Therapeutic education improves rheumatoid arthritis patients' knowledge about methotrexate: a single center retrospective study.

To assess, by means of a questionnaire, the effectiveness of a therapeutic education session on rheumatoid arthritis patients' knowledge about methotrexate. Retrospective study of data collected in routine care. STROBE guidelines were used. Rheumatoid arthritis patients treated with methotrexate had a therapeutic education session conducted by a rheumatology nurse at time 0 and 6 months after. They completed a questionnaire to assess their knowledge about methotrexate before the first therapeutic education session and 6 and 12 months after. A score from 0 to 100 was calculated based on 20 questions. A total of 66 patients were enrolled (50 women), with a mean age of 57 years, median disease duration of 4 years, and methotrexate treatment duration of 2 years. The knowledge score improved 6 months after the first therapeutic education session and was unchanged at 12 months. Significant improvement was observed in knowledge about the need for contraception, the contraindication of trimethoprim, the maximum dose not to be exceeded, reduction in alcohol consumption, and the value of combining folic acid with methotrexate. Knowledge about the risk of hypersensitivity pneumonitis did not improve. Skills related to the need for and timing of laboratory testing and contraception were evaluated using two role-playing situations. None of the skills improved. A therapeutic education session improves patients' knowledge about methotrexate at 6 months.

French survey on the crossed needs on sexual health for chronic inflammatory rheumatism patients and healthcare professionals.

Patients with Inflammatory Chronic Rheumatic disease have approximately three times more sexual dysfunction than the healthy population. However, health professionals do not dare to discuss the subject with them, largely because they do not feel educated on the subject. To define the educational needs in the sexual health of health professionals involved in patient education and those of patients with Inflammatory Chronic Rheumatic disease. This French multicenter cross-sectional online study included health professionals involved in patient education and patients with Inflammatory Chronic Rheumatic disease. Two surveys were designed to assess, both of them the specific needs. They were filled out anonymously online with a secured server. The influence of professionals and patients' characteristics on their sexual health needs were tested. 57 health professionals and 239 patients answered. 71,6% of the patients reported sexual difficulties and 79,9% had never discussed them with health professionals. To facilitate discussion, the health professionals most often wanted a colleague specialized in sexual health in their team (59,7%) and access to tools (52,6%). The patients' primary expectations were psychological support (65.7%), information (51.9%), and referral to specialists if needed (43.1%). The topics the health professionals and patients considered most useful were adverse effects of treatment and impact of rheumatism on sexuality and body image. 70,2% of the health professionals felt they needed training. This survey demonstrates the need to offer educational training to health professionals designed to enable them to address and discuss sexual health issues and give their patients appropriate advice.

Impact of age on care pathways of people living with HIV followed up in hospital.

The aging population of people living with human immunodeficiency virus (HIV) (PLWH) is exposed to a widening spectrum of non-AIDS-defining diseases. Thus, our objective was to compare the health care offered to PLWH according to age. We conducted a multicenter cross-sectional study on PLWH who consulted at one of 59 French HIV reference centers from 15th to 19th October 2012. Using our survey questionnaires, PLWH self-reported the medical care they received, whether or not tied to HIV infection monitoring, during the previous year. A total of 650 PLWH participated in the survey (median age 48 years, Interquartile range (IQR) 40-54), of which 95 were aged 60 years or over (14.5%). Compared to younger PLWH, 60-and-over PLWH were more often under complementary health insurance cover and less socially deprived based on the French EPICES (Evaluation of Precarity and Inequalities in Health Examination Centers) score. The elderly PLWH presented more comorbidities and less coinfections with hepatitis viruses. During health care, therapeutic education was less often offered to older PLWH (14% vs. 26%, p = .01), but this difference was mainly explained by sociodemographic factors and clinical status. Over the previous 6 months, 74% of PLWH who were followed up in hospital had also consulted another doctor, with a mean of 3.75 consultations (±4.18) without difference between age groups. After adjustment for sociodemographic factors and comorbidities, PLWH over 60 years were more likely to have consulted medical specialists as outpatients in the last 6 months (odds ratio [OR] = 2.63 [1.11-6.20]). Whatever their age, 13% of PLWH had been refused care on disclosure of their HIV status, and 27% of PLWH still did not disclose their HIV status to some caregivers. Coordinated health care throughout patients' lives is crucial, as health-care pathways evolve toward outpatient care as the patients get older.

Girl-boy differences in perceptions of health determinants and cancer: a more systemic view of girls as young as 6 years.

