Regional Health and Social Care Personal and Public Involvement Forum: Annual Update Report 2013/14

The Regional HSC PPI Annual Report for 2013/14 provides an up-date of the work of the Forum and outlines the key areas that have been progressed including the development of PPI standards and the advancement of a generic PPI awareness raising and training programme.

Evaluation à l'aide d'un livre de bord des compétences cliniques acquises par des stagiaires en médecine. [Evaluation using a logbook of mastering of clinical skills by medical students]

La maîtrise des compétences cliniques est extrêmement importante pour le médecin. Leur enseignement est aujourd'hui facilité grâce à la disponibilité du «Swiss Catalogue of Learning Objectives for Undergraduate Medical Training» où sont décrits les niveaux de compétence à atteindre au terme des études de médecine. Un carnet de bord a été préparé à la Faculté de biologie et de médecine de Lausanne à partir de ce document. Il a permis de mettre en évidence chez les étudiants une très nette amélioration de la maîtrise des compétences cliniques entre le début et la fin des stages en médecine interne, chirurgie/orthopédie, pédiatrie, gynécologie/obstétrique et psychiatrie. Un tel outil devrait permettre dans l'avenir de mieux guider l'apprentissage des étudiants et de suivre leurs progrès à chaque étape du curriculum. [Abstract] The mastering of the clinical skills is of utmost importance for the physician. The teaching of the skills is nowadays made easier with the <<Swiss Catalogue of Learning Objectives for Undergraduate Medical Training>> which lists all the skills and their respective level of expected mastering at graduation. In order to do a survey on how good the students are at those skills, a logbook based on this document has been setup at the Faculty of biology and medicine of the University of Lausanne. This has shown that students went through a clear progression of the mastering of the skills during their elective year in internal medicine, surgery/orthopaedics, paediatric, obstetric and gynaecology as well as psychiatry. Such an instrument should in the future help to better guide the learning process of the clinical skills and to do a better follow-up of their progress.

Self-reported health needs and use of primary health care services by adolescents enrolled in post-mandatory schools or vocational training programmes in Switzerland.

BACKGROUND: The second Swiss Multicenter Adolescent Survey on Health (SMASH02) was conducted among a representative sample (n = 7428) of students and apprentices aged 16 to 20 from the three language areas of Switzerland during the year 2002. This paper reports on health needs expressed by adolescents and their use of health care services over the 12 months preceding the survey. METHODS: Nineteen cantons representing 80% of the resident population agreed to participate. A complex iterative random cluster sample of 600 classes was drawn with classes as primary sampling unit. The participation rate was 97.7% for the classes and 99.8% for the youths in attendance. The self-administered questionnaire included 565 items. The median rate of item non-response was 1.8%. Ethical and legal requirements applying to surveys of adolescent populations were respected. RESULTS: Overall more than 90% of adolescents felt in good to excellent health. Suffering often or very often from different physical complaints or pain was also reported such as headache (boys: 15.9%, girls: 37.4%), stomach-ache (boys: 9.7%, girls: 30.0%), joint pain (boys: 24.7%, girls: 29.5%) or back pain (boys: 24.3%, girls: 34.7%). Many adolescents reported a need for help on psychosocial and lifestyle issues, such as stress (boys: 28.5%, girls: 47.7%) or depression (boys: 18.9%, girls: 34.4%). Although about 75% of adolescents reported having consulted a general practitioner and about one-third having seen another specialist, reported reasons for visits do not correspond to the expressed needs. Less than 10% of adolescents had visited a psychiatrist, a family planning centre or a social worker. CONCLUSIONS: The reported rates of health services utilisation by adolescents does not match the substantial reported needs for help in various areas. This may indicate that the corresponding problems are not adequately detected and/or addressed by professionals from the health and social sectors.

El desenvolupament dels Itineraris Personals d'Inserció (IPI) : Projecció des de la Psicologia de la Intervenció Social

Aquest document és el resultat d'una tasca de recerca en intentar donar una visió des del punt de vista de la Psicologia de la Intervenció Social als Itineraris Personalitzats d'Inserció (IPI) i el rol del psicòleg com a orientador professional en aquests, trobar quines teories són les més adients per explicar el perquè d'aquests processos formatius en particular, i el perquè de les polítiques socials orientades a la integració social dels discapacitats en general cercar quina metodologia i quines eines poden servir per intervenir com a orientador professional al servei d'aquest col·lectiu.

Construcción y validación de un cuestionario para medir conductas, conocimientos y actitudes sobre la higiene de las manos en personal sanitario en formacion.

