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Background In 2019, there are 6.5 million migrants living in France. Numerous quantitative studies show inequalities in access and quality of care, in particular in women’s health. This study aimed to explore migrant women’s experience of gynaecological care. Methods We conducted 17 semi-structured in-depth interviews with migrant women in Toulouse (France). We used a Grounded Theory approach to perform the analysis. Results Although migrant women were generally satisfied with the gynaecological care received, they also reported dysfunctions. Positive elements were the French health insurance system, the human qualities of the healthcare providers and the performance of the health system. Although reassuring, the structured framework was perceived to have little flexibility. This was sometimes felt as oppressive, paternalistic or discriminatory. These obstacles, amplified by the women’s lifestyle instability and precariousness, the language barrier and the difficulty to understand a totally new healthcare system, made women’s health care and, especially, preventive care, a difficult-to-achieve and low-priority objective for the women. Conclusions Migrant women’s overall satisfaction with the healthcare system contrasted with the known health inequalities in these populations. This is a good example of the concept of acculturation. Healthcare professionals need to make an introspective effort to prevent the emergence of stereotypes and of discriminatory and paternalistic behaviours. A better understanding and respect of the other person’s culture is an indispensable condition for intercultural medicine, and thus for reducing the health inequalities that migrant women experience.

Background Vulnerable social groups have more difficulty in accessing care and a lower quality of care. Health systems that focus on primary care appear to be more effective, efficient and equitable. However, difficulties in accessing primary care persist. We focused on primary care screening for cervical cancer by Cervico-Uterine Smear (CUS), which has been shown to be effective in reducing incidence and mortality. To analyse the population screened by CUS and the health professionals who perform these tests, and to analyse differences in access to care in socio-economic and geographical terms.Methods This was a retrospective observational study based on data from the main health insurance schemes, allowing analysis of health care consumption according to socioeconomic level, and proximity to health care services. We included women (695,694) aged 25 to 64 years in 2012 relevant to CUS. The sociodemographic and territorial indicators were age, geographical area deprivation, and the availability of gynaecological care. The analysis was performed by using multinomial logistic regression.Results 202,271 (29%) patients underwent CUS, 68% by gynaecologists and 28% by general practitioners (GPs). However, inequalities in CUS were observed, with a decrease in the number of CUS performed with age, rural location, deprivation, and sparse health care provision. GPs’ practice seemed to penalize deprived populations less.Conclusions Screening should be conducted more by GPs in primary care, thus providing better access to deprived populations. Health care should be organised more around primary care than hospital care. The specific needs of deprived populations should be considered.

Resume Introduction Les psychologues sont les acteurs les plus consultes, avec les psychiatres, pour un probleme de sante mentale, apres les medecins generalistes (MG). Ils sont les acteurs privilegies par les patients pour une psychotherapie. Les donnees publiees sur leur activite sont rares. Objectif Decrire l’activite des psychologues liberaux (demographie, environnement professionnel, modalites d’exercice, outils psychotherapeutiques utilises, motifs de recours des patients/sujets, interactions). Methode Un questionnaire auto-administre a ete adresse par voie postale aux 1 128 psychologues liberaux de la region Midi-Pyrenees en 2017. Resultats Parmi les 434 repondants, les psychologues utilisaient en moyenne entre trois et quatre outils. Leur approche principale etait : therapies d’orientation analytiques pour 42,2 % des psychologues, therapies cognitivo-comportementales (16,8 %), therapies humanistes (10,1 %), therapies integratives (9,7 %), EMDR (6,7 %), therapies systemiques (4,6 %), hypnose (2,3 %). Les psychologues recevaient en moyenne 17 patients par semaine ; le tarif moyen affiche etait de 44 euros. Les troubles anxiodepressifs et leur retentissement social et professionnel etaient les principaux motifs de recours. Six patients sur dix venaient d’eux-memes chez les psychologues. Conclusion Notre effectif representait un large echantillon socio-demographiquement representatif, malgre un possible biais de selection et une probable influence sur les reponses de l’ancrage regional universitaire de l’approche psychanalytique. Les psychologues constituent une ressource accessible d’acteurs en sante mentale, malgre la diversite de leurs formations et de leurs pratiques, et pourraient contribuer a un meilleur acces aux psychotherapies, dans l’interet des patients et pour une meilleure prise en charge interprofessionnelle coordonnee en sante mentale.

