High prevalence of osteoporosis in Swiss women aged 60 and older: a 2-year pilot screening campaign.

Background: Osteoporosis (OP) is frequent in postmenopausal women, but remains underdiagnosed and undertreated. In Switzerland, DXA is not reimbursed by the insurances for screening, even if it is recommended to test women's Bone Mineral Density (BMD) at the age of 65. Methods: To assess the feasibility of a screening program for OP, the Bone diseases center of Lausanne has been mandated to perform a 2-year information and screening campaign (3 days per months) for women age 60 and older through the state of Vaud using a mobile unit for bone assessment. This project is still ongoing. Women are informed by media for dates and screening locations. Appointments are taken by phone. Women known for osteoporosis or already treated are excluded. During the evaluation every women is assessed by a questionnaire for risk factors, by a DXA measurement (Discovery C, Hololgic), and by Vertebral Fracture Assessment (VFA) for Genant's grades 2 and 3 prevalent vertebral fractures (VF). Women are considered at high risk of fracture if they have a hip fracture, a VF, another fragility fracture with a BMD T-score ≤-2 or a BMD T-score ≤-2.5. Results: After 17 months (50 days of screening), 752 women were assessed, mean age 66±6 yrs, mean BMI 26±5 kg/m2, mean lowest T-score -1.6±1.0 SD. 215 women (29%) were considered at high risk, 92 of them (12%) having established OP and 50 (7%) having one or more fragility VF. VF were unknown for 83% of the women and discovered by VFA. The number needed to screen (NNS) were 3.5 for high risk women, 8.2 for established OP and 15 for VF. Conclusions: After near ¾ of the project, prevalence of women at high risk of fracture was high, with a NNS below 4. Knowing the global cost of OP and that current treatment have a high efficacy for fracture risk reduction, such a screening program could have a positive economic impact. VFA allowed discovering many women with unknown VF, who were at very high risk of further fractures. A systematic screening for VF should be added to BMD measurements after the age of 60.

Retrospective analysis of stored dried blood spots from children with cystic fibrosis and matched controls to assess the performance of a proposed newborn screening protocol in Switzerland.

BACKGROUND: Newborn screening (NBS) for Cystic Fibrosis (CF) has been introduced in many countries, but there is no ideal protocol suitable for all countries. This retrospective study was conducted to evaluate whether the planned two step CF NBS with immunoreactive trypsinogen (IRT) and 7 CFTR mutations would have detected all clinically diagnosed children with CF in Switzerland. METHODS: IRT was measured using AutoDELFIA Neonatal IRT-Kit in stored NBS cards. RESULTS: Between 2006 and 2009, 66 children with CF were reported, 4 of which were excluded for various reasons (born in another country, NBS at 6 months, no informed consent). 98% (61/62) had significantly higher IRT compared to matched control group. There was one false negative IRT result in an asymptomatic child with atypical CF (normal pancreatic function and sweat test). CONCLUSIONS: All children but one with atypical CF would have been detected with the planned two step protocol.

Dépistage des cancers en pratique clinique: une place privilégiée pour le partage de la décision. [Cancer screening in clinical practice: the value of shared decision-making]

Shared decision-making approach to uncertain clinical situations such as cancer screening seems more appropriate than ever. Shared decision making can be defined as an interactive process where physician and patient share all the stages of the decision making process. For patients who wish to be implicated in the management of their health conditions, physicians might express difficulty to do so. Use of patient decision aids appears to improve such process of shared decision making. L'incertitude quant à l'efficacité de certains dépistages de cancers et du traitement en cas de test positif rend l'application du partage de la décision particulièrement appropriée. Le concept du partage de la décision peut être défini comme un processus interactif où le médecin et le patient partagent les étapes du processus de décision. Face aux patients qui désirent être impliqués dans les décisions concernant leur santé, les médecins peinent parfois à le faire. Or, l'utilisation d'outils d'aide à la décision est un moyen efficace de favoriser ce partage de l'information et, si souhaité par le patient, de la décision.

De la recommandation d'un dépistage à son (non) implantation: le cas de l'anévrisme de l'aorte abdominale. [From guidelines for screening to their (poor) implementation: the case of the abdominal aortic aneurysm].