Background: Hand hygiene in the health context is a complex behaviour. There have been rarely given the role of the knowledge and attitudes as predictors of hand hygiene behaviour. The main objective of this work is the description of the development of a questionnaire on hand hygiene and the analysis of their measurement properties. Method: An instrument which was designed and validated a questionnaire. It was held in January 2009. It finally has had 50 items that assess risk behaviour intention before and after contact with the patient, declarative knowledge and attitudes about hand hygiene. It has been applied to 431 students of health sciences at the University of Granada. Results: There were three factor analysis, ultimately obtaining a general convergence value that explains 46.01% of the total variance and high reliability (a=0,843). There is correlation between knowledge and behavior intentions before and after patient contact (p <0.01).In turn, the attitude correlates only with behavioral intention before (p <0.05). The hand hygiene behavior refers to a higher mean after the completion of various health activities before the same (4.26 and 3.96 respectively). Both declarative knowledge and attitudes significantly predict behavioral intention, in particular the conduct before the contact with the patient (R2 = 0.100, standardized Beta 0.256 for knowledge and 0.145 for attitudes). Conclusions: The questionnaire shows high internal consistency. We have obtained a valid tool for assessing risk behavior, knowledge and attitudes about students’ hand hygiene in health sciences. The tool detects deficiencies in basic skills in students.

Escuela de gestión social Creciendo Juntos

Reflexió i recopilació de les experiències viscudes i dels aprenentatges adquirits durant les pràctiques realitzades a la comunitat educativa “Creciendo Juntos” a Moreno, dintre de la província de Buenos Aires, a l’Argentina

Inmigrantes en formación: desplazamientos y fijaciones de la cohesión social promovida por el Estado del Bienestar en la formación para la inserción laboral de las personas migrantes en Barcelona

En la investigación llevada a cabo nos hemos aproximado, desde un punto de vista cualitativo, a los recursos de formación para la inserción sociolaboral dirigidos a personas inmigrantes en la ciudad de Barcelona. Dicha formación forma parte de los recursos del sistema de bienestar español, caracterizado como mediterráneo (Esping-Andersen, 1990; Ferrara 1996; Moreno, 2002); y responde a los lineamientos de las políticas de integración dirigidas al mencionado colectivo. Para llevar a cabo el trabajo hemos adoptado la perspectiva metodológica de Antropología de las Políticas (Shore y Wright, 1997). La construcción del marco teórico bebió de los aportes que enfatizan el papel político de los Estados-nación en relación con los procesos migratorios (Sayad, 2010), señalando que la inmigración, lejos de ser un proceso que les “sucede” a las sociedades de recepción, es un fenómeno conformado por éstas (Geddes, 2006). La profunda transformación en los modos de la cohesión social (Castel, 1997) en las sociedades de recepción de personas inmigradas constituyen el contexto en el cual actúan las políticas de integración. A través de las condiciones de acceso a los recursos de formación para la inserción sociolaboral, mediante los contenidos impartidos y las maneras en que lo hacen, se configuran los inmigrantes “deseados” e “indeseados” funcionando como “fronteras organizativas”. Los resultados del análisis, indican que se espera que las personas inmigradas sean sujetos disponibles y activos, donde la formación emerge más que como un derecho que favorece y consolida la cohesión social o la “integración”, como un recurso que hay que “merecer”. Paralelamente a dicha emergencia, la formación se perfila como un dispositivo que antes que servir para la promoción social es un débil sustituto del empleo, fatigosamente anhelado por las personas que llevan a cabo los procesos formativos.

Effectiveness of two interventions based on improving patient-practitioner communication on diabetes self-management in patients with low educational level: study protocol of a clustered randomized trial in primary care.

BACKGROUND In the last decades the presence of social inequalities in diabetes care has been observed in multiple countries, including Spain. These inequalities have been at least partially attributed to differences in diabetes self-management behaviours. Communication problems during medical consultations occur more frequently to patients with a lower educational level. The purpose of this cluster randomized trial is to determine whether an intervention implemented in a General Surgery, based in improving patient-provider communication, results in a better diabetes self-management in patients with lower educational level. A secondary objective is to assess whether telephone reinforcement enhances the effect of such intervention. We report the design and implementation of this on-going study. METHODS/DESIGN The study is being conducted in a General Practice located in a deprived neighbourhood of Granada, Spain. Diabetic patients 18 years old or older with a low educational level and inadequate glycaemic control (HbA1c > 7%) were recruited. General Practitioners (GPs) were randomised to three groups: intervention A, intervention B and control group. GPs allocated to intervention groups A and B received training in communication skills and are providing graphic feedback about glycosylated haemoglobin levels. Patients whose GPs were allocated to group B are additionally receiving telephone reinforcement whereas patients from the control group are receiving usual care. The described interventions are being conducted during 7 consecutive medical visits which are scheduled every three months. The main outcome measure will be HbA1c; blood pressure, lipidemia, body mass index and waist circumference will be considered as secondary outcome measures. Statistical analysis to evaluate the effectiveness of the interventions will include multilevel regression analysis with three hierarchical levels: medical visit level, patient level and GP level. DISCUSSION The results of this study will provide new knowledge about possible strategies to promote a better diabetes self-management in a particularly vulnerable group. If effective, this low cost intervention will have the potential to be easily incorporated into routine clinical practice, contributing to decrease health inequalities in diabetic patients. TRIAL REGISTRATION Clinical Trials U.S. National Institutes of Health, NCT01849731.

