Paris Region Research Articles

Interruption volontaire de grossesse et COVID-19 : ce que la pandémie a modifié en 2020

ObjectiveThe management measures to contain the SARS-CoV-2 pandemic in 2020 has upset the organization of society, particularly the organization of the health system. We aimed to analyze the evolution of induced abortions in the Paris region in 2020 and to highlight the impact of the first confinement. MethodData from the National Health Insurance plan was analyzed to study abortion during the pandemic period (2020) compared to the previous four years (2016–2019). In 2020 the indicators of induced abortion were studied monthly to highlight the impact of the confinement. The age of women, the method used to terminate the pregnancy, the gestational age at the time of the abortion and the area of residence of women were analyzed. ResultsAfter five consecutive years of increasing abortion rates, our result showed that the number of abortions declined from 53,601 in 2019 to 50,615 in 2020 (decline of 5.6%). The abortion rate was 17.3 per 1,000 women aged 15–49 in 2019 and 16.3‰ in 2020. This drop was observed within 4 weeks following the first confinement. It concerned particularly abortions carried out in the hospital context and abortions of young women (< 25 years old). In 2020 the rate of medical abortions increased compared to the 4 years preceding the pandemic. The use of local anesthesia for surgical abortions also increased in the Paris region during the first confinement. Our study showed a fewer proportion of late abortion (over 12 weeks of amenorrhea) in 2020. This analysis also showed a drop in the number of births in the eight to nine months that followed the first confinement in the Paris region. Discussion and ConclusionThe COVID-19 pandemic has had health consequences not directly attributable to the virus. In terms of reproduction, the pandemic, particularly the first lockdown, has been associated to a decrease in conceptions resulting in a decrease in the number pregnancies including those ending in induced abortion or childbirth. The reduction of abortions is observed in the four weeks following the first confinement and the fall in the birth rate in the following 8 to 9 months.

SARS-CoV-2 and post-donation information: a one-year experience of the French haemovigilance network.

There is growing evidence to support the hypothesis that SARS-CoV-2 is probably not transmissible by blood transfusion. In this study, we use the data gathered over one year by the French haemovigilance network on post-donation information related to SARS-CoV-2, and virological investigations on corresponding plasma to explore viral transmission by transfusion. Whenever a donor reported COVID-19 symptoms and/or a positive SARS-CoV-2 nasopharyngeal (NP) PCR test, information regarding diagnosis and symptoms was collected using a specific questionnaire, and repository plasmas were screened using the SARS-COV-2 R-GENE® assay (Biomérieux). RNA sequencing (Sanger and deep sequencing) and virus isolation on Vero E6 cells were applied in plasma from donors testing positive. We investigated 1,092 SARS-CoV-2-related post-donation information (PDI) reports. PDI donors were younger than the global donor population and donated more often in the Paris region. Sixty-eight percent reported a positive NP real-time (RT)-PCR or antigenic testing and 22% of these also had symptoms at the time of testing. Thirty-seven (3.4%) donations tested positive for SARS-CoV-2 RNA, 11 (30%) were confirmed by another molecular assay, and 7 (19%) by sequencing, confirming low viral level. Most RNAemic blood donors donated in southern regions and in Paris. There was no difference in demographic data or duration parameter between RNAemic and non-RNAemic donors. Duration parameter was determined as the time elapsed between donation and: i) the onset of symptoms; ii) a positive NP RT-PCR; and iii) PDI. Cell culture experiments did not show any infectivity related to RNAemic plasmas. SARS-CoV-2 RNA can be detected in a small fraction of blood donors with PDI, reporting very low levels of RNA. The corresponding plasma is probably not infectious. These findings highlight the value of haemovigilance and PDI to guide blood safety strategies.

Examining the benefits of the build back better concept for Parisian critical infrastructures vulnerable to flooding: From build back better to build better before

In this paper, we propose to study the operational interest of the build back better concept (BBB) and highlighting its importance in mitigating risks and improving the resilience of critical infrastructures in the Paris region to flood risk during the recovery and the reconstruction phases. Based on an in-depth examination of the BBB concept and its relevance to risk management, we propose an adapted methodological approach suitable for the Paris Region critical infrastructures. Finally, the approach, initially designed for a reconstruction context, is implemented to reduce the vulnerabilities of infrastructures in the prevention phase. We then talk about build better before and present here a development in this sense. Our proposed framework is structured into two major axes: risk quantification and decision support for the multi-criteria optimization of the investments required to mitigate the quantified risks. With this in mind, we first propose to develop an FMEA (Failure Mode and Effects Analysis) in order to identify and formalize the direct and indirect vulnerabilities of critical infrastructures in a flooding context. The output of the risk assessment is then used within a multi-criteria optimization framework for optimal risk reduction under budget constraints.

