Mechanisms of action of brief alcohol interventions remain largely unknown - a narrative review.

A growing body of evidence has shown the efficacy of brief intervention (BI) for hazardous and harmful alcohol use in primary health care settings. Evidence for efficacy in other settings and effectiveness when implemented at larger scale are disappointing. Indeed, BI comprises varying content; exploring BI content and mechanisms of action may be a promising way to enhance efficacy and effectiveness. Medline and PsychInfo, as well as references of retrieved publications were searched for original research or review on active ingredients (components or mechanisms) of face-to-face BIs [and its subtypes, including brief advice and brief motivational interviewing (BMI)] for alcohol. Overall, BI active ingredients have been scarcely investigated, almost only within BMI, and mostly among patients in the emergency room, young adults, and US college students. This body of research has shown that personalized feedback may be an effective component; specific MI techniques showed mixed findings; decisional balance findings tended to suggest a potential detrimental effect; while change plan exercises, advice to reduce or stop drinking, presenting alternative change options, and moderation strategies are promising but need further study. Client change talk is a potential mediator of BMI effects; change in norm perceptions and enhanced discrepancy between current behavior and broader life goals and values have received preliminary support; readiness to change was only partially supported as a mediator; while enhanced awareness of drinking, perceived risks/benefits of alcohol use, alcohol treatment seeking, and self-efficacy were seldom studied and have as yet found no significant support as such. Research is obviously limited and has provided no clear and consistent evidence on the mechanisms of alcohol BI. How BI achieves the effects seen in randomized trials remains mostly unknown and should be investigated to inform the development of more effective interventions.

I have faith in my thing, you know what I mean? Mixed method elements on individual investments on religious markets.

In contemporary society, religious signification and secular systems mix and influence each other. Holistic conceptions of a world in which man is integrated harmoniously with nature meet representations of a world run by an immanent God. On the market of the various systems, the individual goes from one system to another, following his immediate needs and expectations without necessarily leaving any marks in a meaningful long term system. This article presents the first results of an ongoing research in Switzerland on contemporary religion focusing on (new) paths of socialization of modern that individuals and the various (non-) belief systems that they simultaneously develop

The value of 'positive' clinical signs for weakness, sensory and gait disorders in conversion disorder: a systematic and narrative review.

Experts in the field of conversion disorder have suggested for the upcoming DSM-V edition to put less weight on the associated psychological factors and to emphasise the role of clinical findings. Indeed, a critical step in reaching a diagnosis of conversion disorder is careful bedside neurological examination, aimed at excluding organic signs and identifying 'positive' signs suggestive of a functional disorder. These positive signs are well known to all trained neurologists but their validity is still not established. The aim of this study is to provide current evidence regarding their sensitivity and specificity. We conducted a systematic search on motor, sensory and gait functional signs in Embase, Medline, PsycINfo from 1965 to June 2012. Studies in English, German or French reporting objective data on more than 10 participants in a controlled design were included in a systematic review. Other relevant signs are discussed in a narrative review. Eleven controlled studies (out of 147 eligible articles) describing 14 signs (7 motor, 5 sensory, 2 gait) reported low sensitivity of 8-100% but high specificity of 92-100%. Studies were evidence class III, only two had a blinded design and none reported on inter-rater reliability of the signs. Clinical signs for functional neurological symptoms are numerous but only 14 have been validated; overall they have low sensitivity but high specificity and their use should thus be recommended, especially with the introduction of the new DSM-V criteria.

A Mixed-method Social Networks Study Design for Research on Transnational Families

This paper advocates the adoption of a mixed-methods research design to describe and analyze ego-centered social networks in transnational family research. Drawing on the experience of the Social Networks Influences on Family Formation project (2004-2005), I show how the combined use of network generators and semistructured interviews (N = 116) produces unique data on family configurations and their impact on life course choices. A mixed-methods network approach presents specific advantages for research on children in transnational families. On the one hand, quantitative analyses are crucial for reconstructing and measuring the potential and actual relational support available to children in a context where kin interactions may be hindered by temporary and prolonged periods of separation. On the other hand, qualitative analyses can address strategies and practices employed by families to maintain relationships across international borders and geographic distance, as well as the implications of those strategies for children's well-being.

