Gait disturbances as specific predictive markers of the first fall onset in elderly people: a two-year prospective observational study

Falls are common in the elderly, and potentially result in injury and disability. Thus, preventing falls as soon as possible in older adults is a public health priority, yet there is no specific marker that is predictive of the first fall onset. We hypothesized that gait features should be the most relevant variables for predicting the first fall. Clinical baseline characteristics (e.g., gender, cognitive function) were assessed in 259 home-dwelling people aged 66 to 75 that had never fallen. Likewise, global kinetic behavior of gait was recorded from 22 variables in 1036 walking tests with an accelerometric gait analysis system. Afterward, monthly telephone monitoring reported the date of the first fall over 24 months. A principal components analysis was used to assess the relationship between gait variables and fall status in four groups: non-fallers, fallers from 0 to 6 months, fallers from 6 to 12 months and fallers from 12 to 24 months. The association of significant principal components (PC) with an increased risk of first fall was then evaluated using the area under the Receiver Operator Characteristic Curve (ROC). No effect of clinical confounding variables was shown as a function of groups. An eigenvalue decomposition of the correlation matrix identified a large statistical PC1 (termed "Global kinetics of gait pattern"), which accounted for 36.7% of total variance. Principal component loadings also revealed a PC2 (12.6% of total variance), related to the "Global gait regularity." Subsequent ANOVAs showed that only PC1 discriminated the fall status during the first 6 months, while PC2 discriminated the first fall onset between 6 and 12 months. After one year, any PC was associated with falls. These results were bolstered by the ROC analyses, showing good predictive models of the first fall during the first six months or from 6 to 12 months. Overall, these findings suggest that the performance of a standardized walking test at least once a year is essential for fall prevention.

Three essays in dynamic corporate finance

The three essays constituting this thesis focus on financing and cash management policy. The first essay aims to shed light on why firms issue debt so conservatively. In particular, it examines the effects of shareholder and creditor protection on capital structure choices. It starts by building a contingent claims model where financing policy results from a trade-off between tax benefits, contracting costs and agency costs. In this setup, controlling shareholders can divert part of the firms' cash ows as private benefits at the expense of minority share- holders. In addition, shareholders as a class can behave strategically at the time of default leading to deviations from the absolute priority rule. The analysis demonstrates that investor protection is a first order determinant of firms' financing choices and that conflicts of interests between firm claimholders may help explain the level and cross-sectional variation of observed leverage ratios. The second essay focuses on the practical relevance of agency conflicts. De- spite the theoretical development of the literature on agency conflicts and firm policy choices, the magnitude of manager-shareholder conflicts is still an open question. This essay proposes a methodology for quantifying these agency conflicts. To do so, it examines the impact of managerial entrenchment on corporate financing decisions. It builds a dynamic contingent claims model in which managers do not act in the best interest of shareholders, but rather pursue private benefits at the expense of shareholders. Managers have discretion over financing and dividend policies. However, shareholders can remove the manager at a cost. The analysis demonstrates that entrenched managers restructure less frequently and issue less debt than optimal for shareholders. I take the model to the data and use observed financing choices to provide firm-specific estimates of the degree of managerial entrenchment. Using structural econometrics, I find costs of control challenges of 2-7% on average (.8-5% at median). The estimates of the agency costs vary with variables that one expects to determine managerial incentives. In addition, these costs are sufficient to resolve the low- and zero-leverage puzzles and explain the time series of observed leverage ratios. Finally, the analysis shows that governance mechanisms significantly affect the value of control and firms' financing decisions. The third essay is concerned with the documented time trend in corporate cash holdings by Bates, Kahle and Stulz (BKS,2003). BKS find that firms' cash holdings double from 10% to 20% over the 1980 to 2005 period. This essay provides an explanation of this phenomenon by examining the effects of product market competition on firms' cash holdings in the presence of financial constraints. It develops a real options model in which cash holdings may be used to cover unexpected operating losses and avoid inefficient closure. The model generates new predictions relating cash holdings to firm and industry characteristics such as the intensity of competition, cash flow volatility, or financing constraints. The empirical examination of the model shows strong support of model's predictions. In addition, it shows that the time trend in cash holdings documented by BKS can be at least partly attributed to a competition effect.

