RESUMO
BACKGROUND: Health-related quality of life (HRQoL) is an important element of patient care and clinical research. The aim of this study was to describe HRQoL changes and identify associated factors during a 6-month follow-up of outpatients starting care for alcohol or opioid dependence. METHODS: HRQoL was measured at baseline and 3 and 6 months later using the SF-12. Data on the patients' sociodemographics, clinical characteristics and levels of anxiety and depression were collected using the Hospital Anxiety and Depression Scale (HADS). Repeated-measures analyses were performed to assess factors associated with global HRQoL differences and the evolution of HRQoL indicated by both physical and mental scores (PCS and MCS, respectively). RESULTS: The mean PCS and MCS scores were initially low at 45.4 (SD = 8.6) and 36.0 (SD = 10.9), respectively. The improvement in HRQoL was rapid in the first 3-month period and then slowed and remained stable over the subsequent 3-month period. Being employed (p = 0.012), having no comorbidities (p = 0.014) and having no depression (p = 0.004) were associated with significant differences in the average PCS scores at the 3 time points. Patients who had lower overall HRQoL MCS scores on average were those for whom a medication was initiated (p = 0.009), as was the case for patients with anxiety (p < 0.001) and depression (p < 0.001). Patients with depression at baseline were also those for whom a significantly greater increase in MCS score during the 6 months of follow-up was observed. CONCLUSION: Our findings highlight the importance of screening early psychological distress and considering other factors associated with HRQoL changes in outpatients after the first 3-month period of treatment for substance use disorder.
Assuntos
Qualidade de Vida , Transtornos Relacionados ao Uso de Substâncias , Ansiedade , Comorbidade , Humanos , Pacientes Ambulatoriais , Qualidade de Vida/psicologiaRESUMO
BACKGROUND AND OBJECTIVES: Few studies exist regarding the management and support of adults with autism spectrum disorder (ASD) in family practice. Most of them concern the management of children. As a primary care professional however, the general practitioner (GP) has a role to play at every step of the autistic adult's care pathway. With this study, we sought to identify GPs' experienced difficulties in caring for and managing their adult patients with ASD. METHODS: We conducted a qualitative study of 11 French GPs caring for adults with ASD via semistructured interviews and a thematic content analysis. GPs were recruited from 5 counties of the Grand Est Region (Marne, Haute-Marne, Meurthe-et-Moselle, Meuse and Vosges). RESULTS: All of the GPs described difficulties with the diagnostic process and the lack of initial training. Most of the respondents expressed difficulties with medical consultations of patients presenting an intellectual disability (ID) and with the lack of communication between GPs and mental health specialists during the patient care process. More than half of the GPs described difficulties with referral pathways for diagnosis due to lengthy delays and patient reluctance to seek psychiatric care. More than half of the respondents also experienced difficulties with providing proper social care, and with responding to patient distress due to their healthcare experiences. CONCLUSION: Improving awareness and training about ASD in adults, as well as harmonizing the diagnostic process and referral pathways, might reduce GPs' experienced difficulties in caring for this population.
Autism spectrum disorder (ASD) is a heterogeneous and lifelong disorder, which impacts the communication and social abilities of the person, including sometimes behavioral challenges. Adults with ASD are consequently exposed to psychiatric complications such as anxiety, depression, and suicide. The general practitioners (GPs) are on the frontline providing care for these patients. However, several studies show that GPs lack confidence in their ability to provide the best care for adults with ASD. We interviewed 11 French GPs from five counties in order to identify their difficulties managing adult patients with ASD. We found that they were challenged mostly by diagnostic and referral processes, by their lack of training, and by the insufficiency of communication with mental health specialists. These results highlight the need to organize and coordinate effective training in ASD and to facilitate the care process. This work also underscores the need for more collaboration and coordination between general practice and psychiatry in regard to a disorder for which both medical fields are needed. Addressing these issues is an opportunity to improve health care experiences for both patients and GPs.
