Knowledge, Attitudes and Practices Related to Medication, Antibiotics, and Vaccination among Public Service Population: National Survey Conducted in France.

Medication, antibiotics, and immunization are three major and cost-effective medical interventions but their use is balanced. Knowledge, attitudes and practices (KAP) are a cornerstone. This retrospective study aims at analyzing KAP related to these concerns among the public service population in order to establish the basis for the implementation of selective preventive actions. From a cross-sectional anonymous online questionnaire-based survey among the insurees of a French mutual organization (Union Prévention Santé pour la Fonction publique, UROPS), 33 questions related to medication, antibiotics and vaccination were extracted to evaluate KAP. New variables were constituted: levels of knowledge, antibiotic misuse, proactive behavior and vaccinophobia. Multiple correspondence analysis was performed to identify respondents' homogenous groups. In addition, bivariate statistical comparisons were provided and logistic regressions were carried out to identify determinants of these new variables. Public service population (workers and retired) were highly exposed to polymedication (8.7% vs. 24.4%, p < 0.0001), hypnotics overtake (24.3% vs. 18.4%, p < 0.0001), and misuse antibiotics (33.2% vs. 22.6%, p < 0.0001) despite good levels of knowledge. Proportions of vaccinophobia was low (0.8% vs. 1.7%, p < 0.0001). However, workers have different KAP than retired, without shared determinants in the 3 health domains studied. Respondents were proactive (85.8% vs. 81.6%, p < 0.0001), used multiple sources of trustworthy information and seems to be ready for the delegation of health tasks. Thus, preventive actions related to antibiotics and polymedication should be a priority in vaccination education for mutual organizations such as UROPS. Studying their insurees longitudinally could be interesting to highlight the impact of selective prevention on behaviors, through trusted health professionals (general practitioners, pharmacists…).

Cost savings using a test-based de-escalation strategy for patients with Crohn's disease in remission on optimized infliximab: A discrete event model study.

BACKGROUND: Drug de-escalation is considered in Crohn's disease patients in sustained remission on optimized infliximab treatment. AIM: We built a model to evaluate the magnitude of cost savings in patients' disease course with or without drug de-escalation guided by infliximab trough levels. METHODS: We designed 4 virtual cohorts (P1-P4) of 10,000 patients in clinical remission on optimized infliximab treatment followed for 2 years. P1: no drug de-escalation - 10 mg/kg/8 weeks; P2: drug de-escalation from 10 mg/kg/8 weeks to 5 mg/kg/8 weeks according to trough levels; P3: no drug de-escalation - 10 mg/kg/6 weeks; and P4: drug de-escalation from 10 mg/kg/6 weeks to 10 mg/kg/8 weeks according to trough levels. For P2 and P4 cohorts, drug de-escalation was decided if trough levels were ≥7 µg/mL and no de-escalation if trough levels were <7 µg/mL. Only costs related to drug administration were considered. RESULTS: The cost differences when comparing P1 versus P2 and P3 versus P4 were 7.6% and 4.6%, respectively, corresponding to costs savings of €30.5 millions and €20.3 million for 10,000 patients. CONCLUSION: Over a 2-year period, infliximab de-escalation according to trough levels led to cost saving of about 6%, corresponding to around €25.4 million.

Cost savings of anti-TNF therapy using a test-based strategy versus an empirical dose escalation in Crohn's disease patients who lose response to infliximab.

BACKGROUND: The use of pharmacokinetics is associated with cost savings in anti-tumor necrosis factor (anti-TNF) therapy, but the long-term cost savings in a large cohort of Crohn's disease (CD) patients are unknown. AIM: The goal of this study was to compare the cost of anti-TNF therapy in two cohorts of CD patients losing response to infliximab, one using a test-based strategy and one an empirical dose escalation. METHODS: We used a selected mathematical model to describe the trajectories of CD patients based on a discrete event system. This design allowed us to track over a given period a double cohort of patients who moved randomly and asynchronously from one state to another, while keeping all the information on their entire trajectory. Both cohorts were modeled using state diagram parameters where transition probabilities from one state to another are derived from literature data. Costs were estimated based on the French health care system. RESULTS: Cost savings among the 10,000 CD patients using a test-based strategy were €131,300,293 at 5 years. At 5 years the mean cost saving was €13,130 per patient. The direct cost of the test had no impact on the results until the cost per test reached €2,000. CONCLUSIONS: A test-based strategy leads to major cost savings related to anti-TNF therapy in CD.

