Do Spirituality and Faith Make a Difference? Report from the Southern European Psycho-Oncology Study Group

OBJECTIVE: In the last decade, some attention has been given to spirituality and faith and their role in cancer patients' coping. Few data are available about spirituality among cancer patients in Southern European countries, which have a big tradition of spirituality, namely, the Catholic religion. As part of a more general investigation (Southern European Psycho-Oncology Study--SEPOS), the aim of this study was to examine the effect of spirituality in molding psychosocial implications in Southern European cancer patients. METHOD: A convenience sample of 323 outpatients with a diagnosis of cancer between 6 to 18 months, a good performance status (Karnofsky Performance Status > 80), and no cognitive deficits or central nervous system (CNS) involvement by disease were approached in university and affiliated cancer centers in Italy, Spain, Portugal, and Switzerland (Italian speaking area). Each patient was evaluated for spirituality (Visual Analog Scale 0-10), psychological morbidity (Hospital Anxiety and Depression Scale--HADS), coping strategies (Mini-Mental Adjustment to Cancer--Mini-MAC) and concerns about illness (Cancer Worries Inventory--CWI). RESULTS. The majority of patients (79.3%) referred to being supported by their spirituality/faith throughout their illness. Significant differences were found between the spirituality and non-spirituality groups (p ≤ 0.01) in terms of education, coping styles, and psychological morbidity. Spirituality was significantly correlated with fighting spirit (r = -0.27), fatalism (r = 0.50), and avoidance (r = 0.23) coping styles and negatively correlated with education (r = -0.25), depression (r = -0.22) and HAD total (r = -0.17). SIGNIFICANCE OF RESULTS: Spirituality is frequent among Southern European cancer patients with lower education and seems to play some protective role towards psychological morbidity, specifically depression. Further studies should examine this trend in Southern European cancer patients.

Integração de Sistemas de Gestão da Qualidade, Ambiente e Segurança

Analisando numa perspectiva mais ampla, esta Tese/Dissertação deverá ser uma ferramenta de apoio a quem necessite de implementar e integrar sistemas de gestão normalizados. Seguindo uma abordagem empresarial, visa ajudar os praticantes de uma filosofia Kaizen, a melhorar continuamente, acrescentando valor às suas organizações, através de um conjunto de estratégias e técnicas de carácter prático. Em termos mais específicos, o objectivo foi apresentar um caso prático onde se aplicassem essas mesmas ferramentas. O case-study incidiu na análise da implementação da certificação integrada da Qualidade, Ambiente e Segurança na Divisão de Equipamento Industrial da Toyota Caetano Portugal. Esta tese/dissertação retrata a implementação teórica e prática do SIG QAS, aplicando os requisitos definidos pela TMHE (Toyota Material Handeling Europe), entre os quais o TPS (Toyota Production System), Kaizen, Toyota Way, Elimination of Waste, Gemba, JIT, Genchi Genbutsu, etc. Os resultados obtidos foram positivos por várias razões. Por ter conseguido elaborar um documento simples de entender, com sugestões de fácil aplicação futura e porque as propostas resultantes do case-study permitirão à TCAP - DEI a promoção da qualidade, a eliminação do desperdício, a completa satisfação dos clientes pela análise, antecipação das suas necessidades e expectativas e pelo cumprimento dos requisitos legais Ambientais e de Segurança aplicáveis, adoptando boas práticas ambientais e de prevenção de acidentes. Temos assim o comprometimento de que esta Tese/Dissertação contribuirá de forma inabalável para o principal desígnio, de assegurar a melhoria contínua do desempenho, garantindo a sustentabilidade da Organização.

Ligantes de baixo impacto ambiental e baixo custo, baseados na ativação química de escórias de aciaria

Dissertação de mestrado integrado em Engenharia Civil

Treatment of advanced soft-tissue sarcomas using a combined strategy of high-dose ifosfamide, high-dose doxorubicin and salvage therapies.

