[Society, medicine and caregiver stress]. / Société, médecine et souffrance des soignants.

CARING STAFF DISTRESS: Is a theme regularly discussed among those who care for patients. The current approach is in favor of the psychological interpretation of this distress. This approach is obviously pertinent, but could be widened to a more sociological vision: is the demand that society places on medicine excessive? THE SEARCH FOR AUTONOMY: The demand of the society emerges in a social universe that privileges the autonomy of the individual. Medicine serves this research for autonomy. Techniques, instrumentalization of the body, and the search for mastery engender the collective utopia of the perfect body; medicine has become a new faith, keeper of potential redemption measures. THE MEDIATOR FUNCTION OF CARING STAFF: Part of the caring staff distress is generated by the encounter between the utopia of health and the reality of suffering patients. In the present context of our society, one of the caring staff's missions is to act as mediator between the patient and the experience of the disease, the patient and the representation that he/she has of his/her body and health, and society and the expectations society projects on medicine.

Long-term benefits of exercise maintenance after outpatient rehabilitation program in patients with chronic obstructive pulmonary disease.

BACKGROUND: Optimal strategies to maintain short-term benefits of an initial rehabilitation program (RP) are not known. To assess the long-term effects of exercise maintenance (EM) after an initial outpatient RP, the authors conducted a prospective study. PATIENTS AND METHODS: Fifty-eight patients with moderate to moderately severe chronic obstructive pulmonary disease who completed an initial 7-week outpatient RP were included. They were allocated into four groups according to the conditions of EM they self-selected: 15 patients received a structured EM session supervised by a physiotherapist twice a week (group A); 14 patients received a structured EM session supervised by a physiotherapist once a week (group B); 15 patients continued self EM daily at home (group C); and 14 patients did not continue EM (group D). Patients were evaluated before, immediately after, and 18 months after the initial outpatient RP. Measurements included exercise testing on a cycle ergometer and a visual analog scale to evaluate chronic dyspnea. RESULTS: After RP, all patients exhibited improvements in maximal workload (P < 0.05) and in dyspnea (P < 0.05). Improvements in maximal workload were maintained at 18 months in patients in groups A, B, and C but these only reached significance in groups B and C (P < 0.05). On the other hand, maximal workload returned to baseline values in group D (P = 0.01) at 18 months. CONCLUSION: Our results indicate definite benefits of EM after an initial outpatient RP compared with no EM. Daily EM at home appears to be as efficient as structured EM sessions supervised by a physiotherapist, once or twice a week, in moderate to moderately severe chronic obstructive pulmonary disease.