A transversal cross-sectional study of factors related to HPV vaccination status and cancer screening participation among French women aged 25-40.

BACKGROUND: In 2020, uterine cervical cancer (UCC) was the 12th most common cancer among women in France and the 4th worldwide. French health authorities wanted to increase Human Papilloma Virus (HPV) vaccination and screening rates. There were still many barriers to these measures among young women, their families, and health professionals and teachers. Between 2014 and 2019, international studies found inconsistent effects of HPV vaccination on UCC screening. In 2022, a survey was conducted among women aged 25 to 40 in the Nord-Pas-de-Calais region to assess participation 1) in HPV vaccination and its barriers, 2) in UCC screening as a function of HPV vaccination status. METHODS: Data were collected using an anonymous online questionnaire distributed by QR code in 80 general practices randomly selected in the Nord-Pas-de-Calais region between January and June 2022. Results were analyzed bivariately using the Chi2 test, multivariately when numbers allowed, and in age subgroups (sensitivity analysis). RESULTS: 407 complete questionnaires (for 602 participating women) were analyzed. In our sample, 41% of women aged 25 to 40 in the Nord-Pas-de-Calais region were vaccinated against HPV viruses in 2022. The risk factors for non-vaccination, after multivariable adjustment, were: the periods of eligibility for vaccination in the early days of French vaccination (2007-2012: odds ratio OR = 0.04 [95% CI, 0.02-0.09]; 2012-2017: OR = 0.5 [0.3-0.8]), information received from non-medical sources (OR = 0.3 [0.2-0.6]), and absence of information about vaccination (OR = 0.12 [0.05-0.27]). In our sample, 90% of women were screened for UCC. In bivariate analysis, women at risk of not being screened were those who were youngest, had been vaccinated against HPV, were not heterosexual, lived alone, had gynecological follow-up by their general practitioner, and did not have regular gynecological follow-up. Sensitivity analysis showed that the only risk factor significantly correlated with non-screening regardless of age group was lack of regular gynecological follow-up. CONCLUSIONS: Participation in HPV vaccination and UCC screening is improved by medical education and gynecological follow-up. This multicenter study, limited by the relative youth of vaccination in France, should be repeated after 2037 to assess the possible effect of vaccination on screening.

Pattern of encounters to emergency departments for suicidal attempts in France: Identification of high-risk days, months and holiday periods.

INTRODUCTION: Seasonal change in patterns of suicidal attempts is not well known in France and may differ from other western countries. We aimed to determine the peak times (days, months and holiday periods) of suicidal attempts in France. METHODS: We carried out a multicentre retrospective epidemiological study, using data from the Organization for Coordinated Monitoring of Emergencies (OSCOUR®) network. We aggregated daily data from January 1, 2010, to December 31, 2019. Variations in suicidal attempts on specific days were investigated by comparing their frequencies (ad hoc Z-scores). RESULTS: 114,805,488 ED encounters were recorded including 233,242 ED encounters regarding suicidal attempts. Men accounted for 45.7%. A significantly higher frequency of ED encounters for suicidal acts were found on Sundays in the months of May-June for both sexes and on New Year's Day for all genders and age groups. An increased risk was also noted on July 14th (National Day) and June 22nd (Summer Solstice). A protective effect was noted on the day after Valentine's Day, on Christmas Day and Christmas time (in particular December 24 and 26). CONCLUSION: Sundays, June, New Year's Day were at increased risk of suicidal attempts in France requiring a strengthening of prevention.

Participation rate in cervical cancer screening in general practice related to the proximity of gynecology care facilities: A 3 year follow-up cohort study.