Association entre consommation d'alcool et facteurs de risque cardiovasculaire: une étude sur la population lausannoise. [Association between alcohol consumption and cardiovascular risk factors: a narrative review]

Alors que la consommation modérée d'alcool est liée à un risque plus faible de développer une maladie coronarienne, l'impact d'une consommation plus importante d'alcool sur les facteurs de risque cardiovasculaire (FRCV) et la maladie coronarienne est moins clair. Nous avons étudié l'association entre la consommation d'alcool, les FRCV et l'estimation du risque à dix ans de faire un événement cardiovasculaire dans l'étude populationnelle lausannoise CoLaus. Dans cette étude, 73% des participants consomment de l'alcool, 16% consomment de 14 à 34 unités d'alcool par semaine et 2% consomment 35 unités ou plus par semaine. Cet article montre notamment l'impact d'une consommation importante d'alcool sur les FRCVet passe en revue les liens entre la consommation d'alcool, le type de boissons et les FRCV. [Abstract] Moderate alcohol consumption has been associated with lower coronary heart disease (CHD) risk. However, the impact of higher alcohol consumption on cardiovascular risk factors (CVRFs) is conflicting. We examined the association between alcohol consumption, CVRFs and the estimated 10-year CHD risk in the population-based CoLaus study in Lausanne, Switzerland. Among 5'769 participants without cardiovascular disease, 73% of the participants were alcohol drinkers; 16% consumed 14-34 drinks/week and 2% consumed >= 35 drinks/week. This article shows the impact of high alcohol consumption on CVRFs and reviews the literature on the associations between alcohol consumption and CVRFs.

Standard care practices and psychosocial interventions aimed at reducing parental distress following stillbirth: A systematic narrative review

Objective: To summarise and critically evaluate the evidence informing the provision of standard care practices and psychosocial interventions following stillbirth. Background: Stillbirth is increasingly recognised as a significant bereavement experience with the potential to cause substantial psychological distress for parents. Standard care practices and psychosocial interventions to support parents have undergone dramatic changes, with limited basis in evidence. Methods: A systematic narrative review was conducted of quantitative studies examining interventions designed to reduce psychological distress in parents following the loss of a stillborn baby. Results: Twenty-five studies met the inclusion criteria for the review. Substantial methodological weaknesses were identified among reviewed studies, including small and heterogeneous loss samples, weak study designs and lack of clarity in reported methods and outcomes. Inadequate replication of many findings substantially limits the generalisability of the evidence. Conclusion: Tentative evidence was found for the provision of mementoes of the baby and information regarding the cause of the loss, support group attendance, and cognitive behavioural interventions for parents identified with clinical levels of distress. Contradictory findings for the impact of contact with the baby prevent the formation of clear conclusions for this practice. Due to the methodological weaknesses prevalent in the research identified, the current evidence base is not considered sufficiently able to reliably inform care practices and intervention approaches. High-quality research evidence in this field is urgently required.

The economic cost of hospital malnutrition in Europe; a narrative review

Background: Malnutrition among hospitalized patients increases length of stay (LOS) and carries extra hospitalization costs. Objective: To review the impact of malnutrition on hospital LOS and costs in Europe. Methods: PubMed and Google Scholar search. All articles from January 2004 until November 2014 were identified. Reference lists of relevant articles were also manually searched. Results: Ten studies on LOS and nine studies on costs were reviewed. The methods used to assess malnutrition and to calculate costs differed considerably between studies. Malnutrition led to an increased LOS ranging from 2.4 to 7.2 days. Among hospitalized patients, malnutrition led to an additional individual cost ranging between 1640 V and 5829 V. At the national level, the costs of malnutrition ranged between 32.8 million V and 1.2 billion V. Expressed as percentage of national health expenditures, the values ranged between 2.1% and 10%. Conclusions: In Europe, malnutrition leads to an increase in LOS and in hospital costs, both at the individual and the national level. Standardization of methods and results reported is needed to adequately compare results between countries. © 2015 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

Causes and implications of overdiagnosis

Background: Overdiagnosis is defined as the diagnosis of a condition not associated with a substantial risk for health in an asymptomatic person. There are several causes of overdiagnosis. Clinical and public health implications of overdiagnosis are underappreciated. Objective: To review the causes of overdiagnosis, and its clinical and public health implications Method: Narrative review Results: Overdiagnosis results from some screening activities, increasingly sensitive diagnostic test procedures, incidental findings on routine exams, and widening diagnostic criteria to define a condition requiring an intervention. The fear of missing a diagnosis and the patients' requests for reassurance are further causes of overdiagnosis. Examples of overdiagnosis include some cases of breast and prostate cancers found by screening, pulmonary emboli identified on highly sensitive CT-scans, and kidney cancers found incidentally following abdominal CTscans. Lowering the critical levels of blood pressure, glycemia, and cholesterol to define hypertension, diabetes, and hypercholesterolemia, respectively, is also the causes of overdiagnosis. An overdiagnosed condition implies unnecessary procedures to confirm or exclude the presence of the disease and unnecessary treatments, both having potential adverse effects. Overdiagnosis also diverts health professionals from caring about other health issues and generates costs without any benefit. Measures to prevent overdiagnosis are notably 1) to increase awareness of health professionals and the population about its occurrence, 2) to account systematically for the risks and benefits of screening and diagnostic procedures using an evidence-based framework, and 3) to decide at which risk level to intervene based on the absolute risk of health events and the absolute risk reduction expected from an intervention. Conclusion: Overdiagnosis has major clinical and public health implications. Increasing awareness of its causes and implications is a step toward its prevention.

