[A comparison of the management of severe high blood pressure between 1999 and 2003 in France]. / Comparaison des prises en charge de l'hypertension artérielle sévère en France entre 1999 et 2003.

AIM: To measure the change in blood-pressure control in two populations of patients with severe high blood pressure between 1999 and 2003. METHOD: The French National Healthcare Fund performed two observational, cross-sectional surveys on the medical management of high blood pressure, the first in 1999 and the second in 2003. Each survey enrolled patients aged between 20 and 80 years old who filed a first-time request for exemption from co-payments for this long-term disorder. Study data was collected by the health fund's salaried physician advisors who directly examined the patients and from information gathered from each patient's attending physician. Adequate blood pressure control was defined according to the guidelines set out by the ANAES in 1997 and determined by calculating the average of the last three blood pressure figures recorded by the patient's attending physician (systolic [SBP] and diastolic [DBP] arterial blood pressures). RESULTS: 10,665 patients were enrolled in the 1999 survey and 2,584 were enrolled in the 2003 survey. The average age was 63.1 +/- 0.2 years in 1999 and 64.4 +/- 0.4 years in 2003. The proportion of diabetic patients in the two surveys remained stable: 27.5% +/- 1.0 in 1999 and 28.4% +/- 1.7 in 2003. Between 1999 and 2003, the percentage of patient who were treated for hypercholesterolemia increased from 44.0% +/- 1.1 to 54.3% +/- 1.9. Between 1999 and 2003, the proportion of patients who were considered well-controlled (SBP and DBP < 140/90 mmHg) or, if older than 60 years with isolated systolic high blood pressure (DBP < 90 mmHg and SBP < or = 160 mmHg) increased almost 5% points, going from 40.8% +/- 1.1 in 1999 to 45.5% +/- 1.9 in 2003. In diabetic patients, in whom the cut-off threshold is 130/85 mmHg, 6.7% +/- 1.1 were considered well-controlled in 1999 while 5.4% +/- 1.7 were deemed well-controlled in 2003. The proportion of well-controlled patients in the sub-group of hypertensive patients with renal failure (cut-off thresholds: 125/75 mmHg) remained relatively stable between 1999 and 2003: 5.2% [2.5; 7.9] versus 2.8% [0.5; 8.6]. CONCLUSION: There was a significant increase in the proportion of well-controlled hypertensive patients between 1999 and 2003. This increase occurred at the same time as a number of initiatives (scientific societies, federal government as well as the National Health Fund) intended to sensitize physicians to the need to obtain adequate blood pressure control.

[Oral health screening: evaluation of implementation of a national programme]. / Evaluation de la réalisation du bilan bucco-dentaire (BBD) conventionnel.

BACKGROUND: The first national French oral health screening was implemented in 1998 toward young people aged from 15 to 18 Years. These adolescents were invited every year to a free dental check up performed by their dentist. The aim of this study, carried out for self-employed persons insured by compulsory national health insurance, was to measure the rate of dental checks during years 1998-1999-2000, to estimate the oral health status, to assess the factors related to the dental care consumption in 1998, and the predictive factors for a successive dental check. METHODS: We included seventy four French counties. Every teenager born in 1983 (23.874) was invited. We collected data from both the health insurance databases and the form filled in by the consulted dental surgeons. We selected four variables: gender, residence place, social, and occupational group to study the consumption in 1998. RESULTS: In 1998, 10% (2462) of teenagers have got a dental check up (EXP1). Only 0,7% participated in the three screenings (1998-1999-2000). We noted a higher female consumption and disparities between the main categories of self-employed persons. Participation by boys was higher than girls. The lowest participation rates concerned the Ile of France area and adolescents living with single parents. In 1998 (EXP1), 57% of teenagers had at least one decayed tooth. Only 69% of them received appropriate curative dental treatments in the following six-Months period. However, among teenagers followed during the three years, higher rates of care reaching 90% were observed on the second and third EXP. CONCLUSION: This small participation rate may be related to the recent implementation of screening. It should lead to optimize screening and to associate other partners in particular the state education system. It should also be helpful in focusing the oral health prevention policy toward the population with a high risk of decay.

Type 2 diabetes mellitus among beneficiaries of the french national health insurance for self-employed workers (AMPI): comparison of the management of craftsmen or tradesmen with professionals patients.

BACKGROUND: Although the management of diabetes mellitus varies according to non medical factors, the influence of socioprofessional category has been not fully studied. This study compared the management of type 2 diabetes mellitus in craftsmen or tradesmen with professionals categories. METHODS: All claims to the French National Sickness Insurance Fund for self-employed workers (AMPI) from its mainland France beneficiaries in 1998 were retrospectively analysed. Patients were beneficiaries, insured or dependants of craftsmen or tradesmen, or professionals receiving oral hypoglycemic drugs during a 3-month inclusion period. Patients were compared on the proportion of care received in private practice over the preceding 12 months using adjusted odds ratio (OR). RESULTS: Compared to patients in professionals (n=1,456), patients in craftsmen or tradesmen (n=35,703) were statistically more likely to see a general practitioner (OR 3.867, 95% CI=3.048; 4.907), to have blood glucose test (OR 1.530, 95% CI=1.332; 1.757) and serum creatinine assay (OR 1.207, 95% CI=1.052; 1.270). They were statistically less likely to consult or have a specialist procedure (ophthalmologist, OR 0.792, 95% CI=0.698; 0.900; cardiologist, OR 0.749, 95% CI=0.658; 0.852; dentist, OR 0.679, 95% CI=0.596; 0.773; endocrinologist, OR 0.522, 95% CI=0.424; 0.642), microalbuminuria test (OR 0.749, 95% CI=0.622; 0.902) and serum creatinine assay or microalbuminuria test (OR 0.746, 95% CI=0.611; 0.912). The two groups did not differ on HbA1c, blood lipid tests and electrocardiogram. CONCLUSIONS: The management of type 2 diabetes mellitus differed between craftsmen or tradesmen and professionals patients. These results should be confirmed.