Renoncement aux soins: comment appréhender cette réalité en médecine de premier recours [Patients forgoing health care for economic reasons: how to identify this in a primary care setting?].

Although the performance of the Swiss health system is high, one out of ten patients in general practitioner's (GP) office declares having foregone care in the previous twelve months for economic reasons. Reasons for foregoing care are several and include a lack of knowledge of existing social aids in getting health insurance, unavailability of GPs and long waiting lists for various types of care. Although long term knowledge of patients or a psychosocial history of deprivation or poverty may help identify individuals at risk of foregoing care, many may remain undetected. We propose then a few instruments to help GPs to identify, in a simple and structured approach, patients at risk of forgoing care for economic reasons; these patients are frequently deprived and sometimes poor.

El Dios en la maleta. Análisis antropológico de las representaciones y prácticas religiosas de los ecuatorianos migrados a Bercelona y Nueva York

Nuestra investigación pretende abordar el estudio de la identidad católica ecuatoriana y su vivencia entre los migrantes residentes en Barcelona y New York. Cuando hablamos de identidad católica, pensamos en un determinado hábitat de sentido (Hannerz) o sistema cultural (Geertz) que satisface la sed de sentido de sus seguidores proveyéndoles de una determinada cosmovisión que éstos perciben como “emocionalmente convincente” (Geertz). A través de nuestra etnografía multisituada, desarrollada en Barcelona (6 meses), New York (6 meses) y Ecuador (3 meses), intentamos definir el tipo de influencia de este referente identitario en la manera de significar la realidad y de actuar de sus portadores, ante la experiencia de la movilidad y del encuentro con la alteridad. Para definir correctamente el influjo de este universo significativo en la experiencia migratoria vamos, paralelamente, a tratar de interpretar su “estructura significativa” (Geertz). En particular, reanudando los estudios propios de la Antropología de las Religiones (y el enfoque geertziano en la dimensión cultural de la religión), analizaremos sus creencias (sus mitos) y sus prácticas (los rituales); interpretándolos simbólicamente y analizando los efectos que estos dos diferentes niveles expresivos del universo católico (ecuatoriano) derraman tanto en la dimensión íntima del creyente, como en la social.

Media exposure and internal migration-evidence from Indonesia

This paper investigates the impact of television on internal migration in Indonesia. We exploit the differential introduction of private television throughout the country and the variation in signal reception due to topography to estimate the causal effect of media exposure. Our estimates reveal important long and short run effects. An increase of one standard deviation in the number of private TV channels received in the area of residence reduces future inter-provincial migration by 1.7-2.7 percentage points, and all migration (inter and intra-provincial) by 4-7.4 percentage points. Short run effects are slightly smaller, but still sizeable and statistically significant. We also show that respondents less exposed to private TV are more likely to consider themselves among the poorest groups of the society. As we discuss in a stylized model of migration choice under imperfect information, these findings are consistent with Indonesia citizens over-estimating the net gains from internal migration.

Le partage du savoir dans les arts du soin : mélanges en l'honneur de Marco Vannotti

La circularité relationnelle du savoir-être : l'enseignement post-grade selon une perspective systémique / Marco Vannotti - La passion de transmettre : une lecture platonicienne en hommage à M. Vannotti / Michèle Gennart - «Apprendre à coopérer pour apprendre» : la construction des échanges coopératifs / Olivier Real del Sarte - Apprendre à traiter les enfants battus : la transformation de l'intervenant / Stefano Cirillo - Fin de thérapie / Ferenc Rakoczy - La transmission du savoir psychiatrique à la Policlinique Médicale Universitaire : les liaisons dangereuses / Christian Marin - Entre transmission et acquisition des savoirs : le poids de la parole / Brikela Sulstarova - La volonté de faire sens en médecine : clinique, intersubjectivité, et reconnaissance / Francesco Panese - Médecine et rationalité / Jean Starobinski

Assaig de definició de l’àrea urbana de Girona

This article is an essay aiming at the definition of the urban district of Girona, having as a base the analysis of the intensities and directional tendencies of labour mobility fluxes in it. Several cathegories will be signaled inside this area which wil enable us to differenciate a number of crowns of municipalities according to their respective links with Girona town. A reflection set forth by Francesco Indovina on the concept of diffused town will be the first step in the attempt to typify this area. Thus, the existence of a diffused city core of which would be Girona town will be argued, an issue this one which is to be analysed in future studies

Genome-wide association study of multiple sclerosis confirms a novel locus at 5p13.1.

