T Hanslik

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

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Publications (209)555.67 Total impact

  • [Show abstract] [Hide abstract]
    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; · 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; · 0.21 Impact Factor
  • Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 01/2015;
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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;
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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.
    Journal of Affective Disorders. 01/2015; 170:150–154.
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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; · 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; · 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. · 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. · 2.32 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. · 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. · 3.71 Impact Factor
  • Revue d Épidémiologie et de Santé Publique 09/2014; 62:S206. · 0.66 Impact Factor
  • Eurosurveillance: bulletin europeen sur les maladies transmissibles = European communicable disease bulletin 08/2014; 19(34). · 4.66 Impact Factor
  • Médecine et Maladies Infectieuses 06/2014; 44(6, supplement):89. · 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; · 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; · 9.42 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 01/2014; 35(1):45–55. · 1.32 Impact Factor
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    ABSTRACT: In primary care surveillance systems based on voluntary participation, biased results may arise from the lack of representativeness of the monitored population and uncertainty regarding the population denominator, especially in health systems where patient registration is not required. Based on the observation of a positive association between number of cases reported and number of consultations by the participating general practitioners (GPs), we define several weighted incidence estimators using external information on consultation volume in GPs. These estimators are applied to data reported in a French primary care surveillance system based on voluntary GPs (the Sentinelles network) for comparison. Depending on hypotheses for weight computations, relative changes in weekly national-level incidence estimates up to 3% for influenza, 6% for diarrhea, and 11% for varicella were observed. The use of consultation-weighted estimates led to bias reduction in the estimates. At the regional level (NUTS2 level - Nomenclature of Statistical Territorial Units Level 2), relative changes were even larger between incidence estimates, with changes between -40% and +55%. Using bias-reduced weights decreased variation in incidence between regions and increased spatial autocorrelation. Post-stratification using external administrative data may improve incidence estimates in surveillance systems based on voluntary participation.
    Population Health Metrics 01/2014; 12:19. · 2.11 Impact Factor
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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. · 1.50 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).

Publication Stats

1k Citations
555.67 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
  • 2011–2014
    • Clinique Ambroise Paré
      Tolosa de Llenguadoc, Midi-Pyrénées, 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
    • 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
  • 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
  • 2010
    • Ecole des hautes études en santé publique
      Roazhon, Brittany, France
  • 2008
    • Hôpital Saint-Antoine (Hôpitaux Universitaires Est Parisien)
      • Service de Médecine Interne
      Paris, Ile-de-France, France
    • Groupe Hospitalier Saint Vincent
      Strasburg, Alsace, France