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ObjectiveTo estimate the comparative effectiveness of combination therapy with hydroxychloroquine (HCQ) and azithromycin for coronavirus disease 2019 (COVID-19)- related death based on a large monocentric cohort independent of investigators’ putative biases in a real-world setting.DesignRetrospective monocentric cohort study, with comprehensive data collection authenticated by an external bailiff and death reports from a national database (French National Death Registry).SettingInstitut Hospitalo-Universitaire Méditerranée Infection Center in Marseille, France.ParticipantsAll adults older than 18 years with PCR-proven COVID-19 who were treated directly in our centre between 2 March 2020 and 31 December 2021 and did not refuse the use of their data.InterventionsHCQ and azithromycin (HCQ-AZ) as a reference treatment were compared to other regimens containing HCQ, ivermectin and azithromycin alone, combined, or none of these three drugs. The effect of vaccination was also evaluated.Main outcome measures6-week all-cause mortality. Multivariable logistic regression estimated treatment effectiveness with adjustments for age, sex, comorbidities, vaccination, period of infection or virus variant, and outpatient or inpatient care.ResultsTotal 30,423 COVID-19 patients were analysed (86 refused the analysis of their data) including 30,202 with available treatment data, and 535 died (1.77%). All-cause mortality was very low among patients < 50 years (8/15,925 (0.05%)) and among outpatients treated with HCQ-AZ (21 deaths out of 21,135 (0.1%), never exceeding 0.2% regardless of epidemic period). HCQ-AZ treatment was associated with a significantly lower mortality rate than no HCQ-AZ after adjustment for sex, age, period and patient care setting (adjusted OR (aOR) 95% confidence interval (CI) 0.55, 0.45-0.68). The effect was greater among outpatients (71% death protection rate) than among inpatients (45%). In a subset of 16,063 patients with available comorbidities and vaccinations status, obesity (2.01, 1.23-3.29), chronic respiratory disease (2.93, 1.29-6.64), and immunodeficiency (4.01, 1.69-9.50), on the one hand, and vaccination (0.29, 0.12-0.67) and HCQ-AZ treatment (0.47, 0.29-0.76), on the other hand, were independent factors associated with mortality. HCQ, alone or in any association, was associated with significant protection from death among outpatients (0.41, 0.21-0.79) and inpatients (0.59, 0.47-0.73).ConclusionsHCQ prescribed early or late protects in part from COVID-19-related death. During pandemic health crises, financial stakes are enormous. Authentication of the data by an independent external judicial officer should be required. Public sharing of anonymized databases, ensuring their verifiability, should be mandatory in this context to avoid fake publications.

Introduction Following the first year of the COVID-19 pandemic, a complete analysis of the characteristics of the deceased hospitalized patients was performed, to identify factors related to premature mortality and to compare patient profiles according to the epidemic periods. Methods Retrospective analysis of 1104 deceased patients in two University Hospitals in South-eastern France, between March 1, 2020 and March 12, 2021 from Hospital’s electronic medical records was performed. Results Mean age was 80 years (± 11.1) and 10% of the deceased were younger than 65 years with specific comorbidities, e.g., genetic conditions, metastatic cancer, or massive obesity. Among the three clusters identified, two clusters (75% of deceased patients) include very elderly patients with numerous comorbidities, and differ by their proportion of dependent institutionalized patients. The third cluster is made up of younger patients with fewer but severe comorbidities. Deceased patients’ profiles varied according to the epidemic periods: during the first period (March–June 2020), more patients were institutionalized. The second period (September–December2020) coincided with a higher mortality rate. Conclusions This study confirmed that most patients hospitalized and dying from COVID-19 were frail, i.e., elderly and/or highly comorbid and that the small proportion of young patients had severe comorbidities.

Introduction : une solution proposee par les autorites pour faire face aux enjeux de sante publique consiste a deployer une nouvelle categorie de professionnels a competences elargies : les infirmiers en pratique avancee (IPA). La litterature identifie la complexite des projets de deploiement de ces professionnels. Le modele PEPPA, approuve par le conseil international des infirmiers, represente le modele de reference pour l’implantation des IPA. Les objectifs de cette etude etaient d’explorer la perception des parties prenantes vis-a-vis de l’implantation des IPA en etablissement de sante afin de proposer des recommandations pour accompagner les etablissements.Methode : une etude qualitative multicentrique au sein de la region PACA a ete menee aupres de medecins, encadrants, infirmiers, patients et etudiants en pratique avancee.Resultats : les IPA representent une opportunite pour les patients et le systeme de sante, mais leur implantation comporte des risques lies a leur integration. Les projets d’implantation IPA doivent etre anticipes et favoriser leur integration.Discussion : les resultats en adequation avec le modele PEPPA ont permis de proposer sept recommandations pour faciliter une implantation de qualite a l’hopital.Conclusion : ce travail necessite d’etre poursuivi avec des etudes en lien avec l’extrahospitalier et l’evaluation de la qualite de l’implantation.

