Assessment of driving capability through the use of clinical and psychomotor tests in relation to blood cannabinoids levels following oral administration of 20 mg dronabinol or of a cannabis decoction made with 20 or 60 mg Delta9-THC.

Delta(9)-Tetrahydrocannabinol (THC) is frequently found in the blood of drivers suspected of driving under the influence of cannabis or involved in traffic crashes. The present study used a double-blind crossover design to compare the effects of medium (16.5 mg THC) and high doses (45.7 mg THC) of hemp milk decoctions or of a medium dose of dronabinol (20 mg synthetic THC, Marinol on several skills required for safe driving. Forensic interpretation of cannabinoids blood concentrations were attempted using the models proposed by Daldrup (cannabis influencing factor or CIF) and Huestis and coworkers. First, the time concentration-profiles of THC, 11-hydroxy-Delta(9)-tetrahydrocannabinol (11-OH-THC) (active metabolite of THC), and 11-nor-9-carboxy-Delta(9)-tetrahydrocannabinol (THCCOOH) in whole blood were determined by gas chromatography-mass spectrometry-negative ion chemical ionization. Compared to smoking studies, relatively low concentrations were measured in blood. The highest mean THC concentration (8.4 ng/mL) was achieved 1 h after ingestion of the strongest decoction. Mean maximum 11-OH-THC level (12.3 ng/mL) slightly exceeded that of THC. THCCOOH reached its highest mean concentration (66.2 ng/mL) 2.5-5.5 h after intake. Individual blood levels showed considerable intersubject variability. The willingness to drive was influenced by the importance of the requested task. Under significant cannabinoids influence, the participants refused to drive when they were asked whether they would agree to accomplish several unimportant tasks, (e.g., driving a friend to a party). Most of the participants reported a significant feeling of intoxication and did not appreciate the effects, notably those felt after drinking the strongest decoction. Road sign and tracking testing revealed obvious and statistically significant differences between placebo and treatments. A marked impairment was detected after ingestion of the strongest decoction. A CIF value, which relies on the molar ratio of main active to inactive cannabinoids, greater than 10 was found to correlate with a strong feeling of intoxication. It also matched with a significant decrease in the willingness to drive, and it matched also with a significant impairment in tracking performances. The mathematic model II proposed by Huestis et al. (1992) provided at best a rough estimate of the time of oral administration with 27% of actual values being out of range of the 95% confidence interval. The sum of THC and 11-OH-THC blood concentrations provided a better estimate of impairment than THC alone. This controlled clinical study points out the negative influence on fitness to drive after medium or high dose oral THC or dronabinol.

Progressive Taxes and Firm Births

Tax reform proposals in the spirit of the "flat tax" model typically aim to reduce three parameters: the average tax burden, the progressivity of the tax schedule, and the complexity of the tax code. We explore the implications of changes in these three parameters for entrepreneurial activity, measured by counts of firm births. The Swiss fiscal system offers sufficient intra-national variation in tax codes to allow us to estimate such effects with considerable precision. We find that high average taxes and complicated tax codes depress firm birth rates, while tax progressivity per se promotes firm births. The latter result supports the existence of an insurance effect from progressive corporate income taxes for risk averse entrepreneurs. However, implied elasticities with respect to the level and complexity of corporate taxes are an order of magnitude larger than elasticities with respect to the progressivity of tax schedules.

First anal intercourse and condom use among men who have sex with men in Switzerland.

The aim of this study was to analyze the circumstances of first anal intercourse (FAI) among men who have sex with men (MSM) and to identify factors associated with condom use at this event. We conducted a cross-sectional survey among a convenience sample of MSM living in Switzerland (N = 2,200). Anonymous questionnaires were distributed using Swiss gay communication channels (newspapers, associations, websites) and gay bathhouses. We gathered data on age at FAI, age of the partner, degree of familiarity with him, place of first meeting, and sociodemographic indicators. We did not ask whether FAI was insertive, receptive, or both. Data were stratified by birth year classes (birth cohorts). The median age at FAI fell from 24.5 years among men born before 1965 to 20.0 years among those born between 1975 and 1984 (p < .001). In each birth cohort, between 20 and 30% reported a partner 10 years older or more. Of eight variables examined in multivariate analysis, two were positively associated with condom use: age of participants at FAI and low degree of familiarity between partners. Conversely, large age discrepancy between partners was negatively associated with condom use. In conclusion, our data showed that early initiation of anal intercourse and large age discrepancy were associated with risk taking: a pattern of initiation that may facilitate HIV transmission from older to younger cohorts of MSM. Since age at FAI is on the decrease, there is an urgent need to heighten awareness of prevention actions regarding sexual debut of MSM.

HIV-1 elite controllers: beware of super-infections.

