Influència de l'educació sanitària en l'adaptació dels pacients ostomitzats a la nova situació produïda per l'ostomia digestiva

Introducció: Les persones ostomitzades presenten una sèrie de canvis de tipus fisiològic, psicològic i social, els quals els obliga a adaptar-se a la seva vida diària. Per adaptar-se a aquesta nova situació utilitzen una sèrie d'estratègies d'afrontament, sent l'acceptació el producte final. Per a que les estratègies adoptades siguin les més efectives, han de rebre una educació sanitària adequada.Contràriament, l'escassetat d'educació sanitària o l'educació sanitària inadequada que reben aquests pacients és un problema real que ens trobem en l'actualitat.Objectiu: Conèixer si l'educació sanitària rebuda pels pacients ostomitzats, té influencia en la seva adaptació a la nova situació produïda per l'ostomia digestiva.Metodologia: Estudi qualitatiu fenomenològic, on les dades es recolliran a través d'entrevistessemiestructurades a pacients amb ostomia digestiva, els quals van rebre l'alta hospitalària fa almenys 2 mesos. Les entrevistes seran gravades, transcrites i analitzades, utilitzant en aquest últim pas la triangulació d'investigadors. La mostra serà de tipus intencional, la seleccionaré a l'Hospital Universitàri de Bellvitge entre els pacients que acudeixen a la consulta de la infermera estomaterapeuta, i el seu tamany estarà definit per la saturació teòrica. L'estudi estarà reglat en tot moment pel dret a la intimitat, incloent en aquest l'anonimat i la confidencialitat, i el dret a la lliure decisió.Consideracions finals: Inclou una explicació argumentada sobre els meus punts febles i forts del treball, una reflexió sobre la satisfacció amb les competències que he adquirit i finalment una autoavaluació dels resultats del meu aprenentatge.

Does unemployment hurt less if there is more of it around? A panel analysis of life satisfaction in Germany and Switzerland

This paper examines the existence of a habituation effect to unemployment: Do theunemployed suffer less from job loss if unemployment is more widespread, if their ownunemployment lasts longer and if unemployment is a recurrent experience? Theunderlying idea is that unemployment hysteresis may operate through a sociologicalchannel: if many people in the community lose their job and remain unemployed over anextended period, the psychological cost of being unemployed diminishes and the pressureto accept a new job declines. We analyze this question with individual-level data from theGerman Socio-Economic Panel (1984-2009) and the Swiss Household Panel (2000-2009). We find no evidence for a mitigating effect of high surrounding unemployment onunemployed individuals' subjective well-being: Becoming unemployed hurts as muchwhen regional unemployment is high as when it is low. Likewise, the strongly harmfulimpact of being unemployed on well-being does not wear off over time, nor do repeatedepisodes of unemployment make it any better. It thus appears doubtful that anunemployment shock becomes persistent because the unemployed become used to, andhence reasonably content with, being without a job.

Official Positions for FRAX® clinical regarding biochemical markers from Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX®.

The best indirect evidence that increased bone turnover contributes to fracture risk is the fact that most of the proven therapies for osteoporosis are inhibitors of bone turnover. The evidence base that we can use biochemical markers of bone turnover in the assessment of fracture risk is somewhat less convincing. This relates to natural variability in the markers, problems with the assays, disparity in the statistical analyses of relevant studies and the independence of their contribution to fracture risk. More research is clearly required to address these deficiencies before biochemical markers might contribute a useful independent risk factor for inclusion in FRAX(®).

Qualité de vie après traitement de l'insuffisance veineuse superficielle primaire. [Quality of life in patients traited for primary superficial venous insufficiency].

