Nudging health care workers towards a flu shot: reminders are accepted but not necessarily effective. A randomized controlled study among residents in general practice in France.

BACKGROUND: A nudge corresponds to any procedure that influences choice architecture, without using persuasion or financial incentives. Nudges are effective in increasing vaccination with heterogeneous levels of acceptability. OBJECTIVE: To evaluate the effectiveness and acceptability of a nudge promoting influenza vaccination for general practice trainees, also called residents. METHODS: The hypothesis was that a reminder would be efficient and accepted and that prior exposure to a nudge increases its acceptability. Residents were randomly divided into three parallel experimental arms: a nudge group, a no-nudge group and a control group in order to evaluate the Hawthorne effect. The nudge consisted of providing a paper form for the free delivery of the vaccine and contacts for occupational health services. RESULTS: The analysis included 161 residents. There was a strong consensus among the residents that it is very acceptable to nudge their peers and patients. Acceptability was better with residents exposed to the nudge and with residents included in step 1 (Hawthorne effect). The nudge did not increase vaccination coverage. CONCLUSION: The failure of this nudge highlights the importance of matching an intervention to the population's needs. The experimental approach is innovative in this context and deserves further attention. CLINICALTRIALS.GOV PRE-REGISTRATION: NCT03768596.

Home-based palliative care management: what are the useful resources for general practitioners? a qualitative study among GPs in France.

BACKGROUND: Most French people (71%) would like to die at home, but only one out of four actually do. While the difficulties inherent in the practice of home-based palliative care are well described, few studies highlight the resources currently used by general practitioners (GPs) in real life. We have therefore sought to highlight the resources actually used by GPs providing home-based palliative care. METHODS: Twenty-one GPs of different ages and practice patterns agreed to participate to this qualitative study based upon semi-structured interviews. They were recruited according to a purposive sampling. Transcripts analysis was based upon General Inductive Analysis. RESULTS: The resources highlighted have been classified into two main categories according to whether they were internal or external to the GPs. The internal resources raised included the doctor's practical experience and continuous medical education, personal history, work time organization and a tacit moral contract related to the referring GP's position. External resources included resource personnel, regional assistance platforms and health facilities, legislation. CONCLUSION: This study provides a simple list that is easy to share and pragmatic solutions for GPs and policymakers. Home-based palliative care practice can simultaneously be burdensome and yet a fulfilling, meaningful activity, depending on self-efficacy and professional exhaustion (burnout), perhaps to a greater extent than on medical knowledge. Home-based palliative care promotion is a matter of social responsibility. The availability of multidisciplinary teams such as regional assistance platforms and Hospitalization at Home is particularly important for the management of palliative care. Policymakers should consolidate these specific resources out of hospitals, in community settings where the patients wish to end their life.

[Risks of Urogenital Infections and Expulsion Associated with the Combination of an IUD and a Menstrual Cup]. / Étude RIESC : Risques d'Infections uro-génitales et d'Expulsion dans l'association Stérilet et Coupe menstruelle.

OBJECTIVES: The increase in intrauterine devices (IUDs) contraception, and the growing use of reusables menstrual hygiene products such as the menstrual cup, necessitates an assessment of the implications of their co-use. The objectives are to assess whether women with IUDs who use menstrual cups have an increased risk of IUD expulsion and/or a change in the risk of upper and lower urogenital tract infections compared to women who use other menstrual hygiene products. METHOD: An observational, prospective, multicenter study was conducted in France between 2020 and 2023. Participants were recruited by health professionals and data were collected by telephone questionnaire at the time of IUD insertion and at one year. The primary endpoints were the occurrence of IUD expulsion and the occurrence of urogenital tract infections in menstrual cup users compared to non-users. RESULTS: One hundred and three women out of 119 included were analyzed, 25 of them were regular menstrual cup users and five experienced IUD expulsion. Among regular users, 12% experienced IUD expulsion compared to 2.6% among non-users, with no statistically significant difference (Chi2 = 3.65; p = .056). Regarding urogenital tract infections, nine women (36%) of the regular menstrual cup users had urogenital infections, compared with 27 (34,6%) of the non-users or not regular users, with no statistically significant difference. CONCLUSION: The tendency of menstrual cup users to expel their IUDs is a reason for caution, although it is not sufficient to contraindicate co-use. Physicians should therefore systematically screen such co-use and inform patients of the risks and monitoring instructions.

Incidence of sexual violence among recently arrived asylum-seeking women in France: a retrospective cohort study.

Background: The prevention of sexual violence (SV) occurring shortly after arrival in host countries towards female asylum seekers requires knowledge about its incidence. We aimed to determine the incidence of SV and its associated factors during the past year of living in France among asylum-seeking females who had arrived more than one year earlier but less than two years. Methods: We conducted a retrospective cohort study using a life-event survey of asylum-seeking females who had been registered in southern France by the Office for Immigration for more than one year but less than two. The primary outcome was the occurrence of SV during the past year, weighted by the deviation in age and geographical origin of our sample from all females registered. The nature of SV was noted, and associated factors were explored by a logistic regression model. Findings: Between October 1, 2021, and March 31, 2022, 273 females were included. Eighty-four females experienced SV during the past year of living in France (26.3% weighted [95% CI, 24-28.8]), 17 of whom were raped (4.8% weighted [95% CI, 3.7-6.1]). Being a victim of SV prior to arrival in France (202, 75.7%) was associated with the occurrence of SV after arrival (OR = 4.6 [95% CI, 1.8-11.3]). Lack of support for accommodation was associated with se.xual assault (OR = 2.6 [95% CI, 1.3-5.1]). Interpretation: The months following arrival in a European host country among asylum-seeking females appear to be a period of high incidence of SV; even higher for those who previously experienced SV prior to arrival. Reception conditions without support for accommodation seem to increase exposure to sexual assault. Funding: DGOS-GIRCI.

