Estimating the burden of influenza-related and associated hospitalizations and deaths in France: an eight-season data study, 2010-2018

Background: In France, each year, influenza viruses are responsible for seasonal epidemics leading to 2-6 million cases. Influenza can cause severe disease that may lead to hospitalization or death. As severe disease may be due to the virus itself or to disease complications, estimating the burden of severe influenza is complex. The present study aimed at estimating the epidemiological and economic burden of severe influenza in France during eight consecutive influenza seasons (2010-2018). Methods: Influenza-related hospitalization and mortality data and patient characteristics were taken from the French hospital information database, PMSI. An ecological approach using cyclic regression models integrating the incidence of influenza syndrome from the Sentinelles Network supplemented the PMSI data analysis in estimating excess hospitalization and mortality (CépiDc – 2010-2015) and medical costs. Results: Each season, the average number of influenza-related hospitalizations was 18,979 (range: 8,627-44,024), with an average length of stay of 8 days. The average number of respiratory hospitalizations indirectly related with influenza (i.e., influenza-associated) was 31,490 (95% CI: 24,542-39,012), with an average cost of \euro141 million (range: 54-217); 70% of these hospitalizations and 77% of their costs concerned individuals ≥ 65 years of age (65+). More than 90% of excess mortality was in 65+ subjects. Conclusions: The combination of two complementary approaches allowed estimation of both influenza-related and associated hospitalizations and deaths and their burden in France, showing the substantial impact of complications. The present study highlighted the major public health burden of influenza and its severe complications, especially in 65+ subjects.

Making sense of the French public hospital system: a network-based approach to hospital clustering using unsupervised learning methods

Background Hospitals in the public and private sectors tend to join larger organizations to form hospital groups. This increasingly frequent mode of functioning raises the question of how countries should organize their health system, according to the interactions already present between their hospitals. The objective of this study was to identify distinctive profiles of French hospitals according to their characteristics and their role in the French hospital network. Methods Data were extracted from the national hospital database for year 2016. The database was restricted to public hospitals that practiced medicine, surgery or obstetrics. Hospitals profiles were determined using the k-means method. The variables entered in the clustering algorithm were: the number of stays, the effective diversity of hospital activity, and a network-based mobility indicator (proportion of stays followed by another stay in a different hospital of the same Regional Hospital Group within 90 days). Results Three hospital groups were identified by the clustering algorithm. The first group was constituted of 34 large hospitals (median 82,100 annual stays, interquartile range 69,004 – 117,774) with a very diverse activity. The second group contained medium-sized hospitals (with a median of 258 beds, interquartile range 164 - 377). The third group featured less diversity regarding the type of stay (with a mean of 8 effective activity domains, standard deviation 2.73), a smaller size and a higher proportion of patients that subsequently visited other hospitals (11%). The most frequent type of patient mobility occurred from the hospitals in group 2 to the hospitals in group 1 (29%). The reverse direction was less frequent (19%). Conclusions The French hospital network is organized around three categories of public hospitals, with an unbalanced and disassortative patient flow. This type of organization has implications for hospital planning and infectious diseases control.

Quantification of the effects of climatic conditions on French hospital admissions and deaths induced by SARS-CoV-2

An estimation of the impact of climatic conditions—measured with an index that combines temperature and humidity, the IPTCC—on the hospitalizations and deaths attributed to SARS-CoV-2 is proposed. The present paper uses weekly data from 54 French administrative regions between March 23, 2020 and January 10, 2021. Firstly, a Granger causal analysis is developed and reveals that past values of the IPTCC contain information that allow for a better prediction of hospitalizations or deaths than that obtained without the IPTCC. Finally, a vector autoregressive model is estimated to evaluate the dynamic response of hospitalizations and deaths after an increase in the IPTCC. It is estimated that a 10-point increase in the IPTCC causes hospitalizations to rise by 2.9% (90% CI 0.7–5.0) one week after the increase, and by 4.1% (90% CI 2.1–6.4) and 4.4% (90% CI 2.5–6.3) in the two following weeks. Over ten weeks, the cumulative effect is estimated to reach 20.1%. Two weeks after the increase in the IPTCC, deaths are estimated to rise by 3.7% (90% CI 1.6–5.8). The cumulative effect from the second to the tenth weeks reaches 15.8%. The results are robust to the inclusion of air pollution indicators.

Marketisation and regional planning in neoliberal public services: Evidence from French hospitals

Marxist scholarship has documented the implications of ‘neoliberal’ reforms to public services. This scholarship often considers these reforms as class projects which have disciplined working populations and created new opportunities for capitalist profit-making. But in this article, we shift emphasis to the internal dysfunction that shapes states’ pursuit of market-oriented policy agendas. We place closer focus on the specific levers through which marketising reforms are implemented, noting the conflicting pressures they unleash, and the cracks this may open through which a more democratic agenda can be advanced. Taking the French hospital sector as an example, we show how attempts to expand and intensify competition in public services have coincided with attempts to decentralise governance to the regional level. While ostensibly part of the same ‘reforming’ policy agenda, marketising policies have a strongly centralising logic which has in practice undermined efforts to develop meaningful regional planning. These institutional tensions have catalysed new political currents, as the relationship between public authorities and private sector actors has become more overtly conflictual. We argue that Marxist theorists of the state need to pay closer attention to the often dysfunctional relationship between different branches of the state, and that in the context of neoliberal public service reform, the tensions between central and regional states are particularly salient. We conclude that opponents of the marketisation of public services need to pay attention to the contested and ambiguous nature of ‘decentralisation’: while it is often a rhetorical cover for marketisation, there are opportunities for the left in demanding more meaningful and authentic forms of regional planning.

