Relação entre macrofauna edáfica e atributos químicos do solo em diferentes agroecossistemas

O objetivo deste trabalho foi avaliar o efeito do uso do solo sobre a densidade e a diversidade da macrofauna invertebrada, bem como a relação dessa com atributos químicos do solo em diferentes agroecossistemas. Foram estudados cinco agroecossistemas: sistema ecológico com três anos de adoção (SE3), sistemas agroflorestais com seis (SAF6) e dez (SAF10) anos de adoção; agricultura de corte e queima (ACQ), e floresta nativa (FN). Em cada sistema, foram coletadas aleatoriamente cinco amostras solo, em forma de blocos (25x25 cm), na profundidade de 10 cm, nas épocas seca (outubro, 2006) e chuvosa (maio, 2007). A relação entre os atributos químicos e a macrofauna edáfica, nos diferentes sistemas de uso do solo, foi determinada por meio da análise da coinércia. Maior abundância da macrofauna foi observada na época chuvosa. Os sistemas SE3, SAF6 e SAF10 apresentaram maior riqueza de espécies e índices de Shannon e Pielou, independentemente da época de coleta. O manejo agroflorestal favoreceu a ocorrência de "engenheiros do ecossistema". Os sistemas agroflorestais propiciam melhores características químicas do solo e aumentos na abundância e riqueza da macrofauna invertebrada do solo.

Revue des hospitalisations du Service de neurologie du CHUV en 1997

La présente étude s'inscrit dans la continuité des revues d'hospitalisation déjà conduites au CHUV. Elle consiste à documenter la pertinence des admissions et des journées d'hospitalisation dans le Service de neurologie pour les patients admis entre le 1er octobre 1996 et le 30 mars 1997. Soutenue par le Fonds de performance vaudois, cette étude pousuit trois buts: 1. vérifier l'applicabilité du protocole de Gertman et Restuccia au contexte de la neurologie; 2. élaborer un instrument de détection des journées non justifiées; 3. identifier les mesures permettant de diminuer le taux de journées non justifiées (...). [Table des matières] 1. Matériel et méthode. 1.1. Protocole princeps. 1.2. Protocole adapté. 1.3. Analyse des causes de délai. 2. Résultats : exhaustivité de la cueillette de données. 3. Discussion et conclusions. 4. Annexes : 1. Limites temporelles du critère C15. 2. Soins requis (PNR). 3. Formulaire de saisie. 4. Responsabilités des délais. 5. Distribution des critères. 6. Causes de délai.

Surgical safety and hospital volume across a wide range of interventions

OBJECTIVES:: For certain major operations, inpatient mortality risk is lower in high-volume hospitals than those in low-volume hospitals. Extending the analysis to a broader range of interventions and outcomes is necessary before adopting policies based on minimum volume thresholds. METHODS:: Using the United States 2004 Nationwide Inpatient Sample, we assessed the effect of intervention-specific and overall hospital volume on surgical complications, potentially avoidable reoperations, and deaths across 1.4 million interventions in 353 hospitals. Outcome variations across hospitals were analyzed through a 3-level hierarchical logistic regression model (patients, surgical interventions, and hospitals), which took into account interventions on multiple organs, 144 intervention categories, and structural hospital characteristics. Discriminative performance and calibration were good. RESULTS:: Hospitals with more experience in a given intervention had similar reoperation rates but lower mortality and complication rates: odds ratio per volume deciles 0.93 and 0.97. However, the benefit was limited to heart surgery and a small number of other operations. Risks were higher for hospitals that performed more interventions overall: odds ratio per 1000 for each event was approximately 1.02. Even after adjustment for specific volume, mortality varied substantially across both high- and low-volume hospitals. CONCLUSION:: Although the link between specific volume and certain inpatient outcomes suggests that specialization might help improve surgical safety, the variable magnitude of this link and the heterogeneity of hospital effect do not support the systematic use of volume-based referrals. It may be more efficient to monitor risk-adjusted postoperative outcomes and to investigate facilities with worse than expected outcomes.

Social and medical vulnerability factors of frequent users at the emergency department: a case-control study