Having determined in a phase I study the maximum tolerated dose of high-dose ifosfamide combined with high-dose doxorubicin, we now report the long-term results of a phase II trial in advanced soft-tissue sarcomas. Forty-six patients with locally advanced or metastatic soft-tissue sarcomas were included, with age <60 years and all except one in good performance status (0 or 1). The chemotherapy treatment consisted of ifosfamide 10 g m(-2) (continuous infusion for 5 days), doxorubicin 30 mg m(-2) day(-1) x 3 (total dose 90 mg m(-2)), mesna and granulocyte-colony stimulating factor. Cycles were repeated every 21 days. A median of 4 (1-6) cycles per patient was administered. Twenty-two patients responded to therapy, including three complete responders and 19 partial responders for an overall response rate of 48% (95% CI: 33-63%). The response rate was not different between localised and metastatic diseases or between histological types, but was higher in grade 3 tumours. Median overall survival was 19 months. Salvage therapies (surgery and/or radiotherapy) were performed in 43% of patients and found to be the most significant predictor for favourable survival (exploratory multivariate analysis). Haematological toxicity was severe, including grade > or =3 neutropenia in 59%, thrombopenia in 39% and anaemia in 27% of cycles. Three patients experienced grade 3 neurotoxicity and one patient died of septic shock. This high-dose regimen is toxic but nonetheless feasible in multicentre settings in non elderly patients with good performance status. A high response rate was obtained. Prolonged survival was mainly a function of salvage therapies.

Ecoetiqueta de serveis i aprofitament dels recursos hídrics i energètics als establiments hotelers de Sitges

Aquest projecte té com a objectiu l’estudi de l’estat ambiental dels hotels del municipi de Sitges i l’estudi d’aprofitament dels recursos hídrics i energètics característics d’aquesta zona del Mediterrani per hotels de 4 i 5 estrelles. Sitges és un municipi que al període estival dobla la població, i que amb una superfície de 43,85 Km2 conta amb 35 hotels i apart pensions, hostals i càmpings, per tant, el turisme és l’activitat més important a Sitges. Per desenvolupar aquest projecte s’ha realitzat una enquesta senzilla sobre qualitat ambiental per conèixer el comportament ambiental dels diferents hotels. En aquest estudi han participat 15 dels 35 hotels del municipi, ja que el 49% d’aquests romanen tancats des d’Octubre fins a Març i dels 18 hotels restants 15 han accedit a formar part d’aquest estudi. A través d’una prova pilot s’ha avaluat la implantació del Distintiu de Garantia de Qualitat Ambiental a l’hotel Antemare i a l’hotel Sunway Playa Golf, aquests dos hotels pertanyen a la categoria de quatre estrelles, categoria que reuneix més nombre d’hotels i el tant per cent d’ocupació és major en comparació amb les altres categories. El DGQA és una ecoetiqueta de serveis que atorga la Generalitat de Catalunya a partir de la revisió de l’establiment per mitjà d’un tècnic autoritzat. S’ha analitzat l’aprofitament dels recursos local com, les aigües pluvials i la radiació solar en els hotels de 4 i 5 estrelles per obtenir l’autosuficiència individual dels 9 hotels objecte d’estudi. Els resultats obtinguts en aquest estudi reflecteixen la possibilitat de millorar l’estat ambiental dels establiments hotelers, duent a terme alguns criteris bàsics com, la recollida selectiva i una major implantació d’energies renovables, així com també la utilització d’aquestes per assolir un cert nivell d’autosuficiència energètica i hídrica. La prova pilot mostra que els dos hotels estudiats estan molt a prop d’aconseguir el DGQA, els vectors on s’haurien de fer millores són, informació ambiental, energia, aigua i residus.

