Nantes Area Research Articles

The perceived impact of homelessness on health during pregnancy and the postpartum period: A qualitative study carried out in the metropolitan area of Nantes, France.

The number of homeless people has been constantly increasing in Europe over recent years, as well as the proportion of women among the homeless population. Pregnancy can increase the risk of becoming homeless and, on the other hand, homelessness has been widely connected to adverse perinatal outcomes. The objective of this study was to describe the overall perceived impact of homelessness on health during pregnancy and the postpartum period, using a qualitative research approach to prioritize women's perspective. One-time semi structured interviews were conducted with 10 pregnant women and 10 women in the postpartum period experiencing homelessness in the metropolitan area of Nantes, as well as with six people from their social surroundings. A thematic analysis was performed to identify major themes and sub-themes. Homelessness was perceived as having an overall negative impact on all aspects of health (physical health, mental health, and social well-being) during pregnancy and the postpartum period. Stress and anxiety, food insecurity, social isolation, physical suffering, deterioration of chronic diseases, and pregnancy complications, were the main perceived consequences of homelessness on health. On the other hand, social support, and the "welcomeness" of healthcare professionals during pregnancy and the postpartum period were identified as capable of palliating those consequences. Finally, basic needs, such as having access to suitable housing, being independent, and being in good health, were identified by participants in the study as their main priorities. The results of this study, as well as those found by previous research, allowed us to identify possible axes in tackling homelessness and its complex consequences on health during pregnancy and the postpartum period. Housing and income assistance interventions, promoting social support and employment, outreach services enhancing collaborative networks among healthcare service providers, and integrating coordinated multidisciplinary approaches in primary care have shown to provide promising solutions to this issue.

Attitudes and Expectations of Clinical Research Participants Toward Digital Health and Mobile Dietary Assessment Tools: Cross-Sectional Survey Study.

BackgroundThe adoption of health technologies is key to empower research participants and collect quality data. However, the acceptance of health technologies is usually evaluated in patients or healthcare practitioners, but not in clinical research participants.MethodsA 27-item online questionnaire was provided to the 11,695 members of a nutrition clinical research participant database from the Nantes area (France), to assess (1) participants' social and demography parameters, (2) equipment and usage of health apps and devices, (3) expectations in research setting and (4) opinion about the future of clinical research. Each item was described using frequency and percentage overall and by age classes. A global proportion comparison was performed using chi-square or Fisher-exact tests.ResultsA total of 1529 respondents (81.0% women, 19.0% men) completed the survey. Main uses of health apps included physical activity tracking (54.7%, age-related group difference, p < 0.001) and food quality assessment (45.7%, unrelated to age groups). Overall, 20.4% of respondents declared owning a connected wristband or watch. Most participants (93.8%) expected the use of connected devices in research. However, protection of personal data (37.5%), reliability (35.5%) and skilled use of devices (28.5%) were perceived as the main barriers. Most participants (93.3%) would agree to track their food intake using a mobile app, and 80.5% would complete it for at least a week while taking part in a clinical study. Only 13.2% would devote more than 10 min per meal to such record. A majority (60.4%) of respondents would accept to share their social media posts in an anonymous way and most (82.2%) of them would accept to interact with a chatbot for research purposes.ConclusionsOur cross-sectional study suggests that clinical study participants are enthusiastic about all forms of digital health technologies and participant-centered studies but remain concerned about the use of personal data. Repeated assessments are suggested to evaluate the research participant's interest in technologies following the increase in use and demand for innovative health services during the pandemic of COVID-19.

