Diabetes care: opinions, needs and proposed solutions of Swiss patients and healthcare professionals: a qualitative study.

AIMS: To explore, both among patients with diabetes and healthcare professionals, opinions on current diabetes care and the development of the "Regional Diabetes Program". METHODS: We employed qualitative methods (focus groups - FG) and used purposive sampling strategy to recruit patients with diabetes and healthcare professionals. We conducted one diabetic and one professional FG in each of the four health regions of the canton of Vaud/Switzerland. The eight FGs were audio-taped and transcribed verbatim. Thematic analysis was then undertaken. RESULTS: Results showed variability in the perception of the quality of diabetes care, pointed to insufficient information regarding diabetes, and lack of collaboration. Participants also evoked patients' difficulties for self-management, as well as professionals' and patients' financial concerns. Proposed solutions included reinforcing existing structures, developing self-management education, and focusing on comprehensive and coordinated care, communication and teamwork. Patients and professionals were in favour of a "Regional Diabetes Program" tailored to the actors' needs, and viewed it as a means to reinforce existing care delivery. CONCLUSIONS: Patients and professionals pointed out similar problems and solutions but explored them differently. Combined with coming quantitative data, these results should help to further develop, adapt and implement the "Regional Diabetes Program".

Investigação qualitativa e abordagem psico-cultural do desvio [Qualitative research and psycho-cultural approaches of deviance]

Qualitative research and psycho-cultural approaches to deviant behaviour¦In this paper, the authors discuss the relevance of some historical, theoretical and¦methodological features of qualitative research for a psycho-cultural approach to¦deviance. Specifically, three methods are presented: ethnography, life stories and¦grounded theory. Some common features of these methods are: their potentialities of¦articulation with other methods, their plasticity and their procedures grounded in¦research contexts, experiences and meanings lived by participants. The role of the¦researcher, as well as the constructed and dialogical characteristics of both process¦and products of research, are also emphasised in these approaches. In this way,¦qualitative methods seem particularly adequate to a psycho-cultural approach to¦deviance, allowing the research of "hidden" phenomena and an understanding of¦deviance that takes into account its cultural norms. Thus, qualitative research is as a¦methodological device which allows to get beyond the traditional ethnocentrism of psychology.

Chronic disease management: a qualitative study investigating the barriers, facilitators and incentives perceived by Swiss healthcare stakeholders.

BACKGROUND: Chronic disease management has been implemented for some time in several countries to tackle the increasing burden of chronic diseases. While Switzerland faces the same challenge, such initiatives have only emerged recently in this country. The aim of this study is to assess their feasibility, in terms of barriers, facilitators and incentives to participation. METHODS: To meet our aim, we used qualitative methods involving the collection of opinions of various healthcare stakeholders, by means of 5 focus groups and 33 individual interviews. All the data were recorded and transcribed verbatim. Thematic analysis was then performed and five levels were determined to categorize the data: political, financial, organisational/ structural, professionals and patients. RESULTS: Our results show that, at each level, stakeholders share common opinions towards the feasibility of chronic disease management in Switzerland. They mainly mention barriers linked to the federalist political organization as well as to financing such programs. They also envision difficulties to motivate both patients and healthcare professionals to participate. Nevertheless, their favourable attitudes towards chronic disease management as well as the fact that they are convinced that Switzerland possesses all the resources (financial, structural and human) to develop such programs constitute important facilitators. The implementation of quality and financial incentives could also foster the participation of the actors. CONCLUSIONS: Even if healthcare stakeholders do not have the same role and interest regarding chronic diseases, they express similar opinions on the development of chronic disease management in Switzerland. Their overall positive attitude shows that it could be further implemented if political, financial and organisational barriers are overcome and if incentives are found to face the scepticism and non-motivation of some stakeholders.

Violence-related injury and gender: The role of alcohol and alcohol combined with illicit drugs.

