Understanding informal payments in health care: motivation of health workers in Tanzania

BACKGROUND: There is growing evidence that informal payments for health care are fairly common in many low- and middle-income countries. Informal payments are reported to have a negative consequence on equity and quality of care; it has been suggested, however, that they may contribute to health worker motivation and retention. Given the significance of motivation and retention issues in human resources for health, a better understanding of the relationships between the two phenomena is needed. This study attempts to assess whether and in what ways informal payments occur in Kibaha, Tanzania. Moreover, it aims to assess how informal earnings might help boost health worker motivation and retention. METHODS: Nine focus groups were conducted in three health facilities of different levels in the health system. In total, 64 health workers participated in the focus group discussions (81% female, 19% male) and where possible, focus groups were divided by cadre. All data were processed and analysed by means of the NVivo software package. RESULTS: The use of informal payments in the study area was confirmed by this study. Furthermore, a negative relationship between informal payments and job satisfaction and better motivation is suggested. Participants mentioned that they felt enslaved by patients as a result of being bribed and this resulted in loss of self-esteem. Furthermore, fear of detection was a main demotivating factor. These factors seem to counterbalance the positive effect of financial incentives. Moreover, informal payments were not found to be related to retention of health workers in the public health system. Other factors such as job security seemed to be more relevant for retention. CONCLUSION: This study suggests that the practice of informal payments contributes to the general demotivation of health workers and negatively affects access to health care services and quality of the health system. Policy action is needed that not only provides better financial incentives for individuals but also tackles an environment in which corruption is endemic.

Multi-level modeling of aspects associated with poor mental health in a sample of prehospital emergency professionals.

BACKGROUND: The goal of this paper is to investigate the respective influence of work characteristics, the effort-reward ratio, and overcommitment on the poor mental health of out-of-hospital care providers. METHODS: 333 out-of-hospital care providers answered a questionnaire that included queries on mental health (GHQ-12), demographics, health-related information and work characteristics, questions from the Effort-Reward Imbalance Questionnaire, and items about overcommitment. A two-level multiple regression was performed between mental health (the dependent variable) and the effort-reward ratio, the overcommitment score, weekly number of interventions, percentage of non-prehospital transport of patients out of total missions, gender, and age. Participants were first-level units, and ambulance services were second-level units. We also shadowed ambulance personnel for a total of 416 hr. RESULTS: With cutoff points of 2/3 and 3/4 positive answers on the GHQ-12, the percentages of potential cases with poor mental health were 20% and 15%, respectively. The effort-reward ratio was associated with poor mental health (P < 0.001), irrespective of age or gender. Overcommitment was associated with poor mental health; this association was stronger in women (β = 0.054) than in men (β = 0.020). The percentage of prehospital missions out of total missions was only associated with poor mental health at the individual level. CONCLUSIONS: Emergency medical services should pay attention to the way employees perceive their efforts and the rewarding aspects of their work: an imbalance of those aspects is associated with poor mental health. Low perceived esteem appeared particularly associated with poor mental health. This suggests that supervisors of emergency medical services should enhance the value of their employees' work. Employees with overcommitment should also receive appropriate consideration. Preventive measures should target individual perceptions of effort and reward in order to improve mental health in prehospital care providers.

Evolution of spirituality and religiousness in chronic schizophrenia or schizo-affective disorders: A 3 years follow-up study

Purpose : Spirituality and religiousness have been shown to be highly prevalent in patients with schizophrenia. Religion can help instil a positive sense of self, decrease the impact of symptoms and provide social contacts. Religion may also be a source of suffering. In this context, this research explores whether religion remains stable over time. Methods : From an initial cohort of 115 out-patients, 80% completed the 3-years follow-up assessment. In order to study the evolution over time, a hierarchical cluster analysis using average linkage was performed on factorial scores at baseline and follow-up and their differences. A sensitivity analysis was secondarily performed to check if the outcome was influenced by other factors such as changes in mental states using mixed models. Results : Religion was stable over time for 63% patients; positive changes occurred for 20% (i.e., significant increase of religion as a resource or a transformation of negative religion to a positive one) and negative changes for 17% (i.e., decrease of religion as a resource or a transformation of positive religion to a negative one). Change in spirituality and/or religiousness was not associated with social or clinical status, but with reduced subjective quality of life and self-esteem; even after controlling for the influence of age, gender, quality of life and clinical factors at baseline. Conclusions : In this context of patients with chronic schizophrenia, religion appeared to be labile. Qualitative analyses showed that those changes expressed the struggles of patients and suggest that religious issues need to be discussed in clinical settings.

Early dyadic patterns of mother-infant interactions and outcomes of prematurity at 18 months.

