BackgroundThe vaccine coverage against human papillomavirus (HPV) vaccination remains low in France. The objective of this study was to study adolescent perceptions by comparing boys and girls, in order to build effective school-based interventions.MethodsThis paper presents a cross-sectional study in French middle school pupils. They completed online questionnaires on their knowledge and attitudes toward the HPV vaccine, HPV vaccination status, their intention, reasons to vaccinate or not to vaccinate, and psychological antecedents of vaccination. A structural equation modeling (SEM) analysis was used to test the hypothesized model.ResultsThe participants are 818 pupils aged from 12 to 16 years (Mage = 13.78). Most pupils were in the pre-contemplative stage (62.7 % of boys and 40.8 % of girls). SEM analysis indicated that the relationship between the level of HPV knowledge, the representations of vaccines in general, and vaccine intention was mediated by attitudes towards the HPV vaccine among both boys and girls.ConclusionsThese findings reveal a high percentage of boys who do not feel concerned by the HPV vaccine and highlight the need to consider the psychological antecedents of vaccination in general in addition to the specific attitudes to the HPV vaccine.

Background Antimicrobial stewardship (AMS) programs aim to optimize antibiotic use through a panel of interventions. The implementation of computerized clinical decision support systems (CDSSs) offers new opportunities for semiautomated antimicrobial review by AMS teams. This study aimed to evaluate the perceived facilitators, barriers and benefits of end-users related to a commercial CDSS recently implemented in a hospital and to assess its usability. Methods A mixed-method approach was used among AMS team members nine months after the implementation of the CDSS in a university hospital in northeastern France. A qualitative analysis based on individual semistructured interviews was conducted to collect end-users’ perceptions. A quantitative analysis was performed using the System Usability Scale (SUS). Results Eleven AMS team members agreed to participate. The qualitative analysis revealed technical, organizational and human barriers and facilitators of CDSS implementation. Effective collaboration with information technology teams was crucial for ensuring the installation and configuration of the software. CDSS adoption by the AMS team required time, human resources, training, adaptation and a clinical leader. Moreover, the CDSS had to be well designed, user-friendly and provide benefits to AMS activities. The quantitative analysis indicated that the CDSS was a “good” system in terms of perceived ease of use (median SUS score: 77.5/100). Conclusions This study shows the value of the studied CDSS to support AMS activities. It reveals barriers, facilitators and benefits to the implementation and adoption of the CDSS. These barriers and facilitators could be considered to facilitate the implementation of the software in other hospitals.

Precisely defining the delay in onset of dementia is a particular challenge for early diagnosis. Brain [18F] fluoro-2-deoxy-2-D-glucose (18F-FDG) Positron Emission Tomography (PET) is a particularly interesting tool for the early diagnosis of neurodegenerative diseases, through the measurement of the cerebral glucose metabolic rate. There is currently a lack of longitudinal studies under real-life conditions, with sufficient patients, to accurately evaluate the predictive values of brain 18F-FDG PET scans. Here, we aimed to estimate the value of brain 18F-FDG PET for predicting the risk of dementia conversion and the risk of occurrence of a neurodegenerative pathology. Longitudinal data for a cohort of patients with no diagnosis of dementia at the time of recruitment referred by a tertiary memory clinic for brain 18F-FDG PET were matched with (Prince M, Wimo A, Guerchet Maëlenn, Ali G-C, Wu Y-T et al. World Alzheimer Report 2015. The Global Impact of Dementia: An analysis of prevalence, incidence, cost and trends. [Research Report] Alzheimer’s Disease International. 2015. 2015.) data from the French National Health Data System (NHDS), (Jack CR, Bennett DA, Blennow K, Carrillo MC, Dunn B, Haeberlein SB, et al. NIA-AA Research Framework: Toward a biological definition of Alzheimer’s disease. Alzheimers Dement. 2018;14(4):535–62.) data from the National Alzheimer Bank (NAB), and (Davis M, O`Connell T, Johnson S, Cline S, Merikle E, Martenyi F, et al. Estimating Alzheimer’s Disease Progression Rates from Normal Cognition Through Mild Cognitive Impairment and Stages of Dementia. CAR. 2018;15(8):777–88.) lumbar puncture (LP) biomarker data. The criteria for dementia conversion were the designation, within the three years after the brain 18F-FDG PET scan, of a long-term condition for dementia in the NHDS and a dementia stage of cognitive impairment in the NAB. The criterion for the identification of a neurodegenerative disease in the medical records was the determination of LP biomarker levels. Among the 403 patients (69.9 ± 11.4 years old, 177 women) from the initial cohort with data matched with the NHDS data, 137 were matched with the NAB data, and 61 were matched with LP biomarker data. Within three years of the scan, a 18F-FDG PET had negative predictive values of 85