Social influences on fertility : a comparative mixed methods study in eastern and western Germany

This article uses a mixed methods design to investigate the effects of social influence on family formation in a sample of eastern and western German young adults at an early stage of their family formation. Theoretical propositions on the importance of informal interaction for fertility and family behavior are still rarely supported by systematic empirical evidence. Major problems are the correct identification of salient relationships and the comparability of social networks across population subgroups. This article addresses the two issues through a combination of qualitative and quantitative data collection and analysis. In-depth interviewing, network charts, and network grids are used to map individual personal relationships and their influence on family formation decisions. In addition, an analysis of friendship dyads is provided.

Choix professionnels, orientations temporelles et scripts sexués des professions

Les trois recherches (mixed method) que nous avons menées sur les professions supérieures (enseignant.e.-chercheur.e.s du monde académique, cadres de l'administration publique et enseignant.e.s de la scolarité post-obligatoire) ont montré que les organisations professionnelles jouent un rôle important dans la manière dont les deux sexes articulent temps professionnels et temps privé, orientant ainsi leur carrière selon des références prioritaires qui peuvent tenir à l'identité professionnelle ou à celle de genre. Ces résultats nous amènent à discuter du pouvoir d'imposition des « images-guides » de l'orientation temporelle, intériorisées et fortement sexuées du fait d'une socialisation différencielle, et du rôle des contextes professionnels dans leur activation. Dans certains cas l'organisation professionnelle favorise un partage inégal et traditionnel des tâches éducatives alors que ses normes peuvent dans d'autres cas être à la source d'une remise en cause du régime de genre.

Des hommes en mouvement : vers une reconfiguration des modèles masculins? L'exemple de la Suisse

This project is a study of the men's movement in Switzerland, especially regarding organizations seeking to redefine male identity. So far, this topic has been understudied, in Switzerland. The few studies available on the subject mostly adopt a (pro)feminist perspective. Their main purpose is to criticize men's movement participants. What is more, scarce researches on this problem mostly conducted by members of the Swiss men's movement themselves are mainly descriptive and methodologically problematic. In this context, I initiated the first national and sociological study of the men's movement in Switzerland. My main goals are: firstly, to propose a typology of organizations forming the men's movement in Switzerland. Secondly, I develop a sociological analysis of this phenomenon, taking into account in this process especially the characteristics of the Swiss context. Consequently, I adopted a mixed method approach, which included two main research steps: Firstly, I defined a representative sample of men's movement organizations in Switzerland. Based on a content analysis of men's organizations' websites, I was able to distinguish three ideal-types: Radical Criticism of Masculinity, Criticism of Hegemonic Masculinity, Defense of Men and Traditional Masculinity. Based on these three concepts, I subsequently analyzed the discourse on masculinity amongst men's movement organizations. Secondly, I conducted a survey of men's movement participants. This survey was based on the results of the content analysis. In this particular stage, I mainly used factor analysis. My results show that it would be all too simplistic to characterize the men's movement, in Switzerland, as a criticism of women's emancipation. On the contrary, my analysis reveals a more complex picture: The two main factors, which influence the men's movement, in Switzerland, are the contemporary sociological context and the Swiss society's particular features. I find that male roles, on the one hand, depend very much on today's cultural shift from materialistic to self-expression values. On the other hand, male role models reflect a social adaptation process. Moreover, as a reaction to deep changes in contemporary family structures, I observe an individualization process, characterized by separation between parental and conjugal functions that greatly shapes male role models. - Cette thèse analyse le phénomène des hommes en mouvement, dans le contexte de la Suisse. Cet ensemble est formé d'organisations regroupant des hommes impliqués consciemment dans un processus d'actions et de réflexions sur l'identité masculine. La revue de la littérature révèle qu'en Suisse, le sujet des hommes en mouvement est très peu étudié. Jusqu'ici, les rares recherches s'y intéressant adoptent généralement une approche (pro)féministe, dont l'objectif est de dénoncer ce phénomène. En outre, de rares recherches, issues des acteurs mêmes de ce mouvement, proposent une vue descriptive de l'ensemble, mais souffrant de faiblesses méthodologiques. Par notre recherche, nous souhaitons contribuer à l'étude de ce sujet, en initiant la première étude d'envergure nationale portant sur les hommes en mouvement. L'objectif final est de déboucher sur une typologie des organisations réunissant les hommes en mouvement, puis sur une analyse de la spécificité de cet ensemble, dans le contexte suisse. Pour remplir ces objectifs, nous avons mis en place un dispositif de méthodes mixtes, en deux phases. Lors d'une première étape, nous avons sélectionné un échantillon représentatif de la diversité des organisations masculines. Par une analyse de contenu effectuée sur la documentation récoltée sur les sites Internet de ces dernières, nous avons pu, en utilisant une démarche inductive et qualitative, faire émerger trois idéaux-types : Critique radicale de la masculinité, Critique de la masculinité hégémonique, Défense des hommes et de la masculinité traditionnelle. Ces concepts permettent de rendre compte, de manière schématique, des trois types de discours contemporains sur l'identité masculine diffusés par les hommes en mouvement. Lors d'une seconde étape, nous avons réalisé une enquête auprès des membres des organisations masculines. Pour y parvenir, nous avons créé un questionnaire incluant des propositions élaborées à partir des résultats de l'étape précédente. Lors de cette phase, nous avons réalisé une analyse factorielle. Les résultats montrent que le phénomène du mouvement des hommes ne saurait se réduire, en Suisse, à un mouvement de ressac visant à attaquer les droits des femmes. Au contraire, il s'agit d'un phénomène complexe, fortement dépendant du contexte sociologique contemporain et des caractéristiques de la société helvétique. Nous affirmons, entre autres, que les modèles masculins observables dans cet ensemble sont façonnés, d'une part, par une transition culturelle, caractérisée par le passage des valeurs matérialistes aux valeurs d'expression de soi. D'autre part, les modèles masculins prônés par les hommes en mouvement reflètent un processus d'adaptation sociale. En effet, en réaction au contexte de reconfiguration des formes familiales, on assiste à une individualisation des rapports de filiation et au détachement de la fonction parentale et conjugale, qui imprègnent fortement les modèles masculins défendus par ces hommes.

