Avaluació de programes formatius de seguretat viària i la reincidència posterior

Els programes formatius d’educació viària són una mesura penal alternativa que s’imposa habitualment als autors dels delictes relacionats amb el trànsit (articles 379 i següents del Codi Penal) per suspendre o substituir la pena de presó. Aquests programes tenen un doble objectiu: aconseguir reduir a curt termini la sinistralitat viària i propiciar un canvi cultural permanent en la conducció. L’objectiu principal d’aquesta recerca va ser identificar les característiques comunes dels infractors de trànsit que fan aquest tipus d’intervenció, conèixer els factors de risc associats a aquests infractors i en quina mesura l’estat psicològic és un factor de risc en l’estil de conducció. També es volia determinar si hi havia diferències entre les entitats que impartien la formació, avaluar l’efectivitat d’aquests programes en l’estil de conducció dels participants en finalitzar el curs i conèixer la reincidència dels seus participants i la seva relació amb l’estat i el canvi de les variables de l’estudi. La mostra va comptar amb 278 participants voluntaris del total de 354 infractors de trànsit que van realitzar un programa formatiu entre l’1 d’abril de 2009 i el 13 de febrer de 2010. D’aquests, un total de 100 participants van autoritzar a ser contactats novament entre el desembre del 2011 i el gener del 2012, per mirar la reincidència. Les fonts d’informació van ser els qüestionaris passats als infractors i el buidatge de la base de dades d’execució penal del Departament de Justícia, amb informació judicial i personal i el seguiment dels usuaris fins a dos anys després d’haver finalitzat el curs formatiu, per saber si havien tornat a reincidir en el mateix delicte.

Evaluación de programas formativos de seguridad vial y su reincidencia posterior

Los programas formativos de educación vial son una medida penal alternativa que se impone habitualmente a los autores de delitos relacionados con el tráfico (artículos 379 y siguientes del Código Penal) para suspender o sustituir la pena de prisión. Estos programas tienen un doble objetivo: conseguir reducir a corto plazo la siniestralidad vial y propiciar un cambio cultural permanente en la conducción. El objetivo principal de esta investigación fue identificar las características comunes de los infractores de tráfico que han de hacer este tipo de intervención y conocer sus factores de riesgo. También se estudiaron las diferencias entre las entidades que imparten los cursos formativos, se evaluó su efectividad y se estudió la reincidencia de los conductores. En total participaron 278 infractores que realizaron un programa formativo entre el 1 de abril de 2009 y el 13 de febrero de 2010 y se les siguió hasta enero de 2012.

Fitness, sport et pression artérielle [Fitness, sports and blood pressure].

Blood pressure is lowered for a few hours after aerobic exercise, but also after resistance exercise, although for a shorter period of time. An exercise program can significantly lower resting and ambulatory BP measurements. Multiple mechanisms interact for the BP lowering effect, such as decreased total peripheral resistance, enhanced endothelial function, diminished sympathetic or rennin plasmatic activity, structural vascular modifications and baroreceptor reflex modulation. New exercises like eccentric or isometric (handgrip) contractions are promising. Resistance activities have long been considered dangerous for blood vessels because of increased arterial stiffness, but if the intensity remains moderate and aerobic exercises are integrated, then the effects are altogether beneficial.

Differential migration of in vivo primed B and T lymphocytes to lymphoid and non-lymphoid organs.

Our study describes tissue-specific migration of T and B cells during a localized anti-viral immune response. After mouse mammary tumor virus (MMTV) injection, B lymphocytes of the draining lymph node become infected and present a retroviral superantigen to CD4(+) T lymphocytes. Infected B cells receive superantigen-mediated help in a fashion comparable to classical immune responses. To investigate the fate of T and B lymphocytes that had interacted via cognate help in the same peripheral lymph node microenvironment we adoptively transferred them into naive recipients. Here we show that MMTV-infected B cells and superantigen-stimulated T cells were programmed to migrate to distinct sites of the body. Plasmablasts but not T cells migrated to the mammary gland and activated alpha4beta1 integrins were found to have a crucial role in the migration to the mammary gland. In contrast, T cells had a much higher affinity for secondary lymphoid organs and large intestine. This demonstrates that upon antigen-driven B and T lymphocyte interaction in the local draining lymph node a subset-specific homing program for B and T lymphocytes is induced.

