Best practice in the management of mild-to-moderately active ulcerative colitis and achieving maintenance of remission using mesalazine.

Optimizing treatment goals in ulcerative colitis requires recognizing the needs of patients. It is increasingly recognized that adapting treatment strategies aligned with patient needs can improve patient compliance and consequently minimize relapse rates. Tailoring of treatment strategies can improve not only patient quality of life, and decrease the number harmed by adverse events from more potent drugs, but can also save valuable healthcare costs by avoiding high-cost treatment interventions associated with acute ulcerative colitis. This review will consider several elements of mesalazine management from the patient perspective based on a range of clinical and patient-focused evidence. By highlighting patient preferences in disease management it is envisaged that this review will aid physicians to optimize treatment decisions with the different mesalazine preparations available.

How critical is timing for the diagnosis of influenza in general practice?

Résumé La performance diagnostic des signes et symptômes de la grippe a principalement été étudiée dans le cadre d'études contrôlées avec des critères d'inclusion stricts. Il apparaît nécessaire d'évaluer ces prédicteurs dans le cadre d'une consultation ambulatoire habituelle en tenant compte du délai écoulé entre le début des symptômes et la première consultation ainsi que la situation épidémiologique. Cette étude prospective a été menée à la Policlinique Médicale Universitaire durant l'hiver 1999-2000. Les patients étaient inclus s'ils présentaient un syndrome grippal et si le praticien suspectait une infection à Influenza. Le médecin administrait un questionnaire puis une culture d'un frottis de gorge était réalisée afin de documenter l'infection. 201 patients ont été inclus dans l'étude. 52% avaient une culture positive pour Influenza. En analyse univariée, une température > 37.8° (OR 4.2; 95% CI 2.3-7.7), une durée des symptômes < 48h (OR 3.2; 1.8-5.7), une toux (OR 3.2; 1-10.4) et des myalgies (OR 2.8; 1.0-7.5) étaient associés au diagnostic de grippe. En analyse de régression logistique, le modèle le plus performant qui prédisait la grippe était l'association d'une durée des symptômes <48h, une consultation en début d'épidémie, une température > 37.8° et une toux (sensibilité 79%, spécificité 69%, valeur prédictive positive 67%, une valeur prédictive négative de 73% et aire sous la courbe (ROC) de 0.74). En plus des signes et symptômes prédicteurs de la grippe, le médecin de premier recours devrait prendre en compte dans son jugement la durée des symptômes avant la première consultation et le contexte épidémiologique (début, pic, fin de l'épidémie), car ces deux paramètres modifient considérablement la valeurs des prédicteurs lors de l'évaluation de la probabilité clinique d'un patient d'avoir une infection à Influenza.

Inadequate and infrequent are not alike : ERPs to deviant prosodic patterns in spoken sentence comprehension

The current study on German investigates Event-Related brain Potentials (ERPs) for the perception of sentences with intonations which are infrequent (i.e. vocatives) or inadequate in daily conversation. These ERPs are compared to the processing correlates for sentences in which the syntax-to-prosody relations are congruent and used frequently during communication. Results show that perceiving an adequate but infrequent prosodic structure does not result in the same brain responses as encountering an inadequate prosodic pattern. While an early negative-going ERP followed by an N400 were observed for both the infrequent and the inadequate syntax-to-prosody association, only the inadequate intonation also elicits a P600.

Méthodes de visualisation en analyse criminelle: approche générale de conception des schémas relationnels et développement d'un catalogue de patterns