Microplastic occurrence after conventional and nanofiltration processes at drinking water treatment plants: Preliminary results

Microplastics (MP) have been detected in almost all matrices, including drinking water, and assessing the contamination of drinking water with this type of pollution is of the utmost sanitary importance. This study aims to evaluate MP contamination of inlet river water and drinking water at three drinking water treatment plants (DWTPs) in the Paris region in France. Each plant performs water treatment processes that are efficient for particulate matter removal such as coagulation-flocculation, sand filtration, and granular activated carbon filtration. One of the plants also has a parallel water treatment file that uses microfiltration and nanofiltration processes. This file was investigated to assess its efficiency compared to the others. To our knowledge, this study is the first to investigate MP contamination in a DWTP using nanofiltration processes. The drinking water distribution network was also investigated, with samples taken at three network points. Microplastics contamination of sizes 25–5,000 μm was characterized using micro-Fourier transform infrared spectroscopy (μ-FTIR) in large volume samples (500 L) with complete mapping of each sample. Concentrations ranging from 7.4 to 45.0 MP/L were found in inlet water while concentrations ranging from blank level (0.003 MP/L) to 0.260 MP/L were found in outlet drinking water (overall removal rate above 99%). Polyethylene, polypropylene, and polyethylene terephthalate were the main polymers found both at the inlet and outlet, but ratios varied significantly at the outlet. No MP were detected in four out of the six samples from the nanofiltration file, and were not found to have significantly different concentrations compared to blank level. Concentrations in the distribution network were higher overall than at the corresponding DWTP outlet, although a high degree of variation between samples was observed. Our results suggest that membrane processes of microfiltration and nanofiltration are more efficient than typical treatment processes, and also that a MP re-contamination within the distribution network itself might occur.

Using Crack or Smoking Cocaine, That Is the Question: The Association of Sociodemographic Factors with Self-Labeling Choices in France

ABSTRACT The label “crack user” is profoundly stigmatizing. Such labels are foundational to an individual’s identity, affecting how others view them, their self-perceptions, and subsequent behavior. Individuals can also resist labels such as “crack user,” creating distinctions for the same behavior. To elucidate characteristics associated with self-application of stigmatizing labels, we use data from individuals (N = 50,721) serviced for smoking cocaine in French drug treatment centers (N = 263) from 2010–2020 to assess who self-labels their behavior “crack use” or does not in favor of “smoked cocaine,” which are identical behaviors. Multilevel models reveal higher odds of using the less stigmatizing “smoked cocaine” in earlier years, among those with less risky cocaine use profiles, and among those not using other stimulants. Importantly, this less stigmatizing label is more common among those of high SES and outside the Paris region. An interaction demonstrates that even within Paris, those of high SES have higher odds of using this label than their lower SES Parisian counterparts. Those in privileged positions may use this alternative label to avoid stigmatization of the “crack user” label. Such distinctions potentially perpetuate inequalities associated with the more stigmatized label. We suggest that treatment centers can act as sites to combat these differences.

The anisotropy of high cycle fatigue property and fatigue crack growth behavior of Ti–6Al–4V alloy fabricated by high-power laser metal deposition

In the present work, several large Ti–6Al–4V blocks were successfully fabricated by high-power laser metal deposition (HP-LMD). The high cycle fatigue (HCF) property and fatigue crack growth (FCG) behavior of the as-build Ti–6Al–4V alloy were investigated from two sampling directions (horizontal and vertical). The results showed that the fatigue limit of horizontal and vertical specimens was 357.5 MPa and 358.57 MPa, respectively. However, the HCF performance of vertical specimens was superior to horizontal specimen under a high-stress level. In addition, the HCF performance of both horizontal and vertical specimens was inferior to the wrought Ti–6Al–4V. Meanwhile, the FCG rate of vertical specimen was lower than that of horizontal specimen in both near-threshold region and Paris region. The anisotropic microstructure (prior β columnar grains with preferential orientation and α colonies) was found to be the main reason that contributed to an anisotropic HCF property and FCG behavior. For horizontal specimen, the fatigue crack interacted with only one or two columnar grains, thus leading to a lower FCG resistance. For vertical specimen, the fatigue crack interacted with multiple columnar grains, which led to a better plasticity and enhanced FCG resistance.

