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09-10; International audience

Si les changements environnementaux liés à l'humanité ne font aucun doute, leur ampleur et leurs conséquences ne sont pas si faciles à évaluer. Pour le savant, il s'agit d'établir les liens de causalité et les impacts avec le plus de précision possible, puis de poser un diagnostic. Le présent dictionnaire s'appuie sur le concept récent d'anthropocène', qui a le mérite, qu'on l'approuve ou non, de relancer la réflexion sur les rapports entre nature et société, entre constat scientifique et action politique, à travers une approche spatiale et territoriale. Procédant de façon critique, et fruit d'une démarche collective, cette vaste entreprise éditoriale se fonde sur une pratique de terrain, attentive aux détails et méfiante à l'égard des discours pré-établis. Parmi les 330 notices, plusieurs thèmes sont au coeur des débats contemporains (biodiversité, changement climatique...), d'autres se réfèrent à des courants de pensée (écoféminisme, transhumanisme...). Les concepts mobilisés abordent des questions politiques (capitalocène, justice environnementale...), philosophiques (catastrophes, Gaïa...), ou épistémologiques (finitude, population...). Des notions classiques sont réinterrogées (nature, ressource...), tandis que des concepts sont précisés (biosphère, écosystème...). D'autres notices discutent de mécanismes environnementaux (érosion, tsunami...), de pratiques récentes (agroécologie, ville durable...), de phénomènes territorialisés (déforestation, désertification...) ou d'artefacts (aéroport, autoroute...). Certaines examinent des lieux emblématiques (Amazonie, Fukushima...). D'autres, enfin, offrent un regard original sur l'anthropocène, sa faune (chien, ours...), ses mutations socio-économiques, institutionnelles ou politiques (biopiraterie, ZAD...). Un dictionnaire de référence sur un concept devenu incontournable

15-10; International audience

15-07; International audience

Objectives: To evaluate the clinical and economic burden of head and neck squamous cell carcinoma (HNSCC) in France. Methods: All 53,255 incident adult patients discharged with a first diagnosis of HNSCC in 2010-2012 were identified from the 2008-2013 French National Hospital Discharge (PMSI) database. We conducted a retrospective longitudinal analysis of prognosis and direct costs attributable to HNSCC. Results: Direct medical costs attributable to HNSCC care amounted to 665 million euros in 2012 in France. The majority (62%) of incident patients were 64 years old or less at HNSCC diagnosis and incurred 1.3-fold higher mean direct costs as compared to elderly patients (41,909 vs 32,221 euros over 3 years, respectively; p

BackgroundHealth state utility (HSU) is a core component of QALYs and cost-effectiveness analysis, although HSU is rarely estimated among a representative sample of patients. We explored the feasibility of assessing HSU in head and neck cancer from the French National Hospital Discharge database.MethodsAn exhaustive sample of 53,258 incident adult patients with a first diagnosis of head and neck cancer was identified in 2010-2012. We used a cross-sectional approach to define five health states over two periods: three "cancer stages at initial treatment" (early, locally advanced or metastatic stage); a "relapse state" and otherwise a "relapse-free state" in the follow-up of patients initially treated at early or locally advanced stage. In patients admitted in post-acute care, a two-parameter graded response model (Item Response Theory) was estimated from all 144,012 records of six Activities of Daily Living (ADLs) and the latent health state scale underlying ADLs was calibrated with the French EQ-5D-3L social value set. Following linear interpolation between all assessments of the patient, daily estimates of utility in post-acute care were averaged by health state, patient and month of follow-up. Finally, HSU was estimated by health state and month of follow-up for the whole patient population after controlling for survivorship and selection in post-acute care.ResultsHead and neck cancer was generally associated with poor HSU estimates in a real-life setting. As compared to distant metastasis at initial treatment, mean HSU was higher in other health states, although numerical differences were small (0.45 versus around 0.54). It was primarily explained by the negative effects on HSU of an older age (38.4% aged >= 70years in early stage at initial treatment) and comorbidities (>50% in other health states). HSU estimates significantly improved over time in the relapse-free state (from 8 to 12months of follow-up).ConclusionsHSU estimates in head and neck cancer were primarily driven by age at diagnosis, comorbidities, and time to assessment of cancer survivors. This feasibility study highlights the potential of estimating HSU within and across severe conditions in a systematic way at the national level.