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Background Studying social disparities in health implies the ability to measure them accurately, to compare them between different areas or countries and to follow trends over time. This study proposes a method for constructing a French European deprivation index, which will be replicable in several European countries and is related to an individual deprivation indicator constructed from a European survey specifically designed to study deprivation. Methods and Results Using individual data from the European Union Statistics on Income and Living Conditions survey, goods/services indicated by individuals as being fundamental needs, the lack of which reflect deprivation, were selected. From this definition, which is specific to a cultural context, an individual deprivation indicator was constructed by selecting fundamental needs associated both with objective and subjective poverty. Next, the authors selected among variables available both in the European Union Statistics on Income and Living Conditions survey and French national census those best reflecting individual experience of deprivation using multivariate logistic regression. An ecological measure of deprivation was provided for all the smallest French geographical units. Preliminary validation showed a higher association between the French European Deprivation Index (EDI) score and both income and education than the Townsend index, partly ensuring its ability to measure individual socioeconomic status. Conclusion This index, which is specific to a particular cultural and social policy context, could be replicated in 25 other European countries, thereby allowing European comparisons. EDI could also be reproducible over time. EDI could prove to be a relevant tool in evidence-based policy-making for measuring and reducing social disparities in health issues and even outside the medical domain.

Objectives Guidelines for systematic microsatellite instability (MSI) testing in colorectal cancer have emerged in recent years, and more specifically in France since November 2021. Besides detection of Lynch syndrome for early detection of other cancer and family screening, MSI is associated with different treatment options depending on cancer stage. The aim of this study was to describe MSI testing frequency in patients with colorectal cancer in a French region in the years leading up to the publication of official guidelines. Methods Cases from the Calvados digestive cancer registry were studied between 2019 and 2021. Age, sex, socioeconomic deprivation, tumour location, stage at diagnosis, progression, type of hospital for surgery and for multidisciplinary meetings were collected. These characteristics were compared between cases that underwent testing and those that didn’t, and between unstable and stable cases when tested, using descriptive analyses. Results A total of 1169 cases were included, of which 60% were tested for MSI. Younger patients (80% of patients under the age of 65 vs. 57% of patients over the age of 80) and more advanced stages were more frequently tested (52% stage I vs. 70% stage IV). A higher proportion of cases was tested in 2021 than in 2019 and 2020. A higher proportion of colon cancer cases were tested than rectal cancer (75% vs. 61%). Of the 816 cases tested, 13.6% had MSI. A higher percentage of colon cancer cases were unstable compared to rectal cancer cases (19% vs. 2%). When the analysis was restricted to the year 2021, 18% of cases remained untested. The only significant differences remaining in 2021 were for location (more frequent for colon than for rectal cancer cases), and for stage at diagnosis (performed less for stage I). Conclusions This population-based French study reveals disparities before emergence of official national guidelines and the reduction in these disparities in the most recent years. However, achievement of systematic testing was not yet attained in 2021.

Blinding is a cornerstone of treatment evaluation. Blinding is more difficult to obtain in trials assessing nonpharmacological treatment and frequently relies on \"creative\" (nonstandard) methods. The purpose of this study was to systematically describe the strategies used to obtain blinding in a sample of randomized controlled trials of nonpharmacological treatment. We systematically searched in Medline and the Cochrane Methodology Register for randomized controlled trials (RCTs) assessing nonpharmacological treatment with blinding, published during 2004 in high-impact-factor journals. Data were extracted using a standardized extraction form. We identified 145 articles, with the method of blinding described in 123 of the reports. Methods of blinding of participants and/or health care providers and/or other caregivers concerned mainly use of sham procedures such as simulation of surgical procedures, similar attention-control interventions, or a placebo with a different mode of administration for rehabilitation or psychotherapy. Trials assessing devices reported various placebo interventions such as use of sham prosthesis, identical apparatus (e.g., identical but inactivated machine or use of activated machine with a barrier to block the treatment), or simulation of using a device. Blinding participants to the study hypothesis was also an important method of blinding. The methods reported for blinding outcome assessors relied mainly on centralized assessment of paraclinical examinations, clinical examinations (i.e., use of video, audiotape, photography), or adjudications of clinical events. This study classifies blinding methods and provides a detailed description of methods that could overcome some barriers of blinding in clinical trials assessing nonpharmacological treatment, and provides information for readers assessing the quality of results of such trials.