Background:GPs are responsible for more than 70% of outpatient antibiotic prescriptions in France. Metrics are important antibiotic stewardship tools that can be used to set targets for improvement and to give feedback to professionals and stakeholders.Objectives:The primary objective of the present study was to select a set of proxy indicators (PIs) based on 10 previously developed PIs, to estimate the appropriateness of antibiotic prescriptions by GPs. The secondary objective was to evaluate the clinimetric properties of the selected PIs.Methods:A RAND-modified Delphi consensus procedure was conducted with a multidisciplinary panel of stakeholders. This procedure consisted of two successive online surveys with a consensus meeting in between. Clinimetric properties (measurability, applicability and potential room for improvement) were evaluated for the PIs selected through the consensus procedure, using 2022 Regional Health Insurance data.Results:Seventeen experts participated in the first-round survey and 14 in the second-round. A final set of 12 PIs was selected. Among the 10 initial PIs, 3 were selected without modification and 7 were modified and selected. Moreover, two newly suggested PIs were selected. Ten of the 12 PIs presented good clinimetric properties.Conclusions:The 12 selected PIs cover the main situations responsible for inappropriate and unnecessary use of antibiotics in general practice. These PIs, easily calculable using routinely collected health insurance reimbursement data, might be used to give feedback to prescribers and stakeholders and help improve antibiotic prescriptions in primary care.

Introduction: Despite documented effectiveness in preventing several cancers, genital warts and safety of Human Papillomavirus (HPV) vaccine, immunization coverage among French adolescents remains far from the 80 % target. University health students (HS) in France may promote HPV vaccine through a national service (Service Sanitaire des Etudiants en Sante ). We aimed to evaluate intentions to recommend the HPV vaccine to friends and relatives, to receive HPV vaccine, and to identify factors associated with these attitudes. Methods: We conducted a cross-sectional survey in five French Universities from October 2019 to February 2020, using a self-administered online questionnaire. We used bivariable and multivariable logistic regression models to identify determinants of behavior around HPV vaccine: (i) individual intention for vaccination, and (ii) vaccine recommendation to friends and relatives. Results: Among the 732 respondents (180 men, 552 women), 305 (41.7%) reported previous HPV vaccination (54.5 % among women), 504 (68.9%) would recommend the HPV vaccine to friends and relatives, 532 (72.7%) respondents would be vaccinated today if it was recommended for them. Intentions to recommend or to receive the HPV vaccine were less frequent in nursing students compared to medical and pharmacy students. After adjustment for demographical factors, HPV vaccine knowledge was associated with intention [aOR 1.30 (95%confidence interval, 1.15 - 1.47)] and recommendation [1.26 (1.10 - 1.45)], respectively. Additionally, adjusting for knowledge about HPV infections, and confidence in vaccines in general was associated with vaccine intention [1.55, (1.30-1.84)] and recommendation [1.52 (1.24-1.86)]. HPV-vaccinated HS were more prone to recommend the HPV vaccine to friends and relatives [10.9 (6.6-17.9)]. Conclusion: A majority of HS would accept and/or recommend HPV vaccines. HS with greater knowledge about the HPV vaccine were more prone to recommend it. Strengthening knowledge about HPV and its vaccination is probably necessary before their Involvement in a HPV immunization program.

