Prenatal diagnosis: Women's interactions with practitioners when severe abnormalities are discovered at birth.

BACKGROUND: In an increasingly litigious medical environment, this study examined women's experiences of their interactions with practitioners when severe abnormalities are discovered at birth. METHODS: Eight in-depth interviews with women were conducted in France. Data were analysed using Interpretative Phenomenological Analysis. RESULTS: Four superordinate themes were identified: the importance of attunement to women's emotions and needs; the possibility of litigation but no direct accusation; reasons for not resorting to litigation; and reframing and positive transformations. Despite experiencing distress, women were reluctant to make a complaint against practitioners. Several factors may account for this, but practitioners' ability to relate to women with humanity was particularly significant. CONCLUSION: Women understood the limits of technology and of the care practitioners can provide, but greatly valued practitioners' empathic and honest communications. Thus, adopting a transparent and open approach may foster trusting relationships with women/parents. In turn, this may lower the prospect of litigation being brought against practitioners when severe abnormalities are discovered at birth.

Gaining insight into benzodiazepine prescribing in General Practice in France: a data-based study.

BACKGROUND: In recent decades, benzodiazepine (BZD) prescriptions have been called into question in most European countries by physicians and health authorities alike, and guidelines on medical indications and treatment duration have been established to avoid long-term use and dependency. In France, many public policy measures have been implemented as BZDs are among the most prescribed medications. General practitioners (GPs) were identified by the Caisse d'Assurance Maladie (the French public health insurance fund) as high prescribers for these drugs. In this context, the aim of the study was to determine GPs' rates and to identify correlates of BZD and Z-drugs prescribing. METHODS: Data on patient characteristics, diagnoses and BZD prescriptions were drawn from French GPs' electronic medical records. These were accessed via the database which the Société Française de Médecine Générale, the French Society of General Practice, has been compiling since 1993 in a network of 90 GPs working mainly in solo practices. The participants in this network routinely register data in their daily practice. The present study examined 51,216 patients from 52 GP practices and we performed a multivariate logistic regression. The dependent variable was whether a patient was prescribed BZD at least once during 2006. RESULTS: In the present study, 12.5% of patients older than 18 were prescribed BZDs at least once during 2006 and the average (SD) was 2.6 (2.4) BZD prescriptions/patient/year. The adjusted odds (confidence interval) of having at least one BZD prescription were 1.20 (1.10 - 1.30) in patients older than 65; 1.05 (1.01 - 1.10) in women; 1.25 (1.17 - 1.33) in patients with associated comorbidities (cardiovascular diseases) and 1.76 (1.62 - 1.92) in heavy consumers of health care (more than 4 consultations with a GP per year). CONCLUSIONS: The present study showed the persistence of high rates of BZD prescription by GPs, particularly in women and older patients, which highlights the difficulties of implementing effective public policies and the necessity of using new approaches enabling doctors and patients to understand the true relative advantages, disadvantages, and consequences of using these drugs and of non-pharmaceutical treatments.

French pediatricians' knowledge, attitudes, beliefs towards and practices in the management of weight problems in children.

A representative sample of 611 French pediatricians was interviewed on their knowledge, attitudes, beliefs towards and practices regarding childhood obesity through a 39-item Likert format questionnaire. A vast majority of the respondents regarded obesity as an illness (86.4%), 70.2% were aware that without any treatment an obese child has a high risk to remain obese in adulthood, 84% reported that managing obesity is part of their responsibility in the routine practice and 89.3% affirmed to systematically inform parents of obese children on health risks associated with obesity. At the same time, 82.4% were convinced that managing obesity is bound to fail and only 46.5% that it is professionally gratifying. However, doctors who followed a vocational training dedicated to obesity felt themselves more efficient in managing childhood obesity (p<0.01), those who knew the national recommendations were also less likely to report that the management of childhood obesity leads to a failure (p<0.05). Probably one of the main result of our study concerns doctors' perception of the relative impact of the different etiologic factors of obesity. Beside sedentary life, poor eating behavior, lack of parental concern and heredity which are cited by more than three-fourth of the pediatricians, an economic situation more and more insecure and a food industry increasingly more powerful are reported for the first time by doctors themselves, respectively by 59.9% and 60.8% of them, to kill the goodwill of health professionals. These findings reinforce the idea that the solution to the obesity problem does not lie just within the doctor's office and stress the need for prompt regulatory actions to curb obesity.

