Diabetes care: opinions, needs and proposed solutions of Swiss patients and healthcare professionals: a qualitative study.

AIMS: To explore, both among patients with diabetes and healthcare professionals, opinions on current diabetes care and the development of the "Regional Diabetes Program". METHODS: We employed qualitative methods (focus groups - FG) and used purposive sampling strategy to recruit patients with diabetes and healthcare professionals. We conducted one diabetic and one professional FG in each of the four health regions of the canton of Vaud/Switzerland. The eight FGs were audio-taped and transcribed verbatim. Thematic analysis was then undertaken. RESULTS: Results showed variability in the perception of the quality of diabetes care, pointed to insufficient information regarding diabetes, and lack of collaboration. Participants also evoked patients' difficulties for self-management, as well as professionals' and patients' financial concerns. Proposed solutions included reinforcing existing structures, developing self-management education, and focusing on comprehensive and coordinated care, communication and teamwork. Patients and professionals were in favour of a "Regional Diabetes Program" tailored to the actors' needs, and viewed it as a means to reinforce existing care delivery. CONCLUSIONS: Patients and professionals pointed out similar problems and solutions but explored them differently. Combined with coming quantitative data, these results should help to further develop, adapt and implement the "Regional Diabetes Program".

Measurement of the mechanical power of walking by satellite positioning system (GPS).

PURPOSE: This descriptive article illustrates the application of Global Positioning System (GPS) professional receivers in the field of locomotion studies. The technological challenge was to assess the external mechanical work in outdoor walking. METHODS: Five subjects walked five times during 5 min on an athletic track at different imposed stride frequency (from 70-130 steps x min(-1)). A differential GPS system (carrier phase analysis) measured the variation of the position of the trunk at 5 Hz. A portable indirect calorimeter recorded breath-by-breath energy expenditure. RESULTS: For a walking speed of 1.05 +/- 0.11 m x s(-1), the vertical lift of the trunk (43 +/- 14 mm) induced a power of 46.0 +/- 20.4 W. The average speed variation per step (0.15 +/- 0.03 m x s(-1)) produced a kinetic power of 16.9 +/- 7.2 W. As compared with commonly admitted values, the energy exchange (recovery) between the two energy components was low (39.1 +/- 10.0%), which induced an overestimated mechanical power (38.9 +/- 18.3 W or 0.60 W x kg(-1) body mass) and a high net mechanical efficiency (26.9 +/- 5.8%). CONCLUSION: We assumed that the cause of the overestimation was an unwanted oscillation of the GPS antenna. It is concluded that GPS (in phase mode) is now able to record small body movements during human locomotion, and constitutes a promising tool for gait analysis of outdoor unrestrained walking. However, the design of the receiver and the antenna must be adapted to human experiments and a thorough validation study remains to be conducted.

Partnership for fragility bone fracture care provision and prevention program (P4Bones): study protocol for a secondary fracture prevention pragmatic controlled trial.

ABSTRACT: BACKGROUND: Fractures associated with bone fragility in older adults signal the potential for secondary fracture. Fragility fractures often precipitate further decline in health and loss of mobility, with high associated costs for patients, families, society and the healthcare system. Promptly initiating a coordinated, comprehensive pharmacological bone health and falls prevention program post-fracture may improve osteoporosis treatment compliance; and reduce rates of falls and secondary fractures, and associated morbidity, mortality and costs.Methods/design: This pragmatic, controlled trial at 11 hospital sites in eight regions in Quebec, Canada, will recruit community-dwelling patients over age 50 who have sustained a fragility fracture to an intervention coordinated program or to standard care, according to the site. Site study coordinators will identify and recruit 1,596 participants for each study arm. Coordinators at intervention sites will facilitate continuity of care for bone health, and arrange fall prevention programs including physical exercise. The intervention teams include medical bone specialists, primary care physicians, pharmacists, nurses, rehabilitation clinicians, and community program organizers.The primary outcome of this study is the incidence of secondary fragility fractures within an 18-month follow-up period. Secondary outcomes include initiation and compliance with bone health medication; time to first fall and number of clinically significant falls; fall-related hospitalization and mortality; physical activity; quality of life; fragility fracture-related costs; admission to a long term care facility; participants' perceptions of care integration, expectations and satisfaction with the program; and participants' compliance with the fall prevention program. Finally, professionals at intervention sites will participate in focus groups to identify barriers and facilitating factors for the integrated fragility fracture prevention program.This integrated program will facilitate knowledge translation and dissemination via the following: involvement of various collaborators during the development and set-up of the integrated program; distribution of pamphlets about osteoporosis and fall prevention strategies to primary care physicians in the intervention group and patients in the control group; participation in evaluation activities; and eventual dissemination of study results.Study/trial registration: Clinical Trial.Gov NCT01745068Study ID number: CIHR grant # 267395.

