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26 results on '"MESH: Attitude to Health"'

1. Transparency of Health Informatics Processes as the Condition of Healthcare Professionals’ and Patients’ Trust and Adoption: the Rise of Ethical Requirements

Author

Brigitte Séroussi, Lina Fatima Soualmia, Kate Fultz Hollis, Laboratoire d'Informatique Médicale et Ingénierie des Connaissances en e-Santé (LIMICS), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Sorbonne Paris Nord, Oregon Health and Science University [Portland] (OHSU), Equipe Traitement de l'information en Biologie Santé (TIBS - LITIS), Laboratoire d'Informatique, de Traitement de l'Information et des Systèmes (LITIS), Institut national des sciences appliquées Rouen Normandie (INSA Rouen Normandie), Institut National des Sciences Appliquées (INSA)-Normandie Université (NU)-Institut National des Sciences Appliquées (INSA)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Université Le Havre Normandie (ULH), Normandie Université (NU)-Institut national des sciences appliquées Rouen Normandie (INSA Rouen Normandie), Normandie Université (NU), Université Le Havre Normandie (ULH), Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Institut National des Sciences Appliquées (INSA)-Normandie Université (NU)-Institut National des Sciences Appliquées (INSA)-Université Le Havre Normandie (ULH), Institut National des Sciences Appliquées (INSA)-Normandie Université (NU)-Institut National des Sciences Appliquées (INSA), and Soualmia, Lina F

Subjects
[INFO.INFO-AI] Computer Science [cs]/Artificial Intelligence [cs.AI], Artificial intelligence, 020205 medical informatics, Attitude of Health Personnel, Health Personnel, MESH: Attitude of Health Personnel, Internet privacy, MESH: Attitude to Health, 02 engineering and technology, Trust, Health informatics, [INFO.INFO-AI]Computer Science [cs]/Artificial Intelligence [cs.AI], 03 medical and health sciences, 0302 clinical medicine, 0202 electrical engineering, electronic engineering, information engineering, Humans, MESH: Artificial Intelligence, Bioethical Issues, 030212 general & internal medicine, Ethics, MESH: Humans, business.industry, Health Insurance Portability and Accountability Act, Health Information Technology, General Medicine, Transparency (behavior), 3. Good health, Data sharing, Information sensitivity, MESH: Medical Informatics, Editorial, General Data Protection Regulation, MESH: Trust, MESH: Bioethical Issues, MESH: Health Personnel, Informatics, medical, Yearbook, business, Attitude to Health, Medical Informatics, Medical ethics, IMIA Yearbook of Medical Informatics
Abstract

Objectives: To provide an introduction to the 2020 International Medical Informatics Association (IMIA) Yearbook by the editors. Methods: This editorial provides an introduction and overview to the 2020 IMIA Yearbook which special topic is: “Ethics in Health Informatics”. The keynote paper, the survey paper of the Special Topic section, and the paper about Donald Lindberg’s ethical scientific openness in the History of Medical Informatics chapter of the Yearbook are discussed. Changes in the Yearbook Editorial Committee are also described. Results: Inspired by medical ethics, ethics in health informatics progresses with the advances in biomedical informatics. With the wide use of EHRs, the enlargement of the care team perimeter, the need for data sharing for care continuity, the reuse of data for the sake of research, and the implementation of AI-powered decision support tools, new ethics requirements are necessary to address issues such as threats on privacy, confidentiality breaches, poor security practices, lack of patient information, tension on data sharing and reuse policies, need for more transparency on apps effectiveness, biased algorithms with discriminatory outcomes, guarantee on trustworthy AI, concerns on the re-identification of de-identified data. Conclusions: Despite privacy rules rooted in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) in the USA and even more restrictive new regulations such as the EU General Data Protection Regulation published in May 2018, some people do not believe their data will be kept confidential and may not share sensitive information with a provider, which may also induce unethical situations. Transparency on healthcare data processes is a condition of healthcare professionals’ and patients’ trust and their adoption of digital tools.

Published
2020
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2. The first pelvic examination: A rite of passage for the women. A qualitative study about French women

Author

Amandine Yvon, Béatrice Lognos, Elodie Million, Bernard Clary, Agnès Oude-Engberink, Philippe Serayet, Sylvain Pavageau, Pierre Mares, Institut Desbrest de santé publique (IDESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Université de Montpellier (UM), Dynamique des capacités humaines et des conduites de santé (EPSYLON), Université Paul-Valéry - Montpellier 3 (UPVM), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Maison de Santé Pluriprofessionnelle Universitaire Avicenne (MSP-U), Centre d’Evaluation des programmes de Prévention Sante [Montpellier] (Plateforme CEPS), and lognos, béatrice

Subjects
Adult, medicine.medical_specialty, Rite of passage, [SDV]Life Sciences [q-bio], MESH: Attitude to Health, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, patient centred care, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Pelvic examination, prevention, MESH: Grounded Theory, medicine, Humans, 030212 general & internal medicine, Physician-Patient Relations, lcsh:R5-920, medicine.diagnostic_test, business.industry, 030503 health policy & services, MESH: Gynecological Examination / psychology, [SDV] Life Sciences [q-bio], MESH: France, Snowball sampling, patient-centred care, MESH: Young Adult, Family medicine, Grounded Theory, woman, MESH: Physician-Patient Relations, Original Article, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, Gynecological Examination, lcsh:Medicine (General), 0305 other medical science, Family Practice, business, Attitude to Health, qualitative research, Qualitative research
Abstract

International audience; Background: French general practitioners (GP) and gynaecologists can make use of recommendations when performing a patient's first pelvic examination. The indications and techniques for this examination are clear. The relational aspects and experience of the patients have been dealt with little.Objectives: To analyse and understand the experience of French women during their first pelvic examination to propose practice recommendations based on their experiences.Methods: Qualitative semi-structured interviews was conducted with 13 French women aged 18-30 years recruited from the surgery of a general practitioner using the snowball method. The data were analysed using an inductive method.Results: The first pelvic examination was considered an indispensable rite of passage into adulthood and the life of a woman. They wanted a preparation for a consultation devoted to the first pelvic examination, with a time that is adapted to each woman. A patient-centred practitioner was more important than the pelvic examination itself.Conclusion: Women requested for a general practitioner or a gynaecologist with a deeper understanding of a woman's experience to perform their first pelvic examination. We propose practical recommendations: the following 3 phases for the consultation: before the pelvic examination where the women and the practitioners may get to know one another; during the examination, which would involve the technical aspects and the associated procedures; and after the examination, where the patients and the practitioners review the experience and discuss prevention.

Published
2020
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3. [New drugs toxicities: A new fight]

Author

Gilles L'Allemain, Denis Maillet, Jacques-Olivier Bay, Role of intra-Clonal Heterogeneity and Leukemic environment in ThErapy Resistance of chronic leukemias (CHELTER), Université Clermont Auvergne [2017-2020] (UCA [2017-2020]), Institut de Biologie Valrose (IBV), Université Nice Sophia Antipolis (1965 - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Côte d'Azur (UCA), Université Nice Sophia Antipolis (... - 2019) (UNS), and COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Côte d'Azur (UCA)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Cancer Research, MESH: Attitude of Health Personnel, MEDLINE, MESH: Attitude to Health, MESH: Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Quality of life (healthcare), Nursing, Medicine, MESH: Physicians, Radiology, Nuclear Medicine and imaging, [SDV.BDD]Life Sciences [q-bio]/Development Biology, ComputingMilieux_MISCELLANEOUS, 030304 developmental biology, MESH: Medical Oncology, MESH: Drug Development, 0303 health sciences, MESH: Humans, business.industry, MESH: Quality of Life, [SDV.MHEP.HEM]Life Sciences [q-bio]/Human health and pathology/Hematology, Hematology, General Medicine, MESH: Drug-Related Side Effects and Adverse Reactions, Oncology, Drug development, 030220 oncology & carcinogenesis, business, Risk assessment
Abstract

International audience

Published
2019
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4. The Role of the Residential Neighborhood in Linking Youths’ Family Poverty Trajectory to Decreased Feelings of Safety at School

Author

Yan Kestens, Mai Thanh Tu, Carolyn Côté-Lussier, Louise Séguin, Tracie A. Barnett, Université de Montréal [Montréal], CHU Sainte Justine [Montréal], Institut Armand Frappier (INRS-IAF), Institut National de la Recherche Scientifique [Québec] (INRS) - Réseau International des Instituts Pasteur - Institut Armand Frappier, Concordia University [Montreal, Canada], Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Institut de recherche en santé publique de l'université de Montréal (IRSPUM), International Network for Research on Inequalities in Child Health (INRICH), Centre de Recherche Léa-Roback sur les Inégalités Sociales de Santé de Montréal, This study was funded by the Canadian Institutes of Health Research (CIHR) Grant Number 00309MOP-123079. Data were collected by the Institut de la Statistique du Québec, Direction Sante Québec. The IRSPUM and CRCHUM receivedinfrastructure funding from the Fonds de la Recherche en Santé du Québec. CCL is funded by a Fonds de Recherche du Québec -Sociéte et Culture fellowship. TB is supported by a FRQS Junior 2 Research Scholar award. YK holds a Young Investigator Award from Fonds de Recherche du Québec – Santéand a CIHR Applied Public Health Chair on Urban Interventions and Population Health. MTT was funded by a young investigator fellowship from the IRSPUM and was the recipient of a Young Investigator Award from the National Alliance for Research on Schizophrenia and Depression, the former name of the Brain & Behavior Research Foundation, at the time of the contribution. These funding agencies were not involved in the studydesign, data analyses, data interpretation or manuscript writing and submission processes. These findings were presented at the 81st conference of the Association Francophone pour le Savoir (ACFAS) and the 5th Annual Workshop of the International Network for Research on Inequalities in Child Health (INRICH)., Université de Montréal (UdeM), Institut National de la Recherche Scientifique [Québec] (INRS)-Réseau International des Instituts Pasteur (RIIP), Concordia University [Montreal], and Centre Hospitalier de l'Université de Montréal (CHUM)

Subjects
School, Male, Longitudinal study, Youth, MESH: Quebec, MESH: Poverty, [SDV]Life Sciences [q-bio], Poverty trajectory, Poison control, Social Environment, Occupational safety and health, [SHS]Humanities and Social Sciences, Developmental psychology, [SHS.ENVIR] Humanities and Social Sciences/Environmental studies, Residence Characteristics, MESH: Child, Developmental and Educational Psychology, MESH: Residence Characteristics, Longitudinal Studies, MESH: Longitudinal Studies, Child, media_common, MESH: Social Environment, Family Characteristics, education.field_of_study, Quebec, MESH: Follow-Up Studies, MESH: Infant, [SDV] Life Sciences [q-bio], Feeling, Child, Preschool, Female, [SHS] Humanities and Social Sciences, Safety, Psychology, Attitude to Health, Adolescent, Social Psychology, media_common.quotation_subject, education, Population, MESH: Attitude to Health, Education, Environmental health, MESH: Family Characteristics, [SDV.EE.SANT] Life Sciences [q-bio]/Ecology, environment/Health, Humans, Poverty, MESH: Adolescent, [SDV.EE.SANT]Life Sciences [q-bio]/Ecology, environment/Health, [SHS.ANTHRO-SE] Humanities and Social Sciences/Social Anthropology and ethnology, MESH: Humans, Neighborhood, Latent growth modeling, MESH: Safety, MESH: Child, Preschool, Infant, [SHS.ANTHRO-SE]Humanities and Social Sciences/Social Anthropology and ethnology, Residential, MESH: Male, MESH: Adolescent Behavior, Disadvantaged, Adolescent Behavior, [SHS.ENVIR]Humanities and Social Sciences/Environmental studies, MESH: Female, Social Sciences (miscellaneous), Follow-Up Studies
Abstract

