La crise sanitaire du Covid-19 et le confinement sont associés à un taux élevé de troubles du sommeil et de prise d'hypnotiques en France

Objectif La crise de la COVID-19 a perturbé les habitudes de milliards de personnes dans le monde. Pour de nombreux pays, le confinement à la maison est obligatoire et les familles sont forcées de vivre ensemble en permanence, dans des environnements souvent petits, avec leurs propres habitudes de sommeil et de veille. Le sommeil est essentiel pour nos vies et crucial pour équilibrer leur système immunitaire, la santé physique et psychologique. Méthodes Pour évaluer les problèmes de sommeil et l'utilisation des somnifères, nous avons réalisé une étude transversale d'un échantillon représentatif de la population générale en France (1005 sujets). Nous avons utilisé les mêmes éléments autodéclarés de plaintes de sommeil au cours des 8 derniers jours, tirés de l'échelle du Duke Health Profile, que ceux utilisés depuis 1995 dans les Baromètres de la santé français, une série d'enquêtes transversales sur diverses questions de santé publique. Résultats Après deux semaines de confinement, 74 % des participants ont signalé des plaintes de sommeil, comparativement à des taux de prévalence de 44 % à 49 % au cours des 25 dernières années. Les femmes ont déclaré plus de problèmes de sommeil que les hommes : 31 % contre 16 %. Les jeunes (18-35 ans) plus fréquemment que leurs aînés (79 % contre 72 % des 35 ans et plus) : 60 % ont déclaré que ces problèmes augmentaient avec le confinement, contre 51 % de leurs aînés. Enfin, 16 % des participants ont déclaré avoir pris des somnifères au cours des 12 derniers mois et 41 % d'entre eux ont déclaré avoir consommé ces médicaments depuis le début du confinement. Conclusion Ces résultats suggèrent que la crise de la COVID-19 est associée à de graves troubles du sommeil au sein de la population française, en particulier chez les jeunes.

Measuring psychosocial determinants of vaccination behavior in healthcare professionals: validation of the Pro-VC-Be short-form questionnaire.

BACKGROUND: Vaccine confidence among health care professionals (HCPs) is a key determinant of vaccination behaviors. We validate a short-form version of the 31-item Pro-VC-Be (Health Professionals Vaccine Confidence and Behaviors) questionnaire that measures HCPs' confidence in and commitment to vaccination. RESEARCH DESIGN AND METHODS: A cross-sectional survey among 2,696 HCPs established a long-form tool to measure 10 dimensions of psychosocial determinants of vaccination behaviors. Confirmatory factor analysis (CFA) models tested the construct validity of 69,984 combinations of items in a 10-item short form tool. The criterion validity of this tool was tested with four behavioral and attitudinal outcomes using weighted modified Poisson regressions. An immunization resource score was constructed from summing the responses of the dimensions that can influence HCPs' pro-vaccination behaviors: vaccine confidence, proactive efficacy, and trust in authorities. RESULTS: The short-form tool showed good construct validity in CFA analyses (RMSEA = 0.035 [0.024; 0.045]; CFI = 0.956; TLI = 0.918; SRMR 0.027) and comparable criterion validity to the long-form tool. The immunization resource score showed excellent criterion validity. CONCLUSIONS: The Pro-VC-Be short-form showed good construct validity and criterion validity similar to the long-form and can therefore be used to measure determinants of vaccination behaviors among HCPs.

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

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

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

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

Factors associated with COVID-19 vaccine uptake among French population aged 65 years and older: results from a national online survey.

