Impact des instruments de recevabilité sur la mise en oeuvre des politiques d'insertion socioprofessionnelle en Suisse romande

Cette thèse vise à apporter des éléments concrets permettant d'évaluer l'efficacité et la pertinence de la nouvelle gestion publique (NGP) dans le contexte de l'assurance-chômage en Suisse. Ancrée dans une approche des politiques publiques partant de ces dernières telles qu'elles sont mises en oeuvre plutôt que de ce qu'elles devraient être, elle s'attache à observer l'impact d'une catégorie spécifique d'instruments de gestion caractéristiques de la NGP, les instruments de redevabilité. La redevabilité désigne la nécessité ou l'obligation qu'ont des individus ou des organisations de rendre compte de leurs activités, d'en accepter la responsabilité et d'en exposer les résultats de façon transparente. À partir d'un matériau empirique constitué d'entretiens semi-directifs et d'observations participantes et non-participantes, complété par l'analyse d'un corpus documentaire varié, elle répond à cinq questions de recherche liant les agents de base, les managers qui les encadrent et les instruments gestionnaires de redevabilité. Ces questions concernent les effets réels, désirés ou non, des instruments gestionnaires encadrant la mise en oeuvre des politiques d'insertion socioprofessionnelle. Elles permettent également d'évaluer la pertinence des instruments de la NGP au regard de l'objectif général d'amélioration de la qualité du service aux usagers. En résumé, les instruments étudiés incitent les managers et les agents à la conformité (légale et budgétaire) et entraînent des conséquences inattendues limitant l'efficacité des interventions, ce qui met en question la pertinence du lien entre NGP et qualité du service rendu aux usagers. Les résultats obtenus font également ressortir l'importance d'étudier l'ensemble de la chaîne d'exécution des politiques publiques en tenant compte des interactions entre niveaux.

Relaciones entre conocimiento del catalán y del castellano y el rendimiento matemático. Un estudio empírico

Este trabajo se desarrolla en el contexto sociocultural y lingüístico de la provincia de Lleida. En él se analiza la relación entre el dominio de las dos lenguas en contacto (catalán y castellano) con el rendimiento en matemáticas. Los resultados revelan que existe una correlación significativa entre el dominio de la lengua vehicular y el rendimiento matemático y, a su vez, que el mayor conocimiento de la lengua vehicular tiene efectos superiores en el rendimiento de los tres tipos de conocimiento que contempla la prueba de matemáticas. Por otra parte, se constata una elevada correlación entre el dominio del castellano y el resultado de la prueba de matemáticas, lo que revela que el conocimiento matemático obtenido a través de una de las lenguas se transfiere a la otra.

Pregnancy outcome following maternal exposure to mirtazapine: a multicenter, prospective study.

This multicenter, observational prospective cohort study addresses the risk associated with exposure to mirtazapine during pregnancy. Pregnancy outcomes after exposure to mirtazapine were compared with 2 matched control groups: (1) exposure to any selective serotonin reuptake inhibitor (SSRI, control subjects with a psychiatric condition) and (2) no exposure to medication known to be teratogenic or any antidepressant (general control subjects). Data were collected by members of the European Network of Teratology Information Services between 1995 and 2011. Observations from 357 exposed pregnancies were compared with 357 pregnancies from each control group. The rate of major birth defects between the mirtazapine and the SSRI group did not differ significantly (4.5% vs 4.2%; odds ratio [OR], 1.1; 95% confidence interval [95% CI], 0.5-2.3; P = 0.9). A trend toward a higher rate of birth defects in the mirtazapine group compared with general control subjects (4.5% vs 1.9%; OR, 2.4; 95% CI, 0.9-6.3; P = 0.08) reached statistical significance after exclusion of chromosomal or genetic anomalies (4.1% vs 1.3%; OR, 3.3; 95% CI, 1.04-10.3; P = 0.03), but this difference became again nonsignificant if cases of exposure not comprising the first trimester were excluded from the analysis (3.4% vs 1.9%; OR, 1.8; 95% CI, 0.6-5.0; P = 0.26). The crude miscarriage rate did not differ significantly between the mirtazapine, the SSRI, and the general control groups (12.1% vs 12.0% vs 9.3%; P = 0.44). However, a higher rate of elective pregnancy termination was observed in the mirtazapine group compared with SSRI and general control subjects (7.8% vs 3.4% vs 5.6%; P = 0.03). This study did not observe a statistically significant difference in the rate of major birth defects after first-trimester exposure between mirtazapine, SSRI-exposed, and nonexposed pregnancies. A marginally higher rate of birth defects was, however, observed in the mirtazapine and SSRI groups compared with the low rate of birth defects in our general control subjects. Overall pregnancy outcome after mirtazapine exposure was similar to that of the SSRI-exposed control group.

