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Face à l’immense défi soulevé par l’épidémiologie galopante des maladies chroniques, la télémédecine présente l’immense avantage de pouvoir pallier les carences de l’offre de soin ; elle peut venir en aide aux hôpitaux qui cherchent à opérer un virage vers l’ambulatoire. Mais, la pratique de la télémédecine établit à la fois un contact et une distance. La question, dès lors, se pose : que peut bien devenir l’empathie en télémédecine ? Il est répondu que l’empathie requiert de la distance ; qu’empathie et télémédecine ne sont nullement incompatibles ; que le véritable enjeu, c’est le corps, un corps mis à distance et ainsi désinvesti ; que, enfin, la télémédecine ne pourra jamais se substituer à la relation de soin, à la relation incarnée.

Dans le présent article, nous passons en revue un champ sémantique, celui des mots ou des formulations relatifs à « l’éducation thérapeutique du patient » ; un champ dont les énoncés nous semblent, non seulement insatisfaisants, mais antinomiques même avec la visée d’autonomie pour un être souffrant. Nous procéderons à une analyse critique de ces termes et proposerons de nouvelles formulations à l’aune de la philosophie morale.

In eastern and southern Africa, the human immunodeficiency virus (HIV) epidemic appeared first in urban centres and then spread to rural areas. Its overall prevalence is lower in West Africa, with the highest levels still found in cities. Rural areas are also threatened, however, because of the population's high mobility. We conducted a study in three different communities with contrasting infection levels to understand the epidemiology of HIV infection in rural West Africa.

In spite of an improving trend, childhood mortality in rural sub-Saharan Africa remains high and has recently risen in some countries. The factors associated with the long-term decline in childhood mortality are poorly known, due to a lack of data.

Background In many developing countries, breastfed children have a lower nutritional status than those weaned from 12 months of age. Reverse causality, that is, earlier weaning of healthy and well-nourished children, is a possible explanation.
Methods Maternal reasons for early and late weaning were investigated in a cohort of 485 rural Senegalese children using structured interviews during two rounds at the ages of 18-28 and 23-33 months, respectively. Length, weight and height were assessed, and dates of weaning were monitored.
Results The mean duration of breastfeeding was 24.1 months (quartiles 21.9 and 26.3). Two-thirds of mothers of breastfed children under 2 stated that they would wean at the age of 2, while for breastfed children aged 2 years, a 'tall and strong' child was the most prevalent criterion. The main reasons for weaning prior to 2 years (N = 244) were that the child ate well from the family plate (60%), that the child was 'tall and strong' (46%) and maternal pregnancy (35%). The main reasons for weaning later than the age of 2 were: a 'little, weak' child (33%), food shortage (25%), illness of the child (24%) and refusal of family food (14%, N = 120). Children breastfed above the age of 2 because they were 'small and weak' had lower mean height-for-age and a greater prevalence of stunting than children breastfed late for other reasons (P < 0.0001).
Conclusion The habit of postponing weaning of stunted children very likely explains why breastfed children have lower height-for-age than weaned children in this setting.

In many developing countries, breastfed children have a lower nutritional status than those weaned from 12 months of age. Reverse causality, that is, earlier weaning of healthy and well-nourished children, is a possible explanation.