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Food literacy is gaining importance in nutrition education programs for children. To date, food literacy assessment tools have been developed in many countries, however, none exist in France. The objectives of this study were to develop a questionnaire and to evaluate its measurement properties among French schoolchildren aged 8-11 years. The questionnaire was developed in three phases: i) item selection (literature review and adaptation or creation of items) and content validity (submission to an expert panel), ii) questionnaire development including a pre-test in a small sample of children (n = 41) and item reduction and dimensionality based on the responses of children who completed the questionnaire in 31 schools between December 2022 and March 2023, and iii) questionnaire evaluation in terms of reliability, validity and acceptability. In total, 1187 responses were included in the analysis. The mean age of the children was 9.6 ± 0.7 years (girls: 51.2%, boys: 48.8%). The development process resulted in a 25-item questionnaire with good acceptability and satisfactory estimated reliability (McDonald omega coefficient = 0.73). Factor evaluation revealed a three-dimensional structure encompassing food and nutrition knowledge, participation in food preparation activities and food habits. To our knowledge, this study was the first to assess food literacy for schoolchildren in France. Our questionnaire can contribute to assess the factors that make food literacy vary, especially regarding socioeconomic variables to target priority populations for nutrition education actions and to describe changes in food literacy scores from a longitudinal perspective.
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Comportamento Alimentar , Letramento em Saúde , Humanos , Criança , França , Masculino , Feminino , Inquéritos e Questionários/normas , Reprodutibilidade dos Testes , Comportamento Alimentar/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Instituições AcadêmicasRESUMO
BACKGROUND: Nursing homes (NHs) have been particularly affected by COVID-19. The aim of this study is to estimate the burden of COVID-19 and to investigate factors associated with mortality during the first epidemic wave in a large French NHs network. METHODS: An observational cross-sectional study was conducted in September-October 2020. 290 NHs were asked to complete an online questionnaire covering the first epidemic wave on facilities and resident characteristics, number of suspected/confirmed COVID-19 deaths, and preventive/control measures taken at the facility level. Data were crosschecked using routinely collected administrative data on the facilities. The statistical unit of the study was the NH. Overall COVID-19 mortality rate was estimated. Factors associated with COVID-19 mortality were investigated using a multivariable multinomial logistic regression. The outcome was classified in 3 categories: "no COVID-19 death in a given NH", occurrence of an "episode of concern" (at least 10% of the residents died from COVID-19), occurrence of a "moderate episode" (deaths of COVID-19, less than 10% of the residents). RESULTS: Of the 192 (66%) participating NHs, 28 (15%) were classified as having an "episode of concern". In the multinomial logistic regression, moderate epidemic magnitude in the NHs county (adjusted OR = 9.3; 95%CI=[2.6-33.3]), high number of healthcare and housekeeping staff (aOR = 3.7 [1.2-11.4]) and presence of an Alzheimer's unit (aOR = 0.2 [0.07-0.7]) were significantly associated with an "episode of concern". CONCLUSIONS: We found a significant association between the occurrence of an "episode of concern" in a NH and some of its organizational characteristics and the epidemic magnitude in the area. These results can be used to improve the epidemic preparedness of NHs, particularly regarding the organization of NHs in small units with dedicated staff. Factors associated with COVID-19 mortality and preventive measures taken in nursing homes in France during the first epidemic wave.
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COVID-19 , Humanos , COVID-19/epidemiologia , Estudos Transversais , Casas de Saúde , França/epidemiologiaRESUMO
Hip fracture is a common injury and represents a major health problem with an increasing incidence. In older adults, opioids such as oxycodone are often preferred to other analgesics such as tramadol because of a lower risk of delirium. Different parameters, such as inhibition of cytochrome P450 (CYP450) 2D6 and/or 3A4, can potentially lead to pharmacokinetic variations of oxycodone representing a risk of adverse drugs effects or lack of drug response. There is a risk of drug-drug interactions involving CYP450 in older adults due to the high prevalence of polypharmacy. This study sought to identify patient characteristics that influence oxycodone administration. A single-center observational study included 355 patients with a hip fracture hospitalized in a geriatric postoperative unit. Composite endpoint based on form, duration, and timing to intake separated patients into three groups: "no oxycodone", "low oxycodone ", and "high oxycodone ". CYP450 interactions were studied based on a composite variable defining the most involved CYP450 pathways between CYP2D6 and CYP3A4. CYP450 interactions with CYP2D6 pathway involved were associated with the risk of "high oxycodone" [odds ratio adjusted on age and the type of hip fracture (OR*) 4.52, 95% confidence interval (CI) 1.39-16.83, p = 0.02)], as well as serum albumin levels (OR* 1.09, 95% CI 1.02-1.17, p = 0.01). Cognitive impairment was negatively associated with the risk of "high oxycodone" (OR* 0.38, 95% CI 0.18-0.77, p = 0.02). This study showed an association between CYP2D6 interactions and higher oxycodone consumption indirectly reflecting the existence of uncontrolled postoperative pain.
