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Hypersensitivity Pneumonitis (HP) is a common immune-mediated interstitial lung disease (ILD) induced by repeated exposure to environmental antigens in susceptible individuals. The most commonly known forms are bird fancier's disease and farmer's lung. However, the antigens involved are widely diverse. Therefore, the list of causes of HP is frequently expanding. HP seems to be under-diagnosed owing to its highly heterogeneous presentation in both the non-fibrotic and fibrotic subtypes and could represent up to 15% of all ILDs encountered in clinical practice. However, the recognition of HP cases is essential to ensure appropriate therapy for the patient. Home health care workers' intervention is sometimes critical in this context. In case of confirmed exposure, the diagnosis could be considered with high confidence if the high-resolution computed tomography (HR-CT) shows a typical HP pattern associated with a lymphocytosis over 30% in the broncho-alveolar lavage (BAL). In all other situations, the patients should undergo further investigations and additional histopathological sampling should be considered and submitted to a multidisciplinary team discussion. After diagnosis, antigenic eviction is the rule whenever possible. Corticosteroid treatment is the first-line medical treatment for severe forms and aims to prevent the development of fibrosis. Anti-fibrotic therapy is now an option for patients with progressive ILD and failure of immunomodulatory/immunosuppressive therapies.

Background First responders (FRs) are frequently exposed to potentially traumatic events, including terror attacks, and may consequently be at risk of developing mental health disorders. Prior research suggests that FRs with mental health disorders often do not receive appropriate treatment. More knowledge is needed about their use of mental health care (MHC). Aims This study aimed to identify factors associated with receiving immediate support, post-immediate support and engagement in MHC among FRs of the November 2015 terror attacks in Paris. Methods A web-based study was conducted 8–12 months after the attacks on 663 FRs who were mobilized during the night and/or the aftermath of the attacks. Logistic regression was performed to analyse factors associated with MHC. Results Overall, 44 FRs sought MHC. Among FRs with post-traumatic stress disorder (PTSD), partial PTSD or depression (n = 60), 38% sought MHC (n = 23). Post-immediate support was associated with immediate support, and both were associated with knowing someone who could help regarding the potential psychological risks following a traumatic event. MHC engagement was associated with a history of MHC, post-immediate support and the presence of PTSD, partial PTSD or depression. Conclusions Among FRs with PTSD, partial PTSD or depression, few sought MHC. Improved access to MHC for FRs after terror attacks is essential. Knowing someone who could help regarding potential psychological risks may facilitate immediate and/or post-immediate support. Furthermore, post-immediate support could encourage engagement in MHC. Efforts should be made before and after potentially traumatic events to ensure mental health education for FR.

Introduction Evacuation of infected fluid in pleural infections is essential. To date, the use of an intrapleural fibrinolytic agent such as urokinase and DNase has not yet been assessed in infections managed by repeated therapeutic thoracentesis (RTT). Methods We performed a retrospective comparative study of two successive cohorts of consecutive patients with pleural infections from 2001 to 2018. Between 2001 and 2010, patients had RTT with intrapleural urokinase (RTT-U). After 2011, patients received intrapleural urokinase and DNase with RTT (RTT-UD). Data were collected through a standardized questionnaire. Results One hundred and thirty-three patients were included: 93 were men and the mean age was 59 years (standard deviation 17.2). Eighty-one patients were treated with a combination of intrapleural urokinase and DNase, and 52 were treated with intrapleural urokinase only. In the RTT-UD, RTT failure occurred in 14 patients (17%) compared to 10 (19%) in the RTT-U group (P = 0.82). There was no difference between the two groups in intensive care unit admission, surgical referrals or in-hospital mortality. RTT-UD was associated with faster time to apyrexia (aOR = 0.51, 95%CI [0.37–0.72]), a reduced length of hospital stay (aOR = 0.61, 95%CI [0.52–0.73]) and a higher volume of total pleural fluid retrieved (aOR = 1.38, 95%CI [1.02–1.88]). Complications were rare with only one hemothorax in the RTT-UD group and no pneumothorax requiring drainage in either group. Conclusion Compared to urokinase only, intrapleural use of urokinase and DNase in RTT was associated with quicker defervescence, shorter hospital stay and increased volumes of pleural fluid drained. Randomized controlled trials evaluating urokinase and DNase with RTT technique would be required to confirm these results.

Background HIV, HBV and HCV infections continue to represent major health concerns, especially among key at-risk populations such as men who have sex with men (MSM), people who inject drugs (PWIDs), transgender women (TGW) and sex workers (SW). The objective of the ANRS-CUBE study was to evaluate the acceptability of a healthcare, community-based strategy offering a triple rapid HIV-HBV-HCV testing, and HBV vaccination, targeted at three priority groups (MSM, PWIDs and TGW/SWs), in three community centers, in the Paris area. Methods This longitudinal multicentric non-randomized study included all adult volunteers attending one of the three specialized community centers in Paris, between July 2014 and December 2015. HIV, HBV and HCV status and acceptability of HBV vaccination were evaluated. Results A total of 3662, MSM, 80 PWIDs and 72 TGW/SW were recruited in the three centers respectively. Acceptability of rapid tests was 98.5% in MSM and 14.9% in TGW/SWs, but could not be estimated in PWIDs since the number of users attending and the number of proposals were not recorded. User acceptability of HBV vaccination was weak, only 17.9% of the eligible MSM (neither vaccinated, nor infected) agreed to receive the first dose, 12.2% two doses, 5.9% had a complete vaccination. User acceptability of HBV vaccination was greater in PWIDs and TGW/SWs, but decreased for the last doses (66.7 and 53.3% respectively received a first dose, 24.4 and 26.7% a second dose and 6.7 and 0% a third dose). Fifty-three participants (49 MSM and 4 PWIDs) were discovered HIV positive, more than half with a recent infection. All but two HIV positive participants were linked to appropriate care in less than one month. Conclusions Rapid HIV-HCV-HBV screening showed a very high level of acceptability among MSM. Efforts need to be made to improve immediate acceptability for HBV vaccination, especially among MSM, and follow-up doses compliance. Our results show the important role of community centers in reaching targets, often fragile, populations, while also suggesting the need to reinforce on-site human support in terms of testing and vaccination, especially when addressing PWIDs.

