Opérationnaliser la théorie de la justice sociale d'Amartya Sen au champ de l'orientation scolaire : les apports d'une étude multicas qualitative et comparative

Nos travaux traitent des dispositifs d'orientation scolaire et professionnelle (DOSP) voués au soutien et à l'accompagnement de jeunes inégalement dotés dans leur parcours d'orientation au moment de la transition aux études supérieures. Des innovations méthodologiques étaient requises afin d'étudier cette question dans la perspective théorique de justice sociale d'Amartya Sen. Nous avons procédé à l'élaboration et à la vérification des qualités scientifiques d'outils de récolte de données dans une étude comparative internationale. Notre étude multicas se fonde sur cinq pays (Burkina Faso, Canada, France, Turquie, Suisse). Dans chacun des cas, des données qualitatives ont été récoltées sur le système éducatif, l'organisation des services et les prestations de service d'orientation. Vingt-six entretiens semi-structurés ont été menés auprès de responsables de service, de conseillères et conseillers d'orientation psychologues ainsi que de jeunes en transition vers le supérieur. La validité interne ou crédibilité des outils a été assurée tout au long de l'élaboration et des révisions du protocole de recherche, empruntant les procédés propres à l'étude de cas. La vérification de la validité de construit et de la validité externe ou transférabilité, effectuée à partir des données de la préenquête, a mis en lumière la valeur heuristique de nos outils. Au final, le cadre comparatif des DOSP, présenté en annexe, compte parmi les toutes premières formes d'opérationnalisation du cadre théorique de Sen au champ de l'orientation.

Responding to Young People's Health Risks in Primary Care: A Cluster Randomised Trial of Training Clinicians in Screening and Motivational Interviewing.

OBJECTIVE: To evaluate the effectiveness of a complex intervention implementing best practice guidelines recommending clinicians screen and counsel young people across multiple psychosocial risk factors, on clinicians' detection of health risks and patients' risk taking behaviour, compared to a didactic seminar on young people's health. DESIGN: Pragmatic cluster randomised trial where volunteer general practices were stratified by postcode advantage or disadvantage score and billing type (private, free national health, community health centre), then randomised into either intervention or comparison arms using a computer generated random sequence. Three months post-intervention, patients were recruited from all practices post-consultation for a Computer Assisted Telephone Interview and followed up three and 12 months later. Researchers recruiting, consenting and interviewing patients and patients themselves were masked to allocation status; clinicians were not. SETTING: General practices in metropolitan and rural Victoria, Australia. PARTICIPANTS: General practices with at least one interested clinician (general practitioner or nurse) and their 14-24 year old patients. INTERVENTION: This complex intervention was designed using evidence based practice in learning and change in clinician behaviour and general practice systems, and included best practice approaches to motivating change in adolescent risk taking behaviours. The intervention involved training clinicians (nine hours) in health risk screening, use of a screening tool and motivational interviewing; training all practice staff (receptionists and clinicians) in engaging youth; provision of feedback to clinicians of patients' risk data; and two practice visits to support new screening and referral resources. Comparison clinicians received one didactic educational seminar (three hours) on engaging youth and health risk screening. OUTCOME MEASURES: Primary outcomes were patient report of (1) clinician detection of at least one of six health risk behaviours (tobacco, alcohol and illicit drug use, risks for sexually transmitted infection, STI, unplanned pregnancy, and road risks); and (2) change in one or more of the six health risk behaviours, at three months or at 12 months. Secondary outcomes were likelihood of future visits, trust in the clinician after exit interview, clinician detection of emotional distress and fear and abuse in relationships, and emotional distress at three and 12 months. Patient acceptability of the screening tool was also described for the intervention arm. Analyses were adjusted for practice location and billing type, patients' sex, age, and recruitment method, and past health risks, where appropriate. An intention to treat analysis approach was used, which included multilevel multiple imputation for missing outcome data. RESULTS: 42 practices were randomly allocated to intervention or comparison arms. Two intervention practices withdrew post allocation, prior to training, leaving 19 intervention (53 clinicians, 377 patients) and 21 comparison (79 clinicians, 524 patients) practices. 69% of patients in both intervention (260) and comparison (360) arms completed the 12 month follow-up. Intervention clinicians discussed more health risks per patient (59.7%) than comparison clinicians (52.7%) and thus were more likely to detect a higher proportion of young people with at least one of the six health risk behaviours (38.4% vs 26.7%, risk difference [RD] 11.6%, Confidence Interval [CI] 2.93% to 20.3%; adjusted odds ratio [OR] 1.7, CI 1.1 to 2.5). Patients reported less illicit drug use (RD -6.0, CI -11 to -1.2; OR 0·52, CI 0·28 to 0·96), and less risk for STI (RD -5.4, CI -11 to 0.2; OR 0·66, CI 0·46 to 0·96) at three months in the intervention relative to the comparison arm, and for unplanned pregnancy at 12 months (RD -4.4; CI -8.7 to -0.1; OR 0·40, CI 0·20 to 0·80). No differences were detected between arms on other health risks. There were no differences on secondary outcomes, apart from a greater detection of abuse (OR 13.8, CI 1.71 to 111). There were no reports of harmful events and intervention arm youth had high acceptance of the screening tool. CONCLUSIONS: A complex intervention, compared to a simple educational seminar for practices, improved detection of health risk behaviours in young people. Impact on health outcomes was inconclusive. Technology enabling more efficient, systematic health-risk screening may allow providers to target counselling toward higher risk individuals. Further trials require more power to confirm health benefits. TRIAL REGISTRATION: ISRCTN.com ISRCTN16059206.

