Actividade física e qualidade de vida na gravidez

Pouco se conhece acerca da actividade física e qualidade de vida da mulher na gravidez. Este estudo teve como objectivos 1) comparar os padrões de actividade física antes e durante a gravidez, 2) avaliar a percepção da qualidade de vida relacionada com a saúde durante os primeiros seis meses de gestação, e 3) comparar a percepção da qualidade de vida nas mulheres activas e insuficientemente activas considerando as recomendações de saúde pública. Método: Estudo longitudinal com 59 grávidas seleccionadas em consultórios médicos privados. Às 10-15 semanas foi recolhida informação sociodemográfica e médica, bem como informação sobre a actividade física três meses antes da concepção. Medidas de auto-relato foram administradas entre as 10-15 semanas e as 19-24 semanas de gestação para avaliar o tempo de actividade física (QAFG) (no trabalho, lazer, deslocações) e a qualidade de vida (SF-36). Resultados: A prevalência de actividade física recomendada é menor durante do que antes da gravidez (16.7% e 17.5% nos 1.º e 2.º trimestres, respectivamente vs. 47.4% antes da gravidez). Com a gravidez, não se verificaram alterações no tempo médio em diferentes tipos de actividade física, mas a actividade física no lazer registou uma diminuição significativa no 1.º trimestre face ao período anterior à concepção. Em comparação com uma amostra normativa de mulheres portuguesas, as grávidas apresentam, nos dois primeiros trimestres de gestação, uma percepção de qualidade da vida mais positiva na generalidade das dimensões do SF-36. No 2.º trimestre, o nível de limitação é significativamente maior nas dimensões físicas, à excepção da Dor Corporal, e nos resultados sumários do Componentes Físico e Mental. As mulheres que no 1.º trimestre atingem os níveis recomendados de actividade física no lazer (≥150 minutos por semana) apresentam melhor estado de saúde geral e estados de humor mais positivos do que as menos activas. Conclusão: A actividade física no lazer, embora diminua após a concepção, tem um impacto positivo na percepção do estado saúde geral e estados de humor da grávida, o que sugere a sua importância para a saúde da mulher também durante este período da vida.

Prevalencia de Trastornos Mentales en consultantes de Centros de Atención Primaria de la Ciudad de Córdoba, Argentina.Prevalence of Mental Disorders among Consultants in Primary Health Care Centers of the City of Córdoba, Argentina

