Expert consultation using the on-line Delphi method for the revision of syndromic groups compiled from emergency data (SOS Médecins and OSCOUR®) in France.

BACKGROUND: Consultation data from emergency general practitioners known as SOS Médecins and emergency departments (ED) from OSCOUR® network to the French syndromic surveillance system SurSaUD® (Surveillance sanitaire des urgences et décès). These data are aggregated and monitored on a daily basis through groupings of one or more medical symptoms or diagnoses ("syndromic groups" (SG)). The objective of this study was to evaluate, revise and enrich the composition of SGs through a consensus of experts who contributed or have experience in syndromic surveillance. METHODS: Three rounds of a Delphi survey were organised, involving 15 volunteers from SOS Médecins and 64 ED physicians in the OSCOUR® network as well as 8 international epidemiologists. Thirty-four SOS Médecins and 40 OSCOUR® SGs covering major medical specialities were put to the experts, along with their diagnostic codes and their surveillance objectives. In each round, the experts could retain or reject the codes according to the surveillance objective. The panel could also put forward new diagnostic codes in the 1st round, included in subsequent rounds. Consensus was reached for a code if 80% of participants had chosen to keep it, or less than 20% to reject it. RESULTS: A total of 12 SOS Médecins doctors (80%), 30 ED doctors (47%) and 4 international experts (50%) participated in the three rounds. All of the SGs presented to the panel included 102 initial diagnostic codes and 73 additional codes for SOS Médecins, 272 initial diagnostic codes and 204 additional codes for OSCOUR®. At the end of the 3 rounds, 14 SOS Médecins (40%) and 11 OSCOUR® (28%) SGs achieved a consensus to maintain all of their diagnostic codes. Among these, indicators of winter seasonal surveillance (bronchiolitis and gastroenteritis) were included. CONCLUSION: This study involved a panel of national experts with international representation and a good level of involvement throughout the survey. In the absence of a standard definition, the Delphi method has been shown to be useful in defining and validating syndromic surveillance indicators.

Network analysis of knowledge and practices regarding sexual and reproductive health: a study among adolescent street girls in Kinshasa (DRC).

OBJECTIVES: The aim of the study was to ascertain the influence of knowledge and interventions in sexual and reproductive health and contraception practices among adolescent street girls from Kinshasa, Democratic Republic of the Congo. METHODS: A cross-sectional study was carried out among street girls between 12 and 21 years of age. A standardised questionnaire was used, encompassing socio-demographic data and knowledge and practices regarding sexual and reproductive health. A network analysis was carried out. RESULTS: The study comprised 293 street girls. The mean age was 17.1 years (range 12-21 years) and the mean time spent living on the streets was 3.9 years (range 0-15 years). Commercial sex was reported by 78.5% (95% confidence interval [CI] 73.3%, 83.2%) as the main source of their income. During their last sexual intercourse, 44.0% (95%CI 38.1%, 50.4%) had not used a condom; 29.3% (95%CI 23.3%, 35.9%) had used hormonal contraception. Previous pregnancy was reported by 62.5% (95%CI 56.7%, 68.3%) and current pregnancy by 12.3% (95%CI 8.8%, 17.2%); 24.5% of previous pregnancies ended in voluntary termination, with a higher rate among the youngest street girls (12-15 years, 50.0%; p = 0.01). Time spent living on the streets was independently associated with pregnancy (odds ratio 1.2; 95%CI 1.1, 1.4). Practices and outcomes (previous or current pregnancy) were poorly correlated with knowledge about sexual and reproductive health. The network analysis confirmed the poor influence of exposure to intervention activities on sexual and reproductive health practices and outcomes, but did confirm a centrality effect of knowledge about HIV/AIDS. CONCLUSION: Street girls in Kinshasa are extremely vulnerable with regard to their sexual and reproductive health, especially the youngest street girls. Behavioural and biomedical interventions have had limited influence. Structural and societal changes are necessary to positively impact street girls' sexual and reproductive health. Knowledge about HIV/AIDS than about risk of pregnancy had a greater influence on sexual and reproductive health practices.

