Cet article rend compte de l’expérience de professionnelles intervenant au domicile de personnes âgées, au début de l’épidémie de Covid-19 en France, en mettant en regard deux contextes : la gestion de cas dans un dispositif MAIA et la kinésithérapie en libéral. Cette recherche a été menée conjointement par deux professionnelles et une sociologue, depuis la collecte de données (entretiens et récits de pratiques de mars à juin 2020) jusqu’à l’analyse et l’écriture. Nous analysons les épreuves vécues dans cette période marquée par le confinement, le risque sanitaire, les incertitudes et la pénurie de moyens. Les professionnelles ont dû arbitrer sur l’arrêt ou la reprise des visites à domicile, adapter leurs pratiques et leurs missions pour soigner et accompagner à distance, répondre à l’isolement et aux difficultés sanitaires et sociales accrues des personnes. Cependant, les difficultés vécues au quotidien n’ont pas été créées uniquement par la pandémie mais ont révélé des enjeux structurels propres à ces métiers. La crise sanitaire a mis en lumière leur rôle indispensable, ouvrant des possibilités de reconnaissance, de nouveaux projets et partenariats ; dans le même temps, les hiérarchies entre groupes professionnels ont été exacerbées, certaines actions invisibilisées ; les restructurations en cours dans les secteurs sanitaire et médico-social ont fortement contraint le champ des possibles.
Que signifie, pour une personne se declarant aidee ou pour son proxy, le fait de donner les coordonnees de ses aidants ? Que signifie, pour ces personnes declarees aidantes, le fait d'accepter la visite d'un enqueteur puis, deux ans apres, la visite plus informelle d'un autre enqueteur ? Comment interpreter les reponses qui se recoupent, l'aidant confirmant la declaration de l'aide a son sujet, et celles qui se contredisent ? Ces questions ont guide la recherche effectuee sur l'enquete Handicap Sante (Menages HSM et Aidants HSA) 2008. Les auteurs ont d'abord interroge des responsables nationaux et regionaux de l'enquete, ainsi que des enqueteurs INSEE y ayant participe, pour examiner les difficultes posees par un protocole inhabituel : interroger tous les aidants declares d'une personne HSM. Ils ont decouvert que, malgre une frayeur initiale, les donnees HSA etaient fiables. Ils ont ensuite verifie les consequences de l' effet enqueteur sur le respect du protocole : enregistrer la presence d'aidants, obtenir leurs coordonnees, enqueter ceux qui peuvent etre joints et qui acceptent de repondre. Elles sont statistiquement negligeables. Par un effet d'apprentissage de l'enquete HSM-HSA, le protocole est d'autant mieux applique que les enqueteurs ont realise davantage de cas. Il subsiste une difference, parmi les enqueteurs âges de 45 a 54 ans, entre les femmes dont la definition de l'aide est plus restrictive (et qui, de ce fait, reussissent a interroger davantage d'aidants identifies), et les hommes qui identifient davantage d'aidants dans HSM et connaissent davantage d'echecs pour la passation de HSA. Les auteurs examinent statistiquement ces blocages d'enquete, d'une part, et la divergence ou la convergence des declarations de la personne aidee ou de son proxy et des aidants, dans l'enquete Medips et dans l'enquete HSM-HSA. Les resultats confirment l'interet de ce protocole polyphonique pour comprendre les differences dans la mesure de l'aide, selon le genre de l'aide et de l'aidant, selon le type de handicap et selon la place dans la parente. Ce protocole est donc necessaire pour analyser la difference entre le point de vue de l'aide et ceux des aidants declares. En revanche, il peut etre drastiquement allege et reduit a la simple circulation de l'enqueteur : recueil des adresses des aidants, prise de contact avec les aidants. L'analyse de douze cas ethnographiques permet enfin de revenir sur le role du proxy, sur la difference entre deficiences purement motrices et deficiences intellectuelles, et sur la dynamique des situations. Lorsque l'enqueteur a acces au point de vue de l'aide, il decouvre l'importance des conditions economiques de l'autonomie. Lorsque les aides sont des enfants vieillissant avec une deficience intellectuelle, c'est la question de la transmission de la tutelle qui se pose avec acuite. Enfin, seule l'enquete ethnographique permet de comprendre la dynamique des situations, qu'il s'agisse pour l'entourage de sauver l'identite sociale de la personne handicapee ou encore, pour l'aide, de conquerir ou de perdre son autonomie.
The respondent reports on health problems collected in 1999 by the French national “Handicaps–Incapacites–Dependance” [“HID,” Disabilities–infirmities–dependence] survey provide insight into the multitude of ways laypersons have of presenting health disorders. Textual statistics show that respondent reports vary by social background, thereby illustrating Luc Boltanski’s notion of somatic cultures. However, it is possible to go beyond that observation to show that ways of presenting health problems cannot be dissociated from ways of understanding disease—what we have called “diagnostic theories.” Drawing on the examples of mental illness and Alzheimertype disorders, the article shows the relevance of taking into account factors other than social background, particularly the social and moral construction of pathologies and treatment configurations specific to medical-social sectors in the given society. Family configurations also play a role, as the issues involved in organizing daily life and care vary with those configurations.
