La salut reproductiva de la dona immigrant: una anàlisi des de la influència cultural

El progressiu increment del flux migratori en els darrers anys a Catalunya genera un major percentatge de dones en estat fèrtil que requereixen d’una atenció vinculada a la seva salut reproductiva. D’aquesta manera, els professionals sanitaris es veuen sotmesos a treballar sota una diversitat cultural que moltes vegades genera un “xoc intercultural” dificultant la relació assistencial entre professional i usuari. Per aquest motiu, el següent estudi pretén donar una aproximació de la influència cultural de la dona immigrant (marroquina i subsahariana) en quatre àmbits: embaràs, part, post-part i maternitat.Hipòtesis: S’identifiquen necessitats bàsiques assistencials no resoltes satisfactòriament en el grup de dones immigrants (marroquines i subsaharianes) en el període del part, puerperi immediat i intermedi, a més d’un impacte intercultural associat.Objectiu principal: Conèixer les vivències, percepcions i conductes de les dones marroquines i subsaharianes en l’embaràs, el part, el post-part, la maternitat dins el seu marc cultural i com influeixen en l’atenció sanitària del nostre país.Material i mètodes: S’ha realitzat un estudi de disseny mixt. Per una banda s’ha disposat d’una metodologia qualitativa descriptiva que utilitza la teoria fonamentada “Grounded Theory” com a instrument metodològic, i per l’altra, s’ha optat per una metodologia quantitativa per analitzar les dades clíniques i epidemiològiques de gestants immigrants que havien donat a llum al Servei d’Obstetrícia-Sala de Parts de l’Hospital Sta. Caterina (Girona), durant el període comprès entre el mes de novembre de 2012 i gener de 2013.La recollida de dades s’ha realitzat sota una entrevista semiestructurada i una observació participant com a instruments qualitatius, i el suport del “carnet de l’embaràs” i la “història obstètrica” de cada dona per elaborar l’estudi quantitatiu. Pel que fa a l’anàlisi de les dades en l’estudi qualitatiu s’ha seguit el procés analític plantejat per la Teoria fonamentada i en el cas de l’estudi quantitatiu, s’ha comptatamb el suport d’una tesi doctoral per comparar els resultats amb els de les dones autòctones, dels quals fa referència la tesi.Resultats: En l’estudi qualitatiu, s’han trobat especificitats culturals en relació a la percepció del part, desenvolupament del part ( a nivell conductual), implicació en el post-part, valoració de l’atenció sanitària rebuda i el concepte de maternitat. Pel que fa a l’estudi quantitatiu comparatiu, s’han indentificat diferències entre el col·lectiu de la mostra estudiada i les dones autòctones referent als antecedents obstètrics i paritat, al control gestacional i al desenvolupament del part ( a nivell fisiològic)

Effect of religion on suicide attempts in outpatients with schizophrenia or schizo-affective disorders compared with inpatients with non-psychotic disorders

Little is known of the relations between psychosis, religion and suicide. One hundred and fifteen outpatients with schizophrenia or schizo-affective disorder and 30 inpatients without psychotic symptoms were studied using a semi-structured interview assessing religiousness/spirituality. Their past suicide attempts were examined. Additionally, they were asked about the role (protective or incentive) of religion in their decision to commit suicide. Forty-three percent of the patients with psychosis had previously attempted suicide. Religiousness was not associated with the rate of patients who attempted suicide. Twenty-five percent of all subjects acknowledged a protective role of religion, mostly through ethical condemnation of suicide and religious coping. One out of ten patients reported an incentive role of religion, not only due to negatively connotated issues but also to the hope for something better after death. There were no differences between groups (i.e. psychotic vs. non-psychotic patients). Religion may play a specific role in the decisions patients make about suicide, both in psychotic and non-psychotic patients. This role may be protective, a finding particularly important for patients with psychosis who are known to be at high risk of severe suicide attempts. Interventions aiming to lower the number of suicide attempts in patients with schizophrenia should take these data into account.

