L'impact de la COVID-19 sur la santé des enfants, groupe « protégé ¼ de l'infection.

OBJECTIVE: This article underlines that a viral epidemic and strategies to deal with it 1) have a major impact on groups that are a priori spared by the disease itself, in this case children, and 2) can generate health problems beyond the disease and lead to major social, economic and educational difficulties and an increase of social inequalities in health. METHOD: The observations presented are based on the scientific literature available in the first half of 2020 and on discussions with actors in the field, experts and heads of institutions, conducted by a working group of the Haut Conseil de la Santé Publique reflecting on a global and concerted policy for children's health. RESULTS: The health crisis and its management have had an impact on children's development and their quality of life. They have been more exposed to sedentary lifestyles, screens, accidents, and violence at home. The closure of schools and leisure facilities has led to difficulties in school, socialization, psychological well-being and mental health. Curative or preventive care has been postponed. These effects occurred with significant social and territorial inequalities. CONCLUSION: Any health crisis management requires an assessment of the overall impact of the epidemic and the proposed measures on health, economic, social, and educational indicators. This crisis shows the need for a coordinated children's policy, which is not currently the case in France.

Health in adulthood after severe anorexia nervosa in adolescence: a study of exposed and unexposed women.

OBJECTIVE: To compare the global health status, frequency of somatic and psychological problems, and alcohol use in adulthood among women hospitalized in adolescence for severe anorexia nervosa (AN), with a matched control sample from the general population. METHOD: Women (n = 86) who had been hospitalized for AN 9.31 ± 1.82 years previously were compared with 258 controls matched for gender, age, and socio-professional category. Data were retrieved from a French survey on health and social insurance coverage, and was mainly collected by self-report, except for the assessment of current eating disorders for those previously hospitalized for AN (assessed with the MINI). RESULTS: The women who had been hospitalized for AN reported significantly poorer current health status compared to controls (OR 2.9, 95% CI 1.5-5.79). According to the MINI, 13 women previously hospitalized with severe AN still presented an eating disorder (ED). Women with past AN reported more frequent acute throat infections (OR 4.9, 95% CI 1.81-13.51), gastralgia (OR 3.6, 95% CI 1.9-6.83), gastro-oesophageal reflux (OR 5.279, 95%CI 2.11-13.22), excess blood cholesterol or triglyceride levels (OR 2.55, 95% CI 1.03-6.33), anxiety (OR 8.7, 95% CI 3.48-21.8) and depression (OR 5.02 (2.8-9.01). These differences remained significant and of the same order of magnitude in sensitivity analyses among subjects with previous AN but without current ED, except for perceived health status and excess cholesterol and triglyceride levels. DISCUSSION: Women who had been hospitalized for severe AN reported more symptoms 10 years after treatment, implies psychological and somatic follow-up in the long term. LEVEL OF EVIDENCE: Level III, case-control analytic study.

La santé des enfants en France : un enjeu négligé ?

INTRODUCTION: As part of the National Health Strategy, the High Council for Public Health (HCSP) was tasked with leading a reflection on a “comprehensive and concerted child health policy”. Policy-making requires relevant knowledge and statistical benchmarks. It therefore seemed useful to examine the French statistical system and active research topics. This assessment is expected to provide a current portrait of the priorities and implicit health choices for the children. It also aims to reveal insufficiently explored aspects of children’s health. METHODS: The inventory of this system was carried out on the basis of several methods, hearings, work of two documentalists, and analysis of the published and grey literature. RESULTS: The emphasis is on pathologies, medical prevention and behaviors conceived primarily as individual. The idea that the health of tomorrow’s adults is built up behind this apparent good health and its inequalities does not appear, or only marginally. The elements on affective, cognitive or relational development are not sufficiently analyzed, for lack of data. The living conditions of children, especially poverty and violence in all its forms, are not sufficiently considered as health issues. Research is developing today with a hospital-centric vision, without a real strategy of research on children’s health. DISCUSSION: Given the dispersion of data, publishing a summary report on children’s health on a regular basis is essential, as enriching the system with data on the environment, poverty and psychomotor, psychosocial and cognitive development. There is an urgent need to develop research on children’s health and to define a research strategy that does not exist today.

The association between asthma control, health care costs, and quality of life in France and Spain.