Introduction: To model and analyze the differences between girls' and boys' conceptions of the determinants of health and cancer, as expressed and perceived by children and adolescents. Method: A multicentric qualitative study was conducted in five schools (ages 6-11 years), four middle schools (ages 11-15 years), and three high schools (ages 15-18 years). A multi-phase protocol (phase 1 uses the e.Photoexpression© and phase 2 uses the Photonarration) enables children and teenagers to express themselves through photography and storytelling. Results: A total of 4,174 qualitative productions were produced by 1,068 children, of which 47% were girls and 53% were boys, all in the ages of 6-18 years. From the results of the productions, it can be noticed that children mentioned and were aware of 30 determinants of health and cancer. The three determinants most mentioned were "Consumption of psychotropic drugs", "Diet", and "Harmful environment". Among these 30 determinants, some were mentioned to a greater or lesser extent by girls and boys. These significant gender differences are present for 20 determinants of health and cancer. These differences evolve with age: (1) In elementary school (ages 6-11), girls gave significantly more importance (p < 0.05) to 11 determinants, while boys attached significantly more importance (p < 0.05) to 2 determinants. (2) In middle school (ages 11-16), girls gave significantly (p < 0.05) more importance to 12 determinants, while boys gave significantly (p < 0.05) more importance to one determinant. (3) In high school (ages 15-18 years), girls gave significantly (p < 0.05) more importance to 13 determinants. There was no significant difference (p < 0.05) in favor of boys for high school students. Girls also have a more systemic view of health determinants than boys. The increase in the number of determinants cited by girls is significant (p = 0.017) between the ages of 6-11 and 15-18 years. This gap widens with age (+1.45 determinants) for girls and (+0.68 determinants) for boys between elementary school and high school. Conclusion: The determinants identified as predominantly female or male, as well as age-related specificities, constitute a resource for effective preventive action, as close as possible to the needs and particularities of a population. This mapping of people's conceptions could provide a decision-making aid in defining the strategic orientations of prevention policies.

Are Energy and Protein Intakes Lower Than Requirements in Older Adults? An Urgent Issue in Hospitals and Nursing Homes.

Energy and protein intakes lower than requirements are associated with worsening health outcomes. Here we set out to evaluate gaps between energy and protein intakes and requirements in older adults in hospitals and in nursing homes (NH). A cross-sectional study included 360 inpatients and residents aged 75 years and older in two acute care wards; i.e., a multidisciplinary care unit (MCU) and a geriatric care unit (GCU), a geriatric rehabilitation unit (GRU), and two NH. Intakes were measured for three days. Requirements were based on French National Health Authority recommendations. Energy and protein intakes were under the minimum requirement of 30 kcal/kg/day and 1.2 g/kg/day in 89.5% and 100% of MCU patients, respectively, 75.5% and 64.2% of GCU patients, 92.7% and 90.9% of GRU patients, and 83.8% and 83.8 of NH residents. Intake-to-requirement gaps were not significantly associated with malnutrition, except in the GCU group where non-malnourished patients had higher energy gaps than malnourished patients. Intakes fell dramatically short of requirements in older adults in both hospital and NH settings irrespective of malnutrition status. A new paradigm based on a patient-centered approach should be developed to adapt meals served in hospital and in NH.

Survey of adolescents' needs and parents' views on sexual health in juvenile idiopathic arthritis.

BACKGROUND: Although the advent of new therapeutics for juvenile idiopathic arthritis (JIA) patients has considerably lessened the impact of the disease and reduced its sequelae, the outcomes of JIA remain important in their lives. Disease repercussions and side effects of treatments may affect sexual health and cause psychological distress. This aim of the study was to determine the expectations of adolescent JIA patients and the perceptions of their parents regarding knowledge and communication with healthcare providers (HCPs) in the field of sexual health (SH). METHODS: In France, from September 2021 to April 2022, a survey was conducted, using anonymous self-administered questionnaires, among JIA patients (adults (aged 18-45 years) to provide insights from their recollection of their adolescence) and their parents in nine rheumatology centers and three patient associations. RESULTS: The responses to the 76 patient questionnaires and 43 parent questionnaires that were collected were analyzed. Half of the patients thought JIA impacted their romantic relationships, but the results were less clear-cut for their sexual activity; and 58.7% of the patients said they would be comfortable discussing the subject with HCPs, but only 26.3% had done so, mainly regarding biomedical issues. The patients and their parents thought that ideally, the topic should be addressed in an individual patient education session at the hospital (51.3% and 34.9%, respectively), in a regular consultation (47.4% and 53.5%), or in a dedicated consultation requested by the adolescent without the adolescent's parents being informed (38.2% and 20.9%). Most of the respondents thought HCPs should be proactive in SH (77.6% of the patients and 69.8% of their parents). More patients than parents said the following digital information tools must be used: videos (29.0% vs. 9.3%, p = 0.0127) and smartphone applications (25.0% vs. 9.3%, p = 0.0372). CONCLUSION: HCPs should consider addressing the unmet need for SH discussions during their patient encounters. To meet this need, we propose concrete actions in line with the wishes of patients and parents. CLINICAL TRIAL REGISTRATION NUMBER: NCT04791189.

