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BACKGROUND: General practitioners (GPs) often manage individuals with work-related common mental disorders (CMD: depressive disorders, anxiety and alcohol abuse). However, little is known about the ways in which they proceed. The aim of this study is to analyze GPs' management and patterns of referral to other health professionals of patients with work-related CMD and associated factors. METHOD: We used data from a cross-sectional study of 2027 working patients of 121 GPs in the Nord - Pas-de-Calais region in France (April - August 2014). Statistical analyses focused on patients with work-related CMD detected by the GP and examined the ways in which GPs managed these patients' symptoms. Associations between patient, work, GP and contextual characteristics and GPs' management were explored using modified Poisson regression models with robust variance. RESULTS: Among the 533 patients with work-related CMD in the study, GPs provided psychosocial support to 88.0%, prescribed psychotropic treatment to 82.4% and put 50.7% on sick leave. Referral rates to mental health specialists and occupational physicians were respectively 39.8 and 26.1%. Several factors including patients' characteristics (occupational and sociodemographic), GPs' characteristics and environmental data were associated with the type of management used by the GP. CONCLUSION: Our study emphasizes the major and often lonesome role of the GP in the management of patients with work-related CMDs. Better knowledge of the way GPs manage those patients could help GPs in their practice, improve patients care and be a starting point to implement a more collaborative care approach.
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Alcoholismo , Ansiedad , Trastorno Depresivo , Medicina General , Estrés Laboral , Intervención Psicosocial , Psicotrópicos/uso terapéutico , Adulto , Alcoholismo/epidemiología , Alcoholismo/etiología , Alcoholismo/psicología , Alcoholismo/terapia , Ansiedad/epidemiología , Ansiedad/etiología , Ansiedad/terapia , Trastorno Depresivo/epidemiología , Trastorno Depresivo/etiología , Trastorno Depresivo/terapia , Femenino , Francia/epidemiología , Medicina General/métodos , Medicina General/estadística & datos numéricos , Humanos , Masculino , Salud Mental , Estrés Laboral/complicaciones , Estrés Laboral/psicología , Pautas de la Práctica en Medicina , Intervención Psicosocial/métodos , Intervención Psicosocial/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Factores de Riesgo , Ausencia por Enfermedad/estadística & datos numéricos , Factores SocioeconómicosRESUMEN
BACKGROUND: Lyme borreliosis (LB) is the most frequent vector-borne disease in France. Since 2009, surveillance of LB is conducted by a sentinel network of general practitioners (GPs). This system, in conjunction with the national hospitalisation database was used to estimate the incidence and describe the characteristics of LB in France. AIM: To describe the estimated incidence and trends in GP consultations and hospital admissions for LB in France and identify risk groups and high-incidence regions. RESULTS: From 2011 to 2016, the mean yearly incidence rate of LB cases was 53 per 100,000 inhabitants (95% CI: 41-65) ranging from 41 in 2011 to 84 per 100 000 in 2016. A mean of 799 cases per year were hospitalised with LB associated diagnoses 2005-16. The hospitalisation incidence rate (HIR) ranged from 1.1 cases per 100,000 inhabitants in 2005 to 1.5 in 2011 with no statistically significant trend. We observed seasonality with a peak during the summer, important inter-regional variations and a bimodal age distribution in LB incidence and HIR with higher incidence between 5 and 9 year olds and those aged 60 years. Erythema migrans affected 633/667 (95%) of the patients at primary care level. Among hospitalised cases, the most common manifestation was neuroborreliosis 4,906/9,594 (51%). CONCLUSION: Public health strategies should focus on high-incidence age groups and regions during the months with the highest incidences and should emphasise prevention measures such as regular tick checks after exposure and prompt removal to avoid infection.
