T Hanslik

Clinique Ambroise Paré, Tolosa de Llenguadoc, Midi-Pyrénées, France

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Publications (203)428.56 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background General Practitioners (GPs) play a central role in suicide prevention. This study aims to compare the characteristics of individuals who attempt suicide to those who complete suicide in a same primary care setting. Methods We compared the characteristics and GP׳s management of all patients with attempted (N=498, SA) or completed suicide (N=141, SC) reported to the GPs׳ French Sentinelles surveillance system (2009–2013). Results Compared to patients who attempted suicide, those who completed suicide were more likely to be male, older and to have used a more lethal method; for men they were less likely to have a history of previous suicide attempt and prior contacts with their GP. In terms of GPs׳ management, we found no differences between the SA and SC groups in the identification of psychological difficulties and in the care, but GPs were more likely to provide psychological support to the SA group. During the last consultation, the SC group expressed suicidal ideas more frequently than the SA group (26.7% vs. 14.8%, p<0.01), only for women. Limitations The network may have missed cases and selected more serious SA. Conclusions Individuals who commit suicide differ from those who attempt suicide in terms of demographic characteristics and by sex, of history of suicide attempt, previous contact and expressed suicidal ideas. We show that GPs do not act more intensively with patients who will commit suicide, as if they do not foresee them. Current prevention programs particularly in primary care should be tailored.
    Journal of Affective Disorders. 01/2015; 170:150–154.
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    ABSTRACT: The Internet is becoming more commonly used as a tool for disease surveillance. Similarly to other surveillance systems and to studies using online data collection, Internet-based surveillance will have biases in participation, affecting the generalizability of the results. Here we quantify the participation biases of Influenzanet, an ongoing European-wide network of Internet-based participatory surveillance systems for influenza-like-illness.
    BMC Public Health 09/2014; 14(1):984. · 2.08 Impact Factor
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    ABSTRACT: General Practitioners (GPs) play a central role in suicide prevention. This study aims to compare the characteristics of individuals who attempt suicide to those who complete suicide in a same primary care setting.
    Journal of Affective Disorders 09/2014; 170C:150-154. · 3.30 Impact Factor
  • Médecine et Maladies Infectieuses 06/2014; 44(6, supplement):89. · 0.75 Impact Factor
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    ABSTRACT: 1) To describe autoimmune diseases (AD) in HIV-infected people; 2) to perform a literature review concerning this issue. 52 HIV-infected patients that presented an AD in 14 medical departments in Paris and Ile-de-France area were retrospectively included in this study. The ADs were vasculitis (11), immune cytopenias (8), rheumatic diseases (8), lupus (7), sarcoidosis (7), thyroid diseases (6), hepatic diseases (5), antiphospholipid syndrome (4). Four patients presented 2 ADs. In 5 patients the AD preceded HIV infection, in 14 HIV infection was diagnosed at the same time as the AD and 34 were HIV-infected when they developed an AD. 40 ADs (80%) occurred in patients with a CD4 T lymphocyte count of more than 200/mm3. Cases of autoimmune hemolytic anemia occurred only in patients severely immunodepressed. In five patients (a vasculitis case, a sarcoidosis case, three thyroid disease cases) the AD presented as a form of immune restoration inflammatory syndrome (IRIS). Some ADs allowed HIV-infection diagnosis at a stage of moderate immune deficiency (vasculitis, antiphospholipid syndrome, immune thrombocytopenia). 37 patients received immunosuppressant treatments with good tolerance. These results confirm in a large series of patients previous data concerning autoimmune diseases occurrence in HIV-infected people. In the HAART era, when HIV-infected people are treated more and more early, autoimmune diseases can occur, mainly at the phase of immunological recovery. HIV infection should not limit immunosuppressant treatment use.