Accreditation of forensic pathology service: a priviledge or a nightmare?

Forensic experts play a major role in the legal process as they offer professional expert opinion and evidence within the criminal justice system adjudicating on the innocence or alleged guilt of an accused person. In this respect medico-legal examination is an essential part of the investigation process, determining in a scientific way, the cause(s) and manner of unexpected and/or unnatural death or bringing clinical evidence in case of physical, psychological or sexual abuse in living people. From a legal perspective, these types of investigation must meet international standards i-e it should be independent, effective and prompt. Ideally the investigations should be conducted by board certified experts in forensic medicine, endowed with a solid experience in this field, without any hierarchical relationship with the prosecuting authorities and having access to appropriate facilities in order to provide forensic reports of high quality. In this respect, there is a need for any private or public national or international authority including non-governmental organisations seeking experts qualified in forensic medicine,to have at disposal a list of specialists working in accordance with high standards of professional performance within forensic pathology services that have been successfully submitted to an official accreditation/certification process using valid and acceptable criteria. To reach this goal the National Association of Medical examiners (NAME) has elaborated an accreditation/certification check-list which should be served as decision-making support to assist inspectors appointed to evaluate applicants. In the same spirit than NAME Accreditation Standards, ECLM board decided to set up an ad hoc working group with the mission to elaborate an accreditation/certification procedure similar to the NAME's one but taking into account the realities of forensic medicine practices in Europe and restricted to post-mortem investigations. This accreditation process applies to services and not to individual practitioners by emphasizing policies and procedures rather than professional performance. In addition the standards to be complied with should be considered as the minimum standards needed to get the recognition of performing and reliable forensic pathology service.

Effective corporate governance : experimental evidence on international auditors'judgments and the contribution of financial accounting education

