Infections in Infants during the First 12 Months of Life: Role of Placental Malaria and Environmental Factors

Background: The association between placental malaria (PM) and first peripheral parasitaemias in early infancy was assessed in Tori Bossito, a rural area of Benin with a careful attention on transmission factors at an individual level. Methodology: Statistical analysis was performed on 550 infants followed weekly from birth to 12 months. Malaria transmission was assessed by anopheles human landing catches every 6 weeks in 36 sampling houses and season defined by rainfall. Each child was located by GPS and assigned to the closest anopheles sampling house. Data were analysed by survival Cox models, stratified on the possession of insecticide-treated mosquito nets (ITNs) at enrolment. Principal Findings: Among infants sleeping in a house with an ITN, PM was found to be highly associated to first malaria infections, after adjusting on season, number of anopheles, antenatal care (ANC) visits and maternal severe anaemia. Infants born from a malaria infected placenta had a 2.13 fold increased risk to present a first malaria infection than those born from a non infected placenta ([1.24-3.67], p<0.01) when sleeping in a house with an ITN. The risk to present a first malaria infection was increased by 3.2 to 6.5, according to the level of anopheles exposure (moderate or high levels, compared to the absence of anopheles). Conclusions: First malaria infections in early childhood can be attributed simultaneously to both PM and high levels of exposure to infected anopheles. Protective measures as Intermittent Preventive Treatment during pregnancy (IPTp) and ITNs, targeted on both mothers and infants should be reinforced, as well as the research on new drugs and insecticides. In parallel, investigations on placental malaria have to be strengthened to better understand the mechanisms involved, and thus to protect adequately the infants high risk group

Direct impact of COVID-19 by estimating disability-adjusted life years at national level in France in 2020

Background: The World Health Organization declared a pandemic of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), on March 11, 2020. The standardized approach of disability-adjusted life years (DALYs) allows for quantifying the combined impact of morbidity and mortality of diseases and injuries. The main objective of this study was to estimate the direct impact of COVID-19 in France in 2020, using DALYs to combine the population health impact of infection fatalities, acute symptomatic infections and their post-acute consequences, in 28 days (baseline) up to 140 days, following the initial infection. Methods: National mortality, COVID-19 screening, and hospital admission data were used to calculate DALYs based on the European Burden of Disease Network consensus disease model. Scenario analyses were performed by varying the number of symptomatic cases and duration of symptoms up to a maximum of 140 days, defining COVID-19 deaths using the underlying, and associated, cause of death. Results: In 2020, the estimated DALYs due to COVID-19 in France were 990 710 (1472 per 100 000), with 99% of burden due to mortality (982 531 years of life lost, YLL) and 1% due to morbidity (8179 years lived with disability, YLD), following the initial infection. The contribution of YLD reached 375%, assuming the duration of 140 days of post-acute consequences of COVID-19. Post-acute consequences contributed to 49% of the total morbidity burden. The contribution of YLD due to acute symptomatic infections among people younger than 70 years was higher (67%) than among people aged 70 years and above (33%). YLL among people aged 70 years and above, contributed to 74% of the total YLL. Conclusions: COVID-19 had a substantial impact on population health in France in 2020. The majority of population health loss was due to mortality. Men had higher population health loss due to COVID-19 than women. Post-acute consequences of COVID-19 had a large contribution to the YLD component of the disease burden, even when we assume the shortest duration of 28 days, long COVID burden is large. Further research is recommended to assess the impact of health inequalities associated with these estimates

Healthcare utilizaton of youths with a chronic disease transitioning to adulthood

