[Therapeutic patient education in chronic hand dermatitis]. / Éducation thérapeutique du patient dans l'eczéma chronique des mains.

Hand dermatitis (HD) is usually due to a combination of various interacting factors. It involves significant impairment of the quality of life with psychological and socioeconomic impact. A therapeutic education program in HD.was elaborated by 19 health professionals (dermatologists, occupational clinical physicians, nurses, psychologists, environmental medical advisor) with experience in therapeutic education or skills in HD, according to the recommendations of Haute Autorité de Santé. The program includes an individual medical consultation to perform educational diagnostic, two collective workshops and a medical evaluation consult. Two group workshops "the disease, irritant factors and its treatments" and "the experiences and feelings" were elaborated with learning objectives and educative tools. Different scores were proposed to evaluate the program and acquired skills. Therapeutic education is an efficient way to help patients to adopt skin protection measures essential to healing. We propose a guideline of therapeutic education in HD including skills and educative tools and intended for health professionals to serve as working basis.

[Guide for therapeutic education program in psoriasis]. / Élaboration d'un référentiel d'éducation thérapeutique dans le psoriasis.

INTRODUCTION: Psoriasis is a chronic inflammatory skin disease which can cause significant impairment of quality of life, absenteeism at work and significant psychological distress. This justifies the elaboration of a multidisciplinary education program for patients. The objective of this work was to develop the content of a therapeutic education program in psoriasis, which may serve as a basis for teams wishing to develop psoriasis therapeutic education in their community. PATIENTS AND METHODS: A group of 15 health professionals (dermatologists, dermatology nurses, and psychologist) and four psoriasis patients representatives of the psoriasis patient association (Association pour la lutte contre le psoriasis) participated in the development of this program. Health professionals all had an experience in therapeutic patient education in psoriasis through prior participation in a multicenter open pilot study, evaluating a therapeutic education program in psoriasis. Based on the previous experience, preparatory work in subteams was initiated to prepare draft objectives and content of the program. A two-day meeting was then organized to discuss in depth content of the therapeutic education program and elaborate recommendations. The meeting structure combined subteam work and plenary sessions. The following program was elaborated: two individual sessions and three group sessions. The groups have worked for two days, according to a predefined pattern: interview guide of educational diagnostic, content of collective workshops and knowledge questionnaire. All these documents were validated in plenary session. The methodology used for the development of this program followed the recommendations of the HAS in the field of chronic disease. RESULTS: In the end, were retained three collective workshops, preceded by a consultation of individual educational diagnosis and knowledge questionnaire followed by an evaluation session at the end of the program. The interview guide for educational diagnosis and the knowledge basis questionnaire have been defined. Three themes of group workshops were defined: (1) understanding the disease, (2) understanding the mechanism of onset of disease and treatments available, (3) how to live with psoriasis in everyday life. For each workshop, were defined learning objectives, skills to acquire and how to get there. DISCUSSION: We describe here a framework of educational therapy program in psoriasis comprising educational objectives, skills to acquire, basic disease knowledge, suitable for patients with psoriasis. The content was tailored to patient language and knowledge based on feedback from participating patients. The list of skills may be adapted to patient's individual needs. This program serves primarily as a working basis for the caregiver, to standardize practices in terms of therapeutic education in psoriasis in France.

Flood vulnerability indices at varying spatial scales.

Populations around the world are vulnerable to natural disasters. Such disasters are occurring with increased frequency as a consequence of socio-economic and land-use developments and due to increased climate variability. This paper describes a methodology for using indicators to compute a Flood Vulnerability Index which is aimed at assessing the conditions which influence flood damage at various spatial scales: river basin, sub-catchment and urban area. The methodology developed distinguishes different characteristics at each identified spatial scale, thus allowing a more in-depth analysis and interpretation of local indicators. This also pinpoints local hotspots of flood vulnerability. The final results are presented by means of a standardised number, ranging from 0 to 1, which symbolises comparatively low or high flood vulnerability between the various spatial scales. The Flood Vulnerability Index can be used by international river basin organisations to identify and develop action plans to deal with floods and flooding or on smaller scales to improve local decision-making processes by selecting measures to reduce vulnerability at local and regional levels. In this work the methodology has been applied to various case studies at different spatial scales. This leads to some interesting observations on how flood vulnerability can be reflected by quantifiable indicators across scales, e.g. the relationship between the flood vulnerability of a sub-catchment with its river basin or the weak relation between the flood vulnerability of an urban area with the sub-catchment or river basin which it belongs to.