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Background Spatial inequalities in health result from different exposures to health risk factors according to the features of geographical contexts, in terms of physical environment, social deprivation, and health care accessibility. Using a common geographical referential, which combines indices measuring these contextual features, could improve the comparability of studies and the understanding of the spatial dimension of health inequalities. Methods We developed the Geographical Classification for Health studies (GeoClasH) to distinguish French municipalities according to their ability to influence health outcomes. Ten contextual scores measuring physical and social environment as well as spatial accessibility of health care have been computed and combined to classify French municipalities through a K-means clustering. Age-standardized mortality rates according to the clusters of this classification have been calculated to assess its effectiveness. Results Significant lower mortality rates compared to the mainland France population were found in the Wealthy Metropolitan Areas (SMR = 0.868, 95% CI 0.863–0.873) and in the Residential Outskirts (SMR = 0.971, 95% CI 0.964–0.978), while significant excess mortality were found for Precarious Population Districts (SMR = 1.037, 95% CI 1.035–1.039), Agricultural and Industrial Plains (SMR = 1.066, 95% CI 1.063–1.070) and Rural Margins (SMR = 1.042, 95% CI 1.037–1.047). Conclusions Our results evidence the comprehensive contribution of the geographical context in the constitution of health inequalities. To our knowledge, GeoClasH is the first nationwide classification that combines social, environmental and health care access scores at the municipality scale. It can therefore be used as a proxy to assess the geographical context of the individuals in public health studies.

The planetary health diet (PHD) promotes dietary habits that are beneficial to human health and environmental sustainability, two closely related goals of modern public health. Health care professionals are expected to lead by example and use their position to encourage their patients and communities to adopt healthier and more sustainable behaviors. However, little is known about health care professionals' knowledge, attitudes, and behaviors (KAB) related to the PHD, which limits the ability to design targeted interventions for this key population. This study aimed to analyze KAB profiles related to the PHD among French health care professionals and assess associations with individual characteristics. This cross-sectional study was conducted from April 2024 to June 2024 among health care professionals. Participants were recruited using a nonprobabilistic convenience sampling method. Inclusion criteria were to be aged ≥18 years, fluent in French, and working as a health care professional at Hospices Civils de Lyon. Data were collected through an online questionnaire including sociodemographic and geographic variables, KAB items related to the PHD, and dietary intake. Adherence to the PHD was calculated using a validated scoring system. KAB items were analyzed using k-means clustering to identify distinct profiles. Associations with sociodemographic and geographic variables were explored using chi-square tests and ANOVA. Among 1104 respondents (n=927, 83.97% women and n=882, 79.89% aged between 30 and 59 years), 3 KAB clusters were identified: cluster 1 (\"knowledge-attitude gap\"; n=481, 43.57%) included professionals with good knowledge but moderate attitudes and partially consistent behaviors; cluster 2 (\"high intent, low action\"; n=318, 28.8 included those with strong knowledge and positive attitudes but limited behavioral change, and cluster 3 (\"behavior-driven alignment\"; n=305, 27.63%) included participants who reported pro-PHD behaviors despite lower knowledge and less favorable attitudes. PHD adherence was significantly associated with being female, having a vegetarian or flexitarian diet, and reporting environmental concerns (P<.01 in all cases). Distinct KAB profiles among health care professionals suggest differing levels of engagement regarding the PHD. Findings suggest that tailored interventions addressing knowledge, attitudes, or behaviors could improve health care professionals' alignment with planetary health goals within similar institutional contexts.

Digital Epidemiology and E-Health Research Hub, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg Guy Fagherazzi 7. Rights and permissions Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Beyond the map: evidencing the spatial dimension of health inequalities [RAW_REF_TEXT] Yohan Fayet ORCID: orcid.org/0000-0002-5664-46361,2 , Delphine Praud3,4 , Béatrice Fervers3,4 , Isabelle Ray-Coquard1,2 , Jean-Yves Blay5 , Françoise Ducimetiere1 , Guy Fagherazzi6,7 & Elodie Faure7,8 [/RAW_REF_TEXT] International Journal of Health Geographics volume 20, Article number: 1 (2021) Cite this article [RAW_REF_TEXT] 137 Accesses Metrics details The original article was published in International Journal of Health Geographics 2020 19:46

