[Algorithms to identify chronic inflammatory rheumatism and psoriasis in medico-administrative databases: A review of the literature]. / Algorithmes d'identification des rhumatismes inflammatoires chroniques et du psoriasis dans les bases médico-administratives : revue de la littérature.

BACKGROUND: We aimed to describe and discuss the algorithms used to identify chronic inflammatory rheumatisms and psoriasis in medico-administrative databases. METHODS: We performed a literature review on the Medline database of articles published up to 31 January 2018. Our inclusion criteria were: original articles using medico-administrative databases in accordance with the International Classification of Diseases, version 10 (ICD-10) and concerning rheumatoid arthritis (RA) or ankylosing spondylitis (AS) or psoriatic arthritis (PsoA) or Psoriasis (Pso). Our exclusion criteria were: letters to the editor, commentaries on published articles, studies using codes other than those of the ICD or a previous version. RESULTS: Out of the 590 articles identified, 37 studies were included. Concerning RA (n=10), all studies used the M05 code, associated with the M06 code in six studies. The remaining four studies specifically targeted codes M06.0, M06.2, M06.3, M06.8, M06.9, and two of them also used code M12.3. For AS (n=8), 7 studies used the M45 code, while only one study used M45.9, M46.1 or M46.8. For Pso (n=17), all studies used the L40 code and/or at least two dispensations of vitamin D. Concerning PsoA (n=13), all studies used the same codes: M07.0, M07.1, M07.2, M07.3. CONCLUSION: We recommend using codes M05 and M06 rather than M06.1 and M06.4 for RA, M45 for AS, the algorithm L40 and/or two dispensations of topical vitamin D for psoriasis, and codes M070 to M073 to identify PsoA patients in medico-administrative databases.

[Impact of the obstructive sleep hypopnea-apnea syndrom treated on employment for military employment]. / Impact du syndrome d'apnées-hypopnées obstructives du sommeil appareillé sur le maintien dans l'emploi chez les militaires d'active.

INTRODUCTION: The diurnal hypersomnia associated with obstructive sleep apnea (OSA) affects soldier employment and deployability. In this study, we examined the impact of OSA on the employment of soldiers on continuous positive airways pressure (CPAP) therapy by measuring several items: work absenteeism using the Work Productivity and Activity Impairment (WPAI) questionnaire, diurnal hypersomnia, and career advancement. METHODS: A questionnaire was sent by regular mail to 940 soldiers with OSA on CPAP therapy who are insured by the French Military Healthcare Fund (Caisse Nationale Militaire de Sécurité Sociale). RESULTS: Questionnaires were returned by 439 soldiers: mean age 47 years; mean body mass index 29.8kg/m2. Absenteeism reached 0.45%, and work productivity impairment 8.7%. Hypersomnia was reported by 15.4% and was severe for 9.7%. The average daily working time was 6.5hours. Quality of life was improved for 91.1%. The military practitioner had diagnosed OSA in 19.6% of these soldiers and had prescribed treatment in 14.9%. DISCUSSION: Residual OSA in these soldiers on CPAP therapy had little impact on work productivity impairment that was less than observed in populations with chronic diseases. In our study population, hypersomnia was less common than observed in the general population. An impact on career advancement could not be clearly demonstrated. Close medical follow-up is warranted in certain populations due to the persistence of severe somnolence in a significant number of patients.

[The use of administrative health databases in infectious disease epidemiology and public health]. / Apport des bases médico-administratives en épidémiologie et santé publique des maladies infectieuses.

BACKGROUND: The public health burden resulting from infectious diseases requires efforts in surveillance and evaluation of health care. The use of administrative health databases (AHD) and in particular the French national health insurance database (SNIIRAM) is an opportunity to improve knowledge in this field. The SNIIRAM data network (REDSIAM) workshop dedicated to infectious diseases conducted a narrative literature review of studies using French AHD. From the results, benefits and limits of these new tools in the field of infectious diseases are presented. METHODS: Publications identified by the members of the workgroup were collected using an analytical framework that documented the pathology of interest, the aim of the study, the goal of the developed algorithm, the kind of data, the study period, and the presence of an evaluation or a discussion of the performance of the performed algorithm. RESULTS: Fifty-five articles were identified. A majority focused on the field of vaccination coverage and joint infections. Excluding vaccine coverage field, the aim of 28 studies was epidemiological surveillance. Twenty-six studies used hospital databases exclusively, 18 used ambulatory databases exclusively and 4 used both. Validation or discussion of the performed algorithm was present in 18 studies. CONCLUSIONS: The literature review confirmed the interest of the French AHD in the infectious diseases field. The AHD are additional tools of the existing surveillance systems and their use will probably be more frequent in the coming years given their advantage and reliability. However, incoming users need to be assisted. Thus, the workgroup will contribute to a reasonable use of AHD and support future developments.

