High prevalence of forgoing healthcare for economic reasons in Switzerland: a population-based study in a region with universal health insurance coverage.

OBJECTIVE: To investigate the determinants and the 4-year evolution of the forgoing of healthcare for economic reasons in Switzerland. METHOD: Population-based survey (2007-2010) of a representative sample aged 35-74years in the Canton of Geneva, Switzerland. Healthcare forgone, socioeconomic and insurance status, marital status, and presence of dependent children were assessed using standardized methods. RESULTS: A total of 2601 subjects were included in the analyses. Of the subjects, 13.8% (358/2601) reported having forgone healthcare for economic reasons, with the percentage varying from 3.7% in the group with a monthly income ≥13,000CHF (1CHF≈1$) to 30.9% in the group with a monthly income <3000CHF. In subjects with a monthly income <3000CHF, the percentage who had forgone healthcare increased from 22.5% in 2007/8 to 34.7% in 2010 (P trend=0.2). Forgoing healthcare for economic reasons was associated with lower income, female gender, smoking status, lower job position, having dependent children, being divorced and single, paying a higher deductible, and receiving a premium subsidy. CONCLUSION: In a Swiss region with universal health insurance coverage, the reported prevalence of forgoing healthcare for economic reasons was high and greatly dependent on socioeconomic factors. Our data suggested an increasing trend among participants with the lowest income.

Jurassic and Early Cretaceous Radiolaria of the Lower Amurian Terrane: Khabarovsk region, far east of Russia

New data on biostratigraphy, sedimentology and tectonics of the Russian Far Eastern region (Lower Amurian terrane) are presented. This study shows that sedimentary sequence of the terrane consists of interbedded Radiolaria-bearing siliceous and volcaniclastic sediments spanning an interval of over 90 million years. It is shown that accumulation of radiolarian deposits on an oceanic plate was associated with alkaline (intraplate) volcanism in the Jurassic, while the plate was drifting, and with some are volcanism during the Early Cretaceous. The younger siliceous rocks contain volcaniclastic material and indicate that the studied sequence approached the trench in the Early Cretaceous (Hauterivian-Barremian) and became accreted in the late Albian-early Cenomanian. We describe and illustrate radiolarian species extracted fi om 21 samples. A taxonomic list of 194 taxa and nine plates of Jurassic-Early Cretaceous Radiolaria are presented.

Cross-Sectional and Longitudinal Associations between Body Mass Index and Cardiometabolic Risk Factors in Adolescents in a Country of the African Region.

We assessed the association between several cardiometabolic risk factors (CRFs) (blood pressure, LDL-cholesterol, HDL-cholesterol, triglycerides, uric acid, and glucose) in 390 young adults aged 19-20 years in Seychelles (Indian Ocean, Africa) and body mass index (BMI) measured either at the same time (cross-sectional analysis) or at the age of 12-15 years (longitudinal analysis). BMI tracked markedly between age of 12-15 and age of 19-20. BMI was strongly associated with all considered CRFs in both cross-sectional and longitudinal analyses, with some exceptions. Comparing overweight participants with those having a BMI below the age-specific median, the odds ratios for high blood pressure were 5.4/4.7 (male/female) cross-sectionally and 2.5/3.9 longitudinally (P < 0.05). Significant associations were also found for most other CRFs, with some exceptions. In linear regression analysis including both BMI at age of 12-15 and BMI at age of 19-20, only BMI at age of 19-20 remained significantly associated with most CRFs. We conclude that CRFs are predicted strongly by either current or past BMI levels in adolescents and young adults in this population. The observation that only current BMI remained associated with CRFs when including past and current levels together suggests that weight control at a later age may be effective in reducing CRFs in overweight children irrespective of past weight status.

Cross-scale analysis of the region effect on vascular plant species diversity in southern and northern European mountain ranges.