Evolution and cellular function of monothiol glutaredoxins: involvement in iron-sulphur cluster assembly

A number of bacterial species, mostly proteobacteria, possess monothiol glutaredoxins homologous to the Saccharomyces cerevisiae mitochondrial protein Grx5, which is involved in iron–sulphur cluster synthesis. Phylogenetic profiling is used to predict that bacterial monothiol glutaredoxins also participate in the iron–sulphur cluster (ISC) assembly machinery, because their phylogenetic profiles are similar to the profiles of the bacterial homologues of yeast ISC proteins. High evolutionary cooccurrence is observed between the Grx5 homologues and the homologues of the Yah1 ferredoxin, the scaffold proteins Isa1 and Isa2, the frataxin protein Yfh1 and the Nfu1 protein. This suggests that a specific functional interaction exists between these ISC machinery proteins. Physical interaction analyses using low-definition protein docking predict the formation of strong and specific complexes between Grx5 and several components of the yeast ISC machinery. Two-hybrid analysis has confirmed the in vivo interaction between Grx5 and Isa1. Sequence comparison techniques and cladistics indicate that the other two monothiol glutaredoxins of S. cerevisiae, Grx3 and Grx4, have evolved from the fusion of a thioredoxin gene with a monothiol glutaredoxin gene early in the eukaryotic lineage, leading to differential functional specialization. While bacteria do not contain these chimaeric glutaredoxins, in many eukaryotic species Grx5 and Grx3/4-type monothiol glutaredoxins coexist in the cell.

Inserción laboral de las matronas graduadas entre los años 2001 y 2005

Objetivo: Conocer las características de la inserción laboral de las matronas que se graduaron entre los años 2001 y 2005. Personas y método: Estudio observacional, descriptivo y transversal. Se estudiaron todas las matronas que se graduaron en España entre los años 2001 y 2005, en 18 Unidades Docentes de Matronas pertenecientes a 15 Comunidades Autónomas. Se utilizó un cuestionario elaborado por el equipo investigador que se envió por correo postal o electrónico. Resultados: Se recibieron 328 cuestionarios cumplimentados, un 44,14% de los enviados. Todas las matronas que respondieron habían trabajado como matrona, y el 89,3% (293) consiguió trabajo en menos de un mes. Tenía un contrato fijo el 12,2% (38), lo tenía interino el 43,9% (136), y el resto tenía un contrato eventual. El 84,8 (263) desarrollaba su actividad asistencial en el hospital. Un 24,2% (74) estaba en situación de pluriempleo. El 5,4% (18) no trabajaban como matronas. El número de matronas que estaba trabajando en la misma CC.AA. que se había formado era inferior al 50% de las matronas formadas en Canarias, Castilla-La Mancha, Cataluña, Galicia y País Vasco. Conclusiones: La inserción laboral se realiza rápidamente y la situación de pluriempleo es alta, lo que indica escasez de profesionales. La mayoría de las matronas desarrolla su actividad asistencial en hospitales. Hay unidades que forman a más matronas procedentes de otra comunidad que de la propia, como consecuencia de esto son menos las matronas que trabajan en estas comunidades que las que se formaron en ellas.

