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Sexist behaviour in the workplace contributes to create a hostile environment, hindering the chance of women and gender non-conforming individuals to pursue an academic career, but also reinforcing gender stereotypes that are harmful to their progress and recognition. The Did this really happen?! project aims at publishing real-life, everyday sexism in the form of comic strips. Its major goal is to raise awareness about unconscious biases that transpire in everyday interactions in academia and increase the visibility of sexist situations that arise within the scientific community, especially to those who might not notice it. Through the website didthisreallyhappen.net, we collect testimonies about everyday sexism occurring in the professional academic environment (universities, research institutes, scientific conferences…). We translate these stories into comics and publish them anonymously without any judgement or comments on the website. By now, we have collected over 100 testimonies. From this collection, we identified six recurrent patterns: (1) behaviours that aim at maintaining women in stereotypical feminine roles, (2) behaviours that aim at maintaining men in stereotypical masculine roles, (3) the questioning of the scientific skills of female researchers, (4) situations where women have the position of an outsider, especially in informal networking contexts, (5) the objectification of women, and (6) the expression of neosexist views. We first present a detailed analysis of these categories, then we report on the different ways we interact and engage with the Earth science community, the scientific community at large and the public in this project.

The development of closed-loop systems for glycemia control in type I diabetes relies heavily on simulated patients. Improving the performances and adaptability of these close-loops raises the risk of over-fitting the simulator. This may have dire consequences, especially in unusual cases which were not faithfully-if at all-captured by the simulator. To address this, we propose to use offline RL agents, trained on real patient data, to perform the glycemia control. To further improve the performances, we propose an end-to-end personalization pipeline, which leverages offline-policy evaluation methods to remove altogether the need of a simulator, while still enabling an estimation of clinically relevant metrics for diabetes.

Background Lead poisoning is a significant public health issue globally. In French Guiana, a French overseas territory in South America, several studies have reported widespread lead exposure in the local population. However, the associated risk factors remain insufficiently understood. People working in informal gold mining share part of their lifestyle with French Guianese communities. The objectives of this study were to describe the prevalence of lead poisoning and to identify associated risk factors among gold mine workers in 2022. Methods This cross-sectional descriptive study was based on data collected by questionnaire and blood sampling. Persons working in informal gold mines were enrolled on the logistic rear bases on the Surinamese and Brazilian sites of the bordering rivers. Blood lead levels were measured on dry blood spots (50 µl). Using a threshold of 100 µg/L, single and multiple regressions were used to assess the associated factors. Results Among the 526 persons included, the median age was 38 years and 73.5% were men. The prevalence of lead poisoning was 44.7% (95%CI = 40.4%-49.0%). The factors associated with a BLL over 100 µg/L were: amount of time spent in gold mining (OR = 1.31 [1.09–1.58]), occupation with mud exposure (OR = 1.67 [1.13–2.48]), working in the Southwestern region (OR = 2.09 [1.34–3.27]) and consuming game (OR = 1.58 [1.06–2.36]). Conclusion The people working on gold mining sites are highly exposed to lead poisoning. The risk factors are suggestive of environmental contamination and differ from those suspected in the population of French Guiana. Trial registration This study is registered on ClinicalTrials.gov under the identifier NCT05540470 (registered on September 12, 2022).

Scaling-up an experimental intervention is always a challenge. On the border between French Guiana, Brazil and Suriname, an interventional study demonstrated the effectiveness of distributing self-diagnosis and self-treatment kits (Malakits) to control malaria in mobile and hard-to-reach populations. Its integration into the Suriname’s National Malaria Elimination Plan after a 2-year experiment faced numerous challenges, including human resources to cope with the additional workload of coordinators and to maintain the motivation of community health workers. The economic recession in Suriname, the Covid pandemic, and logistical issues also hampered the scale-up. Finally, thanks to the commitment of stakeholders in Suriname and French Guiana, the integration of Malakit distribution into the Surinamese national programme was proved possible.