Distance Transforms on Gray-Level Surfaces

This thesis studies gray-level distance transforms, particularly the Distance Transform on Curved Space (DTOCS). The transform is produced by calculating distances on a gray-level surface. The DTOCS is improved by definingmore accurate local distances, and developing a faster transformation algorithm. The Optimal DTOCS enhances the locally Euclidean Weighted DTOCS (WDTOCS) with local distance coefficients, which minimize the maximum error from the Euclideandistance in the image plane, and produce more accurate global distance values.Convergence properties of the traditional mask operation, or sequential localtransformation, and the ordered propagation approach are analyzed, and compared to the new efficient priority pixel queue algorithm. The Route DTOCS algorithmdeveloped in this work can be used to find and visualize shortest routes between two points, or two point sets, along a varying height surface. In a digital image, there can be several paths sharing the same minimal length, and the Route DTOCS visualizes them all. A single optimal path can be extracted from the route set using a simple backtracking algorithm. A new extension of the priority pixel queue algorithm produces the nearest neighbor transform, or Voronoi or Dirichlet tessellation, simultaneously with the distance map. The transformation divides the image into regions so that each pixel belongs to the region surrounding the reference point, which is nearest according to the distance definition used. Applications and application ideas for the DTOCS and its extensions are presented, including obstacle avoidance, image compression and surface roughness evaluation.

Evaluación de la educación emocional en el ciclo medio de Educación Primaria

El principal propósito de la educación consiste en favorecer el desarrollo integral de la persona, lo cual implica atender el aspecto cognitivo y afectivo. Tradicionalmente, se han priorizado sólo los contenidos cognitivos por este motivo queremos incidir sobre los afectos. El objetivo general de este trabajo de investigación que presentamos consiste en aplicar y evaluar un Programa de Educación Emocional (PEEP), integrado dentro del currículum de Primaria de ciclo medio que ayude a prevenir los efectos nocivos de las emociones negativas y facilite la relación consigo mismo y con los demás. Objetivo general que se constatara a partir de cuatro criterios: conseguir un mejor conocimiento de las propias emociones y de las emociones de los demás, desarrollar estrategias de regulación emocional, mejorar la autoestima, aprender habilidades de vida y socioemocionales. Pues, la finalidad es intervenir en la mejora de la educación emocional de los alumnos entre los 8 y los 10 años, en total 510 alumnos de los cuales 104 formaron la muestra de investigación. Fueron divididos en dos grupos el grupo experimental y el grupo control, ambos constituían una muestra homogénea y estadísticamente comparable por lo que podíamos plantearnos una intervención y valorar su incidencia. Los resultados indican que mejora el nivel de Educación Emocional (EE) de estos alumnos con un nivel de significación de p= 0,001. A partir de este momento, podemos concretar que los resultados conseguidos por los alumnos que han seguido la aplicación del programa mejoran significativamente. Este resultado, nos permite afirmar que el uso intencional del programa de educación emocional para mejorar el ámbito afectivo ha incidido positivamente en el proceso de aprendizaje de los alumnos. Sin embargo consideramos esencial llevar a cabo una formación y posterior evaluación del profesorado en EE, como paso previo necesario para una aplicación óptima del programa.

