Optimization strategies of person-centered communication between health pathway stakeholders, people with chronic conditions and their caregivers : the example of Parkinson's disease

Contexte. Les personnes ayant la maladie de Parkinson (PcP) et leurs aidants changent pendant leur parcours de vie. Ces changements impliquent de nombreux acteurs professionnels de parcours (APP). Une communication optimale, entre PcP et APP et entre les différents APP est incontournable pour répondre aux nouveaux besoins des PcP et de leurs aidants. L'exploration de l'expérience vécue de la maladie au quotidien, via une communication centrée sur la personne, permet d'identifier ces besoins.Méthodes. Trois nouveaux outils d'aide à la communication ont été développés pour permettre une exploration et une évaluation multidimensionnelles de l'expérience vécue des PcP : le PARKINSUN (expérience rapportée par les PcP), les questionnaires Bela-A-P-k (exploration croisée de la perspective des PcP et des aidants), et le projet PROXIPARK (recherche action participative prospective avec les PcP, aidants, et APP).Résultats. Ces outils ont été expérimentés in vivo et analysés. Ils sont basés sur une approche introspective et réflexive qui permet aux PcP, aidants, et APP d'analyser et évaluer l'expérience vécue de la maladie au quotidien. Les outils invitent à ouvrir le dialogue entre PcP, APP et aidants et augmentent leur compréhension mutuelle à partir d'une augmentation de leur répertoire commun concernant l'expérience vécue au quotidien avec la maladie de Parkinson.Conclusions. L'évaluation multidimensionnelle via ces outils a lieu régulièrement au cours du suivi global, temporo-spatial, interdisciplinaire et interprofessionnel. Elle permet d'adapter les stratégies d'accompagnement.Background. People with Parkinson's disease (PcP) and their carers change during their life course. These changes involve many professional care providers (PCPs). Optimal communication between PcP and PPAs and between different PPAs is essential to meet the new needs of PcP and their carers. The exploration of the daily experience of the disease, through person-centred communication, helps to identify these needs.Methods. Three new communication tools were developed to allow a multidimensional exploration and evaluation of the lived experience of PCPs: PARKINSUN (PCP-reported experience), Bela-A-P-k questionnaires (cross-exploration of the perspective of PCPs and caregivers), and the PROXIPARK project (prospective participatory action research with PCPs, caregivers, and APPs).Results. These tools were tested in vivo and analysed. They are based on an introspective and reflexive approach that allows PCPs, carers and PPAs to analyse and evaluate their daily experience of the disease. The tools invite to open the dialogue between PcP, PPA and caregivers and increase their mutual understanding by increasing their common repertoire of the daily experience with Parkinson's disease.Conclusions. The multidimensional assessment using these tools takes place regularly during the global, temporo-spatial, interdisciplinary and interprofessional follow-up. It allows for the adaptation of support strategies

La féminisation de la médecine générale face à la crise démographique (un atout pour la Picardie ?)

L effectif des médecins généralistes se féminise et la crise démographique en France touche particulièrement la Picardie. Les femmes étant censées travailler moins que leurs confrères et privilégier leur vie familiale, nous avons voulu examiner si la féminisation de la médecine générale contribuera à une modification de l offre de soins en Picardie. Nous avons, à l aide de deux questionnaires, interrogé un échantillon de médecins généralistes installés en Picardie et les internes en DES de médecine générale de la faculté d Amiens afin d évaluer l exercice actuel et l exercice envisagé. 96 médecins généralistes et 175 internes en DES de médecine générale ont participé à l étude. 59 % des internes sont des femmes. 81% des femmes déclarent vouloir exercer en Picardie contre 65% des hommes. Un interne sur deux envisage un exercice libéral. L exercice seul au cabinet et en zone rurale sont délaissés par les femmes. Les internes envisagent de diminuer leur temps de travail et d effectuer moins de gardes, par rapport à leurs aînés, pour préserver leur qualité de vie. La famille est une des priorités principales des jeunes médecins, qui ne souhaitent plus se consacrer exclusivement à leur exercice médical et privilégient le cabinet de groupe afin de faciliter l organisation du temps de travail. La féminisation et le changement générationnel de la profession modifieront l exercice de la MG. Les nouvelles priorités des futurs généralistes imposent une restructuration de l exercice de la MG, c est pourquoi nous proposons des aménagements basés sur les desirata des internes, c est à ce prix que la féminisation sera un atout pour l offre de soins en Picardie.We note a feminization of the effective of general practitioners and the demographical crisis in France concerns particularly Picardy. Women doctors are supposed to work less than their male s colleagues and to prefer their family life. We analyzed if feminization of general practice changes the care offer in Picardy. We asked general doctors exercising in Picardy and assistants of general medicine at the faculty of Amiens to answer at our questionnaire in the aim to study the current and future general practice. 96 general doctors and 175 assistants in general medicine participate in our study. 59% of assistants in general practice are women. 81% of the women can imagine to exercise in Picardy, 65% of the men. Female doctors are not interested in single practice and they don t want to work in rural region. The future general practitioner plans to work and to take less night duties than their older colleagues in the aim to preserve their quality of life. Family is one of their principal priorities, they don t want to consecrate anymore their whole time at medical practice and prefer group exercise which allows a better organization of working time. Feminization and generational change of general medicine modifies the future general practice. New priorities require the restructure of general medicine; we give some ideas based on the desire of the futures general practitioners. At this price feminization may become a trump for the care offer in Picardy.AMIENS-BU Santé (800212102) / SudocSudocFranceF