Évaluation d’un parcours de soin chez la femme au décours d’une prééclampsie

IntroductionThe medical treatment of preeclampsia is well structured in its acute phase but the required follow-up with patients in post-partum is discussed. However, preeclampsia is associated with an increased risk of cardiovascular morbi-mortality in the long term. In order to optimize the post-partum treatment, a care program has been developed for these patients in the city of Nantes, France. This includes a check-up of the cardiovascular risks at a day hospital. Our study presents the first results of this program. MethodsThe study included 134 patients who were diagnosed with preeclampsia between October 2016 and January 2019 in the Nantes area, France, and took part in the program within the year following their childbirth. A descriptive analysis was first carried out and then a multivariate logistic regression model was used to investigate the risk factors for persistent high blood pressure after preeclampsia. ResultsThe study detected 28 cases of persistent hypertension (20.9%), 34 cases of obesity (25.3%) and 1 case of diabetes. Hypertension was predominantly diastolic, mild and sometimes masked (35.7%). In a third of the cases (32.1%), the hypertension was secondary. High blood pressure was found to be more frequent in older patients (OR: 2.26; 95% CI: 1.25-4.11, p=0.072), patients from sub-Saharan Africa (OR: 11.52; 95% CI: 2.67-49.86, p=0.01) and multiparous patients (OR: 7.82; 95% CI: 1.15-53.21, p=0.035). ConclusionThe study confirmed that this care program enables an earlier detection and therefore treatment of the cardiovascular risk factors of these young women.

Where to find questing Ixodes frontalis ticks? Under bamboo bushes!

Tick-borne diseases have a complex epidemiology that depends on different ecological communities, associating several species of vertebrate hosts, vectors and pathogens. While most studies in Europe are focused on Ixodes ricinus, other Ixodes species may also be involved in the transmission or maintenance of pathogens. This is the case of Ixodes frontalis, a poorly known species associated with different bird species such as blackbirds, thrushes and robins, with a wide distribution covering most European countries.In a previous study, high densities of questing I. frontalis larvae were found during autumn-winter at a site close to Nantes (western France) where a long-term survey focused on I. ricinus was conducted. These I. frontalis were mostly observed under bamboo bushes. In the present study, we investigated the presence of I. frontalis under bamboo bushes at various locations. With that aim in mind, a systematic search for questing I. frontalis was undertaken by the flagging method in public urban parks and private gardens presenting bamboo bushes (32 sites). This survey was carried out during autumn-winter to maximize the probability of finding the most abundant stage, i.e. larvae. We searched for I. frontalis first in the area of Nantes (10 sites), then in other regions of France (21 sites) and at one site in northern Italy. A single visit to each site revealed the presence of I. frontalis at 29 out of 32 sites: larvae were always present, nymphs were frequent (59 % of the positive sites), while adults were found at only 14 % of the sites. Questing stages of this understudied species are thus easy to find, by dragging or flagging under bamboo bushes in autumn or winter. We make the assumption that bamboo offers a favourable place for birds to roost overnight outside their breeding period (i.e. spring), sheltered from both predators and wind. This would explain higher densities of I. frontalis under bamboo, relative to other biotopes.As I. frontalis is known to harbour zoonotic pathogens, the consequences of this discovery on the epidemiology of tick-borne diseases are discussed.

Un commerce alimentaire de détail aux liens tenus au territoire dans l’aire urbaine de Nantes

Penser le commerce alimentaire de détail à partir de sa territorialisation est doublement original. Non seulement, ce maillon intermédiaire des systèmes alimentaires est peu présent dans la littérature scientifique, mais ses liens à un territoire donné sont plutôt envisagés à partir de ses stratégies de localisation. Dans le cadre du projet Frugal, deux études ont ciblé son lien aux lieux dans l’aire urbaine de Nantes en retenant quatre catégories de commerces : les boucheries-charcuteries, les crèmeries-fromageries, les primeurs, et secondairement les épiceries fines. A partir d’un travail de recensement et d’une enquête par questionnaire suivie d’entretiens semi-directifs, la réflexion s’est organisée autour d’un « triangle de la territorialisation du commerce de détail ». En croisant les stratégies de localisation, d’approvisionnement et spatiales, nous constatons que peu de sens est donné au territoire même si par leur implantation, les commerçants impulsent des stratégies en réponse aux demandes des populations environnantes. L’entrée « produits » ne semble pas confirmer une tendance territoriale dans l’approvisionnement, bien qu’ils participent à la relocalisation de l’alimentation. L’arrimage est encore à construire, ce qui interroge dans le contexte des constructions en cours de projets alimentaires territorialisés.

