Risk factors of obesity and their determinants in preschool children (the Swiss Ballabeina study)

This thesis has been conducted in the context of a lifestyle intervention in 40 Swiss kindergarten classes in the cantons St. Gallen and Vaud, in areas with a high migrant prevalence (Ballabeina study). The main objective of this work was to fill certain gaps of the literature and to bring a better understanding of the risk factors of overweight and obesity and their determinants in preschool children. Our data show that parental migrant status and educational level influence independently of each other adiposity and/or eating habits in these children. In addition, sports club participation at this young age seems to be a better indicator of healthy lifestyle characteristics in terms of physical activity, sedentary behaviour and eating habits than weight status. Finally, we found that in this population higher scores of hyperactivity/inattention are associated with lower adiposity and with both healthy (more physical activity and less sedentary activity) and unhealthy (more television viewing and more unhealthy eating habits) lifestyle characteristics. Thus, our findings can be used by different actors of health and education system to better target their preventive actions and can serve as a basis for future complementary researches. - Cette thèse a été réalisée dans le cadre d'un projet de promotion de la santé mené dans 40 classes enfantines suisses issues de régions à forte prévalence migrante des cantons de St. Gall et de Vaud (étude Ballabeina). L'objectif principal de ce travail était de combler certaines lacunes de la littérature et d'approfondir nos connaissances sur les facteurs de risque du surpoids et de l'obésité et de leurs déterminants chez les enfants d'âge préscolaire. Nos analyses montrent que le statut de migrant des parents et leur niveau d'éducation influencent indépendamment l'un de l'autres l'adiposité et les habitudes alimentaires chez ces enfants. De plus, à ce jeune âge la participation dans un club de sport semble être un meilleur indicateur de style de vie sain en termes d'activité physique, de comportements sédentaires et d'habitudes alimentaires que le statut pondéral. Nous avons également trouvé que dans cette population, un score plus élevé d'hyperactivité/inattention est associé aussi bien à des caractéristiques de style de vie saines (plus d'activité physique, moins d'activité sédentaire) que malsaines (plus de consommation de télévision et moins bonnes habitudes alimentaire. Ainsi, nos résultats peuvent aider les différents acteurs de la santé et de l'éducation à mieux cibler leurs actions de prévention et servir de base à de futures recherches complémentaires.

Practical considerations for conducting ecotoxicity test methods with manufactured nanomaterials: what have we learnt so far?

This review paper reports the consensus of a technical workshop hosted by the European network, NanoImpactNet (NIN). The workshop aimed to review the collective experience of working at the bench with manufactured nanomaterials (MNMs), and to recommend modifications to existing experimental methods and OECD protocols. Current procedures for cleaning glassware are appropriate for most MNMs, although interference with electrodes may occur. Maintaining exposure is more difficult with MNMs compared to conventional chemicals. A metal salt control is recommended for experiments with metallic MNMs that may release free metal ions. Dispersing agents should be avoided, but if they must be used, then natural or synthetic dispersing agents are possible, and dispersion controls essential. Time constraints and technology gaps indicate that full characterisation of test media during ecotoxicity tests is currently not practical. Details of electron microscopy, dark-field microscopy, a range of spectroscopic methods (EDX, XRD, XANES, EXAFS), light scattering techniques (DLS, SLS) and chromatography are discussed. The development of user-friendly software to predict particle behaviour in test media according to DLVO theory is in progress, and simple optical methods are available to estimate the settling behaviour of suspensions during experiments. However, for soil matrices such simple approaches may not be applicable. Alternatively, a Critical Body Residue approach may be taken in which body concentrations in organisms are related to effects, and toxicity thresholds derived. For microbial assays, the cell wall is a formidable barrier to MNMs and end points that rely on the test substance penetrating the cell may be insensitive. Instead assays based on the cell envelope should be developed for MNMs. In algal growth tests, the abiotic factors that promote particle aggregation in the media (e.g. ionic strength) are also important in providing nutrients, and manipulation of the media to control the dispersion may also inhibit growth. Controls to quantify shading effects, and precise details of lighting regimes, shaking or mixing should be reported in algal tests. Photosynthesis may be more sensitive than traditional growth end points for algae and plants. Tests with invertebrates should consider non-chemical toxicity from particle adherence to the organisms. The use of semi-static exposure methods with fish can reduce the logistical issues of waste water disposal and facilitate aspects of animal husbandry relevant to MMNs. There are concerns that the existing bioaccumulation tests are conceptually flawed for MNMs and that new test(s) are required. In vitro testing strategies, as exemplified by genotoxicity assays, can be modified for MNMs, but the risk of false negatives in some assays is highlighted. In conclusion, most protocols will require some modifications and recommendations are made to aid the researcher at the bench. [Authors]