1 Summary This dissertation deals with two major aspects of corporate governance that grew in importance during the last years: the internal audit function and financial accounting education. In three essays, I contribute to research on these topics which are embedded in the broader corporate governance literature. The first two essays consist of experimental investigations of internal auditors' judgments. They deal with two research issues for which accounting research lacks evidence: The effectiveness of internal controls and the potentially conflicting role of the internal audit function between management and the audit committee. The findings of the first two essays contribute to the literature on internal auditors' judgment and the role of the internal audit function as a major cornerstone of corporate governance. The third essay theoretically examines a broader issue but also relates to the overall research question of this dissertation: What contributes to effective corporate governance? This last essay takes the perspective that the root for quality corporate governance is appropriate financial accounting education. r develop a public interest approach to accounting education that contributes to the literature on adequate accounting education with respect to corporate governance and accounting harmonization. The increasing importance of both the internal audit function and accounting education for corporate governance can be explained by the same recent fundamental changes that still affect accounting research and practice. First, the Sarbanes-Oxley Act of 2002 (SOX, 2002) and the 8th EU Directive (EU, 2006) have led to a bigger role for the internal audit function in corporate governance. Their implications regarding the implementation of audit committees and their oversight over internal controls are extensive. As a consequence, the internal audit function has become increasingly important for corporate governance and serves a new master (i.e. the audit committee) within the company in addition to management. Second, the SOX (2002) and the 8th EU Directive introduced additional internal control mechanisms that are expected to contribute to the reliability of financial information. As a consequence, the internal audit function is expected to contribute to a greater extent to the reliability of financial statements. Therefore, effective internal control mechanisms that strengthen objective judgments and independence become important. This is especially true when external- auditors rely on the work of internal auditors in the context of the International Standard on Auditing (ISA) 610 and the equivalent US Statement on Auditing Standards (SAS) 65 (see IFAC, 2009 and AICPA, 1990). Third, the harmonization of international reporting standards is increasingly promoted by means of a principles-based approach. It is the leading approach since a study of the SEC (2003) that was required by the SOX (2002) in section 108(d) was in favor of this approach. As a result, the Financial Accounting Standards Board (FASB) and the International Accounting Standards Board (IASB) commit themselves to the development of compatible accounting standards based on a principles-based approach. Moreover, since the Norwalk Agreement of 2002, the two standard setters have developed exposure drafts for a common conceptual framework that will be the basis for accounting harmonization. The new .framework will be in favor of fair value measurement and accounting for real-world economic phenomena. These changes in terms of standard setting lead to a trend towards more professional judgment in the accounting process. They affect internal and external auditors, accountants, and managers in general. As a consequence, a new competency set for preparers and users of financial statements is required. The basil for this new competency set is adequate accounting education (Schipper, 2003). These three issues which affect corporate governance are the initial point of this dissertation and constitute its motivation. Two broad questions motivated a scientific examination in three essays: 1) What are major aspects to be examined regarding the new role of the internal audit function? 2) How should major changes in standard setting affect financial accounting education? The first question became apparent due to two published literature reviews by Gramling et al. (2004) and Cohen, Krishnamoorthy & Wright (2004). These studies raise various questions for future research that are still relevant and which motivate the first two essays of my dissertation. In the first essay, I focus on the role of the internal audit function as one cornerstone of corporate governance and its potentially conflicting role of serving both management and the audit committee (IIA, 2003). In an experimental study, I provide evidence on the challenges for internal auditors in their role as servant for two masters -the audit committee and management -and how this influences internal auditors' judgment (Gramling et al. 2004; Cohen, Krishnamoorthy & Wright, 2004). I ask if there is an expectation gap between what internal auditors should provide for corporate governance in theory compared to what internal auditors are able to provide in practice. In particular, I focus on the effect of serving two masters on the internal auditor's independence. I argue that independence is hardly achievable if the internal audit function serves two