Assessment of inflammatory Bowel Disease patient's needs and problems from a nursing perspective

BACKGROUND: In this study, we aimed at assessing Inflammatory Bowel Disease patients' needs and current nursing practice to investigate to what extent consensus statements (European Crohn's and Colitis Organization) on the nursing roles in caring for patients with IBD concur with local practice. METHODS: We used a mixed-method convergent design to combine quantitative data prospectively collected in the Swiss IBD cohort study and qualitative data from structured interviews with IBD healthcare experts. Symptoms, quality of life, and anxiety and depression scores were retrieved from physician charts and patient self-reported questionnaires. Descriptive analyses were performed based on quantitative and qualitative data. RESULTS: 230 patients of a single center were included, 60% of patients were males, and median age was 40 (range 18-85). The prevalence of abdominal pain was 42%. Self-reported data were obtained from 75 out of 230 patients. General health was perceived significantly lower compared with the general population (p < 0.001). Prevalence of tiredness was 73%; sleep problems, 78%; issues related to work, 20%; sexual constraints, 35%; diarrhea, 67%; being afraid of not finding a bathroom, 42%; depression, 11%; and anxiety symptoms, 23%. According to experts' interviews, the consensus statements are found mostly relevant with many recommendations that are not yet realized in clinical practice. CONCLUSION: Identified prevalence may help clinicians in detecting patients at risk and improve patient management. © 2015 S. Karger AG, Basel.

[Place of volunteers in home care setting for taking care of individuals with Alzheimer's disease related dementia: Qualitative survey in a specialized unit] Place du bénévolat en EHPAD dans la prise en charge des personnes atteintes de la maladie d'Alzheimer ou démences apparentées : enquête qualitative dans une unité protégée.

Objectifs En EHPAD, selon les recommandations de la Haute Autorité de santé (HAS), la prise en charge non médicamenteuse des troubles psychocomportementaux associés à la maladie d'Alzheimer ou aux syndromes apparentés, implique une réorganisation, une formation spécifique du personnel et du temps. Se pose ici la question du rôle des bénévoles dans cette prise en charge. Matériels et méthodes Enquête descriptive à partir de questionnaires distribués aux différents intervenants (bénévoles, professionnels de santé et aidants familiaux) d'une unité protégée de l'EHPAD de la clinique du Diaconat (Colmar, France) et spécifiquement élaborés pour évaluer leur vécu de l'expérience de bénévolat dans la prise en charge des résidents souffrant d'une maladie d'Alzheimer ou d'un syndrome apparenté. Résultats Sur les 101 questionnaires qui ont été remplis, 85,7 % des aidants, 60 % des bénévoles et 42,1 % des professionnels constataient des bénéfices pour eux-mêmes. Les professionnels et les aidants avaient confiance dans l'intervention des bénévoles. Cependant, les bénévoles semblaient manquer de compétence pour le soutien des aidants et dans les techniques de communication avec les résidents. Les points essentiels pour permettre un fonctionnement harmonieux entre les différents intervenants étaient de bien définir préalablement le rôle de bénévoles et d'en informer les autres intervenants, de former les bénévoles à ce rôle et de favoriser la communication entre les bénévoles et les professionnels. Conclusion Cette enquête montre que les bénévoles ont une place aux côtés des équipes soignantes pour participer à la prise en charge non médicamenteuse des personnes atteintes de maladie d'Alzheimer ou syndromes apparentés. Ils ont une position singulière et jouent un rôle complémentaire de celui des soignants et des aidants. Objectives According to the recommendation of the French High Authority of Health (HAS), the non-pharmaceutical management of psycho-behavioural disorders associated with Alzheimer's disease or related disorders in a nursing home, involves reorganization an specific training for staff members and time. This raises the question of the role of volunteering in this approach. Materials and methods A descriptive survey using questionnaires distributed to various stakeholders (volunteers, healthcare professionals and caregivers) of a protected unit of the nursing home of the Diaconat clinic (Colmar, France) and specifically designed to assess their experience of the volunteering in supporting residents suffering from Alzheimer's diseases or related disorders. Results Of the 101 questionnaires that were filled in, 85.7% of caregivers, 60% of volunteers and 42.1% of professionals recorded benefits for themselves. Professionals and informal carers had confidence in the intervention of volunteers. However, volunteers seemed to lack skills to support informal caregivers and specific knowledge about the technique of communicating with residents. The key points to favor harmonious collaborations between the different stakeholders were: to properly define the role of volunteers and to inform other stakeholders about this role previously, and to specifically educate themselves in this task and to promote communication between volunteers and all other professionals. Conclusion This study shows that volunteers have a place alongside medical teams to participate in the non-pharmaceutical treatment for people with Alzheimer's disease or related syndromes. They have a unique position and play a complementary role to that of carers and informal caregivers.

