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International audience; Les auteurs s'interrogent d'une part sur les enjeux, sociaux et scientifiques, soulevés par les nouvelles problématiques de santé en éducation et en formation, en France et à l'étranger, et, d'autre part, sur l'impact des enjeux éducatifs dans les questions de santé. Ils dressent un portrait d'ensemble de ce champ de recherche en abordant les racines historiques et philosophiques liant santé et éducation, les savoirs et pratiques pédagogiques mis en jeu, les acteurs professionnels impliqués ou les méthodes utilisées.

Resume L’hospitalite a l’hopital L’hospitalite correspond a une attente des patients, aussi importante que la qualite (dont elle est une partie) et la securite : les patients et leurs proches veulent etre accueillis comme des personnes. Le premier objectif de cet article est de montrer comment le fait d’ameliorer l’hospitalite a l’hopital peut etre compris comme le desir de reintroduire dans la relation profondement asymetrique du soin un rapport symetrique impose par le concept meme d’hospitalite, dans laquelle le mot « hote » a les deux acceptions : celui qui accueille et celui qui est accueilli. Le second objectif de cet article est de presenter le programme developpe par l’Assistance publique–Hopitaux de Paris (AP–HP) visant a promouvoir l’hospitalite dans ses hopitaux. Il s’agit d’une demarche en deux temps (autoevaluation interne suivie d’une visite externe) qui lui confere une valeur pedagogique.

Background and Objectives A socioeconomic gradient related to type 2 diabetes (T2D) prevalence has been demonstrated in high-income countries. However, there is no evidence of such a socioeconomic gradient regarding diabetes complications. Thus, the aim of this systematic review was to collect data on risk of complications according to socioeconomic status in patients with T2D. Methods PubMed and EMBASE were searched for English-language observational studies evaluating the prevalence or incidence of micro- and macrovascular complications according to individual and geographical socioeconomic status (SES). Observational studies reporting the prevalence and risk of micro- and macrovascular diabetes complications, according to an individual or geographical index of deprivation, were selected, and estimated crude and adjusted risks for each complication were reported. Results Among the 28 included studies, most described a clear relationship between SES and diabetes complications, especially retinopathy (in 9 of 14 studies) and cardiopathy (in 8 of 9 studies). Both individual and area-based low SES was associated with an increased risk of complications. However, very few studies adjusted their analyses according to HbA1c level. Conclusion Evaluation of SES is necessary for every T2D patient, as it appears to be a risk factor for diabetes complications. However, the available studies are insufficient for gradation of the impact of low socioeconomic level on each of these complications. Regardless, strategies for the improved screening, follow-up and care of high-risk patients should now be implemented.

Resume Les troubles du rapport au corps pourraient favoriser la survenue d’une obesite, en masquant l’exces de poids et/ou les sensations de faim et de rassasiement, et en favorisant l’alimentation emotionnelle et les difficultes a pratiquer une activite physique. Par ces memes mecanismes, ils peuvent egalement perturber la prise en charge des personnes atteintes d’obesite. Cette revue narrative decrit les differents types de troubles de la relation au corps susceptibles d’etre rencontres chez les sujets atteints d’obesite, en les classant en 3 categories principales : distorsion de la silhouette ; alteration des signaux alimentaires internes ; dysperception des sensations corporelles interoceptives. Chacune de ces categories est detaillee quant a son phenotype clinique et ses mecanismes potentiels. Les enjeux therapeutiques de ces differents troubles sont egalement developpes, ainsi que les limites des principaux outils existants pour les identifier. Les auteurs concluent que les troubles du rapport au corps devraient faire l’objet d’une evaluation systematique dans la pratique clinique de la medecine de l’obesite.

International audience; Our objective was to determine whether the provision of therapeutic advice (i.e., any recommendation for an increase or decrease in drug dosage, or for the addition, withdrawal or replacement of at least one drug) by hospital geriatric mobile teams (GMTs) was associated with long-term mortality among older inpatients. Data on therapeutic advice provided by the GMT of Angers University Hospital, France, were collected from 694 consecutive inpatients examined in 2012 (mean age 84.4 ± 6.3 years; 65.6% female), who were followed up after 3 years. We found no between-group differences regarding the 3-year mortality (P = 0.30) and no cumulative survival difference (log-rank P = 0.43). The provision of therapeutic advice by a GMT was not associated with better 3-year survival (HR = 1.18, P = 0.40) in these frail inpatients.