International audience; IntroductionThis study aimed to develop and undertake a preliminary validation of a French Survey Questionnaire for the Determinants of HPV Vaccine Hesitancy (FSQD-HPVH).MethodsWe undertook an electronic-based Delphi consultation among a panel of Francophone experts in two rounds. Round 1 consisted of the assessment of a structured questionnaire comprising of three parts ((i) Contextual influences, (ii) Individual and group influences, and (iii) Vaccine/vaccination-specific issues), in line with the WHO Strategic Advisory Group of Experts (SAGE) Vaccine Hesitancy (VH) Model of Determinants. Items included in this questionnaire were based on a literature review. Definitions of the factors included in the SAGE model were provided in the questionnaire. The panel of experts was asked to score each item using a 3-point Likert scale, in which 1 meant “Essential”, 2 “Useful but not essential”, and 3 “Not necessary”. The panel was also invited to comment on the clarity/comprehension of the questions and suggest reformulations/additional items. Lawshe's Content Validity Ratio (CVR) was computed to assess the level of consensus for each statement. Only items upon which agreement was not reached in Round 1 (CVR < 0.6) and newly proposed items were submitted for evaluation in Round 2, using the same procedure.ResultsFifteen experts completed the two rounds. Of 83 items evaluated in Round 1, 35 (42%) had a CVR ≥ 0.6 and were accepted without modification. In Round 2, 66 items were submitted to the same panel and consensus was reached for 22 (33%) items using the threshold of 0.6. The final FSQD-HPVH version includes 57 items.ConclusionThis study developed a survey instrument for the evaluation of HPV VH in France with good content validity. It will be used to assess the determinants of HPV VH, the first step towards an evidence-based approach to improving HPV vaccination rates in France.

Objectives To investigate the relationship between patterns of gynaecological check-up and body mass index while accounting for various determinants of health care use. Methods Sequence analysis and clustering were used to highlight patterns of gynaecological check-up, which included the regularity of breast and cervical cancer screening and visits to the gynaecologist over four years, among 6182 women aged 54–65 included in the CONSTANCES cohort between 2013 and 2015 in France. Multinomial logistic regressions were used to study the association between these patterns and women’s body mass index. Results We identified four patterns of gynaecological check-up, from (A) no or inappropriate check-up (20%) to (D) almost one visit to the gynaecologist every year, overscreening for cervical cancer and frequent use of opportunistic breast cancer screening (12%). From patterns A to D, the proportion of obese women decreased and that of women with normal body mass index increased. Obese and overweight women underwent more breast than cervical cancer screening and were less often overscreened than normal weight women. These differences were only partly explained by the lower socioeconomic situation of overweight and obese women. Beyond the financial barrier, the screening modality and the type of exam may play a role. Among women who were screened for cervical cancer, obese and overweight women were less often screened by a gynaecologist. Conclusion Further efforts should be made to enhance the take-up of screening among obese women who are deterred by the healthcare system.

Background Non-participation and attrition are rarely studied despite being important methodological issues when performing post-disaster studies. A longitudinal survey of civilians exposed to the January 2015 terrorist attacks in Paris, France, was conducted 6 (Wave 1) and 18 months (Wave 2) after the attacks. We described non-participation in Wave 1 and determined the factors associated with attrition in Wave 2. Methods Multivariate logistic regression models were used to compare participants in both waves with those who participated in the first wave only. Analyses were performed taking the following factors into account: socio-demographic characteristics, exposure to terror, peri-traumatic reactions, psychological support, perceived social support, impact on work, social and family life, and mental health disorders. Characteristics of new participants in Wave 2 were compared with participants in both waves using a chi-square test. Results Of the 390 persons who were eligible to participate in the survey, 190 participated in Wave 1 (participation rate: 49%). The most frequently reported reason for non-participation was to avoid being reminded of the painful event (32%, n = 34/105). In Wave 2, 67 were lost to follow-up, 141 people participated, of whom 123 participated in Wave 1 (re-participation rate: 65%) and 18 were new. Attrition in Wave 2 was associated with socio-demographic characteristics (age, French origin) and location during the attacks, but not with terror exposure or mental health disorders. Compared with those who participated in both waves, new participants declared less social and psychological support since the attacks. Conclusions Attrition at 6 months was not associated with exposure to terror or mental health disorders, which indicates that any bias in future analyses on IMPACTS on mental health outcomes will be limited. Our findings suggest the importance of adapting similar surveys for people of foreign origin and of improving strategies to avoid attrition of younger people, for example by using social media, peers, and the educational environment. The present study also revealed that a high level of exposure to terror and a lack of social and psychological support after a terrorist event could impede individuals’ participation in similar surveys in the short term.

Between 1 and 2% of people aged 50 years and over living at home in France are likely to experience a fragility fracture each year. Three-quarters of these individuals are not diagnosed with osteoporosis and lose the opportunity for appropriate care. To estimate the incidence of fragility fractures in France and to describe the characteristics of individuals with such fractures and of their fractures. In April–May 2018, a postal survey was performed in France targeting a representative panel of 15,000 individuals aged ≥ 50 years, who were invited to complete a questionnaire. If they reported experiencing a fracture in the previous 3 years, they were asked to provide information on demographics, fracture type, risk factors for fractures and osteoporosis diagnosis. Only fragility fractures were considered, and these were classified as major (associated with increased mortality) or minor, based on the fracture site. Around 13,914 panellists returned an exploitable questionnaire (92.8%). About 425 participants reported ≥ 1 fragility fracture (453 fractures), corresponding to a 12-month incidence rate of 1.4% [95%CI: 1.2, 1.6]. Incidence was higher in women (1.99% [1.87, 2.05]) than in men (0.69% [0.38, 0.86]) and increased with age. Around 157 fractures (34.6%) were classified as major. Participants reporting major fractures were older than those reporting minor fractures (mean age: 72.6 ± 11.3 vs 67.1 ± 10.6) and more likely to report previous corticosteroid use (odds ratio: 1.90 [95%CI: 1.13, 3.18]). No other patient characteristic was associated with fracture severity. About 117 participants with fractures (27.5%) had undergone bone densitometry, and 97 (22.8%) declared having received a diagnosis of osteoporosis. Around 340,000 people aged ≥ 50 years living at home in France are estimated to experience osteoporotic fractures each year. However, > 75% of panellists reporting fractures were never diagnosed with osteoporosis and thus did not have the opportunity to receive appropriate care.

International audience; During the evening of 13 November 2015, the deadliest terror attacks in France in recent times occurred in the Paris area. Overall, 130 people were killed, 643 were physically injured and several thousands were psychologically impacted. Thousands of first responders, including health professionals, firefighters, affiliated volunteers and police officers were mobilized that night and during the subsequent weeks. The aims of our study were to measure the psychological impact on first responders in terms of post-traumatic stress disorder (PTSD) and partial PTSD as well as associated factors 12 months after the 13 November 2015 terrorist attacks. First responders who had intervened during the night and/or the aftermath of the terror attacks had the possibility of answering a web-based study 8-12 months after the attacks. They satisfied criterion A of the DSM 5 definition of PTSD. PTSD and partial PTSD were measured using the PCL-5. Gender, age, educational level, exposure, first responder category, mental health and traumatic event history, training and social support were all analysed as potential factors associated with PTSD and partial PTSD, using multinomial logistic regression. Overall, 663 participants were included in this analysis. Prevalence of PTSD in our sample went from 3.4% among firefighters to 9.5% among police officers and prevalence of partial PTSD from 10.4% among health professionals to 23.2% among police officers. Low educational level and social isolation were associated with PTSD and partial PTSD. Intervention on unsecured crime scenes and lack of training were associated with PTSD. Special attention should be given to first responders living in social isolation, those with low educational levels and those who intervene in unsecured crime scenes. Education and training about the potential mental health consequences of mass trauma intervention should be developed.

