Attitudes and burden in relatives of patients with schizophrenia in a middle income country

BACKGROUND: Most studies of family attitudes and burden have been conducted in developed countries. Thus it is important to test the generalizability of this research in other contexts where social conditions and extended family involvement may be different. The aim of this study was to assess the relationship between the attitudes of caregivers and the burden they experience in such a context, namely Arica, a town located in the northernmost region of Chile, close to the border with Peru and Bolivia. METHODS: We assessed attitudes towards schizophrenia (including affective, cognitive and behavioural components) and burden (including subjective distress, rejection and competence) in 41 main caregivers of patients with schizophrenia, all of whom were users of Public Mental Health Services in Arica. RESULTS: Attitude measures differed significantly according to socio-demographic variables, with parents (mainly mothers) exhibiting a more negative attitude towards the environment than the rest of the family (t = 4.04; p = 0.000).This was also the case for caregivers with a low educational level (t = 3.27; p < 0.003), for the oldest caregivers (r = 0.546; p = 0.000) and for those who had spent more time with the patient (r = 0.377; p = 0.015). Although attitudes had significant association with burden, their explanatory power was modest (R2 = .104, F = 4,55; p = .039). CONCLUSIONS: Similar to finding developed countries, the current study revealed a positive and significant relationship between the attitudes of caregivers and their burden. These findings emphasize the need to support the families of patients with schizophrenia in this social context.

A comprehensive model for quantum noise characterization in digital mammography.

NlmCategory="UNASSIGNED">A version of cascaded systems analysis was developed specifically with the aim of studying quantum noise propagation in x-ray detectors. Signal and quantum noise propagation was then modelled in four types of x-ray detectors used for digital mammography: four flat panel systems, one computed radiography and one slot-scan silicon wafer based photon counting device. As required inputs to the model, the two dimensional (2D) modulation transfer function (MTF), noise power spectra (NPS) and detective quantum efficiency (DQE) were measured for six mammography systems that utilized these different detectors. A new method to reconstruct anisotropic 2D presampling MTF matrices from 1D radial MTFs measured along different angular directions across the detector is described; an image of a sharp, circular disc was used for this purpose. The effective pixel fill factor for the FP systems was determined from the axial 1D presampling MTFs measured with a square sharp edge along the two orthogonal directions of the pixel lattice. Expectation MTFs were then calculated by averaging the radial MTFs over all possible phases and the 2D EMTF formed with the same reconstruction technique used for the 2D presampling MTF. The quantum NPS was then established by noise decomposition from homogenous images acquired as a function of detector air kerma. This was further decomposed into the correlated and uncorrelated quantum components by fitting the radially averaged quantum NPS with the radially averaged EMTF(2). This whole procedure allowed a detailed analysis of the influence of aliasing, signal and noise decorrelation, x-ray capture efficiency and global secondary gain on NPS and detector DQE. The influence of noise statistics, pixel fill factor and additional electronic and fixed pattern noises on the DQE was also studied. The 2D cascaded model and decompositions performed on the acquired images also enlightened the observed quantum NPS and DQE anisotropy.

Whole-body MRI: comprehensive evaluation on a 48-channel 3T MRI system in less than 40 minutes. Preliminary results

OBJECTIVE: To evaluate a comprehensive MRI protocol that investigates for cancer, vascular disease, and degenerative/inflammatory disease from the head to the pelvis in less than 40 minutes on a new generation 48-channel 3T system. MATERIALS AND METHODS: All MR studies were performed on a 48-channel 3T MR scanner. A 20-channel head/neck coil, two 18-channel body arrays, and a 32-channel spine array were employed. A total of 4 healthy individuals were studied. The designed protocol included a combination of single-shot T2-weighted sequences, T1-weighted 3D gradient-echo pre- and post-gadolinium. All images were retrospectively evaluated by two radiologists independently for overall image quality. RESULTS: The image quality for cancer was rated as excellent in the liver, pancreas, kidneys, lungs, pelvic organs, and brain, and rated as fair in the colon and breast. For vascular diseases ratings were excellent in the aorta, major branch vessel origins, inferior vena cava, portal and hepatic veins, rated as good in pulmonary arteries, and as poor in the coronary arteries. For degenerative/inflammatory diseases ratings were excellent in the brain, liver and pancreas. The inter-observer agreement was excellent. CONCLUSION: A comprehensive and time efficient screening for important categories of disease processes may be achieved with high quality imaging in a new generation 48-channel 3T system.