Life events in conversion disorder: Role of timing and nature of events

Aims: To compare the frequency of life events in the year preceding illness onset in a series of Conversion Disorder (CD) patients, with those of a matched control group and to characterize the nature of those events in terms of "escape" potential. Traditional models of CD hypothesise that relevant stressful experiences are "converted" into physical symptoms to relieve psychological pressure, and that the resultant disability allows "escape" from the stressor, providing some advantage to the individual. Methods: The Life Events and Difficulties Schedule (LEDS) is a validated semi-structured interview designed to minimise recall and interviewer bias through rigorous assessment and independent rating of events. An additional "escape" rating was developed. Results: In the year preceding onset in 25 CD patients (mean age 38.9 years ± 8) and a similar matched period in 13 controls (mean age 36.2 years ± 10), no significant difference was found in the proportion of subjects having ≥ 1 severe event (CD 64%, controls 38%; p=0.2). In the last month preceding onset, a higher number of patients experienced ≥1 severe events than controls (52% vs 15%, odds ratio 5.95 (CI: 1.09-32.57)). Patients were twice as much more likely to have a severe escape events than controls, in the month preceding onset (44% vs 7%, odds ratio 9.43 (CI: 1.06-84.04). Conclusion: Preliminary data from this ongoing study suggest that the time frame (preceding month) and the nature ("escape") of the events may play an important role in identifying key events related to CD onset.

Associations between mood, anxiety or substance use disorders and inflammatory markers after adjustment for multiple covariates in a population-based study.

Inflammation is one possible mechanism underlying the associations between mental disorders and cardiovascular diseases (CVD). However, studies on mental disorders and inflammation have yielded inconsistent results and the majority did not adjust for potential confounding factors. We examined the associations of several pro-inflammatory cytokines (IL-1β, IL-6 and TNF-α) and high sensitive C-reactive protein (hsCRP) with lifetime and current mood, anxiety and substance use disorders (SUD), while adjusting for multiple covariates. The sample included 3719 subjects, randomly selected from the general population, who underwent thorough somatic and psychiatric evaluations. Psychiatric diagnoses were made with a semi-structured interview. Major depressive disorder was subtyped into "atypical", "melancholic", "combined atypical-melancholic" and "unspecified". Associations between inflammatory markers and psychiatric diagnoses were assessed using multiple linear and logistic regression models. Lifetime bipolar disorders and atypical depression were associated with increased levels of hsCRP, but not after multivariate adjustment. After multivariate adjustment, SUD remained associated with increased hsCRP levels in men (β = 0.13 (95% CI: 0.03,0.23)) but not in women. After multivariate adjustment, lifetime combined and unspecified depression were associated with decreased levels of IL-6 (β = -0.27 (-0.51,-0.02); β = -0.19 (-0.34,-0.05), respectively) and TNF-α (β = -0.16 (-0.30,-0.01); β = -0.10 (-0.19,-0.02), respectively), whereas current combined and unspecified depression were associated with decreased levels of hsCRP (β = -0.20 (-0.39,-0.02); β = -0.12 (-0.24,-0.01), respectively). Our data suggest that the significant associations between increased hsCRP levels and mood disorders are mainly attributable to the effects of comorbid disorders, medication as well as behavioral and physical CVRFs.

