Social Stigma and COVID-19 Vaccine Refusal in France.

CONTEXT: In 2021, French health authorities strongly promoted the vaccination against Covid-19. We assumed that refusing this vaccine became a 'stigma', and we investigated potential 'public stigma' toward unvaccinated people among the French population. METHODS: A representative sample of the French adult population (N = 2,015) completed an online questionnaire in September 2021. We focused on participants who were already vaccinated against Covid-19, or intended to get vaccinated (N = 1,742). A cluster analysis was used to obtain contrasted attitudinal profiles, and we investigated associated factors with logistic regressions. FINDINGS: Regarding attitudes toward unvaccinated people, several pejorative statements were supported by a majority of respondents, and a significant minority also endorsed social rejection attitudes. We found four contrasted attitudinal profiles: Moral condemnation only (32% of respondents), Full stigma (26%), No stigma (26%) and Stigma rejection (16%). Early vaccination, civic motives for it, faith in science, rejection of political extremes and being 65 or over were the main factors of stigmatizing attitudes toward unvaccinated people. CONCLUSIONS: We found some evidence of stigmatization toward unvaccinated people, but further research is needed, especially to investigate perceived stigmatization among them. We discussed our results in reference with the concept of 'Folk Devils', and from a public health perspective.

Explaining Political Differences in Attitudes to Vaccines in France: Partisan Cues, Disenchantment with Politics and Political Sophistication.

CONTEXT: The role of political identities in determining attitudes to vaccines has attracted a lot of attention in the last decade. Explanations have tended to focus on the influence of party representatives on their sympathizers (partisan cues). METHODS: Four representatives samples of the French adult population completed online questionnaires between July 2021 and May 2022 (N = 9,177). Bivariate and multivariate analyses were performed to test whether partisan differences in attitudes to vaccines are best explained by partisan cues or by parties' differences in propensity to attract people who distrust the actors involved in vaccination policies. FINDINGS: People who feel close to parties at the far left, the far right and to green parties are more vaccine hesitant. We found a small evidence for the effect of partisan cues and a much stronger effect of trust. But more importantly, we show that the more politically sophisticated are less vaccine hesitant and that the non-partisan are the biggest and most vaccine-hesitant group. CONCLUSIONS: The literature has focused on the case of the USA but turning the attention towards countries where disenchantment with politics is more marked helps better understand the different ways trust, partisanship and political sophistication can affect attitudes to vaccines.

Vaccine hesitancy about the HPV vaccine among French young women and their parents: a telephone survey.

BACKGROUND: The human papillomavirus (HPV) vaccine reduces the burden of cervical and other cancers. In numerous countries, a slow uptakeof this vaccine persists, calling for a better understanding of the structural factors leading to vaccine acceptation. We aimed to assess the attitudes toward HPV vaccination among its intended public to explore its specific characteristics. METHODS: A random cross-sectional telephone survey of the French general population provided data from a sample of 2426 respondents of the target public: the parents of young women and the young women aged 15-25 themselves. We applied cluster analysis to identify contrasting attitudinal profiles, and logistic regressions with a model averaging method to investigate and rank the factors associated with these profiles. RESULTS: A third of the respondents had never heard of HPV. However, most of the respondents who had heard of it agreed that it is a severe (93.8%) and frequent (65.1%) infection. Overall, 72.3% of them considered the HPV vaccine to be effective, but 54% had concerns about its side effects. We identified four contrasting profiles based on their perceptions of this vaccine: informed supporters, objectors, uninformed supporters, and those who were uncertain. In multivariate analysis, these attitudinal clusters were the strongest predictors of HPV vaccine uptake, followed by attitudes toward vaccination in general. CONCLUSIONS: Tailored information campaigns and programs should address the specific and contrasted concerns about HPV vaccination of both young women and of their parents.

When the patient is making the (wrong?) diagnosis: a biographical approach to patients consulting for presumed Lyme disease.

