Healthy choices. Choose wisely: Advice for parents

This booklet shows how parents and carers of primary school children can choose food from the different food groups to make sure their family is getting all the nutrients they need to stay healthy.

After-hours paediatric telephone triage and advice : the Neuchâtel experience

Résumé Introduction : Plusieurs études américaines et australiennes ont décrit des systèmes de tri téléphonique des urgences pédiatriques. En Europe, les services publics d'urgences pédiatriques ont peu de données épidémiologiques sur lesquelles s'appuyer pour répondre à la demande de soins. Depuis 1996, le département de pédiatrie de l'hôpital Pourtalès, Neuchâtel, offre, en dehors des heures ouvrables, mi tri téléphonique infirmier gratuit. Le présent travail analyse : 1) la situation suisse de l'offre en tri téléphonique infirmier pour les urgences pédiatriques ; 2) une partie des données épidémiologiques de l'expérience neuchâteloise. Méthode : 1) Un questionnaire a été envoyé aux 35 services d'urgences pédiatriques publics de Suisse pour Savoir si un tel tri était utilisé ; 2) une analyse rétrospective de tous les appels reçus, consignés sur fiches standardisées, en 1997 et 2000 a été menée. Résultats : 1) La majorité des services (27/35) ont effectivement un système de tri infirmier. Peu offrent une formation spécifique pour ce travail (14/27) ; 2) Au total, 7870 appels ont été analysés (3242 en 1997; 4628 en 2000, ± 43%). En semaine, la majorité ont été reçus entre 18h et 23h et le week-end en milieu de matinée. Septante-cinq % des appels ont concerné des enfants de 5 ans ou moins. La fièvre, les otalgies et la toux ont représenté 42% des plaintes. Vingt-sept % des appels ont été pris en charge uniquement par les conseils infirmiers, 15 % ont été transmis à l'interne de garde et 50% ont conduit à un rendez-vous dans le service le jour même. Conclusion : Nos données peuvent aider d'autres services d'urgences pédiatriques à planifier au mieux la mise en place d'un tel système de tri téléphonique. Abstract Delivery of paediatric primary care by call centres has emerged as a satisfactory system. It been reported in the literature in the United States and Australia. European public-funded paediatric emergency departments (ED) have little epidemiological data to rely on to match the demand in care. Since 1996, we have run a free nurse-led after-hours paediatric telephone triage and advice (TTA) system, To determine wether other Swiss public paediatric departments practiced formal TTA, we conducted a nation-wide postal survey. To delineate who used our call centre and for what reasons, we embarked on a retrospective study of ail the 1997/2000 calls. Most of the units run a TTA (27/35) but few specifically train their staff (14/27). A 43% increase in call numbers was seen between 1997 (3242) and 2000 (4628). During week-days, most of the calls were between 6 and 11 pm and at weekends, a mid morning activity peak was seen. Some 75% of calls were for children aged 5 years or less. Fever, earache and cough accounted for 42% of the main complaints. Of all calls, 27% were dealt by nurses' advice only. About 15% of the calls were transferred to the on-call resident. About 50% led to a same day ED appointment. Conclusion: Nurse-led paediatric telephone triage and advice is common in Switzerland where training seems to be irregular. Our data can help units to better plan an eventual paediatric telephone triage and advice service. After-hours; Paediatric; Telephone advice; Telephone triage

The Impact of advice on women's and men's selection into competition

We conduct a laboratory experiment to study how advice affects the gender gap in the entry into a real-effort tournament. Our experiment is motivated by the concerns raised by approaching the gender gap through affirmative action. Advice is given by subjects who have already had some experience with the participation decision. We show that advice improves the entry decision of subjects, in that forgone earnings due to wrong entry decisions go significantly down. This is mainly driven by significantly increased entry of strong performing women, who also become significantly more confident, and reduced entry of weak performing men.

Why bystanders decline telephone cardiac resuscitation advice.