Background: The divergent glacial histories of southern and northern Europe affect present-day species diversity at coarse-grained scales in these two regions, but do these effects also penetrate to the more fine-grained scales of local communities?Methodology/Principal Findings: We carried out a cross-scale analysis to address this question for vascular plants in two mountain regions, the Alps in southern Europe and the Scandes in northern Europe, using environmentally paired vegetation plots in the two regions (n = 403 in each region) to quantify four diversity components: (i) total number of species occurring in a region (total gamma-diversity), (ii) number of species that could occur in a target plot after environmental filtering (habitat-specific gamma-diversity), (iii) pair-wise species compositional turnover between plots (plot-to-plot beta-diversity) and (iv) number of species present per plot (plot gamma-diversity). We found strong region effects on total gamma-diversity, habitat-specific gamma-diversity and plot-to-plot beta-diversity, with a greater diversity in the Alps even towards distances smaller than 50 m between plots. In contrast, there was a slightly greater plot alpha-diversity in the Scandes, but with a tendency towards contrasting region effects on high and low soil-acidity plots.Conclusions/Significance: We conclude that there are strong regional differences between coarse-grained (landscape- to regional-scale) diversity components of the flora in the Alps and the Scandes mountain ranges,but that these differences do not necessarily penetrate to the finest-grained (plot-scale) diversity component, at least not on acidic soils. Because different processes can lead to a similar pattern, we discuss the consistency of our results with Quaternary history and other divergent features between the two regions such as habitat connectivity, selection for vagility and environmental differences not accounted for in our analyses

Trends in cardiovascular risk factors (1984-1993) in a Swiss region: results of three population surveys.

BACKGROUND: This study attempted to assess the time trends in lifestyle and cardiovascular risk factors in the Swiss region of Vaud-Fribourg (population 784,000). METHODS: Three surveys (1984/1985, 1988/1989, and 1992/1993), based on independent representative samples (n = 3,300) of the population ages 25 to 74, were conducted within the framework of the international WHO-MONICA Project. RESULTS: The most favorable changes were observed in reported behaviors: increased physical activity in leisure time, healthier dietary habits (switch from unskimmed milk, butter, and meat to skimmed milk, margarine, and fish, with no change for fruits and vegetables), and lower prevalence of regular smoking among men (from 32 to 28%). Body mass index did not vary significantly, apart from an increase in the prevalence of obesity among men (from 11 to 15%). Total cholesterol varied only slightly, while the HDL cholesterol levels decreased steadily (from 1.37 to 1.19 mmol/L among men; from 1.59 to 1.51 among women). Average systolic blood pressure regressed among women (from 127.2 to 124.4 mm Hg), while the prevalence of untreated hypertension increased among older men. CONCLUSION: The self-reported changes in lifestyle were only partially reflected by favorable trends in objective measurements. Physical activity, even at moderate intensity, and consumption of fruits, vegetables, and fiber in general should be promoted.

Signature polymorphisms in the internal transcribed spacer region relevant for the differentiation of zoophilic and anthropophilic strains of Trichophyton interdigitale and other species of T. mentagrophytes sensu lato.

Summary Background Dermatophytes are the main cause of superficial mycoses in humans and animals. Molecular research has given useful insights into the phylogeny and taxonomy of the dermatophytes to overcome the difficulties with conventional diagnostics. Objectives The Trichophyton mentagrophytes complex consists of anthropophilic as well as zoophilic species. Although several molecular markers have been developed for the differentiation of strains belonging to T. mentagrophytes sensu lato, correct identification still remains problematic, especially concerning the delineation of anthropophilic and zoophilic strains of T. interdigitale. This differentiation is not academic but is essential for selection of the correct antimycotic therapy to treat infected patients. Methods One hundred and thirty isolates identified by morphological characteristics as T. mentagrophytes sensu lato were investigated using restriction fragment length polymorphism (RFLP) and sequence analysis of the polymerase chain reaction-amplified internal transcribed spacer (ITS) region of the rDNA. Results Species of this complex produced individual RFLP patterns obtained by the restriction enzyme MvaI. Subsequent sequence analysis of the ITS1, 5.8S and ITS2 region of all strains, but of T. interdigitale in particular, revealed single unique polymorphisms in anthropophilic and zoophilic strains. Conclusions Signature polymorphisms were observed to be useful for the differentiation of these strains and epidemiological data showed a host specificity among zoophilic strains of T. interdigitale/Arthroderma vanbreuseghemii compared with A. benhamiae as well as characteristic clinical pictures in humans when caused by zoophilic or anthropophilic strains. The delineation is relevant because it helps in determining the correct treatment and provides clues regarding the source of the infection.

