Prescription de statines en prévention primaire: quel score de risque cardiovasculaire faut-il utiliser en Suisse? [Statin prescription in primary prevention: which cardiovascular risk score should be used in Switzerland?]

La prévention primaire des maladies cardiovasculaires par les médecins s'effectue par une prise en charge individualisée des facteurs de risque. L'indication à un traitement par statines se base sur une estimation du risque de survenue d'une maladie cardiovasculaire et sur le taux de LDL-cholestérol. Trois scores de risque sont couramment utilisés: le score PROCAM, le score Framingham, et le SCORE européen. En Suisse, le Groupe Suisse Lipides et Athérosclérose (GSLA) recommande en première instance l'utilisation du score PROCAM avec une adaptation du niveau de risque pour la Suisse. Une enquête a aussi montré que c'est le score le plus utilisé en Suisse. Dans cet article, les particularités de ces scores et leurs applications pratiques en ce qui concerne la prescription de statines en prévention primaire sont discutées. Les conséquences et les bénéfices potentiels de l'application de ces scores en Suisse sont également abordés. [Abstract] Primary prevention of cardiovascular disease by physicians is achieved by management of individual risk factors. The eligibility for treatment with statins is based on both an estimate of the risk of developing cardiovascular disease and the LDL-cholesterol. Three risk scores are commonly used : the PROCAM score, the Framingham score, and the European score. In Switzerland, the Swiss Group Lipids and Atherosclerosis (GSLA) recommends to use the PROCAM score with an adjustment of the level of risk for Switzerland. A survey also showed that PROCAM is the most used in Switzerland. In this article, the differences of these scores and their practical applications regarding the prescription of statins in primary prevention are discussed. The consequences and potential benefits of applying these scores in Switzerland are also discussed.

Glasgow Coma Score für den Patienten mit Schädel-Hirn-Trauma [Glasgow Coma Scale in traumatic brain injury].

Even 30 years after its first publication the Glasgow Coma Scale (GCS) is still used worldwide to describe and assess coma. The GCS consists of three components, the ocular, motor and verbal response to standardized stimulation, and is used as a severity of illness indicator for coma of various origins. The GCS facilitates information transfer and monitoring changes in coma. In addition, it is used as a triage tool in patients with traumatic brain injury. Its prognostic value regarding the outcome after a traumatic brain injury still lacks evidence. One of the main problems is the evaluation of the GCS in sedated, paralysed and/or intubated patients. A multitude of pseudoscores exists but a universal definition has yet to be defined.

Herramientas estadísticas para el estudio de perfiles de riesgo

En este documento se ilustra de un modo práctico, el empleo de tres instrumentos que permiten al actuario definir grupos arancelarios y estimar premios de riesgo en el proceso que tasa la clase para el seguro de no vida. El primero es el análisis de segmentación (CHAID y XAID) usado en primer lugar en 1997 por UNESPA en su cartera común de coches. El segundo es un proceso de selección gradual con el modelo de regresión a base de distancia. Y el tercero es un proceso con el modelo conocido y generalizado de regresión linear, que representa la técnica más moderna en la bibliografía actuarial. De estos últimos, si combinamos funciones de eslabón diferentes y distribuciones de error, podemos obtener el aditivo clásico y modelos multiplicativos

Un modelo de riesgo de crédito basado en opciones compuestas con barrera. Aplicación al mercado continuo español

In this work the valuation methodology of compound option written on a downand-out call option, developed by Ericsson and Reneby (2003), has been applied to deduce a credit risk model. It is supposed that the firm has a debt structure with two maturity dates and that the credit event takes place when the assets firm value falls under a determined level called barrier. An empirical application of the model for 105 firms of Spanish continuous market is carried out. For each one of them its value in the date of analysis, the volatility and the critical value are obtained and from these, the default probability to short and long-term and the implicit probability in the two previous probabilities are deduced. The results are compared with the ones obtained from the Geskemodel (1977).

