ABSTRACT
OBJECTIVES: To describe and analyze the roles of pharmacists in the multi-disciplinary protocols of French medical homes (MHs). METHODS: Multi-methods study combining: (i) a descriptive cross-sectional study identifying the MHs with active pharmacists in Loire-Atlantique and Vendée in 2020, (ii) an analysis of the roles of the pharmacists within the multi-disciplinary protocols of these MHs, (iii) a qualitative study by semi-directed interviews with the pharmacists participating in these protocols. RESULTS: Among the 40 MHs in Loire-Atlantique and Vendée in 2020, 22 (55%) included a pharmacist and 8 (20%) reported at least one protocol between GPs and pharmacists. Three roles of the pharmacist were identified: identification of a target population according to the inclusion criteria of the protocols, counseling and education, and new missions of the pharmacist. The interviews carried out highlighted a gap between the actions stated in the protocols and the actions carried out with the patient. CONCLUSION: There are many barriers to the involvement of pharmacists in the protocols: significant administrative difficulties, low financial profitability, lack of time, and even persistent mistrust between general practitioners and pharmacists. Despite these barriers, pharmacists experience improvements in communication between professionals and in their practice conditions.
Subject(s)
General Practitioners , Pharmacists , Humans , Pharmacists/psychology , Cross-Sectional Studies , Attitude of Health Personnel , General Practitioners/psychology , Patient-Centered CareABSTRACT
Candidate gene and genome-wide association studies have not identified common variants, which are reliably associated with depression. The recent identification of obesity predisposing genes that are highly expressed in the brain raises the possibility of their genetic contribution to depression. As variation in the intron 1 of the fat mass- and obesity-associated (FTO) gene contributes to polygenic obesity, we assessed the possibility that FTO gene may contribute to depression in a cross-sectional multi-ethnic sample of 6561 depression cases and 21,932 controls selected from the EpiDREAM, INTERHEART, DeCC (depression case-control study) and Cohorte Lausannoise (CoLaus) studies. Major depression was defined according to DSM IV diagnostic criteria. Association analyses were performed under the additive genetic model. A meta-analysis of the four studies showed a significant inverse association between the obesity risk FTO rs9939609 A variant and depression (odds ratio=0.92 (0.89, 0.97), P=3 × 10(-4)) adjusted for age, sex, ethnicity/population structure and body-mass index (BMI) with no significant between-study heterogeneity (I(2)=0%, P=0.63). The FTO rs9939609 A variant was also associated with increased BMI in the four studies (ß 0.30 (0.08, 0.51), P=0.0064) adjusted for age, sex and ethnicity/population structure. In conclusion, we provide the first evidence that the FTO rs9939609 A variant may be associated with a lower risk of depression independently of its effect on BMI. This study highlights the potential importance of obesity predisposing genes on depression.
Subject(s)
Depression/genetics , Obesity/genetics , Polymorphism, Single Nucleotide/genetics , Proteins/genetics , Alpha-Ketoglutarate-Dependent Dioxygenase FTO , Depressive Disorder, Major/genetics , Female , Genetic Predisposition to Disease/genetics , Genotype , Humans , Male , Middle Aged , PhenotypeABSTRACT
The radial nanostructure of the binary liquid triethylamine/water confined in 60 nm diameter independent cylindrical pores of anodic aluminium oxide membranes is studied by small angle neutron scattering. It is shown that composition inhomogeneities are present in the confined mixtures well below the bulk critical point. An analysis of the neutron scattering form factor reveals the existence of an adsorbed water layer of a few nanometers at the liquid/alumina interface, coexisting with a TEA-rich phase in the core.
