Post-Traumatic Stress Disorder (PTSD) and Its relationship with perinatal bereavement: definitions, reactions, adjustments, and grief.

A small percentage of women present with diagnosed PTSD post childbirth; however, though this an area of increasing research and clinical interest generally, little is known about PTSD in relation to perinatal bereavement. Health professionals must however be aware of the mechanisms and models of loss following perinatal bereavement in order to identify potential mental health phenomena which may be implicated in the development of PTSD symptomology. Understanding the predictive factors which may give early warning signs is an important component of the clinical evidence base. This chapter discusses mechanisms, models, and risk factors in relation to perinatal bereavement and the development of PTSD.

The Effects of Age, Ethnicity, Sexual Dysfunction, Urinary Incontinence, Masculinity, and Relationship with the Partner on the Quality of Life of Men with Prostate Cancer

Prostate cancer, the leading cause of cancer in men, has positive survival rates and constitutes a challenge to men with its side effects. Studies have addressed the bivaritate relationships between prostate cancer treatment side effects masculinity, partner relationship, and quality of life (QOL). However, few studies have highlighted the relationships among prostate cancer treatment side effects (i.e., sexual dysfunction, urinary incontinence), masculinity, and relationship with the partner together on QOL in men. Most studies were conducted with predominately Caucasian sample of men. Miami is a unique multiethnic setting that hosts Cuban, Columbian, Venezuelan, Haitian, other Latin American and Caribbean communities that were not represented in previous literature. The purpose of this study was to examine relative contributions of age, ethnicity, sexual dysfunction, urinary incontinence, masculinity, and perception of the relationship with the partner on the quality of life in men diagnosed with prostate cancer. Data were collected using self administered questionnaires measuring demographic variables, sexual and urinary functioning (UCLA PCI), masculinity (CMNI), partner relationship (DAS), and QOL (SF-36). A total of 117 partnered heterosexual men diagnosed with prostate cancer were recruited from four urology clinics in Miami, Florida. Men were 67.47 (SD = 8.42) years old and identified themselves to be of Hispanic origin (54.3 %, n = 63). Findings demonstrated that there was a significant moderate negative relationship between urinary and sexual functioning of men. There was a significant strong negative association between men’s perceived relationship with partner and masculinity. There was a weak negative relationship between the partner relationship and QOL. Hierarchal multiple regression showed that the partner relationship (β = -.25, t (91) = -2.28, p = .03) significantly contributed overall to QOL. These findings highlight the importance of the relationship satisfaction in the QOL of men with prostate cancer. Nursing interventions to enhance QOL for these men should consider strengthening the relationship and involving the female partner as an active participant.

The human gut microbiome in disease: Role in chemotherapy treatments and relationship with clinical outcomes

The gut microbiome (GM) is a plastic entity, capable of adapting in response to intrinsic and extrinsic factors. However, several circumstances can disrupt this homeostatic balance, forcing the GM to shift from a health-associated mutualistic configuration to a disease-associated profile. Nowadays, a new frontier of microbiome research is understanding the GM role in chemo-immunotherapies and clinical outcomes. Here, the role of the genotoxin‐producing pathogen Salmonella in colorectal carcinogenesis was characterized by in-vitro models. A synergistic effect of Salmonella and the CRC-associated mutation (APC gene) promoted a tumorigenic microenvironment by increasing cellular genomic instability. Subsequently, the GM involvement in anti-cancer therapies was investigated via next-generation sequencing in different patient cohorts. The GM trajectory during treatments was characterized for women with epithelial ovarian cancer and pediatric patients undergoing hematopoietic stem cell transplantation (HSCT). The results highlighted the loss of GM homeostasis, with diversity reduction, decrease in health-associated microorganisms and pathobiont bloom. Interestingly, a distinctive GM profile was identified in ovarian cancer patients with a poor response to chemotherapy compared to patients in remission. Moreover, maintenance of GM homeostasis through enteral feeding in pediatric HSCT patients highlighted a better prognosis, with reduced risk of clinical complications. In this context, the gut resistome – the pattern of GM antibiotic-resistance genes (ARGs) – was evaluated longitudinally in HSCT patients. The results showed new acquisitions and consolidation of ARGs already present in patients developing clinical complications. Antibiotic exposure was also evaluated in infants under low-dose antibiotic prophylaxis for vesico-ureteral reflux showing an impairment of the GM configuration with possible long-term health implications. Dramatic GM dysbiosis was finally observed in critically ill patients with COVID-19 (undergoing multiple drug therapies) and correlated with increased risk of bloodstream infection. All these findings pointed out the importance of maintaining GM homeostasis during chemotherapy treatments for improving patients’ clinical outcomes.

