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.

Polychlorinated and polybrominated biphenyls

This volume of the IARC Monographs provides evaluations of the carcinogenicity of polychlorinated biphenyls and polybrominated biphenyls. Polychlorinated biphenyls are a class of aromatic compounds comprising 209 congeners, each containing 1 to 10 chlorine atoms attached to a biphenyl nucleus. Technical products, which were manufactured to obtain a certain degree of chlorination, are mixtures of numerous congeners. These products were widely used as dielectric fluid in capacitors and transformers, and to a lesser extent in building materials. Although their production and use has been banned in most countries, these compounds are ubiquitous environmental pollutants, including in polar regions and the deep ocean, because they are persistent and bioaccumulate. Worldwide monitoring programmes have shown that polychlorinated biphenyls are present in most samples of human milk. An IARC Monographs Working Group reviewed epidemiological evidence, animal bioassays, and mechanistic and other relevant data to reach conclusions as to the carcinogenic hazard to humans of polychlorinated biphenyls, of the subclass of dioxinlike polychlorinated biphenyls, and of polybrominated biphenyls.

Assessing e-procurement System for Improving the Purchasing Operations

Diplomityön tavoitteena oli luoda suunnitelma elektronisen hankintatoimen aloittamiseksi, analysoimalla nykyisiä ostoprosesseja ja konsernin laajuista elektronista hankintajärjestelmää. Työ pohjautuu yritysten väliseen elektroniseen kauppaan, elektroniseen hankintatoimeen ja systeemisuunnitteluun liittyvään kirjallisuuteen. Työssä tehdyn suunnitelman tarkoituksena on auttaa Siemens Oy:tä siirtymään uuteen elektroniseen ostotoimintaan. Elektroniselle ostotoiminnalle suunniteltiin tavoitteet ja näitä vastaavat vaatimukset. Elektronisen hankintajärjestelmän analysointi perustuu kirjallisuudessa esitettyihin järjestelmän elinkaari-mallin vaiheisiin. Analysoinnin tarkoituksena oli saada selville järjestelmän soveltuvuus Siemens Oy: n liiketoimintaympäristöön, prosesseihin ja vaatimuksiin. Elektronisen hankintatoiminnan etuja ovat liiketoiminta prosessien johtamisen parantuminen, kustannusten väheneminen sekä taloudellisen suorituskyvyn lisääntyminen. Elektronisen hankintatoiminnan aloittaminen vaatii kuitenkin huolellista suunnittelua. Työssä tehdyt suunnitelmat ja analysoinnit auttavat arvioidessa järjestelmän sopivuutta Siemens Oy: n vaatimuksiin. Oikean ja toimivan järjestelmän valinta ei kuitenkaan takaa elektronisesta hankintatoiminnasta hyötymistä. Tärkeimpiä jatkotoimenpiteitä onkin suorittaa kustannus/hyöty analyysi ja arvioida toimittajien halukkuutta ja kykyjä osallistua markkinapaikkaan.

Operational Knowledge in Process Design

Työn tarkoituksena on selvittää, miten käyttötietämystä hyödynnetään prosessisuunnittelussa. Tavoitteena on löytää keinoja parantaa käyttötietämyksen hallintaa suunnitteluprosessin aikana ja selvittää, vaikuttaako tämä prosessisuunnittelun laatuun.Prosessisuunnittelun laatua arvioidaan seitsemällä kriteerillä, jotka ovat investointikustannukset, käyttökustannukset, turvallisuus, ympäristövaikutukset, käytettävyys, innovatiivisuus ja aikataulu. Suunnitteluprosessi jaetaan kolmeen vaiheeseen: esisuunnitteluun, perussuunnitteluun ja detaljisuunnitteluun. Prosessisuunnittelua, investointiprojektia, prosessisuunnittelun laatukriteerejä, suunnitteluprosessin eri vaiheita ja käyttötietämyksen luokittelua tarkastellaan yleisesti. Työssä selvitettiin käyttötietämyksen hyödyntämistä Kemiralla. Aluksi muotoiltiin yleisiä väittämiä käyttötietämyksen hyödyntämisestä Kemiran ulkopuolisten eri alojen asiantuntijoiden haastattelujen perusteella. Tämän jälkeen Kemiran prosessisuunnittelijat arvioivat väittämiä. Arvioiden perusteella tehtiin johtopäätöksiä yleisesti käyttötietämyksen hyödyntämisestä prosessisuunnittelussa. Seuraavaksi haastateltiin kahdessa erityyppisessä case-projektissa mukana olleita henkilöitä ja muotoiltiin yleiset väittämät näihin projekteihin sopiviksi. Projekteissa mukana olleet henkilöt arvioivat väittämiä, ja näiden arvioiden perusteella projekteja vertailtiin keskenään. Lopussa esitetään johtopäätökset kaikkien väittämien arvioiden perusteella. Johtopäätöksenä voidaan todeta, että käyttötietämystä voidaan hyödyntää kaikissa suunnittelun vaiheissa, mutta paras hyöty saadaan perus- ja detaljisuunnittelussa. Käyttötietämyksellä voidaan vaikuttaa joihinkin prosessisuunnittelun laatukriteereihin, kuten esimerkiksi käytettävyyteen ja turvallisuuteen enemmän kuin muihin. Kemiralle suositellaan nykyisten tiedonhallintamenetelmien kehittämistä, jotta käyttötietämyksen saatavuus ja sen siirtäminen paranisi. Pr

