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Cazalis A, Lambert L, Auriacombe M. Stigmatization of people with addiction by health professionals: Current knowledge. A scoping review. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 9:100196. [PMID: 38023342 PMCID: PMC10656222 DOI: 10.1016/j.dadr.2023.100196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023]
Abstract
Background Stigma of people with substance and non-substance use disorders (SNSUD) is a long-known phenomenon. The aim of this review was to assess the stigmatization, by health professionals, of people with SNSUD, its characteristics and change over time. Methods A scoping review of literature reviews was conducted with systematic search of PubMed, Scopus and PsycINFO databases. Results From the 19 selected reviews, all focused on people with SUD (PWSUD) only and 20 % to 51 % of health professionals had negative attitudes/beliefs about SUD. Addiction training and clinical experience with PWSUD were associated with a less negative attitude. Health professionals' negative beliefs, lack of time or support were associated with less involvement in addiction care. Tobacco use disorder, SUDs other than alcohol and tobacco, relapse, psychiatric comorbidity or criminal records were associated with a more negative attitude. The influence of several variables potentially related to stigmatization was inconsistent across selected reviews. The evolution of stigmatization over time was not systematically assessed and showed mixed results. Conclusions The stigmatization of PWSUD has an impact on their care, and a change in some variables could reduce its importance: moral model of addiction, health professionals' negative beliefs, lack of training, time, and role support. Teaching what addiction is according to the medical chronic disease model, and developing stigma-focused training could improve caregivers' attitudes and further reduce stigma. Further studies are needed to determine whether stigma of PWSUD by health professionals has changed over time and to characterize stigma for people with non-substance use disorders.
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Affiliation(s)
- Anthony Cazalis
- University of Bordeaux, Bordeaux, France
- Addiction Team, Sleep, Addiction and Neuropsychiatry, (Sanpsy), Centre National de la Recherche Scientifique (CNRS) Unité mixte de recherche (UMR) 6033, University of Bordeaux, Bordeaux, France
- Pôle interétablissement d'Addictologie, CH Charles Perrens and CHU de Bordeaux, Bordeaux, France
| | - Laura Lambert
- University of Bordeaux, Bordeaux, France
- Addiction Team, Sleep, Addiction and Neuropsychiatry, (Sanpsy), Centre National de la Recherche Scientifique (CNRS) Unité mixte de recherche (UMR) 6033, University of Bordeaux, Bordeaux, France
- Pôle interétablissement d'Addictologie, CH Charles Perrens and CHU de Bordeaux, Bordeaux, France
| | - Marc Auriacombe
- University of Bordeaux, Bordeaux, France
- Addiction Team, Sleep, Addiction and Neuropsychiatry, (Sanpsy), Centre National de la Recherche Scientifique (CNRS) Unité mixte de recherche (UMR) 6033, University of Bordeaux, Bordeaux, France
- Pôle interétablissement d'Addictologie, CH Charles Perrens and CHU de Bordeaux, Bordeaux, France
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Albouy M, Parthenay M, Nogues M, Leyris A, Degorce L, Barthelemy Z, Rafidison D, Gourgues AS, Migeot V, Pylouster J, Dupuis A. A Clinical Preventive Strategy Based on a Digital Tool to Improve Access to Endocrine Disruptors Exposure Prevention: The MEDPREVED Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11993. [PMID: 36231296 PMCID: PMC9565443 DOI: 10.3390/ijerph191911993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
Introduction: The digitalized PREVED (PREgnancy, PreVention, Endocrine Disruptor) questionnaire was used in the clinical practices of health professionals (HP) who adhered to the MEDPREVED strategy. The objectives were to assess the strategy and to determine if it could improve access to endocrine disruptor (ED) exposure prevention. Methods: After having filled in the digital questionnaire in HP waiting rooms, patients were invited to talk about ED exposure during the consultation. HPs were previously trained in ED and had received a prevention kit for their patients. After the seven-month implementation phase, the evaluation phase consisted of five mixed assessments: interviews with: (i) patients who were young children's parents; (ii) patients in the general population; (iii) paediatricians; (iv) midwives; and a quantitative study on GPs. Assessment concerned feasibility, accessibility, and usefulness of the strategy; we then used the Levesque model to evaluate how it could improve access to ED exposure prevention. Results: The study included 69 participants. The strategy appeared feasible for the filling-out step due to digital and environment access. However, it depended on patient and HP profiles. The strategy seemed useful insofar as it facilitated reflexive investment, an intention to healthy behaviour and, rather rarely, talk about ED exposure. The beginning of this discussion depended on time, prioritizing of the topic and HP profile. The strategy has confirmed the Levesque model's limiting factors and levers to access ED prevention. Conclusions: The MEDPREVED strategy is feasible, accessible, and useful in clinical prevention practice. Further study is needed to measure the impact on knowledge, risk perception and behavior of beneficiaries of the MEDPREVED strategy in the medium and long term.
