Epidemiology of myasthenia gravis in France: A retrospective claims database study (STAMINA).

BACKGROUND: The objectives of this observational study were to report the incidence and prevalence of myasthenia gravis (MG) in France, describe patients' characteristics and treatment patterns, and estimate mortality. METHODS: A historical cohort analysis was performed using the French National Health Data System (SNDS) database between 2008 and 2020. Patients with MG were identified based on ICD-10 codes during hospitalization and/or long-term disease (ALD) status, which leads to a 100% reimbursement for healthcare expenses related to MG. The study population was matched to a control group based on age, sex and region of residence. RESULTS: The overall incidence of MG was estimated at 2.5/100,000 in 2019 and the overall prevalence at 34.2/100,000. The mean age was 58.3 years for incident patients and 58.6 for prevalent patients. Among patients with MG, 57.1% were women. In the first year after identification of MG, acetylcholinesterase inhibitors were the most commonly used treatments (87.0%). Corticosteroids were delivered to 58.3% of patients, intravenous immunoglobulin to 34.4%, and azathioprine to 29.9%. Additionally, 8% of patients underwent thymectomy. The proportions of patients with exacerbations and crises were 59.7% and 13.5% respectively in the first year after MG identification. All-cause mortality was significantly higher in patients with MG compared to matched controls (HR=1.82 (95% CI [1.74;1.90], P<0.0001)). CONCLUSION: In this study, the incidence and prevalence of MG estimated in France were found to be higher than previously reported. Most exacerbations and crises occurred within the first year after MG identification. MG was associated with increased mortality compared to a control population matched on age, gender, and geographical region.

[Patterns of alcohol consumption in France and their medical and social consequences as seen through the family circle and friends and general practitioners]. / L'alcool en France et ses conséquences médicales et sociales: regard de l'entourage et des médecins généralistes.

BACKGROUND: Data on the frequency of high-risk alcohol consumption and its medical and social consequences in the French general population remain fragmented. Therefore, our aim was two-fold: (i) to assess the prevalence of different patterns of alcohol consumption using the AUDIT-C scale, according to two different perspectives, i.e., that of family circle members or friends, and that of the general practitioners (GPs), and (ii) to examine the prevalence of medical and social consequences associated with alcohol consumption profiles. METHOD: Data were drawn from two national surveys conducted in 2013. Investigators were respectively GPs and family circle members or friends. These surveys were respectively representative of GPs (n=1308) and of the general adult population (n=1018). RESULTS: The 12-month prevalence rates of harmful or at risk alcohol consumption rose respectively to 11.1% in the GPs adult patients and to 11.9% in the general adult population. The majority of participants with "at risk" alcohol consumption presented with significant social and medical consequences. Thus, more than seven out of ten participants with chronic at risk consumption endorsed significant negative social event potentially associated with alcohol like withdrawal of driving licence, getting divorced or separated, and losing friends. Over 10% of these participants had liver disease and diabetes mellitus, more than 30% increased blood pressure and nearly 50% anxiety disorder or major depression. Following adjustments for sociodemographic characteristics and alcohol treatment, prevalences of numerous social and medical consequences significantly differed between alcohol-dependent participants, chronic at risk consumers and episodic at risk consumers. CONCLUSIONS: Our results suggest that more than one adult out of ten in France showed during the past year harmful or "at risk" alcohol consumption, which appears insufficiently detected and treated. In addition, the majority of at risk alcohol consumers already presents with serious medical and social consequences. Furthermore, we found that AUDIT-C scale can identify different patterns of alcohol consumption, which form a continuum in terms of medical and social consequences. Our study indicates the need for vigorous education efforts for the public, professionals and policy makers about alcohol use disorders, to encourage help-seeking among those who cannot stop drinking despite considerable harm to themselves and others, and ideally to promote early detection and treatment of individuals with at risk alcohol consumption before the development of social and medical consequences and alcohol dependence.

[Excessive alcohol consumption: what is the burden on natural caregivers?]. / La consommation excessive d'alcool: un lourd fardeau pour l'entourage.