    Autoimmunity reviews 04/2014; · 6.37 Impact Factor
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    ABSTRACT: Vaccine-induced antibodies may wane more quickly in persons living with HIV than in healthy individuals. Here, we reviewed the literature on vaccines routinely recommended in HIV-infected patients to estimate how seroprotection decreases over time in those who initially responded to immunization. For each study retrieved from the literature, the decrease of seroprotection was modeled with a log binomial generalized linear model, and data were pooled in a meta-analysis in order to provide estimates of seroprotection two and five years after last vaccine administration. Our analyses confirmed that duration of seroprotection was shorter in HIV-infected patients, and that with current guidelines, a substantial proportion of patients would have lost protective antibodies before being proposed a booster. We therefore discuss the implications on the monitoring of antibody levels and timing of revaccination in these patients.
    Clinical Infectious Diseases 01/2014; · 9.37 Impact Factor
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    ABSTRACT: Introduction Dans la surveillance des maladies communautaires à partir de réseaux de professionnels des soins primaires volontaires, les estimations produites en population générale peuvent être biaisées par défaut de représentativité ou de caractérisation précise de la population surveillée, d’autant plus dans les pays où l’enregistrement des patients auprès des médecins n’est pas obligatoire. Méthodes Dans la méthodologie des sondages, l’estimateur de Horvitz-Thomson permet de redresser les estimations par post-stratification. Nous proposons plusieurs estimations post-stratifiées pour calculer l’incidence d’une maladie à partir du nombre de cas déclaré par des médecins du réseau. Les caractéristiques des populations surveillées sont obtenues à partir des volumes de consultations des médecins participants ou non, fournies par l’assurance maladie. Les caractéristiques des estimateurs sont comparées, avec une application aux données du réseau Sentinelles. Résultats Nous montrons que le nombre de cas rapporté par les médecins est corrélé avec leur activité de consultation. Plusieurs estimateurs post-stratifiés sont définis, considérant la densité d’échantillonnage des médecins ou des consultations. Selon le niveau de post-stratification, l’incidence nationale présente des variations jusqu’à 3 % pour la grippe, 6 % pour les diarrhées aiguës et 11 % pour la varicelle. Au niveau régional, les écarts observés sont plus importants, variant entre −40 % et +55 %. La post-stratification par le volume de consultations réduit la variabilité des estimations entre régions. Discussion En utilisant des données administratives relatives aux participants et non participants d’un réseau de surveillance, on peut réduire le biais des incidences estimées, étape importante dans l’amélioration de la mesure de la santé des populations.
    Revue d'Épidémiologie et de Santé Publique. 01/2014; 62:S181.
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    ABSTRACT: Renal tubular acidosis (RTAs) are a group of metabolic disorders characterized by metabolic acidosis with normal plasma anion gap. There are three main forms of RTA: a proximal RTA called type II and a distal RTA (type I and IV). The RTA type II is a consequence of the inability of the proximal tubule to reabsorb bicarbonate. The distal RTA is associated with the inability to excrete the daily acid load and may be associated with hyperkalaemia (type IV) or hypokalemia (type I). The most common etiology of RTA type IV is the hypoaldosteronism. The RTAs can be complicated by nephrocalcinosis and obstructive nephrolithiasis. Alkalinization is the cornerstone of treatment.
    La Revue de Médecine Interne. 01/2014; 35(1):45–55.
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    ABSTRACT: Introduction The purpose of this study was to estimate the prevalence of monoclonal immunoglobulin (MIg) among patients with systemic sclerosis (SSc) according to method of detection (capillary electrophoresis or immunofixation) and to search for any related clinical correlations. Patients and Methods Retrospective multicenter comparison of capillary electrophoresis and immunofixation results in SSc patients and of the characteristics of patients with and without MIg. Results The study included 244 SSc patients (216 women and 28 men, mean age: 55 ± 14 years). Median time since SSc diagnosis was 51 months [0–320]; disease was diffuse in 48% of cases. Ten percent of patients had cancer, including Waldenström macroglobulinemia (n = 1) and multiple myeloma (n = 3). Capillary electrophoresis showed a γ-globulin anomaly in 41% of cases, and immunofixation in 18%: MIg (13.5%) and restriction of heterogeneity (4.5%). Capillary electrophoresis failed to detect 60% of the 33 MIg patients. Measurable MIg concentrations were obtained from 7 patients. MIg patients were significantly older at SSc diagnosis than those without MIg (p = 0.002), had a lower diffusing capacity (p = 0.002), a higher prevalence of pulmonary hypertension and cancer (p = 0.002) and were more frequently positive for anti-mitochondrial and anti-beta2-glycoprotein-I antibodies (p = 0.03 and p = 0.02, respectively). Multivariate analyses showed that only age at test [hazard ratio 1.03 (95%CI, 1.00–1.07, p = 0.04)] and presence of cancer [hazard ratio 4.46 (95%CI, 1.6–12.4, p = 0.004)] were associated with MIg. Conclusion Immunofixation detected a high prevalence of MIg among SSc patients especially in patients aged 50-years or older. MIg was not detected by the standard capillary electrophoresis in 60% of cases and was significantly associated with cancer.
