Publications by authors named "Emmanuel Rusch"

38 Publications

Health democracy in time of COVID-19: a perspective from France.

Lancet Public Health 2021 04;6(4):e201

Conférence Nationale de Santé, Paris, France; Université Tours, Education Éthique Santé, Tours, France.

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http://dx.doi.org/10.1016/S2468-2667(21)00053-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7993937PMC
April 2021

The oral health of individuals with schizophrenia: A major public health problem.

Spec Care Dentist 2021 05 29;41(3):327-328. Epub 2021 Jan 29.

Department of Odontology, Tours University Hospital, Tours, France.

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http://dx.doi.org/10.1111/scd.12576DOI Listing
May 2021

Consommation de soins dentaires préventifs en région Centre-Val de Loire : une étude rétrospective.

Sante Publique 2020 Jun;Vol. 32(1):87-95

Context: The demography of dentist-surgeons in the Centre-Val de Loire region is far inferior to the national average and characterized by many territorial inequalities of health. The aim of this study is to provide details concerning the dental hygienic care-seeking consumption habits in this region based on one dental care treatment, dental scaling, which allows for the mechanical elimination of dental plaque in order to prevent periodontal diseases.

Method: This retrospective study is based on data from several databases of the National Health Insurance Cross-Schemes Information System (Sniiram) for the year 2016, analyzed by the Statistical Institute of Liberal Health Professionals.

Results: It can be observed that less scaling treatments have been sought out in this region in comparison with metropolitan France and certain territories which also face difficulties in terms of care treatment offers and scaling treatment inferior to the regional average. Although the care offer is unequally distributed, it seems to have little influence on the number of treatment acts consumed per patient and notably scaling treatments. Inversely, indicators of wealth or poverty do have an impact on treatment consumption HBJD001.

Conclusion: This study suggests that the consumption of scaling treatment is independent from the dental care offers, but linked to the social gradient of the population. It points to the deficit in the consumption of this treatment in comparison to metropolitan France. The potential role of the HBJD001 treatment as a marker of the trajectory of preventive health care as well as the necessity of the adjustment of the zones determined by the ARS are put forward.
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http://dx.doi.org/10.3917/spub.201.0087DOI Listing
June 2020

Switching to Single-use Flexible Ureteroscopes for Stones Management: Financial Impact and Solutions to Reduce the Cost Over a 5-Year Period.

Urology 2020 Sep 12;143:68-74. Epub 2020 Jun 12.

Health-economic Evaluation Unit, University Hospital of Tours, France; EA 7505 Education, Ethics, Health, University of Tours, France. Electronic address:

Objectives: To assess the financial impact of switching to single-use ureteroscopes (sURS) in urolithiasis management for a hospital, over a 5-year period, and to identify possible solutions to contain or reduce it.

Methods: A Budget Impact (BI) model was designed for a public hospital performing around 200 ureteroscopies or extracorporeal shockwave lithotripsies per year. The BI was estimated as the difference between financial balances (between costs and revenues) of 2 environments (with and without sURS). The population was defined as adults treated for urolithiasis. The BI model was based on assumptions about the expected progression in the incidence of urolithiasis, and the expected change in clinical practices due to the availability of sURS. We considered the costs and revenues of hospital stays, the purchase price of sURS and the costs of digital or fiberoptic reusable ureteroscopes (rURS). Univariate and multivariate sensitivity analyses were performed.

Results: The cumulative 5-year financial impact of switching completely to sURS was €807,824 and €649,677 in comparison with fiberoptic and digital rURS respectively. This impact could be reduced by half or more if the health-care facility were to adopt different solutions, including negotiating the purchase price of sURS, developing outpatient activity and reducing production costs for ureteroscopy procedures.

Conclusion: The BI model gives decision-makers a more accurate picture of the financial impact of switching to sURS and highlights ways to reduce the expected additional cost.
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http://dx.doi.org/10.1016/j.urology.2020.05.062DOI Listing
September 2020

Oral health treatment habits of people with schizophrenia in France: A retrospective cohort study.

PLoS One 2020 9;15(3):e0229946. Epub 2020 Mar 9.

Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France.

Objective: To identify the differences between persons with schizophrenia (PWS) and general population in France in terms of oral health treatment (tooth scaling, dental treatment and tooth extraction) and the factors associated with these differences.

Methods: This retrospective cohort study included PWS identified from a representative sample of 1/97th of the French population (general sample of beneficiaries). PWS were identified from 2014 data by an algorithm that included: F2 diagnostic codes in the register of long-term diseases in 2014 AND {(at least three deliveries of antipsychotics in 2014) OR (F20 diagnostic codes as a main or associated diagnosis in hospital discharge abstracts in 2012 or 2013 (hospital data for medicine, surgery and obstetrics)}. Follow-up dental care was explored for all people over a period of 3 years (2014 to 2017).