BACKGROUND: Media coverage of Lyme disease (LD) has led to an increase in consultations for presumed LD in Europe. However, LD is confirmed in only 10%-20% of patients, with a significant number remaining in a diagnostic dead-end. OBJECTIVES: To reach a deeper understanding of how patients themselves contribute to the diagnostic process. To describe the genesis of the LD hypothesis in care pathways. METHODS: In 2019, 30 patients from a prospective cohort consulting in the infectious diseases department at University Hospital in Marseille for presumed LD were recruited for semistructured interviews. The inclusion criteria were: suffering from subjective symptoms for 6 months, no clinical or paraclinical argument suggesting current LD. The patients' medical trajectories were collected using a biographical approach. RESULTS: The diagnosis of LD was primarily triggered by identification with personal testimonies found on the Internet. Most of patients were leading their own diagnostic investigation. The majority of participants were convinced they had LD despite the lack of medical evidence and the scepticism of their referring GP. CONCLUSION: GPs should first systematically explore patients' aetiologic representations in order to improve adherence to the diagnosis especially in the management of medically unexplained symptoms. Long COVID-19 syndrome challenge offers an opportunity to promote active patient involvement in diagnosis.

Incidence of PTSD in the French population a month after the COVID-19 pandemic-related lockdown: evidence from a national longitudinal survey.

BACKGROUND: In view of experts' warnings about the potential negative mental health consequences of the sudden nationwide lockdowns implemented in many countries to limit the spread of the COVID-19 pandemic, we sought to study the incidence of posttraumatic stress disorder (PTSD) after traumatic events related to this unprecedented lockdown in the French general population. METHODS: This longitudinal study among adults (aged =18) consisted of two surveys: the first during the last days of the lockdown and the second a month later. We estimated PTSD incidence with the PCL-5 and ran multiple Poisson regression models to identify factors associated with PTSD. RESULTS: Among the 1736 participants, 30.1% reported at least one traumatic event. PTSD incidence was 17.5% (95% confidence interval CI = 15.7-19.3). It was higher in participants who reported multiple traumatic events, who had high COVID-19-related media use, who had general anxiety disorder (GAD-7) during the lockdown, and who had GAD, depression (PHQ-9), or sleep problems 1 month later. In addition, 43.1% of people with PTSD reported suicidal thoughts. CONCLUSIONS: These results should help clinicians to target people who are at high risk of developing PTSD after a pandemic-related lockdown and could benefit from preventive measures. Collaboration between the media and mental health professionals could be envisioned to inform the population about care resources. Follow-up recommendations should also be disseminated to general practitioners to facilitate PTSD screening and ensure that they are aware of the appropriate management.

Attitudes about COVID-19 Lockdown among General Population, France, March 2020.

Because the effectiveness of a coronavirus disease lockdown in curbing coronavirus disease spread depends on public support, acquiring real-time information about the way populations reacted to the lockdown is crucial. In France, such public support remained fragile among low-income persons, probably because the lockdown exacerbated preexisting social inequalities and conflicts.

Covid-19 health crisis and lockdown associated with high level of sleep complaints and hypnotic uptake at the population level.

The Covid-19 pandemic has disrupted the habits of billions of people around the world. Lockdown at home is mandatory, forcing many families, each member with their own sleep-wake habits, to spend 24 hr a day together, continuously. Sleep is crucial for maintaining immune systems and contributes deeply to physical and psychological health. To assess sleep problems and use of sleeping pills, we conducted a cross-sectional study of a representative sample of the general population in France. The self-reported sleep complaint items, which covered the previous 8 days, have been used in the 2017 French Health Barometer Survey, a cross-sectional survey on various public health issues. After 2 weeks of confinement, 74% of the participants (1,005 subjects) reported trouble sleeping compared with a prevalence rate of 49% in the last general population survey. Women reported more sleeping problems than men, with greater frequency or severity: 31% vs. 16%. Unusually, young people (aged 18-34 years) reported sleep problems slightly more frequently than elderly people (79% vs. 72% among those aged 35 or older), with 60% of the younger group reporting that these problems increased with confinement (vs. 51% of their elders). Finally, 16% of participants reported they had taken sleeping pills during the last 12 months, and 41% of them reported using these drugs since the lockdown started. These results suggest that the COVID crisis is associated with severe sleep disorders among the French population, especially young people.

Regional variations of childhood immunisations in Senegal: a multilevel analysis.