Intervention de la pensée représentative de futurs enseignant-e-s dans leurs prises de position envers l'intégration scolaire

In the past two decades, international recommendations have made inclusive education a priority issue. Many countries have adopted school policies inciting players to question their representations about the duties and purposes of schooling and their role therein. In Switzerland, a new national and cantonal framework defines the integration of students with disabilities or special educational needs in the regular classroom as a priority. However, progress in this area is modest and many researchers are left wondering how teachers could be better prepared to meet the special needs of some students. Initial training is thus seen as essential in bringing pre-service teachers to develop open attitudes toward students with disabilities or special educational needs. While many studies have examined the role of training in building professional attitudes, very few deal with teacher representations of inclusive education, let alone those of future teachers. Our research focuses on two samples of pre-service teachers in the beginning, middle or end of their initial training. 261 pre-service teachers for primary education and 212 pre-service teachers for secondaiy education are involved in the study. The research aims to highlight the role of their representative thinking in building their attitudes towards inclusive education. Our results show that objectification remains essentialist and focuses on the prototypes of the most publicized disabilities. They also showed the weakness of the training system as perceived by future teachers. Even though they have maintained or strengthened positive attitudes towards integration, most leave their training with a reinforced sense of apprehension when faced with the disabilities or special educational needs that they expect to encounter in their future work. Although pre-service teachers consider their training insufficient, it nevertheless positively influences their attitudes toward integration. In particular, greater internship practice, however modest it may be, has a significant effect on attitudes of future teachers by increasing their perception of competence and confidence. -- Ces deux dernières décennies, les recommandations internationales ont fait de l'inclusion scolaire une thématique prioritaire. De nombreux pays ont adopté des politiques scolaires obligeant les acteurs scolaires à interroger leurs représentations des missions de l'école et leur rôle au sein de celle-ci. En Suisse, un nouveau cadre national et cantonal a défini comme prioritaire l'intégration dans l'école ordinaire des élèves en situation de handicap ou ayant des besoins éducatifs particuliers. Or, les avancées en la matière restent modestes et de nombreux chercheurs se questionnent sur la manière dont les enseignant-e-s pourraient être mieux préparés à répondre aux besoins éducatifs particuliers de certains élèves. La formation initiale est ainsi perçue comme essentielle pour amener les futurs enseignant-e-s pour développer des attitudes ouvertes envers les élèves en situation de handicap ou ayant des besoins éducatifs particuliers. Si beaucoup d'études portent sur le rôle de la formation dans la construction d'attitudes professionnelles, très peu traitent des représentations des enseignant-e-s à l'égard de l'intégration scolaire et encore moins de celles des futurs enseignant-e-s. Notre recherche porte sur deux populations de futurs enseignant-e-s en début, au milieu ou en fin de formation. Elles sont composées respectivement de 261 étudiant-e-s se destinant à l'enseignement primaire et de 212 étudiant-e-s se destinant à l'enseignement secondaire. La recherche vise à mettre en évidence l'intervention de leur pensée représentative dans leurs prises de position envers l'intégration scolaire. Nos résultats montrent que l'objectivation reste essentialiste et se focalise sur les prototypes de situations de handicap les plus médiatisés. Nos résultats font également fait apparaître la faiblesse du dispositif de formation tel que perçu les futurs enseignant-e-s. Quand bien même ont-ils conservé ou renforcé des attitudes favorables à l'intégration, ils quittent pour la plupart leur formation avec une appréhension renforcée à l'égard des situations de handicap ou de besoins éducatifs particuliers qu'ils s'attendent à rencontrer dans leur future pratique. Bien que la formation soit jugée insuffisante par les étudiant-e-s, elle oriente néanmoins favorablement leurs prises de position envers l'intégration des élèves concernés. En particulier, une plus grande pratique de stage, si modeste soit-elle, a un effet important sur ces prises de position par l'augmentation du sentiment de compétence et la perception d'assurance des futurs enseignant-e-s.

Points to consider for prioritizing clinical genetic testing services: a European consensus process oriented at accountability for reasonableness.

