Use of Smartphone Health Apps Among Patients Aged 18 to 69 Years in Primary Care: Population-Based Cross-sectional Survey.

BACKGROUND: The World Health Organization has defined mobile health (mHealth) as the "use of mobile and wireless technologies to support the achievement of health objectives." Smartphones currently represent one of the main media forms for mHealth democratization. Health apps can be an interesting tool for changing health behaviors. However, their use in France is still poorly documented. OBJECTIVE: The main aim of this study was to evaluate the frequency of use of health apps among patients consulting in the primary care setting in France. The secondary aims were to evaluate the use of health apps according to the sociodemographic and medical characteristics of patients and to determine their use. METHODS: A population-based cross-sectional survey was carried out between November 2017 and January 2018 in the Grenoble area of France among patients aged between 18 and 69 years who were consulting at 13 primary care physician offices. Patients were provided with anonymous paper self-questionnaires. The main criterion for participation was the use of a smartphone health app, defined for the purpose of this study as any app supporting patients in efforts to be healthy. RESULTS: The participation rate was 49.27% (739/1500; 95% CI 46.7%-51.8%). The smartphone use was estimated at 82.6% (597/723; 95% CI 79.6%-85.2%). Of 597 smartphone owners, 47.7% (283/595; CI 43.6%-51.6%) used at least one smartphone health app. Health apps identified in this study were mainly related to wellness, prevention, and fitness (66.1%), as well as medication, treatments, and follow-up care (50.0%). The main factors associated with health app use were: use of social networks (odds ratio [OR] 3.4, 95% CI 2.1-5.3), age under 30 years (OR 2.7, CI 1.4-4.9), city size between 5001 and 10,000 inhabitants (OR 1.8, CI 1.1-2.8), and city size more than 10,000 inhabitants (OR 2.1, CI 1.4-3.2). CONCLUSIONS: In this survey, nearly one out of two patients reported the use of smartphone health apps, which are currently focused on wellness, prevention, and fitness, and are largely used by the younger population. TRIAL REGISTRATION: ClinicalTrials.gov NCT03351491; https://clinicaltrials.gov/ct2/show/NCT03351491.

The pros and cons of the implementation of a chronic care model in European rural primary care: the points of view of European rural general practitioners.

INTRODUCTION: This article describes the views of European rural general practitioners regarding the strengths, weaknesses, opportunities and threats (SWOT) of the implementation of a chronic care model (CCM) in European rural primary care. METHODS: This was a mixed-methods online survey. Data were collected from 227 general practitioners between May and December 2017. Categorical data were analysed using descriptive methods while free-text responses were analysed using qualitative methods. The setting was rural primary care in nine European countries (including Central and Eastern Europe). Main outcomes measures were respondents' evaluations of a chronic care model in their rural healthcare settings in terms of SWOT. RESULTS: The SWOT analysis showed that the expertise of healthcare professionals and the strength of relationships and communications between professionals, caregivers and patients are positive components of the CCM system. However, ensuring adequate staffing levels and staff competency are issues that would need to be addressed. Opportunities included the need to enable patients to participate in decision making by ensuring adequate health literacy. CONCLUSION: The CCM could certainly have benefits for health care in rural settings but staffing levels and staff competency would need to be addressed before implementation of CCM in such settings. Improving health literacy among patients and their carers will be essential to ensure their full participation in the implementation of a successful CCM.

Severe Pneumocystis jirovecii pneumonia in an idiopathic CD4+ lymphocytopenia patient: case report and review of the literature.

INTRODUCTION: When diagnosing Pneumocystis jirovecii pneumonia (PJP), the clinical suspicion must be confirmed by laboratory tests. PJP is rarely described in patients with idiopathic CD4+ lymphocytopenia (ICL), a rare T-cell deficiency of unknown origin with persistently low levels of CD4+ T-cells (<300 µl-1 or <20 % of total lymphocytes) but repeated negative human immunodeficiency virus (HIV) tests. We retrospectively analysed a case of an ICL patient with severe PJP associated with multiple opportunistic infections (OIs). We also reviewed the literature since 1986. CASE PRESENTATION: A laboratory-confirmed case of PJP associated with invasive candidiasis and cytomegalovirus infection was reported in an ICL patient. Despite early treatment, the patient died of respiratory failure under polymicrobial pneumonia. According to the literature, the mortality rate of ICL patients is 10.4 % (33/316). In ICL patients, the risk of OI is 83.2 % (263/316), with viral infections being the most prevalent (58.2 %, 184/316), followed by fungal infections (52.2 %, 165/316) and mycobacterial infections (15.5 %, 49/316). Dysimmunity is reported in 15.5 % (49/316) of ICL patients. Among the fungal infections, cryptococcal infections are the most prevalent (24.1 %, 76/316), followed by candidiasis (15.5 %, 49/316) and PJP (7.9 %, 25/316). CONCLUSIONS: The high risk of OIs underlines the importance of more vigorous preventative actions in hospitals. The response to therapy and the detection of early relapse of PJP may be monitored by several laboratory tests including quantitative PCR. It is essential to treat the ICL and to follow the guidelines concerning therapy and prophylaxis of OIs as given to HIV patients.

Characteristics and clinical relevance of the quantitative touch-down major surface glycoprotein polymerase chain reaction in the diagnosis of Pneumocystis pneumonia.

The evaluation of quantitative polymerase chain reaction (PCR) characteristics can increase the accuracy of the laboratory diagnosis of Pneumocystis pneumonia (PCP). Between July 2008 and September 2009, 66 non-sequential prospective bronchoalveolar lavage (BAL) samples, obtained from five HIV-infected and 49 non HIV-infected patients were investigated, using a quantitative-touch-down-PCR to determine the number of copies of major surface glycoprotein (MSG) genes of Pneumocystis jirovecii (q-TD-MSG-PCR). PCP was confirmed by microscopic observation of Pneumocystis, radio-clinical and therapeutic data in 18/54 patients. For PCP, the cut-off was 54.3 MSG copies per ml of BAL fluid. The PCR was positive in these same 18 cases and it was the only positive assay in two cases and the earliest diagnosis test in one case of PCP relapse. The likelihood positive ratio, sensitivity and specificity of the q-TD-MSG-PCR were 44, 100% and 97.7%, respectively. The Predictive Negative Value was 100% and the Predictive Positive Value of 95.5%, the intra- and inter-assay variability values were 2.7% (at more than 30 MSG copies) and 11.7% (at 10,000 MSG copies), respectively. Quantitative PCR can help diagnose PCP even in cases of low Pneumocystis load and might decrease morbidity in association with very early specific treatments.