Background: Informal care provided by family caregivers (FCGs) to elderly persons is associated with a high risk of burden and poor health status. Social support services (3S) for the elderly persons were characterized by assistance in various activities of daily living. This study aimed to analyze the impact of 3S on the burden of FCGs of elderly persons living in the community and identify factors associated with changes in their burden. Methods: This pre-post study was performed in the southeast of France: FCGs of non-dependent elderly persons still living at home who received a 3S were consecutively included. FCG burden was assessed with the Mini-Zarit scale before the setting up of the 3S (pre-3S) and 6 months after (post-3S). Results: A total of 569 FCGs were included in the study. Mean age of the FCGs was 62.9 years old (±13.3), 67% were women, 61.2% were children or stepchildren. Burden was present for 81% of FCGs. In most cases, 3S targeted household chores (95.8%); 59.8% of elderly persons and their FCGs were fully satisfied. The improvement in burden was greater for FCGs perceiving less obstacles post-3S in helping elderly persons (OR = 4.083) but also for FCGs fully satisfied with the 3S (OR = 2.809) and for FCGs whose perceived health status had improved post-3S (OR = 2.090). Conclusions: FCGs of non-dependent elderly persons experience a burden similar to those of dependent elderly persons. The implementation of a 3S in daily life helps to reduce their burden.

The purpose of this study was to develop and validate a pediatric individual-level index for deprivation, usable in clinical practice and in public health. The index had a 4 phases development: items generation with literature review and experts interviews, items reduction with steering committee consensus, index derivation with multivariate analysis, and index validation with psychometric and Pearson analysis. French Child Individual-Level Deprivation Index (FrenChILD-Index) was addressed by untrained healthcare professionals in a cross-sectional multicentric study. The deprivation burden was blindly evaluated in every domain of lifestyle by an expert. Children in need of one specific type of healthcare for deprived children were: moderately deprived. Children in need of referral to a socio-medical unit for access to healthcare were: severely deprived. The main outcome measure was the agreement between FrenChILD-Index results and expert evaluation.Development phases produced a 12-item instrument. Validation phases were carried out in a 986 children sample. FrenChILD-Index fulfilled the Terwee validity criterion for screening instruments. For moderate deprivation, sensitivity was 96.0% [92.6; 98.7] and specificity 68.3% [65.2; 71.4]. For severe deprivation, sensitivity was 96.3% [92.7; 100] and specificity 91.1% [89.2; 92.9]. It correlated with the number of lifestyle deprived domains 0.80 [0.77; 0.83] and the amount of specific healthcare for children 0.86 [0.83; 0.88].Conclusions: FrenChILD-Index is the first pediatric individual-level index of deprivation, methodologically validated in Europe. FrenChILD-Index enables individual appropriate referral for deprived children. It enables considering social determinants of health into account in epidemiological adjustment, patient sample stratification and program impact measurement. (NCT03640715, 21/08/2018)

Objectives To evaluate the impact of COVID-19’s lockdown on radiological examinations in emergency services. Methods Retrospective, multicentre analysis of radiological examinations requested, via our teleradiology network, from 2017 to 2020 during two timeframes (calendar weeks 5–8 and then 12–15). We included CT scans or MRIs performed for strokes, multiple traumas (Body-CT), cranial traumas (CTr) and acute non-traumatic abdominal pain (ANTAP). We evaluated the number and percentages of examinations performed, of those with a pathological conclusion, and of examinations involving the chest. Results Our study included 25 centres in 2017, 29 in 2018, 43 in 2019 and 59 in 2020. From 2017 to 2019, the percentages of examinations were constant, which was also true for chest CTs. Each centre’s number of examinations, gender distribution and patient ages were unchanged. In 2020, examinations significantly decreased: suspected strokes decreased by 36% (1052 vs 675, p p p p p Conclusion Teleradiology enabled us to monitor the impact of the COVID-19 pandemic management on emergency activities, showing a global decrease in the population's use of care.

Background: Loneliness is a public health issue that may affect the entire population. Loneliness is associated with depression, sleep disorders, fatigue, and increased risk of obesity and diabetes. Risk factors for loneliness include having a poor social network and poor physical and mental health. The main objective was to study factors related to loneliness of family caregivers caring for independent older people. Methods: We performed a non-interventional observational cross-sectional study in south-eastern France. Family caregivers caring for people aged 70 and over and living at home were included. These older people were independent, without long-term conditions, and had applied for professional social assistance for daily living. Data were collected through a questionnaire, administered face-to-face or by telephone. Loneliness and perceived health status were measured through a single-question. Burden was assessed through the Mini-Zarit Scale, and frailty was measured through the Gerontopole Frailty Screening Tool. Results: Of the 876 family caregivers included, 10% felt lonely often or always. They reported more physical and mental health issues than those who did not feel loneliness (p < 0.001). Family caregivers with loneliness were more likely to be looking after a parent and were twice as likely to have a moderate to severe burden (OR = 2.6). They were more likely to feel anxious (OR = 5.6), to have sleep disorders (OR = 2.4), to be frail (OR = 2), and to view the status of their health as poor or bad (OR = 2). Conclusions: Loneliness has a negative impact on health, causes frailty, and places a burden on family caregivers. Means must be implemented to anticipate the consequences of the loneliness felt by family caregivers, notably by orienting them towards the relevant services.

