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Nilsen LG, Wentzel-Larsen T, Stene LE. The short-term impact of terrorism on public mental health: an emergency primary care approach. BMC Public Health 2023; 23:2325. [PMID: 37996852 PMCID: PMC10668408 DOI: 10.1186/s12889-023-17240-z] [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: 03/31/2023] [Accepted: 11/16/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Terrorist attacks commonly have mental health consequences for those directly affected. Existing research is, however, divided when it comes to how and whether terrorist attacks affect the general population's mental health. There is a need for studies investigating a broader range of mental health reactions to understand more about how different groups of the population are affected by terrorist attacks, while also illuminating important systemic factors. METHODS In this study we investigated whether there was any change in the number of consultations with out-of-hours emergency primary care for psychological reactions in association with the 2011 terrorist attacks in Norway. Data covering the entire Norwegian population's primary care contacts in 2008-2013, where the reason for encounter was coded as psychological concerns or psychiatric disorders, were studied. A time series intervention analysis, using ARIMA modelling, was used to estimate whether there was indeed a change in healthcare utilisation associated with the terrorist attacks. RESULTS The analysis uncovered an increase in contacts with emergency primary care by the overall population for mental health concerns associated with the terrorist attacks. When divided into groups according to geographical proximity to attacks, no significant change was found in the area closest to the attack in Oslo, whereas an increase was found for the rest of the country. There was also heterogeneity across different age groups. An increase was found among youths, young adults, and middle-aged people, but not the other age groups, and an increase was found for both men and women. CONCLUSIONS These findings highlight the need for primary care services to be prepared to meet mental health reactions in the general population when planning for healthcare provision in the aftermath of terrorism. Simultaneously, it should be noted that needs may vary across different groups of the population.
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Affiliation(s)
- Lisa Govasli Nilsen
- Norwegian Centre for Violence and Traumatic Stress Studies, P.B. 181 Nydalen, 0409, Oslo, Norway.
- Department of Sociology and Political Science, Norwegian University of Science and Technology, NTNU, Trondheim, Norway.
| | - Tore Wentzel-Larsen
- Norwegian Centre for Violence and Traumatic Stress Studies, P.B. 181 Nydalen, 0409, Oslo, Norway
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Lise Eilin Stene
- Norwegian Centre for Violence and Traumatic Stress Studies, P.B. 181 Nydalen, 0409, Oslo, Norway
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2
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Fernandez A, Meurice L, Franke F, Vuillermoz C, Gindt M, Askenazy F, Vandentorren S. Impact of the 7/14/2016 Nice terrorist attack on pediatric emergency department visits thanks to syndromic surveillance: a descriptive study. Front Public Health 2023; 11:1248993. [PMID: 37915811 PMCID: PMC10616791 DOI: 10.3389/fpubh.2023.1248993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/02/2023] [Indexed: 11/03/2023] Open
Abstract
Objective Study the impact of 14th July 2016 Nice terrorist attack on Pediatric Emergency Department (PED) visits by youth under 18 years of age. Methods PED visits diagnoses (ICD10) were clustered and analyzed based on retrospective data from the syndromic surveillance system of the Children's university hospital of Nice (Southern France). The studied period ranges from 2013 to 2019, i.e., 3 years before and after the terrorist attack of 14th July 2016. Results Among 416,191 PED visits, the number of visits for stress in 4-17 years old appeared to increase in the 3 years after the attack compared to the 3 years before, particularly in September 2016 (acute effect) with 11 visits compared to an average of 2.3 visits per month from September 2013 to 2016 (p = 0.001827). In September 2017, we noticed 21 visits compared to an average of 4.8 visits per month during the following period (2013-2019). In 2017, PED visits for stress among 4-17 year olds were higher in comparison to the other years of the study: 107 visits compared to an annual average of 57. Conclusion To our knowledge, this is the first study of the use of the pediatric care system before and after a terrorist attack involving syndromic surveillance. This suggests acute and long-term effects of the terrorist attack on PED use by youth for mental health issues. Further studies of the pediatric care system involving syndromic surveillance are needed in the context of mass violent events, such as terrorist attacks.
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Affiliation(s)
- Arnaud Fernandez
- University Department of Child and Adolescent Psychiatry, Children’s Hospitals of Nice CHU-Lenval, Nice, France
- CoBTek, Université Côte d'Azur, Nice, France
| | - Laure Meurice
- Santé publique France, French National Public Health Agency, Nouvelle-Aquitaine Regional Office, Bordeaux, France
| | - Florian Franke
- Santé Publique France, French National Public Health Agency, Regional Unit (CIRE, Provence-Alpes-Côte d'Azur and Corsica), Marseille, France
| | - Cecile Vuillermoz
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP), Social Epidemiology Research Team, Paris, France
| | - Morgane Gindt
- University Department of Child and Adolescent Psychiatry, Children’s Hospitals of Nice CHU-Lenval, Nice, France
- CoBTek, Université Côte d'Azur, Nice, France
| | - Florence Askenazy
- University Department of Child and Adolescent Psychiatry, Children’s Hospitals of Nice CHU-Lenval, Nice, France
- CoBTek, Université Côte d'Azur, Nice, France
| | - Stéphanie Vandentorren
- Université Bordeaux, Inserm, UMR1219, Vintage Team, Bordeaux, France
- Santé publique France, French National Public Health Agency, Saint-Maurice, France
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3
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Smith G, Harcourt S, Hoang U, Lemanska A, Elliot A, Morbey R, Hughes H, Lake I, Edeghere O, Oliver I, Sherlock J, Amlôt R, de Lusignan S. Observational study of mental health presentations across healthcare setting during the first 9 months of the COVID-19 pandemic in England. JMIR Public Health Surveill 2022; 8:e32347. [PMID: 35486809 PMCID: PMC9359118 DOI: 10.2196/32347] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 03/15/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background The COVID-19 pandemic has resulted in an unprecedented impact on the day-to-day lives of people, with several features potentially adversely affecting mental health. There is growing evidence of the size of the impact of COVID-19 on mental health, but much of this is from ongoing population surveys using validated mental health scores. Objective This study investigated the impact of the pandemic and control measures on mental health conditions presenting to a spectrum of national health care services monitored using real-time syndromic surveillance in England. Methods We conducted a retrospective observational descriptive study of mental health presentations (those calling the national medical helpline, National Health Service [NHS] 111; consulting general practitioners [GPs] in and out-of-hours; calling ambulance services; and attending emergency departments) from January 1, 2019, to September 30, 2020. Estimates for the impact of lockdown measures were provided using an interrupted time series analysis. Results Mental health presentations showed a marked decrease during the early stages of the pandemic. Postlockdown, attendances for mental health conditions reached higher than prepandemic levels across most systems—a rise of 10% compared to that expected for NHS 111 and 21% for GP out-of-hours service—while the number of consultations to GP in-hours service was 13% lower compared to the same time previous year. Increases were observed in calls to NHS 111 for sleep problems. Conclusions These analyses showed marked changes in the health care attendances and prescribing for common mental health conditions across a spectrum of health care provision, with some of these changes persisting. The reasons for such changes are likely to be complex and multifactorial. The impact of the pandemic on mental health may not be fully understood for some time, and therefore, these syndromic indicators should continue to be monitored.
