[Physical exercise health promotion in the workplace: participative experimentation in a private company]. / Promotion de la santé par l'activité physique sur les lieux de travail : expérimentation participative dans une entreprise privée.

CONTEXT: The objective of this study was to identify collaborative processes involved in a physical activity health promotion project in companies, conducted through a participatory approach in a cross-sectoral partnership, and to estimate the preliminary effects in terms of employee health. METHODS: Action research was conducted in an industrial company comprising 240 employees over a 2-year period. This research was based on 4 criteria: description of the actors' network, the opportunities and constraints of the project, the implementation of physical activities, the participation of employees in the various activities, the impacts observed (after 3 months of activities) on physical parameters and quality of life. RESULTS: Six work groups selected two activities : muscle-development exercise and Taïchi. We evaluated muscle strengthening activity. The participation rate in the activity was 16%. A higher age, female gender and being a manager or employee rather than a worker were significantly associated with participation. A tendency towards increased physical and mental scores of SF12 was observed. We identified two major barriers: logistic and communicational. CONCLUSION: The participatory approach, based on a cross-sectoral partnership, is the determining element of the project's success in a context of local opportunities. Two factors were identified to perpetuate this dynamic and improve the system: rationalization of the structuring of the service and greater resources, particularly financial resources.

Antipsychotic prescribing for Alzheimer's disease and related disorders in specialized settings from 2010 to 2014 in France: a repeated cross-sectional study.

BACKGROUND: Safety warnings from health authorities are currently intended to limit the use of antipsychotics (APs) in dementia-related conditions to treat neuropsychiatric symptoms, such as disturbing and/or delusional behaviors. The aim of this study is to investigate prevalence, correlates and trends of AP prescribing among people with dementia between 2010 and 2014 in the French population. METHODS: AP prescribing and associated factors among individuals with AD, mixed dementia and vascular dementia in the French National Alzheimer Database between 2010 and 2014 were analyzed using multivariate generalized estimating equations models (n = 199,549). RESULTS: In 2014, 7.7% of people with dementia were prescribed an AP. Compared with 2010 there was a 16% increase in AP use. Multivariate analysis showed a linear increase risk of prescription with an adjusted odds ratio (95% confidence interval) of 1.23 (1.17-1.30) in 2014 compared with 2010. Factors associated with AP prescribing were male gender, more severe cognitive decline and living in long-term care facilities. Older age and higher education were protective toward AP prescribing. The type of dementia did not have any influence on AP prescribing. CONCLUSION: An increase in AP prescribing among individuals with dementia in French specialized settings over the last 5 years occurred despite safety warnings. This phenomenon suggests that alternative solutions for the management of behavioral and psychiatric symptoms in these populations are still urgently needed.

Protocol of the "As du Coeur" study: a randomized controlled trial on physical activity maintenance in cardiovascular patients.

BACKGROUND: Although the benefits of supervised physical activity programs in cardiac rehabilitation have been well documented, the amount of physical activity often drops quickly after the end of the supervised period. This trial (registered as ISRCTN77313697 ) will evaluate the effectiveness of an experimental intervention based on habit formation theory applied to physical activity maintenance. METHODS/DESIGN: Cardiovascular patients (N = 56) will be individually randomized into two groups. Two supervised physical activity (SPA) sessions per week will be offered to the first group for 20 weeks. Progressively autonomous physical activity (PAPA) will be offered to the second group as follows: 10 weeks of the same supervised program as the SPA group followed by 10 more weeks in which one supervised session will be replaced by a strategy to build and sustain the habit of autonomous practice of physical activity. The primary outcome is the amount of physical activity measured by the International Physical Activity Questionnaire (IPAQ; Craig et al., Med Sci Sport Exercises 35(8):1381-95, 2003). To compensate for the limited capacity to recruit subjects, multiple IPAQ measurements will be made (at T0, T5, T7, T9 and T12 months after the start of the intervention) and analyzed using the mixed model approach. We will also assess changes in physical and physiological indicators, automaticity of the physical activity behavior, motivation and quality of life. Last, we will assess the cost-effectiveness for each type of program. DISCUSSION: If proven to be effective, the PAPA intervention, which requires fewer supervised sessions, should provide a cost-effective solution to the problem of physical activity maintenance in cardiac rehabilitation.

Evolution of the Antidepressant Prescribing in Alzheimer's Disease and Related Disorders Between 2010 and 2014: Results from the French National Database on Alzheimer's Disease (BNA).

