Vulnérabilités urbaines à Conakry, Guinée

L’évaluation des vulnérabilités urbaines dans la ville de Conakry a été commissionnée par MSF-CH pour identifier les populations les plus vulnérables et mieux comprendre les facteurs sanitaires de vulnérabilité afin de proposer des pistes de réflexion pour un futur projet.\ud \ud Cette évaluation qualitative a été réalisée par l’Unité d’évaluation de MSF à Vienne. Elle a été menée dans les cinq (5) communes de la ville de Conakry entre août et septembre 2012. Les recommandations et le rapport final sont présentés en octobre 2012. Le manque de temps était la contrainte majeure de cette évaluation

Géographie et politiques de l’aide d’urgence au Bangladesh ; les désastres engendrés par le typhon Sidr, le 16 novembre 2007

Le typhon Sidr a frappé le Sud du Bangladesh le 16 novembre 2007 (4 000 victimes, 8 millions de déplacés et sans abris). La réputation controversée de ce pays mal connu lui a valu l’attention de l’opinion internationale. Le Bangladesh a une longue expérience en matière de catastrophes naturelles, et est doté d’un large réseau d’organisations de solidarité. La prévention de l’aléa et la gestion de l’aide d’urgence ont permis de limiter les pertes humaines. Grâce à cette bonne coordination, la phase de reconstruction a été amorcée rapidement. La situation demeure difficile et le pays n’est pas encore sorti du marasme économique et social qui le caractérise.Sidr typhoon struck the Southern districts in Bangladesh on November 16, 2007 (4000 victims, 8 millions of displaced people / homeless). The discussed reputation of this country supports the attention of the international opinion to him. Thanks to its experience about natural hazards and to a broad humanitarian organizations network, the prevention of the catastrophe and the management of emergency aid made it possible to limit the human lives losses. A good relief aid management offered the opportunity of quickly switching from an emergency to a development stage.Still, the situation remains complex and the country has not overcome the economic and social depression which characterizes it

Co-produire et partager des connaissances pour décloisonner acteurs et niveaux territoriaux et agir sur les inégalites infra-communales de santé