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Affiliation(s)
- Marion Albouy
- Faculty of Medicine and Pharmacy, University of Poitiers, 6 Rue de la Milétrie, 86000 Poitiers, France
- Ecology and Biology of Interaction, CNRS UMR 7267, CEDEX, 86073 Poitiers, France
- INSERM-CIC1402, University Hospital of Poitiers, 2 Rue de la Milétrie, CEDEX, 86021 Poitiers, France
- BioSPharm Pole, University Hospital of Poitiers, 2 Rue de la Milétrie, CEDEX, 86021 Poitiers, France
| | - Maud Parthenay
- Faculty of Medicine and Pharmacy, University of Poitiers, 6 Rue de la Milétrie, 86000 Poitiers, France
| | - Maeva Nogues
- Faculty of Medicine and Pharmacy, University of Poitiers, 6 Rue de la Milétrie, 86000 Poitiers, France
| | - Agathe Leyris
- Faculty of Medicine and Pharmacy, University of Poitiers, 6 Rue de la Milétrie, 86000 Poitiers, France
| | - Léa Degorce
- Faculty of Medicine and Pharmacy, University of Poitiers, 6 Rue de la Milétrie, 86000 Poitiers, France
| | - Zacharie Barthelemy
- Faculty of Medicine and Pharmacy, University of Poitiers, 6 Rue de la Milétrie, 86000 Poitiers, France
| | - Diana Rafidison
- Faculty of Medicine and Pharmacy, University of Poitiers, 6 Rue de la Milétrie, 86000 Poitiers, France
| | - Anne-Sophie Gourgues
- BioSPharm Pole, University Hospital of Poitiers, 2 Rue de la Milétrie, CEDEX, 86021 Poitiers, France
| | - Virginie Migeot
- Faculty of Medicine and Pharmacy, University of Poitiers, 6 Rue de la Milétrie, 86000 Poitiers, France
- Ecology and Biology of Interaction, CNRS UMR 7267, CEDEX, 86073 Poitiers, France
- INSERM-CIC1402, University Hospital of Poitiers, 2 Rue de la Milétrie, CEDEX, 86021 Poitiers, France
- BioSPharm Pole, University Hospital of Poitiers, 2 Rue de la Milétrie, CEDEX, 86021 Poitiers, France
| | - Jean Pylouster
- Research Centre on Cognition and Learning, MSHS, 5 Rue T. Lefebvre, CEDEX, 86073 Poitiers, France
| | - Antoine Dupuis
- Faculty of Medicine and Pharmacy, University of Poitiers, 6 Rue de la Milétrie, 86000 Poitiers, France
- Ecology and Biology of Interaction, CNRS UMR 7267, CEDEX, 86073 Poitiers, France
- INSERM-CIC1402, University Hospital of Poitiers, 2 Rue de la Milétrie, CEDEX, 86021 Poitiers, France
- BioSPharm Pole, University Hospital of Poitiers, 2 Rue de la Milétrie, CEDEX, 86021 Poitiers, France
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En quoi la pandémie Covid-19 a-t-elle mis en question le pouvoir médical ? ÉTHIQUE & SANTÉ 2022; 19:31-38. [PMID: 34721675 PMCID: PMC8542456 DOI: 10.1016/j.etiqe.2021.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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4
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Besson A, Tarpin A, Flaudias V, Brousse G, Laporte C, Benson A, Navel V, Bouillon-Minois JB, Dutheil F. Smoking Prevalence among Physicians: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413328. [PMID: 34948936 PMCID: PMC8705497 DOI: 10.3390/ijerph182413328] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Smoking is a major public health problem. Although physicians have a key role in the fight against smoking, some of them are still smoking. Thus, we aimed to conduct a systematic review and meta-analysis on the prevalence of smoking among physicians. METHODS PubMed, Cochrane, and Embase databases were searched. The prevalence of smoking among physicians was estimated and stratified, where possible, by specialties, continents, and periods of time. Then, meta-regressions were performed regarding putative influencing factors such as age and sex. RESULTS Among 246 studies and 497,081 physicians, the smoking prevalence among physicians was 21% (95CI 20 to 23%). Prevalence of smoking was 25% in medical students, 24% in family practitioners, 18% in surgical specialties, 17% in psychiatrists, 16% in medical specialties, 11% in anesthesiologists, 9% in radiologists, and 8% in pediatricians. Physicians in Europe and Asia had a higher smoking prevalence than in Oceania. The smoking prevalence among physicians has decreased over time. Male physicians had a higher smoking prevalence. Age did not influence smoking prevalence. CONCLUSION Prevalence of smoking among physicians is high, around 21%. Family practitioners and medical students have the highest percentage of smokers. All physicians should benefit from targeted preventive strategies.
