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1.
Breastfeed Med ; 15(5): 321-330, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32091916

RESUMO

Background: In France, the proportion of children who are exclusively breastfed has been decreasing in recent years. The aim of the study is to assess the link between quality of life (QOL) in pregnant women from the first trimester to the end of pregnancy using the French version EQ5D-3L questionnaire and the feeding method at birth (breast or bottle). Materials and Methods: Five hundred pregnant adult women were monitored between 2015 and 2017 at the Toulouse University Hospital (France). The data were collected monthly. After analyzing the QOL (EQ-5D-Index) and health status (EQ-5D-Visual Analogue Scale) for 1 month, we carried out a nine-group category analysis based on their QOL in the third month (low QOL [score <0.50 out of 1], intermediate [score between 0.50 and 0.90 out of 1], or high [score ≥0.90 out of 1]) and then based on changes in their QOL between the third and eighth month [marked reduction (low >0.6 point), intermediate (low between 0.1 and 0.6 point), and slight reduction (low <0.1 points increase)]. Results: Around1,847 questionnaires were collected and analyzed from 500 women. The monthly analysis did not highlight any link between QOL or health status reported during pregnancy and the feeding method at birth. As regard to the category analysis, following adjustment, the logistic regression model shows that breastfeeding is not linked to QOL in the third month of pregnancy (p = 0.171) or to changes in QOL during pregnancy (p = 0.426). However, there is less of a tendency to breastfeed in individuals with a high QOL in the third month of pregnancy compared to an intermediate QOL during the third month of pregnancy (p = 0.06). Conclusion: In this cohort of pregnant women for whom QOL was assessed throughout pregnancy, no link between QOL and feeding method was highlighted.

2.
Acta Obstet Gynecol Scand ; 98(10): 1282-1291, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-30985917

RESUMO

INTRODUCTION: The objective was to evaluate the quality of life of pregnant women with a full-term birth from the first trimester to the 9th month using the EQ5D-3L questionnaire, comparing physiological, simple pathological, or complex pathological pregnancies. MATERIAL AND METHODS: A prospective cohort of 500 pregnant women over the age of 18 was monitored between 2015 and 2017 at the Toulouse University Hospital (France). The data were collected monthly with an online report. Given that the decrease in quality of life was not linear during pregnancy, unadjusted and adjusted piecewise linear regression models were performed, considering 3 periods of time during pregnancy: 3-4, 4-8, and 8-9 months. The 5 dimensions of the EQ5D-Index and perceived health status were also analyzed. RESULTS: In total, 1847 questionnaires were collected. Between the 4th and 8th months, the quality of life was lower for pathological pregnancies (P < 0.001) than for physiological ones and decreased over time for each type of pregnancy (physiological: -0.08 points per month, P < 0.001; simple pathological: -0.12 points per month, P < 0.001; complex pathological: -0.11 points per month, P < 0.001). Interestingly, the perceived health status was lower at the 9th month than at the 3rd month of pregnancy, for physiological pregnancies (mean difference = -10.5 points, P < 0.001), pathological pregnancies (mean difference = -10.0 points, P < 0.002), and for complex pathological pregnancies (mean difference = -7.8 points, P = 0.058). CONCLUSIONS: In our population, the quality of life decreased between the 4th and 8th months, and decreased to a greater degree in a pathological pregnancy.


Assuntos
Complicações na Gravidez/fisiopatologia , Gravidez/fisiologia , Qualidade de Vida , Adulto , Feminino , França , Indicadores Básicos de Saúde , Humanos , Estudos Prospectivos , Fatores de Risco , Inquéritos e Questionários , Nascimento a Termo
3.
Palliat Support Care ; 10(4): 255-63, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22583756

RESUMO

OBJECTIVE: Depression is a frequent problem in cancer patients, which is known to reduce quality of life; however, many cancer patients with depression are not treated because of the difficulties in assessing depression in this population. Our aim was to evaluate and improve the depression assessment strategies of palliative care (PC) physicians and oncologists. METHOD: We invited all medical oncologists and PC physicians from three cancer centers to participate in this multicenter prospective study. They were asked to classify 22 symptoms (related and specific to depression in cancer patients, related but not specific, and unrelated) as "very important," "important," "less important," or "not important" for the diagnosis of depression in cancer patients, at three different time points (at baseline, after a video education program, and after 4 weeks). They were also asked to complete a questionnaire exploring physicians' perceptions of depression and of their role in its systematic screening. RESULTS: All 34 eligible physicians participated. Baseline performance was good, with >70% of participants correctly classifying at least seven of nine related and specific symptoms. We found no significant improvement in scores in the immediate and 4-week follow-up tests. Additionally, 24 (83%) and 23 (79%) participants expressed support for systematic depression screening and a role for oncologists in screening, respectively. SIGNIFICANCE OF RESULTS: Oncologists had good baseline knowledge about depression's main symptoms in cancer patients and a positive attitude toward being involved in screening. Underdiagnosis of depression is probably related to problems associated with the oncology working environment rather than the physicians' knowledge.