Suite à des essais cliniques randomisés démontrant l'efficacité du dépistage de l'anévrisme de l'aorte abdominale (AAA) par échographie, plusieurs recommandations ont été publiées dans de nombreux pays en faveur du dépistage dans une partie de la population générale. De plus, au-delà de la rupture aortique, le dépistage d'un petit AAA semble être une bonne occasion d'appliquer les stratégies de prévention secondaire, permettant une amélioration globale du pronostic cardiovasculaire du patient. Ces recommandations sont cependant peu suivies; les campagnes de dépistage systématique sont rares, laissant la responsabilité du dépistage au médecin généraliste. Cet article se propose de discuter les raisons de la non-implantation du dépistage de l'AAA. [Abstract] Following the evidence of benefits of ultrasound screening for abdominal aorta aneurysms (AAA), several guidelines support this screening in population. Beyond the prompt diagnosis of AAA prior to its rupture of grim vital prognosis, small AAA can beconsidered as a prognostic marker for cardiovascular diseases (CVD). Yet, its detection is an opportunity for secondary prevention to reduce CVD mortality. Despite, these guidelines are poorly applied: systematic screening campaigns are infrequent, making the screening of family physicians responsibility. While the major benefit from this screening strategy is to reduce AAA-related death (but only trivial effect on long-term total mortality), this explains only partially the lack of guidelines implementation. The reasons of the poor implementation of these guidelines are discussed herein.

Insuffisance rénate chronique: attitudes et pratiques de dépistages en l'absence d'etudes randomisées. [Chronic kidney disease: screening attitude and practice in the absence of randomized controlled trials].

Au vu de l'augmentation de la prévalence de l'insuffisance rénale chronique (IRC), une détection précoce a été proposée. Certaines organisations de santé proposent des mesures de détection précoce (par exemple : taux de filtration glomérulaire). L'efficacité du dépistage de l'IRC n'est cependant pas connue puisqu'aucune étude randomisée contrôlée n'a été conduite. Si le test de dépistage de l'IRC est simple et peu onéreux, un dépistage n'est justifié que s'il améliore le pronostic par rapport à l'absence de dépistage avec un rapport risques-bénéfices favorable et un rapport coût-efficacité acceptable. Sur la base d'études observationnelles et de modèles de rapport coût-efficacité, le dépistage de l'IRC doit être proposé chez les patients hypertendus et/ou diabétiques mais pas dans la population générale. [Abstract] Given the increasing prevalence of chronic kidney disease (CKD), early detection has been proposed. Some organizations recommend CKD screening. Yet, the efficacy of CKD screening is unknown given the absence of randomized controlled trial conducted so far. While CKD screening tests (e.g., glomerular filtration rate) are simple and inexpensive, CKD screening can only be justified if it reduces CKD-related mortality and/or CKD-related morbidity compared to no screening. In addition, CKD screening must provide more benefits than risks to the participants and must be cost-effective. Based on observational studies and cost-effectiveness models, CKD screening has to be proposed to high risk population (patients with hypertension and/or diabetes) but not to the general population.

Alpha-band suppression in the visual word form area as a functional bottleneck to consciousness.

The current state of empirical investigations refers to consciousness as an all-or-none phenomenon. However, a recent theoretical account opens up this perspective by proposing a partial level (between nil and full) of conscious perception. In the well-studied case of single-word reading, short-lived exposure can trigger incomplete word-form recognition wherein letters fall short of forming a whole word in one's conscious perception thereby hindering word-meaning access and report. Hence, the processing from incomplete to complete word-form recognition straightforwardly mirrors a transition from partial to full-blown consciousness. We therefore hypothesized that this putative functional bottleneck to consciousness (i.e. the perceptual boundary between partial and full conscious perception) would emerge at a major key hub region for word-form recognition during reading, namely the left occipito-temporal junction. We applied a real-time staircase procedure and titrated subjective reports at the threshold between partial (letters) and full (whole word) conscious perception. This experimental approach allowed us to collect trials with identical physical stimulation, yet reflecting distinct perceptual experience levels. Oscillatory brain activity was monitored with magnetoencephalography and revealed that the transition from partial-to-full word-form perception was accompanied by alpha-band (7-11 Hz) power suppression in the posterior left occipito-temporal cortex. This modulation of rhythmic activity extended anteriorly towards the visual word form area (VWFA), a region whose selectivity for word-forms in perception is highly debated. The current findings provide electrophysiological evidence for a functional bottleneck to consciousness thereby empirically instantiating a recently proposed partial perspective on consciousness. Moreover, the findings provide an entirely new outlook on the functioning of the VWFA as a late bottleneck to full-blown conscious word-form perception.

Effectiveness of organised versus opportunistic mammography screening.

BACKGROUND: Detailed comparison of effectiveness between organised and opportunistic mammography screening operating in the same country has seldom been carried out. PATIENTS AND METHODS: Prognostic indicators, as defined in the European Guidelines, were used to evaluate screening effectiveness in Switzerland. Matching of screening programmes' records with population-based cancer registries enabled to compare indicators of effectiveness by screening and detection modality (organised versus opportunistic screening, unscreened, interval cancers). Comparisons of prognostic profile were also drawn with two Swiss regions uncovered by service screening of low and high prevalence of opportunistic screening, respectively. RESULTS: Opportunistic and organised screening yielded overall little difference in prognostic profile. Both screening types led to substantial stage shifting. Breast cancer prognostic indicators were systematically more favourable in Swiss regions covered by a programme. In regions without a screening programme, the higher the prevalence of opportunistic screening, the better was the prognostic profile. CONCLUSIONS: Organised screening appeared as effective as opportunistic screening. Mammography screening has strongly influenced the stage distribution of breast cancer in Switzerland, and a favourable impact on mortality is anticipated. Extension of organised mammography screening to the whole of Switzerland can be expected to further improve breast cancer prognosis in a cost-effective way.

