Henri Panjo

Personality and breast cancer screening in women of the GAZEL cohort study

The potential benefit of breast cancer screening is mitigated by the risk of false positives and overdiagnosis, thus advocating for a more personalized approach, based on the individual benefit‐harm balance. Since personality might influence the womens appraisal of this balance, this prospective observational cohort study examined whether it could influence mammography use. A total of 2691 postmenopausal women of the GAZEL Cohort Study completed the Bortner Type A Rating Scale and the Buss and Durkee Hostility Inventory in 1993. Associations between personality scores and subsequent mammography use, self‐reported through up to five triennial follow‐up questionnaires, were estimated with Odds Ratio (OR) and 95% confidence interval (CI) with logistic mixed model regressions, adjusting for age, occupational grade, marital status, family history of breast cancer, age at menarche, age at first delivery, gynecological follow‐up, hormone therapy use, and depressive symptoms. Individual propensity scores were used to weight the analyses to control for potential selection biases. More than 90% of the participants completed at least two follow‐up questionnaires. Type A personality, but not hostility, was associated with mammography use in both univariate (crude OR [95% CI]: 1.62 [1.24–2.11], P < 0.001) and multivariate analyses (OR [95% CI]: 1.46 [1.13–1.90], P < 0.01). Type A personality traits (i.e., sense of time urgency, high job involvement, competitiveness) independently predicted mammography use among postmenopausal women. While paying more attention to the adherence of women with low levels of these traits, clinicians may help those with higher levels to better consider the risks of false positives and overdiagnosis.

Are primary-care physician practices related to health behaviors likely to reduce social inequalities in health? ☆

Our objective was to examine patients health behaviors and the related practices of their primary-care physicians to determine whether physicians actions might help to reduce the social inequalities in health behaviors among their patients. Fifty-two general practitioners, who were also medical school instructors in the Parisian area, volunteered to participate. A sample of 70 patients (stratified by sex) aged 40-70years was randomly chosen from each physicians patient panel and asked to complete a questionnaire about their social position and health behaviors: tobacco and alcohol use, diet, physical activity, and participation in breast and cervical cancer screening. Each physician reported their practices related to each such behavior of each patient. Mixed models were used to test for social differences. Questionnaires were collected in 2008-2009 from both patient and physician for 71% of the 3640 patients. Our results showed social inequalities disfavored those at the bottom of the social scale for all but one of the health behaviors studied among both men and women (exception: excessive alcohol consumption among women). Physicians practices related to these health behaviors also appeared to be socially differentiated. Among men, this differentiation favored those with the lowest social position for all behaviors except physical activity. Among women, however, practices favored the most disadvantaged only for breast cancer screening. In all other cases, they were either socially neutral or unfavorable to the most disadvantaged. Physicians practices related to their patients health behaviors should focus more on those lowest in the social hierarchy, especially among women.

Accumulation of unhealthy behaviors: Marked social inequalities in men and women

The objective of this study was to compare the accumulation of unhealthy behaviors at the bottom of the social scale in men and women and, secondarily, to compare social and gender-based inequalities. Fifty-two general practitioners from the Paris area volunteered to participate. A sample of 70 patients (stratified by gender) aged 40–74u202fyears was randomly chosen from each physicians patient panel and asked to complete a questionnaire about their social position and health behaviors: tobacco and alcohol use, unhealthy diet, and physical inactivity. Mixed Poisson models were used to describe, with relative risks (RRs) and relative inequality indexes (RIIs), the social inequalities in the accumulation of these four unhealthy behaviors. In 2008–2009, 71% of the 3640 patients returned their questionnaires. Men had an average of 1.59 of the 4 unhealthy behaviors we studied, and women 1.35 (RRu202f=u202f1.18; 95% CI [1.11–1.25]). The mean number of unhealthy behaviors increased significantly for both genders from the top to the bottom of the social scale. The order of magnitude of RIIs was similar among men and women, ranging from 1.33 (occupational RII among women, 95% CI [1.11–1.60]) through 1.69 (financial RII among women, 95% CI [1.43–1.99]). None of the interaction tests between gender and social position was significant. The social inequalities had significantly wider amplitudes than those between genders for two of the three indicators of social position. The amplitude of social gradients related to unhealthy behaviors was similar between men and women and exceeded the gender inequality between them.

