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Chyderiotis S, Sicsic J, Gagneux-Brunon A, Raude J, Barret AS, Bruel S, Gauchet A, Le Duc Banaszuk AS, Michel M, Giraudeau B, Thilly N, Mueller JE. Optimizing Communication on HPV Vaccination to Parents of 11- to 14-Year-Old Adolescents in France: A Discrete Choice Experiment. Patient 2024:10.1007/s40271-024-00687-6. [PMID: 38693318 DOI: 10.1007/s40271-024-00687-6] [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] [Subscribe] [Scholar Register] [Accepted: 03/03/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND With the aim to optimize communication during HPV vaccination campaigns in France, we elicited parental preferences around HPV vaccination. METHODS We conducted a single-profile discrete choice experiment (DCE) among parents of 11- to 14-year-old middle-school pupils, who completed an anonymous, self-administered, internet-based questionnaire during 2020-2021. The DCE comprised five attributes (vaccine-preventable disease, justification of optimal age, information on safety, indirect protection and coverage) of vaccination against an unnamed disease that were presented to respondents in ten choice tasks, or scenarios. We use fixed effect logit models to estimate attribute weights on theoretical vaccine acceptance, and random effect linear regression to estimate attribute coefficients on vaccine eagerness (decision and decision certainty). We estimated marginal effects of attributes on expected vaccine acceptance. RESULTS Vaccination scenarios were accepted by 55.6-89.2% of the 1291 participants. The largest marginal effects on expected vaccine acceptance in the full sample arose from prevention of cancer versus genital warts (+ 11.3 percentage points); from a "severe side effect suspicion that was not scientifically confirmed" versus a statement about "more benefits than risks" (+ 8.9 percentage points), and information on 80% vaccine coverage in neighbouring countries versus on "insufficient coverage" (+ 4.2 percentage points). Explaining the early age of vaccination by sexual debut had a strong negative impact among French monolingual parents with lower education level (vs age-independent, OR 0.48, 95% CI 0.27-0.86), but not other socio-economic groups. After removing low-quality responses (unvaried certainty and short questionnaire completion), among serial non-demanders with children not vaccinated against HPV, only disease elimination impacted vaccine eagerness positively (coefficient 0.54, 0.06-1.02). DISCUSSION Using DCEs to elicit parents' preferences around communication messages, notably on cancer prevention, vaccine coverage and information about vaccine safety, could help to optimize HPV vaccination promotion efforts.
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Affiliation(s)
- Sandra Chyderiotis
- Institut Pasteur, Université Paris Cité, Emerging Disease Epidemiology Unit, 75015, Paris, France
| | | | - Amandine Gagneux-Brunon
- CHU de Saint-Etienne-Service d'Infectiologie, Saint-Etienne, France
- Centre International de Recherche en Infectiologie, Team GIMAP, Université de Lyon, Université Jean Monnet, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530, Lyon, France
- CIC-Inserm, 1408, CHU de Saint-Etienne, Saint-Etienne, France
| | - Jocelyn Raude
- Univ. Rennes, EHESP, CNRS, Inserm, Arènes-UMR 6051, RSMS (Recherche sur les Services et Management en Santé)-U1309, 35000, Rennes, France
| | | | - Sébastien Bruel
- Department of General Practice, Jacques Lisfranc Faculty of Medicine, Saint-Etienne-Lyon University, Saint-Etienne, France
- Health, Systemic, Process. UR 4129 Research Unit, University Claude Bernard, University of Lyon, Lyon, France
| | - Aurélie Gauchet
- Université Savoie Mont Blanc, Univ. Grenoble Alpes, LIP/PC2S, 73000, Chambéry, France
| | - Anne-Sophie Le Duc Banaszuk
- Centre Régional de Coordination des Dépistages des cancers-Pays de la Loire, 5 Rue des Basses Fouassières, 49000, Angers, France
| | - Morgane Michel
- Université Paris Cité, ECEVE, UMR 1123, Inserm, 75010, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Unité d'épidémiologie clinique, 75019, Paris, France
| | - Bruno Giraudeau
- Université de Tours, Université de Nantes, INSERM, SPHERE U1246, INSERM CIC 1415, CHRU de Tours, Tours, France
| | - Nathalie Thilly
- Université de Lorraine, APEMAC, 54500, Nancy, France
- Département Méthodologie, Promotion, Investigation, Université de Lorraine, CHRU-Nancy, 54500, Nancy, France
| | - Judith E Mueller
- Institut Pasteur, Université Paris Cité, Emerging Disease Epidemiology Unit, 75015, Paris, France.
- Univ. Rennes, EHESP, CNRS, Inserm, Arènes-UMR 6051, RSMS (Recherche sur les Services et Management en Santé)-U1309, 35000, Rennes, France.
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Lièvre G, Sicsic J, Galmiche S, Charmet T, Fontanet A, Mueller JE. Are the 7C psychological antecedents associated with COVID-19 vaccine behaviours beyond intentions? A cross-sectional study on at-least-one-dose and up-to-date vaccination status, and uptake speed among adults in France. Vaccine 2024:S0264-410X(24)00438-9. [PMID: 38643038 DOI: 10.1016/j.vaccine.2024.04.024] [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] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 03/27/2024] [Accepted: 04/04/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Widely documented psychological antecedents of vaccination are confidence in vaccines, complacency, convenience, calculation, collective responsibility (5C model) with the recent addition of confidence in the wider system and social conformism. While the capacity of these seven antecedents (7C) to explain variance in COVID-19 vaccine intentions has been previously documented, we study whether these factors also are associated with vaccine behaviours, beyond intentions. METHODS From February to June 2022, we recruited a sample of adults in France, including persons with notified recent SARS-CoV-2 infection, along with relatives and randomly selected non-infected persons. Participants completed self-administered questionnaires assessing COVID-19 vaccination history and the 7C antecedents. We defined vaccination behaviours as three outcomes: at-least-one-dose vaccine status by 2022 (N = 49,019), up-to-date vaccination status (N = 46,566), and uptake speed of first dose (N = 25,998). We conducted multivariable logistic regressions and Cox models. RESULTS Among the 49,019 participants, 95.0% reported receipt of at least one dose and 89.8% were up to date with recommendations. All 7C antecedents were significantly associated with the outcomes, although effects were weaker for up-to-date vaccination status and uptake speed. The strongest effects (most vs. least vaccine-favourable attitude level, at-least-one-dose vaccination status) were observed for collective responsibility (OR: 14.44; 95%CI: 10.72-19.45), calculation (OR: 10.29; 95%CI: 7.53-14.05), and confidence in the wider system (OR: 8.94; 95%CI: 6.51-12.27). CONCLUSION This study demonstrates that the 7C not only explain vaccine intention, but also vaccine behaviours, and underpins the importance of developing vaccine promotion strategies considering the 7C antecedents.
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Affiliation(s)
- Gaëlle Lièvre
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Université Paris Cité, Paris, France; Sorbonne Université, Ecole Doctorale Pierre Louis de Santé Publique, Paris, France
| | | | - Simon Galmiche
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Université Paris Cité, Paris, France; Sorbonne Université, Ecole Doctorale Pierre Louis de Santé Publique, Paris, France
| | - Tiffany Charmet
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Université Paris Cité, Paris, France
| | - Arnaud Fontanet
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Université Paris Cité, Paris, France
| | - Judith E Mueller
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Université Paris Cité, Paris, France; Univ. Rennes, EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS (Recherche sur les Services et Management en Santé) - U 1309 - F-35000 Rennes, France.
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Rapp T, Sicsic J, Ronchetti J, Cicchetti A. Preventing autonomy loss with multicomponent geriatric interventions: A resource-saving strategy? Evidence from the SPRINT-T study. SSM Popul Health 2023; 24:101507. [PMID: 37860705 PMCID: PMC10582469 DOI: 10.1016/j.ssmph.2023.101507] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/24/2023] [Accepted: 08/29/2023] [Indexed: 10/21/2023] Open
Abstract
Background The objective of healthy aging strategies is to support interventions targeting autonomy loss prevention, with the assumption that these interventions are likely to be efficient by simultaneously improving clinical outcomes and saving costs. Methods We compare the economic impact of two interventions targeting frailty prevention in older European populations: a multicomponent intervention including physical activity monitoring, nutrition management, information and communications technology use and a relatively simple healthy aging lifestyle education program based on a series of workshops. Our sample includes 1,519 male and female participants from 11 European countries aged 70 years or older. Our econometric model explores trends in several outcomes depending on intervention receipt and frailty status at baseline. Results Implementing a multicomponent intervention among frail older people does not lead to a lower use of care and do not prevent quality of life losses associated with aging. However, it impacts older people's sense of priorities and interest in the future. We find no statistically significant differences between the two interventions, suggesting that the implementation of a multicomponent intervention may not be the most efficient strategy. The impact of the interventions does not differ by frailty status at baseline. Conclusions Our results show the need to implement healthy aging strategies that are more focused on people's interests.
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Affiliation(s)
- Thomas Rapp
- Université Paris Cité, Chaire AgingUP! and LIRAES (URP 4470), F-75006, Paris, France
- LIEPP Sciences Po Paris, France
| | - Jonathan Sicsic
- Université Paris Cité, Chaire AgingUP! and LIRAES (URP 4470), F-75006, Paris, France
- LIEPP Sciences Po Paris, France
| | - Jérôme Ronchetti
- Laboratoire de Recherche Magellan (EA 3713), Université Lyon 3, France
| | - Americo Cicchetti
- Università Cattolica del Sacro Cuore, ALTEMS, Faculty of Economics, Rome, Italy
| | - SPRINTT consortium
- Université Paris Cité, Chaire AgingUP! and LIRAES (URP 4470), F-75006, Paris, France
- LIEPP Sciences Po Paris, France
- Laboratoire de Recherche Magellan (EA 3713), Université Lyon 3, France
- Università Cattolica del Sacro Cuore, ALTEMS, Faculty of Economics, Rome, Italy
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Oudin Doglioni D, Gagneux-Brunon A, Gauchet A, Bruel S, Olivier C, Pellissier G, Thilly N, Sicsic J, Raude J, Mueller JE. Psychometric validation of a 7C-model of antecedents of vaccine acceptance among healthcare workers, parents and adolescents in France. Sci Rep 2023; 13:19895. [PMID: 37963903 PMCID: PMC10646074 DOI: 10.1038/s41598-023-46864-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 11/06/2023] [Indexed: 11/16/2023] Open
Abstract
Support for vaccine decision-making requires a tailored approach taking into account psychological antecedents of vaccine acceptance. We aimed at validating an extended 7C-model of antecedents in three different target population groups (healthcare workers [n = 3870], parents [n = 2002] and adolescents [n = 7118]) and two vaccinations (COVID-19, HPV) in France. We performed a secondary analysis of questionnaires collecting sociodemographic characteristics, attitudes and knowledge on vaccination, and vaccine status and intention. We used standard psychometric techniques to validate a first and second order latent structure, and evaluated their association with vaccine intentionality in three levels (refusal, indecision, acceptance). In all populations, the 7C-model yielded a very good model fit (CFI and TLI > 0.90) and, in comparison with non-nested and nested 5C-models, significantly improved the model performance (Ω2, p < 0.05; Wald's test, p < 0.05). The resulting vaccine readiness score was strongly associated with vaccine intentionality (acceptance vs. indecision: βHCW = 2.93, βParents = 2.41, βAdolescents = 1.34; refusal vs. indecision: βHCW = - 1.68, βParents = - 0.16, βAdolescents = - 0.89.). The addition of confidence in the system and social conformism among antecedents of vaccine acceptance allowed a finer understanding of the continuum moving from refusal to indecision and acceptance. To work with these antecedents in interventional research, appropriate questionnaire items should be developed for various vaccines and target populations.
