Public Health

Purpose: Genital lymphedema is a chronic debilitating condition associated with highly impaired health-related quality of life (QoL). This prospective multicenter study evaluated the use of a new compressive garment in patients with secondary and primary genital lymphedema. Methods: Thirty-two patients prospectively enrolled were advised to wear the compressive garment for 12 weeks (day and night). The primary endpoint was change in patient-reported QoL at 12 weeks via the patient global impression of change (PGI-C) instrument. Secondary outcomes included change in other QoL measures at 12 weeks (visual analog scale, Lymphedema Quality of Life Inventory [LyQLI], and EQ-5D questionnaires), lymphedema severity (genital lymphedema score [GLS]), and physician assessment (Clinical Global Impression-Improvement [CGI-I]). Safety and tolerability were also assessed. Results: After 12 weeks, improvement was reported in 78.6% of patients (PGI-C). Physician assessment (CGI-I) indicated clinical improvement in 82.8% of patients. Patient assessment of lymphedema symptoms showed a significant decrease in discomfort (p = 0.02) and swelling (p = 0.01). Significant declines in the mean global GLS (p < 0.0001), and in the proportion of patients reporting heaviness, tightness, swelling, or urinary dysfunction (p < 0.05 for all), were also observed. LyQLI scores decreased (indicating improved QoL) in each of the physical, psychosocial (p = 0.05), and practical domains. The compressive garment was well tolerated with high compliance, and adverse events (due to swelling or discomfort) led to permanent discontinuation in only three patients. Conclusion: The use of a new genital compression garment over 12 weeks improves the QoL and clinical measures in patients with genital lymphedema (ClinicalTrials.gov ID: NCT04602559; Registration: October 20, 2020).

Sinds 2010 wordt de performantie van de Belgische gezondheidszorg regelmatig onderworpen aan een algemene check-up. Na een grondige herziening van de methode in juni, werden er zes dimensies en vier specifieke domeinen onder de loep genomen, aan de hand van 142 zorgvuldig geselecteerde indicatoren. Op die manier komen we tot een zeer volledig beeld van de sterke en zwakke punten van ons gezondheidszorgsysteem. Voor 2024 is er een nieuwe dimensie bijgekomen, namelijk veerkracht (het vermogen van het systeem om zich te herpakken na een crisis), onderzocht in het licht van de COVID-19 pandemie.

BackgroundLyme disease is one of the most commonly reported infectious diseases in the United States (US), accounting for more than 90% of all vector-borne diseases in North America.ObjectiveIn this paper, self-reported tweets on Twitter were analyzed in order to predict potential Lyme disease cases and accurately assess incidence rates in the US.MethodsThe study was done in three stages: (1) Approximately 1.3 million tweets were collected and pre-processed to extract the most relevant Lyme disease tweets with geolocations. A subset of tweets were semi-automatically labelled as relevant or irrelevant to Lyme disease using a set of precise keywords, and the remaining portion were manually labelled, yielding a curated labelled dataset of 77, 500 tweets. (2) This labelled data set was used to train, validate, and test various combinations of NLP word embedding methods and prominent ML classification models, such as TF-IDF and logistic regression, Word2vec and XGboost, and BERTweet, among others, to identify potential Lyme disease tweets. (3) Lastly, the presence of spatio-temporal patterns in the US over a 10-year period were studied.ResultsPreliminary results showed that BERTweet outperformed all tested NLP classifiers for identifying Lyme disease tweets, achieving the highest classification accuracy and F1-score of 90%. There was also a consistent pattern indicating that the West and Northeast regions of the US had a higher tweet rate over time.ConclusionsWe focused on the less-studied problem of using Twitter data as a surveillance tool for Lyme disease in the US. Several crucial findings have emerged from the study. First, there is a fairly strong correlation between classified tweet counts and Lyme disease counts, with both following similar trends. Second, in 2015 and early 2016, the social media network like Twitter was essential in raising popular awareness of Lyme disease. Third, counties with a high incidence rate were not necessarily related with a high tweet rate, and vice versa. Fourth, BERTweet can be used as a reliable NLP classifier for detecting relevant Lyme disease tweets.

