[Cancer prevention in France: Implication of health professionals]. / Prévention des cancers en France : quel rôle pour les professionnels de santé ?

Almost 40% of cancers are attributable to preventable cancer risk factors related to behavior. Health professionals must take into account the respective weight of the different causes of cancer to enforce effective cancer prevention. Their involvement is needed on several levels. In primary prevention, not only for vaccinations, detection and support the withdrawal of addiction, but also by a greater consideration in their patients of all cancer risk behavioral factors. This involvement is essential in the care and monitoring of patients with cancer. Thus, enhancing patient compliance with cancer prevention tips (stopping smoking, reducing alcohol consumption, practice physical activity, physical inactivity reduction, reduction of overweight, adopting a diversified and balanced diet) appears as a new challenge of personalized care in oncology that not only aims to reduce the incidence of cancer but also to reduce the risks of morbidity and long-term mortality.

Human Papillomavirus vaccination in general practice in France, three years after the implementation of a targeted vaccine recommendation based on age and sexual history.

In France, vaccination against human papilloma virus (HPV) was recommended in 2007 for all 14-year-old girls as well as "catch-up" vaccination for girls between 15-23 y of age either before or within one year of becoming sexually active. We evaluated the vaccine coverage according to the eligibility for vaccination in a sample of young girls aged 14 to 23 years, who were seen in general practices. A survey was proposed to 706 general practitioners (GPs) and carried out from July to September 2010. GPs, also called "family doctor," are physicians whose practice is not restricted to a specific field of medicine but instead covers a variety of medical problems in patients of all ages. Each participating GP included, retrospectively, the last female patient aged 14-17 y and the last female patient aged 18-23 y whom he had seen. A questionnaire collected information regarding the GP and the patients' characteristics. The vaccine coverage was determined according to the eligibility for vaccination, i.e. the coverage among younger women (14-17) and among those sexually active in the second age range (18-23). Sexual activity status was assessed by GP, according to information stated in the medical record. The 363 participating physicians (response rate 51.4%) included 712 patients (357 in the 14- to 17-year-old group and 355 in the 15- to 23-year-old group) in their responses. The rate of the vaccination coverage in the 14- to 17-year-old group was 55%. Among the girls in the 18- to 23-year-old group, 126 were eligible, and their vaccination coverage rate was 82%. The evaluation of the eligibility by the GPs was incorrect in 36% of the cases. Of the 712 patients, 6% of the girls had been vaccinated without a need for the vaccination, and 26% of the girls had not been vaccinated, although they needed to be vaccinated. Regarding the vaccine uptake, vaccination at the age of 14 was not as effective as vaccinating the older population for which vaccination was indicated as a catch-up program, based on sexual history. However, in more than one-third of the older population, difficulties remained regarding the determination of eligibility, according to the sexual history of the patient.

Use of clean intermittent self-catheterization in France: A survey of patient and GP perspectives.

AIMS: To estimate the prevalence of GP (general practitioner) patients performing ISC (intermittent self-catheterization), to describe GP and patient knowledge about ISC and to assess the patients' quality of life. METHODS: A cross-sectional study was conducted in metropolitan France between November 2012 and September 2013 with French Sentinelles GPs and their patients (≥18 years) performing ISC. Linear regression models assessed independent associations between quality of life scores (Qualiveen and SF-12 scores) and patients' characteristics. RESULTS: The prevalence of ISC performers was estimated to be 61.7 (95% confidence interval [CI] = 61.0-62.4) of 100,000 inhabitants. Patients were males in 58.8% of cases and 53.8 years of age on average. They performed 4.84 catheterizations per day for 10.5 years. Over 1 year, there were 118 (55.1%) cases of patient-reported urinary incontinence (UI) and 158 (63.3%) cases of patient-reported urinary tract infection (UTI). Symptomatic UTIs were treated with antibiotics in 79.7% of cases. The average Qualiveen score was 1.38 (95%CI: 1.23-1.53). The average SF-12 Physical Component Score (PCS) and Mental Component Score (MCS) were 38.6 (95%CI: 36.8-40.4) and 46.4 (95%CI: 44.3-48.5), respectively. According to multivariate analysis, a poorer Qualiveen score and constipation reduced the PCS and a urinary medication prescription reduced the MCS. A poorer Qualiveen score was also associated with UI and UTI on bivariate analysis. CONCLUSIONS: ISC seems to be significant in French general practice whereas practical skills remain heterogeneous. UI, UTI, and constipation are recurrent issues among ISC performers that significantly decrease their quality of life. Education and adapted guidelines for GP guidance could improve these patients' conditions. Neurourol. Urodynam. 35:528-534, 2016. © 2015 Wiley Periodicals, Inc.