Human Papillomavirus (HPV) vaccine coverage was <50% in France in 2022 and even lower among socially disadvantaged populations. We aimed to evaluate socio-demographic determinants of HPV vaccine awareness, uptake, and intention among parents of adolescents, and related attitudes and knowledge items. Parents of adolescents attending middle schools across France, who participated in a randomized trial responded to an anonymous baseline survey, conducted between November 2021 and February 2022. We used logistic regression models adjusting for a child’s age and sex to explore sociodemographic determinants (including at-home multilingualism, occupational categories, local deprivation index and urbanity) of HPV vaccine awareness, uptake, and intention. Among the 1889 participants from 61 schools, parents working as factory workers/farmers had significantly lower odds of vaccine awareness compared to executives/professionals, both if they reported (OR = 0.07; 0.03–0.15) or not (OR = 0.20; 0.11–0.36) speaking also another language than French at home. Parents in lower occupational categories with multilingual families were less likely to have the intention to vaccinate their child (OR = 0.19; 0.07–0.56). Recent physician visit or vaccine offer was strong positive determinants of awareness, uptake and intention. A substantial gradient across occupational categories was observed for attitudes and knowledge around HPV vaccine usefulness, safety, and accessibility. This study confirms the disparities on HPV vaccine uptake in France and provides insight into mechanisms of social disparities in HPV vaccine awareness, access and intention.

Background:Antibiotic resistance is a major public health threat, especially in nursing homes (NHs). Nursing home nurses (NHNs) can play a crucial role in antimicrobial stewardship (AMS), but research on their opinions regarding potential expanded AMS roles is limited. Objectives:To identify different profiles of NHNs according to their opinions on the potential evolution of their AMS roles and to study facilitators/barriers to implementing new AMS roles and the demographic and professional characteristics associated with these profiles. Methods:Data were collected from a national cross-sectional online survey conducted from May to July 2022 among French NHNs. Profiles were identified via hierarchical clustering. Factors associated with the identified profiles were studied via Fisher's exact tests. Results:Among the 922 participants included in the analysis, three distinct profiles were identified. NHNs 'more favourable to the evolution of the AMS role' (40% of the sample) expressed strong support for the potential evolution of their AMS role. NHNs 'moderately favourable to the evolution of the AMS role' (46%) were less prone to reinforce discussion with general practitioners about antibiotic prescription. NHNs 'less favourable to the evolution of the AMS role' (14%) showed little or no agreement regarding several potential new AMS roles. Being a head nurse was associated with more favourable opinions on the evolution of the AMS role as opposed to practicing in NHs connected to a hospital. Conclusions:These findings could help healthcare managers and policy-makers tailor the implementation of these new roles among NHNs, if they prove effective and safe.

Background: In France, uptake of the recommended human papillomavirus (HPV) vaccination remains low. The vaccine cannot be administered without parental consent, but studies have shown that adolescents can make informed decisions about their health. We aimed at understanding the weight of adolescents' vaccination intention in parents' vaccination decision, using data from parent-adolescent dyads collected at baseline of a randomized trial of vaccine promotion interventions. Method: About 649 parent-adolescent dyads from 61 middle schools in France independently completed an online questionnaire on their knowledge and attitudes toward HPV vaccination, structured around the seven psychological domains of vaccine readiness (VR). We used multivariate and path analyses to understand the family decision-making process. Results: HPV vaccination was reported by 50.1% of adolescents and 45.5% of parents. Individual antecedents of VR were poorly correlated within dyads (r = .14-.36). Vaccine intentionality among parents of girls depended both on their own VR (beta = .53, p < .001) and on their daughters' vaccine intention (beta = .25, p < .001). But among parents of boys, vaccine intention depended only on their own VR (beta = .72, p < .001). Adolescents' VR depended more strongly on the social environment's attitude among boys than among girls (beta = .54 vs. .34, p < .01). Conclusions: The defined model showed shared decision processes between parents and adolescent girls, but not boys, which can be understood in the context of a recent expansion of HPV vaccination to boys. Beyond this, it suggests that promotion targeting adolescents and their social environment can have a positive influence on parental intentions.

