Programa de Atención a Población Inmigrante en Salud Mental (PAPI-SM)

Publicado en la página web del Servicio Andaluz de Salud. http://www.juntadeandalucia.es/servicioandaluzdesalud (Servicio Andaluz de Salud/principal/la organización/publicaciones)

Validation of a new tool to assess health-related quality of life in psoriasis: the PSO-LIFE questionnaire.

BACKGROUND Several questionnaires have been used to measure health related quality of life (HRQoL) in patients with psoriasis, few have been adapted for use in Spain; none of them was developed specifically for the Spanish population. The purpose of the study was to validate and assess the sensitivity to change of a new questionnaire to measure HRQOL in patients with psoriasis (PSO-LIFE). METHODS Observational, prospective, multicenter study performed in centers around Spain. Patients with active or inactive psoriasis completed the PSO-LIFE together with other Dermatology Quality of Life Index (DLQI) and Psoriasis Disability Index (PDI). A control group of patients with urticaria or atopic dermatitis was also included. Internal consistency and test-retest reliability of the PSO-LIFE were assessed by calculating Cronbach's alpha and Intraclass Correlation Coefficient (ICC). Validity was assessed by examining factorial structure, the capacity to discriminate between groups, and correlations with other measures. Sensitivity to change was measured using effect sizes. RESULTS The final sample included for analysis consisted of 304 patients and 56 controls. Mean (SD) age of psoriasis patients was 45.3 (14.5) years compared to 38.8 (14) years for controls (p < 0.01). Cronbach's alpha for the PSO-LIFE was 0.95 and test-retest reliability using the ICC was 0.98. Factor analysis showed the questionnaire to be unidimensional. Mean (SD) PSO-LIFE scores differed between patients with psoriasis and controls (64.9 [22.5] vs 69.4 [17.3]; p < 0.05), between those with active and inactive disease (57.4 [20.4] vs 76.4 [20.6]; p < 0.01), and between those with visible and non-visible lesions (63.0 [21.9] vs. 74.8 [23.9]; p < 0.01). The correlation between PSO-LIFE and PASI scores was moderate (r = -0.43) while correlations with DLQI and PDI dimensions ranged from moderate to high (between 0.4 and 0.8). Effect size on the PSO-LIFE in patients reporting 'much improved' health status at study completion was 1.01 (large effect size). CONCLUSIONS The present results provide substantial support for the reliability, validity, and responsiveness of the PSO-LIFE questionnaire in the population for which it was designed.

Utility of the mini-cog for detection of cognitive impairment in primary care: data from two spanish studies.

Objectives. To study the utility of the Mini-Cog test for detection of patients with cognitive impairment (CI) in primary care (PC). Methods. We pooled data from two phase III studies conducted in Spain. Patients with complaints or suspicion of CI were consecutively recruited by PC physicians. The cognitive diagnosis was performed by an expert neurologist, after formal neuropsychological evaluation. The Mini-Cog score was calculated post hoc, and its diagnostic utility was evaluated and compared with the utility of the Mini-Mental State (MMS), the Clock Drawing Test (CDT), and the sum of the MMS and the CDT (MMS + CDT) using the area under the receiver operating characteristic curve (AUC). The best cut points were obtained on the basis of diagnostic accuracy (DA) and kappa index. Results. A total sample of 307 subjects (176 CI) was analyzed. The Mini-Cog displayed an AUC (±SE) of 0.78 ± 0.02, which was significantly inferior to the AUC of the CDT (0.84 ± 0.02), the MMS (0.84 ± 0.02), and the MMS + CDT (0.86 ± 0.02). The best cut point of the Mini-Cog was 1/2 (sensitivity 0.60, specificity 0.90, DA 0.73, and kappa index 0.48 ± 0.05). Conclusions. The utility of the Mini-Cog for detection of CI in PC was very modest, clearly inferior to the MMS or the CDT. These results do not permit recommendation of the Mini-Cog in PC.

Expectations, experiences and attitudes of patients and primary care health professionals regarding online psychotherapeutic interventions for depression: protocol for a qualitative study.