El informe de la Organización Mundial de la Salud (2001), refiere que en un plazo de 20 años los trastornos mentales pasarán a ser la segunda causa dentro de la carga de morbilidad a nivel mundial, y en la actualidad una de cada cuatro personas padece de algún trastorno mental en alguna etapa de su vida. Los estudios realizados en diversos países revelan que una proporción importante de los consultantes de la atención primaria en salud presentan algún tipo de trastornos mentales. Desde esta perspectiva, la atención primaria de la salud ofrece una oportunidad de intervenir en el manejo de los trastornos mentales de forma temprana y eficaz. En Argentina, es limitada la información acerca del registro epidemiológico en salud mental, no contando con estudios abordados desde la Atención Primaria en la provincia de Córdoba. El objetivo general del proyecto es estimar la prevalencia de trastornos mentales entre los consultantes de atención primaria por problemas de salud general. Para ello se propone: Estimar la prevalencia de trastornos mentales en una muestra representativa de consultantes adultos por problemas de salud general, de centros de atención primaria de la ciudad de Córdoba, identificar y describir los tipos de trastornos mentales que presentan estos consultantes adultos de centros de atención primaria y analizar la prevalencia de los trastornos mentales por sexo y edad de la población en estudio. Metodología: el estudio se realizará en consultorios de Atención Primaria de Salud distribuídos en todo el éjido de la ciudad, teniendo en cuenta la representación de las 12 zonas de CPC. La muestra es probabilística, estratificada, polietápica de pacientes que consultan en el primer nivel de atención. Se entrevistarán 1200 pacientes utilizando la versión computorizada del CIDI 3.0, que proporciona diagnóstico de acuerdo a la DSM IV y la CIE-10. La confiabilidad y la validez del instrumento ha sido ampliamente documentada y la traducción de la encuesta al español fue realizada conforme a las recomendaciones de la OMS. El análisis efectuado será de prevalencia de Trastornos Mentales y del Comportamiento (TMC),asociación entre factores sociodemográficos y TCM estimados calculando las razones de disparidad (odds ratio), regresión logística a fin de ajustar los resultados por la posible interacción entre variables, análisis de la asociación de todas las variables con los TMC, análisis univariado de la asociación de cada variable con los TMC, controlando sexo y edad, se construirá un modelo de regresión logística. En todos los casos el nivel de significación será de 0,05. El equipo de trabajo, de cooperación internacional entre profesionales de la UNC y de la Universidad de Chile, y con la participación en colaboración de los profesionales dependientes de la Secretaría de Salud de la municipalidad de Córdoba, representa un avance para trabajar en los centros de salud de esta ciudad, constituyéndose en un avance, cualitativo y cuantitativo de la actividad científica en Atención Primaria en salud mental con abordaje epidemiológico. Se espera contribuir al conocimiento acerca de la prevalencia de los problemas de salud mental de esta población en la ciudad de Córdoba, proporcionando información a los funcionarios y responsables por la gestión de las áreas vinculadas a la salud mental, aportando conocimiento que promueva una temprana identificación de riesgos iniciales en salud mental y conductas de cuidado en la población como potencial de bienestar.Así mismo, se espera sistematizar una experiencia que pueda ser replicada en otros sitios geográficos. Por todo lo anterior, esta propuesta permitirá conocer por primera vez en la ciudad de Córdoba la frecuencia y características de los problemas de salud mental entre consultantes de Atención Primaria, información fundamental para el desarrollo posterior de estrategias que busquen mejorar la detección y el tratamiento de estos problemas. According to the WHO Report (2001), in 20 years, mental health disorders (MHDs) will be the world’s second most frequent cause of morbidity. Primary care offers the opportunity to handle MHDs efficiently at an early stage. In Argentina, the epidemiologic data on mental health (MH) is limited, and there are no records for Córdoba. The aim of this project is to assess the prevalence of MHDs among consultants who resort to primary health centers (PHCCs) in the city of Córdoba for common health problems, by using a representative sample of adult consultants, identifying and describing the types of MHDs evinced, and analysing prevalence by sex and age group under study. Methodology:the study will be carried out in PHCCs located in the municipal area of Córdoba, covering the 12 zones corresponding to the CPCs (municipal branch offices for each zone). A multi-stage stratified random sample of 1200 patients will be interviewed using the program CIDI 3.0 to produce a diagnostic according to DSM IV and CIE-10, a tool with proven reliability and validity.The aspects to be analysed are prevalence of mental and behavior disorders, their association with socio-demographic factors estimated by odds ratios, logistic regression for adjustment of potential interaction among variables, association with all variables, and univariate analysis for association with each variable. Significance level will be 0.05 in all cases. The international teamwork including professionals from the Universities of Córdoba, Chile and the Public Health Department of the Municipality of Córdoba constitutes a qualitative and quantitative step forward in the field of primary health care studies with an epidemiologic approach. This project aims at providing administrators in the MH area with data for the early detection of initial risks in MH and the promotion of prevention habits. This will be the first study conducted in Córdoba, and is aimed at facilitating replication in other geographical areas.

Welfare comparisons: sequential procedures for heterogenous populations

Some analysts use sequential dominance criteria, and others use equivalence scales in combination with non-sequential dominance tests, to make welfare comparisons of oint distributions of income and needs. In this paper we present a new sequential procedure hich copes with situations in which sequential dominance fails. We also demonstrate that there commendations deriving from the sequential approach are valid for distributions of equivalent income whatever equivalence scale the analyst might adopt. Thus the paper marries together the sequential and equivalizing approaches, seen as alternatives in much previous literature. All results are specified in forms which allow for demographic differences in the populations being compared.

Daily physical activities and sports in adult survivors of childhood cancer and healthy controls: a population-based questionnaire survey.

