Metropolitan France Research Articles

Efficient pathway for men fertility preservation in testicular cancer or lymphoma: a cross-sectional study of national 2018 data

BackgroundIn 15–49 years-old men, the main cancers are testicular cancer (TC) and lymphomas (L): freezing of ejaculated sperm is primarily used for male fertility preservation (FP) before cancer treatment.Our objective was to analyze the French FP rate in 15–49 years-old men diagnosed with TC or L in 2018.We designed a national descriptive cross-sectional study of sperm banking rate in men with a diagnosis of TC, Hodgkin L (HL) or non-Hodgkin L (NHL).From the French National Cancer Institute (INCa) 2018 data, we extracted the estimated incidence of TC and L in metropolitan France. From the 2018 activity report of CECOS network (Centers for Study and Banking of Eggs and Sperm), we extracted the number of men with TC or L who banked ejaculated sperm. We estimated the proportion of 15–49 years-old men diagnosed with TC or L who banked sperm.ResultsAmong 15–49 years-old men, INCa estimated 38,048 new cancer diagnoses in metropolitan France in 2018: 2,630 TC and 3,913 L (943 HL and 2,970 NHL). The CECOS network provided data from 26/27 metropolitan centers (96% response rate): 1,079 sperm banking for men with TC, 375 for HL and 211 for NHL.We estimated that the 2018 sperm banking rate in France was 41% for TC, 40% for HL, and 7% for NHL.ConclusionsTo our knowledge, our paper is the first cross-sectional study with multicenter and national data analyzing FP rate in cancer men: it suggests an efficient pathway for men to FP before cancer treatment, compared to previously published studies. Although sperm banking rate in 15–49 years-old men could definitely be improved, further studies should evaluate the information given to patients before gonadotoxic treatments, the factors associated with the absence of sperm banking and whether this lack of referral induces a loss of chance for these men.

Archeohandi: protocol for a national disabilities database in archaeology in France

The archaeology of disability is a relatively recent and little-known approach in France. While the study of palaeopathology now goes hand in hand with funerary archaeology and osteoarchaeology, the French study of disabilities and disabling pathologies remains marginal and unevenly treated, depending on location, chronology and researcher’s interest. This paper focuses on highlighting the compatibility between this new research area, the obligations of osteoarchaeology, and the benefits of developing a national, diachronic, and interdisciplinary study. A database is designed within an interpretive, consensual framework, that can be adapted to overcome limitations and promote open-minded research on the care of the disabled in their own communities. A preliminary category selection of disabling pathologies has been made. These are trepanation, completely edentulous and/or compensating denture, neuronal impairment, severe scoliosis, Paget's disease, Diffuse Idiopathic Skeletal Hyperostosis (DISH), rickets, dwarfism, infectious diseases, unreduced fracture, amputation, severe degenerative disease and others. This list has been critically reviewed by experts in the field; it will evolve in a somewhat Darwinian fashion. Our database is hosted on the Huma-Num platform, with a management interface and quick access based on multiple tabs. The data includes information about archaeological operations, subjects, and pathologies; it is complemented by pictorial data stored on the Nakala platform. The development involved creating a prototype using HTML, CSS, JavaScript, SQL, and PHP, with features to display, add, modify, and delete operations and subjects. Enhancements have been made, including search optimization, charts, and the ability to export data in CSV format. The database, whose administrative interface can be accessed at archeohandi.huma-num.fr, contains so far 211 existing operations with a total of 1232 registered subjects spread throughout metropolitan France. These initial data reveal numerous research perspectives in osteoarchaeology that can be combined with other research topics, such as virtual reality.

Development of Geographical Information System for agricultural land mapping in metropolitan France and its application to estimate residential proximity to crops in the GEOCAP Agri Project

Development of Geographical Information System for agricultural land mapping in metropolitan France and its application to estimate residential proximity to crops in the GEOCAP Agri Project

Spatiotemporal and Individual Patterns of Domestic Cat (Felis catus) Hunting Behaviour in France.

