"We don't have the same bodies; we don't react the same way": mothers and adolescent girls' perceptions of the risks and benefits of HPV vaccination in France.

Human Papillomavirus (HPV) vaccination is one of the most publicly mistrusted vaccines in Europe, with countries such as France struggling with low vaccine uptake due to parental questioning of vaccine risks and benefits. However, limited evidence exists on adolescent girls' perceptions of the risks and benefits of HPV vaccination. The aim of this qualitative study was to provide an in-depth exploration and comparison of French mothers (n = 21) and adolescent girls' (n = 36) perceptions of the risks and benefits of HPV vaccination. A thematic analysis showed that adolescent girls and mothers perceived the risks and benefits of HPV vaccination differently, with girls reporting positive and beneficial views and emotions toward vaccination and mothers expressing concerns about possible risks. Adolescent girls also reported that both perceptions and actual risks and benefits may vary from one individual to another. Vaccine safety was also understood differently, with mothers reporting a widespread view that vaccines are unsafe and focusing on controversial side effects and girls discussing short-term consequences of vaccination (e.g. pain, fever) and administration and storage issues. Strategies to improve uptake of HPV vaccination should consider and address both the mothers' and daughters' perceptions and understandings of HPV vaccination.

'I trust them because my mum trusts them': Exploring the role of trust in HPV vaccination decision-making among adolescent girls and their mothers in France.

The success of vaccination programmes relies on high uptake and acceptance of vaccines, which is in part influenced by public trust in vaccines, providers, policy-makers and information. France is one of the countries in the world with the lowest confidence in vaccination, with parents expressing particular concerns about the human papillomavirus (HPV) vaccine. This qualitative study explored the role of trust in HPV vaccination decision-making among mothers and adolescent girls in France. Semi-structured interviews and focus groups were conducted with 15-16-year-old adolescent girls and their mothers in Paris. A thematic analysis based on deductive and inductive coding was conducted. HPV vaccination decision-making was described as a complex and uncertain process, a possible consequence of erosion of trust in the vaccine, in healthcare professionals and health authorities, and in information itself. Due to public criticism of the vaccine and conflicting advice received from medical professionals, the vaccine was perceived as controversial. The mothers' strong trust in doctors did not always increase HPV vaccine acceptance, as doctors themselves failed to recommend or recommended against the vaccine. Furthermore, the perceived mismanagement of previous health events tainted the mothers' trust in health authorities. Contrastingly, while adolescents expressed trust in doctors and health authorities, their trust in their own mothers was stronger. A lack of exposure to positive sources of information (e.g. from doctors, schools or media) contributed to low awareness about HPV vaccination among adolescent girls. While both mothers and girls discussed the importance of trusting themselves, they also acknowledged being influenced by others around them as well as information, often negative, from the internet. Adolescent girls also expressed mistrust about information in general, explaining that any information can be manipulated. Low confidence in HPV vaccination in France can be explained by broader trust issues, which will require long-term efforts to address.

The role of maturity in adolescent decision-making around HPV vaccination in France.

Mothers are often responsible for vaccination decisions in the household. However, their confidence in certain vaccines such as Human Papillomavirus (HPV) vaccines is eroding in some countries. France is one of the countries with the lowest HPV vaccine uptake in Europe, with parents delaying or refusing the vaccine for their adolescent daughters due to safety- and effectiveness-related concerns. Although parental consent is required for vaccination, adolescents' involvement in HPV vaccination decision-making could improve vaccine uptake, with self-consent procedures already introduced in some countries. Adolescents' capacity to engage in decision-making is influenced by their maturity and autonomy in health. This study explored the role of maturity in decision-making around HPV vaccination in France through qualitative interviews with adolescent girls (n = 24) and their mothers (n = 21) and two focus groups with adolescent girls (n = 12). A codebook approach to thematic analysis revealed that adolescent girls' involvement in HPV decision-making is a process that evolved with maturity. As adolescents progressed towards maturity at different speeds, some expressed childlike traits such as impulsive decisions and others described more rational, reflective decision-making. Despite these differences, most adolescents in this study described a passive role in HPV vaccination decision-making, following their parents' lead. However, their expressed desire for information and involvement in discussions indicates that their lack of engagement may not only be due to a lack of maturity but also a result of mothers and doctors excluding them from getting involved. Furthermore, as health behaviours are shaped during adolescence, the influence of vaccine hesitant mothers on their daughters' own views and beliefs could be significant, together with exposure to regular controversies in the mainstream media. Individualised approaches to engage adolescents in decision-making around their own health are needed, for example through strengthening discussions and information around HPV vaccination with parents and doctors.

