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Prolonged Hospital Length of Stay (PLOS) is an indicator of deteriorated efficiency in Quality of Care. One goal of public health management is to reduce PLOS by identifying its most relevant predictors. The objective of this study is to explore Machine Learning (ML) models that best predict PLOS.Our dataset was collected from the French Medico-Administrative database (PMSI) as a retrospective cohort study of all discharges in the year 2015 from a large university hospital in France (APHM). The study outcomes were LOS transformed into a binary variable (long vs. short LOS) according to the 90Our analysis included 73,182 hospitalizations, of which 7,341 (10.0%) led to PLOS. The GB classifier was the most performant model with the highest AUC (0.810), superior to all the other models (all p-values0.0001). The performance of the RF, GB and NN models (AUC ranged from 0.808 to 0.810) was superior to that of the LR model (AUC = 0.795); all p-values0.0001. In contrast, LR was superior to CART (AUC = 0.786), p 0.0001. The variable most predictive of the PLOS was the destination of the patient after hospitalization to other institutions. The typical clinical profile of these patients (17.5% of the sample) was the elderly patient, admitted in emergency, for a trauma, a neurological or a cardiovascular pathology, more often institutionalized, with more comorbidities notably mental health problems, dementia and hemiplegia.The integration of ML, particularly the GB algorithm, may be useful for health-care professionals and bed managers to better identify patients at risk of PLOS. These findings underscore the need to strengthen hospitals through targeted allocation to meet the needs of an aging population.

Background: Patients with schizophrenia (SCZ) represent a vulnerable population who have been understudied in COVID-19 research. We aimed to establish whether health outcomes and care differed between patients with SCZ and patients without a diagnosis of severe mental illness. Methods: We conducted a population-based cohort study of all patients with identified COVID-19 and respiratory symptoms who were hospitalized in France between February and June 2020. Cases were patients who had a diagnosis of SCZ. Controls were patients who did not have a diagnosis of severe mental illness. The outcomes were in-hospital mortality and intensive care unit (ICU) admission. Findings: A total of 50,750 patients were included, of whom 823 were SCZ patients (1.6%). The SCZ patients had an increased in-hospital mortality (25.6% vs. 21.7%; adjusted odds ratio (aOR) 1.30 [95% CI 1.08-1.56], p=0.0093) and a decreased ICU admission rate (23.7% vs. 28.4%; aOR 0.75 [95% CI 0.62-0.91], p=0.0062) compared to controls. Significant interactions between SCZ and age for mortality and ICU admission were observed (p=0.0006 and p

Air pollution exposure is suspected to alter both the incidence and mortality in acute respiratory distress syndrome (ARDS). The impact of chronic air pollutant exposure on the incidence and mortality of ARDS from various aetiologies in Europe remains unknown. The main objective of this study was to evaluate the incidence of ARDS in a large European region, 90-day mortality being the main secondary outcome.The study was performed in the Provence-Alpes-Cote-d'Azur (PACA) region. Nitrogen dioxide (NO2), particulate matter (PMFrom 2016 to 2018, 4733 adults with ARDS treated in intensive care units were analysed. The incidence rate ratios for 1-year average exposure to PMWhile chronic exposure to NO2, PM2.5, and PM10 was associated with an increased ARDS incidence and a higher mortality rate (for PM2.5) in those patients presenting with ARDS, further research on this topic is required.

Background The use of artificial nutrition, defined as a medical treatment that allows a non‐oral mechanical feeding, for cancer patients with limited life expectancy is deemed nonbeneficial. High‐quality evidence about the use of artificial nutrition near the end of life is lacking. This study aimed (a) to quantify the use of artificial nutrition near the end‐of‐life, and (b) to identify the factors associated with the use of artificial nutrition. Methods This was a retrospective cohort study of decedents based on data from the French national hospital database. The study population included adult cancer patients who died in hospitals in France between 2013 and 2016 and defined to be in a palliative condition. Use of artificial nutrition during the last 7 days before death was the primary endpoint. Results A total of 398 822 patients were included. The median duration of the last hospital stay was 10 (interquartile range, 4‐21) days. The artificial nutrition was used for 11 723 (2.9%) during the last 7 days before death. Being a man, younger, having digestive cancers, metastasis, comorbidities, malnutrition, absence of dementia, and palliative care use were the main factors associated to the use of artificial nutrition. Conclusion This study indicates that the use of artificial nutrition near the end of life is in keeping with current clinical guidelines. The identification of factors associated with the use of artificial nutrition, such as cancer localization, presence of comorbidities or specific symptoms, may help to better manage its use., In France, the artificial nutrition management is rather in accordance with the available clinical guidelines for cancer patients with limited life expectancy.