Inserción laboral de las matronas graduadas entre los años 2001 y 2005

Objetivo: Conocer las características de la inserción laboral de las matronas que se graduaron entre los años 2001 y 2005. Personas y método: Estudio observacional, descriptivo y transversal. Se estudiaron todas las matronas que se graduaron en España entre los años 2001 y 2005, en 18 Unidades Docentes de Matronas pertenecientes a 15 Comunidades Autónomas. Se utilizó un cuestionario elaborado por el equipo investigador que se envió por correo postal o electrónico. Resultados: Se recibieron 328 cuestionarios cumplimentados, un 44,14% de los enviados. Todas las matronas que respondieron habían trabajado como matrona, y el 89,3% (293) consiguió trabajo en menos de un mes. Tenía un contrato fijo el 12,2% (38), lo tenía interino el 43,9% (136), y el resto tenía un contrato eventual. El 84,8 (263) desarrollaba su actividad asistencial en el hospital. Un 24,2% (74) estaba en situación de pluriempleo. El 5,4% (18) no trabajaban como matronas. El número de matronas que estaba trabajando en la misma CC.AA. que se había formado era inferior al 50% de las matronas formadas en Canarias, Castilla-La Mancha, Cataluña, Galicia y País Vasco. Conclusiones: La inserción laboral se realiza rápidamente y la situación de pluriempleo es alta, lo que indica escasez de profesionales. La mayoría de las matronas desarrolla su actividad asistencial en hospitales. Hay unidades que forman a más matronas procedentes de otra comunidad que de la propia, como consecuencia de esto son menos las matronas que trabajan en estas comunidades que las que se formaron en ellas.

Rainfall is a risk factor for sporadic cases of Legionella pneumophila Pneumonia

It is not known whether rainfall increases the risk of sporadic cases of Legionella pneumonia. We sought to test this hypothesis in a prospective observational cohort study of non-immunosuppressed adults hospitalized for community-acquired pneumonia (1995-2011). Cases with Legionella pneumonia were compared with those with non-Legionella pneumonia. Using daily rainfall data obtained from the regional meteorological service we examined patterns of rainfall over the days prior to admission in each study group. Of 4168 patients, 231 (5.5%) had Legionella pneumonia. The diagnosis was based on one or more of the following: sputum (41 cases), antigenuria (206) and serology (98). Daily rainfall average was 0.556 liters/m2 in the Legionella pneumonia group vs. 0.328 liters/m2 for non-Legionella pneumonia cases (p = 0.04). A ROC curve was plotted to compare the incidence of Legionella pneumonia and the weighted median rainfall. The cut-off point was 0.42 (AUC 0.54). Patients who were admitted to hospital with a prior weighted median rainfall higher than 0.42 were more likely to have Legionella pneumonia (OR 1.35; 95% CI 1.02-1.78; p = .03). Spearman Rho correlations revealed a relationship between Legionella pneumonia and rainfall average during each two-week reporting period (0.14; p = 0.003). No relationship was found between rainfall average and non-Legionella pneumonia cases (−0.06; p = 0.24). As a conclusion, rainfall is a significant risk factor for sporadic Legionella pneumonia. Physicians should carefully consider Legionella pneumonia when selecting diagnostic tests and antimicrobial therapy for patients presenting with CAP after periods of rainfall.

Subclinical thyroid dysfunction and fracture risk: a meta-analysis.

