Equipes de psychiatrie mobiles pour les trois âges de la vie: l'expérience lausannoise [Psychiatric mobile teams for the three ages of live: the Lausanne experience]

Des équipes mobiles de psychiatrie ont été développées dans les trois âges pour répondre aux besoins de personnes qui devraient bénéficier d'une évaluation ou de soins spécialisés, lorsque ceux-ci doivent avoir lieu à domicile. Pour arriver à ce but, les équipes tissent de forts liens de partenariat dans le réseau, que ce soit avec les proches ou avec les professionnels impliqués. Les principes généraux d'intervention sont semblables entre les âges : une population cible définie, une intervention à domicile au bénéfice également des proches et des soins de proximité, des équipes pluridisciplinaires avec une charge de cas limitée pour garantir leur disponibilité. Les spécificités de chaque âge seront analysées. Mobile teams have been developed for the three ages to meet the needs of people who should receive--but do not access to--a psychiatric assessment or to specialized care. To achieve this goal, the teams built a strong partnership within the social network, both with relatives and professionals involved. The general principles of intervention are similar between the ages: a focused target population, assertive outreach which benefits also relatives and carers, multidisciplinary teams with a limited caseload to ensure availability. The specificities of each age will be analyzed

Emplacement of Jurassic - Lower Cretaceous radiolarites of the Nicoya Complex (Costa Rica)

We present a new model to explain the origin, emplacement and stratigraphy of the Nicoya Complex in the NW part of the Nicoya Peninsula (Costa Rica) based on twenty-five years of field work, accompanied with the evolution of geochemical, vulcanological, petrological, sedimentological and paleontological paradigms. The igneous-sedimentary relation, together with radiolarian biochronology of the NW-Nicoya Peninsula is re-examined. We interpret the Nicoya Complex as a cross-section of a fragment of the Late Cretaceous Caribbean Plateau, in which the deepest levels are exposed in the NW-Nicoya Peninsula. Over 50% of the igneous rocks are intrusive (gabbros and in less proportion plagiogranites) which have a single mantle source; the remainder are basalts with a similar geochemical signature. Ar39/Ar40 radioisotopic whole rock and plagioclase ages range throughout the area from 84 to 83 Ma (Santonian) for the intrusives, and from 139 to 88 Ma (Berriasian-Turonian) for the basalts. In contrast, Mn-radiolarites that crop out in the area are older in age, Bajocian (Middle Jurassic) to Albian (middle Cretaceous). These Mn-radiolaritic blocks are set in a "matrix" of multiple gabbros and diabases intrusions. Chilled margins of magmatites, and hydrothermal baking and leaching of the radiolarites confirm the Ar39/Ar40 dating of igneous rocks being consistently younger than most of the radiolarian cherts. No Jurassic magmatic basement has been identified on the Nicoya Peninsula. We interpret the Jurassic-Cretaceous chert sediment pile to have been disrupted and detached from its original basement by multiple magmatic events that occurred during the formation of the Caribbean Plateau. Coniacian-Santonian (Late Cretaceous), Fe-rich radiolarites are largely synchronous and associated with late phases of the Plateau.

Prevalence of cardiovascular risk factors in a middle-income country and estimated cost of a treatment strategy.

BACKGROUND: We assessed the prevalence of risk factors for cardiovascular disease (CVD) in a middle-income country in rapid epidemiological transition and estimated direct costs for treating all individuals at increased cardiovascular risk, i.e. following the so-called "high risk strategy". METHODS: Survey of risk factors using an age- and sex-stratified random sample of the population of Seychelles aged 25-64 in 2004. Assessment of CVD risk and treatment modalities were in line with international guidelines. Costs are expressed as USD per capita per year. RESULTS: 1255 persons took part in the survey (participation rate of 80.2%). Prevalence of main risk factors was: 39.6% for high blood pressure (> or =140/90 mmHg or treatment) of which 59% were under treatment; 24.2% for high cholesterol (> or =6.2 mmol/l); 20.8% for low HDL-cholesterol (<1.0 mmol/l); 9.3% for diabetes (fasting glucose > or =7.0 mmol/l); 17.5% for smoking; 25.1% for obesity (body mass index > or =30 kg/m2) and 22.1% for the metabolic syndrome. Overall, 43% had HBP, high cholesterol or diabetes and substantially increased CVD risk. The cost for medications needed to treat all high-risk individuals amounted to USD 45.6, i.e. 11.2 dollars for high blood pressure, 3.8 dollars for diabetes, and 30.6 dollars for dyslipidemia (using generic drugs except for hypercholesterolemia). Cost for minimal follow-up medical care and laboratory tests amounted to 22.6 dollars. CONCLUSION: High prevalence of major risk factors was found in a rapidly developing country and costs for treatment needed to reduce risk factors in all high-risk individuals exceeded resources generally available in low or middle income countries. Our findings emphasize the need for affordable cost-effective treatment strategies and the critical importance of population strategies aimed at reducing risk factors in the entire population.