International audience; RATIONALE & OBJECTIVE: Health-related quality of life (HRQoL) is a major outcome measure increasingly used in patients with chronic kidney disease (CKD). We evaluated the association between different stages of CKD and the physical and mental health domains of HRQoL.STUDY DESIGN: Cross-sectional study.SETTING & PARTICIPANTS: 2,693 outpatients with moderate (stage 3, estimated glomerular filtration rate [eGFR], 30-60mL/min/1.73m2) or advanced (stages 4-5, estimated glomerular filtration rate40% of those with advanced CKD or receiving dialysis, 12% with a functioning transplant, and 3% of the general population sample. HRQoL physical scores (adjusted for age, sex, education, obesity, and diabetes) were significantly lower in patients in all CKD subgroups than in the general population. For patients receiving dialysis, the magnitude of the difference in physical score versus the general population exceeded 4.5 points, the minimal clinically important difference for this score in this study; for both kidney transplant recipients and patients with advanced CKD, the magnitude of the difference was close to this threshold. For mental score, only dialysis patients had a score that differed from that of the general population by more than the minimal clinically important difference.LIMITATIONS: Cross-sectional study design for each subpopulation.CONCLUSIONS: This study highlights the degree to which perceived physical health is lower in the setting of CKD than in the general population, even in the absence of kidney failure, and calls for greater attention to CKD-related quality of life.

In pediatric emergency departments (PEDs), seasonal viral outbreaks are believed to be associated with an increase of workload, but no quantification of this impact has been published. A retrospective cross-sectional study aimed to measure this impact on crowding and health care quality in PED. The study was performed in 1 PED for 3 years. Visits related to bronchiolitis, influenza, and gastroenteritis were defined using discharge diagnoses. The daily epidemic load (DEL) was the proportion of visits related to one of these diagnoses. The daily mean of 8 crowding indicators (selected in a published Delphi study) was used. A total of 93,976 children were admitted (bronchiolitis, 2253; influenza, 1277; gastroenteritis, 7678). The mean DEL was 10.4% (maximum, 33.6%). The correlation between the DEL and each indicator was significant. The correlation was stronger for bronchiolitis (Pearson R from 0.171 for number of hospitalization to 0.358 for length of stay). Between the first and fourth quartiles of the DEL, a significant increase, between 50% (patients left without being seen) and 8% (patient physician ratio), of all the indicators was observed. In conclusion, seasonal viral outbreaks have a strong impact on crowding and quality of care. The evolution of "patients left without being seen" between the first and fourth quartiles of DEL could be used as an indicator reflecting the capacity of adaptation of an emergency department to outbreaks.

This study aimed to explore work environment and mental health in nurse assistants, nurses and health executives in a national large-scale study.We have data for physicians but not for other health care workers categories.A total of 6935 participants were recruited between May and June 2021 by professional mailings and professional networks.All professional categories reported high rates of high psychological demand (90%), low social support (60%), burnout (50% to 60%), exposure to potentially morally injurious events (40%) and depression (approximately 30%). Surgery nurses reported the highest exposure to potentially morally injurious events. Major depression was identified in approximately 30% of participants in all categories, but less than 10% reported consuming antidepressants. A total of 31% to 49% of participants reported sleep disorders and 16% to 21% reported consuming regularly hypnotics. Physicians reported high hazardous drinking behaviour and nurse assistant high smoking rates.Our results suggest that preventing burnout and depression in health care workers is a priority. To reach this goal, nursing managers could develop some interventions to reduce psychological demand and increase personal accomplishment and social support between colleagues, and prevent sustained bullying at the workplace and health risk behaviours. These interventions should be further developed and evaluated.

Burn out is defined as a state of psychological exhaustion in the face of an unfavourable work environment. In the health sector, this includes, among other things, an excessive care burden, the lack of autonomy or control over work, the vicious circle of absenteeism, the lack of support, moral and sexual harassment, discrimination or the Covid-19 health crisis. Burn-out also increases the risk of depression among care workers.

