Predictive value of Glasgow Coma Scale after brain trauma: change in trend over the past ten years.

BACKGROUND: Age and the Glasgow Coma Scale (GCS) score on admission are considered important predictors of outcome after traumatic brain injury. We investigated the predictive value of the GCS in a large group of patients whose computerised multimodal bedside monitoring data had been collected over the previous 10 years. METHODS: Data from 358 subjects with head injury, collected between 1992 and 2001, were analysed retrospectively. Patients were grouped according to year of admission. Glasgow Outcome Scores (GOS) were determined at six months. Spearman's correlation coefficients between GCS and GOS scores were calculated for each year. RESULTS: On average 34 (SD: 7) patients were monitored every year. We found a significant correlation between the GCS and GOS for the first five years (overall 1992-1996: r = 0.41; p<0.00001; n = 183) and consistent lack of correlations from 1997 onwards (overall 1997-2001: r = 0.091; p = 0.226; n = 175). In contrast, correlations between age and GOS were in both time periods significant and similar (r = -0.24 v r = -0.24; p<0.002). CONCLUSIONS: The admission GCS lost its predictive value for outcome in this group of patients from 1997 onwards. The predictive value of the GCS should be carefully reconsidered when building prognostic models incorporating multimodality monitoring after head injury.

Activities of daily living with reverse prostheses: importance of scapular compensation for functional mobility of the shoulder.

HYPOTHESIS: The nonanatomical design of reverse shoulder prostheses induce medial displacement of the center of rotation, impingements and may reduce the mobility of the shoulder. The aim of this study is to test the hypothesis that during activities of daily living functional mobility of the shoulder can be restored by scapular compensation. MATERIAL AND METHODS: A numerical 3-dimensional model was developed to reproduce the movement of the scapula and humerus, during 4 activities of daily living measured experimentally. This hypothesis was tested in 4 configurations of the aequalis reverse prosthesis (standard 36-mm glenosphere, 42-mm glenosphere, lateralized 36-mm glenosphere, lateralized Bony Increased-Offset Reverse Shoulder Arthroplasty [BIO-RSA]), which were implanted in the virtual model. All impingement positions were evaluated, as the required scapular compensation to avoid impingements. RESULTS: With the 36-mm glenosphere, impingements occurred only for rest of hand to back-pocket positions. The 42-mm partly improved the mobility. The 2 lateralized glenospheres were free of impingement. When impingements occurred, the scapular compensation was less than 10°. CONCLUSION: Most reverse prostheses impingements reported in clinical and biomechanical studies can be avoided, either by scapular compensation or by a glenosphere lateralization. After reverse shoulder arthroplasty, a fraction of the mobility of the gleno-humeral is transferred to the scapulo-thoracic joint.

Transitions familiales et brouilles conjugales : cumulation ou compensation des problèmes d'intimité à travers les phases du parcours de vie familial ?

Cette étude esquisse, sur la base d'un grand échantillon représentatif et longitudinal de couples vivant en Suisse et du point de vue des femmes ayant répondu à l'enquête, un tableau de l'évolution des problèmes conjugaux rencontrés au cours des différentes phases de la vie familiale. Le processus de dégradation de la relation est reconstitué à partir de 2 mesures faites dans un intervalle de 5 ans. La genèse des difficultés conjugales est considérée à travers le prisme des transitions familiales, en particulier la naissance des enfants, leur entrée à l'école et leur départ du domicile parental. L'analyse révèle le potentiel déstabilisateur de ces transitions pour le couple. Les bouleversements de l'équilibre relationnel évoluent, dans certains cas, vers un cumul de difficultés qui envahissent l'espace conjugal pour déboucher sur une situation rapidement inextricable.

Mainmise sur l'état social : mobilisation patronale et caisse de compensation en Suisse (1908-1960)