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Affiliation(s)
- Damien Oudin Doglioni
- Emerging Disease Epidemiology Unit, Institut Pasteur, Université Paris Cité, 75015, Paris, France
- Laboratoire Interuniversitaire de Psychologie/Personnalité, Cognition, Changement Social (LIP/PC2S), Univ. Grenoble Alpes, Univ. Savoie Mont-Blanc, 38000, Grenoble, France
| | - Amandine Gagneux-Brunon
- CHU de Saint-Étienne - Service d'infectiologie, Saint-Étienne, France
- Centre International de Recherche en Infectiologie, Team GIMAP, Inserm, U1111, CNRS, UMR530, Université de Lyon, Université Jean Monnet, Université Claude Bernard Lyon 1, Saint-Étienne, France
| | - Aurélie Gauchet
- Laboratoire Interuniversitaire de Psychologie/Personnalité, Cognition, Changement Social (LIP/PC2S), Univ. Savoie Mont-Blanc, Univ. Grenoble Alpes, 38000, Grenoble, France
| | - Sebastien Bruel
- Department of General Practice, Faculté de Médecine Jacques Lisfranc, Université Jean Monnet, Université de Lyon, Saint-Étienne, France
- Health, Systemic, Process UR 4129 Research Unit, University Claude Bernard, University of Lyon, Lyon, France
| | - Cyril Olivier
- GERES (Groupe d'Étude sur le Risque d'Exposition des Soignants), UFR de Médecine Bichat, Paris, France
| | - Gérard Pellissier
- GERES (Groupe d'Étude sur le Risque d'Exposition des Soignants), UFR de Médecine Bichat, Paris, France
| | - Nathalie Thilly
- APEMAC, Université de Lorraine, 54000, Nancy, France
- Département Méthodologie, Promotion, Investigation, CHRU-Nancy, Université de Lorraine, 54000, Nancy, France
| | | | - Jocelyn Raude
- EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS (Recherche sur les Services et Management en Santé) - U 1309, Université de Rennes, 35000, Rennes, France
| | - Judith E Mueller
- Emerging Disease Epidemiology Unit, Institut Pasteur, Université Paris Cité, 75015, Paris, France.
- EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS (Recherche sur les Services et Management en Santé) - U 1309, Université de Rennes, 35000, Rennes, France.
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Moffroid H, Doglioni DO, Chyderiotis S, Sicsic J, Barret AS, Raude J, Bruel S, Gauchet A, Michel M, Gagneux-Brunon A, Thilly N, Mueller JE. Can physicians and schools mitigate social inequalities in human papillomavirus vaccine awareness, uptake and vaccination intention among adolescents? A cross-sectional study, France, 2021 to 2022. Euro Surveill 2023; 28:2300166. [PMID: 37971661 PMCID: PMC10655205 DOI: 10.2807/1560-7917.es.2023.28.46.2300166] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/27/2023] [Indexed: 11/19/2023] Open
Abstract
BackgroundIn France, human papillomavirus (HPV) vaccination coverage varies across socioeconomic levels.AimWe aimed at assessing HPV vaccine awareness, uptake and vaccination intention among adolescents in France.MethodsIn a cluster-randomised study, 13-15-year-old students in 61 French middle schools completed a web-based questionnaire. We used multivariable logistic regression to evaluate determinants of HPV vaccine awareness, self-reported uptake and vaccination intention among unvaccinated students and interaction terms to explore effects of visits to family physician and remembering school lessons on vaccination. The French deprivation index of school municipalities served as proxy for socioeconomic levels.ResultsAmong 6,992 participants, awareness was significantly associated with parental education (odds ratio (OR) = 0.82; 95% confidence interval (CI): 0.71-0.95), language spoken at home (OR = 0.59; 95% CI: 0.52-0.66) and deprivation level (OR = 0.57; 95% CI: 0.44-0.71), regardless of physician visit or school lessons. Vaccine uptake was associated with parental education without a recent physician visit (OR = 0.31; 95% CI: 0.16-0.59, vs OR = 0.64; 95% CI: 0.52-0.78 with a visit, interaction p = 0.045). Vaccination intention among unvaccinated was associated with deprivation level (moderate-low vs low) among students not remembering school lessons on vaccination (OR = 0.17; 95% CI: 0.05-0.62, vs OR = 0.93; 95% CI: 0.51-1.67 remembering school lessons, interaction p = 0.022). Parental education was associated with vaccination intention among students reporting a physician visit (OR = 0.41; 95% CI: 0.26-0.64 vs OR = 1.05; 95% CI: 0.50-2.20 without a visit, interaction p = 0.034).ConclusionOur results suggest that healthcare and school could promote vaccination and mitigate social inequalities in HPV vaccination coverage.
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Affiliation(s)
- Hadrien Moffroid
- Institut Pasteur, Université Paris Cité, Emerging Disease Epidemiology Unit, 75015 Paris, France
- University of Melbourne, Melbourne, Australia
| | - Damien Oudin Doglioni
- Institut Pasteur, Université Paris Cité, Emerging Disease Epidemiology Unit, 75015 Paris, France
| | - Sandra Chyderiotis
- Institut Pasteur, Université Paris Cité, Emerging Disease Epidemiology Unit, 75015 Paris, France
| | | | | | - Jocelyn Raude
- Université Rennes, EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS (Recherche sur les Services et Management en Santé) - U1309 - 35000 Rennes, France
| | - Sebastien Bruel
- Department of General Practice, Faculté de Médecine Jacques Lisfranc, Université Jean Monnet, Université de Lyon, Saint-Etienne, France
- Health, Systemic, Process UR 4129 Research Unit, University Claude Bernard, University of Lyon, Lyon, France
| | - Aurelie Gauchet
- Université Savoie Mont Blanc, Université Grenoble Alpes LIP/PC2S, Grenoble, France
| | - Morgane Michel
- Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Unité d'épidémiologie clinique, Paris, France
- Université Paris Cité, ECEVE, UMR1123, Inserm, Paris, France
| | - Amandine Gagneux-Brunon
- CHU de Saint-Etienne - Service d'infectiologie
- Centre International de Recherche en Infectiologie, Team GIMAP, Université de Lyon, Université Jean Monnet, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530
| | - Nathalie Thilly
- Université de Lorraine, APEMAC, Nancy, France
- Université de Lorraine, CHRU-Nancy, Département Méthodologie, Promotion, Investigation, Nancy, France
| | - Judith E Mueller
- Institut Pasteur, Université Paris Cité, Emerging Disease Epidemiology Unit, 75015 Paris, France
- Université Rennes, EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS (Recherche sur les Services et Management en Santé) - U1309 - 35000 Rennes, France
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Araujo-Chaveron L, Sicsic J, Moffroid H, Díaz Luévano C, Blondel S, Langot F, Mueller JE. Impact of a COVID-19 certificate requirement on vaccine uptake pattern and intention for future vaccination. A cross-sectional study among French adults. Vaccine 2023; 41:5412-5423. [PMID: 37481404 DOI: 10.1016/j.vaccine.2023.07.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/22/2023] [Accepted: 07/02/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND In August 2021, France enacted a COVID-19 certificate requirement (vaccination/recovery/test) to access specific services, with mandates for professional groups. We evaluated the impact of this incentive-coercive policy in terms of vaccine uptake equality, future vaccine intention and confidence in authorities' crisis management. METHODS In late August 2021, a representative sample of adults (18-75 years) completed an internet-based questionnaire. We classified vaccinated participants by stated reasons for vaccination and estimated adjusted prevalence ratios (aPR) using multivariable Poisson regression. Counterfactual vaccine status assumed non-vaccination of those vaccinated for the certificate. We analysed the association of free-text testimonial themes with level of confidence in authorities. RESULTS Among 972 participants, 85.7% were vaccinated or intended vaccination: 3.6% only for certificate/mandate, 17.7% mainly for certificate/mandate plus other reasons, and 64.4% mainly for other reasons. In the counterfactual situation, vaccine uptake would have been significantly more likely among older vs. younger participants (aPR = 1.35) and among those with moderate-high vs. low levels of confidence in authorities for COVID-19 crisis management (aPR = 2.04). In the observed situation, confidence was the only significant determinant of vaccine status (moderate-high vs. low, aPR = 1.39). Among those without genuine motivation for vaccination, professionally active persons were more likely to have ceded to the certificate requirement (aPR = 3.76). Those vaccinated only for the certificate were more likely to express future COVID-19 vaccine intention than unvaccinated persons (aPR = 6.41). Themes significantly associated with lower confidence were criticism of morality (aPR = 1.76) and poor communication by the authorities (aPR = 1.66). CONCLUSION The incentive-coercive policy has reduced the negative association of vaccine status with younger age and low confidence in authorities, but may have reinforced isolation of professionally inactive persons. The requirement did not negatively impact future COVID-19 vaccine intention. Future vaccine-incentive policies should pay special attention to populations with low levels of confidence in authorities.
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Affiliation(s)
- Lucia Araujo-Chaveron
- EHESP French School of Public Health, Rennes, France; Institut Pasteur, Université Paris Cité, Emerging Disease Epidemiology Unit, F-75015 Paris, France
| | | | - Hadrien Moffroid
- Institut Pasteur, Université Paris Cité, Emerging Disease Epidemiology Unit, F-75015 Paris, France; University of Melbourne, Australia
| | | | - Serge Blondel
- Université Paris Cité, LIRAES, F-75006 Paris, France; GRANEM - Groupe de Recherche Angevin en Economie et Management, Paris, France
| | - François Langot
- Le Mans Université (Gains-TEPP, IRA), Le Mans, France; IUF - Institut Universitaire de France, Paris, France; PSE - Paris School of Economics, Paris, France; CEPREMAP - Centre pour la recherche économique et ses applications, Paris, France; IZA - Forschungsinstitut zur Zukunft der Arbeit - Institute of Labor Economics, Bonn, Germany
| | - Judith E Mueller
- EHESP French School of Public Health, Rennes, France; Institut Pasteur, Université Paris Cité, Emerging Disease Epidemiology Unit, F-75015 Paris, France; Univ. Rennes, EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS (Recherche sur les Services et Management en Santé) - U 1309, F-35000 Rennes, France.
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7
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Isa YS, Sicsic J, Njuguna H, Ward J, Chakroun M, El-Kassas M, Ramanampamonjy R, Chalal S, Vincent JP, Andersson M, Desalegn H, Fall F, Johannessen A, Matthews PC, Ndow G, Okeke E, Riches N, Seydi M, Sinkala E, Spearman CW, Stockdale A, Vinikoor MJ, Wandeler G, Sombié R, Lemoine M, Mueller JE, Shimakawa Y. Informing a target product profile for rapid tests to identify HBV-infected pregnant women with high viral loads: a discrete choice experiment with African healthcare workers. BMC Med 2023; 21:243. [PMID: 37403107 DOI: 10.1186/s12916-023-02939-y] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 06/13/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Elimination of mother-to-child transmission of hepatitis B virus (HBV) requires infant immunoprophylaxis and antiviral prophylaxis for pregnant women with high viral loads. Since real-time polymerase chain reaction (RT-PCR), a gold standard for assessing antiviral eligibility, is neither accessible nor affordable for women living in low-income and middle-income countries (LMICs), rapid diagnostic tests (RDTs) detecting alternative HBV markers may be needed. To inform future development of the target product profile (TPP) for RDTs to identify highly viremic women, we used a discrete choice experiment (DCE) and elicited preference and trade-off of healthcare workers (HCW) in Africa between the following four attributes of fictional RDTs: price, time-to-result, diagnostic sensitivity, and specificity. METHODS Through an online questionnaire survey, we asked participants to indicate their preferred test from a set of two RDTs in seven choice tasks with varying levels of the four attributes. We used mixed multinomial logit models to quantify the utility gain or loss generated by each attribute. We attempted to define minimal and optimal criteria for test attributes that can satisfy ≥ 70% and ≥ 90% of HCWs, respectively, as an alternative to RT-PCR. RESULTS A total of 555 HCWs from 41 African countries participated. Increases in sensitivity and specificity generated significant utility and increases in cost and time-to-result generated significant disutility. The size of the coefficients for the highest attribute levels relative to the reference levels were in the following order: sensitivity (β = 3.749), cost (β = -2.550), specificity (β = 1.134), and time-to-result (β = -0.284). Doctors cared most about test sensitivity, while public health practitioners cared about cost and midwives about time-to-result. For an RDT with 95% specificity, costing 1 US$, and yielding results in 20 min, the minimally acceptable test sensitivity would be 82.5% and the optimally acceptable sensitivity would be 87.5%. CONCLUSIONS African HCWs would prefer an RDT with the following order of priority: higher sensitivity, lower cost, higher specificity, and shorter time-to-result. The development and optimization of RDTs that can meet the criteria are urgently needed to scale up the prevention of HBV mother-to-child transmission in LMICs.