Background Sarcomas are rare cancers with great variability in clinical and histopathological presentation. The main objective of clinical practice guidelines (CPGs) is to standardize diagnosis and treatment. Methods From March 2005 to February 2007, all patients diagnosed with localized sarcoma in the Rhône-Alpes region were included in a cohort-based study, to evaluate the compliance of sarcoma management with French guidelines in routine practice and to identify predictive factors for compliance with CGPs. Results 634 (71 %) patients with localized sarcoma satisfying the inclusion criteria were included out of 891 newly diagnosed sarcomas. Taking into account initial diagnosis until follow-up, overall conformity to CPGs was only 40 % [95 % confidence interval (CI) = 36–44], ranging from 54 % for gastrointestinal stromal tumor to 36 % for soft tissue sarcoma and 42 % for bone sarcoma. In multivariate analysis, primary tumor type [relative risk (RR) = 4.42, 95 % CI = 2.79–6.99, p  < 0.001], dedicated multidisciplinary staff before surgery (RR = 4.19, 95 % CI = 2.39–7.35, p  < 0.001) and management in specialized hospitals (RR = 3.71, 95 % CI = 2.43–5.66, p  < 0.001) were identified as unique independent risk factors for conformity to CPGs for overall treatment sequence. Conclusions With only 40 % of total conformity to CPGs, the conclusions support the improvement of initial sarcoma management and its performance in specialized centres or within specialized dedicated networks.

This article provides a critical and genealogical analysis of the allostatic load research framework. AL research is used as a case study to analyse how the current biosocial context is articulated in the field of health inequalities research. Providing a contemporary analysis of AL studies with a genealogy of the AL concept, we show that the ambition to use biological tools to improve measurements, predictions, and ultimately public health action, is rooted in a history that predates current biosocial entanglements. We analyse the conceptual and methodological grounding of AL studies in relation to the ambitious propositions to address health inequalities they often convey. The difficulties in translating AL research findings into public health policies and the risks of biomedicalisation that could emerge through the use of AL are also addressed. While acknowledging these risks, however, we nuance the risk of depoliticisation associated with the biomedicalisation of social inequalities in health. In light of the historical analysis, we qualify the risks associated to a biologisation of social life that could emerge from AL research: it appears that these risks are more specifically rooted in methodological and epistemological problems that researchers would need to consider in the pursuit of AL research.

Background Spatial inequalities in cancer management have been evidenced by studies reporting lower quality of care or/and lower survival for patients living in remote or socially deprived areas. NETSARC+ is a national reference network implemented to improve the outcome of sarcoma patients in France since 2010, providing remote access to specialized diagnosis and Multidisciplinary Tumour Board (MTB). The IGéAS research program aims to assess the potential of this innovative organization, with remote management of cancers including rare tumours, to go through geographical barriers usually impeding the optimal management of cancer patients. Methods Using the nationwide NETSARC+ databases, the individual, clinical and geographical determinants of the access to sarcoma-specialized diagnosis and MTB were analysed. The IGéAS cohort ( n  = 20,590) includes all patients living in France with first sarcoma diagnosis between 2011 and 2014. Early access was defined as specialised review performed before 30 days of sampling and as first sarcoma MTB discussion performed before the first surgery. Results Some clinical populations are at highest risk of initial management without access to sarcoma specialized services, such as patients with non-GIST visceral sarcoma for diagnosis [OR 1.96, 95% CI 1.78 to 2.15] and MTB discussion [OR 3.56, 95% CI 3.16 to 4.01]. Social deprivation of the municipality is not associated with early access on NETSARC+ remote services. The quintile of patients furthest away from reference centres have lower chances of early access to specialized diagnosis [OR 1.18, 95% CI 1.06 to 1.31] and MTB discussion [OR 1.24, 95% CI 1.10 to 1.40] but this influence of the distance is slight in comparison with clinical factors and previous studies on the access to cancer-specialized facilities. Conclusions In the context of national organization driven by reference network, distance to reference centres slightly alters the early access to sarcoma specialized services and social deprivation has no impact on it. The reference networks’ organization, designed to improve the access to specialized services and the quality of cancer management, can be considered as an interesting device to reduce social and spatial inequalities in cancer management. The potential of this organization must be confirmed by further studies, including survival analysis.