Johtamisosaaminen osuustoimintayrityksen menestystekijänä

Työn tarkoituksena on kuvata ja ymmärtää ylimmän johdon osaamista ja osaamisen strategista merkitystä osuustoimintayrityksen liiketoiminnassa. Tavoitteena on ymmärtää, millainen rooli osaamisella on osuustoimintayrityksen johtamisessa ja liiketoiminnassa sekä tutkia osuustoiminnallisten erityispiirteiden vaikutusta johtamiseen. Työ on luonteeltaan kvalitatiivinen, ja sen tutkimusaineisto koostuu S-ryhmän ylimmässä johdossa loka-joulukuussa 2007 tehdyistä teemahaastatteluista sekä kohdeorganisaation johtamista käsittelevistä kirjallisista dokumenteista. Tutkimustulokset osoittavat, että osaamisen strateginen rooli on kasvanut kohdeorganisaatiossa tasaisesti 1980-luvulta lähtien. Johtamisen osaamisvaatimukset ovat samaan aikaan kasvaneet ja monipuolistuneet. Erityisesti ihmisten johtamiseen sekä yritysverkoston johtamiseen liittyvän osaamisen merkityksen kasvu on ollut huomattava. Lisäksi tutkimus esittää väitteen, jonka mukaan yrityksen osuustoiminnalliset erityispiirteet vaikuttavat merkittävästi johdon osaamisvaatimuksiin.

Consumption of Fashion Luxury Brands

The main objective of this study is to find out why people buy luxury brands and which factors influence their decisions. The elements of luxury brands as well as motivation, culture and self-concept is researched as being the main factors behind luxury consumption. It was important to conduct this study because the luxury market is growing with a fast pace and it has hardly been research before. This study was conducted as a qualitative research. Theoretical part is based on the literature and on researches conducted before about the matter. Purposeful sampling method was used in empirical part by interviewing designers Jukka Rintala and Hanna Sarén as well as consumers of luxury brands, who work in the fashion industry. Two different viewpoints were chosen in order to research if designers’ and consumers’ thoughts differed. This study shows that the elements of luxury brands are deemed pretty much the same all around the world and also between the designers and consumers interviewed. Exclusivity referring to unique design and “hard to get” as well as good quality meaning superior materials, were mentioned as the most important elements of luxury brands. According to this study motivation behind luxury consumption is to a great extent dependent on the culture where the luxuries are consumed. However, self-concept has the biggest effect on luxury consumption. This study shows that people in individualistic cultures buy luxuries because they want to. People tend to spoil themselves and show off, thus making them feel good when buying luxuries. However, uniqueness is appreciated. On contrast, in collectivistic cultures people buy luxuries because they have to. Social pressure is much greater in Eastern than in Western culture that being the reason wealth is expected show. This study shows that in some cases designers' and consumers' thoughts about luxury consumption differ. Especially, a big gap was found when talking about materialism behind luxury consumption. The designers did not believe it to be the reason behind luxury consumption where consumers strongly did.

Sähköisen taloushallinnon vaikutus tilitoimistojen tuottavuuteen Case: Heeros Systems Oy

Tässä tutkimuksessa tarkasteltiin tuottavuuden käsitettä ja mittaamista palvelualoilla. Tutkielman tavoitteena oli kuvata ja ymmärtää sähköisen taloushallinnon vaikutusta tilitoimistojen tuottavuuteen. Aihetta lähestyttiin sähköisiä taloushallinto-ohjelmia valmistavan case-yhtiö Heeros Systems Oy:n avulla. Tutkimus on luonteeltaan laadullinen tutkimus, jonka tutkimusmenetelmä-nä käytettiin teemahaastatteluja. Tutkimusaineisto kerättiin haastattelemal-la yhteensä kymmentä tutkimuksen kohteena olevan tilitoimiston edusta-jaa. Tutkimuksen perusteella ei havaittu sähköisen taloushallinnon selkeästi vaikuttavan tilitoimistojen tuottavuuteen tässä vaiheessa, mutta toiminto-ympäristön sähköistyessä, esimerkiksi verkkolaskujen yleistyessä, tilan-teen uskotaan muuttuvan nopeasti. Tällöin tuottavuuden kasvu edellyttää työprosessin muuttamista ja huolellista suunnittelua.