Mode-I fracture parameters of quasi-brittle materials: direct evaluation using DIC and relationship with Mode-II interfacial parameters

The objective of this thesis is the investigation of the Mode-I fracture mechanics parameters of quasi-brittle materials to shed light onto the influence of the width and size of the specimen on the fracture response of notched beams. To further the knowledge on the fracture process, 3D digital image correlation (DIC) was employed. A new method is proposed to determine experimentally the critical value of the crack opening, which is then used to determine the size of the fracture process zone (FPZ). In addition, the Mode-I fracture mechanics parameters are compared with the Mode-II interfacial properties of composites materials that feature as matrices the quasi-brittle materials studied in Mode-I conditions. To investigate the Mode II fracture parameters, single-lap direct shear tests are performed. Notched concrete beams with six cross-sections has been tested using a three-point bending (TPB) test set-up (Mode-I fracture mechanics). Two depths and three widths of the beam are considered. In addition to concrete beams, alkali-activated mortar beams (AAMs) that differ by the type and size of the aggregates have been tested using the same TPB set-up. Two dimensions of AAMs are considered. The load-deflection response obtained from DIC is compared with the load-deflection response obtained from the readings of two linear variable displacement transformers (LVDT). Load responses, peak loads, strain profiles along the ligament from DIC, fracture energy and failure modes of TPB tests are discussed. The Mode-II problem is investigated by testing steel reinforced grout (SRG) composites bonded to masonry and concrete elements under single-lap direct shear tests. Two types of anchorage systems are proposed for SRG reinforced masonry and concrete element to study their effectiveness. An indirect method is proposed to find the interfacial properties, compare them with the Mode-I fracture properties of the matrix and to model the effect of the anchorage.

Esimiehen ydinkompetenssit tuloksen ja työtyytyväisyyden selittäjänä – Case S-market

Työn tarkoituksena on kehittää suorittavalle esimiestasolle työkalu, millä voidaan mitata esimiehen kompetensseja. S-market esimiehen ydinosaamiset työssä jakautuvat kahteen kokonaisuuteen vuorovaikutus- ja ketjuyksikön johtamiseen. Työn tavoitteena on myös tarkastella millä esimiehen ydinosaamisella on merkitystä työtyytyväisyyteen ja yrityksen tulokseen. Tutkimus on kvantitatiivinen ja sen aineisto on verkkokyselylomakkeen avulla kerätystä 129 vastauksesta. Verkkokyselylomakkeen väittämät ovat rakennettu esimiestyön kompetensseista, jotka pohjautuvat tutkielman teoriaan. Verkkokyselyn, työtyytyväisyyden ja tuloksen lukuarvot on analysoitu tilastollisella tulostenkäsittelyohjelmalla, SPSS:llä. Työtyytyväisyystulokset ovat koottu tutkimukseen osallistuneen viidentoista S-marketin työtyytyväisyystutkimuksen tuloksista vuodelta 2008. Tuloksen mittareina tutkielmassa on käytetty samojen S-markettien työtehokkuutta ja toimintakateprosenttia vuodelta 2008. Työn tulokset vahvistivat sen, että esimiestyöllä on suora syy-seuraussuhde työtyytyväisyyteen ja tuloksellisuuteen. Tutkimustuloksien perusteella esimieskäyttämisen vaikutus työtyytyväisyyden kokemiseen on vahva. Hyvällä vuorovaikutusjohtamisella tuloksien perusteella oli vaikutusta työtyytyväisyyteen. Tuloksista kävi ilmi, että työtyytyväisyyteen esimiehen kompetensseista eniten vaikuttivat yksilöllinen huomiointi, tavoitteisiin kannustaminen ja motivointi sekä asiakaslähtöisyys. Tuloksen mittareihin eniten vaikutti tulos- ja tavoitejohtaminen. Tuloksellisuuteen vaikuttavat tutkimuksen mukaan esimiehen jämäkkä ja vaativa tavoitteisiin ohjaava toiminta sekä päätöksenteko ja organisointikyky. Tarkempien ja täsmällisimpien S-market esimiehen kompetenssien löytämiseksi kehitysehdotuksena tutkielmassa on laajemman tutkimusaineiston käsittely neljän faktorin avulla.