A survey of French general practitioners and a qualitative study on their use and assessment of predictive clinical scores.

BACKGROUND: Predictive clinical scores, diagnostic as well as prognostic, are considered to be useful tools for making decisions under conditions of uncertainty. They are not intended to replace clinical judgment or medical experience, but to help physicians in the interpretation of clinical information. The general practitioner (GP), the gateway to care in the French health system, should be the main beneficiary of their utilization. However, there is no information on the prevalence of their use in general practice in France. METHODS: A national, transversal epidemiological survey was conducted by electronic mail among GPs belonging to the French Sentinelles network. GPs were asked about their use of scores, the context of their utilization and the expected benefit. A qualitative study (focus groups) was also carried out with three groups of GPs within the context of continuous medical education. RESULTS: The study consisted of 358 GPs. They were questioned on their use of seven predictive clinical scores (six diagnostic and one prognostic). Clinical scores were used by 75% of GPs, with no statistical difference with regard to their age or sex. The most often used were: the Mini Mental Status Examination (MMSE) (95%), Fagerström test (90%), Hamilton scale (65%), McIsaac scores (61%), DETA/CAGE (45%), Simple Calculated Osteoporosis Risk Estimation (SCORE) for osteoporosis (33%), and the only prognostic score CHADS2 (28%). Clinical scores were especially used when elderly people were involved (77%) and when the diagnosis was uncertain (63%). The qualitative study gave additional information on the barriers and obstacles to the use of predictive clinical scores. CONCLUSION: This study, the first one in France, gives information on the perception of clinical scores and on the rationale for their use by GPs. Suggestions to improve the situation (availability and rate of utilization of clinical scores) are provided.

Hospitalization of influenza-like illness patients recommended by general practitioners in France between 1997 and 2010.

BACKGROUND: The case-hospitalization ratio (CHR) is a key quantity for the management of emerging pathogens such as pandemic influenza. Yet, few running surveillance systems prospectively monitor the CHR during influenza epidemics. Here, we analyze the proportion of recommended hospitalizations (PRH) among influenza-like illness (ILI) patients attended in general practice in France and compare the PRH observed during the 2009-2010 A(H1N1) pandemic with the one of the twelve previous seasons. METHODS: ILI cases were recorded by general practitioners (GPs) involved in surveillance, who indicated for each case whether they recommended hospitalization. We stratify the analysis by age, sex, and viral subtype. We investigate the reasons why GPs recommended hospitalization and the presence of risk factors for pandemic A(H1N1) complications. RESULTS: The average PRH over the seasons 1997-1998 to 2008-2009 was 3·4‰ (3-3·9). It was three times higher during the 2009-2010 pandemic than during seasonal influenza epidemics (OR = 2·89, 95% CI: 2·28-3·64). The highest increase was among 20-39-year-old women: OR = 11·8 (5·04-29·59). Overall, the principal reasons for recommending hospitalization were "respiratory problems" and "bad general condition." However, during the pandemic, "age" (mainly associated with infants), "pregnancy," and "diagnostic" became more frequent than before (P < 0·001). Finally, pregnancy was the reported risk factor for pandemic A(H1N1) complications that had the largest impact on hospitalization recommendation during the pandemic (OR = 38·62, P < 0·001). CONCLUSION: Easily implemented in surveillance systems, this protocol has the potential to reveal changes in hospitalization recommendation by GPs. Moreover, if the right data are collected alongside, it could give timely insights into epidemic severity.

