Núm 4, octubre de 2013

Artículos destacados: Buenas prácticas en gestión clínica: Utilidad de la ecografía en rehabilitación. Seguimiento del acuerdo de gestión clínica. Organigrama de funciones de la Unidad de Gestión Clínica. Los antibióticos se acaban, es tiempo de actuar.

Suicidal ideation and the risk of suicide in patients with fibromyalgia: a comparison with non-pain controls and patients suffering from low-back pain.

Fibromyalgia is associated with an increased rate of mortality from suicide. In fact, this disease is associated with several characteristics that are linked to an increased risk of suicidal behaviors, such as being female and experiencing chronic pain, psychological distress, and sleep disturbances. However, the literature concerning suicidal behaviors and their risk factors in fibromyalgia is sparse. The objectives of the present study were to evaluate the prevalence of suicidal ideation and the risk of suicide in a sample of patients with fibromyalgia compared with a sample of healthy subjects and a sample of patients with chronic low-back pain. We also aimed to evaluate the relevance of pain intensity, depression, and sleep quality as variables related to suicidal ideation and risks. Logistic regression was applied to estimate the likelihood of suicidal ideation and the risk of suicide adjusted by age and sex. We also used two logistic regression models using age, sex, pain severity score, depression severity, sleep quality, and disease state as independent variables and using the control group as a reference. Forty-four patients with fibromyalgia, 32 patients with low-back pain, and 50 controls were included. Suicidal ideation, measured with item 9 of the Beck Depression Inventory, was almost absent among the controls and was low among patients with low-back pain; however, suicidal ideation was prominent among patients with fibromyalgia (P<0.0001). The risk of suicide, measured with the Plutchik Suicide Risk Scale, was also higher among patients with fibromyalgia than in patients with low-back pain or in controls (P<0.0001). The likelihood for suicidal ideation and the risk of suicide were higher among patients with fibromyalgia (odds ratios of 26.9 and 48.0, respectively) than in patients with low-back pain (odds ratios 4.6 and 4.7, respectively). Depression was the only factor associated with suicidal ideation or the risk of suicide.

Suicidal ideation and the risk of suicide in patients with fibromyalgia: a comparison with non-pain controls and patients suffering from low-back pain.

Fibromyalgia is associated with an increased rate of mortality from suicide. In fact, this disease is associated with several characteristics that are linked to an increased risk of suicidal behaviors, such as being female and experiencing chronic pain, psychological distress, and sleep disturbances. However, the literature concerning suicidal behaviors and their risk factors in fibromyalgia is sparse. The objectives of the present study were to evaluate the prevalence of suicidal ideation and the risk of suicide in a sample of patients with fibromyalgia compared with a sample of healthy subjects and a sample of patients with chronic low-back pain. We also aimed to evaluate the relevance of pain intensity, depression, and sleep quality as variables related to suicidal ideation and risks. Logistic regression was applied to estimate the likelihood of suicidal ideation and the risk of suicide adjusted by age and sex. We also used two logistic regression models using age, sex, pain severity score, depression severity, sleep quality, and disease state as independent variables and using the control group as a reference. Forty-four patients with fibromyalgia, 32 patients with low-back pain, and 50 controls were included. Suicidal ideation, measured with item 9 of the Beck Depression Inventory, was almost absent among the controls and was low among patients with low-back pain; however, suicidal ideation was prominent among patients with fibromyalgia (P<0.0001). The risk of suicide, measured with the Plutchik Suicide Risk Scale, was also higher among patients with fibromyalgia than in patients with low-back pain or in controls (P<0.0001). The likelihood for suicidal ideation and the risk of suicide were higher among patients with fibromyalgia (odds ratios of 26.9 and 48.0, respectively) than in patients with low-back pain (odds ratios 4.6 and 4.7, respectively). Depression was the only factor associated with suicidal ideation or the risk of suicide.

Trends in socioeconomic inequalities in preventable mortality in urban areas of 33 Spanish cities, 1996-2007 (MEDEA project).