BACKGROUND In the year 2020, depression will cause the second highest amount of disability worldwide. One quarter of the population will suffer from depression symptoms at some point in their lives. Mental health services in Western countries are overburdened. Therefore, cost-effective interventions that do not involve mental health services, such as online psychotherapy programs, have been proposed. These programs demonstrate satisfactory outcomes, but the completion rate for patients is low. Health professionals' attitudes towards this type of psychotherapy are more negative than the attitudes of depressed patients themselves. The aim of this study is to describe the profile of depressed patients who would benefit most from online psychotherapy and to identify expectations, experiences, and attitudes about online psychotherapy among both patients and health professionals that can facilitate or hinder its effects. METHODS A parallel qualitative design will be used in a randomised controlled trial on the efficiency of online psychotherapeutic treatment for depression. Through interviews and focus groups, the experiences of treated patients, their reasons for abandoning the program, the expectations of untreated patients, and the attitudes of health professionals will be examined. Questions will be asked about training in new technologies, opinions of online psychotherapy, adjustment to therapy within the daily routine, the virtual and anonymous relationship with the therapist, the process of online communication, information necessary to make progress in therapy, process of working with the program, motivations and attitudes about treatment, expected consequences, normalisation of this type of therapy in primary care, changes in the physician-patient relationship, and resources and risks. A thematic content analysis from the grounded theory for interviews and an analysis of the discursive positions of participants based on the sociological model for focus groups will be performed. DISCUSSION Knowledge of the expectations, experiences, and attitudes of both patients and medical personnel regarding online interventions for depression can facilitate the implementation of this new psychotherapeutic tool. This qualitative investigation will provide thorough knowledge of the perceptions, beliefs, and values of patients and clinicians, which will be very useful for understanding how to implement this intervention method for depression.

Construcción y validación del cuestionario G_Clinic para medir la satisfacción laboral en profesionales de enfermería de las unidades de gestión clínica.

BACKGROUND Job satisfaction of nurses is a determinant factor in the quality and organizational adaptation of clinical management models in the current socio-economic context. The aim of this study was to construct and validate a questionnaire to measure job satisfaction of nurses in the Clinical Management Units in the Andalusian Public Health System. METHODS Clinimetric and cross-sectional study with a sample of 314 nurses of two university hospitals from Seville. Nurses were surveyed in 2011, from March to June. We used the Font Roja questionnaire adapted to our study variables. We performed analyses of correlations, reliability and construct validity, using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to test the a priori model. RESULTS The end questionnaire consists of 10 items, whose internal consistency was 0.75, with a percentage of variance explaining of 63.67%. CFA confirmed 4 dimensions (work environment, work relationships, motivation, and recognition): significant χ2 (p < .001); χ2/gl = 2.013; GFI= 0.958, RMR = 0.055 y RMSEA = 0.057; AGFI = 0.927, NFI = 0.878, TLI = 0.902, CFI =0.933 e IFI = 0.935; AIC = 132.486 y ECVI = 0.423. CONCLUSION This new questionnaire (G_Clinic) improves clinimetric values of the Font Roja questionnaire, because it reduces the number of items, improves the reliability of the dimensions, increases the value of variance explained, and allows knowing job satisfaction of nurses in clinical managementt.

Permanent demand excess as business strategy: an analysis of the Brazilian higher-education market

Many Higher Education Institutions (HEIs) establish tuition below the equilibrium price to generate permanent demand excess. This paper first adapts Becker’s (1991) theory to understand why the HEIs price in this way. The fact that students are both consumers and inputs on the education production process gives rise to a market equilibrium where some firms have excess demand and charge high prices, and others charge low prices and have empty seats.Second, the paper analyzes this equilibrium empirically. We estimated the demand for undergraduate courses in Business Administration in the State of São Paulo. The results show that tuition, quality of incoming students and percentage of lecturers holding doctorates degrees are the determining factors of students’ choice. Since the student quality determines the demand for a HEI, it is calculated what the value is for a HEI to get better students; that is the total revenue that each HEI gives up to guarantee excess demand. Regarding the “investment” in selectivity, 39 HEIs in São Paulo give up a combined R$ 5 million (or US$ 3.14 million) in revenue per year per freshman class, which means 7.6% of the revenue coming from a freshman class.