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Fraturas do Quadril , Oxicodona , Humanos , Idoso , Oxicodona/efeitos adversos , Estudos Transversais , Citocromo P-450 CYP2D6/metabolismo , Inibidores do Citocromo P-450 CYP2D6 , Analgésicos Opioides/efeitos adversos , Interações MedicamentosasRESUMO
BACKGROUND: As part of a decades-long process of restructuring primary care, independent (also known as community) healthcare workers are being encouraged to work in groups to facilitate their coordination and continuity of care in France. French independent midwives perform about half of the early prenatal interviews that identify mothers' needs during pregnancy and then refer them to the appropriate resources. The French government, however, structured the COVID-19 pandemic response around public health institutions and did not directly mobilise these community healthcare workers during the lockdown phase. These responses have raised questions about their role within the healthcare system in crises. This survey's main objectives were to estimate the proportion of independent midwives who experienced new difficulties in referring women to healthcare facilities or other caregivers and in collaborating with hospitals during the first stage of this pandemic. The secondary objective was to estimate the proportion, according to their mode of practice, of independent midwives who considered that all the women under their care had risked harm due to failed or delayed referral to care. METHODS: We conducted an online national survey addressed to independent midwives in France from 29 April to 15 May 2020, around the end of the first lockdown (17 March-11 May, 2020). RESULTS: Of the 5264 registered independent midwives in France, 1491 (28.3%) responded; 64.7% reported new or greater problems during the pandemic in referring women to health facilities or care-providers, social workers in particular, and 71.0% reported new difficulties collaborating with hospitals. Nearly half (46.2%) the respondents considered that all the women in their care had experienced, to varying degrees, a lack of or delay in care that could have affected their health. This proportion did not differ according to the midwives' form of practice: solo practice, group practice with other midwives only, or group practice with at least two types of healthcare professionals. CONCLUSIONS: The pandemic has degraded the quality of pregnant women's care in France and challenged the French model of care, which is highly compartmentalised between an almost exclusively independent primary care (community) sector and a predominantly salaried secondary care (hospital) sector.
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COVID-19 , Tocologia , Enfermeiros Obstétricos , COVID-19/epidemiologia , Controle de Doenças Transmissíveis , Feminino , Humanos , Pandemias , GravidezRESUMO
BACKGROUND: To ensure the success of COVID-19 vaccination, public authorities need to have the support of the entire population and build vaccine confidence. Identifying and understanding the determinants of vaccine acceptance is essential for conducting vaccine strategy. The aim was to estimate vaccine hesitancy among healthcare students in France and to investigate the associated factors. METHODS: A web-based cross-sectional study was conducted in a large French University in greater Paris area, among 4927 healthcare students from the different training courses such as medicine studies, midwifery studies, physiotherapy studies, nurse studies and others health studies. The study was conducted between January 21 and February 8, 2021 based on a questionnaire including 25 single or multiple-choice questions, made using the free software Limesurvey. The link of the questionnaire was distributed to the students by the teachers and the student associations. The SAGE group definition of vaccine hesitancy was used. All estimates were weighted using the gender and training courses category of all healthcare students registered for the 2020-2021 year. Crude and adjusted weighted odds ratio (wOR) and 95% confidence interval (95%CI) were estimated using logistic regression. RESULTS: A total of 1465 healthcare students answered. A proportion of 44.5% (95%CI = [41.7-47.3]) of them were considered as hesitant. Women were more hesitant (50.9, 95%CI = [48.0-53.9]) than men (21.6, 95%CI = [15.2-28.0]). Vaccine hesitancy was significantly associated with gender (wOR = 0.27, 95%CI = [0.18-0.39]) and training courses: medical students were less likely to be hesitant than students in the common and first year of several health studies (wOR = 0.48, 95%CI = [0.33-0.70]) while nursing students were more than 5 times more likely to be hesitant (wOR = 5.20, 95%CI = [3.71-7.28]). Students who did an internship during the epidemic (wOR = 0.53, 95%CI = [0.41-0.69]) and who downloaded the mobile contact-tracing mobile app "TousAntiCovid" (wOR = 0.34, 95%CI = [0.26-0.44]) were significantly less likely to be hesitant. CONCLUSIONS: Overall vaccine hesitancy among healthcare students was high, substantial differences were found between training courses. To reduce these disparities, interdisciplinary lectures on vaccines for all healthcare students may be implemented and evaluated.
