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Abstract Impulsivity dimensions have been shown to be associated with smoking status and tobacco use disorder severity. However, it is important to determine the specific impulsivity traits associated with smoking relapse. This study aimed at investigating the associations between impulsivity traits and smoking cessation success among adult smokers at 12 months after a quit attempt. Participants were 68 adult smokers enrolled in a 3-month course of simvastatine or placebo associated with behavioral cessation support, with a 9-month follow-up (ADDICSTATINE study). They were classified in 3 groups according to smoking status: abstinent, reduction ≥ 50%baseline or reduction

Abstract Background Several studies have shown the influence of the perceptions of aging on the cognitive functioning and the mental and physical health of older people. These relationships have not to date been studied in France where validated instruments are lacking. The primary objective of this study was to validate a French-language version of the Aging Perceptions Questionnaire (APQ) in the French general population aged 65 and over. The secondary objective was to study the stability of the dimensions of this instrument among participants aged 55 to 64. Methods The study was proposed to the cohort of the Observatoire Régional du Vieillissement (OPREVI) (observatory of aging), located in a small town in Poitou-Charentes (western France). An anonymous questionnaire including the APQ was sent by mail to inhabitants aged 55 and over. The original English language APQ was described with adults aged 65 and older. It has 32 items distributed on 7 dimensions: timeline chronic and cyclical, positive and negative consequences, positive and negative control and emotional representations. Results 656 adults participated in this survey (286 men, 370 women). Among those aged 65 and over (n = 394), the seven-factor structure estimated by confirmatory factor analysis was coherent with original findings. Internal consistency as evaluated by Cronbach alpha, was between 0.83 for consequences negative and 0.52 for control negative. Several dimensions were strongly correlated. Among participants aged 55 to 64 (n = 262), the same factorial model yielded an acceptable fit. Multi-group confirmatory factor analysis concluded to approximate factorial invariance between the two age groups with a null delta in comparative fit index. Conclusion This study among French people aged 65 and over, added further evidence of the multidimensional structure of the French version of the APQ which is superimposed to the dimensions of the original Irish version. The same factorial structure applies acceptably to the younger group (aged 55–64). The OPREVI study is ongoing, and will collect data on the physical, material and social characteristics of participants. It will therefore be possible to analyse the variables associated with the perceptions of aging. On the basis of an individual's perceptions of aging as captured by this questionnaire, and his or her clinical profile, tailored multi-dimensional assistance could be made available aiming to provide incentives to anticipate or to adapt to difficulties.

Abstract Background Targeted colonosocopic screening is recommended for first-degree relatives of colorectal cancer patients diagnosed before the age of 60 and offers the possibility of reducing morbidity and mortality, but participation remains too low. The objective of this study was to determine in a French population the factors that affect siblings' participation in screening, notably those relating to the individuals, their medical care, their family and their social network. Methods A cross sectional survey was conducted in siblings of index patients having undergone surgery for colorectal cancer between 1999 and 2002 in two French counties. Siblings were contacted during 2007 and 2008 through the index patient. The factors affecting participation in colonoscopic screening were studied by logistic regression taking into account family cluster effect. Results 172 siblings of 74 index cases were included. The declared rate of undergoing at least one colonoscopy among siblings was 66%; 95%CI 59-73%. Five variables were independently associated with colonoscopic screening: perceiving fewer barriers to screening (OR = 3.2; 95%CI 1.2-8.5), having received the recommendation to undergo screening from a physician (OR = 4.9; 1.7-13.7), perceiving centres practising colonoscopy as more accessible (OR = 3.2, 1.3-7.8), having discussed screening with all siblings (OR = 3.9; 1.6-9.6) and being a member of an association (OR = 2.6; 1.0-6.6). Conclusions The factors independently associated with participation in CRC screening by an individual at increased risk belonged to each of four dimensions relating to his individual psychosocial characteristics, to his relationship with a physician, within the family and social environment. The relevance of these results to clinical practice may help to improve compliance to recommendations in a global preventive strategy including all stages of the information pathway from the physician to the index patient and his relatives.