BACKGROUND: In France, the increase in COVID-19 vaccine uptake among older adults slowed down between May and June 2021. Using the data from a national survey, we aimed to assess COVID-19 vaccine uptake among French residents aged 65 years and older, particularly at risk of severe form of the infection, and identify factors associated with non-vaccination. METHODS: A cross-sectional online survey collected the immunization status/intention to get the COVID-19 vaccine, reasons for vaccination/non-vaccination and factors potentially associated with vaccine uptake between May 10 and 23, 2021 among a large sample of French residents. Characteristics of participants were compared according to immunization status. Factors potentially associated with non-vaccination were computed into a multivariate logistic regression. RESULTS: Among the 1941 survey participants, 1612 (83%) reported having received at least one dose of COVID-19 vaccine. Among the 329 unvaccinated, 197 (60%) declared having the intention to get vaccinated. Younger age (adjusted odds ratio (aOR) = 1.50; 95% confidence interval (CI), 1.05-2.14), thinking previously having COVID-19 (aOR = 4.01; 95% CI, 2.17-7.40), having suffered economic impact due to the pandemic (aOR = 2.63; 95% CI, 1.71-4.04), reporting an "unsafe" opinion about COVID-19 vaccine safety (aOR = 6.79; 95% CI, 4.50-10.26), reporting an "unsupportive" opinion about vaccination in general (aOR = 4.24; 95% CI, 2.77-6.49) were independent risk factors for non-vaccination. On the other hand, trust in COVID-19 vaccine information delivered by the doctor (aOR = 0.28; 95% CI, 0.16-0.48) and trust in the government's actions (aOR = 0.50; 95% CI, 0.34-0.74) were independent protective factors for non-vaccination. Political affiliation also remained significantly associated with vaccine uptake. CONCLUSIONS: Despite high overall COVID-19 vaccine uptake among the study participants, differences in vaccine uptake according to the level of concerns regarding COVID-19 vaccine safety, socioeconomic profile and trust in the government were observed. Our results reinforce the importance of "reaching out" vaccination strategy that specifically targets the most vulnerable fringe of older adult population.

United, can we be stronger? Did French general practitioners in multi-professional groups provide more chronic care follow-up during lockdown?

BACKGROUND: Given the importance of the continuous follow-up of chronic patients, we evaluated the performance of French private practice general practitioners (GPs) practicing in multi-professional group practices (MGP) regarding chronic care management during the first Covid-19 lockdown in Spring 2020 compared to GPs not in MGP. We consider two outcomes: continuity of care provision for chronic patients and proactivity in contacting these patients. METHODS: The cross-sectional web questionnaire of 1191 GPs took place in April 2020. We exploit self-reported data on: 1) the frequency of consultations for chronic patients during lockdown compared to their "typical" week before the pandemic, along with 2) GPs' proactive behaviour when contacting their chronic patients. We use probit and bivariate probit models (adjusted for endogeneity of choice of engagement in MGP) to test whether GPs in MGP had significantly different responses to the Covid-19 crisis compared to those practicing outside MGP. RESULTS: Out of 1191 participants (response rate: 43.1%), around 40% of GPs were female and 34% were younger than 50 years old. Regression results indicate that GPs in MGP were less likely to experience a drop in consultations related to complications of chronic diseases (- 45.3%). They were also more proactive (+ 13.4%) in contacting their chronic patients compared to their peers practicing outside MGP. CONCLUSION: We demonstrate that the MGP organisational formula was beneficial to the follow-up of patients with chronic conditions during the lockdown; therefore, it appears beneficial to expand integrated practices, since they perform better when facing a major shock. Further research is needed to confirm the efficiency of these integrated practices outside the particular pandemic setup.

Prebunking messaging to inoculate against COVID-19 vaccine misinformation: an effective strategy for public health

Background Objective Method Results Conclusion Vaccination coverage needs to reach more than 80% to resolve the COVID-19 pandemic, but vaccine hesitancy, fuelled by misinformation, may jeopardize this goal. Unvaccinated older adults are not only at risk of COVID-19 complications but may also be misled by false information. Prebunking, based on inoculation theory, involves ‘forewarning people [of] and refuting information that challenges their existing belief or behavior’.To assess the effectiveness of inoculation communication strategies in countering disinformation about COVID-19 vaccines among Canadians aged 50 years and older, as measured by their COVID-19 vaccine intentions.Applying an online experiment with a mixed pre–post design and a sample size of 2500 participants, we conducted a national randomized survey among English and French-speaking Canadians aged 50 years and older in March 2021. Responses to two different disinformation messages were evaluated. Our primary outcome was the intention to receive a COVID-19 vaccine, with attitudes toward COVID-19 vaccine a secondary outcome. The McNemar test and multivariate logistic regression analysis on paired data were conducted when the outcome was dichotomized. Wilcoxon sign rank test and Kruskal–Wallis were used to test difference scores between pre- and post-tests by condition.Group comparisons between those who received only disinformation and those who received the inoculation message show that prebunking messages may safeguard intention to get vaccinated and have a protective effect against disinformation.Prebunking messages should be considered as one strategy for public health communication to combat misinformation. [ FROM AUTHOR] Copyright of Journal of Communication in Healthcare is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

An instrument to measure psychosocial determinants of health care professionals' vaccination behavior: Validation of the Pro-VC-Be questionnaire.

