Pandemi Sürecinde Devletin Geri Dönüşü: Fransa ve Türkiye Örnekleri

Bu çalışmada pandemi sürecinde devletin rolü ve işlevleri Fransa ve Türkiye örnekleri üzerinden karşılaştırmalı olarak ele alınmaktadır. Kovid-19 pandemisinin kamu sağlığı güvenliği açısından yarattığı aciliyet, şok ve kriz ortamı, kamusal otoritelerin önlem alma pratiklerini dönüştürürken her ülkenin, sınırlarını ve güvenlik politikalarını yeniden gözden geçirmesine yol açmıştır. 1980'lerden itibaren refah politikalarından rekabetçi politikalara geçiş, ulusal sınırların esnekleşip uluslararası sermayeye açılması;küreselleşme ve kozmopolitleşme yönünde güçlü bir irade olduğu sanısını yaratmıştır. Ancak pandeminin yarattığı koşullara verilen tepki bunun aksi yönde sonuç vermiştir: Korumacı ekonomi politikalarının, gelir dağıtıcı yaklaşımının yanı sıra ulusal sınırların ve milliyetçi reflekslerin yükselişine şahit olunmuştur. Bu çalışmada bu gelişmelerin pandemi dönemi ile sınırlı ve geçici bir refleks olmayıp post-pandemik toplumsal koşullarda da süreceği iddia edilmekte ve bu süreci anlamak için devletin dönüşümü üzerinden bir okuma önerilmektedir. Çalışmada, hukuki bilgi ve belgelerin yanı sıra aktörlerin açıklamaları ve basına yansıyan haberler incelenmekte ve bahsi geçen dönüşümün sebepleri, mahiyeti ve olası sonuçları betimleyici ve yorumlayıcı yöntemle ele alınmaktadır.Alternate :In this study, the role and functions of the state in the pandemic process are discussed comparatively through the examples of France and Turkey. The urgency, shock, and crisis environment created by the Covid-19 pandemic in terms of public health security have led each country to reconsider its borders and security policies while transforming the precautionary practices of public authorities. Since the 1980s, it has been assumed that there was a strong will for the transition from welfare policies to competitive policies and the flexibility of national borders for strengthening globalization and cosmopolitanism. However, the reaction to the conditions created by the pandemic resulted in the opposite direction: The rise of national borders and nationalist reflexes, as well as the protectionist economic policies and income distribution approach, were witnessed. In this study, it is claimed that these developments will not be a temporary reflex limited to the pandemic period but will continue in post-pandemic social conditions. In addition, it will be suggested that an analysis of the transformation of the state in a historical process is crucial to understand this process. In addition to the legal information and documents, the explanations of the actors and the news will be examined, and the reasons, nature, and possible consequences of the transformation will be discussed with a descriptive and interpretive method.

Oncolytic virus TG6002 safety and activity after intrahepatic artery administration in patients with liverdominant metastatic colorectal cancer