Due to the massive use of antibiotics, antimicrobial resistance (AMR) continues to spread, endangering global disease control and environmental quality. The sources of bacteria or antimicrobial resistance genes are linked to human activities: urban, hospital and industrial discharges, livestock farms). The role of sanitation systems—sewerage, wastewater treatment and sludge treatment (WWTP)—in the problem of AMR has not yet been clearly established by the scientific community. The data available to date show that they eliminate part of the bacteria, genes and antibiotics, although this is not their primary vocation. WWTPs thus play an important filtering role to limit dissemination in the environment. On the other hand, some authors warn against their potential involvement in the selection of new resistant germs, given the conditions conducive to the exchange of genetic material between microbial strains of various types and exposed to selective agents. Today, knowledge of the mechanisms involved in the selection of antibiotic resistance and the fate of bacteria and resistance genes within sanitation systems remains limited. Research is needed to better characterize the contribution of wastewater systems and the performance of wastewater, recycled water, stormwater and sludge treatment processes.

Abstract Background The care itinerary for cancer involves difficulties that occur in several different areas, whether in the diagnostic procedures, in surgery, or in adjuvant treatment. The aim of this work was to obtain a valid instrument measuring satisfaction among patients with breast cancer and exploring their care itinerary overall. Methods Development phase: Patient focus groups were implemented in two French regions in order to identify areas of satisfaction in relation to the different phases of care provision in breast cancer. On the basis of the literature and the themes and wordings derived from the focus groups, the patients identified several areas of satisfaction, which they found to be partially covered in an American satisfaction measure that has been validated in the French general population (the Consumer Satisfaction Survey in its French version, CSS-VF, 39 items). The patient focus groups suggested adaptation of certain dimensions of this instrument to the potential care providers (37 items) and produced 45 new items in six areas. Validation phase: Using a large sample of patients (cohort of 820 women with invasive non-metastatic breast cancer) approached one month after treatment, this phase selected items that were comprehensible (non-response rate < 10%), non-redundant (r < 0.80) and reproducible (test-retest conducted on a sub-sample of 166 patients). The dimensions were identified by factor analysis on the selected items. Divergent and discriminant validity were assessed (relationships with quality of life questionnaire, comparisons between extreme groups). Results Results were in favour of not inserting additional broken-down items into the CSS-VF and retaining 21 new items. The factor analysis found the initial structure of the CSS-VF (39 items in 9 dimensions) and the 21 new items divide up into four dimensions (listening abilities and information provided by doctors, organisation and follow-up of medical care provision, psychological support, material environment). No redundancy was observed between new items and CSS-VF items. Internal consistency was high. Divergent and discriminant validity were satisfactory. Conclusion Adding four new dimensions to the CSS-VF yielded a valid 60-item instrument for assessment of care provided in breast cancer. These promising results now require further investigations of its responsiveness and its robustness in other linguistic, cultural and healthcare settings.

Abstract Background Great variability in breast cancer (BC) treatment practices according to patient, tumour or organisation of care characteristics has been reported but the relation between these factors is not well known. In two French regions, we measured compliance with Clinical Practice Guidelines for non-metastatic BC care management and identified factors associated with non-compliance at clinical and organisational levels. Methods Eligible patients had invasive unilateral BC without distant metastases and at least two contacts with one of the two regional healthcare systems (2003-2004) in the first year after diagnosis. Medical data were collected from patient medical records in all public and private hospitals (99 hospitals). The care process was defined by 20 criteria: clinical decisions for treatment and therapeutic procedures. Each criterion was classified according to level of compliance ("Compliant", "Justifiable" and "Not Compliant") and factors of non-compliance were identified (mixed effect logistic regression). Results 926 women were included. Non-compliance with clinical decisions for treatment was associated with older patient age (OR 2.1; 95%CI: 1.3-3.6) and region (OR 3.0; 95%CI: 1.2-7.4). Non-compliance with clinical decisions for radiotherapy was associated with lymph node involvement or the presence of peritumoural vascular invasion (OR 1.5; 95%CI: 1.01-2.3) and non-compliance with overall treatment (clinical decisions for treatment + therapeutic procedures) was associated with the presence of positive lymph nodes (OR 2.0; 95%CI: 1.2-3.3), grade III versus grade I (OR 2.9; 95%CI: 1.4-6.2), and one region of care versus another (OR 3.5; 95%CI: 1.7-7.1). Finally, heterogeneity of compliance in overall treatment sequence was identified between local cancer units (p < 0.05). Conclusion This study provides interesting insights into factors of non-compliance in non-metastatic BC management and could lead to quality care improvements.