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COVID-19 , Estudantes de Medicina , Vacinas , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacinas contra COVID-19 , Estudos Transversais , Feminino , Humanos , Masculino , Vacinação , Hesitação VacinalRESUMO
CONTEXT: In the context of the COVID-19 pandemic, the French government has authorized the practice of teleconsultations for midwives since March 20th. A questionnaire survey of 1491 liberal midwives reported that 88.5% of them had implemented this practice. We therefore wished to explore their motivations and the way in which they have integrated this new practice modality into their practice. METHODS: We conducted 22 semi-structured interviews with liberal midwives who had implemented teleconsultations since their authorization. The study was conducted between May and July 2020 and ended when saturation of the results was reached. A content analysis was used to identify recurrences and exceptions in the discourse. RESULTS: The main motivations of the liberal midwives for offering teleconsultations were to maintain access to care for women and their own professional activity. They pointed to a number of limitations, including the issue of professional secrecy and guaranteed confidentiality, and inequality of access to care in relation to the digital divide. The integration of teleconsultation into their practice has made it possible to highlight and enhance the support work carried out by midwives, which until now has not been very visible or recognized. CONCLUSION: Midwives quickly adopted teleconsultations, which have been made permanent since the confinement. This tool helps to ensure continuity of care but also raises new questions about equal access to care.
Contexte: Dans le contexte de la pandémie COVID-19, le gouvernement français a autorisé la pratique des téléconsultations pour les sages-femmes à partir du 20 mars 2020. Une enquête par questionnaire menée auprès de 1 491 sages-femmes libérales a rapporté que 88,5 % d'entre elles avaient mis en Åuvre cette pratique. Nous avons donc souhaité explorer leurs motivations et la façon dont elles ont intégré cette nouvelle modalité d'exercice dans leur pratique. Méthodes: Nous avons mené 22 entretiens semi-directifs auprès de sages-femmes libérales ayant mis en place des téléconsultations depuis leur autorisation. L'étude, réalisée entre mai et juillet 2020, a pris fin lorsque la saturation des résultats a été atteinte. Une analyse de contenu a permis de dégager les récurrences et les exceptions dans le discours. Résultats: Les principales motivations des sages-femmes libérales à proposer des téléconsultations étaient de maintenir l'accès aux soins pour les femmes et préserver leur propre activité professionnelle. Elles pointaient un certain nombre de limites, parmi lesquelles la question du secret professionnel et de la garantie de la confidentialité, ou encore l'inégalité d'accès aux soins en lien avec la fracture numérique. L'intégration de la téléconsultation dans leur pratique a permis de mettre en lumière et valoriser le travail d'accompagnement réalisé par les sages-femmes jusqu'à présent peu visible et reconnu. Conclusion: Les sages-femmes se sont rapidement approprié les téléconsultations qui ont, depuis le confinement, été pérennisées. Cet outil permet une aide à la continuité des soins, mais pose également de nouvelles questions d'égalité d'accès aux soins.
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COVID-19 , Tocologia , Consulta Remota , Gravidez , Humanos , Feminino , Pandemias , Inquéritos e Questionários , Pesquisa QualitativaRESUMO
INTRODUCTION: The COVID-19 epidemic represented a major challenge for the primary care sector. We present the results of an interprofessional collaborative research endeavor conducted by the ACCORD network to describe primary care actors' and organizations' response to the first wave of the epidemic and national lockdown in France. METHODS: This work draws from quantitative and qualitative material. The quantitative data results from the cross-analysis of the six online surveys carried out by the ACCORD network between March and May 2020, among general practitioners, midwives, and multi-professional primary care organizations in France. This data was enriched by collective multi-professional and multi-disciplinary exchanges conducted in virtual focus groups during an online seminar. RESULTS: There was a significant decrease in primary care activity during the first wave of the epidemic. Many primary care actors adapted their organizations to lower the risk of coronavirus transmission while maintaining access and continuity of care. Professionals received and used information from multiple sources. The crisis revealed both the importance and the diversity of local networks of exchange and collaboration. CONCLUSIONS: Primary care actors adapted quickly and with important local variability to the COVID epidemic, highlighting the importance of pre-existing organizations and collaborations at the local level.