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Borrelia burgdorferi/aislamiento & purificación , Enfermedad de Lyme/epidemiología , Admisión del Paciente/estadística & datos numéricos , Alta del Paciente/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Vigilancia de Guardia , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Animales , Niño , Preescolar , Bases de Datos Factuales , Femenino , Francia/epidemiología , Médicos Generales , Humanos , Incidencia , Enfermedad de Lyme/diagnóstico , Enfermedad de Lyme/microbiología , Masculino , Persona de Mediana Edad , Admisión del Paciente/tendencias , Derivación y Consulta/tendencias , Estaciones del Año , Enfermedades por Picaduras de Garrapatas/epidemiología , Enfermedades por Picaduras de Garrapatas/microbiología , Adulto JovenRESUMEN
Influenza epidemics are monitored using influenza-like illness (ILI) data reported by health-care professionals. Timely detection of the onset of epidemics is often performed by applying a statistical method on weekly ILI incidence estimates with a large range of methods used worldwide. However, performance evaluation and comparison of these algorithms is hindered by: (1) the absence of a gold standard regarding influenza epidemic periods and (2) the absence of consensual evaluation criteria. As of now, performance evaluations metrics are based only on sensitivity, specificity and timeliness of detection, since definitions are not clear for time-repeated measurements such as weekly epidemic detection. We aimed to evaluate several epidemic detection methods by comparing their alerts to a gold standard determined by international expert consensus. We introduced new performance metrics that meet important objective of influenza surveillance in temperate countries: to detect accurately the start of the single epidemic period each year. Evaluations are presented using ILI incidence in France between 1995 and 2011. We found that the two performance metrics defined allowed discrimination between epidemic detection methods. In the context of performance detection evaluation, other metrics used commonly than the standard could better achieve the needs of real-time influenza surveillance.
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Algoritmos , Epidemias , Monitoreo Epidemiológico , Gripe Humana/epidemiología , Estadística como Asunto , Francia/epidemiología , Humanos , Incidencia , Análisis de Regresión , Estaciones del AñoRESUMEN
A better understanding of physician practices in requesting stool samples for patients with acute gastroenteritis (AG) is needed to more accurately interpret laboratory-based surveillance data. A survey was conducted in General Practitioners (GPs) between August 2013 and July 2014 to estimate the proportion of stool samples requested for patients with AG and to identify factors associated with GP requests for a stool sample. National health insurance (NHI) data together with surveillance data from a French Sentinel GP network were also used to estimate the proportion of stool samples requested. This proportion was estimated at 4·3% in the GP survey and 9·1% (95% confidence interval 8·7-9·6) using NHI data. Multivariate analysis indicated that the ratio of stool samples requested was almost five times higher in patients with bloody diarrhoea and 10-20 times higher in patients with a long duration of illness before consultation. Laboratory-based surveillance data underestimates the actual burden of disease as fewer than one in 10 AG cases consulting their GP will be requested to submit a stool sample for laboratory testing. This underestimation varies by pathogen as stool samples are more frequently requested for severe illness.
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Heces/microbiología , Gastroenteritis/microbiología , Medicina General/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Enfermedad Aguda , Adolescente , Adulto , Anciano , Técnicas Bacteriológicas/estadística & datos numéricos , Niño , Preescolar , Diarrea/microbiología , Femenino , Francia , Humanos , Lactante , Recién Nacido , Seguro de Salud/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Pautas de la Práctica en Medicina/tendencias , Estaciones del Año , Vigilancia de Guardia , Adulto JovenRESUMEN
Lyme borreliosis (LB) has become a major concern recently, as trends in several epidemiological studies indicate that there has been an increase in this disease in Europe and America over the last decade. This work provides estimates of LB incidence and hospitalisation rates in France. LB data was obtained from the Sentinelles general practitioner surveillance network (20092012) and from the Programme de Médicalisation des Systèmes d'Information (PMSI) data processing centre for hospital discharges (200409). The yearly LB incidence rate averaged 42 per 100,000 inhabitants (95% confidence interval (CI): 3748), ranging from 0 to 184 per 100,000 depending on the region. The annual hospitalisation rate due to LB averaged 1.55 per 100,000 inhabitants (95% CI: 1.421.70). Both rates peaked during the summer and fall and had a bimodal age distribution (510 years and 5070 years). Healthcare providers should continue to invest attention to prompt recognition and early therapy for LB, whereas public health strategies should keep promoting use of repellent, daily checks for ticks and their prompt removal.