Given the cost constraints of the European health-care systems, criteria are needed to decide which genetic services to fund from the public budgets, if not all can be covered. To ensure that high-priority services are available equitably within and across the European countries, a shared set of prioritization criteria would be desirable. A decision process following the accountability for reasonableness framework was undertaken, including a multidisciplinary EuroGentest/PPPC-ESHG workshop to develop shared prioritization criteria. Resources are currently too limited to fund all the beneficial genetic testing services available in the next decade. Ethically and economically reflected prioritization criteria are needed. Prioritization should be based on considerations of medical benefit, health need and costs. Medical benefit includes evidence of benefit in terms of clinical benefit, benefit of information for important life decisions, benefit for other people apart from the person tested and the patient-specific likelihood of being affected by the condition tested for. It may be subject to a finite time window. Health need includes the severity of the condition tested for and its progression at the time of testing. Further discussion and better evidence is needed before clearly defined recommendations can be made or a prioritization algorithm proposed. To our knowledge, this is the first time a clinical society has initiated a decision process about health-care prioritization on a European level, following the principles of accountability for reasonableness. We provide points to consider to stimulate this debate across the EU and to serve as a reference for improving patient management.

Laajakaistaliitynnät - xDSL-tekniikat ja muut vaihtoehdot

Tietoliikenteen suuria linjoja ovat mm. siirtonopeuksien kasvu, IP-tekniikan yleistyminen ja Internet-liitäntöjen kautta käytettävien palvelujen valtaisa lisääntyminen. Kotien verkkoliitännöissä eräänä haasteena on vielä tarjota kohtuullisilla kustannuksilla suuri liikennöintikapasiteetti, mikä voidaan tehdä usealla eri tavalla. Kotien laajakaistaiseen tulevaisuuteen johtaakin useita polkuja, joita tässä diplomityössä on kartoitettu. Työssä on esitelty erilaisia kotitalouksiin soveltuvia nopeita langallisia ja langattomia liitäntätekniikoita. Painopiste on nykyisessä valtavirrassa, kuparikaapelia käyttävässä xDSL-tekniikkaperheessä ja niihin pohjautuvissa verkoissa mukaan lukien ATM-pohjaiset runkoverkot Käytännön liitäntöjen laatua ja toimivuutta on selvitetty mittaamalla perinteistä ADSL-liitäntää sekä uudempaa tekniikkaa edustavaa SHDSL-liitäntää. Liittymiä mitattiin sekä xDSL-mittarilla että spektrianalysaattorilla. Mittauksissa kiinnitettiin huomiota kupariparien toimintaan, kuormituksen ja häiriöiden vaikutukseen sekä liittymän toimintaan käyttäjän kannalta. Mittauksissa todettiin, että kuparikaapeli sietää hyvin häiriöitä myös uusien tekniikoiden käytössä. Tulevaisuutta kartoitettiin haastattelututkimuksella, josta työhön on koostettu operaattoreiden, konsulttien ja käyttäjien näkemyksiä laajakaistaliitäntöjen ja niiden kautta saatavien palveluiden kehittymisestä. Tehty tutkimus osoittaa, että ADSL-tekniikka hyödyntää hyvin sille varattuja taajuusalueita. SHDSL-tekniikassa voidaan lähettää ja vastaanottaa suuria datamääriä molempiin suuntiin.