Entrepreneurial Initiative Selling Within Organizations: Towards a More Comprehensive Motivational Framework

We develop and test a motivational framework to explain the intensity with which individuals sell entrepreneurial initiatives within their organizations. Initiative selling efforts may be driven by several factors that hitherto have not been given full consideration: initiative characteristics, individuals' anticipation of rewards, and their level of dissatisfaction. On the basis of a survey in a mail service firm of 192 managers who proposed an entrepreneurial initiative, we find that individuals' reported intensity of their selling efforts with respect to that initiative is greater when they (1) believe that the organizational benefits of the initiative are high, (2) perceive that the initiative is consistent with current organizational practices (although this effect is weak), (3) believe that their immediate organizational environment provides extrinsic rewards for initiatives, and (4) are satisfied with the current organizational situation. These findings extend previous expectancy theory-based explanations of initiative selling (by considering the roles of initiative characteristics and that of initiative valence for the proponent) and show the role of satisfaction as an important motivational driver for initiative selling.

Cost-effectiveness of Tenofovir / Emtricitabine / Efavirenz versus Zidovudine / Lamivudine / Efavirenz as fist-line regimens for the treatment of HIV-infected patients in low-income settings

The Highly Active Antiretroviral Therapy (HAART) is the combination of at least three antiretroviral compounds. The combination purpose is to reduce the likelihood of drug resistance. However in the long-term the resistance to the first-line combination occurs and leads to treatment failure. Thus, a second-line and even a third-line regimen are recommended in the long run. [...] [P. 5] The two treatment alternatives under comparison: Tenofovir (300 mg) CO-formulated with Emtricitabine (200 mg) and Efavirenz (600 mg) currently known under the brand name Atripla (R) was introduced in July 2006 in the United States market. The excellent safety profile and ease of use make this combination a perfect first-line regimen in low-income settings. Therefore, this treatment option was recommended in WHO 2006 reviewed guidelines. Unfortunately, Tenofovir and Emtricitabine compounds are still costly and not yet widely available. For a matter of simplification this regimen is referred in this report as "the recent" therapy. Initially, we had in mind to consider the most frequently used first-line regimen in low-income countries (Stavudine / Larnivudme / Nevirapine) as a comparator for this economic evaluation. Unfortunately, according to the literature review results (see Annex 3); there was no data available comparing head to head the effectiveness of this regimen with the recent one. Instead, we selected a less frequently but commonly used first-line regimen in low-income countries as a comparator: Zidovudine, Lamivudine, Efavirenz. This combination has extensive experience in durability, safety and toxicity and seems to be an optimal choice for a first-line regimen according to the clinical trial group 384 team. Furthermore, Zidovudine, one of the compounds of this combination is now recommended as one of the preferred NNRTI [Non Nucleoside Reverse Transcriptase Inhibitors] options to be considered by countries instead of Stavudine (the most used NNRTI in limited-income countries). As this combination has been included in the WHO guidelines as a first-line therapy since 2003 when WHO launched the "3 by 5" scaling-up initiative, this combination of drugs is referred in this report as the "old" therapy. Objectives: The primary objective of this economic evaluation is to compare the two first-line HAARTs introduced above, in a low-income setting context. Both of these combinations are recommended by the 2006 WHO guidelines as potential first-line regimens. The secondary objective is to provide a simplified and comprehensible cost-effectiveness modeling tool in order to help policy makers, in resource-limited settings, make decisions about which first-line HAART to fund using the scarce resources available. [P. 6-7]

Ideal Body Size as a Mediator for the Gender-Specific Association Between Socioeconomic Status and Body Mass Index: Evidence From an Upper-Middle-Income Country in the African Region.