Injuries and child abuse increase during the pandemic over 12942 emergency admissions

IntroductionA strict lockdown was decided from 17/03/2020 to 11/05/2020 in France in order to tackle the first wave of the COVID19 pandemic. In the Great Paris region, several areas are severely affected by overcrowding, creating difficult conditions for children and their families during a period of nearly two months. The objective was to assess the effects of the 2020 spring lockdown on injuries, child abuse and neglect. Material and methodsThe central medical data warehouse was screened for all pediatric admissions at emergency and critical care departments of 20 hospitals, in a cohort of 12942 children. Specific keywords were used to screen for both injuries and child abuse and neglect. ResultsWe found head and neck trauma (1.2% in 2020 vs. 0.7% in 2019, p<0.001), burns (0.6% in 2020 vs. 0.1% in 2019, p < 0.001), lacerations (0.5% in 2020 vs. 0.3% in 2019, p<0.001), fractures (0.5% in 2020 vs. 0.3% in 2019, p<0.017), dog bites (0.1% in 2020 vs. 0.0% in 2019, p<0.001), and child abuse and neglect (18 cases during the 2020 lockdown vs. 24 cases in 2019, p=0.005) were significantly more prevalent during this period than during the same control period in 2019. ConclusionsThese results indicate that specific prevention measures are crucial if strict lockdowns are to be decided in the future.

Small-Area Estimations from Survey Data for High-Resolution Maps of Urban Flood Risk Perception and Evacuation Behavior

“Behavior-blind” risk assessments, mapping, and policy do not account for individual responses to risks, due to challenges in collecting accurate information at scales relevant to decision-making. There is useful spatial information in social survey data that is sometimes analyzed for spatial patterns despite potential biases. This article explores whether risk perception and adaptive behavior can be inferred from census and hazard exposure data with a specifically designed survey. An underlying question is what precautions surveys should take before mapping the results. We find that a hybrid multilevel regression and (synthetic) poststratification (MRP-MRSP) model can facilitate the transition from individual survey data to small-area estimations at different scales, including 200-m grid cells. We demonstrate this model using municipal-level survey data collected in the Paris region, France. We find that model accuracy is not decreased at finer scales provided there is a strong spatial predictor such as hazard exposure. Our findings show that a wide range of flood risk perception and evacuation behavior can be estimated with such downscaling techniques. Although this type of modeling is not yet commonly used among geographers, our study suggests that it can improve mapping of survey results and, in particular, can provide spatially explicit behavioral information for risk assessment and policy.

Calibration of a complex hydro-ecological model through Approximate Bayesian Computation and Random Forest combined with sensitivity analysis

An automated calibration method is proposed and applied to the complex hydro-ecological model Delft3D-BLOOM which is calibrated from monitoring data of the lake Champs-sur-Marne, a small shallow urban lake in the Paris region (France). This method (ABC-RF-SA) combines Approximate Bayesian Computation (ABC) with the machine learning algorithm Random Forest (RF) and a Sensitivity Analysis (SA) of the model parameters. Three target variables are used (total chlorophyll, cyanobacteria and dissolved oxygen concentration) to calibrate 133 parameters. ABC-RF-SA is first applied on a set of simulated observations to validate the methodology. It is then applied on a real set of high-frequency observations recorded during about two weeks on the lake Champs-sur-Marne. The methodology is also compared to standard ABC and ABC-RF formulations. Only ABC-RF-SA allowed the model to reproduce the observed biogeochemical dynamics. The coupling of ABC with RF and SA thus appears crucial for its application to complex hydro-ecological models.

