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1.
Revue Medicale Suisse ; 17(757):1878-1882, 2021.
Article in French | EMBASE | ID: covidwho-1819196

ABSTRACT

The sanitary crisis due to the Covid-19 pandemic limited the social network of elderly people, already at risk of social isolation and loneliness (SIL). Isolated and lonely people have a higher mortality risk and suffer from severe health repercussions. The management of SIL faces multiple difficulties, such as the lack of consensus on the definitions, as well as the absence of reliable screening tools and intervention strategies. SIL have a significant impact on individual health and the overall health system, they should be considered as a distinct geriatric syndrome. Taking care of this condition is necessary and should include the development of preventive strategies to limit its deleterious consequences.

2.
Bulletin ..pid..miologique Hebdomadaire ; 2022.
Article in French | GIM | ID: covidwho-1743817

ABSTRACT

Background - In the context of the global COVID-19 pandemic and the expansion of the more transmissible 20J/501Y.V3 (P1) variant of concern (VOC), mRNA vaccines were made available in French Guiana, an overseas French territory in South America, from mid-January 2021. This study aimes to estimate the willingness to be vaccinated and the socio-demographic and motivational correlates among Health Care Workers (HCWs) in French Guiana. Methods - A cross-sectional survey was conducted from January 22 to March 26, 2021, among a sample of HCWs in French Guiana based on an anonymous online questionnaire. Results - A total of 579 HCWs were interviewed, including 220 physicians and 200 nurses most often working in hospital (54%) or in the liberal sector (22%). Overall, 65.6% of respondents reported that they were willing to be or had already been vaccinated against COVID-19, while 24.3% of respondents reported that they did not want to get vaccinated against COVID-19 and 11.2% were unsure. In multivariate analysis, factors associated with vaccination willingness were older age, level of concern about COVID-19, confidence in vaccine information, and having been vaccinated against influenza in the previous year. Conversely, reluctance to certain vaccinations in general (adjusted OR=0.23, CI95%: [0.13-0.41]) and being from the West Indies or French Guiana (aOR=0.39 [0.21-0.73]) were associated with greater vaccine distrust. Conclusion - Negative opinions and attitudes toward vaccines are a major public health concern among HCWs in French Guiana when considering the current active epidemic with P1 VOC. Territorial specificities, general vaccine hesitancy and concerns about future side effects in particular represent important barriers and/or issues. Low confidence in government and science are important for COVID-19 vaccine refusal among non-medical staff. Public health messages with information on vaccine safety should be tailored to address these concerns.

3.
Gastroenterology ; 160(6):S-391, 2021.
Article in English | EMBASE | ID: covidwho-1597588

ABSTRACT

Background: Vaccination rates remain low among patients with inflammatory bowel disease (IBD) despite guideline recommendations and evidence-based publications. Reported barriers include perceived lack of benefit, fear of side effects, and inconvenience. At our IBD center we follow approximately 1700 patients. During the 2019-2020 influenza season, our vaccination rate for the entire IBD population was 40.3% and 45.5% for those receiving biologic therapies at our infusion center (n=772). We developed a quality improvement initiative to evaluate vaccination practices and to determine effective strategies to increase vaccine uptake. As a first-step, we targeted our most vulnerable and accessible population: patients receiving biologic infusions. Methods: Our initiative began in August 2020. Plan-do-study-act cycles included creation of a multi-disciplinary team to review vaccination barriers and distribution of a survey to caregivers or IBD patients >=18 years to explore vaccination decision making process, awareness of recommendations, and impact of vaccine availability in the infusion center on uptake. The next phase was optimizing access among patients receiving biologic therapies at our infusion center. The strategies we implemented included educational sessions with the division providers and infusion center nurses, creation of an Epic EMR order set, active phone screening of our population prior to infusion visits, at which point unvaccinated patients were offered the vaccine during the appointment. Chi squared analysis compared survey responses between caregivers and patients. Two proportion sample test identified differences in vaccination rates between the two influenza seasons. Results: The survey was answered by 14.4% (n=269 caregivers and n=60 patients), with 71.3% on either anti-TNF alpha (infliximab, adalimumab) or vedolizumab. Of respondents, 13.4% were unvaccinated in 2019-2020. Top reasons for non-vaccination included “unsure of safety” (31.8%), “unsure of benefit” (29.5%), and “forgot to schedule” (13.6%). Patients and caregivers had similar vaccine impressions, with no statistically significant differences (Figure 1). For the 2020-2021 season, 88.75% plan to get vaccinated and 51.7% expressed interest in receiving the vaccine during their infusion appointment. Since implementing our initiative, the vaccination rate has already increased to 59.2% compared to 45.5% (p=0.001). Conclusions: Our initiative increased vaccination rates in patients receiving biologic infusions by 13.7% thus far. Particularly during the COVID-19 pandemic, the influenza vaccine is essential to protect this vulnerable population and decrease the burden on the healthcare system. We have identified pre-screening prior to appointments and providing access in conjunction to scheduled appointments as the most effective strategies to optimize vaccination uptake.(figure presented)