Bedside Evaluation of Early VAS/NRS Based Protocols for Intravenous Morphine in the Emergency Department: Reasons for Poor Follow-Up and Targeted Practices

Intravenous (IV) morphine protocols based on patient-reported scores, immediately at triage, are recommended for severe pain in Emergency Departments. However, a low follow-up is observed. Scarce data are available regarding bedside organization and pain etiologies to explain this phenomenon. The objective was the real-time observation of motivations and operational barriers leading to morphine avoidance. In a single French hospital, 164 adults with severe pain at triage were included in a cross-sectional study of the prevalence of IV morphine titration; caregivers were interviewed by real-time questionnaires on “real” reasons for protocol avoidance or failure. IV morphine prevalence was 6.1%, prescription avoidance was mainly linked to “Pain reassessment” (61.0%) and/or “alternative treatment prioritization” (49.3%). To further evaluate the organizational impact on prescription decisions, a parallel assessment of “simulated” prescription conditions was simultaneously performed for 98/164 patients; there were 18 titration decisions (18.3%). Treatment prioritization was a decision driver in the same proportion, while non-eligibility for morphine was more frequently cited (40.6% p = 0.001), with higher concerns about pain etiologies. Anticipation of organizational constraints cannot be excluded. In conclusion, IV morphine prescription is rarely based on first pain scores. Triage assessment is used for screening by bedside physicians, who prefer targeted practices to automatic protocols.

Do Hospital Workers Feel They Are Ready to Manage a Sanitary Crisis in a Pre-Crisis Context?

Objective: The aim of this study was to measure the perception of readiness to manage a sanitary crisis for hospital workers and to study the factors related to this perception. Methods: This study was a cross-sectional study; 408 French hospital workers responded to an online questionnaire. The variables studied concerned the perceived personal preparedness, the perception of colleagues’ and hospital’s preparedness, perception of the situation, and preparatory behavioral acts. Correlations, partial correlations, and multiple linear regressions were applied. Results: Based on Pearson’s correlations, the higher the participants’ sense of personal efficacy and control over their behavior, the more ready they feel (r p = 0.77*** and r p = 0.55***). The more participants perceive their colleagues as ready and their hospital as prepared, the more ready they feel (r p = 0.52*** and r p = 0.46***). Based on Pearson’s partial correlations, upon controlling the effect of preparedness perception, declared preparedness is not significantly correlated with personal readiness perception (r p = 0.01). Conclusion: The perception of personal readiness does not depend only on actual preparedness but also on individual and collective variables. Technically, these results confirm the value of relying on psychosocial variables during training. It would be interesting to propose empowerment in training courses. It also seems necessary to demonstrate crisis management efficacy at different levels: institutional, collective, and individual.

Autoantibodies neutralizing type I interferons in 20% of COVID-19 deaths in a French hospital

Recent studies reported the presence of pre-existing autoantibodies (auto-Abs) neutralizing type I interferons (IFNs) in at least 15% of patients with critical or severe COVID-19 pneumonia. In one study, these auto-Abs were found in almost 20% of deceased patients across all ages. We aimed to assess the prevalence and clinical impact of the auto-Abs to type I IFNs in Seine-Saint-Denis district, which was one of the most affected areas by COVID-19 in France during the first wave. We tested for the presence of auto-Abs neutralizing type I IFNs in a cohort of patients admitted for critical COVID-19 pneumonia during the first wave in the spring of 2020 in medicine departments at Robert Ballanger Hospital, Aulnay sous Bois. We found circulating auto-Abs that neutralized 100 pg/mL IFN-α2 and/or IFN-ω in plasma 1/10 in 7.9% (11 of 139) of patients hospitalized for critical COVID-19. The presence of neutralizing auto-Abs was associated with an increased risk of mortality as these auto-Abs were detected in 21% of patients who died from COVID-19 pneumonia. Deceased patients with and without auto-Abs did not present overt clinical differences. These results confirm both the importance of IFN-I immunity in host defense against SARS-CoV-2 infection and the usefulness of detection of auto-Abs neutralizing type I IFNs in the management of patients.

Hepatitis C virus (HCV) incidence among men who have sex with men (MSM) living with HIV: results from the French Hospital Database on HIV (ANRS CO4-FHDH) cohort study, 2014 to 2017

Background Despite the availability of highly effective direct-acting antivirals (DAAs) and the expected treatment as prevention (TasP) effect, transmission of hepatitis C virus (HCV) persists in men who have sex with men (MSM) who engage in high-risk sexual behaviours. Aim We aimed to estimate the incidence of primary HCV infection among MSM living with HIV in France when DAA was readily available. Methods We used data from a large French hospital cohort of persons living with HIV (ANRS CO4-FHDH) prospectively collected between 2014 and 2017. HCV incidence rates were calculated using person-time methods for HCV-negative MSM at inclusion who had serological follow-up from 1 January 2014 to 31 December 2017. Sensitivity analyses were performed by varying the main assumptions to assess their impact on the results. Results Of 14,273 MSM living with HIV who were initially HCV-seronegative, 330 acquired HCV during follow-up over 45,866 person-years (py), resulting in an overall estimated incidence rate of 0.72/100 py (95% CI: 0.65–0.80). HCV incidence significantly decreased from 0.98/100 py (95% CI: 0.81–1.19) in 2014 to 0.45/100 py (95% CI: 0.35–0.59) in 2017 (54% decrease; 95% CI: 36–67). This trend was confirmed by most of the sensitivity analyses. Conclusion The primary incidence of HCV was halved for MSM living with HIV between 2014 and 2017. This decrease may be related to unrestricted DAA availability in France for individuals living with HIV. Further interventions, including risk reduction, are needed to reach HCV micro-elimination in MSM living with HIV.