The increasingly female face of chronic obstructive pulmonary disease (COPD) prevalence among women has equalled that of men since 2008, due in part to increased tobacco use among women worldwide and exposure to biomass fuels. This finding is supported by a number of characteristics. There is evidence of susceptibility to smoking and other airborne contaminants, along with epidemiological and phenotypic manifestations. COPD has thus become the leading cause of death in women in the USA. The clinical presentation is characterised by increasingly pronounced dyspnoea with a marked tendency towards anxiety and depression, undernutrition, nonsmall cell lung cancer (especially adenocarcinoma) and osteoporosis. Quality of life is also more significantly impacted. The theories advanced to explain these differences involve the role played by oestrogens, impaired gas exchange in the lungs and smoking habits. While these differences require appropriate therapeutic responses (smoking cessation, pulmonary rehabilitation, long-term oxygen therapy), barriers to the treatment of women with COPD include greater under-diagnosis than in men, fewer spirometry tests and medical consultations. Faced with this serious public health problem, we need to update and adapt our knowledge to the epidemiological changes.

pdf/women-and-copd-do-we-need-more-evidence-1e01c1fc2m.pdf

Women and COPD: do we need more evidence?

Identified in December 2019 in China, the coronavirus 2019 (COVID-19) has been declared a Public Health Emergency of International Concern (PHEIC). Pandemics share features that increase fear. While some fear can stimulate preventive health behaviors, extreme fear can lead to adverse psychological and behavioral response. The media play a major role shaping these responses. When dealing with a PHEIC, the authorities' communication strategies are embedded in a multilevel governance and a highly hierarchal system, which adds another layer of complexity. Carrying out more 'real-world research' is crucial to generate evidence relating to the psychosocial and behavioral aspects involved during the COVID-19 pandemic and how it is shaped by authorities and media discourses. Interdisciplinary research and international collaborations could contribute to improve our understanding and management of risk information. Emerging from a socio-ecological perspective, future research must integrate multilevel analytical elements, to ensure triangulation of evidence and co-constructing robust recommendations. A mixed-method approach should be privileged to address these issues. At the micro-level, a population-based survey could be conducted in various jurisdictions to assess and compare psychosocial issues according to sociocultural groups. Then, a quantitative/qualitative discourse analysis of the media could be performed. Finally, a network analysis could allow assessing how official information flows and circulates across levels of governance. The COVID-19 represents an opportunity to evaluate the impacts of information/communication strategy and misinformation on various cultural and socioeconomic groups, providing important lessons that could be applied to future health emergencies and disasters.

/pdf/communication-strategies-and-media-discourses-in-the-age-of-425154bxbt.pdf

Communication strategies and media discourses in the age of COVID-19: an urgent need for action.

Introduction: Undergraduate medical education curricula in France rarely include training in patient education and few data is available for postgraduates training. The aim was to assess actual practices, perceptions, and needs of French primary care physicians in the field of postgraduate training in patient education. Methods: A total of 2083 physicians completed a detailed questionnaire on current practices, perceptions and needs with respect to training in patient education. Results: Overall, the attitude of physicians towards patient education was positive and they are largely involved. Half of them underwent training in the last 12 months, and another 25% were planning to do some. However, there was a conflict between effective practices and perceived needs. Involvement in an association of patients and working in a group practice are positively correlated with the enrolment to TPE trainings. Lack of time was the main reason given by physicians who did not plan any training. Conclusion: The results of this study highlight the gap between primary care physicians’ intentions and their feedback concerning current practices, as well as the difficulty experienced by primary care physicians in “catching up” with the social dimensions that were missed out in undergraduate medical education. This survey raises questions about the initial training of primary care physicians in France. The complexity of patient management means that a body of knowledge needs to be created, including input from the field of human and social sciences.

