Second-hand tobacco exposure in children: evidence for action

International audienc

Vaccination anti-hépatite B par les médecins généralistes français

International audienceEn France, l'idée que le vaccin contre le virus de l'hépatite B (VHB) ait pu être associé au développement de pathologies démyélinisantes a largement circulé. Par suite, après une phase initiale d'excellente adhésion de la population à cette recommandation vaccinale, la couverture vaccinale a chuté pour devenir l'une des plus basses parmi les pays recommandant cette vaccination. Nous avons étudié les facteurs limitant l'utilisation du vaccin anti-VHB par les médecins généralistes, acteurs importants de cette vaccination. Nous avons conduit une enquête auprès de 2175 généralistes libéraux de France métropolitaine, fondée sur un questionnaire interactif adressé par courriel. Ce questionnaire visait à caractériser la perception du vaccin, les comportements et difficultés pratiques des participants dans le processus de vaccination. Leurs caractéristiques démographiques et conditions d'exercice ont également été recueillies. L'échantillon final compte 341 médecins. Sa représentativité a été vérifiée. La structure des réponses a été explorée par une Analyse des Correspondances Multiples (ACM). Des comportements-type ont été identifiés par une Classification Ascendante Hiérarchique (CAH). Certaines liaisons entre les réponses ont été recherchées et testées spécifiquement. L'étude montre que : (1) la mobilisation pour la vaccination des nourrissons s'accentue, (2) en comparaison, les rattrapages vaccinaux des adolescents sont moins proposés ; (3) l'utilité de la vaccination systématique est contestée par ¼ de l'échantillon, (4) l'obstacle principal à la vaccination dans l'opinion publique reste la crainte d'effets secondaires du vaccin, (5) parmi les médecins, un excès de précaution dans les prescriptions et des idées fausses sur l'hépatite B et la vaccination limitent celle-ci

Understanding the complexity of population health interventions: assessing intervention system theory (ISyT)

Given their inherent complexity, we need a better understanding of what is happening inside the "black box" of population health interventions. The theory-driven intervention/evaluation paradigm is one approach to addressing this question. However, barriers related to semantic or practical issues stand in the way of its complete integration into evaluation designs. In this paper, we attempt to clarify how various theories, models and frameworks can contribute to developing a context-dependent theory, helping us to understand the black box of population health interventions and to acknowledge their complexity. To achieve this goal, we clarify what could be referred to as "theory" in the theory-driven evaluation of the interventional system, distinguishing it from other models, frameworks and classical theories. In order to evaluate the interventional system with a theory-driven paradigm, we put forward the concept of interventional system theory (ISyT), which combines a causal theory and an action model. We suggest that an ISyT could guide evaluation processes, whatever evaluation design is applied, and illustrate this alternative method through different examples of studies. We believe that such a clarification can help to promote the use of theories in complex intervention evaluations, and to identify ways of considering the transferability and scalability of interventions

Dimensions of the Complexity of Health Interventions: What Are We Talking about? A Review

Many recommendations and innovative approaches are available for the development and evaluation of complex health interventions. We investigated the dimensions of complexity described in health research and how these descriptions may affect the adopted research methodology (e.g., the choice of designs and methods). We used a mixed method approach to review the scientific literature evaluating complex interventions in the health field. Of 438 articles identified, 179 were subjected to descriptive analysis and 48 to content analysis. The three principal dimensions of complexity were: stakeholder characteristics, intervention multimodality and context. Recognition of such dimensions influenced the methodological choices made during evaluation of the interventions with their use of designs and methods, which aimed to address the complexity. We analysed not only how researchers view complexity but also the effects of such views on researcher practices. Our results highlight the need for clarification of what complexity means and to consider complexity when deciding how to evaluate research interventions

