Stress, coping and personal strengths and difficulties in internationally adopted children in spain

This study analyses the types of coping strategies used by internationally adopted children, and explores the relation between these strategies and personal strengths and difficulties. The Kidcope checklist (Spirito, Stark, & Williams, 1998) and the Strengths and Difficulties Questionnaire (SDQ; Goodman, 1997) were administered to a sample of 35 Spanish adoptees (25.7% boys and 74.3% girls, aged 8-12 years) and their parents. Self-reported problems were categorised and their relation with coping strategies and psychological adjustment was explored. Results indicated that adopted children report problems of interpersonal nature. The content of the problems mainly refers to relationships and health, illness, or accidents. Parents reported that children were generally well-adjusted and they had no problems outside the normal range. International adoptees used mainly control-oriented coping strategies. Escape-oriented coping was linked to parents' ratings of total difficulties, with self-criticism accounting for the highest percentage of the variance.

Valoración de las necesidades formativas de los profesionales de enfermería frente a los usuarios inmigrantes de culturas ajenas a la propia: estudio sobre las barreras de comunicación dentro del ámbito de atención primaria

Este trabajo tiene como finalidad identificar que áreas temáticas en relación a la salud, y en el caso de que existan, necesitan cubrir los profesionales de enfermería, teniendo en cuenta los factores asociados a la diversidad cultural, para que sea de eficaz y eficiente la atención a usuarios de otras culturas en sus consultas. Dentro de los objetivos específicos, se plantea en primer lugar, determinar las áreas temáticas de mayor importancia que deberán estar presentes en un programa de intervención de diversidad cultural para mejorar la calidad en la asistencia a usuarios de otras culturas desde la atención de enfermería. Por otro lado se propondrán estrategias de intervención para mejorar la comunicación entre los profesionales de la salud y la población inmigrante de habla no hispana. Dentro del ámbito de investigación cualitativa este proyecto se definirá mediante el paradigma construccionista interpretativo. Los participantes en el estudio serán profesionales de enfermería del CAP Vic Sud y CAP Vic Nord (Osona) con más de 6 años de experiencia en atención primaria y con un cupo de población asignada un mínimo de un 15% de usuarios de procedencia extranjera de una cultura ajena. Para acceder a la información se llevará a cabo la entrevista semiestructurada realizada de forma individual a cada profesional de enfermería, y la observación participante que se llevará a cabo en el centro y las consultas. Para el análisis de esta información previamente recogida mediante una guía de categorías de análisis, de la que se obtendrá una descripción general que capta la opinión de los participantes y de las áreas a traba

Challenges to patient-centred care in a general internal medicine context: findings from an exploratory study

Introduction. If we are to promote more patient-centred approaches in care delivery, we have to better characterize the situations in which being patient-centred is difficult to achieve. Data from professionals in health and social care are important because they are the people charged with operationalizing patient-centred care (PCC) in their daily practice. However, empirical accounts from frontline care providers are still lacking, and it is important to gather experiences not only from doctors but also from the other care providers. Indeed, experiences from different professions can help inform our understanding of patient care, which is expected to be both patient-centred and collaborative. Methods. This study was based on the following research question: What factors make the provision of PCC difficult to achieve? Sample and setting. A purposeful sampling technique was used, allowing for a series of choices about the participants and their professional affiliation. Because patient-centredness is the focus, 3 professions appeared to be of special interest: general internists, nurses and social workers. The study was undertaken in the General Internal Medicine Division of a teaching hospital located in a North American context. Data Collection. To answer the research question, a methodological approach based on a theory called phenomenology was chosen. Accordingly, semi-structured interviews were used since they generate understanding of the meanings different individuals have of their lived world. Interviews with 8 physicians, 10 nurses and 10 social workers were eventually conducted. Data analysis. An inductive thematic analysis was employed to make sense of the interview data. Results. The thematic analysis allowed identifying various types of challenges to PCC. Although most of the challenges were perceived by all three groups of professionals, they were perceived to a different degree across the professions, which likely reflected the scope of practice of each profession. The challenges and their distribution across the professions are illustrated in Table 1. Examples of challenges are provided in Table 2. Discussion. There is a tension between what is supposed to be done - what stands in the philosophy of patient -centredness - and what is currently done - the real life with all the challenges to PCC. According to some participants' accounts, PCC clearly risks becoming a mere illusion for health care professionals on which too great pressures are imposed.

