Post-traumatic stress disorders in women victims-survivors of intimate partner violence: a mixed-methods pilot study in a French coordinated structure.

OBJECTIVES: This study aimed to examine the prevalence of post-traumatic stress disorder (PTSD) in victims-survivors of intimate partner violence (IPV) consulting at the specialised and original facility 'Maison des Femmes' (MdF) or in two close municipal health centres (MHCs). DESIGN: A mixed-methods study using a convergent parallel design from July 2020 to June 2021. SETTING/PARTICIPANTS: A questionnaire was proposed to women aged 18 years and over having suffered from IPV, in the MdF and in two MHCs. We also conducted qualitative interviews with a subsample of the women, asking for victim-survivors' perceptions of the effect of the MdF's care. PRIMARY AND SECONDARY OUTCOME MEASURES: The presence of a PTSD using the PTSD self-report checklist of symptoms, possibility of reaching women by phone 6 months after the inclusion visit, level of self-rated global health, number of emergency visits in the past 6 months, substances use, readiness to change and safety behaviours. RESULTS: A total of 67 women (mean age: 34 years (SD=9.7)) responded to our questionnaire. PTSD diagnosis was retained for 40 women (59.7%). Around 30% of participants self-rated their global health as bad. Less than 30% (n=18) of women were regular smokers, and only 7.5% of participants had a problematic alcohol use (Alcohol Use Disorders Identification Test-Consumption score ≥4), 19.4% women used psychotropic drugs. Six months after inclusion, half of participants had been reached by phone. Analysis of the qualitative interviews clarified victim-survivors' perceptions of the MdF's specific care: social networking, multidisciplinary approach, specialised listening, healthcare facilities, evasion and 'feeling at home'. CONCLUSIONS: The high prevalence of PTSD at inclusion was nearly the same between the three centres. This mixed-methods comparison will serve as a pilot study for a larger comparative trial to assess the long-term impact of the MdF's specialised care on victims-survivors' mental health, compared with the care of uncoordinated structures. TRIAL REGISTRATION NUMBER: NCT04304469.

Do Determinants of Smoking Cessation and Relapse Differ between Men and Women? Data from a French National Study.

Introduction: There is limited understanding of different predictors of smoking cessation success (SCS) among women and men, despite well-documented differences in smoking behavior.Methods: Using data from DePICT (Description des Perceptions, Images, et Comportements liés au Tabagisme), a national survey of French adults which recruited 2377 regular and former smokers we investigated whether major determinants of SCS differed by sex. Factors associated with unsuccessful vs. No successful quit attempt; vs. SCS were studied using multivariate multinomial logistic regression analyses stratified by sex.Results: Women and men share some determinants of SCS including no cannabis use, living in a nonsmoker household and importance giving to being a nonsmoker. However, no e-cigarette use, low-to-moderate alcohol consumption, early smoking initiation, and higher education were associated with SCS only among women. No use of nicotine replacement, having family members who smoke, family opinion on smoking and current employment, were associated with SCS only among men. Neutral or negative friends' opinion on smoking or living with a smoker were associated with unsuccessful smoking attempts among men.Conclusions: Our results show differences between determinants of SCS according to sex, which highlights the importance of developing tailored interventions that account for sex/gender differences in smoking cessation.

Health professional's perception of a smoking cessation intervention among disadvantaged patients participating in a pragmatic randomized trial.

INTRODUCTION: Individuals who have a low socio-economic position (SEP) are more likely to smoke and face greater barriers to quitting tobacco. However, the effectiveness of tailored interventions has been limited probably due to specific challenges relative to this population. We conducted a mixed-method study to better understand health professionals' perceptions and barriers when implementing a preference-based smoking cessation (SC) intervention among disadvantaged smokers. METHODS: A self-administered online questionnaire was sent to health professionals (doctors' and other health professionals specialized in SC) participating in "STOP" a pragmatic multicentre randomized controlled trial. Perceptions regarding patient eligibility, the doctor-patient relationship, general study organization, and satisfaction were measured. RESULTS: Twenty-eight STOP study investigators responded. Health professionals prioritize smoking cessation for disadvantaged patients, but face challenges in approaching and following them. A research intervention providing cessation tools based on preference was deemed useful but generally undermined by time constraints. Health professionals' preconceptions regarding patients in low SEP having other "pressing problems" which might be exacerbated by quitting smoking were also identified. Further, participation in a research intervention was perceived as not satisfactory due to workload and lack of time. CONCLUSION: Our results highlight general barriers inherent to implementing pragmatic trials. They also present specific challenges in smoking cessation trials among disadvantaged population, essential to advance equity in tobacco control.

