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CONTEXT: In France, care workers and health students have been intensely mobilized during the first wave of the COVID-19 pandemic. But few studies have evaluated psychological distress on non-medical health students, in addition to the challenges posed by pedagogical continuity while universities are closed following health and safety regulations. OBJECTIVES: This study aims to assess COVID-19's impact on health students in France on different levels: psychological, educational and social. METHODS: An online national cross-sectional study, from April 11 to May 30 2020, included sociodemographic, work conditions and numeric scales. RESULTS: A total of 4411 students answered. Regarding the K6 scale, 39% of students had moderate distress, and 21% had a high level of distress. Risk factors of psychological distress included being a woman (P<0.001), being between 19 and 21 years old (P<0.001), living alone (P=0.008), and not having the ability to isolate (P<0.001). Students on the frontline had less psychological distress (57 vs 62%, P=0.003), better quality of sleep (34% vs 28% high quality, P<0.001) but a higher consumption of medical (8.5% vs 6.5%, P=0.044) and non-medical (18% vs 10%, P<0.001) psychotropic drugs. Nurse and medical students had more distress and used more non-medical psychotropic substances than other health students (15% vs 9.2%). DISCUSSION: COVID-19' crisis had an important impact on health students' mental health, social life and training with discrepancies regarding the speciality whether they were on the frontline or not. There is an urgent need for psychological and pedagogical support for students, and even more so regarding the prolongation of the COVID-19 epidemic.
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Introduction: La pandémie COVID-19 a débuté quelque mois après le début de l'étude MOVE, étude visant à décrire les modalités d'utilisation en vie réelle du dupilumab chez les patients adultes atteints de dermatite atopique (DA) modérée à sévère. En France, des mesures de confinement strictes ont été adoptées pour limiter l'expansion de l'infection, puis différentes périodes ont suivi: déconfinement, restrictions sanitaires… Au cours de ces différentes périodes, après une phase initiale de sidération pendant laquelle l'initiation de traitements systémiques a été réduite, les experts et sociétés savantes ont été unanimes sur l'absence de risque d'immunosuppression du dupilumab du fait de son mécanisme d'action. Son utilisation a donc été poursuivie. L'objectif de cette analyse complémentaire était de décrire l'impact de la pandémie sur la prise en charge thérapeutique des patients adultes atteints de dermatite atopique (DA) modérée à sévère. Matériel et méthodes: Une comparaison a été effectuée parmi les 594 patients de l'étude MOVE entre ceux dont le traitement par dupilumab a été initié avant le premier confinement (17 mars 2020) et ceux dont le traitement a été initié après, afin de comparer leurs caractéristiques et leurs traitements systémiques antérieurs. Résultats: Cent cinquante-trois patients (25,8 %) avaient débuté le traitement par dupilumab avant le 17 mars 2020 : 100 (65,4 %) avaient eu une prescription antérieure de ciclosporine A (CsA) ;441 patients (74,2 %) avaient débuté le traitement par dupilumab après le début du confinement : 191 (43,3 %) avaient eu une prescription antérieure de CsA. À partir du confinement, la CsA n'a pas été prescrite pour des raisons liées à la pandémie pour 67 patients sur 233 (30,0 %), et la CsA a été arrêtée chez 8 patients sur 15 (53,3 %) pour les mêmes raisons. Au total, parmi les 594 patients éligibles, la contre-indication circonstancielle (risque d'infection COVID-19) a été le motif rapporté spontanément par les médecins observateurs pour 77 patients (12,7 %) pour expliquer soit la non-prescription : 8 patients (1,3 %), soit l'arrêt de CsA : 69 patients (11,6 %). Discussion: La pandémie COVID-19 a eu un impact sur la prescription de CsA chez les patients adultes atteints de DA modérée à sévère à partir de mars 2020. La contre-indication circonstancielle a été déclarée spontanément par les médecins observateurs, et est probablement sous-estimée dans ces résultats. Cette étude montre que, malgré ces circonstances exceptionnelles, les modalités de prescription du dupilumab étaient, pour la majorité des patients, conformes à son périmètre de remboursement.
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Déclaration de liens d'intérêts : Les auteurs déclarent ne pas avoir de liens d'intérêts.
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BACKGROUND: The first wave of the COVID-19 pandemic in France was associated with a reduced number of hospitalizations for self-harm, with the exception of older people. The on-going pandemic may have both sustained and delayed effects. METHODS: Data were extracted from the French national hospital database (PMSI), a nationwide exhaustive database. The number of self-harm hospitalizations (ICD-10 codes X60-84) between September 1, 2020 and August 31, 2021 (N = 85,679) was compared to 2019 (N = 88,782) using Poisson regression models. RESULTS: There was a decrease in the total number of self-harm hospitalizations during the studied period versus 2019 (-3.5%; Relative Risk [RR] [95% Confidence Intervals] = 0.97 [0.96-0.97]; p < 0.0001). However, sex and age effects were identified. While adults aged 30-59-years-old showed a decrease (monthly decreases: -12.6 to -15.0%), we found an increase in adolescent girls (+27.7%, RR = 1.28 [1.25-1.31]; p < 0.0001), notably since January 2021. Moreover, the numbers were similar to 2019 in adolescent boys, in youths aged 20-29 years, and in people aged 70 and more. Hospitalizations in intensive care units decreased (-6.7%, RR = 0.93 [0.91-0.96]; p < 0.0001) and deaths at hospital following self-harm remained stable (+0.6%, Hazard Ratio = 0.99 [0.91-1.08], p = 0.79). CONCLUSIONS: During this second stage, the number of self-harm hospitalizations remained at a lower level than in the prepandemic period. However, significant variations over time, age, and sex were observed. Young people (notably adolescent girls) appear to have particularly suffered from the persistence of the pandemic, while older people did not show any decrease since the beginning. Vigilance and continuing prevention are warranted.