Objective To analyse whether patient–general practitioner (GP) interaction, measured by their disagreement, varies among overweight or obese patients compared with normal-weight patients. Methods Twenty-seven GPs and 585 patients participated in the quantitative phase of the multidisciplinary INTERMEDE project and answered “mirrored” questionnaires collecting both GPs and patients’ perceptions on information and advice given at the end of the consultation. Multilevel logistic regressions were performed to explore associations between patient body mass index (BMI) and patient–GP disagreement on information and advice given during the consultation. Results Disagreement increased with the patients’ excess weight, and it was particularly pronounced for advice given by GPs on weight and lifestyle issues. Compared with patients with a “normal” BMI, overweight patients were more likely to disagree with their GP regarding advice given on weight loss (odds ratio [OR] = 10.7, 95% confidence interval [CI] = 4.1–27.3), advice given on doing more physical activity (OR = 1.9, 95% CI = 1.1–3.4), and nutritional advice (OR = 2.9, 95% CI = 1.5–5.6). Conclusion These disagreements could degrade the quality of patient–physician relationship. Our study provides an opportunity for GPs to reflect on how they communicate with overweight and obese patients, particularly with regard to lifestyle and weight-related advice and interventions taking into account the patient’s representations.

ObjectiveThe objective of this cross-sectional study was to investigate the impact of socio-territorial characteristics on mammography and pap smear uptake according to the place of residence in the recommended age groups, and second outside the recommended age groups.Setting and participantsWe used an existing dataset of 1 027 039 women which combines data from the Health Insurance information systems, with census data from Midi-Pyrénées, France.Primary and secondary outcome measuresOur outcome was, for each woman, the uptake of the pap smear and the uptake of the mammography during the year.ResultsA social gradient of screening uptake was found in the recommended age groups. This gradient was stronger in large urban areas:(1) For mammography: decile 10 (the most deprived) vs 1 (the least deprived), adjusted OR 0.777, 95% CI (0.748 to 0.808) in large urban area; adjusted OR= 0.808 for decile 1 to 0.726 for decile 10 in other areas vs decile 1 in urban areas;(2) For pap smear: decile 10 vs 1 adjusted OR 0.66, 95%CI (0.642 to 0.679) in large urban areas; adjusted OR= 0.747 for decile 1 to 0.562 for decile 10 in other areas vs decile 1 in urban areas).Screening rates were globally higher in large urban areas.For mammography, the social and territorial disparities were higher outside the recommended age group.ConclusionsOffering a universal approach to every woman, as it is often the case in nationally organised screening programmes, is likely to be insufficient to ensure real equity in access. Developing global dataset combining health data and diverse socioeconomic data, at individual and contextual levels, could enable a better understanding of the mechanisms involved in this social gradient, and therefore, the development of targeted territorial actions to improve equity of access to healthcare.

IntroductionPatients suffering from cancer are often managed by multiple health professionals. General practitioners with specific skills in oncology could facilitate care coordination between hospital and general practice in the management of these patients. To explore this hypothesis, we run a randomised clinical trial, called ‘Concertation de REtour à DOmicile, CREDO’. The main objective is to explore the effectiveness of a ‘return home’ consultation compared with standard care. The number of unscheduled visits to care centres is used to evaluate the effectiveness of the treatment.Methods and analysisCREDO is a multicentre, randomised, open-label, prospective trial. It takes place in two specialised cancer care centres in southern France (Occitania region). Patient inclusion criteria are: be over 18 years old; be treated with a first cycle of metastatic chemotherapy in a specialised cancer care centre; have a metastatic solid cancer and be returning home after treatment. Patients are randomised in two arms: standard-arm (conventional management) or intervention-arm (CREDO management). In the intervention arm, a ‘return home’ consultation is carried out in three steps. First, the investigating GP (GP with specific skills in oncology) from the specialised care centre collects information about the patient and patient’s management choices. Then, the investigating GP conducts an interview with the patient’s referring GP to quickly communicate and discuss information about the patient. Finally, the investigating GP summarises these exchanges and transmits this information to the care centres chosen by the patient.All the patients are followed for 1 year.Statistical and medicoeconomic analysis are planned.Ethics and disseminationThis clinical trial is registered under ClinicalTrials.gov identifier and was approved by the ethics committee of South-Western French Committee for the Protection of Persons (number: 2016-A01587-44) and from the French National Drug Safety Agency (ANSM, number: 2016111500034).An international publication of the final results and conference presentations will be planned.Trial registration numberNCT02857400.

