Adults at risk of pneumococcal disease in France.

BACKGROUND: Immunocompromised patients and those with certain underlying medical conditions are at risk of pneumococcal disease, but in France their vaccine coverage is largely unknown. We aimed to assess the number of adult patients eligible for pneumococcal vaccination in France. METHODS: We conducted an annual cross-sectional study based on retrospective data from the French National Health Data System. Over 2014-2018, we included all adults continuously affiliated to the General health insurance scheme (covering 76% of the population), at risk of pneumococcal disease. Patients were identified with published or newly developed algorithms using diagnoses and reimbursements for hospital stays, medical procedures, and specific treatments, laboratory tests, or medical devices. RESULTS: On January 1, 2018, we identified 4,045,021 at-risk patients (11% increase since 2014). Mean age was 66.1years (55.1% were aged≥65), 51% were men, and 18% had at least two conditions. Of these, 3,634,594 had a chronic medical condition (including 2,617,921 patients treated for diabetes, 616,003 for chronic respiratory disease, 424,223 for heart failure, and 285,214 for chronic liver disease) and 570,035 were immunocompromised (of these, 191,527 were treated with immunosuppressive drugs or biotherapy, 152,255 with chemotherapy for cancer, and 100,604 for HIV). CONCLUSION: These published or newly developed algorithms - which can be used to address other public health issues - identified more than 4 million adults eligible for pneumococcal vaccination in the main health insurance scheme (10% of the studied adult population). This is a first step towards ensuring patients get vaccinated as part of their chronic condition management.

[Patients with a complete or partial remission of Major Depressive Episode as part of Recurrent Major Depressive Disorder: description of ECLAIR study population]. / Patients en rémission partielle ou totale d'un Episode Dépressif Majeur dans le cadre d'un trouble dépressif récurrent: description de la population incluse dans l'étude ECLAIR.

Some guidelines and expert consensus consider the way of care management practices for the recurrent depressive disorder, particularly according to different identified risk factors for recurrence. But, few data are available about the way that these risk factors influence the care management of depressive recurrent patients during the partial or complete remission phase. Eclair study is a longitudinal observatory multicentric and national study, which describes the different risk factors that influence the psychiatrist decision about the following of patients suffering form Major Depressive Disorder (at least 3 Major Depressive Episode (MDE) according to DSM IV). This article presents the inclusion data (V0) of patients, with a focus on their demography characteristics and history of trouble, diagnosis, symptomatology evaluation (with CGI-S, HAM-D, Carroll scale and Sheehan scale) and Cloninger's personality questionnaire (TCI). A total of 596 patients with a recurrent depression either on partial remission (PaR) or complete remission (ToR) to their last episode at the selection, have been included. Complete remission was defined by the presence of a maximum of two criteria of MDE (according to DSM IV) excepted depressed mood and diminished interest or pleasure during at least two months with a HAM-D (17 items) score < 7 and partial remission was defined by the persistence of depressed symptoms but not sufficient to complete a diagnosis of MDE (according to DSM IV) associated with a HAM-D (17 items) score between 8 and 13 included. Mean HAM-D scores at V0 were 10.3 +/- 1.6 for PaR group and 4.0 +/- 1.9 for the ToR group. Free time since last episode was 6.5 +/- 10.5 months in ToR group and 11.2 +/- 16.9 months in PaR group (n = 385). Residual symptomatology between prior episodes was systematically present for 47.6% patients in PaR group, and for 26.7% patients ToR group. The feel to have a stressful daily life persisted for 62.5% of patient in PaR group and 34.3% in ToR group; 70.3% patients in PaR group and 57.9% patients in ToR group reported persistence of causal factor. The main collected risk factors for recurrence were the number of prior depressive episodes (64.9%), familial conflict existence (52.9%) and recent events of life (45.1%). In the TCI, a significant difference in comparison with the French normative data has been found for 3 dimensions: Harm Avoidance, Cooperativeness and Self-Directedness. Some differences were obtained for Novelty Seeking, Reward Dependence, and Self-Transcendence, but without sufficient clinical significance.This study confirms various characteristics about the unipolar depressive disorder, particularly the high risk of recurrence in patients with high number of previous episodes. In the research of predictive depressive recurrence signs, it would be interesting to focus on discriminating elements between complete remitted patients and partial remitted patients.