T Hanslik

Université de Versailles Saint-Quentin, Versailles, Île-de-France, France

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Publications (224)609.79 Total impact

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    ABSTRACT: The ongoing influenza epidemic is characterized by intense activity with most influenza infections due to the A(H3N2) viruses. Using the screening method, mid-season vaccine effectiveness (VE) in preventing influenza-like illness in primary care was estimated to 32% (95% CI; 23 to 40) among risk groups and was 11% (95% CI; -4 to 23) among the elderly (≥65 years). The VE in ≥65 years was the lowest estimate regarding the four previous seasonal influenza epidemics.
    Human Vaccines & Immunotherapeutics 06/2015; DOI:10.1080/21645515.2015.1046661 · 3.64 Impact Factor
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    ABSTRACT: In 2012 and 2013, a cross-sectional survey was conducted in women visiting a general practitioner for a urinary tract infection (UTI) to i) describe the patterns of antibiotic resistance of Enterobacteriaceae involved in community-acquired UTIs and ii) identify the factors associated with UTIs due to a multi-drug-resistant Enterobacteriaceae (MDREB). Urine analyses were performed systematically for all adult women presenting with signs of UTI. Characteristics of women with UTI due to MDREB were compared to those with UTI due to non-MDREB. Weighted logistic regressions were performed to adjust for the sampling design of the survey. Significant factors associated with MDREB included the use of penicillin by the patient in the last three months (OR = 3.1; [1.2-8.0]); having provided accommodation in the previous 12 months to a resident from a country at high risk for drug resistance (OR = 4.0; [1.2-15.1]); and the consumption of raw meat within the previous three months (OR = 0.3; [0.1-0.9]). In the community, antibiotic use and exposure to a person returning from an area with a high risk of drug resistance are associated with UTIs due to MDREB. The potentially protective role of raw meat consumption warrants further study. Copyright © 2015 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
    The Journal of infection 06/2015; DOI:10.1016/j.jinf.2015.05.012 · 4.02 Impact Factor
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    ABSTRACT: To estimate the prevalence of GP (general practitioner) patients performing ISC (intermittent self-catheterization), to describe GP and patient knowledge about ISC and to assess the patients' quality of life. A cross-sectional study was conducted in metropolitan France between November 2012 and September 2013 with French Sentinelles GPs and their patients (≥18 years) performing ISC. Linear regression models assessed independent associations between quality of life scores (Qualiveen and SF-12 scores) and patients' characteristics. The prevalence of ISC performers was estimated to be 61.7 (95% confidence interval [CI] = 61.0-62.4) of 100,000 inhabitants. Patients were males in 58.8% of cases and 53.8 years of age on average. They performed 4.84 catheterizations per day for 10.5 years. Over 1 year, there were 118 (55.1%) cases of patient-reported urinary incontinence (UI) and 158 (63.3%) cases of patient-reported urinary tract infection (UTI). Symptomatic UTIs were treated with antibiotics in 79.7% of cases. The average Qualiveen score was 1.38 (95%CI: 1.23-1.53). The average SF-12 Physical Component Score (PCS) and Mental Component Score (MCS) were 38.6 (95%CI: 36.8-40.4) and 46.4 (95%CI: 44.3-48.5), respectively. According to multivariate analysis, a poorer Qualiveen score and constipation reduced the PCS and a urinary medication prescription reduced the MCS. A poorer Qualiveen score was also associated with UI and UTI on bivariate analysis. ISC seems to be significant in French general practice whereas practical skills remain heterogeneous. UI, UTI, and constipation are recurrent issues among ISC performers that significantly decrease their quality of life. Education and adapted guidelines for GP guidance could improve these patients' conditions. Neurourol. Urodynam. 9999:1-7, 2015. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.