Anemia management in non-menopausal women in a primary care setting: a prospective evaluation of clinical practice

Abstract Background The study aimed to analyze anemia management in non-pregnant, and non-menopausal women aged from 18 to 50 years old, in a French primary care setting. Methods An observational descriptive prospective study was conducted between November 2018 and February 2019. Inclusion criteria were as followed: anemia diagnosed in women aged from 18 to 50, not pregnant and not menopausal. Quantitative and qualitative data were anonymized and collected through an electronic survey. Investigating general practitioners completed the questionnaire for each newly diagnosed woman. Mean values and medians were calculated for the quantitative data. Answers to the open questions were encoded manually and proportions of the different modalities have been calculated. Results Altogether, 43 women with anemia were ascertained. Moderate microcytic anemia, due to an iron deficiency in a context of menorrhagia, was the most observed anemia profile. The mean value of hemoglobin was 10.5 ± 1 g/dl. Among these women: 32 (74%) presented an iron deficiency, 17 (53%) had inappropriate intakes, and 9 (28%) reported menorrhagia. For 17 (40%) women, unnecessary or inappropriate exams were prescribed. The investigations did not allow to establish a differential diagnosis for 12 women (28%). Even for similar clinical situations, anemia management was variable. Among the women who presented iron deficiency, 15 (47%) were informed about an iron-rich diet and received a daily iron supplementation of ferrous sulfate between 80 mg and 160 mg. Conclusions Our study highlights that, in the absence of specific national guidelines for anemia management in non-pregnant, non-menopausal women in primary care settings, French GPs undergo various clinical management strategies leading to a heterogeneous, sometimes inappropriate follow-up. Women with iron deficiency were prescribed higher daily iron supplementation than recommended, according to new evidence, suggesting a maximal daily dose of 50 mg of elementary iron in a context of Hepcidin up-regulation in the case of an iron overload. Additional longitudinal studies with a bigger sample size and randomized controlled trials are needed to confirm our results and to elaborate national guidelines

Spécificités des stratégies d'adaptation en cas de syndrome de fatigue chronique identifiées dans une enquête flash française pendant le confinement de COVID-19