AbstractIntroductionDespite various efforts to improve human papillomavirus (HPV) vaccine coverage in France, it has always been lower than in most other high‐income countries. The health authorities launched in 2018 the national PrevHPV research programme to (1) co‐develop with stakeholders and (2) evaluate the impact of a multicomponent complex intervention aimed at improving HPV vaccine coverage amongst French adolescents.ObjectiveTo describe the development process of the PrevHPV intervention using the GUIDance for rEporting of intervention Development framework as a guide.MethodsTo develop the intervention, we used findings from (1) published evidence on effective strategies to improve vaccination uptake and on theoretical frameworks of health behaviour change; (2) primary data on target populations' knowledge, beliefs, attitudes, preferences, behaviours and practices as well as the facilitators and barriers to HPV vaccination collected as part of the PrevHPV Programme and (3) the advice of working groups involving stakeholders in a participatory approach. We paid attention to developing an intervention that would maximise reach, adoption, implementation and maintenance in real‐world contexts.ResultsWe co‐developed three components: (1) adolescents' and parents' education and motivation using eHealth tools (web conferences, videos, and a serious video game) and participatory learning at school; (2) general practitioners' e‐learning training on HPV using motivational interviewing techniques and provision of a decision aid tool and (3) easier access to vaccination through vaccination days organised on participating middle schools' premises to propose free of charge initiation of the HPV vaccination.ConclusionWe co‐developed a multicomponent intervention that addresses a range of barriers and enablers of HPV vaccination. The next step is to build on the results of its evaluation to refine it before scaling it up if proven efficient. If so, it will add to the small number of multicomponent interventions aimed at improving HPV vaccination worldwide.Patient or Public ContributionThe public (adolescents, their parents, school staff and health professionals) participated in the needs assessment using a mixed methods approach. The public was also involved in the components' development process to generate ideas about potential activities/tools, critically revise the successive versions of the tools and provide advice about the intervention practicalities, feasibility and maintenance.

BACKGROUND:Electronic surveillance software (ESS) collects multiple patient data from hospital software to assist infection control professionals in the prevention and control of hospital-associated infections. This study aimed to understand the perceptions of end users (i.e., infection control professionals) and the facilitators and barriers related to a commercial ESS named ZINC and to assess its usability. METHODS:A mixed-method research approach was adopted among infection control professionals 10 months after the implementation of commercial ESS in the university hospital of Nancy, France. A qualitative analysis based on individual semistructured interviews was conducted to collect professionals' perceptions of ESS and to understand barriers and facilitators. Qualitative data were systematically coded and thematically analyzed. A quantitative analysis was performed using the System Usability Scale (SUS). RESULTS:Thirteen infection control professionals were included. Qualitative analysis revealed technical, organizational and human barriers to the installation and use stages and five significant facilitators: the relevant design of the ESS, the improvement of infection prevention and control practices, the designation of a champion/superuser among professionals, training, and collaboration with the developer team. Quantitative analysis indicated that the evaluated ESS was a "good" system in terms of perceived ease of use, with an overall median SUS score of 85/100. CONCLUSIONS:This study shows the value of ESS to support inpatient infections as perceived by infection control professionals. It reveals barriers and facilitators to the implementation and adoption of ESS. These barriers and facilitators should be considered to facilitate the installation of the software in other hospitals.