A reliable pediatric triage tool is essential for nurses working in pediatric emergency departments to quickly identify children requiring priority care (high-level emergencies) and those who can wait (low-level emergencies). In the absence of a gold standard in France, the objective of our study was to validate our 5-level pediatric triage tool -We prospectively included 100,506 children who visited the Pediatric Emergency Department at Lenval Children's Hospital (Nice, France) in 2016 and 2017. The performance of

Background Muscle strength decreases as kidney failure progresses. Low muscle strength affects more than 50% of hemodialysis patients and leads to daily life activities impairment. In the general population, numerous studies have linked low 25OH-vitamin D (25OHD) concentrations to the loss of the muscle strength and low physical performances. Data on native vitamin D and muscle function are scarce in the chronic kidney disease (CKD) population, but low 25OHD levels have been associated with poor muscle strength. We present in this article the protocol of an ongoing study named VITADIAL testing if cholecalciferol supplementation in hemodialysis patients with low 25OHD improves their muscle strength. Methods/design VITADIAL is a prospective open randomized French multicenter study. All patients will have 25OHD levels ≤50nmol/L at randomization. One group will receive 100,000 UI cholecalciferol once a month during 6 months; the other group will receive no treatment during 6 months. In order to randomize patients with 25OHD ≤50nmol/L, supplemented patients will undergo a 3 months wash-out period renewable 3 times (maximum of 12 months wash-out) until 25OHD reaches a level ≤50nmol/L. The main objective of this study is to analyze if a 6-month period of oral cholecalciferol (i.e., native vitamin D) supplementation improves muscle strength of hemodialysis patients with low 25OHD vitamin D levels. Muscle strength will be assessed at 0, 3, and 6 months, by handgrip strength measured with a quantitative dynamometer. Secondary objectives are (1) to analyze 25OHD plasma levels after vitamin D wash-out and/or supplementation, as well as factors associated with 25OHD lowering speed during wash-out, and (2) to analyze if this supplementation improves patient’s autonomy, reduces frailty risk, and improves quality of life. Fifty-four patients are needed in each group to meet our main objective. Discussion In the general population, around 30 randomized studies analyzed the effects of vitamin D supplementation on muscle strength. These studies had very different designs, sizes, and studied population. Globally, these studies and the meta-analysis of studies favor a beneficial effect of vitamin D supplementation on muscle strength, but this effect is mainly found in the subgroup of aged patients and those with the lowest 25OHD concentrations at inclusion. We reported a positive independent association between 25OHD and handgrip strength in a population of 130 hemodialysis patients in a dose-dependent manner. In our cohort, a plateau effect was observed above 75 nmol/L. Only two randomized studies analyzed the effect of native vitamin D supplementation on muscle strength in hemodialysis patients, but unfortunately, these two studies were underpowered. VITADIAL is a trial specifically designed to assess whether cholecalciferol might benefit to hemodialysis patient’s muscle strength. Trial registration ClinicalTrials.govNCT04262934. Registered on 10 February 2020 - Retrospectively registered.

Compare G8 scores according to the cancer site and G8 items in older patients with thoracic cancers. In our sample study, older patients with thoracic and lung cancers presented a lower BMI, less neuropsychological disorders and were younger compared to older patients with other cancer pathologies. Management of frailties in older patients treated for thoracic and lung cancers should consider nutritional status impairment and psychological status maintenance as priorities. Assessment of vulnerability with the G8 screening tool according to cancer localization and weight of the G8 items when screening frailty in thoracic and lung cancer (TLC) compared to other cancer localizations. This study was conducted retrospectively on all G8 data collected for older cancer patients between April 2015 and December 2019 at Marseille University Hospital. One thousand four hundred and thirty-one patients were included; the median age was 80.6 years and 62.3% of the patients were men. The most common type of cancer was thoracic cancer (34.5%). A majority of patients with thoracic cancers (74.4%) had an impaired G8. In a logistic regression model, male gender, age

Introduction : One solution proposed by the authorities to address public health issues is to deploy a new category of professionals with a greater range of skills : advanced practice nurses (APNs). The literature identifies the complexity of the deployment projects of these professionals. The PEPPA model approved by the International Council of Nurses is the reference model for the introduction of APNs. The objectives of this study were to explore various stakeholders' perceptions on the introduction of APNs into health institutions, in order to propose recommendations to support the institutions.Method : A multicenter qualitative study was conducted in France's Provence-Alpes-Côte d'Azur region with physicians, managers, nurses, patients, and advanced practice students.Results : APNs are beneficial for patients and the health system, but their introduction into health institutions brings with it risks, primarily linked to their integration. APN introduction projects need to be well planned and should prioritize their integration.Discussion : Results consistent with the PEPPA model identified seven recommendations to facilitate the successful introduction of APNs into hospitals.Conclusion : This work needs to be continued with studies related to the out-of-hospital setting and the evaluation of the successfulness of APNs' introduction.

