Le dosage de l’Insulin-Like Growth Factor-1 : les difficultés de la détermination sérique et de l’interprétation des résultats

The IGF-I assay is now at the crossroads of endocrine pathology, which is essential both for diagnosis and for therapeutic management. However, due to the complexity and the intricacies of the regulatory factors and the existence of technical difficulties, results’ interpretation is far from a mundane procedure. In this work, we recalled the main sources of interference, the particular clinical situations that could compromise the results and the recommendations for each disputed case because we think it is useful for any practitioner to be warned in order to better manage them and to minimize errors ‘risk.     

Caractéristiques des centres de santé et conseils prénatals de préparation à la naissance

AimCounseling relating to birth preparedness is an essential component of the WHO Focused Antenatal Care model. During the antenatal visits, women should receive the information and education they need to make choices to reduce maternal and neonatal risks. The objective of this study conducted among women attending antenatal visits in rural Burkina Faso was to search for a link between the characteristics of the center delivering the health care and the probability of being exposed to information and advice relating to birth preparedness.MethodsA multilevel study was performed using survey data from women (n = 464) attending health centres (n = 30) in two rural districts in Burkina Faso (Dori and Koupela). The women were interviewed using the modified questionnaire of the Johns Hopkins Program for International Education in Gynecology and Obstetrics (JHPIEGO).ResultsWomen reported receiving advice about institutional delivery (72%), signs of danger (55%), cost of institutional delivery (38%) and advice on transportation in the event of emergency (12%). One independent factor was found to be associated with reception of birth preparedness advice: number of antenatal visits attended. Compared with women from Dori, women from Koupela were more likely to have received information on signs of danger (OR = 3.72; 95%CI: 1.26–7.89), institutional delivery (OR = 4.37; 95%CI: 1.70–10.14), and cost of care (OR = 3.01; 95%CI: 1.21–7.46). The reduced volume of consultations per day and the availability of printed materials significantly remain associated with information on the danger signs and with the institutional delivery advices. Comparison by center activity level showed that women attending health centers delivering less than 10 antenatal visits per day were more likely to receive information on signs of danger (OR = 2.63; 95%CI: 1.12–6.24) and to be advised about institution delivery (OR = 6.30; 95%CI: 2.47–13.90) compared to health centers delivering more than 20 antenatal visits per day. Women attending health centres equipped with printed materials (posters, illustrated documents) were more likely to receive information on signs of danger (OR = 4.25; 95%CI: 1.81–12.54) and be advised about institutional delivery (OR = 6.85; 95%CI: 3.17–14.77).ConclusionEfforts should be made to reach women with birth preparedness messages. Rural health centres in Burkna Faso need help to upgrade their organizational services and provide patients with printed materials so they can improve antenatal care delivery.     

Étude de la santé déclarée par les personnes riveraines de sources locales de pollution environnementale : une revue de la littérature. Seconde partie : analyse des résultats et perspectives

BackgroundEpidemiological studies have investigated the health impacts of local sources of environmental pollution using as an outcome variable self-reported health, reflecting the overall perception interviewed people have of their own health. This work aims at analyzing the advantages and the results of this approach. This second part presents the results of the studies.MethodsBased on a literature review (51 papers), this article presents an analysis of the contribution of self-reported health to epidemiological studies investigating local sources of environmental pollution. It discusses the associations between self-reported health and exposure variables, and other risk factors that can influence health reporting.ResultsStudies using self-reported health showed that local sources can be associated with a wide range of health outcomes, including an impact on mental health and well-being. The perception of pollution, especially sensory information such as odors, affects self-reported health. Attitudes referring to beliefs, worries and personal behaviors concerning the source of pollution have a striking influence on reported health. Attitudes can be used to estimate the reporting bias in a biomedical approach, and also constitute the main explanatory factors in biopsychosocial studies taking into account not only the biological, physical, and chemical factors but also the psychological and social factors at stake in a situation of environmental exposure.ConclusionStudying self-reported health enables a multifactorial approach to health in a context of environmental exposure. This approach is most relevant when conducted within a multidisciplinary framework involving human and social sciences to better understand psychosocial factors. The relevance of this type of approach used as an epidemiological surveillance tool to monitor local situations should be assessed with regard to needs for public health management of these situations.     

L’organisation locale de l’équité en santé ou les errements de l’intersectorialité

In recent years, there has been a new institutional set of developments in France aimed at promoting the adoption of partnership-based, cross-sectoral and modulated health policies based on the health status of the population. Nevertheless, because addressing the challenge of health equity depends largely on the mobilization of a large number of protagonists with very heterogeneous initiatives, interests and values, the conduct of such policies potentially opens up a space for confrontation between those who wish to promote it and those who refuse, challenge, circumvent or neutralize the reconfigurations of public action and the work routines it inevitably induces. This company can therefore be marked by tensions and additional constraints for the actors. In this context, it remains largely conditional.     

Approche terminologique de l’engagement des patients : point de vue d’un établissement de santé français

BackgroundThe establishment of a common pragmatic terminology represents the first step in structuring patient engagement initiatives in healthcare facilities. However, none is currently available in French. As part of the deployment of patient engagement within a French University Hospital Center, we propose a terminology of patient engagement.MethodsWe conducted a scoping review of the international literature that aimed at identifying the main conceptual and terminological frameworks for the engagement of patients, users and citizens in the healthcare system until 2019 in the PubMed and Cairn.info databases for English and French language articles. Additionally, we identified concepts and practices in the leading organizations of countries where this approach was implemented (United States, Canada and especially the province of Quebec, United Kingdom) and completed this approach by close exchanges and reflections with the team that developed the Montreal model.ResultsIn total, 75 references and Internet resources were consulted. Patient, interaction, patient experience, experiential knowledge, patient engagement, patient partner and its variations as a resource patient, peer-supporter, trainer, researcher and coach have been defined.ConclusionThis terminology of patient engagement proposes an initial stabilization of the vocabulary, using a pragmatic approach. This contribution is a first step aiming at promoting the development of a new model of care and more broadly of healthcare system management, involving scientific and experiential knowledge.