Domestic cats (Felis catus), one of the most popular pets, are widespread worldwide. This medium-sized carnivore has well-known negative effects on biodiversity, but there is still a need to better understand the approximate causes of their predation. Based on a citizen science project, we assessed the role of spatiotemporal (i.e., latitude, longitude, and seasons), climatic (i.e., rainfall), anthropogenic (i.e., human footprint, HFI), and individual (i.e., sex and age) variables on the number of preys returned home by cats in metropolitan France. Over the 5048 cats monitored between 2015 and 2022, prey from 12 different classes (n = 36,568) were returned home: 68% mammals, 21% birds, and 8% squamates. Shrews brought home by cats peaked during summer, while rodents were recorded during summer-autumn. Birds brought home by cats peaked in spring-summer and in autumn, and lizards peaked in spring and in late summer. Lower HFI was associated with more voles and mice brought home, and the opposite trend was observed for lizards and birds. Younger cats were more prone to bring home shrews, birds, and reptiles. Although environmental factors play a minor role in prey brought home by cats, some geographical characteristics of prey species distribution partly explains the hunting behaviour of cats.

The Skills of Citizenship

Abstract This article analyzes the history of adult vocational training (AVT) programs for Algerian migrants, funded by the French state, between the end of World War II in 1945 and the aftermath of Algerian independence in 1962. These programs responded to the postwar expansion of citizenship and rights of indigenous Algerians, including rights to migrate and to take jobs in metropolitan France. Across changing governments and diverse ministries, French officials were convinced that vocational training was necessary for indigenous Algerians to find stable employment, to mitigate the supposed risks of migration, and to enable migrants to transform themselves into an idealized version of the French citizen. The widespread adoption of AVT for Algerian migrants calls into question the pervasive image of the unskilled, interchangeable migrant. At the same time, the shortcomings of AVT programs shed light on how migrants frequently contributed to postwar economic expansion and economic modernization while enjoying the fruits of economic growth only meagerly and on an individual basis. More broadly, this study reveals the importance of skill, industry, and labor in French postwar conceptions of (social) citizenship.

Major field margin vegetation types in France and their relationships with climate, agricultural landscapes and management intensity

ABSTRACT Arable field margins are an important semi-natural habitat providing multiple functions in agroecosystems. Despite three decades of research, analyses of species assemblage and functional traits are lacking. Leveraging a national monitoring network in metropolitan France, we aim to provide a comprehensive taxonomic and functional synthesis of field margin flora, outline main field margin types and explore their associations with management practices, climate, and agricultural landscapes. We analysed data from 532 field margins surveyed between 2013 and 2017, using both uni- and multivariate analyses. Field margins exhibited great diversity with 711 distinct taxa (12% of all flora in mainland France) at the national scale and an average of 16 species per 10 m2 locally. While field margins contained few species of conservation value, they offered a refuge for many declining species as well as rare arable weed species. We identified seven main field margin types, each linked to distinct conditions of climate, soil, landscape and agricultural practices. Mediterranean field margins notably differed from all others. In the main cluster, vineyard margins also stood out as distinct from annual crop margins. Additionally, field margins in landscapes with a high proportion of grassland differed from those within intensively cultivated field crop plains in conventional agriculture. Overall, our study highlights the high botanical diversity of field margins and their interest for plant conservation in agricultural landscapes. Promoting the installation and/or maintenance of field margins through agri-environmental schemes should thus favour biodiversity conservation and associated ecosystem provision.

Prevalence of past-year major depressive episode among young adults between 2005 and 2021: Results from four national representative surveys in France