The TG6002.03 trial is a dose-escalation phase 1 clinical trial of TG6002 infusion via the hepatic artery in patients with liver-dominant colorectal cancer metastases. TG6002 is an engineered Copenhagen strain oncolytic Vaccinia virus, deleted of thymidine kinase and ribonucleotide reductase to enhance tumor selective viral replication and expressing FCU1, an enzyme converting the non-cytotoxic prodrug 5-fluorocytosine (5-FC) into the chemotherapeutic compound 5-fluorouracil (5-FU). In this trial, patients with advanced unresectable liver-dominant metastatic colorectal cancer who had failed previous oxaliplatin and irinotecan-based chemotherapy were treated with up to 2 cycles of TG6002 infusion 6 weeks apart via the hepatic artery on day 1 combined with oral 5-FC on days 5 to 14 (where day 1 = TG6002 infusion). TG6002 infusion was performed over 30 minutes via selective catheterization of the hepatic artery proper. 5-FC oral dosing was 50mg/kg x4 daily. Blood was sampled for TG6002 pharmacokinetics and 5-FC and 5-FU measurements. Sampling of liver metastases was performed at screening and on day 4 or day 8 for virus detection and 5-FC and 5-FU quantification. In total, 15 patients (median age 61 years, range 37-78) were treated in 1 UK centre and 2 centres in France and received a dose of TG6002 of 1 x 106 (n=3), 1 x 107 (n=3), 1 x 108 (n=3), or 1 x 109 pfu (n=6). Fourteen of the 15 patients received a single cycle of treatment, including one patient who did not received 5-FC, and one patient received two cycles. TG6002 was transiently detected in plasma following administration, suggesting a strong tissue selectivity for viral replication. In the highest dose cohort, a virus rebound was observed on day 8, concordant with replication time of the virus. In serum samples, 5-FU was present on day 8 in all patients with a high variability ranging from 0.8 to 1072 ng/mL and was measurable over several days after initiation of therapy. Seven of the 9 patients evaluable showed the biodistribution of the virus in liver lesions by PCR testing on day 4 or day 8. Translational blood samples showed evidence for T-cell activation and immune checkpoint receptor-ligand expression. At 1 x 109 pfu, there was evidence for T-cell proliferation and activation against tumour-associated antigens by ELISpot and for immunogenic cell death. In terms of safety, a total of 34 TG6002-related adverse events were reported, of which 32 were grade 1-2 and 2 were grade 3. The maximum tolerated dose was not reached, and a single dose-limiting toxicity was observed consisting of a myocardial infarction in a context of recent Covid-19 infection in a 78-year-old patient. These results indicate that TG6002 infused via the hepatic artery in combination with oral 5-FC was well tolerated, effectively localized and replicated in the tumor tissues, expressed its therapeutic payload and showed anti-tumoral immunological activity.

Leaving: Residential mobility and housing conditions in France during the Covid-19 epidemic

In the spring of 2020, a national lockdown was declared in France to control the Covid-19 epidemic - the longest and strictest to date. This led to spontaneous population movements, widely publicised in the media as the urban exodus of Parisians. But were departures from large cities to low-density areas the only types of mobility during this period? And what can we learn from housing changes during lockdown about the ordinary residential practices and dwelling conditions of households, as well as about the resources mobilised to cope with these exceptional situations? Based on the EpiCOV survey (Inserm-Drees), conducted in France among a sample of 135,000 people aged 15 and over at the end of the first lockdown, this article examines the different types of residential mobility that took place in the spring of 2020 on French territory. While this study does not predict whether or not these movements are to become permanent, or whether they would be repeated during further phases of lockdown, it highlights the heterogeneity of mobility practices, captured here in terms of distance travelled, changes within the urban gradient, types and conditions of housing, as well as the variety of resources mobilised according to sex, age and social position of individuals. While long-distance mobility more often concerns wealthy populations, local movements are almost as frequent and concern more heterogeneous fractions of the population. © 2023 Geographie-Cites. All rights reserved.

Overview of the Healthcare Systems of the Maghreb Countries: Issues and Progress

Objectives: To provide an update overview on the current status of healthcare systems in the Maghreb region (Algeria, Morocco, and Tunisia) and to emphasize the progress made in the midst of the challenges facing these countries. Method(s): A descriptive comparative approach of healthcare systems in the three countries, based on data from sources with an established methodology, including descriptive healthcare data from the WHO database. Result(s): The population of the Maghreb will increase from 102 million to 132 million by 2050. The current population is mostly centered in Algeria and Morocco, accounting for 77%. Annual healthcare expenditure per capita is 447.9$, 776.8$ and 854.6$ in Morocco, Tunisia and Algeria, respectively. The average infant mortality rate per 1000 live improved to 10.9 in Tunisia, 16.8 in Morocco and 18.9 in Algeria. Maternal mortality rates have dropped to 43 and 48.5/100 000 births in Tunisia and Algeria, respectively while remaining relatively high in Morocco: 72.6. Number of hospital beds/1000 inhabitants is only 1.1 in Morocco, 1.9 and 2.9 in Algeria and Tunisia, respectively. The number of physicians/1000 people was 0.73 in Morocco, 1.3 in Tunisia and 1.72 in Algeria. This remains considerably low compared to the 3.9/1000 in Europe. The Maghreb countries are currently facing an exodus of physicians, mainly to France, which represents 7.1% and 10.7% of Tunisians and Moroccans, respectively, and more than 24% for Algerians. The Maghreb countries were very early mobilized (governments, ministries of health, civil society) to fight against COVID-19 and have successfully controlled the pandemic, according to pre-established control strategies and the strongly commitment of health professional. Conclusion(s): Despite the considerable progress made, the Maghreb countries still face major challenges. Physicians migration, rising cost of care and endemic infectious disease outbreaks constitute a huge hurdle on the already overburdened and resilient healthcare systems.Copyright © 2023

