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There are differences in esophageal cancer care across different counties in Sweden. According to national guidelines, all patients should be offered equal care which should be administrated by regional multidisciplinary cancer conferences (MCCs). The aim of the study was to investigate differences between the six regional MCCs in Sweden regarding clinical stageing and recommended treatment. Ten consecutive cases per participating center, 60 cases in total, were planned for inclusion. After anonymization the radiological investigations were presented, along with the original case-specific medical history, anew at the six regional MCCs. Estimation of clinical TNM and treatment allocation (curative, palliative or best supportive care) were compared between MCCs as well as with the original assessment. Interim analysis was performed in April 2022 when ten cases had been presented at five of the six regional MCCs. All available cases were assessed at five MCCs in addition to the previous original assessment (60 assessments). The mean age for the first ten cases was 74.8 years (SD ± 9.8 years). Eight out of ten cases were men. In estimations of T- and N-stage the MCCs agreed in only one out of ten cases. In half of the cases more than three different estimations of N-stage were made. For clinical M-stage there was exact agreement in three cases. In determination of recommended treatment, all five MCCs were in agreement on half of the cases. Preliminary data show striking differences, both in assessment of TNM as well as treatment recommendation at different MCCs. One patient, recommended curative treatment by one MCC could be allocated to palliative care by another. Inclusion is ongoing and further analysis of these differences are warranted to achieve more equal care for esophageal cancer patients in Sweden. MCC_fig1.jpg (could not be inserted).

Many factors influence vaccination practices and attitudes. This study aimed to identify vaccine information sources used by parents of children aged 1-15 years to get a better understanding of the relation between vaccine information sources, practices for two vaccines (MMR, HBV), vaccine acceptance, and vaccine hesitancy.A total of 3938 parents, drawn by random sampling, were interviewed by telephone as part of the "2016 health barometer" survey. Vaccine information sources were described and analyzed according to socio-demographic variables. Multivariate logistic regression models were then built to explain vaccine information sources usage, vaccination practices and attitudes.Healthcare professionals (HCP), the Internet, and relatives were the three main vaccine information sources. Vaccination practices and acceptance were better when parents were getting information from HCPs compared with parents getting information from the Internet or relatives. Besides, getting information from the three different types of sources was associated with the highest rate of vaccine hesitancy: 70.9% (OR=4.6; P0.0001) versus 34.6% among parents getting information from HCPs only.Those results suggest an interest in providing quality information about vaccination on the Internet. The primary role of HCPs in vaccination decision is once again demonstrated.

Background Vaccination policy in France was previously characterised by the coexistence of eight recommended and three mandatory vaccinations for children younger than 2 years old. These 11 vaccines are now mandatory for all children born after 1 January 2018. Aim To study the French population’s opinion about this new policy and to assess factors associated with a positive opinion during this changing phase. Methods A cross-sectional survey about vaccination was conducted from 16 November–19 December 2017 among the GrippeNet.fr cohort. Data were weighted for age, sex and education according to the French population. Univariate and multivariate analyses were performed to identify factors associated with a favourable opinion on mandatory vaccines’ extension and defined in the ‘3Cs’ model by the World Health Organization Strategic Advisory Group of Experts working group on vaccine hesitancy. Results Of the 3,222 participants (response rate 50.5%) and after adjustment, 64.5% agreed with the extension of mandatory vaccines. It was considered a necessary step by 68.7% of the study population, while 33.8% considered it unsafe for children and 56.9% saw it as authoritarian. Factors associated with a positive opinion about the extension of mandatory vaccines were components of the confidence, complacency and convenience dimensions of the ‘3Cs’ model. Conclusions In our sample, two thirds of the French population was in favour of the extension of mandatory vaccines for children. Perception of vaccine safety and benefits were major predictors for positive and negative opinions about this new policy.

The high rates of antibiotic prescriptions and antimicrobial resistance in France motivated its participation in the European e-Bug school project concerning microbes, and infection transmission, prevention and treatment. The prospect of raising awareness among children, helping them to adopt suitable attitudes and behaviour towards infection transmission and treatment starting from childhood, generated enthusiastic support from relevant national educational and health institutions throughout the Project. France was actively involved in every stage: background research showed that the subject matter was best suited to the national science curricula of the fourth and fifth forms in junior schools, and the sixth and ninth forms in senior schools; a focus group study with junior and senior teachers elicited teachers' needs concerning teaching resources; and a qualitative and quantitative evaluation, after translation and pack review, enabled further adaptation of the packs. This evaluation showed an overall enthusiastic reception by teachers and their students in France, and reassured teachers on the ease of use of the Project's resources and students' progress. The e-Bug Project was launched through a national institutional implementation plan in September 2009 and orders for e-Bug tools increased rapidly. By the end of October, 57% of all senior science teachers and 16% of all junior school teachers had ordered the pack. France is one of the most frequent users of the e-Bug web site. The collaboration with both educational and health partners was particularly helpful to implementing the Project, and this was confirmed by the favourable reception and participation of teachers and students in the field.