Diabète et conduite: réflexions et atelier pratique [Diabetes and driving: thoughts and educational perspectives].

In Switzerland over 200'000 people with diagnosed diabetes drive a car. Their physicians endorse many roles: usual medical care as well as informing properly about driving recommandations and handling the legal issues behing the licensing procedure. Ability to drive can be impaired in three ways: hypogylcemia, diabetes complications and hyperglycemia. Hypoglycemia is the main risk factor of vehicle accident for diabetic drivers and frequent while driving. However few accidents are reported due to hypoglycemia. Swiss medical guidelines about diabetes and driving mention the requested conditions, but practically how should we do? We sought to answear by creating a specific educationnal program focused on hypoglycemia management. Building patient knowledges through experiences is the main goal of the course diabetes and driving.

Development of pharmaceutical care services in nursing homes: practice and research in a Swiss canton.

OBJECTIVE: The aim of this study was to assess the implementation process and economic impact of a new pharmaceutical care service provided since 2002 by pharmacists in Swiss nursing homes. SETTING: The setting was 42 nursing homes located in the canton of Fribourg, Switzerland under the responsibility of 22 pharmacists. METHOD: We developed different facilitators, such as a monitoring system, a coaching program, and a research project, to help pharmacists change their practice and to improve implementation of this new service. We evaluated the implementation rate of the service delivered in nursing homes. We assessed the economic impact of the service since its start in 2002 using statistical evaluation (Chow test) with retrospective analysis of the annual drug costs per resident over an 8-year period (1998-2005). MAIN OUTCOME MEASURES: The description of the facilitators and their implications in implementation of the service; the economic impact of the service since its start in 2002. RESULTS: In 2005, after a 4-year implementation period supported by the introduction of facilitators of practice change, all 42 nursing homes (2,214 residents) had implemented the pharmaceutical care service. The annual drug costs per resident decreased by about 16.4% between 2002 and 2005; this change proved to be highly significant. The performance of the pharmacists continuously improved using a specific coaching program including an annual expert comparative report, working groups, interdisciplinary continuing education symposia, and individual feedback. This research project also determined priorities to develop practice guidelines to prevent drug-related problems in nursing homes, especially in relation to the use of psychotropic drugs. CONCLUSION: The pharmaceutical care service was fully and successfully implemented in Fribourg's nursing homes within a period of 4 years. These findings highlight the importance of facilitators designed to assist pharmacists in the implementation of practice changes. The economic impact was confirmed on a large scale, and priorities for clinical and pharmacoeconomic research were identified in order to continue to improve the quality of integrated care for the elderly.

The effect of virtual reality on visual vertigo symptoms in patients with peripheral vestibular dysfunction: a pilot study.

Individuals with vestibular dysfunction may experience visual vertigo (VV), in which symptoms are provoked or exacerbated by excessive or disorientating visual stimuli (e.g. supermarkets). VV can significantly improve when customized vestibular rehabilitation exercises are combined with exposure to optokinetic stimuli. Virtual reality (VR), which immerses patients in realistic, visually challenging environments, has also been suggested as an adjunct to VR to improve VV symptoms. This pilot study compared the responses of sixteen patients with unilateral peripheral vestibular disorder randomly allocated to a VR regime incorporating exposure to a static (Group S) or dynamic (Group D) VR environment. Participants practiced vestibular exercises, twice weekly for four weeks, inside a static (Group S) or dynamic (Group D) virtual crowded square environment, presented in an immersive projection theatre (IPT), and received a vestibular exercise program to practice on days not attending clinic. A third Group D1 completed both the static and dynamic VR training. Treatment response was assessed with the Dynamic Gait Index and questionnaires concerning symptom triggers and psychological state. At final assessment, significant betweengroup differences were noted between Groups D (p = 0.001) and D1 (p = 0.03) compared to Group S for VV symptoms with the former two showing a significant 59.2% and 25.8% improvement respectively compared to 1.6% for the latter. Depression scores improved only for Group S (p = 0.01) while a trend towards significance was noted for Group D regarding anxiety scores (p = 0.07). Conclusion: Exposure to dynamic VR environments should be considered as a useful adjunct to vestibular rehabilitation programs for patients with peripheral vestibular disorders and VV symptoms.