Qui sait qu'en Suisse, les associations patronales mettent en oeuvre l'Etat social ? Qui sait que associations organisent la majorité des caisses de compensation, dont la fonction principale est de collecter les cotisations et de payer les rentes de l'Assurance-vieillesse et survivants ? Qui connaît ces caisses par lesquelles transitent les milliards de l'Etat social ? L'objectif de cette thèse consiste à comprendre les raisons qui ont poussé le patronat helvétique à mettre en oeuvre les politiques de protection sociale, dont il a pourtant toujours essayé de limiter le développement. Résoudre ce paradoxe implique de se pencher sur près d'un siècle d'histoire mêlée du patronat et des politiques sociales. Ce travail retrace, sur la base d'archives privées et publiques souvent inédites, les raisons qui ont poussé les patrons à créer les premières caisses de compensation dans l'entre-deux-guerres, puis à imposer cette forme d'organisation pour l'aide aux soldats mobilisés (autour de 1940) et l'Assurance- vieillesse et survivants (autour de 1948). Il étudie également comment les associations patronales sont parvenues à défendre leurs caisses jusqu'à aujourd'hui, contre ceux qui dénonçaient l'irrationalité de l'existence d'une centaine de caisses de compensation publiques et privées concurrentes pour mettre en oeuvre un seul système d'assurances sociales. Cette recherche amène deux grands résultats. D'une part, elle propose une histoire originale des politiques sociales en Suisse. Le prisme des caisses de compensation patronales contribue en effet à interroger notre compréhension de l'histoire des politiques de protection sociale, dans laquelle on sous-estime parfois l'importance des conflits pour fixer les frontières entre formes de protection publique et privée. D'autre part, ce travail présente une histoire inédite de l'action collective des patrons dans les régulations du travail au sens large. A travers les caisses de compensation, c'est en effet à réaliser une histoire de l'Union centrale des associations patronales suisses que je me suis aussi attelé. Faute de parvenir à empêcher tout développement des politiques sociales, les patrons ont fait en sorte d'acquérir sur ces politiques une forme de mainmise. Entre histoire des politiques sociales et histoire du patronat, ce travail tente d'expliquer comment les caisses de compensation y ont contribué. Who knows that, in Switzerland, employers' associations implement the best known policies constituting the welfare state? Who knows that the equalization funds, (Caisses de compensation / Ausgleichskassen), organized by employers' associations or by the Swiss Cantons, are responsible for pooling payroll deductions and for paying benefits of the Swiss public pay-as-you-go, old-age insurance and many other branches of the welfare policies? Who knows these caisses de compensation that channel the monies dedicated to the financing of the Welfare state ? The main objective of this research is to understand the reasons why Swiss employers do implement such welfare policies that they usually reject for political reasons. In order to solve this puzzle, this research investigates half of a century of the connected histories of welfare policies and employers' collective action. It also investigates, based on public and private archive records, how employers founded the first caisses in the Interwar period, and imposed them to organize the main developments of the Welfare state during the Second World War. The research also underlines how employers defended their caisses de compensation against those questioning the rationality of this fragmented system aiming to implement one single set of public welfare through one hundred competing private and public caisses de compensation. This research highlights two main results. On the one hand, it helps to improve our understanding of the history of the welfare policies in Switzerland. Underlining the role of the caisses de compensation helps to highlight the importance of the interplay of public and private actors regarding social polices. On the other hand, this research charts a pioneering history of Swiss' employers' collective action regarding labor issues. Because they could not prevent all public welfare policy, employers achieved a form of stranglehold (mainmise) on the welfare State. Halfway between social policy and employers' associations' history, this research try to reveal how their caisses de compensation helped them in this objective.

Age above 60 years is not a negative predictive factor for combined antiviral therapy with pegylated interferon alpha and ribavirin in hepatitis C patients