Herpes zoster: family history and psychological stress-case-control study.

BACKGROUND: Several studies have reported risk factors for herpes zoster (HZ), but their results remain controversial and difficult to compare because of their limitations regarding sampling and design. OBJECTIVES: This study was aimed to determine risk factors in ambulatory patients aged 50 years or more, by consulting general practitioners (GPs) in France. STUDY DESIGN: A prospective, national, matched case-control study was conducted. It involved 121 GPs who recruited 250 cases of HZ and 500 controls (matched by age and sex), aged 50 years and older, between April 2009 and September 2010. GP and patient questionnaires explored the following risk factors: family history of HZ, comorbidities, depression, anxiety, negative life events, physical trauma, alcohol and tobacco consumption, level of education, and various protective factors (such as exposure to children). Odds ratios were estimated using conditional logistic regression. RESULTS: In multivariate adjusted analysis, a family history of HZ (OR 3.69, 95% CI 1.81-7.51), a HAD depressive score≥8 (OR 4.15, 95% CI 1.88-9.16), and a recent negative life event (OR 3.40, 95% CI 1.67-6.93) were all significantly associated with HZ. CONCLUSIONS: This case-control study conducted in ambulatory patients in general practice reinforced the hypothesis that, in addition to the age-related decline in VZV-specific T-cell-mediated immunity, depression negative life event and familiar history of zoster increase the risk of occurrence of herpes zoster. In people with familiar history, this risk could be prevented by vaccination.

A survey of primary care physician practices in antibiotic prescribing for the treatment of uncomplicated male gonoccocal urethritis.

BACKGROUND: The development of resistance to antimicrobial therapy by Neisseria gonorrhoeae causes on-going problems for individual case management of gonorrhoea. Surveillance data about N. gonorrhoeae have indicated an increase in the incidence of gonorrhoea in France in 2006. As a consequence of the development of antibiotic resistance in N. gonorrhoeae, French guidelines excluded fluoroquinolones as a standard treatment for N. gonorrhoeae. Ceftriaxone became the recommended treatment, associated with azithromycin for Clamydia trachomatis infection. Our aim was to describe the practice patterns of general practitioners (GPs) in managing the antibiotic treatment of patients with symptoms suggestive of uncomplicated male urethritis. METHODS: We developed a clinical vignette describing a man with typical gonococcal urethritis symptoms to elicit questions about antibiotic treatment. We mailed the electronic questionnaire to a random sample of 1000 French GPs belonging to the Sentinelles Network. RESULTS: By the end of the survey period, 350 vignettes were received, yielding a response rate of 35%. Sixty-six GPs (20.2%) prescribed the recommended antibiotics for the simultaneous treatment of N. gonorrhoeae and C. trachomatis infections, while 132 GPs (40.4%) prescribed only non-recommended antibiotics, including ciprofloxacin in 69 cases (21.1%). General practitioners with less than 10 years in practice showed better compliance to guidelines than those with more years in practice (p<0.05). CONCLUSIONS: The results suggest a mismatch between the guidelines and the antibiotic treatment of male uncomplicated urethritis by French GPs, mostly among the subgroup of physicians who have been in practice longer. Educational approaches based on practice feedback need to be developed to improve these deficits in the quality of care.

Pertussis prevention and diagnosis practices for adolescents and adults among a national sample of French general practitioners.

Authors report a cross-observational study conducted to determine the awareness and adherence of general practioners (GPs) to pertussis vaccine guidelines; to identify the barriers encountered by GPs to adhering to these guidelines; and to describe diagnosis and case management approaches for adolescent and adult pertussis in France. This study, conducted independently of any pharmaceutical companies, concludes that greater awareness of the public health morbidity and mortality of pertussis, intensive immunization adherence for all those in contact with infants, and adherence to routine immunization schedules are necessary to reduce the burden of disease due to Bordetella pertussis. The barriers encountered (the most important were the incomprehension of patients who are not informed about the circulation of pertussis in the adult population and the fact that pertussis is not commercialized as a monovalent vaccine) should be examined further as they do not seem to be related to a lack of GP knowledge. Public information campaigns are needed. The results emphasize the need of policy development for management of pertussis in France.

