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Abstract Objective To investigate the prevalence and associated factors of depression and anxiety among hospital healthcare workers during the COVID-19 pandemic in the extreme south of Brazil. Method Cross-sectional study was conducted with 264 healthcare workers, between August and December 2020. Depression and anxiety were assessed using the Patient Health Questionnaire and the Generalized Anxiety Scale. Multivariable linear regression analysis was performed. Results The prevalence of depression and anxiety among healthcare workers was 32.4% and 26.2%, respectively. The profession of nursing technician, having a family member who had lost a job, being responsible for family income, being 50 or more years old, being divorced or widowed, having a test for COVID-19, having suffered a traumatic event in life and having received psychological counseling at work were associated with depression and anxiety. Conclusion In this study, receiving psychological counseling at work was a protective factor for anxiety and depression.

The present work aims to identify the predictive power of psychosocial factors at work (work and family conflict, bullying at work, work stress), and sociodemographic and health variables for the outcome of psychological distress in public health professionals during the pandemic. It is a quantitative study, with a sample composed of 478 public health professionals during COVID-19. The instruments, applied online, were sociodemographic, work and health data sheet; questionnaire on psychosocial risk factors at work; the Work-Family Conflict Scale, and the Clinical Outcome Routine Evaluation- Outcome Measures (CORE-OM). Data analysis was executed by multiple linear regression. Work-family conflict was the main cause of psychological distress, followed by bullying at work, family-work interaction, and prior psychiatric/psychological diagnosis. These variables predicted 37.8% of the sample's psychological distress. It should be noted that the pandemic may have contributed to the escalation of existing symptoms. These psychosocial risk factors, particularly work-family conflict, should be considered when planning interventions that aim to promote mental health.

The increase in heatwaves, a significant consequence of global warming, represents a major public health issue and is the main cause of death related to hyperthermia. The seriousness of such exposure to extreme ambient temperature lies in the difficulty to the general population to identify the warning signs and take appropriate protective measures. This article therefore presents guidelines for the prevention, recognition and treatment of heat-related illnesses, and thus arms clinicians and healthcare professionals who are on the front line in protecting the general population from this 'silent killer'., Competing Interests: Les auteur-es n’ont déclaré aucun conflit d’intérêts en relation avec cet article. Le Laboratoire Sport, Expertise et Performance (EA 7370) est partenaire du Réseau Francophone de Recherche en Médecine du Sport (ReFORM), reconnu comme Centre de Recherche pour la Prévention de la Blessure et la Protection de la Santé de l’Athlète par le Comité Olympique (CIO). En tant que membre du réseau de recherche médicale du CIO, ReFORM a reçu un financement du CIO pour établir des programmes de recherche à long terme sur la prévention des blessures et des maladies dans le sport pour la protection de la santé des athlètes.

This project is a way of improving the quality of working life for female professionals during their pregnancy, with shared benefits for the agent and the team. But it's also a lever of attractiveness for caregivers and a guarantee of quality for users., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

The subjective experience of contact with the deceased (VSCD), spontaneous and direct, by people most often in mourning, is neither rare nor new. It's even considered a universal and timeless phenomenon. Yet this psychological and sensory manifestation, which can manifest itself through sight, hearing, smell or touch, remains little known to the general public and health professionals alike. This article is an opportunity for many to discover this phenomenon, also known as necrophany., (Copyright © 2024. Publié par Elsevier Masson SAS.)