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Affiliation(s)
- Gillian Smith
- Real-time Syndromic Surveillance Team, Field Service, UK Health Security Agency, 1st Floor, 5 St Philips Place, Birmingham, GB.,NIHR Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, GB
| | - Sally Harcourt
- Real-time Syndromic Surveillance Team, Field Service, UK Health Security Agency, 1st Floor, 5 St Philips Place, Birmingham, GB
| | - Uy Hoang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, GB
| | - Agnieszka Lemanska
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, GB
| | - Alex Elliot
- Real-time Syndromic Surveillance Team, Field Service, UK Health Security Agency, 1st Floor, 5 St Philips Place, Birmingham, GB.,NIHR Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, GB
| | - Roger Morbey
- Real-time Syndromic Surveillance Team, Field Service, UK Health Security Agency, 1st Floor, 5 St Philips Place, Birmingham, GB.,NIHR Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, GB
| | - Helen Hughes
- Real-time Syndromic Surveillance Team, Field Service, UK Health Security Agency, 1st Floor, 5 St Philips Place, Birmingham, GB
| | - Iain Lake
- School of Environmental Science, University of East Anglia, Norwich, GB.,NIHR Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, GB
| | - Obaghe Edeghere
- Real-time Syndromic Surveillance Team, Field Service, UK Health Security Agency, 1st Floor, 5 St Philips Place, Birmingham, GB.,NIHR Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, GB
| | - Isabel Oliver
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, Population Health Sciences, University of Bristol, Bristol, GB.,Chief Scientist Advisor Group, UK Health Security Agency, London, GB
| | - Julian Sherlock
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, GB
| | - Richard Amlôt
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, GB.,NIHR Health Protection Research Unit in Behavioural Science and Evaluation, Population Health Sciences, University of Bristol, Bristol, GB.,Behavioural Science and Insights Unit, UK Health Security Agency, London, GB
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, GB.,Faculty of Health and Medical Sciences, University of Surrey, Surrey, GB.,Royal College of General Practitioners, London, GB
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Spector E, Zhang Y, Guo Y, Bost S, Yang X, Prosperi M, Wu Y, Shao H, Bian J. Syndromic Surveillance Systems for Mass Gatherings: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084673. [PMID: 35457541 PMCID: PMC9026395 DOI: 10.3390/ijerph19084673] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/02/2022] [Accepted: 04/06/2022] [Indexed: 11/16/2022]
Abstract
Syndromic surveillance involves the near-real-time collection of data from a potential multitude of sources to detect outbreaks of disease or adverse health events earlier than traditional forms of public health surveillance. The purpose of the present study is to elucidate the role of syndromic surveillance during mass gathering scenarios. In the present review, the use of syndromic surveillance for mass gathering scenarios is described, including characteristics such as methodologies of data collection and analysis, degree of preparation and collaboration, and the degree to which prior surveillance infrastructure is utilized. Nineteen publications were included for data extraction. The most common data source for the included syndromic surveillance systems was emergency departments, with first aid stations and event-based clinics also present. Data were often collected using custom reporting forms. While syndromic surveillance can potentially serve as a method of informing public health policy regarding specific mass gatherings based on the profile of syndromes ascertained, the present review does not indicate that this form of surveillance is a reliable method of detecting potentially critical public health events during mass gathering scenarios.
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Affiliation(s)
- Eliot Spector
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL 32610, USA; (E.S.); (Y.G.); (S.B.); (X.Y.); (Y.W.)
| | - Yahan Zhang
- Department of Pharmaceutical Outcomes & Policy, University of Florida, Gainesville, FL 32610, USA; (Y.Z.); (H.S.)
| | - Yi Guo
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL 32610, USA; (E.S.); (Y.G.); (S.B.); (X.Y.); (Y.W.)
| | - Sarah Bost
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL 32610, USA; (E.S.); (Y.G.); (S.B.); (X.Y.); (Y.W.)
| | - Xi Yang
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL 32610, USA; (E.S.); (Y.G.); (S.B.); (X.Y.); (Y.W.)
| | - Mattia Prosperi
- Department of Epidemiology, University of Florida, Gainesville, FL 32610, USA;
| | - Yonghui Wu
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL 32610, USA; (E.S.); (Y.G.); (S.B.); (X.Y.); (Y.W.)
| | - Hui Shao
- Department of Pharmaceutical Outcomes & Policy, University of Florida, Gainesville, FL 32610, USA; (Y.Z.); (H.S.)
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL 32610, USA; (E.S.); (Y.G.); (S.B.); (X.Y.); (Y.W.)
- Correspondence:
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Stene LE, Vuillermoz C, Overmeire RV, Bilsen J, Dückers M, Nilsen LG, Vandentorren S. Psychosocial care responses to terrorist attacks: a country case study of Norway, France and Belgium. BMC Health Serv Res 2022; 22:390. [PMID: 35331222 PMCID: PMC8953389 DOI: 10.1186/s12913-022-07691-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 02/11/2022] [Indexed: 01/25/2023] Open
Abstract
Background The international terrorism threat urges societies to invest in the planning and organization of psychosocial care. With the aim to contribute to cross-national learning, this study describes the content, target populations and providers of psychosocial care to civilians after terrorist attacks in Norway, France and Belgium. Methods We identified and reviewed pre- and post-attack policy documents, guidelines, reports and other relevant grey literature addressing the psychosocial care response to terrorist attacks in Oslo/Utøya, Norway on 22 July 2011; in Paris, France on 13 November 2015; and in Brussels, Belgium on 22 March 2016. Results In Norway, there was a primary care based approach with multidisciplinary crisis teams in the local municipalities. In response to the terrorist attacks, there were proactive follow-up programs within primary care and occupational health services with screenings of target groups throughout a year. In France, there was a national network of specialized emergency psychosocial units primarily consisting of psychiatrists, psychologists and psychiatric nurses organized by the regional health agencies. They provided psychological support the first month including guidance for long-term healthcare, but there were no systematic screening programs after the acute phase. In Belgium, there were psychosocial intervention networks in the local municipalities, yet the acute psychosocial care was coordinated at a federal level. A reception centre was organized to provide acute psychosocial care, but there were no reported public long-term psychosocial care initiatives in response to the attacks. Conclusions Psychosocial care responses, especially long-term follow-up activities, differed substantially between countries. Models for registration of affected individuals, monitoring of their health and continuous evaluation of countries’ psychosocial care provision incorporated in international guidelines may strengthen public health responses to mass-casualty incidents. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07691-2.
