Éditeur(s) : HAL CCSD
Résumé : International audience
TRAMIL is a research program applied to the use of medicinal plants in the Caribbean, established in the 1980s. Significant uses of herbal remedies to address self limiting health problems are identified through participatory ethnopharmacological surveys and are the subject of scientific validation. The results are then disseminated to several audiences.While comprising an international scientific contribution to academic research, the TRAMIL network activities value the popular and local knowledge. This fertile relationship between local knowledge and scientific research draws answers to key challenges for Caribbean societies: improving the health of Caribbean populations first and foremost, but also indirectly developing economic prospects in various sectors (agriculture, industry, tourism, and health).The success of TRAMIL is based on a rigorous methodology and on a noteworthy informal network of collaborators invested at different levels of the program, locally and / or regionally. TRAMIL is one of the few trilingual networks that have been active for nearly forty years, well before the popularization of the Internet, in more than twenty Caribbean territories. It involves people and communities, health care professionals, researchers in many disciplines, and information and documentation professionals.This paper proposes to explore these new ways of working together and the accomplishments to which they give rise by presenting some concrete examples of the TRAMIL program in Puerto Rico and examining the program's website and the complex challenges faced by the stakeholders involved in its implementation.
TRAMIL es un programa de investigación aplicada a la medicina popular del Caribe, iniciado en la década de los ‘80. Su trabajo se basa en llevar a cabo encuestas etnofarmacológicas participativas para identificar usos significativos de remedios de plantas, que son objeto de la validación científica, para tratar problemas comunes de salud. La difusión de los resultados de validación de los remedios con uso significativo completa las líneas de acción de TRAMIL. Al tiempo que representan una contribución científica internacional para la investigación académica, las actividades de TRAMIL constituyen la valoración de los saberes populares y locales. Esta relación fecunda entre el conocimiento local y la investigación científica es una respuesta a desafíos fundamentales para las sociedades del Caribe: mejorar la salud de las poblaciones del Caribe directa y en primer lugar, pero también, indirectamente, desarrollar oportunidades económicas en varios sectores (agricultura, la industria, el turismo y la salud).El éxito de TRAMIL se basa en una metodología rigurosa y una importante red informal de colaboradores que participan en diversas funciones del programa, a nivel de país y regional. TRAMIL es una de las pocas redes totalmente trilingües, activa durante casi cuarenta años, mucho antes de la popularización del Internet, en más de una veintena de territorio caribeños. Asocia especialmente a comunidades, profesionales de la salud, investigadores en muchas disciplinas, y profesionales de la información y documentación.Este trabajo tiene como objetivos explorar las modalidades de cooperación y logros sin precedentes de TRAMIL, presentando algunos ejemplos concretos del programa en Puerto Rico y examinar el sitio Web del programa y la complejidad de los desafíos que han enfrentado los actores involucrados en su implementación.
TRAMIL est un programme de recherche appliquée à l’usage des plantes médicinales dans la Caraïbe, né dans les années 1980. Les usages significatifs des plantes pour répondre à des problèmes de santé sont recensés par des enquêtes ethnopharmacologiques participatives puis font l’objet de travaux scientifiques destinés à les valider. Les résultats sont ensuite diffusés auprès de larges publics.Tout en constituant un apport scientifique international à la recherche universitaire, les activités du réseau TRAMIL s’inscrivent dans la valorisation des savoirs locaux. Cette relation fertile entre savoirs locaux et recherche scientifique dessine des réponses à des défis essentiels pour les sociétés caribéennes : l’amélioration de la santé des populations caribéennes de façon directe et en premier lieu, mais également, de façon indirecte, le développement de perspectives économiques dans des secteurs divers (agriculture, industrie, tourisme, santé).Le succès de TRAMIL repose sur une méthodologie rigoureuse et sur un important réseau informel d’acteurs investis à différents niveaux du programme, sur le plan local et/ou pancaribéen. C’est l’un des rares réseaux entièrement trilingue, actifs depuis près de quarante ans (bien avant la popularisation d’internet), dans plus d’une vingtaine de territoire de la Caraïbe. Il associe notamment les populations, les professionnels de santé, les chercheurs dans de nombreuses disciplines, et les professionnels de l’information et de la documentation.La présente contribution propose d’explorer ces modalités de collaboration inédites et les réalisations auxquelles elles donnent lieu, en présentant quelques exemples concrets du programme TRAMIL à Porto Rico, puis en examinant le site internet du programme et les défis complexes auxquels il a confronté les acteurs impliqués dans sa réalisation.
ACURIL 2017
San Juan, Puerto Rico