Prise en charge des jeunes patients avec endocrinopathies pediatriques chroniques: les défis d'une transition souvent difficile [Caring for patients with pediatric endocrinopathies and diabetes into adulthood: challenges of an often difficult transition].

The success of therapies for a number of pediatric disorders has posed new challenges for the long-term follow-up of adolescents with chronic endocrinopathies. Unfortunately, too many patients are lost during the transfer from pediatric to adult clinics. The transition process should be well-organized and include the young person and family. Recognizing the special needs of these adolescents is an important step in developing patient-centered approaches to care that enable patients to develop autonomy and self care skills. Key elements in this process include structured policies and guidelines, communication and close collaboration between pediatric and adult clinics, and integrating nurse clinicians in the transition process to help close the gaps in care.

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Climate change data and predictions for the Himalayas are very sparse and uncertain, characterized by a ?Himalayan data gap? and difficulties in predicting changes due to topographic complexity. A few reliable studies and climate change models for Nepal predict considerable changes: shorter monsoon seasons, more intensive rainfall patterns, higher temperatures, and drought. These predictions are confirmed by farmers who claim that temperatures have been increasing for the past decade and wonder why the rains have ?gone mad.? The number of hazard events, notably droughts, floods, and landslides are increasing and now account for approximately 100 deaths in Nepal annually. Other effects are drinking water shortages and shifting agricultural patterns, with many communities struggling to meet basic food security before climatic conditions started changing. The aim of this paper is to examine existing gaps between current climate models and the realities of local development planning through a case study on flood risk and drinking water management for the Municipality of Dharan in Eastern Nepal. This example highlights current challenges facing local-level governments, namely, flood and landslide mitigation, providing basic amenities ? especially an urgent lack of drinking water during the dry season ? poor local planning capacities, and limited resources. In this context, the challenge for Nepal will be to simultaneously address increasing risks caused by hazard events alongside the omnipresent food security and drinking water issues in both urban and rural areas. Local planning is needed that integrates rural development and disaster risk reduction (DRR) with knowledge about climate change considerations. The paper concludes with a critical analysis of climate change modeling and the gap between scientific data and low-tech and low capacities of local planners to access or implement adequate adaptation measures. Recommendations include the need to bridge gaps between scientific models, the local political reality and local information needs.

Medical and legal professionals' attitudes towards confidentiality and disclosure of clinical information in forensic settings: a survey using case vignettes.

OBJECTIVE: When potentially dangerous patients reveal criminal fantasies to their therapists, the latter must decide whether this information has to be transmitted to a third person in order to protect potential victims. We were interested in how medical and legal professionals handle such situations in the context of prison medicine and forensic evaluations. We aimed to explore the motives behind their actions and to compare these professional groups. METHOD: A mail survey was conducted among medical and legal professionals using five fictitious case vignettes. For each vignette, participants were asked to answer questions exploring what the professional should do in the situation and to explain their justification for the chosen response. RESULTS: A total of 147 questionnaires were analysed. Agreement between participants varied from one scenario to another. Overall, legal professionals tended to disclose information to a third party more easily than medical professionals, the latter tending to privilege confidentiality and patient autonomy over security. Perception of potential danger in a given situation was not consistently associated with actions. CONCLUSION: Professionals' opinions and attitudes regarding the confidentiality of potentially dangerous patients differ widely and appear to be subjectively determined. Shared discussions about clinical situations could enhance knowledge and competencies and reduce differences between professional groups.

