[Weight gain during menopause: physiology and practical implications]. / Prise de poids pendant la ménopause : physiologie et implications pratiques.

Fluctuations in sex hormones at different stages of reproductive life, such as the menopausal transition, have been suggested as players in weight regulation. Indeed, the transition from a predominantly estrogenic state to an androgenic state characteristic of the menopausal transition contributes to changes in body composition with accumulation of fat and simultaneous loss of lean mass. However, whether these changes contribute to the weight gain remains debatable. Other physiological and psychosocial factors come into play. It is therefore important to offer individualized support with the objective to minimize the risk of weight gain and associated complications.

La fluctuation des hormones sexuelles à différentes étapes de la vie reproductive, telles que la transition ménopausique, a été proposée comme une des composantes de la régulation de poids. Effectivement, le passage d'un état principalement œstrogénique à un état androgénique, caractéristique de la transition ménopausique, contribue à des modifications de la composition corporelle avec une accumulation de graisse et une perte simultanée de masse maigre. Cependant, la question de savoir si ces changements contribuent à une prise de poids reste discutable. L'obésité est une maladie multifactorielle et d'autres facteurs d'ordre physiologique et psychosociaux rentrent en jeu. Il est donc important d'offrir un accompagnement individualisé aux femmes concernées pour les aider à minimiser le risque de prise pondérale et des complications associées.

Redefining Foot Symptoms in a Kidney-Pancreas-Transplanted Type 1 Diabetic Patient: Challenging the Conventional Charcot Foot Diagnosis.

BACKGROUND Acute Charcot foot can be difficult to diagnose, especially because of other alternate diagnoses that can mimic this condition, particularly stress fracture and acute bone and joint infections, which are 2 conditions that require immediate management. Here, we present the case of a patient who received kidney-pancreas-transplantation for type 1 diabetes mellitus, who consulted for right foot pain after walking. CASE REPORT Our patient was a 47-year-old man who had benefited from a kidney-pancreas transplantation in 2014 for type 1 diabetes and terminal kidney failure and was recently followed for a right foot plantar ulcer that was fully healed. He later presented for right foot pain after walking. Clinical examination showed a red, swollen, and warm foot. Blood test results were unremarkable. Imaging (X-ray/MRI) revealed features compatible with acute Charcot foot. The management consisted of prompt right-foot offloading followed by physiotherapy and adapted orthopedic insoles. CONCLUSIONS This case shows the successful treatment of an active phase of Charcot foot, which avoided the classic transition to chronic Charcot foot with severe osteoarticular destruction. Arguments were developed to rule out other possible diagnoses. The underlying mechanisms of Charcot foot in diabetic patients are related to the neurological and micro-vascular complications induced by poor glycemic control, but the mechanisms are unclear. This case report may help clinicians to better understand and consider another less known and less frequent diagnosis when faced with these clinical features.

[The evolution of the perception of obesity: the "weight" of social norms]. / Évolution de la perception de l'obésité : le « poids ¼ des normes sociales.

The perception of obesity and the ideal body image has evolved over time, largely due to social norms that are not always guided by scientific knowledge. The use of social media for health promotion is an emerging area of investigation. Preliminary research suggests that they have the potential to both serve as a platform for combating the stigma of obesity and promoting positive body image. But there is also evidence that supports the contrary. In particular, the dissemination of digitally altered images that convey ideals of the slim female form can be detrimental to physical and psychological health. Further research is needed to determine how best to use social networks and media as a health promotion tool.

La perception de l'obésité et du corps idéal a bien évolué au cours du temps, liée en grande partie à des normes sociales qui ne sont pas toujours guidées par les connaissances scientifiques. L'utilisation des médias sociaux pour la promotion de la santé est un domaine d'investigation émergent. Les recherches préliminaires suggèrent qu'ils ont le potentiel d'être une plateforme permettant à la fois de lutter contre la stigmatisation de l'obésité et de promouvoir une image corporelle positive. Mais il y a également des preuves qui suggèrent le contraire. Notamment, la diffusion d'images retouchées qui véhiculent des idéaux de minceur irréalistes peut nuire à la santé physique et psychologique. Des recherches supplémentaires sont nécessaires pour déterminer comment utiliser au mieux les réseaux et médias sociaux comme outil de promotion de la santé.

