Journal Article > ResearchFull Text
BMJ Open. 2022 September 20; Volume 12 (Issue 9); e060276.; DOI:10.1136/bmjopen-2021-060276
Dujmovic M, Roederer T, Frison S, Melki C, Lauvin T, et al.
BMJ Open. 2022 September 20; Volume 12 (Issue 9); e060276.; DOI:10.1136/bmjopen-2021-060276
INTRODUCTION
French nursing homes were deeply affected by the first wave of the COVID-19 pandemic, with 38% of all residents infected and 5% dying. Yet, little was done to prepare these facilities for the second pandemic wave, and subsequent outbreak response strategies largely duplicated what had been done in the spring of 2020, regardless of the unique needs of the care home environment.
METHODS
A cross-sectional, mixed-methods study using a retrospective, quantitative data from residents of 14 nursing homes between November 2020 and mid-January 2021. Four facilities were purposively selected as qualitative study sites for additional in-person, in-depth interviews in January and February 2021.
RESULTS
The average attack rate in the 14 participating nursing facilities was 39% among staff and 61% among residents. One-fifth (20) of infected residents ultimately died from COVID-19 and its complications. Failure to thrive syndrome (FTTS) was diagnosed in 23% of COVID-19-positive residents. Those at highest risk of death were men (HR=1.78; 95% CI: 1.18 to 2.70; p=0.006), with FTTS (HR=4.04; 95% CI: 1.93 to 8.48; p<0.001) or in facilities with delayed implementation of universal FFP2 masking policies (HR=1.05; 95% CI: 1.02 to 1.07; p<0.001). The lowest mortality was found in residents of facilities with a partial (HR=0.30; 95% CI: 0.18 to 0.51; p<0.001) or full-time physician on staff (HR=0.20; 95% CI: 0.08 to 0.53; p=0.001). Significant themes emerging from qualitative analysis centred on (1) the structural, chronic neglect of nursing homes, (2) the negative effects of the top-down, bureaucratic nature of COVID-19 crisis response, and (3) the counterproductive effects of lockdowns on both residents and staff.
CONCLUSION
Despite high resident mortality during the first pandemic wave, French nursing homes were ill-prepared for the second, with risk factors (especially staffing, lack of medical support, isolation/quarantine policy, etc) that affected case fatality and residents’ and caregivers’ overall well-being and mental health.
French nursing homes were deeply affected by the first wave of the COVID-19 pandemic, with 38% of all residents infected and 5% dying. Yet, little was done to prepare these facilities for the second pandemic wave, and subsequent outbreak response strategies largely duplicated what had been done in the spring of 2020, regardless of the unique needs of the care home environment.
METHODS
A cross-sectional, mixed-methods study using a retrospective, quantitative data from residents of 14 nursing homes between November 2020 and mid-January 2021. Four facilities were purposively selected as qualitative study sites for additional in-person, in-depth interviews in January and February 2021.
RESULTS
The average attack rate in the 14 participating nursing facilities was 39% among staff and 61% among residents. One-fifth (20) of infected residents ultimately died from COVID-19 and its complications. Failure to thrive syndrome (FTTS) was diagnosed in 23% of COVID-19-positive residents. Those at highest risk of death were men (HR=1.78; 95% CI: 1.18 to 2.70; p=0.006), with FTTS (HR=4.04; 95% CI: 1.93 to 8.48; p<0.001) or in facilities with delayed implementation of universal FFP2 masking policies (HR=1.05; 95% CI: 1.02 to 1.07; p<0.001). The lowest mortality was found in residents of facilities with a partial (HR=0.30; 95% CI: 0.18 to 0.51; p<0.001) or full-time physician on staff (HR=0.20; 95% CI: 0.08 to 0.53; p=0.001). Significant themes emerging from qualitative analysis centred on (1) the structural, chronic neglect of nursing homes, (2) the negative effects of the top-down, bureaucratic nature of COVID-19 crisis response, and (3) the counterproductive effects of lockdowns on both residents and staff.
CONCLUSION
Despite high resident mortality during the first pandemic wave, French nursing homes were ill-prepared for the second, with risk factors (especially staffing, lack of medical support, isolation/quarantine policy, etc) that affected case fatality and residents’ and caregivers’ overall well-being and mental health.
Journal Article > ResearchFull Text
Neonatology. 2018 May 25; Volume 114 (Issue 2); DOI:10.1159/000486705
Umphrey L, Breindahl M, Brown AL, Saugstad OD, Thio M, et al.