To support reflective skills development, French nursing students write analyses of professional situations (Situation Analysis) experienced during their practice. Sixteen nursing schools in Paris have developed a common framework to support and evaluate students on these skills. The aims of the study were to assess and understand the implementation of the Situation Analysis in French nursing schools as well as their effects on students' learning. A quantitative approach was based on two questionnaires: students (n = 1525, 27.6% of participation) and teachers (n = 131, 49.2%). The results showed that there were variations in teaching of situation analysis. There were correlations between the perception of learning and the modalities of implementation. Not always easy to choose, the situations described were authentic for 97.8% of students, concerned mainly their own practice and relationship with patients. Emotional situations were less frequent. Feedback was generally present and encouraging, but not enough on the students' self-evaluation skills. Slightly more than half of students and teachers were satisfied of the situation analysis. Both of them made positive and negative comments. The study highlights what can be improved in teaching to increase student's learning through situation analysis, for example teamdefined objectives.

To compare the preferences of older (≥70 years old) versus younger (70 years old) cancer patients regarding surrogate designation and decision making.A cross-sectional survey. Patient characteristics and information about surrogacy and involvement in decision making were collected. Associations between patient characteristics and preferences were examined.The study included 130 patients aged ≥70 years (mean age 80 years) and 102 patients aged70 years (mean age 55) and. Factors independently associated with surrogate knowledge (66%): younger age, more children living nearby, high income; factors associated with having already designated a surrogate (62%): younger age, decreased number of daily medications; factors associated with designating a surrogate after questionnaire administration (40%): low education, metastasis. Patients requiring an informed consent for any intervention was associated with older age (adjusted OR [aOR]All cancer patients, wanted to be fully informed and 72% wanted to be involved in medical decisions. Preferences for decision control vary between age groups, depending on family members' presence and living alone.Sharing complete and clear information should be an important key in the process of cancer patients' care, regardless of patient age.

Resume Objectifs Decrire les lesions broncho-pulmonaires residuelles et evaluer l’interet de la tomodensitometrie (TDM) en fin de traitement d’une tuberculose pulmonaire. Materiels et methodes Analyse des TDM thoraciques initiales et de fin de traitement de 56 patients avec tuberculose pulmonaire selon une grille de lecture incluant les lesions parenchymateuses et des voies aeriennes. Les donnees TDM de fin de traitement ont ete analysees en fonction des donnees cliniques, mycobacteriologiques et du TDM initial. Resultats Des lesions actives (cavite a paroi epaisse et/ou micronodules centrolobulaires) persistaient chez 24 patients (43 %) apres un traitement moyen de 7 mois. La persistance de ces signes d’activite etait correlee initialement a la presence d’un syndrome cavitaire (p = 0,027), a une atteinte bronchique predominant en sous-segmentaire, a une extension plus importante des micronodules (p = 0,024) et a des bronchectasies (p = 0,04). Ces lesions residuelles n’etaient pas associees a un risque plus eleve de rechute. Conclusion La persistance de signes d’activite sur la TDM de fin de traitement d’une tuberculose ne correspond pas obligatoirement a une absence de guerison mais a un retard radiologique. Cette imagerie est neanmoins utile pour faire le bilan des sequelles de l’arbre bronchique, voire estimer le risque de complications ulterieures.

