Etude romande sur le jeu: une collaboration entre IUMSP et ISPA sur mandat du Programme Intercantonal de Lutte contre la Dépendance au Jeu (PILDJ)

En Suisse, l'offre en matière de jeu est très importante. Que ce soit pour les loteries ou les casinos, les revenus bruts des jeux (RBJ) ont augmenté considérablement au cours de ces dix dernières années. Une offre de prévention et de traitement s'est développée en Suisse romande et le nombre de joueurs qui consultent ne cesse d'augmenter. Toutefois, il n'en reste pas moins qu'il s'agit là d'une petite proportion des joueurs problématiques qui font appel aux services d'aide. Le Programme intercantonal de lutte contre la dépendance au jeu (PILDJ) vise en premier lieu à sensibiliser la population au problème du jeu excessif. Il prévoit pour cela, notamment, de faciliter l'accès à l'information et au traitement. Par ailleurs, il a aussi pour objectif de sensibiliser les professionnels, afin d'améliorer la détection et la prise en charge des joueurs pathologiques. Le PILDJ entend finalement centraliser les informations relatives aux actions menées dans les cantons afin d'améliorer l'échange d'expériences. La coordination de ce Programme a été confiée au Groupement romand d'études des addictions (GREA). Le PILDJ comprend la mise sur pied de 4 modules parmi lesquels figure l'Etude romande sur le jeu. Ce rapport présente les résultats des volets couverts par l'Etude romande sur le jeu. [résumé, p. 5]

La remédiation cognitive des schizophrènes : le programme RECOS : [guide pour praticiens]

La remédiation cognitive est devenue en quelques années un outil thérapeutique important dans le domaine des maladies psychiatriques, et plus particulièrement dans celui des troubles schizophréniques. Parmi les programmes utilisés, RECOS est l'un des seuls à proposer un entraînement qui tient compte du profil cognitif individuel, permettant ainsi de répondre de manière ciblée à la grande hétérogénéité des déficits observés. Cet ouvrage constitue le support de base indispensable à la formation délivrée aux futurs thérapeutes RECOS. Il se divise en deux parties. La première partie présente les données scientifiques actuelles sur les troubles cognitifs de la schizophrénie et les moyens d'y remédier. Le lien entre les performances cognitives et les capacités fonctionnelles permet de comprendre comment et pourquoi la remédiation cognitive favorise la réinsertion sociale et professionnelle. La deuxième partie fait office de manuel d'utilisation pour tous les thérapeutes (psychologues, psychiatres, infirmiers, ergothérapeutes) souhaitant utiliser RECOS. L'ouvrage décrit les pathologies psychiatriques visées par le programme, la schizophrénie n'étant pas la seule concernée. Il aborde ensuite les différentes étapes du traitement, en consacrant une place importante à 1 'évaluation cognitive et clinique ainsi qu'aux exercices de remédiation. Des cas cliniques illustrent la manière d'adapter le travail thérapeutique au profil cognitif de chaque participant. Afin que le lecteur puisse bénéficier d'un maximum d'informations et de documents pratiques, plusieurs outils nécessaires à 1 'utilisation du programme figurent en annexe de l'ouvrage.

Qualitative analysis of barriers and facilitators encountered by HIV patients in an ART adherence programme.