Osteogenic sarcoma of the maxillary region in a Mexican mestizo population.

Background and Objectives: This study analyzed maxillary osteosarcoma in a mestizo population, with particular emphasis on the type of treatment and disease-free and overall survival. Methods: This is a retrospective study including all mestizo patients with osteosarcoma of the maxilla seen in a single cancer institution in Mexico during a 20-year period. Results: There were 21 patients. Age ranged from 16 to 76 years (mean, 37.5 y). Mean evolution time to diagnosis was 13 months, with a mean tumor size of 7 x 6 cm(2). Surgery was the initial treatment in 19 patients, 17 of whom received adjuvant treatment. Disease-free survival according to surgical margin and overall survival were not statistically significant. Disease-free survival was 29% at 5 years, and overall survival was 50% and 25% at 5 and 10 years, respectively. Conclusions: Osteosarcomas of the maxilla are infrequent lesions that merit early diagnosis and proper treatment because of their rapid evolution. Treatment is currently based on a well-planned surgery with free surgical margins plus adjuvant radiotherapy and/or chemotherapy.

Distribution and risk factors for Plasmodium and helminth co-infections: a cross-sectional survey among children in Bagamoyo district, coastal region of Tanzania.

BACKGROUND: Plasmodium and soil transmitted helminth infections (STH) are a major public health problem, particularly among children. There are conflicting findings on potential association between these two parasites. This study investigated the Plasmodium and helminth co-infections among children aged 2 months to 9 years living in Bagamoyo district, coastal region of Tanzania. METHODS: A community-based cross-sectional survey was conducted among 1033 children. Stool, urine and blood samples were examined using a broad set of quality controlled diagnostic methods for common STH (Ascaris lumbricoides, hookworm, Strongyloides stercoralis, Enterobius vermicularis, Trichuris trichura), schistosoma species and Wuchereria bancrofti. Blood slides and malaria rapid diagnostic tests (mRDTs) were utilized for Plasmodium diagnosis. RESULTS: Out of 992 children analyzed, the prevalence of Plasmodium infection was 13% (130/992), helminth 28.5% (283/992); 5% (50/992) had co-infection with Plasmodium and helminth. The prevalence rate of Plasmodium, specific STH and co-infections increased significantly with age (p < 0.001), with older children mostly affected except for S. stercoralis monoinfection and co-infections. Spatial variations of co-infection prevalence were observed between and within villages. There was a trend for STH infections to be associated with Plasmodium infection [OR adjusted for age group 1.4, 95% CI (1.0-2.1)], which was more marked for S. stercoralis (OR = 2.2, 95% CI (1.1-4.3). Age and not schooling were risk factors for Plasmodium and STH co-infection. CONCLUSION: The findings suggest that STH and Plasmodium infections tend to occur in the same children, with increasing prevalence of co-infection with age. This calls for an integrated approach such as using mass chemotherapy with dual effect (e.g., ivermectin) coupled with improved housing, sanitation and hygiene for the control of both parasitic infections.

Late mesozoic to neogene radiolarian biostratigraphy and palaeoceanography in the Caribbean and East pacific region

