Patterns and factors associated with low adherence to psychotropic medications during pregnancy-a cross-sectional, multinational web-based study.

BACKGROUND: No previous studies have explored how closely women follow their psychotropic drug regimens during pregnancy. This study aimed to explore patterns of and factors associated with low adherence to psychotropic medication during pregnancy. METHODS: Multinational web-based study was performed in 18 countries in Europe, North America, and Australia. Uniform data collection was ensured via an electronic questionnaire. Pregnant women were eligible to participate. Adherence was measured via the 8-item Morisky Medication Adherence Scale (MMAS-8). The Beliefs about Prescribed Medicines Questionnaire (BMQ-specific), the Edinburgh Postnatal Depression Scale (EPDS), and a numeric rating scale were utilized to measure women's beliefs, depressive symptoms, and antidepressant risk perception, respectively. Participants reporting use of psychotropic medication during pregnancy (n = 160) were included in the analysis. RESULTS: On the basis of the MMAS-8, 78 of 160 women (48.8%, 95% CI: 41.1-56.4%) demonstrated low adherence during pregnancy. The rates of low adherence were 51.3% for medication for anxiety, 47.2% for depression, and 42.9% for other psychiatric disorders. Smoking during pregnancy, elevated antidepressant risk perception (risk≥6), and depressive symptoms were associated with a significant 3.9-, 2.3-, and 2.5-fold increased likelihood of low medication adherence, respectively. Women on psychotropic polytherapy were less likely to demonstrate low adherence. The belief that the benefit of pharmacotherapy outweighed the risks positively correlated (r = .282) with higher medication adherence. CONCLUSIONS: Approximately one of two pregnant women using psychotropic medication demonstrated low adherence in pregnancy. Life-style factors, risk perception, depressive symptoms, and individual beliefs are important factors related to adherence to psychotropic medication in pregnancy.

Spanish adaptation of the Expectancy Questionnaire (EQ) about alcohol effects in adolescents

Background: Alcohol-related expectancies are especially relevant in relation to alcohol consumption during adolescence. The main aim of this study was to adapt and translate into Spanish (Castilian) the Expectancy Questionnaire (EQ), and to study its psychometric properties in adolescents. Method: The sample was composed of 514 adolescents (57.20% female, mean age = 15.21; SD = .63) who completed the EQ and the alcohol consumption questionnaire AIS-UJI. Results: Confi rmatory factor analysis indicated that an eight-factor model, grouped into two general factors of positive and negative expectancies, had acceptable fi t indices. Cronbach’s alphas ranged from .75 to .96. Finally, the structural equation model showed that positive expectancies were positively related to alcohol use, whereas negative expectancies were negatively related to drinking. Conclusions: Results showed that the Spanish version of the EQ for adolescents is a valid and reliable questionnaire to measure expectancies about alcohol effects.

The transtheoretical model in weight management: Validation of the Processes of Change Questionnaire

Objective: The processes of change implied in weight management remain unclear. The present study aimed to identify these processes by validating a questionnaire designed to assess processes of change (the P-Weight) in line with the transtheoretical model. The relationship of processes of change with stages of change and other external variables is also examined. Methods: Participants were 723 people from community and clinical settings in Barcelona. Their mean age was 32.07 (SD = 14.55) years; most of them were women (75.0%), and their mean BMI was 26.47 (SD = 8.52) kg/m2. They all completed the P-Weight and the stages of change questionnaire (SWeight), both applied to weight management, as well as two subscales from the Eating Disorders Inventory-2 and Eating Attitudes Test-40 questionnaires about the concern with dieting. Results: A 34-item version of the PWeight was obtained by means of a refinement process. The principal components analysis applied to half of the sample identified four processes of change. A confirmatory factor analysis was then carried out with the other half of the sample, revealing that the model of four freely correlated first-order factors showed the best fit (GFI = 0.988, AGFI = 0.986, NFI = 0.986, and SRMR = 0.0559). Corrected item-total correlations (0.322-0.865) and Cronbach"s alpha coefficients (0.781-0.960) were adequate. The relationship between the P-Weight and the S-Weight and the concern with dieting measures from other questionnaires supported the validity of the scale. Conclusion: The study identified processes of change involved in weight management and reports the adequate psychometric properties of the P-Weight. It also reveals the relationship between processes and stages of change and other external variables.