Super- and co-infection with HIV-1 are generally associated with accelerated disease progression. We report on the outcome of super-infection in two HIV-1 infected individuals previously known as elite controllers. Both presented an acute retroviral syndrome following super-infection and showed an immuno-virological progression thereafter. Host genotyping failed to reveal any of the currently recognized protective factors associated with slow disease progression. This report indicates that elite controllers should be informed of the risk of super-infection, and illustrates the complexity of mounting broad anti-HIV immunity.

Conductes de risc en els joves-adults : Projecte YAGISSP

YAGISSP és un projecte europeu que estudia la vida dels joves-adults amb edats compreses entre 20 i 30 anys de les ciutats de Munic, Milà, Göteborg, Barcelona i Porto. Aquest projecte comprèn moltes dimensions del jove, com el seu ajustament psicològic, les formes i processos d’emancipació, les relacions de parella, la relació amb la família d’origen, etc., de manera que forma un conjunt de dades ampli i ric. La finalitat última del projecte és estudiar les diferències entre els joves de les diferents ciutats. En aquest article presentem els resultats sobre les conductes de risc dels joves, mesurat amb la Risk Taking Behaviour Scale, tant a nivell d’escala com a nivell d’ítems concrets, i el seu comportament diferenciat en relació a sis variables sociodemogràfiques, que són les següents: edat, sexe, estudis, parella, treball, i individuació. Els resultats han estat obtinguts a partir de l’anàlisi d’una mostra de 520 subjectes que viuen o treballen a Barcelona i la seva àrea metropolitana.

Associations between online pornography and sexual behavior among adolescents: myth or reality?

This study aimed to compare the sexual behavior of adolescents who were or were not exposed to online pornography, to assess to what extent the willingness of exposure changed these possible associations, and to determine the profiles of youths who were exposed to online pornography. Data were drawn from the 2002 Swiss Multicenter Adolescent Survey on Health, a self-administered cross-sectional, paper and pencil questionnaire. From the 7529 adolescents aged 16-20 years, 6054 (3283 males) used the Internet during the previous month and were eligible for our study. Males were divided into three groups (wanted exposure, 29.2%; unwanted exposure, 46.7%; no exposure, 24.1%) whereas females were divided into two groups (exposure, 35.9%; no exposure, 64.1%). The principal outcome measures were demographic characteristics, Internet use parameters and risky sexual behaviors. Risky sexual behaviors were not associated with online pornography exposure in any of the groups, except that males who were exposed (deliberately or not) had higher odds of not having used a condom at last intercourse. Bi/homosexual orientation and Internet use parameters were not associated either. Additionally, males in the wanted exposure group were more likely to be sensation-seekers. On the other hand, exposed girls were more likely to be students, higher sensation-seekers, early maturers, and to have a highly educated father. We conclude that pornography exposure is not associated with risky sexual behaviors and that the willingness of exposure does not seem to have an impact on risky sexual behaviors among adolescents.

Challenging the "inoffensiveness" of regular cannabis use by its associations with other current risky substance use--a census of 20-year-old Swiss men.

3,537 men enrolling in 2007 for mandatory army recruitment procedures were assessed for the co-occurrence of risky licit substance use among risky cannabis users. Risky cannabis use was defined as at least twice weekly; risky alcohol use as 6+ drinks more than once/monthly, or more than 20 drinks per week; and risky tobacco use as daily smoking. Ninety-five percent of all risky cannabis users reported other risky use. They began using cannabis earlier than did non-risky users, but age of onset was unrelated to other risky substance use. A pressing public health issue among cannabis users stems from risky licit substance use warranting preventive efforts within this age group.

Ohjelmistoalan pk-yrityksen kansainvälistyminen

Pienen ohjelmistoyrityksen kansainvälistyminen on haasteellista niukkojen resurssien ja dynaamisen liiketoimintaympäristön paineessa. Työn tarkoituksena on selvittää sitä, millaisin perustein pieni tai keskisuuri ohjelmistotekniikan yritys tekee päätöksen kansainvälisille markkinoille siirtymisestä ja millaisen toimintamuodon yritys valitsee uudella markkinalla. Työn teoreettinen osa käsittelee päätöksenteon taustalla olevia vaikuttavia tekijöitä liiketoimintaympäristön, yritysjohdon ja yrityksen erityispiirteiden näkökulmista. Empiirinen osa on toteutettu kanden laajan ja neljän suppean yrityshaastat- telun muodossa. Karkeasti jaoteltuna yrityksen kansainvälistymiseen käyttämä polku voi olla joko orgaaniseen kasvuunperustuva tai Born Global-tyyppinen. Tutkimus nosti esille kansainvälistymispolun valintaan vaikuttavina tekijöinä yrittäjien riskinottohalukkuuden ja kansainvälisen kokemuksen, tuotteen palveluintensiivisyyden asteen sekä toimintakon- septin markkina- tai tuoteorientaation. Yleisellä tasolla korkea riskinottohalu, vähäinen kansainvälinen kokemus, standardinomainen tuote ja markkinaorientoitunut toimintatapa kannustivat yritystä valitsemaan Born Global-tyyppisen kansainvälistymispolun. Vastaavasti pieni riskinottohalu, runsaampi kansainvälinen kokemus, palveluintensiivinen tuote ja tuoteorientoitunut toimintatapa olivat kannustimia orgaaniselle kasvulle kansainvälisesti.

