Health education of diabetes as a chronic disease : transmission of information or active appropriation ?

Résumé du poster : Diabetes is both an important chronic disease and a real public health problem. It requires a great control over the body and a great mastery of the tools used in the daily struggle to reach a physiological balance. It is therefore a disease in which health education plays an important role, since patients are expected to reach a certain autonomy in the management of their disease. But how can the patients' autonomy be promoted? This is the question to which this study tried to answer from the perspective of socio-cultural psychology. The study was launched by the Cantonal Diabetes Program Vaud and aimed at evaluating a health education setting located in the east region of the Canton Vaud. It was based on both quantitative and qualitative methodological approaches. The results showed that there is a correlation between the number of hospitalizations and the quality of support provided by this particular health education setting. Moreover, the acquisition of expertise appears to be a distributed and collective process based upon the actors' active participation in various types of activities and involving and extended network. Further research is now required in order to examine how health education might be grasped through the lens of social-cultural psychology.

Health literacy and substance use in young Swiss men.

OBJECTIVES: The purpose of the present study was to describe health literacy and its association with substance use among young men. METHODS: The present study was part of the Cohort Study on Substance Use Risk Factors that included 11,930 Swiss males participating in initial screening from August 2010 to July 2011. Self-completed questionnaires covered use of three substances and three components of health literacy. RESULTS: Roughly 22 % reported having searched the Internet for health information and 16 % for information on substances over the past 12 months. At-risk and not at-risk users of alcohol (adjusted odds ratio (AOR) = 2.50 and 1.46), tobacco (AOR = 2.51 and 1.79) and cannabis (AOR = 4.86 and 3.53) searched for information about substances significantly more often via the Internet than abstainers. Furthermore, at-risk users reported better knowledge of risks associated with substance use and a marginally better ability to understand health information than abstainers. CONCLUSIONS: Substance users appear to be more informed and knowledgeable about the risks of substance use than non-users. Consequently, interventions that focus only on information provision may be of limited benefit for preventing substance use.

Version brève du DISCERN, une voie d'amélioration de la recherche d'information médicale sur le net [Brief-DISCERN, a possible way to improve patient's search on the health-related web]

Internet is increasingly used as a source of information on health issues and is probably a major source of patients' empowerment. This process is however limited by the frequently poor quality of web-based health information designed for consumers. A better diffusion of information about criteria defining the quality of the content of websites, and about useful methods designed for searching such needed information, could be particularly useful to patients and their relatives. A brief, six-items DISCERN version, characterized by a high specificity for detecting websites with good or very good content quality was recently developed. This tool could facilitate the identification of high-quality information on the web by patients and may improve the empowerment process initiated by the development of the health-related web.

Evaluation of email alerts in practice: Part 2. Validation of the information assessment method.

RATIONALE AND OBJECTIVE:. The information assessment method (IAM) permits health professionals to systematically document the relevance, cognitive impact, use and health outcomes of information objects delivered by or retrieved from electronic knowledge resources. The companion review paper (Part 1) critically examined the literature, and proposed a 'Push-Pull-Acquisition-Cognition-Application' evaluation framework, which is operationalized by IAM. The purpose of the present paper (Part 2) is to examine the content validity of the IAM cognitive checklist when linked to email alerts. METHODS: A qualitative component of a mixed methods study was conducted with 46 doctors reading and rating research-based synopses sent on email. The unit of analysis was a doctor's explanation of a rating of one item regarding one synopsis. Interviews with participants provided 253 units that were analysed to assess concordance with item definitions. RESULTS AND CONCLUSION: The content relevance of seven items was supported. For three items, revisions were needed. Interviews suggested one new item. This study has yielded a 2008 version of IAM.