Innovaatiojohtaminen suunnittelutoimistossa

Työn tavoitteena oli tutkia konsulttiyrityksen metsäteollisuusliiketoimintaryhmän innovatiivisuutta sekä sitä, onko johdon asettamia innovatiivisuuden tavoitteita saavutettu. Tavoitteena oli myös laatia innovaatiojohtamisen malli sekä antaa toimenpide-ehdotuksia ja suosituksia. Tutkimuksen teoriaosuus tehtiin kirjallisuustutkimuksena ja siinä selvitettiin, mitä innovatiivisuus merkitsee yrityksille, mitkä asiat vaikuttavat organisaation innovatiivisuuteen ja mitä innovaatiojohtamisessa tulee ottaa huomioon. Tutkimuksen empiirinen osuus suoritettiin case-analyysinä, ja se toteutettiin linjajohdon henkilöhaastattelujen, ja henkilöstölle tehtyjen kyselyjen avulla. Innovaatio on idean toimeenpano käytännössä, markkinoille saatettu toteutus tai uusittu prosessi. Jos innovaatioiden avulla saavutetaan radikaalia parannusta, niin kaizen-filosofia on pienin askelin tehtävää jatkuvaa parantamista. Yritysten innovatiivisuuteen vaikuttaa sekä kovia että pehmeitä asioita. Kovia asioita ovat mm. strategia, organisaation rakenne ja järjestelmät. Pehmeitä asioita taas ovat mm. yhteiset arvot, osaaminen, henkilöstö ja johtamistyyli. Kaikki edellä mainitut asiat tulee huomioida innovatiivisuuden kehittämisessä. Yritysten tietopääoma syntyy kyvystä käyttää hyväksi aineetonta pääomaa, joka on mm. dataa, informaatiota, immateriaalioikeuksia, osaamista, motivaatiota ja sitoutumista. Tutkitun konsulttiyrityksen metsäteollisuusliiketoimintaryhmällä on johdon asettamat innovatiivisuustavoitteet. Yrityksessä on valtavasti irrallista tietoa. Henkilöstön osaaminen ja motivaatio ovat korkeata luokkaa. Yritykselle on määritelty strategia, mutta sen jalkauttaminen henkilöstölle ei ole ollut tehokasta. Tutkitulla yrityksellä on monia innovatiivisuuteen kannustavia järjestelmiä. Järjestelmien käyttö on vain pienen ryhmän käytössä. Yrityksen innovatiivisuuspotentiaali on valtava. Toimenpide-ehdotuksina ja suosituksina esitetään yritykselle innovaatiojohtamisen mallia. Esitetyssä mallissa määritellään mm. innovaatiojohtamisen vastuut uudelleen. Innovaatioprosessi määritellään kokonaisvaltaisena asiana. Nykyisten järjestelmien käyttö laajennetaan koko henkilöstön käytettäväksi

Quality of life after pulmonary embolism: Prospective validation of the German version of the PEmb-QoL questionnaire.

BACKGROUND: The Pulmonary Embolism Quality of Life questionnaire (PEmb-QoL) is a 40-item questionnaire to measure health-related quality of life in patients with pulmonary embolism. It covers six 6 dimensions: frequency of complaints, limitations in activities of daily living, work-related problems, social limitations, intensity of complaints, and emotional complaints. Originally developed in Dutch and English, we prospectively validated a German version of the PEmb-QoL. METHODS: A forward-backward translation of the English version of the PEmb-QoL into German was performed. German-speaking consecutive adult patients aged ≥18 years with an acute, objectively confirmed pulmonary embolism discharged from a Swiss university hospital (01/2011-06/2013) were recruited telephonically. Established psychometric tests and criteria were used to evaluate the acceptability, reliability, and validity of the German PEmb-QoL questionnaire. To assess the underlying dimensions, an exploratory factor analysis was performed. RESULTS: Overall, 102 patients were enrolled in the study. The German version of the PEmb-QoL showed a good internal consistency (Cronbach's alpha ranging from 0.72 to 0.96), item-total (0.53-0.95) and inter-item correlations (>0.4), and test-retest reliability (intra-class correlation coefficients 0.59-0.89) for the dimension scores. A moderate correlation of the PEmb-QoL with SF-36 dimension and summary scores (0.21-0.83) indicated convergent validity, while low correlations of PEmb-QoL dimensions with clinical characteristics (-0.16-0.37) supported discriminant validity. The exploratory factor analysis suggested four underlying dimensions: limitations in daily activities, symptoms, work-related problems, and emotional complaints. CONCLUSION: The German version of the PEmb-QoL questionnaire is a valid and reliable disease-specific measure for quality of life in patients with pulmonary embolism.