hal-01629021
https://hal.univ-antilles.fr/hal-01629021

Éditeur(s) : HAL CCSD
Résumé : The purpose of this thesis is to improve the knowledge about and apply data mining techniques and some Bayesian model in the field of social and environmental health inequalities. On the neighborhood scale on the Paris, Marseille, Lyon and Lille metropolitan areas, the health event studied is infant mortality. We try to explain its risk with socio-economic data retrieved from the national census and environmental exposures such as air pollution, noise, proximity to traffic, green spaces and industries. The thesis is composed of two parts. The data mining part details the development of a procedure of creation of multidimensional socio-economic indices and of an R package that implements it, followed by the creation of a cumulative exposure index. In this part, data mining techniques are used to synthesize information and provide composite indicators amenable for direct usage by stakeholders or in the framework of epidemiological studies. The second part is about Bayesian models. It explains the "BYM" model. This model allows to take into account the spatial dimension of the data when estimating mortality risks. In both cases, the methods are exposed and several results of their usage in the above-mentioned context are presented. We also show the value of the socio-economic index procedure, as well as the existence of social inequalities of infant mortality in the studied metropolitan areas.
Cette thèse a pour but d'améliorer les connaissances concernant les techniques d'analyse de données et certains modèles bayésiens dans le domaine de l'étude des inégalités sociales et environnementales de santé. À l'échelle géographique de l'IRIS sur les agglomérations de Paris, Marseille, Lyon et Lille, l'événement sanitaire étudié est la mortalité infantile dont on cherchera à expliquer le risque avec des données socio-économiques issues du recensement et des expositions environnementales comme la pollution de l'air, les niveaux de bruit et la proximité aux industries polluantes, au trafic automobile ou aux espaces verts. Deux volets principaux composent cette thèse. Le volet analyse de données détaille la mise au point d'une procédure de création d'indices socio-économiques multidimensionnels et la conception d'un package R l'implémentant, puis la création d'un indice de multi-expositions environnementales. Pour cela, on utilise des techniques d'analyse de données pour synthétiser l'information et fournir des indicateurs composites utilisables directement par les décideurs publics ou dans le cadre d'études épidémiologiques. Le second volet concerne les modèles bayésiens et explique le modèle " BYM ". Celui-ci permet de prendre en compte les aspects spatiaux des données et est mis en œuvre pour estimer le risque de mortalité infantile. Dans les deux cas, les méthodes sont présentées et différents résultats de leur utilisation dans le contexte ci-dessus exposés. On montre notamment l'intérêt de la procédure de création d'indices socio-économiques et de multi-expositions, ainsi que l'existence d'inégalités sociales de mortalité infantile dans les agglomérations étudiées.
https://tel.archives-ouvertes.fr/tel-00943004

tel-00943004
https://tel.archives-ouvertes.fr/tel-00943004
https://tel.archives-ouvertes.fr/tel-00943004/document
https://tel.archives-ouvertes.fr/tel-00943004/file/Manuscrit_LallouA_final.pdf

Éditeur(s) : HAL CCSD BioMed Central
Résumé : International audience
Background: Ameloblastin (AMBN) is a phosphorylated, proline/glutamine-rich protein secreted during enamel formation. Previous studies have revealed that this enamel matrix protein was present early in vertebrate evolution and certainly plays important roles during enamel formation although its precise functions remain unclear. We performed evolutionary analyses of AMBN in order to (i) identify residues and motifs important for the protein function, (ii) predict mutations responsible for genetic diseases, and (iii) understand its molecular evolution in mammals. Results: In silico searches retrieved 56 complete sequences in public databases that were aligned and analyzed computationally. We showed that AMBN is globally evolving under moderate purifying selection in mammals and contains a strong phylogenetic signal. In addition, our analyses revealed codons evolving under significant positive selection. Evidence for positive selection acting on AMBN was observed in catarrhine primates and the aye-aye. We also found that (i) an additional translation initiation site was recruited in the ancestral placental AMBN, (ii) a short exon was duplicated several times in various species including catarrhine primates, and (iii) several polyadenylation sites are present. Conclusions: AMBN possesses many positions, which have been subjected to strong selective pressure for 200 million years. These positions correspond to several cleavage sites and hydroxylated, O-glycosylated, and phosphorylated residues. We predict that these conserved positions would be potentially responsible for enamel disorder if substituted. Some motifs that were previously identified as potentially important functionally were confirmed, and we found two, highly conserved, new motifs, the function of which should be tested in the near future. This study illustrates the power of evolutionary analyses for characterizing the functional constraints acting on proteins with yet uncharacterized structure.
ISSN: 1471-2148