International audience; Although disadvantaged youth are more likely to be victimized at school, victimization only partly explains their decreased feelings of safety at school. We applied a socioecological approach to test the hypotheses that the experience of poverty is associated with decreased feelings of safety at school, and that residential neighborhood features partly mediate the relationship between poverty and feeling less safe at school. This study draws on the Québec Longitudinal Study of Child Development (QLSCD) which began in 1998 with a representative population-based cohort of 2,120 5-month old infants (49.1% female) and their primary caregiver. The study also includes measures of ego-centred residential neighborhood exposures (based on a 500 m circular buffer zone surrounding the family's residential postal code) derived from a spatial data infrastructure. We used latent growth modeling to estimate youth's family poverty trajectory from age 5 months to 13 years, and structural equation modeling to test our hypotheses. The results suggest that youth experiencing chronic and later-childhood poverty felt less safe at school in part because they lived in neighborhoods that their parents described as being disorderly (e.g., demarked by the presence of garbage, drug use and groups of trouble-makers). These neighborhoods also tended to have less greenery (e.g., trees, parks) and more lone-parent households. Neighborhood features did not help explain the relationship between early-childhood poverty and feeling less safe at school. The findings suggest that targeting residential neighborhood features such as greenery and disorder could improve youth's felt safety at school, particularly for those experiencing chronic and later-childhood poverty.

Published
2014
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5. Couples, PMTCT programs and infant feeding decision-making in Ivory Coast

Author

Madina Querre, Valériane Leroy, Annabel Desgrées-du-Loû, Hermann Brou, Alice Desclaux, Annick Tijou Traoré, Aménagement, Développement, Environnement, Santé et Sociétés ( ADES ), Université Bordeaux Segalen - Bordeaux 2-Université Bordeaux Montaigne-Centre National de la Recherche Scientifique ( CNRS ), Centre de Recherche Cultures, Santé, Sociétés (JE 2424) ( CReCSS ), Université Paul Cézanne - Aix-Marseille 3-JE2424, Ecole nationale supérieure de statistique et d'économie appliquée [Abidjan] ( ENSEA ), Epidémiologie et Biostatistique [Bordeaux], Université Bordeaux Segalen - Bordeaux 2-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre population et développement ( CEPED - UMR_D 196 ), Institut de Recherche pour le Développement ( IRD ) -Université Paris Descartes - Paris 5 ( UPD5 ), Aménagement, Développement, Environnement, Santé et Sociétés (ADES), Université Bordeaux Segalen - Bordeaux 2-Université Bordeaux Montaigne (UBM)-Centre National de la Recherche Scientifique (CNRS), Centre de Recherche Cultures, Santé, Sociétés (JE 2424) (CReCSS), Ecole nationale supérieure de statistique et d'économie appliquée [Abidjan] (ENSEA), Université Bordeaux Segalen - Bordeaux 2-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre population et développement (CEPED - UMR_D 196), Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5), Centre National de la Recherche Scientifique (CNRS)-Université Bordeaux Segalen - Bordeaux 2-Université Bordeaux Montaigne, Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Université Bordeaux Segalen - Bordeaux 2, Université Bordeaux Segalen - Bordeaux 2-Université Bordeaux Montaigne-Centre National de la Recherche Scientifique (CNRS), and Mouillet, Evelyne

Subjects
Male, MESH: Decision Making, Health (social science), MESH : Infant Nutritional Physiological Phenomena, HIV Infections, 0302 clinical medicine, ACTION SANITAIRE, Medicine, education.field_of_study, MESH: Middle Aged, SIDA, COUPLE, MESH: Sex Distribution, MESH : Infant, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: HIV Infections, MESH: Interviews as Topic, MESH: Infant, Project team, 3. Good health, Breast Feeding, ENFANT, SANTE DE LA REPRODUCTION, MESH: Young Adult, Spouse, MESH: Breast Feeding, MESH: Truth Disclosure, 0305 other medical science, Attitude to Health, medicine.medical_specialty, MESH: Cote d'Ivoire, MESH: Attitude to Health, MESH : Young Adult, Developing country, Truth Disclosure, Feeding Methods, 03 medical and health sciences, History and Philosophy of Science, MESH : HIV Infections, Humans, Interpersonal Relations, MESH : Middle Aged, education, MESH: Age Distribution, MESH: Humans, Public health, MESH : Humans, Infant, MESH : Feeding Methods, ALLAITEMENT MATERNEL, MESH: Adult, PREVENTION SANITAIRE, medicine.disease, Infectious Disease Transmission, Vertical, MESH : Attitude to Health, MESH : Interviews as Topic, MESH : Breast Feeding, ENQUETE, MESH: Female, Pediatrics, TRANSMISSION MERE ENFANT, MESH: Infant Nutritional Physiological Phenomena, MESH : Age Distribution, Breastfeeding, MESH : Interpersonal Relations, 5. Gender equality, MESH : Socioeconomic Factors, MESH : Female, 030212 general & internal medicine, Infant Nutritional Physiological Phenomena, MESH : Infectious Disease Transmission, Vertical, MESH : Sex Distribution, Family Characteristics, MESH: Feeding Methods, Middle Aged, MESH: Interpersonal Relations, MESH : Adult, MESH : Truth Disclosure, MESH: Infectious Disease Transmission, Vertical, Female, Adult, MESH: Socioeconomic Factors, TRANSMISSION, MESH : Male, Decision Making, Population, Interviews as Topic, SYSTEME DE REPRESENTATIONS, Young Adult, Age Distribution, Acquired immunodeficiency syndrome (AIDS), MESH: Family Characteristics, Sex Distribution, MESH : Family Characteristics, 030505 public health, business.industry, PARENT, MESH : Cote d'Ivoire, MESH: Male, MESH : Decision Making, Cote d'Ivoire, Socioeconomic Factors, FEMME, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Family medicine, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, Breast feeding
Abstract

International audience; In Sub-Saharan Africa, prevention of HIV pediatric infection due to breastfeeding requires turning to alternatives to prolonged breastfeeding: artificial feeding or exclusive breastfeeding with early weaning. Choosing a preventive option and applying it does not only depend upon the mother but also on the father and more specifically on couple interactions. To date, not enough studies have considered this question. In Abidjan, Ivory Coast, HIV-positive women and their infants were followed over two years in Ditrame Plus, a prevention of mother-to-child transmission (PMTCT) project. Using data from this project and from interviews conducted with couples and women, we analyzed the construction of decisions and practices concerning the application of preventive infant feeding options. Differences may be found between women and men in discourses regarding their attitudes, which are in part related to their conceptions of motherhood and fatherhood. We found that when men know their wife is HIV positive and are involved in the PMTCT project, they play an active role in applying the advice received. However, women do not always need the support of their spouse to undertake preventative behaviour. The project team also plays an important role in the adoption of such by women and men. The implementation of preventive options is a complex process in which three groups of actors (women, men and the project team) interact. In order to optimize PMTCT programs for couples, it is essential that this dynamic be taken into account.

Published
2009
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6. Acculturating Human Experimentation: An Empirical Survey in France

Author

Séverine Mathieu, Anne Fagot-Largeault, Philippe Amiel, Institut Novexis, Université Lille 2 - Faculté de Médecine, Institut d'Histoire et de Philosophie des Sciences et des Techniques (IHPST), Université Paris 1 Panthéon-Sorbonne (UP1)-Département d'Etudes Cognitives - ENS Paris (DEC), École normale supérieure - Paris (ENS Paris), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-École normale supérieure - Paris (ENS Paris), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Centre National de la Recherche Scientifique (CNRS), Chaire Philosophie des sciences biologiques et médicales, Collège de France (CdF (institution)), and Faculté de Médecine Henri Warembourg - Université de Lille

Subjects
MESH: Human Experimentation, Applied psychology, Empirical survey, Researcher-Subject Relations, 0302 clinical medicine, Empirical research, Government regulation, Informed consent, MESH: Informed Consent, MESH: Data Collection, Sociology, health care economics and organizations, media_common, Clinical Trials as Topic, [SHS.SOCIO]Humanities and Social Sciences/Sociology, Informed Consent, Data Collection, 06 humanities and the arts, General Medicine, MESH: Interviews as Topic, 3. Good health, Negotiation, MESH: Government Regulation, MESH: History, 20th Century, Aptitude, France, MESH: Researcher-Subject Relations, Attitude to Health, Social psychology, MESH: Clinical Trials as Topic, media_common.quotation_subject, education, MESH: Attitude to Health, Context (language use), 0603 philosophy, ethics and religion, Article, Anecdotes as Topic, Interviews as Topic, 03 medical and health sciences, Humans, MESH: Humans, History, 20th Century, MESH: France, Philosophy, Issues, ethics and legal aspects, Human Experimentation, MESH: Anecdotes as Topic, Government Regulation, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, 060301 applied ethics, 030215 immunology
Abstract

International audience; Preliminary results of an empirical study of human experimentation practices are presented and contrasted with those of a survey conducted a hundred years ago when clinical research, although tolerated, was culturally deviant. Now that biomedical research is both authorized and controlled, its actors (sponsors, committees, investigators, subjects) come out with heterogeneous rationalities, and they appear to be engaged in a transactional process of negotiating their rationales with one another. In the European context "protective" of subjects, surprisingly the subjects we interviewed (and especially patient-subjects) were creative and revealed an aptitude for integrating experimental medicine into common culture.

