Michelle Kelly-Irving’s research while affiliated with Université de Toulouse and other places

The good functioning of aquatic ecosystems is essential for providing diverse ecosystem services that benefit humans. The degradation of ecosystem health due to continuous stressors, such as climate change or water pollution, is leading to an increase in human health risks and well-being. Indicators have been developed to determine human health risks from recreational and drinking water. Still, a general application to aquatic ecosystems linking ecosystem health and human health risks has not been done. We here reviewed indicators and indices applied to assess the health of aquatic ecosystems and their links with human health risk and well-being. We evaluated the extent to which indicators can witness a risk to human health and well-being. A total of 245 articles were reviewed, consisting of 185 on the assessment of aquatic ecosystem health and 60 linking ecosystem health and human health or well-being. Out of the 65 indices described, we evaluated the use of several parameters and their relevance to evaluate human health risks, including physico-chemical parameters, bioindicators, contaminants, and pathogens, therefore covering the various sources of ecosystem disturbance. Based on our assessment, we propose a set of indicators that would allow for the inclusion of risks for human health and well-being in the assessment of ecosystem health (e.g. coliforms, algae, pH, nutrients, chemical compounds, and ecosystem services). Measuring these parameters should be incorporated into future studies to allow an understanding of the linkage of ecosystem and human health.

Background Sex and gender inequalities in ischemic heart diseases persist. Although ischemic heart disease is less common in women, they experience worse clinical outcomes and are less likely to receive guideline-recommended treatments. The primary scientific literature from which clinical guideline recommendations are derived may not have considered potential sex- and gender biases. This study aims to determine whether the literature cited in recent cardiovascular guidelines’ clinical recommendations contain sex and gender biases. Methods We analysed publications cited in the 2019 European Society of Cardiology (ESC) guideline recommendations on chronic coronary syndromes, using a checklist to guide data extraction and evaluate the individual studies for sex- and gender-related aspects, such as inclusion/exclusion criteria, outcome measures, and demographic data reporting. To assess representation over time, the proportion of women participants in each study was computed and analysed using a beta regression model. We also examined the associations between women’s representation, journal impact factor and author gender. Findings Among the 20 ESC recommendations on chronic coronary syndromes, four contained sex-related statements; we did not identify any gender-specific suggestions. The referenced literature upon which these recommendations were based consisted of 108 articles published between 1991 and 2019, encompassing more than 1.6 million study participants (26.8%; 432,284 women). Only three studies incorporated sex-sensitive designs; none were gender-specific. The term “gender” did not occur in 84% (n = 91/108) of the publications; when used, it was exclusively to denote biological sex. The proportion of women (assumed by investigators) among study participants fluctuated over time. Having a woman as first (odds ratio (OR) = 1.68, 95% CI: 1.19–2.39) or last author (OR = 2.28, 95% CI: 1.31–3.97), was significantly associated with having more women participants in the study. Interpretation The data underlying ESC guideline recommendations largely lack reporting of possible sex- and gender-specific aspects, and women are distinctly underrepresented. To what extent these recommendations apply to members of specific population groups who are not well-represented in the underlying evidence base remains unknown. Funding This study is part of the Gender and Health Inequalities (GENDHI) project, ERC-2019-SyG. This project has received funding from the 10.13039/501100000781European Research Council (ERC).

While there is a large body of evidence indicating that sexual minority youth experience inequitably high rates of mental health problems (eg, depression, suicidality), we know little about how temporal changes in sexual attractions, identities and behaviour may impact mental health (and other) outcomes. In this essay, we review existing research regarding sexual fluidity and mental health among young adults in order to identify critical knowledge gaps with respect to an epidemiological understanding of the relationship between these factors. We describe three gaps that in turn inform a larger public health research agenda on this topic. First, there are a number of methodological challenges given that fluidity can occur over short or long periods of time and across multiple dimensions of sexual orientation (eg, attractions, identities and behaviour) with various patterns (eg, directionality of change). Tailored measures that accurately and inclusively reflect diversities of sexual fluidity trajectories are needed. Second, causal relationships between sexual fluidity and mental health remain uncertain and unquantified. Third, little is known about how features of context (eg, gender norms and political climate) influence youth experiences with sexual fluidity and mental health. Finally, we propose a set of recommendations to address these knowledge gaps to improve the quality of epidemiological research involving young people.