Results: In 2014, 580,219 persons older than 15 years were identified from the 96 metropolitan departments in France; 2,213 were PWS (0.4%). Fewer PWS were found along a diagonal line from north-east to south-west France, and the highest numbers were located in urban departments. PWS were more often male (58.6% vs 48.7%, p<0.001). They were less likely to have had tooth scaling but more likely to have undergone a dental extraction. In one third of departments, more than 50% of PWS had at least one tooth scaling over a three-year period; the rate of dental extraction in these departments ranged from 6 to 23%. Then, a quarter of the departments in which 40 to 100% of PWS had had at least one dental extraction (2/8) presented a rate of tooth scaling ranging from 0 to 28% over the study period.

Conclusions: Compared with the general population, PWS were less likely to have had tooth scaling and dental treatment but more likely to have undergone dental extraction.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0229946PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7062238PMC
June 2020

[Total denial of pregnancy and childbirth: The death of the newborn is not criminal].

Presse Med 2019 Dec 19;48(12):1580-1582. Epub 2019 Nov 19.

CHU d'Amiens, 80054 Amiens cedex, France. Electronic address:

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http://dx.doi.org/10.1016/j.lpm.2019.09.055DOI Listing
December 2019

[Knowledge, attitudes and practices of parents on vaccination against polio in Abeche-Tchad].

Pan Afr Med J 2018 4;31:219. Epub 2018 Dec 4.

Laboratoire de Santé Publique, EE1 EES, Université François Rabelais, Tours, France.

Introduction: in Chad, transmission of poliovirus has been interrupted in 2000, but imports from Nigeria and weakness of vaccination coverage are a major risk of disease reactivation. This study aims to investigate knowledge, attitudes and practices of parents of children aged 0 to 5 years on vaccination against polio in Chad.

Methods: this cross-sectional study was carried out in the six districts of Abéché. Only households who had children under 5 years of age were included. Data were collected through interviews with parents and guardians of eligible children using a tested and validated questionnaire.

Results: we interviewed 210 households. No family had a vaccination record notebook of their children. However, 97% reported vaccinated children who had participated in mass vaccination campaigns. About 97% were aware of poliomyelitis disease and 98% knew vaccination campaign. The most cited channels of information were radio (98%) and vaccinators (72%). Only 3% of parents reported refusing vaccination. There was an association between the negative influence of the relatives and the non-vaccination of children (p = 0.005).

Conclusion: disease and vaccine knowledge is good in Chad despite the existence of rumours about, in particular, vaccine effects. The lack of immunization cards limited the analysis of survey results which were only declarative with a very high declared vaccination rate. Immunization cards are essential for eradication in association with prevention policy.
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http://dx.doi.org/10.11604/pamj.2018.31.219.12966DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6693789PMC
September 2019

Etiology and Outcomes of Thrombotic Microangiopathies.

Clin J Am Soc Nephrol 2019 04 12;14(4):557-566. Epub 2019 Mar 12.

Service de Néphrologie-hypertension, Dialyses, Transplantation Rénale, Hôpital Bretonneau et hôpital Clocheville,

Background And Objectives: Thrombotic microangiopathies constitute a diagnostic and therapeutic challenge. Secondary thrombotic microangiopathies are less characterized than primary thrombotic microangiopathies (thrombotic thrombocytopenic purpura and atypical hemolytic and uremic syndrome). The relative frequencies and outcomes of secondary and primary thrombotic microangiopathies are unknown.

Design, Setting, Participants, & Measurements: We conducted a retrospective study in a four-hospital institution in 564 consecutive patients with adjudicated thrombotic microangiopathies during the 2009-2016 period. We estimated the incidence of primary and secondary thrombotic microangiopathies, thrombotic microangiopathy causes, and major outcomes during hospitalization (death, dialysis, major cardiovascular events [acute coronary syndrome and/or acute heart failure], and neurologic complications [stroke, cognitive impairment, or epilepsy]).