BACKGROUND: Up to 5% of patients presenting to the emergency department (ED) four or more times within a 12 month period represent 21% of total ED visits. In this study we sought to characterize social and medical vulnerability factors of ED frequent users (FUs) and to explore if these factors hold simultaneously. METHODS: We performed a case-control study at Lausanne University Hospital, Switzerland. Patients over 18 years presenting to the ED at least once within the study period (April 2008 toMarch 2009) were included. FUs were defined as patients with four or more ED visits within the previous 12 months. Outcome data were extracted from medical records of the first ED attendance within the study period. Outcomes included basic demographics and social variables, ED admission diagnosis, somatic and psychiatric days hospitalized over 12 months, and having a primary care physician.We calculated the percentage of FUs and non-FUs having at least one social and one medical vulnerability factor. The four chosen social factors included: unemployed and/or dependence on government welfare, institutionalized and/or without fixed residence, either separated, divorced or widowed, and under guardianship. The fourmedical vulnerability factors were: ≥6 somatic days hospitalized, ≥1 psychiatric days hospitalized, ≥5 clinical departments used (all three factors measured over 12 months), and ED admission diagnosis of alcohol and/or drug abuse. Univariate and multivariate logistical regression analyses allowed comparison of two JGIM ABSTRACTS S391 random samples of 354 FUs and 354 non-FUs (statistical power 0.9, alpha 0.05 for all outcomes except gender, country of birth, and insurance type). RESULTS: FUs accounted for 7.7% of ED patients and 24.9% of ED visits. Univariate logistic regression showed that FUs were older (mean age 49.8 vs. 45.2 yrs, p=0.003),more often separated and/or divorced (17.5%vs. 13.9%, p=0.029) or widowed (13.8% vs. 8.8%, p=0.029), and either unemployed or dependent on government welfare (31.3% vs. 13.3%, p<0.001), compared to non-FUs. FUs cumulated more days hospitalized over 12 months (mean number of somatic days per patient 1.0 vs. 0.3, p<0.001; mean number of psychiatric days per patient 0.12 vs. 0.03, p<0.001). The two groups were similar regarding gender distribution (females 51.7% vs. 48.3%). The multivariate linear regression model was based on the six most significant factors identified by univariate analysis The model showed that FUs had more social problems, as they were more likely to be institutionalized or not have a fixed residence (OR 4.62; 95% CI, 1.65 to 12.93), and to be unemployed or dependent on government welfare (OR 2.03; 95% CI, 1.31 to 3.14) compared to non-FUs. FUs were more likely to need medical care, as indicated by involvement of≥5 clinical departments over 12 months (OR 6.2; 95%CI, 3.74 to 10.15), having an ED admission diagnosis of substance abuse (OR 3.23; 95% CI, 1.23 to 8.46) and having a primary care physician (OR 1.70;95%CI, 1.13 to 2.56); however, they were less likely to present with an admission diagnosis of injury (OR 0.64; 95% CI, 0.40 to 1.00) compared to non-FUs. FUs were more likely to combine at least one social with one medical vulnerability factor (38.4% vs. 12.1%, OR 7.74; 95% CI 5.03 to 11.93). CONCLUSIONS: FUs were more likely than non-FUs to have social and medical vulnerability factors and to have multiple factors in combination.

Atmung, Aufmerksamkeit und Ablenkung als Funktion emotionaler Stimuli: Ablenkung, Atmung, Aufmerksamkeit, Emotion, Erregung, Valenz

Mittels Bilder, Musikstücken und Geräuschen induzierten wir Emotionen und gingen einerseits der Frage nach, wie emotionale Bewertung und physiologische Vorgänge, insbesondere die Atmung, miteinander verknüpft sind. Andererseits untersuchten wir mit Geruchsexpositionen während einer Mehrfachverrichtung, welche Rolle die Geruchs-Valenz bei der Arbeitsablenkung spielt. Unsere Versuche zeigten, dass die Atmungsantworten auf induzierte Emotionen in einem gewissen Rahmen dem Dimensionsmodell von Valenz und Arousal folgten, insbesondere bildeten sie die induzierte Erregung konsistent ab. Auch das Aufmerksamkeits-Engagement hing von der emotionalen Bedeutung des Stimulus ab, da nur die negativ attribuierten Gerüche eine Leistungsminderung in der Mehrfachverrichtung auslösten. [Autoren]

Improving breast cancer education: the case of an evolving multidisciplinary module for undergraduate medical students (lausanne medical school, 1993-2008).

Breast cancer is a public health issue in numerous countries. Multidisciplinary collaboration is required for patient care, research, and also education of future physicians. This paper uses Kern's framework for curriculum design to demonstrate how a breast diseases module for undergraduate medical students created in 1993 evolved over 15 years. The main outcomes of program refinements were better integrated course content, the development of electronic course documents, and implementation of computer-aided small group learning. A main future challenge is to further develop efficient instructional strategies in line with well-defined learning needs for undergraduate students.

Prevalence of frailty in middle-aged and older community-dwelling Europeans living in 10 countries.

BACKGROUND: Frailty is an indicator of health status in old age. Its frequency has been described mainly for North America; comparable data from other countries are lacking. Here we report on the prevalence of frailty in 10 European countries included in a population-based survey. METHODS: Cross-sectional analysis of 18,227 randomly selected community-dwelling individuals 50 years of age and older, enrolled in the Survey of Health, Aging and Retirement in Europe (SHARE) in 2004. Complete data for assessing a frailty phenotype (exhaustion, shrinking, weakness, slowness, and low physical activity) were available for 16,584 participants. Prevalences of frailty and prefrailty were estimated for individuals 50-64 years and 65 years of age and older from each country. The latter group was analyzed further after excluding disabled individuals. We estimated country effects in this subset using multivariate logistic regression models, controlling first for age, gender, and then demographics and education. RESULTS: The proportion of frailty (three to five criteria) or prefrailty (one to two criteria) was higher in southern than in northern Europe. International differences in the prevalences of frailty and prefrailty for 65 years and older group persisted after excluding the disabled. Demographic characteristics did not account for international differences; however, education was associated with frailty. Controlling for education, age and gender diminished the effects of residing in Italy and Spain. CONCLUSIONS: A higher prevalence of frailty in southern countries is consistent with previous findings of a north-south gradient for other health indicators in SHARE. Our data suggest that socioeconomic factors like education contribute to these differences in frailty and prefrailty.