OBJECTIVES: To estimate geographical variations of child immunisation at the regional level in Senegal, to identify individual and contextual factors that could explain these regional discrepancies, and to measure their effects. METHODS: Data come from the 2015, 2016 and 2017 Senegalese Demographic and Health Survey, a national survey targeting women aged 15-49, with a questionnaire focusing on health and reproductive issues including their children's immunisation status. We restricted the analysis to children aged 12-23 months (n = 4955) and conducted a multilevel logistic regression to assess individual and contextual factors associated with complete immunisation coverage. RESULTS: The complete immunisation coverage rate of children was estimated at 68% and ranged from 41% in the region of Kedougou to 83% in the region of Dakar. The inter-regional variance was significantly different from zero (P = 0.006) in the empty multilevel model. It decreased by more than half (57 %) after adjusting for individual factors but remained significantly different from zero (P = 0.010). Regional variations of complete immunisation rates drastically decreased and were no longer statistically significant (P = 0.343) after adjusting for the following regional factors: population density, density of hospitals, literacy rate and proportion of health facilities with an antenatal care service. CONCLUSIONS: Regarding health policies designed to improve childhood immunisation and to reduce related inequalities, our results highlight the need to take into account both individual and contextual factors, with a focus on rural and deprived areas where children are at higher risk of incomplete immunisation.

OBJECTIFS: Estimer les variations géographiques de la vaccination des enfants au niveau régional au Sénégal, identifier les facteurs individuels et contextuels qui pourraient expliquer ces écarts régionaux et mesurer leurs effets. MÉTHODES: Les données proviennent de l'enquête démographique et la santé du Sénégal de 2015, 2016 et 2017, une enquête nationale ciblant les femmes âgées de 15 à 49 ans, avec un questionnaire axé sur les problèmes de santé et de reproduction, y compris le statut vaccinal de leurs enfants. Nous avons limité l'analyse aux enfants âgés de 12 à 23 mois (n = 4.955) et avons effectué une régression logistique à plusieurs niveaux pour évaluer les facteurs individuels et contextuels associés à une couverture vaccinale complète. RÉSULTATS: Le taux de couverture vaccinale complète des enfants était estimé à 68% et variait de 41% dans la région de Kédougou à 83% dans la région de Dakar. La variance interrégionale était significativement différente de zéro (P = 0,006) dans le modèle vide à plusieurs niveaux. Il diminuait de plus de la moitié (57%) après ajustement pour les facteurs individuels mais est restait significativement différent de zéro (P = 0,010). Les variations régionales des taux de vaccination complète ont considérablement diminué et n'étaient plus statistiquement significatives (P = 0,343) après ajustement pour les facteurs régionaux suivants: densité de population, densité des hôpitaux, taux d'alphabétisation et proportion d'établissements de santé disposant d'un service de soins prénatals. CONCLUSIONS: En ce qui concerne les politiques de santé conçues pour améliorer la vaccination des enfants et réduire les inégalités associées, nos résultats soulignent la nécessité de prendre en compte les facteurs individuels et contextuels, en mettant l'accent sur les zones rurales et défavorisées où les enfants sont plus à risque de vaccination incomplète.

The positive effect of workplace accommodations on the continued employment of cancer survivors five years after diagnosis.

PURPOSE: To address the gap highlighted in the literature on the effect of professional interventions to facilitate continued employment, this study aims to evaluate the effect of workplace accommodations on the continued employment 5 years after a cancer diagnosis. METHODS: This study is based on VICAN5, a French survey conducted in 2015-2016 to examine the living conditions of cancer survivors 5 years after diagnosis. Two subsamples, one with and one without workplace accommodations, were matched using a propensity score to control for the individual, professional, and medical characteristics potentially associated with receipt of workplace accommodations. RESULTS: The study sample was composed of 1514 cancer survivors aged 18-54 and employed as salaried at diagnosis. Among them, 61.2% received workplace accommodations within 5 years after diagnosis: 35.5% received a modified workstation, 41.5% received a modified schedule, and 49.2% received reduced hours. After matching, receipt of workplace accommodations appeared to improve the continued employment rate 5 years after cancer diagnosis from 77.8% to 95.0%. CONCLUSIONS: Receipt of workplace accommodations strongly increases the continued employment of cancer survivors 5 years after diagnosis. More research is needed to better understand the differences in receipt of workplace accommodations along with the related selection effect.