Septic shock is responsible for high morbidity and mortality rates and its incidence is increasing worldwide. Its evolution over the last few years and the leverage points for action to improve associated outcomes remain unclear. Our aim was to determine trends in the incidence and mortality of septic shock and associated risk factors in intensive care unit (ICU) patients and readmission rates after hospital discharge.We performed a retrospective cohort study using data from the French national hospitalisation database, including adult patients with septic shock from 2014 to 2018. Primary outcomes were the incidence of septic shock and the hospital mortality rate at 30, 90 and 365 days. Secondary outcomes were all-cause hospital readmission.Septic shock was identified in 187,587 ICU stays. The age- and sex-adjusted incidence rate of septic shock per 100 ICU admissions increased from 6.5% to 6.8% (P .001); age- and sex-adjusted hospital mortality rates decreased from 47.3% to 44.5% (P .001). The hospital readmission rate at 365 days was 65.0%. Older age, higher Charlson score, occurrence of organ failure and previous hospitalisation were associated with increased risk of mortality. Identification of a specific microorganism and a time between hospitalisation and ICU admission of less than one day were associated with a decreased risk of death.Our study revealed an increase in the incidence of septic shock and a decrease in mortality rates. Pathogen identification and rapid admission to the ICU were associated with better outcomes. The rate of hospital readmission increased, raising questions about the discharge criteria for these patients.

Little is known on the end-of-life (EOL) care of terminal breast cancer in women with severe psychiatric disorder (SPD). The objective was to determine if women with SPD and terminal breast cancer received the same palliative and high-intensity care during their end-of-life than women without SPD. Study design, setting, participants. This population-based cohort study included all women aged 15 and older who died from breast cancer in hospitals in France (2014–2018). Key measurements/outcomes. Indicators of palliative care and high-intensity EOL care. Multivariable models were performed, adjusted for age at death, year of death, social deprivation, duration between cancer diagnosis and death, metastases, comorbidity, smoking addiction and hospital category. The analysis included 1742 women with SPD (287 with bipolar disorder, 1075 with major depression and 380 with schizophrenia) and 36,870 women without SPD. In multivariate analyses, women with SPD had more palliative care (adjusted odd ratio aOR 1.320, 95%CI [1.153–1.511], p p

BackgroundIt remains unknown whether coronavirus disease 2019 (COVID-19) patients with bipolar disorders (BDs) are at an increased risk of mortality. We aimed to establish whether health outcomes and care differed between patients infected with COVID-19 with BD and patients without a diagnosis of severe mental illness.MethodsWe conducted a population-based cohort study of all patients with identified COVID-19 and respiratory symptoms who were hospitalized in France between February and June 2020. The outcomes were in-hospital mortality and intensive care unit (ICU) admission. We used propensity score matching to control for confounding factors.ResultsIn total, 50 407 patients were included, of whom 480 were patients with BD. Patients with BD were 2 years older, more frequently women and had more comorbidities than controls without a diagnosis of severe mental illness. Patients with BD had an increased in-hospital mortality rate (26.6% v. 21.9%; p = 0.034) and similar ICU admission rate (27.9% v. 28.4%, p = 0.799), as confirmed by propensity analysis [odds ratio, 95% confidence interval (OR, 95% CI) for mortality: 1.30 (1.16–1.45), p < 0.0001]. Significant interactions between BD and age and between BD and social deprivation were found, highlighting that the most important inequalities in mortality were observed in the youngest [OR, 95% CI 2.28 (1.18–4.41), p = 0.0015] and most deprived patients with BD [OR, 95% CI 1.60 (1.33–1.92), p < 0.001].ConclusionsCOVID-19 patients with BD were at an increased risk of mortality, which was exacerbated in the youngest and most deprived patients with BD. Patients with BD should thus be targeted as a high-risk population for severe forms of COVID-19, requiring enhanced preventive and disease management strategies.

