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.

Living with diabetes: literature review and secondary analysis of qualitative data.

AIM: To review the published qualitative literature on the lived experience of people with diabetes, describe the emerging findings and research methods over the last 25 years, and make recommendations for future research. METHODS: We describe a 'Next-Generation' mixed-method approach to reporting qualitative data that combines the advantages of traditional qualitative analysis (assessing depth of meaning from participants themselves) with those of descriptive analysis (assessing breadth and representativeness). We used our Next-Generation approach to conduct a secondary analysis of qualitative data derived from a systematic search of PubMed. A formal coding scheme was developed and systematically applied to 2050 respondent quotations contained in the 74 selected articles; inter-rater agreement was high (κ = 0.90). Quotations were aggregated at the level of the article and reported to assess both narratives and numerical counts of the data. RESULTS: The rate of qualitative research on the lived experience of diabetes has increased over the last 25 years. Both positive and negative aspects of lived experience were reported, although the former was less common. Data from many different populations were reported, but most studies emphasized breadth of coverage over depth. Some findings are well established and there is little benefit to repeating these studies. Best practices of qualitative methodology were often not utilized. CONCLUSIONS: The amount of qualitative research in diabetes is substantial and increasing. We recommend that future research be focused on specific understudied topics rather than repeating existing research. We also provide recommendations for how qualitative study methodology can be improved by implementing the Next-Generation approach.

State of the art: understanding and integration of the social context in diabetes care.

We review the past 25 years of research addressing challenges people living with diabetes experience in their daily lives related to social contexts, i.e. in their family, at work and in society at large, and identify research gaps. We found that young people with diabetes, as they develop through to adulthood, are exposed to considerable risks to their physical and mental health. Family-system interventions have had mixed outcomes. Research in this area would benefit from attention to ethnic/cultural diversity, and involving fathers and other family members. In adults with diabetes, social support relates to better diabetes outcomes. While family member involvement in care is likely to affect health and psychosocial outcomes of the person with diabetes, key elements and mediators of effective family interventions need to be identified. The challenges of diabetes management at work are under-researched; distress and intentional hyperglycaemia are common. When depression is comorbid with diabetes, there are increased work-related risks, e.g. unemployment, sickness absence and reduced income. Research to support people with diabetes at work should involve colleagues and employers to raise awareness and create supportive environments. Stigma and discrimination have been found to be more common than previously acknowledged, affecting self-care, well-being and access to health services. Guidance on stigma-reducing choice of language has been published recently. Resilience, defined as successful adaptation to adversity such as stigma and discrimination, requires studies relevant to the specific challenges of diabetes, whether at diagnosis or subsequently. The importance of the social context for living well with diabetes is now fully recognized, but understanding of many of the challenges, whether at home or work, is still limited, with much work needed to develop successful interventions.

Motivation: key to a healthy lifestyle in people with diabetes? Current and emerging knowledge and applications.

AIM: Motivation to take up and maintain a healthy lifestyle is key to diabetes prevention and management. Motivations are driven by factors on the psychological, biological and environmental levels, which have each been studied extensively in various lines of research over the past 25 years. Here, we analyse and reflect on current and emerging knowledge on motivation in relation to lifestyle behaviours, with a focus on people with diabetes or obesity. Structured according to psychological, (neuro-)biological and broader environmental levels, we provide a scoping review of the literature and highlight frameworks used to structure motivational concepts. Results are then put in perspective of applicability in (clinical) practice. RESULTS: Over the past 25 years, research focusing on motivation has grown exponentially. Social-cognitive and self-determination theories have driven research on the key motivational concepts 'self-efficacy' and 'self-determination'. Neuro-cognitive research has provided insights in the processes that are involved across various layers of a complex cortical network of motivation, reward and cognitive control. On an environmental - more upstream - level, motivations are influenced by characteristics in the built, social, economic and policy environments at various scales, which have provided entry points for environmental approaches influencing behaviour. CONCLUSIONS: Current evidence shows that motivation is strongly related to a person's self-efficacy and capability to initiate and maintain healthy choices, and to a health climate that supports autonomous choices. Some approaches targeting motivations have been shown to be promising, but more research is warranted to sustainably reduce the burden of diabetes in individuals and populations.

Biometrics and citizenship: Measuring diabetes in the United States in the interwar years.