Droits : http://creativecommons.org/licenses/by/
hal-01212816
http://hal.upmc.fr/hal-01212816
http://hal.upmc.fr/hal-01212816/document
http://hal.upmc.fr/hal-01212816/file/s12862-015-0431-0.pdf
DOI : 10.1186/s12862-015-0431-0

Éditeur(s) : HAL CCSD American Society of Tropical Medicine and Hygiene
Résumé : International audience
These authors contributed equally to this work. Abstract. Human behaviors are increasingly recognized to play a key role in the spread of infectious diseases. Although a set of social and cognitive determinants has been consistently found to affect the adoption of health protective behaviors aiming to control and prevent a variety of infections, little is currently known about the ecological drivers of these behaviors in epidemic settings. In this article, we took advantage of the outbreak of chikungunya, a reemerging mosquito-borne disease, that occurred in French Guiana in 2014–15 to test empirically the assumption proposed by Zielinski-Gutierrez and Hayden that the proximity of the disease and perceptions of the natural environment may considerably shape public response to an emerging health threat. To achieve this, a cross-sectional survey was conducted among high school students of the region (N = 1462) at an early stage of the epidemic. Surprisingly, spatial analysis of the collected data leads to counterintuitive results as the participants who lived in the most affected area expressed less concern about the disease and practiced preventive behaviors less frequently than did other participants. These paradoxical results may be attributed to the possible activation of risk denial processes which have previously been observed in the risk perception literature, and described by several social and psychological defensiveness theories.
ISSN: 0002-9637

hal-01589232
http://hal.univ-reunion.fr/hal-01589232
http://hal.univ-reunion.fr/hal-01589232/document
http://hal.univ-reunion.fr/hal-01589232/file/Flamand%20...Raude%202017%20%28CHIKV%20French%20Guiana%29.pdf
DOI : 10.4269/ajtmh.16-1028

Éditeur(s) : HAL CCSD BioScientifica
Résumé : International audience
BACKGROUND: Differences in circulating steroid hormone levels have been hypothesized to explain ethnic differences in steroid-related diseases. The aim of this study was to determine the serum levels of a wide panel of steroid hormones, both androgens and estrogens, in healthy middle-aged African-Caribbean and European men. DESIGN AND METHODS: Serum steroid hormone levels were determined in men participating in a systematic public health study funded by the French National Health Insurance system. Blood was collected in the morning from 304 healthy African-Caribbean and European men aged between 40 and 69 years. Serum steroids were measured by mass spectrometry-gas chromatography, except for DHEAS and sex hormone-binding globulin, which were determined by RIA. Data were analyzed in 10-year age intervals by analysis of covariance, with adjustment for age, body mass index, waist-to-hip ratio, tobacco and alcohol consumption, and season of sampling. RESULTS: Compared with Europeans, African-Caribbean men presented significantly higher serum levels of measured bioavailable testosterone, 4-androstenedione (4-dione), and estrone (E1) regardless of the age group, of 5-androstenediol (5-diol) in those aged 40-49 and 50-59 years, and of testosterone (TT) and dihydrotestosterone in those aged 40-49 years. In contrast, European men aged 40-69 years showed significantly higher serum levels of DHEA and DHEAS. CONCLUSIONS: Significant differences in serum steroid hormone levels were observed in middle-aged African-Caribbean and European men. Whether such differences could contribute to ethnic differences in disease risk in adult men remains to be investigated. Some steroids, such as bioavailable TT, 4-dione, 5-diol, and E1, deserve particular attention.
ISSN: 0804-4643

hal-00876034
https://hal.archives-ouvertes.fr/hal-00876034
DOI : 10.1530/EJE-11-0551
PUBMED : 21951700