Collaborative mental health practices in primary care significantly enhances patients' health. Collaboration between general practitioners (GPs) and psychologists could improve non-drug mental care. Little is known of psychologists' perception of GPs and their collaboration. This study aimed to assess the quality of collaboration between GPs and psychologists from the psychologists' perspective and to identify factors associated with satisfactory collaboration. A questionnaire was sent by post to all private psychologists in a region of France in February, 2017. We carried out descriptive and multivariate analysis of factors associated with satisfactory collaboration. The response rate was 38% (n = 434 out of 1128). Collaboration between GPs and psychologists was considered unsatisfactory by 64% (n = 278) of psychologists. The main barriers reported were lack of time, lack of understanding and poor interactions/communication. Sixty-nine percent of psychologists felt that GPs knew little about their work. Psychologists had professional exchanges with an average of three local GPs and received referral information for 12% of new patients. Out of 10 new patients, 2 were referred by a GP. In a multivariate analysis, satisfactory collaboration was significantly associated with the number of GPs psychologists exchanged with (OR 1.29), receipt of referral information (OR 2.18) and a positive assessment of GPs' understanding of psychologists' activity (OR 3.35). Psychologists considered the collaboration between GPs and psychologists as substandard, as well as GPs' knowledge of psychologists' activity. More interactions and better understanding would improve their collaboration.

In response to the complexity of medical care in oncology, 2 years ago, we designed a new teaching method (SPOC, Small Private Online Course) to improve cancer treatment and its management by emphasizing the community-hospital interface. The educational objective of this study was to evaluate after 1 year if the interest for this teaching remained constant over the long term to meet both educational and financial requirements. We designed a questionnaire including 18 questions grouped in 3 main parts describing the profile of the participants, his/her own experience, and the current utilization of the SPOC. Of 1574 participants of the 2 first sessions, 182 (11.5%) completed the questionnaire after 1 year. The majority of respondents were between the ages of 31 and 60 and belonged to a paramedical group (47.81%). After 1 year, 84.6% participants were satisfied or very satisfied with the content of the SPOC, 83.6% would recommended it, and 67% would be interested in using an updated SPOC again. Only 4.9% kept some contacts with other participants and 4.9% with teachers. 31.3% considered that the SPOC had a medium impact on their professional activity, 33.5% a lot, and 2.7% completely whereas 24.7% considered that it had little impact. The evaluation at 1 year showed that this digital learning method had a global positive impact on the professional practice of the participants. This study highlighted the empowerment of participants after this kind of teaching, but the network between participants was not enhanced.

Background Among patients with cancer, discussion about the desired care is important, because progression of the disease, particularly signs of impaired consciousness, can lead to unwanted care in situations where no advance directives (ADs) have been provided. The aim of this study was to identify the most appropriate individual and time for addressing the subject of ADs with patients with cancer.Methods A systematic literature review was carried out between September 2014 and August 2015, using the following databases or sets of databases: PubMed, Web of Science, Cochrane Library, EM Premium, and the French database Public Health Data Bank. The methodological aspects of the articles were selected and evaluated with the help of PRISMA international guidelines.Results Of the 1170 articles identified, 7 were included (6 descriptive studies, 1 interventional study). A doctor was cited as the preferred individual for discussing the subject of advance directives with the patient. In 3 studies, this was listed as a general practitioner, whereas in the other 3 studies, it was an oncologist. The most opportune time was during the absence of a serious pathology (3 studies) and at the time the disease was diagnosed (2 studies).Conclusions Our results support the goals of Claeys-Leonetti, a 2016 French law concerned with the rights of patients receiving end-of-life care, and they suggest the implementation of a consultation for discussing and drafting ADs.