Results: We identified primary thrombotic microangiopathies in 33 of 564 patients (6%; thrombotic thrombocytopenic purpura: 18 of 564 [3%]; atypical hemolytic and uremic syndrome: 18 of 564 [3%]). Secondary thrombotic microangiopathies were found in 531 of 564 patients (94%). A cause was identified in 500 of 564 (94%): pregnancy (35%; 11 of 1000 pregnancies), malignancies (19%), infections (33%), drugs (26%), transplantations (17%), autoimmune diseases (9%), shiga toxin due to (6%), and malignant hypertension (4%). In the 31 of 531 patients (6%) with other secondary thrombotic microangiopathies, 23% of patients had sickle cell disease, 10% had glucose-6-phosphate dehydrogenase deficiency, and 44% had folate deficiency. Multiple causes of thrombotic microangiopathies were more frequent in secondary than primary thrombotic microangiopathies (57% versus 19%; <0.001), and they were mostly infections, drugs, transplantation, and malignancies. Significant differences in clinical and biologic differences were observed among thrombotic microangiopathy causes. During the hospitalization, 84 of 564 patients (15%) were treated with dialysis, 64 of 564 patients (11%) experienced major cardiovascular events, and 25 of 564 patients (4%) had neurologic complications; 58 of 564 patients (10%) died, but the rates of complications and death varied widely by the cause of thrombotic microangiopathies.

Conclusions: Secondary thrombotic microangiopathies represent the majority of thrombotic microangiopathies. Multiple thrombotic microangiopathies causes are present in one half of secondary thrombotic microangiopathies. The risks of dialysis, neurologic and cardiac complications, and death vary by the cause of thrombotic microangiopathies.
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http://dx.doi.org/10.2215/CJN.11470918DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6450353PMC
April 2019

[Prevalence and risk markers of anxiety and depression among health students].

Presse Med 2019 Feb 13;48(2):100-108. Epub 2019 Feb 13.

CHRU de Tours, laboratoire de santé publique, 37000 Tours, France; Université de Tours, faculté de médecine, équipe « Éducation, éthique, santé » (EA 7505), 37000 Tours, France; Université de Tours, faculté de médecine, 37000 Tours, France.

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http://dx.doi.org/10.1016/j.lpm.2019.01.002DOI Listing
February 2019

Telerehabilitation for Stroke Survivors: Systematic Review and Meta-Analysis.

J Med Internet Res 2018 10 26;20(10):e10867. Epub 2018 Oct 26.

Service d'Information Médicale, Epidémiologie et Economie de la Santé, Centre Hospitalier Régional Universitaire de Tours, Tours, France.

Background: Telerehabilitation is an emerging technology through which medical rehabilitation care can be provided from a distance.

Objective: This systematic review and meta-analysis aims to investigate the efficacy of telerehabilitation in poststroke patients.

Methods: Eligible randomized controlled trials (RCTs) were identified by searching MEDLINE, Cochrane Central, and Web of Science databases. Continuous data were extracted for relevant outcomes and analyzed using the RevMan software as the standardized mean difference (SMD) and 95% CI in a fixed-effect meta-analysis model.

Results: We included 15 studies (1339 patients) in our systematic review, while only 12 were included in the pooled analysis. The combined effect estimate showed no significant differences between the telerehabilitation and control groups in terms of the Barthel Index (SMD -0.05, 95% CI -0.18 to 0.08), Berg Balance Scale (SMD -0.04, 95% CI -0.34 to 0.26), Fugl-Meyer Upper Extremity (SMD 0.50, 95% CI -0.09 to 1.09), and Stroke Impact Scale (mobility subscale; SMD 0.18, 95% CI -0.13 to 0.48]) scores. Moreover, the majority of included studies showed that both groups were comparable in terms of health-related quality of life (of stroke survivors), Caregiver Strain Index, and patients' satisfaction with care. One study showed that the cost of telerehabilitation was lower than usual care by US $867.

Conclusions: Telerehabilitation can be a suitable alternative to usual rehabilitation care in poststroke patients, especially in remote or underserved areas. Larger studies are needed to evaluate the health-related quality of life and cost-effectiveness with the ongoing improvements in telerehabilitation networks.
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http://dx.doi.org/10.2196/10867DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6250558PMC
October 2018

Clinical Effectiveness of Telemedicine in Diabetes Mellitus: A Meta-Analysis of 42 Randomized Controlled Trials.

Telemed J E Health 2019 07 20;25(7):569-583. Epub 2018 Aug 20.

2 CHU de Tours-SIMEES-Medico-Economic Evaluation Unit, Tours Area, France.

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http://dx.doi.org/10.1089/tmj.2018.0128DOI Listing
July 2019

Consensus study to define appropriate inaction and inappropriate inertia in the management of patients with hypertension in primary care.

BMJ Open 2018 07 30;8(7):e020599. Epub 2018 Jul 30.

Department of Primary and Interdisciplinary Care, University of Antwerp, Wilrijk, Belgium.

Objectives: To elaborate and validate operational definitions for appropriate inaction and for inappropriate inertia in the management of patients with hypertension in primary care.

Design: A two-step approach was used to reach a definition consensus. First, nominal groups provided practice-based information on the two concepts. Second, a Delphi procedure was used to modify and validate the two definitions created from the nominal groups results.