Le travail policier et l'enquête judiciaire nécessitent de prendre de nombreuses décisions : choisir quelle trace analyser, mettre sous surveillance ou en détention un suspect, sont autant de décisions qui sont prises quotidiennement par les acteurs du système judiciaire. Ces décisions font l'objet de pesées d'intérêts qui se fondent sur l'analyse de l'information accessible. C'est le rôle de l'analyse criminelle de mettre en perspective l'information colligée pour la rendre intelligible aux décideurs compétents. L'usage de représentations graphiques est notamment recommandé pour soutenir l'analyse et la communication de ces informations.Des techniques de visualisation relationnelle sont notamment exploitées dans les enquêtes judiciaires afin de faciliter le traitement d'affaires d'envergure. Les éléments pertinents de l'enquête sont représentés sous la forme de schémas décrivant les relations entre les événements et les entités d'intérêts (tel que des personnes, des objets et des traces). Les exploitations classiques de ces techniques qui s'apparentent à des graphes, sont par exemple : la représentation de réseaux criminels, de trafics de marchandises, de chronologies d'événements, ainsi que la visualisation de relations téléphoniques et financières. Dans ce contexte, la visualisation soutient un nombre importants d'objectifs, tels qu'analyser les traces et les informations collectées, évaluer a posteriori une investigation, aider à qualifier les infractions, faciliter l'appréhension d'un dossier, voire soutenir une argumentation lors du procès.La pratique intègre des outils logiciels simples qui produisent des graphiques élégants et souvent percutants. Leur utilisation semble néanmoins soulever des difficultés. Cette recherche tend à montrer qu'il existe des disparités étonnantes lors de l'exploitation de ces techniques. Des biais de raisonnement et de perception peuvent être induits, allant jusqu'à provoquer des décisions aux conséquences parfois désastreuses. Ce constat révèle la nécessité de consolider les méthodes pratiquées.Pour mettre en évidence ces difficultés, des évaluations ont été effectuées avec des praticiens et des étudiants. Elles ont permis d'établir une image empirique de l'étendue des variations de conception et d'interprétation des représentations, ainsi que de leurs impacts sur la prise de décision. La nature et la diversité des concepts à représenter, l'absence d'un consensus émergeant sur la manière de représenter les données, la diversité des solutions visuelles envisageables, les contraintes imposées par les outils exploités et l'absence d'une formalisation claire du langage, sont autant de causes supposées des difficultés.Au cours des vingt dernières années, plusieurs axes de développement ont été proposés pour traiter les difficultés observées, tels que l'amélioration des automatismes facilitant la conception d'une représentation, l'exploitation des techniques de réseaux sociaux, l'automatisation de l'identification et de l'extraction des entités dans du texte non-structuré et la définition de langages formels. Cette recherche propose une approche parallèle fondée sur une exploitation adaptée de structures de graphe et de propriétés visuelles pour optimiser la représentation en fonction des objectifs définis et de la nature des informations à représenter.Des solutions ont été recherchées selon plusieurs axes. Des recommandations générales, issues de diverses communautés de recherche liées à la visualisation, ont été recherchées afin de proposer une démarche générale de conception des schémas relationnels. Par ailleurs, le développement d'un catalogue de bonnes pratiques formalisées sous la forme de patterns de visualisation a été amorcé. Chaque pattern décrit une solution particulière pour un problème d'analyse récurrent, tel que l'analyse d'une série de cambriolages. Finalement, l'impact sur les outils de la méthodologie proposée est discuté en regard des limites qu'ils imposent. Un prototype de visualisation multidimensionnel a été élaboré.Cette recherche met en évidence les difficultés rencontrées lors de l'exploitation de représentations graphiques pour soutenir le processus de l'enquête judiciaire et propose des éléments de méthode et des innovations techniques utiles tant pour l'enseignement de la discipline que pour sa pratique.

Weekly sport practice and adolescent well-being.

OBJECTIVE: Sport practice is widely encouraged, both in guidelines and in clinical practice, because of its broad range of positive effects on health. However, very limited evidence directly supports this statement among adolescents and the sport duration that we should recommend remains unknown. We aimed to determine sport durations that were associated with poor well-being. METHODS: We conducted a survey including 1245 adolescents (16-20 years) from the general Swiss population. Participants were recruited from various settings (sport centres, peers of sport practicing adolescents, websites) and asked to complete a web-based questionnaire. Weekly sport practice was categorised into four groups: low (0-3.5 h), average (≈ recommended 7 h (3.6-10.5)), high (≈14 h (10.6-17.5)) and very high (>17.5 h). We assessed well-being using the WHO-5 Well-Being Index. RESULTS: Compared with adolescents in the average group, those in the very high group had a higher risk of poor well-being (OR 2.29 (95% CI 1.11 to 4.72)), as did those in the low group (OR 2.33 (1.58 to 3.44)). In contrast, those in the high group had a lower risk of poor well-being than those in the average group (OR 0.46 (0.23 to 0.93)). CONCLUSIONS: We found an inverted, U-shaped relationship between weekly sport practice duration and well-being among adolescents. The peak scores of well-being were around 14 h per week of sport practice, corresponding to twice the recommended 7 h. Practicing higher sport durations was an independent risk factor of poor well-being.

European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring.

Given the increasing use of ambulatory blood pressure monitoring (ABPM) in both clinical practice and hypertension research, a group of scientists, participating in the European Society of Hypertension Working Group on blood pressure monitoring and cardiovascular variability, in year 2013 published a comprehensive position paper dealing with all aspects of the technique, based on the available scientific evidence for ABPM. The present work represents an updated schematic summary of the most important aspects related to the use of ABPM in daily practice, and is aimed at providing recommendations for proper use of this technique in a clinical setting by both specialists and practicing physicians. The present article details the requirements and the methodological issues to be addressed for using ABPM in clinical practice, The clinical indications for ABPM suggested by the available studies, among which white-coat phenomena, masked hypertension, and nocturnal hypertension, are outlined in detail, and the place of home measurement of blood pressure in relation to ABPM is discussed. The role of ABPM in pharmacological, epidemiological, and clinical research is also briefly mentioned. Finally, the implementation of ABPM in practice is considered in relation to the situation of different countries with regard to the reimbursement and the availability of ABPM in primary care practices, hospital clinics, and pharmacies.

