Employment Situation of Parents of Long-Term Childhood Cancer Survivors.

BACKGROUND Taking care of children diagnosed with cancer affects parents' professional life. The impact in the long-term however, is not clear. We aimed to compare the employment situation of parents of long-term childhood cancer survivors with control parents of the general population, and to identify clinical and socio-demographic factors associated with parental employment. METHODS As part of the Swiss Childhood Cancer Survivor Study, we sent a questionnaire to parents of survivors aged 5-15 years, who survived ≥5 years after diagnosis. Information on control parents of the general population came from the Swiss Health Survey (restricted to men and women with ≥1 child aged 5-15 years). Employment was categorized as not employed, part-time, and full-time employed. We used generalized ordered logistic regression to determine associations with clinical and socio-demographic factors. Clinical data was available from the Swiss Childhood Cancer Registry. RESULTS We included 394 parent-couples of survivors and 3'341 control parents (1'731 mothers; 1'610 fathers). Mothers of survivors were more often not employed (29% versus 22%; ptrend = 0.007). However, no differences between mothers were found in multivariable analysis. Fathers of survivors were more often employed full-time (93% versus 87%; ptrend = 0.002), which remained significant in multivariable analysis. Among parents of survivors, mothers with tertiary education (OR = 2.40, CI:1.14-5.07) were more likely to be employed. Having a migration background (OR = 3.63, CI: 1.71-7.71) increased the likelihood of being full-time employed in mothers of survivors. Less likely to be employed were mothers of survivors diagnosed with lymphoma (OR = 0.31, CI:0.13-0.73) and >2 children (OR = 0.48, CI:0.30-0.75); and fathers of survivors who had had a relapse (OR = 0.13, CI:0.04-0.36). CONCLUSION Employment situation of parents of long-term survivors reflected the more traditional parenting roles. Specific support for parents with low education, additional children, and whose child had a more severe cancer disease could improve their long-term employment situation.

A cross-sectional study of disparities in suicide ideation between Hispanic and non-Hispanic white female adolescents

Suicide is recognized as a major public health and clinical problem in the United States. One fifth of adolescents in the United States seriously consider suicide each year, and about 8% of high school students attempt suicide at least once. Hispanic ethnicity constitutes a risk factor for suicidal ideation and suicide attempts, with Hispanic females at highest risk. Nevertheless, published studies on suicidal behavior in Hispanic female adolescents are extremely limited and focus on suicidal ideation in school samples. Given the severity of the problem and the paucity of information on this topic, more research on ethnic differences in suicidal ideation in community samples of high-risk children is urgently needed. This cross-sectional study delineated differences in suicide ideation between Hispanic female adolescents and non-Hispanic white female adolescents attending a mental health clinic and examined the association of ethnicity with suicide ideation independent of other known risk factors. Data were accrued between June 2004 and December 2008 in a Harris County Mental Health and Mental Retardation Association (MHMRA) clinic. Data were limited to adolescents who were Harris County Residents between the ages of 10 to 17 years when they were admitted to the clinic. The objective of this study was to determine whether differences in socio-demographic and clinical variables play a significant role in ethnic disparities in suicide ideation. A series of logistic regressions were performed to estimate the association between ethnicity and suicide ideation after controlling for potentially confounding factors. ^ Results showed an interaction between Hispanic ethnicity and having a history of treatment: Hispanic girls having history of treatment had lower odds of having suicide ideation than Hispanic girls without such a history. After adjusting for treatment history, family problems, substance use, juvenile justice involvement, current treatment, and age, Hispanic girls had 1.86 times the odds of having suicide ideation than non Hispanic girls (OR=1.86, 95% CI=0.88-1.46). Although additional studies on community samples of high risk adolescents are needed to verify these findings, our study highlights the fact that Hispanic girls are at significantly higher risk and need to be targeted for prevention and treatment efforts. ^

Racial/ethnic disparities in colorectal cancer screening and survival in a large nationwide population-based cohort

Background. Colorectal cancer (CRC) is the third most commonly diagnosed cancer (excluding skin cancer) in both men and women in the United States, with an estimated 148,810 new cases and 49,960 deaths in 2008 (1). Racial/ethnic disparities have been reported across the CRC care continuum. Studies have documented racial/ethnic disparities in CRC screening (2-9), but only a few studies have looked at these differences in CRC screening over time (9-11). No studies have compared these trends in a population with CRC and without cancer. Additionally, although there is evidence suggesting that hospital factors (e.g. teaching hospital status and NCI designation) are associated with CRC survival (12-16), no studies have sought to explain the racial/ethnic differences in survival by looking at differences in socio-demographics, tumor characteristics, screening, co-morbidities, treatment, as well as hospital characteristics. ^ Objectives and Methods. The overall goals of this dissertation were to describe the patterns and trends of racial/ethnic disparities in CRC screening (i.e. fecal occult blood test (FOBT), sigmoidoscopy (SIG) and colonoscopy (COL)) and to determine if racial/ethnic disparities in CRC survival are explained by differences in socio-demographic, tumor characteristics, screening, co-morbidities, treatment, and hospital factors. These goals were accomplished in a two-paper format.^ In Paper 1, "Racial/Ethnic Disparities and Trends in Colorectal Cancer Screening in Medicare Beneficiaries with Colorectal Cancer and without Cancer in SEER Areas, 1992-2002", the study population consisted of 50,186 Medicare beneficiaries diagnosed with CRC from 1992 to 2002 and 62,917 Medicare beneficiaries without cancer during the same time period. Both cohorts were aged 67 to 89 years and resided in 16 Surveillance, Epidemiology and End Results (SEER) regions of the United States. Screening procedures between 6 months and 3 years prior to the date of diagnosis for CRC patients and prior to the index date for persons without cancer were identified in Medicare claims. The crude and age-gender-adjusted percentages and odds ratios of receiving FOBT, SIG, or COL were calculated. Multivariable logistic regression was used to assess race/ethnicity on the odds of receiving CRC screening over time.^ Paper 2, "Racial/Ethnic Disparities in Colorectal Cancer Survival: To what extent are racial/ethnic disparities in survival explained by racial differences in socio-demographics, screening, co-morbidities, treatment, tumor or hospital characteristics", included a cohort of 50,186 Medicare beneficiaries diagnosed with CRC from 1992 to 2002 and residing in 16 SEER regions of the United States which were identified in the SEER-Medicare linked database. Survival was estimated using the Kaplan-Meier method. Cox proportional hazard modeling was used to estimate hazard ratios (HR) of mortality and 95% confidence intervals (95% CI).^ Results. The screening analysis demonstrated racial/ethnic disparities in screening over time among the cohort without cancer. From 1992 to 1995, Blacks and Hispanics were less likely than Whites to receive FOBT (OR=0.75, 95% CI: 0.65-0.87; OR=0.50, 95% CI: 0.34-0.72, respectively) but their odds of screening increased from 2000 to 2002 (OR=0.79, 95% CI: 0.72-0.85; OR=0.67, 95% CI: 0.54-0.75, respectively). Blacks and Hispanics were less likely than Whites to receive SIG from 1992 to 1995 (OR=0.75, 95% CI: 0.57-0.98; OR=0.29, 95% CI: 0.12-0.71, respectively), but their odds of screening increased from 2000 to 2002 (OR=0.79, 95% CI: 0.68-0.93; OR=0.50, 95% CI: 0.35-0.72, respectively).^ The survival analysis showed that Blacks had worse CRC-specific survival than Whites (HR: 1.33, 95% CI: 1.23-1.44), but this was reduced for stages I-III disease after full adjustment for socio-demographic, tumor characteristics, screening, co-morbidities, treatment and hospital characteristics (aHR=1.24, 95% CI: 1.14-1.35). Socioeconomic status, tumor characteristics, treatment and co-morbidities contributed to the reduction in hazard ratios between Blacks and Whites with stage I-III disease. Asians had better survival than Whites before (HR: 0.73, 95% CI: 0.64-0.82) and after (aHR: 0.80, 95% CI: 0.70-0.92) adjusting for all predictors for stage I-III disease. For stage IV, both Asians and Hispanics had better survival than Whites, and after full adjustment, survival improved (aHR=0.73, 95% CI: 0.63-0.84; aHR=0.74, 95% CI: 0.61-0.92, respectively).^ Conclusion. Screening disparities remain between Blacks and Whites, and Hispanics and Whites, but have decreased in recent years. Future studies should explore other factors that may contribute to screening disparities, such as physician recommendations and language/cultural barriers in this and younger populations.^ There were substantial racial/ethnic differences in CRC survival among older Whites, Blacks, Asians and Hispanics. Co-morbidities, SES, tumor characteristics, treatment and other predictor variables contributed to, but did not fully explain the CRC survival differences between Blacks and Whites. Future research should examine the role of quality of care, particularly the benefit of treatment and post-treatment surveillance, in racial disparities in survival.^