Uudistumista tukeva johtaminen ja organisaation uudistumiskyvyn mittaaminen

Tämän työn tavoitteena on tarkastella sitä mitä tarkoitetaan organisaation uudistumiskyvyllä sekä mikä tämän yhteys on organisaation kilpailuetuun ja suorituskykyyn. Tarkimmin keskitytään siihen, millaista on uudistumista tukeva johtajuus. Samoin kerrotaan lyhyesti millaisin mittarein uudistumiskykyä voidaan mitata. Tutkielman empiirinen osuus keskittyy erään Suomessa toimivan palvelualan yrityksen uudistumiskyvyn mittaamiseen. Erityishuomiossa ovat johtajuus, ajan hyödyntäminen sekä oppiminen. Tutkimus suoritettiin strukturoituna teemahaastatteluina ORCI¿-uudistumiskykymittarin perusteella lokakuussa 2007. Tutkitun organisaation uudistumiskyvystä voidaan sanoa, että se on hyvä. Tutkittujen ORCI¿-uudistumiskykymittariston kriteerien mukaan sekä muiden kirjallisuudessa havaittujen uudistumiskyvyn näkemysten mukaan, tutkittu organisaatio kykenee toimimaan tavalla, jolla sen voidaan katsoa olevan uudistumiskykyinen organisaatio. Ennen kaikkea organisaatio kykenee oppimaan ja kehittämään toimintaansa sekä tekemään havaintoja näistä asioista. Haastatteluiden perusteella tutkitusta organisaatiosta nousi esiin päätöksenteon vapaus ja helppous, luottamus sekä valtuuttaminen. Tämä tutkimus ei tuonut uusia näkökulmia uudistumiskykyyn, mutta empiirinen tutkimus vahvisti niitä aspekteja, joita kirjallisuudessa oltiin jo havaittu.

Coping with an HIV infection. A multicenter qualitative survey on HIV positive adolescents' perceptions of their disease, therapeutic adherence and treatment.

HIV-positive adolescents face a number of challenges in dealing with their disease and its treatment. In this qualitative study, twenty-nine HIV-positive adolescents aged 13 to 20 years (22 girls), who live in Switzerland, were asked, in a semi-structured interview (duration of 40-110 minutes), to describe their perceptions and experiences with the disease itself and with therapeutic adherence. While younger adolescents most often thought of their disease as fate, older adolescents usually knew that they had received it through vertical transmission, although the topic appeared to be particularly difficult to discuss for those living with their HIV-positive mothers. Based on their attending physician's assessment, 18 subjects were judged highly adherent, 4 fairly and 7 poorly adherent. High adherence appeared linked with adequate psychological adjustment and effective coping mechanisms, as well as with the discussion and adoption of explicit medication-taking strategies. The setting and organisation of health care teams should allow for ongoing discussions with HIV-positive adolescents that focus on their perceptions of their disease, how they cope with it and with the treatment, and how they could improve their adherence.

Análisis discursivo de las actitudes lingüísticas de los escolares de origen inmigrante en Cataluña

La continua llegada de población inmigrante a los países de la Europa Occidental está produciendo transformaciones en estas sociedades. Evidentemente, la sociedad catalana no es ajena a estos cambios y, año tras año, ve incrementado el número de recién llegados/ as procedentes de orígenes geográficos, culturales y lingüísticos muy diversos. Estas personas, en ocasiones sin un conocimiento previo, se encuentran con las peculiaridades socioculturales y lingüísticas de la sociedad receptora. En el caso de Cataluña, nos interesa destacar la cuestión lingüística, a la cual se han dedicado muchos esfuerzos durante los últimos años en un intento de acercarse a una situación de normalidad en lo referente al conocimiento y uso de la lengua catalana. En el presente artículo se presentan los principales resultados de una investigación centrada en el análisis de los discursos sobre los que anclan las actitudes lingüísticas de los escolares de origen inmigrante en Cataluña. La técnica de investigación social utilizada ha sido la entrevista en profundidad semidirigida, realizando el análisis del contenido de las mismas a partir del «Análisis de contenido temático basado en categorías» (Bardin, 1986). Las conclusiones más relevantes indican que, por encima del Área de Origen o la Condición Lingüística Familiar, la principal variable que permite articular los discursos detectados es la que se puede denominar «Satisfacción y Percepción de Valoración e Integración Escolar y Social», de tal manera que los jóvenes de origen inmigrante que se sienten más valorados e integrados escolar y socialmente desarrollan mejores actitudes hacia la lengua catalana y castellana. Este hecho tiene claras repercusiones respecto las generalizaciones reduccionistas y estereotipadas que vinculan un área de origen con unas determinadas actitudes hacia las lenguas oficiales en Cataluña, así como de cara a la política lingüística y las ideologías lingüísticas de la sociedad en general.

