Implementation of a self-management programme: recruitment strategies in five European countries

Introduction

The Chronic Disease Self-Management Programme (CDSMP) has been successfully implemented in over 30 countries worldwide, demonstrating its effectiveness and cost savings to healthcare systems. The CDSMP aims at people with any chronic condition and caregivers, but it has not targeted specific vulnerable populations at different sites simultaneously. In this sense, this study presents the recruitment strategies to involve vulnerable populations in the CDSMP framed under the EU-funded project EFFICHRONIC (ref.: 738127).

Methods

The CDSMP was implemented in five countries (Spain, Italy, France, the Netherlands and the United Kinkdom) approaching several vulnerable target groups. The programme consists of strictly scripted group sessions during 6 weeks imparted by previously trained monitors. EFFICHRONIC recruitment was performed in 3 consecutive steps combining population-based and individual strategies: i) development of vulnerable maps to detect areas with higher vulnerability; ii) creation of alliances with different actors; and iii) identification of end-users.

Results

Over 234 leaders were trained distributed over the five sites and 237 workshops with end-users were organized following the recruitment strategies. The average number of engaged participants per workshop was 13. In total, 2,962 vulnerable persons were engaged and 2,177 finalized the programme, meaning a drop-out rate of 25%. The sample was composed of ethnic minorities, immigrants, refugees, older people living alone or in institutions, people with few economic resources or living in therapeutic communities, inmates and members of different kinds of associations.

Discussion

The strategic coordination at loco-regional level between multidisciplinary stakeholders has been a key success factor to obtain maximum recruitment. The activation of different strategies simultaneously optimized the project results approaching a wide variety of end-users and communities.

Key messages

Stakeholder engagement is crucial to identify and recruit vulnerable individuals in need of support for the management of their chronic conditions. Recruitment strategies must be adapted to each specific context and culture to achieve relevant adherence levels and benefits.

Integrated care pathways for airway diseases (AIRWAYS-ICPs)

The objective of Integrated Care Pathways for Airway Diseases (AIRWAYS-ICPs) is to launch a collaboration to develop multi-sectoral care pathways for chronic respiratory diseases in European countries and regions. AIRWAYS-ICPs has strategic relevance to the European Union Health Strategy and will add value to existing public health knowledge by: 1) proposing a common framework of care pathways for chronic respiratory diseases, which will facilitate comparability and trans-national initiatives; 2) informing cost-effective policy development, strengthening in particular those on smoking and environmental exposure; 3) aiding risk stratification in chronic disease patients, using a common strategy; 4) having a significant impact on the health of citizens in the short term (reduction of morbidity, improvement of education in children and of work in adults) and in the long-term (healthy ageing); 5) proposing a common simulation tool to assist physicians; and 6) ultimately reducing the healthcare burden (emergency visits, avoidable hospitalisations, disability and costs) while improving quality of life. In the longer term, the incidence of disease may be reduced by innovative prevention strategies. AIRWAYSICPs was initiated by Area 5 of the Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing. All stakeholders are involved (health and social care, patients, and policy makers).

Psychological interventions to fight against the burden of the informal caregivers

Informal care has been conceptualized as a vital stress factor, which jointly with its chronic character and the lack of foresight about the time of its finalization, has been associated to the negative repercussions on the physical and psychological wellbeing of the informal caregiver. This situation has been generically denominated with the overall term of caregiver burden. Burden is associated with depression and anxiety as well as with abandonment and mistreatment of the dependent person. Optimal psychosocial interventions to be assumed by European Governments in their long - term care systems are still needed to be developed to fight succesfully against this burden.

The objective is to review the main psychological and social programmes developed to deal with the informal caregivers burden, with the aim to propose the more appropiate programmes to be adopted by the European long-term care systems.

A review of the main theories and results of the existing research to date about the concept of the informal caregiver's burden has been done mainly in policy papers, peer-reviewed journals and research developed by the authors.

The results lead to conclude that the psycho-educational intervention programs framed within the respite services jointly with the knowledge of the determining variables of the burden can comprise the first optimal approach in order to effectively deal with the burden problem of the informal caregivers of dependent senior citizens.

Case management method applied to older adults in the primary care centres in Burjassot (Valencian Region, Spain)

This research determines if the case management for health primary care means changes in: (a) frequency of use of social and health care resources, (b) number of patients visiting a doctor or social worker in the primary care centre, and visits that these professionals receive, (c) number of drugs consumed, (d) urgent hospital admittances which did not need significant intervention and (e) patients' and caregivers' satisfaction towards the social and health care resources received. The data were gathered with a questionnaire elaborated by the Administration and supervised by researchers. One hundred and fifty-two older dependent patients receiving home care in 2004, in a health department of the Valencia Region (Spain) collaborated. Results show: (a) Increase in the use of combined health and social resources in the intervention group; (b) number of patients visiting a practitioner or a social worker is lower in the intervention group, with a significant difference in both cases;

Care needs among the dependent population in Spain: an empirical approach

The objective of the present paper was to identify the profile and needs of social and healthcare users in Spain who required long-term care. To achieve this goal, an extensive empirical study was carried out in 2001 of a typical southern European region: the Valencia Autonomous Region in Spain. The method used was a questionnaire-based survey. The data collection instrument was a questionnaire comprising 119 questions grouped into seven sections: social and demographic data; clinical diagnosis and treatment; living environment; degree of dependence in activities of daily living (ADLs); cognitive state; social support; and the social, demographic and attendance data of the carer, if available. The sampling was carried out in two strata, i.e. social and healthcare: first, the authors randomly selected the centres and services as sampling points, and then they randomly selected the subjects. A total of 1265 people were interviewed. The results show different care profiles: users aged under 65 years were mostly mentally ill and/or drug users requiring short- and medium-term care from the health services, while those aged over 65 years had chronic illnesses for which they were actively receiving treatment, were functionally dependent for ADLs, and were normally receiving social care that basically provided company and resolved functional limitations.