AN ANALYSIS OF THE GENERAL WELL-BEING OF BLACKS AND WHITES

The importance of race as a factor in mental health status has been a topic of controversy. This study reviews the history of research in this area and examines racial variances in the relationship between selected socio-demographic variables and general well-being. The study also examines the appropriateness of an additive versus an interactive statistical model for this investigation.^ The sample consists of 6,913 persons who completed the General Well-Being Schedules as administered in the detailed component of the first National Health and Nutrition Examination Survey (NHANES I) conducted by the National Center for Health Statistics between April, 1971 and October, 1975. The sampling design is a multistage, probability sample of clusters of persons in area based segments. Of the 6,913 persons, 873 are Black.^ Unlike other recent community based mental health studies, this study revealed significant differences between the general well-being of Blacks and Whites. Blacks continued to exhibit significantly lower levels of well-being even after adjustments were made for income, education, marital status, sex, age and place of residence. Statistical interaction was found between race and sex with Black females reporting lower levels of well-being than either Black or White males or their White female counterparts.^ The study includes a detailed review of the NHANES I sample design. It is shown that selected aspects of the design make it difficult to render appropriate national comparisons of Black-White differences. As a result conclusions pertaining to these differences based on NHANES I may be of questionable validity. ^

A descriptive analysis of the consumers at farm stands outside WIC clinics

Because fruit and vegetable intake remains low in low-income populations, the attention of public health researchers has focused on different strategies to reach this population. One possible method of reaching low income populations is through government food assistance programs like the WIC's Farmers Market Nutrition Program (FMNP). This program provides vouchers to WIC recipients that are redeemable only at farmers' markets. In the summer of 2010, two farm stands near WIC clinics in Austin were surveyed in order to establish socio-demographic characteristics of the clientele of the markets. The overall purpose of this pilot study was to describe the clientele of the markets and to examine associations between food insecurity, acculturation, socio-demographic factors, and farmers' market participants' fruit and vegetable intake. The sample was a convenience sample of farmers' market customers. One hundred study participants completed self-administered surveys. Independent t-tests were used to explore the differences in means of fruit and vegetable intake according to acculturation and food insecurity levels. The overall mean (SD) of daily fruit and vegetable intake was 4.20±2.69 for customers of both markets. Significant differences were reported between the two markets in overall fruit and vegetable intake and specifically in the following: 100% juice (P=.023), fruit consumption (P=.028), green salad (P=.003), and salsa (P=.044). The differences showed that customers at the market in a more busy location were on average reporting eating more fruits and vegetables than customers at another market that was located in a more secluded location. When examined by level of food security, individuals who were more food secure consumed more fruit (P=.016). When examined by level of acculturation, the overall fruit and vegetable intake was not significantly different between levels of acculturation. The overall findings in this report suggest that the population at these markets consists of individuals who are food insecure and on government assistance programs. While there were no significant differences between fruit and vegetable intake, acculturation and food insecurity, this report suggests the need for culturally tailored interventions that serve the Hispanic population and would assist this population to become more food secure.^

Geographic variation in the utilization and survival associated with oxaliplatin chemotherapy in patients with stage III colon cancer

Background: Overall objectives of this dissertation are to examine the geographic variation and socio-demographic disparities (by age, race and gender) in the utilization and survival of newly FDA-approved chemotherapy agents (Oxaliplatin-containing regimens) as well as to determine the cost-effectiveness of Oxaliplatin in a large nationwide and population-based cohort of Medicare patients with resected stage-III colon cancer. Methods: A retrospective cohort of 7,654 Medicare patients was identified from the Surveillance, Epidemiology and End Results – Medicare linked database. Multiple logistic regression was performed to examine the relationship between receipt of Oxaliplatin-containing chemotherapy and geographic regions while adjusting for other patient characteristics. Cox proportional hazard model was used to estimate the effect of Oxaliplatin-containing chemotherapy on the survival variation across regions using 2004-2005 data. Propensity score adjustments were also made to control for potential bias related to non-random allocation of the treatment group. We used Kaplan-Meier sample average estimator to calculate the cost of disease after cancer-specific surgery to death, loss-to follow-up or censorship. Results: Only 51% of the stage-III patients received adjuvant chemotherapy within three to six months of colon-cancer specific surgery. Patients in the rural regions were approximately 30% less likely to receive Oxaliplatin chemotherapy than those residing in a big metro region (OR=0.69, p=0.033). The hazard ratio for patients residing in metro region was comparable to those residing in big metro region (HR: 1.05, 95% CI: 0.49-2.28). Patients who received Oxalipaltin chemotherapy were 33% less likely to die than those received 5-FU only chemotherapy (adjusted HR=0.67, 95% CI: 0.41-1.11). KMSA-adjusted mean payments were almost 2.5 times higher in the Oxaliplatin-containing group compared to 5-FU only group ($45,378 versus $17,856). When compared to no chemotherapy group, ICER of 5-FU based regimen was $12,767 per LYG, and ICER of Oxaliplatin-chemotherapy was $60,863 per LYG. Oxaliplatin was found economically dominated by 5-FU only chemotherapy in this study population. Conclusion: Chemotherapy use varies across geographic regions. We also observed considerable survival differences across geographic regions; the difference remained even after adjusting for socio-demographic characteristics. The cost-effectiveness of Oxaliplatin in Medicare patients may be over-estimated in the clinical trials. Our study found 5-FU only chemotherapy cost-effective in adjuvant settings in patients with stage-III colon cancer.^

