The Health Impact of Symptomatic Adult Spinal Deformity: Comparison of Deformity Types to United States Population Norms and Chronic Diseases.

Study designA retrospective analysis of a prospective, multicenter database.ObjectiveThe aim of this study was to evaluate the health impact of symptomatic adult spinal deformity (SASD) by comparing Standard Form Version 2 (SF-36) scores for SASD with United States normative and chronic disease values.Summary of background dataRecent data have identified radiographic parameters correlating with poor health-related quality of life for SASD. Disability comparisons between SASD patients and patients with chronic diseases may provide further insight to the disease burden caused by SASD.MethodsConsecutive SASD patients, with no history of spine surgery, were enrolled into a multicenter database and evaluated for type and severity of spinal deformity. Baseline SF-36 physical component summary (PCS) and mental component summary (MCS) values for SASD patients were compared with reported U.S. normative and chronic disease SF-36 scores. SF-36 scores were reported as normative-based scores (NBS) and evaluated for minimally clinical important difference (MCID).ResultsBetween 2008 and 2011, 497 SASD patients were prospectively enrolled and evaluated. Mean PCS for all SASD was lower than U.S. total population (ASD = 40.9; US = 50; P < 0.05). Generational decline in PCS for SASD patients with no other reported comorbidities was more rapid than U.S. norms (P < 0.05). PCS worsened with lumbar scoliosis and increasing sagittal vertical axis (SVA). PCS scores for patients with isolated thoracic scoliosis were similar to values reported by individuals with chronic back pain (45.5 vs 45.7, respectively; P > 0.05), whereas patients with lumbar scoliosis combined with severe sagittal malalignment (SVA >10 cm) demonstrated worse PCS scores than values reported by patients with limited use of arms and legs (24.7 vs 29.1, respectively; P < 0.05).ConclusionsSASD is a heterogeneous condition that, depending upon the type and severity of the deformity, can have a debilitating impact on health often exceeding the disability of more recognized chronic diseases. Health care providers must be aware of the types of SASD that correlate with disability to facilitate appropriate diagnosis, treatment, and research efforts.Level of evidence3

Limited morbidity and possible radiographic benefit of C2

Background: The study aims to evaluate differences in alignment and clinical outcomes between surgical cervical deformity (CD) patients with a subaxial upper-most instrumented vertebra (UIV) and patients with a UIV at C2. Use of CD-corrective instrumentation in the subaxial cervical spine is considered risky due to narrow subaxial pedicles and vertebral artery anatomy. While C2 fixation provides increased stability, the literature lacks guidelines indicating extension of CD-corrective fusion from the subaxial spine to C2. Methods: Included: operative CD patients with baseline (BL) and 1-year postop (1Y) radiographic data, cervical UIV ≥ C2. Patients were grouped by UIV: C2 or subaxial (C3-C7) and propensity score matched (PSM) for BL cSVA. Mean comparison tests assessed differences in BL and 1Y patient-related, radiographic, and surgical data between UIV groups, and BL-1Y changes in alignment and clinical outcomes. Results: Following PSM, 31 C2 UIV and 31 subaxial UIV patients undergoing CD-corrective surgery were included. Groups did not differ in BL comorbidity burden (P=0.175) or cSVA (P=0.401). C2 patients were older (64 Conclusions: C2 UIV patients showed similar cervical range of motion and baseline to 1-year functional outcomes as patients with a subaxial UIV. C2 UIV patients also showed greater baseline to 1-year horizontal gaze improvement and had complication profiles similar to subaxial UIV patients, demonstrating the radiographic benefit and minimal functional loss associated with extending fusion constructs to C2. In the treatment of adult cervical deformities, extension of the reconstruction construct to the axis may allow for certain clinical benefits with less morbidity than previously acknowledged

DMTs and Covid-19 severity in MS: a pooled analysis from Italy and France

We evaluated the effect of DMTs on Covid-19 severity in patients with MS, with a pooled-analysis of two large cohorts from Italy and France. The association of baseline characteristics and DMTs with Covid-19 severity was assessed by multivariate ordinal-logistic models and pooled by a fixed-effect meta-analysis. 1066 patients with MS from Italy and 721 from France were included. In the multivariate model, anti-CD20 therapies were significantly associated (OR = 2.05, 95%CI = 1.39–3.02, p < 0.001) with Covid-19 severity, whereas interferon indicated a decreased risk (OR = 0.42, 95%CI = 0.18–0.99, p = 0.047). This pooled-analysis confirms an increased risk of severe Covid-19 in patients on anti-CD20 therapies and supports the protective role of interferon

Difficulty adhering to antidiabetes treatment : factors associated with persistence and compliance.