masters with conflicting priorities. The second essay provides evidence on the effectiveness of accountability as an internal control mechanism. In general, internal control mechanisms based on accountability were enforced by the SOX (2002) and the 8th EU Directive. Subsequently, many companies introduced sub-certification processes that should contribute to an objective judgment process. Thus, these mechanisms are important to strengthen the reliability of financial statements. Based on a need for evidence on the effectiveness of internal control mechanisms (Brennan & Solomon, 2008; Gramling et al. 2004; Cohen, Krishnamoorthy & Wright, 2004; Solomon & Trotman, 2003), I designed an experiment to examine the joint effect of accountability and obedience pressure in an internal audit setting. I argue that obedience pressure potentially can lead to a negative influence on accountants' objectivity (e.g. DeZoort & Lord, 1997) whereas accountability can mitigate this negative effect. My second main research question - How should major changes in standard setting affect financial accounting education? - is investigated in the third essay. It is motivated by the observation during my PhD that many conferences deal with the topic of accounting education but very little is published about what needs to be done. Moreover, the Endings in the first two essays of this thesis and their literature review suggest that financial accounting education can contribute significantly to quality corporate governance as argued elsewhere (Schipper, 2003; Boyce, 2004; Ghoshal, 2005). In the third essay of this thesis, I therefore focus on approaches to financial accounting education that account for the changes in standard setting and also contribute to corporate governance and accounting harmonization. I argue that the competency set that is required in practice changes due to major changes in standard setting. As the major contribution of the third article, I develop a public interest approach for financial accounting education. The major findings of this dissertation can be summarized as follows. The first essay provides evidence to an important research question raised by Gramling et al. (2004, p. 240): "If the audit committee and management have different visions for the corporate governance role of the IAF, which vision will dominate?" According to the results of the first essay, internal auditors do follow the priorities of either management or the audit committee based on the guidance provided by the Chief Audit executive. The study's results question whether the independence of the internal audit function is actually achievable. My findings contribute to research on internal auditors' judgment and the internal audit function's independence in the broader frame of corporate governance. The results are also important for practice because independence is a major justification for a positive contribution of the internal audit function to corporate governance. The major findings of the second essay indicate that the duty to sign work results - a means of holding people accountable -mitigates the negative effect of obedience pressure on reliability. Hence, I found evidence that control .mechanisms relying on certifications may enhance the reliability of financial information. These findings contribute to the literature on the effectiveness of internal control mechanisms. They are also important in the light of sub-certification processes that resulted from the Sarbanes-Oxley Act and the 8th EU Directive. The third essay contributes to the literature by developing a measurement framework that accounts for the consequences of major trends in standard setting. Moreovér, it shows how these trends affect the required .competency set of people dealing with accounting issues. Based on this work, my main contribution is the development of a public interest approach for the design of adequate financial accounting curricula. 2 Serving two masters: Experimental evidence on the independence of internal auditors Abstract Twenty nine internal auditors participated in a study that examines the independence of internal auditors in their potentially competing roles of serving two masters: the audit committee and management. Our main hypothesis suggests that internal auditors' independence is not achievable in an institutional setting in which internal auditors are accountable to two different parties with potentially differing priorities. We test our hypothesis in an experiment in which the treatment consisted of two different instructions of the Chief audit executive; one stressing the priority of management (cost reduction) and one stressing the priority of the audit committee (effectiveness). Internal auditors had to evaluate internal controls and their inherent costs of different processes which varied in their degree of task complexity. Our main results indicate that internal auditors' evaluation of the processes is significantly different when task complexity is high. Our findings suggest that internal auditors do follow the priorities of either management or the audit committee depending on the instructions of a superior internal auditor. The study's results question whether the independence of the internal audit function is actually achievable. With our findings, we contribute to research on internal auditors' judgment and the internal audit function's independence in the frame of corporate governance.

