Quality of life transformations before and after kidney transplantation: A prospective qualitative study.

The aim of this IRB-approved study was to analyze prospectively quality of life (QOL) and psychological changes in 30 ESRD patients before and after kidney transplantation (KT). Semi-structured interviews were conducted after inclusion on the waiting list (A). Follow-up interviews were performed 6 months later with patients still awaiting KT (B6, n= 15), and with transplant recipients 6, 12 and 24 months after KT (C6, n=15; C12, n=15; C24, n=14). Qualitative thematic analysis was performed. A: All patients reported loss of freedom, 87% tried to maintain normality; 57% modified medical directives. All mentioned emotional fragility, negative thoughts (43%), and suicidal thoughts (20%) related to loss of QOL from dialysis (D), and professional tension (26%). B6: 40% reported no change compared to baseline, while 60% mentioned increase of illness intrusiveness, 46% D side effects, 40% communication problems, and 33% concerns about the waiting list handling. Fear of emotional breakdown (40%), couple problems (47%), and worsened professional difficulties (20%) were reported. C6: All patients reported recovery of QOL and concerns about acute rejection. 73% were anxious about laboratory results. 93% felt dependent on immunosuppressants (IS), 47% reported difficulties coping with their regimen, and 47% were concerned about side effects; 67% had resumed work, but medical constraints led 40% to professional stigmatization. C12: All enjoyed good QOL. Adherence to IS was mandatory (100%). All were aware of the limited long-term graft survival and 47% anxious about a possible return to D. 60% underlined positive life value; 47% resumed a full time job; 40% were on social security. C24: Good QOL was underlined (86%). Patients stated they would prefer re-TX to resuming D (71%). Post-TX health problems were mentioned (64%); increase of creatinine levels induced fear (36%). 79% complained about side effects. 64% reported changes in life values. This study reveals positive QOL and psychological transformations after KT, which are associated with positive changes related to graft survival and freedom from D. Psychological follow-up should be offered to patients who face relapsing ESRD or post-TX co-morbidities.

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Le problème de l'impunité et de la dévalorisation des droits des femmes qui vivent des violences machistes dans le couple (intimate Partner Violence) continue à être présent dans les systèmes pénaux européens. À travers une recherche innovante effectuée en Espagne, en Italie, en Angleterre et en Roumanie, à partir d'entretiens avec des femmes et des personnes travaillant dans le système pénal, d'observations ethnographiques des tribunaux et d'analyses des dossiers judiciaires, nous montrons comment la violence machiste dans le couple est traitée dans le système pénal.

The impact of labour market status on second and higher-order births. A comparative study of Denmark, Italy, Spain and United Kingdom

This paper investigates the effects of women‘s labour force participation on fertility, as well as the effects of the combined labour force participation of both members of a couple. It specifically focuses on such dimensions as unemployment, earnings, temporary contracts and part-time jobs, and it shows that their effects differ in accordance with national institutions and labour market regulations. Event-history methods and a longitudinal sample of the European Community Household Panel are used in the analyses, concerning the years 1993-2000. The results show that labour market insecurity of one or both members of a couple has a particularly strong impact in reducing birth rates in the Southern European countries studied. The more conventional model of men’s employment combined with housewifery has a positive impact on second or higher order births in United Kingdom, Spain and Italy, while in Denmark the effect is the opposite. These differences are consistent with different national models of combining parental responsibilities and participation by gender across the life course.

What made him change? an individual and national analysis of men's participation in housework in 26 countries

We offer new evidence on multi-level determinants of the gender division of housework. Using data from the 2004 European Social Survey (ESS) for 26 European, we study the micro and macro-level factors which increase the likelihood of men doing an equal or greater share of housework than their female partners. A sample of 11,915 young men and women is analysed with a multi-level logistic regression in order to test at individual level the classic relative-income, time-availability and gender-role values, and a new couple conflict hypothesis. At individual level we find significant relationships between relative resources, values, couple's disagreement, and the division of housework which support more economic dependency than "doing gender" perspectives. At the macro-level, we find important composition effects and also support for gender empowerment, family model and social stratification explanations of cross-country differences.