L’amélioration du pronostic des pathologies chroniques à début pédiatrique s’est accompagnée d’un nombre grandissant de patients atteignant l’âge adulte. Cependant, l’adolescence et l’entrée dans la vie adulte est une période de multiples changements et de crises, pouvant être à l’origine de rupture avec le système de soins et de complications médicales. Dans cette thèse, j’ai tout d’abord décrit les hospitalisations et la mortalité des jeunes ayant été déclarés en affection de longue durée (ALD) avant 14 ans (N=1752), en comparaison à des jeunes sans pathologie chronique (N=52346). Pour cela, une cohorte rétrospective (2005-2014) a été reconstruite à partir de l’échantillon généraliste des bénéficiaires de l’Assurance maladie. Environ 3% des jeunes de 14 ans avaient déjà été déclarés en ALD. Les profils de mortalité par sexe et les tendances par âge de l’incidence des hospitalisations étaient différents de ceux de la population générale du même âge, en particulier après 18 ans, où l’on observait une chute de l’incidence des hospitalisations. Ensuite, à partir de ces mêmes données, j’ai montré que le pronostic de ces jeunes malades, y compris la mortalité, était associé à la précarité sociale, mesurée par la couverture maladie universelle complémentaire, montrant ainsi que la gratuité des soins à laquelle ces jeunes ont droit dans le système de santé français ne permettait pas de compenser les inégalités sociales dans cette population. Enfin, à un moment ou un autre, ces jeunes sont transférés vers un service d’adultes. Ce passage est un moment crucial dans leur suivi, qui peut être à l’origine d’une discontinuité du suivi médical. Des programmes de transition sont mis en place progressivement pour préparer et accompagner ce transfert. J’ai réalisé une revue systématique de la littérature (23 études) qui a montré qu’il existait deux aspects de la continuité des soins au moment de ce transfert : l’engagement (premier contact) et le maintien dans le suivi en service d’adultes. Cette analyse a également mis en exergue la pauvreté des études existant actuellement pour évaluer les programmes de transition en termes de continuité des soins. Finalement, ces résultats soulèvent de nombreuses questions, notamment les stratégies d’adaptation de ces jeunes vis-à-vis des situations à haut risque et le rôle du transfert en service d’adultes sur le comportement des patients, le pronostic et les pratiques cliniques. Des études incluant largement l’ensemble des jeunes atteints d’une pathologie chronique, intégrant notamment des facteurs liés à l’organisation des soins, liés à la pathologie, individuels et familiaux, devraient être encouragées.The prognosis of childhood-onset chronic conditions has improved, such that more patients now reach adulthood. However, adolescence and entry into adulthood is a critical period that may be associated with poor outcomes, including gaps in care continuity and medical complications. Here, I first described hospitalization and mortality rates in youths registered for a long-term disease (LTD) before the age of 14 (N=1,752), relative to those with no LTD (N=52,346). A retrospective cohort (2005-2014) was built from a sample of the French national health insurance database, called Echantillon généraliste des Bénéficiaires. Approximately 3% of 14-year-old youths had been registered for a LTD. The mortality patterns by gender and the trend in hospitalization rates by age were different from those in the general population of the same age, especially after reaching the age of 18, which was followed by a fall in hospitalization rates. Then, using the same data, I showed that the prognosis of these youths living with a chronic disease, including mortality, was associated with low socio-economic level, as measured by being covered by Couverture Maladie Universelle Complementaire, a public complementary health insurance offering free access to care, delivered on the basis of very low househould incomes. Hence, overcoming financial barriers did not offset social health inequalities in this population. At last, one day, these youths have to be transferred to adult care. Moving to adult care is a critical time in patients’ follow-up that may lead to discontinuity in medical care. Transition programs are being gradually implemented, to prepare and smooth the transfer and support youths during this period. I performed a systematic review of literature (23 studies) that highlighted two aspects of continuity of care during transfer: engagement (first contacts) and retention in adult care once the first contact has been established. This review also emphasized the paucity of knowledge to evaluate transition programs in terms of care continuity. Finally, the results of this PhD raises many issues that need to be addressed, including coping strategies of young patients with high risk situations, and the role of transfer to adult care on patient behavior, prognosis and clinical practices. Studies involving patients with a large spectrum of severe chronic diseases, including factors related to healthcare organization, related to the disease, individual and familial, should be encouraged

Recours aux soins des jeunes en transition vers l’âge adulte ayant une pathologie chronique