This study examines hypertension control beyond the cascade of care framework, which assesses awareness, treatment, and control sequentially. The analysis included 52 434 hypertensive adults (blood pressure (BP) ≥140/90 mm Hg and/or treatment in the past 6 months), aged 25–69, from the French population‐based CONSTANCES cohort from 2012 to 2021. The authors assessed the typical “awareness, treatment, and control” scenario and characterized other possible control patterns. The authors found that 13% achieved control. This percentage rose to 19% when considering individuals who were not aware but treated and controlled. This alternative control scenario was associated with female sex, younger age, higher education, Northern‐African origin, and reporting prior cardiovascular diseases (CVD). Sub‐Saharan African origin, diabetes and overweight/obesity were associated with the typical control scenario. This study highlights that applying a typical sequential cascade of care approach may lead to the exclusion of some specific groups of participants who do not fit into the defined categories.

The present text builds on an earlier publication* which had the same aim: namely, to encourage clarity and coherence in the interdisciplinary area we called social-to-biological transitions. This burgeoning area of research involves a complex workforce with differing career levels and disciplinary traditions, reflecting which the present authors comment from different perspectives (one author from each of early career research, epidemiology, biology and public health) and invite debate. (* Blane, D., Kelly-Irving, M., d’Errico, A., Bartley, M. and Montgomery, S. (2013) Social-biological transitions: how does the social become biological?, Longitudinal and Life Course Studies , 4(2): 136–46.)

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.

Context: It is widely recognised that the COVID-19 pandemic has negatively impacted individuals' mental health. However, little emphasis has been put on the possible influence of socio-economic factors in the relationship. In the context of the COVID-19 pandemic, our objectives were (i) to assess the relationship between education level and mental health in French adults, and (ii) to study the influence of the economic, social, health and the COVID-19-related factors in men and women respectively. Method: Data are from 32,581 individuals representative of the French population who responded to the weekly survey "Baromètre COVID-19" between April 7th and May 31st 2020. Education level was self-reported (university degree, high school qualification, vocational certificate/qualification, no diploma). Anxiety-depressive state was derived from four items related to the frequency of occurrence of depressive and anxiety symptoms, and summarized in an overall validated anxiety-depressive score. Multivariate linear regression analyses were carried out with nested adjustments of variables related to economic, social, health and COVID-19 contexts to assess the relationship between education and anxiety-depressive state. Results: In total, 45% of individuals reported symptoms of anxiety-depressive state (53% in women versus 36% in men). Among men, those with a vocational certificate/qualification and those with no diploma had a greater risk of having a higher anxiety-depressive state compared to those with a university degree (βVocational certificate/qualification = 0.16 [0.04; 0.27]; βNo diploma = 0.75 [0.43; 1.07]) while among women, the risk of anxiety-depressive state increased as education level decreased (βBaccalaureate = 0.37 [0.25; 0.49]; βVocational certificate/qualification = 0.41 [0.28; 0.54]; βNo diploma = 0.8 [0.49; 1.12]). For both men and women, economic, health, and COVID-19 factors partly attenuate these associations while social factors marginally modified the relationship. After accounting for confounders and intermediate variables, the absence of a diploma remained associated with anxiety-depressive state among men, while the whole educational gradient of anxiety-depressive state persisted among women. Conclusion: In France, at the end of the first wave of COVID-19, individuals with a lower level of education had a higher risk of anxiety-depressive state. This association was more pronounced for women, highlighting a process of social inequality in health possibly related to gender. This should be considered in future prevention and public health interventions.

