Initial risk perception and feeling of preparedness of primary care physicians regarding the COVID-19 pandemic in Belgium, France and Spain in February 2020.

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.

Baseline characteristics and clinical symptoms related to respiratory viruses identified among patients presenting with influenza-like illness in primary care.

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.

Estimation of seasonal influenza vaccine effectiveness using data collected in primary care in France: comparison of the test-negative design and the screening method.

OBJECTIVES: We discussed which method between the test-negative design (TND) and the screening method (SM) could provide more robust real-time and end-of-season vaccine effectiveness (VE) estimates using data collected from routine influenza surveillance in primary care. METHODS: We used data collected during two influenza seasons, 2014-15 and 2015-16. Using the SM, we estimated end-of-season VE in preventing medically attended influenza-like illness and laboratory-confirmed influenza among the population at risk. Using the TND, we estimated end-of-season VE in preventing influenza among both the general and the at-risk population. We estimated real-time VE using both methods. RESULTS: For the SM, the overall adjusted end-of-season VE was 24% (95% confidence interval (CI), 16 to 32) and 12% (95% CI, -16 to 33) during season 2014-15, and 53% (95% CI, 44 to 60) and 47% (95% CI, 23 to 64) during season 2015-16, in preventing influenza-like illness and laboratory-confirmed influenza, respectively. For the TND, the overall adjusted end-of-season VE was -17% (95% CI, -79 to 24) and -38% (95% CI, -199 to 13) in 2014-15, and 10% (95% CI, -31 to 39) and 18% (95% CI, -33 to 50) in 2015-16, among the general and at-risk population, respectively. Real-time VE estimates obtained through the TND showed more variability across each season and lower precision than those estimated with the SM. CONCLUSIONS: Although the worldwide use of the TND allows for comparison of overall VE estimates among countries, the SM performs better in providing robust real-time VE estimates among the population at risk.

Performances of statistical methods for the detection of seasonal influenza epidemics using a consensus-based gold standard.

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.

The economic burden of urinary tract infections in women visiting general practices in France: a cross-sectional survey.

BACKGROUND: Urinary tract infections (UTIs) are among the most common bacterial infections. Despite this burden, there are few studies of the costs of UTIs. The objective of this study was to determine the costs of UTIs in women over 18 years of age who visit general practitioners in France. METHODS: The direct and indirect costs of clinical UTIs were estimated from societal, French National Health Insurance and patient perspectives. The study population was derived from a national cross-sectional survey entitled the Drug-Resistant Urinary Tract Infection (Druti). The Druti included every woman over 18 years of age who presented with symptoms of UTI and was conducted in France in 2012 and 2013 to estimate the annual incidence of UTIs due to antibiotic-resistant Enterobacteriaceae in women visiting general practitioners (GPs) for suspected UTIs. RESULTS: Of the 538 women included in Druti, 460 were followed over 8 weeks and included in the cost analysis. The mean age of the women was 46 years old. The median cost of care for one episode of a suspected UTI was €38, and the mean cost was €70. The annual societal cost was €58 million, and €29 million of this was reimbursed by the French National Health Insurance system. In 25 % of the cases, the suspected UTIs were associated with negative urine cultures. The societal cost of these suspected UTIs with negative urine cultures was €13.5 million. No significant difference was found between the costs of the UTIs due to antibiotic-resistant E. coli and those due to wild E. coli (p = 0.63). CONCLUSION: In the current context in which the care costs are continually increasing, the results of this study suggests that it is possible to decrease the cost of UTIs by reducing the costs of suspected UTIs and unnecessary treatments, as well as limiting the use of non-recommended tests.

Fighting the spread of AmpC-hyperproducing Enterobacteriaceae: beneficial effect of replacing ceftriaxone with cefotaxime.

