Necessitats dels familiars de pacients amb càncer

El càncer produeix un impacte a la família en totes les seves esferes, la família ha de modificar les seves rutines familiars i adoptar nous rols. En el moment del diagnòstic del càncer, a cada família hi ha una persona que assumeix el rol de cuidador principal. Aquest cuidador és el que s’ocupa del malalt a casa i fa d’enllaç entre la família i l’equip sanitari. En front del càncer, la família i el cuidador tenen un conjunt de dubtes, d’inquietuds, de preocupacions que s’acaben traduint en necessitats. L’equip sanitari i Infermeria especialment ha d’atendre aquestes necessitats i ajudar a satisfer-les. Objectiu: L’objectiu principal d’aquest treball es descriure quines són les necessitats que presenten la família i el cuidador dels pacients oncològics. Metodologia: Es va dur a terme una revisió de la literatura entre setembre del 2013 i maig del 2014. Es va utilitzar la base de dades Pubmed, a més de pàgines web i llibres. Es van obtenir un total de 75 fonts, 56 en angles, 18 en espanyol i 1 en català. Resultats: La bibliografia agrupa les necessitats de les famílies i els cuidadors en 7 grans categories: físiques, psicològiques i emocionals, socials, de informació i formació, econòmiques, de transport i espirituals. Pel que fa a necessitats més especifiques, algunes de les més freqüents són tenir informació sobre el pronòstic del malalt, assegurar-se de que l’equip sanitari està donant la millor atenció possible al malalt. Sembla haver-hi una relació entre el grau de no satisfacció de les necessitats i el grau d’ansietat i depressió en la família i el cuidador. Els autors consultats no coincideixen en afirmar si la majoria del les necessitats es veuen satisfetes o no. Conclusions: La família i el cuidador d’un pacient amb càncer també han de rebre atenció per part dels professionals. En moltes ocasions la família treu importància a les seves necessitats per tal de que l’equip sanitari es centri només en el malalt. Infermeria té un paper fonamental en detectar les necessitats dels familiars i cuidadors i en ajudar a satisfer-les, de manera que la família estigui en les millors condicions possibles per cuidar del malalt. Paraules clau: Càncer, família, cuidador, necessitats familiars, rol d’Infermeria

Comunicación Terapéutica : Requisitos fundamentales para acompañar emocionalmente al paciente paliativo y su familia.

La comunicación entre los enfermeros y los pacientes oncológicos es fundamental en la construcción de la relación profesional y terapéutica y esencial para administrar unos cuidados realmente enfocados en la persona como ser holístico y no como entidad patológica. Diferentes estudios han demostrado la influencia positiva de la comunicación en la satisfacción del paciente e incluso se ha encontrado relación entre una comunicación efectiva y una mayor adherencia al tratamiento, mejor control del dolor y estado psicológico. La comunicación, como herramienta para establecer una relación terapéutica eficaz, a su vez básica para el cuidado de cualquier paciente, es entonces “la herramienta” y prerrequisito indispensable para cuidar estos pacientes desde una perspectiva holística. Pese a la centralidad en el cuidado enfermero, la comunicación no se emplea en modo correcto en muchos casos. Objetivos: Este trabajo tiene como objetivo individuar las principales habilidades (skills) para lograr una comunicación terapéutica eficaz y cómo emplearlas en la construcción y mantenimiento de la relación terapéutica con el paciente y su familia. Método: búsqueda bibliográfica con las siguientes palabras clave: comunicación, paliativos, enfermería. Se han incluido en la revisión 27 artículos de 17 revistas distintas. Resultados: Las habilidades y factores encontrados en la literatura han sido clasificados en: a. barreras a la comunicación terapéutica b. condiciones y habilidades facilitadoras de la comunicaciónvi c. habilidades de relación d. habilidades para solicitar información e. estrategias y modelos de comunicación Conclusiones: La comunicación es la herramienta principal del cuidado enfermero en cuidados paliativos, difiere de la comunicación social y tiene como objetivo aumentar la calidad de vida del paciente. La habilidad en comunicación no es un don innato sino que es el resultado de un proceso de aprendizaje continuo. Entre las habilidades más citadas y efectivas hay que recordar la escucha activa (entendida como conjunto de técnicas), el tacto terapéutico, el contacto visual, la empatía y la importancia fundamental de la comunicación no verbal. El modelo de comunicación COMFORT es el único centrado en el paciente y a la vez en su familia. Palabras clave: Habilidades comunicación, paliativos, enfermería

Mentoring in the acquisition of professional skills through practices in companies by degree students