Evolution of Therapeutic Patient Education: A Systematic Scoping Review and Scientometric Analysis.

Therapeutic patient education (TPE) aims to empower the patients and their caregivers to effectively care for and manage their conditions. Such educational programs have been shown to improve health behaviors, disease outcomes, and quality of life among different patient populations. The field of TPE has evolved extensively over decades, owing to interdisciplinary research. No study so far has been done to map this field, to identify the stakeholders and gaps requiring future research. By leveraging the theory of co-citation, CiteSpace was used to visualize the bibliographic data pertaining to TPE research. A total of 54,533 articles published in English language were analyzed to identify influential funders, regions, and institutes contributing to this field. Besides these, significant theoretical and empirical contributions that shaped this field were mapped. Our analysis revealed several important insights. Most of the important theories that helped shape TPE were inspired from the social sciences. Five important research themes were identified: disorders, study designs utilized in TPE research, the scope of the TPE literature and outcomes, and populations. The research focused on improving perceptions, behaviors, and attitudes toward health promotion, reducing stigma, self-management and medication adherence. Most of the research was developed in the context of high-income countries. Future research should involve patients and use digital technology. Meta-analytical studies need to be done to identify the effectiveness and moderators of TPE interventions across different disorders. Further research should involve low and middle-income countries (LMIC) to ensure knowledge and technology transfer.

[How to manage obesity in the general practitioner's office ?] / Comment prendre en charge l'obésité au cabinet d'un médecin généraliste ?

The prevalence of obesity continues to increase and only a change in behavior can lead to a reduction in weight and an improvement of the cardio-metabolic profile. The general practitioner plays an important role in preventing excess weight and in identifying patients at risk. He is often on the front line to provide hygiene- dietetic advice and long-term support. The purpose of this article is to give the primary care physician some guidelines from reception at the office to referral to a specialist center if necessary.

La prévalence de l'obésité ne cesse d'augmenter et seul un changement de comportement peut permettre une diminution de poids et une amélioration du profil cardiométabolique. Le médecin généraliste joue un rôle important dans la prévention de l'excès pondéral et dans l'identification des patients à risque. Il est souvent en première ligne pour leur donner des conseils hygiénodiététiques et pour les accompagner sur le long terme. Le but de cet article est de fournir au médecin de premier recours quelques directives dans la prise en charge de l'obésité, de l'accueil au cabinet médical jusqu'à l'orientation vers un centre spécialisé en cas de nécessité.

[Evolution and effectiveness of therapeutic patient education for obesity and diabetes]. / Évolution et efficacité de l'éducation thérapeutique du patient pour l'obésité et le diabète.

Therapeutic patient education (TPE) aims to help patients acquire or maintain the skills they need to best manage their lives with a chronic disease. Through a scientometric analysis of the literature, we identified the most influential bibliographic data related to TPE research that have strengthened the field and increased its effectiveness. These were studies from the fields of education, philosophy, psychology, anthropology and medical sociology. We have conducted a meta-analysis that has demonstrated the effectiveness of TPE for the management of obesity and diabetes on biological and psychological parameters. It allowed patients to improve their knowledge, their therapeutic adherence and their sense of self-efficacy.

L'éducation thérapeutique du patient (ETP) vise à aider les patients à acquérir ou maintenir les compétences dont ils ont besoin pour gérer au mieux leur vie avec une maladie chronique. À travers une analyse scientométrique de la littérature, nous avons identifié les données bibliographiques les plus influentes, relatives à la recherche en ETP, qui ont permis de renforcer le domaine et augmenter son efficacité. Ce sont des études issues des sciences de l'éducation, de la philosophie, de la psychologie, de l'anthropologie et de la sociologie médicale. Nous avons mené une méta-analyse qui a permis de démontrer l'efficacité de l'ETP pour la prise en charge de l'obésité et du diabète sur les paramètres biologiques et psychologiques. Elle a permis aux patients d'améliorer leurs connaissances, leur adhérence thérapeutique et le sentiment d'efficacité personnelle.

