Search

BackgroundDuring the pandemic period, healthcare systems were substantially reorganized for managing COVID-19 cases. The corresponding changes on the standard care of persons with chronic diseases and the potential consequences on their outcomes remain insufficiently documented. This observational study investigates the direct and indirect impact of the pandemic period on the survival of kidney transplant recipients (KTR), in particular in those not hospitalized for COVID-19.MethodsWe conducted a cohort study using the French national health data system which contains all healthcare consumptions in France. Incident persons with end stage kidney disease between January 1, 2015 and December 31, 2020 who received a kidney transplant were included and followed-up from their transplantation date to December 31, 2021. The survival of KTR during the pre-pandemic and pandemic periods was investigated using Cox models with time-dependent covariates, including vaccination and hospitalization events.FindingsThere were 10,637 KTR included in the study, with 324 and 430 deaths observed during the pre-pandemic (15,115 person-years of follow-up) and pandemic periods (14,657 person-years of follow-up), including 127 deaths observed among the 659 persons with a COVID-19-related hospitalization. In multivariable analyses, the risk of death during the pandemic period was similar to that observed during the pre-pandemic period (hazard ratio (HR) [95% confidence interval]: 0 ·92 [0·77–1·11]), while COVID-19-related hospitalization was associated with an increased risk of death (HR: 10 ·62 [8·46–13·33]). In addition, pre-emptive kidney transplantation was associated with a lower risk of death (HR: 0·71 [0·56–0·89]), as well as a third vaccine dose (HR: 0·42 [0·30– 0·57]), while age, diabetes and cardiovascular diseases were associated with higher risks of death.InterpretationConsidering persons living with a kidney transplant with no severe COVID-19-related hospitalization, the pandemic period was not associated with a higher risk of death.FundingInitiative Économie de la Santé de Sorbonne Université (Idex Sorbonne Université, programmes Investissements d’Avenir); Ministère de la Solidarité et de la Santé (PREPS 20-0163).

Les personnes âgees dependantes sont plus souvent confrontees a des depenses sanitaires elevees. Des dispositifs d’exoneration du ticket moderateur (ALD, pension d’invalidite…) leur permettent de reduire leurs restes a charge, mais aucune etude francaise n’a encore mesure l’efficacite du systeme de protection sociale pour ces personnes. Cet article propose une analyse sur les personnes âgees de 60 ans et plus residant en logement ordinaire. A partir des donnees de l’enquete Handicap Sante Menages collectees en 2008, nous classons les assures en fonction de leur recours a l’aide humaine et analysons les niveaux et la structure de leurs depenses sanitaires. Malgre une croissance des depenses avec le niveau de dependance, le systeme de protection sociale maintient les restes a charge a un montant moyen de 900 euros annuels quel que soit le niveau de dependance. Nos resultats montrent egalement que les postes qui pesent le plus sur le reste a charge sont bien couverts par les complementaires. Les inegalites de restes a charge dependent donc principalement de la capacite des menages a financer leur assurance complementaire.

National audience

International audience; Background: Pressure ulcer risk assessment provides an indicator of quality of care in French health establishments. The reliability and validity of assessment tools have been shown to be lower for people with spinal cord injury (SCI). We hypothesized that skin complications would be less frequent in people with traumatic SCI and tetraplegia (TSCIt), who were initially managed in French regions with a high level of specialized SCI rehabilitation experience.Methods: First, we used the most recent French territorial survey about SCI to determine a 'Level of Regional Experience (LRE) in Specialized Physical Medicine and Rehabilitation'. We then studied the individual variables reported in the Tetrafigap survey (which compiled a cohort of TSCIts people to assess their trajectory and life conditions following their return to community life by questionnaires) using univariate analysis according to these LREs (chi2 test using a significance threshold of P < 0.05). Finally, we performed a series of logistic regressions to determine the link between LREs and pressure ulcers.Results: Management in high-LRE regions was linked with a lower declaration of pressure ulcers during early treatment and in the long term (on average, 8 years post-trauma).Conclusions: Using pressure ulcers as a marker, our study showed the protective element of regional experience in the early management of TSCIts patients. A dilution effect between SCI specialized units and more polyvalent physical medicine and rehabilitation departments should be prevented within each region within the scope of a regional organization that would link referral centres and local health care networks.

Introduction/Background Pressure ulcer risk assessment provides an indicator of quality of care in French health establishments. The predictive value of clinical assessment tools is lower for people with spinal cord injury (SCI). We hypothesized that skin complications would be less frequent in traumatic SCI patients with tetraplegia (TSCIt) who were initially managed in French regions with a high level of specialized SCI rehabilitation experience. Material and method First, we used the most recent French epidemiological survey of patients with SCI to determine a “Level of Regional Experience in Specialized Physical Medicine and Rehabilitation” (LRE). We then studied the medical and social variables reported in the Tetrafigap survey (which compiled a cohort of TSCIt, to assess their trajectory and life conditions following the return to community life) using univariate analysis according to these LREs (Chi2 test using a significance threshold of P Results Management in high-LRE regions was associated with a lower occurrence of pressure ulcers during early treatment and in the long-term (on average, 8 years post-trauma). Conclusion Using pressure ulcers as a marker, our study demonstrated the protective link of regional experience of the early management of TSCIt. In our opinion, efforts should first prevent a dilution effect through holistic health care for SCI, within the scope of a regional organization that would link referral centers and local health care networks.

Objective To identify the long-term clinical, individual, and social risk factors for the development of pressure ulcers (PUs) in traumatic spinal cord-injured persons with tetraplegia (TSCIt). Material/Patients and methods/Design Cohort survey with self-applied questionnaires in 1995 and 2006. Thirty-five French-speaking European physical medicine and rehabilitation centers participating in the Tetrafigap surveys. A total of 1641 tetraplegic adults were surveyed after an initial post-traumatic period of at least 2 years. Eleven years later, a follow-up was done for 1327 TSCIt, among whom 221 were deceased and 547 could be surveyed again. Main outcome measure was the proportion of PUs documented at the various defined time points, relative to the medical and social situations of the TSCIt, by using univariate analyses followed by logistic regression. Results Of the participants, 73.4% presented with a PU during at least one period after their injury. Four factors had an effect on the occurrence of PU at the long-term. On the one hand, a protective feature for this population, persons with incomplete motor impairment (OR = 0.5) and moreover those who were able to walk (OR = 0.2); on the other hand, a strong predictive factor was the development of a PU during the initial post-trauma phase (OR = 2.7). Finally, a significant situational factor was the lack of social network (OR = 3.1). Discussion/Conclusion We believe that the highlighting of a motor incomplete feature of SCI, protective for the development of PU, and of a medical risk factor, an early PU, which served as a definitive marker of the trajectory of TSCIt, together with a social situational factor, indicates the crucial role of initial management and of long-term follow-up.