Análisis de los factores de adopción de comercio electrónico en segmentos de consumidores finales. Aplicación al caso español

El comercio electrónico ha experimentado un fuerte crecimiento en los últimos años, favorecido especialmente por el aumento de las tasas de penetración de Internet en todo el mundo. Sin embargo, no todos los países están evolucionando de la misma manera, con un espectro que va desde las naciones pioneras en desarrollo de tecnologías de la información y comunicaciones, que cuentan con una elevado porcentaje de internautas y de compradores online, hasta las rezagadas de rápida adopción en las que, pese a contar con una menor penetración de acceso, presentan una alta tasa de internautas compradores. Entre ambos extremos se encuentran países como España que, aunque alcanzó hace años una tasa considerable de penetración de usuarios de Internet, no ha conseguido una buena tasa de transformación de internautas en compradores. Pese a que el comercio electrónico ha experimentado importantes aumentos en los últimos años, sus tasas de crecimiento siguen estando por debajo de países con características socio-económicas similares. Para intentar conocer las razones que afectan a la adopción del comercio por parte de los compradores, la investigación científica del fenómeno ha empleado diferentes enfoques teóricos. De entre todos ellos ha destacado el uso de los modelos de adopción, proveniente de la literatura de adopción de sistemas de información en entornos organizativos. Estos modelos se basan en las percepciones de los compradores para determinar qué factores pueden predecir mejor la intención de compra y, en consecuencia, la conducta real de compra de los usuarios. Pese a que en los últimos años han proliferado los trabajos de investigación que aplican los modelos de adopción al comercio electrónico, casi todos tratan de validar sus hipótesis mediante el análisis de muestras de consumidores tratadas como un único conjunto, y del que se obtienen conclusiones generales. Sin embargo, desde el origen del marketing, y en especial a partir de la segunda mitad del siglo XIX, se considera que existen diferencias en el comportamiento de los consumidores, que pueden ser debidas a características demográficas, sociológicas o psicológicas. Estas diferencias se traducen en necesidades distintas, que sólo podrán ser satisfechas con una oferta adaptada por parte de los vendedores. Además, por contar el comercio electrónico con unas características particulares que lo diferencian del comercio tradicional –especialmente por la falta de contacto físico entre el comprador y el producto– a las diferencias en la adopción para cada consumidor se le añaden las diferencias derivadas del tipo de producto adquirido, que si bien habían sido consideradas en el canal físico, en el comercio electrónico cobran especial relevancia. A la vista de todo ello, el presente trabajo pretende abordar el estudio de los factores determinantes de la intención de compra y la conducta real de compra en comercio electrónico por parte del consumidor final español, teniendo en cuenta el tipo de segmento al que pertenezca dicho comprador y el tipo de producto considerado. Para ello, el trabajo contiene ocho apartados entre los que se encuentran cuatro bloques teóricos y tres bloques empíricos, además de las conclusiones. Estos bloques dan lugar a los siguientes ocho capítulos por orden de aparición en el trabajo: introducción, situación del comercio electrónico, modelos de adopción de tecnología, segmentación en comercio electrónico, diseño previo del trabajo empírico, diseño de la investigación, análisis de los resultados y conclusiones. El capítulo introductorio justifica la relevancia de la investigación, además de fijar los objetivos, la metodología y las fases seguidas para el desarrollo del trabajo. La justificación se complementa con el segundo capítulo, que cuenta con dos elementos principales: en primer lugar se define el concepto de comercio electrónico y se hace una breve retrospectiva desde sus orígenes hasta la situación actual en un contexto global; en segundo lugar, el análisis estudia la evolución del comercio electrónico en España, mostrando su desarrollo y situación presente a partir de sus principales indicadores. Este apartado no sólo permite conocer el contexto de la investigación, sino que además permite contrastar la relevancia de la muestra utilizada en el presente estudio con el perfil español respecto al comercio electrónico. Los capítulos tercero –modelos de adopción de tecnologías– y cuarto –segmentación en comercio electrónico– sientan las bases teóricas necesarias para abordar el estudio. En el capítulo tres se hace una revisión general de la literatura de modelos de adopción de tecnología y, en particular, de los modelos de adopción empleados en el ámbito del comercio electrónico. El resultado de dicha revisión deriva en la construcción de un modelo adaptado basado en los modelos UTAUT (Unified Theory of Acceptance and Use of Technology, Teoría unificada de la aceptación y el uso de la tecnología) y UTAUT2, combinado con dos factores específicos de adopción del comercio electrónico: el riesgo percibido y la confianza percibida. Por su parte, en el capítulo cuatro se revisan las metodologías de segmentación de clientes y productos empleadas en la literatura. De dicha revisión se obtienen un amplio conjunto de variables de las que finalmente se escogen nueve variables de clasificación que se consideran adecuadas tanto por su adaptación al contexto del comercio electrónico como por su adecuación a las características de la muestra empleada para validar el modelo. Las nueve variables se agrupan en tres conjuntos: variables de tipo socio-demográfico –género, edad, nivel de estudios, nivel de ingresos, tamaño de la unidad familiar y estado civil–, de comportamiento de compra – experiencia de compra por Internet y frecuencia de compra por Internet– y de tipo psicográfico –motivaciones de compra por Internet. La segunda parte del capítulo cuatro se dedica a la revisión de los criterios empleados en la literatura para la clasificación de los productos en el contexto del comercio electrónico. De dicha revisión se obtienen quince grupos de variables que pueden tomar un total de treinta y cuatro valores, lo que deriva en un elevado número de combinaciones posibles. Sin embargo, pese a haber sido utilizados en el contexto del comercio electrónico, no en todos los casos se ha comprobado la influencia de dichas variables respecto a la intención de compra o la conducta real de compra por Internet; por este motivo, y con el objetivo de definir una clasificación robusta y abordable de tipos de productos, en el capitulo cinco se lleva a cabo una validación de las variables de clasificación de productos mediante un experimento previo con 207 muestras. Seleccionando sólo aquellas variables objetivas que no dependan de la interpretación personal del consumidores y que determinen grupos significativamente distintos respecto a la intención y conducta de compra de los consumidores, se obtiene un modelo de dos variables que combinadas dan lugar a cuatro tipos de productos: bien digital, bien no digital, servicio digital y servicio no digital. Definidos el modelo de adopción y los criterios de segmentación de consumidores y productos, en el sexto capítulo se desarrolla el modelo completo de investigación formado por un conjunto de hipótesis obtenidas de la revisión de la literatura de los capítulos anteriores, en las que se definen las hipótesis de investigación con respecto a las influencias esperadas de las variables de segmentación sobre las relaciones del modelo de adopción. Este modelo confiere a la investigación un carácter social y de tipo fundamentalmente exploratorio, en el que en muchos casos ni siquiera se han encontrado evidencias empíricas previas que permitan el enunciado de hipótesis sobre la influencia de determinadas variables de segmentación. El capítulo seis contiene además la descripción del instrumento de medida empleado en la investigación, conformado por un total de 125 preguntas y sus correspondientes escalas de medida, así como la descripción de la muestra representativa empleada en la validación del modelo, compuesta por un grupo de 817 personas españolas o residentes en España. El capítulo siete constituye el núcleo del análisis empírico del trabajo de investigación, que se compone de dos elementos fundamentales. Primeramente se describen las técnicas estadísticas aplicadas para el estudio de los datos que, dada la complejidad del análisis, se dividen en tres grupos fundamentales: Método de mínimos cuadrados parciales (PLS, Partial Least Squares): herramienta estadística de análisis multivariante con capacidad de análisis predictivo que se emplea en la determinación de las relaciones estructurales de los modelos propuestos. Análisis multigrupo: conjunto de técnicas que permiten comparar los resultados obtenidos con el método PLS entre dos o más grupos derivados del uso de una o más variables de segmentación. En este caso se emplean cinco métodos de comparación, lo que permite asimismo comparar los rendimientos de cada uno de los métodos. Determinación de segmentos no identificados a priori: en el caso de algunas de las variables de segmentación no existe un criterio de clasificación definido a priori, sino que se obtiene a partir de la aplicación de técnicas estadísticas de clasificación. En este caso se emplean dos técnicas fundamentales: análisis de componentes principales –dado el elevado número de variables empleadas para la clasificación– y análisis clúster –del que se combina una técnica jerárquica que calcula el número óptimo de segmentos, con una técnica por etapas que es más eficiente en la clasificación, pero exige conocer el número de clústeres a priori. La aplicación de dichas