BACKGROUND: Safety warnings from health authorities are currently intended to limit the use of psychotropic agents in dementia-related conditions. Evidence concerning the use of antidepressants in dementia is, however, scarce and contradictory. OBJECTIVE: To evaluate antidepressant use among individuals with Alzheimer's disease (AD) and related disorders in the French population between 2010 and 2014. METHOD: Antidepressant prescriptions in individuals with AD, mixed dementia (MD), and vascular dementia (VaD) in the French National Alzheimer Database between 2010 and 2014 were analyzed (N = 199,544). RESULTS: Multivariate analysis showed an annual significant increase (p < 0.001) in the prescription rate of antidepressants from 26% (2010) to 31% (2014), and identified female gender, younger age, higher education, living in long-term facilities, more severe cognitive decline, and presence of vascular signs (VaD and MD) as associated factors for antidepressant prescribing. CONCLUSION: The annual increase of antidepressant prescribing among individuals with AD, MD, and VaD in French specialized settings may be partially related to the lack of current valuable medications for dementia-related behavioral symptoms.

Progression of mild cognitive impairment to dementia due to AD in clinical settings.

OBJECTIVES: To describe the positive predictive value of mild cognitive impairment (MCI) and the factors associated with progression in routine practice. METHODS: A retrospective cohort study was conducted from the French National Alzheimer Database. Among 446,439 patients cared for in the participating centers between January 2009 and January 2014, 45,386 (10.2%) were classified as having MCI and 23,676 had at least one follow-up visit. Annual progression rate was used to describe the progression of patients with MCI to dementia due to Alzheimer disease. Hazard ratios of dementia due to Alzheimer disease were estimated using Cox regression model. RESULTS: Annual progression rate (95% confidence interval) was 13.7% person-years (py) (13.5%-13.9%) with higher rate for amnestic MCI (aMCI) (18.2% py [17.9%-18.5%]) than for nonamnestic MCI (naMCI) (9.5% py [9.3%-9.6%]). Separate regression models were performed for each MCI subtype. Higher education, older age, female sex, and lower Mini-Mental State Examination score were associated with an increased risk of progression for both subtypes. Use of anxiolytics (adjusted hazard ratio [95% confidence interval]: 0.77 [0.66-0.91]) was a protective factor for aMCI whereas antidepressant drugs (1.16 [1.04-1.29]) were associated with an increased risk. For naMCI, prescriptions of antidepressants (0.85 [0.74-0.98]) and antipsychotics (0.55 [0.32-0.93]) were protective for progression. CONCLUSIONS: Under circumstances emulating routine clinical practice, the positive predictive value of an MCI diagnosis is in line with previous clinical studies and the external validity of the concept is strengthened. Distinguishing between aMCI and naMCI is particularly relevant.

The mini mental state examination at the time of Alzheimer's disease and related disorders diagnosis, according to age, education, gender and place of residence: a cross-sectional study among the French National Alzheimer database.

THE AIM OF THIS STUDY: was firstly to describe the MMSE (Mini-Mental State Examination) score upon initial diagnosis of Alzheimer's disease and related disorders among the French population, according to age. Secondly, education, gender and place of residence were studied as factors potentially associated with delayed Alzheimer's disease diagnosis. DESIGN: we conducted a cross sectional analysis of the French National Alzheimer database (BNA). Data from 2008 to 2012 were extracted. Patients were selected at the moment of their first diagnosis of AD (n = 39,451). RESULTS: The MMSE score at initial diagnosis dropped significantly with increasing age. The test score increased with the degree of educational background regardless of age. Gender and place of residence were significantly related to the MMSE score, women and persons living in medical institutions having lower MMSE scores under the age of 90 years and at all educational levels. CONCLUSIONS: Health care professionals should be aware of these risk factors in order to maximize chances of earliest possible diagnosis of Alzheimer's disease and related disorders.

The French National Alzheimer database: a fast growing database for researchers and clinicians.

BACKGROUND: Alzheimer's disease (AD) is a major public health issue. The French National Alzheimer database (BNA) registers all medical acts performed by memory units and independent specialists throughout France. This article describes the national coverage, the registered patient characteristics and illustrates research possibilities. METHODS: All data transmitted up to December 2012 were analyzed. The following patient characteristics were studied: age, sex, educational level, place of living, diagnosis, Mini-Mental State Examination score and existence of pharmacological or psychosocial interventions. RESULTS: At the end of 2012, the BNA included 84% (n = 357) of all French memory units, contained 341,498 patients and more than 800,000 medical acts. AD accounted for 26.4% of all registered diagnoses, related disorders for 21.7% and mild cognitive impairment for 8.7%. CONCLUSION: The BNA offers a multitude of research possibilities. In the coming years, the BNA will play a major role in monitoring trends and related risk factors in AD.

