Cost effectiveness and cost utility of risedronate for osteoporosis treatment and fracture prevention in women: a Swiss perspective.

OBJECTIVES: To assess the incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR) of risedronate compared to no intervention in postmenopausal osteoporotic women in a Swiss perspective. METHODS: A previously validated Markov model was populated with epidemiological and cost data specific to Switzerland and published utility values, and run on a population of 1,000 women of 70 years with established osteoporosis and previous vertebral fracture, treated over 5 years with risedronate 35 mg weekly or no intervention (base case), and five cohorts (according to age at therapy start) with eight risk factor distributions and three lengths of residual effects. RESULTS: In the base case population, the ICER of averting a hip fracture and the ICUR per quality-adjusted life year gained were both dominant. In the presence of a previous vertebral fracture, the ICUR was below euro45,000 (pound30,000) in all the scenarios. For all osteoporotic women>or=70 years of age with at least one risk factor, the ICUR was below euro45,000 or the intervention may even be cost saving. Age at the start of therapy and the fracture risk profile had a significant impact on results. CONCLUSION: Assuming a 2-year residual effect, that ICUR of risedronate in women with postmenopausal osteoporosis is below accepted thresholds from the age of 65 and even cost saving above the age of 70 with at least one risk factor.

Assessing alpine plant vulnerability to climate change: A modeling perspective

The potential ecological impact of ongoing climate change has been much discussed. High mountain ecosystems were identified early on as potentially very sensitive areas. Scenarios of upward species movement and vegetation shift are commonly discussed in the literature. Mountains being characteristically conic in shape, impact scenarios usually assume that a smaller surface area will be available as species move up. However, as the frequency distribution of additional physiographic factors (e.g., slope angle) changes with increasing elevation (e.g., with few gentle slopes available at higher elevation), species migrating upslope may encounter increasingly unsuitable conditions. As a result, many species could suffer severe reduction of their habitat surface, which could in turn affect patterns of biodiversity. In this paper, results from static plant distribution modeling are used to derive climate change impact scenarios in a high mountain environment. Models are adjusted with presence/absence of species. Environmental predictors used are: annual mean air temperature, slope, indices of topographic position, geology, rock cover, modeled permafrost and several indices of solar radiation and snow cover duration. Potential Habitat Distribution maps were drawn for 62 higher plant species, from which three separate climate change impact scenarios were derived. These scenarios show a great range of response, depending on the species and the degree of warming. Alpine species would be at greatest risk of local extinction, whereas species with a large elevation range would run the lowest risk. Limitations of the models and scenarios are further discussed.

Eosinophile Ösophagitis : Die Sicht des Gastroenterologen [Eosinophilic esophagitis : The gastroenterologist's perspective].

Eosinophilic esophagitis is characterized by symptoms of esophageal dysfunction and eosinophil-predominant esophageal inflammation. Eosinophilic inflammation in other parts of the gastrointestinal tract is absent and several differential diagnoses for esophageal eosinophilia have to be excluded before diagnosing eosinophilic esophagitis. Most patients are male and have concomitant atopic disorders. Therapeutic options are based on drugs, diet and dilation.

A systems perspective on the integrative child psychiatry approach. Discussion of paper: "Working here and now with the individual and family system: A case of a traumatized child"

In this discussion, after a few general comments, I will propose a systems reading of the intervention so elegantly described by Kaija Puura. I will draw parallels between the therapeutic and the family groups as framing-developing systems and formalize the steps taken by the family toward healing under the influence of the therapist's team. En esta discusión, después de algunos comentarios generales, propongo una lectura sistemática de la intervención tan elegantemente descrita por Kaija Puura. Buscaré paralelos entre los grupos terapéuticos y de familia como sistemas de desarrollo enmarcado y formalizaré los pasos tomados por la familia hacia la cicatrización bajo la influencia del equipo del terapista. Après quelques commentaires généraux, je proposerai dans cette discussion une lecture systémique de l'intervention si élégamment décrite par Kaija Puura. J'établirai des parallèles entre les groupes thérapeutiques et familiaux en tant que systèmes d'encadrement-développement et je formaliserai les étapes de guérison franchies par la famille grâce à l'influence de l'équipe thérapeutique. In dieser Diskussion, werde ich nach einigen allgemeineren Aussagen, eine systemische Lesart der von Kaija Puura so eingängig beschriebenen Intervention vorschlagen. Ich werde darin Parallelen zwischen der therapeutischen und Rahmengebenden Familiengruppen ziehen, und die Schritte der Familien hin zu einer Heilung unter dem Einfluss des Therapeutenteams formalisieren.