[Reimbursement of opiate substitution drugs to militaries in 2007]. / Remboursement des médicaments de substitution aux opiacés chez les militaires en 2007.

INTRODUCTION: The use of psychoactive drugs by militaries is not compatible with the analytical skills and self-control required by their jobs. Military physicians take this problem into consideration by organising systematic drugs screening in the French forces. However, for technical reasons, opiates are not concerned by this screening with the agreement of the people concerned. The estimated number of militaries who use an opiate substitute may be an approach of heroin consumption in the French forces. This study describes buprenorphine and methadone reimbursements made during 2007 by the national military healthcare centre to French militaries. MATERIAL AND METHOD: Each French soldier is affiliated to a special health insurance. The national military healthcare centre has in its information system, all the data concerning drug reimbursement made to French military personnel. This is a retrospective study of buprenorphine and methadone reimbursements made during 2007 by the military healthcare centre, to militaries from the three sectors of the French forces, and from the gendarmerie and joint forces. Only one reimbursement of one of these two drugs during this period allowed the patient to be included in our study. Daily drug dose and treatment steadiness profile have been calculated according to the criteria of the French monitoring centre for drugs and drug addiction. The criteria of the National guidelines against frauds have been used to identify misuse of these drugs. Doctors' shopping behaviour has also been studied. Finally, the nature of the prescriber and the consumption of other drugs in combination with opiate substitute have been analysed. RESULTS: One hundred and eighty-one military consumers of opiate substitute drugs (167 men and 14 women) participated. This sample included people from the three sectors of the French forces as well as from the gendarmerie and from the joint forces. The average age of the consumers was 26.6 years (20-42 years). The average length of service was 6.1 years (maximum 22 years service). One hundred and fifty-nine militaries had been delivered buprenorphine, 15 had been delivered methadone and seven had been delivered both. The prevalence of opiate substitute drug consumption by the militaries (52 per 100,000) is lower than in general population. According to the criteria of the National Healthcare Insurance, this population is not affected by abuse or fraud behaviour. Doctors' shopping behaviour is unusual. Opiate substitutes are prescribed by general physicians in 88% of issues. Only one prescriber was a military physician. An analysis of reimbursement of some drugs associated with opiate substitute has been made. The sampled military consume more psychoactive drugs (anxiolytics, antidepressants, hypnotics) than the French population under opiate substitution. CONCLUSION: In our observation, the military physician is almost always excluded the process of substitution. His/her different responsibilities of care, but also in determining the working aptitude, lead to dissimulation behaviour by the militaries. The difficulty for military physicians is to identify such consumption. They have to evaluate the capacity to work through a physical and psychological examination.

[Retrospective study of ALS in French military personnel]. / Sclérose latérale amyotrophique (SLA) chez les militaires français: enquête rétrospective.

INTRODUCTION: An apparent increased risk for developing Amyotrophic Lateral Sclerosis (ALS), a multifactorial neurodegenerative disease, is considered to exist in the military population. PATIENTS AND METHODS: ALS military and veteran patients were retrospectively recruited in April 2008 by searching medical data (Hippocrate) and repayment data (Erasme) of the French National Military Health Care Fund (Caisse nationale militaire de sécurité sociale, CNMSS) from de January 1991 to December 2007. RESULTS: We report a series of 73 patients, 69 male and four female, average age of 52.5 years (range 27 to 72 years) with a peak of patients in the 50-59 year age class. The branch of military service was Army (n=26 patients), Air force (n=14), Navy (n=10) and State Police Force (n=22). The incidence among male active duty military personnel was stable from 2002 to 2007; it was less than the general population (1.7/100,000 per year in 2007), but higher in the 40-44 and 50-54 year age classes (1.90 and 5.07/100,000 per year in 2007 respectively). Duration of active duty was on average 31 years. CONCLUSION: The retrospective nature of the data and the incomplete population with loss of retired military personnel without CNMSS affiliation are limitations of our study. Another means of collecting all cases of ALS among French military personnel and veterans would be to conduct a search in the 17 ALS centers in France with analysis by occupational activity for entire career.