Évaluation de la politique de formation de la police. Enquête par questionnaire et entretiens approfondis auprès des policiers/ères récemment assermenté-e-s

Ce rapport de recherche a été commandé par la Commission externe d'évaluation des politiques publiques du Canton de Genève (Suisse) dans le cadre d'une évaluation de la politique de formation de la police dans ce canton. L'étude montre que, d'une manière générale, les policiers/ères récemment assermenté-e-s jugent positivement leur formation, en particulier certains éléments du dispositif pédagogique (durée de la formation, charge de travail, formateurs/trices) et se sentent bien préparé-e-s à gérer les contacts avec leurs différents publics (en particulier les personnes agressives et les victimes de violences domestiques). Néanmoins, la plupart des policiers/ères interrogé-e-s perçoivent le travail effectué au sein des services comme étant éloigné des prescriptions scolaires. Ils estiment que ces dernières ne sont pas celles qui sont appliquées par leurs collègues expérimenté-e-s. Les matières physico-techniques sont, d'une manière générale, considérées comme plus utiles et plus importantes que les matières relationnelles. Dans cet ordre d'idée, un certain nombre de policiers/ères réclament moins de psychologie. Il s'agit cependant de la matière relationnelle à propos de laquelle les jugements sont les plus nuancés, en particulier à propos des savoirs permettant de gérer les personnes présentant des troubles mentaux, d'améliorer la communication et de gérer les conflits (au détriment de ceux visant à l'introspection). Les enseignements de police de proximité ont quant à eux tendance à être associés à une spécialisation propre à la gendarmerie et inutile pour les nouveaux/elles entrant-e-s, en particulier les inspecteurs/trices. L'éthique et les droits de l'Homme concentrent par contre les jugements négatifs : ces cours sont perçus comme diffusant des « bonnes paroles » prêchées par des formateurs/trices extérieurs à la profession (si ce n'est réellement, du moins symboliquement), éloignées de la réalité du métier et échouant à combattre les préjugés, en particulier ceux basés sur l'origine ethnico-nationale. L'étude montre en outre que les compétences relationnelles et les rapports aux différents publics sont centrales dans les appréciations portées sur l'adéquation entre formation et pratique. À ce sujet, ont été repérés néanmoins des points qui posent problèmes (aux yeux des policiers/ères interrogé-e-s ou à nos yeux) : peu de réflexivité en ce qui concerne les risques associés au «délit de faciès», problèmes avec les « maghrébins » et les jeunes en groupe (liés en particulier à la remise en cause de l'autorité policière), imprévisibilité des consommateurs/trices de drogue et vision pessimiste (parfois très peu empathique) de la toxicomanie, sentiment de difficulté et d'inconfort associé aux tâches visant à prendre en charge la souffrance d'autrui, relégation de la plupart des situations de violence domestique au rang de tâches indues, difficultés associées aux contacts avec les personnes atteintes de maladies psychiques graves, et la mention en priorité des cours de TTI pour la gestion des personnes agressives (au détriment des matières relationnelles).

Human Capital Questionnaire (PHCQ): Assessment of European nurses' perception as indicators of human capital quality

Healthcare accreditation models generally include indicators related to healthcare employees' perceptions (e.g. satisfaction, career development, and health safety). During the accreditation process, organizations are asked to demonstrate the methods with which assessments are made. However, none of the models provide standardized systems for the assessment of employees. In this study, we analyzed the psychometric properties of an instrument for the assessment of nurses' perceptions as indicators of human capital quality in healthcare organizations. The Human Capital Questionnaire was applied to a sample of 902 nurses in four European countries (Spain, Portugal, Poland, and the UK). Exploratory factor analysis identified six factors: satisfaction with leadership, identification and commitment, satisfaction with participation, staff well-being, career development opportunities, and motivation. The results showed the validity and reliability of the questionnaire, which when applied to healthcare organizations, provide a better understanding of nurses' perceptions, and is a parsimonious instrument for assessment and organizational accreditation. From a practical point of view, improving the quality of human capital, by analyzing nurses and other healthcare employees' perceptions, is related to workforce empowerment.