Management of the risk of HIV infection in male homosexual couples.

OBJECTIVES: To study the ways of managing HIV risk within male homosexual steady relationships (gay couples), including factors associated with consistent condom use during anal sex with the steady partner.¦METHOD: An anonymous and standardized questionnaire completed by a convenience sample of homosexuals in Switzerland in 1997 (n = 1097). Information on the couple was provided by the 74% (n = 786) of male respondents who reported having a steady partner in the past 12 months. Data were analysed by contingency tables and logistic regression.¦RESULTS: Different ways of managing HIV risk were reported: negotiated safety (both HIV negative, condoms abandoned) was chosen by one quarter of the couples, but the most frequent solution was reliance on condoms for anal sex, chosen by more than four in 10. Altogether 84% of couples exhibited safe management of HIV risk within their partnership. The 16% of couples showing inadequate management of HIV risk within the couple mostly relied on questionable assumptions about past or present risks. A total of 74% of couples had spoken about managing HIV risk with possible casual partners. Reported behaviour with the steady partner and with casual partners was highly consistent with claimed strategies chosen to manage HIV risk. Consistent condom use with the steady partner was mostly associated with variables characterizing the relationship: initial 2 years of the relationship, discordant or unknown serological HIV status, non-exclusivity.¦CONCLUSION: Gay couples manage HIV risk in a variety of ways. Most strategies provide adequate protection with casual partners, but leave gaps in protection between the steady partners themselves.

Sex differences in obesity and the regulation of energy homeostasis.

Obesity prevalence is generally higher in women than in men, and there is also a sex difference in body fat distribution. Sex differences in obesity can be explained in part by the influence of gonadal steroids on body composition and appetite; however, behavioural, socio-cultural and chromosomal factors may also play a role. This review, which evolved from the 2008 Stock Conference on sex differences in obesity, summarizes current research and recommendations related to hormonal and neuroendocrine influences on energy balance and fat distribution. A number of important gaps in the research are identified, including a need for more studies on chromosomal sex effects on energy balance, the role of socio-cultural (i.e. gender) factors in obesity and the potential deleterious effects of high-fat diets during pregnancy on the foetus. Furthermore, there is a paucity of clinical trials examining sex-specific approaches and outcomes of obesity treatment (lifestyle-based or pharmacological), and research is urgently needed to determine whether current weight loss programmes, largely developed and tested on women, are appropriate for men. Last, it is important that both animal and clinical research on obesity be designed and analysed in such a way that data can be separately examined in both men and women.

Earthquake impacts in old-growth Nothofagus forests in New Zealand

Six stands located on different land forms in mixed old-growth Nothofagus forests in the Matiri Valley (northwest of South Island. New Zealand) were sampled to examine the effects of two recent large earthquakes on tree establishment and tree-ring growth, and how these varied across land forms. 50 trees were cor ed in each stand to determine age structure and the cores were cross-dated to precisely date unusual periods of radial growth. The 1968 earthquake (M = 7.1, epicentre 35 km from the study area) had no discernible impact on the sampled stands. The impact of the 1929 earthquake (M = 7.7, epicentre 20 kin from the study area) varied between stands, depending on whether or not they had been damaged by soil or rock movement. In all stands, the age structures showed a pulse of N. fusca establishment following the 1929 earthquake, with this species dominating establishment in large gaps created by landslides. Smaller gaps, created by branch or tree death, were closed by both N. fusca and N. menziesii. The long period of releases (1929-1945) indicates that direct earthquake damage was not the only cause of tree death, and that many trees died subsequently most likely of pathogen attack or a drought in the early 1930s. The impacts of the 1929 earthquake are compared to a storm in 1905 and a drought in 1974-1978 which also affected forests in the region. Our results confirm that earthquakes are an important factor driving forest dynamics in this tectonically active region, and that the diversity of earthquake impacts is a major source of heterogeneity in forest structure and regeneration.