ObjectivesTo determine the diagnostic performance of cardiac computed tomography (CT)–based modalities including coronary CT angiography (CTA), stress myocardial CT perfusion (stress CTP), computer simulation of fractional flow reserve by CT (FFRCT), and transluminal attenuation gradients (TAG), for the diagnosis of hemodynamic significant coronary artery disease (CAD), using invasive fractional flow reserve as the reference standard.MethodsPubMed and Cochrane databases were searched for original articles until July 2018. Diagnostic accuracy results were pooled at per-patient and per-vessel level using random effect models.ResultsFifty articles were included in the meta-analysis (3024 subjects). The per-patient analysis per imaging modality demonstrated a pooled positive likelihood ratio (PLR) of 1.78 (95% confidence interval CI 1.49–2.11), 4.58 (95% CI 3.54–5.91), and 3.45 (95% CI 2.38–5.00) for CTA, stress CTP, and FFRCT respectively. Per-patient specificity of stress CTP (82%, 95% CI 76–86) and FFRCT (72%, 95% CI 68–76) were higher than for CTA (48%, 95% CI 44–51). At the vessel level, PLR was 2.42 (95% CI 1.93–3.02), 7.72 (95% CI 5.50–10.83), 3.50 (95% CI 2.73–4.78), 1.97 (95% CI 1.32–2.93) for CTA, stress CTP, FFRCT, and TAG respectively.ConclusionWith improved PLR and specificity, stress CTP and FFRCT have incremental value over CTA for the detection of functionally significant CAD.Key Points• New functional CT imaging techniques, such as stress CTP and FFRCT, improve diagnostic accuracy of coronary CTA to predict hemodynamically relevant stenosis.• TAG yields poor diagnostic performance.• Combination of CTA and some functional CT techniques (stress CTP and FFRCT) might become a “must” to improve diagnostic accuracy of CAD and to reduce unnecessary invasive coronary angiography.

Colorectal cancer (CRC) screening has been proven to reduce both mortality and the incidence of this disease. Most CRC screening programs are based on fecal immunochemical tests (FITs), which have a low participation rate. Searching for blood protein biomarkers can lead to the development of a more accepted screening test. The aim of this systematic review was to compare the diagnostic potential of the most promising serum protein biomarkers. A systematic review based on PRISMA guidelines was conducted in the PubMed and Web of Science databases between January 2010 and December 2023. Studies assessing blood protein biomarkers for CRC screening were included. The sensitivity, specificity, and area under the ROC curve of each biomarker were collected. Among 4685 screened studies, 94 were considered for analysis. Most of them were case–control studies, leading to an overestimation of the performance of candidate biomarkers. The performance of no protein biomarker or combination of biomarkers appears to match that of the FIT. Studies with a suitable design and population, testing new assay techniques, or based on algorithms combining FIT with serum tests are needed. The search for a blood screening test for colorectal cancer is a major challenge. Many protein biomarkers have been identified as potentially interesting. However, their performance must be interpreted according to the design of the study. This systematic review reports protein biomarkers with the best potential for screening for colorectal cancer or advanced adenomas.

Background Participation in the colorectal cancer screening program (CRC-SP) based on biennial faecal occult blood testing is low in France as in many countries. The aim was to evaluate the inter-physician heterogeneity in CRC-SP participation, and its determinants. Methods The study used the French National Health Data System. All beneficiaries eligible to CRC-SP (50–74 years old, no history of CRC or inflammatory bowel disease, nor colonoscopy within 5 years) and affiliated to 5,000 general practitioners (GPs) randomly selected from 41,589 eligible liberal GPs (main selection criteria: less than 75 years-old, caseload eligible to CRC-SP > 50, pay-for-performance indicators available) were included. Associations between beneficiaries’ and GPs’ characteristics and 2016–2017 CRC-SP participation, and its inter-physician heterogeneity (intraclass correlation coefficient, ICC) were evaluated using logistic mixed models. Results Of the 1.5 million beneficiaries included, 32.2% participated in the CRC-SP. Younger age, male gender, social deprivation and comorbidity score of beneficiaries were associated with lower participation, as well as the absence of GP consultation, or the absence of any healthcare reimbursement in the year before the screening campaign. GPs’ characteristics positively associated with participation were younger age, statutory sector with no extra billing, and high pay-for-performance prevention indicators. The volume of activity was negatively associated with participation. Adjustment on beneficiaries’ characteristics had little effect on the ICC (4.9% vs. 5.2% in the empty model). The ICC decreased after the addition of GPs’ characteristics (4.2%, including age, gender, extra billing, caseload characteristics and volume of activity) and pay-for-performance indicators (2.9%). Conclusions GPs and healthcare engagement play a key role in CRC screening participation. Improving uptake requires reducing structural barriers, enhancing GP support for prevention, and tailoring strategies to reach vulnerable populations. These findings support multifaceted interventions targeting both patient-level disparities and provider-level capacities to foster better and equitable participation. Trial registration not applicable.