In-situ estimation of non-regulated pollutant emission factors in an urban area of Nantes, France, with fleet composition characterization

The purpose of this study is to estimate the in-situ emission factors of several pollutants (particle number [PN], black carbon [BC] and several volatile and semi-volatile organic compounds [VOCs and SVOCs]) in an urban area of Nantes, France, with real-world traffic conditions and characterization of the fleet composition. The fleet composition and driving conditions are characterized by the number of vehicles, their speeds and their types (passenger cars [PCs], light commercial vehicles [LCVs], heavy-duty vehicles [HDVs]) as well as their characteristics (make, model, fuel, engine, EURO emission standard, etc.). The number of vehicles passing on the boulevard is around 20,000 per day with about 44% of Euro 5 and Euro 6 vehicles. The impacts of fleet composition on emission were analyzed by ANOVA. The results show that the fleet composition has a significant impact on emissions for different pollutants. Higher percentage of gasoline PCs between Euro 4 to Euro 6 and Euro 4 diesel PCs induces more BC emission. Higher percentage of old gasoline and diesel vehicles (≤ Euro 3) induces higher emission of toluene, ethylbenzene and m + p- and o-xylene. Furthermore, emission factors estimated in this work were compared to those calculated in other in-situ studies that show a good agreement. For the chassis bench comparison, the in-situ PN and BC emission factors are in the same range as those measured for diesel vehicles without particle filter and gasoline vehicles with direct injection system. These EFs are also comparable with old heavy duty vehicles without particle filter (5 × 1013–2 × 1014 #/km).

Spatial Heterogeneity of Sustainable Transportation Offer Values: A Comparative Analysis of Nantes Urban and Periurban/Rural Areas (France)

Innovative solutions have been implemented to promote sustainable mobility in urban areas. In the Nantes area (northwestern part of France), alternatives to single-occupant car use have increased in the past few years. In the urban area, there is an efficient public transport supply, including tramways and a “busway” (Bus Rapid Transit), as well as bike-sharing services. In periurban and rural areas, there are carpool areas, regional buses and the new “tram-train” lines. In this article, we focus on the impact on house prices of these “sustainable” transportation infrastructures and policies, in order to evaluate their values. The implicit price of these sustainable transport offers was estimated through hedonic price functions describing the Nantes urban and periurban/rural housing markets. Spatial regression models (SAR, SEM, SDM and GWR) were carried out to capture the effect of both spatial autocorrelation and spatial heterogeneity. The results show patterns of spatial heterogeneity of transportation offer implicit prices at two scales: (i) between urban and periurban/rural areas, as well as (ii) within each territory. In the urban area, the distance to such offers was significantly associated with house prices. These associations varied by type of transportation system (positive for tramway and railway stations and negative for bike-sharing stations). In periurban and rural areas, having a carpool area in a 1500-m buffer around the home was negatively associated with house prices, while having a regional bus station in a 500-m buffer was non-significant. Distance to the nearest railway station was negatively associated with house prices. These findings provide research avenues to help public policy-makers promote sustainable mobility and pave the way for more locally targeted interventions.

Mesures compensatoires : le dossier de l'aéroport de Notre-Dame-des-Landes et les apports de la loi Biodiversité

