Estimating national-level syringe availability to injecting drug users and injection coverage: Switzerland, 1996-2006.

BACKGROUND: Measuring syringe availability and coverage is essential in the assessment of HIV/AIDS risk reduction policies. Estimates of syringe availability and coverage were produced for the years 1996 and 2006, based on all relevant available national-level aggregated data from published sources. METHODS: We defined availability as the total monthly number of syringes provided by harm reduction system divided by the estimated number of injecting drug users (IDU), and defined coverage as the proportion of injections performed with a new syringe, at national level (total supply over total demand). Estimates of supply of syringes were derived from the national monitoring system, including needle and syringe programmes (NSP), pharmacies, and medically prescribed heroin programmes. Estimates of syringe demand were based on the number of injections performed by IDU derived from surveys of low threshold facilities for drug users (LTF) with NSP combined with the number of IDU. This number was estimated by two methods combining estimates of heroin users (multiple estimation method) and (a) the number of IDU in methadone treatment (MT) (non-injectors) or (b) the proportion of injectors amongst LTF attendees. Central estimates and ranges were obtained for availability and coverage. RESULTS: The estimated number of IDU decreased markedly according to both methods. The MT-based method (from 14,818 to 4809) showed a much greater decrease and smaller size of the IDU population compared to the LTF-based method (from 24,510 to 12,320). Availability and coverage estimates are higher with the MT-based method. For 1996, central estimates of syringe availability were 30.5 and 18.4 per IDU per month; for 2006, they were 76.5 and 29.9. There were 4 central estimates of coverage. For 1996 they ranged from 24.3% to 43.3%, and for 2006, from 50.5% to 134.3%. CONCLUSION: Although 2006 estimates overlap 1996 estimates, the results suggest a shift to improved syringe availability and coverage over time.

Training effects with the observer-rated cognitive errors and the coping action patterns scales

The use of observer-rated scales requires that raters be trained until they have become reliable in using the scales. However, few studies properly report how training in using a given rating scale is conducted or indeed how it should be conducted. This study examined progress in interrater reliability over 6 months of training with two observer-rated scales, the Cognitive Errors Rating Scale and the Coping Action Patterns Rating Scale. The evolution of the intraclass correlation coefficients was modeled using hierarchical linear modeling. Results showed an overall training effect as well as effects of the basic training phase and of the rater calibration phase, the latter being smaller than the former. The results are discussed in terms of implications for rater training in psychotherapy research.

Metacognitive training for adolescents with psychosis: A multiple case study

Cognitive biases may be one of the explaining factor underlying psychotic symptoms like delusions and hallucinations. Metacognitive training (MCT) was demonstrated, in adults with schizophrenia, to reduce these cognitive biases. However, to the best of our knowledge, there has been no research on adolescents with psychosis. The current study aimed at assessing the feasibility, treatment adherence and its benefi cial effects on psychotic symptoms, depression, social functioning and self-esteem of a MCT. Participants were fi ve psychotic adolescents with psychosis, aged 16-18, who attended the Day Care Unit for Adolescents (DCUA). The MCT, delivered in group, corresponds to 2x8 modules, lasting between 45 and 60 minutes once a week. To measure MCT's effi ciency, the Positive And Negative Syndrome Scale (PANSS), the Social and Occupational Functioning Assessment Scale (SOFAS), the Health of Nation Outcome Scale for Children and Adolescent (HoNOSCA), the depression scale of Calgary and the self-esteem scale of Rosenberg have been used. The results of the 5 patients indicate that MCT is feasible and the treatment adherence is moderate. The schedule of the MCT needs to be adapted to the availability of the participants. At a descriptive level, the MCT allows to reduce psychotic and depressive symptoms (PANSS & Calgary) as well as to improve the social functioning (SOFAS & HoNOSCA) and self-esteem (Rosenberg). To sum up, MCT seem to be an interesting alternative and/or a good additional treatment to reduce cognitive bias, psychotic symptoms as well as improving social functioning

Effectiveness of interventions targeting frequent users of emergency departments: a systematic review.

