Convergences and divergences of diabetic patients' and healthcare professionals' opinions of care : a qualitative study

OBJECTIVES: To investigate opinions' convergences and divergences of diabetic patients and health-care professionals on diabetes care and the development of a regional diabetes programme. BACKGROUND: Development and implementation of a regional diabetes programme. RESEARCH DESIGN: Qualitative study using focus groups to elicit diabetic patients' and health-care professionals' opinions, followed by content analysis. SETTING AND PARTICIPANTS: Eight focus groups: four focus groups with diabetic patients (n = 39) and four focus groups with various health-care professionals (n = 34) residing or practicing in the canton of Vaud, Switzerland, respectively. RESULTS: Perceived quality of diabetes care varied between individuals and types of participants. To improve quality, patients favoured a comprehensive follow-up while professionals suggested considering existing structures and trained professionals. All participants mentioned communication difficulties between professionals and were favouring teamwork. In addition, they described the role that patients should have in care and self-management. Financial difficulties were also mentioned by both groups of participants. Finally, they were in favour of the development of a regional diabetes programme adapted to actors' needs. For patients indeed, such a programme would represent an opportunity to improve information and to have access to comprehensive care. For professionals, it would help the development of local networks and the reinforcement of existing tools and structures. DISCUSSION AND CONCLUSIONS: Acknowledging convergences and divergences of opinions of both diabetic patients and health-care professionals should help the further development of a programme adapted to users' needs, taking all stakeholders interests and priorities into consideration.

A new highly penetrant form of obesity due to deletions on chromosome 16p11.2.

Obesity has become a major worldwide challenge to public health, owing to an interaction between the Western 'obesogenic' environment and a strong genetic contribution. Recent extensive genome-wide association studies (GWASs) have identified numerous single nucleotide polymorphisms associated with obesity, but these loci together account for only a small fraction of the known heritable component. Thus, the 'common disease, common variant' hypothesis is increasingly coming under challenge. Here we report a highly penetrant form of obesity, initially observed in 31 subjects who were heterozygous for deletions of at least 593 kilobases at 16p11.2 and whose ascertainment included cognitive deficits. Nineteen similar deletions were identified from GWAS data in 16,053 individuals from eight European cohorts. These deletions were absent from healthy non-obese controls and accounted for 0.7% of our morbid obesity cases (body mass index (BMI) >or= 40 kg m(-2) or BMI standard deviation score >or= 4; P = 6.4 x 10(-8), odds ratio 43.0), demonstrating the potential importance in common disease of rare variants with strong effects. This highlights a promising strategy for identifying missing heritability in obesity and other complex traits: cohorts with extreme phenotypes are likely to be enriched for rare variants, thereby improving power for their discovery. Subsequent analysis of the loci so identified may well reveal additional rare variants that further contribute to the missing heritability, as recently reported for SIM1 (ref. 3). The most productive approach may therefore be to combine the 'power of the extreme' in small, well-phenotyped cohorts, with targeted follow-up in case-control and population cohorts.

The evolution of conventions under incomplete information

We formulate an evolutionary learning process in the spirit ofYoung (1993a) for games of incomplete information. The process involves trembles. For many games, if the amount of trembling is small, play will be in accordance with the games' (semi-strict) Bayesian equilibria most of the time. This supports the notion of Bayesian equilibrium. Further, often play will most of the time be in accordance with exactly one Bayesian equilibrium. This gives a selection among the Bayesian equilibria. For two specific games of economic interest wecharacterize this selection. The first is an extension to incomplete information of the prototype strategic conflict known as Chicken. The second is an incomplete information bilateral monopoly, which is also an extension to incompleteinformation of Nash's demand game, or a simple version ofthe so-called sealed bid double auction. For both gamesselection by evolutionary learning is in favor of Bayesianequilibria where some types of players fail to coordinate, such that the outcome is inefficient.

