[Returning to work after an acute coronary syndrome: When waiting is wasting]. / Retour au travail après un accident coronarien aigu.

BACKGROUND: Return to work (RTW) after acute coronary syndrome (ACS) is an important issue for the patient's future. AIMS: The study aim was to determine whether RTW practice complies with guidelines or is delayed by failure in patient management. We analysed the factors influencing RTW beyond the 90-day period recommended by guidelines. METHODS: We conducted a survey of 216 self-employed workers admitted to the hospital for ACS using self-report questionnaires and medical examination. Factors influencing RTW, occupational and cardiac features, and recall and source of medical information were investigated. RESULTS: Ninety-three of 216 patients did not return to work by 90 days, despite good cardiac performance in 30 cases (32 %). The mean sick leave duration was 93.3±103.7 days. Advice concerning return to work was completely missing for 44 % of patients. Cardiac performance was independent of sick leave duration, but was correlated with the likelihood of RTW (P<0.001). Patients assimilated about 70 % of the medical information they were provided, but only 53 % of work-related information. Recall of work-related information was better among patients admitted to a rehabilitation facility (65 %) compared to those who did not receive rehabilitation (P<0.05). CONCLUSION: Cardiologists should assess the patient's cardiac performance within 2 months after ACS. Patient management should also include cardiac rehabilitation or therapeutic education toward improving information recall.

MRI dedicated to bones and joints: what are their market shares in terms of number of patients in private practice in France?

PURPOSE: The French government plans to install MRI facilities dedicated to musculoskeletal indications. We have analyzed the use of imaging investigations in the community to assess their market share. MATERIALS AND METHODS: We undertook a retrospective analysis of all reimbursements during the year 2012 by the French Social Plan for Independent Workers for 4 imaging methods for a musculoskeletal indication (MRI, CT scan with or without opacification and contrast-enhanced conventional radiography). RESULTS: Three hundred and thirty-two thousand eight hundred and ninety-three beneficiaries were included. The following investigations were used: MRI 12659 investigations; CT scan without direct opacification 7392; CT scan with direct opacification 1271; contrast-enhanced conventional radiography 1187. Of those beneficiaries who underwent investigations of the spine, 39.91% had MRI alone, 8.62% had both MRI and one of the other investigations and 51.46% did not have MRI. The corresponding figures for beneficiaries undergoing lower limb investigations were 79.57%, 4.53% and 15.90% and those for beneficiaries undergoing upper limb investigations were 35.49%, 6.56% and 57.94% respectively. CONCLUSION: In terms of the numbers of investigations, our results show that in France MRI dedicated to musculoskeletal indications has a wide market share for the spine, upper and lower limbs.

[Trends in prevalence of continuous positive airway pressure treatment for adults from 2006 to 2010]. / Évolution de 2006 à 2010 du nombre d'adultes traités par pression positive continue.

INTRODUCTION: The aim of this study was to evaluate the evolution from 2006 to 2010 of the prevalence of continuous positive airway pressure treatment for the beneficiaries of two regional health care insurance funds (17 and 43). METHODS: One million forty-eight thousand four hundred and thirty beneficiary-years were analyzed from 2006 to 2010. The prevalence of continuous positive airway pressure treatment was tested with regard to the effect of the year of delivery. A logit regression was used to adjust for potentially confounding differences in age and gender, which were included as covariates. The prevalence of alternative treatments and of controls of reimbursement benefits implemented by the funds are evaluated too during the same period. RESULTS: Continuous positive airway pressure treatment annual prevalence was 6.34/1000. A significant annual increase of prevalence from 2006 to 2008 was followed by a slowing of the rate of growth starting from 2008. In the same time for fund 43, obesity surgery rose from 41.85/100,000 to 55.44/100,000 and mandibular osteotomy surgery rose from 0.97/100,000 to 4.78/100,000. For fund 17 mandibular advancement devices rose from 10.72/100,000 to 21,08/100,000. The two funds started a reinforced inspections of reimbursement benefits for continuous positive airway pressure treatment in 2008. CONCLUSIONS: The dynamics of continuous positive airway pressure treatment have to be considered in the context of policies introduced and trends in the application of alternative treatments in each fund.

[Individual factors and mortality associated with hormone replacement therapy in a French cohort of women from 60 to 69 years of age]. / Caractéristiques individuelles et mortalité associées au traitement hormonal substitutif de la ménopause: étude d'une cohorte française de femmes d'âge compris entre 60 et 69 ans.

OBJECTIVES: Given the specificity of French postmenopausal hormonal replacement therapy, we study the link with overall mortality. MATERIALS AND METHODS: A cohort of 1200 women from 60 to 69 years of age was followed up from 2001 to 2009. We computerized from the health care repayment database the current reimbursement of behind-the-counter hormonal therapy. We sent a questionnaire to identify their lifetime history of hormone use. We test whether current and former users have higher risk of death from all cause combined. We adjusted the survival analysis on the individuals factors associated to the hormone use. The statistical methods Kaplan-Meier curves in univariate analysis and Cox Regression Model in multivariate analysis were used. RESULTS: Current users present a reduced all-cause mortality rate while former users have a higher all-cause mortality rate. This trend suggests a "healthy estrogen user survivor effect" bias. After adjustment on confounding factors, hormonal users do not have a statistically significant increased risk of overall mortality. CONCLUSION: Postmenopausal hormone replacement therapy is not linked with mortality for women from 60 to 69 years of age covered by the self-employed workers health and retirement French insurance fund.

Cost-effectiveness analysis of treatments for phimosis: a comparison of surgical and medicinal approaches and their economic effect.

OBJECTIVE: To compare the cost-effectiveness of surgery and topical steroids as treatments for phimosis (defined as a clinically verifiable, pathological, cicatricial stenosis of the prepuce) and to evaluate the financial basis of these treatments. METHODS: Data on treatment using topical steroids was obtained from published reports and those for circumcision from claims by private hospitals for children < 13 years old registered at the health insurance department of our facility. The estimate of the French national financial cost of the treatments for 1998 was calculated from public and private institutional information. RESULTS: Treatment with topical steroids for 4-8 weeks was successful in approximately 85% of patients (mean age 5 years) and had no side-effects; the remaining 15% were treated by circumcision. Topical steroid therapy costs (in French francs) F 360 per patient. For those primarily treated by circumcision (81 boys, mean age 4.3 years) and diagnosed as having phimosis, the cost was F 3330 per patient in the private sector. The total number of circumcisions performed in France, regardless of sector (public or private) for 1998 was estimated to be 51 080, which represents an annual cost of F 195.7 million. CONCLUSION: As topical pharmacological treatment avoids the disadvantages, trauma and potential complications of penile surgery, including anaesthesia-related risks, the use of topical steroids as a primary treatment appears to be justified in boys with clinically verifiable phimosis. This treatment could reduce costs by 75%, which represents a potential annual saving of approximately F 150 million.