Abstract This work has had as objective to analyze the skills acquired through internships in business companies by students of the Faculty of Economics and Business at the University Pompeu Fabra. The internship is a basic item in order to obtain a hard connection between the University and social-economic world where University and Enterprises develop their activity. In this study we want to know about two aspects. The first one, we want to know the profit that is obtained from the Student as a consequence of internship and mentoring. Also, we want to study about the importance of mentoring as a principal element that establishes the relationship between the Student and the Company. Moreover, it has sought to analyze if certain factors such as the size of the company where the practices has been performed, the study rank level that was achieved or the fact of being a man or a woman, were among the determining factors at the time of acquiring the skills. The results presented here indicate that the size of the company that have been making the practices and the gender of the student are related to the acquisition of certain skills. There was not a statistically significant relationship related to the rank level have by the students in the practice. In the future we are going to study if the labor market Integration is easier if the Student has performed work placement. Keywords Skills; employability; internship; meatoring.

Host Genetics of Response to Hepatitis B Vaccine: A Systematic Review

Background. Hepatitis B virus (HBV) is an important cause of chronic viral disease worldwide and can be life threatening. While a safe and effective vaccine is widely available, 5 to 10% of healthy vaccinees fail to achieve a protective anti-hepatitis B surface antigen antibody (anti-HBs) titer (>10mIU/ml). A limited number of studies investigated host genetics of the response to HBV vaccine. To our knowledge, no comprehensive overview of genetic polymorphisms both within and outside the HLA system has been done so far. Aim. The aim of this study was to perform a systematic review of the literature of human genetics influencing immune response after hepatitis B vaccination. Methods. Literature searches using keywords were conducted in the electronic databases Medline, Embase and ISI Web of Science the cut-off date being March 2014. After selection of papers according to stringent inclusion criteria, relevant information was systematically collected from the remaining articles, including demographic data, number of patients, schedule and type of vaccine, phenotypes, genes and single nucleotide polymorphisms (SNPs) genotyping results and their association with immune response to hepatitis B vaccine. Results. The literature search produced a total of 1968 articles from which 46 studies were kept for further analyses. From these studies, data was extracted for 19 alleles from the human leukocyte antigen (HLA) region that were reported as significant at least twice. Among those alleles, 9 were firmly associated with vaccine response outcome (DQ2 [DQB1*02 and DQB1*0201], DR3 [DRB1*03 and DRB1*0301], DR7 [DRB1*07 and DRB1*0701], C4AQ0, DPB1*0401, DQ3, DQB1*06, DRB1*01 and DRB1*13 [DRB1*1301]). In addition, data was extracted for 55 different genes from which 13 extra-HLA genes had polymorphisms that were studied by different group of investigators or by the same group with a replication study. Among the 13 genes allowing comparison, 4 genes (IL-1B, IL-2, IL-4R and IL- 6) revealed no significant data, 6 genes (IL-4, IL-10, IL-12B, IL-13, TNFA, IFNG and TLR2) were explored with inconsistent results and 2 genes (CD3Z and ITGAL) yielded promising results as their association with vaccine response was confirmed by a replication approach. Furthermore, this review produced a list of 46 SNPs from 26 genes that were associated with immune response to vaccine only once, providing novel candidates to be tested in datasets from existing genome-wide association studies (GWAS). Conclusion. To the best of our knowledge, this is the first systematic review of immunogenetic studies of response to hepatitis B vaccine. While this work reassesses the role of several HLA alleles on vaccine response outcome, the associations with polymorphisms in genes outside the HLA region were rather inconsistent. Moreover, this work produced a list of 46 significant SNPs that were reported by a single group of investigators, opening up some interesting possibilities for further research.

