Social perceptions of floods and flood management in a Mediterranean area (Costa Brava, Spain)

Taking as an example three study cases in the Costa Brava area, this paper examines the social perceptionof floods through surveys, interviews and Focus Group sessions. Perception is then related to vulnerability, flood management, and citizen’s preferences regarding alternatives to curb flood losses in the future. The study concludes that flood awareness and the willingness to take actions regarding this hazard are clearly related to the degree of social involvement with the affairs of the local community. Furthermore, participatory settings such as Focus Group sessions appear to enable a better environment for assessing and implementing flood management options that attempt to modify human activities rather than modify natural processes as has been frequently the case in the past

Introduction d'un questionnaire de dépistage de l'Etat de stress post traumatique (ESPT) : quel impact sur le diagnostic dans une unité d'urgence psychiatrique ambulatoire ?

Contexte: Impression clinique que l'Etat de Stress Post-traumatique (ESPT) est sous-diagnostiqué dans la prise en charge des patients qui sont évalués dans le cadre d'une urgence psychiatrique. Objectifs: (i) identifier la prévalence de l'ESPT dans une unité d'urgence psychiatrique au moyen d'un instrument diagnostic et la comparer avec le diagnostic clinique retenu dans un échantillon historique (ii) évaluer la perception des cliniciens quant à l'utilisation systématique d'un instrument diagnostic Méthodes: la prévalence de l'ESPT a été évaluée chez des patients consécutifs (N = 403) qui ont bénéficié d'une consultation par des psychiatres de l'Unité urgence-crise du Service de Psychiatrie de Liaison (PLI) du CHUV, en utilisant le module J du Mini Mental Neuropsychologic Interview (MINI 5.0.0, version CIM-10). Ce résultat a été comparé avec la prévalence de l'ESPT mentionné comme diagnostic dans les dossiers (N = 350) d'un échantillon historique. La perception des médecins-assistants de psychiatrie quant au dépistage systématique de l'ESPT avec un instrument a été étudiée en se basant sur la conduite d'un focus group d'assistants travaillant dans l'Unité urgence-crise du PLI. Résultats: Parmi les patients (N = 316) évalués à l'aide de l'instrument diagnostic, 20,3% (n = 64) réunissaient les critères de l'ESPT. Cela constitue un taux de prévalence significativement plus élevé que la prévalence d'ESPT documentée dans les dossiers de l'échantillon historique (0,57%). Par ailleurs, la prévalence de l'ESPT est significativement plus élevée parmi les groupes socio- économiques précarisés, tels que réfugiés et sans papiers (50%), patients venant d'un pays à histoire de guerre récente (47,1%), patients avec quatre (44,4%) ou trois comorbidités psychiatriques (35,3%), migrants (29,8%) et patients sans revenus professionnels (25%). Le focus groupe composé de 8 médecins-assistants a révélé que l'utilisation systématique d'un outil- diagnostic ne convenait pas dans le setting d'urgence psychiatrique, notamment parce que l'instrument a été considéré comme non adapté à une première consultation ou jugé avoir un impact négatif sur l'entretien clinique. Toutefois, après la fin de l'étude, les médecins-assistants estimaient qu'il était important de rechercher activement l'ESPT et continuaient à intégrer les éléments principaux du questionnaire dans leur travail clinique. Conclusion et perspectives: cette étude confirme que l'ESPT est largement sous-diagnostiqué dans le contexte des urgences psychiatriques, mais que l'usage systématique d'un outil diagnostic dans ce cadre ne satisfait pas les praticiens concernés. Pour améliorer la situation et au vu du fait qu'un instrument diagnostic est considéré comme non-adapté dans ce setting, il serait peut-être bénéfique d'envisager un dépistage ciblé et/ou de mettre en place une stratégie de formation institutionnelle.