Assuntos
Atitude do Pessoal de Saúde , Depressão/diagnóstico , Transtorno Depressivo/diagnóstico , Oncologia/métodos , Neoplasias/psicologia , Medicina Paliativa/métodos , Adulto , Depressão/classificação , Depressão/etiologia , Transtorno Depressivo/classificação , Transtorno Depressivo/etiologia , Feminino , França , Humanos , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/estatística & dados numéricos , Oncologia/estatística & dados numéricos , Neoplasias/complicações , Pacientes Ambulatoriais , Medicina Paliativa/estatística & dados numéricos , Projetos Piloto , Padrões de Prática Médica/estatística & dados numéricos , Estudos Prospectivos , Inquéritos e Questionários
5.
J Contin Educ Health Prof ; 29(1): 58-62, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19288575

RESUMO

INTRODUCTION: Since reliable information is scarce to describe continuing medical education (CME) and revalidation in Europe, we carried out a survey in 5 selected countries (France, Germany, Italy, Spain, and the United Kingdom). METHODS: A tested questionnaire was sent to 2 experts per country (except in Germany), during August-September 2004. RESULTS: In the analyzed countries medical societies, medical associations, and employers are the main CME providers. Pharmaceutical industry sponsorship accounts on the average for more than 50% of the CME financing in those countries. In all 5 countries, CME accreditation systems exist; the national health authorities and medical associations are mainly responsible for them. In France, Italy, and Germany CME is mandatory; in Spain and the United Kingdom it is voluntary. CME credits/points are mainly used for professional career purposes. Revalidation systems have not been introduced in any of these countries, although in the United Kingdom it is being introduced as part of a relicensing process. DISCUSSION: Recommendations for the implementation of a European system of CME/CPD harmonization are made by the authors.


Assuntos
Competência Clínica/normas , Educação Médica Continuada , Médicos/normas , Acreditação , Coleta de Dados , Indústria Farmacêutica , Europa (Continente) , Apoio Financeiro
7.
J Contin Educ Health Prof ; 25(4): 290-6, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16365899

RESUMO

INTRODUCTION: During the past decade, the public, health care professionals, and governments have shown much interest in ensuring that professionals, specifically physicians, are skilled in their work and competent in managing health care organizations. The need to assess competence in the health care sector was explored, with the aim of proposing a policy for monitoring and assessing competence during active professional life. METHODS: A literature search and semistructured interviews were conducted. The 16 health care professions listed in the French health care code were included. The main questions were: What is your organization's definition of competence? What are the principal elements that define competence in health care activities? How can a system for assessing competence be implemented? Which methods for such a system are most appropriate, based on foreign experiences? Who are the players in the field of competence? And how can organizations participate in monitoring competence? RESULTS: 265 people representing 148 French organizations were interviewed. Competence in health care should be defined as follows: "professional competence is based on the initial diploma, the implementation of effective continuing education, a minimal professional activity and a regular peer review process." There was an agreement on the basic elements of competence, on the responsibilities of public institutions and professional organizations, and on the need to work together. DISCUSSION: We have shown that in France health care professionals would like to have a better system that allows them to exchange more information on the main health care issues; this is a serious requirement for most professionals.


Assuntos
Competência Clínica/estatística & dados numéricos , Competência Profissional/estatística & dados numéricos , Competência Clínica/normas , Educação Médica Continuada/estatística & dados numéricos , Escolaridade , França , Humanos , Entrevistas como Assunto , Revisão por Pares , Competência Profissional/normas
9.
Artigo em Inglês | MEDLINE | ID: mdl-15176174

RESUMO

Health technology assessment (HTA) in France covers a variety of activities performed for different customers (e.g., health professionals in the field and policy makers in government) for the benefit of patients. To promote the improvement of quality in health care, France has set up a series of distinct agencies that report to the Ministry of Health but are also accountable to their other customers. We place particular emphasis on ANAES (National Agency for Accreditation and Evaluation in Health) whose main remit is HTA. We show how the diversity of HTA activities and their decentralization suggests tight collaboration among all the different bodies which perform HTA or are closely involved with HTA, and we provide examples of such collaboration.


Assuntos
Avaliação da Tecnologia Biomédica/organização & administração , Assistência à Saúde/organização & administração , França , Guias de Prática Clínica como Assunto , Saúde Pública
11.
Presse Med ; 31(17): 775-81, 2002 May 11.
Artigo em Francês | MEDLINE | ID: mdl-12148359

RESUMO

THE IMPACT FACTOR OF MEDICAL JOURNALS: Is a criterion for the assessment of their activity. Three bibliometrical indicators are published every year: the impact factor, the rapidity of citation index, which reflects the upward slope in increased citations and the duration of their actuality, reflecting the downward slope, after the peak. THE JOURNALS USED TO CALCULATE THESE INDICATORS: Are selected according to their periodicity, conformity to international editorial conventions, presence of a reading committee, of their citation frequency and, for a new journal, the earlier publications of the redaction committee and the authors. THERE ARE SEVERAL BIASES IN THE CALCULATION OF THE IMPACT FACTOR: The choice of the citations is subjective and the non-pertinence of the citations is well known. Several variables may intervene, such as the type of journal and its size, domain concerned, language of the publication, self-citations, coding of the articles depending on their nature, and the choice of the manuscripts published ("hot papers"). The impact factor is an indicator of citations and not of their quality, and can certainly not be used to assess an authors' work.


Assuntos
Publicações Periódicas como Assunto/tendências , Bibliometria , França , Idioma , Publicações Periódicas como Assunto/normas , Editoração/tendências , Leitura
14.
Acta méd. colomb ; 19(2): 97-103, mar.-abr. 1994.
Artigo em Espanhol | LILACS | ID: lil-292812

RESUMO

A very important discipline in Medicine is the so called "Synthesis of Knowledge", based upon preventive, diagnostic, and therapeutic strategies. Among several methods of synthesis used in evaluation of medical knowledge are the Consensus Conferences. They allow to establish the state of the art in a given field at a given time. This paper resumes the history, methodology and usefulness of the Consensus Conferences


Assuntos
Humanos , Educação Médica/métodos , Educação Médica/normas , Educação Médica/tendências
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