Distintiu de garantia de qualitat ambiental per a equipaments culturals: aplicació pilot en biblioteques

El DGQA per a Equipaments Culturals és un distintiu per a la certificació ambiental de biblioteques i museus. L’objectiu del projecte és avaluar el distintiu mitjançant una aplicació pilot en 26 biblioteques de la província de Barcelona, i proposar millores tant per al distintiu com per a les biblioteques. També es pretén fer recerca sobre l’ecoetiquetatge de serveis, ja que és un àmbit poc desenvolupat, i sobre el sistema d’estudi, les biblioteques. Una anàlisi de les ecoetiquetes a nivell mundial, considerant 4 macroregions, ha permès caracteritzar les ecoetiquetes i determinar la situació actual dels serveis en l’ecoetiquetatge. Hi han variacions en el nombre de categories entre ecoetiquetes, i el percentatge de categories de serveis és, en general, reduït (8% de mitjana). Els subsectors serveis dominants són els d’Hosteleria, serveis de neteja i comerç. No hi ha cap experiència de certificació ambiental de serveis culturals, per tant, l’ecoetiquetatge de serveis culturals és un àmbit nou. El sistema d’estudi són 26 biblioteques de la província de Barcelona. L’aplicació del distintiu a aquestes s’ha dut a terme realitzant treball de camp a cadascuna per tal de determinar el seu estat ambiental. Posteriorment, s’han analitzat les dades per establir el grau de compliment de cadascuna. La majoria de les biblioteques (85%) compleixen més de la meitat dels criteris bàsics, i un 60% superen la puntuació mínima de compliment dels criteris opcionals. Els resultats obtinguts han permès avaluar la viabilitat de la implantació del distintiu, a través de l’anàlisi de cadascun dels seus criteris. Per tal de millorar les possibilitats d’èxit en la implantació del distintiu, s’han aportat un seguit de propostes a nivell individual i col·lectiu. S’ha realitzat una fitxa per a cadascuna de les 26 biblioteques, per tal d’orientar els gestors de les biblioteques en l’adopció de mesures per a l’acompliment dels criteris. També s’han inclòs propostes a l’avaluació dels criteris, dirigides als gestors del distintiu.

Recanalization and Collaterals Predict Outcome in Proximal MCA Occlusion, but neither Penumbra nor Core of Stroke

Data on new predictors of outcome include penumbra core or collaterals.Objective: To test the predictive value of recanalization, collaterals, penumbra and core of ischemia for functional outcome in a large group of patients with MCA occlusion. Method: Consecutive events included prospectively in the Acute Stroke Registry and Analysis of Lausanne from April 2002 to April 2009 with an acute stroke due to proximal MCA occlusion (M1) were considered for analysis. Acute CTA were reviewed to grade the collaterals (dichotomized in poor __50% or good _50% compared to the normal side) and localization of M1 occlusion (proximal or mid-distal). Acute CTP were reviewed and reconstructed to determine penumbra, core and stroke index (penumbra/penumbra_core) of brain ischemia. Good outcome was defined by mRS 0-2 at 3 months.Results: Among 242 events (115 male, mean NIHSS 18.1, SD 5.8, mean age 66, SD 15), 42% were treated with intravenous thrombolysis, and 3% with intraarterial thrombolysis. Collateral status was rated as poor in 53% of events and proximal M1 occlusion was present in 64%. Recanalization determined at 24 hours with CTA was complete in 26% events and partial/absent in 54%.CTP was available for 212 events. Mean penumbra was 88.6 cm3 (median 84.4, SD 53.8), mean core was 54.1 cm3 (median 46.2, SD 45.7) and stroke index was 64% (median 68%, SD 25%). Good outcome was observed in 87 events (36%) and was associated in multivariate logistic regression with thrombolysis (p_0.02, OR_2.5, 95% CI 1.2-5.4), recanalization (p_0.001, OR_4.1, 95% CI 1.9-8.9), lower NIHSS (p_0.001, OR_0.84, 95% CI 0.78-0.91), male gender (p_0.01, OR_2.8, 95% CI 1.3-5.9), mRS prior to stroke (p_0.02, OR_0.5, 95% CI 0.28-0.9) and good collateral status (p_0.005, OR_3, 95% CI 1.4-6.4). Nor penumbra, nor core, nor stroke index were significant in the multivariate model, even if an association was present in the univariate model between good functional outcome and penumbra (p_0.004, OR_1.008, 95% CI 1.003-1.01), core (p_0.001, OR_0.98, 95% CI 0.976-0.99) and strokeindex (p_0.001, OR_16.7, 95% CI 4.6 59.9).Conclusion: MCA recanalization is the best predictor for good functional outcome, followed by collateral status. CTP data did not predict the functional outcome in our large group of M1 occlusion. Author Disclosures: C. Odier: None. P. Michel: Research Grant; Significant; Paion, Lundbeck. Speakers; Modest; Boehringer-Ingelheim. Consultant/Advisory Board; Modest; Boehringer- Ingelheim. Consultant/Advisory Board; Significant; Servier, Lundbeck.