Introduction : In France, therapeutic patient education (TPE) is an important contribution to the development of the autonomy of people with chronic diseases. Low health literacy (HL) is a major obstacle to accessing this education,particularly among illiterate patients. There is every indication that these individuals would first need to have their LS increased in order to be able to take a TPE. However, it seems possible to reverse this reasoning by considering LS no longeras an obstacle to health education but to think of TPE as an opportunity to meet the specific needs of LS and literacy more broadly. The aim of this work is to develop a pedagogical intervention model to adapt TPE to the specific needs of chronic patients with illiteracy. Methods : This qualitative research is based on three sequential methods : two scoping reviews, a focus group with 10 TPE programs coordinators and semi-structured interviews with 11 people experiencing illiteracy and 9 experts in the field ofilliteracy. Results : According to systemic and socioconstructivist logics, the results show that taking into account illiteracy in TPE is possible and could contribute to the increase in LS skills and more broadly in literacy skills. In a logic of proportionate universalism, the model proposes two different educational approaches, depending on the educational opportunity of the moment. The first is an adaptation of TPE programs and their constituant stages. The second involves proposing therapeutic education actions that could strengthen the current educational offer and adapt to a vulnerable public. Discussion : While TPE could be considered as a first step towards a return to learning for illiterate people, taking LS into account in care will require the establishment of links between the health and socio-educational sectors in order to provide a gateway for these groups, which are often far from the care system. The training of carers/educators and the recognition of different educational formats would make it possible to adapt the educational offer in its content and methods. Conclusion : The proposed pedagogical intervention model responds to inequalities in access to TPE of illiterate people. It promotes a singular and global vision of the person contributing to his or her autonomy in health within the framework of a personal medicine. Future intervention research in collaboration with all stakeholders should make it possible to test the feasibility and then the effectiveness of such a pedagogical model.; Introduction : En France, l’éducation thérapeutique du patient (ETP) est une contribution importante au développement de l’autonomie des personnes atteintes de maladies chroniques. Un faible niveau de littératie en santé (LS) constitue un obstacle majeur pour accéder à cette éducation, particulièrement chez les patients illettrés. Tout laisse à penser qu’il faudrait d’abord augmenter la LS de ces personnes pour qu’elles puissent suivre une ETP. Cependant, il semble possible d’inverser ce raisonnement en envisageant la LS non plus comme un obstacle aux éducations en santé mais en appréhendant l’ETP comme une opportunité́ pour répondre aux besoins propres en LS et plus largement en alphabétisation. Le but de ce travail est d’élaborer un modèle d’intervention pédagogique visant à adapter l’ETP aux besoins spécifiques des patients chroniques en situation d’illettrisme. Méthode : Cette recherche qualitative s’appuie sur trois méthodes séquentielles : deux revues de portée, un focus group auprès de 10 coordonnateurs de programmes d’ETP et des entretiens semi-dirigés auprès de 11 personnes en situation d’illettrisme et 9 experts du champ de l’illettrisme. Résultats : Selon des logiques systémiques et socioconstructivistes, les résultats montrent que la prise en compte de l’illettrisme en ETP est possible et pourrait concourir à l’augmentation des compétences en LS et plus largement des compétences en littératie. Dans une logique d’universalisme proportionné, le modèle propose deux approches éducatives différentes, fonction de l’opportunité éducative du moment. La première consiste en une adaptation des programmes d’ETP et des étapes qui les constituent. La seconde passe par la proposition d’actions d’éducation thérapeutique qui pourrait renforcer l’offre éducative actuelle et s’adapter à un public vulnérable. Discussion : Alors que l’ETP pourrait être considérée comme une première étape vers un retour à l’apprentissage des personnes illettrées, la prise en compte de la LS dans les soins devra passer par la mise en place de liens entre les milieux sanitaire et socio-éducatif afin de constituer une porte d’accès pour ces publics souvent éloignés du système de soins. La formation des soignants/éducateurs et la reconnaissance de différents formats d’éducation permettraient d’adapter l’offre éducative dans ses contenus et ses méthodes. Conclusion : Le modèle d’intervention pédagogique proposé apporte une réponse aux à l’inégalité d’accès à l’ETP des personnes illettrées. Il promeut une vision singulière et globale de la personne concourant à son autonomie en santé dans le cadre d’une médecine de la personne. De futurs recherches interventionnelles en collaboration avec l’ensemble des acteurs devraient permettre de tester la faisabilité puis l’efficacité de ce modèle pédagogique.