Médecine interne générale en pratique hospitalière: l'année 2011 mise en perspective par les chefs de clinique [Hospital-based internal medicine: year 2011 in chief resident's perspective].

The year 2011 was full of significant advances in all areas of medicine. Whether small or large issues, they all have an impact on daily practice in general internal medicine. For example, intravenous administration of diuretics in heart failure shows no benefit. But double dose may improve symptoms faster. Direct Xa inhibitors are emerging as alternative to anti-vitamin K. beta-blockers reduce overall mortality in COPD and do not worsen lung function significantly. Each year, the chief residents from the Department of internal medicine at the University hospital of Lausanne meet to share their readings. Twelve new therapeutic considerations of 2011 are reviewed here.

Achievement goals in educational contexts: A social psychology perspective

Research on achievement goals usually defines mastery goals as the desire to acquire knowledge, and performance goals as the desire to outperform (or not to underperform) others. Educational contexts are most of the time social contexts, involving various persons and groups, of various hierarchical positions, and various cultural and ideological contexts. Surprisingly, most research in the achievement goal field has been conducted at an individual level of analysis. In the present paper, we will review the social consequences and antecedents of goal endorsement. This research indicates that goals strongly affect the way one behaves with co-learners. Moreover, it suggests that more than merely individual dispositions, goals reflect the social relation students have with other persons, institutions, and with the society to which they belong. We conclude this paper by setting an agenda for future achievement goal research.

Monitoring Disease Activity and Progression in Crohn's Disease. A Swiss Perspective on the IBD Ahead 'Optimised Monitoring' Recommendations.

BACKGROUND AND AIMS: The structured IBD Ahead 'Optimised Monitoring' programme was designed to obtain the opinion, insight and advice of gastroenterologists on optimising the monitoring of Crohn's disease activity in four settings: (1) assessment at diagnosis, (2) monitoring in symptomatic patients, (3) monitoring in asymptomatic patients, and (4) the postoperative follow-up. For each of these settings, four monitoring methods were discussed: (a) symptom assessment, (b) endoscopy, (c) laboratory markers, and (d) imaging. Based on literature search and expert opinion compiled during an international consensus meeting, recommendations were given to answer the question 'which diagnostic method, when, and how often'. The International IBD Ahead Expert Panel advised to tailor this guidance to the healthcare system and the special prerequisites of each country. The IBD Ahead Swiss National Steering Committee proposes best-practice recommendations adapted for Switzerland. METHODS: The IBD Ahead Steering Committee identified key questions and provided the Swiss Expert Panel with a structured literature research. The expert panel agreed on a set of statements. During an international expert meeting the consolidated outcome of the national meetings was merged into final statements agreed by the participating International and National Steering Committee members - the IBD Ahead 'Optimized Monitoring' Consensus. RESULTS: A systematic assessment of symptoms, endoscopy findings, and laboratory markers with special emphasis on faecal calprotectin is deemed necessary even in symptom-free patients. The choice of recommended imaging methods is adapted to the specific situation in Switzerland and highlights the importance of ultrasonography and magnetic resonance imaging besides endoscopy. CONCLUSION: The recommendations stress the importance of monitoring disease activity on a regular basis and by objective parameters, such as faecal calprotectin and endoscopy with detailed documentation of findings. Physicians should not rely on symptoms only and adapt the monitoring schedule and choice of options to individual situations. © 2014 S. Karger AG, Basel.