BACKGROUND: Healthy lifestyle including sufficient physical activity may mitigate or prevent adverse long-term effects of childhood cancer. We described daily physical activities and sports in childhood cancer survivors and controls, and assessed determinants of both activity patterns. METHODOLOGY/PRINCIPAL FINDINGS: The Swiss Childhood Cancer Survivor Study is a questionnaire survey including all children diagnosed with cancer 1976-2003 at age 0-15 years, registered in the Swiss Childhood Cancer Registry, who survived ≥5 years and reached adulthood (≥20 years). Controls came from the population-based Swiss Health Survey. We compared the two populations and determined risk factors for both outcomes in separate multivariable logistic regression models. The sample included 1058 survivors and 5593 controls (response rates 78% and 66%). Sufficient daily physical activities were reported by 52% (n = 521) of survivors and 37% (n = 2069) of controls (p<0.001). In contrast, 62% (n = 640) of survivors and 65% (n = 3635) of controls reported engaging in sports (p = 0.067). Risk factors for insufficient daily activities in both populations were: older age (OR for ≥35 years: 1.5, 95CI 1.2-2.0), female gender (OR 1.6, 95CI 1.3-1.9), French/Italian Speaking (OR 1.4, 95CI 1.1-1.7), and higher education (OR for university education: 2.0, 95CI 1.5-2.6). Risk factors for no sports were: being a survivor (OR 1.3, 95CI 1.1-1.6), older age (OR for ≥35 years: 1.4, 95CI 1.1-1.8), migration background (OR 1.5, 95CI 1.3-1.8), French/Italian speaking (OR 1.4, 95CI 1.2-1.7), lower education (OR for compulsory schooling only: 1.6, 95CI 1.2-2.2), being married (OR 1.7, 95CI 1.5-2.0), having children (OR 1.3, 95CI 1.4-1.9), obesity (OR 2.4, 95CI 1.7-3.3), and smoking (OR 1.7, 95CI 1.5-2.1). Type of diagnosis was only associated with sports. CONCLUSIONS/SIGNIFICANCE: Physical activity levels in survivors were lower than recommended, but comparable to controls and mainly determined by socio-demographic and cultural factors. Strategies to improve physical activity levels could be similar as for the general population.

Insertion dans les soins après une première hospitalisation dans un secteur pour psychose [Linkage to care after first hospitalisation for psychosis]

