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Background

Assessment and management of frail elderly patients is organised in primary care worldwide. Multidisciplinary organisation in France is now becoming structured within multidisciplinary health centres (MHCs).

Objective

To describe the functioning of multidisciplinary management programmes in MHCs, identification and assessment of the frail population, and difficulties encountered by the professionals.

Methods

This prospective study was carried out in 2 components from October 2016 to March 2019 in all the MHCs in our region that are involved in the management of frail patients. To examine the functioning of management programmes, we questioned the general practitioners (GPs) and registered nurses (RNs) involved in the management of frail patients. The medical records of the frail patients managed were analysed after anonymisation.

Results

A validated scale was used for patient identification in one-third of cases. Geriatric assessment was carried out by nurses. Patient follow-up was conducted according to a protocol and reproducible in half of cases. The geriatric characteristics of the 235 patients assessed were similar to those of the frail population assessed in hospital facilities. Three-quarters of the 574 proposed personalised care plans were implemented, whether follow-up followed a protocol or not.

Conclusions

Management of frail elderly patients in primary care is complex but feasible. Primary care teams that are novices to patient assessment and follow-up could at first manage pre-frail patients. The more complex patients could be assessed in hospital facilities. Use of the dedicated GFST questionnaire, rather than subjective assessment, would enable early identification and management of these patients.

Objectives

This study was undertaken to compare subjects diagnosed with Antisocial Personality Disorder (ASPD) and healthy controls in terms of alexithymia, empathy and theory of mind.

Material and methods

A total of 43 patients diagnosed with ASPD and 43 healthy controls were included. Study tools administered include the Sociodemographic Data Form, Barratt Impulsivity Scale - Version 11 (BIS-11), Reading the Mind in the Eyes Test (RMET), Empathy Quotient (EQ), Toronto Alexithymia Scale (TAS-20) and Beck Depression Inventory (BDI).

Results

As compared to controls, patients had significantly lower RMET and total EQ scores (p<0.001) and significantly higher BIS total and planning, motor and attention, TAS-20 total, identifying feelings, describing feelings, and externally oriented thinking scores (p= 0.002; p=0.008; p <0.001; p<0.001; p<0.001; p<0.001; p<0.001; and p=0.017, respectively). There was a positive significant correlation between RMET and EQ scores (p=0.006, r=0.415), while EQ scores were negatively and significantly correlated with TAS-20 scores (p=0.001, r= -0.487). There was a significant negative correlation between EQ and BIS-11 scores (p< 0.001, r= -0.609), while a positive and significant correlation was identified between TAS-20 and BIS-11 scores (p=0.012, r=0.379). Patients with self-mutilating behaviors had significantly lower total RMET scores than patients without such behaviors (p=0.028).

Conclusion

In conclusion, ASPD patients experience difficulty in reading the mind in the eyes, exhibit less empathy toward others, and have more pronounced alexithymia. Our observations suggest that ASPD patients experience challenges in the theory of mind concepts as well as in understanding and identifying the emotions of others and the self. We believe that comprehensive therapy programs specifically developed for ASPD patients and encompassing both the theory of mind and emotional perception may assist in improving these concepts that have significant roles in social interactions.

Background

Self-medication practices are a common trend among physicians, despite demonstrated risks and occupational hazards. Common mental health disorders such as anxiodepressive disorders are more frequent among medical students worldwide.

Aims

To estimate the prevalence of self-treatment with psychotropic drugs during residency across all medical and surgical specialties.

Methods

This cross-sectional study was based on a questionnaire constructed from a literature review that addressed reported mental health disorders, patterns of psychotropic drug utilization, screening for depression (validated two-question screen test), mental health status numerical rating scale, and care pathways. The self-administered questionnaire was pretested and sent to all managers of French residents' organizations for dissemination. Sampling was voluntary with no predefined response threshold.

Results

Of the 2,314 respondents, 30.5% reported having used a psychotropic drug during residency; 21.7% (95% CI [20.0; 23.4]), for self-medication; and 8.0%, for regular self-medication. Of the 72% that reported a mental disorder, 22% consulted a professional about it. The proportion of residents who reported self-treatment with psychotropic drugs significantly increased with seniority (p<0.05). During residency, 41% reported they had never consulted an occupational physician, and 71% had never consulted a family medicine physician.

