Chronic disease self-management education

Self management programs for chronic conditions, such as asthma, have an important place in healthcare delivery. When properly implemented, they can curb the impact of disease and reduce both the high personal costs for individuals and significant financial costs for health care systems. The purpose of this review was to establish an understanding of current published literature on asthma self management programs in adults and to identify any reported attributes or components which serve to either assist or obstruct the uptake of self management strategies. Electronic data sources including Scopus, Proquest 5000, CINAHL, PubMed and Web of Science were accessed and literature searches were conducted using the key terms: asthma, chronic disease, self management, morbidity, quality of life, health outcomes, patient education and best practice. Inclusion criteria for the search included journal articles relating to adults with asthma published in English in peer reviewed journals from 1995 to 2011. Exclusion criteria included research targeting children, parents of children or families; and articles examining Asthma and COPD (or any other co-morbidity). Sixty four articles were included in this review due to their relevance to the major components of asthma self management, as defined by the Australian Asthma Management Handbook. A major conclusion from this review was that the uptake of asthma self management strategies is poor despite global recommendations for over twenty years; and that a likely reason for this is that generic asthma self management advice does not engage the individual with asthma.

Diabetes Mellitus leads to death if it is not prevented at the initial phase when seeing signs, symptoms, and pain. Diabetes Mellitus is a health crisis in Fiji today. The aim of this paper is a systematic review of diabetes in Fiji. 
The research gathered findings from available medical journals, articles, discussion papers, and reports from previous researchers on Diabetes Mellitus and its health effects within the period of 2007 to 2017. The research study uses 54 articles including databases, reports, journals, discussion and research paper, and media link relevant to the study topic. 
Diabetes mellitus was the number one leading disease in 2007 & 2010. From 2012 to 2017 it was still ranked as the number one NCD disease in Fiji. It was identified that indigenous Fijians iTaukei had higher rates than on non-Fijian population. Males were identified as having higher rates of Diabetes mellitus than females. However females also reported higher rates of Gestational Diabetes mellitus. The review found that Diabetes mellitus was also the cause of poor sedentary lifestyle such as diet, a lack of physical activity and poor nutrition. There was poor management by diabetic patients in controlling there diabetes, an increase in weight, an increase in high Body Mass Index rates, high rates of eye disease, and  high rates of amputations.                           
There are numbers of interventions, awareness, and services provisions in Fiji. The National Ministry of Health and its partners in the country are working together in partnerships to promote national wellness and well-being programmes, and reduce premature mortality and morbidity for diabetes mellitus.  The partners consist of non-governmental organisations, faith based organisations, civil society organisations, the private sector, other government Ministries, and non-health organisations. The recommendations were made to upscale and improve the healthcare system in Fiji that benefits all Fijians.

Planning for a Baby:  https://youtu.be/2iwLh6XCnq8

Pregnancy with IBD: https://youtu.be/br0kciD8xJk

Motherhood with IBD: https://youtu.be/TQjt8pnMv4I


Our aim is to provide an understanding of the experience of women with inflammatory bowel disease (IBD) who have made the transition to motherhood. A total of 22 mothers with IBD were recruited from around the United Kingdom. Semi-structured interviews were conducted and analyzed using thematic analysis. The central concept—Blurred Lines—offers a novel frame for understanding the transition to motherhood with IBD through identifying parallels between having IBD and becoming, and being, a mother. Parallels clustered into three main themes: Need for Readiness, Lifestyle Changes, and Monitoring Personal and Physical Development. Hence, women with IBD are in some ways well prepared for the challenges of motherhood even though, as a group, they tend to restrict their reproductive choices. We recommend health professionals initiate conversations about reproduction early and provide a multidisciplinary approach to pregnancy and IBD in which women have confidence that their ongoing treatment will be integrated successfully with their maternity care.

Una empresa farmacéutica global cuenta con una de las tres más importantes marcas de biológicos para tratar una enfermedad crónica y recientemente desarrolló una nueva indicación del fármaco que requería de una estrategia innovadora para posicionar la marca en el mercado.

Objective: To systematically review empirical evidence regarding the efficacy of depression selfmanagement support (SMS) interventions for improving depression symptomatology and preventing relapse. Methods: Pubmed and PsycINFO databases were searched for relevant articles on depression SMS interventions. Scanning of references in the articles and relevant reviews and communications with field experts yielded additional articles. Two independent reviewers analyzed the articles for inclusion and data was extracted from the selected articles. Results: 13 papers met the inclusion criteria and reported the results of six separate studies, including three pilot studies. The results were mostly positive. A majority of the trials assessing depression severity changes found SMS to be superior to care as usual. SMS interventions were found to improve selfmanagement behaviors and self-efficacy. Mixed results were found concerning relapse rates. Promising results were found on assessments of functional status. Based on the findings, cost-effectiveness remains unclear. Conclusion: SMS has been mostly examined through pilot studies with insufficient power. The results are promising, but larger randomized controlled trials are needed. Practice implications: SMS interventions can be administered by non-physician professionals and are well accepted by patients, but more research is needed before we can recommend implementing specific depression SMS approaches in primary care. ß