OBJECTIVES: The aim of this study was to evaluate the rate and reason for refusal of telephone-based cardiopulmonary resuscitation (CPR) instruction by bystanders after the implementation of the dispatch center's systematic telephone CPR protocol. METHODS: Over a 15-month period the authors prospectively collected all case records from the emergency medical services (EMS) dispatch center when CPR had been proposed to the bystander calling in and recorded the reason for declining or not performing that the bystander spontaneously mentioned. All pediatric and adult traumatic and nontraumatic cases were included. Situations when resuscitation had been spontaneously initiated by bystanders were excluded. RESULTS: During the study period, dispatchers proposed CPR on 264 occasions: 232 adult nontraumatic cases, 17 adult traumatic cases, and 15 pediatric (traumatic and nontraumatic) cases. The proposal was accepted in 163 cases (61.7%, 95% confidence interval [CI] = 54.6% to 66.5%), and CPR was eventually performed in 134 cases (51%, 95% CI = 43.2% to 55.3%). In 35 of the cases where resuscitation was not carried out, the condition of the patient or conditions at the scene made this decision medically appropriate. Of the remaining 95 cases, 55 were due to physical limitations of the caller, and 33 were due to emotional distress. CONCLUSIONS: The telephone CPR acceptance rate of 62% in this study is comparable to those of other similar studies. Because bystanders' physical condition is one of the keys to success, the rate may not improve as the population ages.

Computerized advice on drug dosage to improve prescribing practice.

BACKGROUND: Maintaining therapeutic concentrations of drugs with a narrow therapeutic window is a complex task. Several computer systems have been designed to help doctors determine optimum drug dosage. Significant improvements in health care could be achieved if computer advice improved health outcomes and could be implemented in routine practice in a cost effective fashion. This is an updated version of an earlier Cochrane systematic review, by Walton et al, published in 2001. OBJECTIVES: To assess whether computerised advice on drug dosage has beneficial effects on the process or outcome of health care. SEARCH STRATEGY: We searched the Cochrane Effective Practice and Organisation of Care Group specialized register (June 1996 to December 2006), MEDLINE (1966 to December 2006), EMBASE (1980 to December 2006), hand searched the journal Therapeutic Drug Monitoring (1979 to March 2007) and the Journal of the American Medical Informatics Association (1996 to March 2007) as well as reference lists from primary articles. SELECTION CRITERIA: Randomized controlled trials, controlled trials, controlled before and after studies and interrupted time series analyses of computerized advice on drug dosage were included. The participants were health professionals responsible for patient care. The outcomes were: any objectively measured change in the behaviour of the health care provider (such as changes in the dose of drug used); any change in the health of patients resulting from computerized advice (such as adverse reactions to drugs). DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed study quality. MAIN RESULTS: Twenty-six comparisons (23 articles) were included (as compared to fifteen comparisons in the original review) including a wide range of drugs in inpatient and outpatient settings. Interventions usually targeted doctors although some studies attempted to influence prescriptions by pharmacists and nurses. Although all studies used reliable outcome measures, their quality was generally low. Computerized advice for drug dosage gave significant benefits by:1.increasing the initial dose (standardised mean difference 1.12, 95% CI 0.33 to 1.92)2.increasing serum concentrations (standradised mean difference 1.12, 95% CI 0.43 to 1.82)3.reducing the time to therapeutic stabilisation (standardised mean difference -0.55, 95%CI -1.03 to -0.08)4.reducing the risk of toxic drug level (rate ratio 0.45, 95% CI 0.30 to 0.70)5.reducing the length of hospital stay (standardised mean difference -0.35, 95% CI -0.52 to -0.17). AUTHORS' CONCLUSIONS: This review suggests that computerized advice for drug dosage has some benefits: it increased the initial dose of drug, increased serum drug concentrations and led to a more rapid therapeutic control. It also reduced the risk of toxic drug levels and the length of time spent in the hospital. However, it had no effect on adverse reactions. In addition, there was no evidence to suggest that some decision support technical features (such as its integration into a computer physician order entry system) or aspects of organization of care (such as the setting) could optimise the effect of computerised advice.