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COVID-19 , Clínicos Gerais , COVID-19/epidemiologia , Controle de Doenças Transmissíveis , França/epidemiologia , Humanos , Atenção Primária à SaúdeRESUMO
Introduction: Electronic cigarette use is significantly higher among 15-24-year-olds than in other age-groups. Electronic cigarettes, which may contain nicotine, could be a gateway to smoking initiation among young people. In this article, we reviewed the literature on smoking initiation or smoking enhancement by the use of e-cigarettes. Methods: We carried out a qualitative analysis in January 2016. We selected all longitudinal studies among adolescents or young adults using electronic cigarettes. Results: The analysis focused on 5 of the 544 articles identified, corresponding to five prospective observational studies. Four studies concluded that e-cigarette use was statistically associated with a high risk of smoking initiation. Young vapers were 8.3 (95% CI = 1.-58.6) to 12.7 (95% CI = 4.0-40.3) times more likely to initiate smoking at 1 year than non-vapers. Previous exposure to electronic cigarettes increased the risk of smoking conventional cigarettes by 14-year-old adolescents by 75% at 1 year follow-up. Conclusion: Trying e-cigarettes during adolescence or young adulthood may have contributed to starting and continuation of smoking. However, these results must be interpreted cautiously due to methodological weaknesses.
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Sistemas Eletrônicos de Liberação de Nicotina/efeitos adversos , Fumar/epidemiologia , Adolescente , Humanos , Medição de Risco , Adulto JovemAssuntos
COVID-19/epidemiologia , Saúde Mental , Pandemias , Cirurgiões/educação , Cirurgiões/psicologia , Ansiedade/etiologia , Depressão/etiologia , Feminino , França , Humanos , Masculino , Estudos Prospectivos , SARS-CoV-2 , Distúrbios do Início e da Manutenção do Sono/etiologia , Estresse Psicológico/etiologia , Carga de TrabalhoRESUMO
BACKGROUND: Most the Organization for Economic Co-operation and Development (OECD) countries are currently facing the challenges of the health transition, the aging of their populations and the increase in chronic diseases. Effective and comprehensive primary healthcare (PHC) services are considered essential for establishing an equitable, and cost-effective healthcare system. Developing care coordination and, on a broader scale, care integration, is a guarantee of quality healthcare delivery. The development of healthcare systems at the meso-level supports this ambition and results in a process of territorial structuring of PHC. In France, the Health Territorial and Professional Communities (HTPC) constitute meso-level organizations in which healthcare professionals (HCPs) from the same territory gather. We conducted a study to determine, in a qualitative step, the key elements of the territorial structuring of PHC in France and, then, to develop, in a quantitative step, a typology of this structuring. METHODS: A sequential-exploratory mixed-method study with a qualitative step using a multiple case approach and a quantitative step as a hierarchical clustering on principal components (HCPC) from a multiple correspondence analysis (MCA). RESULTS: A total of 7 territories were qualitatively explored. Territorial structuring appears to depend on: past collaborations at the micro-level, meso-level coordination among HCPs and multiprofessional structures, diversity of independent professionals, demographic dynamics attracting young professionals, and public health investment through local health contracts (LHCs). The typology identifies 4 clusters of mainland French territories based on their level of structuring: under or unstructured (38.6%), with potential for structuring (34.7%), in the way for structuring (25.3%) and already structured territories (1.4%). CONCLUSION: Interest in territorial structuring aligns with challenges in meso-level healthcare organization and the need for integrated care. Typologies of territorial structuring should be used to understand its impact on access, care quality, and medical resources.