Introduction: International clinical guidelines
consistently endorse the promotion of selfmanagement
(SM), including physical activity for
patients with chronic low back pain (CLBP) and
osteoarthritis (OA). Patients frequently receive
individual treatment and advice to self-manage from
physiotherapists in primary care, but the successful
implementation of a clinical and cost-effective group
SM programme is a key priority for health service
managers in Ireland to maximise long-term outcomes
and efficient use of limited and costly resources.
Methods/analysis: This protocol describes an
assessor-blinded cluster randomised controlled
feasibility trial of a group-based education and exercise
intervention underpinned by self-determination theory
designed to support an increase in SM behaviour in
patients with CLBP and OA in primary care
physiotherapy. The primary care clinic will be the unit
of randomisation (cluster), with each clinic randomised
to 1 of 2 groups providing the Self-management of
Osteoarthritis and Low back pain through Activity and
Skills (SOLAS) intervention or usual individual
physiotherapy. Patients are followed up at 6 weeks, 2
and 6 months. The primary outcomes are the (1)
acceptability and demand of the intervention to patients
and physiotherapists, (2) feasibility and optimal study
design/procedures and sample size for a definitive trial.
Secondary outcomes include exploratory analyses of:
point estimates, 95% CIs, change scores and effect
sizes in physical function, pain and disability
outcomes; process of change in target SM behaviours
and selected mediators; and the cost of the
intervention to inform a definitive trial.
Ethics/dissemination: This feasibility trial protocol
was approved by the UCD Human Research Ethics—
Sciences Committee (LS-13-54 Currie-Hurley) and
research access has been granted by the HealthServices Executive Primary Care Research Committee
in January 2014. The study findings will be
disseminated to the research, clinical and health
service communities through publication in peer reviewed
journals, presentation at national and
international academic and clinical conferences.
Trial registration number: ISRCTN 49875385;
Pre-results.

ID: 329 Fachbereich: Prävention sozial und nachhaltig gestalten Themenbereich: Sozialepidemiologie/ Psychosoziale Einflüsse auf Gesundheit Beitragsart: Beitrag zu organisierter Veranstaltung Psychosocial stress as an indicator for disease severity, mental health and health care utilization in IBD patients. Evaluation of a short scale of perceived stress in chronic diseases J Hardt, S Conrad, C Muche-Borowski, H Raspe

The authors used grounded theory to explore and develop a substantive theory to explain how 20 young women with type
1 diabetes managed their lives when facing turning points and undergoing transitions. The women experienced a basic
social problem: being in the grip of blood glucose levels (BGLs), which consisted of three categories: (a) the impact of
being susceptible to fluctuating BGLs, (b) the responses of other people to the individual woman’s diabetes, and (c) the
impact of the individual women’s diabetes on other people’s lives. The women used a basic social process to overcome
the basic social problem by creating stability, which involved using three interconnected subprocesses: forming meaningful
relationships, enhancing attentiveness to blood glucose levels, and putting things in perspective. Insights into the
processes and strategies used by the women have important implications for provision of care and service delivery.

IBD is an overarching term that defines severe digestive disorders such as Crohn's disease and ulcerative colitis Comment on this article Women with inflammatory bowel disease (IBD) need more advice about pregnancy in order to make informed choices about their pregnancy. A research project that documented the experiences of 22 women and found that some had decided not to have children, or restrict their family size, and many women feared the consequences of pregnancy. 'It is desperately sad that women are opting to remain childless because they are unable to get an accurate picture of the risks they face,' said Anna Madill, a supervisor of the research. 'If they have access to that information, they may make an entirely different choice. The healthcare system needs to make sure that women living with IBD have access to all the facts necessary to make a fully informed decision.' Participants were concerned that they would pass down the condition to their children as well as worried that they would be unable to cope with a small child during periods when their condition would flare-up. IBD is an overarching term that defines severe digestive disorders such as Crohn's disease and ulcerative colitis, both of which can cause severe stomach pains, weight loss, and recurring diarrhoea. There is no cure for IBD and people living with the condition will experience periods of stability, with no symptoms, and then periods of flare-ups which be debilitating and affect quality of life. In the UK, 1 in 250 people have the condition and its incidence is increasing. The researchers, from the University of Leeds, made three films featuring participants describing their experiences of living with, being pregnant with, and being a mother with IBD. 'One of the main points to emerge from the study is that learning to live with a chronic illness has helped the women prepare for motherhood,' added Ms Madill. 'These women coped well with becoming parents.'

