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Simple Summary: This pilot study aimed to highlight the value of spinal cord diffusion imaging and tractography in providing predictive factors for tumor resection in patients with intramedullary tumors. Tensor metrics provided predictive factors of spinal cord damage with a high correlation between fractional anisotropy, mean diffusivity, and radial diffusivity, and suggested changes in microstructural architecture, axonal density, and myelinated fibers of the spinal cord. Spinal cord tractography also provided predictive factors for tumor resection by helping to perform histological tumor differentiation and differentiating spinal tracts and, thus, defining relationships between spinal cord tissue and tumor; all these elements argue in favor of tumor resectability. This pilot study aimed to investigate the interest of high angular resolution diffusion imaging (HARDI) and tractography of the spinal cord (SC) in the management of patients with intramedullary tumors by providing predictive elements for tumor resection. Eight patients were included in a prospective study. HARDI images of the SC were acquired using a 3T MRI scanner with a reduced field of view. Opposed phase-encoding directions allowed distortion corrections. SC fiber tracking was performed using a deterministic approach, with extraction of tensor metrics. Then, regions of interest were drawn to track the spinal pathways of interest. HARDI and tractography added value by providing characteristics about the microstructural organization of the spinal white fibers. In patients with SC tumors, tensor metrics demonstrated significant changes in microstructural architecture, axonal density, and myelinated fibers (all, p < 0.0001) of the spinal white matter. Tractography aided in the differentiation of tumor histological types (SC-invaded vs. pushed back by the tumor), and differentiation of the spinal tracts enabled the determination of precise anatomical relationships between the tumor and the SC, defining the tumor resectability. This study underlines the value of using HARDI and tractography in patients with intramedullary tumors, to show alterations in SC microarchitecture and to differentiate spinal tracts to establish predictive factors for tumor resectability. [ABSTRACT FROM AUTHOR]

Simple Summary: Spinal cord tumors represent a significant surgical challenge. Neurophysiological evaluation using motor evoked potentials (MEPs) and somatosensory evoked potentials (SSEPs) is used to assess the function of motor and somatosensory pathways before and during surgery. However, its role with respect to the detection of neurological damage is not fully known. This study assesses the prognostic value of alterations of pre- and per-operative MEPs and SSEPs in a cohort of 67 patients undergoing spinal cord tumor surgery. We show that pre- and intraoperative alterations to MEPs and SSEPs are strongly associated with a risk of neurological deterioration 3 months after surgery that is independent of initial clinical severity, tumor size, or histological subtype. Leveraging a classical machine learning approach, it is possible to predict neurological outcomes with an accuracy of 84%. Thus, this study demonstrates the pivotal role of pre- and intraoperative neurophysiological explorations in detecting and preventing neurological suffering during spinal tumor surgery. Surgery for spinal cord tumors poses a significant challenge due to the inherent risk of neurological deterioration. Despite being performed at numerous centers, there is an ongoing debate regarding the efficacy of pre- and intraoperative neurophysiological investigations in detecting and preventing neurological lesions. This study begins by providing a comprehensive review of the neurophysiological techniques commonly employed in this context. Subsequently, we present findings from a cohort of 67 patients who underwent surgery for intradural tumors. These patients underwent preoperative and intraoperative multimodal somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs), with clinical evaluation conducted three months postoperatively. The study aimed to evaluate the neurophysiological, clinical, and radiological factors associated with neurological outcomes. In univariate analysis, preoperative and intraoperative potential alterations, tumor size, and ependymoma-type histology were linked to the risk of worsening neurological condition. In multivariate analysis, only preoperative and intraoperative neurophysiological abnormalities remained significantly associated with such neurological deterioration. Interestingly, transient alterations in intraoperative MEPs and SSEPs did not pose a risk of neurological deterioration. The machine learning model we utilized demonstrated the possibility of predicting clinical outcome, achieving 84% accuracy. [ABSTRACT FROM AUTHOR]

Background and Aims Mitral valve surgery and, more recently, mitral transcatheter edge-to-edge repair (TEER) are the two treatments of severe mitral regurgitation in eligible patients. Clinical comparison of both therapies remains limited by the number of patients analysed. The objective of this study was to analyse the outcomes of mitral TEER vs. isolated mitral valve surgery at a nationwide level in France. Methods Based on the French administrative hospital discharge database, the study collected information for all consecutive patients treated for mitral regurgitation with isolated TEER or isolated mitral valve surgery between 2012 and 2022. Propensity score matching was used for the analysis of outcomes. Results A total of 57 030 patients were found in the database. After matching on baseline characteristics, 2160 patients were analysed in each arm. At 3-year follow-up, TEER was associated with significantly lower incidence of cardiovascular death (hazard ratio 0.685, 95% confidence interval 0.563–0.832; P =.0001), pacemaker implantation, and stroke. Non-cardiovascular death (hazard ratio 1.562, 95% confidence interval 1.238–1.971; P =.0002), recurrent pulmonary oedema, and cardiac arrest were more frequent after TEER. No significant differences between the two groups were observed regarding all-cause death (hazard ratio 0.967, 95% confidence interval 0.835–1.118; P =.65), endocarditis, major bleeding, atrial fibrillation, and myocardial infarction. Conclusions Our results suggest that TEER for severe mitral regurgitation was associated with lower cardiovascular mortality than mitral surgery at long-term follow-up. Pacemaker implantation and stroke were less frequently observed after TEER. [ABSTRACT FROM AUTHOR]