Whole brain radiotherapy with a conformational external beam radiation boost for lung cancer patients with 1-3 brain metastasis: a multi institutional study.

BACKGROUND: To determine the outcome of patients with brain metastasis (BM) from lung cancer treated with an external beam radiotherapy boost (RTB) after whole brain radiotherapy (WBRT). METHODS: A total of 53 BM patients with lung cancer were treated sequentially with WBRT and RTB between 1996 and 2008 according to our institutional protocol. Mean age was 58.8 years. The median KPS was 90. Median recursive partitioning analysis (RPA) and graded prognostic assessment (GPA) grouping were 2 and 2.5, respectively. Surgery was performed on 38 (71%) patients. The median number of BM was 1 (range, 1-3). Median WBRT and RTB combined dose was 39 Gy (range, 37.5-54). Median follow-up was 12.0 months. RESULTS: During the period of follow-up, 37 (70%) patients died. The median overall survival (OS) was 14.5 months. Only 13 patients failed in the brain. The majority of patients (n = 29) failed distantly. The 1-year OS, -local control, extracranial failure rates were 61.2%, 75.2% and 60.8%, respectively. On univariate analysis, improved OS was found to be significantly associated with total dose (< or = 39 Gy vs. > 39 Gy; p < 0.01), age < 65 (p < 0.01), absence of extracranial metastasis (p < 0.01), GPA > or = 2.5 (p = 0.01), KPS > or = 90 (p = 0.01), and RPA < 2 (p = 0.04). On multivariate analysis, total dose (p < 0.01) and the absence of extracranial metastasis (p = 0.03) retained statistical significance. CONCLUSIONS: The majority of lung cancer patients treated with WBRT and RTB progressed extracranially. There might be a subgroup of younger patients with good performance status and no extracranial disease who may benefit from dose escalation after WBRT to the metastatic site.

Transcatheter aortic valve implantation in failed bioprosthetic surgical valves.

