L'exercice de la médecine générale à l'épreuve des crises sanitaires : de Lubrizol à la COVID.

INTRODUCTION: Following the fire of the chemical products stored by the Lubrizol (Seveso upper tier) and Normandie Logistique companies on 26 September 2019 in Rouen, a research group bringing together general practitioners (GP), anthropologists and sociologists has undertaken a multidisciplinary qualitative investigation of general practitioners. The initial objective was to study the practice of primary care health professionals following the event. Initiated in February 2020, this survey was strongly transformed by the COVID-19 pandemic. COVID-19 changed the object of this study, imposed a reflection and a link between the two crises, where GPs found themselves once again on the front line. PURPOSE OF RESEARCH: To analyze the practices of general practitioners in situations of uncertainty in the context of these extraordinary events, namely an industrial fire and a viral pandemic. METHODS: Eighteen general practitioners were interviewed between February and July 2019 in semi-structured interviews conducted by a pair of researchers (sociologist and GP). An analysis inspired by the grounded theory was carried out on three levels (individual thematic analysis, paired confrontation, and collective restitution). CONCLUSION: In the health crisis contexts studied, GPs were confronted with more recurrent complaints while they had relatively little robust knowledge on which to base their responses. Finally, physicians responded to these situations of high uncertainty by drawing in original ways on their personal experiences of these crises.

Fasting and weight-loss restrictive diet practices among 2,700 cancer survivors: results from the NutriNet-Santé cohort.

Nutrition is often used by cancer survivors as a lever to take charge of their own health. However, some dietary behaviors are not currently recommended for patients without medical supervision. Our study aimed at evaluating weight-loss restrictive diets and fasting practices among cancer survivors of the NutriNet-Santé cohort, as well as related socio-demographic and lifestyle factors. In October 2016, 2,741 cancer survivors had completed a specific questionnaire about their practices. Fasting and non-fasting patients (respectively dieting and non-dieting) were compared using logistic regression models. Analyses were weighted according to the age, gender, and cancer location distribution of French cancer cases. 13.8% had already practiced weight-loss restrictive diet as their diagnosis. They were more likely to be women, professionally active, overweight/obese, to use dietary supplements and to have breast cancer (all p < 0.05). 6.0% had already fasted, 3.5% as their diagnosis. They were more likely to be younger, with higher educational level, higher incomes, professionally active, to have a healthy weight, and to use dietary supplements (all p < 0.05). Fasting was associated with the opinion that such practice could improve cancer prognosis (p < 0.0001). Patients who received nutritional information from health care professionals were less likely to practice fasting or weight-loss restrictive diet (0.42[0.27-0.66], p < 0.0001 and 0.49[0.38-0.64], p < 0.0001 respectively). Our study provided original results suggesting that weight-loss restrictive diets are widely practiced by cancer survivors. Fasting was less common in our study though non negligible. Sources of nutritional information received as cancer diagnosis seemed to be a key determinant of these practices.