técnicas estadísticas sobre los modelos resultantes de considerar los distintos criterios de segmentación, tanto de clientes como de productos, da lugar al análisis de un total de 128 modelos de adopción de comercio electrónico y 65 comparaciones multigrupo, cuyos resultados y principales consideraciones son elaboradas a lo largo del capítulo. Para concluir, el capítulo ocho recoge las conclusiones del trabajo divididas en cuatro partes diferenciadas. En primer lugar se examina el grado de alcance de los objetivos planteados al inicio de la investigación; después se desarrollan las principales contribuciones que este trabajo aporta tanto desde el punto de vista metodológico, como desde los punto de vista teórico y práctico; en tercer lugar, se profundiza en las conclusiones derivadas del estudio empírico, que se clasifican según los criterios de segmentación empleados, y que combinan resultados confirmatorios y exploratorios; por último, el trabajo recopila las principales limitaciones de la investigación, tanto de carácter teórico como empírico, así como aquellos aspectos que no habiendo podido plantearse dentro del contexto de este estudio, o como consecuencia de los resultados alcanzados, se presentan como líneas futuras de investigación. ABSTRACT Favoured by an increase of Internet penetration rates across the globe, electronic commerce has experienced a rapid growth over the last few years. Nevertheless, adoption of electronic commerce has differed from one country to another. On one hand, it has been observed that countries leading e-commerce adoption have a large percentage of Internet users as well as of online purchasers; on the other hand, other markets, despite having a low percentage of Internet users, show a high percentage of online buyers. Halfway between those two ends of the spectrum, we find countries such as Spain which, despite having moderately high Internet penetration rates and similar socio-economic characteristics as some of the leading countries, have failed to turn Internet users into active online buyers. Several theoretical approaches have been taken in an attempt to define the factors that influence the use of electronic commerce systems by customers. One of the betterknown frameworks to characterize adoption factors is the acceptance modelling theory, which is derived from the information systems adoption in organizational environments. These models are based on individual perceptions on which factors determine purchase intention, as a mean to explain users’ actual purchasing behaviour. Even though research on electronic commerce adoption models has increased in terms of volume and scope over the last years, the majority of studies validate their hypothesis by using a single sample of consumers from which they obtain general conclusions. Nevertheless, since the birth of marketing, and more specifically from the second half of the 19th century, differences in consumer behaviour owing to demographic, sociologic and psychological characteristics have also been taken into account. And such differences are generally translated into different needs that can only be satisfied when sellers adapt their offer to their target market. Electronic commerce has a number of features that makes it different when compared to traditional commerce; the best example of this is the lack of physical contact between customers and products, and between customers and vendors. Other than that, some differences that depend on the type of product may also play an important role in electronic commerce. From all the above, the present research aims to address the study of the main factors influencing purchase intention and actual purchase behaviour in electronic commerce by Spanish end-consumers, taking into consideration both the customer group to which they belong and the type of product being purchased. In order to achieve this goal, this Thesis is structured in eight chapters: four theoretical sections, three empirical blocks and a final section summarizing the conclusions derived from the research. The chapters are arranged in sequence as follows: introduction, current state of electronic commerce, technology adoption models, electronic commerce segmentation, preliminary design of the empirical work, research design, data analysis and results, and conclusions. The introductory chapter offers a detailed justification of the relevance of this study in the context of e-commerce adoption research; it also sets out the objectives, methodology and research stages. The second chapter further expands and complements the introductory chapter, focusing on two elements: the concept of electronic commerce and its evolution from a general point of view, and the evolution of electronic commerce in Spain and main indicators of adoption. This section is intended to allow the reader to understand the research context, and also to serve as a basis to justify the relevance and representativeness of the sample used in this study. Chapters three (technology acceptance models) and four (segmentation in electronic commerce) set the theoretical foundations for the study. Chapter 3 presents a thorough literature review of technology adoption modelling, focusing on previous studies on electronic commerce acceptance. As a result of the literature review, the research framework is built upon a model based on UTAUT (Unified Theory of Acceptance and Use of Technology) and its evolution, UTAUT2, including two specific electronic commerce adoption factors: perceived risk and perceived trust. Chapter 4 deals with client and product segmentation methodologies used by experts. From the literature review, a wide range of classification variables is studied, and a shortlist of nine classification variables has been selected for inclusion in the research. The criteria for variable selection were their adequacy to electronic commerce characteristics, as well as adequacy to the sample characteristics. The nine variables have been classified in three groups: socio-demographic (gender, age, education level, income, family size and relationship status), behavioural (experience in electronic commerce and frequency of purchase) and psychographic (online purchase motivations) variables. The second half of chapter 4 is devoted to a review of the product classification criteria in electronic commerce. The review has led to the identification of a final set of fifteen groups of variables, whose combination offered a total of thirty-four possible outputs. However, due to the lack of empirical evidence in the context of electronic commerce, further investigation on the validity of this set of product classifications was deemed necessary. For this reason, chapter 5 proposes an empirical study to test the different product classification variables with 207 samples. A selection of product classifications including only those variables that are objective, able to identify distinct groups and not dependent on consumers’ point of view, led to a final classification of products which consisted on two groups of variables for the final empirical study. The combination of these two groups gave rise to four types of products: digital and non-digital goods, and digital and non-digital services. Chapter six characterizes the research –social, exploratory research– and presents the final research model and research hypotheses. The exploratory nature of the research becomes patent in instances where no prior empirical evidence on the influence of certain segmentation variables was found. Chapter six also includes the description of the measurement instrument used in the research, consisting of a total of 125 questions –and the measurement scales associated to each of them– as well as the description of the sample used for model validation (consisting of 817 Spanish residents). Chapter 7 is the core of the empirical analysis performed to validate the research model, and it is divided into two separate parts: description of the statistical techniques used for data analysis, and actual data analysis and results. The first part is structured in three different blocks: Partial Least Squares Method (PLS): the multi-variable analysis is a statistical method used to determine structural relationships of models and their predictive validity; Multi-group analysis: a set of techniques that allow comparing the outcomes of PLS analysis between two or more groups, by using one or more segmentation variables. More specifically, five comparison methods were used, which additionally gives the opportunity to assess the efficiency of each method. Determination of a priori undefined segments: in some cases, classification criteria did not necessarily exist for some segmentation variables, such as customer motivations. In these cases, the application of statistical classification techniques is required. For this study, two main classification techniques were used sequentially: principal component factor analysis –in order to reduce the number of variables– and cluster analysis. The application of the statistical methods to the models derived from the inclusion of the various segmentation criteria –for both clients and products–, led to the analysis of 128 different electronic commerce adoption models and 65 multi group comparisons. Finally, chapter 8 summarizes the conclusions from the research, divided into four parts: first, an assessment of the degree of achievement of the different research objectives is offered; then, methodological, theoretical and practical implications of the research are drawn; this is followed by a discussion on the results from the empirical study –based on the segmentation criteria for the research–; fourth, and last, the main limitations of the research –both empirical and theoretical– as well as future avenues of research are detailed.