An Experiment to Study Atmospheric Oxidation Chemistry and Physics of Mixed Anthropogenic–Biogenic Air Masses in the Greater Paris Area

Abstract ACROSS (Atmospheric ChemistRy Of the Suburban foreSt) is an integrative, innovative, multi-scale project within the “Make Our Planet Great Again” (MOPGA) initiative designed to advance understanding of the fate of urban and biogenic air mass mixtures in the Paris region. An ACROSS hypothesis is that the anthropogenic-biogenic air mass mixing leads to changes in the production of oxygenated volatile organic compounds (VOCs) whose properties alter their importance in incorporation into secondary organic aerosols (SOA) and their roles in the production of ozone and other relevant secondary species. A likely important factor is NOx transport to suburban biogenic environments and the resulting modification of key chemical processes. A highlight of ACROSS is an intensive, multi-platform measurement campaign that will take place in the summer of 2022. The campaign will include a 40-meter tower and ground-based measurements in the Rambouillet suburban forest to the southwest of Paris, airborne regional observations across Paris and suburban forested areas, and several other multi-instrumented ground sites located in the urban, rural, and semi-rural Paris region. The data collected from this campaign will provide a unique snapshot of the properties and mixing of urban and biogenic air masses around one of the most populated and polluted European megacities. This new knowledge will advance our understanding at the process level and lead to the ability to represent such complex systems in numerical models, ultimately resulting in improved capability to predict the impacts on air quality, regional climate, and global climate change.

Ambulatory Glucose Profile According to Different Phases of the Menstrual Cycle in Women Living With Type 1 Diabetes.

Some women living with type 1 diabetes complain of changes in glucose values according to the different phases of menstruation. To evaluate this variability through continuous glucose monitoring (CGM) data in type 1 diabetes patients. Observational study. Ambulatory data, recruitment in 2 centers in the Paris region. Twenty-four women with type 1 diabetes having spontaneous menstrual cycles. Collection of CGM data for 62 spontaneous menstrual cycles, with evaluation of five 3-day phases during each cycle: (1) early follicular (menstruations), (2) mid-follicular, (3) peri-ovulatory, (4) mid-luteal, and (5) late luteal. Time in range (TIR, prespecified). TIR decreased for each consecutive phase (61 ± 18%; 59 ± 18%; 59 ± 20%; 57 ± 18%; and 55 ± 20%, P = 0.02). The linear mixed model highlighted a decrease in TIR in the mid-luteal (P = 0.03) and late luteal (P < 0.001) phases compared with the early follicular phase. Time above range was significantly higher during the late luteal phase than the early follicular phase (P = 0.003). Time below range was significantly higher during the mid-follicular phase than in the early follicular phase. In most of the study population, glucose levels rose linearly throughout the menstrual cycle, reaching a maximum in the late luteal phase. A sharp decrease was seen for most participants at the beginning of menstrual bleeding. This should be taken into consideration in daily care of type 1 diabetes patients to avoid hypoglycemia.

High‐Resolution Lagrangian Inverse Modeling of CO2 Emissions Over the Paris Region During the First 2020 Lockdown Period

AbstractStringent mobility restrictions across the world during the COVID 19 pandemic have impacted local economies and, consequently, city carbon budgets, offering a unique opportunity to evaluate the capability of scientific approaches to quantify emissions changes. Our study aims to quantify and map CO2 emissions from fossil fuel and biogenic CO2 fluxes over the Paris metropolitan area during the first lockdown period (March‐May 2020) in France, in comparison with the same period in 2019. Our inversion system relies on transport model simulations initiated with the Weather Research and Forecasting chemistry transport model combined with a high‐resolution fossil fuel CO2 emissions inventory, and biogenic CO2 fluxes from a vegetation model. The inversion with atmospheric observations from a network of six towers resulted in a positive re‐adjustment of fossil fuel CO2 emissions in 2019 and 2020 compared to prior. In 2020, the inversion resulted in a large emission reduction (43%) compared to 2019, while the reductions were estimated to be 37% based on the prior inventory itself. By assimilating CO mixing ratios in addition to CO2, the traffic emission estimates were reduced by 68% in 2020, compared to nontraffic (29%). Various sensitivity tests show that prior emission uncertainty and different background conditions significantly impacted the emissions estimates. We conclude that our current inversion system with atmospheric CO2 monitoring makes it possible to identify the emission decrease in 2020 partly over the urban region. However, additional information on prior emission errors and a dense network will be needed to map emissions precisely.

