Impact of a communication strategy on family satisfaction in the intensive care unit.

BACKGROUND Family satisfaction of critically ill patients has gained increased interest as important indicator to evaluate the quality of care in the intensive care unit (ICU). The family satisfaction in the ICU questionnaire (FS-ICU 24) is a well-established tool to assess satisfaction in such settings. We tested the hypothesis that an intervention, aiming at improved communication between health professionals and patients' next of kin in the ICU improves family satisfaction, as assessed by FS-ICU 24. METHODS Using a multicenter before-and-after study design, we evaluated medium-term effectiveness of VALUE, a recently proposed strategy aiming at improved communication. Satisfaction was assessed using the FS-ICU 24 questionnaire. Performance-importance plots were generated in order to identify items highly correlated with overall satisfaction but with low individual score. RESULTS A total of 163 completed family questionnaires in the pre-intervention and 118 in the post-intervention period were analyzed. Following the intervention, we observed: (1) a non-significant increase in family satisfaction summary score and sub-scores; (2) no decline in any individual family satisfaction item, and (3) improvement in items with high overall impact on satisfaction but quoted with low degree of satisfaction. CONCLUSION No significant improvement in family satisfaction of critically ill adult patients could be found after implementing the VALUE strategy. Whether these results are due to insufficient training of the new strategy or a missing effect of the strategy in our socio-economic environment remains to be shown.

CATCH across Texas: Building a model for the diffusion of effective school-based health promotion programs

The impact of health promotion programs is related to both program effectiveness and the extent to which the program is implemented among the target population. The purpose of this dissertation was to describe the development and evaluation of a school-based program diffusion intervention designed to increase the rate of dissemination and adoption of the Child and Adolescent Trial for Cardiovascular Health, or CATCH program (recently renamed the Coordinated Approach to Child Health). ^ The first study described the process by which schools across the state of Texas spontaneously began to adopt the CATCH program after it was tested and proven effective in a multi-site randomized efficacy trial. A survey of teachers and administrator representatives of all schools on record that purchased the CATCH program, but were not involved in the efficacy trial, was used to find out who brought CATCH into the schools, how they garnered support for its adoption, why they decided to adopt the program, and what was involved in deciding to adopt. ^ The second study described how the Intervention Mapping framework guided the planning, development and implementation of a program for the diffusion of CATCH. An iterative process was used to integrate theory, literature, the experience of project staff and data from the target population into a meaningful set of program determinants and performance objectives. Proximal program objectives were specified and translated into both media and interpersonal communication strategies for program diffusion. ^ The third study assessed the effectiveness of the diffusion program in a case-comparison design. Three of the twenty Education Service Center regions in Texas were chosen, selected based on similar demographic criteria, and were followed for adoption of the CATCH curriculum. One of these regions received the full media and interpersonal channel intervention; a second received a reduced media-only intervention, and a third received no intervention. Results suggested the use of the interpersonal channels with media follow-up is an effective means to facilitate program dissemination and adoption. The media-alone condition was not effective in facilitating program adoption. ^

On the Way to Becoming Global Citizens: Use of ICT by Ukrainian Students

Information is one of the important assets in today's society. Information and communication technologies (ICT) may be particular important for students as one of the tools to become global citizens. The objective of this study was to investigate use of ICT by high school students (n=122) from Ukraine, a developing country. The analysis indicates that majority of students from Ukraine have computer at home and more than half of students have the Internet access at home. In addition, gender differences in the use of computer and the Internet were identified. Educational implications and future directions are discussed.

