Is COVID-19 to Blame? Trends of Incidence and Sex Ratio in Youth-Onset Type 2 Diabetes in Germany.

OBJECTIVE: We investigated the incidence of pediatric type 2 diabetes (T2D) in Germany during 2 years of the coronavirus disease 2019 (COVID-19) pandemic (2020-2021) compared with the control period 2011-2019. RESEARCH DESIGN AND METHODS: Data on T2D in children (aged 6 to <18 years) were obtained from the DPV (German Diabetes Prospective Follow-up) Registry. Poisson regression was used to estimate incidences for 2020 and 2021 based on data from 2011 to 2019, and these were compared with observed incidences in 2020 and 2021 by estimating incidence rate ratios (IRRs) with 95% CIs. RESULTS: Incidence of youth-onset T2D increased from 0.75 per 100,000 patient-years (PYs) in 2011 (95% CI 0.58, 0.93) to 1.25 per 100,000 PYs in 2019 (95% CI 1.02, 1.48), an annual increase of 6.8% (95% CI 4.1, 9.6). In 2020, T2D incidence increased to 1.49 per 100,000 PYs (95% CI 1.23, 1.81), which was not significantly higher than predicted (IRR 1.15; 95% CI 0.90, 1.48). In 2021, the observed incidence was significantly higher than expected (1.95; 95% CI 1.65, 2.31 vs. 1.38; 95% CI 1.13, 1.69 per 100,000 PYs; IRR 1.41; 95% CI 1.12, 1.77). Although there was no significant increase in incidence in girls in 2021, the observed incidence in boys (2.16; 95% CI 1.73, 2.70 per 100,000 PYs) significantly exceeded the predicted rate (IRR 1.55; 95% CI 1.14, 2.12), leading to a reversal of the sex ratio of pediatric T2D incidence. CONCLUSIONS: In Germany, incidence of pediatric T2D increased significantly in 2021. Adolescent boys were more affected by this increase, resulting in a reversal of the sex ratio of youth-onset T2D.

Effet du confinement lié au COVID-19 sur les rythmes veilles-sommeil chez l'adulte présentant un trouble du spectre autistique vs contrôles

Objectif Le confinement lié au Covid-19 a conduit à un changement des activités et routines du quotidien des français, pouvant affecter le sommeil différemment selon les populations. Notre étude est la 1ère à comparer l'effet du confinement sur les rythmes veille-sommeil et les comportements associés chez des sujets avec trouble du spectre autistique (TSA) et la population générale. Méthodes Une enquête en ligne nationale a permis de recruter 207 adultes avec TSA (56 % femmes) et 1652 contrôles (77 % femmes), d'un âge moyen égal (35 ans [17-70]). Résultats Avant le confinement, les sujets avec TSA avaient un sommeil plus tardif que les contrôles (13 % se couchant après 1 h et 6 % se levant après 11 h, contre 4 % et 0,6 %, p < 0,01), un rythme veille-sommeil plus irrégulier (15 % pouvant décaler leur rythme de plus de 2 h d'un jour à l'autre, contre 7 % chez les contrôles, p < 0,001), et un temps passé devant les écrans plus grand (21 % ≥ 4 heures par jour contre 9 % pour les contrôles, p < 0,001). L'ensemble des variables de sommeil et comportement associés ont été affecté significativement par le confinement (heure de lever et de coucher plus tardif, rythme veille-sommeil plus irrégulier, exposition aux écrans plus élevé, exposition à la lumière du jour réduite), la différence avant/pendant confinement était proche dans les deux populations. Conclusion Les rythmes veille-sommeil se sont détériorés pendant le confinement pour les sujets avec TSA et population générale. En revanche, les sujets TSA présentant déjà des difficultés avant le confinement, le décalage de phase et l'irrégularité des rythmes étaient encore plus extrêmes.

COVID-19: Mental Health Prevention and Care for Healthcare Professionals.

The Coronavirus Disease 2019 (COVID-19) pandemic exposed health professionals to high stress levels inducing significant psychological impact. Our region, Grand Est, was the most impacted French region during the first COVID-19 wave. In this context, we created CoviPsyHUS, local mental health prevention and care system dedicated explicitly to healthcare workers affected by the COVID-19 pandemic in one of this region's tertiary hospitals. We deployed CoviPsyHUS gradually in 1 month. To date, CoviPsyHUS comprises 60 mental health professionals dedicated to 4 complementary components: (i) a mental health support hotline (170 calls), (ii) relaxation rooms (used by 2,120 healthcare workers with 110 therapeutic workshops offered), (iii) mobile teams (1,200 contacts with healthcare staff), and (iv) a section dedicated to patients and their families. Among the critical points to integrate mental health care system during a crisis, we identified: (i) massive dissemination of mental health support information with multimodal communication, (ii) clear identification of the mental health support system, (iii) proactive mobile teams to identify healthcare professionals in difficulty, (iv) concrete measures to relieve the healthcare professionals under pressure (e.g., the relay in communication with families), (v) support for primary needs (body care (physiotherapy), advice and first-line therapy for sleep disorders), and (vi) psychoeducation and emotion management techniques. The different components of CoviPsyHUS are vital elements in meeting the needs of caregivers in situations of continuous stress. The organization of 4 targeted, modular, and rapidly deployable components makes CoviPsyHUS an innovative, reactive, and replicable mental health prevention and care system that could serve as a universal support model for other COVID-19 affected teams or other exceptional health crises in the future.

