This study was designed to identify factors associated with at least one emergency department (ED) visit and those associated without consultation by a general practitioner or paediatrician (GPP) ...before ED visit. Levels of annual consumption of healthcare services as a function of the number of ED visit were reported.
This retrospective study focused on children < 18 years of age living in mainland France and followed for one-year after their birth or birthday in 2018. Children were selected from the national health data system, which includes data on healthcare reimbursements, long-term chronic diseases (LTD) eligible for 100% reimbursement, and individual complementary universal insurance (CMUc) status granted to households with a low annual income. Adjusted odds ratios (OR) were estimated using multivariate logistic regression.
There were 13.211 million children included (94.2% of children; girls 48.8%). At least one annual ED visit was found for 24% (1: 16%, 2: 5%, 3 or more: 3%) and 14% of visits led to hospitalization. Factors significantly associated with at least one ED visit were being a girl (47.1%; OR = 0.92), age < 1 year (9.1%; OR = 2.85), CMUc (22.7%, OR = 1.45), an ED in the commune of residence (33.3%, OR = 1.15), type 1 diabetes (0.25%; OR = 2.4), epilepsy (0.28%; OR = 2.1), and asthma (0.39%; OR = 2.0). At least one annual short stay hospitalisation (SSH) was found for 8.8% children of which 3.4% after an ED visit. A GPP visit the three days before or the day of the ED visit was found for 19% of children (< 1 year: 29%, 14-17 years: 13%). It was 30% when the ED was followed by SSH and 17% when not. Significant factors associated with the absence of a GPP visit were being a girl (OR = 0.9), age (1 year OR = 1.4, 14-17 years OR = 3.5), presence of an ED in the commune of residence (OR = 1.12), epilepsy LTD (OR = 1.1).
The low level of visits to GPP prior to a visit to the ED and the associated factors are the elements to be taken into account for appropriate policies to limit ED overcrowding. The same applies to factors associated with a visit to the ED, in order to limit daily variations.
To report results of the 2021 French National Perinatal Survey (ENP) in metropolitan France and assess trends in the main indicators of perinatal health, medical practices, and risk factors in France ...since 1995.
All the samples included all women giving birth at a gestational age of at least 22 weeks of gestation and/or to an infant weighing at least 500 grams in all maternity units in metropolitan France during one week in 1995 (N=13 048), 2003 (N=14 324), 2010 (N=14 546), 2016 (N=12 553), and 2021 (N=12 088). The data came from postpartum interviews of the women at the hospital and their medical records. Comparisons between surveys showed trends over time.
Between 1995 and 2021, maternal characteristics changed. Maternal age and the frequency of women with obesity rose: in 2021, 24.6% of women were 35 years or older (21.1% in 2016, 19.2% in 2010, 15.9% in 2003 and 12.4% in 1995) and 14.4% were obese (11.8% in 2016, 9.9% in 2010 and 7.4% in 2003). Some antenatal prevention behaviors that improved in 2021 were not smoking during the third trimester, acid folic administration before pregnancy, and vaccination against influenza. The percentage of women with an early prenatal appointment ("4
month appointment"), implemented to facilitate screening of maternal vulnerability during pregnancy, has continued to rise. The percentage of women receiving prenatal care by midwives has risen markedly (39.0% in 2021 versus 11.7% in 2016). Serum screening for Down syndrome continues to increase (91.8% of women in 2021). The rate of induction of labor has risen significantly (20.2% in 1995 and 25.8% in 2021). The mode of delivery has not varied significantly since 2003; in 2021, the cesarean rate was 21.4% and the instrumental vaginal delivery rate 12.4%. Episiotomy was increasingly rare, among both primiparous and multiparous women (16.5% and 2.9% in 2021, respectively). The prevalence of coronavirus (SARS-CoV2) infection during pregnancy was 5.7%. Preterm live births increased regularly, slightly but significantly over the 1995-2016 period and then remained stable between 2016 and 2021 (7.0%). In 2021, 56.3% of women exclusively breastfed during their hospital stay, a modest increase in comparison with 2016 (54.6%).