Objectives: This article aims to elaborate chronotope disruption - a changed relation to time and space - as a sensitizing concept for understanding chronic illness narratives. Methods: Sixteen men and 16 women with Type 2 diabetes were purposefully sampled. Each was interviewed about his or her experience of diabetes self-management using the biographical-narrative interview method. Transcripts were inspected for key moments defined as emotionally laden stories relevant to the purpose of the research. We present dialogically inflected discursive analysis of exemplar extracts. Results: The analysis demonstrates how the concept of chronotope disruption helps identify, and understand, important aspects of patients’ chronic illness narratives. First, we investigate how medical advice can conflict with embodied experience and how progressive bodily deterioration can provoke a reevaluation of past illness (self-mis)management. Second, the increasing temporal and spatial intrusion of chronic illness into participants’ lives is examined. Finally, we focus on the masquerade of health as an attempt to manage, hide, or deny that one is physically challenged. Conclusions: Chronotope disruption offers a useful sensitizing concept for approaching chronic illness narratives and around which to organize analytical insights and to develop practice. Chronotope analysis fills an important gap in the science
through compensating current health sciences’ focus on rationality, cognition, and prospective time (prediction) with a patient-oriented focus on emotionality, embodiment, and retrospective time (nostalgia). Chronotope disruption could be used to develop practice by gaining empathic understanding of patients’ life-worlds and provides a tool to examine how new technologies change the way in which the chronically ill have “being” in the world.

Objective: To systematically review empirical evidence regarding the efficacy of depression self-management support (SMS) interventions for improving depression symptomatology and preventing relapse. Methods: Pubmed and PsycINFO databases were searched for relevant articles on depression SMS interventions. Scanning of references in the articles and relevant reviews and communications with field experts yielded additional articles. Two independent reviewers analyzed the articles for inclusion and data was extracted from the selected articles. Results: 13 papers met the inclusion criteria and reported the results of six separate studies, including three pilot studies. The results were mostly positive. A majority of the trials assessing depression severity changes found SMS to be superior to care as usual. SMS interventions were found to improve self-management behaviours and self-efficacy. Mixed results were found concerning relapse rates. Promising results were found on assessments of functional status. Based on the findings, cost-effectiveness remains unclear. Conclusion: SMS has been mostly examined through pilot studies with insufficient power. The results are promising, but larger randomized controlled trials are needed. Practice implications: SMS interventions can be administered by non-physician professionals and are well accepted by patients, but more research is needed before we can recommend implementing specific depression SMS approaches in primary care.

Epilepsy is a chronic neurological disorder, which restricts the patient in a range of activities, it has a profound effect on the health and quality of life. Epilepsy may limit the development of independence, social functioning and peer relationships, especially for adolescents it considered a powerful trigger of many psychological and social problems. The pediatric nurse has an important role in helping adolescents to overcome these problems through developing a strategy ensuring the adherence to self-management skills which consequently improve their quality of life. This study aimed to evaluate the effect of an educational program for adolescents with epilepsy on their quality of life and self-management skills. Design: Quasi-experimental design for one group was utilized in carrying out the study at the Pediatric Neurological Unit and Epilepsy Clinic of Mansoura University Children's Hospital, on a sample of 55 adolescents diagnosed with epilepsy for at least 6 months. Dat...

Background: COPD often occurs in the presence of co-morbidities which impact its presentation and management. Primary care patients usually have low self-efficacy in terms of disease knowledge and healthcare utilisation for their COPD.

Aims: The Activating Primary Care COPD Patients with Multi-morbidity (APCOM) pilot study aimed to empower patients with their COPD self-efficacy and overall health behaviour in general practices in Sydney, Australia.

Methods: This interventional study included patients aged 40 to 84 years with a spirometry diagnosis of COPD and at least one other co-morbidity. A self-management education program (SMEP) for COPD in the context of multi-morbidity, developed by the researchers, was tailored and delivered to the patients by trained practice nurses (PNs). Impact of the SMEP was assessed by Patient Activation Measure, COPD Knowledge Questionnaire, COPD Assessment Test, Multimorbidity Illness Perceptions Scale, Morisky Medication Adherence Scale and accuracy of inhaler technique. Qualitative evaluation of the SMEP was done by interviewing PNs, general physicians (GPs) and patients.

Results: Pre and post-test comparison of data from 44 patients who completed 6 months’ follow-up show significant improvement in patient activation (p<0.001), COPD knowledge (p<0.001), impact of COPD (p=0.012) and accuracy of inhaler technique (p=0.001). The qualitative interviews, currently being analysed, have yielded mostly positive feedback.

Conclusions: The study successfully increased self-efficacy of COPD patients and their overall health behaviour, forming an evidence base to test the SMEP in a future randomised controlled trial.

Aims & rationale: Understanding of chronic obstructive pulmonary disease (COPD) and uptake of relevant healthcare by patients is suboptimal, especially in primary care, further complicated by the presence of co-morbidities. This innovative pilot project aims to empower primary care COPD patients with multi-morbidity by improving their disease knowledge and self-efficacy through a practice nurse-delivered, tailored self-management intervention.

