Building legitimacy by criticising the pharmaceutical industry: a qualitative study among prescribers and local opinion leaders.

PRINCIPLES: The literature has described opinion leaders not only as marketing tools of the pharmaceutical industry, but also as educators promoting good clinical practice. This qualitative study addresses the distinction between the opinion-leader-as-marketing-tool and the opinion-leader-as-educator, as it is revealed in the discourses of physicians and experts, focusing on the prescription of antidepressants. We explore the relational dynamic between physicians, opinion leaders and the pharmaceutical industry in an area of French-speaking Switzerland. METHODS: Qualitative content analysis of 24 semistructured interviews with physicians and local experts in psychopharmacology, complemented by direct observation of educational events led by the experts, which were all sponsored by various pharmaceutical companies. RESULTS: Both physicians and experts were critical of the pharmaceutical industry and its use of opinion leaders. Local experts, in contrast, were perceived by the physicians as critical of the industry and, therefore, as a legitimate source of information. Local experts did not consider themselves opinion leaders and argued that they remained intellectually independent from the industry. Field observations confirmed that local experts criticised the industry at continuing medical education events. CONCLUSIONS: Local experts were vocal critics of the industry, which nevertheless sponsor their continuing education. This critical attitude enhanced their credibility in the eyes of the prescribing physicians. We discuss how the experts, despite their critical attitude, might still be beneficial to the industry's interests.

Innovatiivisen virtuaaliyhteisön edellytykset

Tutkielmassa tutkittiin innovatiivisen virtuaaliyhteisön toiminnan edellytyksiä. Teoreettinen viitekehys muodostui virtuaaliyhteisöjen, innovatiivisuuden ja luovuuden tarkastelusta. Tutkielman empiirisessä osuudessa käytettiin kvalitatiivista tutkimusotetta. Tutkimusaineisto perustui internetiin tutkimusta varten perustetun innovointiin keskittyneen keskustelufoorumin tuottamiin tuloksiin sekä ko. foorumin käyttäjien palautteeseen. Tutkimuksessa kävi ilmi, että innovatiivisuus vaatii motivoitumista käsiteltävään aiheeseen. Ideoijan täytyy kokea aihe mielenkiintoiseksi, jotta virtuaaliyhteisössä tapahtuva innovointi pystyy tarjoamaan parhaan etunsa eli välineen ajasta ja paikasta riippumattomaan ideointiin. Virtuaaliyhteisöllä tulee olla koordinaattori, joka pitää huolen tiedon kokoamisesta, yhteenvedoista ja ruokkii yhteisön aktiivisuutta. Yhteisössä innovoiminen edellyttää yhteisön ilmapiirin rakentamista otolliseksi avoimelle viestinnälle. Tämä syntyy rakentamalla luottamusta toimijoiden välille mm. kannustamalla sosiaaliseen viestintään. Virtuaaliyhteisössä passivoituminen on suuri uhka. Virtuaaliyhteisöä täytyy johtaa kannustaen ja pitäen kaikin keinoin huolta jäsenten aktiivisen keskustelun ylläpidosta. Passiivisuus aiheuttaa yleistä passiivisuutta, aktiivisuus nostaa aktiivisuutta. Toimijoiden anonyymius voi olla yhteisön voimavara, mutta tuo sitoutumattomuutta, jolloin mikä tahansa häiritsevä tekijä saa aikaan sen, että toimija voi jättää osallistumatta asian käsittelyyn ilman muualta kohdistuvia paineita. Anonyymiyden hyödyt ja haitat tulee punnita tarkoin.

Confirmatory factor analysis of an inventory of perception of insecurity and fear of crime

This paper focuses on the study of the factorial structure of an inventory to estimate the subjective perception of insecurity and fear of crime. Made from the review of the literature on the subject and the results obtained in previous works, this factor structure shows that this attitude towards insecurity and fear of crime is identified through a number of latent factors which are schematically summarized in (a) personal safety, (b) the perception of personal and social control, (c) the presence of threatening people or situations, (d) the processes of identity and space appropriation, (e) satisfaction with the environment, and (f) the environmental and the use of space. Such factors are relevant dimensions to analyze the phenomenon. Method: A sample of 571 participants in a neighborhood of Barcelona was evaluated with the proposed inventory, which yielded data from the distributions of all the items provided. The administration was conducted by researchers specially trained for it and the results were analyzed by using standard procedures in the confirmatory factor analysis (CFA) from the hypothesized theoretical structure. The analysis was performed by decatypes according to the different response scales prepared in the inventory and their ordinal nature, and by estimating the polychoric correlation coefficients. The results show an acceptable fit of the proposed model, an appropriate behavior of the residuals and statistically significant estimates of the factor loadings. This would indicate the goodness of the proposed factor structure.