Simulated Patient as Co-facilitators: Benefits and Challenges of the Interprofessional Team OSCE (Submission #9350).

Hypothesis: The quality of care for chronic patients depends on the collaborative skills of the healthcare providers.1,2 The literature lacks reports of the use of simulation to teach collaborative skills in non-acute care settings. We posit that simulation offers benefits for supporting the development of collaborative practice in non-acute settings. We explored the benefits and challenges of using an Interprofessional Team - Objective Structured Clinical Examination (IT-OSCE) as a formative assessment tool. IT-OSCE is an intervention which involves an interprofessional team of trainees interacting with a simulated patient (SP) enabling them to practice collaborative skills in non-acute care settings.5 A simulated patient are people trained to portray patients in a simulated scenario for educational purposes.6,7 Since interprofessional education (IPE) ultimately aims to provide collaborative patient-centered care.8,9 We sought to promote patient-centeredness in the learning process. Methods: The IT-OSCE was conducted with four trios of students from different professions. The debriefing was co-facilitated by the SP with a faculty. The participants were final-year students in nursing, physiotherapy and medicine. Our research question focused on the introduction of co-facilitated (SP and faculty) debriefing after an IT-OSCE: 1) What are the benefits and challenges of involving the SP during the debriefing? and 2) To evaluate the IT-OSCE, an exploratory case study was used to provide fine grained data 10, 11. Three focus groups were conducted - two with students (n=6; n=5), one with SPs (n=3) and one with faculty (n=4). Audiotapes were transcribed for thematic analysis performed by three researchers, who found a consensus on the final set of themes. Results: The thematic analysis showed little differentiation between SPs, student and faculty perspectives. The analysis of transcripts revealed more particularly, that the SP's co-facilitation during the debriefing of an IT-OSCE proved to be feasible. It was appreciated by all the participants and appeared to value and to promote patient-centeredness in the learning process. The main challenge consisted in SPs feedback, more particularly in how they could report accurate observations to a students' group rather than individual students. Conclusion: In conclusion, SP methodology using an IT-OSCE seems to be a useful and promising way to train collaborative skills, aligning IPE, simulation-based team training in a non-acute care setting and patient-centeredness. We acknowledge the limitations of the study, especially the small sample and consider the exploration of SP-based IPE in non-acute care settings as strength. Future studies could consider the preparation of SPs and faculty as co-facilitators. References: 1. Borrill CS, Carletta J, Carter AJ, et al. The effectiveness of health care teams in the National Health Service. Aston centre for Health Service Organisational Research. 2001. 2. Reeves S, Lewin S, Espin S, Zwarenstein M. Interprofessional teamwork for health and social care. Oxford: Wiley-Blackwell; 2010. 3. Issenberg S, McGaghie WC, Petrusa ER, Gordon DL, Scalese RJ. Features and uses of high-fidelity medical simulations that lead to effective learning - a BEME systematic review. Medical Teacher. 2005;27(1):10-28. 4. McGaghie W, Petrusa ER, Gordon DL, Scalese RJ. A critical review of simulation-based medical education research: 2003-2009. Medical Education. 2010;44(1):50-63. 5. Simmons B, Egan-Lee E, Wagner SJ, Esdaile M, Baker L, Reeves S. Assessment of interprofessional learning: the design of an interprofessional objective structured clinical examination (iOSCE) approach. Journal of Interprofessional Care. 2011;25(1):73-74. 6. Nestel D, Layat Burn C, Pritchard SA, Glastonbury R, Tabak D. The use of simulated patients in medical education: Guide Supplement 42.1 - Viewpoint. Medical teacher. 2011;33(12):1027-1029. Disclosures: None (C) 2014 by Lippincott Williams & Wilkins, Inc.