Psychotropic drug use among older people in general practice: discrepancies between opinion and practice.

BACKGROUND: The use of psychotropic drugs has increased over recent years in France. GPs are the first prescribers, especially for older patients. AIM: To analyse discrepancies between GPs' opinions and practice when prescribing psychotropic drugs to older patients. SETTING: Postal surveys sent to GPs all over mainland France. DESIGN OF STUDY: Cross-sectional postal study. METHOD: A questionnaire collected data on characteristics of GPs' practices, their opinions about psychotropic drug consumption in older people, and a full description of their last older patient receiving a psychotropic drug and seen last by the GP on that particular day. RESULTS: A total of 350 participating GPs saw 2498 patients aged > or =65 years. Among these patients, the prevalence of psychotropic use was 32.1% (803/2498) for anxiolytics/hypnotics, and 17.5% for antidepressants (438/2498). A total of 91% of GPs agreed that it was possible to reduce or stop psychotropic drugs for these patients. Characteristics of 339 patients taking psychotropic drug were reported: 85.8% (291/339) received at least one anxiolytic/hypnotic and 56.9% (193/339) received at least one antidepressant; there were prescribed for more than 1 year in 68.4% (199/291) and 43.5% (84/193) of the cases respectively. GPs stated that it was possible to reduce or stop anxiolytic/hypnotic drugs for only 27% (79/291) of these patients. Barriers to doing this were patients' refusal (79%), and the absence of any local offer of psychotherapy (73%) or alternative therapy (70%). CONCLUSION: A mismatch exists between GPs' intent (91%) and practice (27%) regarding reduction of psychotropic prescription in individuals aged > or =65 years. The barriers encountered should be examined further to help physicians improve management of psychotropic prescription.

[Description of French general practitioners' practices regarding long term systemic corticosteroid therapy-associated measures]. / Mesures adjuvantes à une corticothérapie systémique prolongée. Pratiques des médecins généralistes français.

BACKGROUND: Except for the prevention of osteoporosis, no consensual recommendations are available regarding the therapeutic measures associated with the prescription of a long term corticosteroid therapy. We assessed the French general practitioners'practices regarding the prescription of these measures. METHODS: In September 2007, we sent by e-mail a questionnaire to 860 general practitioners members of the reseau Sentinelles, a national survey system which collect data from volunteers French general practitioners. We assessed the frequency of prescription of measures associated with systemic corticosteroids and for whom no consensual recommendations were available (dietary advices, physical training, potassium supplementation, gastric protection, influenza vaccination, prescription of hydrocortisone). RESULTS: 293 out of 860 general practitioners completed the questionnaire (response rate: 34%). The practitioners were predominantly male (87%). Regarding the dietary measures, low sodium diet was recommended by most of the physicians, 68% of them prescribing such dietary regimen in more than 80% of their corticosteroid-treated patients. The concomitant prescription of caloric restriction, low carbohydrate diet or high protein diet was not consensual. Prescriptions of muscular physiotherapy and gastric protection were unusual (80% and 67% of physicians prescribing these measures in less than 20% of their patients, respectively). Recommendations for daily physical training, potassium supplementation, influenza vaccination or hydrocortisone prescription were not consensual. CONCLUSION: There is no consensus in the French general practitioners community regarding most of the measures associated with a long term systemic corticosteroid therapy.

Urinary incontinence in French women: prevalence, risk factors, and impact on quality of life.