In 1936, the journalist Hannah Lees published "Two Million Tightrope Walkers," drawing attention to the significant number of people in the United States estimated to have diabetes. Focusing on how people with diabetes should live, she emphasized the importance of recording the exact values of everything they ate and avoiding all "riotous living" lest they be unable to keep careful measurements of calories, insulin, and sleep. Employing two meanings of measured - as counted and as moderate - Lees was doing more than communicating how someone might control their disease; she was also calling for a "controlled and self-reliant citizenry." Indeed, Lees insisted that diabetics who followed a regime of measurement "make a good deal better citizens than the average." Drawing on the writings of Lees and other social commentators, I explore the link between biometrics, citizenship, and diabetes in the United States in the interwar years. In particular, I look at how this disease came to symbolize both the regimes of discipline thought to be necessary in a society moving to consumption as its economic motor, and the fears of what could happen if consumption ran amok. Biometrics, I argue, offered clinicians and patients a potent tool for measuring deviance and, potentially, for restoring a person to the "norm."

El camino de desarrollo personal a través del cuidado de San Juan de Dios / The path of personal development through the care of Saint John of God

FUNDAMENTO: La enfermería, por su vocación de servicio y al estar en contacto diario con el mundo del sufrimiento y la muerte, puede padecer una fatiga por compasión o un burn-out. Por ello es necesario la mejora de ciertas habilidades psico-espirituales para seguir desarrollándose como personas y profesionalmente, de manera que a través del autocuidado puedan llegar a alcanzar una mayor eficacia e integralidad en sus cuidados, a la vez que mejore su salud y autorrealización. OBJETIVO: describir las habilidades psico-espirituales en la enfermería propuestas por San Juan de Dios, influido por su guía espiritual San Juan de Ávila. METODOLOGÍA: realizamos un estudio historiográfico siguiendo la corriente de la historia de las mentalidades. Resultados principales: desde su juventud, Juan de Dios supo que su vocación era cuidar todo tipo de injusticias, especialmente de aquellos más vulnerables como son los pobres y enfermos. Sin embargo, presentaba ciertas dificultades para mantenerse con salud, siendo su guía espiritual quien fue marcando el desarrollo de las habilidades psico-espirituales para que, a través del autocuidado, pudiese cuidar al otro sin sufrir en su cuerpo o en su espíritu. Estas habilidades fueron las que le dieron su calidad humana y asistencial, cuidando de manera integral al otro sin abandonarse a sí mismo, convirtiendo la profesión en un camino de desarrollo personal. CONCLUSIONES: el padre de la enfermería moderna desarrolló tres habilidades psicológicas y tres habilidades espirituales por diadas, las cuales hoy en día son descritas como empatía-compasión, aceptación incondicional-hospitalidad, y autenticidad-presencia. Con ello, a través del autocuidado llegó a crear un modelo de enfermería que aún hoy se mantiene en el tiempo

INTRODUCTION: Nursing, due to its vocation of service and being in daily contact with the world of suffering and death, can suffer from compassion fatigue or burn-out. Therefore, it is necessary to develop certain psycho-spiritual skills to continue developing as individuals and professionally, so that through self-care they can achieve greater efficiency and comprehensiveness in their care, while improving their health and self-realization. OBJECTIVE: describing the psycho-spiritual abilities in Nursing proposed by San Juan de Dios, influenced by his spiritual guide San Juan de Ávila. METHODOLOGY: we carried out a historiographic study following the current of the history of mentalities. Documentary analysis: from his youth, Juan de Dios knew that his vocation was to take care of all kinds of injustices, especially those most vulnerable such as the poor and the sick. However, he had certain difficulties to stay healthy, being his spiritual guide who was marking the development of psycho-spiritual abilities so that, through self-care, he could take care of the other without suffering in his body or in his spirit. These skills were what gave him his human and caring quality, taking care of the other in an integral way without abandoning himself, turning the profession into a path of personal development. CONCLUSIONS: the father of modern nursing developed 3 psychological abilities and 3 spiritual abilities per dyad, which today are described as empathy-compassion, unconditional acceptance-hospitality, and authenticity-presence. With this, through self-care he came to create a Nursing that even today is maintained over time