Lancet Public Health

BACKGROUND: Opinion polls on vaccination intentions suggest that COVID-19 vaccine hesitancy is increasing worldwide; however, the usefulness of opinion polls to prepare mass vaccination campaigns for specific new vaccines and to estimate acceptance in a country's population is limited. We therefore aimed to assess the effects of vaccine characteristics, information on herd immunity, and general practitioner (GP) recommendation on vaccine hesitancy in a representative working-age population in France. METHODS: In this survey experiment, adults aged 18-64 years residing in France, with no history of SARS-CoV-2 infection, were randomly selected from an online survey research panel in July, 2020, stratified by gender, age, education, household size, and region and area of residence to be representative of the French population. Participants completed an online questionnaire on their background and vaccination behaviour-related variables (including past vaccine compliance, risk factors for severe COVID-19, and COVID-19 perceptions and experience), and were then randomly assigned according to a full factorial design to one of three groups to receive differing information on herd immunity (>50% of adults aged 18-64 years must be immunised [either by vaccination or infection]; >50% of adults must be immunised [either by vaccination or infection]; or no information on herd immunity) and to one of two groups regarding GP recommendation of vaccination (GP recommends vaccination or expresses no opinion). Participants then completed a series of eight discrete choice tasks designed to assess vaccine acceptance or refusal based on hypothetical vaccine characteristics (efficacy [50%, 80%, 90%, or 100%], risk of serious side-effects [1 in 10 000 or 1 in 100 000], location of manufacture [EU, USA, or China], and place of administration [GP practice, local pharmacy, or mass vaccination centre]). Responses were analysed with a two-part model to disentangle outright vaccine refusal (irrespective of vaccine characteristics, defined as opting for no vaccination in all eight tasks) from vaccine hesitancy (acceptance depending on vaccine characteristics). FINDINGS: Survey responses were collected from 1942 working-age adults, of whom 560 (28·8%) opted for no vaccination in all eight tasks (outright vaccine refusal) and 1382 (71·2%) did not. In our model, outright vaccine refusal and vaccine hesitancy were both significantly associated with female gender, age (with an inverted U-shaped relationship), lower educational level, poor compliance with recommended vaccinations in the past, and no report of specified chronic conditions (ie, no hypertension [for vaccine hesitancy] or no chronic conditions other than hypertension [for outright vaccine refusal]). Outright vaccine refusal was also associated with a lower perceived severity of COVID-19, whereas vaccine hesitancy was lower when herd immunity benefits were communicated and in working versus non-working individuals, and those with experience of COVID-19 (had symptoms or knew someone with COVID-19). For a mass vaccination campaign involving mass vaccination centres and communication of herd immunity benefits, our model predicted outright vaccine refusal in 29·4% (95% CI 28·6-30·2) of the French working-age population. Predicted hesitancy was highest for vaccines manufactured in China with 50% efficacy and a 1 in 10 000 risk of serious side-effects (vaccine acceptance 27·4% [26·8-28·0]), and lowest for a vaccine manufactured in the EU with 90% efficacy and a 1 in 100 000 risk of serious side-effects (vaccine acceptance 61·3% [60·5-62·1]). INTERPRETATION: COVID-19 vaccine acceptance depends on the characteristics of new vaccines and the national vaccination strategy, among various other factors, in the working-age population in France. FUNDING: French Public Health Agency (Santé Publique France)

Determinants of COVID-19 Vaccination Intention among Health Care Workers in France: A Qualitative Study

COVID-19 vaccines are one of the best tools to limit the spread of the virus. However, vaccine hesitancy is increasing worldwide, and France is one of the most hesitant countries. From the beginning of the COVID-19 vaccination campaign, health care workers (HCW) have been prioritized in the vaccination strategy but were also hesitant. This study was conducted to identify and understand the determinants of COVID-19 vaccination intention in the French context, with a view to promoting HCW vaccination. A qualitative study using individual semi-structured interviews of HCWs was carried out at the beginning of the vaccination campaign (January to April 2021) in a French university hospital. Interviews indicated that the vaccination intention of HCWs was influenced by confidence in the proposed vaccines, past experience with vaccines and disease, the opinions and vaccination status of others, and media handling of information related to COVID-19 vaccination. Improving HCW vaccination intention regarding COVID-19 vaccines could be achieved through the dissemination of clear, reassuring, scientific information. Information should be disseminated by HCWs and vaccination experts and adapted to local contexts. To improve the level of confidence and vaccination uptake through a compliance effect, it would be useful to promote positive COVID-19 vaccination experiences and increased rates of immunization.Etude des leviers permettant de maximiser la vaccination contre la Covid-19 dans la population adulte âgée de 18 à 64 ans à faible risque d'infection sévèr

