How family caregivers' medical and moral assumptions influence decision making for patients in the vegetative state: a qualitative interview study.

Background Decisions on limiting life-sustaining treatment for patients in the vegetative state (VS) are emotionally and morally challenging. In Germany, doctors have to discuss, together with the legal surrogate (often a family member), whether the proposed treatment is in accordance with the patient's will. However, it is unknown whether family members of the patient in the VS actually base their decisions on the patient's wishes. Objective To examine the role of advance directives, orally expressed wishes, or the presumed will of patients in a VS for family caregivers' decisions on life-sustaining treatment. Methods and sample A qualitative interview study with 14 next of kin of patients in a VS in a long-term care setting was conducted; 13 participants were the patient's legal surrogates. Interviews were analysed according to qualitative content analysis. Results The majority of family caregivers said that they were aware of aforementioned wishes of the patient that could be applied to the VS condition, but did not base their decisions primarily on these wishes. They gave three reasons for this: (a) the expectation of clinical improvement, (b) the caregivers' definition of life-sustaining treatments and (c) the moral obligation not to harm the patient. If the patient's wishes were not known or not revealed, the caregivers interpreted a will to live into the patient's survival and non-verbal behaviour. Conclusions Whether or not prior treatment wishes of patients in a VS are respected depends on their applicability, and also on the medical assumptions and moral attitudes of the surrogates. We recommend repeated communication, support for the caregivers and advance care planning.

Politicians in the Media: Determinants of Legislators' Presence and Prominence in Swiss Newspapers

In times of increasing "mediatization" of politics, when voters and their elected representatives primarily communicate through the media, the question of who gets into the news and why becomes of the utmost importance. This article examines the determinants of Swiss legislators' presence and prominence in the print media by focusing on three competing approaches drawn from communication studies. The first approach regards the media as a "mirror" of political reality and argues that the media focus on the most active deputies in parliament. Second, news values theory predicts that "authoritative" politicians in leadership positions get the most media coverage. Third, theories of "news bias" hold that the media privilege legislators who are in line with their own editorial interests. Overall, the statistical analyses show an important leadership effect and provide strong support for the second explanation. While deputies in official functions get the most extensive news coverage, media access can also be won by parliamentary activity. The least support is shown for the news bias theory, although some newspapers try to localize parliamentary news coverage by focusing on deputies from their own media market.

Second-hand tobacco smoke in prison: tackling a public health matter through research.

OBJECTIVES: This action-research study conducted in a Swiss male post-trial detention centre (120 detainees and 120 staff) explored the attitudes of detainees and staff towards tobacco smoking. Tackling public health matters through research involving stakeholders in prisons implies benefits and risks that need exploration. STUDY DESIGN: The observational study involved multiple strands (quantitative and qualitative components, and air quality measurements). This article presents qualitative data on participants' attitudes and expectations about research in a prison setting. METHODS: Semi-structured interviews were used to explore the attitudes of detainees and staff towards smoking before and after a smoke-free regulation change in the prison in 2009. Specific coding and thematic content analysis for research were performed with the support of ATLAS.ti. RESULTS: In total, 77 interviews were conducted (38 before the regulation change and 39 after the regulation change) with 31 detainees (mean age 35 years, range 22-60 years) and 27 prison staff (mean age 46 years, range 29-65 years). Both detainees and staff expressed satisfaction regarding their involvement in the study, and wished to be informed about the results. They expected concrete changes in smoke-free regulation, and that the research would help to find ways to motivate detainees to quit smoking. CONCLUSION: Active involvement of stakeholders promotes public health. Interviewing detainees and prison staff as part of an action-research study aimed at tackling a public health matter is a way of raising awareness and facilitating change in prisons. Research needs to be conducted independently from the prison administrators in order to increase trust and to avoid misunderstandings.

Des hommes en mouvement : vers une reconfiguration des modèles masculins? L'exemple de la Suisse