Interdisciplinary intervention for work-related musculoskeletal disorders

The proposed research aims to address the work-related MSD management issue through an interdisciplinary intervention involving clinical and occupational health competencies (rheumatology, occupational medicine, ergonomics). Workers enduring MSD (especially back-pain) and absent from work are selected from volunteering companies (construction, hospitals, public transport, delivery networks). The workers are randomly placed into two groups : the control group benefits from an usual MSD management strategy and the intervention group benefits from a case-management strategy including workhardening treatment (work oriented reeducation) and ergonomic intervention in the workplace. The comparison of health and work-related variables prior and after intervention in the two groups will be used to assess the intervention efficiency and its economic benefits. We expect to produce new strategies for the management of MSD and workplace rehabilitation as well as guidelines for both authorities and companies.

La planification de sortie des personnes âgées hospitalisées dans un service de médecine

Contexte: la planification infirmière de sortie des personnes âgées est une composante importante des soins pour assurer une transition optimale entre l'hôpital et la maison. Beaucoup d'événements indésirables peuvent survenir après la sortie de l'hôpital. Dans une perspective de système de santé, les facteurs qui augmentent ce risque incluent un nombre croissant de patients âgés, l'augmentation de la complexité des soins nécessitant une meilleure coordination des soins après la sortie, ainsi qu'une augmentation de la pression financière. Objectif: évaluer si les interventions infirmières liées à la planification de sortie chez les personnes âgées et leurs proches aidants sont prédictives de leur perception d'être prêts pour le départ, du niveau d'anxiété du patient le jour de la sortie de l'hôpital et du nombre de recours non programmé aux services de santé durant les trente jours après la sortie. Méthode: le devis est prédictif corrélationnel avec un échantillon de convenance de 235 patients. Les patients âgés de 65 ans de quatre unités d'hôpitaux dans le canton de Vaud en Suisse ont été recrutés entre novembre 2011 et octobre 2012. Les types et les niveaux d'interventions infirmières ont été extraits des dossiers de soins et analysés selon les composantes du modèle de Naylor. La perception d'être prêt pour la sortie et l'anxiété ont été mesurées un jour avant la sortie en utilisant l'échelle de perception d'être prêt pour la sortie et l'échelle Hospital Anxiety and Depression. Un mois après la sortie, un entretien téléphonique a été mené pour évaluer le recours non programmé aux services de santé durant cette période. Des analyses descriptives et un modèle randomisé à deux niveaux ont été utilisés pour analyser les données. Résultats: peu de patients ont reçu une planification globale de sortie. L'intervention la plus fréquente était la coordination (M = 55,0/100). et la moins fréquente était la participation du patient à la planification de sortie (M = 16,1/100). Contrairement aux hypothèses formulées, les patients ayant bénéficié d'un plus grand nombre d'interventions infirmières de préparation à la sortie ont un niveau moins élevé de perception d'être prêt pour le départ (B = -0,3, p < 0,05, IC 95% [-0,57, -0,11]); le niveau d'anxiété n'est pas associé à la planification de sortie (r = -0,21, p <0,01) et la présence de troubles cognitifs est le seul facteur prédictif d'une réhospitalisation dans les 30 jours après la sortie de l'hôpital ( OR = 1,50, p = 0,04, IC 95% [1,02, 2,22]). Discussion: en se focalisant sur chaque intervention de la planification de sortie, cette étude permet une meilleure compréhension du processus de soins infirmiers actuellement en cours dans les hôpitaux vaudois. Elle met en lumière les lacunes entre les pratiques actuelles et celles de pratiques exemplaires donnant ainsi une orientation pour des changements dans la pratique clinique et des recherches ultérieures. - Background: Nursing discharge planning in elderly patients is an important component of care to ensure optimal transition from hospital to home. Many adverse events may occur after hospital discharge. From a health care system perspective, contributing factors that increase the risk of these adverse events include a growing number of elderly patients, increased complexity of care requiring better care coordination after discharge, as well as increased financial pressure. Aim: To investigate whether older medical inpatients who receive comprehensive discharge planning interventions a) feel more ready for hospital discharge, b) have reduced anxiety at the time of discharge, c) have lower health care utilization after discharge compared to those who receive less comprehensive interventions. Methods: Using a predictive correlational design, a convenience sample of 235 patients was recruited. Patients aged 65 and older from 4 units of hospitals in the canton of Vaud in Switzerland were enrolled between November 2011 and October 2012. Types and level of interventions were extracted from the medical charts and analyzed according to the components of Naylor's model. Discharge readiness and anxiety were measured one day before discharge using the Readiness for Hospital Discharge Scale and the Hospital Anxiety and Depression scale. A telephone interview was conducted one month after hospital discharge to asses unplanned health services utilization during this follow-up period. Descriptive analyses and a two- level random model were used for statistical analyses. Results: Few patients received comprehensive discharge planning interventions. The most frequent intervention was Coordination (M = 55,0/100) and the least common was Patient participation in the discharge planning (M = 16,1/100). Contrary to our hypotheses, patients who received more nursing discharge interventions were significantly less ready to go home (B = -0,3, p < 0,05, IC 95% [-0,57, -0,11]); their anxiety level was not associated with their readiness for hospital discharge (r = -0,21, p <0,01) and cognitive impairment was the only factor that predicted rehospitalization within 30 days after discharge ( OR = 1,50, p = 0,04, IC 95% [1,02, 2,22]). Discussion: By focusing on each component of the discharge planning, this study provides a greater and more detailed insight on the usual nursing process currently performed in medical inpatients units. Results identified several gaps between current and Best practices, providing guidance to changes in clinical practice and further research.