Routine national perinatal surveys highlight positive trends over time in some preventive practices, decreases in some medical interventions consistent with national guidelines, and the increasing role of midwives in prenatal care. Nonetheless, some indicators remain less than optimal and require more detailed analyses.
Objective
To assess changes in caesarean section (CS) rates in Europe from 2015 to 2019 and utilise the Robson Ten Group Classification System (TGCS) to evaluate the contribution of different ...obstetric populations to overall CS rates and trends.
Design
Observational study utilising routine birth registry data.
Setting
A total of 28 European countries.
Population
Births at ≥22 weeks of gestation in 2015 and 2019.
Methods
Using a federated model, individual‐level data from routine sources in each country were formatted to a common data model and transformed into anonymised, aggregated data.
Main Outcome Measures
By country: overall CS rate. For TGCS groups (by country): CS rate, relative size, relative and absolute contribution to overall CS rate.
Results
Among the 28 European countries, both the CS rates (2015, 16.0%–55.9%; 2019, 16.0%–52.2%) and the trends varied (from −3.7% to +4.7%, with decreased rates in nine countries, maintained rates in seven countries (≤ ± 0.2) and with increasing rates in 12 countries). Using the TGCS (for 17 countries), in most countries labour induction increased (groups 2a and 4a), whereas multiple pregnancies (group 8) decreased. In countries with decreasing overall CS rates, CS tended to decrease across all TGCS groups, whereas in countries with increasing rates, CS tended to increase in most groups. In countries with the greatest increase in CS rates (>1%), the absolute contributions of groups 1 (nulliparous term cephalic singletons, spontaneous labour), 2a and 4a (induction of labour), 2b and 4b (prelabour CS) and 10 (preterm cephalic singletons) to the overall CS rate tended to increase.
Conclusions
The TGCS shows varying CS trends and rates among countries of Europe. Comparisons between European countries, particularly those with differing trends, could provide insight into strategies to reduce CS without clinical indication.
Several series reported obstetric complications among pregnant women hospitalized for COVID. These data, because they focused on women with the most severe presentations or with specific ...immunosuppression, were likely to overestimate the risks associated with the infection at a global level. To date, population-based studies, most of which collected data from registers of women hospitalized during pregnancy for COVID-19, remain sparse. Neither the prevalence of COVID-19 in pregnant women nor the overall extent of obstetric complications worldwide, compared with uninfected pregnant women is clear. The impact of COVID-19 on perinatal care and obstetric management is thus difficult to evaluate.
To evaluate the prevalence and determinants of COVID-19 diagnosis during pregnancy and assess related obstetric practices and perinatal outcomes.
Used data collected at childbirth in France from women included in the 2021 national perinatal survey, we compared women with and without a COVID-19 diagnosis (for sociodemographic characteristics) and then women with no COVID-19 diagnosis during pregnancy, women diagnosed more than 15 days preceding childbirth, and those diagnosed within those 15 days for outcomes.
The COVID-19 prevalence during pregnancy was 5.7 % (95 %CI 5.3–6.1) (678/11 930). The aOR for COVID-19 diagnosis associated with non-French nationality was 1.27 (95 %CI 1.03–1.58), with non-smoking 0.63 (95 %CI 0.55–0.81) and with multiparity 1.21 (95 %CI 1.02–1.45). Diagnosis occurred in the third trimester for 49 % —28.5 % in the 15 days before childbirth. Women with COVID-19 diagnosed during pregnancy had preterm births more often (9.6 %) than women without this diagnosis (6.9 %) (P = 0.007). Women with COVID-19 diagnosed within the 15 days preceding childbirth had more cesarean deliveries (28.3 %) than those diagnosed earlier (17.4 %) (P = 0.02).