Aims. – This study aimed to assess the 1-year treatment persistence and compliance of new oral antidiabetic drug (OAD) users with their treatment, and to identify the factors associated with both persistence and compliance. Methods. – This population-based cohort study of new OAD users aged 18 years or above used the Quebec health insurance board databases. Those having a prescription filled for antidiabetic treatment during the period leading up to the 1-year anniversary of their first claim were considered to be persistent with their antidiabetic treatment. Of these patients, individuals with a medication possession ratio (MPR) greater or equal to 80% for OAD or insulin were deemed compliant. Also identified were the characteristics associated with both outcomes, using a multivariate logistic regression model. Results. – Our cohort consisted of 151,173 individuals, 119,832 (79.3%) of whom were considered persistent. Of these, 93,418 (78.0%) were also deemed compliant. Persistence and compliance were associated with older ages, living in a rural region, low socioeconomic status, having the first OAD prescribed by a general practitioner and a history of using five different drugs or more. People were less likely to be persistent and compliant if their initial OAD was a secretagogue and if they had consulted a physician eight times or more during the year prior to starting treatment. Conclusion. – One year after OAD treatment initiation, 21% had discontinued their treatment and 22% of those still being treated were non-compliant. These results could help to tailor interventions aimed at optimizing the use of OAD treatments.La difficulté à adhérer à un traitement antidiabétique : les facteurs associés à la persistance et à l’observance. Buts. – Déterminer la persistance au traitement chez les nouveaux utilisateurs d’antidiabétique oral (ADO) un an après l’initiation du traitement. Parmi les persistants, évaluer leur observance du traitement et, enfin, identifier les facteurs associés à la persistance et à l’observance. Méthodes. – Nous avons effectué une étude de cohorte populationnelle de nouveaux utilisateurs d’ADO âgés de 18 ans ou plus en utilisant les banques de données de la Régie de l’assurance maladie du Québec. Les personnes qui ont acquis une ordonnance pour un traitement antidiabétique dans la période précédant le premier anniversaire de leur première acquisition ont été considérées persistantes à prendre leur traitement antidiabétique. Parmi ces personnes, celles pour qui plus de 80 % des jours étaient couverts par un ADO ou de l’insuline ont été considérées observantes. Nous avons identifié les caractéristiques associées à la persistance et à l’observance en utilisant un modèle de régression logistique multivariée. Résultats. – Notre cohorte était composée de 151 173 individus dont 119 832 (79,3 %) étaient considérés persistants. De ces individus, 93 418 (78,0 %) ont été jugés observants. La persistance et l’observance étaient associées à l’augmentation de l’âge, au fait de vivre dans une région rurale, à un statut socioéconomique bas, au fait que le premier ADO prescrit l’ait été par un médecin généraliste et au fait d’avoir utilisé cinq médicaments différents ou plus dans l’année précédente. Les individus étaient moins susceptibles d’être persistants et observants si le premier ADO prescrit était une sulfonylurée et s’ils avaient consulté un médecin huit fois ou plus dans l’année précédant l’initiation de leur ADO. Conclusions. – Un an après l’initiation d’un traitement ADO, 21 % des individus avaient cessé leur traitement et 22 % de ceux toujours traités n’étaient pas observants. Ces résultats pourront guider le développement d’interventions ciblées visant à favoriser l’usage optimal des antidiabétique

Leçons méthodologiques tirées du modèle logique du programme de prévention « Une Affaire de Famille »

International audienceContexte : Ces trois dernières décennies, ont vu émerger un consensus sur la nécessité de fonder l’évaluation des programmes sur la logique d’intervention (ou théorie du programme). Cette approche permet d’identifier les indicateurs d’évaluation à partir des fonctions génératrices des changements attendus.Dans cette communication, nous présentons quelques enseignements méthodologiques tirés de l’analyse d’un programme de prévention de la transmission intergénérationnelle des conduites addictives : « Une affaire de famille ! » (UADF). Le programme, développé au Québec, est déployé en Normandie et à La Réunion par Association Addictions France (AAF) et leurs partenaires.Méthode : Afin d’identifier la logique d’intervention d’UADF, les traces écrites du programme ont été collectées. Des entretiens semi-directifs ont ensuite été réalisés sur les deux sites de mise en œuvre, auprès des professionnels d’AAF, puis auprès des participants.Ces données ont fait l’objet d’une analyse de contenu à partir d’une grille de codification reprenant les catégories de notre modèle logique conceptuel (activités, impacts proximaux et intermédiaires, effets ultimes attendus).Résultats : L’identification des activités et des locus de changement d’UADF dans les deux régions a montré que le programme québécois avait fait l’objet d’adaptation au niveau de sa forme ; ceci afin de prendre en compte les spécificités et les contraintes des participants recrutés. L’analyse met en lumière la façon dont les fonctions du programme ont été affectées par ces modifications.Par ailleurs, plusieurs activités de soutien du programme et de recrutement des participants ont montré l’enjeu de la mobilisation des populations les plus susceptibles de bénéficier du programme. Discussion : Notre étude, en mobilisant différentes sources de données, a fait ressortir plusieurs enjeux du transfert d’un programme vers une autre population et vers un autre contexte de pratique. La modélisation de la logique d’intervention ressort comme une étape cruciale préalable à l’évaluation des changements générés par le programme

Qualité des données NGS : de la séquence aux bases de données

Qualité des données NGS : de la séquence aux bases de donnée

Effectiveness of an asthma integrated care program on asthma control and adherence to inhaled corticosteroids

<div><p></p><p><i>Objective</i>: To measure the effectiveness of an integrated care program for individuals with asthma aged 12–45 years, on asthma control and adherence to inhaled corticosteroids (ICS). <i>Methods</i>: Researchers used a theoretical model to develop the program and assessed effectiveness at 12 months, using a pragmatic controlled clinical trial design. Forty-two community pharmacists in Quebec, Canada recruited participants with either uncontrolled or mild-to-severe asthma. One group was exposed to the program; another received usual care. Asthma control was measured with the Asthma Control Questionnaire; ICS adherence was assessed with the Morisky medication adherence scale and the medication possession ratio. Program effectiveness was assessed with an intention-to-treat approach using multivariate generalized estimating equation models. <i>Results</i>: Among 108 exposed and 241 non-exposed, 52.2% had controlled asthma at baseline. At 12-months, asthma control had improved in both groups but the interaction between study groups and time was not significant (<i>p</i> = 0.09). The proportion of participants with good ICS adherence was low at baseline. Exposed participants showed improvement in adherence and the interaction between study groups and time was significant (<i>p</i> = 0.02). <i>Conclusion</i>: An integrated intervention, with healthcare professionals collaborating to optimize asthma control, can improve ICS adherence.</p></div