Depuis 2011, un groupe de travail francilien dénommé « Plateforme Géodépistage » réunit des acteurs de différentes sphères professionnelles (chercheurs, acteurs institutionnels et de santé publique, élus locaux) agissant à différents niveaux territoriaux (de l’Etat à l’intra-communal) autour de la question des inégalités socio-territoriales de santé. Ce rapprochement s’opère autour de la production de connaissances sur les disparités d’accès au dépistage du cancer du sein dans des villes d’Ile-de-France. L’article propose de décrire la démarche de co-production, partage et application des connaissances portée par ce groupe de travail régional et de mettre en évidence deux types d’effets produits par le décloisonnement d’acteurs qu’induit cette démarche, à la fois au sein de la plateforme elle-même et dans une ville, en s’appuyant sur l’exemple d’Argenteuil (Val d’Oise). La première expression de ce décloisonnement s’observe dans la création de références communes entre les acteurs de la plateforme autour de la notion de territoire et d’inégalités de santé. La seconde se révèle dans la mise en œuvre au niveau local de collaborations avec de nouveaux acteurs qui n’étaient pas encore associés au processus de co-production de connaissances“Territorialisation” can be considered as the contextualization of public action (Clavier, 2011). With this redefinition of the shape of public action, combined with the growing recognition of the holistic view of health determinants and social and spatial health inequalities, Public Health is not anymore a medical problem that would be solely addressed by health professionals. It rather becomes a social issue on which political actors (locally elected-officials, institutional and associative territory-based players, etc.) may legitimately take decisions (Clavier, 2011). Indeed, social and spatial determinants of health inequalities comprehend a wide array of factors that combine differently according to places. When being considered at various scales, these factors incorporate a range of stakeholders from various sectors and involved at different territorial levels. These stakeholders face the challenge to coordinate themselves to tackle the issue of reducing social and spatial health inequalities effectively. “Territorialisation” of public action in regards to health implies changing the way local health policies are implemented and managed within the territories (territory being defined as “institutionalized geographical space”). This involves new practices based on new knowledge and new coordination patterns between actors (Torre & Vollet, 2016). Focusing at local level recombines the content of public policy. The State / national level is then required to authorize – whether it is acknowledged or not – a set of tasks set by a “lower” level of action. Locally-based actors redefine problems related to their territories (Thoenig, 1996). However, if locally-elected officials and local actors (from the health sector or not) are claiming proximity as a way to better adjust policies to local issues, optimal degree of proximity (city, district, region, and others), strategic choices and programs’ implementation still vary drastically depending on their own intervention area. Thus, linking and coordinating actors has become a major challenge to territorialize public action (Gumuchian et al., 2003). This coordination deals with connecting various actors working at different scales in order to act in a consistent, synergetic and integrated manner. In addition, defining issues and the objectives of the public policy meant to answer these questions require building the foundations of a collective intelligence (Clavier, 2011) and an increased capacity of territory-based information for action. Therefore, knowledge, including its production, sharing and transfer modalities and access, becomes a strong challenge for the players if they wish to be part of this public action territorialisation and influence it. Since 2011, a French regional working group called “GeoScreening Platform” (“Plateforme Géodépistage”) brings together stakeholders from various professional spheres (scholars, public health and institutional stakeholders, local decision makers) working at different territorial levels (from State to intra-urban). The working group focuses on social and territorial health inequalities in the Paris Region. Bridging these stakeholders is done through production of local health diagnosis carried out by health geography students from Paris Nanterre University (UPN) as part of their academic training. These studies compile an inventory of disparities in accessing breast cancer screening in cities within the Paris Region. They also highlight the potential explanatory factors of these social and territorial inequalities. “GeoScreening Platform” connects health geography scholars / lecturers from Paris Nanterre University (UPN), the National Association of Cities for Public Health (Elus, Santé publique et Territoires, ESPT), eight associations managing breast cancer screening programs at district level (structures départementales de gestion des dépistages), Health Insurance, Regional Health Agency (ARS- IdF) and the Regional Union of Health Practitioners (URPS-Médecins IdF). The article aims at portraying the co-production, sharing and transfer of knowledge carried by the regional working group. It emphasizes two kind of effects resulting from stakeholder decompartmentalisation induced by this approach. This analysis will draw on the example of the city of Argenteuil (Val d’Oise) where several studies have been co-produced (four in geography and one in sociology, between 2012 to 2016). The first proof of the decompartmentalisation is observed in the creation of common references among the Platform’s members. The collaborative working group gradually evolved into a true partnership and developed a cross-sectoral approach. From the initial motivation to investigate a technical issue (namely geocoding data to better target populations and identify intervention areas), the members gradually moved towards incorporating a health geography approach. This is shown through an evolution of language and the use of paradigms. The stakeholders adopt the concept of reducing social and territorial inequalities in health through their actions. By producing a common knowledge, the members themselves become owners of the approach as well as the results produced by the studies that they convey within their own spheres. Indeed, they contribute to their diffusion and dissemination. A second proof of the decompartmentalisation is seen in the implementation at local level – in the city of Argenteuil – through collaboration with new stakeholders who had not yet been involved in the knowledge co-production process. Argenteuil is a working class city where health has long been an important local agenda. The city is known to be socially and physically fragmented, marked by major social and health inequalities between neighborhoods. For these reasons, the local health policy does not only focus on access to health care but it also considers prevention interventions as well as programs tackling social and territorial inequalities. To develop this local policy, both in the implementation of actions and in its construction as a vision, the city needs to rely on knowledge. Since 2012, the platform collaborates with Argenteuil’s stakeholders and decision makers, who shared their interest in this partnership; a project bridging research to action. In a context of major political changes, the principle of the commitment on these health issues is not compromised. We observed how the studies carried out by the students in Argenteuil and other cities in the Paris Region first served the local stakeholders as a primarily foundation for further reflection. Then we saw the process of knowledge co-production and transfer. The way Argenteuil’s stakeholders integrated it, gives an opportunity to the local health department to work with new staff who have not been involved in actions related to health inequalities yet. These new players are from within the health department (eg. working in the City Health Centers) or from another department (eg. working in urban poor targeted areas, on sports, etc.)

Coproduire et partager des connaissances pour décloisonner acteurs et niveaux territoriaux et agir sur les inégalités de santé

International audienceDepuis 2011, un groupe de travail francilien dénommé « Plateforme Géodépistage » réunit des acteurs de différentes sphères professionnelles (chercheurs, acteurs institutionnels et de santé publique, élus locaux) agissant à différents niveaux territoriaux (de l’Etat à l’intra-communal) autour de la question des inégalités socio-territoriales de santé. Ce rapprochement s’opère autour de la production de connaissances sur les disparités d’accès au dépistage du cancer du sein dans des villes d’Ile-de-France.L’article propose de décrire la démarche de co-production, partage et application des connaissances portée par ce groupe de travail régional et de mettre en évidence deux types d’effets produits par le décloisonnement d’acteurs qu’induit cette démarche, à la fois au sein de la plateforme elle-même et dans une ville, en s’appuyant sur l’exemple d’Argenteuil (Val d’Oise). La première expression de ce décloisonnement s’observe dans la création de références communes entre les acteurs de la plateforme autour de la notion de territoire et d’inégalités de santé. La seconde se révèle dans la mise en oeuvre au niveau local de collaborations avec de nouveaux acteurs qui n’étaient pas encore associés au processus de co-production de connaissances