Background Screening of colorectal cancer (CRC) can reduce incidence and mortality. First-degree relatives (FDRs) of patients with CRC or advanced adenoma before the age of 65 (index patients) are at increased risk of CRC; however, the guidelines for screening of FDRs by colonoscopy are poorly followed.Objectives The present study, conducted in the context of the COLOR3 interventional study project, aimed to explore the positioning of general practitioners (GPs) in familial CRC screening in France.Methods From February 2020 to April 2021, 35 semi-structured interviews with GPs of index patients and/or their FDRs were conducted by telephone. The full-data transcribed corpus was subjected to horizontal thematic analysis.Results Knowledge and compliance with the guidelines vary greatly between GPs. Although initiating the diagnostic process, GPs do not consider themselves as actors in the flow of information concerning familial risk. Their accompaniment of index patients in this role varies. GPs should overcome barriers to implementing colonoscopic screening for FDRs. They underline the importance of exploring family history, but they lack the time and doubt the reliability of the information given by FDRs.Conclusion Challenges include circumventing gaps in knowledge, adherence to guidelines and improving family history updates. The GPs interviewed suggested personalised guidelines in specialists' reports to initiate information campaigns raising awareness of familial risk, and to enhance coordination between organised screening and familial screening.

Three-breed rotational crossbreeding can improve the functional traits of dairy cows, but few farmers in most Western countries use it. This could be due to a lack of knowledge of its medium- and long-term effects on animal performance at the herd level, regardless of the initial states of the farm and herd, the crossbreeding programme(s) used and changes in farm management and structure while transitioning to it. We aimed at assessing changes in animal performance of dairy cattle herds transitioning towards three-breed rotational crossbreeding and at identifying factors that explained them. We sampled 13 French dairy cattle farms for which animal performance data were available for a 9-year period (2009–2017) and described their trends in herd management and the farming system when introducing crossbreeding. We calculated five herd performance variables: mean milk productivity per cow-year (MilkCow), mean Milk solids content (FatProtCont), and the percentages in the herd of cows with no more than 117 days open (FertileCow), with mean somatic cell score less than 4 over the lactation period (HealthyLact) and with four lactations or more (L4+). We defined 15 variables related to herd and farm structure and management. We applied linear regression to each variable over the study period and used the intercept and slope to describe their initial values in 2009 and their trends, respectively. We performed partial least squares (PLS) regression to assess relationships between the trends in herd performance variables and potential explanatory variables, including the initial values of herd performance variables and the initial values of and trends in herd and farm structure and management variables. Linear regressions showed that within herds, median MilkCow decreased (–177 kg/cow per year), FertileCow increased (+1.5%/year) and FatProtCont either remained stable or increased (+0.1 g/kg per cow). Conversely, changes were less distinct for HealthyLact and L4+. From 2009 to 2017, herd size increased in most farms (med = +1.2 LU/year). The PLS regression highlighted that herds in which MilkCow decreased the most over time were those in which HealthyLact and L4+ decreased and increased the most, respectively. Moreover, for herds in which FertileCow increased the most, FatProtCont either decreased, or increased less. Based on association scores from the PLS, changes in the genetic composition of the herd influenced changes in herd performance variables more than did changes in overall farm management (|0.28|–|0.59| vs |0.26|–|0.50|). Our findings suggest that dairy crossbreeding is relevant to rebalance herd performance between production and functional traits.

Road crashes are the first cause of mortality for young adults aged 18–25 years and the human factor contributes to 90–95% of events. The present study was carried out to determine the efficacity of the ECARR2 recurrence prevention program among adolescents and young adults at high risk of having a new traffic crash in the following months. A total of 288 participants having had a traffic crash that required going to the emergency room, at high risk of accident recurrence (ECARR≥5) were randomly allocated to either the intervention group (n = 144) or the control group (n = 144). Results: revealed that the risk of recurrence was highest during the first 6 months (66% of recurrences). In per-protocol analysis population, at 6 months after inclusion, the accident recurrence rate was 14.2% ± 3.3% in the intervention group, and 23.5% ± 4.0% in the control group. The intervention had an effect per se, independently of the other predictors (p = 0.020). This effect was mediated by the three interaction variables: BDI, Impulsive Behavior Scale lack of perseverance, and Orientation to Happiness engagement. It was therefore through these dimensions that the intervention had an effect. In conclusion, the ECARR score predicts the risk of recurrence, risk which is the highest during the first 6 months. Finally, results confirm the predictive validity of the ECARR scale. The ECARR score had an effect on the risk of recurrence regardless of group (p = 0.045) and was predictive of recurrence (p = 0.045).A brief psychological intervention such as ECARR2 program, offered to young people ar hight risk of having a new crash, just after the crash, seems to halve the risk of recurrence at 6 months. Future research should improve the brief psychological intervention and its access via a mobile application or few hours in high school or in a driving school given.