Acute ambulatory blood pressure response to short-term black carbon exposure: The MobiliSense sensor-based study

Documented relationships between black carbon (BC) exposure and blood pressure (BP) have been inconsistent. Very few studies measured both BC exposure and ambulatory BP across the multiple daily environments visited in the general population, and none adjusted for personal noise exposure, a major confounder. Our study addresses these gaps by considering 245 adults living in the Grand Paris region. Personal exposure to BC was monitored for 2 days using AE51 microaethalometers. Ambulatory BP was measured every 30 min after waking up using Arteriograph 24 monitors (n = 6772). Mixed effect models with a random intercept at the individual level and time-autocorrelation structure adjusted for personal noise exposure were used to evaluate the associations between BC exposure (averaged from 5 min to 1 h before each BP measurement) and BP. To increase the robustness of findings, we eliminated confounding by unmeasured time-invariant personal variables, by modelling the associations with fixed-effect models. All models were adjusted for potential confounders and short-term time trends. Results from mixed models show that a 1-μg/m3 increase in 5-minute averaged BC exposure was associated with an increase of 0.57 mmHg in ambulatory systolic blood pressure (SBP) (95 % CI: 0.30, 0.83) and with an increase of 0.36 mmHg in diastolic blood pressure (DBP) (95 % CI: 0.14, 0.58). The slope of the exposure-response relationship gradually decreased for both SBP and DBP with the increase in the averaging period of BC exposure from 5 min to 1 h preceding each BP measurement. Findings from the fixed-effect models were consistent with these results. There was no effect modification by noise in the associations, across all exposure windows. We found evidence of a relationship between BC exposure and acute increase in ambulatory SBP and DBP after adjustment for personal noise exposure, with potential implications for the development of adverse cardiovascular outcomes.

PM2.5 and PM10 air pollution peaks are associated with emergency department visits for psychotic and mood disorders.

Particulate matters with a diameter of less than 10 µm (PM10) or less than 2.5 µm (PM2.5) are major air pollutants. Their relationship to psychiatric disorders has not yet been extensively studied. We aimed to explore the relationship between PM10 and PM2.5 air pollution peaks and the daily number of emergency visits for psychotic and mood disorders. Clinical data were collected from the Emergency Department of a Paris suburb (Créteil, France) from 2008 to 2018. Air pollution data were measured by the Paris region air quality network (Airparif) and collected from public databases. Pollution peak periods were defined as days for which the daily mean level of PM was above nationally predefined warning thresholds (20 µg/m3 for PM2.5, and 50 µg/m3 for PM10), and the 6 following days. Multivariable analyses compared the number of daily visits for psychotic and mood (unipolar and bipolar) disorders according to pollution peak, using negative binomial regression. After adjustment on meteorological variables (temperature, humidity, amount of sunshine in minutes), the daily number of emergency visits for psychotic disorders was significantly higher during PM2.5 and PM10 air pollution peak periods; while the number of visits for unipolar depressive disorders was higher only during PM10 peak periods (β = 0.059, p-value = 0.034). There were no significant differences between peak and non-peak periods for bipolar disorders. Differences in the effects of PM air pollution on psychotic and mood disorders should be analyzed in further studies.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11356-022-21964-7.

Social Inequalities in Participation in Cervical Cancer Screening in a Metropolitan Area Implementing a Pilot Organised Screening Programme (Paris Region, France).

Objectives: We aimed to examine social inequalities in participation in cervical cancer screening (CCS) in a metropolitan area by implementing a pilot organised screening programme. The pilot programme consisted of sending invitations to women who did not perform a pap smear within the past 3 years, managing interventions to reach vulnerable women, training healthcare professionals, and organising follow-ups of abnormal pap smears. Methods: We studied participation in CCS between January 2014 and December 2016 among 241,257 women aged 25–63 years old. To assess relative inequalities, Odds Ratios were computed using multilevel logistic regression. To assess absolute inequalities, the CCS coverage and the rate difference were calculated. Inequalities were computed by age and neighbourhood characteristics (social deprivation and proportion of single women). Results: Disparities in participation in CCS were observed by age and social deprivation. For overall screening compared to opportunistic screening, disparities by age were larger (OR25-35_vs._55–64 = 2.13 [2.08–2.19] compared to 2.02 [1.96–2.07]), but disparities by social deprivation were decreased (OR10%_most_vs._10%_least_deprived = 2.09 [1.90–2.30] compared to 2.22 [2.02–2.44]). Conclusion: Disparities in CCS participation remain despite the organised programme. To reduce these inequalities, free screening should be proposed and evaluated.

