Cannabis use in a Swiss male prison: qualitative study exploring detainees' and staffs' perspectives.

BACKGROUND: Several studies suggest a high prevalence of cannabis use before and during imprisonment, but subjective perspectives of detainees and staff towards its use in prison are lacking. This issue was explored in the framework of an observational study addressing tobacco use in three Swiss prisons in 2009 and 2010 that involved multiple strands (quantitative and qualitative components). This article presents qualitative data on cannabis use collected in one of the settings. METHODS: We used in-depth semi-structured interviews with both detainees and staff to explore their attitudes towards cannabis in one post-trial male Swiss prison. We performed specific coding and thematic analysis for cannabis with the support of ATLAS.ti, compared detainees' and staff's opinions, and considered the results with regard to drug policy in prison in general. RESULTS: 58 participants (31 male offenders, mean age 35 years, and 27 prison staff, mean age 46 years, 33% female) were interviewed. Detainees estimated the current use of cannabis use to be as high as 80%, and staff 50%. Participants showed similar opinions on effects of cannabis use that were described both at individual and institutional levels: analgesic, calming, self-help to go through the prison experience, relieve stress, facilitate sleep, prevent violence, and social pacifier. They also mentioned negative consequences of cannabis use (sleepiness, decreased perception of danger and social isolation), and dissatisfaction regarding the ongoing ambiguous situation where cannabis is forbidden but detection in the urine was not sanctioned. However, the introduction of a more restrictive regulation induced fear of violence, increased trafficking and a shift to other drug use. CONCLUSION: Although illegal, cannabis use is clearly involved in daily life in prison. A clearer and comprehensive policy addressing cannabis is needed, including appropriate measures tailored to individual users. To sustain a calm and safe environment in prison, means other than substance or medication use are required.

Family doctors' consultations with people suffering from chronic pain without objective findings: Which protective practices might they develop in these challenging medical encounters?

Introduction: Consultations with patients suffering from chronic pain without objective findings represent a challenge fo r family doctors (FDs). A mutual lack of understanding may arise, which threatens the doctor-patient relationship and may lead to dissatisfaction of both patient and doctor and to a breakdown of the therapeutic alliance. Objectives: This study aims to investigate FDs' potential protective practices to preserve the doctor-patient relationship during this type of consultation. Method: In the first step of this qualitative research, I carried out a range of 10 se- mi-structured interviews with FDs to explore their reported practices and repre- sentations during consultations with people suffering from chronic pain without objective findings. The interviews' transcripts were integrally analysed with computer-assisted thematic content analysis (QSR NVivo ® ) to highlight the main themes related to the topic in the participants' talk. Results: At this point of the research, two types of FDs' protective practices can be identified: first the use of complementary sources of knowledge in addition to the medical model to provide explanations to patients, second the collaboration with multidisciplinary teams or support gr oups that allow them to share profes- sional expertise and emotional experiences. Conclusion: The findings could be useful to develop ways to improve the follow- up of patients suffering from chronic pain without objective findings and conse- quently the FDs' work satisfaction.

Finding the right interactional temperature: do colder patients need more warmth in physician communication style?

Being aware of which communication style should be adopted when facing more difficult patients is important for physicians; it can help prevent patient reactions of dissatisfaction, mistrust, or non-adherence that can be detrimental to the process of care. Past research suggests that less agreeable patients are especially critical towards, and reactive to, their physician's communication style, compared to more agreeable patients. On the basis of the literature, we hypothesized that less agreeable patients would react more negatively than agreeable patients to lower levels of affiliativeness (i.e., warmth, friendliness) in the physicians, in terms of satisfaction with the physician, trust in the physician, and determination to adhere to the treatment. Thirty-six general practitioners (20 men/16 women) working in their own practice in Switzerland were filmed while interacting with 69 patients (36 men/33 women) of different ages (M = 50.7; SD = 18.19; range: 18-84) and presenting different medical problems (e.g., back pain, asthma, hypertension, diabetes). After the medical interview, patients filled in questionnaires measuring their satisfaction with the physician, their trust in the physician, their determination to adhere to the treatment, and their trait of agreeableness. Physician affiliativeness was coded on the basis of the video recordings. Physician gender and dominance, patient gender and age, as well as the gravity of the patient's medical condition were introduced as control variables in the analysis. Results confirmed our hypothesis for satisfaction and trust, but not for adherence; less agreeable patients reacted more negatively (in terms of satisfaction and trust) than agreeable patients to lower levels of affiliativeness in their physicians. This study suggests that physicians should be especially attentive to stay warm and friendly with people low in agreeableness because those patients' satisfaction and trust might be more easily lowered by a cold or distant physician communication style.

