Ascertaining late-life depressive symptoms in Europe: an evaluation of the survey version of the EURO-D scale in 10 nations. The SHARE project.

The reported prevalence of late-life depressive symptoms varies widely between studies, a finding that might be attributed to cultural as well as methodological factors. The EURO-D scale was developed to allow valid comparison of prevalence and risk associations between European countries. This study used Confirmatory Factor Analysis (CFA) and Rasch models to assess whether the goal of measurement invariance had been achieved; using EURO-D scale data collected in 10 European countries as part of the Survey of Health, Ageing and Retirement in Europe (SHARE) (n = 22,777). The results suggested a two-factor solution (Affective Suffering and Motivation) after Principal Component Analysis (PCA) in 9 of the 10 countries. With CFA, in all countries, the two-factor solution had better overall goodness-of-fit than the one-factor solution. However, only the Affective Suffering subscale was equivalent across countries, while the Motivation subscale was not. The Rasch model indicated that the EURO-D was a hierarchical scale. While the calibration pattern was similar across countries, between countries agreement in item calibrations was stronger for the items loading on the affective suffering than the motivation factor. In conclusion, there is evidence to support the EURO-D as either a uni-dimensional or bi-dimensional scale measure of depressive symptoms in late-life across European countries. The Affective Suffering sub-component had more robust cross-cultural validity than the Motivation sub-component.

Extremity and eye lens doses in interventional radiology and cardiology procedures: first results of the ORAMED project.

The main objective of WP1 of the ORAMED (Optimization of RAdiation protection for MEDical staff) project is to obtain a set of standardised data on extremity and eye lens doses for staff in interventional radiology (IR) and cardiology (IC) and to optimise staff protection. A coordinated measurement program in different hospitals in Europe will help towards this direction. This study aims at analysing the first results of the measurement campaign performed in IR and IC procedures in 34 European hospitals. The highest doses were found for pacemakers, renal angioplasties and embolisations. Left finger and wrist seem to receive the highest extremity doses, while the highest eye lens doses are measured during embolisations. Finally, it was concluded that it is difficult to find a general correlation between kerma area product and extremity or eye lens doses.

Surrogate markers for atheriosclerosis in overweight subjects with atherogenic dyslipidemia : the GEMS project

Rapport de synthèseLe syndrome métabolique (défini par les critères ATP III par la présence au minimum de 3 des facteurs suivants : taux plasmatiques d'HDL-cholestérol < 1,04 mmol/1 chez l'homme et < 1.29 mmol/1 chez la femme, taux plasmatiques de triglycérides > 1,69 mmol/1, tension artérielle > 130/85 mmHg, glycémie >6,1 mmol/1, tour de taille > 108 cm chez l'homme et > 88 cm chez la femme) représente une constellation de facteurs de risque majeurs pour le développement de maladies cardiovascu-laires. Il n'est pas encore établi actuellement quelle composante de ce syndrome contribue de manière plus marquée au risque de développer une athérosclérose. Dans le but d'éclaircir la pathogenèse de ce syndrome, une étude multicentrique intitulée GEMS (« Genetic Epidemiology of Metabolic Syndrome ») a été initiée afin de déterminer si la constellation d'une dyslipidémie avec HDL-C bas et TG élevé est un marqueur sensible de l'homogénéité génétique chez les individus atteints de syndrome métabolique.Dans l'étude menée à Lausanne (multicentrique), la contribution de la dyslipidémie avec HDL-C bas et TG élevé dans la pathogenèse de l'athérosclérose a été évaluée par 2 examens, reconnus comme marqueurs fiables de la vasculopathie : la mesure de l'épaisseur intima média carotidienne par ultrasonographic et l'évaluation de la dysfonction endothéliale de la microcirculation cutanée. Deux groupes de sujets comparables en terme d'âge et de sexe et souffrant d'un excès pondéral (BMI > 25 kg/m2) mais normoglycémiques ont été comparés. Ces deux groupes (étude cas-témoins) étaient uniquement discordants quant à leurs profils lipidiques. Ainsi, 120 cas, définis comme ayant un HDL-cholestérol bas (< 25 percentile pour l'âge et le sexe dans la population générale) et des TG élevés (> 75 percentile) ont été comparés à 120 contrôles avec un HDL-cholestérol haut (> 50 percentile) et des TG bas (< 50 percentile). Un doppler des artères carotides et fémorales a été effectué pour déterminer l'épaisseur de l'intima média et la présence ou non de plaques d'athérome. La fonction endothéliale a été évaluée par un laser doppler sur la micro-circulation cutanée (réponse hyperémique à une occlusion transitoire de la circulation de l'avant-bras par une manchette à pression et mesure de la vasodilatation induite par un échauffement local de la peau avec de l'eau). Un enregistrement de la pression artérielle ambulatoire sur la journée (Remler) a été pratiqué chez tous les sujets.Les résultats obtenus montrent que les cas ont une prévalence plus élevée de plaques d'athérome (médiane 1,5 ± 0,15 vs 0,8 > 0,15, p<.001), une épaisseur intima média plus importante (médiane 0,66 ± 0,15 vs 0,61 ± 0,15, p<.01), ainsi qu'une réduction significative de la vasodilatation endothéliale induite par la chaleur et post-ischémique comparativement aux contrôles.En conclusion, le profil lipidique associant un HDL-cholestérol bas et des triglycérides élevés représente un risque majeur de développer une maladie athéromateuse périphérique et est associée à une augmentation de l'épaisseur intima média et une altération de la fonction endothéliale chez les individus en surcharge pondérale. Bien qu'un HDL-cholestérol bas soit fréquemment associé à une hypertriglycéridémie, les résultats de notre étude peuvent suggérer un rôle potentiel de la fraction HDL-cholestérol comme un puissant agent anti-athérogénique.