Background Patients suffering from cancers are increasingly numerous in general practice consultations. The General Practitioner (GP) should be at the heart of the management of patients. Several studies have examined the perceptions of GPs confronted with the patient suffering from cancer and the relationships of GPs with oncologists, but few studies have focused on the patients’ perspective. We studied the three-way relationship between the oncologist, the GP, and the patient, from the patient’s point of view. Methods A questionnaire validated by a group consisting of GPs, oncologists, nurses, an epidemiologist and quality analyst, was administered over a three-week period to patients suffering from cancer receiving chemotherapy in a day hospital. Results The analysis was based on 403 questionnaires. Patients had confidence in the GP’s knowledge of oncology in 88% of cases; 49% consulted their GP for pain, 15% for cancer-related advice, and 44% in emergencies. Perceived good GP/oncologist communication led patients to turn increasingly to their GP for cancer-related consultations (RR = 1.14; p = 0.01) and gave patients confidence in the GP’s ability to manage cancer-related problems (RR = 1.30; p p p Conclusion Patients suffering from cancer considered that the GP was competent, but did not often consult their GP for cancer-related problems. There is a discrepancy between patients’ beliefs and their behaviour. When the oncologist spoke to patients of the GP’s role, patients had recourse to their GP more often. Systematically integrating a GP consultation to conclude cancer diagnosis disclosure, could improve management and care coordination.

Background Deaf people represent 0.1% of the French population and their access to public health campaigns is limited due to their frequent illiteracy and the infrequent use of sign language in campaigns. There is also a lack of general health knowledge in spite of the existence of French Deaf Care Units (UASS). The aim of this study is to assess the average diagnostic stage of cancer in the Deaf Community and discuss deafness as a contributing factor. Methods Four thousand three hundred sixty-three Deaf patients recorded in five UASS, 80 diagnosed between 2005/01/01 and 2014/12/31 were selected from medical records and/or ICD-10 coding. Data regarding cancers were extracted, grouped by stage and compared to literature. Statistical significance was tested with Fisher’s Exact Test. Results Eighty patients were selected. Most cancers were diagnosed at advanced stages: of 11 prostate cancers, 46% were locally advanced and 18% were metastatic. (In the general population, this was respectively 3% and 10.4% (p

Background: The script concordance test (SCT) is a validated method of examining students’ clinical reasoning. Medical students’ professional skills are assessed during their postgraduate years as they study for a specialist qualification in general practice. However, no specific provision is made for assessing their clinical reasoning during their postgraduate study. Objective: The aim was to demonstrate the reliability and validity of the SCT in general practice and to determine if this tool could be used to assess medical students’ progress in acquiring clinical reasoning. Methods: A 135-question SCT was administered to postgraduate medical students at the beginning of their first year of specialized training in general practice, and then every six months throughout their three-year training, as well as to a reference panel of 20 expert general practitioners. For score calculation, we used the combined scoring method as the calculator made available by the University of Montreal’s School of Medicine in Canada. For the validity, student’ scores were compared with experts, p

Consequences of inappropriate prescriptions and polymedication in patients suffering from cancer are beginning to be well documented. However, the methods used to evaluate these consequences are often discussed. Few studies evaluate the risk of interaction with anticancer drugs in elderly patients suffering from cancer. To describe the prevalence (i) of polypharmacy, (ii) of potentially inappropriate drug prescriptions and (iii) of drug interactions involving anticancer treatments, using a multiple reference tools. A retrospective, cross-sectional, multicenter study performed from January to December 2012. Patients aged 65 years or older suffering from cancer presented at the oncogeriatric multidisciplinary meeting. Polymedication (>6 drugs), potentially inappropriate prescriptions and drug interactions involving anticancer treatment were analyzed in combination with explicit and implicit criteria within a global approach. Among the 106 patients included in this study, polypharmacy was present in 60.4% of cases, potentially inappropriate drug prescription in 63.1% and drug interactions in 16% of case, of which 47% involved anti-cancer treatments. Twenty-seven major drug interactions were identified and eight interactions involved chemotherapy. Polymedication, inappropriate prescribing and drug interactions involving anti-cancer drugs are common and largely underestimated in elderly cancer patients.