Middle and late Cenomanian oceanic anoxic events in shallow and deeper shelf environments of western Morocco

The response of shallow-water sequences to oceanic anoxic event 2 and mid-Cenomanian events 1a and 1b was investigated along the west African margin of Morocco north of Agadir (Azazoul) and correlated with the deep-water sequence of the Tarfaya Basin (Mohammed Beach) based on biostratigraphy, mineralogy, phosphorus and stable isotopes. In the deeper Mohammed Beach section results show double peaks in delta 13C(org) for mid-Cenomanian events 1a and 1b (Rotalipora reicheli biozone, lower CC10a biozone), the characteristic oceanic anoxic event 2 delta 13C excursion (Rotalipora cushmani extinction, top of CC10a biozone) and laminated (anoxic) black shale. In the shallow environment north of Agadir, a fluctuating sea-level associated with dysoxic, brackish and mesotrophic conditions prevailed during the middle to late Cenomanian, as indicated by oyster biostromes, nannofossils, planktonic and benthonic foraminiferal assemblages. Anoxic conditions characteristic of oceanic anoxic event 2 (for example, laminated black shales) did not reach into shallow-water environments until the maximum transgression of the early Turonian. Climate conditions decoupled along the western margin of Morocco between mid-Cenomanian event 1b and the Cenomanian-Turonian boundary, as also observed in eastern Tethys. North of Agadir alternating humid and dry seasonal conditions prevailed, whereas in the Tarfaya Basin the climate was dry and seasonal. This climatic decoupling can be attributed to variations in the Intertropical Convergence Zone and in the intensity of the north-east trade winds in tropical areas.

Socioeconomic determinants of dietary patterns in low- and middle-income countries : a systematic review

BACKGROUND: In high-income countries, high socioeconomic status (SES) is generally associated with a healthier diet, but whether social differences in dietary intake are also present in low- and middle-income countries (LMICs) remains to be established. OBJECTIVE: We performed a systematic review of studies that assessed the relation between SES and dietary intake in LMICs. DESIGN: We carried out a systematic review of cohort and cross-sectional studies in adults in LMICs and published between 1996 and 2013. We assessed associations between markers of SES or urban and rural settings and dietary intake. RESULTS: A total of 33 studies from 17 LMICs were included (5 low-income countries and 12 middle-income countries; 31 cross-sectional and 2 longitudinal studies). A majority of studies were conducted in Brazil (8), China (6), and Iran (4). High SES or living in urban areas was associated with higher intakes of calories; protein; total fat; cholesterol; polyunsaturated, saturated, and monounsaturated fatty acids; iron; and vitamins A and C and with lower intakes of carbohydrates and fiber. High SES was also associated with higher fruit and/or vegetable consumption, diet quality, and diversity. Although very few studies were performed in low-income countries, similar patterns were generally observed in both LMICs except for fruit intake, which was lower in urban than in rural areas in low-income countries. CONCLUSIONS: In LMICs, high SES or living in urban areas is associated with overall healthier dietary patterns. However, it is also related to higher energy, cholesterol, and saturated fat intakes. Social inequalities in dietary intake should be considered in the prevention and control of noncommunicable diseases in LMICs.

Cardiovascular risk factor profiles and their social gradient from adolescence to age 74 in a Swiss region.

BACKGROUND: Few European studies have investigated how cardiovascular risk factors (CRF) in adults relate to those observed in younger generations. OBJECTIVE: To explore this issue in a Swiss region using two population health surveys of 3636 adolescents ages 9-19 years and 3299 adults ages 25-74 years. METHODS: Age patterns of continuous CRF were estimated by robust locally weighted regression and those of high-risk groups were calculated using adult criteria with appropriate adjustment for children. RESULTS: Gender differences in height, weight, blood pressure, and HDL cholesterol observed in adults were found to emerge in adolescents. Overweight, affecting 10-12% of adolescents, was increasing steeply in young adults (three times among males and twice among females) in parallel with inactivity. Median age at smoking initiation was decreasing rapidly from 18 to 20 years in young adults to 15 in adolescents. A statistically significant social gradient in disfavor of the lower education level was observed for overweight in all age groups of women above 16 (odds ratios (ORs) 2.4 to 3.3, P < 0.01), for inactivity in adult males (ORs 1.6 to 2.0, P < 0.05), and for regular smoking in older adolescents (OR 1.9 for males, 2.7 for females, P < 0.005), but not for elevated blood pressure. CONCLUSION: Discontinuities in the cross-sectional age patterns of CRF indicated the emergence of a social gradient and the need for preventive actions against the early adoption of persistent unhealthy behaviors, to which low-educated girls and women are particularly exposed.