Influence of massage on respiratory and circulatory parameters in a post- COVID-19 patient: a case study

Monitoring the SaO2 levels and other respiratory function parameters after recovering from COVID-19 can have essential meaning in the assessment of the efficacy of using physiotherapy methods, including classical massage. Purpose of the research was to assess the influence of an individual classical back massage session as well as the effects of an entire 8-session back massage therapy on SaO2, HR and spirometry parameters in a patient after recovering from COVID-19, with constant monitoring of massage areas' temperature changes. Data and methods. The study comprised a case study of a patient who recovered from COVID-19. The patient was subjected to a classical back and spine massage therapy utilising all the basic techniques. The design was based on the results of the following tests: lung x-ray, SaO2, HR, spirometry parameters, and the 6-minute walking distance test. The degree of the influence of the classical massage techniques was monitored using the infrared thermography. Results. Continuous oxygen saturation monitoring during the massage sessions enabled to observe a decrease in the level of this parameter during utilisation of rubbing and tapotement on muscles of both the right and the left side of the back. During the usage of the intense massage techniques SaO2 dropped maximally to 92-93%. Such decrease was noted after massaging the right as well as the left side of the back, during every massage session. I addition it was found that in the case of the patient who recovered from COVID-19 changing the body position from sitting down to lying down after the massage session the level of tissues saturation decreased. The observed changes in the VA/Q ratio that occurred in response to the 8-session massage therapy lasting for 3 weeks might indicate that better conditions for ventilation and oxygen perfusion at the alveolar surface were reached. This translated in the patient who recovered from COVID-19 into 2% increase in oxygen saturation level after completing the massage therapy. Conclusion. Utilising the intense rubbing and tapotement techniques has to be carefully considered due to their significant influence on decrease in the level of saturation.

Advanced Manufacturing Technologies Shift # Outside the Box

The call for reshoring manufacturing may be answered in part by using these advanced technologies to produce APIs or to continuously manufacture drug products end-to-end, beginning with basic raw materials and ending with a finished drug form. The US Department of Defense's Defense Advanced Research Projects Agency (DARPA) has funded several continuous flow chemistry projects, promoting portable technologies that can be used to make medicines on-site in the field for the US military using a few essential raw materials. "To compete with the cost-effectiveness of offshore API manufacturing, innovative streamlined and automated systems are needed," notes Nathan Collins, chief strategy officer of SRI's Biosciences Division and the principal investigator for the ProSyn project. In mid-2020 the process development company doubled its R&D capacity and opened a lab to produce gram to kilogram-scale APIs and demonstrate its continuous flow manufacturing technology at pilot scale.

Predicting Changes in Physical Education Teachers' Behaviors Promoting Physical Activity during the COVID-19 Pandemic Using an Integrated Motivational Model

Purpose: To identify motivational determinants explaining Physical Education teachers' behaviors promoting students' physical activity (PA) amidst the COVID-19 pandemic. Method: Nine hundred thirty-one Italian and French teachers completed a questionnaire assessing motivational determinants (self-determined motivation, self-efficacy, perceived ease and usefulness toward digital technologies, engagement at work), their intention and behaviors promoting PA, in reference to before and during the pandemic. Path analyses tested the associations of changes in motivational determinants with changes in intention and behaviors. Results: Increases in autonomous, controlled motivation, self-efficacy, and perceived usefulness toward digital technologies, and a decrease in amotivation were associated with an increase in the intention to promote PA. In turn, an increase in intention, but also in self-efficacy, autonomous motivation, and perceived usefulness toward digital technologies were paired with an increase in behaviors promoting PA. Conclusion: Implications regarding the commitment of Physical Education teachers to challenging pedagogical situations, such as promoting PA amidst the COVID-19 pandemic, are discussed.

