Claudine Burton-Jeangros

Acceptability of maternal immunization against influenza: the critical role of obstetricians

Introduction: Pregnant women and infants are at increased risk of vaccine-preventable complications due to influenza. In Switzerland, immunization was first recommended to all pregnant women in 2009. We assessed the acceptability of this recommendation and its determinants two seasons later. Methods: Women having delivered in the University Hospitals of Geneva during March 2011 were asked to fill in a questionnaire assessing their knowledge, beliefs and acceptability of influenza vaccination during pregnancy. Results: The questionnaire was completed by 261/323 (80%) women. Out of 261, 213 (82%) were aware of increased risks of influenza during pregnancy, and 119/261 (46%) knew that immunization was recommended during pregnancy. Only 110/261 (42%) recalled an immunization advise during their pregnancy and only 47/261 (18%) had been immunized. A direct recommendation was the main predictor of immunization, associated with a 107-fold increased likelihood of vaccination. Factors identified by multivariate analyses as independently associated with the likelihood of immunization were to have been recommended immunization by a private (OR 9.1) or hospital (OR 4.7) obstetrician rather than a midwife, to have no fear that immunization could cause preterm delivery (OR 0.3) and to have been immunized in previous years (OR 10.7). Conclusion: Two years after the recommendation of influenza immunization during pregnancy, most post-partum women recalled being neither recommended nor adequately informed about influenza vaccine and its safety. This identifies major gaps in awareness and/or communication in healthcare workers and suggests that improving immunization safety/efficacy awareness among obstetricians as the most likely method to improve flu immunization during pregnancy.

Between tolerable uncertainty and unacceptable risks: how health professionals and pregnant women think about the probabilities generated by prenatal screening

Prenatal screening provides a good illustration of the tensions existing between the intention of control associated with standard risk surveillance and the permanence of uncertainty around life processes. During the screening process, health professionals and pregnant women are not only confronted with the limitations of probabilistic thinking, they are also concretely reminded of the extent of uncertain outcomes. We analysed such tensions, emblematic of the notion of manufactured uncertainty, with qualitative data collected in Switzerland from both gynaecologists and mothers-to-be. Doctors experienced difficulties in regard to expectations raised by risk surveillance, the duty to inform and the anxiety surveillance induced. Pregnant women coped in different ways with probabilistic thinking, developing contrasting responses to uncertainty, ranging from scepticism about risk thinking to aspiration for control, leading to over-use of medical procedures. As uncertainty was central to professional as well as lay thinking, both made use of subjective interpretations and cultural meanings in decisions related to future events.

Adhésion et résistance aux vaccinations infantiles : une étude auprès de mères suisses

Position du probleme Cette etude examine les pratiques et les attitudes de meres face a la vaccination de leurs enfants. Dans ce domaine, comme dans d’autres, on constate des ecarts entre le modele de sante publique de gestion des risques et les attentes et comportements de la population. Methods Les donnees ont ete recueillies par questionnaire standardise aupres de 1 295 femmes ayant, en 1999, un enfant de nationalite suisse frequentant le systeme scolaire public genevois et âge de 7 a 8 ans. Resultats Quatre profils de vaccination ont ete distingues a l’aide d’une typologie integrant 1) le degre de satisfaction (par rapport aux choix realises), 2) le sentiment d’en savoir assez sur les vaccinations et 3) les pratiques. Les meres se repartissent dans les categories suivantes : compliantes (57 %), compliantes ambivalentes (19 %), resistantes moderees (17 %) et resistantes (7 %). Les meres ayant atteint un niveau de formation intermediaire tendent a etre plus resistantes. Une attitude critique envers les institutions biomedicales et le recours a des praticiens alternatifs sont egalement associes a une resistance plus marquee. Nous avons par ailleurs observe une plus grande reticence a vacciner chez les meres qui estiment avoir un certain controle personnel sur la sante du groupe familial. Conclusion Nos resultats confirment l’existence d’une resistance a la vaccination infantile au sein d’une frange de la population. Elle n’est pas synonyme d’ignorance des meres, mais rendrait plutot compte de leur perplexite face aux choix a faire. Le poids accorde par certains parents au controle individuel de la sante peut ainsi s’opposer a des objectifs communautaires de sante publique. Les actions entreprises pour promouvoir la vaccination devraient prioritairement s’adresser aux familles indecises (compliantes ambivalentes et resistantes moderees). En meme temps, les difficultes inherentes a la gestion — individuelle et collective — des risques appellent a developper de nouvelles formes de dialogue entre les experts et le public.