Information technologies and communication between parents and children

This is an exploratory study that aims, on the one hand, to examine in more detail how children between 12 and 16 years of age use different audiovisual technologies, what they feel and think when using them, and whom they like to speak to about such experiences. On the other hand, we look more deeply into the interactions between adults and children, particularly between parents and their children, in relation to these technologies when children use them at home or in other places. We analysed responses to questionnaires with several common items, administered separately to parents and children. Children’s responses reflect an important level of dissatisfaction when talking with different adults about media activities. Our findings support the thesis that more and more children socialise through new information and communication technologies with little or no recourse to adult criteria, giving rise to the emergence of specific children’s cultures. Crossing of the responses of parents and those of their own children shows us which aspects of media reality adults overestimate or underestimate in comparison to children, and to what degree certain judgements coincide and differ between generations. The results can be applied to the improvement of relations between adults and adolescents, taking advantage of adolescents’ strong motivation to engage in activities using audiovisual media

Association of candidate genes with phenotypic traits relevant to anorexia nervosa.

This analysis is a follow-up to an earlier investigation of 182 genes selected as likely candidate genetic variations conferring susceptibility to anorexia nervosa (AN). As those initial case-control results revealed no statistically significant differences in single nucleotide polymorphisms, herein, we investigate alternative phenotypes associated with AN. In 1762 females, using regression analyses, we examined the following: (i) lowest illness-related attained body mass index; (ii) age at menarche; (iii) drive for thinness; (iv) body dissatisfaction; (v) trait anxiety; (vi) concern over mistakes; and (vii) the anticipatory worry and pessimism versus uninhibited optimism subscale of the harm avoidance scale. After controlling for multiple comparisons, no statistically significant results emerged. Although results must be viewed in the context of limitations of statistical power, the approach illustrates a means of potentially identifying genetic variants conferring susceptibility to AN because less complex phenotypes associated with AN are more proximal to the genotype and may be influenced by fewer genes. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.

Aplicação da Teoria de Filas na Análise da Capacidade Operacional de um Sistema - Estudo Caso BCA Porto Novo

O presente trabalho tem como objectivo demonstrar a importância da teoria de filas de espera para avaliar a capacidade de atendimento da agência do Banco Comercial do Atlântico da Cidade do Porto Novo em Santo Antão. A procura de clientes que utilizam os serviços da agência é considerado grande, sendo comum entre esses clientes a insatisfação pelo tempo esperado na fila. O objectivo da teoria das filas de espera consiste em obter modelos adequados de situações que envolvem filas, de modo a prever o seu comportamento. Esse comportamento é expresso por diversas medidas de desempenho, designadamente, a taxa de chegada dos clientes e taxa de atendimento do sistema de fila. Com a realização deste estudo de caso foi possível identificar a capacidade de atendimento e simular e analisar o comportamento do sistema, quanto ao tempo de espera na fila e no sistema, tamanho da fila e do sistema. Para a resolução do problema foram então construídos dois cenários a fim de propor melhoria no sistema. The present task has as aim to show a study research based on the queue line to evaluate the capacity of service at the agency of Banco Comercial do Atlantico of Porto Novo City in Santo Antão. The search of the clients who use the agency services is considered enormous, and this clients have in common the dissatisfaction with the time that they wait in the queue line. The aim of the queue line theory is to acquire appropriate model of the situations in which thequeue lines are formed, in order to forsee its behaviour. This behaviour is expressed by diverse measures of performance, relatively the cllients’ comimg rates and the service rates found at the line system, and it was possible to identify the capacity of service and simulate and analise the system’s behaviour considering the time of waiting in the queue line and in the system, the queue line and system’s size To solve the problem were built 2 scenes so that to propose an improvement in the system.