Training in therapeutic patient education of French primary care physicians : practices and perceived needs

Resume Introduction Le pharmacien joue un role essentiel dans la prise en charge du patient asthmatique du fait de la frequence de ses visites en officine pour la delivrance de ses medicaments. Methodes Afin d’evaluer le comportement et les connaissances des pharmaciens du Bas-Rhin dans l’asthme, 120 pharmaciens ont ete selectionnes au hasard pour repondre a un questionnaire standardise. Resultats Les 86 pharmaciens ayant participe a l’etude ont une bonne connaissance generale de l’asthme et de son traitement. Cependant, 26,4 % des pharmaciens connaissaient l’ensemble des criteres de gravite d’une crise d’asthme. Parmi les 57 pharmaciens ayant effectue une demonstration de l’utilisation de dispositifs inhales, 16,3 % ont realise toutes les etapes de manipulation d’un spray-doseur. Ces resultats sont comparables a ceux des medecins non pneumologues et des infirmieres pour lesquels la mauvaise utilisation varie de 63 a 100 % et 65 a 96 %, respectivement. Les scores moyens des pharmaciens etaient de 10,5/12 etapes (± 1,2) pour l’aerosol-doseur, 10,4/11 (± 1,0) pour le Turbuhaler ® , 9,3/12 (± 1,7) pour l’Autohaler ® et 8,1/9 (± 0,9) pour la chambre d’inhalation. L’attente principale du patient asthmatique vis-a-vis du pharmacien concerne la methode d’utilisation des dispositifs prescrits (87,2 %), soulignant ainsi le manque d’informations recues ou retenues par le patient lors de la prescription. Conclusion L’amelioration des connaissances en matiere de signes de gravite de l’asthme et d’utilisation des dispositifs inhales pourrait etre utilement l’un des objectifs de formation du pharmacien d’officine.

Prise en charge de l'asthme à l'officine : enquête auprès de 120 pharmaciens du Bas-Rhin

Resume Introduction La BPCO est une priorite de sante publique depuis maintenant plusieurs annees, et de multiples recommandations ont ete publiees sur sa detection et sa prise en charge. Etat des connaissances De nombreuses etudes montrent que les pratiques restent sous-optimales sur le plan du diagnostic et du traitement, en etat stable et lors des exacerbations. Les facteurs en cause sont multiples, tenant aux recommandations elles-memes (methode de developpement, format, diffusion…) et a la persistance de zones d’ombre dans la litterature sur laquelle elles reposent. Perspectives Ameliorer cette situation necessitera de mieux preciser la place des differents traitements au cours de l’evolution et les meilleures modalites organisationnelles de la prise en charge, et de produire des recommandations precises et didactiques, largement diffusees et implementees. Conclusions De reels progres peuvent etre esperes, considerant la qualite croissante des recommandations et des essais cliniques sur lesquels elles reposent.

Qualité des soins dans le domaine de la BPCO.

INTRODUCTION Therapeutic education is part of the recommendations for management of asthmatics. The general practitioner (GP) is an essential link in the management and his/her presentation of education plays an important role in how it is received. This study examines the presentation of therapeutic education by GP's. METHODS 21 GP's took part in a qualitative enquiry bearing on the following themes: "the asthmatic" and "education of the asthmatic patient". The interviews were analysed by the ALCESTE software programme (Analysis of co- occurrent leximes in the wording of a text) which allows the extraction of the major significant structures of a text. RESULTS It was found that GP's associate therapeutic education with education in general. They evoke self-teaching tools while they retain the group as the most relevant structure. The notions of time and background treatment were separated. The idea of patient autonomy did not appear spontaneously in the discussion even though it is the foundation of the concept. Analysis of the discussion illustrates the gap that exists between the concepts upon which the recommendations are based and presentation of therapeutic education to asthmatics by GP's. CONCLUSION Training of GP's appears to be an essential condition for the development of therapeutic education.