Mild cognitive impairment and anti-Alzheimer disease medications: A cross sectional study of the French National Alzheimer Databank (BNA).

Unlike Alzheimer's disease (AD), there are no drugs approved for the treatment of mild cognitive impairment (MCI). The objective of this study was to evaluate real world prescriptions of anti-AD medications in patients with MCI in France and to determine characteristics associated with treatment. A cross sectional study of the French National Alzheimer Databank (BNA) was conducted. Patients diagnosed with MCI by physicians of the BNA network in 2010 and 2011 were included in this study. We included 16,236 patients with a diagnosis of MCI in the study. Mean age was 76.4 years old and females were 59.5%. Nine hundred eighty five patients (6.1%) were taking an anti-AD medication. Results of a multivariate analysis show that use was associated with older age, lower MMSE score, amnestic MCI subtype, living at home, and higher education. Treatment with antidepressant drugs was also associated with anti-AD medication use (odd ratio: 1.68; 95% confidence interval: 1.44 to 1.96). "Off label" prescription of anti-AD drugs is low in France and seems to be limited to a population at risk of conversion to AD. Similar analysis will be required to monitor this practice in the future.

Use of drug treatments for Alzheimer's disease in France: a study on a national level based on the National Alzheimer's Data Bank (Banque Nationale Alzheimer).

PURPOSE: To examine the way in which specific drug treatments for Alzheimer's disease are used and whether their use complies with clinical practice guidelines issued by the French National Authority for Health in patients with Alzheimer's disease. METHODS: We analysed a cross-section of the French National Alzheimer's databank (BNA). Participants were individuals who consulted centres contributing to the BNA in 2010 and diagnosed with Alzheimer's disease and with at least one Mini Mental State Examination (MMSE) score recorded during the course of the year. RESULTS: Of 191, 919 consultations recorded in the database, 29.9% involved a diagnosis of Alzheimer's disease, and 26, 809 patients had completed at least one MMSE. In 76.9% of cases, treatment was given with an anti-Alzheimer's drug. Monotherapy with an acetylcholinesterase inhibitor was prescribed for 48.3% of patients, monotherapy with memantine in 14.2% and dual therapy in 14.4% of cases. Treatment given did not comply with the guidelines in 20.7% of cases. Prescriptions not complying with the guidelines were associated with a lower mean MMSE score (13.6 vs. 18.0; p < 0.00001) and more cases of treatment with antidepressants (29.2% vs. 22.8%; p < 0.00001), anxiolytics (14.7% vs. 12.3%; p < 0.00001) and antipsychotics (8.7% vs. 4.9%; p < 0.00001). CONCLUSION: Four of five prescriptions for treatment with anti-Alzheimer's drugs complied with the specific drug treatment chapter of the 2008 French clinical guidelines. Prescriptions not complying with the guidelines for acetylcholinesterase inhibitors and memantine were usually issued in situations involving advanced-stage Alzheimer's disease. The BNA can provide precise information on medical practice in Alzheimer's disease and related disorders.

Colorectal cancer screening program: cost effectiveness of systematic recall letters.

OBJECTIVES: The French colorectal cancer screening program has planned a stepwise strategy for delivery of a fecal occult blood test kit (Hemocult II) with an initial medical phase followed by systematic mailing of the test. Our aim was to ascertain the cost effectiveness of another recall method. METHODS: In the Bouches-du-Rhône administrative area, we conducted a cost effectiveness study comparing two second line delivery methods: mailing the test kit systematically to all non-responders to the initial medical phase (conventional strategy) and mailing the test kit to non-responders to the initial medical phase who requested a kit after receiving a recall letter (experimental strategy). After randomization, two groups were constituted among a sample of 10 930 persons. RESULTS: The participation rate was significantly higher in the conventional strategy group than with the experimental strategy group (14.7% vs 8.3%; P<10(-5)). The mean cost of the conventional strategy test was 33.59 euros compared to only 18.50 euros with the experimental strategy (kit mailed only to persons who requested it). CONCLUSION: These findings suggest that mailing a recall letter with a test order coupon can lead to substantial economy with a lost of participation of 6.4% at the test mailing phase. Better allocation of the spared cost (communication, information) might lead to increased participation, a hypothesis which should be tested further.