Burnout and associated factors in employees of a Swiss teaching hospital

Background Working in a teaching hospital is a highly stressful occupation, which can lead to burnout. The consequences of burnout in health professionals can be very serious, both for themselves and patients. The aim of this cross-sectional study was to assess the extent of burnout and associated factors in hospital employees. Methods In the Fall of 2007, all employees of a Swiss teaching hospital were invited to complete a job satisfaction survey. It included the work-related burnout scale (scored 0-100) of the Copenhagen Burnout Inventory (CBI-French version), measuring the degree of physical and psychological fatigue and exhaustion perceived as related to the person's work; a high degree of burnout was defined as a score _50. Logistic regression analyses were used to determine factors associated with a high degree of burnout. Results A total of 4575 individuals returned the questionnaire (response rate 54%). Of them, 1503 (33%) had a high degree of burnout. The rate of burnout was higher among women (34.3% versus 30.5%, P = 0.012) and respondents younger than 40 years (37.7% versus 28.6%, P < 0.001). Executives were less prone to burnout than employees (27.1% versus 33.9%, P < 0.0019). Rates of burnout differed by profession: nurses and physicians had higher rates than administrative and logistic staff (42.8% and 37.4% versus 25.6% and 20.9%, respectively P < 0.001). Burnout was inversely associated with job satisfaction. In multivariate analysis, factors associated with burnout were overall dissatisfaction (OR 3.23; 95% CI 2.66-3.91), dissatisfaction with workload (OR 2.09; 95% CI 1.74-2.51) and work-life balance (OR 2.25; 95% CI 1.83-2.77), being a woman (OR 1.56; 95% CI 1.28-1.90), working fulltime (OR 1.41; 95% CI 1.08-1.85) and working as a nurse, a physician or in the psychosocial sector. Conclusions One-third of respondents, mostly nurses and physicians, experienced burnout and had lower levels of job satisfaction. The factors associated with burnout may help to tailor programmes aiming at reducing burnout at both the individual and organizational level within the hospital.

Family Health Strategy professionals' view on the effects of Hansen's disease training

OBJECTIVEEvaluating how professionals of family health teams from three municipalities of Pernambuco perceive and interpret the effects of Hansen's disease training.METHODSA qualitative study using the perspective of Habermas. Six focus groups, totaling 33 nurses and 22 doctors were formed. The guide consisted of: reactions to training, learning, transfer of knowledge and organizational results.RESULTSThere were recurrent positive opinions on instructor performance, course materials, and an alert attitude to the occurrence of cases; the negative points were about lack of practical teaching, a lot of information in a short period of time and little emphasis on basic content. Low perceived self-efficacy and low locus of control, ambiguity, conflict of skills and the lack of support for the learning application. Nurses showed greater dissatisfaction with the organizational support.CONCLUSIONThe low effectiveness of training reveals the need to negotiate structured training from work problematization, considering performance conditions.

Entre a Terra e o Mar - Grau de Satisfação dos Cruzeiristas na Ilha de São Vicente

