[Analysing hypertension in France : A call for an intersectional approach of the cascade of care]. / Analyse de l'hypertension en France : pour une analyse intersectionnelle de la cascade de soins.

In metropolitan France, estimates suggest that more than one in three adults has hypertension. Low-cost treatments are available, yet fewer than one in four hypertensive adults has a controlled level of hypertension below 140/90 mmHg. This rate is higher in other high-income countries such as Canada (65%) or Germany (52%).  Using a 'cascade of care' model, that decomposes the hypertension care continuum in awareness, treatment, and control, provides a better understanding of the origins of poor control. Furthermore, the theoretical framework of intersectionality, which simultaneously considers social positions of gender, class, and ethno-racial origin, could be used to understand the complexity of the social inequalities observed in hypertension-related outcomes. In this article we conducted a critical review of the international literature to identify new lines of analyses that could be applied to examine complex inequalities in France.

The psychological effects of COVID-19-related containment in children: The E-COCCON French study.

The first containment of the Sars-Cov2 pandemic had the potential to generate posttraumatic stress (PTS) symptoms in children. OBJECTIVE: The main objective of the study was to determine the prevalence of PTS symptoms within 6 weeks of the end of lockdown, in children contained between March 17, 2020 and May 11, 2020 in France. MATERIAL AND METHODS: This was a French prospective cross-sectional study between May 15 and July 2, 2020 conducted via telephone survey. Parents of children aged between 8 and 15 years were eligible. The invitation to participate was proposed through social networks (Instagram and Facebook), various local and national media, and by e-mail to the staff of our University Hospital Center. The PTS symptoms were assessed using the CRIES-13. A score of 30 and over has been confirmed as the cut-off for screening cases. RESULTS: During the study period, 379 children (male, n = 207) were included, their mean age was 10.8±2.1 years. Symptoms of PTSD were identified in 17% of the children (girls 20.5%, boys 13.5%). These children were younger (p = 0.04), lacked access to a private outdoor space (p < 0.0001; OR: 7.8), had parents whose profession exposed them more to the coronavirus, and had parents who were more afraid of COVID-19. CONCLUSION: After the first lockdown related to the pandemic crisis, children developed PTSD symptoms. The onset of such symptoms is correlated with gender, age, lockdown conditions, and parental perceptions. These last considerations were worse for pink- or blue-collar families, attesting to the subsequent intensification of health inequalities.

The role of the early social environment on Epstein Barr virus infection: a prospective observational design using the Millennium Cohort Study.

Epstein-Barr virus (EBV) is a highly prevalent herpesvirus linked to infectious mononucleosis and several malignancies. This paper aims to study the association between children's early life social environment at 9 months and EBV infection at 3 years of age. METHODS: We used data on children included in the UK Millennium Cohort Study. We described the social environment using area-level and material factors as well as socioeconomic position (SEP) at 9 months. EBV was measured at 3 years of age (n = 12 457). RESULTS: Lower rates of EBV infection were observed in children living in towns and rural areas compared with those living in cities. Lower SEP and overcrowding in the household increased the odds of being infected. Children whose parents were social tenants were more likely to be infected than homeowners. In the overall model, the strength of the association between material factors and EBV infection weakened. CONCLUSIONS: We showed that early life material deprivation was associated with a higher risk of EBV infection among 3-year-olds. Children living in more deprived social conditions may be more likely to become EBV carriers at an earlier age.

The early life nutritional environment and early life stress as potential pathways towards the metabolic syndrome in mid-life? A lifecourse analysis using the 1958 British Birth cohort.

