Radiation protection education and training in several ionising radiation applications

Ionising radiation (IR) applications are quiet common among several areas of knowledge, medicine or industry. Medical X-rays, Nuclear Medicine, Xrays used in non-destructive testing or applications in research are a few examples. These radiations originate from radioactive materials or radiation emitting devices. Radiation Protection education and training (E&T) is of paramount importance to work safely in areas that imply the use of IR. TheTechnical Unit for Radiation Protection at the University of Barcelona has anextensive expertise in basic, initial and refresher training, in general or specificareas, as well as in courses validated by the Spanish Nuclear Safety Council orto satisfy specific needs with bespoke courses. These specific customer needsare evaluated and on-site courses can also be carried out.

Els nens i nenes amb “Dictamen d’escolarització” i amb suport del CDIAP: estudi de les dimensions de l’atenció a les necessitats especials de l’alumnat, entre tres i sis anys, escolaritzat en un centre públic de la comarca d’Osona

La meva recerca ha tingut com a punt de partida “Els nens i nenes amb “Dictamen d’escolarització” i amb suport del CDIAP: estudi de les dimensions de l’atenció a les necessitats especials de l’alumnat, entre tres i sis anys, escolaritzat en un centre públic de la comarca d’Osona”. A partir d’aquí, s’ha elaborat un marc teòric a partir de les lleis d’educació, decrets que regulen els diferents serveis i un seguit de conceptes bàsics. Un cop elaborat aquest marc teòric per tal de recollir les dades dels alumnes, de tres a sis anys, d’una escola en concret s’ha dissenyat un instrument de recollida de dades que li diem full resum de serveis (FRS). El FRS és un instrument que ens ha servit per recollir totes les dades d’alumnes amb necessitats específiques i, sobretot, per saber quin suport reben per part de l’escola i per part d’altres serveis. A més a més, per recollir informació sobre els diferents serveis que atenen aquesta diversitat s’ha elaborat un guió d’entrevistes (GE). Aquest GE serveix per recollir els aspectes més importants de les entrevistes realitzades a l’EAP (Equip d’Assessorament i Orientació Psicopedagògica), CDIAP (Centre de Desenvolupament Infantil i Atenció Precoç) i CSMIJ (Centre de Salut Mental Infantil i Juvenil). A partir de la informació extreta dels dos instruments, s’han elaborat unes conclusions respecte els objectius plantejats en aquest projecte i la pregunta plantejada a l’inici.

Candidat à l'échec scolaire incompris et ignoré : l'enfant de migrants = Misunderstood and ignored candidate to the school failure: The child of migrants

Immigration, intégration, précarité, échec scolaire, ignorance du français, délinquance sont des thèmes qui animent régulièrement les débats publics, médiatiques et politiques. Bien que les migrations ont toujours fait partie de l'histoire humaine, elles sont souvent décrites comme un trouble aux identités nationales, elles-mêmes mises à mal par la mondialisation. Cependant, les mécanismes sous-tendant les difficultés rencontrées par certains enfants de migrants demeurent bien moins débattus et considérés que leurs conséquences bruyantes et visibles. Après une réflexion sur l'impact de la migration elle-même sur le sujet et un bref aperçu de l'ethnopsychiatrie, nous allons décrire les difficultés que peut rencontrer l'enfant de migrants, leurs origines et leurs conséquences. Nous nous intéresserons ensuite à la manière dont notre société, nos institutions en tiennent compte ou pas. Nous terminerons notre propos par la mise en relief des besoins thérapeutiques et éducatifs spéciaux de ces enfants et la manière dont ceux-ci sont comblés (ou non). Immigration, social integration, precariousness, language barrier, delinquency are constantly stimulating public, political and media debate. Migrations always were part of the human history but they are often described like a disorder of the national identities, themselves put at evil by globalization. However, the origin of the difficulties that certain children of migrants encounter is often overlooked. Only their disturbing implications are frequently studied. After a brief comment on the impact of the migration and the ethnopsychiatry, we will outline the difficulties sometimes faced by the children of migrants, their origins and consequences. Then we will describe how the society and the institutions take them in account (or not). We finally will delineate the specific needs of those children and how they are meeting (or not).

The path: sustainable development in conjunction with meeting the demands of a changing environment.