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Affiliation(s)
- Lise Eilin Stene
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway.
| | - Cécile Vuillermoz
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP), Department of social epidemiology, Paris, France
| | - Roel Van Overmeire
- Mental Health & Wellbeing research group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Johan Bilsen
- Mental Health & Wellbeing research group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Michel Dückers
- ARQ National Psychotrauma Centre, Diemen, Netherlands.,Netherlands Institute of Health Services Research (NIVEL), Utrecht, Netherlands.,Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, Netherlands
| | - Lisa Govasli Nilsen
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway.,Department of Sociology and Political Science, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Stéphanie Vandentorren
- Santé publique France, Saint Maurice, France.,Université Bordeaux, Inserm, UMR 1219, Vintage team, Bordeaux, France
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6
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Thiam MM, Pontais I, Forgeot C, Pedrono G, Paget LM, Fouillet A, Caserio-Schönemann C. Syndromic surveillance: A key component of population health monitoring during the first wave of the COVID-19 outbreak in France, February-June 2020. PLoS One 2022; 17:e0260150. [PMID: 35143501 PMCID: PMC8830636 DOI: 10.1371/journal.pone.0260150] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 11/03/2021] [Indexed: 01/27/2023] Open
Abstract
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.
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Affiliation(s)
- Marie-Michèle Thiam
- Data Science Division, Santé Publique France, Saint-Maurice, France
- * E-mail:
| | - Isabelle Pontais
- Data Science Division, Santé Publique France, Saint-Maurice, France
| | - Cécile Forgeot
- Data Science Division, Santé Publique France, Saint-Maurice, France
| | - Gaëlle Pedrono
- Data Science Division, Santé Publique France, Saint-Maurice, France
| | | | - SOS Médecins
- SOS Médecins France National Board, Paris, France
| | | | - Louis-Marie Paget
- Non-Communicable and Traumatic Diseases Division, Santé Publique France, Saint-Maurice, France
| | - Anne Fouillet
- Data Science Division, Santé Publique France, Saint-Maurice, France
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7
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Robert M, Stene LE, Garfin DR, Vandentorren S, Motreff Y, du Roscoat E, Pirard P. Media Exposure and Post-traumatic Stress Symptoms in the Wake of the November 2015 Paris Terrorist Attacks: A Population-Based Study in France. Front Psychiatry 2021; 12:509457. [PMID: 34093248 PMCID: PMC8175798 DOI: 10.3389/fpsyt.2021.509457] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 03/24/2021] [Indexed: 01/18/2023] Open
Abstract
The intense mass media coverage of the Paris terrorist attacks on November 13, 2015 exposed a majority of the French population to the attacks. Prior research has documented the association between media exposure to terrorism and post-traumatic stress symptoms (PTSS). The present study replicated and extended these findings in a French sample. A population-based sample (N = 1,760) was drawn from a national web-enabled panel in June 2016. Hours of attack-related media exposure (i.e., TV-watching, viewing internet images, engaging in social media exchanges) in the 3 days following the attacks were assessed. Multivariate regression models, adjusting for gender, age, direct exposure (i.e., witnessing in person or knowing someone injured or killed), residential area, social support, pre-attack mental health service utilization, and other adverse life events, examined the association between media exposure and PTSS (assessed using the self-report PCL-5). Compared to those reporting less than 2 hours of daily attack-related television exposure, those reporting 2-4 hours (β = 3.1, 95% CI = 0.8-5.3) or >4 hours (β = 4.7, 95% CI = 2.0-7.4) of media exposure reported higher attack-related PTSS. This finding was replicated with social media use: those with moderate (β = 3.2, 95% CI = 0.9-5.5) or high (β = 6.8, 95% CI = 1.9-11.7) use reported higher PTSS than those reporting no use. Subanalyses demonstrated that media exposure and PTSS were not associated in those directly exposed to the attacks. Results highlight the potential public health risk of extensive mass media exposure to traumatic events.
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Affiliation(s)
| | - Lise Eilin Stene
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Dana Rose Garfin
- Sue & Bill Gross School of Nursing, University of California, Irvine, Irvine, CA, United States
| | | | | | - Enguerrand du Roscoat
- Santé publique France, Saint Maurice, France.,Laboratoire Parisien de Psychologie Sociale, EA 4386, Université Paris Ouest Nanterre-La Défense, Nanterre, France
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8
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Gallien Y, Martin A, Caserio-Schönemann C, Le Strat Y, Thiam MM. Epidemiological study of opioid use disorder in French emergency departments, 2010-2018 from OSCOUR database. BMJ Open 2020; 10:e037425. [PMID: 33127629 PMCID: PMC7604823 DOI: 10.1136/bmjopen-2020-037425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
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.
