Optimising patients’ medical care after prison in Luxembourg

Introduction : Passing through prison can be a health gain for the incarcerated population and release from prison can become a period of vulnerability where this potentially acquired gain is lost if the transition back to civil society in not anticipated. The main objective was the identification and analysis of the factors favor and oppose primary care practice for patients leaving prison in Luxembourg. The secondary objective was to develop recommendations based on the key findings through a literature’s review. Methods : A qualitative study using semi-structured interviews was conducted with general practitioners and patient-inmates. The questions from the two interview guides were similar so that the analysis allowed the results to be mirrored. Using the interviews’ transcripts, a categorical thematic content analysis of those was conducted based on the objectives. On the basis of verbatim, items were formulated and grouped into dimensions and then themes. Results : Our analysis has highlighted the lack of links between the prison and the outside world at each stage of medical and psychosocial care from the point of view of care and support proposed in prison until prison release. Recommendations for doable improvements have been proposed, such as the creation of a general practitioners’ network continuing the medical care as well as genuine cooperation with organisations dealing with drug addicts. Conclusion : Reforms concerning prison care should be considered between the system of prison release, the creation of socio-medical relays and alternatives to incarceration, in analogy to the transitions clinics found in the United State

Les malades chroniques veulent avoir des rapports nouveaux « plus jeunes » avec les professionnels de santé….

« S’appuyer sur Nos expériences liées à notre maladie, aux soins reçus, c’est faire entendre Notre vécu et reconnaitre Notre savoir à Nous ». L’équipe du Pr Michèle BAUMANN est allée à la rencontre de personnes (dyalisées, victimes d’un Accident Vasculaire Cérébral, de cancer du sein, de maladies rares, …) pour qu’elles nous parlent des relations qu’elles ont avec les professionnels et les équipes (infirmiers, médecins, spécialistes, etc.). Dans le cadre d’un projet INTERREG (cofinancé FEDER) concernant le Luxembourg, mais aussi les pays frontaliers de la Grande-Région, les membres d’associations ont exprimé leurs attentes sur la façon dont ils souhaiteraient avoir des relations de PARTENAIRES. « S’intéresser à mes questions car pour moi c’est survivre… m’impliquer dans les soins pour que j’apprenne … partager et échanger les informations qui me concernent… et surtout m’investir dans le processus …pour que je me sente partie prenante dans les décisions qui doivent être prises… » sont des demandes d’une époque nouvelle. Les discours de ces personnes en cours d’analyses, avec l’appui d’Angela ODERO doctorante, permettront de comprendre les points forts à discuter pour mettre en œuvre des réseaux de porte-parole, des formations pour les patients et professionnels, etc. Les personnes des associations qui veulent aussi s’exprimer en groupe, doivent nous contacter. Michèle Baumann, professeure en sociologie médicale et santé publique à l’IRSEI, à l’Université du Luxembourg, a été nommée en octobre 2018 par la Commission Européenne, experte indépendante pour le Luxembourg sur les soins de santé de longue durée et membre de l’European Social Policy Network (ESPN)

New cultural competences needed for healthcare teams as a priority in treatment of chronic diseases

Technological changes and higher prevalence of chronic diseases require changing patients’ and healthcare professionals’ position with more participation in healthcare organization, and more implication in their relationships. Based on the Canadian ‘patient-as-partner in healthcare’ approach, our aims were to identify and categorize cultural values underlying this term in Luxembourg, and to characterize a set of cultural competencies needed for its practical application. Method: A qualitative study using a semi-directive guide developed within an INTERREG project was conducted among 30 healthcare professionals. A categorical thematic content analysis was realized using N'Vivo software. Results: For some professionals, the word ‘partner’ is not appropriate in Luxembourgish, but they defined it as a companion who engages in a mutual cooperation, structured collaboration and sharing of information with a common goal: Quality of healthcare. For others, a ‘partner’ is an associate who takes part in decision making, discussions, negotiations and evaluations. This partner approach would allow processes of change, bringing autonomy (surveillance, self-education, and monitoring treatment) to the patients, provided that professionals partly cede their traditional power. Trust and respect would be the main start of this process. Difficulties in communication and relationships would arise when helping the patients understand their disease, adhering to instructions, and giving a balanced place to the information found on Internet. Conclusion: This ‘collaborative accompaniment’ appears to allow decisional balance, an interdisciplinary method which requires training for all partners (physicians GP or specialists, patients and psychologist) and not only case-managers to help patients acquire self-efficacy for behavioral changes

