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Introduction Regular physical activity (PA) is recommended by all type 2 diabetes mellitus (T2DM) management guidelines. The OPADIA study aimed to determine whether using a specific patient questionnaire (Optima-PA©) could help T2DM patients increase their PA by leading to better physician-patient communication and improved levels of shared decision making concerning Specific, Measurable, Acceptable, Realistic, Timely (SMART)-PA micro-objectives. Methods Physicians participating in this multicentre, prospective, randomised, real-life study were allocated to a standard group (T2DM patients managed according to usual clinical practice, n = 24) or the OPTIMA-PA group (additional use of the questionnaire, n = 30). The main outcome was the percentage of inclusion visits ending with the setting up of at least one SMART-PA micro-objective. Other outcomes were the impact of the OPTIMA-PA questionnaire on patient perceptions of shared decision making (ENTRED questionnaire) and the impact of the OPTIMA-PA questionnaire and establishing SMART-PA micro-objectives as well as patient-perceived physician empathy (ENTRED questionnaire) and GP aptitude for patient-centredness (SEPCQ scores) on patient PA levels over a 3-month period (IPAQ-SF scores). Results One hundred twenty-two patients were included in the standard group and 134 in the OPTIMA-PA group. Unexpectedly, more inclusion visits ended with SMART-PA micro-objectives being set up in the standard group (p

BackgroundCovid-19 pandemic and its consequences have raised fears of its psychological impact. The objective of this study was to estimate the effect of student status on mental health conditions during Covid-19 general lockdown among adults in France.MethodsUsing cross-sectional data of the Confins cohort, we estimated the effect of student status on depressive and anxiety symptoms, suicidal thoughts and perceived stress using multivariate logistic regression analyses. Stratified models for college students and non- students were performed to identify associated population-specific factors.ResultsAmong the 2260 included participants, students represented 59% (n=1335 vs 925 non- students) and 78% of the total sample were female. Student status was more frequently associated with depressive symptoms (adjusted OR(aOR)=1.58; 95%CI 1.17;2.14), anxiety symptoms (aOR=1.51; 95%CI 1.10;2.07), perceived stress (n=1919, aOR=1.70, 95%CI 1.26;2.29) and frequent suicidal thoughts (n=1919, aOR=1.57, 95%CI 0.97;2.53). Lockdown conditions that could be potentially aggravating on mental health like isolation had a higher impact on students than non-students.LimitationsParticipants were volunteers, which could limit generalisation of the findings. The cross-sectional design did not allow determining if lockdown impacted directly mental health or if there is another cause. However, we adjusted analyses with the history of psychiatric disorders, and factors related to lockdown conditions were associated with mental health disturbances.ConclusionsCollege student’s mental health is of great importance in the context of the general lockdown set up during the pandemic. Follow-up and interventions should be implemented especially for those at high-risk (younger people and those with history of psychiatric disorders).

Background The COPD "frequent exacerbator" phenotype is usually defined by at least two treated exacerbations per year and is associated with a huge impact on patient health. However, existence of this phenotype and corresponding thresholds still need to be formally confirmed by statistical methods analyzing exacerbation profiles with no specific a priori hypothesis. The aim of this study was to confirm the existence of the frequent exacerbator phenotype with an innovative unbiased statistical analysis of prospectively recorded exacerbations. Methods Data from patients with COPD from the French cohort in Exacerbations of COPD Patients (EXACO) were analyzed using the KmL method designed to cluster longitudinal data and receiver operating characteristic (ROC) curve analysis to determine the best threshold to allocate patients to identified clusters. Univariate and multivariate analyses were performed to study characteristics associated with different clusters. Results Two clusters of patients were identified based on exacerbation frequency over time, with 2.89 exacerbations per year on average in the first cluster (n = 348) and 0.71 on average in the second cluster (n = 116). The best threshold to distinguish these clusters was two moderate to severe exacerbations per year. Frequent exacerbators had more airflow limitation, symptoms, and health-related quality of life impairment. A simple clinical score was derived to help identify patients at risk of exacerbations. Conclusions These analyses confirmed the existence and clinical relevance of a frequent exacerbator subgroup of patients with COPD and the currently used threshold to define this phenotype.