Background: Wilson's disease (WD) is one of the few genetic disorders that can be successfully treated with pharmacological agents. Copper-chelating agents (D-penicillamine and Trientine salts) and zinc salts have been demonstrated to be effective. There are two salts of trientine. Trientine dihydrochloride salt (TETA 2HCL) is unstable at room temperature and requires storage at 2–8 °C. Trientine tetrahydrochloride (TETA 4HCL) is a more stable salt of trientine that can be stored at room temperature. No comparative study between both of the salts of trientine has been performed to date. As the two chemical forms were available in France between 1970 and 2009, we conducted a study to evaluate their efficacy and safety profiles. Methods: This retrospective cohort study was conducted by reviewing data from the national WD registry in France. Forty-three WD patients who received TETA 2HCL or TETA 4HCL monotherapy for at least one year until 2010 were included. The primary endpoints were hepatic and neurological outcomes. Secondary endpoints were the events leading to a discontinuation of medication. Results: Changes in medication were common, leading to the analysis of 57 treatment sequences of TETA 4HCL or TETA 2HCL. The mean duration of treatment sequence was significantly longer in the TETA 4 HCL group (12.6 years) than in the TETA 2HCL group (7.6 years) (p = 0.011). Ten patients experienced both trientine salts: eight stopped TETA 4 HCL (six had a hepatologic phenotype and two had a neurological phenotype) because this treatment was not available anymore (mean duration 7.4 years). Three of these patients already experienced TETA 2 HCL before the sequence. Two patients with a hepatologic phenotype (one had a previous sequence of TETA 4 HCL before) stopped TETA 2 HCL because of cold storage issues (mean duration 42.8 years). The total number of sequences was 57. All of the patients were clinically stable. No difference in efficacy was detected. Both treatments were well tolerated, except for a case of recurrence of lupus erythematosus-like syndrome in the TETA 2HCL group. The major reason for interruption of TETA 4HCL was due to a discontinuation in production of this salt. The reasons for stopping TETA 2HCL were mainly due to adherence issues largely attributed to the cold storage requirement. Conclusions: The two salts of trientine were effective in treating patients with WD. However, interruption of TETA 2HCL was frequent, linked to the cold storage requirement. As adherence to treatment is a key factor in the successful management of WD, physicians need to be even more vigilant in detecting adherence difficulties in patients receiving treatment with TETA 2HCL. [ABSTRACT FROM AUTHOR]

Based on empirical information recorded in audio-visual and virtual media, online religionist and non-religious websites, and an academic literature review, I examine the relationships between religions and politics as they are disclosed in the context of the coronavirus outbreak in France. In secularized France, religions did not play an important role in the pandemic, either as facilitator of the disease or as a limitation on its spread. Religious repertoires served marginally, if at all, as resources for interpretation, except in circumscribed sectors of French society. Religious references, however, flourished under different oblique and rather discreet forms. I thus expose the reactions to COVID-19 in France and question the complex connections with secularism (laïcité). In contrast to other countries affected by COVID-19, in France the pandemic brought about the paradoxical situation of a secular country stimulating, on the one side, the engagement of religious organizations in the fight against the virus, and on the other, maintaining limitations to religious action in the public sphere. [ABSTRACT FROM AUTHOR]

Background: Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces a complex antibody response that varies by orders of magnitude between individuals and over time.Methods: We developed a multiplex serological test for measuring antibodies to 5 SARS-CoV-2 antigens and the spike proteins of seasonal coronaviruses. We measured antibody responses in cohorts of hospitalized patients and healthcare workers followed for up to 11 months after symptoms. A mathematical model of antibody kinetics was used to quantify the duration of antibody responses. Antibody response data were used to train algorithms for estimating time since infection.Results: One year after symptoms, we estimate that 36% (95% range, 11%-94%) of anti-Spike immunoglobulin G (IgG) remains, 31% (95% range, 9%-89%) anti-RBD IgG remains, and 7% (1%-31%) of anti-nucleocapsid IgG remains. The multiplex assay classified previous infections into time intervals of 0-3 months, 3-6 months, and 6-12 months. This method was validated using data from a seroprevalence survey in France, demonstrating that historical SARS-CoV-2 transmission can be reconstructed using samples from a single survey.Conclusions: In addition to diagnosing previous SARS-CoV-2 infection, multiplex serological assays can estimate the time since infection, which can be used to reconstruct past epidemics. [ABSTRACT FROM AUTHOR]

Background and purpose: Ischaemic stroke has been described in association with COVID‐19. Several pathophysiological mechanisms have been suggested, i.e. prothrombotic state, cardiac injury etc. It was sought to assess the potential association between ischaemic stroke associated with SARS‐CoV‐2 infection and underlying atherosclerotic lesions. Methods: A retrospective analysis of stroke related to large vessel occlusion was conducted amongst patients with SARS‐CoV‐2 infection and underlying mild atherosclerotic disease, between 19 March and 19 April 2020 in six different stroke centers in the Île‐de France area, France. Results: The median age was 52 years, median body mass index was 29.5 kg/m2. All patients displayed previous vascular risk factors such as high blood pressure, diabetes, dyslipidemia or body mass index > 25. The delay between the first respiratory symptoms of COVID‐19 and stroke was 11.5 days. At baseline, all had tandem occlusions, i.e. intracerebral and extracerebral thrombus assessed with computed tomography or magnetic resonance imaging. Cases displayed a large thrombus in the cervical carotid artery with underlying mild non‐stenosing atheroma, after an etiological workup based on angio‐computed tomography or magnetic resonance imaging and/or cervical echography. Conclusion: Our study should alert clinicians to scrutinize any new onset of ischaemic stroke during COVID‐19 infection, mainly in patients with vascular risk factors or underlying atherosclerotic lesions. [ABSTRACT FROM AUTHOR]