Productivities, preferences, and parental child care

We study the interplay of preferences and market productivities on parenting, and show the preferences, when identified, provide a better explanation of caring decisions than has, so far, been demonstrated in the literature. We qualify the standard finding the parental education in a key determinant of care by showing important interaction effects with marital homogamy. We find that homogamy has opposite effects on child care and couple specialization for high and low educated parents. Identification has been made possible by a unique couple-based time diary study for Denmark

A reassessment of family reunification in Europe. The case of Senegalese couples

Contemporary policy makers in most European destination countriesexpress a great concern about reunification of migrants’ families. Newrestrictions multiply in almost all countries, on the grounds thatmigrants would take advantage of a too lax system and that it wouldfoster an influx of non-desirable migrants. So far, quantitative evidenceis scarce on migrants’ practices in matter of family reunification.Taking advantage of a unique longitudinal dataset that includesSenegalese individuals surveyed both at origin (in Senegal) and inEurope (France, Italy and Spain), we perform event-history analyses toshow three things. First, couple separation is very often a long lastingsituation. Second, when separated because of international migration,wives and husbands do not only reunify in Europe but quite commonlyin Senegal. And third, those who reunify in Europe are those who arethe most adapted or adaptable to the European culture and economy.

Explaining parental dedication to child care in Spain

The quality of the time dedicated to child care has potential positive effects on children’s life chances. However, the determinants of parental time allocation to child care remain largely unexplored, particularly in context undergoing rapid family change such as Spain. We assess two alternative explanations for differences between parents in the amount of time spent with children. The first, based in the relative resources hypothesis, links variation in time spent with children to the relative attributes (occupation, education or income) of one partner to the other. The second, derived from the social status hypothesis, suggests that variation in time spent with children is attributable to the relative social position of the pair (i.e. higher status couples spend more time with children regardless of within-couple difference).To investigate theses questions, we use a sample of adults (18-50) from the Spanish Time Use Survey (STUS) 2002-2003 (n=7,438). Limiting the analysis to adults who are married or in consensual unions, the STUS allows to assess both the quantity and quality of parental time spent with children. We find little support for the “relative resources hypothesis”. Instead, consistent with the “social status hypothesis”, we find that time spent on child care is attributable to the social position of the couple, regardless of between-parent differences in income of education.

Parental investments in children: how bargaining and educational homogamy affect time allocation

This study examines parental time investment in their children, distinguishing between developmental and non-developmental care. Our analyses centre on three influential determinants: educational background, marital homogamy, and spouses' relative bargaining power. We find that the emphasis on quality care time is correlated with parents' education, and that marital homogamy reduces couple specialization, but only among the highly educated. In line with earlier research, we identify gendered parental behaviour. The presence of boys is an important condition for fathers' time dedication, but primarly among lower educated fathers. To the extent that parental stimulation is decisive for child outcomes, our findings suggest the persistence of important inequalities. This emerges through our special attention to behavioural differences across the educational distribution among households.

Management of the risk of HIV infection in male homosexual couples.

OBJECTIVES: To study the ways of managing HIV risk within male homosexual steady relationships (gay couples), including factors associated with consistent condom use during anal sex with the steady partner.¦METHOD: An anonymous and standardized questionnaire completed by a convenience sample of homosexuals in Switzerland in 1997 (n = 1097). Information on the couple was provided by the 74% (n = 786) of male respondents who reported having a steady partner in the past 12 months. Data were analysed by contingency tables and logistic regression.¦RESULTS: Different ways of managing HIV risk were reported: negotiated safety (both HIV negative, condoms abandoned) was chosen by one quarter of the couples, but the most frequent solution was reliance on condoms for anal sex, chosen by more than four in 10. Altogether 84% of couples exhibited safe management of HIV risk within their partnership. The 16% of couples showing inadequate management of HIV risk within the couple mostly relied on questionable assumptions about past or present risks. A total of 74% of couples had spoken about managing HIV risk with possible casual partners. Reported behaviour with the steady partner and with casual partners was highly consistent with claimed strategies chosen to manage HIV risk. Consistent condom use with the steady partner was mostly associated with variables characterizing the relationship: initial 2 years of the relationship, discordant or unknown serological HIV status, non-exclusivity.¦CONCLUSION: Gay couples manage HIV risk in a variety of ways. Most strategies provide adequate protection with casual partners, but leave gaps in protection between the steady partners themselves.