NEW INSIGHTS ON EPIDEMIOLOGICAL DATA AND IMPACT OF THE COVID-19 PANDEMIC ON IGA VASCULITIS IN CHILDREN AND ADULTS IN FRANCE: A NATIONWIDE COHORT

BackgroundIgA vasculitis (IgAV) is a rare autoimmune disease affecting small vessels. It is well established that the incidence is higher in children (3 to 26 per 100,000 children/year,) [1] than in adults (0.1 to 1.8 per 100,000 individuals/year) [1]. However others epidemiological data and impact of the COVID-19 on IgAV remain overlooked [2].ObjectivesTo collect and analyze epidemiological data on IgAV in both adults and children in France.MethodsWe conducted an observational study using a national database called "BNDMR” [3] (Banque Nationale de Données Maladies Rares) on IgA vasculitis (code ORPHA761), which gathered patients managed in the French rare disease expert network. The incidence was estimated from the date of diagnosis, and we calculated the median annual incidence over the period 2010-2022. We specifically assessed the north/south gradient (latitude of the residence higher/lower than the median of the latitudes), the seasonality, and the impact of the COVID-19 pandemic compared to other patients reported within the same period and addressed in the same expert centers used as controls.ResultsDuring this 12-year period, 1988 patients with IgAV were reported (1498 children;490 adults). The male to female ratio was 1.57 for adults and 1.05 for children. The median IgAV annual incidence was 15 cases/year [IQR 9-30] and 82 cases/year [IQR 72-86] for adult and children cases respectively. Time to diagnosis was less than 1 month for both. Compared with other patients reported in the same expert centers, IgAV was more frequently reported in the southern part of France than in the north (OR 4.88 [95% confidence intervals: 4.17 - 5.74] in adults and OR 1.51 [1.35 - 1.68] in children). IgAV was also more frequently observed in winter than during the rest of the year in both adults (OR 1.60 [1.39 - 1.82]) and children (OR 1.22 [1.01 - 1.48]). The incidence of IgAV decreased during the COVID-19 pandemic period (from March 2020 to September 2022) in children (OR 0.62 [0.47 - 0.81]) but not in the adult population (OR 0.90 [0.76 - 1.06]).ConclusionOur study confirms the winter seasonality and sex ratio in IgAV [4,5], but suggests that the incidence or the reporting of IgAV decreased in children during the COVID19 pandemia, possibly due to barrier measures [6]. The observed north/south gradient need confirmation. The main limitation of this study is a possible IgAV under-reporting as this study rely only on cases addressed in expert centers.References[1]Audemard-Verger A, Pillebout E, Guillevin L, Thervet E, Terrier B. IgA vasculitis (Henoch-Shönlein purpura) in adults: Diagnostic and therapeutic aspects. Autoimmun Rev. 2015;14(7):579-585. doi:10.1016/j.autrev.2015.02.003[2]Deshayes S, Moulis G, Pillebout E, Aouba A, Audemard-Verger A. Positive predictive value of hospital discharge diagnosis code to identify immunoglobulin A vasculitis in France: A validation study. Eur J Intern Med. 2017;43:e18-e19. doi:10.1016/j.ejim.2017.05.025[3]Jannot AS, Messiaen C, Khatim A, Pichon T, Sandrin A, BNDMR infrastructure team. The ongoing French BaMaRa-BNDMR cohort: implementation and deployment of a nationwide information system on rare disease. J Am Med Inform Assoc. 2022;29(3):553-558. doi:10.1093/jamia/ocab237[4]Piram M, Maldini C, Biscardi S, et al. Incidence of IgA vasculitis in children estimated by four-source capture-recapture analysis: a population-based study. Rheumatology (Oxford). 2017;56(8):1358-1366. doi:10.1093/rheumatology/kex158[5]Gardner-Medwin JMM, Dolezalova P, Cummins C, Southwood TR. Incidence of Henoch-Schönlein purpura, Kawasaki disease, and rare vasculitides in children of different ethnic origins. Lancet. 2002;360(9341):1197-1202. doi:10.1016/S0140-6736(02)11279-7[6]Kaya Akca U, Atalay E, Cuceoglu MK, et al. Impact of the COVID-19 pandemic on the frequency of the pediatric rheumatic diseases. Rheumatol Int. 2022;42(1):51-57. doi:10.1007/s00296-021-05027-7Figure.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