Extra-European studies report high rates of multi-drug resistant bacteria colonization of healthcare workers' mobile phones in intensive care units. We aimed to assess the prevalence of bacterial colonization of healthcare workers' mobile phones in an intensive care unit in France and the effectiveness of a sanitization product. We designed a prospective, monocentric study in a 15-bed intensive care unit within a 300-bed private hospital. Bacterial colonization was assessed on 56 healthcare workers' mobile phones immediately before and 5 min after sanitization of the phones with bactericidal wipes. The mobile phones of 42 administrative staff acted as controls. All mobile phones in both groups were colonized. Healthcare workers' phones had a higher number of different bacterial species per phone (2.45 ± 1.34 vs. 1.81 ± 0.74, p = 0.02). Colonization with pathogens did not differ significantly between healthcare workers' and controls' phones (39.3% vs. 28.6%, p = 0.37). Excluding coagulase negative Staphylococcus, Staphylococcus aureus was the most common pathogen found in both groups (19.6% and 11.9%, p = 0.41). Only one healthcare workers' mobile phone was colonized by methicillin-resistant Staphylococcus aureus, and no other multi-drug resistant bacteria was detected. No covariate was associated with pathogen colonization. After sanitization, 8.9% of mobile phones were sterilized, and colonization with pathogenic bacteria decreased (21.4% vs. 39.3%, p = 0.04) as did the number of CFUs/mL (367 ± 404 vs. 733 ± 356, p < 0.001). Colonization of intensive care unit healthcare workers' and administrative staff's mobile phones was similar. Colonization with pathogens was frequent but colonization with multi-drug resistant bacteria was rare. Disinfecting the phones with bactericidal wipes is not completely effective. Specific sanitization protocols and recommendations regarding the management of healthcare workers' mobile phones in intensive care units should be developed. Additionally, good hand hygiene after touching mobile phones should be kept in mind to prevent cross-infections. [ABSTRACT FROM AUTHOR]

Objectives To compare the efficacy, in current clinical practice, of first regimens containing abacavir with lamivudine ( ABC/3 TC) or tenofovir with emtricitabine ( TDF/ FTC) in patients with baseline viral load ≥100 000 HIV-1 RNA copies/mL. Methods Using a prospective cohort, we selected all patients starting a first HIV regimen based either on ABC/3 TC or on TDF/ FTC. The propensity score ( PS) method was used to limit the indication bias due to the observational nature of the data. Adjusting and weighting methods via PS were used to compare the effectiveness of a first regimen containing ABC/3 TC or TDF/ FTC. The primary outcome was treatment failure by month 12 (M12). Results Overall, 2781 patients started an antiretroviral ( ARV) regimen with ABC/3 TC or TDF/ FTC each in combination with efavirenz, boosted atazanavir or boosted darunavir. Among the 2472 uncensored patients before M12, 962 (39%) had a baseline viral load ≥100 000 copies/ mL of whom 294 were in treatment failure at or before M12. Our analyses showed no difference between ABC/3 TC and TDF/ FTC in the risk of treatment failure at M12 in patients starting an ARV regimen with a high viral load (≥100 000 copies/ mL). Conclusions Using a large prospectively collected cohort of patients seeking care in France, we found no evidence that ABC/3 TC based regimens led to more failures than TDF/ FTC based ones in patients with high baseline viral loads. [ABSTRACT FROM AUTHOR]

We aimed to identify risk factors associated with delayed diagnosis of HIV infection in a French region highly affected by AIDS. Data were collected in southeastern France through the HIV-surveillance system based upon anonymous declarations by laboratories and physicians prescribing HIV testing. From January 1996 to December 1997, 825 persons were diagnosed for the first time as HIV infected (female: 32%; >40 years: 28%); 46% had been infected through heterosexual intercourse, 26% through homosexual intercourse, and 19% through intravenous drug use. The semestrial (6 monthly) incidence rate decreased from 122.7 to 69.7 per million inhabitants (P<0.001). County of residence, age, sex, country of birth, and transmission category did not change significantly during the observation period. Twenty-seven per cent had a delayed diagnosis of HIV infection. This proportion did not differ significantly according to sex or country of birth, or during the observation period. However, after controlling for the other factors, delay was more frequent among injecting drug users (IDUs) (35%, P<10(-2)) than other transmission categories; it was also positively associated with age (47% above 50 years vs 13% under 30 years, P<10(-2)). This study highlights that, in spite of the current AIDS prevention policy and wide access to HIV screening, the proportion of delayed diagnosis of HIV infection remains high. Physicians should concern themselves with this public health issue, and campaigns should target people insufficiently aware, especially IDUs and older people. Further research is needed to understand better the causes of delayed diagnoses and of inequalities in access to HIV screening. [ABSTRACT FROM AUTHOR]