This project is a study of the men's movement in Switzerland, especially regarding organizations seeking to redefine male identity. So far, this topic has been understudied, in Switzerland. The few studies available on the subject mostly adopt a (pro)feminist perspective. Their main purpose is to criticize men's movement participants. What is more, scarce researches on this problem mostly conducted by members of the Swiss men's movement themselves are mainly descriptive and methodologically problematic. In this context, I initiated the first national and sociological study of the men's movement in Switzerland. My main goals are: firstly, to propose a typology of organizations forming the men's movement in Switzerland. Secondly, I develop a sociological analysis of this phenomenon, taking into account in this process especially the characteristics of the Swiss context. Consequently, I adopted a mixed method approach, which included two main research steps: Firstly, I defined a representative sample of men's movement organizations in Switzerland. Based on a content analysis of men's organizations' websites, I was able to distinguish three ideal-types: Radical Criticism of Masculinity, Criticism of Hegemonic Masculinity, Defense of Men and Traditional Masculinity. Based on these three concepts, I subsequently analyzed the discourse on masculinity amongst men's movement organizations. Secondly, I conducted a survey of men's movement participants. This survey was based on the results of the content analysis. In this particular stage, I mainly used factor analysis. My results show that it would be all too simplistic to characterize the men's movement, in Switzerland, as a criticism of women's emancipation. On the contrary, my analysis reveals a more complex picture: The two main factors, which influence the men's movement, in Switzerland, are the contemporary sociological context and the Swiss society's particular features. I find that male roles, on the one hand, depend very much on today's cultural shift from materialistic to self-expression values. On the other hand, male role models reflect a social adaptation process. Moreover, as a reaction to deep changes in contemporary family structures, I observe an individualization process, characterized by separation between parental and conjugal functions that greatly shapes male role models. - Cette thèse analyse le phénomène des hommes en mouvement, dans le contexte de la Suisse. Cet ensemble est formé d'organisations regroupant des hommes impliqués consciemment dans un processus d'actions et de réflexions sur l'identité masculine. La revue de la littérature révèle qu'en Suisse, le sujet des hommes en mouvement est très peu étudié. Jusqu'ici, les rares recherches s'y intéressant adoptent généralement une approche (pro)féministe, dont l'objectif est de dénoncer ce phénomène. En outre, de rares recherches, issues des acteurs mêmes de ce mouvement, proposent une vue descriptive de l'ensemble, mais souffrant de faiblesses méthodologiques. Par notre recherche, nous souhaitons contribuer à l'étude de ce sujet, en initiant la première étude d'envergure nationale portant sur les hommes en mouvement. L'objectif final est de déboucher sur une typologie des organisations réunissant les hommes en mouvement, puis sur une analyse de la spécificité de cet ensemble, dans le contexte suisse. Pour remplir ces objectifs, nous avons mis en place un dispositif de méthodes mixtes, en deux phases. Lors d'une première étape, nous avons sélectionné un échantillon représentatif de la diversité des organisations masculines. Par une analyse de contenu effectuée sur la documentation récoltée sur les sites Internet de ces dernières, nous avons pu, en utilisant une démarche inductive et qualitative, faire émerger trois idéaux-types : Critique radicale de la masculinité, Critique de la masculinité hégémonique, Défense des hommes et de la masculinité traditionnelle. Ces concepts permettent de rendre compte, de manière schématique, des trois types de discours contemporains sur l'identité masculine diffusés par les hommes en mouvement. Lors d'une seconde étape, nous avons réalisé une enquête auprès des membres des organisations masculines. Pour y parvenir, nous avons créé un questionnaire incluant des propositions élaborées à partir des résultats de l'étape précédente. Lors de cette phase, nous avons réalisé une analyse factorielle. Les résultats montrent que le phénomène du mouvement des hommes ne saurait se réduire, en Suisse, à un mouvement de ressac visant à attaquer les droits des femmes. Au contraire, il s'agit d'un phénomène complexe, fortement dépendant du contexte sociologique contemporain et des caractéristiques de la société helvétique. Nous affirmons, entre autres, que les modèles masculins observables dans cet ensemble sont façonnés, d'une part, par une transition culturelle, caractérisée par le passage des valeurs matérialistes aux valeurs d'expression de soi. D'autre part, les modèles masculins prônés par les hommes en mouvement reflètent un processus d'adaptation sociale. En effet, en réaction au contexte de reconfiguration des formes familiales, on assiste à une individualisation des rapports de filiation et au détachement de la fonction parentale et conjugale, qui imprègnent fortement les modèles masculins défendus par ces hommes.

D'alumnes a mestres: explorant records escolars de noves generacions de mestres. Una mirada qualitativa i de gènere

Aquest treball de recerca té la finalitat de conèixer com noves generacions de mestres van construint la seva identitat professional. Com que la recerca es situa a l’inici del seu pas per la formació inicial, el que es pretén analitzar són les concepcions i l’experiència prèvies que han tingut amb el món docent durant la seva trajectòria escolar. Es vol comprendre quines poden haver estat les motivacions que les han i els han portat realment a escollir la carrera de Mestres, quines expectatives tenen sobre la professió des de la vivència personal de ser testimonis d’una professió que ara volen convertir en la seva. El disseny respon a una investigació de caràcter exploratori i descriptiu i el mètode d’investigació s’ha basat en l’anàlisi de contingut de textos autobiogràfics elaborats en el context d’una assignatura de primer de Grau en les carreres de Mestres. La informació s’ha analitzat amb el programa d’anàlisi qualitativa Atlas.ti.

