473 research outputs found
Social heterogeneity in self-reported health status and measurement of inequalities in health
This study aims to analyse the impact of the measurement of health status on socioeconomic inequalities in health. A MIMIC model with structural equations is used to create a latent variable of health status from four health indicators: self-assessed health, report of chronic diseases, report of activity limitations and mental health. Then, we disentangle the impact of sociodemographic characteristics on latent health from their direct impact on each heath indicator and discuss their effects on the assessment of socioeconomic inequalities in health. This study emphasises differences in inequalities in health according to latent health. In addition, it suggests the existence of reporting heterogeneity biases. For a given latent health status, women and old people are more likely to report chronic diseases. Mental health problems are over-reported by women and isolated people and under-reported by the oldest people. Active and retired people as well as non manual workers in the top of the social hierarchy more often report activity limitations. Finally, highly educated and socially advantaged people more often report chronic diseases whereas less educated people under-report a poor self-assessed health. To conclude, the four health indicators suffer from reporting heterogeneity biases and the report of chronic diseases is the indicator which biases the most the measurement of socioeconomic inequalities in health.inequalities in health - MIMIC - reporting bias - structural equations
The prediction and monitoring of toxicity associated with long-term systemic glucocorticoid therapy
Glucocorticoids are often required for adequate control of inflammation in many serious inflammatory diseases; common indications for long-term treatment include polymyalgia rheumatica, giant cell arteritis, asthma and chronic obstructive pulmonary disease. Long-term glucocorticoid therapy is, however, associated with many adverse effects involving skin, gastro-intestinal, eye, skeletal muscle, bone, adrenal, cardio-metabolic and neuropsychiatric systems. This balance between benefits and risks of glucocorticoids is important for clinical practice and glucocorticoid-related adverse effects can significantly impair health-related quality of life. Understanding the nature and mechanisms of glucocorticoid-related adverse effects may inform how patients are monitored for toxicity and identify those groups, such as older people, that may need closer monitoring. For clinical trials in diseases commonly treated with glucocorticoids, standardised measurement of glucocorticoid-related adverse effects would facilitate future evidence synthesis and meta-analysis
La santé des seniors selon leur origine sociale et la longévité de leurs parents.
Les descendants des cadres dirigeants et professions intellectuelles ont-ils une meilleure santĂ© que les descendants dâouvriers ? Est-ce que la longĂ©vitĂ© des parents infl uence lâĂ©tat de santĂ© Ă lâĂąge adulte ? Ces deux questions interrogent lâexistence dâinĂ©galitĂ©s des chances en santĂ©. La premiĂšre question a dĂ©jĂ fait lâobjet de travaux de recherche : lâinfl uence du milieu social dâorigine rĂ©sulterait Ă la fois dâun effet direct des conditions de vie dans lâenfance sur la santĂ© Ă lâĂąge adulte et dâun effet indirect passant par lâinfl uence du milieu dâorigine sur le statut socioĂ©conomique du descendant. La seconde, qui concerne une transmission de la santĂ© entre les gĂ©nĂ©rations a Ă©tĂ© peu explorĂ©e. Cependant, une infl uence directe de lâĂ©tat de santĂ© des parents sur celui de leurs enfants devenus adultes peut ĂȘtre envisagĂ©e du fait non seulement dâun patrimoine gĂ©nĂ©tique commun mais aussi de prĂ©fĂ©rences similaires pour la santĂ© et dâune reproduction des comportements liĂ©s Ă la santĂ©. Ă partir des donnĂ©es de lâenquĂȘte Share, cette recherche Ă©tudie, pour la premiĂšre fois en France, le rĂŽle de la profession des deux parents et de leur Ă©tat de santĂ©, sur celui de leurs descendants Ă lâĂąge adulte, en contrĂŽlant pour les caractĂ©ristiques socioĂ©conomiques de ceux-ci. La comparaison des distributions de santĂ© des seniors selon le milieu social dâorigine et la longĂ©vitĂ© des ascendants directs tĂ©moignent de lâexistence dâinĂ©galitĂ©s des chances en santĂ© chez les seniors. Au-delĂ de son association avec la situation sociale actuelle de lâindividu, lâĂ©tat de santĂ© Ă lâĂąge adulte est directement infl uencĂ© par le statut socioĂ©conomique de la mĂšre, le statut socioĂ©conomique du pĂšre ayant au contraire une infl uence indirecte passant par la dĂ©termination du statut socioĂ©conomique de lâenfant. Une transmission intergĂ©nĂ©rationnelle de la santĂ© est Ă©galement observĂ©e : la longĂ©vitĂ© relative du pĂšre et en particulier son statut vital infl uence la santĂ© Ă lâĂąge adulte.Intergenerational transmission; Economie de la santĂ©; Seniors; Origine sociale; Statistiques;
Iatrogénie des diurétiques dans l insuffisance cardiaque (étude de 50 cas)
Cette thÚse consiste dans un premier temps, en une description des différentes formes d insuffisance cardiaque et quelques données épidémiologiques, des maniÚres de diagnostiquer la pathologie ainsi que les différents traitements adaptés à chaque type de formes décrites. Dans un second temps, elle consiste plus particuliÚrement en un exposé de la iatrogénie des diurétiques, des mécanismes mis en place par l organisme lors de l installation d une insuffisance rénale aiguë. Dans un dernier temps, les résultats d une étude incluant 50 patients insuffisants cardiaques sont publiés. La recherche des facteurs prédictifs d insuffisance rénale chez ces patients et donc de prolongation de l hospitalisation ou l augmentation de la mortalité ont été déterminés. Une discussion sur cette étude a ensuite été entreprise.ROUEN-BU Médecine-Pharmacie (765402102) / SudocSudocFranceF
Origine sociale et Ă©tat de santĂ© des parents : Quelle influence sur lâĂ©tat de santĂ© Ă lâĂąge adulte ?.