IMPORTANCE: Owing to a considerable shift toward bioprosthesis implantation rather than mechanical valves, it is expected that patients will increasingly present with degenerated bioprostheses in the next few years. Transcatheter aortic valve-in-valve implantation is a less invasive approach for patients with structural valve deterioration; however, a comprehensive evaluation of survival after the procedure has not yet been performed. OBJECTIVE: To determine the survival of patients after transcatheter valve-in-valve implantation inside failed surgical bioprosthetic valves. DESIGN, SETTING, AND PARTICIPANTS: Correlates for survival were evaluated using a multinational valve-in-valve registry that included 459 patients with degenerated bioprosthetic valves undergoing valve-in-valve implantation between 2007 and May 2013 in 55 centers (mean age, 77.6 [SD, 9.8] years; 56% men; median Society of Thoracic Surgeons mortality prediction score, 9.8% [interquartile range, 7.7%-16%]). Surgical valves were classified as small (≤21 mm; 29.7%), intermediate (>21 and <25 mm; 39.3%), and large (≥25 mm; 31%). Implanted devices included both balloon- and self-expandable valves. MAIN OUTCOMES AND MEASURES: Survival, stroke, and New York Heart Association functional class. RESULTS: Modes of bioprosthesis failure were stenosis (n = 181 [39.4%]), regurgitation (n = 139 [30.3%]), and combined (n = 139 [30.3%]). The stenosis group had a higher percentage of small valves (37% vs 20.9% and 26.6% in the regurgitation and combined groups, respectively; P = .005). Within 1 month following valve-in-valve implantation, 35 (7.6%) patients died, 8 (1.7%) had major stroke, and 313 (92.6%) of surviving patients had good functional status (New York Heart Association class I/II). The overall 1-year Kaplan-Meier survival rate was 83.2% (95% CI, 80.8%-84.7%; 62 death events; 228 survivors). Patients in the stenosis group had worse 1-year survival (76.6%; 95% CI, 68.9%-83.1%; 34 deaths; 86 survivors) in comparison with the regurgitation group (91.2%; 95% CI, 85.7%-96.7%; 10 deaths; 76 survivors) and the combined group (83.9%; 95% CI, 76.8%-91%; 18 deaths; 66 survivors) (P = .01). Similarly, patients with small valves had worse 1-year survival (74.8% [95% CI, 66.2%-83.4%]; 27 deaths; 57 survivors) vs with intermediate-sized valves (81.8%; 95% CI, 75.3%-88.3%; 26 deaths; 92 survivors) and with large valves (93.3%; 95% CI, 85.7%-96.7%; 7 deaths; 73 survivors) (P = .001). Factors associated with mortality within 1 year included having small surgical bioprosthesis (≤21 mm; hazard ratio, 2.04; 95% CI, 1.14-3.67; P = .02) and baseline stenosis (vs regurgitation; hazard ratio, 3.07; 95% CI, 1.33-7.08; P = .008). CONCLUSIONS AND RELEVANCE: In this registry of patients who underwent transcatheter valve-in-valve implantation for degenerated bioprosthetic aortic valves, overall 1-year survival was 83.2%. Survival was lower among patients with small bioprostheses and those with predominant surgical valve stenosis.

Adenoid Cystic Carcinoma of the Breast: A Rare Cancer Network Study

Purpose/Objective(s): Mammary adenoid cystic carcinoma (ACC) is a rare breast cancer variant. It accounts for less than 0.1% of all invasive breast malignancies. Typically, it presents as a small breast lump with a low propensity to metastasize to regional lymph nodes or distant sites. The aim of this retrospective multicenter Rare Cancer Network study is to assess prognostic factors and patterns of failure in ACC, as well as the role of radiation therapy (RT) in this rare disease. Materials/Methods: Between January 1980 and December 2007, 61 women with breast ACC were included in this study. Median age was 59 years (range, 28-94 years). The majority of the patients had good performance status (49 patients with WHO 0, 12 patients with WHO 1), and 70% of the patients (n = 42) were premenopausal. Surgery consisted of tumorectomy in 35 patients, mastectomy in 20, or quadrantectomy in 6. Median tumor size was 20 mm (range, 6-170 mm). Surgical margins were clear in 50 (82%) patients. Axillary dissection (n = 41) or sentinel node assessment (n = 10) was realized in the majority of the patients. There were 53 (87%) pN0 and 8 pNx (13%) patients. Estrogen (ER) and progesterone receptor (PR) was negative in 43 (71%) and 42 (69%) patients, respectively. In 16 patients (26%), the receptor status was unknown. Adjuvant chemotherapy or hormonotherapy was administered in 8 (13%) and 7 (12%) patients, respectively. Postoperative RT with a median total dose of 50 Gy (1.8-2.0 Gy/fraction; range, 44-70 Gy) was given in 40 patients. Results: With a median follow-up of 79 months (range, 6-285 months), 5-year overall and disease-free survival (DFS) rates were 94% (95% confidence interval [CI]: 88-100%) and 82% (95% CI: 71-93%), respectively. Five-year locoregional control rate was 95% (95% CI: 89-100%). There were only 4 patients with local relapse who were all salvaged successfully, and 4 other patients developed distant metastases. According to the Common Terminology Criteria for Adverse Events v3.0, late toxicity consisted of grade 2-3 cutaneous fibrosis in 4 (10%) patients, grade 1-2 edema in 2 (5%), and grade 3 lung fibrosis in 2 (5%). In univariate analyses, the outcome was influenced neither by the type of surgery nor the use of postoperative RT. However, positive receptor status had a negative influence on the outcome. Multivariate analysis (Cox model) revealed that negative ER (p = 0.006) or PR (p = 0.04) status was associated with improved DFS. Conclusions: ACC of the breast is a relatively indolent disease with excellent local control and survival. The prognosis of patients with ACC is much better than that for patients with other breast cancers, especially those who are ER and PR negative. The role of postoperative RT is not clear. More aggressive treatments may be warranted for patients with positive receptor status.