Una Lliçó d'història de la llengua literària: El pròleg a l'Atheneo de Grandesa, de Josep Romaguera

Text de la lliçó que Francesc Feliu va pronunciar en les seves oposicions. S’estudia el pròleg de l’Atheneo de Grandesa. S'hi pretén establir la lectura correcta i exhaustiva d'un text difícil, que ha estat prou conegut i citat pels estudiosos de la llengua i la literatura catalanes del Setcents, però que gairebé sempre ha estat també mal entès, o entès de manera incompleta

Transgression et initiation : tendances idéologiques et développement littéraire du récit de Genèse 2-3

Several questions about the story of Gen 2-3 remain unresolved in current scholarship. For instance, the implications and manifold consequences of the transgression act - the consumption of the forbidden fruit - are much debated. Interpreters generally agree that the story is connected to several "J" / "non-P" narratives of the primeval history. Besides the use of the tetragrammaton as the designation for God, a common characteristic of these stories is the strong opposition between Yhwh as a harsh deity on one hand and disobedient and transgressing humankind on the other. This paper reconsiders several open questions as well as the aforementioned consensus. The analysis of important motifs in Gen 2-3 leads to the conclusion that this story differs in theologically important ways from the postulated "J"-narrative in Genesis. This indicates that it was not composed as an integral part of that narrative. There are, in Gen 2-3, ideological features and linguistic elements typical of the "J" stratum, but they are all found in the sections that present Yhwh God's investigation and punishment of the couple (3,8-19.24). Since these verses are in tension with or even contradict their immediate context, it should be assigned to a redactional ("J") layer. According to this analysis, the transgression in Gen 2-3 should not be considered a sin. Rather, it is an important step in human evolution towards a self-conscious and autonomous being. The plot has a structure similar to some episodes in ancient Near Eastern myths. 'Initiation' functions as a central theme. Finally, the article discusses the literary milieu of the story. Because of several linguistic and thematic similarities with Gen 1, with P-texts in general, and with the book of Ezekiel, the relationship of Gen 2-3 to these literary entities needs to be reconsidered.

The learning about imaging diagnosis technology

Objective To investigate the learning about management of the technology (efficient use, acquisition and maintenance of imaging diagnosis equipment) in the radiology residency program of Escola Paulista de Medicina - Universidade Federal de São Paulo, with a view to improving the education of radiologists. Materials and Methods Exploratory research where residents, faculty staff and tutors of the program were quantitative and qualitatively approached with Likert scale questionnaires (46), and deepening with recorded interviews (18) and categorization based upon meaning units (thematic analysis). Results Among the participants, 66% agreed that they had the opportunity of learning about the use of radiological equipment; for 61% the program should include knowledge on the importance of acquiring equipment; and 72% emphasized the lack of learning about equipment management and maintenance. Conclusion As the major moment in the education of specialists, the medical residency program provides residents with a favorable environment to the learning of the skills required to the future of their professional practice, but with limited emphasis on the management of the technology: efficient use, acquisition and mainly maintenance of equipment, still poorly explored. Both the investigated program and the medical residency in radiology should incorporate, whenever possible, the commitment with the training in supplementary skills related to equipment management, developing the competence of the future radiologists.

