Living with diabetes: quality of care and quality of life

Background: The aim of this research was to characterize the experience of living with diabetes mellitus (DM) and identify patients" opinions of the quality of care received and the results of interventions. Methods: A descriptive, exploratory evaluation study using qualitative methodology was performed. Participants consisted of 40 adult patients diagnosed with DM and followed up in a public hospital in Barcelona, Spain. A semistructured interview and a focus group were used and a thematic content analysis was performed. Results: Patients described DM as a disease that is difficult to control and that provokes lifestyle changes requiring effort and sacrifice. Insulin treatment increased the perception of disease severity. The most frequent and dreaded complication was hypoglycemia. The main problems perceived by patients affecting the quality of care were related to a disease-centered medical approach, lack of information, limited participation in decision-making, and the administrative and bureaucratic problems of the health care system. Conclusion: The bureaucratic circuits of the health care system impair patients" quality of life and perceived quality of care. Health professionals should foster patient participation in decision-making. However, this requires not only training and appropriate attitudes, but also adequate staffing and materials.

Living with diabetes: quality of care and quality of life

Background: The aim of this research was to characterize the experience of living with diabetes mellitus (DM) and identify patients" opinions of the quality of care received and the results of interventions. Methods: A descriptive, exploratory evaluation study using qualitative methodology was performed. Participants consisted of 40 adult patients diagnosed with DM and followed up in a public hospital in Barcelona, Spain. A semistructured interview and a focus group were used and a thematic content analysis was performed. Results: Patients described DM as a disease that is difficult to control and that provokes lifestyle changes requiring effort and sacrifice. Insulin treatment increased the perception of disease severity. The most frequent and dreaded complication was hypoglycemia. The main problems perceived by patients affecting the quality of care were related to a disease-centered medical approach, lack of information, limited participation in decision-making, and the administrative and bureaucratic problems of the health care system. Conclusion: The bureaucratic circuits of the health care system impair patients" quality of life and perceived quality of care. Health professionals should foster patient participation in decision-making. However, this requires not only training and appropriate attitudes, but also adequate staffing and materials.

L'ensenyament de la història i el living history

Hi ha diferents estratègies per apropar la història als escolars. La utilització de les fonts primàries (objectes, documents, etc.) esdevé una estratègia important per fer viure els temps passats. Els objectes i els documents del passat ens permeten intervenir a partir del plantejament d'enigmes i preguntes que l'alumnat pot anar resolent a partir d'una veritable recerca històrica. Una de les estratègies utilitzades en el món anglosaxó és el living history. Es tracta de "fer reviure" el passat a través de la representació de fets, estil de vida i personatges propis d'una època determinada. Aquesta estratègia s'empra en espais de presentació del patrimoni, especialment en museus i assentaments històrics i arqueològics. Dos elements són fonamentals en aquest tipus d'intervencions: la preparació del context de presentació del patrimoni i els mediadors entre la institució o espai patrimonial i els visitants. A continuació, es presenta, de manera concreta, el cas de Colonial Williamsburg, institució dels EUA pionera en la utilització d'aquesta estratègia de presentació i interpretació del patrimoni històric i arqueològic.

Poverty and living arrangements among youth in Spain, 1980-2005

One of the most relevant demographic events in Spain from a recent historical perspective was the baby boom of the 1960s and 1970s. The “adapting to circumstances” of these generations of youth and their families through delayed emancipation and childbearing has been key in preventing a decline in their economic status. The results show that the reduction of the poverty risk among non-emancipated youth for the period 1980-2005 is explained by the fact that an increasing number of young Spaniards live with two employed parents. Thus, emancipation delay is found most in those families that can best afford it. Furthermore, the salaries of young workers remaining in the parental home have become an important factor in reducing their family poverty risk. On the other hand, fertility decline is readily explained by the economic difficulties young couples encounter in sustaining their offspring

Are we living longer but less healthy? Trends in mortality and morbidity in Catalonia (Spain), 1994-2011

Evidence on trends in prevalence of disease and disability can clarify whether countries are experiencing a compression or expansion of morbidity. An expansion of morbidity as indicated by disease have appeared in Europe and other developed regions. It is likely that better treatment, preventive measures and increases in education levels have contributed to the declines in mortality and increments in life expectancy. This paper examines whether there has been an expansion of morbidity in Catalonia (Spain). It uses trends in mortality and morbidity from major causes of death and links of these with survival to provide estimates of life expectancy with and without diseases and functioning loss. We use a repeated cross-sectional health survey carried out in 1994 and 2011 for measures of morbidity; mortality information comes from the Spanish National Statistics Institute. Our findings show that at age 65 the percentage of life with disease increased from 52% to 70% for men, and from 56% to 72% for women; the expectation of life unable to function increased from 24% to 30% for men and 40% to 47% for women between 1994 and 2011. These changes were attributable to increases in the prevalences of diseases and moderate functional limitation. Overall, we find an expansion of morbidity along the period. Increasing survival among people with diseases can lead to a higher prevalence of diseases in the older population. Higher prevalence of health problems can lead to greater pressure on the health care system and a growing burden of disease for individuals.