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COVID-19 , Self-Injurious Behavior , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , Female , France/epidemiology , Hospitalization , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , Self-Injurious Behavior/epidemiologyABSTRACT
COVID-19 limitation strategies have led to widespread school closures around the world. The present study reports children's mental health and associated factors during the COVID-19 school closure in France in the spring of 2020. We conducted a cross-sectional analysis using data from the SAPRIS project set up during the COVID-19 pandemic in France. Using multinomial logistic regression models, we estimated associations between children's mental health, children's health behaviors, schooling, and socioeconomic characteristics of the children's families. The sample consisted of 5702 children aged 8-9 years, including 50.2% girls. In multivariate logistic regression models, children's sleeping difficulties were associated with children's abnormal symptoms of both hyperactivity-inattention (adjusted Odds Ratio (aOR) 2.05;95% Confidence Interval 1.70-2.47) and emotional symptoms (aOR 5.34;95% CI 4.16-6.86). Factors specifically associated with abnormal hyperactivity/inattention were: male sex (aOR 2.29;95% CI 1.90-2.76), access to specialized care prior to the pandemic and its suspension during school closure (aOR 1.51;95% CI 1.21-1.88), abnormal emotional symptoms (aOR 4.06;95% CI 3.11-5.29), being unschooled or schooled with assistance before lockdown (aOR 2.13;95% CI 1.43-3.17), and tutoring with difficulties or absence of a tutor (aOR 3.25;95% CI 2.64-3.99;aOR 2.47;95% CI 1.48-4.11, respectively). Factors associated with children's emotional symptoms were the following: being born pre-term (aOR 1.34;95% CI 1.03-1.73), COVID-19 cases among household members (aOR 1.72;95% CI 1.08-2.73), abnormal symptoms of hyperactivity/inattention (aOR 4.18;95% CI 3.27-5.34) and modest income (aOR 1.45;95% CI 1.07-1.96;aOR 1.36;95% CI 1.01-1.84). Multiple characteristics were associated with elevated levels of symptoms of hyperactivity-inattention and emotional symptoms in children during the period of school closure due to COVID-19. Further studies are needed to help policymakers to balance the pros and cons of closing schools, taking into consideration the educational and psychological consequences for children.
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OBJECTIVES: During the COVID-19 pandemic, the French government has decided a general lockdown. This unprecedented situation has raised concerns about children's and adolescent's mental health. Children and adolescents diagnosed with attention deficit hyperactivity disorder (ADHD) may find this context of restrained activity particularly tricky. The objectives of our study are to gather information about the well-being and global life conditions of children and adolescents with ADHD during the COVID-19 outbreak in France. METHODS: We designed a survey including both open-ended questions and questionnaire items for parents of children and adolescents with ADHD. Parents responded to the following open-ended questions: 1) "How is your child doing since the lockdown?" 2) "How is life at home since the lockdown?" 3) "If you had a remote service provision with a mental health professional (e.g. by telephone or video technology), please share your thoughts and any suggestions with us" 4) "Please share any other items that you think are important about ADHD symptoms of your child and the lockdown situation". This survey was posted on social media on the 6th of April and disseminated by French ADHD-parent and patient organizations. The present article reports the descriptive, qualitative and textometrical analyses of the survey. RESULTS: Between day 20 and 30 of lockdown, 538 parents responded to the survey, and we included 533 responses in the final analysis. The vast majority of responders were women 95 % (95 % CI 93,50; 97,18) with children whose mean age was 10,5 (95 % CI 7.58; 13.44). Since the lockdown, 34.71 % (95 % CI 30.70; 38.94) of children experienced a worsening in well-being, 34.33 % (95 % CI 30.34; 38.56) showed no significant changes and 30.96 % (95 % CI 27.09; 35.10) were doing better according to their parents. The thematic analysis showed that an improvement of their children's anxiety was one of the main topics addressed by parents. This improvement related to less school-related strain and flexible schedules that respected their children's rhythm. Improved self-esteem was another topic that parents linked with a lesser exposure of their children to negative feed-back. Parents repeatedly reported both inattention and hyperactivity/impulsivity. However, optimal lockdown life conditions seemed to compensate for the impact of ADHD symptoms (e.g. sufficient space at home, presence of a garden). Some parents reported worsening of general well-being in their children, and this manifested as oppositional/defiant attitudes and emotional outbursts. Parents also cited sleep problems and anxiety in this context. As regards everyday life during lock-down, at-home schooling was another major topic-parents described that their children struggled to complete school-related tasks and that teachers seemed to have forgotten about academic accommodations. The lockdown situation seems to have raised parents' awareness of the role of inattention and ADHD symptoms in their children's learning difficulties. Due to potential selection biases, the results of our survey may not be generalizable to all children and adolescents with ADHD. The main strengths of this rapid survey-based study lies in the reactivity of the participants and the quality and diversity of their responses to the open-ended questions. CONCLUSIONS: According to their parents, most children and adolescents with ADHD experience stability or improvement of their well-being. An improvement in school-related anxiety and the flexible adjustment to the children's' rhythms as well as parents' increased awareness of the difficulties their children experience are among the key topics in parents' descriptions.