Directives pratiques de la Société européenne d'hypertension sur la mesure de la pression artérielle à domicile [Practice guidelines of the European Society of Hypertension for home blood pressure measurement].

Self-measurement of blood pressure at home is increasingly used in the diagnostic and therapeutic approach of hypertension. This technique allows multiple measurements of blood pressure away from the clinical setting, making it possible to improve the evaluation of cardiovascular risk. Recently new guidelines on the use of self-measured blood pressure have been made available by the European Society of Hypertension, as summarized in the present paper.

Database Rights in Safe European Home: The Path to More Rigorous Protection of Information

1. Introduction "The one that has compiled ... a database, the collection, securing the validity or presentation of which has required an essential investment, has the sole right to control the content over the whole work or over either a qualitatively or quantitatively substantial part of the work both by means of reproduction and by making them available to the public", Finnish Copyright Act, section 49.1 These are the laconic words that implemented the much-awaited and hotly debated European Community Directive on the legal protection of databases,2 the EDD, into Finnish Copyright legislation in 1998. Now in the year 2005, after more than half a decade of the domestic implementation it is yet uncertain as to the proper meaning and construction of the convoluted qualitative criteria the current legislation employs as a prerequisite for the database protection both in Finland and within the European Union. Further, this opaque Pan-European instrument has the potential of bringing about a number of far-reaching economic and cultural ramifications, which have remained largely uncharted or unobserved. Thus the task of understanding this particular and currently peculiarly European new intellectual property regime is twofold: first, to understand the mechanics and functioning of the EDD and second, to realise the potential and risks inherent in the new legislation in economic, cultural and societal dimensions. 2. Subject-matter of the study: basic issues The first part of the task mentioned above is straightforward: questions such as what is meant by the key concepts triggering the functioning of the EDD such as presentation of independent information, what constitutes an essential investment in acquiring data and when the reproduction of a given database reaches either qualitatively or quantitatively the threshold of substantiality before the right-holder of a database can avail himself of the remedies provided by the statutory framework remain unclear and call for a careful analysis. As for second task, it is already obvious that the practical importance of the legal protection providedby the database right is in the rapid increase. The accelerating transformationof information into digital form is an existing fact, not merely a reflection of a shape of things to come in the future. To take a simple example, the digitisation of a map, traditionally in paper format and protected by copyright, can provide the consumer a markedly easier and faster access to the wanted material and the price can be, depending on the current state of the marketplace, cheaper than that of the traditional form or even free by means of public lending libraries providing access to the information online. This also renders it possible for authors and publishers to make available and sell their products to markedly larger, international markets while the production and distribution costs can be kept at minimum due to the new electronic production, marketing and distributionmechanisms to mention a few. The troublesome side is for authors and publishers the vastly enhanced potential for illegal copying by electronic means, producing numerous virtually identical copies at speed. The fear of illegal copying canlead to stark technical protection that in turn can dampen down the demand for information goods and services and furthermore, efficiently hamper the right of access to the materials available lawfully in electronic form and thus weaken the possibility of access to information, education and the cultural heritage of anation or nations, a condition precedent for a functioning democracy. 3. Particular issues in Digital Economy and Information Networks All what is said above applies a fortiori to the databases. As a result of the ubiquity of the Internet and the pending breakthrough of Mobile Internet, peer-to-peer Networks, Localand Wide Local Area Networks, a rapidly increasing amount of information not protected by traditional copyright, such as various lists, catalogues and tables,3previously protected partially by the old section 49 of the Finnish Copyright act are available free or for consideration in the Internet, and by the same token importantly, numerous databases are collected in order to enable the marketing, tendering and selling products and services in above mentioned networks. Databases and the information embedded therein constitutes a pivotal element in virtually any commercial operation including product and service development, scientific research and education. A poignant but not instantaneously an obvious example of this is a database consisting of physical coordinates of a certain selected group of customers for marketing purposes through cellular phones, laptops and several handheld or vehicle-based devices connected online. These practical needs call for answer to a plethora of questions already outlined above: Has thecollection and securing the validity of this information required an essential input? What qualifies as a quantitatively or qualitatively significant investment? According to the Directive, the database comprises works, information and other independent materials, which are arranged in systematic or methodical way andare individually accessible by electronic or other means. Under what circumstances then, are the materials regarded as arranged in systematic or methodical way? Only when the protected elements of a database are established, the question concerning the scope of protection becomes acute. In digital context, the traditional notions of reproduction and making available to the public of digital materials seem to fit ill or lead into interpretations that are at variance with analogous domain as regards the lawful and illegal uses of information. This may well interfere with or rework the way in which the commercial and other operators have to establish themselves and function in the existing value networks of information products and services. 4. International sphere After the expiry of the implementation period for the European Community Directive on legal protection of databases, the goals of the Directive must have been consolidated into the domestic legislations of the current twenty-five Member States within the European Union. On one hand, these fundamental questions readily imply that the problemsrelated to correct construction of the Directive underlying the domestic legislation transpire the national boundaries. On the other hand, the disputes arisingon account of the implementation and interpretation of the Directive on the European level attract significance domestically. Consequently, the guidelines on correct interpretation of the Directive importing the practical, business-oriented solutions may well have application on European level. This underlines the exigency for a thorough analysis on the implications of the meaning and potential scope of Database protection in Finland and the European Union. This position hasto be contrasted with the larger, international sphere, which in early 2005 does differ markedly from European Union stance, directly having a negative effect on international trade particularly in digital content. A particular case in point is the USA, a database producer primus inter pares, not at least yet having aSui Generis database regime or its kin, while both the political and academic discourse on the matter abounds. 5. The objectives of the study The above mentioned background with its several open issues calls for the detailed study of thefollowing questions: -What is a database-at-law and when is a database protected by intellectual property rights, particularly by the European database regime?What is the international situation? -How is a database protected and what is its relation with other intellectual property regimes, particularly in the Digital context? -The opportunities and threats provided by current protection to creators, users and the society as a whole, including the commercial and cultural implications? -The difficult question on relation of the Database protection and protection of factual information as such. 6. Dsiposition The Study, in purporting to analyse and cast light on the questions above, is divided into three mainparts. The first part has the purpose of introducing the political and rationalbackground and subsequent legislative evolution path of the European database protection, reflected against the international backdrop on the issue. An introduction to databases, originally a vehicle of modern computing and information andcommunication technology, is also incorporated. The second part sets out the chosen and existing two-tier model of the database protection, reviewing both itscopyright and Sui Generis right facets in detail together with the emergent application of the machinery in real-life societal and particularly commercial context. Furthermore, a general outline of copyright, relevant in context of copyright databases is provided. For purposes of further comparison, a chapter on the precursor of Sui Generi, database right, the Nordic catalogue rule also ensues. The third and final part analyses the positive and negative impact of the database protection system and attempts to scrutinize the implications further in the future with some caveats and tentative recommendations, in particular as regards the convoluted issue concerning the IPR protection of information per se, a new tenet in the domain of copyright and related rights.