Prescribing patterns for upper respiratory tract infections in general practice in France and in the Netherlands.

BACKGROUND: France and the Netherlands are often presented as two contrasting countries with regard to drug prescriptions and consumption. This study aimed to analyse general practitioners' (GP's) prescription patterns for upper respiratory tract infections (URTI). METHODS: Data on diagnoses and prescriptions were derived from two databases recording daily electronic medical patient files: the 'Société Française de Médecine Générale' database (SFMG-DB) and the Dutch Landelijk Informatie Netwerk Huisatsenzorg database (LINH-DB). Logit regression models were developed to estimate and compare prescription patterns in both countries. We carried out a study including all the patients consulting for URTI in 2003. RESULTS: French GPs had more URTI patients than their Dutch counterparts (372.1 URTI patients/GP versus 181.3). They prescribed higher volumes of URTI medications (3.55 per patient/year versus 0.82). Striking differences were observed in analgesic and symptomatic prescriptions (0.84 per patient/year versus 0.12 and 1.01 per patient/year versus 0.21, respectively). We did not observe important discrepancies in volume of antibiotic prescriptions (0.29 per patient/year in France versus 0.32). After adjustment for patient characteristics, the logit model showed that prescription patterns for antibiotic were quite similar and associated with a diagnosis of acute tonsillitis. CONCLUSION: The analysis per consultation in this study did not highlight important differences in antibiotic prescribing volumes and patterns. But symptomatic and analgesic prescriptions were significantly higher in the French database. This can be explained by differences in help-seeking behaviour, medication perception, status of OTC medications and remuneration system.

Down syndrome screening information in midwifery practices in the Netherlands: Strategies to integrate biomedical information.

The aim of this qualitative study was to analyse counselling with regard to prenatal screening in midwifery consultations in the Netherlands where a national prenatal screening programme has only existed since 2007, after years of social and political debates. The methodology is based on in situ observations of 25 counselling consultations in four midwifery practices in two main cities in the Netherlands. The results of this study show that, since midwives are obliged to offer information on Down syndrome screening to all pregnant women (2007), they have to deal with the communication of medical screening information using biostatistical concepts to explain risks, calculations, probabilities and chromosomal anomalies. In order to avoid the risk of medicalization of their consultation, midwives develop strategies that allow them to integrate this new biomedical discourse while maintaining their low medicalized approach of midwife-led care. One of their main strategies is to switch from 'alarming' biomedical messages to 'reassuring words' in order to manage the anxiety induced by the information and to keep the control over their low medicalized consultation. They also tend to distance themselves from the obligation to talk about screening. The way midwives handle these counselling consultations allows them to respect their obligation to propose information, and to remain faithful to their struggle to protect the natural process of pregnancy as well as their professional autonomy.

Cancer and stigma: experience of patients with chemotherapy-induced alopecia.

Chemotherapy-induced alopecia is one of the most distressing side-effects of chemotherapy. In this article we examine how patients react to hair loss due to chemotherapy; for women in particular, the reaction involves a confrontation with the lethal nature of cancer, whilst for men it is a normal and inevitable consequence of treatment. We then analyse the strategies used to cope with alopecia. One strategy involves camouflaging and hiding; the patients wear wigs in an attempt to partially or completely hide their hair loss. Another strategy is to treat it as commonplace: wearing a wig is played down and banalised. Sometimes this can take the form of provocation, in which case baldness is seen as the symbol of the cancer patient's new identity.

[Assessing fatigue in the cancer patient: complementary contribution of quantitative and qualitative tools]. / Evaluer la fatigue chez le patient cancéreux: l'apport complémentaire des outils quantitatif et qualitatif.

Fatigue is a frequent symptom experienced by cancer patients. Many quantitative tools has been developed to measure and assess the impact of fatigue on the quality of life of cancer patients. This article: 1) summarises quantitative research that has investigated fatigue in cancer patients and 2) presents preliminary results of our quantitative and qualitative study which has been conducted at the Institut Gustave-Roussy. The aim of the quantitative part was the validation of a measurement instrument (Fact) before its utilisation in a clinical trial comparing the efficiency of blood transfusion and erythropoietin in the treatment of anemia in cancer patients. The aim of the qualitative part was to analyse the experience of fatigue in daily life, the impact on work, social life and family relations, and the strategies developed by the patients in order to reduce fatigue. This article shows the complementary contribution of a quantitative tool (standardized questionnaire and statistical treatment of findings) and a qualitative instrument (interview and qualitative analysis) in the assessment of fatigue in cancer patients.