Discrepancies between clinical needs and helpseeking behaviors in co-occurring posttraumatic stress and alcohol use disorders.

OBJECTIVE: The aim of the study was to compare subjects dually diagnosed with posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) to those with only one or none of these conditions regarding helpseeking needs and behaviors. METHOD: Data from a large community sample (N=3694) were used to assess the associations among lifetime PTSD and AUD, other psychiatric disorders, clinical characteristics and lifetime helpseeking behaviors derived from a semi-structured interview. RESULTS: Comorbid individuals had more severe clinical profiles and were more impaired than individuals with either PTSD or AUD alone or those with no/other psychiatric conditions. However, they did not differ in overall helpseeking behavior from any other group. Those with comorbid PTSD/AUD were even less likely than the other groups to seek help for depression and anxiety disorders through specific treatment facilities or the use of prescribed psychotropic drugs. CONCLUSIONS: Despite a greater need for treatment the comorbid group did not seek more help than the others. Their lower use of prescribed drugs supports the self-medication hypothesis, suggesting that those individuals relieve their symptoms through higher alcohol use instead. Our findings underline the need for health care facilities to encourage helpseeking behavior in the aftermath of stressful life events.

Clinical and course characteristics of depression and all-cause mortality: A prospective population-based study.

BACKGROUND: Given the large heterogeneity of depressive disorders (DD), studying depression characteristics according to clinical manifestations and course is a more promising approach than studying depression as a whole. The purpose of this study was to determine the association between clinical and course characteristics of DD and incident all-cause mortality. METHODS: CoLaus|PsyCoLaus is a prospective cohort study (mean follow-up duration=5.2 years) including 35-66 year-old randomly selected residents of an urban area in Switzerland. A total of 3668 subjects (mean age 50.9 years, 53.0% women) underwent physical and psychiatric baseline evaluations and had a known vital status at follow-up (98.8% of the baseline sample). Clinical (diagnostic severity, atypical features) and course characteristics (recency, recurrence, duration, onset) of DD according to the DSM-5 were elicited using a semi-structured interview. RESULTS: Compared to participants who had never experienced DD, participants with current but not remitted DD were more than three times as likely to die (Hazard Ratio: 3.2, 95% CI: 1.1-10.0) after adjustment for socio-demographic and lifestyle characteristics, comorbid anxiety disorders, antidepressant use, and cardiovascular risk factors and diseases. There was no evidence for associations between other depression characteristics and all-cause mortality. LIMITATIONS: The small proportion of deceased subjects impeded statistical analyses of cause-specific mortality. CONCLUSIONS: A current but not remitted DD is a strong predictor of all-cause mortality, independently of cardiovascular or lifestyle factors, which suggests that the effect of depression on mortality diminishes after remission and further emphasizes the need to adequately treat current depressive episodes.

Valoración de las necesidades formativas de los profesionales de enfermería frente a los usuarios inmigrantes de culturas ajenas a la propia: estudio sobre las barreras de comunicación dentro del ámbito de atención primaria

