Vers un accès a des soins de qualité pour les personnes lesbiennes, gays, bisexuelles et transgenres [Access to quality primary care for LGBT people].

This article offers a comprehensive approach to the health of lesbian, gay, bisexual and transgender (LGBT) people, where respect for diversity and non judgemental care play a central role. It calls for a health and medical vision that goes beyond HIV risk. For those who never had to question their own sexual orientation or gender identity, it is certainly difficult to understand how the discovery of one's identity trait in childhood or early adolescence can be transformed under social pressure into a burden which often remains invisible but is associated with considerable emotional and medical morbidity. This article raises the following question: How many LGBT patients go unnoticed every week, leaving the physician's office without an opportunity to receive appropriate listening, support and care?

Survey on image quality and dose levels used in Europe for mammography.

Quality assurance programmes are becoming a common practice in the field of mammography. At the present time several recommendations exist and different test objects are used to optimize this radiological procedure. The goal of this study was to check if geographically distant centres using different quality control procedures were comparable when using a common objective way of assessing image quality. The results show that consensus still needs to be found among radiologists to reach a satisfactory level of harmony between patient doses and image quality in Europe.

Association between education and quality of diabetes care in Switzerland

PURPOSE: Low socioeconomic status is associated with higher prevalence of diabetes, worse outcomes, and worse quality of care. We explored the relationship between education, as a measure of socioeconomic status, and quality of care in the Swiss context. PATIENTS AND METHODS: Data were drawn from a population-based survey of 519 adults with diabetes during fall 2011 and summer 2012 in a canton of Switzerland. We assessed patients and diabetes characteristics. Eleven indicators of quality of care were considered (six of process and five of outcomes of care). After bivariate analyses, regression analyses adjusted for age, sex, and diabetic complications were performed to assess the relationship between education and quality of care. RESULTS: Of 11 quality-of-care indicators, three were significantly associated with education: funduscopy (patients with tertiary versus primary education were more likely to get the exam: odds ratio, 1.8; 95% confidence interval [CI], 1.004-3.3) and two indicators of health-related quality of life (patients with tertiary versus primary education reported better health-related quality of life: Audit of Diabetes-Dependent Quality of Life: β=0.6 [95% CI, 0.2-0.97]; SF-12 mean physical component summary score: β=3.6 [95% CI, 0.9-6.4]). CONCLUSION: Our results suggest the presence of educational inequalities in quality of diabetes care. These findings may help health professionals focus on individuals with increased needs to decrease health inequalities.

Formulation and Implementation of Air Quality Control Pogrammes : Patterns of Interest Consideration

This article investigates some central aspects of the relationships between programme structure and implementation of sulphur dioxide air quality control policies. Previous implementation research, primarily adopting American approaches, has neglected the connections between the processes of programme formulation and implementation. 'Programme', as the key variable in implementation studies, has been defined too narrowly. On the basis of theoretical and conceptual reflections and provisional empirical results from studies in France, Italy, England, and the Federal Republic of Germany, the authors demonstrate that an integral process analysis using a more extended programme concept is necessary if patterns of interest recognition in policies are to be discovered. Otherwise, the still important question of critical social science cannot be answered, namely, what is the impact of special interests upon implementation processes.

An image quality comparison of standard and dual-side read CR systems for pediatric radiology.

An objective analysis of image quality parameters was performed for a computed radiography (CR) system using both standard single-side and prototype dual-side read plates. The pre-sampled modulation transfer function (MTF), noise power spectrum (NPS), and detective quantum efficiency (DQE) for the systems were determined at three different beam qualities representative of pediatric chest radiography, at an entrance detector air kerma of 5 microGy. The NPS and DQE measurements were realized under clinically relevant x-ray spectra for pediatric radiology, including x-ray scatter radiations. Compared to the standard single-side read system, the MTF for the dual-side read system is reduced, but this is offset by a significant decrease in image noise, resulting in a marked increase in DQE (+40%) in the low spatial frequency range. Thus, for the same image quality, the new technology permits the CR system to be used at a reduced dose level.

Objective comparison of image quality and dose between conventional and synchrotron radiation mammography.

The shape of the energy spectrum produced by an x-ray tube has a great importance in mammography. Many anode-filtration combinations have been proposed to obtain the most effective spectrum shape for the image quality-dose relationship. On the other hand, third generation synchrotrons such as the European Synchrotron Radiation Facility in Grenoble are able to produce a high flux of monoenergetic radiation. It is thus a powerful tool to study the effect of beam energy on image quality and dose in mammography. An objective method was used to evaluate image quality and dose in mammography with synchrotron radiation and to compare them to standard conventional units. It was performed systematically in the energy range of interest for mammography through the evaluation of a global image quality index and through the measurement of the mean glandular dose. Compared to conventional mammography units, synchrotron radiation shows a great improvement of the image quality-dose relationship, which is due to the beam monochromaticity and to the high intrinsic collimation of the beam, which allows the use of a slit instead of an anti-scatter grid for scatter rejection.

Impact of thermal proofing of a church on its indoor air-quality - The combustion of candles and incense as a source of pollution

Some years ago, a parish in Geneva decided to reduce heating costs by insulating its church to make it more energy efficient. Three years after the last renovations, it was observed that the internal surfaces of the naves had already become dusty compared with the customary frequency of 10-12 years. Dust even deposited on various surfaces during religious services. Our investigation showed that nearly all the dust found inside the church may in fact be soot from incense and candle combustion. Incense appears to be a significant source of polycyclic aromatic hydrocarbons. With a mechanical ventilation system and petrol lamps resembling candles the problem can be resolved.

Conceiving Comparative Policy Analysis : Implementing Air Quality Improvement Programs

The comparative analysis of air quality control policies provides an interesting field for studies of comparative policy analysis including program formulation and implementation processes. In European countries, the problem is comparable, whereas implementation structures, programs and policy impacts vary to a considerable extent. Analysis testing possibilities and constraints of air control policies under varying conditions are likely to contribute to a further development of a theory of policy analysis. This paper presents the analytical framework applied in a continuing empirical study explaining program formulation and implementation processes with respect to the different actors involved. Concrete emitter behavior can be explained by interaction processes at the very local level, by program elements of national legislation, and by structural constraints under which such programs are produced.

Cercles de qualité médecins-pharmaciens, pour une responsabilité partagée de la liberté de prescription [Physicians-pharmacists quality circles: shared responsibility of the freedom of prescription].

Physicians-pharmacists quality circles (PPQCs) were introduced in 1997-98 by visionary healthcare practitioners of the French-speaking part of Switzerland with the aim to improve the quality of drug prescription. Indeed the challenge is to manage the 7917 brand names of the Swiss drug market (2010), including 19793 different dosages, galenic formulations and packaging. The impact of these PPQCs on the containment of drug costs and on drug prescribing profiles has been demonstrated and has led to their spread throughout Switzerland. PPQCs provide clear educational benefits and have thus been accredited by various continuous education bodies. In this article, participating physicians and pharmacists share their vision and illustrate how they work and influence the safety and efficiency of drug prescription, a routine process complex enough to warrant sharing of its burden in a constructive interdisciplinary collaboration.