Identidad, apropiación, sentido de comunidad y satisfacción residencial: claves de análisis para los estudios urbanos y la planificación. El caso del barrio Embajadores, Madrid

Las rápidas y continuas transformaciones urbanas que experimentan las ciudades actuales han generado importantes cambios en la forma en que se vive, experimenta y percibe la vida en ellas. Estos procesos de transformación, a veces fruto del rápido crecimiento de los entornos urbanos, de su heterogeneidad, de sus dinámicas económicas, de la confrontación de las diferencias sociales de los habitantes o simplemente producto de nuevos usos en los entornos, han propiciado un creciente interés por comprender el efecto que un determinado contexto urbano tiene sobre el individuo y viceversa. O dicho de forma más general, se ha buscado comprender la relación entre el ser humano y el entorno. Así, más recientemente, la atención de muchos estudios se ha posado también en los patrones de uso de los espacios, los cuales van acompañados de una infinidad de cogniciones y valoraciones surgidas en los residentes producto de sus experiencias con el entorno construido. Dentro del desarrollo de estas investigaciones, han surgido una gran variedad de conceptos que han sido identificados por la trascendencia que tienen sobre el vínculo entre el individuo y el contexto, entre los cuales encontramos los conceptos de Identidad, Apropiación de lugar, Sentido de Comunidad y Satisfacción residencial. Este trabajo, tomando como base estos cuatro conceptos, se ha preocupado por comprender la forma en que éstos se relacionan con una serie de variables socio-demográficas, físico-urbanas y cognitivas en la dimensión urbana, con el propósito de valorar el poder de estos constructos —y las variables vinculadas— con los procesos de transformación urbana. La finalidad de la realización de dicho análisis se sustenta en poder identificar como estos factores son tomados en consideración en el urbanismo para así poder reconocer diversas opciones para mediar o incidir sobre estas variables desde las políticas públicas, la planificación urbana o el proyecto urbano. Esto pues, se parte del entendimiento de que la práctica urbanística tiene la opción de interceder sobre una serie de cuestiones que afectan directamente el bienestar y la calidad de vida de las personas, por lo cual su absoluto entendimiento sobre los efectos que fenómenos urbanos como éstos tienen sobre los entornos, es de gran transcendencia para la disciplina. Por tanto, esta investigación ha recopilado y analizado, mediante diferentes herramientas estadísticas, gran cantidad de datos provenientes de una encuesta realizada en un barrio de la ciudad de Madrid, que le han permitido identificar las variables que más peso tienen en los procesos urbanos que desembocan en una mayor Identificación, Apropiación, Sentido de Comunidad y Satisfacción Residencial en el individuo. Esta primera etapa, permitió posteriormente indagar, con ayuda de un panel de expertos urbanistas, sobre las posibilidades de la disciplina para mediar o interceder sobre esos aspectos, lo que nos permitió finalmente alcanzar algunos resultados y conclusiones que permiten valorar las opciones de las diferentes escalas de intervención urbana y los retos de cara al futuro de trabajos sobre esta temática. ABSTRACT The fast and continuous urban transformations that current major cities experience, have generated important changes in the way in which we live, experience and perceive life in them. These transformation processes, sometimes result of rapid growth of urban environments, of their heterogeneity, of their economic dynamics, of the confrontation of social differences amongst its population or just as a product of new ways environments are used, have led to a growing interest in understanding the effect that a given urban context has on the individual and vice versa. In other words, it’s sought to understand the relationship between human beings and the environment. Thus, more recently, the attention of many studies have also focused in the patterns of use of space, which are accompanied by a multitude of cognitions and valuations arising in residents product of their experiences with the built environment. Within the development of those investigations, there have been a great variety of concepts that have been identified due to the importance they have on the relationship between the individual and the context, among which are the concepts of identity, appropriation of place, sense of community and residential satisfaction. This work, based on these four concepts, has been concerned with understanding how they relate to a series of socio-demographic, physical and cognitive variables in an urban dimension, in order to assess the power of these constructs —and related variables— with urban transformation processes. The purpose of that analysis is based on being able to identify how these factors are taken into consideration in planning, in order to recognize different options to mediate or influence on these variables from public policies, urban planning or urban project. This then, is on the understanding that the planning practice has the option to intercede on a number of issues that directly affect the welfare and quality of life of people, so the absolute understanding of the effects of urban phenomena like these have over environments, is of great importance to the discipline. Therefore, this research has collected and analyzed, using different statistical tools, lots of data obtained from a survey performed in a neighborhood of the city of Madrid, which enabled it to identify the variables that have more weight in urban processes that lead in higher identification, appropriation, sense of community and residential satisfaction in the individual. This first step, then allows investigating, with the help of a panel of expert planners, on the possibility of the discipline to mediate or intercede on these aspects, which ultimately enabled us to achieve some results and conclusions that allow evaluating the options of different scales of urban intervention and challenges for the future of work on this subject.