International audience; Près de 10% des femmes enceintes françaises déclarent avoir ressenti un mal-être psychologique au cours de leur grossesse. Cette prévalence peut être doublée ou triplée parmi les femmes présentant des facteurs de vulnérabilité sociale. Parmi ces femmes, 81.3% n'ont pas consulté un professionnel de santé au cours de leur grossesse pour ces difficultés. Le projet Bien-être vise à améliorer le repérage précoce des vulnérabilités psychologiques ou sociales et le parcours de soin actuel des femmes enceintes vulnérables, et à évaluer l'intérêt de l'entretien prénatal précoce dans l'accompagnement de ces femmes. Nombre de mots: 115 2 The "Wellbeing" project: To better identify and support pregnant women with psychological or social vulnerabilities ABSTRACT Perinatality is one of the most critical periods in the life cycle. The health of the mother and children are strongly and permanently influenced by events occurred during pregnancy, delivery or the first ages of infancy. In psychological terms, nearly 10% of the women reported poor self-rated mental health during pregnancy. Moreover, socio-demographic characteristics indicative of social disadvantage are associated with a higher risk of poor self-rated mental health. Among them, 81.3% did not consult a healthcare professional for psychological problems. The well-being project aims at optimising pregnant women care with psychological or socioeconomic vulnerabilities on the one hand, and at assessing the early prenatal interview's interest on the other hand. Nombre de mots : 93

Background In this study, we aim to measure and compare the frequency of reported denial of care in sub-Saharan African migrants living in the Paris area, according to their HIV and HBV status and social and migration characteristics. Methods The ANRS-PARCOURS study is a life-event survey conducted in 2012-13 in healthcare facilities in the Paris area, among three groups of sub-Saharan migrants recruited in primary care centres (N = 760; reference group), in dedicated centres for HIV care (N = 922; HIV group) and in centres for chronic hepatitis B care (N = 777; CHB group). Characteristics associated with refusal of care since arrival in France were identified using a logistic regression model. Results Compared to the reference group (6%, P < 0.001), the reported refusal of care was twice as high in the HIV group (12%) and the CHB group (10%). In the multivariate analysis, men and women living with HIV were at greater risk of being denied care (aOR = 2.20[1.14-4.25] and 2.24[1.25-4.01]). Women covered by the specific health insurance (HI) for precarious or undocumented migrants were also at higher risk (aOR = 2.07[1.10-3.89] and 2.69[1.18-6.10], respectively). The risk was also increased in men who remained for at least one year without permit of residence or without HI and among those who were threatened in their country. Conclusion Refusals to provide healthcare are frequent and deleterious situations especially for migrants living with HIV. Health decision makers, public insurance bodies and health professional councils must address this issue to improve equity in the healthcare system.

BackgroundTerrorist attacks occurred in Paris in January 2015.AimsTo assess the mental health impact and the access to psychomedical care of people exposed to the attacks.MethodWe implemented an open-cohort design 6 and 18 months after the attacks. Exposed civilians and rescue workers were included according to the exposure criteria A for post-traumatic stress disorder (PTSD) in DSM-5. A face-to-face questionnaire conducted by trained psychologists was used to collect sociodemographic characteristics, exposure level, scores on psychometric scales, an international neuropsychiatric interview and access to care.ResultsSix months after the attacks, 18% of civilians reported symptoms of PTSD, 31% had anxiety disorders and 11% depression. Among rescue workers, 3% reported symptoms of PTSD and 14% anxiety disorders. During the 48 h following the attacks, 53.2% of civilian had access to psychomedical carev. 35% of rescue and police staff.ConclusionsWe found severe psychological consequences, even in people who were less exposed.Declaration of interestNone.

Internet is a popular source of information regarding vaccination. This study aimed to determine whether there is a negative association between Internet use among French vaccine-hesitant mothers and HPV vaccine uptake by their daughters, and to gain insight into the pathways that would link Internet use to the lack of HPV vaccine uptake. We conducted a pooled cross-sectional analysis across the 2015, 2016, 2017 and 2018 Vaccinoscopie® Survey. Multivariate logistic regression and path models were used in the analysis. The study sample included a total of 2038 respondent mothers. Of those, 89 (4.4%) declared having never been in the situation of searching for information regarding a vaccination they had hesitated about, leaving 1949 mothers for the present analysis. Approximately 24% (466/1949) of the mothers declared using the Internet as a source of vaccine information. In multivariate logistic regression adjusted for physician recommendation of HPV vaccination, attitudes towards vaccines in general, perception of HPV vaccine usefulness, maternal level of education, region of residence, and the survey year, the use of Internet by the mothers was significantly associated with a lower HPV vaccination among their daughters (adjusted odds ratio (aOR), 0.66; 95% confidence interval (CI), 0.47-0.91). Path analysis further confirmed the negative effect of Internet use (β = -0.10, standard error (SE) = 0.02, P 0.0001), highlighting how the Internet plays a detrimental role in HPV vaccine uptake through a lower perceived level of HPV vaccine usefulness, a lower perceived level of information on childhood vaccination, and unfavorable attitudes towards vaccination in general.

Little is known about the prevalence of cervical cancer screening (CCS) and its correlates among homeless women in France. The objectives of this study were to determine the prevalence of women who had never been screened for cervical cancer and to identify the associated factors. This cross-sectional study was based on data collected in the ENFAMS survey, which was conducted in 2013 among 764 sheltered homeless mothers in the Greater Paris Area. Robust Poisson regression models were used to estimate the association between no lifetime CCS and certain sociodemographic and health-related factors (selected from the behavioral model of vulnerable populations). Analyses were carried out separately for women with and without a regular gynaecological follow-up (RGF). The proportion of never-screeners was 33% among the women with an RGF versus 64% among those without an RGF (P

