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Beck F, Leger D, Cortaredona S, Verger P, Peretti-Watel P. Would we recover better sleep at the end of Covid-19? A relative improvement observed at the population level with the end of the lockdown in France. Sleep Med 2020; 78:115-119. [PMID: 33422813 PMCID: PMC7722490 DOI: 10.1016/j.sleep.2020.11.029] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/27/2020] [Accepted: 11/29/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND The outbreak of the Covid-19 pandemic and the accompanying lockdown measures have had a major impact on societies around the world, leading to sleep problems for a large part of the population. In order to assess the sustainability of sleeping troubles related to the sanitary crisis, it was crucial to measure its prevalence after the end of the Covid-19 confinement. METHODS As part of an epidemiological survey on Covid and Confinement (COCONEL), we enquired on sleep disorders using two items in 4 repetitive cross-sectional surveys. The first took place during the first week of the French confinement (March 31 to April 2; N = 1005 participants). The second took place in the middle of this period (April 15-17; N = 1005). The two last surveys were held at the end of the confinement (May 7-10; N = 2003) and one month after the end (June 10-12; N = 1736). Using a random constant, the mixed model took into account the longitudinal character of the last two waves (intra-individual correlations for individuals surveyed in waves 3 and 4). RESULTS The prevalence of sleep problems significantly decreased during the last weeks of the confinement, and this trend was confirmed one month after the end of confinement. One quarter of the population reported that their sleep was better one month after the end of the confinement. Sleep improvement was reported more often by women and people aged less than 65. Such improvement was less frequent among those who were still highly exposed to the pandemic's media coverage after the end of the confinement. CONCLUSION The possibility of recovering a good sleep largely depends on the type of sleep disorder. The decrease in sleep problems occurred mainly among people with mild sleep problems during the confinement. Further research is needed to assess the long-term effects of the Covid-19 pandemic and its confinement period on sleep quality in the general population.
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Affiliation(s)
- Francois Beck
- CESP (Centre de recherche en Épidémiologie et Santé des Populations), Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm U1018, Villejuif, 94807, France
| | - Damien Leger
- Université de Paris, EA 7330 VIFASOM (Vigilance Fatigue Sommeil et Santé Publique), Paris, France; APHP, Hôtel-Dieu, Centre du Sommeil et de la Vigilance, Consultation de pathologie professionnelle Sommeil Vigilance et Travail, Paris, France.
| | | | - Pierre Verger
- Southeastern Health Regional Observatory (ORS Paca), Marseille, France; AMU, UMR Vitrome, IHU Méditerrannée, IRD, France
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Peretti-Watel P, Seror V, Cortaredona S, Launay O, Raude J, Verger P, Beck F, Legleye S, L'Haridon O, Ward J, Longitudinale E. Attitudes about COVID-19 Lockdown among General Population, France, March 2020. Emerg Infect Dis 2020; 27. [PMID: 33183493 PMCID: PMC7774552 DOI: 10.3201/eid2701.201377] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Because the effectiveness of a coronavirus disease lockdown in curbing coronavirus disease spread depends on public support, acquiring real-time information about the way populations reacted to the lockdown is crucial. In France, such public support remained fragile among low-income persons, probably because the lockdown exacerbated preexisting social inequalities and conflicts.
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Lalaoui R, Bakour S, Raoult D, Verger P, Sokhna C, Devaux C, Pradines B, Rolain JM. What could explain the late emergence of COVID-19 in Africa? New Microbes New Infect 2020; 38:100760. [PMID: 32983542 PMCID: PMC7508045 DOI: 10.1016/j.nmni.2020.100760] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 01/08/2023] Open
Abstract
At the end of November 2019, a novel coronavirus responsible for respiratory tract infections emerged in China. Despite drastic containment measures, this virus, known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), spread in Asia and Europe. The pandemic is ongoing with a particular hotspot in southern Europe and America in spring 2020. Many studies predicted an epidemic in Africa similar to that currently seen in Europe and the USA. However, reported data do not confirm these predictions. Several hypotheses that could explain the later emergence and spread of the coronavirus disease 2019 (COVID-19) pandemic in African countries are being discussed, including the lack of health-care infrastructure capable of clinically detecting and confirming COVID-19 cases, the implementation of social distancing and hygiene, international air traffic flows, the climate, the relatively young and rural population, the genetic polymorphism of the angiotensin-converting enzyme 2 receptor, cross-immunity and the use of antimalarial drugs.
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Affiliation(s)
- R. Lalaoui
- Aix Marseille Univ, IRD, APHM, MEPHI, Marseille, France
- IHU-Méditerranée Infection, Marseille, France
| | - S. Bakour
- Aix Marseille Univ, IRD, APHM, MEPHI, Marseille, France
- IHU-Méditerranée Infection, Marseille, France
| | - D. Raoult
- Aix Marseille Univ, IRD, APHM, MEPHI, Marseille, France
- IHU-Méditerranée Infection, Marseille, France
| | - P. Verger
- IHU-Méditerranée Infection, Marseille, France
- Southeastern Health Regional Observatory, Marseille, France
- Aix Marseille Univ, IRD, SSA, AP-HM, VITROME, Marseille, France
| | - C. Sokhna
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, SSA, AP-HM, VITROME, Marseille, France
| | - C. Devaux
- Aix Marseille Univ, IRD, APHM, MEPHI, Marseille, France
- IHU-Méditerranée Infection, Marseille, France
- CNRS, Marseille, France
| | - B. Pradines
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, SSA, AP-HM, VITROME, Marseille, France
- Unité parasitologie et entomologie, Institut de recherche biomédicale des armées, Marseille, France
- Centre national de référence du paludisme, Marseille, France
| | - J.-M. Rolain
- Aix Marseille Univ, IRD, APHM, MEPHI, Marseille, France
- IHU-Méditerranée Infection, Marseille, France
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Affiliation(s)
- Pierre Verger
- Research department, Southeastern Health Regional Observatory , Marseille, France.,Aix Marseille University, IRD, AP-HM, SSA, VITROME , Marseille, France
| | - Eve Dubé
- Institut de santé publique du Québec, Centre de recherche du CHU de Québec - Université Laval , D'Estimauville, QC, Canada
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Tréhard H, Landret C, Mocaer S, Bazin I, Guagliardo V, Verger P. Le SISTEPACA, un outil de formation et d’échanges multidisciplinaires en santé-travail pour les médecins de soins. ARCH MAL PROF ENVIRO 2020. [DOI: 10.1016/j.admp.2020.03.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Peretti-Watel P, Alleaume C, Léger D, Beck F, Verger P. Anxiety, depression and sleep problems: a second wave of COVID-19. Gen Psychiatr 2020; 33:e100299. [PMID: 33083692 PMCID: PMC7513629 DOI: 10.1136/gpsych-2020-100299] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/09/2020] [Accepted: 07/22/2020] [Indexed: 01/22/2023] Open
Affiliation(s)
- Patrick Peretti-Watel
- VITROME, Aix Marseille Université, IRD, AP-HM, SSA, Marseille, France.,ORS PACA, Marseille, Provence-Alpes-Côte d'Azur, France
| | | | - Damien Léger
- EA 7330 VIFASOM (Vigilance Fatigue Sommeil et Santé Publique), Université Paris 5 Descartes, Paris, Île-de-France, France.,Centre du Sommeil et de la Vigilance, Consultation de pathologie professionnelle Sommeil Vigilance et Travail, APHP, Paris, Île-de-France, France
| | - François Beck
- CESP, Université Paris-Sud, Villejuif, Île-de-France, France
| | - Pierre Verger
- ORS PACA, Marseille, Provence-Alpes-Côte d'Azur, France
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57
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Affiliation(s)
- Damien Léger
- Université de Paris, EA 7330 VIFASOM (Vigilance Fatigue Sommeil et Santé Publique), Paris, France.,APHP, Hôtel-Dieu, Centre du Sommeil et de la Vigilance, Consultation de pathologie professionnelle Sommeil Vigilance et Travail, Paris, France
| | - François Beck
- CESP (Centre de recherche en Épidémiologie et Santé des Populations), Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm U1018, Villejuif, France
| | - Lisa Fressard
- Southeastern Health Regional Observatory (ORS Paca), Marseille, France
| | - Pierre Verger
- AMU, UMR Vitrome, IHU Méditerrannée, IRD, Marseille, France
| | - Patrick Peretti-Watel
- Southeastern Health Regional Observatory (ORS Paca), Marseille, France.,AMU, UMR Vitrome, IHU Méditerrannée, IRD, Marseille, France
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58
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Beck F, Léger D, Fressard L, Peretti-Watel P, Verger P. Covid-19 health crisis and lockdown associated with high level of sleep complaints and hypnotic uptake at the population level. J Sleep Res 2020; 30:e13119. [PMID: 32596936 PMCID: PMC7361195 DOI: 10.1111/jsr.13119] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 11/28/2022]
Abstract
The Covid‐19 pandemic has disrupted the habits of billions of people around the world. Lockdown at home is mandatory, forcing many families, each member with their own sleep–wake habits, to spend 24 hr a day together, continuously. Sleep is crucial for maintaining immune systems and contributes deeply to physical and psychological health. To assess sleep problems and use of sleeping pills, we conducted a cross‐sectional study of a representative sample of the general population in France. The self‐reported sleep complaint items, which covered the previous 8 days, have been used in the 2017 French Health Barometer Survey, a cross‐sectional survey on various public health issues. After 2 weeks of confinement, 74% of the participants (1,005 subjects) reported trouble sleeping compared with a prevalence rate of 49% in the last general population survey. Women reported more sleeping problems than men, with greater frequency or severity: 31% vs. 16%. Unusually, young people (aged 18–34 years) reported sleep problems slightly more frequently than elderly people (79% vs. 72% among those aged 35 or older), with 60% of the younger group reporting that these problems increased with confinement (vs. 51% of their elders). Finally, 16% of participants reported they had taken sleeping pills during the last 12 months, and 41% of them reported using these drugs since the lockdown started. These results suggest that the COVID crisis is associated with severe sleep disorders among the French population, especially young people.