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Affiliation(s)
- Yasir Shitu Isa
- Institut Pasteur, Université Paris Cité, Unité d'Épidémiologie Des Maladies Émergentes, 25-28 Rue du Dr Roux, 75015, Paris, France
- EHESP French School of Public Health, Rennes, France
| | | | - Henry Njuguna
- Coalition for Global Hepatitis Elimination, Decatur, GA, USA
| | - John Ward
- Coalition for Global Hepatitis Elimination, Decatur, GA, USA
| | - Mohamed Chakroun
- Infectious Disease Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Mohamed El-Kassas
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Rado Ramanampamonjy
- Unité de Gastro-Entérologie, Hôpital Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | - Salim Chalal
- Institut Pasteur, Université Paris Cité, Unité d'Épidémiologie Des Maladies Émergentes, 25-28 Rue du Dr Roux, 75015, Paris, France
- Plateforme de Data Management, Institut Pasteur, Paris, France
| | - Jeanne Perpétue Vincent
- Institut Pasteur, Université Paris Cité, Unité d'Épidémiologie Des Maladies Émergentes, 25-28 Rue du Dr Roux, 75015, Paris, France
| | - Monique Andersson
- Division of Medical Virology, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa
- Nuffield Division of Clinical Laboratory Science, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Hailemichael Desalegn
- Medical Department, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Fatou Fall
- Department of Hepatology and Gastroenterology, Hopital Principal de Dakar, Dakar, Senegal
| | - Asgeir Johannessen
- Department of Infectious Diseases, Vestfold Hospital, Tønsberg, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Philippa C Matthews
- The Francis Crick Institute, London, UK
- Division of Infection and Immunity, University College London, London, UK
- Department of Infectious Diseases, University College London Hospital, London, UK
| | - Gibril Ndow
- Medical Research Council Unit The Gambia, London School of Hygiene & Tropical Medicine, Fajara, The Gambia
- Department of Metabolism, Digestion & Reproduction, Imperial College London, London, UK
| | - Edith Okeke
- Faculty of Medical Sciences, University of Jos, Jos, Nigeria
| | - Nicholas Riches
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Moussa Seydi
- Service de Maladies Infectieuses Et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | - Edford Sinkala
- Department of Internal Medicine, University of Zambia, Lusaka, Zambia
| | - C Wendy Spearman
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Alexander Stockdale
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, University of Liverpool, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Michael J Vinikoor
- Department of Internal Medicine, University of Zambia, Lusaka, Zambia
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roger Sombié
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Maud Lemoine
- Medical Research Council Unit The Gambia, London School of Hygiene & Tropical Medicine, Fajara, The Gambia
- Department of Metabolism, Digestion & Reproduction, Imperial College London, London, UK
| | - Judith E Mueller
- Institut Pasteur, Université Paris Cité, Unité d'Épidémiologie Des Maladies Émergentes, 25-28 Rue du Dr Roux, 75015, Paris, France
- EHESP French School of Public Health, Rennes, France
| | - Yusuke Shimakawa
- Institut Pasteur, Université Paris Cité, Unité d'Épidémiologie Des Maladies Émergentes, 25-28 Rue du Dr Roux, 75015, Paris, France.
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Sicsic J, Ronchetti J, Rapp T. [Analyzing and comparing healthy aging in France and OECD countries based on a new physiological age measure]. Med Sci (Paris) 2023; 39:551-557. [PMID: 37387664 DOI: 10.1051/medsci/2023077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023] Open
Abstract
We introduce a new individual measure of healthy aging on a sample of more than 39,000 individuals and compare the results for France with 11 other European countries and the United States. Our healthy aging measure is based on the discrepancy between the calendar age of populations with their estimated physiological age, which corresponds to a measure of age adjusted for the effects of comorbidities and functional health. France is ranked in the lower middle of our healthy aging scale, with the Nordic countries (Denmark, Sweden, Netherlands), Switzerland and Greece being ahead. Economic capital has a strong impact on the estimated physiological age and on healthy aging trajectories. Socioeconomic inequalities are particularly marked in France as well as in Italy and the United States. The generosity of long-term care policies seems to be positively associated with the level of healthy aging of the populations. More work is required to identify the drivers of healthy aging among individuals living in OECD countries.
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Affiliation(s)
- Jonathan Sicsic
- Université Paris Cité, LIRAES (laboratoire interdisciplinaire de recherche appliquée en économie-gestion et santé), 45 rue des Saints-Pères, F-75006 Paris, France - Chaire « Aging UP ! », université Paris Cité, Paris, France - LIEPP (laboratoire interdisciplinaire d'évaluation des politiques publiques), Sciences Po, 27 rue Saint-Guillaume, 75337 Paris, France
| | - Jérôme Ronchetti
- Laboratoire de recherche Magellan (EA 3713), université Lyon 3, Lyon, France
| | - Thomas Rapp
- Université Paris Cité, LIRAES (laboratoire interdisciplinaire de recherche appliquée en économie-gestion et santé), 45 rue des Saints-Pères, F-75006 Paris, France - Chaire « Aging UP ! », université Paris Cité, Paris, France - LIEPP (laboratoire interdisciplinaire d'évaluation des politiques publiques), Sciences Po, 27 rue Saint-Guillaume, 75337 Paris, France
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Bonner KE, Chyderiotis S, Sicsic J, Mueller JE, Ulrich AK, Toomey T, Horvath KJ, Neaton JD, Basta NE. What motivates adults to accept influenza vaccine? An assessment of incentives, ease of access, messaging, and sources of information using a discrete choice experiment. SSM Popul Health 2023; 22:101384. [PMID: 37008807 PMCID: PMC10060740 DOI: 10.1016/j.ssmph.2023.101384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/15/2023] Open
Abstract
Seasonal influenza vaccination rates remain low, and contribute to preventable influenza cases, hospitalizations, and deaths in the US. While numerous interventions have been implemented to increase vaccine uptake, there is a need to determine which interventions contribute most to vaccine willingness, particularly among age groups with vaccination rates that have plateaued at suboptimal levels. This study aimed to quantify the relative effect of multiple interventions on vaccine willingness to receive influenza vaccine in three age groups using a series of hypothetical situations with different behavioral interventions. We assessed the relative impact of four categories of interventions: source of vaccine messages, type of vaccination messages, vaccination incentives, and ease of vaccine access using a discrete choice experiment. Within each category, we investigated the role of four different attributes to measure their relative contribution to willingness to be vaccinated by removing one option from each of the intervention categories. Among the 1,763 Minnesota residents who volunteered for our study, participants expressed vaccine willingness in over 80% of the scenarios presented. Easy access to drop-in vaccination sites had the greatest impact on vaccine willingness in all age groups. Among the younger age group, small financial incentives also contributed to high vaccine willingness. Our results suggest that public health programs and vaccination campaigns may improve their chances of successfully increasing vaccine willingness if they offer interventions preferred by adults, including facilitating convenient access to vaccination and offering small monetary incentives, particularly for young adults.
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Sicsic J, Blondel S, Chyderiotis S, Langot F, Mueller JE. Preferences for COVID-19 epidemic control measures among French adults: a discrete choice experiment. Eur J Health Econ 2023; 24:81-98. [PMID: 35305178 PMCID: PMC8934018 DOI: 10.1007/s10198-022-01454-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 02/21/2022] [Indexed: 06/04/2023]
Abstract
In this stated preferences study, we describe for the first time French citizens' preferences for various epidemic control measures, to inform longer-term strategies and future epidemics. We used a discrete choice experiment in a representative sample of 908 adults in November 2020 (before vaccination was available) to quantify the trade-off they were willing to make between restrictions on the social, cultural, and economic life, school closing, targeted lockdown of high-incidence areas, constraints to directly protect vulnerable persons (e.g., self-isolation), and measures to overcome the risk of hospital overload. The estimation of mixed logit models with correlated random effects shows that some trade-offs exist to avoid overload of hospitals and intensive care units, at the expense of stricter control measures with the potential to reduce individuals' welfare. The willingness to accept restrictions was shared to a large extent across subgroups according to age, gender, education, vulnerability to the COVID-19 epidemic, and other socio-demographic or economic variables. However, individuals who felt at greater risk from COVID-19, and individuals expressing high confidence in the governmental management of the health and economic crisis, more easily accepted all these restrictions. Finally, we compared the welfare impact of alternative strategies combining different epidemic control measures. Our results suggest that policies close to a targeted lockdown or with medically prescribed self-isolation were those satisfying the largest share of the population and achieving high gain in average welfare, while average welfare was maximized by the combination of all highly restrictive measures. This illustrates the difficulty in making preference-based decisions on restrictions.
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Affiliation(s)
- Jonathan Sicsic
- Université Paris Cité, LIRAES F-75006, 45 rue des Saints-Pères, 75006 Paris, France
| | - Serge Blondel
- Université Paris Cité, LIRAES F-75006, 45 rue des Saints-Pères, 75006 Paris, France
- Université d’Angers, GRANEM, SFR Confluences, F-49000 Angers, France
| | | | - François Langot
- Le Mans Université (GAINS-TEPP and IRA), IUF, PSE, Cepremap, Le Mans, France
- IZA, Bonn, Germany
| | - Judith E. Mueller
- EHESP French School of Public Health, Rennes and Institut Pasteur, Paris, France
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Rapp T, Sicsic J, Tavassoli N, Rolland Y. Do not PIMP my nursing home ride! The impact of Potentially Inappropriate Medications Prescribing on residents' emergency care use. Eur J Health Econ 2022:10.1007/s10198-022-01534-x. [PMID: 36271304 DOI: 10.1007/s10198-022-01534-x] [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] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
Nursing home residents often are poly-medicated, which increases their risks of receiving potentially inappropriate medications. This problem has become a major public health issue in many countries, and in particular in France. Indeed, high uses of potentially inappropriate medication prescriptions can lead to adverse effects that are likely to increase emergency room (ER) visits. However, there is a lack of empirical evidence on the causal relationship between the amount of use of potentially inappropriate medications and ER visit risks among nursing homes residents. Indeed, this question is subject to endogeneity issues due to omitted variables that simultaneously affect inappropriate medications prescriptions and ER use. We take advantage of the IDEM Randomized Clinical Trial (Systematic Dementia Screening by Multidisciplinary Team Meetings in Nursing Homes for Reducing Emergency Department Transfers) to overcome that issue. Indeed, randomization in the IDEM intervention group created exogenous variations in potentially inappropriate prescriptions, and was thus used as an instrument. Using an instrumental variable model, we show that over a 12-month period, a 1% increase in the share of potentially inappropriate medications spending in total medication spending leads to a 5.7 percentage point increase in residents' ER use risks (p < 0.001). This effect is robust to various model specifications. Moreover, the intensity of this correlation persists over an 18-month period. While tackling wasteful spending has become a priority in most countries, our results have important policy implications. Indeed, reducing potentially inappropriate medication spending in nursing homes should be a key component of value-based aging policies, which objectives are to reduce inefficient care, and provide health care services centered in people's interest.
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Affiliation(s)
- Thomas Rapp
- Université Paris Cité, Chaire AgingUP! and LIRAES, 75006, Paris, France.
- LIEPP Sciences Po, Paris, France.
| | - Jonathan Sicsic
- Université Paris Cité, Chaire AgingUP! and LIRAES, 75006, Paris, France
| | - Neda Tavassoli
- Gérontopôle de Toulouse, Département de Médecine Interne et Gérontologie Clinique, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | - Yves Rolland
- Gérontopôle de Toulouse, Département de Médecine Interne et Gérontologie Clinique, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
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Rapp T, Ronchetti J, Sicsic J. Where Are Populations Aging Better? A Global Comparison of Healthy Aging Across Organization for Economic Cooperation and Development Countries. Value Health 2022; 25:1520-1527. [PMID: 35710893 DOI: 10.1016/j.jval.2022.05.007] [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: 11/23/2021] [Revised: 03/15/2022] [Accepted: 05/09/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Global comparisons and large samples are needed to inform policy makers about aging trends among people aged older than 60 years. Using harmonized data gathered from the Gateway to Global Aging data, we introduce a new framework to measure healthy aging across 13 OECD countries. METHODS First, we developed an original measure of physiological age (PA), that is, a measure of age weighted for the influence of frailty, activities of daily living limitations, and comorbidities. Second, we compared healthy aging measures across 13 countries based on a ranking of the countries according to the discrepancy between estimated PA and chronological age (CA). Third, we explored the socioeconomic factors associated with healthy aging. RESULTS We found a strong correlation between our PA measure and biological age. Italy, Israel, and the United States are the 3 countries where PA is the highest (independent of CA), thus indicating aging in poor health. In contrast, Switzerland, The Netherlands, Greece, Sweden, and Denmark have much lower PA than CA, thus indicating healthy aging. Finally, the PA-CA discrepancy is higher among poorer, less educated, and single older individuals. CONCLUSIONS Countries with higher PA need to implement or reinforce healthy aging measures and target the disadvantaged populations.
