Attachment, psychopathology, and religion: Introduction to this special section of Mental Health, Religion, & Culture

An international conference of psychology of religion, organised at the University of Lausanne (Switzerland) on 16 May 2012, took up the theme: "Attachment, psychopathology, and religion". Four speakers were invited: Pehr Granvist, Andrew Gumley, Isabelle Rieben, and Pascal Roman. Their reworked contributions are gathered in this special section of Mental Health, Religion, & Culture. The goal of this special section is to re-examine the whole of this subject of the bond between attachment and religion and/or spirituality in the cases of those persons suffering from mental health disorders.

Finding an apprenticeship : hidden curriculum and social consequences

In Switzerland, the majority of students are oriented towards professional training after compulsory schooling. At this stage, one of the biggest challenges for them is to find an apprenticeship position. Matching supply and demand is a complex process that not only excludes some students from having direct access to professional training but also forces them to make early choices regarding their future sector of employment. So, how does one find an apprenticeship? And what do the students' descriptions of their search for apprenticeships reveal about the institutional determinants of social inequalities at play in the system? Based on 29 interviews conducted in 2014 with 23 apprentices and 6 recruiters in the Canton of Vaud, this article interrogates how the dimensions of educational and social trajectories combine to affect access to apprenticeships and are accentuated by recruiters using a "hidden curriculum" during the recruitment process. A hidden curriculum consists of knowledge and skills not taught by the educational institution but which appear decisive in obtaining an apprenticeship. By analysing the contrasting experiences of students in their search for an apprenticeship, we identify four types of trajectories that explain different types of school-to-apprenticeship transitions. We show how these determinants are reinforced by the "hidden curriculum" of recruitment based on the soft skills of feeling, autonomy, anticipation and reflexivity that are assessed in the context of recruitment interactions. The discussion section debates how the criteria that appear to be used to identify the "right apprentice" tend to (re)produce inequalities between students. This not only depends on their academic results but also on their social and cultural skills, their ability to anticipate their choices and, more widely, their ability to be a subject in their recruitment search. "The Subject is neither the individual, nor the self, but the work through which an individual transforms into an actor, meaning an agent able to transform his/her situation instead of reproducing it." (Touraine, 1992, p.476).

Switzerland as a "fractured" nation

This article deals with Swiss nationalism and Swiss nation-building. Its main thesis is that Switzerland cannot accurately be described as either a nation or a non-nation but is something in between, and could thus best be characterised as a 'fractured' nation. Switzerland has experienced some powerful nationalist moments, from the creation of the Swiss state in 1848 to the last few decades. Yet this recurrent nationalism among the Swiss, considered alongside their more traditional reluctance to consider themselves a nation, make Switzerland a peculiar object: a 'fractured' nation. This flawed process of nation-building in turn reveals some basic characteristics of all nations - inherent artificiality, and the tremendous efforts undertaken to hide it. Switzerland could be considered an unfinished, incomplete nation, and this is precisely why its study can be interesting for scholars of nations and nationalism.

Adjusting for the environment in DEA: a comparison of alternative models based on empirical data

Due to the existence of free software and pedagogical guides, the use of Data Envelopment Analysis (DEA) has been further democratized in recent years. Nowadays, it is quite usual for practitioners and decision makers with no or little knowledge in operational research to run their own efficiency analysis. Within DEA, several alternative models allow for an environmental adjustment. Four alternative models, each user-friendly and easily accessible to practitioners and decision makers, are performed using empirical data of 90 primary schools in the State of Geneva, Switzerland. Results show that the majority of alternative models deliver divergent results. From a political and a managerial standpoint, these diverging results could lead to potentially ineffective decisions. As no consensus emerges on the best model to use, practitioners and decision makers may be tempted to select the model that is right for them, in other words, the model that best reflects their own preferences. Further studies should investigate how an appropriate multi-criteria decision analysis method could help decision makers to select the right model.

Eligibility to treatment and economic effect of the implementation of the new U.S. or European Society of Hypertension/European Society of Cardiology hypertension guidelines.