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Affiliation(s)
- Francois Beck
- CESP (Centre de recherche en Épidémiologie et Santé des Populations), Université Paris-Saclay, UVSQ, Université de Paris-Sud, Villejuif, France
| | - Damien Léger
- Université de Paris, VIFASOM (EA 7330, Vigilance Fatigue Sommeil et Santé Publique), Paris, France.,APHP, Hôtel Dieu, Centre du Sommeil et de la Vigilance, Consultation de pathologie professionnelle Sommeil Vigilance et Travail, Centre de référence hypersomnies rares, Paris, France
| | - Lisa Fressard
- Southeastern Health Regional Observatory (ORS Paca), Marseille, France
| | | | - Pierre Verger
- Southeastern Health Regional Observatory (ORS Paca), Marseille, France.,UMR Vitrome, AMU, IHU Méditerrannée, IRD, Marseille, France
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59
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Bocquier A, Fressard L, Cortaredona S, Ward J, Seror V, Peretti-Watel P, Verger P. [Vaccine hesitancy in France: prevalence and association with parents' socioeconomic status]. Med Sci (Paris) 2020; 36:461-464. [PMID: 32452367 DOI: 10.1051/medsci/2020076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Aurélie Bocquier
- Aix-Marseille Université, IRD, AP-HM, Service de Santé des Armées (SSA), Vecteurs -Infections Tropicales et Méditeranéennes (VITROME), Marseille, France. - Institut hospitalo-universitaire Méditerranée infection, 19-21 boulevard Jean Moulin, 13385 Marseille Cedex 05, France - Observatoire régional de la santé Provence-Alpes-Côte d'Azur (ORS PACA), Marseille, France
| | - Lisa Fressard
- Aix-Marseille Université, IRD, AP-HM, Service de Santé des Armées (SSA), Vecteurs -Infections Tropicales et Méditeranéennes (VITROME), Marseille, France. - Institut hospitalo-universitaire Méditerranée infection, 19-21 boulevard Jean Moulin, 13385 Marseille Cedex 05, France - Observatoire régional de la santé Provence-Alpes-Côte d'Azur (ORS PACA), Marseille, France
| | - Sébastien Cortaredona
- Aix-Marseille Université, IRD, AP-HM, Service de Santé des Armées (SSA), Vecteurs -Infections Tropicales et Méditeranéennes (VITROME), Marseille, France. - Institut hospitalo-universitaire Méditerranée infection, 19-21 boulevard Jean Moulin, 13385 Marseille Cedex 05, France
| | - Jeremy Ward
- Aix-Marseille Université, IRD, AP-HM, Service de Santé des Armées (SSA), Vecteurs -Infections Tropicales et Méditeranéennes (VITROME), Marseille, France. - CNRS, Université Paris-Sorbonne, Groupe d'Étude des Méthodes de l'Analyse Sociologique de la Sorbonne (GEMASS), Paris, France
| | - Valérie Seror
- Aix-Marseille Université, IRD, AP-HM, Service de Santé des Armées (SSA), Vecteurs -Infections Tropicales et Méditeranéennes (VITROME), Marseille, France. - Institut hospitalo-universitaire Méditerranée infection, 19-21 boulevard Jean Moulin, 13385 Marseille Cedex 05, France
| | - Patrick Peretti-Watel
- Aix-Marseille Université, IRD, AP-HM, Service de Santé des Armées (SSA), Vecteurs -Infections Tropicales et Méditeranéennes (VITROME), Marseille, France. - Institut hospitalo-universitaire Méditerranée infection, 19-21 boulevard Jean Moulin, 13385 Marseille Cedex 05, France - Observatoire régional de la santé Provence-Alpes-Côte d'Azur (ORS PACA), Marseille, France
| | - Pierre Verger
- Aix-Marseille Université, IRD, AP-HM, Service de Santé des Armées (SSA), Vecteurs -Infections Tropicales et Méditeranéennes (VITROME), Marseille, France. - Institut hospitalo-universitaire Méditerranée infection, 19-21 boulevard Jean Moulin, 13385 Marseille Cedex 05, France - Observatoire régional de la santé Provence-Alpes-Côte d'Azur (ORS PACA), Marseille, France - Inserm, French Clinical Research Infrastructure Network (F-CRIN), Innovative clinical research network in vaccinology (I-REIVAC), Paris, France
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60
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Correard F, Montaleytang M, Costa M, Astolfi M, Baumstarck K, Loubière S, Amichi K, Auquier P, Verger P, Villani P, Honore S, Daumas A. Impact of medication review via tele-expertise on unplanned hospitalizations at 3 months of nursing homes patients (TEM-EHPAD): study protocol for a randomized controlled trial. BMC Geriatr 2020; 20:147. [PMID: 32312242 PMCID: PMC7169005 DOI: 10.1186/s12877-020-01546-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 04/02/2020] [Indexed: 01/03/2023] Open
Abstract
Background Inappropriate drug prescribing causes preventable drug-related adverse events that result in increased morbidity and mortality, additional costs and diminished quality of life. Numerous initiatives have been launched to improve the quality of drug prescribing and safeguard the security of drug administration processes in nursing homes. Against the backdrop of implementation of telemedicine services, the focus of the present work is to evaluate the impact of a telemedication review carried out by a hospital physician and pharmacist as part of the telemedicine offer. Methods The present study is a randomized controlled clinical trial. A total of 364 patients will be randomized into two groups: (1) an experimental group (182 patients) benefiting from a telemedication review using tele-expertise and (2) a control group (182 patients) receiving standard care. The primary endpoint will be rate of all-cause unplanned hospital admissions occurring within 3 months of randomization. The secondary endpoints will be rate of unplanned admissions at 6 months, patient quality of life, incidence of behavioral disturbances, number of falls, number of residents prescribed at least one inappropriate medication, nursing staff satisfaction, proposed medication reviews and their acceptability rate, characteristics of patients whose general practitioners have taken account of tele-expertise, efficacy of tele-expertise as compared to standard prescription and acceptability and satisfaction surveys of participating caregivers. Discussion In the literature, various studies have investigated the utility of structured medication review processes, but outcome measures are heterogeneous, and results vary widely. Medication review can detect medication-related problems in many patients, but evidence of clinical impact is scant. Incremental cost-effectiveness ratios will be used to compare the cost and effectiveness of the experimental strategy and that of standard care. Our approach, involving the combination of an acceptability survey and a mixed-method (qualitative and quantitative) satisfaction survey, is particularly innovative. The results of this randomized trial are expected to confirm that medication review using tele-expertise has potential as a worthwhile care management strategy for nursing home residents. Trial registration Clinicaltrials.gov NCT03640845; registered August 21, 2018 (Clinicaltrials.gov NCT03640845).
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Affiliation(s)
- F Correard
- Service pharmacie, hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille (AP-HM), Marseille, France. .,Aix-Marseille Univ, Marseille, France.
| | - M Montaleytang
- Service pharmacie, hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille (AP-HM), Marseille, France.,Aix-Marseille Univ, Marseille, France
| | - M Costa
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - M Astolfi
- Service pharmacie, hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille (AP-HM), Marseille, France
| | - K Baumstarck
- Aix-Marseille Univ, Marseille, France.,EA3279, Self-perceived Health Assessment Research Unit, Marseille, France
| | - S Loubière
- Aix-Marseille Univ, Marseille, France.,EA3279, Self-perceived Health Assessment Research Unit, Marseille, France
| | - K Amichi
- Direction de la Recherche Clinique et de l'Innovation (DRCI), AP-HM, Marseille, France
| | - P Auquier
- Aix-Marseille Univ, Marseille, France.,EA3279, Self-perceived Health Assessment Research Unit, Marseille, France.,Direction de la Recherche Clinique et de l'Innovation (DRCI), AP-HM, Marseille, France
| | - P Verger
- Aix-Marseille Univ, Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, Marseille, France.,IRD, AP-HM, SSA, VITROME, Marseille, France.,IHU-Méditerranée Infection, Marseille, France
| | - P Villani
- Aix-Marseille Univ, Marseille, France.,Internal Medicine, Geriatrics and Therapeutics department, AP-HM, Marseille, France
| | - S Honore
- Service pharmacie, hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille (AP-HM), Marseille, France.,Aix-Marseille Univ, Marseille, France
| | - A Daumas
- Aix-Marseille Univ, Marseille, France.,Internal Medicine, Geriatrics and Therapeutics department, AP-HM, Marseille, France
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Abstract
ObjectivesTo explore in a community-based sample of persons aged 0–25 years:– trends in antipsychotic prescribing;– characteristics of the zone of residence associated with antipsychotic prescribing rates;– the pattern of antipsychotic prescribing.MethodsThe study was performed using reimbursement data from the French Insurance Healthcare system. Prescribing trends were investigated over the period 2006–2013. An ecological design was used to assess the impact of the socio-economical and health resource characteristics of the zone of residence (n = 96 administrative subdivisions of French territory) on antipsychotic prescribing rates. The pattern of antipsychotic prescribing was explored in a cohort of youths newly treated with antipsychotics.ResultsOver the period 2006–2013, antipsychotic dispensing rates were globally stable in persons aged 0–25 years (4.8 per 1000 in 2006 and 4.9 per 1000 in 2013). First-generation antipsychotic dispensing rates decreased from 3.1 to 2.6 per 1000 (OR = 0.96, 95% CI = 0.94–0.98), while second-generation antipsychotic dispensing rates increased from 2.7 to 3.4 per 1000 (OR = 1.03, 95% CI = 1.01–1.05). Antipsychotic prescribing rates were impacted by health resource characteristics of the zone of residence in children aged 10 years and under and by socio-economical characteristics in those aged 16–20 years. In all the age groups, antipsychotics were principally started by hospital practitioners (47%) and general practitioners (34%). The rates of psychostimulants concomitantly prescribed with antipsychotics were lower than 5%.ConclusionRates of youths exposed to second-generation antipsychotics are still rising. The impact of environmental characteristics on antipsychotics prescribing and appropriateness of these prescriptions in youths should be further investigated.
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Carrier H, Cortaredona S, Philipps V, Jacqmin-Gadda H, Tournier M, Verdoux H, Verger P. Long-term risk of hip or forearm fractures in older occasional users of benzodiazepines. Br J Clin Pharmacol 2020; 86:2155-2164. [PMID: 32285959 DOI: 10.1111/bcp.14307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 03/21/2020] [Accepted: 03/24/2020] [Indexed: 01/14/2023] Open
Abstract
AIMS This article sought to study the association between patterns of benzodiazepine (BZD) use and the risk of hip and forearm fractures in people aged 50 and 75 years or more. METHODS In a representative cohort of the French National Health Insurance Fund of individuals aged 50 years or older (n = 106 437), we followed up BZD dispensing (reflecting their patterns of use) and the most frequent fall-related fractures (hip and forearm) for 8 years. We used joint latent class models to simultaneously identify BZD dispensing trajectories and the risk of fractures in the entire cohort and in those 75 years or older). We used a survival model to estimate the adjusted hazard ratios (aHRs) between these trajectories and the risk of fractures. RESULTS In the entire cohort, we identified 5 BZD trajectories: non-users (76.7% of the cohort); occasional users (15.2%); decreasing users (2.6%); late increasing users (3.0%); and early increasing users (2.4%). Compared with non-users, fracture risk was not increased in either occasional users (aHR = 0.99, 95% confidence interval [CI] 0.99-1.00) or in decreasing users (aHR = 0.90, 95% CI 0.74-1.08). It was significantly higher in early increasing users (aHR = 1.86, 95% CI 1.62-2.14) and in late increasing users (aHR = 1.39, 95% CI 1.15-1.60). We observed similar trajectories and risk levels in the people older than 75 years. CONCLUSION Occasional BZD use, which is compatible with current recommendations, was not associated with an excess risk of the most frequent fall-related fractures in people older than 50 or 75 years.
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Affiliation(s)
- Hélène Carrier
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France.,IHU-Méditerranée Infection, Marseille, France.,Department of General Practice, Aix-Marseille University, Marseille, France.,ORS Paca, Regional Health Observatory, Provence-Alpes-Côte d'Azur, Marseille, France
| | - Sébastien Cortaredona
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France.,IHU-Méditerranée Infection, Marseille, France
| | - Viviane Philipps
- Univ. Bordeaux, Inserm, Bordeaux Population Health, UMR 1219, ISPED, Bordeaux, France
| | - Hélène Jacqmin-Gadda
- Univ. Bordeaux, Inserm, Bordeaux Population Health, UMR 1219, ISPED, Bordeaux, France
| | - Marie Tournier
- Univ. Bordeaux, Inserm, Bordeaux Population Health, UMR 1219, ISPED, Bordeaux, France.,Centre Hospitalier Charles Perrens, Bordeaux, France
| | - Hélène Verdoux
- Univ. Bordeaux, Inserm, Bordeaux Population Health, UMR 1219, ISPED, Bordeaux, France.,Centre Hospitalier Charles Perrens, Bordeaux, France
| | - Pierre Verger
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France.,IHU-Méditerranée Infection, Marseille, France.,ORS Paca, Regional Health Observatory, Provence-Alpes-Côte d'Azur, Marseille, France
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Darmon N, Bocquier A, Dubois C, Vinet A, Verger P, Alapage C. ALAPAGE, une recherche interventionnelle visant à améliorer l’alimentation et l’activité physique du sujet âgé vivant à domicile. NUTR CLIN METAB 2020. [DOI: 10.1016/j.nupar.2020.02.434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Bocquier A, Cortaredona S, Fressard L, Galtier F, Verger P. Seasonal influenza vaccination among people with diabetes: influence of patients' characteristics and healthcare use on behavioral changes. Hum Vaccin Immunother 2020; 16:2565-2572. [PMID: 32209014 PMCID: PMC7644174 DOI: 10.1080/21645515.2020.1729628] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Annual seasonal influenza vaccination (SIV) is recommended for people with diabetes, but vaccine coverage remains low. We estimated the probabilities of stopping or starting SIV, their correlates, and the expected time spent in the vaccinated state over 10 seasons for different patient profiles. We set up a retrospective cohort study of patients with diabetes in 2006 (n = 16,026), identified in a representative sample of beneficiaries of the French National Health Insurance Fund. We followed them up over 10 seasons (2005/06–2015/16). We used a Markov model to estimate transition probabilities and a proportional hazards model to study covariates. Between two consecutive seasons, the probabilities of starting (0.17) or stopping (0.09) SIV were lower than those of remaining vaccinated (0.91) or unvaccinated (0.83). Men, older patients, those with type 1 diabetes, treated diabetes or more comorbidities, frequent contacts with doctors, and with any hospital stay for diabetes or influenza during the last year were more likely to start and/or less likely to stop SIV. The mean expected number of seasons with SIV uptake over 10 seasons (range: 2.6–7.9) was lowest for women <65 years with untreated diabetes and highest for men ≥65 years with type 1 diabetes. Contacts with doctors and some clinical events may play a key role in SIV adoption. Healthcare workers have a crucial role in reducing missed opportunities for SIV. The existence of empirical patient profiles with different patterns of SIV uptake should encourage their use of tailored educational approaches about SIV to address patients’ vaccine hesitancy.