Organisaation päätöksenteko ja tiedon rooli. Case: UPM-Kymmene Oyj, Kaukas

Tutkielman tavoitteena on selvittää, mihin päätöksenteko perustuu teollisuusyrityksessä. Tutkimuksessa kartoitettiin kohdeorganisaation päätöksentekijöiden näkemyksiä toimintaympäristöstään, itsestään päätöksentekijöinä ja päätöksenteosta sekä tiedosta ja sen käytöstä. Lisäksi sivutaan päätöksenteon sosiaalista luonnetta. Empiirisen tutkimuksen kohdeyksikkönä on UPM-Kymmene Oyj, Kaukas Lappeenrannassa. Tutkimus on toteutettu esimiestasolle suunnattuna lomakekyselynä lokakuussa 2003. Päätöksistä yleisimpiä olivat operatiivisen tason päätökset; taktisen ja strategisen tason päätöksiä tehtiin vähemmän. Päätöstilanteista useimmin kohdattuja olivat puolijäsentyneet ja jäsentyneet tilanteet, kun taas jäsentymättömät päätöstilanteet olivat harvinaisempia. Päätöksentekoprosesseista yleisimmin käytetty oli kirjallisuudessa taktiseen päätöstasoon ja puolijäsentyneisiin päätöstilanteisiin liitetty rajoitetun rationaalisuuden malliin perustuva vaiheittainen malli. Kirjallisuudessa strategiseen päätöksentekotasoon ja jäsentymättömiin päätöstilanteisiin liitetyn ns. iteratiivisesti vaiheittaisen mallin todettiin soveltuvan myös tämänkaltaiseen päätöksentekoon. Esimiehet pitivät toimintaympäristöään teollisuusyrityksessä pääasiallisesti orgaanisena. Tällaisessa ympäristössä vaikutussuhteet ja keinot ohjata ympäristöä perustuvat pitkälti vuorovaikutteisuuteen. Päätöksentekijöiden johtamistyylin todettiin olevan pikemminkin demokraattinen kuin autoritäärinen, mikä tukee edellä mainittuja tuloksia. Tiedon lähteistä päätöksenteon kannalta tärkeimpinä ja luotettavimpina koettiin henkilökohtaiset lähteet. Sisäiset lähteet nähtiin ulkoisia tärkeämpinä ja luotettavampina niin henkilökohtaisten, tekstimuotoisten kuin online-lähteidenkin osalta. Esimiesten todettiin hyödyntävän tosiasiatietoa, kokemusta ja intuitiota eri tavoin erilaisissa päätöstilanteissa, joten myös tehokkaat keinot tukea päätöksentekoa vaihtelevat päätöstyypeittäin. Tutkimuksen tulokset perustuvat kohderyhmän kyselylomakkeella kerättyihin mielipiteisiin. Käytetystä menetelmästä johtuen mielipiteiden taustatekijät ja todellinen toiminta organisaatiossa jäävät vielä avoimiksi. Tutkimustulosten syventäminen ja vahvistaminen sekä lisätiedon saaminen organisaation päätöksenteon todellisuudesta edellyttäisi empiiristä havainnointia tai vähintäänkin haastatteluja.

Attachment, psychopathology, and religion: Introduction to this special section of Mental Health, Religion, & Culture

An international conference of psychology of religion, organised at the University of Lausanne (Switzerland) on 16 May 2012, took up the theme: "Attachment, psychopathology, and religion". Four speakers were invited: Pehr Granvist, Andrew Gumley, Isabelle Rieben, and Pascal Roman. Their reworked contributions are gathered in this special section of Mental Health, Religion, & Culture. The goal of this special section is to re-examine the whole of this subject of the bond between attachment and religion and/or spirituality in the cases of those persons suffering from mental health disorders.