Cervical cancer screening (CCS) by Pap tests is mainly performed by gynecologists in France, but also by general practitioners (GPs) and midwives. The screening uptake is insufficient to reduce the incidence of cervical neoplasms. Our aim was to investigate the association between screening rates in patients listed with GPs and the distance between GPs' offices and gynecology facilities. The population of 345 GPs, and their 93,918 female patients eligible for screening over 3 years (2013-2015), were derived from the Health Insurance claim database. We estimated the socioeconomic level of the geographical area of GPs' offices using the European Deprivation Index (EDI). The proximity of gynecology facilities was calculated by computing their distance from GPs' offices (in order to adjust the proximity of gynecology facilities with EDI and performance of smears by the GP). The number of gynecologists within 5 km of a GP's office was associated with the CCS rate increasing by 0.31% for every unit increase in the density of gynecologists within 5 km (p < 0.0001). The close proximity of gynecology facilities was not significantly associated with screening uptake among female patients when the office of the GP where they were registered was settled in a deprived area.

Type 2 diabetics followed up by family physicians: Treatment sequences and changes over time in weight and glycated hemoglobin.

INTRODUCTION: The treatment of type 2 diabetes mellitus (T2DM) is based on preventive hygiene and dietary measures (HDM), oral antidiabetic drugs (OADs), and insulin. The objective of the present study was to reuse general practice data from electronic health records and describe changes over time among patients with T2DM in primary care. METHODS: We analyzed data on patients with T2DM collected by three family physicians in Tourcoing (France) from 2006 to 2018. RESULTS: 403 patients, 1030 treatment sequences, 39,042 appointments, 2440 glycated hemoglobin (HbA1c) measurements, and 9722 wt measurements were included. On inclusion, the mean age was 57.0, the mean weight was 84.4 kg, the mean body mass index was 30.3 kg/m2, and the median HbA1c level was 6.8 % (51 mmol/mol). The patients were following appropriate HDM (40.7 %) and/or were being treated with OADs (54.1 %) or insulin (5.2 %). The median length of follow-up was 3.51 years. Overall, bodyweight was stable for two years during HDM and then increased. The HbA1c level decreased and then increased during HDM, was stable on OADs, and then decreased on insulin. DISCUSSION/CONCLUSION: The present descriptive results may be of value in helping to predict changes over time in bodyweight and HbA1c in T2DM.

Artificial Intelligence and Clinical Decision Support Systems or Automated Interpreters: What Characteristics Are Expected by French General Practitioners?

Development of artificial intelligence (AI) modules should rely on technical progress, but also on users' needs. Our objective is to identify criteria that make a hypothetical AI module desirable for general practitioners (GPs). Method: random selection of 200 French GPs, and paper-based questionnaire. Results: the population was representative. GPs expect AI modules to diagnose or eliminate an urgent pathology for which they are not competent and for which specialists are not available. They also demand interoperability, automated electronic health record integration and facilitated information sharing. GPs would like AI modules to make them save time, simplify some procedures and delegate tasks to the secretary. They expect AI modules to allow them to associate the patient with the care, to reassure him or her, and to personalize the care. Interestingly, GPs would also rely on a machine to cut off abusive requests, such as work stoppages or certificates of convenience.

Awareness and Perception of Google® Reviews Among French GPs.

The objective of this study was to assess the perception of French general practitioners (GPs) and the impact of the Google® online physician rating system. We questioned the French GPs with a self-administered questionnaire. A total of 412 GPs had answered the complete questionnaire. 83.25% of respondents did not validate the relevance of the physician rating websites. The most decried limitations were the lack of validity of these opinions and the negative impact on physicians.

Doping with aromatase inhibitors and oestrogen receptor modulators in steroid users: Analysis of a forum to identify dosages, durations and adverse drug reactions.

