Les médecins aujourd'hui en France. Histoire et démographie médicales.

International audienceEn France, il est facile d'avoir une représentation claire de la profession médicale, qu'il s'agisse de ses caractéristiques, de ses activités voire de ses privilèges, mais aussi de ses contraintes. L'existence d'un diplôme unique national, l'inscription à un Ordre, un statut bien identifié conduit à une vision homogène de la profession. Cependant, celle-ci a connu d'importantes transformations en termes d'effectifs, d'exercice professionnel ou de rémunération

Histoire et démographie médicales.

En France, il est facile d'avoir une représentation claire de la profession médicale, qu'il s'agisse de ses caractéristiques, de ses activités voire de ses privilèges, mais aussi de ses contraintes. L'existence d'un diplôme unique national, l'inscription à un Ordre, un statut bien identifié conduit à une vision homogène de la profession. Cependant, celle-ci a connu d'importantes transformations en termes d'effectifs, d'exercice professionnel ou de rémunération

Les médecins aujourd'hui en France. Histoire et démographie médicales.

International audienceEn France, il est facile d'avoir une représentation claire de la profession médicale, qu'il s'agisse de ses caractéristiques, de ses activités voire de ses privilèges, mais aussi de ses contraintes. L'existence d'un diplôme unique national, l'inscription à un Ordre, un statut bien identifié conduit à une vision homogène de la profession. Cependant, celle-ci a connu d'importantes transformations en termes d'effectifs, d'exercice professionnel ou de rémunération

Evaluation de l’accès aux psychothérapies pour troubles légers/modérés : enquêtes transverses

International audienc

Quality of life and utility decrement associated with Clostridium difficile infection in a French hospital setting

Abstract Background Clostridium difficile infection (CDI) is associated with a substantial Quality of life impact on patients that has not been so far measured with a generic validated instrument. Methods A prospective study was performed in 7 French acute-care settings in patients presenting with a bacteriologically-confirmed CDI. The EQ-5D-3 L was filled in by patients at 7 ± 2 days after CDI diagnosis to describe their state of health at that date as well as their state of health immediately before the CDI episode (baseline). Individual utility decrement was obtained by subtracting the corresponding utilities. The Quality Adjusted Life Year (QALY) loss was calculated by multiplying the days spent from baseline to the date of the interview, by the decrement of utility. A multivariate analysis of variance of the utility decrement according to CDI and patients characteristics was performed. Results Eighty patients were enrolled (mean age: 69.4 years, 55% females). The utility scores dropped from a mean 0.542 (SD: 0.391) at baseline to 0.050 (SD: 0.404) during the CDI episode with a mean adjusted utility decrement of 0.492 (SD: 0.398) point. This decrement increased significantly with CDI severity (Zar score ≥ 3) (p = 0.001), in patients with a positive baseline utility (p = 0.032), in women as compared to men (p = 0.041) and in patients aged more than 65 years (p = 0.041). No association with the Charlson index was found. The associated QALY loss not integrating the excess mortality was 0.028 (SD: 0.053). Conclusions The impact on quality of life of CDI episodes is major and translates in a substantial QALY loss despite their short duration

Prospective acceptability of digital therapy for major depressive disorder in France: multicentric real-life study

International audienceBackground: Major depressive disorder is one of the leading causes of disability worldwide. Recently, the WHO has highlighted the negative impact of recent crises (COVID-19 pandemic, war in Ukraine, economic crisis). Although most international guidelines recommend psychological and psychosocial interventions as a first-line treatment for mild to moderate depression, access remains limited in France due to limited availability of trained clinicians, high costs for patients in a context of non-reimbursement and fear of stigmatisation. Therefore, online blended psychological treatment such as deprexis® could improve access to care for people with depression. It has several advantages such as easy access, scalability and is supported by evidence.Objective: This study aims to evaluate the real-life acceptability of a deprexis® for people with depression in France, outside of a reimbursement pathway.Methods: DARE was designed as a multicentre cross-sectional study in which deprexis® was offered to any patient meeting the inclusion criteria during the fixed inclusion period June 2022-March 2023. Inclusion criteria were: 1/ depression, 2/ age between 18 and 65 years, 3/ sufficient French language skills, 4/ access to internet with a device to connect to the deprexis® platform. Exclusion criteria were previous or current diagnosis of bipolar disorder, psychotic symptoms and/or suicidal thoughts during the current episode. The primary objective is to measure the prospective acceptability of deprexis®, a new digital therapy. Secondary objectives are to examine differences in acceptability according to patient and clinician characteristics and to identify reasons for refusal. All investigators received video-based training on deprexis® prior to enrolment to ensure that they all had the same level of information and understanding of the programme.Results: 245 patients were eligible (56.3% women and 56.3% single). Mean age 40.7+-14.1 years. 78% had moderate to severe depression (according to PHQ-9). More than half of the population had another psychiatric comorbidity (excluding bipolar disorder, psychotic disorders and suicidal ideation). 33.9% of patients accepted the idea of using deprexis® and the main reason for refusal was financial, at 83.3%. Multivariate logistic regression identified factors that might favour acceptability of deprexis®. Among these, being in a couple, being treated with an antidepressant or having a low severity level favoured acceptance of deprexis®.Conclusions: DARE is the first French study aiming at evaluating prospective acceptability of a Digital therapy in the treatment of depression. The main reason for refusal of deprexis® was financial. DARE will allow a better identification of factors influencing it in a natural setting. This study highlights the importance of investigating factors that may be associated with the acceptability of digital interventions, such as marital status, medication use and severity of depression

Evaluation de 10 ans de politique de lutte contre le cancer 2004-2014

National audienc

Evaluation de 10 ans de politique de lutte contre le cancer 2004-2014

National audienc