Information systems have been driving technological advances in healthcare, especially over the past two decades. Digital health is transforming care by emphasizing efficiency, accessibility, and integrating technology at every stage of the patient journey. The Electronic Health Record (EHR), a software used in hospitals or clinics, emerges as a cornerstone in this transformation by consolidating medical data to facilitate care coordination. This integration promises to enhance the quality of care and the patient-healthcare professional relationship, while presenting practical challenges such as increased documentation. In this article, we explore various aspects of the EHR, addressing its challenges and potential adaptations in our practice., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

A sedentary lifestyle is a significant cardiovascular risk factor and increases premature mortality. Engaging in routine physical activity (PA) provides a wide range of health benefits. Accordingly, physical inactivity must be identified and sedentary patients supported systematically to achieve recommended levels of PA. The level of PA can be assessed by taking patients' history and using specific tools. Support begins by assessing PA contraindications and patients' level of motivation to change their lifestyle. Patients are then encouraged to adopt a more active lifestyle through tailored advice, and if necessary, referred to specialists with expertise in exercise medicine. This article details the key aspects of accompanying sedentary patients, to help healthcare professionals integrate them into their practice., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

As the French population is ageing, the number of older people on the road is increasing all the time. For many older adults, this everyday activity remains an important way of maintaining their independence. Putting this right into question on the sole basis of age can be seen as a particularly stigmatising measure. However, this population is particularly vulnerable on the road. While behavioural factors are frequently involved in young adults, driving errors seem to be more frequently the main mechanism in older people. Driving is a succession of complex tasks that can be affected by ageing and the presence of pathologies (cognitive decline, sensory deficiencies or cardiovascular conditions that have not stabilised, etc.). As these medical conditions increase with age, it is important that healthcare professionals identify high-risk situations. When it is required, the professionals should assist patients to stop driving and find alternatives. Maintaining the mobility and ensure safety for older adults on the road remain challenging for the community. In this article, we discuss the issues surrounding the maintenance of driving in older adults. We also discuss the appropriate way to help patients stop driving when necessary.

At the end of December 2019, they emerged a new coronavirus (SARS-CoV-2), triggering a pandemic of an acute respiratory syndrome (COVID-19) in humans. We report the relevant features of the first two confirmed cases of COVID-19 recorded from the 29th April 2020 in the Far North Region of Cameroon. We did a review of the files of these two patients who were admitted to the internal medicine ward of a medical Centre in Maroua Town, Far North Region. We present 2 cases of symptomatic COVID-19 patients, both males and health personnel, with an average age of 53 years, with no recent history of travel to a COVID-19 zone at risk and working in a then COVID-19 free region. They presented with extreme fatigue as their main symptom. Both were treated initially for severe malaria with quinine sulfate infusion with initial relief of symptoms. In the first confirmed case, at his re-hospitalization with an acute respiratory syndrome, a Polymerase chain reaction (PCR) test in search of SARS-COV-2 was requested with his results available 7 days into admission. For the second case, he had his results 48 hours on admission while he was prepared to be discharged. Both control PCR tests for COVID-19 came back negative 14 days after hospitalization. Health personnel remains a group at risk for the COVID-19 infection. The clinical manifestation at an early stage may be atypical mimicking endemic tropical infections. Also, the therapeutic potential of Quinine salts in the relief of symptoms of COVID-19 is questionable and remains a subject to explore in our context.

Introduction: The advent of e-health has an impact on many areas of health care practice, including TPE. The impact of the introduction of information and communication technologies (ICTs) in health care, such as serious games, remains largely unexplored in the field of e-TPE., Purpose of the Research: To ask patients and health care professionals about the use of a serious game, in order to clarify the impact of these technologies on health care practices and on the relationship between caregiver and patient, as well as their advantages and limitations., Method: A qualitative study based on the grounded theory approach, using semi-structured interviews with six health care professionals and six patients using the DRAGO© serious game, a smartphone application designed to improve compliance with allergy treatment. A lexicometric analysis was carried out, with classification by theme and sub-theme, followed by a statistical breakdown of verbatims according to whether they expressed a favorable or unfavorable opinion., Results: 64% of professionals surveyed are in favor of digital innovations in health care, and 67% of patients. Health care professionals have reservations about their patients’ eligibility for these new technologies. In both categories, the ethical issues surrounding the emergence of e-health are positively echoed, with 69% of health care professionals and up to 83% of patients in favor. Both categories are more reserved about the impact of ICTs on the health care relationship., Conclusion: Health care professionals and patients alike consider the presence of ICTs in TPE to be “acceptable,” although they remain vigilant about the impact they can have on the health care relationship. These developments imply a necessary change in the practices of health care professionals, leading them to think about and encourage the emergence of the profile of tomorrow’s e-caregiver working with e-patients.