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Affiliation(s)
- A Bocquier
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME , Marseille, France.,IHU-Méditerranée Infection , Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur , Marseille, France
| | - S Cortaredona
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME , Marseille, France.,IHU-Méditerranée Infection , Marseille, France
| | - L Fressard
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME , Marseille, France.,IHU-Méditerranée Infection , Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur , Marseille, France
| | - F Galtier
- INSERM, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-Reivac), GH Cochin Broca Hôtel Dieu , Paris, France.,CIC 1411, CHU Montpellier, Hôpital Saint Eloi , Montpellier, France
| | - P Verger
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME , Marseille, France.,IHU-Méditerranée Infection , Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur , Marseille, France.,INSERM, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-Reivac), GH Cochin Broca Hôtel Dieu , Paris, France
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Affiliation(s)
- Jeremy K Ward
- CNRS, Université Paris-Sorbonne, GEMASS, Paris, France. .,Aix Marseille Université, IRD, AP-HM, SSA, VITROME, Marseille, France.
| | - Patrick Peretti-Watel
- Aix Marseille Université, IRD, AP-HM, SSA, VITROME, Marseille, France.,IHU-Méditerranée Infection, Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, Marseille, France.,INSERM, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), Paris, France
| | - Aurélie Bocquier
- Aix Marseille Université, IRD, AP-HM, SSA, VITROME, Marseille, France.,IHU-Méditerranée Infection, Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Valérie Seror
- Aix Marseille Université, IRD, AP-HM, SSA, VITROME, Marseille, France.,IHU-Méditerranée Infection, Marseille, France
| | - Pierre Verger
- Aix Marseille Université, IRD, AP-HM, SSA, VITROME, Marseille, France.,IHU-Méditerranée Infection, Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, Marseille, France.,INSERM, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), Paris, France
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Tubiana S, Launay O, Galtier F, Tattevin P, Postil D, Vanhems P, Lenzi N, Verger P, Duval X. Attitudes, knowledge, and willingness to be vaccinated against seasonal influenza among patients hospitalized with influenza-like-illness: impact of diagnostic testing. Hum Vaccin Immunother 2020; 16:851-857. [PMID: 31589554 DOI: 10.1080/21645515.2019.1674598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Influenza vaccine adherence remains low. Communication of virological diagnosis to adults hospitalized with influenza-like illness (ILI) could improve their willingness to be subsequently vaccinated. We prospectively assessed, in adults hospitalized with ILI in six French university hospitals, their willingness to be vaccinated against influenza in the subsequent season, both before and after the communication of RT-PCR Influenza laboratory result; we identified then the determinants associated with the willingness to be vaccinated.A total of 309 patients were included during the 2012-2013 and 2013-2014 influenza seasons; 43.8% reported being vaccinated against influenza for the current season; before communication of influenza laboratory results, 65.1% reported willingness to be vaccinated during the subsequent season. Influenza was virologically confirmed in 103 patients (33.3%). The rate of vaccine willingness increased to 70.4% (p = .02) after communication of influenza laboratory results. Factors independently associated with the willingness to be vaccinated were the perception of influenza vaccine benefits (adjusted relative risk (aRR): 1.06, 95%CI 1.02-1.10), cues to action (aRR: 1.08, 95%CI 1.03-1.12), current season influenza vaccination (aRR: 1.38, 95%CI 1.20-1.59) and communication of a positive influenza laboratory result (aRR: 1.18, 95%CI 1.03-1.34). This last was associated with the willingness to be vaccinated only in the subpopulation of patients not vaccinated (aRR: 1.53, 95%CI 1.19-1.96).In patients hospitalized with ILI, communication of a positive influenza diagnostic led to a better appreciation of the disease's severity and increased the willingness to be vaccinated. This approach might be particularly beneficial in patients who do not have a history of influenza vaccination.
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Affiliation(s)
- Sarah Tubiana
- Inserm CIC1425 Bichat, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,IAME, UMR1137, Sorbonne Paris Cité, Paris, France
| | - Odile Launay
- Université Paris Descartes, Sorbonne Paris Cité, Inserm, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Cochin, CIC Cochin Pasteur, Paris, France.,Inserm, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), Paris, France
| | - Florence Galtier
- Inserm, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), Paris, France.,CIC 1411, Hôpital Saint-Eloi, CHU de Montpellier, Montpellier, France
| | - Pierre Tattevin
- Inserm, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), Paris, France.,Faculté de Médecine, Hôpital Pontchaillou, INSERM U835, Université Rennes 1, Rennes, France
| | - Deborah Postil
- Inserm, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), Paris, France.,CIC de Limoges, CHU Dupuytren, Limoges, Limoges, France
| | - Philippe Vanhems
- Inserm, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), Paris, France.,Service d'Hygiène, Epidémiologie et Prévention, Groupement Hospitalier Edouard Herriot, Lyon, and Emerging Pathogens Laboratory - Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI) Inserm U1111, Lyon, France
| | - Nezha Lenzi
- Inserm, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), Paris, France
| | - Pierre Verger
- Inserm, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), Paris, France.,UMR VITROME (Vecteurs, Infections TROpicales et MEditerranéennes), Aix Marseille Univ, INSERM, IRD, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d׳Azur, Marseille, France
| | - Xavier Duval
- Inserm CIC1425 Bichat, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,IAME, UMR1137, Sorbonne Paris Cité, Paris, France.,Inserm, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), Paris, France
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Armaroli E, Bechaux C, Delagrave R, Ingenbleek L, Leblanc JC, Verger P. A method to prioritize the surveillance of chemicals in food commodities to access international market and its application to four countries in Sub-Saharan Africa. Environ Int 2020; 135:105386. [PMID: 31864029 DOI: 10.1016/j.envint.2019.105386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 10/10/2019] [Accepted: 12/02/2019] [Indexed: 06/10/2023]
Abstract
The purpose of this study was to propose an approach to predict the distribution of chemicals in food in developing countries to assess consumer risk and access to the international market with a limited number of laboratory analyses. The first step consists of identifying the GEMS/Food Contaminants database and the chemical/food combination relevant for a particular country. The identification of critical chemical/food combination should be used to prioritize the analysis to be performed in a total diet study (TDS). The second step consists of modelling a distribution model based on the mean concentration generated from TDS associated with the variability observed in a larger dataset consisting of individual food contamination data from the GEMS food database. The simulated distributions may provide information regarding how to establish food safety standards and to assess the potential for accessing international market in the context of a value chain. This method is illustrated by case studies from the recent Regional TDS (RTDS) conducted in Sub Saharan Africa. We concluded that further work is needed to gain experience and to fully validate this approach. However, organized data sharing and developing harmonized methods for data analysis are key roles for international organizations, such as FAO, WHO, and WTO. Finally, it is important to remember that such a data-driven approach still requires significant investments in terms of human resources and analytical capacity.
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Affiliation(s)
- E Armaroli
- World Health Organization, Regional Centre for Environmental Health (WHO/EMR/CEHA), Amman, Jordan
| | - C Bechaux
- Agence Nationale pour la Sécurité de l'Alimentation, de l'Environnement et du Travail (ANSES), Maisons Alfort, France
| | - R Delagrave
- World Health Organization, Regional Centre for Environmental Health (WHO/EMR/CEHA), Amman, Jordan
| | - L Ingenbleek
- Centre Pasteur du Cameroon (CPC), Yaounde, Cameroon; LABERCA Oniris, Nantes, France
| | - J Ch Leblanc
- Food and Agriculture Organization of the United Nations (FAO), Rome, Italy.
| | - P Verger
- World Health Organization, Regional Centre for Environmental Health (WHO/EMR/CEHA), Amman, Jordan
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68
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Ingenbleek L, Lautz LS, Dervilly G, Darney K, Astuto MC, Tarazona J, Liem AKD, Kass GEN, Leblanc JC, Verger P, Le Bizec B, Dorne JLCM. Risk Assessment of Chemicals in Food and Feed: Principles, Applications and Future Perspectives. Issues in Environmental Science and Technology 2020. [DOI: 10.1039/9781839160431-00001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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69
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Wilson R, Zaytseva A, Bocquier A, Nokri A, Fressard L, Chamboredon P, Carbonaro C, Bernardi S, Dubé E, Verger P. Vaccine hesitancy and self-vaccination behaviors among nurses in southeastern France. Vaccine 2020; 38:1144-1151. [DOI: 10.1016/j.vaccine.2019.11.018] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 11/08/2019] [Accepted: 11/11/2019] [Indexed: 11/17/2022]
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Vivion M, Hennequin C, Verger P, Dubé E. Supporting informed decision-making about vaccination: an analysis of two official websites. Public Health 2020; 178:112-119. [DOI: 10.1016/j.puhe.2019.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/02/2019] [Accepted: 09/10/2019] [Indexed: 12/26/2022]
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Bocquier A, Dubois C, Verger P, Darmon N. Improving participation of hard-to-reach older people in diet interventions: the INVITE strategy. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
A lot of behavioural interventions promoting healthy eating and physical activity are focusing older people, but, among them, individuals from low socioeconomic status and/or experiencing social isolation participate less. The aim of the present study was to design, pilot and perform a formative evaluation of an active recruitment strategy called ’INVITE’. This strategy aimed to improve participation of hard-to-reach older people in existing collective workshops combining diet and physical activities dedicated to older people.
Methods
We co-constructed this strategy, based on results from a literature review, qualitative interviews with older people and professionals using the Behaviour Change Wheel framework as a guide. INVITE includes 5 steps: i) identification of socially deprived/isolated people aged 60-85 years in retirement fund databases; ii) postal invitation letter; iii) phone call; iv) home visit by a social worker. The formative evaluation used questionnaires (closed and open-ended questions) completed by 2 social workers in April 2019.
Results
Among the 54 older people selected in the databases, 29 could be reached by phone. Among these 29 persons, 25 reported being interested by the collective workshops; 17 refused the home visit (main reasons: not available during the workshops period, current health problems); 12 accepted the home visit, but only 10 could be visited at home (one was ill; one cancelled the visit). Nine out of these 10 persons accepted to participate to the workshops. The main motivating factors were that workshops were: free; perceived as friendly; and as an opportunity to “go out” and to receive diet counselling to improve diet quality with no additional cost.
Conclusions
The INVITE strategy was perceived positively but adjustments are needed to improve home visits acceptation rate (e.g., by revising the criteria used to identify people in the databases). We will now evaluate the attendance rate to the collective workshop.
Key messages
The INVITE strategy was designed to improve participation of hard-to-reach older people in combined diet and physical activity collective workshops. This strategy was perceived positively by most older people contacted and both social workers.
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Affiliation(s)
- A Bocquier
- Aix Marseille Univ, IRD, AP-HM, SSA, Vitrome, Marseille, France
- IHU-Méditerranée Infection, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - C Dubois
- Trophis, Les Pennes Mirabeau, France
| | - P Verger
- Aix Marseille Univ, IRD, AP-HM, SSA, Vitrome, Marseille, France
- IHU-Méditerranée Infection, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - N Darmon
- MOISA, INRA, CIHEAM-IAMM, CIRAD, Montpellier SupAgro,Univ Montpellier,Campus Inra-SupAgro de la Gaillarde, Montpellier, France
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Jardin M, Banide MC, Saba G, Burlot E, Jozancy F, Guagliardo V, Verger P. Relevance of the health insurance databases to study potentially inappropriate prescriptions. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Issue/problem
Potentially inappropriate prescriptions (PIP) for the elderly constitute a major issue in the quality of ambulatory care. In France, people aged 80 years or older use on average five drugs per day. This polypharmacy is justified in most cases by multimorbidity but it increases the risk of adverse events.
Description of the problem
In order to optimize general practitioners’ (GPs) prescribing practices for the elderly, a project involving the Southeastern Health Regional Observatory (ORS Paca), the Regional Medical Department of Health Insurance Fund (DRSM Paca-Corse) and the Regional Union of Private Practitioners (URPS-ML Paca) was conducted in 2014-2016. Its main objective was to set up a regional mapping tool giving GPs access to drug prescriptions indicators for the elderly in their practice area.
Results
Based on national guidelines and advice of experts in the field, we calculated 7 different indicators of potentially inappropriate prescriptions (PIPs) for people aged 65 years or older, using drug reimbursement data from the Health Insurance Fund. Those indicators were calculated among patient lists of GPs and covered prescriptions of benzodiazepines, non-steroidal anti-inflammatory (NSAI) drugs, new oral anticoagulants, proton pump inhibitors, antiplatelet therapy... PIPs’ prevalence were calculated among GPs’ lists of patients. PIPs prevalence differed between drugs type, GPs and territories: for example, the age standardized prevalence of long-term treatment with NSAI drugs varied in 2014 from 2 to 15% between municipalities and from 0 to 14% in 2017.
