Significant decrease in in-hospital mortality and major adverse cardiac events in Swiss STEMI patients between 2000 and December 2007.

To evaluate the in-hospital outcome of STEMI (ST elevation myocardial infarction) patients admitted to Swiss hospitals between 2000 and December 2007, and to identify the predictors of in-hospital mortality and major cardiac events. Data from the Swiss national registry AMIS Plus (Acute Myocardial Infarction and Unstable Angina in Switzerland) were used. All patients admitted between January 2000 and December 2007 with STEMI or a new LBBB (left bundle branch block) were included in the registry. We studied 12 026 STEMI patients admitted to 68 hospitals. The mean age was 64 +/- 13 years and 73% of the patients were male. Incidence of in-hospital death was 7.6% in 2000 and 6% in 2007. Reinfarction fell from 3.7% in 2000 to 0.9% in 2007. Thrombolysis decreased from 40.2% in 2000 to 2% in 2007. Clinical predictors of mortality were: age >65 years, Killips class III or IV, diabetes, Q wave myocardial infarction (at presentation). Patients undergoing percutaneous coronary intervention (PCI) had lower mortality and reinfarction rates (3.9% versus 11.2% and 1.1% versus 3.1% respectively, p <0.001) over time, although their numbers increased from 43% in 2000 to 85% in 2007. Patients admitted to hospitals with PCI facilities had lower mortality than patients hospitalised in hospitals without it, but the demographic characteristics differ widely between the two groups. Both in-hospital mortality and reinfarction decreased significantly over the time, parallel to an increased number of PCI. PCI was also the strongest predictor of survival. In-hospital mortality and reinfarction rate have decreased significantly in Swiss STEMI patients in the last seven years, parallel to a significant increase in the number of percutaneous coronary interventions in addition to medical therapy. Outcome is not related to the site of admission but to PCI access.

Les paiements pour services environnementaux de la Fondation Natura Bolivia entre logiques réciprocitaires, redistributives et marchandes

La diffusion internationale des paiements pour services environnementaux (PSE) a été interprétée en 2010 par le gouvernement bolivien d'Evo Morales comme une réponse strictement néolibérale à la nécessité d'assurer une gestion durable des ressources naturelles. Supposée amener à terme à l'éviction de toute régulation autre que marchande - qu'elle s'applique à la nature ou aux rapports entre personnes -, la mise en place de PSE n'a pas été encouragée par les autorités nationales boliviennes. Des projets de PSE ont toutefois été lancés, dont les Acuerdos Reciprocos por el Agua (ARA), issus d'un partenariat public-privé dans le département de Santa Cruz. En analysant leur conception et leur fonctionnement au prisme du référentiel polanyien, nous montrons que, contrairement aux craintes gouvernementales, ces PSE ne font pas abstraction des logiques organisationnelles réciprocitaires et redistributives, ajustant au contexte local un objet global. The international dissemination of payments for ecosystem services (PES) has been interpreted in 2010 by the Bolivian government of Evo Morales as a strictly neo-liberal response to the need to ensure a sustainable management of natural resources. Supposed to contribute to the crowding-out of any other regulation than market - applied to the nature or the relationship between people - the implementation of PES was not encouraged by the Bolivian national authorities. However some PES projects stemming from a public-private partnership have been initiated at local level, as the Acuerdos Reciprocos por el Agua (ARA), in the department of Santa Cruz. Analysing their design and operating through the Polanyian framework, we show that, contrary to the government fears, these PES do not ignore the reciprocal and redistributive organisational logics, adjusting a global object to the local context.