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Affiliation(s)
- Anaïs Besson
- Family Medicine, University Hospital of Clermont-Ferrand, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France; (A.B.); (A.T.)
| | - Alice Tarpin
- Family Medicine, University Hospital of Clermont-Ferrand, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France; (A.B.); (A.T.)
| | - Valentin Flaudias
- Univ Angers, Laboratoire de psychologie des Pays de la Loire, Université de Nantes, LPPL, EA 4638, F-44000 Nantes, France;
| | - Georges Brousse
- Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, Université Clermont Auvergne, F-63000 Clermont–Ferrand, France; (G.B.); (C.L.)
| | - Catherine Laporte
- Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, Université Clermont Auvergne, F-63000 Clermont–Ferrand, France; (G.B.); (C.L.)
| | - Amanda Benson
- Sport Innovation Research Group, Department of Health and Biostatistics, Swinburne University of Technology, Melbourne, VIC 3122, Australia;
| | - Valentin Navel
- CNRS, INSERM, GReD, Translational Approach to Epithelial Injury and Repair, CHU Clermont-Ferrand, Ophthalmology, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France;
| | - Jean-Baptiste Bouillon-Minois
- CNRS, LaPSCo, Physiological and Psychosocial Stress, University Hospital of Clermont-Ferrand, Emergency Medicine, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
- Correspondence: ; Tel.: +33-6-74-36-04-23; Fax: +33-4-73-27-46-49
| | - Frédéric Dutheil
- CNRS, LaPSCo, Physiological and Psychosocial Stress, University Hospital of Clermont-Ferrand, Occupational and Environmental Medicine, Université Clermont Auvergne, WittyFit, F-63000 Clermont-Ferrand, France;
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Peiffer G, Underner M, Perriot J, Ruppert AM, Tiotiu A. [Smoking cessation and lung cancer screening]. Rev Mal Respir 2020; 37:722-734. [PMID: 33129612 DOI: 10.1016/j.rmr.2020.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/03/2020] [Indexed: 02/08/2023]
Abstract
Several studies have shown that lung cancer screening, using annual low-dose computed tomography (CT) scan in a targeted population of smokers and ex-smokers reduces overall and lung cancer specific mortality rates. This form of screening strategy is not currently established for use in France by the French High Authority for Health. Quitting smoking is the most important measure in reducing mortality from lung cancer. The maximum benefit in reducing mortality from lung cancer should be seen through an effective combination of smoking cessation intervention and chest CT screening to identify early, curable disease. However, current data to guide clinicians in the choice of smoking cessation interventions in this specific context are limited due to the small number of randomized studies that have been carried out. The optimal approach to smoking cessation during lung cancer screening needs to be clarified by new studies comparing different motivation strategies, establishing the ideal moment to propose stopping smoking and the most effective therapies to use.
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Affiliation(s)
- G Peiffer
- Service de pneumologie, CHR de Metz-Thionville, 1, allée du Château, 57085 Metz, France.