Syndromic surveillance: A key component of population health monitoring during the first wave of the COVID-19 outbreak in France, February-June 2020.

BACKGROUND: The French syndromic surveillance (SyS) system, SurSaUD®, was one of the systems used to monitor the COVID-19 outbreak. AIM: This study described the epidemiological characteristics of COVID-19-related visits to both emergency departments (EDs) and the network of emergency general practitioners known as SOS Médecins (SOSMed) in France from 17 February to 28 June 2020. METHODS: Data on all visits to 634 EDs and 60 SOSMed associations were collected daily. COVID-19-related visits were identified using ICD-10 codes after coding recommendations were sent to all ED and SOSMed doctors. The time course of COVID-19-related visits was described by age group and region. During the lockdown period, the characteristics of ED and SOSMed visits and hospitalisations after visits were described by age group and gender. The most frequent diagnoses associated with COVID-19-related visits were analysed. RESULTS: COVID-19 SyS was implemented on 29 February and 4 March for EDs and SOSMed, respectively. A total of 170,113 ED and 59,087 SOSMed visits relating to COVID-19 were recorded, representing 4.0% and 5.6% of the overall coded activity with a peak in late March representing 22.5% and 25% of all ED and SOSMed visits, respectively. COVID-19-related visits were most frequently reported for women and those aged 15-64 years, although patients who were subsequently hospitalised were more often men and persons aged 65 years and older. CONCLUSION: SyS allowed for population health monitoring of the COVID-19 epidemic in France. As SyS has more than 15 years of historical data with high quality and reliability, it was considered sufficiently robust to contribute to defining the post-lockdown strategy.

Emergency department admissions for myocardial infarction and stroke in France during the first wave of the COVID-19 pandemic: National temporal trends and regional disparities.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic and the national lockdown have led to significant changes in the use of emergency care by the French population. AIMS: To describe the national and regional temporal trends in emergency department (ED) admissions for myocardial infarction (MI) and stroke, before, during and after the first national lockdown. METHODS: The weekly numbers of ED admissions for MI and stroke were collected from the OSCOUR® network, which covers 93.3% of all ED admissions in France. National and regional incidence rate ratios from 02 February until 31 May (2020 versus 2017-2019) were estimated using Poisson regression for MI and stroke, before, during and after lockdown. RESULTS: A decrease in ED admissions was observed for MI (-20% for ST-segment elevation MI and-25% for non-ST-segment elevation MI) and stroke (-18% for ischaemic and-22% for haemorrhagic) during the lockdown. The decrease became significant earlier for stroke than for MI. No compensatory increase in ED admissions was observed at the end of the lockdown for these diseases. Important regional disparities in ED admissions were observed, without correlation with the regional levels of COVID-19 cases. The impact of lockdown on ED admissions was particularly significant in six regions (Ile-de France, Occitanie, Provence-Alpes-Côte d'Azur, Nouvelle Aquitaine, Hauts-de-France and Bretagne). CONCLUSIONS: The decrease in ED admissions for MI and stroke observed during the lockdown was probably caused by fear of COVID-19 and augmented by the lockdown, and was heterogeneous across the French territory. ED admissions were slow to return to the usual levels from previous years, without a compensatory increase. These results underline the need to reinforce messages directed at the population to encourage them to seek care without delay in case of cardiovascular symptoms.

Epidemiological study of opioid use disorder in French emergency departments, 2010-2018 from OSCOUR database.