Scale for assessing the quality of Mexican adults' mealtime habits / Escala para evaluar la calidad de los hábitos al comer en adultos mexicanos

OBJECTIVE: To construct a scale for assessing the quality of mealtime habits in a sample of urban Mexican adults, computing the contribution of a set of advisable and unadvisable mealtime habits. MATERIAL AND METHODS: We performed an exploratory factor analysis among 7 472 adults participating in the baseline assessment of the Health Workers Cohort Study, to assess the mealtime habits quality. Likelihood ratio test for difference of two probabilities and test for the difference of two means were used to identify differences between low and high categories of the Mealtime Habits Quality Scale (MHQS) across variables of interest. RESULTS: Participants with the top quality of mealtime habits showed lower rates of overweight, obesity, abdominal obesity, and elevated body fat. They were also more adherent to a prudent dietary pattern than a western dietary pattern, and consumed more fruits and vegetables. CONCLUSIONS: Anthropometric and dietary variables differed across MHQS categories. However, further validation of the scale, and assessment of their ability to predict weight gain or related diseases are needed, using prospective and intervention studies.

OBJETIVO: Construir una escala para evaluar la calidad de los hábitos al comer, calculando la contribución de un grupo de hábitos recomendables y no recomendables, en población adulta urbana de México. MATERIAL Y MÉTODOS: Realizamos un análisis exploratorio de factores en 7 472 adultos participantes en el Estudio de Cohorte de Trabajadores de la Salud para evaluar la calidad de los hábitos al comer. Para identificar diferencias entre la baja y alta calidad de los hábitos al comer a través de las variables de interés, utilizamos la prueba de razón de probabilidades a fin de evaluar la diferencia entre dos proporciones y la prueba de comparación de medias. RESULTADOS: Los participantes clasificados en la categoría de alta calidad de los hábitos al comer presentaron prevalencias más bajas de sobrepeso, obesidad, obesidad abdominal y porcentaje de grasa corporal elevado. Además, mostraron mayor adherencia al patrón dietario prudente que al patrón dietario occidental, así como mayor consumo de frutas y verduras. CONCLUSIONES: Las variables antropométricas y de dieta muestran diferencias a través de las categorías de la escala de la calidad de hábitos al comer. Sin embargo, será necesario validar la escala y evaluar su capacidad para predecir ganancia de peso o enfermedades relacionadas, mediante estudios prospectivos o de intervención.

Concordance rate differences of 3 noninvasive imaging techniques to measure carotid stenosis in clinical routine practice: results of the CARMEDAS multicenter study.

BACKGROUND AND PURPOSE: To replace digital subtraction angiography (DSA) in carotid stenosis evaluation, noninvasive imaging techniques have to reach a high concordance rate. Our purpose is to compare the concordance rates of contrast-enhanced MR angiography (CEMRA) and CT angiography (CTA) with Doppler ultrasound (DUS) in clinical routine practice. METHODS: We evaluated prospectively with DUS, CEMRA, and CTA 150 patients suspected of carotid stenosis. The overall concordance rates of the 3 techniques were calculated for symptomatic stenosis > or =50% and > or =70%, for asymptomatic stenosis > or =60%, and for occlusion. For the carotid arteries treated by surgery (n=97), the results of each method and combined techniques were recorded, and misclassification rates were evaluated from surgical reports. RESULTS: The overall concordance rates of DUS-CEMRA, DUS-CTA, and CEMRA-CTA were not statistically different. However, the concordance rate of DUS-CEMRA (92.53%) was significantly higher than that for DUS-CTA (79.10%) in the surgical asymptomatic stenosis group (P=0.0258). CTA considered alone would misclassify the stenosis in a significant number of cases (11 of 64) in the surgical asymptomatic group compared with CEMRA (3 of 67) and DUS (1 of 66) (P=0.0186 versus MRA, P=0.0020 versus DUS). CONCLUSIONS: With the techniques as utilized in our study, the overall concordance rates of combined noninvasive methods are similar for measuring carotid stenosis in clinical routine practice, but in asymptomatic carotid stenosis, the decision making for surgery is significantly altered if DUS and CTA are considered in place of DUS and CEMRA.