Circulating autoantibodies (auto-Abs) neutralizing high concentrations (10 ng/mL, in plasma diluted 1 to 10) of IFN-α and/or -ω are found in about 10% of patients with critical COVID-19 pneumonia, but not in subjects with asymptomatic infections. We detect auto-Abs neutralizing 100-fold lower, more physiological, concentrations of IFN-α and/or -ω (100 pg/mL, in 1/10 dilutions of plasma) in 13.6% of 3,595 patients with critical COVID-19, including 21% of 374 patients80 years, and 6.5% of 522 patients with severe COVID-19. These antibodies are also detected in 18% of the 1,124 deceased patients (aged 20 days-99 years; mean: 70 years). Moreover, another 1.3% of patients with critical COVID-19 and 0.9% of the deceased patients have auto-Abs neutralizing high concentrations of IFN-β. We also show, in a sample of 34,159 uninfected subjects from the general population, that auto-Abs neutralizing high concentrations of IFN-α and/or -ω are present in 0.18% of individuals between 18 and 69 years, 1.1% between 70 and 79 years, and 3.4%80 years. Moreover, the proportion of subjects carrying auto-Abs neutralizing lower concentrations is greater in a subsample of 10,778 uninfected individuals: 1% of individuals70 years, 2.3% between 70 and 80 years, and 6.3%80 years. By contrast, auto-Abs neutralizing IFN-β do not become more frequent with age. Auto-Abs neutralizing type I IFNs predate SARS-CoV-2 infection and sharply increase in prevalence after the age of 70 years. They account for about 20% of both critical COVID-19 cases in the over-80s, and total fatal COVID-19 cases.

Background Long boarding time in emergency department (ED) leads to increased morbidity and mortality. Prediction of admissions upon triage could improve ED care efficiency and decrease boarding time. Objective To develop a real-time automated model (MA) to predict admissions upon triage and compare this model with triage nurse prediction (TNP). Patients and methods A cross-sectional study was conducted in four EDs during 1 month. MA used only variables available upon triage and included in the national French Electronic Emergency Department Abstract. For each patient, the triage nurse assessed the hospitalization risk on a 10-point Likert scale. Performances of MA and TNP were compared using the area under the receiver operating characteristic curves, the accuracy, and the daily and hourly mean difference between predicted and observed number of admission. Results A total of 11 653 patients visited the EDs, and 19.5-24.7% were admitted according to the emergency. The area under the curves (AUCs) of TNP [0.815 (0.805-0.826)] and MA [0.815 (0.805-0.825)] were similar. Across EDs, the AUCs of TNP were significantly different (P 0.2). Originally, using daily and hourly aggregated data, the percentage of errors concerning the number of predicted admission were 8.7 and 34.4%, respectively, for MA and 9.9 and 35.4%, respectively, for TNP. Conclusion A simple model using variables available in all EDs in France performed well to predict admission upon triage. However, when analyzed at an hourly level, it overestimated the number of inpatient beds needed by a third. More research is needed to define adequate use of these models.

Resume Position du probleme L’augmentation de l’esperance de vie et le vieillissement de la population a un impact important sur les soins informels delivres par les proches aidants. La prevention d’un fardeau excessif pour cette population est devenue une priorite en matiere de sante publique. La majorite des etudes sur les aidants ne ciblent que ceux de personnes âgees dependantes. L’objectif de cet article est de decrire les caracteristiques des aidants de personnes âgees non dependantes, leurs difficultes et le niveau de fardeau. Methodes Une etude transversale a ete conduite aupres de 876 dyades (personne âgee de plus de 70 ans, autonome, vivant a domicile, ayant fait une demande d’aide aupres de la Carsat Sud-Est et son aidant). Deux questionnaires ont ete administres : un pour la personne âgee (incluant la grille « Frailty Groupe Iso-Ressource Evaluation ») et un pour l’aidant (incluant le mini-Zarit). Une analyse en composantes multiples et une regression logistique ont ete realisees. Resultats Les personnes âgees sont des femmes (77,6 %) avec un âge moyen de 82,2 ± 5,8 ans, et sont fragiles (94,7 %). Les aidants sont le plus souvent des femmes (64,5 %) âgees en moyenne de 62,7 ± 13,7 ans. Pour l’analyse a composantes multiples, trois categories d’aidants ont ete definies : les conjoints, les enfants et une categorie « autres ». Les conjoints realisent le plus de tâches (4,8 ± 2,6) et ont un fardeau eleve. Les autres sont ceux ayant le moins de fardeau et sont les moins impactes dans leur vie quotidienne. Les enfants sont divises en deux sous-groupes : un dont les specificites se rapprochent des aidants « autres » et l’autre groupe des aidants conjoints. Les variables associees a un fardeau modere ou severe sont l’impact sur la vie quotidienne, la qualite de la relation avec la personne âgee et le fait d’eprouver de plus en plus de difficultes a remplir son role d’aidant. Conclusion Cette etude confirme et affine la grande heterogeneite des profils d’aidants et montre que les aidants des personnes âgees autonomes fragiles sont assez similaires dans leurs caracteristiques et sur le niveau de fardeau ressenti des aidants de personnes âgees dependantes.