Gender and age disparities in the associations of occupational factors with alcohol abuse and smoking in the French working population

Background. – This study assessed the associations of short-term employment, physical and psychological occupational demands, and job dissatisfaction with alcohol abuse (using the Audit-C test) and daily smoking among working French men and women in different age groups. Methods. – The sample included 13,241 working people, 18–29, 30–39, and 40–59-years-old, randomly selected in France and interviewed by phone. Occupation, type of employment, physical demands, psychological demands, job dissatisfaction, gender, age, educational level, and income were considered. Data were analyzed with logistic models. Results. – Alcohol abuse affected 20.4% of men and 7.5% of women; smoking 32.1% and 24.2%, respectively. Their patterns of association with the occupational factors varied with gender and age. Job dissatisfaction was the leading factor among young men (adjusted odds ratio for alcohol abuse and smoking: 1.71 and 2.02), whereas short-term employment was the leading factor among young women (1.69 and 1.58), this pattern being reversed in older generations. The pattern of associations of physical and psychological demands with outcomes is more complex, but overall psychological demands were more important for women (especially the younger ones) than men, especially for smoking (OR > 1.6). Smoking within 5 min after waking was much more common among male and female smokers with these occupational factors, suggesting a potential dependency. Conclusions. – Workers with short-term employment and occupational demands are subject to a higher risk for alcohol abuse and smoking with high gender and age disparities. Gender and age should be considered when designing measures to prevent substance abuse related to occupation

Prevalence of Problem Drug Use and Injecting Drug Use in Luxembourg: A Longitudinal and Methodological Perspective.

To estimate the prevalence of problem drug use (PDU) and injecting drug use (IDU) in Luxembourg and analyze trends between 1997 and 2009. To assess the feasibility of prevalence estimations based on drug use surveillance systems. Methods: Serial multi-method PDU/IDU prevalence estimations based upon capture-recapture, Poisson regression, multiplier and back-calculation methods. Comparative analysis of methods and assessment of their robustness to variations of external factors. Results: National PDU and IDU prevalence rates were estimated at 6.16/1,000 (95% CI 4.62/1,000 to 7.81/1,000) and 5.68/1,000 (95% CI 4.53/1,000 to 6.85/1,000) inhabitants aged 15–64 years, respectively. Absolute prevalence and prevalence rates of PDU increased between 1997 and 2000 and declined from 2003 onwards, whereas IDU absolute prevalence and prevalence rates witnessed an increasing trend between 1997 and 2007. Conclusions: Drug use surveillance systems can be valuable instruments for the estimation and trend analysis of drug misuse prevalence given multiple methods are applied that rely on serial and representative data from different sources and different settings, control multiple counts and build upon standardized and sustained data collection routines. The described institutional contact indicator revealed to be a useful tool in the context of PDU/IDU prevalence estimations and thus contributes to enhancing evidence-based drug policy planning

Generation of Patients-as-Partner Items Through a Qualitative Data Analysis : Initial Item Reduction

