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Levels of cannabis use are high during adolescence, but the proportion of cannabis users among adults is also progressing, often for medical reasons. This study describes the reasons and motivations for using medical cannabis among adults over 30 years old in France. This qualitative study was performed using an interpretative phenomenological analysis. People with a history of cannabis use or current cannabis users were recruited from the TEMPO cohort. Homogeneous purposive sampling was applied among those using medical cannabis. Twelve participants, among thirty-six who reported using cannabis for medical reasons, were selected and interviewed. Five superordinate themes were identified in the analysis: 1—soothing a traumatic experience through cannabis use; 2—an ambivalent relationship with the user and cannabis and with the user and close relatives; 3—cannabis, a known soft drug comparable to alcohol or tobacco, leading to an illogical demonization; 4—recreational use in the context of experimentation; and 5—a paradoxical desire for exemplary parenting. In this first recent study to describe the reasons and views adults have in order to continue using cannabis after 30 years of age, we identified ways to explain this consumption. The internal appeasement provoked by cannabis stems from a struggle to appease a violent external situation.

Background The COVID-19 pandemic and the resulting lockdowns triggered social discontent on an unprecedented scale. Descriptive phenomenological studies showed that pregnant women were under intense stress during the COVID-19 outbreak, even though they remained uninfected. The purpose of this study was to report on the experiences of pregnant women affected by mild COVID-19 during the first wave of the pandemic. Methods In this non- interventional qualitative study, we analyzed pregnant women’s experiences using an interpretive phenomenological analysis approach. We conducted semi-structured interviews with women who had had a mild COVID-19 during their pregnancy, and gave birth or planned to give birth in the maternity units of Sorbonne University in Paris, France. Results Participants reported that at the time they had COVID-19, they were not afraid of being seriously ill, but of transmitting COVID-19 to their close relatives. Their main concern was being pregnant and becoming a parent in a world where the pandemic deeply altered social environment. This included uncertainty about the future and an acute feeling of isolation related to lockdown. The idea that their partner might not be allowed to attend childbirth was almost unanimously felt as intolerable. In contrast, women had positive feelings regarding the fact that lockdown resulted in a de facto paternity leave leading to a certain degree of equality in the couple regarding baby care and household chores. Unexpectedly, the pandemic social distancing measures helped participants escaping from behavioral constraints, including the unspoken rule that they should welcome greetings from friends and family, despite being exhausted by the recent birth. Conclusions Our results suggest that avoiding separation from their partner is a key to benevolent medical care for pregnant women in times of health crises. The unexpected benefits women reported in a world of lockdown cast a new light on their expectation regarding parenthood today.

Aim: This project aims to evaluate the quality of life for parents of children affected by neurodevelopmental disorders using the survey approved by Par-DD-Qol.Methods: It is a quantitative, descriptive, and analytical study directed at a population of 130 parents of children affected by neurodevelopmental disorders in the Ile-de-France region between January and May 2019.Results: The main factors associated with better scores in quality of life are the support of the general practitioner as well as being in a relationship. The parents’ level of education, autism spectrum disorders, and delays in the diagnosis are associated with worst results when it comes to the quality of life.Conclusion: Knowing the factors associated with the quality of life allows to target actions needed to support the parents as their well-being is crucial for better general care of the child.

International audience; Purpose: Despite the emergence of a growing qualitative literature about the personal recovery process in mental disorders, this topic remains little understood in anorexia nervosa (AN), especially severe AN during adolescence. This cases series is a first step that aims to understand recovery after severe AN among adolescents in France, from a first-person perspective. Methods: This cases series applied the interpretative phenomenological analysis (IPA) method to data collected in semi-structured face-to-face interviews about the recovery process of five young women who had been hospitalized with severe AN 10 years earlier during adolescence. Results: A model of recovery in four stages (corseted, vulnerable, plastic, and playful) crossing seven dimensions (struggle and path of initiation; work on oneself; self-determination and help; body; family; connectedness; and timeline) emerged from the analysis. New features of the AN personal recovery process were characterized: bodily well-being and pleasure of body; stigmatization; the role of the group; relation to time; and importance of narratives. We suggest a new shape to model the AN recovery process, one that suggests several tipping points. Recruitment must now be widened to different AN contexts. Conclusions: The personal recovery paradigm may provide a new approach to care, complementary to medical paradigm. Registration of clinical trial: No. NCT03712384. Our study was purely observational, without assignment of medical intervention. As a consequence, this clinical trial was registered retrospectively. Level of evidence: Level V, descriptive study.