Methods: Potential participants (N=40) will be identified from Sydney general practices based on: i) age between 40 - 84 years, ii) COPD diagnosis ≤ 24 months, iii) presence of one or more co-morbidity and iv) history of smoking. Following an initial needs assessment, the self-management intervention based on Health Belief Model will be tailored by trained practice nurses and delivered to patients in subsequent one-to-one sessions. The intervention framework, which includes constructs from renowned self-care models, will involve active engagement of patients with strategies towards enhancing their COPD knowledge, self-management capacity and prioritisation of multiple chronic conditions. Impact of the intervention will be measured by pre and post-test outcome measures covering activation, knowledge, beliefs and self-efficacy regarding COPD and multi-morbidity. After a 6-month follow-up period, feasibility and sustainability of the intervention will be evaluated by qualitative feedback from participating healthcare providers.

Relevance to policy, research and/or practice needs: No prior study has focused on improving self-efficacy of recently-diagnosed COPD patients with multi-morbidity. The project seeks to motivate these patients to actively manage their COPD while effectively balancing other chronic conditions, which will lead to improved long-term health outcomes, better healthcare utilisation and enhanced patient-provider relationships.

In the United States, chronic pain is often poorly treated at an exceedingly high cost. The use of the biomedical model to manage pain is frequently ineffective, and evidence suggests that the biopsychosocial (BPS) model is a better choice. A problem with the BPS model is that it has not been operationalized in terms of patient behavior. This commentary addresses that issue by suggesting that people with chronic pain and illness participate daily in four self-management health behaviors: socialize, work, exercise, and meditation, and discusses evidence that supports these recommendations. These self-management behaviors may decrease pain and thus reduce the need for pain medications and other medical interventions. Additional topics include patient adherence and health coaching.

Women with inflammatory bowel disease (IBD) should be given more advice about pregnancy so they can make informed choices about whether to have a family, say researchers. In their paper in the journal Qualitative Health Research, the scientists draw on evidence that women with the disease often decide not to have children, or to restrict the size of their family, because of fears the pregnancy would affect their health or that of their baby. Although inflammatory bowel disease can cause complications during pregnancy, research shows that one third of women with the condition will not get worse and another third will actually see an improvement in their health. The study, led by the University of Leeds, chronicled the experiences of 22 women who have had children, to plug an information gap about the realities of becoming a mother with IBD.

This video talks about how women with IBD cope with young children within the early years of motherhood. If you want to find out more about planning for a baby with IBD click here: https://www.youtube.com/watch?v=2iwLh6XCnq8&t=4s

For more information on pregnancy and IBD click here: https://www.youtube.com/watch?v=br0kciD8xJk&t=5s

Background music "Where I am From" by Topher Mohr and Alex Elena (taken from YouTube audio Library, free to use)

If you wish to know more about the study "IBD and Mums-to-Be" you can follow us on Facebook or Twitter @IBDandMumstoBe

This video talks about the challenges and considerations women with IBD face when planning for a baby. The stories end well for all the mums we interviewed as they all went on to have successful pregnancies and healthy babies.

For more information on planning for a child within the context of IBD check Crohn's and Colitis UK's website: https://www.youtube.com/watch?v=2iwLh6XCnq8&t=4s
To watch a video on pregnancy with IBD click here: https://www.youtube.com/watch?v=br0kciD8xJk&t=5s

To watch a video on the early years of motherhood with IBD click here: https://www.youtube.com/watch?v=TQjt8pnMv4I&t=10s

Background music "Where I am From" by Topher Mohr and Alex Elena (taken from YouTube audio Library, free to use)

If you wish to know more about the study "IBD and Mums-to-Be" you can follow us on Facebook or Twitter @IBDandMumstoBe

Background: Self-management support interventions can improve health outcomes, but their impact is limited by the numbers of people able or willing to access them. Men's attendance at existing self-management support services appears suboptimal despite their increased risk of developing many of the most serious long term conditions. The aim of this review was to determine whether current self-management support interventions are acceptable and accessible to men with long term conditions, and explore what may act as facilitators and barriers to access of interventions and support activities.

Type 2 diabetes is a metabolic disorder characterized by chronically elevated blood glucose and high risk of comorbidities. In this article we report a metasynthesis of the 21st-Century qualitative research concerning the self-management of type 2 diabetes. We identified 38 relevant articles (sample size range 6 to 175), which were synthesized through a process of iterative reading and theory development. In this literature, authors argued and assumed that diabetes management is influenced by multiple, complex, competing factors, including interpersonal relations, gender, and sociocultural context. Conversely, self-management was sometimes construed as a facet of individual agency and was accepted uncritically, placing accountability for health with patients themselves. We conclude that a satisfactory account of diabetes care would pay attention to the “inner” world, while acknowledging the social and political conditions in which diabetes-related experiences unfold.

The aim of this study was to provide baseline data on chronic disease management (CDM) provision in Irish general
practice (GP). The survey instrument was previously used in a study of primary care physicians in 11 countries, thus
allowing international comparisons. The response rate was 72% (380/527).The majority of GPs (240/380; 63%) reported
significant changes are needed in our health care system to make CDM work better. Small numbers of routine clinical
audits are being performed (95/380; 25%). Irish GPs use evidence based guidelines for treatment of diabetes (267/380;
71%), asthma / COPD (279/380; 74%) and hypertension (297/380; 79%), to the same extent as international counterparts.
Barriers to delivering chronic care include increased workload (379/380; 99%), lack of appropriate funding (286/380;
76%), with GPs interested in targeted payments (244/380; 68%). This study provides baseline data to assess future
changes in CDM.

