Evaluation of physiotherapy in a prospective cohort of early axial spondyloarthritis. Data from the DESIR cohort

International audienc

Respective contribution of chronic conditions to disability in France: results from the national Disability-Health Survey.

BACKGROUND: Representative national data on disability are becoming increasingly important in helping policymakers decide on public health strategies. We assessed the respective contribution of chronic health conditions to disability for three age groups (18-40, 40-65, and >65 years old) using data from the 2008-2009 Disability-Health Survey in France. METHODS: Data on 12 chronic conditions and on disability for 24,682 adults living in households were extracted from the Disability-Health Survey results. A weighting factor was applied to obtain representative estimates for the French population. Disability was defined as at least one restriction in activities of daily living (ADL), severe disability as the inability to perform at least one ADL alone, and self-reported disability as a general feeling of being disabled. To account for co-morbidities, we assessed the contribution of each chronic disorder to disability by using the average attributable fraction (AAF). FINDINGS: We estimated that 38.8 million people in France (81.7% [95% CI 80.9;82.6]) had a chronic condition: 14.3% (14.0;14.6) considered themselves disabled, 4.6% (4.4;4.9) were restricted in ADL and 1.7% (1.5;1.8) were severely disabled. Musculoskeletal and sensorial impairments contributed the most to self-reported disability (AAF 15.4% and 12.3%). Neurological and musculoskeletal diseases had the largest impact on disability (AAF 17.4% and 16.4%, respectively). Neurological disorders contributed the most to severe disability (AAF 31.0%). Psychiatric diseases contributed the most to disability categories for patients 18-40 years old (AAFs 23.8%-40.3%). Cardiovascular conditions were also among the top four contributors to disability categories (AAFs 8.5%-11.1%). CONCLUSIONS: Neurological, musculoskeletal, and cardiovascular chronic disorders mainly contribute to disability in France. Psychiatric impairments have a heavy burden for people 18-40 years old. These findings should help policymakers define priorities for health-service delivery in France and perhaps other developed countries

Benefits of homeopathic complementary treatment in breast cancer patients. A retrospective cohort.

International audienceIntroduction: There is a growing use of complementary therapy in oncology and homeopathy features prominently. Their purpose is to help patients better cope with the illness and the side effects (SEs) of cancer treatments that particularly affect quality of life (HRQOL). However, there are few comparative studies. The objective of this study is to assess the benefits of homeopathy treatment on the HRQOL for patients with non-metastatic breast cancer (BC), prescribed in post-surgical complementary therapy, compared to treatment without homeopathy.Methods: An extraction from the French nationwide healthcare database targeted all patients who underwent mastectomy for newly diagnosed BC during 2012-2013. HRQOL was assessed through proxies, primarily the use of medication palliating the SEs of cancer treatments. Exposure to homeopathy and use of SEs medication were measured by the number of dispensing. The association was assessed using a Random Effect Poisson Count Model, with adjustment for co-factors.Results: 98,009 patients were included (mean age 61.1). Patients taking homeopathy appeared to have less cardiovascular and diabetes comorbidities. Usage of homeopathy was observed in 11% of patients 7-12 months before surgery, 26% during the 6 months before surgery, 22% during the 6 months after, 18% 7-12 months after, then stable at 15% for 4 years. During the six months after surgery, there was a significant overall decrease (RR=0.88, CI95=[0.87; 0.89]) in the dispensing of SEs medication for patients with ?3 homeopathy dispensing vs. none. Decrease appeared to be greater for immunostimulants (RR=0.79, CI95=[0.74; 0.84]), corticosteroids (RR=0.82, CI95=[0.79; 0.85]), antidiarrheals (RR=0.83, CI95=[0.77; 0.88]), systemic antifungals (RR=0.86, CI95=[0.8; 0.92]), and antiemetics (RR=0.9, CI955=[0.87; 0.93]).Conclusion: The study showed a rising use of homeopathy by patients with BC, starting with diagnosis. This use was sustained after surgery and seemed to play an important role in helping to better tolerate SEs of cancer treatments

Development and validation of a questionnaire assessing fears and beliefs of patients with knee osteoarthritis: the Knee Osteoarthritis Fears and Beliefs Questionnaire (KOFBeQ).