Lessons
These results allowed to identify priority areas for intervention, in which continuous medical education sessions with an individual feedback to GPs on their own indicators were implemented, to improve prescribing practices.
Key messages
A substantial proportion of elderly people receive PIPs. Medico-administrative databases can be used to produce indicators of prescription practices to be used to guide public health interventions.
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Affiliation(s)
- M Jardin
- Southeastern Health Regional Observatory (ORS Paca), Marseille, France
| | - M C Banide
- Southeastern Regional Medical Department for Health Insurance Fund (DRSM Paca-Corse), Marseille, France
| | - G Saba
- Southeastern Regional Medical Department for Health Insurance Fund (DRSM Paca-Corse), Marseille, France
| | - E Burlot
- Southeastern Regional Medical Department for Health Insurance Fund (DRSM Paca-Corse), Marseille, France
| | - F Jozancy
- Southeastern Regional Union of Private Practitioners (URPS-ML Paca), Marseille, France
| | - V Guagliardo
- Southeastern Health Regional Observatory (ORS Paca), Marseille, France
| | - P Verger
- Southeastern Health Regional Observatory (ORS Paca), Marseille, France
- Aix Marseille University, IRD, AP-HM, SSA, Vitrome, Marseille, France
- IHU-Méditerranée Infection, Marseille, France
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Bocquier A, Cortaredona S, Andrieu-Semmel M, Dagnet L, Pouget V, Urban-Boudjelab S, Verger P. Environmental health risks perceptions: results from cross-sectional surveys in Southeastern France. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In accordance with commitments made as part as the European conferences on environment and health in the 90s, France has adopted national environmental health plans since 2004. These plans include regional offshoots to take local specificities into account. To guide stakeholders in defining this plan in Southeastern France, studies were carried out to document general population environmental health risks perceptions and practices.
Methods
Data come from the Southeastern Baromètre santé environment, random cross-sectional telephone surveys carried out in 2007 and 2017 among the population aged 18-75 years (n = 1415 and 1960 respectively). They focused on people perceptions’ about environmental health risks (e.g., air pollution) and actions to reduce them, trust in sources of information, and their practices. We performed descriptive analyses of the 2017 data, and logistic regression models adjusted for sociodemographic variables to test time evolutions.
Results
In 2017, the main environmental health risks perceived were pesticides, carbon monoxide, and air pollution (over 90% of the participants thought they carry high health risks). As in 2007, over 90 % thought the air quality had been worsening. The most efficient ways to reduce air pollution were the improvement of public transportation, of bike paths and the development of car sharing. Between 2007 and 2017, self-reported use of soft mobility and/or car sharing increased from 54% to 66%; and consumption of organic food increased from 40% to 69%. Participants perceived physicians as the most trustful source of information about environmental health.
Conclusions
Habitants from Southeastern France are highly concerned by environmental health risks, especially pesticides and air pollution. They call stakeholders to take actions to reduce these risks, but appear to have changed some of their own practices too. These results helped stakeholders to define priorities of the current regional environmental health plan.
Key messages
The general population was highly concerned by environmental health risks (especially pesticides and air pollution), and has become aware of the necessity of changing its own practices. Such results about the regional population main concerns have been used to define regional priorities for actions.
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Affiliation(s)
- A Bocquier
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
- IHU-Méditerranée Infection, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-C, Marseille, France
| | - S Cortaredona
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
- IHU-Méditerranée Infection, Marseille, France
| | - M Andrieu-Semmel
- ARS PACA, Agence Régionale de Santé, Provence-Alpes-Côte d’A, Marseille, France
| | - L Dagnet
- Région Sud-Provence-Alpes-Côte d’Azur, Marseille, France
| | - V Pouget
- Région Sud-Provence-Alpes-Côte d’Azur, Marseille, France
| | - S Urban-Boudjelab
- ARS PACA, Agence Régionale de Santé, Provence-Alpes-Côte d’A, Marseille, France
| | - P Verger
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
- IHU-Méditerranée Infection, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-C, Marseille, France
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Douchement O, Dumesnil H, Dagnet L, Saugeron B, Sonnier P, Verger P, Guagliardo V. A methodological support to set up multidisciplinary group practices in Southeastern France. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Issue/Problem
Despite high medical densities in Southeastern France, access to prevention and care is difficult in some territories due to a lack of health professionals. The Regional Council supports multidisciplinary group practices (MGP) to improve primary care access and quality. When developing them, health professionals have to propose a health project addressing population health needs in the area.
Description of the problem
Two complementary resource centres -the Southeastern Regional Health Observatory and the Regional Committee for Health Education- collaborate to provide support to health professionals in the creation of MGP. The process includes a territorial assessment based on quantitative indicators about various environmental and socio-economic determinants, morbidity, mortality, and health-seeking behaviours. Stakeholders then discuss the results of this assessment in order to confront it to their experiences, identify priorities and design the health project: it defines the forms according to which professionals will work together and set specific objectives and activities to cover main public health needs in the corresponding territory.
Results
Since 2011, our methodological support has benefited 45 MGP projects: 19 were successful, 13 are still in progress and 13 projects were not completed. It helped decision-makers in the identification of priority territories in terms of prevention and care; it also presented outlooks of the current and coming health needs of various areas.
Lessons
Levers to the MGP setting up have been identified: a project is more successful when it is initiated by health professionals supported by local authorities, and up for discussion. On the contrary, preconceived ideas about the MGP project complicate the assessment’s appropriation.
Key messages
Taking into account the results of the assessment helps to propose MGP projects that better match population needs. It also improves collective knowledge of public health issues between health professionals and various local stakeholders.
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Affiliation(s)
- O Douchement
- Southeastern Health Regional Observatory (Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur), Marseille, France
| | - H Dumesnil
- Southeastern Health Regional Observatory (Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur), Marseille, France
| | - L Dagnet
- Southeastern Regional Council (Région Sud Provence-Alpes-Côte d’Azur), Marseille, France
| | - B Saugeron
- Regional Committee for Health Education (Comité Régional d’Education à la Santé Provence-Alpes-Côte d’Azur), Marseille, France
| | - P Sonnier
- Regional Committee for Health Education (Comité Régional d’Education à la Santé Provence-Alpes-Côte d’Azur), Marseille, France
| | - P Verger
- Southeastern Health Regional Observatory (Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur), Marseille, France
- Aix Marseille University, IRD, AP-HM, SSA, Vitrome, Marseille, France
- IHU-Méditerranée Infection, Marseille, France
| | - V Guagliardo
- Southeastern Health Regional Observatory (Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur), Marseille, France
- Aix Marseille University, IRD, AP-HM, SSA, Vitrome, Marseille, France
- IHU-Méditerranée Infection, Marseille, France
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Jardin M, Kurkdji P, Dagnet L, Tonnaire G, Nauleau S, Verger P, Guagliardo V. Southeastern Regional Health Information System: a mapping tool for public health actors. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Issue/problem
Local public health actors often need to identify public health priorities in their territories to guide public health policy and/or action.
Description of the problem
The Southeastern Health Regional Observatory (ORS Paca) has been developing since 2006 a health information system for Southeastern France (SIRSéPACA). The objective of this mapping tool is to give access to regional and local public health actors to public health indicators for various population groups and geographical scales (municipality, districts...) within the region.
Results
Indicators are displayed under the format of maps and tables on the following topics: morbidity, mortality, health social, economic or environmental determinants. Indicators are constructed using national and regional databases (open or accessible through agreements). SIRSéPACA is in free access (www.sirsepaca.org) and regularly updated. A function allows the users to obtain a portrait for a defined geographical area and to obtain in one click a description of various indicators (socio-economic and demographic characteristics, mortality and morbidity causes, health care and prevention, environmental health). Indicators for a given territory can be compared to the regional average (or another area). SIRSéPACA is regularly used to provide a description of the main public health characteristics of territories (“territorial diagnose”), e.g. to help health professionals intending to set up of a multidisciplinary group practice designing their project.
Lessons
Trainings on how to use the tool, interpret the maps produced, and about territorial diagnoses implementation are regularly done. We are also developing a similar tool for all French regions for the Ministry of Health.
Key messages
SIRSéPACA facilitates access to and overview of a lot of indicators and data for local public health actors. This regional experience has been expanded to national level.
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Affiliation(s)
- M Jardin
- Southeastern Health Regional Observatory (ORS Paca), Marseille, France
| | - P Kurkdji
- Southeastern Health Regional Observatory (ORS Paca), Marseille, France
| | - L Dagnet
- Southeastern Regional Council (Région Sud Provence-Alpes-Côte d’Azur), Marseille, France
| | - G Tonnaire
- Southeastern Regional Health Agency (ARS Paca), Marseille, France
| | - S Nauleau
- Southeastern Regional Health Agency (ARS Paca), Marseille, France
| | - P Verger
- Southeastern Health Regional Observatory (ORS Paca), Marseille, France
- Aix Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France
- IHU-Méditerranée Infection, Marseille, France
| | - V Guagliardo
- Southeastern Health Regional Observatory (ORS Paca), Marseille, France
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76
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Davin B, Cortaredona S, Guagliardo V, Nauleau S, Ventelou B, Verger P. Prospective study on chronic diseases and healthcare costs for the south of France region, 2016-2028. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
In France, Health Regional Agencies (HRA) have to elaborate a Public Health Plan for the 5 coming years. For estimating future population health needs and associated costs to adapt the health services on the regional territory, the HRA in southeastern France requested a prospective analysis, based on demographic and epidemiologic scenarios about major chronic diseases, to evaluate future trends.
Methods
Six chronic diseases were selected: diabetes (1 or 2), cardiovascular diseases, respiratory diseases, cancers, neurological diseases and dementia. We used medico-administrative data from the National health insurance fund, and adapted algorithms to identify people with these diseases. We calculated prevalence rates according to gender and age and used two alternative scenarios (a constant one, and a trend-based one) to estimate the number of people with chronic diseases in 2023 and 2028, starting in 2016. We also estimated future healthcare costs according a constant and a trend-based scenario.
Results
The algorithms detect reasonable rates of disease compared to official rates available for 2016. Due to demographic (ageing) and/or epidemiologic trends, the number of people with chronic diseases will highly increase during the next ten years in the South of France region. For instance, between 2016 and 2028, there will be from 15% to 20% more people with diabetes. Associated costs will also be higher (+33% between 2016 and 2028), especially those granted to nursing care (+40%).
Conclusions
Burden of diseases and health expenditures are going to increase in the future. Projections are needed to help policymakers anticipating the required health services adaptation. Medico-administrative database are an invaluable source of data to do so. The next step of this project will consist in estimating those trends for smaller geographical areas.
Key messages
Data of the French Health Insurance fund can be used to predict future prevalence of chronic diseases and healthcare costs. South of France will face a main increase of people with chronic diseases.
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Affiliation(s)
- B Davin
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - S Cortaredona
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
- IHU-Méditerranée Infection, Marseille, France
| | - V Guagliardo
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - S Nauleau
- ARS PACA, Southeastern Health Regional Agency, Marseille, France
| | - B Ventelou
- Aix-Marseille Univ, CNRS, EHESS, Centrale Marseille, Aix-Marseille School of Economics, Marseille, France
| | - P Verger
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
- IHU-Méditerranée Infection, Marseille, France
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77
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Verger P, Fressard L, Cortaredona S, Lévy-Bruhl D, Loulergue P, Galtier F, Bocquier A. Trends in seasonal influenza vaccine coverage of target groups in France, 2006/07 to 2015/16: Impact of recommendations and 2009 influenza A(H1N1) pandemic. ACTA ACUST UNITED AC 2019; 23. [PMID: 30514414 PMCID: PMC6280418 DOI: 10.2807/1560-7917.es.2018.23.48.1700801] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background and aimsSeasonal influenza vaccination (SIV) uptake (SIVU) rates in France are below target. We (i) describe trends in French SIVU over 10 consecutive seasons among different target groups and (ii) examine the effects of the 2009 influenza A(H1N1) pandemic and the publication of new SIV recommendations in 2011 and 2013.MethodsOur study was based on records of vaccines delivered in community pharmacies for a permanent, representative sample of 805,000 beneficiaries of the French National Health Insurance Fund. For the first objective, we analysed SIVU rate trends among ≥ 65 year olds as well as among < 65 year olds with each of the following conditions: diabetes, respiratory, cardiovascular, neuromuscular, or chronic liver disease. For the second goal, we computed segmented log-binomial regression analyses.ResultsAfter the 2009 pandemic, except for the target group with liver diseases, where the difference was not statistically significant, SIVU fell significantly in all groups during the 2010/11 season, remaining relatively stable until 2015/16 in groups not targeted by new recommendations. Crude SIVU rates in 2015/16 were 48% (43,950/91,794) for ≥ 65 year olds and between 16% (407/2,565) and 29% (873/3,056) for < 65 year olds depending on their condition. SIVU increased modestly after new recommendations were published, but only in patients newly eligible for a free vaccine voucher.ConclusionsOur results suggest: (i) a prolonged confidence crisis in SIV, initially impelled by the 2009 pandemic vaccination campaign; (ii) that new recommendations are ineffective without additional measures. Interventional research in this field is a priority.