4.
Infectious Diseases Now ; 51(5, Supplement):S65, 2021.
Article in French | ScienceDirect | ID: covidwho-1336495

ABSTRACT

Introduction La Guyane française a fait face à une première vague significative l’été 2020, quelques mois après la métropole. L’étude EpiCovid a révélé que 25 % des guyanais avaient été touchés par le COVID. Les soignants, comme ailleurs, ont fait partie des populations significativement impactées par l’épidémie. Après l’autorisation du vaccin à ARNm Comirnaty® par l’Agence européenne du médicament fin décembre, la métropole a commencé à vacciner dans les EHPAD. L’arrivée des vaccins a été retardée de 15 jours en Guyane du fait de l’attente de l’arrivée d’un congélateur à −80°C à l’hôpital de Cayenne. Dès le début de la campagne vaccinale dans les EHPAD et auprès des soignants, des réticences vis-à-vis du vaccin ont été exprimées. La vaccination était accessible à tous les soignants de plus de 50 ans ou avec comorbidités au moment de l’enquête. Dans le contexte de l’émergence du variant 20J/501Y.V3 en Amérique du Sud, une meilleure compréhension des attitudes et de l’intention vaccinale des professionnels de santé de ce territoire particulier est susceptible d’aider à l’ajustement de la campagne. Matériels et méthodes Une enquête épidémiologique transversale a été mis en place en février et mars 2021 à destination de l’ensembles des soignants de Guyane à l’aide d’un questionnaire en ligne sur le site wepi.org, diffusé par mailing larges en partenariat avec les structures de santé du territoire, les URPS et les ordres médecins et infirmiers, la lettre de l’ARS, les groupes What'sApp de professionnels, sous forme de QR code affichés et sur les fonds d’écran des ordinateurs professionnels et sur support papier dans les services du CH de Cayenne et les 17 centres délocalisés de prévention et de soins (CDPS) des communes de l’intérieur. Résultats Au total, 578 professionnels de santé ont répondu à l’enquête, dont 42 % de médecins ou sage femmes, 37 % d’infirmiers et 20 % d’autres professionnels de santé. Les médecins et les infirmiers exerçaient en libéral (30 % et 23 %), en milieu hospitalier (48 % et 51 %) et en CDPS (10 % et 18 %, respectivement). Dans l’ensemble, 91 % des soignants interrogés se déclaraient favorables aux vaccinations en général, mais 26 % défavorables à certains vaccins. Concernant la vaccination contre le COVID-19, 65 % étaient déjà vaccinés ou envisageaient probablement de se faire vacciner, 11 % étaient indécis et 24 % déclaraient ne pas vouloir se faire vacciner. L’intention vaccinale était plus élevée parmi les médecins (87 %) que parmi les infirmiers et les autres professions de santé (50 % et 46 %, p<0,001). Le refus du vaccin n’était pas différent selon le mode d’exercice, libéral ou hospitalier. L’opposition au vaccin était plus fréquente parmi les femmes (30 %), les moins de 35 ans (37 %) et parmi les professionnels de santé originaires de Guyane et des Antilles françaises (48 %). Ces facteurs restaient associés en analyse multivariée par régression logistique. À l’inverse, parmi les professionnels originaires de métropole ou de l’étranger, elle n’était pas différente en fonction de l’ancienneté d’arrivée en Guyane (qui était en médiane de 8 ans, IIQ [19–2]). Elle ne variait pas non plus en fonction du lieu d’exercice. Conclusion Les intentions vaccinales des professionnels de santé de Guyane française dans la période initiale de mise à disposition des vaccins sont assez contrastées, avec près d’un soignant sur quatre ne souhaitant pas se faire vacciner.

6.
Exercer-La Revue Francophone De Medecine Generale ; - (170):79-84, 2021.
Article in English | Web of Science | ID: covidwho-1250557

ABSTRACT

Context. General practitioners (GPs) work alongside to help provide a COVID-19 vaccination for anyone. They face plenty of questions from concerned patients, such as about vaccine-related anaphylaxis. Objective. To provide an up-to-date overview to help GPs answer questions about a COVID-19 vaccination in case of history of allergies. Methods. A narrative literature review was performed until January 21, 2021. Data were collected from French and international authorities guidance and the main international scientific societies of Allergy. The guidelines for the management of anaphylaxis were added a posteriori. Results. Anaphylactic reactions related to the mRNA COVID-19 vaccine are very rare. A history of allergic reactions or anaphylaxis is generally not a contraindication to the vaccination, except in case of a systemic reaction to the 1st dose of the vaccine or a previous reaction to any of its components. These are absolute ones. People with a local reaction to the 1st dose can receive the 2nd dose. Conclusion. The up-to-date collected data are reassuring: the rate of anaphylaxis related to the mRNA COVID-19 vaccine is similar to other vaccines. People with history of allergies, including anaphylaxis (except for the COVID-19 vaccine or its components), can receive the vaccine. The benefit of the vaccination in case of history of allergies outweighs the risk. These data will allow GPs and their patients to make an enlightened and more rational choice in the shared decision-making process.

7.
Journal of Surgical Case Reports ; 2021(4):rjab090, 2021.
Article in English | MEDLINE | ID: covidwho-1208915

ABSTRACT

A 42-year-old woman from a medically underserved community in rural New England was referred by her primary care provider (PCP) for televisit during the coronavirus disease 2019 (COVID-19) pandemic following 2 years of chronic neck pain and numbness in her left hand that was initially concerning for demyelinating disease. Upon further evaluation, it was revealed that she had experienced a traumatic fall with a concussion and symptoms consistent with central cord syndrome but had refused magnetic resonance imaging (MRI) at her initial medical evaluation. On MRI conducted 1 month prior to neurosurgical evaluation she was found to have a disc bulge and 4-mm T2-hyperintense lesion at the C4-C5 level that was consistent with a chronic spinal cord injury secondary to spinal trauma with associated vertebrogenic injury. This televisit confirmed the diagnosis of chronic spinal cord injury for this patient and allowed for discussion of future interventions, avoided further unnecessary referrals, and increased access to care.

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