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Atenção Primária à Saúde , França , Atenção Primária à Saúde/organização & administração , Humanos , Territorialidade , Atenção à Saúde/organização & administração , Pessoal de Saúde/organização & administração , Pessoal de Saúde/estatística & dados numéricosRESUMO
OBJECTIVES: The prevention school diary is distributed each year to children aged between 10 and 11 years old by La Ligue contre le cancer, a French association promoting prevention and research against cancer. While they write their homework in the diary, children can learn about a range of health determinants. This diary promotes health in a fun and educational way, as it integrates drawings made by children about the different themes covered by the diary. This paper aims to present the evaluability assessment of this intervention in Ile-de-France (Paris area), where it is already widely deployed. MATERIAL AND METHODS: We have traced the history of the prevention school diary and assessed how it is currently used in Ile-de-France by leading interviews with county committees of La Ligue contre le cancer. Successive versions of the diary and results of teacher satisfaction surveys were examined. All information collected was integrated into a logic model, which characterizes the main components, actors, and effects of the intervention. RESULTS: The prevention school diary was created in the West of France in the late 90s. It was then implemented in Paris and extended to other counties of Ile-de-France. Currently, six counties collaborate on the production of a common diary. Whereas it only dealt with tobacco consumption at the beginning, the prevention school diary now covers nutrition, physical activity, sun exposure, sleep and screen use, addiction, as well as safety in some counties. Three levels of intervention have been identified, depending on whether or not the distribution of the diary is followed by the production of drawings for the next edition or health education sessions. The expected effects of the prevention school diary have been integrated into a logic model emphasizing children, school, and family level. Outcomes include Capabilities (knowledge and skills), Opportunities, and Motivation to adopt healthy Behaviours, according to the theoretical model of behaviour change COM-B. CONCLUSION: The evaluability assessment phase enabled us to gain a better understanding of the conditions under which the intervention is deployed, and thus to identify the factors to be considered for a broad assessment of its effectiveness. It is especially important since the intervention is already well established in Ile-de-France.
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Promoção da Saúde , Humanos , Criança , Promoção da Saúde/métodos , Masculino , Feminino , Instituições Acadêmicas , Neoplasias/prevenção & controle , França , Serviços de Saúde Escolar , Avaliação de Programas e Projetos de Saúde , Paris , Diários como AssuntoRESUMO
OBJECTIVE: To determine the impact of the SARS-CoV-2 (COVID-19) pandemic and lockdowns on the mental health status, training, perceptions of the physiotherapy profession, and career plans of French physiotherapy students. DESIGN: A descriptive cross-sectional study was conducted, representing the first and only survey of its kind, using a national online survey. SUBJECTS: A total of 2678 French physiotherapy students participated in the study. METHODS: Mental health status was assessed using the validated French versions of established depression, anxiety, and insomnia scales. RESULTS: The survey revealed that female sex, age below 21 years, living alone, and having a psychiatric history or COVID-19 risk factors were associated with more severe symptoms of depression, anxiety, and insomnia in the surveyed students. In addition, stress, anxiety, and depression induced by the COVID-19 crisis were linked to apprehension about continuing practical training in physiotherapy. These factors also affected students' perceptions of the profession and the initially envisioned mode of practice, particularly among fifth-year students (odds ratio (OR) = 2.25, 95% confidence interval (95% CI) = (1.69, 2.99), p < 0.001). Notably, the pandemic significantly reduced the desire of these students to pursue a career as physiotherapists (adjusted OR (aOR) 1.41 (1.06, 1.86)). CONCLUSION: French physiotherapy students, especially those in their fifth year, have experienced significant impacts from the COVID-19 pandemic, affecting their mental health, education, perceptions of the physiotherapy profession, and career plans.
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COVID-19 , Distúrbios do Início e da Manutenção do Sono , Feminino , Humanos , Adulto Jovem , Adulto , Estudos Transversais , Pandemias , Saúde Mental , COVID-19/epidemiologia , SARS-CoV-2 , Controle de Doenças Transmissíveis , Estudantes , França/epidemiologia , Modalidades de FisioterapiaRESUMO
In France, towards the end of the first lockdown, COVID-19 management was largely transferred from hospitals to primary care. Primary care actors adapted their practices to ensure patients' access to care, while limiting contamination. In this study, we aimed to identify patterns of adaptations implemented by French general practitioners (GPs) in May 2020 for outpatients with confirmed or suspected COVID-19, and factors associated with these adaptions. A French survey concerning care organization adaptations, and individual, organizational, and territorial characteristics, was sent to GPs. Data were analyzed by multiple correspondence analysis followed by agglomerative hierarchical clustering to identify GPs' adaptation clusters. A multinomial logistic regression model estimated the associations between clusters and individual, organizational, and territorial factors. Finally, 3068 surveys were analyzed (5.8% of French GPs). Four GPs' adaptation clusters were identified: autonomous medical reorganization (64.2% of responders), interprofessional reorganization (15.9%), use of hospital (5.1%), and collaboration with COVID-19 outpatient centers (14.8%). Age, practice type and size, and territorial features were significantly associated with adaptation clusters. Our results suggest that healthcare systems should consider organizational features of primary care to effectively deal with future challenges, including healthcare crises, such as the COVID-19 pandemic, but also those linked to epidemiologic and societal changes.