V, (3)

Le médecin légiste - celui qui fascine la littérature policière, les scénaristes et les médias - c'est essetiellement celui qui pratique l'autopsie médico-légale. Or les médecins légistes aiment rappeler que leur spécialité dépasse, et de loin, cet exercice. En effet, la médecine légale est la médecine de toutes les violences. Le plus souvent, et c'est heureux, les victimes restent en vie, même si elles sont parfois marquées profondément par le traumatisme qu'elles ont subi. En associant quatre vingt-dix auteurs, ce traité constitue un panorama des situations de violence dans leur gravité clinique, leur réalité sociale et leur épidémiologie. Abordant dans la seconde partie de l'ouvrage les rapports entre médecine et justice, les auteurs s'adressent à tous les praticiens du droit et de la santé pour montrer qu'un médecin légiste a bien d'autres territoires d'intervention que la salle d'autopsie.

Travailleuses du sexe: un accès aux soins limité ? [Sex workers: limited access to healthcare ?].

Les travailleuses du sexe constituent un groupe hétérogène qui cumule les facteurs de vulnérabilité, comme l'instabilité géographique, la migration forcée, les addictions et la précarité du permis de séjour. Leur accès aux soins dépend notamment des lois régissant le "marché du sexe" et de la politique migratoire du pays d'accueil. Dans cet article, nous passons en revue diverses stratégies sanitaires européennes destinées à ce groupe vulnérable et présentons les résultats préliminaires d'une étude pilote réalisée auprès de 50 travailleuses du sexe pratiquant dans les rues de Lausanne. Les résultats sont préoccupants : 56% n'ont pas d'assurance maladie, 96% sont migrantes et 66% sans permis de séjour. Ces résultats préliminaires devraient sensibiliser les décideurs politiques à améliorer l'accès aux soins des travailleuses du sexe. [Abstract] Sex workers constitute a heterogeneous group possessing a combination of vulnerability factors such as geographical instability, forced migration, substance addiction and lack of legal residence permit. Access to healthcare for sex workers depends on the laws governing the sex market and on migration policies in force in the host country. In this article, we review different European health strategies established for sex workers, and present preliminary results of a pilot study conducted among 50 sex workers working on the streets in Lausanne. The results are worrying: 56% have no health insurance, 96% are migrants and 66% hold no legal residence permit. These data should motivate public health departments towards improving access to healthcare for this vulnerable population.

Diagnose nutricional de nitrogênio em folhas de feijoeiro pela análise digital de imagens

O objetivo deste trabalho foi avaliar o uso da análise digital de imagens na diagnose nutricional de N no feijoeiro. Foram avaliados quatro tratamentos, em que se combinaram duas doses de N e de P aplicadas ao solo. Na emissão de vagens, determinou-se o índice de clorofila Falker, digitalizaram-se as imagens dos trifólios e determinou-se o teor foliar de N. Nas imagens, foi atribuída uma nota com o programa AFSoft, baseada na área ocupada por padrões de verde. O teor foliar de N correlacionou-se ao índice de clorofila Falker e à nota atribuída com o AFSoft, mas a correlação entre o índice de clorofila e a nota AFSoft foi superior.

Prevalence and predictors of suicide attempt in an incidence cohort of 661 young people with first-episode psychosis

OBJECTIVES: Studies investigating suicidal behaviour in psychosis rarely focus on incidence cohorts of first-episode patients. This is important, because patients who refuse study participation have higher rates of comorbid substance use disorders and longer duration of untreated psychosis as well as worse course illness, variables potentially linked to higher prevalence of suicidal behaviour. The aims of the present study were therefore to examine the prevalence and predictors of suicide and suicide attempt before and during the first 18-24 months of treatment. METHOD: A retrospective file audit of 661 patients was carried out. RESULTS: Six patients (0.9%) died by suicide, 93 (14.3%) attempted suicide prior to entry, and 57 (8.7%) did so during treatment. Predictors of suicide attempt were: previous attempt (odds ratio (OR)=45.54, 95% confidence interval (CI)=9.46-219.15), sexual abuse (OR=8.46, 95%CI=1.88-38.03), comorbid polysubstance (OR=13.63, 95%CI=2.58-71.99), greater insight (OR=0.17, 95%CI=0.06-0.49), lower baseline Global Assessment of Functioning Scale and Scale of Occupational and Functional Assessment score (OR=0.96, 95%CI=0.62-0.91; OR=0.98, 95%CI=0.95-0.99), and longer time in treatment (OR=1.05, 95%CI=1.03-1.08). CONCLUSIONS: The prevalence of suicidal behaviour was high, indicating that suicidal behaviour in incidence populations is higher than in non-epidemiological cohorts of first-episode patients. The rate of repetition of suicide attempt among the sample, however, was lower than expected, suggesting that specialist services can play a role in reducing suicide risk.