The International Symposium of the World Association of Veterinary Laboratory Diagnosticians (ISWAVLD) is the unmissable biannual meeting of all diagnostic veterinary laboratories including biologists, veterinarians and other scientists involved in laboratory diagnostics. It took place at the Lyon Convention Centre (29 June-1 July 2023). It was a pleasant and enriching moment, which allowed participants to discover and/or discuss new diagnostic methods and the epidemiology of animal diseases, around all themes involving veterinarians (animal health, but also environmental and human health, and food safety).

Migrants living in precarious conditions face many health-related vulnerabilities, particularly in the area of sexual health. This is a real challenge for healthcare professionals, who need to adopt appropriate approaches in order to help them become anchored in a care pathway., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Context: Family caregivers play an essential role in the continuity of care for patients with mental health problems. However, the lack of consideration for their role and difficulties in their collaboration with health professionals impact their involvement., Objective: The purpose of this study is to identify the issues underlying the family-professional partnership., Method: A qualitative and exploratory study is used to collect data from providers of support services, family caregivers of patients with psychiatric disorders, and mental health professionals. Semi-structured interviews and focus groups conducted from October 2017 to August 2018 were analyzed to determine key issues surrounding this partnership., Results: A total of thirty-two family caregivers, nine healthcare professionals, and eleven providers participated in the study. The central concerns related to the partnership are information, continuity of care, and the relationship between patients, family members, and professionals. The relational dimension appears to be an important element for all three groups of participants, who nevertheless point out difficulties with regard to their positioning in this tripartite relationship., Discussion/conclusion: In the context of the current healthcare system, the concept of partnership creates obstacles to family caregivers being able to contribute their expertise while feeling recognized by the other actors.

Abstract: Rural communities are geographically isolated from large urban areas, affecting access to definitive care, specialists and other health services that only service urban areas. Rural decision-makers are often faced with numerous challenges regarding the availability, capacity, sustainability and performance of health systems in rural and remote areas. We evaluated the current body of literature on educational initiatives being used in under-resourced areas to increase the knowledge or skills of healthcare workers. This rapid review followed the methods laid out by the Cochrane Rapid Reviews Methods Group and included published articles from any of three databases that described and evaluated an educational intervention, in which healthcare workers were the learners and which took place in an under-resourced area. Papers were excluded if they were deemed to be too resource intensive, were an opinion or concept paper or took place in an urban area. Results were synthesised descriptively. Ten studies were identified that contained information on educational initiatives in a variety of countries. The healthcare workers targeted in the studies varied from physicians, nurses and midwives to community health workers and students. The quality of studies also varied and included randomised control trials, systematic reviews and both prospective and retrospective studies. Initiatives involving simulation or point-of-care ultrasound were most common and showed the most benefit to a learner's knowledge and skill development. A limited body of literature exists on educational initiatives for healthcare workers in under-resourced areas. While simulation and hands-on learning showed positive results, the opportunity remains for a low-cost, high-yield educational initiative tailored to the unique needs of healthcare workers in under-resourced areas.Les communautés rurales sont géographiquement isolées des grandes zones urbaines, ce qui affecte l'accès à des soins définitifs, à des spécialistes et à d'autres services de santé qui ne desservent que les zones urbaines. Les décideurs ruraux sont souvent confrontés à de nombreux défis concernant la disponibilité, la capacité, la durabilité et la performance des systèmes de santé dans les zones rurales et éloignées. Nous avons évalué l'ensemble de la littérature actuelle sur les initiatives éducatives utilisées dans les zones sous-dotées pour améliorer les connaissances ou les compétences des travailleuses et travailleurs de la santé. Cette examen rapide a suivi les méthodes définies par le Cochrane Rapid Reviews Methods Group et a inclus des articles publiés dans l'une des trois bases de données qui décrivaient et évaluaient une intervention éducative dans laquelle les travailleuses et travailleurs de la santé étaient les apprenants et qui SE déroulait dans une zone manquant de ressources. Des articles jugés trop gourmands en ressources, des opinions, des documents conceptuels ou en lien avec des zones urbaines, ont été exclus. Les résultats ont été synthétisés de manière descriptive. 10 études ont été identifiées, contenant des informations sur des initiatives éducatives dans divers pays. Les travailleurs de la santé ciblés dans les études variaient des médecins, des infirmières et des sages-femmes aux travailleurs de la santé communautaire et aux étudiants. La qualité des études était également variable et comprenait des essais contrôlés randomisés, des revues systématiques et des études prospectives et rétrospectives. Les initiatives impliquant la simulation ou le POCUS étaient les plus courantes et présentaient le plus d'avantages pour le développement des connaissances et des compétences de l'apprenant. Il existe un nombre limité de documents sur les initiatives éducatives destinées aux travailleurs de la santé dans les zones sous-dotées. Bien que la simulation et l'apprentissage pratique aient donné des résultats positifs, il est toujours possible de mettre en place une initiative éducative peu coûteuse et à haut rendement, adaptée aux besoins spécifiques des travailleuses et travailleurs de la santé dans les zones sous-dotées., (Copyright © 2024 Copyright: © 2024 Society of Rural Physicians of Canada.)