In the context of severe economic recession, the Library is compelled to adapt to this changing environment, in order to meet the requirements and demands of users with very specific needs. Taking the pillars of sustainable development as a reference point, and extrapolating them to our domain, we establish the next main goals

Predictors of functional recovery in patients admitted to geriatric postacute rehabilitation.

OBJECTIVE: To examine characteristics associated with functional recovery in older patients undergoing postacute rehabilitation. DESIGN: Observational study. SETTING: Postacute rehabilitation facility. PARTICIPANTS: Patients (N=2754) aged ≥65 years admitted over a 4-year period. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Functional status was assessed at admission and again at discharge. Functional recovery was defined as achieving at least 30% improvement on the Barthel Index score from admission compared with the maximum possible room for improvement. RESULTS: Patients who achieved functional recovery (70.3%) were younger and were more likely to be women, live alone, and be without any formal home care before admission, and they had fewer chronic diseases (all P<.01). They also had better cognitive status and a higher Barthel Index score both at admission (mean ± SD, 63.3±18.0 vs 59.6±24.7) and at discharge (mean ± SD, 86.8±10.4 vs 62.2±22.9) (all P<.001). In multivariate analysis, patients <75 years of age (adjusted odds ratio [OR]=1.51; 95% confidence interval [CI], 1.16-1.98; P=.003), women (adjusted OR=1.24; 95% CI, 1.01-1.52; P=.045), patients living alone (adjusted OR=1.61; 95% CI, 1.31-1.98; P<.001), and patients without in-home help prior to admission (adjusted OR=1.39; 95% CI, 1.15-1.69; P=.001) remained at increased odds of functional recovery. In addition, compared with those with moderate-to-severe cognitive impairment (Mini-Mental State Examination score <18), patients with mild-to-moderate impairment (Mini-Mental State Examination score 19-23) and those cognitively intact also had increased odds of functional recovery (adjusted OR=1.56; 95% CI, 1.13-2.15; P=.007; adjusted OR=2.21; 95% CI, 1.67-2.93; P<.001, respectively). CONCLUSIONS: Apart from sociodemographic characteristics, cognition is the strongest factor that identifies older patients more likely to improve during postacute rehabilitation. Further study needs to determine how to best adapt rehabilitation processes to better meet the specific needs of this population and optimize their outcome.

Specialized home palliative care for adults and children: differences and similarities.

OBJECTIVE: To compare the provision of specialized home palliative care (SHPC) by the adult and pediatric SHPC teams at the Munich University Hospital. METHODS: All patients treated by one of the SHPC teams and their primary caregivers were eligible for the prospective nonrandomized survey. We analyzed the demographics, the underlying diseases, duration and impact of SHPC on symptom control and quality of life (QOL) as well as the caregivers' burden and QOL. RESULTS: Between April 2011 and June 2012, 100 adult and 43 pediatric patients were treated consecutively; 60 adults (median age, 67.5 years; 55% male) and 40 children (median age, 6 years, 57% male) were included in the study. Oncologic diseases were dominant only in the adult cohort (87 versus 25%, p<0.001). The median period of care was higher in the pediatric sample (11.8 versus 4.3 weeks; NS). Ninety-five percent of adult and 45% of pediatric patients died by the end of the study (p<0.001), 75% and 90% of them at home, respectively. The numbers of significant others directly affected by the patient's disease was higher in children (mean 3.4 versus 1.2; p<0.001). The QOL of adult patients and children (p<0.05 for both), as well as of their primary caregivers (p<0.001 for both) improved during SHPC, while the caregivers' burden was lowered (p<0.001 for both). CONCLUSIONS: Our results show important differences in several clinically relevant parameters between adults and children receiving SHPC. This should assist in the development of age-group specific SHPC concepts that effectively address the specific needs of each patient population.

