Agents anti-infectieux et fonction réna!e: vers des posologies sur mesure [Antimicrobial agents and renal elimination: towards individual dosage adjustment?].

The efficacy and safety of anti-infective treatments are associated with the drug blood concentration profile, which is directly correlated with a dosing adjustment to the individual patient's condition. Dosing adjustments to the renal function recommended in reference books are often imprecise and infrequently applied in clinical practice. The recent generalisation of the KDOQI (Kidney Disease Outcome Quality Initiative) staging of chronically impaired renal function represents an opportunity to review and refine the dosing recommendations in patients with renal insufficiency. The literature has been reviewed and compared to a predictive model of the fraction of drug cleared by the kidney based on the Dettli's principle. Revised drug dosing recommendations integrating these predictive parameters are proposed.

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

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

La Inteligencia y la seguridad emocional: el caso de la adaptación de los preadolescentes en la escuela

Resumen Las investigaciones desarrolladas hasta ahora muestran que hay una relación entre la capacidad de las personas de rendir efectivamente y sus niveles de seguridad e inteligencia emocional. Los adolescentes deben adaptarse a la escuela, y su inteligencia y seguridad emocional pueden ser factores determinantes en su rendimiento. Por ello, este estudio investiga la relación entre la inteligencia emocional y la inseguridad de los preadolescentes, así como su relación con su adaptación a la escuela. Participaron una muestra de 243 preadolescentes de entre 11 y 13 años, y sus tutores escolares. Los participantes contestaron un grupo de cuestionarios que informan sobre las variables de estudio. Los resultados muestran varias relaciones entre dimensiones de la inseguridad emocional y del la inteligencia emocional. También muestran la capacidad de la inseguridad y de la inteligencia emocional de predecir el ajuste interno y externo de los preadolescentes. No se encontraron efectos de la interacción de las dos variables, pero en cambio, se puede afirmar que la inseguridad juega un papel mediador entre la inteligencia emocional y los problemas de ajuste interno de los niños a la escuela.

The assessment of spirituality and religiousness in schizophrenia.

To assess religious coping in schizophrenia, we developed and tested a clinical grid, as no validated questionnaire exists for this population. One hundred fifteen outpatients were interviewed. Results obtained by 2 clinicians were compared. Religion was central in the lives of 45% of patients, 60% used religion extensively to cope with their illness. Religion is a multifaceted construct. Principal component analysis elicited 4 factors: subjective dimension, collective dimension, synergy with psychiatric treatment, and ease of talking about religion with psychiatrist. Different associations were found between these factors and psychopathology, substance abuse, and psychosocial adaptation. The high prevalence of spirituality and religious coping clearly indicates the necessity of addressing spirituality in patient care. Our clinical grid is suitable for this purpose. It proved its applicability to a broad diversity of religious beliefs, even pathological ones. Interjudge reliability and construct validity were high and specific training is not required.

Feasibility of Therapeutic Drug Monitoring (TDM) for Imatinib: Preliminary considerations on the dosage adjustment approach for CML patients enrolled in the Imatinib Concentration Monitoring (I-COME) study

Background: As imatinib pharmacokinetics are highly variable, plasma levels differ largely between patients under the same dosage. Retrospective studies in chronic myeloid leukemia (CML) patients showed significant correlations between low levels and suboptimal response, and between high levels and poor tolerability. Monitoring of plasma levels is thus increasingly advised, targeting trough concentrations of 1000 μg/L and above. Objectives: Our study was launched to assess the clinical usefulness of systematic imatinib TDM in CML patients. The present preliminary evaluation questions the appropriateness of dosage adjustment following plasma level measurement to reach the recommended trough level, while allowing an interval of 4-24 h after last drug intake for blood sampling. Methods: Initial blood samples from the first 9 patients in the intervention arm were obtained 4-25 h after last dose. Trough levels in 7 patients were predicted to be significantly away from the target (6 <750 μg/L, and 1 >1500 μg/L with poor tolerance), based on a Bayesian approach using a population pharmacokinetic model. Individual dosage adjustments were taken up in 5 patients, who had a control measurement 1-4 weeks after dosage change. Predicted trough levels were confronted to anterior model-based extrapolations. Results: Before dosage adjustment, observed concentrations extrapolated at trough ranged from 359 to 1832 μg/L (median 710; mean 804, CV 53%) in the 9 patients. After dosage adjustment they were expected to target between 720 and 1090 μg/L (median 878; mean 872, CV 13%). Observed levels of the 5 recheck measurements extrapolated at trough actually ranged from 710 to 1069 μg/L (median 1015; mean 950, CV 16%) and had absolute differences of 21 to 241 μg/L to the model-based predictions (median 175; mean 157, CV 52%). Differences between observed and predicted trough levels were larger when intervals between last drug intake and sampling were very short (~4 h). Conclusion: These preliminary results suggest that TDM of imatinib using a Bayesian interpretation is able to bring trough levels closer to 1000 μg/L (with CV decreasing from 53% to 16%). While this may simplify blood collection in daily practice, as samples do not have to be drawn exactly at trough, the largest possible interval to last drug intake yet remains preferable. This encourages the evaluation of the clinical benefit of a routine TDM intervention in CML patients, which the randomized Swiss I-COME study aims to.