OBJECTIVE: To evaluate the population and economic impact of implementing the new Joint National Committee (JNC) or European Society of Hypertension (ESH)/European Society of Cardiology (ESC) hypertension guidelines in the Swiss population. METHODS: Cross-sectional, population-based sample (6708 participants) collected between 2003 and 2006 in the city of Lausanne, Switzerland. Blood pressure categories were defined according to both the JNC (JNC-7 and JNC-8) and the ESH/ESC (2007 and 2013) guidelines. RESULTS: The proportion of participants aged 35-60 years eligible for drug treatment was 25.6% [95% confidence interval (CI) 24.4-26.9%] and 24.8% (95% CI 23.6-26.0%) for the JNC-7 and the JNC-8 guidelines, respectively; for participants aged 60-75 years, the values were 62.3% (95% CI 60.1-64.5%) and 46.8% (95% CI 44.5-49.0%), respectively. Shifting from the JNC-7 to the JNC-8 guidelines would lead to an annual saving of 163.6 million Swiss francs (187.7 million US dollars or 134.5 million European euro). The proportion of participants aged 35-75 years without chronic kidney disease, diabetes mellitus or reported history of cardiovascular disease and eligible for treatment was 30.2% (95% CI 29.0-31.4%) for the ESH/ESC 2007 and 2013 guidelines. For participants with chronic kidney disease, diabetes mellitus or reported history of cardiovascular disease, the values were 73.6% (95% CI 70.8-76.3%) and 55.6% (95% CI 52.5-58.8%), respectively. Shifting from the ESH/ESC 2007 to the ESH/ESC 2013 guidelines would lead to an annual saving of 86.9 million Swiss francs (99.5 million US dollars or 71.4 million European euro). CONCLUSION: In Switzerland, shifting from the JNC-7 to the JNC-8 guidelines or from the ESH/ESC 2007 to the ESH/ESC 2013 guidelines would decrease the prevalence of patients eligible for treatment and increase the percentage of treated patients within blood pressure goals. Both strategies lead to potential savings in antihypertensive drug treatment.

Aux sources de l'orthopédie clinique : l'histoire revisitée de Jean-André Venel, "père de l'orthopédie" (fin XVIIIe-début XIXe siècle)

(ENGLISH VERSION BELOW) En 1780, le médecin Jean-André Venel fonde à Orbe, dans le canton de Vaud, le premier institut orthopédique connu dans le monde, proposant une version clinique d'un savoir-faire médical ancestral. A travers des sources qui réactualisent les travaux consacrés à Venel, cet article retrace les origines de son institution et de sa pensée médicale, dans un contexte de production et de diffusion d'un savoir particulier en termes de technique du corps et de médecine de l'enfant. Revisitant la figure légendaire - ou mythique ? - de ce que l'histoire de la médecine a retenu comme étant le « père de l'orthopédie », l'article s'interroge par la même occasion sur les conditions d'émergence d'une spécialité médicale au sortir de l'Ancien Régime, et de son impact dans les premières décennies du XIXe siècle. In 1780, the physician Jean-André Venel creates in Orbe (canton of Vaud) the first orthopedic institute of the world, offering a clinical version of an ancient medical savoir-faire. By using sources that enable us to update the scholarship on Venel, this article traces the origins of his institute and of his medical thought, in the context of the production and diffusion of a specialized knowledge on the body and on children. With this new perspective on the legendary, if not mythical, figure, whom the history of medicine has canonized as the "father of orthopedia", this article also examines the conditions of emergence of a medical specialization at the end of the Ancien Régime and its impact in the first decades of the nineteenth century.

Urinary oxalate and urate to creatinine ratios in a healthy pediatric population.

The purpose of the study was to determine reference percentiles for the urinary (U) oxalate (Ox) and urate (Ura) to creatinine (Cr) concentration ratios in the second morning urine of healthy infants, children, and adolescents. The urinary oxalate and urate to creatinine ratios were determined in the spontaneously voided second morning urine sample. To test reproducibility, two urine samples were analyzed on 2 consecutive weeks in 63% of the subjects. Three hundred eighty-four healthy children (181 girls, 203 boys), aged 1 month to 17 years, from nurseries, kindergartens, and schools of Lausanne, Switzerland, were studied. The 5th and 95th percentiles were determined from the total number of urine samples (627) after confirmation that there was no order effect between repeated measurements and there were no significant sex differences. A nonlinear regression analysis in terms of age was used to smooth the calculated percentiles. In this manner, curves were obtained from which the reference values can be read at any given age. The 95th percentiles decreased with age: for UOx/Cr from 0.175 mg/mg (0.22 mol/mol) at 1 to 6 months to 0.048 mg/mg (0.06 mol/mol) from 7 years and beyond; and UUra/Cr from 2.378 mg/mg (1.6 mol/mol) at 1 to 6 months to 0.594 mg/mg (0.4 mol/mol) in adolescence. We provide 5th and 95th percentile curves for the UOx/Cr and UUra/Cr ratios determined from the second morning urine samples in a large cohort of healthy infants, children, and adolescents. Values were determined by standard analytical chemical techniques and were analyzed by powerful statistical methods. The calculated 95th percentile for the UOx/Cr values fell rather rapidly and reached normal adult values by the age of 7 years, whereas for UUra/Cr, the 95th percentile decreased slowly and stabilized in adolescence.