| | - M Underner
- Unité de recherche clinique, centre hospitalier Henri-Laborit, université de Poitiers, 86021 Poitiers, France
| | - J Perriot
- CLAT 63, dispensaire Emile-Roux, centre de tabacologie, 63100 Clermont-Ferrand, France
| | - A-M Ruppert
- Unité de tabacologie, service de pneumologie, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75970 Paris cedex 20, France
| | - A Tiotiu
- Département de pneumologie, CHRU de Nancy, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
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Leleu O, Vincent G, Auquier M, Basille D, Clarot C, Hoguet E, Pétigny V, Duban P, Zerkly S, Ganry O, Chauffert B, Berna P, Jounieaux V. Predictive factors for the participation of general practitioners in lung cancer screening by low-dose CT scan in the Somme department in northern France. Respir Med Res 2020; 77:95-99. [PMID: 32512523 DOI: 10.1016/j.resmer.2020.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 12/24/2019] [Accepted: 01/02/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION A study on lung cancer screening using low-dose computed tomography (DEP KP80) was conducted in the Somme department in northern France between May 2016 and December 2018. We conducted a cross-sectional survey of family physicians in that department to identify potential predictive factors for their participation in this pilot study. METHODS A survey questionnaire was sent to the 545 general practitioners (GPs) of the Somme department. This survey rendered it possible to identify the investigators who were active in the DEP KP80 study. The questionnaire's content was focused on the socio-demographic conditions of GPs, their professional practices, and their medical practice situations. RESULTS The response rate was 38% (206 completed questionnaires). Active investigators in DEP KP80 accounted for 55% (n=113) of the GPs surveyed, and non-investigators for 45% (n=93). Age, gender, or medical practice situation were not related to the active GPs' participation in DEP KP80. A multivariate analysis revealed that two factors were correlated with active participation in organized screening: (1) prescription of nicotine replacement therapy; (2) smoking history of the GP. CONCLUSIONS Securing the active involvement of family physicians and of the French regional cancer screening coordination centers seems essential for the future organization of lung cancer screening on a regional or national level. Our results demonstrate that incorporating smoking cessation support structures into the program would maximize the mechanism's potential.
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Affiliation(s)
- O Leleu
- Department of Pulmonology and Thoracic Oncology, Abbeville Hospital Center, Abbeville, France.
| | - G Vincent
- Maison Médicale, Bray-sur-Somme, France
| | - M Auquier
- Department of Radiology, CHU Amiens, Amiens, France
| | - D Basille
- Department of Pulmonology, CHU Amiens, Amiens, France
| | - C Clarot
- Department of Pulmonology and Thoracic Oncology, Abbeville Hospital Center, Abbeville, France
| | - E Hoguet
- Department of Pulmonology and Thoracic Oncology, Abbeville Hospital Center, Abbeville, France
| | | | - P Duban
- Maison Médicale, Bray-sur-Somme, France
| | - S Zerkly
- Department of Hospital Epidemiology, CHU Amiens, Amiens, France
| | - O Ganry
- Department of Hospital Epidemiology, CHU Amiens, Amiens, France
| | - B Chauffert
- Department of Medical Oncology, CHU Amiens, Amiens, France
| | - P Berna
- Department of Thoracic Surgery, CHU Amiens, Amiens, France
| | - V Jounieaux
- Department of Pulmonology, CHU Amiens, Amiens, France
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7
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[Smoking cessation: A challenge for cardiologists and pulmonologists]. Rev Mal Respir 2019; 36:527-537. [PMID: 31006577 DOI: 10.1016/j.rmr.2018.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 03/18/2018] [Indexed: 12/23/2022]
Abstract
In addition to public health measures that need to be strongly supported politically, smoking is also a major medical issue. Tobacco dependence is a chronic disease, and, given its extremely addictive nature, treatment for tobacco dependence must be addressed actively by all health professionals. Because smoking is a major contributor to many of the pathologies their specialties address, cardiologists and pulmonologists must be at the forefront of this care. In this review we analyse the current state of smoking cessation treatment and its inadequacies, the limiting impact that doctors' own smoking has, as well as the misconceptions held by smokers and sometimes by doctors as well, which act as brakes on smoking cessation. Smoking cessation must become a treatment delivered in real clinical practice and any doctor must know how to manage it fluently. Do not be satisfied with simply advising smokers to quit. Learn how to approach the subject with smokers effectively, know how the various pharmacotherapies are used and know how to organize smoking cessation follow-up, an essential guarantee of success. If optimal management of this major pathological factor is a role for all doctors, it is of course especially so for our two specialties. It's up to us, cardiologists and pulmonologists, to take up this challenge.
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Peiffer G, Underner M, Perriot J. [COPD and smoking cessation: Patients' expectations and responses of health professionals]. REVUE DE PNEUMOLOGIE CLINIQUE 2018; 74:375-390. [PMID: 30455124 DOI: 10.1016/j.pneumo.2018.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The importance of smoking cessation in the management of COPD is well-established: the benefit of quitting smoking as regards morbidity and mortality outcomes in patients, is unquestioned. The smoking cessation in COPD patients is difficult: high levels of consumption, the duration of smoking, high dependence level, psychological co-morbidities such as anxiety and depression, lower socio-economic and intellectual level, constitute barriers. Studies have shown that patients often minimize the risks of smoking, that others do not believe in the benefits of quitting or doubt their ability to quit smoking. The patients' experience, and expectations with regard to smoking cessation are incompletely satisfied: are considered, the smoking characteristics of these patients, the understanding of the tobacco dependence, the beliefs and ideas of smokers, the knowledge of smoking cessation methods, the role of validated aids and alternative treatments, failure management. The answers of the health professionals can be in several directions: establishment of a better communication patient-doctor (empathy), more centered on the needs of the smoker, the role of the motivation and the place of the motivational interview, the understanding of the mechanisms of addiction, a better individualisation of therapeutics, the necessity of a extended follow-up, the contribution of modern technologies, the electronic cigarette, the smoking cessation in respiratory rehabilitation, guidelines that address smoking cessation treatment.