[Weight-loss promoting dietary supplements : overview of their efficacy and safety]. / Compléments alimentaires pour la perte de poids : revue de leur efficacité et sécurité.

Due to the increase in the prevalence of obesity, the consumption of dietary supplements promoting weight loss has increased in the last few years. Many dietary supplements are available on the market, such as L-carnitine, glucomanan, chitosan, and Hoodia gordonii. The safety and clinical effectiveness of most of these supplements have not been assessed by high-quality trials. The scientific evidence of their benefit remains weak. The risk of adverse effects and drug interactions, most often unknown to patients, exists and must be carefully considered before initiating supplementation, in consultation with a physician, in the same way as other aspects of the treatment of obese patients.

Face à l'augmentation de la prévalence de l'obésité, la consommation de compléments alimentaires promouvant la perte pondérale s'est accrue au cours des dernières années. De nombreux compléments alimentaires sont disponibles sur le marché, tels que la L-carnitine, le glucomannane, le chitosan et la Hoodia gordonii. La sécurité et l'efficacité clinique de la plupart de ces compléments n'ont pas été évaluées par des essais de bonne qualité. L'évidence scientifique de leur bénéfice reste ainsi faible. Le risque d'effets indésirables et d'interactions médicamenteuses, le plus souvent méconnu des patients, existe et doit être pris en considération avant de débuter une supplémentation, en consultation avec un médecin, au même titre que les autres aspects de la prise en charge des patients obèses.

Effectiveness of therapeutic patient education interventions for chronic diseases: A systematic review and meta-analyses of randomized controlled trials.

Background: Chronic disorders are highly prevalent and are a major contributor to death and disability worldwide. Evidence has shown that therapeutic patient education (TPE) interventions are effective in improving a range of biomedical and psychological outcomes for a variety of chronic disorders. This has been demonstrated in scores of randomized controlled and evidence-synthesis studies. However, no quantitative evidence has been published so far on the content and effective teaching strategies in TPE programs. The present systematic review and meta-analysis aim to bridge this gap by answering the who, what, and how of TPE programs. Methods: Using a pretested search strategy, we searched the Web of Science, MEDLINE, CINAHL, PsycINFO, and the COCHRANE databases, from inception to August 2019. The search strategy was based on four comprehensive search concepts (patient education, chronic diseases, study design, and outcomes). After a careful screening for eligible studies, two reviewers extracted qualitative and quantitative data from the randomized controlled trials on the TPE interventions. We also developed a taxonomy of curriculum skills and intervention delivery techniques to aid the extraction of data in these domains. Results: We found that these interventions were effective in improving biological outcomes (SMD = 0.48; 95% CI: 0.38-0.57), adherence to the treatment regimen (SMD = 0.73; 95% CI: 0.46-1.002), knowledge (SMD = 1.22; 95% CI: 0.79-1.65), self-efficacy (SMD = 0.43; 95% CI: 0.30-0.56), and psychological health (SMD = -0.41; 95% CI: -0.53 to -0.29). This effectiveness was consistent across different delivery formats (individual, group, and electronic) and delivery agents (non-specialists vs. specialists). Conclusion: The flexibility in the choice of mode of delivery and curriculum development gives stakeholders an opportunity to scale up TPE interventions in healthcare settings. Systematic review registration: Identifier: CRD42019141294.

Implementation of Digital Monitoring Services During the COVID-19 Pandemic for Patients With Chronic Diseases: Design Science Approach.

BACKGROUND: The COVID-19 pandemic is straining health systems and disrupting the delivery of health care services, in particular, for older adults and people with chronic conditions, who are particularly vulnerable to COVID-19 infection. OBJECTIVE: The aim of this project was to support primary health care provision with a digital health platform that will allow primary care physicians and nurses to remotely manage the care of patients with chronic diseases or COVID-19 infections. METHODS: For the rapid design and implementation of a digital platform to support primary health care services, we followed the Design Science implementation framework: (1) problem identification and motivation, (2) definition of the objectives aligned with goal-oriented care, (3) artefact design and development based on Scrum, (4) solution demonstration, (5) evaluation, and (6) communication. RESULTS: The digital platform was developed for the specific objectives of the project and successfully piloted in 3 primary health care centers in the Lisbon Health Region. Health professionals (n=53) were able to remotely manage their first patients safely and thoroughly, with high degrees of satisfaction. CONCLUSIONS: Although still in the first steps of implementation, its positive uptake, by both health care providers and patients, is a promising result. There were several limitations including the low number of participating health care units. Further research is planned to deploy the platform to many more primary health care centers and evaluate the impact on patient's health related outcomes.