This paper critically examines and rejects arguments made by contemporary sociologists in France about the appropriateness of Durkheim's sociology in general, and his sociology of religion in particular. A century after the publication of The Elementary Forms, social scientists, especially in Europe, contend that "individualized" spiritualities are the definitive feature of contemporary forms of modern, globalised religion and infer from this empirical evidence that Durkheim's "sociologism" is outdated. However, contemporary evidence indicates that collective religious expressions are colonizing the public spaces from whence they ostensibly had been withdrawn. Individualization, per se, is not only a contested concept but also a normative discursive technique of rationalization by which the great religions and new religious movements adjust to the "individualistic" values of modernity in global settings. This paper addresses the question of whether Durkheim really was wrong about the collective, yet complex nature and future of religion. [ABSTRACT FROM AUTHOR]

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Like many other traditions, Buddhism has become a globalised religion. Religious studies and social sciences to date have been interested in the history of the globalisation of Buddhism, or in the sociological impacts of such processes, and have somewhat overlooked the spatial dimensions of the worldwide spread of Buddhism. More than a 'glocalisation' or a 'deterritorialisation', the globalisation of Buddhism is also shaped by territorialisation processes (diffusion, settlement, the institutionalisation of sites, the territorialisation of memory and identity, 'swarming', network structuring, etc.). On the basis of ethnographic evidence collected in France, one of the countries of Europe where Buddhism has settled to a greater extent, this article aims to emphasise the role of space and territory in the globalisation of Buddhism, and further, questions the issue of deterritorialisation in global religious studies. [ABSTRACT FROM AUTHOR]

HIV infection may result in stressful situations such as disclosure to others and could be a mediator between seropositivity status and psychiatric illness, depression, or anxiety. Several results have shown that anxiolytic use (mainly benzodiazepines [BDZ]) is highly prevalent in HIV-infected individuals, but few studies have highlighted to what extent this use could be associated with HIV disclosure. A national cross-sectional survey representative of people living with HIV and AIDS in France enrolled 2932 individuals in 102 French HIV hospital departments. Face-to-face interviews and self-administered questions collected information about patients' experience with HIV and HIV care, including use of psychotropic drugs, social support, stigma, and disclosure of HIV status. We identified factors associated with regular BDZ use (i.e., more than once a week) using a weighted logistic regression model. Regular BDZ use and anxiety symptoms were reported by 16% and 29% of the patients, respectively. After multiple adjustment for known correlates of BDZ use and anxiety symptoms, individuals who had disclosed their HIV status to relatives or friends were found to be more likely (OR [95% CI] = 1.78 [1.02-3.09]) to regularly use BDZ. These results show both to what extent disclosure to others continues to be a stressful step in the course of HIV infection and that disclosure is something that could be identified by BDZ use. They also highlight the need for appropriate case management and psychiatric care to help patients manage the consequences of disclosure. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: In France, a recent law emphasizes patient rights and prohibits unwanted therapies in end-of-life care. As end-of-life home care is increasing, we aimed to assess French district nurses'' attitudes toward terminally ill patients'' autonomy. Materials and Methods: We used data from a nationwide telephone survey conducted in 2005 among a random sample of French district nurses (n = 602). Nurses'' attitudes were assessed with a clinical case describing a patient (randomly defined as a male or a female aged 50 years) having amyotrophic lateral sclerosis (ALS) who urgently needs mechanical ventilation. Nurses were asked whether patient consent was necessary before performing intubation/tracheotomy, and the analysis took into account various covariates, including nurses'' religiosity, nurses'' attitudes toward living wills, and patient sex. Results: Overall, 44% of nurses considered that an ALS patient with respiratory failure should always be intubated (53% for a female patient, 40% for a male patient, P < .01), and after intubation, 27% upheld tracheotomy without considering patient consent as a necessary prerequisite (39% among male nurses, 30% among female nurses, P < .05). Poor communication with terminal patients and hostility toward living will were also predictive of willingness to perform both mechanical ventilation and tracheotomy without patient consent. Conclusions: A significant part of French district nurses may have a disturbing propensity to support intubation and tracheotomy with insufficient attention paid to the patient''s will. Further research should investigate potential causal factors (such as increased workload) as well as sex-related attitudes in nurse-patient relationship. [Copyright &y& Elsevier]

This study examined the prevalence and characteristics of attempted suicide among a representative sample of French Human Immunodeficiency virus (HIV) infected individuals. In 2003, a face-to-face survey was conducted among people living with HIV/AIDS (PLWHA) selected in a random, stratified sample of French hospital departments. Among solicited individuals, 2,932 agreed to participate and were asked if they had ever AS. Among the respondents, 23% had AS. Female gender, younger age, native French citizenship, reporting household financial difficulties, having been HIV-contaminated through homosexual contact or through injection drug use and suffering from lipodystrophy-related symptoms were all independently associated with AS. HIV-discrimination and the lack of social support from family remained independently associated with AS. Our findings indicate a high level of AS among PLWHA and emphasize the multiple roles of factors associated with living with HIV, together with sociodemographic factors. The results enable the possibility for vulnerable groups to be targeted for specific future interventions in order to prevent attempted suicide. [ABSTRACT FROM AUTHOR]