While obesity continues to rise globally, the associations between body size, gender, and socioeconomic status (SES) seem to vary in different populations, and little is known on the contribution of perceived ideal body size in the social disparity of obesity in African countries. We examined the gender and socioeconomic patterns of body mass index (BMI) and perceived ideal body size in the Seychelles, a middle-income small island state in the African region. We also assessed the potential role of perceived ideal body size as a mediator for the gender-specific association between SES and BMI. A population-based survey of 1,240 adults aged 25 to 64 years conducted in December 2013. Participants' BMI was calculated based on measured weight and height; ideal body size was assessed using a nine-silhouette instrument. Three SES indicators were considered: income, education, and occupation. BMI and perceived ideal body size were both higher among men of higher versus lower SES (p< .001) but lower among women of higher versus lower SES (p< .001), irrespective of the SES indicator used. Multivariate analysis showed a strong and direct association between perceived ideal body size and BMI in both men and women (p< .001) and was consistent with a potential mediating role of perceived ideal body size in the gender-specific associations between SES and BMI. Our study emphasizes the importance of gender and socioeconomic differences in BMI and ideal body size and suggests that public health interventions that promote perception of healthy weight could help mitigate SES-related disparities in BMI.

Sticky income inequality in the Spanish transition (1973-1990)

This paper investigates the evolution of income inequality in Spain during its transition to democracy, suggesting a method for the correction of under-reporting of earnings and profits in the Household Budget Surveys’ data. The contribution is twofold: the methodological proposal, based on income expenditure discrepancy and scaling-up to National Accounts, improves on previous work, and can be convenient for similar historical sources in other countries. Secondly, its application results in an alternative history of the distribution of income in this case, changing the levels and also the observed trend. Previous literature asserted a substantial equalization, related to the democratization process, while after the adjustment inequality in disposable income is shown to have been quite persistent.

Built environment and elderly population health: a comprehensive literature review

Global population aging over recent years has been linked to poorer health outcomes and higher healthcare expenditure. Policies focusing on healthy aging are currently being developed but a complete understanding of health determinants is needed to guide these efforts. The built environment and other external factors have been added to the International Classification of Functioning as important determinants of health and disability. Although the relationship between the built environment and health has been widely examined in working age adults, research focusing on elderly people is relatively recent. In this review, we provide a comprehensive synthesis of the evidence on the built environment and health in the elderly.

Specificity and selectivity improvement in doping analysis using comprehensive two-dimensional gas chromatography coupled with time-of-flight mass spectrometry

Comprehensive two-dimensional gas chromatography coupled with time-of-flight mass spectrometry was used for the identification of forty doping agents. The improvement in the specificity was remarkable, allowing the resolution of analytes that could not be done by one-dimensional chromatographic systems. The sensitivity observed for different classes of prohibited substances was clearly below the value required by the World Anti-Doping Agency. In addition time-of-flight mass spectrometry gives full spectrum for all analytes without any interference from the matrix, resulting in selectivity improvements. These results could support the implementation of an exhaustive monitoring approach for hundreds of doping agents in a single injection.

Developing a Comprehensive Model for Marketing Planning — Combining the Major Approaches

Mix marketing and relationships marketing are two major approaches that often form a basis for organizational marketing planning. The superiority of these approaches has been debated for long without any rational conclusion. Lately there have been studies indicating that both of the major approaches are many times used side by side in marketing planning. There have been also studies suggesting that even combining the mix marketing and relationship marketing approaches might be possible. The aim of this thesis is to provide knowledge about the usage of mix marketing and relationship marketing approaches in organizations and possibilities in combining the approaches. Also a settlement of strengths, weaknesses and risks of combining is intended to provide. The objectives were met through the literature and a case study research. In the case study, interviews were conducted in order to gain a deeper knowledge about marketing planning in various organizations. Based on this study, the combining of the major marketing approaches will be possible and even recommended when keeping in mind few aspects which might cause some troubles in the combining process.