Telemedicine to deliver diabetes care in low- and middle-income countries: a systematic review and meta-analysis.

OBJECTIVE: To determine the effectiveness of telemedicine in the delivery of diabetes care in low- and middle-income countries. METHODS: We searched seven databases up to July 2020 for randomized controlled trials investigating the effectiveness of telemedicine in the delivery of diabetes care in low- and middle-income countries. We extracted data on the study characteristics, primary end-points and effect sizes of outcomes. Using random effects analyses, we ran a series of meta-analyses for both biochemical outcomes and related patient properties. FINDINGS: We included 31 interventions in our meta-analysis. We observed significant standardized mean differences of -0.38 for glycated haemoglobin (95% confidence interval, CI: -0.52 to -0.23; I 2 = 86.70%), -0.20 for fasting blood sugar (95% CI: -0.32 to -0.08; I 2 = 64.28%), 0.81 for adherence to treatment (95% CI: 0.19 to 1.42; I 2 = 93.75%), 0.55 for diabetes knowledge (95% CI: -0.10 to 1.20; I 2 = 92.65%) and 1.68 for self-efficacy (95% CI: 1.06 to 2.30; I 2 = 97.15%). We observed no significant treatment effects for other outcomes, with standardized mean differences of -0.04 for body mass index (95% CI: -0.13 to 0.05; I 2 = 35.94%), -0.06 for total cholesterol (95% CI: -0.16 to 0.04; I 2 = 59.93%) and -0.02 for triglycerides (95% CI: -0.12 to 0.09; I 2 = 0%). Interventions via telephone and short message service yielded the highest treatment effects compared with services based on telemetry and smartphone applications. CONCLUSION: Although we determined that telemedicine is effective in improving several diabetes-related outcomes, the certainty of evidence was very low due to substantial heterogeneity and risk of bias.

[Efficacy of smartphone applications for weight loss]. / Applications smartphone pour la perte de poids.

In recent years, smartphone applications (« apps ¼) for weight loss have emerged on the market. Their potential in the management of overweight or obesity is interesting thanks to their various features discussed in the article. The analyzed studies show that apps allow significant weight reduction, however without showing any difference with other interventions. In the future, functions based on artificial intelligence may be useful tools to improve patients' adherence to weight loss programs. Moreover, these apps present deficiencies in terms of respect of scientific evidence and the contribution of health experts in their design. In the future, interdisciplinary collaboration between developers, researchers and clinicians is necessary before considering the use of these apps in current practice.

Ces dernières années, les applications smartphone (« apps ¼) pour la perte de poids ont émergé sur le marché. Leur potentiel dans la prise en charge des patients en surpoids ou atteints d'obésité peut être intéressant grâce à leurs différentes fonctionnalités qui sont discutées dans l'article. Les études analysées montrent que les apps permettent une diminution significative du poids, sans toutefois montrer de différence avec d'autres interventions. Par ailleurs, elles présentent des lacunes au niveau du respect des évidences scientifiques et de l'apport d'experts de la santé dans leur conception. À l'avenir, une collaboration interdisciplinaire entre les développeurs, chercheurs et cliniciens est nécessaire avant d'envisager l'utilisation de ces apps dans la pratique courante.

Harnessing Telemedicine for the Provision of Health Care: Bibliometric and Scientometric Analysis.