ObjectiveWe aimed to develop a questionnaire assessing fears and beliefs of patients with knee OA.DesignWe sent a detailed document reporting on a qualitative analysis of interviews of patients with knee OA to experts, and a Delphi procedure was adopted for item generation. Then, 80 physicians recruited 566 patients with knee OA to test the provisional questionnaire. Items were reduced according to their metric properties and exploratory factor analysis. Reliability was tested by the Cronbach α coefficient. Construct validity was tested by divergent validity and confirmatory factor analysis. Test-retest reliability was assessed by the intra-class correlation coefficient (ICC) and the Bland and Altman technique.Results137 items were extracted from analysis of the interview data. Three Delphi rounds were needed to obtain consensus on a 25-item provisional questionnaire. The item-reduction process resulted in an 11-item questionnaire. Selected items represented fears and beliefs about daily living activities (3 items), fears and beliefs about physicians (4 items), fears and beliefs about the disease (2 items), and fears and beliefs about sports and leisure activities (2 items). The Cronbach α coefficient of global score was 0.85. We observed expected divergent validity. Confirmation factor analyses confirmed higher intra-factor than inter-factor correlations. Test-retest reliability was good, with an ICC of 0.81, and Bland and Altman analysis did not reveal a systematic trend.ConclusionsWe propose an 11-item questionnaire assessing patients' fears and beliefs concerning knee OA with good content and construct validity

Apports de la prise en charge homéopathique en soins de support dans le cancer du sein : Impact sur la consommation des traitements palliant les effets indésirables liés à la prise en charge du cancer du sein - Étude d’après les données du Système National des Données de Santé (SNDS)

International audienceIntroductionOn observe un recours croissant aux soins de support associés aux traitements conventionnels du cancer, (plus de 40 % des patients), et l’homéopathie occupe une place prépondérante (> 60 %). Le but est d’aider les patients à mieux supporter la maladie et les effets indésirables (EI) des traitements anticancéreux qui affectent particulièrement la qualité de vie (QDV). Cependant, il n’existe que peu d’études comparatives à ce sujet.ObjectifL’objectif est d’évaluer, en France, les bénéfices sur la QDV pour les patientes atteintes d’un cancer du sein non métastatique, d’une prise en charge homéopathique, prescrite en soins oncologiques de support post-chirurgie, comparativement à une prise en charge sans homéopathie.MéthodeUne extraction du SNDS a ciblé sur la période 2012-2013 l’ensemble des patientes françaises ayant eu recours à une mastectomie pour un cancer du sein nouvellement diagnostiqué. Les données analysées portent sur 2 ans avant la chirurgie et 5 ans après. L’évaluation de la QDV est réalisée à l’aide d’indicateurs indirects et en premier lieu la consommation des médicaments palliant les EI des traitements du cancer.L’exposition à l’homéopathie et la consommation des traitements palliant les EI sont déterminées selon le nombre de délivrances. L’évaluation de leur association est réalisée à l’aide d’un modèle de Poisson mixte ajusté avec effet aléatoire sur le patient, par périodes successives de 180 jours, avec facteurs d’ajustement (chimiothérapies et radiothérapie, comorbidités, continuité des soins, pratique homéopathique du médecin le plus consulté).RésultatsUn total de 98 009 patientes a été inclus (97,8 % de stade I-II), 21 % avec une mastectomie totale. L’âge moyen est de 61 ans (± 13). Les patientes consommant de l’homéopathie semblent moins défavorisées, présentent moins d’antécédents cardiovasculaires (8 % vs 10 %), sont moins traitées par antidiabétiques (6 % vs 8 %) et par antihypertenseurs ou hypolipémiants (39 % vs 44 %). Il n’y a pas de différence concernant les autres comorbidités. Par ailleurs, la consommation de produits homéopathiques semble associée à davantage d’arrêts de travail.La consommation de produits homéopathiques, observée chez 11 % des patientes de 7 à 12 mois avant chirurgie (avant le diagnostic), progresse à 26 % durant les 6 mois avant chirurgie, puis 22 % durant les 6 mois après, 18 % de 7 à 12 mois après et demeure ensuite stable à 15 % durant les 4 ans qui suivent. Au cours du premier semestre après chirurgie, on observe une diminution globale significative (RR = 0,88, IC95= [0,87 ; 0,89]) des délivrances des médicaments palliant les EI pour les patientes ayant 3 délivrances ou plus d’homéopathie vs aucune. Cette diminution apparait plus importante pour les immunostimulants (RR = 0,79, IC95= [0,74 ; 0,84]), les corticoïdes (RR = 0,82, IC95= [0,79 ; 0,85]), les antidiarrhéiques (RR = 0,83, IC95= [0,77 ; 0,88]), les antifongiques à usage systémique (RR = 0,86, IC95= [0,8 ; 0,92]), et les antémétiques (RR = 0,9, IC95= [0,87 ; 0,93]).ConclusionL’étude révèle une augmentation du recours à l’homéopathie par les patientes atteintes d’un cancer du sein dès l’annonce du diagnostic. Cet usage se poursuit après chirurgie et semble jouer un rôle important en aidant à mieux supporter les EI des traitements. Cette étude est l’une des premières à notre connaissance à mettre en lumière l’exploitation possible des données du SNDS dans le but d’évaluer les bénéfices attendus sur la QDV des patients