Background : In France, human papillomavirus (HPV) vaccination coverage is low, with 30.7% of 17-year-old girls having received a complete HPV vaccination schedule in 2020. Aim : To determine the perspective and behaviors of general practitioners (GPs) regarding HPV vaccination with their patients and if a reluctance is observed. Design and Setting : A qualitative study based on semi-directed individual interviews was conducted between December 2019 and December 2020. A representative sample of GPs with various profiles were included in 4 French regions. Method : A purposive sampling was used and interviews were continued until data saturation was reached. The analysis was based on the grounded theory. Results : Twenty-six GPs aged 29-66 years were interviewed. The measures taken by the French health authorities (lowering the target age, reimbursing the vaccine, extending the target population to boys) were perceived as facilitators. The reported barriers were organizational, due to low attendance of adolescents, and relational, mainly due to parental vaccine hesitancy. Physicians had to deal with fears about the perceived risks and concerns about sexuality conveyed by HPV vaccination and linked to the socio-cultural characteristics of the families. Physicians developed strategies, including scientific knowledge mobilization, empowerment of families by promoting health through prevention, repetition of the vaccination proposals, personal experience and relationship. Different practices were identified according to three GP typologies: effective, convinced but unpersuasive, and reluctant physicians. Conclusion : Based on these results, specific interventions, including communication techniques, especially for hesitant or unpersuasive physicians, are needed to enable GPs to become more effective.

IntroductionMalgré l'efficacité et la sécurité du vaccin anti-HPV, la couverture vaccinale (CV) demeure faible dans certains pays, dont la France. Une intervention incluant trois composantes (1-Education et motivation des adolescents et de leurs parents, 2-Formation des médecins généralistes aux HPV et à l'entretien motivationnel, 3-Vaccination gratuite en collège) a été co-développée et évaluée dans neuf régions françaises pendant l'année scolaire 2021-22. L'objectif est de présenter l'effet des composantes sur la CV deux mois après la fin de l'intervention.Matériels et méthodesUn essai contrôlé, randomisé, en cluster a été mis en oeuvre en utilisant un design de plan factoriel incomplet permettant de comparer 6 groupes bénéficiant de 0, 1, 2 ou 3 des composantes évaluées. La composante ‘vaccination gratuite en collège' n'a jamais été mise en oeuvre sans que les adolescents et parents bénéficient au préalable de la composante ‘Education / motivation'. La randomisation était stratifiée sur la région et sur l'indice de défavorisation des communes. Le critère de jugement principal était la CV (au moins 1 dose) des adolescents de 11-14 ans résidant dans la commune. L'analyse a été conduite en intention de traiter (ITT), puis en tenant compte de la dose d'intervention réellement reçue (DIR). L'effet de l'intervention selon le sexe de l'adolescent, l'indice de défavorisation de la commune et l'accessibilité potentielle aux médecins généralistes de la commune a été étudié.RésultatsAu total, 91 communes ont été incluses et analysées. La CV avant intervention variait de 8,9% à 15,0% selon les communes, et a augmenté de 4,0% à 14,2% deux mois après l'intervention. La vaccination en collèges a significativement augmenté la CV quel que soit le type d'analyse (ITT : +5,5%, IC95% [3,1;7,9]; DIR : +11,3%, IC95% [9,1;13,4]), contrairement à la formation des médecins généralistes dont l'effet n'est significatif qu'en tenant compte de la dose d'intervention (ITT : -1,5%, IC95% [-3,4;0,5] ; DIR : +3,6%, IC95% [0,02;7,1] ), et l'éducation / motivation des adolescents et de leurs parents, mise en oeuvre seule, reste non significative (ITT : -0,1%, IC95% [-2,5;2,4] ; DIR : +2,6%, IC95% [-1,7;6,9]). Il n'a pas été mis en évidence de différence selon le sexe de l'adolescent, mais l'effet de la vaccination en collège était plus important dans les communes ayant un faible accès aux médecins généralistes (p=0,007).ConclusionLa vaccination en collège, précédée d'une éducation / motivation des adolescents et de leurs parents, permet d'augmenter la CV anti-HPV, et ce plus particulièrement dans les communes ayant un faible accès aux médecins généralistes. La formation des médecins généralistes permet elle aussi d'augmenter la CV dès lors qu'ils y participent.Aucun lien d'intérêt

