Youth and Health as an issue of Research in Social Work - Two examples of current Research

Health issues under aspects pertaining to social work are currently being investigated in our department under two main perspectives. The study of Youth, Health, and Internet is based on experiences with a project of e-mail counseling for youths we have been running in our department for one year so far. Our thesis is that the internet has become an important platform for youngsters in general as well as concerning health issues specifically. So far, however, little is known about the ways youths address their health related problems in the net. We believe that research in this area is badly needed since future concepts of effective health improvement and prevention for youths cannot ignore this medium. Biography and Health is our second focus of investigation, addressing deficiencies in the empirical research of Aaron Antonovsky´s salutogenetic concept that has lately become quite popular in many health discussions. Drawing from biographical methods we are currently investigating the development of the so called "sense of coherence" - the center piece of salutogenesis.

CECOG experts' recommendations on the use of denosumab in the prevention of skeletal-related events in bone metastases of lung cancer

Purpose Skeletal-related events represent a substantial burden for patients with advanced cancer. Randomized, controlled studies suggested superiority of denosumab over zoledronic acid in the prevention of skeletal-related events in metastatic cancer patients, with a favorable safety profile. Experts gathered at the 2012 Skeletal Care Academy in Istanbul to bring forward practical recommendations, based on current evidence, for the use of denosumab in patients with bone metastases of lung cancer. Recommendations Based on current evidence, use of denosumab in lung cancer patients with confirmed bone metastases is recommended. It is important to note that clinical judgment should take into consideration the patient’s general performance status, overall prognosis, and live expectancy. Currently, the adverse event profile reported for denosumab includes hypocalcemia and infrequent occurrence of osteonecrosis of the jaw. Therefore, routine calcium and vitamin D supplementation, along with dental examination prior to denosumab initiation are recommended. There is no evidence for renal function impairment due to denosumab administration. At present, there is no rationale to discourage concomitant use of denosumab and surgery or radiotherapy.

Worksite Tobacco Prevention: A Randomized, Controlled Trial of Adoption, Dissemination Strategies, and Aggregated Health-Related Outcomes across Companies

Evidence based public health requires knowledge about successful dissemination of public health measures. This study analyses (a) the changes in worksite tobacco prevention (TP) in the Canton of Zurich, Switzerland, between 2007 and 2009; (b1) the results of a multistep versus a “brochure only” dissemination strategy; (b2) the results of a monothematic versus a comprehensive dissemination strategy that aim to get companies to adopt TP measures; and (c) whether worksite TP is associated with health- related outcomes. A longitudinal design with randomized control groups was applied. Data on worksite TP and health-related outcomes were gathered by a written questionnaire (baseline

The prevention of catheter related bloodstream infections in a pediatric population

Catheter related bloodstream infections are a significant barrier to success in many inpatient healthcare facilities. The goal of this study was to analyze and determine if an evidence based methodology to reduce the number of catheter related bloodstream infections in a pediatric inpatient healthcare facility had significant impact on the infection rate. Catheter related bloodstream infection rates were compared before and after program implementation. The patient population was selected based upon a recommendation in the 2010 National Healthcare Safety Network report on device related infections. This report indicated a need for more data on pediatric populations requiring admission to a long term care facility. The study design is a retrospective cohort study. Catheter related bloodstream infection data was gathered between 2008 and 2011. In October of 2008 a program implementation began to reduce the number of catheter related bloodstream infections. The key components of this initiative were to implement a standardized catheter maintenance checklist, introduce the usage of a chlorhexadine gluconate based product for catheter maintenance and skin antisepsis, and a multidisciplinary education plan that focused on hand hygiene and aseptic technique. The catheter related bloodstream infection rate in 2008 was 21.21 infections per 1000 patient-line days. After program implementation the 2009 catheter related bloodstream infection rate dropped to 1.11 per 1000 patient-line days. The infection rates in 2010 and 2011 were 2.19 and 1.47 respectively. Additionally, this study demonstrated that there was a potential cost savings of $620,000 to $1,240,000 between 2008 and 2009. In conclusion, an evidence based program based upon CDC guidelines can have a significant impact on catheter related bloodstream infection rates. ^