Rôle des paramètres sociopolitiques et des connaissances dans la gestion des risques hydrologiques

Résumé Rôle des paramètres sociopolitiques et des connaissances dans la gestion des risques hydrologiques¦La recherche analyse (1) la mise en oeuvre de la gestion des risques hydrologiques et (2) les connaissances dont disposent les acteurs sur ces derniers, ainsi que (3) les interdépendances entre ces deux volets. Au total, trois études de cas ont été réalisées dont deux études régionales (ville de Berne, commune de Saillon) et une étude sur un acteur spécifique (les corporations de digues dans le canton de Berne). Les données empiriques ont été obtenues par des entretiens oraux semi-directifs et des enquêtes écrites.¦La gestion des risques hydrologiques est fortement influencée par des paramètres sociopolitiques, c'est-à-dire par les intérêts et les objectifs des acteurs, par les rapports de force entre ceux-ci ainsi que par les processus de négociation et de décision. Dans la pratique, les démarches de gestion se restreignent toutefois majoritairement aux aspects physiques, techniques et administratifs des risques hydrologiques. La dimension sociopolitique est ainsi négligée, ce qui est source de conflits qui ralentissent considérablement la planification de la protection contre les crues, voire la bloquent même complètement. La gestion des risques hydrologiques est en outre largement focalisée sur la réduction des aléas. Lés débats sur la vulnérabilité sont nettement plus rares bien qu'ils soient indispensables lorsqu'il s'agit de traiter les risques de façon holistique.¦Etant donné l'importance de la dimension sociopolitique et de la vulnérabilité, il est nécessaire que les démarches prévues dans la gestion des risques hydrologiques soient reconsidérées et adaptées. De plus, une meilleure intégration de tous les acteurs concernés est primordiale afin de trouver des solutions qui soient acceptables pour une majorité. Pour l'instant, le recours à des instruments de négociation est insuffisant.¦Les connaissances des risques hydrologiques et de leur gestion peuvent être classées en quatre répertoires (connaissances du système, de l'événement, de l'intervention et connaissances sociopolitiques) qui influent tous sur la réduction des risques. Parmi les facteurs les plus importants susceptibles de déclencher des transformations se trouvent l'occurrence de crues, la réalisation d'études (portant sur les aléas, la vulnérabilité, les mesures, etc.), l'échange de connaissances entre les acteurs, ainsi que la recherche de solutions lors de la gestion.¦Les caractéristiques des connaissances varient considérablement selon les acteurs. L'appartenance à un groupe donné ne permet toutefois pas à elle seule de déterminer l'état des connaissances : tous les acteurs peuvent avoir des connaissances pertinentes pour la gestion des risques. Les différences entre les acteurs rendent pourtant la communication compliquée. Ce problème pourrait être atténué par des médiateurs qui assureraient un travail de traduction. Dans la pratique, de telles instances manquent généralement.¦La gestion et les connaissances des risques hydrologiques sont fortement interdépendantes. L'état et les caractéristiques des connaissances déterminent directement la qualité de la protection contre les crues. Des lacunes ou des imprécisions peuvent donc entraîner une gestion non adaptée aux risques présents. Afin d'éviter une telle situation, il est important que les connaissances sur les risques hydrologiques et sur les possibilités d'y faire face soient régulièrement remises à jour. Ne devant pas se restreindre à l'expérience de crues passées, il est impératif qu'elles contiennent aussi des réflexions prospectives et des scénarios novateurs.¦La gestion n'est pas seulement demandeuse en connaissances, elle est également susceptible d'en générer de nouvelles et d'élargir les connaissances existantes. Il convient donc de considérer la création et le transfert de connaissances comme une tâche centrale de la gestion des risques.¦Zusammenfassung Die Rolle der soziopolitischen Parameter und des Wissens im Umgang mit hydrologischen Risiken¦Die Arbeit untersucht drei Themenbereiche: (1) den soziopolitischen Umgang mit hydrologischen Risiken, (2) das Wissen, über das die Akteure bezüglich der Hochwasserrisiken verfügen sowie (3) die Wechselwirkungen zwischen diesen beiden Themenfeldern. Insgesamt wurden drei Fallstudien durchgeführt, darunter zwei regionale Studien (Stadt Bern, Gemeinde Saillon) und eine Untersuchung eines spezifischen Akteurs (Schwellenkorporationen im Kanton Bern). Die empirischen Daten wurden anhand von halbstandardisierten Interviews und schriftlichen Umfragen erhoben.¦Das Management hydrologischer Risiken ist stark von soziopolitischen Parametern beeinflusst, d.h. von Interessen und Zielvorstellungen der Akteure, von Machtverhältnissen und von Verhandlungs- und Entscheidungsprozessen. Die in der Praxis vorgesehenen Schritte zur Reduktion der Hochwasserrisiken beschränken sich jedoch meist auf die physischen, administrativen und technischen Aspekte der Risiken. Die Vernachlässigung ihrer soziopolitischen Dimension führt zu Konflikten, welche die Planung von Hochwasserschutzprojekten deutlich verlangsamen oder gar blockieren. Des Weiteren konzentriert sich das Risikomanagement im Wesentlichen auf die Reduktion der Gefahren. Gesellschaftliche Debatten zur Vulnerabilität sind deutlich seltener, obschon sie für einen umfassenden Umgang mit Risiken unabdingbar sind.¦Angesichts der Bedeutung der soziopolitischen Dimension und der Vulnerabilität ist es notwendig, dass die Vorgehensweise im Risikomanagement überdacht und angepasst wird. Zudem ist eine bessere Integration aller betroffener Akteure unablässig, um mehrheitsfähige Lösungen zu finden. Zur Zeit ist der Rückgriff auf entsprechende Instrumente ungenügend.