Background As in other European countries, the French vaccination schedule changes according to epidemiological and socio-economic situations. Further changes are planned for 2013, including the withdrawal of one dose for primary vaccination against diphtheria, tetanus, polio, pertussis and Haemophilus influenzae. A partnership between the French Technical Vaccination Committee and the French Institute for Health and Medical Research designed a study to assess primary care physicians’ agreement about this modification. Methods Qualitative study with focus groups and semi-structured interviews in France. Four focus groups were conducted with physicians, supplemented by four individual interviews. Results The physicians of the survey had accepted the suggested vaccination schedule well. A few concerns had been underlined: fear of less follow-up care for infants resulting from the removal of one visit driven by the primary vaccination; fear of loss of vaccine efficacy; suspicion of the existence of financial arguments at the origin of this change; and adjustment to current vaccination schedule. Several suggestions were made: providing strong support from health authorities; developing stable and simple recommendations; providing effective tools for monitoring patient’s vaccination status. Conclusions Physicians’ opinions suggested a good acceptance of a possible change about primary vaccination against diphtheria, tetanus, polio, pertussis and Haemophilus influenzae. Physicians’ suggestions resulted from this qualitative study on a new vaccination schedule. It showed how that their involvement was feasible for preparing the implementation of a new vaccination schedule.

International audience; OBJECTIVE: To assess the prevalence of and factors associated with squamous intraepithelial lesions and condyloma [human papillomavirus (HPV)-related lesions) in HIV-infected patients. DESIGN: A cross-sectional study in a tertiary-care university hospital conducted in 516 consecutive outpatients. INTERVENTION: A systematic examination for macroscopic HPV-related lesions through anoscopy with histological confirmation, evaluation of dysplasia and HPV typing. Sexual behaviours were assessed using a semi-directive questionnaire. RESULTS: Of 473 patients examined, (200 homosexual men, 123 heterosexual men, 150 women), 108 (23%) had histologically confirmed anal HPV-related lesions (36, 15 and 11% of the respective populations), including 51 (47%) with only endoanal localization. Among these 108 patients, histological dysplasia of grades I or II and grade III were noted in 59 and two patients, respectively, invasive endoanal cancer in one; three patients also had high-risk oncogenicity HPV without dysplasia. Independent identified associated factors of HPV-related condyloma were the number of incidents of sexual intercourse per month [odds ratio (OR) 1.04; 95% confidence interval (CI) 1.01-1.06], CD4 cell count below 200 x 10 cells/l (OR 3.22; 95% CI 1.37-7.60), history of anal HPV lesion (OR 4.57; 95% CI 2.13-9.81), and receptive anal intercourse (OR 2.30; 95% CI 1.11-4.77). The two latter factors remained associated with histological dysplasia (OR 2.82; 95% CI 1.38-5.76 for history of anal condyloma, and OR 4.29; 95% CI 2.18-8.44 for receptive anal intercourse). CONCLUSION: The high rate of condyloma and histological dysplasia seen argues for a systematic screening for these lesions in HIV-infected individuals.

The aim of this study was to determine yields of colonoscopy by indication, especially after a positive Hemoccult test, in the Isère area in southeastern France where a mass screening campaign for colorectal cancer using the Hemoccult test was conducted in women aged 50 to 69 years.This prospective survey was conducted with the participation of all gastroenterologists in the Isère department. Information about indications of all colonoscopies performed and their results were collected.The study involved 1,779 colonoscopies performed for: digestive symptoms (40%), surveillance of colon disease (22%), hematochezia (18%), a family history of colon cancer (10%), anemia, poor general condition or metastasis (4%), and a positive test for blood in the stool (3%). The presence of a pathological colonic condition was significantly related to age (11% of cancers or large polyps after 50 years compared to 3% before), sex (10% of the women with lesions and 15% of the men) and the reason for prescription: after the age 50 a cancer or a large polyp was found in 27% of the cases if the colonoscopy was performed for anemia, metastasis or poor general condition, 21% for hematochezia, 20% for a positive test, 8% for digestive symptoms, and 2% because of a family history.Positive Hemoccult tests represent only a small part of the indications for colonoscopies performed in the Isère department. However, the screening program should be extended to develop its use given its yield which is equivalent to that of hematochezia and much higher than that of digestive symptoms or family history.