Developing an Effective Construction Training Program for American Supervisors with Hispanic Craft Workers, 2005

In the construction industry, Hispanics have the highest rate of fatal work injuries among the racial/ethnic groups, and productivity in the field is limited by the language barrier between Hispanic workers and their supervisors and the level of education of many Hispanic craft workers. This research developed a training program designed to facilitate the integration process between American supervisors and Hispanic craft workers in a practical and cost-effective way, thus improving productivity and lowering fatality rates. The Iowa State University research team conducted a survey of 38 American supervisors, representing 14 Iowa construction companies. Survey results confirm that communication is the main problem experienced by American supervisors in the job site. Many American supervisors also use or depend on a link-person (an individual who interprets tasks to the rest of the Hispanic crew) to communicate to the Hispanic crew members. Research findings show that language differences affect productivity and workplace safety in the construction industry. Additionally, the educational levels of Hispanic workers indicate that they may not have the literacy skills necessary to understand training materials. This research developed two training courses designed to expand the Spanish communication skills of American supervisors. The research team modified the English-as-a-second-language course developed in Phase I into the Spanish as a Second Language (SSL) Survival Course. A series of technical training courses were also developed, titled Concrete Pavement Construction Basics (CPCB), that cover general practices in concrete pavement construction. They are much shorter and more specialized than the SSL course. The CPCB courses provide American supervisors simple and practical communication tools on a variety of topics to choose from according to their specific needs.

Health-related quality of life in patients with dual diagnosis: clinical correlates

Background: Although the studies published so far have found an affectation in the Health Related Quality of Life (HRQOL) in both psychiatric and substance use dependence disorders, very few studies have applied HRQOL as an assessment measure in patients suffering both comorbid conditions, or Dual Diagnosis. The aim of the current study was to assess HRQOL in a group of patients with Dual Diagnosis compared to two other non-comorbid groups and to determine what clinical factors are related to HRQOL. Methods: Cross-sectional assessment of three experimental groups was made through the Short Form 36 Item Health Survey (SF-36). The sample consisted of a group with Dual Diagnosis (DD; N=35), one with Severe Mental Illness alone (SMI; N=35) and another one with Substance Use Dependence alone (SUD; N=35). The sample was composed only by males. To assess the clinical correlates of SF-36 HRQOL, lineal regression analyses were carried out. Results: The DD group showed lower scores in most of the subscales, and in the mental health domain. The group with SUD showed in general a better state in the HRQOL while the group with SMI held an intermediate position with respect to the other two groups. Daily medication, suicidal attempts and daily number of coffees were significantly associated to HRQOL, especially in the DD group. Conclusions: The DD group showed lower self-reported mental health quality of life. Assessment of HRQOL in dual patients allows to identify specific needs in this population, and may help to establish therapeutic goals to improve interventions.

Identifying Critical Business Success Factors of Paperboard Tray

Työn tavoitteena oli kartonkivuoan kriittisten menestystekijöiden ja kilpailuaseman selvittäminen jäähdytettyjen ruokatuotteiden markkinoilla Euroopassa. Kilpailija- ja tavoiteanalyysi suoritettiin kahden suomalaisen pakkaajan kesken. Pakkaajien haastattelut toteutettiin joko henkilökohtaisena tai sähköpostihaastatteluna. Muovi on yleisimmin käytetty jäähdytettyjen ruokatuotteiden pakkausmateriaali. Alumiinivuokien osuus on merkittävä erityisesti laatikkoruokien pakkauksena. Kartonkivuoille on kuitenkin havaittavissa selvää menestyspotentiaalia jäähdytettyjen ruokien pakkauksena. Kartonkivuokien hyvä imago ja edistyksellinen tuotekehitystyö mahdollistavat pakkaajien erityisvaatimuksien täyttämisen ja menestymisen markkinoilla. Kartonkivuoilla on useita ainutlaatuisia kilpailuetu- ja menestystekijöitä, kuten hyvä ulkonäkö ja painojälki. Suurin haaste on saada ruokatuotteiden pakkaajat tietoisiksi kartonkivuokien tuomista pakkausmahdollisuuksista.

The biological family from the perspective of kinship fostered adolescents

Background: Previous studies emphasise the importance of the biological family to the welfare of fostered adolescents. However, the majority of these studies only take into consideration the viewpoints of the professionals, foster parents and biological parents not those of the adolescents themselves. For this reason little is known about the perceptions the adolescents have and the needs they express. Method: This study has gathered data from 57 adolescents in kinship family fostering in Spain (AFE). The study applied qualitative reseach, using focus groups to gather data and the Atlas.ti programme to analyse the data. The qualitative data give us a more profound understanding of how the fostered adolescents relate to their biological families. Results: The results highlight the specific needs of these adolescents a) an understanding of their family history b) the impact of visits from and relationship with their biological family and c) the relationship between the biological family and the foster family. Conclusions: These findings reveal implications to consider when creating support programmes aimed at this group.