^Raduolarians constitute a good tool for contributing to the biostratigraphy of accreted terranes and in deep-sea sediment sequences. The use of radiolarians is also proven to be valuable as a palaeoceanographic indicator. The present study evaluates radiolarians in three different geological settings, in order to better constrain the age of the sites and to try to understand their palaeoenvironmental situation at different periods, particularly in the Caribbean-Central America area. On the Jarabacoa Block, in Central Dominican Republic, a hundred meters of siliceous mudstones (Pedro Brand section in the Tireo Group) was dated as Turonian- Coniancian in age using radiolarians. A 40Ar-39Ar whole rock age of 75.1±1.1 Ma (Campanian), obtained in a basalt dyke crosscutting the radiolarian bearing rocks, a consistent minimum age for the pelagic-hemipelagic Pedro Brand section. The Jarabacoa Block is considered as the most complete outcrop section of Pacific ocean crust overlain by a first Aptian-Albian phase of Caribbean Large Igneous Province-type activity (CLIP), followed by the development of a Cenomanian-Santonian intraoceanic arc, which is in turn overlain by a late Campanian-Maastrichtian CLIP-phase. The Tireo Group records an episode of pelagic to hemi-pelagic and intermediate to acidic arc-derived sedimentation, previous to the youngest magmatic phase of the CLIP. Thus, the section of Pedro Brand has been interpreted in this study as being part of the intraoceanic arc. In northern Venezuela, a greenish radiolarite section from Siquisique Ophiolite (basalts, gabbros and some associated cherts) in Guaparo Creek has been studied. In previous studies, the Ophiolite unit (Petacas Creek section) has been dated as Bajocian-Bathonian, based on ammonites present in interpillow sediments from basalt blocks. New dating of the present study concluded in an Aptian?-Albian-Cenomanian age for the Guaparo creek section (middle Cretaceous), based on radiolarian assemblage associated to basalts-gabbros rocks of the unit. Previous plagioclase 40Ar-39Ar ages from the Siquisuique Ophiolite may be slightly younger (94-90 Ma.) and may, therefore, represent younger dykes that intruded onto a well-developed sheeted dyke complex of the Siquisique. The geochemistry of these rocks and the palaeotectonic reconstruction of the Caribbean area during this period suggest that these rocks were derived from a mid-ocean ridge with an influence of deep mantle plume. The Siquisique Ophiolite most probably represents a fragment of the proto-Caribbean basin. The Integrated Ocean Drilling Program Expedition 344 drilled a transect across the convergent margin off Costa Rica. Two sites of this expedition were chosen for radiolarian biostratigraphy and palaeoceanographic studies. Both sites (U1381C and U1414A) are located in the incoming Cocos plate, in the eastern Equatorial Pacific. The succession of U1381C yields a Middle Miocene to Pleistocene age, and presents an important hiatus of approximately 10 Ma. The core of U1414A exposes a continuous sequence that deposited during Late Miocene to Pleistocene (radiolarian zones RN6-RN16). The ages were assigned based on radiolarians and correlated with nannofossil zonation and tephra 40Ar-39Ar datation. With those results, and considering the northward movement of the Cocos plate motion (about 7 cm/year), deduction is made that the sites U1381C and U1414A were initially deposited during the Miocene, several hundreds of kilometres from the current location, slightly south of the Equator. This suggests that the faunas of these sites have been subjected to different currents, first influenced by the cold tongue of the South Equatorial Current and followed by the warm Equatorial Countercurrent. At last, coastal upwelling influenced faunas of the Pleistocene. -- Les radiolaires sont considérés comme un outil utile à la biostratigraphie des terrains accrétés et des sédiments profonds. Leur utilité est aussi prouvée comme