Rapport au travail, mobilité professionnelle et parcours de vie : le cas de jeunes infirmières et infirmières auxiliaires d'un centre de santé et de services sociaux

Cette thèse de doctorat, qui s’inscrit dans un programme de doctorat en sciences humaines appliquées, s’est d’abord construite en réponse à un problème concret, celui du roulement des infirmières et des infirmières auxiliaires dans le réseau de la santé et des services sociaux. En cours de route, il est toutefois apparu nécessaire d’élargir le questionnement à la question du rapport au travail des jeunes infirmières pour être en mesure de saisir les dynamiques sociales plus larges qui conditionnent certains choix professionnels, dont la décision de quitter son emploi. Cette thèse poursuit donc deux grands objectifs. D’une part, elle s’attarde à cerner l’ensemble des processus qui conduisent les jeunes infirmières à faire le choix de quitter leur emploi. D’autre part, elle vise à mieux comprendre comment a évolué leur rapport au travail dans le temps. La perspective théorique retenue s’appuie sur deux approches complémentaires, soit celles de la perspective des parcours de vie et de divers courants en sociologie de l’individu qui ont comme point commun d’accorder une place importante au contexte social, aux contraintes structurelles, de même qu’à l’autonomie des acteurs et à leur capacité d’agir sur leur parcours de vie. Ces approches s’avèrent particulièrement pertinentes dans le cadre de notre étude puisqu’elles permettent de rendre compte des liens complexes entre le contexte social plus global, les différents contextes de vie d’un individu et ses comportements en emploi. Elles invitent à conceptualiser le rapport au travail comme un processus qui évolue dans le temps à travers lequel plusieurs éléments de la vie d’un individu et de ses proches se combinent pour donner une orientation particulière aux trajectoires professionnelles. Vu sous cet angle, la décision de quitter se présente également comme un processus qui se construit dans un laps de temps plus ou moins long où entrent en jeu plusieurs dimensions de la vie d’un individu. La perspective adoptée dans le cadre de cette thèse permet de combler des lacunes dans ce champ de recherche où peu d’études se sont attardées à comprendre les différents processus qui façonnent le rapport au travail dans le temps et qui conduisent les infirmières à la décision de quitter leur emploi. Pour répondre aux objectifs de recherche, une étude qualitative a été menée. Des entrevues individuelles de type récit de vie ont été effectuées pour comprendre, du point de vue des participantes, comment a évolué leur rapport au travail et les processus qui les ont amenées à quitter leur emploi. Une étude de cas a été effectuée dans un centre de santé et de services sociaux de la province de Québec qui affichait un taux de roulement particulièrement élevé. L’étude visait les infirmières et les infirmières auxiliaires, groupe professionnel fortement touché par le roulement de la main-d’œuvre. Des entretiens en profondeur, d’une durée de 2h30 à 3 heures, ont été réalisées auprès de 42 infirmières et infirmières auxiliaires. Les résultats de la recherche sont présentés à travers la production de trois articles scientifiques. Le premier article, Pour une compréhension dynamique du rapport au travail: la valeur heuristique de la perspective des parcours de vie, a pour objectif de faire