Published
2001
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7. Increased risk of coronary heart disease among individuals reporting adverse impact of stress on their health: the Whitehall II prospective cohort study

Author

Hermann Nabi, G. David Batty, Jussi Vahtera, Mika Kivimäki, Archana Singh-Manoux, Eric J. Brunner, Martin J. Shipley, Alexis Elbaz, Cédric Lemogne, Annie Britton, Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ) - Université Paris-Sud - Paris 11 (UP11) - Assistance publique - Hôpitaux de Paris (AP-HP) - Hôpital Paul Brousse - Institut National de la Santé et de la Recherche Médicale (INSERM), Department of Epidemiology and Public Health, University College of London [London] (UCL), Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Department of Public Health, University of Turku, Finnish Institute of Occupational Health, Centre de Psychiatrie et Neurosciences (CPN - U894), Université Paris Descartes - Paris 5 (UPD5) - Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Psychiatrie de l’adulte et du sujet âgé, Hôpitaux Universitaires Paris-Ouest (HUPO), Centre de Gérontologie, Assistance publique - Hôpitaux de Paris (AP-HP) - Hôpital Sainte Périne, The Whitehall II study is supported by grants from the Medical Research Council, British Heart Foundation, National Heart Lung and Blood Institute (R01HL036310), US, NIH and the National Institute on Aging (R01AG013196 and R01AG034454), US, NIH. H.N. is supported by a grant from Institut de Recherche en Santé Publique (IReSP). M.K. is sup- ported by the Medical Research Council (K013351), the EU OSH ERA Research Programme, the Academy of Finland, the US National Institutes of Health (R01HL036310, R01AG034454) and an ESRC professorship. J.V. is supported by the EU ERA-AGE2 Research Programme. M.J.S. is sup- ported by a grant from the British Heart Foundation. A.S.-M. is supported by a ‘European Young Investigator Award’ from the European Science Foundation, and the National Institute on Aging, NIH (R01AG013196, R01AG034454)., Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Institut de psychiatrie et neurosciences (U894 / UMS 1266), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Sainte Perine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), SZTAJNBOK, Pascale, and Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Male, Epidemiology, Coronary Disease, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, MESH: Perception, law.invention, 0302 clinical medicine, Randomized controlled trial, MESH: Risk Factors, law, Interquartile range, Risk Factors, London, 030212 general & internal medicine, Myocardial infarction, Prospective cohort study, MESH: Middle Aged, Hazard ratio, MESH: Stress, Psychological, ta3142, Middle Aged, 3. Good health, Coronary heart disease, Female, Cardiology and Cardiovascular Medicine, Attitude to Health, Cohort study, MESH: Socioeconomic Factors, medicine.medical_specialty, MESH: Attitude to Health, Stress, 03 medical and health sciences, Social support, Clinical Research, Internal medicine, medicine, Humans, MESH: Kaplan-Meier Estimate, MESH: Humans, business.industry, MESH: London, medicine.disease, MESH: Male, MESH: Prospective Studies, Socioeconomic Factors, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Physical therapy, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Perception, MESH: Coronary Disease, business, MESH: Female, Prospective studies, Stress, Psychological
Abstract

International audience; Response to stress can vary greatly between individuals. However, it remains unknown whether perceived impact of stress on health is associated with adverse health outcomes. We examined whether individuals who report that stress adversely affects their health are at increased risk of coronary heart disease (CHD) compared with those who report that stress has no adverse health impact. Analyses are based on 7268 men and women (mean age: 49.5 years, interquartile range: 11 years) from the British Whitehall II cohort study. Over 18 years of follow-up, there were 352 coronary deaths or first non-fatal myocardial infarction (MI) events. After adjustment for sociodemographic characteristics, participants who reported at baseline that stress has affected their health 'a lot or extremely' had a 2.12 times higher (95% CI 1.52-2.98) risk of coronary death or incident non-fatal MI when compared with those who reported no effect of stress on their health. This association was attenuated but remained statistically significant after adjustment for biological, behavioural, and other psychological risk factors including perceived stress levels, and measures of social support; fully adjusted hazard ratio: 1.49 (95% CI 1.01-2.22). In this prospective cohort study, the perception that stress affects health, different from perceived stress levels, was associated with an increased risk of coronary heart disease. Randomized controlled trials are needed to determine whether disease risk can be reduced by increasing clinical attention to those who complain that stress greatly affects their health.

Published
2013
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8. Adherence to treatment in systemic lupus erythematosus patients

Author

Gaëlle Guettrot-Imbert, Jacques Pouchot, Nathalie Costedoat-Chalumeau, Véronique Le Guern, Jean-Charles Piette, Donata Marra, Nathalie Morel, Gaëlle Leroux, Université Paris Descartes - Paris 5 (UPD5), Service de médecine interne et centre de référence des maladies rares [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Médecine Interne [CHU HEGP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Centre de référence des syndromes drépanocytaires majeurs, Université de Clermont-Ferrand, Service de Médecine Interne [CHU Clermont-Ferrand], CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de Chirurgie Générale, Viscérale et Endocrinienne [CHU Pitié-Sapêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Cochin [AP-HP]-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Centre de référence des syndromes drépanocytaires majeurs, Service de Médecine Interne Clermont Ferrand (MéDECINE INTERNE - CLERMONT-FERRAND), Hopital, CHU Pitié-Salpêtrière [APHP], Service de Chirurgie Générale [CHU Pitié-Salpêtrière], and Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP]

Subjects
medicine.medical_specialty, MESH: Antirheumatic Agents, MESH: Hydroxychloroquine, MESH: Attitude to Health, Medication adherence, Disease, Therapeutic drug monitoring, Medication Adherence, Poor adherence, 03 medical and health sciences, 0302 clinical medicine, Systemic lupus erythematosus, Rheumatology, MESH: Drug Monitoring, Medicine, Humans, Lupus Erythematosus, Systemic, In patient, MESH: Lupus Erythematosus, Systemic, 030212 general & internal medicine, skin and connective tissue diseases, Intensive care medicine, 030203 arthritis & rheumatology, MESH: Humans, medicine.diagnostic_test, business.industry, Health advice, Hydroxychloroquine, MESH: Medication Adherence, 3. Good health, Adherence, Antirheumatic Agents, Assessment methods, Physical therapy, MESH: Biomarkers, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Drug Monitoring, business, Attitude to Health, Biomarkers, Flare, medicine.drug, Compliance
Abstract

International audience; Adherence is defined as "the extent to which a person's behaviour coincides with medical or health advice." Poor adherence to therapeutic regimens is a common and expensive problem in patients with chronic diseases including systemic lupus erythematosus (SLE) and is associated with a higher risk of flares, morbidity, hospitalisations and poor renal outcome. Non-adherence to the treatment is multifactorial for most patients and varies according to unintentional or intentional patterns. The rates of non-adherence in SLE patients range from 3% to 76% depending on the assessment methods, which are all subject to limitations. Indeed, poor adherence to therapeutic regimens is difficult to evaluate. Two studies have shown that undetectable blood hydroxychloroquine (HCQ) concentration may be a simple, objective and reliable marker of non-adherence in SLE patients. The accurate diagnosis of non-adherence may prevent one from incorrectly interpreting disease manifestations as a lack of response. It may then avoid an unnecessary or even dangerous treatment escalation.

Published
2013
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9. Adherence to and effectiveness of highly active antiretroviral treatment for HIV infection: assessing the bidirectional relationship

Author

Luminita Schneider, Bruno Spire, Christian Michelet, Maria Patrizia Carrieri, Camelia Protopopescu, Catherine Leport, Fidéline Collin, François Raffi, Karine Lamiraud, Jean-Paul Moatti, Théorie économique, modélisation et applications (THEMA), Université de Cergy Pontoise (UCP), Université Paris-Seine-Université Paris-Seine-Centre National de la Recherche Scientifique (CNRS), ESSEC Business School, Essec Business School, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U912 INSERM - Aix Marseille Univ - IRD), Institut de Recherche pour le Développement (IRD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Aix Marseille Université (AMU), ORS PACA, Aix Marseille Université (AMU), Maladies infectieuses et tropicales, Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Service des maladies infectieuses et tropicales [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Epidémiologie et Biostatistique [Bordeaux], Université Bordeaux Segalen - Bordeaux 2-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Modèles et méthodes de l'évaluation thérapeutique des maladies chroniques (U738 / UMR_S738), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Crepin, Anne, Economics Department, Service des maladies infectieuses et réanimation médicale [Rennes] = Infectious Disease and Intensive Care [Rennes], CHU Pontchaillou [Rennes], Service de Maladies Infectieuses et Tropicales [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Laboratoire de recherche en pathologie infectieuse, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)

Subjects
Adherence, HIV, relationship between adherence and effectiveness, simultaneous equations, GEE, Male, MESH: CD4 Lymphocyte Count, Human immunodeficiency virus (HIV), Psychological intervention, HIV Infections, medicine.disease_cause, 01 natural sciences, Gee, MESH: Antiretroviral Therapy, Highly Active, HI, Cohort Studies, 010104 statistics & probability, 0302 clinical medicine, JEL: I - Health, Education, and Welfare/I.I1 - Health, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Antiretroviral Therapy, Highly Active, Hiv infected patients, 030212 general & internal medicine, adherence, MESH: Cohort Studies, MESH: Treatment Outcome, MESH: Middle Aged, Depression, MESH: HIV Infections, Middle Aged, Response to treatment, 3. Good health, Models, Economic, Treatment Outcome, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, Data Interpretation, Statistical, [SHS.GESTION]Humanities and Social Sciences/Business administration, Female, [SHS.GESTION] Humanities and Social Sciences/Business administration, Attitude to Health, Adult, medicine.medical_specialty, MESH: Socioeconomic Factors, Alcohol Drinking, MESH: Depression, MESH: Attitude to Health, Medication Adherence, Plasma viral load, 03 medical and health sciences, medicine, Antiretroviral treatment, Humans, 0101 mathematics, Intensive care medicine, MESH: Models, Economic, MESH: Humans, Adherence,HIV,relationship between adherence and effectiveness,simultaneous equations,GEE, business.industry, Public Health, Environmental and Occupational Health, MESH: Adult, JEL: C - Mathematical and Quantitative Methods/C.C3 - Multiple or Simultaneous Equation Models • Multiple Variables, MESH: Medication Adherence, MESH: Male, CD4 Lymphocyte Count, Socioeconomic Factors, Immunology, business, MESH: Data Interpretation, Statistical, MESH: Female, MESH: Alcohol Drinking
Abstract

International audience; BACKGROUND: It is well established that high adherence to HIV-infected patients on highly active antiretroviral treatment (HAART) is a major determinant of virological and immunologic success. Furthermore, psychosocial research has identified a wide range of adherence factors including patients' subjective beliefs about the effectiveness of HAART. Current statistical approaches, mainly based on the separate identification either of factors associated with treatment effectiveness or of those associated with adherence, fail to properly explore the true relationship between adherence and treatment effectiveness. Adherence behavior may be influenced not only by perceived benefits-which are usually the focus of related studies-but also by objective treatment benefits reflected in biological outcomes. METHODS: Our objective was to assess the bidirectional relationship between adherence and response to treatment among patients enrolled in the ANRS CO8 APROCO-COPILOTE study. We compared a conventional statistical approach based on the separate estimations of an adherence and an effectiveness equation to an econometric approach using a 2-equation simultaneous system based on the same 2 equations. RESULTS: Our results highlight a reciprocal relationship between adherence and treatment effectiveness. After controlling for endogeneity, adherence was positively associated with treatment effectiveness. Furthermore, CD4 count gain after baseline was found to have a positive significant effect on adherence at each observation period. This immunologic parameter was not significant when the adherence equation was estimated separately. In the 2-equation model, the covariances between disturbances of both equations were found to be significant, thus confirming the statistical appropriacy of studying adherence and treatment effectiveness jointly. CONCLUSIONS: Our results, which suggest that positive biological results arising as a result of high adherence levels, in turn reinforce continued adherence and strengthen the argument that patients who do not experience rapid improvement in their immunologic and clinical statuses after HAART initiation should be prioritized when developing adherence support interventions. Furthermore, they invalidate the hypothesis that HAART leads to "false reassurance" among HIV-infected patients.