Rates and determinants of virologic and immunological response to HAART resumption after treatment interruption in HIV-1 clinical practice.

OBJECTIVE: To describe CD4 and HIV RNA changes during treatment resumption (TR) after treatment interruption (TI) compared with response to first highly active antiretroviral therapy (HAART) and to investigate predictors. METHODS: Using Concerted Action on SeroConversion to AIDS and Death in Europe (CASCADE) data, we identified subjects who interrupted first HAART, not initiated during primary infection. We estimated rate of CD4 change during TR and time from TR to HIV RNA<500 copies per milliliter and subsequent rebound and factors associated with these outcomes. RESULTS: Of 281 persons treated for median 18.4 months before interrupting, 259 resumed HAART. CD4 increases in the first 3 months on HAART were similar pre-TI and post-TI but after 3 months were significantly higher during pre-TI HAART, with median +106 and +172 cells per microliter at 3 and 18 months, respectively, during initial HAART compared with +99 and +142 cells per microliter during post-TI HAART, respectively. Subjects with lower CD4 counts at TI, aged older than 40 years, and those resuming the same HAART as their pre-TI regimen had lower CD4 increases during the first 3 months of TR. The majority (86%) of individuals reinitiating therapy achieved HIV RNA<500 copies per milliliter. CONCLUSIONS: Immune reconstitution after TI is generally poorer than after first HAART, particularly for patients aged older than 40 years at TI and those with poorer immunological responses to pre-TI HAART. Reinitiation of the same HAART regimen as pre-TI also seems to have unfavorable outcomes.

Variability of gait patterns during unconstrained walking assessed by satellite positioning (GPS).

It is established that the ratio between step length (SL) and step frequency (SF) is constant over a large range of walking speed. However, few data are available about the spontaneous variability of this ratio during unconstrained outdoor walking, in particular over a sufficient number of steps. The purpose of the present study was to assess the inter- and intra-subject variability of spatio-temporal gait characteristics [SL, SF and walk ratio (WR=SL/SF)] while walking at different freely selected speeds. Twelve healthy subjects walked three times along a 100-m athletic track at: (1). a slower than preferred speed, (2). preferred speed and (3). a faster than preferred speed. Two professional GPS receivers providing 3D positions assessed the walking speed and SF with high precision (less than 0.5% error). Intra-subject variability was calculated as the variation among eight consecutive 5-s samples. WR was found to be constant at preferred and fast speeds [0.41 (0.04) m.s and 0.41 (0.05) m.s respectively] but was higher at slow speeds [0.44 (0.05) m.s]. In other words, between slow and preferred speed, the speed increase was mediated more by a change in SF than SL. The intra-subject variability of WR was low under preferred [CV, coefficient of variation = 1.9 (0.6)%] and fast [CV=1.8 (0.5)%] speed conditions, but higher under low speed condition [CV=4.1 (1.5)%]. On the other hand, the inter-subject variability of WR was 11%, 10% and 12% at slow, preferred and fast walking speeds respectively. It is concluded that the GPS method is able to capture basic gait parameters over a short period of time (5 s). A specific gait pattern for slow walking was observed. Furthermore, it seems that the walking patterns in free-living conditions exhibit low intra-individual variability, but that there is substantial variability between subjects.

Concurrent and simultaneous polydrug use among young Swiss males: use patterns and associations of number of substances used with health issues.

Background: Simultaneous polydrug use (SPU) may represent a greater incremental risk factor for human health than concurrent polydrug use (CPU). However, few studies have examined these patterns of use in relation to health issues, particularly with regard to the number of drugs used. Methods: In the present study, we have analyzed data from a representative sample of 5734 young Swiss males from the Cohort Study on Substance Use Risk Factors. Exposure to drugs (i.e., alcohol, tobacco, cannabis, and 15 other illicit drugs), as well as mental, social and physical factors, were studied through regression analysis. Results: We found that individuals engaging in CPU and SPU followed the known stages of drug use, involving initial experiences with licit drugs (e.g., alcohol and tobacco), followed by use of cannabis and then other illicit drugs. In this regard, two classes of illicit drugs were identified, including first uppers, hallucinogens and sniffed drugs; and then "harder" drugs (ketamine, heroin, and crystal meth), which were only consumed by polydrug users who were already taking numerous drugs. Moreover, we observed an association between the number of drugs used simultaneously and social issues (i.e., social consequences and aggressiveness). In fact, the more often the participants simultaneously used substances, the more likely they were to experience social problems. In contrast, we did not find any relationship between SPU and depression, anxiety, health consequences, or health. Conclusions: We identified some associations with SPU that were independent of CPU. Moreover, we found that the number of concurrently used drugs can be a strong factor associated with mental and physical health, although their simultaneous use may not significantly contribute to this association. Finally, the negative effects related to the use of one substance might be counteracted by the use of an additional substance.