International audience; Research is a necessity for high-quality medicine. We used the MEDLINE database to conduct a bibliometric analysis of research output with respect to primary care by 21 countries. For the period 1974 to 2017, the United States and the United Kingdom stood out in terms of publication volume, and the UK, Canada, and Australia had the greatest percentage of publications in primary care. As of 2017, publications in primary care represented a small proportion of total publications. The countries with the greatest publication productivity possess factors that should be considered with respect to strengthening research in primary care.

The incidence and prevalence of eating disorders (ED) is low in general practice (GP) settings. Studies in secondary care suggest that the general practitioner has an important role to play in the early detection of patients with EDs. The aim of this study was to describe the effect (clinical outcomes and care trajectory) of screening for EDs among patients in general practice settings. A systematic review was conducted on Medline, PsycINFO, CINAHL, Embase and WOS. The studies included were to have been carried out in a primary care setting, with screening explicitly performed in GP practices and follow-up information. Ten studies met the inclusion criteria. For all ED patients, there was an increase in the frequency of consultations in GP setting, referrals to psychiatric resources and drug prescriptions such as antidepressants, following screening procedures. Clinical outcomes remained unclear and heterogeneous. One study focused on the course and outcome of ED patients identified by screening in the GP setting and reported recovery for anorexia nervosa (AN) and BN in more than half of the cases, after 4.8 years of mean follow-up. In this study, early age at detection predicted better recovery. Most of the literature on the role of the GP in screening for and managing EDs consists of opinion papers and original studies designed in a secondary care perspective. The impact of systematically screening for EDs in a primary care setting is not clarified and requires further investigation in collaborative cohort studies with a patient-centered approach, and outcomes focused on symptoms.

Introduction : Les recommandations actuelles de l’Organisation Mondiale de la Sante preconisent un allaitement maternel exclusif pendant les six premiers mois de vie. L’objectif de cette etude a ete de determiner quelle etait l’influence de l’entourage, notamment personnel et professionnel, dans l’initiation de l’allaitement maternel.Methodes : Une etude observationnelle transversale a ete realisee dans deux maternites lyonnaise et francilienne. Le questionnaire a comporte une partie descriptive des caracteristiques du couple et du nouveau-ne, et une partie decrivant le mode de prise de decision des femmes vis-a-vis du type d’alimentation. Les comites d’ethique des deux maternites ont donne leur accord pour la realisation de l’etude. L’analyse a ete realisee avec le logiciel SAS 9.2.Resultats : L’echantillon a compte 249 meres recrutees en suites de couches. Une majorite des femmes (85 %) ont pris leur decision du type d’alimentation apres en avoir discute avec un membre de leur entourage personnel ou professionnel. Douze pour cent d’entre elles ne connaissaient pas l’attitude des professionnels de sante vis-a-vis de l’allaitement maternel. Compare aux femmes ayant choisi l’alimentation au sein ou au biberon exclusif, les femmes optant pour un allaitement mixte ont pris leur decision plus tardivement au cours de la grossesse. L’entourage familial, et en particulier le conjoint, semblait avoir le plus d’influence sur cette decision. L’encouragement des autres membres de son entourage personnel ou professionnel etait egalement associe a un plus grand taux d’initiation de l’allaitement maternel.Conclusion : Ces resultats suggerent d’impliquer les femmes et leur famille pour une meilleure promotion de l’allaitement maternel par les professionnels de sante.