Patrolling portals: the regulation of online genetic data sharing

Background/Objectives: Online portals are being increasingly used to disseminate genetics data. While portal-facilitated sharing might have significant scientific value, it is also likely to raise difficult legal and ethical questions. Many of these questions were highlighted during the Covid-19 pandemic, as the urgency of efficient data sharing became apparent. Responding to these emerging concerns, regulators around the world have implemented regimes for 'software used as a medical device.' It is unclear how these regimes affect online portals for genetic data sharing. This study addresses how online data sharing may be shaped by new forms of regulatory oversight. Method(s): We performed an international comparative analysis of advisory documents applicable to software as medical devices prepared by medical regulators in Canada, the United States, France, and the United Kingdom. We selected 20 documents for review. Result(s): We found that regulatory agencies are likely to regulate online tools as medical devices only when they are intended to perform a medical purpose. Online portals for genetic data sharing will not usually meet this threshold. Nevertheless, regulatory guidance provides significant insight into the kinds of issues to which regulators are likely to be attentive in addressing online data sharing. We identify eight normative and logistical issues: efficiency, equity, transparency, confidentiality, communication, empowerment, training, and safety. Conclusion(s): This review clarifies how the regulation of medical software might apply to portals for genetic data sharing. We offer recommendations to portal developers and researchers.

Place production, urban tourism geographies and experiences of Muße

Urban tourism, as a social, cultural, and economic field, has been strongly affected by the COVID-19 pandemic. As a reverse effect of this crisis, however, there is a recent shift away from the dominant logics of performance and efficiency towards mindfulness, serenity, and similar concepts that shape the everyday life of an increasing number of people. All these terms are related to the semantic field of Muße, a word derived from the German language, which is defined as the experience of moments of freedom, indulgence, placidity, and recreation. Following the idea that social phenomena are reflected and reproduced in tourism, the objective is to explore how and where tourists experience Muße in urban tourism. A focus on Muße first enables a better understanding of tourists' travel behaviour, expectations, and needs. In the same vein, it is possible to examine tourism place-making since the need for Muße produces and transforms individual tourists' worlds of experiences. Although place-making practices and experiences have been widely studied, their relationship to Muße remains to be explored in urban and tourism research. With the aim to study practices and places of Muße in urban tourism, the presented qualitative content analysis draws upon 84 interviews conducted with tourists in Barcelona, Florence, and Paris in 2019. Findings show that the practice of sitting is relevant for experiences of Muße with a particular impact on place-making. Six categories are suggested to illustrate how Muße can be effective while tourists are sitting. This includes a detailed discussion of the spatial dimensions of Muße. In conclusion, places of Muße are highly individual, intangible, and complex. Insights into the characteristics of Muße and engagement with this new concept in international tourism research can be used as resources to study tourist place-making and support the planning for sustainable tourism development. [ FROM AUTHOR] Copyright of Tourism Geographies is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Should China Expand Its Medical Education Scale? Evidence From Comparative Research

Purpose This study compares doctor staffing level and the scale of medical education in China with those of other countries and proposes policy recommendations for future adjustments to the scale of China's medical education. Design/Approach/Methods This study employs a literature review and descriptive analysis. Findings China had 1.98 medical doctors per 1,000 people in 2018, ranking 85th out of the 193 member-states of the World Health Organization (WHO). In 2017, China had 1.99 practicing doctors per 1,000 people, only ranking above Turkey (1.88) in Organisation for Economic Co-operation and Development (OECD) countries. China had only 10.28 medical graduates per 100,000 people—placing in the bottom third of OECD countries. China's provision of 1.4 medical schools per 10 million people was also significantly lower than the global average (3.9). However, the average number of students enrolled in medical schools (509) in China was significantly higher than the global average (160). Originality/Value Although the scale of admission in undergraduate medical education must be expanded in China, this needs to be achieved while controlling the average number of medical students per school and reducing enrollment in low-quality medical schools. Furthermore, it is necessary to establish new medical schools while improving the operating level of existing ones.