A study chronicling the experiences of women with inflammatory bowel disease (IBD) during and after pregnancy found nurses and midwives were often unable to provide information and advice.

The qualitative research, led by the University of Leeds, is based on detailed interviews with 22 women who have both been diagnosed with the condition and have given birth to children.......

Introduction: One of the factors which increase the rehabilitation efficacy and accelerate the convalescence and return to society of the patients after myocardial infarction may be the self-care attitude. Therefore it seems justifiable to seek such factors which will affect the self-care level. Self-estimation belongs to the most important determinants of coping efficacy and undertaking health behaviours. Considering that health behaviours may be treated as a behavioural manifestation of
the self-care attitude, it is probable that the correlation between the self-image and self-care attitude appears to be strong.
Aim: The aim of the research was determination of the strength of the correlation between the level of self-image and selfcare attitude as well as the care types in patients after myocardial infarction. Methods: The study involved 127 persons who had myocardial infarction for the first time and did not undergo any other severe concomitant illnesses. The study covered 28 women and 99 men aged from 39 to 81, with the average age 57.74. The study consisted in completing the KTS questionnaire measuring the self-care level and OS questionnaire measuring the self-image level. The results were analysed statistically
and discussed. Results: Analysis of the levels of self-care and self-image in patients after myocardial infarction showed a strong correlation between those variables at the 0.01 significance level. It is a linear correlation which means that the higher the self-image level, the higher the self-care level. This rule applies to each of the care dimensions, i.e. responsibility, involvement and future perspective as well as each of the types of self-care.
Conclusions: The research indicated a strong correlation between the self-care level and types and the self-image level in those who underwent myocardial infarction. It appeared that the higher the self-image level after myocardial infarction, the higher the self-care level and the fuller
the self-care. Therefore the self-acceptance level should be increased in the patient, because in the case of those who underwent myocardial infarction it is extremely important for development of the self-care attitude. A change in the self-image from negative into positive may be directly translated into an increase in the self-care level.

Motivation -Thanks to the mobile measurement and tele-care technology, it becomes possible to build self-management support systems for renal transplant patients. This project aims to provide (1) a trusted and accepted self-management support systems for renal transplant patients, (2) guidelines for building a virtual coach for supporting feedback in the self-management support system for chronic disease self-management, and (3) an overview of the human factors that should be taken into account in self-management support system development processes.

Diabetes, a chronic disease affecting over 29 million people in the United States, requires the integration of complex medical tasks into a person’s daily life. Patient-centered care and compassion are recognized as essential dimensions of the quality care experience. This research examined provider attributes that influence adherence to type 2 diabetes mellitus (T2DM) regimens and sought to understand the phenomena of provider attributes, treatment adherence, and their relationship to coping ability and treatment outcomes. This quantitative study sampled 474 people with T2DM using a 62-item online survey administered to three different groups. The sample population included people over age 18 diagnosed with T2DM. The first group included 91 persons with T2DM identified through a Facebook group and personal social media connections, the second group included 120 Amazon Mechanical Turk participants with T2DM, and the third group included 263 respondents from a Qualtrics panel who had T2DM. Results indicated that perceived provider compassion (β = .41, ρ < .001) and optimism (β = .48, ρ < .001) positively affected coping ability. Additionally, full mediation effects for self-management were revealed, with coping ability positively mediating the effect of compassion on self-management and the effects of optimism on self-management. Furthermore, full mediation effects were found for treatment satisfaction, with coping ability positively mediating the effect of compassion on treatment satisfaction and the effects of optimism on treatment satisfaction. This research has implications for patients, healthcare professionals, and leaders suggesting that providers who communicate with optimism and compassion positively affect coping ability. As a result, healthcare providers and professionals have an opportunity to enhance self-management adherence by helping their patients cope with the burdens of diabetes. In addition, this study has implications for developing provider communication tools aimed at assessing patients’ coping capacity and increasing compassionate communication.

Context and aims: Chronic obstructive pulmonary disease (COPD) often occurs in the presence of co-morbidities which impact its presentation and management. Primary care patients usually have low self-efficacy in terms of disease knowledge and healthcare utilisation for their COPD. The Activating Primary Care COPD Patients with Multi-morbidity (APCOM) pilot study aimed to empower patients in terms of their COPD self-efficacy and overall health behaviour in general practices in Sydney, New South Wales, Australia.

Methods: This interventional study included 50 patients aged 40 to 84 years with a spirometry diagnosis of COPD and at least one other co-morbidity. A self-management education program (SMEP) for COPD in the context of multi-morbidity, developed by the researchers, was tailored and delivered to the patients by trained practice nurses in a series of one-to-one sessions. Impact of the SMEP was assessed by Patient Activation Measure, COPD Knowledge Questionnaire, COPD Assessment Test, Multimorbidity Illness Perceptions Scale, Morisky Medication Adherence Scale and accuracy of inhaler technique.