Attachment and spiritual coping in patients with chronic schizophrenia

Many studies on spirituality in psychosis have shown that, compared to a nonclinical population, patients make more use of spiritual beliefs/religious practices to deal with their problems. Our research question was to test whether attachment to spiritual figures could be a good explanation for religious coping strategies in patients with psychosis. First, adult attachment was investigated in 28 patients with chronic psychosis and 18 controls, using the Adult Attachment Interview. Diagnostic evaluations were performed with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (4th edition, Text Revision) Axis I disorders and symptomatic evaluation with the Brief Psychiatric Rating Scale. Results also show a high prevalence of insecure avoidant attachment in patients, and suggest that a significant part of religious coping might be explained by the theory of attachment (64% of the patients, 78% of controls). The implications of these results are interpreted in light of correspondence and compensation hypotheses.

Development process and initial validation of the ethical conflict in nursing questionnaire-critical care version

Background: Ethical conflicts are arising as a result of the growing complexity of clinical care, coupled with technological advances. Most studies that have developed instruments for measuring ethical conflict base their measures on the variables"frequency" and"degree of conflict". In our view, however, these variables are insufficient for explaining the root of ethical conflicts. Consequently, the present study formulates a conceptual model that also includes the variable"exposure to conflict", as well as considering six"types of ethical conflict". An instrument was then designed to measure the ethical conflicts experienced by nurses who work with critical care patients. The paper describes the development process and validation of this instrument, the Ethical Conflict in Nursing Questionnaire Critical Care Version (ECNQ-CCV). Methods: The sample comprised 205 nursing professionals from the critical care units of two hospitals in Barcelona (Spain). The ECNQ-CCV presents 19 nursing scenarios with the potential to produce ethical conflict in the critical care setting. Exposure to ethical conflict was assessed by means of the Index of Exposure to Ethical Conflict (IEEC), a specific index developed to provide a reference value for each respondent by combining the intensity and frequency of occurrence of each scenario featured in the ECNQ-CCV. Following content validity, construct validity was assessed by means of Exploratory Factor Analysis (EFA), while Cronbach"s alpha was used to evaluate the instrument"s reliability. All analyses were performed using the statistical software PASW v19. Results: Cronbach"s alpha for the ECNQ-CCV as a whole was 0.882, which is higher than the values reported for certain other related instruments. The EFA suggested a unidimensional structure, with one component accounting for 33.41% of the explained variance. Conclusions: The ECNQ-CCV is shown to a valid and reliable instrument for use in critical care units. Its structure is such that the four variables on which our model of ethical conflict is based may be studied separately or in combination. The critical care nurses in this sample present moderate levels of exposure to ethical conflict. This study represents the first evaluation of the ECNQ-CCV.

Development process and initial validation of the ethical conflict in nursing questionnaire-critical care version

Background: Ethical conflicts are arising as a result of the growing complexity of clinical care, coupled with technological advances. Most studies that have developed instruments for measuring ethical conflict base their measures on the variables"frequency" and"degree of conflict". In our view, however, these variables are insufficient for explaining the root of ethical conflicts. Consequently, the present study formulates a conceptual model that also includes the variable"exposure to conflict", as well as considering six"types of ethical conflict". An instrument was then designed to measure the ethical conflicts experienced by nurses who work with critical care patients. The paper describes the development process and validation of this instrument, the Ethical Conflict in Nursing Questionnaire Critical Care Version (ECNQ-CCV). Methods: The sample comprised 205 nursing professionals from the critical care units of two hospitals in Barcelona (Spain). The ECNQ-CCV presents 19 nursing scenarios with the potential to produce ethical conflict in the critical care setting. Exposure to ethical conflict was assessed by means of the Index of Exposure to Ethical Conflict (IEEC), a specific index developed to provide a reference value for each respondent by combining the intensity and frequency of occurrence of each scenario featured in the ECNQ-CCV. Following content validity, construct validity was assessed by means of Exploratory Factor Analysis (EFA), while Cronbach"s alpha was used to evaluate the instrument"s reliability. All analyses were performed using the statistical software PASW v19. Results: Cronbach"s alpha for the ECNQ-CCV as a whole was 0.882, which is higher than the values reported for certain other related instruments. The EFA suggested a unidimensional structure, with one component accounting for 33.41% of the explained variance. Conclusions: The ECNQ-CCV is shown to a valid and reliable instrument for use in critical care units. Its structure is such that the four variables on which our model of ethical conflict is based may be studied separately or in combination. The critical care nurses in this sample present moderate levels of exposure to ethical conflict. This study represents the first evaluation of the ECNQ-CCV.