The French general population's attitudes toward lockdown against COVID-19: a fragile consensus.

BACKGROUND: In March 2020, as the coronavirus disease 2019 (COVID- 19) pandemic was spreading across the globe, many countries have implemented unprecedented lockdown measures. But how populations did react to these measures? We examined the case of France. Our aims were threefold: assessing some aspects of their impact on French's daily living conditions; investigating their attitudes toward the lockdown; investigating the factors associated with these attitudes. METHODS: A cross-sectional online survey was carried out 10 days after the nationwide lockdown (from March 27th to March 29th 2020), among a representative sample of the mainland French population aged 18 and over. A quota sampling method was applied to achieve a sample of 1012 respondents. We used a cluster analysis to obtain contrasted attitudinal profiles, and logistic regressions to investigated which factors were associated to these profiles. RESULTS: After 10 days of lockdown, there were already significant consequences regarding respondents' living conditions and mental health. Most respondents supported the current lockdown. However, it appeared as a stopgap measure due to a lack of alternatives, and a large majority acknowledged its heavy drawbacks. We found three contrasted attitudinal profiles: full support (38%), strong but critical support (31%), limited support (31%). Regarding respondents' SES, low-income and low-education respondents were more likely to display critical or limited support to the lockdown, as well as those who reported deteriorated living conditions or psychological distress. CONCLUSIONS: In France, the large public support to the lockdown was fragile. First, it was a critical consensus anchored in current controversies and recent social struggles. Second, it was weaker among people with a lows SES, especially since the lockdown have exacerbated preexisting social inequalities.

Vaccination card availability and childhood immunization in Senegal.

BACKGROUND: The World Health Organization recommends recording vaccination status according to maternal recall in countries where administrative reporting systems are insufficiently reliable, as maternal recall in developing countries has been shown to be quite reliable compared with data from vaccination cards. This study aimed to investigate childhood vaccination coverage and its determinants according to the mothers' presentation of vaccination cards. METHODS: The data come from the 2017 Senegalese Demographic and Health Survey, a nationally representative household survey of women aged 15-49 years, with a questionnaire focusing on children's health. This analysis was restricted to children aged 12-35 months (n = 4032) and it assessed vaccination coverage and associated sociodemographic factors with weighted multivariate logistic regressions. Stratified multivariate logistic regressions were also performed to investigate factors associated with routine childhood immunization uptake of the Bacillus Calmette-Guérin (BCG) vaccine, recommended for administration shortly after birth, as well as of the vaccines against yellow fever and measles (recommended at 9 months). RESULTS: Comparison of vaccination coverage estimates according to the vaccination card or parental recall resulted in a 5-10% difference in estimated coverage for the BCG, pentavalent, measles, and yellow fever vaccines, but a huge difference for the polio vaccine (93.0% with the card, 32.0% without it). Presentation of the vaccination card was correlated with mothers' attendance at health facilities (suggesting it serves as a concrete manifestation of a bond between mothers and the healthcare system) and their region of residence, but it was not correlated with usually strong predictors of childhood vaccination, such as maternal education level. Factors associated with vaccinations differed depending on whether they were administered shortly after birth or later on. CONCLUSIONS: Maternal recall was found to be quite reliable except for oral polio vaccination, which raises the possibility that complete immunization coverage rates could have been significantly underestimated due to potential confusion between injection and vaccination. Considering the ability to present vaccination cards as the materialization of a bond with the healthcare system, the decision path leading to vaccination among those who lack such a bond appears longer and more likely to be driven by supply-side effects.

Sexual desire of French representative prostate cancer survivors 2 years after diagnosis (the VICAN survey).