La participación de los jóvenes universitarios en la planificación urbana. Estudios de caso de Lisboa, Madrid y Fortaleza

La participación de los jóvenes en los procesos de planificación urbana en Lisboa, Madrid y Fortaleza ha sido tema central de la presente tesis. Los principales objetivos perseguidos consisten en: caracterizar y analizar críticamente las dimensiones más importantes de la participación de jóvenes universitarios en los procesos participativos; aportar características de interés juvenil para un “modelo” de planificación urbana; elaborar directrices para el diseño de actuaciones en un proceso urbano participativo desde la perspectiva de los jóvenes; establecer el alcance de un instrumento urbano participativo reglamentado por el gobierno local entre los jóvenes; determinar si la percepción de los jóvenes universitarios acerca de las acciones del gobierno local tiene influencia en los procesos participativos. El universo estadístico de la muestra lo conforman la totalidad de 737 jóvenes universitarios encuestados en Lisboa, Madrid y Fortaleza. Que se distribuye en 104 encuestados en Lisboa, 329 en Madrid, y 304 en la ciudad de Fortaleza. El cuestionario contiene preguntas: abiertas, cerradas y mixtas. La mayor parte de las cuestiones son cerradas, y en cuanto a las opciones de respuesta: en muchas preguntas se ha aplicado, una escala tipo Likert, entre 1 y 4, siendo 4 el grado más alto (totalmente de acuerdo), y 1 el grado más bajo (nada de acuerdo), y para otras, una opción múltiple, con solamente una opción de respuesta. Se realizó un cuestionario de 31 preguntas en Lisboa, y tras su aplicación y obtención de resultados se revisó y mejoró obteniendo un cuestionario de 23 preguntas que fue aplicado en Madrid y Fortaleza. Se realizan análisis descriptivos, y algún análisis factorial en diversas preguntas del cuestionario, y se estudian diferencias en función de las variables sociodemográficas planteadas. Los resultados constatan que es muy baja la participación en los procesos institucionalizados por el gobierno local, en contrapartida es bastante alta en los procesos organizados por los ciudadanos. La información limita la participación de los jóvenes y ya que estos reconocen como motivación estar más y mejor informados y controlar y acompañar las acciones de su gobierno local. Por otra parte, desean participar en grupo en foros y debates presenciales. Los jóvenes madrileños consideran que las etapas más importantes en un proceso urbano participativo son: información, seguimiento y evaluación, mientras que para los jóvenes de Fortaleza son: Fiscalización, concienciación e información. Se ha verificado que desde la percepción de los jóvenes de Lisboa los ciudadanos son consultados en los procesos urbanos participativos y de acuerdo con los jóvenes de Madrid y Fortaleza los ciudadanos son dirigidos, influenciados y manipulados. Los problemas de carácter urbano no tienen una conceptualización clara y precisa entre los jóvenes universitarios y los problemas urbanos que más afectan la vida de los jóvenes universitarios son aparcamientos, contaminación y seguridad urbana. Sin embargo, los transportes son apuntados por los jóvenes universitarios de Lisboa, Madrid y Fortaleza. Además no saben identificar los problemas de su barrio. Así como de las causas y consecuencias y soluciones de los problemas urbanos. Eligen como mejor estrategia para desarrollar un proceso urbano participativo el acuerdo entre técnicos, población y el gobierno local. Los jóvenes universitarios de Fortaleza apuntan directrices para una planificación urbana con énfasis en la seguridad urbana, la sostenibilidad y la investigación, tecnología e innovación. Por otro lado, los jóvenes universitarios de Madrid perfilan tres “modelos” de planificación urbana: un “Modelo” socio-económica, un “Modelo” sostenible e innovadora y un “Modelo” de Planificación Urbana con énfasis en espacios públicos, entretenimiento, seguridad urbana y deporte. Los jóvenes universitarios rechazan la idea que la planificación urbana lleva en cuenta sus perspectivas y opiniones. Respeto al Presupuesto Participativo, el alcance de dicho proceso entre los jóvenes universitarios es extremamente bajo. Sin embargo, opinan que la aproximación entre ciudadanos, técnicos y gobierno en los procesos de Presupuesto Participativo mejora la rendición de cuentas. Además los jóvenes creen que dichos procesos conceden un poder moderado a los ciudadanos, y consideran que el poder concedido en los procesos urbanos influye directamente en el interés y empeño en participar. ABSTRACT Youth participation in urban planning processes in Lisbon, Madrid and Fortaleza is the main subject of this thesis. Our key goals are the following: characterising and critically analysing the most important dimensions of young university students’ participation in participative processes; providing features of interest for the young for an urban planning “model”; developing a variety of guidelines for designing actions in a participative urban process from the perspective of young people; analysing the impact upon the young of a participative urban instrument implemented by the local government; determining whether young university students’ perception of local government actions influences participative processes. The statistical universe of the sample comprises a total of 737 young university students who were surveyed in Lisbon, Madrid and Fortaleza, distributed as follows: 104 respondents in Lisbon, 329 in Madrid, and 304 in Fortaleza. The survey is made up of open-ended, closed-ended and mixed questions. Most questions are closed-ended. Regarding the answer options, a Likert-type scale has been used in many questions. The scale ranges from 1 to 4, 4 being the highest value (completely agree) and 1 the lowest (completely disagree). Besides, there are multiple-choice questions with only one possible answer. A 31- question survey was conducted in Lisbon. After the survey was run and the results were obtained, it was reviewed and improved. The improved version was a 23- question survey which was conducted in Madrid and Fortaleza. Descriptive analyses as well as some factorial analyses are carried out in several questions, and differences are studied depending on the socio-demographic variables involved. The results show that participation in processes implemented by local governments is very low. In contrast, participation is quite high in processes organised by citizens. Information limits youth participation, as young people point out that they are motivated by more and better information and by the possibility of monitoring and keeping track of their local government actions. They also wish to take part in face-to-face group forums and discussions. Young people from Madrid think that the most important stages in participative urban processes are information, follow-up and assessment, whereas young people from Fortaleza highlight tax matters, awareness and information. It has been confirmed that Lisbon youth perceive that citizens are consulted in participative urban processes. Youth from Madrid and Fortaleza, on the other hand, state that citizens are directed, influenced and manipulated. Young university students do not have a clear, precise concept of urban problems. Among these, they are most affected by car parks, pollution and urban safety, but the transport problem is pointed out by young university students from Lisbon, Madrid and Fortaleza. Furthermore, they cannot identify the problems in their neighbourhoods, nor are they able to specify the causes, consequences and solutions of urban problems. Their preferred strategy for developing a participative urban process is an agreement between technicians, the population and the local government. Young university students from Fortaleza suggest guidelines for an urban planning approach emphasising urban safety, sustainability and research, technology and innovation. Those from Madrid, for their part, outline three urban planning “models”: a socioeconomic “model”, a sustainable and innovative “model”, and an urban planning “model” with a focus on public areas, entertainment, urban safety and sport. Young university students disagree that urban planning takes their perspectives and views into account. Moreover, the impact of the Participative Budget upon their lives is extremely low. In their opinion, however, closer collaboration between citizens, technicians and governments in Participative Budget processes promotes accountability. The young also think that these processes give moderate power to citizens, and in their view the power that can be exerted in urban processes directly influences the interest in participating and the will to do so.