Health literacy [Document électronique] : an economic perspective and data for Switzerland. Part 2, A review of health literacy measures and a cost assessment of limited health literacy

Summary : 1. Measuring health literacy in Switzerland: a review of six surveys: 1.1 Comparison of questionnaires - 1.2 Measures of health literacy in Switzerland - 1.3 Discussion of Swiss data on HL - 1.4 Description of the six surveys: 1.4.1 Current health trends and health literacy in the Swiss population (gfs-UNIVOX), 1.4.2 Nutrition, physical exercise and body weight : opinions and perceptions of the Swiss population (USI), 1.4.3 Health Literacy in Switzerland (ISPMZ), 1.4.4 Swiss Health Survey (SHS), 1.4.5 Survey of Health, Ageing and Retirement in Europe (SHARE), 1.4.6 Adult literacy and life skills survey (ALL). - 2 . Economic costs of low health literacy in Switzerland: a rough calculation. Appendix: Screenshots cost model

Economics of public governance with strategic production of information: four essays

SUMMARY This paper analyses the outcomes of the EEA and bilateral agreements vote at the level of the 3025 communities of the Swiss Confederation by simultaneously modelling the vote and the participation decisions. Regressions include economic and political factors. The economic variables are the aggregated shares of people employed in the losing, Winning and neutral sectors, according to BRUNETTI, JAGGI and WEDER (1998) classification, Which follows a Ricardo-Viner logic, and the average education levels, which follows a Heckscher-Ohlin approach. The political factors are those used in the recent literature. The results are extremely precise and consistent. Most of the variables have the predicted sign and are significant at the l % level. More than 80 % of the communities' vote variance is explained by the model, substantially reducing the residuals when compared to former studies. The political variables do have the expected signs and are significant as Well. Our results underline the importance of the interaction between electoral choice and participation decisions as well as the importance of simultaneously dealing with those issues. Eventually they reveal the electorate's high level of information and rationality. ZUSAMMENFASSUNG Unser Beitrag analysiert in einem Model, welches gleichzeitig die Stimm- ("ja" oder "nein") und Partizipationsentscheidung einbezieht, den Ausgang der Abstimmungen über den Beitritt zum EWR und über die bilateralen Verträge für die 3025 Gemeinden der Schweiz. Die Regressionsgleichungen beinhalten ökonomische und politische Variabeln. Die ökonomischen Variabeln beinhalten die Anteile an sektoriellen Arbeitsplatzen, die, wie in BRUNETTI, JAGGIl.1I1d WEDER (1998), in Gewinner, Verlierer und Neutrale aufgeteilt Wurden, gemäß dem Model von Ricardo-Viner, und das durchschnittliche Ausbildungsniveau, gemäß dem Model von Heckscher-Ohlin. Die politischen Variabeln sind die in der gegenwärtigen Literatur üblichen. Unsere Resultate sind bemerkenswert präzise und kohärent. Die meisten Variabeln haben das von der Theorie vorausgesagte Vorzeichen und sind hoch signifikant (l%). Mehr als 80% der Varianz der Stimmabgabe in den Gemeinden wird durch das Modell erklärt, was, im Vergleich mit früheren Arbeiten, die unerklärten Residuen Wesentlich verkleinert. Die politischen Variabeln haben auch die erwarteten Vorzeichen und sind signifikant. Unsere Resultate unterstreichen die Bedeutung der Interaktion zwischen der Stimm- und der Partizipationsentscheidung, und die Bedeutung diese gleichzeitig zu behandeln. Letztendlich, belegen sie den hohen lnformationsgrad und die hohe Rationalität der Stimmbürger. RESUME Le présent article analyse les résultats des votations sur l'EEE et sur les accords bilatéraux au niveau des 3025 communes de la Confédération en modélisant simultanément les décisions de vote ("oui" ou "non") et de participation. Les régressions incluent des déterminants économiques et politiques. Les déterminants économiques sont les parts d'emploi sectoriels agrégées en perdants, gagnants et neutres selon la classification de BRUNETTI, JAGGI ET WEDER (1998), suivant la logique du modèle Ricardo-Viner, et les niveaux de diplômes moyens, suivant celle du modèle Heckscher-Ohlin. Les déterminants politiques suivent de près ceux utilisés dans la littérature récente. Les résultats sont remarquablement précis et cohérents. La plupart des variables ont les signes prédits par les modèles et sont significatives a 1%. Plus de 80% de la variance du vote par commune sont expliqués par le modèle, faisant substantiellement reculer la part résiduelle par rapport aux travaux précédents. Les variables politiques ont aussi les signes attendus et sont aussi significatives. Nos résultats soulignent l'importance de l'interaction entre choix électoraux et décisions de participation et l'importance de les traiter simultanément. Enfin, ils mettent en lumière les niveaux élevés d'information et de rationalité de l'électorat.