Active civic participation of immigrants in Portugal

Portugal’s historical past strongly influences the composition of the country’s immigrant population. The main third-country foreign nationals in Portugal originate traditionally from Portuguese-speaking African countries (namely Cape Verde, Angola, Guinea Bissau, and S. Tomé e Príncipe) and Brazil. In 2001, a newly created immigrant status entitled “permanence” authorization uncovered a quantitative and a qualitative change in the structure of immigrant population in Portugal. First, there was a quantitative jump from 223.602 foreigners in 2001 to 364.203 regularized foreigners in 2003. Secondly, there was a substantial qualitative shift in the composition of immigrants. The majority of the new immigrants began coming from Eastern European countries, such as Ukraine, Moldavia, Romania, and the Russian Federation. Thus, European countries outside the E.U. zone now rank second (after African countries) in their contribution of individuals to the stocks of immigrant population in Portugal. The differences between the new and traditional immigration flows are visible in the geographical distribution of immigrants and in their insertion into the labour market. While the traditional flows would congregate around the metropolitan area of Lisbon and in the Algarve, the new migratory flows tend to be more geographically dispersed and present in less urbanized areas of Portugal. In terms of insertion in the labour market, although the construction sector is still the most important industry for immigrant labour, Eastern European workers may also be found in the agriculture and manufacturing sectors. The institutional conditions that encourage immigrants’ civic participation are divided at three different levels: the state, the local, and the civil society levels. At the state level, the High Commissioner for Migrations and Ethnic Minorities is the main organizational structure along with a set of interrelated initiatives operating under specific regulatory frameworks, which act as mediators between state officials and the Portuguese civil society, and more specifically, immigrant communities. At the local level, some municipalities created consultative councils and municipal departments aiming at encouraging the participation and representation of interests from immigrant groups and association in local policies. In the civil society sphere, the main actors in Portugal spurring immigrants civic participation are immigrant associations, mainstream associations directed toward immigration topics, and unions. The legal conditions framing immigrants’ access to social housing, education, health, and social security in Portugal are also considered to be positive. Conditions restricting immigrants’ civic participation are mainly normative and include the Portuguese nationality law, the regulations shaping the political participation of immigrants, namely in what concerns their right to vote, and employment regulations restricting immigrants’ access to public administration positions. Part II of the report focuses on the active civic participation of third country immigrants. First, reasons for the lack of research on this issue in Portugal are explained. On the one hand, the recent immigration history and the more urgent needs regarding school and economic integration kept this issue out of the research spotlight. On the other hand, it was just in the beginning of the 1990s that immigrants took the very first steps toward collective mobilisation. Secondly, the literature review of Portuguese bibliography covers research on third country immigrants’ associative movement, research on local authorities’ policies and discussion about ethnic politics and political mobilisation of immigrants in Portugal. As political mobilisation of these groups has been made mainly through ethnic and/or migrant organisations, a brief history of immigrants' associative movement is given. Immigrant associations develop multiple roles, covering the social, the cultural, the economic and the political domains. Political claiming for the regularisation of illegal immigrants has been a permanent and important field of intervention since the mid-1990s. Research results reveal the com5 plex relations between ethnic mobilisation and the set of legal and institutional frameworks developed by local and national governmental authorities targeted to the incorporation of minority groups. Case studies on the Oeiras district and on the Amadora district are then presented. Conclusions underline that the most active immigrant groups are those from Cape Verde and Guinea Bissau, since these groups have constituted a higher number of ethnic associations, give priority to political claiming and present a more politicised discourse. Reflecting on the future of research on civic participation of third country immigrants in Portugal, the authors state that it would be interesting and relevant to compare the Portuguese situation with those of other European countries, with an older immigration history, and analyse how the Portuguese immigrants’ associative movement will be affected by a changing legal framework and the emergence of new opportunities within the set of structures regarding the political participation of minority groups.

Workshop: Capacity building for national public health advocacy: case studies from national associations

The first statement of the EUPHA on the Future of Public Health in Europe refers to the need for going 'to policymakers, politicians and practitioners in all sectors of society and advise them on how to promote public health throughout society'. WHO-EURO Director General Marc Danzon, quoted in the second EUPHA statement on the responsibility of policy makers indicates that 'learning is not systematically applied in health policy development in our continent'. Statement 3 calls for the integration of public health into the political agenda in all sectors. The first EUPHA president, Louise Gunning-Schepers, quoted in Statement 10 called on EUPHA to become 'a powerful advocate of the public health community'. In addition to the above, the EU is now actively seeking ways to build capacity to implement its health strategy. Learning and building the capacity to achieve our aims The aims and objectives to promote the public's health as reflected in EUPHA's 10 statements are also mirrored in the national public health associations. However, many of EUPHA's national associations have little or limited experience in promoting public health policy at the national level. To assist in the learning of advocacy for public health policies, case studies presenting experiences of national public health organizations in lobbying for national public health policy will be presented and discussed. In addition to sharing experiences, the presentations will identify successful approaches to public health advocacy as well as lessons learned from unsuccessful attempts.

On information and competition in private value auctions

How much information does an auctioneer want bidders to have in a private value environment?We address this question using a novel approach to ordering information structures based on the property that in private value settings more information leads to a more disperse distribution of buyers updated expected valuations. We define the class of precision criteria following this approach and different notions of dispersion, and relate them to existing criteria of informativeness. Using supermodular precision, we obtain three results: (1) a more precise information structure yields a more efficient allocation; (2) the auctioneer provides less than the efficient level of information since more information increases bidder informational rents; (3) there is a strategic complementarity between information and competition, so that both the socially efficient and the auctioneer s optimal choice of precision increase with the number of bidders, and both converge as the number of bidders goes to infinity.