The effect of virtual reality on visual vertigo symptoms in patients with peripheral vestibular dysfunction: a pilot study

Individuals with vestibular dysfunction may experience visual vertigo (VV), in which symptoms are provoked or exacerbated by excessive or disorientating visual stimuli (e.g. supermarkets). VV can significantly improve when customized vestibular rehabilitation exercises are combined with exposure to optokinetic stimuli. Virtual reality (VR), which immerses patients in realistic, visually challenging environments, has also been suggested as an adjunct to VR to improve VV symptoms. This pilot study compared the responses of sixteen patients with unilateral peripheral vestibular disorder randomly allocated to a VR regime incorporating exposure to a static (Group S) or dynamic (Group D) VR environment. Participants practiced vestibular exercises, twice weekly for four weeks, inside a static (Group S) or dynamic (Group D) virtual crowded square environment, presented in an immersive projection theatre (IPT), and received a vestibular exercise program to practice on days not attending clinic. A third Group D1 completed both the static and dynamic VR training. Treatment response was assessed with the Dynamic Gait Index and questionnaires concerning symptom triggers and psychological state. At final assessment, significant betweengroup differences were noted between Groups D (p = 0.001) and D1 (p = 0.03) compared to Group S for VV symptoms with the former two showing a significant 59.2% and 25.8% improvement respectively compared to 1.6% for the latter. Depression scores improved only for Group S (p = 0.01) while a trend towards significance was noted for Group D regarding anxiety scores (p = 0.07). Conclusion: Exposure to dynamic VR environments should be considered as a useful adjunct to vestibular rehabilitation programs for patients with peripheral vestibular disorders and VV symptoms.

L'impacte d'un programa de tennis com a eina de millora de la qualitat de vida i l'estrès percebut en dones físicament inactives d'entre 43 i 50 anys

Introducció: L’activitat física és una necessitat imprescindible per a la salut de les persones, i tot i ser conscients dels seus beneficis encara es troben alts percentatges d’inactivitat física i sedentarisme. Per aquest motiu, els objectius principals d’aquest estudi són esbrinar si les dones adultes d’entre 43 i 50 anys que realitzen activitat física regularment, més concretament que practiquen l’esport del tennis, tenen una qualitat de vida i un estrès percebut millor que les que no realitzen activitat física, i per tant, valorar l’impacte d’un programa de tennis adequat i específic, és a dir, adaptat a les característiques i les necessitats dels alumnes, com a eina per millorar aquestes dues variables: l’estrès percebut i la qualitat de vida. Metodologia: El treball és un estudi experimental el qual consta d’una mostra total de 12 dones, 6 es varen assignar al grup control (practiquen el tennis) i 6 al grup intervenció (no realitzen AF), i totes elles de manera aleatòria. Les participants del grup intervenció varen realitzar un programa de 8 sessions de 60 minuts de treball durant 4 setmanes, mentre que les participants del grup control van seguir la seva rutina habitual. Les variables dependents (qualitat de vida i estrès percebut) es varen mesurar abans i després de la intervenció. Resultats: Els resultats obtinguts mostren, pel que fa al grup intervenció, millores significatives respecte a les dues variables mentre que el grup control presenta alguna mínima millora puntual però, en general no es produeixen canvis. Quan a la variable de qualitat de vida, les participants del grup intervenció han obtingut millores en les 8 dimensions del qüestionari un cop finalitzat el programa, les quals han estat més significatives pel que fa al rol emocional i la funció física. I respecte a l’estrès percebut, el grup intervenció ha aconsegui reduir el seu nivell d’estrès 3’17 punts. Discussió: Per tant, podem dir que el tennis, amb el disseny adequat d’un programa, millora l’estat de salut de les persones, en aquest cas redueix l’estrès percebut i millora la qualitat de vida. Extretes les conclusions i coneixent l’elevat nombre de dones que practiquen el tennis és de gran interès i molt factible oferir aquest programa a clubs de tennis amb l’objectiu de millorar la salut de les persones.