IMPORTANCE: Associations between subclinical thyroid dysfunction and fractures are unclear and clinical trials are lacking. OBJECTIVE: To assess the association of subclinical thyroid dysfunction with hip, nonspine, spine, or any fractures. DATA SOURCES AND STUDY SELECTION: The databases of MEDLINE and EMBASE (inception to March 26, 2015) were searched without language restrictions for prospective cohort studies with thyroid function data and subsequent fractures. DATA EXTRACTION: Individual participant data were obtained from 13 prospective cohorts in the United States, Europe, Australia, and Japan. Levels of thyroid function were defined as euthyroidism (thyroid-stimulating hormone [TSH], 0.45-4.49 mIU/L), subclinical hyperthyroidism (TSH <0.45 mIU/L), and subclinical hypothyroidism (TSH ≥4.50-19.99 mIU/L) with normal thyroxine concentrations. MAIN OUTCOME AND MEASURES: The primary outcome was hip fracture. Any fractures, nonspine fractures, and clinical spine fractures were secondary outcomes. RESULTS: Among 70,298 participants, 4092 (5.8%) had subclinical hypothyroidism and 2219 (3.2%) had subclinical hyperthyroidism. During 762,401 person-years of follow-up, hip fracture occurred in 2975 participants (4.6%; 12 studies), any fracture in 2528 participants (9.0%; 8 studies), nonspine fracture in 2018 participants (8.4%; 8 studies), and spine fracture in 296 participants (1.3%; 6 studies). In age- and sex-adjusted analyses, the hazard ratio (HR) for subclinical hyperthyroidism vs euthyroidism was 1.36 for hip fracture (95% CI, 1.13-1.64; 146 events in 2082 participants vs 2534 in 56,471); for any fracture, HR was 1.28 (95% CI, 1.06-1.53; 121 events in 888 participants vs 2203 in 25,901); for nonspine fracture, HR was 1.16 (95% CI, 0.95-1.41; 107 events in 946 participants vs 1745 in 21,722); and for spine fracture, HR was 1.51 (95% CI, 0.93-2.45; 17 events in 732 participants vs 255 in 20,328). Lower TSH was associated with higher fracture rates: for TSH of less than 0.10 mIU/L, HR was 1.61 for hip fracture (95% CI, 1.21-2.15; 47 events in 510 participants); for any fracture, HR was 1.98 (95% CI, 1.41-2.78; 44 events in 212 participants); for nonspine fracture, HR was 1.61 (95% CI, 0.96-2.71; 32 events in 185 participants); and for spine fracture, HR was 3.57 (95% CI, 1.88-6.78; 8 events in 162 participants). Risks were similar after adjustment for other fracture risk factors. Endogenous subclinical hyperthyroidism (excluding thyroid medication users) was associated with HRs of 1.52 (95% CI, 1.19-1.93) for hip fracture, 1.42 (95% CI, 1.16-1.74) for any fracture, and 1.74 (95% CI, 1.01-2.99) for spine fracture. No association was found between subclinical hypothyroidism and fracture risk. CONCLUSIONS AND RELEVANCE: Subclinical hyperthyroidism was associated with an increased risk of hip and other fractures, particularly among those with TSH levels of less than 0.10 mIU/L and those with endogenous subclinical hyperthyroidism. Further study is needed to determine whether treating subclinical hyperthyroidism can prevent fractures.

VARIABILIDAD GENÉTICA DE PARENTALES Y POBLACIONES F1 INTER E INTRAESPECÍFICAS DE Physalis peruviana L. Y P. floridana Rydb.

RESUMENLa uchuva, Physalis peruviana, es un frutal andino de importancia para la exportación; el principal limitante de su producción en Colombia es el marchitamiento vascular ocasionado por Fusarium oxysporum. En el presente trabajo se propuso generar poblaciones F1 entre parentales contrastantes por su respuesta a éste patógeno y evaluarlas molecularmente como apoyo al conocimiento y uso de los recursos genéticos de la especie. Para ello, cuatro genotipos de P. peruviana y uno de la especie relacionada P. floridana, fueron caracterizados a nivel morfo-agronómico empleando 34 variables cualitativas y 20 cuantitativas, y a nivel molecular con 328 marcadores tipoCOSII y 154 IRGs. Dichos genotipos se utilizaron como parentales para la generación y caracterización molecular de poblaciones F1. Las variables cuantitativas permitieron diferenciar las especies P. floridana y P. peruviana así como genotipos cultivados y silvestres dentro de P. peruviana. Se encontró un 100% de viabilidad en cruces F1 intraespecíficos y un 50% en interespecíficos, siendo viables aquellos donde P. floridana fue receptor de polen. A nivel molecular no se identificaron polimorfismos dentro de P. peruviana pero sí entre P. floridana y P. Peruviana. En una población F1 de 51 individuos generada entre las especies se encontró un total de 127 alelos con un promedio de 3,18 por locus, un PIC de 0,358 y altos valores de heterocigocidad (Ho: 0,737 y He: 0,449). Los análisis de PCA y agrupamiento permitieron discriminar la población F1 en tres grupos, en su mayoría con mayor similitud al parental P. floridana. Lo anterior se reflejó en una distorsión mendeliana del 75% favorecida por la presencia de un 63,75% de alelos maternos. El estudio aporta conocimiento sobre la cruzabilidad en uchuva y la variabilidad genética de genotipos parentales y poblaciones F1.