BackgroundThe objectives are to examine time trends in the prevalence of past year major depressive episode (MDE) among young adults, and to identify differences by occupational status comparing students, those employed, and those who are not in employment, education or training (NEET). MethodsData were drawn from the Health Barometer survey, a cross-sectional computer-assisted telephone interview survey on a national representative sample of residents of metropolitan France and conducted approximately every 5 years. The surveys relied on the Composite International Diagnostic Interview-Short Form to determine the presence of DSM-IV past-year major depressive episode. Data from the 2005, 2010, 2017, and 2021 surveys were pooled and respondents aged 18 to 25 were selected (n = 7556) and categorized based on their occupational status: students, those employed, and NEET. ResultsOverall, significant differences in the prevalence of MDE was observed by occupational status: NEET had the highest rate (18.5 %) followed by students (14.3 %) and those employed (11.0 %). The prevalence of MDE among young adults was 10.1 % in 2005, 9.7 % in 2010 and 11.3 % in 2017, reflecting a stable prevalence between 2005 and 2017. The prevalence then nearly doubled in 2021, with 20.9 % of MDE, with a significant increase of 9.6 points between 2017 and 2021. LimitationsNo assessment of lifetime psychopathology. ConclusionsThe prevalence of major depression among young adults significantly increased between 2005 and 2021, those at greatest risk are females and those not in employment, education or training. The contribution of pandemic-related factors may be elucidated in future national health surveys.

Analyse de l'hypertension en France : pour une analyse intersectionnelle de la cascade de soins

In metropolitan France, estimates suggest that more than one in three adults has hypertension. Low-cost treatments are available, yet fewer than one in four hypertensive adults has a controlled level of hypertension below 140/90 mmHg. This rate is higher in other high-income countries such as Canada (65%) or Germany (52%). Using a ‘cascade of care’ model, that decomposes the hypertension care continuum in awareness, treatment, and control, provides a better understanding of the origins of poor control. Furthermore, the theoretical framework of intersectionality, which simultaneously considers social positions of gender, class, and ethno-racial origin, could be used to understand the complexity of the social inequalities observed in hypertension-related outcomes. In this article we conducted a critical review of the international literature to identify new lines of analyses that could be applied to examine complex inequalities in France.

Assessment of the condition of psychic health of French firefighters: Burnout

To date, there has been little research on burnout in firefighters despite the acknowledged impact of occupational stress on both individuals and society. According to a survey conducted by the French National Research and Security Institute, the annual cost to society of occupational stress in France is 2–3 billion euros. The aim of the present study was to assess the prevalence of occupational burnout in a large and representative sample of French firefighters. A nationwide survey was conducted in 2021, targeting all categories of firefighters (except for military firefighters in Paris and Marseille) both in metropolitan France and in its overseas departments and territories. This survey came in two parts: questions eliciting basic sociodemographic and job-related data, followed by the Burnout Assessment Tool which assesses the intensity of job-related burnout. We collated results for 3038 firefighters: 2418 men (79.59%), 619 women (20.38%), and 1 gender neutral (0.03%). Findings revealed that while 2455 respondents (80.8%) did not meet the criteria for burnout, 345 (11.4%) reported mild/moderate symptoms of burnout, and 238 (7.8%) could be deemed to have severe burnout symptoms. Further research is warranted into the causes of burnout and its prevention in this specific population.

Farmland biodiversity benefits from small woody features

Although positive effects on biodiversity of woody features in agricultural landscapes are widely recognized, questions remain as to which landscape context to prioritize their implementation and in what proportion. To investigate the response of farmland biodiversity to small woody features (SWF) density in different landscape compositions (cropland, grassland, mixed), we analyzed fine-resolution data from standardized monitoring schemes on 111 birds, 22 bats, and 25 bush cricket's species, at national scale (relying on 3772, 834 and 727 monitoring points) over the period 2015–2019, in metropolitan France. We used Generalized Additive Mixed Models to analyze population and community responses, through different metrics (abundance, species diversity, and functional composition). We found a positive response exhibited by the three taxa to SWF, more especially in cropland where the SWF density is the lowest relative to grassland and mixed landscapes. Also, our results suggested a non-linear response common to the three taxa, with an increased benefit up to at least 6 % of SWF density in cropland, and beyond for most of the metrics but to a lesser extent (e.g., maximum abundance reached at 7–12 % SWF). We note, however, that some species among farmland bird specialists are negatively impacted by SWF. Overall, we emphasize the benefits to promote woody features in agricultural landscapes, notably in cropland, to support biodiversity and its associated ecosystem functions. Our study provides crucial empirical evidence to the recommendations from previous studies and the relevance of the EU Biodiversity Strategy for 2030 to dedicate at least 10 % of farmland to high-diversity landscape features.

COVID-19 lockdown related to decrease in premature birth rate and increase in birth weight in metropolitan France.