The Moderating Effects of Corporate Social Responsibility on Corporate Financial Performance: Evidence from OECD Countries

This study aims to investigate the nature and intensity of the changes in corporate financial performance due to the corporate social responsibility (CSR) disclosures as a result of certain relationships between corporate governance and company performance in the non-financial sector. This study selected 625 non-financial companies across six organizations for economic cooperations (OECD) countries' stock markets for the period of 10 years (2012–2021). For this qualitative study, corporate governance, financial performance, and corporate social responsibility score data were collected from the DataStream, a reliable database for examining the research on OECD countries' listed companies. For the data analysis we applied various statistical tools such as regression analysis and moderation analysis. The findings of the study show that all attributes of the corporate governance mechanism, except for audit board attendance, have significant positive impacts on financial performance indicators for all the selected OECD economies except the country France. France's code of corporate governance has a significant negative impact on return on asset (ROA) and return on equity (ROE) due to differences in cultural and operational norms of the country. The audit board attendance has no significant impact on ROA. Moreover, all the attributes except board size (BSIZ) have significant positive impacts on the earnings per share (EPS) in Spain, The United Kingdom (UK) and Belgium. The values obtained from the moderation effect show that Corporate social responsibility is the key factor in motivating corporate governance practices which eventually improves corporate financial performance. However, this study advocated the implications, Investors and stakeholders should consider both corporate governance and CSR disclosures when making investment decisions. Companies that prioritize both governance and CSR tend to have better financial performance and are more likely to mitigate risks. Moreover, the policy makers can improve the code of corporate governance in order to attain sustainable development in the stock market.

PPE: what now for the global supply chain?

Covid-19 has turned the spotlight on healthcare supply chains, challenging 30 years of ever growing globalisation, writes Jane Feinmann

STATE CAPITALISM: A Comparative And Historical Outlook

States and capitalisms have coevolved and formed contrasted configurations from feudalism to contemporary configurations. Under the same label of state capitalism, economic history exhibits some definite mixes of various components: economic nationalism, public ownership of firms and banks, planning or large public spending, and income redistribution. The French state capitalism variant is one of these configurations. The coordination among public entities from industry to finance, an indicative planning as an anti-uncertainty device and complementary economic policy instruments used to define a rather coherent and dynamic regime. The large opening to European and world competition and the financial deregulation have progressively eroded the performance of this successful modernization. The early twenty-first century evolution raises an intriguing issue: are not the nation-states and the transnational platform capitalism trading place? Governments react to price signals whereas GAFAM exert the strategic leadership in the redeployment of contemporary capitalism. Will the COVID-19 mean a reversal and the revival of various brands of state capitalism? © Oxford University Press 2022.

Unknown Circovirus in Immunosuppressed Patient with Hepatitis, France, 2022.

Hepatitis of undetermined origin can be caused by a wide variety of pathogens, sometimes emerging pathogens. We report the discovery, by means of routine shotgun metagenomics, of a new virus belonging to the family Circoviridae, genus Circovirus, in a patient in France who had acute hepatitis of unknown origin.

Nurses' experience during the COVID-19 pandemic and consequences on their relationship with patients. Consensual qualitative research / Vécu des infirmières lors de la pandémie de COVID-19 et conséquences sur leur relation avec les patients : une recherche qualitative consensuelle

Much the same as other healthcare services, when the COVID-19 pandemic hit, psychiatric hospitals implemented significant and rapid changes in the organization of their services. The aim of this research study is to describe and understand the experience of nurses and nursing supervisors in psychiatric units in the light of the occupational transformations caused by the first wave of the COVID-19 pandemic, as well as the impact of these events on their relationships with patients. A consensual qualitative research study based on Hill's model was implemented. Sixteen individual interviews were conducted with eleven nurses and five nursing supervisors. The themes discussed can be grouped into five areas: aspects of the caregiving relationship, positive aspects of caregivers' experiences, negative aspects of caregivers' experiences, reflections on the post-pandemic era, and the role of supervisors. These five areas can be subdivided into 11 categories and 31 subcategories. Values, attitudes, and behaviors centered around a humanistic caring approach are identified as integral to future development. They appear to be elements of both the transformation process and the desired outcome. In light of these findings, it seems that an immediate rethink of the organization of care is needed.

