Allocation aux adultes handicapés : pathologies et recours aux soins des bénéficiaires en 2017.

OBJECTIVE: We described the pathologies and health care utilization of beneficiaries of the general health insurance scheme via the Allocation Adulte Handicapé (AAH - Adult Disability Allowance) compared to the general population. METHOD: Mapping of pathologies and expenditures allowed the identification of 58 pathologies and chronic treatments in the SNDS, thanks to ICD-10 codes for long-term conditions or hospitalizations, specific drugs or medical procedures, among all beneficiaries of the general health insurance scheme aged 20 to 64 years with reimbursed care (>1€) in 2017. The prevalence and annual rates of care utilization among all beneficiaries of the general scheme via AAH (“AAH” group) and in the rest of the population (“non-AAH”) were standardized and described. RESULTS: Among the 793,934 (2.51% of the population) “AAH” persons, all the pathologies studied were more frequent than among the “non-AAH”, with 44% having psychiatric pathologies (compared with 3.2%), and 14% a neurological pathology (compared with 1%). AAH beneficiaries were more likely to use hospital care (63% versus 40%), but less likely to use specialist care (63% versus 68%) and dental care (37% versus 45%). CONCLUSION: The beneficiaries of the general scheme via the AAH had mainly psychiatric and neurological pathologies, but other pathologies were also much more frequent than in the general population. The lower use of dental and specialist care was probably related to a lack of access to care, potentially caused by the absence of 100% coverage of care.

Homeless Patients in the ICU: An Observational Propensity-Matched Cohort Study.

OBJECTIVE: To describe epidemiology and outcome of critically ill homeless patients, as compared with those of nonhomeless patients. DESIGN: Homeless and nonhomeless admissions were matched on the basis of a 1:4 ratio, using a propensity score-based procedure involving age, sex, date, and main diagnosis at ICU admission. SETTING: A 18-bed closed medical ICU of a French tertiary care university hospital. PATIENTS: All consecutive admissions from July 2000 to December 2012. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: There were 421 homeless and 9,353 nonhomeless admissions. Considering homeless admissions, 50% patients had no health insurance, 56% had no financial resource, 91% were socially isolated, and 69% lived in street. In a multivariable analysis of homeless admissions including age, sex, and Simplified Acute Physiology Score II, living in street was significantly associated with hospital mortality (odds ratio=2.94; 95% CI, 1.30-7.10; p=0.012). As compared with nonhomeless, homeless admissions more frequently concerned men (89% vs 57%; p<0.0001) and younger patients (49 yr [43-57] vs 62 yr [46-76]; p<0.0001), whereas Simplified Acute Physiology Score II (37 [24-50] vs 37 [25-52]; p=0.99) and distribution of the number of organ supports (p=0.49) were similar. ICU mortality concerned 19.1% and 18% of matched homeless and nonhomeless admissions, respectively. The corresponding figures for hospital mortality were 20.8% and 20.6%. In multivariable analysis, homeless status was associated with neither ICU (odds ratio=1.27 [0.92-1.73]; p=0.14) nor hospital mortality (odds ratio=1.07 [0.77-1.49]; p=0.68), while it was independently associated with longer ICU (means ratio=1.16 [1.01-1.34]; p=0.035) and hospital (means ratio=1.30 [1.12-1.49]; p=0.0002) stay of survivors. CONCLUSIONS: Critically ill homeless patients benefit from the same level of care and have globally the same prognosis than housed patients but experience longer lengths of stay. Most precarious patients living in street have a higher mortality rate. The study perspective is not ICU centered but also concerns the global organization of healthcare since homeless patients are referred by numerous sources and discharged to different wards.

Non-invasive in vivo hyperspectral imaging of the retina for potential biomarker use in Alzheimer's disease.

Studies of rodent models of Alzheimer's disease (AD) and of human tissues suggest that the retinal changes that occur in AD, including the accumulation of amyloid beta (Aß), may serve as surrogate markers of brain Aß levels. As Aß has a wavelength-dependent effect on light scatter, we investigate the potential for in vivo retinal hyperspectral imaging to serve as a biomarker of brain Aß. Significant differences in the retinal reflectance spectra are found between individuals with high Aß burden on brain PET imaging and mild cognitive impairment (n = 15), and age-matched PET-negative controls (n = 20). Retinal imaging scores are correlated with brain Aß loads. The findings are validated in an independent cohort, using a second hyperspectral camera. A similar spectral difference is found between control and 5xFAD transgenic mice that accumulate Aß in the brain and retina. These findings indicate that retinal hyperspectral imaging may predict brain Aß load.

Single-Cell Profiling Identifies Key Pathways Expressed by iPSCs Cultured in Different Commercial Media.

We assessed the pluripotency of human induced pluripotent stem cells (iPSCs) maintained on an automated platform using StemFlex and TeSR-E8 media. Analysis of transcriptome of single cells revealed similar expression of core pluripotency genes, as well as genes associated with naive and primed states of pluripotency. Analysis of individual cells from four samples consisting of two different iPSC lines each grown in the two culture media revealed a shared subpopulation structure with three main subpopulations different in pluripotency states. By implementing a machine learning approach, we estimated that most cells within each subpopulation are very similar between all four samples. The single-cell RNA sequencing analysis of iPSC lines grown in both media reports the molecular signature in StemFlex medium and how it compares to that observed in the TeSR-E8 medium.