Compétences en soins patiatifs : que faut-il savoir faire en tant que médecin [Competencies in palliative care : what should the physicians be able to do?]

Palliative patients (patients with progressive incurable illnesses) have a number of needs, early and late in their illness trajectories. This article highlights some of the most important competencies required by physicians to address these needs. They cover a broad spectrum of domains and include pain and symptom management, communication, disclosure, prognostication, and psychological, social and spiritual needs. All physicians, generalists and specialists alike, should possess the basic competencies but should also recognize that some patients, especially those not responding to initial strategies, require timely referrals to specialized palliative care teams.

Quines són les necessitats espirituals en els adolescents afectats de càncer en situació de malaltia avançada-terminal, en una unitat de cures pal·liatives?

En les cures pal·liatives pediàtriques es contemplen les dimensions essencials de la persona: la física, la psicològica, la social i l’espiritual. Tot i que s’han fet estudis sobre la dimensió espiritual, en la revisió bibliogràfica es mostra que és un àmbit poc desenvolupat. És important conèixer l’aspecte de creences i valors per tal que la infermera oncològica, juntament amb altres professionals, puguin proporcionar una atenció holística. L’objectiu d’aquest estudi és identificar les necessitats espirituals en adolescents (13 a 18 anys) malalts de càncer en situació avançada-terminal. S’utilitza la metodologia qualitativa. La mostra és de vuit adolescents, que són seleccionats d’acord amb els criteris d’inclusió. Aquests seran entrevistats per la infermera, la investigadora, la qual realitzarà entrevistes semiestructurades i un fotomuntatge depenent de la predisposició de l’adolescent. L’àmbit de realització d’aquest estudi és en un hospital de tercer nivell on es proporcioni atenció especialitzada amb pediatria oncològica i, concretament, en una unitat de cures pal·liatives pediàtriques. Per finalitzar, és important tenir en compte que les entrevistes i el fotomuntatge poden tenir les seves limitacions i que no sempre s’obtingui el resultat esperat.

Presència de Rousseau a Catalunya: entre el mite i la realitat

En aquest article s’ofereix un perfil del pensament de Rousseau a partir de la seva relació amb la filosofia estoica i la seva dependència respecte de les idees de Montaigne, alhora que es remarca —atenint-se a la Professió de fe del vicari savoià— la dimensió religiosa i espiritual de la seva cosmovisió. Sobre la base d’aquests supòsits es revisa l’impacte de les idees de Rousseau en el Romanticisme del segle xix, sense perdre de vista les crítiques que la seva pedagogia va merèixer dels ideòlegs del Noucentisme (Eugeni d’Ors, Joaquim Xirau). Finalment, es conclou que la presència de la pedagogia de Rousseau en el Moviment de Renovació Pedagògica, viscut durant les primeres dècades del segle xx a Catalunya, constitueix més un horitzó que no pas una realitat bastida sistemàticament i sòlidament.

The fallacy of slimming products: a case analysis in Switzerland

Introduction: Many people desire to lose weight. This favors the marketing of "miracle" products with overemphasized slimming capacities. To our knowledge, no study regarding the claimed performances of slimming products has ever been conducted in Switzerland. Objectives: To assess weight loss claims of slimming products available in Switzerland by analyzing their corresponding advertisements. Methods: Between May 2008 and February 2013, 31 advertisements for 13 different slimming products from a single producer were collected. Weight loss claims and text of the advertisement were analyzed. Results: Weight loss claims ranged between 7 and 31 kg, with an estimated daily weight loss ranging between 300 g and 1 kg. 84% of the advertisements targeted women (by including the photograph of a woman), 61% showed a picture of a person before and after using the product, and 51% claimed that the product had improved marital relationships. The terms "natural", "miracle/extraordinary" and "scientific" were present in 92%, 77%, and 31% of the products, respectively. Free gifts were provided to buyers for 69% of the products. Cost was very similar for all 13 products (range: 49 to 59 CHF, with 8 products costing the same amount) and no correlation was found between cost of the product and weight loss claims. No differences were found for weight loss claims according to presence or absence of a picture or of the terms ".natural", ".miracle/extraordinary" and ".scientific" Finally, the yearly costs for advertising such products (French-speaking Switzerland) ranged between 56,000 and 126,000 CHF, suggesting that the gains obtained were higher than this value. Conclusion: In Switzerland, advertisements for slimming products use positive and reassuring terms to attract consumers, which are lured by unreachable, false promises of rapid and easy weight loss. Taking into account the costs of advertising, the gains obtained appear to be significant. Legislation on advertising of such products is urgently needed.