When does charisma matter for top-level leaders? Effect of attributional ambiguity

One stream of leadership theory suggests leaders are evaluated via inferential observer processes that compare the fit of the target to a prototype of an ideal (charismatic) leader. Attributional theories of leadership suggest that evaluations depend on knowledge of past organizational performance, which is attributed to the leader's skills. We develop a novel theory showing how inferential and attributional processes simultaneously explain top-level leader evaluation and ultimately leader retention and selection. We argue that observers will mostly rely on attributional mechanisms when performance signals clearly indicate good or poor performance outcomes. However, under conditions of attributional ambiguity (i.e., when performance signals are unclear), observers will mostly rely on inferential processes. In Study 1 we tested our theory in an unconventional context-the U.S. presidential election-and found that the two processes, due to the leader's charisma and country economic performance, interact in predicting whether a leader is selected. Using a business context and an experimental design, in Study 2 we show that CEO charisma and firm performance interact in predicting leader retention, confirming the results we found in Study 1. Our results suggest that this phenomenon is quite general and can apply to various performance domains.

Emotional intelligence compensates for low IQ and boosts low emotionality individuals in a self-presentation task

The research on emotional intelligence (EI) has focused mainly on testing the incremental validity of EI with respect to general intelligence and personality; less attention has been devoted to investigating the potential interaction effects. In a self-presentation task that required participants to obtain positive evaluations from others, individuals low in IQ but high in EI performed as well as the high IQ individuals. In addition, the low emotionality individuals performed significantly higher when also high in EI. The results extend the previous findings on the compensatory effect of EI on low IQ to the domain of interpersonal effectiveness and shed light on the effective functioning of personality traits when interpreted with the interaction of EI. Overall this study suggests that the role of EI in predicting performance might have been overlooked by checking solely for main effects and illustrates new venues for understanding the contribution of EI in explaining emotion-laden performance.

Triplement subalternes

La poeta i traductora Maria-Mercè Marçal moltes vegades va escriure sobre la seva «triple rebel·lió» per haver nascut dona, de classe baixa i nació oprimida. Amb el temps ella mateixa va explicar que de les tres circumstàncies dues van pesar més, la condició de dona i la llengua. En aquest article voldríem afegir-n’hi una altra: la traducció. En els països catalans la història de la traducció en femení, potser pel fet de ser dones, catalanes i traductores, està impregnada de trets no hegemònics. La tria d’originals, els textos introductoris a les versions i els comentaris que han rebut mostren que tenim al davant una genealogia femenina traductològica en català, la qual, però, en bona part ha estat invisibilitzada fins ara.

Distal and proximal influences on the use of business and moral frames in responsible decisions

We empirically contribute to the debate on business education in building on a decision frame perspective of decision making in corporate responsibility settings. Business schools have been accused to teach amoral theories, leading their students to behave less morally and engendering corporate responsibility scandals. Research has also pointed toward self-selection: business students would differ from non-business students before entering business school. We examine the role of socioeconomic status, core self-evaluations in this regard. Further, we investigate the belief in a free market as a distal influence triggering a business frame, and moral intensity as a proximal influence triggering a moral frame on responsible decision making by business and non-business students. Cross-sectional data obtained from 566 students on two decision making scenarios mostly supported our hypotheses. Socioeconomic status but not core self-evaluations explain the belief in a free market, and had indirect effects on the likelihood to make a less responsible decision. Importantly, the relationship between business studies and the belief in a free market remained significant after accounting for these variables. Our study thus contributes to the socialization and self-selection arguments. We discuss theoretical and practical implications for research on decision frames and for business education, respectively.