Fishing effort control regulations influence on stability, safety and operability of small fishing vessels: study of a series of stability related accidents occurred in Spain between 2004 and 2007

Entre los años 2004 y 2007 se hundieron por problemas de estabilidad cinco pesqueros españoles de pequeña eslora, de características parecidas, de relativamente poca edad, que habían sido construidos en un intervalo de pocos años. La mayoría de los tripulantes de esos pesqueros fallecieron o desaparecieron en esos accidentes. Este conjunto de accidentes tuvo bastante repercusión social y mediática. Entre ingenieros navales y marinos del sector de la pesca se relacionó estos accidentes con los condicionantes a los diseños de los pesqueros impuestos por la normativa de control de esfuerzo pesquero. Los accidentes fueron investigados y publicados sus correspondientes informes; en ellos no se exploró esta supuesta relación. Esta tesis pretende investigar la relación entre esos accidentes y los cambios de la normativa de esfuerzo pesquero. En la introducción se expone la normativa de control de esfuerzo pesquero analizada, se presentan datos sobre la estructura de la flota pesquera en España y su accidentalidad, y se detallan los criterios de estabilidad manejados durante el trabajo, explicando su relación con la seguridad de los pesqueros. Seguidamente se realiza un análisis estadístico de la siniestralidad en el sector de la pesca para establecer si el conjunto de accidentes estudiados supone una anomalía, o si por el contrario el conjunto de estos accidentes no es relevante desde el punto de vista estadístico. Se analiza la siniestralidad a partir de diversas bases de datos de buques pesqueros en España y se concluye que el conjunto de accidentes estudiados supone una anomalía estadística, ya que la probabilidad de ocurrencia de los cinco sucesos es muy baja considerando la frecuencia estimada de pérdidas de buques por estabilidad en el subsector de la flota pesquera en el que se encuadran los cinco buques perdidos. A continuación el trabajo se centra en la comparación de los buques accidentados con los buques pesqueros dados de baja para construir aquellos, según exige la normativa de control de esfuerzo pesquero; a estos últimos buques nos referiremos como “predecesores” de los buques accidentados. Se comparan las dimensiones principales de cada buque y de su predecesor, resultando que los buques accidentados comparten características de diseño comunes que son sensiblemente diferentes en los buques predecesores, y enlazando dichas características de diseño con los requisitos de la nueva normativa de control del esfuerzo pesquero bajo la que se construyeron estos barcos. Ello permite establecer una relación entre los accidentes y el mencionado cambio normativo. A continuación se compara el margen con que se cumplían los criterios reglamentarios de estabilidad entre los buques accidentados y los predecesores, encontrándose que en cuatro de los cinco casos los predecesores cumplían los criterios de estabilidad con mayor holgura que los buques accidentados. Los resultados obtenidos en este punto permiten establecer una relación entre el cambio de normativa de esfuerzo pesquero y la estabilidad de los buques. Los cinco buques accidentados cumplían con los criterios reglamentarios de estabilidad en vigor, lo que cuestiona la relación entre esos criterios y la seguridad. Por ello se extiende la comparativa entre pesqueros a dos nuevos campos relacionados con la estabilidad y la seguridad delos buques: • Movimientos a bordo (operatividad del buque), y • Criterios de estabilidad en condiciones meteorológicas adversas El estudio de la operatividad muestra que los buques accidentados tenían, en general, una mayor operatividad que sus predecesores, contrariamente a lo que sucedía con el cumplimiento de los criterios reglamentarios de estabilidad. Por último, se comprueba el desempeño de los diez buques en dos criterios específicos de estabilidad en caso de mal tiempo: el criterio IMO de viento y balance intenso, y un criterio de estabilidad de nueva generación, incluyendo la contribución original del autor de considerar agua en cubierta. Las tendencias observadas en estas dos comparativas son opuestas, lo que permite cuestionar la validez del último criterio sin un control exhaustivo de los parámetros de su formulación, poniendo de manifiesto la necesidad de más investigaciones sobre ese criterio antes de su adopción para uso regulatorio. El conjunto de estos resultados permite obtener una serie de conclusiones en la comparativa entre ambos conjuntos de buques pesqueros. Si bien los resultados de este trabajo no muestran que la aprobación de la nueva normativa de esfuerzo pesquero haya significado una merma general de seguridad en sectores enteros de la flota pesquera, sí se concluye que permitió que algunos diseños de buques pesqueros, posiblemente en busca de la mayor eficiencia compatible con dicha normativa, quedaran con una estabilidad precaria, poniendo de manifiesto que la relación entre seguridad y criterios de estabilidad no es