Parmi les facteurs explicatifs proposĂ©s pour expliquer les inĂ©galitĂ©s sociales de santĂ©, la littĂ©rature Ă©pidĂ©miologique a rĂ©cemment mis en avant lâinfluence du milieu social dâorigine sur lâĂ©tat de santĂ© Ă lâĂąge adulte, cette influence rĂ©sultant Ă la fois dâun effet direct des conditions de vie dans lâenfance sur la santĂ© (latency model) et dâun effet indirect passant par lâinfluence du milieu dâorigine sur le statut socioĂ©conomique de lâenfant (pathway model). Par ailleurs, on peut supposer une influence directe de lâĂ©tat de santĂ© des parents sur celui des enfants, sâexpliquant non seulement par un patrimoine gĂ©nĂ©tique commun mais aussi par une transmission des comportements liĂ©s Ă la santĂ©. A partir dâune exploitation de lâenquĂȘte SHARE, cette recherche propose dâexplorer ces trois modĂšles, pour la premiĂšre fois en France, en Ă©tudiant le rĂŽle de la profession des deux parents et de leur Ă©tat de santĂ©, sur lâĂ©tat de santĂ© dâun individu Ă lâĂąge adulte, contrĂŽlĂ© par son statut socioĂ©conomique. Les rĂ©sultats montrent que lâĂ©tat de santĂ© Ă lâĂąge adulte, au-delĂ de son association avec la situation sociale actuelle de lâindividu, nâest pas indĂ©pendant de lâorigine sociale ni de lâĂ©tat de santĂ© des parents. La santĂ© Ă lâĂąge adulte semble ĂȘtre directement influencĂ©e par le statut socioĂ©conomique de la mĂšre et lâĂ©tat de santĂ© des deux parents, le statut socioĂ©conomique du pĂšre ayant au contraire une influence indirecte passant par la dĂ©termination du statut socioĂ©conomique de lâenfant. Ces rĂ©sultats suggĂšrent ainsi lâexistence en France dâune inĂ©galitĂ© des chances en matiĂšre de santĂ©.EgalitĂ©s des chances; inĂ©galitĂ©s de santĂ©; transmission intergĂ©nĂ©rationnelle; early life hypothesis;
Cost effectiveness of treatment with percutaneous Kirschner wires versus volar locking plate for adult patients with a dorsally displaced fracture of the distal radius: Analysis from the DRAFFT trial
We present an economic evaluation using data from the Distal Radius Acute Fracture Fixation Trial (DRAFFT) to compare the relative cost effectiveness of percutaneous Kirschner wire (K-wire) fixation and volar locking-plate fixation for patients with dorsally-displaced fractures of the distal radius. The cost effectiveness analysis (cost per quality-adjusted life year; QALY) was derived from a multi-centre, two-arm, parallel group, assessor-blind, randomised controlled trial which took place in 18 trauma centres in the United Kingdom. Data from 460 patients were available for analysis, which includes both a National Health Service cost perspective including costs of surgery, implants and healthcare resource use over a 12-month period after surgery, and a societal perspective, which includes the cost of time off work and the need for additional private care. There was only a small difference in QALYs gained for patients treated with locking-plate fixation over those treated with K-wires. At a mean additional cost of ÂŁ714 (95% confidence interval 588 to 865) per patient, locking-plate fixation presented an incremental cost effectiveness ratio (ICER) of ÂŁ89 322 per QALY within the first 12 months of treatment. Sensitivity analyses were undertaken to assess the ICER of locking-plate fixation compared with K-wires. These were greater than ÂŁ30 000. Compared with locking-plate fixation, K-wire fixation is a 'cost saving' intervention, with similar health benefits
Cost-effectiveness of total hip arthroplasty versus resurfacing arthroplasty : economic evaluation alongside a clinical trial
Objective: To report on the relative cost-effectiveness of total hip arthroplasty and resurfacing arthroplasty (replacement of articular surface of femoral head only) in patients with severe arthritis suitable for hip joint resurfacing arthroplasty.
Design: Cost-effectiveness analysis on an intention-to-treat basis of a single-centre, single-blind randomised controlled trial of 126 adult patients within 12â
months of treatment. Missing data were imputed using multiple imputations with differences in baseline quality of life and gender adjusted using regression techniques.
Setting: A large teaching hospital trust in the UK.
Participants: A total of 126 adult patients with severe arthritis of the hip joint suitable for a resurfacing arthroplasty of the hip.
Results: Data were received for 126 patients, 4 of whom did not provide any resource use data. For the remainder, data were imputed for costs or quality of life in at least one time point (baseline, 3, 6â
months and 1â
year) for 18 patients. Patients in the resurfacing arm had higher quality of life at 12â
months (0.795 vs 0.727) and received 0.032 more QALYs within the first 12â
months postoperation. At an additional cost of ÂŁ564, resurfacing arthroplasty offers benefits at ÂŁ17â
451 per QALY within the first 12â
months of treatment. When covariates are considered, the health economic case is stronger in men than in women.
Conclusions: Resurfacing arthroplasty appears to offer very short-term efficiency benefits over total hip arthroplasty within a selected patient group. The short-term follow-up in this trial should be noted, particularly in light of the concerns raised regarding adverse reactions to metal debris from metal-on-metal bearing surfaces in the longer term. Longer-term follow-up of resurfacing arthroplasty patients and decision analytic modelling is also advised.
Trial registration Current controlled Trials: ISRCTN33354155. UKCRN 4093
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