Abstract BackgroundDiphtheria, caused byCorynebacterium diphtheriae, reemerges in Europe since 2022. Genomic sequencing can inform on transmission routes and genotypes of concern, but currently, no standard approach exists to detect clinically important genomic features and to interpret emergence in the globalC. diphtheriaepopulation framework.MethodsWe developed the bioinformatics pipeline DIPHTOSCAN (available athttps://gitlab.pasteur.fr/BEBP/diphtoscan) to extract from genomes of Corynebacteria of thediphtheriaespecies complex, medically relevant features includingtoxgene presence and disruption. We analyzed 101 humanC. diphtheriaeisolates collected in 2022 in metropolitan and overseas France (France-2022). To define the population background of this emergence, we sequenced 379 additional isolates (mainly from France, 2018-2021) and collated 870 publicly-available genomes.ResultsThe France-2022 isolates comprised 45tox-positive (44 toxigenic) isolates, mostly imported, belonging to 10 sublineages (&lt;500 distinct core genes). The global dataset comprised 245 sublineages and 33.9%tox-positive genomes, with DIPHTOSCAN predicting non-toxigenicity in 16.0% of these. 12% of the global isolates, and 43.6% of France-2022 ones, were multidrug resistant. Convergence of toxigenicity with penicillin and erythromycin resistance was observed in 2 isolates from France-2022. Phylogenetic lineages Gravis and Mitis contrasted strikingly in their pathogenicity-associated genes.ConclusionsThis work provides a bioinformatics tool and global population framework to analyzeC. diphtheriaegenomes, revealing important heterogeneities in virulence and resistance features. Emerging genotypes combining toxigenicity and first-line antimicrobial resistance represent novel threats. Genomic epidemiology studies ofC. diphtheriaeshould be intensified globally to improve understanding of reemergence and spatial spread.

BackgroundThe SHAMISEN (Nuclear Emergency Situations - Improvement of Medical And Health Surveillance) European project was conducted in 2015-2017 to review the lessons learned from the experience of past nuclear accidents and develop recommendations for preparedness and health surveillance of populations affected by a nuclear accident. Using a toolkit approach, Tsuda et al. recently published a critical review of the article by Cléro et al. derived from the SHAMISEN project on thyroid cancer screening after nuclear accident.Main bodyWe address the main points of criticism of our publication on the SHAMISEN European project.ConclusionWe disagree with some of the arguments and criticisms mentioned by Tsuda et al. We continue to support the conclusions and recommendations of the SHAMISEN consortium, including the recommendation not to launch a mass thyroid cancer screening after a nuclear accident, but rather to make it available (with appropriate information counselling) to those who request it.

Abstract Background Mechanisms underlying the associations between changes in the urban environment and changes in health-related outcomes are complex and their study requires specific approaches. We describe the protocol of the interdisciplinary UrbASanté study, which aims to explore how urban interventions can modify environmental exposures (built, social, and food environments; air quality; noise), health-related behaviors, and self-reported health using a natural experiment approach. Methods The study is based on a natural experiment design using a before/after protocol with a control group to assess changes in environmental exposures, health-risk behaviors, and self-reported health outcomes of a resident adult population before and after the implementation of a time series of urban interventions in four contiguous neighborhoods in Paris (France). The changes in environmental exposures, health-related behaviors, and self-reported health outcomes of a resident adult population will be concurrently monitored in both intervention and control areas. We will develop a mixed-method framework combining substantial fieldwork with quantitative and qualitative analytical approaches. This study will make use of (i) data relating to exposures and health-related outcomes among all participants and in subsamples and (ii) interviews with residents regarding their perceptions of their neighborhoods and with key stakeholders regarding the urban change processing, and (iii) existing geodatabases and field observations to characterize the built, social, and food environments. The data collected will be analyzed with a focus on interrelationships between environmental exposures and health-related outcomes using appropriate approaches (e.g., interrupted time series, difference–in-differences method). Discussion Relying on a natural experiment approach, the research will provide new insights regarding issues such as close collaboration with urban/local stakeholders, recruitment and follow-up of participants, identification of control and intervention areas, timing of the planned urban interventions, and comparison of subjective and objective measurements. Through the collaborative work of a consortium ensuring complementarity between researchers from different disciplines and stakeholders, the UrbASanté study will provide evidence-based guidance for designing future urban planning and public health policies.

