Interruption volontaire de grossesse et COVID-19 : ce que la pandémie a modifié en 2020

ObjectiveThe management measures to contain the SARS-CoV-2 pandemic in 2020 has upset the organization of society, particularly the organization of the health system. We aimed to analyze the evolution of induced abortions in the Paris region in 2020 and to highlight the impact of the first confinement.MethodData from the National Health Insurance plan was analyzed to study abortion during the pandemic period (2020) compared to the previous four years (2016–2019). In 2020 the indicators of induced abortion were studied monthly to highlight the impact of the confinement. The age of women, the method used to terminate the pregnancy, the gestational age at the time of the abortion and the area of residence of women were analyzed.ResultsAfter five consecutive years of increasing abortion rates, our result showed that the number of abortions declined from 53,601 in 2019 to 50,615 in 2020 (decline of 5.6%). The abortion rate was 17.3 per 1,000 women aged 15–49 in 2019 and 16.3‰ in 2020. This drop was observed within 4 weeks following the first confinement. It concerned particularly abortions carried out in the hospital context and abortions of young women (< 25 years old). In 2020 the rate of medical abortions increased compared to the 4 years preceding the pandemic. The use of local anesthesia for surgical abortions also increased in the Paris region during the first confinement. Our study showed a fewer proportion of late abortion (over 12 weeks of amenorrhea) in 2020. This analysis also showed a drop in the number of births in the eight to nine months that followed the first confinement in the Paris region.Discussion and ConclusionThe COVID-19 pandemic has had health consequences not directly attributable to the virus. In terms of reproduction, the pandemic, particularly the first lockdown, has been associated to a decrease in conceptions resulting in a decrease in the number pregnancies including those ending in induced abortion or childbirth. The reduction of abortions is observed in the four weeks following the first confinement and the fall in the birth rate in the following 8 to 9 months.     

Jusqu’où l’Afrique peut-elle limiter l’impact de la pandémie de COVID-19 ?

Following the onset of the global COVID-19 pandemic and the alerts issued by the World Health Organization, for several months attention has been focused on Africa as a potentially severely endangered continent. A sizable number of African countries, mainly low and middle income, suffer from limited available resources, especially in critical care, and COVID-19 is liable to overwhelm their already fragile health systems. To effectively manage what is shaping up as a multidimensional crisis, the challenge unquestionably goes beyond the necessary upgrading of public health infrastructures. It is also a matter of anticipating and taking timely action with regard to factors that may mitigate the propagation of SARS-CoV2 and thereby cushion the shock of the pandemic on the African continent. While some of these factors are largely unmanageable (climate, geography…), several others (socio-cultural, religious, audio-visual, and potentially political…) could be more or less effectively dealt with by African governments and populations.     

Apport de la téléconsultation et de l’isolement des cas symptomatiques dans la maîtrise de l’épidémie COVID-19 au sein d’une base militaire

BackgroundThe first wave of COVID-19 swept over France during the first quarter of 2020, leading to saturation of the health care system. We wished to study, in a French military medical unit assisting one of the country's largest armed forces populations, the impact of teleconsultation and the systematic isolation of all possible, probable and confirmed cases of COVID-19.MethodsThis is a retrospective study carried out from March 9 to May 31, 2020 on the basis of our activity register. The variables collected included type of medical consultation procedure, occupational status, classification of cases and date of onset of first symptoms. We have paralleled our activity with that of SOS Médecins and the emergency departments of the Île-de-France region.Results/discussionDuring this period, 1719 episodes of care (teleconsultations or physical consultations) were recorded, of which 91% (n = 1561) were linked to COVID-19. We identified 598 “suspected” (possible and probable) and confirmed cases. “Isolated” teleconsultations (not followed by a face-to-face medical consultation, sample taking or necessitating the dispatch of prompt assistance) represented 86% of episodes of care (n = 1482). Comparison of our activity and the number of new cases with the databases of SOS Médecins and the Île-de-France emergency services suggests that our isolation strategy was timely and effective.ConclusionThe contribution of teleconsultation was substantial and reassuring. Teleconsultation makes it possible to absorb a large volume of patients, is easy to implement, and entails no nosocomial risk. Isolation of infected patients should be a priority during an outbreak. Once it has become a priority to rapidly bring an epidemic under control, this attitude must be extended to all symptomatic patients.     