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Borrelia burgdorferi/aislamiento & purificación , Hospitalización/estadística & datos numéricos , Enfermedad de Lyme/epidemiología , Garrapatas/parasitología , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Animales , Niño , Preescolar , Femenino , Francia/epidemiología , Humanos , Incidencia , Lactante , Recién Nacido , Enfermedad de Lyme/microbiología , Masculino , Persona de Mediana Edad , Vigilancia de Guardia , Distribución por Sexo , Adulto JovenRESUMEN
Pertussis is a respiratory disease that can be fatal at all ages but especially in infants before their mandatory vaccination. Recent epidemiological data shows a decrease in the number of pertussis cases, but a resurgence cannot be excluded in the coming years due to the cyclic evolution of the disease and the loosening of hygiene measures. Two approaches are used to protect infants before their vaccination: vaccination of the mother during pregnancy and vaccination of all the infant's close relatives (cocooning). The vaccination of the mother during pregnancy is more effective. The uncertain risk of chorioamniotitis associated with vaccination during pregnancy is insufficient to question this strategy.
RESUMEN
Although being complex, suicide is a phenomenon considered as preventable, and its prevention has been made as a public health priority. Some interventions to prevent suicide have been evaluated, such as the education of the healthcare workers, especially in the suicidal assessment (suicidal risk and suicidal emergency/dangerousness), the diagnosis and management of common mental disorders, the care provided after a suicide attempt, the restriction access to common means of suicide, the use of websites to educate the public, or the appropriate reports of suicide in media. Other interventions, even not rigorously evaluated, are implemented in France as in many parts of the world. It is the case of interventions among identified high-risk groups. To be efficient, prevention programs should simultaneously include different strategies targeting several known risk factors for suicide. Clinicians play a crucial role in the suicide prevention strategies.
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Trastornos Mentales , Intento de Suicidio , Recolección de Datos , Humanos , Factores de Riesgo , Ideación Suicida , Intento de Suicidio/prevención & controlRESUMEN
BACKGROUND: The knowledge of risk perceptions in primary care could help health authorities to manage epidemics. METHODS: A European multi-center cross-sectional study was conducted in France, Belgium and Spain to describe the perceptions, the level of anxiety and the feeling of preparedness of primary healthcare physicians towards the COVID-19 infection at the beginning of the pandemic. The factors associated with the feeling of preparedness were studied using multivariate logistic regressions. RESULTS: A total of 511 physicians participated to the study (response rate: 35.2%). Among them, only 16.3% (n=82) were highly anxious about the pandemic, 50.6% (n=254) had the feeling to have a high level of information, 80.5% (n=409) found the measures taken by the health authorities suitable to limit the spread of COVID-19, and 45.2% (n=229) felt prepared to face the epidemic. Factors associated with feeling prepared were: being a Spanish practitioner (adjusted OR=4.34; 95%CI [2.47; 7.80]), being a man (aOR=2.57, 95%CI [1.69; 3.96]), finding the measures taken by authorities appropriate (aOR=1.72, 95%CI [1.01; 3.00]) and being highly informed (aOR=4.82, 95%CI [2.62; 9.19]). CONCLUSIONS: Regarding the dramatic evolution of the pandemic in Europe in the weeks following the study, it appears that information available at this time and transmitted to the physicians could have given a wrong assessment of the spread and the severity of the disease. It seems essential to better integrate the primary care physicians into the information, training and protection channels. A comparison between countries could help to select the most effective measures in terms of information and communication.
