Communication with the patient in General Practice

Patient communication plays an essential role in everyday clinical practice in General Practice (GP). It is possible to observe the communication skillstechniques in European countries, during the exchange programmes for GP trainees, which are organised by the Vasco da Gama Movement. The patientagenda often does not match the physician’s and sometimes is also neglected or misinterpreted. This may lead to low patient satisfaction and suboptimalclinical practice. Knowing how to approach the patient’s problems and fears, besides managing his/hers expectations, is of high importance in order toenhance satisfaction and quality of care. Furthermore, GP’s unique position should be considered, as he/she can discuss difficult and sensible topicswith his/her patients. The ICE (Ideas, Concerns and Expectations) model is an example of holistic and patient-centred approach, which is appropriatefor GPs, and explores the patient’s point of view concerning diagnosis and treatment. The importance of medical communication is also emphasised ineducation. For instance, a correct and consistent assessment of the communication skills in GP is possible with the use of the MAAS-Global scale

Polonium and Lung Cancer

The alpha-radioactive polonium 210 (Po-210) is one of the most powerful carcinogenic agents of tobacco smoke and is responsible for the histotype shift of lung cancer from squamous cell type to adenocarcinoma. According to several studies, the principal source of Po-210 is the fertilizers used in tobacco plants, which are rich in polyphosphates containing radio (Ra-226) and its decay products, lead 210 (Pb-210) and Po-210. Tobacco leaves accumulate Pb-210 and Po-210 through their trichomes, and Pb-210 decays into Po-210 over time. With the combustion of the cigarette smoke becomes radioactive and Pb-210 and Po-210 reach the bronchopulmonary apparatus, especially in bifurcations of segmental bronchi. In this place, combined with other agents, it will manifest its carcinogenic activity, especially in patients with compromised mucous-ciliary clearance. Various studies have confirmed that the radiological risk from Po-210 in a smoker of 20 cigarettes per day for a year is equivalent to the one deriving from 300 chest X-rays, with an autonomous oncogenic capability of 4 lung cancers per 10000 smokers. Po-210 can also be found in passive smoke, since part of Po-210 spreads in the surrounding environment during tobacco combustion. Tobacco manufacturers have been aware of the alpha-radioactivity presence in tobacco smoke since the sixties

Achieving Universal Health Coverage: Technology for innovative primary health care education