Considering Target Groups in the Creation of a Comprehensive City Branding Process

The aim of the research was to create a comprehensive city branding process. This was done by identifying the key target groups of the city and considering them in the city branding process. Also key stakeholders were identified and taken into consideration when creating the branding process. As an empirical study, three first stages of the city branding process were implemented for the city of Lappeenranta having "students" as the case target group. An interview with the city officials was conducted, as well as a student survey on the current city image of Lappeenranta. Quantitative research methods were used to analyze the results of the survey. A comprehensive city branding process with eight stages was created in the research. Target groups were considered in the process by identifying the target group dependent stages. The empirical study revealed that the current city image held by the students consists of six dimensions. These dimensions were analyzed from the viewpoint of Lappeenranta with the help of an importance performance analysis.

Rahatalous

Suomen Pankin kirjaston rahatalouden kokoelma on maan kattavin ja monipuolisin rahatalouteen ja rahoitusmarkkinoihin painottunut kokoelma. Kokoelmaan kuuluu merkittävä määrä nimekkeitä, joita ei ole hankittu muihin suomalaisiin kirjastoihin. Rahatalouden kokoelma koostuu monografioista, painetuista kausijulkaisuista ja elektronisista lehtitietokannoista. Kokoelma on painottunut tieteelliseen kirjallisuuteen, joka tukee pankissa tehtävää tutkimusta. Lisäksi aineistossa on huomattava määrä yleistajuista kirjallisuutta rahatalouden eri aihealueilta. Rahatalouden kokoelmaan kuuluu monografioita n. 9000 nimekettä (joulukuu 2010). Kokoelma käsittää nimekkeitä useilta eri aihealueilta, kuten rahapolitiikka ja rahateoria (n. 900), valuutat, valuuttajärjestelmät ja valuuttakurssit (n. 1100), pankkitoiminta ja keskuspankit (n. 1300), rahoitusmarkkinat (n. 1700), yleinen talousteoria ja oppihistoria (n. 1300), talouspolitiikka ja -historia (n. 450), hyöty- ja hintateoriat (n. 300), taloudellinen kasvu ja kansantulo (n. 700), suhdanteet (n. 250), julkinen talous ja verotus (n. 400) ja ekonometria (n. 600). Lehtiä kokoelmaan kuuluu n. 300 nimekettä, joista edelleen tilataan 200 nimekettä. Osa lehdistä löytyy painettuna ja osa on käytettävissä kirjastoon hankittujen elektronisten lehtitietokantojen kautta. Kokoelma karttuu pääosin ostojen kautta ja uutta aineistoa hankitaan jatkuvasti. Kokoelmaa on kartutettu systemaattisesti 1950-luvulta lähtien, minkä vuoksi siihen kuuluu merkittävästi vanhempaa aineistoa. Kokoelmaan kuuluvista kirjoista n. 26 % on julkaistu 2000-luvulla ja n. 21 % 1990-luvulla. Varsin suuri osa kirjoista, n. 29 %, on julkaistu 1970- ja 1980-luvulla. Ennen vuotta 1950 julkaistua aineistoa on n. 10 % kokoelmasta. Aineisto on valtaosin englanninkielistä, mutta kokoelmaan kuuluu myös suomen-, ruotsin- ja saksankielisiä nimekkeitä. Monografiat on luokiteltu Suomen Pankin kirjaston oman luokitusjärjestelmän mukaan. Kokoelmaa säilytetään Suomen Pankin kirjaston tiloissa jaettuna avokokoelmaan ja varastokokoelmaan. Aineiston ensisijaisia käyttäjiä ovat pankin oma henkilökunta, mutta kirjasto on avoinna myös kaikille ulkoisille asiakkaille. Kokoelma on lainattavissa muutamia poikkeuksia lukuun ottamatta.