ressortir l’intérêt que présentent les principes analytiques associés à cette perspective dans l’étude du rapport au travail. Dans cet article, nous démontrons que le rapport au travail est le résultat d’un processus complexe où les aspirations des individus, leurs conditions concrètes d’emploi et les événements qui surviennent dans leur vie personnelle et familiale entretiennent des liens dynamiques et interdépendants qui façonnent le rapport au travail tout au long de la vie. Cet article apporte des éléments de réflexion à la question posée par plusieurs chercheurs : par quel moyen saisir ce qu’il en est du rapport au travail des jeunes? Le deuxième article, Rencontre entre l’idéaltype de travailleur et l’idéal de travail : le cas de jeunes infirmières en début de vie professionnelle, vise à rendre compte de la manière dont s’est faite la rencontre entre les attentes que les infirmières nourrissent à l’égard du travail et leur réalité concrète de travail à une période précise de leur trajectoire professionnelle, soit celle de leur insertion en emploi et des premières années de pratique. L’article démontre que trois dimensions du rapport au travail sont affectées par les nouvelles normes managériales qui prévalent dans le réseau de la santé et des services sociaux : 1) la place souhaitée du travail dans la vie, 2) la réalisation de soi par le travail et 3) le sens au travail. Cet article apporte une contribution dans la compréhension du rapport au travail de jeunes professionnelles qui exercent un métier de relation d’aide dans le contexte spécifique du réseau québécois de la santé et des services sociaux. Le troisième article, Comprendre le roulement comme un processus lié au cycle de la vie : le cas des infirmières, traite plus spécifiquement de la question du roulement de la main d’œuvre infirmière. Quatre parcours de départs sont présentés qui possèdent des caractéristiques distinctes relatives à la rencontre entre les attentes et la réalité concrète de travail, l’interaction entre le travail et la vie hors travail et la manière dont s’est construite dans le temps la décision de quitter son emploi. Les résultats démontrent que la décision de quitter se présente comme un processus qui se construit dans un laps de temps plus ou moins long, qui implique différentes dimensions de la vie d’un individu et qui est intimement lié à la quête de réalisation de soi au travail et dans les autres domaines de la vie. Cet article propose une façon d’appréhender le phénomène du roulement qui se distingue des modèles dominants qui abordent cette question à partir d’une lecture essentiellement individualisante et psychologisante des départs. La contribution de cette thèse à l’avancement des connaissances réside principalement dans le fait qu’elle appréhende autrement la question du rapport au travail et celle du roulement de la main-d’œuvre en recourant à la perspective des parcours de vie et à la sociologie de l’individu. L’approche que nous avons préconisée permet de saisir les processus sociaux et la multiplicité des éléments à prendre en considération dans l’étude du rapport au travail des jeunes infirmières et de la décision de quitter son emploi. Elle met en exergue l’importance de considérer le contexte social plus global dans lequel s’inscrit tout individu qui, dans les sociétés contemporaines, doit s’engager dans un travail de construction identitaire tout au long de la vie.