Health psychology aspires to find ways for evaluating the Patient as a Partner. The Montréal model, proposes a verbal and conceptual interpretation. Developed by a University of Montréal research team, this approach advances that patients should play an active role in the healthcare process. Quantitative assessments employing a methodological framework involving a qualitative approach do not exist. Our study aimed at analyzing a procedure for generating patient as a partner related items and to elaborate their classification. Five semi-structured focus groups with 20 chronic disease patients and 15 professionals (doctors, nurses) were conducted. A qualitative analysis, combining inductive (data abstraction was conducted from specific to general), and deductive (guided by a predefined protocol) methods was employed to create a flexible framework of analysis. A thematic categorical content analysis of the transcriptions was conducted. Verbatim were extracted and classified into categories. Cluster analysis using Sorensen’s coeffient was performed with the software N’Vivo 12. Sorensen’s similarity analysis helped to structure a conceptual framework for the assessment of patient as partner at the doctor patient interaction level. The content of each category was verfied through consensus by multidisciplinary experts, who formulated items to capture the overall patient as partner experience. Our list of items constituted fundamental dimensions of partnership, constituting a first classification and a basis for the development of a routine clinical assessment tool. This process should guarantee that the items are acceptable, comprehensive and relevant (reflecting the lived experience of the participants) ensuring a validity of the future questionnaire

Social inequalities of health and handicap. The example of the cerebral vascular attack

The social inequalities of health are observed in the field of illness and death. What about the inequalities with a handicap?. The studies and surveys that highlight the relationship between handicap and social health inequalities are cruelly lacking. It is for this reason that we tried to explore this relationship in the scope of a survey carried out in France on the social and family repercussions of a cerebral vascular attack. The method used, a significant national survey in France (1000 people questioned in 260 families where a stroke took place in the previous year), carried out in 2004/2005 taking into account the family repercussion of a cerebral vascular attack, we tried to highlight the differences and the social inequalities that exist as much in the frequency and the gravity of deficiencies due to a stroke, as in the effects produced on the family life, in particular to the spouse. This survey, conducted in the home, is made up of three questionnaires, one of which is the main one( particularly the spouse’s) takes into account all the aspects of family life and the social relationships whilst trying to highlight the repercussions following the stroke. The results. The results show the extent of the impact on the family, especially in the relationship of the couple. On the whole, they confirm the assumption of social inequalities between social groups defined according to the income, the educational level and the profession, in particular with regards to the gravity of deficiencies, progress of rehabilitation, the quality of the financial responsibility, the standard of living and in several dimensions of social life (leisure and cultural activities). However it is necessary to underline the difficulty in isolating the social inequalities which are expressed apart from the situation due to the stroke; inequalities which can be enhanced or which take on a particular character because of this accident. Conclusion We can hold on to the hypothesis that the stroke represents an event that can be considered as an indicator of the previous social state and relationship, bringing on in some way aggravating effects that can be as positive as they can be negative. Social health inequalities must be analyses whilst taking this hypothesis into account

Life satisfaction of non-mobile vs.mobile postgraduates intra EU and outside EU Universities, and its associations with mental health and career attitudes.

Specific attention should be devoted to the needs of young adults enrolled in a mobility abroad programme of their universities. Among mobile vs. non-mobile postgraduates, our study analysed their life satisfaction (LS) as well as the associations with mental health-related factors and career attitudes. We determined factors contributing to their LS. Method. In 2012/13, three groups (non-mobile = 66; mobile intra-EU = 382; mobile outside-EU = 44) who had obtained a financial aid from the Luxembourgish government, without family’s socioeconomic criteria. Master students completed an online questionnaire, and analyses included multiple linear regression models in which only relationships (p<0.05) were introduced. Results. Further mobility showed higher levels of LS (outside-EU 8.5/10, intra-EU 7.8 and 7.9 non-mobile). For all groups, health satisfaction (HS) was positively correlated with LS; for mobile outside-EU, it is the only determinant. For mobile intra-EU, the quality of their autonomy and their career adaptability were also associated to LS (regression parameter estimates β: 0.208 and 0.128, respectively), and worry (β:-0.146). For non-mobile, in addition to HS, their career optimism and planning were positively correlated to their LS (β: 0.402 and 0.214, respectively). Conclusion. Promoting programmes proposed by the universities’ services towards counselling and an accompaniment to their career project may enhance postgraduates’ LS which is a major indicator for a successful mobility. The assessment of outside-EU’ LS was higher than the EU-28 LS’ indicator (age group 25-34 years; in 2013: 7.5/10). More cross-cultural research would be warranted to better understand the etiology of their LS