Background Medication adherence is a complex, dynamic and changing behaviour that is affected by a variety of factors, including the patient's beliefs and life circumstances. Studies have highlighted barriers to medication adherence (e.g., unmanaged side effects or a lack of social support), as well as facilitators of medication adherence (e.g., technical simplicity of treatment and psychological acceptance of the disease). Since August 2004, in Lausanne (Switzerland), physicians have referred patients who are either experiencing or are at risk of experiencing problems with their HIV antiretroviral treatment (ART) to a routine interdisciplinary ART adherence programme. This programme consists of multifactorial intervention including electronic drug monitoring (MEMS(TM)). Objective This study's objective was to identify the barriers and facilitators encountered by HIV patients with suboptimal medication adherence (≤90 % adherence over the study period). Setting The community pharmacy of the Department of Ambulatory Care and Community Medicine in Lausanne (Switzerland). Method The study consisted of a retrospective, qualitative, thematic content analysis of pharmacists' notes that were taken during semi-structured interviews with patients and conducted as part of the ART adherence programme between August 2004 and May 2008. Main outcome measure Barriers and facilitators encountered by HIV patients. Results Barriers to and facilitators of adherence were identified for the 17 included patients. These factors fell into three main categories: (1) cognitive, emotional and motivational; (2) environmental, organisational and social; and (3) treatment and disease. Conclusion The pharmacists' notes revealed that diverse barriers and facilitators were discussed during medication adherence interviews. Indeed, the results showed that the 17 non-adherent patients encountered barriers and benefited from facilitators. Therefore, pharmacists should inquire about all factors, regardless of whether they have a negative or a positive impact on medication adherence, and should consider all dimensions of patient adherence. The simultaneous strengthening of facilitators and better management of barriers may allow healthcare providers to tailor care to a patient's specific needs and support each individual patient in improving his medication-related behaviour.

EviPrev, un programme de prévention et de promotion de la santé à l'intention des médecins praticiens

Un groupe de médecins et de spécialistes de la prévention, en collaboration avec des médecins installés, s'est récemment constitué pour lancer le projet EviPrev, acronyme pour Evidence based preventive medicine. Ce développement vise à apporter aux médecins suisses (médecins de famille et médecins spécialistes) qui le souhaitent de nouveaux outils pour leur intervention en médecine préventive. Cet article résume les principaux objectifs et les conditions de développement.

Cost-utility analysis of a three-month exercise programme vs usual care following multidisciplinary rehabilitation for chronic low back pain.

OBJECTIVE: To assess the cost-utility of an exercise programme vs usual care after functional multidisciplinary rehabilitation in patients with chronic low back pain. DESIGN: Cost-utility analysis alongside a randomized controlled trial. SUBJECTS/PATIENTS: A total of 105 patients with chronic low back pain. METHODS: Chronic low back pain patients completing a 3-week functional multidisciplinary rehabilitation were randomized to either a 3-month exercise programme (n = 56) or usual care (n = 49). The exercise programme consisted of 24 training sessions during 12 weeks. At the end of functional multidisciplinary rehabilitation and at 1-year follow-up quality of life was measured with the SF-36 questionnaire, converted into utilities and transformed into quality--adjusted life years. Direct and indirect monthly costs were measured using cost diaries. The incremental cost-effectiveness ratio was calculated as the incremental cost of the exercise programme divided by the difference in quality-adjusted life years between both groups. RESULTS: Quality of life improved significantly at 1-year follow-up in both groups. Similarly, both groups significantly reduced total monthly costs over time. No significant difference was observed between groups. The incremental cost-effectiveness ratio was 79,270 euros. CONCLUSION: Adding an exercise programme after functional multidisciplinary rehabilitation compared with usual care does not offer significant long-term benefits in quality of life and direct and indirect costs.

Programme latin de don d'organes (PLDO): une initiative efficace pour augmenter les dons d'organes en Suisse [Latin organ donation programme (LODP): an effective initiative to increase organ donation in Switzerland].

The 1st federal transplant law was enforced in July 2007 with the obligation to promote quality and efficiency in the procedures for organ and tissue donation for transplantation. The Latin organ donation programme (LODP) created in 2008 aims to develop organ donation in 17 public hospitals in 7 Latin cantons, covering 2.2 million people; 29% of the Swiss population. The implementation of various effective measures by the LODP enabled the increase in the number of donors by 70% between 2008 and 2010, with four organs procured per donor; greatly exceeding the European average of three. The results show that LODP has successfully professionalised the system and we can only hope that similar organisations will be put into place throughout Switzerland.