BACKGROUND: First hospitalisation for a psychotic episode causes intense distress to patients and families, but offers an opportunity to make a diagnosis and start treatment. However, linkage to outpatient psychiatric care remains a notoriously difficult step for young psychotic patients, who frequently interrupt treatment after hospitalisation. Persistence of symptoms, and untreated psychosis may therefore remain a problem despite hospitalisation and proper diagnosis. With persisting psychotic symptoms, numerous complications may arise: breakdown in relationships, loss of family and social support, loss of employment or study interruption, denial of disease, depression, suicide, substance abuse and violence. Understanding mechanisms that might promote linkage to outpatient psychiatric care is therefore a critical issue, especially in early intervention in psychotic disorders. OBJECTIVE: To study which factors hinder or promote linkage of young psychotic patients to outpatient psychiatric care after a first hospitalisation, in the absence of a vertically integrated program for early psychosis. Method. File audit study of all patients aged 18 to 30 who were admitted for the first time to the psychiatric University Hospital of Lausanne in the year 2000. For statistical analysis, chi2 tests were used for categorical variables and t-test for dimensional variables; p<0.05 was considered as statistically significant. RESULTS: 230 patients aged 18 to 30 were admitted to the Lausanne University psychiatric hospital for the first time during the year 2000, 52 of them with a diagnosis of psychosis (23%). Patients with psychosis were mostly male (83%) when compared with non-psychosis patients (49%). Furthermore, they had (1) 10 days longer mean duration of stay (24 vs 14 days), (2) a higher rate of compulsory admissions (53% vs 22%) and (3) were more often hospitalised by a psychiatrist rather than by a general practitioner (83% vs 53%). Other socio-demographic and clinical features at admission were similar in the two groups. Among the 52 psychotic patients, 10 did not stay in the catchment area for subsequent treatment. Among the 42 psychotic patients who remained in the catchment area after discharge, 20 (48%) did not attend the scheduled or rescheduled outpatient appointment. None of the socio demographic characteristics were associated with attendance to outpatient appointments. On the other hand, voluntary admission and suicidal ideation before admission were significantly related to attending the initial appointment. Moreover, some elements of treatment seemed to be associated with higher likelihood to attend outpatient treatment: (1) provision of information to the patient regarding diagnosis, (2) discussion about the treatment plan between in- and outpatient staff, (3) involvement of outpatient team during hospitalisation, and (4) elaboration of concrete strategies to face basic needs, organise daily activities or education and reach for help in case of need. CONCLUSION: As in other studies, half of the patients admitted for a first psychotic episode failed to link to outpatient psychiatric care. Our study suggests that treatment rather than patient's characteristics play a critical role in this phenomenon. Development of a partnership and involvement of patients in the decision process, provision of good information regarding the illness, clear definition of the treatment plan, development of concrete strategies to cope with the illness and its potential complications, and involvement of the outpatient treating team already during hospitalisation, all came out as critical strategies to facilitate adherence to outpatient care. While the current rate of disengagement after admission is highly concerning, our finding are encouraging since they constitute strategies that can easily be implemented. An open approach to psychosis, the development of partnership with patients and a better coordination between inpatient and outpatient teams should therefore be among the targets of early intervention programs. These observations might help setting up priorities when conceptualising new programs and facilitate the implementation of services that facilitate engagement of patients in treatment during the critical initial phase of psychotic disorders.

The joint influence of gender and amount of smoking on weight gain one year after smoking cessation.

Weight gain is often associated with smoking cessation and may discourage smokers from quitting. This study estimated the weight gained one year after smoking cessation and examined the risk factors associated with weight gain in order to identify socio-demographic groups at higher risk of increased weight after quitting. We analyzed data from 750 adults in two randomized controlled studies that included smokers motivated to quit and found a gradient in weight gain according to the actual duration of abstinence during follow-up. Subjects who were abstinent for at least 40 weeks gained 4.6 kg (SD = 3.8) on average, compared to 1.2 kg (SD = 2.6) for those who were abstinent less than 20 weeks during the 1-year follow-up. Considering the duration of abstinence as an exposure variable, we found an age effect and a significant interaction between sex and the amount of smoking before quitting: younger subjects gained more weight than older subjects; among light smokers, men gained more weight on average than women one year after quitting, while the opposite was observed among heavy smokers. Young women smoking heavily at baseline had the highest risk of weight gain after quitting.

Contribució de les varietats locals a la conservació de l'agrobiodiversitat: cas d'estudi en horts d'alta muntanya al Pallars Jussà, Pirineu català

Durant les últimes dècades, el paper dels horts familiars en la conservació de la agrobiodiversitat ha adquirit cada vegada més importància a nivell mundial. Les varietats locals que es cultiven en aquests horts tenen propietats intrínseques que les fan superiors a les comercials en molts aspectes, com han demostrat alguns dels estudis sobre aquests agroecosistemes duts a terme als Tròpics, i que posen en evidència l'actual sistema agrícola, alhora que representen una oportunitat per al desenvolupament sostenible de l´agricultura. En aquest treball d'investigació, dut a terme a la Vall Fosca (Pirineus Català d'Espanya) s'ha estudiat el paper les varietats locals dels horts familiars com a mecanisme de millora i manteniment d'aquests agroecosistemes, analitzant quins són els possibles factors sociodemogràfics i ecològics que condicionen el desenvolupament d'aquestes varietats als horts familiars.