Biodiversity act, which was adopted on the 8th of August 2016, has strengthened the legal frame of compensatory measures, unifying a framework that was progressively developed since nature’s protection act (law n° 76-629 of 10th July 1976), especially through environmental assessment. In France, compensation related issues have particularly arisen during the last ten years regarding big infrastructures projects, one of the most iconic being Notre-Dame-des-Landes project, state project implying the construction of a new airport in the North-west area of Nantes’ agglomeration. Conceived in the 70’ s, the project’s implementation would involve the destruction of hundreds of wetlands, and thousands of protected species typical from former french rural landscapes («bocage » ), requiring compensatory measures in several environnemental authorizations according to environmental Code (water act authorization, derogation for protected species). Notre-Dame-des-Landes’ project is now subject to a mediation process driven by Ecological and solidary transition Ministry, mediators having to analyze the project’s alternatives before the 1st of December 2017. It’s the occasion to put the legal issues of this project in perspective with the new framework stemming from Biodiversity Act, to see how Notre-Dame-des-Landes’ lessons have contributed to an evolution of compensation legal provisions, especially regarding guarantees given by the project initiator to prove the sufficiency and feasibility of compensatory measures.

Community-acquired Clostridium difficile infections

ObjectiveTo describe the management and treatment of community-acquired C. difficile infections (CDI) and to evaluate family physicians’ (FP) knowledge and practice. Patients and methodsObservational study from December 2013 to June 2014. All community-acquired CDI case patients diagnosed in the community or at the University Hospital of Nantes were prospectively included. A questionnaire was mailed to 150 FPs of the area of Nantes. ResultsA total of 27 community-acquired CDI case patients were included (incidence: 7.7 case patients/100,000 inhabitants). Mean age was higher among case patients diagnosed at hospital (69years) compared with those diagnosed in the community (44years). Fifteen patients were treated at home (55%) and 22 received a first-line treatment with metronidazole. Only one patient did not receive any prior antibiotic treatment. Amoxicillin-clavulanic acid was mainly prescribed (68%) for respiratory and ENT infections (40%). Twenty-three patients were cured on Day 7 and three had complications (two deaths). Thirty-one of 47 FPs reported to have already managed CDI patients. Twenty-two FPs reported to usually treat patients with uncomplicated CDI at home, 21 to refer patients to a specialist, and three to hospital. Forty-one FPs reported to prescribe a CD toxin test only after recent antibiotic exposure and 30 when patients are at risk of CDI. ConclusionThe incidence and impact of community-acquired CDIs may be underestimated and the unjustified use of antibiotics may promote their emergence. FPs are not used to treat CDIs as more than 50% prefer referring patients to hospital or to a specialist.

Dependence on Prescription Benzodiazepines and Z-drugs Among Young to Middle-aged Patients in France

Background: Benzodiazepines (BZD) and nonbenzodiazepines hypnotics (z-drugs) are recognized as one of the most widely prescribed medications in the world. Objectives: The purpose of the study was to assess the BZD and z-drugs dependence in young to middle-aged outpatients who were taking BZD/z-drugs on a chronic basis, and to characterize their profile. Methods: This is a forward-looking cross-sectional epidemiological study. Data were collected through a semi-structured interview within a network of partner pharmacies from the Nantes area, in France. All data were obtained exclusively through patients’ declarations. 212 patients (19-64 years old) were included: they were considered dependent when they answered positively to at least three items of the DSM IV. A multivariate logistic regression and a principal component analysis (PCA) were carried out to determine their profile. Results: Almost half of the patients met criteria for BZD/z-drugs dependence. The risk to develop BZD/z-drugs dependence is significantly associated with psychiatric history and with the quantity of BZD/z-drugs that is taken. A two factor concept of dependence could be identified according to the PCA: one axis with items of “tolerance” and “long term administration or higher doses”, and a second axis with “concerned by treatment” and “somatic consequences”. Conclusions/Importance: Among this BZD/z-drug dependent population, the two axes identified in the PCA represent two profiles of dependence: being in positive conditioning or suffering from negative consequences. Clinicians need to know them: these two clinical profiles may have an influence in terms of decision-making, especially to manage discontinuation.