International audienceThe COVID‐19 pandemic has focused health systems on supporting patients affected by this virus. Meanwhile in the community, many other contained patients could only use self‐care strategies, especially in countries that have set up a long and strict containment such as France. The study aimed to compare coping strategies deployed by patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS; a poorly recognised syndrome) to those with better known and referenced chronic conditions. An online flash survey was conducted during the containment period in partnership with French Patients Organizations including ME/CFS national association. Therefore, ‘Brief COPE’ version of Lazarus and Folkman's Ways of Coping Check List has been adapted to the specificity of the containment. The survey was e‐distributed in France from 15 April to 11 May 2020. Differences of coping strategies were analyzed using Wilcoxon–Mann–Withney test. Amongst 637 responses, 192 were complete, presenting a wide variety of diseases, including 93 ME/CFS. The latter have significantly different coping strategies than recognised diagnosed diseases patients: similar uses of emotion focused coping but less uses of seek social support and problem‐focused copings. In conclusion, coping strategies are different for those who deal with the daily experience of ME/CFS, highly disabling chronic condition with diagnostic ambiguity, low degree of medical and social recognition and without treatment. Better understanding of those strategies is needed to provide the means for health promotion researchers, managers and clinicians, to accompany those patients.La pandémie de COVID-19 a concentré les systèmes de santé sur le soutien aux patients touchés par ce virus. Pendant ce temps, dans la communauté, de nombreux autres patients confinés ne pouvaient utiliser que des stratégies d'auto-soins, en particulier dans les pays qui ont mis en place un long et strict confinement comme la France. L'étude visait à comparer les stratégies d'adaptation déployées par les patients atteints d'encéphalomyélite myalgique/syndrome de fatigue chronique (EM/SFC ; un syndrome mal reconnu) à celles de patients souffrant de maladies chroniques mieux connues et référencées. Une enquête flash en ligne a été menée pendant la période de confinement en partenariat avec des associations de patients françaises dont l'association nationale ME/CFS. Par conséquent, la version "Brief COPE" de la liste de contrôle des moyens de faire face de Lazarus et Folkman a été adaptée à la spécificité du confinement. L'enquête a été distribuée par voie électronique en France du 15 avril au 11 mai 2020. Les différences de stratégies d'adaptation ont été analysées à l'aide du test de Wilcoxon-Mann-Withney. Parmi les 637 réponses, 192 étaient complètes, présentant une grande variété de maladies, dont 93 EM/SFC. Ces derniers ont des stratégies d'adaptation significativement différentes de celles des patients atteints de maladies diagnostiquées : utilisation similaire de l'adaptation centrée sur les émotions, mais utilisation moindre de la recherche de soutien social et de l'adaptation centrée sur les problèmes. En conclusion, les stratégies d'adaptation sont différentes pour ceux qui font face à l'expérience quotidienne de l'EM/SFC, une maladie chronique hautement invalidante, au diagnostic ambigu, au faible degré de reconnaissance médicale et sociale et sans traitement. Une meilleure compréhension de ces stratégies est nécessaire pour donner les moyens aux chercheurs, gestionnaires et cliniciens de la promotion de la santé, d'accompagner ces patients

Meeting the needs of pregnant women in socially vulnerable situations: A phenomenological qualitative study

Objective: Vulnerability relates to fragile physical, psychological, and socio-environmental circumstances. Pregnant women's social vulnerability can lead to disruptions in their medical follow-ups, prematurity, and increased infant mortality rates, such that their special needs must be considered. Yet, despite different governments' ‘perinatality’ plans, international literature suggests their care can be improved. Although quantitative studies regularly evaluate these plans, few studies have assessed vulnerable pregnant women's views. This study explores the needs and expectations of vulnerable women regarding their follow-ups during pregnancy and identified strategies to improve their circumstances. Methods: The study was a phenomenological qualitative study involving semi-structured interviews with women who gave birth in the past six months (December 2017 to June 2018) and who fulfilled at least one vulnerability criterion. The women were recruited by French midwives and general practitioners (GPs). Findings: Concerning these vulnerable pregnant women, three phenomenological categories emerged: 1) they need to be monitored by a single trusted contact; 2) they seek medical and social support adapted to their situations that addresses their needs; and 3) they expect kind and person-centred communication skills from professionals who provide them appropriate information. Conclusion: We identified various international recommendations to screen and care for vulnerable pregnant women, but still these women often experience numerous challenges. Finally, the implementation of recommendations for healthcare professionals based on women's real-life experiences could help optimise the identification of vulnerable pregnant women as well as their follow-up care

Translation and validation of two Parkinson's disease specific burden questionnaires from German into French

International audienceObjective: The study purpose was to translate the questionnaires and to evaluate their internal consistency and temporal stability in a French study population, composed of patients and their caregivers (spouses).Background: Parkinson’s Disease (PD) is a common neurodegenerative condition. It’s various clinical expression affects patient’s and caregivers’ psycho-social well-being. To assess the PD-related psychosocial burden in a dyad (patient and spouse), two specific questionnaires exist in German. The Bela-A-K and Bela-P-K, questionnaires allow healthcare professionals to cross-check the patient’s (Bela-P-K) and the caregiver’s (Bela-A-K) perspective of well-being despite PD, whereas the Zarit questionnaire is limited to the caregiver’s perspective. Four dimensions are explored: physical performance, emotional charge, social relationships, and couple/family life.Method: The questionnaires have been translated from German into French, using the for-and backward translation, followed by a cultural cross-check. The participants were recruited by a GP and a PD-nurses and invited to test the consensual French version in its online administered version, created via the Lime Survey® software. The participants had to fill out the questionnaires twice to respect the “test-re-test” method. Five days after their first assessment, they answered again. Data analysis was performed, using the SPSS software.Results: Nineteen couples participated in the study;18 patients (14 M/4F); 18 spouses (4M/14F). The Bela-A-K showed a strong temporal stability, whereas it was weak for the dimension of social relationships. The Bela-P-K showed a strong internal consistency, but significative differences for ten items between the moment of test and retest. Some items of the Bela-P-K must be simplified to improve its temporal stability, considering the patient’s changing form on the day. The items related to the dimension of social relationships must be adjusted for the Bela-A-K.Conclusion: The questionnaires are useful and reliable. They contribute to a socio-psychological dyad-centred follow-up and health education in case of PD.References: [1] Spliethoff-Kamminga NGA, Zwinderman AH, Springer MP, Roos RAC. A disease-specific psychosocial questionnaire for Parkinson’s disease caregivers. J Neurol. 1 oct 2003;250(10):1162‑8. [2] Spliethoff‐Kamminga NGA, Zwinderman AH, Springer MP, Roos RAC. Psychosocial problems in Parkinson’s disease: Evaluation of a disease-specific questionnaire. Mov Disord. 2003;18(5):503‑9. [3] Ortelli P, Maestri R, Zarucchi M, Cian V, Urso E, Giacomello F, et al. Italian validation of the Belastungsfragebogen Parkinson kurzversion (BELA-P-k): a disease-specific questionnaire for evaluation of the subjective perception of quality of life in parkinson’s disease. J Clin Mov Disord. 25 juill 2017;4(1):12