OBJECTIVE This study aimed to describe end-of-life (EOL) care in individuals with bipolar disorder (BD) who died of cancer compared with mentally healthy individuals. METHODS This was a nationwide cohort study of all adult individuals who died of cancer in hospitals in France between 2013 and 2016. Outcomes were compared between individuals with BD and mentally healthy individuals in the last month of life including palliative care and high-intensity EOL care (chemotherapy, artificial nutrition, and other interventions). A subanalysis explored differences between patients with BD and patients with schizophrenia. RESULTS The study included 2015 individuals with BD and 222,477 mentally healthy controls. Compared with the controls, individuals with BD died 5 years earlier, more often had comorbidities and thoracic cancer, and had fewer metastases, but did not have shorter delays from cancer diagnosis to death. After matching and adjustment for covariates, individuals with BD more often received palliative care in the last 3 days of life (25% versus 13%, p < .001) and less high-intensity care (e.g., chemotherapy 12% versus 15%, p = .004), but more artificial nutrition (6% versus 4.6%, p = .003). Compared with the schizophrenia comparison group, chemotherapy was received more by individuals with BD in the last 14 days of life (12.5% for BD versus 9.4%, p < .001). CONCLUSIONS Individuals with BD were more likely to receive palliative care and less likely to receive high-intensity EOL care, except for artificial nutrition. These results may not be specific to BD, as no difference was found between patients with BD and schizophrenia except for chemotherapy.

Schizophrenia is marked by inequities in cancer treatment and associated with high smoking rates. Lung cancer patients with schizophrenia may thus be at risk of receiving poorer end-of-life care compared to those without mental disorder. The objective was to compare end-of-life care delivered to patients with schizophrenia and lung cancer with patients without severe mental disorder. This population-based cohort study included all patients aged 15 and older who died from their terminal lung cancer in hospital in France (2014–2016). Schizophrenia patients and controls without severe mental disorder were selected and indicators of palliative care and high-intensity end-of-life care were compared. Multivariable generalized log-linear models were performed, adjusted for sex, age, year of death, social deprivation, time between cancer diagnosis and death, metastases, comorbidity, smoking addiction and hospital category. The analysis included 633 schizophrenia patients and 66,469 controls. The schizophrenia patients died 6 years earlier, had almost twice more frequently smoking addiction (38.1%), had more frequently chronic pulmonary disease (32.5%) and a shorter duration from cancer diagnosis to death. In multivariate analysis, they were found to have more and earlier palliative care (adjusted Odds Ratio 1.27 [1.03;1.56]; p = 0.04), and less high-intensity end-of-life care (e.g., chemotherapy 0.53 [0.41;0.70]; p

OBJECTIVES To compare outcomes at 12 months between video-assisted thoracic surgery (VATS) and open thoracotomy (OT) in patients with non-small-cell lung cancer (NSCLC) using real-world evidence. METHODS We did a nationwide propensity-matched cohort study. We included all patients who had a diagnosis of NSCLC and who benefitted from lobectomy between 1 January 2015 and 31 December 2017. We divided this population into 2 groups (VATS and OT) and matched them using propensity scores based on patients’ and hospitals’ characteristics. Unplanned readmission, mortality, complications, length of stay and hospitalization costs within 12 months of follow-up were compared between the 2 groups. RESULTS A total of 13 027 patients from 180 hospitals were included, split into 6231 VATS (47.8%) and 6796 OT (52.2%). After propensity score matching (5617 patients in each group), VATS was not associated with a lower risk of unplanned readmission compared with OT [20.7% vs 21.9%, hazard ratio 1.03 (0.95–1.12)] during the 12-months follow-up. Unplanned readmissions at 90 days were mainly due to pulmonary complications (particularly pleural effusion and pneumonia) and were associated with higher mortality at 12 months (13.4% vs 2.7%, P CONCLUSIONS VATS and OT were both associated with high incidence of unplanned readmissions within 12 months, requiring a better identification of prognosticators of unplanned readmissions. Our study highlights the need to improve prevention, early diagnosis and treatment of pulmonary complications in patients with VATS and OT after discharge. These findings call for improving the dissemination of systematic perioperative care pathway including efficient pulmonary physiotherapy and rehabilitation.

