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Purpose To address the gap highlighted in the literature on the effect of professional interventions to facilitate continued employment, this study aims to evaluate the effect of workplace accommodations on the continued employment 5 years after a cancer diagnosis. Methods This study is based on VICAN5, a French survey conducted in 2015–2016 to examine the living conditions of cancer survivors 5 years after diagnosis. Two subsamples, one with and one without workplace accommodations, were matched using a propensity score to control for the individual, professional, and medical characteristics potentially associated with receipt of workplace accommodations. Results The study sample was composed of 1514 cancer survivors aged 18–54 and employed as salaried at diagnosis. Among them, 61.2% received workplace accommodations within 5 years after diagnosis: 35.5% received a modified workstation, 41.5% received a modified schedule, and 49.2% received reduced hours. After matching, receipt of workplace accommodations appeared to improve the continued employment rate 5 years after cancer diagnosis from 77.8% to 95.0%. Conclusions Receipt of workplace accommodations strongly increases the continued employment of cancer survivors 5 years after diagnosis. More research is needed to better understand the differences in receipt of workplace accommodations along with the related selection effect.

During the early spring of 2020, as the COVID-19 (coronavirus disease 2019) pandemic spread across the globe like a viral tsunami, many countries urgently implemented unprecedented mitigation measures to slow it down, following the example of China, where the disease first emerged at the end of 2019. As a result, more than 3 billion unprepared people worldwide had to cope with living under stringent lockdown measures for weeks or months, depending on the country. Together with the deaths of hundreds of thousands of people from this disease, a frightening emotional shock has touched populations everywhere around the planet. Millions have lost their jobs, others have had their personal lives changed drastically; the elderly, for example, have sometimes been isolated from any visits. To our knowledge, no guidelines to prevent psychological trauma have been proposed, even for the most vulnerable individuals. Nonetheless, before this crisis began, several experts had warned about the potential impact of such measures on the populations’ mental health, based on previous experiences of quarantine, as summarised in a review published, as this pandemic reached Europe and before any lockdowns.1 This warning was confirmed a few days later by the publication of a nationwide study conducted in China reporting that the quarantine triggered a wide variety of psychological disorders.2 In France, one of the hardest hit countries in Europe, a nationwide lockdown started on 17 March and lasted till 11 May. Public health authorities made daily recommendations on how to prevent COVID-19 infection with almost no specific advice on psychological prevention.

With record levels of vaccine hesitancy, France faces the challenges of the contemporary crisis of trustin vaccines in a heightened form. For this reason, a closer look at its situation helps to highlight someoften overlooked factors behind the rise of vaccine hesitancy. The prevalence of hesitancy amongmedical professionals, and doctors in particular, is one of them. The changing landscape of vaccine-critical activism is another. The French context also underlines the limitations of the current toolsavailable to public health actors. As in many countries, traditional top-down communication effortshave proved unable to restore trust in vaccines. This led French public health authorities to concludethat extending the list of vaccines required for daycare and school entry was necessary to reachsatisfactory vaccine coverage. This extension of mandatory vaccination constitutes a live experimentto test the effectiveness of coercion in the so-called “post-truth era”. Where vaccine hesitancy is soprevalent, vaccine-critical arguments circulate widely and trust in public authorities is low, this type ofmeasure could polarize attitudes toward vaccines. There is a risk that the public health authorities willbecome complacent and rely upon coercion to do all the work. Coercive measures must be part of acomprehensive plan aimed at restoring trust in vaccines and not just at increasing vaccine coverage.The goal should still be to build a healthcare system immunized against doubts about vaccination

The passe sanitaire increased levels of vaccination, but to a lower extent among the most vulnerable, and did not reduce vaccine hesitancy itself, showing the importance of outreach to underserved communities and the potential limits of mandatory vaccination policies.