Asiantuntijan hiljainen tieto. Case: Tullihallitus, verotusosasto

Tutkielman tavoitteena on selvittää ja analysoida, mitä ja minkälaista tietoa ja osaamista asiantuntija tarvitsee jokapäiväisessä työssään. Tutkielman teoriaosuudessa pohditaan asiantuntijuutta, hiljaista tietoa, tiedon rakennetta sekä tiedon merkitystä ja haasteita tietojohtamisen näkökulmasta. Empiirisen tutkimuksen kohdeorganisaationa oli Tullihallituksen verotusosasto. Asiantuntijan osaaminen koostui opitusta tiedosta, mutta myös asenteesta ja halusta oppia. Asiantuntijaksi kehittyminen vaati käytännön harjoittelua oikeassa ympäristössä ja oikeilla asioilla. Asiantuntijan työssään tarvitsema tieto ja osaaminen osoittautuivat kohdeorganisaatiossa niin hiljaiseksi, että sitä ei välttämättä pystytä dokumentoimaan, eikä siten myöskään formaalilla tavalla siirtämään tai säilyttämään. Tutkimustulosten analysointi tuotti osaamispolkuja, jotka kuvaavat aloittelijan tarvitsemia tietoja ja osaamista matkalla asiantuntijaksi. Asiantuntijan tieto ja osaaminen koostuu viidestä pääpolusta, jotka liittyvät osaamisen henkilösidonnaisuuteen, tiedon ymmärtämiseen ja soveltamiseen, tiedon jakamiseen ja yhteistyöhön, henkilökohtaiseen kokemukseen työstä sekä kokemukseen ja käytännön tietoon. Tutkimustulokset perustuvat kohdeorganisaatiossa tehtyihin haastatteluihin, jotka analysoitiin käyttäen aineistolähtöisen teorian menetelmiä.

Strategian viestintä sisäisen viestinnän keinoin

Tämän tutkimuksen avulla on haettu parannusehdotuksia sisäisen viestinnän keinoin toteutettavaan yrityksen strategian viestintään. Tutkimuksen case-yrityksenä on UPM:n Kymin tehdas. Tutkimus perustuu etukäteen yrityksessä tehtyjen erilaisten viestintätutkimusten analysointiin sekä saatujen tulosten vertailuun teoriaan ja yrityksessä asetettuihin viestinnän tavoitteisiin. Tutkittavan aineiston perusteella tutkimus voidaan luokitella sekä laadulliseen että määrälliseen tutkimukseen. Aineiston laajuuden ja erilaisuuden takia se käsitellään laadullisen analyysin mukaan. Teoreettisena viitekehyksenä on suhdemarkkinointi ja edelleen sisäinen markkinointi. Teoreettisesti asiaa tarkastellaan myös johtamisen ja viestinnän näkökulmasta. Tietämyksen, ymmärryksen, osaamisen, osallistumisen ja palkitsemien kautta saadaan ihmiset hyväksymään asetetut strategiat ja muutos. Sisäinen viestintä saadaan parhaiten palvelemaan strategian viestintää johdon ja esimieskunnan viestintäosaamisen ja asenteen varmistamisella. Kaikkia viestintäkanavia tarvitaan, mutta niiden oikea hallinta ja tärkeyden painotus on tärkeä. Viestinnän strategian ja toimenpiteiden suunnittelu ovat asia, jota ei voi unohtaa. Näitä vielä tärkeämpää on strategisten viestien sisältö.

Corporate Social and Regional Responsibility - The View of Small and Medium-sized Enterprises