Capturing diagnosis-timing in ICD-coded hospital data: recommendations from the WHO ICD-11 topic advisory group on quality and safety.

PURPOSE: To develop a consensus opinion regarding capturing diagnosis-timing in coded hospital data. METHODS: As part of the World Health Organization International Classification of Diseases-11th Revision initiative, the Quality and Safety Topic Advisory Group is charged with enhancing the capture of quality and patient safety information in morbidity data sets. One such feature is a diagnosis-timing flag. The Group has undertaken a narrative literature review, scanned national experiences focusing on countries currently using timing flags, and held a series of meetings to derive formal recommendations regarding diagnosis-timing reporting. RESULTS: The completeness of diagnosis-timing reporting continues to improve with experience and use; studies indicate that it enhances risk-adjustment and may have a substantial impact on hospital performance estimates, especially for conditions/procedures that involve acutely ill patients. However, studies suggest that its reliability varies, is better for surgical than medical patients (kappa in hip fracture patients of 0.7-1.0 versus kappa in pneumonia of 0.2-0.6) and is dependent on coder training and setting. It may allow simpler and more precise specification of quality indicators. CONCLUSIONS: As the evidence indicates that a diagnosis-timing flag improves the ability of routinely collected, coded hospital data to support outcomes research and the development of quality and safety indicators, the Group recommends that a classification of 'arising after admission' (yes/no), with permitted designations of 'unknown or clinically undetermined', will facilitate coding while providing flexibility when there is uncertainty. Clear coding standards and guidelines with ongoing coder education will be necessary to ensure reliability of the diagnosis-timing flag.

Alteration and recovery of arm usage in daily activities after rotator cuff surgery.

BACKGROUND: The objective measurement of dominant/nondominant arm use proportion in daily life may provide relevant information on healthy and pathologic arm behavior. This prospective case-control study explored the potential of such measurements as indicators of upper limb functional recovery after rotator cuff surgery. METHODS: Data on dominant/nondominant arm usage were acquired with body-worn sensors for 7 hours. The postsurgical arm usage of 21 patients was collected at 3, 6, and 12 months after rotator cuff surgery in the sitting, walking, and standing postures and compared with a reference established with 41 healthy subjects. The results were calculated for the dominant and nondominant surgical side subgroups at all stages. The correlations with clinical scores were calculated. RESULTS: Healthy right-handed and left-handed dominant arm usage was 60.2% (±6.3%) and 53.4% (±6.6%), respectively. Differences in use of the dominant side were significant between the right- and left-handed subgroups for sitting (P = .014) and standing (P = .009) but not for walking (P = .328). The patient group showed a significant underuse of 10.7% (±8.9%) at 3 months after surgery (P < .001). The patients recovered normal arm usage within 12 months, regardless of surgical side. The arm underuse measurement was weakly related to function and pain scores. CONCLUSION: This study provided new information on arm recovery after rotator cuff surgery using an innovative measurement method. It highlighted that objective arm underuse measurement is a valuable indicator of upper limb postsurgical outcome that captures a complementary feature to clinical scores.