OBJECTIVE: With the increased survival of very preterm infants, there is a growing concern for their developmental and socioemotional outcomes. The quality of the early mother-infant relationship has been noted as 1 of the factors that may exacerbate or soften the potentially adverse impact of preterm birth, particularly concerning the infant's later competencies and development. The first purpose of the study was to identify at 6 months of corrected age whether there were specific dyadic mother-infant patterns of interaction in preterm as compared with term mother-infant dyads. The second purpose was to examine the potential impact of these dyadic patterns on the infant's behavioral and developmental outcomes at 18 months of corrected age. METHODS: During a 12-month period (January-December 1998), all preterm infants who were <34 weeks of gestational age and hospitalized at the NICU of the Lausanne University Hospital were considered for inclusion in this longitudinal prospective follow-up study. Control healthy term infants were recruited during the same period from the maternity ward of our hospital. Mother-infant dyads with preterm infants (n = 47) and term infants (n = 25) were assessed at 6 months of corrected age during a mother-infant play interaction and coded according to the Care Index. This instrument evaluates the mother's interactional behavior according to 3 scales (sensitivity, control, and unresponsiveness) and the child's interactional behavior according to 4 scales (cooperation, compliance, difficult, and passivity). At 18 months, behavioral outcomes of the children were assessed on the basis of a semistructured interview of the mother, the Symptom Check List. The Symptom Check List explores 4 groups of behavioral symptoms: sleeping problems, eating problems, psychosomatic symptoms, and behavioral and emotional disorders. At the same age, developmental outcomes were evaluated using the Griffiths Developmental Scales. Five areas were evaluated: locomotor, personal-social, hearing and speech, eye-hand coordination, and performance. RESULTS: Among the possible dyadic patterns of interaction, 2 patterns emerge recurrently in mother-infant preterm dyads: a "cooperative pattern" with a sensitive mother and a cooperative-responsive infant (28%) and a "controlling pattern" with a controlling mother and a compulsive-compliant infant (28%). The remaining 44% form a heterogeneous group that gathers all of the other preterm dyads and is composed of 1 sensitive mother-passive infant; 10 controlling mothers with a cooperative, difficult, or passive infant; and 10 unresponsive mothers with a cooperative, difficult, or passive infant. Among the term control subjects, 68% of the dyads are categorized as cooperative pattern dyads, 12% as controlling pattern dyads, and the 20% remaining as heterogeneous dyads. At 18 months, preterm infants of cooperative pattern dyads have similar outcomes as the term control infants. Preterm infants of controlling pattern dyads have significantly fewer positive outcomes as compared with preterm infants of cooperative pattern dyads, as well as compared with term control infants. They display significantly more behavioral symptoms than term infants, including more eating problems than term infants as well as infants from cooperative preterm dyads. Infants of the controlling preterm dyads do not differ significantly for the total development quotient but have worse personal-social development than term infants and worse hearing-speech development than infants from cooperative preterm dyads. The preterm infants of the heterogeneous group have outcomes that can be considered as intermediate with no significant differences compared with preterm infants from the cooperative pattern or the controlling pattern dyads. CONCLUSION: Among mother-preterm infant dyads, we identified 2 specific patterns of interaction that could play either a protective (cooperative pattern) or a risk-precipitating (controlling pattern) role on developmental and behavioral outcome, independent of perinatal risk factors and of the family's socioeconomic background. The controlling pattern is much more prevalent among preterm than term dyads and is related to a less favorable infant outcome. However, the cooperative pattern still represents almost 30% of the preterm dyads, with infants' outcome comparable to the ones of term infants. These results point out the impact of the quality of mother-infant relationship on the infant's outcome. The most important clinical implication should be to support a healthy parent-infant relationship already in the NICU but also in the first months of the infant's life. Early individualized family-based interventions during neonatal hospitalization and transition to home have been shown to reduce maternal stress and depression and increase maternal self-esteem and to improve positive early parent-preterm infant interactions.

A LIBRARY IN THE MAKING: Pioneer History of the Territorial and State Library of Iowa,October 1912

The discovery of early manuscript reports of Territorial and State Librarians, buried in the mass of old official papers transferred from the several departments of State to the new Department of Archives in the Historical Building, has suggested the propriety of completing as far as possible, the historical record of Iowa's State Library, "from the earliest period to the present time." After a thorough research through the papers on file in the Archives Department, the published Journals and departmental reports in the State Library and documents and private papers loaned me by Mr. Newton R. Parvin, librarian of the Iowa Masonic Library, Cedar Rapids. I am now able to present the following historical sketch, Supplemented by the hitherto unpublished papers referred to this filling a gap in the history of a State institution which from very small beginnings has grown to large proportions and has made for itself a firm place in the respect and esteem of every citizen of Iowa.