The impact of the COVID-19 epidemic on primary care in South-eastern France: implementation of a real-time monitoring system based on regional health insurance system data.

BACKGROUND: The spring 2020 COVID-19 epidemic severely impacted France's healthcare system. The associated lockdown (17 March- 11 May 2020) and the risk of exposure to SARS-CoV-2 led patients to change their use of healthcare. This article presents the development and implementation of a real-time system to monitor i) private doctors' activity in South-eastern France, and ii) changes in prescription of drugs for people with diabetes, mental health disorders and for certain vaccines from Mars 2020 to October 2020. METHODS: Data extracted from the regional healthcare insurance databases for 2019 and 2020 were used to construct indicators of healthcare use. They were calculated on a weekly basis, starting from week 2 2020 and compared for the same period between 2019 and 2020. RESULTS: Private doctors' activity decreased during the spring 2020 lockdown (by 23 % for general practitioners and 46 % for specialists), followed by an almost complete return to normal after it ended until week 41. Over the same period, a huge increase in teleconsultations was observed, accounting for 30 % of private doctors' consultations at the height of the crisis. The start of the lockdown was marked by a peak in drug prescriptions, while vaccinations declined sharply (by 39 % for the measles, mumps and rubella (MMR) vaccine in children under 5 years old, and by 54 % for human papillomavirus vaccine in girls aged 10-14 years old). CONCLUSION: The ongoing COVID-19 epidemic may lead to health consequences other than those directly attributable to the disease itself. Specifically, lockdowns and foregoing healthcare could be very harmful at the individual and population levels. The latter issue is a concern for French public authorities, which have implemented actions aimed at encouraging patients to immediately seek treatment. However, the COVID-19 crisis has also created opportunities, such as the roll-out of teleconsultation and tele-expertise. The indicators described here as part of the monitoring system can help public decision-makers to become more responsive and to implement tailored actions to better meet the general population's healthcare needs.

[The impact of the COVID-19 pandemic on first-line primary care in southeastern France: Feedback on the implementation of a real-time monitoring system based on regional health insurance data]. / L'impact de l'épidémie de COVID-19 sur les soins de premier recours en région Provence-Alpes-Côte d'Azur : retour d'expérience sur la mise en place d'un dispositif de surveillance en temps réel à partir des données régionales de l'Assurance maladie.

BACKGROUND: Starting in spring 2020, the COVID-19 pandemic markedly impacted the French healthcare system. Lockdown and risks of exposure to the coronavirus induced patients to modify their ways of use. The objective of this article was to share feedback on the implementation of a real-time monitoring system concerning (a) the activity of private practitioners in southeastern France, and (b) the evolution of reimbursements for drugs prescribed to persons with diabetes, for treatment of mental health disorders, and for performance of some vaccines. METHODS: Data regarding 2019 and 2020 were extracted from regional health insurance databases. They were used to elaborate several indicators relative to the general health insurance scheme, which were calculated and updated each week, starting with week 2. RESULTS: We observed a drop in private physician activity during the lockdown (-23% for general practitioners; -46% for specialist doctors), followed by a return to a semblance of normalcy. Concomitantly, a boom in teleconsultations occurred: at the height of the crisis they represented 30% of medical acts. The initial stage of the lockdown was characterized by peak provisioning for drugs, whereas vaccination strongly declined (-39% regarding measles, mumps and rubella vaccine among children aged less than 5 years; -54% regarding human papillomavirus vaccine among girls aged 10 to 14 years). CONCLUSION: The COVID-19 pandemic could lead to health effects other than those directly attributable to the coronavirus itself. Renouncing care may result in healthcare delays highly deleterious for people and society. Public authorities are preoccupied with these questions; they have set up action plans aimed at encouraging patients to seek treatment without delay. That said, the COVID-19 pandemic crisis has also created opportunities, such as the expansion of telemedicine. Although partial, these indicators can provide useful information enabling public decision makers to be reactive and to implement specific actions to meet the health needs of the population.