Predicting unplanned rehospitalizations has traditionally employed logistic regression models. Machine learning (ML) methods have been introduced in health service research and may improve the prediction of health outcomes. The objective of this work was to develop a ML model to predict 30-day all-cause rehospitalizations based on the French hospital medico-administrative database. This was a retrospective cohort study of all discharges in the year 2015 from acute-care inpatient hospitalizations in a tertiary-care university center comprising 4 French hospitals. The study endpoint was unplanned 30-day all-cause rehospitalization. Logistic regression (LR), classification and regression trees (CART), random forest (RF), gradient boosting (GB), and neural networks (NN) were applied to the collected data. The predictive performance of the models was evaluated using the H-measure and the area under the ROC curve (AUC). Our analysis included 118,650 hospitalizations, of which 4127 (3.5%) led to rehospitalizations via emergency departments. The RF model was the most performant model according to the H-measure (0.29) and the AUC (0.79). The performances of the RF, GB and NN models (H-measures ranged from 0.18 to 0. 29, AUC ranged from 0.74 to 0.79) were better than those of the LR model (H-measure = 0.18, AUC = 0.74); all P values

Background Existing studies evaluating the association between schizophrenia and complications associated with pregnancy, delivery and neonatal outcomes are based on data prior to 2014 and have reported heterogeneous results. The objective of our study was to determine whether pregnant women with schizophrenia were at increased risk of pregnancy, delivery and neonatal complications compared with women without severe mental disorders. Methods We performed a population-based cohort study of all singleton deliveries in France between Jan. 1, 2015, and Dec. 31, 2019. We divided this population into cases (i.e., women with schizophrenia) and controls (i.e., women without a diagnosis of severe mental disorder). Cases and controls were matched (1:4) inside the same hospital and the same year by age, social deprivation, parity, smoking, alcohol and substance addictions, malnutrition, obesity, and comorbidities. Univariate and multivariate models with odds ratios and 95% confidence intervals (ORs [95% CIs]) were used to estimate the association between schizophrenia and 24 pregnancy, delivery and neonatal outcomes. Findings Over 5 years, 3,667,461 singleton deliveries were identified, of which 3,108 occurred in women with schizophrenia. Compared to controls, women with schizophrenia were found to be older; have more frequent smoking, alcohol and substance addictions; suffer from obesity, diabetes and chronic obstructive pulmonary disease; and often be hospitalized in tertiary maternity hospitals. Compared to matched controls, women with schizophrenia had more pregnancy complications (adjusted OR=1.41[95%CI 1.31-1.51]) (i.e., gestational diabetes, gestational hypertension, genito-urinary infection, intrauterine growth retardation and threatened preterm labour). They had more delivery complications (aOR=1.18[95%CI 1.09 1.29]) with more still births/medical abortions (aOR=2.17[95%CI 1.62-2.90]) and caesarean sections (aOR=1.15[95%CI 1.05-1.25]). Newborns of women with schizophrenia had more neonatal complications (aOR=1.38[95%CI 1.27-1.50]) with more born preterm (aOR=1.64[95%CI1.42 -1.90]), small for gestational age (aOR=1.34[95%CI 1.19-1.50]) and low birth weight (aOR=1.75[95%CI 1.53-2.00]). Interpretation Our results highlight the importance of health disparities between pregnant women with and without schizophrenia, as well as in their newborns. Our study calls for health policy interventions during and before pregnancy, including proportionate intensified care to the level of needs, effective case management and preventive and social determinant approaches. Funding No funding.

