Care-seeking strategies of migrants during the transition from a specific primary healthcare facility for uncovered individuals to common ambulatory general practice: A French qualitative study.

BACKGROUND: Migrants have complex health needs but face multiple barriers to accessing health care. In France, permanent healthcare access offices (PASSs), as specific primary health care facilities (SPHCs), provide care to people without health insurance coverage. Once these patients obtain health insurance, they are referred to common ambulatory general practice. The aim of this study was to explore migrants' experiences and strategies for seeking common primary care after having been treated by an SPHC. METHODS: We conducted a qualitative study based on grounded theory between January and April 2022. We held semi-structured interviews with migrants who had consulted a PASS. Two researchers performed an inductive analysis. RESULTS: We interviewed 12 migrants aged 22 to 65 to confirm data saturation. The interviewees relied on "referents": professional referents (to be properly treated for specific health problems), guides (to find their way through the healthcare system), or practical referents (to address practical issues such as translation, travel needs, or medical matters). Those who considered the PASS to be a referent expressed disappointment and incomprehension at the time of discharge. Referral procedures and the first encounter with common ambulatory general practice were decisive in whether the interviewees accessed and stayed in a coordinated primary care pathway. The perceived quality of care depended on a feeling of being considered and listened to. For interviewees who received first-time services from an ambulatory general practice, the way in which they were referred to and their first experience with an ambulatory GP could influence their adherence to care. CONCLUSIONS: The conditions of transition from SPHCs to common ambulatory general practice can impact migrants' adherence to a coordinated primary care pathway. Referral can improve these patients' care pathways and ease the transition from a PASS to ambulatory care. Healthcare professionals at SPHCs should pay special attention to vulnerable migrants without previous experience in ambulatory general practice and who depend on referents in their care pathways. For these patients, adapted referral protocols with further individual support and empowerment should be considered.

On the association between SARS-COV-2 variants and COVID-19 mortality during the second wave of the pandemic in Europe

BACKGROUNDPreliminary clinical evidence suggests an increased COVID-19 mortality associated with the variant of concern 20I/501Y.V1. The evidence outside the UK and a real-world comparison of variants spread and mortality is sparse. This study aims at investigating the association between COVID-19 mortality and SARS-COV-2 variants spread during the second wave of the COVID-19 pandemic in Europe. METHODSFor 38 European countries, publicly available data were collected on numbers of COVID-19 deaths, SARS-COV-2 variants spread through time using Nextstrain classification and countries demographic and health characteristics. The cumulative number of COVID-19 deaths and the height of COVID-19 daily deaths peak during the second wave of the pandemic were considered as outcomes. Pearson correlations and multivariate generalized linear models with selection algorithms were used. FINDINGSThe average proportion of 20I/501Y.V1 variant (B.1.1.7) was found to be a significant predictor of cumulative number of COVID-19 deaths within two months before the deaths peak and between 1 January - 25 February 2021, as well as of the deaths peak height when calculating the proportion during the second wave and the pre-peak period. The average proportion of 20A.EU2 variant (S:477N) was a significant predictor of cumulative COVID-19 deaths in the pre-peak period. INTERPRETATIONOur findings suggest that the spread of a new variant of concern 20I/501Y.V1 had a significant impact on the mortality during the second wave of COVID-19 pandemic in Europe and that proportions of 20A.EU2 and 20I/501Y.V1 variants were associated with increased mortality in the initial phase of that wave. Research in contextO_ST_ABSEvidence before this studyC_ST_ABSEmerging evidence suggests that the new variant of concern 20I/501Y.V1 (B.1.1.7) may be associated with an increased risk of death. The 20A.EU2 variant (S:447N), observed firstly in July 2020 in western Europe, was found to be capable of increasing SARS-COV-2 infectivity. The evidence outside the UK is still sparse, same as a real-world comparison of distinct variants spread and mortality through time. Added value of this studyIn this study we investigated whether the change of the proportion of any SARS-COV-2 variant, including 20I/501Y.V1 and 11 other variants identified by Nextstrain up to 25 February 2021, has an association with COVID-19 cumulative mortality or with the height of the second wave COVID-19 mortality peak. Implications of all the available evidenceOur findings shed light on the causes of the increased COVID-19 mortality during the second wave of the pandemic in Europe. It shows the need for early containment strategies when the variant 20I/501Y.V1 emerges. These findings also support the need for systematic SARS-CoV-2 regular genome sequencing to control the COVID-19 pandemic.

Actor-partner interdependence analysis in depressed patient-caregiver dyads: Influence of emotional intelligence and coping strategies on anxiety and depression.

OBJECTIVE: Major depressive disorder (MDD) is a leading cause of suffering for both patients and their natural caregivers. A preliminary study highlights the association of emotional intelligence (EI) and coping strategies with quality of life. However, there is a lack of studies concerning dyadic (i.e., patient and natural caregiver) characteristics' impact on anxious and depressive symptoms. In a sample of MDD patients-caregivers dyads, we explored the influence of EI and coping strategies on anxious and depressive symptoms using the actor-partner interdependence model (APIM). METHODS: The cross-sectional study included 79 MDD patient-caregiver dyads. Self-reported data, completed by patients and their primary caregivers, were collected including socio-demographic, EI using TEIQue-SF, coping strategies using BriefCope, depressive symptoms using Beck Depression Inventory, anxious symptoms using STAI. The APIM was used to test the dyadic effects of EI and coping strategies on anxious and depressive symptoms, using structural equation modelling. RESULTS: Patients and caregivers reported both anxious and depressive symptoms. Coping strategies, such as problem solving, positive thinking and avoidance, exhibited evidence of actor (degree to which the individual's coping strategies are associated with their own anxiety or depression level) and partner effect (degree to which the individual's coping strategies are associated with the anxiety or depression level of the other member of the dyad). The caregivers' EI was associated with a decrease of their own depression level contrary to patients for which the results were not significant. The patients' and caregivers' EI was associated with a decrease of their own level of anxiety. CONCLUSION: EI and coping strategies were moderately associated with anxious and depressive symptomatology among MDD patient-caregiver dyads. These results suggest that targeted interventions could be proposed to both patients and caregivers.

Neural substrate of quality of life in patients with schizophrenia: a magnetisation transfer imaging study.

The aim of this study was to investigate the neural substrate underlying quality of life (QoL) and to demonstrate the microstructural abnormalities associated with impaired QoL in a large sample of patients with schizophrenia, using magnetisation transfer imaging. A total of 81 right-handed men with a diagnosis of schizophrenia and 25 age- and sex-similar healthy controls were included and underwent a 3T MRI with magnetization transfer ratio (MTR) to detect microstructural abnormalities. Compared with healthy controls, patients with schizophrenia had grey matter (GM) decreased MTR values in the temporal lobe (BA21, BA37 and BA38), the bilateral insula, the occipital lobe (BA17, BA18 and BA19) and the cerebellum. Patients with impaired QoL had lower GM MTR values relative to patients with preserved QoL in the bilateral temporal pole (BA38), the bilateral insula, the secondary visual cortex (BA18), the vermis and the cerebellum. Significant correlations between MTR values and QoL scores (p < 0.005) were observed in the GM of patients in the right temporal pole (BA38), the bilateral insula, the vermis and the right cerebellum. Our study shows that QoL impairment in patients with schizophrenia is related to the microstructural changes in an extensive network, suggesting that QoL is a bio-psychosocial marker.