What could explain the late emergence of COVID-19 in Africa?

At the end of November 2019, a novel coronavirus responsible for respiratory tract infections emerged in China. Despite drastic containment measures, this virus, known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), spread in Asia and Europe. The pandemic is ongoing with a particular hotspot in southern Europe and America in spring 2020. Many studies predicted an epidemic in Africa similar to that currently seen in Europe and the USA. However, reported data do not confirm these predictions. Several hypotheses that could explain the later emergence and spread of the coronavirus disease 2019 (COVID-19) pandemic in African countries are being discussed, including the lack of health-care infrastructure capable of clinically detecting and confirming COVID-19 cases, the implementation of social distancing and hygiene, international air traffic flows, the climate, the relatively young and rural population, the genetic polymorphism of the angiotensin-converting enzyme 2 receptor, cross-immunity and the use of antimalarial drugs.

Impact of medication review via tele-expertise on unplanned hospitalizations at 3 months of nursing homes patients (TEM-EHPAD): study protocol for a randomized controlled trial.

BACKGROUND: Inappropriate drug prescribing causes preventable drug-related adverse events that result in increased morbidity and mortality, additional costs and diminished quality of life. Numerous initiatives have been launched to improve the quality of drug prescribing and safeguard the security of drug administration processes in nursing homes. Against the backdrop of implementation of telemedicine services, the focus of the present work is to evaluate the impact of a telemedication review carried out by a hospital physician and pharmacist as part of the telemedicine offer. METHODS: The present study is a randomized controlled clinical trial. A total of 364 patients will be randomized into two groups: (1) an experimental group (182 patients) benefiting from a telemedication review using tele-expertise and (2) a control group (182 patients) receiving standard care. The primary endpoint will be rate of all-cause unplanned hospital admissions occurring within 3 months of randomization. The secondary endpoints will be rate of unplanned admissions at 6 months, patient quality of life, incidence of behavioral disturbances, number of falls, number of residents prescribed at least one inappropriate medication, nursing staff satisfaction, proposed medication reviews and their acceptability rate, characteristics of patients whose general practitioners have taken account of tele-expertise, efficacy of tele-expertise as compared to standard prescription and acceptability and satisfaction surveys of participating caregivers. DISCUSSION: In the literature, various studies have investigated the utility of structured medication review processes, but outcome measures are heterogeneous, and results vary widely. Medication review can detect medication-related problems in many patients, but evidence of clinical impact is scant. Incremental cost-effectiveness ratios will be used to compare the cost and effectiveness of the experimental strategy and that of standard care. Our approach, involving the combination of an acceptability survey and a mixed-method (qualitative and quantitative) satisfaction survey, is particularly innovative. The results of this randomized trial are expected to confirm that medication review using tele-expertise has potential as a worthwhile care management strategy for nursing home residents. TRIAL REGISTRATION: Clinicaltrials.gov NCT03640845; registered August 21, 2018 (Clinicaltrials.gov NCT03640845).

Seasonal influenza vaccination among people with diabetes: influence of patients' characteristics and healthcare use on behavioral changes.

Annual seasonal influenza vaccination (SIV) is recommended for people with diabetes, but vaccine coverage remains low. We estimated the probabilities of stopping or starting SIV, their correlates, and the expected time spent in the vaccinated state over 10 seasons for different patient profiles. We set up a retrospective cohort study of patients with diabetes in 2006 (n = 16,026), identified in a representative sample of beneficiaries of the French National Health Insurance Fund. We followed them up over 10 seasons (2005/06-2015/16). We used a Markov model to estimate transition probabilities and a proportional hazards model to study covariates. Between two consecutive seasons, the probabilities of starting (0.17) or stopping (0.09) SIV were lower than those of remaining vaccinated (0.91) or unvaccinated (0.83). Men, older patients, those with type 1 diabetes, treated diabetes or more comorbidities, frequent contacts with doctors, and with any hospital stay for diabetes or influenza during the last year were more likely to start and/or less likely to stop SIV. The mean expected number of seasons with SIV uptake over 10 seasons (range: 2.6-7.9) was lowest for women <65 years with untreated diabetes and highest for men ≥65 years with type 1 diabetes. Contacts with doctors and some clinical events may play a key role in SIV adoption. Healthcare workers have a crucial role in reducing missed opportunities for SIV. The existence of empirical patient profiles with different patterns of SIV uptake should encourage their use of tailored educational approaches about SIV to address patients' vaccine hesitancy.