Background It is known that asthma is related to obesity but also to small birth weight. The objective of the present study was to clarify this issue by assessing the putative relationship between the change between birth and childhood in child's corpulence as assessed by body mass index (BMI) and asthma phenotypes. Methods The following status in corpulence were assessed in 7781 schoolchildren using quartile of BMI at birth and at around 10 (9-11years): underweight at birth and at around 10, underweight at birth and overweight at around 10, overweight at birth and underweight at around 10, overweight at birth and at around 10 and the reference group constituted by all the other children in whom corpulence changes were not extreme. Determination of asthma phenotypes (allergic, non-allergic and exercise-induced asthma) was based on a clinical examination including skin prick tests, an exercise challenge test and a questionnaire. Results The risk of allergic asthma was higher in children with persistent underweight, children with persistent overweight and children becoming markedly more corpulent. In boys, the risk of allergic asthma was significantly higher for the less corpulent children at birth, regardless of whether they remained so or become overweight. In girls, the risk of allergic asthma was significantly higher in those with persistent overweight. There were no significant associations between BMI changes and non-allergic and exercise-induced asthma. Conclusions We observed that some extreme changes in BMI, persistent underweight and persistent overweight in childhood increased the risk of allergic asthma.

Objective To construct a typology of general practitioners’ (GPs) responses regarding their justification of therapeutic inertia in cardiovascular primary prevention for high-risk patients with hypertension. Design Empirically grounded construction of typology. Types were defined by attributes derived from the qualitative analysis of GPs’ reported reasons for inaction. Participants 256 GPs randomised in the intervention group of a cluster randomised controlled trial. Setting GPs members of 23 French Regional Colleges of Teachers in General Practice, included in the EffectS of a multifaceted intervention on CArdiovascular risk factors in high-risk hyPErtensive patients (ESCAPE) trial. Data collection and analysis The database consisted of 2638 written responses given by the GPs to an open-ended question asking for the reasons why drug treatment was not changed as suggested by the national guidelines. All answers were coded using constant comparison analysis. A matrix analysis of codes per GP allowed the construction of a response typology, where types were defined by codes as attributes. Initial coding and definition of types were performed independently by two teams. Results Initial coding resulted in a list of 69 codes in the final codebook, representing 4764 coded references in the question responses. A typology including seven types was constructed. 100 GPs were allocated to one and only one of these types, while 25 GPs did not provide enough data to allow classification. Types (numbers of GPs allocated) were: ‘optimists’ (28), ‘negotiators’ (20), ‘checkers’ (15), ‘contextualisers’ (13), ‘cautious’ (11), ‘rounders’ (8) and ‘scientists’ (5). For the 36 GPs that provided 50 or more coded references, analysis of the code evolution over time and across patients showed a consistent belonging to the initial type for any given GP. Conclusion This typology could provide GPs with some insight into their general ways of considering changes in the treatment/management of cardiovascular risk factors and guide design of specific physician-centred interventions to reduce inappropriate inaction. Trial registration number NCT00348855.

World Health Organization guidelines recommend exclusive breastfeeding for the first six months of life. The objective of this study was to determine the influence of the mother's personal circle and coworkers initiation of breastfeeding.A cross-sectional observational study was conducted in two maternity hospitals in Lyon and in the Paris area. The questionnaire described the characteristics of the couple and the newborn, and the mother's decision concerning the type of feeding. This study was approved by the ethics committees of the two maternity hospitals. Statistical analysis was performed with SAS 9.2 software.The sample included 249 mothers recruited during the post-partum period. A majority of women (85%) decided on the type of feeding after discussion with a member of their personal circle or coworkers. Twelve percent of women did not know the health professionals' opinion concerning breastfeeding. Compared to women who chose breast or bottle feeding, women opting for mixed feeding made their decision later during pregnancy. The family environment, especially the husband, appeared to have the greatest influence on this decision. Encouragement from other family members or coworkers was also associated with higher breastfeeding initiation rates.These results suggest the need for more intensive breastfeeding promotion by health care professionals while taking into account the mother's and the family's opinions.