The prognosis of childhood-onset chronic conditions has improved, such that more patients now reach adulthood. However, adolescence and entry into adulthood is a critical period that may be associated with poor outcomes, including gaps in care continuity and medical complications. Here, I first described hospitalization and mortality rates in youths registered for a long-term disease (LTD) before the age of 14 (N=1,752), relative to those with no LTD (N=52,346). A retrospective cohort (2005-2014) was built from a sample of the French national health insurance database, called Echantillon généraliste des Bénéficiaires. Approximately 3% of 14-year-old youths had been registered for a LTD. The mortality patterns by gender and the trend in hospitalization rates by age were different from those in the general population of the same age, especially after reaching the age of 18, which was followed by a fall in hospitalization rates. Then, using the same data, I showed that the prognosis of these youths living with a chronic disease, including mortality, was associated with low socio-economic level, as measured by being covered by Couverture Maladie Universelle Complementaire, a public complementary health insurance offering free access to care, delivered on the basis of very low househould incomes. Hence, overcoming financial barriers did not offset social health inequalities in this population. At last, one day, these youths have to be transferred to adult care. Moving to adult care is a critical time in patients’ follow-up that may lead to discontinuity in medical care. Transition programs are being gradually implemented, to prepare and smooth the transfer and support youths during this period. I performed a systematic review of literature (23 studies) that highlighted two aspects of continuity of care during transfer: engagement (first contacts) and retention in adult care once the first contact has been established. This review also emphasized the paucity of knowledge to evaluate transition programs in terms of care continuity. Finally, the results of this PhD raises many issues that need to be addressed, including coping strategies of young patients with high risk situations, and the role of transfer to adult care on patient behavior, prognosis and clinical practices. Studies involving patients with a large spectrum of severe chronic diseases, including factors related to healthcare organization, related to the disease, individual and familial, should be encouraged.L’amélioration du pronostic des pathologies chroniques à début pédiatrique s’est accompagnée d’un nombre grandissant de patients atteignant l’âge adulte. Cependant, l’adolescence et l’entrée dans la vie adulte est une période de multiples changements et de crises, pouvant être à l’origine de rupture avec le système de soins et de complications médicales. Dans cette thèse, j’ai tout d’abord décrit les hospitalisations et la mortalité des jeunes ayant été déclarés en affection de longue durée (ALD) avant 14 ans (N=1752), en comparaison à des jeunes sans pathologie chronique (N=52346). Pour cela, une cohorte rétrospective (2005-2014) a été reconstruite à partir de l’échantillon généraliste des bénéficiaires de l’Assurance maladie. Environ 3% des jeunes de 14 ans avaient déjà été déclarés en ALD. Les profils de mortalité par sexe et les tendances par âge de l’incidence des hospitalisations étaient différents de ceux de la population générale du même âge, en particulier après 18 ans, où l’on observait une chute de l’incidence des hospitalisations. Ensuite, à partir de ces mêmes données, j’ai montré que le pronostic de ces jeunes malades, y compris la mortalité, était associé à la précarité sociale, mesurée par la couverture maladie universelle complémentaire, montrant ainsi que la gratuité des soins à laquelle ces jeunes ont droit dans le système de santé français ne permettait pas de compenser les inégalités sociales dans cette population. Enfin, à un moment ou un autre, ces jeunes sont transférés vers un service d’adultes. Ce passage est un moment crucial dans leur suivi, qui peut être à l’origine d’une discontinuité du suivi médical. Des programmes de transition sont mis en place progressivement pour préparer et accompagner ce transfert. J’ai réalisé une revue systématique de la littérature (23 études) qui a montré qu’il existait deux aspects de la continuité des soins au moment de ce transfert : l’engagement (premier contact) et le maintien dans le suivi en service d’adultes. Cette analyse a également mis en exergue la pauvreté des études existant actuellement pour évaluer les programmes de transition en termes de continuité des soins. Finalement, ces résultats soulèvent de nombreuses questions, notamment les stratégies d’adaptation de ces jeunes vis-à-vis des situations à haut risque et le rôle du transfert en service d’adultes sur le comportement des patients, le pronostic et les pratiques cliniques. Des études incluant largement l’ensemble des jeunes atteints d’une pathologie chronique, intégrant notamment des facteurs liés à l’organisation des soins, liés à la pathologie, individuels et familiaux, devraient être encouragées

Réponse au traitement antirétroviral initié pendant ou en dehors de la grossesse chez des femmes infectées par le VIH

Près d un tiers des femmes enceintes infectées par le VIH qui ne sont pas sous traitement antirétroviral (ART) à la conception n atteint pas l indétectabilité de la charge virale (CV) à l accouchement tel que recommandé en France. Cet objectif virologique est très exigeant au vu du temps imparti, par rapport à ce qui est recommandé en dehors de la grossesse. L objectif était d étudier si la grossesse pouvait avoir en plus un impact sur la réponse immuno-virologique précoce suivant l instauration d un traitement antirétroviral combiné (cART).Toutes les femmes naïves d ART des cohortes multicentriques françaises ANRS EPF, COPANA et PRIMO étaient éligibles. La réponse virologique (CV <400 cp/mL et <50 cp/mL) à 1, 3 et 6 mois a été comparée chez les femmes commençant un cART au cours (n=708) ou en dehors (n=110) de la grossesse depuis 2004. A M1, la réponse virologique était meilleure pendant la grossesse qu en dehors, mais après ajustement sur la CV initiale la différence n était plus significative. La réponse virologique à 400 cp/mL était excellente et similaire dans les deux groupes : 90% à M3 et plus de 95% à M6. Cependant, la réponse virologique à 50 cp/mL tendait à être moins bonne chez les femmes enceintes que non enceintes à M3 et M6. La réponse immunologique était similaire dans les deux groupes.En conclusion, la réponse au cART était similaire pendant ou en dehors de la grossesse, bien qu il ne soit pas exclu que certains facteurs liés à la grossesse pourraient expliquer en partie la moins bonne réponse virologique à 50 cp/mL. Le principal facteur limitant l atteinte d une CV indétectable à l'accouchement semble être la courte durée de traitement.PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocSudocFranceF

Interactive telemedicine: effects on professional practice and health care outcomes.