Adaptations de la prise en charge des patients en nutrition artificielle à domicile au cours de l’épidémie virale COVID-19 en France : avis du Comité de nutrition à domicile de la Société Francophone de Nutrition Clinique et Métabolisme (SFNCM)

Home artificial nutrition, whether enteral or parenteral, is provided to chronic and fragile patients. The current COVID-19 epidemics may compromise their care at several levels: difficulties to access to hospitals mainly focused on treating COVID-19 patients, possible lack of nurses at home, strong reduction of visits by homecare providers, tended flow or lack of hand sanitizers, surgical masks and pumps. The aim of these recommendations put together by the French-speaking Society for Clinical Nutrition and Metabolism (SFNCM)’s Home Artificial Nutrition Committee is to define in terms of healthcare resources the minimum care to provide to these patients. We also aim to help cope with the possible tensions, in order to secure the care we must provide to home artificial nutrition patients during this crisis.     

Impact de la pandémie de grippe A sur la vaccination des médecins généralistes français contre la grippe saisonnière : suivi d’une cohorte entre 2007 et 2010

BackgroundOur objective was to assess the impact of the A influenza pandemic on the anti-seasonal influenza vaccination of French general practitioners.MethodsA survey was conducted in 2007 in a random sample of general practitioners. A second survey conducted in 2010 included all general practitioners who had not been vaccinated in 2007 and one-third of those who had been.ResultsResponses were obtained from 1010 general practitioners in 2007. The coverage rate of anti-seasonal influenza vaccination reached 73%. In 2010, the coverage was 73.5% and rate of anti-A influenza vaccination was 59% (weighted numbers). Between the two surveys, 130 family physicians (15.5%) changed their behavior. Analysis showed that the A influenza pandemic had a slight positive impact on anti-seasonal influenza vaccination.ConclusionThis first cohort of French general practitioners concerning influenza vaccination found the same anti-seasonal influenza vaccination rates widely reported in the literature and showed that the A influenza pandemic had slight impact on it.     

El impacto de las primeras olas pandémicas de la COVID-19 en las personas mayores con demencia

Patients with dementia are in themselves more vulnerable, and have been especially affected by the effect of the COVID-19 pandemic, both directly due to the disease itself, and indirectly due to the deprivation of cognitive stimulation due to isolation social due to confinement.SARS-CoV-2 virus infection has given rise to a wide variety of symptoms, including neurological symptoms and especially delirium in the elderly with dementia. The virus has affected the central nervous system, both directly due to the neurotropism of the virus, and indirectly due to inflammation and tissue hypoxia of vascular origin.The different causes that have been able to lead, in the different waves prior to the omicron variant, to the significant increase in morbidity and mortality in patients with dementia, especially the elderly, are analyzed.     

Activité physique lors de la sclérose latérale amyotrophique

For a long time, an intense physical activity has been suspected to be a risk factor for developing amyotrophic lateral sclerosis (ALS). Moreover, the patients would like to know if their disease may be worsened by physical activity, but also if physical activity may be useful against spasticity, and if creatine, a nitrogenous compound occurring in the first anaerobic phase of exercise may have an interest. Animal studies suggest a global favourable effect of moderate exercise, but these data cannot be strictly applied in humans. Human studies show that an intense physical activity like football or American football might be a risk factor for developing ALS. Studies are not enough powerful to indicate an interest of exercise after the onset of the disease. Physical activity does not improve the spasticity, and creatine seems not to be effective during ALS.     

Repenser la place des soins de santé primaires en France – Le rôle de la médecine générale

Primary healthcare is poorly structured in France while it is well defined at the international level: it is the point of first medical contact of the population with the healthcare system. General practice is the clinical specialty oriented to primary healthcare. Data in the scientific literature highlight the need of refocusing the health system on primary care known to improve both morbi-mortality and care efficiency. In France, health authorities acknowledge general practitioners as playing a key role in the health care system: its time to move from intention to action. Structural changes are needed to achieve this reinforcement of primary healthcare: to re-orientate medical studies towards primary care; to develop research in primary care; to promote cooperation between care providers; to ease the daily workload of practitioners; to diversify methods of payment; to propose a guide for patient's use of primary care. The transformation of the healthcare system in France requires a real strategy of primary healthcare implementation. Regardless of financial constraints, it is possible to redistribute the resources towards ambulatory care. Strengthening the role of general practice and favoring its societal recognition will be the major stages of this change.