Säästämispalveluiden henkilöasiakasmarkkinoiden segmentointi - Case: Merita Pankki Oyj

Tutkielman tavoitteena on säästämiskäyttäytymisen tutkiminen ja tarpeet tunnistavan segmentoinnin suorittaminen. Tavoitteena on muodostaa syvällinen näkemys säästämispalveluiden asiakkaista. Segmentointi perustetaan käyttäytymiselle. Tutkielma koostuu teoreettisesta ja empiirisestä osiosta. Teoreettinen osio on kirjoituspöytätutkimusta, jonka tietolähteinä ovat teoriakirjallisuuden lisäksi aiemmat tutkimukset pankkikäyttäytymisestä. Empiirisen osion aineisto on tilastollinen data 96 502 Merita Pankin asiakkaasta. Segmentointi suoritetaan K-klusterianalyysilla ja tuloksia tarkastellaan ristiintaulukoimalla. Tutkimus osoittaa säästämiskäyttäytymisen saavan erilaisia muotoja markkinoilla. Käyttäytymiselle perustuvalla segmentoinnilla syntyy viiden erilaisen säästäjätyypin profiilit. Tarkastelemalla tarjottuja palveluita ja asiakkaiden palvelukokonaisuuksia rinnakkain voidaan tunnistaa asiakkaiden tarpeita. Säästämispalveluiden markkinoiden yksityiskohtaisten tarpeiden tunnistamiseen tarvitaan tutkielmassa käytettyjen tietojen lisäksi kvantitatiivista tietoa asiakkaiden elämänkaaresta ja säästämisen tavoitteesta.