Les maladies infectieuses ont encore un bel avenir [Infectious diseases have again a good future!].

Invasive fungal diseases (IFDs) have become major causes of morbidity and mortality among highly immunocompromised patients. Authoritative consensus criteria to diagnose IFD have been useful in establishing eligibility criteria for antifungal trials. There is an important need for generation of consensus definitions of outcomes of IFD that will form a standard for evaluating treatment success and failure in clinical trials. Therefore, an expert international panel consisting of the Mycoses Study Group and the European Organization for Research and Treatment of Cancer was convened to propose guidelines for assessing treatment responses in clinical trials of IFDs and for defining study outcomes. Major fungal diseases that are discussed include invasive disease due to Candida species, Aspergillus species and other molds, Cryptococcus neoformans, Histoplasma capsulatum, and Coccidioides immitis. We also discuss potential pitfalls in assessing outcome, such as conflicting clinical, radiological, and/or mycological data and gaps in knowledge.

Research recommendations for selected IARC-classified agents.

OBJECTIVES: There are some common occupational agents and exposure circumstances where evidence of carcinogenicity is substantial but not yet conclusive for humans. The objectives are to identify research gaps and needs for twenty agents prioritized for review based on evidence of widespread human exposures and potential carcinogenicity in animals or humans. DATA SOURCES: A systematic review was conducted of new data published since the most recent pertinent IARC monograph meeting. DATA EXTRACTION: Reviewers were charged with identifying data gaps and general and specific approaches to address them, focusing on research that would be important in resolving classification uncertainties. An expert meeting brought reviewers together to discuss each agent and the identified data gaps and approaches. DATA SYNTHESIS: Several overarching issues were identified that pertained to multiple agents; these included the importance of recognizing that carcinogenic agents can act through multiple toxicity pathways and mechanisms, including epigenetic mechanisms, oxidative stress and immuno- and hormonal modulation. CONCLUSIONS: Studies in occupational populations provide important opportunities to understand the mechanisms through which exogenous agents cause cancer and intervene to prevent human exposure and/or prevent or detect cancer among those already exposed. Scientific developments are likely to increase the challenges and complexities of carcinogen testing and evaluation in the future, and epidemiologic studies will be particularly critical to inform carcinogen classification and risk assessment processes.[Authors]

Effective continuing professional development for translating shared decision making in primary care: A study protocol.