¦Das Wissen über hydrologische Risiken und deren Management kann in vier Repertoires eingeteilt werden (Systemwissen, Ereigniswissen, Interventionswissen, soziopolitisches Wissen), die alle bei der Reduktion von Risiken bedeutsam sind. Zu den wichtigsten Faktoren, die Wissenstransformationen auslösen, gehören Hochwasserereignisse, die Durchführung von Studien (zu Gefahren, zur Vulnerabilität, zu Massnahmen usw.), der Wissensaustausch zwischen Akteuren und die Suche nach Lösungen während des Risikomanagements.¦Die Merkmale der Wissensformen unterschieden sich stark zwischen den verschiedenen Akteuren. Die Zugehörigkeit eines Akteurs zu einer bestimmten Gruppe ist jedoch kein ausreichendes Kriterium, um dessen Wissensstand zu bestimmen: Alle Akteure können über Wissen verfügen, das für den Umgang mit Risiken relevant ist. Die Unterschiede zwischen den Akteuren gestalten die Kommunikation allerdings schwierig. Das Problem liesse sich entschärfen, indem Mediatoren eingesetzt würden, die als Übersetzer und Vermittler agierten. In der Praxis fehlen solche Instanzen weitgehend.¦Zwischen dem Umgang mit hydrologischen Risken und dem Wissen bestehen enge Wechselwirkungen. Der Zustand und die Eigenschaften der Wissensformen bestimmen direkt die Qualität des Hochwasserschutzes. Lückenhaftes und unpräzises Wissen kann demnach zu einem Risikomanagement führen, das den tatsächlichen Gegebenheiten nicht angepasst ist. Um eine solche Situation zu verhindern, muss das Wissen über Risiken und Hochwasserschutz regelmässig aktualisiert werden. Dabei darf es sich nicht auf die Erfahrung vergangener Hochwasser beschränken, sondern hat auch vorausschauende Überlegungen und neuartige Szenarien einzubeziehen.¦Das Risikomanagement benötigt nicht nur Wissen, es trägt auch dazu bei, neues Wissen zu t generieren und bestehendes zu erweitern. Die Erarbeitung und der Transfer von Wissen sind deshalb als zentrale Aufgaben des Risikomanagements zu betrachten.¦Abstract¦The role of socio-political parameters and of knowledge in the management of hydrological risks¦The purpose of the thesis is to analyse (1) the socio-political management of hydrological risks, (2) the knowledge about hydrological risks, and (3) the interaction between risk management and knowledge. Three case studies were carried out, two at a regional level (city of Berne, village of Saillon) and one about a specific stakeholder (the dyke corporations in the canton of Berne). Empirical data were collected by the means of semi-structured interviews and surveys.¦The management of hydrological risks is highly influenced by socio-political issues, i.e. by interests and goals of stakeholders, by the balance of power between stakeholders, as well as by negotiations and decision-making processes. In practice, however, risk management is mainly constrained by physical, technical, and administrative aspects. The neglect of the socio-political dimension may thus be the source of conflicts which significantly delay the planning and implementation of flood protection measures, or even stop them. Furthermore, risk management mostly concentrates on hazard reduction. Discussions on vulnerability issues are less frequent although they are fundamental for treating risks in a holistic manner.¦Because of the importance of the social-political dimension and of vulnerability issues, it is necessary that the common approach of managing hydrological risks is reconsidered and adapted. Moreover, the integration of all stakeholders that are concerned with hydrological risks is essential for finding solutions which are supported by a majority. For instance, the application of appropriate negotiation instruments is insufficient.¦Knowledge about hydrological risks and their management can be classified into four categories (system knowledge, event knowledge, intervention knowledge, socio-political knowledge) which are all influencing the reduction of risks. Among the most important factors that are likely to trigger knowledge transformations, one can point out flood events, studies about risk parameters (hazards, vulnerability, protection measures, etc.), knowledge exchange between stakeholders, and the search for solutions during risk management.¦The characteristics of knowledge vary considerably between stakeholders. The affiliation to a specific group is thus not a sufficient criterion to determine the quality of a stakeholder's knowledge: every stakeholder may have knowledge that is relevant for risk management. However, differences between stakeholders complicate the communication. This problem could be attenuated by mediators which ensure the translation between stakeholders. In practice, such instances are generally lacking.¦The management and knowledge of hydrological risks are highly interdependent. The state and the characteristics of the four categories of knowledge determine directly the quality of flood protection. Gaps and imprecison may thus lead to forms of management which are not adapted to the actual risks. This kind of situation can be avoided by updating regularly the knowledge about hydrological risks and about protection measures. However, knowledge must not be restricted to the experience of past floods. On the contrary, it is indispensable also to involve prospective reflections and new scenarios.¦Risk management does not only require knowledge, it may also generate new knowledge and enlarge existing knowledge. The creation and the transfer of knowledge has thus to be seen as a central task in risk management.