Published
2012
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10. CD-ROM-based program for breastfeeding mothers

Author

Labarère, José, Gelbert-Baudino, Nathalie, Laborde, Laurent, Arragain, Domitille, Schelstraete, Camille, François, Patrice, BCM, Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-CHU Grenoble, Université Grenoble Alpes - UFR Médecine (UGA UFRM), Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), CHU Grenoble, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, and VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)

Subjects
Adult, Postnatal Care, Time Factors, MESH: Attitude to Health, MESH: CD-ROM, MESH: Patient Education as Topic, Health Promotion, Patient Education as Topic, MESH: Self Concept, Humans, MESH: Postnatal Care, MESH: Computer-Assisted Instruction, MESH: Humans, MESH: Time Factors, MESH: Adult, Original Articles, Self Concept, MESH: France, Breast Feeding, CD-ROM, MESH: Breast Feeding, Female, MESH: Health Promotion, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, Attitude to Health, MESH: Female, Computer-Assisted Instruction
Abstract

International audience; The vast majority of breastfeeding mothers in Western countries have routine access to multimedia and Internet resources at home. The aim of this study was to assess the effectiveness of a CD-ROM-based intervention in increasing the rates of breastfeeding. We conducted a pre- and post-intervention study involving four control and four intervention maternity units in France. All breastfeeding mothers in intervention units were given a CD-ROM-based program addressing various breastfeeding topics. The primary outcome was any breastfeeding at 4 weeks assessed by follow-up telephone interview. The secondary outcomes included breastfeeding duration, breastfeeding difficulties after discharge and satisfaction with the breastfeeding experience. The rates of any breastfeeding at 4 weeks varied from 88.6% (209/236) to 87.9% (211/240) and from 86.0% (222/258) to 88.0% (228/259) for mothers enrolled in intervention and control maternity units, respectively (P for interaction=0.54). The hazard of breastfeeding discontinuation for mothers enrolled in intervention units did not vary significantly across study periods after adjusting for education level, epidural anaesthesia, breastfeeding assessment score and return to work (P for interaction=0.18). The rates of breastfeeding at 4 weeks remained unchanged when restricting the analysis to the mothers who actually received (87.8% [173/197]) or used [88.2% (105/119)] the CD-ROM during the post-intervention period. No significant differences were found in secondary outcomes between the two study groups. A CD-ROM-based intervention for breastfeeding mothers provides no additional benefit to usual post-natal care. Further study is needed to assess the effectiveness of multimedia packages as part of more intensive multifaceted interventions.

Published
2011
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11. Sociocultural dimension of epilepsy: an anthropological study among Guaraní communities in Bolivia--an International League Against Epilepsy/International Bureau for Epilepsy/World Health Organization Global Campaign against Epilepsy regional project

Author

Higinio Segundo, Donata Magnelli, Alessandra Nicoletti, Mario Zappia, Vito Sofia, Alessandro Bartoloni, Filippo Bartalesi, Elisa Bruno, Graziella Quattrocchi, Sandra Padilla, Elio Ortiz, Pierre-Marie Preux, Florentina Rafael, Department of Neurosciences, Università degli studi di Catania [Catania], Neuroépidémiologie Tropicale et Comparée (NETEC), Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST FR CNRS 3503)-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Université de Limoges (UNILIM), Service de l'Information Médicale et de l'Évaluation [CHU Limoges] (SIME), CHU Limoges, Laboratoire de Biostatistique et d'Informatique Médicale, and Université de Limoges (UNILIM)

Subjects
Complementary Therapies, Male, International Cooperation, Culture, Disease, MESH: World Health Organization, MESH: Anthropology, Behavioral Neuroscience, Epilepsy, MESH: Aged, 80 and over, 0302 clinical medicine, Residence Characteristics, Health care, MESH: Residence Characteristics, Medical anthropology, Sociocultural evolution, media_common, MESH: Aged, Aged, 80 and over, education.field_of_study, MESH: Middle Aged, Middle Aged, MESH: Interviews as Topic, MESH: Bolivia, 3. Good health, Neurology, Feeling, MESH: Young Adult, MESH: Epilepsy, Anticonvulsants, Female, MESH: Culture, Attitude to Health, Adult, medicine.medical_specialty, Bolivia, Adolescent, media_common.quotation_subject, 030231 tropical medicine, Population, MESH: Attitude to Health, World Health Organization, Interviews as Topic, 03 medical and health sciences, Young Adult, MESH: Anticonvulsants, medicine, Humans, education, Psychiatry, Aged, MESH: Adolescent, Family Health, MESH: Humans, MESH: Complementary Therapies, business.industry, MESH: Adult, medicine.disease, MESH: Male, MESH: International Cooperation, Anthropology, MESH: Family Health, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Neurology (clinical), business, MESH: Female, 030217 neurology & neurosurgery, Traditional society
Abstract

International audience; This study was performed to analyze sociocultural beliefs about epilepsy among Guaraní communities in Bolivia. People with epilepsy, their family members, the general population, and local health care personnel were interviewed about the meaning of and beliefs, feelings, and practices concerning epilepsy. Epilepsy is called mano-mano, a term that means being in a constant passage between life and death. The disease is attributed mainly to a failure to observe a fasting period and to other eating habits. Natural remedies are the most recommended treatments even though half of respondents reported that antiepileptic drugs may be effective. The concept of epilepsy as an embodied disease with natural causes appears to differ from that documented in other traditional societies. People with epilepsy do not represent a threat to the community, which seems to have an attitude aimed at their protection. Moreover, people from these communities appear to favor a combination of biomedical and traditional care systems.

Published
2011
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12. Uptake of breast cancer screening in women aged over 75 years: a controversy to come?

Author

Yvan Coscas, Xavier Pivot, François Eisinger, Jean-François Morère, Jean-Yves Blay, Claire Roussel, Jérôme Viguier, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U912 INSERM - Aix Marseille Univ - IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Recherche en Cancérologie de Lyon (UNICANCER/CRCL), Centre Léon Bérard [Lyon]-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Clinique de la Porte de St Cloud, ROCHE SAS, Roche SAS, Service d'Oncologie Médicale [CHRU Besançon], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Institut de Recherche pour le Développement (IRD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Aix Marseille Université (AMU), E11, and Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre Léon Bérard [Lyon]-Université Claude Bernard Lyon 1 (UCBL)

Subjects
MESH: Carcinoma, Cancer Research, Epidemiology, Breast cancer screening, 0302 clinical medicine, MESH: Aged, 80 and over, 030212 general & internal medicine, Early Detection of Cancer, Aged, 80 and over, MESH: Aged, education.field_of_study, medicine.diagnostic_test, Attendance, Age Factors, Health Care Costs, Dissent and Disputes, 3. Good health, Oncology, Female, France, 0305 other medical science, Attitude to Health, Algorithms, Mammography, medicine.medical_specialty, Population, MESH: Mammography, MESH: Attitude to Health, MESH: Health Care Costs, Breast Neoplasms, MESH: Algorithms, [SDV.CAN]Life Sciences [q-bio]/Cancer, 03 medical and health sciences, Breast cancer, medicine, Humans, MESH: Early Detection of Cancer, education, Aged, MESH: Age Factors, 030505 public health, MESH: Humans, business.industry, Public health, Carcinoma, Public Health, Environmental and Occupational Health, Odds ratio, medicine.disease, Confidence interval, MESH: France, MESH: Dissent and Disputes, business, MESH: Female, MESH: Breast Neoplasms, Demography
Abstract

International audience; In France, the age range for organized screening for breast cancer is 50-74 years. From a layperson's perspective, the public health message focusing on a specific target population may be difficult to understand. The aim of this study is to assess how women aged over 75 years deal with this absence of screening recommendations for their age group. The population-based survey, EDIFICE, was carried out by telephone in 2008. Women were interviewed with regard to their behaviour, and in particular relating to breast cancer screening. For 136 breast cancer-free women, aged 75 and above and who had undergone at least one mammography in their lifetime, the test had been done within the last 2 years for only 62 (51%) of them. In a multiregression analysis, only one item (i.e. already having undergone at least five mammographies) was statistically associated with a higher rate of attendance (odds ratio=3.3, 95% confidence interval=1.03-11.1). According to our data, for women aged 75 and above, an estimated 17,000,000 Euros are spent each year on breast cancer screening in France, the net benefit of which is still unknown.

Published
2011
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13. Factors associated with presentation to care with advanced HIV disease in Brussels and Northern France: 1997-2007

Author

Bernard Vandercam, Karine Cochonat, Pierre Bataille, Anne Vincent, Julia Salleron, Clotilde Fontier, Hugues Melliez, Yazdan Yazdanpanah, Frederique Bonnevie, Habib Guerroumi, Bakhao Ndiaye, Philippe Choisy, UCL - (SLuc) Département de médecine interne et services associés, Cellule interrégionale d'épidémiologie (CIRE), Direction Régionale des Affaires Sanitaires et Sociales du Nord Pas-de-Calais (DRASS), Laboratoire de Biostatistiques, CERIM - Faculté de Médecine, pôle Recherche-EA 2694 Santé Publique : épidémiologie et qualités des soins, COREVIH Nord Pas-de-Calais, Centre Hospitalier de Tourcoing, Pathologies infectieuses et tropicales, Cliniques Universitaires Saint-Luc [Bruxelles], Néphrologie Hémodialyse, Centre hospitalier de Boulogne sur mer, Service d'hématologie, Centre Hospitalier de Dunkerque, Service Régional Universitaire des Maladies Infectieuses et du Voyageur, Service VIH, CH Lens-Pôle Santé Publique de Lens-Service d'Addictologie du CH de Lens, Dermatologie - Vénérologie, Centre Hospitalier de Valenciennes, Inflammation: mécanismes et régulation et interactions avec la nutrition et les candidoses, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, Droit et Santé, We thank Stop-SIDA for their financial support, and BMC, Ed.