Factors of change and cumulative factors in self-rated health trajectories: A systematic review

In Western societies, self-rated health (SRH) inequalities have increased over the past decades. Longitudinal studies suggest that the SRH trajectories of disadvantaged populations are declining at a faster rate than those of advantaged populations, resulting in an accumulation of (dis)advantages over the life course, as postulated by the Cumulative Advantage/Disadvantage (CAD) model. The objectives of this study are to conduct a systematic review of the factors influencing SRH trajectories in the adult population and to assess to what extent the findings support the CAD model. Based on the inclusion criteria, 36 articles, using 15 nationally representative databases, were reviewed. The results show that young age, high socioeconomic position and marital transitions (entering a partnership) are advantageous factors of change in SRH trajectories. However, evidence for cumulative influences supporting the CAD model remains limited: gender, ethnicity, education and employment status are only moderately associated with growing influences over time, and the cumulative influences of income, occupation, age and marital status are weak. In conclusion, this systematic review provides consolidated evidence on the factors influencing SRH trajectories, though the inclusion of only 15 nationally representative databases may limit the generalization of the results.

Colorectal Cancer Screening in Switzerland: Cross-Sectional Trends (2007-2012) in Socioeconomic Disparities

Background Despite universal health care coverage, disparities in colorectal cancer (CRC) screening by income in Switzerland have been reported. However, it is not known if these disparities have changed over time. This study examines the association between socioeconomic position and CRC screening in Switzerland between 2007 and 2012. Methods Data from the 2007 (n = 5,946) and 2012 (n = 7,224) population-based Swiss Health Interview Survey data (SHIS) were used to evaluate the association between monthly household income, education, and employment with CRC screening, defined as endoscopy in the past 10 years or fecal occult blood test (FOBT) in the past 2 years. Multivariable Poisson regression was used to estimate prevalence ratios (PR) and 95% Confidence Intervals (CI) adjusting for demographics, health status, and health utilization. Results CRC screening increased from 18.9% in 2007 to 22.2% in 2012 (padjusted: = 0.036). During the corresponding time period, endoscopy increased (8.2% vs. 15.0%, padjusted:<0.001) and FOBT decreased (13.0% vs. 9.8%, padjusted:0.002). CRC screening prevalence was greater in the highest income (>

Prostate cancer screening in Switzerland: 20-year trends and socioeconomic disparities

6,000) vs. lowest income (≤

Animals in the media: New boundaries of risk?

2,000) group in 2007 (24.5% vs. 10.5%, PR:1.37, 95%CI: 0.96-1.96) and in 2012 (28.6% vs. 16.0%, PR:1.45, 95%CI: 1.09-1.92); this disparity did not significantly change over time. Conclusions While CRC screening prevalence in Switzerland increased from 2007 to 2012, CRC screening coverage remains low and disparities in CRC screening by income persisted over time. These findings highlight the need for increased access to CRC screening as well as enhanced awareness of the benefits of CRC screening in the Swiss population, particularly among low-income residents.

‘Doctor, what would you do in my position?’ Health professionals and the decision-making process in pregnancy monitoring

BACKGROUND Despite important controversy in its efficacy, prostate cancer (PCa) screening has become widespread. Important socioeconomic screening disparities have been reported. However, trends in PCa screening and social disparities have not been investigated in Switzerland, a high risk country for PCa. We used data from five waves (from 1992-2012) of the population-based Swiss Health Interview Survey to evaluate trends in PCa screening and its association with socioeconomic indicators. METHODS We used multivariable Poisson regression to estimate prevalence ratios (PR) and 95% Confidence Intervals (CI) adjusting for demographics, health status, and use of healthcare. RESULTS The study included 12,034 men aged ≥50 years (mean age: 63.9). Between 1992 and 2012, ever use of PCa screening increased from 55.3% to 70.0% and its use within the last two years from 32.6% to 42.4% (p-value <0.05). Income, education, and occupational class were independently associated with PCa screening. PCa screening within the last two years was greater in men with the highest (>

Unresolved issues in risk communication research: the case of the H1N1 pandemic (2009-2011).

6,000/month) vs. lowest income (≤

Life satisfaction trajectories of elderly women living in Switzerland: an age–period–cohort analysis

2,000) (46.5% vs. 38.7% in 2012, PR for overall period =1.29, 95%CI: 1.13-1.48). These socioeconomic disparities did not significantly change over time. CONCLUSIONS This study shows that about half of Swiss men had performed at least one PCa screening. Men belonging to high socioeconomic status are clearly more frequently screened than those less favored. Given the uncertainty of the usefulness of PCa screening, men, including those with high socioeconomic status, should be clearly informed about benefits and harms of PCa screening, in particular, the adverse effect of over-diagnosis and of associated over-treatment.