[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.

Critical urban areas, deprived areas and neighbourhood effects on health in France.

Since the 1980s, different French governments have formulated public policies aimed at taking into account the specific problems of deprived neighbourhoods. The aim of this paper is to determinate the existence of a neighbourhood effect on health and to discuss the implementation of a geographical index of deprived areas in France. Using the National Health Survey of 2002-2003 and 1999 French census data, we attempt to measure the individual and collective determinants of Self-Reported Health Status (SRH). By using a principal component analysis of aggregated census data, we obtain three synthetic factors: "economic and social condition", "residential stability" and "generational", and show that these contextual factors are correlated with individual SRH. Our research shows that health inequalities cannot be tackled by using only the Critical Urban Area criterion (the fact of living in a CUA or not) because some inequalities remain ignored and thus, hidden. We suggest a methodology to build a new health deprivation index allowing to better target health inequalities.

PCA analgesia for children with chemotherapy-related mucositis: a double-blind randomized comparison of morphine and pethidine.

AIMS: This study aimed to compare pethidine and morphine on efficacy and toxicity in children with severe mucositis following chemotherapies. PATIENTS AND METHODS: From March 2000 to November 2003, 35 hospitalized children with chemotherapy-related mucositis were randomly assigned to receive double blindly "patient-controlled analgesia" (PCA) bolus doses of morphine or pethidine. The mucositis pain score was the mean of pain measured four times a day with a Visual Analogue Scale from day 2 to 5 of PCA. RESULTS: Study stops before total accrual for difficulties of recruitment. Out of the 29 patients with more than one day of PCA, the median (range) of the Mean Pain Score was 44 (13-72) and 33 (3-89) in the morphine (n = 14) and pethidine (n = 15) groups, respectively (P = 0.32). PCA was stopped for failure in 10 cases (five in each group). Constipation requiring specific treatment was higher in the morphine group (43% versus 0%). CONCLUSIONS: PCA with pethidine appears not inferior to morphine, with less constipation requiring specific treatment, but a larger study is warranted to confirm this.

MR quantification of the washout changes in breast tumors under preoperative chemotherapy: feasibility and preliminary results.

OBJECTIVE: The objective of our study was to describe and determine the feasibility of an MR washout quantification method in patients with breast cancer under preoperative chemotherapy. MATERIALS AND METHODS: Nineteen patients with breast T2 or T3 tumors were enrolled in a previous study for tumor response evaluation during chemotherapy based on dynamic contrast-enhanced MRI. We retrospectively used the dynamic acquisition data to produce parametric images representing the washout pattern. Two radiologists unaware of the final pathologic results measured the volume of pixels exhibiting washout within the tumor before chemotherapy (volume 1), after two courses of chemotherapy (volume 2), and before surgery after four courses of chemotherapy (volume 3). The interobserver variability and intraobserver variability were calculated to evaluate the reproducibility of our method with the Pearson's correlation coefficient and the concordance correlation coefficient. We correlated the washout changes by means of a Student's t test and noted the histopathologic final outcome. RESULTS: A washout pattern was present in all patients on the initial MR study. The quantification method of the washout changes was reproducible with good interobserver agreement (r = 0.85, p < 10(-5)) and an excellent intraobserver agreement (r = 0.94, p < 10(-5)). A significant decrease of the washout volume was observed after two courses of chemotherapy (p = 0.004), whereas no significant modification was observed between two and four courses of chemotherapy (p = 0.52). CONCLUSION: Quantification of the washout variation in breast tumor based on the use of parametric images is feasible and reproducible. It may add information to the evaluation of tumor response to preoperative therapy.