Non-anemic iron deficiency: correlations between symptoms and iron status parameters.

OBJECTIVES: To register all symptoms reported by non-anemic menstruating women, and examine the links between these symptoms and iron status parameters available including serum ferritin (SF) in primary care. SUBJECTS AND METHODS: In this cross-sectional study, we collected clinical and biological data from 780 French menstruating women aged 18-50 years. The data included an anonymous questionnaire (biometric information, physical and cognitive symptoms, reduction in physical performance, current quality of life with SF-36 questionnaire) and seven biological parameters available in primary care. We excluded women with anemia (hemoglobin < 12 g/dl) or chronic disease. Correlations were studied for 554 participants in bivariate analysis (BVA) and multivariate analysis (MVA), with adjusted odds ratio (OR). Receiver operating characteristic (ROC) curves were established for significant correlations in MVA (p < 0.05). RESULTS: Among these 554 non-anemic women included, 304 (54.9%) had SF level below 50 µg/l, 103 (18.6%) had SF level below 20 µg/l, and 60 (10.8%) had SF level below 15 µg/l. Iron deficiency was significantly correlated with recent hair loss for SF ≤ 15 µg/l (OR = 2.19 with p = 0.02 in MVA) and SF ≤ 20 µg/l (OR = 2.26 with p < 0.01 in MVA). SF ≤ 20 µg/l was also correlated with limitations due to emotional problems according to SF-36 questionnaire (p = 0.01 in MVA). SF ≤ 50 µg/l was significantly correlated with restless legs syndrome (OR = 2.82 with p = 0.01 in MVA). Only one ROC curve for restless legs syndrome could suggest an optimal SF cut-off point at 39 µg/l (sensitivity 73%, specificity 61%). CONCLUSION: We identified two symptoms significantly more reported by non-anemic iron-deficient menstruating women: recent hair loss for serum ferritin (SF) ≤ 20 µg/l and restless legs syndrome for SF ≤ 50 µg/l. Non-anemic iron deficiency may also impact their quality of life, but further investigation is needed. If one of these symptoms is reported in primary care, the possibility of a symptomatic iron deficiency cannot be ruled out, and iron supplementation should be considered.

Handgrip strength as a valid practical tool to screen early-onset sarcopenia in acute care wards: a first evaluation.

BACKGROUND/OBJECTIVES: Sarcopenia is an age-related muscle disease associated with higher mortality, morbidity risk and health costs. An easy and convenient sarcopenia screening test would be hugely valuable for clinical critical care. The study aimed to assess handgrip strength (HGS) as a screening tool for sarcopenia in acute care-unit inpatients, using the EWGSOP 1 reference-standard definition. SUBJECTS/METHODS: Inpatients, aged 75 years old or above, of two acute care wards-a multidisciplinary care unit (MCU) and a geriatric care unit (GCU), were included between September 2017 and June 2018 in a cross-sectional study. HGS, sarcopenia, nutritional status, functional status, number of medications and sociodemographic data were collected. The accuracy of HGS as a screening test for sarcopenia was assessed by gender using receiver operating characteristic (ROC) curves and area under the curve (AUC) in a population of older patients (n = 223; age: 85.8 yrs; BMI: 26.7 kg/m²). RESULTS: Screening was positive (patients confirmed with sarcopenia by the HGS test) with cut-off values of 18 kg for women and 25.5 kg for men, with ROC analysis giving a sensitivity of 92.9% in women and 78.6% in men. ROC curve analysis found also that HGS should be strictly higher than 15 kg in women and 18 kg in men to maximise AUC. Prevalence of sarcopenia according to the EWGSOP1 definition was 31.8% (95% CI: 22.1-41.6%) in the MCU and 27.8% (95% CI: 19.6-36.0%) in the GCU. CONCLUSIONS: Acute care wards can use HGS as a valid, easy tool for early screening of sarcopenia.