Por uma sociologia da autoajuda: o esboço de sua legitimação na sociedade contemporânea / Toward a sociology of self-help: an outline of its legitimacy in contemporary society

Resumo Este artigo tem como objetivo revisar o tema da autoajuda, esquematizando a origem do conceito e sua ligação com temáticas cotidianas e ramos acadêmicos responsáveis pela construção desse fenômeno. Para isso, o ponto de partida é o pensamento de intelectuais que procuram expor como a autoajuda acompanha o percurso do mundo do trabalho e do sistema capitalista, apropriando-se de artifícios de legitimação. Busca-se apontar caminhos pelos quais é possível abordar a temática da autoajuda para além de sua crítica como literatura supérflua.

Abstract This article reviews the topic of self-help, from the origin of this concept to its connection with everyday themes, as well as the branches of academia responsible for the construction of this phenomenon. The starting point in this process is intellectual thinking meant to show how self-help is present in the world of work and the capitalist system, appropriating methods of legitimation. Ways of addressing the topic of self-help are sought out, beyond its critiques as superfluous literature.

Recurrent themes in the history of the home use of electrical stimulation: Transcranial direct current stimulation (tDCS) and the medical battery (1870-1920).

BACKGROUND: In recent years, neuroscientists and ethicists have warned of the dangers of the unsupervised home use of transcranial direct current stimulation (tDCS), in which individuals stimulate their own brains with low levels of electricity for self-improvement purposes. Although the home use of tDCS is often referred to as a novel phenomenon, in reality the late nineteenth and early twentieth century saw a proliferation of electrical stimulation devices for home use. In particular, the use of an object known as the medical battery bears a number of striking similarities to the modern-day use of tDCS. OBJECTIVE: This article reviews a number of features thought to be unique to the present day home use of brain stimulation, with a particular focus on analogies between tDCS and the medical battery. METHODS: Archival research was conducted at the Bakken Museum and at the American Medical Association's Historical Health Fraud Archives. RESULTS: Many of the features characterizing the contemporary home use tDCS-a do-it-yourself (DIY) movement, anti-medical establishment themes, conflicts between lay and professional usage-are a repetition of themes that occurred a century ago with regard to the medical battery. A number of features, however, seem to be unique to the present, such as the dominant discourse about risk and safety, the division between cranial and non-cranial stimulation, and utilization for cognitive enhancement purposes. CONCLUSION(S): Viewed in the long durée, the contemporary use of electrical stimulation at home is not a novel phenomenon, but rather the latest wave in a series of ongoing attempts by lay individuals to utilize electricity for therapeutic purposes.

The Common-Sense Model of Self-Regulation (CSM): a dynamic framework for understanding illness self-management.

The Common-Sense Model of Self-Regulation (the "Common-Sense Model", CSM) is a widely used theoretical framework that explicates the processes by which patients become aware of a health threat, navigate affective responses to the threat, formulate perceptions of the threat and potential treatment actions, create action plans for addressing the threat, and integrate continuous feedback on action plan efficacy and threat-progression. A description of key aspects of the CSM's history-over 50 years of research and theoretical development-makes clear the model's dynamic underpinnings, characteristics, and assumptions. The current article provides this historical narrative and uses that narrative to highlight dynamic aspects of the model that are often not evaluated or utilized in contemporary CSM-based research. We provide suggestions for research advances that can more fully utilize these dynamic aspects of the CSM and have the potential to further advance the CSM's contribution to medical practice and patients' self-management of illness.

'No "Sane" Person Would Have Any Idea': Patients' Involvement in Late Nineteenth-century British Asylum Psychiatry.

In his 1895 textbook, Mental Physiology, Bethlem Royal Hospital physician Theo Hyslop acknowledged the assistance of three fellow hospital residents. One was a junior colleague. The other two were both patients: Walter Abraham Haigh and Henry Francis Harding. Haigh was also thanked in former superintendent George Savage's book Insanity and Allied Neuroses (1884). In neither instance were the patients identified as such. This begs the question: what role did Haigh and Harding play in asylum theory and practice? And how did these two men interpret their experiences, both within and outside the asylum? By focusing on Haigh and Harding's unusual status, this paper argues that the notion of nineteenth-century 'asylum patient' needs to be investigated by paying close attention to specific national and institutional circumstances. Exploring Haigh and Harding's active engagement with their physicians provides insight into this lesser-known aspect of psychiatry's history. Their experience suggests that, in some instances, representations of madness at that period were the product of a two-way process of negotiation between alienist and patient. Patients, in other words, were not always mere victims of 'psychiatric power'; they participated in the construction and circulation of medical notions by serving as active intermediaries between medical and lay perceptions of madness.