OBJECTIVES: The lack of validated instruments assessing vaccine hesitancy/confidence among health care professionals (HCPs) for themselves, and their patients led us to develop and validate the Pro-VC-Be instrument to measure vaccine confidence and other psychosocial determinants of HCPs' vaccination behavior among diverse HCPs in different countries. METHODS: Cross-sectional survey in October-November 2020 among 1,249 GPs in France, 432 GPs in French-speaking parts of Belgium, and 1,055 nurses in Quebec (Canada), all participating in general population immunization. Exploratory and confirmatory factor analyses evaluated the instrument's construct validity. We used HCPs' self-reported vaccine recommendations to patients, general immunization activity, self-vaccination, and future COVID-19 vaccine acceptance to test criterion validity. RESULTS: The final results indicated a 6-factor structure with good fit: vaccine confidence (combining complacency, perceived vaccine risks, perceived benefit-risk balance, perceived collective responsibility), trust in authorities, perceived constraints, proactive efficacy (combining commitment to vaccination and self-efficacy), reluctant trust, and openness to patients. The instrument showed good convergent and criterion validity and adequate discriminant validity. CONCLUSIONS: This study found that the Pro-VC-Be is a valid instrument for measuring psychosocial determinants of HCPs' vaccination behaviors in different settings. Its validation is currently underway in Europe among various HCPs in different languages.

Acceptance of childhood and adolescent vaccination against COVID-19 in France: a national cross-sectional study in May 2021.

The French health authorities extended vaccination against COVID-19 to adolescents in June 2021, during the epidemic resurgence linked to the delta variant and because of insufficient vaccination coverage to ensure collective protection. In May 2021, we conducted a national online cross-sectional survey of 2533 adults in France to study their attitudes toward COVID-19 vaccines and their acceptance of child/adolescent vaccination according to targeted age groups (<6 years; 6-11; 12-17) and its determinants. We applied a multi-model averaged logistic regression for each of these age groups to study the determinants of favorability to vaccination. Among the respondents, 62.7% (1597) accepted COVID-19 vaccination for adolescents, 48.3% (1223) for children aged 6-11 years, and only 31% (783) for children under 6 years. Acceptance increased with fear of contracting COVID-19 and trust in institutions and decreased as the COVID-19 vaccine risk perception score increased. People favorable to vaccination in general and those sensitive to social pressure were also more often favorable to vaccinating children/adolescents than those who were not. Drivers of acceptance were ranked differently for the different age groups. Understanding these differences is essential to anticipating obstacles to vaccination of these age groups and designing appropriate information and motivational strategies to support it.

Public opinion on a mandatory COVID-19 vaccination policy in France: a cross-sectional survey.

OBJECTIVES: Reaching the last pockets of unvaccinated people is challenging, and has led to the consideration of mandatory vaccination for coronavirus disease 2019 (COVID-19). Our aim was to assess attitudes toward mandatory COVID-19 vaccination in France before the announcement of-and factors associated with opposition to-this type of policy. METHODS: Between the 10th and 23rd May 2021, we conducted a cross-sectional online survey among a representative sample of the French population aged 18 and over, and a specific sample of the French senior population aged over 65. RESULTS: Among 3056 respondents, 1314 (43.0%) were in favour of mandatory COVID-19 vaccination, 1281 (41.9%) were opposed to such a policy, and 461 (15.1%) were undecided. Among opponents to mandatory COVID-19 vaccination for the general population, 385 (30.05%) were in favour of mandatory COVID-19 vaccination for healthcare workers (HCWs). In multivariate analysis, the age groups 18-24 and 25-34 years were significantly more opposed than the reference group (>75 years old) with respective adjusted odds ratio (aOR) and 95% confidence interval (95%CI) 4.67 (1.73-12.61) and 3.74 (1.57-8.93). Having no intention of getting COVID-19 vaccination was strongly associated with opposition to mandatory vaccination (aOR 10.67, 95%CI 6.41-17.76). In comparison with partisans of the centre, partisans of the far left and green parties were more likely to be opposed to mandatory COVID-19 vaccine, with respective aORs (95%CI) of 1.89 (1.06-3.38) and 2.08 (1.14-3.81). CONCLUSION: Attitudes toward mandatory COVID-19 vaccination are split in the French general population, and the debate might become politicized.