    Autoimmunity Reviews. 01/2014;
  • 01/2014; 19(34).
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    ABSTRACT: Assessing the accuracy of influenza epidemic periods determined by statistical models is important to improve the performance of algorithms used in real-time syndromic surveillance systems. This is a difficult problem to address in the absence of a reliable gold standard. The objective of this study is to establish an expert-based determination of the start and the end of influenza epidemics in France. A three-round international web-based Delphi survey was proposed to 288 eligible influenza experts. Fifty-seven (20%) experts completed the three-rounds of the study. The experts were invited to indicate the starting and the ending week of influenza epidemics, on 32 time-series graphs of influenza seasons drawn using data from the French Sentinelles Network (Influenza-like illness incidence rates) and virological data from the WHO-FluNet. Twenty-six of 32 time-series graphs proposed corresponded to each of the French influenza seasons observed between 1985 and 2011. Six influenza seasons were proposed twice at each round to measure variation among expert responses. We obtained consensual results for 88% (23/26) of the epidemic periods. In two or three rounds (depending on the season) answers gathered around modes, and the internal control demonstrated a good reproducibility of the answers. Virological data did not appear to have a significant impact on the answers or the level of consensus, except for a season with a major mismatch between virological and incidence data timings. Thanks to this international web-based Delphi survey, we obtained reproducible, stable and consensual results for the majority of the French influenza epidemic curves analysed. The detailed curves together with the estimates from the Delphi study could be a helpful tool for assessing the performance of statistical outbreak detection methods, in order to optimize them.
    BMC Medical Informatics and Decision Making 12/2013; 13(1):138. · 1.60 Impact Factor
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    ABSTRACT: Most of the methods used for estimating the influenza vaccine effectiveness (IVE) target the individuals who have an influenza-like illness (ILI) rather than virologically-proven influenza and access the healthcare system. The objective of this study was to estimate the 2012-2013 IVE in general French population, using a cohort of volunteers registered on GrippeNet.fr, an online surveillance system for ILI. The IVE estimations were obtained through a logistic regression, and analyses were also performed by focusing on at-risk population of severe influenza, and by varying inclusion period and ILI definition. Overall, 1996 individuals were included in the analyses. The corrected IVE was estimated to 49% (20 to 67) for the overall population, and 32% (0 to 58) for the at-risk population. Three covariables appeared with a significant effect on the occurrence of at least one ILI during the epidemic: the age (P = 0.045), the presence of a child in the household (P<10(-3)), and the frequency of cold/flu (P<10(-3)). Comparable results were found at epidemic peak time in the hypothesis of real-time feed of data. In this study, we proposed a a novel, follow-up, web-based method to reveal seasonal vaccine effectiveness, which enables analysis in a portion of the population that is not tracked by the health care system in most VE studies.
    Human vaccines & immunotherapeutics. 12/2013; 10(3).
  • T Hanslik, O Launay
    La Revue de Médecine Interne 11/2013; · 0.90 Impact Factor
  • La Revue de Médecine Interne 09/2013; · 0.90 Impact Factor
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    ABSTRACT: Renal tubular acidosis (RTAs) are a group of metabolic disorders characterized by metabolic acidosis with normal plasma anion gap. There are three main forms of RTA: a proximal RTA called type II and a distal RTA (type I and IV). The RTA type II is a consequence of the inability of the proximal tubule to reabsorb bicarbonate. The distal RTA is associated with the inability to excrete the daily acid load and may be associated with hyperkalaemia (type IV) or hypokalemia (type I). The most common etiology of RTA type IV is the hypoaldosteronism. The RTAs can be complicated by nephrocalcinosis and obstructive nephrolithiasis. Alkalinization is the cornerstone of treatment.