Neonatology. 2018 May 25; Volume 114 (Issue 2); DOI:10.1159/000486705
Neonatal resuscitation (NR) combines a set of life-saving interventions in order to stabilize compromised newborns at birth or when critically ill. Médecins Sans Frontières/Doctors Without Borders (MSF), as an international medical-humanitarian organization working particularly in low-resource settings (LRS), assisted over 250,000 births in obstetric and newborn care aid projects in 2016 and provides thousands of newborn resuscitations annually. The Helping Babies Breathe (HBB) program has been used as formal guidance for basic resuscitation since 2012. However, in some MSF projects with the capacity to provide more advanced NR interventions but a lack of adapted guidance, staff have felt prompted to create their own advanced algorithms, which runs counter to the organization's aim for standardized protocols in all aspects of its care.
Conference Material > Video
Mitha A
MSF Paediatric Days 2022. 2022 November 29; DOI:10.57740/qgmc-j654
English
Français
Journal Article > Meta-AnalysisAbstract
J Acquir Immune Defic Syndr. 2013 June 14; Volume 64 (Issue 1); DOI:10.1097/QAI.0b013e31829f05ac
Bonner K, Mezochow A, Roberts TR, Ford NP, Cohn J
J Acquir Immune Defic Syndr. 2013 June 14; Volume 64 (Issue 1); DOI:10.1097/QAI.0b013e31829f05ac
Journal Article > ResearchFull Text
Int Health. 2017 November 1; Volume 9 (Issue 6); 335-342.; DOI:10.1093/inthealth/ihx040
Bouhenia M, Farhat JB, Coldiron ME, Abdallah S, Visentin D, et al.
Int Health. 2017 November 1; Volume 9 (Issue 6); 335-342.; DOI:10.1093/inthealth/ihx040
BACKGROUND
In 2015, more than 1 million refugees arrived in Europe. During their travels, refugees often face harsh conditions, violence and torture in transit countries, but there is a lack of quantitative evidence on their experiences. We present the results of a retrospective survey among refugees in the 'Jungle' of Calais, France, to document their health problems and the violence they endured during their journeys.
METHODS
We conducted a cross-sectional population-based survey in November and December 2015. The sample size was set at 402 individuals, and geospatial simple random sampling was used. We collected data on demographics, routes travelled, health status, violence and future plans.
RESULTS
Departures from the country of origin increased beginning in September 2015. Sixty-one percent of respondents reported having at least one health problem, especially while in Calais. Overall, 65.6% (95% CI 60.3-70.6) experienced at least one violent event en route; 81.5% of refugees wanted to go to the UK.
CONCLUSIONS
This first quantitative survey conducted among refugees in Europe provides important socio-demographic data on refugees living in Calais and describes the high rate of violence they encountered during their journeys. Similar documentation should be repeated throughout Europe in order to better respond to the needs of this vulnerable population.
In 2015, more than 1 million refugees arrived in Europe. During their travels, refugees often face harsh conditions, violence and torture in transit countries, but there is a lack of quantitative evidence on their experiences. We present the results of a retrospective survey among refugees in the 'Jungle' of Calais, France, to document their health problems and the violence they endured during their journeys.
METHODS
We conducted a cross-sectional population-based survey in November and December 2015. The sample size was set at 402 individuals, and geospatial simple random sampling was used. We collected data on demographics, routes travelled, health status, violence and future plans.
RESULTS
Departures from the country of origin increased beginning in September 2015. Sixty-one percent of respondents reported having at least one health problem, especially while in Calais. Overall, 65.6% (95% CI 60.3-70.6) experienced at least one violent event en route; 81.5% of refugees wanted to go to the UK.
CONCLUSIONS
This first quantitative survey conducted among refugees in Europe provides important socio-demographic data on refugees living in Calais and describes the high rate of violence they encountered during their journeys. Similar documentation should be repeated throughout Europe in order to better respond to the needs of this vulnerable population.
Journal Article > Meta-AnalysisFull Text
PLOS Med. 2012 August 28; Volume 9 (Issue 8); DOI:10.1371/journal.pmed.1001300
Ahuja SD, Ashkin D, Avendano M, Banerjee R, Bayona J, et al.
PLOS Med. 2012 August 28; Volume 9 (Issue 8); DOI:10.1371/journal.pmed.1001300
Treatment of multidrug resistant tuberculosis (MDR-TB) is lengthy, toxic, expensive, and has generally poor outcomes. We undertook an individual patient data meta-analysis to assess the impact on outcomes of the type, number, and duration of drugs used to treat MDR-TB.
Conference Material > Abstract
Mitha A, Marchand L, Rozé JC, Kuhn P, Kaminski M, et al.