Findings: Pre and post-test comparison of data from 44 patients who completed six months’ follow-up show significant improvement in patient activation (p<0.001), COPD knowledge (p<0.001), reduced impact of COPD (p=0.012) and better accuracy of inhaler technique (p=0.001).

Innovative contribution to practice and research: The study successfully increased self-efficacy of COPD patients and their overall health behaviour through its innovative SMEP. The findings form a strong evidence base to further test the SMEP in a future randomised controlled trial. This capacity-building initiative also promoted collaboration and knowledge translation between the participating stakeholders.

Contemporary disease self-management programs aim to renegotiate the terms on which patients participate in their own health care. Though the notion of 'patient 2.0' has mainly been used to speak to patient empowerment through IT, we therefore propose to view self-management as eliciting "the patient" in a diff erent shape. In this paper, we explore the embedded assumptions, imagined potentials and concrete practices of the Stanford Chronic Disease Self-Management Program (CDSMP), in order to understand how this program reconfi gures a particular form of global patient. To analyse this process we consider the CDSMP as a traveling technology. First, we demonstrate that its successful globalization has been enabled by tying together specifi c forms of theorizing, evidence-basing, and scripting in a theory-methods package. Second, we show that the globalization of the program entails various forms of localization in the national health care setting of Denmark. In this context, we examine diff erent kinds of eff orts required to maintain the 'global' identity of the program even as it is 'localized'. In particular, we show that the insertion of the program into Danish health care generates frictions. Such frictions are brought to light comparatively as Danish health care policy-makers, practitioners, consultants and chronic patients engage with and refl ect upon the characteristics of the program. We argue that this analysis holds implications for 'patient 2.0', both as practical accomplishment and as a conceptual tool for social studies of medicine and health care.

Epilepsy is a chronic neurological disorder, which restricts the patient in a range of activities, it has a profound effect on the health and quality of life. Epilepsy may limit the development of independence, social functioning and peer relationships, especially for adolescents it considered a powerful trigger of many psychological and social problems. The pediatric nurse has an important role in helping adolescents to overcome these problems through developing a strategy ensuring the adherence to self-management skills which consequently improve their quality of life. This study aimed to evaluate the effect of an educational program for adolescents with epilepsy on their quality of life and selfmanagement skills. Design: Quasi-experimental design for one group was utilized in carrying out the study at the Pediatric Neurological Unit and Epilepsy Clinic of Mansoura University Children&#39;s Hospital, on a sample of 55 adolescents diagnosed with epilepsy for at least 6 months. Data...

In past decades, chronic diseases have become a salient social, political and healthcare issue. Empowerment, autonomy and self-management have been defined as medical priorities for the therapeutic support and healthcare of people living with chronic disease. The ways people cope with chronic disease require heterogeneous knowledge, including lay and medical notions and skills, and interactions with a large variety of healthcare professionals and other supporting actors (relatives, friends, patients, etc.). Thus, the complexity of chronic care implies a delegation of part of the medical tasks to patients, in order to enable them to undertake by themselves effective self-care and, in so doing, to improve their quality of life. Indeed, patients' self-management of chronic diseases and their relationship with healthcare practitioners rely more and more on the use of various tools which are expected to be driven by evidence-based knowledge in order to enhance efficient and effective care and self-care. This situation needs an accurate understanding on how techniques and tools do or not contribute to this effective self-care. In this increasingly widespread situation, knowledge translation appears to be inseparable from practices, whose understanding requires the analysis of activities in which actors are involved and tools that mediate their activity in chronic (self-)care management. A sharp focus upon practices, contexts of use and tools could thus produce a better understanding of the production, transmission, transformation and negotiation of knowledge between the actors involved in the management of chronic diseases. This interdisciplinary conference aims at crossing concepts and empirical research on the processes through which knowledge translation takes place in the self-management of chronic diseases, with a specific scrutiny of the expected and actual functions of the tools and the context in which translation occurs, on the one hand, and of the difficulties and negotiations that people living with a chronic disease face in gaining autonomy, on the other hand. For this purpose, the conference brings together scholars working within different disciplines as well as healthcare practitioners, designers of medical devices and policy makers, i.e. actors who contribute to the ongoing reflection on these salient issues.

Background: Understanding of COPD and uptake of evidence-based healthcare by patients is suboptimal in primary care, particularly in the context of multi-morbidity. This innovative study aims to empower primary care COPD patients with co-morbidities by improving their disease knowledge and self-efficacy by piloting a practice nurse-delivered, tailored self-management programme in Sydney, Australia.

Methods: Potential COPD patients with co-morbidities were recruited from participating general practices. Following an initial needs assessment, the self-management programme is being tailored by trained practice nurses and delivered to patients in subsequent one-to-one sessions. The programme, based on constructs from the Health Belief Model, involves active engagement of patients with strategies aimed at enhancing their COPD knowledge, self-management capacity and skills in prioritisating multiple chronic conditions. Primary outcome of the study is assessment of patient knowledge, skills and self-management capacity of multiple chronic conditions using the Patient Activation Measure (PAM). Secondary outcome measures include COPD Knowledge Questionnaire, COPD Assessment Test, Multi-morbidity Illness Perceptions Scale, Morisky Medication Adherence Scale and accuracy of inhaler technique.