INTRODUCTION AND AIMS: The positive relationship between alcohol use, gender and violence-related injury is well established. However, less is known about injuries when alcohol is used in combination with other drugs. DESIGN AND METHODS: Self-report information was collected on alcohol and illicit drug use in the 6 h before a violence-related injury in probability samples of patients presenting to emergency departments (n = 9686). RESULTS: Patients with violence-related injuries reported the highest rates of alcohol use (49% of men; 23% of women) and alcohol use combined with illicit drugs (8% of men; 4% of women) whereas non-violent injury patients reported lower rates of alcohol use (17% of men; 8% of women) and alcohol use combined with drugs (2% for men; 1% for women). Marijuana/hashish was the most commonly reported drug. The odds of a violent injury were increased when alcohol was used [men: odds ratio (OR) = 5.4, 95% confidence interval (CI) 4.6-6.3; women: OR = 4.0, 95% CI 3.0-5.5] or when alcohol was combined with illicit drug use before the injury (men: OR = 6.6, 95% CI 4.7-9.3; women: OR = 5.7, 95% CI = 2.7-12.2) compared with non-users. No significant change in the odds of a violent injury was observed for men or women when alcohol users were compared with alcohol and drug users. DISCUSSION AND CONCLUSIONS: The positive association between alcohol and violent injury does not appear to be altered by the added use of drugs. Additional work is needed to understand the interpersonal, contextual and cultural factors related to substance use to identify best prevention practices and develop appropriate policies. [Korcha RA, Cherpitel CJ, Witbrodt J, Borges G, Hejazi-Bazargan S, Bond JC, Ye Y, Gmel G. Violence-related injury and gender: The role of alcohol and alcohol combined with illicit drugs. Drug Alcohol Rev 2014;33:43-50].

From dialysis to transplantation, illness experience and patients' concerns about future: A longitudinal qualitative study

Background: Transplantation is the treatment of choice when compared to dialysis. Long-term evolution of patients is rarely comprehensively described. Thirty end-stage renal disease patient's experience of illness was explored from registration for transplantation until twenty-four months after transplantation. Methods: Longitudinal semi-structured interviews were conducted, and qualitative discourse analysis performed. Findings: Before transplantation loss of quality of life (QOL), emotional fragility related to dialysis constraints were reported, and increased with waiting-time. Six months after transplantation, recovered freedom was described but acute rejection, and life-dependency to immunosuppressants generated concerns. After twelve months, long-term survival of the graft, and possible return-to-dialysis were mentioned. After twenty months graft's dysfunction, co-morbidities, immunosuppressants side effects rose concerns even though QOL persisted. Most patients report positive transformations after transplantation, which are related to graft survival and limited co-morbidities. Discussion: As time passes, patients deal with changing illness constraints, and contemplate with anxiety possible new return to dialysis and/or transplantation.

Evaluation and comparison of current fetal ultrasound image segmentation methods for biometric measurements: a grand challenge.

This paper presents the evaluation results of the methods submitted to Challenge US: Biometric Measurements from Fetal Ultrasound Images, a segmentation challenge held at the IEEE International Symposium on Biomedical Imaging 2012. The challenge was set to compare and evaluate current fetal ultrasound image segmentation methods. It consisted of automatically segmenting fetal anatomical structures to measure standard obstetric biometric parameters, from 2D fetal ultrasound images taken on fetuses at different gestational ages (21 weeks, 28 weeks, and 33 weeks) and with varying image quality to reflect data encountered in real clinical environments. Four independent sub-challenges were proposed, according to the objects of interest measured in clinical practice: abdomen, head, femur, and whole fetus. Five teams participated in the head sub-challenge and two teams in the femur sub-challenge, including one team who tackled both. Nobody attempted the abdomen and whole fetus sub-challenges. The challenge goals were two-fold and the participants were asked to submit the segmentation results as well as the measurements derived from the segmented objects. Extensive quantitative (region-based, distance-based, and Bland-Altman measurements) and qualitative evaluation was performed to compare the results from a representative selection of current methods submitted to the challenge. Several experts (three for the head sub-challenge and two for the femur sub-challenge), with different degrees of expertise, manually delineated the objects of interest to define the ground truth used within the evaluation framework. For the head sub-challenge, several groups produced results that could be potentially used in clinical settings, with comparable performance to manual delineations. The femur sub-challenge had inferior performance to the head sub-challenge due to the fact that it is a harder segmentation problem and that the techniques presented relied more on the femur's appearance.

The REporting of Studies Conducted Using Observational Routinely-Collected Health Data (RECORD) Statement: Methods for Arriving at Consensus and Developing Reporting Guidelines.