Abstract Background HPV vaccine coverage (VC) remains lower than expected in many countries, particularly France. We developed and evaluated the PrevHPV multicomponent intervention to improve HPV VC among French adolescents. We evaluated the implementation of the school-based components of the intervention. Methods We carried out a mixed-method study embedded in a cluster randomized controlled trial (July 2021-April 2022; 14/25 French school districts). The cluster was the municipality (n = 91). The school-based components of the intervention were ‘education and motivation’ and ‘at-school vaccination’. Quantitative data were collected through standardized activity reports and self-administered questionnaires; the implementation outcomes were fidelity, dose, reach, acceptability and sustainability. Qualitative data were collected through semistructured group interviews with school staff and analyzed using the Consolidated Framework for Implementation Research. Results We found high rates for: fidelity (e.g., 69% of the targeted classes had two educational sessions and 89% of schools invited all pupils for at-school vaccination, as planned); acceptability (e.g., pupils’ participation satisfying in 90% of the sessions, 96% of vaccinated pupils and 78% of school staff satisfied with at-school vaccination); and sustainability (e.g., respectively 91% and 76% of schools considered conducting sessions and vaccination days during the following year). However, the withdrawal of 1/3 of schools before the trial started and difficulties in mobilizing parents negatively impacted dose and reach. Several facilitators and barriers influenced the implementation of the components; they were related to the components’ design, the characteristics of both the external and internal environment of the school, the numerous stakeholders and individuals involved, and the implementation strategies used. Conclusions These results can guide policy making on school-based HPV vaccine promotion in France and Europe. Key messages • The PrevHPV study is supported by the French health authorities and conducted by a multidisciplinary consortium to tackle a long-lasting public health concern in France. • These findings have practical implications for implementing effective and acceptable school-based interventions in real life to improve HPV vaccine uptake and reduce HPV-associated burdens.

With the aim to optimize communication during HPV vaccination campaigns in France, we elicited parental preferences around HPV vaccination. We conducted a single-profile discrete choice experiment (DCE) among parents of 11- to 14-year-old middle-school pupils, who completed an anonymous, self-administered, internet-based questionnaire during 2020–2021. The DCE comprised five attributes (vaccine-preventable disease, justification of optimal age, information on safety, indirect protection and coverage) of vaccination against an unnamed disease that were presented to respondents in ten choice tasks, or scenarios. We use fixed effect logit models to estimate attribute weights on theoretical vaccine acceptance, and random effect linear regression to estimate attribute coefficients on vaccine eagerness (decision and decision certainty). We estimated marginal effects of attributes on expected vaccine acceptance. Vaccination scenarios were accepted by 55.6–89.2

Importance The human papillomavirus (HPV) vaccine is safe and effective, yet vaccination coverage remains below public health objectives in many countries. Objective To examine the effectiveness of a 3-component intervention on HPV vaccination coverage among adolescents aged 11 to 14 years 2 months after the intervention ended, each component being applied alone or in combination. Design, Setting, and Participants A cluster randomized trial with incomplete factorial design (PrevHPV) was conducted between July 1, 2021, and April 30, 2022, in French municipalities receiving 0, 1, 2, or 3 components of the intervention. Randomization was stratified by school district and municipalities’ socioeconomic level. Analyses were carried out on 11- to 14-year-old adolescents living in all participating municipalities, regardless of what had been implemented. Intervention The PrevHPV intervention had 3 components: (1) educating and motivating 11- to 14-year-old adolescents in middle schools, along with their parents; (2) training general practitioners (GPs) on up-to-date HPV information and motivational interviewing techniques; and (3) free HPV vaccination at school. Main Outcomes and Measures The primary outcome was HPV vaccination coverage (≥1 dose) 2 months after the intervention ended among 11- to 14-year-old adolescents living in participating municipalities, based on the French national reimbursement database and data collected during the trial in groups randomized to implement at-school vaccination. Results A total of 91 municipalities comprising 30 739 adolescents aged 11 to 14 years (15 876 boys and 14 863 girls) were included and analyzed. Half the municipalities were in the 2 lowest socioeconomic quintiles and access to GPs was poor in more than two-thirds of the municipalities. Thirty-eight of 61 schools (62.3%) implemented actions and 26 of 45 municipalities (57.8%) had at least 1 trained GP. The median vaccination coverage increased by 4.0 percentage points (IQR, 2.0-7.3 percentage points) to 14.2 percentage points (IQR, 9.1-17.3 percentage points) at 2 months. At-school vaccination significantly increased vaccination coverage (5.50 percentage points [95% CI, 3.13-7.88 percentage points]) while no effect was observed for adolescents’ education and motivation (−0.08 percentage points [95% CI, −2.54 to 2.39 percentage points]) and GPs’ training (−1.46 percentage points [95% CI, −3.44 to 0.53 percentage points]). Subgroup analyses found a significant interaction between at-school vaccination and access to GPs, with a higher effect when access was poor (8.62 percentage points [95% CI, 5.37-11.86 percentage points] vs 2.13 percentage points [95% CI, −1.25 to 5.50 percentage points]; P = .007 for interaction). Conclusions and Relevance In this cluster randomized trial, within the context of the late COVID-19 pandemic period and limited school and GP participation, at-school HPV vaccination significantly increased vaccination coverage. The trial did not show a significant effect for training GPs and education and motivation, although it may be observed after more time has elapsed after the intervention. Trial Registration ClinicalTrials.gov Identifier: NCT04945655