Éditeur(s) : HAL CCSD Elsevier
Résumé : International audience
Much research is being carried out into indoor exposure to harmful agents. This review focused on the impact on children's health, taking a broad approach to the indoor environment and including chemical, microbial, physical and social aspects. Papers published from 2006 onwards were reviewed, with regards to scientific context. Most of publications dealt with chemical exposure. Apart from the ongoing issue of combustion by-products, most of these papers concerned semi volatile organic compounds (such as phthalates). These may be associated with neurotoxic, reprotoxic or respiratory effects and may, therefore, be of particular interest so far as children are concerned. In a lesser extent, volatile organic compounds (such as aldehydes) that have mainly respiratory effects are still studied. Assessing exposure to metals is still of concern, with increasing interest in bioaccessibility. Most of the papers on microbial exposure focused on respiratory tract infections, especially asthma linked to allergens and bio-aerosols. Physical exposure includes noise and electromagnetic fields, and articles dealt with the auditory and non auditory effects of noise. Articles on radiofrequency electromagnetic fields mainly concerned questions about non-thermal effects and papers on extremely low-frequency magnetic fields focused on the characterization of exposure. The impact of the indoor environment on children's health cannot be assessed merely by considering the effect of these different types of exposure: this review highlights new findings and also discusses the interactions between agents in indoor environments and also with social aspects.
ISSN: 1438-4639

hal-00687403
https://hal.archives-ouvertes.fr/hal-00687403
DOI : 10.1016/j.ijheh.2011.07.008
PUBMED : 21889403

Éditeur(s) : HAL CCSD Cambridge University Press (CUP)
Résumé : International audience
Background. Adverse psychosocial working environments characterized by job strain (the combination of high demands and low control at work) are associated with an increased risk of depressive symptoms among employees, but evidence on clinically diagnosed depression is scarce. We examined job strain as a risk factor for clinical depression. Method. We identified published cohort studies from a systematic literature search in PubMed and PsycNET and obtained 14 cohort studies with unpublished individual-level data from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium. Summary estimates of the association were obtained using random-effects models. Individual-level data analyses were based on a pre-published study protocol. Results. We included six published studies with a total of 27 461 individuals and 914 incident cases of clinical depression. From unpublished datasets we included 120 221 individuals and 982 first episodes of hospital-treated clinical depression. Job strain was associated with an increased risk of clinical depression in both published [relative risk (RR) = 1.77, 95% confidence interval (CI) 1.47-2.13] and unpublished datasets (RR = 1.27, 95% CI 1.04-1.55). Further individual participant analyses showed a similar association across sociodemographic subgroups and after excluding individuals with baseline somatic disease. The association was unchanged when excluding individuals with baseline depressive symptoms (RR = 1.25, 95% CI 0.94-1.65), but attenuated on adjustment for a continuous depressive symptoms score (RR = 1.03, 95% CI 0.81-1.32). Conclusions. Job strain may precipitate clinical depression among employees. Future intervention studies should test whether job strain is a modifiable risk factor for depression.
ISSN: 0033-2917

hal-01560152
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01560152
DOI : 10.1017/S003329171600355X
PUBMED : 28122650

Éditeur(s) : HAL CCSD
Résumé : International audience
BACKGROUND: Africa faces a number of unique environmental challenges. Unfortunately, it lacks the infrastructure needed to support the comprehensive environmental studies that could provide the scientific basis to inform environmental policies. There are a number of known sources of endocrine-disrupting chemicals (EDCs) and other hazardous chemicals in Africa. However, a coordinated approach to identify and monitor these contaminants and to develop strategies for public health interventions has not yet been made. OBJECTIVES: This commentary summarizes the scientific evidence presented by experts at the First African Endocrine Disruptors meeting. We describe a "call to action" to utilize the available scientific knowledge to address the impact of EDCs on human and wildlife health in Africa. DISCUSSION: We identify existing knowledge gaps about exposures to EDCs in Africa and describe how well-designed research strategies are needed to address these gaps. A lack of resources for research and a lag in policy implementation slows down intervention strategies and poses a challenge to advancing future health in Africa. CONCLUSION: To address the many challenges posed by EDCs, we argue that Africans should take the lead in prioritization and evaluation of environmental hazards, including EDCs. We recommend the institution of education and training programs for chemical users, adoption of the precautionary principle, establishment of biomonitoring programs, and funding of community-based epidemiology and wildlife research programs led and funded by African institutes and private companies. https://doi.org/10.1289/EHP1774.
Environmental Health Perspectives

hal-01616487
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01616487
DOI : 10.1289/EHP1774
PUBMED : 28935616