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Affiliation(s)
- Yves Gallien
- Data Science Division, Santé publique France, Saint-Maurice, France
- SBIM, APHP, Paris, France
| | - Adrien Martin
- Data Science Division, Santé publique France, Saint-Maurice, France
| | | | - Yann Le Strat
- Data Science Division, Santé publique France, Saint-Maurice, France
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9
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Vuillermoz C, Stene LE, Aubert L, Motreff Y, Pirard P, Baubet T, Lesieur S, Chauvin P, Vandentorren S. Non-participation and attrition in a longitudinal study of civilians exposed to the January 2015 terrorist attacks in Paris, France. BMC Med Res Methodol 2020; 20:63. [PMID: 32171236 PMCID: PMC7071581 DOI: 10.1186/s12874-020-00943-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 02/28/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Non-participation and attrition are rarely studied despite being important methodological issues when performing post-disaster studies. A longitudinal survey of civilians exposed to the January 2015 terrorist attacks in Paris, France, was conducted 6 (Wave 1) and 18 months (Wave 2) after the attacks. We described non-participation in Wave 1 and determined the factors associated with attrition in Wave 2. METHODS Multivariate logistic regression models were used to compare participants in both waves with those who participated in the first wave only. Analyses were performed taking the following factors into account: socio-demographic characteristics, exposure to terror, peri-traumatic reactions, psychological support, perceived social support, impact on work, social and family life, and mental health disorders. Characteristics of new participants in Wave 2 were compared with participants in both waves using a chi-square test. RESULTS Of the 390 persons who were eligible to participate in the survey, 190 participated in Wave 1 (participation rate: 49%). The most frequently reported reason for non-participation was to avoid being reminded of the painful event (32%, n = 34/105). In Wave 2, 67 were lost to follow-up, 141 people participated, of whom 123 participated in Wave 1 (re-participation rate: 65%) and 18 were new. Attrition in Wave 2 was associated with socio-demographic characteristics (age, French origin) and location during the attacks, but not with terror exposure or mental health disorders. Compared with those who participated in both waves, new participants declared less social and psychological support since the attacks. CONCLUSIONS Attrition at 6 months was not associated with exposure to terror or mental health disorders, which indicates that any bias in future analyses on IMPACTS on mental health outcomes will be limited. Our findings suggest the importance of adapting similar surveys for people of foreign origin and of improving strategies to avoid attrition of younger people, for example by using social media, peers, and the educational environment. The present study also revealed that a high level of exposure to terror and a lack of social and psychological support after a terrorist event could impede individuals' participation in similar surveys in the short term.
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Affiliation(s)
- Cécile Vuillermoz
- Centre National de la Recherche Scientifique (CNRS), Centre Maurice Halbwachs (CNRS-UMR8097, EHESS, ENS), F75014, Paris, France.
| | - Lise Eilin Stene
- Norwegian centre for violence and traumatic stress studies (NKVTS), Oslo, Norway
| | - Lydéric Aubert
- Santé publique France, Direction des régions, F94415, Saint-Maurice, France
| | - Yvon Motreff
- Department of Social Epidemiology, INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F75012, Paris, France
- Santé publique France, Direction des maladies non transmissibles et traumatismes, F94415, Saint-Maurice, France
| | - Philippe Pirard
- Santé publique France, Direction des maladies non transmissibles et traumatismes, F94415, Saint-Maurice, France
| | - Thierry Baubet
- CESP Inserm 1178, Université Paris 13, Paris, France
- Psychopathology Department for Children, Adolescents, General Psychiatry and Specialized Addiction, APHP Hôpital Avicenne, F93009, Bobigny, France
- Centre national de Ressources et de Résilience (CNRR), Paris, France
| | - Sophie Lesieur
- Department of Social Epidemiology, INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F75012, Paris, France
| | - Pierre Chauvin
- Department of Social Epidemiology, INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F75012, Paris, France
| | - Stéphanie Vandentorren
- Santé publique France, Direction des régions, F94415, Saint-Maurice, France
- Department of Social Epidemiology, INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F75012, Paris, France
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10
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General Practitioner House Call Network (SOS Médecins): An Essential Tool for Syndromic Surveillance - Bordeaux, France. Prehosp Disaster Med 2020; 35:326-330. [PMID: 32131924 DOI: 10.1017/s1049023x20000308] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION In the French mainland administrative region Nouvelle-Aquitaine, syndromic surveillance is based on hospital emergency data, mortality data, and data from associations belonging to the SOS Médecins network. The aim of the present article is to describe the functioning of this network and to illustrate its use for syndromic surveillance in Nouvelle-Aquitaine. METHOD The SOS Médecins network participates in the syndromic surveillance system SurSaUD, developed by Santé publique France (SpF; the French National Public Health Agency; Saint-Maurice, Paris, France). Near real-time data are automatically transmitted daily to a data server and analyzed by SpF's Nouvelle Aquitaine's regional unit to identify, monitor, and evaluate the impact of expected and unexpected health events in the region. RESULTS The SOS Médecins network has five local associations spread across the region with 146 participating physicians. Data have been recorded for more than 10 years and represented nearly 481,000 visits in 2017. The resulting database has helped to identify and monitor seasonal epidemics and unexpected events, as well as measure the health impact of these events. CONCLUSION The data from the SOS Médecins network are an essential source in syndromic surveillance. They complement surveillance data from other sources. More specifically, mortality and emergency unit traffic reflect the most severe cases, while SOS Médecins data help early detection of epidemics and health events in the general population. The network has shown its responsiveness and its reliability, not only for the surveillance of seasonal epidemics, but also for the detection of unusual signals. It therefore constitutes an essential link in syndromic surveillance in France, and specifically in the Nouvelle-Aquitaine region.
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11
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Motreff Y, Baubet T, Pirard P, Rabet G, Petitclerc M, Stene LE, Vuillermoz C, Chauvin P, Vandentorren S. Factors associated with PTSD and partial PTSD among first responders following the Paris terror attacks in November 2015. J Psychiatr Res 2020; 121:143-150. [PMID: 31821960 DOI: 10.1016/j.jpsychires.2019.11.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/10/2019] [Accepted: 11/29/2019] [Indexed: 10/25/2022]
Abstract
During the evening of 13 November 2015, the deadliest terror attacks in France in recent times occurred in the Paris area. Overall, 130 people were killed, 643 were physically injured and several thousands were psychologically impacted. Thousands of first responders, including health professionals, firefighters, affiliated volunteers and police officers were mobilized that night and during the subsequent weeks. The aims of our study were to measure the psychological impact on first responders in terms of post-traumatic stress disorder (PTSD) and partial PTSD as well as associated factors 12 months after the 13 November 2015 terrorist attacks. First responders who had intervened during the night and/or the aftermath of the terror attacks had the possibility of answering a web-based study 8-12 months after the attacks. They satisfied criterion A of the DSM 5 definition of PTSD. PTSD and partial PTSD were measured using the PCL-5. Gender, age, educational level, exposure, first responder category, mental health and traumatic event history, training and social support were all analysed as potential factors associated with PTSD and partial PTSD, using multinomial logistic regression. Overall, 663 participants were included in this analysis. Prevalence of PTSD in our sample went from 3.4% among firefighters to 9.5% among police officers and prevalence of partial PTSD from 10.4% among health professionals to 23.2% among police officers. Low educational level and social isolation were associated with PTSD and partial PTSD. Intervention on unsecured crime scenes and lack of training were associated with PTSD. Special attention should be given to first responders living in social isolation, those with low educational levels and those who intervene in unsecured crime scenes. Education and training about the potential mental health consequences of mass trauma intervention should be developed.
