Francesco Panese

Detecting and measuring deprivation in primary care: development, reliability and validity of a self-reported questionnaire: the DiPCare-Q

Objectives Advances in biopsychosocial science have underlined the importance of taking social history and life course perspective into consideration in primary care. For both clinical and research purposes, this study aims to develop and validate a standardised instrument measuring both material and social deprivation at an individual level. Methods We identified relevant potential questions regarding deprivation using a systematic review, structured interviews, focus group interviews and a think-aloud approach. Item response theory analysis was then used to reduce the length of the 38-item questionnaire and derive the deprivation in primary care questionnaire (DiPCare-Q) index using data obtained from a random sample of 200 patients during their planned visits to an ambulatory general internal medicine clinic. Patients completed the questionnaire a second time over the phone 3 days later to enable us to assess reliability. Content validity of the DiPCare-Q was then assessed by 17 general practitioners. Psychometric properties and validity of the final instrument were investigated in a second set of patients. The DiPCare-Q was administered to a random sample of 1898 patients attending one of 47 different private primary care practices in western Switzerland along with questions on subjective social status, education, source of income, welfare status and subjective poverty. Results Deprivation was defined in three distinct dimensions: material (eight items), social (five items) and health deprivation (three items). Item consistency was high in both the derivation (Kuder-Richardson Formula 20 (KR20) =0.827) and the validation set (KR20 =0.778). The DiPCare-Q index was reliable (interclass correlation coefficients=0.847) and was correlated to subjective social status (rs=−0.539). Conclusion The DiPCare-Q is a rapid, reliable and validated instrument that may prove useful for measuring both material and social deprivation in primary care.

Dissatisfaction of hospital patients, their relatives, and friends: Analysis of accounts collected in a complaints center

OBJECTIVE This study aimed to analyze complaints of patients, their relatives, and friends who consulted a complaints center based (Espace Patients & Proches (EPP)) in a hospital so as to better understand the reasons that motivated them and their underlying expectations. METHODS This study was based on the analysis of written accounts of the 253 situations that occurred during the first year of operation of the EPP. The accounts were analyzed qualitatively using an inductive, thematic analytic approach. RESULTS We identified 372 different types of complaints and 28 main analytic themes. Five clustered themes emerged from the analysis of the interconnections among the core themes: (1) interpersonal relationship (N=160-the number of accounts including a complaint related to this general theme); (2) technical aspects of care (N=106); (3) health-care institution (N=69); (4) billing and insurance; (5) access to information (N=13). CONCLUSION The main reason for patients, their relatives, and friends going to EPP was related to the quality of the interpersonal relationship with health-care professionals. Such complaints were markedly more frequent than those concerning technical aspects of care. PRACTICE IMPLICATIONS These results raise important questions concerning changing patient expectations as well as how hospitals integrate complaints into the process of quality health care.

Meeting physicians’ needs: a bottom-up approach for improving the implementation of medical knowledge into practice

BackgroundMultiple barriers to knowledge translation in medicine have been identified (ranging from information overload to abstraction of models), leading to important implementation gaps. This study aimed at assessing the suggestions of practicing physicians for possible improvements of knowledge translation (KT) effectiveness into clinical practice.MethodsWe used a mixed methods design. French- German- and Italian-speaking general practitioners, psychiatrists, orthopaedic surgeons, cardiologists, and diabetologists practicing in Switzerland were interrogated through semi-structured interviews, focus group discussions, and an online survey.ResultsA total of 985 physicians from three regions of Switzerland participated in the online survey, whereas 39 participated in focus group discussions and 14 in face-to-face interviews. Physicians expressed limitations and difficulties related to KT into their daily practice. Several barriers were identified, including influence and pressure of pharmaceutical companies, non-publication of negative results, mismatch between guidelines and practice, education gaps, and insufficient collaboration between research and practice. Suggestions to overcome barriers were improving education concerning the evaluation of scientific publications, expanding applicability of guidelines, having free and easy access to independent journals, developing collaborations between research and practice, and creating tools to facilitate access to medical information.ConclusionsOur study provides suggestions for improving KT into daily medical practice, matching the views, needs and preferences of practicing physicians. Responding to suggestions for improvements brought up by physicians may lead to better knowledge translation, higher professional satisfaction, and better healthcare outcomes.

Excess winter deaths caused by cardiovascular diseases are associated with both mild winter temperature and socio-economic inequalities in the U.S.

a University of California, San Francisco, Department of Epidemiology and Biostatistics, San Francisco, CA 94158, USA b University of California, Berkeley, Department of Environmental Science, Policy, and Management, Berkeley, CA 94720, USA c University of Lausanne, Institute of Social and Preventive Medicine, 1010 Lausanne, Switzerland d University of Lausanne, Institute of History of Medicine and Public Health, 1007 Lausanne, Switzerland

The neural basis of what? Discontents in defining “human nature”

Historian Ellenberger (1970) has identified in the history of psychiatry and brain science “the trend that consists in describing and understanding psychological and psychopathological phenomena in terms of real or hypothetical brain structures”, a trend he called a “brain mythology”. The rise of neuroscience in the last two decades has certainly given it a new significance. It is clear that neuroscience is extending its territory toward psychosocial, moral and cultural attitudes. The neuroscientific question “how does the human brain work?” has become more and more inseparable from the question “what does it mean to be human?” We may observe how contemporary neuroscience participates in the embodiment of the mind in the brain. Vidal (2009) calls “brainhood” the idea that “the brain is necessarily the location of the modern self”. This historical and epistemological situation generates conflicting claims and controversies, which are the evidence of the tensed relationship among neuroscience, social sciences and humanities today. Firstly, there is a tension between the neural and the social bases of the human mind (i.e. its competences, behaviours and attitudes) and there is a tension between individual identities and generic categories of people supposed to share neural configurations. These controversies are closely linked to the development of brain imaging as a possibility to visualize individual brain processes and construct cerebral types by subtracting and averaging imaging data (Posner and Raichle, 1994). They are also part of the history of understanding what being human means and of the conflict between “free will” and “biological shaping”. This conflict has been recently revived by the rise of neuroscience and by some social and political controversies related to the concepts of identity and personhood. In this short article, I would like to suggest that a more specific historical contextualization of these tensions and conflicts may help us to better understand the contemporary epistemological debate between neuroscience and social sciences.