Therapeutic patient education for stroke survivors: Non-pharmacological management. A literature review.

International audienceOBJECTIVES: Focus on the different therapeutic patient education (TPE) programs for stroke survivors found in the literature. Verify their content and efficacy. METHOD: A literature review was conducted by searching for entries from 1966 to 2011 in the Medline and Cochrane Library databases. The references for the accepted articles were taken into consideration and the articles corresponding to the criteria inclusion but not present within the initial search were selected. The keywords used were "self care", "self management", "patient education" and "stroke". Given the multiplicity of symptoms that may be addressed in TPE programs, and following expert advice, the symptoms were grouped after expanding the bibliographic search using the following, additional keywords: "dysphagia"; "swallowing disorder"; "urinary incontinence"; "caregiver"; "fall prevention"; "falling"; "injury"; "shoulder pain"; "physical activity"; "exercise"; "aphasia" and "cognitive impairment". RESULTS: We found 30 article abstracts. In the end, we only accepted seven articles on general TPE programs that were well structured and detailed enough. The TPE programs found in the literature were often of questionable methodological quality. The multiplicity of symptoms led to very general TPE programs that covered all possible stroke after-effects. The purpose of these programs was to reduce stress and anxiety, to improve quality of life and to alleviate psychosocial after-effects. A change in caregiver and patient behavior was observed at times. We expanded the bibliographic search to include scientific arguments that could help implement TPE programs for more specific targets. CONCLUSION: TPE programs for stroke survivors could be improved by standardizing and assessing programs that focus on a specific problem caused by the various possible after-effects of strokes. In order to promote education for stroke survivors, specific training for health care professionals and appropriate funding are necessary

Two decades of French urban policy: from social development of neighbourhoods to the republican penal state

This paper provides an overview of French national urban policy for the period 1981-2002, organized around three themes: spatial conceptualizations of intervention areas and changing scales of intervention, discursive articulations of intervention areas, and legitimation of state intervention. By relating the transformations of this policy to the contemporary restructuring of the French state, the paper argues that although there are elements of convergence, the contemporary restructuring of the French state differs remarkably from a US or UK-style neoliberalization, partly because of the republican tradition emphasizing the active role of the state for the well-being of its citizens. This restructuring carries the signs of the strong state tradition in France, and is best understood as an articulation of neoliberalism with established political traditions, an articulation that I try to capture with the notion of a "republican penal state"