BACKGROUND: Telemedicine (TM) is the use of telecommunication systems to deliver health care at a distance. It has the potential to improve patient health outcomes, access to health care and reduce healthcare costs. As TM applications continue to evolve it is important to understand the impact TM might have on patients, healthcare professionals and the organisation of care. OBJECTIVES: To assess the effectiveness, acceptability and costs of interactive TM as an alternative to, or in addition to, usual care (i.e. face-to-face care, or telephone consultation). SEARCH METHODS: We searched the Effective Practice and Organisation of Care (EPOC) Group's specialised register, CENTRAL, MEDLINE, EMBASE, five other databases and two trials registers to June 2013, together with reference checking, citation searching, handsearching and contact with study authors to identify additional studies. SELECTION CRITERIA: We considered randomised controlled trials of interactive TM that involved direct patient-provider interaction and was delivered in addition to, or substituting for, usual care compared with usual care alone, to participants with any clinical condition. We excluded telephone only interventions and wholly automatic self-management TM interventions. DATA COLLECTION AND ANALYSIS: For each condition, we pooled outcome data that were sufficiently homogenous using fixed effect meta-analysis. We reported risk ratios (RR) and 95% confidence intervals (CI) for dichotomous outcomes, and mean differences (MD) for continuous outcomes. MAIN RESULTS: We included 93 eligible trials (N = 22,047 participants), which evaluated the effectiveness of interactive TM delivered in addition to (32% of studies), as an alternative to (57% of studies), or partly substituted for usual care (11%) as compared to usual care alone.The included studies recruited patients with the following clinical conditions: cardiovascular disease (36), diabetes (21), respiratory conditions (9), mental health or substance abuse conditions (7), conditions requiring a specialist consultation (6), co morbidities (3), urogenital conditions (3), neurological injuries and conditions (2), gastrointestinal conditions (2), neonatal conditions requiring specialist care (2), solid organ transplantation (1), and cancer (1).Telemedicine provided remote monitoring (55 studies), or real-time video-conferencing (38 studies), which was used either alone or in combination. The main TM function varied depending on clinical condition, but fell typically into one of the following six categories, with some overlap: i) monitoring of a chronic condition to detect early signs of deterioration and prompt treatment and advice, (41); ii) provision of treatment or rehabilitation (12), for example the delivery of cognitive behavioural therapy, or incontinence training; iii) education and advice for self-management (23), for example nurses delivering education to patients with diabetes or providing support to parents of very low birth weight infants or to patients with home parenteral nutrition; iv) specialist consultations for diagnosis and treatment decisions (8), v) real-time assessment of clinical status, for example post-operative assessment after minor operation or follow-up after solid organ transplantation (8) vi), screening, for angina (1).The type of data transmitted by the patient, the frequency of data transfer, (e.g. telephone, e-mail, SMS) and frequency of interactions between patient and healthcare provider varied across studies, as did the type of healthcare provider/s and healthcare system involved in delivering the intervention.We found no difference between groups for all-cause mortality for patients with heart failure (16 studies; N = 5239; RR:0.89, 95% CI 0.76 to 1.03, P = 0.12; I(2) = 44%) (moderate to high certainty of evidence) at a median of six months follow-up. Admissions to hospital (11 studies; N = 4529) ranged from a decrease of 64% to an increase of 60% at median eight months follow-up (moderate certainty of evidence). We found some evidence of improved quality of life (five studies; N = 482; MD:-4.39, 95% CI -7.94 to -0.83; P < 0.02; I(2) = 0%) (moderate certainty of evidence) for those allocated to TM as compared with usual care at a median three months follow-up. In studies recruiting participants with diabetes (16 studies; N = 2768) we found lower glycated haemoglobin (HbA1c %) levels in those allocated to TM than in controls (MD -0.31, 95% CI -0.37 to -0.24; P < 0.00001; I(2)= 42%, P = 0.04) (high certainty of evidence) at a median of nine months follow-up. We found some evidence for a decrease in LDL (four studies, N = 1692; MD -12.45, 95% CI -14.23 to -10.68; P < 0.00001; I(2 =) 0%) (moderate certainty of evidence), and blood pressure (four studies, N = 1770: MD: SBP:-4.33, 95% CI -5.30 to -3.35, P < 0.00001; I(2) = 17%; DBP: -2.75 95% CI -3.28 to -2.22, P < 0.00001; I(2) = 45% (moderate certainty evidence), in TM as compared with usual care.Seven studies that recruited participants with different mental health and substance abuse problems, reported no differences in the effect of therapy delivered over video-conferencing, as compared to face-to-face delivery. Findings from the other studies were inconsistent; there was some evidence that monitoring via TM improved blood pressure control in participants with hypertension, and a few studies reported improved symptom scores for those with a respiratory condition. Studies recruiting participants requiring mental health services and those requiring specialist consultation for a dermatological condition reported no differences between groups. AUTHORS' CONCLUSIONS: The findings in our review indicate that the use of TM in the management of heart failure appears to lead to similar health outcomes as face-to-face or telephone delivery of care; there is evidence that TM can improve the control of blood glucose in those with diabetes. The cost to a health service, and acceptability by patients and healthcare professionals, is not clear due to limited data reported for these outcomes. The effectiveness of TM may depend on a number of different factors, including those related to the study population e.g. the severity of the condition and the disease trajectory of the participants, the function of the intervention e.g., if it is used for monitoring a chronic condition, or to provide access to diagnostic services, as well as the healthcare provider and healthcare system involved in delivering the intervention