Assessing the Glaucoma Quality of Life-15 (GCL-15) Questionnaire, Goldmann Tonometry and Moorfields Motion Displacement Test in Glaucoma Case Finding

Purpose: To compare the performance Glaucoma Quality of Life-15 (GQL-15) Questionnaire, intraocular pressure measurement (IOP Goldmann tonometry) and a measure of visual field loss using Moorfields Motion Displacement Test (MDT) in detecting glaucomatous eyes from a self referred population. Methods: The GQL-15 has been suggested to correlate with visual disability and psychophysical measures of visual function in glaucoma patients. The Moorfields MDT is a multi location perimetry test with 32 white line stimuli presented on a grey background on a standard laptop computer. Each stimulus is displaced between computer frames to give the illusion of "apparent motion". Participants (N=312, 90% older than 45 years; 20.5% family history of glaucoma) self referred to an advertised World Glaucoma Day (March 2009) Jules Gonin Eye Hospital, Lausanne Switzerland. Participants underwent a clinical exam (IOP, slit lamp, angle and disc examination by a general ophthalmologist), 90% completed a GQL-15 questionnaire and over 50% completed a MDT test in both eyes. Those who were classified as abnormal on one or more of the following (IOP >21 mmHg/ GQL-15 score >20/ MDT score >2/ clinical exam) underwent a follow up clinical examination by a glaucoma specialist including imaging and threshold perimetry. After the second examination subjects were classified as "healthy"(H), "glaucoma suspect" (GS) (ocular hypertension and/or suspicious disc, angle closure with SD) or "glaucomatous" (G). Results: One hundred and ten subjects completed all 4 initial examinations; of these 69 were referred to complete the 2nd examination and were classified as; 8 G, 24 GS, and 37 H. MDT detected 7/8 G, and 7/24 GS, with false referral rate of 3.8%. IOP detected 2/8 G and 8/24 GS, with false referral rate of 8.9%. GQL-15 detected 4/8 G, 16/24 GS with a false referral rate of 42%. Conclusions: In this sample of participants attending a self referral glaucoma detection event, the MDT performed significantly better than the GQL-15 and IOP in discriminating glaucomatous patients from healthy subjects. Further studies are required to assess the potential of the MDT as a glaucoma screening tool.

Recovery of postoperative visual loss following treatment of severe anaemia.

A 29-year-old pregnant woman noted acute visual loss following emergent Caesarean section complicated by excessive uterine bleeding. Postoperative visual acuity was count fingers in both eyes. Funduscopic changes were consistent with a diagnosis of anaemia-associated ischaemic optic neuropathy and retinopathy. One month later, because of persistent anaemia and poor visual recovery, blood transfusion was given. Following transfusion, the patient's vision improved over the next 6 months. In an otherwise healthy patient, visual loss associated with postoperative blood loss may still be partially reversible with correction of the anaemia, even after a delayed period of time.

Dépistage: principes et méthodes. [Screening: principles and methods].

The concept of early detection to then intervene and improve the prognostic seems straightforward. Applied to asymptomatic subjects, this concept--screening--is rather complex. This review presents the rational and fundamental principles of screening. It underscores the fundamental principles related to the disease and to the screening test considered, the importance of considering screening as a program rather than a test only, and the validity of measures used to evaluate the efficacy of screening. Lastly, it reviews the most frequently bias encountered in screening studies and interpretations.

La stratégie thérapeutique anti-VEGF améliore le pronostic visuel de la dégénérescence maculaire liée à l'âge exsudative [Intravitreal anti-VEGF injections improve the visual prognosis of wet age related macular degeneration].

Age related macular degeneration (AMD) is an ocular disease with high prevalence among elderly persons. Two different forms exist: dry AMD, usually slowly progressive, and neovascular AMD (wet form) more aggressive. Photodynamic therapy is used to treat the wet form and anti VEGF treatments recently became available and offer a real change in the prognostic of wet AMD. Two products are registered and used in Switzerland (Macugen and Lucentis), a third "off labels product", Avastin is also currently used in clinical practice. Nevertheless, both the duration of treatment and the number of injection requested to stabilise the disease were not defined in the studies. Ongoing studies are mainly evaluating combined treatments and long acting form of the drug.