Objectives To describe the care trajectories of adults aged ≥ 50 years with fragility fractures in France. Methods A postal questionnaire was sent to 15,000 individuals aged ≥ 50 years extracted from a representative panel of the French population (METASKOPE) in April-May 2018. Respondents experiencing a single fragility fracture in the previous three years constituted the study population. Information was collected regarding diagnosis, hospitalisations, physician visits and treatment related to the fractures. Results 13,914 participants returned a questionnaire (92.8%), of whom 436 reported a single fragility fracture. Their mean age was 68.7 ± 10.3 years. 11.9% of this sample had undergone bone densitometry (DXA) prior to the fracture and 11.9% had received a diagnostic of osteoporosis. Following the fracture, a further 17.4% underwent DXA and 8.5% were diagnosed with osteoporosis. 74.3% of fractures were initially managed in an emergency department and 29.6% led to immediate hospitalisation. Prior to fracture, 3.4% received a specific anti-osteoporotic treatment, 10.1% vitamin D and 6.4% calcium supplementation. After the fracture, these figures rose to 10.8%, 26.8% and 19.0% respectively. 86.2% participants made at least one follow-up visit to a physician. Conclusions The rate of DXA screening following fragility fractures in subjects over fifty is very low. Most patients with fragility fractures did not receive a diagnosis of osteoporosis. The proportion of patients treated with a specific anti-osteoporotic treatment after a fracture is low even though around half consulted their general practitioner after the fracture. Practice guidelines are thus not being adhered to in everyday clinical practice in France.

Background Social and physical characteristics of the daily visited neighborhoods have gained an extensive interest in analyzing socio-territorial inequalities in health and healthcare. The objective of the present paper is to estimate and discuss the role of individual and contextual factors on participation in preventive health-care activities (smear screening) in the Greater Paris area focusing on the characteristics of daily visited neighborhoods in terms of medical densities and social deprivation. Methods The study included 1817 women involved in the SIRS survey carried out in 2010. Participants could report three neighborhoods they regularly visit (residence, work/study, and the next most regularly visited). Two “cumulative exposure scores” have been computed from household income and medical densities (general practitioners and gynecologists) in these neighborhoods. Multilevel logistic regression models were used to measure association between late cervical screening (> 3 years) and characteristics of daily visited neighborhoods (residential, work or study, visit). Results One-quarter of the women reported that they had not had a smear test in the previous 3 years. Late smear test was found to be more frequent among younger and older women, among women being single, foreigners and among women having a low-level of education and a limited activity space. After adjustment on individual characteristics, a significant association between the cumulative exposure scores and the risk of a delayed smear test was found: women who were exposed to low social deprivation and to low medical densities in the neighborhoods they daily visit had a significantly higher risk of late cervical cancer screening than their counterparts. Conclusions For a better understanding of social and territorial inequalities in healthcare, there is a need for considering multiple daily visited neighborhoods. Cumulative exposure scores may be an innovative approach for analyzing contextual effects of daily visited neighborhoods rather than focusing on the sole residential neighborhood.

International audience; PURPOSE:Despite their higher risk for and mortality from cervical cancer, evidence indicates low rates of cervical cancer screening (CCS) among women with obesity. The literature on the specific factors related to CCS nonadherence in this population is limited.METHODS:We examined the data on 2,934 women with obesity included in the CONSTANCES survey from 2012 to 2015. Using the Andersen's behavioral model, we studied the relationships between the socioeconomic, sociodemographic, health, health personal behaviors, and healthcare use-related factors with CCS nonadherence. The analysis was performed using structural equation models.RESULTS:Regular follow-up by a gynecologist, good quality of primary care follow-up, and comorbidities were negatively associated with CCS nonadherence. Limited literacy, older age, being single, living without children, and financial strain were positively associated with CCS nonadherence. Our results do not point to competitive care, since women with comorbidities had better CCS behaviors, which were explained by a good quality of primary care follow-up.CONCLUSION:Our study identified the factors that explain CCS nonadherence among women with obesity and clarified the effects of health status and healthcare use on screening. Further efforts should be undertaken to reduce the obstacles to CCS by improving care among women with obesity.

Background: Certain fragility fractures (for example of the hip and femur) in the elderly are considered major since they are associated with increased mortality and morbidity.1 Objectives: To describe the characteristics of adults aged ≥50 years in France experiencing fragility fractures according to the site of fracture. Methods: A postal questionnaire was sent to 15,000 individuals aged ≥50 years in order to identify and characterise subjects with a history of fragility fracture. Subjects were asked whether they had experienced a fracture in the previous 3 years and, if so, how many. Fractures were classified according to site into major (shoulder, vertebrae, pelvis, hip or femur and ≥3 ribs) or minor (other sites).1 Results: Of the 13,914 subjects returning the questionnaire, 425 (3%) reported ≥1 fragility fracture. The fracture history rate in the previous year was 1.4% [95%CI: 1.2–1.6]; this rate was higher in women (2.0%) than in men (0.7%) and increased with age. 147 subjects reported major fractures and 287 subjects minor fractures. Most fractures (82.4%) resulted from falling over. The most frequent major fracture sites were the humerus (10.6% of all fractures), vertebra (8.1%) and hip (7.1%). The most frequent minor fracture sites were the forearm/wrist (24.7%) and ankle (17.7%). 25 subjects reported >1 fractures and were excluded from further analyses. Subjects with a history of major fractures were older (p Conclusion: Extrapolated to the total French population, >340,000 people aged ≥50 years would be expected to experience a fragility fracture each year. One third of these fractures are major. Characteristics found to be associated with the severity of the prior fracture were older age, corticosteroid use, post-menopausal status and use of oestrogens. Limitations of the study include retrospective data collection, risk of recall bias, lack of ascertainment of fracture history and failure to capture subjects in residential care or who had died since the fracture. References [1] Bliuc, et al. JAMA 2009; 301:513-21. Acknowledgement: The study was jointly conducted and funded by AFLAR and UCB. Editorial support was provided by Foxymed, funded by UCB Disclosure of Interests: Bernard Cortet Consultant for: Bernard Cortet has received consultancy honoraria of speaker’s fees from Amgen, Expanscience, Ferring, Lilly, Medtronic, MSD, Novartis, Roche diagnostics, Theramex and UCB, Pierre Chauvin: None declared, Jean-Marc Feron Consultant for: Jean-Marc Feron has received consultancy honoraria and conference fees from UCB, Amgen and Lilly, LAURENT GRANGE Consultant for: Laurent Grange has received honoraria from Amgen, Lilly and UCB and research support from Lilly, Amgen, UCB, Expanscience, Mylan, Roche diagnostics and TEVA, Alain Coulomb: None declared, Robert Launois: None declared, Francoise Alliot Launois: None declared, Rahma Sellami: None declared, Chantal Touboul: None declared, Benoit Vincent Employee of: Benoit Vincent is an employee of UCB Pharma, France, Jean-Michel Joubert Employee of: Jean-Michel Joubert is an employee of UCB Pharma, France, Karine Briot Consultant for: Karine Briot has received consultancy honoraria and conference fees from UCB, Amgen, Lilly and MSD