PURPOSE: The prostate cancer impacts on the future life of survivors. The complexity of sexual health problems in prostate cancer survivors is underestimated or often reduced to the erectile dysfunction. Especially, factors influencing sexual desire of patients have to be more explored. This study aims to describe the therapeutic management of patients with prostate cancer and assess their sexual desire 2 years after diagnosis. METHODS: This study is part of the National VICAN survey (Vie après le CANcer) implemented in France in 2012. This analysis was performed on a population of 414 men who had prostate cancer. The questionnaire dealt with several topics including socioeconomic status, treatments received, and sexual desire. RESULTS: Prostatectomy (42.8%), radiotherapy + hormonotherapy (17.6%), and radiotherapy alone (12.8%) were the main treatments used. 41.3% of men stated that their sexual desire was all gone since disease. The "satisfying" perceived financial situation was significantly associated to a sexual desire loss (p = 0.008). Radiotherapy + hormonotherapy treatment only is significantly associated with a loss of sexual desire (P = 0.003). CONCLUSIONS: Two years after diagnosis, the sexual desire of prostate cancer survivors is deteriorated with the cancer experience. However, clinical characteristics do not seem to be decisive unlike a "satisfying" financial situation. Research about the impact of socio economics characteristics on sexual health should probably be engaged. Programs have to be developed in France to have personalized sexual support progressed for survivors and take spouses into consideration in this context.

'I Think I Made The Right Decision I Hope I'm Not Wrong'. Vaccine hesitancy, commitment and trust among parents of young children.

During the last decade, public health research has emphasised the growing public disaffection with vaccination. This contemporary vaccine hesitation (VH) refers to a delay in acceptance or refusal of vaccines, as well as agreement despite doubt and reluctance. We investigated VH among French parents of young children, with an emphasis on two key features of VH: trust towards physicians and commitment to vaccination issues. We targeted two populations with contrasting socioeconomic profiles, using in-depth interviews (n = 25). Most parents exhibited some kind of VH, with differentiated attitudes across vaccines, including acceptance despite enduring doubts, especially for vaccines already provided to older siblings ('vaccine inertia'). Despite the rise of the Internet and social media, our participants still strongly relied on face-to-face interactions with peers and significant others. Most participants trusted their own physician but this was the result of a selection process: they had engaged resources to find a physician they could trust. Participants with contrasted socioeconomic profiles struggled with the same dilemmas, and they committed themselves to the same quest to find the 'right' physician. Nevertheless, parents with a higher socioeconomic status were able to engage more resources and use a wider repertoire of actions, and they also displayed greater health literacy.

Flu vaccination among patients with diabetes: motives, perceptions, trust, and risk culture - a qualitative survey.

BACKGROUND: Vaccination against seasonal influenza (SIV) is recommended for patients with diabetes, but their vaccination coverage is unsatisfactory in France and elsewhere. This qualitative survey of people with diabetes sought to explore 1) the extent to which SIV-related behaviour is more or less automatic; 2) reasons they choose/reject SIV; 3) their trust/distrust in authorities, science, and medicine. METHODS: We conducted semi-structured in-depth interviews of 19 adults with diabetes in 2014. We recruited them through physicians or patient associations and implemented an analysis of thematic content. RESULTS: Eight patients were vaccinated against flu in the preceding flu season and 11 were not. SIV uptake and refusal were stable over time and justified by multiple arguments. Coupons for free vaccines and regular doctor visits contributed to the habit of vaccination. Vaccination decisions were frequently anchored in past experiences of influenza and its vaccine. Patients often justified non-vaccination with attitudes of trivialisation/relativisation of influenza-associated risks and the perception that these can be controlled by means other than vaccination (e.g., through the avoidance of exposure). Some misbeliefs (e.g., SIV causes influenza) and doubts about SIV effectiveness and safety also existed. Several patients reported increased mistrust of SIV since the A/H1N1 pandemic in 2009. Patients trusted their doctors strongly regardless of their SIV behaviour, but unvaccinated patients had little trust in the government and pharmaceutical companies. Some discordances were found between perceptions and behaviour (e.g., remaining vaccinated despite doubts about SIV effectiveness or remaining unvaccinated despite feelings of vulnerability towards influenza complication), suggesting the existence of some vaccine hesitancy among patients. CONCLUSION: This study among patients with diabetes suggest that SIV uptake is stable, thanks to a favourable environment. Nonetheless, SIV refusal is also stable over time. Unvaccinated patients used multiple arguments to justify SIV refusal, including compensatory health beliefs. Physicians should take every opportunity to recommend SIV. The necessary individualised patient education regarding SIV requires better physician training in patients priorities. While almost all patients strongly trust their doctors, unvaccinated patients distrust distal stakeholders: it is absolutely essential to restore trust in them and to develop new more effective influenza vaccines.