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Transtorno do Espectro Autista , Clínicos Gerais , Adulto , Atitude do Pessoal de Saúde , Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/terapia , Criança , Medicina de Família e Comunidade , Clínicos Gerais/psicologia , Humanos , Pesquisa Qualitativa , Encaminhamento e ConsultaRESUMO
BACKGROUND: Although research on health-related quality of life (HRQoL) has increased in the addiction field, few studies have focused on the determinants of HRQoL changes. This study aimed to describe dependent patients' HRQoL changes at a 3-month follow-up and to assess whether satisfaction with care can predict those changes among outpatients starting care for alcohol or opioid dependence. METHODS: HRQoL was measured with the SF-12 at baseline and 3 months later in a prospective cohort of dependent outpatients. Satisfaction was assessed with the EQS-C early after inclusion. Data on sociodemographics, clinical characteristics and patients' levels of anxiety and depression were also collected. A multivariable analysis was performed to identify factors associated with HRQoL changes in both the physical and mental component summary scores (PCS and MCS, respectively). RESULTS: Of the 172 patients included at baseline, a total of 136 patients assessed their satisfaction with care. The mean PCS and MCS scores were initially low, and HRQoL improvement was significant after 3 months for both the PCS and MCS. Never having been married (ß = 5.5; p = 0.001) and a lower baseline PCS score (ß = - 0.6; p < 0.0001) were associated with significant PCS improvement, whereas being legally compelled to undergo drug treatment (ß = - 5.9; p = 0.02) was associated with less PCS change. Higher early satisfaction with care (ß = 0.1; p = 0.02) and a lower baseline MCS score (ß = - 0.7; p < 0.0001) were associated with significant MCS improvement. CONCLUSION: The study supported the hypothesis that greater satisfaction with care may predict HRQoL improvement among dependent outpatients. Further studies are needed to understand the factors that affect patients' early satisfaction to identify areas of improvement and thus improve HRQoL.
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Satisfação do Paciente , Qualidade de Vida , Transtornos Relacionados ao Uso de Substâncias/terapia , Adulto , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Satisfação Pessoal , Estudos Prospectivos , Transtornos Relacionados ao Uso de Substâncias/psicologiaRESUMO
Previous research showed that coping strategies are associated with depressive symptoms and health-related quality of life (HRQoL) in patients with chronic somatic conditions. The aim of this study was to examine the coping strategies used in patients with substance use disorders and to assess the relationships between coping strategies, HRQoL, anxiety and depression. Coping was assessed in a prospective outpatient cohort by the Brief COPE. Additionally, sociodemographic and clinical data were collected, and questionnaires assessing HRQoL (SF-12) and states of anxiety and depression were completed. Cross-sectional analysis using Pearson correlations and multiple linear regression was performed. A total of 244 patients were included. Acceptance, planning and self-blame were the most used coping strategies. Strong correlations were found between anxiety, depression, coping strategies and HRQoL. On the MCS-12, better scores were associated with male gender, lack of anxiety or depression and coping styles based on less self-blame, on positive reframing, acceptance, and behavioral disengagement. Patients without depression or anxiety, and no comorbidity had better scores on the SF-12 PCS. Coping strategies of substance-dependent outpatients should be assessed, as they might be useful for identifying patients in need of support. Furthermore, interventions that improve coping capabilities might be helpful for improving HRQoL.
