Hôpital de la Conception

Socioeconomic deprivation has been consistently associated with worse COVID-19 outcomes, yet it remains unclear whether social gradients persist in populations receiving regular, highly structured, life-sustaining care. Dialysis patients provide a specific context to explore whether structural social determinants continue to shape epidemic vulnerability beyond healthcare access alone. To assess the association between socioeconomic deprivation and both COVID-19 infection and clinical severity among dialysis patients in the Provence-Alpes-Côte d’Azur (PACA) region during the pre-vaccination period (2020). We conducted a retrospective cohort study using the REIN registry including adult dialysis patients living in PACA in 2020. Area-level deprivation was measured using the French Deprivation Index (FDep) at the IRIS level. We analysed factors associated with (i) COVID-19 infection and (ii) severe COVID-19 among infected patients using multivariable models accounting for individual characteristics, comorbidities, dialysis modality, and contextual variables. A sensitivity analysis was performed by epidemic wave to assess robustness. Higher socioeconomic deprivation was associated with increased risk of COVID-19 infection and with more severe clinical forms among infected patients, after adjustment for individual and contextual covariates. Associations were consistent across epidemic waves in sensitivity analyses, supporting the robustness of the findings. Social gradients in COVID-19 infection and severity persisted in a population benefiting from regular, continuous dialysis care, suggesting that structural social determinants (e.g. living conditions and deprivation-related vulnerabilities) play a critical role in epidemic risk. Beyond the COVID-19 pandemic, these findings provide lessons for epidemic preparedness and the management of socially vulnerable populations with chronic diseases, supporting the integration of deprivation indicators into routine care and epidemic preparedness strategies.

The Annali Italiani di Chirurgia (ISSN/eISSN: 0003-469X/2239-253X) is the oldest national surgery journal in Italy. It covers all aspects of surgery, elective, including emergency and experimental surgery, as well as problems involving technology, teaching, organization, and forensic medicine. Annali Italiani di Chirurgia supports the publication of articles in English, and all manuscripts published in Annali Italiani di Chirurgia are freely available for reading. Annali Italiani di Chirurgia is currently indexed in MEDLARS and MEDLINE (PubMed), ISI Master Journal List, Science Citation Index Expanded, and Scopus (Elsevier). More information about the Annali Italiani di Chirurgia.

ObjectivePosttraumatic stress disorder (PTSD) is more prevalent in epilepsy than in the general population. However, it remains unclear whether this association is specific to epilepsy or a broader consequence of experiencing unpredictable acute episodes within chronic diseases. This study aimed to (1) compare PTSD prevalence and severity in patients with drug‐resistant epilepsy (DRE) and patients with other chronic episodic diseases, namely, type 1 diabetes (T1D) and drug‐resistant atrial fibrillation (AF); and (2) examine psychiatric comorbidities, emotion regulation, and quality of life across groups.MethodsA total of 122 patients (64 with DRE; 58 with chronic diseases: 30 with AF, 28 with T1D) completed questionnaires assessing PTSD symptoms, trauma exposure, anxiety, depression, dissociation, emotion regulation, and quality of life. Statistical analyses included χ2 tests, t‐tests, analyses of covariance controlling for age, and correlation analyses.ResultsPTSD was significantly more prevalent in the DRE group (34.94%) than in the chronic disease group (12.07%; χ2 = 9.5, p = .004). DRE patients also reported significantly more repeated trauma exposures (54.69% vs. 27.59%, p = .004). Compared to other groups, DRE patients showed higher anxiety (p = .002), depression (p = .002), and dissociation (p < .001), poorer emotion regulation (p = .003), and lower quality of life (p < .001).SignificanceOur findings suggest that the psychiatric burden observed in DRE cannot be solely attributed to chronic episodic disease status. Instead, it may reflect the impact of early and repeated traumatic exposures and their interaction with the neurobiological underpinnings of epilepsy. The strong association between complex trauma, psychiatric comorbidities, and poor quality of life supports the hypothesis of psychoepileptogenesis and calls for integrated trauma‐informed care in epilepsy management.

Metabolic syndrome (MetS) is a common complication in survivors of childhood acute lymphoblastic and myeloid leukemia (AL), and a major risk factor for premature cardiovascular disease, type-2-diabetes, and metabolic dysfunction-associated steatotic liver disease (MASLD). Lifestyle interventions, including a healthy diet and physical activity, are the cornerstone of the management of MetS. In long-term childhood AL survivors with MetS, the benefits of classical lifestyle interventions remain poorly documented. We conducted a one-year dietary and behavioral intervention with monthly dietitian coaching in this specific population. We assessed clinical, biological metabolic parameters, noninvasive biomarkers of hepatic steatosis and fibrosis, and eating habits at baseline and after one year of coaching. We enrolled 48 patients from the LEA cohort, diagnosed with MetS. The mean age was 32 years. At baseline, 62.2% of patients had hepatic steatosis and 15% had fibrosis F3-F4 (VCTE > 8kPa). Daily energy intakes were already limited (average, 1611Kcal/day). After one year of lifestyle coaching, the body mass index (27.1vs. 26.5kg/m2, p = 0.041) and the waist circumference (91.9vs. 89.5cm, p = 0.027) had decreased. Daily intakes had significantly decreased (1213Kcal/day) with a healthier diet. Hepatic and metabolic parameters had not significantly improved in the study population. Liver steatosis was improved only in the subgroup of patients who lost weight and/or waist circumference. Survivors of childhood AL have a high prevalence of MASLD at a young age. Classical lifestyle intervention appears incompletely efficient in improving metabolic and hepatic parameters in this specific population. New therapeutic approaches to reduce MetS and its complications in this unique population need to be studied.