Innovative Outstanding Weatherization Assistance News, January 2003. Vol.1, no.1

This is the first of what we hope will be a quarterly newsletter for the Iowa Weatherization Program. The purpose of the newsletter is to share with you information on all aspects of the program as well as spotlight a couple of agencies in each issue. We will provide information on upcoming events, training schedules, monitoring schedules and general news about the program. There will be a section of questions we have received from you and the answers provided. The section called Speed Bumps lists various problems Mike has found during state inspections. Chris Taylor, who is our editor-in-chief, will be contacting agencies for information. This can include staff news, program highlights or any other news fit to print. If there is anything you would like to see included in the newsletter or have information to get out to everyone, please let us know.

Elokuvien levittäminen Internetissä

Movie distribution on the Internet has become more common in recent years along with fast broadband internet connections. The problem so far has been that the greatest part of movie distribution on the Internet has been illegal. This is about to change because the major film distributors are finally starting to rent and sell movies more and more on the Internet due to their growing confidence in new copy protection methods. The importance of movie online distribution to the movie industry is still tiny but it is increasing rapidly as is investing in new business models and distribution methods in the USA and Europe. This thesis examines the basic concepts of online movie distribution, such as distribution techniques and copy protection, the main companies that rent and sell movies on the internet and their business models, the effects of movie piracy and non-commercial distribution channels. The intention was to provide the reader with an overview of different aspects of movie distribution on the Internet and its future. The conclusion was that movie distribution on the Internet will play a bigger financial part in the future although it was still too early to say just how significant that will be. We will probably see many corresponding distribution techniques, like peer-to-peer networks and streaming servers distributing and broadcasting movies to different end-user platforms like television, PC and portable media players. Internet distribution of movies will not revolutionize movie distribution in the next couple of years but it will make possible new efficient and inexpensive ways to distribute movies globally which will in turn increase the possibilities for revenue, especially for small independent movie producers and distributors.

Improve the quality of care for diabetic patients in the hospital. [Améliorer la qualité de la prise en charge des patients diabétiques à l'hôpital.]

Objectif : La prise en charge des patients avec hyperglycémie en soins aigus estdifficile et les erreurs de prescription d'insuline sont fréquentes. Notre objectifest de promouvoir l'évolution des pratiques vers une gestion efficace et sécuritairede l'hyperglycémie.Matériels et méthodes : Création d'un programme de formation structuré pourla gestion de l'hyperglycémie en soins aigus. Ce programme est le produit dumétissage entre le modèle de l'accompagnement thérapeutique et la systémiquedu management. Il vise l'acquisition d'une métacognition pour une réflexiontransversale face à l'hyperglycémie. Les objectifs spécifiques sont : comprendreles particularités de l'hyperglycémie en aigu ; gérer le basal/bolus ; argumenterle choix thérapeutique ; s'approprier l'outil sécuritaire d'aide à l'insulinothérapie ;anticiper la sortie du patient. Une analyse mixte a été effectuée : quantitative,glycémies, hypoglycémies, durée de séjour et qualitative, évolution de la réflexionautour de l'hyperglycémie.Résultats : Nov. 2009-2010, dans le Service de Médecine du CHUV, nous avonsdispensé 3 sessions de formation (15 cours), suivies d'une période de coaching,pour 78 internes. Évaluation quantitative : 85 patients (56,4 % H), âge moyen72,7 ± 9,6 ans, glycémies à J3 dans la cible (4-8,5 mmol/l) 44,6 %, glycémiemoyenne 8,5 ± 1,8 mmol/l, hypoglycémies 0,9 %, durée moyenne de séjour9,7 ± 5,4 J. Évaluation qualitative : choix du schéma thérapeutique pertinentdans la majorité des cas, environ 90 % des internes ont intégré les éléments depondération de l'insulinothérapie, estiment que cette formation a eu un impactpositif sur leur gestion, sont plus confiants dans leurs capacités et ont unmeilleur sentiment d'auto-efficacité. Les modalités pédagogiques adoptées ontfavorisé le transfert des compétences et le niveau de satisfaction globale atteint90 %.Conclusion : Le développement d'un programme de formation des soignants,basé sur l'approche réflexive et participative, permet une amélioration importantede la gestion de l'hyperglycémie. Notre projet s'inscrit dans une démarcheglobale visant à doter les bénéficiaires d'une vision systémique du diabète.