Introduction: It has been reported that Matrigel (a kind of extracellular matrix) can be used to coat on the surface of culture dishes which supports a greater proportion of viable follicles developed during culture in vitro.However, it has been concerned that Matrigel is an extract of a tumor cells.Therefore, an alternative, human decidua momolayer cells, was used instead of Matrigel in this study.The objective of this study was to establish a new culture system, using human decidua monolayer cells to restore survival and development of follicles following co-culture with human frozen-thawing ovarian tissue in vitro.Materials and Methods: Ovarian tissues were obtained from 15 women who underwent gynecologic surgery for the indication of mature teratoma.The ovarian cortex was cut into small strips (10mm × 1mm × 1mm)and cryopreserved by vitrification method.Decidua biopsy was performed during induced abortion surgery.Decidae cells were cultured in 4-well dishes to generate monolayer cells in culture medium DMEM/F12 with 15% fetal bovine serum (FBS) containing penicillin and streptomycin in a 5% CO 2 incubator at 37°C in high humidity.The frozen ovarian tissues were thawed and further cut into cubes, and then allocated into the 4-well dishes where decidua monolayer cells generated (10 cubes in 1 well of dish).The experiment was designed with following: Group A, frozen-thawed tissue cultured with monolayer cells; Group B, frozenthawed tissue cultured without monolayer cells; Group C, fresh tissue cultured with monolayer cells; Group D, fresh tissue cultured without monolayer cells.Following culture, the medium was extracted every other day and added the same volume of medium up to 14 days to detect the concentration of estradiol and progesterone.End of culture, the ovarian tissues were fixed for histological analysis.Total follicle surviving rate (TFSR) and growing follicle rate (GFR) were assessed.The statistical analyses were applied for t and χ 2 tests.Results: There were no differences in the TFSR (92.3% versus 94.5%) and GFR (59.8% versus 53.3%) between group A and C. Also there were no differences in the concentrations of Estradiol (311.7 ± 73.6pmol/l versus 328.4 ± 63.9pmol/l), and Progesterone (1.6 ± 0.7IU/L versus 1.5 ± 0.6IU/L) at the end of 14 days between group A and C.However, these numbers were significantly higher than group B and D. Conclusions: Co-culture of human decidua monolayer cells with the frozenthawed ovarian tissue improves survival and development of follicles cultured in vitro.This new culture system will be beneficial to ovarian tissue culture.
The prevention and the treatment of oestrogen deficiency induced by breast cancer treatments are crucial in the management of patients. The impacts of this deficiency must not be neglected: quality of life impairments inducing eventually premature withdrawal of hormonotherapies, and excess of bone and cardio-vascular morbidities and mortalities, especially in good prognosis young women. Management strategies of short and long term effects of this deficiency are reviewed and discussed here.
Background The acute nature of the COVID-19 pandemic has put a strain on health resources that are usually dedicated to chronic illnesses. Resulting changes in care practices and networks have had major repercussions on the experience of people with chronic disorders. Objective This paper presents the protocol of the Parcours, Associations, Réseau, Chronicité, Organisation, Usagers, Retour d’expérience, Soins (PARCOURS)-COVID study. The aim of this study is to evaluate the effects of reorganization of the health system on the usual care network of patients with chronic illness, which fosters and qualifies the quality and continuum of care provided. The first objective of this study is to document these patients’ experiences through transformations and adaptations of their network, both in the practical dimension (ie, daily life and care) and subjective dimension (ie, psychosocial experience of illness and relationship to the health system). The second objective of the study is to understand and acknowledge these reorganizations during the COVID-19 lockdown and postlockdown periods. The third objective is to produce better adapted recommendations for patients with chronic illness and value their experience for the management of future health crisis. Methods The PARCOURS-COVID study is a qualitative and participatory research involving patient organizations as research partners and members of these organizations as part of the research team. Three group of chronic diseases have been selected regarding the specificities of the care network they mobilize: (1) cystic fibrosis and kidney disease, (2) hemophilia, and (3) mental health disorders. Four consecutive phases will be conducted, including (1) preparatory interviews with medical or associative actors of each pathology field; (2) in-depth individual interviews with patients of each pathology, analyzed using the qualitative method of thematic analysis; (3) results of both these phases will then be triangulated through interviews with members of each patient’s care ecosystem; and finally, (4) focus groups will be organized to discuss the results with research participants (ie, representatives of chronic disease associations; patients; and actors of the medical, psychosocial, and family care network) in a research-action framework. Results The protocol study has undergone a peer review by the French National Research Agency’s scientific committee and has been approved by the research ethical committee of the University of Paris (registration number: IRB 00012020-59, June 28, 2020). The project received funding from August 2020 through April 2021. Expected results will be disseminated in 2021 and 2022. Conclusions Our findings will better inform the stakes of the current health crisis on the management of patients with chronic illness and, more broadly, any future crisis for a population deemed to be at risk. They will also improve health democracy by supporting better transferability of knowledge between the scientific and citizen communities. International Registered Report Identifier (IRRID) DERR1-10.2196/28728
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