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Affiliation(s)
- Thomas Rapp
- Université Paris Cité, LIRAES F-75006, Paris, France; LIEPP Sciences Po, Paris, France.
| | - Jérôme Ronchetti
- Laboratoire de Recherche Magellan (EA 3713), Université Lyon 3, Lyon, France; Healthcare Values Chair, Université Lyon 3, Lyon, France
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Bonner KE, Ssekyanzi H, Sicsic J, Mueller JE, Toomey T, Ulrich AK, Horvath KJ, Neaton JD, Banura C, Basta NE. What drives willingness to receive a new vaccine that prevents an emerging infectious disease? A discrete choice experiment among university students in Uganda. PLoS One 2022; 17:e0268063. [PMID: 35587501 PMCID: PMC9119467 DOI: 10.1371/journal.pone.0268063] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 04/21/2022] [Indexed: 11/18/2022] Open
Abstract
Background There is a critical need to identify the drivers of willingness to receive new vaccines against emerging and epidemic diseases. A discrete choice experiment is the ideal approach to evaluating how individuals weigh multiple attributes simultaneously. We assessed the degree to which six attributes were associated with willingness to be vaccinated among university students in Uganda. Methods We conducted a single-profile discrete choice experiment at Makerere University in 2019. Participants were asked whether or not they would be vaccinated in 8 unique scenarios where attributes varied by disease risk, disease severity, advice for or against vaccination from trusted individuals, recommendations from influential figures, whether the vaccine induced indirect protection, and side effects. We calculated predicted probabilities of vaccination willingness using mixed logistic regression models, comparing health professional students with all other disciplines. Findings Of the 1576 participants, 783 (49.8%) were health professional students and 685 (43.5%) were female. Vaccination willingness was high (78%), and higher among health students than other students. We observed the highest vaccination willingness for the most severe disease outcomes and the greatest exposure risks, along with the Minister of Health’s recommendation or a vaccine that extended secondary protection to others. Mild side effects and recommendations against vaccination diminished vaccination willingness. Interpretation Our results can be used to develop evidence-based messaging to encourage uptake for new vaccines. Future vaccination campaigns, such as for COVID-19 vaccines in development, should consider acknowledging individual risk of exposure and disease severity and incorporate recommendations from key health leaders.
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Affiliation(s)
- Kimberly E. Bonner
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
- * E-mail:
| | - Henry Ssekyanzi
- College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Judith E. Mueller
- EHESP French School of Public Health, La Plaine St Denis, France
- Institute Pasteur, Paris, France
| | - Traci Toomey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Angela K. Ulrich
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Keith J. Horvath
- Department of Psychology, San Diego State University, United States of America
| | - James D. Neaton
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
| | - Cecily Banura
- Child Health and Development Centre, College of Health Sciences, School of Medicine, Makerere University, Kampala, Uganda
| | - Nicole E. Basta
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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Roux A, Cholerton R, Sicsic J, Moumjid N, French DP, Giorgi Rossi P, Balleyguier C, Guindy M, Gilbert FJ, Burrion JB, Castells X, Ritchie D, Keatley D, Baron C, Delaloge S, de Montgolfier S. Study protocol comparing the ethical, psychological and socio-economic impact of personalised breast cancer screening to that of standard screening in the "My Personal Breast Screening" (MyPeBS) randomised clinical trial. BMC Cancer 2022; 22:507. [PMID: 35524202 PMCID: PMC9073478 DOI: 10.1186/s12885-022-09484-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [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: 02/17/2022] [Accepted: 04/02/2022] [Indexed: 12/11/2022] Open
Abstract
Background The MyPeBS study is an ongoing randomised controlled trial testing whether a risk-stratified breast cancer screening strategy is non-inferior, or eventually superior, to standard age-based screening at reducing incidence of stage 2 or more cancers. This large European Commission-funded initiative aims to include 85,000 women aged 40 to 70 years, without prior breast cancer and not previously identified at high risk in six countries (Belgium, France, Italy, Israel, Spain, UK). A specific work package within MyPeBS examines psychological, socio-economic and ethical aspects of this new screening strategy. It compares women’s reported data and outcomes in both trial arms on the following issues: general anxiety, cancer-related worry, understanding of breast cancer screening strategy and information-seeking behaviour, socio-demographic and economic characteristics, quality of life, risk perception, intention to change health-related behaviours, satisfaction with the trial. Methods At inclusion, 3-months, 1-year and 4-years, each woman participating in MyPeBS is asked to fill online questionnaires. Descriptive statistics, bivariate analyses, subgroup comparisons and analysis of variations over time will be performed with appropriate tests to assess differences between arms. Multivariate regression models will allow modelling of different patient reported data and outcomes such as comprehension of the information provided, general anxiety or cancer worry, and information seeking behaviour. In addition, a qualitative study (48 semi-structured interviews conducted in France and in the UK with women randomised in the risk-stratified arm), will help further understand participants’ acceptability and comprehension of the trial, and their experience of risk assessment. Discussion Beyond the scientific and medical objectives of this clinical study, it is critical to acknowledge the consequences of such a paradigm shift for women. Indeed, introducing a risk-based screening relying on individual biological differences also implies addressing non-biological differences (e.g. social status or health literacy) from an ethical perspective, to ensure equal access to healthcare. The results of the present study will facilitate making recommendations on implementation at the end of the trial to accompany any potential change in screening strategy. Trial registration Study sponsor: UNICANCER. My personalised breast screening (MyPeBS). Clinicaltrials.gov (2018) available at: https://clinicaltrials.gov/ct2/show/NCT03672331 Contact: Cécile VISSAC SABATIER, PhD, + 33 (0)1 73 79 77 58 ext + 330,142,114,293, contact@mypebs.eu. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09484-6.
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Affiliation(s)
- Alexandra Roux
- IRIS (UMR8156 CNRS & U997 INSERM), Paris 13 University, Aubervilliers, France
| | | | | | - Nora Moumjid
- Université Lyon 1, P2S EA 4129, Centre Léon Bérard, F-69373, Lyon, France
| | | | | | | | - Michal Guindy
- Assuta Medical Centers, Tel Aviv, Israel.,Ben Gurion University, Beersheba, Israel
| | | | | | - Xavier Castells
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | | | | | | | - Suzette Delaloge
- Institut Gustave Roussy, Villejuif, France.,Unicancer, Paris, France
| | - Sandrine de Montgolfier
- IRIS (UMR8156 CNRS & U997 INSERM), Paris 13 University, Aubervilliers, France. .,Paris Est Creteil University, Créteil, France.
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Rapp T, Ronchetti J, Sicsic J. Impact of formal care consumption on informal care use in Europe: What is happening at the beginning of dependency? Health Policy 2022; 126:632-642. [DOI: 10.1016/j.healthpol.2022.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 06/10/2021] [Accepted: 04/17/2022] [Indexed: 01/11/2023]
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Chyderiotis S, Sicsic J, Thilly N, Mueller JE. Vaccine eagerness: A new framework to analyse preferences in single profile discrete choice experiments. Application to HPV vaccination decisions among French adolescents. SSM Popul Health 2022; 17:101058. [PMID: 35284615 PMCID: PMC8914374 DOI: 10.1016/j.ssmph.2022.101058] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 02/04/2022] [Accepted: 02/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background We previously conducted a single-profile discrete choice experiment to elicit preferences of adolescents around HPV vaccine communication, finding that only half of participants made variable choices (non-uniform respondents) from which preferences were elicited. In this paper we provide a framework to evaluate post-choice certainty information to elicit preferences even among respondents who uniformly accepted (serial demanders) or refused (serial non-demanders) hypothetical vaccination scenarios. Methods During an in-class online questionnaire among 1458 French adolescents aged 13–15 years old, we collected certainty levels (0–10) after decisions on nine hypothetical scenarios, including four vaccination attributes: information on vaccine-preventable disease type, on vaccine safety, on potential for indirect protection and on vaccine coverage. We developed a vaccine eagerness scale (ranging from −10 to 10), by combining information on the binary decision (accept vs. refuse the hypothetical vaccine) and the decision certainty level. We used random effects linear regressions to evaluate attributes’ impact on vaccine eagerness. Sensitivity analyses were performed taking into account low response quality, assessed as invariant certainty and low response time. Results Attributes’ impact on decision certainty were similar between serial demanders (N = 659) and non-uniform respondents (N = 711): mentioning a positive benefit-risk balance significantly decreased certainty to accept (coefficient −0.93), while information on 80% coverage in other countries (+0.33) and potential for disease elimination (+0.09) increased it. Among serial non-demanders, significant attribute impacts were observed only after exclusion of low-quality responses (N = 31): a potential for disease elimination (coefficient: +0.24) and 80% coverage in other countries (+0.42) significantly increased certainty of refusing vaccination. Combining decision and certainty into a vaccine eagerness indicator allowed analysing preferences in the full sample, including “hesitant” respondents, who were sensitive to the content of the vaccination profile. Conclusion Choice certainty informs on respondents’ preferences in single-profile discrete-choice experiments, in particular among those with uniform responses. Preferences are not identified among “uniform respondents” in single profile DCEs. Analysis of post-choice certainty can reveal information on their preferences. We propose a new concept for DCEs on vaccination, “vaccine eagerness”. Vaccine eagerness allows analyzing preferences among serial non-demanders.
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Affiliation(s)
- Sandra Chyderiotis
- Unité de Recherche et d’Expertise Epidémiologie des maladies émergentes, Institut Pasteur, 25 rue du Dr Roux - 75724 Paris cedex 15, France
| | - Jonathan Sicsic
- Université de Paris, LIRAES, F-75006, Paris, France
- Corresponding author. Centre Universitaire des Saints-Pères. 45, rue des Saints-Pères, 75006, Paris, France.
| | - Nathalie Thilly
- Université de Lorraine, APEMAC, CHRU-Nancy, Département Méthodologie, Promotion, Investigation, F-54000, Nancy, France
| | | | - Judith E. Mueller
- Unité de Recherche et d’Expertise Epidémiologie des maladies émergentes, Institut Pasteur, 25 rue du Dr Roux - 75724 Paris cedex 15, France
- EHESP French School of Public Health, Rennes, Paris, France
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Díaz Luévano C, Sicsic J, Pellissier G, Chyderiotis S, Arwidson P, Olivier C, Gagneux-Brunon A, Botelho-Nevers E, Bouvet E, Mueller J. Quantifying healthcare and welfare sector workers' preferences around COVID-19 vaccination: a cross-sectional, single-profile discrete-choice experiment in France. BMJ Open 2021; 11:e055148. [PMID: 34607874 PMCID: PMC8491005 DOI: 10.1136/bmjopen-2021-055148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To analyse preferences around promotion of COVID-19 vaccination among workers in the healthcare and welfare sector in Fance at the start of the vaccination campaign. DESIGN Single-profile discrete-choice experiment. Respondents in three random blocks chose between accepting or rejecting eight hypothetical COVID-19 vaccination scenarios. SETTING 4346 healthcare and welfare sector workers in France, recruited through nation-wide snowball sampling, December 2020 to January 2021. OUTCOME The primary outcomes were the effects of attributes' levels on hypothetical acceptance, expressed as ORs relative to the reference level. The secondary outcome was vaccine eagerness as certainty of decision, ranging from -10 to +10. RESULTS Among all participants, 61.1% made uniform decisions, including 17.2% always refusing vaccination across all scenarios (serial non-demanders). Among 1691 respondents making variable decisions, a strong negative impact on acceptance was observed with 50% vaccine efficacy (compared with 90% efficacy: OR 0.05, 95% CI 0.04 to 0.06) and the mention of a positive benefit-risk balance (compared with absence of severe and frequent side effects: OR 0.40, 0.34 to 0.46). The highest positive impact was the prospect of safely meeting older people and contributing to epidemic control (compared with no indirect protection: OR 4.10, 3.49 to 4.82 and 2.87, 2.34 to 3.50, respectively). Predicted acceptance was 93.8% for optimised communication on messenger RNA vaccines and 16.0% for vector-based vaccines recommended to ≥55-year-old persons. Vaccine eagerness among serial non-demanders slightly but significantly increased with the prospect of safely meeting older people and epidemic control and reduced with lower vaccine efficacy. DISCUSSION Vaccine promotion towards healthcare and welfare sector workers who hesitate or refuse vaccination should avoid the notion of benefit-risk balance, while collective benefit communication with personal utility can lever acceptance. Vaccines with limited efficacy will unlikely achieve high uptake.