Modelling the determinants of health and cancers as perceived by children: using imagery as a mediator of expression and narration.

OBJECTIVES: To model and analyse conceptions of determinants of health and cancer that are expressed and perceived by school children aged 6-11 based on a multiphase qualitative protocol. METHODOLOGY: This is a multicentric, qualitative study of human and social sciences conducted among school children aged 6-11 years old. Two different tools were used, e.Photoexpression and Photonarration, in four French schools. This innovative and exploratory method addresses global health during the first phase (e.Photoexpression) and the theme of cancer during the second phase (Photonarration). The children express themselves through photography and narration. RESULTS: 1498 qualitative productions were made by 381 children aged 6-11 years old. The analysis of these productions of expression and narration through images allowed modelling of determinants of health and cancer as perceived by children through 7 fields and 28 categories. The conceptions of determinants of health and child cancer refer to rationalities that are centred on individual determinants (76%), minimise environmental determinants (20%) and conceal the parameters of access to healthcare and social services (3%). DISCUSSION: These findings provide new data to the international literature on children's perceptions of determinants of health and cancer. These research findings, which can be applied to interventions and current practices, will enable prevention workers to act more effectively, closer to children's perceptions and needs.

Global Health Determinants Perceived and Expressed by Children and Adolescents Between 6 and 17 Years: A Systematic Review of Qualitative Studies.

Aim: To identify the determinants of global health in the literature as perceived and expressed by children and adolescents in order to adapt prevention actions to this young audience. To also question the pertinence of a qualitative approach when interviewing children. Method:Systematic review of the literature from PubMed, Google Scholar, CINAHL, PsycINFO databases. The studies selected used qualitative methods alone for investigating the views of health determinants in children and adolescents. Results:185 articles were read to reach a final selection of 13 articles on global health, excluding studies with children who were ill, studies using quantitative, mixed, or retrospective methodologies, and those dealing exclusively with themes of health. Collecting information from children and adolescents showed the pertinence and effectiveness of qualitative methods. It also appears necessary to explore new paths: improving and adapting the tools and methodological supports used and combining them to enrich repositories. Conclusion:The small amount of qualitative data available with the views of children and adolescents on health determinants requires that new studies with better adapted collection methodologies be set up. To increase pertinence and effectiveness among a young audience, it is necessary, considering the methodologies identified during this literature review, to turn toward a multi-phase method that combines these methods. A methodology in several phases allows each one to use a different approach with young people and to obtain richer and more varied information. A corpus of images appeared as a powerful tool for collection: it facilitates children's capacity for oral expression and places the researcher in a position of listening.

Relapses in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis: a retrospective study.

OBJECTIVE: To investigate the activity of relapsing events (RE) and their mode of presentation in patients with anti-neutrophil cytoplasmic (ANCA)-associated vasculitis (AAV). METHODS: Patients diagnosed with AAV between 1990 and 2015 experiencing at least one RE were investigated. The different organ involvements were registered during each RE. Presentation at initial onset (IO) and RE were compared. The Birmingham Vasculitis Activity Score was used to assess the activity. RESULTS: Ninety-nine patients were followed: 54 patients with 96 RE and 45 patients with none. The rate of RE was 53% with a median time of follow-up of 6.8 years. The mean time to first RE was 2.8 years. Thirty patients experienced one single RE, 15 had 2, 5 had 3, 2 had 4, and 2 had, respectively, 7 and 8. Fifty-five percent of RE had the same features as IO. Compared to IO, some clinical manifestations were less present: constitutional symptoms (29% vs 69%), ear-nose-throat (50% vs 76%), lung involvement (59% vs 76%), peripheral neuropathies (14% vs 24%), arthritis (7% vs 27%), kidney (25% vs 41%), and heart (4% vs 20%) (p < 0.001). Skin, eye, and bowel manifestations were not significantly less involved during RE. The mean Birmingham Vasculitis Activity Score at IO was 9.02 and 5.11 at relapse (p < 0.0001). Among the 96 RE, 46% had a new organ involvement compared to IO: none were life-threatening. CONCLUSION: Global activity of RE in AAV patients is lower than that of IO. Fewer organs are involved in relapses. RE turned out to begin with the same manifestations as IO in most cases.Key Points•First study looking into clinical characteristics of relapses including mostly granulomatosis with polyangiitis.•Around half of patients with AAV seemed to relapse in a similar way compared to the initial diagnosis.•The activity score during relapsing events is less important.