OBJECTIVES: Considering the hypothesis that the high biliary elimination of ceftriaxone could be responsible for the selection of Enterobacteriaceae harbouring high-level AmpC ß-lactamase (HL-CASE), the use of ceftriaxone was discontinued in our hospital in 2006 and replaced with cefotaxime. METHODS: Antibiotic consumption, expressed as defined daily dose (DDD)/1000 patient-days (PD), and HL-CASE incidence, expressed as the number of patients carrying HL-CASE/1000 PD, were compared between the pre-intervention period (Period 1, 2001-05) and the post-intervention period (Period 2, 2006-12) using an interrupted time series analysis. RESULTS: The incidence of HL-CASE increased significantly from 0.32 to 0.69/1000 PD during Period 1 (coefficient = 0.082, P < 0.01). A significant inflection of the slope in the incidence curve occurred in Period 2 (coefficient = -0.061, P = 0.05), mainly owing to the stabilization of the HL-CASE incidence of Enterobacteriaceae harbouring chromosomally inducible cephalosporinase (Period 1, 0.27 to 0.64/1000 PD; Period 2, 0.58 to 0.61/1000 PD) and especially for Enterobacter cloacae (Period 1, 0.09 to 0.30/1000 PD; Period 2, 0.26 to 0.27/1000 PD). This deceleration was observed despite a significant increase in the slope of cefotaxime consumption over Period 2 (coefficient = 2.97, P < 0.01). CONCLUSION: Despite the disadvantages of using cefotaxime compared with ceftriaxone (administration three times daily versus once a day), the ecological benefits of this substitution seem sufficiently convincing to preferentially use cefotaxime. Control of HL-CASE incidence is crucial to limiting carbapenem use and preventing the selection of carbapenemase-producing Enterobacteriaceae.

Decrease in milk yield associated with exposure to bluetongue virus serotype 8 in cattle herds.

Decreased milk yield and reduced fertility are the primary consequences of infection by bluetongue virus serotype 8 (BTV-8). These effects must be quantified to fully assess the economic benefit of vaccination. This can be estimated by measuring the effect of BTV-8 exposure on milk yield and fertility for all cows belonging to an infected herd. The objectives of this study were (1) to quantify the mean effect of exposure to BTV-8 on milk yield following natural challenge for cows in herds previously naïve, (2) to determine the duration of reduced milk yield before and after the date disease was first detected in the herd to estimate the cumulative loss of milk yield during this period, and (3) to evaluate the influence of the proportion of infected neighboring herds on the reduction in milk yield following exposure to BTV-8. The effects of exposure to BTV-8 during the French outbreak of 2007 were assessed using mixed linear models, which allow adjustment for factors known to influence milk yield. Exposure to BTV-8 was associated with a sharp decrease in milk yield over a period of 6 mo (2 mo before to 4 mo after the reported date of disease detection in the herd). The cumulative loss of milk yield was more than 3% of annual production. The relatively earlier reduction in milk yield in infected herds detected later in the outbreak period suggests that detection of clinical signs was delayed in these herds. Finally, the greatest decrease in milk yield was observed in herds detected early during the outbreak period and located in areas with the highest disease incidence. This may be due to a greater within-herd incidence or to a greater amount of virus injected by midges to individual cows in these herds.

[Orientation of patients referred by their general practionner to the public or private hospital sector in France: A prospective epidemiologic study]. / Orientation des patients par leur médecin généraliste vers les secteurs hospitaliers publics ou privés en France : étude épidémiologique prospective du réseau Sentinelles.