Context: The literature review highlights that joint preparation and training of first aid responders is necessary to deal with a major chemical incident. Improved knowledge of exposure assessments makes it possible to estimate the risk and adjust immediate measures. The aim of this paper is to summarize recommendations for assessing exposure during chemical incidents that require emergency responses. Actions allowing the chemical contamination to be better anticipated and health protection to be optimized were analyzed., Methodology: A review of the literature was conducted, and research questions were formulated using the PECO method. The PRISMA method was used to select the literature., Results and Discussion: The selected papers (n=16) show that preparation for chemical incidents in terms of individual and collective protective equipment, and knowledge of the risk assessment process remain lacking. We propose training to master the steps of risk assessment. Our analysis also points out the importance of monitoring the state of the environment after a chemical incident, allowing adjusted measures to protect the health of the exposed population and vulnerable groups in particular. This monitoring must be accurate and dynamic to provide realistic recommendations during the intervention phase., Conclusions: All first-aid responders and health workers knowing the risk assessment process should result in improvements: in the use of protective measures in time and space, the delimitation of exposure to contamination, and the characterization of the risk.

Introduction: The accessibility of Therapeutic Patient Education (TPE) is essential to reduce social inequalities and to meet the challenges posed by the increase in chronic diseases. In France, the distribution of TPE throughout the territory is heterogeneous and patients still lack sufficient access. With these perspectives in mind, a municipal health center has developed an innovative TPE device by involving concerned patients from the outset., Objectives: The objectives of this article are to present the methodology implemented to co-construct a TPE program for patients with one or more prevalent diseases in the territory, as well as the results of the co-construction., Methods: Creation of a project team with various actors: patients, health professionals, administrators, researchers. Organization of synchronous and asynchronous times., Results: Four meetings and numerous exchanges made it possible to: define the common values and operating rules of the project team, reflect on the coordination of the care pathway, identify the specific and shared needs of patients affected by type 2 diabetes, arterial hypertension and/or obesity, agree on the principles of the device., Conclusion: The advantages of this device were discussed: flexible organization with numerous links with local actors, development of partnerships, expansion of the population concerned. Questions and difficulties were encountered, such as the coordination of actors and the representation of partner patients for the targeted diseases. This device will be tested and evaluated, mainly with an objective of improving it.