Abstract Background: Preventable mortality is a good indicator of possible problems to be investigated in the primary prevention chain, making it also a useful tool with which to evaluate health policies particularly public health policies. This study describes inequalities in preventable avoidable mortality in relation to socioeconomic status in small urban areas of thirty three Spanish cities, and analyses their evolution over the course of the periods 1996–2001 and 2002–2007. Methods: We analysed census tracts and all deaths occurring in the population residing in these cities from 1996 to 2007 were taken into account. The causes included in the study were lung cancer, cirrhosis, AIDS/HIV, motor vehicle traffic accidents injuries, suicide and homicide. The census tracts were classified into three groups, according their socioeconomic level. To analyse inequalities in mortality risks between the highest and lowest socioeconomic levels and over different periods, for each city and separating by sex, Poisson regression were used. Results: Preventable avoidable mortality made a significant contribution to general mortality (around 7.5%, higher among men), having decreased over time in men (12.7 in 1996–2001 and 10.9 in 2002–2007), though not so clearly among women (3.3% in 1996–2001 and 2.9% in 2002–2007). It has been observed in men that the risks of death are higher in areas of greater deprivation, and that these excesses have not modified over time. The result in women is different and differences in mortality risks by socioeconomic level could not be established in many cities. Conclusions: Preventable mortality decreased between the 1996–2001 and 2002–2007 periods, more markedly in men than in women. There were socioeconomic inequalities in mortality in most cities analysed, associating a higher risk of death with higher levels of deprivation. Inequalities have remained over the two periods analysed. This study makes it possible to identify those areas where excess preventable mortality was associated with more deprived zones. It is in these deprived zones where actions to reduce and monitor health inequalities should be put into place. Primary healthcare may play an important role in this process. Keywords: Preventable avoidable mortality, Causes of death, Inequalities in health, Small area analysis

Sudden death among young people with first-episode psychosis: an 8-10 year follow-up study.

Individuals with first episode psychosis (FEP) experience high rates of premature mortality, in particular due to suicide. The study aims were to: a) Estimate the rate of sudden death among young people with FEP during an 8-10 year period following commencement of treatment; b) Examine and describe the socio-demographic and clinical characteristics associated with sudden death; and c) Examine the timing of death in relation to psychiatric treatment.This was a cohort study. The sample comprised 661 patients accepted into treatment at the Early Psychosis Prevention and Intervention Centre between 1/1/1998 and 31/12/2000. Demographic and clinical data were collected by examination of the medical files. Mortality data were collected via a search of the National Coroners Information System; the Victorian State Coroner's office and clinical files. Nineteen patients died and just over two thirds of deaths were classified as intentional self-harm or suicide. Death was associated with male gender, previous suicide attempt and greater symptom severity at last contact. People with FEP are at increased risk of premature death, in particular suicide. A previous suicide attempt was very common amongst those who died, suggesting that future research could focus upon the development of interventions for young people with FEP who engage in suicidal behaviour.

The value of useless information

There are many situations in which individuals have a choice of whether or notto observe eventual outcomes. In these instances, individuals often prefer to remainignorant. These contexts are outside the scope of analysis of the standard vonNeumann-Morgenstern (vNM) expected utility model, which does not distinguishbetween lotteries for which the agent sees the final outcome and those for which hedoes not. I develop a simple model that admits preferences for making an observationor for remaining in doubt. I then use this model to analyze the connectionbetween preferences of this nature and risk-attitude. This framework accommodatesa wide array of behavioral patterns that violate the vNM model, and thatmay not seem related, prima facie. For instance, it admits self-handicapping, inwhich an agent chooses to impair his own performance. It also accommodatesa status quo bias without having recourse to framing effects, or to an explicitdefinition of reference points. In a political economy context, voters have strictincentives to shield themselves from information. In settings with other-regardingpreferences, this model predicts observed behavior that seems inconsistent witheither altruism or self-interested behavior.

Spatiotemporal order out of noise

Experimental observations of self-organized behavior arising out of noise are also described, and details on the numerical algorithms needed in the computer simulation of these problems are given.

Spatiotemporal order out of noise

Experimental observations of self-organized behavior arising out of noise are also described, and details on the numerical algorithms needed in the computer simulation of these problems are given.

Professional development among educators pursuing a B.Ed. program in special education in Tanzania : a study of motives and perceived outcomes

Implementation of different policies and plans aiming at providing education for all is a challenge in Tanzania. The need for educators and professionals with relevant knowledge and qualifications in special education is substantial. Teacher education does not equip educators with sufficient knowledge and skills in special education and professional development programs in special education are few in number. Up to 2005 no degree programs in special education at university level were available in Tanzania. The B.Ed. Special Education program offered by the Open University of Tanzania in collaboration with Åbo Akademi University in Finland was one of the efforts aimed at addressing the big national need for teachers and other professionals with degree qualifications in special education. This pilot program offered unique possibilities to study professional development in Tanzania. The research group in this study consisted of the group of students who participated in the degree program 2005-2007. The study is guided by three theoretical perspectives: individual, social and societal. The individual perspective emphasizes psychological factors as motives, motivation, achievement, self-directed behavior and personal growth. Within social perspective, professional development is viewed as situated within the social and cultural context. The third perspective, the societal, focuses on change, reforms, innovations and transformation of school systems and societies. Accordingly, professional development is viewed as an individual, social and societal phenomenon. The overall aim of the study is to explore the participants’ motives for participating in a B.Ed. Special Education program and the perceived outcomes of the program in terms of professional development. In order to achieve the objectives of the study, a case study approach was adopted. Questionnaires and semi-structured interviews were administered in three waves between January 2007 and February 2009 to the 35 educators participating in the B.Ed. Special Education program. The findings of the study reveal that the participants expressed motives which were related to job performance, knowledge, skills, academic degree and career. Also altruistic motives were expressed by the participants in terms of helping and supporting students with special needs and their communities. The perceived outcomes of the program were in line with the expressed motives. However, the results indicate that the participants also learned new skills, as interaction skills and guidance and counseling skills. Increased self-confidence was also mentioned as an outcome. The participants also got deepened understanding of disability issues. In addition, they learned strategies for creating awareness of persons with disability in the communities. Thus the findings of the study indicate positive outcomes of the program in terms of professional development. The conclusion of the study is that individual, social and societal factors interact when it comes to explaining why Tanzanian educators in special education choose to pursue a degree program in special education. The individual motives, as increased knowledge and better prospects of career development interact with the social and societal motives to help and support vulnerable student groups. The study contributes to increased understanding of the complexity of professional development and of the realities educators meet when educational reforms are implemented in a developing country.