Opportunities for prevention in primary care in a country with universal insurance coverage.

Data from studies in the United States suggest that young people engaging in health-compromising behaviors have lower access to health care. Using data from a Swiss national survey we tested the hypothesis that in a country with universal insurance coverage, adolescents engaging in health-compromising behaviors access primary care to the same extent as those who do not engage in these behaviors.

Srategisen suunnittelun piirteitä yrityksen talousjohtamisessa: tapaustutkimus budjetoinnista

Tutkimuksen tavoitteena on ensiksi teoreettisesti tuoda esille miten budjetointia käytetään yrityksen strategisessa johtamisessa, ja sitten testata miten case-yritys soveltaa budjetointia strategiatyöskentelyssä. Case-tutkimuksen tulokset viittaavat vahvasti siihen, että budjettiensoveltamisroolit ovat samanlaisia kuin oli kuvattu teoriaosuudessa. Siksi suunnittelu-, toteuttamis- sekä valvontaroolit löytyivät case-yhtiöstä. Bonuksiin liittyvää budjettiharhaa ei voitu objektiivisesti löytää case-yhtiöstä. Kuitenkin kävi ilmi, että yhtiössä oli budjettiharhaa liittyen investointien tuottoarvioiden systemaattiseen minimointiin. Simonsin teoreettinen yrityksen johtamisen suorituskyvyn analysoinnin malli on käytössä case-yhtiössä koska yhtiö tekee pitkän aikavälin strategisen investointibudjetin. Investointiehdotuksia arvioidaan pääomantuottoasteen, markkinaosuuskehittymisen sekä nykyarvomenetelmän avulla. Case-tutkimus toi esille, että yksikönjohtajat haluavat enemmän päätösvaltaa ja riskinottoa, erityisesti investointibudjettia tehtäessä.

Conductes arriscades

Els adolescents tendeixen a prendre decisions que impliquen una recompensa immediata, malgrat que el seu valor sigui inferior.

Johdon yritysoston onnistumisen tukeminen pääomasijoitusyhtiön post-buyout toiminnan avulla

Tutkielman tavoitteena on analysoida, miten pääomasijoitusyhtiö voi post-buyout toiminnallaan tukea sijoituksensa onnistumista erilaisissa johdon yritysostotapauksissa. Tutkielmassa rakennetaan teoreettinen viitekehys, jonka avulla pääomasijoitusyhtiö voi tukea sijoituksensa arvon säilymistä ja toisaalta lisäarvon syntymistä. Tätä viitekehystä tarkennetaan ja testataan empiirisellä aineistolla, joka koostuu suomalaisen pääomasijoitusyhtiön ja sen neljän johdon yritysoston läpikäyneen kohdeyrityksen haastatteluista sekä pääomasijoitusyhtiön tuottamasta kirjallisesta materiaalista. Teorian ja empiirisen materiaalin perusteella johdon yritysoston onnistu-minen on usein subjektiivista sekä suhteellista suunniteltuun irtautumistapaan nähden. Joissakin tapauksissa jo pelkkä pääomasijoittajan mukaantulo voi vaikuttaa positiivisesti kohdeyrityksen riskinottoon ja siten pääomasijoitusyhtiön post-buyout toiminnan onnistumiseen.

Factores de riesgo psicosociales en el consumo de tabaco de los adolescentes: estados de ánimo negativos, grupo de iguales y estilos parentales

Existe una multiplicidad de factores que pueden afectar el riego del consumo de tabaco en la adolescencia. Mediante el análisis de estos factores de manera conjunta podemos desentrañar la relevancia específica que cada uno de ellos tiene en la conformación de la conducta individual de los adolescentes. El objetivo de esta investigación es profundizar en el conocimiento sobre la relación entre el consumo de tabaco en la adolescencia y variables socio-demográficas y socio-emocionales. Contamos con una muestra representativa de 2.289 adolescentes catalanes (15-18 años) que participaron en el Panel de Familias e Infancia. Se han realizado modelos de regresión para determinar la asociación estadística de los diferentes estados de ánimo (tristeza, nerviosismo y soledad), características del grupo de iguales y estilos parentales, con el consumo de tabaco. Los resultados indican que el comportamiento adictivo es más probable cuando los adolescentes muestran estados de ánimo negativos, controlando por variables socio-demográficas y otros factores de riesgo. Entre estos factores adicionales, los estilos parentales autoritativos reducen el riesgo del consumo de tabaco en comparación con la parentalidad autoritaria, permisiva y negligente. El consumo generalizado de tabaco en el grupo de iguales es el factor de riesgo que tiene una asociación más alta con el comportamiento individual del adolescente.