Using narratives to study the impact of social networks on the educational paths of immigrant students

This paper presents the qualitative data collection process aimed at the study of the impactsocial relations and networks have on educational paths of immigrant students. In theframework of a R & D longitudinal study funded by the Ministry of Science and Innovation(2012-2014), the research team tracked the path of 87 immigrant students, from whom only 17successfully achieved the transition through the first and second year of Post-16 Education.A vast range of literature notes that relationships are an important part of migration process andsocial integration analysis, as well as school history in terms of success or failure. Through thefieldwork researchers collect the personal networks of all immigrant students from 3 highschools who were at that time attending last course of compulsory school. The network structureinfluences their social capital and therefore determines the resources, goods and types of supportindividuals can access. All these aspects are influential elements in the configuration anddevelopment of academic trajectories of immigrant students.At the end of the second year of Post-16 Education (two years later), the study captures personalnetworks of these students again, analyses and discusses their evolution and influence on theirpaths through qualitative interviews. Such interviews facilitated the discussion of theirrelationships while providing interesting narratives that are presented in the text. In order to do so, the biographical interpretive narrative method of interviewing is implemented.

Data triangulation in the context of opioids monitoring via wastewater analyses.

BACKGROUND: The need to contextualise wastewater-based figures about illicit drug consumption by comparing them with other indicators has been stressed by numerous studies. The objective of the present study was to further investigate the possibility of combining wastewater data to conventional statistics to assess the reliability of the former method and obtain a more balanced picture of illicit drug consumption in the investigated area. METHODS: Wastewater samples were collected between October 2013 and July 2014 in the metropolitan area of Lausanne (226,000 inhabitants), Switzerland. Methadone, its metabolite 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), the exclusive metabolite of heroin, 6-monoacetylmorphine (6-MAM), and morphine loads were used to estimate the amounts of methadone and heroin consumed. RESULTS: Methadone consumption estimated from EDDP was in agreement with the expectations. Heroin estimates based on 6-MAM loads were inconsistent. Estimates obtained from morphine loads, combined to prescription/sales data, were in agreement with figures derived from syringe distribution data and general population surveys. CONCLUSIONS: The results obtained for methadone allowed assessing the reliability of the selected sampling strategy, supporting its ability to capture the consumption of a small cohort (i.e., 743 patients). Using morphine as marker, in combination with prescription/sales data, estimates in accordance with other indicators about heroin use were obtained. Combining different sources of data allowed strengthening the results and suggested that the different indicators (i.e., administration route, average dosage and number of consumers) contribute to depict a realistic representation of the phenomenon in the investigated area. Heroin consumption was estimated to approximately 13gday(-1) (118gday(-1) at street level).