Vaccine hesitancy in the French population in 2016, and its association with vaccine uptake and perceived vaccine risk-benefit balance.

BackgroundVaccine hesitancy (VH) is prominent in France. Objectives: This study aimed to estimate the prevalence and socio-demographic correlates of VH in sub-groups of the French population and to investigate the association of VH with both vaccine uptake and perceived risk-benefit balance (RBB) for four vaccines. Methods: During the 2016 Health Barometer - a national cross-sectional telephone survey in a representative sample of the French population - parents of 1-15 year-old children, parents of 11-15 year-old girls and elderly people aged 65-75 years were asked about VH (using three questions adapted from the World Health Organization definition), vaccine uptake and perceived RBB for measles and hepatitis B (children's parents), human papillomavirus (girls' parents) and seasonal influenza (elderly people) vaccines. Results: A total of 3,938 parents including 959 girls' parents - and 2,418 elderly people were interviewed. VH prevalence estimates were 46% (95% confidence interval (CI): 44-48) among parents, 48% (95%CI: 45-51) among girls' parents and 35% (95% CI: 33-36) among elderly people, with higher estimates associated with high education level, children's age (10-15 years), and, for the elderly, poor perception of health status. VH was associated with uncertainty about and/or an unfavourable perception of vaccines' RBB for the four vaccines and with lower self-reported vaccine uptake, except for human papillomavirus vaccine in girls. Results were confirmed by multivariable analysis. Conclusion: Further research is needed to study the association between VH and vaccine uptake for other vaccines, and to design and validate measurement tools to monitor VH over time.

Alcohol and cancer: risk perception and risk denial beliefs among the French general population.

Background: Worldwide, millions of deaths each year are attributed to alcohol. We sought to examine French people's beliefs about the risks of alcohol, their correlates, and their associations with alcohol use. Methods: Data came from the 2010 Baromètre Cancer survey, a random cross-sectional telephone survey of the French general population (n = 3359 individuals aged 15-75 years). Using principal component analysis of seven beliefs about alcohol risks, we built two scores (one assessing risk denial based on self-confidence and the other risk relativization). Two multiple linear regressions explored these scores' socio-demographic and perceived information level correlates. Multiple logistic regressions tested the associations of these scores with daily drinking and with heavy episodic drinking (HED). Results: About 60% of the respondents acknowledged that alcohol increases the risk of cancer, and 89% felt well-informed about the risks of alcohol. Beliefs that may promote risk denial were frequent (e.g. 72% agreed that soda and hamburgers are as bad as alcohol for your health). Both risk denial and risk relativization scores were higher among men, older respondents and those of low socioeconomic status. The probability of daily drinking increased with the risk relativization score and that of HED with both scores. Conclusions: Beliefs that can help people to deny the cancer risks due to alcohol use are common in France and may exist in many other countries where alcoholic beverages have been an integral part of the culture. These results can be used to redesign public information campaigns about the risks of alcohol.

Patient Discussion About Sexual Health With Health Care Providers After Cancer-A National Survey.

INTRODUCTION: A discussion about sexuality should become a routine part of the personalized care pathway for patients with cancer. AIM: To assess rates of patient discussion about sexuality with health care providers after cancer. METHODS: We used data from the representative French nationwide 2012 VICAN survey, which included 4,349 adults 18 to 82 years old who were still alive 2 years after diagnosis at 12 cancer sites. MAIN OUTCOME MEASURES: Self-reported rates of discussion about sexuality with health care providers were assessed, and associated factors were tested after systematic adjustment for a sexual health indicator (created from six items of the Relationship and Sexuality Scale). RESULTS: Of 4,181 respondents to the question on a discussion about sexuality, 54.7% reported that nobody had proposed a discussion to them, 21.9% did not want any discussion, and 23.4% had had a discussion. Women had less discussion about sexuality with health care providers (11.1% vs 36.7% of men, P < .001) and were more likely to request a discussion at their own initiative (62.9% vs 48.0% of men, P < .001). Discussion about sexuality was more frequent with patients with prostate (56.3%) and cervical (39.6%) cancer, but increasing age was associated with a greater reluctance to discuss this issue (odds ratio = 1.17, 95% CI = 1.04-1.2). The likelihood of discussion increased with severe sexual problems, radiotherapy, general sequelae, having an information-seeker profile, previous professional psychological help, and initial treatment in private centers. Patients initially wishing for psychological help were more likely to desire a discussion about sexuality. CONCLUSION: Sexuality receives little attention in French patients with cancer. Inequalities in the discussion about sexuality were observed in relation to the type of care center where the patient was initially managed. Information on supportive interventions, including more systematic referral for professional psychological help, should be developed to facilitate discussion and should be offered to all patients, irrespective of severity of sexual problems, age, sex, cancer site, and care center.