Appréhender les constructions socio-territoriales des inégalités d'accès au dépistage du cancer du sein à Gonesse (Val d'Oise) : diagnostic territorial et aide à la décision

National audienceA veni

Transfert de connaissances pour réduire les inégalités infra-communales d'accès au dépistage du cancer du sein

International audienceA veni

Do in vitro fertilization, intrauterine insemination or female infertility impact the risk of congenital anomalies in singletons? A longitudinal national French study

International audienceAbstract STUDY QUESTION Do IVF, IUI or female infertility (i.e. endometriosis, polycystic ovary syndrome [PCOS] and primary ovarian insufficiency [POI]) lead to an increased risk of congenital anomalies in singletons? SUMMARY ANSWER After multivariable adjustments, the increased risks of congenital defects associated with IUI were no longer significant, but the underlying maternal infertility presented a potential emental risk, in addition to the risk associated with IVF. WHAT IS KNOWN ALREADY Most epidemiological studies suggest that singletons born from ART have a higher risk of birth defects, specifically musculoskeletal, cardiovascular and urogenital disorders. However, most of these studies were established on data obtained at birth or in the neonatal period and from relatively small populations or several registries. Moreover, to our knowledge, female infertility, which is a potential confounder, has never been included in the risk assessment. STUDY DESIGN, SIZE, DURATION Using data from the French National Health System database, we conducted a comparative analysis of all singleton births (deliveries ≥22 weeks of gestation and/or >500 g of birthweight) in France over a 5-year period (2013–2017) resulting from fresh embryo or frozen embryo transfer (fresh-ET or FET from IVF/ICSI cycles), IUI and natural conception (NC). Data were available for this cohort of children at least up to early childhood (2.5 years old). PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 3 501 495 singleton births were included (3 417 089 from NC, 20 218 from IUI, 45 303 from fresh-ET and 18 885 from FET). Data were extracted from national health databases and used to identify major birth defects. Malformations were classified according to the 10th revision of the International Classification of Disease. To analyse the effect of mode of conception, multivariable analyses were performed with multiple logistic regression models adjusted for maternal age, primiparity, obesity, smoking, history of high blood pressure or diabetes and female infertility. MAIN RESULTS AND THE ROLE OF CHANCE In our cohort of children, the overall prevalence of congenital malformations was 3.78% after NC, 4.53% after fresh-ET, 4.39% after FET and 3.91% after IUI (132 646 children with major malformations). Compared with infants conceived naturally, children born after fresh-ET and after FET had a significantly higher prevalence of malformations, with an adjusted odds ratio (aOR) of 1.15 [95% CI 1.10–1.20, P < 0.0001] and aOR of 1.13 [95% CI 1.05–1.21, P = 0.001], respectively. Among the 15 relevant subgroups of malformations studied, we observed a significantly increased risk of eight malformations in the fresh-ET group compared with the NC group (i.e. musculoskeletal, cardiac, urinary, digestive, neurological, cleft lip and/or palate and respiratory). In the FET group, this increased risk was observed for digestive and facial malformations. The overall risk of congenital malformations, and the risk by subtype, was similar in the IUI group and the NC group (overall risk: aOR of 1.01 [95% CI 0.94–1.08, P = 0.81]). In addition, there was an overall independent increase in the risk of congenital defects when the mothers were diagnosed with endometriosis (1.16 aOR [95% CI 1.10–1.22], P < 0.0001), PCOS (1.20 aOR [95% CI 1.08–1.34], P = 0.001) or POI (1.52 aOR [95% CI 1.23–1.88], P = 0.0001). Chromosomal, cardiac and neurological anomalies were more common in the three maternal infertility groups. LIMITATIONS, REASONS FOR CAUTION Male infertility, the in vitro fertilization method (i.e. in vitro fertilization without or with sperm injection: conventional IVF vs ICSI) and embryo stage at transfer could not be taken into account. Furthermore, residual confounding cannot be excluded as well as uncertainties regarding the diagnostic criteria used for the three female infertilities. Findings for specific malformations should be interpreted with caution because the number of cases was small in some sub-groups (potentially due to the Type I error or multiple testing). WIDER IMPLICATIONS OF THE FINDINGS In this large study, after multivariable maternal adjustments, a moderately increased risk of defects subsisted after IVF, while those associated with IUI were no longer significant. In addition, our results showed that underlying maternal infertility could contribute to the increased risk of defects associated with IVF. These novel findings highlight the importance of taking into account the ART treatment methods and the type of infertility. STUDY FUNDING/COMPETING INTEREST(s) This work was supported by the National Agency of Biomedicine. The authors have no competing interests to disclose. TRIAL REGISTRATION NUMBER NA.NA