Reduced risk of cancer among low‐dose aspirin users: Data from French health care databases

International audiencePURPOSE: The effect of chronic use of low-dose aspirin (LDA) on overall cancer is still unclear owing to many controversial results and methodological limitations of studies. This study aimed to assess the effect of LDA use on overall cancer incidence among the French population.METHODS: We conducted a 10-year historical cohort study using the permanent sample of the French national health care databases: the Système National des Données de Santé (SNDS). We used data for 111 025 individuals aged 50 to 80 years at study entry (January 1, 2006) without prevalent cancer or LDA use. Individuals were followed until the earliest of cancer incidence, death from any cause, exit from the database, or end of the study on December 31, 2015. We estimated the effect of LDA on cancer incidence by using a dynamic model to account for the competing risk of death in the presence of time-dependent exposure and risk factors.RESULTS: LDA use was associated with reduced 10-year risk of cancer (subdistribution hazard ratio [SHR] 0.81 [95% CI 0.77-0.86]). The SHRs were 0.88 [0.82-0.94] for men and 0.93 [0.85-1.02] for women. Moreover, each additional year of LDA use was associated with reduced 10-year risk of cancer (SHR 0.93 [0.92-0.95]). LDA use was also associated with reduced 10-year risk of death (SHR 0.86 [0.82-0.91]).CONCLUSIONS: This is the first population-based study to demonstrate a protective effect of LDA on overall cancer incidence and to account for the main methodological issues of previous observational studies

Effect of adherence to European treatment recommendations on early arthritis outcome: data from the ESPOIR cohort.

International audienceOBJECTIVE: To assess the association of adherence to the 2007 recommendations of the European League Against Rheumatism (EULAR) for managing early arthritis and radiographic progression and disability in patients METHODS: The authors conducted a prospective population-based cohort study. The ESPOIR cohort was a French cohort of 813 patients with early arthritis not receiving disease-modifying antirheumatic drugs (DMARDs). Adherence to the 2007 EULAR recommendations was defined by measuring adherence to three of the recommendations concerning the initiation and early adjustment of DMARDs. The study endpoints were radiographic progression, defined as the presence of at least one new erosion between baseline and 1 year, and disability as a heath assessment questionnaire score ≥1 at 2 years. A propensity score of being treated according to the recommendations was developed. RESULTS: After adjustment for propensity score, treatment centre and the main confounding factors, patients without recommendation adherence were at increased risk of radiographic progression at 1 year, and of functional impairment at 2 years (OR 1.98, (95% CI: 1.08 to 3.62 and OR: 2.36, (95% CI: 1.17 to 4.67), respectively). CONCLUSIONS: Early arthritis patients whose treatment adhered to the 2007 EULAR recommendations seemed to benefit from such treatment in terms of risk of clinical and radiographic progression. Using a propensity score of being treated according to recommendations in observational studies may be useful in assessing the potential impact of these recommendations on outcome