Background The human papillomavirus (HPV) vaccine reduces the burden of cervical and other cancers. In numerous countries, a slow uptakeof this vaccine persists, calling for a better understanding of the structural factors leading to vaccine acceptation. We aimed to assess the attitudes toward HPV vaccination among its intended public to explore its specific characteristics. Methods A random cross-sectional telephone survey of the French general population provided data from a sample of 2426 respondents of the target public: the parents of young women and the young women aged 15-25 themselves. We applied cluster analysis to identify contrasting attitudinal profiles, and logistic regressions with a model averaging method to investigate and rank the factors associated with these profiles. Results A third of the respondents had never heard of HPV. However, most of the respondents who had heard of it agreed that it is a severe (93.8%) and frequent (65.1%) infection. Overall, 72.3% of them considered the HPV vaccine to be effective, but 54% had concerns about its side effects. We identified four contrasting profiles based on their perceptions of this vaccine: informed supporters, objectors, uninformed supporters, and those who were uncertain. In multivariate analysis, these attitudinal clusters were the strongest predictors of HPV vaccine uptake, followed by attitudes toward vaccination in general. Conclusions Tailored information campaigns and programs should address the specific and contrasted concerns about HPV vaccination of both young women and of their parents.

Background Long‐term medico‐social follow‐up of cancer survivors is a challenge because of frequent subsequent troubles. In particular survivors with lower health literacy (HL) have poorer health and might more often use primary care services. However, the impact of HL on cancer survivors’ medico‐social follow‐up visits is not known. Our aim was to study medico‐social follow‐up and its associated determinants with a focus on HL 5 years after diagnosis. Methods VICAN is a national survey of French adult cancer survivors 5 years after a primary cancer. The Single‐Item Literacy Screener was used to define functional HL in this sample. We also asked patients to report the frequency of follow‐up visits with a general practitioner (GP) and/or social worker (SW) regarding their cancer disease. Results The 4045 participants were 57.4 ± 12.9 years old at diagnosis (range 20‐82) and 1495 (37%) were classified as having inadequate HL. Most cancer survivors (66.7%) were followed up by a GP regarding their cancer while only 14.5% had contact with a SW. After adjustment for sociodemographic, medical, and psychosocial characteristics, medico‐social follow‐ups (GP and SW visits) were more frequent among survivors with low HL. Furthermore, low income, unemployment, impaired mental health, treatment by chemotherapy, and perception of sequelae and fatigue were also associated with more frequent medico‐social follow‐up. Cancer localization association with medico‐social follow‐up was heterogeneous. Conclusion French cancer survivors with limited HL, lower socioeconomic status, and more severe cancer were more likely to use GP care and social services. Raising awareness and training GPs and SWs on medico‐social follow‐up for patients with limited HL seem necessary to support these vulnerable survivors. Among French cancer survivors, 37% had a limited health literacy level. They were more likely to use GP care and social services. Raising awareness and training general practitioners and social workers on medico‐social follow‐up for patients with limited health literacy seem necessary to support these vulnerable survivors.

•We assessed French GPs’ attitudes and behaviors about HPV vaccination.•HPV vaccine hesitancy is fairly prevalent among GPs.•Perception of the vaccine risk-benefit balance is the strongest determinant of this behavior. General practitioners (GPs) play a crucial role in human papillomavirus (HPV) vaccine acceptance in France. We sought to study: (1) GPs’ perceptions of its risks and efficacy and their recommendation behavior; (2) the relative importance of factors associated with the frequency of their recommendations. Cross-sectional observational study in 2014 nested in a national panel of 1712 randomly selected GPs in private practice in France (response rate: 92.4%). We used model averaging to analyze the associations of self-reported frequency of GPs’ HPV vaccine recommendations with their perception of its risk-benefit balance and their opinions about the utility of vaccines in general. Overall, 72% of participants reported frequently recommending HPV vaccination; 60% considered that not enough is known about its risks. The model averaging showed that the factors most associated with infrequent recommendation of this vaccine by GPs were: unfavorable perceptions of its risk-benefit balance (OR=0.13; 95%CI=0.09–0.21; partial R2=0.10), a decision not to vaccinate one's own daughter(s) with this vaccine (OR=0.13; 95%CI=0.07–0.24; partial R2=0.05), and doubts about vaccine utility in general (OR=0.78; 95%CI=0.71–0.86; partial R2=0.03). Although nearly three-quarters of French GPs frequently recommended the HPV vaccine, our findings indicate that a substantial percentage of them are hesitant about it. Doubts about its risks and efficacy strongly influence their recommendation behavior. More research is warranted to help design and evaluate tailored tools and multicomponent intervention strategies to address physician's hesitancy about this vaccine.

