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Asmaa Janah,1 Lynn R Gauthier,2 Lucas Morin,3 Philippe Jean Bousquet,1,4 Christine Le Bihan,4 Philippe Tuppin,5 Patrick Peretti-Watel,6 Marc-Karim Bendiane11Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), Marseille, France; 2Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval - Centre Hospitalier Universitaire de Québec-Université Laval Research Centre, Oncology Division and Équipe de recherche Michel-Sarrazin en oncologie psychosociale et soins palliatifs, Université Laval Cancer Research Centre, Québec, Canada; 3Aging Research Center, Karolinska Institutet, Stockholm, Sweden; 4Survey, Monitoring and Assessment Department, Public Health and Healthcare Division, Institut National du Cancer (French National Cancer Institute - INCa), Boulogne Billancourt, France; 5Département des études sur les pathologies et les patients (DEPP), Caisse Nationale d’Assurance Maladie, Paris, France; 6Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, and ORS PACA, Southeastern Health Regional Observatory, Marseille, FranceBackground and purpose: Introducing palliative care earlier in the disease trajectory has been found to provide better management of physical and psychological suffering. In France, the proportion of cancer patients who receive palliative care is unclear. This study aimed primarily to measure the prevalence of access to inpatient palliative care and associated patient-level factors, and to identify the time between access to palliative care and death.Patients and methods: A nationwide retrospective cohort study using data from the French national health system database (SNDS). All those diagnosed with cancer in 2013 who died between 2013 and 2015 were included. Access to inpatient palliative care was the main outcome.Results: Of the 313,059 patients diagnosed with cancer in 2013 in France, 72,315 (23%) died between 2013 and 2015. Overall, 57% had access to inpatient palliative care. The following groups were the most likely to have access to palliative care: women (adjusted odds ratio, aOR: 1.15; 95% CI: 1.11–1.20), people aged 18–49 (aOR: 1.38; 95% CI: 1.26–1.51), individuals with metastatic cancer (aOR: 2.04; 95% CI: 1.96–2.13), and patients with cancer of the nervous system (aOR: 1.80; 95% CI: 1.62–2.01). The median time between palliative care and death was 29 (interquartile range: 13–67) days.Conclusion: More than half of cancer patients who died within 2 years after diagnosis had access to inpatient palliative care. Access to palliative care occurs late in the disease trajectory, often during the final month of life. Further research and guidelines are warranted to optimize access to early, standardized palliative care.Keywords: French national health system database, palliative care, cancer, death, factors, timing

Objective: To study drug-related beliefs among adolescents, and specifically their propensity to distinguish "soft drugs" from "hard drugs"; to investigate factors associated with such a propensity as well as its relationship with cannabis use. Design & setting: A cross-sectional self-administered survey conducted among a random sample of 5,812 French high-school pupils. Method: A score was designed for assessing respondents' propensity to distinguish "soft" from "hard" drugs. The correlates were studied, and then used to model various levels of cannabis use. Separate analyses were performed for boys and girls. Results: The propensity to distinguish "soft drugs" from "hard drugs" was tightly associated with cannabis use. For both genders, exposure to preventive information during a course, or through posters or booklets had no impact on such a propensity, and indeed attending a conference on drugs reinforced this propensity among boys. For both genders, this propensity was also strongly associated with cannabis use, and exposure to anti-drug information through a specific lecture was positively associated with cannabis experimentation. Conclusion: The effectiveness of preventive information in French high schools is highly questionable, especially when it endorses an unbalanced "anti-drug" discourse that may even boomerang. As cannabis use and related beliefs are probably built together and reinforce each other, one should neither overestimate the impact of beliefs on behaviours, nor underestimate users' adherence to such beliefs. (Contains 3 tables and 2 figures.)

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2005.10.020 Byline: P. Peretti-Watel (a)(b), B. Spire (a)(b), M.A. Schiltz (c), A.D. Bouhnik (a)(b), I. Heard (d), F. Lert (e), Y. Obadia (a)(b) Keywords: HIV/AIDS; HAART; Adherence; Unsafe sex; France Abstract: Current socio-behavioural research in HIV-infected people has tried to identify patients with 'high-risk' profiles, i.e. who simultaneously exhibit non-adherence to highly active anti-retroviral therapy (HAART) and unsafe sex with serodiscordant partners. We challenged this approach by investigating the correlates of both behaviours, for homosexual men, heterosexual men and heterosexual women separately, among a representative sample of 4963 HIV-infected people in France. Variables introduced in the analysis dealt with patients' background and daily life, with a focus on situations of economic, social and personal vulnerability. Overall, 2932 patients agreed to participate, and 1809 were both receiving HAART and sexually active. Among heterosexual women, non-adherence and unsafe sex appeared as joint outcomes of similar situations of vulnerability. Among heterosexual men, these behaviours were weakly correlated and shared some predictors related to situations of vulnerability. Among homosexual men, non-adherence and unsafe sex were not correlated and had distinct determinants. Situations of vulnerability, the context and the motives of unsafe sex, as well as factors associated with non-adherence and unsafe sex varied greatly with gender and sexual preference. Theoretical models used for designing behavioural interventions should take into account this diversity. Author Affiliation: (a) Regional Centre for Disease Control of South-Eastern France, Marseille, France (b) Health and Medical Research National Institute, Research Unit 379, 'Social Sciences Applied to Medical Innovation', Institut Paoli Calmettes, Marseille, France (c) National Centre of Scientific Research (CNRS-CERMES) and Health and Medical Research National Institute, Research Unit 504 (d) Health and Medical Research National Institute, Research Unit 430, European Hospital Georges Pompidou, Paris, France (e) Health and Medical Research National Institute, Research Unit 88, Paris, France

We assume that actors of the professionalization process of palliative care make a special effort to demarcate it from euthanasia, and that such an effort has a significant impact on beliefs and attitudes toward euthanasia among the whole medical profession. We investigated concurrently attitudes toward palliative care, conceptions of euthanasia and opinion toward its legalization among a sample of 883 French general practitioners, oncologists and neurologists. We found four contrasted profiles of attitudes toward palliative care, which were closely correlated with being in touch with palliative care providers. Attitudes toward palliative care were closely correlated with beliefs about which medical practices should be labelled euthanasia, and these beliefs were in turn strongly associated with opinions toward euthanasia legalization. Our results suggest that the relationship between palliative care and euthanasia mixes semantic and strategic aspects, beyond cognitive and conative ones. Keywords: Physicians: Palliative care; Euthanasia: Professionalization: France