[The contribution of therapeutic education in mental health]. / Apport de l'éducation thérapeutique en santé mentale.

Long absent in the provision of psychiatric care, therapeutic education programmes for patients with mental illness appeared in the 1980s, mainly for schizophrenia or bipolar disorders.

Trends in diabetes self-management education: where are we coming from and where are we going? A narrative review.

AIMS: To summarize the history, development and efficacy of diabetes self-management education on glycaemic control and mental health in adults and children or adolescents with type 1 diabetes and people with type 2 diabetes. A further aim was to review the status of implementation of diabetes self-management education into routine care and outline current gaps in implementation and research. METHODS: We searched PubMed and Google scholar for German- and English-language articles regarding diabetes self-management education, glycaemic control and mental health, and restricted this search to meta-analyses. RESULTS: Diabetes education has evolved from a compliance- and knowledge-oriented approach to an empowerment- and self-management-oriented approach. Diabetes self-management education seems to have a greater impact on glycaemic outcomes than on mental health outcomes, but the latter are rarely assessed. Technological development and digitalization can provide chances and challenges for diabetes self-management education. Digital solutions show promising results and great potential for improving the efficacy of diabetes self-management education further and providing ongoing support. The implementation of diabetes self-management education into routine clinical care frequently remains a challenge. CONCLUSION: Diabetes self-management education has been acknowledged as an essential part of diabetes therapy; however, current gaps regarding the efficacy of diabetes self-management education on mental health, and the need for education on the use of diabetes technology, are future avenues for research.

Patient-Physician Communication in the 21st Century.

In clinical practice, a successful patient-physician partnership can improve the outcome of treatment, especially in cases of chronic disease or cancer. To establish this partnership, physicians must explain treatment options and potential outcomes, but how to best do this when treatment is based on scientific principles and findings that the lay patient will not be familiar with? Here we present a paradigm for patient-physician communication using the immunotherapy of cancer as a model. In this context, we argue for the importance of incorporating techniques in communicating science with patients into the training of early career physicians.

Establecimiento de los conocimientos, actitudes y opiniones de la población sobre el uso racional de medicamentos / Establishment of knowledge, attitudes and opinions of general population about rational use of medicines

OBJETIVO: Identificar el nivel de conocimientos, actitudes y opiniones respecto al uso de medicamentos (UM) en población general. MÉTODO: Estudio descriptivo transversal, cuantitativo, realizado en usuarios de la sanidad pública ≥ 18 años asignada a centros de atención primaria de la ciudad de Barcelona. Muestreo bietápico, estratificación: barrio, sexo y edad. Administración presencial de un cuestionario propio validado. Análisis: SPSSv15. Período estudio: diciembre 2011. RESULTADOS: Cuatrocientas ochenta y cuatro encuestas (IC 95%, α = 5%).53% mujeres; 21,3% estudios universitarios. UM : 81% ha tomado medicamentos en los últimos 3 meses; media, 1,9. Conceptos técnicos: El 80% de los que se medican saben indicar qué medicamentos toman y para qué. En el 90% de los casos no saben indicar el nombre del principio activo (pa). El 55,6% no sabe definir el concepto pa. Sólo un 35% reconoce algún pa indicado en el envase de tres medicamentos diferentes y un 44,5% no reconoce ninguno. El 22,7% conoce el significado de contraindicación, efecto adverso e interacción medicamentosa. El 20% tiene total desconocimiento y este aumenta con la edad y disminuye con el nivel de estudios. Opinión y actitud: Valor del indicador global de uso racional (IGUR) de medicamentos, 5,03 puntos: 6,18 praxis, 5,02 información, 3,85 uso sostenible y 3,49 nuevos medicamentos/genéricos. El 70% de los encuestados cree que no se hace un uso racional de medicamentos y el 21,3% cree que es necesaria mayor concienciación social. CONCLUSIONES: Los conocimientos, actitudes y opiniones de los ciudadanos sobre medicamentos son bajos. Es necesario implicar a los ciudadanos y mejorar sus conocimientos básicos para avanzar en el uso racional

