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Introduction: We conducted a national longitudinal survey among healthcare workers in the context of the Covid-19 pandemic, (1) to assess mental health and (2) to describe the results of an intervention to improve capacity of resilience. Non-participation is rarely studied despite being an important methodological matter when performing studies on mental health. Objective(s): The study aims to describe and identify the factors associated with non-participation of healthcare workers to the intervention part of a national longitudinal study on the psychological impact of the COVID-19 pandemic. Method(s): Participants were recruited from April to October 2021 via an Internet link widely disseminated. Data collected include participant' socio-demographic, occupational and working conditions, general health, professional burnout and mental health. The intervention proposed the use of tools for self-management of stress and resilience (PsySTART-Responder and Anticipate.Plan.DeterTM program). A robust Poisson regression was used to identify factors associated with non-participation. Result(s): Among 724 participants, 41% participated to the intervention part. Factors associated to non-participation to the intervention were to work with few or no COVID-19 patients, and low scores in the anxiety scale. Social determinants, occupational characteristics or general health were not associated with non-participation. Conclusion(s): Our study provides a better understanding of the participation of healthcare workers that was not frequently studied. The results logically suggest lower participation among those with better mental health and not directly concerned with management of COVID-19 patients. Non-participation to the intervention was not associated with social factors, which is an argument in favour of using such a design/intervention in a socially heterogeneous population.
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Background The association between health inequalities and the SARS-CoV-2 infection dynamic remains to be studied in France. The objective of this study was to analyse the relationship between an area-based deprivation indicator and SARS-CoV-2 infection indicators, during four epidemic waves running from August 4th 2020 to January 27th 2021 (second wave), January 28th to June 24th 2021 (third wave), June 25th to October 28th 2021 (fourth wave), and October 29th 2021 to March 29th 2022 (fifth wave). Methods We analysed weekly indicators of SARS-CoV-2 infection, extracted from the national testing information system: incidence, positivity and testing rates. The associations of these outcomes with the European Deprivation Index (EDI) quintiles were estimated with negative binomial generalized additive models adjusted for epidemic waves, population density (sparsely, moderately, densely populated), region (random effect) and interactions between epidemic waves and the variables EDI, population density, and region. Results The most deprived areas had a higher positivity rate than the least deprived ones during the second, third and fourth waves, but a lower rate during the fifth wave. They also had higher incidence during the third and fourth waves, but a similar incidence than the least deprived areas during the second wave, and even a lower rate during the fifth wave. The testing rate was lower in the most deprived areas than elsewhere, irrespective of the epidemic waves. Conclusions People living in the most deprived areas were less likely to be tested and more likely to test positive than people living in less deprived areas. The lower incidence, positivity and testing rates during the fifth wave in the most deprived areas may be explained by the enacted change in policy whereby screening tests were no longer free. These findings may reflect structural differences in access to care and lower capacity to benefit from prevention measures by deprived populations. Key messages • People living in the most deprived areas were less likely to be tested for COVID-19 irrespective of the epidemic waves. • Health authorities should address the issues of social inequalities more rapidly and target prevention strategy to disadvantaged populations.
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Introduction Les populations en grande précarité ont été surexposées au SARS-CoV2 avec une morbi-mortalité plus importante. La vaccination de ces personnes, enjeu prioritaire souligné par différentes recommandations, se heurte néanmoins à plusieurs difficultés. Une enquête a été menée pour estimer cette couverture vaccinale, et les facteurs qui lui sont associés. Matériels et méthodes Nous avons mené une enquête transversale stratifiée avec échantillonnage aléatoire par grappe à deux degrés. Entre le 15 novembre et le 22 décembre 2021, 227 sites abritant des publics précaires ont pu être investigués en Ile-de-France (IDF) et à Marseille, répartis en 6 strates. Au total, 3811 entretiens individuels ont été effectués dans la langue du participant. Résultats En IDF, l'accès à la primo-vaccination a été de 79.3 % [95 % IC : 76.0-82.6] dans les centres d'hébergements, 70.4 % [67.2-73.6] dans les hôtels sociaux du « 115 », 86.1 % [83.3-88.7] dans les foyers de travailleurs, 41.3 % [22.3-60.4] dans les aires permanentes d'accueil de gens du voyage, 44.3 % [35.5-53.2] dans les bidonvilles, squats informels et à la rue. Cet accès était de 40.4 % [30.8-50.0] parmi les sans-abris à Marseille. Le schéma vaccinal initial complet (2 injections ou équivalent) y était respectivement de 75,7 % [72.2-79.3], 63.0 % [59.5-66.5], 81.6 % [78.7-84.5], 30.5 % [14.0-46.9], 38.4 % [30.4-46.5] et 32.4 % [23.1-41.8]. Cette vaccination a été effectuée principalement dans les centres de vaccination pour la population générale (54.9 % au total), tandis que le recours aux dispositifs « d'aller-vers » ont concerné 17,6 % des vaccinés. Les raisons de non-vaccination étaient davantage liées à des refus d'effectuer le vaccin plutôt qu'à des barrières d'accès, avec une crainte des effets secondaires et un sentiment d'inefficacité du vaccin. Par ailleurs, 24.2 % déclaraient le Pass Sanitaire comme la raison déterminante de leur vaccination. En analyse univariée, l'accès à la primo-vaccination est associée au fait d'avoir une couverture maladie (OR=2,6 ; 95 % IC : 2,2-3,1), un médecin habituel (OR=2.0 ; IC : 1.7-2.3), une opinion personnelle positive sur la vaccination anti-Covid-19 (OR= 17.2 ; IC : 14.0-21.1), ainsi que celle de son entourage (OR= 4.3 ; IC : 3.4-5.4) et le fait d'avoir été sensibilisé à la vaccination par les hébergeurs (OR= 2.5 ; IC : 1.6-3.9). Il y a aussi une forte association avec le type de logement et l'environnement social, comme le reflète la disparité entre les strates. Les analyses multivariées et stratifiées sont en cours et seront présentées aux JNI. Conclusion L'accès à la vaccination contre la Covid-19 est faible pour un public surexposé. Renforcer une prise en charge sociale globale et inclusive de ces personnes dans la société, s'appuyer sur des médiateurs de confiance connaissant individuellement ces personnes, et encourager les dispositifs du « aller-vers » sont autant de leviers déterminants pour améliorer la couverture vaccinale. Aucun lien d'intérêt