Outcome and Experience from the Swiss Mammography Screening Pilot Programmes

BACKGROUND:The Swiss breast cancer screening pilot programme was conducted in 3 districts of theFrench-speaking canton of Vaud (ca. 300,000 resident women) between October 1993 and January 1999.Women aged 50 to 69 were invited by mail every 2 years for a free of charge screening mammography (doubleview, multiple reading). This first ever-organised cancer screening programme in Switzerland showed thefeasibility and acceptability of this kind of public health intervention in the liberal Swiss healthcare system, whichwas the main objective of the pilot programme. This mammographic screening programme was extended to thewhole canton in 1999, and contributed to the implementation of similar programmes in 2 neighbouring cantons. OBJECTIVE:To appraise the use, the quality and the effectiveness of the Swiss screening pilot programme. METHODS:About 15,000 women (aged 50-69) were enrolled. Logistic regression analyses were performedseparately to identify determinants of initial and subsequent attendance. Standard indicators of quality,effectiveness and impact of the programme were assessed and compared with European recommendations. Tothis intent, linkage with data from the Vaud Cancer Registry was performed. RESULTS:About half the target population was screened at least once during the pilot trial. Participation washigher among Swiss than foreigners, among widowed or married women than among single, divorced or separatedones. Attendance also increased with age and decreasing distance between residence and the dedicatedscreening centre. Apart from Swiss citizenship, socio-demographic factors were not associated with reattendance.Intensity of prior recruitment, outcome of previous screening test (positive vs. negative) and indicators of women'shealth behaviour (time of last mammography prior to initial screen, smoking status) were the main determinants ofreattendance. Programme performance and quality indicators were, overall, in line with European Guidelines. Theywere overall more favourable among 60-69 than 50-59 year-olds and improved over time. CONCLUSION:The objectives of the pilot programme were met. Even if participation should increase in order toreach European standards, performance indicators overall met quality requirements. Ways to improve screeninguse, quality and effectiveness were devised and taken into account for the generalisation of the programme.

Life partnerships in childhood cancer survivors, their siblings, and the general population.

BACKGROUND: Life partnerships other than marriage are rarely studied in childhood cancer survivors (CCS). We aimed (1) to describe life partnership and marriage in CCS and compare them to life partnerships in siblings and the general population; and (2) to identify socio-demographic and cancer-related factors associated with life partnership and marriage. METHODS: As part of the Swiss Childhood Cancer Survivor Study (SCCSS), a questionnaire was sent to all CCS (aged 20-40 years) registered in the Swiss Childhood Cancer Registry (SCCR), aged <16 years at diagnosis, who had survived ≥ 5 years. The proportion with life partner or married was compared between CSS and siblings and participants in the Swiss Health Survey (SHS). Multivariable logistic regression was used to identify factors associated with life partnership or marriage. RESULTS: We included 1,096 CCS of the SCCSS, 500 siblings and 5,593 participants of the SHS. Fewer CCS (47%) than siblings (61%, P < 0.001) had life partners, and fewer CCS were married (16%) than among the SHS population (26%, P > 0.001). Older (OR = 1.14, P < 0.001) and female CCS (OR = 1.85, <0.001) were more likely to have life partners. CCS who had undergone radiotherapy, bone marrow transplants (global P Treatment = 0.018) or who had a CNS diagnosis (global P Diagnosis < 0.001) were less likely to have life partners. CONCLUSION: CCS are less likely to have life partners than their peers. Most CCS with a life partner were not married. Future research should focus on the effect of these disparities on the quality of life of CCS.

Correlates of extracurricular sport participation among Swiss adolescents.