Summary: Background: Patients with schizophrenia represent a vulnerable, underserved, and undertreated population who have been neglected in health disparities work. Understanding of end-of-life care in patients with schizophrenia and cancer is poor. We aimed to establish whether end-of-life care delivered to patients with schizophrenia and cancer differed from that delivered to patients with cancer who do not have diagnosed mental illness. Methods: We did a population-based cohort study of all patients older than 15 years who had a diagnosis of advanced cancer and who died in hospital in France between Jan 1, 2013, and Dec 31, 2016. We divided this population into cases (ie, patients with schizophrenia) and controls (ie, patients without a diagnosis of mental illness) and compared access to palliative care and indicators of high-intensity end-of-life care between groups. In addition to unmatched analyses, we also did matched analyses (matched in terms of age at death, sex, and site of primary cancer) between patients with schizophrenia and matched controls (1:4). Multivariable generalised linear models were done with adjustment for social deprivation, year of death, time from cancer diagnosis to death, metastases, comorbidity, and hospital type (ie, specialist cancer centre vs non-specialist centre). Findings: The main analysis included 2481 patients with schizophrenia and 222 477 controls. The matched analyses included 2477 patients with schizophrenia and 9896 controls. Patients with schizophrenia were more likely to receive palliative care in the last 31 days of life (adjusted odds ratio 1·61 [95% CI 1·45–1·80]; p

Efforts to improve the quality of end-of-life (EOL) care depend on better knowledge of the care that children, adolescents, and young adults with cancer receive, including high-intensity EOL (HI-EOL) care. The objective was to assess the rates of HI-EOL care in this population and to determine patient- and hospital-related predictors of HI-EOL from the French national hospital database.This was a population-based, retrospective study of a cohort of patients aged 0 to 25 years at the time of death who died at hospital as a result of cancer in France between 2014 and 2016. The primary outcome was HI-EOL care, defined as the occurrence of ≥1 chemotherapy session14 days from death, receiving care in an intensive care unit ≥1 time,1 emergency room admission, and1 hospitalization in an acute care unit in the last 30 days of life.The study included 1899 individuals from 345 hospitals; 61.4% experienced HI-EOL care. HI-EOL was increased with social disadvantage (adjusted odds ratio [AOR], 1.30; 95% confidence interval [CI], 1.03-1.65; P = .028), hematological malignancies (AOR, 2.09; 95% CI, 1.57-2.77; P .001), complex chronic conditions (AOR, 1.60; 95% CI, 1.23-2.09; P = .001) and care delivered in a specialty center (AOR, 1.70; 95% CI, 1.22-2.36; P = .001). HI-EOL was reduced in cases of palliative care (AOR, 0.31; 95% CI, 0.24-0.41; P .001).A majority of children, adolescents, and young adults experience HI-EOL care. Several features (eg, social disadvantage, cancer diagnosis, complex chronic conditions, and specialty center care) were associated with HI-EOL care. These findings should now be discussed with patients, families, and professionals to define the optimal EOL.

International audience; IntroductionIn industrialised countries, trauma is a public health challenge. Despite disposing of a highly evolved and complex health care system, France does not dispose of a national trauma registry or trauma system. Little is known about the epidemiology of trauma in France. This study aims at describing, using the national billing database, the epidemiology of French trauma.MethodsA retrospective population-based cohort study has been conducted on trauma patients in France using the National Hospital Discharge Data Set Database for 2016. Patients were selected using the Trauma Audit and Research Network (TARN) criteria, inspired by the UK trauma system. Sociodemographic, clinical information and hospital characteristics were collected. The main outcome was 30-day mortality.ResultsAmong 1,144,596 patients hospitalised in French hospitals for trauma in 2016, 144,058 patients were included based on the TARN criteria. The mean age of the patients was 64 years (± 24). Women (50.8%) were over-represented among patients older than 75 years. The 30-day mortality was 5.9%, and regional variations were identified. In multivariate analysis, age, gender, area-level deprivation, injury localisation, co-morbidities, injury severity, transfusion, surgery, and ICU admission were independent factors of risk for 30-day mortality. Age and injury severity were the stronger predictors for mortality and area-level deprivation was associated with higher mortality.ConclusionThe national burden of trauma care was assessed with medico-administrative data in a country without a trauma system. The 30-day mortality associated with trauma in France was around 6%, with regional variations.