A time series study of gastroenteritis and tap water quality in the Nantes area, France, 2002–2007

In the Nantes area, 410,000 inhabitants are supplied with water pumped from the Loire River. The treatment of this water is carried out through a process of complete clarification and disinfection. During the study period (2002-07), the quality of drinking water complied with European microbial standards and mean turbidity in finished water was 0.05 NTU (nephelometric turbidity units). We aimed to characterize the link between produced water turbidity and other operational data and the incidence of acute gastroenteritis (AGE) in the Nantes area. The daily number of medical prescriptions for AGE was drawn from the French national health insurance system's drug reimbursement data. We modeled this time series using Poisson regression within the framework of a Generalized Additive Model. We showed that an interquartile range turbidity degradation (0.042-0.056 NTU) was connected to a 4.2% (CI95=(1.5%; 6.9%)) increase in the risk of AGE in children and a 2.9% (CI95=(0.5%; 5.4%)) increase in adults. The slope of the turbidity risk function was higher during both high- and low-water conditions of the river. High values of daily flow of produced water were also associated with higher endemic levels of AGE.

Analysis of the hydrological behaviour of an urbanizing basin

AbstractSuburban areas undergo rapid land‐use changes due to urban growth. Consequently, the mitigation of hydrological impacts is a major issue in the field of flood and water pollution management. Nevertheless, suburban catchments have seldom been studied. This paper presents a method for analyzing the hydrological behaviour of suburban catchments; the particular method is tested on the Chézine catchment, located in a suburban area of Nantes (western France). Chézine provides a typical example of a suburban catchment, yet features the unique behaviour of a response time ranging from 1 to 6 h. It is proposed herein to classify rainfall‐runoff events in homogeneous groups according to their flow coefficient. A group of events is characterized by its mean flow coefficient and by its transfer function, which are considered as the signatures of the hydrological behaviour of these similar events. The transfer function is identified from the available series of rainfall and outflow data. The identified transfer functions serve to estimate the localization of contributing zones over the basin by estimating the basin transfer function from flowpaths. The consistency of these assumptions is then verified by comparing the estimated transfer function with the identified one. The application of this method to the Chézine catchment demonstrates that it is possible to distinguish various types of hydrological behaviour regimes associated with significantly different transfer functions. The joint analysis of the flow coefficient and transfer function of each group confirms that the Chézine catchment reacts like an urban basin with just the urban zones contributing to runoff under dry conditions. Otherwise, the wetter the initial state, the greater the tendency of this basin to react like a natural basin, as reflected by the different transfer function shapes. These results confirm the validity of the proposed method to analyse the various behaviour regimes of suburban catchments. In addition, this method helps define the specifications of hydrological models suited to suburban catchments. Copyright © 2013 John Wiley &amp; Sons, Ltd.

Prospective trial on a school-based skin cancer prevention project

The objective of this study was to assess the impact of an educational programme on both children's knowledge and behaviour towards the sun. The study included 282 children aged between 8 and 11 years in their third year of primary school coming from 13 schools in the Nantes area (located in the west of France). It was a two-arm opened control trial, with group A in which the children were taught by their teacher about their skin and sun protection, according to the programme called 'to live with the sun' and a control group (B) in which the children did not receive any educational programme about sun protection. Self-administrated questionnaires at the baseline, posttest and follow-up were used to assess knowledge and behaviour of the students. The data were paired to follow the evolution of each child and a knowledge score and a sun protection habits score were calculated. At the baseline there was no significant difference in knowledge and sun protection habits scores between the two groups. Six months after the educational prevention programme we observed a knowledge score significantly higher in group A (mean: 7.66) compared with group B (mean: 6.77) (P<0.00001), but concerning the sun protection habits score there was no significant difference between the two groups. The programme had a beneficial effect on the children's knowledge persisting for at least a few months but had no impact on their behaviour towards the sun.