In pursuit of an intercultural dimension in EFL-teaching : exploring cognitions among Finland-Swedish comprehensive school teachers

This thesis is about the educational purpose of foreign language teaching (FLT) in an increasingly internationalised world.The past 20-30 years have witnessed a fundamental rethinking of the aims of FLT, entailing a shift in emphasis from linguistic competence over communicative competence to intercultural competence. The growing emphasis on cultural issues, called for by research and international curricular documents, places new demandson language teachers. The overall aim of this study is to deepen the knowledge about the attitudes of teachers at the upper level of the Finland-Swedish comprehensive school towards the treatment of culture in English foreign language (EFL) teaching. The questions in focus are: 1) How do teachers interpret the concept"culture" in EFL-teaching?, 2) How do they specify the cultural objectives of their teaching? and 3) What do they do to attain these objectives? The thesis strives to reveal whether or not language teaching today can be describedas intercultural, in the sense that culture is taught with the aim of promotingintercultural understanding, tolerance and empathy. This abductive and largely exploratory study is placed within a constructivist and sociocultural framework,and is inspired by both phenomenography and hermeneutics. It takes its starting-point in language didactics, and can also be regarded as a contribution to teacher cognition research. The empirical data consists of verbatim transcribed interviews with 13 Finland-Swedish teachers of English at grades 7-9. The findings are presented according to three orientations and reviewed with reference to the 2004 Finnish National Framework Curriculum. Within the cognitive orientation, "culture" is perceived as factual knowledge, and the teaching of cultureis defined in terms of the transmission of knowledge, especially about Britain and the USA (Pedagogy of Information). Within the action-related orientation, "culture" is seen as skills of a social and socio-linguistic nature, andthe teaching aims at preparing the students for contacts with people from the target language areas (Pedagogy of Preparation). Within the affective orientation, which takes a more holistic approach, "culture" is seen as a bi-directional perspective. Students are encouraged to look at their own familiar culture from another perspective, and learn to empathise with and show respect for otherness in general, not just concerning representatives of English-speaking countries (Pedagogy of Encounter). Very few of the interviewed teachers represent the third approach, which is the one that can be characterised as truly intercultural. The study indicates that many teachers feel unsure about how to teach culture in an appropriate and up-to-date manner. This is attributed to, among other things, lack of teacher insights as well as lack of time and adequate material. The thesis ends with a set of recommendations as to how EFL could be developed ina more intercultural direction.

Pankki- ja vakuutustoiminnan asiakaskannattavuus ja asiakkuuksien johtaminen

The main objective of this master’s thesis was to determine, what are the insights, challenges and problems related to differing business logics and principles of income generation and how can they be integrated in a financial group with insurance and banking operations from the perspective of customer profitability. Review of the industrial specific features had a high priority in the study. The study is a qualitative case study with empirical data collected from semi-structured interviews. Qualitative research method was chosen since it produces kind of data required to answer the research questions. Interviewees were chosen from different organizational levels to achieve a comprehensive big picture of the subject. The key result of the study is that the most important factor for the customer profitability on the financial sector is to find and fulfill the customer needs with a comprehensive service package. Also long-term customer relationships were considered significant and customer life cycle assessment essential. In the case-organization the most significant factors in this process were a strong local presence and the tacit knowledge of the customers’ business and activities, although there are major challenges in systematic exploitation of this information. The management of the customer profitability in case-organization faces great challenges because of the history of growth via acquisitions, which has led to so-called “problem of the two balance sheets”, conflict in corporate culture and establishment of the mutual goals and performance measurement.