Dans les hôpitaux psychiatriques, des modifications importantes et rapides de l'organisation des services ont été décidées dès le début de la pandémie de COVID-19. Le but de cette recherche est de décrire et comprendre le vécu des infirmières et cadres de santé, en unités intrahospitalières de psychiatrie, confrontés aux bouleversements professionnels occasionnés par la première vague de l'épidémie, ainsi que l'impact de cet événement sur la relation avec les patients. Une recherche qualitative consensuelle selon Hill a été mise en œuvre. Seize entretiens individuels ont été réalisés auprès de onze infirmières et cinq cadres de santé. Les idées exprimées peuvent être regroupées en cinq domaines : les aspects du vécu se rapportant à la relation de soins, les aspects positifs du vécu des soignants, les aspects négatifs du vécu des soignants, les réflexions sur l'après-crise et le rôle du cadre remis en question. Ces cinq domaines peuvent être subdivisés en 11 catégories et 31 sous-catégories. Des valeurs, attitudes et comportements humanistes ­ caring ­ sont identifiés comme faisant partie d'un futur désirable. Ils semblent être à la fois des éléments du processus de transformation et du résultat souhaité. Il parait indispensable de repenser sans délais l'organisation des soins sur cette base.

Social deprivation and SARS-CoV-2 testing: a population-based analysis in a highly contrasted southern France region.

Background: Testing was the cornerstone of the COVID-19 epidemic response in most countries until vaccination became available for the general population. Social inequalities generally affect access to healthcare and health behaviors, and COVID-19 was rapidly shown to impact deprived population more drastically. In support of the regional health agency in Provence-Alpes-Côte d'Azur (PACA) in South-Eastern France, we analyzed the relationship between testing rate and socio-demographic characteristics of the population, to identify gaps in testing coverage and improve targeting of response strategies. Methods: We conducted an ecological analysis of SARS-CoV-2/COVID-19 testing rate in the PACA region, based on data aggregated at the finest spatial resolution available in France (IRIS) and by periods defined by public health implemented measures and major epidemiological changes. Using general census data, population density, and specific deprivation indices, we used principal component analysis followed by hierarchical clustering to define profiles describing local socio-demographic characteristics. We analyzed the association between these profiles and testing rates in a generalized additive multilevel model, adjusting for access to healthcare, presence of a retirement home, and the age profile of the population. Results: We identified 6 socio-demographic profiles across the 2,306 analyzed IRIS spatial units: privileged, remote, intermediate, downtown, deprived, and very deprived (ordered by increasing social deprivation index). Profiles also ranged from rural (remote) to high density urban areas (downtown, very deprived). From July 2020 to December 2021, we analyzed SARS-CoV-2/COVID-19 testing rate over 10 periods. Testing rates fluctuated strongly but were highest in privileged and downtown areas, and lowest in very deprived ones. The lowest adjusted testing rate ratios (aTRR) between privileged (reference) and other profiles occurred after implementation of a mandatory healthpass for many leisure activities in July 2021. Periods of contextual testing near Christmas displayed the largest aTRR, especially during the last periods of 2021 after the end of free convenience testing for unvaccinated individuals. Conclusion: We characterized in-depth local heterogeneity and temporal trends in testing rates and identified areas and circumstances associated with low testing rates, which the regional health agency targeted specifically for the deployment of health mediation activities.

Are we equally at risk of changing smoking behavior during a public health crisis? Impact of educational level on smoking from the TEMPO cohort.

