Effect of Automobile Travel Time Between Patients' Homes and Ophthalmologists' Offices on Screening for Diabetic Retinopathy.

PURPOSE: The accessibility of ophthalmologists appears to influence the quality of screening for diabetic retinopathy (DR). The principal objective of this study was to analyze the effect of automobile travel time to the closest ophthalmologist on the time to DR screening. METHODS: This historical cohort study used reimbursement databases from the principal national health insurance fund. Patients were included if they had been reimbursed at least thrice for oral antidiabetic medications in the 12 months before the study start date. Patients were followed up from January 1, 2008, for 4 years. The expected event was a DR screening by an ocular fundus examination. The automobile travel time to the nearest ophthalmologist was calculated by the distance between communes, estimated by appropriate software. A Kaplan-Meier curve and a multivariate Cox model were used to model the effect of travel time on the time until DR screening. A sensitivity analysis of travel time described the results of the Cox model. RESULTS: At the start of 2008, 6,573 patients living in 328 different municipalities were included. The multivariate model found that patients living 60 min or more away from an ophthalmologist had a lower instantaneous probability of DR screening than those living <30 min away (adjusted risk ratio = 0.82; 95% confidence interval 0.71-0.95; p = 0.009). The sensitivity analysis showed that this difference became significant at 35 min of travel time. CONCLUSION: Increased automobile travel time for patients with diabetes to the nearest ophthalmologist was associated with a longer time to DR screening.

[Sudden death of a young man as late sequelae complicating a pediatric disease: About a case]. / Mort subite d'un homme jeune dans le cadre de séquelles tardives d'une pathologie pédiatrique : à propos d'un cas.

In France, sudden death is responsible every year for 40,000 deaths. The most frequent etiology is cardiac disease. Atheromatous-related pathology is the most common etiology beyond 35, but cardiomyopathies and channelopathies are responsible for a significant number of deaths in young adults. Some acquired disorders can also cause sudden cardiac death. We report the case of a 17-year-old man who died suddenly after sport. Autopsy and pathological study found multiple giant coronary aneurysms. Thrombosis and fibrous scar of myocardial ischemic events were observed. These lesions were in favor of late sequelae of Kawasaki disease. Kawasaki disease is a rare but not exceptional cause of sudden cardiac death in young adults. In the lack of known clinical history, some aspects, even not specific, should evoke this diagnosis. Even in front of apparent good clinical tolerance, these sequelae require appropriate follow-up because of a significant risk of sudden death.