Foreword (2004)

This is the first issue of Geologica Acta dedicated to the memory of Professor Francesc Calvet, whose life was cut short in January 2002 when he was only 54. Francesc was a man with great human qualities, a distinguished scientist and an inspiring teacher who was held in high esteem by all those who knew him. His academic achievements, talent and friendly personality attracted numerous colleagues and students. Unfailingly courteous and polite, he was passionately committed to social justice and was a staunch defender of freedom of conscience and tolerance.

Foreword (2007)

This is the second issue of Geologica Acta dedicated to the memory of Professor Francesc Calvet, who passed away in January 2002. Francesc was a man with great human qualities, a distinguished scientist and an inspiring teacher who was held in high esteem by all those who knew him. The first volume contained six papers on specific areas of research in which Francesc was engaged, and a biography (Geologica Acta, volume 2, Nº 4, 2004). This second volume is made up of contributions by colleagues and former students who wish to salute Francesc Calvet as an outstanding geologist and teacher. The papers included in this volume are also subjects in which Francesc was closely involved.

Programa d'intervenció d'educació emocional i social per a l'etapa infantil: l'educació de la consciència emocional i l'autoestima

L’objectiu d’aquest treball és comprovar si l’aplicació d’un programa d’educació emocional i social millora el benestar emocional i social dels infants d’Educació Infantil. Per tal d’assolir aquest objectiu, primerament es va triar una mostra de 4 infants per realitzar el test PAI (Precepció de l’Autoconcepte Infantil) i així, mesurar el seu nivell d’autoestima. Després es va aplicar el programa d’educació emocional i social a l’aula, treballant la consciència emocional i l’autoestima. Seguidament es va tornar a realitzar el test PAI per poder observar i mesurar els canvis en el percentil dels mateixos 4 infants. S’han observat unes millores en el nivell d’autoestima dels nens i nenes de l’aula; s’ha adquirit una bona consciència emocional i s’han anat desenvolupant habilitats socioemocionals i, per tant, ha millorat el clima de l’aula. El treball de l’educació emocional i social a les aules és necessari per millorar el benestar emocional i social dels infants i així, ajudar en seu desenvolupament integral.

El treball amb percussió corporal ajuda a millorar l'atenció i la concentració?

Diferents civilitzacions han basat les seves mostres culturals en el ritme i l’ús del cos com a instrument. Moltes són tradicions ancestrals, que passen de generació en generació, sense cap anotació musical. Per tant, aquestes danses, basades en la percussió corporal, tenen com a elements bàsics l’atenció i la memorització. Diversos professionals (K. Terry, J. Romero, S. Serratosa...) han defensat que la pràctica de la percussió corporal aporta beneficis a tots nivells: potenciació de l’autoestima, reconeixement i acceptació del propi cos... Són precisament aquests fets els que han convertit aquesta disciplina en una metodologia present a les aules de Primària. L’objectiu d’aquesta recerca segueix aquesta línia: comprovar si, a través del treball de la percussió corporal, els alumnes de cicle mitjà del centre La Monjoia milloren la seva capacitat d’atenció i memorització. Per avaluar-ho, s’usaran un test de percepció auditiva i un de percepció visual i els resultats es contrastaran amb l’opinió de diversos docents.

Proposta d’un programa d’intervenció psicoeducativa per a un infant de 6 anys amb possible TDAH

Aquest treball té per objectiu identificar i avaluar preventivament les característiques d’un infant de sis anys que podrien desenvolupar el Trastorn per Dèficit d’Atenció amb Hiperactivitat. Per a la realització d’aquest treball es va proposar realitzar un programa psicopedagògic enfocat a millorar diferents comportaments negatius del propi infant. El programa està constituït per cinc activitats, realitzades amb tot el grup-classe, que intenten millorar diversos conceptes: la consciència emocional, el nivell d’empatia, l’autoestima i l’autocontrol emocional. El subjectes del grup d’intervenció han millorat en els diferents comportaments, i en concret, s’ ha vist un canvi important positiu en la conducta de l’infant. A més, l’observació d’actuacions no adequades en infants d’edats primerenques suposarà realitzar un bon treball psicopedagògic per poder-les prevenir o disminuir.

Com treballar l'autoestima al parvulari mitjançant activitats d'aprenentatge

L’autoestima és un aspecte que influeix en el desenvolupament integral dels infants. Amb freqüència la nostra autoestima es veu afectada per les experiències i exigències que rebem del món exterior. Per tant, un infant necessita tenir una adequada autoestima, d’aquesta manera, tindrà més confiança en si mateix, més interès i serà més positiu en tots els aspectes. El treball que trobem a continuació està format per un marc teòric i un marc empíric. En el marc teòric els conceptes que es treballen són l’educació inclusiva i l’atenció a la diversitat com a àmbits on es desenvolupa l’autoestima dels alumnes. En relació a l’autoestima es tracten temes com les característiques bàsiques que presenten els infants segons el seu grau d’autoestima (excessiva, adequada, baixa, deficient), a més de la importància del paper del mestre en la formació d’aquesta. En el marc empíric s’exposen les tècniques que s’utilitzen per avaluar l’autoestima i les possibles activitats d’intervenció que es poden portar a terme a l’aula per tal de treballar-la.