Background Clandestine gold miners remain key hosts for malaria in French Guiana (FG) and contribute to imported malaria cases in Suriname and Brazil. The Malakit intervention, implemented in FG borders with Suriname and Brazil, provided gold miners with training on malaria and kits for self-diagnosis and self-treatment. Having shown a likely impact on malaria transmission, Suriname has now implemented it in routine care for cross-border moving populations. However, a decrease in malaria transmission is frequently associated with a decrease in risk perception, knowledge, and good practices regarding malaria. This study aims to describe the evolution of the perceptions, knowledge, attitudes, and practices (KAP) related to malaria among clandestine gold miners between 2015 and 2019, and to estimate the impact of Malakit on the FG/Suriname border. Methods The primary outcome was the overall KAP score over time and among participants and not participants in the Malakit intervention. A propensity score matching analysis and an inverse probability of treatment weighing analysis were used to estimate the Average Treatment effect on the Treated and the Average Treatment Effect of Malakit, respectively. Results Perception and knowledge scores were significantly lower in 2019 compared to 2015 (− 0.27 and − 0.23 points, respectively, p < 0.001) while attitude and practice scores were higher (+ 0.16 and + 0.47 points, respectively, p < 0.001). The overall KAP score was significantly higher among participants in Malakit with both propensity score matching (+ 0.72 points, 95%IC [0.29; 1.15]) and inverse probability of treatment weighting analysis (+ 0.70 points, 95%IC [0.34; 1.05]). Conclusion A decrease in perception and knowledge about malaria but an improvement of attitudes and practices as the incidence of malaria decreased are observed. The Malakit intervention seems to have a significant positive impact on the overall KAP related to malaria. The integration of this strategy into malaria control programmes could help to improve the KAP, even in areas where malaria is nearly eliminated, through optimal training and health empowerment. Trial registration ClinicalTrials.gov registration number: NCT03695770.

Most emerging pathogens are zoonoses and have a wildlife origin. Anthropization and disruption of ecosystems favor the crossing of inter-species barriers. We hypothesize that the marginalized population of undocumented goldminers in the Amazon is at risk of acquiring zoonoses. A multicentric cross-sectional study included consenting gold-mining adult workers in 2019. A clinical examination recorded dermatological signs of leishmaniosis and past history of yellow fever vaccination. Biological tests were performed for yellow fever, Q fever and leptospirosis serologies. Additional blood samples from a previous study in 2015 were also tested for leptospirosis. In 2019, 380 individuals were included in the study, along with 407 samples from the 2015 biological collection. The seroprevalence of leptospirosis was 31.0% [95%CI = 26.4-35.5] in 2015 and 28.1% [23.5-32.7] in 2019. The seroprevalence of Q fever was 2.9% [1.2-4.6]. The majority of participants reported being vaccinated against yellow fever (93.6%) and 97.9% had seroneutralizing antibodies. The prevalence of suspected active mucocutaneous leishmaniasis was 2.4% [0.8-3.9]. These unique data shed new light on the transmission cycles of zoonoses still poorly understood in the region. They support the existence of a wild cycle of leptospirosis but not of Q fever. Leishmaniasis prevalence was high because of life conditions and tree felling. High yellow fever vaccine coverage was reassuring in this endemic area. In the era of global health, special attention must be paid to these vulnerable populations in direct contact with the tropical ecosystem and away from the health care system.

To eliminate malaria, all populations must be included. For those who are not reached by the health care system, specific interventions must be tailor-made. An innovative Malakit strategy, based on the distribution of self-diagnosis and self-treatment kits, has been evaluated in the Suriname-French Guiana- Amapá (Brazil) region. The results showed effectiveness and good acceptability. The Malakit intervention is complex and has many components. Its transferability requires adaptation to other populations and regions, while retaining the main features of the intervention. This article provides the keys to adapting, implementing and evaluating it in other contexts facing residual malaria in hard-to-reach and/or mobile populations. The process of transferring this intervention includes: diagnosis of the situation (malaria epidemiology, characteristics of the population affected) to define the relevance of the strategy; determination of the stakeholders and the framework of the intervention (research project or public health intervention); adaptation modalities (adaptation of the kit, training, distribution strategy); the role of community health workers and their need for training and supervision. Finally, evaluation needs are specified in relation to prospects for geographical or temporal extension. Malaria elimination is likely to increasingly involve marginalized people due to climate change and displacement of populations. Evaluation of the transferability and effectiveness of the Malakit strategy in new contexts will be essential to increase and refine the evidence of its value, and to decide whether it could be an additional tool in the arsenal recommended in future WHO guidelines.