Saúde mental e trabalho: significados atribuídos pela equipe da saúde da família ao adoecimento dos usuários

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Agentes sociales : trayectorias, estrategias, capitales

Este artículo centra su indagación en las estrategias ocupacionales y las trayectorias vitales y laborales de hogares urbanos en situaciones de pobreza histórica del Gran Mendoza, desde la crisis argentina del 2001 al 2008. El propósito central consiste en analizar la asociación existente entre las trayectorias laborales, las estrategias desplegadas y las trayectorias vitales de los hogares en momentos de crisis que afectan las relaciones de los agentes sociales con el trabajo.

Relationship of health workers with their organization and work: a cross-cultural study

ABSTRACT We analyzed the differences, by Student’s t-test and ANOVA, between nurses and physicians from Portugal, Poland, Spain, and United Kingdom regarding their relationship with their work and organization. In total, 1,401 professionals answered the HSA-QHPR questionnaire. There are different levels of connection between physicians and nurses. The United Kingdom has the lowest levels of connection with the work while Portugal has the highest levels of relationship with the organization. The results provide guidelines for the development of policies and differential strategies aimed at improving the quality of healthcare service.

The relationship between lymphatic vascular density and vascular endothelial growth factor A (VEGF-A) expression with clinical-pathological features and survival in pancreatic adenocarcinomas

Abstract: Background Pancreatic cancer is a rare tumor with an extremely low survival rate. Its known risk factors include the chronic use of tobacco and excessive alcohol consumption and the presence of chronic inflammatory diseases, such as pancreatitis and type 2 diabetes. Angiogenesis and lymphangiogenesis, which have been the focus of recent research, are considered prognostic factors for cancer development. Knowing the angiogenic and lymphangiogenic profiles of a tumor may provide new insights for designing treatments according to the different properties of the tumor. The aim of this study was to evaluate the density of blood and lymphatic vessels, and the expression of VEGF-A, in pancreatic adenocarcinomas, as well as the relationship between blood and lymphatic vascular density and the prognostically important clinical-pathological features of pancreatic tumors. Methods Paraffin blocks containing tumor samples from 100 patients who were diagnosed with pancreatic cancer between 1990 and 2010 were used to construct a tissue microarray. VEGF expression was assessed in these samples by immunohistochemistry. To assess the lymphatic and vascular properties of the tumors, 63 cases that contained sufficient material were sectioned routinely. The sections were then stained with the D2-40 antibody to identify the lymphatic vessels and with a CD34 antibody to identify the blood vessels. The vessels were counted individually with the Leica Application Suite v4 program. All statistical analyses were performed using SPSS 18.0 (Chicago, IL, USA) software, and p values ≤ 0.05 were considered significant. Results In the Cox regression analysis, advanced age (p=0.03) and a history of type 2 diabetes (p=0.014) or chronic pancreatitis (p=0.02) were shown to be prognostic factors for pancreatic cancer. Blood vessel density (BVD) had no relationship with clinical-pathological features or death. Lymphatic vessel density (LVD) was inversely correlated with death (p=0.002), and by Kaplan-Meyer survival analysis, we found a significant association between low LVD (p=0.021), VEGF expression (p=0.023) and low patient survival. Conclusions Pancreatic carcinogenesis is related to a history of chronic inflammatory processes, such as type 2 diabetes and chronic pancreatitis. In pancreatic cancer development, lymphangiogenesis can be considered an early event that enables the dissemination of metastases. VEGF expression and low LVD can be considered as poor prognostic factors as tumors with this profile are fast growing and highly aggressive. Virtual slides. The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/5113892881028514

Career and work-family relationship among academics : An exploratory study

Despite the increase, in recent years, of women’s participation in the labour market, sex discrimination remains a reality in most work organisations. In this matter, academic organisations are no exception. Evidence of sex inequalities is well documented in the literature. At the individual level, inequalities are partly explained by family responsibilities mainly held by women. Having to spend a considerable amount of time in home and children related activities women are left with less time available for scientific work than their male colleagues. With the purpose of understanding how academics experience the relationship between work and family, 32 in-depth interviews were conducted among Portuguese academics of both sexes in one particular university. The findings confirmed that work-family conflict is stronger among female faculty than among their male counterparts. Additionally, the prejudice against maternity and the way it is compatible with a successful career appears to survive the new gender relations. Difficulties felt by female academics could be minimised by the introduction of «family-friendly» policies and the development of a positive organisational climate towards maternity and family issues.

Relationship of autonomic imbalance and circadian disruption with obesity and type 2 diabetes in resistant hypertensive patients