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Affiliation(s)
- Carolina Díaz Luévano
- Department of Quantitative Methods in Public Health, EHESP French School of Public Health, Paris and Rennes, La Plaine St Denis, France
| | | | - Gerard Pellissier
- Research Group for the Prevention of Occupational Infections in Healthcare Workers (GERES), Paris, France
| | - Sandra Chyderiotis
- Emerging Infectious Disease Epidemiology Unit, Institut Pasteur, Paris, France
| | - Pierre Arwidson
- Prevention and Health Promotion, Santé publique France, Saint-Maurice, France
| | - Cyril Olivier
- Research Group for the Prevention of Occupational Infections in Healthcare Workers (GERES), Paris, France
| | - Amandine Gagneux-Brunon
- Department of Infectious Diseases, University Hopital of Saint-Etienne, Saint-Etienne, France
- Chaire PreVacCI, Institut PRESAGE, University Jean Monnet University, Lyon University, Saint-Etienne, France
| | - Elisabeth Botelho-Nevers
- Department of Infectious Diseases, University Hopital of Saint-Etienne, Saint-Etienne, France
- Chaire PreVacCI, Institut PRESAGE, University Jean Monnet University, Lyon University, Saint-Etienne, France
| | - Elisabeth Bouvet
- Research Group for the Prevention of Occupational Infections in Healthcare Workers (GERES), Paris, France
| | - Judith Mueller
- Department of Quantitative Methods in Public Health, EHESP French School of Public Health, Paris and Rennes, La Plaine St Denis, France
- Emerging Infectious Disease Epidemiology Unit, Institut Pasteur, Paris, France
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Rapp T, Ronchetti J, Sicsic J. Are long-term care jobs harmful? Evidence from Germany. Eur J Health Econ 2021; 22:749-771. [PMID: 33839969 DOI: 10.1007/s10198-021-01288-y] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 03/12/2021] [Indexed: 06/12/2023]
Abstract
Like many OECD countries, Germany is currently facing a shortage of long-term care (LTC) workers. This situation is concerning in the context of the ageing of the German population. A potential reason why Germany fails to recruit and retain LTC workers is that LTC jobs are particularly demanding (physical and psychological strain) which may be harmful to health. However, there is a lack of empirical evidence demonstrating this effect. This article fills the gap in the literature by exploring to what extent LTC jobs reduce workers' health over time. We estimate a dynamic panel data model on the German Socio-Economic Panel (v.35; 1984-2018), which allows adressing selection issues into occupations. Our paper provides innovative findings on the impact of LTC occupations on workers' health. We confirm that LTC jobs have a negative impact on self-reported health. Our results have strong policy implications: we emphasize the need to provide sufficient assistance to LTC workers, who are at risk of facing more health issues than other workers. This issue is key to increase the attractiveness of LTC jobs and reduce turnover in the LTC workforce.
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Affiliation(s)
- Thomas Rapp
- LIRAES, Université de Paris (URP 4470), 45 rue des Saints-Pères, 75006, Paris, France.
- LIEPP, Sciences Po, Paris, France.
| | - Jérôme Ronchetti
- Université Lyon 3 - Laboratoire Magellan (EA 3713), 1C avenue des Frères Lumière, 69372, Lyon, France
| | - Jonathan Sicsic
- LIRAES, Université de Paris (URP 4470), 45 rue des Saints-Pères, 75006, Paris, France
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Roquebert Q, Sicsic J, Santos-Eggimann B, Sirven N, Rapp T. FRAILTY, SARCOPENIA AND LONG TERM CARE UTILIZATION IN OLDER POPULATIONS: A SYSTEMATIC REVIEW. J Frailty Aging 2021; 10:272-280. [PMID: 34105712 DOI: 10.14283/jfa.2021.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/11/2022]
Abstract
This systematic literature review documents the link between frailty or sarcopenia, conceptualized as dimensions of physical health, and the use of long-term care services by older individuals. Long-term care services include formal and informal care provided at home as well as in institutions. A systematic review was performed according to PRISMA requirements using the following databases: PubMed-Medline, Embase, CINAHL, Web of Science, and Academic Search Premier. We included all quantitative studies published in English between January 2000 and December 2018 focusing on individuals aged 50 or more, using a relevant measurement of sarcopenia or physical frailty and a long-term care related outcome. A quality assessment was carried out using the questionnaire established by the Good Practice Task Force Report of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Five subsets of long-term care outcome were considered: 1/ nursing home placement (NHP), 2/ nursing home short stay (NHSS), 3/ formal personal care (FPC), 4/ formal home help (FHH), 5/ informal care (IC). Out of 1943 studies, 17 were finally included in the review. With some studies covering several LTC outcomes, frailty and / or sarcopenia were associated with increased LTC use in 17 out of 26 cases (NHP: 5/6, NHSS: 3/4, FPC: 5/7, FHH: 1/4, IC: 3/5) The association was not consistent in 5 cases (NHP: 1/6, NHSS: 1/4, FPC: 2/7, FHH: 0/4, IC: 1/5) and the association was either not significant or the results inconclusive in the remaining 9 cases. Overall, while results on sarcopenia are scarce, evidence support a positive association between frailty and LTC use. The evidence is stronger for the association of physical frailty with nursing home placement / short stay as well as on FPC. There is less (more heterogeneous) evidence regarding the correlation between physical frailty and FHH or IC use. Results need to be confirmed by more advanced statistical methods or design based on longitudinal data.
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Affiliation(s)
- Q Roquebert
- Jonathan Sicsic (PhD), LIRAES, 45 rue des Saints-Pères, Université de Paris 75006 Paris, . +33(0)177219361
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Chyderiotis S, Sicsic J, Raude J, Bonmarin I, Jeanleboeuf F, Le Duc Banaszuk AS, Gauchet A, Bruel S, Michel M, Giraudeau B, Thilly N, Mueller JE. Optimising HPV vaccination communication to adolescents: A discrete choice experiment. Vaccine 2021; 39:3916-3925. [PMID: 34088507 DOI: 10.1016/j.vaccine.2021.05.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/28/2021] [Accepted: 05/22/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Human Papillomavirus (HPV) vaccine coverage in France is below 30%, despite proven effectiveness against HPV infections and (pre-)cancerous cervical lesions. To optimise vaccine promotion among adolescents, we used a discrete choice experiment (DCE) to identify optimal statements regarding a vaccination programme, including vaccine characteristics. METHODS Girls and boys enrolled in the last two years of five middle schools in three French regions (aged 13-15 years) participated in an in-class cross-sectional self-administered internet-based study. In ten hypothetical scenarios, participants decided for or against signing up for a school-based vaccination campaign against an unnamed disease. Scenarios included different levels of four attributes: the type of vaccine-preventable disease, communication on vaccine safety, potential for indirect protection, and information on vaccine uptake among peers. One scenario was repeated with an added mention of sexual transmission. RESULTS The 1,458 participating adolescents (estimated response rate: 89.4%) theoretically accepted vaccination in 80.1% of scenarios. All attributes significantly impacted theoretical vaccine acceptance. Compared to a febrile respiratory disease, protection against cancer was motivating (odds ratio (OR) 1.29 [95%-CI 1.09-1.52]), but not against genital warts (OR 0.91 [0.78-1.06]). Compared to risk negation ("vaccine does not provoke serious side effects"), a reference to a positive benefit-risk balance despite a confirmed side effect was strongly dissuasive (OR 0.30 [0.24-0.36]), while reference to ongoing international pharmacovigilance without any scientifically confirmed effect was not significantly dissuasive (OR 0.86 [0.71-1.04]). The potential for indirect protection motivated acceptance among girls but not boys (potential for eliminating the disease compared to no indirect protection, OR 1.57 [1.25-1.96]). Compared to mentioning "insufficient coverage", reporting that ">80% of young people in other countries got vaccinated" motivated vaccine acceptance (OR 1.94 [1.61-2.35]). The notion of sexual transmission did not influence acceptance. CONCLUSION HPV vaccine communication to adolescents can be tailored to optimise the impact of promotion efforts.
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Affiliation(s)
- Sandra Chyderiotis
- Unité de Recherche et d'Expertise Epidémiologie des maladies émergentes, Institut Pasteur, 25 rue du Dr Roux 75724 Paris cedex 15, 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
| | | | - Florian Jeanleboeuf
- GIMAP: groupe Immunité des Muqueuses et Agents Pathogènes, EA 3064, Université Jean Monnet, Université de Lyon, Saint-Etienne, France; Chaire PREVacCI Prévention, Vaccination et Contrôle de l'Infection, Institut PRESAGE, Université Jean Monnet, Université de Lyon, Saint-Etienne, France
| | | | - Aurélie Gauchet
- Université Grenoble Alpes, LIP/PC2S, EA 4145 Grenoble, France
| | - Sébastien Bruel
- HESPER EA7425, Saint-Etienne-Lyon University, Saint-Etienne, France; CIC-INSERM 1408, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Morgane Michel
- Université de Paris, ECEVE, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôtel Dieu, URC Eco Ile-de-France/Hôpital Robert Debré, Unité d'épidémiologie clinique, Paris, France; INSERM, ECEVE, UMR 1123, Paris, France
| | - Bruno Giraudeau
- Université de Tours, Université de Nantes, INSERM, SPHERE U1246, Tours, France, INSERM CIC 1415, CHRU de Tours, Tours, France
| | - Nathalie Thilly
- Université de Lorraine, APEMAC, Nancy, France; Université de Lorraine, CHRU-Nancy, Département Méthodologie, Promotion, Investigation, Nancy, France
| | - Judith E Mueller
- Unité de Recherche et d'Expertise Epidémiologie des maladies émergentes, Institut Pasteur, 25 rue du Dr Roux 75724 Paris cedex 15, France; EHESP Rennes, Université Sorbonne Paris Cité, Paris, France
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21
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Roquebert Q, Sicsic J, Rapp T. Health measures and long-term care use in the European frail population. Eur J Health Econ 2021; 22:405-423. [PMID: 33587220 DOI: 10.1007/s10198-020-01263-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 12/23/2020] [Indexed: 06/12/2023]
Abstract
This paper explores the association between health measures and long-term care (LTC) use in the 70+ old population. We examine how different measures of health-subjective versus objective-predict LTC use, provided either formally or informally. We consider an absolute measure of subjective health, the grade given by the individual to his/her health status, and additionally construct a relative measure capturing the difference between this grade and the average grade given to health by individuals sharing the same characteristics. Conceptually, this difference comes from the perception of the individual, corresponding to both the private health information and the reporting behavior affecting self-rated health. We use the baseline data from the SPRINTT study, an ongoing randomized control trial on 1519 subjects facing physical frailty and sarcopenia (PF&S) in 11 European countries. Our sample population is older than 70 (mean: 79 years) and comprises a majority (71%) of women. Results show that self-rated health indicators correlate to formal care even when objective health measures are included, while it is not the case for informal care. Formal care consumption thus appears to be more sensitive to the individual's perception of health than informal care.
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Affiliation(s)
- Quitterie Roquebert
- Université de Strasbourg, Université de Lorraine, CNRS, BETA, 67000, Strasbourg, France.
| | | | - Thomas Rapp
- LIRAES (EA4470), Université de Paris, Paris, France
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Godinot LD, Sicsic J, Lachatre M, Bouvet E, Abiteboul D, Rouveix E, Pellissier G, Raude J, Mueller JE. Quantifying preferences around vaccination against frequent, mild disease with risk for vulnerable persons: A discrete choice experiment among French hospital health care workers. Vaccine 2021; 39:805-814. [PMID: 33419603 DOI: 10.1016/j.vaccine.2020.12.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
The individual determinants of vaccine acceptance among health workers (HCWs) have been described in the literature, but there is little evidence regarding the impact of vaccine characteristics and contextual factors (e.g., incentives, communication) on vaccination intentions. We developed a single profile discrete choice experiment (DCE) to assess the impact of seven attributes on stated vaccination intention against an unnamed disease, described as frequent with rapid clinical evolution and epidemic potential (similar to influenza or pertussis). Attributes evaluated vaccine characteristics (effectiveness, security profile), inter-individual aspects (epidemic risk, controversy, potential for indirect protection, vaccine coverage) and incentives (e.g., badge, hierarchical injunction). A total of 1214 French hospital-based HCWs, recruited through professional organizations, completed the online DCE questionnaire. The relative impact of each attribute was estimated using random effects logit models on the whole sample and among specific subgroups. Overall, 52% of included HCWs were vaccinated against influenza during 2017-18 and the average vaccination acceptance rate across all scenarios was 58%. Aside from the management stance, all attributes' levels had significant impact on vaccination decisions. Poor vaccine safety had the most detrimental impact on stated acceptance (OR 0.04 for the level controversy around vaccine safety). The most motivating factor was protection of family (OR 2.41) and contribution to disease control (OR 2.34). Other motivating factors included improved vaccine effectiveness (OR 2.22), high uptake among colleagues (OR 1.89) and epidemic risk declared by health authorities (OR 1.76). Social incentives (e.g., a badge I'm vaccinated) were dissuasive (OR 0.47). Compared to HCWs previously vaccinated against influenza, unvaccinated HCWs who were favorable to vaccination in general were most sensitive towards improved vaccine effectiveness. Our study suggests that vaccine safety considerations dominate vaccine decision-making among French HCWs, while adapted communication on indirect protection and social conformism can contribute to increase vaccination acceptance.