STUDY OBJECTIVE: Frequent users of emergency departments (EDs) are a relatively small group of vulnerable patients accounting for a disproportionally high number of ED visits. Our objective is to perform a systematic review of the type and effectiveness of interventions to reduce the number of ED visits by frequent users. METHODS: We searched MEDLINE, EMBASE, CINAHL, PsychINFO, the Cochrane Library, and ISI Web of Science for randomized controlled trials, nonrandomized controlled trials, interrupted time series, and controlled and noncontrolled before-and-after studies describing interventions targeting adult frequent users of EDs. Primary outcome of interest was the reduction in ED use. We also explored costs analyses and various clinical (alcohol and drug use, psychiatric symptoms, mortality) and social (homelessness, insurance status, social security support) outcomes. RESULTS: We included 11 studies (3 randomized controlled trials, 2 controlled and 6 noncontrolled before-and-after studies). Heterogeneity in both study designs and definitions of frequent users precluded meta-analyses of the results. The most studied intervention was case management (n=7). Only 1 of 3 randomized controlled trials showed a significant reduction in ED use compared with usual care. Six of the 8 before-and-after studies reported a significant reduction in ED use, and 1 study showed a significant increase. ED cost reductions were demonstrated in 3 studies. Social outcomes such as reduction of homelessness were favorable in 3 of 3 studies, and clinical outcomes trended toward positive results in 2 of 3 studies. CONCLUSION: Interventions targeting frequent users may reduce ED use. Case management, the most frequently described intervention, reduced ED costs and seemed to improve social and clinical outcomes. It appears to be beneficial to patients and justifiable for hospitals to implement case management for frequent users in the framework of a clear and consensual definition of frequent users and standardized outcome measures.

Regional fat mobilization and training type on sedentary, premenopausal overweight and obese women.

OBJECTIVE: Little is known about the influence of different training types on relative fat mobilization with exercise. The purpose of this study was to analyze the changes induced by aerobic training (AT), resistance (RT) or a combination of both (AT+RT) on total fat mass (TFM) and regional fat mass (RFM). Further, the relative contribution of different regions, upper limbs (UL), lower limbs (LL), and trunk (Tr), were compared. DESIGN AND METHODS: Forty-five overweight and premenopausal women were randomized in either AT, RT or AT+RT. All training groups exercised for the same duration (60 min), 3 times per week for 5 months. Body composition was estimated using dual energy X-ray absorptiometry. RESULTS: TFM decreased significantly in all groups (-4.6 ± 1.9 kg; -3.8 ± 2.6 kg, and -4.7 ± 3.0 kg in AT, RT, and AT+RT groups respectively; P < 0.001). The relative contribution of FM into each segment changed significantly: TrFM represented 46.6% ± 5.8% of TFM at baseline and reduced to 43.1% ± 5.5% (P < 0.001); LLFM was 39.7% ± 5.8% vs. 41.6% ± 5.7% (P < 0.01); ULFM was 11.3% ± 1.3% vs. 12.2% ± 1.4% (P < 0.01). CONCLUSION: Training type did not influence changes of TFM and RFM. Fat mobilization came predominantly from Tr in all training protocols. These findings suggest that overweight and obese women can reduce TFM and RFM, independently of training type.

Workforce - Iowa's Employee Training Programs, 2002

Manual for employee training.

Iowa New Jobs Training Program Annual Report, 2003

Annual Report

Traduir i interpretar les llengües de la immigració a Catalunya: cap a la formació i acreditació d’un perfil professional emergent