What do women do? World population growth and fertility patterns, 1960-2000

In this paper we attempt to describe the general picture reasons behind the world population explosion during the 20th century. In general we comment that if, according to some, at the end of the 20th century there were too many people, this was has a consequence of scientific innovation, circulation of information, and economic growth, leading to a dramatic improvement in life expectancies. Nevertheless, a crucial variable shaping differences in demographic growth is fertility. In this paper we identify as important exogenous variables affecting fertility female education levels, infant mortality, and racial identity and diversity. It is estimated that three additional years of schooling for mothers leads on average (at the world level ) to one child less per couple. Even if we can identify a worldwide trend towards convergence in demographic trends, the African case needs to be given more attention, not only because of its different demographic patterns, but also because this is the continent where the worldwide movement towards a higher quality of life has not yet been achieved for an important share of the world's population.

Influence of the primary cleft palate closure on the future need for orthognathic surgery in unilateral cleft lip and palate patients

RESUME : Introduction : L'objectif de cette étude est de déterminer l'influence de la dissection du palais lors de la chirurgie primaire et le type de chirurgie orthognathique requise chez les patients porteurs d'une séquelle de fente labio-maxillo-palatine unilatérale complète Méthode : Cette revue porte sur 58 enfants nés avec une fente labio-maxillo-palatine complète unilatérale et traités entre 1994 et 2008 à Page approprié pour une chirurgie orthognathique. C'est une étude rétrospective longitudinale mixte. Les patients avec des syndromes ou anomalies associées ont été exclus. Tous les patients ont été traités parle même orthodontiste et par la même équipe chirurgicale. Les enfants sont divisés en deux groupes; le premier comprend les patients avec une chirurgie primaire du palais conventionnelle, avec un décollement extensif de la fibro-muqueuse palatine. Le deuxième groupe comprend les patients opérés selon le protocole de Malek. Le palais mou est fermé a |'âge de trois mois, le palais dur à |'âge de six mois, avec un décollement minimal de la tibro-muqueuse palatine. Les radiographies du crâne de profil ainsi que les données chirurgicales ont été comparées. Résultats: La nécessité d'une chirurgie orthognathique est plus élevée dans le premier groupe par rapport au deuxième (60% versus 47,8%). Concernant le type de chirurgie orthognathique réalisé, des ostéotomies Lefort I en deux ou trois pièces ou des ostéotomies bi-maxillaires ont aussi été plus fréquentes dans le premier groupe Conclusion : La chirurgie primaire du palais selon le protocole de Malek améliore le pronostic des patients avec une fente labio-maxillo-palatine. Avec un décollement minimal de la fibro-muqueuse palatine, le nombre d'interventions de chirurgie orthognathique a été diminué. Lorsque ces opérations étaient néanmoins indiquées, elles étaient simplifiées.

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L'association entre haut potentiel (HP) et Trouble Déficit de l'Attention/Hyperactivité (TDA/H), couple mythique ou infernal, représente un vrai défi diagnostique et thérapeutique, du fait de similitudes sémiologiques entre les deux syndromes d'une part, mais aussi de leur possible coexistence d'autre part. Identifier, poser un diagnostic puis traiter deviennent un challenge complexe, à la hauteur de ces enfants à besoins particuliers. Nombre d'enfants sont amenés en consultation car ils souffrent d'isolement, de difficultés scolaires, voire sont poursuivis par la réputation d'être ingérables ou mal éduqués. La question d'un HP ou d'un TDA/H est alors évoquée. Mais si l'enfant HP peut être pris pour un TDA/H et inversement, l'un peut-il masquer l'autre, en cas de co-morbidité? Comment éviter alors de se fourvoyer en traitant des faux positifs tout en négligeant les faux négatifs ?