    Neurourology and Urodynamics 03/2015; DOI:10.1002/nau.22752 · 2.46 Impact Factor
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    ABSTRACT: In a context of controversy about influenza antiviral treatments, this study assessed primary health care physicians' prescription of neuraminidase inhibitors (NIs) in France during pandemic and seasonal influenza between 2009 and 2013. This observational study, using data recorded in three national databases, estimated the rate of NIs' prescription among influenza like-illness (ILI) patients seen in GPs' and paediatricians' consultations, and determined factors associated with this prescription according to a multivariate analysis. NIs' delivery by pharmacists was also evaluated. Rates of NIs' prescription were estimated to 61.1% among ILI patients with a severe influenza risk factor seen in GPs' consultation during the A(H1N1)pdm2009 pandemic versus an average rate of 25.9% during the three following seasonal influenza epidemics. Factors associated with NIs' prescription were a chronic disease in patients under 65 years (OR, 14.85; 95%CI, 13.00-16.97) and in those aged 65 and older (OR, 7.54; 5.86-9.70), an age ≥ 65 years in patients without chronic disease (OR, 1.35; 1.04-1.74), a pregnancy (OR, 10.63; 7.67-15.76), obesity (OR, 4.67; 3.50-6.22), and a consultation during the pandemic A(H1N1)pdm2009 (OR, 3.19; 2.93-3.48). The number of antiviral treatments delivered by pharmacists during the A(H1N1)pdm2009 pandemic was 835 per 100 000 inhabitants, and an average of 275 per 100 000 inhabitants during the three following seasonal influenza epidemics. Although physicians seem to follow the recommended indications for NIs in primary health care practice, this study confirms the low rate of NIs prescription to ILI patients with a severe influenza risk factor, especially during seasonal epidemics.
    Antiviral therapy 02/2015; DOI:10.3851/IMP2945 · 3.14 Impact Factor
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    ABSTRACT: When a hospitalisation is required in France, the general practitioner has the choice between public or private hospitals. The reasons for this choice are poorly known. All the cases of hospitalisation requirement reported between 1997 and 2001 by the general practitioners involved in the Réseau Sentinelles(®) were included in this study. The cardiovascular reasons were extracted from all these declarations. Factors influencing the general practitioners' choice between public and private sector were assessed by using logistic regression. During the study period, 45,960 cases of hospitalisation requirement were reported. Amongst these cases, 4475 (10.8%) were made for clearly defined cardivoascular diseases (cardiac failure 38.0%, coronary heart disease 24.7%, atrial fibrillation 11.7%, pulmonary embolism 8.4%, hypertension 3.6%, pericarditis 1.6%, cardiovascular check-up 1.5%). Referrals to private sector depended on the reason for hospitalisation, cardiovascular check-up being the reasons the most referred to a private institution (33.8% of patients) and cardiac insufficiency the less referred to private institution (17.2% of patients). Referral to private sector was also associated with physician (patient's usual general practitioner) and consultation (consultation outside of a context of emergency) characteristics. Whether patients suffering from cardiovascular diseases are sent to a public or private sector is not completely haphazard. Further analyses are needed in the context of new French health policies. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
    Annales de cardiologie et d'angeiologie 01/2015; DOI:10.1016/j.ancard.2015.01.009 · 0.30 Impact Factor
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    ABSTRACT: Background. Recent studies have shown a decrease in the incidence of herpes zoster (HZ) among human immunodeficiency virus (HIV)-infected patients since the combined antiretroviral therapy (cART) era, but more data are needed on a possible increase in the risk early after cART initiation. Methods. We studied HZ incidence and risk factors among patients followed in the French Hospital Database on HIV (FHDH) between 1992 and 2011. Standardized incidence ratios (SIRs) were used for comparison with the general population between 2005 and 2008. The risk of HZ following cART initiation (0-5 and ≥6 months) was studied with Poisson regression models. Results. A total of 7167 cases of incident HZ were diagnosed among 91 044 individuals (583 125 person-years [PY]). The incidence declined significantly, from 2955 per 100 000 PY in 1992-1996 to 628 per 100 000 PY in 2009-2011. This decline was mainly explained by cART (relative risk [RR], 0.60; 95% confidence interval {CI}, .57-.64). The risk of HZ was associated with low CD4 cell counts, high HIV RNA levels, low CD4/CD8 ratios, and prior AIDS. Compared to the general population, the risk of HZ was higher in HIV-infected patients (overall SIR, 2.7; 95% CI, 2.6-2.9), particularly those aged 15-44 years (SIR, 4-6). In ART-naive patients, a moderate increase in the HZ risk was observed during the first 6 months of cART, with a peak at 3 months (RR, 1.47; 95% CI, 1.26-1.73), a finding that disappeared after adjustment for the current CD4 cell count (RR, 1.03; 95% CI, .81-1.32). Conclusions. The risk of HZ has declined markedly among HIV-infected patients in the cART era, but remains 3 times higher than in the general population. The risk increases moderately during the first 6 months of cART.