Workplace adjustment of an expatriate manager: identifying key components from a social capital perspective

Perustaen tutkimuksen kansainvälisen sopeutumisen teoreettiselle rungolle täydentäen sitä sosiaalisen pääoman teorialla, tämä tutkielma tutkii kuinka johtoasemassa oleva ulkosuomalainen luo hyvin toimivan sosiaalisen verkoston hong kongilaisella työpaikallansa. Tutkielma lähestyy aihetta Nahapietin ja Ghoshalin (1998) kehittämän sosiaalisen pääoman kolmen ulottuvuuden mallin avulla. Tutkielmassa kirjallisuudesta haettua teoriaa käytetään tutkimustavarten tehtyjen haastattelujen analysointiapuna. Tutkimalla sosiaalista pääomaa, kansainvälisen sopeutumisen kirjallisuutta, ekspatriootin perinteisiä menestystekijöitä ja guanxia (kiinalaisten henkilökohtaisia siteitä) tämän tutkimuksen teoriaosuus implikoi, että sosiaalisella pääomalla tulisi olla täydentävä rooli kansainvälisen sopeutumisen kirjallisuudessa. Sosiaalisen pääoman kolmen ulottuvuuden mallia käytetään pohjana empiirisen datan analysointiin. Tutkielman empiiriset tulokset osoittavat, että työpaikan sosiaaliseen verkostoon sopeutuminen liittyy exspatriootin kykyyn käsitellä estäviä ja mahdollistajia sosiaalisen pääoman luontiin vaikuttavia tekijöitä. Lisäksi sopeutuminen vaatii exspatriootin tunnistavan kohdemaalle tyypillisiä exspatriootin menestystekijöitä ja ekspatriootinomia tärkeitä henkilökohtaisia ominaisuuksia.

Personality, social values, and marital satisfaction as predictors of parents’ rearing styles

Los estilos de crianza parentales pueden afectar la conducta y socialización de los adolescentes, por lo que es de interés conocer cómo algunas variables psicológicas de los padres se relacionan con los estilos de crianza. Este estudio tiene el objetivo de analizar los estilos de crianza de los padres, valores sociales (prestigio social, orden, benevolencia, y conservadurismo-liberalismo), los cinco grandes factores de personalidad, y la satisfacción de pareja (acuerdo general, afecto, satisfacción, y cohesión) en los padres de adolescentes. Este es un estudio prospectivo basado en método de análisis correlacional. Se encontró que los estilos educativos definidos por el cariño y aceptación se relacionan con los rasgos de personalidad como responsabilidad y estabilidad emocional, alta satisfacción de pareja y preferencia por valores prosociales. Al contrario, los estilos de crianza de sobreprotección y favoritismo se relacionan con baja amabilidad y baja apertura el poco ajuste de pareja con falta de cohesión y valores sociales definidos por falta de benevolencia y preferencia por valores de prestigio social.

Why do university graduates regret their study program? A comparison between Spain and the Netherlands

[cat] En aquest article investiguem els factors que porten a universitaris espanyols i holandesos a lamentar els estudis cursats. Espanya i Holanda tenen un sistema educatiu molt diferent en termes de la rigidesa de l’educació secundària i el vincle entre l’educació i el mercat laboral. Comparant Espanya i Holanda ens permet aprendre sobre les conseqüències de dos sistemes educatius molt diferenciats a la probabilitat de lamentar els estudis cursats. Basant-nos en la literatura psicològica sobre l’arrepentiment/lamentació, derivem unes hipòtesis de partida que contrastem empíricament. Els resultats mostren que tant la rigidesa de l’educació secundària com el desajustament entre educació i ocupació són factors importants per explicar la lamentació dels estudis universitaris cursats. L’article conclou amb recomenacions sobre el sistema educatiu universitari.

Why do university graduates regret their study program? A comparison between Spain and the Netherlands

[cat] En aquest article investiguem els factors que porten a universitaris espanyols i holandesos a lamentar els estudis cursats. Espanya i Holanda tenen un sistema educatiu molt diferent en termes de la rigidesa de l’educació secundària i el vincle entre l’educació i el mercat laboral. Comparant Espanya i Holanda ens permet aprendre sobre les conseqüències de dos sistemes educatius molt diferenciats a la probabilitat de lamentar els estudis cursats. Basant-nos en la literatura psicològica sobre l’arrepentiment/lamentació, derivem unes hipòtesis de partida que contrastem empíricament. Els resultats mostren que tant la rigidesa de l’educació secundària com el desajustament entre educació i ocupació són factors importants per explicar la lamentació dels estudis universitaris cursats. L’article conclou amb recomenacions sobre el sistema educatiu universitari.