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Adaptação Psicológica , Ansiedade/psicologia , Depressão/psicologia , Pacientes Ambulatoriais/psicologia , Qualidade de Vida/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto , Comorbidade , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
Winter flu is an epidemic infectious disease which sometimes causes serious complications in vulnerable people treated in general practice. Currently, the most effective means of prevention is influenza vaccination, which is recommended for healthcare professionals, including general medicine interns. The target of 75% coverage set by WHO for healthcare professional is rarely reached. Our survey provides an assessment of reported influenza vaccination of general medicine interns (GMI) and evaluates factors influencing their vaccination status. A cross-sectional survey was conducted from 27 September to 2 November 2017 in the Faculty of Medicine at the University of Lorraine in France. An anonymous self-administered questionnaire was distributed electronically (SurveyMonkey software) to all GMI. It collected data on their vaccination status and on levers and barriers to influenza vaccination. The data were analysed using SAS 9.4 software. Multivariate analysis helped identify factors associated with their influenza vaccination status. Of the 595 GMI invited, 269 participated in the survey, with a response rate of 45.2%. During the 2015, 2016, and 2017 winters, overall self-declared vaccine coverage was 37.9, 49.4, and 56.5%, respectively. Being at the end of training (p = 0.008, OR = 3.2), the presence of a mobile vaccination team (p = 0.019, OR = 3.1), and recommending vaccination to one's relatives and friends (p < 0.0001, OR = 5.4) were the three factors independently associated with influenza vaccination. The two main reasons which had a strong influence on non-vaccination were forgetting to do so (30.5%) and lack of time (24.8%). Influenza vaccination coverage of GMI in Nancy falls well short of WHO targets. Vaccination campaigns and facilitated access to vaccination at study and work placement locations should be considered.
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Medicina Geral/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Vacinas contra Influenza/administração & dosagem , Internato e Residência/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , França/epidemiologia , Medicina Geral/educação , Pesquisas sobre Atenção à Saúde , Pessoal de Saúde/educação , Acessibilidade aos Serviços de Saúde , Humanos , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Internato e Residência/organização & administração , Masculino , Estações do Ano , Vacinação/psicologia , Cobertura Vacinal/organização & administração , Cobertura Vacinal/estatística & dados numéricos , Adulto JovemRESUMO
Cannabis and tobacco are two of the most prevalent addictive drugs used worldwide. Concurrent use of cannabis and tobacco is common, whether simultaneous in joints or not. In France, cannabis is mainly used in joints also containing tobacco. According to the current literature, combined use of cannabis and tobacco exacerbates on additive or multiplicative mode the somatic, psychological and social consequences of each drug. In addition, concurrent use of cannabis and tobacco potentiates tobacco and cannabis dependence, which maintains the use of both drugs, increases the risk of relapse and reduces motivation to care. Combined use thus leads to a reduced likelihood of therapeutic success. We discuss the usefulness of simultaneous cessation treatment together with the use of currently available pharmacological and psychological help as valuable therapeutic tools.
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Fumar Maconha/epidemiologia , Fumar Maconha/terapia , Abandono do Hábito de Fumar/métodos , Uso de Tabaco/epidemiologia , Uso de Tabaco/terapia , França/epidemiologia , Humanos , Fumar Maconha/efeitos adversos , Fumar Maconha/psicologia , Recidiva , Uso de Tabaco/efeitos adversos , Uso de Tabaco/psicologiaRESUMO
Acetaminophen (paracetamol), the highest over-the-counter (OTC) selling drug in France, is also the first cause of acute hepatic failure. We aimed to assess the good use and the knowledge of acetaminophen in a setting of urban self-medicated patients. We conducted a prospective observational study in randomly selected community pharmacies of Metz (France) agglomeration. Patients coming to buy OTC acetaminophen for themselves or their family had to answer to an anonymous autoquestionnaire. Responses were individually and concomitantly analyzed through 3 scores: good use, knowledge and overdosage. Twenty-four community pharmacies participated and 302 patients were interviewed by mean of a dedicated questionnaire. Most of patients (84.4%) could be considered as "good users" and independent factors of good use were (i) a good knowledge of acetaminophen (OR=5.3; P<0.0001) and more surprisingly; (ii) the fact of having no children (parentality: OR=0.1; P=0.006). Responses corresponding to involuntary overdosage were mostly due to a too short interval between drug intakes (3hours). Only 30.8% of patients were aware of liver toxicity of acetaminophen and only 40.7% knew the risk of the association with alcohol. Both good use and knowledge were significantly higher in patients looking for information from their pharmacist, physician and package leaflet. Patients should definitely be better informed about acetaminophen to warrant a better safety of its consumption. Pharmacists and physicians have to remind patients the risk factors of unintentional overdose and liver toxicity. Package leaflets have also to be more informative.