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Affiliation(s)
- Yvon Motreff
- Santé publique France, Direction des maladies non transmissibles et traumatismes, F-94415 Saint-Maurice, France; Sorbonne Université, Inserm, Institut Pierre Louis D'Epidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, F75012, Paris, France.
| | - Thierry Baubet
- CESP Inserm 1178, Université Paris 13, Paris, France; Psychopathology Department for Children, Adolescents, General Psychiatry and Specialized Addiction, APHP Hôpital Avicenne, F93009, Bobigny, France; Centre National de Ressources et de Résilience (CNRR), Paris, France
| | - Philippe Pirard
- Santé publique France, Direction des maladies non transmissibles et traumatismes, F-94415 Saint-Maurice, France; CESP Inserm 1178, Université Paris 13, Paris, France
| | - Gabrielle Rabet
- Santé publique France, Direction appui traitements et analyses des données, F-94415 Saint-Maurice, France
| | - Matthieu Petitclerc
- Service Médical D'urgence - Bureau de Santé et de Prévention, Brigade de Sapeurs-pompiers de Paris, 1, Place Jules-Renard, 75017, Paris, France; Université Paris 13, Ecole Doctorale Erasme, Laboratoire UTRPP, F93430, Villetaneuse, France
| | - Lise Eilin Stene
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | - Cécile Vuillermoz
- Centre National de La Recherche Scientifique (CNRS), Équipe de Recherche sur Les Inégalités Sociales - Centre Maurice Halbwachs (CNRS-UMR8097, EHESS, ENS), Paris, France
| | - Pierre Chauvin
- Sorbonne Université, Inserm, Institut Pierre Louis D'Epidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, F75012, Paris, France
| | - Stéphanie Vandentorren
- Sorbonne Université, Inserm, Institut Pierre Louis D'Epidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, F75012, Paris, France; Santé publique France, Direction des régions, F-94415 Saint-Maurice, France
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12
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Bruckner TA, Lebreton É, Perrone N, Mortensen LH, Blondel B. Preterm birth and selection in utero among males following the November 2015 Paris attacks. Int J Epidemiol 2019; 48:1614-1622. [DOI: 10.1093/ije/dyz089] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2019] [Indexed: 02/06/2023] Open
Abstract
Abstract
Background
On 13 November 2015, coordinated terrorist attacks swept through Paris. This large stressor, like earlier terrorist attacks in the USA, may have perturbed the health of pregnant women. We test whether the attacks preceded an increase in the risk of preterm parturition among live-born males as well as excess male loss in utero. We focused on males on the basis of previous findings of elevated male frailty following population stressors.
Methods
We examined live births in the Paris region (n = 1 049 057) over 70 months, from January 2011 to October 2016. Interrupted time-series methods identified and removed serial correlation in the monthly risk of preterm birth; these methods employed non-linear least-squares estimation. We also repeated analyses using month of conception, and performed sensitivity tests among females as well as among male births outside Paris.
Results
Males exhibited an elevated incidence of preterm birth in November 2015 and January 2016 [risk difference for November 2015 = 0.006, 95% confidence interval (CI): 0.0002—0.012; risk difference for January 2016 = 0.010, 95% CI: 0.004—0.016], which equates to an 11% increase in the count of preterm births. Females, as well as males born outside Paris, showed no change in preterm delivery. The sex ratio also fell below expected values in December 2015, January 2016 and February 2016.
Conclusions
Among males, more preterm births, but fewer live births, occurred after the November 2015 Paris attacks. Future examinations of perinatal health responses to unexpected stressors may benefit from sex-specific analyses.
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Affiliation(s)
- Tim A Bruckner
- Program in Public Health, University of California at Irvine, Irvine, CA, USA
| | - Élodie Lebreton
- Perinat-ARS-IDF, Agence Régionale de Santé d'Île-de-France, Paris, France
| | - Natalie Perrone
- Department of Sociology, New York University, New York, NY, USA
| | - Laust H Mortensen
- Department of Social Medicine, and Statistics Denmark, University of Copenhagen, Copenhagen, Denmark
| | - Béatrice Blondel
- INSERM U1153, Center for Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
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13
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Lake IR, Colón-González FJ, Barker GC, Morbey RA, Smith GE, Elliot AJ. Machine learning to refine decision making within a syndromic surveillance service. BMC Public Health 2019; 19:559. [PMID: 31088446 PMCID: PMC6515660 DOI: 10.1186/s12889-019-6916-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 04/29/2019] [Indexed: 12/27/2022] Open
Abstract
Background Worldwide, syndromic surveillance is increasingly used for improved and timely situational awareness and early identification of public health threats. Syndromic data streams are fed into detection algorithms, which produce statistical alarms highlighting potential activity of public health importance. All alarms must be assessed to confirm whether they are of public health importance. In England, approximately 100 alarms are generated daily and, although their analysis is formalised through a risk assessment process, the process requires notable time, training, and maintenance of an expertise base to determine which alarms are of public health importance. The process is made more complicated by the observation that only 0.1% of statistical alarms are deemed to be of public health importance. Therefore, the aims of this study were to evaluate machine learning as a tool for computer-assisted human decision-making when assessing statistical alarms. Methods A record of the risk assessment process was obtained from Public Health England for all 67,505 statistical alarms between August 2013 and October 2015. This record contained information on the characteristics of the alarm (e.g. size, location). We used three Bayesian classifiers- naïve Bayes, tree-augmented naïve Bayes and Multinets - to examine the risk assessment record in England with respect to the final ‘Decision’ outcome made by an epidemiologist of ‘Alert’, ‘Monitor’ or ‘No-action’. Two further classifications based upon tree-augmented naïve Bayes and Multinets were implemented to account for the predominance of ‘No-action’ outcomes. Results The attributes of each individual risk assessment were linked to the final decision made by an epidemiologist, providing confidence in the current process. The naïve Bayesian classifier performed best, correctly classifying 51.5% of ‘Alert’ outcomes. If the ‘Alert’ and ‘Monitor’ actions are combined then performance increases to 82.6% correctly classified. We demonstrate how a decision support system based upon a naïve Bayes classifier could be operationalised within an operational syndromic surveillance system. Conclusions Within syndromic surveillance systems, machine learning techniques have the potential to make risk assessment following statistical alarms more automated, robust, and rigorous. However, our results also highlight the importance of specialist human input to the process.