BACKGROUND: In recent decades, advances in information technology have given new momentum to telemedicine research. These advances in telemedicine range from individual to population levels, allowing the exchange of patient information for diagnosis and management of health problems, primary care prevention, and education of physicians via distance learning. OBJECTIVE: This scientometric investigation aims to examine collaborative research networks, dominant research themes and disciplines, and seminal research studies that have contributed most to the field of telemedicine. This information is vital for scientists, institutions, and policy stakeholders to evaluate research areas where more infrastructural or scholarly contributions are required. METHODS: For analyses, we used CiteSpace (version 4.0 R5; Drexel University), which is a Java-based software that allows scientometric analysis, especially visualization of collaborative networks and research themes in a specific field. RESULTS: We found that scholarly activity has experienced a significant increase in the last decade. Most important works were conducted by institutions located in high-income countries. A discipline-specific shift from radiology to telestroke, teledermatology, telepsychiatry, and primary care was observed. The most important innovations that yielded a collaborative influence were reported in the following medical disciplines, in descending order: public environmental and occupational health, psychiatry, pediatrics, health policy and services, nursing, rehabilitation, radiology, pharmacology, surgery, respiratory medicine, neurosciences, obstetrics, and geriatrics. CONCLUSIONS: Despite a continuous rise in scholarly activity in telemedicine, we noticed several gaps in the literature. For instance, all the primary and secondary research central to telemedicine was conducted in the context of high-income countries, including the evidence synthesis approaches that pertained to implementation aspects of telemedicine. Furthermore, the research landscape and implementation of telemedicine infrastructure are expected to see exponential progress during and after the COVID-19 era.

Telemedicine in Arab Countries: Innovation, Research Trends, and Way Forward.

Background: The progress and innovation in telemedicine within the Middle Eastern countries have not been heavily monitored. Therefore, the present study aims to analyze the scholarly work conducted in the Arab world, using reproducible statistical and scientometric techniques. Methods: An electronic search of Web of Science (core database) had been conducted through use of an extensive search strategy comprising of keywords specific to the Arab region, EMRO countries, telehealth, medical conditions, and disorders. A total yield of 1,630 search results were processed, indexed through July 7, 2020. CiteSpace (5.7.R1, Drexel University, Pennsylvania, USA) is a Java-based application, a user-friendly tool for conducting scientometric analyses. Results: The present analyses found a lack of innovation in the field of digital health in the Arab countries. Many gaps in research were found in Arab countries, which will be discussed subsequently. Digital health research was clustered around themes of big data and artificial intelligence; a lack of progress was seen in telemedicine and digital health. Furthermore, only a small proportion of these publications had principal or corresponding authors from Arab countries. A clear disparity in digital health research in the Arab world was evident after comparing these insights with our previous investigation on telemedicine research in the global context. Conclusion: Telemedicine research is still in its infancy in the Middle Eastern countries. Recommendations include diversification of the research landscape and interdisciplinary collaborations in this area.

Implementation and evaluation of a specialized diabetes clinic in Guinea-Bissau: lessons learnt from the field.

INTRODUCTION: diabetes care in Guinea-Bissau (GB) is characterized by a lack of properly trained healthcare professionals (HCPs) and guidelines for diagnosis, treatment and follow up of patients. To address these issues, this project was launched with the objective to train HCPs in the management of diabetic patients and establish a specialized diabetes clinic in the Hospital Nacional Simão Mendes, a public tertiary care hospital in Bissau, capital of GB. This project is led by the Geneva University Hospitals (HUG) in collaboration with the Swiss Association for the Aid to Diabetic People in Guinea-Bissau, with the support of the International Solidairty Office (SSI) of the State of Geneva, and AIDA (Ayuda, Intercambio y Desarrollo). METHODS: specialists from the HUG in collaboration with local experts in GB developed and delivered a culturally and contextually adapted training course pertaining to diabetes care to HCPs in this hospital. Pre and post training tests were conducted to assess differences in knowledge and practices. Following the training program, a diabetes clinic was set up and an audit was conducted to assess its performance. RESULTS: a total of 24 HCP attended the training program and exhibited statistically significant improvements in their knowledge pertaining to diabetes care (mean difference between pre and post-test = 14.53, SD 11.60, t=-4.8, p < 0.001). The diabetes clinic was established and provided consultations 2 days per week. A total of 63 patients consulted at this clinic, of which 49 had type two diabetes treated with oral antidiabetic drugs and 14 were type 1 diabetics treated with insulin. Patients had blood glucose measurements and received therapeutic, dietary and physical activity counselling. Several barriers leading to occasional interruptions of service were encountered, including a political instability in the country and strikes of healthcare staff demanding better wages and working conditions. CONCLUSION: this study delineates the feasibility of setting up a diabetes consultation clinic in GB despite important barriers. To ensure successful running of such consultation clinics, continued buy-in and support from stakeholders should be ensured. Diabetes training should be incorporated in pre-and post-graduate training curriculums of all HCP to help shape a better workforce.