BACKGROUND: The lack of epidemiologic data on the prevalence of female urinary incontinence (UI) attending general practitioners (GPs) in France led us to conduct a cross-sectional study in our country. OBJECTIVES: To determine the prevalence of UI and to assess its impact on the quality of life (QoL). DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study of women aged >18 yr was conducted by attending GPs between June 2007 and July 2007. MEASUREMENTS: The main outcome measures were urinary symptoms, functional impairment, International Consultation on Incontinence Questionnaire-Short Form score, and medical care seeking. RESULTS AND LIMITATIONS: Overall, 241 GPs enrolled 2183 women seen during 1 d. The prevalence of UI was 26.8% (n=584) and increased with age, body mass index (BMI), and number of children delivered (p<0.0001). Among women with UI, 496 were included in a cross-sectional survey: 45.2% (n=224) had stress UI, 42.1% (n=209) had mixed UI, and 10.9% (n=53) had urge UI, while 2% (n=10) had UI of indeterminate type. Overall, 288 of 496 women (51.8%) stated that UI had a negative impact on their QoL; this effect remained mostly mild or moderate, and only 197 of 496 women (39.7%) had asked for medical help. Longer duration of symptoms, higher frequency of comorbid urinary symptoms, and altered QoL were most frequent among women with mixed UI (p<0.001). Misclassification may have occurred because the diagnosis of UI was based on self-reported data rather than on clinical or urodynamic examinations. CONCLUSIONS: UI symptoms were found in almost one in four women attending GPs. Clinical and functional UI impairment were associated with age, BMI, and parity. UI caused distress to women, but only those who were severely affected sought help. The results emphasize the need for policy development for UI prevention and management in France.

Testicular and epididymal dual origin of hCAP-18/SOB3, a human sperm protein.

The expression and localization of the human sperm protein hCAP-18/SOB3 were evaluated in human testis and epididymis through in situ hybridization and immunohistochemistry with the use of an anti-recombinant hCAP-18/SOB3 polyclonal antibody. Both hCAP-18/SOB3 messenger RNA and hCAP-18/SOB3 protein were detected in testis germinal cells (from late spermatogonia to spermatozoa) and in the epididymal epithelium. This localization is in agreement with the antimicrobial properties previously described and supports its involvement in zona pellucida binding, as we had previously suggested.

Identification of human sperm proteins involved in the interaction with homologous zona pellucida.

OBJECTIVE: To identify human sperm proteins involved in homologous zona pellucida (ZP) interaction. DESIGN: Prospective study. SETTINGS: Basic research laboratory. PATIENT(S): Semen samples from normozoospermic donors, tissue sections from surgical pieces, and ZP from nonfertilized oocytes. INTERVENTION(S): Antibodies for sperm proteins (HSE; high salt extract) were developed (anti-HSE) and partially characterized. Participation of sperm proteins on ZP-interaction was tested with the hemizona assay (HZA). Antigens were immunolocalized in sperm and tissues. MAIN OUTCOME MEASURE(S): Sperm and tissue immunostaining; Western blotting; and number of sperm bound to the ZP. RESULT(S): Anti-HSE antibodies recognized several polypeptides in HSE (9 to 200 kd). Specific antibodies for 49 and 66 kd proteins (p49, p66) were obtained. Both (anti-p49 and anti-p66) stained the head of ejaculated and capacitated sperm. In the HZA, sperm preincubation with a mixture of anti-p49 and anti-p66 (100 micro g/mL) resulted in a decrease in the number of spermatozoa bound to the ZP. Presence of p66 (10 micro g/mL) inhibited sperm-ZP interaction. In contrast, p49 did not alter sperm binding to the ZP. Immunohistochemical analysis showed that p66 is present in the epididymis. No staining was observed in testicular sections. CONCLUSION(S): We found that p66 is an epididymal protein that participates in human sperm interaction with homologous ZP.

