Population norms in France with EQ-5D-5L: health states, value indexes, and VAS.

PURPOSE: To provide EuroQoL EQ-5D-5L French population norms based on a sample of 15,000 responders. METHODS: Based on the National Health and Wellness Survey, an international, annual, selfadministered Internet-based survey, this study extracted data from France for 2018 involving a sample of 15,000 respondents stratified by age and gender. Responses to the EQ-5D-5L questionnaire and the Visual Analog Scale (VAS) score, together with sociodemographic, health behavior, and disease status variables were collected. VAS, value indexes, the level sum score, and the distribution of levels per dimension were described. Multivariate regression analyses were performed to identify covariates with a statistically significant effect on the five dimensions and the three scores. RESULTS: The mean [standard deviation (SD)] VAS was 73.4 (22.2) for the entire sample (male 74.8 vs female 72.2, p < 0.0001). The Mean SD value index was 0.905 (0.158) (male 0.915 vs female 0.895, p < 0.0001). The mean SD level sum score was 7.6 (3.0) (7.4 for males vs. 7.9 for females p < 0.0001). Health state 11,111 (no problem in any dimension) represented 25.1% of all responses. "No problem" responses' proportions were Self Care (91.3%), Usual Activities (74.2%), Mobility (72.4%), Anxiety/Depression (52.6%) and Pain/Discomfort (37.7%). Multivariate regressions revealed a significant relationship for health states, value indexes, and VAS with age, income, employment, marital status, smoking and alcohol consumption, obesity, and the presence of one or more health problems. CONCLUSION: Based on a large sample, this study is the first to report EQ-5D-5L population norms for France.

Prevalence and management of gastroesophageal reflux disease in children and adolescents: a nationwide cross-sectional observational study.

UNLABELLED: This cross-sectional observational study aimed to determine the nationwide prevalence of gastroesophageal reflux disease (GORD) in French children and adolescents. Four hundred four general practitioners and 180 paediatricians compiled a register of all children and adolescents (n = 10,394, aged 0 to 17 years, mean 3.8 ± 5.6 years) who presented over two 3-day periods. For all children who, in the physician's opinion, showed symptoms of gastroesophageal reflux (GOR), a 24-item questionnaire covering the history and management of GOR was completed. Children with symptoms that impaired their daily lives were defined as having GORD, the remainder as having physiological GOR. Of the patients, 15.1 % showed GOR symptoms. Extrapolation to the overall French population yielded a prevalence of 10.3 % for GOR and 6.2 % for GORD. There was a significantly (p < 0.05) greater use of volume reduction or milk thickeners and dorsal positioning among infants with GORD versus physiological GOR. Significantly (p < 0.05) more of the infants and children with GORD received pharmacological therapy. The use of proton pump inhibitors increased with age but was significantly (p < 0.05) higher among those with GORD. CONCLUSIONS: Ten percent of French children and adolescents show GOR symptoms and 6 % have GORD. Clinical presentation and treatment vary in different age groups, but those with GORD are more likely to require pharmacological treatment.

Assessment of cardiovascular risk in primary care patients in France.

BACKGROUND: Current guidelines for the prevention of cardiovascular disease emphasize the importance of assessing global cardiovascular risk, but there is evidence that risk is often assessed inaccurately. AIMS: To compare general practitioner-reported global cardiovascular risk in French primary care patients with estimates based on established risk-scoring systems, and to identify factors accounting for any mismatch between the analyses. METHODS: Data on patients, aged 50 years or older, seen during two 3-day periods were provided by 619 general practitioners. Physicians rated each patient's cardiovascular risk as low, moderate or high, according to their perception; in addition, risk was assessed using the Framingham and Systematic coronary risk evaluation (SCORE) risk-scoring systems. RESULTS: A total of 13,446 patients aged greater or equal to 50 years were included. Of 11,241 patients with no previous history of cardiovascular disease, 47% were considered by their physicians to be at low risk of cardiovascular disease and 14% to be at high risk. In that population, 72% of patients rated as high risk according to the Framingham system and 77% rated as high risk according to SCORE system were incorrectly assessed by their physicians; similar results were observed in patient cohorts based on whether or not patients had received treatment for dyslipidaemia. Weighted kappa analysis showed poor agreement between physician risk assessment and both the Framingham and SCORE risk-scoring systems. CONCLUSION: This study underlines the mismatch between GP-estimated cardiovascular risk and the risk assessed using scoring systems, especially for high-risk patients.

The French Observational Cohort of Usual Smokers (FOCUS) cohort: French smokers perceptions and attitudes towards smoking cessation.

BACKGROUND: Despite increasing governmental anti-smoking measures, smoking prevalence remains at a high level in France. METHODS: The objectives of this panel study were (1) to estimate smoking prevalence in France, (2) to identify smokers' profiles according to their perceptions, attitudes and behaviour in relation to smoking cessation, (3) to determine predictive factors of quit attempts, and (4) to assess tobacco-related behaviours and their evolutions according to the changes in the smokers' environments. A representative sample of French population was defined using the quota method. The identified cohort of smokers was assessed, in terms of smoking behaviour, previous quit attempts, and intention to quit smoking. RESULTS: A response rate of 66% for the screening enabled to identify a representative sample of the French population (N = 3 889) comprising 809 current smokers (21%). A majority of current smokers (63%) had made an attempt to quit smoking. Main reasons for having made the last attempt were cost (44%), social pressure (39%), wish to improve physical fitness (36%), fear of a future smoking-related disease (24%), and weariness of smoking (21%). Few attempts (16%) were encouraged by a physician. In those who used some kind of support (38%), NRT was the mostly used. Relapse was triggered by craving (45%), anxiety/stress (34%), a significant life event (21), weight gain (18%), and irritability (16%). Depression was rarely quoted (5%). Forty percent of smokers declared they intended to quit smoking permanently. Main reasons were cost (65%), physical fitness improvement (53%), fear of a future smoking-related disease (43%), weariness of tobacco (34%), and social pressure (30%). Using a smoking cessation treatment was considered by 43% of smokers that intended to quit. Barriers to smoking cessation were mainly fear of increased stress (62%), irritability (51%), and anxiety (42%), enjoying smoking (41%), and weight concerns (33%). CONCLUSION: Smoking prevalence and smoking cessation attempts rate were lower in this survey than in previous reports. Cost and social pressure were the main reasons for quitting smoking, maybe an effect of dramatic tax increases and smoking ban.