International audience; Background: Young French postgraduates in general practice increasingly prefer salaried practice to private practice in spite of the financial incentives offered by the French government or local communities to encourage the latter. This study aimed to explore the determinants of choice between private or salaried practice among young general practitioners.Methods: A qualitative study was conducted in the South West of France. Semi-structured interviews of young general practitioners were audio-recorded until data saturation. Recordings were transcribed and then analyzed according to Grounded Theory by three researchers working independently.Results: Sixteen general practitioners participated in this study. For salaried and private doctors, the main factors governing their choice were occupational factors: working conditions, need of varied scope of practice, quality of the doctor-patient relationship or career flexibility. Other factors such as postgraduate training, having worked as a locum or self-interest were also determining. Young general practitioners all expected a work-life balance. The fee-for-service scheme or home visits may have discouraged young general practitioners from choosing private practice.Conclusions: National health policies should increase the attractiveness of ambulatory general practice by promoting the diversification of modes of remuneration and encouraging the organization of group exercises in multidisciplinary medical homes and community health centers.

The third and fifth authors’ names are incorrectly spelled. The correct names are: Jean Sebastien Cadwallader and John L Dywer. The correct citation is: Chastang J, Baiz N, Cadwallader JS, Robert S, Dywer JL, Charpin DA, et al. (2015) Postnatal Environmental Tobacco Smoke Exposure Related to Behavioral Problems in Children. PLoS ONE 10(8): e0133604. doi: 10.1371/journal.pone.0133604

Background: Since the 1990s, professional institutions worldwide have emphasised the need to develop research in general practice to improve the health of the population. The recent creation of professorships in general practice in French Universities should foster research in this field. Our aim was to explore the views of patients and relevant professionals on research in general practice. Methods: Qualitative study, using the grounded theory approach according to Strauss and Corbin, conducted in 2010 in three French regions. Nine focus groups were run to data saturation, and included 57 participants in four different categories: patients, non-academic GPs, academic GPs, academics in other disciplines. Results: Most of the participants in the four categories described research in general practice as specific to the population managed and relevant for health care. They considered that its grounding in day-to-day practice enabled pragmatic approaches. The influence of the pharmaceutical industry, rivalries between university disciplines and a possible gap between research and practice were considered as pitfalls. The barriers identified were representations of the medical researcher as a “laboratory worker”, the lack of awareness of any research in the discipline, and lack of time and training. While the views of patients and non-academic GPs are mostly focused on professional issues and the views of academics other than GPs on technical issues, academic GPs are in a position to play a role of interface between the universities and general practices. Conclusions: Although the role of GPs in research is perceived differently by the various protagonists, research in general practice has an undisputed legitimacy in France. Solutions for overcoming the identified barriers include research networks with appropriate resources and training and scientifically sound collaborative research projects, as already implemented in leading countries.

Introduction : Les patients souhaitent majoritairement finir leur vie (81%) au domicile mais seulement 25% des Français décèdent chez eux. Bien que désiré par les médecins généralistes et faisant partie intégrante de leurs missions, leur exercice en matière de soins palliatifs reste toutefois assez restreint.Matériels et méthodes : Nous avons réalisé une revue narrative de la littérature entre 2008 et 2019 en questionnant différentes bases de données (BDSP, Sudoc, LiSSa, Pubmed) à propos des difficultés rencontrées par les médecins généralistes en France dans la délivrance de tels soins à domicile.Résultats : 47 travaux ont été retenus (43 thèses de médecine générale et 4 articles). Les médecins généralistes sont globalement motivés à réaliser des soins palliatifs au lieu de vie du patient mais sont confrontés à de nombreuses difficultés : manque de ressources (manque de formation, de moyens matériels et humains, difficultés économiques et environnementales), difficultés organisationnelles (manque de temps, de coordination et de continuité des soins), la souffrance psychique ressentie par le médecin de famille, les problèmes liés à l’entourage ainsi que des difficultés éthiques, sociétales, culturelles ou religieuses.Conclusion : De nombreuses solutions et perspectives sont envisagées afin de répondre à ces difficultés et combler les lacunes encore persistantes de nos jours. Néanmoins, certaines d’entre elles existent déjà mais sont peu connues par les médecins traitants. La législation en matière d’euthanasie reste insuffisante selon eux.