Comment faire de la surveillance sanitaire? L'exemple de l'Observatoire Valaisan de la Santé en Suisse [How to conduct public health surveillance? The example of the Observatoire Valaisan de la Santé in Switzerland].

OBJECTIVE: To describe the goals and methods of contemporary public health surveillance and to present the activities of the Observatoire Valaisan de la Santé (OVS), a tool unique in Switzerland to conduct health surveillance for the population of a canton. METHODS: Narrative review and presentation of the OVS. RESULTS: Public health surveillance consists of systematic and continuous collection, analysis, interpretation and dissemination of health data necessary for public health planning. Surveillance is organized according to contemporary public health issues. Switzerland is currently in an era dominated by chronic diseases due to ageing of the population. This "new public health" era is also characterized by the growing importance of health technology, rational risk management, preventive medicine and health promotion, and the central role of the citizen/patient. Information technologies provide access to new health data, but public health surveillance methods need to be adapted. In Switzerland, health surveillance activities are conducted by several public and private bodies, at federal and cantonal levels. The Valais canton has set up the OVS, an integrative, regional, and reactive system to conduct surveillance. CONCLUSION: Public health surveillance provides information useful for public health decisions and actions. It constitutes a key element for public health planning.

How to assess prognosis after cardiac arrest and therapeutic hypothermia.

The prognosis of patients who are admitted in a comatose state following successful resuscitation after cardiac arrest remains uncertain. Although the introduction of therapeutic hypothermia (TH) and improvements in post-resuscitation care have significantly increased the number of patients who are discharged home with minimal brain damage, short-term assessment of neurological outcome remains a challenge. The need for early and accurate prognostic predictors is crucial, especially since sedation and TH may alter the neurological examination and delay the recovery of motor response for several days. The development of additional tools, including electrophysiological examinations (electroencephalography and somatosensory evoked potentials), neuroimaging and chemical biomarkers, may help to evaluate the extent of brain injury in these patients. Given the extensive literature existing on this topic and the confounding effects of TH on the strength of these tools in outcome prognostication after cardiac arrest, the aim of this narrative review is to provide a practical approach to post-anoxic brain injury when TH is used. We also discuss when and how these tools could be combined with the neurological examination in a multimodal approach to improve outcome prediction in this population.

Defining substance use disorders: do we really need more than heavy use?

AIMS: The aim of the study was to explore whether the concept of heavy substance use over time can be used as definition of substance use disorder. METHODS: Narrative review. RESULTS: Heavy use over time clearly underlies the neurobiological changes associated with current thinking of substance use disorders. In addition, there is evidence that heavy use over time can explain the majority of social problems and of burden of disease (morbidity and mortality). A definition of substance use disorders via heavy use over time would avoid some of the problems of current conceptualizations, for instance the cultural specificity of concepts such as loss of control. Finally, stressing the continuum of use may avoid the high level of stigmatization currently associated with substance use disorders. CONCLUSION: 'Heavy substance use over time' seems to be a definition of substance use disorders in line with results of basic research and epidemiology. Additionally, it reduces stigmatization. This approach should thus be further explored.