AS RELAÇÕES ENTRE SUPORTE SOCIAL E BALANÇO EMOCIONAL

O objetivo deste estudo foi descrever os níveis de dimensões de suporte social (emocional e prático) e de balanço emocional, analisar as suas correlações e investigar as suas relações com variáveis sócio demográficas de um grupo de pessoas que participam de programa de apoio emocional e informacional em uma instituição beneficente de São Paulo. A amostra pesquisada, escolhida aleatoriamente, consistiu de 95 pessoas do sexo masculino e feminino com idade média de 47,99 anos (DP=12,11). O instrumento de coleta de dados foi um questionário de auto preenchimento composto por duas medidas que aferiram as variáveis de estudo (percepção de suporte social, afetos positivos e negativos), além dos dados sócio demográficos. Foram utilizadas análises estatísticas descritivas, testadas diferenças entre médias, bem como calculados os índices de correlação entre as variáveis. Os resultados mostraram que não há diferenças significativas na percepção de suporte social (emocional e prático) e as variáveis sócio demográficas sexo, trabalho, estudo, voluntariado, permanência na instituição, escolaridade e estado civil. Os mais jovens, com menos de 30 anos, revelaram maior percepção do suporte social (emocional e prático). Revelaram também que não há diferença significativa do balanço emocional em relação às variáveis sócio demográficas, com exceção do trabalho voluntário que repercutiu expressiva e positivamente no balanço emocional. A análise das relações entre suporte social (emocional e prático) e idade revelou existir uma correlação significativa, baixa e negativa, isto é, com o aumento da idade há uma tendência a decrescer levemente a percepção de suporte social. A descrição dos níveis de suporte social revelou que as percepções de suporte emocional e prático são significativamente diferentes, embora a diferença entre as médias seja pequena, prevalece a percepção de maior suporte emocional. A descrição dos escores de balanço emocional revelou que cerca de três quartos dos entrevistados registrou balanço emocional positivo e cerca de um quarto registrou balanço emocional negativo. Não foi constatada correlação significativa entre balanço emocional e idade. As análises das relações entre suporte emocional, suporte prático e balanço emocional revelaram correlações significativas e positivas, isto é, com um acréscimo na percepção de suporte social (emocional e prático) há a tendência de acréscimo no balanço emocional. Portanto, os resultados deste estudo poderão contribuir para a compreensão do quadro psicológico dos indivíduos pesquisados, bem como, suscitar aos gestores de instituições reflexões para o aprimoramento dos serviços de programas assistenciais.(AU)

AS RELAÇÕES ENTRE SUPORTE SOCIAL E BALANÇO EMOCIONAL

O objetivo deste estudo foi descrever os níveis de dimensões de suporte social (emocional e prático) e de balanço emocional, analisar as suas correlações e investigar as suas relações com variáveis sócio demográficas de um grupo de pessoas que participam de programa de apoio emocional e informacional em uma instituição beneficente de São Paulo. A amostra pesquisada, escolhida aleatoriamente, consistiu de 95 pessoas do sexo masculino e feminino com idade média de 47,99 anos (DP=12,11). O instrumento de coleta de dados foi um questionário de auto preenchimento composto por duas medidas que aferiram as variáveis de estudo (percepção de suporte social, afetos positivos e negativos), além dos dados sócio demográficos. Foram utilizadas análises estatísticas descritivas, testadas diferenças entre médias, bem como calculados os índices de correlação entre as variáveis. Os resultados mostraram que não há diferenças significativas na percepção de suporte social (emocional e prático) e as variáveis sócio demográficas sexo, trabalho, estudo, voluntariado, permanência na instituição, escolaridade e estado civil. Os mais jovens, com menos de 30 anos, revelaram maior percepção do suporte social (emocional e prático). Revelaram também que não há diferença significativa do balanço emocional em relação às variáveis sócio demográficas, com exceção do trabalho voluntário que repercutiu expressiva e positivamente no balanço emocional. A análise das relações entre suporte social (emocional e prático) e idade revelou existir uma correlação significativa, baixa e negativa, isto é, com o aumento da idade há uma tendência a decrescer levemente a percepção de suporte social. A descrição dos níveis de suporte social revelou que as percepções de suporte emocional e prático são significativamente diferentes, embora a diferença entre as médias seja pequena, prevalece a percepção de maior suporte emocional. A descrição dos escores de balanço emocional revelou que cerca de três quartos dos entrevistados registrou balanço emocional positivo e cerca de um quarto registrou balanço emocional negativo. Não foi constatada correlação significativa entre balanço emocional e idade. As análises das relações entre suporte emocional, suporte prático e balanço emocional revelaram correlações significativas e positivas, isto é, com um acréscimo na percepção de suporte social (emocional e prático) há a tendência de acréscimo no balanço emocional. Portanto, os resultados deste estudo poderão contribuir para a compreensão do quadro psicológico dos indivíduos pesquisados, bem como, suscitar aos gestores de instituições reflexões para o aprimoramento dos serviços de programas assistenciais.(AU)

Uso de Internet y prácticas políticas de los jóvenes españoles

A partir de un análisis secundario de los microdatos procedentes del estudio 2.889 del Centro de Investigaciones Sociológicas de España, pretendemos observar la posible relación entre el uso de Internet por parte de los jóvenes y sus prácticas políticas. En concreto, las variables disponibles permiten estudiar tres aspectos fundamentales: si existe relación entre la frecuencia de uso de Internet y la participación política; si el grado de participación política en el espacio virtual se correlaciona con la participación fuera de este espacio; y si se observan diferencias en términos de participación política online según variables sociodemográficas. Entre los resultados obtenidos podemos destacar la existencia de una relación estadísticamente significativa entre una mayor frecuencia de uso de Internet y una mayor implicación política tanto en el espacio virtual como offline.