R&D cooperation and spillovers: Some empirical evidence

This paper provides some first empirical evidence on the relationshipbetween R&D spillovers and R&D cooperation. The results suggest disentangling different aspects of know-how flows. Firms which rate incoming spillovers more importantly and who can limit outgoing spillovers by a more effective protection of know-how, are more likely to cooperate in R&D. Our analysis also finds that cooperating firms have higher incoming spillovers and higher protection of know-how, indicating that cooperation may serve as a vehicle to manage information flows. Our results thus suggest that on the one hand the information sharing and coordination aspects of incoming spillovers are crucial in understanding cooperation, while on the other hand, protection against outgoing spillovers is important for firms to engage in stable cooperative agreements by reducing free-rider problems. Distinguishing different types of cooperative partners reveals that while managing outgoing spillovers is less critical in alliances with non-commercial research partners than between vertically related partners, the incoming spillovers seem to be more critical in understanding the former type of R&D cooperation.

DIGITAL LIBRARY FOR DIGITAL DIVIDE AND ENVIRONMENT OF SCARCE ACCESS TO PRINTED MATERIALS: THE CASE OF UNIVERSITY JEAN PIAGET OF CAPE VERDE

With the failure of the traditional mechanisms of distributing bibliographic materials into developing countries, digital libraries show up as a strong alternative in accomplishing such job, despite the challenges of the digital divide. This paper discusses the challenges of building a digital library (DL) in a developing country. The case of Cape Verde as a digital divide country is analyzed, in terms of current digital library usage and its potentiality for fighting the difficulties in accessing bibliographic resources in the country. The paper also introduces an undergoing project of building a digital library at the University Jean Piaget of Cape Verde.

An Examination of Iowa State Patrol Traffic Stops, October 2000 - March 2002

this report describes traffic law enforcement data collected by the Iowa State Patrol (ISP) related to traffic stops made by Troopers for October 1, 2000 through March 30, 2002. The data contained in this report summarizes the activities of approximately 435 troopers who are assigned to 15 posts throughout the State of Iowa The purpose of this voluntary data collection process was to provide the ISP with the ability to review traffic law enforcement variables in relation to traffic stops. The methodology for this research project was developed and implemented by ISP. Following the data collection period, the Iowa Division of Criminal and Juvenile Justice Planning (CJJP) was asked to assist in the analysis and reporting phase of this ambitious project.

Railroad Abandonment, Revised March, 23, 1997

Abandonment and discontinuance of railroad service is allowed by federal law which permits a carrier to end its obligation to provide common carrier service over a particular rail line. Although a number of specific reasons may be given for the abandonment, it is generally based on economic factors. This booklet is intended to provide information about the abandonment process and some guidance concerning how to prepare for an abandonment. This information is based on rules established by the Interstate Commerce Commission Termination Act of 1995, the Surface Transportation Board (successor to the former Interstate Commerce Commission), and the Staggers Rail Act of 1980, and the policies and procedures of the Iowa Department of Transportation.

Forward, Spring 2009

Newsletter for the Iowa Commission on the Status of Women. Forward is the new quarterly newsletter published by the Iowa Commission on the Status of Women. We are sure that you will continue to find information of use for Iowa’s women and girls.

Forward, Summer 2009

Newsletter for the Iowa Commission on the Status of Women. Forward is the quarterly newsletter published by the Iowa Commission on the Status of Women. We are sure that you will continue to find information of use for Iowa’s women and girls.

Motifs de consultation en médecine du travail [Reasons for consultation in occupational medicine].

The inability to characterize more precisely the extent of occupational diseases limits the implementation of an effective preventive policy. Furthermore, not all work-related conditions are reported by the Swiss workers' compensation system. A seven-year (1986 to 1992) retrospective study of medical visits in an Institute of Occupational Health Sciences is presented. The objective of this study is to expand data on occupational diseases for clinical and public health intervention. 298 patients have been examined for a possible work-related condition. In 140 cases (47%), an occupational disease according to the Swiss Law was found. Respiratory tract was the main target of industrial pollutants. Respiratory irritation , solvent intoxications, contact dermatitis and asthma were the most frequent conditions seen. 97 workplace visits (32% of all medical visits) were necessary for diagnostic purposes. Painters (construction, cars) and other solvent exposed workers were at particular risk. Rare alpha-1-antitrypsin phenotypes were found several times in workers with respiratory diseases confirming the value of this test in occupational medicine. Despite many referral biases, direct clinical and public health applications of the data are possible. This study confirms the hypothesis that occupational respiratory diseases and intoxications are probably underreported in the workers' compensation statistics. Activities with an increased risk of work-related diseases have been identified so workplace intervention could be highly targeted. This study shows also that a more intense collaboration between primary care physicians, hospital services and occupational medical specialists is necessary to improve clinical and epidemiological surveillance of work-related health conditions.