[Therapeutic education of the asthmatic patient: the presentation of the general practitioner]

Resume Introduction L’education des asthmatiques est un sujet d’actualite, elle fait partie des recommandations. Tout le monde s’accorde sur l’importance de la representation de la maladie dans les comportements therapeutiques des patients, mais il existe peu de travaux sur la representation de l’education selon le patient asthmatique. Methodes Quarante-deux asthmatiques adultes ont repondu a un entretien abordant les themes suivants : l’asthme au quotidien ; l’education therapeutique ; les moyens de l’education therapeutique. Ces entretiens ont ete traites par le logiciel ALCESTE (Analyse de Lexemes Co-occurrents dans les Enonces Simples d’un Texte) qui extrait les structures signifiantes majeures du discours. Resultats Le premier theme est domine par les notions de traitement, de fond plus que de crise, de gene dans la vie quotidienne et de relation aux autres ; le deuxieme, par les notions d’organisation, de media d’information et de forme educative ; le troisieme, par les notions d’implication, de besoins et d’appropriation des connaissances. Conclusions La representation de l’education therapeutique du patient asthmatique est floue. Ses attentes sont implicites, elles sont presentes mais il n’en a pas conscience. Eclaircir ces elements sera un moyen de mieux fonder les bases de la demarche educative.

L'éducation thérapeutique : le discours du patient asthmatique

Resume Introduction L’interet de l’education therapeutique (ET) dans la BPCO a deja ete demontre, elle fait partie des recommandations. Le Medecin Generaliste (MG) se pose comme un acteur essentiel de la prise en charge et la representation qu’il a de l’education joue un role important dans sa facon de l’aborder. Cette enquete descriptive a pour objectif d’etudier le point de vue du MG en matiere d’ET dans la BPCO. Methode Vingt-sept MG ont participe a une enquete qualitative portant sur les themes suivants : « le malade et sa maladie », « l’ET du patient », les « moyens et supports de l’ET du patient atteint de BPCO ». Les entretiens ont ete analyses a l’aide du logiciel ALCESTE (Analyse de Lexemes Co-occurrents dans les Enonces Simples d’un Texte) qui permet d’extraire les structures signifiantes majeures d’un texte. Resultats Les MG ont une representation assez floue de l’ET. Ils font face au quotidien a un manque de prise de conscience de la maladie par les patients, ils evoquent un modele educatif groupal de type Alcoolique Anonymes (AA), dont le lieu de realisation le plus adequat est l’hopital, montrant l’association d’idee des MG entre ET dans la BPCO et sevrage tabagique. La dimension affective et emotionnelle est presente dans le discours des MG, elle concerne le patient et son entourage. Les MG decrivent leur role aupres de ces patients dans une dynamique de prescription, plus que d’education. Conclusion L’analyse du discours des MG montre que l’ET ne fait pas partie integrante de leur demarche de soin dans la BPCO ; les resultats de notre etude nous permettent d’entrevoir les actions a mener pour rendre ce concept operationnel en medecine generale.

L'éducation thérapeutique du patient atteint de BPCO : le discours du médecin généraliste

L’éducation thérapeutique du patient atteint de BPCO : le discours du médecin généraliste: Résultats d’une étude d’analyse automatique du discours

Introduction Education in COPD is clearly recommended. The general practitioner (GP) plays a key role in COPD management, and his view on education in medicine is crucial for him to implement it. This work aims at exploring what is the GP's representation of education in COPD. Methods Twenty-seven GP were enrolled in this qualitative research focused on three points: "COPD patient", "COPD patient's education", "tools in COPD patient education". The interviews processing has been carried out by an ALCESTE software (Analysis of Co-occurrent Lexemes in the Simple Terms of a Text) that extracts the key significant structures of a text. Results Actually, the GPs do not really speak about therapeutic education, they have a rather fuzzy representation of it. They face, in their daily practice, a lack of patients' awareness of the disease, they call to mind an educational model group close to the Alcoholics Anonymous (AA), and the most adequate location for this education looks to be, for them, the hospital. The emotional dimension is noticed, targeted atthe patient and his family circle. In their relationship with their patients, the GPs describe their part as more prescriptive than educative. Conclusion The GPs' speech analysis shows that education is not a part of their COPD management; the results of our study enable us to foresee the actions to carry out to develop the concept of COPD education in general practice.

[Therapeutic education of COPD patients: what does the general practitioner say? Results of an automatic speech study analysis].

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