Diabetes management in Guinea Bissau: a situational analysis.

INTRODUCTION: There is an increasing commitment in the African Region towards diabetes care, following acknowledgement that it is an important public health issue which needs to be addressed in order to improve population health. We conducted a situational analysis of diabetes care in Guinea Bissau in order to identify the main issues faced in the management of the disease in this country. METHODS: The study design was qualitative and data collection was done using semi directive interviews and focus groups with participants involved in primary diabetes care and management in Guinea Bissau (health care professionals, non-governmental organization staff, traditional healers) and patients. The data was analyzed using the five-phase approach of the thematic analysis framework. RESULTS: The major themes identified included: the lack of specialists and properly trained healthcare personnel; no standardized care protocol for diagnosis, treatment, follow up and proper management for diabetic patients; resources poor primary health care settings; no validated epidemiological dataset on prevalence and the lack of awareness about diabetes (in general population and also in medical staff). CONCLUSION: This first situational analysis can serve as a baseline to develop an action plan to address the main issues identified.

Interventions targeting hypertension and diabetes mellitus at community and primary healthcare level in low- and middle-income countries:a scoping review.

BACKGROUND: Hypertension (HTN) and diabetes mellitus (DM) are highly prevalent in low- and middle-income countries (LMIC) and a leading cause of morbidity and mortality. Recent evidence on effectiveness of primary care interventions has attracted renewed calls for their implementation. This review aims to synthesize evidence pertaining to primary care interventions on these two diseases, evaluated and tested in LMICs. METHODS: Two reviewers conducted an electronic search of three databases (Pubmed, EMBASE and Web of Science) and screened for eligible articles. Interventions covering health promotion, prevention, treatment, or rehabilitation activities at the PHC or community level were included. Studies published in English, French, Portuguese and Spanish, from January 2007 to January 2017, were included. Key extraction variables included the 12 criteria identified by the Template for Intervention Description and Replication (TIDieR) checklist and guide. The Innovative Care for Chronic Conditions Framework (ICCCF) was used to guide analysis and reporting of results. RESULTS: 198 articles were analyzed. The strategies focused on healthcare service organization (76.5%), community level (9.7 %), creating a positive policy environment (3.6%) and strategies covering multiple domains (10.2%). Studies included related to the following topics: description or testing of interventions (n=81; 41.3%), implementation or evaluation projects (n=42; 21.4%), quality improvement initiatives (n=15; 7.7%), screening and prevention efforts (n=26; 13.2%), management of HTN or DM (n=13; 6.6%), integrated health services (n=10; 5.1%), knowledge and attitude surveys (n=5; 2.5%), cost-effective lab tests (n=2; 1%) and policy making efforts (n=2; 1%). Most studies reported interventions by non-specialists (n=86; 43.4%) and multidisciplinary teams (n=49; 25.5%). CONCLUSION: Only 198 articles were found over a 10 year period which demonstrates the limited published research on highly prevalent diseases in LMIC. This review shows the variety and complexity of approaches that have been tested to address HTN and DM in LMICs and highlights the elements of interventions needed to be addressed in order to strengthen delivery of care. Most studies reported little information regarding implementation processes to allow replication. Given the need for multi-component complex interventions, study designs and evaluation techniques will need to be adapted by including process evaluations versus simply effectiveness or outcome evaluations.

[Information and communication technologies for weight loss]. / Technologies d'information et de communication pour la perte de poids.

The potential of information and communication technologies has quickly been identified for health and in particular to promote weight loss. Several types of technologies exist with varying degrees of efficiency. These include programs on the Internet, using text messages, smartphone applications or portable devices. All these technologies are based on a set of weight loss strategies known to be effective, such as self-monitoring, feedback and social support. Despite promising results, several important limitations must be addressed such as the quality of the information being disseminated, the risk of promoting eating disorders, the place of these tools in patient follow-up, as well as data confidentiality issues.