Avaliação da Qualidade do Transporte Colectivo Urbano, na Cidade da Praia, e a Satisfação dos Utentes

A qualidade nas organizações de serviço tem-se tornado num tópico de muita importância, sendo reconhecida como uma variável estratégica para aumentar a sua eficácia e eficiência, ganhar vantagem competitiva e conduzir à satisfação dos seus clientes. Promover uma escala apropriada, que reflicta convenientemente as percepções e as expectativas dos clientes, deve ser uma preocupação tanto dos gestores de empresas como das agências governativas. O presente estudo empírico desenvolve e analisa uma escala de medição da qualidade de serviço, através da aplicação do modelo SERVQUAL, desenvolvido por Parasuraman et al. (1985, 1988, 1991), e adaptado para o serviço de transporte colectivo urbano de passageiros (TCUP). O procedimento levado a efeito na presente investigação apresenta 4 fases e 9 etapas, com a combinação do paradigma de Churchill (1979) e entrevistas focus group. A escala final SERVQUAL adaptada, com 23 itens, e as dimensões obtidas indicam que a mesma é altamente fiável (0,891) e válida, demonstrando assim que o procedimento seguido é aplicável e que os seus itens foram desenhados de acordo com as condições do sector. A pesquisa exploratória foi conduzida em Cabo Verde, na cidade da Praia, em Setembro de 2008, com 230 utentes regulares do serviço de TCUP. Os dados confirmam a existência de gaps, encontrando-se a maioria dos inquiridos (67%) insatisfeita com esse serviço. A análise factorial confirmou a existência de cinco dimensões, que determinam a qualidade de serviço no TCUP, na Praia, pela seguinte ordem de importância: “aparência física dos veículos/conforto”, “atenção personalizada/desempenho dos colaboradores”, “empatia”, “conveniência do serviço”, e, por último, “equipamento tangível”. Service quality has become a topic of great importance and it is recognized as a strategic variable to increase its efficiency and effectiveness in getting competitive advantage and leading to customer satisfaction. To seek a proper scale that can reflect perceptions and customers’ expectations accurately should be a concern for business managers as well as government agencies. Present empirical study develops and analyzes a measurement scale of quality service, through the application of SERVQUAL model developed by Parasuraman et al. (1985, 1988, 1991) and adapted for the urban passenger transportation. The procedure followed in present research indicates four phases and nine steps in connection to Churchill paradigm (1979) and focus group interview. The adapted final SERVQUAL scale, with 23 items, and the dimensions obtained indicated that it is highly reliable (0.891) and valid, showing this way that the procedure followed is applicable and their items were drawn according to the sector conditions. This exploratory research was performed in Cape Verde, at Praia in September 2008 with 230 regular’s users of bus service. The data confirms the existence of gaps and that the majority of the inquired are not pleased (67%) with their bus service. The factorial analysis confirms the existence of five dimensions, which determines the service quality in the bus service at Praia according to the following order of importance : “physical appearance of the bus/confort”, “personalized attention/results from the collaborators”, “empathy”, “service convenience” and lastly “tangible equipment”.

Caring for family caregivers: An analysis of a family-centered intervention

Objective To assess the effectiveness of Problem-Solving Therapy (PST) on family caregivers through the use of scales to measure anxiety, depression and emotional distress; and to explore facilitating factors and obstacles for its use based on the narrative of nurses. Method A clinical trial and an exploratory focus group with the use of mixed analysis methodology. The study was conducted in a primary health care center in Tarragona, Spain, and the sample consisted of 122 family caregivers who were included in the home care service, and 10 nurses who participated in the intervention group. Family caregivers with evident symptoms of anxiety, depression and emotional distress received PST in the intervention group. The intervention group also consisted of a discussion with eight nurses, which was transcribed and submitted to content analysis. Conclusion Problem-Solving Therapy proved to be effective in reducing perceived anxiety, depression and emotional distress. We identified its strong points and obstacles as described by nurses.