Sorafenib as third- or fourth-line treatment of advanced gastrointestinal stromal tumour and pretreatment including both imatinib and sunitinib, and nilotinib: A retrospective analysis.

BACKGROUND: Tyrosine kinase inhibitors (TKI) improve the outcome of patients with advanced gastrointestinal stromal tumour (GIST), but treatment failure is frequent, and prognosis then bleak. Smaller trials in this setting suggested activity for sorafenib, a multikinase inhibitor of receptor tyrosine kinases and RAF serine/threonine kinases. PATIENTS AND METHODS: We retrospectively evaluated the efficacy of sorafenib, starting dose 400mg twice daily, in a large community-based cohort of 124 patients treated in 12 European and one United States (U.S.) cancer centre. All but one patient had a WHO performance score 0-2. All had failed both imatinib and sunitinib, 68 patients nilotinib and 26 had failed investigational therapy, too. RESULTS: Twelve (10%) patients responded to sorafenib and 70 (57%) patients achieved disease stabilisation. Sorafenib was moderately tolerated, and toxicity reported in 56% of the patients. Rash, hand-foot-syndrome and diarrhea occurred frequently. Sorafenib dosage was reduced in a third of patients, but this did not have an impact on progression-free survival (PFS) (p=0.15). Median PFS was 6.4months (95% confidence interval [CI], 4.6-8.0months) and median overall survival (OS) 13.5months (95% CI, 10.0-21.0months). Patients with a good performance status and those who responded to sorafenib had a significant better PFS. CONCLUSION: We conclude that sorafenib is active in GIST resistant to imatinib, sunitinib and nilotinib. These results warrant further investigation of sorafenib or similar molecules in GIST.

Buccodental health and oral mucositis. Clinical study in patients with hematological diseases

Objectives: The objective of the present study is to assess whether a good buccodental status (evaluated by means of dentogingival indices), is associated with a lower incidence and severity of oral mucositis in patients with hematological diseases who receive treatment with chemotherapy or bone marrow transplant. Study design: The study was carried out on 97 patients admitted to the Hematology Service of the Hospital Duran y Reynals in Barcelona during 2002-2003. These patients received treatment with chemotherapy or conditioning prior to bone marrow transplant. A descriptive study was made, analyzing oral hygiene, one dental index, and two gingivales indices, and evaluating their relationship with the appearance of mucositis. Results: The patients with high plaque (PI) and gingival (GI) indices during chemotherapy presented a higher percentage of mucositis (77.4% and 65.7% respectively) against those who had little or no visible plaque. In the case of the PI, the differences were statistically significant (p=0.015). Likewise, patients who brushed their teeth 3 times/day presented mucositis in only 26.7% of cases, against those who did not brush, or brushed only once a day (65.9% and 68.4%), these differences also being statistically significant (p=0.013). The CAO showed similar results in patients with or without mucositis (7.59 and 7.03 respectively). Conclusions: In our study, a good gingival status as well as good oral hygiene during chemoradiotherapy is associated with a lower incidence and severity of mucositis.