The Quality of Paediatric Nursing Care - Children’s Perspective

Hoitotyön laatu - lasten näkökulma Tämän kolmivaiheisen tutkimuksen tarkoituksena oli kuvailla lasten odotuksia ja arviointeja lasten hoitotyön laadusta sekä kehittää mittari kouluikäisille sairaalassa oleville lapsille laadun arviointiin. Perimmäisenä tavoitteena oli lasten hoitotyön laadun kehittäminen sairaalassa. Ensimmäisessä vaiheessa 20 alle kouluikäistä (4-6v) sekä 20 kouluikäistä (7-11v) lasta kuvailivat odotuksiaan lasten hoitotyön laadusta. Aineisto kerättiin haastattelulla ja lasten piirustusten avulla, sekä analysoitiin sisällön analyysilla. Lasten odotukset lasten hoitotyön laadusta kohdistuivat hoitajaan, hoitotyön toimintoihin ja ympäristöön, fyysinen ympäristö korostui piirustuksissa. Ensimmäisen vaiheen tulosten, aikaisemman kirjallisuuden sekä Leino-Kilven “HYVÄ HOITO” mittarin pohjalta kehitettiin “Lasten Hoidon Laatu Sairaalassa” (LHLS) mittari ja testattiin sen psykometrisiä ominaisuuksia tutkimuksen toisessa vaiheessa. Mittaria kehitettiin ja testattiin kolmen vaiheen kautta. Aluksi asiantuntijapaneeli (n=7) arvioi mittarin sisältöä. Seuraavaksi mittari esitestattiin kahdesti kouluikäisillä sairaalassa olevilla lapsilla (n=41 ja n=16), samassa vaiheessa myös viiden lastenosaston hoitajat (n=19) yhdessä arvioivat mittarin sisältöä sekä 8 lasta. Lopuksi mittaria testattiin kouluikäisillä lapsilla (n=388) sairaalassa sekä hoitajat (n=198) arvioivat mittarin sisällön validiteettia. Mittarin kehittämisen aikana päälaatuluokkien: hoitajan ominaisuudet, hoitotyön toiminnot ja hoitotyön ympäristö Cronbachin alfa kertoimet paranivat. Pääkomponentti analyysi tuki mittarin hoitotyön toimintojen ja ympäristön alaluokkien teoreettista rakennetta. Kolmannessa vaiheessa “Lasten Hoidon Laatu Sairaalassa” (LHLS III, versio neljä) mittarilla kerättiin aineisto Suomen yliopistosairaaloiden lastenosastoilta kouluikäisiltä 7-11 -vuotiailta lapsilta (n=388). Mittarin lopussa lapsia pyydettiin lisäksi kuvailemaan kivointa ja ikävintä kokemustaan sairaalahoidon aikana lauseen täydennystehtävänä. Aineisto analysoitiin tilastollisesti sekä sisällön analyysilla. Lapset arvioivat fyysisen hoitoympäristön, hoitajien inhimillisyyden ja luotettavuuden sekä huolenpidon ja vuorovaikutustoiminnot kiitettäviksi. Lapset arvioivat hoitajien viihdyttämistoiminnot kaikkein alhaisimmiksi. Lapsen ikä ja sairaalantulotapa olivat yhteydessä lasten saamaan tiedon määrään. Lasten kivoimmat kokemukset liittyivät ihmisiin ja heidän ominaisuuksiinsa, toimintoihin, ympäristöön sekä lopputuloksiin. Ikävimmät kokemukset liittyivät potilaana oloon, tuntemuksiin sairauden oireista sekä erossaoloon, hoitotyön fyysisiin toimintoihin sekä ympäristöön. Tutkimuksen tulokset osoittavat lasten olevan kykeneviä arvioimaan omaa hoitoaan ja heidän näkökulmansa tulisi nähdä osana koko laadun kehittämisprosessia parannettaessa laatua käytännössä todella lapsilähtöisemmällä lähestymistavalla. “Lasten Hoidon Laatu Sairaalassa” (LHLS) mittari on mahdollinen väline saada tietoa lasten arvioinneista lasten hoitotyön laadusta, mutta mittarin testaamista tulisi jatkaa tulevaisuudessa

Gathering support from rivals: the two rivals case

Two voters must choose between two alternatives. Voters vote in a fixed linear order. If there is not unanimity for any alternative, the procedure is repeated. At every stage, each voter prefers the same alternative to the other, has utilities decreasing with stages, and has an impatience degree representing when it is worth voting for the non-preferred alternative now rather than waiting for the next stage and voting for the preferred alternative. Intuition suggests that the more patient voter will get his preferred alternative. I found that in the unique solution of the sequential voting procedure obtained by backward induction, the first voter get his preferred alternative at the first stage independently from his impatience rate. Keywords: sequential voting, impatience rate, multi-stage voting, unanimity

The Effects of Corruption and Seigniorage on Growth and Inflation

In the last two decades, cases of corruption have been unveiled in different countries, raising public awareness and reinforcing a trend in which society expects more from their leaders. Our objective in this paper is to examine the effects of corruption and seigniorage on inflation and growth rates. The model used in this article is an extension of the model used by Huang and Wei (2006). We find interesting results and one of them is that, under some conditions, corruption has a positive impact on the growth rate. JEL classification : D73, E52, E58, E62. Keywords : Corruption; Fiscal Policy; Growth; Monetary Policy; Seigniorage.