Trends in mortality from coronary heart and cerebrovascular disease in Switzerland, 1969-87.

Trends in age-specific and age-standardized death certification rates from all ischaemic heart disease and cerebrovascular disease in Switzerland have been analysed for the period 1969-87, i.e. since the introduction of the Eighth Revision of the International Classification of Diseases for coding causes of death. For coronary heart disease, overall age-standardized rates of males in the mid-late 1980's were similar to those in the late 1960's, although some upward trend was evident up to the mid 1970's (with a peak rate of 120.4/100,000, World standard, in 1978) followed by steady declines in more recent years (103.8/100,000 in 1987). These falls were larger in truncated (35 to 64 years) rates. For females, overall age-standardized rates were stable around a value of 40/100,000, while truncated rates tended to decrease, particularly over most recent years, with an overall decline of over 25%. Examination of age-specific trends showed that in both sexes declines at younger ages were already evident in the earlier calendar period, while above age 50 some fall became evident only in most recent years. Thus, in a formal log-linear age/period/cohort model, both a period and a cohort component emerged. In relation to cerebrovascular diseases, the overall declines were around 40% in males (from 67.4 to 41.2/100,000, World standard) and 45% for females (from 56.6 to 31.7/100,000), and were proportionally comparable across subsequent age groups above age 45. The estimates for the age/period/cohort model were thus downwards both for the period and the cohort component although, in such a situation, it is difficult to disentangle the major underlying component.(ABSTRACT TRUNCATED AT 250 WORDS)

Rupture of a concealed aneurysm after intravenous thrombolysis of a thrombus in the parent middle cerebral artery.

BACKGROUND: Management of ischemic stroke in the presence of aneurysmal brain disease is controversial. Recent retrospective evidence suggests that in selected patients, intravenous thrombolysis (IVT) remains a safe approach for reperfusion. METHODS: We document a case of post-thrombolysis aneurysmal rupture. Supported by additional scientific literature we postulate that acute aneurysmal thrombosis leading to stroke in the culprit artery may be an ominous sign of rupture and should be considered separately from fortuitously discovered distant aneurysmal disease. RESULTS: A 71-year-old female presented with an acute right middle cerebral artery stroke syndrome. IVT allowed vessel reperfusion and revealed a previously concealed, juxtaposed non-giant M1 segment saccular aneurysm. Secondary aneurysmal rupture ensued. The aneurysm was secured by surgical clipping. Postoperative course was uneventful. CONCLUSIONS: This case shows that despite reports of thrombolysis safety in the presence of brain aneurysms, thrombolysis remains potentially hazardous and hints toward an increased risk when the stroke arises on the parent vessel itself.

Prograde mica 40Ar/39Ar growth ages recorded in high pressure rocks (Syros, Cyclades, Greece)

Phengites from the eclogite and blueschist-facies sequences of the Cycladic island of Syros (Greece) have been dated by the in situ UV-laser ablation Ar-40/Ar-39 method. A massive, phengite-rich eclogite and an omphacite-rich metagabbro were investigated. The phengites are eubedral and coarse-grained (several 100 mum), strain-free and exhibit no evidence for late brittle deformation or recrystallization. Apparent ages in these samples range from 43 to 50 Ma for the phengite-rich eclogite and 42 to 52 Ma for the ompbacitic metagabbro. This large spread of ages is visible at all scales-within individual grains as well as in domains of several 100 mum and across the entire sample (ca. 2 cm). Such variations have been traditionally attributed to metamorphic cooling or the incorporation of excess argon. However, the textural equilibrium between the phengites and other high pressure phases and the subtle compositional variations within the phengites, especially the preservation of growth textures, alternatively suggest that the observed range in ages may reflect variations of radiogenic argon acquired during phengite formation and subsequent growth, thus dating a discrete event on the prograde path. This implies that the oldest phengite 40Ar/39Ar ages provide the best estimate of a minimum crystallization age, which is in agreement with recently reported U-Pb and Lu-Hf geochronological data. Our results are consistent with available stable isotope data and further suggest that, under fluid-restricted conditions, both stable and radiogenic isotopic systems can survive without significant isotopic exchange during subduction and exhumation from eclogite-facies P-T conditions. (C) 2004 Elsevier B.V. All rights reserved.