El projecte que sol•licitem és el resultat natural d’una recerca iniciada l’any 2008 pel grup de recerca MIRAS (Mediació i Interpretació: Recerca en l’Àmbit Social) de la Universitat Autònoma de Barcelona. La recerca del grup MIRAS ha tingut com a objectiu general, durant els darrers dos anys, la definició del perfil professional del traductor/intèrpret als serveis públics. Aquesta figura emergent i encara poc reconeguda al nostre país va començar a sorgir a partir del boom migratori de les darreres dècades a Catalunya com a resposta als problemes de comunicació freqüents entre la població nouvinguda i els serveis públics locals. Per a assolir l’objectiu esmentat, la primera fase de la recerca del grup MIRAS s’ha centrat en el disseny, distribució, buidatge, anàlisi i creuament de dades de 250 qüestionaris semioberts dirigits als tres principals agents implicats en la interacció comunicativa que estudiem: els traductors/intèrprets, els usuaris i els proveïdors dels serveis. Els resultats d’aquest estudi han demostrat, entre d’altres qüestions rellevants, la manca d’una formació específica per als traductors/intèrprets als serveis públics, així com una absència de regulació de la professió que aquests exerceixen. Un cop realitzat aquest primer estudi pilot, i en vista dels resultats obtinguts, ens sembla doncs evident que el següent pas de la nostra recerca ha d’anar orientat cap a la formació i regulació professional dels traductors/intèrprets als serveis públics. En concret, en el projecte que sol•licitem ens proposem dissenyar una formació especialitzada per a traductors/intèrprets als serveis públics que compleixi amb els següents tres prerequisits: a) estar oberta a tot tipus de persones, independentment del seu nivell d’estudis; b) oferir un ampli ventall de llengües, principalment les llengües de la immigració a Catalunya (per a una primera selecció d’aquestes llengües, vegeu informe demogràfic de la SIM de l’1 de gener de 2010 i resultats de l’estudi pilot de MIRAS), i c) conduir a una acreditació nacional que reguli l’exercici de la professió de traductor/intèrpret als serveis públics de Catalunya. La implementació d’un sistema d’acreditació, segon objectiu del projecte que presentem, és essencial ja que no només permetrà la regulació d’una professió fins avui poc o mal definida, sinó que també garantirà la qualitat dels serveis oferts per aquests professionals en el futur.

Whole-Body Vibration Training Elevates Creatine-Kinase Levels in Sedentary Subjects

METHODS: 20 inactive (10 male, 10 female) underwent a single typical WBV session, with a total of 27 minutes of exercise on an oscillating platform at 26 Hz, involving upper and lower body muscles. Each exercise lasted 90 seconds, with 40 seconds pauses inbetween. Muscle enzymes (CK, transaminase, LDH, troponin I) were measured before, at 24, 48 and 96 hours post exercise. Lactate was measured immediately after the session. Muscle aches were assessed during 4 days post-exercise.RESULTS: Subjects' mean age was 23.0 ± 3.5 (male), 22.4 ± 1.4 (female), BMI 22.8 ± 2.3 and 22.1 ± 1.9, and all had been inactive for at least 12 months. Post exercise lactatemia was 10.0 ± 2.4 and 6.9 ± 2.4. CK elevation was significant (at least doubling of baseline values) in 1 male and 4 female subjects, while they remained at baseline values for the remaining 15 subjects. One female subject peaked at 3520 U/l at 96 hours post exercise, and all but one peaked at the same late time. Troponin and CK-MB never increased. No correlation was found between muscle soreness and CK levels.CONCLUSIONS: WBV can elicit important anaerobic processes reflected by the high lactacidemia, and CK elevation was significant in 25 % of subjects, peaking at the fourth day after exercise for 80 % of those. Such exercises should not be regarded as trivial and "easy" as they are advertised, since they can provoke important anaerobia and CK elevation. Many fragile patients or patients treated for cardiovascular disease could benefit from WBV but it is important to recognise these potential effects, especially in those treated with statins, known to cause a myopathy and CK elevation. Before considering a side effect of an important therapeutic agent, doctors should be aware of the possible interaction with not-so-harmless exercising machines.

Relève en médecine interne générale: enjeux et perspectives [Perspectives and challenges to guarantee training and renewal in general internal medicine]

Training new doctors in general internal medicine represents a challenge. This requires to define future needs, which result from interest that are not necessarily convergent between patients, doctors, insurers and politicians. Problems related to medical demography in Switzerland, with the ageing of the population, the increase in health care costs and the place of Switzerland within the European Community require the implementation of specific objectives to train new physicians in general internal medicine. The success of these opportunities depends on social factors, political choices and choices from physician's association. In this article we will approach these challenges by formulating some proposals--nonexhaustive--in order to guarantee sufficient renewal in general internal medicine.