Internet as a medium to seek partners among men who have sex with men

While there are reports of developing sexual relationships on the Internet (I) among MSM, there are few reports that have examined the process of developing sexual relationships on the I and comparing to that in real life (IRL). This study examines the process to provide insight into how MSM make decisions about courtship, engages in negotiations for sex, and choose sexual partners and examines the comparative sexual risks taken between I vs. IRL negotiation. This self-selected convenience sample at a national level (n=1001) of MSM recruited through the I, systematically explored the different steps, the process of courtship in a flow chart of I and IRL dating to portray the process of filtering, courtship and/or negotiation for sex. Risk behaviors in both environments are presented along with interactions that create predictable sequences or "scripts". These sequences constitute 'filtering' and 'sexual positioning'. Differences between I & IRL suggest discussion of HIV/STD status to have consistent differences for all variables except 'unprotected sex' meaning no condom use. There was more communication on the I in regards to self revealing information or variables relating to reducing risks which enable 'filtering' (including serosorting). Data indicate more steps in the I process, providing more complex, multiple steps to filter and position with regard not only to HIV/STD risk but also to negotiate position for complementary sexual interest. The study established a pattern of MSM's courtships or negotiation for sex and a pattern of acquisition, and more I negotiation. Data suggest negotiation opportunities which could lend to intervention to advise people how to negotiate safely. ^ Previous studies have reviewed MSM and drug use. This is a study to review the process of drug use associated with sexual behavior regarding the Internet (I) and in real life (IRL) using a self-selected, convenience sample of MSM (n=1001) recruited nation-wide through the Internet. Data on MSM and drugs illustrate the Internet being used as a tool to filter for drug use among MSM. MSM's drug use in both environments highlights the use of sexual performance drugs with an IRL pursuit of intimacy or negotiation for sex. IRL encounters were more likely to involve drug use (both recreational and sexual performance-enhancing) than Internet encounters. This may be due to more IRL meetings occurring at bars, clubs or parties where drug use is a norm. Compared with IRL, the Internet may provide a venue for persons who do not want to use drugs to select partners with similar attitudes. This suggests that filtering may be occurring as part of the internet negotiation. Data indicated that IRL persons get drunk/high before having sex in past 60 days significantly more often than Internet participants. Age did not alter the pattern of results. Thus drug filtering is really not recreational drug filtering or selecting for PNP, but appears to be situationally-based. Thus, it should perhaps be seen as another form of filtering to select drug-free partners, rather than using the Internet to specifically recruit and interact with other recreational drug users. ^

Evaluation of therapist and client language in Motivational Interviewing (MI) sessions: A secondary analysis of data from the Southern Methodist Alcohol Research Trial (SMART) study

In the United States, ���binge��� drinking among college students is an emerging public health concern due to the significant physical and psychological effects on young adults. The focus is on identifying interventions that can help decrease high-risk drinking behavior among this group of drinkers. One such intervention is Motivational interviewing (MI), a client-centered therapy that aims at resolving client ambivalence by developing discrepancy and engaging the client in change talk. Of late, there is a growing interest in determining the active ingredients that influence the alliance between the therapist and the client. This study is a secondary analysis of the data obtained from the Southern Methodist Alcohol Research Trial (SMART) project, a dismantling trial of MI and feedback among heavy drinking college students. The present project examines the relationship between therapist and client language in MI sessions on a sample of ���binge��� drinking college students. Of the 126 SMART tapes, 30 tapes (���MI with feedback��� group = 15, ���MI only��� group = 15) were randomly selected for this study. MISC 2.1, a mutually exclusive and exhaustive coding system, was used to code the audio/videotaped MI sessions. Therapist and client language were analyzed for communication characteristics. Overall, therapists adopted a MI consistent style and clients were found to engage in change talk. Counselor acceptance, empathy, spirit, and complex reflections were all significantly related to client change talk (p-values ranged from 0.001 to 0.047). Additionally, therapist ���advice without permission��� and MI Inconsistent therapist behaviors were strongly correlated with client sustain talk (p-values ranged from 0.006 to 0.048). Simple linear regression models showed a significant correlation between MI consistent (MICO) therapist language (independent variable) and change talk (dependent variable) and MI inconsistent (MIIN) therapist language (independent variable) and sustain talk (dependent variable). The study has several limitations such as small sample size, self-selection bias, poor inter-rater reliability for the global scales and the lack of a temporal measure of therapist and client language. Future studies might consider a larger sample size to obtain more statistical power. In addition the correlation between therapist language, client language and drinking outcome needs to be explored.^