We read with great interest the article by Neyens et al.1 published in your journal. This study describes the population pharmacokinetics (PK) modelling strategy of the rilpivirine long-acting (LA) formulation after intramuscular (IM) dosing in healthy and HIV-infected subjects. Data from seven clinical trials were analysed. Briefly, a one-compartment model with linear elimination and two parallel absorption pathways with sequential zero first-order processes adequately captured rilpivirine PK. As stated by the authors, the aim of the study was to quantify the inter- and intra-individual variability and to provide a quantitative assessment of the potential effect of intrinsic and extrinsic factors on rilpivirine exposure. Nevertheless, it is noteworthy that the influence of physiologically plausible covariates (i.e. age, body weight, BMI, sex, race, health status and needle length) was evaluated on absorption parameters only (it is not clear on which parameters). It was stated that a previously developed population PK model for rilpivirine after oral administration in Phase III studies did not identify statistically significant covariates.2 The disposition and elimination being independent of the administration mode, the authors deemed it unnecessary to assess the covariate effects on all pharmacokinetic parameters. However, reading the results of the Crauwels et al. study,2 gender and race were identified as statistically significant covariates on rilpivirine apparent clearance although the authors considered these effects as not clinically significant. Furthermore, in another ‘real-life’ observational population PK study, Néant et al.3 pointed out a rilpivirine half-life two times shorter compared with the one estimated by Crauwels et al.2 from the ECHO/THRIVE Phase III trials. The authors ascribed this discrepancy on half-life to the difference between the ‘real-life’ population coming from therapeutic drug monitoring (TDM) and the population included in the clinical trials.

The French National Reference Centre for Escherichia coli, Shigella and Salmonella (FNRC-ESS) detected two human clusters of 33 cases (median age: 10 years; 17 females) infected by Salmonella enterica serotype Bovismorbificans, ST142, HC5_243255 (EnteroBase HierCC‑cgMLST scheme) in September–November 2020 and of 11 cases (median age: 11 years; seven males) infected by S. enterica serotype 4,12:i:-, ST34, HC5_198125 in October–December 2020. Epidemiological investigations conducted by Santé publique France linked these outbreaks to the consumption of dried pork sausages from the same manufacturer. S. Bovismorbificans and S. 4,12:i:- were isolated by the National Reference Laboratory from different food samples, but both strains were identified in a single food sample only by qPCR. Three recalls and withdrawals of dried pork products were issued by the French general directorate of food of the French ministry for agriculture and food in November 2020, affecting eight supermarket chains. A notification on the European Rapid Alert System for Food and Feed and a European urgent enquiry on the Epidemic Intelligence Information System for Food and Waterborne Diseases and Zoonoses (EPIS-FWD) were launched. No cases were reported outside France. Outbreaks caused by multiple serotypes of Salmonella may go undetected by protocols in standard procedures in microbiology laboratories.

BackgroundHome and leisure injuries (HLIs) have a high impact on health.AimsThe aims of this study were to characterize HLI mortality for France in 2016 by sex, age, type, lesion, place of death, geographic region, and its main evolutions from 2012 to 2016.MethodsWe used the International Classification of Diseases, 10th Revision, to code the causes of death from the French mortality database. We expressed results in numbers, crude death rates, specific death rates by sex and age, and age-adjusted death rates.ResultsIn 2016, we recorded 24,211 deaths due to HLIs. Deaths due to HLIs occurred mainly at an elderly age with 79% of all cases. Falls represented nearly half of all HLI deaths, of which two-thirds concerned those over 65 years.HLIs were the first cause of death among children aged 1 to 4 years representing 20% of total deaths. Children under 15 were mainly victims of suffocations and drownings. The number of deaths related to HLIs increased by 10% between 2012 and 2016 with a 13% increase in the elderly and a 10% decrease in children.ConclusionThis study provides increased knowledge on fatal HLIs characteristics in France. We could avoid many deaths due to HLIs with adapted prevention measures. The decrease of HLI mortality in children could be partly attributed to effective prevention campaign and reinforcement of children products regulation.Learning OutcomesDescribe the latest available HLI mortality statistics in FranceIdentify the main results for HLI prevention campaigns to reduce health inequalities