Este trabajo tiene como finalidad identificar que áreas temáticas en relación a la salud, y en el caso de que existan, necesitan cubrir los profesionales de enfermería, teniendo en cuenta los factores asociados a la diversidad cultural, para que sea de eficaz y eficiente la atención a usuarios de otras culturas en sus consultas. Dentro de los objetivos específicos, se plantea en primer lugar, determinar las áreas temáticas de mayor importancia que deberán estar presentes en un programa de intervención de diversidad cultural para mejorar la calidad en la asistencia a usuarios de otras culturas desde la atención de enfermería. Por otro lado se propondrán estrategias de intervención para mejorar la comunicación entre los profesionales de la salud y la población inmigrante de habla no hispana. Dentro del ámbito de investigación cualitativa este proyecto se definirá mediante el paradigma construccionista interpretativo. Los participantes en el estudio serán profesionales de enfermería del CAP Vic Sud y CAP Vic Nord (Osona) con más de 6 años de experiencia en atención primaria y con un cupo de población asignada un mínimo de un 15% de usuarios de procedencia extranjera de una cultura ajena. Para acceder a la información se llevará a cabo la entrevista semiestructurada realizada de forma individual a cada profesional de enfermería, y la observación participante que se llevará a cabo en el centro y las consultas. Para el análisis de esta información previamente recogida mediante una guía de categorías de análisis, de la que se obtendrá una descripción general que capta la opinión de los participantes y de las áreas a traba

Troubles du comportement alimentaire (TCA), sports de remise en forme et motivations de pratique = Fitness sports, sport motives and eating disorders

Cet article a pour but d'identifier et de mieux comprendre les liens entre les motivations des pratiquantes de sports de remise en forme, les troubles du comportement alimentaire (TCA) et les troubles psychologiques associés (i.e., insatisfaction corporelle, dépendance à l'exercice physique). Au total, 1270 pratiquantes ont répondu à un questionnaire et 40 ont participé à un entretien semi-directif. Les motivations de perte de poids et/ou modification de l'apparence corporelle sont en lien avec les TCA et l'insatisfaction corporelle. La dépendance à l'exercice physique n'est pas systématique chez les femmes avec TCA. Les pratiquantes de sports de remise en forme motivées uniquement par la perte de poids et/ou la modification de l'apparence sont plus à risques dans levdéveloppement des TCA. The aim of this study was to identify and to better understand links between females' motives in fitness sports, eating disorders (ED) and associated psychological disorders (i.e. body dissatisfaction, exercise dependence). In all, 1270 women were asked by questionnaire and 40 by semi-structured interview. Weight loss/body appearance change motives are related to ED and body dissatisfaction. Exercise dependence are not systematic in women with ED. Fitness sports are at risk in the development of ED for women motivated only by weight loss/body appearance change motives

Lautakuntien toiminnan arviointi Case: Lappeenrannan kaupunki

Pro gradu- tutkielma tehdään Lappeenrannan kaupungin tarkastuslautakunnan toimeksiannosta. Tutkimuksen kohteena on Lappeenrannan kaupungin neljä lautakuntaa. Tutkimuksen tarkoituksena on arvioida näiden lautakuntien toimintaa. Tutkimuksessa selvitetään, tekevätkö lautakunnat sitä työtä mitä niiden tulisi tehdä ja mitä niiden odotetaan tekevän. Varsinainen tutkimusongelma on: kuinka hyvin lautakunnan ja virkamiesjohdon väliset odotukset lautakuntien toiminnasta kohtaavat? Kyseessä on kvalitatiivinen casetutkimus. Haastatteluissa käytetään tutkimusmenetelmänä teemahaastattelua ja lautakuntien jäsenille tehdään kirjallinen kysely puolistrukturoidun kyselyn muodossa. Aineisto analysoidaan teemoittelemalla. Tutkimuksen johtopäätöksenä esitetään, että virkamiesjohdon, lautakuntien puheenjohtajien ja lautakunnan odotukset lautakuntien toimintaa kohtaan eivät aina kohtaa. Lautakunnan puheenjohtaja ja toimialajohtaja voivat olla odotuksissaan hyvin samoilla linjoilla, mutta lautakunnan jäsenet voivatkin odottaa aivan eri asioita.