Information provision and information needs in adult survivors of childhood cancer.

BACKGROUND: Knowledge about their past medical history is central for childhood cancer survivors to ensure informed decisions in their health management. Knowledge about information provision and information needs in this population is still scarce. We thus aimed to assess: (1) the information survivors reported to have received on disease, treatment, follow-up, and late effects; (2) their information needs in these four domains and the format in which they would like it provided; (3) the association with psychological distress and quality of life (QoL). PROCEDURE: As part of the Follow-up survey of the Swiss Childhood Cancer Survivor Study, we sent a questionnaire to all survivors (≥18 years) who previously participated to the baseline survey, were diagnosed with cancer after 1990 at an age of <16 years. RESULTS: Most survivors had received oral information only (on illness: oral: 82%, written: 38%, treatment: oral: 79%, written: 36%; follow-up: oral: 77%, written: 23%; late effects: oral: 68%, written: 14%). Most survivors who had not previously received any information rated it as important, especially information on late effects (71%). A large proportion of survivors reported current information needs and would like to receive personalized information especially on late effects (44%). Survivors with higher information needs reported higher psychological distress and lower QoL. CONCLUSIONS: Survivors want to be more informed especially on possible late effects, and want to receive personalized information. Improving information provision, both qualitatively and quantitatively, will allow survivors to have better control of their health and to become better decision makers.

Condom use with steady partners among heterosexual people living with HIV in Europe: testing the information-motivation-behavioral skills model.

Guided by a modified information-motivation-behavioral skills model, this study identified predictors of condom use among heterosexual people living with HIV with their steady partners. Consecutive patients at 14 European HIV outpatient clinics received an anonymous, standardized, self-administered questionnaire between March and December 2007. Data were analyzed using descriptive statistics and two-step backward elimination regression analyses stratified by gender. The survey included 651 participants (n = 364, 56% women; n = 287, 44%). Mean age was 39 years for women and 43 years for men. Most had acquired HIV sexually and more than half were in a serodiscordant relationship. Sixty-three percent (n = 229) of women and 59% of men (n = 169) reported at least one sexual encounter with a steady partner 6 months prior to the survey. Fifty-one percent (n = 116) of women and 59% of men (n = 99) used condoms consistently with that partner. In both genders, condom use was positively associated with subjective norm conducive to condom use, and self-efficacy to use condoms. Having a partner whose HIV status was positive or unknown reduced condom use. In men, higher education and knowledge about condom use additionally increased condom use, while the use of erectile-enhancing medication decreased it. For women, HIV disclosure to partners additionally reduced the likelihood of condom use. Positive attitudes to condom use and subjective norm increased self-efficacy in both genders, however, a number of gender-related differences appeared to influence self-efficacy. Service providers should pay attention to the identified predictors of condom use and adopt comprehensive and gender-related approaches for preventive interventions with people living with HIV.

Compétences en santé déficientes: obstacle à une prise en charge optimale [Low health literacy: barrier to optimal care].

Health literacy is defined as "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions." Low health literacy mainly affects certain populations at risk limiting access to care, interaction with caregivers and self-management. If there are screening tests, their routine use is not advisable and recommended interventions in practice consist rather to reduce barriers to patient-caregiver communication. It is thus important to include not only population's health literacy but also communication skills of a health system wich tend to become more complex.