Family doctors' consultations with people suffering from chronic pain without objective findings: Which protective practices might they develop in these challenging medical encounters?

Introduction: Consultations with patients suffering from chronic pain without objective findings represent a challenge fo r family doctors (FDs). A mutual lack of understanding may arise, which threatens the doctor-patient relationship and may lead to dissatisfaction of both patient and doctor and to a breakdown of the therapeutic alliance. Objectives: This study aims to investigate FDs' potential protective practices to preserve the doctor-patient relationship during this type of consultation. Method: In the first step of this qualitative research, I carried out a range of 10 se- mi-structured interviews with FDs to explore their reported practices and repre- sentations during consultations with people suffering from chronic pain without objective findings. The interviews' transcripts were integrally analysed with computer-assisted thematic content analysis (QSR NVivo ® ) to highlight the main themes related to the topic in the participants' talk. Results: At this point of the research, two types of FDs' protective practices can be identified: first the use of complementary sources of knowledge in addition to the medical model to provide explanations to patients, second the collaboration with multidisciplinary teams or support gr oups that allow them to share profes- sional expertise and emotional experiences. Conclusion: The findings could be useful to develop ways to improve the follow- up of patients suffering from chronic pain without objective findings and conse- quently the FDs' work satisfaction.

Coating carbon nanotubes with a polystyrene-based polymer protects against pulmonary toxicity.

BACKGROUND: carbon nanotubes (CNT) can have adverse effects on health. Therefore, minimizing the risk associated with CNT exposure is of crucial importance. The aim of this work was to evaluate if coating multi-walled CNT (MWCNT) with polymers could modify their toxicity, thus representing a useful strategy to decrease adverse health effects of CNT. We used industrially-produced MWCNT uncoated (NT1) or coated (50/50 wt%) with acid-based (NT2) or polystyrene-based (NT3) polymer, and exposed murine macrophages (RAW 264.7 cell line) or Balb/c mice by intratracheal administration. Biological experiments were performed both in vitro and in vivo, examining time- and dose-dependent effects of CNT, in terms of cytotoxicity, expression of genes and proteins related to oxidative stress, inflammation and tissue remodeling, cell and lung tissue morphology (optical and transmission electron microscopy), and bronchoalveolar lavage fluid content analysis.RESULTS: extensive physico-chemical characterization of MWCNT was performed, and showed, although similar dimensions for the 3 MWCNT, a much smaller specific surface area for NT2 and NT3 as compared to NT1 (54.1, 34 and 227.54 m(2)/g respectively), along with different surface characteristics. MWCNT-induced cytotoxicity, oxidative stress, and inflammation were increased by acid-based and decreased by polystyrene-based polymer coating both in vitro in murine macrophages and in vivo in lung of mice monitored for 6 months.CONCLUSIONS: these results demonstrate that coating CNT with polymers, without affecting their intrinsic structure, may constitute a useful strategy for decreasing CNT toxicity, and may hold promise for improving occupational safety and that of general the user.

Which European Public Sphere? Normative Standards and Empirical Insights from Multilingual Switzerland

Since the beginning of the 1990s, the EU has been increasingly criticised for its democratic deficit, which is intrinsically linked to the absence of a public sphere at the European level. Whereas scholars consider the emergence of such a public sphere as a necessary requirement for the democratisation of the EU, they disagree on the conceptualisation and normative requirements for a meaningful public sphere at the European level. This article takes an empirical perspective and draws on the nation-state context of multilingual Switzerland to get insights into what a European public sphere might realistically look like. Based on a content analysis of the leading quality paper from each German- and French-speaking Switzerland by means of political claims analysis, it shows that three of the most often cited criteria for a European public sphere - horizontal openness and interconnectedness, shared meaning structures, and inclusiveness - are hardly met in the Swiss context. On this basis, it concludes that the normative barrier for finding a European public sphere might be unrealistically high and should be reconsidered.

Intergenerational representations of schistosomiasis in endemic area, Jaboticatubas, Minas Gerais

The analysis of the intergenerational process of disease/health representations constitutes a requisite for the construction of projects and health education interventions. The objective of this work is to describe the meaning attributed to schistosomiasis in the family context. Twenty-one residents of an endemic area were interviewed. The interviews were submitted to content analysis. The results demonstrated different representations of the disease by the children, parents and grandparents. This paper discusses the differences in these representations and its impact in schistosomiasis control programs.

