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    • Convincing vaccine hesitant patients to be vaccinated requir

    2018-10-23

    Convincing vaccine-hesitant patients to be vaccinated requires a response to GPs\' VH. Necessary steps include both better training and updating of GPs\' knowledge of vaccines\' benefits and risks: more time must be devoted to find more information during medical studies than is currently spent. Training should also aim at improving GPs\' skills for communicating with vaccine-hesitant or reluctant patients. Initiatives such as the guide “Let\'s talk about protection” can build the foundations for developing such approaches, but they have not been offered to doctors in the field of vaccination in France, as they have been elsewhere (European Centre for Disease Prevention and Control, 2012). However, these training tools and methods should also be evaluated for effectiveness. Finally, GPs and other doctors need supporting tools that provide them with arguments to respond to allegations on the Internet or in the news media: these tools should be regularly updated to new perceptions and rumors. This would require the permanent monitoring of various media, an approach that already exists in various fields due to the progress of data mining technologies (Larson et al., 2013).
    Research in Context
    Conclusion Overall our findings suggest that VH is prevalent among French GPs. It may make them ill at ease in addressing their patients\' concerns about vaccination, which in turn might reinforce patients\' VH (Gowda and Dempsey, 2013). More research is warranted to assess VH among GPs and other health care workers for an extended set of vaccines, target populations, and countries. Better understanding of the determinants of VH among physicians is also necessary, in particular to assess the extent to which patients\' VH contributes to physicians\' VH (Peretti-Watel et al., 2015; McRee et al., 2014). Our findings also call for the development and evaluation of interventions and tools targeting GPs to contain and restrain their VH and help them cope with patients\' VH. GPs would benefit from tools and training focusing on communication skills to address their patients\' concerns about vaccination (European Centre for Disease Prevention and Control, 2012). Another important aspect lies in addressing their distrust of the health authorities: this is not a simple task, as it necessitates changes far beyond the vaccination field.
    Contributors
    Declaration of Interests
    Funding DREES, INPES, and IReSP.
    Acknowledgments
    Introduction With a lifetime prevalence of 16% in the United States, major depressive disorder (MDD) is one of the most common psychiatric disorders (Kessler et al., 2003). Despite the large range of available pharmacological treatments, they remain unsatisfactory because of their delayed onset of action (3–6weeks) and their partial therapeutic efficacy. Indeed, 30–40% of patients are considered to have chronic and refractory forms of MDD (Berton and Nestler, 2006). Recently, high frequency deep brain stimulation (DBS) within the subcallosal cingulate gyrus (SCG) was shown to rapidly improve depressive symptoms in refractory patients, with 60% of patients being characterized as responders, including 35% of them in total remission (Mayberg et al., 2005; Kennedy et al., 2011; Lozano et al., 2012). Despite these promising and exciting results, the neurobiological bases underlying DBS therapeutic action remain largely unknown. In rat, the anatomical connections and functional roles of the ventromedial prefrontal cortex (Gabbott et al., 2003) have led to consider this region as the equivalent of the human SCG. The stimulation of the ventromedial prefrontal cortex (vmPFC) induces antidepressant-like behavior in the forced swim test (FST) (Hamani et al., 2010), and reverses anhedonic-like behavior in animal models of depression (Hamani et al., 2012). Curiously, they found that the antidepressant-like behavioral response of DBS in the FST was unchanged after an ibotenic acid-induced neuronal lesion of the vmPFC, suggesting the involvement of “en-passant” fibers (Hamani et al., 2010) and/or glial cells.