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Affiliation(s)
- Pierre Verger
- INSERM, F-CRIN, Innovative Clinical research Network in vaccinology (I-Reivac), GH Cochin Broca Hôtel Dieu, Paris, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.,Aix-Marseille Université, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | - Lisa Fressard
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Sébastien Cortaredona
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.,Aix-Marseille Université, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | - Daniel Lévy-Bruhl
- Santé publique France, Direction des maladies infectieuses, Saint-Maurice, France
| | - Pierre Loulergue
- Assistance Publique Hôpitaux de Paris, CIC Cochin-Pasteur, Paris, France.,Inserm CIC 1417, Paris, France.,Université Paris Descartes, Sorbonne Paris cité, Paris, France.,INSERM, F-CRIN, Innovative Clinical research Network in vaccinology (I-Reivac), GH Cochin Broca Hôtel Dieu, Paris, France
| | - Florence Galtier
- CIC 1411, CHU Montpellier, Hôpital Saint Eloi, Montpellier, France.,INSERM, F-CRIN, Innovative Clinical research Network in vaccinology (I-Reivac), GH Cochin Broca Hôtel Dieu, Paris, France
| | - Aurélie Bocquier
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.,Aix-Marseille Université, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
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Rey D, Fressard L, Cortaredona S, Bocquier A, Gautier A, Peretti-Watel P, Verger P, On Behalf Of The Baromètre Santé Group. Vaccine hesitancy in the French population in 2016, and its association with vaccine uptake and perceived vaccine risk-benefit balance. ACTA ACUST UNITED AC 2019; 23. [PMID: 29717693 PMCID: PMC5930729 DOI: 10.2807/1560-7917.es.2018.23.17.17-00816] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Vaccine hesitancy (VH) is prominent in France. Objectives: This study aimed to estimate the prevalence and socio-demographic correlates of VH in sub-groups of the French population and to investigate the association of VH with both vaccine uptake and perceived risk–benefit balance (RBB) for four vaccines. Methods: During the 2016 Health Barometer – a national cross-sectional telephone survey in a representative sample of the French population – parents of 1–15 year-old children, parents of 11–15 year-old girls and elderly people aged 65–75 years were asked about VH (using three questions adapted from the World Health Organization definition), vaccine uptake and perceived RBB for measles and hepatitis B (children’s parents), human papillomavirus (girls’ parents) and seasonal influenza (elderly people) vaccines. Results: A total of 3,938 parents including 959 girls' parents – and 2,418 elderly people were interviewed. VH prevalence estimates were 46% (95% confidence interval (CI): 44–48) among parents, 48% (95%CI: 45–51) among girls’ parents and 35% (95% CI: 33–36) among elderly people, with higher estimates associated with high education level, children’s age (10–15 years), and, for the elderly, poor perception of health status. VH was associated with uncertainty about and/or an unfavourable perception of vaccines’ RBB for the four vaccines and with lower self-reported vaccine uptake, except for human papillomavirus vaccine in girls. Results were confirmed by multivariable analysis. Conclusion: Further research is needed to study the association between VH and vaccine uptake for other vaccines, and to design and validate measurement tools to monitor VH over time.
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Affiliation(s)
- Dominique Rey
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Lisa Fressard
- Aix-Marseille University, IRD, UMR-S912, Marseille, France.,INSERM, UMR S912, « Economics and Social Sciences Applied to Health & Analysis of Medical Information » (SESSTIM), Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Sébastien Cortaredona
- IRD, AP-HM, VITROME, IHU-Méditerranée Infection, Aix-Marseille University, Marseille, France
| | - Aurélie Bocquier
- IRD, AP-HM, VITROME, IHU-Méditerranée Infection, Aix-Marseille University, Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Arnaud Gautier
- Santé Publique France, French National Public Health Agency, Saint-Maurice, France
| | - Patrick Peretti-Watel
- IRD, AP-HM, VITROME, IHU-Méditerranée Infection, Aix-Marseille University, Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Pierre Verger
- IRD, AP-HM, VITROME, IHU-Méditerranée Infection, Aix-Marseille University, Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, Marseille, France
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Roux P, Marcellin F, Ndiaye K, Suzan-Monti M, Mayet A, Duracinsky M, Briand-Madrid L, Maradan G, Mora M, Préau M, Verger P, Carrieri P, Dray-Spira R, Spire B. Posttraumatic Stress Disorder as a Significant Correlate of Voluntary Antiretroviral Treatment Interruption in Adult HIV-Infected Patients Followed up in French Hospitals: Data From the ANRS-VESPA2 National Survey. J Clin Psychiatry 2019; 79. [PMID: 29659208 DOI: 10.4088/jcp.17m11659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 09/11/2017] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Although antiretroviral treatment (ART) no longer requires 100% adherence, voluntary treatment interruption (VTI) still may have a negative impact on virologic success. Previous studies have shown that posttraumatic stress disorder (PTSD) is more prevalent in HIV-infected patients than in the general population. However, no study has yet investigated the relationship between PTSD and VTI. We analyzed this relationship using data from a French national survey representative of HIV-infected adults followed up in hospitals. METHODS A total of 3,022 HIV-infected adults participated in the ANRS-VESPA2 survey (April 2011-January 2012) and answered a face-to-face questionnaire that included the Composite International Diagnostic Interview Short-Form to diagnose PTSD and assess sociobehavioral variables such as VTI. Multivariable logistic regression models were used to study the relationship between PTSD and VTI. RESULTS Among the 2,768 ART-treated participants with available data for both PTSD screening and ART interruption (study sample), prevalence of PTSD was 13.3%, and 7.2% of individuals reported VTI during the previous month. After adjustment for being a female Sub-Saharan African immigrant and reporting harmful alcohol consumption (Alcohol Use Disorders Identification Test score ≥ 8), lifetime PTSD was found to be independently associated with VTI (adjusted odds ratio [95% CI] = 1.64 [1.07-2.53], P = .025). CONCLUSIONS PTSD is highly prevalent in HIV-infected patients followed up in French hospitals and is a significant predictor of VTI. PTSD is a psychiatric disorder that is still underdiagnosed and undertreated in many countries despite its negative consequences on health behaviors. As there is evidence of effective treatment for PTSD, HIV care providers need to be trained in screening for this disorder.
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Affiliation(s)
- Perrine Roux
- Inserm UMR-S912, IHU-Méditerranée Infection, 19-21 Blvd Jean Moulin, 13005 Marseille, France. .,Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Fabienne Marcellin
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Khadim Ndiaye
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Marie Suzan-Monti
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Aurélie Mayet
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Marseille, France.,Centre d'Épidémiologie et de Santé Publique des Armées, Marseille, France
| | - Martin Duracinsky
- EA 7334 REMES, Patient-Centered Outcomes Research, Sorbonne Paris Cité, Paris-Diderot University, Paris, France.,URC-ECO, Hôpital Hôtel-Dieu, AP-HP, Paris, France.,Service de Médecine Interne et d'Immunologie Clinique, Hôpital Bicêtre, AP-HP, Kremlin-Bicêtre, France
| | - Laélia Briand-Madrid
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Gwenaëlle Maradan
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Marion Mora
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Marie Préau
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Marseille, France.,Groupe de Recherche en Psychologie Sociale, Université Lyon 2, Lyon, France
| | - Pierre Verger
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Patrizia Carrieri
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Rosemary Dray-Spira
- INSERM, UMR_S1136, Pierre Louis Institute of Epidemiology and Public Health, Team Research in Social Epidemiology, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, UMR_S1136, Pierre Louis Institute of Epidemiology and Public Health, Team Research in Social Epidemiology, Paris, France
| | - Bruno Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
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80
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Collange F, Zaytseva A, Pulcini C, Bocquier A, Verger P. Unexplained variations in general practitioners' perceptions and practices regarding vaccination in France. Eur J Public Health 2019; 29:2-8. [PMID: 30085024 DOI: 10.1093/eurpub/cky146] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Given geographical disparities in vaccination coverage (VC) and the crucial role general practitioners (GPs) play in vaccination in France, we sought to: 1) determine the existence of geographical variations in GPs' perceptions of vaccines, their trust in information sources, and the frequency of their recommendations to patients by comparing data from southeast (SE), central-west (CW), northwest (NW), and the rest of France; and 2) identify individual and contextual factors associated with regional variations in GPs' recommendations. Methods This cross-sectional observational study in 2014 collected data from a panel of 2586 French GPs in private practice: 3 specific regional samples and a fourth sample for the rest of France. We calculated a composite score summarizing GPs' vaccine recommendation frequency for 6 vaccine situations and used a five-step hierarchical linear regression to study the score's links with practice location and individual and contextual factors. Results GPs' vaccine recommendation frequency score was highest in NW France and lowest in the SE. The low SE score was explained by GPs' greater doubts about vaccine utility and risks and lower trust in information sources. The high NW score was partially explained by greater adherence to guidelines by GPs there. The contextual factors studied did not explain regional differences. Conclusion The geographical variations in GPs' vaccination-related attitudes and practices suggest that vaccine hesitancy among GPs differs in prevalence between regions. These variations coincide with north/south trends in population VC. Intervention strategies to restore confidence in vaccines should target GPs and must be adapted to each regional context.
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Affiliation(s)
- Fanny Collange
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France.,Southeastern Health Regional Observatory, ORS PACA, Marseille, France
| | - Anna Zaytseva
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France.,Southeastern Health Regional Observatory, ORS PACA, Marseille, France
| | - Céline Pulcini
- Université de Lorraine, EA 4360 APEMAC and, CHRU de Nancy, Service de Maladies Infectieuses et Tropicales, Nancy, France
| | - Aurélie Bocquier
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France.,Southeastern Health Regional Observatory, ORS PACA, Marseille, France
| | - Pierre Verger
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France.,Southeastern Health Regional Observatory, ORS PACA, Marseille, France
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81
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Bocquier A, Cortaredona S, Fressard L, Loulergue P, Raude J, Sultan A, Galtier F, Verger P. Trajectories of seasonal influenza vaccine uptake among French people with diabetes: a nationwide retrospective cohort study, 2006-2015. BMC Public Health 2019; 19:918. [PMID: 31288768 PMCID: PMC6617633 DOI: 10.1186/s12889-019-7209-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 06/20/2019] [Indexed: 01/20/2023] Open
Abstract
Background Annual seasonal influenza vaccination (SIV) is recommended for people with diabetes, but their SIV rates remain far below public health targets. We aimed to identify temporal trajectories of SIV uptake over a 10-year period among French people with diabetes and describe their clinical characteristics. Methods We identified patients with diabetes in 2006 among a permanent, representative sample of beneficiaries of the French National Health Insurance Fund. We followed them up over 10 seasons (2005/06–2015/16), using SIV reimbursement claims and group-based trajectory modelling to identify SIV trajectories and to study sociodemographic, clinical, and healthcare utilization characteristics associated with the trajectories. Results We identified six trajectories. Of the 15,766 patients included in the model, 4344 (28%) belonged to the “continuously vaccinated” trajectory and 4728 (30%) to the “never vaccinated” one. Two other trajectories showed a “progressive decrease” (2832, 18%) or sharp “postpandemic decrease” (1627, 10%) in uptake. The last two trajectories (totalling 2235 patients, 14%) showed an early or delayed “increase” in uptake. Compared to “continuously vaccinated” patients, those in the “progressively decreasing” trajectory were older and those in all other trajectories were younger with fewer comorbidities at inclusion. Worsening diabetes and comorbidities during follow-up were associated with the “increasing” trajectories. Conclusions Most patients with diabetes had been continuously vaccinated or never vaccinated and thus had stable SIV behaviours. Others adopted or abandoned SIV. These behaviour shifts might be due to increasing age, health events, or contextual factors (e.g., controversies about vaccine safety or efficacy). Healthcare professionals and stakeholders should develop tailored strategies that take each group’s specificities into account. Electronic supplementary material The online version of this article (10.1186/s12889-019-7209-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Aurélie Bocquier
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, 19-21 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France. .,IHU-Méditerranée Infection, Marseille, France. .,ORS PACA Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.