Planning and implementation efficacy as a determinant of health risk communication outcomes: Case studies of the U.S. Public Health Service (PHS)

This study was conducted under the auspices of the Subcommittee on Risk Communication and Education of the Committee to Coordinate Environmental Health and Related Programs (CCEHRP) to determine how Public Health Service (PHS) agencies are communicating information about health risk, what factors contributed to effective communication efforts, and what specific principles, strategies, and practices best promote more effective health risk communication outcomes.^ Member agencies of the Subcommittee submitted examples of health risk communication activities or decisions they perceived to be effective and some examples of cases they thought had not been as effective as desired. Of the 10 case studies received, 7 were submitted as examples of effective health risk communication, and 3, as examples of less effective communication.^ Information contained in the 10 case studies describing the respective agencies' health risk communication strategies and practices was compared with EPA's Seven Cardinal Rules of Risk Communication, since similar rules were not found in any PHS agency. EPA's rules are: (1) Accept and involve the public as a legitimate partner. (2) Plan carefully and evaluate your efforts. (3) Listen to the public's specific concerns. (4) Be honest, frank, and open. (5) Coordinate and collaborate with other credible sources. (6) Meet the needs of the media. (7) Speak clearly and with compassion.^ On the basis of case studies analysis, the Subcommittee, in their attempts to design and implement effective health risk communication campaigns, identified a number of areas for improvement among the agencies. First, PHS agencies should consider developing a focus specific to health risk communication (i.e., office or specialty resource). Second, create a set of generally accepted practices and guidelines for effective implementation and evaluation of PHS health risk communication activities and products. Third, organize interagency initiatives aimed at increasing awareness and visibility of health risk communication issues and trends within and between PHS agencies.^ PHS agencies identified some specific implementation strategies the CCEHRP might consider pursuing to address the major recommendations. Implementation strategies common to PHS agencies emerged in the following five areas: (1) program development, (2) building partnerships, (3) developing training, (4) expanding information technologies, and (5) conducting research and evaluation. ^

Proyecto de Desarrollo Inteligente Departamento Burruyacu - Tucum��n Propuesta integrada con distintos actores institucionales a partir de mesa de gesti��n territorial

El presente proyecto 'Desarrollo Inteligente del Departamento Burruyacu - Tucum��n' elaborado en base a un diagnostico participativo que dio como resultado, 'ex ante', el poder identificar una realidad con una problem��tica de territorio, basada en las siguientes dimensiones: a) Ambientales y de infraestructura, b) Organizacionales y econ��micos, c) De competitividad, en las econom��as locales, d) Educativos y de articulaci��n institucional. Las posibilidades de avanzar en proyectos que contemplen solo las inherentes a inversiones productivas no ten��an un origen genuino en el esp��ritu emprendedor de los habitantes y productores de la zona Este del Departamento (Gobernador Piedrabuena, Gobernador Garmendia y 7 de Abril) pero si se pudo identificar un importante sector de potenciales productores porcinos, bovinos de carne y av��colas, - cadenas no relevantes en la zona -, m��s un gran n��mero de productores agr��colas -peque��os y medianos- en plena actividad, pero con nulas experiencias en producci��n pecuaria. Con esto, la provincia a trav��s de sus herramientas de pol��ticas publicas, puso la mirada en la concepci��n de estos nuevos enfoques de desarrollo territorial, con proyectos que posibilitar��n desarrollar con equidad y sustentabilidad dicha zona profundizando los 4 ejes estrat��gicos. El concepto de desarrollo de los territorios, incluidos en el ��mbito rural, se ha asociado tradicionalmente a la b��squeda de viabilidad de las zonas m��s alejadas, poco accesibles y que sufren distintas formas de marginalidad. Sin embargo, la ruralidad ha cambiado de manera significativa. Entre los cambios identificados por diferentes autores (Sarraceno, 1994; P��rez, 2001; Echeverri y Ribeiro, 2002), se destacan: a) el incremento en la importancia de las actividades no agr��colas como generadoras de empleo e ingresos para la poblaci��n rural; b) la creciente integraci��n de los espacios urbanos y rurales; c) la importancia de integrar las preocupaciones por la gesti��n sostenible del ambiente y de los recursos naturales; d) las transformaciones en la institucionalidad rural; e) el reconocimiento de la importancia de nuevos actores sociales; f) las nuevas y mayores expectativas de los consumidores y de los mercados; g) el papel de las nuevas tecnolog��as de informaci��n y comunicaci��n, h)la persistencia de la pobreza rural y la desigualdad, i) la persistencia de brechas regionales y sectoriales