Increasing prehospital emergency medical service interventions for nursing home residents.

QUESTION: In the ageing European population, the proportion of interventions by the emergency medical services (EMS) for elderly patients is increasing, but little is known about the recent trend of EMS interventions in nursing homes. The aim of this analysis was to describe the evolution of the incidence of requests for prehospital EMS interventions for nursing home residents aged 65 years and over between 2004 and 2013. METHODS: A prospective population-based register of routinely collected data for each EMS intervention in the Canton of Vaud. Linear time trends of incidence of requests to the EMS in nursing homes were calculated and stratified by age categories. RESULTS: The number of ambulance interventions in nursing homes for people aged 65 years and over (65+) increased by 68.9% (1124‒1898) between 2004 and 2013. A significant linear increase of the annual incidence of requests to EMS per 1,000 nursing home residents was found for people aged 65-79 (10.2, 95% confidence interval [CI] 6.2-14.2), 80-89 (16.5, 95% CI 14.0-19.0) and over 90 (12.1, 95% CI 5.8-18.4). EMS interventions in nursing home residents who required an emergency physician increased during the same period by 205.6% (from 106 to 324), representing an increase from 2% to 7% of all emergency physician interventions in the Canton. CONCLUSIONS: Our results confirmed an important increase in the incidence of EMS interventions in nursing homes during the last decade, far exceeding the actual increase of the nursing home population during the same period. This evolution represents an important opportunity to reconsider the EMS missions in the context of an ageing society.

Extension des prestations de type "équipe mobile" aux foyers socio-éducatifs: projet pilote dans le canton de Vaud [Extension of mobile team services to socio-educational home: pilot project in the Vaud canton].