Background We have done a systematic literature review about CRC Screening over 75 years old in order to update knowledge and make recommendations. Methods PUBMED database was searched in October 2021 for articles published on CRC screening in the elderly, and generated 249 articles. Further searches were made to find articles on the acceptability, efficacy, and harms of screening in this population, together with the state of international guidelines. Results Most benefit-risk data on CRC screening in the over 75 s derived from simulation studies. Most guidelines recommend stopping cancer screening at the age of 75. In private health systems, extension of screening up to 80–85 years is, based on the life expectancy and the history of screening. Screening remains effective in populations without comorbidity given their better life-expectancy. Serious adverse events of colonoscopy increase with age and can outweigh the benefit of screening. The great majority of reviews concluded that screening between 75 and 85 years must be decided case by case. Conclusion The current literature does not allow Evidence-Based Medicine propositions for mass screening above 75 years old. As some subjects over 75 years may benefit from CRC screening, we discussed ways to introduce CRC screening in France in the 75–80 age group. IRB An institutional review board composed of members of the 2 learned societies (SOFOG and FFCD) defined the issues of interest, followed the evolution of the work and reviewed and validated the report.

Background Cervical cancer screening is effective in reducing mortality due to uterine cervical cancer (UCC). However, inequalities in participation in UCC screening exist, especially according to age and social status. Considering the current situation in France regarding the ongoing organized UCC screening campaign, we aimed to assess general practitioners’ (GPs) and gynaecologists’ preferences for actions designed to reduce screening inequalities. Methods French physicians’ preferences to UCC screening modalities was assessed using a discrete choice experiment. A national cross-sectional questionnaire was sent between September and October 2014 to 500 randomly selected physicians, and numerically to all targeted physicians working in the French region Midi-Pyrénées. Practitioners were offered 11 binary choices of organized screening scenarios in order to reduce inequalities in UCC screening participation. Each scenario was based on five attributes corresponding to five ways to enhance participation in UCC screening while reducing screening inequalities. Results Among the 123 respondents included, practitioners voted for additional interventions targeting non-screened women overall ( p  <  0.05), including centralized invitations sent from a central authority and involving the mentioned attending physician, or providing attending physicians with the lists of unscreened women among their patients. However, they rejected the specific targeting of women over 50 years old ( p  <  0.01) or living in deprived areas ( p  <  0.05). Only GPs were in favour of allowing nurses to perform Pap smears, but both GPs and gynaecologists rejected self-collected oncogenic papillomavirus testing. Conclusions French practitioners tended to value the traditional principle of universalism. As well as rejecting self-collected oncogenic papillomavirus testing, their reluctance to support the principle of proportionate universalism relying on additional interventions addressing differences in socioeconomic status needs further evaluation. As these two concepts have already been recommended as secondary development leads for the French national organized screening campaign currently being implemented, the adherence of practitioners and the adaptation of these concepts are necessary conditions for reducing inequalities in health care.

Following recent health scandals in France, the French parliament adopted law n°2011-2012 to regulate ties between physicians and the pharmaceutical industry. The law also requires pharmaceutical companies to publicize financial and other benefits given to medical students. In this context, we administered a survey to medical students in France, in an effort to identify priorities for future education regarding conflicts of interest (COI). This web-based survey encompassed knowledge about, training on, personal exposure to, and opinions on COI among preclinical and clinical students as well as residents. Two thousand one hundred and one (2,101) students participated. Although most students (64.6%) believed that they are able to define what a COI is, they failed to correctly identify several situations as COI (receiving a gift, being offered a meal, being invited to a conference). Most students reported feeling inadequately educated about COI (85.2%). Compared to other class levels, residents were more exposed to pharmaceutical sales representatives. This exposure is highly associated to receipt of gifts (OR 14.51, 95% CI 11.67-18.05). Medical students were aware of potential bias induced by COI with respect to drug prescriptions and research, but felt personally immune towards COI. In our survey, personal research performed by students was more likely to be associated with perception of potential bias on prescription for self (but not for others) than attending a lecture on COI. Promulgating laws that regulate ties between physicians/students and the pharmaceutical industry is a mandatory first step. However, complementary strategies should be implemented within medical schools, in particular, specific training about COI in early medical education.

Cervical cancer screening rates are known to be strongly associated with socioeconomic status. Our objective was to assess whether the rate is also associated with an aggregated deprivation marker, defined by the location of family doctors' offices. To access this association, we 1) collected data from the claim database of the French Health Insurance Fund about the registered family doctors and their enlisted female patients eligible for cervical screening; 2) carried out a telephone survey with all registered doctors to establish if they were carrying out Pap-smears in their practices; 3) geotracked all the doctors' offices in the smallest existing blocks of socioeconomic homogenous populations (IRIS census units) that were assigned a census derived marker of deprivation, the European Deprivation Index (EDI), and a binary variable of urbanization; and 4) we used a multivariable linear mixed model with IRIS as a random effect. Of 348 eligible doctors, 343 responded to the telephone survey (98.6%) and were included in the analysis, encompassing 88,152 female enlisted patients aged 25-65 years old. In the multivariable analysis (adjusted by the gender of the family doctor, the practice of Pap-smears by the doctor and the urbanization of the office location), the EDI of the doctor's office was strongly associated with the cervical cancer screening participation rate of eligible patients (p<0.001). The EDI linked to the location of the family doctor's office seems to be a robust marker to predict female patients' participation in cervical cancer screening.