Organisaation innovatiivisuutta edistävät ja estävät tekijät. Case Technology Business Research Center

Tämän työn toimeksiantajaorganisaatio oli Lappeenrannan teknillisen yliopiston alainen, kauppatieteitä, teknologiaa ja tuotantotaloutta työssään yhdistävä tutkimusyksikkö, Technology Business Research Center, TBRC. Erään innovatiivisuustutkimusprojektin (InnoSpring) yhteydessä haluttiin selvittää myös oman tutkimusyksikön innovatiivisuuteen vaikuttavia, edistäviä ja estäviä tekijöitä. Tutkielman tavoitteena oli kartoittaa niitä seikkoja, jotka organisaation - tässä tapauksessa yliopiston tutkimusyksikön - henkilökunnan, projektityöntekijöiden, projektipäälliköiden sekä johdon mukaan vaikuttavat yksikön kykyyn luoda ja omaksua uutta, sen innovatiivisuuteen. Työ toteutettiin focus group-ryhmähaastattelumenetelmällä (kvalitatiivinen tutkimus), joihin osallistuivat omina ryhminään työntekijätaso, projektipäälliköt sekä johto.Haastattelut äänitettiin, litteroitiin ja koodattiin Atlas-Ti-ohjelmistolla. Loppuraportti verkostokuvineen luovutettiin tutkimuslaitokselle heinäkuussa 2005. Ryhmäkeskustelun teemoista ja kysymysten muodosta johtuen tulokset käsittelivät niin tutkimusyksikön nykyistä tilaa kuin eräänlaista "toivetilaa", millainen olisi ihanteellinen ja innovatiivinen työpaikka. Merkillepantavaa oli, että työssä tuli systemaattisesti esiin enemmän innovatiivisuutta edistäviä kuin ehkäiseviä seikkoja - vaikka osa edistävistä seikoista koskikin nimenomaan "toivetilaa". Keskustelluimpia teemoja olivat johtajuus,tavoitteellisuus ja strategian, yhteisen suunnan tarve. Samoin olemassa olevienprosessien kehittäminen, osaamisen (niin oman kuin koko organisaationkin) kokoaminen ja kehittäminen edelleen sekä tulosten jalkauttaminen.

A Spanish version of the athens insomnia scale

Objectives To develop and validate a Spanish version of the Athens Insomnia Scale (AIS). Methods The AIS is designed to assess sleep difficulty and comprises eight items: the first five refer to the sleep disturbance and the last three to the daytime consequences. Either the full eight-item scale (AIS-8) or the brief form (AIS-5) can be administered. The adaptation used a backtranslation design. The validation process was based on a sample of 323 participants (undergraduates, community sample and psychiatric outpatients), which completed the AIS and other questionnaires: anxiety (BAI), depression (BDI) and psychological well-being (GHQ-12) scales. Results The internal consistency coefficients for both versions were above 0.80. The study of dimensionality revealed a single factor with high loadings and a percentage of explained variance above 50% in both versions. Test-retest reliability was above 0.70 (AIS-5) and over 0.80 (AIS-8) at a one-month interval. The correlation between the AIS and the previously mentioned scales was for both the AIS-5 and the AIS-8 above 0.40 and 0.50, respectively.