L'objectif principal de ce projet d'extension des prestations, de type Antenne d'intervention dans le milieu pour enfants et adolescents (AIMEA) aux foyers socio-éducatifs pour l'ensemble du canton de Vaud, vise à décloisonner les champs socio-éducatifs et pédopsychiatriques. 64 patients ont fait l'objet d'une évaluation au cours de la phase pilote (après une année de fonctionnement). De plus, une enquête de satisfaction a été effectuée soit à la fin du suivi, soit à la fin de la phase pilote de ce projet (au 31.12.2012). Cette expérience très positive, relevée par une grande majorité des acteurs impliqués dans la prise en charge socio-éducative et pédopsychiatrique des mineurs, suscite un désir d'extension des prestations de type équipe mobile à d'autres structures ou à d'autres types de situations. The main objective of this project about mobile team service extension to the socio-educational home of the whole Vaud canton targets to decompartmentalize the socio-educational and youth-psychiatry domains. 64 patient were assessed during this pilot phase (after one-year functioning). In addition, a satisfaction survey was done either at the end of the follow up or at the end of the pilot phase of the project (31.12.2012). This experience was very positive as highlighted by the vast majority of the person involved in the socio-educational and youth-psychiatric domains taking care of youth. A desire of extension of mobile team service to other institutional structure or other situations was expressed.

[Place of volunteers in home care setting for taking care of individuals with Alzheimer's disease related dementia: Qualitative survey in a specialized unit] Place du bénévolat en EHPAD dans la prise en charge des personnes atteintes de la maladie d'Alzheimer ou démences apparentées : enquête qualitative dans une unité protégée.

Objectifs En EHPAD, selon les recommandations de la Haute Autorité de santé (HAS), la prise en charge non médicamenteuse des troubles psychocomportementaux associés à la maladie d'Alzheimer ou aux syndromes apparentés, implique une réorganisation, une formation spécifique du personnel et du temps. Se pose ici la question du rôle des bénévoles dans cette prise en charge. Matériels et méthodes Enquête descriptive à partir de questionnaires distribués aux différents intervenants (bénévoles, professionnels de santé et aidants familiaux) d'une unité protégée de l'EHPAD de la clinique du Diaconat (Colmar, France) et spécifiquement élaborés pour évaluer leur vécu de l'expérience de bénévolat dans la prise en charge des résidents souffrant d'une maladie d'Alzheimer ou d'un syndrome apparenté. Résultats Sur les 101 questionnaires qui ont été remplis, 85,7 % des aidants, 60 % des bénévoles et 42,1 % des professionnels constataient des bénéfices pour eux-mêmes. Les professionnels et les aidants avaient confiance dans l'intervention des bénévoles. Cependant, les bénévoles semblaient manquer de compétence pour le soutien des aidants et dans les techniques de communication avec les résidents. Les points essentiels pour permettre un fonctionnement harmonieux entre les différents intervenants étaient de bien définir préalablement le rôle de bénévoles et d'en informer les autres intervenants, de former les bénévoles à ce rôle et de favoriser la communication entre les bénévoles et les professionnels. Conclusion Cette enquête montre que les bénévoles ont une place aux côtés des équipes soignantes pour participer à la prise en charge non médicamenteuse des personnes atteintes de maladie d'Alzheimer ou syndromes apparentés. Ils ont une position singulière et jouent un rôle complémentaire de celui des soignants et des aidants. Objectives According to the recommendation of the French High Authority of Health (HAS), the non-pharmaceutical management of psycho-behavioural disorders associated with Alzheimer's disease or related disorders in a nursing home, involves reorganization an specific training for staff members and time. This raises the question of the role of volunteering in this approach. Materials and methods A descriptive survey using questionnaires distributed to various stakeholders (volunteers, healthcare professionals and caregivers) of a protected unit of the nursing home of the Diaconat clinic (Colmar, France) and specifically designed to assess their experience of the volunteering in supporting residents suffering from Alzheimer's diseases or related disorders. Results Of the 101 questionnaires that were filled in, 85.7% of caregivers, 60% of volunteers and 42.1% of professionals recorded benefits for themselves. Professionals and informal carers had confidence in the intervention of volunteers. However, volunteers seemed to lack skills to support informal caregivers and specific knowledge about the technique of communicating with residents. The key points to favor harmonious collaborations between the different stakeholders were: to properly define the role of volunteers and to inform other stakeholders about this role previously, and to specifically educate themselves in this task and to promote communication between volunteers and all other professionals. Conclusion This study shows that volunteers have a place alongside medical teams to participate in the non-pharmaceutical treatment for people with Alzheimer's disease or related syndromes. They have a unique position and play a complementary role to that of carers and informal caregivers.

Effect Estimation of an Innovative Nursing Intervention to Improve Delirium among Home-Dwelling Older Adults: A Randomized Controlled Pilot Trial.