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Affiliation(s)
- G Peiffer
- Service de pneumologie, hôpital de Mercy, CHR Metz-Thionville, 57038 Metz, France.
| | - M Underner
- Centre hospitalier Henri Laborit, unité de recherche clinique, 86000 Poitiers, France
| | - J Perriot
- Dispensaire Emile Roux - CLAT 63, 11, rue Vaucanson, 63100 Clermont-Ferrand, France
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9
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The practices of French general practitioners regarding screening and counselling pregnant women for tobacco smoking and alcohol drinking. Int J Public Health 2018; 63:631-640. [PMID: 29679105 DOI: 10.1007/s00038-018-1103-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 03/02/2018] [Accepted: 04/06/2018] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVES Our study aims to describe French general practitioners' (GPs') practices toward pregnant patients regarding alcohol consumption and smoking and to highlight factors associated with specific practices. METHODS In 2015, a representative sample of 1414 French GPs completed a telephone survey based on a stratified random sampling. RESULTS 61% of GPs declared screening for alcohol use and 82% for smoking at least once with each pregnant patient; quitting was not systematically advised either for alcohol or for smoking. GPs' practices were significantly better among those who had more recent ongoing training. GPs who drank regularly were less likely to screen for alcohol use and GPs' drinking frequency was inversely related to recommending quitting. Current and former smokers were less likely to recommend quitting to pregnant patients smoking over five cigarettes per day. CONCLUSIONS Screening and counselling practices for substance use during pregnancy are heterogeneous among French GPs and are notably related to their personal consumption. GP's role in preventing substance use during pregnancy could be strengthened by actions regarding their own consumption and by modifications in their initial and ongoing training.
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Daix A, Bakayoko-Yéo A, Koné Z, Samaké K, Coulibaly G, Touhon O, Domoua K. Connaissances et attitudes des médecins ivoiriens vis-à-vis du tabagisme chez les patients atteints de tuberculose. Rev Mal Respir 2015; 32:513-8. [DOI: 10.1016/j.rmr.2014.04.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 04/21/2014] [Indexed: 10/24/2022]
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Merson F, Perriot J, Underner M, Peiffer G, Fieulaine N. [Smoking cessation and social deprivation]. Rev Mal Respir 2014; 31:916-36. [PMID: 25496789 DOI: 10.1016/j.rmr.2013.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 12/28/2013] [Indexed: 02/05/2023]
Abstract
Smoking is a major of public health policy issue; one in two lifelong smokers will die from a disease related to tobacco use. In France, smoking is responsible for more than 70,000 deaths every year. The benefits linked to stopping smoking include reduced mortality and morbidity related to the use of tobacco. Recent data show an increase in the prevalence of smoking in the lowest socioeconomic population. Tobacco control needs a better understanding of the determinants of smoking in this population, which are also factors in the failure of cessation attempts. Based on international literature, this review specifies the educational and socioeconomic factors involved in tobacco smoking and in the result of an attempt to quit. Its aim is to propose ways to improve the management of smoking cessation in a socially deprived population.
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Affiliation(s)
- F Merson
- Dispensaire Emile-Roux, centre d'aide à l'arrêt du tabagisme, centre de lutte antituberculeuse (CLAT 63), 11, rue Vaucanson, 63100 Clermont-Ferrand, France; Laboratoire GRePS, institut de psychologie, université de Lyon-2, 69676 Bron, France.