The worldwide rate of preterm birth (PTB) has been increasing over the last two decades. COVID-19 lockdowns provide a unique opportunity to assess the effects of socioenvironmental and lifestyle factors on premature birth and birth weight. We explored the effects of COVID-19 lockdowns on the PTB rate and birth weight at a nationwide scale in France until one year after their occurrence. This national retrospective observational study evaluated the rate of PTB and birth weight in France from January 2016 to December 2020. Data were obtained from the national Programme Médicalisé des Systèmes d'Information database. The rates of global and sub-categories of PTB were tested. The birth weight was studied before and after lockdown for all live births, for term and premature neonates, and for each category of low birth weight (LBW) by a stratified analysis. Data from 2,949,372 births from January 2016 to December 2019, including 228,857 PTB, were compared to those of 699,344 births and 51,886 PTB from January to December 2020. The national rate of PTB decreased significantly from 7.7% to 7.3%, when compared with the 2016-2019 period. This decrease was persistent up to 9 months later. It was observed only for moderate PTB, whereas very PTB and extremely PTB remained stable. The national mean birth weight for full-term babies increased after the lockdown and was still observable up to 8 months later (+0.16%, p < 0.0001). The proportion of children with LBW also decreased 2 months after lockdown (-0.15%; p = 0.02). For VLBW, the difference only appeared over the 6-month post-lockdown period (-0.06%; p = 0.006). This nationwide study shows a significant reduction in prematurity and a significant increase in birth weight in France after the lockdown for a period of time not limited to the lockdown itself. A more in-depth study of the factors determining these variations may help to drive PTB prevention policies.

Modalities ofMedical Assistance to Populations inFrench Role 1 Facilities From January 2020 to December 2021.

Medical assistance to populations (MAP) is a rich and varied activity, but it is not well known, and its modalities are inconsistent and unclear, particularly in the pediatric field; they can confront the military doctor with difficult management issues. Today, a military doctor deployed in foreign operations (FOs) does not know if he will perform MAP. He does not know how it will be carried out, nor if it will include a pediatric component. Finally, he does not know what difficulties he will face and therefore cannot prepare himself effectively. The primary objective of this work is to describe the modalities of MAP in FO, with an emphasis on the pediatric activity. The secondary objective is to develop a template for a post-session MAP registry. This was a retrospective descriptive study. An electronic questionnaire was sent to all physicians in Forces Medicine. All military physicians deployed to a role 1 structure between January 1, 2020, and December 31, 2021, were included. The questionnaire reports the sociodemographic data of the responding physicians and their skills in pediatrics, the modalities of MAP, and the difficulties encountered, and questions the interest of setting up a "tactical health watch" and a tele-expertise with pediatricians in France. Analyses are descriptive (means, graphs, and percentages). This work was authorized by the Directorate of Forces Medicine and the Directorate of Training, Research, and Innovation of the French Defense Health Service. We obtained 140 analyzable responses, among which 102 deployments in a role 1 facility, and 44% of the physicians practiced MAP. The share of pediatrics during MAP sessions is estimated to be significant (i.e., >50% of patients) by 42% of physicians. Physicians felt that they were having difficulties in their MAP activity in 26% of the cases and in their pediatric activity in 38% of the cases. Difficulties encountered in pediatrics seemed to diminish with the level of experience in FO or when the practitioner had a pediatric activity back in metropolitan France. On the contrary, difficulties seemed to increase when the training in pediatrics was greater. MAP in FO is an activity in which modalities are very variable depending on the theater. Practitioners must have a solid theoretical and practical preparation beforehand, particularly in pediatrics. Keeping a specific activity register is an essential basis for judiciously adapting human and material resources dedicated to this activity. Future studies should aim to investigate more precisely the difficulties encountered.

Individual and contextual risk factors for mortality in nursing home residents during the first wave of COVID-19 in France: a multilevel analysis of a nationwide cohort study.