[Antibiotic consumption in active French soldiers in 2007]. / La consommation d'antibiotiques en 2007 chez les militaires d'active.

INTRODUCTION: Analysis of antibiotic consumption among active duty soldiers can contribute to the development of actions designed to avoid unsuitable population exposure to antibiotics. This survey was conducted among active soldiers to establish a reference year for refund data on antibiotic prescriptions by gender and age. Another aim was to use the refund data among soldiers to learn more about the pattern of antibiotic prescriptions by general practitioners. MATERIAL AND METHODS: A standardized dose of antibiotics prescribed by general practitioners in 2007 for the active duty military population in France was determined from an analysis of the Health fund database. The defined daily dose (DDD), as well as the DDD/1000 contributors to the national healthcare insurance fund, was then used as a technical unit of measurement. RESULTS: For the military population under study, the DDD was 15.76 per 1000 people. It was higher for women than for men (25.1 DDD for 1000 women vs 14.2 DDD for 1000 men). The DDD increased regularly with age: from 11.4 DDD for 1000 people aged less than 20 to 19.3 DDD for 1000 people aged over 50. Military physicians accounted for only 4% of the prescribing practitioners. DISCUSSION: Careful analysis of antibiotic consumption together with closer cooperation between the military healthcare center and the National healthcare fund will enable the development of a prevention policy concerning health and better control of infectious risk.

[Duty militaries' consumption of psychotropic drugs in 2005]. / Consommation de médicaments psychotropes chez les militaires d'active en 2005.

UNLABELLED: The knowledge of psychotropic medication consumption is a Public Health stake for the armies and their social partners. Indeed, indirectly, it permits not only assessment of the state of health or the mental state of the working militaries, but also the development of actions to increase consumers' and prescribers' awareness of the main effects of psychotropic drugs and their side effects. The evaluation of the consumption of psychotropic drugs is based on the reimbursements requested from the "Caisse nationale militaire de Sécurité sociale", a particular scheme of the health fund, to which every working military is affiliated. MATERIAL AND METHOD: A retrospective inquiry was led on elements of reimbursement for antidepressants, anxiolytics, hypnotics, neuroleptics, lithium salts and medicines used in alcoholic weaning during the year 2005. RESULTS: The study concerned 35 365 social insurance contributors, i.e. 8.6% of the working militaries' population. They were mainly men (74.8%) and the mean age was 35.7 years. The refund rate was more important for women (15.6% versus 7.43%) and when the age increased: 6.13% for the 15-24 years versus 15.3% for the 50-59 years. Only 1.4% of the consumers exhibited a long-term psychiatric disorder. A percentage of 21.8% of the consumers had at least four refunds in the year. Anxiolytics, followed by antidepressants and hypnotics, were the medication most often reimbursed. A total of 93,119 prescriptions, including at least one psychotropic medication, were reimbursed in 2005. A percentage of 54.1% of the consumers had only had one prescription in the year. The coprescription of different therapeutic classes represented 41.5% of the prescriptions, the most common being an association between an anxiolytic and an antidepressant (46.8%). The consumers had consulted 49,802 doctors, mainly general practitioners (GPs) (83.6%), and psychiatrists (7.1%). The army doctor, counted with the GPs, was very little sought after (5.3%). Most of the doctors (67.4%) prescribed only once for the same consumer. Compared with GPs, psychiatrists mainly prescribed antidepressants (47.6% versus 35.7% for GPs) and associated more often, another therapeutic class on the same prescription (53.9% versus 30.9% for GPs). CONCLUSION: Our results show that the consumer's profile in the class of the working militaries does not differ from that found in other studies conducted on professionals. The GP is the main prescriber of psychotropic drugs, but this kind of prescription is different from the psychiatrist's. The military doctor is little implicated in the prescription of psychotropics, the link between aptitude and use is obviously the main explanation. The good use of psychotropic medication has to be reinforced for both consumers and prescribers. Other alternatives than the call on medicine have to be reinforced by improving the prevention and the management of psychological disorders and psychiatric affections.