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COVID-19 , Médicos de Atención Primaria , Bélgica/epidemiología , Estudios Transversales , Francia/epidemiología , Humanos , Masculino , Pandemias/prevención & control , Percepción , SARS-CoV-2 , España/epidemiologíaRESUMEN
Since the introduction in 1998 of an adolescent pertussis vaccine booster (for persons aged 11-13 years) in France, the incidence of pertussis in adolescents and adults has been unknown. We therefore undertook a study to estimate the incidence of pertussis in these population groups and to evaluate the feasibility of a real-time electronic surveillance system for pertussis in general practices in France. The general practitioners selected for the study were located in Paris and the surrounding area. Polymerase chain reaction (PCR) or measurement of anti-pertussis toxin IgG levels by enzyme-linked immunosorbent assay (ELISA) was used to confirm the infection. Among the 204 patients enrolled in the study, 46 (23%) were diagnosed as having pertussis: 21 were confirmed cases, 24 were clinical cases and one was an epidemiological case. The median age of the 204 patients was 44 years and 134 (66%) were female. The median duration of the patients' cough at enrolment was 24 days. No clinical difference was observed between those with and without a pertussis diagnosis. The incidence of pertussis was estimated to be 145 (95% confidence interval: 121-168) per 100,000 population based on the results from the 10-month study period (calculated for 12 months). Problems in sample collection were identified: pertussis sentinel surveillance cannot be developed without training the staff of medical laboratories who take the biological samples. French health authorities were alerted and training procedures were developed.
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Bordetella pertussis/aislamiento & purificación , Vigilancia de Guardia , Tos Ferina/epidemiología , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Ensayo de Inmunoadsorción Enzimática , Femenino , Francia/epidemiología , Médicos Generales , Humanos , Inmunoglobulina G/análisis , Incidencia , Masculino , Persona de Mediana Edad , Toxina del Pertussis/inmunología , Proyectos Piloto , Reacción en Cadena de la Polimerasa , Distribución por Sexo , Tos Ferina/diagnóstico , Tos Ferina/prevención & control , Adulto JovenRESUMEN
Pre-exposure prophlaxis (PrEP) is the use of antiretroviral drugs by uninfected people to prevent human immunodeficiency virus (HIV) infection. PrEP is used by people who are at substantial risk of being exposed to HIV. Numerous clinical trials have confirmed its effectiveness in reducing HIV acquisition and PrEP has been approved and allowed in several countries including France. However, PrEP uptake remains low as concerns about increase in sexual risk behaviour with PrEP use in the wake of a growing epidemic of sexually transmitted infections, and fear of drug resistance have been expressed. As a result, the difference between the proportion of people on PrEP and the proportion of people who would be very likely to use PrEP if they could access it -otherwise known as the PrEP gap- remains high. Nowadays, studies continue to explore long-term effects of PrEP as well as expand the array of available technologies and regimens.
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Fármacos Anti-VIH , Infecciones por VIH , Profilaxis Pre-Exposición , Enfermedades de Transmisión Sexual , Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Homosexualidad Masculina , Humanos , MasculinoRESUMEN
OBJECTIVES: Emerging infectious diseases are a public health issue of international concern. Identifying methods to limit their expansion is essential. We assessed the feasibility of a screening strategy in which each traveler would actively participate in the screening process after an intercontinental flight by reporting their own health status via a web-based self-administered questionnaire. PATIENTS AND METHODS: In 2015 and 2017, we invited passengers arriving at or departing from Pointe-à-Pitre international airport to answer an online health questionnaire during the four days following their arrival from or at Paris-Orly international airport. SPIRE 1 was intended for passengers arriving at Pointe-à-Pitre and was conceived as a pilot study. SPIRE 2 was an improved version of SPIRE 1 and consisted in three parts, which permitted to further assess the benefits of pre-flight request and email follow-up. Endpoints were the connection rates and response rates to online health questionnaire. RESULTS: For SPIRE 1, 4/1038 travelers (0.4%) completed the two steps of the online health questionnaire. In SPIRE 2, response rates ranged from 3/1059 (0.3%) to 19/819 (2.3%). Response rates were significantly better when passengers were approached before their flight. CONCLUSIONS: The yield of an online health questionnaire was unexpectedly low.
