Hepatitis B virus vaccination by French family physicians

Vaccine coverage against hepatitis B virus (HBV) in France has decreased to one of the lowest levels among countries that recommend it, over the last decade. The probable cause was that the vaccine was suspected to induce demyelinating diseases. We studied the factors limiting the use of HBV vaccine amongst French family physicians (FPs), who play a significant role in the implementation of the vaccination policy.

Method

We conducted a national survey in 2008, using an interactive questionnaire sent by e-mail to 2175 private general practitioners in metropolitan France. This questionnaire provided us with demographic data and information on perception, opinions and practices of FPs regarding HBV vaccination. It also assessed practical barriers to vaccination FPs encountered. The answer structure was analyzed by multiple correspondence analysis (MCA). An agglomerative hierarchical clustering (AHC) identified typical behaviors among FPs. We determined and tested specific links among answers. The representativeness of the final sample (341 FPs) was tested.

Results

HBV vaccination for infants is increasingly recommended; children and teenage vaccine catch-up is less routinely recommended; 25% of FPs are opposed to systematic vaccination; the main barrier to vaccination, according to FPs, remains public opinion on the vaccine's potential adverse effects; barriers among physicians include excessive precaution principle in prescribing the vaccine and misconceptions on hepatitis B and vaccination.     

Do French low-income GPs choose to work less?

In France, a significant number of General Practitioners (GPs) earn less than 1.5 times the French minimum salary. Using a representative panel of self-employed GPs over the years 1993-2004, this paper tests whether these low-income GPs choose to work less than all other GPs or whether they are constrained to do so. The test is based on measuring reactions to positive and negative demand shocks. As low-income GPs do not increase activity in response to a positive demand shock but decrease activity in response to a negative demand shock, it appears that their low-income status is attributable to a strong preference for leisure.     

Perception of Alzheimer’s disease in the French population

Background: Objective

The aim of this study was to investigate the perception, knowledge, opinions and beliefs about AD in the French population to improve care for patients with Alzheimer’s disease.

Design

A cross-sectional telephone survey in 2008.

Setting

French “Alzheimer Plan 2008–2012”.

Participants

2013 respondents, representative of the French population.

Measurements

The respondents answered a questionnaire in which they were presented with a series of attitudinal statements about health in general and AD.

Results

Main results are summarized as followed: (a) Respondents think that AD can be devastating for a family (93%). This devastating feeling prevails in the population >75 years old and in people who know patient with AD. (b) General population has a reasonable knowledge about AD, but is still unable to recognize early stages: 95% of respondents considered that difficulties to manage administrative papers and find their way back home suggest early AD. (c) 91% of the population would like to know the diagnosis if they had AD. (d) 38% of the population know or have known at least one patient within their social circle. People think that the care of AD’s patient can be better but they trust in the French government to improve it.

Conclusion

General representation of AD is changing in a positive way and, even though AD is perceived as a calamity, people are confident that solutions will be found in the future.     

Nonurgent patients in the emergency department? A French formula to prevent misuse

Background  

Overcrowding in emergency department (EDs) is partly due to the use of EDs by nonurgent patients. In France, the authorities responded to the problem by creating primary care units (PCUs): alternative structures located near hospitals. The aims of the study were to assess the willingness of nonurgent patients to be reoriented to a PCU and to collect the reasons that prompted them to accept or refuse.     

Impact of a pay for performance programme on French GPs’ consultation length

BackgroundIn 2009, a voluntary-based pay for performance scheme targeting general practitioners (GPs) was introduced in France through the ‘Contract for Improving Individual Practices’ (CAPI).ObjectiveTo study the impact of the CAPI on French GPs’ consultation length.MethodsUnivariate 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.ResultsBetween 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.ConclusionAlthough 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.     