| | - J Perriot
- Dispensaire Emile-Roux, centre d'aide à l'arrêt du tabagisme, centre de lutte antituberculeuse (CLAT 63), 11, rue Vaucanson, 63100 Clermont-Ferrand, France
| | - M Underner
- Service de pneumologie, unité de tabacologie, centre de lutte antituberculeuse (CLAT 86), CHU de Poitiers, 86021 Poitiers, France
| | - G Peiffer
- Service de pneumologie, unité de tabacologie, CHR de Metz-Thionville, 57038 Metz, France
| | - N Fieulaine
- Laboratoire GRePS, institut de psychologie, université de Lyon-2, 69676 Bron, France
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12
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[Hospitalization: an important opportunity to treat addiction to tobacco smoke]. Rev Mal Respir 2012; 29:851-2. [PMID: 22980543 DOI: 10.1016/j.rmr.2012.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 05/23/2012] [Indexed: 11/23/2022]
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13
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Diagnosis Management of Obesity: A Survey of General Practitioners' Awareness of Familiarity with the 2006 Canadian Clinical Practice Guidelines. Can J Diabetes 2011. [DOI: 10.1016/s1499-2671(11)53010-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Meshefedjian GA, Gervais A, Tremblay M, Villeneuve D, O'Loughlin J. Physician smoking status may influence cessation counseling practices. Canadian Journal of Public Health 2010. [PMID: 21033533 DOI: 10.1007/bf03405288] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Smoking cessation counseling practices may differ between physicians who smoke and those who have quit or never smoked. METHOD Of 917 general practitioners (GP) in Montreal mailed self-report questionnaires in 2000 and 2004, 610 provided data on their smoking status and counseling practices. RESULTS Seven percent were current smokers, 32% were former smokers, and 61% were never-smokers. Current smokers were more interested than never- or former smokers in learning about counseling methods (64%, 56%, 45%, respectively; p = 0.018). In multivariable analyses, current smokers were less likely than never-smokers to ascertain the smoking status of their patients (OR 0.6, 95% CI 0.2-1.6); to provide advice on how to quit (OR 0.6, 0.3-1.3); and to provide complete cessation counseling coverage (OR 0.5, 0.2-1.1). Former smokers were more likely to provide adjunct support (OR 1.5, 1.0-2.4). CONCLUSION GP smoking status was associated with the content of their cessation interventions with patients who smoke. Taking physician smoking status into consideration in the design of cessation training programs may improve cessation counseling interventions.
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Affiliation(s)
- Garbis A Meshefedjian
- Agence de la santé et des services sociaux de Montréal, Direction de sante publique, Montréal, QC.
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De Col P, Baron C, Guillaumin C, Bouquet E, Fanello S. [Influence of smoking among family physicians on their practice of giving minimal smoking cessation advice in 2008. A survey of 332 general practitioners in Maine-et-Loire]. Rev Mal Respir 2010; 27:431-40. [PMID: 20569875 DOI: 10.1016/j.rmr.2010.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Accepted: 08/24/2009] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Smoking among doctors would be an obstacle to effective smoking prevention, in particular the practice of minimal advice. OBJECTIVES To assess the smoking habits of general practitioners (GPs) in the department of Maine-et-Loire and to study the link between their smoking status and their practice of minimal smoking cessation advice in 2008 in a legislative context unfavourable to smokers. METHODS Three hundred and thirty-two GPs in the department of Maine-et-Loire answered a survey (response rate: 60%) investigating their own smoking habits and how they approach patients who smoke. RESULTS The prevalence of active smoking among general practitioners responders was 18%, 34% were former smokers and 47% had never smoked. Regular smokers (10%) smoked on average 14 cigarettes a day and 51% were nicotine dependent (9% strongly). When consulting, 32% of doctors systematically addressed smoking habits, 20% said that they gave minimal smoking cessation advice regardless of their smoking status. Doctors who smoked were less prone to ask their patients if they smoke (p=0.002) and they believed that their smoking does not influence their practice of giving minimal smoking advice. Moreover, the incentive and coercive measures introduced in 2006 had no influence on the smoking status of physicians, but allowed them to speak more frequently about smoking to their patients. CONCLUSION Minimal smoking cessation advice is applied systematically by only 20% of physicians regardless of their smoking status. Non-systematic smoking cessation advice benefited from the measures introduced in 2006.