OBJECTIVE: Routinely collected health data, collected for administrative and clinical purposes, without specific a priori research questions, are increasingly used for observational, comparative effectiveness, health services research, and clinical trials. The rapid evolution and availability of routinely collected data for research has brought to light specific issues not addressed by existing reporting guidelines. The aim of the present project was to determine the priorities of stakeholders in order to guide the development of the REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement. METHODS: Two modified electronic Delphi surveys were sent to stakeholders. The first determined themes deemed important to include in the RECORD statement, and was analyzed using qualitative methods. The second determined quantitative prioritization of the themes based on categorization of manuscript headings. The surveys were followed by a meeting of RECORD working committee, and re-engagement with stakeholders via an online commentary period. RESULTS: The qualitative survey (76 responses of 123 surveys sent) generated 10 overarching themes and 13 themes derived from existing STROBE categories. Highest-rated overall items for inclusion were: Disease/exposure identification algorithms; Characteristics of the population included in databases; and Characteristics of the data. In the quantitative survey (71 responses of 135 sent), the importance assigned to each of the compiled themes varied depending on the manuscript section to which they were assigned. Following the working committee meeting, online ranking by stakeholders provided feedback and resulted in revision of the final checklist. CONCLUSIONS: The RECORD statement incorporated the suggestions provided by a large, diverse group of stakeholders to create a reporting checklist specific to observational research using routinely collected health data. Our findings point to unique aspects of studies conducted with routinely collected health data and the perceived need for better reporting of methodological issues.

Brown algal phlorotannins: Improving and applying chemical methods

Phlorotannins are the least studied group of tannins and are found only in brown algae. Hitherto the roles of phlorotannins, e.g. in plant-herbivore interactions, have been studied by quantifying the total contents of the soluble phlorotannins with a variety of methods. Little attention has been given to either quantitative variation in cell-wall-bound and exuded phlorotannins or to qualitative variation in individual compounds. A quantification procedure was developed to measure the amount of cell-wall-bound phlorotannins. The quantification of soluble phlorotannins was adjusted for both large- and small-scale samples and used to estimate the amounts of exuded phlorotannins using bladder wrack (Fucus vesiculosus) as a model species. In addition, separation of individual soluble phlorotannins to produce a phlorotannin profile from the phenolic crude extract was achieved by high-performance liquid chromatography (HPLC). Along with these methodological studies, attention was focused on the factors in the procedure which generated variation in the yield of phlorotannins. The objective was to enhance the efficiency of the sample preparation procedure. To resolve the problem of rapid oxidation of phlorotannins in HPLC analyses, ascorbic acid was added to the extractant. The widely used colourimetric method was found to produce a variation in the yield that was dependent upon the pH and concentration of the sample. Using these developed, adjusted and modified methods, the phenotypic plasticity of phlorotannins was studied with respect to nutrient availability and herbivory. An increase in nutrients decreased the total amount of soluble phlorotannins but did not affect the cell-wall-bound phlorotannins, the exudation of phlorotannins or the phlorotannin profile achieved with HPLC. The presence of the snail Thedoxus fluviatilis on the thallus induced production of soluble phlorotannins, and grazing by the herbivorous isopod Idotea baltica increased the exudation of phlorotannins. To study whether the among-population variations in phlorotannin contents arise from the genetic divergence or from the plastic response of algae, or both, algae from separate populations were reared in a common garden. Genetic variation among local populations was found in both the phlorotannin profile and the content of total phlorotannins. Phlorotannins were also genetically variable within populations. This suggests that local algal populations have diverged in their contents of phlorotannins, and that they may respond to natural selection and evolve both quantitatively and qualitatively.

L'anticoagulation du patient âgé en fibrillation atriale: que prescrivent les cardiologues, les gériatres et les médecins généralistes [Anticoagulation in the aged patient with atrial fibrillation: What are prescribing cardiologists, geriatricians and general practitioners?].