International audience; Background: In France, with the growing scarcity of gynecologists and a globally low and socially differentiated coverage of cervical cancer screening (CCS), general practitioners (GPs) are valuable resources to improve screening services for women. Still all GPs do not perform Pap smears. In order to promote this screening among GPs, the characteristics of physicians who never perform CCS should be more precisely specified. Besides already-known individual characteristics, the contextual aspects of the physicians’ office, such as gynecologist density in the area, could shape GPs gynecological activities.Methods: To analyze county (département) characteristics of GPs’ office associated with no performance of CCS, we used a representative sample of 1063 French GPs conducted in 2009 and we constructed mixed models with two levels, GP and county.Results: Almost 35% (n = 369) of the GPs declared never performing CCS. GPs working in counties with a poor GP-density per inhabitants were more likely to perform CCS (odds ratio (OR) = 0.52 for each increase of density by 1 GP per 10,000 inhabitants, 95% confidence interval (CI) = 0.37–0.74). On the contrary, GPs working in counties with an easier access to a gynecologist were more likely not to perform CCS (OR = 1.06 for each increase of density by 1 gynecologist per 100,000 women, 95%CI = 1.03–1.10 and OR = 2.02 if the first gynecologist is reachable in less than 15 min, 95%CI = 1.20–3.41) as well as GPs working in areas with a poverty rate above the national average (OR = 1.66, 95%CI = 1.09–2.54). These contextual characteristics explain most of the differences between counties concerning rates of not performing CCS.Conclusions: Specific programs should be developed for GPs working in contexts unfavorable to their involvement in CCS.

Migrants from sub-Saharan Africa (SSA) are often diagnosed at an advanced stage of HIV, and many of them have harsh living conditions. We aimed to evaluate the entry into care after HIV diagnosis and examine the related social determinants. The ANRS PARCOURS study is a life-event survey conducted in 2012-2013 in the Paris region among. Time between HIV diagnosis of SSA migrants living diagnosed HIV positive in France and HIV care and the determinants was assessed yearly by using mixed-effects logistic regression models. Among a total of 792 participants, 94.2% engaged in HIV care within the year of HIV diagnosis, 4.3% in the following year and 2.5% beyond the second year after diagnosis. The participants were more likely to engage in HIV care during years when they were effectively covered by health insurance and if the HIV test was carried out at the initiative of the doctor. Immigration for economic reasons or owing to threats in his/her country of origin was associated with delayed engagement in HIV care. Additionally, 4.3% of treated participants discontinued HIV care at least once at the time of the survey and more often if diagnosed at an advanced HIV disease stage and financially dependent.

International audience; BACKGROUND:Immigrant women often have lower cervical cancer screening (CCS) rates, tend to have a higher body mass index (BMI) and may be more vulnerable to BMI-related stigmatization. Our aim was to assess the role of BMI in differences in CCS rates by migration history.METHODS:Analyses were based on the 2012-2015 inclusion data (n = 27,226) for the population-based CONSTANCES cohort, including detailed, self-reported information on demographics and socioeconomic characteristics, migration history, health behaviours, health, and health care use. Measured BMI (underweight (30)) was collected. Poisson regression models with robust variance were conducted to assess the contribution of BMI to differences in CCS rates by migration history, and analyses stratified by BMI were done. Multiple imputations were performed.RESULTS:The CCS rates ranged from 87% among French-born women with two French parents to 86% among French-born women with at least one parent of foreign origin, 82% among naturalized immigrants and 74% among non-naturalized immigrants. After adjusting for covariates, non-naturalized immigrants showed an 11% (95% CI: 8%-14%) lower CCS rate than French-born women with two French parents. Adjusting for BMI did not change the estimates. When stratifying by BMI category, non-naturalized immigrants showed an 11% (7%-14%) lower CCS rate then French-born with two French parents when normal weight, a 9% (2%-16%) lower CCS rate when overweight, and an 18% (5%-30%) lower CCS rate when obese.CONCLUSION:Migration history and BMI jointly impact CCS rates. They were lower among all non-naturalized immigrants, particularly those who were obese.

International audience; Delayed presentation to care among HIV-infected individuals continued to be frequent in France. Migrants are at high risk for late presentation. This cross-sectional study investigated barriers to HIV testing in the specific population of men from sub-Saharan Africa living in four migrant worker hostels in Paris, France. Factors associated with never having been tested for HIV were examined using logistic regression. In all, 550 men participated, coming mainly from Mali and Senegal, with 31 % having lived in France for less than 5 years, and 25 % without any health insurance. Only 37 % have ever been tested for HIV. Not having health insurance was the main risk factor for never-testing [adjusted odds ratio (aOR) 2.4; 95 % confidence interval (CI) 1.4–4.0]. Despite free and anonymous HIV testing available at dedicated public screening centers, 63 % of men living in migrant worker hostels had never been tested for HIV.

International audience; Research is a necessity for high-quality medicine. We used the MEDLINE database to conduct a bibliometric analysis of research output with respect to primary care by 21 countries. For the period 1974 to 2017, the United States and the United Kingdom stood out in terms of publication volume, and the UK, Canada, and Australia had the greatest percentage of publications in primary care. As of 2017, publications in primary care represented a small proportion of total publications. The countries with the greatest publication productivity possess factors that should be considered with respect to strengthening research in primary care.

International audience; Background: Territorial differences in the access to innovative anticancer drugs have been reported from many countries. The objectives of this study were to evaluate access to innovative treatments for metastatic lung cancer in France, and to assess whether socioeconomic indicators were predictors of access at the level of the municipality of residence.Methods: All incident cases of metastatic lung cancer hospitalised for a chemotherapy in public hospitals in 2011 were identified from the French National Hospital discharge database. Information on prescription of innovative drugs from an associated database (FICHCOMP) was crossed with the population density of the municipality and a social deprivation index based on national census data.Results: Overall, 21,974 incident cases of metastatic lung cancer were identified, all of whom were followed for 2 years. Of the 11,486 analysable patients receiving chemotherapy in the public sector, 6959 were treated with a FICHCOMP drug at least once, principally pemetrexed. In multivariate analysis, prescription of FICHCOMP drugs was less frequent in patients ≥66 years compared to those ≤55 years (odds ratio: 0.49 [0.44–0.55]), in men compared to women (0.86 [0.79–0.94]) and in patients with renal insufficiency (0.55 [0.41–0.73]) and other comorbidities. Prescription rates were also associated with social deprivation, being lowest in the most deprived municipalities compared to the most privileged municipalities (odds ratio: 0.82 [0.72–0.92]). No association was observed between the population density of the municipality and access to innovative drugs.Conclusion: Although access to innovative medication in France seems to be relatively equitable, social deprivation is associated with poorer access. The reasons for this need to be investigated and addressed.