Jóvenes que estuvieron en el sistema de protección social a la infancia : reflexiones a partir de una investigación realizada en Girona, España = Young people who were in the child protection system : reflections from a study done in Girona, Spain

Research on residential care is still scarce despite its high implementation in Spain. This article presents the results of a research using qualitative methods. The study analyses the situation experienced by young people who lived in foster care in the province of Girona (1994-2002) based on their opinions and perceptions expressed in a semi-structured interview. The results, clustered into subcategories, show lack of knowledge about the reasons why they needed foster care, if it was better being there than staying with their parents, and the lack of support for transition to adulthood. The study shows implications for children and youth policies, professional practice and research

Tuotteen käytönaikaisen asiakastarvetiedon hyödyntäminen tuotekehitysprojekteissa

Diplomityö on tehty osana Sinfonet-tutkimusprojektia, ja sen tavoitteena on laatia uusi toimintamalli asiakaslähtöisen tuotekehitystoiminnan tehostamiseksi. Toimintamallin vaatimuksena oli asiakastarvetiedon kerääminen koko tuotteen elinkaaren käyttövaiheen ajalta, ja rinnakkainen prosessi asiakastarpeiden analysointiin sekä hyödyntämiseen. Työssä yhdistetään asiakastarpeiden kartoittamiseen, analysointiin ja hyödyntämiseen käytettävät menetelmät yhdeksi systemaattiseksi kokonaisuudeksi, jota Laroxin henkilöstö voi tehokkaasti käyttää työssään. Menetelmä laatittiin teoriaosuudessa havaittujen viitekehysten ja Laroxin avainhenkilöiden kanssa suoritettujen haastattelujen pohjalta. On ehdottoman tärkeätä, että toimintamallin käyttö ja siitä saavutettavat hyödyt saadaan perusteltua yrityksen henkilöstölle. Toimintamallissa asiakastarpeiden kartoitusmenetelmiksi valittiin AVAIN-ryhmähaastattelu sekä puolistrukturoitu haastattelu, ja analysointimenetelmiksi tulkintataulukko sekä QFD (Quality Function Deployment). Tarpeiden dokumentointiin valittiin tietokannaksi Laroxin käytössä jo valmiiksi oleva wiki-pohjainen Live-järjestelmä. Uusi toimintamalli ja siinä mukana olevat prosessit kuvataan diplomityössä yksityiskohtaisesti tietovirtakaaviona.

Tietohallinnon portfolion hallinta ammattikorkeakoulussa

Tutkimuksen tarkoituksena on tietohallinnon projektiportfolion hallinnan kehittäminen Metropolia ammattikorkeakoulussa. Portfolion hallinta kattaa projektiesitysten luomisen, projektien ja projektiesitysten arvioinnin ja priorisoinnin sekä projektien käynnistämisen. Painopisteenä arvioinnin ja priorisoinnin lisäksi on portfolion tarkastelu yhtenä kokonaisuutena. Tutkimus toteutettiin konstruktiivisena tutkimuksena, yhteistyössä Metropolia ammattikorkeakoulun kanssa. Tutkimusmenetelminä käytettiin kirjallisuuskatsausta, strukturoituahaastattelua ja kyselylomaketta. Kirjallisuuskatsaus kohdennettiin portfolion hallinnan prosessiin, siinä käytettäviin menetelmiin sekä projektien arviointikriteereihin. Metropoliassa tehtyjen haastattelujen ja kirjallisten kyselyjen avulla selvitettiin portfolion hallinnan nykytilannetta ja kehittämiskohteita. Haastattelemalla kahta julkishallinnon organisaatiota kartoitettiin portfolion hallinnan parhaita käytäntöjä. Tutkimuksen tuloksena on Metropolian tietohallinnon portfolion hallintaprosessi sekä sitä tukevat menetelmät ja projektien arviointikriteerit. Näiden avulla portfolio voidaan priorisoida yhtenäisesti ja systemaattisesti, huomioiden portfolion hallinnan tärkeimmät näkökulmat. Tutkimuksen tulokset ovat hyödynnettävissä Metropolian muissa yksiköissä tai vastaavanlaisissa organisaatioissa