Subjects
Male, Pediatrics, Delayed Diagnosis, HIV Infections, Health Services Accessibility, 0302 clinical medicine, Medical microbiology, MESH: Belgium, Belgium, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, 030212 general & internal medicine, Hiv transmission, MESH: Health Services Accessibility, MESH: Middle Aged, Age Factors, virus diseases, MESH: HIV Infections, Middle Aged, 3. Good health, Infectious Diseases, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Female, France, Presentation (obstetrics), 0305 other medical science, Attitude to Health, Hiv disease, Research Article, Adult, medicine.medical_specialty, MEDLINE, MESH: Attitude to Health, Injection drug use, lcsh:Infectious and parasitic diseases, 03 medical and health sciences, medicine, Humans, In patient, lcsh:RC109-216, MESH: Age Factors, 030505 public health, MESH: Humans, business.industry, MESH: Adult, MESH: Male, MESH: France, MESH: Delayed Diagnosis, Tropical medicine, Immunology, business, MESH: Female
Abstract

Background Our objective was to determine the frequency and determinants of presentation to care with advanced HIV disease in patients who discover their HIV diagnosis at this stage as well as those with delayed presentation to care after HIV diagnosis in earlier stages. Methods We collected data on 1,819 HIV-infected patients in Brussels (Belgium) and Northern France from January 1997 to December 2007. "Advanced HIV disease" was defined as CD4 count 3 or clinically-defined AIDS at study inclusion and was stratified into two groups: (a) late testing, defined as presentation to care with advanced HIV disease and HIV diagnosis ≤6 months before initiation of HIV care; and (b) delayed presentation to care, defined as presentation to care with advanced HIV disease and HIV diagnosis >6 months before initiation of HIV care. We used multinomial logistic regression to determine the factors associated with delayed presentation to care and late testing. Results Of the 570 patients initiating care with advanced HIV disease, 475 (83.3%) were tested late and 95 (16.7%) had delayed presentation to care. Risk factors for delayed presentation to care were: age 30-50 years, injection drug use, and follow-up in Brussels. Risk factors for late testing were: sub-Saharan African origin, male gender, and older age. HIV transmission through heterosexual contact was associated with an increased risk of both delayed presentation to care and late testing. Patients who initiated HIV care in 2003-2007 were less likely to have been tested late or to have a delayed presentation to care than patients who initiated care before 2003. Conclusion A considerable proportion of HIV-infected patients present to care with advanced HIV disease. Late testing, rather than a delay in initiating care after earlier HIV testing, is the main determinant of presentation to care with advanced HIV disease. The factors associated with delay presentation to care differ from those associated with late testing. Different strategies should be developed to optimize early access to care in these two groups.

Published
2010
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14. Determinants of the frequency of online health information seeking: results of a web-based survey conducted in France in 2007.: Determinants of ehealth searches' frequency

Author

Renahy, Emilie, Parizot, Isabelle, Chauvin, Pierre, Chauvin, Pierre, ESIM - Déterminants Sociaux de la Santé et du Recours aux Soins (DS3), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Maurice Halbwachs (CMH), École des hautes études en sciences sociales (EHESS)-Centre National de la Recherche Scientifique (CNRS)-Département de Sciences sociales ENS-PSL, École normale supérieure - Paris (ENS-PSL), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-École normale supérieure - Paris (ENS-PSL), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL), Pôle de Pharmacie - Santé Publique - Information médicale [CHU Saint-Antoine], Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), and E. Renahy was a recipient of a research grant from the French Ministry of Research. This work is a part of a research program supported by the City of Paris Medical and Health Research Fund.

Subjects
MESH: Adolescent, MESH: Age Factors, MESH: Socioeconomic Factors, MESH: Middle Aged, MESH: Humans, MESH: Questionnaires, education, MESH: Attitude to Health, MESH: Consumer Health Information, MESH: Adult, MESH: Caregivers, MESH: Male, MESH: France, MESH: Internet, MESH: Sex Factors, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Young Adult, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Female, MESH: Health Status
Abstract

International audience; In the general population, social disparities in Internet practices have been less described than disparities in health information access. Aim is to determine whether there are differences in the frequency of Internet use for health information among health seekers. We conducted an Internet-based survey from November 2006 to March 2007. We considered the 3720 residents of France who had searched for health information during the previous 12 months. This study reveals different uses of the Internet for health information seeking (HIS) between men and women and between the general population and people who work in the health sector. Health status, taking care of somebody who is sick, and active Internet use were associated with higher frequencies of online HIS to varying degrees. The effects of age and level of education were not clear or were not significant. Greater health concerns and some issues in the physician-patient relationship were associated with higher frequencies of Internet use for HIS in the general population. Considering that this increasing use of online tools for HIS is consistent with current public health policies that promote the development of the 'informed patient', one should remain cautious about these social disparities in online HIS practices.

Published
2010
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15. Determinants of the frequency of online health information seeking: results of a web-based survey conducted in France in 2007.: Determinants of ehealth searches' frequency

Author

Renahy, Emilie, Parizot, Isabelle, Chauvin, Pierre, ESIM - Déterminants Sociaux de la Santé et du Recours aux Soins (DS3), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Maurice Halbwachs (CMH), École normale supérieure - Paris (ENS Paris), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-École des hautes études en sciences sociales (EHESS)-Centre National de la Recherche Scientifique (CNRS), Pôle de Pharmacie - Santé Publique - Information médicale [Saint-Antoine], Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), E. Renahy was a recipient of a research grant from the French Ministry of Research. This work is a part of a research program supported by the City of Paris Medical and Health Research Fund., École des hautes études en sciences sociales (EHESS)-Centre National de la Recherche Scientifique (CNRS)-Département de Sciences sociales ENS-PSL, École normale supérieure - Paris (ENS-PSL), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-École normale supérieure - Paris (ENS-PSL), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL), CHU Saint-Antoine [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)

Subjects
MESH: Adolescent, MESH: Age Factors, MESH: Socioeconomic Factors, MESH: Middle Aged, MESH: Humans, MESH: Questionnaires, education, MESH: Attitude to Health, MESH: Consumer Health Information, MESH: Adult, MESH: Caregivers, MESH: Male, MESH: France, MESH: Internet, MESH: Sex Factors, MESH: Young Adult, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Female, MESH: Health Status
Abstract

International audience; In the general population, social disparities in Internet practices have been less described than disparities in health information access. Aim is to determine whether there are differences in the frequency of Internet use for health information among health seekers. We conducted an Internet-based survey from November 2006 to March 2007. We considered the 3720 residents of France who had searched for health information during the previous 12 months. This study reveals different uses of the Internet for health information seeking (HIS) between men and women and between the general population and people who work in the health sector. Health status, taking care of somebody who is sick, and active Internet use were associated with higher frequencies of online HIS to varying degrees. The effects of age and level of education were not clear or were not significant. Greater health concerns and some issues in the physician-patient relationship were associated with higher frequencies of Internet use for HIS in the general population. Considering that this increasing use of online tools for HIS is consistent with current public health policies that promote the development of the 'informed patient', one should remain cautious about these social disparities in online HIS practices.

Published
2010
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16. Risk perception and priority setting for intervention among hepatitis C virus and environmental risks: a cross-sectional survey in the Cairo community

Author

Mostafa K. Mohamed, Arnaud Fontanet, Stéphane Luchini, Fabrice Carrat, Sahar Dewedar, Michaël Schwarzinger, R.R. Gad, Epidémiologie des maladies infectieuses et modélisation (ESIM), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Department of Health Research and Policy [Stanford] (HRP), Stanford Medicine, Stanford University-Stanford University, Department of Community, Université Ain Shams-Faculty of Medicine-Environmental and Occupational Medicine, Epidémiologie des Maladies Emergentes - Emerging Diseases Epidemiology, Pasteur-Cnam Risques infectieux et émergents (PACRI), Institut Pasteur [Paris] (IP)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Institut Pasteur [Paris] (IP)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Groupement de Recherche en Économie Quantitative d'Aix-Marseille (GREQAM), École des hautes études en sciences sociales (EHESS)-Aix Marseille Université (AMU)-École Centrale de Marseille (ECM)-Centre National de la Recherche Scientifique (CNRS), This work was supported by the Agence Nationale de Recherche sur le SIDA et les hépatites - France (grant number ANRS 12.79)., Institut Pasteur [Paris]-Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Institut Pasteur [Paris]-Conservatoire National des Arts et Métiers [CNAM] (CNAM), Pôle de Pharmacie - Santé Publique - Information médicale [Saint-Antoine], Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), École Centrale de Marseille (ECM)-École des hautes études en sciences sociales (EHESS)-Centre National de la Recherche Scientifique (CNRS)-Aix Marseille Université (AMU), Pôle de Pharmacie - Santé Publique - Information médicale [CHU Saint-Antoine], and BMC, Ed.

Subjects
Male, Cross-sectional study, Psychological intervention, Hepacivirus, MESH: Risk Assessment, Health Services Accessibility, MESH: Egypt, 0302 clinical medicine, Cost of Illness, 11. Sustainability, Health care, Epidemiology, MESH: Hepacivirus, 030212 general & internal medicine, MESH: Health Services Accessibility, MESH: Middle Aged, lcsh:Public aspects of medicine, 1. No poverty, Hepatitis C, Middle Aged, MESH: Cost of Illness, MESH: Interviews as Topic, 6. Clean water, 3. Good health, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, 030220 oncology & carcinogenesis, Egypt, Female, Public Health, MESH: Public Health, Attitude to Health, Research Article, Adult, medicine.medical_specialty, MESH: Attitude to Health, Risk Assessment, Interviews as Topic, 03 medical and health sciences, MESH: Cross-Sectional Studies, Environmental health, medicine, Humans, [SDV.MP] Life Sciences [q-bio]/Microbiology and Parasitology, MESH: Hepatitis C, MESH: Humans, business.industry, Public health, Public Health, Environmental and Occupational Health, lcsh:RA1-1270, MESH: Adult, medicine.disease, MESH: Male, Risk perception, Cross-Sectional Studies, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Biostatistics, business, MESH: Female
Abstract

Background Hepatitis C virus (HCV) recently emerged as a major public health hazard in Egypt. However, dramatic healthcare budget constraints limit access to the costly treatment. We assessed risk perception and priority setting for intervention among HCV, unsafe water, and outdoor air pollution in Cairo city. Methods A survey was conducted in the homes of a representative sample of household heads in Cairo city. Risk perception was assessed using the "psychometric paradigm" where health hazards are evaluated according to several attributes and then summarized by principal component analysis. Priority setting was assessed by individual ranking of interventions reducing health hazards by 50% over five years. The Condorcet method was used to aggregate individual rankings of the three interventions (main study) or two of three interventions (validation study). Explanatory factors of priority setting were explored in multivariate generalized logistic models. Results HCV was perceived as having the most severe consequences in terms of illness and out-of-pocket costs, while outdoor air pollution was perceived as the most uncontrollable risk. In the main study (n = 2,603), improved water supply received higher priority than both improved outdoor air quality (60.1%, P < .0001) and screening and treatment of chronic hepatitis C (66.3%, P < .0001), as confirmed in the validation study (n = 1,019). Higher education, report of HCV-related diseases in the household, and perception of HCV as the most severe risk were significantly associated to setting HCV treatment as the first priority. Conclusions The Cairo community prefers to further improving water supply as compared to improved outdoor air quality and screening and treatment of chronic hepatitis C.

