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Boyer L, Pauly V, Brousse Y, Orleans V, Tran B, Yon DK, Auquier P, Fond G, Duclos A. The impact of hospital saturation on non-COVID-19 hospital mortality during the pandemic in France: a national population-based cohort study. BMC Public Health 2024; 24:1798. [PMID: 38970000 PMCID: PMC11227237 DOI: 10.1186/s12889-024-19282-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/26/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND A previous study reported significant excess mortality among non-COVID-19 patients due to disrupted surgical care caused by resource prioritization for COVID-19 cases in France. The primary objective was to investigate if a similar impact occurred for medical conditions and determine the effect of hospital saturation on non-COVID-19 hospital mortality during the first year of the pandemic in France. METHODS We conducted a nationwide population-based cohort study including all adult patients hospitalized for non-COVID-19 acute medical conditions in France between March 1, 2020 and 31 May, 2020 (1st wave) and September 1, 2020 and December 31, 2020 (2nd wave). Hospital saturation was categorized into four levels based on weekly bed occupancy for COVID-19: no saturation (< 5%), low saturation (> 5% and ≤ 15%), moderate saturation (> 15% and ≤ 30%), and high saturation (> 30%). Multivariate generalized linear model analyzed the association between hospital saturation and mortality with adjustment for age, sex, COVID-19 wave, Charlson Comorbidity Index, case-mix, source of hospital admission, ICU admission, category of hospital and region of residence. RESULTS A total of 2,264,871 adult patients were hospitalized for acute medical conditions. In the multivariate analysis, the hospital mortality was significantly higher in low saturated hospitals (adjusted Odds Ratio/aOR = 1.05, 95% CI [1.34-1.07], P < .001), moderate saturated hospitals (aOR = 1.12, 95% CI [1.09-1.14], P < .001), and highly saturated hospitals (aOR = 1.25, 95% CI [1.21-1.30], P < .001) compared to non-saturated hospitals. The proportion of deaths outside ICU was higher in highly saturated hospitals (87%) compared to non-, low- or moderate saturated hospitals (81-84%). The negative impact of hospital saturation on mortality was more pronounced in patients older than 65 years, those with fewer comorbidities (Charlson 1-2 and 3 vs. 0), patients with cancer, nervous and mental diseases, those admitted from home or through the emergency room (compared to transfers from other hospital wards), and those not admitted to the intensive care unit. CONCLUSIONS Our study reveals a noteworthy "dose-effect" relationship: as hospital saturation intensifies, the non-COVID-19 hospital mortality risk also increases. These results raise concerns regarding hospitals' resilience and patient safety, underscoring the importance of identifying targeted strategies to enhance resilience for the future, particularly for high-risk patients.
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Affiliation(s)
- Laurent Boyer
- CEReSS - Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, APHM, Marseille, 13005, France.
| | - Vanessa Pauly
- CEReSS - Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, APHM, Marseille, 13005, France
| | - Yann Brousse
- CEReSS - Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, APHM, Marseille, 13005, France
| | - Veronica Orleans
- CEReSS - Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, APHM, Marseille, 13005, France
| | - Bach Tran
- CEReSS - Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, APHM, Marseille, 13005, France
- Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, 100000, Vietnam
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Pascal Auquier
- CEReSS - Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, APHM, Marseille, 13005, France
| | - Guillaume Fond
- CEReSS - Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, APHM, Marseille, 13005, France
| | - Antoine Duclos
- RESHAPE - Research on Healthcare Performance Lab, Inserm U1290, Claude Bernard Lyon 1 University, Lyon, 69424, France
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Bělobrádek J, Šídlo L, Philipp T. Influence of practice location on prescribing, diabetes care, and colorectal cancer screening among Czech general practitioners during the COVID-19 pandemic. Epidemiol Health 2024; 46:e2024033. [PMID: 38453333 PMCID: PMC11176716 DOI: 10.4178/epih.e2024033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/10/2024] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVES The provision of primary health care was not interrupted during the coronavirus disease 2019 (COVID-19) pandemic in Czechia, although the capacity and resources of providers changed. We examined how the pandemic affected individual general practices throughout 2017-2021, focusing on differences between urban and rural practices. METHODS We analysed data from the largest health insurance company in Czechia, which provides care to 4.5 million people (60% of the population). We evaluated the prescription volume, diabetes care procedures, and faecal immunochemical test (FIT) in preventive care and new pandemic-related procedures (remote consultations, testing, and vaccinations). For the spatial distribution of practices, we adapted the Organisation for Economic Cooperation and Development typology. RESULTS We observed minimal declines in 2020 in the rate of prescribing (-1.0%) and diabetes care (-5.1%), with a rapid resumption in 2021, but a substantial decline in FIT (-17.8% in 2020) with slow resumption. Remote consultations were used by 94% of all practices regardless of location, with testing and vaccinations more commonly performed by rural general practitioners (GPs). CONCLUSIONS Primary care in Czechia rose to the challenge of the COVID-19 pandemic, as shown by the finding that the volume of healthcare services provided through primary care did not decrease across most of the monitored parameters. This study also confirmed that rural GPs provide more care in-house, both in terms of prescribing and procedures performed in their practices. Future studies will need to focus on preventive care, which the pandemic has dampened in GP practices in Czechia.