Findings: The study is currently in the phase of intervention delivery and follow-up. The average PAM score from baseline data of 49 participants (24 male and 25 female, mean age: 69.2) was 57.67, indicating lack of confidence and skill to modify health behaviour. Impact of the programme will be tested by comparing pre and post-test outcome measures after six months’ follow-up. Feasibility and sustainability will be evaluated by qualitative feedback from participating clinicians.

Implications: There has been good uptake of the programme by participating nurses following training workshops conducted by the researchers. We have faced challenges in practice recruitment and patient retention, mainly due to their co-morbidities. A first of its kind, our study could lead to improved long-term health outcomes, healthcare utilisation and patient-provider relationships. The study also broadens the practice nurse’s role in patient empowerment, which is vital given the surge in multi-morbidity worldwide.

Aim: To describe the evaluation of the NBN enabled telehealth pilot of Feros Care’s My Health Clinic at Home (MHCAH which involves daily vital-sign monitoring which is triaged by a telehealth nurse and video-conferencing.
Methods: A mixed methods, prospective, uncontrolled study design was used to capture learning on the processes of implementation and the impact of the project on clients. Data sources included surveys with service users and providers, pre-post test clinical data, audit data, documentary evidence from meetings and interviews and focus groups. 
Results: Overall, 181 of 200 clients recruited to the trial between April 2013 and June 2014 were included in the evaluation. Most clients (64%) self-referred into the pilot with the goals of monitoring their own health (68%) and identifying problems before they became serious (65%).Clients reported that as a result of participating in MHCAH, they better understood their vital sign monitoring (48%) and consequently: could better manage their own health (48%); were better informed (44%) and more confident (25%) to discuss their health with their doctor. Clients also reported making medication changes (17%), positive dietary changes (34%); and increased their physical activity (33%). Overall, client self-rated general health improved (mean improvement 0.303, SD= 0.80, 95% CI 0.16 – 0.45, 118 df, p=0.000), with more participants reporting that their health is “excellent” or “very good” health at the end of the trial. Clients also reported making fewer doctor visits (24%), which was supported by the comparative data at baseline and discharge (p=0.000); fewer visits to the emergency department at the local hospital (p=0.021) and fewer non-local hospital admissions (p=0.000) compared with the preceding year. There was no significant reduction in local hospital admissions (p=0.171). All health practitioner engagement was poor despite a willingness of clients to video-conference with a range of services. Cost was a barrier to most clients continuing to use MHCAH. Few clients were willing to pay more than $10 per week to use MHCAH, whereas the weekly cost of providing the service is $111.76.
Conclusions: While a causal link cannot be demonstrated, the findings suggest that MHCAH empowers clients to better understand and manage their own health, and may be associated with improved health outcomes and reduced service use. Having regular, daily access to a telehealth nurse reassured clients, and triggered changes to services and behaviour that are likely to have influenced outcomes. The ongoing costs of MHCAH appear high, however if the potential benefits demonstrated by this trial are realised, then the downstream savings could substantially outweigh these.

""Background
Structured education programmes for patients with diabetes and other chronic conditions are being widely adopted. However, follow-up studies suggest that course graduates may struggle to sustain the self-care practices taught on their courses over time. This study explored the support needs of patients with type 1 diabetes after attending a structured education programme promoting an empowerment approach and training in use of flexible intensive insulin therapy, a regimen now widely advocated and used to manage this condition. The objective was to inform future support offered to course graduates.

Methods
Repeat, in-depth interviews with 30 type 1 diabetes patients after attending Dose Adjustment for Normal Eating (DAFNE) courses in the UK, and six and 12 months later. Data were analysed using an inductive, thematic approach.

Results
While the flexible intensive insulin treatment approach taught on DAFNE courses was seen as a logical and effective way of managing one’s diabetes, it was also considered more technically complex than other insulin regimens. To sustain effective disease self-management using flexible intensive insulin treatment over time, patients often expected, and needed, on-going input and support from health care professionals trained in the approach. This included: help determining insulin dose adjustments; reassurance; and, opportunities to trouble-shoot issues of concern. While some benefits were identified to receiving follow-up support in a group setting, most patients stated a preference or need for tailored and individualised support from appropriately-trained clinicians, accessible on an ‘as and when needed’ basis.

Conclusions
Our findings highlight potential limitations to group-based forms of follow-up support for sustaining diabetes self-management. To maintain the clinical benefits of structured education for patients with type 1 diabetes over time, course graduates may benefit from and prefer ongoing, one-to-one support from health care professionals trained in the programme’s practices and principles. This support should be tailored and personalised to reflect patients’ specific and unique experiences of applying their education and training in the context of their everyday lives, and could be the subject of future research.""