Differential effects of COVID-related lockdown on sleep-wake rhythms in adults with autism spectrum disorder compared to the general population.

COVID-related lockdown led to a radical modification of daily activities and routines which are known to affect sleep. Compared to the general population, participants with autism may be particularly vulnerable to the repercussions of lockdown on sleep, given their intrinsic inflexible adherence to routines and the high overall prevalence of sleep disturbances in this population. The study is a French nation-wide online survey assessing sleep-wake rhythms and behaviors known to affect sleep (daily screen time, daylight exposure, and physical activity), before and during COVID-related lockdown. Respondents were 207 adults with autism (56% female) and 1652 adults of the general population (77% female), with a mean age 35.3 years (SD 11.3). Before lockdown, the adults with autism displayed on average later bedtime and waking hours, lower sleep quality, more evening screen time, less exposure to daylight, and less exercise (all p < 0.01). Lockdown affected all studied measures of sleep and related exposures in a similar way in both groups: poorer self-rated sleep quality as well as a less regular and delayed sleep-wake rhythm, longer screen time in the evening and less exposure to daylight (all p < 0.001). Adults with autism displayed significantly higher levels of sleep and circadian rhythm disturbances and less favorable daily routines known to regulate sleep. While the effect of confinement on sleep and sleep related behaviors was similar in both groups, the results highlight that the pre-existing shift in circadian rhythms and lifestyles in adults with ASD further deteriorated during lockdown. LAY ABSTRACT: COVID-related lockdown led to a radical modification of daily activities and routines known to affect sleep. In a sample of 1800 adults, we observed that, before lockdown, participants with autism displayed significantly higher levels of sleep disturbances and less favorable daily routines known to regulate sleep, compared to the general population. While the deleterious effect of lockdown on sleep was similar in both groups, pre-existing difficulties in adults with autism reached worrying levels during lockdown.

Sleep and circadian rhythm characteristics in individuals from the general population during the French COVID-19 full lockdown

Summary The full 2-month lockdown to fight the coronavirus disease 2019 (COVID-19) pandemic in 2020 led to substantial disruption of daily life and routines. The present study aimed to comprehensively identify the lockdown?s effects on sleep, daily rhythms and emotions of the French population. A survey was published online during the last week of the 2-month full lockdown and 1,627 individuals completed the online survey. The survey was self-administered and included standardised questionnaires. Sleep schedules were delayed during lockdown in more than half of the participants. New severe delayed sleep phase affected 10% of participants with sleep schedules delayed by ≥3 hr during the lockdown compared to before. A significant decrease in exposure to morning (p < 0.001) and evening natural light (p < 0.001), a significant increase in screen exposure time (with a significant screen exposure >3 hr during the evening for 45% of the participants during lockdown versus 18% before lockdown, p < 0.001), an increase in substance use for one-quarter of participants, a poorer sleep quality in 56% of participants, and less regular sleep schedules in 48% of participants were observed. We also found a poorer sleep quality in women than men during lockdown (p = 0.004). The French full lockdown had a severe impact on sleep quality, sleep?wake rhythms, and sleep behaviours. The implementation of public health strategies for the prevention and care of sleep?wake cycles during lockdown are therefore essential.

Effet du confinement lié au COVID-19 sur les rythmes veilles-sommeil chez l’adulte présentant un trouble du spectre autistique vs contrôles