Elder abuse and neglect in institutions is frequent, but is still not studied enough. This study aims to better understand the risks of elder abuse, through daily experiences of health professionals. This is a monocentric, qualitative study, with semi-structured interviews of health professionals working in a geriatric hospital. Geriatrics is a specialty at risk of abuse and neglect. There is a real taboo around this issue. The difficulty for its reporting is multifactorial (tolerance, trivialization of abusive behaviors, isolation, and apprehension of caregivers...). The lack of human, material, and educational resources provided by health institutions does not enable professionals, whoever they may be, to care for patients humanely. The guidance and support of caregivers (training, increased team cohesion, and dedicated time for multidisciplinary reflection) are aimed at improving patient care and quality of care. All health professionals are concerned with elder abuse and neglect. It is necessary to break the taboo around mistreatment, to learn to talk about it among colleagues, and to recognize and evaluate oneself in order to change, evolve, and train others to treat patients the best way possible. Health professionals have to train and learn about the specificities of geriatrics early, repetitively, and continuously during their training. Health professionals must be able to work in a stable environment, with a supportive management. Their work must be valued in a sustainable way. Better working conditions should enable a more caring and compassionate approach by healthcare professionals toward their patients.

In October 2010, the decree n°2010–1229 relating to telemedicine, published in the “Journal officiel de la république française” (JORF) n°0245 of October 21, 2010, specified the terms of the application of telemedicine in France. The practice of remote oral medicine is now becoming more widespread in the country. Since 2010, the dental public health team of the University Hospital (CHU) of Montpellier and the University of Montpellier has been working on the subject, with nearly ten thousand telemedicine acts performed as part of the work of the “First consultation and telemedicine” Medical Activity Unit of the Center for Dental Care, Teaching and Research (CSERD) of the CHU of Montpellier. Various studies have been conducted with multiple target populations to evaluate the value of teledentistry in different settings. The practice of teledentistry should help fight against inequalities of access to care and prevention in France. It has shown to be beneficial for patients, health professionals, dentists and health institutions, but improvements are needed to structure and perpetuate this practice. The profession must make major decisions and relaunch discussions so that France remains one of the leaders in this field.

From the earliest stages of adolescence, the question of alcohol consumption should be addressed by health professionals (GPs, midwives, gynecologists, pediatricians, nurses) working in the field of perinatal care or public health. All alcohol consumption is prohibited during pregnancy. In fact, a 2022 study showed that even low exposure to alcohol in utero has measurable effects on the structure of children's brains., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Ballistic wounds, which historically concerned military populations, now also affect civilian practice. Terrorist attacks, urban violence and certain accidents have brought them into the daily routine of some French hospitals. Their frequency fully justifies the need for every health-care professional to be aware of the major issues involved in their management. In this section, we will describe the various penetrating ballistic wounds and their specific features. We will also rectify certain preconceived ideas that should not be peddled by healthcare professionals, in order to maintain a high standard of care., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