BackgroundMost research on mortality in people with severe psychiatric disorders has focused on natural causes of death. Little is known about trauma-related mortality, although bipolar disorder and schizophrenia have been associated with increased risk of self-administered injury and road accidents.AimsTo determine if 30-day in-patient mortality from traumatic injury was increased in people with bipolar disorder and schizophrenia compared with those without psychiatric disorders.MethodA French national 2016 database of 144 058 hospital admissions for trauma was explored. Patients with bipolar disorder and schizophrenia were selected and matched with mentally healthy controls in a 1:3 ratio according to age, gender, social deprivation and region of residence. We collected the following data: sociodemographic characteristics, comorbidities, trauma severity characteristics and trauma circumstances. Study outcome was 30-day in-patient mortality.ResultsThe study included 1059 people with bipolar disorder, 1575 people with schizophrenia and their respective controls (n = 3177 and n = 4725). The 30-day mortality was 5.7% in bipolar disorder, 5.1% in schizophrenia and 3.3 and 3.8% in the controls, respectively. Only bipolar disorder was associated with increased mortality in univariate analyses. This association remained significant after adjustment for sociodemographic characteristics and comorbidities but not after adjustment for trauma severity. Self-administered injuries were associated with increased mortality independent of the presence of a psychiatric diagnosis.ConclusionsPatients with bipolar disorder are at higher risk of 30-day mortality, probably through increased trauma severity. A self-administered injury is predictive of a poor survival prognosis regardless of psychiatric diagnosis.

Introduction Despite many efforts to improve mechanical ventilation strategies and the use of rescue strategies, ARDS-related mortality remains high. The primary objective of this study was to determine the incidence and 90-day mortality of ARDS patients admitted to all French ICUs following the introduction of the Berlin definition of ARDS. Patients and methods The data source for this nationwide cohort study was the French national hospital database (Programme de Medicalisation des Systemes d’Information (PMSI)), which systematically collects administrative and medical information related to all patients hospitalised and hospital stays. Patient-level data were obtained from the PMSI database for all patients admitted to an ICU from the 1st of January 2017, through the 31st of December 2017. The inclusion criteria were as follows: ICU patients ≥ 18 years old with at least one International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10) diagnosis code of J80 (ARDS), either as a primary diagnosis or a secondary diagnosis, during their ICU stay. Results A total of 12,846 ICU adult patients with ARDS were included. The crude incidence of ARDS was 24.6 per 100,000 person-years, varying with age from 6.7 per 100,000 person-years for those 18 through 40 years of age to 51.9 per 100,000 person-years for those 68 through 76 years of age. The in-hospital mortality rate was 51.1%. Day-90 mortality (day-1 being the ICU admission) was 51.2% and increased with age from 29.0% for patients 18 through 40 years of age to 69.3% for patients 77 years of age or older (p Conclusions The incidence and mortality of ARDS in adults in France are higher than that generally reported in other countries.