Vaarinpidosta virtuaaliaikaan : Sata vuotta suomalaista tilintarkastusta

Tämän tutkimuksen aiheena on tilintarkastuksen historiallinen kehittyminen Suomessa runsaan sadan vuoden aikana. Tutkimuksen tavoitteena on analysoida osakeyhtiön tilintarkastuksen kehitystä ja yhdistää vuosisadan kehityspiirteet tilintarkastuksen kokonaiskuvaksi. Tutkittava periodi alkaa 1800-luvun lopulta ja päättyy 2000-luvun taitteeseen. Tutkimuksessa tarkastellaan suomalaista tilintarkastusinstituutiota, joka jaetaan kolmeen osaan: tilintarkastusta säätelevään normistoon (normit), tilintarkastajajärjestelmään (toimijat) ja tilintarkastuksen sisältöön (tehtävät). Tutkimuksessa tavoitellaan vastauksia kysymyksiin: mitä tarkastettiin, milloin tarkastettiin, kuka tarkasti ja miten tarkastettiin eri aikakausina? Tutkimus perustuu historialliseen lähdeaineistoon, jonka muodostavat tutkimusajanjakson lainsäädäntö, lainvalmisteluasiakirjat, viranomaisten ohjeet ja päätökset, alan järjestöjen suositukset, ammattilehtien artikkelit sekä laskentatoimen ja tilintarkastuksen ammattikirjallisuus. Metodologisesti tutkimus on teoreettinen, kvalitatiivinen historiantutkimus, jossa lähdeaineistoa käsitellään lähdekriittisesti ja osittain sisältöanalyysin keinoin. Tilintarkastusta säätelevässä normistossa keskeisiä lakeja ovat olleet osakeyhtiölaki, kirjanpitolaki ja tilintarkastuslaki. Lakisääteinen tilintarkastus alkoi vuoden 1895 osakeyhtiölaista, joka uudistui vuonna 1978 ja jälleen vuonna 1997. Kirjanpitolainsäädäntö on uudistunut viidesti: 1925 ja 1928, 1945, 1973, 1993 sekä 1997. Vuoden 1994 tilintarkastuslakiin koottiin tilintarkastuksen säädökset useista laeista. Muita normistoja ovat olleet EY:n direktiivit, Kilan ohjeet, KHT-yhdistyksen suositukset, Keskuskauppakamarin säännökset ja viimeisimpinä IAS- ja ISA-standardit. Ammattimainen tilintarkastajajärjestelmä saatiin maahamme kauppiaskokousten ansiosta. Ammattimaisena tilintarkastuksen toimijana aloitti Suomen Tilintarkastajainyhdistys vuonna 1911, ja sen toimintaa jatkoi KHT-yhdistys vuodesta 1925 alkaen. Tilintarkastajien auktorisointi siirtyi Keskuskauppakamarille vuonna 1924. HTM-tilintarkastajat ovat olleet alalla vuodesta 1950 lähtien. Kauppakamarijärjestö on toiminut hyväksyttyjen tilintarkastajien valvojana koko ammattimaisen tilintarkastustoiminnan ajan. Valtion valvontaa suorittaa VALA (Valtion tilintarkastuslautakunta). Koko tutkittavan periodin ajan auktorisoitujen tilintarkastajien rinnalla osakeyhtiöiden tarkastajina ovat toimineet myös maallikot.Tilintarkastuksen tehtäviin kuului vuoden 1895 osakeyhtiölain mukaan hallinnon ja tilien tarkastus. Myöhemmin sisältö täsmentyi tilinpäätöksen, kirjanpidon ja hallinnon tarkastukseksi. Tutkimusajanjakson alussa tilintarkastus oli manuaalista kaikkien tositteiden prikkausta ja virheiden etsimistä. Myöhemmin tarkastus muuttui pistokokeiksi. Kertatarkastuksesta siirryttiin jatkuvaan valvontatarkastukseen 1900-luvun alkupuolella. Dokumentoinnista ja työpapereista alkaa olla havaintoja 1930-luvulta lähtien. Atk-tarkastus yleistyi 1970- ja 1980-luvuilla, jolloin myös riskianalyyseihin alettiin kiinnittää huomiota. Hallinnon tarkastuksen merkitys on kasvanut kaiken aikaa. Tilintarkastuskertomukset olivat tutkimusajanjakson alussa vapaamuotoisia ja sisällöltään ilmaisurikkaita ja kuvailevia. Kertomus muuttui julkiseksi vuoden 1978 osakeyhtiölain myötä. Myöhemmin KHT-yhdistyksen vakiokertomusmallit yhdenmukaistivat ja pelkistivät raportointia. Tutkimuksen perusteella tilintarkastuksen historia voidaan jakaa kolmeen kauteen, jotka ovat tilintarkastusinstituution rakentumisen kausi (1895 - 1950), vakiintumisen kausi (1951 - 1985) ja kansainvälistymisen ja julkisuuden kausi (1986 alkaen). Tutkimusajanjakson jokaisella vuosikymmenellä keskusteltiin jatkuvasti tilintarkastajien riittävyydestä, alalle pääsyn ja tutkintojen vaikeudesta, tilintarkastajien ammattitaidon tasosta,hallinnon tarkastuksen sisällöstä, tilintarkastuskertomuksesta sekä maallikkotarkastajien asemasta. 1990-luvun keskeisimmät keskusteluaiheet olivat konsultointi, riippumattomuus, odotuskuilu sekä tilintarkastuksen taso ja laadunvalvonta. Analysoitaessa tilintarkastuksen muutoksia runsaan sadan vuoden ajalta voidaan todeta, että tilintarkastuksen ydintehtävät eivät juurikaan ole muuttuneet vuosikymmenien kuluessa. Osakeyhtiön tilintarkastus on edelleenkin laillisuustarkastusta. Sen tarkoituksena on yhä kirjanpidon, tilinpäätöksen ja hallinnon tarkastus. Tilintarkastajat valvovat osakkeenomistajien etua ja raportoivat heille tarkastuksen tuloksista. Tilintarkastuksen ulkoinen maailma sen sijaan on muuttunut vuosikymmenten saatossa. Kansainvälistyminen on lisännyt säännösten määrää, odotuksia ja vaatimuksia on nykyisin enemmän, uusi tekniikka mahdollistaa nopean tiedonkulun ja valvonta on lisääntynyt nykypäivää kohti tultaessa. Tilintarkastajan pätevyys perustuu nykyään tietotekniikan, tietojärjestelmien ja yrityksen toimialantuntemukseen. Runsaan sadan vuoden takaisen lain vaarinpitovaatimuksesta on tultu virtuaaliaikaiseen maailmaan!