Nouveau programme de formation en médecine interne générale: implications pour les médecins de premier recours [The new postgraduate training program in general internal medicine: implications for the primary care physician].

The Swiss postgraduate training program in general internal medicine is now designed as a competency-based curriculum. In other words, by the end of their training, the residents should demonstrate a set of predefined competences. Many of those competences have to be learnt in outpatient settings. Thus, the primary care physicians have more than ever an important role to play in educating tomorrows doctors. A competency-based model of training requires a regular assessment of the residents. The mini-CEX (mini-Clinical Evaluation eXercise) is the assessment tool proposed by the Swiss institute for postgraduate and continuing education. The mini-CEX is based on the direct observation of the trainees performing a specific task, as well as on the ensuing feedback. This article aims at introducing our colleagues in charge of residents to the mini-CEX, which is a useful tool promoting the culture of feedback in medical education.

Evaluation d'un programme d'intervention interdisciplinaire d'adhésion thérapeutique chez les patients VIH-positifs. Travail de thèse

Ce travail de recherche évalue dans quelle mesure le pharmacien, en collaboration avec les autres professionnels de soins, peut soutenir le patient VIH-positif dans sa prise médicamenteuse en associant de façon originale l'entretien motivationnel et les piluliers électroniques. Les résultats montrent que l'adhésion thérapeutique peut être maintenue à un niveau élevé même dans un groupe de patients à risque de non-adhésion. [Auteurs]

Programme national VIH/sida 1999-2003 : état et dynamique de la mise en oeuvre à fin 2001

Cette étude a été menée par l'Unité d'évaluation de programmes de prévention de l'Institut de médecine sociale et préventive (IUMSP) de Lausanne. Elle s'inscrit dans le cadre de l'évaluation globale de la stratégie de prévention du VIH/sida pour laquelle l'IUMSP a reçu mandat de l'Office fédéral de la santé publique. Le programme national "VIH et sida : Programme national de 1999 à 2003" a été préparé en 1998 par l'OFSP en collaboration avec des experts et publié en février 1999. Il fait suite au manuel "Prévention du VIH en Suisse : buts, stratégies, mesures" publié en 1993 et couvre la période de 1999 à 2003. Les 14 objectifs qu'il définit, avec leurs jalons, sont répartis dans cinq grands domaines à savoir: promotion de la santé, prévention, thérapie et diagnostic, conseil et soutien, savoir et transfert des compétences. Afin d'en planifier la mise en oeuvre, l'OFSP a organisé 14 plates-formes régionales en août et septembre 1999 qui ont fait l'objet d'un rapport publié en janvier 2000. Les plates-formes ont été suivies d'une "Conférence intercantonale VIH/sida" le 8 septembre 2000 à Berne, organisée conjointement par l'Office fédéral de la santé publique (OFSP)/Section Sida et l'Aide Suisse contre le Sida (ASS), dont le thème général était "Transfert dans la lutte contre le VIH/sida". Faisant suite à la première phase d'évaluation qui, elle, a porté sur l'état des activités de lutte contre le VIH/sida dans les cantons, la deuxième phase de l'évaluation fait le point sur la mise en oeuvre du programme national 1999-2003 au niveau national et dans les cinq cantons pour la période 2000-2001 et porte sur l'implantation du programme national. Y sont analysés le développement des activités dans tous les domaines, la pertinence des objectifs et jalons, les éléments garantissant la pérennité et la qualité des interventions, et le développement des collaborations à différents niveaux.