Placental malaria is associated with increased risk of nonmalaria infection during the first 18 months of life in a Beninese population

PRIFPRI3; ISI; CRP4PHND; A4NHCGIAR Research Program on Agriculture for Nutrition and Health (A4NH

Projection of age of individuals living with HIV and time since ART initiation in 2030: estimates for France

International audienceIntroduction: Thanks to antiretroviral treatment (ART), people living with HIV (PLHIV) are living longer and ageing. However, ageing involves increased risks of co-morbidities, which also depend on when PLHIV individuals started ART. To tackle the HIV age-related upcoming challenges, knowledge of the current and future age structure of the HIV population is needed. Here, we forecast the demographic profile of the adult population living with diagnosed HIV (aPLdHIV) in France until 2030, accounting for the impact of the ART initiation period on mortality.Methods: We used national data from the French Hospital Database on HIV (ANRS CO4-FHDH) and a sample of the National Health Data System to, first, characterize the aPLdHIV in 2018 and estimate their mortality rates according to age, sex and ART initiation period. Second, we used national HIV surveillance data to define three scenarios for the numbers of newly diagnosed HIV cases over 2019-2030: 30% decrease in HIV cases (S1), status quo situation (S2) and epidemic elimination (S3). We then combined these data using a matrix model, to project the age structure of aPLdHIV and time since ART initiation.Results: In 2018, there was an estimated 161,125 aPLdHIV (33% women), of which 55% were aged 50 or older (50+), 22% aged 60+ and 8% aged 70+. In 2030, the aPLdHIV would grow to 195,246 for S1, 207,972 for S2 and 167,221 for S3. Whatever the scenario, in 2030, the estimated median time since ART initiation would increase and age distribution would shift towards older ages: with 65-72% aPLdHIV aged 50+, 42-48% 60+ and 17-19% 70+. This corresponds to ∼83,400 aPLdHIV (28% women) aged 60+, among which ∼69% started ART more than 20 years ago (i.e. before 2010) and ∼39% ≥30 years ago (i.e. before 2000), and to ∼33,100 aPLdHIV (27% women) aged 70+, among which ∼72% started ART ≥20 years ago and ∼43% ≥30 years ago.Conclusions: By 2030, in France, close to 20% of the aPLdHIV will be aged 70+, of which >40% would have started ART more than 30 years ago. These estimates are essential to adapt co-morbidities screening and anticipate resource provision in the aged care sector

Social deprivation and the use of healthcare services over one year by children less than 18 years of age in 2018: A French nationwide observational study.

This study aimed to describe the health status of children and how social deprivation affects their use of healthcare services and mortality. Children living in mainland France were selected from the national health data system (SNDS) on their date of birth or birthday in 2018 ( 1 night (rQ5/Q1 = 1.44). Psychiatric hospitalization was more frequent for children with CMUc (rCMUc/Not = 3.5, 0.7% vs 0.2%). Higher mortality was observed for deprived children < 18 years (rQ5/Q1 = 1.59). Our results show a lower use of pediatricians, other specialists, and dentists among deprived children that may be due, in part, to an insufficient supply of care in their area of residence. These results have been used to recommend optimization and specifically adapted individual or area-wide policies on the use of healthcare services, their density, and activities