Espiritualitat: heterodòxia i punt de trobada, un actiu per a l’educació social

El món occidental contemporani està desvetllant un interès creixent per les necessitats no materials de la persona, el que podríem anomenar interioritat o espiritualitat. Hem passat de la lluita col·lectiva i del compromís social al culte del jo, i es fa palesa la necessitat de tenir cura de la dimensió interior des d’una visió no religiosa de la persona, que ha de conviure amb les tradicions religioses que poblen les ciutats. L’afirmació que l’espiritualitat és una dimensió pròpia de l’ésser humà és cada vegada més acceptada per una majoria de persones. En aquest sentit, la religiositat, com a conjunt de creences que donen peu a una determinada visió de la vida, és una manera determinada de concretar l’espiritualitat. Aquest escenari afegeix al model bio-psico-social de les ciències humanes, sobre el qual s’ha basat la formació dels educadors socials, un quart pilar, el que fa referència a la dimensió espiritual.

Diversitat funcional (discapacitat) i espiritualitat

Aquest treball pretén reflexionar al voltant de l’espiritualitat i la diversitat funcional, especialment des de l’òptica del treball dels professionals de l’acció social i des del que es promou des de les institucions. Pel que fa a la diversitat funcional, revisarem críticament el terme discapacitat i dependència i tindrem en compte les diferents dimensions de la persona, especialment l’espiritual. La premissa “la recerca del sentit de la vida és una força primària de la vida humana que té relació amb la felicitat” (Benavent) serà l’eix vertebral de la major part d’idees que aquest article pretén abordar.

Transitoriness in cancer patients: a cross-sectional survey of lung and gastrointestinal cancer patients.

Despite earlier diagnosis and advancements in treatment, cancer remains a leading cause of death in the world (13% of all deaths according to the World Health Organization) among men and women. Cancer accounts for approximately 20% of the deaths in the USA every year. Here, we report the findings from a cross-sectional survey of psychosocial factors in lung and gastrointestinal cancer patients. The aim of the study was to explore the associations among transitoriness, uncertainty, and locus of control (LOC) with quality of life. Transitoriness is defined as a person's confrontation with life's finitude due to a cancer diagnosis. A total of 126 patients with lung or gastrointestinal cancer completed eight self-reporting questionnaires addressing demographics, spiritual perspective, symptom burden, transitoriness, uncertainty, LOC, and quality of life. Transitoriness, uncertainty, and LOC were significantly associated with one another (r = 0.3267, p = 0.0002/r = 0.1994, p = 0.0252, respectively). LOC/belief in chance has a significant inverse relationship with patients' quality of life (r = -0.2505, p = 0.0047). Transitoriness, uncertainty, and LOC were found to have a significant inverse relationship with patients' quality of life (transitoriness state: r = -0.5363, p = 0.0000/trait: r = -0.4629, p = 0.0000/uncertainty: r = -0.4929, p = 0.0000/internal LOC: r = 0.1759, p = 0.0489/chance LOC: r = -0.2505, p = 0.0047). Transitoriness, uncertainty, and LOC are important concepts as they adversely influence patients' quality of life. Incorporating this finding into the care of cancer patients may provide them with the support they need to cope with treatment and maintenance of a positive quality of life.

Transactional sex and HIV risks - evidence from a cross-sectional national survey among young people in Uganda.