Markkinointiviestinnän välittämä imago business-to-business markkinoilla, mielikuvatavoitteena kestävä kehitys

Tässä pro gradu -tutkielmassa tarkasteltiin kansainvälisen metsäteollisuudessa toimivan yrityksen markkinointiviestintää ja sen välittämien imagoviestien siirtymistä business-to-business markkinoilla. Tutkittavat viestit liittyivät kartonkipakkausten kestävän kehityksen ja ympäristöystävällisyyden imagon rakentumiseen. Tutkimuksessa käytettiin kvalitatiivista tutkimusmenetelmää. Tutkimus pohjautui yrityksen teettämän aiemman asiakastutkimuksen aineistoon, jossa selvitettiin pakkauskartonkien mielikuvia kohderyhmässä. Lisäksi tutkittiin imagon viestintää markkinointiviestinnän näkökulmasta. Yrityksen online viestintää verrattiin asiakkaiden vastaavaan viestintään loppukäyttäjille ja selvitettiin siirtyivätkö kestävän kehityksen viestit loppukäyttäjille asti. Tuloksena saatiin osittain yhtenevä viestintä sekä yrityksen asiakkaiden että näiden loppukäyttäjille viestimien teemojen sisällöstä. Tutkimus osoitti, että tärkein viestinnällinen teema on pakkauksen kierrätettävyys. Toisena tärkeänä teemana ilmeni hiilijalanjäljen pienentämisestä viestivät seikat. Nousevana teemana voitiin havaita biohajoavia materiaaleja kohtaan osoitettu kiinnostus. Tutkimuksessa jaettiin vastaajat eri segmentteihin pakkauskartonkien käyttötarkoituksen mukaan ja verrattiin kestävän kehityksen tärkeyttä näiden segmenttien välillä. Segmenteittäin tarkasteltuna suuria eroja ei ollut havaittavissa.

Sotilasyksikön integraatio – koulutuskulttuurien kohtaaminen ja konfliktit

Tutkimuksen kohteena on yksi sotilasyksikkö, Reserviupseerikoulun Esikunta- ja viestikomppania. Kyseisessä yksikössä koulutetaan reservinupseereita sotilaspo-liisi-, huolto-, johtamisjärjestelmä- ja komentopaikkatehtäviin. Sotilaspoliisilinja ja huoltolinja ovat liittyneet yksikköön vuoden 2014 lopulla. Tämä integraatio on saanut aikaan tiedonintressin koulutuslinjojen kulttuureihin liittyen. Tarkoituksena on selvittää miten linjojen koulutuskulttuurit poikkeavat toisistaan ja mitä kulttuurien integraatiossa tapahtuu. Tutkimuksen tavoitteena on myös antaa suosituksia yksikölle mahdollisten kulttuuriristiriitojen ja konfliktien hallitsemiseksi. Tutkimus on luonteeltaan sosiaaliantropologista kauppatieteellistä kulttuurintutki-musta. Taustatieteinä ovat liiketaloustiede, antropologia, sosiologia ja osittain or-ganisaatiopsykologia. Tutkimusote on laadullinen ja aineiston hankinnan mene-telminä on käytetty yksikön kouluttajien haastatteluja ja osallistuvaa havainnointia. Tutkimusaineisto on analysoitu teoriaohjaavaa laadullista sisällönanalyysiä käyttäen. Analyysin tavoitteena oli tunnistaa erot integroituvissa koulutuskulttuureissa, ymmärtää eroista johtuvien konfliktien logiikkaa ja tarkastella kulttuurien vuotamisen logiikkaa. Esikunta- ja viestikomppanian koulutuskulttuurien erilaisuutta analysoitiin seuraavien teoriateemojen kautta: oppilaskäsitys, suhtautuminen upseerioppilaisiin, artefaktit (koulutusmenetelmät), arvot, asenteet ja kouluttamisen syväoletukset. Koulutuskulttuurien kohtaamista analysoitiin psykologisen omistajuuden, reviirikäyttäytymisen ja kulttuurin vuotamisen teorioiden kautta. Tutkimustulokset osoittavat, että kulttuurilla todella on merkitystä sotilasorganisaa-tion integraatiotilanteessa. Esikunta- ja viestikomppanian koulutuskulttuureissa on havaittavissa huomattavia eroja, mutta myös samankaltaisuuksia. Kulttuurien erot johtavat ristiriitaisuuksiin, konflikteihin, reviirikäyttäytymiseen ja saavat ihmiset osoittamaan mieltään eri tavoin. Toisaalta kulttuuripiirteillä on myös taipumusta vuotaa ympäristöön nopeuttaen uusien organisaation osien sopeutumista. Johtajan rooli kulttuurien hallinnassa on keskeinen. Johtajan oma kulttuuriorientaatio voi johtaa konflikteihin, mutta toisaalta myös ratkaista niitä. Tärkeimpänä johtopäätöksenä on, että suuressa sotilasyksikössä kannattaisi laatia strategia eli suunnitelma kulttuurin johtamista varten silloin, kun integraatio on tapahtumassa. Strategian avulla voidaan ottaa kantaa useisiin kulttuurillisiin ristiriitoihin, joita siis Esikunta- ja viestikomppaniankin tapauksessa ilmenee. Koko yksikön henkilöstä kannattaisi sitouttaa ja ottaa mukaan strategian laadintaan. Strategia selventäisi esimerkiksi yksikön arvoja, visiota, missiota, tehtäviä, erilaisten linjojen erityisasemaa ja poikkeuksia, haluttua ja toivottua toimintaa ja asennetta, palkitsemiskäytäntöjä, toisin sanoen kulttuurin eri tekijöitä. Strategia ei ole vain liiketaloudellinen tulosyksikön pitkän tähtäimen pakollinen työkalu, vaan myös sotilasorganisaation kulttuurin johtamisen väline.