From policy making to service use. Down's syndrome antenatal screening in England, France and the Netherlands.

In industrialised countries, certain biomedical innovations have come into general use, but the ways they are used vary considerably. Prenatal screening techniques for Down's syndrome are a perfect example of this. In 2010, screening rates stood at 61% in England and 84% in France; the previous year the rate was 26% in the Netherlands. The objective of our research, which took place in these three countries between 2008 and 2011, was to explain these differences. In these countries, public authorities focus on women's free access to innovations and on receiving their informed consent. But other aspects of screening policy vary, as do the health systems in which they are implemented. Our study shows that the sociotechnical settings which vary from country to country affected the interactions during the consultations we observed and thus impacted the decision of whether or not to screen.

[SOR SAVOIR PATIENT Cancer and fatigue. Information dedicated to cancer patients and relatives]. / SOR SAVOIR PATIENT Fatigue et cancer. Information à l'usage des personnes malades et de leurs proches.

In response to the evolution of the information-seeking behaviour of patients and concerns from health professionals regarding cancer patient information, the French National Federation of Comprehensive Cancer Centres (FNCLCC) introduced, in 1998, an information and education program dedicated to patients and relatives,the SOR SAVOIR PATIENT program. The methodology of this program adheres to established quality criteria regarding the elaboration of patient information. Cancer patient information, developed in this program, is based on clinical practice guidelines produced by the FNCLCC and the twenty French regional cancer centres, the National League against Cancer, The National Cancer Institute, the French Hospital Federation, the National Oncology Federation of Regional and University Hospitals,the French Oncology Federation of General Hospitals, many learned societies, as well as an active participation of patients, former patients and caregivers. The handbookSOR SAVOIR PATIENT Cancer and Fatigue is an adapted version of different publications regarding fatigue in oncology. It is meant to provide a basis for the explanationof the disease and to facilitate discussions with the healthcare team. It is available from the FNCLCC (101, rue de Tolbiac, 75013 Paris, Tel. (0033) 1, 01 76 64 78 00,www.fnclcc.fr). This document has been validated at the end of 2005 and published in January 2006. SOR SAVOIR PATIENT guides are systematically updated when new research becomes available. This article is extract from the handbook SOR SAVOIR PATIENT Cancer and Fatigue and concerns the causes and effects of fatigue and how to cope with fatigue. This information allow patients to better understand the causes and effects of fatigue, how to cope fatigue...which represent important patient information needs. This article is meant to inform patients and relatives about the disease and its treatments. It also offers health professionals a synthetic evidence-based patient information source which facilitates discussions with the patient.

Development of a preference-weighted health status classification system in France: the Health Utilities Index 3.

The Health Utilities Index is a generic multiattribute preference-based system for assessing health-related quality of life, devised by Torrance et al. It is being used in cost-effectiveness evaluations in North America and in international multicentre studies but was not available in France. Following adaptation of the HUI3 classification in France, the purpose of the reported investigation was to derive French preference weights. This article provides a reminder of the theoretical foundations used to model the multiattribute utility function. Within this framework, a multiattribute multiplicative aggregate utility function was constructed in accordance with the explicitly decomposed approach. The study took place in June 1999 over a sample of 365 persons from the French general population, aged between 20 and 65, and not suffering from any chronic or incapacitating illness. The recruitment procedure was based upon a random selection of individuals, using the phone book. Interviews took place in the homes of the interviewees. The methods of revelation (VAS and SG) were applied by setting the value of the best possible state of the HUI3 a priori at 1, and leaving a choice between two states (worst possible state, death) for 0. The aggregated individuals (person-mean and median) were calculated and the multiplicative utility functions constructed. A comparison of the calculated utilities with the observed ones provides a primary indicator of the validity of the person-mean or median functions constructed. The slight absolute differences obtained between observed and calculated utilities and the low RMSE scores lead us towards a favourable conclusion.