We analysed sexual difficulties in a nationally representative sample of HIV-infected outpatients in France. Analyses were restricted to the 1,812 HIV-treated participants who reported at least one sexual partner during the 12 months prior to the study. The sample included 40.6% homosexual men and 24.4% women; 68.1% had a steady partner and 48.2% reported casual partners. Sexual difficulties were reported by 33.3% of the selected individuals and were more frequent in those with low sexual activity. Immuno-virological outcomes were not associated with sexual difficulties. After multiple adjustment for sexual frequency and antidepressant consumption, it was found that a larger HIV-network, reporting HIV-discrimination from friends and/or sexual partners, suffering from lipodystrophy and reporting very disturbing HIV-related symptoms were all significantly associated with sexual difficulties. HIV and HIV-treatment experience are associated with sexual difficulties. Psychological support focused on HIV-experience should be tested as a possible tool for improving sexual quality of life. [ABSTRACT FROM AUTHOR]

Objectives: To assess French district nurses' opinions towards euthanasia and to study factors associated with these opinions, with emphasis an altitudes towards terminal patients. Design and setting: An anonymous telephone survey carried out in 2005 among a national random sample of French district nurses. Participants: District nurses currently delivering home care who have at least 1 year of professional experience. Of 803 district nurses contacted, 602 agreed to participate (response rate 75%). Main outcome measures: Opinion towards the legalisation of euthanasia (on a five-point Likert scale from "strongly agree" to "strongly disagree"), altitudes towards terminal patients (discussing end-of-life issues with them, considering they should be told their prognosis, valuing the role of advance directives and surrogates). Results: Overall, 65% of the 602 nurses favoured legalising euthanasia. Regarding associated factors, this proportion was higher among those who discuss end-of-life issues with terminal patients (70%), who consider competent patients should always be told their prognosis (81%) and who value the role of advance directives and surrogates in end-of-life decision-making for incompetent patients (68% and 77% respectively). Women and older nurses were less likely to favour legalising euthanasia, as were those who believed in a god who masters their destiny. Conclusions: French nurses are more in favour of legalising euthanasia than French physicians; these two populations contrast greatly in the factors associated with this support. Further research is needed 2006 investigate how and to what extent such attitudes may affect nursing practice and emotional well-being in the specific context of end-of-life home care. [ABSTRACT FROM AUTHOR]

This study investigated patterns of HIV disclosure to significant others (parents, siblings, children, other relatives, friends and colleagues) and describe them in terms of socio-demographic background and other characteristics, including experiences of AIDS-related discrimination. It also assessed the relationship between disclosure patterns and adherence to HAART. We used a cross-sectional survey conducted among a national representative sample of 2,932 HIV-infected people recruited in French hospitals. HIV disclosure patterns were both selective and cumulative: disclosure was more frequent for friends and siblings, while concealment prevailed concerning children, other relatives, and colleagues; but patients who disclosed their seropositivity to one significant other were also more likely to disclose it to other significant others. Patients reporting experiences of discrimination from sexual partners were less likely to be highly adherent, and we also found a significant relationship between uncontrolled disclosure and non-adherence. Patients who have opted for concealment probably consider non-adherence and uncontrolled disclosure as competing risks, but among them a significant minority loses on both counts. Counselling provided to HIV-infected people should not separate the adherence and disclosure issues, and adherence interventions should seek to help patients to manage concurrently disclosure/concealment of their seropositivity and its consequences. [ABSTRACT FROM AUTHOR]

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This article aims to investigate the effect of French mass media national prevention campaigns on attitudes and behaviours of people living with HIV/AIDS (PLWHAs), with a special emphasis on HIV-related sexual risk behaviours. In 2001, a face-to-face survey was conducted in 32 hospital departments delivering HIV care randomly selected in two French regions (Paris metropolitan area and South-Eastern France). Eligible respondents were HIV-infected outpatients aged 18 or older, and diagnosed for at least 1 year. Overall, 1386 patients were asked to participate and 900 agreed to answer the questionnaire (response rate: 64.9%). Most respondents supported national AIDS information media campaigns; some have found support from these campaigns to talk to relatives or friends about AIDS (19.7%), or to manage their sexual life (24.5%). In multivariate analysis, PLWHAs who declared that these media campaigns have helped them to manage their sexual life were more likely to report condom use in the prior 6 months (“sometimes” vs. “never”: OR?=?2.77 [95% CI?=?1.15?–?6.71]; “always” vs. “never”: 2.46 [1.14?–?5.29]). So mass media general information campaigns can play an efficient role for secondary prevention among PLWHAs and may need to be redesigned to include this goal more explicitly. [ABSTRACT FROM AUTHOR]

Background: Disclosure of the prognosis to terminally ill patients is a strong prerequisite for integrating the physical, psychological, spiritual, and social aspects of end-of-life care. Objective: This study aimed to assess French physicians' general attitudes and effective practices (with patients followed up to death recently) toward such disclosure. Design/subjects: We used data from a cross-sectional survey conducted among a national sample of 917 French general practitioners, oncologists, and neurologists. Results: A majority of respondents opted for prognosis disclosure only at patients' request, very few opted for systematic disclosure without patient's request, and a significant minority opted for systematic concealment. Concerning deceased patients described by respondents, 44.5% of competent patients were informed of prognosis by their physician, 27.3% were informed by someone else, 9.0% refused to be informed, and 19.2% were simply not informed. Concealment was more frequent for older patients, and physicians involved in a nongovernmental organization (NGO) for patients' support were more likely to disclose the prognosis, even without patient's request. Conclusions: Disclosure of the prognosis to terminally ill patients is still far from systematic in France. Further research is needed to better understand the motivations of French physicians' disclosure practices, which are probably culturally shaped. [ABSTRACT FROM AUTHOR]