OBJECTIVE: To assess prescribing of anticoagulants in atrial fibrillation (AF) in the elderly, both a quantitative point of view (rate of anticoagulation) and qualitative (type of anticoagulation). Determinants of prescribing and non-prescribing were also analysed. METHODS: Prospective survey of practice, based on one clinical case and questionnaire conducted in 60 practitioners (20 cardiologists [C], 20 geriatricians [G] and 20 general practitioners [GP]). RESULTS: In reading the clinical case, 88.3% of physicians would have initiated a treatment; three types of treatments would have been chosen: AVK (68.3%), ODA (20.0%) and platelet antiaggregant (11.7%). Criteria taken into account to initiate anticoagulation varied according to the specialty. Cardiologists considered more the age criteria (C: 95.0%, G: 75.0%, MG: 60.0%; P<0.05), diabetes (C: 90.0%, G: 60.0%, MG: 55.0%; P<0.05), hypertension (C: 85.0%, G: 55.0%, MG: 60.0%; P<0.05) and female gender (C: 80.0%, G: 35.0%, MG: 25.0%; P<0.05). The quality of renal function was however a more secondary criteria (C: 15.0%, G: 5.0%, MG: 0.0%; P<0.05). General practitioners considered most frequently the presence of underlying heart disease (C: 35.0%, G: 5.0%, MG: 45.0%; P<0.05) as well as usual cardiovascular risk factors (overweight, dyslipidaemia; P<0.05). Risk of bleeding, however, was observed by 76.7% of physicians in the clinical situation presented (C: 70.0%, G: 75.0%, MG: 85.0%; P<0.05). CONCLUSION: This survey confirms that the FA remains under anticoagulated in the elderly and the barriers to the prescription of oral anticoagulation are often without rational basis.

Managerial Careers in the IT Industry: Women in China and in Finland

This research focuses on the career experiences of women managers in the IT industry in China and Finland, two countries with different cultures, policies, size of population, and social and economic structures regarding work-life support and equal opportunities. The object of this research is to present a cross-cultural comparison of women’s career experiences and how women themselves understand and account for their careers. The study explores how the macro and the micro levels of cultural and social processes become manifested in the lives of individual women. The main argument in this thesis is that culture plays a crucial role in making sense of women’s career experiences, although its role should be understood through its interrelationship with other social processes, e.g., institutional relations, social policies, industrial structures and organizations, as well as globalization. The interrelationship of a series of cultural and social processes affects individuals’ attitudes to, and arrangement and organization of, their work and family lives. This thesis consists of two parts. The first part introduces the research topic and discusses the overall results. The second part comprises five research papers. The main research question of the study is: How do cultural and social processes affect the experiences of women managers? Quantitative and qualitative research methods, which include in-depth interviews, Q-methodology, interpretive analysis, and questionnaires, are used in the study. The main theoretical background is culturally sensitive career theory and the theory of individual differences. The results of this study are viewed through a feminist lens. The research methodology applied allows new explorations on how demographic factors, work experiences, lifestyle issues, and organizational cultures can jointly affect women’s managerial careers. The sample group used in the research is 42 women managers working in IT companies in China (21) and Finland (21). The results of the study illustrate the impact of history, tradition, culture, institutional relations, social politics, industry and organizations, and globalization on the careers of women managers. It is claimed that the role of culture – cultural norms within nations and organizations – is of great importance in the relationship of gender and work. Women’s managerial careers are affected by multiple factors (personal, social and cultural) reflecting national and inter-individual differences. The results of the study contribute to research on careers, adding particularly to the literature on gender, work and culture, and offering a complex and holistic perspective for a richer understanding of pluralism and global diversity. The results of the study indicate how old and new career perspectives are evidenced in women managers in the IT industry. The research further contributes to an understanding of women’s managerial careers from a cross-culture perspective. In addition, the study contributes to the literature on culture and extends understanding of Hofstede’s work. Further, most traditional career theories do not perceive the importance of culture in determining an individual’s career experience and this study richens understanding of women managers’ careers and has considerable implications for international human resource management. The results of this study emphasize the need, when discussing women managers’ careers, to understand the ways by which gendering is produced rather than merely examining gender differences. It is argued that the meaning of self-knowledge is critical. Further, the environment where the careers under study develop differs greatly; China and Finland are very different – culturally, historically and socially. The findings of this study should, therefore, be understood as a holistic, specific, and contextually-bound.