Supporting informed decision-making about vaccination: an analysis of two official websites.

OBJECTIVE: To analyze the content of two official French-speaking websites that are used to inform the general public about recommended vaccines in France and Quebec. STUDY DESIGN: Qualitative content analysis. METHODS: All pages that inform and educate parents regarding childhood vaccination were downloaded and analyzed according to evidence-informed risk communication metrics. RESULTS: A total of 32 webpages, 14 videos, and two infographics were included in the analysis. The following were the most frequent risk communication approaches: 'debunking common misconceptions about vaccination' or 'answering common questions about vaccines.' Harm and benefit information focused primarily on the risks of vaccine-preventable diseases and the risks of adverse events after immunization. Most materials used qualitative terminology to describe the risk (e.g., vaccines are among the safest tools, adverse events are rare). Very few materials provided numeric likelihood of harms and benefits. When numeric information was stated, they were only presenting the risks of the diseases or number of cases in an outbreak. The approaches used to debunk misconceptions generally focused on the myth itself rather than the correct information. Few materials used visual aids (e.g., graphics, pictures, icons arrays, etc.) to convey important information. CONCLUSIONS: It is often assumed that misinformation and rumors about vaccination found online is a leading cause of the increase in vaccine hesitancy. Existing communication materials could be improved to better align with best practices in risk communication. Given the availability of confusing and conflicting vaccine narratives, it is crucial that authoritative communication materials aim to build trust and support informed choices about vaccination.

A method to prioritize the surveillance of chemicals in food commodities to access international market and its application to four countries in Sub-Saharan Africa.

The purpose of this study was to propose an approach to predict the distribution of chemicals in food in developing countries to assess consumer risk and access to the international market with a limited number of laboratory analyses. The first step consists of identifying the GEMS/Food Contaminants database and the chemical/food combination relevant for a particular country. The identification of critical chemical/food combination should be used to prioritize the analysis to be performed in a total diet study (TDS). The second step consists of modelling a distribution model based on the mean concentration generated from TDS associated with the variability observed in a larger dataset consisting of individual food contamination data from the GEMS food database. The simulated distributions may provide information regarding how to establish food safety standards and to assess the potential for accessing international market in the context of a value chain. This method is illustrated by case studies from the recent Regional TDS (RTDS) conducted in Sub Saharan Africa. We concluded that further work is needed to gain experience and to fully validate this approach. However, organized data sharing and developing harmonized methods for data analysis are key roles for international organizations, such as FAO, WHO, and WTO. Finally, it is important to remember that such a data-driven approach still requires significant investments in terms of human resources and analytical capacity.

FAO/WHO GIFT (Global Individual Food consumption data Tool): a global repository for harmonised individual quantitative food consumption studies.

Knowing who eats what, understanding the various eating habits of different population groups, according to the geographical area, is critical to develop evidence-based policies for nutrition and food safety. The FAO/WHO Global Individual Food consumption data Tool (FAO/WHO GIFT) is a novel open-access online platform, hosted by FAO and supported by WHO, providing access to harmonised individual quantitative food consumption (IQFC) data, especially in low- and middle-income countries (LMIC). FAO/WHO GIFT is a growing repository, which will serve as the global FAO/WHO hub to disseminate IQFC microdata. Currently five datasets from LMIC are available for dissemination, and an additional fifty datasets will be made available by 2022. To facilitate the use of these data by policy makers, ready-to-use food-based indicators are provided for an overview of key data according to population segments and food groups. FAO/WHO GIFT also provides an inventory of existing IQFC data worldwide, which currently contains detailed information on 188 surveys conducted in seventy-two countries. In order for end-users to be able to aggregate the available data, all datasets are harmonised with the European Food Safety Authority's food classification and description system FoodEx2 (modified for global use). This harmonisation is aimed at enhancing the consistency and reliability of nutrient intake and dietary exposure assessments. FAO/WHO GIFT is developed in synergy with other global initiatives aimed at increasing the quality, availability and use of IQFC data in LMIC to enable evidence-based decision-making and policy development for better nutrition and food safety.

Multi-trajectories of antidepressant and antipsychotic use: a 11-year naturalistic study in a community-based sample.

