Self-management of coronary heart disease in angina patients after percutaneous coronary intervention: A mixed methods study.

After having elective percutaneous coronary intervention (PCI) patients are expected to self-manage their coronary heart disease (CHD) by modifying their risk factors, adhering to medication and effectively managing any recurring angina symptoms but that may be ineffective. Objective: Explore how patients self-manage their coronary heart disease (CHD) after elective PCI and identify any factors that may infl uence that. Design and method: This mixed methods study recruited a convenience sample of patients (n=93) approximately three months after elective PCI. Quantitative data were collected using a survey and were subject to univariate, bivariate and multi-variate analysis. Qualitative data from participant interviews was analysed using thematic analysis. Findings: After PCI, 74% of participants managed their angina symptoms inappropriately. Younger participants and those with threatening perceptions of their CHD were more likely to know how to effectively manage their angina symptoms. Few patients adopted a healthier lifestyle after PCI. Qualitative analysis revealed that intentional non-adherence to some medicines was an issue. Some participants felt unsupported by healthcare providers and social networks in relation to their self-management. Participants reported strong emotional responses to CHD and this had a detrimental effect on their self-management. Few patients accessed cardiac rehabilitation.

Solidarity, the network and the history of workers' self-management from the Gdańsk Agreement to shock therapy

This PhD thesis is an empirical research project in the field of modern Polish history. The thesis focuses on Solidarity, the Network and the idea of workers’ self-management. In addition, the thesis is based on an in-depth analysis of Solidarity archival material. The Solidarity trade union was born in August 1980 after talks between the communist government and strike leaders at the Gdansk Lenin Shipyards. In 1981 a group called the Network rose up, due to cooperation between Poland’s great industrial factory plants. The Network grew out of Solidarity; it was made up of Solidarity activists, and the group acted as an economic partner to the union. The Network was the base of a grass-roots, nationwide workers’ self-management movement. Solidarity and the self-management movement were crushed by the imposition of Martial Law in December 1981. Solidarity revived itself immediately, and the union created an underground society. The Network also revived in the underground, and it continued to promote self-management activity where this was possible. When Solidarity regained its legal status in April 1989, workers’ self-management no longer had the same importance in the union. Solidarity’s new politico-economic strategy focused on free markets, foreign investment and privatization. This research project ends in July 1990, when the new Solidarity-backed government enacted a privatization law. The government decided to transform the property ownership structure through a centralized privatization process, which was a blow for supporters of workers’ self-management. This PhD thesis provides new insight into the evolution of the Solidarity union from 1980-1990 by analyzing the fate of workers’ self-management. This project also examines the role of the Network throughout the 1980s. There is analysis of the important link between workers’ self-management and the core ideas of Solidarity. In addition, the link between political and economic reform is an important theme in this research project. The Network was aware that authentic workers’ self-management required reforms to the authoritarian political system. Workers’ self-management competed against other politico-economic ideas during the 1980s in Poland. The outcome of this competition between different reform concepts has shaped modern-day Polish politics, economics and society.

Towards a Workflow Management Approach for Health Monitoring of Bridges

Part 14: Interoperability and Integration

The Impact of Education and Socioeconomic and Occupational Conditions on Self-Perceived and Mental Health Inequalities Among Immigrants and Native Workers in Spain

There is limited evidence on the influence of social determinants on the self-perceived and mental health of immigrants settled at least 8 years in Spain. The aim of this study was to examine differences between workers related to migrant-status, self-perceived and mental health, and to assess their relationship to occupational conditions, educational level and occupational social class, stratified by sex. Using data from the Spanish National Health Survey of 2011/12, we computed prevalence, odds ratios and explicative fractions. Mental (OR 2.02; CI 1.39–2.93) and self-perceived health (OR 2.64; CI 1.77–3.93) were poorer for immigrant women compared to natives. Occupational social class variable contributes 25 % to self-perceived health OR in immigrant women. Settled immigrant women workers are a vulnerable group in Spain.