Resume Introduction La prise en charge des patients dependants aux opiaces en France est realisee par les centres specialises dans la prise en charge des addictions et les medecins generalistes. L’objectif de l’etude est de decrire les caracteristiques des sujets sous medicaments de substitution aux opiaces vus en medecine generale. Methode Les donnees de l’enquete « observation des pharmacodependances en medecine ambulatoire » (OPEMA) de 2013 ont ete analysees a partir de la population consommant de la buprenorphine haut dosage (BHD) ou de la methadone prescrites ou obtenues illegalement. Resultats L’etude a concerne 862 consommateurs de medicaments de substitution aux opiaces dont 433 de BHD et 429 de methadone. Les deux populations sont constituees majoritairement d’hommes (plus de 70 %), l’âge moyen est de 39 ± 9 ans pour les consommateurs de BHD et de 36 ± 8 ans pour les consommateurs de methadone. Dans les deux populations, 55 % des sujets ont une activite remuneree et plus de 30 % signalent des prestations sociales. Dans les deux populations, plus de 50 % des sujets presentent des troubles anxieux et depressifs, plus de 25 % presentent des troubles somatiques associes dont les pathologies digestives, respiratoires, les douleurs qui sont les plus frequentes. Pour les modalites de consommation de ces medicaments de substitution aux opiaces (MSO), pres de 99 % des sujets utilisent la voie orale, avec pour presque 100 % d’entre eux une consommation quotidienne et 20 % environ consomment de l’alcool concomitamment a leur MSO. Pour les consommations associees, 24 % des consommateurs de BHD consomment egalement des benzodiazepines versus 18 % des consommateurs de methadone (p = 0,06) ; 21 % des consommateurs de BHD consomment des substances psychoactives illicites (en particulier le cannabis) versus 33 % des consommateurs de methadone (p Conclusion La population consommant des MSO est precaire et presente une vulnerabilite somatique et psychiatrique. Des formes de mesusage et des consommations associees d’autres substances psychoactives et drogues illicites sont observees. Malgre la complexite de prise en charge de ces sujets, les medecins generalistes ont un role majeur a jouer.

Background: In France, the management of trauma exhibits several peculiarities, including a developed pre-hospital medicalisation and a large number of facilities. However, there is neither a national trauma system nor register. The billing system reflects the entire nation's hospital activity. The study aims at describing, using this database, the epidemiology of French trauma. Methods: A retrospective population-based cohort study has been conducted on trauma patients in France using the French National Uniform Hospital Discharge Data Set Database (PMSI-MCO) for 2016. Patients were selected using the Trauma Audit and Research Network (TARN) criteria, inspired by the UK trauma system. Sociodemographic and clinical information and hospital characteristics were collected. The main outcomes were 24-hour and 30-day mortality. Findings: Among 1 144 596 patients hospitalised in French hospitals for trauma in 2016, 144 058 patients were included in the study based on the TARN criteria. The mean age of the patients was 64 years. Females (50·8%) were over-represented among patients older than 75 years. The 24-hour and 30-day mortality was 1·4% and 5·9%, respectively. The severity of trauma differed according to the type of hospitals; university hospitals admitted severe trauma cases. In multivariate analysis, age, gender, injury body regions, co-morbidities, injury severity, transfusion, need for surgery, and ICU admission were independent factors of risk for both early and delayed mortality. Age and injury severity were the stronger predictors for mortality. Area-level deprivation was an adverse factor for 30-day mortality. Interpretation: The national burden of trauma care was assessed with administrative data in a country without a trauma system. The mortality associated with trauma in France was around 6%. Risk factors include age and severity, but other variables like the socioeconomic status influences the outcomes. Funding: None. Declaration of Interest: The authors have no conflicts of interest to disclose in relation with this manuscript.

Resume Objectif Cette etude presente le programme Observations des pharmacodependances en medecine ambulatoire (OPEMA) et les principaux resultats de sa derniere enquete (novembre 2010). Methode Les informations recueillies concernent la situation sociodemographique des sujets, leur etat de sante et leur consommation actuelle de substances psychoactives. Resultats En 2010, 1 394 sujets ont ete inclus, decrivant la consommation de 2 450 substances. Leur moyenne d’âge est de 38,2 ± 12,7 ans. Quatre-vingt-six pour cent disposent d’un logement stable et 52 % exercent une activite professionnelle. Cinquante-six pour cent des sujets presentent une comorbidite psychiatrique. Parmi les sujets inclus, les prevalences du VIH et du VHC sont de 3 % et 20 %. Quarante-cinq pour cent des sujets inclus ont ete injecteurs de substances psychoactives, dont 6% actuellement. Quatre-vingt-deux pour cent sont consommateurs de traitement de substitution de la dependance aux opiaces et 29 % de benzodiazepines. Conclusion Le programme OPEMA complete le dispositif d’addictovigilance en recueillant des donnees en provenance des medecins generalistes, et favorise une connaissance globale de l’etat de sante des sujets pharmacodependants.