Mortality amongst nursing home (NH) residents increased by 43% during the first wave of coronavirus disease 2019 (COVID-19). We estimated the 'contextual effect' on mortality, tried to explain it by NH characteristics and identified resident- and NH-level risk factors for mortality. The contextual effect was measured for two cohorts of NH residents managed by the general scheme in metropolitan France (RESIDESMS data from 03/01/2020 to 05/31/2020 and 03/01/2019 to 05/31/2019) by the intraclass correlation coefficient (ICC) estimated from mixed-effects logistic regression. Amongst 385,300 residents (5,339 NHs) included in 2020 (median age 89years, 25% men), 9.1% died, versus 6.7% of 379,926 residents (5,270 NHs) in 2019. In the empty model, the ICC was 9.3% in 2020 and 1.5% in 2019. Only the geographic location partially explained the heterogeneity observed in 2020 (ICC: 6.5% after adjustment). Associations with mortality were stronger in 2020 than in 2019 for male sex and diabetes and weaker for heart disease, chronic respiratory disease and residence <6months. Mortality was higher in 2020 (15.1%) than 2019 (6.3%) in NHs with at least one death with a mention of COVID-19 and more heterogeneous (ICC: 8.0%) than in the others (mortality: 6.7% in both years; ICC: 1.1%). Our results suggest that the COVID-19 crisis had a heterogeneous impact on mortality in NH residents and that geographic location explain a part of the contextual effect, which appears to have had little influence on mortality in NHs not being affected by the virus.

Prospective observational study of stroke in Cayenne, Tours and Besançon: The BECATOUR study

BackgroundStroke is a major public health issue. Its epidemiology is still poorly known in French Guiana. MethodWe conducted a prospective observational study including 100 consecutive patients hospitalized for stroke in Cayenne (in French Guiana), and Tours and Besançon (in metropolitan France). We compared their age, medical history, cardiovascular risk factors, pre-admission Rankin score, Glasgow and NIHSS scores, usual treatments, acute phase management, type of stroke, duration of hospitalization, mechanism of stroke according to TOAST classification, NIHSS and Rankin scores at discharge, discharge treatments, and mode of discharge. ResultsIn French Guiana, the average age of patients was 7years lower (62 y), patients were more frequently affected by hypertension (75%) and diabetes (31%). Lacunar strokes were overrepresented (16.1%), and infarctions of cardioembolic origin were underrepresented (12%). NIHSS entry and Glasgow scores were similar between French Guiana and mainland France. Acute management was different: thrombolysis rate (9.3%) was 3 to 4 times lower, thrombectomy was not available. Fewer patients were transferred to rehabilitation centers and more patients were transferred to home hospitalization. DiscussionIn Tours and Besançon, patients eligible for thrombectomy were overrepresented. This bias explains the overrepresentation of more severe infarctions and probably the overrepresentation of strokes of cardioembolic origin. Infarctions of undetermined origin were more numerous in French Guiana because patients were often discharged from hospital with an incomplete cardiological workup. ConclusionDespite some caveats, the profile of patients admitted for stroke in French Guiana is different from mainland France. The establishment of a stroke unit and an information campaign on the symptoms of stroke would allow better management.

How was France invaded? 170 years of colonisation of metropolitan France by freshwater mussels

How was France invaded? 170 years of colonisation of metropolitan France by freshwater mussels

Functional forms of socio-territorial inequities in breast cancer screening – A French cross-sectional study using hierarchical generalised additive models

To reduce the breast cancer burden, the French National Organised Breast Cancer Screening Programme (FNOBCSP) was implemented in 2004. The recommended participation rate has never been achieved and socio-territorial inequities in participation have been reported on several occasions. We investigated the functional forms and consistency of the relationships between neighbourhood deprivation, travel time to the nearest accredited radiology centre and screening uptake. We used two-level hierarchical generalised additive models in 8 types of territories classified by socio-demographic and economic factors. The first level was 368,201 women aged 50–72 invited to the 2013–2014 screening campaign in metropolitan France. They were nested in 41 départements, the level of organisation of the FNOBCSP. The effect of travel time showed two main patterns: it was either linear (with participation decreasing as travel time increased) or participation first increased with increasing travel time to a peak around 5–15 min and decreased afterward. In nearly all types and départements, the probability of participation decreased linearly with increasing deprivation. Territorial inequities in participation were more context-dependent and complex than social inequities. Inequities in participation represent a loss of opportunity for individuals who already have the worst cancer outcomes. Evidence-based public health policies are needed to increase the effectiveness and equity of breast cancer screening.