Are Voting Advice Applications (VVAs) more than Toys ? : First findings on Impact and Accountability of VAAs

To what extent do Voting Advice Applications (VAA) have an influence on voting behaviour and to what extent should providers be hold accountable for such tools? This paper puts forward some empirical evidence from the Swiss VAA smartvote. The enormous popularity of smartvote in the last national elections in 2007 and the feedback of users and candidates let us come to the conclusion that smartvote is more than a toy and likely to have an influence on the voting decisions. Since Swiss citizens not only vote for parties but also for candidates, and the voting recommendation of smartvote is based on the political positions of the candidates, smartvote turns out to be particularly helpful. Political scientists must not keep their hands off such tools. Scientific research is needed to understand their functioning and possibilities to manipulate elections. On the bases of a legal study we come to the conclusion, that a science driven way of setting up such tools is essential for their legitimacy. However, we do not believe that there is a single best way of setting up such a tool and rather support a market like solution with different competing tools, provided they meet minimal standards like transparency and equal access for all parties and candidates. Once the process of selecting candidates and parties are directly linked to the act of voting, all these questions will become even more salient.

Mirror me : the effect of the voting advice application smartvote on voting preferences and behavior of Swiss voters

Voting Advice Applications (VAAs) have become a central component of election campaigns worldwide. Through matching political preferences of voters to parties and candidates, the web application grants voters a look into their political mirror and reveals the most suitable political choices to them in terms of policy congruence. Both the dense and concise information on the electoral offer and the comparative nature of the application make VAAs an unprecedented information source for electoral decision making. In times where electoral choices are found to be highly individualized and driven by political issue positions, an ever increasing number of voters turn to VAAs before casting their ballots. With VAAs in high demand, the question of their effects on voters has become a pressing research topic. In various countries, survey research has been used to proclaim an impact of VAAs on electoral behavior, yet practically all studies fail to provide the scientific evidence that would allow for making such claims. In this thesis, I set out to systematically establish the causal link between VAA use and electoral behavior, using various data sources and appropriate statistical techniques in doing so. The focus lies on the Swiss VAA smartvote, introduced in the forefront of the 2003 Swiss federal elections and meanwhile an integral part of the national election campaign, smartvote has produced over a million voting recommendations in the last Swiss federal elections to an active electorate of two million, potentially guiding a vast amount of voters in their choices on the ballot. In order to determine the effect of the VAA on electoral behavior, I analyze both voting preferences and choice among Swiss voters during two consecutive election periods. First, I introduce statistical techniques to adequately examine VAA effects in observational studies and use them to demonstrate that voters who used smartvote prior to the 2007 Swiss federal elections were significantly more likely to swing vote in the elections than non- users. Second, I analyze preference voting during the same election and show that the smartvote voting recommendation inclines politically knowledgeable voters to modify their ballots and cast candidate specific preference votes. Third, to further tackle the indication that smartvote use affects the preference structure of voters, I employ an experimental research design to demonstrate that voters who use the application tend to strengthen their vote propensities for their most preferred party and adapt their overall party preferences in a way that they consider more than one party as eligible vote options after engaging with the application. Finally, vote choice is examined for the 2011 Swiss federal election, showing once more that the VAA initiated a change of party choice among voters. In sum, this thesis presents empirical evidence for the transformative effect of the Swiss VAA smartvote on the electoral behavior.

Compliance to dietary advice directed towards increasing the carbohydrate to fat ratio of the everyday diet.