Evaluation-conseil, demarche comprehensive, indicateurs de perception

peer reviewedSous l’impulsion du processus de Bologne, les établissements de l'Espace Européen de l'Enseignement Supérieur mettent en place des systèmes Qualité. Des référentiels d'évaluation communs et des guides visent, au nom du processus d'harmonisation, à diffuser les "bonnes pratiques" dans tous les pays participants. Les universités sont sommées d'être productives et d'adopter une gestion rationnelle de l'ensemble de leurs ressources. Ainsi, les programmes sont généralement évalués a posteriori à l'aide d'indicateurs de performance comme les taux de réussite aux examens ou d'insertion professionnelle des diplômés, et la pratique généralisée du benchmarking tend à favoriser l'utilisation de ces statistiques descriptives pour effectuer des comparaisons puis des classements nationaux et internationaux (Shanghai, Times Higher Education). Cependant, certains enseignants et chercheurs souhaitent, dans une perspective holistique, considérer également le bien-être et le développement personnel des étudiants. Le dispositif SQALES, testé auprès d'un échantillon de 282 étudiants belges, luxembourgeois et roumains, propose une approche de l'évaluation novatrice reposant sur de la perception qu'ont les étudiants de leurs compétences relatives à l'employabilité (échelle CRE), de leur santé psychologique (GHQ12) et de leur sentiment d'appartenance à la vie étudiante (échelle d'Identité Sociale d'Etudiant, ISE). Cette évaluation-conseil s'appuie sur une démarche compréhensive qui tient compte du contexte local et implique les bénéficiaires en tant que partenaires du processus décisionnel. Réalisée en cours de cursus, elle permet de prendre en compte "en temps réel" les difficultés rencontrées par les apprenants et d'adapter les curricula à leurs besoins, lesquels évoluent au fil de la formation, en fonction de leur construction identitaire. L'évaluateur n'agit pas en juge, mais encourage la réflexivité des acteurs et des institutions. La recherche d'un consensus concernant les ajustements à réaliser permet de réduire l'écart entre les besoins ressentis et les dispositions prises, décisions dont elle permet d'obtenir une meilleure tolérance et une mise en œuvre facilitée.F3R-INS-PUL-08SQLE > SQALES > > BAUMANN Michèl

How patients perceive the therapeutic communications skills of their general practitioners, and how that perception affects adherence: use of the TCom-skill GP scale in a specific geographical area

To study: (1) the structure and test-retest reliability of a measure of how patients perceive the therapeutic communications skills of their general practitioners (TCom-skill GP), and (2) the associations of that scale with socio-demographic and health-related characteristics, and adherence. Methods: A total of 393 people who lived in the same geographic area and invited to attend a preventive medical centre for a check up were asked to complete a self-administered questionnaire concerning TCom-skill GP (15 items), socio-demographic and health-related characteristics, and to answer two questions on perceived adherence. Results: The average age of respondents was 46.8 years (SD 14), and 50.4% were men. The TCom-skill GP score was one-dimensional, had high internal coherence (Cronbach α 0.92), and good test-retest reliability (intra-class correlation coefficient 0.74). The overall score was positively related to increasing age. Respondents aged 60+ were more likely to be adherent. The higher the score, the higher the probability of adherence. Multivariate analysis showed that the TCom-skill score was associated with advancing age and the number of consultations with the GP during the previous 3 months, but not with gender, living alone, being employed, job category or educational level. Multivariate analysis also showed that adherence was associated with TCom-skill GP score which concealed the association between adherence and advancing age observed in univariate analysis. Conclusion: The TCom-skill GP scale probably has value in assessing the quality of doctor-patient relationships and therapeutic communications. The psychometric properties of the TCom-skill GP scale were appropriate for its use in this context. Adherence related to the TCom-skill GP and the latter related to the age of patients and the number of their previous consultations. The TCom-skill GP scale may be a useful way to assess, in a specific geographical location, the impact of medical professional training on therapeutic communication