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Affiliation(s)
- Jan Bělobrádek
- Institute of Preventive Medicine, Charles University Faculty of Medicine in Hradec Králové, Hradec Králové, Czech Republic
| | - Luděk Šídlo
- Department of Demography and Geodemography, Charles University Faculty of Science, Praha, Czech Republic
| | - Tom Philipp
- General Health Insurance Company (GHIC), Praha, Czech Republic
- Charles University, Third Faculty of Medicine, Rheumatology and Rehabilitation Clinic, Praha, Czech Republic
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Fond G, Smith L, Boussat B, Lucas G, Yon DK, Tran B, Nguyen TT, Stubbs B, Boyer L. Association between physical activity and health in healthcare professionals : Results from the nationwide AMADEUS survey. Rev Epidemiol Sante Publique 2023; 71:102183. [PMID: 37944193 DOI: 10.1016/j.respe.2023.102183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/05/2023] [Accepted: 10/07/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE The objective of this study was to assess the prevalence of healthcare professionals engaging in insufficient levels of physical activity (PA) and to identify sociodemographic, professional and health characteristics associated with insufficient PA levels. METHODS We conducted a nationwide online cross-sectional study targeting healthcare professionals in France from May 2021 to June 2021. Participant recruitment involved outreach through social networks, professional networks, and email invitations. PA levels were assessed using the International Physical Activity Questionnaire (IPAQ), with insufficient PA defined as weekly PA totaling less than 600 mets/week. RESULTS The study included a total of 10,325 participants, of whom 3939 (38.1%, 95% confidence interval 37.1-39.0%) exhibited insufficient levels of PA. In the multivariable analysis, we identified factors associated with insufficient PA: ages between 35-44 (aOR=1.58, 95%CI [1.21-2.06], p=.001) and 45-54 years (aOR=1.40, 95%CI [1.07-1.83], p =.015), gender (female aOR=1.47, 95%CI [1.12-1.44], p<.001), and professions including health executive (aOR=1.27, 95%CI [1.32-1.64], p<.001), nurse assistant (aOR=1.25, 95%CI [1.07-1.47], p=.006), and physician (aOR=1.18, 95%CI [1.03-1.34], p=.015). Additionally, burnout (aOR=1.32, 95%CI [1.21-1.44], p<.001), tobacco use (aOR=1.33, 95%CI [1.20-1.58], p<.001), being overweight (aOR=1.39, 95%CI [1.28-1.52], p<.001), major depression (aOR=1.44, 95%CI [1.20-1.47], p<.001), and sleep disorders (aOR=1.14, 95%CI [1.05-1.25], p=.002) were associated with insufficient PA. Work night shifts was associated with sufficient PA. CONCLUSION Our study has revealed a substantial prevalence of healthcare professionals with insufficient PA levels. This prevalence, coupled with various associated health-damaging behaviors and mental health issues, underscores the importance of acknowledging the barriers they encounter in adopting a physically active lifestyle.