Este trabalho apresenta os resultados de um estudo realizado em São Vicente, de Março a Abril de 2012 a turistas de cruzeiro. Este estudo teve como objectivo analisar o perfile a satisfação dos visitantes durante a sua estadia na ilha, para ajudar a indústria do turismo na melhoria do produto e infra-estrutura turística, e ao fazê-lo melhorar aexperiência para os cruzeiristas. O estudo foi conduzido através da revisão da literaturasobre turismo de cruzeiro, imagem do destino, elementos da oferta turística, qualidade esatisfação e sua relação com o turismo. Para a avaliação do perfil e satisfação do turistade cruzeiro, aplicou-se um questionário a uma amostra de 131 cruzeiristas, no fim dasua visita à ilha. Os resultados do questionário aplicado aos cruzeiristas evidenciaram maior satisfação com aspectos como paisagem natural, clima, simpatia da população local, oportunidadepara conhecer pessoas e limpeza urbana. Os atributos que demonstraram valores maisaltos de insatisfação são: museus, sanitários, gastronomia, sinalização, serviços derestauração e de informação turística. O perfil do cruzeirista é caracterizado pela disponibilidade em viajar, nível académico eprofissional médio alto, poder de compra médio alto e de média idade. Verificou-se que os vários sectores não estão bem organizados e integrados entre si paraatender às necessidades e desejos dos visitantes. Assim, recomenda-se uma série deactividades, tendo em vista, minimizar os aspectos negativos identificados peloscruzeiristas e integrar a oferta turística entre os vários elementos que a compõem. This research is based on the results acquired from tourists who traveled to the island of Sao Vicente on cruise ships during the months of March and April of 2012. The object of this study was to analyze the characteristics and level of satisfaction of those visiting the island of Sao Vicente, in order to help improve the tourism industry, and its infrastructure in hopes of bettering the overall experience for cruise tourists. The study emerged from a profound revision of cruise ship literature, now detailing destination images, available touristic elements, as well as quality and satisfaction ratings in relationship to tourism. In order to measure the satisfaction of the tourists we implemented a questionnaire where a sample of 131 people was surveyed at the end of their visit to the island. The questionnaire resulted in evidence detailing higher satisfaction regarding natural landscape, climate, local acceptance, ability to meet others and urban cleanliness. However, elements such as museums, sanitation, gastronomy, signage, restaurant services and travel information demonstrated higher levels of dissatisfaction. Cruise tourists are characterized as middle aged, frequent travelers with high academic and professional levels, and by their ability to consume heavily. This study verifies that various elements within the tourism sector are not well organized to satisfy the necessities and desires of cruise tourists. Therefore, an implementation of more activities is recommended for those visiting the island of Sao Vicente on cruise ships. While considering the need to minimize the negative aspects identified by the surveyed cruise tourists it is also important to integrate the offered tourist attractions within the various elements that embody tourism.

Donor-site morbidity of the sensate extended lateral arm flap.

The free extended lateral arm flap (ELAF) has gained increasing popularity thank to its slimness and versatility, longer neurovascular pedicle, and greater flap size when compared with the original flap design. The aim of this study was to assess the donor-site morbidity associated with this extended procedure. A retrospective study of 25 consecutive patients analyzing postoperative complications using a visual analogue scale questionnaire revealed high patients satisfaction and negligible donor-site morbidity of the ELAF. Scar visibility was the commonest negative outcome. Impaired mobility of the elbow had the highest correlation with patient dissatisfaction. Sensory deficits or paresthetic disorders did not affect patient satisfaction. The extension of the lateral arm flap and positioning over the lateral humeral epicondyle is a safe and well-accepted procedure with minimal donor-site morbidity. To optimize outcomes, a maximal flap width of 6 or 7 cm and intensive postoperative mobilization therapy is advisable.

Wet-Reflective Pavement Marking Demonstration Project, November 2011

One of the leading complaints from drivers is the inability to see pavement markings under wet night conditions. This issue is a major source of dissatisfaction in state department of transportation (DOT) customer satisfaction surveys. Driving under wet night conditions is stressful and fatiguing for all drivers, but particularly so for the more vulnerable young and older driver age groups. This project focused on the development of a two-year, long-line test deck to allow for the evaluation and demonstration of a variety of wet-reflective pavement marking materials and treatments under wet night conditions. Having the opportunity to document the performance of these various products and treatments will assist the Iowa DOT and local agencies in determining when and where the use of these products might be most effective. Performance parameters included durability, presence, retroreflectivity, and wet night visibility. The test sections were located within Story County so that Iowa DOT management and staff, as well as local agencies, could drive these areas and provide input on the products and treatments.