Assuntos
Acetaminofen/uso terapêutico , Analgésicos não Narcóticos/uso terapêutico , Conhecimentos, Atitudes e Prática em Saúde , Medicamentos sem Prescrição/uso terapêutico , Farmácias , Automedicação , Acetaminofen/administração & dosagem , Acetaminofen/efeitos adversos , Adulto , Analgésicos não Narcóticos/administração & dosagem , Analgésicos não Narcóticos/efeitos adversos , Peso Corporal , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Overdose de Drogas/etiologia , Características da Família , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto/estatística & dados numéricos , Farmácias/estatística & dados numéricos , Estudos Prospectivos , Automedicação/estatística & dados numéricos , Inquéritos e QuestionáriosRESUMO
Objective: The objective of this study was to determine current practices in the Lorraine region in the treatment of neuropathic pain and to assess the challenges faced by general practitioners (GPs). Methods: We conducted a qualitative study by the focus group technique, by constituting a balanced panel of GPs to meet diversification requirements. The number of focus groups was defined to obtain data saturation. The lead author of this study acted as an observer, while a facilitator was responsible for moderating the debate. Analysis of transcripts was performed in two ways: firstly, several readings of the transcripts to highlight the main ideas emerging from these discussions, and secondly, integration of verbatim transcripts in NVivo 10 software to allow complementary computer analysis. Results: The GPs interviewed reported that they prescribed Clonazepam (Rivotril®), Carbamazepine (Tegretol®) and Amitriptyline (Laroxyl®) less often than ten years ago, and Gabapentin (Neurontin®), Pregabalin (Lyrica®), Venlafaxin (Effexor®) and Duloxetine (Cymbalta®) more often than ten years ago. They reported many difficulties in the daily management of these patients, especially concerning the psychological or psychiatric components associated with this pain, comorbidities, iatrogenic effects, the inefficacy of the available molecules, the difficulties of access to a specialist (including pain centres), acceptance of treatment by patients, limiting requirements (restrictive marketing authorisations, withdrawal of certain products ). Conclusion: The treatment of neuropathic pain raises a number of difficulties for GPs, but changes in prescribing habits reflect a constant adaptation of clinical practices.
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Clínicos Gerais/estatística & dados numéricos , Neuralgia/terapia , Manejo da Dor/tendências , Padrões de Prática Médica/tendências , Adulto , Idoso , Aminas/uso terapêutico , Ácidos Cicloexanocarboxílicos/uso terapêutico , Cloridrato de Duloxetina/uso terapêutico , Feminino , Gabapentina , Clínicos Gerais/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Neuralgia/epidemiologia , Manejo da Dor/métodos , Padrões de Prática Médica/estatística & dados numéricos , Pregabalina/uso terapêutico , Inquéritos e Questionários , Ácido gama-Aminobutírico/uso terapêuticoRESUMO
CONTEXT: General practitioners encounter difficulties in the management of patients in precarious situations. In order to identify and understand these difficulties, a survey combining both quantitative et qualitative approaches was conducted among general practitioners of the Meurthe-et-Moselle department. METHODS: Quantitative data were collected by self-administered questionnaires sent to all 856 general practitioners and 28 general practitioners grouped by geographic sector participated in 6 focus groups. RESULTS: Among the 46.5% of respondents, 92.5% doctors declared that they encountered difficulties in the management of precarious patients. 87.5% declared that they had an average or insufficient knowledge of the existing medical social organizations on their territory and two-thirds were interested in specific training. Analysis of the interviews showed that experience facilitates multidisciplinary networking, a good relationship with patients and ultimately their monitoring. Financial access to care is a major obstacle, which doctors consider to be a political issue. Ideas for improvement were proposed in response to the obstacles related to the characteristics of the medical consultation itself. Confirming the results of the questionnaire survey, training appeared to be essential to identify vulnerability and facilitate the doctor-patient relationship. CONCLUSION: We showed that the difficulties experienced by physicians contributes to socio-cultural inequalities in access to health care. Patient support, an enhanced self image and social ties were identified as major determinants of access to health. The development of training of physicians and multidisciplinary structures should be encouraged.