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COVID-19 , Clínicos Gerais , Humanos , Pandemias , COVID-19/epidemiologia , Controle de Doenças Transmissíveis , Inquéritos e Questionários , Atitude do Pessoal de SaúdeRESUMO
INTRODUCTION: Forty years passed between the two most important definitions of primary health care from Alma Alta Conference in 1978 to WHO's definition in 2018. Since then, reforms of healthcare systems, changes in ambulatory sector and COVID 19, have created a need for reinterpretations and redefinition of primary healthcare. The primary objective of the study was to precise the definitions and the representations of primary healthcare by healthcare professionals. METHODS: We conducted a descriptive cross-sectional study using a web-based anonymized questionnaire including opened-ended and closed-ended questions but also "real-life" case-vignettes to assess participant's perception of primary healthcare, from September to December 2020. Five case-vignette, describing situations involving a specific primary health care professional in a particular place for a determined task were selected, before the study, by test/retest method. RESULTS: A total of 585 healthcare practitioners were included in the study, 29% were general practitioners and 32% were midwives. Amongst proposed healthcare professions, general practitioners (97.6%), nurses (85.3%), midwives (85.2%) and pharmacists (79.3%) were those most associated with primary healthcare. The functions most associated with primary healthcare, with over 90% of approval were "prevention, screening", "education to good health", "orientation in health system". Two case-vignettes strongly emerged as describing a situation of primary healthcare: Midwife/Hospital/Pregnancy (74%) and Pharmacist/Pharmacy/Flu shot (90%). The profession and the modality of practice of the responders lead to diverging answers regarding their primary healthcare representations. CONCLUSIONS: Primary healthcare is an ever-evolving part of the healthcare system, as is its definition. This study explored the perception of primary healthcare by French healthcare practitioners in two complementary ways: oriented way for the important functions and more practical way with the case-vignettes. Understanding their differences of representation, according to their profession and practice offered the authors a first step to a shared and operational version of the primary healthcare definition.
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COVID-19 , Clínicos Gerais , Feminino , Gravidez , Humanos , Estudos Transversais , Farmacêuticos , Atenção Primária à SaúdeRESUMO
INTRODUCTION: Smoking remains a leading cause of preventable death in France, even among the elderly. Although smoking prevalence has decreased overall, it still affects a significant portion of older adults. This study investigates the knowledge, attitudes, and practices of primary healthcare professionals regarding smoking and smoking cessation among the elderly in France. METHODS: A cross-sectional study involved 300 primary care professionals (general practitioners, pharmacists, nurses) in the Ile-de-France region. Data collection occurred via telephone interviews in September and October 2019. The study employed a questionnaire focusing on knowledge (10 questions), attitudes (12 statements), and clinical practices (7 questions) related to tobacco dependence in older adults. Responses were scored based on correctness for knowledge and appropriateness for attitudes and practices. RESULTS: The surveyed professionals were predominantly female (57.7%), with a mean age of 53.0 years, and most were non-smokers or former smokers (85.3%). While 66.7% believed older smokers had lower cessation rates, only 64.3% knew it was safe to prescribe nicotine replacement therapy for the elderly. Attitude scores averaged 8.8/12, with pharmacists scoring highest (9.9) and nurses lowest (8.2). Practices scores averaged 2.8/7, with physicians scoring highest (3.8) and pharmacists lowest (1.9). CONCLUSIONS: Primary healthcare professionals have a relatively good knowledge of the management of tobacco dependence in the elderly and consider it to be part of their mission. However, their confidence in their abilities needs to be strengthened, and many opportunities to counsel and assist this population to quit smoking are still being missed. Preventive approaches to older smokers are essential, in keeping with the concept that 'every contact with the healthcare system counts'. Improving practice will require education and training that will not only build knowledge but also change perceptions, leading to better attitudes and practices in the management of smoking cessation among older adults.
