Geochemical and geochronological characteristics of palaeozoic volcanism in the Saint Georges sur Loire synclinorium (S. Armorican massif). Evidance for pre-hercynian tectonic evolution

International audienc

Création et validation d'un outil de détection de la fraude par falsification d'ordonnance à partir des bases de données de l'Assurance Maladie

Objectifs. Permettre la détection des ordonnances falsifiées qui ont été délivrées et remboursées. 
Méthode. 1- Sélection dans les bases régionales de l'assurance maladie de patients à comportement hautement suspect de fraude (multiprésentation de la même ordonnance, le même jour dans plusieurs pharmacies différentes) 2- Attribution d'un "diagnostic" de fraude par le CEIP (Centre d'Évaluation et d'Information sur la Pharmacodépendance) à partir des données transmises et par le service médical (analyse de l'ensemble du dossier et convocation éventuelle) 3- Calcul des qualités métrologiques de l'outil. 
Résultats. Ont été sélectionnés 2030 patients ; parmi eux 25 patients ont obtenu à l'aide de 114 ordonnances, 553 délivrances dans 288 pharmacies en un an. La spécificité de notre outil est de 99,5 % et sa sensibilité de 69,4 %. 
Conclusion. La création de cet outil automatisable et utilisable à grande échelle apporte un nouvel éclairage dans l'évaluation, en permettant une détection a posteriori de la fraude

Réactivité et communication des décisions de pharmacovigilance des autorités de santé vers les professionnels de santé : exemples du pergolide et du célécoxib

Objectifs : Évaluer l'impact des communications des autorités de santé sur les pratiques médicales à travers deux exemples : célécoxib et prise en compte de la nouvelle contre-indication concernant les risques cardio-vasculaires ; pergolide et prise en compte du risque de valvulopathie cardiaque. Matériel et méthodes : Suivi dans la base de données de l'assurance maladie des Pays de Loire du nombre de patients à risque cardiovasculaire recevant du célécoxib et de la surveillance cardiologique chez les patients exposés au pergolide. Résultats : Pour le célécoxib, après communication des autorités de santé, on observe une diminution majeure (71,9 %) du nombre de patients à risque exposés et pour le pergolide on observe une diminution de 14 % des patients qui n'ont aucun suivi cardiologique (183 patients au lieu de 222 parmi les 277 patients traités pendant au moins 6 mois). Conclusions : L'information concernant le célécoxib a été complètement suivie contrairement à celle concernant le pergolide. La différence semble se situer dans la médiatisation

Did the new French pay-for-performance system modify benzodiazepine prescribing practices?

International audienceBACKGROUND: French general practitioners (GPs) were enrolled in a new payment system in January 2012. As part of a national agreement with the French National Ministry of Health, GPs were asked to decrease the proportion of patients who continued their benzodiazepine treatment 12 weeks after its initiation and to decrease the proportion of patients older than 65 who were prescribed long half-life benzodiazepines. In return, GPs could expect an extra payment of up to 490 euros per year. This study reports the evolution of the corresponding prescribing practices of French GPs during that period regarding patients who were prescribed a benzodiazepine for the first time. METHODS: The national healthcare system's administrative database was used to report the longitudinal follow-up of two historical cohorts of French patients from the Pays de la Loire area. STUDY PATIENTS: The "2011" and "2012" cohorts included all patients who initiated benzodiazepine regimens from April 1 to June 30 in 2011 and 2012, respectively.The primary outcomes were the proportion of those study patients who continued benzodiazepine treatment after 12 weeks and the proportion of study patients >65 years who were prescribed long half-life benzodiazepines.Analyses were performed using a multi-level regression. RESULTS: In total, 41,436 and 42,042 patients initiated benzodiazepine treatment in 2011 and 2012, respectively. A total of 18.97% of patients continued treatment for more than 12 weeks in 2012, compared with 18.18% in 2011. In all, 27.43% and 28.06% of patients >65 years continued treatment beyond 12 weeks in 2011 and 2012, respectively. The proportion of patients >65 years who were prescribed long half-life benzodiazepines decreased from 53.5% to 48.8% (p 65 years who were prescribed short half-life benzodiazepines were more likely to continue treatment after 12 weeks (p < 0.005). CONCLUSIONS: Despite the pay-for-performance strategy, the number of short half-life benzodiazepine prescriptions increased between 2011 and 2012, and the number of long half-life benzodiazepine initiations remained unchanged. Reducing the proportion of long half-life benzodiazepine prescriptions might be counterproductive because prescribing short half-life benzodiazepines was associated with higher rates of continuation beyond the recommended duration

Influence of Socioeconomic Status on Antipsychotic Prescriptions among Youth in France