Conclusion

Based on this large-sample study, self-consumption of psychotropic drugs could involve 2 out of 10 residents during residency. We noted a discrepancy between reports of psychotropic medication use and reports of related mental disorders. Most residents reporting a mental disorder had not consulted a professional. These findings encourage consideration of residents’ perceptions and ambivalence regarding self-medication and mental health promotion during residency.

The consumption of psychoactive substances, and especially alcohol, in the hours before a dive affects the behavior and performance of divers and may increase the risk of accidents during diving. Alcohol consumption has a direct impact on diving, in addition to impairing psychomotor ability. Given the paucity of research on the topic, we decided to conduct a cross-sectional study with the aim of evaluating attitude toward alcohol consumption, predictors of chronic alcohol consumption and at-risk diving behavior defined as drinking within 6 h or less before a dive, in a French scuba diving population.

In our study, 4,302 responses were analyzed including 1,308 (30.4%) responses from women and 2,994 (69.6%) from men. In our sample, 49.9% of divers had a medium or high risk of alcohol dependence based on Alcohol Use Disorders Identification Test criteria. A total of 955 (30.0%) reported having drunk alcohol within 6 h or less before a dive. The number of divers who stated that alcohol consumption had affected or altered their dive was 280 (8.8%). A total of 853 (19.8%) participants declared having dived with a drunk partner. In univariate and multivariate analyses, males under 55 years with divemaster certification, had an increased risk of alcohol consumption before diving.

Millions of divers around the world could be given fair and balanced information on the risks associated with alcohol consumption on diving, and whenever possible, on safe alternatives to drinking before diving.

Background

Gateway access to a medical school currently represents 10% of medical students in France. It should increase to 40% in the coming years, starting with the 2020–2021 academic year, due to the implementation of a national reform designed to diversify the selection process and ease access to medical education. The objective of this study was to describe and analyze characteristics of gateway students and their academic performance in France.

Methods

A retrospective multicentric study on gateway students (Passerelle) enrolled between 2011 and 2019 at three medical schools was conducted. Student characteristics, academic performance (examination results from second to sixth year) and rankings at the national residency exam, Epreuves Classantes Nationale (ECN), were described. A multiple correspondence analysis (MCA) described those with an ECN ranking between 1 to 4000.

Results

In total, there were 243 gateway entry students, with females representing 57.6% (n = 140). The mean age of students was 26.2 ± 3.6 years. Those with a degree in sciences accounted for 89.3% of the total. Gateway students that dropped out accounted for 6.6%, and mostly at the end of second year (n = 10). 110 gateway entry students completed the ECN with a mean ranking position of 5,624 ± 2,108. ECN rankings between 1 to 4000 were significantly associated with (i) males, (ii) having a mention (score ≥ 12/20) on the French baccalaureate, (iii) never having enrolled in the first year of medical school, and iv) having a low number of uncompleted modules. With the MCA, a mention of ‘very good’ on the French baccalaureate exam (score ≥ 16/20) was associated with an ECN ranking between 1 to 4000.

Conclusions

This study was the first to describe the characteristics of gateway medical students in France. Most students came from a sciences academic background and had a low rate of dropping out. Future studies on academic performance should be conducted.

Background

Human Papilloma Virus (HPV) vaccination rate in France is low, and has decreased between 2010 and 2011. The High Council Of Public Health (Haut Conseil à la Santé Publique, HCSP) has published a notice which modified the recommendations on the age of first fixed vaccination from 14 to 11 years, and the catch up vaccination from 15-23 to 12-20 years. Our study aimed to assess the change in HPV vaccination rates following the HCSP notice among girls of 11-19 years old.

Methods

Retrospective study of HPV vaccines reimbursements from SNIIRAM databases (Système National d'Information Inter-Régime de l'Assurance Maladie) at the regional level (Midi-Pyrenees), 291 working days before and after the publication of new recommendations. Main outcome measures: Dispensing records were those of the health insurance database. Medical prescribing is mandatory for eligibility to reimbursement. Birth year, prescriber specialty, pack code and date of dispensing were collected.

Results

after the publication of the notice of HCSP, no significant increase was observed in HPV vaccination rates across all age groups: 3.62% of the girls aged 11-19 years of study area received at least one vaccine dose before the recommendations vs. 6.05% after (p-value = 0.75). The percentage of prescribing general practitioners has not increased.

Conclusion

There was no significant increase in HPV vaccine prescribing rates despite the extension of the recommended age range. The impact of this change in the study area was modest and did not allow to sufficiently increasing the immunization coverage. Given the low HPV vaccination rates in France, these results provide important evidence to inform public health interventions to increase HPV vaccination.