Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 19 de 19
Filter
3.
J Hosp Infect ; 108: 168-173, 2021 Feb.
Article in English | MEDLINE | ID: mdl-33259883

ABSTRACT

BACKGROUND: Healthcare workers (HCWs) are at the frontline of the COVID-19 pandemic and identified as a priority target group for COVID-19 vaccines. We aimed to determine COVID-19 vaccine acceptance rate in HCWs in France. METHODS: We conducted an anonymous survey from 26th March to 2nd July 2020. The primary endpoint was the intention to get vaccinated against COVID-19 if a vaccine was available. RESULTS: Two-thousand and forty-seven HCWs answered the survey; women accounted for 74% of respondents. Among respondents, 1.554 (76.9%, 95% confidence interval 75.1-78.9) would accept a COVID-19 vaccine. Older age, male gender, fear about COVID-19, individual perceived risk and flu vaccination during previous season were associated with hypothetical COVID-19 vaccine acceptance. Nurses and assistant nurses were less prone to accept vaccination against COVID-19 than physicians. Vaccine hesitancy was associated with a decrease in COVID-19 vaccine acceptance. Flu vaccine rate was 57.3% during the previous season, and 54.6% of the respondents had the intention to get a flu vaccine during the next season. CONCLUSIONS: Intention to get vaccinated against COVID-19 reached 75% in HCWs with discrepancies between occupational categories. COVID-19 pandemic had no positive effect on flu vaccine acceptance rate.


Subject(s)
COVID-19 Vaccines/supply & distribution , COVID-19/prevention & control , Health Personnel/psychology , Patient Acceptance of Health Care/psychology , Vaccination/statistics & numerical data , Adult , Aged , Attitude of Health Personnel , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , Cross-Sectional Studies , Female , France/epidemiology , Health Personnel/statistics & numerical data , Humans , Influenza Vaccines , Intention , Male , Middle Aged , Nurses/psychology , Nurses/statistics & numerical data , Physicians/psychology , Physicians/statistics & numerical data , SARS-CoV-2/genetics , SARS-CoV-2/immunology , Surveys and Questionnaires
4.
Expert Rev Vaccines ; 19(4): 305-311, 2020 04.
Article in English | MEDLINE | ID: mdl-32163307

ABSTRACT

INTRODUCTION: Decision-making for patients and their families in the field of vaccination is difficult, involving many multidimensional factors. The complexity of this process is directly responsible for the phenomenon of vaccine hesitancy. Decision aids are instruments that provide information on a specific subject, explaining the advantages and disadvantages of a decision in a personalized way, thus clarifying the patient's values. AREAS COVERED: A systematic review using PRISMA guidelines was conducted to carry out an inventory of decision aids in the field of vaccination and assess their impact on vaccine coverage and decisional conflict. EXPERT OPINION: Decision aids reduce decision-making conflict and could be good tools to address the phenomenon of vaccine hesitancy. It seems essential to integrate health professionals and patients into the design of future decision aids. This would simplify the use of these tools during the consultation. However, their effect on vaccine coverage remains uncertain. Further studies seem necessary in order to conclude that vaccination coverage is effective.


Subject(s)
Decision Support Techniques , Vaccination Refusal/psychology , Vaccination/psychology , Decision Making , Humans , Patient Participation , Vaccination Coverage , Vaccines/administration & dosage
5.
Rev Epidemiol Sante Publique ; 68(1): 25-31, 2020 Feb.
Article in English | MEDLINE | ID: mdl-31718831

ABSTRACT

BACKGROUND: Vaccine hesitancy is a major issue in general practice. Regarding human papillomavirus, less than 20% of young French girls are vaccinated. With widespread availability of health information, the Internet seems to be a place of choice to discuss this reluctance. The main objective of this study was to explore perceptions of human papillomavirus vaccination through an analysis of the Doctissimo.fr forum data. METHODS: Using Nvivo software, a qualitative study was carried out from October 2017 to May 2018 on the Doctissimo.fr discussion forum. Online discussion threads not having any message since 2010 were excluded. All threads were analyzed by two independent evaluators. RESULTS: Faced with the doubt that emanated from the discussions and the confusion about the role of the vaccine, Internet users used multiple references in order to develop a reliable discourse. The general practitioner remained a trusted person. While the vaccine was perceived as risky, the cervical smear was approved and encouraged. Although the vaccine remained a feminine concern, males also entered this debate. Through their shared experiences, Internet users tried to influence others about whether or not to get vaccinated. CONCLUSION: Changing the sexual image of the vaccine could help to establish a collective vaccination policy. Public health policies play an essential role by working with general practitioners and by increasing visibility on the web. The usefulness of the vaccine in 2019 seems to be questioned by Internet users as shown by their major approval of cervical smears. However, these two methods remain complementary in the fight against cervical cancer.