Financial Slack and Bidding Firms’ Takeover Announcement Stock Returns – an Event Study

Despite the fact that the literature on mergers and acquisitions is extensive, relatively little effort has been made to examine the relationship between the acquiring firms’ financial slack and short-term post-takeover announcement abnormal stock returns. In this study, the case is made that the financial slack of a firm is not only an outcome of past business and financing activities but it also may affect the quality of acquisition decisions. We will hypothesize that the level of financial slack in a firm is negatively associated with the abnormal returns following acquisition announcements because slack reduces managerial discipline over the use of corporate funds and also because it may give rise to managerial self-serving behavior. In this study, financial slack is measured in terms of three financial statements ratios: leverage ratio, cash and equivalents to total assets ratio and free cash flow to total assets ratio. The data used in this paper is collected from two main sources. A list comprising 90 European acquisition announcements is retrieved from Thomson One Banker database. The stock price data and financial statements information for the respective firms is collected using Datastream. Our empirical analysis is two-fold. First, we conduct a two-sample t-test where we find that the most slack-rich firms experience lower abnormal returns than the most slack-poor firms in the event window [-1, +1], significant at 5% risk level. Second, we perform a cross sectional regression for sample firms using three financial statements ratios to explain cumulative abnormal returns (CAR). We find that leverage shows a statistically significant positive relationship with cumulative abnormal returns in event window [-1; +1] (significance 5%). Moreover, cash to total assets ratio showed a weak negative relationship with CAR (significant at 10%) in event window [-1; +1]. We conclude that our hypothesis for the inverse relationship between slack and abnormal returns receives empirical support. Based on the results of the event study we get empirical support for the hypothesis that the capital markets expect the acquisitions undertaken by slack-rich firms to more likely be driven by managerial self-serving behavior and hubris than do those undertaken by slackpoor firms, signaling possible agency problems and behavioral biases.

FUTURES OF FINNISH FOOD SYSTEM BY 2050. The perspective of resilience

Modern food systems face complex global challenges such as climate change, resource scarcities, population growth, concentration and globalization. It is not possible to forecast how all these challenges will affect food systems, but futures research methods provide possibilities to enable better understanding of possible futures and that way increases futures awareness. In this thesis, the two-round online Delphi method was utilized to research experts’ opinions about the present and the future resilience of the Finnish food system up to 2050. The first round questionnaire was constructed based on the resilience indicators developed for agroecosystems. Sub-systems in the study were primary production (main focus), food industry, retail and consumption. Based on the results from the first round, the future images were constructed for primary production and food industry sub-sections. The second round asked experts’ opinion about the future images’ probability and desirability. In addition, panarchy scenarios were constructed by using the adaptive cycle and panarchy frameworks. Furthermore, a new approach to general resilience indicators was developed combining “categories” of the social ecological systems (structure, behaviors and governance) and general resilience parameters (tightness of feedbacks, modularity, diversity, the amount of change a system can withstand, capacity of learning and self- organizing behavior). The results indicate that there are strengths in the Finnish food system for building resilience. According to experts organic farms and larger farms are perceived as socially self-organized, which can promote innovations and new experimentations for adaptation to changing circumstances. In addition, organic farms are currently seen as the most ecologically self-regulated farms. There are also weaknesses in the Finnish food system restricting resilience building. It is important to reach optimal redundancy, in which efficiency and resilience are in balance. In the whole food system, retail sector will probably face the most dramatic changes in the future, especially, when panarchy scenarios and the future images are reflected. The profitability of farms is and will be a critical cornerstone of the overall resilience in primary production. All in all, the food system experts have very positive views concerning the resilience development of the Finnish food system in the future. Sometimes small and local is beautiful, sometimes large and international is more resilient. However, when probabilities and desirability of the future images were questioned, there were significant deviations. It appears that experts do not always believe desirable futures to materialize.