Contribució a l'estudi de la presència de Balmes en l'obra de Verdaguer

A partir d’una recerca exhaustiva dins l’obra de Verdaguer, l’article ressegueix la presència de Balmes en la producció de l’escriptor de Folgueroles. Tot i no ésser irrellevant, es constata que el reflex de l’obra balmesiana en la verdagueriana és menor del que, en principi, caldria suposar en un membre tan destacat de la Renaixença vigatana, un moviment que va sentir pel pensador de Vic una pregona admiració. De fet, només dos poemes de l’extensa producció de Verdaguer són dedicats a Balmes, per bé que un altre, molt ideològic, en mostra una influència evident.

Mesurer la stigmatisation perçue chez les personnes souffrant de troubles psychiques : traduction française, validation et adaptation de la Stigma Scale [French translation, validation and adaptation of the Stigma Scale].

AIM: People suffering from mental illness are exposed to stigma. However, only few tools are available to assess stigmatization as perceived from the patient's perspective. The aim of this study is to adapt and validate a French version of the Stigma Scale (King et al., 2007 [8]). This self-report questionnaire has a three-factor structure: discrimination, disclosure and positive aspects of mental illness. Discrimination subscale refers to perceived negative reactions of others. Disclosure subscale refers mainly to managing disclosure to avoid discrimination and finally positive aspects subscale taps into how patients are becoming more accepting, more understanding toward their illness. METHOD: In the first step, internal consistency, convergent validity and test-retest reliability of the French adaptation of the 28-item scale were assessed in a sample of 183 patients. Results of confirmatory factor analyses (CFA) did not confirm the hypothesized structure. In the light of the failed attempts to validate the original version, an alternative 9-item short-form version of the Stigma Scale, maintaining the integrity of the original model, was developed based on results of exploratory factor analyses in the first sample and cross-validated in a new sample of 234 patients. RESULTS: Results of CFA did not confirm that the data fitted well to the three-factor model of the 28-item Stigma Scale (χ(2)/df=2.02, GFI=0.77, AGFI=0.73, RMSEA=0.07, CFI=0.77 and NNFI=0.75). Cronbach's α was excellent for discrimination (0.84) and disclosure (0.83) subscales but poor for potential positive aspects (0.46). External validity was satisfactory. Overall Stigma Scale total score was negatively correlated with the score on Rosenberg's Self-Esteem Scale (r=-0.49), and each subscale was significantly correlated with a visual analogue scale that referred to the specific aspect of stigma (0.43≤|r|≤0.60). Intraclass correlation coefficients between 0.68 and 0.89 indicated good test-retest reliability. The results of the CFA demonstrated that the items chosen for the short version of the Stigma Scale have the expected fit properties (χ(2)/df=1.02, GFI=0.98, AGFI=0.98, RMSEA=0.01, CFI=1.0 and NNFI=1.0). Considering the small number (three) of items in each subscale of the short version of the Stigma Scale, α coefficients for discrimination (0.57), disclosure (0.80) and potential positive aspects subscales (0.62) are considered as good. CONCLUSION: Our results suggest that the 9-item French short version of the Stigma Scale is a useful, reliable and valid self-report questionnaire to assess perceived stigmatization in people suffering from mental illness. The time of completion is really short and questions are well understood and accepted by the patients.

"Varmaan se oma itsetunto on nousussa" : itsereflektio ja kohentunut vointi haastattelupuheessa

Summary: "I guess my self-esteem is going up" : self-reflection and reports of improved condition in interview talk

Ego identity in adolescence: preliminary validation of a French short-form of the EIPQ

Following the seminal work on personal identity of Erikson, Marcia's identity status model has been one of the most enduring paradigms. The Ego Identity Process Questionnaire (EIPQ; Balistreri, Busch-Rossnagel, & Geissinger, 1995) is a widely used measure of identity status. The purpose of this study was to evaluate the factor structure and the reliability of a French version of the EIPQ. The hypothesized structures were not confirmed. In light of the failed attempts to validate the original version, an alternative short-form version of the EIPQ (EIPQ-SF), maintaining the integrity of the original model, was developed in one sample and cross-validated in another sample. Additionally, theoretically consistent associations between the EIPQ-SF dimensions and self-esteem confirmed convergent validity. Globally, the results indicated that the French short-version of the EIPQ might be a useful instrument for the assessment of the identity statuses in adolescence and emerging adulthood.