unívoca, y la necesidad de que éstos evolucionen y se adapten a los nuevos diseños de buques pesqueros para continuar garantizando su seguridad. También se concluye que la estabilidad es un aspecto transversal del diseño de los buques, por lo que cualquier reforma normativa que afecte al diseño de los pesqueros o su forma de operar debería estar sujeta a evaluación por parte de las autoridades responsables de la seguridad marítima con carácter previo a su aprobación. ABSTRACT Between 2004 and 2007 five small Spanish fishing vessels sank in stability related accidents. These vessels had similar characteristics, had relatively short age, and had been built in a period of a few years. Most crewmembers of these five vessels died or disappeared in those accidents. This set of accidents had significant social and media impact. Among naval architects and seamen of the fishing sector these accidents were related to the design constraints imposed by the fishing control effort regulations. The accidents were investigated and the official reports issued; this alleged relationship was not explored. This thesis aims to investigate the relationship between those accidents and changes in fishing effort control regulations. In the introduction, the fishing effort control regulation is exposed, data of the Spanish fishing fleet structure and its accident rates are presented, and stability criteria dealt with in this work are explained, detailing its relationship with fishing vessel safety. A statistical analysis of the accident rates in the fishing sector in Spain is performed afterwards. The objective is determining whether the set of accidents studied constitute an anomaly or, on the contrary, they are not statistically relevant. Fishing vessels accident rates is analyzed from several fishing vessel databases in Spain. It is concluded that the set of studied accidents is statistically relevant, as the probability of occurrence of the five happenings is extremely low, considering the loss rates in the subsector of the Spanish fishing fleet where the studied vessels are fitted within. From this point the thesis focuses in comparing the vessels lost and the vessels that were decommissioned to build them as required by the fishing effort control regulation; these vessels will be referred to as “predecessors” of the sunk vessels. The main dimensions between each lost vessel and her predecessor are compared, leading to the conclusion that the lost vessels share design characteristics which are sensibly different from the predecessors, and linking these design characteristics with the requirements imposed by the new fishing control effort regulations. This allows establishing a relationship between the accidents and this regulation change. Then the margin in fulfilling the regulatory stability criteria among the vessels is compared, resulting, in four of the five cases, that predecessors meet the stability criteria with greater clearance than the sunk vessels. The results obtained at this point would establish a relationship between the change of fishing effort control regulation and the stability of vessels. The five lost vessels complied with the stability criteria in force, so the relation between these criteria and safety is put in question. Consequently, the comparison among vessels is extended to other fields related to safety and stability: • Motions onboard (operability), and • Specific stability criteria in rough weather The operability study shows that the lost vessels had in general greater operability than their predecessors, just the opposite as when comparing stability criteria. Finally, performance under specific rough weather stability criteria is checked. The criteria studied are the IMO Weather Criterion, and one of the 2nd generation stability criteria under development by IMO considering in this last case the presence of water on deck, which is an original contribution by the author. The observed trends in these two cases are opposite, allowing to put into question the last criterion validity without an exhaustive control of its formulation parameters; indicating that further research might be necessary before using it for regulatory purposes. The analysis of this set of results leads to some conclusions when comparing both groups of fishing vessels. While the results obtained are not conclusive in the sense that the entry into force of a new fishing effort control in 1998 caused a generalized safety reduction in whole sectors of the Spanish fishing fleet, it can be concluded that it opened the door for some vessel designs resulting with precarious stability. This evidences that the relation between safety and stability criteria is not univocal, so stability criteria needs to evolve for adapting to new fishing vessels designs so their safety is still guaranteed. It is also concluded that stability is a transversal aspect to ship design and operability, implying that any legislative reform affecting ship design or operating modes should be subjected to assessing by the authorities responsible for marine safety before being adopted.