Model of ICT skills and new professional profile of the Guidance Counsellors in some European countries

El art��culo analiza la utilizaci��n de las Tecnolog��as de la Informaci��n y Comunicaci��n en el escenario de algunos pa��ses europeos en el ��mbito de la Orientaci��n Educativa y Profesional.

Model of ICT skills and new professional profile of the Guidance Counsellors in some European countries

El art��culo analiza la utilizaci��n de las Tecnolog��as de la Informaci��n y Comunicaci��n en el escenario de algunos pa��ses europeos en el ��mbito de la Orientaci��n Educativa y Profesional.

Proyecto de Desarrollo Inteligente Departamento Burruyacu - Tucum��n Propuesta integrada con distintos actores institucionales a partir de mesa de gesti��n territorial

El presente proyecto 'Desarrollo Inteligente del Departamento Burruyacu - Tucum��n' elaborado en base a un diagnostico participativo que dio como resultado, 'ex ante', el poder identificar una realidad con una problem��tica de territorio, basada en las siguientes dimensiones: a) Ambientales y de infraestructura, b) Organizacionales y econ��micos, c) De competitividad, en las econom��as locales, d) Educativos y de articulaci��n institucional. Las posibilidades de avanzar en proyectos que contemplen solo las inherentes a inversiones productivas no ten��an un origen genuino en el esp��ritu emprendedor de los habitantes y productores de la zona Este del Departamento (Gobernador Piedrabuena, Gobernador Garmendia y 7 de Abril) pero si se pudo identificar un importante sector de potenciales productores porcinos, bovinos de carne y av��colas, - cadenas no relevantes en la zona -, m��s un gran n��mero de productores agr��colas -peque��os y medianos- en plena actividad, pero con nulas experiencias en producci��n pecuaria. Con esto, la provincia a trav��s de sus herramientas de pol��ticas publicas, puso la mirada en la concepci��n de estos nuevos enfoques de desarrollo territorial, con proyectos que posibilitar��n desarrollar con equidad y sustentabilidad dicha zona profundizando los 4 ejes estrat��gicos. El concepto de desarrollo de los territorios, incluidos en el ��mbito rural, se ha asociado tradicionalmente a la b��squeda de viabilidad de las zonas m��s alejadas, poco accesibles y que sufren distintas formas de marginalidad. Sin embargo, la ruralidad ha cambiado de manera significativa. Entre los cambios identificados por diferentes autores (Sarraceno, 1994; P��rez, 2001; Echeverri y Ribeiro, 2002), se destacan: a) el incremento en la importancia de las actividades no agr��colas como generadoras de empleo e ingresos para la poblaci��n rural; b) la creciente integraci��n de los espacios urbanos y rurales; c) la importancia de integrar las preocupaciones por la gesti��n sostenible del ambiente y de los recursos naturales; d) las transformaciones en la institucionalidad rural; e) el reconocimiento de la importancia de nuevos actores sociales; f) las nuevas y mayores expectativas de los consumidores y de los mercados; g) el papel de las nuevas tecnolog��as de informaci��n y comunicaci��n, h)la persistencia de la pobreza rural y la desigualdad, i) la persistencia de brechas regionales y sectoriales

Model of ICT skills and new professional profile of the Guidance Counsellors in some European countries

El art��culo analiza la utilizaci��n de las Tecnolog��as de la Informaci��n y Comunicaci��n en el escenario de algunos pa��ses europeos en el ��mbito de la Orientaci��n Educativa y Profesional.