Douteur testiculaire, un défi diagnostique [Testicular pain, a diagnostic challenge?].

Scrotal pain is frequently encountered in practice, as it affects 4 men in 1000, with a peak of incidence between the ages of 45 and 50. After excluding an urological or gastrointestinal cause, referred pain of musculoskeletal origin should be considered, even in the absence of back pain. Described by Dr. Robert Maigne, this referred pain originates from a minor intervertebral dysfunction of the thoracolumbar junction. Imaging of the spine is not helpful. Rather, the diagnosis is made by seeking pain triggered by the mobilization of the lumbar vertebrae; the pinch and roll skin manoeuvre will highlight this referred pain. Treatment is symptomatic, though manual therapies by spine specialists are also recommended.

Carbon isotope stratigraphy and carbonate production during the Early-Middle Jurassic: examples from the Umbria-Marche-Sabina Apennines (Central Italy)

The carbon isotopic signature of carbonates depends on secular variations of organic carbon and carbonate carbon production/burial rates. A decrease in carbonate productivity makes the organic/carbonate carbon ratio unstable up to the point that even minor variations in the organic carbon reservoirs can provoke carbon isotopic shifts. The delta(13)C positive shifts of the middle Carixian (early Pliensbachian) and the early Bajocian recorded in the Umbria-Marche-Sabina domain represent a good example of this mechanism. Both sedimentology and lithostratigraphy of pelagic platform-basin carbonate systems in this area show that important changes in the source of carbonates correspond to the observed isotopic shifts. The middle Carixian event is in fact well correlatable to the drastic reduction of benthic carbonate production on rift-related intrabasinal highs, which then became pelagic carbonate platforms. The early Bajocian event is concomitant with the beginning of a long hiatus on the pelagic carbonate platforms and with a drop of the biodiversity of calcareous organisms followed by the onset of biosiliceous sedimentation in basins. (C) 2002 Elsevier Science B.V. All rights reserved.

Detrital zircon and micropalaeontological ages as new constraints for the lowermost tectonic unit (Talea Ori unit) of Crete, Greece

The Talea Ori unit is the lowermost known tectonic unit of Crete and the most external part of the Hellenides. Its stratigraphy ranges from Late Carboniferous to Oligocene and outcrops of the lower part are only known in the Talea Ori mountains (central Crete). In this area, a black sandstone at the base of the Galinos Beds, thought to be the oldest formation, contains zircons which were dated using the single grain evaporation method. The majority of these grains yielded Late Carboniferous ages (Variscan), while a small group yielded Early Proterozoic ages. The age distribution of these zircons suggests that, at the Carboniferous-Permian boundary, not much of the older North Gondwanan basement was exposed and that a river system carried detrital material from the Variscan belt towards the forming Neotethyan rift. Additionally, higher up in the stratigraphy benthic foraminifers (miliolids) were found in clasts from a conglomerate which was so far thought to be of Early Triassic age [Epting, M., Kudrass, H.-R., Leppig, U., Schaffer, A., 1972. Geologie der Talea Ori/Kreta. N. Jb. Geol. Palaont. Abh. 141, 259-285.]. These miliolids belong to the species Hoyenella inconstans [Michalik, J., Jendrejakova, O., Borza, K., 1979. Some new foraminifera species of the Fatra-Formation (Uppermost Triassic) in the West Carpathians. Geol. Carpath. 30 (1), 61-91.], thus attributing a Late Triassic (Carnian-Norian?) maximal age to this conglomerate. The carbonate platform from which the miliolids-bearing clasts come is not known. The presence to the north of a continuous hemipelagic record from the Carboniferous to the Triassic (Phyllite-Quartzite and Tripali units), attributed to the Palaeotethys realm, allows the Talea Ori unit and its lateral equivalents (the Ionian zone) to be assigned to the westward continuation of the Cimmerian block and therefore to the northern margin of the East Mediterranean Neotethys ocean. (c) 2006 Elsevier B.V. All rights reserved.

"We are all middle class: On the subjective status in Chile"

Chile is one of the countries with the highest level of income inequality worldwide. Given the association between economic inequality and patterns of social stratification, in such context it would be expected to find a large dispersion of subjective social status' indicators in the population. Nevertheless, analyses from international surveys reveal a strong tendency to the mean of the subjective status i.e. there would be downward and upward biases of the subjective status regarding the objective status. The present research attempts to tackle this phenomenon for the Chilean case, with a focus on the influence of status and class variables on the subjective status. For the analysis we use Chilean data from the social inequality module of the International Social Survey Programme 2009. The results indicate a strong tendency to the mean of the subjective status in the population, particularly from the side of those with higher objective status.