Evolution of smoking rates among immigrants in France in the context of comprehensive tobacco control measures, and a decrease in the overall prevalence.

BACKGROUND: The evolution of smoking rates according to migrant status has not been examined in France, despite a recent reduction in overall smoking rates. METHODS: DePICT is a two waves (2016: n = 4356; 2017: n = 4114) nationwide telephone survey, representative of the French adult population. We compared smoking-related behaviors before and after implementation of tobacco-control measures (2017), according to the geographical region of birth. RESULTS: Compared to 2016, individuals originating from Africa or the Middle East had a slightly higher smoking prevalence in 2017 (34.7% vs 31.3%), despite a higher intention to quit or attempt in the preceding year (adjusted OR(ORa) = 2.72[1.90; 3.90]) compared to non-immigrants. They were also less likely to experience an unsuccessful quit attempt (ORa = 1.76[1.18; 2.62]). CONCLUSION: Tobacco-control measures could have widened smoking inequalities related to migrant status. The evolution of smoking-related behaviors among immigrants should be examined when studying the long-term effects of such policies.

Superspreading events of SARS-CoV-2 in Paris: A retrospective analysis of data from the first wave of COVID-19 in 2020.

BACKGROUND: The 2020 COVID-19 pandemic led to a strict lockdown in France from March 17 to May 11, 2020. After the lockdown, the French strategy to mitigate the impact of SARS-CoV-2 relied partly on investigations of all confirmed cases. Monitoring collective settings is particularly important since SARS-CoV-2 seems prone to superspreading events (SSEs). METHODS: Our study is based on data gathered in Paris from May 11 to December 31, 2020, by the Ile-de-France Regional Health Agency (RHA) to investigate cases occurring in collective and high-risk settings. Specific events in high-risk settings were systematically transmitted to the RHA, and screenings were organized by the facilities, while other settings were reported when three cases were identified within a short period. These settings were more difficult to identify through the surveillance system since no systematic screening was organized by the facility, leaving screenings to rely on the national contact-tracing programme. No official superspreading threshold has been set for SARS-CoV-2. We defined a SSE as an event involving ten cases. RESULTS: We analysed 15,706 events associated with 38,670 cases, representing an average of 2.70 cases per event. Most clusters occurred in educational facilities, workplace environments, social care settings, and healthcare facilities. SSEs represented 3.4% but accounted for 28% of all cases reported. The highest number of SSEs occurred in college settings (12.6%), followed by hospitals and retirement homes. Educational facilities had the lowest number of SSEs, with around 1% in preschools and elementary schools. CONCLUSIONS: We observed different SSE rates in each setting. Preschools and primary schools represented the majority of events but experiencing very few SSEs. Colleges were prone to SSEs and were associated with a high number of secondary cases. These findings provide some insights on contact tracing activities and SARS-CoV-2 transmission in different settings.

Serum progesterone concentration and live birth rate in frozen-thawed embryo transfers with hormonally prepared endometrium.

RESEARCH QUESTION: Is serum progesterone measurement on the day of embryo transfer associated with outcome of frozen-thawed embryo transfer (FET) in cycles using hormonal replacement therapy (HRT) for endometrium preparation? DESIGN: This single-centre retrospective study assessed the relationship between serum progesterone on embryo transfer day and live birth rates in 227 FET cycles. Endometrial preparation was performed by sequential administration of vaginal oestradiol until endometrial thickness was >7 mm, followed by transdermal oestradiol combined with 600 mg vaginal micronized progesterone. RESULTS: Mean serum embryo transfer day progesterone was 11.4 ng/ml. Serum progesterone <10 ng/ml was observed in 37% of cycles and was associated with significantly lower pregnancy (34% versus 48%, P= 0.04) and live birth rates (17% versus 31%, P= 0.01). Multivariate logistic regression analysis identified serum embryo transfer day progesterone as a significant prognostic factor for live birth rate (odds ratio [OR]: 2.75, 95% confidence interval [CI]: 1.40-5.43]). Receiver operator curve analysis for live birth rates by serum progesterone levels on embryo transfer day gave an area under the curve of 0.62 (95% CI: 0.53-0.72). CONCLUSIONS: The data show that serum progesterone concentration is associated with live birth rate. This outlines the importance of measuring serum progesterone in FET with HRT although progesterone monitoring is not usually performed in routine practice. However, the optimal timing for measurement and further adaptive management in the presence of low values remain to be determined.