Éditeur(s) : HAL CCSD Wiley
Résumé : International audience
Background Although the French eating model may differ from those of other countries, no studies to date have investigated dietary patterns in a wide age range of adults and at the national level. We aimed to identify dietary patterns (DP) of French adults and assess their associations with demographic, socio-economic and behavioural factors. Methods The present study included 2624 adults (1087 men, 1537 women) aged 18–79 years from the cross-sectional national French INCA2 dietary survey. Dietary data were collected using a 7-day estimated food record. Clusters of DP were derived using principal component analysis and clustering, conjointly. Age-adjusted logistic regression analyses were used to investigate the association between DP and correlates. Results Five DP were identified, namely ‘traditional’, ‘prudent’, ‘diversified’, ‘processed’ and ‘sandwiches’. Men were more likely to follow a traditional diet and women the ‘prudent’ pattern. Members of the ‘processed’ and ‘sandwiches’ patterns were younger compared to non-members. Healthier dietary patterns were overall positively associated with a higher socio-economic position, healthier behaviours (in terms of sedentary behaviours and smoking status) and lower body mass index. Under-reporting of energy intake, restrictive diet to lose weight and dietary supplement consumption were also related to specific DP, although differentially in men and women. Associations with contextual factors (i.e. household composition, agglomeration size and region) were also observed. Conclusions The identification of adults’ dietary patterns and associated behaviours (all modifiable) is important for the conceptualisation of multi-behavioural programs. The additional information on social and environmental correlates is also essential for targeting the most vulnerable population groups in the context of such public health interventions
ISSN: 0952-3871

hal-01299975
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01299975
DOI : 10.1111/jhn.12315
PUBMED : 25233099

Éditeur(s) : HAL CCSD Publisher : Baltimore : Williams & Wilkins, c1950-. Latest Publisher : Bethesda, MD : American Association of Immunologists
Résumé : International audience
Schistosome infection is a major public health concern affecting millions of people living in tropical regions of Africa, Asia, and South America. Schistosomes cause mild clinical symptoms in most subjects, whereas a small proportion of individuals presents severe clinical disease (as periportal fibrosis (PPF)) that may lead to death. Severe PPF results from an abnormal deposition of extracellular matrix proteins in the periportal spaces due to a chronic inflammation triggered by eggs and schistosome Ags. Extracellular matrix protein production is regulated by a number of cytokines, including IFN-gamma. We have now screened putative polymorphic sites within this gene in a population living in an endemic area for Schistosoma mansoni. Two polymorphisms located in the third intron of the IFN-gamma gene are associated with PPF. The IFN-gamma +2109 A/G polymorphism is associated with a higher risk for developing PPF, whereas the IFN-gamma +3810 G/A polymorphism is associated with less PPF. The polymorphisms result in changes in nuclear protein interactions with the intronic regions of the gene, suggesting that they may modify IFN-gamma mRNA expression. These results are consistent with the results of previous studies. Indeed, PPF is controlled by a major locus located on chromosome 6q22-q23, closely linked to the gene encoding the alpha-chain of the IFN-gamma receptor, and low IFN-gamma producers have been shown to have an increased risk of severe PPF. Together, these observations support the view that IFN-gamma expression and subsequent signal transduction play a critical role in the control of PPF in human hepatic schistosome infection (S. mansoni).
ISSN: 0022-1767

Droits : http://creativecommons.org/licenses/by-nc-nd/
hal-01211760
https://hal.archives-ouvertes.fr/hal-01211760
https://hal.archives-ouvertes.fr/hal-01211760/document
https://hal.archives-ouvertes.fr/hal-01211760/file/J%20Immunol-2003-Chevillard-5596-601.pdf
DOI : 10.4049/jimmunol.171.10.5596

Éditeur(s) : HAL CCSD BioMed Central
Résumé : International audience
Background: Adolescent obesity is prevalent in Pacific region ethnic groups (European, Melanesian and Polynesian) living in both urban and rural areas. Although body perception is an important factor of weight gain or loss, little is known about the body self-perceptions of Pacific region adolescents. This study therefore evaluated adolescent perceptions of body weight according to ethnicity (European, Melanesian or Polynesian), socioeconomic status (low, intermediate or high) and living area (rural or urban) in New Caledonia.Methods: Sociodemographic and anthropomorphic data from 737 adolescents (351 boys and 386 girls) with ages ranging from 11 to 16 years were collected and analysed. The International Obesity Task Force (IOTF) standards were used to define weight status as normal-weight, underweight or overweight/obese. Weight perception was assessed from detailed questionnaires, with adolescents rating their own weight with the following descriptors: 'about the right weight', 'too heavy', or 'too light'.Results: Results showed that only 8.5% of normal-weight adolescents (7% boys and 10% girls) identifying themselves as ‘too heavy’. Normal-weight Melanesian adolescents were less likely than their European counterparts to assess themselves as too heavy (OR = 0.357). However, half the overweight/obese adolescents underestimated their weight status (53% boys and 48% girls). Weight misperception was associated with ethnicity, socioeconomic status and living area, with gender-specific differences.Conclusions: The results of this study suggest that these sociodemographic factors should be taken into account when designing public health policies and health education school programmes in New Caledonia and, more broadly, the Pacific regio
ISSN: 1471-2458