Looking younger, dying later: General practitioners' intuitive clinical impression predicts mortality

Abstract In daily practice, general practitioners (GPs) have to assess the health status of their older patients. One way to do this is to determine how old they look compared to their chronological age, that is, to estimate their apparent age. The objective of this study was to analyse the characteristics associated with this estimate of apparent age and to determine if it is predictive of death in the next 3u202fyears. This study included 3434 patients from the S.AGES cohort. Patients were classified into 3 categories according to whether they looked their age or older or younger than their age. Depression was associated with a higher risk of looking older and a lower risk of looking younger. A gradient was observed according to the IADL score: OR 2.43 (1.68–3.52) for IADL scores of 2–3 and OR 5.04 (2.96–8.61) for IADL scores of 0–1, compared with a normal IADL score of 4. Patients who looked their age or older had a higher risk of death than those who looked younger: hazard ratio (HR) 1.27 (0.93–1.73) and 1.79 (1.16–2.76), respectively ( p u202f=u202f0.008). GPs integrate past medical history and deep knowledge of their patients to ascertain an apparent age for each patient. Its relation to the individuals chronological age was associated with the risk of death during the three-year follow-up. These results support the hypothesis that the apparent age may be considered to be a marker of health status.

Level of agreement between physician and patient assessment of non-medical health factors

BackgroundnGPs need to consider assorted relevant non-medical factors, such as family or work situations or health insurance coverage, to determine appropriate patient care. If GPs knowledge of these factors varies according to patients social position, less advantaged patients might receive poorer care, resulting in the perpetuation of social inequalities in health.nnnObjectivenTo assess social disparities in GPs knowledge of non-medical factors relevant to patient care.nnnMethodsnObservational survey of GPs who supervise internships in the Paris metropolitan area. Each of the 52 enrolled GPs randomly selected 70 patients from their patient list. Their knowledge of five relevant factors (coverage by publicly funded free health insurance, or by supplementary health insurance, living with a partner, social support and employment status) was analysed as the agreement between the patients and GPs answers to matching questions. Occupational, educational and financial disparities were estimated with multilevel models adjusted for age, sex, chronic disease and GP-patient relationship.nnnResultsnAgreement varied according to the factor considered from 66% to 91%. The global agreement score (percentage of agreement for all five factors) was 72%. Social disparities and often gradients, disfavouring the less well-off patients, were observed for each factor considered. Social gradients were most marked according to perceived financial situation and for health insurance coverage.nnnConclusionnGPs must be particularly attentive toward their least advantaged patients, to be aware of the relevant non-medical factors that affect these patients health and care, and thus provide management adapted to each individuals personal situation.

Disengagement of general practitioners in cervical cancer screening.

In the absence of organized cervical cancer screening (CCS) programs, gynecologists remain principal actors in obtaining a Pap smear, followed by general practitioners (GPs). In France, with the growing scarcity of gynecologists and social inequalities in access to opportunistic screening, GPs are valuable resources for women’s gynecologic follow-up. We aimed to investigate the characteristics of GPs who do not perform CCS, analyzing the effect of GPs’ sex and their evolution over time. On the basis of data from three cross-sectional surveys conducted among representative samples of French GPs in 1998, 2002, and 2009 (n=5199), we constructed univariate and multivariate logistic mixed models (level 2: county, level 1: GP) with random intercept stratified on GPs’ sex to investigate the characteristics of the GPs associated with no practice of CCS ever. Almost one-third of all GPs did not perform CCS ever and it increased with time. Male GPs were always more likely not to perform it (odds ratio=0.50, 95% confidence interval=0.42–0.59). The percentage of GPs not performing CCS increased more markedly among male than among female GPs, and increased more among the youngest age group. Increasingly fewer GPs engage in CCS when the growing scarcity of medical gynecologists calls for more participation. Female GPs remain significantly more active in CCS than male GPs. The participation in CCS is determined differently according to the practitioner’s sex.