Debris flow hazard modelling on medium scale: Valtellina di Tirano, Italy

Debris flow hazard modelling at medium (regional) scale has been subject of various studies in recent years. In this study, hazard zonation was carried out, incorporating information about debris flow initiation probability (spatial and temporal), and the delimitation of the potential runout areas. Debris flow hazard zonation was carried out in the area of the Consortium of Mountain Municipalities of Valtellina di Tirano (Central Alps, Italy). The complexity of the phenomenon, the scale of the study, the variability of local conditioning factors, and the lacking data limited the use of process-based models for the runout zone delimitation. Firstly, a map of hazard initiation probabilities was prepared for the study area, based on the available susceptibility zoning information, and the analysis of two sets of aerial photographs for the temporal probability estimation. Afterwards, the hazard initiation map was used as one of the inputs for an empirical GIS-based model (Flow-R), developed at the University of Lausanne (Switzerland). An estimation of the debris flow magnitude was neglected as the main aim of the analysis was to prepare a debris flow hazard map at medium scale. A digital elevation model, with a 10 m resolution, was used together with landuse, geology and debris flow hazard initiation maps as inputs of the Flow-R model to restrict potential areas within each hazard initiation probability class to locations where debris flows are most likely to initiate. Afterwards, runout areas were calculated using multiple flow direction and energy based algorithms. Maximum probable runout zones were calibrated using documented past events and aerial photographs. Finally, two debris flow hazard maps were prepared. The first simply delimits five hazard zones, while the second incorporates the information about debris flow spreading direction probabilities, showing areas more likely to be affected by future debris flows. Limitations of the modelling arise mainly from the models applied and analysis scale, which are neglecting local controlling factors of debris flow hazard. The presented approach of debris flow hazard analysis, associating automatic detection of the source areas and a simple assessment of the debris flow spreading, provided results for consequent hazard and risk studies. However, for the validation and transferability of the parameters and results to other study areas, more testing is needed.