Objectif Le confinement lié au Covid-19 a conduit à un changement des activités et routines du quotidien des français, pouvant affecter le sommeil différemment selon les populations. Notre étude est la 1ère à comparer l’effet du confinement sur les rythmes veille-sommeil et les comportements associés chez des sujets avec trouble du spectre autistique (TSA) et la population générale. Méthodes Une enquête en ligne nationale a permis de recruter 207 adultes avec TSA (56 % femmes) et 1652 contrôles (77 % femmes), d’un âge moyen égal (35 ans [17-70]). Résultats Avant le confinement, les sujets avec TSA avaient un sommeil plus tardif que les contrôles (13 % se couchant après 1h et 6 % se levant après 11h, contre 4 % et 0,6 %, p<0,01), un rythme veille-sommeil plus irrégulier (15 % pouvant décaler leur rythme de plus de 2h d’un jour à l’autre, contre 7 % chez les contrôles, p<0,001), et un temps passé devant les écrans plus grand (21 % ≥4heures par jour contre 9 % pour les contrôles, p<0,001). L’ensemble des variables de sommeil et comportement associés ont été affecté significativement par le confinement (heure de lever et de coucher plus tardif, rythme veille-sommeil plus irrégulier, exposition aux écrans plus élevé, exposition à la lumière du jour réduite), la différence avant/pendant confinement était proche dans les deux populations. Conclusion Les rythmes veille-sommeil se sont détériorés pendant le confinement pour les sujets avec TSA et population générale. En revanche, les sujets TSA présentant déjà des difficultés avant le confinement, le décalage de phase et l’irrégularité des rythmes étaient encore plus extrêmes.

Conseils d’experts du sommeil pour bien dormer et garder le rythme chez les adultes et les enfants en cette période de confinement liée au CoVid-19

Résumé A la fois le confinement lié au virus Covid-19 et le stress induit par la pandémie peuvent entraîner des perturbations importantes des rythmes et du sommeil. Des experts du sommeil de la section Sommeil et rythmes biologiques en Psychiatrie (SoPsy) de l’Association Française de Psychiatrie Biologique et de Neuropsychopharmacologie (AFPBN) et de la Société Française de Recherche et Médecine du Sommeil (SFRMS), en partenariat avec le Réseau Morphée et l’Institut National du Sommeil et de la Vigilance (INSV), proposent ici des conseils pour bien dormir et garder ses rythmes. Des recommandations spécifiques sont adressées d’une part aux adultes et d’autre part aux parents pour leurs enfants. Les personnes avec un trouble de l’humeur (dépression, trouble bipolaire, etc) doivent particulièrement prêter attention et conserver des routines durant cette période afin de maintenir une humeur stable. Il est proposé des stratégies d’autogestion pour renforcer l’horloge biologique, tous les jours ! Les recommandations comportent des astuces simples et pratiques pour le jour et la nuit, mais aussi des conseils spécifiques à ce contexte pour limiter l’exposition au stress et mieux le gérer. Enfin, quelques sources et liens utiles sont proposés. Both, the confinement itself and the stress induces by the Covid-19 virus pandemic can lead to significant disruptions in habitual rhythms and sleep. Sleep experts from the Sleep and Biological Rhythms in Psychiatry section (SoPsy) of the French Association for Biological Psychiatry and Neuropsychopharmacology (AFPBN) and the French Society of Sleep Research and Medicine (SFRMS), in partnership with the Morphée network and the National Institute of Sleep and Vigilance (INSV), offer recommendations on how to sleep well and to keep your rhythms. Specific recommendations are addressed on the one hand to adults and on the other hand to parents for their children. People affected by mood disorders (depression, bipolar disorder, etc.) should particularly pay attention to maintaining routines during this period in order to maintain a stable mood. Self-management strategies are suggested to strengthen the biological clock, every day! The recommendations include tips for day and night, but also some specific advices for this context, to limit stress exposure and to improve its management. Finally, useful online ressources and links are suggested.

Stratégies de gestion de l’impact du confinement sur le sommeil : Une synthèse d’experts

Résumé En plus de l’impact psychologique du confinement et de l’épidémie, il existe des répercussions sur le sommeil qu’il faut prendre en compte par la mise en place de stratégies adaptées afin de maintenir un bon état de santé mental et de santé général. Le confinement peut désorganiser le sommeil en impactant d’une part les rythmes circadiens par une diminution de l’intensité des synchroniseurs extérieurs, d’autre part peut favoriser l’insomnie dans cette période de stress aigu et enfin être source d’une privation de sommeil chez ceux qui sont en première ligne et qui gèrent la crise. Pour cela il est important de mettre en place certaines stratégies de préventions de ces perturbations de sommeil afin d’atténuer l’impact psychologique, infectieux et faire face de manière optimale à cette situation que nous vivons tous. In addition to the psychological impact of quarantine, there are sleep disturbances that must be taken into account by implementing appropriate strategies in order to maintain good mental and general health. Quarantine can disrupt sleep first in impacting circadian rhythms by decreasing the intensity of zeitgebers, second can promote insomnia in this period of acute stress and third can be a source of sleep deprivation in those on the front line and managing the crisis. For this it is important to put in place strategies to prevent these sleep disturbances in order to reduce the psychological, infectious impact and deal optimally with this situation that we are all experiencing.