Participants: 14 French practicing general practitioners participated in each of the two nominal groups, held in two different areas in France. For the Delphi procedure, 30 academics, international experts in the field, were contacted; 20 agreed to participate and 19 completed the procedure.

Results: Inappropriate inertia was defined as: to not initiate or intensify an antihypertensive treatment for a patient who is not at the blood pressure goals defined for this patient in the guidelines when all following conditions are fulfilled: (1) elevated blood pressure has been confirmed by self-measurement or ambulatory blood pressure monitoring, (2) there is no legitimate doubt on the reliability of the measurements, (3) there is no observance issue regarding pharmacological treatment, (4) there is no specific iatrogenic risk (which alters the risk-benefit balance of treatment for this patient), in particular orthostatic hypotension in the elderly, (5) there is no other medical priority more important and more urgent, and (6) access to treatment is not difficult. Appropriate inaction was defined as the exact mirror, that is, when at least one of the above conditions is not met.

Conclusion: Definitions of appropriate inaction and inappropriate inertia in the management of patients with hypertension have been established from empirical practice-based data and validated by an international panel of academics as useful for practice and research.
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http://dx.doi.org/10.1136/bmjopen-2017-020599DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6067345PMC
July 2018

[African community empowerment approach to diagnosis in Health Care in two countries: Guinea Conakry and Congo Brazzaville].

Pan Afr Med J 2017 28;28:276. Epub 2017 Nov 28.

CHRU de Tours, Département de Santé Publique et d'Information Médicale, Equipe Emergente 'Education Ethique Santé', Tours Cedex 9, France.

Background: After immigration to France, the populations of Sub-Saharan Africa have often maintained their traditional lifestyles, this is why housing policies have been promoting their clustering in priority neighborhoods. Discussing issues about health promotion, requires to investigate health policies in their countries of origin.

Method: For this, we (i) organized brainstorming sessions with a group of 16 persons resident in France who were involved in a process of empowerment strengthening of community health programs in order to make them understood the incentives and the obstacles in health care in their countries of origin. We also (ii) collected literature data prior to undertake several trips to Guinea and Congo, in order to compare literature data with those of these countries.

Result: The result concerning health promotion in these countries allowed the identification of measures to be put in place. Among them, the facilitation of accessing to community health programs, basing on successful experiences, with the prospect of transferring them to France for migrants. These measures are based on the involvement of the institutional actors and of the populations in educational approaches to health behavior change.

Conclusion: "Territorial" diagnosis allows to emphasize the importance of the influence of health environment in the country of origin on subsequent behaviours. Moreover, it allows to highlight solutions that can promote harmonization of African community health in France.
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http://dx.doi.org/10.11604/pamj.2017.28.276.14098DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5989178PMC
June 2018

Promoting public health in nutrition: Nutri-Score and the tug of war between public health and the food industry.

Eur J Public Health 2018 06;28(3):396-397

Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre de Recherche en Epidémiologie et Biostatistiques Sorbonne Paris Cité-CRESS UMR1153 Inserm, U1125 INRA, CNAM, Université Paris 13, Bobigny, France.

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http://dx.doi.org/10.1093/eurpub/cky037DOI Listing
June 2018

Cost of diabetic foot in France, Spain, Italy, Germany and United Kingdom: A systematic review.

Ann Endocrinol (Paris) 2018 Apr 12;79(2):67-74. Epub 2018 Mar 12.

Regional unit of hôpital épidémiologie, université François-Rabelais, 37000 Tours, France; EES Interdisciplinary Research Unit (Health Education & Ethics), François-Rabelais University of Tours, France.

Aim: Cost estimates for diabetic foot are available for developed countries based on cost data for different years. This study aimed to provide a comparison of the cost of diabetic foot in E5 (France, Spain, Italy, Germany, and the United Kingdom) and its characteristics across different conditions.

Methods: PubMed, Central and Embase databases were searched in February 2017 for English language publications. Bibliographies of relevant papers were also searched manually. Reviews and research papers from E5 regions reporting on cost of diabetic foot were included. Reported cost was converted to equivalent 2016 $ for comparison purposes. All the costs presented are mean cost per patient per year in 2016 $.

Results: Nine studies were included in the analysis. The total cost of amputation ranged from $ 15,046 in 2001 to $ 38,621 in 2005. The direct cost of amputation ranged from $ 13,842 in 2001 to $ 83,728 during 2005-2009. Indirect cost of amputation was more uniform, ranging from between $ 1,043 to $ 1,442. The direct cost of gangrene ranged from $ 3,352 in 2003 to $ 8,818 in Germany. Although, for the same year, 2003, the cost for Spain was almost double that for Germany. The total cost of an uninfected ulcer was $ 6,174 in 2002, but increased to $ 14,441 in 2005; for an infected ulcer the cost increased from $ 2,637 to $ 2,957. The different countries showed variations in the components used to calculate the cost of diabetic foot.