Background Vaccination against seasonal influenza (SIV) is recommended for patients with diabetes, but their vaccination coverage is unsatisfactory in France and elsewhere. This qualitative survey of people with diabetes sought to explore 1) the extent to which SIV-related behaviour is more or less automatic; 2) reasons they choose/reject SIV; 3) their trust/distrust in authorities, science, and medicine. Methods We conducted semi-structured in-depth interviews of 19 adults with diabetes in 2014. We recruited them through physicians or patient associations and implemented an analysis of thematic content. Results Eight patients were vaccinated against flu in the preceding flu season and 11 were not. SIV uptake and refusal were stable over time and justified by multiple arguments. Coupons for free vaccines and regular doctor visits contributed to the habit of vaccination. Vaccination decisions were frequently anchored in past experiences of influenza and its vaccine. Patients often justified non-vaccination with attitudes of trivialisation/relativisation of influenza-associated risks and the perception that these can be controlled by means other than vaccination (e.g., through the avoidance of exposure). Some misbeliefs (e.g., SIV causes influenza) and doubts about SIV effectiveness and safety also existed. Several patients reported increased mistrust of SIV since the A/H1N1 pandemic in 2009. Patients trusted their doctors strongly regardless of their SIV behaviour, but unvaccinated patients had little trust in the government and pharmaceutical companies. Some discordances were found between perceptions and behaviour (e.g., remaining vaccinated despite doubts about SIV effectiveness or remaining unvaccinated despite feelings of vulnerability towards influenza complication), suggesting the existence of some vaccine hesitancy among patients. Conclusion This study among patients with diabetes suggest that SIV uptake is stable, thanks to a favourable environment. Nonetheless, SIV refusal is also stable over time. Unvaccinated patients used multiple arguments to justify SIV refusal, including compensatory health beliefs. Physicians should take every opportunity to recommend SIV. The necessary individualised patient education regarding SIV requires better physician training in patients priorities. While almost all patients strongly trust their doctors, unvaccinated patients distrust distal stakeholders: it is absolutely essential to restore trust in them and to develop new more effective influenza vaccines.

With France one of the European countries most strongly affected by COVID-19 in the spring of 2020, French authorities imposed a nationwide lockdown for 8 weeks (March 17-May 10). This study explored the perception of the adult population about the need for-and access to-psychological support from health care professionals (HCP) in response to concerns about the psychological needs during lockdown. This online cross-sectional survey of a representative sample of the adult general population of mainland France (N = 2,003) took place during the last four days of the French lockdown (May 7-10, 2020). One in eight respondents (12.2%) perceived a need for psychological support from an HCP during the lockdown; most had symptoms of depression and/or anxiety of at least moderate intensity. Only a third (29.8%, 3.6% of the entire sample) actually obtained this support. Factors associated with this perceived need included: age under 35, economic difficulties due to lockdown, pre-lockdown use of psychological support, infection with COVID-19, serious worries about becoming infected, and heavy media use to obtain information about the disease. Among those who perceived a need for psychological support, the elderly were the most likely not to consult an HCP. People aged 35-64, those with high income, and those seriously worried about developing COVID-19 were the most likely to forgo seeking access to care because of their fear of infection by the coronavirus-2019. The perceived need for psychological support from an HCP and access to it appeared to be strongly associated with COVID-19 exposure factor. More research about this association is needed to improve the health authorities' understanding of the population's psychological needs in this situation and to enhance HCPs' abilities to meet them. In particular, further research of its specific impact on youth is necessary.