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Affiliation(s)
- Guillaume Fond
- Assistance Publique des Hôpitaux de Marseille, Aix-Marseille University, CEReSS-Health Service Research and Quality of Life Center, UR3279, 27 boulevard Jean -Moulin, 13005 Marseille, France; Fondation FondaMental, Créteil, France
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Bastien Boussat
- Service d'épidémiologie et évaluation médicale, Epidemiology and medical evaluation unit, CHU Grenoble-Alpes, Grenoble, France ; Laboratoire TIMC-IMAG, UMR 5525 Joint Research Unit, Centre National de Recherche Scientifique, National Center for Scientific Research, Université Grenoble-Alpes, France
| | - Guillaume Lucas
- Assistance Publique des Hôpitaux de Marseille, Aix-Marseille University, CEReSS-Health Service Research and Quality of Life Center, UR3279, 27 boulevard Jean -Moulin, 13005 Marseille, France
| | - Dong Keon Yon
- Department of Pediatrics, Kyung Hee University College of Medicine, Seoul, Republic of Korea; Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Bach Tran
- Assistance Publique des Hôpitaux de Marseille, Aix-Marseille University, CEReSS-Health Service Research and Quality of Life Center, UR3279, 27 boulevard Jean -Moulin, 13005 Marseille, France; Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Tham Thi Nguyen
- Assistance Publique des Hôpitaux de Marseille, Aix-Marseille University, CEReSS-Health Service Research and Quality of Life Center, UR3279, 27 boulevard Jean -Moulin, 13005 Marseille, France; Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Brendon Stubbs
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Laurent Boyer
- Assistance Publique des Hôpitaux de Marseille, Aix-Marseille University, CEReSS-Health Service Research and Quality of Life Center, UR3279, 27 boulevard Jean -Moulin, 13005 Marseille, France; Fondation FondaMental, Créteil, France.
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Coelho J, Lucas G, Micoulaud-Franchi JA, Tran B, Yon DK, Taillard J, D'Incau E, Philip P, Boyer L, Fond G. Sleep timing, workplace well-being and mental health in healthcare workers. Sleep Med 2023; 111:123-132. [PMID: 37769583 DOI: 10.1016/j.sleep.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/07/2023] [Accepted: 09/13/2023] [Indexed: 10/03/2023]
Abstract
INTRODUCTION Healthcare workers face an elevated risk of burnout, sleep disorders, and mental health issues, potentially stemming from the misalignment of their circadian rhythm due to nonstandard work schedules. This cross-sectional survey aims to examine the connections between sleep timing, workplace well-being (including burnout and absenteeism), and mental health outcomes (specifically depression and poor sleep) in healthcare workers. Additionally, the survey takes into account individual and professional factors, as well as the interaction with work schedules. METHODS The study encompasses 4,971 healthcare workers from both public and private healthcare facilities in France, including nurses, nursing assistants, and physicians recruited during the third wave of the COVID-19 pandemic. The Maslach Burnout Inventory assesses burnout, the Center for Epidemiologic Studies Depression Scale measures depression, and the Pittsburgh Sleep Quality Index evaluates poor sleep. Sleep timing is categorized into morning, neutral, and evening timing, referred to as midsleep. Multivariate logistic regression analysis is conducted to explore the relationships between sleep timing and burnout, depression, and poor sleep, while adjusting for various factors. RESULTS The findings reveal that 56.5% of participants experience burnout, 29.8% report depression, and 64.5% report poor sleep. Nurses and nursing assistants exhibit a higher prevalence of poor sleep. Morning sleep timing is associated with burnout among those with fixed schedules and with depression among those with shift schedules. Among physicians, both morning and evening sleep timing are associated with depression, while morning sleep timing is linked to poor sleep across all subgroups. INTERPRETATION This study suggests that the misalignment between healthcare workers' internal circadian rhythm and their work schedules may contribute to an increased risk of burnout, depression, and poor sleep. Occupational health services and policymakers should recognize the potential for enhancing workplace well-being and mental health outcomes by enabling healthcare workers to maintain sleep schedules that accommodate their needs.