CREATING A MODEL FOR INVENTORY MANAGEMENT SYSTEM

Tutkielman tarkoituksena oli mallintaa varastonhallintajärjestelmä, joka olisi sopiva case yritykselle. Tutkimus aloitettiin case yrityksen varastonhallinan nykytilan kartoituksella, jonka jälkeen tutkittiin varastonhallinnan eri osa-alueisiin. Varastonhallinnan osa-alueista käsiteltiin varastotyyppejä, motiiveja, tavoitteita, kysynnän ennustamista sekä erilaisia varastonhallinnan työkaluja. Sen lisäksi tutkittiin erilaisia varaston täydennysmalleja. Teoriaosuudessa käsiteltiin lisäksi kolmea erilaista tietojärjestelmätyyppiä: toiminnanohjausjärjestelmää, sähköisen kaupankäynnin järjestelmää sekä räätälöityä järjestelmää. Tutkimussuunnitelmassa nämä kolme järjestelmää rajattiin vaihtoehdoiksi, joista jokin valittaisiin case yrityksen varastonhallintajärjestelmäksi. Teorian ja nykytilan pohjalta tehtiin viitekehys, jossa esiteltiin varastonhallintajärjestelmän tieto- ja toiminnallisuusominaisuuksia. Nämä ominaisuudet priorisoitiin neljään eri luokkaan ominaisuuden kriittisyyden mukaan. Järjestelmävaihtoehdot arvioitiin viitekehyksen kriteerien mukaisesti, miten helposti ominaisuudet olisivat toteutettavissa eri vaihtoehdoissa. Tulokset laskettiin näiden arviointien perusteella, jonka jälkeen tulosten analysoinnissa huomattiin, että toiminnanohjausjärjestelmä sopisi parhaiten case yrityksen varastonhallintajärjestelmäksi.

Attachment and spiritual coping in patients with chronic schizophrenia

Many studies on spirituality in psychosis have shown that, compared to a nonclinical population, patients make more use of spiritual beliefs/religious practices to deal with their problems. Our research question was to test whether attachment to spiritual figures could be a good explanation for religious coping strategies in patients with psychosis. First, adult attachment was investigated in 28 patients with chronic psychosis and 18 controls, using the Adult Attachment Interview. Diagnostic evaluations were performed with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (4th edition, Text Revision) Axis I disorders and symptomatic evaluation with the Brief Psychiatric Rating Scale. Results also show a high prevalence of insecure avoidant attachment in patients, and suggest that a significant part of religious coping might be explained by the theory of attachment (64% of the patients, 78% of controls). The implications of these results are interpreted in light of correspondence and compensation hypotheses.

Outcome of patients admitted with acute coronary syndrome on palliative treatment: insights from the nationwide AMIS Plus Registry 1997-2014.

OBJECTIVE: Compliance with guidelines is increasingly used to benchmark the quality of hospital care, however, very little is known on patients admitted with acute coronary syndromes (ACS) and treated palliatively. This study aimed to evaluate the baseline characteristics and outcomes of these patients. DESIGN: Prospective cohort study. SETTING: Eighty-two Swiss hospitals enrolled patients from 1997 to 2014. PARTICIPANTS: All patients with ACS enrolled in the AMIS Plus registry (n=45,091) were analysed according to three treatment groups: palliative treatment, defined as use of aspirin and analgesics only and no reperfusion; conservative treatment, defined as any treatment including antithrombotics or anticoagulants, heparins, P2Y12 inhibitors, GPIIb/IIIa but no pharmacological or mechanical reperfusion; and reperfusion treatment (thrombolysis and/or percutaneous coronary intervention during initial hospitalisation). The primary outcome measure was in-hospital mortality and the secondary measure was 1-year mortality. RESULTS: Of the patients, 1485 (3.3%) were palliatively treated, 11,119 (24.7%) were conservatively treated and 32,487 (72.0%) underwent reperfusion therapy. In 1997, 6% of all patients were treated palliatively and this continuously decreased to 2% in 2013. Baseline characteristics of palliative patients differed in comparison with conservatively treated and reperfusion patients in age, gender and comorbidities (all p<0.001). These patients had more in-hospital complications such as postadmission onset of cardiogenic shock (15.6% vs 5.2%; p<0.001), stroke (1.8% vs 0.8%; p=0.001) and a higher in-hospital mortality (25.8% vs 5.6%; p<0.001).The subgroup of patients followed 1 year after discharge (n=8316) had a higher rate of reinfarction (9.2% vs 3.4%; p=0.003) and mortality (14.0% vs 3.5%; p<0.001). CONCLUSIONS: Patients with ACS treated palliatively were older, sicker, with more heart failure at admission and very high in-hospital mortality. While refraining from more active therapy may often constitute the most humane and appropriate approach, we think it is important to also evaluate these patients and include them in registries and outcome evaluations. CLINICAL TRIAL NUMBER: ClinicalTrials.gov Identifier: NCT01 305 785.