MSF Paediatric Days 2022. 2022 November 26; DOI:10.57740/0773-xv06
BACKGROUND AND AIMS
Long-term effects on neurodevelopment of Skin-to-Skin Contact (SSC) for very preterm infants are still debated. This study aims to evaluate the association of early SSC on neurodevelopmental outcomes at 5½ years among very preterm infants.
METHODS
Using the national population based EPIPAGE-2 cohort, exposure to SSC during the first week of life was evaluated by a propensity score analysis, based on individual and unit characteristics with inverse probability of treatment weighting approach. Outcomes were full-scale-intelligence-quotient (Wechsler Preschool and Primary Scale of Intelligence, 4th edition); behaviour (strengths and difficulties questionnaire); and social communication difficulties (social communication questionnaire) among 2561 infants born between 24 and 31 weeks, and surviving at 5½ years.
RESULTS
Among survivors, 1581 (61.8%) were exposed to SSC during the first week of life (range among neonatal units from 15 to 75%). At 5½ years, SSC was associated with an increased full-scale-intelligence-quotient +1.8 points (+0.0 to +3.6); and with trends for lower scores of behavioural difficulties -0.4 points (-1.1 to +0.4) and social communication difficulties -0.3 points (-0.8 to 0.2).
CONCLUSIONS
Early SSC during the first week of life among very preterm infants was associated with increased full-scale-intelligence-quotient at 5½ years. Variability of practices among units deserves attention. Further evaluation of the dose-effect is needed.
Long-term effects on neurodevelopment of Skin-to-Skin Contact (SSC) for very preterm infants are still debated. This study aims to evaluate the association of early SSC on neurodevelopmental outcomes at 5½ years among very preterm infants.
METHODS
Using the national population based EPIPAGE-2 cohort, exposure to SSC during the first week of life was evaluated by a propensity score analysis, based on individual and unit characteristics with inverse probability of treatment weighting approach. Outcomes were full-scale-intelligence-quotient (Wechsler Preschool and Primary Scale of Intelligence, 4th edition); behaviour (strengths and difficulties questionnaire); and social communication difficulties (social communication questionnaire) among 2561 infants born between 24 and 31 weeks, and surviving at 5½ years.
RESULTS
Among survivors, 1581 (61.8%) were exposed to SSC during the first week of life (range among neonatal units from 15 to 75%). At 5½ years, SSC was associated with an increased full-scale-intelligence-quotient +1.8 points (+0.0 to +3.6); and with trends for lower scores of behavioural difficulties -0.4 points (-1.1 to +0.4) and social communication difficulties -0.3 points (-0.8 to 0.2).
CONCLUSIONS
Early SSC during the first week of life among very preterm infants was associated with increased full-scale-intelligence-quotient at 5½ years. Variability of practices among units deserves attention. Further evaluation of the dose-effect is needed.
Journal Article > Meta-AnalysisFull Text
Emerg Infect Dis. 2019 May 1 (Issue 5); DOI:10.3201/eid2505.181823.
Mbuagbaw L, Guglielmetti L, Hewison CCH, Bakare N, Bastard M, et al.
Emerg Infect Dis. 2019 May 1 (Issue 5); DOI:10.3201/eid2505.181823.
Bedaquiline is recommended by the World Health Organization for the treatment of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB). We pooled data from 5 cohorts of patients treated with bedaquiline in France, Georgia, Armenia, and South Africa and in a multicountry study. The rate of culture conversion to negative at 6 months (by the end of 6 months of treatment) was 78% (95% CI 73.5%-81.9%), and the treatment success rate was 65.8% (95% CI 59.9%-71.3%). Death rate was 11.7% (95% CI 7.0%-19.1%). Up to 91.1% (95% CI 82.2%-95.8%) of the patients experienced >1 adverse event, and 11.2% (95% CI 5.0%-23.2%) experienced a serious adverse event. Lung cavitations were consistently associated with unfavorable outcomes. The use of bedaquiline in MDR and XDR TB treatment regimens appears to be effective and safe across different settings, although the certainty of evidence was assessed as very low.
Journal Article > ResearchAbstract Only
J Acquir Immune Defic Syndr; JAIDS. 2023 September 28; Online ahead of print; DOI:10.1097/QAI.0000000000003310
Ben Farhat J, Hessamfar M, Farbos S, Desclaux A, Dumondin G, et al.
J Acquir Immune Defic Syndr; JAIDS. 2023 September 28; Online ahead of print; DOI:10.1097/QAI.0000000000003310
OBJECTIVES
The Covid-19 pandemic’s impact on initiation and effectiveness of antiretroviral therapy (ART) in people diagnosed with HIV remains unclear. We evaluated critical delays in HIV care in people diagnosed before and during the pandemic in ex-Aquitaine, France.