The French National Nutrition and Health Program: 2001–2006–2010

Summary Objectives: Established in 2001–2005 then extended to 2010, the French National Nutrition and Health Program (PNNS) is a nutrition policy whose objective is to improve the health status of the population by acting on one of its major determinants, nutrition. Methods: Nine priority objectives focusing on diet, physical activity and nutritional status were determined. Program strategies are based on fundamental principles including food culture, pleasure, and gastronomy. This multidisciplinary program involves stakeholders from ministries, research and educational institutions, food industry, healthcare, and consumers. Results: More than 75 % of the public health actions planned were accomplished or in progress by the end of 2005, particularly those concerning nutrition communication, education, research and nutritional surveillance. Dietary guidelines were established and are now considered the official reference in France. Actions focusing on the healthcare system, economic actors and players and specific population groups need further development. Conclusions: The success of a public health program like the PNNS requires a combination of synergistic and complementary actions, measures, regulations and laws. A national study at the end of the PNNS will determine if objectives were achieved. Submitted: 28 February 2007; Revised: 05 July 2007, 10 December 2007; Accepted: 21 December 2007     

General practitioners’ attitudes and behaviors toward HPV vaccination: A French national survey

ObjectiveGeneral practitioners (GPs) play a crucial role in human papillomavirus (HPV) vaccine acceptance in France. We sought to study: (1) GPs’ perceptions of its risks and efficacy and their recommendation behavior; (2) the relative importance of factors associated with the frequency of their recommendations.MethodsCross-sectional observational study in 2014 nested in a national panel of 1712 randomly selected GPs in private practice in France (response rate: 92.4%). We used model averaging to analyze the associations of self-reported frequency of GPs’ HPV vaccine recommendations with their perception of its risk-benefit balance and their opinions about the utility of vaccines in general.ResultsOverall, 72% of participants reported frequently recommending HPV vaccination; 60% considered that not enough is known about its risks. The model averaging showed that the factors most associated with infrequent recommendation of this vaccine by GPs were: unfavorable perceptions of its risk-benefit balance (OR = 0.13; 95%CI = 0.09–0.21; partial R² = 0.10), a decision not to vaccinate one's own daughter(s) with this vaccine (OR = 0.13; 95%CI = 0.07–0.24; partial R² = 0.05), and doubts about vaccine utility in general (OR = 0.78; 95%CI = 0.71–0.86; partial R² = 0.03).ConclusionAlthough nearly three-quarters of French GPs frequently recommended the HPV vaccine, our findings indicate that a substantial percentage of them are hesitant about it. Doubts about its risks and efficacy strongly influence their recommendation behavior. More research is warranted to help design and evaluate tailored tools and multicomponent intervention strategies to address physician's hesitancy about this vaccine.     

Mortality analyses in the updated French cohort of uranium miners (1946–2007)

Purpose

The objectives are to analyze mortality risks in the extended follow-up of the French uranium miners’ cohort and to examine their potential relation to occupational exposure to ionizing radiation (IR).

Methods

The total cohort includes 5,086 uranium miners employed in the CEA-COGEMA group and followed up from 1946 to 2007. Vital status, causes of death, and cumulative radon exposures were recorded. The post-55 subcohort includes 3,377 miners first employed after 1955, for whom long-lived radionuclides (LLR) and external gamma-ray exposure were also recorded. External mortality analyses were performed by computing standardized mortality ratios (SMR). Excess relative risks (ERRs) due to IR exposures were estimated from Poisson regression models.

Results

The miners included in the total cohort were followed up for 35.4 years and exposed to 36.6 working level months (WLM) on average. There was no evidence of a difference in overall mortality between miners and the general French male population. Miners had a statistically significant excess mortality rate from lung cancer (SMR = 1.34 [95 % CI 1.16–1.53]) and from kidney cancer (SMR = 1.60 [1.03–2.39]). Cumulative radon exposure was significantly associated with lung cancer risk (ERR/100 WLM = 0.71 [0.31–1.30]) and cerebrovascular risk (ERR/100 WLM = 0.41 [0.04–1.03]). In the post-55 subcohort, this excess mortality from lung cancer remained associated with exposure to radon, and also with exposure to LLR and external gamma rays.