Assuntos
Clínicos Gerais/organização & administração , Acessibilidade aos Serviços de Saúde , Relações Médico-Paciente , Populações Vulneráveis , Adulto , Idoso , Feminino , Grupos Focais , França , Disparidades em Assistência à Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , MigrantesRESUMO
BACKGROUND: Early adolescence (10-16 years) is a crucial period for physical, mental and cognitive development where a wide range of school, behavior and health-related difficulties may occur. These issues may be aggravated in adolescents with early affective/sexual live and contraceptive consultation. This study assessed the risk of school, behavior and health-related problems among younger boys and girls having a contraceptive consultation. Such knowledge would inform care providers about their main role in monitoring and caring adolescent problems. METHODS: This cross-sectional study included 1559 middle-school adolescents from north-eastern France (mean age 13.5±1.3). They completed a questionnaire gathering socioeconomic features, obesity, school difficulties, substances use, physical health, psychological health, social relationship, violence, sexual abuse, and suicide behaviors. Data were analyzed for each gender separately using logistic regression models. RESULTS: The contraceptive consultation concerned 6.7% of girls and 3.2% of boys (P=0.002). Based on Odds Ratio (adjusted for age, school-class level and socioeconomic factors), both boys and girls with contraceptive consultation had 2-to-7-time higher risk of consumption of alcohol, tobacco, cannabis and other drogues, poor physical health, relational problems, and perpetrated violence. Additionally, the girls had a 4-time higher risk of low academic-performance and obesity while the boys had 6-to-37-time higher risk of sexual abuse, school dropout ideation, suicide ideation and suicide attempts. CONCLUSIONS: Although based on self-reported data, we found that primary care providers play a prominent role in detecting and monitoring school, behavior and health-related problems during adolescent contraceptive consultations.
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Anticoncepcionais , Instituições Acadêmicas , Masculino , Feminino , Humanos , Adolescente , Criança , Estudos Transversais , França/epidemiologia , ObesidadeRESUMO
Screening for sarcopenia is a growing public health issue since associated with functional alterations and an increase in morbidity and mortality. OBJECTIVE: To analyze the prevalence of decreased muscle strength (dynapenia) in patients aged 18 to 74 in community medicine, as measured in the general practitioner's office, and to assess the prevalence of undernutrition in this population. METHOD: Muscle strength was measured with a Hand Grip (HG) dynamometer according to European recommended thresholds and French guidelines. Malnutrition was defined according to the GLIM criteria. RESULTS: Of 341 patients, 303 were evaluated (89%): mean age was 47.8 ± 17.4 years, including 51.2% women, 103 with an acute disease (AD) and 200 with a chronic disease (CD). 23.5% were below the 10th percentile threshold in the CD group and 19.4% in the AD group. For these patients, muscle age, evaluated on the median values for age, was higher by 39.3 ± 15.2 years for men and by 41.5 ± 13.6 years for women. Maximum HG values were significantly correlated with changes in International Physical Activity Questionnaire (IPAQ) score (F = 10.22; p = 0.0017) and weight changes (%) (F = 5.30; p = 0.0227) in women only, regardless of age, BMI, disease, professional status or type of work (manual or not); 19.1% suffered from malnutrition (10.9% Stage 1 and 8.3% Stage 2), with 20.0% in the CD group and 17.4% in the AD group. CONCLUSION: This study highlights the feasibility of screening for sarcopenia in primary care community medicine. The prevalence of dynapenia in the studied population (nearly one in 5 patients) and the observed higher-than-expected undernutrition (17.5%) justify their screening for appropriate management care. CLINICAL TRIAL REGISTRATION: NCT04451694; referred to as "observational research", "non-interventional", or « non-RIPH ¼.
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Desnutrição , Sarcopenia , Masculino , Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Medicina Comunitária , Força da Mão , Sarcopenia/diagnóstico , Sarcopenia/epidemiologia , Desnutrição/diagnóstico , Desnutrição/epidemiologia , Atenção Primária à SaúdeRESUMO
Undernutrition is common in elderly people living at home. A loss of autonomy can lead them to use home help services, such as home delivered meals. However this solution is not always effective and having meals brought to the home seems to aggravate their isolation, as the results of a survey of twenty people showed.