This narrative review exhibits the construction and validation of a hypothesis to explain how treatment non-adherence in people with chronic disease, a major issue in contemporary medicine, occurs. I propose that non-adherence to long-term therapies is at least in part due to failure to prioritize the future, which is caused by a condition I dub disruption in time projection. This article gives the rationale for this hypothesis, which is largely grounded on philosophical arguments. Then, it demonstrates the plausibility of the hypothesis: on the one hand, it is consistent with certain epidemiological data found in the literature. On the other, it is possible to predict the underlying mechanisms of this lack of prioritization from recent achievements of neuro-economics and neuroscience. Next, it reviews empirical data that provide an experimental verification for this explanatory hypothesis. Finally, a general evolutionary and philosophical meaning for adherence is proposed, considering the advantages of its preconditions, namely, patience and foresight.

Background The 15- to 35-year-old population has little contact with the health care system and is exposed to risk factors. Several studies demonstrated the feasibility of brief interventions (BIs) in different settings, e.g., in addiction medicine during police custody, where arrestees are entitled to a medical examination. Approximately 700,000 individuals are detained in police custody in France annually, and custody is an opportunity for young people to be medically examined. The characteristics of the detainees and previous experience with BIs suggest that custody is an opportunity to contribute to primary prevention. We propose to investigate the feasibility of such a contribution. Objectives The aim of this article is to present a study protocol and some preliminary results. The primary research objective is to assess the feasibility of performing brief interventions without a specific topic in police custody settings in arrestees aged 15–35 years. The secondary research objectives include i) testing four strategies for engaging in BIs that maximize the chances of success of the BI; ii) identifying the determinants that can orient the practitioner's choice to use a specific strategy over another one; and iii) analysing the differences between individuals who engage in BIs and those who do not and, in those who do engage, the determinants of success of the intervention. Methods A two-step randomized and prospective study: i) randomization of eligible patients into 4 groups of 500 patients each; analysis of the response rates for each strategy; performance of the BI; and analyses of the associated factors and ii) a real-life, full-scale phase study evaluating the effectiveness of BIs performance of the BI; and analyses of the interventions. Analyses of the determinants of a positive response to BI, of success and of the topic of intervention will be conducted. Expected results The rates of BI performed, rates of success, and characteristics associated with response and with success are the main expected results. Additionally, the development and assessment of filter questions and an improved BI dedicated to primary prevention for police custody settings will be attained.

This commentary follows the article of Moni R. Saha and her co-authors, entitled "Postpartum women's use of medicines and breastfeeding practices: a systematic review." As highlighted in this systematic review, medication use is common during the postpartum period often creating difficulty for mothers. Several studies illustrate the negative impact medication has on breastfeeding, initiation and duration despite reassuring advice from health professionals. Current data only describe the use of medication and behavior adopted by mothers when medication is prescribed. The factors influencing maternal behaviors have not been studied. Behaviors depend on knowledge, representations and attitudes.To better understand the behaviors of mothers faced with medication, we conducted a qualitative study, utilizing semistructured interviews to investigate knowledge, risk perception and difficulties women experienced. The study consisted of a description and comparison of the perceived needs of two populations : 19 breastfeeding mothers and 12 health professionals. Divergences between the two populations were highlighted, focusing specifically, on knowledge needed by the women. This commentary is intended to highlight the need for further research essential to explain the influences on maternal behavior when medication is a consideration, allowing health professionals to better help mothers deal with these situations frequently affecting their breastfeeding plans.; L'allaitement maternel est un réel enjeu de santé publique au regard de ces bénéfices pour la santé de la mère comme de son enfant. La prise de médicaments représente un obstacle à l'allaitement et peut conduire à la non initiation de l'allaitement ou à son sevrage prématuré quelques soient les données biomédicales disponibles. La compréhension des comportements maternels face à la prise de médicament est essentielle à explorer pur pouvoir apporter des interventions éducatives adaptées pour répondre à cette problématique [...].