Secure and Privacy-aware Data Collection and Processing in Mobile Health Systems

Healthcare systems have assimilated information and communication technologies in order to improve the quality of healthcare and patient's experience at reduced costs. The increasing digitalization of people's health information raises however new threats regarding information security and privacy. Accidental or deliberate data breaches of health data may lead to societal pressures, embarrassment and discrimination. Information security and privacy are paramount to achieve high quality healthcare services, and further, to not harm individuals when providing care. With that in mind, we give special attention to the category of Mobile Health (mHealth) systems. That is, the use of mobile devices (e.g., mobile phones, sensors, PDAs) to support medical and public health. Such systems, have been particularly successful in developing countries, taking advantage of the flourishing mobile market and the need to expand the coverage of primary healthcare programs. Many mHealth initiatives, however, fail to address security and privacy issues. This, coupled with the lack of specific legislation for privacy and data protection in these countries, increases the risk of harm to individuals. The overall objective of this thesis is to enhance knowledge regarding the design of security and privacy technologies for mHealth systems. In particular, we deal with mHealth Data Collection Systems (MDCSs), which consists of mobile devices for collecting and reporting health-related data, replacing paper-based approaches for health surveys and surveillance. This thesis consists of publications contributing to mHealth security and privacy in various ways: with a comprehensive literature review about mHealth in Brazil; with the design of a security framework for MDCSs (SecourHealth); with the design of a MDCS (GeoHealth); with the design of Privacy Impact Assessment template for MDCSs; and with the study of ontology-based obfuscation and anonymisation functions for health data.

Comparing children's self-report instruments for health-related quality of life using the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY)

Children with chronic conditions often experience a long treatment which can be complex and negatively impacts the child's well-being. In planning treatment and interventions for children with chronic conditions, it is important to measure health-related quality of life (HrQoL). HrQoL instruments are considered to be a patient-reported outcome measure (PROM) and should be used in routine practice. Purpose: The aim of this study was to compare the content dimensions of HrQoL instruments for children's self-reports using the framework of ICF-CY. Method: The sample consist of six instruments for health-related quality of life for children 5 to 18 years of age, which was used in the Swedish national quality registries for children and adolescents with chronic conditions. The following instruments were included: CHQ-CF, DCGM-37, EQ-5D-Y, KIDSCREEN-52, Kid-KINDL and PedsQL 4.0. The framework of the ICF-CY was used as the basis for the comparison. Results: There were 290 meaningful concepts identified and linked to 88 categories in the classification ICF-CY with 29 categories of the component body functions, 48 categories of the component activities and participation and 11 categories of the component environmental factors. No concept were linked to the component body structures. The comparison revealed that the items in the HrQoL instruments corresponded primarily with the domains of activities and less with environmental factors. Conclusions: In conclusion, the results confirm that ICF-CY provide a good framework for content comparisons that evaluate similarities and differences to ICF-CY categories. The results of this study revealed the need for greater consensus of content across different HrQoL instruments. To obtain a detailed description of children's HrQoL, DCGM-37 and KIDSCREEN-52 may be appropriate instruments to use that can increase the understanding of young patients' needs.

Psychological characterization of hypertensive patients: associations with adherence to pharmacological treatment and self-management

Introduction: The role of psychosocial factors in the onset and progression of essential hypertension has been object of a large body of literature, yet findings appear to be controversial. Aims: We assessed the predictive role of psychosomatic syndromes, affective symptomatology, psychological reactance, psychological distress, well-being and quality of life on adherence to antihypertensive medications, lifestyle behaviors, hypertension severity and absolute cardiovascular risk grading, as well as their temporal stability at 1-year follow-up, in a sample of hypertensive patients. In addition, we aimed to validate the Italian version of the Hong Psychological Reactance Scale (HPRS). Methods: Eighty consecutive hypertensive outpatients treated with antihypertensive medications were compared to 80 controls. Psychosocial variables were assessed using clinical interviews and self-rating questionnaires at baseline and at 1-year follow-up. Cardiac parameters were also collected. One-hundred and fifty individuals from general population provided data for the HPRS validation. Results: Hypertensive patients reported significantly higher levels of psychological distress and lower levels of psychological well-being at baseline compared to controls. Among hypertensive patients, allostatic overload (AO) was the most frequently reported psychosomatic syndrome at baseline. Patients with AO displayed significantly greater levels of psychological distress and lower levels of well-being and quality of life than those without. Further, patients with illness denial were significantly more likely to report poor adherence to pharmacological treatment and, as well as those with higher levels of affective symptomatology, were less likely to follow a balanced diet. At follow-up, patients displayed significantly higher levels of well-being and lower levels of stress, mental pain and quality of life. Conclusions: Findings suggest the clinical relevance of psychosocial factors and psychosomatic syndromes in the progression of hypertension, with important implications for its management. As to the Italian validation of the HPRS, results support previous findings, even though a confirmatory factor analysis should be carried out.