Droits : info:eu-repo/semantics/OpenAccess
hal-01678909
https://hal.univ-antilles.fr/hal-01678909
https://hal.univ-antilles.fr/hal-01678909/document
https://hal.univ-antilles.fr/hal-01678909/file/Misperception%20of%20weight%20status%20in%20the%20pacific-%20preliminary%20findings%20in%20rural%20and%20urban%2011-%20to%2016-year-olds%20of%20New%20Caledonia%20Ste%CC%81phane%20Frayon%20et%20al%202017.pdf
DOI : 10.1186/s12889-016-3982-0

Éditeur(s) : HAL CCSD
Résumé : International audience
Direct examinations of blood and serologic tests were used to assess the intensity of the filarial endemicity in Gabon. Both methods revealed that the prevalence of filariasis with microfilaremia (Loa loa and Dipetalonema perstans) is presently very elevated. The areas that are more involved are the forest regions as well as the highest ones (ogoue, Lolo, Ngounie). Women appeared to be suffering from loasis to a lesser extent than men. On the other hand, the prevalence was identical for Dipetalonema perstans. For the gabonese population one can approximately say that 3 out of 5 adults patients have filariasis, two being D. perstans and one L. loa. Consequently these affections represent a major public health problem. Finally one must note that no case of lymphatic filariasis has been identified.
Bull Soc Pathol Exot Filiales

hal-00717069
https://hal.univ-antilles.fr/hal-00717069
PUBMED : 6936082

Éditeur(s) : HAL CCSD Elsevier
Résumé : International audience
Because many biological processes related to the dynamics of infectious diseases are caused by complex interactions between the environment, the host(s) and the agent(s), the necessity to address the methodological implications of this inherent complexity has recently emerged in epidemiology. Most epidemiologists now acknowledge that most human infectious diseases are likely to have complex dynamics. However, this knowledge still percolates with difficulty in their statistical "modus operandi". Indeed, for the study of complex systems, the traditional first-line statistical toolbox of epidemiologists (mainly built around the Generalized Linear Model family), despite its undeniable practicality and robustness, has structural limitations deprecating its usefulness. Three major sources of complexity neglected or not taken into account by this first-line statistical toolbox and having deep statistical implications are the multi-level organization of data, the non-linear relationships between variables and the complex interactions between variables. Three promising candidates to incorporate along with traditional tools for a new first-line statistical toolbox more suitable to apprehend these sources of complexity are the generalized linear mixed models, the generalized additive models, and the structural equation models. The aforementioned methodologies have the advantage to be generalizations of GLM models and are relatively easy to implement. Their assimilation and implementation would thus be greatly facilitated for epidemiologists. More globally, this text underlines that an improved use of other methods as such described here compared to traditional ones has to be performed to better understand the complexity challenging epidemiologists every day. This is particularly true in the field of infectious diseases for which major public health challenges will have to be addressed in the coming decades.
ISSN: 1567-1348

inserm-00872354
http://www.hal.inserm.fr/inserm-00872354
http://www.hal.inserm.fr/inserm-00872354/document
http://www.hal.inserm.fr/inserm-00872354/file/main_document.pdf
DOI : 10.1016/j.meegid.2013.09.006

Éditeur(s) : HAL CCSD
Résumé : International audience
Chronic obstructive pulmonary disease (COPD) is the chronic respiratory disease with the most important burden on public health in terms of morbidity, mortality and health costs. For patients, COPD is a major source of disability because of dyspnea, restriction in daily activities, exacerbation, risk of chronic respiratory failure and extra-respiratory systemic organ disorders. The previous French Language Respiratory Society (SPLF) guidelines on COPD exacerbations were published in 2003. Using the GRADE methodology, the present document reviews the current knowledge on COPD exacerbation through 4 specific outlines: (1) epidemiology, (2) clinical evaluation, (3) therapeutic management and (4) prevention. Specific aspects of outpatients and inpatients care are discussed, especially regarding assessment of exacerbation severity and pharmacological approach.
Revue Des Maladies Respiratoires

hal-01560287
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01560287
DOI : 10.1016/j.rmr.2017.03.034
PUBMED : 28552256