Published
2010
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17. Adherence and effectiveness of drug combination in curative treatment among children suffering uncomplicated malaria in rural Senegal

Author

Diarietou Sow, Aurélia Souares, Jean-Yves Le Hesran, Richard Lalou, Ibra Sene, Santé de la mère et de l'enfant en milieu tropical : épidémiologie génétique et périnatale, Université Paris Descartes - Paris 5 (UPD5), Laboratoire Population-Environnement-Développement (LPED), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU), and Institut de Recherche pour le Développement (IRD) - Université de Provence - Aix-Marseille 1 - Aix Marseille Université (AMU)

Subjects
Male, Pediatrics, medicine.medical_treatment, Rural Health, Parasitemia, Drug resistance, 0302 clinical medicine, Chloroquine, MESH: Child, MESH: Animals, 030212 general & internal medicine, Malaria, Falciparum, Treatment outcome, Child, MESH: Plasmodium falciparum, MESH: Treatment Outcome, education.field_of_study, MESH: Malaria, Falciparum, Drug combination therapy, General Medicine, MESH: Caregivers, MESH: Patient Compliance, MESH: Infant, Senegal, 3. Good health, Drug Combinations, Pyrimethamine, Treatment Outcome, Infectious Diseases, Caregivers, Child, Preschool, Drug Therapy, Combination, Female, Attitude to Health, medicine.drug, medicine.medical_specialty, Sulfadoxine, MESH: Pyrimethamine, Plasmodium falciparum, 030231 tropical medicine, Population, MESH: Attitude to Health, Amodiaquine, Medication Adherence, Antimalarials, 03 medical and health sciences, MESH: Senegal, parasitic diseases, medicine, Animals, Humans, [SDV.EE.SANT] Life Sciences [q-bio]/Ecology, environment/Health, education, MESH: Amodiaquine, MESH: Drug Combinations, [SDV.EE.SANT]Life Sciences [q-bio]/Ecology, environment/Health, MESH: Humans, business.industry, MESH: Child, Preschool, Public Health, Environmental and Occupational Health, Infant, MESH: Medication Adherence, MESH: Rural Health, medicine.disease, MESH: Antimalarials, MESH: Male, Malaria, MESH: Drug Therapy, Combination, Clinical research, Adherence, Patient Compliance, Parasitology, business, MESH: Female, MESH: Sulfadoxine
Abstract

Increased Plasmodium falciparum resistance to chloroquine has prompted national malaria programs to develop new policies in several African countries. Less than a year after the introduction of amodiaquine/sulfadoxine-pyrimethamine (AQ/SP) as first-line treatment in Senegal, we examined adherence rates to therapy and its efficacy among children. The study was conducted in five dispensaries in rural Senegal. Children aged 2-10 years with a presumptive diagnosis of malaria were prescribed AQ/SP. Thick blood film analyses were carried out on days 0, 3, 7, 14 and 28. Blood and urine samples were collected on day 3 for drug level measurements. The principal caregivers were questioned on treatment adherence. Among the 289 recruited children, 144 had a parasitemia >2500/microl. The results demonstrated markedly good efficacy for the treatment, as no detectable parasitemia was observed on day 28 for 97.9% of the children. However, we noticed that 35.3% of children did not comply with the recommended doses and 62.3% did not exactly adhere to the drug schedule. Despite the good efficacy of the drugs, adherence to the therapeutic scheme was poor. Strategies to promote patient adherence would improve drug performance and thus might help to prevent the rapid emergence of drug resistance.

Published
2008
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18. Impact of organised programs on colorectal cancer screening

Author

Sylvie Dolbeault, Claire Roussel, Anne Calazel-Benque, Jean-François Morère, Xavier Pivot, Daniel Serin, Olivier Rixe, Jean-Yves Blay, Laurent Cals, Yvan Coscas, François Eisinger, Moïse Namer, Cancérologie (Inserm U599/IPC), Université de la Méditerranée - Aix-Marseille 2-Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hopital Font-Pre, Capio Clinique du Parc, Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Clinique de la Porte de St Cloud, Conception synthèse et étude d'antitumoraux, Institut Curie [Paris]-Centre National de la Recherche Scientifique (CNRS), Centre Azureen de cancérologie, Interactions hôte-greffon-tumeur, ingénierie cellulaire et génique - UFC (UMR INSERM 1098) (RIGHT), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Etablissement français du sang [Bourgogne-Franche-Comté] (EFS [Bourgogne-Franche-Comté]), Service d'Oncologie Médicale [CHRU Besançon], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut Sainte Catherine [Avignon], ROCHE SAS, Roche SAS, Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), The EDIFICE committee, Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement français du sang [Bourgogne-Franche-Comté] (EFS BFC)-Université de Franche-Comté (UFC), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Saas, Philippe, and Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement français du sang [Bourgogne-Franche-Comté] (EFS [Bourgogne-Franche-Comté])-Université de Franche-Comté (UFC)

Subjects
Male, Cancer Research, Colorectal cancer, MESH: Logistic Models, MESH: Health Care Surveys, Logistic regression, 0302 clinical medicine, Mass Screening, Practice Patterns, Physicians', MESH: Aged, education.field_of_study, MESH: Middle Aged, Physicians, Family, Middle Aged, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, 3. Good health, Oncology, Colorectal cancer screening, 030220 oncology & carcinogenesis, [SDV.IMM]Life Sciences [q-bio]/Immunology, Female, 030211 gastroenterology & hepatology, France, Colorectal Neoplasms, Attitude to Health, Research Article, medicine.medical_specialty, [SDV.IMM] Life Sciences [q-bio]/Immunology, Attitude of Health Personnel, MESH: Physicians, Family, MESH: Attitude of Health Personnel, Population, MESH: Attitude to Health, MEDLINE, lcsh:RC254-282, 03 medical and health sciences, Genetics, medicine, Humans, MESH: Mass Screening, MESH: Physician's Practice Patterns, education, Mass screening, Aged, Gynecology, MESH: Humans, business.industry, Odds ratio, medicine.disease, MESH: Male, MESH: France, Logistic Models, Health Care Surveys, Family medicine, Observational study, business, MESH: Female, MESH: Colorectal Neoplasms
Abstract

Purpose Colorectal cancer (CRC) screening has been shown to decrease CRC mortality. Organised mass screening programs are being implemented in France. Its perception in the general population and by general practitioners is not well known. Methods Two nationwide observational telephone surveys were conducted in early 2005. First among a representative sample of subjects living in France and aged between 50 and 74 years that covered both geographical departments with and without implemented screening services. Second among General Practionners (Gps). Descriptive and multiple logistic regression was carried out. Results Twenty-five percent of the persons(N = 1509) reported having undergone at least one CRC screening, 18% of the 600 interviewed GPs reported recommending a screening test for CRC systematically to their patients aged 50–74 years. The odds ratio (OR) of having undergone a screening test using FOBT was 3.91 (95% CI: 2.49–6.16) for those living in organised departments (referent group living in departments without organised screening), almost twice as high as impact educational level (OR = 2.03; 95% CI: 1.19–3.47). Conclusion CRC screening is improved in geographical departments where it is organised by health authorities. In France, an organised screening programs decrease inequalities for CRC screening.

Published
2008
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19. [The Alzheimer's disease or the fall of the neocortical empire at the age of nonsense]

Author

Valleix, Denis, Service de Chirurgie Viscérale et Transplantation [CHU Limoges], CHU Limoges, Equipe de Recherche Médicale Appliquée (ERMA), and Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST FR CNRS 3503)-Université de Limoges (UNILIM)-CHU Limoges

Subjects
Neurons, MESH: Hippocampus, MESH: Humans, MESH: Attitude to Health, MESH: Neurons, Neocortex, History, 20th Century, Hippocampus, MESH: Limbic System, MESH: Neocortex, Alzheimer Disease, Limbic System, Humans, MESH: History, 20th Century, Attitude to Health, MESH: Alzheimer Disease, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

ERMA; International audience; If we observe the evolution of the Alzheimer's disease of a premature entorhinal stage at an evolved stage of the neocortex, the succession of the confusions of the simple mnesic complaint in the aphasia, praxia, gnosia, visual, psychological and comportemental difficulties testify of the extension of the lesions in the neocortical structures. This neocortical regression seems to take the inverse road of the phylo- and ontogenetic evolution, where this hegemonic neocerebral cortex - which had grown again on the borders of the archeocortical and paleocortical barbarian empire - sees itself dispossessed of its conquests and gives free rein to these ancestral structures. We could compare the Alzheimer's disease with the fall of the neocortical empire at the age of nonsense.

Published
2008
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20. Breast cancer screening in France: results of the EDIFICE survey

Author

Yvan Coscas, Daniel Serin, Jf Morere, François Eisinger, L. Cals, Xavier Pivot, Jean-Yves Blay, Olivier Rixe, Moïse Namer, Sylvie Dolbeault, Claire Roussel, Interactions hôte-greffon-tumeur, ingénierie cellulaire et génique - UFC (UMR INSERM 1098) (RIGHT), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Etablissement français du sang [Bourgogne-Franche-Comté] (EFS [Bourgogne-Franche-Comté]), CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre de la Porte de Saint-Cloud, Hôpital Front-Pré, CHITS, Centre Azuréen de cancérologie, Centre Azureen de cancérologie, Institut Sainte Catherine [Avignon], Conception synthèse et étude d'antitumoraux, Institut Curie [Paris]-Centre National de la Recherche Scientifique (CNRS), Cancérologie (Inserm U599/IPC), Université de la Méditerranée - Aix-Marseille 2-Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Roche Affiliate, Centre Léon Bérard [Lyon], Saas, Philippe, Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement français du sang [Bourgogne-Franche-Comté] (EFS [Bourgogne-Franche-Comté])-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement français du sang [Bourgogne-Franche-Comté] (EFS BFC)-Université de Franche-Comté (UFC)

Subjects
Medical Oncology, Breast cancer screening, 0302 clinical medicine, Breast cancer, 5. Gender equality, Cancer screening, Odds Ratio, Mass Screening, Tissue Distribution, 030212 general & internal medicine, Survey, MESH: Medical Oncology, MESH: Aged, education.field_of_study, MESH: Middle Aged, medicine.diagnostic_test, General Medicine, Middle Aged, 3. Good health, 030220 oncology & carcinogenesis, [SDV.IMM]Life Sciences [q-bio]/Immunology, Female, France, Attitude to Health, Research Paper, Adult, medicine.medical_specialty, [SDV.IMM] Life Sciences [q-bio]/Immunology, mammography, Population, MESH: Mammography, MESH: Attitude to Health, Breast Neoplasms, MESH: Multivariate Analysis, 03 medical and health sciences, medicine, Mammography, Humans, MESH: Mass Screening, MESH: Tissue Distribution, education, Mass screening, Aged, Gynecology, MESH: Humans, business.industry, screening, MESH: Adult, Odds ratio, medicine.disease, MESH: Odds Ratio, MESH: France, Family medicine, Multivariate Analysis, Observational study, MESH: Gynecology, business, MESH: Female, MESH: Breast Neoplasms
Abstract