Contexte : la prevalence du diabete de type 1 chez l’enfant en Suisse et dans le monde est en constante augmentation. La coordination des soins semblerait etre un element determinant et incontournable pour une prise en soin efficace et efficiente.Objectif : identifier les difficultes et les leviers de coordination rencontres par les soignants et les familles lors de la phase de decouverte d’un diabete de type 1, de la naissance a 15 ans.Methode : analyse qualitative par entretiens semi-diriges.Resultats : trois familles et cinq soignants ont participe a l’etude. L’annonce de diagnostic est vecue comme douloureux, un choc pour les familles. Les infirmieres specialisees en diabetologie pediatrique sont reconnues comme des experts en soins et pour l’enseignement. La prise en charge est vecue comme stressante et complexe par les infirmieres non specialisees. La collaboration entre les unites est decrite comme cloisonnee. Les outils informatiques ne sont pas communs entre les unites. L’accompagnement psychologique est vecu comme non satisfaisant par les familles.Discussion : les infirmieres ont besoin de travailler en interdisciplinarite et dans une coordination de soins structuree.

Patients with cancer are at higher risk of severe coronavirus infectious disease 2019 (COVID-19), but the mechanisms underlying virus-host interactions during cancer therapies remain elusive. When comparing nasopharyngeal swabs from cancer and non-cancer patients for RT-qPCR cycle thresholds measuring acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in 1063 patients (58% with cancer, 89% COVID-19+), we found that malignant disease favors the magnitude and duration of viral RNA shedding concomitant with prolonged serum elevations of type 1 IFN that anticorrelated with anti-RBD IgG antibodies. Chronic viral RNA carriers exhibited the typical immunopathology of severe COVID-19 at the early phase of infection including circulation of immature neutrophils, depletion of non-conventional monocytes and a general lymphopenia that, however, was accompanied by a rise in plasmablasts, activated follicular T helper cells, and non-naive Granzyme B+ FasL+, EomehighTCF-1high, PD-1+CD8+ Tc1 cells. Virus-induced lymphopenia worsened cancer-associated lymphocyte loss, and low lymphocyte counts correlated with chronic SARS-CoV-2 RNA shedding, COVID-19 severity and a higher risk of cancer-related death in the first and second surge of the pandemic. Lymphocyte loss correlated with significant changes in metabolites from the polyamine and biliary salt pathways as well as increased blood DNA from Enterobacteriaceae and Micrococcaceae gut family members in long term viral carriers. We surmise that cancer therapies may exacerbate the paradoxical association between lymphopenia and COVID-19-related immunopathology, and that the prevention of COVID-19-induced lymphocyte loss may reduce cancer-associated death.

Context Burnout is an international phenomenon defined as a state of professional exhaustion. It can lead to depression and have major economic and organizational impacts. Previous studies of healthcare professionals in France have focused on physicians, but none to date have explored other healthcare professions. Objectives The main objective of our study is to determine the prevalence of burnout among healthcare workers. The secondary objectives are to explore the associations of burnout with professional and psycho-social factors and the risk of depression, professional harassment, sexual harassment, sexual-orientation based discrimination, consumption of antidepressants, anxiolytics and also the lifestyle of the individual: smoking, alcohol consumption, coffee consumption, physical activity and sleep quality. Materials and methods The survey will take the form of a voluntary and anonymous online questionnaire carried out on the FramaForm1® platform and will be disseminated via social networks, professional networks and mailings. Study Population Senior doctors, interns, directors of care, nurses, head nurses and senior head nurses, physiotherapists and occupational therapists, dieticians, radiology technicians, laboratory technicians, psychologists, nurses’ aides, auxiliary nurses and midwives will be included. Collected data Burnout will be measured with the Maslach Inventory burnout (MBI) questionnaire, work environment with the Karasek questionnaire and anxiety, depression risk with the Center for Epidemiologic Studies- Depression (CES-D), physical activity with the Global Physical Activity Questionnaire (GPAQ) and sleep quality with the Pittsburgh Sleep Quality Index (PSQI). Ethics This protocol has been accepted by the ethical committee (IRB n°C08/21.01.06.93911, CNIL). Expected results Based on international studies, we expect a high rate of burnout with disparities according to profession, socio-demographic data, seniority and type of service. We also expect a significant rate of untreated depression. This study will provide evidence for policy makers to implement collective strategies to reduce burnout and depression in the different populations studied.

