Cet article a pour objectif d’étudier les usages d’Internet pour la santé en termes de consultation d’informations médicales en ligne. Les internautes cherchent-ils sur Internet des informations en vue de comprendre ou confirmer le diagnostic du médecin (Internet comme complément) ou pour remplacer ou contester son diagnostic (Internet comme substitut) ? Nous avons mené une étude empirique sur 1344 internautes bretons et développé trois modèles économétriques de type Logit. Nous constatons que le principal usage en santé est la recherche d’informations pour obtenir des informations sur une maladie ou les symptômes d’une maladie. Les résultats sont conformes à la revue de littérature et montrent que la recherche d’informations en ligne sur la santé est plus élevée pour les femmes, pour les personnes ayant un faible niveau de santé et pour ceux qui passent plus de temps sur Internet. Les profils des internautes qui recherchent des informations complémentaires sont différents de ceux qui recherchent des informations de substitution. Un des avantages d’avoir accès à de l’information médicale en ligne est la diminution des coûts en termes de temps, d’accès et de revenu. Les personnes actives dans le sens d’avoir un emploi, mais aussi pour le temps passé sur Internet sont enclines à chercher plus d’informations pour un second avis. L’état de santé est aussi un facteur explicatif très important pour les informations de substitution. Cependant, l’enquête n’était pas suffisamment détaillée pour conclure en une baisse du nombre de consultations médicales réelles et qualifier l’impact d’internet sur la confiance accordée au médecin.

Background: A literature review concerning the economic evaluation of telemonitoring was requested by the authority in charge of health evaluation in France, in a context of deployment of remote patient monitoring and identification of its financing. Due to the heterogeneity of existing telemonitoring solutions, it was necessary to stratify the evaluation according to patient involvement. Three levels of patient involvement are considered: weak (automated monitoring), medium (monitoring supported by a professional), and strong (active remote participation). Objectives: We performed a scoping review to provide a comprehensive overview of different systems of telemonitoring and their reported cost-effectiveness. Methods: Following PRISMA-ScR guidelines, a search was performed in four databases: PubMed, MEDLINE, EMBASE, and Cochrane Library between January 1, 2013 and May 19, 2020. Remote patient monitoring should include the combination of three elements: a connected device, an organizational solution for data analysis and alert management, and a system allowing personalized interactions, and three degrees of involvement. Results: We identified 61 eligible studies among the 489 records identified. Heart failure remains the pathology most represented in the studies selected (n = 24). The cost-utility analysis was chosen in a preponderant way (n = 41). Forty-four studies (72 percent) reported that the intervention was expected cost-effective. Heterogeneity has been observed in the remote monitoring solutions but all systems are reported cost-effective. The small number of long-term studies does not allow conclusions to be drawn on the transposability. Conclusions: Remote patient monitoring is reported to be cost-effective whatever the system and patient involvement.

Three-dimensional printing is a technology that has been developed and applied in several medical specialties, especially orthopedic surgery. Knee arthroplasty is the most commonly performed procedure. To fit the morphology of each knee, surgeons can choose between different standardized off-the-shelf implant sizes or opt for customized 3D-printed implants. However, routine adoption of the latter has been slow and faces several barriers. Existing studies focus on technical improvements or case studies and do not directly address the surgeon’s perspective. Our study invited surgeons to express themselves freely and answer the question “What do you think about the manufacture of a prosthesis by 3D printing?”. The questionnaire was completed by 90 surgeons. On average, they had more than 10 years of experience (52, 57.8% ± 10.2%), worked in public hospitals (54, 60% ± 10.1%), and performed between 0 and 100 prostheses per year (60, 66.7% ± 9.7%). They also reported not using planning software (47, 52.2% ± 9.7%), navigation systems, or robots (62, 68.9% ± 9.6%). Regarding the use of technological innovation, they agreed on the extra surgical time needed (67, 74.4% ± 9.0%). The answers obtained were classified according to two criteria: (i) opinions, and (ii) motivations. Among the respondents, 51 (70% ± 9.5%) had positive and 22 (30% ± 9.5%) had negative opinions about 3D printing. The motivations were distributed among seven categories (surgery, materials, costs, logistics, time, customization, and regulatory) and mainly related to “pre-surgery” and “post-surgery” concerns. Finally, the results showed that the use of navigation systems or robots may be associated with a more positive view of 3DP. The purpose of our study was to examine knee surgeons’ perceptions of 3DP at a time of significant expansion of this technology. Our study showed that there was no opposition to its implementation, although some surgeons indicated that they were waiting for validated results. They also questioned the entire supply chain, including hospitals, insurance companies, and manufacturers. Although there was no opposition to its implementation, 3D printing is at a crucial point in its development and its full adoption will require advances in all areas of joint replacement.

Background: Social participation is a fundamental right; however, restrictions often arise due to environmental barriers, both physical and social. The ‘Handicap Innovation Territoire’ (HIT) project aims to enhance social participation for individuals with disabilities living in Brittany, France. To gain insight into the desired areas of intervention and evaluate the HIT project, an initial experiment was conducted to assess the level of social participation and perceived environmental quality among people with disabilities. Methods: A cross-sectional investigation was performed, utilizing the Assessment of Life Habits (LIFE-H) and Measure of the Quality of the Environment (MQE). Results: Twenty-five individuals with disabilities, with an average age of 46.0 ± 23.6 years, were recruited. The results indicated an overall high level of social participation, while work, education, and leisure showed participation restrictions. The MQE scores revealed variations in the environmental perception across disability groups concerning work environment (p = 0.035), stores and services (p = 0.014), health care services (p = 0.006), education (p = 0.043), access to radio and television (p = 0.002), road accessibility (p = 0.003), and time allowed for tasks (p = 0.001). Conclusion: The study identified factors that influence social participation among individuals with disabilities living in Brittany, and highlighted the actions implemented within the HIT project to address the challenges related to social participation.