La atención a la diversidad cultural en Cataluña: exclusión, segregación e interculturalidad

La diversidad cultural se ha incrementado notablemente en los centros escolares españoles por la llegada de alumnado de origen inmigrado y esto, más los discursos de toma en consideración de las diferencias culturales que han realizado la Unión Europea y las administraciones autonómicas, ha contribuido a la aparición del discurso intercultural. Este artículo presenta la evolución realizada hasta llegar al discurso dominante actual basándose en un trabajo empírico de análisis de documentación editada por la Generalitat de Cataluña sobre política de integración y de escolarización de los inmigrados y entrevistas en profundidad a políticos y técnicos de los diferentes niveles de la administración catalana. De ello se concluye la existencia de tres etapas en la política de integración de los inmigrados en Cataluña: un primer momento de mera observación del fenómeno; una segunda etapa en la que sin abandonar la observación se insiste en la organización vertical y horizontal de la administración para trabajar de forma coordinada un fenómeno que empieza a despertar preocupación; y, una tercera, en la que sin abandonar la necesaria observación y organización, el énfasis se sitúa en la intervención. Estas fases son el marco de lo realizado a nivel educativo donde observamos la dificultad de traducción del discurso intercultural a la práctica cotidiana de los centros escolares, de los noventa, es necesario incrementar los esfuerzos para incorporar al alumnado de origen inmigrado en el dominio de la creencia de que la educación intercultural (en contra de lo que esta implica) es cuestión que deben trabajar los centros con inmigrantes y, ante la presión existente en las aulas (por el incremento del alumnado, la matrícula viva, etc.), el retorno a prácticas potencialmente segregacionistas que nos recuerdan actuaciones implementadas para escolarizar a los gitanos años atrás. Sin negar los avances realizados desde mediados aulas y centros de Cataluña.

Las asociaciones de inmigrantes africanos. Organización, proyección y actuaciones

El asociacionismo de personas de origen extranjero ha crecido de forma notable desde los años 90 y, especialmente, desde los 2000, influenciado por los intereses de estas personas pero también por el contexto social, político e institucional que lo ha favorecido y condicionado. Este trabajo presenta los resultados de una encuesta realizada a 206 representantes de asociaciones de inmigrantes de origen africano de las comunidades autónomas de Cataluña, Valencia y Navarra. Nuestro objetivo ha consistido en clasificar las asociaciones, estudiar su organización y funcionamiento y conocer sus ámbitos de actuación. Entre otras cuestiones, hemos observado que este asociacionismo es joven y no responde a una única forma organizativa, sino que, en función de dinámicas internas y externas, intereses de los asociados y años de vida de cada asociación, adquiere diferentes estructuras y estrategias.

Nursing student-patient relationship and associated factors

The purpose of this study was to analyse the nursing student-patient relationship and factors associated with this relationship from the point of view of both students and patients, and to identify factors that predict the type of relationship. The ultimate goal is to improve supervised clinical practicum with a view to supporting students in their reciprocal collaborative relationships with patients, increase their preparedness to meet patients’ health needs, and thus to enhance the quality of patient care. The study was divided into two phases. In the first phase (1999-2005), a literature review concerning the student-patient relationship was conducted (n=104 articles) and semi-structured interviews carried out with nursing students (n=30) and internal medicine patients (n=30). Data analysis was by means of qualitative content analysis and Student-Patient Relationship Scales, which were specially developed for this research. In the second phase (2005-2007), the data were collected by SPR scales among nursing students (n=290) and internal medicine patients (n=242). The data were analysed statistically by SPSS 12.0 software. The results revealed three types of student-patient relationship: a mechanistic relationship focusing on the student’s learning needs; an authoritative relationship focusing on what the student assumes is in the patient’s best interest; and a facilitative relationship focusing on the common good of both student and patient. Students viewed their relationship with patients more often as facilitative and authoritative than mechanistic, while in patients’ assessments the authoritative relationship occurred most frequently and the facilitative relationship least frequently. Furthermore, students’ and patients’ views on their relationships differed significantly. A number of background factors, contextual factors and consequences of the relationship were found to be associated with the type of relationship. In the student data, factors that predicted the type of relationship were age, current year of study and support received in the relationship with patient. The higher the student’s age, the more likely the relationship with the patient was facilitative. Fourth year studies and the support of a person other than a supervisor were significantly associated with an authoritative relationship. Among patients, several factors were found to predict the type of nursing student-patient relationships. Significant factors associated with a facilitative relationship were university-level education, several previous hospitalizations, admission to hospital for a medical problem, experience of caring for an ill family member and patient’s positive perception of atmosphere during collaboration and of student’s personal and professional growth. In patients, positive perceptions of student’s personal and professional attributes and patient’s improved health and a greater commitment to self-care, on the other hand, were significantly associated with an authoritative relationship, whereas positive perceptions of one’s own attributes as a patient were significantly associated with a mechanistic relationship. It is recommended that further research on the student-patient relationship and related factors should focus on questions of content, methodology and education.