International audience; BACKGROUND: The EDIFICE survey aimed to investigate the compliance of the general population to the screening tests available in France for the 4 most common cancers: breast, colorectal, prostate and lung. Implementation of breast cancer screening has been generalized in France since 2003: women aged between 50 and 74 years are systematically invited to perform a mammography every second year. Results pertaining to breast cancer are reported hereafter. METHODS: This nationwide observational survey was carried out in France from 18 January to 2 February 2005 among representative samples of 773 women aged between 40 and 75 years and 600 general practitioners (GPs). Information collected included socio-demographic characteristics, attitude towards cancer screening and actual experience of cancer screening, as well as GPs' practice regarding screening. The precision of the results is +/- 4.3% for a 95% confidence interval. RESULTS: Among the 507 participating women aged between 50 and 74 years, 92.5% (469/507) had undergone at least one mammography: 54.6% (256/469) underwent this test on their own initiative and 44.6% (209/469) of women performed it in the framework of a systematic screening plan. Most women participating in the systematic screening (89.0% i.e. 186/209) had a mammography within the last dating from less than 2 years versus 73.8% (189/256) of those who performed it outside the screening program (Chi(2) test; p

Published
2008

21. Overcoming a stigma: the lung cancer patient in the intensive care unit

Author

N. Schönfeld, Jean-François Timsit, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, INSERM U823, équipe 11 (Epidémiologie des cancers et des affections graves), Institut d'oncologie/développement Albert Bonniot de Grenoble (INSERM U823), Institut National de la Santé et de la Recherche Médicale (INSERM)-EFS-CHU Grenoble-Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM)-EFS-CHU Grenoble-Université Joseph Fourier - Grenoble 1 (UJF)-Service de réanimation cardio-vasculaire et thoracique, Hôpital Michallon-CHU Grenoble-Université Joseph Fourier - Grenoble 1 (UJF)-Hôpital Michallon, Vesin, Aurélien, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM)-Service de réanimation cardio-vasculaire et thoracique, and Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon-Hôpital Michallon

Subjects
Pulmonary and Respiratory Medicine, MESH: Ethics, Medical, medicine.medical_specialty, Lung Neoplasms, Time Factors, Referral, MESH: Attitude to Health, Pulmonary disease, Disease, law.invention, 03 medical and health sciences, 0302 clinical medicine, Patient Admission, Bias, law, Intensive care, medicine, Humans, Ethics, Medical, MESH: Lung, Lung cancer, Intensive care medicine, Lung, ComputingMilieux_MISCELLANEOUS, MESH: Humans, Critically ill, business.industry, MESH: Patient Admission, MESH: Time Factors, MESH: Bias (Epidemiology), medicine.disease, Intensive care unit, 3. Good health, MESH: Lung Neoplasms, Intensive Care Units, 030228 respiratory system, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, 030220 oncology & carcinogenesis, Interdisciplinary Communication, MESH: Intensive Care Units, MESH: Interdisciplinary Communication, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Complication, business, Attitude to Health
Abstract

Before embarking on a discussion of the lung cancer patient in intensive care, it is important to clarify that this editorial will not be referring to the group of patients with a good prognosis having undergone surgery with a curative intent, but to patients whose malignancies more or less determine the outcome in terms of survival time, and who are suffering from acute or subacute deterioration in the form of a complication resulting either from the underlying disease or tumour or from treatment-related sequelae. In such cases, most doctors' knowledge and experience will be confounded with those dark emotions that serve to sustain a misconception that is still associated with lung cancer patients, despite certain advances in treatment achieved through multimodal regimes and “new drugs”. As the technical possibilities of intensive medicine, including in particular the improvement of ventilation techniques with varying degrees of invasiveness, increase, it seems desirable to take a fresh look at the survival and prognostic factors in lung cancer patients admitted to a medical intensive care unit (ICU). Adam and Soubani 1 have taken up this challenge. Their results are reported in the present issue of the European Respiratory Journal . At first sight, the range of reasons leading to referral for intensive care appears quite familiar and unspectacular: first, pneumonia, followed by exacerbated chronic obstructive pulmonary disease, pulmonary oedema and haemoptysis. As with most studies of this kind 2, 3, the analysis is retrospective. However, that does not, by any means, detract from its evidential value, since the criteria on which referrals of critically ill patients with nonmalignant disease to intensive care have been based to date fail to do justice to lung cancer patients with their complex requirements 4, 5. As in other recent studies published in the field 2 …

Published
2008
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22. Socioeconomic differences in the impact of HIV infection on workforce participation in France in the era of highly active antiretroviral therapy

Author

Rosemary Dray-Spira, Alice Gueguen, Jean-François Ravaud, France Lert, Kaniewski, Nadine, Santé publique et épidémiologie des déterminants professionnels et sociaux de la santé, Epidémiologie, sciences sociales, santé publique (IFR 69), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM), CERMES - Centre de recherche Médecine, Science, Santé Société (CERMES - UMR 8169 / U750), Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), and Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)

Subjects
Male, Research and Practice, Epidemiology, HIV Infections, MESH: Antiretroviral Therapy, Highly Active, 0302 clinical medicine, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Antiretroviral Therapy, Highly Active, HIV Seropositivity, 030212 general & internal medicine, 10. No inequality, Sida, Substance Abuse, Intravenous, MESH: HIV Seronegativity, education.field_of_study, MESH: Middle Aged, biology, MESH: Employment, virus diseases, MESH: HIV Infections, Middle Aged, Workforce, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Nationality, Educational Status, HIV/AIDS, Female, France, 0305 other medical science, Attitude to Health, Prejudice, MESH: Prejudice, Adult, Employment, medicine.medical_specialty, MESH: Socioeconomic Factors, Population, MESH: Attitude to Health, MESH: Social Class, 03 medical and health sciences, MESH: HIV Seropositivity, MESH: Cross-Sectional Studies, Acquired immunodeficiency syndrome (AIDS), HIV Seronegativity, medicine, Humans, education, Socioeconomic differences, 030505 public health, MESH: Humans, business.industry, Public health, Public Health, Environmental and Occupational Health, MESH: Adult, medicine.disease, biology.organism_classification, Confidence interval, MESH: Male, MESH: France, Cross-Sectional Studies, Social Class, Socioeconomic Factors, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Chronic Disease, MESH: Substance Abuse, Intravenous, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, MESH: Educational Status, MESH: Female, Demography
Abstract

Objectives. We sought to measure the difference in employment rates between HIV-seropositive and HIV-seronegative persons and to establish whether this difference varied according to the HIV-infected persons’ socioeconomic position as defined by education level. Methods. We used data from the VESPA (VIH: Enquête Sur les Personnes Atteintes) study, a large cross-sectional survey conducted among a nationally representative sample of 2932 HIV-infected patients in France. Age-, gender-, nationality-, and education-standardized employment rates were estimated with the French general population as the reference. The differences in employment rates with the general population were computed overall and according to education level. Results. Compared with that of the general population, the overall employment rate was 25% lower (95% confidence interval [CI]=16%, 32%) among HIV-infected patients diagnosed before 1994 and 9% lower (95% CI = 5%, 16%) among HIV-infected patients diagnosed from 1994 onward. The difference in employment rates with the general population was significantly higher among patients with a low education level. The employment rate of highly educated HIV-infected patients diagnosed from 1994 onward did not differ from that of the general population. Conclusions. HIV infection was associated with decreased workforce participation among those with a low education level but not among highly educated individuals.

Published
2007
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23. Factors correlated with disclosure of HIV infection in the French Antilles and French Guiana: results from the ANRS-EN13-VESPA-DFA Study

Author

Kim Bouillon, France Lert, Rémi Sitta, Annie Schmaus, Bruno Spire, Rosemary Dray-Spira, Santé publique et épidémiologie des déterminants professionnels et sociaux de la santé, Epidémiologie, sciences sociales, santé publique (IFR 69), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM), Epidémiologie et Sciences Sociales Appliquées à l'Innovation Médicale, Université de la Méditerranée - Aix-Marseille 2-Institut National de la Santé et de la Recherche Médicale (INSERM), ANRS, Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), and Kaniewski, Nadine

Subjects
Gerontology, Sexually transmitted disease, MESH: Caribbean Region, Cross-sectional study, Immunology, Population, Psychological intervention, MESH: Attitude to Health, Logistic regression, Article, 03 medical and health sciences, 0302 clinical medicine, MESH: Cross-Sectional Studies, Acquired immunodeficiency syndrome (AIDS), MESH: Sex Factors, medicine, Immunology and Allergy, 030212 general & internal medicine, 10. No inequality, education, MESH: Age Factors, education.field_of_study, 030505 public health, MESH: Humans, MESH: Middle Aged, business.industry, MESH: Adult, Odds ratio, MESH: HIV Infections, medicine.disease, Confidence interval, MESH: Male, 3. Good health, Infectious Diseases, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Truth Disclosure, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, 0305 other medical science, business, MESH: Female, Demography, MESH: Prejudice
Abstract

OBJECTIVES: To determine the rate, patterns and predictors of HIV disclosure in the French Antilles and French Guiana. METHODS: A cross-sectional survey was carried out among a 15% random sample (n=398) of the hospital caseload in hospitals providing HIV care. Determinants of disclosure to a steady partner and other members of the individual's social network were analysed using logistic regression. RESULTS: From the time of diagnosis, 84.6% of those in a couple (n=173) disclosed their HIV-positive status to their steady partner, 55.6% disclosed to others, and 30.3% did not tell their status to anyone. Disclosure within a steady partnership was less likely among non-French individuals [Haitians: adjusted odds ratio (AOR) 0.11, 95% confidence interval (CI) 0.02-0.72; other nationalities: AOR 0.13, 95% CI 0.02-0.68]; and among those diagnosed with HIV after 1997 (AOR 0.21, 95% CI 0.05-0.86). Determinants of disclosure to others were found to be sex (women: AOR 2.04, 95% CI 1.24-3.36), age at diagnosis (>or=50 versus

Published
2007
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24. Communication of pharmacogenetic research results to HIV-infected treated patients: standpoints of professionals and patients