Using narratives to study the impact of social networks on the educational paths of immigrant students

This paper presents the qualitative data collection process aimed at the study of the impactsocial relations and networks have on educational paths of immigrant students. In theframework of a R & D longitudinal study funded by the Ministry of Science and Innovation(2012-2014), the research team tracked the path of 87 immigrant students, from whom only 17successfully achieved the transition through the first and second year of Post-16 Education.A vast range of literature notes that relationships are an important part of migration process andsocial integration analysis, as well as school history in terms of success or failure. Through thefieldwork researchers collect the personal networks of all immigrant students from 3 highschools who were at that time attending last course of compulsory school. The network structureinfluences their social capital and therefore determines the resources, goods and types of supportindividuals can access. All these aspects are influential elements in the configuration anddevelopment of academic trajectories of immigrant students.At the end of the second year of Post-16 Education (two years later), the study captures personalnetworks of these students again, analyses and discusses their evolution and influence on theirpaths through qualitative interviews. Such interviews facilitated the discussion of theirrelationships while providing interesting narratives that are presented in the text. In order to do so, the biographical interpretive narrative method of interviewing is implemented.

Lake-level and salinity reconstruction from diatom analyses in Quillagua Formation (Late Neogene, Central Andean Forearc, Northern Chile)

A sedimentary and micropaleontological study of the Quillagua Formation provides a detailed paleohydrological reconstruction of the lacustrine system which occupied the present-day hyperarid Quillagua-Llamara fore-arc Basin (Northern Chile) from lattermost Miocene to Early Pliocene times.

Méta-analyses d'essais randomisés sur données individuelles dans le traitement des cancers ORL non métastatiques : principes, résultats, perspectives [Individual patient data meta-analyses of randomized trials for the treatment of non-metastatic head and neck squamous cell carcinomas: Principles, results and perspectives].

Meta-analyses are considered as an important pillar of evidence-based medicine. The aim of this review is to describe the main principles of a meta-analysis and to use examples of head and neck oncology to demonstrate their clinical impact and methodological interest. The major role of individual patient data is outlined, as well as the superiority of individual patient data over meta-analyses based on published summary data. The major clinical breakthrough of head and neck meta-analyses are summarized, regarding concomitant chemotherapy, altered fractionated chemotherapy, new regimens of induction chemotherapy or the use of radioprotectants. Recent methodological developments are described, including network meta-analyses, the validation of surrogate markers. Lastly, the future of meta-analyses is discussed in the context of personalized medicine.

Identification of potential HIV restriction factors by combining evolutionary genomic signatures with functional analyses.

BACKGROUND: Known antiretroviral restriction factors are encoded by genes that are under positive selection pressure, induced during HIV-1 infection, up-regulated by interferons, and/or interact with viral proteins. To identify potential novel restriction factors, we performed genome-wide scans for human genes sharing molecular and evolutionary signatures of known restriction factors and tested the anti-HIV-1 activity of the most promising candidates. RESULTS: Our analyses identified 30 human genes that share characteristics of known restriction factors. Functional analyses of 27 of these candidates showed that over-expression of a strikingly high proportion of them significantly inhibited HIV-1 without causing cytotoxic effects. Five factors (APOL1, APOL6, CD164, TNFRSF10A, TNFRSF10D) suppressed infectious HIV-1 production in transfected 293T cells by >90% and six additional candidates (FCGR3A, CD3E, OAS1, GBP5, SPN, IFI16) achieved this when the virus was lacking intact accessory vpr, vpu and nef genes. Unexpectedly, over-expression of two factors (IL1A, SP110) significantly increased infectious HIV-1 production. Mechanistic studies suggest that the newly identified potential restriction factors act at different steps of the viral replication cycle, including proviral transcription and production of viral proteins. Finally, we confirmed that mRNA expression of most of these candidate restriction factors in primary CD4+ T cells is significantly increased by type I interferons. CONCLUSIONS: A limited number of human genes share multiple characteristics of genes encoding for known restriction factors. Most of them display anti-retroviral activity in transient transfection assays and are expressed in primary CD4+ T cells.