COVID-19 diagnosis during pregnancy was associated with an increased risk of preterm birth. Obstetric outcomes were poorer in women with a COVID-19 diagnosis in the 15 days preceding childbirth.
Importance There are wide disparities in neonatal mortality rates (NMRs, deaths <28 days of life after live birth per 1000 live births) between countries in Europe, indicating potential for ...improvement. Comparing country-specific patterns of births and deaths with countries with low mortality rates can facilitate the development of effective intervention strategies. Objective To investigate how these disparities are associated with the distribution of gestational age (GA) and GA-specific mortality rates. Design, Setting, and Participants This was a cross-sectional study of all live births in 14 participating European countries using routine data compiled by the Euro-Peristat Network. Live births with a GA of 22 weeks or higher from 2015 to 2020 were included. Data were analyzed from May to October 2023. Exposures GA at birth. Main Outcomes and Measures The study investigated excess neonatal mortality, defined as a rate difference relative to the pooled rate in the 3 countries with the lowest NMRs (Norway, Sweden, and Finland; hereafter termed the top 3). The Kitagawa method was used to divide this excess into the proportion explained by the GA distribution of births and by GA-specific mortality rates. A sensitivity analysis was conducted among births 24 weeks’ GA or greater. Results There were 35 094 neonatal deaths among 15 123 428 live births for an overall NMR of 2.32 per 1000. The pooled NMR in the top 3 was 1.44 per 1000 (1937 of 1 342 528). Excess neonatal mortality compared with the top 3 ranged from 0.17 per 1000 in the Czech Republic to 1.82 per 1000 in Romania. Excess deaths were predominantly concentrated among births less than 28 weeks’ GA (57.6% overall). Full-term births represented 22.7% of the excess deaths in Belgium, 17.8% in France, 40.6% in Romania and 17.3% in the United Kingdom. Heterogeneous patterns were observed when partitioning excess mortality into the proportion associated with the GA distribution vs GA-specific mortality. For example, these proportions were 9.2% and 90.8% in France, 58.4% and 41.6% in the United Kingdom, and 92.9% and 7.1% in Austria, respectively. These associations remained stable after removing births under 24 weeks’ GA in most, but not all, countries. Conclusions and Relevance This cohort study of 14 European countries found wide NMR disparities with varying patterns by GA. This knowledge is important for developing effective strategies to reduce neonatal mortality.
Ce volume réunit les actes d’un colloque international consacré en 2000 à François-Bonaventure-Joseph Dumont (1739-1787), marquis de Gages, et à la franc-maçonnerie dans les Pays-Bas autrichiens.
Les médecins de demain Vilain, Annick; Gottely, Jacqueline
Economie & statistique,
1994, 1994-00-00, Letnik:
274, Številka:
1
Journal Article
Odprti dostop
fre Les médecins de demain . Depuis trente ans, le corps médical, comme l'ensemble des professions de santé, a connu une forte croissance. Dans le même temps, le développement économique et celui de ...la protection sociale ont permis une nette augmentation du recours aux soins. Dès la fin des années soixante, des mesures ont été prises pour réguler le nombre de médecins à former, puis pour maîtriser les dépenses de santé. . La décélération de la croissance du nombre de médecins s'observe dès 1978. D'ici à 2040, elle provoquerait des changements importants dans cette profession : . ment, nette féminisation, surtout parmi les généralistes. La proportion d'un spécialiste sur deux médecins, atteinte récemment, devrait se maintenir, mais les spécialités évolueraient différemment les unes des autres. Enfin, le nombre de médecins progresserait de moins en moins vite et diminuerait à partir de 201 0, sous l'hypothèse d'un redressement progressif, du numerus clausus. . Ces changements structurels du corps médical modifieraient ses