étant remarquable au niveau des reconstructions paléocéanographiques. La présente étude évalue l'importance et la présence des radiolaires de trois localités géologiquement différentes d'Amérique Centrale-Caraïbes, dans le but d'améliorer les model d'âges et de mieux comprendre la situation paléoenvironnementale à travers le temps. Dans le Bloque de Jarabacoa, au centre de la République Dominicaine, une section de cent mètres (section de Pedro Brand, Groupe de Tireo) a été datée comme faisant partie du Turonien-Santonien, en utilisant les radiolaires. Une datation 40Ar-39Ar sur roche totale de 75±1.1 Ma (Campanien) a été obtenu pour vin dyke traversant les sédiments riches en radiolaires, en cohérence avec l'âge minimum accordé à la section de Pedro Brand. Aux Caraïbes, le Bloque de Jarabacoa est considéré comme l'affleurement le plus complet présentant une succession de croûte océanique d'origine Pacifique recouverte d'une première phase d'activité volcanique de type CLIP (Caribbean Large Igneous Province) d'âge Aptien- Albien, de dépôts d'arc volcanique intra-océanique d'âge Cénomanien-Santonien, puis d'une seconde phase de type CLIP d'âge Campanien-Maastrichtien. Le Groupe de Tireo enregistre un épisode de dépôt pélagiques-hémipélagiques et d'arc volcanique, antérieur à la plus jeune phase de type CLIP. Cette étude place donc la formation de la section de Pedro Brand au moment du développement de l'arc intra-océanique. A Guaparo Creek (nord du Vénézuela), une section de radiolarite verdâtre faisant partie des ophiolites de Siquisique (basaltes, gabbros, cherts) a été étudiée. Dans des études précédentes, sur la localité de Petacas Creek, l'unité ophiolitique a été daté d'âge Bajocien- Bathonien (Jurassique) sur la base d'ammonites trouvées dans des sédiments intercalés entre des laves en coussins. Les nouvelles datations de notre étude, basées sur des assemblages à radiolaires de l'unité à basaltes-gabbros, donnent un âge Aptien?-Albien-Cénomanien (Crétacé moyen). Les âges de l'Ophiolite de Siquisique, précédement calculés par la méthode sur plagioclases, pourraient être légèrement plus jeune (94-90 Ma) et donc représenter des intrusions plus récentes de dykes dans le complexe filonien déjà bien dévelopé. La géochimie de ces roches magmatiques, ainsi que les reconstructions paléotectoniques de la zone Caraïbes durant cette période, suggèrent que ces formations sont dérivées d'une ride médio-océanique associée à l'influence d'un panache mantellique. L'ophiolite de Siquisique représente très probablement un fragment du bassin de proto¬Caraïbe. L'expédition 344 du programme IODP (Integrated Ocean Drilling Program) a eu lieu dans l'optique de forer et dresser une coupe de la marge convergente au large du Costa Rica. Deux sites de cette expédition ont été choisis pour les besoins des études de biostratigraphie et de reconstruction paléocéanographique. Ces deux sites (U1381C et U1414A) sont situés sur la plaque subductante de Cocos, dans la zone Pacifique est-équatoriale. La carotte U1381C expose une séquence s'étalant du Miocène moyen au Pléistocène, et présente un important hiatus d'environ 10 Ma. La carotte U1414A expose une séquence continue s'étalant du Miocène tardif au Pléistocène (zone à radiolaires RN6-RN16). Les âges ont été assignés sur la base des radiolaires et corrélés avec les zones à nanofossiles et les datations 40Ar-39Ar sur téphras. Avec ces résultats, et en considérant le mouvement nord de la plaque de Cocos (environ 7 cm/an), déduction est faite que les deux sites étaient initialement situés, au cours du Miocène, à plusieurs centaines de kilomètres de leur location actuelle, au sud de l'équateur. Cela suggère que les faunes de ces sites ont été sujettes à différents courants; premièrement influencées par la langue froide du SEC (South Equatorial Current), puis par les eaux chaudes du ECC (Equatorial Countercurrent). Pour terminer, les remontées d'eau côtières ont influencées les faunes Pléistocène.