Subject(s)
Health Knowledge, Attitudes, Practice , Papillomaviridae/immunology , Papillomavirus Infections/prevention & control , Papillomavirus Vaccines/therapeutic use , Patient Acceptance of Health Care/statistics & numerical data , Vaccination , Adolescent , Adult , Congresses as Topic/organization & administration , Congresses as Topic/statistics & numerical data , Databases, Factual/statistics & numerical data , Female , France/epidemiology , Health Policy , Health Promotion/organization & administration , Health Promotion/standards , Humans , Information Seeking Behavior , Internet/organization & administration , Internet/statistics & numerical data , Male , Public Health/standards , Qualitative Research , Social Media/organization & administration , Social Media/standards , Uterine Cervical Neoplasms/prevention & control , Vaccination/methods , Vaccination/psychology , Vaccination/statistics & numerical data , Young Adult
11.
J Mal Vasc ; 41(1): 12-7, 2016 Feb.
Article in French | MEDLINE | ID: mdl-26631922

ABSTRACT

CONTEXT: For a long time, superficial venous thrombosis (SVT) of the lower limbs was considered as benign. Due to lack of clear scientific evidence, its treatment was heterogeneous and even potentially deleterious. Since 2010, several major studies have highlighted the seriousness of SVT, and prophylactic doses of fondaparinux have proven their efficacy for this indication. While the French recommendations have not yet taken on board all this data, has practice already changed? AIM: To describe in general practice the usual management of suspected SVT. METHODS: A descriptive cross-sectional study of general practitioners in Saône-et-Loire. Each doctor taking part was asked to note on a paper questionnaire the details of the last patient in whom they suspected SVT. Data collected included: clinical presentation, diagnostic and therapeutic management and follow-up of the patients. RESULTS: Between 01/01/2014 and 31/03/2014, 88 doctors out of 443 contacted (20%) completed the questionnaire. According to the information they provided, 36 physicians (40.9% [95% CI: 30.6-50.2]) searched for an associated pulmonary embolism. Eighty-two physicians (93.2% [95% CI: 87.9-98.4]) prescribed a venous compression ultrasound (CUS) exploration. Twelve etiological assessments were carried out (13.6% [95% CI: 6.5-20.8]) of which 6 (6.8%) appeared to be justified. 64 (72.7%) of the patients were given an anticoagulant therapy (heparin or fondaparinux), including 15 (17%) at a prophylactic dose and 49 (55.7%) at a curative dose. Forty-nine doctors (55.7% [95% CI: 45.3-66.1]) prescribed a CUS follow-up. CONCLUSION: General practitioners seem to have adapted their diagnostic practices to the data highlighting the potential seriousness of SVT. The treatment they give, however, remains very variable and potentially deleterious, in particular due to a high rate of treatments given at curative doses.


Subject(s)
Anticoagulants/therapeutic use , General Practitioners/statistics & numerical data , Heparin/therapeutic use , Leg/blood supply , Polysaccharides/therapeutic use , Practice Patterns, Physicians'/statistics & numerical data , Venous Thrombosis/drug therapy , Anti-Inflammatory Agents/therapeutic use , Cross-Sectional Studies , Fibrin Fibrinogen Degradation Products/analysis , Fondaparinux , France/epidemiology , General Practitioners/psychology , Health Care Surveys , Humans , Platelet Aggregation Inhibitors/therapeutic use , Pulmonary Embolism/complications , Pulmonary Embolism/diagnosis , Risk Factors , Stockings, Compression , Surveys and Questionnaires , Ultrasonography, Doppler/statistics & numerical data , Venous Thrombosis/complications , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/epidemiology
12.
J Thromb Haemost ; 13 Suppl 1: S230-7, 2015 Jun.
Article in English | MEDLINE | ID: mdl-26149029

ABSTRACT

Spontaneous acute superficial vein thrombosis (SVT) of the leg is now generally recognized as an integral component of venous thromboembolic disease with potentially severe consequences. However, the relatively low grades of some current international recommendations and uncertainty regarding the cost-effectiveness of available therapies may prompt questioning of the real need to treat patients with SVT and explain the persisting heterogeneity of their management in practise. Yet several studies have consistently shown high rates of thromboembolic complications associated with SVT, whether at first presentation or during follow-up. The CALISTO trial established for the first time the clinical benefit of a well-defined anticoagulant regimen for the prevention of serious thromboembolic complications in SVT patients, and we believe that patients such as those included in this trial should receive this regimen as tested. However, several areas of uncertainty remain for categories of SVT patients not evaluated in CALISTO.


