Impact of therapeutic education on the evolution of social representations of medication in patients with Parkinson's disease: A quantitative and qualitative study (ETPARK REMED).

BACKGROUND: Among the workshops of our therapeutic patient education (TPE) program, the medication workshop (TPEM workshop) is very frequently proposed to patients in view of the difficulties they encounter related to the complexity of managing antiparkinsonian treatment. Patients' appropriation of their medications could depend on their social representations. OBJECTIVES: To evaluate the effect of our TPEM workshop on the social representations PD patients have of their medications and to compare it with that of another therapeutic intervention such as a talking group defined as the control group. METHODS: This single-center, prospective, randomized, parallel-group study investigated the social representations of medication through a questionnaire on knowledge about antiparkinsonian medications, a questionnaire on beliefs about medication (BMQ), and a word association task. RESULTS: In the TPEM group (n=16), the workshop induced significant effects over time on the knowledge questionnaire (P=0.01), BMQ specific necessity and concerns scores (P=0.04 and 0.01, respectively), necessity-concerns differential (P=0.04), and BMQ general harm (P=0.04). No significant difference was found in the talking group (n=6). Comparison of the two groups showed a significant difference of the BMQ general harm with a decrease in belief in the harmfulness of the medications in the workshop group (P=0.03). The results of the verbal association task showed a modification in the content and structure of the social representations of medication in the TPEM group. DISCUSSION: The TPEM workshop helped reduce initial negative aspects of medication representations. Improved knowledge of their medication allowed patients to feel more competent and legitimate in communicating with caregivers, modifying their beliefs about medications. Indeed, the medication was perceived as less restrictive, care becoming central as shown by the emergence of the medical team in the social representations of the medication. CONCLUSION: All the results show a specific beneficial effect of the TPEM workshop through an evolution of the social representations of medications, which became more positive in our PD patients.

[A therapeutic educational program in Parkinson's disease: ETPARK]. / Éducation thérapeutique chez le patient parkinsonien: le programme ETPARK.

We developed a therapeutic educational program in Parkinson's disease (PD). The needs analysis for this program was performed through a survey involving 41 PD patients. This survey questionnaire was elaborated through the analysis of 395 patients' semi-directive interviews, performed in our specialized hospitalisation unit during explanation workshops between 2005 and 2007. We managed to design an educational program tailored to specificities of PD and according to the recommendations of the High Authority of Health in France (HAS). This program was based on individual sessions conducted by a nurse experienced in PD and trained in education. Collective workshops concerning specific themes such as physical therapy, communication, social supports, sleep disorders, stress management, therapies in PD could be proposed to volunteer patients and were performed by the nurse, a physiotherapist and a specialized practitioner. This program focused on skills structured in knowledge, expertise, and learning. It was intended for patients without any motor or cognitive severe impairment. We educated 231 patients between 2008 and 2012 individually and 113 in collective workshops. Patients had an interesting improvement in their self-esteem (6.2±1.4 before and 7.3±1.1 after one year of this educational program). This program has been validated by our regional medical agency and we performed a medico-economic study demonstrating a significant improvement in quality-of-life of educated patients without extra costs.

Prevention of silica health effects in Italy: current challenges for the Occupational Health and Safety Unit of the Italian National Health Service.

BACKGROUND: Since its foundation in 2002, the Italian Silica Network (NIS), a collaborative network of professionals and public authorities, has been engaged in several aspects of research, control, and prevention of silica exposure and effects, and also in support for compensation claims for silica-related occupational health effects in Italy. METHODS: We start with a report on the NIS point of view concerning the recent scientific results (from epidemiology and laboratory studies), including those carried out by NIS in cooperation with Italian universities and other public agencies. This is followed by a description of the data on silica exposure in different Italian workplaces and guidelines for the management of occupational exposure to silica, as developed by two model regional programmes for the ceramics industry, metal foundries and tunnel excavation. RESULTS: The NIS initiatives highlighted the persistence of workplace conditions posing a significant risk for silica-related health effects, particularly in small industries and workshops. Experimental work has also shown that a number of physical and chemical factors affect the bioreactivity of silica particles. CONCLUSION: Based on NIS experience, it appears clear that currently conditions exist in Italy so as to positively contribute to the WHO Programme for the eradication of silicosis and the other diseases related to silica exposure. In order to achieve this goal, a coordinated and wide-ranging effort is required to reduce the wide gap in specific prevention activities, particularly in small industries and workshops, where high levels of silica exposure sometimes occur.