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Affiliation(s)
| | | | - Marie Lachatre
- Research Group for the Prevention of Occupational Infections in Healthcare Workers (GERES), Paris, France; Centre d'Investigation Clinique Cochin Pasteur CIC 1417, Hôpital Cochin, AP-HP, Paris, France
| | - Elisabeth Bouvet
- Research Group for the Prevention of Occupational Infections in Healthcare Workers (GERES), Paris, France; Haute autorité de santé (HAS), Commission technique des vaccinations (CTV), La Plaine Saint Denis, France
| | - Dominique Abiteboul
- Research Group for the Prevention of Occupational Infections in Healthcare Workers (GERES), Paris, France
| | - Elisabeth Rouveix
- Research Group for the Prevention of Occupational Infections in Healthcare Workers (GERES), Paris, France; CHU Ambroise Paré, Assistance Publique Hôpitaux de Paris (APHP,) Université Paris Saclay, France
| | - Gérard Pellissier
- Research Group for the Prevention of Occupational Infections in Healthcare Workers (GERES), Paris, France
| | - Jocelyn Raude
- EHESP French School of Public Health, Paris and Rennes, France; Unité des Virus Émergents (UVE: Aix-Marseille Univ - IRD 190 - Inserm 1207 - IHU Méditerranée Infection), Marseille, France
| | - Judith E Mueller
- EHESP French School of Public Health, Paris and Rennes, France; Institut Pasteur, Paris, France
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Abstract
The long-term care (LTC) sector will soon face a shortage of care workers. The consequences are potentially dramatic, urging the need to design policies aiming at reducing the turnover rate of LTC workers. Immigrant workers are an important part of the LTC workforce. Pooling data from the Annual Social and Economic (ASEC) supplement to the Current Population Survey (CPS) for years 2003-2019, we compare US-born and immigrant LTC workers' propensity to stay in the LTC workforce over one year. We distinguish two categories of LTC workers: personal care workers and nurses. We show that for both categories, naturalized citizens, legal noncitizen immigrants, and unauthorized immigrants have a higher probability of staying in the LTC workforce compared to US-born citizens. We provide two potential explanations: we show that immigrant personal care workers are more likely to report a better health, and that immigrant nurses have a lower wage variation sensitivity. Our results also suggest that wage increases are likely to be associated with higher retention rates in the profession.
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Affiliation(s)
- Thomas Rapp
- Chaire Ageinomix & LIRAES (EA 4470), Université de Paris, France.
| | - Jonathan Sicsic
- Chaire Ageinomix & LIRAES (EA 4470), Université de Paris, France
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Sicsic J, Ravesteijn B, Rapp T. Are frail elderly people in Europe high-need subjects? First evidence from the SPRINTT data. Health Policy 2020; 124:865-872. [PMID: 32507482 DOI: 10.1016/j.healthpol.2020.05.009] [Citation(s) in RCA: 5] [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] [Received: 07/30/2019] [Revised: 05/01/2020] [Accepted: 05/07/2020] [Indexed: 01/15/2023]
Abstract
Physical frailty and sarcopenia (PF&S) has received growing attention in empirical models of health care use. However, few articles focused on objective measures of PF&S to assess the extent of care consumption among the frail population at risk of dependency. Using baseline data from the SPRINTT study, a sample of 1518 elderly people aged 70+ recruited in eleven European countries, we analyse the association between various PF&S measures and health care / long term care (LTC) use. Multiple health care and LTC outcomes are modelled using linear probability models adjusted for a range of individual characteristics and country fixed effects. We find that PF&S is associated with a significant increase in emergency admissions and hospitalizations, especially among low-income elders. All PF&S measures are significantly associated with increased use of formal and informal LTC. There is a moderating effect of income on LTC use: poor frail elders are more likely to use any of the formal LTC services than rich frail elders. Our results are robust to various statistical specifications. They suggest that the inclusion of PF&S in the eligibility criteria of public LTC allowances could contribute to decrease the economic gradient in care use among the elderly community-dwelling European population.
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Affiliation(s)
| | | | - Thomas Rapp
- University of Paris, LIRAES, F-75006 Paris, France
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25
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François M, Sicsic J, Pelletier-Fleury N. Determinants of antidementia drug prescription in patients older than 65: A latent class analysis. Pharmacoepidemiol Drug Saf 2020; 29:444-452. [PMID: 32067291 DOI: 10.1002/pds.4921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 09/19/2019] [Accepted: 10/20/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Antidementia drugs (cholinesterase inhibitors and memantine) are still widely prescribed despite their controversial effects and 2011 guidelines that no longer encourage their prescription. The objective was to assess which factors remained determinants of antidementia drug prescriptions. METHODS A cross-sectional study was performed in 2013. Patients suffering from dementia, aged 65 and over, identified in the French national health insurance database were included. Because we anticipated a high correlation between age, comorbidities, and health care use, we first identified the patients' health status by a latent class analysis. Second, we performed adjusted logistic regression models. The explanatory variables were patients' health status, gender, prescription of nonpharmacological treatments (physical and speech therapies), prescription of psychotropic drugs, and access to health care. RESULTS Among the 3873 patients included, 38% received antidementia drugs. Three latent classes of patients with different health status were identified. Patients with poor health status received significantly fewer antidementia drugs (P < .001). Patients with speech therapy or antidepressant drugs received significantly more antidementia drugs (P < .001), whereas patients with physical therapy received significantly fewer antidementia drugs (P = .006). CONCLUSION Antidementia drugs were less likely to be prescribed for patients with poor health status. This result is encouraging for these frail patients who are more vulnerable to the adverse effects of treatments. At the same time, this result encourage targeting specifically patients in good health status for the use of a decision aid, in an attempt to limit prescriptions by involving patients and families.
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Affiliation(s)
- Mathilde François
- INSERM, Centre de Recherche en Epidémiologie et Santé des Populations, UMR1018, hôpital Paul Brousse, Université Paris Saclay, Villejuif Cedex, France.,Département de médecine générale, Faculté des sciences de la santé Simone Veil, Université Versailles-Saint-Quentin-en-Yvelines, Montigny le Bretonneux, France
| | - Jonathan Sicsic
- INSERM, Centre de Recherche en Epidémiologie et Santé des Populations, UMR1018, hôpital Paul Brousse, Université Paris Saclay, Villejuif Cedex, France
| | - Nathalie Pelletier-Fleury
- INSERM, Centre de Recherche en Epidémiologie et Santé des Populations, UMR1018, hôpital Paul Brousse, Université Paris Saclay, Villejuif Cedex, France
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Abstract
OBJECTIVE There is relative consensus that chronic conditions, disability, and time-to-death are key drivers of age-related health care expenditures. In this paper, we analyze the specific impact of frailty transitions on a wide range of health care outcomes comprising hospital, ambulatory care, and dental care use. DATA SOURCE Five regular waves of the SHARE survey collected between 2004 and 2015. STUDY DESIGN We estimate dynamic panel data models on the balanced panel (N = 6078; NT = 30 390 observations). Our models account for various sources of selection into frailty, that is, observed and unobserved time-varying and time-invariant characteristics. PRINCIPAL FINDINGS We confirm previous evidence showing that frailty transitions have a statistically significant and positive impact on hospital use. We find new evidence on ambulatory and dental care use. Becoming frail has greater impact on specialist compared to GP visit, and frail elderly are less likely to access dental care. CONCLUSIONS By preventing transitions toward frailty, policy planners could prevent hospital and ambulatory care uses. Further research is needed to investigate the relationship between frailty and dental care by controlling for reverse causation.
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Affiliation(s)
- Jonathan Sicsic
- LIRAES (EA 4470)Sorbonne Paris CitéCentre Universitaire des Saints‐PèresUniversity Paris DescartesParisFrance
| | - Thomas Rapp
- LIRAES (EA 4470)Sorbonne Paris CitéCentre Universitaire des Saints‐PèresUniversity Paris DescartesParisFrance
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Piroulas C, Devillers L, Souty C, Sicsic J, Boisnault P, François M. Non-steroids anti-inflammatory drugs and risk of peritonsillar abscess in pharyngitis: a French longitudinal study in primary care†. Fam Pract 2019; 36:425-430. [PMID: 30423110 DOI: 10.1093/fampra/cmy111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The safety of non-steroids anti-inflammatory drugs (NSAIDs) in the context of pharyngitis is doubtful with contradictory results in the literature. OBJECTIVE To evaluate the risk of peritonsillar abscess (PTA) associated to NSAIDs consumption during a pharyngitis episode observed in primary care. METHOD A retrospective cohort study using Observatory of General Medicine Datalink from 1995 to 2010. All patients consulting a GP from the Datalink network for pharyngitis have been included. The occurrence of a PTA in the 15 days following the consultation for pharyngitis was matched. The association between PTA and prescriptions of NSAIDs was studied via an adjusted logistic regression model. RESULTS During the study period, 105 802 cases of pharyngitis and 48 cases of PTA following a pharyngitis were reported, concerning respectively 67 765 and 47 patients. In the multivariate analysis, the risk of PTA was associated positively with a NSAIDs prescription (OR = 2.9, 95% CI = 1.6-5.2). Other factors associated with PTA occurrence were the prescription of corticosteroids (OR = 3.1, 95% CI = 1.3-7.6) and an age between 20 and 40 years (OR = 5.7, 95% CI = 2.5-13.0). The prescription of antibiotics was not significantly associated with PTA (P = 0.7). CONCLUSION Prescription of NSAIDs in pharyngitis may increase the risk of PTA. This study encourages considering cautiously the balance between benefits and harms before prescription of NSAIDs for pharyngitis.
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Affiliation(s)
- Cedric Piroulas
- Département de médecine générale, UFR des sciences de la santé Simone Veil, Université Versailles-Saint-Quentin-en-Yvelines, Montigny le Bretonneux, France
| | - Louise Devillers
- Département de médecine générale, UFR des sciences de la santé Simone Veil, Université Versailles-Saint-Quentin-en-Yvelines, Montigny le Bretonneux, France
| | - Cecile Souty
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMR-S1136), Paris, France
| | - Jonathan Sicsic
- Université Paris Saclay, INSERM, Centre de Recherche en Epidémiologie et Santé des Populations, Villejuif cedex, France
| | - Philippe Boisnault
- Société Française de Médecine Générale (SFMG), Issy les Moulineaux, France
| | - Mathilde François
- Département de médecine générale, UFR des sciences de la santé Simone Veil, Université Versailles-Saint-Quentin-en-Yvelines, Montigny le Bretonneux, France.,Université Paris Saclay, INSERM, Centre de Recherche en Epidémiologie et Santé des Populations, Villejuif cedex, France
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Krucien N, Sicsic J, Ryan M. For better or worse? Investigating the validity of best-worst discrete choice experiments in health. Health Econ 2019; 28:572-586. [PMID: 30761661 DOI: 10.1002/hec.3869] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 08/24/2017] [Revised: 11/15/2018] [Accepted: 11/29/2018] [Indexed: 06/09/2023]
Abstract
Discrete choice experiments (DCEs) are frequently used in health economics to measure preferences for nonmarket goods. Best-worst discrete choice experiment (BWDCE) has been proposed as a variant of the traditional "pick the best" approach. BWDCE, where participants choose the best and worst options, is argued to generate more precise preference estimates because of the additional information collected. However, the validity of the approach relies on two necessary conditions: (a) best and worst decisions provide similar information about preferences and (b) asking individuals to answer more than one choice question per task does not reduce data quality. Whether these conditions hold in empirical applications remains under researched. This is the first study to compare participants' choices across three experimental conditions: (a) BEST choices only, (b) WORST choices only, and (c) BEST and WORST choices (BWDCE). We find responses to worst choices are noisier. Implied preferences from the best only and worst only choices are qualitatively different, leading to different WTP values. Responses to BWDCE tasks have lower consistency, and respondents are more likely to use simplifying decision heuristics. We urge caution in using BWDCE as an alternative to the traditional "pick the best" DCE.