Subject(s)
Anticoagulants/therapeutic use , Lower Extremity/blood supply , Venous Thromboembolism/prevention & control , Venous Thrombosis/drug therapy , Acute Disease , Humans , Patient Selection , Risk Assessment , Risk Factors , Treatment Outcome , Venous Thromboembolism/blood , Venous Thromboembolism/diagnosis , Venous Thrombosis/blood , Venous Thrombosis/diagnosis
13.
J Thromb Haemost ; 12(6): 831-8, 2014 Jun.
Article in English | MEDLINE | ID: mdl-24679145

ABSTRACT

BACKGROUND: The incidence of superficial vein thrombosis (SVT) in the general adult population remains unknown. OBJECTIVES: To assess the annual diagnosis rate of symptomatic, objectively confirmed lower limb SVT, associated or not with concomitant deep vein thrombosis and/or symptomatic pulmonary embolism. METHODS/PATIENTS: We conducted, from November 14, 2011, to November 13, 2012, a multicenter, community-based study in the Saint-Etienne urban area, France, representing a population of 265 687 adult residents (according to the 2009 census). All 248 general practitioners located within the area were asked to refer any patient with clinically suspected lower limb acute SVT to a vascular physician for systematic compression ultrasonography. All 28 vascular physicians located within the area participated in the study. The annual diagnosis rate, with the corresponding 95% confidence interval (CI), was calculated as the number of patients with symptomatic, objectively confirmed SVT divided by the number of person-years at risk defined by population data of the area. All venous thromboembolic events were validated by an independent central adjudication committee. RESULTS: Overall, 171 patients with symptomatic, confirmed SVT were reported. The annual diagnosis rate was 0.64& (95% CI, 0.55%-0.74&), was higher in women, and increased with advancing age regardless of gender [corrected]. Concomitant deep vein thrombosis (20 proximal) was observed in 42 patients (24.6% [95% CI, 18.3%-31.7%]), and concomitant symptomatic pulmonary embolism was observed in eight patients (4.7% [95% CI, 2.0%-9.0%]). CONCLUSIONS: This first community-based study showed that symptomatic SVT with confirmed diagnosis is a relatively common disease frequently associated with thromboembolic events in the deep venous system.


Subject(s)
Lower Extremity/blood supply , Pulmonary Embolism/diagnosis , Pulmonary Embolism/epidemiology , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/epidemiology , Adolescent , Adult , Aged , Female , France/epidemiology , Humans , Male , Middle Aged , Predictive Value of Tests , Risk Factors , Time Factors , Ultrasonography , Young Adult
15.
Ann Oncol ; 24(3): 586-97, 2013 Mar.
Article in English | MEDLINE | ID: mdl-23136229

ABSTRACT

BACKGROUND: Despite advances in cancer therapy, mortality is still high except in early-stage tumors, and screening remains a challenge. The randomized National Lung Screening Trial (NLST), comparing annual low-dose computed tomography (LDCT) and chest X-rays, revealed a 20% decrease in lung-cancer-specific mortality. These results raised numerous questions. The French intergroup for thoracic oncology and the French-speaking oncology group convened an expert group to provide a coherent outlook on screening modalities in France. METHODS: A literature review was carried out and transmitted to the expert group, which was divided into three workshops to tackle specific questions, with responses presented in a plenary session. A writing committee drafted this article. RESULTS: The multidisciplinary group favored individual screening in France, when carried out as outlined in this article and after informing subjects of the benefits and risks. The target population involves subjects aged 55-74 years, who are smokers or have a 30 pack-year smoking history. Subjects should be informed about the benefits of quitting. Screening should involve LDCT scanning with specific modalities. Criteria for CT positivity and management algorithms for positive examinations are given. CONCLUSIONS: Individual screening requires rigorous assessment and precise research in order to potentially develop a lung-cancer screening policy.