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Affiliation(s)
- I R Lake
- School of Environmental Sciences, University of East Anglia, Norwich, NR4 7TJ, UK. .,National Institute for Health Research Health Protection Research Unit in Emergency Preparedness and Response, London, UK.
| | - F J Colón-González
- School of Environmental Sciences, University of East Anglia, Norwich, NR4 7TJ, UK.,National Institute for Health Research Health Protection Research Unit in Emergency Preparedness and Response, London, UK
| | - G C Barker
- National Institute for Health Research Health Protection Research Unit in Emergency Preparedness and Response, London, UK
| | - R A Morbey
- National Institute for Health Research Health Protection Research Unit in Emergency Preparedness and Response, London, UK.,Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, B3 2PW, UK
| | - G E Smith
- National Institute for Health Research Health Protection Research Unit in Emergency Preparedness and Response, London, UK.,Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, B3 2PW, UK
| | - A J Elliot
- National Institute for Health Research Health Protection Research Unit in Emergency Preparedness and Response, London, UK.,Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, B3 2PW, UK
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14
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De Stefano C, Akodad H, Gauducheau H, Reuter PG, Ricard JD, Petrovic T, Adnet F, Truchot J, Lapostolle F. Role of Student Nurse in the Prehospital Medical Teams Responding to the Scene of A Terrorist Attack in France. Nurs Outlook 2019; 67:441-449. [PMID: 30929957 DOI: 10.1016/j.outlook.2019.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/12/2019] [Accepted: 02/07/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The terrorist attacks in Paris and in Saint-Denis in November 2015 were unprecedented events involving various human and material resources. These events question the role of nurse students in prehospital teams. PURPOSE To investigate nursing students' preference about whether they wished to participate in the prehospital care during a terrorist attack. METHODS This cross-sectional study was conducted with student nurses, from two nursing schools in the Greater Paris area. They completed an anonymous survey assessing the desire to be called to help the mobile intensive care units (MICU) or another ward; whether their presence should be mandatory, and the feelings associated with their experience. The responses were collected with a visual analogue scale and could range from 1 (yes, very much) to 10 (no, not at all). A Chi-square test was performed for qualitative variables and a Mann-Whitney test for quantitative variables. FINDINGS Among 225 students, 205 (91%) responded, 133 (65%) were women. When on duty, 169 (82%) would have preferred to accompany the MICU team, compared with 31 (15%) who would have preferred not to go. Overall, 146 students (71%) considered that this presence should be optional. Only gender was significantly associated with the choice to accompany the MICU team (W = 87% vs. M = 13%; p = .002). Students expressed a moderate feeling of frustration and fear. DISCUSSION Students would prefer to assist the MICU team responding to the scene of a terrorist attack but feel this choice should be optional. A discussion in nursing schools and universities should be considered for the implementation of a "systematic" procedure to ensure the student's willingness to participate in such interventions.
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Affiliation(s)
- Carla De Stefano
- AP-HP, SAMU93 - UF Research Teaching Quality, Avicenne Hospital, Paris 13 University, Bobigny, France; Paris 13 University, Sorbonne Cité, Bobigny, France; AP-HP, Department of Child and Adolescent Pyschiatry and General Psychiatry, Avicenne Hospital, Paris 13 Sorbonne University, Paris Cité, Laboratoire UTRPP, France.
| | - Hayatte Akodad
- AP-HP, SAMU93 - UF Research Teaching Quality, Avicenne Hospital, Paris 13 University, Bobigny, France
| | - Helene Gauducheau
- IADE School Nurse-Anesthetists Theodore Simon, Paris 13 University, Sorbonne Cité, Neuilly sur Marne, France
| | - Paul-Georges Reuter
- AP-HP, SAMU93 - UF Research Teaching Quality, Avicenne Hospital, Paris 13 University, Bobigny, France; Paris 13 University, Sorbonne Cité, Bobigny, France
| | - Jean-Damien Ricard
- AP-HP, Intensive Care Unit, Louis Mourier Hospital, Colombes, France; Paris Diderot University, Paris, France
| | - Tomislav Petrovic
- AP-HP, SAMU93 - UF Research Teaching Quality, Avicenne Hospital, Paris 13 University, Bobigny, France
| | - Frédéric Adnet
- AP-HP, SAMU93 - UF Research Teaching Quality, Avicenne Hospital, Paris 13 University, Bobigny, France; Paris 13 University, Sorbonne Cité, Bobigny, France
| | - Jennifer Truchot
- Paris Diderot University, Paris, France; AP-HP, Emergency Department, Lariboisière Hospital, Paris, France
| | - Frédéric Lapostolle
- AP-HP, SAMU93 - UF Research Teaching Quality, Avicenne Hospital, Paris 13 University, Bobigny, France; Paris 13 University, Sorbonne Cité, Bobigny, France
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15
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Colón-González FJ, Lake IR, Morbey RA, Elliot AJ, Pebody R, Smith GE. A methodological framework for the evaluation of syndromic surveillance systems: a case study of England. BMC Public Health 2018; 18:544. [PMID: 29699520 PMCID: PMC5921418 DOI: 10.1186/s12889-018-5422-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 04/09/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Syndromic surveillance complements traditional public health surveillance by collecting and analysing health indicators in near real time. The rationale of syndromic surveillance is that it may detect health threats faster than traditional surveillance systems permitting more timely, and hence potentially more effective public health action. The effectiveness of syndromic surveillance largely relies on the methods used to detect aberrations. Very few studies have evaluated the performance of syndromic surveillance systems and consequently little is known about the types of events that such systems can and cannot detect. METHODS We introduce a framework for the evaluation of syndromic surveillance systems that can be used in any setting based upon the use of simulated scenarios. For a range of scenarios this allows the time and probability of detection to be determined and uncertainty is fully incorporated. In addition, we demonstrate how such a framework can model the benefits of increases in the number of centres reporting syndromic data and also determine the minimum size of outbreaks that can or cannot be detected. Here, we demonstrate its utility using simulations of national influenza outbreaks and localised outbreaks of cryptosporidiosis. RESULTS Influenza outbreaks are consistently detected with larger outbreaks being detected in a more timely manner. Small cryptosporidiosis outbreaks (<1000 symptomatic individuals) are unlikely to be detected. We also demonstrate the advantages of having multiple syndromic data streams (e.g. emergency attendance data, telephone helpline data, general practice consultation data) as different streams are able to detect different outbreak types with different efficacy (e.g. emergency attendance data are useful for the detection of pandemic influenza but not for outbreaks of cryptosporidiosis). We also highlight that for any one disease, the utility of data streams may vary geographically, and that the detection ability of syndromic surveillance varies seasonally (e.g. an influenza outbreak starting in July is detected sooner than one starting later in the year). We argue that our framework constitutes a useful tool for public health emergency preparedness in multiple settings. CONCLUSIONS The proposed framework allows the exhaustive evaluation of any syndromic surveillance system and constitutes a useful tool for emergency preparedness and response.