1421-P: Ten-Year Trend in Socioeconomic Inequalities in the Prevalence and Incidence of Pharmacologically Treated Type 2 Diabetes in France—2010–2020

The aim was to describe the association between socio-economic inequalities (SEI) and the prevalence/incidence of pharmacologically-treated type 2 diabetes (T2D) in France over the 2010-2020 period. Diabetes cases were identified using a validated algorithm in the French national health data system. Analyses were restricted to adults ≥45 years to focus on T2D. SEI were measured, each year, via the French Deprivation index (FDep, by population quintiles; Q1: corresponding to the less deprived municipalities) for metropolitan France. The relative risks (RR) of being T2D (prevalence) and developing T2D (incidence) in Q2, Q3, Q4 and Q5 were estimated by sex over the period via Poisson regression. Denominators were the French health consumers (from 24,228,526 in 2010 to 29,772,928 in 2020) for prevalence and the at risk population for incidence. A positive gradient was observed in the RR of T2D prevalence and incidence by FDep quintiles in all years. The influence of SEI (reference Q1) on T2D prevalence increased over the period for men in Q2, Q3, Q4 and Q5, and for women in Q3, Q4 and Q5; and on T2D incidence for men in Q4 and Q5. To conclude, SEI were positively associated with the prevalence/incidence of pharmacologically-treated T2D in metropolitan France. Further, the association increased over last decade for prevalence, and only in most deprived men for incidence. Disclosure M.Guion: None. L.Mandereau-bruno: None. S.Goria: None. S.Fosse-edorh: None. E.Cosson: Board Member; Abbott, Medtronic. Funding Fondation de France (00107045)

Combining crop-exposure matrices and land use data to estimate indices of environmental and occupational exposure to pesticides.

Exposure assessment represents a major challenge for studies on the relation between pesticides and health. We developed a method combining information from crop-exposure matrices (CEMs) and land use data, in order to compute indices of environmental and occupational pesticide exposure. We illustrate our approach using French data (1979-2010). We used CEMs for five crops (straw cereals, grain corn, corn fodder, potatoes, vineyards) that describe use (annual probability, frequency, intensity) of pesticide subgroups, chemical families, and active substances by region and time since 1960. We combined these data with land use data from agricultural censuses (1979, 1988, 2000, 2010) to compute indices of environmental and occupational pesticide exposure in cantons (small French administrative units). Indices of environmental exposure were calculated based on the area of each crop in the cantons, while indices of occupational exposure depended on combinations of crops in each farm from the cantons. To illustrate our approach, we selected a pesticide group (herbicides), chemical family of herbicides (phenoxyacetic acids), and active substance from the phenoxyacetic acids chemical family (2,4-D). The estimated proportion of the area of crops with CEMs and of farms sprayed with herbicides was close to 100% between 1979-2010, but the estimated average annual number of applications increased. There were decreasing time-trends for phenoxyacetic acids and 2,4-D over the same period for all indices of exposure. There was a high use of herbicides throughout France in 2010, except in the South coast. For phenoxyacetic acids and 2,4-D, the spatial distribution was heterogeneous for all indices of exposure, with the highest values in the Centre and North regions. Assessment of pesticide exposure is a key issue for epidemiological studies on their association with health outcomes. However, it presents some unique challenges, particularly for retrospective exposure and the investigation of chronic diseases. We present a method to compute indices of exposure by combining information from crop-exposure matrices for five crops and land use data. Specificities of environmental and occupational exposure are addressed using different methods. These methods are applied to pesticides used in agriculture in France for five crops (3 groups, 91 chemical families,197 activesubstances) to produce indices at a small geographic scale from 1979 to 2010 for the whole metropolitan France. Besides using these indices in French epidemiological studies, our approach could be relevant for other countries.