The objective of this research was to understand and describe what corpo-rate social and regional responsibility is in SMEs and define the meaning of these concepts to the community and region. Corporate social respon-sibility (CSR) creates a basis for regional responsibility. Regional respon-sibility is a new concept and this research examines it from SMEs’ view-point. This is a theoretical research and the aim is to create a theoretical framework of SMEs’ corporate social and regional responsibility. This framework supports the future research on the subject. The research results show that CSR of SMEs is practical, informal and dependent on the scarce resources of SMEs. CSR is a complex and deep concept and SMEs have their own way of interpreting it. It can be stated that CSR-practises in SMEs are closely connected to employment, envi-ronment, community and supply chain. The challenge is to find motivation to socially and regionally responsible behaviour in SMEs. Benefiting from responsible behaviour and the attitude of SME’s owner-manager are the key reasons for SMEs to involve in CSR and regional responsibility. The benefits of this involvement are for example improved image, reputation and market position. CSR can also be used in SMEs as risk management tool and in cost reduction. This study indicates also that creation of strate-gic partnerships, local government participation, a proper legal system and financial support are the basic issues which support CSR of SMEs. This research showed that regional responsibility of SMEs includes active participation in regional strategy processes, L&RED initiatives and regional philanthropy. For SMEs regional responsibility means good relationships with the community and other related stakeholders, involvement in L&RED initiatives and acting responsibly towards the operating environment. In SMEs’ case this means that they need to understand the benefits of this kind of involvement in order to take action and participate. As regional responsibility includes the relationships between firm and the community, it can be stated that regional responsibility extends CSR’s view of stakeholders and emphasises both, the regional stakeholders and public-private partnerships. Community engagement and responsible be-haviour towards community can be seen as a part of SMEs’ social and regional responsibility. This study indicates that social and regional re-sponsibility of SMEs have a significant influence on the community and region where they are located. Better local and regional relationships with regional and community actors are the positive impacts of social and re-gional responsibility of SMEs. Socially and regionally responsible behav-iour creates a more positive environment and deepens the involvement of SMEs to community and L&RED initiatives.

Työn ja perheen suhteen sosiaalinen rakentuminen eri ikäisten puheessa

Tämän tutkielman tavoite on selvittää, miten eri ikäiset ihmiset puhuvat työ- ja perhe-elämän yhteensovittamisesta. Tarkoituksena on tuoda esille haastattelujen puheessa vakiintuneita diskursseja, jotka luovat sosiaalista todellisuutta. Aineistona käytetään kandeksaa eräässä Etelä-Karjalan Osuuspankin konttorissa tehtyä teemahaastattelua. Näitä haastatteluja analysoidaan diskurssianalyyttisesti. Haastateltujen puheessa toistuu kandeksan eri diskurssityyppiä: ihannediskurssi, "normaali" -diskurssi, organisaatio joustajana -diskurssi, omatuntodiskurssi, stressidiskurssi, minä päätän -diskurssi, ylitehokkuusdiskurssi sekä ikä ja asenteet -diskurssi.

Attitudes Regarding Palliative Sedation and Death Hastening Among Swiss Physicians: A Contextually Sensitive Approach.

In Switzerland, where assisted suicide but not euthanasia is permitted, the authors sought to understand how physicians integrate palliative sedation in their practice and how they reflect on existential suffering and death hastening. They interviewed 31 physicians from different care settings. Five major attitudes emerged. Among specialized palliative care physicians, convinced, cautious and doubtful attitudes were evident. Within unspecialized settings, palliative sedation was more likely to be considered as death hastening: clinicians either avoid it with an inexperienced attitude or practice it with an ambiguous attitude, raising the issue of unskilled and abusive uses of sedatives at the end of life.

Transition of young people with chronic conditions: a cross-sectional study of patient perceptions before and after transfer from pediatric to adult health care.

UNLABELLED: The aim of this study was to compare perceived barriers to and the most preferred age for successful transition to adult health care between young people with chronic disorders who had not yet transferred from pediatric to adult health care (pre-transfer) and those who had already transferred (post-transfer). In a cross-sectional study, we compared 283 pre-transfer with 89 post-transfer young people, using a 28-item questionnaire that focused on perceived barriers to transition and beliefs about the most preferred age to transfer. Feeling at ease with the pediatrician was the most important barrier to successful transition in both groups, but was rated significantly higher in the pre-transfer compared to the post-transfer group (OR = 2.03, 95 %CI 1.12-3.71). Anxiety and lack of information were the next most important barriers, rated equally highly by the two groups (OR = 0.67, 95 %CI 0.35-1.28 and OR = 0.71, 95 %CI 0.36-1.38, respectively). More than 80 % of the respondents in both groups reported that 16-19 years was the most preferred age to transfer; more than half of all the respondents reported 18-19 years and older as the most preferred age. CONCLUSION: Better transition planning through the provision of regular and more detailed information about adult health-care providers and the transition process could reduce anxiety and contribute to a more positive attitude to overcome perceived barriers to transition from young people's perspective. Young people's preferences about transferring to adult health care provide a challenge to those children's hospitals that transfer to adult health care at a younger age.

Sickness certification in primary care: a survey on views and practices among Swiss physicians.