[Sexually transmitted diseases and sexual contamination with human immunodeficiency virus in the French Forces in 2006]. / Infections sexuellement transmissibles et contaminations sexuelles par le virus de l'immunodéficience humaine dans les armées françaises en 2006.

BACKGROUND: Servicemen constitute a group at risk for exposure to sexually transmitted diseases (STD) and for this reason specific surveillance of STD and human immunodeficiency virus (HIV) seroconversion has been conducted in the French Armed Forces since 1996. METHODS: All cases of STD and HIV seroconversion occurring in military personnel and corresponding to the notification criteria are reported by a military doctor, wherever the diagnosis is made. Incidence rates are calculated based on numbers of military personnel provided by the Ministry of Defence Social Observatory. RESULTS: In 2006, 67 cases of STD and 10 of HIV seroconversion due to sexual contamination were reported in the French Forces. The incidence of STD and HIV seroconversion was respectively 19.2 and 2.8 cases per 100,000. Gonorrhoea was the principal notified STD, with half of the cases of HIV seroconversion involving acute HIV infection. 59.7% of STD and 70.0% of HIV seroconversion were contracted in metropolitan France. DISCUSSION: STD and HIV seroconversion remain a subject of concern for the French Medical Forces despite low rates of incidence.

Screening for multidrug-resistant bacteria as a predictive test for subsequent onset of nosocomial infection.

OBJECTIVE: To investigate whether carriage of multidrug-resistant bacteria is a risk factor for nosocomial infection and whether detection of carriage is predictive of subsequent onset of nosocomial infection. METHODS: In this observational cohort (study period, June 1998 through October 2002), nasal and rectal swab specimens from 412 consecutive patients admitted to the intensive care unit were tested for carriage of multidrug-resistant bacteria. Concomitantly, the bacteria responsible for any subsequent nosocomial infection, the date of infection, and some of the known clinical risk factors for nosocomial infection were noted. These factors were adjusted for potential confounders, using a Cox model stratified on the propensity score of multidrug-resistant bacteria carriage. The diagnostic characteristics of a carriage test, including the positive and negative diagnostic likelihood ratios, were calculated for all strata of the propensity score. RESULTS: Forty-two patients were carrying multidrug-resistant bacteria. Nosocomial infection occurred in 95 patients, of whom 16 (38%) were carriers, and 79 (83%) were noncarriers (P=.01). After adjustment for potential confounders, statistical analysis revealed that carriage remained a risk factor for nosocomial infection (relative risk, 2.08 [95% confidence interval {CI}, 1.13-3.81]). Receipt of antibiotic treatment at the time of intensive care unit admission was found to be protective against nosocomial infection. A positive result of test for detection of carriage seemed to be an efficient predictor of subsequent nosocomial infection (positive diagnostic likelihood ratio, 2.05 [95% CI, 1.15-3.66]), although a negative test result was not a predictor of subsequent nosocomial infection (negative likelihood ratio, 0.91 [95% CI, 0.73-1.11]). CONCLUSION: Carriage proved to be a risk factor for subsequent nosocomial infection. However, the carriage test was useful as a predictive tool only for patients with a positive test result.

[Influence of temperature and delayed centrifugation: stability studies of 28 analytes currently analysed]. / Influence de la température et du délai avant centrifugation sur la stabilité de 28 paramètres de détermination courante en biochimie.

A large amount of off-site blood sampling are analysed in our laboratory with a variable conveying time of up to 7 hours. Fifteen healthy volunteers were included in this study. The aim was to evaluate the stability of current analytes in regard to the temperature and the time before centrifugation. Whole blood obtained by venipuncture was collected into collector tubes respectively with heparinate for plasma recovery and on dry tube for TSH determination. All the analytes, except potassium and phosphate showed a good stability at +22 degrees C, with a centrifugation delay of up to 7 hours. A sample storage at +4 degrees C didn't show any better stability for potassium but allowed a significant improvement of phosphate stability. Sample conservation at +22 degrees C can be considered as well suited for current biochemistry determinations. However, in specific calcium and phosphate metabolism investigations, samples preservation at +4 degrees C can be justified. Finally, in potassium assay, regardless of the chosen conservation temperature, centrifugation should occur within 2 hours of sampling.