A qualitative study of adolescents with medically unexplained symptoms and their parents. Part 2: How is healthcare perceived?

Medically unexplained symptoms (MUS) are common among adolescents and an important cause of clinical visits. This study sought to understand the experiences with, and perceptions of, the healthcare of adolescents who have MUS and their parents. Using a qualitative approach, six focus groups and two individual interviews were conducted with a total of ten adolescents and sixteen parents. The participants were recruited in a university hospital in Switzerland. A thematic analysis was conducted in accordance with the Grounded Theory. Six main themes emerged: needing a label for the symptoms, seeking an etiology to explain the symptoms, negotiating the medical system, medication and treatments, interactions with doctors, and the inclusion of parents during consultations. Transcending these themes, however, was the need for good communication between the adolescents, their parents and the clinicians. When explaining the symptoms, clinicians should make sure to discuss the results, investigations and lack of organic origin.

A qualitative study of adolescents with medically unexplained symptoms and their parents. Part 1: Experiences and impact on daily life.

Medically unexplained symptoms (MUS) are common among adolescents and are frequently encountered in primary care. Our aim was to explore how these adolescents and their parents experience the condition and its impact on their daily lives and to provide recommendations for health professionals. Using a qualitative approach, six focus groups and two individual interviews were conducted. These involved a total of ten adolescents with different types of MUS and sixteen parents. The respondents were recruited in a university hospital in Switzerland. A thematic analysis was conducted according to the Grounded Theory. The analysis of the data highlighted four core themes: disbelief, being different, concealing symptoms, and priority to adolescent's health. Transcending these themes was a core issue regarding the discrepancy between the strategies that adolescents and their parents use to cope with the symptoms. Health professionals should be made aware of the emotional needs of these patients and their families.

Qualitative, quantitative and temporal study of cutting agents for cocaine and heroin over 9 years

Forensic laboratories mainly focus on the qualification and the quantitation of the illicit drug under analysis as both aspects are used for judiciary purposes. Therefore, information related to cutting agents (adulterants and diluents) detected in illicit drugs is limited in the forensic literature. This article discusses the type and frequency of adulterants and diluents detected in more than 6000 cocaine specimens and 3000 heroin specimens, confiscated in western Switzerland from 2006 to 2014. The results show a homogeneous and quite unchanging adulteration for heroin, while for cocaine it could be characterised as heterogeneous and relatively dynamic. Furthermore, the results indicate that dilution affects more cocaine than heroin. Therefore, the results provided by this study tend to reveal differences between the respective structures of production or distribution of cocaine and heroin. This research seeks to promote the systematic analysis of cutting agents by forensic laboratories. Collecting and processing data related to the presence of cutting agents in illicit drug specimens produces relevant information to understand and to compare the structure of illicit drug markets.

Building legitimacy by criticising the pharmaceutical industry: a qualitative study among prescribers and local opinion leaders.

PRINCIPLES: The literature has described opinion leaders not only as marketing tools of the pharmaceutical industry, but also as educators promoting good clinical practice. This qualitative study addresses the distinction between the opinion-leader-as-marketing-tool and the opinion-leader-as-educator, as it is revealed in the discourses of physicians and experts, focusing on the prescription of antidepressants. We explore the relational dynamic between physicians, opinion leaders and the pharmaceutical industry in an area of French-speaking Switzerland. METHODS: Qualitative content analysis of 24 semistructured interviews with physicians and local experts in psychopharmacology, complemented by direct observation of educational events led by the experts, which were all sponsored by various pharmaceutical companies. RESULTS: Both physicians and experts were critical of the pharmaceutical industry and its use of opinion leaders. Local experts, in contrast, were perceived by the physicians as critical of the industry and, therefore, as a legitimate source of information. Local experts did not consider themselves opinion leaders and argued that they remained intellectually independent from the industry. Field observations confirmed that local experts criticised the industry at continuing medical education events. CONCLUSIONS: Local experts were vocal critics of the industry, which nevertheless sponsor their continuing education. This critical attitude enhanced their credibility in the eyes of the prescribing physicians. We discuss how the experts, despite their critical attitude, might still be beneficial to the industry's interests.