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Serviços de Alimentação , Desnutrição/epidemiologia , Idoso de 80 Anos ou mais , Feminino , Idoso Fragilizado , Humanos , Masculino , Isolamento SocialRESUMO
The aim of this article was to present the medical management and follow-up of a recurrent oral granuloma gravidarum (OGG). OGG is a common benign tumour that can occur during pregnancy in response to poor oral hygiene and hormonal factors. Its identification and management by primary health care professionals is necessary, including an orientation to a dentist, if needed. Indeed, this lesion may induce troubles such as gingival bleeding, oral hygiene difficulties, and sometimes pain or eating difficulties, but also presents a high risk of relapse. An early twenties woman consulted several times during two pregnancies for an OGG presented in the same proximal maxillary gingival area. The patient reported dental hygiene difficulties because of orthodontic treatment and developed this recurrent tumour four times in two years, despite surgical excisions. Oral hygiene, and information continuously provided by healthcare professionals are required to prevent gingival inflammation and recurrence of OGG. This tumour usually regresses spontaneously post-partum, except in the presence of aggravating factors such as orthodontics treatment and mouth breathing. Surgery of OGG is required when it interferes with normal oral functions.
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BACKGROUND: Substance use disorders (SUDs) are based on pathophysiological mechanisms common to all psychoactive substances. However, general practitioners (GPs) hold different views depending on the substance in question. OBJECTIVES: To determine whether the perceptions that teaching GPs and final-year residents in general practice have of patients with a SUD vary according to the substance involved and explore their professional responsibility and management experiences. METHODS: A cross-sectional observational study was carried out by asking residents and teaching GPs from eight faculties of medicine about their perceptions, professional responsibility and management experience of patients with tobacco, alcohol and opioid use disorders, using an online questionnaire between June and September 2017. RESULTS: The responses of 238 teaching GPs (mean age 50 years SD 3.5; 58% men) and 327 residents (mean age 28 years SD 9.9; 67% women) were analysed (response rates: 9 and 15% respectively). Tobacco smokers were considered to be more responsible for their acts than the other users. Teaching GPs and residents considered that it was their responsibility to discuss substance use. They did not feel able to manage alcohol and opioid use disorders. Tobacco cessation was mainly managed alone (78%). The results were quite similar among teaching GPs and residents. CONCLUSION: The majority of practitioners had no difficulty managing smoking cessation. During the management of alcohol and particularly opioid use disorders, practitioners did not feel competent. The gap between their perceived responsibility and competencies should be addressed by training and promoting collaborative care.
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Medicina Geral , Clínicos Gerais , Transtornos Relacionados ao Uso de Opioides , Adulto , Atitude do Pessoal de Saúde , Estudos Transversais , Humanos , Pessoa de Meia-Idade , Percepção , NicotianaRESUMO
The nutritional sequelae of COVID-19 have not been explored in a large cohort study. OBJECTIVES: To identify factors associated with the change in nutritional status between discharge and 30 days post-discharge (D30). Secondary objectives were to determine the prevalence of subjective functional loss and severe disability at D30 and their associated factors. METHODS: Collected data included symptoms, nutritional status, self-evaluation of food intake, Performance Status (PS) Scale, Asthenia Scale, self-evaluation of strength (SES) for arms and legs at discharge and at D30. An SES <7 was used to determine subjective functional loss. A composite criteria for severe disability was elaborated combining malnutrition, subjective functional loss and PS >2. Patients were classified into three groups according to change in nutritional status between discharge and D30 (persistent malnutrition, correction of malnutrition and the absence of malnutrition). RESULTS: Of 549 consecutive patients hospitalised for COVID-19 between 1 March and 29 April 2020, 130 died including 17 after discharge (23.7%). At D30, 312 patients were at home, 288 (92.3%) of whom were interviewed. Of the latter, 33.3% were malnourished at discharge and still malnourished at D30, while 23.2% were malnourished at discharge but no longer malnourished at D30. The highest predictive factors of persistent malnutrition were intensive care unit (ICU) stay (OR=3.42, 95% CI: 2.04 to 5.75), subjective functional loss at discharge (OR=3.26, 95% CI: 1.75 to 6.08) and male sex (OR=2.39, 95% CI: 1.44 to 3.97). Subjective functional loss at discharge (76.8%) was the main predictive factor of subjective functional loss at D30 (26.3%) (OR=32.6, 95% CI: 4.36 to 244.0). Lastly, 8.3% had a severe disability, with a higher risk in patients requiring an ICU stay (OR=3.39, 95% CI: 1.43 to 8.06). CONCLUSION: Patients who survived a severe form of COVID-19 had a high risk of persistent malnutrition, functional loss and severe disability at D30. We believe that nutritional support and rehabilitation should be strengthened, particularly for male patients who were admitted in ICU and had subjective functional loss at discharge. TRIAL REGISTRATION NUMBER: NCT04451694.