[Stability of blood glucose collected with or without antiglycolytic agent]. / Stabilité de la glycémie avant centrifugation avec ou sans antiglycolytique.

Glycolysis in blood samples is well-known to induce a rapid decrease of glucose concentration and the use of an antiglycolysis is supposed to prevent this phenomenon. Fifteen healthy volunteers were included in this study. The aim was to evaluate the stability of glucose concentration in regard to the type of blood collection tube used (with or without antiglycolytic agent (monoiodoacetate)) and the time before centrifugation. During the first two hours, a similar decrease was observed with both kind of tube (about 9% in two hours), then the effect of the antiglycolytic agent became significant. It is re-emphasised that glycolysis inhibitor should be used for glucose determination, especially when centrifugation is delayed.

[Suicide and attempted suicide in the armed forces in 1998]. / Données épidémiologiques sur les suicides et tentatives de suicide dans les armées en 1998.

UNLABELLED: Little data exists concerning suicides and attempted suicides on professional duty. Now that the French Army is becoming professional, it is necessary to describe methods of self-destruction, in order to facilitate preventive measures. METHODS: The French Army operated a surveillance system to record all instances of suicide and attempted suicide. Under this surveillance system, all suicidal acts and attempts must be reported through an anonymous standard form completed by a military physician. This form records demographic data, the circumstances and known motives. For the epidemiological analysis, we used the chi square test and the Student test. A method of indirect standardization was employed to enable comparisons between military suicides and those within the general French population in 1996. We chose a risk of error of 5%. RESULTS: During the course of 1998, 145 forms were gathered for professional armed forces. Of these, 40 were recorded as actual suicides and 105 as attempted suicides. The suicide rate corresponded to 14p 100,000. Suicides were limited exclusively to males, the average age at death was 36. Comparisons with the French male population at large (using the indirect method of standardization) showed a standardized mortality rate of 0.43 (p > 0.05). Methods of self-destruction employed were mostly hanging and using firearms. Attempted suicide rate was 31.5 p 100,000, with a relatively even balance between males and females. The average age was 30. Methods of self-destruction employed were mostly drug ingestion and laceration. Difficulties with personal relationships were the principal motive recorded, whilst instances of psychiatric diseases were rare. Previous suicide attempts were known in 21% of recorded suicide attempts in 1998 and in 10% of actual suicide. There was no suicidal act during or linked to an outside army operation. The ratio suicide-attempted suicide was 0.38. DISCUSSION: The fact that the rate of suicide in the French Army is lower than the national average could be explained by the medical criteria used to select army personnel on active duty. These results should be interpreted with caution: our data only covers a single year. Moreover, there is a certain bias in the surveillance system used. Measures in the French Army to prevent suicide are based on a significant medical component within units, particularly during operational tours where there is sometimes a psychiatrist. Although the military physician is constrained by professional secrecy, he must execute his duty as an advisor to the commanding officer to signal human factors that need to be taken into account. Responsibility for knowing men and living conditions lies with the commanding officer. Epidemiological surveillance is a key element of analyzing the risks of suicidal. Its contributing role should be regularly reevaluated.

Early risk factors in acute type A aortic dissection: is there a predictor of preoperative mortality?

