Pediatric diabetes training for healthcare professionals in Europe: Time for change.

BACKGROUND: Training for healthcare professionals (HCPs) in Europe who care for children and young people (CYP) with type 1 diabetes and their families is variable depending on the country. Building on the work of SWEET (Better control in Pediatric and Adolescent diabeteS: Working to crEate CEnTers of Reference) and using the German Certified Diabetes Educators (CDEs) curriculum, a European collaboration of pediatric diabetes experts aimed to (1) establish current core elements that should be included in a pediatric diabetes education training course and (2) create a template for a European CDE's training curriculum. METHODS: A qualitative methodology incorporating a survey questionnaire, focus group discussions, individual semi-structured interviews and workshops was employed to explore participants' experiences and opinions. HCPs-pediatric consultants, diabetes nurses, dietitians and psychologists, national and local diabetes leads, academic and education leads and children, and young people with diabetes and families took part in the study. The total number of participants equaled 186. RESULTS: A template for a European Certified Diabetes Educator Curriculum (EU-CDEC) was developed based on the themes that emerged from the participants' expertise and experiences. This provides a model for HCPs' pediatric diabetes training provision. CONCLUSIONS: There is a severe shortage of high quality, standardized training for HCPs across the majority of European countries. Lack of trained HCPs for CYP with diabetes will result in the delivery of suboptimal care and impact on health, wellbeing and clinical and psychological outcomes. The EU-CDEC template can be used to increase access to high quality training provision for all HCPs across Europe and worldwide

Metaphors we die by? Geoengineering, metaphors and the argument from catastrophe

Geoeengineering the climate by reflecting sunlight or extracting carbon dioxide from the atmosphere has attracted increasing attention from natural scientists, social scientists, policy makers and the media. This article examines promotional discourse related to geoengineering from the 1980s to 2010. It asks in particular how this option for dealing with the problems posed by climate change were framed through the use of conceptual and discourse metaphors and whether one can argue that these are metaphors we ‘live by’ or metaphors we might ‘die by’. Findings show that an overarching argument from catastrophe was bolstered by three conceptual master-metaphors, namely The Planet is a body, The Planet is a machine and The planet is a patient/addict, linked to a variety of discourse metaphors, older conceptual metaphors and clichés. This metaphorical landscape began to shift while the article was being written and will have to be closely monitored in the future

Diabetes self-management arrangements in Europe: a realist review to facilitate a project implemented in six countries

Background: Self-management of long term conditions can promote quality of life whilst delivering benefits to the financing of health care systems. However, rarely are the meso-level influences, likely to be of direct relevance to these desired outcomes, systematically explored. No specific international guidelines exist suggesting the features of the most appropriate structure and organisation of health care systems within which to situate self-management approaches and practices. This review aimed to identify the quantitative literature with regard to diabetes self-management arrangements currently in place within the health care systems of six countries (The United Kingdom, The Netherlands, Norway, Spain, Bulgaria, and Greece) and explore how these are integrated into the broader health care and welfare systems in each country. Methods: The methodology for a realist review was followed. Publications of interest dating from 2000 to 2013 were identified through appropriate MeSH terms by a systematic search in six bibliographic databases. A search diary was maintained and the studies were assessed for their quality and risk of bias. Results: Following the multi-step search strategy, 56 studies were included in the final review (the majority from the UK) reporting design methods and findings on 21 interventions and programmes for diabetes and chronic disease self-management. Most (11/21, 52%) of the interventions were designed to fit within the context of primary care. The majority (11/21, 52%) highlighted behavioural change as an important goal. Finally, some (5/21, 24%) referred explicitly to Internet-based tools. Conclusions: This review is based on results which are derived from a total of at least 5,500 individuals residing in the six participating countries. It indicates a policy shift towards patient-centred self-management of diabetes in a primary care context. The professional role of diabetes specialist nurses, the need for multidisciplinary approaches and a focus on patient education emerge as fundamental principles in the design of relevant programmes. Socio-economic circumstances are relevant to the capacity to self-manage and suggest that any gains and progress will be hard to maintain during economic austerity. This realist review should be interpreted within the wider context of a whole systems approach regarding self-care support and chronic illness management

Rebirth, devastation and sickness: analyzing the role of metaphor in media discourses of nuclear power

International audienceNuclear power plays an important but controversial role in policies to ensure domestic energy security, fuel poverty reduction and the mitigation of climate change. Our article construes the problem of nuclear power in terms of social discourse, language and public choice; specifically examining the role that metaphors play in the policy domain. We empirically analyze metaphors as framing devices in nuclear energy policy debates in the UK between April 2009 and March 2013, thereby capturing the impact of the Fukushima nuclear disaster in 2011. We employ documentary analysis of major UK national broadsheet and tabloid newspapers, using electronic bibliographic tools to extract the metaphors. We then map these metaphors using a Type Hierarchy Analysis, which examines how elements of the target domain (energy technologies and policies) originate from a different source domain. Type hierarchies identify and categorize metaphors, defining the affectual and emotional responses associated with them, providing us with grounded insight into their role in shaping discourse and as a consequence influence public engagement with energy policy. Our analysis highlights three emergent domains of discourse metaphors and discusses the implications of their deployment. Metaphors were found to be classified into three different categories: Rebirth (Renaissance), Devastation (Apocalypse, Inferno, Genie and Bomb) and Sickness (Addiction and Smoking)