Premise: Given the need to develop educational programmes integrated into more generalmodels to promote oral health (Petersen, 2010), we observe that there are few studies on the cognitiverepresentations of the independent elderly on oral health. This observation is made after an qualitative review ofthe literature drawing on the Precede-Proceed model (Green et Kreuter, 1991). The lack of studies on this topicis especially apparent regarding tooth decay, gingivitis, dental mobility, dry mouth and bruxism. Aims: Toidentify the cognitive representations, defined by Meunier (2002), present in oral health behaviour. Method:According to the qualitative method of Grounded theory, the verbatim’s analysis is realized from the codingstage up to the integrating stage (Paillé, 1994). The sample, non-representative, is based on 12 voluntaryrespondents (5 men and 7 women, aged from 66 years to 90 years). The semi-directive interviews are led with aninterview guide based on the reference design of the Health Belief Model. Data includes reported health status,reported description of the respondent and their resources and reported description of their own oral health.Results: The categories of causal attribution and mechanism of appearance include most of cognitiverepresentations, either positive or negative. The respondents express an important proportion of “ I don’t know”regarding diseases in oral health, with the exception of cavities. They do not perceive themselves as sick persons.They define a good oral health only as opposed to poor oral health. Finally, while these topics are not addressedin the interview guide, aesthetics and financial concerns occupy an important place in the discourses.Discussion: These results reveal the representational barriers to improved oral health behaviour and stress thevarious characteristics of it. The results contribute to structuring a relevant educational diagnosis that isnecessary to prior in an education programme. Every health educational programme must include a positive oralhealth definition. Conclusion: There is a need for further research to address the objectives of educationalprogrammes. The main stake is to bring people to adopting knowledge based on reasoning yielding improvedoral health decisions., Problématique: Devant les recommandations de concevoir des interventions éducatives en santébucco-dentaire intégrées dans des modèles de promotion de la santé (Petersen, 2010), le constat est fait, aprèsune recension qualitative des écrits en s’adossant au modèle Precede-Proceed (Green et Kreuter, 1991) qu’ilexiste peu d’études sur les représentations cognitives en santé bucco-dentaire des personnes âgées autonomes enparticulier sur la maladie carieuse, la gingivite, la mobilité dentaire, la sécheresse buccale et le bruxisme.Objectif : Identifier les représentations cognitives, selon Meunier (2002), exprimées dans le comportement desanté bucco-dentaire. Méthode: Suivant la méthode qualitative de la théorisation ancrée, l’analyse des verbatimest réalisée de l’étape de codification à l’étape de mise en relation (Paillé,1994). L’échantillon, non représentatif,repose sur 12 répondants volontaires (5 hommes et 7 femmes, de 66 ans à 90 ans). Les entretiens semi-directifssont menés à l’aide d’un guide d’entretien, préalablement testé, qui s’appuie sur plusieurs concepts dont leHealth Belief Model. Il comprend : un état de santé déclaré, une description de sa propre santé bucco-dentaire etune description du répondant et de ses ressources. Résultats : Les représentations cognitives, favorables ou non,sont proportionnellement plus présentes au niveau de l’attribution causale et du mécanisme d’apparition desmaladies bucco-dentaires. Les répondants expriment une proportion importante de « je ne sais pas» concernantles maladies en santé orale sauf pour la maladie carieuse. Ils ne se perçoivent pas comme malade. La notion debonne santé orale est difficile à définir autrement que par opposition à une mauvaise santé orale. Enfin, alors queles thèmes ne sont pas questionnés dans le guide d’entretien, l’esthétique et les préoccupations financièresoccupent une place importante dans les discours. Discussion : Ces résultats font émerger des obstaclesreprésentationnels vis-à-vis de la santé orale et mettent en exergue les différentes caractéristiques d’uncomportement en santé orale. Ils semblent confirmer que l’étape du diagnostic éducatif est incontournable dansla conception d’un programme d’éducation en santé orale car elle permet, entre autre, de faire émerger lesreprésentations cognitives, les connaissances déjà acquises et les nombreuses incertitudes. Il est à noter que touteintervention en éducation doit prévoir une définition positive de la santé orale. Conclusion : La poursuite derecherche s’avère nécessaire afin de répondre aux objectifs d’une intervention éducative. Un des principauxenjeux est l’adoption par l’individu d’un raisonnement basé sur l’acquisition de connaissances et de savoir luipermettant de prendre des décisions plus favorables à sa santé.