Xarxa digital multimèdia de pantalles i kioscs interactius

Internet s’ha alçat en poc temps com el mitjà més utilitzat pels turistes per a planificar, organitzar i comprar un viatge, és per això que es proposa donar les mateixes facilitats en el destí. La Publicitat Dinàmica o “Digital Signage” és un nou servei de comunicació que consisteix en un conjunt de tecnologies i aplicacions informàtiques que permeten emetre missatges multimèdia i comunicar-se així d’una manera innovadora amb el públic objectiu de cada empresa, si s’afegeix un sistema independent, multimèdia i interactiu que pot utilitzar-se per a proporcionar informació i/o permetre la realització de transaccions es potencia al màxim el servei. D’aquesta manera es proposa crear una Xarxa Digital Multimèdia de Kioscs Interactius recolzats amb una pantalla de plasma per a la tecnologia Digital Signage. La ubicació escollida estratègicament és en un dels punts de major afluència turística, tal com l’entrada dels hotels. Així es tracta de crear circuits tancats en àrees geogràfiques on es troben els principals nuclis turístics de Mallorca. La possibilitat d’accedir a segments de població altament interessants per al producte o servei es multiplica al ser una manera fàcil, eficaç i altament suggestiva de promocionar el què es pretén. Un avantatge és la simplicitat de la infraestructura tecnològica que es necessita, el dispositiu mitjançant el qual es visualitzaran els missatges serà una pantalla de plasma convencional, i un terminal de punt de venda instal.lat en un lloc de pas. Cada mòdul està connectat a la xarxa ADSL mitjançant un servidor local a Internet. La connexió a la xarxa és imprescindible per a que el manteniment i actualització dels continguts es puguin efectuar remotament. L’objectiu principal d’aquest treball és estudiar la viabilitat de la implantació de la xarxa, mitjançant la realització d’un estudi de mercat on s’analitzen els grups claus per a la implantació: els hotelers, la indústria turística i el Govern Balear. S’identifiquen els beneficis que aportarà al nou servei i les repercussions que tendrà la seva instal.lació. Entre els resultats més destacats d’aquest estudi cal remarcar l’acceptació que ha tengut la idea entre els hotelers entrevistats i la resposta positiva de la indústria turística. Es reconeix: una millora de la imatge del sector, l’ús com a eina de promoció turística pel Govern, i la contribució a la sostenibilitat econòmica pel fet que augmenta la competitivitat de les empreses i això millora la qualitat del servei.

Estudi sobre el perfil de persones grans amb dependència del servei d'ajuda a domicili del Consell Comarcal d'Osona i el tipus de suport formal i informal

The aim of this study is to determine the profile of dependent elderly people users of the home care services (SAD) of the regional council in Osona (Consell Comarcal d´Osona) , and the characteristics of formal and informal types of support they use. Methodology. An observational study of a transversal format has been carried out, with retrospective and descriptive purposes. The target population is 63 people (26 men and 37 women) included in the program of the regional SAD They have a recognized dependence grade approved by the law 39 /2006, December 14th , promoting the individual autonomy and care of elderly people in a dependent situation. The data were collected by social workers of basic social services, first with a home visit and followed by handed out questionnaires, specifically designed for this study, in order to obtain information on socio-demographic characteristics, and the type of support formal and informal. The obtained results on the SAD users are women in a 58.7% and a 41.3 % are men. The 84% of the total sampling are 80 years old and more, being the average age of 85.2 years old. 45% of them are married, 41% are widows and widowers and 14% are single. 54% are rated with severe dependence (grade II), 42.8% with high dependence (grade III). 86% live accompanied. 100% have an informal caregiver and a 95% of the times, the caregiver is a relative who in 73% of the cases the dedication time is permanent. The coverage of the SAD has an average of 4.27 hours per week and per user. The formal services most used are the technical (62%), also the assessment of an occupational therapist at home (57%) and the telecare service in a (56%). Conclusions. The SAD is used primarily for women in an advanced age and severe dependence. The informal assistance structures have an informal caregiver, being a member of the family mostly, living with the dependent, and mainly in a permanent dedication basis. The SAD has a varied intensity in each case. The formal support services complementary to the SAD, are largely used in all cases.