A PCR screen identifies a novel, unconventional myosin heavy chain gene (MYO1) in Tetrahymena thermophila

Degenerate primers for two regions of sequence homology in the myosin head domain were used in a polymerase chain reaction screen of Tetrahymena thermophila genomic DNA to amplify a 765 bp fragment that was cloned and sequenced. Based on the presence of conserved, myosin-specific sequences, the 765 bp PCR product was identified as a fragment of a myosin gene, the first to be discovered in ciliated protozoa and herein referred to as MYO1. An inverse polymerase chain reaction strategy was used to obtain additional sequence data that included the entire head domain of MYO1. Alignment of the predicted amino acid sequence of the MYO1 head domain with known myosin sequences identified the ATP-binding site, a phosphorylation site, and other myosin-specific consensus regions. In a northern blot analysis, a 765 bp MYO1-specific probe detected a 6.6 kb transcript under highly stringent hybridization conditions. Phylogenetic analysis revealed that the predicted protein encoded by MYO1 is not a member of any of the previously defined myosin classes and therefore represents a presumptive new myosin class.

Two functional forms of the Xenopus laevis estrogen receptor translated from a single mRNA species

Steroid receptors are nuclear proteins that regulate gene transcription in a ligand-dependent manner. Over-expression of the Xenopus estrogen receptor in a vaccinia virus-derived expression system revealed that the receptor localized exclusively in the nucleus of the infected cells, irrespective of the presence or absence of the ligand. Furthermore, two forms of the receptor were produced, a full-length and a N-terminal truncated version, which are translated from a single mRNA species by the use of two AUG within the same reading frame. These 66- and 61-kDa receptors were also observed after in vitro translation of the mRNA as well as in primary Xenopus hepatocytes. Both forms are potent estrogen-dependent transcriptional activators in transient transfection experiments, as well as in in vitro transcription assays.

Reactivation of transcription from a vaccinia virus early promoter late in infection

We have studied the kinetics of RNA synthesis from the vaccinia virus 7,500-molecular-weight gene (7.5K gene) which is regulated by early and late promoters arranged in tandem. Unexpectedly, after a first burst of RNA synthesis early in infection, transcription was reactivated late in infection. Reactivation was not dependent on the location of the promoter in the genome or on the presence of the upstream late regulatory sequences. The mRNA synthesized from the reactivated promoter in the late phase had the same 5' and 3' ends as the molecules transcribed in the early phase. Interestingly, these molecules were efficiently translated despite the absence of the poly(A) leader characteristic of late mRNAs. Reactivation appears to be dependent on virus assembly since it is prevented by rifampin, a specific inhibitor of morphogenesis. Finally, analysis of various other early genes showed that reactivation is not unique to the 7.5K early promoter.

[Review of tetanus points of entry. Study of 229 cases]

A revision of tetanus points of entry in 229 tetanic patients who were cared for at the Hospital del Mar, Barcelona, between 1970 and 1983, i carried out in order to determine in which kind of patients a adequate prophylaxis is not performed. It is found that 83% of point of entry are wounds which are not medically assisted. At the same time points of entry are classified in four main groups: a first group consisting of wounds localized in head and extremities (46.8%), second group to contaminated intramuscular injections (21.8%) a third group related to surgical and obstetric procedures (15.3%) an a fourth group which includes other points of entry not included in the previous groups (16.2%). This classification permits the detection of epidemiological characteristics of each group and the observation of the possible influence of point of entry on the evolution and prognosis of tetanus highlighting that the most severe situations are due to intramuscular injections and surgical and obstetric procedures. With this study we can conclude that an adequate antitetanic prophylaxis must not be restricted to high risk patients, but should be extended to the whole population.

Reverse-transcriptase-associated RNaseH activity mediates template switching during reverse transcription in vitro

During the first steps of reverse transcription of the retroviral genome, sequences present at the extremities of the RNA are used to reconstitute a host cell PolII promoter. The assembly of the promoter occurs by template switching, which takes advantage of a direct repeat at the ends of the RNA molecule. These steps are catalysed by the viral reverse transcriptase, which carries an intrinsic RNaseH activity that is probably also involved therein. To study the role of the RNaseH activity in this first template-switching event, an in vitro system has been developed based on primer extensions of synthetic RNAs. When an RNA was reverse transcribed with wild-type reverse transcriptase in the presence of a second RNA the 3' part of which was repeated at the 5' end of the first one, extension products could be observed corresponding to a chimeric cDNA comprising both RNA species. This template switching could not be detected when a mutant reverse transcriptase lacking the RNaseH activity was used. The results show that the RNaseH activity is needed to remove the 5' RNA sequences from the cDNA:RNA hybrid thereby enabling its translocation to another RNA containing an appropriate complementary target sequence.

Hand skeletal development among Ecuadorians living under conditions of iodine deficiency and endemic goiter

Hand radiographic assessment has revealed the pattern of skeletal growth and maturation among Ecuadorian Indian villagers where iodine deficiency has resulted in an endemia of goiter and cretinism. This is intended to provide base line information for future attempts to learn about physical impairment among people living under inadequate iodine nutriture.