Background: Hypertension, diabetes and obesity are not isolated findings, but a series of interacting interactive physiologic derangements. Taking into account genetic background and lifestyle behavior, AI (autonomic imbalance) could be a common root for RHTN (resistant hypertension) or RHTN plus type 2 diabetes (T2D) comorbidity development. Moreover, circadian disruption can lead to metabolic and vasomotor impairments such as obesity, insulin resistance and resistant hypertension. In order to better understand the triggered emergence of obesity and T2D comorbidity in resistant hypertension, we investigated the pattern of autonomic activity in the circadian rhythm in RHTN with and without type 2 diabetes (T2D), and its relationship with serum adiponectin concentration. Methods: Twenty five RHTN patients (15 non-T2D and 10 T2D, 15 males, 10 females; age range 34 to 70 years) were evaluated using the following parameters: BMI (body mass index), biochemical analysis, serum adiponectinemia, echocardiogram and ambulatory electrocardiograph heart rate variability (HRV) in time and frequency domains stratified into three periods: 24 hour, day time and night time. Results: Both groups demonstrated similar characteristics despite of the laboratory analysis concerning T2D like fasting glucose, HbA1c levels and hypertriglyceridemia. Both groups also revealed disruption of the circadian rhythm: inverted sympathetic and parasympathetic tones during day (parasympathetic > sympathetic tone) and night periods (sympathetic > parasympathetic tone). T2D group had increased BMI and serum triglyceride levels (mean 33.7 +/- 4.0 vs 26.6 +/- 3.7 kg/m(2) - p = 0.00; 254.8 +/- 226.4 vs 108.6 +/- 48.7 mg/dL - p = 0.04), lower levels of adiponectin (6729.7 +/- 3381.5 vs 10911.5 +/- 5554.0 ng/mL - p = 0.04) and greater autonomic imbalance evaluated by HRV parameters in time domain compared to non-T2D RHTN patients. Total patients had HRV correlated positively with serum adiponectin (r = 0.37 [95% CI - 0.04 - 1.00] p = 0.03), negatively with HbA1c levels (r = -0.58 [95% CI -1.00 - -0.3] p = 0.00) and also adiponectin correlated negatively with HbA1c levels (r = -0.40 [95% CI -1.00 - -0.07] p = 0.02). Conclusion: Type 2 diabetes comorbidity is associated with greater autonomic imbalance, lower adiponectin levels and greater BMI in RHTN patients. Similar circadian disruption was also found in both groups indicating the importance of lifestyle behavior in the genesis of RHTN.

How to teach mathematics with MOODLE

The aim of this article is to present a Project in the Oporto’s Institute of Accounting and Administration, which pretends to contribute for a change in the way of teaching and learning Mathematics. One of the main objectives of this project is to innovate the teaching and learning processes, exploring technologies as a pedagogical resource and to induce higher motivation to students, improve the rate of success and make available to students a set of materials adapted to their needs. This concern is justified due to the fact that students have a weak preparation, without consolidated basis. Since the year 2007/2008 the courses were adjusted to the Bologna process, which requires several changes in teacher’s and student’s roles, methodologies and assessment. The number of weekly classes has been reduced, so it was necessary to develop new strategies and methodologies to support the student. With the implementation of the Bologna Process in the Accounting degree, we felt a great need to provide other types of activities to students. To complement our theoretical and practical classes we have developed a project called MatActiva based on the Moodle platform offered by PAOL - Projecto de Apoio On-Line (Online Support Project). Moodle allows us to use the language TEX to create materials that use mathematical symbols. Using this functionality, we created a set of easy to use interactive resources. In MatActiva project, the students have access to a variety of different materials. We have followed a strategy that makes the project compatible with the theoretical and practical subjects/classes, complementing them. To do so, we created some resources, for instance multiple-choice tests, which are the most accessed by the students. These tests can be realized and corrected on-line and for each wrong answer there is a feedback with the resolution. We can find other types of resources: diagnostic tests, theoretical notes. There are not only the pre-requirements for subjects mathematics, but also materials to help students follow up the programs. We also developed several lessons. This activity consists of a number of pages, where each page has contents and leads to other pages, based on the student's progress. The teacher creates the choices and determines the next page that the student will see, based upon their knowledge. There is also an area of doubts, where the students can place all the mathematical doubts they have, and a teacher gives the answers or clues to help them in their work. MatActiva also offers an area where we can find some humour, curiosities, contests and games including mathematical contents to test the math skills, as well as links to pages about mathematical contents that could be useful for the study. Since ISCAP receives ERASMUS students and some of them attend mathematics, we developed some materials in English, so they can also use MatActiva. The main objectives of our project are not only to bring success in the subjects of mathematics, but also to motivate the students, encourage them to overcome theirs difficulties through an auto-study giving them more confidence and improve their relationship with the mathematics as well as the communication between students and teachers and among students.