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OBJECTIVES: Our primary and secondary objectives were to measure and understand the determinants of independent midwives' implementation of teleconsultations and their intention to continue these in the future. DESIGN: A two-phase mixed-methods approach: (1) quantitative data to measure factors determining the initiation and continuation of teleconsultation, collected by an online survey from 29 April to 15 May 2020, at the end of the first COVID-19 lockdown, followed by (2) qualitative data to understand these determinants, by interviewing some participants in May-July 2020 to explore the quantitative findings in more detail. SETTING: Mainland France PARTICIPANTS: The target population comprised independent midwives currently practising in France. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary and secondary outcomes were binary variables: implementation of teleconsultations, and intention to continue them. The qualitative results provided the themes explaining these decisions. RESULTS: We obtained 1491 complete responses from independent midwives, that is, 28.3% of French independent midwives, and interviewed 22 volunteers among them. Among the 1491, 88.5% implemented teleconsultations and 65.8% intended to continue them. Both individual and organisational factors favoured implementation of teleconsultations: older age (adjusted OR (aOR): 0.40, 95% CI: 0.28 to 0.58), female gender (aOR: 6.88, 95% CI: 2.71 to 17.48), married or living with a partner (aOR: 1.67, 95% CI: 1.10 to 2.52) and working in a group practice (midwives only-aOR: 2.34, 95% CI: 1.47 to 3.72; multiprofessional group-aOR: 1.75, 95% CI: 1.16 to 2.64). The qualitative analysis did not identify any new factors but helped us to understand the satisfaction better: midwives adopted telemedicine for their patients' access to and continuity of care, to maintain their professional activity and income, and to limit the risks of infection. CONCLUSION: Personal and organisational factors motivated the implementation of teleconsultation during the pandemic, but maintaining it raises technical, regulatory, and ethical issues.
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COVID-19 , Tocologia , Consulta Remota , COVID-19/epidemiologia , COVID-19/prevenção & controle , Controle de Doenças Transmissíveis , Feminino , Humanos , Tocologia/métodos , Gravidez , Inquéritos e QuestionáriosRESUMO
BACKGROUND: In France, the first COVID-19-related lockdown (17th March to 10th May 2020) resulted in a major decrease in healthcare service utilization. This raised concerns about the continuity of care for vulnerable patients. OBJECTIVES: To identify individual and organizational factors associated with the initiatives taken by French GPs to contact vulnerable patients during the lockdown. METHODS: A national observational survey using an online questionnaire was conducted to document French GPs' adaptations to the COVID-19 situation, their individual and organizational characteristics, including practice type (individual, group, multidisciplinary) and size. Data were collected from 7th to 20th May 2020 using mailing lists of GPs from the study partners and GPs who participated in a previous survey. This paper analysed answers to the question exploring whether and how GPs took initiatives to contact vulnerable patients. Responses were categorized in: no initiative; selection of patients to contact with a criteria-based strategy; initiative of contact without criteria-based strategy. Multivariate multinomial logistic regression identified factors associated with each category. Key components of the reported initiatives were described by inductive analysis of verbatim material. RESULTS: Among the 3012 participant GPs (~ 5.6% of French GPs), 1419 (47.1%) reported initiatives to contact some patients without criteria-based strategy, and 808 (26.8%) with a strategy using various clinical/psychological/social criteria. Women GPs more often declared initiatives of contacts with a criteria-based strategy (OR = 1.41, 95% CI [1.14-1.75]) as well as GPs with more than two patients who died due to COVID-19 in comparison with those having none (OR = 1.84, 95% CI [1.43-2.36]). Teaching GPs more often used criteria-based strategies than the other GPs (OR = 1.94, 95% CI [1.51-2.48]). Compared with those working in small monodisciplinary practice, GPs working alone were less likely to implement criteria-based initiatives of contacts (OR = 0.70, 95% CI [0.51-0.97]), while GPs working in multidisciplinary practice were more likely (OR = 1.94, 95% CI [1.26-2.98] in practices > 20 professionals). CONCLUSION: French GPs took various initiatives to keep in touch with vulnerable patients, more frequently when working in group practices. These findings confirm the importance of primary care organization to ensure continuity of care for vulnerable people.