OBJECTIVE: To assess the effects, on food intake, body weight and body composition, of compliance to advice aiming at increasing the carbohydrate to fat ratio of the everyday diet without imposing voluntary restriction on the amount of food consumed. DESIGN: Eight moderately overweight women (body mass index > 27 kg/m2, relative body fat mass > 30%) received dietary advice during a 2 month period. Additionally, each evening the subjects had to consume a meal artificially enriched with 13C-glucose in order to assess their compliance from the 13CO2 enrichment in expired air. MEASUREMENTS: Dietary intakes, body weight, body composition and individual compliance. RESULTS: The energy derived from fat decreased from 44 +/- 1% to 31 +/- 1% and the proportion of carbohydrate increased from 38 +/- 2% to 50 +/- 1%, whereas the absolute carbohydrate intake remained constant (182 +/- 18 g/d). Energy intake decreased by 1569 +/- 520 kJ/d. There was a net loss of fat mass (1.7 +/- 0.7 kg, P = 0.016) with fat free mass maintenance. Dietary compliance ranged from 20 to 93% (mean: 60 +/- 8%) and was positively correlated to the loss of body fat mass. CONCLUSION: Advice aiming at increasing diet's carbohydrate to fat ratio induces a loss of fat mass with fat-free mass maintenance.

Repensar el asesoramiento en educación. ¿Qué prácticas para los nuevos retos? = Rethink the advice in education. What practices for the new challenges?

Esta publicación aborda, de manera monográfica, el tema del asesoramiento en educación. Han transcurrido prácticamente treinta años desde que a finales de los 70 y principios de los 80 surgieran en nuestro país los Servicios de Orientación Educativa y Vocacional (SOEV), que junto a los Institutos de Orientación Educativa y Profesional (IOEP) y los Equipos Multiprofesionales (EM) dan origen –en los 90– a los actuales Equipos de Orientación Educativa y Psicopedagógica (EOEP). Han pasado veinticinco años desde el nacimiento en España –a mediados de los 80– de los Centros de Profesores (CEP). Inspirados en los ‘Teachers Centers’ británicos, los CEP vienen a cubrir las necesidades de formación permanente del profesorado como respuesta a la inoperancia de los Institutos de Ciencias de la Educación (ICE) del momento. Han sido, pues, treinta años de lo que ha venido a llamarse asesoramiento institucional, esto es, asesoramiento organizado y estructurado, ofertado desde sistemas de apoyo a la escuela, dando cabida en u actuación a multitud de iniciativas y prácticas de apoyo entre las que se encuentran las de asesoramiento, entremezclándose y confundiéndose a veces como prácticas de orientación, a veces como formación, o simplemente como actividades de asistencia y colaboración entre profesionales para la resolución de necesidades y problemas en el seno de nuestras escuelas. Y tal ha sido su diversidad y tipología, su riqueza y amplitud, que se han invertido no pocos esfuerzos, debates y ríos de tinta para comprender y definir, clasificar y etiquetar un ingente y variopinto conjunto de prácticas que convenimos en llamar, de asesoramiento

The impact of authority advice and accountability on auditors' decision to recognise norm-violating transactions.

Auditors face the difficult responsibilty to approve companies' financial accounting information reliably. They are trained to work according to accounting standards that are designed to help them in their decision making. Yet, auditors do not work in a social vacuum and are thus subject to various influences. One important source of influence at work is authority figures (e.g., experts, supervisors). On this background, we examined within two studies the impact of (1) authority advice to comply with accounting standards or to additionally maximize profits and (2) of participants' accountability for their decision. In Study 1, (n = 184 accounting students), participants who were advised by an authority to comply with accounting standards had a lower probability to recognise transactions that violated those standards than participants who were advised to comply but also to maximise profit. However, holding participants accountable for their decision reduced the difference between the two groups. In Study 2, (n = 58 managers), we again found an interaction between authority advice and accountability. But unlike the first study, participants only showed a lower probability to recognise transactions that violated accounting standards when they were held accountable and when the authority only advised them to comply with the standards. We discuss our results in light of unethical decision making and different norms or pressures to which managers may be exposed but students may not.