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Enfermedades Transmisibles Emergentes/diagnóstico , Internet , Tamizaje Masivo/métodos , Autoinforme , Viaje , Aeronaves , Estudios de Factibilidad , Estado de Salud , Humanos , Paris , Proyectos Piloto , Salud Pública , Encuestas y Cuestionarios , Medicina del ViajeroRESUMEN
BACKGROUND: Factors influencing adherence to long-term (i.e. ≥ 3 months) systemic glucocorticoid therapy are poorly understood. OBJECTIVE: To evaluate the relationship between glucocorticoid-induced adverse events and therapeutic adherence in patients on long-term glucocorticoid treatment. METHODS: A cross-sectional survey was conducted in three departments of dermatology/internal medicine between April and September 2008. Patients were asked to provide data regarding symptoms they attributed to glucocorticoids, and adherence to treatment was measured using the four-item Morisky-Green adherence scale. Logistic regression analyses were used to assess the association between reported adverse events and adherence to glucocorticoids. RESULTS: A total of 255 questionnaires were completed and analysed [women 78%; median age 48 years (interquartile range (IQR) 34-65); connective tissue diseases 59%; median duration of treatment 24 months (IQR 8-72); median daily dose 10 mg (IQR 6-20)]. Among these 255 patients, 199 (78%) reported themselves as 'good adherents' and 56 (22%) as 'poor adherents' to treatment. Poor adherence was associated with younger age [odds ratio (OR) 0·97, 95% confidence interval (CI) 0·95-0·99, per increasing year; P < 0·01], presence of glucocorticoid-induced epigastralgia (OR 4·02, 95% CI 2·00-8·09; P < 0·01) and presence of glucocorticoid-induced morphological changes (OR 2·49, 95% CI 1·19-5·21; P = 0·02). Moreover, patients with poor adherence were likely to report concomitantly poor adherence to dietary advice associated with glucocorticoid therapy (OR 2·44, 95% CI 1·12-5·26; P = 0·02). CONCLUSIONS: As with other chronic therapies, the presence of glucocorticoid-induced adverse events is associated with an altered self-reported adherence to glucocorticoids. Patients who report epigastric pain or morphological changes that they associate with glucocorticoid therapy are particularly at risk of poor adherence. Adherence to dietary advice associated with glucocorticoid therapy may be an indirect measure of treatment adherence.
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Glucocorticoides/efectos adversos , Cooperación del Paciente , Adulto , Anciano , Enfermedades del Tejido Conjuntivo/tratamiento farmacológico , Esquema de Medicación , Métodos Epidemiológicos , Femenino , Glucocorticoides/administración & dosificación , Glucocorticoides/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Vasculitis/tratamiento farmacológicoRESUMEN
In the end of August 2009, an unusually elevated level of influenza-like illness (ILI) activity was reported to the French Sentinel Network. We quantified the observed excess in ILI cases in France during summer 2009 and characterised age patterns in reported cases. An excess of cases has been observed since 5 July, with a time increasing trend. The cumulated estimated excess number of ILI cases was 269,935 [179,585; 316,512], corresponding to 0.5% French population over the period. Compared to the same period in the past years, relative cumulated incidence was greater among young subjects and lower among subjects over 65 years old. Compared to past epidemics, the relative cumulated incidence was greater in children less than 5 years old. This excess of cases may reflect the current spread of the A(H1N1) virus in France, subject to the following limitations: estimates were based on clinical cases consulting a GP; large media coverage may have led to a non specific increase in consultation rates.