Suorituskyvyn analysointi ja mittaaminen julkisella sektorilla

Suorituskyvyn mittaamiselle ja seurannalle on nykyisin laajaa tarvetta myös julkisella sektorilla. Tutkimuksen tarkoituksena oli kehittää soveltuvia suorituskykyä kuvaavia mittareita ja rakentaa niistä käyttökelpoinen suorituskyvyn analysointijärjestelmä julkisen sektorin käyttöön. Ensisijaisena lähtökohtana olivat fyysiset mittarit, koska ne soveltuvat paremmin julkisen sektorin toimintaympäristöön.Tutkimuksen teoriaosassa esitetään joitakin suorituskyvyn analysointijärjestelmiä. Julkiselle sektorille soveliaina viitekehyksinä esitellään yleisellä tasolla balanced scorecard, suorituskykypyramidi, benchmarking, dynaaminen suorituskyvyn mittausjärjestelmä, laatupalkintokriteeristö, SAKE-sovellus ja suorituskykymatriisi.Työssä paneudutaan melko laajalti tekijöihin, joilla on voimakas vaikutus suorituskykyyn. Tällaisia tekijöitä ovat laatuasiat, tuottavuus ja organisaation kilpailukyvykkyys.Tutkimuksen käytännön osassa rakennettiin suorituskyvyn analysointi- ja mittausjärjestelmä. Ensin määriteltiin mittausjärjestelmään soveliaat suorituskyvyn osa-alueet ja seuraavaksi mittarit. Taloudellisia mittareita kehitettiin vain muutama, sillä pääpaino mittarien kehittelyssä olivat ei-taloudelliset mittarit. Mittaristo auttaa organisaatiota mittaamaan sen tilannetta matkalla jatkuvan parantamisen tiellä.

Liiketoimintaprosessien uudelleenrakentaminen PK-yrityksessä

Tutkimuksen päätavoite on kehittää pintakäsittelylaitteita valmistavan PK-yrityksen liiketoimintaedellytyksiä suunnittelemalla sille uusi toimintamalli. Sysäyksen kehitysprojektille antoi liiketoiminnan kasvusta johtunut kontrollin pettäminen, mikä aiheutti kannattavuuden kääntymisen negatiiviseksi. Työn keskeisen viitekehyksen muodostavat kolme tekijää; kehitysmenetelmänä liiketoimintaprosessien uudelleenrakentaminen, yritysmuotona projektiliiketoiminta sekä uuden toimintamallin painopisteenä tuotannon ja asennuksen ulkoistaminen. Käytössä olevia liiketoimintaprosesseja analysoitaessa pystyttiin tunnistamaan useita ongelmakohtia yrityksen toiminnassa, joiden pohjalta määriteltiin parannustarpeet ja vaatimukset uusille prosesseille. Yrityksessä oli selkeänä ongelmana yleinen järjestelmällisyyden puute, mikä näkyi määrittelemättöminä liiketoimintaprosesseina ja tästä johtuvina ongelmina yrityksen lähes kaikissa toiminnoissa. Tekninen osaaminen on yrityksessä hyvää, mutta liikkeenjohdollinen puoli kaipaisi kehittämistä. Tyypillisiä ongelmia olivat vaikeasti ennustettavat tuotantoajat ja niistä johtuneet myöhästymiset toimituksissa, valmistusvirheet sekä tuotannon ja asennuksen tehottomuus. Omat vaatimuksensa uusille prosesseille asetti myös siirtyminen ulkoistettuun valmistukseen ja asennukseen. Uusien prosessien myötä keskeisimmät muutokset olivat panostaminen pitkän tähtäimen suunnitteluun, asiakastiedon hallinnan parantaminen, panostaminen alihankkijaverkoston johtamiseen, organisaation sisäisen viestinnän parantaminen ja siirtyminen etätyön mahdollistavaan ”virtuaalitoimistoon”.

Kohti dynaamista organisaatioviestintää ja organisaatiota – teoreettinen synteesi