Musical training intensity yields opposite effects on grey matter density in cognitive versus sensorimotor networks.

Using optimized voxel-based morphometry, we performed grey matter density analyses on 59 age-, sex- and intelligence-matched young adults with three distinct, progressive levels of musical training intensity or expertise. Structural brain adaptations in musicians have been repeatedly demonstrated in areas involved in auditory perception and motor skills. However, musical activities are not confined to auditory perception and motor performance, but are entangled with higher-order cognitive processes. In consequence, neuronal systems involved in such higher-order processing may also be shaped by experience-driven plasticity. We modelled expertise as a three-level regressor to study possible linear relationships of expertise with grey matter density. The key finding of this study resides in a functional dissimilarity between areas exhibiting increase versus decrease of grey matter as a function of musical expertise. Grey matter density increased with expertise in areas known for their involvement in higher-order cognitive processing: right fusiform gyrus (visual pattern recognition), right mid orbital gyrus (tonal sensitivity), left inferior frontal gyrus (syntactic processing, executive function, working memory), left intraparietal sulcus (visuo-motor coordination) and bilateral posterior cerebellar Crus II (executive function, working memory) and in auditory processing: left Heschl's gyrus. Conversely, grey matter density decreased with expertise in bilateral perirolandic and striatal areas that are related to sensorimotor function, possibly reflecting high automation of motor skills. Moreover, a multiple regression analysis evidenced that grey matter density in the right mid orbital area and the inferior frontal gyrus predicted accuracy in detecting fine-grained incongruities in tonal music.

Metacognitive training for adolescents with psychosis: A multiple case study

Cognitive biases may be one of the explaining factor underlying psychotic symptoms like delusions and hallucinations. Metacognitive training (MCT) was demonstrated, in adults with schizophrenia, to reduce these cognitive biases. However, to the best of our knowledge, there has been no research on adolescents with psychosis. The current study aimed at assessing the feasibility, treatment adherence and its benefi cial effects on psychotic symptoms, depression, social functioning and self-esteem of a MCT. Participants were fi ve psychotic adolescents with psychosis, aged 16-18, who attended the Day Care Unit for Adolescents (DCUA). The MCT, delivered in group, corresponds to 2x8 modules, lasting between 45 and 60 minutes once a week. To measure MCT's effi ciency, the Positive And Negative Syndrome Scale (PANSS), the Social and Occupational Functioning Assessment Scale (SOFAS), the Health of Nation Outcome Scale for Children and Adolescent (HoNOSCA), the depression scale of Calgary and the self-esteem scale of Rosenberg have been used. The results of the 5 patients indicate that MCT is feasible and the treatment adherence is moderate. The schedule of the MCT needs to be adapted to the availability of the participants. At a descriptive level, the MCT allows to reduce psychotic and depressive symptoms (PANSS & Calgary) as well as to improve the social functioning (SOFAS & HoNOSCA) and self-esteem (Rosenberg). To sum up, MCT seem to be an interesting alternative and/or a good additional treatment to reduce cognitive bias, psychotic symptoms as well as improving social functioning

La evaluación entre iguales en el grado de educación social. Aproximación a la vida profesional

La relación educativa entraña, inevitablemente, el debate entorno de la verticalidad y del ejercicio del poder. De qué modo nos relacionamos y cómo gestionamos la comunicación entre educadores y educandos, así como entre iguales. Esa tensión se ve amplificada en la medida que incorporamos lógicas evaluativas en nuestro quehacer profesional. La siguiente comunicación describe la experiencia de la metodología de aprendizaje basada en la evaluación entre iguales aplicada a la profesionalización de los y las educadores/as sociales. Tanto a nivel escolar como en el universitario hay numerosas experiencias publicadas en relación a la metodología de evaluación entre iguales. Además, existen numerosos apartados de los “Documentos profesionalizadores” donde se justifica el hecho de que se entrenen algunas habilidades que deberían darse en la práctica profesional (como por ejemplo en la definición, en el código ético, y en el catálogo de funciones y competencias del/la educador/a social). En esta comunicación pretendemos dar a conocer la experiencia de entrenamiento de futuros educadores en aspectos que tienen una relación directa con la evaluación entre educadores/as sociales. Así pues, utilizaremos una justificación académica y metodológica de la actividad, enlazándola con los documentos profesionalizadores con un fin relacionado directamente con el ejercicio de la profesión.