Staff eye lens and extremity exposure in interventional cardiology: Results of the ORAMED project

Within the ORAMED project a coordinated measurement program for occupationally exposed medical staff was performed in different hospitals in Europe. The main objectives of ORAMED were to obtain a set of standardized data on doses for staff in interventional cardiology and radiology and to optimize staff protection. Doses were measured with thermoluminescent dosemeters on the ring finger and wrist of both hands, on legs and at the level of the eyes of the main operator performing interventional procedures. In this paper an overview of the doses per procedure measured during 646 interventional cardiology procedures is given for cardiac angiographies and angioplasties (CA/PTCA), radiofrequency ablations (RFA) and pacemaker and defibrillator implantations (PM/ICD). 31% of the monitored procedures were associated with no collective protective equipment, whereas 44% involved a ceiling screen and a table curtain. Although associated with the smallest air kerma - area product (KAP), PM/ICD procedures led to the highest doses. As expected, KAP and doses values exhibited a very large variability. The left side of the operator, most frequently the closest to the X-ray scattering region, was more exposed than his right side. An analysis of the effect of parameters influencing the doses, namely collective protective equipment, X-ray tube configuration and catheter access route, was performed on the doses normalized to KAP. Ceiling screen and table curtain were observed to reduce normalized doses by atmost a factor 4, much smaller than theoretical attenuation factors typical for such protections, i.e. from 10 to 100. This observation was understood as their inappropriate use by the operators and their non-optimized design. Configurations with tube above the patient led to higher normalized doses to the operator than tube below, but the effect of using a biplane X-ray suite was more complex to analyze. For CA/PTCA procedures, the upper part of the operator's body received higher normalized doses for radial than for femoral catheter access, by atmost a factor 5. This could be seen for cases with no collective protection. The eyes were observed to receive the maximum fraction of the annual dose limit almost as frequently as legs and hands, and clearly the most frequently, if the former 150 mSv and new 20 mSv recommended limits for the lens of the eye are considered, respectively.

Measurements of eye lens doses in interventional radiology and cardiology: Final results of the ORAMED project

Within the ORAMED project (Optimization of Radiation Protection of Medical Staff) a coordinated measurement program for occupationally exposed medical staff was performed in different hospitals in Europe (www.oramed-fp7.eu). The main objective was to obtain a set of standardized data on extremity and eye lens doses for staff involved in interventional radiology and cardiology and to optimize radiation protection. Special attention was given to the measurement of the doses to the eye lenses. In this paper an overview will be given of the measured eye lens doses and the main influence factors for these doses. The measured eye lens doses are extrapolated to annual doses. The extrapolations showed that monitoringof the eye lens should be performed on routine basis.

The Swiss Willensnation at Risk: Teachers in the Cultural Gap during the First World War

As a neutral and multilingual country, Switzerland struggled with major domestic political conflicts during the First World War due to the two cultures of the French-speaking and German-speaking parts of the country. The divided cultural loyalties ('fossé moral', 'Röstigraben'), consisting of Swiss-Germans supporting Germany and Swiss-French supporting France, were discussed intensively in both of the main teachers' journals in Switzerland. Teachers felt the need to react and to promote unity from the beginning of the war. Despite the fact that the cantons are responsible for public education and, therefore, for the education of their students, teachers considered themselves called to educate their students to be national citizens rather than to be members of a language group. This threefold citizenship - communal, cantonal and national - was not scrutinised, but national unity became crucial due to the critical political circumstances. How did teachers promote and constitute citizenship for themselves and for their students in a nation united by free will during the First World War, a time of severe internal political conflicts?

Dialyse et écologie: est-il possible de faire mieux à l'avenir [Dialysis and ecology: can we do better in the future?].

Development of dialysis has saved the lives of many patients. However, haemodialysis and peritoneal dialysis are very demanding in resources such as water and electricity, and generate a large amount of waste. In this article, we will review the environmental aspects of dialysis. Different solutions will be discussed, such as recycling of water discharged during reverse osmosis, the integration of solar energy, recycling of waste plastics, and the use of other techniques such as sorbent dialysis. In a world where natural resources are precious and where global warming is a major problem, it is important that not only dialysis, but all branches of medicine become more attentive to ecology.