Venous symptoms and quality of life (QOL) of 78 patients (54 women, mean age 49,5±13,3 years) with primary superficial venous insufficiency (PSVI) were compared at one year after treatment with crossectomy and stripping (C/S, 56 patients) or endovenous laser ablation (EVLA, 22 patients) using the VEINES-QOL questionnaire. Both treatments significantly (p<0,001) improved the scores for venous symptoms (difference 10,6±9,9 and 9,9±8,2 score points for C/S and EVLA, respectively) and QOL (difference 10,3±8,7 and 8,4±6,6 score points for C/S and EVLA, respectively). No difference was found between treatments regarding symptoms or QOL improvement (p=0,30). We conclude that C/S and EVLA are equally effective in improving symptoms and QOL in PSVI.

Els nens i nenes amb “Dictamen d’escolarització” i amb suport del CDIAP: estudi de les dimensions de l’atenció a les necessitats especials de l’alumnat, entre tres i sis anys, escolaritzat en un centre públic de la comarca d’Osona

La meva recerca ha tingut com a punt de partida “Els nens i nenes amb “Dictamen d’escolarització” i amb suport del CDIAP: estudi de les dimensions de l’atenció a les necessitats especials de l’alumnat, entre tres i sis anys, escolaritzat en un centre públic de la comarca d’Osona”. A partir d’aquí, s’ha elaborat un marc teòric a partir de les lleis d’educació, decrets que regulen els diferents serveis i un seguit de conceptes bàsics. Un cop elaborat aquest marc teòric per tal de recollir les dades dels alumnes, de tres a sis anys, d’una escola en concret s’ha dissenyat un instrument de recollida de dades que li diem full resum de serveis (FRS). El FRS és un instrument que ens ha servit per recollir totes les dades d’alumnes amb necessitats específiques i, sobretot, per saber quin suport reben per part de l’escola i per part d’altres serveis. A més a més, per recollir informació sobre els diferents serveis que atenen aquesta diversitat s’ha elaborat un guió d’entrevistes (GE). Aquest GE serveix per recollir els aspectes més importants de les entrevistes realitzades a l’EAP (Equip d’Assessorament i Orientació Psicopedagògica), CDIAP (Centre de Desenvolupament Infantil i Atenció Precoç) i CSMIJ (Centre de Salut Mental Infantil i Juvenil). A partir de la informació extreta dels dos instruments, s’han elaborat unes conclusions respecte els objectius plantejats en aquest projecte i la pregunta plantejada a l’inici.

Needs, expectations, and concerns of medical students regarding end-of-life issues before the introduction of a mandatory undergraduate palliative care curriculum.

BACKGROUND: In the past, implementation of effective palliative care curricula has emerged as a priority in medical education. In order to gain insight into medical students' needs and expectations, we conducted a survey before mandatory palliative care education was introduced in our faculty. METHODS: Seven hundred nine students answered a questionnaire mainly consisting of numeric rating scales (0-10). RESULTS: Participants attributed a high importance to palliative care for their future professional life (mean, 7.51 ± 2.2). For most students, symptom control was crucial (7.72 ± 2.2). However, even higher importance was assigned to ethical and legal issues (8.16 ± 1.9). "Self-reflection regarding their own role as a physician caring for the terminally ill along with psychological support" was also regarded as highly important (7.25 ± 2.4). Most students were moderately concerned at the prospect of being confronted with suffering and death (5.13 ± 2.4). This emotional distress was rated significantly higher by female students (5.4 ± 2.4 versus 4.6 ± 2.4; p < 0.001). Seventeen percent of all students rated their distress as being 7 of 10 or higher, which indicates a considerable psychological strain in terms of dealing with end-of-life issues in the future. Professional or personal experience with terminally ill persons lowered these anxieties significantly (4.99 ± 2.34 versus 5.47 ± 2.5, p < 0.05). CONCLUSIONS: Medical students stated a remarkably high interest in learning palliative care competencies. Responding to their specific concerns and needs-especially with regard to the acquisition of emotional coping skills-may be key for the development of successful palliative care curricula.

