[Dental caries as chronic disease, a new therapeutic approach]. / La carie dentaire comme maladie chronique, vers une nouvelle approche clinique.

For many decades, oral health has been improving considerably in France. Caries indicators have decreased strongly. However, some "high risk" populations accumulate the majority of tooth decay. For them, health education and public health policies are inefficient. Tooth decay starts early and continues throughout their lives. Describing dental caries as a chronic pathology enables us to envisage alternative therapies, such as therapeutic patient education.

Therapeutic education unit for heart failure: setting-up and difficulties. Initial evaluation of the I-CARE programme.

BACKGROUND: Education programmes are required in chronic diseases. The insuffisance cardiaque : éducation thérapeutique (I-CARE) programme was developed in France to promote the setting-up of therapeutic education units for chronic heart failure. AIM: To evaluate the setting-up of such units, assessing the influence of training on the creation and organization of the unit, the problems encountered and the contribution of the dedicated educational tools. METHODS: We submitted a questionnaire to the first 136 trained centres. The questionnaire was divided into two sections: one section dealing with educational practices and the other with the advantages and disadvantages of the tools provided. RESULTS: The participation rate reached 69.1%. Seventy-four centres (78.7%) declared themselves to be active in therapeutic education. Unit educational activities determined an educational diagnosis (89.2% of the centres) and provided education by means of collective workshops (73.0%) or one-to-one teaching sessions (75.7%). A complete education programme for a patient consisted of a median of four sessions (25th-75th percentile, 2-5 sessions) and lasted for a median of 6 h (25th-75th percentile, 4-10 h). The education team was multidisciplinary and usually included a nurse (93.2%), a dietician (78.4%), a cardiologist (71.6%) and a physiotherapist (40.5%). Heart failure educational tools were used only in part in most centres (89.2%). All advantages and disadvantages were recorded. CONCLUSION: This first evaluation of the setting-up of therapeutic education units in the I-CARE programme has yielded promising results, despite expected difficulties. The effects of therapeutic education on the behaviour of heart failure patients remain to be determined.

[Partnering with patients to reflect on the conceptual design of a therapeutic patient education programme]. / Associer des patients à la conception d'un programme d'éducation thérapeutique.

Within the framework of a patient education training programme, a group of health sector professionals comprised of hospital doctors, general practitioners, nurses, physiotherapists and dieticians created a programme intended for people with peripheral vascular disease (intermittent claudication). A study was carried out simultaneously utilising a questionnaire and a series of four interviews which permitted professionals to collect data on the patients' expectations regarding such a programme and their points of view at each specific stage of its development. This article analyses the contribution of the patients to the therapeutic patient education programme design, namely with respect to their influence on the programme's content, on the educational process and approach as well as on the professionals' perspectives on disease, various treatments and people with this particular illness. The discussion highlights the range of goals and objectives that can potentially be met through dialogue and exchange between people suffering from the same disease.

A therapeutic education programme for diabetic children: recreational, creative methods, and use of puppets.

Patient education is an important aspect of care to young diabetic children. The use of playthings and recreational activities is an effective way to help children develop harmoniously by integrating the paradox of having to become compliant with treatment and medication while becoming autonomous in life. This paper presents the evaluation of a therapeutic education programme which was attended by 14 young diabetic patients aged 10-12. In order to take into account the learning capacities and strategies linked to the children's age and development stage, the programme's methods were mainly interactive and recreational. In particular, puppets were used as a means to enable the children to express themselves on different aspects of diabetes-related difficulties in their everyday life. The results of the study show that recreational methods and tools can effectively be implemented into therapeutic patient education programmes so as to enable children to develop various treatment-related skills. As far as the psychosocial skill of expressing one's difficulties and emotions is concerned, the use of puppets was found to be an effective means to facilitate the development of such a skill. Moreover, puppets were found to have a projective and transactional function that allowed children to make decisions and react autonomously, and thus regain control on situations in which they had previously felt disempowered.