Conclusions: The E5 incurs a heavy cost from diabetic foot and its complications. There is an unmet need for the identification of cost-cutting strategies, as diabetic foot costs more than major cardiac diseases.
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http://dx.doi.org/10.1016/j.ando.2017.11.005DOI Listing
April 2018

[Community health and interculturality].

Rev Infirm 2018 Mar;67(239):30-32

CHRU de Tours, Département de santé publique et d'information médicale, équipe émergente 'éducation éthique santé', 37044 Tours cedex 9, France.

An interventional research study in public health was carried out with populations originating from sub-Saharan Africa living in France. With the aim of acting on health inequalities through health education, the researchers focused notably on the links between intercultural relationships and the improvement of health promotion actions.
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http://dx.doi.org/10.1016/j.revinf.2018.01.007DOI Listing
March 2018

Telemedicine in Diabetic Foot Care: A Systematic Literature Review of Interventions and Meta-analysis of Controlled Trials.

Int J Low Extrem Wounds 2017 Dec 23;16(4):274-283. Epub 2017 Nov 23.

4 Unité de recherche interdisciplinaire EES, Éducation Éthique Santé, ESS, Université François-Rabelais de Tours, France.

The care of individuals with diabetic foot ulcers is costly and requires multiple hospital visits. Inadequate care leads to serious complications and a high risk of lower extremity amputation. In this review, we aimed at evaluating whether telemedicine can be effective in diabetic foot patient care. We searched Medline through Embase and PubMed and Cochrane Central Register of Controlled Trials (CENTRAL) for relevant studies, published up to April 2017. The studies were summarized and discussed in a narrative method and a meta-analysis of 2 controlled trials was conducted using the fixed-effects model. The main outcomes, assessed in the retrieved studies were the healing rate and satisfaction of patients and health care personnel. Most of the studies showed that implementing telemonitoring programs increased the rate of complete ulcer healing, while the patients were highly satisfied. Two trials providing data on 213 patients on telemedicine and 301 patients on usual care were included for meta-analysis. Subjects in telemedicine, as well as control groups had statistically similar healing time (43 vs 45 days; P = .83), healing time ratio adjusted for age (1 vs 1.4; P = .1), unhealed ulcers or loss to follow-up (3 of 20 vs 7 of 120; P = .13), and amputations (12 of 193 vs 14 of 182; P = .59). Subjects in the telemedicine group experienced a significantly higher mortality rate (8 of 193 vs 1 of 181; P = .0001) due to unexplained factors. No adverse events were attributed to using the telemedicine technology. The odds of complete ulcer healing were statistically similar between the telemedicine group and controls (odds ratio = 0.86; 95% CI = 0.57-1.33; P = .53). Telemedicine care is promising for the management of diabetic foot patients as the results were comparable with usual care. However, further large-scale studies need to be undertaken before it can be implemented widely.
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http://dx.doi.org/10.1177/1534734617739195DOI Listing
December 2017

Relationships between work-related characteristics, needs satisfaction, motivation and mental health in midwifery students.

Psychol Health Med 2017 07 16;22(6):711-718. Epub 2016 Aug 16.

e Department of Public Health and Medical Information , CHRU de Tours, Team Emerging 'Education Ethics Health' , Tours , France.

The present study examined the relationships between work-related characteristics in internships, psychological needs satisfaction, motivation and mental health using a partial least squares path modeling. Midwifery students (N = 214; M = 22.8 years) from three French schools completed different questionnaires online. Results showed (1) the importance of work resources (work control and social support) as protective factors of psychological needs satisfaction; and (2) the role of competence need satisfaction through motivation in the relationships between work resources and mental health. Midwifery schools should pay more attention to these two results, and take them into account in midwifery students' training.
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http://dx.doi.org/10.1080/13548506.2016.1220597DOI Listing
July 2017

General practitioners' justifications for therapeutic inertia in cardiovascular prevention: an empirically grounded typology.

BMJ Open 2016 May 13;6(5):e010639. Epub 2016 May 13.

Department of Primary and Interdisciplinary Care, University of Antwerp. Campus Drie Eiken, Antwerpen, Belgium.

Objective: To construct a typology of general practitioners' (GPs) responses regarding their justification of therapeutic inertia in cardiovascular primary prevention for high-risk patients with hypertension.

Design: Empirically grounded construction of typology. Types were defined by attributes derived from the qualitative analysis of GPs' reported reasons for inaction.

Participants: 256 GPs randomised in the intervention group of a cluster randomised controlled trial.

Setting: GPs members of 23 French Regional Colleges of Teachers in General Practice, included in the EffectS of a multifaceted intervention on CArdiovascular risk factors in high-risk hyPErtensive patients (ESCAPE) trial.