AIMS: Estimating the effect of a nursing intervention in home-dwelling older adults on the occurrence and course of delirium and concomitant cognitive and functional impairment. METHODS: A randomized clinical pilot trial using a before/after design was conducted with older patients discharged from hospital who had a medical prescription to receive home care. A total of 51 patients were randomized into the experimental group (EG) and 52 patients into the control group (CG). Besides usual home care, nursing interventions were offered by a geriatric nurse specialist to the EG at 48 h, 72 h, 7 days, 14 days, and 21 days after discharge. All patients were monitored for symptoms of delirium using the Confusion Assessment Method. Cognitive and functional statuses were measured with the Mini-Mental State Examination and the Katz and Lawton Index. RESULTS: No statistical differences with regard to symptoms of delirium (p = 0.085), cognitive impairment (p = 0.151), and functional status (p = 0.235) were found between the EG and CG at study entry and at 1 month. After adjustment, statistical differences were found in favor of the EG for symptoms of delirium (p = 0.046), cognitive impairment (p = 0.015), and functional status (p = 0.033). CONCLUSION: Nursing interventions to detect delirium at home are feasible and accepted. The nursing interventions produced a promising effect to improve delirium.

La institucionalització o l'educació de l'home com a problema

És molt estrany plantejar-se especular sobre la relació entre l'educació/ educador i el procés d'institucionalització, sobretot perquè es gairebé impossible que aquesta es pugui donar fora de la pròpia institució, o fora d'alguna institució, sigui quin sigui l'àmbit al qual es vulgui assignar. A més d'estrany és paradoxal, doncs és la pròpia institució la que disposa la producció de discursos que atenen a la seva definició, renovació, projecció i fins i tot deixa espai a la producció crítica. L'efecte d'aquestes capacitats ens assenyala una primera constatació: el procés d'institucionalització incrementa hist6ricament el seu desplegament sobre la superfície social i amb aix6 l'abast de les seves influencies.

Current status of pediatric home enteral nutrition in Spain: The importance of the NEPAD register

Home enteral nutrition (HEN) is a type of enteral nutrition (EN) which is becoming progressively more widespread in pediatrics due to the benefits it affords to patients, their families and to reducing hospital costs. However, the true extent of its use is unknown in Spain as the data-base set up for this purpose is still underused (Registro de Nutrición Enteral Pediátrica Ambulatoria y Domiciliaria -NEPAD-). More thorough registration of patients in the NEPAD online register will provide information about the characteristics of HEN in Spain: prevalence, diagnosis, the population sector being administered HEN, complications and developments. Likewise, forecast and planning of the necessary resources could be made while those in use could be analysed.

Aurora Bertrana : Bringing "otherness" home

“Decidida a viure al preu que sigui” underscores contemporary writer Maria-Antònia Oliver in her prologue to Aurora Bertrana’s fourth book, El Marroc sensual i fanàtic (1936). The urge to travel, to explore the world and to slake her thirst for new experiences shaped much of the personality and the work of this Girona-born writer. Taking her own travels as a starting point, Bertrana distinguished herself in the genre of travel writing on exotic countries, which at that time underwent a significant revival in Catalonia. Bertrana’s originality lies partly in the image of the woman traveller that she consciously cultivated for herself, and partly in the way she narrates her travels. This article seeks to recover this author and make visible her singular way of presenting otherness.

A new multidisciplinary home care telemedicine system to monitor stable chronic human immunodeficiency virus-infected patients: a randomized study.

Background: Antiretroviral therapy has changed the natural history of human immunodeficiency virus (HIV) infection in developed countries, where it has become a chronic disease. This clinical scenario requires a new approach to simplify follow-up appointments and facilitate access to healthcare professionals. Methodology: We developed a new internet-based home care model covering the entire management of chronic HIV-infected patients. This was called Virtual Hospital. We report the results of a prospective randomised study performed over two years, comparing standard care received by HIV-infected patients with Virtual Hospital care. HIV-infected patients with access to a computer and broadband were randomised to be monitored either through Virtual Hospital (Arm I) or through standard care at the day hospital (Arm II). After one year of follow up, patients switched their care to the other arm. Virtual Hospital offered four main services: Virtual Consultations, Telepharmacy, Virtual Library and Virtual Community. A technical and clinical evaluation of Virtual Hospital was carried out. Findings: Of the 83 randomised patients, 42 were monitored during the first year through Virtual Hospital (Arm I) and 41 through standard care (Arm II). Baseline characteristics of patients were similar in the two arms. The level of technical satisfaction with the virtual system was high: 85% of patients considered that Virtual Hospital improved their access to clinical data and they felt comfortable with the videoconference system. Neither clinical parameters [level of CD4 + T lymphocytes, proportion of patients with an undetectable level of viral load (p = 0.21) and compliance levels 90% (p = 0.58)] nor the evaluation of quality of life or psychological questionnaires changed significantly between the two types of care. Conclusions: Virtual Hospital is a feasible and safe tool for the multidisciplinary home care of chronic HIV patients. Telemedicine should be considered as an appropriate support service for the management of chronic HIV infection.

