COVID-19 pandemic in France: health emergency experiences from the field

Aim

This paper describes the situation regarding COVID‐19 emergency in France as of early May 2020, the main policies to fight this virus, and the roles and responsibilities of nurses regarding their work at this time, as well as the challenges facing the profession.

Background

Europe continues to be affected by the COVID‐19 pandemic. At the time of writing France was the fourth country with the highest number of detected cases and cumulative deaths.

Sources of evidence

Websites of the World Health Organization, French Government, French Agency of Public Health, French National Council of Nurses and ClinicalTrials.gov database, as well as the experiences of the authors.

Discussion

The history of the development of the pandemic in France helps explain the establishment of the state of health emergency and containment of the population. Many decisions made had undesirable repercussions, particularly in terms of intra‐family violence, mental health disorders and the renunciation of care. Hospitals and primary care services, with significant investment by nurses, played a key role in the care of persons with and without COVID‐19.

Conclusion

France has suffered a very high toll in terms of COVID‐19 morbidity and mortality, and effects on its people, health systems and health professionals, including nurses.

Implications for nursing practice

Nurses are recognized for their social usefulness in France. However, it is important to consider the collateral effects of this crisis on nurses and nursing and to integrate the health emergency nursing skills established during the pandemic into the standard field of nursing competence.

Implications for nursing policy

The nursing profession has expectations of a reflection on and revision of nursing skills as well as of its valorization in the French healthcare system, notably carried out by the French National Council Order of Nurses.

Impact of improved urban environment and coaching on physical condition and quality of life in elderly women: a controlled study

BACKGROUND

Physical activity can slow the ageing process and preserve autonomy in the elderly. The aim of this study was to assess the combined impact of an organized urban walking circuit and individual coaching on women senior citizens' physical well-being and quality of life.

METHODS

Insufficiently physically active women >65 years were included in a quasi-experimental trial. Active arm: District with improved urban environment (IUE). Control arm: District without improved urban environment (WIUE). In each district, subjects were randomly allocated to receive coaching (C+ vs. C-). The main outcome measures were endurance, physical activity score, flexibility, quality of life, physical self-esteem, ageing exercise stereotypes, functional health and perceived health at baseline, three (M3) and six (M6) months.

RESULTS

Fifty-two insufficiently physically active women were included, 23 in IUE and 29 in WIUE. Groups were comparable at baseline. At M3, endurance and physical activity score significantly improved compared with baseline in the IUE group and in the C+ group while no statistically significant change was observed for the WIUE group and the C- group. Moreover, endurance score was higher in the IUE group, whether coupled with coaching or not. After the coaching was removed, the IUE group regresses to baseline overall and the WIUE shows a decrement in endurance.

CONCLUSION

Our study highlights the positive impact of an improved environment and of individual coaching on the level of physical activity and quality of life of insufficiently physically active elderly women.

Oxidative Stress and Cardiovascular Risk in Type 1 Diabetes Mellitus: Insights From the DCCT/EDIC Study

Background

Hyperglycemia leading to increased oxidative stress is implicated in the increased risk for the development of macrovascular and microvascular complications in patients with type 1 diabetes mellitus.

Methods and Results

A random subcohort of 349 participants was selected from the DCCT / EDIC (Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications) cohort. This included 320 controls and 29 cardiovascular disease cases that were augmented with 98 additional known cases to yield a case cohort of 447 participants (320 controls, 127 cases). Biosamples from DCCT baseline, year 1, and closeout of DCCT , and 1 to 2 years post‐ DCCT ( EDIC years 1 and 2) were measured for markers of oxidative stress, including plasma myeloperoxidase, paraoxonase activity, urinary F 2α isoprostanes, and its metabolite, 2,3 dinor‐8 iso prostaglandin F 2α . Following adjustment for glycated hemoblobin and weighting the observations inversely proportional to the sampling selection probabilities, higher paraoxonase activity, reflective of antioxidant activity, and 2,3 dinor‐8 iso prostaglandin F 2α , an oxidative marker, were significantly associated with lower risk of cardiovascular disease (−4.5% risk for 10% higher paraoxonase, P <0.003; −5.3% risk for 10% higher 2,3 dinor‐8 iso prostaglandin F 2α , P =0.0092). In contrast, the oxidative markers myeloperoxidase and F 2α isoprostanes were not significantly associated with cardiovascular disease after adjustment for glycated hemoblobin. There were no significant differences between DCCT intensive and conventional treatment groups in the change in all biomarkers across time segments.

Conclusions

Heightened antioxidant activity (rather than diminished oxidative stress markers) is associated with lower cardiovascular disease risk in type 1 diabetes mellitus, but these biomarkers did not change over time with intensification of glycemic control.

Clinical Trial Registration

URL : https://www.clinicaltrials.gov . Unique identifiers: NCT 00360815 and NCT 00360893.