Post-transcriptional regulation of circadian gene expression by miRNAs

La grande majorité des organismes vivants ont développé un système d'horloges biologiques internes, appelées aussi horloges circadiennes, contrôlant l'expression de gênes impliqués dans de nombreux processus moléculaires et comportementaux. Au cours de la dernière décennie, des analyses « microarray » et séquençages à haut débit sur divers tissus de mammifères, indiquent que jusqu'à 20% du transcriptome serait sous contrôle circadien. Il était jusqu'à présent admis que la majorité des ARNm ayant une accumulation rythmique était générée par une transcription qui était elle-même rythmique. Toutefois, de récentes études ont suggéré qu'une proportion considérable des ARNm cycliques serait en fait générée par des mécanismes post-transcriptionnelles, incluant une régulation par micro-ARN (miARN). Lorsque j'ai débuté mon travail de thèse, l'influence des miARN sur l'expression des gènes circadiens, au niveau pangénomique, était encore méconnue. Par l'utilisation d'un modèle murin, dont la biogenèse des miARN a été spécifiquement désactivée au niveau des cellules hépatiques (knockout conditionnel pour Dicer), je me suis donc intéressée au rôle que jouaient ces molécules régulatrices sur la rythmicité de l'expression génique dans le foie. Des séquençages sur l'ensemble du transcriptome révèlent que l'horloge interne du foie est étonnement résistante à la perte totale des miARN. Nous avons cependant trouvé que les miARN agissent de façon importante sur la régulation de l'expression des gènes contrôlés par l'horloge moléculaire. La corégulation par les miARN, affectant jusqu'à 30% des gènes transcrits de façon rythmiques, conduit ainsi à une modulation de phase et d'amplitude du rythme de l'abondance des ARNm. En revanche, seuls peu de transcrits dépendent uniquement des miARN pour la rythmicité de leur accumulation. Enfin, mon travail met en évidence plusieurs miARN spécifiques, qui semblent préférentiellement moduler l'expression des gènes cycliques et permet l'identification de voies hépatiques particulièrement sujettes à une double régulation par les miARN et l'horloge biologique interne. La première masse d'analyses a essentiellement porté sur le rôle que jouent les miARN au niveau de l'expression des gènes contrôlés par l'horloge interne. Dans deux études de suivi, je me suis penchée sur deux aspects supplémentaires et complémentaires de la manière dont les miARN et l'oscillation de l'expression des gènes interagissent. Dans les hépatocytes murins, spécifiquement privés de Dicer, je me suis demandée si un phénotype horloge avait pu être masqué, dû à un entraînement stable de l'horloge du foie par l'horloge maîtresse du cerveau. J'ai donc commencé une série d'expériences ambitieuses (impliquant la mesure de la rythmicité du foie in vivo, chez l'animal vivant) afin de déséquilibrer l'entrainement de l'horloge hépatique via l'utilisation d'un protocole nutritionnel spécifique. Les premiers résultats suggèrent que dans des conditions où l'animal subit une restriction alimentaire pendant la journée, les miARN sont importants dans la cinétique d'adaptation des organes périphériques à un nouvel horaire de sustentation. Dans une deuxième ligne de recherche, j'ai plus profondément étudié quels seraient les miARN responsables des rythmes post-transcriptionnels des ARNm, en utilisant le séquençage de « small » ARN sur 24h. L'analyse est en cours et se poursuivra après l'obtention de mon diplôme. De façon générale, mon travail révèle d'importants et nouveaux rôles des miARN dans la modulation de l'expression circadienne des gènes hépatiques. De plus, le set de données générées dans l'étude déjà publiée, peut dorénavant servir de ressource valable pour de prochaines investigations sur le rôle physiologique que les miARN jouent au niveau du foie. -- Most living organisms have developed internal timing systems, called circadian clocks, to drive the rhythmic expression of genes involved in many molecular and behavioral processes. Over the last decade, microarray analyses and high- throughput sequencing from various mammalian tissues have indicated that up to 20% of the transcriptome are under circadian control. It was generally assumed that the majority of rhythmic mRNA accumulation is generated by rhythmic transcription. However, recent studies have suggested that a considerable proportion of mRNA cycling may actually be generated by post-transcriptional mechanisms, including by microRNAs. When I started my thesis work, it was still unknown how miRNAs influence circadian gene expression in a genome-wide fashion. Using a mouse model in which miRNA biogenesis can be inactivated in hepatocytes (conditional Dicer knockout mouse), I have thus addressed the role that these regulatory molecules play in rhythmic gene expression in the liver. Whole transcriptome sequencing revealed that the hepatic core clock was surprisingly resilient to total miRNA loss. However, we found that miRNAs acted as important regulators of clock-controlled gene expression. Co- regulation by miRNAs, which affected up to 30% of rhythmically transcribed genes, thus led to the modulation of phases and amplitudes of mRNA abundance rhythms. By contrast, only very few transcripts were strictly dependent on miRNAs for their rhythmic accumulation. Finally, my work highlights several specific miRNAs that appear to preferentially modulate cyclic gene expression, and identifies pathways in the liver that are particularly prone to dual regulation through miRNAs and the clock. The first bulk of analyses mainly dealt with the role that miRNAs play at the level of rhythmic clock output gene expression. In two follow-up studies I further