In conspectu prope totius urbis: an application of different visual methods at the ager Tarraconensis landscape

We present in this paper the results of the application of several visual methods on a group of locations, dated between VI and I centuries BC, of the ager Tarraconensis (Tarragona, Spain) a Hinterland of the roman colony of Tarraco. The difficulty in interpreting the diverse results in a combined way has been resolved by means of the use of statistical methods, such as Principal Components Analysis (PCA) and K-means clustering analysis. These methods have allowed us to carry out site classifications in function of the landscape's visual structure that contains them and of the visual relationships that could be given among them.

Detection of Body Dump Sites and Clandestine Burials: a GIS-Based Landscape Approach

Forensic archaeology has been of inestimable help in the location and excavation of clandestine burials (Hunter 1996a:16-17, 1996b; Killam 2004; Levine et al. 1984). Landscape archaeology techniques have been adapted and widely applied for such purposes. In this article, an adaptation of one of the most common applications of archaeological GIS, that is predictive site location, is applied to the detection of body dump sites and clandestine burial sites, bringing together in the process the fields of landscape archaeology, forensic sciences, and GIS.

Modelling bird species richness with neural networks for forest landscape management in NE Spain

Para preservar la biodiversidad de los ecosistemas forestales de la Europa mediterránea en escenarios actuales y futuros de cambio global mediante una gestión forestal sostenible es necesario determinar cómo influye el medio ambiente y las propias características de los bosques sobre la biodiversidad que éstos albergan. Con este propósito, se analizó la influencia de diferentes factores ambientales y de estructura y composición del bosque sobre la riqueza de aves forestales a escala 1 × 1 km en Cataluña (NE de España). Se construyeron modelos univariantes y multivariantes de redes neuronales para respectivamente explorar la respuesta individual a las variables y obtener un modelo parsimonioso (ecológicamente interpretable) y preciso. La superficie de bosque (con una fracción de cabida cubierta superior a 5%), la fracción de cabida cubierta media, la temperatura anual y la precipitación estival medias fueron los mejores predictores de la riqueza de aves forestales. La red neuronal multivariante obtenida tuvo una buena capacidad de generalización salvo en las localidades con una mayor riqueza. Además, los bosques con diferentes grados de apertura del dosel arbóreo, más maduros y más diversos en cuanto a su composición de especies arbóreas se asociaron de forma positiva con una mayor riqueza de aves forestales. Finalmente, se proporcionan directrices de gestión para la planificación forestal que permitan promover la diversidad ornítica en esta región de la Europa mediterránea.

Old Women, Young Souls: History as a Living Matter

The passionate and deceptive life stories of the protagonists in Angela Carter’s Wise Children (1990) and Rose Tremain’s The Cupboard (1984), women in their seventies and eighties, are entangled with historical events that influenced England, Europe and the rest of the world. In these novels, Angela Carter and Rose Tremain challenge not only notions of ageing by presenting elder protagonists who are lively and strong, but also the idea of history as unique, true and unquestionable by conferring on them the status of story and historytellers.

Land use changes, landscape ecology and their socioeconomic driving forces in the Spanish Mediterranean coast (the Maresme County, 1850-2005)

[cat] Utilitzem un conjunt de mètriques del paisatge per estudiar l'evolució a llarg termini seguida en una típica zona costanera del Mediterrani des de 1850 fins a 2005, que mostren una greu deterioració del medi ambient entre 1950 i 2005. Les principals forces motores d'aquesta degradació del paisatge han estat el creixement urbà experimentat a les antigues zones agrícoles situades a les planes litorals, juntament amb l'abandonament i la reforestació dels vessants dels pujols interceptats per àrees residencials de baixa densitat, carreteres i altres infraestructures lineals. Duem a terme una anàlisi estadística de redundància (RDA) amb la finalitat d'identificar els que considerem com alguns agents rectors socioeconòmics i polítics d'última instància d'aquests impactes ambientals. Els resultats confirmen les nostres hipòtesis interpretatives, que són que: 1) els canvis en les cobertes i usos del sòl determinen canvis en les propietats dels paisatge, tant estructurals com funcionals; 2) aquests canvis no es produeixen per atzar, sinó que estan relacionats amb factors geogràfics i forces socioeconòmiques i polítiques.