Evaluation de la satisfaction des infirmiers(-ères): développement et validation d'un nouvel outil d'analyse [Evaluation of satisfaction of nurses: development and validation of a new analysis tool]

A new device for the analyses of nurses' satisfaction has been developed and validated on two types of general and intensive treatments at the University Hospital in Vaudois, Switzerland. A questionnaire has been elaborated for identifying the variables linked with characteristics of the nurse's work, as well as personal variables of the employer which could have an influence on the level of satisfaction. In identifying the sources of satisfaction and dissatisfaction, it has been possible to propose recommendations and corrective measures in order to improve the level of global satisfaction of the nursing team.

Iowa Motorcycle Ride Meter, HR-1019, 1980

The Iowa Department of Transportation (Iowa DOT) through the Highway Division is responsible for the design, construction and maintenance of roadways that will provide a high level of serviceability to the motorist. First, the motorist expects to be able to get where he wants to go, but now he also demands a minimum level of comfort. In the construction of new roadways, the public is quick to express dissatisfaction with rough pavements. The Highway Division of the Iowa DOT (formerly Iowa State Highway Commission) has a specification which requires a "smooth-riding surface". For over 40 years, new portland cement concrete (pcc) pavement has been checked with a 10-foot rolling straightedge. The contractor is required to grind, saw or mill off all high spots that deviate more than 1/8" from the 10-foot straight line. Unfortunately, there are instances where a roadway that will meet the above criteria does not provide a "smooth-riding surface". The roadway may have monger undulations (swales) that result in an undesirable ride. The objective of this project was to develop a repeatable, reliable time stable, lightweight test unit to measure the riding quality of pcc pavement at normal highway speed the day after construction.

Spatial behavior in groups: an agent-based approach

We present an agent-based model with the aim of studying how macro-level dynamics of spatial distances among interacting individuals in a closed space emerge from micro-level dyadic and local interactions. Our agents moved on a lattice (referred to as a room) using a model implemented in a computer program called P-Space in order to minimize their dissatisfaction, defined as a function of the discrepancy between the real distance and the ideal, or desired, distance between agents. Ideal distances evolved in accordance with the agent's personal and social space, which changed throughout the dynamics of the interactions among the agents. In the first set of simulations we studied the effects of the parameters of the function that generated ideal distances, and in a second set we explored how group macrolevel behavior depended on model parameters and other variables. We learned that certain parameter values yielded consistent patterns in the agents' personal and social spaces, which in turn led to avoidance and approaching behaviors in the agents. We also found that the spatial behavior of the group of agents as a whole was influenced by the values of the model parameters, as well as by other variables such as the number of agents. Our work demonstrates that the bottom-up approach is a useful way of explaining macro-level spatial behavior. The proposed model is also shown to be a powerful tool for simulating the spatial behavior of groups of interacting individuals.

Patient expectations at a multicultural out-patient clinic in Switzerland.

BACKGROUND: Recognizing patient expectation is considered as an important objective for primary care physicians. A number of studies suggest that failure to identify patient expectations can lead to patient dissatisfaction with care, lack of compliance and inappropriate use of medical resources. It has been suggested that identifying patient expectations in multicultural contexts can be especially challenging. OBJECTIVES: The aim of the study was to compare health care expectations of Swiss and immigrant patients attending the out-patient clinic of a Swiss university hospital and to assess physicians' ability to identify their patients' expectations. METHODS: Over a 3-month period, all patients attending the out-patient clinic at a Swiss university hospital were requested to complete pre-consultation surveys. Their physicians were requested to complete post-consultation surveys. Outcome measures were patients' self-rated health, resort to prior home treatment, patients' expectations of the consultation, physicians' perception of their patients' expectations and agreement between patients and physicians. RESULTS: We analysed 343 questionnaires completed by patients prior to their consultation (> 50% immigrants) and 333 questionnaires completed by their physicians after the consultation. Most expectations were shared by all patients. Physicians had inaccurate perceptions of their patients' expectations, regardless of patients' origin. CONCLUSIONS: Our study found no evidence that immigrant patients' expectations differed from those of Swiss patients, nor that physicians had more difficulty identifying expectations of immigrant patients. However, physicians in our study were generally poor at identifying patients' expectations, and therefore inter-group differences may be difficult to detect. Our results point to the need to strengthen physicians' general communication skills which should then serve as a foundation for more specific, cross-cultural communication training.