Tutkimuksen tarkoituksena on selvittää, mitä on dynaaminen organisaatio- viestintä, minkälaisesta maailmankuvasta se ponnistaa ja mitä yhtymä- kohtia sillä on tietojohtamisen kolmiulotteiseen organisaatiomalliin. Tutkimus on teoreettinen synteesi, jonka avulla on tarkoitus löytää myös käytännön menetelmiä, joilla voidaan tukea dynaamista organisaatio- viestintää, organisaation dynaamisuutta sekä itseuudistumista. Tutkimuksen teoreettisina lähtökohtina ovat Pekka Aulan dynaamisen organisaatioviestinnän teoria sekä pääasiassa Pirjo Ståhlen luoma kolmiulotteinen organisaatiomalli ja siihen liittyvä itseuudistuvien systeemien teoriaehdotus. Tutkimuksen käytännönläheisessä osassa analysoidaan suomalaisia organisaatioviestinnän oppikirjoja dynaamisen organisaatioviestinnän teorian valossa. Lopuksi muodostetaan malli, joka tukee dynaamista organisaatioviestintää ja organisaatiota. Tutkimus osoittaa, että useiden teoreetikoiden mielestä organisaatioiden pitäisi luopua vanhentuneista organisaatiorakenteistaan ja kehittää työympäristöjään nostamalla inhimilliset voimavarat ensisijaisiksi sekä keskittymällä työntekijöiden välisen vuorovaikutuksen, tiedon sekä informaation vaihtoon.

Toimitusvarmuuden parantaminen yrityksen sisäistä toimintaa tehostamalla

Time’s meaning as a competitive factor has been growing significantly from 1970’s to 2000. Product life cycles have got significantly shorter, customers are not ready to keep their own inventories and fast changing markets are making it dangerous to count on forecasts. All these factors are forcing companies to shorten their lead times and answer to customer hopes on faster basis. Good delivery reliability is increasing its importance in making difference between competitors.In this thesis we get deep into KWH Pipe Ltd. Finland’s, and especially Vaasa factory’s, delivery reliability problems. Target is to find causes, which are causing problems in delivery reliability. In year 2007 has delivery reliability been 87 %, as management has set target in 95 %. Delivery reliability has been quite the same for few years now, and at the same time storage values have been growing up. The causes of poor delivery reliability were searched by analyzing company’s order-delivery-process using among other things root cause analysis. Furthermore the meters, which are used in company at the moment, are analyzed and some new meters are suggested to take in use. As outcome of process analysis is a list of confirmed problems in order of priority and by using this list it is possible to decide of actions, which are taken in future to bring delivery reliability to better level.

State of Logistics and Operations Management in Finnish and Swedish Companies – Survey Research Findings

In this research we are examining what is the status of logistics and operations management in Finnish and Swedish companies. Empirical data is based on the web based questionnaire, which was completed in the end of 2007 and early 2008. Our examination consists of roughly 30 answers from largest manufacturing (highest representation in our sample), trade and logistics/distribution companies. Generally it could be argued that these companies operate in complex environment, where number of products, raw materials/components and suppliers is high. However, usually companies rely on small amount of suppliers per raw material/component (highest frequency is 2), and this was especially the case among Swedish companies, and among those companies, which favoured overseas sourcing. Sample consisted of companies which mostly are operating in an international environment, and are quite often multinationals. Our survey findings reveal that companies in general have taken logistics and information technology as part of their strategy process; utilization of performance measures as well as system implementations have followed the strategy decisions. In the transportation mode side we identify that road transports dominate all transport flow classes (inbound, internal and outbound), followed by sea and air. Surprisingly small amount of companies use railways, but in general we could argue that Swedish companies prefer this mode over Finnish counterparts. With respect of operations outsourcing, we found that more traditional areas of logistics outsourcing are driving factors in company's performance measurement priority. In contrary to previous research, our results indicate that the scope of outsourcing is not that wide in logistics/operations management area, and companies are not planning to outsource more in the near future. Some support is found for more international operations and increased outsourcing activity. From the increased time pressure of companies, we find evidence that local as well as overseas customers expect deliveries within days or weeks, but suppliers usually supply within weeks or months. So, basically this leads into considerable inventory holding. Interestingly local and overseas sourcing strategy does not have that great influence on lead time performance of these particular sourcing areas - local strategy is anyway considerably better in responding on market changes due to shorter supply lead times. In the end of our research work we have completed correlation analysis concerning items asked with Likert scale. Our analysis shows that seeing logistics more like a process rather than function, applying time based management, favouring partnerships and measuring logistics within different performance dimensions results on preferred features and performance found in logistics literature.