BACKGROUND: The COVID-19 pandemic as a public health crisis has led to a significant increase in mental health difficulties. Smoking is strongly associated with mental health conditions, which is why the pandemic might have influenced the otherwise decline in smoking rates. Persons belonging to socioeconomically disadvantaged groups may be particularly affected, both because the pandemic has exacerbated existing social inequalities and because this group was more likely to smoke before the pandemic. We examined smoking prevalence in a French cohort study, focusing on differences between educational attainment. In addition, we examined the association between interpersonal changes in tobacco consumption and educational level from 2018 to 2021. METHODS: Using four assessments of smoking status available from 2009 to 2021, we estimated smoking prevalence over time, stratified by highest educational level in the TEMPO cohort and the difference was tested using chi2 test. We studied the association between interpersonal change in smoking status between 2018 and 2021 and educational attainment among 148 smokers, using multinomial logistic regression. RESULTS: Smoking prevalence was higher among those with low education. The difference between the two groups increased from 2020 to 2021 (4.8-9.4%, p < 0.001). Smokers with high educational level were more likely to decrease their tobacco consumption from 2018 to 2021 compared to low educated smokers (aOR = 2.72 [1.26;5.89]). CONCLUSION: Current findings showed a widening of the social inequality gap in relation to smoking rates, underscoring the increased vulnerability of persons with low educational level to smoking and the likely inadequate focus on social inequalities in relation to tobacco control policies during the pandemic.

Frustration v Imprévision, Why Frustration is so 'Frustrating': The Lack of Flexibility in the English Doctrine's Legal Consequence.

The COVID-19 pandemic and subsequent economic restrictions have placed many contractual parties under great strain to honour their agreements as contracts have become commercially impracticable and excessively onerous. This article explores the legal position in England, France and the Middle East under the doctrine of impossibility, impracticability and unforeseen circumstances. Strongly rooted in contractual autonomy and commercial certainty, this article argues that frustration in English common law is not sufficiently broad because the consequence (automatic discharge) is too rigid and does not allow a renegotiation of obligations. French civil law is more accommodating but only formally adopted imprévision in civil law in 2016, meaning it lacks traction. However, Middle Eastern civil law countries accept the doctrine as an integral part of their law and theory of justice, allowing obligations to be rebalanced in a more flexible manner. The English legal system should consider the advantages of a similar reform.

The Initial Response of Nuclear Medicine to the COVID-19 Pandemic

Objectives: COVID-19 posed profound challenges to nuclear medicine (NM) practice and education on an international scope. Initial lessons learned may be useful in understanding and optimizing dissemination of critical information during global disasters. To better understand the pandemic's initial manifold impact and responses that were in turn enacted, we systematically reviewed relevant articles published during the 2020 calendar year. Method(s): A librarian experienced in systematic reviews performed a rapid scoping review of the English language literature indexed in PubMed, Embase and Web of Science by crossing NM and COVID terms;445 citations were returned. Duplicate, extraneous, non-English and non-full text articles were excluded leaving 248 articles which were analyzed by origin, topic, design, and imaging details. Result(s): An array of topics, techniques, journals and countries of origin were encountered. 158 articles appeared in primary NMjournals, 26 appeared in generic radiology journals and 65 in non-imaging journals. Most frequent countries represented were USA (55), Italy (33), France (19) and UK (17), reflecting the hard-hit countries early during the pandemic. 118 clinical articles were case reports or small series of which 80 featured FDG-PET/CT. There were 36 observational studies. Among non-clinical topics, articles focused on safetymeasures (102), economics and recovery (23), remote reading (17) and education (8). There were 17 surveys. Society-based guidelines (47) and individual-group best practices (79) were published relating to cardiology (33), lung scintigraphy (12), andmultiple topics (48). Systematic (10) and narrative reviews (61) were less frequent than opinion articles (75). Frequent modalities discussed were FDG PET (156), nuclear cardiology (56) and lung scintigraphy (35). Conclusion(s): The medical literature has memorialized a robust response of information sharing during the initial challenges the COVID-19 pandemic relating to patient care, operations and education. Through scoping review, we have analyzed the nature of information disseminated. Opinions and single group best practices dominated the literature. Clinical reports during the first year were primarily case reports or small series, frequently FDG-PET/ CT. The nature of the literature matured as the year progressed, and sources of information broadened as the epidemic spread.