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Notificación de Enfermedades/estadística & datos numéricos , Brotes de Enfermedades/estadística & datos numéricos , Medicina Familiar y Comunitaria/estadística & datos numéricos , Subtipo H1N1 del Virus de la Influenza A , Gripe Humana/epidemiología , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Francia/epidemiología , Humanos , Incidencia , Lactante , Masculino , Persona de Mediana Edad , Vigilancia de la Población , Medición de Riesgo/métodos , Factores de Riesgo , Distribución por Sexo , Adulto JovenRESUMEN
BACKGROUND: General practitioners' perception of the discomfort their patients experience because of corticosteroid-induced adverse events is unknown. METHODS: An observational epidemiological study was conducted in September 2007. Eight hundred and sixty general practitioners belonging to the réseau Sentinelles were asked to complete an electronical questionnaire. The questionnaire aimed to assess their perception of discomfort induced by adverse events induced by a long-term (i.e.,>or=3 months) corticosteroid therapy among their patients. Results were compared with the declaration made by 115 long-term corticosteroid treated patients followed in an internal medicine department. RESULTS: Two hundred and ninety-three general practitioners responded to the questionnaire (response rate: 34%). They were predominantly male (87%). Forty-eight percent of them reported 400 to 600 monthly visits. The mean length of corticosteroid therapy for patients was 44+/-38 months and the mean daily dosage was 15+/-14 mg. They suffered mainly from lupus erythematosus (33%) or giant cell arteritis (15%). The adverse events considered to be the most disturbing by patients were lipodystrophy (25%), followed by weight gain (18%) and neuropsychiatric complaints (16%). Physicians widely overestimated the discomfort caused by weight gain cited as the most disturbing adverse event by 59% of them and underestimated that induced by mood disorders cited as the most disturbing by only 3% of them. CONCLUSION: The discomfort caused by corticosteroid-induced neuropsychiatric adverse events are underestimated by general practitioners.
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Corticoesteroides/efectos adversos , Actitud del Personal de Salud , Medicina Familiar y Comunitaria , Corticoesteroides/administración & dosificación , Adulto , Anciano , Trastornos de Ansiedad/inducido químicamente , Interpretación Estadística de Datos , Depresión/inducido químicamente , Femenino , Arteritis de Células Gigantes/tratamiento farmacológico , Humanos , Lipodistrofia/inducido químicamente , Lupus Eritematoso Sistémico/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Trastornos del Humor/inducido químicamente , Percepción , Encuestas y Cuestionarios , Factores de Tiempo , Aumento de PesoRESUMEN
INTRODUCTION: Whereas internal medicine physicians frequently prescribe systemic corticosteroids, it is unknown if they assess adequately the frequency and the discomfort caused by corticosteroid-induced adverse events. METHODS: Using an e-mail questionnaire sent to the 813 internal medicine physicians, members of the French National Society of Internal Medicine, we assessed their perception of the frequency and the discomfort induced by the adverse events of long-term (that is, over or at three months) corticosteroid therapy. At the same time, 121 corticosteroid-treated patients, consulting in a department of internal medicine completed an anonymous questionnaire about the frequency and the discomfort caused by the adverse events of their therapy. RESULTS: Three hundred and thirty-six out of 813 internal medicine physicians answered to the questionnaire (response rate: 41%) and 115 of the 121 questionnaires distributed to patients were exploitable. The physicians were predominantly male (71%) working mainly in tertiary centers (53%). The mean length of corticosteroids therapy for patients was 44+/-38 months and the mean daily dosage was 15+/-14mg. Lipodystrophy, trophic skin disorders, neuropsychiatric disorders and insomnia were frequent and reported by more than half of patients. The frequency of neuropsychiatric and skin disorders and of lipodystrophy estimated by practitioners was markedly lower than the frequency reported by patients. If morphological changes (weight-gain and lipodystrophy) were cited by practitioners as the most discomforting adverse event, in agreement with patients' opinion, physicians underestimated the discomfort caused by neuropsychiatric disorders and insomnia. CONCLUSION: Frequency and discomfort caused by corticosteroid-induced neuropsychiatric disorders are underestimated by internal medicine physicians.
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Corticoesteroides/efectos adversos , Actitud del Personal de Salud , Femenino , Humanos , Medicina Interna , Masculino , Persona de Mediana Edad , Médicos , Encuestas y CuestionariosRESUMEN
INTRODUCTION: Depiscan was the pilot phase of a large trial to evaluate low dose computed tomography as a screening method for lung cancer (GranDepiscan). The goal of the study presented in this manuscript was to predict the activity of general practitioners (GPs) involved as investigators in a clinical trial. METHODS: A questionnaire about GP's socio-demographic characteristics, initial involvement and perception of difficulties was sent to 189 GPs volunteers after enrollment into the Depiscan trial was complete. RESULTS: Among the 97 respondents, 61 were active investigators. Age lower than 50 years and presence during the initiation visit were significantly associated with the participation of investigators. Two other factors at the limit of significance were: the status and the type of initiation visit. The following factors: gender, type of practice, membership of a medical society, parallel activity in the public sector and knowledge of the referring pulmonary oncologist were not associated with the level of recruitment, as well as the difficulties mentioned by the investigators. CONCLUSIONS: These results will help for selection of investigators for future clinical trials in general medical practice, particularly for the GranDépiscan trial.