ABSTRACT
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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Introduction - The COVID-19 pandemic, combined with school closures and the circumstances of the first lockdown in France from March to May 2020, have contributed to the exacerbation of existing social inequalities. However, currently, there is a lack of studies in France that explore the impact of living conditions on the mental health of children and adolescents during the lockdown. The objective of the present study is to assess the emotional status and levels of psychological distress of children aged 9 to 18 years old during and after the first lockdown based on their environment and living conditions, as well as to measure resilience and strategies to preserve their well-being. This study was also extended to young people living in child welfare. Methods - Data for the Confeado study were collected via an online parent and child questionnaire from 9 June to 14 September 2020, which collected data on sociodemographic characteristics, living conditions, and the impact of lockdown. Health inequalities were a key focus in the questionnaire. Psychological health was assessed using self-reported responses to psychometric scales. Bivariate analyses were performed via chi-squared tests to describe distress and emotional state and Student's t-test or ANOVA test to describe resilience, by age and sex, according to living conditions, parental characteristics, and activities. Results - In this descriptive study, 3,898 children and adolescents were included, including 81 youth in child welfare. There appeared to be a greater impact on the mental health of adolescents compared to younger children both during and after the lockdown, with girls appeared to have poorer mental health than boys. Factors associated with psychological distress include housing conditions (being confined to an urban area, in an apartment or house without a garden, not having access to an outside space in the home, living in over-occupied housing and not being able to isolate oneself), economic conditions (financial and food difficulties, a period of parental unemployment, a lack of internet connection), parental characteristics (single parent family, low level of education, workers or employees parents, foreign-born parents, lack of social support). A lack of recreational activity - increased use of social networks and screens, a feeling of being overwhelmed by school work, having a relative who was infected with SARS-CoV-2 or hospitalized due to the virus were also associated with greater distress. In contrast, higher resilience scores were associated with better living conditions, a two-parent family composition, higher levels of parental education, having social support, and participating in recreational activities during lockdown. Conclusion - Financial support for single-parent families, and maintaining recreational activities and regular outings are elements that can influence the mental health of children and adolescents during a health crisis. Support for young people whose loved ones have been infected with or hospitalized due to COVID-19 should be promoted, as well as awareness and information for parents and children the need to preserve one's mental well-being. Public policies to promote resilience must therefore be differentiated from social policies to account for social inequalities in health during the COVID-19 pandemic.
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Introduction Dans le but de réduire le nombre de personnes infectées par la COVID-19, plusieurs pays ont mis en œuvre des applications mobiles pour retracer les contacts étroits de la personne infectée par le SARS-CoV-2. Cependant, cette approche nécessite une large adhésion de la population pour être efficace. Cependant, depuis mars, de telles applications n’ont été installées que par 9,3 % des personnes dans le monde. Nos objectifs étaient d’estimer, en France, l’acceptabilité d’une application utilisant les téléphones mobiles pour retracer les contacts étroits entre les personnes lors d’épidémies, et les barrières potentielles à son utilisation. Méthodes Nos données ont été collectées parallèlement à l’enquête « Health Literacy Survey 2019 » réalisée en ligne auprès de 1003 français deux semaines après la fin du premier confinement en France (du 27 mai au 5 juin 2020). Les données utilisées étaient les caractéristiques sociodémographiques, la littératie en santé, la confiance dans les institutions et les connaissances sur la COVID-19 et les comportements préventifs. L’acceptabilité d’une application mobile de traçage a été mesurée par le biais d’une question ad hoc, dont les réponses ont été regroupées en trois modalités : App-partisan, App-favorable et App-réticent. Résultats Seulement 19,2 % étaient des partisans de l’application tandis que la moitié des participants (50,3 %) étaient réticents. Les facteurs associés à la non-réticence (App-adepte, App-favorable) étaient : l‘absence de difficultés financières et l’utilité perçue d’applications mobiles pour envoyer des questionnaires de santé aux médecins. L’âge de plus de 60 ans, la confiance dans les représentants politiques, les préoccupations envers la situation pandémique et des connaissances adéquates sur la transmission du SARS-CoV-2 augmentaient la probabilité d’adhérer complétement à l’application de traçage. Conclusion Les personnes les plus démunies, connues pour être plus à risque d’être atteintes par la COVID-19, sont également les plus réticentes à utiliser une application de traçage des contacts. Par conséquent, une adhésion optimale nécessite de mieux comprendre ces réticences et de larges campagnes de sensibilisation, proposant un discours rationalisé sur les avantages de santé publique d’adopter une telle application.