Background: Shared decision making (SDM) is a process by which a healthcare choice is made jointly by the healthcare professional and the patient. SDM is the essential element of patient-centered care, a core concept of primary care. However, SDM is seldom translated into primary practice. Continuing professional development (CPD) is the principal means by which healthcare professionals continue to gain, improve, and broaden the knowledge and skills required for patient-centered care. Our international collaboration seeks to improve the knowledge base of CPD that targets translating SDM into the clinical practice of primary care in diverse healthcare systems. Methods: Funded by the Canadian Institutes of Health Research (CIHR), our project is to form an international, interdisciplinary research team composed of health services researchers, physicians, nurses, psychologists, dietitians, CPD decision makers and others who will study how CPD causes SDM to be practiced in primary care. We will perform an environmental scan to create an inventory of CPD programs and related activities for translating SDM into clinical practice. These programs will be critically assessed and compared according to their strengths and limitations. We will use the empirical data that results from the environmental scan and the critical appraisal to identify knowledge gaps and generate a research agenda during a two-day workshop to be held in Quebec City. We will ask CPD stakeholders to validate these knowledge gaps and the research agenda. Discussion: This project will analyse existing CPD programs and related activities for translating SDM into the practice of primary care. Because this international collaboration will develop and identify various factors influencing SDM, the project could shed new light on how SDM is implemented in primary care.

Compensation for environmental damages under international law

ABSTRACT The purpose of this research is to clarify the contribution of international dispute adjudication mechanisms in regard to environmental protection. Most specifically, the study aims to identify and develop the criterion adopted by the international judge in relation to the compensation for environmental damages. In this perspective, the study identifies some gaps between international responsibility and environmental protection interests. The premise sustained all along the study is that compensation is determinant to conciliate environmental prerogatives with mechanisms of international adjudication, in particular the system of international responsibility. Supported by the analysis of treaties, international decisions and secondary sources, the thesis defends the idea that some elements of international law allow the adjudicator to adapt the compensation to attend certain environmental interests, creating a new approach which was entitled 'fair compensation'. The antithesis of this approach is the idea that compensation in international law is limited exclusively to the strict reparation of the material losses incurred by the victim. As a synthesis, the study defends the specificity of environmental damages in relation to other kind of damages that are subject to compensation under international law. The measure upon which compensation for environmental damages could be classified as a specific type of damage under international law remains to be determined. The main conclusion of the study is that the existing standard of compensation defined by the theory and practice of international law is impossible to be strictly respected in cases involving environmental damages. This limitation is mainly due to the complexity of the notion of environment, which is constantly conflicting with the anthropologic view of legal theory. The study supports the idea that the establishment of a 'fair compensation' which takes into account the political, legal and technical context of the environmental damage, is the best possible approach to conciliate internationally responsibility and environmental interests. This could be implemented by the observance of certain elements by the international judge/arbitrator through a case-by-case analysis.

Psychological profile of adolescents with a kidney transplant.

To describe the psychological profile of renal transplant adolescents compared to healthy peers and to adolescents with CKD, three groups of adolescents aged 12-18 yr were selected: TX, CX, and adolescents with CKD. Psychiatric symptoms and disorders were evaluated through direct interviews (K-SADS-PL) and self-report questionnaires (YSR and CBCL). Forty TX (14 LRD and 26 DD transplant recipients), 40 CX and 20 CKD were included. Twelve of 40 (30%) TX, three of 20 (15%) CKD, and three of 40 (7.5%) CX had a history of learning difficulties (p = 0.03). Compared to CX, TX had lower total YSR competencies score (p = 0.028) and lower total CBCL competencies score (p = 0.003). Twenty-six of 40 (65%) TX, 12 of 20 (60%) CKD and 15 of 40 (37.5%) CX (p = 0.038) met DSM-IV diagnostic criteria for lifetime psychiatric disorder, with rates of depressive disorder of 35% among TX and CKD compared to 15.2% among CX (p = 0.043). Eight of 40 (20%) TX had a history of simple phobia. Nine of 40 (22.5%) TX met diagnostic criteria for ADHD as compared to one of 20 (5%) CKD and three of 40 (7.5%) CX. In the TX group, we found no significant differences in educational and psychiatric variables between LRD and DD. In conclusion, we found a high prevalence of psychiatric morbidity (depression, phobia, ADHD), educational impairment and social competence problems in the TX group. CKD scored in between TX and CX on most measures.