| | - Sébastien Cortaredona
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, 19-21 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France.,IHU-Méditerranée Infection, Marseille, France
| | - Lisa Fressard
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, 19-21 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France.,IHU-Méditerranée Infection, Marseille, France.,ORS PACA Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Pierre Loulergue
- INSERM, F-CRIN Innovative Clinical research Network in vaccinology (I-Reivac), GH Cochin Broca Hôtel Dieu, 75014, Paris, France.,Université Paris Descartes, Sorbonne Paris cité, Paris, France.,Inserm CIC 1417, Paris, France.,Assistance Publique Hôpitaux de Paris, CIC Cochin-Pasteur, Paris, France
| | - Jocelyn Raude
- EHESP Rennes, Université Sorbonne Paris Cité, Paris, France.,Unité des Virus Emergents (UVE: Aix-Marseille Univ - IRD 190 - Inserm 1207 - IHU Méditerranée Infection), Marseille, France
| | - Ariane Sultan
- Endocrinology-Diabetology-Nutrition Department, University Hospital, Montpellier, France.,PhyMedExp, University of Montpellier CNRS INSERM, Montpellier, France
| | - Florence Galtier
- INSERM, F-CRIN Innovative Clinical research Network in vaccinology (I-Reivac), GH Cochin Broca Hôtel Dieu, 75014, Paris, France.,CIC 1411 CHU Montpellier Hôpital Saint Eloi, Montpellier, France
| | - Pierre Verger
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, 19-21 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France.,IHU-Méditerranée Infection, Marseille, France.,ORS PACA Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.,INSERM, F-CRIN Innovative Clinical research Network in vaccinology (I-Reivac), GH Cochin Broca Hôtel Dieu, 75014, Paris, France
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82
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Peretti-Watel P, Ward JK, Vergelys C, Bocquier A, Raude J, Verger P. 'I Think I Made The Right Decision … I Hope I'm Not Wrong'. Vaccine hesitancy, commitment and trust among parents of young children. Sociol Health Illn 2019; 41:1192-1206. [PMID: 30972804 DOI: 10.1111/1467-9566.12902] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
During the last decade, public health research has emphasised the growing public disaffection with vaccination. This contemporary vaccine hesitation (VH) refers to a delay in acceptance or refusal of vaccines, as well as agreement despite doubt and reluctance. We investigated VH among French parents of young children, with an emphasis on two key features of VH: trust towards physicians and commitment to vaccination issues. We targeted two populations with contrasting socioeconomic profiles, using in-depth interviews (n = 25). Most parents exhibited some kind of VH, with differentiated attitudes across vaccines, including acceptance despite enduring doubts, especially for vaccines already provided to older siblings ('vaccine inertia'). Despite the rise of the Internet and social media, our participants still strongly relied on face-to-face interactions with peers and significant others. Most participants trusted their own physician but this was the result of a selection process: they had engaged resources to find a physician they could trust. Participants with contrasted socioeconomic profiles struggled with the same dilemmas, and they committed themselves to the same quest to find the 'right' physician. Nevertheless, parents with a higher socioeconomic status were able to engage more resources and use a wider repertoire of actions, and they also displayed greater health literacy.
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Affiliation(s)
- Patrick Peretti-Watel
- Aix Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Jeremy K Ward
- Aix Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France
- Paris Diderot University (UMR8236: LIED), Paris, France
| | - Chantal Vergelys
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Aurélie Bocquier
- Aix Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Jocelyn Raude
- EHESP-Rennes, Sorbonne-Paris-Cité, Rennes, France
- EPV-UMR_D 190, Émergence des Pathologies Virales, Marseille, France
| | - Pierre Verger
- Aix Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
- INSERM, F-CRIN, (I-REIVAC), Paris, France
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83
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Verdoux H, Pambrun E, Tournier M, Cortaredona S, Verger P. Multi-trajectories of antidepressant and antipsychotic use: a 11-year naturalistic study in a community-based sample. Acta Psychiatr Scand 2019; 139:536-547. [PMID: 30844084 DOI: 10.1111/acps.13020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To explore the temporal dynamic of antidepressant and antipsychotic co-prescribing in real-life conditions. METHODS The study was performed using reimbursement data from the French Insurance Healthcare system in a cohort of 118 454 persons with at least one dispensing of antidepressants and/or antipsychotics over the period 2006-2016. Latent class analyses were used to identify homogeneous groups of persons following similar multi-trajectories of antidepressant and/or antipsychotic dispensing. Multivariate polynomial logistic regression models were used to explore the characteristics independently associated with distinct trajectories. RESULTS Five multi-trajectories of antidepressant and/or antipsychotic dispensing were identified: more than half of the sample (58%) had very low antidepressant and antipsychotic use; two groups had chronic (12%) or decreasing (11%) antidepressant use with very low antipsychotic use; two groups used both antidepressants and antipsychotics simultaneously either in an increasing (12%) or chronic (7%) way. Persons with chronic antidepressant-antipsychotic use presented with markers of poor social and mental health conditions. CONCLUSIONS Most persons using antipsychotics over the follow-up also used antidepressants over the same period. The benefit/risk ratio of these prescribing practices should be further explored as the long-term efficacy of antidepressant-antipsychotic polypharmacy is poorly documented, while this combination increases the risk of adverse effects.
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Affiliation(s)
- H Verdoux
- U1219, University of Bordeaux, Bordeaux, France.,INSERM, U1219, Bordeaux, France
| | - E Pambrun
- U1219, University of Bordeaux, Bordeaux, France.,INSERM, U1219, Bordeaux, France
| | - M Tournier
- U1219, University of Bordeaux, Bordeaux, France.,INSERM, U1219, Bordeaux, France
| | - S Cortaredona
- IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Aix-Marseille University, Marseille, France
| | - P Verger
- IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Aix-Marseille University, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
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84
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Dimi S, Zucman D, Chassany O, Lalanne C, Prazuck T, Mortier E, Majerholc C, Aubin-Auger I, Verger P, Duracinsky M. Patients' high acceptability of a future therapeutic HIV vaccine in France: a French paradox? BMC Infect Dis 2019; 19:401. [PMID: 31072394 PMCID: PMC6509812 DOI: 10.1186/s12879-019-4056-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 05/01/2019] [Indexed: 12/23/2022] Open
Abstract
Background France is the European country with the lowest level of confidence in vaccines. Measurement of patients’ acceptability towards a future therapeutic HIV vaccine is critically important. Thus, the aim of this study was to evaluate patients’ acceptability of a future therapeutic HIV vaccine in a representative cohort of French patients living with HIV-AIDS (PLWHs). Methods This multicentre study used quantitative and qualitative methods to assess PLWHs’ opinions and their potential acceptance of a future therapeutic HIV vaccine. Cross-sectional study on 220 HIV-1 infected outpatients, aged 18–75 years. Results The participants’ characteristics were similar to those of the overall French PLWH population. Responses from the questionnaires showed high indices of acceptance: the mean score for acceptability on the Visual Analog Scale VAS was 8.4 of 10, and 92% of patients agreed to be vaccinated if a therapeutic vaccine became available. Acceptability depended on the expected characteristics of the vaccine, notably the duration of its effectiveness: 44% of participants expected it to be effective for life. This acceptance was not associated with socio-demographic, clinical (mode of contamination, duration of disease), quality of life, or illness-perception parameters. Acceptability was also strongly correlated with confidence in the treating physician. Conclusion The PLWHs within our cohort had high indices of acceptance to a future therapeutic HIV vaccine. Trial registration This study was retroactively registered on ClinicalTrials.gov with ID: NCT02077101 in February 21, 2014.
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Affiliation(s)
- Svetlane Dimi
- Department of Internal Medicine, Réseau Ville Hôpital Val de Seine, Foch Hospital, Suresnes, France.
| | - David Zucman
- Department of Internal Medicine, Réseau Ville Hôpital Val de Seine, Foch Hospital, Suresnes, France
| | - Olivier Chassany
- EA 7334 REMES, Patient-Centered Outcomes Research, University Paris-Diderot, Sorbonne Paris Cité, Paris, France.,Clinical Research Unit in Health Economics (URC-ECO), Fernand Widal Hospital, AP-HP, Paris, France
| | - Christophe Lalanne
- EA 7334 REMES, Patient-Centered Outcomes Research, University Paris-Diderot, Sorbonne Paris Cité, Paris, France
| | - Thierry Prazuck
- Department of Infectious Diseases, Regional Hospital Orléans, Orléans, France
| | - Emmanuel Mortier
- Department of Internal Medicine, Louis Mourier Hospital, Colombes, France
| | - Catherine Majerholc
- Department of Internal Medicine, Réseau Ville Hôpital Val de Seine, Foch Hospital, Suresnes, France
| | | | - Pierre Verger
- Observatoire régional de la santé Paca, Marseille, France.,AMU-UMR912 SESSTIM-IRD, Marseille France, Marseille, France
| | - Martin Duracinsky
- EA 7334 REMES, Patient-Centered Outcomes Research, University Paris-Diderot, Sorbonne Paris Cité, Paris, France.,Clinical Research Unit in Health Economics (URC-ECO), Fernand Widal Hospital, AP-HP, Paris, France.,Department of Internal Medicine & Clinical Immunology, Bicetre Hospital, AP-HP, Kremlin-Bicetre, Paris, France
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85
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Wilson R, Scronias D, Zaytseva A, Ferry MA, Chamboredon P, Dubé E, Verger P. Seasonal influenza self-vaccination behaviours and attitudes among nurses in Southeastern France. Hum Vaccin Immunother 2019; 15:2423-2433. [PMID: 30829102 DOI: 10.1080/21645515.2019.1587274] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Despite seasonal influenza vaccination (SIV) being recommended to healthcare professionals to protect themselves and their patients, uptake is low, especially among nurses. We sought to study self-vaccination behaviours, attitudes and knowledge about SIV among nurses in Southeastern France. METHODS A cross-sectional survey with community and hospital-based hospital nurses was conducted with the same standardised questionnaire. Multi-model averaging approaches studied factors associated with the following dependent variables: self-reported SIV uptake; and considering SIV a professional responsibility. RESULTS 1539 nurses completed the questionnaire (response rate: 85%). SIV was the most frequently cited vaccine (49%) regarding nurses' unfavourable opinions towards specific vaccines. Thirty-four percent of nurses reported being vaccinated at least once during the 2015-2016 or 2016-2017 seasons. A lack of perceived personal vulnerability to influenza, a fear of adverse effects, and a preference for homeopathy constituted the main deterrents of SIV. Nurses held various misconceptions about the SIV, but 69% considered its benefits to be greater than its risks. The multi-model averaging approach showed that considering SIV as a professional responsibility was the main factor associated with SIV uptake among nurses (Nagelkerke's partial R-squared: 15%). This sense of responsibility was strongly associated with trust in various vaccine information sources. CONCLUSION Nurses had low SIV uptake rates and held various concerns and a lack of knowledge surrounding the vaccine. This is concerning considering the impact that these factors can have on nurses and patients' health, especially considering the increased role that nurses could have surrounding SIV in the near future.
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Affiliation(s)
- Rose Wilson
- ORS PACA, Southeastern Health Regional Observatory , Marseille , France.,IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Aix Marseille Univ , Marseille , France
| | - Dimitri Scronias
- IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Aix Marseille Univ , Marseille , France
| | - Anna Zaytseva
- ORS PACA, Southeastern Health Regional Observatory , Marseille , France.,IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Aix Marseille Univ , Marseille , France
| | - Marie-Ange Ferry
- Conseil Inter-Régional de l'Ordre des Infirmiers (CIROI) PACA , Corse , France
| | - Patrick Chamboredon
- Conseil Inter-Régional de l'Ordre des Infirmiers (CIROI) PACA , Corse , France
| | - Eve Dubé
- Department of Social and Preventive Medicine, Institut National de Santé publique du Québec , Québec , Canada
| | - Pierre Verger
- ORS PACA, Southeastern Health Regional Observatory , Marseille , France.,IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Aix Marseille Univ , Marseille , France
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86
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Karafillakis E, Simas C, Jarrett C, Verger P, Peretti-Watel P, Dib F, De Angelis S, Takacs J, Ali KA, Pastore Celentano L, Larson H. HPV vaccination in a context of public mistrust and uncertainty: a systematic literature review of determinants of HPV vaccine hesitancy in Europe. Hum Vaccin Immunother 2019; 15:1615-1627. [PMID: 30633623 PMCID: PMC6783136 DOI: 10.1080/21645515.2018.1564436] [Citation(s) in RCA: 142] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 12/03/2018] [Accepted: 12/18/2018] [Indexed: 11/15/2022] Open
Abstract
Europe is increasingly described as the region in the world with the least confidence in vaccination, and particularly in the safety of vaccines. The aim of this systematic literature review was to gather and summarise all peer-reviewed and grey literature published about determinants of Human Papillomavirus (HPV) vaccine hesitancy in Europe. Ten thematic categories were identified across the 103 articles which were included in the review. Participants from European studies most commonly reported issues with the quantity and quality of information available about HPV vaccination; followed by concerns about potential side effects of the vaccine; and mistrust of health authorities, healthcare workers, and new vaccines. Comparative analyses indicated that confidence determinants differed by country and population groups. This evidence supports the need to develop context-specific interventions to improve confidence in HPV vaccination and design community engagement strategies aiming to build public trust.