BACKGROUND: Data on the natural caregivers burdened by the excessive consumption of alcohol by members of the family circle or friends in the general population are lacking. Therefore, our aim was twofold: (i) to assess the burden of individuals with excessive alcohol consumption on natural caregivers and (ii) to examine the factors explaining the association between alcohol consumption and the level of burden. METHOD: Data were derived from a national representative survey of the French adult population, conducted in 2013, that involved 1018 participants who had in their close environment a person consuming excessive amounts of alcohol. The level of burden was assessed using the Zarit Burden Scale (ZBI). RESULTS: The average score of the ZBI was 28.5 (SE=16.0). The average volume of alcohol consumed per day, heavy drinking days, as well as the consumers' profiles defined by the AUDIT-C were significantly associated with the level of burden. Following adjustments for the participants' characteristics and for the closeness between participants and individuals with excessive consumption, these associations remained significant. Following adjustments for these variables as well as demographic, social, behavioral and medical characteristics of individuals with excessive consumption, the associations between the level of burden and respectively consumers' profiles and heavy drinking days remained significant. At last, following adjustments for social, behavioral and medical characteristics of individuals with excessive consumption and for the closeness between them and participants, only the association between heavy drinking days and the level of burden remained significant. CONCLUSIONS: One out of five participants having in their close environment a person consuming excessive amount of alcohol reported an important burden. The association between the individuals' alcohol intake and the level of burden for natural caregivers was mainly influenced by social, behavioral and medical consequences of alcohol consumption and by the physical and affective proximity between them. Furthermore, we found that the AUDIT-C scores could define alcohol consumers' profiles which form a continuum in terms of the level of burden, even after adjustments for potentially confounding variables. At last, the high prevalence of psychological complications in participants calls for greater recognition of the natural caregivers' burden in the management of patients with alcohol dependence.

Epidemiology of restless legs syndrome in French adults: a nationwide survey: the INSTANT Study.

OBJECTIVE: To evaluate the prevalence, characteristics, and treatment of restless legs syndrome (RLS) in France. METHODS: In this population-based survey, face-to-face home interviews were conducted among a random sample of 10,263 French adults. A French translation of the four features defined by the International RLS Study Group in 1995 was used to assess the prevalence of symptoms consistent with a diagnosis of RLS. Data on severity of symptoms and their management were also collected. RESULTS: The 12-month prevalence of RLS symptoms in the French adult population was estimated to be 8.5% (95% CI 8.0%, 9.0%), with a higher prevalence (p < 0.001) observed in women (10.8%) than in men (5.8%). Prevalence increases with age until 64 years and decreases thereafter in both sexes. Half of the identified subjects reported symptoms once a week at least. Symptoms were more severe in subjects reporting symptoms once a week at least compared to subjects with less frequent symptoms. In this group, half of the subjects reported a family history, the age at onset was earlier, and severity of symptoms higher. RLS had been previously diagnosed in only 5.3% of the subjects who reported previous medical diagnosis, and recommended RLS drug treatment was received by 3.4% of the 28.7% currently treated subjects. CONCLUSIONS: Restless legs syndrome (RLS) occurred in 10% of women and 5% of men. RLS prevalence decreases after the age of 64. RLS is often underdiagnosed and few subjects receive recommended RLS drug treatment.

Incidence of herpes simplex virus keratitis in France.

OBJECTIVE: To assess the incidence and clinical characteristics of herpes simplex keratitis in France. DESIGN: National multicenter prospective study on herpetic keratitis. PARTICIPANTS: During a 3-month study period (September-December 2002), all cases of herpes simplex keratitis were prospectively reported by a randomly selected sample of 412 ophthalmologists representative of the 5471 French ophthalmologists in terms of gender, geographic distribution, and clinical practice. METHODS: The following set of assumptions were made to calculate the incidence of herpectic keratitis: (1) the participating (self-selected) ophthalmologists in the study could adequately represent French ophthalmologists, (2) estimates based on the 3-month study period could be used to calculate the annual incidence (i.e., no significant seasonal variations), and (3) all patients suffering from herpetic corneal lesions consult or are referred to an ophthalmologist. We calculated the incidence of herpetic keratitis by (1) estimating the average number of incident cases per ophthalmologist per year, (2) multiplying the average number of incident cases by the total number of French ophthalmologists (n = 5471), and (3) dividing the result by the French population. RESULTS: Four hundred twelve ophthalmologists reported 357 cases of herpes keratitis. We estimated that the overall incidence of herpetic keratitis during the study period was 31.5 per 100,000 person-years (95% confidence interval [CI], 25.5-37.5), and incidences were 13.2 per 100,000 person-years for new cases (95% CI, 10.4-15.9) and 18.3 per 100,000 person-years for recurrences (95% CI, 14.6-22.1). The most frequent types were dendritic keratitis (56.3%, n = 153), stromal keratitis (29.5%, n = 81), and geographic keratitis (9.8%, n = 27). Other ocular lesions were associated with keratitis in 35.0% (n = 125) of cases; the most frequent were conjunctivitis (18.8%, n = 67), uveitis (11.8%, n = 42), and/or lid involvement (8.6%, n = 31). CONCLUSIONS: This prospective epidemiological study provides an estimate of the incidence of herpes keratitis in France. Herpetic keratitis remains an epidemiologically important eye disease that justifies the need to pursue health care and research programs aimed at improving the outcome of ocular herpetic disease.