Médecine interne générale ambulatoire: quelques enseignements de la littérature en 2005 [Primary care in general internal medicine: relevant information in 2005]

During the year 2005, the chief residents of the University Medical Outpatient Clinic of Lausanne have done a database of useful articles for daily practice, scientifically validated and with excellent didactic quality, from 10 electronic journals. They have used those selected articles in personal meetings between the chief residents on a regular basis and the possibility to access the database by the junior physicians. Six of these articles concerning different topics (depression, tuberculosis detection, anticoagulation at home, cholinesterase inhibitors, insomnia and therapies, transdermal nitroglycerin and tendinopathies) are presented.

Compétences en santé déficientes: obstacle à une prise en charge optimale [Low health literacy: barrier to optimal care].

Les carences en compétences en santé touchent principalement certaines populations à risques en limitant l'accès aux soins, l'interaction avec les soignants et l'autoprise en charge. L'utilisation systématique d'instruments de dépistage n'est pas recommandée et les interventions préconisées en pratique consistent plutôt à diminuer les obstacles entravant la communication patient-soignant. Il s'agit d'intégrer non seulement les compétences de la population en matière de santé mais aussi les compétences communicationnelles d'un système de santé qui se complexifie. Health literacy is defined as "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions." Low health literacy mainly affects certain populations at risk limiting access to care, interaction with caregivers and self-management. If there are screening tests, their routine use is not advisable and recommended interventions in practice consist rather to reduce barriers to patient-caregiver communication. It is thus important to include not only population's health literacy but also communication skills of a health system wich tend to become more complex.

De la conception à la pratique Reconfiguration d'un dispositif de formation des enseignants aux technologies de l'information et de la communication.

Constatant que la formation des enseignants aux technologies de l'information et de la communication (TIC) pose des problèmes spécifiques, cet article a pour but d'engager une réflexion sur ce thème. Nos réflexions s'appuient sur une expérience de formation réalisée dans 23 écoles professionnelles suisses engagées dans un programme national de soutien à l'utilisation pédagogique des TIC. L'article décrit la manière dont le dispositif de formation prévu a été mis en pratique, les difficultés auxquelles il a donné lieu et les réponses que les acteurs ont élaborées pour faire face à ces difficultés. Nous montrons qu'une analyse du déroulement effectif d'un dispositif de formation et des transformations qu'il subit constitue un élément essentiel pour orienter les futures actions de formation et penser la place des apprenants dans un dispositif de formation.

Oligoanalgesia in the emergency department: short-term beneficial effects of an education program on acute pain.

STUDY OBJECTIVE: Acute pain is the most frequent complaint in emergency department (ED) admissions, but its management is often neglected, placing patients at risk of oligoanalgesia. We evaluate the effect of the implementation of guidelines for pain management in ED patients with pain at admission or anytime during their stay in our ED. METHODS: This prospective pre-post intervention cohort study included data collection both before and after guideline implementation. Consecutive adult patients admitted with acute pain from any cause or with pain at any time after admission were enrolled. The quality of pain management was evaluated according to information in the ED medical records by using a standardized collection form, and its impact on patients was recorded with a questionnaire at discharge. RESULTS: Two hundred forty-nine and 192 patients were included during pre- and postintervention periods. Pain was documented in 61% and 76% of nurse and physician notes, respectively, versus 78% and 85% after the intervention (difference 17%/9%; 95% confidence interval [CI] 8% to 26%/2% to 17%, respectively). Administration of analgesia increased from 40% to 63% (difference 23%; 95% CI 13% to 32%) and of morphine from 10% to 27% (difference 17%; 95% CI 10% to 24%). Mean doses of intravenous morphine increased from 2.4 mg (95% CI 1.9 to 2.9 mg) to 4.6 mg (95% CI 3.9 to 5.3 mg); administration of nonsteroidal antiinflammatory drugs and acetaminophen increased as well. There was a greater reduction of visual analogue scale score after intervention: 2.1 cm (95% CI 1.7 to 2.4 cm) versus 2.9 cm (95% CI 2.5 to 3.3 cm), which was associated with improved patient satisfaction. CONCLUSION: Education program and guidelines implementation for pain management lead to improved pain management, analgesia, and patient satisfaction in the ED.