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Affiliation(s)
- Emilie Karafillakis
- Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Clarissa Simas
- Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Caitlin Jarrett
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- Universität Basel, Basel, Switzerland
| | - Pierre Verger
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
- Aix Marseille Université, UMR_S 912, IRD, Marseille, France
- INSERM, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), GH Cochin Broca Hôtel Dieu, Paris, France
| | - Patrick Peretti-Watel
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
- Aix Marseille Université, UMR_S 912, IRD, Marseille, France
- INSERM, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), GH Cochin Broca Hôtel Dieu, Paris, France
| | - Fadia Dib
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Department of Social Epidemiology, Paris, France
- INSERM CIC 1417, F-CRIN, I-REIVAC, Paris, France
- Assistance Publique Hopitaux de Paris (AP-HP), Hôpital Cochin, CIC Cochin, Pasteur, Paris, France
| | - Stefania De Angelis
- Vaccine Preventable Disease Programme, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Judit Takacs
- Centre for Social Sciences, Hungarian Academy of Sciences, Budapest, Hungary
| | - Karam Adel Ali
- Vaccine Preventable Disease Programme, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Lucia Pastore Celentano
- Vaccine Preventable Disease Programme, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Heidi Larson
- Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
- Department of Global Health, Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
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87
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Verdoux H, Pambrun E, Tournier M, Cortaredona S, Verger P. Trajectories of Antipsychotic Drug Use Over 10 Years in a French Community-Based Sample of Persons Aged 50 and Older. Am J Geriatr Psychiatry 2019; 27:73-83. [PMID: 30442530 DOI: 10.1016/j.jagp.2018.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/10/2018] [Accepted: 09/10/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify the temporal prescribing patterns of antipsychotics among persons aged 50 and older and to explore the demographic and clinical characteristics associated with each trajectory of antipsychotic drug use. METHODS This was a historical fixed cohort study on a community-based sample of persons affiliated with the French Insurance Healthcare system. Data from community drug reimbursement claims were collected by the French Insurance Healthcare system over the period 2006-2015. The study included 160,853 persons aged 50 and older. Trajectories of antipsychotic drug use were identified by examining the distribution of antipsychotic use within consecutive 3-month periods over the entire follow-up period. Latent class analyses were used to identify distinct trajectories. Multivariate polynomial logistic regression models were used to explore the characteristics independently associated with trajectories. RESULTS Five trajectories of antipsychotic use were identified: null or very low use (93.8%), occasional use (2%), decreasing use (1.6%), chronic use (1.5%), and increasing use (1.1%). Occasional users were older and had a lower use of other psychotropic drugs and a high use of health resources. Chronic users had the highest frequency of chronic psychiatric diseases and were less likely to present with dementia or Parkinson disease. Persons with increasing use of antipsychotics were more frequently males and had a high frequency of dementia; half of them died over the follow-up period compared with 20% in the total sample. CONCLUSION Further studies should explore whether the benefit-risk ratio of antipsychotic drugs in older adults differs according to trajectories of use.
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Affiliation(s)
- Hélène Verdoux
- University of Bordeaux (HV, EP, MT), Bordeaux, France; the Institut National de la Santé et de la Recherche Médicale (HV, EP, MT), U1219, F-33000, Bordeaux, France
| | - Elodie Pambrun
- University of Bordeaux (HV, EP, MT), Bordeaux, France; the Institut National de la Santé et de la Recherche Médicale (HV, EP, MT), U1219, F-33000, Bordeaux, France
| | - Marie Tournier
- University of Bordeaux (HV, EP, MT), Bordeaux, France; the Institut National de la Santé et de la Recherche Médicale (HV, EP, MT), U1219, F-33000, Bordeaux, France
| | - Sébastien Cortaredona
- IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection (SC, PV), Aix-Marseille University, Marseille, France
| | - Pierre Verger
- IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection (SC, PV), Aix-Marseille University, Marseille, France; ORS PACA (PV), Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, F-13006, Marseille, France.
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88
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Dubé E, Gagnon D, MacDonald N, Bocquier A, Peretti-Watel P, Verger P. Underlying factors impacting vaccine hesitancy in high income countries: a review of qualitative studies. Expert Rev Vaccines 2018; 17:989-1004. [DOI: 10.1080/14760584.2018.1541406] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Eve Dubé
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, Canada
- Axe maladies infectieuses et immunitaires, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
| | - Dominique Gagnon
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, Canada
| | - Noni MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - Aurélie Bocquier
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Patrick Peretti-Watel
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Pierre Verger
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
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89
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Janah A, Rey D, Bouhnik AD, Mancini J, Sarradon-Eck A, Verger P, Peretti-Watel P, Bendiane MK. Opioid Analgesics Prescription to End-of-Life Cancer Patients: Characteristics, Attitudes, and Practices of French General Practitioners. J Palliat Med 2018; 21:1741-1748. [PMID: 30183469 DOI: 10.1089/jpm.2018.0222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Pain management, especially at the end of life, varies depending on the prescriber's characteristics and attitudes. Little is known about the practices of general practitioners (GPs) regarding end-of-life management for patients with cancer. Objectives: To provide an overview of the characteristics associated with GPs' attitudes and practices regarding opioids prescribing and to explore GPs' perceived role and difficulties in managing end-of-life care for patients with cancer. Design: A cross-sectional study (December 2015 to March 2016). Subjects and Analyses: Data were collected from a representative sample of 376 GPs in southeastern France recruited to participate in a survey on medical practices and opinions regarding cancer patient management. Descriptive analyses and multivariate logistic regressions were conducted to study the characteristics, attitudes, and practices associated with GPs' opioids prescribing attitudes. Results: Almost 97% of GPs stated that they prescribe opioids to end-of-life cancer patients. Among these, 77% said that they prescribe opioids on their own initiative, while 23% declared doing so in coordination with a specialist team. Female GPs, GPs working in solo practices, and GPs reporting more difficulties in managing end-of-life cancer patients were significantly less likely to prescribe opioids on their own initiative. Conclusion: Our results suggest that GPs' characteristics and practices influence the prescribing attitudes at the end of life. Given the dearth of studies on this topic, further research is recommended to better understand the impact of GPs' characteristics on their prescriptive attitudes. The possible interactions between patients' and physicians' characteristics-in particular gender-should also be investigated.
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Affiliation(s)
- Asmaa Janah
- Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), Marseille, France
| | - Dominique Rey
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Anne-Déborah Bouhnik
- Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), Marseille, France
| | - Julien Mancini
- Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), Marseille, France.,BiosTIC, La Timone Hospital, APHM, Marseille, France
| | - Aline Sarradon-Eck
- Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), Marseille, France.,Inst Paoli Calmettes, SESSTIM, Marseille, France
| | - Pierre Verger
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France.,Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | - Patrick Peretti-Watel
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France.,Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | - Marc-Karim Bendiane
- Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, Marseille, France
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Bocquier A, Fressard L, Cortaredona S, Galtier F, Verger P. Trajectories of seasonal influenza vaccination uptake in French people with diabetes from 2006 to 2015. Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.05.401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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91
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Bocquier A, Fressard L, Verger P, Legleye S, Peretti-Watel P. Alcohol and cancer: risk perception and risk denial beliefs among the French general population. Eur J Public Health 2018; 27:705-710. [PMID: 28459975 DOI: 10.1093/eurpub/ckx024] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background Worldwide, millions of deaths each year are attributed to alcohol. We sought to examine French people's beliefs about the risks of alcohol, their correlates, and their associations with alcohol use. Methods Data came from the 2010 Baromètre Cancer survey, a random cross-sectional telephone survey of the French general population (n = 3359 individuals aged 15-75 years). Using principal component analysis of seven beliefs about alcohol risks, we built two scores (one assessing risk denial based on self-confidence and the other risk relativization). Two multiple linear regressions explored these scores' socio-demographic and perceived information level correlates. Multiple logistic regressions tested the associations of these scores with daily drinking and with heavy episodic drinking (HED). Results About 60% of the respondents acknowledged that alcohol increases the risk of cancer, and 89% felt well-informed about the risks of alcohol. Beliefs that may promote risk denial were frequent (e.g. 72% agreed that soda and hamburgers are as bad as alcohol for your health). Both risk denial and risk relativization scores were higher among men, older respondents and those of low socioeconomic status. The probability of daily drinking increased with the risk relativization score and that of HED with both scores. Conclusions Beliefs that can help people to deny the cancer risks due to alcohol use are common in France and may exist in many other countries where alcoholic beverages have been an integral part of the culture. These results can be used to redesign public information campaigns about the risks of alcohol.
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Affiliation(s)
- Aurélie Bocquier
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Economics and Social Sciences Applied to Health & Analysis of Medical Information, Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Lisa Fressard
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Economics and Social Sciences Applied to Health & Analysis of Medical Information, Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Pierre Verger
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Economics and Social Sciences Applied to Health & Analysis of Medical Information, Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Stéphane Legleye
- Institut National d'Études Démographiques (INED), Paris, France.,Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
| | - Patrick Peretti-Watel
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Economics and Social Sciences Applied to Health & Analysis of Medical Information, Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, Marseille, France
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Verger P, Mmadi Mrenda B, Cortaredona S, Tournier M, Verdoux H. Dynamiques temporelles de remboursements de médicaments anxiolytiques chez des nouveaux consommateurs âgés de 50 ans et plus. Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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93
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Mascarène C, Guagliardo V, Verger P, Alcaraz-Mor R, Aydjian A, Bazin I, Bergé-Lefranc C, Catani J, Coulibaly K, Delubac P, Dubois A, François G, Landret C, Leclair I, Martinez L, Milella E, Mocaer S, Piquet P, Viau A. Une offre de formation sur les dispositifs et les acteurs de maintien dans l’emploi aux professionnels de santé de soins la démarche du SISTEPACA. ARCH MAL PROF ENVIRO 2018. [DOI: 10.1016/j.admp.2018.03.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Affiliation(s)
- Jeremy K Ward
- INSERM, IRD, SESSTIM, Economics and Social Sciences Applied to Health & Analysis of Medical Information, Aix Marseille University, Marseille, Provence-Alpes-Côte d'Azur, 13385, France. .,Université Paris-Diderot, CNRS, LIED, Interdisciplinary Laboratory of Tomorrow's Energies, Paris, France
| | - James Colgrove
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Pierre Verger
- INSERM, IRD, SESSTIM, Economics and Social Sciences Applied to Health & Analysis of Medical Information, Aix Marseille University, Marseille, Provence-Alpes-Côte d'Azur, 13385, France.,ORS PACA, Southeastern Health Regional Observatory, Marseille, Provence-Alpes-Côte d'Azur, 13385, France
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95
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Verger P, Mmadi Mrenda B, Cortaredona S, Tournier M, Verdoux H. Trajectory analysis of anxiolytic dispensing over 10 years among new users aged 50 and older. Acta Psychiatr Scand 2018; 137:328-341. [PMID: 29441519 DOI: 10.1111/acps.12858] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To identify temporal trajectories of anxiolytic benzodiazepine (A-BZD) use over 10 years among new A-BZD users aged 50 and older and describe treatment patterns and demographic and clinical characteristics associated with each trajectory. METHOD A representative cohort of the French national health insurance fund users was tracked from 2006 through 2015. We used latent class mixed models to identify the trajectories. RESULTS We observed four trajectories among new users (no A-BZD dispensing in 2005) plus one non-use trajectory. The proportion of occasional use among users was 60%; early increasing use, 10%; late increasing use, 17%; and increasing/decreasing use, 13%. Prevalence of occasional use decreased with age in women, but not men. Duration of treatment episodes and doses differed between trajectories. Multiple regression analyses with occasional use as the reference showed that the other three trajectories shared characteristics (age, coprescriptions of other psychotropic drugs, and more general practitioner consultations) but differed by the presence at inclusion or occurrence during follow-up of psychiatric, neurodegenerative, and somatic conditions. CONCLUSION We found four different long-term temporal trajectories in new A-BZD users (occasional, early increasing, late increasing, and increasing/decreasing use). Difficulties quitting or reducing consumption may be very different for each trajectory, requiring tailored care approaches.