Background/Objectives: The “One Health” approach underscores the connection between human, animal, and environmental health, promoting solutions to global challenges like climate change and biodiversity loss. The Planetary Health Diet (PHD) promotes a plant-based diet with organically grown plants to reduce the environmental impact of meat production and decrease the risk of non-communicable diseases (NCDs). The BIOQUALIM project will evaluate the PHD’s effectiveness in preventing NCDs like periodontal diseases and cancers through four inter-related studies. Methods: The clinical study will involve volunteers reducing their meat consumption and incorporating einkorn into their diet, allow for analysis of their interdental microbiota, oral health, general health, and quality of life. The chemical analysis will study nutrients and anti-cancer compounds in einkorn and common wheat varieties. The behavioral study will explore PHD knowledge, attitudes, and behaviors related to PHD. The psycho-social study will evaluate the impact of peer-support workshops on plant-based dietary cooking among post-therapy cancer patients. Results: The results are expected to demonstrate that einkorn varieties possess nutritional properties that, when incorporated into the PHD enriched with einkorn, can enhance health markers. This study will identify barriers to and facilitators of PHD adoption and highlight how peer-support workshops can improve dietary adherence. Conclusions: BIOQUALIM’s transdisciplinary approach will demonstrate the PHD’s role in preventing NCDs.

Rare cancer patients face lower survival and experience delays in diagnosis and therapeutic mismanagement. Considering the specificities of rare cancers, referral networks have been implemented in France to improve the management and survival of patients. The IGéAS research program aims to assess the networks’ ability to reduce inequalities. Data analysis of the IGéAS cohort (n = 20,590, sarcoma diagnosed between 2011 and 2014) by gathering medical data and geographical index will identify risk factors associated with the belated access to expertise or with no access to expertise. Intermediate results show that referral networks give sarcoma patients access to sarcoma expertise despite the remoteness of some of them. Regional expert centers mostly receive requests from within their area while national referral centers receive requests from the whole country. Delays in the access to expertise may be reduced by making outside practitioners more sensitive to the issues of rare cancers. The perception and involvement of outside practitioners in this device will be assessed using a qualitative survey. All the results are discussed and will contribute to design guidelines to improve early access to expertise and reduce inequalities. Results of the IGéAS research program may contribute to the assessment of referral sarcoma networks and provide some useful lessons to improve cancer care management.

Rare cancer patients face lower survival and experience delays in diagnosis and therapeutic mismanagement. Considering the specificities of rare cancers, referral networks have been implemented in France to improve the management and survival of patients. The IGéAS research program aims to assess the networks' ability to reduce inequalities. Data analysis of the IGéAS cohort ( = 20,590, sarcoma diagnosed between 2011 and 2014) by gathering medical data and geographical index will identify risk factors associated with the belated access to expertise or with no access to expertise. Intermediate results show that referral networks give sarcoma patients access to sarcoma expertise despite the remoteness of some of them. Regional expert centers mostly receive requests from within their area while national referral centers receive requests from the whole country. Delays in the access to expertise may be reduced by making outside practitioners more sensitive to the issues of rare cancers. The perception and involvement of outside practitioners in this device will be assessed using a qualitative survey. All the results are discussed and will contribute to design guidelines to improve early access to expertise and reduce inequalities. Results of the IGéAS research program may contribute to the assessment of referral sarcoma networks and provide some useful lessons to improve cancer care management.

The national reference network NETSARC+ provides remote access to specialized diagnosis and the Multidisciplinary Tumour Board (MTB) to improve the management and survival of sarcoma patients in France. The IGéAS research program aims to assess the potential of this innovative organization to address geographical inequalities in cancer management. Using the IGéAS cohort built from the nationwide NETSARC+ database, the individual, clinical, and geographical determinants of the 3-year overall survival of sarcoma patients in France were analyzed. The survival analysis was focused on patients diagnosed in 2013 (n = 2281) to ensure sufficient hindsight to collect patient follow-up. Our study included patients with bone (16.8%), soft-tissue (69%), and visceral (14.2%) sarcomas, with a median age of 61.8 years. The overall survival was not associated with geographical variables after adjustment for individual and clinical factors. The lower survival in precarious population districts [HR 1.23, 95% CI 1.02 to 1.48] in comparison to wealthy metropolitan areas (HR = 1) found in univariable analysis was due to the worst clinical presentation at diagnosis of patients. The place of residence had no impact on sarcoma patients’ survival, in the context of the national organization driven by the reference network. Following previous findings, this suggests the ability of this organization to go through geographical barriers usually impeding the optimal management of cancer patients.