The Guiana Shield faces significant malaria challenges due to a mobile, hard-to-reach population involved in goldmining. Interventions like Malakit (self-testing and self-treatment kits), Targeted Drug Administration against P. vivax, or their combination, aim to combat malaria. These community-based interventions, evaluated in Brazil, French Guiana, and Suriname, show promising results and potential for scale-up. The research aimed to assess the scalability of these interventions by identifying and mapping stakeholders and doing a SWOT analysis for scale-up. This pre-planning assessment, conducted from June 2023 to March 2024, involved a collaborative, participatory approach. The process included working sessions with the resource team, semi-structured interviews with stakeholders, and participant observation during formal meetings with stakeholders and the resource team. Field notes have been taken and deductive qualitative analysis has been made using the ExpandNet/WHO Framework. Data was used to design Mendelow's Matrix and SWOT analysis. Stakeholders were categorized into implementers, decision-makers, beneficiaries, and partners. Mendelow's matrix and SWOT analysis highlighted strengths like Malakit's effectiveness, while weaknesses included data gaps and regulatory challenges. Opportunities for scaling up were linked to malaria elimination initiatives in Brazil, French Guiana, and Suriname, while funding and regulatory issues posed threats. Stakeholder analysis is crucial in scaling up public health interventions, identifying key contributors and challenges. Financial and regulatory barriers can hinder scalability, but political and epidemiological factors offer opportunities. Effective collaboration across countries, engaging stakeholders, and advocating for evidence-based decisions are essential for malaria elimination in Brazil, French Guiana, and Suriname. •Malakit and TDA are interventions against malaria for hard-to-reach populations.•To assess their scalability in the Guiana Shield, stakeholder involvement is key.•Malakit and TDA are promising, but regulatory or financial issues exist.•Commitments to the E−2025 goal represent a window of opportunity for their scale-up.•Advocacy and regional cooperation are crucial for the scale-up in the Guiana Shield.

French Guiana is a South American French territory, where HIV prevalence consistently exceeds 1% in the adult population. In the only correctional facility, HIV prevalence fluctuates at around 4%. After describing the population of HIV-positive inmates, we aimed to evaluate mortality after release from the correctional facility, and to identify its predictive factors. Outside North American settings, data on treatment outcome and vital status of HIV-positive former inmates are scarce. There were no data in French Guiana. Filling this gap represents a basis for potential improvements. All HIV-infected adults released from an incarceration of 30 days or more, between 2007 and 2013, were enrolled in a retrospective cohort study. Mortality was described over time, one to seven years following release, using Kaplan-Meier estimates. Factors associated with mortality were identified through a non-parametric survival regression model. 147 former inmates were included. The male to female ratio was 4.4. The median age was 37.3 years. The majority were migrants, 25.8% were homeless, 70.1% suffered from substance abuse, with 34.0% of crack-cocaine users. On admission, 78.1% had an early HIV-stage infection (CDC-stage A), with a median CD4 count of 397.5/mm3, 34.0% had one comorbidity, mainly hypertension. Upon release, 50.3% were on ART. Reasons for not being treated were not fulfilling the criteria for 74.6%, and refusing for 15.1%. Before release, 84.5% of the patients on ART had a viral load≤200cp/ml. After release, 8.2% of the cohort had died, with a crude incidence of 33.8/1000 person-years. All recorded deaths were males, with an incidence of 42.2/1000 person-years. Comparing with the age-specific mortality rates for males in French Guiana, the standardized mortality ratio was 14.8. In multivariate analysis, factors associated with death were age and CD4 count before release. Despite access to ART while incarcerated, with good virological outcome, the post-release mortality was very high for males, almost 15 times what is observed in the general male population living in French Guiana, after age standardization. Access to ART in correctional facilities may be a necessary, but not sufficient condition to protect male inmates from death after release.

Background A novel strategy to combat malaria was tested using a methodology adapted to a complex setting in the Amazon region and a hard-to-reach, mobile community. The intervention strategy tested was the distribution, after training, of malaria self-management kits to gold miners who cross the Surinamese and Brazilian borders with French Guiana to work illegally in the remote mining sites in the forest of this French overseas entity. Main text This article aims at presenting all process and implementation outcomes following the Conceptual Framework of Implementation Fidelity i.e. adherence, including content and exposure, and moderators, comprising participant responsiveness, quality of delivery, facilitation strategies, and context. The information sources are the post-intervention survey, data collected longitudinally during the intervention, a qualitative study, data collected during an outreach mission to a remote gold mining site, supervisory visit reports, in-depth feedback from the project implementers, and videos self-recorded by facilitators based on opened ended questions. As expected, being part of or close to the study community was an essential condition to enable deliverers, referred to as “facilitators”, to overcome the usual wariness of this gold mining population. Overall, the content of the intervention was in line with what was planned. With an estimated one third of the population reached, exposure was satisfactory considering the challenging context, but improvable by increasing ad hoc off-site distribution according to needs. Participant responsiveness was the main strength of the intervention, but could be enhanced by reducing the duration of the process to get a kit, which could be disincentive in some places. Regarding the quality of delivery, the main issue was the excess of information provided to participants rather than a lack of information, but this was corrected over time. The expected decrease in malaria incidence became a source of reduced interest in the kit. Expanding the scope of facilitators’ responsibilities could be a suitable response. Better articulation with existing malaria management services is recommended to ensure sustainability. Conclusions These findings supplement the evaluation outcomes for assessing the relevance of the strategy and provide useful information to perpetuate and transfer it in comparable contexts. Trial registration ClinicalTrials.gov.  NCT03695770 . 10/02/2018 “Retrospectively registered”.