OBJECTIVE: To explore the temporal dynamic of antidepressant and antipsychotic co-prescribing in real-life conditions. METHODS: The study was performed using reimbursement data from the French Insurance Healthcare system in a cohort of 118 454 persons with at least one dispensing of antidepressants and/or antipsychotics over the period 2006-2016. Latent class analyses were used to identify homogeneous groups of persons following similar multi-trajectories of antidepressant and/or antipsychotic dispensing. Multivariate polynomial logistic regression models were used to explore the characteristics independently associated with distinct trajectories. RESULTS: Five multi-trajectories of antidepressant and/or antipsychotic dispensing were identified: more than half of the sample (58%) had very low antidepressant and antipsychotic use; two groups had chronic (12%) or decreasing (11%) antidepressant use with very low antipsychotic use; two groups used both antidepressants and antipsychotics simultaneously either in an increasing (12%) or chronic (7%) way. Persons with chronic antidepressant-antipsychotic use presented with markers of poor social and mental health conditions. CONCLUSIONS: Most persons using antipsychotics over the follow-up also used antidepressants over the same period. The benefit/risk ratio of these prescribing practices should be further explored as the long-term efficacy of antidepressant-antipsychotic polypharmacy is poorly documented, while this combination increases the risk of adverse effects.

Trajectory analysis of anxiolytic dispensing over 10 years among new users aged 50 and older.

OBJECTIVE: To identify temporal trajectories of anxiolytic benzodiazepine (A-BZD) use over 10 years among new A-BZD users aged 50 and older and describe treatment patterns and demographic and clinical characteristics associated with each trajectory. METHOD: A representative cohort of the French national health insurance fund users was tracked from 2006 through 2015. We used latent class mixed models to identify the trajectories. RESULTS: We observed four trajectories among new users (no A-BZD dispensing in 2005) plus one non-use trajectory. The proportion of occasional use among users was 60%; early increasing use, 10%; late increasing use, 17%; and increasing/decreasing use, 13%. Prevalence of occasional use decreased with age in women, but not men. Duration of treatment episodes and doses differed between trajectories. Multiple regression analyses with occasional use as the reference showed that the other three trajectories shared characteristics (age, coprescriptions of other psychotropic drugs, and more general practitioner consultations) but differed by the presence at inclusion or occurrence during follow-up of psychiatric, neurodegenerative, and somatic conditions. CONCLUSION: We found four different long-term temporal trajectories in new A-BZD users (occasional, early increasing, late increasing, and increasing/decreasing use). Difficulties quitting or reducing consumption may be very different for each trajectory, requiring tailored care approaches.

General practitioners' perceptions of vaccination controversies: a French nationwide cross-sectional study.

OBJECTIVES: We aimed to study general practitioners' (GPs') perceptions of vaccines that have been a subject of controversy in France. METHODS: A cross-sectional survey in 2014 asked a representative national sample of GPs, randomly selected from the exhaustive database of health professionals in France, about their perceptions of the likelihood of serious adverse events potentially associated with six different vaccines: for two of them the association was based on some scientific evidence, whereas for the other four this is not the case. We performed a cluster analysis to construct a typology of GPs' perceptions about the likelihood of these potential six associations. Factors associated with certain clusters of interest were identified using logistic regression models. RESULTS: Overall, 1582 GPs participated in the questionnaire survey (1582/1712 GPs who agreed to participate, 92%). Cluster analysis identified four groups of GPs according to their susceptibility to vaccine controversies: 1) limited susceptibility to controversies (52%); 2) overall unsure, but rejected the association between hepatitis B vaccine and multiple sclerosis (32%); 3) highly susceptible to controversies (11%); and 4) unsure (5%). We found that GPs who occasionally practised alternative medicine (OR 2.71, 95% CI 1.65-4.45), and those who considered information provided by mass media as reliable (OR 2.04, 95% CI 1.65-3.99) were more susceptible to controversies. CONCLUSIONS: GPs had different profiles of susceptibility to vaccination controversies, and most of their perceptions of these controversies were not based on scientific evidence.

General practitioners and vaccination of children presenting with a benign infection.