Mapping marine ecosystem services in a multifunctional seascape: the case of Grande Vasière (Bay of Biscay)

IntroductionCoastal and continental shelf ecosystems are among the most productive, yet exploited, ecosystems. The Grande Vasière (GV) covers most part of the French Northern part of the Bay of Biscay, a crucial fishing ground for metropolitan France. It is the place of numerous uses, especially fishing, and will soon shelter sand extraction activities and offshore windfarms. All these activities may compete for space and resources and put pressure on habitats, biodiversity and subsequent ecosystem services (ES). Current management strategies integrate these activities and biodiversity conservation schemes but no ES.MethodsTo fill that gap, we quantified and mapped nine indicators of ecosystem processes (EP), used as proxies of four ES (i.e. sea food provisioning, biological control, regulation of environmental conditions and life cycle maintenance). Due to the complexity of ES, we investigated several EP by ES. Then we identified hotspots and coldspots of supply and spatial overlap among EP and other uses (conservation, fishing, offshore windfarms and sand extraction).ResultsEP mapping suggests a higher capacity of supply of the chosen ES in the Northern part of the GV. We found a strong spatial heterogeneity among the EP related to the same ES, underlining a point of vigilance when designing management measures to sustain ES supply. Northern EP hotspots overlap with high amounts of bottom trawl fishing effort. Higher levels of commercial species diversity and sole spawning grounds in the South overlap with higher amounts of gillnet fishing effort. Areas of sand extraction prospection and offshore windfarms under construction should not overlap with hotspots of EP, at the exception of the sole spawning ground and the commercial species diversity hotspots. Finally, we highlight an overlap of more than 20% of four EP hotspots with Natura 2000 areas, while the Marine Natural Park in the South covers more EP coldspots (i.e. hake nursery, encounter rate, trophic links diversity) than hotspots.DiscussionIncorporating such a multifunctional spatial approach with hotspots and coldspots opens new perspective for marine spatial planning, pointing out the potential strengths and weaknesses of areas currently defined or prioritized for future uses like conservation, sand extraction or emerging activities like offshore windfarms.

Dedicated overseas consultation for patients evacuated from the south Pacific: Report of experience after six months of existence.

e18542 Background: The management of rare and/or complex cancers between patients living in metropolitan France and those living overseas remains unequal. Herein, medical transfer to metropolitan France is required in about 20% of overseas-living patients and is often experienced as an additional source of distress, which requires multidisciplinary support (social, psychological, medical, and cultural). Therefore, we developed a dedicated “Overseas” consultation (OC) to provide personalized cancer care in this specific population. We aim to present the evaluation of the first 6 months experience. Methods: The OC was dedicated to patients from the South Pacific (French Polynesia or New Caledonia) requiring “highly specialized” cancer treatments in Gustave Roussy, including surgery, chemotherapy, or diagnostic procedures, which were considered non-achievable in the local hospital after multidisciplinary discussion by videoconference. Multiple interventions including medical, administrative and psychological support were provided. Results: Between July 15, 2022, and January 15, 2023, 25 patients with rare and/or complex cancer diagnosis / treatments benefited from an OC. Median age was 57 years (30-81), 19 patients (76%) were women, 18 (72%) came from French Polynesia and 7 (28%) from New Caledonia. Median number of OC for each patient was 1 (range 1-3), and median length of stay in metropolitan France was 23 days (range 4-95 days). At the time of analysis, 7 patients had not yet returned back home. The most common cancer locations were breast (52%), lung (16%) and gastrointestinal (16%). Patient presented localized disease in 52% of cases. At the first OC, 92% patients were ECOG Performance Status 0-1. The main reasons for metropolitan France medical transfer were an imaging procedure (64%) or a complex surgical or interventional radiology biopsy (24%). Seven patients (28%) had complex management (defined as two or more procedures) during their stay. Eleven patients (44%) benefited from molecular profiling, 7 (27%) from an oncogenetic consultation and 1 (4%) from inclusion in a clinical research trial. Conclusions: OC, set up 6 months ago in our institution, has optimized diagnostic workflow and disease management of these complex patients living overseas and has demonstrated its feasibility. However, it requires the involvement of multiple health-care professionals, multidisciplinary concertation, paramedical interventions such as social and psychological support and the overarching support from institutions.