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COVID-19 , Desnutrição , Assistência ao Convalescente , Estudos de Coortes , Humanos , Masculino , Desnutrição/epidemiologia , Avaliação Nutricional , Estado Nutricional , Alta do Paciente , Estudos Prospectivos , SARS-CoV-2 , SobreviventesRESUMO
BACKGROUND: The buprenorphine (BHD) is an effective maintenance treatment for opioid dependence, used in France until 1996. From 1996 to 2001, it is involved in 137 deaths by respiratory depression including 91 attributable to the benzodiazepines (BDZ) association. The number of deaths caused by the BHD and BDZ, when they are taken jointly, is probably underestimated. The reasons for this association are the misuse, the self-medication and the co-prescription. OBJECTIVE: The objective of this study was to assess the co-prescription of these two drugs by the general practitioners (GPs) of Nancy (France). METHOD: A survey was conducted during the first semester 2007. Using the datas of the Caisse Primaire d'Assurance Maladie (the French national health service), all the requests for a reimbursement of BHD in Nancy were analysed. RESULTS: 1655 BHD consumers were included in this survey. Thirty-one percent of them asked for the reimbursement of at least one BZD at the same time. The BZD consumers were old, consulted more than one prescriber or chemist and more often consumed high dosages of BHD. CONCLUSION: The BZD consumption is often associated to BHD intake (31%). GPs need a better training on the subject: "How to take care of patients who depend on opiod". This would reduce the risks. A better information for the BHD users would be necessary as well as a lowest prescription of BZD by the GPs. Before any BHD prescription, the GPs should assess a possible co-dependence to BZD in order to improve the BHD prescription.
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Benzodiazepinas/administração & dosagem , Buprenorfina/administração & dosagem , Prescrições de Medicamentos/estatística & dados numéricos , Medicina Geral , Antagonistas de Entorpecentes/uso terapêutico , Padrões de Prática Médica , Estudos Transversais , Quimioterapia Combinada/efeitos adversos , Quimioterapia Combinada/estatística & dados numéricos , França , Humanos , RiscoRESUMO
Premature discontinuation of substance use disorder (SUD) treatment is a leading factor associated with poor outcomes. The aim of the study was to investigate factors associated with early dropout among individuals with SUD receiving outpatient care. In a prospective cohort of substance-dependent outpatients, we collected sociodemographic and clinical data, and participants completed questionnaires assessing health-related quality of life, states of anxiety and depression, and coping at baseline. We assessed satisfaction with the EQS-C soon after inclusion. We evaluated factors associated with dropout from care at 3â¯months using logistic regression models. We included a total of 175 patients at baseline. The retention rate over the 3-month period was 69.7%. The results indicate that higher satisfaction with care (ORâ¯=â¯0.96, 95% CIâ¯=â¯0.93-0.98, pâ¯=â¯0.01) and use of positive reframing (ORâ¯=â¯0.77, 95% CIâ¯=â¯0.59-0.96, pâ¯=â¯0.04) led to significantly lower levels of dropout from care at 3â¯months. We also found that female gender (ORâ¯=â¯2.97, 95% CIâ¯=â¯1.1-8, pâ¯=â¯0.03) and the use of the denial coping strategy (ORâ¯=â¯1.37, 95% CIâ¯=â¯1.1-1.8, pâ¯=â¯0.02) were significantly associated with higher early dropout at 3â¯months. These results suggest the need to improve satisfaction with treatment and identify patients' needs to reduce the risk of early dropout from SUD care.