    La Revue de Médecine Interne 09/2013; · 0.90 Impact Factor
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    ABSTRACT: In France, primary-care physicians referring patients for admission can choose between public and private hospitals. The factors that govern their choices are unknown. Among all patient admissions reported from 1997 to 2011 by primary-care physicians participating in the Sentinels(®) network, we identified those due to orthopaedic conditions or trauma. We then identified the factors associated with referral to a private hospital rather than to a public hospital. Of 45,960 admissions reported to Sentinels(®) in 1997-2011, 2794 (6.1%) were for orthopaedic/trauma care. The main reasons for admission were hip fractures (27.5%), elective orthopaedic surgery (15.5%), fractures of the humerus (5.9%), wrist fractures (5.4%), soft-tissue lesions of the forearm or hand (5.0%), and spinal injuries (4.5%). Private hospitals were chosen more often for orthopaedic/trauma patients than for patients with other conditions (40% vs. 21.6% of cases, P<0.0001). When fracture of the humerus was used as the reference, referral to private hospitals was significantly more common for elective surgery (odds ratio, 3.30 [2.02-5.40]) and hip fracture (odds ratio, 1.50 [1.03-2.18]) and significantly less common for spinal injuries (odds ratio, 0.35 [0.19-0.66]). Other factors associated with referral to private hospitals were patient age, admission decision during an office visit or in a non-emergent setting, and admission decision made by the patient's usual physician. Specific factors seem to govern decisions by primary-care physicians to refer orthopaedic/trauma patients to private vs. public hospitals. Identical pricing scales for private and public hospitals will be implemented soon in France, a change that requires further analyses. Level IV.
    Orthopaedics & Traumatology Surgery & Research 09/2013; · 1.06 Impact Factor
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    ABSTRACT: Anti-dopaminergic anti-emetics (ADA) use for the treatment of nausea associated with gastroenteritis (GE) can be considered inappropriate, as their effects are not supported by evidence of clinical efficacy and can potentially induce serious adverse events. This study quantifies the suboptimal consumption of ADA attributable to seasonal GE epidemics in France and its cost. GE epidemiological data were collected and transmitted by the general practitioners (GPs) of Sentinelles network. Epidemic periods were identified by periodic regression. Drug sales data were obtained from pharmacies, and costs data were obtained from the French National Social Security. The ADA use and costs incurred by seasonal GE epidemics were calculated. During the epidemic periods considered in this study, the median age of patients seen by GPs for GE was 24 years old. During each epidemic, a sale increase by 14% for domperidone, by 15% for metoclopramide and 30% for metopimazine was observed. The average cost attributable to seasonal GE epidemic was 5 030 000 Euros, of which 2 160 000 Euros were incurred by the French National Social Security. Linking epidemiological databases helped to identify and quantify inappropriate ADA prescriptions. GE treatment guidelines should be disseminated more widely. Copyright © 2013 John Wiley & Sons, Ltd.
    Pharmacoepidemiology and Drug Safety 08/2013; · 2.90 Impact Factor
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    ABSTRACT: Thanks to the screening method, we estimated among target groups the 2010/2011 field vaccine effectiveness (FVE) against laboratory confirmed influenza cases seen in general practice. We also compared the values of FVE estimations obtained by using three sources of the population vaccination coverage (VC) based on three different methodologies: (1) administrative data from the main social security scheme (Caisse Nationale d'Assurance Maladie des Travailleurs Salariés-CNAMTS) covering about 85% of the French population, (2) a cross-sectional national telephone survey in the general population, and (3) a declarative survey in the population seen in a one-day general practitioner (GP) consultations. The FVE estimates among target groups were stratified by age (< 65 y old with reported chronic illness; ≥65 y old and overall). Using the VC of the CNAMTS, the FVE of the 2010/2011 seasonal trivalent vaccine against laboratory confirmed infection with any influenza virus was 59% (95% Confidence Interval, 17 to 81). It was 85% (17 to 99) and 50% (-16 to 80) for A(H1N1)pdm09 and B influenza infections, respectively. The values of FVE using the influenza VC obtained in a sample of the general population and of the population of GPs' patients were 73% (45 to 87) and 82% (63 to 92), respectively. We estimated a moderate influenza FVE in preventing confirmed influenza viruses in target groups by using the VC of the CNAMTS. We also observed that the screening method generates FVE values dependent on the choice of the source of VC and thus should be used cautiously.