BACKGROUND: Current asthma management guidelines are based on the level of asthma control. The impact of asthma control on health care resources and quality of life (QoL) is insufficiently studied. EUCOAST study was designed to describe costs and QoL in adult patients according to level of asthma control in France and Spain. METHODS: An observational cost of illness study was conducted simultaneously in both countries among patients age greater or equal to 18 with a diagnosis of asthma for at least 12 months. Patients were recruited prospectively by GPs in 2010 in four waves to avoid a seasonal bias. Health care resources utilization of the three months before the inclusion was collected through physician questionnaires. Asthma control was evaluated using 2009 GINA criteria over a 3-month period. QoL was assessed using EQ-5D-3L®. RESULTS: 2,671 patients (France: 1,154; Spain: 1,517) were enrolled. Asthma was controlled in 40.6% [95% CI: 37.7%-43.4%] and 29.9% [95% CI: 27.6%-32.3%] of French and Spanish patients respectively.For all types of costs, the percentage of patients using health care resources varied significantly according to the level of asthma control. The average cost (euros/3-months/patient) of controlled asthma was €85.4 (SD: 153.5) in France compared with €314.0 (SD: 2,160.4) for partially controlled asthma and €537.9 (SD: 2,355.7) for uncontrolled asthma (p<0.0001). In Spain, the corresponding figures were €152.6 (SD: 162.1), €241.2 (SD: 266.8), and €556.8 (SD: 762.4). EQ-5D-3L® score was higher (p<0.0001) in patients with controlled asthma compared to partially controlled and uncontrolled asthma in both countries (respectively 0.88; 0.78; 0.63 in France and 0.89; 0.82; 0.69 in Spain). CONCLUSIONS: In both countries, patients presenting with uncontrolled asthma had a significantly higher asthma costs and lower scores of Qol compared to the others.

[Economic aspects of severe asthma]. / Enjeux économiques de l'asthme sévère.

Severe asthma and difficult-to-treat asthma are major issues in public health, given the mortality and morbidity they induce and their detrimental effects on patients' quality of life. The economic consequences should not be overlooked either. Published studies suggest that asthma-related medical resource use increases with the degree of asthma severity. Medical resource use incurred by severe (and/or difficult-to-treat) asthma could be reduced in part by more appropriate treatment, better patient education, improved coordination of disease management and treatment of comorbid diagnoses. The specific difficulties in the management of severe asthma and/or difficult-to-treat asthma must nonetheless be kept in mind. Recent new treatments appear promising, but their costs and indications in actual medical practice require better definition.

Long-Term Effect of Outdoor Air Pollution on Mortality and Morbidity: A 12-Year Follow-Up Study for Metropolitan France.

BACKGROUND: Short-term effects of air pollution are documented more than long-term effects. OBJECTIVE: We investigated 12-year impacts of ambient air pollutants on cardiovascular and respiratory morbidity and mortality at the departmental level in metropolitan France. METHODS: Daily air pollution data at 2-km resolution, including concentrations of particulate matter of 10 µm or 2.5 µm in diameter or less (PM10 and PM2.5), nitrogen dioxide (NO2), and ozone (O3), were accrued from the CHIMERE database for 1999 and 2000. Simultaneously, morbidity (hospitalizations) and mortality data were collected in 2012 using the ESPS (Enquête Santé et Protection Sociale/Health, Health Care and Insurance Survey) survey data and the CepiDc (Centre d'Épidémiologie sur les Causes Médicales de Décès/French Epidemiology Centre on Medical Causes of Death) database. Based on Poisson regression analyses, the long-term effect was estimated. A higher risk of all-cause mortality was observed using CépiDc database, with a relative risk of 1.024 (95% CI: 1.022, 1.026) and 1.029 (95% CI: 1.027, 1.031) for a 10 µg/m³ increase in PM2.5 and PM10, respectively. Mortality due to cardiovascular and respiratory diseases likewise exhibited long-term associations with both PM2.5 and PM10. Using ESPS survey data, a significant risk was observed for both PM2.5 and PM10 in all-cause mortality and all-cause morbidity. Although a risk for higher all-cause mortality and morbidity was also present for NO2, the cause-specific relative risk due to NO2 was found to be lesser, as compared to PM. Nevertheless, cardiovascular and respiratory morbidity were related to NO2, along with PM2.5 and PM10. However, the health effect of O3 was seen to be substantially lower in comparison to the other pollutants. CONCLUSION: Our study confirmed that PM has a long-term impact on mortality and morbidity. Exposure to NO2 and O3 could also lead to increased health risks.

Economic evaluation in patient safety: a literature review of methods.

Patient safety practices, targeting organisational changes for improving patient safety, are implemented worldwide but their costs are rarely evaluated. This paper provides a review of the methods used in economic evaluation of such practices. International medical and economics databases were searched for peer-reviewed publications on economic evaluations of patient safety between 2000 and 2010 in English and French. This was complemented by a manual search of the reference lists of relevant papers. Grey literature was excluded. Studies were described using a standardised template and assessed independently by two researchers according to six quality criteria. 33 articles were reviewed that were representative of different patient safety domains, data types and evaluation methods. 18 estimated the economic burden of adverse events, 3 measured the costs of patient safety practices and 12 provided complete economic evaluations. Healthcare-associated infections were the most common subject of evaluation, followed by medication-related errors and all types of adverse events. Of these, 10 were selected that had adequately fulfilled one or several key quality criteria for illustration. This review shows that full cost-benefit/utility evaluations are rarely completed as they are resource intensive and often require unavailable data; some overcome these difficulties by performing stochastic modelling and by using secondary sources. Low methodological transparency can be a problem for building evidence from available economic evaluations. Investing in the economic design and reporting of studies with more emphasis on defining study perspectives, data collection and methodological choices could be helpful for strengthening our knowledge base on practices for improving patient safety.