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Affiliation(s)
- Felipe J. Colón-González
- School of Environmental Sciences, University of East Anglia, Norwich, NR4 7TJ UK
- NIHR Health Protection Research Unit for Emergency Preparedness and Response, London, UK
| | - Iain R. Lake
- School of Environmental Sciences, University of East Anglia, Norwich, NR4 7TJ UK
- NIHR Health Protection Research Unit for Emergency Preparedness and Response, London, UK
| | - Roger A. Morbey
- Real-time Syndromic Surveillance Team, National Infection Service, Public Health England, Birmingham, B3 2PW UK
- NIHR Health Protection Research Unit for Emergency Preparedness and Response, London, UK
| | - Alex J. Elliot
- Real-time Syndromic Surveillance Team, National Infection Service, Public Health England, Birmingham, B3 2PW UK
- NIHR Health Protection Research Unit for Emergency Preparedness and Response, London, UK
| | - Richard Pebody
- Respiratory Diseases Department, National Infection Service, Public Health England, London, NW9 5EQ UK
| | - Gillian E. Smith
- Real-time Syndromic Surveillance Team, National Infection Service, Public Health England, Birmingham, B3 2PW UK
- NIHR Health Protection Research Unit for Emergency Preparedness and Response, London, UK
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16
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Chatignoux E, Gabet A, Moutengou E, Pirard P, Motreff Y, Bonaldi C, Olié V. The 2015 and 2016 terrorist attacks in France: was there a short-term impact on hospitalizations for cardiovascular disease? Clin Epidemiol 2018; 10:413-419. [PMID: 29695935 PMCID: PMC5905462 DOI: 10.2147/clep.s154492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The terrorist attacks in Paris and Nice in 2015 and 2016 generated widespread emotional stress in France. Given that acute emotional stress is a well-known trigger for cardiovascular disease, we investigated whether these attacks had any short-term impact on hospitalizations for acute cardiovascular disease in France. Methods Annual hospital discharge data from 2009 to 2016 were extracted from the French Hospital Discharge Database. All hospitalizations with a primary diagnosis of acute coronary syndrome, heart failure, or stroke were selected. Generalized additive Poisson models were used to differentiate "unusual" variations in daily hospitalization numbers in the 15 days following the attacks from the expected background hospitalization rate. Results The average daily number of hospitalizations was 396.4 for acute coronary syndrome, 598.6 for heart failure, and 334.6 for stroke. The daily mean number of hospitalizations for heart failure and stroke was higher in the 15 days following each attack compared with the reference periods. However, multivariate analysis showed no significant variation in the risk of hospitalization in the days following the attacks. Interpretation Watching events unfold on television, no matter how dramatic, was not a sufficiently potent trigger for cardiovascular disease, although it may have led to an increase in hospitalizations for stress or anxiety. The 2015 and 2016 terrorist attacks do not seem to have had any measurable short-term impact on hospitalizations for cardiovascular disease either in the Paris and Nice regions or in the rest of France.
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Affiliation(s)
- Edouard Chatignoux
- Non-Communicable Diseases and Trauma Direction, The French Public Health Agency, Saint-Maurice, France
| | - Amélie Gabet
- Non-Communicable Diseases and Trauma Direction, The French Public Health Agency, Saint-Maurice, France
| | - Elodie Moutengou
- Non-Communicable Diseases and Trauma Direction, The French Public Health Agency, Saint-Maurice, France
| | - Philippe Pirard
- Non-Communicable Diseases and Trauma Direction, The French Public Health Agency, Saint-Maurice, France
| | - Yvon Motreff
- Non-Communicable Diseases and Trauma Direction, The French Public Health Agency, Saint-Maurice, France
| | - Christophe Bonaldi
- Non-Communicable Diseases and Trauma Direction, The French Public Health Agency, Saint-Maurice, France
| | - Valérie Olié
- Non-Communicable Diseases and Trauma Direction, The French Public Health Agency, Saint-Maurice, France
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17
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De Stefano C, Orri M, Agostinucci JM, Zouaghi H, Lapostolle F, Baubet T, Adnet F. Early psychological impact of Paris terrorist attacks on healthcare emergency staff: A cross-sectional study. Depress Anxiety 2018; 35:275-282. [PMID: 29421842 DOI: 10.1002/da.22724] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 01/04/2018] [Accepted: 01/08/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The terrorist attacks in Paris and Saint Denis on November 13, 2015 were an unprecedented traumatic event in France. It was an especially distressing ordeal for the healthcare personnel involved in the care of the victims. The aim of this study was to estimate the effect of direct participation in the rescue on posttraumatic stress disorder (PTSD) symptoms among these workers. METHODS Less than a month later, 613 healthcare providers (professionals and paraprofessionals) from three hospitals in the Paris suburbs were asked to complete an anonymous questionnaire. A multivariable Poisson model estimated the effect of participating onsite in the rescue (exposure variable) on the number of PTSD symptoms measured by the Trauma Screening Questionnaire (TSQ; outcome variable), adjusted for covariates. RESULTS Two hundred thirty-three providers completed the assessment (38% response rate), 130 participated directly in the rescue (56%). Participation was associated with a higher number of symptoms of PTSD (RR = 1.34, P = .002) than for nonparticipants. Female gender (RR = 1.39, P < .001) and basic (vs. advanced or intermediate) life-saving training (RR = 1.42, P = .004) were also associated with more PTSD symptoms. Participants in the rescue were at 2.76 times more risk of a probable PTSD diagnosis (OR = 2.76, P = .037), defined as reporting at least six PTSD symptoms. Sensitivity analyses using propensity score matching supported the robustness of our findings. CONCLUSIONS Healthcare providers directly involved in the rescue of the victims of the Paris and Saint Denis attacks reported a significantly higher psychological impact, defined by PTSD symptoms, than those not directly involved.
