Effectiveness of two interventions based on improving patient-practitioner communication on diabetes self-management in patients with low educational level: study protocol of a clustered randomized trial in primary care.

BACKGROUND In the last decades the presence of social inequalities in diabetes care has been observed in multiple countries, including Spain. These inequalities have been at least partially attributed to differences in diabetes self-management behaviours. Communication problems during medical consultations occur more frequently to patients with a lower educational level. The purpose of this cluster randomized trial is to determine whether an intervention implemented in a General Surgery, based in improving patient-provider communication, results in a better diabetes self-management in patients with lower educational level. A secondary objective is to assess whether telephone reinforcement enhances the effect of such intervention. We report the design and implementation of this on-going study. METHODS/DESIGN The study is being conducted in a General Practice located in a deprived neighbourhood of Granada, Spain. Diabetic patients 18 years old or older with a low educational level and inadequate glycaemic control (HbA1c > 7%) were recruited. General Practitioners (GPs) were randomised to three groups: intervention A, intervention B and control group. GPs allocated to intervention groups A and B received training in communication skills and are providing graphic feedback about glycosylated haemoglobin levels. Patients whose GPs were allocated to group B are additionally receiving telephone reinforcement whereas patients from the control group are receiving usual care. The described interventions are being conducted during 7 consecutive medical visits which are scheduled every three months. The main outcome measure will be HbA1c; blood pressure, lipidemia, body mass index and waist circumference will be considered as secondary outcome measures. Statistical analysis to evaluate the effectiveness of the interventions will include multilevel regression analysis with three hierarchical levels: medical visit level, patient level and GP level. DISCUSSION The results of this study will provide new knowledge about possible strategies to promote a better diabetes self-management in a particularly vulnerable group. If effective, this low cost intervention will have the potential to be easily incorporated into routine clinical practice, contributing to decrease health inequalities in diabetic patients. TRIAL REGISTRATION Clinical Trials U.S. National Institutes of Health, NCT01849731.

Melle [Suzanne] Lenglen, championne du monde de tennis [gagnante de Wimbledon, le samedi 5 juillet 1919] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 54732

Let's talk: how communication affects contract design

We study experimentally how the ability to communicate affects the frequency and effectiveness of flexible and inflexible contracts in a bilateral trade context where sellers can adjust trade quality after observing a post-contractual cost shock and a discretionary buyer transfer. In the absence of communication, we find that rigid contracts are more frequent and lead to higher earnings for both buyer and seller. By contrast, in the presence of communication, flexible contracts are much more frequent and considerably more productive, both for buyers and sellers. Also, both buyer and seller earn considerably more from flexible with communication than rigid without communication. Our results show quite strongly that communication, a normal feature in contracting, can remove the potential cost of flexibility (disagreements caused by conflicting perceptions). We offer an explanation based on social norms.

Information technologies and communication between parents and children

This is an exploratory study that aims, on the one hand, to examine in more detail how children between 12 and 16 years of age use different audiovisual technologies, what they feel and think when using them, and whom they like to speak to about such experiences. On the other hand, we look more deeply into the interactions between adults and children, particularly between parents and their children, in relation to these technologies when children use them at home or in other places. We analysed responses to questionnaires with several common items, administered separately to parents and children. Children’s responses reflect an important level of dissatisfaction when talking with different adults about media activities. Our findings support the thesis that more and more children socialise through new information and communication technologies with little or no recourse to adult criteria, giving rise to the emergence of specific children’s cultures. Crossing of the responses of parents and those of their own children shows us which aspects of media reality adults overestimate or underestimate in comparison to children, and to what degree certain judgements coincide and differ between generations. The results can be applied to the improvement of relations between adults and adolescents, taking advantage of adolescents’ strong motivation to engage in activities using audiovisual media

Cannes 21-1-20, Miss Ryan [Elisabeth] et Ritchie [Josiah] [contre] Mlle Lenglen [Suzanne] et Albarran [Pierre] [tournoi de lawn-tennis du Carlton-Club de Cannes] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 57735

Factum pour François de La Salle, sieur de Clochet, tant pour lui que pour Louis et Suzanne de La Salle, ses neveu et nièce mineurs, et Salomon de La Salle, sieur de Puyrichard,... tous lesdits de La Salle enfants et petits-enfants et héritiers de défunt Jacques de La Salle et de Françoise Penigaud, leur mère,... demandeurs en lettres de rescision du 4 juin 1631,... contre damoiselle Catherine Penigaud, veuve de Barthélemy de Pivert des Gittons, sieur de Chenay...

[Factum. La Salle, Jacques de (Héritiers). 1631?]

B. [Blanche] Amblard, S. [Suzanne] Amblard [joueuses de tennis du Sporting club de Paris, rue de Saussure] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 57566

Cannes 21-1-20, Miss Lenglen [Suzanne] et Albarran [Pierre] [tournoi de lawn-tennis du Carlton-Club de Cannes] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 57731

Mlle Amblard S. [Suzanne, joueuse de tennis du Sporting club de Paris, rue de Saussure] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 57567