Alcoolismo e estética da existência: Jack London e a lógica branca de John Barleycorn / Alcoholism and the aesthetics of existence: Jack London and the white logic of John Barleycorn

Elaborada durante as discussões da Lei Seca e o Sufrágio Universal nos EUA, no início do século XX - duas emendas que seriam aprovadas no sistema constitucional americano -, Memórias alcoólicas, do escritor norteamericano Jack London, é considerada uma obra referencial sobre o tema do alcoolismo. Tendo esse tema como fio condutor, o artigo analisa como a sua prosa se constitui em prática de si enquanto construção de subjetividade e organização da existência. Investiga como essa obra estabelece relações com a temática do cuidado de si, problematizada por Michel Foucault nos volumes 2 e 3 da História da sexualidade, acerca da estética da existência e das artes de viver presentes no universo social greco-romano e helenístico.

Employing this theme as a guideline, this article examines how his prose amounts to self-practice in the construction of subjectivity and the organization of existence. It investigates how this work is related to the theme of self-care, analyzed by Michel Foucault in volumes 2 and 3 of the History of sexuality, as regards the aesthetics of existence and the art of living which existed in the Greco-Roman and Hellenistic worlds.

[Alcoholism and the aesthetics of existence: Jack London and the white logic of John Barleycorn]. / Alcoolismo e estética da existência: Jack London e a lógica branca de John Barleycorn.

Employing this theme as a guideline, this article examines how his prose amounts to self-practice in the construction of subjectivity and the organization of existence. It investigates how this work is related to the theme of self-care, analyzed by Michel Foucault in volumes 2 and 3 of the History of sexuality, as regards the aesthetics of existence and the art of living which existed in the Greco-Roman and Hellenistic worlds.

A social cognitive view of self-regulated learning about health.

Researchers interested in health-related learning have recently begun to study processes people use to self-regulate their health and their ability to prevent or control chronic disease. This paper represents a social cognitive view of self-regulation that involves three classes of influence on self-regulating behavior: personal, behavioral, and environmental. This triadic model assumes that people self-regulate their health through the use of self-care strategies, setting reasonable health goals, and monitoring feedback concerning the effectiveness of strategies in meeting their goals. People's perceptions of self-efficacy are also assumed to play a major role in motivating them to self-regulate their health functioning. According to social cognitive theory, processes entailed in regulating one's health can be taught through social modeling, supports, and feedback; gradually these external supports are withdrawn as one is able to self-regulate. This paper will analyze self-regulation processes related to controlling or preventing lung disease, specifically management of asthma and eliminating smoking. The educational implications of the triadic model of self-regulation for promoting health and related behavioral functioning will be discussed.

A model of self-regulation for control of chronic disease.

Chronic disease poses increasing threat to individual and community health. The day-to-day manager of disease is the patient who undertakes actions with the guidance of a clinician. The ability of the patient to control the illness through an effective therapeutic plan is significantly influenced by social and behavioral factors. This article presents a model of patient management of chronic disease that accounts for intrapersonal and external influences on management and emphasizes the central role of self-regulatory processes in disease control. Asthma serves as a case for exploration of the model. Findings from a 5-year study of 637 children with asthma and their care-taking parents supported that the self-regulation elements of the model were reasonably stable over time and baseline values were predictive of important disease management outcomes.

Self-management in patients with COPD: theoretical context, content, outcomes, and integration into clinical care.

In this narrative review, we put self-management in the context of a 50-year history of research about how patients with COPD respond to their illness. We review a definition of self-management, and emphasize that self-management should be combined with disease management and the chronic care model in order to be effective. Reviewing the empirical status of self-management in COPD, we conclude that self-management is part and parcel of modern, patient-oriented biopsychosocial care. In pulmonary rehabilitation programs, self-management is instrumental in improving patients' functional status and quality of life. We conclude by emphasizing how studying the way persons with COPD make sense of their illness helps in refining self-management, and thereby patient-reported outcomes in COPD.