Conclusions

The analyses in the extended follow-up strengthen the results previously observed among French uranium miners about their excess risk of mortality and its association with their occupational IR exposure.

     

Environmental justice in a French industrial region: Are polluting industrial facilities equally distributed?

Recent studies have suggested that minority or deprived groups are subject to the additional burden of a polluted living environment. Our goal is to determine whether such environmental inequalities occur in France's leading industrial region, using detailed socio-economic data and advanced Bayesian methods. Associations between proximity to hazardous facilities (i.e., within a 2km radius) and the socio-economic characteristics of populations are analyzed at fine geographical scales. Noxious facilities are disproportionately located in higher foreign-born communities after controlling for deprivation (Townsend score), population density and rural/urban status. High deprivation also appears as a predictive factor, although less strongly and less consistently.     

Association of Parkinson’s disease with industry sectors: a French nationwide incidence study

In order to identify working environments at risk for Parkinson’s disease (PD), we investigated the relation between the importance of industry sectors, used as a surrogate for occupational exposures, and PD incidence in French cantons. The number of incident PD cases (2010–2014) in 3689 cantons of metropolitan France was determined using drug claims from French National Health Insurance databases. The proportions of workers in 38 industry sectors in 2006 were calculated for each canton. Associations between the proportions of workers in industry sectors and PD age/sex-standardized incidence ratios were examined using incidence rate ratios (IRR) and 95% confidence intervals (CI) estimated with multilevel negative binomial regressions with a random intercept at the canton-level and adjusted for smoking, deprivation index, and density of neurologists. We then used two-step semi-Bayes hierarchical regression (HR) to include prior information about exposure to pesticides, metals, and solvents in each industry sector. We identified 112,625 incident cases. PD incidence was higher in areas characterized by high proportions of workers in “Agriculture, forestry and fishing” (IRR_HR?=?1.042; CI 95%?=?1.014–1.070; p-Trend_HR?=?0.004), “Manufacture of textiles, wearing apparel, leather and related products” (IRR_HR?=?1.024; CI 95%?=?1.005–1.044; p-Trend_HR?=?0.010), and “Manufacture of basic metals and fabricated metal products, except machinery and equipment” (IRR_HR?=?1.024; CI 95%?=?1.003–1.046; p-Trend_HR?=?0.071). This nationwide study, based on a comprehensive analysis of industry sectors, shows significant associations between high proportions of workers in specific industry sectors (agriculture, metallurgy, textile) and PD incidence that may be targeted in further epidemiological studies to replicate and better understand these associations.     

Diabetes mellitus and obesity in the French Caribbean: A special vulnerability for women?

ABSTRACT

The objective of this study was to analyze the prevalence, awareness, treatment, and control of diabetes and its risk factors among French Caribbean adults. This cross-sectional study included 18–74-year olds (N = 2252; 56.5 percent women) who underwent a heath examination in Guadeloupe during July–December 2014. Diabetes was defined as using antidiabetic treatment, or fasting glucose ≥7 mmol/l, and glycated hemoglobin (HbA1c) ≥6.5 percent; diabetes control was defined as HbA1c < 7 percent. Multilevel logistic regression was used. Diabetes prevalence was 8.2 percent for women and 5 percent for men (age-adjusted odds ratio [aOR] for women = 2.0; 95 percent confidence interval [CI]: 1.4–2.9). The proportion of women with diabetes who were aware of it was 84.5 versus 67.3 percent in men (aOR = 2.7; 95 percent CI: 1.2–6.2). Nearly, all diagnosed participants were being treated. In less than a third of diabetics in both sexes was diabetes control obtained. Most women (55.3 percent) had a waist circumference at or above the National Cholesterol Education Program thresholds versus 14 percent of men (aOR = 9.3; 95 percent CI: 7.5–11.7), which wholly accounted for excess diabetes in women. In women, obesity and diabetes were associated with low education and income. In this French Caribbean sample, abdominal obesity and diabetes affected more women. Diabetes was rarely controlled. A comprehensive women’s health policy for the prevention of abdominal obesity and diabetes is needed.