OBJECTIVES: Opioid consumption in France has remained stable over the last 15 years, with much lower levels than in the USA. However, few data are available on patients who consume opioids and their use of the health system. Emergency department (ED) data has never been used as a source to investigate opioid use disorder (OUD) in France. DESIGN/SETTINGS/PARTICIPANTS: We used the OSCOUR national surveillance network, collecting daily ED data from 93% of French ED, to select and describe visits and hospitalisations after an OUD-related ED visit between 2010 and 2018 using International Classification of Diseases, version 10 (ICD10) codes. We described the population of interest and used binomial negative regressions to identify factors significantly associated with OUD such as gender, age, administrative region, year of admission and ICD10 codes. We also analysed the related diagnoses. PRIMARY OUTCOME MEASURE: Trend in ED visits for an OUD-related ED visit. RESULTS: We recorded 34 362 OUD-related visits out of 97 892 863 ED visits (36.1/100 000 visits). OUD-related visits decreased from 39.2/100 000 visits in 2010 to 32.9/100 000 visits in 2018, resulting in an average yearly decrease of 2.1% (95% CI 1.5% to 2.7%) after multivariate analysis. We recorded 15 966 OUD-related hospitalisations out of 20 359 574 hospitalisations after ED visits (78.4/100 000 hospitalisations) with an increase from 74.0/100 000 hospitalisations in 2010 to 81.4/100 000 hospitalisations in 2018. The analysis of related diagnoses demonstrated mostly polydrug abuse in this population. CONCLUSIONS: While the proportion of OUD visits decreased in the time frame, the hospitalisation proportion increased. The implementation of a nationwide surveillance system for OUD in France using ED visits would provide prompt detection of changes over time.

Early renal damage in patients with sickle cell disease in sub-Saharan Africa: a multinational, prospective, cross-sectional study.

BACKGROUND: Chronic kidney disease is one of the leading causes of mortality in patients with sickle cell disease. However, it has been almost exclusively studied in patients with the SS phenotype and in high-income countries, despite more than 80% of patients living in Africa. We looked for the determinants of glomerulopathy in a multinational cohort of patients with sickle cell disease of different phenotypes in sub-Saharan Africa. METHODS: In the CADRE cohort, we prospectively included patients 3 years and older with sickle cell disease of all haemoglobin phenotypes in Cameroon, Côte d'Ivoire, Mali, and Senegal. All individuals were assessed at steady state. The main outcome of interest was albuminuria defined as a urine albumin-to-creatinine ratio of greater than 30 mg/g. We investigated the clinical and biological determinants (including haemolysis markers) of albuminuria in two main phenotype groups (SS and Sß(0); SC and Sß(+)) with further stratification by age and country. FINDINGS: The study is ongoing because of follow-up. 2582 patients with sickle cell disease were included (1776 SS, 136 Sß(0), 511 SC, and 159 Sß(+)). 644 patients with the SS and Sß(0) phenotypes (33·7%, 95% CI 31·6-35·8) and 110 with the SC and Sß(+) phenotypes (16·4%, 13·6-19·2) had albuminuria. In the SS and Sß(0) group, albuminuria was detected in 144 (27%) of 527 children younger than 10 years and its frequency increased with age (29 [48%] of 60 patients aged >40 years). Multivariable analysis showed that albuminuria was associated with age (odds ratio 1·43, 95% CI 1·20-1·71; p<0·0001), female sex (1·35, 1·02-1·82; p=0·045), low haemoglobin (0·79, 0·66-0·93; p=0·006), high lactate dehydrogenase concentrations (1·33, 1·14-1·58; p=0·0009), and, using Côte d'Ivoire as the reference, Mali (2·49, 1·64-3·79; p=0·042) and Cameroon (1·59, 1·01-2·51; p=0·0007) in patients with the SS and Sß(0) phenotypes. The magnitude of the association of albuminuria with haemoglobin and lactate dehydrogenase concentrations increased with age. In the SC and Sß(+) patients, only low haemoglobin (0·69, 0·48-0·97; p=0·029), high blood pressure (1·63, 1·17-2·27; p=0·0017), and Mali (3·75, 1·75-8·04; p<0·0001) were associated with albuminuria. INTERPRETATION: Hyperhaemolysis is associated with albuminuria, with an age-dependent effect, in the SS and Sß(0) phenotypes only, suggesting a different pathological mechanism for glomerular disease in the patients with SC and Sß(+) phenotypes. However, both phenotypes are associated with a high prevalence of albuminuria in childhood. Therefore, screening for albuminuria is advised in African children with sickle cell disease to detect early renal damage. FUNDING: Paris Cité Sorbonne University (GrEX project) and Cardiology and Development.