FUTURES OF FINNISH FOOD SYSTEM BY 2050. The perspective of resilience

Modern food systems face complex global challenges such as climate change, resource scarcities, population growth, concentration and globalization. It is not possible to forecast how all these challenges will affect food systems, but futures research methods provide possibilities to enable better understanding of possible futures and that way increases futures awareness. In this thesis, the two-round online Delphi method was utilized to research experts’ opinions about the present and the future resilience of the Finnish food system up to 2050. The first round questionnaire was constructed based on the resilience indicators developed for agroecosystems. Sub-systems in the study were primary production (main focus), food industry, retail and consumption. Based on the results from the first round, the future images were constructed for primary production and food industry sub-sections. The second round asked experts’ opinion about the future images’ probability and desirability. In addition, panarchy scenarios were constructed by using the adaptive cycle and panarchy frameworks. Furthermore, a new approach to general resilience indicators was developed combining “categories” of the social ecological systems (structure, behaviors and governance) and general resilience parameters (tightness of feedbacks, modularity, diversity, the amount of change a system can withstand, capacity of learning and self- organizing behavior). The results indicate that there are strengths in the Finnish food system for building resilience. According to experts organic farms and larger farms are perceived as socially self-organized, which can promote innovations and new experimentations for adaptation to changing circumstances. In addition, organic farms are currently seen as the most ecologically self-regulated farms. There are also weaknesses in the Finnish food system restricting resilience building. It is important to reach optimal redundancy, in which efficiency and resilience are in balance. In the whole food system, retail sector will probably face the most dramatic changes in the future, especially, when panarchy scenarios and the future images are reflected. The profitability of farms is and will be a critical cornerstone of the overall resilience in primary production. All in all, the food system experts have very positive views concerning the resilience development of the Finnish food system in the future. Sometimes small and local is beautiful, sometimes large and international is more resilient. However, when probabilities and desirability of the future images were questioned, there were significant deviations. It appears that experts do not always believe desirable futures to materialize.

Needs of High Functioning Teenagers and Adults with Autism (Tips from a Recovered Autistic)

Some of the topics discussed in the article include: Direct Fixations, Gradual Introduction to a Career, Talent and Deficit Areas, Thinking in Pictures, Reading and Language, Social Problems, Recognize Need for Change, Cognitive Differences, Constant Anxiety, Improvement Takes Time, Family Background and Depression, Sensory Problems, Aggressive and Self-Injurious Behavior.

Interventions infirmières en regard du phénomène de l’automutilation en milieu pédopsychiatrique : étude qualitative exploratoire

En milieu pédopsychiatrique, les infirmières connaissent bien le phénomène de l’automutilation des adolescentes parce qu’elles sont souvent appelées à intervenir lorsque ce type de situation survient. Cependant, puisqu’elles ont parfois une mauvaise compréhension du phénomène, des perceptions erronées et des attitudes négatives quant à celui-ci, les infirmières deviennent moins aptes à intervenir auprès de cette clientèle. Cette étude a pour objectifs d’explorer le phénomène de l’automutilation auprès des infirmières œuvrant en milieu pédopsychiatrique et de décrire les interventions infirmières privilégiées en cas d’automutilation ainsi que les facteurs du contexte organisationnel susceptible d’avoir une influence sur la façon dont ces interventions sont prodiguées. L’étude privilégie un devis qualitatif de type exploratoire. Plusieurs méthodes de collecte des données ont été sélectionnées pour mener à bien cette étude entre autres des entrevues auprès des participantes et une période d’observation au sein de l’unité où la recherche a eu lieu. L’analyse des verbatim selon les étapes élaborées par Tesch (1990) a permis d’identifier sept catégories d’interventions infirmières : les interventions de relation d’aide, d’accompagnement, d’évaluation, de sécurité, d’enseignement, les interventions en lien avec les émotions et les perceptions de l’automutilation ainsi que les interventions pour éviter la contamination sociale. En ce qui a trait aux facteurs ayant une influence sur ces interventions infirmières, trois catégories sont ressorties des données : la constitution de l’équipe interpersonnelle, la lourdeur des tâches de l’infirmière en pédopsychiatrie ainsi que la culture organisationnelle dans laquelle évoluent les membres de l’équipe soignante. Les résultats qui sont issus de cette étude permettront aux infirmières de mieux comprendre le phénomène de l’automutilation chez les adolescentes. Cette étude suggère également des pistes d’interventions qui pourraient aider les infirmières œuvrant en milieu pédopsychiatrique à mieux intervenir. De plus, cette étude serait susceptible de permettre aux gestionnaires des établissements d’apporter certains ajustements notamment en ce qui a trait à l’organisation du travail et à la formation des infirmières.