA group, 54 patients). Before IPTW adjustment, the 3-year DFS rates were 29.4% (AA group) and 44% (CA group), respectively. No significant differences were found in DFS (HR = 1.1, 95%CI:0.62–1.9, p = 0.77) and OS (HR = 1.2, 95%CI:0.54–2.6, p = 0.66).After IPTW, DFS and OS analyses showed no differences between the two groups (p = 0.77 and p = 0.46, respectively). Early recurrence rates were similar before and after IPTW. Satellite nodules were the only significant independent risk factor for recurrence. ConclusionAA and CA did not result in significant differences in DFS, OS, or early recurrence after right hepatectomy for HCC before and after IPTW.

Évaluation quantitative de l’effet sur le passage aux urgences et les hospitalisations d’un dispositif départemental innovant de prise en charge des situations de crise durant l’adolescence en Haute-Garonne, France

ObjectivesCrisis situations are common during adolescence. Current data show that adolescents in crisis are either directly referred to hospital psychiatric emergency rooms, or they make an appointment for a specialized consultation, in a medical-psychological center (CMP), in a medical-psychological-pedagogical center (CMPP), or with a private practitioner. The Departmental Reactive System for Adolescents was implemented in 2017 in the French department of Haute-Garonne to provide adolescents in crisis an immediate specialized psychiatric consultation including on-going support for three months. Our objective was to measure the effect of the implementation of this health system organization (HSO) on the evolution of the annual incidence of emergency room visits and hospitalizations of adolescents for psychiatric reasons at the Toulouse University Hospital, the sole facility for such care in Haute-Garonne. MethodsWe conducted a quasi-experimental study comparing the evolution, before and after the implementation of the DDRA31, the annual incidence rates of emergency room visits (pediatric and adult) and hospitalizations related to mental health at the Toulouse University Hospital for adolescents aged 12 to 17 years of age, residing in Haute-Garonne, from 2014 to 2019. Factors associated with the risk of hospitalization were analyzed using mixed-effects logistic regression to measure the effect of the system, over time, with the specific year as the primary explanatory variable, adjusted for sex and age. ResultsFrom 2014 to 2019, 6 686 emergency room visits by 4 245 adolescents took placefor psychiatric motives or diagnostics. The annual incidence rate of emergency department visits related to mental health was stable from 14.0 (95 % CI: 13.2–14.9), per 100 adolescents in 2014 to 13.9 (95 % CI: 13.2–14.7) in 2019, with a higher incidence rate for girls and adolescents aged from 15 to 17 years old. The main reasons for emergency room visits were behavioral problems or agitation, drug intoxications or suicide attempts, and drug or alcohol use or abuse. The annual incidence of hospitalizations decreased significantly since 2017, from 38.3 (95 % CI: 34.1–42.8) per 100 adolescents in 2014 to 24.2 (95 % CI: 21.2–27.4) per 100 adolescents in 2019. This decrease was shown for both males and females but only for adolescents aged from 15 to 17 years old, from 21.8 (CI 95 %: 17.9–26.1) in 2014 to 2.6 (CI 95 %: 1.5–4.1) in 2019. Modeling of the hospitalization risk showed a significant reduction from 2017 onward inclusive with an odds ratio ranging from 0.63 (95 % CI: 0.49–0.80) in 2017 to 0.52 (95 % CI: 0.41–0.67) in 2019. DiscussionThe fact that an impact of the HSO was found only for adolescents aged 15 to 17 years of age could indicate a selective effectiveness depending on age possibly caused by differences in physician attitudes depending on the age of the patient. The chronology of changes in hospitalization rates after a visit to the emergency room corresponded to the period when the HSO was implemented, whereas hospitalization rates were stable over the three years prior to its implementation. The main limitations of our study were the absence of data regarding emergency department diagnoses and discharge modes for the year 2019 and the lack of a temporal perspective. ConclusionOur study did not show any significant effect of the HSO on the annual incidence of emergency room visits related to mental health, but there was a possible effect on reducing the yearly incidence rate and the risk of hospitalization of adolescents in psychiatric services following an emergency room visit. The implementation of reactive ambulatory structures could therefore reduce the demand on hospitalization services that are under pressure.

The Gendered Necropolitics of Migration Control in a French Postcolonial Periphery

This article examines the postcolonial politics of migration control in Mayotte, an overseas French department, and argues that these bear necropolitical consequences. It sheds light on the gendered dimension of this necropolitical power by focusing on the life and border-crossing experiences of undocumented Comorian women. Entrenched barriers to the regularization of their administrative status endanger their access to healthcare and degrade the conditions for life long-term. The constant risk of arrest and massive forced removals furthermore engender dangerous border crossings, each instance exposing the passengers to the risk of death. The article also foregrounds that these necropolitics are exacerbated as a result of the postcolonial conundrum in which Mahoran elites find themselves, with the increasing support of Black and Muslim elites for the French far-right political party.

Management of testicular cancer: Practice survey in localized stage.

Management of testicular cancer requires a complete evaluation to confirm the localized stage and effective treatment according to guidelines to ensure the best outcome. The primary objective of this study was to evaluate practices at each stage of care in patients with a localized testicular tumor. The secondary objective was to evaluate the oncological prognosis of these patients according to the modalities of care. We conducted a multicenter practice evaluation study with retrospective collection and evaluation of patient records. The study was conducted in two French departments (population pool of 2 million inhabitants) between January 1, 2010, and January 31, 2015, enabling a five-year followup of patients. Patients presenting with stage I testicular tumor according to the American Joint Committee on Cancer classification were included in the analysis. A total of 226 records were analyzed; 93% of patients underwent bilateral scrotal ultrasound and 93.25% had a chest-abdomen-pelvis computed tomography scan. A total of 29.65% of patients had a preoperative tumor marker assay in accordance with guidelines; 94% of patients had a total orchiectomy, with a median time of 15 days. At the end of the followup period, 17 patients had suffered a recurrence of their disease. Providing adjuvant care in accordance with guidelines reduced the risk of recurrence in patients with a seminomatous tumor. Our study showed heterogeneity in compliance with guidelines for evaluation and effective treatment of patients with a localized testicular tumor. Some essential practices, such as assays of tumor markers and fertility preservation for patients over 40 years, were not well carried out. Adjuvant management of localized tumors appears to be an important predictor of recurrence.