Learning on human resources management in the radiology residency program

Objective To investigate the process of learning on human resource management in the radiology residency program at Escola Paulista de Medicina – Universidade Federal de São Paulo, aiming at improving radiologists' education. Materials and Methods Exploratory study with a quantitative and qualitative approach developed with the faculty staff, preceptors and residents of the program, utilizing a Likert questionnaire (46), taped interviews (18), and categorization based on thematic analysis. Results According to 71% of the participants, residents have clarity about their role in the development of their activities, and 48% said that residents have no opportunity to learn how to manage their work in a multidisciplinary team. Conclusion Isolation at medical records room, little interactivity between sectors with diversified and fixed activities, absence of a previous culture and lack of a training program on human resources management may interfere in the development of skills for the residents' practice. There is a need to review objectives of the medical residency in the field of radiology, incorporating, whenever possible, the commitment to the training of skills related to human resources management thus widening the scope of abilities of the future radiologists.

El vigatanisme crític de Maria Àngels Anglada

Maria Àngels Anglada tenia una clara consciència del lloc, que va deixar una empremta profunda en la seva obra literària. L’article analitza les visions que l’autora dóna de Vic, la ciutat natal, a través de la poesia, la narrativa i la prosa assagística. En particular, l’anàlisi se centra en el relat de fons autobiogràfic No em dic Laura. Aquest text vehicula una dura crítica política, social i moral del Vic sotmès a la dictadura franquista. I, alhora, constitueix la millor mostra del vigatanisme crític que caracteritza l’autora.

A qualitative study of adolescents with medically unexplained symptoms and their parents

Il est fréquent en médecine de premier recours de rencontrer des adolescents exprimant des symptômes somatiques pour lesquels aucune des investigations entreprises n'a permis de rendre compte d'une pathologie organique. De tels symptômes sont retrouvés dans la littérature sous la terminologie de symptômes médicalement inexpliqués (MUS) ou des troubles fonctionnels. Bien que la prévalence des adolescents souffrant de MUS est fréquente, les médecins éprouvent encore beaucoup de difficultés à prendre en charge et communiquer avec ces patients, principalement en raison d'une incompréhension de leurs besoins et préoccupations tant dans leur vie quotidienne que lors d'une consultation au cabinet. Le but de notre étude est de comprendre les expériences et vécus des adolescents avec des MUS ainsi que de leurs parents afin d'aider le praticien dans la compréhension de son patient dans sa globalité et ainsi d'améliorer sa prise en charge. Dans le premier article présenté, nous nous sommes intéressés à la vie quotidienne de ces adolescents en étudiant leurs relations avec leur famille et leur entourage ainsi que les répercussions sur leurs parcours scolaire et leurs activités extrascolaires. Dans le second article nous nous sommes penchés sur les relations qu'entretiennent ces adolescents et leurs parents avec le système de santé. Nous avons collecté des données qualitatives en moyennant des groupes focus incluant 16 adolescents atteints de troubles fonctionnels et leurs parents. L'analyse a permis de faire émerger les difficultés que ces jeunes et leurs familles vivent au quotidien et comment ils sont confrontés à la solitude dû principalement à l'incompréhension sociale. Les résultats mettent aussi en évidence l'insatisfaction de ces jeunes et de leurs parents par rapport à la prise en charge médical, notamment en raison d'un manque de communication. -- Medically unexplained symptoms (MUS) are common among adolescents and are frequently encountered in primary care. Our aim was to explore how these adolescents and their parents experience the condition and its impact on their daily lives and to provide recommendations for health professionals. Using a qualitative approach, six focus groups and two individual interviews were conducted. These involved a total of ten adolescents with different types of MUS and sixteen parents. The respondents were recruited in a university hospital in Switzerland. A thematic analysis was conducted according to the Grounded Theory. The analysis of the data highlighted four core themes: disbelief, being different, concealing symptoms, and priority to adolescent's health. Transcending these themes was a core issue regarding the discrepancy between the strategies that adolescents and their parents use to cope with the symptoms. Health professionals should be made aware of the emotional needs of these patients and their families.