How can we improve the discussion and documentation of goals of care with older people and their relatives? When promoting advance care planning one is expected to address a threefold challenge: an ethical challenge, a quality of care - patient safety challenge, and a public health challenge. The aim of this article is to describe how we integrated advance care planning at the Geneva University Hospitals with a focus on the department of geriatrics and rehabilitation. We explain how we improved the documentation in the electronic medical records. We detail how we trained healthcare professionals and disseminated the information to patients and to the general public. Finally, we point out the success factors and barriers in this process, as they might be encountered by healthcare institutions and networks implementing advance care planning elsewhere in Switzerland., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Conversion disorder is a psychiatric disorder whose clinic and management lie at the crossroads between body and mind. It challenges healthcare professionals in terms of diagnosis, further investigation, referral and care. A number of questions arise, such as how caregivers perceive the relationship between body and mind, the place of the psychiatric hypothesis among the initial diagnostic hypotheses, and the temporality of care., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Abstract: In the last decade, the International Commission on Radiological Protection recommended a reduction in the annual limits to the dose to the lens of the eye from 150 mSv to 20 mSv y -1 , averaged over defined periods of 5 y, with no single year exceeding 50 mSv. To assist the health physics community in this task, many groups have calculated protection and operational fluence dose coefficients. This led to the publication of multiple coefficient tables that were calculated for arrays of different parameters, including particle type, angle of incidence, target phantom models, presence or absence of secondary charged particle equilibrium, etc. The coefficients available in the literature include protection dose values calculated in a realistic eye model and operational values calculated in a simplified cylindrical head phantom at a point 3 mm below the surface. This paper reports on a simple Windows™ application that was written to aid health physics professionals in accessing and using the large body of available protection and operational eye-lens data. The application is called the Eye-Lens Dose Calculator, as it also performs calculations of the eye-lens dose for radionuclides, where the complete emissions of the selected radionuclides are considered. Test cases show that there is good agreement between the calculated protection and operational dose quantities when radionuclide emission characteristics are considered., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 Health Physics Society.)

Swiss people consume an average of 107g of sugar per day whereas a maximum of 50g is recommended. During May 2023, the MAYbe Less Sugar initiative invited people from the French-speaking part of Switzerland to investigate their use of added sugar. An online calculator enabled them to evaluate it so they could take action. The campaign reached 6 920 participants and more than 11 000 people via the website maybeless-sugar.ch and social networks. In addition, numerous events and media coverage have put sugar at the heart of the debate. Although people who overconsume sugar were targeted, they are still difficult to reach. The 37 partners plead for MAYbe Less Sugar to be continued and involve health professionals as well as politicians in order to change behaviors but also the environment that should become conducive to health for everybody., Competing Interests: Les auteures n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Introduction: It is not rare anymore to find patients with knowledge and experience of a care pathway integrating a team of health professionals in order to improve the quality and relevance of their peers’ care pathways., Purpose of Research: The aim of this article is to propose practical methodological answers and structuring questions to institutions and any health actor interested in integrating a Patient Partner (PP) into a team of health professionals., Results: The results of an action-research (AR) carried out within a Cancer Treatment Centre (CTC) provide both a methodological framework and answers to the questions raised by this experimentation: How did the team and the PP organize themselves to implement the mission of peer support? What evaluations of the project should be put in place? How does everyone find their place in the project? And finally, what are the operational procedures, limits, and levers for integrating the PP into the team?, Conclusions: In the discussion section, we propose a model of experimentation based on AR, highlighting the main drivers and the interventions that feed them. Finally, we share a series of structuring questions arising from the co-construction work carried out by the people involved, which allowed us to build our action plan for the integration of a PP in the care team at the Rennes CTC, and which seems to us sufficiently generalizable to be tested and used by other teams and in other contexts.

DEVELOPMENT OF HOME-BASED PALLIATIVE CARE. Early palliative care improves both the quality and the length of a patient's life and the attending physician is a key player. The care offered is graduated and adapted to all living environments (home, EHPAD, nursing homes, etc.). Symptoms of discomfort (respiratory, digestive, psychological, etc.) can thus be effectively treated, and end-of-life sedation at home can be envisaged., Competing Interests: É. Fossier, É. Balladur et D. Beausire déclarent n’avoir aucun lien d’intérêts. M.-L. Valentin déclare avoir des liens durables avec Santélys.

Autoinflammatory Diseases in Children: THE CONTRIBUTION OF GENETICS. Autoinflammatory diseases (AIDs) have benefited from modern genetic tools, in particular the widespread use of high-throughput sequencing, which has helped to improve our knowledge of the inheritance patterns of AIDs, whether hereditary or multifactorial. The case for genetic testing has become compelling. However, the new modes of inheritance revealed in recent years complicate genetic counselling and justify close collaboration between clinicians and biologists during multidisciplinary clinical meetings., Competing Interests: Les auteures déclarent n’avoir aucun lien d’intérêts.