Conhecimento da doença em pacientes com insuficiência cardíaca / Disease knowledge of patients with heart failure

Uma das maiores dificuldades na adesão ao tratamento de portadoresde insuficiência cardíaca (IC) é a falta de conhecimentosobre a doença e seu tratamento. Este estudo teve como objetivoavaliar o conhecimento do paciente com IC em relação à suadoença. Estudo de natureza descritiva e exploratória realizado noambulatório de Cardiologia de um hospital terciário no interiordo Estado de São Paulo. O conhecimento foi avaliado por meiodo questionário de avaliação do conhecimento e autocuidado daIC. Fizeram parte desta amostra 32 pacientes com idade médiade 61 (± 12) anos. Os pacientes apresentaram média de acertosde 11,4% (± 7), sendo que 44% conheciam sobre a afecção, 25%souberam relatar os sintomas de IC, 31% responderam corretamentea ação do IECA e 28% da digoxina; entretanto, pequenaparcela soube informar os efeitos adversos desses medicamentos.Referente ao tratamento não farmacológico, 16% dos pacientesresponderam corretamente sobre o consumo de bebidas alcoólicas,34% sobre os alimentos que contribuem na soma de líquidosingeridos por dia e 31% entendem a importância do controlede peso. Este estudo revelou que os pacientes portadores de ICapresentaram baixa média de acertos sobre o conhecimento,tratamento e autocuidado. A ampliação do conhecimento dospacientes, com implementação de novas estratégias, constituiaspecto relevante para a mudança do seu comportamento e,consequentemente, melhora do autocuidado.

A major difficulty with treatment adherence in patients withheart failure (HF) is the lack of knowledge about the diseaseand its treatment. This study aimed to assess the knowledgeof patients with HF in relation to their disease. Study of descriptiveand exploratory nature performed in cardiology clinicof a tertiary hospital in the countryside of the state of SãoPaulo. The knowledge was assessed through a questionnaireevaluating knowledge and self-care of HF. This questionnairewas applied in a sample of 32 patients with a mean age of 61years old (± 12). Patients had mean score correct of 11.4%(± 7), 44% knew about the disease, 25% were able to reportthe symptoms of HF, 31% answered correctly the action ofACE inhibitors and 28% knew about the action of digoxin.A small part, however, could inform the adverse effects ofthese drugs. Referring to non-pharmacological treatment,16% of patients answered about the consumption of alcoholicbeverages, 34% about foods that contribute to add to theliquid ingested per day and 31% understood the importanceof weight control. This study showed that patients with HFhad low score correct on knowledge, treatment and self-care.Broadening knowledge of patients with implementation ofnew strategies is a relevant aspect to change their behaviorand therefore improve self-care.

Que(e)rying the clinic before AIDS: practicing self-help and transversality in the 1970s.

In this paper, I offer a treatment of "the clinic" in which the clinic-as concept and space-is que(e)ried, that is, both questioned and made queer. I present two historical case studies that queer clinical thought and practices in the period before AIDS and before the full-blown arrival of queer theory on the western theoretical landscape. These two cases-the practice of self-help developed in the women's health movement in the United States and the practice of tranversality developed out of and beyond the Institutional Psychiatry movement in France-challenge the practice of medicine in the prehistory of both AIDS and queer theory, yet, they are not generally seen as precursors, or related in any way, to AIDS activism. In a sense, then, I also want to question and make queer the history of AIDS as we conventionally know it today by extending that history backwards and outwards to earlier queer critical and clinical practices like self-help and transversality.

Management of the bladder in traumatic injuries of the spinal cord during the First World War and its implications for the current practice of urology.

What's known on the subject? and What does the study add? Prior to the First World War, traumatic injuries to the spinal cord rapidly led to death from severe infections of the bladder. During the Second World War, Ludwig Guttmann resurrected the use of intermittent catheterisation at Stoke Mandeville Hospital, by meticulous attention to detail and was so successful, that this method was introduced into general urological practice. Historical review of the management of the bladder in patients with spinal injuries. Spinal injury patients--literature review--personal experience at Stoke Mandeville Hospital. Review of the different methods of catheterisation from the 19th century to today. Methods learned from the management of the bladder of spinal injuries patients were adopted into mainstream urology.