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Medicina Familiar y Comunitaria , Neoplasias Pulmonares/diagnóstico por imagen , Radiografía Torácica , Investigadores , Tomografía Computarizada por Rayos X , Adulto , Recolección de Datos , Interpretación Estadística de Datos , Femenino , Humanos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Oportunidad Relativa , Ensayos Clínicos Controlados Aleatorios como Asunto , Encuestas y CuestionariosRESUMEN
OBJECTIVE: A questionnaire was used on 44 public and private hospital physicians in Paris to evaluate their knowledge of and adherence to Vaccination Guidelines, three years after their introduction. RESULTS: Eighty per cent of the physicians answered and 92.5% were aware of the vaccination guidelines but only 2 out of 4 respected the targeted vaccination in young adults even when the vaccine was available. A policy of pertussis vaccination was applied only in 12 institutions, but even in these, the rate of vaccinated healthcare workers remained low or was not documented. CONCLUSION: Pertussis is a potential risk to newborns not or partially vaccinated in France. Even if the vaccine is available, adherence to pertussis vaccination guidelines must be improved. Efforts should be made to better publicize and apply pertussis vaccination guidelines.
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Concienciación , Programas de Inmunización/normas , Vacuna contra la Tos Ferina/normas , Vacuna contra la Tos Ferina/uso terapéutico , Médicos/normas , Vacunación/normas , Adulto , Francia , Adhesión a Directriz/normas , Humanos , Recién Nacido , Medicina del Trabajo/normas , Vacuna contra la Tos Ferina/administración & dosificación , Guías de Práctica Clínica como Asunto/normas , Vacunación/estadística & datos numéricos , Adulto JovenRESUMEN
OBJECTIVES: We aimed to identify patients' clinical characteristics associated with respiratory viruses identified among patients presenting with influenza-like illness (ILI). METHODS: A sample of patients of all ages presenting with ILI was included by physicians of the French Sentinelles network during two seasons (2015/16 and 2016/17). Nasopharyngeal samples were tested for the presence of influenza virus (IV), respiratory syncytial virus (RSV), human rhinovirus (HRV) and human metapneumovirus (HMPV). Patients' characteristics associated with each of the four virus classes were studied using multivariate logistic regressions. RESULTS: A total of 5859 individuals were included in the study: 48.0% tested positive for IV, 7.9% for HRV, 7.5% for RSV and 4.1% for HMPV. Cough was associated with IV (OR 2.14, 95% CI 1.81-2.52) RSV (OR 2.52, 95% CI 1.75-3.74) and HMPV detection (OR 2.15, 95% CI 1.40-3.45). Rhinorrhoea was associated mainly with HRV detection (OR 1.75, 95% CI 1.34-2.32). Headache was associated with IV detection (OR 1.75, 95% CI 1.34-2.32), whereas absence of headache was associated with RSV and HMPV detection. Dyspnoea was associated with RSV detection (OR 2.33, 95% CI 1.73-3.12) and absence of dyspnoea with IV detection. Conjunctivitis was associated with IV detection (OR 1.27, 95% CI 1.08-1.50). Some associations were observed only in children: dyspnoea and cough with RSV detection (age <5 years), conjunctivitis with IV detection (age <15 years). Period of onset of symptoms differed among aetiological diagnoses. Seasonal influenza vaccination decreased the risk of IV detection (OR, 0.67, 95% CI 0.51-0.86). CONCLUSIONS: This study allowed the identification of symptoms associated with several viral aetiologies in patients with ILI. A proper knowledge and understanding of these clinical signs may improve the medical management of patients.