The referendum and popular consultations in the Autonomous State

The referendum is a poorly used mechanism for direct participation in the Spanish system, at both state and regional level. The discussion on the feasibility of this system at regional level has been examined by the Constitutional Court. Influenced by the reluctance with which constituents viewed the mechanisms of direct democracy, they still have a reductive view of the referendum. The State therefore reserves the right to exercise very intensive controls on the provision and authorization of referendums and on the specific exercise of each referendum

Effects of physical activity and fitness on the psychological wellbeing of young men and working adults: associations with stress, mental resources, overweight and workability

Background: A positive association has been suggested to exist between physical activity and psychological wellbeing. However, the association between physical fitness, especially muscle fitness and psychological wellbeing, has not yet been fully elucidated. Aims: The objective of the present thesis was to assess the relationship between physical activity and physical fitness with stress symptoms, mental resources and workability among young men and working adults. Subjects and methods: Volunteers of young men (n=831, mean age 25-y (±4.0)), underwent a cardiorespiratory (CRF) and muscle fitness (MFI) test and completed leisure time physical activity (LTPA) and Occupational Stress Questionnaires (OSQ). The participants were divided into tertiles according to LTPA, CRF and MFI. A 12-month exercise intervention evaluated 371 working adults (exercise group, n=338, mean age 45-y (±8.8)); control group, n=33, mean age 41-y (±6.9)).The exercise group underwent a 12-month exercise program followed by a 12-month follow-up. The OSQ, Workability Index (WAI) and CRF were evaluated at baseline and at 4, 8, 12 and 24 months. Results: Physically inactive subjects reported more stress and less available mental resources than the subjects who reported high physical activity levels. Improved physical fitness was associated with less stress and more mental resources among normal weight men, but not in overweight men. After a 12-month exercise intervention, employees in the exercise group increased their physical activity, improved workability, decreased stress symptoms and improved their physical fitness and mental resources. After the follow-up year, workability and stress were improved compared to baseline. Conclusions: In this thesis, good physical fitness was associated with improved psychological wellbeing among young men and working adults.

Psychiatric disorders and cardiac anxiety in exercising and sedentary coronary artery disease patients: a case-control study

Regular physical exercise has been shown to favorably influence mood and anxiety; however, there are few studies regarding psychiatric aspects of physically active patients with coronary artery disease (CAD). The objective of the present study was to compare the prevalence of psychiatric disorders and cardiac anxiety in sedentary and exercising CAD patients. A total sample of 119 CAD patients (74 men) were enrolled in a case-control study. The subjects were interviewed to identify psychiatric disorders and responded to the Cardiac Anxiety Questionnaire. In the exercise group (N = 60), there was a lower prevalence (45 vs 81%; P < 0.001) of at least one psychiatric diagnosis, as well as multiple comorbidities, when compared to the sedentary group (N = 59). Considering the Cardiac Anxiety Questionnaire, sedentary patients presented higher scores compared to exercisers (mean ± SEM = 55.8 ± 1.9 vs 37.3 ± 1.6; P < 0.001). In a regression model, to be attending a medically supervised exercise program presented a relevant potential for a 35% reduction in cardiac anxiety. CAD patients regularly attending an exercise program presented less current psychiatric diagnoses and multiple mental-related comorbidities and lower scores of cardiac anxiety. These salutary mental effects add to the already known health benefits of exercise for CAD patients.

Étude de l’impact d’un programme d’activité physique (Amazone) auprès de femmes en traitement pour un cancer du sein