Official Positions for FRAX® clinical regarding falls and frailty: can falls and frailty be used in FRAX®? From Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX®.

Risk factors for fracture can be purely skeletal, e.g., bone mass, microarchitecture or geometry, or a combination of bone and falls risk related factors such as age and functional status. The remit of this Task Force was to review the evidence and consider if falls should be incorporated into the FRAX® model or, alternatively, to provide guidance to assist clinicians in clinical decision-making for patients with a falls history. It is clear that falls are a risk factor for fracture. Fracture probability may be underestimated by FRAX® in individuals with a history of frequent falls. The substantial evidence that various interventions are effective in reducing falls risk was reviewed. Targeting falls risk reduction strategies towards frail older people at high risk for indoor falls is appropriate. This Task Force believes that further fracture reduction requires measures to reduce falls risk in addition to bone directed therapy. Clinicians should recognize that patients with frequent falls are at higher fracture risk than currently estimated by FRAX® and include this in decision-making. However, quantitative adjustment of the FRAX® estimated risk based on falls history is not currently possible. In the long term, incorporation of falls as a risk factor in the FRAX® model would be ideal.

A satisfaction survey conducted on patients of a medico-legal consultation.

In 2006, a medico-legal consultation service devoted to adult victims of interpersonal violence was set up at the Lausanne University Hospital Centre, Switzerland: the Violence Medical Unit. Patients are received by forensic nurses for support, forensic examination (in order to establish medical report) and community orientation. In 2008, a telephone survey was conducted on patients. The objectives of the survey were to estimate the degree of patients' satisfaction and to document the use of the medical report by six questions. Among the 476 patients admitted to the VMU in 2007, 132 were interviewed. Their overall satisfaction was high with an average mark of 8.7/10. The medical report was used extensively by the interviewed victims (81%) for its primary function - to be produced as evidence. As the consultations are financed by public funds, these results were of interest for advocacy of long-lasting financial support.

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.

Teachers' challenges regarding cultural diversity

This paper presents some findings of the fieldwork of my doctoral thesis “Human Rights Educationas a Tool for Social Cohesion” of the Doctoral Program “Education and Society”The main research question that arises is: Can Human Rights Education be the departurepoint to work from, with and for the cultural diversity that characterizes our societies?Human Rights Education has been introduced in our social politics and among them ineducational policies which have a relevant role on the consecution of a cohesive society. Education,as a social right that has to be guarantee, facilitates the social change and the promotionof values and attitudes that favor cohesion.The work of several organizations like United Nations, The Council of Europe or Amnestyinternational have develop a wide variety of materials regarding human rights education atschools, guides and manuals for teachers, courses, development of competences and compendiumof activities.

Teachers' challenges regarding cultural diversity

This paper presents some findings of the fieldwork of my doctoral thesis “Human Rights Educationas a Tool for Social Cohesion” of the Doctoral Program “Education and Society”The main research question that arises is: Can Human Rights Education be the departurepoint to work from, with and for the cultural diversity that characterizes our societies?Human Rights Education has been introduced in our social politics and among them ineducational policies which have a relevant role on the consecution of a cohesive society. Education,as a social right that has to be guarantee, facilitates the social change and the promotionof values and attitudes that favor cohesion.The work of several organizations like United Nations, The Council of Europe or Amnestyinternational have develop a wide variety of materials regarding human rights education atschools, guides and manuals for teachers, courses, development of competences and compendiumof activities.

Evaluation de la campagne de lutte contre le SIDA de l'Office fédéral de la santé publique (OFSP) : 1987-1988 : questionnaires et guides d'interviews : annexe au Cahier no 16 s.1

[Table des matières] Comportements à risque et usage des préservatifs (enquête représentative auprès des jeunes Suisses de 17-30 ans): questionnaire. - Comportements à risque et usage de préservatifs (enquête auprès des médecins Sentinelles): questionnaires. - Attitudes des leaders d'opinion informels: questionnaires. - Enquête "Adolescents": questionnaire et guide d'entretien. - Enquête "Dragueurs": projet de grille-questionnaire. - Enquête "Sex-tourisme tropical": guide d'interview. - Enquête "Homosexuels": questionnaire et guide d'interview. - Enquête "Toxicomanes": questionnaire.

