Estimation of survival is used in many medical studies that aimed to estimate the prognostic of patient, the impact of some variables on the disease under study. More generally, estimation of survival is a valuable indicator of progress in disease control. For chronic diseases, more especially for cancer, the creation of registries has permitted to increase the knowledge in the epidemiology of the diseases under study. Over the past decade, population-based cancer registry data have been used increasingly worldwide to evaluate and improve the quality of cancer care. In this context, analyses are generally performed using methods of estimation of excess mortality that aimed at estimating and modelling the excess mortality to which a studied group of patient’s cancer is subjected and at estimating their net survival (i.e. the survival corrected for all the other causes of death). In this context, the objective of the modelling is to estimate the impact of prognostic factors on the excess mortality risk and to assess the cure rate in different subgroups of patients. Estimation of the survival of cancer’s patients, obtained from population-based data collected by cancer registries, are analysed regularly and published by the different European countries. Comparisons between countries are justified only if the methods used for that have taken into account bias relative of observational studies and if they are the result of a thought and a strategy adopted by all the partners. The development and the homogenisation of such methodology are totally justified in this context. The overall aim of this project is to improve the current methods for estimating net survival and to broaden their field of application in order to obtain i) tools to model complex data, and ii) more accurate estimates that enable to have information on survival for a studied disease and on its public health impact. More precisely, there are three main research axes devoted to: (1) propose new methodological developments to answer questions that are the result of our works during our previous project (MESURE); (2) extend and assess new statistical methods; (3) transfer net survival methods used in cancer to some other specific applications. These themes correspond to some of the actual challenges in the estimation of net survival. Following our previous project, CENSUR project is more ambitious, considering the scope of the methods investigated and the new development that are envisaged. While the focus is on methodological aspects, the network implies also members that have skills in epidemiology and in population-based data analyzes with the objective to produce survival statistics useful in Public Health. This project will allow to reinforce a network including 5 French team, 3 European and 1 Canadian, having complementarities, internationally known, and having experience in the framework of excess mortality and the development of statistical methods. At the end of this project, in order to optimize the use of methods to estimate net survival, we will organize a course. Furthermore, free-licensed statistical programs derived from our work will be available for the scientific community. If the project goes on well, it will allow to propose an adapted methodology in order to obtain correct estimates of the excess mortality for a disease under study and to its determinants. This methodological approach is a preliminary condition for a rational management of disease, on its medical and socio-economic aspects, that will be obtained from registries data, clinical data, or enterprise data.

Azole resistance in Aspergillus is one of the emerging public health concerns, listed as a WHO priority and suited to an integrated One Health approach. Selective pressure due to the use of azole pesticides in agriculture being incriminated, identification of clinical and environmental resistance patterns, and a greater understanding of the factors driving this resistance are urgently needed in order to issue recommendations to the stakeholders. The multidisciplinary AspergillusOne-health project strengthened with model and innovative methodologies (WGS, genotyping, MALDI typing, metabarcoding, AI) aims to identify hotspots as possible sources for selection of azole-resistance in the environment, after the detection of azole-resistant Aspergillus in patients and patiens's home, avian facilities, the environment (farming and sawmills), and detection of the azole fungicides in soil and air. The role of resistance trait on Aspergillus fitness cost will be investigated, using environmental strains and mutants selected after fungicide pressure, to assess its clinical involvement.

The current sequencing technologies used in genetics and the massive data generated in healthcare and research are challenging patients' rights to prior information, consent and non-opposition. Respect for autonomy is an ethical and legal requirement in France, which means that individuals must participate in decisions concerning their health. In the case of genetics, these requirements are heightened because the information provided may be predictive, shared with part of family members, requires specific informed consent prior to the test, implies rigorous (multi)professional support for the interpretation and communication of results, and has its own timeframe. In this context: do the practices of information, consent and non-opposition in genetics meet the customs and expectations of the parties involved, and do they comply with French law? Is consent given as part of a genuine co-decision process? Are practices consistent across all medical specialities and reseearch in France? The aim of our transdisciplinary research is to encourage the emergence of an informed choice from people undergoing genetic analysis. We are using participatory, human and social science and public health approaches to 1/define the concepts of information, consent and non-opposition in genetics, 2/assess practices (geneticists and other prescribers, Personal Protection Committees, experiences of patients/research participants) and 3/improve existing information and decision-making tools and produce new ones if necessary in a co-construction approach, with stakeholders, in order to clarify the information processes required prior to any consent or non-opposition. More generally, our results will help to improve public health policies for the benefit of patients, their families and professionals.

Plasmodium falciparum malaria persists in Sahelian Africa, where incidence follows a highly seasonal pattern. In the near-absence of mosquito vectors, parasites depend on human hosts to survive the dry season. This carriage is generally asymptomatic and remains untreated allowing parasites hosted by chronically infected individuals to reignite transmission when favourable conditions return. An intervention depleting this reservoir could fill a gap in existing malaria control strategy. To exploit the dry season transmission bottleneck efficiently, we need to understand: - how transmission restarts at the onset of the rainy season - how to intervene most efficiently against this carriage - how to integrate such intervention in ongoing control strategies. We will address these challenges in a population study conducted in Kedougou region, Senegal. We will conduct a pilot trial comparing 4 intervention villages receiving mass drug administration (MDA) to deplete the reservoir to 4 control villages, followed over 18 months (2 transmission seasons). We will evaluate feasibility, safety, acceptability, effectiveness of the intervention, and its process. We will compare transmission dynamics between depleted (intervention) vs full parasite reservoir (control). We will assess the contribution of parasite importation (newcomers and mobile inhabitants) and of infection persistence throughout the dry season) with highly sensitive molecular detection tools and genomics. We will integrate these results into relevant evidence for Malaria Control Programs and Health Systems of Sahel countries, by analysing the cost-effectiveness of the proposed strategy, and conducting a regional geoepidemiological analysis of onset dynamics to propose target intervention areas. Our results will shed light on the community-level dynamics of transmission restoration, and provide evidence to design high impact interventions towards malaria elimination.

Rational: Despite the development of unofficialy occupied living-places ("squats") in France and Europe, there is a lack of scientific data concerning these invisible living situations and precarious housing conditions that are difficult to reach. Hypotheses: People living in unofficialy occupied places in the city of Marseille are numerous and heterogeneous, combining complex life and health histories with precarious and risky living conditions. Objectives: This project is co-constructed by associations and community organizations, involved people, public authorities and scientific laboratorie. It aims to estimate the population of people living in squats in the city and to describe their pathways. The main objective is to understand their living conditions, to identify barriers and levers to access to essential social and health services, and to characterize existing resources and empowerment strategies. Methodology: The project will use a mixed, participatory and community-based methodology with: 1) a quantitative part using Respondent Driven Sampling (RDS) and a questionnaire survey (n=400) associated with the capture/recapture method and; 2) a qualitative part based on semi-structured interviews (n=30), focus groups and observations with the use of mind mapping. Expected results: This cross-analysis of statistical and empirical data aims to improve understanding of the situations of people living in squats, and to propose targeted actions to reduce risks and vulnerabilities and empower residents. The results of the triangulation and integration of quantitative and qualitative data will be discussed with all project partners, and will be the subject of scientific publications and presentations to the different stakeholders - institutional, community, associative and academic. This interdisciplinary and intersectoral (science-society) project is in line with the major priority issues of INSERM (Public Health), CNRS (Health and Environment) and INSHS (Shared Sciences and Experimental Approaches in SHS).