Le potentiel des technologies de l'information et de la communication a rapidement été identifié dans le domaine de la santé et en particulier dans la promotion de la perte de poids. Des programmes sur internet, l'utilisation de SMS, des applications sur smartphone ou encore des appareils portables connectés existent, avec des degrés variables d'efficacité. Toutes ces technologies reposent sur un ensemble de stratégies connues pour faciliter la perte de poids telles que l'autosurveillance, le feedback et le soutien social. Malgré des résultats prometteurs, plusieurs questions se posent, sur le plan de la fiabilité de ces outils, la qualité des messages diffusés, le risque de favoriser des troubles du comportement alimentaire, la place de ces outils dans le suivi ou encore les problèmes de confidentialité des données.

"If you will counsel properly with love, they will listen": A qualitative analysis of leprosy affected patients' educational needs and caregiver perceptions in Nepal.

BACKGROUND: Leprosy remains a disease of concern in many countries including Nepal. To achieve the target of elimination, the WHO strategy promotes comprehensive education of patients, healthcare workers (HCWs), and the public on leprosy-related issues. However most educational programs are based on the concerns of HCWs and not on patients' needs. The objective of this paper is to explore the educational needs of leprosy affected patients in Nepal and compare them to the needs perceived by HCWs. METHODOLOGY/PRINCIPAL FINDINGS: Semi directive interviews were conducted with patients and HCWs. The data was analyzed using the basic interpretative qualitative framework. The study was conducted in two leprosy referral centers, one university hospital and one primary health care center: Lalgadh Leprosy Hospital and Services Centre, Anandaban Hospital and its satellite clinic in Patan, B. P. Koirala Institute of Health Sciences in Dharan, and the Itahari primary health care centre. The results show that there remains a lack of knowledge regarding the disease (origins, manifestations, prevention and treatment) contributing to late care seeking behavior and high levels of stigma, with an important psychological and financial stress for patients. All of the HCWs displayed a good understanding of patients' difficulties and needs and acknowledged the key role of patient education. However, they expressed several challenges in managing patients due to lack of time, human resources and training in patient education. CONCLUSIONS/SIGNIFICANCE: Further efforts need to be made to increase patients' general knowledge of the disease in order to motivate them to seek healthcare earlier and change their perception of the disease to reduce stigma. HCWs need proper training in patient education and counseling for them to acquire the necessary skills required to address the different educational needs of their patients. The use of lay and peer counselors would be an option to address the workload and lack of time expressed by HCWs.

Admission rates in emergency departments in Geneva during tennis broadcasting: a retrospective study.

BACKGROUND: Literature provides mixed results regarding the influence of large-scale sporting events on emergency department attendance. To contribute to the research on the subject, we sought to evaluate whether the broadcasting of major tennis tournaments, one of the most popular sports in Switzerland, has an impact on patient admission rates in emergency units in Geneva including 1) type of match 2) the role of a Swiss player, 3) degree of triage, 4) reason of attendance and 5) age of patients. METHODS: Admission rates between periods with tennis matches regarding the semi-finals and finals of 3 major tennis tournaments were compared to equivalent periods without matches from May 2013 to August 2017. Patient admission data was retrieved retrospectively from administrative databases of two Outpatient Emergency Units in Geneva. Patients' admission rates in periods with and without a tennis match were investigated using a negative binomial regression model with mixed effects. RESULTS: We observed a statistically significant decrease (- 10%, 95% CI -17 to - 2, p = 0.015) in admission rates in periods with a tennis match compared to periods without a tennis match, more pronounced during finals (- 15%, 95% CI -26 to - 3, p = 0.017) than during semi-finals (- 7%, - 16 to 2, p = 0.13). In addition, this effect was more pronounced in patients aged between 26 to 64 years of age, a category representing professionnally active people. No modification in the admission rates was detected in the hours preceding and following the matches, nor in type of consultations (traumatology vs non traumatology related admissions). CONCLUSION: Although modest, the results support the hypothesis that the broadcasting of large-scale sporting events such as tennis matches decreases admission rates in emergency units. Further research is required to explore for a potential causal relationship.