INTRODUCTION: Some users of anabolic androgenic steroids (AAS) secretly consume aromatase inhibitors (AI) and selective oestrogen receptor modulators (SERM). Cyber-forums can be potential sources of information. Our aim was to determine the cycles used, and to identify the adverse drug reactions (ADRs) experienced, reported in a bodybuilding forum. METHOD: We collected discussions on a French forum for AAS users (MESO-Rx®), from January 2013 to 2019 on concerning clomiphene, tamoxifen, anastrozole, exemestane and letrozole were collected. Characteristics of the users, duration of cures, treatments, dosages, point of purchase and occurrence of ADRs were analysed. RESULTS: Among the 1792 posts published on the forum, 845 concerned SERM and 571 concerned AI, i.e. 2180 drugs used (several cycles included concomitant consumption). Our population was exclusively male, with an average age of 28.2±6.3years, and had been practising weight training for 6.7±5.6years. The SERMs were mainly used to "revive the hypothalamohypophyseal axis" and the AIs to "fight against androgen aromatisation". The median treatment duration was 22 days for SERM, 70days for anastrozole, 84days for exemestane and 30days for letrozole, with a mean dose of 69mg/d for clomiphene, 22mg/d for tamoxifen, 0.4mg/d for anastrozole, 10mg/d for exemestane, 2mg/d for letrozole. The main way of obtaining these drugs was through the internet. 157 ADRs were identified: 95 for SERMs and 62 for AI. The most represented were acne, musculoskeletal, mood and reproductive disorders. Impaired quality of life (according to the patient) was described in 54% of the SERM posts and 26% of the AI posts. CONCLUSIONS: Patient narratives posted on forums can be a useful tool in the context of doping, to better understand practices, motivations and possibly to bring up pharmacovigilance signals.

Trends in the delivery of reimbursed nicotine replacement therapies between 2016 and 2019 in France.

OBJECTIVES: Describe the evolution of the expenses and the number of boxes of nicotine replacement therapy reimbursed by the French health insurance between 2016 (flat rate of €.150/year with advance payment) and 2019 (65% reimbursement without in advance payment and without a spending limit). SETTING AND PARTICIPANTS: Descriptive and analytical epidemiological study between January 1, 2016 and December 31, 2019 based on a retrospective collection of data from OpenMEDIC (the merged French health insurances drug claim database) on the number of reimbursed NRT boxes dispensed by community pharmacies and their annual cost. RESULTS: During 4 years, 7.4 million boxes of NRT were reimbursed (total cost of 148.4 million euros): approximately 300,000 in 2016, 650,000 in 2017, 1.9 million in 2018 and 4.6 million in 2019, namely a fifteen-fold increase between 2016 and 2019 (a geometric growth ratio of 2.5 each year). This increase was slightly more pronounced among men than among women, and concerned more NRT delivered from time to time (gums, tablets): transdermal devices proportion decreased from 79.7% of reimbursed NRT in 2016 to 52.9% in 2019, with an increase in gums (8% to 13.3%) and sublingual tablets (8.4% to 15.8%) over the same period. CONCLUSIONS: The evolution of NRT reimbursement comes with an increase in NRT deliveries. This suggests a real medical need rather than a short trend: therefore, this suggests a catch-up in the access to care.

Experimental Efficacy of the Face Shield and the Mask against Emitted and Potentially Received Particles.

There is currently not sufficient evidence to support the effectiveness of face shields for source control. In order to evaluate the comparative barrier performance effect of face masks and face shields, we used an aerosol generator and a particle counter to evaluate the performance of the various devices in comparable situations. We tested different configurations in an experimental setup with manikin heads wearing masks (surgical type I), face shields (22.5 cm high with overhang under the chin of 7 cm and circumference of 35 cm) on an emitter or a receiver manikin head, or both. The manikins were face to face, 25 cm apart, with an intense particle emission (52.5 L/min) for 30 s. The particle counter calculated the total cumulative particles aspirated on a volume of 1.416 L In our experimental conditions, when the receiver alone wore a protection, the face shield was more effective (reduction factor = 54.8%), while reduction was lower with a mask (reduction factor = 21.8%) (p = 0.002). The wearing of a protective device by the emitter alone reduced the level of received particles by 96.8% for both the mask and face shield (p = NS). When both the emitter and receiver manikin heads wore a face shield, the protection allowed for better results in our experimental conditions: 98% reduction for the face shields versus 97.3% for the masks (p = 0.01). Face shields offered an even better barrier effect than the mask against small inhaled particles (<0.3 µm-0.3 to 0.5 µm-0.5 to 1 µm) in all configurations. Therefore, it would be interesting to include face shields as used in our experimental study as part of strategies to reduce transmission within the community setting.