Mixing of Rhône River water in Lake Geneva (Switzerland-France) inferred from stable hydrogen and oxygen isotope profiles

Depth profiles were sampled at different locations throughout Lake Geneva on a monthly and seasonal basis over the course of 2 years and analysed for their stable hydrogen and oxygen isotope compositions. The isotopic compositions indicate an isotopic stratification in the metalimnion during summer and fall. This is related to mixing of Rhône River water, which in summer is dominated by snow and glacier melt waters, and lake water, with the latter having a homogenous isotopic composition. The observed interflow layer is 7-15 m thick and can be traced by the distinct stable isotope composition of the water for about 55 km throughout the lake as well as into shallow bay regions. Depth of the interflow layer close to the Rhône River mouth is similar to those previously described based on echo-soundings and turbidity profiles of sediment dispersion. In contrast to previous descriptions of the interflow within Lake Geneva, the stable isotope compositions allow for direct, natural tracing of the Rhône River water even in cases where the turbidity and conductivity measurements do not indicate such an interflow. In addition, the method allows for a quantification of the Rhône River and lake water in the interflow with the fraction of Rhône River water within the interflow estimated to be up to 37% in summer. The isotopic composition further indicates different vertical mixing processes within the two lake basins of Lake Geneva, related to the density gradients and local stability within the water column. The method may be applicable to other lakes in catchments with large differences in the topography as water that originates from high altitudes or glaciers has a distinct oxygen and hydrogen isotope composition compared to other sources of water originating at lower altitudes and/or from direct precipitation over the lake. Stable isotope measurements thus improve the understanding of the circulation of water within the lake, which is fundamental for an evaluation of the water residence times, dissolved pollutant and nutrient transport as well as oxygenation.

An evaluation of the inorganic and organic geochemistry of the San Vicente Mississippi Valley-type zinc-lead district, central Peru: Implications for ore fluid composition, mixing processes, and sulfate reduction

Mississippi Tialley-type zinc-lead deposits and ore occurrences in the San Vicente belt are hosted in dolostones of the eastern Upper Triassic to Lower Jurassic Pucara basin, central Peru. Combined inorganic and organic geochemical data from 22 sites, including the main San Vicente deposit, minor ore occurrences, and barren localities, provide better understanding of fluid pathways and composition, ore precipitation mechanisms, Eh-pH changes during mineralization, and relationships between organic matter and ore formation. Ore-stage dark replacement dolomite and white sparry dolomite are Fe and rare earth element (REE) depleted, and Mn enriched, compared to the host dolomite. In the main deposit, they display significant negative Ce and probably Eu anomalies. Mixing of an incoming hot, slightly oxidizing, acidic brine (H2CO3 being the dominant dissolved carbon species), probably poor in REE and Fe, with local intraformational, alkaline, reducing waters explains the overall carbon and oxygen isotope variation and the distributions of REE and other trace elements in the different hydrothermal carbonate generations. The incoming ore fluid flowed through major aquifers, probably basal basin detrital units, with limited interaction with the carbonate host rocks. The hydrothermal carbonates show a strong regional chemical homogeneity, indicating access of the ore fluids by interconnected channelways near the ore occurrences. Negative Ce anomalies in the main deposit, that are absent at the district scale, indicate local ore-fluid chemical differences. Oxidation of both migrated and indigenous hydrocarbons by the incoming fluid provided the local reducing conditions necessary for sulfate reduction to H2S, pyrobitumen precipitation, and reduction of Eu3+ to Eu2+. Fe-Mn covariations, combined with the REE contents of the hydrothermal carbonates, are consistent with the mineralizing system shifting from reducing/rock-dominated to oxidizing/fluid-dominated conditions following ore deposition. Sulfate and sulfide sulfur isotopes support sulfide origin from evaporite-derived sulfate by thermochemical organic reduction; further evidence includes the presence of C-13-depleted calcite cements (similar to-12 parts per thousand delta(13)C) as sulfate pseudomorphs, elemental sulfur, altered organic matter in the host dolomite, and isotopically heavier, late, solid bitumen. Significant alteration of the indigenous and extrinsic hydrocarbons, with absent bacterial membrane biomarkers (hopanes) is observed. The light delta(34)S of sulfides from small mines and occurrences compared to the main deposit reflect a local contribution of isotopically light sulfur, evidence of local differences in the ore-fluid chemistry.