Le cancer du sein est la forme de cancer la plus souvent diagnostiquée chez les femmes. Elles doivent vivre avec des séquelles qui nuisent à leur qualité de vie. Plusieurs études ont montré les bienfaits de l’activité physique (AP) sur les composantes physiques et psychologiques des patientes. Toutefois, elles réduisent souvent leur pratique d'AP suite aux traitements en raison de la détérioration de leur condition physique. Or, le maintien à long terme de la pratique d’AP est essentiel pour en conserver les bénéfices. La première section du mémoire présente une recension des écrits sur les bienfaits de l’AP auprès des femmes atteintes d'un cancer du sein et la seconde rend compte d'une étude expérimentale ayant pour objectif d'évaluer l’impact d’un programme d’AP sur le sentiment d’efficacité personnel et sur le plaisir associé à la pratique d'AP. Une enquête de suivi a été menée trois mois après la fin du programme afin d’évaluer le maintien à long terme de la pratique d'AP. L'étude a été réalisée auprès de 18 patientes en cours de traitement. Le groupe expérimental a suivi un programme supervisé d’AP combiné à des séances de counseling sur une période de 16 semaines. Le groupe témoin avait la possibilité de suivre un programme de yoga. Nos résultats indiquent une amélioration statistiquement significative des trois composantes mesurées, soit le sentiment d'efficacité personnelle, le plaisir à faire de l'AP et le maintien de la pratique après la participation au programme.

Évaluation biomécanique de la locomotion à la suite d'une arthroplastie de la hanche

Depuis les dernières années, la prévalence de personnes souffrant de dégénérescence des cartilages articulaires, communément appelée ostéoarthrite (OA), ne cesse d’augmenter. Les douleurs articulaires et les raideurs musculaires associées à cette pathologie mènent à des limitations des capacités fonctionnelles, à une perte de mobilité et d’autonomie affectant grandement la qualité de vie de ces personnes. Afin de soulager les personnes souffrant de cette pathologie, l’arthroplastie de la hanche est une procédure chirurgicale fréquemment utilisée. À la suite de cette chirurgie, une amélioration de la qualité de vie et une reprise des capacités fonctionnelles sont souvent observées. Cependant, comparativement à des sujets sains, la vitesse de marche est diminuée, une faiblesse des muscles abducteurs de la hanche est constatée et des mouvements compensatoires au niveau du tronc sont persistants. L’objectif de cette thèse est d’évaluer le patron locomoteur chez des patients qui subiront une arthroplastie de la hanche. Plus spécifiquement, les adaptations locomotrices pré et post-opératoires seront quantifiées dans le but d’apporter des modifications aux programmes de réhabilitation pour ainsi favoriser un patron locomoteur sans déficit. Afin de répondre à cet objectif, trois études distinctes ont été effectuées. Dans le cadre de la première étude, l’impact de l’implantation d’une prothèse totale de la hanche avec une tête fémorale de large diamètre et une prothèse de resurfaçage a été évalué par rapport aux sujets sains lors de la locomotion. Au cours de cette étude, le contrôle du tronc a été analysé en utilisant la distance entre le centre de masse corporel et le centre articulaire de la hanche opérée. Suite aux résultats obtenus, aucune différence majeure n’existe entre les deux types de prothèses en ce qui a trait au contrôle du tronc et ce, à un an post-opératoire. Lors de la deuxième étude, la symétrie des paramètres biomécaniques des membres inférieurs lors de la locomotion chez des patients ayant bénéficié de l’implantation d’une prothèse de la hanche a été caractérisée suite à un programme d’exercices péri-opératoires (pré et post-opératoire). Lors de cette étude, le programme d’exercices péri-opératoires était complémentaire au protocole de réadaptation du centre hospitalier. D’après les résultats obtenus lors de cette étude exploratoire, ce programme d’exercices péri-opératoires semble permettre d’améliorer la symétrie de la puissance et du travail musculaire au niveau de la hanche, du genou et de la cheville favorisant ainsi un patron de marche avec de minimes compensations. Finalement, dans le cadre de la troisième étude, l’approche prédictive et l’approche fonctionnelle, utilisées pour localiser le centre articulaire de la hanche, ont été comparées aux mesures radiographiques, chez des patients à la suite d’un remplacement articulaire de la hanche. À la suite de cette étude, les résultats démontrent que l’utilisation de l’approche fonctionnelle est plus appropriée chez des patients ayant bénéficié d’une arthroplastie de la hanche. En effet, cette approche individualisée est plus précise ce qui, par conséquent, permettra d’obtenir des résultats de plus grande qualité lors d’analyses biomécaniques de la locomotion.