Can smartphones and tablets improve the management of childhood illness in Tanzania? A qualitative study from a primary health care worker's perspective.

BACKGROUND: The impact of the Integrated Management of Childhood Illness (IMCI) strategy has been less than anticipated because of poor uptake. Electronic algorithms have the potential to improve quality of health care in children. However, feasibility studies about the use of electronic protocols on mobile devices over time are limited. This study investigated constraining as well as facilitating factors that influence the uptake of a new electronic Algorithm for Management of Childhood Illness (ALMANACH) among primary health workers in Dar es Salaam, Tanzania. METHODS: A qualitative approach was applied using in-depth interviews and focus group discussions with altogether 40 primary health care workers from 6 public primary health facilities in the three municipalities of Dar es Salaam, Tanzania. Health worker's perceptions related to factors facilitating or constraining the uptake of the electronic ALMANACH were identified. RESULTS: In general, the ALMANACH was assessed positively. The majority of the respondents felt comfortable to use the devices and stated that patient's trust was not affected. Most health workers said that the ALMANACH simplified their work, reduced antibiotic prescription and gave correct classification and treatment for common causes of childhood illnesses. Few HWs reported technical challenges using the devices and complained about having had difficulties in typing. Majority of the respondents stated that the devices increased the consultation duration compared to routine practice. In addition, health system barriers such as lack of staff, lack of medicine and lack of financial motivation were identified as key reasons for the low uptake of the devices. CONCLUSIONS: The ALMANACH built on electronic devices was perceived to be a powerful and useful tool. However, health system challenges influenced the uptake of the devices in the selected health facilities.

Is blood still thicker than water? A life-course perspective on the transformation of family and friends' roles in personal networks

This thesis addresses the issue of the moving boundaries between family and friends' roles in personal networks, adopting a life-course perspective and using Switzerland as a case study. In a period of major changes in personal life happening in contemporary Western societies, understanding the organization of personal networks intertwined with the unfolding of individual life courses is of prime importance in facing new challenges with regard to social integration. The data stem from a representative national survey carried out in 2011 named Family tiMes, including 803 individuals born either in 1950-1955 or in 1970-1975. An innovative research design was adopted, combing cross-sectional ego-centered network data and retrospective longitudinal life-course data. The results show continuing boundaries between family and friends' roles and that family keeps a prominent role in personal networks despite the notable importance of friendship ties. One relationship stands out above all, that with the partner, followed quite a few steps behind by those with children. Regarding life courses, de-standardization tendencies were found in family formation and also a persistent gendering of occupational trajectories. Two kinds of life trajectories are particularly intertwined with personal networks, co-residence and partnership trajectories, both related to the unfolding of family life. In particular, transition to parenthood functions as a turning point in individuals' lives, deeply transforming their sociability. Finally, a twofold pluralization process was identified, affecting simultaneously the organization of personal networks and the unfolding of individual life courses. This thesis contributes to the literature on the sociology of family and personal life, and to fruitful interlinkage between the network approach and the life-course perspective.

Assessment of inflammatory Bowel Disease patient's needs and problems from a nursing perspective

BACKGROUND: In this study, we aimed at assessing Inflammatory Bowel Disease patients' needs and current nursing practice to investigate to what extent consensus statements (European Crohn's and Colitis Organization) on the nursing roles in caring for patients with IBD concur with local practice. METHODS: We used a mixed-method convergent design to combine quantitative data prospectively collected in the Swiss IBD cohort study and qualitative data from structured interviews with IBD healthcare experts. Symptoms, quality of life, and anxiety and depression scores were retrieved from physician charts and patient self-reported questionnaires. Descriptive analyses were performed based on quantitative and qualitative data. RESULTS: 230 patients of a single center were included, 60% of patients were males, and median age was 40 (range 18-85). The prevalence of abdominal pain was 42%. Self-reported data were obtained from 75 out of 230 patients. General health was perceived significantly lower compared with the general population (p < 0.001). Prevalence of tiredness was 73%; sleep problems, 78%; issues related to work, 20%; sexual constraints, 35%; diarrhea, 67%; being afraid of not finding a bathroom, 42%; depression, 11%; and anxiety symptoms, 23%. According to experts' interviews, the consensus statements are found mostly relevant with many recommendations that are not yet realized in clinical practice. CONCLUSION: Identified prevalence may help clinicians in detecting patients at risk and improve patient management. © 2015 S. Karger AG, Basel.