BACKGROUND: Based on a large national survey on the health of adolescents, this paper focuses on the socio-demographic and lifestyle correlates of sport practice among Swiss adolescents. The SMASH2002 database includes 7428 vocational apprentices and high school students between the ages of 16 and 20 who answered a self-administered anonymous questionnaire containing 565 items targeting perceived health, health attitudes and behaviour. Weekly episodes of extracurricular sport activity were measured by a four-category scale, and the sample was dichotomised between active (>or=two episodes of sport/week) and inactive (<two episodes of sport/week) respondents. Thirty percent of female respondents and 40.2% of male respondents reported engaging in sport activity at least two to three times a week; another 9.7% of the female and 19.4% of the male respondents reported participating in least one sport activity each day (p<0.01). The percentage of active respondents was higher among students than among vocational apprentices (p<.01), and the rates of sport activity decreased more sharply over time among the apprentices than among the students (p<0.01). Most active adolescents reported having a better feeling of well-being than their inactive peers [among male students: odds ratio (OR): 3.13; 95% confidence interval (95%CI): 1.28-7.70]. The percentage of active females who reported being on a diet was high, and female apprentices exhibited higher involvement in dieting than their inactive peers (OR: 1.68; 95%CI: 1.32-2.14). Relative to the inactive male respondents, the proportion of active male respondents smoking was lower; however, a lower proportion of the latter group did not report drunkenness, and the percentage of those who reported lifetime cannabis consumption was higher among active than inactive students (females, OR:1.57; 95%CI:1.09-2.25; males, OR:1.80; 95%CI: 20-2.69). CONCLUSION: Organised sport activities should be better tailored to the work schedules of apprentices. Practitioners should be aware of the potential for problematic behaviour in the area of dieting and substance use among a subset of sport-oriented adolescents.

Psychodynamic interventions in cancer care I: psychometric results of a randomized controlled trial.

OBJECTIVE: This study aimed to assess the effectiveness of psychodynamic interventions in cancer care. METHODS: Between 2006 and 2009, each consecutive outpatient of the Oncology Center of the University Hospital of Lausanne was invited to participate in a trial evaluating the effects of psychological support. Accepting patients were randomly assigned to an immediate intervention or a delayed intervention [4-month waiting list]. Patients who declined support were asked to participate in an observational group [OG]. Socio-demographic and medical data, anxiety, and depression [HADS], psychological distress [SCL-90], alexithymia [TAS] and quality of life [EORTC] were recorded at baseline, and at 1, 4, 8, and 12-months follow-up. RESULTS: Of the 1973 approached patients, 1057 were excluded, 530 refused, and 386 were included with 196 of them participating in the OG. Of the patients in the intervention group [IG] [N = 190], 94 were randomized to the immediate intervention and 96 to the delayed intervention group (dIG). IG patients were younger, predominantly female, and had more psychological symptoms compared with those in the OG. Although patients of the IG and OG showed significant improvement in quality of life from baseline to 12-months follow-up, other outcomes [anxiety, depression, psychological distress, and alexithymia] remained unchanged. CONCLUSIONS: The intervention was not effective with regards to psychometric outcome. The results have to be interpreted in light of the study design [untargeted intervention], the low levels of psychiatric symptoms, dropout of symptomatic patients, and the high prevalence of alexithymia.

Cognition, Resources, and Institutions in the Explanation of Attitudes to Free Trade

This article proposes a framework for the analysis of attitudes to foreign trade policies that challenges the traditional skill-endowment approach. The traditional approach assumes informed individuals who calculate the costs and benefits of alternative policies. We propose that individuals lack information and that their positions rest on economic vulnerability, as mediated through risk-aversion. We also stress the role of environmental signals and political endorsements in guiding individuals' views on trade policy. We test this alternative approach with a Spanish survey conducted in May 2009 and the ISSP survey conducted in 2003 in a large number of less developed and more developed countries. The Spanish data show that the population is largely uninformed and that their ideas about the consequences of free trade policy do not explain attitudes among different socio-demographic groups. Meanwhile, the ISSP data contradict important aspects of the traditional approach and are consistent with the alternative approach.

Gambling among youths in Switzerland and its association with other addictive behaviours: a population-based study.