In March 2020, the IHU Méditerranée Infection set up a screening and treatment center for patients with COVID-19, a system that has been ultimately recommended by French public health authorities. The recent publication of the profiles of patients hospitalized in France published by the Directorate for Research, Studies, Evaluation and Statistics gives us the opportunity to measure the impact of this multidisciplinary early management system coupled with screening on mortality at 90 days. Analysis of the data shows that the system established at IHU-MI was associated with lower mortality, taking age and sex into account. Regarding the age-standardized mortality rate, mortality rates were lower than national data regardless of the period of the epidemic. Early management seems to have significantly decreased the mortality rate in the under-60 age group, suggesting the importance of early management, regardless of age. In addition, these patients had pejorative clinical criteria (high NEWS-2 score, ICU visits, oxygen saturation below 95%) requiring hospitalization, and co-morbidities that are now known to be aggravating factors [7]. This reinforces the need to care for all individuals, regardless of age. Early medical care, as part of a system integrating a screening center and a day hospital, may explain the lower mortality rates.

Asmatullah Kakar,1 Yosra Mouelhi,1 Anderson Loundou,1 Adeline Crémades,1 Stephanie Gentile1,2 1Aix Marseille University School of Medicine — La Timone Medical Campus, EA 3279: CEReSS — Health Service Research and Quality of Life Center, Marseille, France; 2Assistance Publique, Hôpitaux de Marseille (AP-HM), Marseille, FranceCorrespondence: Asmatullah KakarAix Marseille University School of Medicine — La Timone Medical Campus, EA 3279: CEReSS — Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, Marseille, 13005, FranceTel +33-4 9132 4470Fax +33(0)4 91 38 44 82Email asmatullah.kakar@gmail.comIntroduction: The proportion of new dialysis patients with comorbidities increased by an average of 5.6% per year in the Provence-Alpes-Côte d’Azur (PACA) region, with major increases in obese, cancer, and diabetic patients. This study aimed to describe comorbidity profiles among obese–diabetic end-stage renal disease (ESRD) patients in the Renal Epidemiology and Information Network (REIN) registry of the PACA region of France on December 31, 2018.Methods: Data for this retrospective cross-sectional study were retrieved from the REIN registry of the PACA region. Data were analyzed using two models. Firstly, the ESRD patients were divided into two groups and binary logistic regression model used for the analysis of the data. Secondly, ESRD patients were divided into four groups and multinomial logistic regression model used. Univariate analysis was performed for group comparison using x2 and t-tests, while binary logistic and multinomial logistic regression models were used for multivariate analysis to derive ORs and 95% CIs.Results: Among the 4,491 ESRD patients in this study, 623 were obese–diabetic and 3,868 nonobese–nondiabetic and obese only/ diabetic only. Obese–diabetic ESRD patients were younger (< 75 years, OR 0.46, p< 0.001), smoked less (OR 0.51, p< 0.001), were mainly dialyzed at centers (OR 1.29, p=0.014), and less likely to be on the renal transplant waiting list (OR 0.46, p< 0.001) compared to the other group. Obese–diabetic ESRD patients also had more comorbidities, including cardiovascular diseases (OR 1.38, p=0.028), coronary insufficiency (OR 1.49, p=0.001) and chronic obstructive pulmonary disease (OR 1.75, p< 0.001), but had fewer cases of cancer (OR 0.68, p=0.024) compare to the other group.Conclusion: Obese–diabetic patients with ESRD have many specific characteristics. These patients were younger, but had more cardiovascular comorbidities and were less likely to be on the waiting list for transplantation. They should receive special attention and be the subject of prevention and therapeutic education.Keywords: comorbidities, ESRD, CKD, REIN, obesity, diabetes

Background: Obesity and diabetes are the main causes of chronic kidney disease (CKD) and end stage renal disease (ESRD). The objective of this study was to analyze the impact of obesity and diabetes on CKD and ESRD incidence and prevalence. Methods: A comprehensive literature search was conducted from 2001 to 2018. 494 articles were retrieved via PubMed and 125 articles through Google scholar and reference list of the selected articles. Among which thirty (30) studies met our inclusion criteria consisting of 17 cohorts, 11 cross-sectional, and 2 case-control studies.Results: Majority of the studies indicated direct relationship between body mass index (BMI) and ESRD risk. Notably, the association of obesity and diabetes potentially increases the incidence and prevalence of CKD and ESRD. Results from the cohort, case-control and cross-sectional studies pointed out a positive association between obesity, diabetes and risks for renal disease outcomes. Even though many complications may occur, renal transplantation (RT) is still the preferred renal replacement therapy (RRT) advised in multiple studies for diabetic ESRD patients. Renal transplantation was associated with better quality of life and survival advantage than dialysis. Interestingly, overweight and obese ESRD patients on dialysis had a significant survival advantage in comparison to lean body weight patients. Conclusion: Taken together, obesity and diabetes are significantly associated with the increasing incidence and prevalence of CKD and ESRD. Regulation of Weight and diabetes are highly recommended in obese and diabetic patients to prevent the subsequent renal disease. Previous reviews have discussed the relationship between obesity and ESRD or diabetes and ESRD separately. However, importantly, this review gives an insight on the association between obesity, diabetes and CKD/ ESRD.