Multiple Sclerosis (MS) is the most common progressive and disabling neurological condition affecting young adults in the world today. From a genetic point of view, MS is a complex disorder resulting from the combination of genetic and non-genetic factors. We aimed to identify previously unidentified loci conducting a new GWAS of Multiple Sclerosis (MS) in a sample of 296 MS cases and 801 controls from the Spanish population. Meta-analysis of our data in combination with previous GWAS was done. A total of 17 GWAS-significant SNPs, corresponding to three different loci were identified:HLA, IL2RA, and 5p13.1. All three have been previously reported as GWAS-significant. We confirmed our observation in 5p13.1 for rs9292777 using two additional independent Spanish samples to make a total of 4912 MS cases and 7498 controls (ORpooled = 0.84; 95%CI: 0.80-0.89; p = 1.36 × 10-9). This SNP differs from the one reported within this locus in a recent GWAS. Although it is unclear whether both signals are tapping the same genetic association, it seems clear that this locus plays an important role in the pathogenesis of MS.

Viabilitat tècnica i econòmica de la implantació del mètode Ganimede® en un procés de vinificació

L’objecte del projecte és realitzar un estudi de viabilitat tècnica i econòmica respecte laimplantació del mètode Ganimede® en el procés de vinificació enfront els sistemesconvencionals. Aquest mètode es basa en la instal•lació dels dipòsits fermentadors patentats anomenats també Ganimede® que van néixer durant la verema 1997 de la mà de l’enòleg i inventor italià Francesco Marin

13q deletion syndrome and retinoblastoma in identical dichorionic diamniotic monozygotic twins.

PURPOSE: To report the case of identical dichorionic diamniotic female twins with unilateral retinoblastoma in 13q deletion syndrome. METHODS: Clinical and ophthalmoscopic evaluation, combination of multiple ligation-dependent probe amplification, array-comparative genomic hybridization analyses, and magnetic resonance imaging were performed. RESULTS: Peculiar facial features, marked hypotonia, gastroesophageal reflux, interatrial septal defect with left to right shunt and light dilatation of right chambers, 5th finger hypoplasia, 3rd-5th toes clinodactyly, 2nd toe overlapped to 3rd toe, and cutis marmorata were found. Ophthalmoscopic evaluation revealed unilateral retinoblastoma in both girls. Magnetic resonance imaging detected corpus callosum hypoplasia in both twins. A 34.4-Mb deletion involving bands 13q13.2-q21.33 and including the RB1 gene was identified in both twins. The deletion was not present in the DNA of their parents and older brother. CONCLUSIONS: Dysmorphic features in children must be always suspicious of 13q deletion syndrome and a short ophthalmoscopic follow-up is necessary to detect the presence of a retinoblastoma.

International recommendations on the diagnosis and treatment of patients with acquired hemophilia A.

Acquired hemophilia A (AHA) is a rare bleeding disorder characterized by autoantibodies directed against circulating coagulation factor (F) VIII. Typically, patients with no prior history of a bleeding disorder present with spontaneous bleeding and an isolated prolonged aPTT. AHA may, however, present without any bleeding symptoms, therefore an isolated prolonged aPTT should always be investigated further irrespective of the clinical findings. Control of acute bleeding is the first priority, and we recommend first-line therapy with bypassing agents such as recombinant activated FVII or activated prothrombin complex concentrate. Once the diagnosis has been achieved, immediate autoantibody eradication to reduce subsequent bleeding risk should be performed. We recommend initial treatment with corticosteroids or combination therapy with corticosteroids and cyclophosphamide and suggest second-line therapy with rituximab if first-line therapy fails or is contraindicated. In contrast to congenital hemophilia, no comparative studies exist to support treatment recommendations for patients with AHA, therefore treatment guidance must rely on the expertise and clinical experience of specialists in the field. The aim of this document is to provide a set of international practice guidelines based on our collective clinical experience in treating patients with AHA and contribute to improved care for this patient group.