International audience; To estimate rates and identify correlates of HIV disclosure in migrants from sub-Saharan Africa (SSA) successfully treated, a sub-analysis was conducted in HIV-1 native SSA migrants, living in France with undetectable viral load on antiretroviral, included in the VIHVO adherence study. Logistic regression models assessed factors associated with HIV disclosure. Among 246 individuals (40 % male, median age 41), 79 % of those in a steady heterosexual partnership (n = 167) had disclosed their status to their partner, 55 % of the total 246 to a relative, and 33 % to (an)other person(s). Disclosure to one’s steady partner was associated with a follow-up duration since HIV diagnosis of more than 5 years, a higher literacy level, a better social context and marital status. Women were more likely to disclose their HIV status to relatives. Interventions targeting this population should be provided to improve disclosure which in turn ensures better social support, testing of the partner and lower rates of undiagnosed HIV.

National audience

International audience; BACKGROUND: Each year, thousands of cases of uncomplicated malaria are imported into Europe by travellers. Atovaquone-proguanil (AP) has been one of the first-line regimens used in France for uncomplicated malaria for almost ten years. While AP's efficacy and tolerance were evaluated in several trials, its use in "real life" conditions has never been described. This study aimed to describe outcome and tolerance after AP treatment in a large cohort of travellers returning from endemic areas. METHODS: Between September 2002 and January 2007, uncomplicated malaria treated in nine French travel clinics with AP were followed for 30 days after AP initiation. Clinical and biological data were collected at admission and during the follow-up. RESULTS: A total of 553 patients were included. Eighty-eight percent of them were born in Africa, and 61.8 % were infected in West Africa, whereas 0.5 % were infected in Asia. Migrants visiting friends and relatives (VFR) constituted 77.9 % of the patients, the remainder (32.1 %) were backpackers. Three-hundred and sixty-four patients (66 %) fulfilled follow-up at day 7 and 265 (48 %) completed the study at day 30. Three patients had treatment failure. One-hundred and seventy-seven adverse drug reactions (ADR) were reported during the follow-up; 115 (77 %) of them were digestive ADR. Backpackers were more likely to experiment digestive ADR compared to VFR (OR = 3.8; CI 95 % [1.8-8.2]). Twenty patients had to be switched to another regimen due to ADR. CONCLUSION: This study seems to be the largest in terms of number of imported uncomplicated malaria cases treated by AP. The high rate of reported digestive ADR is striking and should be taken into account in the follow-up of patients since it could affect their adherence to the treatment. Beside AP, artemisinin combination therapy (ACT) is now recommended as first-line regimen. A comparison of AP and ACT, in terms of efficacy and tolerance, would be useful.

International audience

Therapeutic education enables patients to develop their self-care and adaptation skills in the management of chronic illness. The aim of our thesis is to understand their nature from every day real-life situations which type 1 diabetics adults and the parents of type 1 diabetics children discuss on asynchronous Internet forums. We analysed 3756 messages written over a three-year period on two discussion forums (314 diabetic patients are included in the study) and we interviewed voluntary patients and users of these forums. We used professional recommendations published by the HAS and the INPES (2007), to link our results to their frame of reference of skills developed by patients suffering from chronic illnesses, and related to educational objectives the topics covered by discussions on forums. Thus, our results bring to light the ability of patients with diabetes to strengthen, via the internet forums, self-care skills in association with their security. The nature of the adaptation and self-care skills indicated by our results emphasizes the relationship that the patients have with the illness and the treatment. The prospects of this thesis are therefore discussed. In order to enable the patients to share in the therapeutic education procedure, as stipulated by current legislation and professional recommendations, the possibility to continue research with examples of other chronic pathologies seems a relevant path to follow. A better understanding of real-life situations and the nature of the skills revealed by exchanges on Internet forums, whilst respecting ethical rules, would permit the elaboration of therapeutic education programmes adapted to the real needs of patients with chronic illness. In addition, our thesis permits an approach to the nature of informal educational situations in relation to everyday life with a type 1 diabetes : we discuss their significance for the elaboration of structured therapeutic education programmes proposed by carers., L'éducation thérapeutique permet aux patients de développer des compétences d'auto-soins et d'adaptation dans la gestion de la maladie chronique. Notre thèse a pour but de comprendre leur nature, à partir des situations de vie quotidienne dont discutent les adultes diabétiques de type 1 et les parents d'enfants diabétiques de type 1, sur les forums asynchrones d'Internet. Nous avons analysé 3756 messages écrits durant trois années, sur deux forums de discussion (314 patients diabétiques sont inclus dans l'étude) et réalisé des entretiens auprès de patients volontaires et usagers de ces forums. Nous avons utilisé les recommandations professionnelles publiées par la HAS et l'INPES (2007), pour relier nos résultats avec leur référentiel de compétences du patient chronique et pour rapporter à des objectifs pédagogiques les thématiques abordées par les discussions sur les forums. Ainsi, nos résultats mettent en évidence la capacité des patients à renforcer, via les forums d'internet, des compétences d'auto-soins liées à leur sécurité. La nature des compétences d'adaptation et d'auto-soins, indiquée par nos résultats, souligne le rapport que les patients entretiennent avec la maladie et le traitement. Les perspectives de cette thèse sont donc discutées. Dans le but d'associer les patients à la démarche en éducation thérapeutique, comme le précisent la législation actuelle et les recommandations professionnelles, la possibilité de poursuivre la recherche avec les exemples d'autres pathologies chroniques s'avère une voie pertinente. Mieux comprendre les situations de vie et la nature des compétences révélées par les échanges sur les forums d'Internet permettrait, en respectant les règles éthiques, de contribuer à l'élaboration des programmes d'éducation thérapeutique adaptés aux besoins réels des patients porteurs de maladie chronique. En outre, notre thèse permet de comprendre la nature des situations d'éducation informelle liées à la vie avec un diabète de type1 : nous en discutons l'intérêt pour l'éducation formelle proposée par les soignants éducateurs.