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Pacientes Ambulatoriais , Transtornos Relacionados ao Uso de Substâncias , Feminino , Humanos , Satisfação Pessoal , Estudos Prospectivos , Qualidade de VidaRESUMO
BACKGROUND: Although patient perceptions of health care have increasingly been explored in the literature, little is known about care satisfaction among individuals with substance dependence. This exploratory study assessed the relationships between patient and physician characteristics and early outpatient satisfaction with care for alcohol and opioid dependence. METHODS: Satisfaction was assessed using a multidimensional, self-administered and validated questionnaire during the early care process among a prospective outpatient cohort. In addition to measuring satisfaction and obtaining sociodemographic and clinical data, this study collected data on the self-reported health status and physician characteristics at inclusion. Cross-sectional analysis with multiple linear regression was performed to identify the variables associated with satisfaction level. RESULTS: A total of 249 outpatients were included, and 63.8% completed the satisfaction questionnaire. Patients without a history of previous care for substance dependence were more satisfied with the appointment-making process (ß=7.2; P=0.029) and with the doctor consultation (ß=10.3; P=0.003) than those who had received care previously. Neither sociodemographic characteristics nor self-reported health status was associated with outpatient satisfaction. CONCLUSION: The factors that affect patients' ratings of early satisfaction with the care that they receive should be studied further because increased understanding of the factors that negatively affect these ratings might enable caregivers and outpatient management facilities to improve the patient experience during the early stages of care, which might in turn improve treatment adherence, continuity of care, and other health-related outcomes.
RESUMO
Hepatitis C is a severe disease, which often evolves into chronicity and for which there is no vaccine available. Therefore its screening is essential, especially among drug users who are the main reservoir of the hepatitis C virus (HCV). Current guidelines for screening are based on the detection of total anti-HCV antibodies (Ab) by means of third generation EIA. This test is performed in a laboratory from a venous sample. Alternative methods have been recently developed, including point-of-care tests (POCT) that offer many advantages. Their excellent diagnostic performance, their quick results and their ease of use by a large number of professionals are arguments in favor of widespread use of these tests. The expected benefits of the use of POCT are individual (better knowledge of HCV status, better access to care and treatment) but also collective (reduction of morbidity and mortality related to HCV and its cost in terms of public health) Because of their clinical interest, POCT should be refunded as well as the currently recommended screening test. In order to optimize their ease of use, POCT use should be integrated into an organized screening and hepatology follow-up system.
Assuntos
Hepatite C/complicações , Hepatite C/diagnóstico , Sistemas Automatizados de Assistência Junto ao Leito , Transtornos Relacionados ao Uso de Substâncias/complicações , Testes Diagnósticos de Rotina , HumanosRESUMO
Chronic psychosis, as for instance schizophrenia, usually begins in young adulthood and may cause severe disability. It causes a mean loss of life expectancy of 22 years. Actual models of psychosis do not trace the beginning of psychosis to the first franc psychotic episode only, but to earlier symptoms. In a classical health system only considering the first psychotic episode, the mean duration of untreated illness (DUI) can last several years. Yet this DUI has a direct impact on the prognosis of the disease. Actual international recommendations prescribe to early detect and treat at risk mental states of psychosis, thus reducing DUI. Such an attitude also helps the patient to integrate care in a moment where she/he is fully in condition to consent and to adhere. Generalist practitioners are crucial actors of early detection. We describe here simple and standardized tools helping early detection of high-risk mental states of psychosis in primary care and the appropriate attitude to do it properly. Numerous countries have developed early detection and treatment centers for psychosis. It has been established that such interventions clearly decrease the risk of transition towards chronic psychosis and improve the prognosis. These recent data about early detection and intervention in psychosis are a major step forward in psychiatry practice. It is now necessary to largely develop such actions in France.