Since the end of the 1980s, `youth risky behaviours' have become a major issue for public health. The relationship between these behaviours and sporting activity is well-documented but still controversial. This article examines some sociological hypotheses related to this relationship, with data from a pilot survey conducted on a sample of 458 elite-student-athletes (ESAs) aged 16-24, gathered and trained in specialized public centres. We found a significant relationship between motives to do sport and `risky behaviours': ESAs who considered sport as a convivial leisure were more prone to use cannabis, while ESAs who mingled sporting and extra-sporting achievements together were more likely to engage in risky behaviours on the road, possibly because they transposed values from the sporting field (speed, competition) into the `real world'. Moreover, sporting activity may provide opportunities for drug use with peers as well as incentives to use drugs in order to cope with the anxiety induced by high-level competition. Thus `recreational' drugs may be used as `integrative' drugs. [ABSTRACT FROM AUTHOR]

To investigate employment levels and identify barriers to work among persons living with HIV/AIDS in France in 2001, we conducted a cross-sectional study among HIV-infected patients seen in the hospital outpatient clinics of the two French regions most affected: Ile-de-France (IDF) and Provence-Alpes-Côte-d'Azur (PACA). Of the 840 outpatients included in the study, 58.8% in IDF and 46.8% in PACA were currently employed, and 28.1 and 47.8%, respectively, were receiving disability benefits. Among unemployed patients, 32.1% in IDF and 29.6% in PACA reported that they planned to (re)enter the workforce. Current and planned employment status were associated with characteristics indicative of the patients' social and demographic situation before the HIV diagnosis (region of residence, educational level, HIV transmission group, age, nationality) and with their health status at the interview (HIV progression, HCV co-infection). Receiving disability benefits was negatively associated with plans to return to work. HIV-related discrimination at work was reported by 11.9% of the patients in IDF and 9.2% in PACA, and was not associated with occupational status. Thus, social interventions should seek to prevent patients, particularly the most socially vulnerable, from leaving their jobs at acute stages of their illness and should promote (re)entry into the workforce among unemployed patients. [ABSTRACT FROM AUTHOR]

Aims. To evaluate the extent to which the introduction (February 1996) of ambulatory prescriptions of buprenorphine for drug maintenance treatment (DMT) has been associated with its intravenous illicit use by French injecting drug users (IDUs). Design. Cross-sectional survey (September 1997), using self-administered questionnaires, in a sample of IDUs recruited at 32 pharmacies, four needle exchange programmes and three syringe vending machines. Setting. Thirty-nine sites where IDUs have access to sterile syringes in the city of Marseille (South-Eastern France). Participants. Sample of IDUs attending community pharmacies, vending machines and needle exchange programs to obtain equipment. Measurement. To compare characteristics of IDUs who declared that they only injected buprenorphine in the prior 6 months versus the rest of the sample. Findings. Among the 343 respondents (response rate = 70.7%), 33.8% were polydrug users who occasionally injected buprenorphine in parallel to heroin and/or cocaine, while 23.9% only injected buprenorphine in the previous 6 months. IDUs in this latter group were younger, injected more frequently, and were more frequently on buprenorphine DMT, but they were less likely to be HIV-infected and to declare HIV-related injecting risky behaviours. Conclusions. Substantial risk of injecting misuse is associated with large-scale diffusion of buprenorphine DMT. A more stringent regulation for medical dispensation of buprenorphine than the current French general freedom of prescription for all physicians, including general practicioners in ambulatory care, may be necessary in other countries which are considering the diffusion of buprenorphine DMT. [ABSTRACT FROM AUTHOR]

Objective: In Marseille, southeastern France, HIV prevention programs for injection drug users (IDUs) simultaneously include access to sterile syringes through needle exchange programs (NEPs), legal pharmacy sales and, since 1996, vending machines that mechanically exchange new syringes for used ones. The purpose of this study was to compare the characteristics of IDUs according to the site where they last obtained new syringes. Methods: During 3 days in September 1997, all IDUs who obtained syringes from 32 pharmacies, four NEPs and three vending machines were offered the opportunity to complete a self-administered questionnaire on demographics, drug use characteristics and program utilization. Results: Of 485 individuals approached, the number who completed the questionnaire was 141 in pharmacies, 114 in NEPs and 88 at vending machines (response rate = 70.7%). Compared to NEP users, vending machine users were younger and less likely to be enrolled in a methadone program or to report being HIV infected, but more likely to misuse buprenorphine. They also had lower financial resources and were less likely to be heroin injectors than both pharmacy and NEP users. Conclusions: Our results suggest that vending machines attract a very different group of IDUs than NEPs, and that both programs are useful adjuncts to legal pharmacy sales for covering the needs of IDUs for sterile syringes in a single city. Assessment of the effectiveness and cost-effectiveness of combining such programs for the prevention of HIV and other infectious diseases among IDUs requires further comparative research.Copyright © 2001 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