Identificación de proteínas espermáticas humanas involucradas en la interacción espermatozoide-zona pellucida / aaa

La interacción inicial entre las gametas es mediada por proteínas de superficie de la cabeza del espermatozoide y de la matriz extracelular del ovocito, la zona pellucida (ZP). El presente trabajo tuvo como objetivo la identificación de antígenos de superficie de espermatozoides humanos potencialmente involucrados en el reconocimiento de la ZP. Para ello se obtuvo un extracto de proteínas periféricas de espermatozoides humanos por tratamiento de las células con solución de alta fuerza iónica (HSE - High Salt Extract) (Buffer Pipes 100mM, pH 7,4; NaCl1M, sacarosa 0,25 M). Se desarrollaron anticuerpos policlonales (anti-HSE) que reconocieron numerosas proteínas en HSE (9-200 KDa). Las proteínas fueron separadas por electroforesis en geles de poliacrilamida, transferidas a membranas de nitrocelulosa y utilizadas para adsorber inmunoglobulinas de anti-HSE. Con éste método se obtuvieron anticuerpos contra dos polipéptidos mayoritarios de 49 (p49) y 66 (p66) kDa. Ambos anticuerpos (anti-p49 y anti-p66) reconocieron epitopes localizados en la cabeza y el flagelo de espermatozoides eyaculados y capacitados...

Identificación de proteínas espermáticas humanas involucradas en la interacción espermatozoide-zona pellucida / aaa

La interacción inicial entre las gametas es mediada por proteínas de superficie de la cabeza del espermatozoide y de la matriz extracelular del ovocito, la zona pellucida (ZP). El presente trabajo tuvo como objetivo la identificación de antígenos de superficie de espermatozoides humanos potencialmente involucrados en el reconocimiento de la ZP. Para ello se obtuvo un extracto de proteínas periféricas de espermatozoides humanos por tratamiento de las células con solución de alta fuerza iónica (HSE - High Salt Extract) (Buffer Pipes 100mM, pH 7,4; NaCl1M, sacarosa 0,25 M). Se desarrollaron anticuerpos policlonales (anti-HSE) que reconocieron numerosas proteínas en HSE (9-200 KDa). Las proteínas fueron separadas por electroforesis en geles de poliacrilamida, transferidas a membranas de nitrocelulosa y utilizadas para adsorber inmunoglobulinas de anti-HSE. Con éste método se obtuvieron anticuerpos contra dos polipéptidos mayoritarios de 49 (p49) y 66 (p66) kDa. Ambos anticuerpos (anti-p49 y anti-p66) reconocieron epitopes localizados en la cabeza y el flagelo de espermatozoides eyaculados y capacitados...(AU)

Effects of moderate chronic alcoholism treatment on fertilization

Se estudió el efecto del tratamiento de etanol al 10 por ciento m/v durante 4 semanas sobre la función reprodutiva del ratón. La tasa de fertilización disminuyó significativamente cuando los oocitos provinieron de hembras alcohólicas. La viabilidad de los oocitos fue disminuida desde que incrementaron los oocitos fragmentados. También se encontró el número de oocitos por oviducto disminuido. La activación espontánea fue incrementada en las hembras alcohólicas. La activación espontánea fue incrementada en las hembras alcoholicas. La motilidad y la hiperactivación no estuvo alterada por el tratamiento. Estos resultados muestran que la gameta femenina parece ser más sensible al alcoholismo crónico moderado que la gameta masculina

Effects of moderate chronic alcoholism treatment on fertilization

Se estudió el efecto del tratamiento de etanol al 10 por ciento m/v durante 4 semanas sobre la función reprodutiva del ratón. La tasa de fertilización disminuyó significativamente cuando los oocitos provinieron de hembras alcohólicas. La viabilidad de los oocitos fue disminuida desde que incrementaron los oocitos fragmentados. También se encontró el número de oocitos por oviducto disminuido. La activación espontánea fue incrementada en las hembras alcohólicas. La activación espontánea fue incrementada en las hembras alcoholicas. La motilidad y la hiperactivación no estuvo alterada por el tratamiento. Estos resultados muestran que la gameta femenina parece ser más sensible al alcoholismo crónico moderado que la gameta masculina (AU)