The use of antibiotics in dental care is often unnecessary or inappropriate. Our objectives were to identify (i) Clusters of dentists grouped according to their appropriateness score based on proxy indicators’ results; and (ii) Dentists’ and patients’ characteristics associated with the appropriateness of antibiotic prescriptions. We used data of the Health Insurance reimbursement databases on antibiotics prescribed in 2019 by general dental practitioners of the Grand Est region in France. The appropriateness of antibiotic prescriptions was estimated by the results of recently published proxy indicators. We conducted a cluster analysis according to an appropriateness score calculated for each dentist, using the Ward method. We then conducted bivariate and multivariable analyses to identify characteristics associated with these clusters. We included 3,014 dentists, who prescribed 373,975 antibiotics in 2019, and which were grouped into three clusters: average practices (n = 1,241), better (n = 686), and worse (n = 1,087) than average practices. Overall, dentists had more appropriate prescription practices when they were male (OR for belonging to cluster with “worse than average practices” = 1.37 (p = 0.003) for female), having a predominant surgery practice (p = 0.028) in the Lorraine area (p < 0.0001) for less years (p = 0.0002), when they had healthier patients (i.e., younger, with no chronic diseases, and who received less procedures), and when they had a more prudent use of drugs in general (i.e., less prescriptions of drugs, antibiotics, and non-steroidal anti-inflammatory). We identified clusters and characteristics associated with the appropriateness of antibiotic prescriptions made by dentists, which might help guiding antimicrobial stewardship interventions.

Support for vaccine decision-making requires a tailored approach taking into account psychological antecedents of vaccine acceptance. We aimed at validating an extended 7C-model of antecedents in three different target population groups (healthcare workers [n = 3870], parents [n = 2002] and adolescents [n = 7118]) and two vaccinations (COVID-19, HPV) in France. We performed a secondary analysis of questionnaires collecting sociodemographic characteristics, attitudes and knowledge on vaccination, and vaccine status and intention. We used standard psychometric techniques to validate a first and second order latent structure, and evaluated their association with vaccine intentionality in three levels (refusal, indecision, acceptance). In all populations, the 7C-model yielded a very good model fit (CFI and TLI > 0.90) and, in comparison with non-nested and nested 5C-models, significantly improved the model performance (Ω 2 , p < 0.05; Wald’s test, p < 0.05). The resulting vaccine readiness score was strongly associated with vaccine intentionality (acceptance vs. indecision: β HCW = 2.93, β Parents = 2.41, β Adolescents = 1.34; refusal vs. indecision: β HCW = − 1.68, β Parents = − 0.16, β Adolescents = − 0.89.). The addition of confidence in the system and social conformism among antecedents of vaccine acceptance allowed a finer understanding of the continuum moving from refusal to indecision and acceptance. To work with these antecedents in interventional research, appropriate questionnaire items should be developed for various vaccines and target populations.