Medical doctors’ (MDs), but not patients’, perception of supportive care in cancer (SCC) in France has been previously assessed in a national survey. This study evaluated MDs and patients’ perceptions of the SCC organization and implementation in France. The French SCC Association conducted two observational studies: study 1 (S1), containing a 30-point questionnaire sent to 2263 MDs, and study 2 (S2), containing a 40-point questionnaire sent to 2000 patients. Overall, 711 MDs completed S1 and 1562 patients completed S2. In S1, 81% of MDs reported relying on a SCC organization and 76% attended SCC multidisciplinary discussions. MDs considered palliative (98%), psychological (98%), and social care (98%) as the top 3 SCC areas of importance for patients. In contrast, patients’ priorities were psychology (61%), nutrition (55%) and organization of intake consultations (55%). The concept of SCC was familiar to 34% of patients; according to MDs, this concept was introduced mainly by MDs (78%) and admission nurses (41%). Outpatients identified as professional resources for SCC information general practitioners (84%), nurses (58%), and pharmacists (52%). Patients reported supportive treatment being prescribed in 63% of cases, with 64% receiving information on the negative side-effects. Among MDs, 87% reported proposing palliative and 41% adjuvant SCC treatment. Furthermore, 72% of MDs recommended SCC treatment at the metastatic stage, and 36% immediately following diagnosis. Oncologists play a vital role in enhancing SCC efficacy. This can be increased by implementing a multidisciplinary integrated approach or by assuring the availability of patient information.

In response to the complexity of medical care in oncology, 2 years ago, we designed a new teaching method (SPOC, Small Private Online Course) to improve cancer treatment and its management by emphasizing the community-hospital interface. The educational objective of this study was to evaluate after 1 year if the interest for this teaching remained constant over the long term to meet both educational and financial requirements. We designed a questionnaire including 18 questions grouped in 3 main parts describing the profile of the participants, his/her own experience, and the current utilization of the SPOC. Of 1574 participants of the 2 first sessions, 182 (11.5%) completed the questionnaire after 1 year. The majority of respondents were between the ages of 31 and 60 and belonged to a paramedical group (47.81%). After 1 year, 84.6% participants were satisfied or very satisfied with the content of the SPOC, 83.6% would recommended it, and 67% would be interested in using an updated SPOC again. Only 4.9% kept some contacts with other participants and 4.9% with teachers. 31.3% considered that the SPOC had a medium impact on their professional activity, 33.5% a lot, and 2.7% completely whereas 24.7% considered that it had little impact. The evaluation at 1 year showed that this digital learning method had a global positive impact on the professional practice of the participants. This study highlighted the empowerment of participants after this kind of teaching, but the network between participants was not enhanced.

BACKGROUND Oncology involves complex care and multidisciplinary management of patients; however, misinformation and ineffective communication remain problematic. OBJECTIVE The educational objective of our study was to develop a new teaching method to improve cancer treatment and management by emphasizing the link between hospitals (inpatients) and their surrounding communities (outpatients). METHODS A team of 22 professionals from public and private institutions developed a small private online course (SPOC). Each offering of the course lasted 6 weeks and covered 6 topics: individual health care plans, cancer surgery, ionizing radiation, cancer medicines, clinical research, and oncological supportive care. For participants in the course, we targeted people working in the cancer field. The SPOC used an active teaching method with collaborative and multidisciplinary learning. A final examination was offered in each session. We evaluated participants’ satisfaction rate through a questionnaire and the success of the SPOC by participants’ completion, success, and commitment rates. RESULTS Of the total participants (N=1574), 446 completed the evaluation form. Most participants were aged 31 to 45 years. Participants included 56 nurses, 131 pharmacists, 80 from the medical field (including 26 physicians), 53 from patients’ associations, 28 health teachers, and 13 students (medical and paramedical). Among the participants, 24.7% (90/446) had an independent medical practice, 38.5% (140/446) worked in a public institution, and 36.8% (134/446) worked in a private institution. After completing the SPOC sessions, 85.9% (384/446) thought they had learned new information, 90.8% (405/446) felt their expectations were met, and 90.4% (403/446) considered that the information had a positive impact on their professional practice. The completion rate was 35.51% (559/1574), the success rate was 71.47% (1025/1574), and the commitment rate was 64.67% (1018/1574). Concerning the cost effectiveness of SPOC compared with a traditional classroom of 25 students, online education became more effective when there were more than 950 participants. CONCLUSIONS SPOCs improved the management of oncology patients. This new digital learning technique is an attractive concept to integrate into teaching practice. It offered optimal propagation of information and met the students’ expectations.