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Affiliation(s)
- Nicolas Krucien
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Jonathan Sicsic
- LIRAES (EA 4470), University Paris Descartes, Sorbonne-Paris-Cité, Paris, France
| | - Mandy Ryan
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
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Sicsic J, Franc C. [General practitioners’ preferences towards incentive measures linked with cancer screening]. Sante Publique 2019; S2:33-41. [PMID: 32372577 DOI: 10.3917/spub.197.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION General practitioners (GPs) play a key role in the delivery of preventive and screening services for breast, cervical, and colorectal cancers. Yet, their current provision of screening services remains low and varies considerably across screening contexts and GPs. This study investigates the determinants of GPs' involvement in cancer screening activities using discrete choice experiment (DCE) methodology. METHODS A representative sample of 402 GPs was recruited in France between March and April 2014. The participants completed 12 choice tasks designed to elicit their preferences for 5 cancer screening attributes aimed at increasing their supply of cancer screening services. RESULTS GPs are sensitive to both financial and non-financial incentives, such as a compensated training and systematic transmission of information about screened patients, aimed to facilitate communication between doctors and patients. There is also evidence that the preferences differ across screening contexts: GPs appear to be relatively more sensitive to financial incentives for being involved in colorectal cancer screening, whereas they have higher preference for non-financial incentives in breast and cervical cancers. CONCLUSION Our study provides new findings for policymakers interested in prioritizing levers to increase the supply of cancer screening services in general practice.
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Sicsic J, Pelletier-Fleury N, Carretier J, Moumjid N. [Eliciting women’s preferences for breast cancer screening]. Sante Publique 2019; 2:7-17. [PMID: 32372583 DOI: 10.3917/spub.197.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Over the past decade, the balance between the benefits and harms of breast cancer screening (BCS) has been widely debated. To date, no French study has interrogated women's points of view and preferences (in the economic sense) for this controversial screening. This study aims to bridge this gap. We aimed to elicit women's trade-offs between the benefits and harms of BCS. METHODS A discrete choice experiment questionnaire was developed and administered by a survey institute to French women in order to elicit their preferences and trade-offs between the benefits and risks of BCS (i.e., overdiagnosis and false-positive mammography). RESULTS Eight hundred and twelve women, representative of the French general population (age, socioeconomic level, and geographical location), completed the survey. The women would be willing to accept on average 14.1 overdiagnosis cases (median = 9.6) and 47.8 women with a false-positive result (median = 27.2) to avoid one BC-related death. Results from our simulations predict that less than 50% of women would be willing to accept 10 overdiagnosis cases (respectively, 30 women with a false-positive mammography) for one BC-related death avoided. CONCLUSION Women are sensitive to both the benefits and harms of BC screening and their preferences are highly heterogeneous. Providing balanced information on both benefits and harms to women through an informed decision-making process would be more respectful of women's preferences.
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Devillers L, Sicsic J, Delbarre A, Le Bel J, Ferrat E, Saint Lary O. General Practitioner trainers prescribe fewer antibiotics in primary care: Evidence from France. PLoS One 2018; 13:e0190522. [PMID: 29370178 PMCID: PMC5784911 DOI: 10.1371/journal.pone.0190522] [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] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 12/15/2017] [Indexed: 02/01/2023] Open
Abstract
Purpose Antibiotic prescription is a central public health issue. Overall, 90% of antibiotic prescriptions are delivered to patients in ambulatory care, and a substantial proportion of these prescriptions could be avoided. General Practitioner (GP) trainers are similar to other GPs in terms of sociodemographic and medical activities, but they may have different prescription patterns. Our aim was to compare the antibiotic prescribing rates between GP trainers and non-trainers. Methods This observational cross-sectional study was conducted on administrative data claims from the French National Health Insurance. The antibiotic prescribing rate was calculated. The main independent variable was the training status of the GPs. Prescribing rates were adjusted for the various GPs’ characteristics (gender, age, location of the practice, number of visits per GP and the case-mix) in a multiple linear regression analysis. Results Between June 2014 and July 2015 the prescribing patterns of 860 GPs were analysed, among which 102 were GP trainers (12%). Over the year 363,580 patients were prescribed an antibiotic out of 3,499,248 visits for 1,299,308 patients seen over the year thus representing around 27.5% of patients. In the multivariate analyses, being a trainer resulted in a significant difference of 6.62 percentage points (IC 95%: [-8.55; -4.69]; p<0.001) in antibiotic prescriptions comparing to being a non-trainer, corresponding to a relative reduction of 23.4%. Conclusion These findings highlight the role of GP trainers in antibiotic prescriptions. By prescribing fewer antibiotics and influencing the next generations of GPs, the human and economic burden of antibiotics could be reduced.
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Affiliation(s)
- Louise Devillers
- Department of Family Medicine, Faculty of Health Sciences Simone Veil, University Versailles Saint-Quentin en Yvelines (UVSQ), Montigny-le-Bretonneux, France
- CESP, University Paris-Sud, UVSQ, INSERM U1018, University Paris-Saclay, Villejuif, France
- * E-mail:
| | - Jonathan Sicsic
- CESP, University Paris-Sud, UVSQ, INSERM U1018, University Paris-Saclay, Villejuif, France
| | - Angelique Delbarre
- CESP, University Paris-Sud, UVSQ, INSERM U1018, University Paris-Saclay, Villejuif, France
| | - Josselin Le Bel
- Department of Family Medicine, University Paris Diderot, Sorbonne Paris Cité, Paris, France
- UMR 1137, INSERM, IAME, Paris, France
| | - Emilie Ferrat
- University Paris-Est Créteil (UPEC), School of Medicine, Primary Care Department, Créteil, France
- University Paris-Est Créteil (UPEC), DHU A-TVB, IMRB, EA 7376 CEpiA (Clinical Epidemiology And Ageing Unit), Créteil, France
| | - Olivier Saint Lary
- Department of Family Medicine, Faculty of Health Sciences Simone Veil, University Versailles Saint-Quentin en Yvelines (UVSQ), Montigny-le-Bretonneux, France
- CESP, University Paris-Sud, UVSQ, INSERM U1018, University Paris-Saclay, Villejuif, France
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François M, Sicsic J, Pelletier Fleury N. Drugs for Dementia and Excess of Hospitalization: A Longitudinal French Study. J Alzheimers Dis 2018; 61:1627-1637. [DOI: 10.3233/jad-170371] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Mathilde François
- Université Paris Saclay, INSERM, Centre de Recherche en Epidémiologie et Santé des Populations, Hôpital Paul Brousse, Villejuif Cedex, France
- Département de Médecine Générale, Faculté des Sciences de la Santé Simone Veille, Université Versailles-Saint-Quentin-en-Yvelines, Montigny le Bretonneux, France
| | - Jonathan Sicsic
- Université Paris Saclay, INSERM, Centre de Recherche en Epidémiologie et Santé des Populations, Hôpital Paul Brousse, Villejuif Cedex, France
| | - Nathalie Pelletier Fleury
- Université Paris Saclay, INSERM, Centre de Recherche en Epidémiologie et Santé des Populations, Hôpital Paul Brousse, Villejuif Cedex, France
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Sicsic J, Pelletier-Fleury N, Moumjid N. Women's Benefits and Harms Trade-Offs in Breast Cancer Screening: Results from a Discrete-Choice Experiment. Value Health 2018; 21:78-88. [PMID: 29304944 DOI: 10.1016/j.jval.2017.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 07/10/2017] [Accepted: 07/14/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Over the past decade, the benefits and harms balance of breast cancer (BC) screening has been widely debated. OBJECTIVES To elicit women's trade-offs between the benefits and harms of BC screening and to analyze the main determinants of these trade-offs. METHODS A discrete-choice experiment with seven attributes depicting BC screening programs including varying levels of BC mortality, overdiagnosis, and false-positive result was used. Eight hundred twelve women aged 40 to 74 years with no personal history of BC recruited by a survey institute and representative of the French general population (age, socioeconomic level, and geographical location) completed the discrete-choice experiment. Preference heterogeneity was investigated using generalized multinomial logit models from which individual trade-offs were derived, and their main determinants were assessed using generalized linear models. Screening acceptance rates under various benefits and harms ratios were simulated on the basis of the distribution of individual preferences. RESULTS The women would be willing to accept on average 14.1 overdiagnosis cases (median = 9.6) and 47.8 false-positive results (median = 27.2) to avoid one BC-related death. After accounting for preference heterogeneity, less than 50% of women would be willing to accept 10 overdiagnosis cases for one BC-related death avoided. Screening acceptance rates were higher among women with higher socioeconomic level and lower among women with poor health. CONCLUSIONS Women are sensitive to both the benefits and the harms of BC screening and their preferences are highly heterogeneous. Our study provides useful results for public health authorities and clinicians willing to improve their recommendations of BC screening on the basis of women's preferences.
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Affiliation(s)
- Jonathan Sicsic
- Centre Léon Bérard, Cancer Environment Team, Lyon, France; CESP, Université Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France; Health Services and Performance Research (HESPER EA 7425), Lyon, France.
| | | | - Nora Moumjid
- Centre Léon Bérard, Cancer Environment Team, Lyon, France; Health Services and Performance Research (HESPER EA 7425), Lyon, France; University Claude Bernard, Lyon, France
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Sicsic J, Franc C. Impact assessment of a pay-for-performance program on breast cancer screening in France using micro data. Eur J Health Econ 2017; 18:609-621. [PMID: 27329654 DOI: 10.1007/s10198-016-0813-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 06/14/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND A voluntary-based pay-for-performance (P4P) program (the CAPI) aimed at general practitioners (GPs) was implemented in France in 2009. The program targeted prevention practices, including breast cancer screening, by offering a maximal amount of €245 for achieving a target screening rate among eligible women enrolled with the GP. OBJECTIVE Our objective was to evaluate the impact of the French P4P program (CAPI) on the early detection of breast cancer among women between 50 and 74 years old. METHODS Based on an administrative database of 50,752 women aged 50-74 years followed between 2007 and 2011, we estimated a difference-in-difference model of breast cancer screening uptake as a function of visit to a CAPI signatory referral GP, while controlling for both supply-side and demand-side determinants (e.g., sociodemographics, health and healthcare use). RESULTS Breast cancer screening rates have not changed significantly since the P4P program implementation. Overall, visiting a CAPI signatory referral GP at least once in the pre-CAPI period increased the probability of undergoing breast cancer screening by 1.38 % [95 % CI (0.41-2.35 %)], but the effect was not significantly different following the implementation of the contract. CONCLUSION The French P4P program had a nonsignificant impact on breast cancer screening uptake. This result may reflect the fact that the low-powered incentives implemented in France through the CAPI might not provide sufficient leverage to generate better practices, thus inviting regulators to seek additional tools beyond P4P in the field of prevention and screening.
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Affiliation(s)
- Jonathan Sicsic
- CESP, Univ. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Hôpital Paul Brousse, 16 avenue Paul Vaillant-Couturier, 94807, Villejuif Cedex, France.
| | - Carine Franc
- CESP, Univ. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Hôpital Paul Brousse, 16 avenue Paul Vaillant-Couturier, 94807, Villejuif Cedex, France
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Constantinou P, Sicsic J, Franc C. Effect of pay-for-performance on cervical cancer screening participation in France. Int J Health Econ Manag 2016; 17:10.1007/s10754-016-9207-3. [PMID: 28005224 DOI: 10.1007/s10754-016-9207-3] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 12/04/2016] [Indexed: 06/06/2023]
Abstract
Pay-for-performance (P4P) has been increasingly used across different healthcare settings to incentivize the provision of targeted services. In this study, we investigated the effect of a nationwide P4P scheme for general practitioners implemented in 2012 in France, on cervical cancer screening practices. Using data from a nationally representative permanent sample of health insurance beneficiaries, we analyzed smear test use of eligible women for the years 2006-2014. Our longitudinal sample was an unbalanced panel comprising 180,167 women eligible from 1 to 9 years each. We took into account that during our study period some women were exposed to another incentive for screening participation: the implementation in 2010 of organized screening (OS) in a limited number of areas. To evaluate the effect of P4P, we defined three different measures of smear utilization. For each measure, we specified binary panel-data models to estimate annual probabilities and to compare each estimate to the 2011 baseline level. To explore the combined effect of P4P and OS in areas exposed to both incentives, we computed interaction terms between year dummies and area of residence. We found that P4P had a modest positive effect on recommended screening participation. This effect is likely to be transient as annual smear use, both for the whole sample and among women overdue for screening, increased only in 2013 and decreased again in 2014. The combined effect of P4P and OS on screening participation was not cumulative during the first years of coexistence.