Influencia social y uso del preservativo en la prevención de la transmisión heterosexual del VIH = Social influence and condom use for VIH heterosexual transmission prevention

Se revisan diferentes formas en que la influencia social puede incidir sobre los comportamientosheterosexuales de prevención de la transmisión del VIH de los jóvenes y se presentanlos resultados de algunos trabajos de las autoras, así como de otros investigadores, en que seanalizan dichas relaciones. Se concluye resaltando: 1) la utilidad clínica de la evaluación de lasexpectativas de autoeficacia para poder intervenir específicamente en aquellas áreas en que losjóvenes se perciban con menores capacidades para ser preventivos, 2) la relación observadaentre el uso de preservativo autoinformado y la creencia en su aceptación por parte de los referentessociales más cercanos y 3) la conveniencia de que los jóvenes posean suficientes habilidadesde comunicación que les permitan negociar con éxito el uso del preservativo y les ayudena compensar posibles influencias sociales en contra de su empleo

Relève en médecine interne générale: enjeux et perspectives [Perspectives and challenges to guarantee training and renewal in general internal medicine]

Training new doctors in general internal medicine represents a challenge. This requires to define future needs, which result from interest that are not necessarily convergent between patients, doctors, insurers and politicians. Problems related to medical demography in Switzerland, with the ageing of the population, the increase in health care costs and the place of Switzerland within the European Community require the implementation of specific objectives to train new physicians in general internal medicine. The success of these opportunities depends on social factors, political choices and choices from physician's association. In this article we will approach these challenges by formulating some proposals--nonexhaustive--in order to guarantee sufficient renewal in general internal medicine.

Sequencing and characterizing the genome of Estrella lausannensis as an undergraduate project: training students and biological insights.

With the widespread availability of high-throughput sequencing technologies, sequencing projects have become pervasive in the molecular life sciences. The huge bulk of data generated daily must be analyzed further by biologists with skills in bioinformatics and by "embedded bioinformaticians," i.e., bioinformaticians integrated in wet lab research groups. Thus, students interested in molecular life sciences must be trained in the main steps of genomics: sequencing, assembly, annotation and analysis. To reach that goal, a practical course has been set up for master students at the University of Lausanne: the "Sequence a genome" class. At the beginning of the academic year, a few bacterial species whose genome is unknown are provided to the students, who sequence and assemble the genome(s) and perform manual annotation. Here, we report the progress of the first class from September 2010 to June 2011 and the results obtained by seven master students who specifically assembled and annotated the genome of Estrella lausannensis, an obligate intracellular bacterium related to Chlamydia. The draft genome of Estrella is composed of 29 scaffolds encompassing 2,819,825 bp that encode for 2233 putative proteins. Estrella also possesses a 9136 bp plasmid that encodes for 14 genes, among which we found an integrase and a toxin/antitoxin module. Like all other members of the Chlamydiales order, Estrella possesses a highly conserved type III secretion system, considered as a key virulence factor. The annotation of the Estrella genome also allowed the characterization of the metabolic abilities of this strictly intracellular bacterium. Altogether, the students provided the scientific community with the Estrella genome sequence and a preliminary understanding of the biology of this recently-discovered bacterial genus, while learning to use cutting-edge technologies for sequencing and to perform bioinformatics analyses.

Developing an Effective Construction Training Program for Hispanic Supervisors and Craft Workers, January 2004

Hispanics make up a growing percentage of the craft workers entering the construction industry, and this has created several challenges for American construction companies. This study addresses the situation by investigating training needs for Hispanic construction craft workers and developing a training program for them within the industry. In order to evaluate current craft workers’ conditions within the construction industry, Iowa State University researchers conducted a survey, with 98 Hispanic craft workers as respondents from 10 construction companies, to determine current working conditions. The results confirm that the language barrier is an obstacle for both the Hispanic workers and the English-speaking employees involved in construction projects. As a part of this research, two training courses were designed to help both American construction companies and their Hispanic labor force to overcome the barriers that keep them from succeeding safely and productively. A training course titled English as a Second Language Survival Course was developed to facilitate basic communication between Hispanic workers and their American supervisors using construction-focused terminology. This course was delivered once as a trial run for a two-hour duration and twice for a full-length duration of eight hours. Important feedback was obtained from participants as part of the evaluations of the course. “How much of the course contents will be useful in your working environment” was asked; 40% of workers said “all of it” and 60% said “most of it.” Another question was “Was it worth taking the time to attend the course?” to which 94% answered “definitely” and 6% answered “yes.” A second training course titled Stepping Up to Supervisor Course for Hispanic Construction Workers was also developed to provide an effective tool to help companies promote those Hispanic craft workers whose willingness and skills meet the requirements to advance to a supervisory position in an American construction company. This course will be offered in the spring of 2004.