Resume Introduction ces dernieres annees ont ete marquees par l’emergence de nouvelles molecules pour le traitement des formes metastatiques avec un benefice significatif sur la survie des patients. Par ailleurs, de nombreuses techniques sont developpees actuellement pour le traitement locoregional des sites metastatiques, apportant ainsi de nouvelles perspectives therapeutiques. Toutefois, la mise a disposition de ces nouveaux traitements souleve aupres des professionnels de sante des interrogations quant a leur utilisation et place dans la strategie therapeutique. Objectif l’Institut national du cancer, dont l’une des missions est de definir et de favoriser la diffusion de recommandations nationales de bonnes pratiques cliniques depuis 2008, a souhaite diffuser un etat des lieux des connaissances sur ces modalites de traitement et formuler des recommandations afin de permettre une diffusion au niveau national de l’innovation tout en favorisant son bon usage. Methode le processus d’elaboration est base sur une revue systematique de la litterature et sur le jugement argumente d’experts cliniciens au sein d’un groupe de travail multidisciplinaire. Avant publication, les recommandations sont revues par des experts cliniciens independants du groupe de travail. Resultats cet article presente les recommandations nationales relatives aux traitements locoregionaux des metastases pulmonaires, osseuses, cutanees, hepatiques et digestives chez des patients atteints d’un melanome cutane pauci-metastatique.

Increased life expectancy and cancer incidence imply the need to develop a specialized care policy for elderly patients with cancer. We created an oncogeriatric consulting team (OGCT) in Toulouse University Hospital to carry out comprehensive gerontological assessment at the bedside of hospitalized patients. We analyze the impact on the final cancer treatment decision of this mobile geriatric assessment. We carried out a descriptive, retrospective real-life analysis of a patient cohort over a two-year period. The OGCT assessed 124 patients, of whom the majority were women (54.8%), median age 81 years, living at home (95.2%) and with family caregivers (86.5%). Nearly all were frail (96.7% according to the classification of Balducci and colleagues) and 3.2% were vulnerable. The team's decisions were analyzed for patients who had not yet been treated (n=107). After analysis, the team's proposal was in line with the initial cancer treatment plan in 68.2% of cases (n=73). In cases where there was a disagreement, the final decision was in line with the mobile team's proposal in 17.75% of 107 patients (n=19). The decision of the team was followed more often when their assessment proposed strictly palliative treatment. The decision to give elderly patients specific cancer treatment seems in our experience rather to be a matter for the oncologists, and is not very susceptible to modification by geriatric opinion. On the other hand, the geriatrician appears to be more credible and his/her opinion more likely to be followed when the patient is considered too frail and less aggressive, or even exclusively palliative, treatment is proposed.

The risk of venous thromboembolic event (VTE) in multiple myeloma is particularly increased. Current guidelines recommend systematic VTE prophylaxis with vitamin K antagonists (VKA) or low weight molecular heparin (LWMH) or unfractionated heparin (UFH) in high-risk patients, based on treatment received [e.g. use of IMiDs (thalidomide, lenalidomide and pomalidomide), alkylating agents or erythropoietin] and individual risk factors (e.g. history of VTE). The aim of this study was to describe strategy of VTE prophylaxis and prescribing of other antithrombotic agents during the first 6 months of multiple myeloma therapy, with stratification on IMiD-based regimens and drug and disease-related risk factors.A retrospective cohort study of French beneficiaries from the health insurance database (SNIIRAM, Système National d'Information Inter-Régime de l'Assurance Maladie) was designed in the Midi-Pyrénées area (South West France). Patients starting a treatment for multiple myeloma in the period 2011-2014 were identified through hospital and chronic disease diagnoses.Among the 236 incident multiple myeloma patients, 56% male (n = 133), 67%65 years (n = 159) and 47% (n = 110) patients received an IMiD-based regimen. In these patients, 63% (n = 69) were identified as high-risk patients with indication for low molecular weight heparin or equivalent, and 37% (n = 41) were identified as low-risk with aspirin recommended. Among the high-risk IMiDs patients, 43% (30/69) currently received a VTE prophylaxis after starting their first regimen: 70% LWMH (21/30), 40% VKA (12/30), 10% UFH (3/30) and 13% (4/30) other drugs (rivaroxaban and fondaparinux); 33% of the patients (23/69) received an antiplatelet drug only, and 23% (16/69) did not receive any antithrombotic drug.These results revealed lack of implementation of VTE prophylaxis in one out of high-risk multiple myeloma patients with IMiD. Copyright © 2017 John WileySons, Ltd.