Lifestyle of the Elderly Receiving Home Care in Spain

The aim of this study is to examine the lifestyle characteristics and health status of the elderly in order to identify aspects that might help promote active ageing. Participants were 26 elderly citizens aged 75 or over who were the recipients of home care services in Vilafranca del Penedès (Barcelona, Spain). They were recruited by means of convenience sampling, and a case study approach was adopted. Fieldwork was conducted in April 2007, with a specially designed questionnaire administered in the context of an in-depth interview. Quantitative data were analyzed with SPSS 15, while qualitative data were analysed and grouped by category. The results indicated that 53.8% of the elderly interviewees perceived their health status as being regular, most did not have adequate nutrition and hydration, while 42.3% had chewing problems and 65.3% presented slight dependence. Most of them received visits at home, but did not go on leisure outings. The only exercise they took was walking. These findings highlight the need to promote and strengthen activities for healthy ageing, and to ensure that people over 75 receive adequate care. Programmes should be implemented to improve those aspects that are currently under-addressed.

Lifestyle of the Elderly Receiving Home Care in Spain

The aim of this study is to examine the lifestyle characteristics and health status of the elderly in order to identify aspects that might help promote active ageing. Participants were 26 elderly citizens aged 75 or over who were the recipients of home care services in Vilafranca del Penedès (Barcelona, Spain). They were recruited by means of convenience sampling, and a case study approach was adopted. Fieldwork was conducted in April 2007, with a specially designed questionnaire administered in the context of an in-depth interview. Quantitative data were analyzed with SPSS 15, while qualitative data were analysed and grouped by category. The results indicated that 53.8% of the elderly interviewees perceived their health status as being regular, most did not have adequate nutrition and hydration, while 42.3% had chewing problems and 65.3% presented slight dependence. Most of them received visits at home, but did not go on leisure outings. The only exercise they took was walking. These findings highlight the need to promote and strengthen activities for healthy ageing, and to ensure that people over 75 receive adequate care. Programmes should be implemented to improve those aspects that are currently under-addressed.

Lifestyle of the Elderly Receiving Home Care in Spain

The aim of this study is to examine the lifestyle characteristics and health status of the elderly in order to identify aspects that might help promote active ageing. Participants were 26 elderly citizens aged 75 or over who were the recipients of home care services in Vilafranca del Penedès (Barcelona, Spain). They were recruited by means of convenience sampling, and a case study approach was adopted. Fieldwork was conducted in April 2007, with a specially designed questionnaire administered in the context of an in-depth interview. Quantitative data were analyzed with SPSS 15, while qualitative data were analysed and grouped by category. The results indicated that 53.8% of the elderly interviewees perceived their health status as being regular, most did not have adequate nutrition and hydration, while 42.3% had chewing problems and 65.3% presented slight dependence. Most of them received visits at home, but did not go on leisure outings. The only exercise they took was walking. These findings highlight the need to promote and strengthen activities for healthy ageing, and to ensure that people over 75 receive adequate care. Programmes should be implemented to improve those aspects that are currently under-addressed.

Differences in seasonal price patterns among second home rentals and hotels: Empirical evidence and practical implications

Hotels and second home rentals are two of the most important tourist accommodation options in Spain. In terms of seasonality, almost all previous studies have analysed tourism demand from the point of view either of total arrivals or the number of tourists lodged in a single accommodation type (hotels, rural accommodation, etc). However, there are no studies focusing on price seasonality orcomparing seasonality among different accommodation types. By using seasonality indicators and a price index constructed by means of hedonic methods, this paper aims to shed some light on seasonal pricing patterns among second home rentals and hotels. The paper relies on a 2004 database of 144 hotels and 1,002 apartments on the Costa Brava (northeast Spain). The results show that prices for second home rentals display a smoother seasonal pattern than hotels due to reduced price differences between shoulder (May and October) and peak periods (August)