PURPOSE: To assess the self-reported vaccination behavior of general practitioners (GPs) when asked whether they would recommend the vaccination of a child presenting with a febrile uncomplicated common cold. METHODS: We performed a cross-sectional survey in 2014 on a national sample of GPs. GPs were randomly assigned to one of eight clinical vignettes, all describing a child presenting with an uncomplicated febrile common cold, but differing by age (4 or 11 months), temperature (38°C or 39°C), and the mother's emotional state (calm or worried). GPs were asked whether they would recommend immediate vaccination of the child with a hexavalent vaccine (diphtheria, tetanus, pertussis, poliomyelitis, Haemophilus influenzae type b, and hepatitis B), or postpone it. We investigated the relation between the GPs' recommendation to vaccinate, the clinical vignette's variables, and the GPs' perceptions, attitudes, and practices toward vaccination in a multivariate model. RESULTS: Among the 1582 participating GPs, 6% recommended immediate vaccination. This behavior was more frequent with a temperature of 38°C rather than 39°C (10% vs. 3%, P<0.001). GPs who felt comfortable giving explanations about vaccine safety were more likely to recommend immediate vaccination of the febrile child (P=0.045), but none of the other GPs' characteristics were associated with their vaccination behavior. CONCLUSIONS: Almost all GPs postponed the hexavalent vaccination of the febrile child presenting with an uncomplicated viral disease; fever being the major factor affecting their decision. More research is needed on vaccination responses in sick children, as well as clearer guidelines.

[Trends in social inequities in diabetes care in the Provence-Alpes-Côte-d'Azur region of France between 2008 and 2011]. / Évolution des inégalités sociales de suivi du diabète en région Provence-Alpes-Côte-d'Azur entre 2008 et 2011.

BACKGROUND: Social inequities in healthcare are known to exist for the management of many chronic diseases in France, including diabetes. The recession that began in 2008 has led to increased income disparities but has it also exacerbated health inequities. The aim of this study was to describe trends in inequities in diabetes-related healthcare between 2008 and 2011 in the PACA region (Provence-Alpes-Côte-d'Azur). METHODS: This analysis used two sources of data: the regional national health insurance fund (PACA region) reimbursement database and the socio-demographic databases of the national statistics office (INSEE) for four full years (2008 to 2011). It included individuals who had been reimbursed for three purchases of oral diabetes drugs during the previous year and assessed the association between the median household income (weighted by number and age of household members) of each patient's municipality of residence and seven indicators of diabetes monitoring and care. Using adjusted mixed logistic models, including an interaction term between time (number of years) and the median household income of the municipality, we examined the performance of the indicators for each year. RESULTS: The total number of patients with diabetes in the 941 municipalities of the PACA region varied by year from 142,055 to 164,929. Models showed that living in a town with a high or intermediate household income was significantly associated with better performance of the seven indicators and that the interaction term was significant for six of them. The effect of the municipal median income decreased significantly between 2008 and 2011 for five indicators: HbA1c, LDL-cholesterol, microalbuminuria, ophthalmoscopy and diabetes specialist visit. CONCLUSION: Social inequities in diabetes-related healthcare persisted between 2008 and 2011 but appeared to be decreasing, despite the recession.

Discrepancies between general practitioners' vaccination recommendations for their patients and practices for their children.

OBJECTIVES: The objectives of our study were to describe the vaccination recommendations by general practitioners (GPs) for their patients and practices for their children, and to identify any discrepancies between them. METHODS: Applying multiple correspondence analysis and agglomerative hierarchical cluster analysis to data from a 2014 cross-sectional survey of a national sample of GPs, we constructed a typology based on the patterns of associations between GPs' vaccine recommendations to their patients and practices to their own children's vaccinations. RESULTS: This study includes the 1038 GPs who reported that they had at least one child aged 2-25 years. Nearly half (47%, 482/1021) reported that all of their children were vaccinated against hepatitis B but that they did not always recommend that vaccine to patients; the same discordance was observed among 36% (369/1027) for the measles-mumps-rubella vaccine, 19% (194/1013) to 28% (290/1019) for routine and catch-up meningococcal C vaccination, and 27% (136/496) for the human papillomavirus vaccine. Cluster analysis showed that 37% (95% CI 33%-39%) of GPs reported an above-average rate of systematic vaccine recommendations for their patients, and most reported that all their children were vaccinated (low level of discordance), whereas 60% (95% CI 58%-64%) had a high level of discordance, that is, most reported that their children were vaccinated, but did not always recommend the same vaccines to their patients. CONCLUSIONS: Many GPs do not report the same attitude concerning the vaccination of their children and their patients. The reasons underlying these discrepancies, possibly including vaccine hesitancy, should be investigated.