Five to ten percent of cancers are of occupational origin but only 0.5% of cancers are compensable occupational diseases recognized in 2001. The project "Curriculum Laboris" was launched in Midi-Pyrenees with the objective to establish an organization to improve the identification, reporting and recognition of occupational cancers. The project consisted firstly in creating an online training module for professionals. Furthermore, a pilot has identified patients with lung, bladder, head and neck or hematologic cancer. Afterwards, four investigators realized an interview with the patients "marked" to define their careers. Finally, a group of experts produced advice, providing the general practitioner, the aid element in drafting the initial medical certificate (CMI) as part of the recognition process. Twenty-three patients were identified, 21 surveys were carried out. Six returns were filed and actually recognized. The generalization of our device measures meet the Cancer Plan II 2009 to 2013 and may improve the number of cancers recognized as compensable occupational diseases.

Many previously considered "chronic" diseases (eg, impaired vision,hip or knee arthritis) can today be efficiently treated and solved. Atthe same time, because of the aging population, the prevalence ofchronic conditions (eg, Alzheimer disease or cardiovascular diseases)is also increasing.Older people are the most clinically heterogeneous subpopulationcompared with any other age group. Although many elders are stillrobust even at advanced age, others experience multimorbidity,frailty, and disability, with consequent reduction of life expectancyand quality of life.Although the definition of frailty is largely debated

The primary care physician (PCP) is central to cancer patients’ management. Announcement of the diagnosis is a critical time for patients, even if they wish to be fully informed. The French National Cancer Plan, developed 10 years ago, includes a diagnosis disclosure procedure (DDP) to be used by oncologists, which makes specific provision for a time of communication with PCPs. So, we asked PCPs about their role in cancer announcement since the launching of the DDP. A cross-sectional prospective study by postal questionnaire was sent to 500 PCPs in the largest region of France. It addressed (1) the characteristics of cancer disclosure, (2) PCPs’ source of information of the diagnosis, (3) time of disclosure, (4) information exchange, and (5) the physicians’ knowledge of the DDP. The response rate was 48 %. In 20 % of cases, oncologists delegated the announcement to PCPs. In 19 % of cases, it was the patient or their family who informed the PCP of the diagnosis. We identified three announcement phases of cancer diagnosis in the physicians’ clinical practice: pre-disclosure, disclosure, and repeat disclosure. In 57 % of cases, PCPs lacked information on prognosis and in 60 % on treatment. Regarding the DDP, nearly half of PCPs did not know the procedure itself or its content. PCPs announce the cancer diagnosis, even if they have not received the necessary information to do so. The DDP needs to be adapted for use in primary care practice.

Fundus photographs using non-mydriatic digital cameras for diabetic retinopathy screening have been studied in France during the past 10 years. Nevertheless, the different screening modalities have not been compared. The main goal of this study was to compare patient recruitment with two different screening modalities, and secondarily to compare diagnostic effectiveness and cost. A retrospective study analyzed data from the Diabetes Midi Pyrenees Network in 2005 and between 2006 and 2010. In 2005, a vehicle with digital camera traveled through a rural department in order to screen diabetic patients whose last fundus examination was performed greater than 1 year previously. Between 2006 and 2010, general practitioners sent their diabetic patients whose last fundus examination was performed greater than 1 year previously to a "local" screening site. In the two cases, fundus photographs were made by trained operator at screening site and analyzed by an ophthalmologist. The "mobile" screening recruited 698 patients, and the "local" screening 345 patients. Patients recruited by "mobile" screening were older than those recruited by "local" screening. They were preferentially men and suffered from diabetes from far longer The diagnostic performance of "local" screening was 26.8%, and it was 28.6% for "mobile" screening (p = 0.47). The cost of screening was higher for "mobile" screening: 116 Euro against 61 Euro for "local" screening. "Mobile" screening could allow more patient recruitment than "local" screening when geographic and demographic constraints are more important.