Depression with atypical features and increase in obesity, body mass index, waist circumference, and fat mass: a prospective, population-based study.

IMPORTANCE: Depression and obesity are 2 prevalent disorders that have been repeatedly shown to be associated. However, the mechanisms and temporal sequence underlying this association are poorly understood. OBJECTIVE: To determine whether the subtypes of major depressive disorder (MDD; melancholic, atypical, combined, or unspecified) are predictive of adiposity in terms of the incidence of obesity and changes in body mass index (calculated as weight in kilograms divided by height in meters squared), waist circumference, and fat mass. DESIGN, SETTING, AND PARTICIPANTS: This prospective population-based cohort study, CoLaus (Cohorte Lausannoise)/PsyCoLaus (Psychiatric arm of the CoLaus Study), with 5.5 years of follow-up included 3054 randomly selected residents (mean age, 49.7 years; 53.1% were women) of the city of Lausanne, Switzerland (according to the civil register), aged 35 to 66 years in 2003, who accepted the physical and psychiatric baseline and physical follow-up evaluations. EXPOSURES: Depression subtypes according to the DSM-IV. Diagnostic criteria at baseline and follow-up, as well as sociodemographic characteristics, lifestyle (alcohol and tobacco use and physical activity), and medication, were elicited using the semistructured Diagnostic Interview for Genetic Studies. MAIN OUTCOMES AND MEASURES: Changes in body mass index, waist circumference, and fat mass during the follow-up period, in percentage of the baseline value, and the incidence of obesity during the follow-up period among nonobese participants at baseline. Weight, height, waist circumference, and body fat (bioimpedance) were measured at baseline and follow-up by trained field interviewers. RESULTS: Only participants with the atypical subtype of MDD at baseline revealed a higher increase in adiposity during follow-up than participants without MDD. The associations between this MDD subtype and body mass index (β = 3.19; 95% CI, 1.50-4.88), incidence of obesity (odds ratio, 3.75; 95% CI, 1.24-11.35), waist circumference in both sexes (β = 2.44; 95% CI, 0.21-4.66), and fat mass in men (β = 16.36; 95% CI, 4.81-27.92) remained significant after adjustments for a wide range of possible cofounding. CONCLUSIONS AND RELEVANCE: The atypical subtype of MDD is a strong predictor of obesity. This emphasizes the need to identify individuals with this subtype of MDD in both clinical and research settings. Therapeutic measures to diminish the consequences of increased appetite during depressive episodes with atypical features are advocated.

Referral patterns and outcomes in noncritically ill patients with hospital-acquired acute kidney injury.

Background and objectives Despite modern treatment, the case fatality rate of hospital-acquired acute kidney injury (HA-AKI) is still high. We retrospectively described the prevalence and the outcome of HA-AKI without nephrology referral (nrHA-AKI) and late referred HA-AKI patients to nephrologists (lrHA-AKI) compared with early referral patients (erHA-AKI) with respect to renal function recovery, renal replacement therapy (RRT) requirement, and in-hospital mortality of HA-AKI. Design, setting, participants, & measurements Noncritically ill patients admitted to the tertiary care academic center of Lausanne, Switzerland, between 2004 and 2008 in the medical and surgical services were included. Acute kidney injury was defined using the Acute Kidney Injury Network (AKIN) classification. Results During 5 years, 4296 patients (4.12% of admissions) experienced 4727 episodes of HA-AKI during their hospital stay. The mean ± SD age of the patients was 61 ± 15 years with a 55% male predominance. There were 958 patients with nrHA-AKI (22.3%) and 2504 patients with lrHA-AKI (58.3%). RRT was required in 31% of the patients with lrHA-AKI compared with 24% of the patients with erHA-AKI. In the multiple risk factor analysis, compared with erHA-AKI, nrHA-AKI and lrHA-AKI were significantly associated with worse renal outcome and higher in-hospital mortality. Conclusions These data suggest that HA-AKI is frequent and the patients with nrHA-AKI or lrHA-AKI are at increased risk for in-hospital morbidity and mortality.

Cross-coding from the Swiss Disability Insurance listing to the ICIDH.