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Affiliation(s)
- P De Col
- UFR de médecine, département de médecine générale, 4, rue Larrey, 49045 Angers cedex 1, France
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Sejourne C, Parot-Schinckel E, Rouquette A, Pare F, Delcroix M, Fanello S. [Impact of exhaled CO measurement. A randomised study among 578 smoking patients in general practice]. Rev Mal Respir 2010; 27:213-8. [PMID: 20359612 DOI: 10.1016/j.rmr.2010.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 08/24/2009] [Indexed: 11/17/2022]
Abstract
UNLABELLED Nicotine addiction (NA) is a serious public health problem and helping patients to stop consumption is a major concern for general practitioners (GP). The positive effects of "brief advice" are well known. The aim of our paper is to evaluate the effectiveness of adding exhaled carbon monoxide (CO) measurement using a CO analyser to a normal smoking cessation practice in a GP's office. METHODS This was a descriptive study, using a questionnaire, among randomised smoking patients; one group receiving brief advice and the other brief advice plus exhaled CO analysis in their GP's office. RESULTS Five hundred and seventy-eight questionnaires were analysed: 60% of smoking patients wished to stop smoking and 72% within the next 6 months, without significant difference between the two groups. In the group "minimal advice plus CO analyser" (282), 60% of the smokers reported that they had been influenced by the results of the level of CO in the exhaled air and were more motivated to quit because of this. CONCLUSION Measuring the level of exhaled CO in smokers helps to inform them of the dangers of their addiction and helps to motivate them to quit.
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Affiliation(s)
- C Sejourne
- Département universitaire de santé publique, CHU d'Angers, 49933 Angers cedex 9, France
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Gokirmak M, Ozturk O, Bircan A, Akkaya A. The attitude toward tobacco dependence and barriers to discussing smoking cessation: a survey among Turkish general practitioners. Int J Public Health 2009; 55:177-83. [PMID: 20013142 DOI: 10.1007/s00038-009-0109-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Revised: 09/04/2009] [Accepted: 09/10/2009] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES To evaluate the general attitude of a sample of Turkish general practitioners (GPs) toward tobacco dependence and to assess their knowledge and behavior regarding smoking cessation (SC). METHODS A self-administered questionnaire modified from WHO, Global Health Professional Survey was distributed to GPs, working in our district, Isparta. RESULTS As much as 41% of GPs were current smokers. Ever smokers were generally less likely to agree with statements that would change their freedom to smoke in certain places. While 46% of GPs frequently inquired about tobacco use in their patients, 13.5% did not advise any of their patients to quit smoking during the month preceding the questionnaire. The most common barriers reported by GPs to discussing SC with their patients were as follows: considering the discussion not to be effective (57.8%), having low confidence in knowledge (48.1%), having unpleasant personal experience or considering it a thankless task (46.1%). CONCLUSIONS It appears essential to reduce the number of GPs who smoke and to improve GP training on SC procedures for integrating SC treatment into primary care in Turkey.
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Affiliation(s)
- Munire Gokirmak
- Department of Pulmonary Diseases, Research and Practice Hospital, Suleyman Demirel University, 32260 Isparta, Turkey.
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Serious psychological distress among adults with and without disabilities. Int J Public Health 2009; 54 Suppl 1:52-60. [PMID: 19363587 DOI: 10.1007/s00038-009-0077-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES Our objective was to examine the extent to which serious psychological distress (SPD) is associated with behavioral and social correlates among US adults with self-reported disabilities. METHODS Self-reported data on disability, SPD, and behavioral and social correlates were collected from 202,383 participants (aged > or = 18 years) of the 2007 Behavioral Risk Factor Surveillance System. Adults with self-reported disabilities were identified using two standardized questions--one relating to activity limitation, the other to special equipment. RESULTS The age-adjusted prevalence of SPD among adults with disabilities was nearly seven times higher than among adults without disabilities (14.1 % vs. 1.8 %, respectively). Adults with disabilities who have both activity limitations and who use assistive technology, and those with activity limitations only consistently experienced a higher prevalence of SPD than those who used assistive technology only (age-adjusted prevalence: 21.0 % and 12.7 % vs. 4.9 %). After adjusting for age, sex, race/ethnicity, educational attainment, marital status, and employment status, in the past 30 days SPD was more common among Hispanic persons, and was significantly associated with younger age, lower educational attainment, marital history, and employment status. Adults with SPD and disabilities experienced increased levels of risk behaviors, life dissatisfaction, and inadequate social support. Most importantly, just over half of adults with disabilities and SPD (51.6 % [95 % CI = 48.6-54.6]) were receiving medical care for a mental health condition compared to 20.6 % (95 % CI = 19.9-21.3) without SPD. CONCLUSIONS Given that SPD is strongly associated with both the behavioral and psychosocial determinants of health, this work underscores the need for evidence-based interventions that may reduce its prevalence among people living with disabilities.