Analysis of the process of translation of knowledge regarding early childhood at the undergraduate level

Objective To analyze innovative contents on Early Child Development Promotion. Method This action-research involves nine faculties from four Higher Education Institutions at inner-state of São Paulo, Brazil.Data were collected by syllabi analyses (2009-2011), interviews and focus group. We have adopted an ECDP underpinning from international consensus, thus evaluating KT Results We have found relevant incorporation between teaching and extension in Nursing (87,5%) and Psychology (75%) undergraduate courses, while Pedagogy was restricted to teaching. Conclusion This KT evaluation has evinced innovative potential of extension, regardless teaching and research, for a better Early Childhood.


Unwanted sexual experiences among adolescents: shedding light on the gray zone between consensual and non-consensual sex.

This study aimed at exploring adolescents' perceptions of unwanted sexual experiences (USE) in order to set up definitions, categories, and boundaries on the continuum between consensual and non-consensual sex. METHODS: We conducted a qualitative thematic analysis of four focus group discussions gathering a total of 29 male and female adolescents aged 16-20 years. RESULTS: Analysis of participants' discourse revealed three main characteristics that define USE, namely, regret, as most situations discussed were said to be acceptable or not in terms of whether there were regrets after the fact; misperception of sexual intent; and lack of communication between partners. CONCLUSIONS: Our findings revealed that health professionals should be aware of the subtle aspects identifying USE when screening for situations that can have adverse psychological consequences. Where prevention is concerned, it appears important to address these aspects of USE in sex education classes.

Avaliação da qualidade do Transporte Colectivo Urbano na Cidade da Praia e a Satisfação dos Utentes

A qualidade nas organizações de serviço tem-se tornado num tópico de muita importância, sendo reconhecida como uma variável estratégica para aumentar a sua eficácia e eficiência, ganhar vantagem competitiva e conduzir à satisfação dos seus clientes. Promover uma escala apropriada, que reflicta convenientemente as percepções e as expectativas dos clientes, deve ser uma preocupação tanto dos gestores de empresas como das agências governativas. O presente estudo empírico desenvolve e analisa uma escala de medição da qualidade de serviço, através da aplicação do modelo SERVQUAL, desenvolvido por Parasuraman et al. (1985, 1988, 1991), e adaptado para o serviço de transporte colectivo urbano de passageiros (TCUP). O procedimento levado a efeito na presente investigação apresenta 4 fases e 9 etapas, com a combinação do paradigma de Churchill (1979) e entrevistas focus group. A escala final SERVQUAL adaptada, com 23 itens, e as dimensões obtidas indicam que a mesma é altamente fiável (0,891) e válida, demonstrando assim que o procedimento seguido é aplicável e que os seus itens foram desenhados de acordo com as condições do sector. A pesquisa exploratória foi conduzida em Cabo Verde, na cidade da Praia, em Setembro de 2008, com 230 utentes regulares do serviço de TCUP. Os dados confirmam a existência de gaps, encontrando-se a maioria dos inquiridos (67%) insatisfeita com esse serviço. A análise factorial confirmou a existência de cinco dimensões, que determinam a qualidade de serviço no TCUP, na Praia, pela seguinte ordem de importância: “aparência física dos veículos/conforto”, “atenção personalizada/desempenho dos colaboradores”, “empatia”, “conveniência do serviço”, e, por último, “equipamento tangível”.

Campo Musical Cabo-verdiano da Area Metropolitana de Lisboa Protoganistas, Identidades e Musica Imigrante