Subject(s)
Early Detection of Cancer , Lung Neoplasms/diagnostic imaging , Aged , Consensus Development Conferences as Topic , France , Humans , Lung Neoplasms/therapy , Middle Aged , Radiography, Thoracic , Randomized Controlled Trials as Topic , Smoking , Tomography, X-Ray Computed
17.
Rev Pneumol Clin ; 68(3): 171-9, 2012 Jun.
Article in French | MEDLINE | ID: mdl-22014768

ABSTRACT

Chronic cough represents a persistent dilemma, for general practitioner (GP), inducing a lot of medical investigations. Few data are available about French GP practice and their expectancy from cough specialists. We studied management in primary care and impressions of GP of patients with chronic cough. Thirty-four patients were studied. They were mostly women, mean age was above 50 years-old, and the waste majority of patients were non-smokers. Halftime, the symptom was persistent (more than 6 months), had promoted numerous medical consultations (more than five). Drugs were prescribed since the first visit for the majority of patients, principally cough-sedation drugs, steroids and bronchodilatators. A chest radiography was realized in almost all patients. Advices were asked (with a decreasing frequency) to physicians specialized in: ear-nose-throat or respiratory, gastroenterology, allergy, or cardiology. The majority of patients were satisfied of their GP, despite persistent symptoms. From the point of the GP, chronic cough remains a relentless dilemma. Their main purpose, when they addressed their patient to a specialized physician, was to obtain an etiologic diagnosis. When they were asked "which tool will be more adequate for you in the next future?", the preferred response was "a simple etiologic algorithm". Despite persistent symptoms, inducing furthers medical consultations, the main ask from GP was to promote a simple etiologic algorithm.


Subject(s)
Algorithms , Cough/etiology , Cough/therapy , Adult , Aged , Aged, 80 and over , Chronic Disease , Disease Management , Female , France , General Practitioners , Humans , Male , Middle Aged , Physician-Patient Relations , Primary Health Care , Referral and Consultation , Young Adult
18.
Cephalalgia ; 31(11): 1189-98, 2011 Aug.
Article in English | MEDLINE | ID: mdl-21700646

ABSTRACT

BACKGROUND: Medication-overuse headache (MOH) management usually includes a medication withdrawal. The choice of withdrawal modalities remains a matter of debate. METHODS: We compared the efficacy of in-patient versus out-patient withdrawal programmes in 82 consecutive patients with MOH in an open-label prospective randomized trial. The main outcome measure was the reduction in number of headache days after 2 months and after 2 years. The responders were defined as patients who had reverted to episodic headaches and to an intake of acute treatments for headache less than 10 days per month. RESULTS: Seventy-one patients had a complete drug withdrawal (n = 36 in the out-patient group; n = 35 in the in-patient group). The reduction of headache frequency and subjective improvement did not differ between groups. The long-term responder rate was similar in the out- and in- patient groups (44% and 44%; p = 0.810). The only predictive factor of a bad outcome 2 years after withdrawal was an initial consumption of more than 150 units of acute treatments for headache per month (OR = 3.1; 95% confidence interval 1.1-9.3; p = 0.044). CONCLUSION: Given that we did not observe any difference in efficacy between the in- and out-patient withdrawals, we would recommend out-patient withdrawal in the first instance for patients with uncomplicated MOH.


Subject(s)
Headache Disorders/chemically induced , Headache Disorders/rehabilitation , Rehabilitation/methods , Substance Withdrawal Syndrome/epidemiology , Adult , Aged , Analgesics/adverse effects , Female , Humans , Inpatients , Male , Middle Aged , Outpatients , Young Adult
19.
Med Mal Infect ; 41(8): 424-9, 2011 Aug.
Article in French | MEDLINE | ID: mdl-21429681

ABSTRACT

OBJECTIVES: The study objectives were to assess how GPs manage the risk of tetanus in wounds, compared to the French Health Ministry guidelines on tetanus toxoid vaccination and immunoglobulin injections. DESIGN: A cross-sectional survey was made using an online questionnaire sent to 3,165 GPs in the French Rhône-Alpes region. RESULTS: The answer rate was 9.1%. Overall, 64.4% of GP complied to recommendations. The best observance was noted for minor risk wounds and for patients whose last booster vaccination was less than 5years old (P<0.05). Generally, GPs underused tetanus toxoid vaccination (-17.1%) and overused immunoglobulin injections (+37.1%). The main difficulties encountered were assessing the patient and his wound, misuse of immunoglobulin injections, and ignorance of recommendations. CONCLUSIONS: The higher the tetanic risk, the less recommendations were observed. A quick diagnostic test and a better availability of new easier to memorize recommendations should help GPs optimize their practices.


Subject(s)
Family Practice , Practice Patterns, Physicians' , Tetanus/therapy , Wound Infection/therapy , Adult , Aged , Cross-Sectional Studies , Female , Guideline Adherence , Humans , Male , Middle Aged , Risk Management , Surveys and Questionnaires
SELECTION OF CITATIONS
SEARCH DETAIL
...