This paper investigates physicians' judgements about adherence to antiretroviral treatment (ART) among patients who have been HIV-infected through injecting drug use (IDU). Comparisons were made between data collected from physicians at enrolment (January 1996 to January 1998) of a prospective cohort study (MANIF 2000) and self-declarations of 196 HIV-infected injecting drug users (IDUs) who have been prescribed ART. The likelihood of being perceived as 'adherent' by physicians was higher for women, patients of 30 years of age or older, with biological markers indicative of a healthier status, and who were perceived as 'free of injecting behaviour' and not in drug maintenance treatment. Although the proportion of non-adherent patients was similar in physicians' assessment (26.0%) and patients' self-declarations (27.0%), a strong discordance occurred: 60.4% of patients self-reporting non-adherence to ART (80.0% for those receiving a protease inhibitor) were classified as adherent by their prescribing physicians. The study suggests that a priori judgements based on clinical experience but also on social stereotypes interfere with physicians' assessment, and that physicians' decisions to initiate complex treatment regimens may further induce optimistic biases and an underestimation of the problems faced by IDU patients to adequately adhere to them. [ABSTRACT FROM AUTHOR]

Drug maintenance treatment (DMT) has only been recently introduced in France (methadone programmes in March 1995, buprenorphine prescriptions in ambulatory medicine in February 1996) in relation to risk reduction policies for HIV infection among intravenous drug users (IDUs). Impact of DMT was assessed in the period of inclusion (October 1995-December 1997) of a French cohort of patients HIV infected through intravenous drug use the MANIF 2000 study). Among the 429 patients, 48.2% were ex-IDUs, 20.3% were active users not in DMT and 31.5% were in DMT. A majority (73.3%) of patients in DMT had persisted in their injection behaviours and their social and psychological characteristics were similar to those of active users not in DMT. Among the 186 active IDUs, those in DMT were more likely to have injected cocaine (42.4%) and buprenorphine or methadone (21.3%) than those who were not (respectively 27.6% and 2.4%), and 23.6% declared direct needle-sharing behaviours during the prior six months. Among younger IDUs (≤ 33 years of age) (n = 100), needle-sharing was associated with polydrug use and cocaine injection but was not significantly reduced by participation in DMT. These results suggest the need for taking into account differences between type of HIV-infected drug users and developing appropriate multidrug maintenance treatment programmes, which may imply adaptations of current dosages of methadone and buprenorphine. [ABSTRACT FROM AUTHOR]

Presents an in-depth survey of French general practitioners (GP) about their knowledge, attitudes and practices in connection with HIV infection. Determinants of AIDS care among French GPs; Factors for regular follow-up of AIDS patients; Coping with pressures and ethical dilemma.

Presents results of two surveys concerning HIV screening policies and seroprevalence for pregnant women in hospital units of south-eastern France. Global prevalence rate; Frequency of routine HIV screening; Focus on fetal concerns with HIV-infected women.

This study estimated the prevalence of hepatitis B virus (HBV) and human immunodeficiency virus (HIV) serological markers among inmates and evaluated inmates' compliance with an HBV immunization programme. During the mandatory consultation at the sexually transmitted disease (STD) clinic of the Marseille Prison (HIV counselling, and syphilis/HIV screening), physicians offered serological testing (anti-HBs, anti-HBc, HbsAg, anti-HIV) and Engerix B vaccination to each entrant. The number participating in the survey is 391/411 (89%); 75% were aged 18 to 35 years and 79% were men; 42% reported having had multiple sexual partners during the last 12 months. Report of an intravenous drug user (IDU) sexual partner was more frequent among women than men (22% vs 8%). Injecting drug use over lifetime was reported by 23%; 27% declared having shared their injection equipment during the last 12 months. 124/267 (32%) had an HBV marker: anti-HBs + only (immunized): 2.3%; anti-HBs + and anti-HBc +: 21.7%; anti-HBc + only: 6.4%; HBsAg +: 1.3%. The HIV seroprevalence was 6% (21% among IDUs). This survey underlines the high HBV and HIV seroprevalence among prisoners and the high proportion of inmates at risk for these infections. There is an urgent need for immunization and education programmes in this population. It demonstrates an HBV immunization programme is feasible and accepted by inmates and staff members. [ABSTRACT FROM AUTHOR]

Aims . To assess attitudes of general practitioners (GPs) toward buprenorphine maintenance drug abuse treatment just after its introduction in French ambulatory care (February, 1996). Design. Cross-sectional survey by telephone interviews in a national random sample of French GPs ( n = 1,186; response rate = 70.3%) carried out in April 1996. Measurements. GPs' experience with care for IDU patients and HIV infection during the last 12 months. Logistic regression model to identify GPs' characteristics associated with readiness to prescribe buprenorphine for maintenance treatment. Findings. A minority (24.0%) of GPs took care of IDU patients and 30.8% of these were prepared to prescribe buprenorphine (vs. only 7.5% in the rest of the sample). A positive attitude toward buprenorphine was related to GPs' experience with care for IDUs and with prescription of opiates for pain management and palliative care, tolerance toward drug use and personal characteristics such as tobacco use and interest in psychoanalysis. Conclusions. Giving general freedom of prescription of buprenorphine (rather than methadone) to all GPs did not lead to widespread acceptance of the drug's use in treating IDUs. The development of organized networks between specialist services for drug abuse treatment and motivated GPs may be necessary to maximize appropriate prescribing practices. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which discusses a study which determines the time to first consultation after diagnosis of HIV and identifies factors associated with delayed entry to care.

The article presents a study that deals with the effects of psychiatric disorders on adherence to highly active antiretroviral therapy (HAART) in HIV-infected women and men. The study used the VIH: Enquête Sur les Personnes Atteintes (VESPA) national cross-sectional survey to study 4,963 HIV-infected patients from 102 French hospitals. Selected participants are 446 women and 1,363 men who were receiving HAART with complete adherence and psychiatric disorders assessment. The authors highlighted the need for interventions to improve adherence.