Prevalence and correlates of vaccine hesitancy among general practitioners: a cross-sectional telephone survey in France, April to July 2014.

This article sought to estimate the prevalence of vaccine hesitancy (VH) among French general practitioners (GPs) and to study its demographic, professional and personal correlates. We conducted a cross-sectional telephone survey about GPs' vaccination-related attitudes and practices in 2014 in a national panel of 1,712 GPs in private practice, randomly selected from an exhaustive database of health professionals in France. A cluster analysis of various dimensions of VH (self-reported vaccine recommendations, perceptions of vaccine risks and usefulness) identified three clusters: 86% of GPs (95% confidence interval (CI): 84-88) were not or only slightly vaccine-hesitant, 11% (95% CI: 9-12) moderately hesitant and 3% (95% CI: 3-4) highly hesitant or opposed to vaccination. GPs in the latter two clusters were less frequently vaccinated and reported occasional practice of alternative medicine more often than those in the first cluster; they also described less experience with vaccine-preventable diseases and more experience with patients who they considered had serious adverse effects from vaccination. This study confirms the presence of VH among French GPs but also suggests that its prevalence is moderate. Given GPs' central role in vaccination, these results nevertheless call for a mobilisation of stakeholders to address VH among GPs.

COVID-19 patient experiences in prehospital pathways: a processual approach using life-events calendar method and state sequence analysis shows detrimental delays.

OBJECTIVES: To our best knowledge, no study in France has comprehensively investigated the prehospital history of patients admitted for severe cases of COVID-19. 'Patients' voice is an excellent means to capture data on primary care pathways.We aimed to identify clusters of COVID-19 hospitalised patients with similar prehospital symptom sequences, and to test whether these clusters were associated with a higher risk of poor clinical outcomes. DESIGN: Cross-sectional online survey using life-event calendars. SETTING: All patients hospitalised for COVID-19 between September 2020 and May 2021 in the Infectious Disease Departments in Nice and in Marseilles in France. PARTICIPANTS: 312 patients responded to the survey. MAIN OUTCOME MEASURES: From the day of symptom onset to the day of hospitalisation, we defined a symptom sequence as the time-ordered vector of the successive symptom grades (grade 1, grade 2, grade 3). State sequence analysis with optimal matching was used to identify clusters of patients with similar symptom sequences. Multivariate logistic regressions were performed to test whether these clusters were associated with admission to intensive care unit (ICU) and COVID-19 sequelae after hospitalisation. RESULTS: Three clusters of symptom sequences were identified among 312 complete prehospital pathways. A specific group of patients (29%) experienced extended symptoms of severe COVID-19, persisting for an average duration of 7.5 days before hospitalisation. This group had a significantly higher probability of being admitted to ICU (adjusted OR 2.01). They were less likely to know a loved one who was a healthcare worker, and more likely to have a lower level of education. Similarly, this group of patients, who were more likely to have previously visited the emergency room without exhibiting severe symptoms at that time, may have been inclined to postpone reassessment when their health worsened.Their relatives played a decisive role in their hospitalisation. CONCLUSION AND RELEVANCE: This study highlights the negative impact of delayed hospitalisation on the health outcomes of French patients with severe COVID-19 symptoms during the first wave and underscores the influence of socioeconomic factors, such as lower education levels and limited connections to the medical field, on patients' experiences.