Uusien rajapintojen vaikutus Nokia TETRA –rajapintapalvelimen arkkitehtuuriin

Nokia TETRA –järjestelmä on digitaaliseen tekniikkaan pohjautuva radiopuhelinjärjestelmä, joka on tarkoitettu erityisvaatimuksia omaavien organisaatioiden ammattikäyttöön. Sen tyypillisiä käyttäjiä ovat erilaiset viranomaiset, kuten poliisi, palo- ja pelastuslaitos sekä rajavartiolaitos. Se perustuu avoimeen TETRA-standardiin, joka määrittelee tärkeimmät palvelut ja rajapinnat tiettyjen verkkoelementtien välillä. TETRA-järjestelmän käyttöpaikkatyöasemat ja palvelimet perustuvat kaikki samaan Nokia TETRA –rajapintapalvelimen arkkitehtuuriin. Käyttöpaikat tarjoavat tehokkaat toiminnot verkon operatiiviseen käyttöön ja hallintaan. Palvelimet puolestaan tarjoavat ohjelmointirajapintansa kautta kolmansille osapuolille mahdollisuuden luoda TETRA-järjestelmän palveluita käyttäviä sovelluksia. Työn tavoitteena oli tutkia uusien rajapintojen soveltuvuutta sekä selvittää niiden vaikutusta Nokia TETRA –rajapintapalvelimen arkkitehtuuriin. Ensin kartoitettiin nykyisen arkkitehtuurin ongelmat ja puutteet äänikommunikaatioon käytetyssä tiedonsiirrossa, ja äänikommunikaatiossa käyttäjään päin. Näiden ratkaisemiseksi tutkittiin uusia rajapinta-vaihtoehtoja. Parhaiten soveltuvista vaihtoehdoista muodostettiin ratkaisu, jonka vaikutus uuden sukupolven arkkitehtuuriin selvitettiin.

Tendinopathies du coude [Elbow tendinopathy].

The lateral and medial epicondylitis is often manifested in a professional or in a sport context leading to repetitive wrist movements. The diagnosis is primarily clinical. Additional tests are indicated in chronic evolution and in searching for differential diagnoses. Elbow X-ray can be completed with ultrasound or MRI, the most efficient but expensive diagnostic procedure. There is no consensus on treatment. After a period of rest, stretching then strengthening exercises are recommended. Corticosteroid injections may provide a short-term beneficial effect. Platelet-Rich Plasma injections have recently gained notoriety. In case of failure of treatment, surgery is possible, but only in a minority of patients.

Welfare spending and ethnic heterogeneity. Evidence from a massive immigration wave

[spa] En este trabajo se analiza la relación entre la heterogeneidad étnica y la redistribución, utilizando la reciente y masiva llegada de inmigrantes a España. En concreto, se estudia el efecto de los cambios en la densidad de inmigrantes, observada entre 1998 y 2006, sobre los cambios en el gasto social municipal. La densidad de inmigrantes se instrumenta utilizando los patrones de establecimiento por país de origen para asignar los flujos predichos de inmigrantes a cada municipio. Los resultados evidencian que el gasto social incrementó menos en los municipios con mayores incrementos en la densidad de inmigrantes. También se proporciona evidencia de la existencia de una relación positiva entre la densidad de inmigrantes y el porcentaje de voto obtenidos por los partidos de derecha. Por tanto, estos resultados son consistentes con las teorías que predicen una relación negativa entre la heterogeneidad étnica y la redistribución.