    Human vaccines & immunotherapeutics. 06/2013; 9(11).
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    ABSTRACT: BACKGROUND: As in other European countries, the French vaccination schedule changes according to epidemiological and socio-economic situations. Further changes are planned for 2013, including the withdrawal of one dose for primary vaccination against diphtheria, tetanus, polio, pertussis and Haemophilus influenzae. A partnership between the French Technical Vaccination Committee and the French Institute for Health and Medical Research designed a study to assess primary care physicians' agreement about this modification. METHODS: Qualitative study with focus groups and semi-structured interviews in France. Four focus groups were conducted with physicians, supplemented by four individual interviews. RESULTS: The physicians of the survey had accepted the suggested vaccination schedule well. A few concerns had been underlined: fear of less follow-up care for infants resulting from the removal of one visit driven by the primary vaccination; fear of loss of vaccine efficacy; suspicion of the existence of financial arguments at the origin of this change; and adjustment to current vaccination schedule. Several suggestions were made: providing strong support from health authorities; developing stable and simple recommendations; providing effective tools for monitoring patient's vaccination status. CONCLUSIONS: Physicians' opinions suggested a good acceptance of a possible change about primary vaccination against diphtheria, tetanus, polio, pertussis and Haemophilus influenzae. Physicians' suggestions resulted from this qualitative study on a new vaccination schedule. It showed how that their involvement was feasible for preparing the implementation of a new vaccination schedule.
    BMC Family Practice 06/2013; 14(1):85. · 1.61 Impact Factor
  • H Lévesque, T Hanslik
    La Revue de Médecine Interne 06/2013; · 0.90 Impact Factor

Publication Stats

964 Citations
428.56 Total Impact Points

Institutions

  • 2011–2014
    • Clinique Ambroise Paré
      Tolosa de Llenguadoc, Midi-Pyrénées, France
  • 2010–2014
    • Hôpital La Pitié Salpêtrière (Groupe Hospitalier "La Pitié Salpêtrière - Charles Foix")
      • Service de Médecine Interne 1
      Lutetia Parisorum, Île-de-France, France
    • Ecole des hautes études en santé publique
      Roazhon, Brittany, France
  • 2003–2014
    • Université de Versailles Saint-Quentin
      Versailles, Île-de-France, France
  • 2013
    • Centre Hospitalier Universitaire Rouen
      Rouen, Upper Normandy, France
  • 2011–2013
    • Hôpital Européen Georges-Pompidou (Hôpitaux Universitaires Paris-Ouest)
      • Service de Médecine Interne
      Paris, Ile-de-France, France
  • 2001–2013
    • Unité Inserm U1077
      Caen, Lower Normandy, France
  • 2000–2013
    • Hôpital Ambroise Paré – Hôpitaux universitaires Paris Ile-de-France Ouest
      Billancourt, Île-de-France, France
  • 1995–2013
    • Université René Descartes - Paris 5
      • Faculté de Médecine
      Lutetia Parisorum, Île-de-France, France
  • 2012
    • Polytech Paris-UPMC
      Lutetia Parisorum, Île-de-France, France
  • 2003–2011
    • Assistance Publique – Hôpitaux de Paris
      • Département de Médecine Interne
      Lutetia Parisorum, Île-de-France, France
    • Pierre and Marie Curie University - Paris 6
      Lutetia Parisorum, Île-de-France, France
  • 2001–2009
    • French Institute of Health and Medical Research
      Lutetia Parisorum, Île-de-France, France
  • 2008
    • Groupe Hospitalier Saint Vincent
      Strasburg, Alsace, France