BACKGROUND: Transactional sex is associated with the HIV epidemic among young people in Uganda. Few quantitative studies based on nationally representative survey data explored the relationship between sexual behaviors, HIV infection, and transactional sex. OBJECTIVE: This study aimed to determine the associations between risky sexual behaviors, participation in transactional sex, and HIV sero-status among men and women aged 15-24 in Uganda. DESIGN: The study uses data from the Uganda AIDS Indicator Survey, a cross-sectional national HIV serological study conducted in 2011. We analyzed data on 1,516 men and 2,824 women aged 15-24 who had been sexually active in the 12 months preceding the survey. Private, face-to-face interviews were also conducted to record the sociodemographics, sexual history, and experiences of sexual coercion. Logistic regression analysis was performed to measure associations between sexual behaviors and transactional sex, and associations between HIV sero-status and transactional sex. RESULTS: Among young people who had been sexually active in the 12 months prior to the survey, 5.2% of young men reported paying for sex while 3.7% of young women reported receiving gifts, favors, or money for sex. Lower educational attainment (ORadjusted 3.25, CI 1.10-9.60) and experience of sexual coercion (ORadjusted 2.83, CI 1.07-7.47) were significantly associated with paying for sex among men. Multiple concurrent sexual relationships were significantly associated with paying for sex among young men (ORadjusted 5.60, CI 2.08-14.95) and receiving something for sex among young women (ORadjusted 8.04, CI 2.55-25.37). Paying for sex among young men and having three to five lifetime sexual partners among young women were associated with increased odds of testing positive for HIV. CONCLUSIONS: Transactional sex is associated with sexual coercion and HIV risk behaviors such as multiple concurrent sexual partnerships among young people in Uganda. In addition, transactional sex appears to place young men at increased risk for HIV in Uganda. Both sexes appear equally vulnerable to risks associated with transactional sex, and therefore should be targeted in intervention programs. In addition, strengthening universal education policy and improving school retention programs may be beneficial in reducing risky sexual behaviors and transactional sex.

Les odeurs répugnantes des démons : une preuve de leur présence corporelle au sabbat ?

The present article examines the meaning and function of olfactory remnants, often repugnant, linked to demons in the context of late medieval witchcraft and demonology. This reflection is developed within the framework of a «make believe» logic sustained by the doctrinal, theological, narrative and judiciary constructions of the witches' Sabbath. Incorporated within the order of sensory perception, references to the fetid smell of demons - who are by nature devoid of odour because they are pure spirits - constitute further proofs bearing witness to demonic presence, and thus testifying to the ignominy of the crime of witchcraft and to the guiltiness of the accused. According to those who attacked demon worshippers, the devil truly revealed himself physically; human beings were able to touch, hear, see and smell him. Sensory faculties were therefore perceived as being instrumental in corroborating the existence and reality of the Sabbath and the presence of the devil in bodily form. These considerations bring us to examine the olfactory fields associated with the devil's odour: odour of corpses, hell, sin, deviance, but also of defilement, impurity, corruption and excrements. These fetid odours are embedded in a logic of moral, spiritual and religious inversion of positive odours, such as the «sweet fragrance» of the saints, the «pure odour» of Christ or the «soft perfume» of virtue.

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The contribution of biodiversity and ecosystem services to our health care needs is significant, both for the development of modern pharmaceuticals (Chivian and Bernstein 2008; Newmann and Cragg 2007; see also chapter on contribution of biodiversity to pharmaceuticals in this volume) and for their uses in traditional medicine (WHO 2013). Long before the rise of pharmaceutical development, societies have been drawing on their traditional knowledge, skills and customary practices, using various resources provided to them by nature to prevent, diagnose and treat health problems. Today, these practices continue to inform health-care delivery at the level of local communities in many places around the world (WHO 2013). In socioecological contexts such as these, several resources used for food, cultural and spiritual purposes are also used as medicines (Unnikrishnan and Suneetha 2012). Traditional medicine practices provide more than health care to these communities; they are considered a way of life and are founded on endogenous strengths, including knowledge, skills and capabilities.