Buddy films and gender identity : representing the bonds of masculinity /

The study examines the buddy film genre and the representation of masculinity in relation to the homosocial and the homoerotic. As a genre, the buddy films focus on male relationships, thematically seeking to mediate the boundaries surrounding the homosocial continuum and the intimacy and eroticism implicit in male bonding. Theories of genre, gender and identity are used to analyze the construction of masculine identity within the films. By providing a qualitative analysis of films from the 1960s to contemporary times, the research establishes a relationship between social changes, attitudes toward men and depictions of men. The buddy films adapt to address changes in the representation of masculinity, embodied in the difference between the male couple in the films. The early films of the 1960s served as templates that deconstructed traditional representations of male identity through articulating the tension within homosocial relationships. However, in the later films this tension became a refle~ive convention, acting to undermine the eroticism onto a displaced Other. The buddy film genre highlights the tension inherent to the male masquerade. This tension is situated in the need to represent the protagonist's homosocial relationship, while disavowing the eroticism that surrounds homosocial bonding. The structure of the buddy film genre, which focuses on the exploration of masculinity and representing the bonds of homosocial intimacy, makes these films a significant site for investigating the cultural construction of masculine identities.

Uncover the Concealed Link: Gender & Ethnicity-Divided Local Knowledge on the Agro-Ecosystem of a Forest Margin

This research is a study about knowledge interface that aims to analyse knowledge discontinuities, the dynamic and emergent characters of struggles and interactions within gender system and ethnicity differences. The cacao boom phenomenon in Central Sulawesi is the main context for a changing of social relations of production, especially when the mode of production has shifted or is still underway from subsistence to petty commodity production. This agrarian change is not only about a change of relationship and practice, but, as my previous research has shown, also about the shift of knowledge domination, because knowledge construes social practice in a dialectical process. Agroecological knowledge is accumulated through interaction, practice and experience. At the same time the knowledge gained from new practices and experiences changes mode of interaction, so such processes provide the arena where an interface of knowledge is manifested. In the process of agro-ecological knowledge interface, gender and ethnic group interactions materialise in the decision-making of production and resource allocation at the household and community level. At this point, power/knowledge is interplayed to gain authority in decision-making. When authority dominates, power encounters resistance, whereas the dominant power and its resistance are aimed to ensure socio-economic security. Eventually, the process of struggle can be identified through the pattern of resource utilisation as a realisation of production decision-making. Such processes are varied from one community to another, and therefore, it shows uniqueness and commonalities, especially when it is placed in a context of shifting mode of production. The focus is placed on actors: men and women in their institutional and cultural setting, including the role of development agents. The inquiry is informed by 4 major questions: 1) How do women and men acquire, disseminate, and utilise their agro ecological knowledge, specifically in rice farming as a subsistence commodity, as well as in cacao farming as a petty commodity? How and why do such mechanisms construct different knowledge domains between two genders? How does the knowledge mechanism apply in different ethnics? What are the implications for gender and ethnicity based relation of production? ; 2) Using the concept of valued knowledge in a shifting mode of production context: is there any knowledge that dominates others? How does the process of domination occur and why? Is there any form of struggle, strategies, negotiation, and compromise over this domination? How do these processes take place at a household as well as community level? How does it relate to production decision-making? ; 3) Putting the previous questions in two communities with a different point of arrival on a path of agricultural commercialisation, how do the processes of struggle vary? What are the bases of the commonalities and peculiarities in both communities?; 4) How the decisions of production affect rice field - cacao plantation - forest utilisation in the two villages? How does that triangle of resource use reflect the constellation of local knowledge in those two communities? What is the implication of this knowledge constellation for the cacao-rice-forest agroecosystem in the forest margin area? Employing a qualitative approach as the main method of inquiry, indepth and dialogic interviews, participant observer role, and document review are used to gather information. A small survey and children’s writing competition are supplementary to this data collection method. The later two methods are aimed to give wider information on household decision making and perception toward the forest. It was found that local knowledge, particularly knowledge pertaining to rice-forest-cacao agroecology is divided according to gender and ethnicity. This constellation places a process of decision-making as ‘the arena of interface’ between feminine and masculine knowledge, as well as between dominant and less dominant ethnic groups. Transition from subsistence to a commercial mode of production is a context that frames a process where knowledge about cacao commodity is valued higher than rice. Market mechanism, as an external power, defines valued knowledge. Valued knowledge defines the dominant knowledge holder, and decision. Therefore, cacao cultivation becomes a dominant practice. Its existence sacrifices the presence of rice field and the forest. Knowledge about rice production and forest ecosystem exist, but is less valued. So it is unable to challenge the domination of cacao. Various forms of struggles - within gender an ethnicity context - to resist cacao domination are an expression of unequal knowledge possession. Knowledge inequality implies to unequal access to withdraw benefit from market valued crop. When unequal knowledge fails to construct a negotiated field or struggles fail to reveal ‘marginal’ decision, e.g. intensification instead of cacao expansion to the forest, interface only produces divergence. Gender and ethnicity divided knowledge is unabridged, since negotiation is unable to produce new knowledge that accommodates both interests. Rice is loaded by ecological interest to conserve the forest, while cacao is driven by economic interest to increase welfare status. The implication of this unmediated dominant knowledge of cacao production is the construction of access; access to the forest, mainly to withdraw its economic benefit by eliminating its ecological benefit. Then, access to cacao as the social relationship of production to acquire cacao knowledge; lastly, access to defend sustainable benefit from cacao by expansion. ‘Socio-economic Security’ is defined by Access. The convergence of rice and cacao knowledge, however, should be made possible across gender and ethnicity, not only for the sake of forest conservation as the insurance of ecological security, but also for community’s socio-economic security. The convergence might be found in a range of alternative ways to conduct cacao sustainable production, from agroforestry system to intensification.