Land use changes, landscape ecology and their socioeconomic driving forces in the Spanish Mediterranean coast (the Maresme County, 1850-2005)

[cat] Utilitzem un conjunt de mètriques del paisatge per estudiar l'evolució a llarg termini seguida en una típica zona costanera del Mediterrani des de 1850 fins a 2005, que mostren una greu deterioració del medi ambient entre 1950 i 2005. Les principals forces motores d'aquesta degradació del paisatge han estat el creixement urbà experimentat a les antigues zones agrícoles situades a les planes litorals, juntament amb l'abandonament i la reforestació dels vessants dels pujols interceptats per àrees residencials de baixa densitat, carreteres i altres infraestructures lineals. Duem a terme una anàlisi estadística de redundància (RDA) amb la finalitat d'identificar els que considerem com alguns agents rectors socioeconòmics i polítics d'última instància d'aquests impactes ambientals. Els resultats confirmen les nostres hipòtesis interpretatives, que són que: 1) els canvis en les cobertes i usos del sòl determinen canvis en les propietats dels paisatge, tant estructurals com funcionals; 2) aquests canvis no es produeixen per atzar, sinó que estan relacionats amb factors geogràfics i forces socioeconòmiques i polítiques.

Landscape Systems and Human Land-Use Interactions in Mediterranean Highlands and Littoral Plains during the Late Holocene: Integrated Analysis from the InterAmbAr Project (North-Eastern Catalonia).

The main goal of the InterAmbAr reseach project is to analyze the relationships between landscape systems and human land-use strategies on mountains and littoral plains from a long-term perspective. The study adopts a high resolution analysis of small-scale study areas located in the Mediterranean region of north-eastern Catalonia. The study areas are distributed along an altitudinal transect from the high mountain (above 2000m a.s.l.) to the littoral plain of Empordà (Fig. 1). High resolution interdisciplinary research has been carried out from 2010, based on the integration of palaeoenvironmental and archaeological data. The micro-scale approach is used to understand human-environmental relationships. It allows better understanding of the local-regional nature of environmental changes and the synergies between catchment-based systems, hydro-sedimentary regimes, human mobility, land-uses, human environments, demography, etc.

The experience of identity transformation process for people living with tetraplegia and paraplegia = El proceso de reconstrucción de la identidad de las personas afectadas de una paraplejia o tetraplejia

A spinal cord injury (SCI) is perceived as a source of biographical disruption, not only at a physical level but also in terms of people’s life stories, their motivation and their self-esteem. The aim of this study is to explore the factors that people with spinal cord injuries perceive as contributing to rebuilding their sense of self. Two focus groups were established from the SCIcommunity, one of which was made up of 14 people with paraplegia and the other of 9 people with tetraplegia. In addition, four individual interviews were conducted with the participants. The results of content analysis show that the two most prominent factors in the process of identity renegotiation are the partial transformation of the subject’s identity followed by a coming to terms with that new identity. To rebuild self-worth, the importance of finding a balance between change and continuity was identified. Renegotiation of identity after a spinal cord injury is a complex phenomenon that greatly influences the SCI individual’s quality of life perceptions. Reaching a balance between the changes experienced due to the injury and finding a sense of continuity can be either facilitated or obstructed by the economic, political, legal, architectural, and social context

Ager Tarraconensis 5. Paisatge, poblament, cultura material i història = Landscape, Settlement, Material Culture and History Proceedings of the International Symposium

Aquesta obra recull 28 comunicacions presentades al Simposi internacional «L’ager Tarraconensis. Paisatge, poblament, cultura material i història», celebrat a Tarragona el 27 i 28 d’octubre del 2010, organitzat per l’Institut Català d’Arqueologia Clàssica a la seu de l’Institut i a la Diputació de Tarragona. Les aportacions al simposi se centren en l'evolució del paisatge al Camp de Tarragona i en altres regions del món romà, en la varietat de les primeres estratègies de control romà del territori, en les tipologies i evolució dels establiments, en aspectes econòmics i en la dinàmica del poblament, sense faltar-hi alguna aportació de l'epigrafia. Tot plegat fa referència molt especialment al territori de Tarraco, tot i que el simposi també va comptar amb comunicacions sobre altres territoris de l'àrea catalana i saguntina i d'altres províncies romanes, com la Lusitània, les Gàl·lies i la Transpadana; les comparacions entre diferents regions han donat una riquesa notable al debat. Entre els resultats més suggerents comptem amb la constatació de la similitud en els models de romanització del territori en les diferents àrees d'àmbit català i valencià, que contrasten significativament amb els models de territoris d'Andalusia, França i Portugal.