Caesarean Birth vs. Vaginal Delivery: Effects upon Maternal Satisfaction, Maternal Confidence and Maternal Perception of the Newborn Behaviour

In order to test the hypothesis that caesarean birth has negative consequences upon newly mothers’ satisfaction and perceptions, women delivering by caesarean birth (WCB) were compared with women delivering by vaginal birth (WVB). Subjects: 180 newly mothers; 93 WCB and 87 WVB. Instruments: A Socio-Demographic Questionnaire developed for this research, the Childbirth Perceptions Questionnaire and the Mother and Baby Scales. Results: WCB had significantly lower scores in perceptions of baby as alert/responsive and nearly significant lower scores for baby as alert during feeds. WVB showed a significantly higher level of satisfaction with delivery and conduct during labour, as also had significantly lower scores for perceptions of baby as irritable during feeds and for lack of confidence in feeds. After controlling for the kind of anesthesia received in labour, three conclusions must be taken into account: 1) between WCB with regional anaesthesia and WCB with general anaesthesia there is only one significant difference, with the former having higher scores for perception of baby as alert during feeds; 2) between WVB with regional anaesthesia and WVB with no anaesthesia there are only two significant differences, with the former having higher scores for lack of confidence in feeding and having lower scores for global confidence; 3) between WCB with regional anaesthesia and WVB with regional anaesthesia four significant differences emerge, with the former having a lower level of satisfaction with delivery and conduct in labour and having lower scores for perception of baby as alert responsive, and also having higher scores of perception of baby as irritable in feeds and higher scores for lack of confidence in feeding. Data seem compatible with the hypothesis that caesarean birth has some negative consequences upon mothers’ satisfaction and perceptions and, for this reason, psychological surveys should constitute a routine procedure in maternity hospitals, especially when newly mothers pertain to families affected by risks of psychological or social nature.

Artrite reumatóide : implicações na funcionalidade das pessoas

Enquadramento: A Artrite Reumatóide (AR) é uma patologia com profundas implicações na funcionalidade das pessoas, com efeitos significativos não só ao nível do funcionamento físico, mas também a nível emocional, familiar, social e económico. Objetivos: Avaliar a funcionalidade das pessoas com artrite reumatóide e analisar a sua relação com as variáveis sócio demográficas, clínicas, dor e qualidade do sono. Métodos: Trata-se de um estudo não experimental, transversal, descritivo-correlacional e de caráter quantitativo, que foi realizado numa amostra não probabilística por conveniência, constituída por 75 pessoas com o diagnóstico de artrite reumatóide, acompanhadas na Unidade de Dor, na Consulta de Reumatologia e na Medicina Física de Reabilitação do CHTV, EPE. Para a mensuração das variáveis utilizou-se um instrumento de colheita de dados que integra uma secção de caracterização sócio demográfica e clínica, o Índice da Qualidade de Sono de Pittsburgh – PSQI e o Health Assessment Questionnaire – HAQ. Resultados: Constatou-se que 60,0% dos inquiridos apresenta dificuldades/incapacidades leves no desempenho das atividades da vida diária, 32,0% apresenta já dificuldades moderadas e 8,0% incapacidade grave, sendo que o valor médio da funcionalidade global avaliado por meio do HAQ foi de 1,48, o que revela a existência de uma incapacidade moderada na nossa amostra. Das variáveis sócio demográficas, a idade (p=0,003), a situação laboral (p=0,000), a escolaridade (p=0,006) e os rendimentos mensais (p=0,001) têm influência no estado funcional das pessoas com AR. Das variáveis clínicas, a intensidade da dor (p=0,007) e o tempo de diagnóstico da doença (p=0,013) mostraram relacionarem-se com a funcionalidade. Em relação à qualidade do sono, apenas existem diferenças estatísticamente significativas nas subescalas “levantar-se” (p=0,030) e “caminhar” (p=0,034), sendo que a má qualidade de sono configurou-se em 94,7% dos inquiridos. Conclusão: As evidências encontradas neste estudo referem que a idade, a situação laboral, a escolaridade, os rendimentos mensais, o tempo de diagnóstico, a intensidade da dor e a qualidade do sono, associam-se a uma pior funcionalidade nas pessoas com AR. O diagnóstico precoce, a adoção de medidas para a promoção da boa qualidade do sono, a aplicação de medidas farmacológicas e não farmacológicas para o alívio da dor, e ações de formação direcionadas aos doentes com AR, devem ser estratégias a desenvolver junto desta população, numa tentativa de minimizar o impacto negativo que esta doença acarreta. Palavras-chave: artrite reumatóide, estado funcional, qualidade do sono.

Retrospective study on structural neuroimaging in first-episode psychosis

Background. No consensus between guidelines exists regarding neuroimaging in firstepisode psychosis. The purpose of this study is to assess anomalies found in structural neuroimaging exams (brain computed tomography (CT) and magnetic resonance imaging (MRI)) in the initial medical work-up of patients presenting first-episode psychosis. Methods. The study subjects were 32 patients aged 18–48 years (mean age: 29.6 years), consecutively admitted with first-episode psychosis diagnosis. Socio-demographic and clinical data and neuroimaging exams (CT and MRI) were retrospectively studied. Diagnostic assessments were made using the Operational Criteria Checklist +. Neuroimaging images (CT and MRI) and respective reports were analysed by an experienced consultant psychiatrist. Results. None of the patients had abnormalities in neuroimaging exams responsible for psychotic symptoms. Thirty-seven percent of patients had incidental brain findings not causally related to the psychosis (brain atrophy, arachnoid cyst, asymmetric lateral ventricles, dilated lateral ventricles, plagiocephaly and falx cerebri calcification). No further medical referral was needed for any of these patients. No significant differences regarding gender, age, diagnosis, duration of untreated psychosis, in-stay and cannabis use were found between patients who had neuroimaging abnormalities versus those without. Discussion. This study suggests that structural neuroimaging exams reveal scarce abnormalities in young patients with first-episode psychosis. Structural neuroimaging is especially useful in first-episode psychosis patients with neurological symptoms, atypical clinical picture and old age.