Data Collection And Analysis: The database consisted of 2638 written responses given by the GPs to an open-ended question asking for the reasons why drug treatment was not changed as suggested by the national guidelines. All answers were coded using constant comparison analysis. A matrix analysis of codes per GP allowed the construction of a response typology, where types were defined by codes as attributes. Initial coding and definition of types were performed independently by two teams.

Results: Initial coding resulted in a list of 69 codes in the final codebook, representing 4764 coded references in the question responses. A typology including seven types was constructed. 100 GPs were allocated to one and only one of these types, while 25 GPs did not provide enough data to allow classification. Types (numbers of GPs allocated) were: 'optimists' (28), 'negotiators' (20), 'checkers' (15), 'contextualisers' (13), 'cautious' (11), 'rounders' (8) and 'scientists' (5). For the 36 GPs that provided 50 or more coded references, analysis of the code evolution over time and across patients showed a consistent belonging to the initial type for any given GP.

Conclusion: This typology could provide GPs with some insight into their general ways of considering changes in the treatment/management of cardiovascular risk factors and guide design of specific physician-centred interventions to reduce inappropriate inaction.

Trial Registration Number: NCT00348855.
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http://dx.doi.org/10.1136/bmjopen-2015-010639DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4874143PMC
May 2016

[Community-based screening: a motivating experience for drug users].

Sante Publique 2015 Sep-Oct;27(5):633-9

Objectives: Hepatitis C virus infection (HCV) is a major public health problem among drug users. Screening for hepatitis C virus in this population is complicated. The aim of the study was to describe a community-based screening experience conducted by the Tours university hospital addiction medicine team.

Methods: Between 2008 and 2010, a free 14-day HCV, hepatitis B virus (HBV) and HIV community-based screening programme was conducted by the addiction medicine and prevention team. A questionnaire collected the main risk factors for transmission of these viruses and the subject's viral serology status.

Results: 76% of the 219 screened subjects reported being drug users. HCV prevalence was 20%. Risk factors for HCV infection were exclusive intravenous use and the use of several routes of administration. Among the 30 HCV patients with positive RNA, 83% were followed up.

Conclusions: The prevalence of HCV infection was similar to that reported in the literature for drug users, whereas the number of patients treated and followed up was higher than in the literature. A community-based screening experience facilitated initiation and follow-up of medical care.
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March 2016

Personality disorders, but not cancer severity or treatment type, are risk factors for later generalised anxiety disorder and major depressive disorder in non metastatic breast cancer patients.

Psychiatry Res 2016 Feb 25;236:64-70. Epub 2015 Dec 25.

CHRU de Tours, Clinique Psychiatrique Universitaire, 2 Boulevard Tonnellé, 37042 Tours Cedex 9, France; UMR INSERM U930, 2 boulevard Tonnellé, 37044 Tours Cedex, France; Université François Rabelais de Tours, 3 rue des Tanneurs BP 4103, 37041 Tours Cedex 1, France.

This study aimed to determine whether personality disorders were associated with later Major Depressive Disorder (MDD) or Generalised Anxiety Disorder (GAD) in breast cancer patients. This longitudinal and multicentric study included 120 French non-metastatic breast cancer patients. After cancer diagnosis (T1) and 7 months after diagnosis (T3), we assessed MDD and GAD (Mini International Neuropsychiatric Interview 5.0). We assessed personality disorders 3 months after diagnosis (VKP). We used multiple logistic regression analysis to determine what were the factors associated with GAD and MDD at T3. At T3, prevalence rate was 10.8% for MDD and 19.2% for GAD. GAD at T3 was significantly and independently associated with GAD at T1 and with existence of a personality disorder, no matter the cluster type. MDD at T3 was significantly and independently associated with MDD at T1 and with the existence of a cluster C personality disorder. Initial cancer severity and the type of treatment used were not associated with GAD or MDD at T3. Breast cancer patients with personality disorders are at higher risk for GAD and MDD at the end of treatment. Patients with GAD should be screened for personality disorders. Specific interventions for patients with personality disorders could prevent psychiatric disorders.
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http://dx.doi.org/10.1016/j.psychres.2015.12.032DOI Listing
February 2016

Major depressive disorder, personality disorders, and coping strategies are independent risk factors for lower quality of life in non-metastatic breast cancer patients.

Psychooncology 2016 May 10;25(5):513-20. Epub 2015 Sep 10.

Clinique Psychiatrique Universitaire, CHRU de Tours, Tours, France.

Objective: Our aim was to identify risk factors for lower quality of life (QOL) in non-metastatic breast cancer patients.