METHODS
We considered adults diagnosed with HIV-1 in 2018-2021 and enrolled in the ANRS CO3 AQUIVIH-NA and followed them until 10/10/2022 for those diagnosed during the pandemic (1/4/2020 - 31/12/2021) and until 31/03/2020 for historical controls. We compared their characteristics at inclusion and the median time between diagnosis and ART initiation, ART initiation and viral suppression and diagnosis and virological suppression (effective management).
RESULTS
83 individuals were diagnosed during the pandemic versus 188 during the pre-pandemic period. Median follow-up was 549 (IQR: 329-713) days. Populations were similar in terms of sex, age, HIV transmission group, hospital type, and clinical characteristics at diagnosis, however, fewer were foreign-born during the pandemic (15.7% versus 33.5%, p=0.003). The probability of ART initiation, therapeutic success, effective management was higher in PLWH diagnosed during the pandemic in adjusted analyses (HR 2.0 95%CI. 1.5-2.7, HR 1.7 95%CI. 1.2-2.3, HR 1.8 95%CI. 1.3-2.6, respectively). Those diagnosed during the pandemic were 2.3 (95%CI: 1.2-4.1) times more likely to be virologically suppressed within 6 months of diagnosis compared to historical controls.
CONCLUSIONS
Pandemic-related reorganizations may have resulted in newly diagnosed PLWH being prioritized, however, the lower proportion of foreign-born PLWH diagnosed during the pandemic period, likely due to reduced migration and potential delays in diagnosis, may contribute to these preliminary findings.
The Covid-19 pandemic’s impact on initiation and effectiveness of antiretroviral therapy (ART) in people diagnosed with HIV remains unclear. We evaluated critical delays in HIV care in people diagnosed before and during the pandemic in ex-Aquitaine, France.
METHODS
We considered adults diagnosed with HIV-1 in 2018-2021 and enrolled in the ANRS CO3 AQUIVIH-NA and followed them until 10/10/2022 for those diagnosed during the pandemic (1/4/2020 - 31/12/2021) and until 31/03/2020 for historical controls. We compared their characteristics at inclusion and the median time between diagnosis and ART initiation, ART initiation and viral suppression and diagnosis and virological suppression (effective management).
RESULTS
83 individuals were diagnosed during the pandemic versus 188 during the pre-pandemic period. Median follow-up was 549 (IQR: 329-713) days. Populations were similar in terms of sex, age, HIV transmission group, hospital type, and clinical characteristics at diagnosis, however, fewer were foreign-born during the pandemic (15.7% versus 33.5%, p=0.003). The probability of ART initiation, therapeutic success, effective management was higher in PLWH diagnosed during the pandemic in adjusted analyses (HR 2.0 95%CI. 1.5-2.7, HR 1.7 95%CI. 1.2-2.3, HR 1.8 95%CI. 1.3-2.6, respectively). Those diagnosed during the pandemic were 2.3 (95%CI: 1.2-4.1) times more likely to be virologically suppressed within 6 months of diagnosis compared to historical controls.
CONCLUSIONS
Pandemic-related reorganizations may have resulted in newly diagnosed PLWH being prioritized, however, the lower proportion of foreign-born PLWH diagnosed during the pandemic period, likely due to reduced migration and potential delays in diagnosis, may contribute to these preliminary findings.
Journal Article > ResearchFull Text
Lancet Public Health. 2021 April 1; Volume 6 (Issue 4); DOI:10.1016/s2468-2667(21)00001-3
Roederer T, Mollo B, Vincent C, Nikolay B, Llosa AE, et al.
Lancet Public Health. 2021 April 1; Volume 6 (Issue 4); DOI:10.1016/s2468-2667(21)00001-3
Between June 23 and July 2, 2020, 426 (52%) of 818 individuals recruited tested positive in 14 sites. Seroprevalence varied significantly by type of recruitment site (χ2 p<0·0001), being highest among those living in workers' residences (88·7%, 95% CI 81·8-93·2), followed by emergency shelters (50·5%, 46·3-54·7), and food distribution sites (27·8%, 20·8-35·7). More than two thirds of COVID-19 seropositive individuals (68%, 95% CI 64·2-72·2; 291 of 426) did not report any symptoms during the recall period. COVID-19 seropositivity was strongly associated with overcrowding (medium density: adjusted odds ratio [aOR] 2·7, 95% CI 1·5-5·1, p=0·0020; high density: aOR 3·4, 1·7-6·9, p<0·0001).