Purpose Performing an antibiotic prophylaxis (ATBP) with a surgical abortion (SA) is recommended in numerous countries, including France where the CNGOF has issued guidelines. There is little data regarding the actual application of these guidelines in clinical practice. The aim of this study was to evaluate the practice of ATBP with SA and to assess the degree of compliance with the national guidelines. Methods This longitudinal, prospective, multicenter, non-interventional study was undertaken between December 2013 and July 2014 with the objective of assessing the modalities of prescription of ATBP under real-life conditions in the setting of SA, and to compare it with the national guidelines. Results A total of 542 pregnant patients agreed to participate and were included by 36 French hospitals. Of these 36 active centers, 18 (50%) systematically prescribed an ATBP, while 10 (27.8%) prescribed an ATBP depending on the risks for the patient. Of these 542 patients, 263 (48.5%) received an ATBP prescription, 274 (50.6%) did not receive such a prescription. The prescribed ATBP was metronidazole (88/263 (33.5%)), azythromycin (76/263 (28.9%)), or doxycycline (44/263 (16.7%)). In total, 208/263 (79.1%) of the patients received an ATBP. Finally, three factors were identified as independent contributors that influence the prescription of an ATBP: the prescribed cervix preparation, the type of center, and the number of surgical abortions per year in the center over 500/year. Conclusion Only half of the patients who undergo an SA receive a prescription for ATBP. Of the prescribed antibiotics, 80% correspond with the recommended ones.

Introduction Few data exist to document the real-life practices regarding surgical abortion for first trimester abortion, in particular regarding the cervical preparation. Using a large national sample of French hospitals practicing surgical abortion, we explore actual practices and described drugs used for cervical preparation and factors that influence the prescription. Methods From December 2013 to July 2014, a longitudinal, prospective, multicenter, non-interventional study was undertaken with the main objective of assessing in real-life conditions the modalities of cervical preparation prior surgical abortion in women with less than 14 weeks of amenorrhea. Results A total of 542 patients agreed to participate and were included by 36 French private or public hospitals. Among 36 active centers, 31 (86.1%) implemented cervical preparation prior surgical abortion, in line with French and international clinical guidelines. For the 510 patients who underwent surgical abortions, the most frequent prescribed treatment was misoprostol only (224/510, 43.9% of patients), following by mifepristone only (167/510, 32.8%) and a combination of misoprostol and mifepristone (99/510, 19.4%). Finally, four factors were identified as independent contributor to guide the treatment prescribed for cervical preparation: woman work situation, gestational age intensity of center's activity regarding the number of abortions yearly and mode of anesthesia. Conclusions Our study showed an almost systematic implementation of cervical preparation before surgical abortion in France. Misoprostol only was the most commonly prescribed treatment for the cervix preparation, followed by mifepristone only. Several factors may have a significant influence on the type of cervical preparation chosen by physicians.

Introduction La sclerose en plaques (SEP) est une cause majeure de diminution de la capacite a travailler. Natalizumab est associe a une amelioration de la productivite dans des etudes observationnelles precedentes. Objectifs Evaluer l’impact du natalizumab sur l’evolution de la productivite au travail de patients actifs atteints de SEP RR en France en comparant l’annee precedant et celle suivant l’initiation du traitement. Patients et methodes Etude observationnelle, en ouvert, multicentrique et nationale. Les inclusions ont eu lieu du 14/06/2017 au 23/12/2019. Les patients etaient contactes par telephone tous les 6 mois afin de recueillir leur situation professionnelle et leurs arrets de travail a l’aide du releve Ameli. La productivite est evaluee a 6 mois (analyse intermediaire) par l’evolution du nombre d’heures travaillees avant et apres initiation du natalizumab et par l’evolution de la capacite a travailler (echelle WPAI). Resultats Sur 185 patients, 75,7 % sont des femmes, de 36,3 (± 9,5) ans avec un score moyen EDSS de 1,9 (± 1,4) et un diagnostic median de 3 ans. Les patients travaillent en moyenne 1295 h/an (± 495), en CDI pour 82 %. Apres 6 mois, 92 % ont une situation professionnelle equivalente ; 65,3 % ont un arret avant natalizumab et 50,3 % apres ; 18,3 % ont augmente leur productivite, 58,5 % sont stables et 23,3 % ont diminue. La capacite a travailler a augmente (WPAI). Discussion Le nombre d’heures travaillees annualisees n’a pas statistiquement evolue sur le groupe total (1259 h/an [± 582] vs 1295 h/an [± 496], p = 0,31) apres 6 mois de traitement. L’impact qualitatif de la SEP a diminue significativement : l’impact physique est passe de 17 % a 11 % (mediane du score MSIS29) et l’impact psychologique de 28 % a 22 %. Conclusion Si a 6 mois, le nombre d’heures travaillees n’a pas evolue significativement, les patients traites par natalizumab declarent une amelioration qualitative de la gene au travail sur la WPAI.