Gender differences on sexual behaviour and school inputs: evidence from Bogota.

This thesis explores the correlation between school factors and the differentiated results on sexual behaviour between boys and girls in Bogota. A school stratified propensity score matching was performed to match each boy of the sample with the most similar girls in individual, household and school characteristics. A regression analysis was performed to estimate the correlation between the five school factors evaluated with four main outcomes: have had sexual intercourse, condom use in the last sexual intercourse, incidence of teenage childbearing and age at first intercourse. Boys - in relation to girls - begin earlier their sexual life, more of them reported have used condom in their last sexual intercourse and have a lower incidence of teenage childbearing. These differences are correlated with have reported the school as main source of knowledge about reproductive health and contraceptive methods, a larger proportion of teachers with a graduate or postgraduate degree, a larger proportion of teachers with a related pedagogy degree and to the average age of teachers in the school. The results suggest that the content of the message about sex that is delivered to girls at school is not complete or accurate and that the competences of the school teachers in charge of this task should be improved to reach equally boys and girls.

Leadership and performance in multicultural business environments a qualitative study in German-Colombian teams

Multicultural leadership is a topic a great interest in nowadays globalized work environment. Colombia emerges as an attractive marketplace with appealing business opportunities, especially for German enterprises. After presenting Colombia’s current political, social and economic situation, the thesis elaborates the complex subject of cultural differences while focusing on the peculiarities of German and Colombian national cultures. The resulting implications for a team’s collaboration and leader effectiveness are theoretically supported with reference to the landmark studies of Hofstede and GLOBE. By utilizing semi-structured interview techniques, a qualitative research enriches the previous findings and gives an all-encompassing insight in German-Colombian teamwork. The investigation identifies distinctive behavioral patterns and relations, which imply challenges and factors of success for multicultural team leaders. Finally, a categorical analysis examines the influence of cultural traits on team performance and evaluates the effectiveness of the applied leadership style.

Psychological response to later life widowhood: coping and the effects of gender

The study examined the effects of psychological response and gender on coping with late life widowhood. Forty-six men and 46 women (55 years +) were interviewed about their experiences of widowhood. Participants were classified as to whether they were coping well or less well. Data were analyzed using grounded theory, content. analysis, and three-way loglinear analyses. Loglinear analyses revealed three-way interactions for Gender, Coping, and Response. Men who report feeling upset or selfish are more likely to be coping, as are women who report being comfortable alone. There were two-way interactions between Coping and Response and Gender and Response. Participants who talk to their dead spouse are more Rely to be coping than those who do not. Those who "keep themselves to themselves" are more likely not to be coping than those who do not. Gender differences, were found in psychological response. Differences were also found between those who coped and those who coped less well. The study has enabled the synthesis of quantitative and qualitative data to present a more complete view of late life widowhood than has previously been possible. In addition, the article draws attention to the importance of distinguishing between the effects of bereavement and those of widowhood.