[Use of the ankle-brachial index in the detection of peripheral arterial disease of the lower extremities in general medicine]. / Utilisation de l'index de pression systolique dans le dépistage de l'artériopathie du membre inférieur en médecine générale.

INTRODUCTION: Peripheral arterial disease of the lower extremities (PAD) is a serious condition, frequently under-evaluated. Long asymptomatic, it is easily detected by measuring the ankle-brachial index (ABI), a reference tool that is reliable, reproducible, simple and inexpensive. The objective of this thesis was to determine the rate of achievement of ABI in French Haute Autorité de santé indications, identify the associated factors and prioritize the obstacles to achieving ABI. METHODS: Descriptive and analytical epidemiological study, with analysis of practices, prospectively addressed by postal questionnaire to a randomized sample of 220 general practitioners practicing in the European Metropolis of Lille between December 15, 2016 and February 15, 2017. RESULTS: Our sample consisted of 92 GPs (42% participation). Among them, only 6 practiced ABI, notably for: intermittent claudication (n=5: 5%, IC95% [1; 10]), the existence of at least 2 cardiovascular risk factors (n=2: 2%, IC95% [0; 5]), diabetic patients over 40 years of age (n=2: 2%, IC95% [0; 5]), patients with diabetes (n=2: 2%, IC95% [0; 5]), patients with diabetes (n=2: 1%, IC95% [0; 5]), patients with diabetes (n=2: 1%, IC95% [0; 5]), and patients with diabetes (n=2: 1%, IC95% [0; 5]): 2%, CI95% [0; 5]), patients over 50 years of age with a history of diabetes or smoking (n=2: 2%, CI95% [0; 5]), or those with an unhealed lower extremity skin lesion (n=5: 5%, CI95% [1; 10]). The most frequently cited barriers were: the prescription of a routine echo-doppler (61%, 95% CI [51; 71]), lack of control (46%, 95% CI [36; 56]), time considered too long (17%, 95% CI [10; 25]), and equipment purchase or maintenance (19%, 95% CI [10.5; 26.4]). CONCLUSION: ABI is few used in our sample, mainly due to delegation to angiologists.

Does hip or knee joint replacement decrease chances to complete an ultra-trail race? Study in participants at the Ultra-Trail du Mont Blanc®.

INTRODUCTION: The number of patients with hip or knee joint replacements is increasing. Some of these patients want to practice sport, including in high-impact sports such as ultra-trails. Is the proportion of drop-out higher among runners after a hip or knee replacement? What are the symptoms of these patients? HYPOTHESIS: Hip or knee joint replacements are associated with a higher drop-out rate during an ultra-trail. MATERIAL AND METHODS: We conducted a monocentric retrospective epidemiological study. A questionnaire translated into French, English and Spanish were sent to all runners registered for one or more of the 5 races of the 2015 to 2017 Ultra-Trail du Mont-Blanc® (UTMB®) editions. There were no exclusion criteria. The drop-out rate of patients who responded to the questionnaire was calculated among patients with and without hip or knee joint replacement. Specific symptoms related to these joint replacements were identified before, during and after the race. RESULTS: Out of the 24,855 participants having run at least one of the 3 editions, 2,469 responded. Some of them ran several races: these 2469 runners were on 3171 start lines and 2548 finish lines (drop-out rate of 19.6%). Among these 2469 runners, 18 had hip and/or knee replacement and were on 27 start lines and 17 finish lines (drop-out rate of 37%). The race was finished by 3 of the 6 runners with a total hip arthroplasty (THA), all of the 8 runners with a hip resurfacing arthroplasty (HRA) and 3 of the 4 runners with a total knee arthroplasty (TKA). Among runners with THA, pubalgia or groin pain was described by one of them before the race, 3 during the race and 2 after the race. Among runners with HRA, pygalgia or groin pain was described by 2 of them during the race. As for the TKA, there was no specific symptom. No answering runner had a unicompartmental knee prosthesis. DISCUSSION: Running ultra-trail is possible after a hip or knee joint replacement. All of the 8 runners with HRA finished the race. We may remain cautious about the long-term survival of prostheses. LEVEL OF PROOF: IV; monocentric retrospective epidemiological study.