Daily and on-demand HIV pre-exposure prophylaxis with emtricitabine and tenofovir disoproxil (ANRS PREVENIR): a prospective observational cohort study

There are few data available regarding the use of on-demand pre-exposure prophylaxis (PrEP) for HIV prevention. We aimed to assess PrEP effectiveness, adherence, and safety in adults using daily or on-demand PrEP. We conducted a prospective observational cohort study (ANRS PREVENIR) at 26 sites in the Paris region, France. We enrolled HIV-negative adults (aged ≥18 years) at high risk of HIV infection who were starting or continuing PrEP. PrEP was prescribed as a fixed-dose combination of tenofovir disoproxil and emtricitabine (245 mg and 200 mg, respectively, per pill). PrEP could be prescribed as a daily regimen with one pill per day or, in men who have sex with men (MSM) or in transgender women who have sex with men, as an on-demand regimen following the IPERGAY dosing recommendation. At enrolment and every 3 months thereafter, participants were tested for HIV and provided information regarding the PrEP dosing regimen used. Adherence to PrEP was assessed by self-report and by tenofovir diphosphate concentrations in dried blood spots. The primary outcome of HIV-1 incidence was assessed using Poisson regression among participants who started PrEP. This study is registered with ClinicalTrials.gov, NCT03113123, and EudraCT, 2016A0157744. Between May 3, 2017, and May 2, 2019, 3082 people were assessed for eligibility and 3065 participants were enrolled. 3056 (99·7%) of 3065 participants reported using PrEP and were included in the analyses. The median age was 36 years (IQR 29-43), 1344 (44·0%) of 3056 participants were PrEP-naive, and 3016 (98·7%) were MSM. At enrolment, 1540 (50·5%) of 3049 participants opted for daily PrEP dosing and 1509 (49·5%) opted for on-demand PrEP dosing; these proportions remained stable during follow-up. Median follow-up was 22·1 months (IQR 15·9-29·7) and incidence of study discontinuation was 17·6 participants (95% CI 16·5-18·7) per 100 person-years. At the data cutoff on Sept 30, 2020, there had been six HIV-1 seroconversions (three participants using daily PrEP and three using on-demand PrEP; all were MSM) over 5623 person-years. Overall HIV-1 incidence was 1·1 cases (95% CI 0·4-2·3) per 1000 person-years, and did not differ between participants using daily PrEP and those using on-demand PrEP (incidence rate ratio 1·00, 95% CI 0·13-7·49; p=0·99). Four participants (two using daily PrEP and two using on-demand PrEP) discontinued PrEP due to treatment-related adverse events (nausea [n=2], vomiting and diarrhoea [n=1], and lumbar pain [n=1]). In this study, which enrolled mainly MSM, HIV-1 incidence on PrEP was low and did not differ between participants using daily PrEP and those using on-demand PrEP. On-demand PrEP therefore represents a valid alternative to daily PrEP for MSM, providing greater choice in HIV prevention. ANRS/Maladies Infectieuses Emergentes, Gilead Sciences, SIDACTION, and Région Ile de France. For the French translation of the abstract see Supplementary Materials section.

La périurbanisation de la pauvreté : politique de soutien à la propriété et inégalités socio-spatiales en France

Cet article examine le rôle joué par les prêts aidés dans l’accès à la propriété et la ségrégation résidentielle des ménages modestes en France. Au cours de la période 1996-2006, le Prêt à taux zéro a bénéficié à 1,4 million de ménages et constitue la principale mesure pour favoriser l’accession à la propriété. L’analyse s’appuie sur les enquêtes Logement (Insee), les registres administratifs du Prêt à taux zéro (SFGFAS) et des entretiens approfondis auprès d’accédants. Elle compare la position de différentes catégories socioprofessionnelles sur le marché du logement avant et après l’introduction du programme. Dans un contexte de hausse des prix de l’immobilier, on constate que le Prêt à taux zéro a limité l’exclusion des ménages modestes du marché du logement neuf, en particulier en dehors de la région parisienne. Pour autant, les ménages ayant bénéficié d’un Prêt à taux zéro ont eu tendance à s’installer plus souvent dans les zones périurbaines et rurales, caractérisées par une moindre proportion de cadres et de professions intellectuelles supérieures si on les compare aux centres villes. De plus, les entretiens suggèrent que les ménages modestes n’avaient pas une perception claire de l’éloignement géographique généré par l’accession à la propriété, ni de ses conséquences sur leur mode de vie et l’accès à certains services publics (systèmes collectifs de garde d’enfants, transports en commun, lycées, opportunités d’emplois).