Background Substance use disorders (SUDs) are based on pathophysiological mechanisms common to all psychoactive substances. However, general practitioners (GPs) hold different views depending on the substance in question. Objectives To determine whether the perceptions that teaching GPs and final-year residents in general practice have of patients with a SUD vary according to the substance involved and explore their professional responsibility and management experiences. Methods A cross-sectional observational study was carried out by asking residents and teaching GPs from eight faculties of medicine about their perceptions, professional responsibility and management experience of patients with tobacco, alcohol and opioid use disorders, using an online questionnaire between June and September 2017. Results The responses of 238 teaching GPs (mean age 50 years SD 3.5; 58% men) and 327 residents (mean age 28 years SD 9.9; 67% women) were analysed (response rates: 9 and 15% respectively). Tobacco smokers were considered to be more responsible for their acts than the other users. Teaching GPs and residents considered that it was their responsibility to discuss substance use. They did not feel able to manage alcohol and opioid use disorders. Tobacco cessation was mainly managed alone (78%). The results were quite similar among teaching GPs and residents. Conclusion The majority of practitioners had no difficulty managing smoking cessation. During the management of alcohol and particularly opioid use disorders, practitioners did not feel competent. The gap between their perceived responsibility and competencies should be addressed by training and promoting collaborative care.

The growing interest in rotational crossbreeding in Western countries is due to its potential to improve reproductive and health performances of cows. Although a large amount of research focuses on assessing crossbred cows’ performances, how to manage the transition from purebred to rotational crossbred herds is under-explored. Based on a retrospective analysis of French dairy herd case studies, we aimed to identify and characterise technical pathways to make such a transition. In 2018, we performed semi-directive interviews on 26 commercial dairy farms. Data were collected to describe changes in breeding, replacement and culling management practices from the first crossbred mating with purebred cows to the management of a mainly crossbred herd in 2018. Based on a multivariate analysis, we identified two main guidelines structuring technical pathways to move towards rotational crossbred herds: (i) the depth and scale of change (i.e. farm v. herd) associated with the introduction of rotational crossbreeding in the whole-farm dynamics and (ii) the changes in herd replacement and breeding practices to adapt to the evolution of herd demographics induced by the evolution of the dairy crossbred mating rate over time (high from the beginning v. distributed over time). Hierarchical clustering discriminated three groups of farmers differing in their technical pathway to move towards a rotational crossbred herd. In pathway 1, farmers customised one or several rotational crossbreeding schemes to support whole-farm transition towards an organic or grass-based system. Once the scheme stabilised, they quickly implemented it and had to readjust replacement and culling practices to regulate imbalance in herd demographics induced by the improvement in cow fertility. In pathway 2, farmers also customised one or several rotational crossbreeding schemes to support whole-farm redesign but they implemented it more gradually in the herd, which induced no major imbalance in herd demographics. In pathway 3, farmers predefined a relatively well-known rotational crossbreeding scheme to correct fertility issues of purebred cows without any changes at the farm level. They implemented it quickly from the beginning and had to adapt herd replacement and culling to regulate imbalance in herd demographics induced by the improvement in cow fertility. These first empirical evidences on how dairy farmers manage the transition from a purebred to rotational crossbred herd provide original scientific and operational contributions.