Participation of French hospital physicians to continuing medical education events: a survey with 300 physicians to assess duration, methods, financing, and needs.

INTRODUCTION: Little data on the educational needs and practices of French hospital physicians have been obtained through surveys. Given that continuing medical education (CME) information is now available on http://www.cnfmc.fr and providers are accredited, we investigated CME practices and knowledge of the CME system with the use of a representative sample of hospital physicians. METHODS: A questionnaire was prepared during 2 work sessions organized by TNS Healthcare Sofres in July 2007. A sample of 300 physicians was selected to represent hospital physicians throughout 5 main regions and hospital types. Telephone numbers were dialed automatically in order to meet quota objectives. Questionnaires were administered by telephone between August 30 and September 7, 2007 by trained operators. RESULTS: Among the 300 interviewed physicians, 218 (73%) were from general or specialized hospitals and 82 (27%) were from university hospitals. They were located equally all over France. Their specialties were: medicine, 130 (43%); laboratory, 51 (17%); pharmacy, 45 (15%); surgery, 15 (5%); psychiatry, 9 (3%); and others, 49 (17%), including emergency and radiology. One hundred twenty-five of the physicians (42%) stated that they took part in continuing education programs for more than 10 days per year, 122 (41%) between 6 and 10 days per year, and 51 (17%) less than 5 days; 2 (<1%) did not answer. Two hundred fourteen of the physicians subscribed to either specialized or general medical journals; 86 (29%) did not subscribe to any journal. For live in-class events, approximately 65% of the educational, travel, and lodging expenses were paid for by physicians and hospitals. The pharmaceutical industry paid for 25% of these expenses. In response to the question "Did you participate in a performance improvement program in your hospital?", 75 (25%) said that they had (16% for the 82 physicians in university hospitals, and 29% for the 211 physicians in general hospitals), 210 (70%) said that they had not, including the 134 (45% of the 300) who said that it was scheduled, and 15 (5%) did not answer. Seminars were preferred for continuing education programs, and interactive workshops and e-learning methods were requested for the future. Among the 300 physicians, 246 (82%) expressed difficulties following up on CME events, and 54 (18%) had no difficulty with their education. DISCUSSION: This telephone survey of 300 hospital physicians showed that although they took part in many educational programs, they had organizational, personal, and financial issues. E-learning could make it easier for physicians to continue their education.

[French hospital doctors attend many educational programmes but have organisational and financial difficulties for their continuing medical education]. / La formation continue des praticiens hospitaliers: importante mais avec des difficultés organisationnelles et financières.

INTRODUCTION: Few data on the educational needs and practices of the French hospital doctors have been obtained through surveys. Considering that the CME information is now available on www.cnfmc.fr and that providers were accredited, we investigated, on a representative sample of hospital doctors, the CME practices and the knowledge of the CME system. METHODS: A questionnaire was prepared during 2 working sessions organised by TNS Healtcare Sofres in July 2007. A sample of 300 doctors was set to be representative of hospital doctors through the 5 main regions, and hospital types. Telephone numbers were dialled by an automat in respect of the objectives of quotas. Questionnaires were administered by telephone between August 30 and September 7, 2007, and done by trained operators. RESULTS: Among the 300 interviewed doctors, 218 (73%) were from general or specialised hospitals and 82 (27%) were from Universitary hospitals. They were equally installed all over France. Their specialties were: medicine 130 (43%); biology 51 (17%); pharmacy 45 (15%); surgery 15 (5%); psychiatry 9 (3%); others 49 (16%) including emergency and radiology. Among the 300 doctors, 125 (42%) declared having continuing education for more than 10 days per year, 122 (41%) between 6 and 10 days per year, and 51 (17%) less than 5 days, 2 (<1%) did not answer. 214 (71%) doctors were subscribing medical specialised or general journals, and 86 (29%) did not subscribe to any journal. For the sessions called " présentielles ", about 65% of the funding of the pedagogic expenses, the travel and housing were supported by the doctors and hospitals. The pharmaceutical industry supported 25% of these expenses. To the question " did you performed a clinical audit in your hospital? ", 75 (25%) answered yes (16% for the 82 doctors in Universitary hospitals, and 29% for the 211 doctors in general hospitals), 210 (70%) answered no, including the 134 (45% of the 300) who said that it was programmed. 15 (5%) did not answer. The educational methods that were preferred were congresses, and interactive workshops were demanded for the future, as well as the e-learning methods. Among the 300 doctors, 165 (55%) had organisational difficulties for their education, 143 (48%) had personal difficulties such as availability, and 135 (45%) had financial difficulties. 54 (18%) had no difficulty at all for their education. DISCUSSION: This survey through telephone interviews of 300 hospital doctors showed that they followed many educational programmes, and they had difficulties to organize their education, with personal and financial difficulties. The e-learning development could be a solution that gives facilities to doctors.