Portugal é um país que acolhe, desde a década de 60 do século pretérito, uma das mais expressivas comunidades africanas – a cabo-verdiana –, cuja característica saliente é marcada, designadamente, pela presença de uma significativa e dinâmica cultura transnacional. A música, através dos seus mais variados géneros e formas, representa seguramente a dimensão mais importante desta diversificada população imigrante, juntamente com a língua cabo-verdiana. Daí o interesse no conhecimento, tanto quanto possível aprofundado, da realidade musical cabo-verdiana em contexto imigratório, a partir de um olhar atento sobre o chamado campo musical, ancorado particularmente na Área Metropolitana de Lisboa (AML). Interessada em caracterizar, nos seus aspectos essenciais, o campo da música migrante cabo-verdiana na Área Metropolitana de Lisboa, esta investigação propõe-se descrever e analisar o funcionamento do campo da música migrante cabo-verdiana, observando a sua configuração, tanto no plano estrutural das relações sociais no seu interior e com o seu exterior, das trajectórias, práticas e perfis sociográficos dos músicos, como no plano simbólico/cultural das representações, identidades, representações e culturas profissionais, com base numa amostra de 102 casos, à qual foi aplicado um inquérito por questionário, para além de métodos qualitativos, designadamente a entrevista em profundidade e o focus group, de forma combinada e de acordo com o princípio da triangulação metodológica.

Improving Transition Outcomes: Henry County Transition Partners: Youth Interview Invitation

Henry County's Transition Partners' youth focus group interview invitation.

Improving Transition Outcomes: Henry County Transition Partners: Teacher Interview Invitation

Henry County's Transition Partners' focus group invitation specifically for teachers.

Reliability of the image evaluation system PGMI

Purpose: Many countries used the PGMI (P=perfect, G=good, M=moderate, I=inadequate) classification system for assessing the quality of mammograms. Limits inherent to the subjectivity of this classification have been shown. Prior to introducing this system in Switzerland, we wanted to better understand the origin of this subjectivity in order to minimize it. Our study aimed at identifying the main determinants of the variability of the PGMI system and which criteria are the most subjected to subjectivity. Methods and Materials: A focus group composed of 2 experienced radiographers and 2 radiologists specified each PGMI criterion. Ten raters (6 radiographers and 4 radiologists) evaluated twice a panel of 40 randomly selected mammograms (20 analogic and 20 digital) according to these specified PGMI criteria. The PGMI classification was assessed and the intra- and inter-rater reliability was tested for each professional group (radiographer vs radiologist), image technology (analogic vs digital) and PGMI criterion. Results: Some 3,200 images were assessed. The intra-rater reliability appears to be weak, particularly in respect to inter-rater variability. Subjectivity appears to be largely independent of the professional group and image technology. Aspects of the PGMI classification criteria most subjected to variability were identified. Conclusion: Post-test discussions enabled to specify more precisely some criteria. This should reduce subjectivity when applying the PGMI classification system. A concomitant, important effort in training radiographers is also necessary.

Campagne cardiovasculaire 2013-2016 du CIPRET Valais : évaluation de la campagne 2013-2014

Le Cipret-Valais, la Société Médicale du Valais (SMV), Pharmavalais et Promotion Santé Valais, ont lancé en 2013 une campagne de sensibilisation sur l'impact du tabac sur les maladies cardiovasculaires (MCV). Cette campagne, qui sera déclinée sur trois ans (2013-2016), informe et sensibilise la population sur les liens existant entre le tabagisme et les MCV. La campagne suit différents axes : sensibiliser les fumeurs de plus de 40 ans aux conséquences du tabagisme sur leur risque de MCV, les encourager à contrôler leur pression artérielle (en pharmacie) et les inciter à prendre les mesures nécessaires à la réduction de leur risque de MCV. Dans une seconde phase, les fumeurs seront guidés dans leur démarche d'arrêt, avec des offres de désaccoutumance. Cette évaluation, qui concerne la première partie de la campagne (novembre 2013 et mars 2014), a pour but d'apporter un complément qualitatif aux données quantitatives récoltées au cours de la campagne (valeurs de tension artérielle (TA)). Des entretiens ont ainsi été menés avec le responsable du Cipret-Valais (A. Dubuis) et le président du Cipret-Valais, également responsable de la SMV pour cette campagne (Dr. D. Evéquoz). Un focus-group avec un échantillon de pharmacien était également prévu. N'ayant pu avoir lieu du fait d'une participation trop faible, il a été remplacé par des entretiens téléphoniques. Pour la partie quantitative de l'évaluation, les données sur les prises de TA en pharmacie ont été fournies par le Cipret-Valais et Pharmavalais, et celles sur la fréquentation du site internet par Cipret-Valais.