Job Insecurity and the Timing of Parenthood: A Comparison between Eastern and Western Germany

This article contributes to the ongoing debate on the economic deter- minants of fertility behavior by addressing the role of job insecurity in couples' intentions concerning parenthood and its timing. It starts from the hypothesis that cultural values moderate individuals' reactions to job insecurity and the way it is related to family formation. With a systematic thematic content analysis of a set of semi-structured interviews with childless men and women around the age of 30 in eastern and western Germany, we are able to show that there are substantial dif- ferences in the consequences of job insecurity on intentions to have a first child. In western Germany, a relatively secure job career is expected to precede family formation, and this sequence of transitions is rather rigid, whereas in eastern Germany job security and family formation are thought of and practiced as parallel investments. We suggest that the lack of convergence in family formation patterns between eastern and western Germany after the unification of the country in 1990 is partially related to different attitudes toward job insecurity in the two contexts.

Modernització tecnològica, canvi organitzatiu i serveis als usuaris en el sistema de salut de Catalunya. Informe de recerca (volum III)

Aquest estudi va analitzar la interacció del canvi organitzatiu, els valors culturals i el canvi tecnològic en el sistema sanitari català. L'estudi se subdivideix en cinc parts diferents. La primera és una anàlisi de contingut de webs relacionats amb la salut a Catalunya. La segona és un estudi dels usos d'Internet en qüestions relacionades amb la salut entre la població en general, les associacions de pacients i els professionals de la salut, i es basa en un sondeig per Internet adaptat a cada un d'aquests grups. La tercera part és un estudi de treball de camp dels programes experimentals duts a terme pel Govern català en diverses àrees i hospitals locals per a integrar electrònicament la història clínica dels pacients. La quarta és un estudi de les implicacions organitzatives de la introducció de sistemes d'informació en la gestió d'hospitals i centres d'assistència primària a l'Institut Català de Salut, el principal proveïdor de salut pública a Catalunya, i es basa en un sondeig per Internet i entrevistes en profunditat. La cinquena part és un estudi de cas dels efectes organitzatius i socials de la introducció de les tecnologies de la informació i la comunicació en un dels principals hospitals de Catalunya, l'Hospital Clínic de Barcelona. L'estudi es va dur a terme entre el maig del 2005 i el juliol del 2007.

Factors influencing interprofessional practices of physiotherapists working in private settings with people with low back pain: a qualitative study

Purpose: Collaboration and interprofessional practices are highly valued in health systems everywhere, partly based on the rationale that they improve outcomes of care for people with complex health problems, such as low back pain. Research in the area of low back pain also supports the involvement of different health professionals in the interventions for people who present this condition. The aim of this studywas to identify factors influencing the interprofessional practices of physiotherapists working in private settings with people with low back pain. Relevance: Physiotherapists, like other health professionals, are encouraged to engage in interprofessional practices in their dailywork. However, to date, very little is known of their interprofessional practices, especially in private settings. Understanding physiotherapists' interprofessional practices and their influencing factors will notably advance knowledge relating to the organisation of physiotherapy services for people with low back pain. Participants: Participants in this study were 13 physiotherapists including 10 women and 3 men, having between 3 and 22 years of professional experience, and working in one of 10 regions of the Province of Quebec (Canada). In order to obtain maximal variation in the perspectives, participants were selected using a recruitment matrix including three criteria: duration of professional experience, work location, and physical proximity with other professionals. Methods: Thiswas a descriptive qualitative study using faceto- face semi-structured interviews as the main method of data collection. An interview guide was developed based on an evidence-derived frame of reference. Each interview lasted between 55 and 95 minutes and was transcribed verbatim. Analysis: Qualitative analyses took the form of content analysis, encompassing data coding and general thematic regrouping. NVivo version 8 was used to assist data organisation and analysis. Results: Multiple factors influencing the interprofessional practices of physiotherapists were identified. The main factors include the consulting person's health condition, the extent of knowledge on health professionals' roles and fields of practice, the proximity and availability of professional resources, as well as daily work schedules. Conclusions: Our findings highlight the influence of multiple factors on physiotherapists' interprofessional practices, including professional practice and organisational issues. However, further research on the interprofessional practices of physiotherapists is still required. Research priorities targeting the views of other health professionals, as well as those of services users, would enhance our comprehension of interprofessional practices of physiotherapists. Implications: This study provides new insights that improve our understanding of the interprofessional practices of physiotherapists working in private settings with people with low back pain, more specifically on the factors influencing these practices. Based on our findings, implementing changes such as improving current and future health professionals' knowledge of the fields and roles of other health professionals through training may contribute to positively influencing interprofessional practices. Keywords: Interprofessional practices; Private practice; Low back pain Funding acknowledgements: This research was supported in part by a B.E. Schnurr Memorial Fund Research Grant administered by the Physiotherapy Foundation of Canada, as well as from a clinical research partnership in physiotherapy between the Quebec Rehabilitation Research Network (REPAR) and the Ordre professionnel de la physiothérapie du Québec (OPPQ). KP received doctoral-level scholarships from the Canadian Institutes of Health Research (CIHR) and the Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST). CE Dionne is a FRSQ senior Research Scholar. Ethics approval: This project was approved by the ethics research committee of the Institut de réadaptation en déficience physique de Québec.