Teknologiayrityksen laajentuminen epävarmassa tilanteessa – reaalioptiolähtöinen kannattavuustarkastelu

Investoinnit ovat välttämättömiä, jotta yritys voi parantaa asemaansa toimintaympäristössään ja ylläpitää saavutettua kilpailuetua. Siksi investointien kannattavuuden tutkiminen on tärkeää. Reaalioptioiden avulla voidaan hyödyntää tulevaisuuden mahdollisuuksia ja vähentää uhkia, jolloin kannattavuuslaskentaan saadaan uusia näkökulmia. Reaalioptiot ovat strategisen suunnittelun työkaluja. Työssä tutkittiin reaalioptioiden mahdollisuuksia teknologiayrityksen päätöksenteon tukena. Tarkastelu tehtiin kohdeyrityksen näkökulmasta keskittyen informaation tuottamiseen ja reaalioptioiden soveltamiseen kerätyssä aineistossa. Reaalioptiot ovat tärkeitä riskienhallintavälineitä, joiden avulla tulevaisuuden muutokset voidaan ottaa muuttujiksi investointeja arvotettaessa. Reaalioptioiden soveltava käyttö on ollut vielä vähäistä niiden monimutkaisuudesta ja muuttujien hallinnan vaikeudesta johtuen. Reaalioptioita on tutkittu tieteellisessä kirjallisuudessa jo merkittävästi. Suomessa käytännön sovellukset ovat olleet vähäisiä. Reaalioptioiden strategisesta luonteesta johtuen tulokset ovat usein myös salaisia. Tässä työssä käytetään kohdeyrityksen pyynnöstä Case-osuudessa kohteista muutettuja nimiä ja arvoja.

Julkishallinnon verkostojohtaminen - Case: Helsingin kaupungin ympäristöjohtaminen

Tämän pro gradu -tutkielman tavoitteena oli tutkia millainen on hyvä ympäristö-johtamisen verkostomalli kunnalle. Lisäksi työssä tarkasteltiin mitä hyötyjä haittoja on kunnan verkostomaisesti organisoidussa ympäristöjohtamisessa verrattuna ei-verkostomaiseen toteutukseen. Työssä selvitettiin myös millaiset verkostojohtamisen mallit ovat tehokkaita ja mitkä ovat verkoston osapuolten odotukset kunnan ympäristöjohtamisen verkostolle. Tutkielman lopputuloksena oli ympäristöjohtamisen verkostomalli kunnalle. Tutkielman teoreettisen viitekehyksen muodostivat julkishallinnon verkoston hallintamalli, verkostojohtaminen, ympäristöjohtaminen ja tehokkuus. Nämä kolme käsitettä muodostivat työn verkostomallin. Tutkimusmenetelmänä työssä käytettiin laadullista tapaustutkimusta, ja tutkimuksen kohteena oli kuntaorganisaation ympäristöjohtamisen verkosto, joka käsitti ympäristöjohtamisen asiantuntijatyöryhmän. Tutkimusaineisto kerättiin teemahaastatteluin ja tutkimuksessa haastateltiin kolmetoista asiantuntijatyöryhmän jäsentä yksilö-, pari- ja ryhmähaastatteluin.

There are more asthmatics in homes with high cockroach infestation

Although asthma has been commonly associated with sensitivity to cockroaches, a clear causal relationship between asthma, allergy to cockroaches and exposure levels has not been extensively investigated. The objective of the present study was to determine whether asthma occurs more frequently in children living in homes with high cockroach infestation. The intensity of household infestation was assessed by the number of dead insects after professional pesticide application. Children living in these houses in the metropolitan area of Recife, PE, were diagnosed as having asthma by means of a questionnaire based on the ISAAC study. All children had physician-diagnosed asthma and at least one acute exacerbation in the past year. Children of both sexes aged 4 to 12 years who had been living in the households for more than 2 years participated in this transverse study and had a good socioeconomic status. In the 172 houses studied, 79 children were considered to have been exposed to cockroaches and 93 not to have been exposed. Children living in residences with more than 5 dead cockroaches after pesticide application were considered to be at high infestation exposure. Asthma was diagnosed by the questionnaire in 31.6% (25/79) of the exposed group and in 11.8% (11/93) of the non-exposed group (P = 0.001), with a prevalence ratio of 3.45 (95%CI, 1.48-8.20). The present results indicate that exposure to cockroaches was significantly associated with asthma among the children studied and can be considered a risk factor for the disease. Blattella germanica and Periplaneta americana were the species found in 96% of the infested houses.