delved into two additional, complementary aspects of how miRNAs and gene expression oscillations interact. First, I addressed whether a core clock phenotype in the hepatocyte-specific Dicer knockout could have been masked due to the stable entrainment of the liver clock by the animals' master clock in the brain. I thus started a series of ambitious experiments (involving the in vivo recording of liver rhythms in live animals) to bring the stable entrainment of the liver clock out of equilibrium using specific feeding protocols. My first results suggest that under conditions when animals are challenged by food restriction to daytime, miRNAs are important for the kinetics of adapting to unusual mealtime in peripheral tissue. In a second line of research, I have more carefully investigated which miRNAs are responsible for post- transcriptional mRNA rhythms using small RNA sequencing around-the-clock. The analyses are ongoing and will be continued after my graduation. Overall, my work uncovered important and novel roles of miRNA activity in shaping hepatic circadian gene expression; moreover, the datasets collect in the published studies can serve as a valuable resource for further investigations into the physiological roles that miRNAs play in liver. -- L'alternance du jour et de la nuit dirige depuis longtemps la vie quotidienne des êtres humains et de la plupart des organismes sur terre. Ce cycle de 24 heures façonne beaucoup de changements comportementaux et physiologiques tels que la vigilance, la température corporelle et le sommeil. Les rythmes journaliers, appelés rythmes circadiens, sont dirigés par des horloges biologiques tournant dans presque chaque cellule du corps. Une structure dans le cerveau agit en tant qu'horloge maitresse pour synchroniser les horloges internes entre elles et en fonction des signaux de jour/nuit extérieurs. Dans les cellules "les gènes de l'horloge" sont activés et désactivés une fois par jour ce qui déclenche des cycles dans lesquels des protéines sont produites de manière circadienne. Ces rythmes protéiques sont spécialisés pour chaque tissu ou organe et peuvent les aider à réaliser leurs tâches quotidiennes. Les rythmes circadiens peuvent être générés d'autres manières n'impliquant pas directement les composants des gènes de l'horloge. Les ARN messagers (ARNm) sont des molécules intermédiaires dans la production de protéines à partir d'ADN. Dans le foie des souris jusqu'à 20% des molécules d'ARNm sont produites suivant des rythmes circadiens. Le foie réalise des tâches essentielles dans le contrôle du métabolisme incluant celui des hydrates de carbone, des graisses et du cholestérol. Un timing précis est important afin de traiter les substances nutritives correctement lors des repas il en résulte une variation des quantités de certains ARNm et protéines coïncidant avec les repas. Les microARNs constituent une autre classe de molécules ARN de très petite taille qui régulent l'efficacité de traduction des ARNm en protéines et la stabilité des ARNm. Lors de mon travail de thèse, j'ai exploré de manière approfondie l'influence de ces petits régulateurs sur les rythmes circadiens du foie de souris. Ces expériences qui impliquaient le "Knock-out" d'un gène essentiel à la production de microARNs montrent qu'au lieu de générer les rythmes des ARNm, les microARNs les ajustent pour répondre aux besoins spécifiques du foie comme assurer leur pic au bon moment de la journée. Le ciblage de microARNs spécifiques peut révéler de nouvelles stratégies pour rectifier ces rythmes lorsque par exemple les fonctions métaboliques ne fonctionnent plus normalement. -- The rising and setting of the sun have long driven the daily schedules of humans and most organisms on the earth. This 24-hr cycle shapes many behavioural and physiological changes, such as alertness, body temperature, and sleep. These daily rhythms, which are called circadian rhythms, are dictated by biological clocks that are ticking in almost every single cell of the body. A region in the brain acts as a master clock to synchronize the internal clocks with each other and with the outside light/dark cycles. In cells, "core clock genes" are turned on and off once per day, which triggers cycles that cause some proteins to be produced in a circadian manner. The protein rhythms are specialized to a particular tissue or organ, and may help them to carry out their designated daily tasks. However, circadian rhythms might also be produced by other ways that do not involve these core clock components. Messenger RNAs (mRNAs) are intermediate molecules in the production of proteins from DNA. In the mouse liver, up to 20% of mRNA molecules are produced in circadian cycles. The liver performs essential tasks that control metabolism-including that of carbohydrates, fats, and cholesterol. Precisely timing when certain mRNAs and proteins reach peaks and troughs in their activities to coincide with mealtimes is important for nutrients to be properly processed. Other RNA molecules called microRNAs, i.e. RNAs of very small size, regulate at which rate mRNA molecules are translated into proteins. In my thesis work, I have explored at the influence of these small regulators on circadian rhythms in the mouse liver in greater detail. These experiments, which involved "knocking out" a gene that is essential for the production of microRNAs, show that rather than generating the mRNA rhythms, the microRNAs appear to adjust them to meet the specific needs of the liver, such as ensuring that they peak at the right time-of-day. Targeting specific microRNA molecules may reveal new strategies to tweak these rhythms, which could help to improve conditions when metabolic functions go wrong.