International audience; ObjectiveThe aim of this study was to describe the health and social conditions of arrestees, as compared to the general population.MethodsWe studied a sample of 600 adult arrestees in three locations in the Greater Paris area, prospectively included (February–May 2013). A descriptive analysis has been performed, then prevalence was estimated using an indirect standardisation according to age, based on data from a population-based, representative survey in the same area.ResultsArrestees had a median age of 31 years; 92% were males. As compared to the general population, arrestees had a lower level of education (8.6 vs. 7.6%, p < 0.001), were more frequently unemployed (42.0 vs. 11.9%, p < 0.001) and in a difficult financial situation (43 vs. 11%, p < 0.001) and had less significant social support (48.1 vs. 87.9%, p < 0.001). They reported also more frequently a chronic health condition (54 vs. 36%, p < 0.001) and a limited health insurance coverage (36 vs. 15%, p < 0.001).ConclusionComparative analysis of male arrestees and males from the general population showed that the former had worse social and health conditions. These results argue for widespread medical interventions on all arrestees. Medical examination during detention could act as a gateway to health care and social support.

Objectives. To describe the adaptive behaviors in a large sample of homeless children and identify factors associated with developmental delay. Methods. Data were from a cross-sectional survey of 557 children younger than 6 years randomly sampled among homeless sheltered families in the Paris region, France (January–May 2013). An interviewer and a psychologist conducted face-to-face interviews to collect information on sociodemographic and health characteristics. We assessed adaptive behaviors using the Vineland Adaptive Behavior Scales, second edition (VABS-II). Results. The mean VABS-II composite score (SD) was 75.4 (12.0), and most participating children (80.9%) were considered developmentally delayed. Characteristics negatively associated with children’s developmental score were age, birth in a country other than France, low birth weight, and past-year hospitalization. Conclusions. There is a high prevalence of developmental delays among children growing up homeless. Public Health Implications. Long-term integrated programs improving parenting and children’s opportunities for stimulation and socialization should be developed in daycare centers, schools, shelters, and medical practices to minimize negative effects of early living conditions on children’s development.

International audience; The number of families living in shelters in the Paris region (France) has increased by a factor of three in 10 years. In 2013, a survey was performed on homeless families in order to characterize their living conditions, their health needs, and the developmental problems in children. This probability survey was conducted in 17 languages among 801 homeless families sheltered in emergency centers for asylum-seekers, emergency housing centers, social rehabilitation centers, and social hotels in the Paris region. Among the 772 families that provided data on food security only 14.0% were with food security, whereas 43.3% were with low food security and 9.8% with very low food security (a situation where children are also affected). Stratified multivariate robust Poisson models showed that some characteristics are associated with a higher risk of food insecurity and/or of falling into very low food security, such as residential instability, single parenthood, having more than three children, depressive symptoms, housing in social hostels, and difficult access to cheap or free food locally. Given the wealth of the Paris region, resources and programs should be concentrated on improving the living situation of this vulnerable population. It needs better detection of these families, a closer social follow-up, and an increase in food aid.

ObjectivesTo develop and validate an outcome measure for assessing fears in patients with rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA).MethodsFears were identified in a qualitative study, and reformulated as assertions with which participants could rate their agreement (on a 0–10 numeric rating scale). A cross-sectional validation study was performed including patients diagnosed with RA or axSpA. Redundant items (correlation >0.65) were excluded. Internal consistency (Cronbach’s α) and factorial structure (principal component analysis) were assessed. Patients were classified into fear levels (cluster analysis). Associations between patient variables and fear levels were evaluated using multiple logistic regression.Results672 patients were included in the validation study (432 RA, 240 axSpA); most had moderate disease activity and were prescribed biologics. The final questionnaire included 10 questions with high internal consistency (α: 0.89) and a single dimension. Mean scores (±SD) were 51.2 (±25.4) in RA and 60.5 (±22.9) in axSpA. Groups of patients with high (17.2%), moderate (41.1%) and low (41.7%) fear scores were identified. High fear scores were associated with high Arthritis Helplessness Index scores (OR 6.85, 95% CI (3.95 to 11.87)); high Hospital Anxiety and Depression Scale anxiety (OR 5.80, 95% CI (1.19 to 4.22)) and depression (OR 2.37, 95% CI (1.29 to 4.37)) scores; low education level (OR 3.48, 95% CI (1.37 to 8.83)); and high perceived disease activity (OR 2.36, 95% CI (1.10 to 5.04)).ConclusionsOverall, 17.2% of patients had high fear scores, although disease was often well controlled. High fear scores were associated with psychological distress. This questionnaire could be useful both in routine practice and clinical trials.

Objectives Our study aimed to describe the prevalence of self-medication among the Paris adult population and to identify the factors associated with self-medication. Materials and methods This cross-sectional study was based on data collected from the SIRS cohort (a French acronym for "Health, inequalities and social ruptures") in 2005 in the Paris metropolitan area using a face-to-face administration questionnaire among a representative sample of 3,023 French-speaking adults. Structural equation models were used to investigate the factors associated with self-medication in the overall population and according to income. Results The prevalence of self-medication in the past four weeks was 53.5% in the Paris metropolitan area. Seven factors were directly associated with self-medication in the structural equation model. Self-medication was found more common among women, young people, in active employment or student, with a high income, but also among people with a health information seeking behavior, with a high daily mobility, and/or with a history of unmet healthcare needs due to economic reasons. When looking at these coefficients according to income, the association between self-medication and daily mobility appeared stronger in the bottom quartile of income whereas it was no longer significant in the rest of the survey population. Conclusion Self-medication is a frequent practice in the Paris metropolitan area. This study confirms the role of some factors found to be associated with self-medication in the literature such as age or gender and draws attention to other factors rarely explored such as daily mobility, especially among people with a low income, or health information seeking behavior.