Efectividad de la intervención psicosocial en pacientes con enfermedad avanzada y final de vida

Objetivos: Demostrar la efectividad de la intervención psicosocial en la atención integral a personas con enfermedades avanzadas. Método: Se ha evaluado la presencia y evolución de parámetros psicológicos y espirituales de 8.964 pacientes, visitados por 117 profesionales de 29 equipos en un estudio de diseño cuasi-experimental, prospectivo, multcéntrico de un solo grupo pre-test post-test. Resultados: Los resultados muestran mejoras significativas en parámetros como ansiedad (RL 657,64; p<0,001), malestar emociona (RL 757,44; p<0,001), sentido de la vida (RL 248,30; p<0,001) y sentimientos de paz y perdón (RL 190,94; p<0,001). Conclusiones: El efecto positivo de la intervención psicosocial en la reducción de los parámetros psicológicos y espirituales evaluados sugiere que esta es eficaz en el contexto de la atención a personas con enfermedades avanzadas.

Tilintarkastajan palkkiot osana riippumattomuussääntelyä

Tutkimuksen tavoitteena on selvittää, millä eri tavoin tilintarkastajan palkkiot voivat vaarantaa tilintarkastajan riippumattomuuden sekä minkälaisen uhan eri tilanteet riippumattomuudelle aiheuttavat. Tavoitteisiin pyritään teoriaosuuden käsiteanalyyttisen tutkimusmetodologian sekä rahoituslaitosten yritystutkijoille suunnatun empiirisen kyselytutkimuksen avulla. Sidosryhmien odotukset eivät aina vastaa säännöksiä tai tilintarkastuskäytäntöä. Palkkioriippuvuutta yhdestä asiakkaasta sekä palkkion riippumista työn tuloksista pidetään uhkina riippumattomuudelle. Tilanneharkintaa on käytettävä, kun tarjotaan muita palveluja tarkastusasiakkaille. Sisäistä tarkastusta sekä konsultointia pidetään usein uhkina riippumattomuudelle. Epätavallisista eduista ja lahjoista tulee kieltäytyä, kun ne liittyvät tilintarkastukseen. Tilintarkastajan oma vakavaraisuus on riippumattomuden kannalta olennaista. Tilintarkastajan valitsevat usein samat henkilöt, joita tarkastetaan. Tätä pidetään riippumattomuuden kannalta hankalana. Tilintarkastajan omaa moraalia ja etiikkaa sekä tilintarkastajiin kohdistuvaa valvontaa pidetään tehokkaimpina keinoina riippumattomuuden turvaamiseksi.

A thematic analysis of delusion with religious content in schizophrenia: open, closed, and mixed dynamics

The aim of the present study was to elicit how patients with delusions with religious contents conceptualized or experienced their spirituality and religiousness. Sixty-two patients with present or past religious delusions went through semistructured interviews, which were analyzed using the three coding steps described in the grounded theory. Three major themes were found in religious delusions: ''spiritual identity,'' ''meaning of illness,'' and ''spiritual figures.'' One higher-order concept was found: ''structure of beliefs.'' We identified dynamics that put these personal beliefs into a constant reconstruction through interaction with the world and others (i.e., open dynamics) and conversely structural dynamics that created a complete rupture with the surrounding world and others (i.e., closed structural dynamics); those dynamics may coexist. These analyses may help to identify psychological functions of delusions with religious content and, therefore, to better conceptualize interventions when dealing with it in psychotherapy.

La donación de órganos en España: competencias del profesional de enfermería

La donación de órganos constituye una base fundamental para el trasplante como tratamiento de algunas alteraciones crónicas y agudas, que salva y mejora la calidad de vida de muchas personas. En las tablas 1 y 2 se presentan los primeros procesos de trasplante exitosos en el ámbito mundial y en España. El buen resultado de este tratamiento...