Forecasting tourism demand using consumer expectations

Abstract Purpose- There is a lack of studies on tourism demand forecasting that use non-linear models. The aim of this paper is to introduce consumer expectations in time-series models in order to analyse their usefulness to forecast tourism demand. Design/methodology/approach- The paper focuses on forecasting tourism demand in Catalonia for the four main visitor markets (France, the UK, Germany and Italy) combining qualitative information with quantitative models: autoregressive (AR), autoregressive integrated moving average (ARIMA), self-exciting threshold autoregressions (SETAR) and Markov switching regime (MKTAR) models. The forecasting performance of the different models is evaluated for different time horizons (one, two, three, six and 12 months). Findings- Although some differences are found between the results obtained for the different countries, when comparing the forecasting accuracy of the different techniques, ARIMA and Markov switching regime models outperform the rest of the models. In all cases, forecasts of arrivals show lower root mean square errors (RMSE) than forecasts of overnight stays. It is found that models with consumer expectations do not outperform benchmark models. These results are extensive to all time horizons analysed. Research limitations/implications- This study encourages the use of qualitative information and more advanced econometric techniques in order to improve tourism demand forecasting. Originality/value- This is the first study on tourism demand focusing specifically on Catalonia. To date, there have been no studies on tourism demand forecasting that use non-linear models such as self-exciting threshold autoregressions (SETAR) and Markov switching regime (MKTAR) models. This paper fills this gap and analyses forecasting performance at a regional level. Keywords Tourism, Forecasting, Consumers, Spain, Demand management Paper type Research paper

Qualitative social differentiation in tertiary education in Spain

[cat] En aquest treball, s'estudia si la hipòtesi de la desigualtat efectivament mantinguda “effectively maintained inequality” es cumpleix a Espanya. Es postula que en les transicions terciàries a Espanya, les influències dels pares no es manifesten tant a través de la probabilitat de fer la transició, sinó més aviat a través de les diferències qualitatives associades a aquesta transició en termes de les qualitats dels programes educatius. Analitzem dues característiques qualitatives dels estudis universitaris: la durada del programa i el seu prestigi acadèmic. Identifiquem per a quins individus la influència parental és més important en cada cas.

Qualitative social differentiation in tertiary education in Spain

[cat] En aquest treball, s'estudia si la hipòtesi de la desigualtat efectivament mantinguda “effectively maintained inequality” es cumpleix a Espanya. Es postula que en les transicions terciàries a Espanya, les influències dels pares no es manifesten tant a través de la probabilitat de fer la transició, sinó més aviat a través de les diferències qualitatives associades a aquesta transició en termes de les qualitats dels programes educatius. Analitzem dues característiques qualitatives dels estudis universitaris: la durada del programa i el seu prestigi acadèmic. Identifiquem per a quins individus la influència parental és més important en cada cas.

Informing patients about limits to confidentiality: A qualitative study in prisons.

AIM: Confidentiality is important in healthcare practice, however, under certain circumstances, confidentiality is breached. In this paper, mental health professionals' (MHPs) practices related to informing imprisoned patients about confidentiality and its limits are presented. METHODS: Twenty-four MHPs working in Swiss prisons were interviewed. Data analysis involved qualitative thematic coding and was validated by discussing results with external experts and study participants. RESULTS: For expert evaluations and court-ordered therapies, participants informed patients that information revealed during these consultations is not bound by confidentiality rules. The practice of routinely informing patients about confidentiality and its limits became more complex in voluntary therapies, for which participants described four approaches and provided justifications in favour of or against their use. CONCLUSIONS: Further training and continued education are needed to improve physicians' ethical and legal knowledge about confidentiality disclosures. In order to promote ethical practices, it is important to understand and address existing motivations, attitudes and behaviours that impede appropriate patient information. Our study adds important new knowledge about the limits to confidentiality, particularly for providers working with vulnerable populations. Results from this study reflect typical ethical and practical dilemmas faced by and of interest to physicians working in forensic medicine and other related settings.