Seurantatiedon hyödyntäminen ohjelma-arvioinnissa : esimerkkinä Euroopan sosiaalirahaston ohjelma-arvioinnit ja seurantajärjestelmä

Abstract: Application of monitoring information in program evaluation: experiences from European Social Fund monitoring and evaluations

Abstracts of the refereed articles

Riitta Hänninen : The Meaning of Freedom in Snowboarding Culture, Inka Juslin : Dance narration and the feminine mimesis in Ob-Ugrian women•s dances, Pirjo Kristiina Virtanen : Multidimensional tradition : distinctions of native youths and their indigenous traditions in Brazilian Amazonia, Tea Virtanen : Pastoralists in Mecca : the moral economy of Mbororo pilgrimage

How patient-centered do female physicians need to be? Analogue patients' satisfaction with male and female physicians' identical behaviors (Published online: 30 Aug 2014)

Previous research suggests that female physicians may not receive appropriate credit in patients' eyes for their patient-centered skills compared to their male counterparts. An experiment was conducted to determine whether a performance of higher (versus lower) verbal patient-centeredness would result in a greater difference in analogue patient satisfaction for male than female physicians. Two male and two female actors portrayed physicians speaking to a patient using high or low patient-centered scripts while not varying their nonverbal cues. One hundred ninety-two students served as analogue patients by assuming the patient role while watching one of the videos and rating their satisfaction and other evaluative responses to the physician. Greater verbal patient-centeredness had a stronger positive effect on satisfaction and evaluations for male than for female physicians. This pattern is consistent with the hypothesis that the different associations between patient-centeredness and patients' satisfaction for male versus female physicians occur because of the overlap between stereotypical female behavior and behaviors that comprise patient-centered medical care. If this is the case, high verbal patient-centered behavior by female physicians is not recognized as a marker of clinical competence, as it is for male physicians, but is rather seen as expected female behavior.

Clinical and course characteristics of depression and all-cause mortality: A prospective population-based study.

BACKGROUND: Given the large heterogeneity of depressive disorders (DD), studying depression characteristics according to clinical manifestations and course is a more promising approach than studying depression as a whole. The purpose of this study was to determine the association between clinical and course characteristics of DD and incident all-cause mortality. METHODS: CoLaus|PsyCoLaus is a prospective cohort study (mean follow-up duration=5.2 years) including 35-66 year-old randomly selected residents of an urban area in Switzerland. A total of 3668 subjects (mean age 50.9 years, 53.0% women) underwent physical and psychiatric baseline evaluations and had a known vital status at follow-up (98.8% of the baseline sample). Clinical (diagnostic severity, atypical features) and course characteristics (recency, recurrence, duration, onset) of DD according to the DSM-5 were elicited using a semi-structured interview. RESULTS: Compared to participants who had never experienced DD, participants with current but not remitted DD were more than three times as likely to die (Hazard Ratio: 3.2, 95% CI: 1.1-10.0) after adjustment for socio-demographic and lifestyle characteristics, comorbid anxiety disorders, antidepressant use, and cardiovascular risk factors and diseases. There was no evidence for associations between other depression characteristics and all-cause mortality. LIMITATIONS: The small proportion of deceased subjects impeded statistical analyses of cause-specific mortality. CONCLUSIONS: A current but not remitted DD is a strong predictor of all-cause mortality, independently of cardiovascular or lifestyle factors, which suggests that the effect of depression on mortality diminishes after remission and further emphasizes the need to adequately treat current depressive episodes.