Five to ten percent of cancers are of occupational origin but only 0.5% of cancers are compensable occupational diseases recognized in 2001. The project "Curriculum Laboris" was launched in Midi-Pyrenees with the objective to establish an organization to improve the identification, reporting and recognition of occupational cancers. The project consisted firstly in creating an online training module for professionals. Furthermore, a pilot has identified patients with lung, bladder, head and neck or hematologic cancer. Afterwards, four investigators realized an interview with the patients "marked" to define their careers. Finally, a group of experts produced advice, providing the general practitioner, the aid element in drafting the initial medical certificate (CMI) as part of the recognition process. Twenty-three patients were identified, 21 surveys were carried out. Six returns were filed and actually recognized. The generalization of our device measures meet the Cancer Plan II 2009 to 2013 and may improve the number of cancers recognized as compensable occupational diseases.

Background: High levels of stigma towards patients with substance use disorder (SUD) have been found in health professionals and medical students. Objectives: To assess the capability of residents in general practice to diagnose SUD correctly; to assess their stigmatization of patients with SUD and to assess the correlation between both variables. We hypothesized a negative correlation. Methods: In 2014, we conducted a cross-sectional survey among French residents in general practice, using a self-administered questionnaire. First, a clinical case of SUD (tramadol) was presented, to assess the diagnosis and retained diagnostic criteria. A second clinical vignette was presented (intravenous heroin user) to assess stigmatization with the Attitudes to Mental Illness Questionnaire (AMIQ). Its score ranges from –10 (negative attitude) to +10 (positive attitude). AMIQ scores of residents who diagnosed SUD correctly versus incorrectly, and who had received at least six hours versus less than six hours of teaching on this topic, were compared using Student’s t-test. Results: Of 1284 solicited residents, 303 participated (23.6%), 249 residents diagnosed SUD correctly (82.2%). The mean AMIQ score was –3.91 (SD 2.4) without significant difference regarding the correct diagnosis of SUD; but with a significant difference between residents who had received training in SUD for at least six hours versus residents less trained (AMIQ scores –3.76 (SD 2.46) versus −4.50 (SD 2.27), p = .0354). Conclusion: Residents in general practice had a good capacity to diagnose SUD correctly but on average expressed negative attitudes toward people with SUD. More SUD teaching seems to help in reducing stigmatizing attitudes.

Background: High levels of stigma towards patients with substance use disorder (SUD) have been found in health professionals and medical students. Objectives: To assess the capability of residents in general practice to diagnose SUD correctly; to assess their stigmatization of patients with SUD and to assess the correlation between both variables. We hypothesized a negative correlation. Methods: In 2014, we conducted a cross-sectional survey among French residents in general practice, using a self-administered questionnaire. First, a clinical case of SUD (tramadol) was presented, to assess the diagnosis and retained diagnostic criteria. A second clinical vignette was presented (intravenous heroin user) to assess stigmatization with the Attitudes to Mental Illness Questionnaire (AMIQ). Its score ranges from –10 (negative attitude) to +10 (positive attitude). AMIQ scores of residents who diagnosed SUD correctly versus incorrectly, and who had received at least six hours versus less than six hours of teaching on this topic, were compared using Student’s t-test. Results: Of 1284 solicited residents, 303 participated (23.6%), 249 residents diagnosed SUD correctly (82.2%). The mean AMIQ score was –3.91 (SD 2.4) without significant difference regarding the correct diagnosis of SUD; but with a significant difference between residents who had received training in SUD for at least six hours versus residents less trained (AMIQ scores –3.76 (SD 2.46) versus −4.50 (SD 2.27), p = .0354). Conclusion: Residents in general practice had a good capacity to diagnose SUD correctly but on average expressed negative attitudes toward people with SUD. More SUD teaching seems to help in reducing stigmatizing attitudes.