Objective: To evaluate the computerized Inter Hemispheric Transfer Time Test (IHTTT), a cognitive test designed for the detection of information processing speed impairment in patients undergoing stereotactic radiation therapy for brain metastases. Methods: Inclusion criteria: age ≥18 years, brain metastases treated by stereotactic radiotherapy (SRT) with dose schedule: 33 Gy in 3 fractions, solid tumour, ≥70 Karnofsky Performance Status, Mini-Mental State Evaluation (MMSE) ≥ 24, no history of stroke brain injury. Twenty-nine patients were recruited from June 2014 to April 2015. All recruited patients were administered Frontal Assessment Battery at Bedside (FAB), IHTTT and QLQ-C30 quality of life questionnaire before SRT, at one-month, six-month and one-year follow-up. The primary endpoint was Interhemispheric Transfer Index (IHTI). Secondary endpoints included Interhemispheric Transfer Time (IHTT), MMSE, FAB, and quality of life. Results: A significant evolution of cognitive function over time was assessed by the IHTTT: IHTT = 720 ± 27 ms at baseline, 728 ± 20 at one month, 736 ± 36 at 6 months, 799 ± 111 at one-year follow-up (p = 0.0010); IHTI = 13.1 ± 31.4, 11.5 ± 24.3, 50.6 ± 57.9, 91.0 ± 59.4 (p

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Introduction Fractures of the tibial plateau are in constant progression. They affect an elderly population suffering from a number of comorbidities, but also a young population increasingly practicing high-risk sports. The conventional open surgical technique used for tibial plateau fractures has several pitfalls: bone and skin devascularisation, increased risks of infection and functional rehabilitation difficulties. Since 2011, Poitiers University Hospital is offering to its patients a new minimally invasive technique for the reduction and stabilisation of tibial plateau fractures, named ‘tibial tuberoplasty’. This technique involves expansion of the tibial plateau through inflation using a kyphoplasty balloon, filling of the fracture cavity with cement and percutaneous screw fixation. We designed a study to evaluate the quality of fracture reduction offered by percutaneous tuberoplasty versus conventional open surgery for tibial plateau fracture and its impact on clinical outcome.Methods and analysis This is a multicentre randomised controlled trial comparing two surgical techniques in the treatment of tibial plateau fractures. 140 patients with a Schatzker II or III tibial plateau fracture will be recruited in France. They will be randomised either in tibial tuberoplasty arm or in conventional surgery arm. The primary outcome is the postoperative radiological step-off reduction blindly measured on CT scan (within 48 hours post-op). Additional outcomes include other radiological endpoints, pain, functional abilities, quality of life assessment and health-economic endpoints. Outcomes assessment will be performed at baseline (before surgery), at day 0 (surgery), at 2, 21, 45 days, 3, 6, 12 and 24 months postsurgery.Ethics and dissemination This study has been approved by the ethics committee Ile-De-France X and will be conducted in accordance with current Good Clinical Practice (GCP) guidelines, Declaration of Helsinki and standard operating procedures. The results will be disseminated through presentation at scientific conferences and publication in peer-reviewed journals.Trial registration number Clinicaltrial.gov:NCT03444779.

There is no robust predictor of response to chemotherapy (CT) in unresectable pancreatic adenocarcinomas (UPA). The objective of the KRASCIPANC study was to analyze the kinetics of cell-free DNA (cfDNA)/circulating tumor DNA (ctDNA) as a predictor of response to CT in UPA. Blood samples were collected just before first CT and at day 28. The primary endpoint was the kinetics of KRAS -mutated ctDNA by digital droplet PCR between D0 and D28 as a predictor of progression-free survival (PFS). We analyzed 65 patients with a KRAS -mutated tumor. A high level of cfDNA and KRAS- mutated ctDNA at D0, as well as the presence of KRAS- mutated ctDNA at D28, were strongly associated with lower centralized disease control rate (cDCR), shorter cPFS and OS in multivariate analysis. A score combining cfDNA level at diagnosis ≥ or <30 ng/mL and presence or not of KRAS- mutated ctDNA at D28 was an optimal predictor of cDCR (OR=30.7, IC95% 4.31–218 P =.001), PFS (HR=6.79, IC95% 2.76–16.7, P <.001) and OS (HR=9.98, IC95% 4.14–24.1, P <.001). A combined score using cfDNA level at diagnosis and KRAS -mutated ctDNA at D28 is strongly associated with patient survival/response to chemotherapy in UPA. ClinicalTrials.gov Identifier: NCT04560270 [ABSTRACT FROM AUTHOR]