Coûts de l’hypotrophie par retard de la croissance intra-utérine (RCIU) attribuable à la pollution atmosphérique en France

Exposure of pregnant women to fine particulate matter < 2.5 μm in diameter (PM_2.5) is responsible for low birthweight (LBW) and intellectual disabilities, as expressed by a lower intelligence quotient (IQ). We estimated the attributable cost due to PM_2.5 of healthcare at birth and cognitive retardation of children with LBW in metropolitan France in 2012. The cost of specific care of the 8300 (range, 3100–13,300) children born every year in France with a LBW attributable to PM_2.5 exposure is estimated at € 25 million (range, € 9.5–39 million). Among these 8300 children, 1880 will present an intelligence quotient (IQ) lower than the average of the general population. The annual cost of the care of these intellectual deficiencies attributable to PM_2.5 is estimated at € 15 million and that of the mental handicap on the lifespan of the LBW children born in 2012 attributable to PM_2.5 is estimated at € 1.2 billion (range, € 458 million to € 1.9 billion). Beyond the elevated costs borne by future generations and the intellectual impoverishment of our society, it is essential to provide continued minimal monitoring of pregnant women exposed to air pollution. For the decision-makers, it is urgent to take effective measures and actions to protect the health of exposed populations.     

A Group Randomized Intervention Trial Increases Participation in the School Breakfast Program in 16 Rural High Schools in Minnesota

BackgroundBreakfast consumption is associated with better diet quality and healthier weights, yet many adolescents miss breakfast. Nationally, 17.1% of students participate in the School Breakfast Program (SBP). Only 10% of high school students participate.ObjectiveOur aim was to evaluate an environmental intervention to increase SBP participation in high schools.DesignA group randomized trial was carried out from 2012 to 2015.Participants/settingNinth- and 10th-grade students enrolled in 16 rural schools in Minnesota (median 387 students) were randomized to intervention or control condition.InterventionA school-based intervention that included two key components was implemented over a 12-month period. One component focused on increasing SBP participation by increasing student access to school breakfast through changes in school breakfast service practices (eg, serving breakfast from a grab-n-go cart in the atrium; expanding breakfast service times). The other component focused on promoting school breakfast through student-directed marketing campaigns.Main outcome measureChange in school-level participation in the SBP was assessed between baseline (among ninth and tenth graders) and follow-up (among tenth and eleventh graders). School meal and attendance records were used to assess change in school-level participation rates in the SBP.Statistical analysesThe Wilcoxon test was used for analysis of difference in change in mean SBP participation rate by experimental group.ResultsThe median change in SBP participation rate between baseline and follow-up was 3% (interquartile range=13.5%) among the eight schools in the intervention group and 0.5% (interquartile range=0.7%) among the eight schools in the control group. This difference in change between groups was statistically significant (Wilcoxon test, P=0.03). The intervention effect increased throughout the intervention period, with change in mean SBP participation rate by the end of the school year reaching 10.3% (95% CI 3.0 to 17.6). However, among the intervention schools, the change in mean SBP participation rates was highly variable (range=–0.8% to 24.8%).ConclusionsInterventions designed to improve access to the SBP by reducing environmental and social barriers have potential to increase participation among high school students.     

The association between the etiology of a spinal cord injury and time to mortality in the United States: A 44-year investigation

Objective: To determine the association between spinal cord injury (SCI) etiology categories and mortality, and examine the association between etiology sub-categories and mortality.

Design: Prospective cohort study.

Setting: Model Systems and Shriners Hospital SCI units.

Participants: Data were analyzed from 42,627 cases in the SCI Model System Collaborative Survival Study Database from 1973 to 2017. Those with SCI etiologies categorized as vehicular, violent, sports, falls, pedestrian, and medical were included.

Interventions: Not applicable.

Outcome Measure: Time to mortality after SCI.

Results: Relative to the sports related etiology category, those with medical, pedestrian, violence, falls, and vehicular related SCIs had a 2.00 (95% confidence intervals (CIs): 1.79–2.24), 1.57 (CIs: 1.34–1.83), 1.54 (CIs: 1.41–1.68), 1.35 (CIs: 1.25–1.45), and 1.26 (CIs: 1.17–1.35) higher hazard for mortality, respectfully. Persons with SCIs from automobile crashes had a 1.38 (CIs: 1.23–1.56) higher hazard for mortality, whereas those with SCIs from motorcycle crashes had a 1.21 (CIs: 1.04–1.39) higher hazard for mortality, relative to other etiologies within the vehicular category. Those with SCIs from diving had a 1.37 (CIs: 1.18–1.59) higher hazard for mortality relative to other etiologies within the sports category.

Conclusions: Injury etiology categories and certain sub-categories were associated with a higher risk for early mortality. Understanding how additional factors such as socioeconomic status, co-occurring injuries, medical co-morbidities, and environmental aspects interact with SCI etiologies may provide insights for how etiology of injury impacts survival. These findings may serve as a development for extending long-term life expectancy by informing SCI prevention programs and care post-injury.     

Parent perspectives on childhood vaccination: How to deal with vaccine hesitancy and refusal?

Background

The aims of the study are to evaluate attitudes about childhood vaccines and vaccine refusal or delay among parents and to assess the role played by the variables mapped as potential determinants to suggest strategies that could improve childhood vaccination rates.

Is public health training in Canada meeting current needs? Defrosting the paradigm freeze to respond to the post-truth era

Health scholars have long been calling for a new approach to understanding and responding to public health challenges, recognizing the dynamic influence of social and ecological processes and the importance of respecting different ways of knowing. With daunting new challenges to collective health, we sought to ascertain how future generations of public health researchers and practitioners are being prepared with the knowledge, attitudes, and skills needed for the tasks ahead. We found that of the 76 graduate level programs listed by the Public Health Agency of Canada, 65% required at least one quantitative methods course, but only 26% required qualitative methods and only 16% required a course in community engagement. While 25% had at least one required course related to social theory or social determinants of health, only 3% required a course on the ecological determinants. Our examination suggests that the majority of schools of public health may still be frozen in old paradigms wherein interdisciplinary inquiry and the development of skills to work with communities to implement and evaluate interventions to promote and protect collective health are still only peripheral considerations. With the intensification of public distrust in experts in this post-truth era, greater emphasis is needed now more than ever to develop skills in understanding and engaging the public in addressing the underlying issues threatening health. We argue that as the challenges of the Anthropocene are upon us, it is urgent that we rethink the skills we are teaching and prepare ourselves to radically adjust our approach.