    Clinical Infectious Diseases 01/2015; 60(8). DOI:10.1093/cid/ciu1161 · 9.42 Impact Factor
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    ABSTRACT: SUMMARY A better understanding of physician practices in requesting stool samples for patients with acute gastroenteritis (AG) is needed to more accurately interpret laboratory-based surveillance data. A survey was conducted in General Practitioners (GPs) between August 2013 and July 2014 to estimate the proportion of stool samples requested for patients with AG and to identify factors associated with GP requests for a stool sample. National health insurance (NHI) data together with surveillance data from a French Sentinel GP network were also used to estimate the proportion of stool samples requested. This proportion was estimated at 4·3% in the GP survey and 9·1% (95% confidence interval 8·7-9·6) using NHI data. Multivariate analysis indicated that the ratio of stool samples requested was almost five times higher in patients with bloody diarrhoea and 10-20 times higher in patients with a long duration of illness before consultation. Laboratory-based surveillance data underestimates the actual burden of disease as fewer than one in 10 AG cases consulting their GP will be requested to submit a stool sample for laboratory testing. This underestimation varies by pathogen as stool samples are more frequently requested for severe illness.
    Epidemiology and Infection 01/2015; DOI:10.1017/S0950268814003884 · 2.49 Impact Factor
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    ABSTRACT: To measure the frequency and nature of wounds in patients treated in general practice and to describe the patients' tetanus vaccination status and the sources providing information about this status. A descriptive, prospective, week-long, national electronic survey was conducted among general practitioners within the Sentinelles network. The participation rate was 12.6% (95% confidence interval [CI], 10.6%-14.6%; 130 general practitioners): 197 patients with wounds were reported, and 175 of them were described. Wound frequency was 1.4 (95% CI, 1.2-1.6) per 100 consultations. These wounds had an acute character in 76 (95% CI, 69.7-82.3) of cases, were mostly of traumatic origin (54.8% of cases; 95% CI, 47.5%-62.1%), were more than 24 hours old (67.1%; 95% CI, 59.1%-75.1%), and were clean, without bone and/or muscle decay (94%; 95% CI, 90.5%-97.5%). Vaccination status was known for 71 (95% CI, 64-78) patients. According to the 2013 immunization schedule, 21% (95% CI, 13.9%-28.1%) of the patients had not updated their vaccinations, mostly among the patients older than 75 years. This survey describes in detail the wounds treated in general practice in France and the associated patients' immunization status. It also shows how difficult it is for general practitioners to assess the risk of contracting tetanus and the disease's development. It highlights as well the fact that the ideal solution to assess tetanus risk is an up-to-date immunization schedule.
    International Journal of General Medicine 01/2015; 8:215-20. DOI:10.2147/IJGM.S75189
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    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.
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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 12/2014; DOI:10.1016/j.autrev.2014.08.016 · 7.10 Impact Factor
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    ABSTRACT: Varicella can be severe in adults. When universal vaccination is not adopted, post-exposure prophylaxis has been recommended in adults with uncertain history of varicella to reduce the burden of the disease in adults, however its impact is not quantified. We developed a Bayesian probabilistic framework to estimate the impact of post-exposure prophylaxis in adults. We hypothesized that post-exposure vaccination would be proposed only after varicella exposure in close relatives. Information regarding the nature of the culprit exposure was obtained from a sample of 221 adult varicella cases. The lifelong probability that adults aged 18 would be infected with varicella was determined using data from the French Sentinelles surveillance network. Estimates of post-exposure vaccination efficacy were then used to compute the number of cases and hospitalizations prevented in adults. Familial exposure to varicella was reported by 81 adult cases out of 221. The probability of infection after exposure was 32%, so that six exposures on average were necessary to explain the observed cumulated lifetime incidence of varicella in non-immune 18 years old and over adults. Among the 35% of the 18 years old population with uncertain history of varicella, 11% would truly be non-immune. Post-exposure vaccination would prevent 26% of the cases (13 cases prevented per 100,000 adults per year) and 31% of the hospitalizations (0.2 hospitalizations prevented per 100,000 adults per year) if vaccination acceptance was 70%. An average of 16 adults would be vaccinated to avert one varicella case. Post-exposure vaccination is associated with a substantial decrease in the burden of the disease in adults in a country where universal vaccination is not recommended. This quantitative information may help inform professionals to uphold the recommendation. Copyright © 2014. Published by Elsevier Ltd.