In France, in the early 21st century, a large number of children and youngsters are still suffering from chronic diseases such as asthma, diabetes or hemophilia. However, these diseases can be kept in check by health care specialists provided a good relationship is established between the young patients and these specialists through "therapeutic education".Therapeutic education aims at providing the young patient with the means to lead a normal life in spite of his or her illness by taking into account its characteristics together with its physical, emotional and social requirements.For the past few years, nursing teams have been using regularly a number of resources such as games, toys, educational activities and documents, in order to better communicate with their young patients and to explain to them their illness and their cure.We've carried out a national survey, in France, among 108 nursing teams looking after young patients aged between 4 and 12 suffering from asthma, diabetes or hemophilia.Questionnaires have been sent out to three different health care structures: hospitals, patients associations and cure centers. In each case, we have tried to identify the educational resources available to them, as well as their pedagogical aims. We have also looked into the origin of these resources, the way they were used and their relative effectiveness.The results of in-depth interviews with 2 leading specialists in the field of health care and educational sciences have been added to the answers supplied by the nursing teams mentioned above.This research leads to a proposal for a typology of educational resources available to nursing teams involved in the therapeutic education of young patients.; En France, au XXI e siècle, un grand nombre d'enfants et d'adolescents sont atteints de maladies chroniques (asthme, diabète...). La prise en charge de ces affections par les professionnels de santé passe aujourd'hui par une relation de partenariat avec les jeunes patients dans le cadre d'une éducation thérapeutique.Cette éducation thérapeutique offre au jeune patient la possibilité d'apprendre à vivre avec sa maladie. Pour éduquer ces patients, les équipes de soignants utilisent différents types de ressources éducatives (jeux, jouets, activités éducatives et documents).Nous avons réalisé une enquête nationale auprès de 108 équipes soignantes éduquant de jeunes patients (de 4 à 12 ans atteints d'asthme, de diabète et d'hémophilie) dans des hôpitaux, associations de patients et centres de cure, pour identifier les ressources éducatives utilisées et les intentions pédagogiques.Il ressort de cette recherche que les éducateurs - soignants privilégient les activités qui font appel à la participation des enfants ainsi qu'aux documents. Les jeux et jouets sont également mobilisés pour faire apprendre aux enfants sur leur maladie et acquérir des habiletés et des techniques. Par contre, d'autres objectifs tous aussi importants aux yeux des éducateurs - soignants tels que l'acceptation de la maladie et la socialisation de l'enfant sont traités avec moins de ressources éducatives.D'une façon générale, l'ensemble de ces ressources éducatives contribue à favoriser une meilleure communication entre soignant et soigné.Ce travail aboutit à une proposition de typologie de ressources éducatives utilisables par les équipes soignantes pratiquant l'éducation thérapeutique des jeunes patients.