OBJECTIVE: To assess the prevalence of problem gambling in a population of youths in Switzerland and to determine its association with other potentially addictive behaviours. METHODS: Cross-sectional survey including 1,102 participants in the first and second year of post-compulsory education, reporting gambling, socio-demographics, internet use and substance use. For three categories of gambling (nongambler; nonproblem gambler and at-risk/problem gambler). socio-demographic and addiction data were compared using a bivariate analysis. All significant variables were included in a multinominal logistic regression using nongamblers as the reference category. RESULTS: The prevalence of gamblers was 37.48% (n = 413), with nonproblem gamblers being 31.94% (n = 352) and at-risk/problem gamblers 5.54% (n = 61). At the bivariate level, severity of gambling increased among adults (over 18 years) and among males, vocational students, participants not living with both parents and youths having a low socio-economic status. Gambling was also associated to the four addictive behaviours studied. At the multivariate level, risk of nonproblem gambling was increased in males, older youths, vocational students, participants of Swiss origin and alcohol misusers. Risk of at-risk/problem gambling was higher for males, older youths, alcohol misusers, participants not living with both parents and problem internet users. CONCLUSIONS: One-third of youths in our sample had gambled in the previous year and gambling is associated with other addictive behaviours. Clinicians should screen their adolescent patients for gambling habits, especially if other addictive behaviours are present. Additionally, gambling should be included in prevention campaigns together with other addictive behaviours.

Prevalence of and associated factors for adult attention deficit hyperactivity disorder in young Swiss men.

OBJECTIVE: The present study aimed to measure the prevalence of adult attention deficit hyperactivity disorder (ADHD) in a large, representative sample of young Swiss men and to assess factors associated with this disorder. METHODS: Our sample consisted of 5656 Swiss men (mean age 20 years) who participated in the Cohort Study on Substance Use Risk Factors (C-SURF). ADHD was assessed with the World Health Organization (WHO) adult ADHD Self Report Screener (ASRS). Logistic regression analyses were conducted to assess the association between ADHD and several socio-demographic, clinical and familial factors. RESULTS: The prevalence of ADHD was 4.0%, being higher in older and French-speaking conscripts. A higher prevalence also was identified among men whose mothers had completed primary or high school/university and those with a family history of alcohol or psychiatric problems. Additionally, adults with ADHD demonstrated impairment in their professional life, as well as considerable mental health impairment. CONCLUSION: Our results demonstrate that ADHD is common among young Swiss men. The impairments in function and mental health we observed highlight the need for further support and interventions to reduce burden in affected individuals. Interventions that incorporate the whole family also seem crucial.

Withdrawal, "serosorting" and "strategic positioning": use of risk reduction strategies with casual sex partners in men who have sex with men (MSM) in Switzerland, 2007

Introduction: 1) Withdrawal before ejaculation, "serosorting" (to choose a partner of same serostatus) and "strategic positioning" (only insertive vs. only receptive role in anal sex according to serostatus) are known to be used by MSM as alternatives to condom use. 2) Despite their questionable levels of effectiveness they are collectively labelled as "risk reduction strategies" (RRS). Objectives: The aim of this study is to estimate the prevalence and factors related to RRS in men who report unprotected anal intercourse (UAI) with occasional partners in the last 12 months. Methods: 1) In 2007, a module on RRS was included in a repeated national survey conducted among readers of gay newspapers, members of gay organizations and visitors of gay websites (N=2953). 2) Using an anonymous self-completed questionnaire, participants were asked whether, with the aim of avoiding HIV infection, RRS were used with occasional partners. Analysis: 1) Prevalences were calculated in participants who reported UAI with occasional partners in the last 12 months (n=416). 2) A logistic regression was performed, using "at least one RRS" as dependent variable. Number of partners in the last 12 months, HIV-status and usual socio-demographic characteristics were used as independent factors. Result : 1) 70% (292/416) of the participants reporting UAI used at least one RRS when they had unprotected sex with casual partners in the last 12 months (Table 1). 2) Withrawal before ejaculation was the most frequently reported strategy, followed by serosorting and strategic positioning (Table 1). 3) Participants who reported at least one RRS were more likely to be over 30 years and to belong to a gay organisation. HIV-positive and non-tested participants were less likely to report RRS than HIV-negative participants (Table 2). Conclusions: 1) The majority of MSM who reported UAI in the last 12 months tried to reduce risk of HIV transmission by using specific strategies (withdrawal, serosorting, strategic positioning). It is not known, however, to what extent the use of these strategies was systematic. 2) It is necessary to provide MSM with balanced information on these strategies and their respective level of effectiveness. 3) It is important to monitor the use of RRS in HIV behavioural surveillance surveys in MSM.