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Gripe Humana/diagnóstico , Gripe Humana/virología , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/virología , Adolescente , Adulto , Factores de Edad , Anciano , Niño , Preescolar , Diagnóstico Diferencial , Femenino , Francia/epidemiología , Humanos , Lactante , Recién Nacido , Gripe Humana/epidemiología , Masculino , Metapneumovirus/aislamiento & purificación , Persona de Mediana Edad , Nasofaringe/virología , Orthomyxoviridae/aislamiento & purificación , Atención Primaria de Salud/estadística & datos numéricos , Virus Sincitial Respiratorio Humano/aislamiento & purificación , Infecciones del Sistema Respiratorio/epidemiología , Rhinovirus/aislamiento & purificación , Estaciones del Año , Adulto JovenRESUMEN
BACKGROUND: The investigation of dual influenza infection human cases is of major interest specifically for the control of new emerging influenza strains. OBJECTIVES: Using RT-PCR assays, we retrospectively assessed the prevalence of dual influenza virus infections that occurred in patients during the 2006-2007 winter season in Corsica Island (France). STUDY DESIGN: One hundred and thirty-four nasal swabbing samples taken from patients suffering from influenza-like illness between February and March 2007 were analysed using a rapid influenza antigen detection test, cell culture and RT-PCR assays. RESULTS AND CONCLUSION: Influenza viruses were detected in 93 (69.4%) of 134 patients with influenza-like illness using the combination of classical and molecular assays. Dual respiratory infections by influenza viruses were detected in 3 (3.2%) of the 93 influenza positive patients, including two cases of infection by influenza A/H3N2 and B viruses and one case of dual infection by influenza A/H3N2 and A/H1N1 viruses. In the present report, human co-infection cases by two influenza viruses appeared as a rare event in symptomatic patients. However, the virological and epidemiological mechanisms that determine the occurrence of dual influenza infections remain to be fully investigated in further prospective multicentric studies.
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Subtipo H1N1 del Virus de la Influenza A/aislamiento & purificación , Subtipo H3N2 del Virus de la Influenza A/aislamiento & purificación , Virus de la Influenza B/aislamiento & purificación , Gripe Humana/diagnóstico , Gripe Humana/virología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Francia/epidemiología , Humanos , Subtipo H1N1 del Virus de la Influenza A/clasificación , Subtipo H1N1 del Virus de la Influenza A/genética , Subtipo H3N2 del Virus de la Influenza A/clasificación , Subtipo H3N2 del Virus de la Influenza A/genética , Virus de la Influenza B/clasificación , Virus de la Influenza B/genética , Gripe Humana/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Estaciones del Año , Cultivo de VirusRESUMEN
INTRODUCTION: Except for the prevention of osteoporosis, no consensual recommendations are available regarding the therapeutic measures associated with the prescription of long-term corticosteroid therapy. The aim of this study was to assess the internal medicine physicians' practices regarding the prescription of long-term corticosteroid therapy. METHODS: In September 2007, we sent, by e-mail, a questionnaire to 813 internal medicine physicians, members of the French National Society of Internal Medicine. With this questionnaire, we assessed the frequency of prescription of measures sometimes associated with systemic corticosteroids and for whom no consensual recommendations were available (dietary advices, physical training, potassium supplementation, gastric protection, influenza vaccination and prescription of hydrocortisone). RESULTS: Three hundred and thirty-six out of 813 internal medicine physicians completed the questionnaire (response rate: 41%). The practitioners were predominantly male (71%) and mainly engaged in tertiary centres (53%). Regarding the dietary measures associated with the prescription of corticosteroids, low-sodium diet was recommended by most of the physicians, 69% of them prescribing such dietary regimen in more than 80% of their corticosteroid-treated patients. The concomitant prescription of caloric restriction, low-carbohydrate diet and/or high-protein diet was not consensual. The prescription of muscular physiotherapy was unusual, 74% of physicians prescribing such reeducation in less than 20% of their patients. The frequency of recommendation for daily physical training varied between physicians as well as for potassium supplementation, gastric protection, influenza vaccination or hydrocortisone prescription. CONCLUSION: There is no consensus between French internal medicine physicians regarding most of the measures, which must be prescribed in association with a long-term corticosteroid therapy.