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Affiliation(s)
- Julien Coelho
- Univ. Bordeaux, SANPSY, UMR 6033, F-33000, Bordeaux, France; CNRS, SANPSY, UMR 6033, F-33000, Bordeaux, France; CHU Bordeaux, Service Universitaire de Médecine du sommeil, F-33000, Bordeaux, France
| | - Guillaume Lucas
- Assistance Publique des Hôpitaux de Marseille, Aix-Marseille University, CEReSS-Health Service Research and Quality of Life Center, 27, boulevard Jean -Moulin, 13005, Marseille, France
| | - Jean-Arthur Micoulaud-Franchi
- Univ. Bordeaux, SANPSY, UMR 6033, F-33000, Bordeaux, France; CNRS, SANPSY, UMR 6033, F-33000, Bordeaux, France; CHU Bordeaux, Service Universitaire de Médecine du sommeil, F-33000, Bordeaux, France
| | - Bach Tran
- Assistance Publique des Hôpitaux de Marseille, Aix-Marseille University, CEReSS-Health Service Research and Quality of Life Center, 27, boulevard Jean -Moulin, 13005, Marseille, France; Fondation FondaMental, Créteil, France
| | - Dong Keon Yon
- Department of Pediatrics, Kyung Hee University College of Medicine, Seoul, Republic of Korea; Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Jacques Taillard
- Univ. Bordeaux, SANPSY, UMR 6033, F-33000, Bordeaux, France; CNRS, SANPSY, UMR 6033, F-33000, Bordeaux, France
| | - Emmanuel D'Incau
- Univ. Bordeaux, SANPSY, UMR 6033, F-33000, Bordeaux, France; CNRS, SANPSY, UMR 6033, F-33000, Bordeaux, France; CHU Bordeaux, Service Universitaire de Médecine du sommeil, F-33000, Bordeaux, France
| | - Pierre Philip
- Univ. Bordeaux, SANPSY, UMR 6033, F-33000, Bordeaux, France; CNRS, SANPSY, UMR 6033, F-33000, Bordeaux, France; CHU Bordeaux, Service Universitaire de Médecine du sommeil, F-33000, Bordeaux, France
| | - Laurent Boyer
- Assistance Publique des Hôpitaux de Marseille, Aix-Marseille University, CEReSS-Health Service Research and Quality of Life Center, 27, boulevard Jean -Moulin, 13005, Marseille, France; Fondation FondaMental, Créteil, France
| | - Guillaume Fond
- Assistance Publique des Hôpitaux de Marseille, Aix-Marseille University, CEReSS-Health Service Research and Quality of Life Center, 27, boulevard Jean -Moulin, 13005, Marseille, France; Fondation FondaMental, Créteil, France.
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Di Gangi S, Lüthi B, Diaz Hernandez L, Zeller A, Zechmann S, Fischer R. Quality outcome of diabetes care during COVID-19 pandemic: a primary care cohort study. Acta Diabetol 2022; 59:1189-1200. [PMID: 35780277 PMCID: PMC9329414 DOI: 10.1007/s00592-022-01920-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/08/2022] [Indexed: 11/14/2022]
Abstract
AIM Management of diabetes care can be affected by COVID-19 pandemic control measures. This study aimed to determine the impact of the pandemic, during 17.03.2020-16.03.2021, on quality outcomes of diabetes care in general practice in Switzerland. METHODS In this retrospective cohort study, diabetes mellitus patients (≥ 18 years) with at least one consultation at a general practitioner, during 17.03.2018-16.03.2019 (cohort 1) and 17.03.2019-16.03.2020 (cohort 2) were included and followed-up for two years. Quality indicators and outcomes of diabetes care, at patient and practitioner level, were compared before and during the pandemic. Logistic regression was performed to identify patient's risk factors for dropout from follow-up. RESULTS Data from 191 practices, 23,903 patients, cohort 1 and 25,092 patients, cohort 2, were analyzed. The fraction of patients lost to follow-up, attributable to the pandemic, was 28% (95% confidence interval: 25%, 30%). During the pandemic, compared to the previous year, regular measurement of weight, HbA1c, blood pressure and serum creatinine were less frequent and less patients per practitioner reached HbA1c and blood pressure target outcomes. Factors associated with continuity of care during the pandemic were: patient age 41-80 years, longer diabetes duration, diagnosis of hypertension or dyslipidemia, influenza vaccination during the last year. Risk factors for dropout were age > 80 and receiving only insulin as anti-diabetic medication. CONCLUSION A considerable quality reduction in diabetes mellitus care could be observed during the pandemic. Though the most vulnerable patients were not the most affected by the pandemic, key factors that might reduce dropout from follow-up were identified.
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Affiliation(s)
- Stefania Di Gangi
- Institute of Primary Care, University and University Hospital Zurich, Pestalozzistrasse 24, CH-8091 Zurich, Switzerland
| | - Benjamin Lüthi
- Centre for Primary Health Care, University of Basel, Basel, Switzerland
| | | | - Andreas Zeller
- Centre for Primary Health Care, University of Basel, Basel, Switzerland
| | - Stefan Zechmann
- Institute of Primary Care, University and University Hospital Zurich, Pestalozzistrasse 24, CH-8091 Zurich, Switzerland
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland
| | - Roland Fischer
- Centre for Primary Health Care, University of Basel, Basel, Switzerland
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