Purpose The purpose of the study was to compare, using data from Observation of Illicit Psychotropic Substances or Non-medical Used Medications (OPPIDUM) surveys, first, the profile of buprenorphine users and their modalities of buprenorphine use from 2006 to 2008 and, second, two subgroups: brand-name and generic buprenorphine users in 2008. Methods OPPIDUM is an annual, nationwide, multicentric, cross-sectional survey, including buprenorphine users followed in specialised centres dedicated to drug dependence. The evolution of the profile during three consecutive years (2006, 2007 and 2008) was analysed using Cochran-Armitage test for trend. A multivariate regression analysis was used to identify the factors associated with the use of generic compared with brand-name buprenorphine in 2008. Results In OPPIDUM, 1311 individuals used buprenorphine in 2006, 1688 in 2007 and 1696 in 2008. The proportion of users of generic buprenorphine increased from 4.2% in 2006 to 31.7% in 2008. From 2006 to 2008, a decrease in intravenous use and higher than recommended dosage, with an increase in occupation, have been observed. According to the multivariate analysis, factors associated with being generic buprenorphine user compared with brand-name buprenorphine user in 2008 were younger age, more education, absence of use of alcohol with buprenorphine, absence of heroin and/or cocaine use and absence of nasal route for buprenorphine. Conclusion Three years after the launch of the buprenorphine generic, the health professionals' and buprenorphine users' perception of generic can still change. Additionally, the long-term impact of generic medications with abuse potential has not yet been studied. Thus, continued monitoring of buprenorphine is needed. Copyright © 2011 John Wiley & Sons, Ltd.

The objective of the study was to determine which psychoactive prescription drugs are illegally obtained and through which ways of acquisition. OPPIDUM is an annual national study. It is based on specialized care centers that included subjects presenting a drug dependency or under opiate maintenance treatment. All their psychoactive substances consumed are reported. This work focuses on the different ways of acquisition specially the illegal ways of acquisition (bought on the street, forged prescription, stolen, given, internet). For each medication illegally obtained, a ratio has been calculated (number of illegal acquisitions divided by the number of described acquisitions). In 2008, 5542 subjects have been included and have described the consumption of 11 027 substances including 63.8% of prescription drugs. Among them, 11% were illegally obtained. The different illegal acquisition ways were 'street market' (77.6%), 'gift' (16.6%), 'theft' (2.3%), 'forged prescription' (2.3%), and 'internet' (0.7%). The third first drugs illegally obtained were high dosage buprenorphine, methadone, and clonazepam. Some prescription drugs, less consumed, have an important ratio of illegal acquisition like ketamine, flunitrazepam, morphine, trihexyphenidyl, or methylphenidate. This study confirms that theft, forged prescription and internet are few used and permits to highlight diversion of prescription drugs. It is important to inform healthcare professionals on the different prescription drugs that are illegally obtained.

Aim. This study presents the OPEMA (Observation des pharmacodépendances en médecine ambulatoire) programme and the main results of its last annual survey (november 2010). Method. Collected data concern mainly subjects' sociodemographic situation, their state of health and their current consumption of psychoactive substance. Results. In 2010, 1394 subjects have been included, describing 2 450 consumptions of psychoactive susbtance. Their mean age is 38,2±12,7 years. Eighty-six per cent have a stable accomodation and 52% are in employment. Fifty-six percent of included subjects present a psychiatric comorbidity. Among included subjects, HIV and HVC prevalence is respectively 3% and 20%. Fourty-five percent of included subjects have been using intraveinous route, 6% of whom using it currently. Eighty-two percent consume opiate maintenance treatment and 29% benzodiazepines. Conclusion. The OPEMA programme supplement the french pharmacodependence assessment system with collecting data from general practitioners, and promotes a global knowledge of dependent subjects' state of health.