The challenges to achieving universal health coverage (UHC) are obvious yet vast in their scope: leading these is a lack of strong primary health care (PHC) systems and a global shortage of well-trained health care professionals. Addressing these challenges is paramount, as it is well-trained health care professionals who will build the strong PHC systems that are necessary for UHC. Due to the continuing spread and evolution of information and communications technology (ICT) in health care and education, ICT should be considered as an essential tool for innovative primary health care education.  Many nations face a distinct lack of UHC, grossly unequal health services and an acute shortage of suitably qualified family doctors, nurses and allied health care professionals that constitute the primary health care team. It is estimated that by 2035, the world will have a shortage of 12.9 million health care professionals, however an additional 1.9 billion people will require health care. Recruiting, educating and retaining these primary health care teams is therefore fundamental to meet ongoing demands.  Family doctors contribute to high quality, cost-effective and accessible primary health care. However, PHC faces considerable challenges, including a preference from policymakers, the public, and members of the health care community for specialisation. Specialist-focused care may be attractive, but it is often economically unsustainable and absorbs resources that are necessary for PHC. Yet, cooperation between primary and secondary care is essential for delivering the best care to patients and communities. It should not be a matter of choosing between primary and secondary care, but rather of recognising and adequately supporting the unique attributes and skillsets that each has to offer.  Family medicine lies at the heart of primary health care. The key to producing skilled family doctors is good family medicine training, particularly at a postgraduate level. There is great potential to improve the scale and quality of family medicine training, starting with exposure to the field as early as possible. For the delivery of primary care to be effective – and lead to the achievement of universal health coverage – the composition of the primary care team should reflect the demography and health needs of the local population. Thus, the composition of the primary care team will differ from location to location, depending on the age/sex/ health needs of the local population. Family doctors and all of the PHC professionals should have a set of universal core skills, in addition to skills specific to the population and geography they serve. To provide effective care, health professionals need to understand the importance of social factors in influencing population health; therefore, training curricula must be adapted to local contexts  Career development through postgraduate training strongly motivates health professionals to stay in their own localities, as well as being vital for patient safety and improved outcomes. Yet, despite a thirst for postgraduate training among family doctors and other primary health care professionals, it is often difficult to access. ICT may be used to address recruitment and retention issues by providing easily accessible and good quality education.  This report examines a key question: Can ICT facilitate the education of PHC professionals worldwide in order to address the challenges facing PHC and UHC? Through in-depth literature reviews, analysis, and targeted interviews with key experts, the report concludes that ICT can indeed support, enhance and accelerate the education of the primary health care team’s members, in six key ways:  1. It is an effective means of developing workforce capacity. By overcoming geographical barriers and supplementing traditional instruction with online delivery from international and regional tutors, ICT can substantially increase health care professionals’ access to postgraduate education without the need for travel, thus helping to avoid disruption to healthcare delivery.  2. It helps to recruit and retain professionals. E-learning overcomes issues of access and isolation, and can be done flexibly to suit the learner. By providing access to specialist support, postgraduate courses and mentoring opportunities, e-learning and telehealth encourage in-country and rural retention of health care workers.  3. It is cost-saving. Traditional models of health professional education are expensive, both for the provider and for health care professionals. Developing ICT solutions may entail high initial costs but these are reduced over time, and with more users, achieve economies of scale.  4. It facilitates social and collaborative learning which has been shown to have the greatest impact on patient outcomes. A blend of synchronous and asynchronous e-learning is likely to be the most effective way of achieving interprofessional learning. Communities of practice are encouraged using ICT and social media, reducing professional isolation and improving collaboration.  5. It can help to bring contextualised care to where it is needed. For example, simulation-based medical education enables problem-based, interactive and contextualised learning. End-user (including patient) participation is paramount when designing ICT-based educational programmes.  6. It improves the quality of care by facilitating access to evidence-based medicine and reflective learning. Email alerts can support education by reaching a large audience and providing trustworthy information tailored to individual needs; social media can aid in streamlining vast amounts of information into a small number of tailored-to-the-individual articles; blogs and electronic portfolios can encourage reflective life-long learning. Capturing these opportunities will require stakeholders to consider the following:  a) Securing political and financial support to establish and maintain strong PHC systems  b) Adopting a collaborative interprofessional approach between health professionals, from medical school through to the workplace  c) Providing education and training relevant to the context and to user needs  d) Improving recruitment and retention through training  e) Encouraging the standardisation and accreditation of health professional education  f) Investing in ICT training for learners, educators and patients  g) Planning and developing programmes that use technology meaningfully to improve care quality, cost-effectiveness, accessibility, equity and patient safety  h) Recognise and consolidate the interdependence of all the health professionals in the PHC setting.

Social Media as an Opportunity for Public Health Interventions: The #Metoo Movement as an Exemplar

Background: Social media have been used exponentially and globally, providing a means for billions of users to connect, interact, share opinions and criticise, becoming one of the main channels of communication for users around the world. One of the most popular free social media networks is Twitter, with more than 100 million active users per day worldwide. Purpose: The aim of this study was to analyse a sample of the public conversations generated, using the hashtag #MeToo, around the topic of sexual abuse on Twitter.  Methods:  Using social media marketing software, the use of the #MeToo hashtag was analysed over a period of 60 days (14 September 2017 to 13 November of 2017). Results: The #MeToo conversation was mainly in English (79.3%), located in the United States (48.2% of cases), but with global repercussions. The volume of mentions of the #MeToo hashtag was far greater (97.7%), compared with other hashtags related to violence over this period of time, using mostly Twitter (96.2%). Conclusions: These results suggest that it is possible to describe different groups using the social media, and analyse their conversations to identify opportunities for successful public health interventions.  If the topic is relevant for the general public, it will generate interest and conversations at the global level, supported by a universal and borderless channel such as Twitter

The D²Rwanda Study: March 2018 Report

The Community- and MHealth-Based Integrated Management of Diabetes in Primary Healthcare in Rwanda: the D²Rwanda Study (which stands for Digital Diabetes Study in Rwanda) is a twin PhD project, developed in collaboration with Aarhus University (AU) and the University of Luxembourg (UL), and under the auspices of the University of Rwanda and Rwanda Biomedical Centre. The project involves two PhD students, Jean Paul Uwizihiwe (enrolled at AU) and Charilaos Lygidakis (enrolled at UL), and is kindly sponsored by the Karen Elise Jensens Foundation, alongside AU and UL. In this report we wished to narrate what we had been working on for the past two years: from the first steps to understanding better the context and mapping the territory; from obtaining the necessary authorisations to developing the app and translating the questionnaires

Social Media as an Opportunity for Public Health Interventions: The #Metoo Movement as an Exemplar

