ABSTRACT
«Health literacy¼ refers to the ability to find, understand and use health information. It is a relatively new concept, which is becoming increasingly important but remains little known by clinicians. Still, insufficient levels of health literacy in our patients are common, underestimated and negatively associated with numerous health indicators. A set of practical tools are already available to the clinician. The aim of this article is to present the concept to clinicians and emphasize how it could revitalize reflection on the effectiveness of our interventions in the field. Physicians could take a leadership role in putting the concept of health literacy on the agenda for health care quality improvement.
La «littératie en santé¼ désigne la capacité à trouver, comprendre et utiliser les informations dans le domaine de la santé. C'est un concept relativement neuf, en pleine expansion, encore peu connu des cliniciens de terrain. Des niveaux de littératie en santé insuffisants chez les patients sont fréquents, sous-estimés et péjorativement associés à de nombreux indicateurs de santé. Cet article se propose d'adopter le point de vue du clinicien de terrain pour montrer en quoi la littératie en santé pourrait redynamiser la réflexion sur l'efficacité pratique des interventions médicales. Il fournit, ensuite, des outils pour transposer ce concept dans la pratique et conclut que les médecins ont certainement un rôle moteur à prendre pour inscrire la littératie en santé à l'agenda des processus d'amélioration de la qualité des soins.
Subject(s)
Communication , Health Literacy , Physician-Patient Relations , HumansABSTRACT
Multidisciplinary work is gaining importance with the ageing of the population, an increase in the number of chronically ill patients, and patients' preference for homebased healthcare. Multidisciplinary team meetings (MDTMs) were designed to foster dialogue between care providers of patients with decreasing autonomy. Despite being financed by the Health Insurance, few professionals use it. This study aimed at an exploration of the professionals' reasons for this lack of MDTM. Semi-structured interviews with health and social care providers who had participated in an MDTM were analysed thematically by two researchers working independently. All of the professionals recognised the importance of MDTMs in improving support for patients and their relatives. Each person's presence at the MDTM helped participants to define their scope of action, to become acquainted with one another, and to coordinate their work. Administrative and logistical limitations were cited as obstacles, as was the absence of a multidisciplinary working culture. MDTMs place the patient at the forefront, and allow professionals to meet and agree on a treatment plan. A range of different working practices and cultures challenges the method.
Le vieillissement de la population, l'augmentation des maladies chroniques, et la préférence des patients pour les soins à domicile demandent plus de travail d'équipe. La Concertation Multidisciplinaire (CM) est une modalité favorisant le dialogue entre différents prestataires de soins au bénéfice des patients en perte d'autonomie. Bien que financée par l'assurance-maladie, elle est peu utilisée. Cette étude qualitative visait à explorer les raisons de ce manque d'utilisation de la CM par les professionnels de santé. Des entretiens semi-structurés individuels ont été menés avec des prestataires d'aide et de soins ayant déjà participé à une CM. Une analyse thématique a été menée par deux chercheurs de façon indépendante. Pour les répondants, la CM est importante pour améliorer le soutien aux patients et à leur famille. Elle permet de définir leur champ d'action, de se rencontrer et de se coordonner. Par contre, les tâches administratives, les contraintes logistiques et l'absence de culture de travail multidisciplinaire sont mentionnées comme des obstacles. La CM place le patient au centre, et permet aux professionnels de se rencontrer et de définir ensemble un plan de traitement. La variété des pratiques et des cultures de travail limite l'intérêt de la méthode.
Subject(s)
Ambulatory Care/organization & administration , Interdisciplinary Communication , Patient Care Team/organization & administration , Adult , Ambulatory Care/standards , Cooperative Behavior , Female , Humans , Interviews as Topic , Male , Middle Aged , Palliative Care/organization & administration , Palliative Care/standards , Patient Care Team/standards , Patient-Centered Care/organization & administration , Patient-Centered Care/standards , WorkforceABSTRACT
In vertebrates, 14-3-3 proteins form a family of seven highly conserved isoforms with chaperone activity, which bind phosphorylated substrates mostly involved in regulatory and checkpoint pathways. 14-3-3 proteins are the most abundant protein in the brain and are abundantly found in the cerebrospinal fluid in neurodegenerative diseases, suggesting a critical role in neuron physiology and death. Here we show that 14-3-3eta-deficient mice displayed auditory impairment accompanied by cochlear hair cells' degeneration. We show that 14-3-3eta is highly expressed in the outer and inner hair cells, spiral ganglion neurons of cochlea and retinal ganglion cells. Screening of YWHAH, the gene encoding the 14-3-3eta isoform, in non-syndromic and syndromic deafness, revealed seven non-synonymous variants never reported before. Among them, two were predicted to be damaging in families with syndromic deafness. In vitro, variants of YWHAH induce mild mitochondrial fragmentation and severe susceptibility to apoptosis, in agreement with a reduced capacity of mutated 14-3-3eta to bind the pro-apoptotic Bad protein. This study demonstrates that YWHAH variants can have a substantial effect on 14-3-3eta function and that 14-3-3eta could be a critical factor in the survival of outer hair cells.
ABSTRACT
Clinical evidence indicates that serotonin-1A receptor (5-HT1AR) gene polymorphisms are associated with anxiety disorders and deficits in cognition. In animal models, exercise (Ex) and environmental enrichment (EE) can change emotionality-related behaviours, as well as enhance some aspects of cognition and hippocampal neurogenesis. We investigated the effects of Ex and EE (which does not include running wheels) on cognition and anxiety-like behaviours in wild-type (WT) and 5-HT1AR knock-out (KO) mice. Using an algorithm-based classification of search strategies in the Morris water maze, we report for we believe the first time that Ex increased the odds for mice to select more hippocampal-dependent strategies. In the retention probe test, Ex (but not EE) corrected long-term spatial memory deficits displayed by KO mice. In agreement with these findings, only Ex increased hippocampal cell survival and BDNF protein levels. However, only EE (but not Ex) modified anxiety-like behaviours, demonstrating dissociation between improvements in cognition and innate anxiety. EE enhanced hippocampal cell proliferation in WT mice only, suggesting a crucial role for intact serotonergic signalling in mediating this effect. Together, these results demonstrate differential effects of Ex vs EE in a mouse model of anxiety with cognitive impairment. Overall, the 5-HT1AR does not seem to be critical for those behavioural effects to occur. These findings will have implications for our understanding of how Ex and EE enhance experience-dependent plasticity, as well as their differential impacts on anxiety and cognition.