BMJ Open

Objective To compare the effectiveness of the mobile e-Tabac Info Service (e-TIS) application (app) for helping adult smokers quit smoking with current practices. Design Pragmatic randomised controlled trial with a 1-year follow-up (2017–2018). Setting France, population-wide level. Participants 2806 adult smokers who wished to quit smoking were recruited via the website of the French National Mandatory Health Insurance fund. Of them, 1400 were randomised to the e-TIS app arm and 1406 were randomised to the current practices arm (control). Intervention The app involved personalised interactive contacts that included questionnaires, advice, activities and text messages. All contacts were individually tailored and based on each smoker’s progress. In the control group, recommended practices for quitting smoking were described on a non-interactive website. Primary and secondary outcomes measures The primary outcome was 7-day point prevalence abstinence (PPA) at 6 months. The secondary outcomes included continuous abstinence rates at 6 and 12 months, minimum 24-hour point abstinence at 3 months, minimum 30-day point abstinence at 12 months and number and duration of quit attempts. Results There was no difference between the e-TIS and control arms for the primary outcome (12.6% vs 13.7% for 7-day PPA at 6 months, p=0.3949, intention-to-treat analysis). However, e-TIS participants with high levels of exposure to the app, which was defined by the completion of at least eight activities or questionnaires, showed higher rates of smoking cessation than the control participants (17.6% vs 12.9% for 7-day PPA at 6 months, p=0.0169, per-protocol analysis). Conclusion Use of the e-TIS app was not associated with a higher rate of smoking cessation. However, high level of exposure to the e-TIS app may have been more effective than current practices

Trials

BACKGROUND: An international workshop on population health intervention research (PHIR) was organized to foster exchanges between experts from different disciplines and different fields. AIMS: This paper aims to summarize the discussions around one of the issues addressed: the place or role of pilot studies in PHIR. Pilot studies are well-established in biomedical research, but the situation is more ambiguous for PHIR, in which a pilot study could refer to different purposes. METHODS: The workshop included formal presentations of participants and moderated discussions. An oral synthesis was carried out by a rapporteur to validate by expert consensus the key points of the discussion and the recommendations. All discussions have been recorded and fully transcribed. DISCUSSION: PHIR generally addresses complex interventions. Thus, numerous tasks may be required to inform the intervention and test different aspects of its design and implementation. While in clinical research the pilot study mainly concerns the preparation of the trial, in PHIR the pilot study focuses on the preparation of both the intervention and the trial. In particular, pilot studies in PHIR could be used for viability evaluation and theory development. RECOMMENDATIONS FROM THE WORKSHOP PARTICIPANTS: The following recommendations were generated by consensus from the workshop discussions: i) terms need to be clarified for PHIR; ii) reporting and publication should be standardized and transparency should be promoted; iii) the objectives and research questions should drive the methods used and be clearly stated; iv) a pilot study is generally needed for complex intervention evaluation and for research-designed programs; and v) for field-designed programs, it is important to integrate evaluability assessments as pilot studies . CONCLUSION: Pilot studies play an important role in intervention development and evaluation. In particular, they contribute to a better understanding of the mechanisms of intervention and the conditions of its applicability and transferability. Pilot studies could therefore facilitate evidence-based decisions about design and conduct of main studies aimed to generate evidence to inform public health policy

Taxonomy of prokaryotic viruses : 2018-2019 update from the ICTV Bacterial and Archaeal Viruses Subcommittee

This article is a summary of the activities of the ICTV's Bacterial and Archaeal Viruses Subcommittee for the years 2018 and 2019. Highlights include the creation of a new order, 10 families, 22 subfamilies, 424 genera and 964 species. Some of our concerns about the ICTV's ability to adjust to and incorporate new DNA- and protein-based taxonomic tools are discussed.Peer reviewe

Comparative genomics reveals high biological diversity and specific adaptations in the industrially and medically important fungal genus Aspergillus

Peer reviewe