BACKGROUND: Lifecourse studies suggest that the metabolic syndrome (MetS) may be rooted in the early life environment. This study aims to examine the pathways linking early nutritional and psychosocial exposures and the presence of MetS in midlife. METHODS: Data are from the National Child Development Study including individuals born during 1 week in 1958 in Great Britain and followed-up until now. MetS was defined based on the National Cholesterol Education Program Adult Treatment Panel III classification. Mother's pre-pregnancy body mass index (BMI) was used as a proxy of the early nutritional environment and Adverse Childhood Experiences (ACE) as a proxy for early psychosocial stress. Socioeconomic characteristics, pregnancy and birth conditions were extracted as potential confounders. Adult health behaviors, BMI, socioeconomic environment and psychological state were considered as mediating variables. Multivariate models were performed by including variables sequentially taking a lifecourse approach. RESULTS: 37.5 % of men and 19.8 % of women had MetS. Participants with an obese/overweight mother presented a higher risk of MetS than those whose mother had a normal pre-pregnancy BMI. Men exposed to two ACE or more, and women exposed to one ACE, were more at risk of MetS compared to unexposed individuals. After including confounders and mediators, mother's pre-pregnancy BMI was still associated with MetS in midlife but the association was weakened after including participant's adult BMI. ACE was no longer associated with MetS after including confounders in models. CONCLUSIONS: The early nutritional environment, represented by mother's pre-pregnancy BMI, was associated with the risk of MetS in midlife. An important mechanism involves a mother-to-child BMI transmission, independent of birth or perinatal conditions, socioeconomic characteristics and health behaviors over the lifecourse. However this mechanism is not sufficient for explaining the influence of mother's pre-pregnancy BMI which implies the need to further explore other mechanisms in particular the role of genetics and early nutritional environment. ACE is not independently associated with MetS. However, other early life stressful events such as emergency caesarean deliveries and poor socioeconomic status during childhood may contribute as determinants of MetS.

[Television viewing and cardiovascular risk behaviors in the adult population of the French West Indies]. / Comportements à risque cardiovasculaire et médias télévisuels en population adulte guadeloupéenne.

OBJECTIVE: Recent studies have shown a link between prolonged television viewing and cardiovascular (CV) morbidity and mortality. We aimed to estimate the relationship between television viewing and CV risk behaviors and in the adult population of the French West Indies. PATIENTS AND METHODS: We used data from Consant, a cross-sectional study carried out in 2007 on a representative sample of the adult Guadeloupean population (1005 subjects aged 25-74 years selected by stratified random sampling and interviewed at home by trained investigators working in pairs). RESULTS: Among respondents who reported watching television for 2 hours or more per day, 46.5% stated practicing no leisure time physical activity, compared with 35.6% among those who reported watching television for less than 2 hours per day. Adjusting for age, sex, education, income, family status, and perceived CV benefits of physical activity, the odds ratio of physical inactivity was estimated at 1.75 (P<10(-3)) among subjects who reported watching television for 2 hours or more per day, compared with other subjects. A similar relationship was observed when considering dieting to prevent weight gain. CONCLUSION: In this representative sample of a French Caribbean population, a strong and very significant relationship was observed between prolonged television viewing and CV risk behaviors. Prolonged television viewing seems common to a lifestyle that is characterized by little physical activity and unhealthy eating habits. This may play a role in social inequalities observed in CV diseases.

[Inequalities in health: from the epidemiologic model towards intervention. Pathways and accumulations along the life course]. / Inégalités sociales de santé : du modèle épidémiologique à l'intervention. Enchaînements et accumulations au cours de la vie.

BACKGROUND: The aim of this paper is to analyse how epidemiology can contribute and assess interventions to reduce inequalities in health. This goal is best attained through an in-depth understanding of the construction of inequalities along the life course. Furthermore, it is concordant with a conception of causality stating that "the idea of causality has lost any other meaning than the pragmatic designation of the point in the causality chain where an intervention would be the most effective". DISCUSSION: In a cross-sectional approach, these chains of causality may be seen as Chinese boxes; in a longitudinal approach, they refer to life course epidemiology. Based on these models, a classification of interventions might be proposed: the approach by individual risk factors refers to the interventions toward vulnerable populations; the Chinese box approach leads to intervention directed toward non proximal factors, i.e., the environment, social factors and where the individual lives; the life course approach leads to intervention on fundamental causes. Understanding these mechanisms would thus lead to a better use and coordination of interventions to reduce health inequalities.