Introduction: Asthma self-regulation interventions help to improve awareness about asthma care and help reinforce positive behavioral
patterns. Management of asthma should not only target symptom control, but also bring about an improvement in Quality of Life (QOL).
Depression is an important co-morbidity in urban teens with asthma but its impact on the effectiveness of educational interventions is not
known.
Methods: The web-based, Puff City asthma management program was developed using tailoring to provide individualized education
related to asthma self-regulation and management, and also to impact negative behaviors that could affect asthma related outcomes. This
program was evaluated with a randomized controlled trial conducted in teenagers from grades 9-11 of six Detroit public high schools. The
intervention group received 4 sessions of web-based tailored messages, while the control group was given generic web-based asthma
education. Assessment of asthma symptoms, depression, and QOL measurements were done through online baseline questionnaires for
teens and a telephone baseline survey for caregivers. Outcomes such as functional status and QOL were assessed based on follow up at 12
months.
Results: Of the 422 teens enrolled, 355 had complete teen and caregiver data for analysis (170 treatment and 185 controls). Prevalence of
depression by randomization assignment was similar for teens (treatment vs. control = 29.4 vs. 24.9%, respectively, p=0.34) and caregivers
(12.4 vs. 13.5%, p=0.75). Analysis was stratified by teen depression at baseline, adjusting for potential confounders using logistic
regression. Depression did not seem to influence intervention effectiveness for functional status, i.e., most adjusted Odds Ratios indicated
intervention benefit regardless of depression status. However, for QOL, intervention benefit seemed to differ by depression status. Among
teens who were depressed, treatment vs. control QOL scores overall, and specifically for the domains related to activities, symptoms, and
emotional functioning respectively, were 4.5 vs. 4.1 (p=0.09), 3.8 vs. 3.7 (p=0.95), 4.7 vs. 4.1 (p=0.078), and 4.9 vs. 4.4 (p=0.010), indicating
intervention benefit for QOL among depressed students. No difference by treatment assignment was noted in QOL for teens without
report of depressive symptoms at baseline.
Conclusions: Results suggest that effect of an asthma self-regulation intervention on QOL can differ by depression
status, in that the intervention effect was greater in teens who met study criteria for depression at baseline compared to
those that did not. Further assessment of self-management educational interventions for asthma should look at how
co-morbidities may alter the intervention effect.

On November 3rd 1906, Aloys Alzheimer presented to the Meeting of the Psychiatrists the neuropathological and clinical features of Auguste D., who had died of dementing illness at the age of 55. The disease was given its eponym by his senior colleague E. Kraepelin. The description initiated the slow separation between Alzheimer’s disease (AD) and other causes of presenile dementia

Whether people with asthma gain and maintain control over their condition depends not only on the availability of effective drugs, but also on multiple patient and health care professional (HCP) behaviors. Research in asthma rarely considers how these behaviors interact with each other and drug effectiveness to determine health outcomes, which may limit real-life applicability of findings. The objective of this study was to develop a logic process model (Asthma Care Model; ACM) that explains how patient and HCP behaviors impact on the asthma care process. Within a European research project on asthma (ASTRO-LAB), we reviewed asthma care guidelines and empirical literature, and conducted qualitative interviews with patients and HCPs. Findings were discussed with the project team and respiratory care experts and integrated in a causal model. The model outlines a causal sequence of treatment events, from diagnosis and assessment to treatment prescription, drug exposure, and health outco...

Researchers say that women with inflammatory bowel disease should be given more advice about pregnancy, so that they can make informed choices about their options and care. The study, led by the University of Leeds, chronicled the experiences of 22 women who have had children, to plug an information gap about the realities of becoming a mother with IBD. The research, published in the journal Qualitative Health Research, draws on the evidence that women with the disease often decide not to have children, or to restrict the size of their family, because of fears for their health during pregnancy and that of their baby too......

Background Chronic disease accounts for nearly three-quarters of US deaths, yet prevalence rates are not consistently reported at the state level and are not available at the sub-state level. This makes it difficult to assess trends in prevalence and impossible to measure sub-state differences. Such county-level differences could inform and direct the delivery of health services to those with the greatest need. Methods We used a database of prescription drugs filled in the US as a proxy for nationwide, county-level prevalence of three top causes of death: heart disease, stroke, and diabetes. We tested whether prescription data are statistically valid proxy measures for prevalence, using the correlation between prescriptions filled at the state level and comparable Behavioral Risk Factor Surveillance System (BRFSS) data. We further tested for statistically significant national geographic patterns. Results Fourteen correlations were tested for years in which the BRFSS questions were asked (1999-2003), and all were statistically significant. The correlations at the state level ranged from a low of 0.41 (stroke, 1999) to a high of 0.73 (heart disease, 2003). We also mapped self-reported chronic illnesses along with prescription rates associated with those illnesses. Conclusions County prescription drug rates were shown to be valid measures of sub-state estimates of diagnosed prevalence and could be used to target health resources to counties in need. This methodology could be particularly helpful to rural areas whose prevalence rates cannot be estimated using national surveys. While there are no spatial statistically significant patterns nationally, there are significant variations within states that suggest unmet health needs.