CRISIS DE LA SANIDAD: EL BIENESTAR LABORAL DE LOS PROFESIONALES DE LA MEDICINA DESDE LA PSICOLOGÍA SOCIAL DEL TRABAJO.

Los cambios en el mundo del trabajo fruto de mega tendencias globalizadoras y postfordistas, han producido profundos procesos de modernización en la sanidad latinoamericana y española, que han supuesto transformaciones en la organización del trabajo y en el sentido del servicio público. La irrupción del New Management en la sanidad ha conllevado importantes cambios en las condiciones de trabajo. Estas circunstancias sumadas a la relevancia sociopolítica de crisis del Estado de Bienestar y de sus derivadas en América Latina, indujeron al planteamiento de la pregunta principal de esta investigación: ¿Cómo las nuevas condiciones de trabajo impuestas por el new management sanitario influyen en el bienestar laboral de los profesionales de la medicina?. Participaron (voluntariamente) 281 profesionales de la medicina de España (47,7%) y de América Latina (52,3%), empleados en hospitales, a quienes se accedió mediante un muestreo de conveniencia, intencional y estratificado. Para ello, se articuló un diseño mixto que combinó tanto metodología cualitativa (entrevistas en profundidad y focus group – análisis de contenido temático inspirado en grounded theory) como cuantitativa (cuestionarios de lápiz y papel – estadística inferencial. Los resultados pusieron de manifiesto la tendencia general a una valoración moderadamente positiva de las condiciones de trabajo y del bienestar laboral general, contrapesada por sentimientos y percepciones ambivalentes hacia el contexto y la propia experiencia laboral. Destacó una valoración de los aspectos materiales y tecnológicos del entorno de trabajo, así como el clima social en los grupos de trabajo y el apoyo social horizontal de parte de colegas. En la negativa sobresalió un complejo entramado de sobrecarga laboral y de intensificación y aceleración del tiempo de trabajo, crecientes niveles percibidos de estrés laboral y algunos síntomas menores relacionados con la salud física y mental, todo ello asociado al aumento percibido de la presión asistencial y de los nuevos requerimientos técnicos y administrativos de la información que los profesionales deben producir y gestionar.

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.

Acceptance of inflammatory bowel disease treatment recommendations based on appropriateness ratings : do practicing gastroenterologists agree with experts?

BACKGROUND: Appropriateness criteria for the treatment of Crohn's disease (CD) and ulcerative colitis (UC) have been developed by experts' panels. Little is known about the acceptance of such recommendations by care providers. The aim was to explore how treatment decisions of practicing gastroenterologists differ from experts using a vignette case study and a focus group. METHODS: Seventeen clinical vignettes were drawn from clinical indications evaluated by the expert panel. A vignette case questionnaire asking for treatment options in 9-10 clinical situations was submitted to 26 practicing gastroenterologists. For each vignette case, practitioners' answers on treatments deemed appropriate were compared to panel decisions. Qualitative analysis was made based on focus group discussion to explore acceptance and divergence reasons. RESULTS: 239 clinical vignettes were completed, 98 for CD and 141 for UC. Divergence between proposed treatments and results from panels was more frequent for CD (34%) than for UC (27%). Among UC clinical vignettes, the main divergences with the panel were linked to 5-ASA failure assessment and to situations where stopping treatment was the main decision. For CD, the care provider propositions diverged with the panel in mild-to-moderate active disease, where practitioners were more prone to an accelerated step up than the panel's recommendations. CONCLUSIONS: In about one third of vignettes cases, IBD treatment propositions made by practicing gastroenterologists diverged as compared to expert recommendations. Practicing gastroenterologists may experience difficulties in applying recommendations in daily practice.