Methods: Our study included 120 patients from the University Hospital Centers of Tours and Poitiers. This cross-sectional study was conducted 7 months after patients' breast cancer diagnosis and assessed QOL (Quality of Life Questionnaire Core 30 = QLQ-C30), socio-demographic characteristics, coping strategies (Brief-COPE), physiological and biological variables (e.g., initial tumor severity and types of treatment received), the existence of major depressive disorder (Mini International Neuropsychiatric Interview), and pain severity (Questionnaire de Douleur Saint Antoine). We assessed personality disorders 3 months after diagnosis (Vragenlijst voor Kenmerken van de Persoonlijkheid questionnaire). We used multiple linear regression models to determine which factors were associated with physical, emotional, and global QOL.

Results: Lower physical QOL was associated with major depressive disorder, younger age, a more severe initial tumor stage, and the use of the behavioral disengagement coping. Lower emotional QOL was associated with major depressive disorder, the existence of a personality disorder, a more severe pain level, higher use of self-blame, and lower use of acceptance coping strategies. Lower global QOL was associated with major depressive disorder, the existence of a personality disorder, a more severe pain level, higher use of self-blame, lower use of positive reframing coping strategies, and an absence of hormone therapy.

Conclusions: Lower QOL scores were more strongly associated with variables related to the individual's premorbid psychological characteristics and the manner in which this individual copes with the cancer (e.g., depression, personality, and coping) than to cancer-related variables (e.g., treatment types and cancer severity). Copyright © 2015 John Wiley & Sons, Ltd.
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http://dx.doi.org/10.1002/pon.3947DOI Listing
May 2016

Support for the usefulness of passive postdischarge surveillance in surgical site infection.

Am J Infect Control 2015 09 29;43(9):1023-4. Epub 2015 Jul 29.

Centre de coordination pour la lutte contre les infections associées aux soins (C-CLIN), Paris, France.

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http://dx.doi.org/10.1016/j.ajic.2015.05.048DOI Listing
September 2015

Surgical site infection after primary hip and knee arthroplasty: a cohort study using a hospital database.

Infect Control Hosp Epidemiol 2015 Oct 8;36(10):1198-207. Epub 2015 Jul 8.

5Ecole des Hautes Etudes en Santé Publique & Centre de coordination pour la lutte contre les infections associées aux soins,Paris,France.

Background: Hip or knee arthroplasty infection (HKAI) leads to heavy medical consequences even if rare.

Objective: To assess the routine use of a hospital discharge detection algorithm of prosthetic joint infection as a novel additional tool for surveillance.

Methods: A historic 5-year cohort study was built using a hospital database of people undergoing a first hip or knee arthroplasty in 1 French region (2.5 million inhabitants, 39 private and public hospitals): 32,678 patients with arthroplasty code plus corresponding prosthetic material code were tagged. HKAI occurrence was then tracked in the follow-up on the basis of a previously validated algorithm using International Statistical Classification of Disease, Tenth Revision, codes as well as the surgical procedures coded. HKAI density incidence was estimated during the follow-up (up to 4 years after surgery); risk factors were analyzed using Cox regression.

Results: A total of 604 HKAI patients were identified: 1-year HKAI incidence was1.31%, and density incidence was 2.2/100 person-years in hip and 2.5/100 person-years in knee. HKAI occurred within the first 30 days after surgery for 30% but more than 1 year after replacement for 29%. Patients aged 75 years or older, male, or having liver diseases, alcohol abuse, or ulcer sore had higher risk of infection. The inpatient case fatality in HKAI patients was 11.4%.

Conclusions: The hospital database method used to measure occurrence and risk factors of prosthetic joint infection helped to survey HKAI and could optimize healthcare delivery.
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http://dx.doi.org/10.1017/ice.2015.148DOI Listing
October 2015

Clinical and economic outcomes of infective endocarditis.

Infect Dis (Lond) 2015 Feb 26;47(2):80-7. Epub 2014 Nov 26.

From the Service de Médecine Interne et Maladies Infectieuses , CHRU de Tours, Tours , France.

Background: In France, the estimated annual incidence of infective endocarditis (IE) is 33.8 cases per million residents. Valvular surgery is frequently undergone. We report an epidemiological and economic study of IE for 2007-2009 in a French region, using the hospital discharge database (HDD).

Methods: The population studied concerned all the patients living in Centre region, France, hospitalized for IE. We extracted hospital stay data for IE from the regional HDD, with a definition based on IE-related diagnosis codes. The predictive positive value (PPV) and sensitivity (Se) of the definition were 87.4% and 90%, respectively, according to the Duke criteria (definite IE frequency 74.4%). Hospitalization costs were estimated, taking into account the fixed hospital charges of the diagnosis-related group (DRG) and supplementary charges due to intensive care unit (ICU) stay.