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The nervous system is a frequent target of industrial chemicals, pharmaceuticals, and environmental pollutants. To screen large numbers of compounds for their neurotoxic potential, in vitro systems are required which combine organ-specific traits with robustness and high reproducibility. These requirements are met by serum-free aggregating brain cell cultures derived from mechanically dissociated embryonic rat brain. The initial cell suspension, composed of neural stem cells, neural progenitor cells, immature postmitotic neurons, glioblasts, and microglial cells, is kept under continuous gyratory agitation. Spherical aggregates form spontaneously and are maintained in suspension culture for several weeks. Within the aggregates, the cells rearrange and mature, reproducing critical morphogenic events such as migration, proliferation, differentiation, synaptogenesis, and myelination. In addition to the spontaneous reconstitution of histotypic brain architecture, the cultures acquire organ-specific functionality as indicated by activity-dependent glucose consumption, spontaneous electrical activity, and brain-specific inflammatory responses. These three-dimensional primary cell cultures offer therefore a unique model for neurotoxicity testing both during development and at advanced cellular differentiation. The high number of aggregates available and the excellent reproducibility of the cultures facilitate routine test procedures. This chapter presents a detailed description of the preparation and maintenance of these cultures as well as their use for routine toxicity testing.

The use of palliative sedation: A comparison of attitudes of French-speaking physicians from Quebec and Switzerland.

OBJECTIVE: Previous literature has suggested that laws and regulations may impact the use of palliative sedation. Our present study compares the attitudes of French-speaking physicians practicing in the Quebec and Swiss environments, where different laws are in place regarding physician-assisted suicide. METHOD: Data were drawn from two prior studies, one by Blondeau and colleagues and another by Beauverd and coworkers, employing the same two-by-two experimental design with length of prognosis and type of suffering as independent variables. Both the effect of these variables and the effect of their interaction on Swiss and Quebec physicians' attitudes toward sedation were compared. The written comments of respondents were submitted to a qualitative content analysis and summarized in a comparative perspective. RESULTS: The analysis of variance showed that only the type of suffering had an effect on physicians' attitudes toward sedation. The results of the Wilcoxon test indicated that the attitudes of physicians from Quebec and Switzerland tended to be different for two vignettes: long-term prognosis with existential suffering (p = 0.0577) and short-term prognosis with physical suffering (p = 0.0914). In both cases, the Swiss physicians were less prone to palliative sedation. SIGNIFICANCE OF RESULTS: The attitudes of physicians from Quebec and Switzerland toward palliative sedation, particularly regarding prognosis and type of suffering, seem similar. However, the results suggest that physicians from Quebec could be slightly more open to palliative sedation, even though most were not in favor of this practice as an answer to end-of-life existential suffering.

A Thematic Comparison of Eight Frameworks of Quality Criteria in Qualitative Health Research

Background: Despite the increasing incidences of the publication of assessment frameworks intending to establish the "standards" of the quality of qualitative research, the research conducted using such empirical methods are still facing difficulties in being published or recognised by funding agencies. Methods: We conducted a thematic content analysis of eight frameworks from psychology/psychiatry and general medicine. The frameworks and their criteria are then compared against each other. Findings: The results illustrated the difficulties in reaching consensus on the definition of quality criteria. This showed the differences between the frameworks from the point of views of the underlying epistemology and the criteria suggested. Discussion: The aforementioned differences reflect the diversity of paradigms implicitly referred to by the authors of the frameworks, although rarely explicitly mentioned in text. We conclude that the increase in qualitative research and publications has failed to overcome the difficulties in establishing shared criteria and the great heterogeneity of concepts raises methodological and epistemological problems.