Geographical disparities in prescription practices of lithium and clozapine: a community-based study.

OBJECTIVE: To explore the socioeconomic and health resource characteristics associated with geographical variations of lithium and clozapine dispensing rates in France. METHOD: The study was performed using reimbursement data from the French Insurance Healthcare system over the period 2006-2013 in a community-based sample of persons aged 16 years and over. An ecological design was used to assess whether lithium and clozapine prescribing rates were associated with socioeconomic and health resource characteristics of the zone of residence (n = 95 French administrative subdivisions). RESULTS: Large geographical disparities were observed in dispensing rates: lithium dispensing rates by zone of residence ranged from 0 to 6.6 per 1000 (mean 2.4 per 1000) and clozapine dispensing rates ranged from 0 to 4.9 per 1000 (mean 0.8 per 1000). Higher density of GPs and regular communication between mental health services and primary care were independently associated with higher rates of lithium and clozapine dispensing and with a higher proportion of lithium users among mood-stabilizer users. CONCLUSION: A sufficient density of GPs and an effective communication and collaboration between mental healthcare services and primary care seems to favor greater access to psychotropic drugs with demonstrated efficacy but often viewed as 'risky' to prescribe.

Design of a national and regional survey among French general practitioners and method of the first wave of survey dedicated to vaccination.

OBJECTIVES: France is currently facing a vaccine-hesitancy crisis. We conducted a questionnaire-based telephone interview with a large sample of general practitioners (GPs) as they play a crucial role in the vaccination process. Our main objectives were to study the GPs' vaccination behaviors when it comes to their own vaccination and that of their relatives, and the vaccine recommendations made to their patients. We also aimed to understand their opinion related to the severity of vaccine-preventable diseases and to assess their trust in various sources of information. Finally, we enquired about their opinion in terms of vaccination-related tools that could help them in their daily practice. The article aimed to present the design of this panel and survey. PATIENTS AND METHODS: Four samples of GPs (one national and three regional) were selected among all the French GPs (metropolitan France) using random sampling. Five cross-sectional surveys should be conducted with that panel. The mean targeted sample size is 2350 GPs for each survey. The survey dedicated to vaccination was conducted by telephone or on the Internet. RESULTS: GPs were included in the survey between December 2013 and February 2014. The national sample included 1582 GPs (response rate: 46%) and the three regional samples included 1297 GPs (response rate: 44%). The survey dedicated to vaccination was conducted between April and July 2014; the national sample response rate was 92% (1582/1712). CONCLUSION: The results of the first wave of surveys, conducted on a large sample of French GPs, provide important information to guide the French vaccination policy.

Characteristics of patients and physicians correlated with regular influenza vaccination in patients treated for type 2 diabetes: a follow-up study from 2008 to 2011 in southeastern France.

We studied a cohort of 110 823 patients treated with oral hypoglycaemic agents for type 2 diabetes in southeastern France from 1 January 2008 to 31 December 2011, to identify influenza vaccination coverage trends and the patient and physician correlates of influenza vaccine (IFV) uptake. We used French national health insurance fund (NHIF) databases to identify these patients and collect data on their IFV reimbursement claims (IFVC) and patient and physician characteristics. We used multilevel multivariate polytomous logistic regressions to test the correlates of IFVC. Between 2008 and 2011 the annual IFVC rate varied from 33.7% to 32.3% in the 18-64 age group and from 69.5% to 61.1% in the 65 + age group, among whom we saw a clear trend towards reduced vaccination after 2008. In the younger group, the probability of regular vaccination each year from 2008 to 2011 increased with diabetes severity and duration, comorbidities, and the number of general practitioner and nurse visits; it was higher among patients seeing endocrinologists and lower among low-income patients than in other patients. In the older group, there was no association with either diabetes severity or physician specialty. These results suggest different patterns of correlates of influenza vaccination according to age. Endocrinologists might help to improve IFV uptake in the younger group of patients with type 2 diabetes. Communication strategies regarding influenza vaccination should be adapted to age, and collaboration between healthcare professionals should be reinforced to achieve vaccination objectives for these patients.