Statistically Prioritized and Contextualized Clinical Decision Support Systems, the Future of Adverse Drug Events Prevention?

Clinical decision support systems (CDSS) fail to prevent adverse drug events (ADE), notably due to over-alerting and alert-fatigue. Many methods have been proposed in the literature to reduce over-alerting of CDSS: enhancing post-alert medical management, taking into account user-related context, patient-related context and temporal aspects, improving medical relevance of alerts, filtering or tiering alerts on the basis of their strength of evidence, their severity, their override rate, or the probability of outcome. This paper analyzes the different options, and proposes the setup of SPC-CDSS (statistically prioritized and contextualized CDSS). The principle is that, when a SPC-CDSS is implemented in a medical unit, it first reuses actual clinical data, and searches for traceable outcomes. Then, for each rule trying to prevent this outcome, the SPC-CDSS automatically estimates the conditional probability of outcome knowing that the conditions of the rule are met, by retrospective secondary use of data. The alert can be turned off below a chosen probability threshold. This probability computation can be performed in each medical unit, in order to take into account its sensitivity to context.

The association between cervical cancer screening participation and the deprivation index of the location of the family doctor's office.

BACKGROUND: Cervical cancer screening rates are known to be strongly associated with socioeconomic status. Our objective was to assess whether the rate is also associated with an aggregated deprivation marker, defined by the location of family doctors' offices. METHODS: To access this association, we 1) collected data from the claim database of the French Health Insurance Fund about the registered family doctors and their enlisted female patients eligible for cervical screening; 2) carried out a telephone survey with all registered doctors to establish if they were carrying out Pap-smears in their practices; 3) geotracked all the doctors' offices in the smallest existing blocks of socioeconomic homogenous populations (IRIS census units) that were assigned a census derived marker of deprivation, the European Deprivation Index (EDI), and a binary variable of urbanization; and 4) we used a multivariable linear mixed model with IRIS as a random effect. RESULTS: Of 348 eligible doctors, 343 responded to the telephone survey (98.6%) and were included in the analysis, encompassing 88,152 female enlisted patients aged 25-65 years old. In the multivariable analysis (adjusted by the gender of the family doctor, the practice of Pap-smears by the doctor and the urbanization of the office location), the EDI of the doctor's office was strongly associated with the cervical cancer screening participation rate of eligible patients (p<0.001). CONCLUSION: The EDI linked to the location of the family doctor's office seems to be a robust marker to predict female patients' participation in cervical cancer screening.

Do Medical Practitioners Trust Automated Interpretation of Electrocardiograms?

The objective is to study the way physicians use the ECG computerized interpretation (ECG-CI). Anonymous questionnaires were mailed to 282 primary care physicians (PCPs) and 140 cardiologists in France. 225 complete surveys were analyzed. PCPs performed a median of 5 ECGs per month, vs. 200 ECGs for cardiologists. Among PCPs with ECG, 57% felt confident about their skills in interpreting ECGs. Whereas 91.7% of cardiologists first interpreted the ECG by themselves, 27.9% of PCPs first read the computerized interpretation. PCPs found that ECG-CI was more reliable than cardiologists did for atrial or ventricular hypertrophy. PCPs and cardiologists agreed that ECG-CI was reliable for conduction troubles and "normal ECG" statement, but was not for other rhythm or repolarization troubles. PCPs are less experienced with ECG interpretation, but are also more likely to trust the computerized interpretation, whereas those interpreters are not fully reliable.