OBJECTIVE: Identify the level of knowledge, opinions and attitudes of medicines in general population. METHODS: Descriptive transversal study realised in a sample of ≥ 18 years old public health users from primary health centres in the city of Barcelona. Sample has been chosen using a two phases sampling, stratified by district, gender and age. Questionnaire administered face-to-face. SPSSv15 used for the analysis. Study period: December 2011. RESULTS: 484 surveys has been done (IC 95%, α = 5%).53% were women and 21,3% had university studies. Medicine use: 81% had taken medicines in the last 3 months; average of 2,34. Technical concepts: 80% of medicated people know what they take and its indication.55,6% don't know active ingredient concept. Only 35% recognise the active ingredient showed in the box of the medicine (3 cases shown) and 44,5% not one.22,7% know the meaning of security concepts contraindication, adverse effect and drug interaction.20% ignore. This fact grows with age and reduces with high study levels. Opinion and attitude: Global rational use of medicines indicator obtains 5,03 from 10: 3,42 opinion and 6,51 attitude.70% of people think there is no rational use of medicines in general and 21,3% would promote raising awareness. CONCLUSIONS: Low level of knowledge and poor attitude and opinion in rational use of medicines have been shown in this study. It is necessary involve citizens and improve their basic knowledge to promote rational use of medicines

Fifteen Years of Explaining Pain: The Past, Present, and Future.

The pain field has been advocating for some time for the importance of teaching people how to live well with pain. Perhaps some, and maybe even for many, we might again consider the possibility that we can help people live well without pain. Explaining Pain (EP) refers to a range of educational interventions that aim to change one's understanding of the biological processes that are thought to underpin pain as a mechanism to reduce pain itself. It draws on educational psychology, in particular conceptual change strategies, to help patients understand current thought in pain biology. The core objective of the EP approach to treatment is to shift one's conceptualization of pain from that of a marker of tissue damage or disease to that of a marker of the perceived need to protect body tissue. Here, we describe the historical context and beginnings of EP, suggesting that it is a pragmatic application of the biopsychosocial model of pain, but differentiating it from cognitive behavioral therapy and educational components of early multidisciplinary pain management programs. We attempt to address common misconceptions of EP that have emerged over the last 15 years, highlighting that EP is not behavioral or cognitive advice, nor does it deny the potential contribution of peripheral nociceptive signals to pain. We contend that EP is grounded in strong theoretical frameworks, that its targeted effects are biologically plausible, and that available behavioral evidence is supportive. We update available meta-analyses with results of a systematic review of recent contributions to the field and propose future directions by which we might enhance the effects of EP as part of multimodal pain rehabilitation. Perspective: EP is a range of educational interventions. EP is grounded in conceptual change and instructional design theory. It increases knowledge of pain-related biology, decreases catastrophizing, and imparts short-term reductions in pain and disability. It presents the biological information that justifies a biopsychosocial approach to rehabilitation.

Historical aspects of immunization and vaccine safety communication.

It has been a long journey starting from the beginnings of variolation [3] leading up to the greatest success in the history of immunization: the eradication of smallpox [39]. Today, vaccines are an acknowledged important medical advance [40]. Nevertheless, immunization has been the subject of public controversy on several occasions [15, 24, 31]. This article shall provide a short overview of some aspects of the early stages of immunization in Western countries, including some examples of vaccine safety controversies in the past.

Information prescriptions, 1930-2013: an international history and comprehensive review.

OBJECTIVES: Recently, government agencies in several countries have promoted information prescription programs to increase patients' understanding of their conditions. The practice has a long history and many publications, but no comprehensive literature reviews such as this. METHODS: Using a variety of high-precision and high-recall strategies, the researcher searched two dozen online bibliographic databases, citation databases, and repositories, as well as many print sources, to identify and retrieve documents for review. Of these documents, ninety relevant English-language case reports, research reports, and reviews published from 1930-2013 met the study criteria. RESULTS: Early to mid-twentieth century reports covered long-standing practices and used no rigorous research methods. The literature since the mid-1990s reports on short-term trial projects, especially of government-sponsored programs in the United States and United Kingdom. Although the concept of information prescription has been in the literature and practiced for decades, no long-term research studies were found. CONCLUSIONS: Most of the literature is anecdotal concerning small pilot projects. The reports investigate physician, patient, and librarian satisfaction but not changes in patient knowledge or behavior. Many twenty-first century projects emphasize materials and projects from specific government agencies and commercial enterprises. IMPLICATIONS: While the practice is commonly believed to be a good idea and there are many publications on the subject, few studies provide any evidence of the efficacy of information prescriptions for increased patient knowledge. Well-designed and executed large or long-term studies might produce needed evidence for professional practice.