Background The association between health inequalities and the SARS-CoV-2 infection dynamic remains to be studied in France. The objective of this study was to analyse the relationship between an area-based deprivation indicator and SARS-CoV-2 infection indicators, during four epidemic waves running from August 4th 2020 to January 27th 2021 (second wave), January 28th to June 24th 2021 (third wave), June 25th to October 28th 2021 (fourth wave), and October 29th 2021 to March 29th 2022 (fifth wave). Methods We analysed weekly indicators of SARS-CoV-2 infection, extracted from the national testing information system: incidence, positivity and testing rates. The associations of these outcomes with the European Deprivation Index (EDI) quintiles were estimated with negative binomial generalized additive models adjusted for epidemic waves, population density (sparsely, moderately, densely populated), region (random effect) and interactions between epidemic waves and the variables EDI, population density, and region. Results The most deprived areas had a higher positivity rate than the least deprived ones during the second, third and fourth waves, but a lower rate during the fifth wave. They also had higher incidence during the third and fourth waves, but a similar incidence than the least deprived areas during the second wave, and even a lower rate during the fifth wave. The testing rate was lower in the most deprived areas than elsewhere, irrespective of the epidemic waves. Conclusions People living in the most deprived areas were less likely to be tested and more likely to test positive than people living in less deprived areas. The lower incidence, positivity and testing rates during the fifth wave in the most deprived areas may be explained by the enacted change in policy whereby screening tests were no longer free. These findings may reflect structural differences in access to care and lower capacity to benefit from prevention measures by deprived populations. Key messages • People living in the most deprived areas were less likely to be tested for COVID-19 irrespective of the epidemic waves. • Health authorities should address the issues of social inequalities more rapidly and target prevention strategy to disadvantaged populations.

Contexte Les recommandations des chercheurs pour sortir du modèle de la boîte noire épidémiologique engagent à expliciter le modèle théorique d'une intervention de santé publique avant sa mise en œuvre. Le modèle théorique peut se décrire comme une représentation des hypothèses des porteurs de projet sur les déterminants de la santé impliqués dans le problème sanitaire/social qu'ils cherchent à prévenir. Nous proposons de co-construire une intervention pour la prévention du diabète. En partant des résultats d'une étude observationnelle conduite dans la même population, notre démarche vise à identifier des déterminants de l'accès aux soins primaires pertinents pour le contexte à l’étude et qui opèrent dans les changements recherchés. Méthodes Cette étude a été réalisée dans des quartiers de l’île-de-la-Réunion, en 2015-2016. Son objectif était d’étudier, par un suivi de cohorte, le recours aux soins primaires de 417 adultes (18-79 ans) présentant des anomalies glycémiques dépistées à domicile. A l'analyse statistique, les caractéristiques qui augmentaient le risque de non-recours étaient: appartenir à la tranche d’âge 18-39 ans, déclarer ne pas avoir l'intention d'aller consulter le médecin, avoir l'habitude de consulter moins d'une fois par an. Ces résultats épidémiologiques alimentent la réflexion sur la future intervention, au sein d'un groupe de travail régional incluant l’équipe investigatrice, des représentants d'associations locales œuvrant au quotidien dans les champs sanitaire ou social et leurs participants. Résultats Les premiers résultats pointent le rôle, chez les jeunes adultes réunionnais, de déterminants psycho-sociaux (estime de soi, perception du risque encouru, perception des contraintes organisationnelles pour l'accès au soin) que des processus interventionnels de renforcement des individus ou de la communauté pourraient cibler. Discussion/Conclusion Il s'agit d'un travail de recherche interventionnelle en cours. Une perspective sera de co-construire le modèle Fonction-clé/Implémentation/Contexte de cette nouvelle intervention dans le but de préciser son évaluation et contribuer à sa transférabilité. Déclaration de liens d'intérêts Les auteurs déclarent ne pas avoir de liens d'intérêts.