The recommendations for the general public as well as the tools offered to healthcare professionals for their practices are consistent with the 2022-2025 national strategy for the prevention of infections and antibiotic resistance. They therefore cover both infection prevention and the proper use of antibiotics., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

In Canada, heart failure (HF) is the second leading cause of hospitalization among the elderly. Heart failure could be improved by the teach-back approach. There are no articles in the French literature describing this educational approach, especially in the context of elderly people living with HF. The aim of this article is to provide French-speaking healthcare professionals, including nurses, with knowledge about this approach, that also includes a specific component on self-care in HF., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

If the obligation to donate as defined by French law ("we are all donors") remains in the wake of sociologist Marcel Mauss's Essai sur le don (Essay on donation), there the similarity ends. How do you make a counter-donation to a deceased person? In the case of inter vivos organ donation, the act is more akin to mutualization than donation., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

The use of psychotropic drugs in the elderly is frequent, and can be problematic due to the risks associated with their inappropriate use and adverse effects. It is essential to adopt a cautious, individualized approach to prescribing psychotropic drugs, regularly assessing their efficacy and considering other non-drug approaches where possible. Collaboration between healthcare professionals and patients can contribute to more appropriate use of these drugs in the elderly., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Shared Decision-Making: ETHICAL ISSUES. Shared decision-making is a decision-making model and a model of interaction between healthcare professionals and healthcare users. Putting together medical-scientific data, experience, values and preferences of the caregiver on the one hand, and knowledge, needs, expectations, values andpreferences of the patient on the other, leads, if both parties wish so, to a discussion followed by a decision based on a common agreement. Cancer area, either in screening or treatment, in the curative or palliative phase, is well suited to shared decision-making. Shared decision-making is based on ethical principles and classical philosophical streams. Autonomy principle is in the foreground but must not become "an ethical injunction". The relationship between caregiver and patient should recognize above all ability and willingness to participate, or not, in decision-making. Key issues are those of mutual listening, uncertainty recognition and the role of emotions as powerful ethical levers., Competing Interests: Les auteurs déclarent n'avoir aucun lien d'intérêts.Les auteurs déclarent n'avoir aucun lien d'intérêts.

Background: Shortages of Human Resources for Health (HRH) in rural areas are often driven by poor working and living conditions, inadequate salaries and benefits, lack of training and career development opportunities amongst others. The South African government has adopted a human resource strategy for the health sector in 2011 aimed at addressing these challenges. Aim: This study reviews the challenges faced by health personnel against government strategies aimed at attracting and retaining health personnel in these underserved areas. Setting: The study was conducted in six primary health care service sites in the Hlabisa sub-district of Umkhanyakude, located in northern KwaZulu-Natal, South Africa. Methods: The study population comprised 25 health workers including 11 professional nurses, 4 staff nurses and 10 doctors (4 medical doctors, 3 foreign medical doctors and 3 doctors undertaking community service). Qualitative data were collected from semi-structured interviews and analysed using thematic analysis. Results: Government initiatives including the rural allowance, deployment of foreign medical doctors and the presence of health personnel undertaking their community service in rural areas are positively viewed by health personnel working in rural health facilities. However, poor living and working conditions, together with inadequate personal development opportunities, remain unresolved challenges. It is these challenges that will continue to dissuade experienced health personnel from remaining in these underserved areas. Conclusion: South Africa’s HRH strategy for the Health Sector 2012/13–2015/16 had highlighted the key challenges raised by respondents and identified strategies aimed at addressing these challenges. Implementation of these strategies is key to improving both living and working conditions, and providing health personnel with opportunities for further development will require inter-ministerial collaboration if the HRH 2030 objectives are to be realised.