The COPD "frequent exacerbator" phenotype is usually defined by at least two treated exacerbations per year and is associated with a huge impact on patient health. However, existence of this phenotype and corresponding thresholds still need to be formally confirmed by statistical methods analyzing exacerbation profiles with no specific a priori hypothesis. The aim of this study was to confirm the existence of the frequent exacerbator phenotype with an innovative unbiased statistical analysis of prospectively recorded exacerbations.Data from patients with COPD from the French cohort in Exacerbations of COPD Patients (EXACO) were analyzed using the KmL method designed to cluster longitudinal data and receiver operating characteristic (ROC) curve analysis to determine the best threshold to allocate patients to identified clusters. Univariate and multivariate analyses were performed to study characteristics associated with different clusters.Two clusters of patients were identified based on exacerbation frequency over time, with 2.89 exacerbations per year on average in the first cluster (n = 348) and 0.71 on average in the second cluster (n = 116). The best threshold to distinguish these clusters was two moderate to severe exacerbations per year. Frequent exacerbators had more airflow limitation, symptoms, and health-related quality of life impairment. A simple clinical score was derived to help identify patients at risk of exacerbations.These analyses confirmed the existence and clinical relevance of a frequent exacerbator subgroup of patients with COPD and the currently used threshold to define this phenotype.

Reimbursement of the hexavalent vaccine (Infanrix hexa) comprising the DTPa-IPV-Hib components and the hepatitis B valence in a single vaccine was decided in March 2008 in France. The impact of its reimbursement on the hepatitis B vaccine coverage rate was assessed in a study conducted in the general population prior to and after implementation of the reimbursement policy.The PopCorn study (NCT01782794) was a national, cross-sectional and repeated study, with four assessment periods over 3 years, from 2009 to 2012, to assess the hepatitis B vaccine coverage in 12- to 15- and 24- to 27-month-old children, vaccinated between 2007 and 2011 and selected by the quota sampling method. Face-to-face interviews were conducted at their homes and vaccination status was collected using their child's health record. Parents were also interviewed on their perceptions and acceptance of hepatitis B vaccination. Three indicators were calculated to assess hepatitis B vaccination coverage: proportions of infants with at least one dose before 6 months of age, with at least two doses before 6 months of age and with a complete schedule at 24 months of age.A total of 4903 children were enrolled in the study. An overall significant increase (P-value [P0.05]) of the three indicators of interest over the four periods of time was observed for both age groups. The proportion of children receiving hepatitis B vaccination before 6 months increased from 21% at baseline (before vaccine reimbursement) to almost 75% at the last assessment period in 2012. More than 60% of 24- to 27-month-old children received a complete schedule in 2012 compared to 33% at baseline. No significant increases in the proportions of parents "favourable" and "moderately in favour" of hepatitis B vaccination were observed across the four evaluation periods (respectively, 17-22% and 48-50%, P=0.09).The rapid increase of hepatitis B vaccination coverage suggests a significant change in hepatitis B vaccination practice related to the hexavalent vaccine's reimbursement. This change was observed in a context of stability regarding parents' perceptions and acceptance of hepatitis B vaccination and of coverage rates for other infant vaccinations.