O impacto do PADCT na química e engenharia química

Among all activities related to the management of science and technology in Brazil, program monitoring and evaluation is certainly one of the less developed and most needed. There are no universal methodologies that can be applied. In essence programs can be evaluated by relating their achievements to pre-established goals. A second strategy is to compare programs similar in nature, utilizing as reference common indicators. Finally programs can be evaluated by their socio-economic impact comparing investments to outcomes. All strategies mentioned require appropriate program design monitoring and expert independent evaluation. In Brazil as in many other countries including developed ones this activity is complicated by the fact that programs vary widely in their scope and goals. In Brazil program designs often do not specify clearly their purposes and output indicators, many are not monitored properly which makes evaluation difficult. Consequently science and technology programs are difficult to be compared to each other, and even evaluated on the basis of pre-established goals. In PADCT monitoring and evaluation proved to be the most challenging activities. Two lessons however were learnt. One is that the process of monitoring and evaluation has to be continuously exposed to criticism to be perfected; and the second is that the evaluation process must not be exhausted shortly after investments since translation of scientific knowledge into industrial applications may prove to be a lengthy process. In this exercise we certainly do not pretend to evaluate the QEQ subprogram but to organize some of the information produced by different sources related to this subject, including the PADCT administration. We use somewhat each strategy described: compare the outputs of the QEQ to predetermined proposed goals (particularly in PADCT II), compare the QEQ to other PADCT subprograms, and specify some outputs in terms of technological and industrial applications. Finally, we utilize this opportunity to discuss science and technology M&E in general and the complexity of developing this area in Brazil.

A formulação ab-initio da segunda lei da termodinâmica

This paper deals with Carathédory's formulation of the second law of thermodynamics. The material is presented in a didatical way, which allows a second year undergraduate student to follow the formalism. An application is made to an ideal gas with two independent variables. A criticism to Carnot formulation of the second law and an investigation of the historical origins of the Carathéodory formalism are also presented.

A la búsqueda del yo: Montaigne y Azorín

Sobre el 'gènere del Jo' en la literatura espanyola de finals del XIX i inicis del XX, concretament sobre l'obra de Montaigne i Azorín

Les Sentències catòliques del diví poeta Dant (1545) d’en Jaume Ferrer de Blanes: edició crítica del text

Procurador reial i nobiliari, cosmògraf, joier, lapidari, mercader i escriptor, i al capdavall, un ciutadà català honrat, en Ferrer (Vidreres, ~1445 – Blanes, 1529) va marxar de ben jove, primer, a la cort de Nàpols, al servei del rei en Ferran I, i després a la cort de Sicília, al servei de la reina na Joana de Sicília. Acabada aquesta peripècia italiana va tornar a Blanes al servei del vescomte de Cabrera i de Bas fins que va morir a la mateixa vila al 1529. Un seu criat, disset anys més tard, va editar uns papers esparsos que havia trobat a can Ferrer, les (sic) Sentèncias cathòlicas del diví poeta Dant florentí, compilades per lo prudentíssim mossèn Jaume Ferrer de Blanes, incloent-hi tres parts. La primera, Conclusions, és un sumari destinat a mostrar (sic) «Entre totas las cosas necessàries a l’home per aconseguir lo seu fi y beatitut eterna principalment són tres»; la segona, Meditació, és una reflexió a fi d’il•luminar els misteris sobre la passió i mort de Jesucrist a (sic) «lo santíssim loch de Calvari»; la tercera, Letras, és un conjunt de dotze documents, entre cartes i d’altres textos, «fetas a mossèn Jaume Ferrer, respostes e regles per ell ordenades en cosmographia y en art de navegar». En Ferrer, home de grans recursos, fa un recorregut per tots els coneixements que havia acumulat al llarg de la seva vida, de Dant Alighieri a Ptolemeu i del marquès de Santillana a Albert Gran o a Aristòtil, fent servir fragments de la Commedia, dels Proverbios, de la Bíblia i de moltes altres autoritats científiques i filosòfiques, en català, italià, espanyol, llatí i, també, set mots en arameu