Patient transport represents the second largest item of cost of dialysis after hospitalization. A significant proportion of patients transported by ambulance are self-sufficient for walking.A study was carried out in the PACA region (France) to analyse the profile of patients transported by ambulance and self-sufficient for walking and then to evaluate the savings for the Health Insurance.A triangulation of data was carried out using data from haemodialysis patients recorded in the French REIN Registry in 2017 and data from two surveys: one of a sample of patients transported by ambulance and autonomous in walking, and the other of 62 nephrologists.The data from the REIN register allowed us to estimate that 44 % of patients transported by ambulance are self-sufficient for walking. Our study allowed us to estimate that 2/3 of patients transported by ambulance, self-sufficient for walking, have a reason for being transported by ambulance; for the third without a reason, the health insurance savings would amount to €2 million per year with a reclassification of their transport as seated transport. The survey of prescribers showed that there are exemptions justified by a temporary deterioration in health and/or housing conditions, but also by the lack of seated transport.One third of the patients, transported by ambulance and self-sufficient for walking, would have an inappropriate transport. This would be explained by the fluctuating state of health of the patients and would also linked to the lack of seated transportation. Savings are possible and depend in part on improved management of the supply.

Objectives In a conventional hospital ward, we used high-flow nasal oxygen (HFNO) to treat elderly COVID-19 patients noneligible for intensive care unit transfer. Methods This study was conducted in the Institut Hospitalo-Universitaire Mediterranee Infection, Assistance Publique-Hopitaux de Marseille (AP-HM), France. We used high-flow nasal oxygen (HFNO) in our conventional infectious disease ward from 15 September 2020 for elderly patients noneligible for intensive care unit transfer. Results Of the 44 patients (median age 83 years (57–94), mean: 80.25), 61.4% (27/44) were men. The median Charlson score was 7 (1–15). The median of the NEWS-2 score upon admission was 8 (3–11) and was 10 at the time of initiation of HFNO. The median PaO2/FiO2 ratio was 103 (71–151) prior to HNFO initiation. Among the 44 patients, 16 patients (36.4%) had been weaned from HFNO, and 28 patients had died (63.6%). Conclusions In this preliminary report, we observed that HFNO saved the lives of one-third of elderly COVID-19 patients who would have systematically died.

Assessment of vulnerability with the G8 screening tool according to cancer localization and weight of the G8 items when screening frailty in thoracic and lung cancer (TLC) compared to other cancer localizations.This study was conducted retrospectively on all G8 data collected for older cancer patients between April 2015 and December 2019 at Marseille University Hospital.One thousand four hundred and thirty-one patients were included; the median age was 80.6 years and 62.3% of the patients were men. The most common type of cancer was thoracic cancer (34.5%). A majority of patients with thoracic cancers (74.4%) had an impaired G8. In a logistic regression model, male gender, age 80 years, BMI 23 kg/mImproving nutritional status and maintaining mental health are important issues to consider before treatment initiation in older patients with thoracic cancers.

OBJECTIVE: There are no recommendations for screening for thoracic aortic aneurysms (TAAs), even in patients with infrarenal abdominal aortic aneurysms (AAAs). The aims of this study were to determine the prevalence of TAAs in patients with AAAs and to analyse the risk factors for this association. METHODS: This was a multicentre prospective study. The Aortic Concomitant Thoracic and Abdominal Aneurysm (ACTA) study included 331 patients with infrarenal AAAs > 40 mm between September 2012 and May 2016. These patients were prospectively enrolled in three French academic hospitals. RESULTS: Patients were classified as having a normal, aneurysmal, or ectatic (non-normal, non-aneurysmal) thoracic aorta according to their maximum aortic diameter indexed by sex, age, and body surface area. Thoracic aortic ectasia (TAE) was defined as above or equal to the 90th percentile of normal aortic diameters according to gender and body surface area. Descending TAA was defined as ≥q 150% of the mean normal value, and ascending TAA as > 47 mm in men and 42 mm in women; 7.6% (n~= 25) had either an ascending (seven cases; 2.2%) or descending aortic TAA (18 cases; 5.4%), and 54.6% (n~= 181) had a TAE. Among the 25 patients with TAAs, five required surgery; two patients had TAAs related to penetrating aortic ulcers < 60 mm in diameter, and three had a TAA > 60 mm. In the multinomial regression analysis, atrial fibrillation (AF) (odds ratio [OR] 11.36, 95% confidence interval [CI] 2.18 - 59.13; p~= .004) and mild aortic valvulopathy (OR 2.89, 1.04-8.05; p~= .042) were independent factors associated with TAAs. Age (OR 1.06, CI 1.02 - 1.09; p~= .003) and AF (OR 4.36, 1.21 - 15.61; p~= .024) were independently associated with ectasia. CONCLUSION: This study confirmed that TAAs coexisting with AAAs are not rare, and one fifth of these TAAs are treated surgically. Systematic screening by imaging the whole aorta in patients with AAAs is clinically relevant and should lead to an effective prevention policy.