The reimbursement of the hexavalent vaccine (Infanrix hexa™), comprising the DTPa-IPV-Hib components and the hepatitis B recombinant in a single vaccine, was approved in France in March of 2008. The impact of its reimbursement on physicians' decisions to vaccinate infants against hepatitis B was assessed in a study conducted with general practitioners and pediatricians.The PRALINE study (NCT01777074) was a national, cross-sectional, repeated study with two measurement periods (T1 and T2) that measured the changes in physicians' acceptance of hepatitis B vaccination of infants before and for the 3 years after the approval of the hexavalent vaccine reimbursement. Two patient registers were created for each measurement period to enroll the first 15 12- to 15-month-old infants and the first 15 24- to 27-month-old children seen by the practitioners. The proportion of eligible children receiving a hepatitis B vaccine for each physician's practice was calculated. Practitioners also answered a vaccination practice questionnaire via telephone interviews.Across the two study periods, 418 general practitioners and 463 pediatricians were recruited and responded to the telephone interview on their vaccination practices. The overall number of children included in the study in both study periods reached almost 20,000. In the general practitioners group, there was a significant increase in the proportion of physicians "practicing hepatitis B vaccination" (i.e., at least 50% of eligible children receiving the initial hepatitis B vaccination) in children 24-27 months old (79% T2 versus 47% T1, P-value [P]0.001). Similarly, the proportion of pediatricians initiating hepatitis B vaccination increased from 51% (T1) to 94% (T2) (P0.0001). General practitioners offered hepatitis B vaccination to infants more systematically in the second study period (87% T2 versus 73% T1, P0.001) and also suggested the use of the hexavalent vaccine to more patients after reimbursement (92% T2 versus 78% T1, P0.0001). The proportion of pediatricians offering vaccination to every infant was high at T1 (94%) and remained steady (97%) with a high use of the hexavalent vaccine (94% T1 and 96% T2).The PRALINE study shows a significant and immediate change in the hepatitis B vaccination practices of general practitioners and pediatricians following hexavalent vaccine reimbursement with a significant increase in hepatitis B vaccine coverage in infants.

Cluster analysis based on clinical and radiological settings does not distinguish any specific phenotype of CPA http://ow.ly/QZq7V

Introduction La bronchopneumopathie chronique obstructive (BPCO) est associee a la survenue d’exacerbations associees a une morbi-mortalite elevee et un retentissement d’autant plus important que ces exacerbations sont frequentes. L’objectif de ce travail est d’identifier les patients BPCO a risque d’exacerbations frequentes. Methodes La methode Kml a ete utilisee pour analyser les donnees des 464 patients, souffrant de BPCO et inclus dans l’etude epidemiologique observationnelle, prospective et nationale EXACO, pour lesquels des informations completes sur la survenue d’exacerbations moderees a severes au cours des 4 annees de suivi etaient disponibles. Cette methode a permis de classer les patients en exacerbateurs frequents (F) ou non (NF). La population de l’etude comprenait 47 % de stade II de Gold, 31 % de stade III et 22 % de stade IV. Les facteurs associes au phenotype F ont ete identifies par une regression logistique bidirectionnelle apres selection des variables d’interet en univarie par la methode des moindres carres. Les variables les plus pertinentes ont ete retenues pour developper un score simple, dont les performances ont ete evaluees par courbe ROC. Resultats Au total, 348 patients etaient classes dans le groupe NF avec une moyenne de 0,71 ± 0,54 exacerbations par an sur 4 ans contre 2,89 ± 1,07 dans le groupe F. La presence d’une exacerbation severe (hospitalisee) l’annee precedente, d’une bronchite chronique (S pour sputum), d’une obstruction bronchique severe (VEMS Conclusion Le score ESOD permet d’identifier avec une bonne sensibilite les patients a risque d’appartenir au sous-groupe « exacerbateurs frequents » alors qu’un score inferieur ou egal a 1 rend peu probable l’appartenance a ce sous-groupe. Ce score simple a realiser en routine reste a valider dans une cohorte independante.