A Cellular Perspective on Brain Energy Metabolism and Functional Imaging.

The energy demands of the brain are high: they account for at least 20% of the body's energy consumption. Evolutionary studies indicate that the emergence of higher cognitive functions in humans is associated with an increased glucose utilization and expression of energy metabolism genes. Functional brain imaging techniques such as fMRI and PET, which are widely used in human neuroscience studies, detect signals that monitor energy delivery and use in register with neuronal activity. Recent technological advances in metabolic studies with cellular resolution have afforded decisive insights into the understanding of the cellular and molecular bases of the coupling between neuronal activity and energy metabolism and point at a key role of neuron-astrocyte metabolic interactions. This article reviews some of the most salient features emerging from recent studies and aims at providing an integration of brain energy metabolism across resolution scales.

Responsiveness et changement thérapeutique au travers de l'études de cas

Le concept de responsiveness ou « responsivité » a été proposé dans le domaine de la recherche en psychothérapie pour décrire l'influence mutuelle qui s'exerce continuellement entre patient et thérapeute. La nature responsive des psychothérapies pose alors un problème majeur aux chercheurs, qui adoptent généralement des plans de recherche impliquant des liens de cause à effet et sont en échec dans leur entreprise de mieux comprendre le changement thérapeutique. L'objectif de notre travail est de proposer des pistes pour répondre à ce problème. Nous avons adopté la méthode d'étude de cas, qui permet une analyse en profondeur et en contexte des processus de changement. Dans les deux premières phases de la recherche, nous nous situions dans une approche spécifique à la recherche qualitative en psychothérapie. Nous avons tout d'abord analysé comment le changement s'effectuait chez le patient, en identifiant pas à pas le niveau d'assimilation de ses expériences problématiques. Nous avons ensuite tenté d'appréhender le rôle du thérapeute dans le processus de changement. Notre objectif était d'analyser comment la responsivité du thérapeute pouvait faciliter le processus de changement chez le patient à chaque instant de la thérapie. En suivant une procédure inspirée de l'analyse de la tâche, nous avons identifié pour chaque niveau d'assimilation des interventions thérapeutiques suivies de progression, et élaboré un modèle empirique séquentiel. Dans la troisième phase de la recherche, nous avons effectué un tournant dans notre parcours et sommes allée du côté des sciences du langage. En adoptant une approche dialogique du discours, notre objectif était d'éclairer notre objet d'étude à partir d'une nouvelle perspective et d'ouvrir la réflexion. Nous avons ainsi pu répondre à certaines limites rencontrées dans les premières phases de la recherche, et faire émerger de nouvelles questions et perspectives pour l'étude des processus de changement dans une dimension interactive. -- The concept of responsiveness was developed in psychotherapy research to describe the mutual and constant influence between patient and therapist. The responsive nature of psychotherapy is a serious problem for researchers, who generally adopt research designs involving cause-effect reasoning and fail to better understand therapeutic change. The purpose of our work is to propose some viable possibilities to respond to this problem. We chose the case study method, which enables an analysis in depth and in context of change processes. In the two first phases of research, our approach was specific to qualitative psychotherapy research. We first analyzed how change occurred in the patient, by identifying moment-by-moment the level of assimilation of his or her problematic experiences. We then tried to apprehend the therapist role in the change process. Our aim was to analyze how the therapist responsiveness could facilitate the patient change process at any moment of psychotherapy. We followed a procedure inspired by task analysis and, for each level of assimilation, we identified therapist interventions followed by progression, and elaborated an empirical sequential model. The third phase of research was a turning point, as we went in the field of linguistics. We adopted a dialogical approach of discourse to open up reflection. Thus, we could answer some limitations encountered in the first phases of research, and new questions and perspectives to study change process taking into account the interactive dimension emerged.