[Feasibility and practical value of statistical matching of a general practice database and a health insurance database applied to diabetes and hypertension]. / Faisabilité et intérét de l'appariement de données individuelles en médecine générale et de données de remboursement appliqué au diabète et a l'hypertension artérielle.

OBJECTIVES: Public Health actors in France are striving to improve the use of national databases for public health and research. The main objective of this project was to develop a research tool in ambulatory care by matching medical data and reimbursement data. METHODS: Data sources were the health insurance database (SNIIRAM) and the General Practice Observatory (OMG) database. The SNIIRAM is a national medical and administrative database comprising data used in healthcare reimbursement. The OMG is a medical database on ambulatory care recording presenting complaints called "Results of Consultation" (RC). Based on data for patients who consulted one of the 30 general practitioners selected in 2008, we performed a probabilistic matching of the two databases. RESULTS: The linkage procedure allowed matching of 89,211 consultations or doctor visits and 29,088 patients. Comparison of long-term diseases (ALD) and RC showed that 94% of patients with diabetes as ALD had at least one RC coded as diabetes during the year, but only 65% of patients with one RC coded as diabetes were reported as ALD for this disease. Matching of the databases identified 12% of diabetic patients without antidiabetic treatment and without ALD for this affection; these patients were therefore not identifiable in the SNIIRAM database. CONCLUSION: This study describes an innovative database matching methodology. It also illustrates the contribution of this model of matched data in terms of targeting populations at risk. Other approaches to analysis of comorbidities, medical practices and care pathways could be proposed.

Breast Cancer Care Pathways for Women with Preexisting Severe Mental Disorders: Evidence of Disparities in France?

The excess cancer mortality in persons with severe mental illness (SMI) has been well documented, and research suggests that it may be influenced by care-related factors. Our objective was to assess breast cancer care pathways in women with SMI in France, using an exhaustive population-based data-linkage study with a matched case-control design. The cases were 1346 women with incident breast cancer in 2013/2014 and preexisting SMI who were matched with three controls without SMI presenting similar demographics, initial breast cancer type, and year of incidence. We compared cancer care pathways and their quality for cases and controls, using a consensual set of indicators covering diagnosis, treatment, follow-up, and mortality (until 2017). After adjusting for covariates, cases had lower odds to undergo the main diagnostic tests, lumpectomy, adjuvant chemotherapy, and radiotherapy, as well as hormone therapy, but higher odds for mastectomy. Suboptimal quality in cancer pathways was observed for both groups, but to a higher extent for cases, especially for not receiving timely care after diagnosis and post-treatment follow-up. Breast cancer mortality, considering competing risks of deaths, was significantly elevated in women with SMI. These findings highlight disparities in cancer care pathways for individuals with SMI, as well as specific aspects of the care continuum which could benefit from targeted actions to reach equity of outcomes.

An evaluation of five regional health information technology-based programmes to improve health and social care coordination: A quasi-experimental controlled before/after mixed design.

OBJECTIVES: Health information technology (HIT) can help coordinate health and social actors involved in patients' pathways. We assess five regional HIT-based programmes ('Territoires de Soins Numériques' or TSN) introduced in France, covering the period 2012-2018. METHODS: This was a quasi-experimental controlled before/after mixed design. We used data from the French National Health Insurance database, qualitative and quantitative surveys, and information extracted from project documents and databases. We assessed the impact of TSN using four main impact indicators: emergency room visits, unplanned hospitalizations, avoidable hospitalizations and rehospitalization within 30 days. We also collected qualitative and secondary quantitative data covering perceived needs, knowledge, use, satisfaction, adoption and understanding of projects, pathway experience, impact on professional practices and appropriateness of hospitalizations. RESULTS: TSN implemented a heterogeneous mix of HIT. Implementation was slower than expected and was not well documented. Users perceived the HIT as having a positive but weak overall effect. There were no significant differences in trends for the main impact indicators, nor on the appropriateness of hospitalizations, but favourable trends on secondary polypharmacy indicators. CONCLUSIONS: If similar innovations take place in future, they should be based on a logical framework that defines causal, measurable links between services provided and expected impacts.

Response of estuarine meio- and macrofauna to in situ bioremediation of oil-contaminated sediment.