Éditeur(s) : HAL CCSD BioMed Central
Résumé : International audience
Background: The evaluation of geographical healthcare accessibility in residential areas provides crucial information to public policy. Traditional methods - such as Physician Population Ratios (PPR) or shortest travel time - offer only a one-dimensional view of accessibility. This paper developed an improved indicator: the Index of Spatial Accessibility (ISA) to measure geographical healthcare accessibility at the smallest available infra-urban level, that is, the Ilot Regroupe pour des Indicateurs Statistiques. Methods: This study was carried out in the department of Nord, France. Healthcare professionals are geolocalized using postal addresses available on the French state health insurance website. ISA is derived from an Enhanced Two-Step Floating Catchment Area (E2FCA). We have constructed a catchment for each healthcare provider, by taking into account residential building centroids, car travel time as calculated by Google Maps and the edge effect. Principal Component Analyses (PCA) were used to build a composite ISA to describe the global accessibility of different kinds of health professionals. Results: We applied our method to studying geographical healthcare accessibility for pregnant women, by selecting three types of healthcare provider: general practitioners, gynecologists and midwives. A total of 3587 healthcare providers are potentially able to provide care for inhabitants of the department of Nord. On average there are 92 general practitioners, 22 midwives and 21 gynecologists per 100,000 residents. The composite ISA for the three types of healthcare provider is 39 per 100,000 residents. A comparative analysis between ISA and physician-population ratios indicates that ISA represents a more even distribution whereas the physician-population ratios show an 'all-or-nothing' approach. Conclusion: ISA is a multidimensional and improved measure, which combines the volume of services relative to population size with the proximity of services relative to the population's location, available at the smallest feasible geographical scale. It could guide policy makers towards highlighting critical areas in need of more healthcare providers, and these areas should be earmarked for further knowledge-based policy making.
ISSN: 1475-9276

hal-01359567
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01359567
DOI : 10.1186/s12939-016-0411-z
PUBMED : 27485740

Éditeur(s) : HAL CCSD Springer Verlag
Résumé : International audience
In France, reducing social health inequalities has become an explicit goal of health policies over the past few years, one of its objectives is specifically the reduction of the perinatal mortality rate. This study investigates the association between infant mortality and social deprivation categories at a small area level in the Lille metropolitan area, in the north of France, to identify census blocks where public authorities should prioritize appropriate preventive actions. We used census data to establish a neighbourhood deprivation index whose multiple dimensions encompass socioeconomic characteristics. Infant mortality data were obtained from the Lille metropolitan area municipalities to estimate a death rate at the census tract level. We used Bayesian hierarchical models in order to reduce the extra variability when computing relative risks (RR) and to assess the associations between infant mortality and deprivation. Between 2000 and 2009, 668 cases of infant death occurred in the Lille metropolitan area (4.2 per 1,000 live births). The socioeconomic status is associated with infant mortality, with a clear gradient of risk from the most privileged census blocks to the most deprived ones (RR = 2.62, 95 % confidence interval [1.87; 3.70]). The latter have 24.6 % of families who were single parents and 29.9 % of unemployed people in the labor force versus 8.5 % and 7.7 % in the former. Our study reveals socio-spatial disparities in infant mortality in the Lille metropolitan area and highlights the census blocks most affected by the inequalities. Fine spatial analysis may help inform the design of preventive policies tailored to the characteristics of the local communities.
ISSN: 1092-7875

hal-00876255
https://hal.archives-ouvertes.fr/hal-00876255
DOI : 10.1007/s10995-013-1251-8
PUBMED : 23479336

Éditeur(s) : HAL CCSD John Libbey Eurotext
Résumé : International audience
The diversity of chemicals used in hospitals (detergents-disinfectants, alcohol-based hand sanitizers, drugs, etc.) and recent developments in indoor air quality regulation of public access buildings require a better understanding of chemical risks in this particular environment. We developed a methodology for semi-quantitative chemical risk assessments in this environment to prioritize inhalation risks by sector and chemical. This methodology is based on a similar approach in the workplace that defines classes of exposures and of hazards. Their combination produces a risk matrix. Four criteria were used to determine the exposure classes: quantity and frequency of the chemical's use, volatility (vapor pressure), and the type of collective protective equipment associated with each area. The hazard class is also derived from four criteria: classification as carcinogenic, mutagenic, or toxic to reproduction, the existence of a toxicity reference value, occupational exposure limit values, and risk phrases (official risk descriptions, on labels, data sheets, etc). This methodology was tested in the Rennes University Hospital (Rennes, France) in five different hospital areas, with a specific survey undertaken to collect data about chemicals in each area. The results show the spatial specificity of chemical risks. Among the various sites analysed, the chemical risks of two require priority attention: the parasitology-mycology laboratory and patients' rooms. Because of their wide use in the hospital and the volatility of some of their components (alcohols), detergents-disinfectants contribute to increasing risk levels in all areas. The model is therefore discriminatory in terms of areas and substances.
ISSN: 1635-0421

hal-00952349
https://hal-univ-rennes1.archives-ouvertes.fr/hal-00952349
DOI : 10.1684/ers.2013.0659