Étude rétrospective des sérologies de syphilis au CHU de Nantes, de 1999 à 2006

Since 2000, a resurgence of syphilis cases was observed in France and, particularly, in Paris area. The aim of this study was to evaluate the evolution of syphilis prevalence in Nantes area and its impact on our laboratory activity. Between 1999 and 2006, serological tests for syphilis performed at the laboratory were analysed according to the results of these tests, the age and patient sex and the wards. We treated about 32,000 serological tests, over an eight-year period. The number of tests increased by 7.5% per year and patients with a positive result were multiplied by three. These patients were men for 78%, with an average age of 43.4 years. The serological tests providing positive results were in general from two sectors, the anonymous and free detection center and the internal medicine ward and infectious diseases unit. Our study highlighted a strong increase in the number of positive tests, since 2001, with a clear orientation towards a sex male ratio in our area. This inclination currently did not show any decrease, at the opposite to what was observed by the InVS in Paris area.

Identification of Lactic Acid Bacteria from Poultry Feces: Evidence on Anti-Campylobacter and Anti-Listeria Activities

Forty-five strains of lactic acid bacteria were isolated from poultry feces sampled from an industrial farm located in the Nantes area (France), and most of them belong to the Streptococcus or Lactobacillus genus according to the results obtained by Galerie API and molecular methods. The most representative lactic acid bacteria strains were screened for antibacterial compound production against 2 indicator organisms (Listeria innocua F and Campylobacter jejuni 11168) by means of the agar diffusion test. Strain S37, identified as Enterococcus faecalis, exhibited a clear anti-listerial activity and a slight anti-Campylobacter activity, whereas strain S42, identified as Lactobacillus reuteri, exhibited only anti-Campylobacter activity. Regarding the results of proteolytic, heat, and neutralizing treatments of supernatants from the aforementioned strains, we can conclude that antagonism observed is attributed to antimicrobial peptide or bacteriocin in the case of strain S37, whereas it is ascribable to a nonbacteriocin, likely a reuterin, in the case of strain S42.

Molecular basis of severe factor XI deficiency in seven families from the west of France. Seven novel mutations, including an ancient Q88X mutation

Inherited factor (F)XI deficiency is a rare disorder in the general population, though it is commonly found in individuals of Ashkenazi Jewish ancestry. In particular, two mutations--a stop mutation (type II) and a missense mutation (type III)--which are responsible for FXI deficiency, predominate. The bleeding tendency associated with plasma FXI deficiency in patients is variable, with approximately 50% of patients exhibiting excessive post-traumatic or postsurgical bleeding. In this study, we identified the molecular basis of FXI deficiency in 10 patients belonging to six unrelated families of the Nantes area in France and one family of Lebanese origin. As in Ashkenazi Jewish or in French Basque patients, we have identified a new ancient mutation in exon 4 resulting in Q88X, specific to patients from Nantes, that can result in a severely truncated polypeptide. Homozygous Q88X was found in a severely affected patient with an inhibitor to FXI and in three other unrelated families, either as homozygous, heterozygous or compound heterozygous states. Other identified mutations are two nonsense mutations in the FXI gene, in exon 7 and 15, resulting in R210X and C581X, respectively, which were identified in three families. A novel insertion in exon 3 (nucleotide 137 + G), which causes a stop codon, was characterized. Finally, sequence analysis of all 15 exons of the FXI gene revealed three missense mutations resulting in G336R and G350A (exon 10) and T575M (exon 15). Two mutations (T575M and G350A) with discrepant antigen and functional values are particularly interesting because most of the described mutations are associated with the absence of secreted protein.

La vie religieuse dans l'Ouest à travers les registres de catholicité clandestins

This study, which is based on the catholic registers of 19 parishes in Anjou, Vendée and in the Nantes area during the french revolution enables us to assess the religious vitality of the west of France in that period. These registers, thanks to the historical value of the notes they coutain, bring back to life these parishes under the authority of dissenting priests. Thanks to the administration of the sacraments of baptism and marriage, they also attest to the religious practices then going on. With these informations, some questions may be clarified concerning the nomber of dissenting priests, the existence or non existence of a secret or public mass, the observance of religious rules and the rôle played by the war of Vendée. The secret parish registers hâve been a precious help for the study of the religious history of the French Revolution.