Background Little is known about the knowledge, perceptions and prevention practices of the French general population with respect to Hepatitis B virus (HBV) infection. This article describes this population’s knowledge of HBV, their perceptions of the disease, and associated screening and vaccination practices. It compares these indicators with those observed in the same population for HIV, an infection with a chronic course and transmission modes resembling those of HBV. Methods A module on hepatitis B was added into the HIV KABP (Knowledge, Attitudes, Beliefs and Practices) survey which was carried out telephonically in 2010 among a random sample of 9,014 individuals aged between 18–69 and living in metropolitan France. Results Compared with HIV, the general population was less aware that needle exchange during intravenous drug use and sexual relationships are HBV transmission modes (HBV: 89.9% and 69.7%; HIV: 99.1% and 99.4%). The fear of both illnesses was similar at 20.3%. The individual perceived risk of infection was higher for HBV than for HIV with, respectively, 60.8% and 40.3% of respondents believing they had an equal or greater risk of being infected than the average person. However, the percentage of those reporting HBV screening during their lifetime (27.4%) was half that for HIV screening (61.4%). In multivariate analysis, HBV screening was reported more often by individuals born in areas with high HBV endemicity (OR = 2.1 [95% CI: 1.5-2.9]) than by those born in low HBV endemicity areas, and more often by those who reported they had taken drugs intravenously during their lifetime (OR = 2.2 [95% CI: 1.2-4.2]) than those who did not report such behavior. Almost one in two respondents (47%) reported HBV vaccination. The intermediate or high endemicity groups did not report vaccination more often than those born in low endemicity areas nor did those reporting intravenously drug use compared with those who did not. Conclusions This study highlights very contrasting levels of knowledge, perceptions and practices regarding HBV and HIV in the French general population. Our results demonstrate the need to improve the general and high-risk populations’ knowledge of HBV, in particular concerning sexual transmission, in order to improve screening and vaccination practices.

International audience; We investigated the potential impact of the 2009 influenza A(H1N1) pandemic on attitudes towards vaccination among people aged 18 to 75 years and living in metropolitan France. We used data from three national telephone surveys conducted on representative samples in 2000, 2005 and 2010 (n=12,256, n=23,931, n=8,573 respectively). In France, unfavourable attitudes towards vaccination in general dramatically increased from 8.5% in 2000 and 9.6% in 2005 to 38.2% in 2010. In 2010, among respondents who held unfavourable attitudes towards vaccination, 50% mentioned specifically their opposition to the influenza A(H1N1) vaccine. The sociodemographic profile associated with these attitudes also changed greatly. In particular, unfavourable attitudes towards vaccination in general became significantly more frequent among less educated people in 2010. These attitudes were also correlated with vaccination behaviours. For example, parents who were unfavourable towards vaccination in general were more likely to report that they had at least one child who did not get the measles-mumps-rubella vaccine. As this shift in attitude may have a significant impact on future vaccination coverage, health authorities should urgently address the vaccine confidence gap.

The risk associated with dengue fever and chikungunya in metropolitan France is increasing, notably due to globalized exchanges of goods and people, the expanding territory of Aedes albopictus and an immunologically naive population. Behaviors play an important role in the spread of infectious diseases. Prevention programs based on perceptions, knowledge and practices are therefore necessary. Thus, a questionnaire about arbovirus infection was introduced for the first time in the health Barometer 2016. This study aimed to describe perceptions and behaviouralresponses to arbovirus infection in metropolitan France and to identify determining factors of thoses behaviors to improve vector control. 3694 french speaking people aged 15-75 years old and residing in French departments exposed to Aedes albopictus were interviewed. The analysis showed that behavioural responses to arbovirus infection in metropolitan France depended on the discomfort created by mosquitoes, the perceived exposure to dengue and chikungunya and the feeling of being informed about these diseases. To promote protective behaviours that limit the risks of arbovirus infection, we identified 3 lines of action: to provide basic knowledge on diseases and their means of prevention; to improve the perception of the expected benefits of protective behaviours; to Involve the population by allowing participation and ownership. Social mobilization could be an an essential tool for vector control.; Le risque lié à la dengue et au chikungunya en France métropolitaine est croissant, notamment lié à la propagation d’Aedes albopictus dans les zones tempérées. Il n’existe ni traitement curatif et ni vaccin pour prévenir ces infections chez une population immunologiquement naïve. La lutte antivectorielle est donc le seul outil disponible pour protéger la population contre ce risque émergent. Les comportements jouent un rôle important dans la dissémination des maladies infectieuses. Des programmes de prévention fondés sur les perceptions, connaissances et pratiques sont donc nécessaires. Ainsi un module interrogeant sur les arboviroses a été introduit dans le Baromètre Santé 2016. Les objectifs de cette étude étaient de faire un état des lieux des perceptions et des comportements de prévention des arboviroses en France métropolitaine et d’identifier des leviers d’action permettant d’améliorer la lutte antivectorielle. 3694 personnes vivant dans les départements exposés à Aedes albopictus ont été interrogées. L’analyse a montré que les comportements de prévention dépendaient de la gêne ressentie vis-à-vis des moustiques, du sentiment d’exposition à la dengue et au chikungunya et du sentiment d’être informé sur ces maladies. Ce travail a permis d’identifier 3 axes stratégiques utile pour promouvoir l’adoption de comportements destinés à limiter les risques de transmission des arboviroses : assurer un socle de connaissances sur les maladies et leurs moyens de prévention ; améliorer la perception des bénéfices attendus des mesures de prévention ; impliquer la population par l’appropriation des messages et des gestes recommandés.