Results: The analysis included 578 patients. The annual average incidence was 45.4 cases per million residents. Valvular surgery was performed in 19.4% of cases. The hospital mortality was 17.6%. Multivariate analysis identified as risk factors for mortality an age ≥ 70 years (odds ratio (OR) = 3.03, 95% confidence interval (CI) = 1.78-5.18), staphylococcal IE (OR = 3.3, 95% CI = 1.9-5.7), chronic renal insufficiency (OR = 2.04, 95% CI = 1.00-4.15), ischemic stroke (OR = 2.55, 95% CI = 1.19-5.47), and hemorrhagic stroke (OR = 5.7, 95% CI = 1.9-17.3). The average cost per episode was $20 103 (€15 281).

Conclusions: We report a higher incidence of IE than described by the French national study of 2008. Valvular surgery was considerably less frequent than in the published data, whereas mortality was similar. IE generates substantial costs.
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http://dx.doi.org/10.3109/00365548.2014.968608DOI Listing
February 2015

Management of osteoporosis in women after forearm fracture: data from a French health insurance database.

Joint Bone Spine 2015 Jan 17;82(1):52-5. Epub 2014 Sep 17.

Université François-Rabelais de Tours, 37000 Tours, France. Electronic address:

Introduction: Despite reliable diagnostic methods and effective drugs, the prevention and management of osteoporosis seems insufficient in France. We evaluated bone mineral density (BMD) assessment and prescription of anti-osteoporotic drugs after forearm fracture in women.

Methods: We used a health insurance database for outpatients from private clinics in a French population of more than 500,000 inhabitants. Medical expenses were analyzed for women 50 years of age or older who had a forearm fracture between August 1, 2010 and June 30, 2012.

Results: We identified 250 forearm fractures in women during the study period. In total, 12 women (4.8%) underwent BMD assessment before the fracture and were not taken into account in the analysis. For the 238 others, 24 (10.1%) had undergone BMD assessment at a median of 4 months after the fracture. A total of 32 women (13.4%) received an anti-osteoporotic drug at the time of the fracture and 14 of 206 untreated women (6.8%) received an anti-osteoporotic drug at a median of 3.8 months after the fracture. Receipt of an anti-osteoporotic drug was more frequent for women with than without BMD assessment after the fracture (8/19 [40.1%] versus 6/187 [3.2%]; P<0.005).

Conclusion: This work, performed in a large sample, suggests that only 10% of women 50 years of age or older in France undergo BMD assessment after a forearm fracture and that BMD assessment is associated with anti-osteoporotic drug prescription.
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http://dx.doi.org/10.1016/j.jbspin.2014.07.007DOI Listing
January 2015

The concept and definition of therapeutic inertia in hypertension in primary care: a qualitative systematic review.

BMC Fam Pract 2014 Jul 2;15:130. Epub 2014 Jul 2.

Department of General Practice, EES, University of Tours, 10 Boulevard Tonnellé, BP 3223, 37032 Tours, Cedex 1, France.

Background: Therapeutic inertia has been defined as the failure of health-care provider to initiate or intensify therapy when therapeutic goals are not reached. It is regarded as a major cause of uncontrolled hypertension. The exploration of its causes and the interventions to reduce it are plagued by unclear conceptualizations and hypothesized mechanisms. We therefore systematically searched the literature for definitions and discussions on the concept of therapeutic inertia in hypertension in primary care, to try and form an operational definition.

Methods: A systematic review of all types of publications related to clinical inertia in hypertension was performed. Medline, EMbase, PsycInfo, the Cochrane library and databases, BDSP, CRD and NGC were searched from the start of their databases to June 2013. Articles were selected independently by two authors on the basis of their conceptual content, without other eligibility criteria or formal quality appraisal. Qualitative data were extracted independently by two teams of authors. Data were analyzed using a constant comparative qualitative method.

Results: The final selection included 89 articles. 112 codes were grouped in 4 categories: terms and definitions (semantics), "who" (physician, patient or system), "how and why" (mechanisms and reasons), and "appropriateness". Regarding each of these categories, a number of contradictory assertions were found, most of them relying on little or no empirical data. Overall, the limits of what should be considered as inertia were not clear. A number of authors insisted that what was considered deleterious inertia might in fact be appropriate care, depending on the situation.

Conclusions: Our data analysis revealed a major lack of conceptualization of therapeutic inertia in hypertension and important discrepancies regarding its possible causes, mechanisms and outcomes. The concept should be split in two parts: appropriate inaction and inappropriate inertia. The development of consensual and operational definitions relying on empirical data and the exploration of the intimate mechanisms that underlie these behaviors are now needed.
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http://dx.doi.org/10.1186/1471-2296-15-130DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4094689PMC
July 2014