Organ donation after out-of-hospital cardiac arrest: a population-based study of data from the Paris Sudden Death Expertise Center

BackgroundOrgan shortage is a major public health issue, and patients who die after out-of-hospital cardiac arrest (OHCA) could be a valuable source of organs. Here, our objective was to identify factors associated with organ donation after brain death complicating OHCA, in unselected patients entered into a comprehensive real-life registry covering a well-defined geographic area.MethodsWe prospectively analyzed consecutive adults with OHCA who were successfully resuscitated, but died in intensive care units in the Paris region in 2011–2018. The primary outcome was organ donation after brain death. Independent risk factors were identified using logistic regression analysis. One-year graft survival was assessed using Cox and log-rank tests.ResultsOf the 3061 included patients, 136 (4.4%) became organ donors after brain death, i.e., 28% of the patients with brain death. An interaction between admission pH and post-resuscitation shock was identified. By multivariate analysis, in patients with post-resuscitation shock, factors associated with organ donation were neurological cause of OHCA (odds ratio [OR], 14.5 [7.6–27.4], P < 0.001), higher pH (OR/0.1 increase, 1.3 [1.1–1.6], P < 0.001); older age was negatively associated with donation (OR/10-year increase, 0.7 [0.6–0.8], P < 0.001). In patients without post-resuscitation shock, the factor associated with donation was neurological cause of OHCA (OR, 6.9 [3.0–15.9], P < 0.001); higher pH (OR/0.1 increase, 0.8 [0.7–1.0], P = 0.04) and OHCA at home (OR, 0.4 [0.2–0.7], P = 0.006) were negatively associated with organ donation. One-year graft survival did not differ according to Utstein characteristics of the donor.Conclusions4% of patients who died in ICU after OHCA led to organ donation. Patients with OHCA constitute a valuable source of donated organs, and special attention should be paid to young patients with OHCA of neurological cause.

Evaluation of the self-reported questionnaires used to assess mental health after the January 2015 terrorist attacks in the Paris Region: IMPACTS survey

IntroductionStructured clinical interviews are the gold standard for assessing mental health. However limited resources may allow the use of only self-report questionnaires. In the context of emergency, such as terrorist attacks, the performance and thresholds of such tools still unclear.ObjectivesWe investigated the performance of the Posttraumatic stress disorder CheckList Scale (PCL-S) and of the Hospital Anxiety and Depression scale (HADS), both compared to the MINI Interview, among civilians and first responders involved in terrorist attacks.MethodsThe data came from the IMPACTS survey which was conducted from 6-10 months among civilians (N=190) and first responders (N=232) after the January 2015 terrorist attacks in the Paris Region, France. Sensitivity and specificity of the PCL-S and HADS were estimated by the ROC curve, and the optimal threshold was defined using the Youden index.ResultsRegarding the PCL-S: for civilians and first responders respectively, the overall AUC was 0.947 and 0.899, and the optimal threshold were 38.5 and 39.5. Regarding the HADS-D: for civilians and first responders respectively, the overall AUC was 0.908 and 0.617 and the optimal thresholds were 7.5 and 1.5. For the HADS-A for civilians and first responders respectively, the overall AUC was 0.823 and 0.717, the optimal threshold were 9.5 and 6.5.ConclusionsIn the context of a terrorist attack, compared to the MINI, our study underlined satisfactory performance of the PCL-S and the HADS-D in screening for PTSD and depression respectively, while the screening of anxiety using the HADS-A was unsatisfactory.DisclosureNo significant relationships.

Is disability more discriminatory in hiring than ethnicity, address or gender? Evidence from a multi-criteria correspondence experiment

In this paper, we conduct a multi-criteria correspondence test to assess the extent of discrimination in access to employment against candidates with a hearing disability and compare it to three other potential grounds for discrimination: ethnicity, place of residence and gender. From October 2019 to February 2020, we sent 2315 applications to 463 job vacancies in the Paris region in France for two occupations, administrative managers and caregiver assistants, in both the private and public sectors. We find that discrimination on the grounds of disability is similar in scope to that found on the grounds of ethnicity in the profession of administrative manager, but discrimination against the disabled candidate is half that experienced by the North African candidate in the profession of caregiver assistant. Moreover, discrimination on the grounds of disability is twice as high in the profession of caregiver assistant, a role which requires more interaction with public, as in the profession of administrative manager. We do not find any evidence of a difference in callback rates based on place of residence or gender. Finally, we cannot conclude that hiring discrimination is systematically lower in the public sector than in the private sector, nor that being eligible for a public subsidy reduces hiring discrimination against the disabled candidate.