It has been suggested that converting, via a process of cross-coding, the listing used by the Swiss Disability Insurance (SDI) for their statistics into codes of the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) would improve the quality and international comparability of disability statistics for Switzerland. Using two different methods we tested the feasibility of this cross-coding on a consecutive sample of 204 insured persons, examined at one of the medical observation centres of the SDI. Cross-coding is impossible, for all practical purposes, in a proportion varying between 30% and 100%, depending on the method of cross-coding, the level of disablement and the required quality of the resulting codes. Failure is due to lack of validity of the SDI codes: diseases are poorly described, consequences of diseases (disability and handicap, including loss of earning capacity), insufficiently described or not at all. Assessment of disability and handicap would provide necessary information for the SDI. It is concluded that the SDI should promote the use of the ICIDH in Switzerland, especially among medical practitioners whose assessment of work capacity is the key element in the decision to award benefits or propose rehabilitation.

Optimizing patient-ventilator synchrony during invasive ventilator assist in children and infants remains a difficult task.

OBJECTIVES: To document and compare the prevalence of asynchrony events during invasive-assisted mechanical ventilation in pressure support mode and in neurally adjusted ventilatory assist in children. DESIGN: Prospective, randomized, and crossover study. SETTING: Pediatric and Neonatal Intensive Care Unit, University Hospital of Geneva, Switzerland. PATIENTS: Intubated and mechanically ventilated children, between 4 weeks and 5 years old. INTERVENTIONS: Two consecutive ventilation periods (pressure support and neurally adjusted ventilatory assist) were applied in random order. During pressure support, three levels of expiratory trigger setting were compared: expiratory trigger setting as set by the clinician in charge (PSinit), followed by a 10% (in absolute values) increase and decrease of the clinician's expiratory trigger setting. The pressure support session with the least number of asynchrony events was defined as PSbest. Therefore, three periods were compared: PSinit, PSbest, and neurally adjusted ventilatory assist. Asynchrony events, trigger delay, and inspiratory time in excess were quantified for each of them. MEASUREMENTS AND MAIN RESULTS: Data from 19 children were analyzed. Main asynchrony events during PSinit were autotriggering (3.6 events/min [0.7-8.2]), ineffective efforts (1.2/min [0.6-5]), and premature cycling (3.5/min [1.3-4.9]). Their number was significantly reduced with PSbest: autotriggering 1.6/min (0.2-4.9), ineffective efforts 0.7/min (0-2.6), and premature cycling 2/min (0.1-3.1), p < 0.005 for each comparison. The median asynchrony index (total number of asynchronies/triggered and not triggered breaths ×100) was significantly different between PSinit and PSbest: 37.3% [19-47%] and 29% [24-43%], respectively, p < 0.005). With neurally adjusted ventilatory assist, all types of asynchrony events except double-triggering and inspiratory time in excess were significantly reduced resulting in an asynchrony index of 3.8% (2.4-15%) (p < 0.005 compared to PSbest). CONCLUSIONS: Asynchrony events are frequent during pressure support in children despite adjusting the cycling off criteria. Neurally adjusted ventilatory assist allowed for an almost ten-fold reduction in asynchrony events. Further studies should determine the clinical impact of these findings.

Comment faire de la surveillance sanitaire ? L'exemple de l'Observatoire valaisan de la santé en Suisse

Objectif : décrire les buts et les méthodes de la surveillance sanitaire contemporaine et présenter les activités de l'Observatoire valaisan de la santé (OVS), un outil unique en Suisse de surveillance sanitaire pour la population d'un canton. Méthodes : revue narrative et présentation des activités de l'OVS. Résultats : la surveillance sanitaire est la récolte, l'analyse, l'interprétation et la dissémination continues et systématiques de données sanitaires essentielles à la planification en santé publique. Elle s'organise en tenant compte des enjeux contemporains de santé publique. La Suisse est dans une ère de prépondérance des affections chroniques à cause du vieillissement de la population. Cette ère de la « nouvelle santé publique » est aussi caractérisée par l'importance grandissante des technologies médicales, de la gestion rationnelle des risques, de la médecine préventive et de la promotion de la santé et du rôle central du citoyen/patient. Les technologies de l'information donnent accès à de nouvelles données sanitaires mais nécessitent d'adapter les méthodes de surveillance. En Suisse, la surveillance sanitaire est morcelée car elle est conduite par des acteurs fédéraux, cantonaux, publics et privés. Le canton du Valais dispose de l'OVS, un outil de surveillance intégratif, régional et réactif. Conclusion : la surveillance sanitaire produit de l'information permettant la décision et l'action dans le domaine de la santé. C'est un élément-clé de la planification sanitaire.