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Affiliation(s)
- Panayotis Constantinou
- INSERM, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay, Université Paris-Sud, UVSQ, 16, avenue Paul Vaillant Couturier, 94807, Villejuif Cedex, France.
| | - Jonathan Sicsic
- INSERM, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay, Université Paris-Sud, UVSQ, 16, avenue Paul Vaillant Couturier, 94807, Villejuif Cedex, France
| | - Carine Franc
- INSERM, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay, Université Paris-Sud, UVSQ, 16, avenue Paul Vaillant Couturier, 94807, Villejuif Cedex, France
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Sicsic J, Krucien N, Franc C. What are GPs' preferences for financial and non-financial incentives in cancer screening? Evidence for breast, cervical, and colorectal cancers. Soc Sci Med 2016; 167:116-27. [DOI: 10.1016/j.socscimed.2016.08.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 08/26/2016] [Accepted: 08/27/2016] [Indexed: 11/25/2022]
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Bussière C, Sicsic J, Pelletier-Fleury N. Simultaneous effect of disabling conditions on primary health care use through a capability approach. Soc Sci Med 2016; 154:70-84. [DOI: 10.1016/j.socscimed.2016.02.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 02/05/2016] [Accepted: 02/14/2016] [Indexed: 01/16/2023]
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Laurent F, Sicsic J, Saint-Lary O. [Contract for improving professional practices: What is the impact perceived by GPs?]. Rev Epidemiol Sante Publique 2015; 63:67-76. [PMID: 25819993 DOI: 10.1016/j.respe.2015.01.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 02/18/2014] [Revised: 10/24/2014] [Accepted: 01/08/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The CAPI (contract for improving professional practices) is a voluntary pay for performance scheme for primary care physicians introduced in France in 2009. Our objective was to analyze general practitioners' (GPs) perceptions of the impact of the CAPI on their healthcare practices. METHOD The methodology was both qualitative, using thematic analysis of responses to three items of a questionnaire mailed to GPs in 2011, and quantitative using thematic multiple correspondence analysis of responses together with cluster analysis based on the ward aggregation criterion. RESULTS A total of 1050 general practitioners answered, 31% had signed a CAPI. For CAPI-participating GPs, the contract was mostly related to changing practices for drug prescription. GPs who did not participate in the CAPI focused on ethical issues. They denounced a conflict of interest between the doctor and the patient and also the risk of patient selection. They connected these concepts to selected indicators. Due to their relationship with the health insurance fund, they feared their freedom of practice would be restricted. CONCLUSION GP involvement in designing indicators would favor better balance between economic goals and values of care. The patients' viewpoint should be studied. Pay for performance has been renewed in the 2011. Further studies will analyze the impact of this new scheme in a medical and economic perspective.
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Affiliation(s)
- F Laurent
- Département de médecine générale, UFR des sciences de la santé Simone-Veil, université Versailles Saint-Quentin-en-Yvelines, 78180 Montigny-le-Bretonneux, France
| | - J Sicsic
- CERMES3, UMR 8211, Inserm U988, 94800 Villejuif, France
| | - O Saint-Lary
- Département de médecine générale, UFR des sciences de la santé Simone-Veil, université Versailles Saint-Quentin-en-Yvelines, 78180 Montigny-le-Bretonneux, France.
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Saint-Lary O, Sicsic J. Impact of a pay for performance programme on French GPs' consultation length. Health Policy 2014; 119:417-26. [PMID: 25458971 DOI: 10.1016/j.healthpol.2014.10.001] [Citation(s) in RCA: 13] [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] [Received: 01/24/2014] [Revised: 09/11/2014] [Accepted: 10/05/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND In 2009, a voluntary-based pay for performance scheme targeting general practitioners (GPs) was introduced in France through the 'Contract for Improving Individual Practices' (CAPI). OBJECTIVE To study the impact of the CAPI on French GPs' consultation length. METHODS Univariate analysis, and multilevel regression analyses were performed to disentangle the different sources of the consultation length variability (intra and inter physician). The dependant variable was the logarithm of the consultation length. Independent variables included patient's sociodemographics as well as the characteristics of GPs and their medical activity. RESULTS Between November 2011 and April 2012, 128 physicians were recruited throughout France and generated 20,779 consultations timed by residents. The average consultation length in the sample was 16.8 min. After adjusting for patients' characteristics only, the consultation length of CAPI signatories was 14.1% lower than that observed for non signatories (p<0.001). After adjusting for GPs' characteristics and the case mix, the CAPI was no longer a significant predictor of the consultation length. The results did not change significantly from one type of consultation to another. CONCLUSION Although the CAPI was extended to all GPs in 2012, our results provide a cautionary message to regulators about its ability to generate higher quality of care.
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Affiliation(s)
- Olivier Saint-Lary
- Collège National des Généralistes Enseignants (CNGE), University Versailles Saint-Quentin en Yvelines, Department of Family Medicine, 78180 Montigny le Bretonneux, France
| | - Jonathan Sicsic
- CERMES3, UMR8211, INSERM U988, Site CNRS, 7, rue Guy Môquet, 94801 Villejuif Cedex, France.
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Sicsic J, Franc C. Obstacles to the uptake of breast, cervical, and colorectal cancer screenings: what remains to be achieved by French national programmes? BMC Health Serv Res 2014; 14:465. [PMID: 25282370 PMCID: PMC4282512 DOI: 10.1186/1472-6963-14-465] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [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: 03/21/2014] [Accepted: 09/16/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In France, equality in access to screening has been one of the main thrusts of public policies implemented between 2009 and 2013 (the national cancer plan). Our aim in this study was to analyse the obstacles to and levers for breast, cervical, and colorectal cancer screening uptake and their trends over time. METHODS Based on representative data from the French Health Care and Health Insurance Survey (three independent, cross-sectional surveys: 2006, 2008, and 2010), multivariate logistic regressions were used to model the association between the nonuse of screening for the three cancers and various independent variables. Then, interactions with survey year dummies allowed the changes in the determinants of these cancer screenings over time to be estimated. RESULTS Whereas the incentives for screening were strengthened during the period considered, cervical and breast cancer screenings decreased, and colorectal cancer screenings increased sharply (from 18.2% (95% CI = [17.0-19.4]) in 2006 to 38.9% (95% CI = [37.4-40.5] in 2010. Under-users of the three cancer screenings were primarily unskilled workers (ORcervix = 1.64 [1.38-1.95]), individuals without complementary health insurance (ORbreast = 2.05 [1.68-2.51]), or individuals with free complementary health insurance who more rarely use outpatient care. Moreover, individuals reporting either risky behaviours, namely heavy smokers (ORcolorectal = 1.70) and high-risk drinkers (ORcervix = 1.42) or very safe behaviours, namely neither smoking nor drinking, underused screenings. Despite the implementation of national programmes for breast and colorectal cancer screenings, the disparities and inequalities in screening uptake did not decrease over the study period. CONCLUSIONS These results demonstrate the need for additional primary prevention efforts targeting the identified under-users by focusing on, for instance, individuals with a very healthy lifestyle. Health authorities could also intensify their efforts to promote increased access to screening for the most disadvantaged individuals.
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Affiliation(s)
- Jonathan Sicsic
- Cermes3, UMR8211, Inserm U988, Site CNRS, 7, rue Guy Moquet, 94801 Villejuif Cedex, France.
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Bussière C, Sicsic J, Pelletier-Fleury N. The effects of obesity and mobility disability in access to breast and cervical cancer screening in france: results from the national health and disability survey. PLoS One 2014; 9:e104901. [PMID: 25133662 PMCID: PMC4136821 DOI: 10.1371/journal.pone.0104901] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 07/15/2014] [Indexed: 12/01/2022] Open
Abstract
Objectives We aimed to disentangle the effects of obesity and mobility limitation on cervical and breast cancer screening among community dwelling women. Methods The data source was the French national Health and Disability Survey - Household Section, 2008. The Body Mass Index (BMI) was used to categorize obesity status. We constructed a continuous score of mobility limitations to assess the severity of disability (Cronbach's alpha = 0.84). Logistic regressions were performed to examine the association between obesity, mobility limitations and the use of Pap test (n = 8 133) and the use of mammography (n = 7 561). Adjusted odds ratios were calculated (AOR). Interaction terms between obesity and the disability score were included in models testing for effect modifications. Results Compared with non-obese women, the odds of having a Pap test in the past 3 years was 24% lower in obese women (AOR = 0.76; 95% CI: 0.65 to 0.89), the odds of having a mammogram in the past 2 years was 23% lower (AOR = 0.77; 95% CI: 0.66 to 0.91). Each time the disability score was 5 points higher, the odds of having a Pap test decreases by 20% (AOR = 0.96; 95% CI: 0.94 to 0.98), the odds of having a mammogram decreases by 25% (AOR = 0.95; 95% CI: 0.94 to 0.97). There was no significant interaction between obesity and disability score. Conclusion Obesity and mobility limitation are independently associated with a lower likelihood of cervical and breast cancer screening. Protective outreach and follow-up are necessary to reduce inequalities and thus to reduce health disparities in these vulnerable and high-risk populations of obese women with disabilities.
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Bussière C, Sicsic J, Pelletier-Fleury N. The effects of obesity and mobility disability in access to breast and cervical cancer screening in France: results from the National Health and Disability Survey. BMC Health Serv Res 2014. [PMCID: PMC4122844 DOI: 10.1186/1472-6963-14-s2-p13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Sicsic J, Le Vaillant M, Franc C. Building a composite score of general practitioners' intrinsic motivation: a comparison of methods. Int J Qual Health Care 2014; 26:167-73. [DOI: 10.1093/intqhc/mzu007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Franc C, Sicsic J. Évolution des inégalités de recours au dépistage des cancers en France entre 2006 et 2010. Rev Epidemiol Sante Publique 2013. [DOI: 10.1016/j.respe.2013.07.177] [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: 10/26/2022] Open
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Saint-Lary O, Bernard E, Sicsic J, Plu I, François-Purssell I, Franc C. Why did most French GPs choose not to join the voluntary national pay-for-performance program? PLoS One 2013; 8:e72684. [PMID: 24039794 PMCID: PMC3767729 DOI: 10.1371/journal.pone.0072684] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 07/17/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In 2009, a voluntary pay for performance (P4P) scheme for primary care physicians was introduced in France through the 'Contract for Improving Individual Practice' (CAPI). Although the contract could be interrupted at any time and without any penalty, two-thirds of French general practitioners chose not to participate. We studied what factors motivated general practitioners not to subscribe to the P4P contract, and particularly their perception of the ethical risks that may be associated with adhering to a CAPI. METHOD A cross-sectional survey among French general practitioners using an online questionnaire based on focus group discussion results. Descriptive and multivariate statistical analyses with logistic regression. RESULTS A sample of 1,016 respondents, representative of French GPs. The variables that were associated with the probability of not signing a CAPI were "discomfort that patients were not informed of the signing of a P4P contract by their doctors" (OR = 8.24, 95% CI = 4.61-14.71), "the risk of conflicts of interest" (OR = 4.50, 95% CI = 2.42-8.35), "perceptions by patients that doctors may risk breaching professional ethics" (OR = 4. 35, 95% CI = 2.43-7.80) and "the risk of excluding the poorest patients" (OR = 2.66, 95% CI = 1.53-4.63). CONCLUSION The perception of ethical risks associated with P4P may have hampered its success. Although the CAPI was extended to all GPs in 2012, our results question the relevance of the program itself by shedding light on potential adverse effects.
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Affiliation(s)
- Olivier Saint-Lary
- University Versailles Saint-Quentin en Yvelines, Department of Family Medicine, Montigny le Bretonneux, France
- Prospere Team Research, Paris, France
| | - Erik Bernard
- University Versailles Saint-Quentin en Yvelines, Department of Family Medicine, Montigny le Bretonneux, France
- Prospere Team Research, Paris, France
| | - Jonathan Sicsic
- CERMES3 - UMR 8211 - INSERM U988, Villejuif, France
- Prospere Team Research, Paris, France
| | - Isabelle Plu
- Forensic Medicine University Paris Descartes, Paris, France
| | | | - Carine Franc
- CERMES3 - UMR 8211 - INSERM U988, Villejuif, France
- Prospere Team Research, Paris, France
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