[Observational study of links of interest disclosure at the Congress of General Medicine France and links of interest of French physicians attending]. / Étude observationnelle des déclarations de liens d'intérêts au Congrès de la médecine générale France et liens d'intérêts des médecins intervenants.

INTRODUCTION: Medical opinion leaders represent a marketing tool whose effectiveness is well documented in France and worldwide. They are less distrusted than pharmaceutical representatives, but this trust declines when they declare their ties. In France, the public database "Transparence-Santé" presents the financial ties of each professional with the health industries since 2012. These ties must be declared at the beginning of any public intervention since 2002 to improve the transparency of healthcare stakeholders. OBJECTIVES: This study assessed the compliance with the obligation to disclose conflicts of interests at the Congress of General Medicine France 2020. Its secondary objective was to assess the financial ties of French physicians attending the congress using the data listed in "Transparence-Santé" through the Eurosfordocs project. METHOD: Prospective cross-sectional observational study of all the interventions available on the congress' internet platform. All speakers, making either an oral or a written and commented presentation, who must declare their conflicts of interest, were included. A descriptive analysis of "Transparence-Santé" data was carried out for the doctors attending the congress. RESULTS: Among 253 interventions, 34% complied with the disclosure requirement. The doctors participating in symposiums links of interests represented 92% of the global amount of congress' links of interests, with an average of 11,2k€/year, significantly higher than the 126€/year of other physicians. CONCLUSION: The legal obligation to declare one's conflict of interest at congresses is little respected in France. Involvement of the organizers and using pre-established disclosure formats would improve transparency. It is necessary to develop the independence of speakers to improve research and medical expertise.

Sunshine on KOLs: assessment of the nature, extent and evolution of financial ties between the leaders of professional medical associations and the pharmaceutical industry in France from 2014 to 2019: a retrospective study.

OBJECTIVE: To investigate the financial relationships between key opinion leader (KOL) or non-KOL physicians and pharmaceutical and device companies in France. DESIGN: Retrospective and descriptive study. SETTING: All doctors practising in France, with a focus on 548 KOLs (board members of the professional medical associations that published guidelines in 2018-2019, identified on the associations' websites between 2018 and 2020). Ties were collected from the 'Transparency in Healthcare' database. MAIN OUTCOME MEASURES: The number and the value of gifts from 2014 to 2019, and of remunerations and contractual agreements from 2017 to 2019. RESULTS: KOLs represented 0.24% of the total number of physicians in France. The total value of gifts declared in the French database for all physicians amounted to €818M (US$936M, £741M). At least one gift was declared for 83% of KOLs. KOLs' gifts represented 0.68% of the total number of gifts to physicians and 1.5% of the total value of gifts, with a mean of €3700 per capita per year.The total value of contractual agreements declared for all physicians amounted to €125M. Contractual agreements involving the KOLs represented 0.72% of the number of contractual agreements with physicians and 2.5% of the value of the agreements, with a mean of €1900 per capita per year.A total of €156M in remunerations were declared for all physicians. KOL remunerations represented 2.3% of the number of physician remunerations and 4.4% of the total value of the remunerations paid to physicians, with a mean of €4100 per capita per year.Almost all professional medical associations (99%) had at least one KOL in their board with a financial tie to the industry, but the amount varied widely among the associations. CONCLUSION: Financial relationships between KOLs and the industry in France are extensive. KOLs have much more financial ties than non-KOL practitioners.

General practitioners and sales representatives: Why are we so ambivalent?

INTRODUCTION: Accepting gifts from pharmaceutical sales representatives (sales reps) or meeting them is correlated with excessive, more expensive and sometimes less rational prescribing. French general practitioners (GPs) tend to hold an unfavorable opinion of the pharmaceutical industry, yet the behavior they adopt with sales reps is generally favorable. Until now, no study has sought to explain the reasons for this discrepancy. This study explores GP experiences to better understand their ambivalent behavior. METHOD: This qualitative descriptive study was based on semi-structured face-to-face interviews with French GPs in the south-east of France. An interpretative phenomenological approach was chosen to explore individual professional practices and to model the phenomenon through in-depth analysis of semi-structured interviews. A general inductive analysis was carried out. Data were analyzed by researchers from different disciplines (psychology, sociology and general practice). RESULTS: Ten GPs were interviewed for an average of 50 minutes. The analysis revealed three forces that combine to motivate GPs to keep meeting sales reps despite their unfavorable opinion of these visits: practical reasons such as the need for a substitute for continuing education; social and cultural reasons such as courtesy towards representatives; and psychological mechanisms such as cognitive dissonance and a hidden curriculum. DISCUSSION: The GP-representative relationship is complex and involves psychological mechanisms that the medical profession often fails to recognize. GPs use reps as a convenient tool for continuing education, particularly in the setting of a private practice where GPs feel pressed for time. Cognitive dissonance is a well-supported theory in social psychology that explains how a person maintains a behavior while having an unfavorable opinion of it. Since GP meetings with sales reps start during their internship, they could also be considered as part of a hidden curriculum. The strength of this work is to combine medical, social psychological and sociological perspectives with the original interpretative phenomenological approach. When the veil is lifted on individual ambivalence, the questions raised are more social and political than individual.