Progettazione e implementazione di applicazioni context-aware su dispositivi mobili

Il progetto descritto in questo documento consiste fondamentalmente nell'integrazione di applicazioni context-aware su dispositivi mobili con reti di sensori e nello studio delle problematiche derivanti, vantaggi e potenziali utilizzi. La rete è stata costruita sfruttando l'insieme di protocolli per comunicazioni via radio Zigbee, particolarmente adatti per interazione tra dispositivi a basso consumo energetico e che necessitano di uno scarso tasso di trasferimento di dati. Le informazioni ottenute da sensori di varia natura sono processate da microcontrollori Arduino, scelti per la loro versatilità di utilizzo e design open source. Uno o più dispositivi sono designati per aggregare i dati rilevati dai singoli nodi in un unico pacchetto di informazioni, semanticamente correlate tra loro, quindi emetterle in broadcast su una diversa interfaccia di rete, in modo che diverse applicazioni esterne in ascolto possano riceverle e manipolarle. Viene utilizzato un protocollo specifico per la comunicazione tra i microcontrollori e le applicazioni che si interfacciano con la rete, costruito su misura per dispositivi con risorse limitate. L'applicazione context-aware che interagisce con la rete è stata sviluppata su piattaforma Android, la cui particolare flessibilità favorisce una migliore capacità di gestire i dati ottenuti. Questa applicazione è in grado di comunicare con la rete, manipolare i dati ricevuti ed eventualmente intraprendere azioni specifiche in totale indipendenza dal suo utilizzatore. Obiettivo del progetto è quello di costruire un meccanismo di interazione tra le tecnologie più adattivo e funzionale possibile.

Un oracolo per la scelta location-based dell'interfaccia di rete nei dispositivi mobili

Viene proposta l'implementazione di un oracolo che utilizza la posizione geografica e informazioni sugli AP WiFi per determinare quali interfacce di un dispositivo mobile mantenere attive.

Studio e valutazione sperimentale di tecniche di radio fingerprinting per navigazione indoor con dispositivi mobili Android

Lo studio effettuato raccoglie informazioni al fine di svolgere un’analisi globale delle tecniche attualmente in uso, o in fase di studio, nel campo della localizzazione di dispositivi all’interno di un ambiente chiuso, ovvero laddove non è possibile sfruttare la copertura del sistema GPS. La panoramica è frutto dell’analisi e dello studio di paper tecnici pubblicati dai collaboratori dell’IEEE, fruibili all’interno del portale IEEE Xplore. A corredo di questo studio è stata sviluppata una applicazione per dispositivi Android basata sulla tecnica del Wi-Fi fingerprint; l’applicazione, che rappresenta un primo approccio alle tecniche di localizzazione, è a tutti gli effetti un sistema standalone per la localizzazione, consente cioè di costruire sia la mappa per la localizzazione, partendo da un ambiente sconosciuto, sia di ottenere la posizione dell’utente all’interno di una mappa conosciuta. La tesi si conclude con una analisi dei risultati e delle performance ottenute dall’applicazione in un uso comune, al fine di poter valutare l’efficacia della tecnica presa in considerazione. I possibili sviluppi futuri sono analizzati in un capitolo a parte e trovano spazio in ambienti nei quali si vogliono offrire servizi "context-based", ovvero basati sulla posizione esatta dell’utente.

Un servizio di gestione del park sharing basato su dispositivi mobili

La seguente tesi tratta: nel primo capitolo la sharing economy, nel secondo si focalizza sul modello di sviluppo Android, mentre nel terzo viene presentata un'applicazione da me ideata e sviluppata che consente la condivisione di parcheggi.

TuCSoN on Android: coordinazione event-driven e geolocalizzata su dispositivi mobili

La tesi si concentra sull’infrastruttura di coordinazione TuCSoN on Android, realizzando il refactoring del servizio di geolocalizzazione platform-independent (lato infrastruttura) e platform-dependent (lato mobile device), nonché l’integrazione del modello event-driven con la proprietà di situatedness.