Welfare spending and ethnic heterogeneity. Evidence from a massive immigration wave

[spa] En este trabajo se analiza la relación entre la heterogeneidad étnica y la redistribución, utilizando la reciente y masiva llegada de inmigrantes a España. En concreto, se estudia el efecto de los cambios en la densidad de inmigrantes, observada entre 1998 y 2006, sobre los cambios en el gasto social municipal. La densidad de inmigrantes se instrumenta utilizando los patrones de establecimiento por país de origen para asignar los flujos predichos de inmigrantes a cada municipio. Los resultados evidencian que el gasto social incrementó menos en los municipios con mayores incrementos en la densidad de inmigrantes. También se proporciona evidencia de la existencia de una relación positiva entre la densidad de inmigrantes y el porcentaje de voto obtenidos por los partidos de derecha. Por tanto, estos resultados son consistentes con las teorías que predicen una relación negativa entre la heterogeneidad étnica y la redistribución.

Distribución espacial de la población inmigrante en los municipios catalanes: igualdad, exposición, concentración y centralidad

Dado el importante crecimiento de la población inmigrante en España, es interesante estudiar su distribución sobre el territorio urbano. Desde la estadística se dispone de diferentes indicadores con una larga tradición, que permiten cuantificar la segregación de grupos de población minoritarios. Mediante la aplicación de estas herramientas a la realidad de los municipios catalanes, se muestra su utilidad a la hora de analizar la segregación residencial dentro de una ciudad, y detectar las pautas que rigen este fenómeno. Los resultados muestran que no hay relación clara entre el porcentaje de población extranjera y el nivel de segregación, y que la segregación difiere según el grupo observado. Una nueva perspectiva de la segregación se obtiene con la utilización de indicadores diseñados mediante elementos de estadística espacial. La combinación de todas estas medidas representa un procedimiento útil para el análisis de la distribución de la población inmigrante en las zonas urbanas, su utilidad se extiende a diferentes áreas como la sociología, la economía, el urbanismo o las políticas de vivienda.

Ammatti-identiteetin rakentuminen sairaanhoitajilla

Ammatti-identiteetti luo pohjan henkilön ammattitaidolle, oman, henkilökohtaisen ammatillisen osaamisen arvostamiselle sekä koko ammattikuvalle, sille millaisena työntekijänä jokainen itsensä näkee. Vahva ammatti-identiteetti aikaansaa positiivisen takaisinkytkennän, kun hyvin tehdyn työn seurauksena saadaan kannustavaa palautetta, mikä kasvattaa itsetuntoa, joka puolestaan luo positiivinen omakuvan, jonka seurauksena syntyy vahva ammatti-identiteetti. Tämän tutkimuksen tarkoituksena on selvittää millä tavoin ammatti-identiteetti rakentuu ja muotoutuu, ja millaisia ovat sitä muovaavat tekijät. Samalla pyritään selvittämään millainen merkitys ammatti-identiteetillä on työn suorittamiseen, työssä viihtymiseen sekä omaan näkemykseen itsestään tietyn alan ammattilaisena. Tutkimuksen kontekstina on terveydenhoitoala, ja empiriassa tutkitaan sairaanhoitajien ammatti-identiteettiä. Tutkimuksen perusteella näyttää siltä, että sairaanhoitajat arvostavat ammattiaan ja ammattitaitoaan huolimatta yhteiskunnallisesta aliarvostuksesta. Tämä tukee käsitystä sairaanhoitajien vahvasta ammatti-identiteetistä. Tutkimuksen tulokset osoittavat, että sairaanhoitajan ammatti-identiteetti on moniulotteinen ilmiö. Ammatti-identiteetti ei ole irrallinen henkilön persoonallisesta identiteetistä, vaan ne tukevat toinen toistaan.