capacités de production d'actes. De ce fait, dès le début du siècle prochain, l'adéquation de l'offre de soins à la demande se poserait dans un contexte nouveau. eng Tomorrow's Doctors . The medical profession, like all the health professions, has grown considerably over the last thirty years. At the same time, economic development and improvements in social security have led to a sharp increase in the demand for treatment. Starting in the late 1960s, measures were taken to regulate the number of doctors trained and then to curb health expenditure. . A slowdown in the growth of the number of doctors was observed as of 1978. By 2040, it will have prompted substantial changes in the profession: aging and a sharp rise in the number of women, especially among general practitioners. The recently attained proportion of one specialist for every two doctors should remain steady, but the group of specialists itself will probably become more diverse. Lastly, based on the hypothesis of a gradual return of restricted-intake measures, growth in the number of doctors should slow down more and more to a state of decrease as of 2010. . These structural changes in the medical profession should alter its capacities to provide medical treatment. Consequently, the match between treatment supply and demand should appear in a new context as of the beginning of the 21st century. ger Die Arzte von morgen . In den letzten dreiBig Jahren ist die Zahl der Ârzte wie auch all derjeniger, die am Gesundheitswesen beteiligt sind, stark angestiegen. Im gleichen Zeitraum hat die Entwicklung der Wirtschaft wie auch der sozialen Sicherung eine wesentlich grô3ere Inanspruchnahme von Gesundheitsleistungen ermôglicht. Bereits Ende der sechziger Jahre sind deshalb MaBnahmen getroffen worden, um die Zahl der Medizinstudenten zu beschrânken und die Gesundheitsausgaben unter Kontrolle zu bringen. . Seit 1 978 lâBt sich eine Verlangsamung des Anstiegs der Ârztezahl beobachten, die voraussichtlich bis zum Jahre 2040 erhebliche Verànderungen in diesem Berufszweig bewirken wird: Ùberalterung, deutliche Feminisierung, . insbesondere bei den praktischen Àrzten. An dem vor kurzem erreichten Verhâltnis von einem Facharzt zu zwei praktischen Ârzten wird sich sicherlich nichts ândern; die einzelnen Fachrichtungen werden sich jedoch unterschiedlich entwickeln. Unter der Annahme einer schrittweisen Wiederherstellung des Numerus Clausus wird die Ârztezahl schlieBlich immer weniger rasch ansteigen und ab dem Jahre 2010 sogar abnehmen. . Dieser strukturelle Wandel in der Ârzteschaft wùrde auch bei der medizinischen Versorgung Ànderungen zur Folge haben; denn bereits zu Beginn des kommenden Jahrhunderts mul3 die Entsprechung zwischen Leistungs- angebot und nachfrage in einem vôllig neuen Kontext gesehen werden. spa Los médicos de mahana . Desde hace unos treinta anos, el cuerpo medico, como la totalidad de las profesiones sanitarias, se va beneficiando de un fuerte crecimiento. Al mismo tiempo, el desarrollo econômico y el de la protecciôn social han permitido un évidente aumento del recurso a cuidados. Desde fines de los sesenta, se vienen tomando medidas que regulen el numéro de médicos por formar, y que permitan dominar el gasto sanitario. . La deseleracion del crecimiento del numéro de médicos se registra desde 1 978. Hasta el 2040, tal vez provoque cambios importantes en dicha profesiôn : envejecimiento, fuerte femenizaciôn, sobre todo entre los generalistas. La . proporciôn de un especialista de cada dos médicos, registrada hace poco, deberfa de mantenerse, pero las especialidades evolucionarian de manera diferente entre si. En fin, el numéro de médicos progresarfa a un ritmo cada vez mâs lento e iria disminuyendo a partir del 2010, siguiendo la hipôtesis de una recuperaciôn progresiva del numéros clausus. . Estos cambios estructurales del cuerpo médico modificaria sus capacidades de producciôn de actos. De hecho, ya a principios del proximo siglo, la adecuaciôn de la oferta de cuidados a la demanda se presentarfa en otro contexto.
PDF