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Affiliation(s)
- Carla De Stefano
- AP-HP, Urgences-Samu 93, hôpital Avicenne, Université Paris 13, Bobigny, France.,AP-HP, Department of Child and Adolescent Psychiatry and General Psychiatry, Avicenne Hospital, Paris 13 Sorbonne University, Paris Cité, Laboratoire UTRPP (EA 4403), Inserm, 669, France
| | - Massimiliano Orri
- CESP, Fac. de médecine-Univ. Paris-Sud, Fac. de médecine-UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
| | | | - Haroun Zouaghi
- French Red Cross, Seine Saint-Denis District, Paris, France
| | - Frederic Lapostolle
- AP-HP, Urgences-Samu 93, hôpital Avicenne, Université Paris 13, Bobigny, France
| | - Thierry Baubet
- AP-HP, Department of Child and Adolescent Psychiatry and General Psychiatry, Avicenne Hospital, Paris 13 Sorbonne University, Paris Cité, Laboratoire UTRPP (EA 4403), Inserm, 669, France
| | - Frederic Adnet
- AP-HP, Urgences-Samu 93, hôpital Avicenne, Université Paris 13, Bobigny, France
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18
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Fleischauer AT, Gaines J. Enhancing Surveillance for Mass Gatherings: The Role of Syndromic Surveillance. Public Health Rep 2018; 132:95S-98S. [PMID: 28692398 DOI: 10.1177/0033354917706343] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Aaron T Fleischauer
- 1 Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA.,2 Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, NC, USA
| | - Joanna Gaines
- 3 Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Deschepper R, Six S, Gidron Y, Depoorter AM, Vandekerckhove M, Gheysens N, Van Overmeire R, Bilsen J. Association between feeling threatened by a terrorist attack and subjective health: a web survey a week after the attacks of 22 March 2016 in Belgium. Eur J Psychotraumatol 2018; 9:1500821. [PMID: 30128083 PMCID: PMC6095037 DOI: 10.1080/20008198.2018.1500821] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 06/17/2018] [Accepted: 06/21/2018] [Indexed: 12/16/2022] Open
Abstract
Background: The wave of terrorist attacks over the past years in Europe and other regions may cause problems such as anxiety and depressive symptoms. Some studies suggest that perceived threat might also trigger physical health problems. Objective: To investigate the association between feeling threatened and subjective health during the week following a terrorist attack. Method: Online survey with a self-selected sample in the Belgian population one week after the terrorist attacks in 2016. Participants were invited through the Belgian media to fill in a questionnaire in Dutch, French or English on a website. The main outcomes were the association between 'feeling threatened' and subjective health problems. Perceived threat was measured with the question 'During the week after the attacks … Did you feel threatened?' Subjective health was measured by using standardized scales (ACSA, PHQ-4, PHQ-15). Results: A total of 2620 respondents completed the questionnaire, of whom 69.8% were female, 27.7% lived and 43.1% worked in Brussels. Gender, age, place of living and working, media exposure, religiousness and religious affiliation were associated significantly with higher perceived threat. A total of 21% of the respondents felt much or very much threatened during the week after the attacks. They reported significantly higher levels of mental and physical health problems. The most frequently reported problems were anxiety and depressive symptoms. The health problems that differentiated most markedly between those with low and high levels of perceived threat were fainting spells, chest pain and shortness of breath. Conclusion: In a self-selected sample of respondents, 'feeling threatened' was strongly associated with lower level of wellbeing and higher levels of mental and physical health problems. The most prevalent health problems were mental health problems but the most pronounced differences between people with low versus high levels of perceived threat were physical health problems.
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Affiliation(s)
- Reginald Deschepper
- Mental Health and Wellbeing Research Group. Vrije Universiteit Brussel, Brussels, Belgium
| | - Stefaan Six
- Mental Health and Wellbeing Research Group. Vrije Universiteit Brussel, Brussels, Belgium
| | - Yori Gidron
- Scalab UMR 9191, Universite Lille, Lille, France
| | - Anne-Marie Depoorter
- Mental Health and Wellbeing Research Group. Vrije Universiteit Brussel, Brussels, Belgium
| | - Marie Vandekerckhove
- Mental Health and Wellbeing Research Group. Vrije Universiteit Brussel, Brussels, Belgium
| | - Nancy Gheysens
- Mental Health and Wellbeing Research Group. Vrije Universiteit Brussel, Brussels, Belgium
| | - Roel Van Overmeire
- Mental Health and Wellbeing Research Group. Vrije Universiteit Brussel, Brussels, Belgium
| | - Johan Bilsen
- Mental Health and Wellbeing Research Group. Vrije Universiteit Brussel, Brussels, Belgium
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Haga JM, Thoresen S, Stene LE, Wentzel-Larsen T, Dyb G. Healthcare to parents of young terrorism survivors: a registry-based study in Norway. BMJ Open 2017; 7:e018358. [PMID: 29273662 PMCID: PMC5778306 DOI: 10.1136/bmjopen-2017-018358] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To assess changes in parents' short-term and long-term primary and specialised healthcare consumption following a terrorist attack threatening the lives of their children. DESIGN Registry-based study comparing parental healthcare service consumption in the 3 years before and the 3 years after a terrorist attack. SETTING The aftermath of the Utøya terrorist attack. The regular, publicly funded, universal healthcare system in Norway. INTERVENTION Parents learning of a terrorist attack on their adolescent and young adult children. PARTICIPANTS Mothers (n=226) and fathers (n=141) of a total of 263 survivors of the Utøya terrorist attack (54.6% of all survivors 13-33 years, n=482). MAIN OUTCOME MEASURES We report primary and specialised somatic and mental healthcare service consumption in the early (0-6 months) and delayed (>6-36 months) aftermath of the attack, both in terms of frequency of services consumed (assessed by age-adjusted negative binomial hurdle regression) and proportions of mothers and fathers provided for (mean semiannual values). The predisaster and postdisaster rates were compared by rate ratios (RRs), and 95% CI were generated through bootstrap replications. RESULTS Frequency of primary healthcare service consumption increased significantly in both mothers and fathers in the early aftermath of the attack (mothers: RR=1.97, 95% CI 1.76 to 2.23; fathers: RR=1.73, 95% CI 1.36 to 2.29) and remained significantly elevated throughout the delayed aftermath. In the specialised mental healthcare services, a significant increase in the frequency of service consumption was observed in mothers only (early: RR=7.00, 95% CI 3.86 to 19.02; delayed: RR=3.20, 95% CI 1.49 to 9.49). In specialised somatic healthcare, no significant change was found. CONCLUSION Following terrorist attacks, healthcare providers must prepare for increased healthcare needs in survivors and their close family members, such as parents. Needs may present shortly after the attack and require long-term follow-up.
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Affiliation(s)
- Jon Magnus Haga
- Norwegian Centre of Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Siri Thoresen
- Norwegian Centre of Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | - Lise Eilin Stene
- Norwegian Centre of Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | - Tore Wentzel-Larsen
- Norwegian Centre of Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Grete Dyb
- Norwegian Centre of Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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