La directiva ya está aquí. ¿Estamos preparados? / The directive is now here. Are we ready?

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["Pflegestützpunkte": Care Support Centers in Germany. Where are We Heading? Results of the Evaluation of all 48 Care Support Centers in Baden-Württemberg]. / Pflegestützpunkte in Deutschland. Quo vadis? Ergebnisse der Evaluation aller baden-württembergischen Pflegestützpunkte.

"Pflegestützpunkte", care support centers in Germany. Where are we heading? Results of the evaluation of all 48 care support centers in Baden-Württemberg. Objectives: The quantitative part of the study was based on an analysis of the structures and concepts as well as the type of services and demand for counseling services for elderly and vulnerable people of all 48 care support centers in Baden-Württemberg. The qualitative part included interviews of employees of the care support centers on the underlying concepts of their organization. Objectives: The counseling infrastructure for elderly and vulnerable people needs to be improved in terms of transparency, networking and coordination of its services. According to the German Care Reform, care support centers, known as "Pflegestützpunkte," should solve this problem by placing all relevant counseling services under one roof. The objective of this study was to distinguish between the various care models of care support centers currently in existence and to investigate how different models meet legal requirements. Results and Conclusions: An evaluation of the interviews and surveys shows that not all legal requirements are met. The 4 main models of care support centers vary widely and are partially incomprehensible. It also remains unclear what role the care support centers play in counseling by health and nursing insurances. These needs for further development should be kept in mind in the planned expansion of care support centers.

Theoretical and practical outline of the Copenhagen PACT narrative-based exercise counselling manual to promote physical activity in post-therapy cancer survivors.

BACKGROUND: Sedentary behaviour and reduced exercise capacity are potential persisting effects of anti-cancer therapy that may predispose to serious health conditions. It is well-established that physical exercise may prevent some of these problems. However, the extent to which cancer survivors are able to adopt long-term physical activity habits depends largely on their motivation. AIM: This theoretical paper aims to outline how researchers and practitioners can draw from Antonovsky's salutogenetic theory and White & Epston's Narrative Therapy to develop and implement intervention efforts centered on promotion of long-term physical activity behaviour, while at the same time increasing the individual cancer survivor's sense of meaning and personal health resources. MATERIAL AND METHODS: The Copenhagen PACT (Physical Activity after Cancer Treatment) Study targeting adoption and maintenance of regular physical activity in post-therapy cancer survivors is briefly presented including a brief review of the theoretical rationale behind the psychological component of the intervention, i.e. a narrative-based exercise counselling programme. Subsequently, particular attention is given to the core principles, different components and structure of the counselling manual including sample questions and examples of written documents that have emanated from the individual counselling sessions. DISCUSSION: The discussion includes consideration of some methodological challenges that arise when attempting to evaluate narrative-based interventions in the context of physical activity promotion in cancer rehabilitation and survivorship care.

"Should I give you my smoking lecture now or later?" Characterizing emergency physician smoking discussions and cessation counseling.

STUDY OBJECTIVE: We determine frequency and manner in which emergency physicians address smoking with their patients. METHODS: This was a descriptive secondary analysis of 871 audiotapes of physician-patient interactions collected during a trial assessing the effect of computer-based health risk assessment on emergency physician-patient communication. Consenting nonemergency female patients, ages 18 to 65 years, were enrolled from 2 socioeconomically diverse academic emergency department (EDs) for audiotaping of the ED visit. All audio files with any mention of smoking were independently coded with an in-depth structured coding form to characterize the nature of smoking-related discussions. Logistic regression was used to determine factors associated with emergency physician screening and discussion of tobacco exposure with women patients. RESULTS: Overall, 484 of 871 (56%) participants were verbally screened for smoking, with 156 of 484 (32%) disclosing current smoking, with similar incidence at both sites. Tobacco screening was higher (odds ratio 2.2; 95% confidence interval 1.3 to 3.5), whereas rates of smoking-related discussions were lower (odds ratio 0.41; 95% confidence interval 0.17 to 0.98) at the urban site. At both sites, physicians tended to screen and discuss smoking when patients presented with a health condition that could be aggravated by smoking. Only 56% of discussions with current smokers contained advice to quit, 16% included assessment of readiness to quit, and a minority (13%) included a referral. Physician empathy/encouragement was associated with patients' detailing quit attempts. CONCLUSION: Emergency physicians were likely to gather information about smoking but not to counsel or advise patients to quit. These results raise the question of whether emergency medicine resident training should include additional emphasis on smoking cessation counseling and motivational interviewing techniques.

Consejo anticonceptivo en la adolescencia. Características de la atención a los adolescentes. Aspectos legales / No disponible

Los adolescentes gozan en general de buena salud; uno de sus riesgos son las relaciones sexuales, que pueden llevar a embarazos no deseados y no adecuados, sin olvidar las infecciones de transmisión sexual. Es necesario potenciar y mejorar la educación sexual principalmente en el medio escolar y los servicios de atención, facilitando su accesibilidad y confidencialidad. La legislación actual reconoce los derechos del adolescente en materia de sexualidad y, por tanto, en anticoncepción. Es necesario que el profesional conozca los distintos métodos anticonceptivos y las garantías jurídicas en cuanto a su prescripción, para no perjudicar la salud del adolescente en una etapa clave de su vida. Existe una variada oferta de métodos anticonceptivos para los adolescentes, con la especial consideración del preservativo, con o sin otros métodos, y la anticoncepción poscoital como segunda oportunidad

Adolescents usually enjoy good health; one of their risks is sexual relationships which can lead to unwanted and/or inappropriate pregnancies, not to mention sexually transmitted diseases. It is necessary to promote and improve sexual education in the school and care giving services, facilitating their accessibility and confidentiality. The current legislation recognises the rights of the adolescent in terms of sexuality and therefore in terms of contraception. It is necessary for the professional to know the different methods of contraception and the legal guarantees in terms of its prescription, so as not to jeopardise the health of the adolescents in a key stage of their life. There is a wide range of contraceptive methods on offer for adolescents, with special consideration for the condom, with or without other methods, and the postcoital pill –or ‘PCP'– as a backup