Generalized three-sided assignment markets: consistency and the core

A class of three-sided markets (and games) is considered, where value is generated by pairs or triplets of agents belonging to different sectors, as well as by individuals. For these markets we analyze the situation that arises when some agents leave the market with some payoff To this end, we introduce the derived market (and game) and relate it to the Davis and Maschler (1965) reduced game. Consistency with respect to the derived market, together with singleness best and individual anti-monotonicity axiomatically characterize the core for these generalized three-sided assignment markets. These markets may have an empty core, but we define a balanced subclass, where the worth of each triplet is defined as the addition of the worths of the pairs it contains. Keywords: Multi-sided assignment market, Consistency, Core, Nucleolus. JEL Classification: C71, C78

Agglomeration vs. dispersion of economic activities in the districts of Paris

The spatial distribution of economic activity has often been analysed for wide geographical areas such as regions or metropolitan areas, but it has rarely been subject to microanalysis, especially outside the U.S. In this paper we focus on what happens within a large European city (Par is), and analyse how the industrial composition of its districts differs and how these districts evolve. We also analyse suburbanization process for both residents and the workforce and provide empirical evidence about the changing roles of the core and intramuros periphery. Keywords: agglomeration, suburbanization, Paris, micropolitan analysis

Investigating the impact of small versus large firms on economic performance of countries and industries

Following earlier work by Audretsch et al. (2002), we assume that an optimal size-class structure exists, in terms of achieving maximal economic growth rates. Such an optimal structure is likely to exist as economies need a balance between the core competences of large firms (such as exploitation of economies of scale) and those of smaller firms (such as flexibility and exploration of new ideas). Accordingly, changes in size-class structure (i.e., changes in the relative shares in economic activity accounted for by micro, small, medium-sized and large firms) may affect macro-economic growth. Using a unique data base of the EU-27 countries for the period 2002-2008 for five broad sectors of economic activity and four size-classes, we find empirical support which suggests that, on average for these countries over this period, the share of micro and large firms may have been ‘above optimum’ (particularly in lower income EU countries) whereas the share of medium-sized firms may have been ‘below optimum’ (particularly in higher income EU countries). This evidence suggests that the transition from a ‘managed’ to an ‘entrepreneurial’ economy (Audretsch and Thurik, 2001) has not been completed yet in all countries of the EU-27. Keywords: small firms, large firms, size-classes, macro-economic performance

Risk-Return Trade-Off for European Stock Markets

This paper adopts dynamic factor models with macro-finance predictors to test the intertemporal risk-return relation for 13 European stock markets. We identify country specific, euro area, and global macro-finance factors to determine the conditional risk and return. Empirically, the risk- return trade-off is generally negative. However, a Markov switching model documents that there is time-variation in this trade-off that is linked to the state of the economy. Keywords: Risk-return trade-off; Dynamic factor model; Macro-finance predictors; European stock markets; Markov switching model JEL Classifications: C22; G11; G12; G17

Idiosyncratic Volatility Puzzle: Influence of Macro-Finance Factors

In this paper, we scrutinize the cross-sectional relation between idiosyncratic volatility and stock returns. As a novelty, the idiosyncratic volatility is obtained by conditioning upon macro-finance factors as well as upon traditional asset pricing factors. The macro-finance factors are constructed from a large pool of macroeconomic and financial variables. Cleaning for macro-finance e§ects reverses the puzzling negative relation between returns and idiosyncratic volatility documented previously. Portfolio analysis shows that the effects from macro-finance factors are economically strong. The relation between idiosyncratic volatility and returns does not vary with the NBER business cycles. The empirical results are highly robust. Keywords: Idiosyncratic volatility puzzle; Macro-finance predictors; Factor analysis; Business cycle. JEL Classifications: G12; G14

The Social Politics of Fatherhood in Spain and France: a Comparative Analysis of Parental Leave and Shared Residence

The Social Politics of Fatherhood in Spain and France: A Comparative Analysis of Parental Leave and Shared Residence The article provides a comparative analysis of policy developments on leaves for fathers and joint custody in Spain and France in the last decade. These two types of measures have been selected because they are both widely recognised as main instruments to promote new fathering styles and consequently more gender equality in the European Union. While the rhetoric of choice has been developed in both countries in relation to maternal employment and childcare, with better results in France than in Spain, it remains to be seen to what extent choice will also be extended to fathers. Keywords: Fatherhood. Family. Comparative social policy. Parental leave. Joint custody.

Is Self-employment a Way to Escape from Skill Mismatches?

During the last two decades, skill mismatches have become one of the most important issues of policy concern in the EU (European Commission, 2008). Hence, the literature has stressed the necessity to reduce skill mismatches. We contribute to this literature by analyzing the impact of the transition from salaried employment to self-employment on self-reported skill mismatches. To do so, we resort to the European Community Household Panel (ECHP) covering the period 1994–2001. Using panel data, we track individuals over time and measure their self-reported skill mismatch before and after the transition. Our empirical findings indicate not only that the average self-employee is less likely to declare being skill-mismatched but also that those individuals who transit from salaried employment to self-employment reduce their probability of skill mismatches after the transition. Keywords: Self-employment, skill mismatches, salaried employment. JEL Classification: L26, J24, B23 __________________________