Proyecto de Desarrollo Inteligente Departamento Burruyacu - Tucum��n Propuesta integrada con distintos actores institucionales a partir de mesa de gesti��n territorial

El presente proyecto 'Desarrollo Inteligente del Departamento Burruyacu - Tucum��n' elaborado en base a un diagnostico participativo que dio como resultado, 'ex ante', el poder identificar una realidad con una problem��tica de territorio, basada en las siguientes dimensiones: a) Ambientales y de infraestructura, b) Organizacionales y econ��micos, c) De competitividad, en las econom��as locales, d) Educativos y de articulaci��n institucional. Las posibilidades de avanzar en proyectos que contemplen solo las inherentes a inversiones productivas no ten��an un origen genuino en el esp��ritu emprendedor de los habitantes y productores de la zona Este del Departamento (Gobernador Piedrabuena, Gobernador Garmendia y 7 de Abril) pero si se pudo identificar un importante sector de potenciales productores porcinos, bovinos de carne y av��colas, - cadenas no relevantes en la zona -, m��s un gran n��mero de productores agr��colas -peque��os y medianos- en plena actividad, pero con nulas experiencias en producci��n pecuaria. Con esto, la provincia a trav��s de sus herramientas de pol��ticas publicas, puso la mirada en la concepci��n de estos nuevos enfoques de desarrollo territorial, con proyectos que posibilitar��n desarrollar con equidad y sustentabilidad dicha zona profundizando los 4 ejes estrat��gicos. El concepto de desarrollo de los territorios, incluidos en el ��mbito rural, se ha asociado tradicionalmente a la b��squeda de viabilidad de las zonas m��s alejadas, poco accesibles y que sufren distintas formas de marginalidad. Sin embargo, la ruralidad ha cambiado de manera significativa. Entre los cambios identificados por diferentes autores (Sarraceno, 1994; P��rez, 2001; Echeverri y Ribeiro, 2002), se destacan: a) el incremento en la importancia de las actividades no agr��colas como generadoras de empleo e ingresos para la poblaci��n rural; b) la creciente integraci��n de los espacios urbanos y rurales; c) la importancia de integrar las preocupaciones por la gesti��n sostenible del ambiente y de los recursos naturales; d) las transformaciones en la institucionalidad rural; e) el reconocimiento de la importancia de nuevos actores sociales; f) las nuevas y mayores expectativas de los consumidores y de los mercados; g) el papel de las nuevas tecnolog��as de informaci��n y comunicaci��n, h)la persistencia de la pobreza rural y la desigualdad, i) la persistencia de brechas regionales y sectoriales

How did the crisis affect small and medium-sized enterprises? -- from a field study of the metal-working industry in Java

This paper focuses on the impact of Indonesia's economic crisis on small and medium-sized enterprises (SMEs). It shows how the performance of SMEs during the crisis varied widely even in the same industrial subsector, and found that the factors most affecting performance have been market orientation and the linkages that the SMEs have formed with the buyers of their products. Well-performing SMEs were found to have utilized putting-out linkages with wholesalers which enabled them to switch to products having better markets. On the other hand, the SMEs which had subcontracting linkages with assemblers or contracting linkages with user-factories (with the exception of SMEs having export-oriented linkages) suffered badly in the crisis because of specificity of products with little room for switching. The paper also found that exposure to debt due to borrowing for investment has been another factor affecting performance, but that enterprise size has had no linear correlation with performance.