Antiretroviral adherence program in HIV patients: a feasibility study in the Swiss HIV Cohort Study.

Objective To evaluate the feasibility of a comprehensive, interdisciplinary adherence program aimed at HIV patients. Setting Two centers of the Swiss HIV Cohort Study: Lausanne and Basel. Method 6-month, pilot, quasi-experimental, 2-arm design (control and intervention). Patients starting a first or second combined antiretroviral therapy line were invited to participate in the study. Patients entering the intervention arm were proposed a multifactorial intervention along with an electronic drug monitor. It consisted of a maximum of six 30-min sessions with the interventionist coinciding with routine HIV check-up. The sessions relied on individualized semi-structured motivational interviews. Patients in the control arm used directly blinded EDM and did not participate in motivational interviews. Main outcome measures Rate of patients' acceptance to take part in the HIV-adherence program and rate of patients' retention in this program assessed in both intervention and control groups. Persistence, execution and adherence. Results The study was feasible in one center but not in the other one. Hence, the control group previously planned in Basel was recruited in Lausanne. Inclusion rate was 84% (n = 21) in the intervention versus 52% (n = 11) in the control group (P = 0.027). Retention rate was 91% in the intervention versus 82% in the control group (P = ns). Regarding adherence, execution was high in both groups (97 vs. 95%). Interestingly, the statistical model showed that adherence decreased more quickly in the control versus the intervention group (interaction group × time P < 0.0001). Conclusion The encountered difficulties rely on the implementation, i.e., on the program and the health care system levels rather than on the patient level. Implementation needs to be evaluated further; to be feasible a new adherence program needs to fit into the daily routine of the centre and has to be supported by all trained healthcare providers. However, this study shows that patients' adherence behavior evolved differently in both groups; it decreased more quickly over time in the control than in the intervention group. RCTs are eventually needed to assess the clinical impact of such an adherence program and to verify whether skilled pharmacists can ensure continuity of care for HIV outpatients.

Managing Decisions Regarding Rural Expressway Routes and Associated Highway Bypasses, 2009

For several years, the Iowa Department of Transportation has constructed bypasses along rural highways. Most bypasses were constructed on the state’s Commercial Industrial Network (CIN). Now that work on the CIN has been completed and the system is open to traffic, it is possible to study the impacts of bypasses. In the past, construction of highway bypasses has led community residents and business people to raise concerns about the loss of business activity. For policy development purposes, it is essential to understand the impacts that a bypass might have on safety, the community, and economics. By researching these impacts, policies can be produced to help to alleviate any negative impacts and create a better system that is ultimately more cost-effective. This study found that the use of trade area analysis does not provide proof that a bypass can positively or negatively impact the economy of a rural community. The analysis did show that, even though the population of a community may be stable for several years and per capita income is increasing, sales leakage still occurs. The literature, site visits, and data make it is apparent that a bypass can positively affect a community. Some conditions that would need to exist in order to maximize a positive impact include the installation of signage along the bypass directing travelers to businesses and services in the community, community or regional plans that include the bypass in future land development scenarios, and businesses adjusting their business plans to attract bypass users. In addition, how proactive a community is in adapting to the bypass will determine the kinds of effects felt in the community. Results of statistical safety analysis indicate that, at least when crashes are separated by severity, bypasses with at-grade accesses appear to perform more poorly than either the bypasses with fully separated accesses or with a mix of at-grade and fully separated accesses. However, the benefit in terms of improved safety of bypasses with fully separated accesses relative to bypasses with a mixed type of accesses is not statistically conclusive.