International audienceRecent studies analysing the trends in antipsychotic (AP) prescriptions for children and adolescents have raised concerns regarding the influence of socioeconomic status. Previous findings have also shown variable prescription rates for first-generation (FG) and second-generation (SG) APs. Method Our objectives were to assess the proportion of patients from low-income families receiving APs and the most commonly prescribed APs in France. We conducted a descriptive analysis of AP drugs dispensed during a 1-year period (July 1, 2013–June 30, 2014) in a northwestern region of France with 941,857 subjects less than 18 years old. All data were extracted from an exhaustive, individual and anonymous social security database. We obtained each subject’s socioeconomic status (by identifying their affiliation with a specific social security program) and also collected sociodemographic data, drug type, prescribing and dispensing dates and amount, and prescriber type (e.g., hospital physician, general practitioner, psychiatrist, paediatrician). Results There were two main novel findings. First, we found that the proportion of patients with AP prescriptions was nearly ten times higher in low-income families than in the general population: 35.9% of CMU-C patients compared to 3.7% in all of Pays de la Loire (X 2 = 7875.1, p < 0.001). Additionally, we found a higher rate of FGAP than SGAP prescriptions (65% vs. 57%). Conclusions Our study suggests two types of AP misuse that could provide interesting targets for public healthcare interventions. First, our results strongly suggest an over-representation of patients from low-income families. Low-income families primarily resided in areas with low physician density and appeared to receive drugs to treat their conditions more frequently than other individuals. This increased prescription rate is a public health issue, potentially requiring political action. Second, the use of FGAPs did not adhere to the latest recommendations for drug use in this population, and this discrepancy should be addressed with informational campaigns targeted to medical practitioners

Influence of socioeconomic status on antipsychotic prescriptions among youth in France

Background: Recent studies analysing the trends in antipsychotic (AP) prescriptions for children and adolescents have raised concerns regarding the influence of socioeconomic status. Previous findings have also shown variable prescription rates for first-generation (FG) and second-generation (SG) APs.Method: Our objectives were to assess the proportion of patients from low-income families receiving APs and the most commonly prescribed APs in France. We conducted a descriptive analysis of AP drugs dispensed during a 1-year period (July 1, 2013-June 30, 2014) in a northwestern region of France with 941,857 subjects less than 18 years old. All data were extracted from an exhaustive, individual and anonymous social security database. We obtained each subject's socioeconomic status (by identifying their affiliation with a specific social security program) and also collected sociodemographic data, drug type, prescribing and dispensing dates and amount, and prescriber type (e.g., hospital physician, general practitioner, psychiatrist, paediatrician).Results: There were two main novel findings. First, we found that the proportion of patients with AP prescriptions was nearly ten times higher in low-income families than in the general population: 35.9% of CMU-C patients compared to 3.7% in all of Pays de la Loire (X-2 = 7875.1, p < 0.001). Additionally, we found a higher rate of FGAP than SGAP prescriptions (65% vs. 57%).Conclusions: Our study suggests two types of AP misuse that could provide interesting targets for public healthcare interventions.First, our results strongly suggest an over-representation of patients from low-income families. Low-income families primarily resided in areas with low physician density and appeared to receive drugs to treat their conditions more frequently than other individuals. This increased prescription rate is a public health issue, potentially requiring political action. Second, the use of FGAPs did not adhere to the latest recommendations for drug use in this population, and this discrepancy should be addressed with informational campaigns targeted to medical practitioners

Interaction between CYP2D6 Inhibitor Antidepressants and Codeine: Is This Relevant?

International audienceINTRODUCTION: Co-occurring pain impairs depression's prognosis. Selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs) are first-line pharmacotherapies for depression and inhibit many cytochrome 2D6 enzymes. Codeine is a first-line treatment for pain and needs to be metabolized into morphine by cytochrome 2D6 to exert its analgesic effect. Concomitant prescription of both pharmacotherapies leads to inadequate analgesia. Areas covered: We performed a systematic review of the literature to amalgamate the current knowledge regarding the clinical effect of this association and quantified its prevalence in clinical practice in the French Pays de la Loire area using a retrospective observational cohort study design. Expert opinion: The literature review highlighted that antidepressants with moderate-to-strong inhibition of CYP2D6 should be avoided in patients receiving codeine. However, 0.44% of the 12,296 sampled patients received concomitant codeine and CYP2D6 inhibitor between January 2015 and June 2015. Switching drugs in both painful and depressive patients depends on the pain and depression subtypes. Promising drugs that both show an effect on pain and depression are currently being studied but are not usable in clinical practice. Until then, tailored communication reinforcement toward health-care professionals is needed to prevent these problematic occurrences of concomitant prescription administration