A Distributive Comparison of Enterprise Size in Korea and Taiwan

Research to date on the economic development of the Republic of Korea and Taiwan has frequently contrasted the two economies by depicting the former as centered on large-scale enterprises and the latter on small and medium-size enterprises (SMEs). The purpose of this study is to see if the appropriateness of this perception will also be verified by the statistical data. In Section I the authors utilized census data on the Korean and Taiwanese manufacturing sectors to compare the distribution pattern of the sizes of enterprises in the two economies. However, on examining the available data for making this comparison, the authors discovered that for Korea the statistics provided are those at the level of the establishment (a physical unit engaging in industrial activities such as a factory, workshop, office, or mine) while the statistics for Taiwan are those at the enterprise level. Mindful of this difference, the authors looked at the portion of the economy accounted for by large-scale establishments in Korea that employed 500 workers or more and by enterprises in Taiwan employing the same number of workers, and they discovered that the portion that these large-scale businesses account for, especially in the area of output, has steadily declined since the 1980s. When comparing the share of total production that these large-scale establishments/enterprises account for in the two economies, the authors concluded that those in Korea accounted for a larger share of that economy's production than did their counterparts in Taiwan. The authors then compared the portion of the economy accounted for by establishments in Korea and enterprises in Taiwan that employed less than ten workers, and they found that the portion of the two economies that these very small-scale production units accounted for has also been on the decline. Section II compares the portions of the two economies accounted for by large business groups. After comparing the percentage of GDP accounted for by the total sales of these business groups, the authors found that large business groups in Korea have played a far more important role in Korean economy than has been the case for such groups in Taiwan. This difference in the importance of such business groups in the two economies has also played an significant part in fostering the perceived dichotomy of large-scale enterprises playing the important role in Korea versus SMEs being the important players in Taiwan. Section III compares the percentage of total exports accounted for by SMEs, and shows that SMEs in Taiwan account for a larger share of exports than do their counterparts in Korea. This section also shows that in Taiwan the share of export sales for SMEs has consistently exceeded that for non-SMEs, while in Korea the relationship between enterprise size and the rate of export sales has been directly proportional. This difference in the size of the major export players is another factor fostering the perception of the Korean economy being centered on big business while Taiwan's is on SMEs. Although there were difficulties and limitations when comparing the data of the two economies, the statistical comparison undertaken in this study shows that in general big business has played the major role in the development of the Korean economy while in Taiwan's economic development this role has been played by SMEs. Thus the statistical data also verifies the perceived dichotomy of these two economies.

A new way of teaching different subjects in a foreign language in the Building Engineering Degree at the Universidad Polit��cnica.

The European Union has been promoting linguistic diversity for many years as one of its main educational goals. This is an element that facilitates student mobility and student exchanges between different universities and countries and enriches the education of young undergraduates. In particular, a higher degree of competence in the English language is becoming essential for engineers, architects and researchers in general, as English has become the lingua franca that opens up horizons to internationalisation and the transfer of knowledge in today���s world. Many experts point to the Integrated Approach to Contents and Foreign Languages System as being an option that has certain benefits over the traditional method of teaching a second language that is exclusively based on specific subjects. This system advocates teaching the different subjects in the syllabus in a language other than one���s mother tongue, without prioritising knowledge of the language over the subject. This was the idea that in the 2009/10 academic year gave rise to the Second Language Integration Programme (SLI Programme) at the Escuela Arquitectura T��cnica in the Universidad Polit��cnica Madrid (EUATM-UPM), just at the beginning of the tuition of the new Building Engineering Degree, which had been adapted to the European Higher Education Area (EHEA) model. This programme is an interdisciplinary initiative for the set of subjects taught during the semester and is coordinated through the Assistant Director Office for Educational Innovation. The SLI Programme has a dual goal; to familiarise students with the specific English terminology of the subject being taught, and at the same time improve their communication skills in English. A total of thirty lecturers are taking part in the teaching of eleven first year subjects and twelve in the second year, with around 120 students who have voluntarily enrolled in a special group in each semester. During the 2010/2011 academic year the degree of acceptance and the results of the SLI Programme have been monitored. Tools have been designed to aid interdisciplinary coordination and to analyse satisfaction, such as coordination records and surveys. The results currently available refer to the first and second year and are divided into specific aspects of the different subjects involved and into general aspects of the ongoing experience.