Misinterpretation of patient beliefs may complicate shared decision-making in rheumatoid arthritis (RA) or axial spondyloarthritis (axSpA). The objective of this study was to develop a questionnaire to assess patients’ beliefs about their disease and its treatment, and to identify patient characteristics associated with these beliefs. All beliefs reported by > 5% of 50 patients in a previous study were reformulated with a partnering patient organization into statements with which participants could rate their agreement on a scale of 0–10 (totally disagree to totally agree). The resulting Questionnaire for Arthritis Dialogue (QuAD) was made available to patients with RA or axSpA. A score ≥ 7 was considered a strongly held belief. Associations between patient characteristics and individual lifestyle beliefs were assessed using multiple logistic regression. The 21-item QuAD was completed by 672 patients (432 RA, 240 axSpA; mean [±SD] age 54.2 [± 14.2]; 63.7% female). The most widely held beliefs were related to uncertainty about progression (n = 354, 54.0%), heredity (n = 309, 47.8%), and flare triggers (n = 283, 42.7%). The unwarranted belief that physical activity is deleterious to disease activity was associated with markers of psychological distress and lower educational levels. The beliefs of patients with RA or axSpA about their disease are wide-ranging. Since these may be unwarranted and may lead to inappropriate behaviors, physicians should discuss these beliefs with their patients. The QuAD may facilitate this dialogue, and may also be useful in population studies to standardize the assessment and evolution of beliefs over time. People with long-term inflammatory conditions such as rheumatoid arthritis (RA; inflammation of the joints) and axial spondyloarthritis (axSpA; inflammation of the spine) may hold a number of beliefs about their disease, including some that are not supported by current scientific evidence (e.g., “I think that my disease was triggered by a vaccination”). Some beliefs, especially those relating to the role of lifestyle factors (such as exercise, diet, smoking, and drinking alcohol), may encourage people living with severe diseases to change their behavior in a way that has an effect on their disease. Within this project, we developed a questionnaire to identify the most common beliefs held by people living with RA or axSpA, which is called the “Questionnaire for Arthritis Dialogue (QuAD).” We also examined whether certain characteristics (or traits) of people living with RA or axSpA are linked to beliefs not currently supported by scientific evidence. A total of 672 people living with RA or axSpA in France were asked to complete the questionnaire (QuAD). The questionnaire included 21 opinion statements that they scored from 0 (totally disagree) to 10 (totally agree). A score of more than 7 was interpreted to mean that the person significantly agreed with the opinion. Based on the responses to specific opinion statements in the questionnaire, we were able to identify possible links between beliefs that are not supported by scientific evidence (e.g., “I think that flare-ups of my disease are triggered by physical effort”), and characteristics of people living with severe diseases. Our findings suggested that beliefs about lifestyle and inflammatory diseases varied from person to person, were sometimes inconsistent (the most widely held beliefs were sometimes contradictory), and were often not supported by scientific evidence. The belief that physical activity had negative effects on the disease was linked to poor education and psychological issues (such as anxiety and helplessness). People living with axSpA were more likely to believe their disease was a result of their genetic make-up, whereas those with RA more often believed their disease was caused by emotional issues. People living with axSpA were also more likely to believe that physical activity could be beneficial for their disease, and less likely to believe that their disease was caused by smoking. Our results suggest that doctors need to discuss with their patients how they might believe lifestyle is associated with their disease. This will help to dispel any unnecessary concerns, and to encourage their patients to take up healthy lifestyles and habits that are beneficial for their disease management. It may also be beneficial for health care providers to discuss the beliefs identified in this study during educational programs about inflammatory diseases, for the benefit of people living with RA or axSpA. Electronic supplementary material The online version of this article (10.1007/s10067-018-4172-5) contains supplementary material, which is available to authorized users.

International audience; In France, the public health insurance system has a principle of universality.1 However, refusal to provide care by health-care professionals has recently emerged as an issue.2 People living with HIV and vulnerable populations have an increased risk of being denied care.The ANRS-PARCOURS study5 analyses how health trajectories and social and migratory paths are interlaced for migrants from sub-Saharan Africa living in France. It is a life-event survey that was done in 2012–13 in health-care facilities in the Paris area, among sub-Saharan migrants recruited in primary care centres (n=760; reference group) and in HIV care centres (n=922; HIV group). A trained interviewer administered a face-to-face, standardised, life-event history questionnaire to each participant. When participants answered that they had been denied care, they were asked about the reason for the denial of care. These reasons were categorised by the investigators and then analysed. We weighted the percentage of patients to take into account the study design.When participants were asked about their experiences with refusal of health-care since their arrival in France and about the reasons underlying refusal, refusal of care was reported more often in the HIV group (119 [12%] of 922 participants) than in the reference group (59 [6%] of 760 participants, p=0·0006; appendix). Denial of care appeared to be more frequent at general practices (6·4% for the HIV group and and 3·2% for the reference group) than at hospitals (3·0% and 1·4%) and pharmacies (5·2% and 2·8%; appendix). The main reasons for refusal of care were refusal of the specific health insurance coverage for poor people and undocumented migrants (28 [40%] of 59 participants in the reference group and 36 [32%] of 119 participants in the HIV group), HIV status (33 [29%] in the HIV group), and being uninsured (16 [26%] in the reference group and 34 [25%] in the HIV group).In France, two schemes—the Universal Health Insurance Coverage and the State Medical Assistance (created in 1999)—are available for vulnerable populations and for undocumented migrants who were previously excluded from the health insurance system. These two schemes ensure free health care for these populations. Nevertheless, some health professionals deny the beneficiaries.4, 6 The reasons identified for denying care to these patients were mainly about delays in payments and minimal payments,4, 6 discriminatory reasons and fear of contracting HIV have also been reported.7As our survey suggests, refusals to provide health care are too frequent. For migrants who have often encountered many bureaucratic obstacles to benefit from French health insurance dedicated to the poor or the undocumented, being denied access to care by health-care professionals or services is unlawful and should not be tolerated. Refusal of care for migrants with and without HIV needs to be addressed to improve equity in health-care systems. Policymakers, insurance bodies, and health councils must act.

International audience; The Samenta study was conducted in 2009 in the Greater Paris area to estimate the prevalence of psychiatric disorders in homeless people. A cross-sectional survey was performed with a three-stage random sample of homeless people (n = 859), including users of day services, emergency shelters, hot meal distribution, long-term rehabilitation centres, and social hotels. Information was collected by a lay interviewer, using the Mini International Neuropsychiatric Interview, and completed by a psychologist through an open clinical interview. In the end, a psychiatrist assessed the psychiatric diagnosis according to the International Statistical Classification of Diseases and Related Health Problems (ICD, 10th revision). One third of homeless people in the Paris area had at least one severe psychiatric disorder (SPD): psychotic disorders (13%), anxiety disorders (12%), or severe mood disorders (7%). One in five was alcohol-dependent and 18% were drug users. Homeless women had significantly higher prevalence of anxiety disorders and depression compared to men, who were more likely to suffer from psychotic disorders. Homeless people of French origin were at higher risk of SPD, as well as people who experienced various adverse life events before the age of 18 (running away, sexual violence, parental disputes, and/or addictions) and those who experienced homelessness for the first time before the age of 26. The prevalence rates of the main psychiatric disorders within the homeless population of our study are consistent with those reported in other Western cities. Our results advocate for an improvement in the detection, housing, and care of psychiatric homeless people.