Plastics can be used more sustainably in agriculture

Plastics have become an integral component in agricultural production as mulch films, nets, storage bins and in many other applications, but their widespread use has led to the accumulation of large quantities in soils. Rational use and reduction, collection, reuse, and innovative recycling are key measures to curb plastic pollution from agriculture. Plastics that cannot be collected after use must be biodegradable in an environmentally benign manner. Harmful plastic additives must be replaced with safer alternatives to reduce toxicity burdens and included in the ongoing negotiations surrounding the United Nations Plastics Treaty. Although full substitution of plastics is currently not possible without increasing the overall environmental footprint and jeopardizing food security, alternatives with smaller environmental impacts should be used and endorsed within a clear socio-economic framework. Better monitoring and reporting, technical innovation, education and training, and social and economic incentives are imperative to promote more sustainable use of plastics in agriculture.ISSN:2662-443

Plastics can be used more sustainably in agriculture

Abstract Plastics have become an integral component in agricultural production as mulch films, nets, storage bins and in many other applications, but their widespread use has led to the accumulation of large quantities in soils. Rational use and reduction, collection, reuse, and innovative recycling are key measures to curb plastic pollution from agriculture. Plastics that cannot be collected after use must be biodegradable in an environmentally benign manner. Harmful plastic additives must be replaced with safer alternatives to reduce toxicity burdens and included in the ongoing negotiations surrounding the United Nations Plastics Treaty. Although full substitution of plastics is currently not possible without increasing the overall environmental footprint and jeopardizing food security, alternatives with smaller environmental impacts should be used and endorsed within a clear socio-economic framework. Better monitoring and reporting, technical innovation, education and training, and social and economic incentives are imperative to promote more sustainable use of plastics in agriculture

Clinical pathway of COVID-19 patients in primary health care in 30 European countries : Eurodata study

BackgroundMost COVID-19 patients were treated in primary health care (PHC) in Europe.ObjectivesTo demonstrate the scope of PHC workflow during the COVID-19 pandemic emphasising similarities and differences of patient's clinical pathways in Europe.MethodsDescriptive, cross-sectional study with data acquired through a semi-structured questionnaire in PHC in 30 European countries, created ad hoc and agreed upon among all researchers who participated in the study. GPs from each country answered the approved questionnaire. Main variable: PHC COVID-19 acute clinical pathway. All variables were collected from each country as of September 2020.ResultsCOVID-19 clinics in PHC facilities were organised in 8/30. Case detection and testing were performed in PHC in 27/30 countries. RT-PCR and lateral flow tests were performed in PHC in 23/30, free of charge with a medical prescription. Contact tracing was performed mainly by public health authorities. Mandatory isolation ranged from 5 to 14 days. Sick leave certification was given exclusively by GPs in 21/30 countries. Patient hotels or other resources to isolate patients were available in 12/30. Follow-up to monitor the symptoms and/or new complementary tests was made mainly by phone call (27/30). Chest X-ray and phlebotomy were performed in PHC in 18/30 and 23/30 countries, respectively. Oxygen and low-molecular-weight heparin were available in PHC (21/30).ConclusionIn Europe PHC participated in many steps to diagnose, treat and monitor COVID-19 patients. Differences among countries might be addressed at European level for the management of future pandemics.Peer reviewe