Organization of the marketing communication activities after fusion - the integration and the decision making processes

This master’s thesis was made in order to gain answers to the question of how the integration of the marketing communications and the decision making related to it in a geographically dispersed service organization could be improved in a situation where an organization has gone through a merger. The effects of the organizational design dimensions towards the integration of the marketing communications and the decision making related to it was the main focus. A case study as a research strategy offered a perfect frames for an exploratory study and the data collection was conducted by semi-structured interviews and observing. The main finding proved that from the chosen design dimensions, decentralization, coordination and power, could be found specific factors that in a geographically dispersed organization are affecting the integration of the marketing communications negatively. The effects can be seen mostly in the decision making processes, roles and in the division of responsibility, which are affecting the other dimensions and by this, the integration. In a post-merger situation, the coordination dimension and especially the information asymmetry and the information flow seem to have a largest affect towards the integration of the marketing communications. An asymmetric information distribution with the lack of business and marketing education resulted in low self-assurance and at the end in fragmented management and to the inability to set targets and make independent decisions. As conclusions it can be stated, that with the organizational design dimensions can the effects of a merger towards the integration process of the marketing communications to be evaluated.

Who expects what from whom? : a gender based study on expectations and secondary school administration

This study is about expectations and aspirations of secondary school teachers. It is an investigation of why some teachers aspire to become administrators and why some teachers do not. My research compares expectations and existing attltudes regarding aspirations toward administration which are held by three distinct groups within the secondary school system: 1) principals/vice-principals, 2) aspiring teachers, and 3) non-aspiring teachers. This study questions why, in the late 60's, secondary school administration is still predominated by men. The conclusions and recommendations were based on interviews with thirty men and women in the Hamilton Secondary School System. In addltion, Mr. Keith Rielly, Superintendent of Operations, made valuable contributions to my work. The interviews revealed experiences and percept ions of men and women in di scourse about f amil y re lat i onshi ps, educational choices and perceived internal and external barriers which inhiblted or enhanced their decision to aspire to secondary school administration. Candidates spoke about their personal and professional Hves wlth respect to encouragement, perceived images of an administrator, netWOrking and the effect of marriage and children on their careers. Historically, women have not accepted the challenge of administration and It would appear as if this is still the case today. My research suggests that women are under-represented in secondary school administration because of internal and external barriers which discourage many women from aspiring. I conclude that many of women's internal barrlers are reinforced by external roadblocks which prevent women from aspiring to secondory school administration. Thus. many women who do not envision a future in educational administration establish priorities outside the general realm of education. I recommend that males and females recognize that women make valuable contributions to educational theory and design based on their experiences which may be "differene from mole experiences. but just as significant. Mole and female representation in secondary school administration represents a balance between attitudes and behaviours which can not be accomplished when an administrative offlce is dominated by on all ma1e or all female staff.