Anton's syndrome following callosal disconnection.

Anosognosia for cortical blindness, also called Anton's syndrome, is a rare neurological disorder usually following bilateral lesions to occipital cortices. Neuropsychological, morphological and functional neuroimaging (SPECT and fMRI) findings are reported in a patient who incurred Anton's syndrome after an ischaemic lesion confined to the left occipital lobe involving the corpus callosum. The present case study suggests that Anton's syndrome may also follow from lesions disconnecting the occipital cortices.

[Chemical agents and laboratory safety]. / Agenti chimici e sicurezza dei lavoratori.

The Decree n(o) 25 of the 2nd of February 2002, according to the Directive 98/24/CE, predetermines the general criteria that the employer, operating in situation of production characterized by chemical risk, must conform to. This risk can derive from the effects of dangerous chemical agents present in the work-place itself or can be a result of working activities. This recent Decree is applied to all chemical agents--including cancerous agents--except for provisions of Title VII of Decree of law 626/1994; the substances and the preparations dangerous for the environment, chemical agents for which measures of radiological protection have come into force and the asbestos, for which a specific regulation subsists, are excluded. A particular attention, in the article, has been given to the activity of analysis and risk evaluation, first obligation for the employer. This obligation is very important in such a contest and moreover indispensable for the adoption of technical and procedural measures. One should emphasize that if the results of such an evaluation show a risk classifiable as moderate, (both as type and quantity of the dangerous chemical agents and as modalities and frequency of workers exposure), the employer is not bound either to assume specific measures of prevention and protection (as technical controls, measures of collective protection, the use of devices for individual protection, medical surveillance), or to comply with dispositions conceived in the case of accidents and emergency. In any case, if this risk is not moderate, the first intervention is the replacement, if possible, of dangerous chemical agent in question with others agents or processes showing no or less level of danger. In conclusion, it is important to emphasize that the recent Decree fixes that medical surveillance must be performed once a year, or following a different periodicity scheduled by the responsible physician.

The economics of vaccinating restaurant workers against hepatitis A.

The economics of vaccinating restaurant workers against hepatitis A were studied using Monte Carlo simulation models, one with a restaurant-owner perspective, and one with a societal perspective. The restaurant model allowed for a different size, number of employees and employee turnover rate. Benefits were the avoidance of loss of business (including the possibility of bankruptcy) after publicity linking the restaurant to an outbreak associated with a case of hepatitis A in a food handler. Additional benefits in the societal model included reductions in costs of food handler-associated cases of hepatitis A. The outcome used was Net Present Value (NPV), allowing comparison between models. Regardless of the cost of vaccination ($50-140/employee), for a restauranteur to ensure that all employees were vaccinated at all times substantial costs were involved (i.e. negative NPV). Even a 75% probability of bankruptcy still resulted in negative NPVs at the 95th percentiles. For society, vaccination was only cost-saving (i.e. positive NPV) if done only during epidemics and if it cost < $20/employee. Vaccinating restaurant employees is unlikely to be economical from either the restaurant owner or the societal perspective, even during hepatitis A epidemics.

Risk factors for drowning and near-drowning among children in Hillsborough County, Florida.

The authors obtained data from 700 households in Hillsborough County, FL, in a telephone random survey to determine risk factors for incidents of drowning and near-drowning among children in the county. The survey was conducted from August through December 1991. A combination of forced-choice and open-ended questions was used to assess adults' drowning-related knowledge, attitudes, and prevention behaviors, as well as the incidence of and the circumstances surrounding drowning and near-drowning among children who lived in those households. The results showed that although most respondents had some knowledge of the epidemiology of drowning and near-drowning among children, deficits were noted in their knowledge of the importance of adult supervision and the recommended age at which to begin children's swimming instruction. Results showed a need for isolation fencing, that which separates a swimming pool from a house and yard. Most respondents reported that they did not know how to perform cardiopulmonary resuscitation (CPR) on an infant or child. More than 40 percent reported not knowing how to perform CPR on an adult. Respondents reported no drowning or near-drowning incidents among children of their household within the last 3 years. However, the respondents did describe water-related immersions that involved children who experienced difficulty in the water, but recovered by themselves or with the aid of a nearby person. In some instances the child's breathing pattern was altered. There were three episodes during which difficulty in breathing occurred. The respondents reported a total of nine childhood water-immersion episodes within their families, none of which had been reported to treatment facilities. Recommendations are provided for programs for prevention of childhood drowning.