Links between specialization in the finishing of bulls, mixing, farmers' attitudes towards animals and the production of finishing bulls: a survey on French farms

In France, beef bulls are finished by breeder-finishers who produce calves and then fatten them, or by specialized finishers who fatten bulls that they buy. According to previous results on both dairy cows and pigs, breeding on the farm promotes positive attitudes of farmers towards animals, which can lead to improved animal health and growth. The mixing of bulls on their arrival at a specialized unit could stress them and thus impair health and growth. We hypothesized that breeder-finishers have more positive attitudes towards bulls and their work with bulls than specialized finishers, and that positive attitudes lead to better production, whereas mixing may be counterproductive. We observed 1038 bulls (67 groups) finished by breeder-finishers or specialized finishers in mixed and unmixed groups. Using a questionnaire, we assessed farmers' beliefs about the sensitivities of bulls, their attitude towards contacts with bulls, their beliefs about successful factors in finishing, and job satisfaction. We recorded the number of clinical signs and weight gain of the bulls. Specialized finishers tended to have more negative contacts with bulls than breeder-finishers (P=0·06). Poor health of bulls was associated with (i) a positive attitude towards gentle contacts with bulls (P<0·01), (ii) job satisfaction (P=0·01), and (iii) was negatively correlated to beliefs in bulls being difficult animals (P=0·09). Fast growth of bulls was associated with job satisfaction (P<0·01). Unmixed bulls grew faster than mixed bulls (P=0·05). We conclude that in finishing bulls, it is production results that have an impact on attitudes, rather than the opposite: the need for close contacts with bulls resulting from health problems engenders more positive attitudes of farmers towards their animals, and good production results increase job satisfaction. Variations in production results between breeder-finishers and specialized finishers seem to lie more in the fact that the latter always use animals mixed at the beginning of the finishing period - with mixing impairing growth - than in the attitudes of farmers towards animals and their work.

Supercooling of the disordered vortex lattice in Bi(2)Sr(2)CaCu(2)O(8+delta)

Time-resolved local induction measurements near the vortex lattice order-disorder transition in optimally doped Bi(2)Sr(2)CaCu(2)O(8+delta) crystals show that the high-field, disordered phase can be quenched to fields as low as half the transition field. Over an important range of fields, the electrodynamical behavior of the vortex system is governed by the coexistence of ordered and disordered vortex phases in the sample. We interpret the results as supercooling of the high-field phase and the possible first-order nature of the order-disorder transition at the "second magnetization peak."

Re-examination of training effects by electrostimulation in the human elbow musculoskeletal system

This study examines the effects of a 7 weeks sub-maximal training period of electrostimulation on the maximal isometric, concentric, eccentric voluntary torque and muscle contractile properties of the elbow flexor muscles of nine subjects. The daily program consisted of five series of six 6-s isometric actions (60 to 70% of maximal isometric voluntary action) at an elbow angle of 90 . After training the maximal voluntary isometric flexion torque increased significantly whereas the maximal voluntary isometric extension torque decreased significantly. Increases in isometric flexion torque were linked to an increase of the myoelectrical activity of the biceps brachii muscle. Under dynamic conditions flexion torque was significantly increased throughout the whole spectrum of angular velocities. These changes were accompanied by an increase in the myoelectrical activity of the agonist muscle under eccentric conditions and at two fast concentric angular velocities, without modifications of the myoelectrical activity of the antagonist muscle. The analysis of the electrical and mechanical twitches indicated that modifications of the muscle membrane electrical activity were also present at the muscle level. These results indicate that torque gains were attributed to neural adaptations and/or to a modification of the relative part of agonist and antagonist muscles in elbow flexion torque production.

Isokinetic elbow flexion and coactivation following eccentric training

The influence of an eccentric training on torque/angular velocity relationships and coactivation level during maximal voluntary isokinetic elbow flexion was examined. Seventeen subjects divided into two groups (Eccentric Group EG, n = 9 Control Group CG, n = 8) performed on an isokinetic dynamometer, before and after training, maximal isokinetic elbow flexions at eight angular velocities (from - 120 degrees s(-1) under eccentric conditions to 240 degrees s(-1) under concentric conditions), and held maximal and submaximal isometric actions. Under all conditions, the myoelectric activities (EMG) of the biceps and the triceps brachii muscles were recorded and quantified as the RMS value. Eccentric training of the EG consisted of 5x6 eccentric muscle actions at 100 and 120% of one maximal repetition (IRM) for 21 sessions and lasted 7 weeks. In the EG after training, torque was significantly increased at all angular velocities tested (ranging from 11.4% at 30 degrees (s-1) to 45.5% at - 120 degrees s(-1)) (p < 0.05). These changes were accompanied by an increase in the RMS activities of the BB muscle under eccentric conditions (from - 120 to - 30 degrees (s-1)) and at the highest concentric angular velocities (180 and 24 degrees s(-1)) (p < 0.05). The RMS activity of the TB muscle was not affected by the angular velocity in either group for all action modes. The influence of eccentric training on the torque gains under eccentric conditions and for the highest velocities was attributed essentially to neural adaptations.