French General Practitioners Frequently See Patients with Long-COVID.

A second epidemic has appeared among some patients infected with COVID-19 persistent disorders, commonly called "long COVID syndrome." Our study sought to identify the proportion of French GPs dealing with patients with potential long COVID syndrome and their symptoms in an online cross-sectional questionnaire-based survey among a representative national panel of GPs. The majority (53.8%) reported at least 1 patient with COVID-19 and persistent symptoms, and 33% 2 or more such patients. Their most frequent symptoms were respiratory difficulties (60.6%), psychological distress (42.8%), and anosmia-dysgeusia (40.8%). Long COVID syndrome's recognition, management, and rehabilitation are priorities requiring effective coordination between primary and secondary care.

Intention to get vaccinated against COVID-19 among the general population in France: Associated factors and gender disparities.

As the coronavirus disease 2019 (COVID-19) spreads across the world, the rapid distribution of an effective vaccine and its acceptability among the population constitute priorities for health authorities. This study aimed to document attitudes of the general population toward a future vaccine against COVID-19. We used the national COCONEL surveys conducted during the lockdown to identify factors associated with vaccine refusal, in the whole population, and separately among men and women. We investigate the role of socioeconomic and demographic factors as well as exposure to COVID-19. Among the 5,018 participants, 24.0% reported their intention to refuse the vaccine. Thinking this vaccine would not be safe, being against vaccination in general, and perceiving COVID-19 to be harmless were the three main reasons given to explain vaccine refusal. Women were more likely to refuse the vaccine, especially due to a reluctance toward vaccination in general or the perception that a COVID-19 vaccine would not be safe. Some factors associated with the intention to refuse the vaccine were the same among men and women such as a lack of prior vaccination against influenza, and concern over being infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), while others differed slightly according to gender such as age, and high prevalence of COVID-19 in their region of residence. Authorities should therefore guarantee that all the necessary precautions are taken before marketing the vaccine and communicate transparently on the process of its development, and on the coverage rate required to reach herd immunity.Abbreviation: EHI: Equivalized Household Income per month; SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2.

Changes in general practitioners' attitudes toward COVID-19 vaccination after first interim results: a longitudinal approach in France.

We assessed whether the a priori acceptance by French general practitioners (GPs) of COVID-19 vaccines changed after the announcements about them in November 2020. In all, between two surveys in October-November and in November-December 2020, acceptance of COVID-19 vaccines increased among 16.9% of GPs and decreased among 23.0%. Among those with high acceptance in October-November (52.5%), 11.6% became hesitant-reluctant in November-December; in those with initial hesitancy-reluctance (24.6%), 15.2% showed high acceptance. Deteriorating acceptance was significantly associated with GPs' distrust in the Ministry of Health and a priori concerns about the safety of vaccines developed during an epidemic; the reverse was found for improving acceptance. In addition, better acceptance was more likely among GPs who perceived the medical severity of COVID-19 to be high and was less common among women. During a severe pandemic, GPs' trust in health institutions and perception of safety issues remain important predictors of their attitudes toward new vaccines. Vigilance is needed regarding health professionals' reactions to events that may cast doubt on the safety or efficacy of certain COVID-19 vaccines. Personalized approaches should be considered and tested to address their concerns as the situation and knowledge evolve.

Online study of health professionals about their vaccination attitudes and behavior in the COVID-19 era: addressing participation bias.