Examines the relative impact of hospitalization for depressive syndrome (DS) in a cohort of HIV-infected patients contaminated through injecting drug use in France. DS representing an important cause of hospitalization of HIV-infected injecting drug users, mainly concerning patients presenting no stable relationship and signs of social instability.

Keywords: LVAD; suicide attempt EN LVAD suicide attempt 934 936 3 04/20/20 20200317 NES 200317 Left ventricular assist device (LVAD) implantation is an alternative therapy for end-stage heart failure. Of 10 patients who attempted or completed suicide, 2 (20%) were followed in a center with an LVAD coordinator compared with 293 of 484 (60.5%) patients without suicide attempt ( I P i =0.02). [Extracted from the article]

Background: Outcomes in recipients who have undergone combined heart and kidney transplantation have mainly been addressed in small, single-center studies. We studied long-term results of combined heart and kidney transplantation in a large multicenter cohort. Methods: Between 1984 and 2007, 67 consecutive patients (61 men and 6 women) from 3 French centers underwent combined heart and kidney transplantation. At transplantation, 38 (57%) were receiving dialysis. All patients received immediate triple immunosuppression therapy (anti-calcineurin, steroids, azathioprine, or mycophenolate). Results: Overall actuarial survival rates were 62.0%, 60.3%, 53.3%, and 46.5% at 1, 3, 5, and 10 years, respectively. These rates were similar to those observed in 2981 isolated heart recipients at the 3 participating centers during the same period (respectively, 71.0%, 65.2%, 60.1%, and 47.2%, p = 0.6). Survival tended to improve during the last decade (1996 to 2007) and reached 71.1%, 67.5%, and 60% at 1, 3, and 5 years. Cardiac allograft rejection requiring treatment occurred in 12 (17.9%). Coronary artery vasculopathy developed in 3 (9.3%). Kidney allograft rejection occurred in 9 (13.4%). Kidney graft survival was 95.9% at 1, 3, 5, and 10 years. Conclusions: Long-term survival rates in a large cohort of combined heart and kidney recipients are similar to those of isolated heart recipients in France. The rates of acute heart and kidney rejection and angiographic coronary artery vasculopathy were low in this patient population. [Copyright &y& Elsevier]

The article reports on the proposal to study the influences of lifestyle characteristics and health-related quality of life (HRQL) on unsafe sex with casual partners in a representative sample of HIV-infected gay men in France. It was concluded that risky sexual behavior with casual partners is frequent among HIV-infected gay men. The behavior of this kind is related to poor mental HRQL.

Abstract: Objective. – This study examined attitudes toward doping and their correlates among elite athletes in South-Eastern France. Method. – Overall, 1,197 young elite athletes aged 16–24 were asked to participate. They were recruited in sporting public centres, in training centres depending on professional football and basketball clubs, and during courses organised by regional federations for their best athletes. Data were collected with a self-administered anonymous questionnaire. We used a cluster analysis in order to summarize attitudes toward doping in contrasted profiles. Results. – Among the initial sample, 996 young athletes agreed to participate (response rate 83%). We found a consensus among respondents concerning negative aspects of doping (dishonest, unhealthy and hazardous because of sanctions, for 95.2% of them). However, the cluster analysis showed that 52.8% of participants were prone to agree with a variety of statements dealing with sportive or non-sportive benefits of doping. This attitude was linked to motives to do sport, and it was more prevalent among males, older respondents, those practising an individual sport without contact (such as athletics or cycling), and those registered in a training centre depending on a professional club. Conclusion. – Information and preventive actions targeting young athletes should focus more on anticipated benefits of doping, because this population seems already well aware of deleterious consequences of doping. Such actions should also take into account the variety of such anticipated benefits, which can be sportive as well as non-sportive. [Copyright &y& Elsevier]

Background: Buprenorphine was approved in France for treating opiate dependence in July 1995 and can be prescribed by general practitioners (GPs). Most studies assessing buprenorphine maintenance treatment (BMT) outcomes have taken place in GP settings. An evaluation of BMT outcomes in patients already followed for their HIV-infection could supply additional information about the changes in addictive practices in a non-GP setting. Methods: We assessed BMT discontinuations and the course of self-reported addictive behaviours and characteristics associated with buprenorphine-injection misuse in 114 HIV-infected patients on BMT who were followed in a hospital-based outpatient department. Results: The continuous series of follow-up visits at which these 114 patients reported regular buprenorphine prescriptions accounted for 237.5 person-years of observation, i.e. 475 follow-up visits. Of the 114 patients on BMT, 43% continued BMT throughout the follow-up, 40% stopped it, and results for 17% were not available either because they did not answer the self-administered questionnaire (5%) or because they were lost to follow-up (12%). Addictive behaviours declined but buprenorphine injection misuse remained stable. Depression measured by the CESD score (RR=1.04 95%CI [1.01–1.06]), cocaine use (RR=2.48 95%CI [1.31–4.68]) and alcohol consumption exceeding 4 alcohol units (AU) per day (RR=2.29, 95%CI [1.17–4.46]) were independently associated with buprenorphine injection misuse among stabilised BMT patients. Conclusions: Despite the reduction in drug injection after starting BMT, buprenorphine injection misuse mainly involves patients with characteristics of severe addiction. Better monitoring of the illicit drug use patterns of patients on BMT may suggest new medical strategies for GPs to improve BMT outcomes. [Copyright &y& Elsevier]