Ideal Births and Ideal Babies: English-Canadian Advice Literature in the 1950s and 1960s.

This paper explores how the ideal birth was constructed after World War Two, noting in particular the abstract enthusiasm on the part of physicians and government advocates for technological innovation accompanied by simultaneous silence regarding the specificities of labour and delivery in advice literature. The relationship of prescriptive mothering to the nascent medical ideology of prevention-oriented surveillance had a direct impact on the disembodying of women in the birthing process. Both vaginal and surgical childbirth were kept firmly within the realm of medical expertise, painting parturition as something that happened to women, rather than something they did themselves.

The early history of ideas on brief interventions for alcohol.

AIMS: This study explores the early development of brief interventions for alcohol using a history of ideas approach with a particular focus on intervention content. METHODS: The source publications of the key primary studies published from approximately 1962 to 1992 were examined, followed by a brief review of the earliest reviews in this field. These studies were placed in the context of developments in alcohol research and in public health. RESULTS: After early pioneering work on brief interventions, further advances were not made until thinking about alcohol problems and their treatment, most notably on controlled drinking, along with wider changes in public health, created new conditions for progress. There was then a golden era of rapid advance in the late 1980s and early 1990s, when preventing the development of problem drinking became important for public health reasons, in addition to helping already problematic drinkers. Many research challenges identified at that time remain to be met. The content of brief interventions changed over the period of study, although not in ways well informed by research advances, and there were also obvious continuities, with a renewed emphasis on the facilitation of self-change being one important consequence of the development of internet applications. CONCLUSIONS: Ideas about brief interventions have changed in important ways. Brief interventions have been studied with different populations of drinkers, with aims embracing both individual and population-level perspectives, and without well-specified contents. The brief intervention field is an appropriate target for further historical investigations, which may help thinking about addressing alcohol and other problems.

Dangers of the menopause. 1910.

Editor's note: From its first issue in 1900 through to the present day, AJN has unparalleled archives detailing nurses' work and lives over the last century. These articles not only chronicle nursing's growth as a profession within the context of the events of the day, but they also reveal prevailing societal attitudes about women, health care, and human rights. Today's nursing school curricula rarely include nursing's history, but it's a history worth knowing. To this end, From the AJN Archives will be a frequent column, containing articles selected to fit today's topics and times.This month's article, from the September 1910 issue, is "Dangers of the Menopause." The author, Anne E. Perkins, MD, states that its purpose is to correct "popular fallacies," so nurses can "disseminate knowledge of the real dangers" of menopause. It's interesting how much information in the article is still valid 100 years later, such as the need to investigate any postmenopausal bleeding. It's also noteworthy that the three symptoms causing women the most distress-hot flashes, insomnia, and mood problems-haven't changed, although a comparison of Dr. Perkins's article with "Managing Menopausal Symptoms" in this issue reveals that menopause management certainly has: from a "trip abroad" and avoiding "fancy work" in 1910 to physical exercise and acupuncture in 2012. To read the complete article from our archives, go to http://bit.ly/IZkCiD.

Evolution and current challenges in the teaching of functional MRI and functional brain imaging.

The report of any new and successful method for studying the world triggers the need to train people in the use of that method. In the case of functional magnetic resonance imaging and its use for examining human brain function in vivo, expertise is required in a greater collection of domains than usual. Development of fMRI training programs started shortly after the announcement of BOLD-based fMRI in humans. These programs had a variety of durations and primary content areas. All programs had to deal with the challenge of bringing interested researchers from a wide variety of areas-many of whom had little or no understanding of MR physics, and/or experimental psychology, and/or the nuances of data analysis and modeling-to a sufficiently detailed level of knowledge that both the funding agencies, and the existing proprietors of the technology (often radiologists or MR physicists at hospitals) would take the research proposals of new investigators seriously. Now that fMRI-based research is well established, there are new educational challenges. Some have to do with the growing list of technologies used to study human brain function in vivo. But perhaps more daunting is the challenge of training consumers of the reports and claims based on fMRI and other brain imaging modalities. As fMRI becomes influential in contexts beyond the research environment-from the clinic to the courtroom to the legislature-training consumers of fMRI-based claims will take on increasing importance, and represents its own unique challenges for education.