QUESTIONS UNDER STUDY: Studies from several countries (Scandinavia, United Kingdom) report that general practitioners (GPs) experience problems in sickness certification. Our study explored views of Swiss GPs towards sickness certification, their practice and experience, professional skills and problematic interactions with patients. METHODS: We conducted an online survey among GPs throughout Switzerland, exploring behaviour of physicians, patients and employers with regard to sickness certification; GPs' views about sickness certification; required competences for certifying sickness absence, and approaches to advance their competence. We piloted the questionnaire and disseminated it through the networks of the five Swiss academic institutes for primary care. RESULTS: We received 507 valid responses (response rate 50%). Only 43/507 GPs experienced sickness certification as problematic per se, yet 155/507 experienced problems in sickness certification at least once a week. The 507 GPs identified estimating a long-term prognosis about work capacity (64%), handling conflicts with patients (54%), and determining the reduction of work capacity (42%) as problematic. Over 75% would welcome special training opportunities, e.g., on sickness certifications during residency (93%), in insurance medicine (81%), and conflict management (80%). CONCLUSION: Sickness certification as such does not present a major problem to Swiss GPs, which contrasts with the experience in Scandinavian countries and in the UK. Swiss GPs did identify specific tasks of sickness certification as problematic. Training opportunities on sick-leave certification and insurance medicine in general were welcomed.

Attitudes and burden in relatives of patients with schizophrenia in a middle income country

BACKGROUND: Most studies of family attitudes and burden have been conducted in developed countries. Thus it is important to test the generalizability of this research in other contexts where social conditions and extended family involvement may be different. The aim of this study was to assess the relationship between the attitudes of caregivers and the burden they experience in such a context, namely Arica, a town located in the northernmost region of Chile, close to the border with Peru and Bolivia. METHODS: We assessed attitudes towards schizophrenia (including affective, cognitive and behavioural components) and burden (including subjective distress, rejection and competence) in 41 main caregivers of patients with schizophrenia, all of whom were users of Public Mental Health Services in Arica. RESULTS: Attitude measures differed significantly according to socio-demographic variables, with parents (mainly mothers) exhibiting a more negative attitude towards the environment than the rest of the family (t = 4.04; p = 0.000).This was also the case for caregivers with a low educational level (t = 3.27; p < 0.003), for the oldest caregivers (r = 0.546; p = 0.000) and for those who had spent more time with the patient (r = 0.377; p = 0.015). Although attitudes had significant association with burden, their explanatory power was modest (R2 = .104, F = 4,55; p = .039). CONCLUSIONS: Similar to finding developed countries, the current study revealed a positive and significant relationship between the attitudes of caregivers and their burden. These findings emphasize the need to support the families of patients with schizophrenia in this social context.

Pediatric advance care planning from the perspective of health care professionals: a qualitative interview study.

BACKGROUND: Pediatric advance care planning differs from the adult setting in several aspects, including patients' diagnoses, minor age, and questionable capacity to consent. So far, research has largely neglected the professionals' perspective. AIM: We aimed to investigate the attitudes and needs of health care professionals with regard to pediatric advance care planning. DESIGN: This is a qualitative interview study with experts in pediatric end-of-life care. A qualitative content analysis was performed. SETTING/PARTICIPANTS: We conducted 17 semi-structured interviews with health care professionals caring for severely ill children/adolescents, from different professions, care settings, and institutions. RESULTS: Perceived problems with pediatric advance care planning relate to professionals' discomfort and uncertainty regarding end-of-life decisions and advance directives. Conflicts may arise between physicians and non-medical care providers because both avoid taking responsibility for treatment limitations according to a minor's advance directive. Nevertheless, pediatric advance care planning is perceived as helpful by providing an action plan for everyone and ensuring that patient/parent wishes are respected. Important requirements for pediatric advance care planning were identified as follows: repeated discussions and shared decision-making with the family, a qualified facilitator who ensures continuity throughout the whole process, multi-professional conferences, as well as professional education on advance care planning. CONCLUSION: Despite a perceived need for pediatric advance care planning, several barriers to its implementation were identified. The results remain to be verified in a larger cohort of health care professionals. Future research should focus on developing and testing strategies for overcoming the existing barriers.

Erforschung und Antworten auf den vorzeitigen Todeswunsch eines Patienten mit einer schweren fortgeschrittenen Krankheit [Exploring and Responding to a Wish to Hasten Death of a patient with Advanced Illness].

It is not uncommon for patients with an advanced disease to express a desire to their physician to hasten their death. Recent studies show that the motivation of such a desire is multifactorial and multidimensional, including depression, physical, psycho-social and spiritual suffering, fears about the process of dying and/or misunderstandings about the options for end-of-life care. The objective of this paper is to propose to the physician how to explore the dimensions of this request and some elements to answer it.