Background: Age is frequently discussed as negative host factor to achieve a sustained virological response (SVR) to antiviral hepatitis C therapy. However, elderly patients often show relevant fibrosis or cirrhosis which is a known negative predictive factor, making it difficult to interpret age as an independent predictive factor. Methods: From the framework of the Swiss hepatitis C cohort (SCCS), we collected data from 545 antiviral hepatitis C therapies, including data from 67 hepatitis C patients ≥ 60 y who had been treated with PEG-interferon and ribavirin. We analyzed host factors (age, gender, fibrosis, haemoglobin, depression, earlier hepatitis C treatment), viral factors (genotype, viral load) and treatment course (early virological response, end of treatment response, SVR). Generalised estimating equations (GEE) regression modelling was used for the primary end point (SVR), with age ≥ 60 y and < 60 y as independent variable and gender, presence of cirrhosis, genotype, earlier treatment and viral load as confounders. SVR was analysed in young and elderly patients after matching for these confounders. Additionally, classification tree analysis was done in elderly patients using these confounders. Results: SVR analyzed in 545 patients was 55%. In genotype 1/4, SVR was 42.9% in 259 patients < 60 y and 26.1% in 46 patients ≥ 60 y. In genotype 2/3, SVR was 74.4% in 215 patients < 60 y and 84% in 25 patients ≥ 60 y. However, GEE model showed that age had no influence on achieving SVR (Odds ratio 0.91). Confounders influenced SVR as known from previous studies (cirrhosis, genotype 1/4, previous treatment and viral load >600'000 IE/ml as negative predictive factors). When young and elderly patients were matched (analysis in 59 elderly patients), SVR was not different in these patient groups (54.2% and 55.9%, resp.; p=0.795 in binomial test). The classification tree-derived best criterion for SVR in elderly patients was genotype, with no further criteria relevant for predicting SVR in genotype 2/3. In patients with genotype 1/4, further criteria were presence of cirrhosis and low viral load <600'000 IE/ml in non-cirrhotic patients. Conclusions: Age is not a relevant predictive factor for achieving SVR, when confounders were taken into account. In terms of effectiveness of antiviral therapy, age does not play a major role and should not be regarded as relevant negative predictive factor. Since life expectancy in Switzerland at age 60 is more than 22 y, hepatitis C therapy is reasonable in elderly patients with known relevant fibrosis or cirrhosis, because interferon-based hepatitis C therapy improves survival and reduces carcinogenesis.

Iowa Workers’ Compensation Manual, July 1, 2004 - June 30, 2005

This booklet has been prepared by the Division of Workers’ Compensation to provide information and guidelines in handling Iowa workers’ compensation claims. For more detailed information, reference should be made to Iowa Code chapters 85 through 87, 17A and chapter 876 of the Iowa Administrative Code.

Iowa Workers’ Compensation Manual, July 1, 2002 - June 30, 2003

This booklet has been prepared by the Division of Workers’ Compensation to provide information and guidelines in handling Iowa workers’ compensation claims. For more detailed informaton, reference should be made to Iowa Code chapters 85 through 87, 17A and chapter 876 of the Iowa Administrative Code.

Iowa Workers’ Compensation Manual, July 1, 2003 - June 30, 2004

This booklet has been prepared by the Division of Workers’ Compensation to provide information and guidelines in handling Iowa workers’ compensation claims. For more detailed informaton, reference should be made to Iowa Code chapters 85 through 87, 17A and chapter 876 of the Iowa Administrative Code.

Iowa Workers’ Compensation Manual, July 1, 1999 - June 30, 2000

This booklet has been prepared by the Division of Workers’ Compensation to provide information and guidelines in handling Iowa workers’ compensation claims. For more detailed informaton, reference should be made to Iowa Code chapters 85 through 87, 17A and chapter 876 of the Iowa Administrative Code.

Guide to Workers’ Compensation, 2005

This guide contains valuable information in an understandable format relating to the rights and duties of those covered by Iowa’s workers’ compensation law. This publication is intended to be used as a compilation of general information for commonly asked questions. Opinions oconclusions expressed or implied in this guide should not be considered to be a final determination of this office. You may copy and distribute the guide to others.

2004 Status Report On the Iowa Unemployment Compensation Trust Fund, 2004

This report evaluates the status of unemployment compensation trust fund as of December 31, 2004. The report reviews fund expenditures and fund revenue. It also discusses the fund solvency in terms of fund balance, fund balance adjusted for wage growth and months of benefits at recession levels.

Questions and Answers About Workers’ Compensation Law For Injured Workers, July 1, 2004 – June 30, 2005

This brochure answers questions injured workers commonly ask about workers’ compensation. You may check Iowa Code chapters 85 through 87 and 17A, as well as Iowa Administrative Code chapter 876, for detailed information. References to Iowa Code sections and Iowa Administrative Rules appear in parentheses.

Questions and Answers About Workers’ Compensation Law For Injured Workers, July 1, 2001 – June 30, 2002

This brochure answers questions injured workers commonly ask about workers’ compensation. You may check Iowa Code chapters 85 through 87 and 17A, as well as Iowa Administrative Code chapter 876, for detailed information. References to Iowa Code sections and Iowa Administrative Rules appear in parentheses.

Questions and Answers About Workers’ Compensation Law For Injured Workers, July 1, 2002 – June 30, 2003

This brochure answers questions injured workers commonly ask about workers’ compensation. You may check Iowa Code chapters 85 through 87 and 17A, as well as Iowa Administrative Code chapter 876, for detailed information. References to Iowa Code sections and Iowa Administrative Rules appear in parentheses.