BACKGROUND: To describe the preoperative clinical, echocardiographic and biological findings in patients with acute aortic dissection and attempt to specify high risk factors of preoperative mortality. METHODS: A retrospective, monocentric study of 148 patients admitted for acute type A aortic dissection. All patients underwent a clinical, echocardiographic and biological evaluation on admission. In 75 patients, we measured serum cardiac troponin I (cTnI). RESULTS: In hospital mortality was 25.9% and 15.6% presented with preoperative cardiac circulatory arrest (POCCA). Patients with POCCA were more likely than others to have hypotension (97+/-56 vs 144+/-24 mmHg, p<0.01) or shock (52% vs 3%, p<0.01) on admission. Pericardial effusion (65% vs 35%, p=0.01) and tamponade (61% vs 8%, p<0.01) were also significantly linked to POCCA but not the aortic ascendant diameter. Detection of cTnI was more frequent in patients with POCCA (24% vs 7%, p=0.051) and was found to be a good predictor of in hospital mortality (47% vs 14%, p<0.01). CONCLUSIONS: For patients with acute type A aortic dissection, hypotension or shock on admission, pericardial effusion or tamponade, as well as cTnI detection, were the main predictors for POCCA and imply immediate surgery.

[Cost-benefit ratio of tick-borne encephalitis vaccination of French troops based in Kosovo]. / Etude coût-bénéfice de la vaccination contre l'encéphalite à tique chez les militaires français au Kosovo.

BACKGROUND: French military troops based in Kosovo are exposed to Tick-Borne Encephalitis (TBE) biorisk. An efficacious vaccine is available to prevent this disease, burdened by high morbidity and mortality. The epidemiologic features of TBE in Kosovo are unprecise. To help the French Department of Defense to make a decision about immunization against TBE, we performed a cost-benefit analysis. METHODS: By a Bayes'analysis decision, we have estimated the net benefits for a three-injection vaccine program versus absence of vaccination, for all French military troops based in Kosovo. Time expectancy was 4 years. Through the review of several medical reports, we have estimated the useful parameters for this study: morbidity incidence rate, mortality rate, sequelae rate, efficacy vaccine and side effects. We have chosen as initial hypothesis a sero-conversion rate of 1,080 per 100,000 men-by-year. Human life was valorized in francs, by calculating the allowance paid by Department of Defense to the family in case of death or for sequelae. RESULTS: Net benefits arised to 2.17 millions of francs. The vaccine program cost was 25.0 millions of francs. 140 cases of encephalitis viruses were saved by vaccination. Nevertheless a sensibility analysis has shown that results are well reliable with TBE incidence rate. CONCLUSION: The break even point being close to the incidence rate of the initial assumption, the decision to vaccine all French military troops depends at the same time on a better knowledge of the incidence of the disease in Kosovo, but also of the number of potentially avoided cases of tick-borne encephalitis and of the programs of vaccination concerning this disease of the other countries forming the United Nations Organization forces.

[Increase of troponin I during acute pericarditis. 69 cases at an emergency service]. / Elévation de troponine i lors d'une péricardite aiguë. 69 observations en service d'urgence.

OBJECTIVE: The purpose of this study was to determine the incidence and significance of troponin i (tni) elevation in acute pericarditis. PATIENTS AND METHODS: We retrospectively included 69 patients with acute idiopathic pericarditis. We analyzed ECG recordings, echocardiography findings and tni level. Thirty-four patients (49%) had detectable tni (> 0.5 ng/ml), 15 (22%) had a significantly elevated level (> 1.5 ng/ml). There was a significant correlation between elevated tni level and ST elevation. All patients were well at one year. CONCLUSIONS: A rise in tni is frequently observed during acute idiopathic pericarditis. According to the correlation with ST segment elevation, a rise in tni is apparently indicative of superficial myocardial damage. The prognostic value remains unknown.

[Acute acoustic trauma in military personnel. Evaluation of 1 year epidemiologic surveillance]. / Traumatismes sonores aigus en population militaire. Bilan d'une année de surveillance épidémiologique.

OBJECTIVES: Acute acoustic trauma (AAT) refers to damage to sensitive cochlear structures caused by excessive exposure to impulse noise. The aim of this study was to 1) assess the incidence of ATT in French soldiers and 2) to clarify the circumstances under which AAT occurs. PATIENTS AND METHODS: We carried out a prospective study of AAT events reported to medical officers in 1998. RESULTS: The incidence of AAT was 156 per 100,000 person-years (150-161). It was higher in conscripts and in soldiers aged under 31 years. Fifty-seven percent were wearing hearing protectors when the accident took place. CONCLUSION: According to these results, specific preventive programs were planned and should be assessed by epidemiological surveillance of exposed populations.