Perspectives thérapeutiques dans la prise en charge de l'acouphène subjectif chronique [Therapeutic perspectives in the treatment of chronic subjective tinnitus].

There are no effective therapies for the treatment of chronic subjective tinnitus. The present study aims to compare two therapeutic approaches: Tinnitus Retraining Therapy (TRT) and a Biopsychosocial Approach (BPS). Results show no difference in evolution of tinnitus' perception between the beginning of the study and after 12 months of treatment in both treatment groups. Important anxiety could be a factor contributed towards the abandonment or ineffectiveness of treatments. Patients with more biopsychosocial comorbidities are more receptive to therapies. The practicioners therefore must assess specific needs, comorbidities and biopsychosocial profiles of patients suffering from tinnitus.

Characterizing the vulnerability of frequent emergency department users by applying a conceptual framework: a controlled, cross-sectional study.

BACKGROUND: Frequent emergency department (ED) users meet several of the criteria of vulnerability, but this needs to be further examined taking into consideration all vulnerability's different dimensions. This study aimed to characterize frequent ED users and to define risk factors of frequent ED use within a universal health care coverage system, applying a conceptual framework of vulnerability. METHODS: A controlled, cross-sectional study comparing frequent ED users to a control group of non-frequent users was conducted at the Lausanne University Hospital, Switzerland. Frequent users were defined as patients with five or more visits to the ED in the previous 12 months. The two groups were compared using validated scales for each one of the five dimensions of an innovative conceptual framework: socio-demographic characteristics; somatic, mental, and risk-behavior indicators; and use of health care services. Independent t-tests, Wilcoxon rank-sum tests, Pearson's Chi-squared test and Fisher's exact test were used for the comparison. To examine the -related to vulnerability- risk factors for being a frequent ED user, univariate and multivariate logistic regression models were used. RESULTS: We compared 226 frequent users and 173 controls. Frequent users had more vulnerabilities in all five dimensions of the conceptual framework. They were younger, and more often immigrants from low/middle-income countries or unemployed, had more somatic and psychiatric comorbidities, were more often tobacco users, and had more primary care physician (PCP) visits. The most significant frequent ED use risk factors were a history of more than three hospital admissions in the previous 12 months (adj OR:23.2, 95%CI = 9.1-59.2), the absence of a PCP (adj OR:8.4, 95%CI = 2.1-32.7), living less than 5 km from an ED (adj OR:4.4, 95%CI = 2.1-9.0), and household income lower than USD 2,800/month (adj OR:4.3, 95%CI = 2.0-9.2). CONCLUSIONS: Frequent ED users within a universal health coverage system form a highly vulnerable population, when taking into account all five dimensions of a conceptual framework of vulnerability. The predictive factors identified could be useful in the early detection of future frequent users, in order to address their specific needs and decrease vulnerability, a key priority for health care policy makers. Application of the conceptual framework in future research is warranted.

Necessitats dels familiars de pacients amb càncer

El càncer produeix un impacte a la família en totes les seves esferes, la família ha de modificar les seves rutines familiars i adoptar nous rols. En el moment del diagnòstic del càncer, a cada família hi ha una persona que assumeix el rol de cuidador principal. Aquest cuidador és el que s’ocupa del malalt a casa i fa d’enllaç entre la família i l’equip sanitari. En front del càncer, la família i el cuidador tenen un conjunt de dubtes, d’inquietuds, de preocupacions que s’acaben traduint en necessitats. L’equip sanitari i Infermeria especialment ha d’atendre aquestes necessitats i ajudar a satisfer-les. Objectiu: L’objectiu principal d’aquest treball es descriure quines són les necessitats que presenten la família i el cuidador dels pacients oncològics. Metodologia: Es va dur a terme una revisió de la literatura entre setembre del 2013 i maig del 2014. Es va utilitzar la base de dades Pubmed, a més de pàgines web i llibres. Es van obtenir un total de 75 fonts, 56 en angles, 18 en espanyol i 1 en català. Resultats: La bibliografia agrupa les necessitats de les famílies i els cuidadors en 7 grans categories: físiques, psicològiques i emocionals, socials, de informació i formació, econòmiques, de transport i espirituals. Pel que fa a necessitats més especifiques, algunes de les més freqüents són tenir informació sobre el pronòstic del malalt, assegurar-se de que l’equip sanitari està donant la millor atenció possible al malalt. Sembla haver-hi una relació entre el grau de no satisfacció de les necessitats i el grau d’ansietat i depressió en la família i el cuidador. Els autors consultats no coincideixen en afirmar si la majoria del les necessitats es veuen satisfetes o no. Conclusions: La família i el cuidador d’un pacient amb càncer també han de rebre atenció per part dels professionals. En moltes ocasions la família treu importància a les seves necessitats per tal de que l’equip sanitari es centri només en el malalt. Infermeria té un paper fonamental en detectar les necessitats dels familiars i cuidadors i en ajudar a satisfer-les, de manera que la família estigui en les millors condicions possibles per cuidar del malalt. Paraules clau: Càncer, família, cuidador, necessitats familiars, rol d’Infermeria