Sociedad del riesgo, producción y sostenibilidad

El concepto sociedad del riesgo se basa en la constatación de que, en las sociedades actuales, la producción social de riqueza va acompañada por una creciente producción social del riesgo. La progresión y el aumento de estos riesgos está teniendo consecuencias políticas y económicas claras. Un primer efecto directo consistiría en la implementación de políticas gubernamentales orientadas al control y a la reducción de los mismos, como consecuencia directa de la mayor visibilidad que, para la opinión pública, tienen los problemas ambientales. De la misma manera que, desde una perspectiva económica, podemos establecer un claro paralelismo entre la teoría de la modernización ecológica y las nuevas estrategias ecoproductivas. Este artículo pretende dar una visión general de todo este proceso partiendo del concepto sociedad del riesgo para, con posterioridad, establecer paralelismos con las nuevas estrategias ecoproductivas, con el proceso de modernización ecológico y con una última reflexión: ¿caminamos hacia un nuevo modelo productivo?.

Zonas de aludes en la Vallferrera: Clasificación y riesgo geomorfológico

La Vallferrera es una cuenca que se encuentra en el Pirineo Occidental Catalán, limitando al E con Andorra. En ella se ha realizado un estudio de las características de las zonas de aludes, desde dos perspectivas (MASES, 1991): En primer lugar se efectúa una descripción y una clasificación de las diferentes morfologías de las zonas de aludes comparando su distribución con algunos parámetros intrínsecos de la cuenca (litología, relieve preexistente, etc.). Se ha observado que las diferentes morfologías de las zonas de aludes son producto de la adaptación de éstas al relieve glacial preexistente. En segundo lugar se entra en el análisis del riesgo geomorfológico que los aludes comportan en esta zona del Pirineo, identificando cuatro sectores donde el riesgo es alto debido a la interferencia de éstos con la estructura social.

Recommendations for the use of ultrasound in rheumatoid arthritis: literature review and SONAR score experience.

Ultrasound (US) has become a useful tool in the detection of early disease, differential diagnosis, guidance of treatment decisions and treatment monitoring of rheumatoid arthritis (RA). In 2008, the Swiss Sonography in Arthritis and Rheumatism (SONAR) group was established to promote the use of US in inflammatory arthritis in clinical practice. A scoring system was developed and taught to a large number of Swiss rheumatologists who already contributed to the Swiss Clinical Quality Management (SCQM) database, a national patient register. This paper intends to give a Swiss consensus about best clinical practice recommendations for the use of US in RA on the basis of the current literature knowledge and experience with the Swiss SONAR score. Literature research was performed to collect data on current evidence. The results were discussed among specialists of the Swiss university centres and private practice, following a structured procedure. Musculoskelatal US was found to be very helpful in establishing the diagnosis and monitoring the evolution of RA, and to be a reliable tool if used by experienced examiners. It influences treatment decisions such as continuing, intensifying or stepping down therapy. The definite modalities of integrating US into the diagnosis and monitoring of RA treatments will be defined within a few years. There are, however, strong arguments to use US findings as of today in daily clinical care. Some practical recommendations about the use of US in RA, focusing on the diagnosis and the use of the SONAR score, are proposed.

Treatment of ruptured abdominal aortic aneurysm, a permanent challenge or a waste of resources? Prediction of outcome using a multi-organ-dysfunction score.

OBJECTIVES: in a retrospective study, attempts have been made to identify individual organ-dysfunction risk profiles influencing the outcome after surgery for ruptured abdominal aortic aneurysms. METHODS: out of 235 patients undergoing graft replacement for abdominal aortic aneurysms, 57 (53 men, four women, mean age 72 years [s.d. 8.8]) were treated for ruptured aneurysms in a 3-year period. Forty-eight preoperative, 13 intraoperative and 34 postoperative variables were evaluated statistically. A simple multi-organ dysfunction (MOD) score was adopted. RESULTS: the perioperative mortality was 32%. Three patients died intraoperatively, four within 48 h and 11 died later. A significant influence for pre-existing risk factors was identified only for cardiovascular diseases. Multiple linear-regression analysis indicated that a haemoglobin <90 g/l, systolic blood pressure <80 mmHg and ECG signs of ischaemia at admission were highly significant risk factors. The cause of death for patients, who died more than 48 h postoperatively, was mainly MOD. All patients with a MOD score >/=4 died (n=7). These patients required 27% of the intensive-care unit (ICU) days of all patients and 72% of the ICU days of the non-survivors. CONCLUSION: patients with ruptured aortic aneurysms from treatment should not be excluded. However, a physiological scoring system after 48 h appears justifiable in order to decide on the appropriateness of continual ICU support.