Assuntos
COVID-19 , Clínicos Gerais , COVID-19/epidemiologia , Controle de Doenças Transmissíveis , Feminino , França/epidemiologia , Humanos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Studies comparing how the European nursing homes (NHs) handled the first wave of the COVID-19 pandemic remain scarce. METHODS: A cross-sectional study was conducted during the first wave in a private NHs network in Belgium, France, Germany and Italy. Mortality rates were estimated, and prevention and control measures were described by country. Data from the Oxford governmental response tracker project were used to elaborate a "modified stringency index" measuring the magnitude of the COVID-19 global response. RESULTS: Of the 580 NHs surveyed, 383 responded to the online questionnaire. The COVID-19 mortality rate was similar in France (3.9 deaths per 100 residents) and Belgium (4.5). It was almost four times higher in Italy (11.9) and particularly low in Germany (0.3). Prevention and control measures were diversely implemented: residents' sectorization was mainly carried out in France and Italy (~90% versus ~30% in Germany and Belgium). The "modified stringency index" followed roughly the same pattern in each country. CONCLUSION: This study, conducted in a European network of NHs, showed differences in mortality rate which could be explained by the characteristics of the residents, the magnitude of the first wave and the prevention and control measures implemented. These results may inform future European preparedness plans.
Assuntos
COVID-19 , Humanos , Estudos Transversais , COVID-19/epidemiologia , Pandemias , Casas de Saúde , Europa (Continente)/epidemiologiaRESUMO
The COVID-19 pandemic is a unique crisis challenging healthcare institutions as it rapidly overwhelmed hospitals due to a large influx of patients. This major event forced all the components of the healthcare systems to adapt and invent new workflows. Thus, our tertiary care hospital was reorganized entirely. During the cruising phase, additional staff was allocated to a one-building organization comprising an intensive care unit (ICU), an acute care unit, a physical medicine and rehabilitation unit, and a COVID-19 screening area. The transfer of patients from a ward to another was more efficient due to these organizations and pavilion structure. The observed mortality was low in the acute care ward, except in the palliative unit. No nosocomial infection with SARS-CoV-2 was reported in any other building of the hospital since this organization was set up. This type of one-building organization, integrating all the components for comprehensive patient care, seems to be the most appropriate response to pandemics.
Assuntos
COVID-19 , Pandemias , COVID-19/epidemiologia , Hospitais , Humanos , Unidades de Terapia Intensiva , Pandemias/prevenção & controle , SARS-CoV-2RESUMO
Adolescents turning into smokers in france .Tobacco kills more than 75,000 people in France each year. Among them, a large majority started their smoking history as an adolescent. More than half of 17-years-old have already tried tobacco and 25.1% of them report daily smoking. This is the lowest prevalence of daily smoking observed in France for 20 years. The daily consumption of 16-years-old decreased from 31% in 1995 to 12% in 2019, placing France in the European average. The initiation of regular tobacco consumption results from complex combinations of social (family, peers), environmental (passive exposure, accessibility, and marketing of products) and individual elements. Passive smoking in the family sphere and the influence of peers, which is most prevalent in adolescence, are two decisive determinants of future adolescent use of cigarette. The study of the entrance into smoking in adolescence should help to adapt preventive strategies to achieve a "tobacco-free generation".
"Entrée des adolescents dans le tabagisme en france. Le tabac tue en France chaque année plus de 75 000 personnes. Parmi elles, une très large majorité a commencé son histoire tabagique dès l'adolescence. Plus de la moitié des jeunes de 17 ans ont déjà essayé le tabac et 25,1 % d'entre eux déclarent fumer quotidiennement. Il s'agit de la prévalence de tabagisme quotidien la plus faible observée en France depuis 20 ans. La consommation quotidienne des jeunes de 16 ans est, quant à elle, passée de 31 % en 1995 à 12 % en 2019, plaçant la France dans la moyenne européenne. Le démarrage d'une consommation régulière de tabac résulte de combinaisons complexes entre des éléments sociaux (famille, pairs), environnementaux (exposition passive, accessibilité et marketing des produits) et individuels. Le tabagisme passif dans la sphère familiale et l'influence des pairs, majeure à l'adolescence, sont deux déterminants décisifs de la consommation future de l'adolescent. L'étude des modalités d'entrée dans le tabagisme à l'adolescence doit aider à adapter les stratégies préventives pour parvenir à une « génération sans tabac ¼."