Phylogenetic relationships of Apodemus Kaup, 1829 (Rodentia: Muridae) species in the Eastern Mediterranean inferred from mitochondrial DNA, with emphasis on iranian species

Wood mice of the genus Apodemus are widely distributed in Eurasia, with the Eastern Mediterranean being considered as a hotspot. Indeed, numerous species have been documented in Iran, including A. witherbyi, A. hyrcanicus, A. uralensis, A. avicennicus, A. hermonensis, and A. arianus. In this study, 129 specimens were collected from different Iranian localities and two specimens from Afghanistan. The animals were identified taxonomically and their phylogenetic relationships were investigated using cytochrome b mitochondrial DNA sequences. Five species of the genus Apodemus were identified in Iran, including A. hyrcanicus, A. witherbyi, A. cf. ponticus, A. uralensis, and A. mystacinus, beside, A. pallipes from Afghanistan. This study found no evidence of A. flavicollis or A. sylvaticus in Iran, despite their occurrence in Turkey, shedding doubt on the status of A. flavicollis in Iran, Asia Minor, and the Levant. Phylogenetic analyses imply that A. witherbyi has priority over A. avicennicus, A. hermonensis, and A. iconicus. Estimation of the divergence time for these taxa suggests a separation at around 7.2 Ma for the subgenera Karstomys (including A. mystacinus and A. epimelas) and Sylvaemus (including A. flavicollis, A. sylvaticus, A. uralensis, A. pallipes, A. hyrcanicus, A. witherbyi, and A. cf. ponticus). Within the subgenus Karstomys, the divergence times for A. mystacinus and A. epimelas were between 3.0 and 6.1 Ma, and divergence times within the subgenus Sylvaemus were between 5.2 and 6.9 Ma for A. witherbyi and other species in this subgenus. It is postulated that vicariance events including the uplifting of the Zagros Mountains and Anatolian Plateau in the middle Miocene and climate oscillations during the Messinian Salinity Crisis besides formation of the Hyrcanian tertiary forests during the Neogene probably played substantial roles in the radiation and distribution of the genus Apodemus in the Eastern Mediterranean.

A qualitative study of adolescents with medically unexplained symptoms and their parents. Part 1: Experiences and impact on daily life.

Medically unexplained symptoms (MUS) are common among adolescents and are frequently encountered in primary care. Our aim was to explore how these adolescents and their parents experience the condition and its impact on their daily lives and to provide recommendations for health professionals. Using a qualitative approach, six focus groups and two individual interviews were conducted. These involved a total of ten adolescents with different types of MUS and sixteen parents. The respondents were recruited in a university hospital in Switzerland. A thematic analysis was conducted according to the Grounded Theory. The analysis of the data highlighted four core themes: disbelief, being different, concealing symptoms, and priority to adolescent's health. Transcending these themes was a core issue regarding the discrepancy between the strategies that adolescents and their parents use to cope with the symptoms. Health professionals should be made aware of the emotional needs of these patients and their families.

Professional trajectories, individual characteristics and staying satisfied and healthy

Staying satisfied and healthy in the face of a complex and uncertain professional world is a priority for individuals. This article examines the contribution of personality traits, career adaptability, and prior well-being as predictors of well-being over 1 year in four different professional trajectory groups: those who remained employed, those who experienced a professional change, those who moved from unemployment to employment, and those who remained unemployed. Results show meaningful differences between these groups in terms of well-being over 1 year. Employed individuals have higher life satisfaction and self-rated health than unemployed individuals. Regaining employment contributes to improved well-being. Different professional situations correspond to varying levels of career adaptability, suggesting it may be a precursor for career changes. Personality traits and career adaptability predict well-being over time, but the strongest predictor of future well-being is prior well-being. Results are discussed in light of career development, personality, and well-being theory.