Responding to Young People's Health Risks in Primary Care: A Cluster Randomised Trial of Training Clinicians in Screening and Motivational Interviewing.

OBJECTIVE: To evaluate the effectiveness of a complex intervention implementing best practice guidelines recommending clinicians screen and counsel young people across multiple psychosocial risk factors, on clinicians' detection of health risks and patients' risk taking behaviour, compared to a didactic seminar on young people's health. DESIGN: Pragmatic cluster randomised trial where volunteer general practices were stratified by postcode advantage or disadvantage score and billing type (private, free national health, community health centre), then randomised into either intervention or comparison arms using a computer generated random sequence. Three months post-intervention, patients were recruited from all practices post-consultation for a Computer Assisted Telephone Interview and followed up three and 12 months later. Researchers recruiting, consenting and interviewing patients and patients themselves were masked to allocation status; clinicians were not. SETTING: General practices in metropolitan and rural Victoria, Australia. PARTICIPANTS: General practices with at least one interested clinician (general practitioner or nurse) and their 14-24 year old patients. INTERVENTION: This complex intervention was designed using evidence based practice in learning and change in clinician behaviour and general practice systems, and included best practice approaches to motivating change in adolescent risk taking behaviours. The intervention involved training clinicians (nine hours) in health risk screening, use of a screening tool and motivational interviewing; training all practice staff (receptionists and clinicians) in engaging youth; provision of feedback to clinicians of patients' risk data; and two practice visits to support new screening and referral resources. Comparison clinicians received one didactic educational seminar (three hours) on engaging youth and health risk screening. OUTCOME MEASURES: Primary outcomes were patient report of (1) clinician detection of at least one of six health risk behaviours (tobacco, alcohol and illicit drug use, risks for sexually transmitted infection, STI, unplanned pregnancy, and road risks); and (2) change in one or more of the six health risk behaviours, at three months or at 12 months. Secondary outcomes were likelihood of future visits, trust in the clinician after exit interview, clinician detection of emotional distress and fear and abuse in relationships, and emotional distress at three and 12 months. Patient acceptability of the screening tool was also described for the intervention arm. Analyses were adjusted for practice location and billing type, patients' sex, age, and recruitment method, and past health risks, where appropriate. An intention to treat analysis approach was used, which included multilevel multiple imputation for missing outcome data. RESULTS: 42 practices were randomly allocated to intervention or comparison arms. Two intervention practices withdrew post allocation, prior to training, leaving 19 intervention (53 clinicians, 377 patients) and 21 comparison (79 clinicians, 524 patients) practices. 69% of patients in both intervention (260) and comparison (360) arms completed the 12 month follow-up. Intervention clinicians discussed more health risks per patient (59.7%) than comparison clinicians (52.7%) and thus were more likely to detect a higher proportion of young people with at least one of the six health risk behaviours (38.4% vs 26.7%, risk difference [RD] 11.6%, Confidence Interval [CI] 2.93% to 20.3%; adjusted odds ratio [OR] 1.7, CI 1.1 to 2.5). Patients reported less illicit drug use (RD -6.0, CI -11 to -1.2; OR 0·52, CI 0·28 to 0·96), and less risk for STI (RD -5.4, CI -11 to 0.2; OR 0·66, CI 0·46 to 0·96) at three months in the intervention relative to the comparison arm, and for unplanned pregnancy at 12 months (RD -4.4; CI -8.7 to -0.1; OR 0·40, CI 0·20 to 0·80). No differences were detected between arms on other health risks. There were no differences on secondary outcomes, apart from a greater detection of abuse (OR 13.8, CI 1.71 to 111). There were no reports of harmful events and intervention arm youth had high acceptance of the screening tool. CONCLUSIONS: A complex intervention, compared to a simple educational seminar for practices, improved detection of health risk behaviours in young people. Impact on health outcomes was inconclusive. Technology enabling more efficient, systematic health-risk screening may allow providers to target counselling toward higher risk individuals. Further trials require more power to confirm health benefits. TRIAL REGISTRATION: ISRCTN.com ISRCTN16059206.