Online surveys of health professionals have become increasingly popular during the COVID-19 crisis because of their ease, speed of implementation, and low cost. This article leverages an online survey of general practitioners' (GPs') attitudes toward the soon-to-be-available COVID-19 vaccines, implemented in October-November 2020 (before the COVID-19 vaccines were authorized in France), to study the evolution of the distribution of their demographic and professional characteristics and opinions about these vaccines, as the survey fieldwork progressed, as reminders were sent out to encourage them to participate. Focusing on the analysis of the potential determinants of COVID-19 vaccine acceptance, we also tested if factors related to survey participation biased the association estimates. Our results show that online surveys of health professionals may be subject to significant selection bias that can have a significant impact on estimates of the prevalence of some of these professionals' behavioral, opinion, or attitude variables. Our results also highlight the effectiveness of reminder strategies in reaching hard-to-reach professionals and reducing these biases. Finally, they indicate that weighting for nonparticipation remains indispensable and that methods exist for testing (and correcting) selection biases.

Psychological support in general population during the COVID-19 lockdown in France: Needs and access.

INTRODUCTION: With France one of the European countries most strongly affected by COVID-19 in the spring of 2020, French authorities imposed a nationwide lockdown for 8 weeks (March 17-May 10). This study explored the perception of the adult population about the need for-and access to-psychological support from health care professionals (HCP) in response to concerns about the psychological needs during lockdown. MATERIAL AND METHOD: This online cross-sectional survey of a representative sample of the adult general population of mainland France (N = 2,003) took place during the last four days of the French lockdown (May 7-10, 2020). RESULTS: One in eight respondents (12.2%) perceived a need for psychological support from an HCP during the lockdown; most had symptoms of depression and/or anxiety of at least moderate intensity. Only a third (29.8%, 3.6% of the entire sample) actually obtained this support. Factors associated with this perceived need included: age under 35, economic difficulties due to lockdown, pre-lockdown use of psychological support, infection with COVID-19, serious worries about becoming infected, and heavy media use to obtain information about the disease. Among those who perceived a need for psychological support, the elderly were the most likely not to consult an HCP. People aged 35-64, those with high income, and those seriously worried about developing COVID-19 were the most likely to forgo seeking access to care because of their fear of infection by the coronavirus-2019. CONCLUSION: The perceived need for psychological support from an HCP and access to it appeared to be strongly associated with COVID-19 exposure factor. More research about this association is needed to improve the health authorities' understanding of the population's psychological needs in this situation and to enhance HCPs' abilities to meet them. In particular, further research of its specific impact on youth is necessary.

La crise sanitaire du Covid-19 et le confinement sont associés à un taux élevé de troubles du sommeil et de prise d’hypnotiques en France

Objectif La crise de la COVID-19 a perturbé les habitudes de milliards de personnes dans le monde. Pour de nombreux pays, le confinement à la maison est obligatoire et les familles sont forcées de vivre ensemble en permanence, dans des environnements souvent petits, avec leurs propres habitudes de sommeil et de veille. Le sommeil est essentiel pour nos vies et crucial pour équilibrer leur système immunitaire, la santé physique et psychologique. Méthodes Pour évaluer les problèmes de sommeil et l’utilisation des somnifères, nous avons réalisé une étude transversale d’un échantillon représentatif de la population générale en France (1005 sujets). Nous avons utilisé les mêmes éléments autodéclarés de plaintes de sommeil au cours des 8 derniers jours, tirés de l’échelle du Duke Health Profile, que ceux utilisés depuis 1995 dans les Baromètres de la santé français, une série d’enquêtes transversales sur diverses questions de santé publique. Résultats Après deux semaines de confinement, 74 % des participants ont signalé des plaintes de sommeil, comparativement à des taux de prévalence de 44 % à 49 % au cours des 25 dernières années. Les femmes ont déclaré plus de problèmes de sommeil que les hommes : 31 % contre 16 %. Les jeunes (18-35 ans) plus fréquemment que leurs aînés (79 % contre 72 % des 35 ans et plus) : 60 % ont déclaré que ces problèmes augmentaient avec le confinement, contre 51 % de leurs aînés. Enfin, 16 % des participants ont déclaré avoir pris des somnifères au cours des 12 derniers mois et 41 % d’entre eux ont déclaré avoir consommé ces médicaments depuis le début du confinement. Conclusion Ces résultats suggèrent que la crise de la COVID-19 est associée à de graves troubles du sommeil au sein de la population française, en particulier chez les jeunes.