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Affiliation(s)
- P Verger
- IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Aix Marseille Université, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - B Mmadi Mrenda
- IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Aix Marseille Université, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - S Cortaredona
- IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Aix Marseille Université, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - M Tournier
- Pharmacoepidemiology Research Team, UMR 1219, Bordeaux Population Health Research Center, Inserm, University of Bordeaux, Bordeaux, France.,Centre Hospitalier Charles Perrens, Bordeaux, France
| | - H Verdoux
- Pharmacoepidemiology Research Team, UMR 1219, Bordeaux Population Health Research Center, Inserm, University of Bordeaux, Bordeaux, France.,Centre Hospitalier Charles Perrens, Bordeaux, France
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96
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Verger P, Cortaredona S, Jacqmin-Gadda H, Tournier M, Verdoux H. Eight-Year Follow-up of Hypnotic Delivery by Adults Aged 50 and Older from an Insurance Database. Sleep 2018; 40:4102300. [PMID: 28958019 DOI: 10.1093/sleep/zsx147] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Study objectives This study sought to (1) identify patterns of hypnotic use among persons aged 50 and older for 8 years and (2) describe characteristics and correlates associated with them. Methods A representative sample of national health insurance system beneficiaries was followed up from 2006 through 2013; individuals were grouped according to hypnotic delivery trajectories by latent class mixed models. Results We identified four different temporal trajectories of hypnotic delivery among users. Delivery was occasional for 40% and regular for 60% (quasi-continuous "use": 27%; increasingly frequent over time: 17%; decreasingly frequent: 16%). Quasi-continuous "users" received hypnotics for more than 70% of the follow-up period and occasional "users" for less than 8%. We found no clear evidence of dose escalation. The three regular-delivery trajectories shared similar correlates (psychiatric disorders, somatic comorbidity, and coprescriptions of antidepressants or antipsychotics), but association with somatic comorbidity was highest by far for quasi-continuous "users." Conclusions Our results suggest that chronic hypnotic use covers different patterns resulting from different long-term temporal delivery trajectories. Because difficulties in stopping or reducing use may vary greatly according to these trajectories, patients may need individualized management approaches.
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Affiliation(s)
- Pierre Verger
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Sébastien Cortaredona
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Hélène Jacqmin-Gadda
- University of Bordeaux, U1219, F-33000, Bordeaux, France.,INSERM, U1219, F-33000, Bordeaux, France
| | - Marie Tournier
- University of Bordeaux, U657, F-33000, Bordeaux, France.,INSERM, U657, F-33000, Bordeaux, France.,Centre Hospitalier Charles Perrens, F-33000, Bordeaux, France
| | - Hélène Verdoux
- University of Bordeaux, U657, F-33000, Bordeaux, France.,INSERM, U657, F-33000, Bordeaux, France.,Centre Hospitalier Charles Perrens, F-33000, Bordeaux, France
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97
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Raude J, Peretti-Watel P, Ward J, Flamand C, Verger P. Are Perceived Prevalences of Infection also Biased and How? Lessons from Large Epidemics of Mosquito-Borne Diseases in Tropical Regions. Med Decis Making 2018; 38:377-389. [PMID: 29436309 DOI: 10.1177/0272989x17750845] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although people are likely to underestimate the frequencies of risks to health from common diseases and overestimate those from rare diseases, we still do not know much about reasons for this systematic bias, which is also referred to as "primary bias" in the literature. In this study, we take advantage of a series of large epidemics of mosquito-borne diseases to examine the accuracy of judgments of risk frequencies. In this aim, we assessed the perceived v. observed prevalence of infection by Zika, chikungunya or dengue fever during these outbreaks, as well as their variations among different subpopulations and epidemiological settings. METHODS We used data drawn from 4 telephone surveys, conducted between 2006 and 2016, among representative samples of the adult population in tropical regions (Reunion, Martinique, and French Guiana). The participants were asked to estimate the prevalence of these infections by using a natural frequency scale. RESULTS The surveys showed that 1) most people greatly overestimated the prevalence of infection by arbovirus, 2) these risk overestimations fell considerably as the actual prevalence of these diseases increased, 3) the better-educated and male participants consistently yielded less inaccurate risk estimates across epidemics, and 4) these biases in the perception of prevalence of these infectious diseases are relatively well predicted by the probability weighting function developed in the field of behavioral decision making. CONCLUSIONS These findings suggest that the primary bias, which has been found in laboratory experiments to characterize a variety of probabilistic judgments, equally affects perception of prevalence of acute infectious diseases in epidemic settings. They also indicate that numeracy may play a considerable role in people's ability to transform epidemiological observations from their social environment to more accurate risk estimates.
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Affiliation(s)
- Jocelyn Raude
- EHESP Rennes, Université Sorbonne Paris Cité, France.,Aix Marseille University, IRD French Institute of Research for Development, EHESP French School of Public Health, UMR_D 190 Emergence des Pathologies Virales, Marseille, France.,UMR PIMIT, INSERM 1187, CNRS 9192, IRD 249. Plateforme Technologique CYROI, Université de La Réunion, Réunion, France
| | - Patrick Peretti-Watel
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Jeremy Ward
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, Marseille, France.,Université Paris-Diderot, CNRS, LIED, Interdisciplinary Laboratory of Tomorrow's Energies, Paris, France
| | - Claude Flamand
- Institut Pasteur de Guyane, Unité d'Epidémiologie, Cayenne, France
| | - Pierre Verger
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, Marseille, France
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98
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Dumesnil H, Apostolidis T, Verger P. Opinions of general practitioners about psychotherapy and their relationships with mental health professionals in the management of major depression: A qualitative survey. PLoS One 2018; 13:e0190565. [PMID: 29385155 PMCID: PMC5791973 DOI: 10.1371/journal.pone.0190565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 11/23/2017] [Indexed: 11/21/2022] Open
Abstract
Background French general practitioners (GPs) refer their patients with major depression to psychiatrists or for psychotherapy at particularly low rates. Objectives This qualitative study aims to explore general practitioners' (GP) opinions about psychotherapy, their relationships with mental health professionals, their perceptions of their role and that of psychiatrists in treating depression, and the relations between these factors and the GPs' strategies for managing depression. Methods In 2011, in-depth interviews based on a semi-structured interview guide were conducted with 32 GPs practicing in southeastern France. Verbatim transcripts were examined by analyzing their thematic content. Results We identified three profiles of physicians according to their opinions and practices about treatment strategies for depression: pro-pharmacological treatment, pro-psychotherapy and those with mixed practices. Most participants considered their relationships with psychiatrists unsatisfactory, would like more and better collaboration with them and shared the same concept of management in general practice. This concept was based both on the values and principles of practice shared by GPs and on their strong differentiation of their management practices from those of psychiatrists, Conclusion Several attitudes and values common to GPs might contribute to their low rate of referrals for psychotherapy in France: strong occupational identity, substantial variations in GPs' attitudes and practices regarding depression treatment strategies, representations sometimes unfavorable toward psychiatrists. Actions to develop a common culture and improve cooperation between GPs and psychiatrists are essential. They include systems of collaborative care and the development of interdisciplinary training common to GPs and psychiatrists practicing in the same area.
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Affiliation(s)
- Hélène Dumesnil
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | | | - Pierre Verger
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.,Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
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99
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Le Marechal M, Fressard L, Agrinier N, Verger P, Pulcini C. General practitioners' perceptions of vaccination controversies: a French nationwide cross-sectional study. Clin Microbiol Infect 2017; 24:858-864. [PMID: 29104170 DOI: 10.1016/j.cmi.2017.10.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 10/12/2017] [Accepted: 10/28/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVES We aimed to study general practitioners' (GPs') perceptions of vaccines that have been a subject of controversy in France. METHODS A cross-sectional survey in 2014 asked a representative national sample of GPs, randomly selected from the exhaustive database of health professionals in France, about their perceptions of the likelihood of serious adverse events potentially associated with six different vaccines: for two of them the association was based on some scientific evidence, whereas for the other four this is not the case. We performed a cluster analysis to construct a typology of GPs' perceptions about the likelihood of these potential six associations. Factors associated with certain clusters of interest were identified using logistic regression models. RESULTS Overall, 1582 GPs participated in the questionnaire survey (1582/1712 GPs who agreed to participate, 92%). Cluster analysis identified four groups of GPs according to their susceptibility to vaccine controversies: 1) limited susceptibility to controversies (52%); 2) overall unsure, but rejected the association between hepatitis B vaccine and multiple sclerosis (32%); 3) highly susceptible to controversies (11%); and 4) unsure (5%). We found that GPs who occasionally practised alternative medicine (OR 2.71, 95% CI 1.65-4.45), and those who considered information provided by mass media as reliable (OR 2.04, 95% CI 1.65-3.99) were more susceptible to controversies. CONCLUSIONS GPs had different profiles of susceptibility to vaccination controversies, and most of their perceptions of these controversies were not based on scientific evidence.
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Affiliation(s)
- M Le Marechal
- Université de Lorraine, EA 4360 APEMAC, Nancy, France
| | - L Fressard
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France; ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - N Agrinier
- Université de Lorraine, EA 4360 APEMAC, Nancy, France; INSERM, CIC-1433 Epidémiologie clinique, CHRU de Nancy, Nancy, France
| | - P Verger
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France; ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France; INSERM, F-CRIN, I-Reivac (Innovative clinical research network in vaccinology), France
| | - C Pulcini
- Université de Lorraine, EA 4360 APEMAC, Nancy, France; Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France; CHRU de Nancy, Service de Maladies Infectieuses et Tropicales, Nancy, France.
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100
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Le Maréchal M, Fressard L, Raude J, Verger P, Pulcini C. General practitioners and vaccination of children presenting with a benign infection. Med Mal Infect 2017; 48:44-52. [PMID: 29113691 DOI: 10.1016/j.medmal.2017.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 09/28/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To assess the self-reported vaccination behavior of general practitioners (GPs) when asked whether they would recommend the vaccination of a child presenting with a febrile uncomplicated common cold. METHODS We performed a cross-sectional survey in 2014 on a national sample of GPs. GPs were randomly assigned to one of eight clinical vignettes, all describing a child presenting with an uncomplicated febrile common cold, but differing by age (4 or 11 months), temperature (38°C or 39°C), and the mother's emotional state (calm or worried). GPs were asked whether they would recommend immediate vaccination of the child with a hexavalent vaccine (diphtheria, tetanus, pertussis, poliomyelitis, Haemophilus influenzae type b, and hepatitis B), or postpone it. We investigated the relation between the GPs' recommendation to vaccinate, the clinical vignette's variables, and the GPs' perceptions, attitudes, and practices toward vaccination in a multivariate model. RESULTS Among the 1582 participating GPs, 6% recommended immediate vaccination. This behavior was more frequent with a temperature of 38°C rather than 39°C (10% vs. 3%, P<0.001). GPs who felt comfortable giving explanations about vaccine safety were more likely to recommend immediate vaccination of the febrile child (P=0.045), but none of the other GPs' characteristics were associated with their vaccination behavior. CONCLUSIONS Almost all GPs postponed the hexavalent vaccination of the febrile child presenting with an uncomplicated viral disease; fever being the major factor affecting their decision. More research is needed on vaccination responses in sick children, as well as clearer guidelines.
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Affiliation(s)
- M Le Maréchal
- Université de Lorraine, EA 4360 APEMAC, 54000 Nancy, France.
| | - L Fressard
- Aix-Marseille université, UMR_S912, IRD, 13000 Marseille, France; Observatoire régional de la santé Provence-Alpes-Côte d'Azur (ORS PACA), 13000 Marseille, France; Inserm, UMR_S912, « Sciences Économiques & Sociales de la Santé et Traitement de l'Information Médicale » (SESSTIM), 13000 Marseille, France
| | - J Raude
- EHESP-Rennes, Sorbonne-Paris-Cité, 35043 Rennes, France; Aix-Marseille université, EPV-UMR_D 190 « Émergence des Pathologies Virales », 13000 Marseille, France
| | - P Verger
- Aix-Marseille université, UMR_S912, IRD, 13000 Marseille, France; Observatoire régional de la santé Provence-Alpes-Côte d'Azur (ORS PACA), 13000 Marseille, France; Inserm, UMR_S912, « Sciences Économiques & Sociales de la Santé et Traitement de l'Information Médicale » (SESSTIM), 13000 Marseille, France; Inserm, F-CRIN, I-Reivac (Innovative clinical research network in vaccinology), 75654 Paris, France
| | - C Pulcini
- Université de Lorraine, EA 4360 APEMAC, 54000 Nancy, France; Inserm, F-CRIN, I-Reivac (Innovative clinical research network in vaccinology), 75654 Paris, France; Service de maladies infectieuses et tropicales, CHRU de Nancy, 54000 Nancy, France
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