PURPOSE: In-patients characteristics generate cost differences between hospitals. In France, there are few data on the characteristics on the patients referred to hospitals by their general practitioners (GPs) and none on the predictors of referral to the public or for-profit hospitals. The aim of this study was to analyze those characteristics and the predictors of referral to the public or for-profit hospitals. METHODS: We collected, prospectively, the request for hospitalizations made by the GPs of the Sentinelles network in France, from 2007 to 2009. Patients' characteristics and also the reasons for that request were analyzed. A logistic regression was used to compare the population between local hospitals. RESULTS: Ten thousand seven hundred and eighteen statements were collected. The median age was 73 years. Patients were women in 51% of the cases, and only 14% of the hospitalizations had been planned. Hospitalization in the public sector was preferred for young children and the elderly (P<0.001). When compared to the patients referred to the private sector, patients addressed to the public sector were more often seen for emergencies (OR: 2.3 [2.0-2.8]), by a doctor different from their referring GP (OR: 1.7 [1.4-2.1]) and out of the GP's office. The reasons for hospital admission were different depending on the sector of hospitalization (P<0.001), patients addressed to the public sector hospitals presented with greater comorbidity or more complex diagnosis (for example: feeling ill, fainting or syncope and fever) or a greater disability (for example: stroke, neurological and psychiatric diseases). CONCLUSION: This study suggests that GPs send their patients to the public or for-profit hospitals according to criteria of severity, comorbidity and disability.

[Effect of injection of a human gonadotropin on the synthesis and liberation of vitellogenin by adipose tissue of the marine crustacean isopod Idotea balthica basteri Audouin]. / Effet de l'injection d'une gonadotropine humaine sur la synthèse et la libération de la vitellogénine par le tissu adipeux du Crustacé Isopode marin Idotea balthica basteri Audouin.

Human chorionic gonadotrophin (HCG) stimulates the rate of vitellogenin synthesis and release by fat bodies in puberal females of the marine Crustacean isopods Idotea balthica basteri. Moreover this effect is specific for vitellogenin: since 48 hr after the treatment, the rate of total protein synthesis, in treated females, is not significantly different from that of females injected with physiological medium, or with denaturated gonadotrophin.

Diurnal rhythms in the synthesis and release of haemolymph proteins in the crustacean Isopoda, Porcellio dilatatus (Brandt), with special reference to vitellogenin.

Synthesis and release of vitellogenin in the crustacean Isopoda, Porcellio dilatatus, were maximal during premolt. At that time, diurnal variations occurred in the haemolymph protein level and in the synthesis and release of vitellogenin and other proteins in the haemolymph. The pattern of variations was always identical and bimodal: the minima were at dusk and at dawn when the maxima occurred in the middle of the day and of the night. These variations were highly significant, and the diurnal means were significantly higher than the nocturnal means.

Vitellogenin synthesis in the fat body of the marine crustacean Isopoda, Idotea balthica basteri, during vitellogenesis.

This paper investigates vitellogenin synthesis in the fat body of the female marine crustacean Isopoda, Idotea balthica basteri, during vitellogenesis. The fat bodies were incubated in a labelled medium; one of the samples was treated with an antiserum against vitellogenin and the antigen-antibody complex counted for radioactivity. We assumed this radioactivity to be due to vitellogenin synthesis. It is indicated that vitellogenin may account for most of the protein synthesized by the fat body during vitellogenesis. The first peak of vitellogenin synthesis was observed in the early stages of vitellogenesis (molting cycle period C), but the major increase in that level appeared during stage 2 of vitellogenesis (molting cycle period D, stage D1). Before laying (and molt), the fat body incorporated less.

Electron microscopic study of follicle cell development during vitellogenesis in the marine crustacean Isopoda, Idotea balthica basteri.

The ultrastructure of follicle cells has been compared to that of developing oocytes in the marine crustacean isopod, Idotea balthica basteri, at different periods of the molting cycle. There was a distinct change in the shape and size of the follicles and in their relation to each other and to the oocytes. During stage 1 of vitellogenesis (molting cycle period C), spaces between the follicles appeared and enlarged. At the same time, the exogenous yolk fraction penetrated the oocytes, and villi, issuing from both the follicle cells and the oocytes, formed. Maximal follicle cell activity occurred during stge 2 of vitellogenesis (molting cycle period D) when micropinocytotic uptake stopped. This cellular activity was characterized by the synthesis of some granular material and the development of the rough endoplasmic reticulum and the Golgi vesicle. The granular material participated in the formation of the chorion. The follicle cells seemed to degenerate shortly before laying, and thus the follicular epithelium did not appear to be permanent in Idotea.