Numerous studies have demonstrated the efficacy of bioremediation for enhancing oil removal but the ecological effect on shoreline biota is unclear. Therefore, a field experiment was designed at an intertidal sandflat in SW England to assess the effects of nutrient addition to oiled sediments on meio- and macrofauna for a period of up to 45 weeks. Natural assemblages were exposed to different types of experimental treatments (no oil, oil alone, oil treated with slow-release fertiliser or liquid fertiliser). Bioremediation stimulated the microbial population and increased oil biodegradation. This, however, did not result in faster recolonisation rates of fertilised versus non-fertilised oiled sediments. Mild effects of oil and bioremediation treatments on benthic fauna were observed, including short-term shifts in dominance patterns. Decreased abundance of dominant species in the oiled compared to unoiled sediments resulted in significantly higher evenness of benthic assemblages within the first 11 weeks of the experiment.

Bacterial community dynamics and hydrocarbon degradation during a field-scale evaluation of bioremediation on a mudflat beach contaminated with buried oil.

A field-scale experiment with a complete randomized block design was performed to study the degradation of buried oil on a shoreline over a period of almost 1 year. The following four treatments were examined in three replicate blocks: two levels of fertilizer treatment of oil-treated plots, one receiving a weekly application of liquid fertilizer and the other treated with a slow-release fertilizer; and two controls, one not treated with oil and the other treated with oil but not with fertilizer. Oil degradation was monitored by measuring carbon dioxide evolution and by chemical analysis of the oil. Buried oil was degraded to a significantly greater extent in fertilized plots, but no differences in oil chemistry were observed between the two different fertilizer treatments, although carbon dioxide production was significantly higher in the oil-treated plots that were treated with slow-release fertilizer during the first 14 days of the experiment. Bacterial communities present in the beach sediments were profiled by denaturing gradient gel electrophoresis (DGGE) analysis of PCR-amplified 16S rRNA gene fragments and 16S rRNA amplified by reverse transcriptase PCR. Similarities between the DGGE profiles were calculated, and similarity matrices were subjected to statistical analysis. These analyses showed that although significant hydrocarbon degradation occurred both in plots treated with oil alone and in the plots treated with oil and liquid fertilizer, the bacterial community structure in these plots was, in general, not significantly different from that in the control plots that were not treated with oil and did not change over time. In contrast, the bacterial community structure in the plots treated with oil and slow-release fertilizer changed rapidly, and there were significant differences over time, as well as between blocks and even within plots. The differences were probably related to the higher concentrations of nutrients measured in interstitial water from the plots treated with slow-release fertilizer. Bacteria with 16S rRNA sequences closely related (>99.7% identity) to Alcanivorax borkumensis and Pseudomonas stutzeri sequences dominated during the initial phase of oil degradation in the plots treated with slow-release fertilizer. Field data were compared to the results of previous laboratory microcosm experiments, which revealed significant differences.

Robust hydrocarbon degradation and dynamics of bacterial communities during nutrient-enhanced oil spill bioremediation.

Degradation of oil on beaches is, in general, limited by the supply of inorganic nutrients. In order to obtain a more systematic understanding of the effects of nutrient addition on oil spill bioremediation, beach sediment microcosms contaminated with oil were treated with different levels of inorganic nutrients. Oil biodegradation was assessed respirometrically and on the basis of changes in oil composition. Bacterial communities were compared by numerical analysis of denaturing gradient gel electrophoresis (DGGE) profiles of PCR-amplified 16S rRNA genes and cloning and sequencing of PCR-amplified 16S rRNA genes. Nutrient amendment over a wide range of concentrations significantly improved oil degradation, confirming that N and P limited degradation over the concentration range tested. However, the extent and rate of oil degradation were similar for all microcosms, indicating that, in this experiment, it was the addition of inorganic nutrients rather than the precise amount that was most important operationally. Very different microbial communities were selected in all of the microcosms. Similarities between DGGE profiles of replicate samples from a single microcosm were high (95% +/- 5%), but similarities between DGGE profiles from replicate microcosms receiving the same level of inorganic nutrients (68% +/- 5%) were not significantly higher than those between microcosms subjected to different nutrient amendments (63% +/- 7%). Therefore, it is apparent that the different communities selected cannot be attributed to the level of inorganic nutrients present in different microcosms. Bioremediation treatments dramatically reduced the diversity of the bacterial community. The decrease in diversity could be accounted for by a strong selection for bacteria belonging to the alkane-degrading Alcanivorax/Fundibacter group. On the basis of Shannon-Weaver indices, rapid recovery of the bacterial community diversity to preoiling levels of diversity occurred. However, although the overall diversity was similar, there were considerable qualitative differences in the community structure before and after the bioremediation treatments.