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Assessing smoking behaviour among medical students by the measurement of expired carbon monoxide (CO). Wien Med Wochenschr 2009; 159:14-6. [PMID: 19225730 DOI: 10.1007/s10354-008-0635-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Accepted: 07/03/2008] [Indexed: 10/21/2022]
Abstract
Smoking behaviour and prevalence rates among medical students and medical professionals are important public health issues, as physicians' attitudes and interventions are decisive for the patients' success in quitting smoking. Studies dealing with prevalence rates of smoking usually use only face-to-face interviews or self-administered questionnaires, which may induce vague findings. Additional measurement of exhaled carbon monoxide is an objective, easy, immediate, non-invasive and inexpensive mode of indicating smoking behaviour and will complement and at some stage replace the usual question regarding the number of cigarettes consumed. CO-measurement of 260 medical students was taken during compulsory public health training at the Medical University Vienna. Definite indication of active smoking was found in 12% of the students, 9.5% showed CO-levels between 6 and 10 ppm and 78% were definitely non-smokers with a CO level between 0 and 5 ppm. The students had the opportunity to get to know an important diagnostic technique and additionally learned about their own smoking habits.
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Amara B, El Ghazi K, Rahimi H, Elbiaze M, Nejjari C, Chakib Benjelloun M. Attitudes et connaissances des pneumo-phtisiologues marocains vis-à-vis du tabagisme chez leurs patients tuberculeux. Rev Mal Respir 2008; 25:569-75. [DOI: 10.1016/s0761-8425(08)71614-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Vergnon J, Denis-Vatant C. Influence du tabagisme des médecins généralistes sur la prise en charge du tabagisme de leurs patients. Rev Mal Respir 2007; 24:1157-8. [DOI: 10.1016/s0761-8425(07)74270-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Blanchon T, Bréchot JM, Grenier PA, Ferretti GR, Lemarié E, Milleron B, Chagué D, Laurent F, Martinet Y, Beigelman-Aubry C, Blanchon F, Revel MP, Friard S, Rémy-Jardin M, Vasile M, Santelmo N, Lecalier A, Lefébure P, Moro-Sibilot D, Breton JL, Carette MF, Brambilla C, Fournel F, Kieffer A, Frija G, Flahault A. Baseline results of the Depiscan study: A French randomized pilot trial of lung cancer screening comparing low dose CT scan (LDCT) and chest X-ray (CXR). Lung Cancer 2007; 58:50-8. [PMID: 17624475 DOI: 10.1016/j.lungcan.2007.05.009] [Citation(s) in RCA: 195] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2007] [Revised: 05/11/2007] [Accepted: 05/17/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Lung cancer has the highest mortality-rate per cancer, with an overall 5-year survival <15%. Several non-randomized studies pointed out the high sensitivity of low dose computed tomography (LDCT) to detect early stage lung cancer. In France, Depiscan, a pilot RCT of LDCT versus chest X-ray (CXR), started on October 2002 to determine the feasibility of enrollment by general practitioners (GPs), investigations and diagnostic procedures by university hospital radiologists and multidisciplinary teams, data management by centralized clinical research assistants, and anticipate the future management of a large national trial. METHODS GPs and occupational physicians (OPs) selected and enrolled 1000 subjects in 1 year. Eligible subjects were asymptomatic males or females aged 50-75 years with a current or former cigarette smoking history of >/=15 cigarettes per day for at least 20 years (former smokers having quit <15 years prior to enrollment). Based to randomization, annual LDCT or CXR screenings were planned at baseline and annually for 2 years. RESULTS Between October 2002 and December 2004, 765 subjects were enrolled by 89 out of the 232 participating GPs and OPs. Complete clinical and imaging baseline data were available for 621 individuals out of the 765 enrolled, due to 144 noncompliant subjects who withdrew their consent. At least one nodule was detected in 152 out of 336 subjects (45.2%) in the LDCT screening, versus 21 out of 285 subjects (7.4%) in the CXR screening arm. Eight lung cancers were detected in the LDCT arm and one in the CXR arm. DISCUSSION This pilot trial allows estimating that non-calcified nodules are 10 [6.36-17.07] times more often detected from LDCT than from CXR. However enrollment by GPs was more difficult than expected with 41% active investigators and a high rate (19%) of noncompliant patients. This experience speaks to the need for a high level of GPs formation and a large, coordinated clinical research team in such a trial. TRIAL REGISTRATION NUMBER 02526.
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Meurice J, Roche N. « La Revue des Maladies Respiratoires : l’aventure continue ». Rev Mal Respir 2007. [DOI: 10.1016/s0761-8425(07)91006-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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