Different locations of dermoid cysts in the orbital region.

BACKGROUND: Dermoid cysts are frequent unilateral congenital benign tumors that can be found at different locations throughout the body. In the orbital region, dermoid cysts occur predominantly in the supero-temporal quadrant. However, different orbital locations are possible, making this entity an important differential diagnosis for orbital tumors. PATIENTS AND METHODS: We retrospectively reviewed the charts of 23 consecutive patients operated in our institution between 2005 and 2014 for orbital tumors that were diagnosed as congenital dermoid or epidermoid cysts. RESULTS: There were 21 dermoid and 2 epidermoid cysts. The median age at surgery time was 7 years (range 1-41). There were 15 females and 8 males. Eleven cysts were located supero-temporally (47.8%), seven supero-medially (30.4%), two temporally (8.7%), one at the frontal bone (4.4%) and two in the fossa of the lacrimal gland (8.7%). The mean cyst diameter was 13.1 mm±5.0 (SD). None had signs of malignant disease. No recurrence was observed after complete excision. CONCLUSION: Dermoid cysts of orbital region are mostly located in the supero-temporal quadrant. However, other orbital locations are possible and dermoid cysts must thus be considered in the differential diagnosis of any mass in the orbital region.

Validity of silhouette showcards as a measure of body size and obesity in a population in the African region : a practical research tool for general-purpose surveys.

BACKGROUND: The purpose of this study is to validate the Pulvers silhouette showcard as a measure of weight status in a population in the African region. This tool is particularly beneficial when scarce resources do not allow for direct anthropometric measurements due to limited survey time or lack of measurement technology in face-to-face general-purpose surveys or in mailed, online, or mobile device-based surveys. METHODS: A cross-sectional study was conducted in the Republic of Seychelles with a sample of 1240 adults. We compared self-reported body sizes measured by Pulvers' silhouette showcards to four measurements of body size and adiposity: body mass index (BMI), body fat percent measured, waist circumference, and waist to height ratio. The accuracy of silhouettes as an obesity indicator was examined using sex-specific receiver operator curve (ROC) analysis and the reliability of this tool to detect socioeconomic gradients in obesity was compared to BMI-based measurements. RESULTS: Our study supports silhouette body size showcards as a valid and reliable survey tool to measure self-reported body size and adiposity in an African population. The mean correlation coefficients of self-reported silhouettes with measured BMI were 0.80 in men and 0.81 in women (P < 0.001). The silhouette showcards also showed high accuracy for detecting obesity as per a BMI ≥ 30 (Area under curve, AUC: 0.91/0.89, SE: 0.01), which was comparable to other measured adiposity indicators: fat percent (AUC: 0.94/0.94, SE: 0.01), waist circumference (AUC: 0.95/0.94, SE: 0.01), and waist to height ratio (AUC: 0.95/0.94, SE: 0.01) amongst men and women, respectively. The use of silhouettes in detecting obesity differences among different socioeconomic groups resulted in similar magnitude, direction, and significance of association between obesity and socioeconomic status as when using measured BMI. CONCLUSIONS: This study highlights the validity and reliability of silhouettes as a survey tool for measuring obesity in a population in the African region. The ease of use and cost-effectiveness of this tool makes it an attractive alternative to measured BMI in the design of non-face-to-face online- or mobile device-based surveys as well as in-person general-purpose surveys of obesity in social sciences, where limited resources do not allow for direct anthropometric measurements.

Ideal Body Size as a Mediator for the Gender-Specific Association Between Socioeconomic Status and Body Mass Index: Evidence From an Upper-Middle-Income Country in the African Region.

While obesity continues to rise globally, the associations between body size, gender, and socioeconomic status (SES) seem to vary in different populations, and little is known on the contribution of perceived ideal body size in the social disparity of obesity in African countries. We examined the gender and socioeconomic patterns of body mass index (BMI) and perceived ideal body size in the Seychelles, a middle-income small island state in the African region. We also assessed the potential role of perceived ideal body size as a mediator for the gender-specific association between SES and BMI. A population-based survey of 1,240 adults aged 25 to 64 years conducted in December 2013. Participants' BMI was calculated based on measured weight and height; ideal body size was assessed using a nine-silhouette instrument. Three SES indicators were considered: income, education, and occupation. BMI and perceived ideal body size were both higher among men of higher versus lower SES (p< .001) but lower among women of higher versus lower SES (p< .001), irrespective of the SES indicator used. Multivariate analysis showed a strong and direct association between perceived ideal body size and BMI in both men and women (p< .001) and was consistent with a potential mediating role of perceived ideal body size in the gender-specific associations between SES and BMI. Our study emphasizes the importance of gender and socioeconomic differences in BMI and ideal body size and suggests that public health interventions that promote perception of healthy weight could help mitigate SES-related disparities in BMI.