Background Patients (pts) with chronic inflammatory rheumatic diseases (CIRDs) such as rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA) have fears related to their disease that can negatively impact health-related quality of life and compromise treatment adherence. Objectives To develop and validate a patient-reported outcome (PRO) questionnaire to explore fears related to CIRDs using the Fears Assessment in Inflammatory Rheumatic Diseases (FAIR) Scale. Methods The preliminary questionnaire included 44 items (23 related to fears) most frequently cited by pts in a qualitative study of 50 French pts.1 Each item was formulated as an affirmative sentence and scored from 0 (completely disagree) to 10 (totally agree). Item scores were summed to provide a total score. The questionnaire was finalised and validated. Pts diagnosed with RA (EULAR/ACR criteria) or axSpA (ASAS criteria), recruited during routine visits by 100 participating rheumatologists across France, completed the preliminary questionnaire, HAD (Hospital Anxiety and Depression) and AHI (Arthritis Helplessness Index) scores. Redundant items (inter-item correlation coefficient >0.65) were eliminated. For the others, internal consistency (Cronbach alpha) and the factorial structure of the scale (principal component analysis) were assessed. Pts were classified according to their level of fears (cluster analysis) and corresponding score thresholds were determined (ROC analysis). The final questionnaire was independently translated into English and back into French twice, with reconciliation of the translated texts. Results 672 pts were included: 432 RA pts (mean±SD disease duration was 13.1±11.4 years, DAS28[ESR] was 2.6±1.2, 77.3% were taking biologics) and 240 axSpA pts (disease duration was 13.8±10.6 years, BASDAI was 3.3±2.2, 72.7% were taking biologics). The final FAIR Scale included 10 questions (Table) with total scores ranging 0–100. Mean±SD scores were 51.2±25.4 in RA and 60.5±22.9 in axSpA. Three pt groups were identified, characterised by high, moderate and low level of fears (17.2%, 41.1% and 41.7% of the population, respectively). The corresponding thresholds of the total score were 77 and 51, respectively. Fear scores were correlated with HAD scores for anxiety (r=0.47) and depression (r=0.40) and with the AHI (r=0.50). Conclusions The FAIR Scale is a 10-question PRO to evaluate disease-related fears in CIRD pts. In this pt population, 17.2% had high fear scores, contrasting with a disease that is often well-controlled. The FAIR Scale was associated with psychological distress. This psychometrically-validated and easy to use questionnaire could be used to improve pt-physician dialogue in CIRDs and also be of value in clinical studies. Further validation in other populations is needed. References Berenbaum F. PloS One 2014; 9(12):e114350. Acknowledgements The authors acknowledge Costello Medical Consulting, funded by UCB Pharma, for editorial assistance. This study was funded by UCB Pharma and Arthritis Foundation Olivier Courtin. Disclosure of Interest L. Gossec Grant/research support from: UCB Pharma, Lilly, Consultant for: AbbVie, BMS, Celgene, Janssen, Novartis, MSD, UCB, P. Chauvin: None declared, C. Hudry: None declared, G. Cukierman Employee of: UCB Pharma, V. Saulot: None declared, F. Russo-Marie: None declared, T. de Chalus Employee of: UCB Pharma, J. M. Joubert Employee of: UCB Pharma, A. Saraux Consultant for: UCB Pharma, F. Berenbaum: None declared

INTRODUCTION/OBJECTIVES: Socio-economic inequalities in access to vaccination are poorly documented in France. This study analyzed socio-economic inequalities in pneumococcal conjugate vaccine (PCV7) immunization coverage, the cost of which is about 180 € for three doses. METHODS: We conducted a cross-sectional survey including children aged 0-5 years living in Paris and its immediate suburbs, selected by a stratified two-stage random sampling design. Data were collected in a face-to-face interview. Vaccination coverage, confirmed by a document, was measured for the first dose and the full primary vaccination series. Poisson regression was used to analyze the association between PCV7 vaccination coverage and several socio-economic and demographic factors. RESULTS: Vaccination coverage for the first dose was 93.7% and 76.7% for the full primary vaccination series. The first-dose vaccination coverage in children from lower income families (first quartile of income) was lower than that of children from higher income families (83.2% versus 97.3%, P=0.033). A similar result was also observed for the full primary vaccination series, although this result was not statistically significant (65.5% versus 87.6%, P=0.09). Full coverage was lower in children with only basic health insurance (70.2%) than in children with additional health insurance either through social assistance (81.4%) or through private insurance (76.1%), but these differences were not significant. CONCLUSIONS: The association of low PCV7 vaccination coverage with low family income suggests the existence of financial barriers to vaccination in the poorest families. However, the lack of a statistical association with the type of health insurance could also indicate the existence of obstacles to vaccination other than purely financial.

International audience; OBJECTIVE: RA and axial SpA have an important impact on patients' lives. The objective of this study was to explore the reporting of different aspects of that impact in publications, with a focus on differences between diseases and over time. METHODS: A systematic literature review retrieved all articles reporting on the life impact of RA or axial radiographic SpA in adults published within the last 10 years and issued from European research. The data were classified into physical impact (including pain, functional assessment and fatigue), psychological impact (including psychological distress and coping) and social impact (including relationships, family and social life). The number of articles published over time was analysed by linear regression. RESULTS: In all, 1352 abstracts were screened and 149 publications (40 056 patients) were analysed: 129 articles (86.5%) concerned RA and 16 (10.7%) concerned axial SpA. The mean number of articles reporting on the physical aspects of impact was 11.4 (s.d. 4.8) per 2-year period, but increased more than 2-fold (from 7 articles in 2001-3 to 15 in 2010-11), in particular due to recent publications on fatigue, whereas the number of articles on psychological aspects [mean 12.4 (s.d. 4.0)] decreased markedly after 2006. Publications reporting on social aspects [mean 8.2 (s.d. 4.1)] remained globally stable. CONCLUSION: In the era of biologics, there is an interest in the patient-perceived life impact of RA and axial SpA in the European literature, but the impact of RA has been the subject of greater exploration. There are clearly trends over time in the reporting of impact.

Objectives This study aims to investigate the association between social contact and social support and women's breast cancer screening (BCS) practices, taking their socioeconomic status (SES) into account. Methods The SIRS survey was conducted in 2010 in the Paris metropolitan area among a representative sample of 3000 French-speaking adults. For the 784 women aged 50 years or older with no history of breast cancer, multivariate logistic regressions and bootstrap methods were used to analyze the factors associated with never having undergone BCS. Results 6.5% of these women had never undergone BCS. In multivariate analysis, being older, having a low education level, having poor-quality health insurance, and having one or less than one social contact per 3-day period were significantly associated with never having undergone BCS during their lifetime, but the level of social support was not. The strength of the association with a low frequency of social contact tended to increase with age. Conclusion This study analyzed the role of social contact in social inequalities in BCS practices in the Paris metropolitan area. Like SES, social integration and social isolation should be taken into consideration by public health professionals and practitioners when planning BCS programs and incentives.