Background: Social media have been used exponentially and globally, providing a means for billions of users to connect, interact, share opinions and criticise, becoming one of the main channels of communication for users around the world. One of the most popular free social media networks is Twitter, with more than 100 million active users per day worldwide. Purpose: The aim of this study was to analyse a sample of the public conversations generated, using the hashtag #MeToo, around the topic of sexual abuse on Twitter. Methods: Using social media marketing software, the use of the #MeToo hashtag was analysed over a period of 60 days (14 September 2017 to 13 November of 2017). Results: The #MeToo conversation was mainly in English (79.3%), located in the United States (48.2% of cases), but with global repercussions. The volume of mentions of the #MeToo hashtag was far greater (97.7%), compared with other hashtags related to violence over this period of time, using mostly Twitter (96.2%). Conclusions: These results suggest that it is possible to describe different groups using the social media, and analyse their conversations to identify opportunities for successful public health interventions. If the topic is relevant for the general public, it will generate interest and conversations at the global level, supported by a universal and borderless channel such as Twitter

Knowledge and behaviour of tourists towards the sun, as studied in a region of northern Greece

Introduction: Melanoma is considered one of the most malignant cancers. Its appearance is related to various factors such as ultraviolet radiation, recurrent sunburn, and phototype. During the summer holidays approximately 14 million tourists from northern European countries visit Greece; this does not include the local tourists. Aims: To discover the extent of European visitors’ awareness of the risk of sunburn. To explore the level of knowledge gained by local and foreign tourists from preventive campaigns related to the harmful effects of sun exposure. Participants: The sample consisted of 802 travelers from northern European countries, and 726 Greeks who departed from the airport ‘Megas Alexandros’ during August and September 2002. Methods: A structured questionnaire was used to gain data about demographics, family history of skin cancer, and identification of phototype. Also requested was information about the hours of sun exposure, and the use of sunscreen (the pattern of application and its sun protective factor [SPF]). Comparisons of mean values between groups were made by Student’s t-test, and the association between categorical variables was tested by Pearson’s c2. Regression analysis was performed to examine the influence of different factors on the likelihood of being sunburned. Results: The majority of foreigners belonged to phototype II or III, while the Greek tourists belonged to phototype III. Foreigners had a higher tendency to burn and a lower tendency to tan. Of the total sample, women presented a higher prevalence of sunburn (p <0.05), and they used sunscreen more frequently (p <0.001) than men did (p <0.001), in both groups. The mean SPF used was 17.3 (SD = 8.98) for the foreigners and 16.0 (SD = 2.0) for the Greeks. The media was the main source of information for both groups. Multiple regression analysis showed that skin type was significantly associated with a high probability of sunburn (p <0.001). Moreover, freckles (p <0.05) were a predictive factor for future sunburn. Conclusions: Our study showed that skin type is the most important predictor of future sunburn. The role of the primary care physician is to promote and encourage healthy habits, including attitude towards sun exposure. Increased susceptibility to sun-induced damage of persons with phototypes I and II mandates their identification as a target group in all media campaigns

Family Violence Curricula in Europe (FAVICUE): a cross-sectional descriptive study protocol

Introduction. Family violence (FV) is a widespread public health problem of epidemic proportions and serious consequences. Doctors may be the first or only point of contact for victims who may be hesitant or unable to seek other sources of assistance, and they tend not to disclose abuse to doctors if not specifically asked. A comprehensive healthcare response is key to a coordinated community-wide approach to FV, but most of the practising physicians have received either no or insufficient education or training in any aspect of FV. Training of medical students concerning FV is often delivered in an inconsistent or ad hoc manner. The main aim of this project, Family Violence Curricula in Europe (FAVICUE), is to (1) describe current FV education delivery in European medical universities (undergraduate period) and during the specialist training in general practice (GP)/family medicine (FM) (postgraduate residency programme), and (2) compare it with WHO recommendations for FV curriculum. Methods and analysis. This is the protocol of a cross-sectional descriptive study consisting of two self-report online surveys (for undergraduate and postgraduate training, respectively) with 40 questions each. For both surveys, general practitioners, residents, medical students and professionals involved in their education from countries of the European region will be identified through the European Regional Branch of the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA Europe) and will be invited to provide information regarding the training on FV. Descriptive tests will be carried out and a thematic analysis will be conducted on the open-ended questions. Ethics and dissemination Ethics approval has been obtained by the University of Luxembourg (ERP 17–015 FAVICUE). The results will provide important information concerning current curricula on FV, and can be used for mapping the educational needs and planning the implementation of future training interventions. They will be published and disseminated through WONCA Europe and its networks

Randomised controlled non-inferiority trial of primary care-based facilitated access to an alcohol reduction website: cost-effectiveness analysis

To evaluate the 12-month costs and quality-adjusted life years (QALYs) gained to the Italian National Health Service of facilitated access to a website for hazardous drinkers compared with a standard face-to-face brief intervention (BI)