    Vaccine 12/2014; 33(3). DOI:10.1016/j.vaccine.2014.11.045 · 3.49 Impact Factor
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    ABSTRACT: Background Data describing the epidemiology and management of viral acute diarrhea (AD) in adults are scant. The objective of this study was to identify the incidence, clinical characteristics, management and risk factors of winter viral AD in adults.Methods The incidence of AD in adults during two consecutive winters (from December 2010 to April 2011 and from December 2011 to April 2012) was estimated from the French Sentinelles network. During these two winters, a subset of Sentinelles general practitioners (GPs) identified and included adult patients who presented with AD and who filled out a questionnaire and returned a stool specimen for virological examination. All stool specimens were tested for astrovirus, group A rotavirus, human enteric adenovirus, and norovirus of genogroup I and genogroup II. Age- and sex-matched controls were included to permit a case¿control analysis with the aim of identifying risk factors for viral AD.ResultsDuring the studied winters, the average incidence of AD in adults was estimated to be 3,158 per 100,000 French adults (95% CI [2,321 ¿ 3,997]). The most reported clinical signs were abdominal pain (91.1%), watery diarrhea (88.5%), and nausea (83.3%). GPs prescribed a treatment in 95% of the patients with AD, and 80% of the working patients with AD could not go to work. Stool examinations were positive for at least one enteric virus in 65% (95% CI [57 ¿ 73]) of patients with AD with a predominance of noroviruses (49%). Having been in contact with a person who has suffered from AD in the last 7 days, whether within or outside the household, and having a job (or being a student) were risk factors significantly associated with acquiring viral AD.Conclusions During the winter, AD of viral origin is a frequent disease in adults, and noroviruses are most often the cause. No preventable risk factor was identified other than contact with a person with AD. Thus, at the present time, reinforcement of education related to hand hygiene remains the only way to reduce the burden of disease.
    BMC Infectious Diseases 10/2014; 14(1):574. DOI:10.1186/PREACCEPT-1129034223134684 · 2.56 Impact Factor
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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. DOI:10.1186/1471-2458-14-984 · 2.32 Impact Factor
  • Revue d Épidémiologie et de Santé Publique 09/2014; 62:S206. DOI:10.1016/j.respe.2014.06.114 · 0.66 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. DOI:10.1016/j.jad.2014.08.037 · 3.71 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 09/2014; 62:S181. DOI:10.1016/j.respe.2014.06.032 · 0.66 Impact Factor
  • Eurosurveillance: bulletin europeen sur les maladies transmissibles = European communicable disease bulletin 08/2014; 19(34). DOI:10.2807/1560-7917.ES2014.19.34.20883 · 4.66 Impact Factor
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    Médecine et Maladies Infectieuses 06/2014; 44(6):76. DOI:10.1016/S0399-077X(14)70273-2 · 0.91 Impact Factor
  • Médecine et Maladies Infectieuses 06/2014; 44(6, supplement):89. DOI:10.1016/S0399-077X(14)70314-2 · 0.91 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; DOI:10.1016/j.autrev.2014.04.005 · 7.10 Impact Factor

Publication Stats

1k Citations
609.79 Total Impact Points


  • 2003–2015
    • Université de Versailles Saint-Quentin
      • UFR des Sciences de la Santé Simone Veil
      Versailles, Île-de-France, France
  • 2014
    • Hôpital La Pitié Salpêtrière (Groupe Hospitalier "La Pitié Salpêtrière - Charles Foix")
      • Service de Médecine Interne 1
      Lutetia Parisorum, Île-de-France, France
  • 2008–2014
    • Clinique Ambroise Paré
      Tolosa de Llenguadoc, Midi-Pyrénées, France
    • Hôpital Saint-Antoine (Hôpitaux Universitaires Est Parisien)
      • Service de Médecine Interne
      Paris, Ile-de-France, France
    • Groupe Hospitalier Saint Vincent
      Strasburg, Alsace, France
  • 2011–2013
    • Hôpital Européen Georges-Pompidou (Hôpitaux Universitaires Paris-Ouest)
      • Service de Médecine Interne
      Lutetia Parisorum, Île-de-France, France
  • 2001–2013
    • Unité Inserm U1077
      Caen, Lower Normandy, France
    • French Institute of Health and Medical Research
      Lutetia Parisorum, Île-de-France, France
  • 2000–2013
    • Hôpital Ambroise Paré – Hôpitaux universitaires Paris Ile-de-France Ouest
      Billancourt, Île-de-France, France
  • 2003–2011
    • Pierre and Marie Curie University - Paris 6
      • Faculté de médecine Pierre et Marie Curie
      Lutetia Parisorum, Île-de-France, France
    • Assistance Publique – Hôpitaux de Paris
      • Département de Médecine Interne
      Lutetia Parisorum, Île-de-France, France
  • 2010
    • Ecole des hautes études en santé publique
      Roazhon, Brittany, France
  • 2008–2010
    • Hôpital Ambroise Paré Paul Desbief
      Marsiglia, Provence-Alpes-Côte d'Azur, France
  • 2007
    • Ipswich Hospital NHS Trust
      Ipswich, England, United Kingdom
  • 1995–2001
    • Université René Descartes - Paris 5
      Lutetia Parisorum, Île-de-France, France