Author

Grégoire Moutel, Lama Sharara, Violaine Noël, François Raffi, Ioannis Theodorou, Christian Hervé, Sandrine de Montgolfier, Catherine Leport, Nathalie Duchange, Ingrid Callies, François Bricaire, EA Management des Organisations de Santé (EA MOS), École des Hautes Études en Santé Publique [EHESP] (EHESP)-PRES Sorbonne Paris Cité, Unité de Médecine Sociale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Corentin Celton [Issy-les-Moulineaux], Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Laboratoire Ethique Politique et Santé (EA 4569), Université Paris Descartes - Paris 5 (UPD5), Maladies infectieuses et tropicales, Laboratoire d'éthique médicale et médecine légale (LEM), Immunologie cellulaire et tissulaire, Université Pierre et Marie Curie - Paris 6 (UPMC)-IFR113-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire de Météorologie Dynamique (UMR 8539) (LMD), Département des Géosciences - ENS Paris, École normale supérieure - Paris (ENS Paris), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-École normale supérieure - Paris (ENS Paris), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Centre National de la Recherche Scientifique (CNRS)-École des Ponts ParisTech (ENPC)-École polytechnique (X)-Institut national des sciences de l'Univers (INSU - CNRS)-Université Pierre et Marie Curie - Paris 6 (UPMC), Institut de Recherche Interdisciplinaire sur les enjeux Sociaux - sciences sociales, politique, santé (IRIS), Université Paris sciences et lettres (PSL)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Sorbonne Paris Cité (USPC)-École des hautes études en sciences sociales (EHESS)-Université Paris 13 (UP13), Laboratoire de Recherche en Pathologie Infectieuse, Université Paris Diderot - Paris 7 (UPD7), Agence Nationale de Recherches sur le Sida (ANRS, Coordinating Action no. 7). Other supports: Collège des Universitaires de Maladies Infectieuses et Tropicales (CMIT, ex APPIT), Sidaction, Ensemble contre le Sida, and associated pharmaceutical companies., Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Corentin Celton [Issy-les-Moulineaux], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut national des sciences de l'Univers (INSU - CNRS)-École polytechnique (X)-École des Ponts ParisTech (ENPC)-Centre National de la Recherche Scientifique (CNRS)-Département des Géosciences - ENS Paris, École normale supérieure - Paris (ENS Paris)-École normale supérieure - Paris (ENS Paris), PSL Research University (PSL)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Sorbonne Paris Cité (USPC)-École des hautes études en sciences sociales (EHESS)-Université Paris 13 (UP13), EA Management des Organisations de Santé ( EA MOS ), École des Hautes Études en Santé Publique [EHESP] ( EHESP ) -PRES Sorbonne Paris Cité, Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpital Corentin Celton [Issy-les-Moulineaux], Laboratoire Ethique Politique et Santé ( EA 4569 ), Université Paris Descartes - Paris 5 ( UPD5 ), Laboratoire d'éthique médicale et médecine légale ( LEM ), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -IFR113-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Laboratoire de Météorologie Dynamique (UMR 8539) ( LMD ), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Institut national des sciences de l'Univers ( INSU - CNRS ) -École polytechnique ( X ) -École des Ponts ParisTech ( ENPC ) -Centre National de la Recherche Scientifique ( CNRS ) -Département des Géosciences - ENS Paris, École normale supérieure - Paris ( ENS Paris ) -École normale supérieure - Paris ( ENS Paris ), Institut de Recherche Interdisciplinaire sur les enjeux Sociaux - sciences sociales, politique, santé ( IRIS ), Université Paris 13 ( UP13 ) -École des hautes études en sciences sociales ( EHESS ) -Université Sorbonne Paris Cité ( USPC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ) -PSL Research University ( PSL ), Université Paris Diderot - Paris 7 ( UPD7 ), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), École normale supérieure - Paris (ENS-PSL), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-École normale supérieure - Paris (ENS-PSL), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL), Université Paris 13 (UP13)-École des hautes études en sciences sociales (EHESS)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris sciences et lettres (PSL), and Duchange, Nathalie

Subjects
MESH: Ethics, Medical, HIV Infections, [SDV.GEN] Life Sciences [q-bio]/Genetics, Pharmacogenetic Study, MESH : Ethics, Medical, 0302 clinical medicine, MESH : Genetic Research, Informed consent, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Surveys and Questionnaires, MESH : Controlled Clinical Trials, MESH: Informed Consent, MESH: Attitude o, 030212 general & internal medicine, Genetics (clinical), Informed Consent, Communication, MESH : Questionnaires, MESH : Attitude o, 06 humanities and the arts, MESH: HIV Infections, MESH : Physician-Patient Relations, 3. Good health, [ SDV.MHEP.MI ] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, MESH: Genetic Research, Cohort, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, [ SDV.ETH ] Life Sciences [q-bio]/Ethics, MESH: Communication, MESH : Communication, Psychology, Attitude to Health, MESH : Pharmacogenetics, Genetic Research, MESH : Interviews, Attitude of Health Personnel, MESH: Attitude of Health Personnel, MESH: Attitude to Health, MESH: Pharmacogenetics, Context (language use), 0603 philosophy, ethics and religion, Article, Interviews as Topic, 03 medical and health sciences, Acquired immunodeficiency syndrome (AIDS), MESH : HIV Infections, Genetics, medicine, Humans, Ethics, Medical, Protocol (science), Physician-Patient Relations, Medical education, [SDV.GEN]Life Sciences [q-bio]/Genetics, Modalities, MESH: Humans, MESH: Questionnaires, MESH : Humans, [SDV.ETH] Life Sciences [q-bio]/Ethics, medicine.disease, MESH: Controlled Clinical Trials, MESH: Interviews, [SDV.ETH]Life Sciences [q-bio]/Ethics, Clinical trial, MESH : Attitude to Health, MESH : Informed Consent, Pharmacogenetics, MESH: Physician-Patient Relations, Controlled Clinical Trials as Topic, 060301 applied ethics, [ SDV.GEN ] Life Sciences [q-bio]/Genetics, MESH : Attitude of Health Personnel
Abstract

International audience; The aim of pharmacogenetic studies is to adapt therapeutic strategies to individual genetic profiles, thus maximising their efficacy and minimising the likelihood of adverse side effects. Since the advent of personalised medicine, the issue of communicating research results to participants has become increasingly important. We addressed this question in the context of HIV infection, as patients and associations are particularly concerned by research and therapeutic advances. We explored the standpoints of both research professionals and participants involved in a pharmacogenetic study conducted in a cohort of HIV-infected patients. The setting of the research protocol was followed over a 2-year period. Participants' standpoints were collected through a questionnaire and interviews were conducted with research professionals. Of 125 participants, 76% wished to receive individual results and 71% wished to receive collective results; 39% did not know when results might be expected. Communication of global research results is a principle that is generally accepted by professionals. Concerning individual feedback, the professionals felt that it was necessary if it could be of direct benefit to the participant, but they expressed doubts for situations with no recognised benefit. Our results highlight the necessity to consider this issue in greater detail. We suggest the need to anticipate the debates concerning individual feedback, to differentiate between situations and the importance of further investigations on the opportunities and modalities of communication. Finally, our work emphasised the opposite pressures between the pursuit of scientific knowledge and the therapeutic orientation of clinical trials.

Published
2005
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25. Original approach to the individual characteristics associated with forgone healthcare: a study in underprivileged areas, Paris region, France, 2001-2003

Author

Bazin, Fabienne, Parizot, Isabelle, Chauvin, Pierre, ESIM - Déterminants Sociaux de la Santé et du Recours aux Soins (DS3), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Chauvin, Pierre, and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC)

Subjects
MESH: Health Services Needs and Demand, Adult, Male, MESH: Health Expenditures, Adolescent, MESH: Attitude to Health, healthcare access, Article, Health Services Accessibility, Treatment Refusal, MESH: Cross-Sectional Studies, health behaviour, Poverty Areas, [SDV.BBM] Life Sciences [q-bio]/Biochemistry, Molecular Biology, Humans, [SDV.BBM]Life Sciences [q-bio]/Biochemistry, Molecular Biology, psychosocial factors, MESH: Poverty Areas, Aged, MESH: Adolescent, MESH: Aged, MESH: Health Services Accessibility, Health Services Needs and Demand, MESH: Humans, MESH: Middle Aged, MESH: Mental Health, MESH: Adult, Middle Aged, MESH: Male, MESH: France, Cross-Sectional Studies, Mental Health, MESH: Research Support, Non-U.S, Socioeconomic Factors, life change events, Female, France, Health Expenditures, logistic models, MESH: Female, Attitude to Health
Abstract

BACKGROUND: The social inequalities in health have endured or even worsened comparatively throughout different social groups since the 1990s. Our objective was to identify the individual characteristics (socio-economic status, living conditions, individuals' social integration, health beliefs, expectations and representation and psychological characteristics) statistically associated with the fact of stating (or not) that healthcare had been forgone because of cost. METHODS: In this cross-sectional, multi-centre study we randomly selected a study sample from five underprivileged areas in the Paris region. A multiple logistic regression model was used to calculate the odds ratios (OR) and 95% confidence interval (CI). The validity of the model was assessed by goodness-of-fit tests (Pearson and deviance) and by the study of 100 bootstrap samples. RESULTS: After making adjustments for numerous individual socio-economic and health characteristics, we observed a higher occurrence of reported forgone healthcare among people who have had financial worries during adulthood [ORyes/no=5.47 (1.44-20.75)], a life-course experience of physical, sexual or psychological abuse [ORyes/no=2.86 (1.40-5.84)]; who have experienced childhood difficulties [OR1/never difficulties=5.28 (1.81-15.39), OR2-4/never=7.62 (2.69-21.57), OR>4/never=8.57 (2.39-30.80)]; who have expressed a low degree of sickness orientation [OR(low/high)=2.62 (1.33-5.14)], a high worry/concern about health [ORhigh/low=2.71 (1.33-5.50)] and a low self-esteem [ORmedium/high=8.28 (1.44-47.64), ORlow/high=16.44 (2.81-96.24)]. CONCLUSION: Aside from purely financial hurdles, other factors play a role in the non-use of healthcare services. Health policies mainly promoting equal financial access to healthcare have little chance of abating health inequalities.

Published
2005
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26. Obtaining informed consent from HIV-infected pregnant women, Abidjan, Côte d'Ivoire

Author

Didier K. Ekouevi, Ida Viho, Valériane Leroy, Clarisse Amani-Bosse, Apollinaire Horo, François Dabis, Laurence Bequet, Renaud Becquet, Ditrame Plus, Programme PAC-CI (ANRS 1201/1202), ANRS France Recherche Nord & sud Sida-hiv hépatites-CHU Treichville, Epidémiologie, santé publique et développement, Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR99-ISPED, and Becquet, Renaud

Subjects
Pediatrics, medicine.medical_specialty, MESH: Cote d'Ivoire, Immunology, Population, Breastfeeding, MESH: Attitude to Health, MESH: Mental Recall, Context (language use), Women in development, Article, Helsinki declaration, Cohort Studies, MESH: Cross-Sectional Studies, MESH: Pregnancy, Acquired immunodeficiency syndrome (AIDS), Informed consent, Pregnancy, MESH: Informed Consent, Immunology and Allergy, Medicine, Humans, MESH: Pregnancy Complications, Infectious, Pregnancy Complications, Infectious, education, MESH: Cohort Studies, MESH: Acquired Immunodeficiency Syndrome, education.field_of_study, Acquired Immunodeficiency Syndrome, MESH: Humans, Informed Consent, business.industry, medicine.disease, Clinical trial, Infectious Diseases, Cote d'Ivoire, Cross-Sectional Studies, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Family medicine, Mental Recall, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Female, business, MESH: Female, Attitude to Health
Abstract

The Helsinki declaration is the reference statement of ethical principles to provide guidance to physicians and other participants in medical research involving human subjects. The main principle imposes on a physician the need to obtain an informed consent document from the research candidate before participating in a clinical trial. However this declaration does not take into account the sociocultural context of developing countries where the majority of the patients are illiterate. Obtaining the consent of study participants is thus often difficult and complex in resource-poor settings especially in the context of HIV infection. In March 2001 in Abidjan we launched the ANRS 1201/1202 Ditrame Plus open-label cohort to assess the field efficiency of a short-course combined regimen of zidovudine and nevirapine combined with alternatives to breastfeeding to prevent the mother-to-child transmission (MTCT) of HIV. We studied the level of understanding of the informed consent document in the HIV-1-infected women enrolled in this project. (excerpt)

Published
2004

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