Éditeur(s) : HAL CCSD BMJ Publishing Group
Résumé : International audience
OBJECTIVE:To identify local meteorological drivers of dengue fever in French Guiana, we applied an original data mining method to the available epidemiological and climatic data. Through this work, we also assessed the contribution of the data mining method to the understanding of factors associated with the dissemination of infectious diseases and their spatiotemporal spread.METHODS:We applied contextual sequential pattern extraction techniques to epidemiological and meteorological data to identify the most significant climatic factors for dengue fever, and we investigated the relevance of the extracted patterns for the early warning of dengue outbreaks in French Guiana.RESULTS:The maximum temperature, minimum relative humidity, global brilliance, and cumulative rainfall were identified as determinants of dengue outbreaks, and the precise intervals of their values and variations were quantified according to the epidemiologic context. The strongest significant correlations were observed between dengue incidence and meteorological drivers after a 4-6-week lag.DISCUSSION:We demonstrated the use of contextual sequential patterns to better understand the determinants of the spatiotemporal spread of dengue fever in French Guiana. Future work should integrate additional variables and explore the notion of neighborhood for extracting sequential patterns.CONCLUSIONS:Dengue fever remains a major public health issue in French Guiana. The development of new methods to identify such specific characteristics becomes crucial in order to better understand and control spatiotemporal transmission.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
ISSN: 1067-5027

lirmm-01379072
https://hal-lirmm.ccsd.cnrs.fr/lirmm-01379072
DOI : 10.1136/amiajnl-2013-002348
PUBMED : 24549761

Éditeur(s) : HAL CCSD
Résumé : International audience
Kisspeptins are well known as mediators of the coordinated communication between the brain-pituitary axis and the gonads in many vertebrates. To test the hypothesis that gonadal steroids regulate kiss1 and kiss2 mRNA expression in European sea bass (a teleost fish), we examined the brains of gonad-intact (control) and castrated animals, as well as castrated males (GDX) and ovariectomized females (OVX) that received testosterone (T) and estradiol (E2) replacement, respectively, during recrudescence. In GDX males, low expression of kiss1 mRNA is observed by in situ hybridization in the caudal hypothalamus (CH) and the mediobasal hypothalamus (MBH), although hypothalamic changes in kiss1 mRNA levels were not statistically different among the groups, as revealed by real-Time PCR. However, T strongly decreased kiss2 expression levels in the hypothalamus, which was documented in the MBH and the nucleus of the lateral recess (NRLd) in GDX T-Treated sea bass males. Conversely, it appears that E2 evokes lowkiss1mRNAin the CH, while there were cells expressing kiss2 in the MBH and NRLd in these OVX females. These results demonstrate that kisspeptin neurons are presumably sensitive to the feedback actions of sex steroids in the sea bass, suggesting that the MBH represents a major site for sex steroid actions on kisspeptins in this species. Also, recent data provide evidence that both positive and negative actions occur in key factors involved in sea bass reproductive function, including changes in the expression of gnrh-1/gonadotropin, cyp19b, er and ar genes and sex steroid and gonadotropin plasma levels in this teleost fish. © 2016. Published by The Company of Biologists Ltd.
Journal of Experimental Biology

hal-01406072
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01406072
DOI : 10.1242/jeb.137364
PUBMED : 27591305

Éditeur(s) : HAL CCSD Elsevier
Résumé : International audience
Archival Pneumocystis jirovecii specimens from 84 patients monitored at Rennes University Hospital (Rennes, France) were assayed at the dihydropteroate synthase (DHPS) locus. No patient was infected with mutants. The results provide additional data showing that P. jirovecii infections involving DHPS mutants do not represent a public health issue in Brittany, western France.
ISSN: 0732-8893

hal-00874675
https://hal.archives-ouvertes.fr/hal-00874675
DOI : 10.1016/j.diagmicrobio.2013.01.018
PUBMED : 23433532