Aplicación de soportes plantares y pseudozapatos en un pie de riesgo. Caso clínico

Se presenta la confección de un pseudozapato con materiales termoadaptables para una paciente que presenta un pie de riesgo. Se somete a revisión los tratamientos con soportes plantares aplicados anteriormente y se ofrece una nueva espectativa terapéutica.

Application in the STRATHE trial of a score system to compare the efficacy and the tolerability of different therapeutic strategies in the management of hypertension

A score system integrating the evolution of efficacy and tolerability over time was applied to a subpopulation of the STRATHE trial, a trial performed according to a parallel group design, with a double-blind, random allocation to either a fixed-dose combination strategy (perindopril/indapamide 2 mg/0.625 mg, with the possibility to increase the dose to 3 mg/0.935 mg, and 4 mg/1.250 mg if needed, n = 118), a sequential monotherapy approach (atenolol 50 mg, followed by losartan 50 mg and amlodipine 5 mg if needed, n = 108), or a stepped-care strategy (valsartan 40 mg, followed by valsartan 80 mg and valsartan 80 mg+ hydrochlorothiazide 12.5 mg if needed, n = 103). The aim was to lower blood pressure below 140/90 mmHg within a 9-month period. The treatment could be adjusted after 3 and 6 months. Only patients in whom the study protocol was strictly applied were included in this analysis. At completion of the trial the total score averaged 13.1 +/- 70.5 (mean +/- SD) using the fixed-dose combination strategy, compared with -7.2 +/- 81.0 using the sequential monotherapy approach and -17.5 +/- 76.4 using the stepped-care strategy. In conclusion, the use of a score system allows the comparison of antihypertensive therapeutic strategies, taking into account at the same time efficacy and tolerability. In the STRATHE trial the best results were observed with the fixed-dose combination containing low doses of an angiotensin enzyme converting inhibitor (perindopril) and a diuretic (indapamide).

Tratamientos provisionales y definitivos en el pie de riesgo

Los autores presentan varios casos de pacientes diabéticos con lesiones en el pie, a los que se les aplican diferentes alternativas de tratamientos ortopodológicos.

Consumer Advisory: Your Credit Report & Credit Score, March 2014

The Attorney General’s Consumer Protection Division receives hundreds of calls and consumer complaints every year. Follow these tips to avoid unexpected expense and disappointments. This record is about: Your Credit Report & Credit Score

Étude des relations entre le score de Gillette et la vitesse de marche chez les enfants paralysés cérébraux

Contexte Aider les enfants atteints de paralysie cérébrale à découvrir, puis à perfectionner leurs possibilités de déplacement et de déambulation, est un des buts essentiels de l'action thérapeutique. Cela implique une connaissance approfondie de leurs capacités de marche. Le but de cette étude était d'essayer de trouver un ou des paramètres spatiotemporels du pattern de marche corrélé au score de Gillette afin de disposer d'un outil objectif d'évaluation des capacités de marche de l'enfant paralysé cérébral. Méthode Cinq sujets âgés de 6 à 14 ans (± 4,4), répondant aux classes 1 à 3 du score de Palisano ont été inclus dans l'étude. Une évaluation des qualités de marche par l'échelle de Gillette a été réalisée à la suite d'une évaluation des paramètres spatiotemporels de marche sur un tapis de type GAITRite®. Résultats Ainsi cinq paramètres spatiotemporels corrélés au score de Gillette ont été mis en évidence. Tous ces paramètres sont liés à la vitesse de déplacement. Discussion Les résultats montrent une corrélation des paramètres liés à la vitesse de foulée et du pas des patients. Les paramètres concernant la foulée et le pas des enfants paralysés cérébraux sont à prendre en compte dans le processus de prise en charge rééducative. Conclusion Une étude future devra comprendre un plus grand nombre de sujets et centrer son investigation sur les paramètres corrélés.

Consumer Advisory: Your Credit Report & Credit Score, March 2014

The Attorney General’s Consumer Protection Division receives hundreds of calls and consumer complaints every year. Follow these tips to avoid unexpected expense and disappointments. This record is about: Your Credit Report & Credit Score