Multimorbidity in primary care : protocol of a national cross-sectional study in Switzerland.

INTRODUCTION: With the ageing of the population and the general improvement of care, an increasing number of people are living with multiple chronic health conditions or 'multimorbidity'. Multimorbidity often implies multiple medical treatments. As a consequence, the risk of adverse events and the time spent by patients for their treatments increase exponentially. In many cases, treatment guidelines traditionally defined for single conditions are not easily applicable. Primary care for individuals with multimorbidity requires complex patient-centred care and good communication between the patient and the general practitioner (GP). This often includes prioritising among the different chronic conditions. METHODS AND ANALYSIS: The main objectives of this study are to describe the burden related to multimorbidity (disease-related burden and burden of treatment) in primary care and to identify the factors influencing it. Other objectives include evaluating patients' perception of treatment burden and quality of life, assessing factors influencing that perception, and investigating prioritisation in the management of multimorbidity from the perspectives of GPs and patients. For this cross-sectional study, patient enrolment will take place in GP's private practices across Switzerland. A convenient sample of 100 GPs will participate; overall, 1000 patients with at least three chronic health conditions will be enrolled. Data will be collected as paper-based questionnaires for GPs and delayed telephone interview questionnaires for patients. GPs will provide demographic and practice-related data. In addition, each GP will complete a paper-based questionnaire for each patient that they enrol. Each patient will complete a telephone interview questionnaire. ETHICS AND DISSEMINATION: This study has been approved by the research ethics committee of Canton Vaud, Switzerland (Protocol 315/14). The results of the study will be reported in international peer-reviewed journals.

Moral disengagement: Towards a context-general category-based measure of the concept

Bandura (1986) developed the concept of moral disengagement to explain how individuals can engage in detrimental behavior while experiencing low levels of negative feelings such as guilt-feelings. Most of the research conducted on moral disengagement investigated this concept as a global concept (e.g., Bandura, Barbaranelli, Caprara, & Pastorelli, 1996; Moore, Detert, Klebe Treviño, Baker, & Mayer, 2012) while Bandura (1986, 1990) initially developed eight distinct mechanisms of moral disengagement grouped into four categories representing the various means through which moral disengagement can operate. In our work, we propose to develop measures of this concept based on its categories, namely rightness of actions, rejection of personal responsibility, distortion of negative consequences, and negative perception of the victims, and which is not specific a particular area of research. Through our measures, we aim at better understanding the cognitive process leading individuals to behave unethically by investigating which category plays a role in explaining unethical behavior depending on the situations in which individuals are. To this purpose, we conducted five studies to develop the measures and to test its predictive validity. Particularly, we assessed the ability of the newly developed measures to predict two types of unethical behaviors, i.e. discriminatory behavior and cheating behavior. Confirmatory Factor analyses demonstrated a good fit of the model and findings generally supported our predictions.

Support for a demographically based selection method at University: The role of competition

Building on the instrumental model of group conflict (IMGC), the present experiment investigates the support for discriminatory and meritocratic method of selections at university in a sample of local and immigrant students. Results showed that local students were supporting in a larger proportion selection method that favors them over immigrants in comparison to method that consists in selecting the best applicants without considering his/her origin. Supporting the assumption of the IMGC, this effect was stronger for locals who perceived immigrants as competing for resources. Immigrant students supported more strongly the meritocratic selection method than the one that discriminated them. However, contrasting with the assumption of the IMGC, this effect was only present in students who perceived immigrants as weakly competing for locals' resources. Results demonstrate that selection methods used at university can be perceived differently depending on students' origin. Further, they suggest that the mechanisms underlying the perception of discriminatory and meritocratic selection methods differ between local and immigrant students. Hence, the present experiment makes a theoretical contribution to the IMGC by delimiting its assumptions to the ingroup facing a competitive situation with a relevant outgroup. Practical implication for universities recruitment policies are discussed.

Quality of Life in Swiss Paediatric Inflammatory Bowel Disease Patients: Do Patients and Their Parents Experience Disease in the Same Way?

BACKGROUND AND AIMS: Inflammatory bowel diseases (IBDs) may impair quality of life (QoL) in paediatric patients. We aimed to evaluate in a nationwide cohort whether patients experience QoL in a different way when compared with their parents. METHODS: Sociodemographic and psychosocial characteristics were prospectively acquired from paediatric patients and their parents included in the Swiss IBD Cohort Study. Disease activity was evaluated by the Paediatric Crohn's Disease Activity Index (PCDAI) and the Paediatric Ulcerative Colitis Activity Index (PUCAI). We assessed QoL using the KIDSCREEN questionnaire. The QoL domains were analysed and compared between children and parents according to type of disease, parents' age, origin, education and marital status. RESULTS: We included 110 children and parents (59 Crohn's disease [CD], 45 ulcerative colitis [UC], 6 IBD unclassified [IBDU]). There was no significant difference in QoL between CD and UC/IBDU, whether the disease was active or in remission. Parents perceived overall QoL, as well as 'mood', 'family' and 'friends' domains, lower than the children themselves, independently of their place of birth and education. However, better concordance was found on 'school performance' and 'physical activity' domains. Marital status and age of parents significantly influenced the evaluation of QoL. Mothers and fathers being married or cohabiting perceived significantly lower mood, family and friends domains than their children, whereas mothers living alone had a lower perception of the friends domain; fathers living alone had a lower perception of family and mood subscores. CONCLUSION: Parents of Swiss paediatric IBD patients significantly underestimate overall QoL and domains of QoL of their children independently of origin and education.

Development and validation of a visual grading scale for assessing image quality of AP pelvis radiographic images.

OBJECTIVE: The aim of this article was to apply psychometric theory to develop and validate a visual grading scale for assessing the visual perception of digital image quality anteroposterior (AP) pelvis. METHODS: Psychometric theory was used to guide scale development. Seven phantom and seven cadaver images of visually and objectively predetermined quality were used to help assess scale reliability and validity. 151 volunteers scored phantom images, and 184 volunteers scored cadaver images. Factor analysis and Cronbach's alpha were used to assess scale validity and reliability. RESULTS: A 24-item scale was produced. Aggregated mean volunteer scores for each image correlated with the rank order of the visually and objectively predetermined image qualities. Scale items had good interitem correlation (≥0.2) and high factor loadings (≥0.3). Cronbach's alpha (reliability) revealed that the scale has acceptable levels of internal reliability for both phantom and cadaver images (α = 0.8 and 0.9, respectively). Factor analysis suggested that the scale is multidimensional (assessing multiple quality themes). CONCLUSION: This study represents the first full development and validation of a visual image quality scale using psychometric theory. It is likely that this scale will have clinical, training and research applications. ADVANCES IN KNOWLEDGE: This article presents data to create and validate visual grading scales for radiographic examinations. The visual grading scale, for AP pelvis examinations, can act as a validated tool for future research, teaching and clinical evaluations of image quality.