Intervention précoce dans les troubles psychotiques: quel rôle pour les praticiens de premier recours [Early intervention in psychotic disorders: which role for primary care practitioners?]

The development of early intervention in psychotic disorders has allowed a more optimistic approach and the development of more adapted and more efficient treatments. Primary care practitioners are often the first professional contact for patients developing psychosis, but diagnostic difficulties and patients' reluctance to engage in treatment are often an obstacle to private practice treatment. It is therefore important to provide more information to primary care practitioners on specific characteristics of these disorders and about locally available treatment structures in order to allow them to suspect this relatively rare diagnosis, facilitate the collaboration with flexible and accessible specialist services, that ideally should provide home treatment, and to improve prognosis.

Cardiopathies congénitales de l'âge adulte: nouvelle population de patients, prise en charge multidisciplinaire [Adults with congenital heart diseases: a growing population, a multidisciplinary approach].

Untill recently, congenital heart disease was considered as a childhood's disease. With improvement in pediatric survival, adults with a congenital heart disease (ACHD) represent an emerging group of patients who need specialized medical care. In 2010, the ESC published newguidelines on global and specific management of adults with congenital heart disease. ACHD centers organize appropriate medical care for these patients, promote specialist training and national scientific research in collaboration with other national ACHD centers.

Shifts in species richness, herbivore specialization, and plant resistance along elevation gradients.

Environmental gradients have been postulated to generate patterns of diversity and diet specialization, in which more stable environments, such as tropical regions, should promote higher diversity and specialization. Using field sampling and phylogenetic analyses of butterfly fauna over an entire alpine region, we show that butterfly specialization (measured as the mean phylogenetic distance between utilized host plants) decreases at higher elevations, alongside a decreasing gradient of plant diversity. Consistent with current hypotheses on the relationship between biodiversity and the strength of species interactions, we experimentally show that a higher level of generalization at high elevations is associated with lower levels of plant resistance: across 16 pairs of plant species, low-elevation plants were more resistant vis-à-vis their congeneric alpine relatives. Thus, the links between diversity, herbivore diet specialization, and plant resistance along an elevation gradient suggest a causal relationship analogous to that hypothesized along latitudinal gradients.

Cardenolides, induced responses, and interactions between above- and belowground herbivores of milkweed (Asclepias spp.).

Theory has long predicted allocation patterns for plant defense against herbivory, but only recently have both above- and belowground plant defenses been considered simultaneously. Milkweeds in the genus Asclepias are a classic chemically defended clade of plants with toxic cardenolides (cardiac glycosides) and pressurized latex employed as anti-herbivore weapons. Here we combine a comparative approach to investigate broadscale patterns in allocation to root vs. shoot defenses across species with a species-specific experimental approach to identify the consequences of defense allocational shifts on a specialist herbivore. Our results show phylogenetic conservatism for inducibility of shoot cardenolides by an aboveground herbivore, with only four closely related tropical species showing significant induction; the eight temperate species examined were not inducible. Allocation to root and shoot cardenolides was positively correlated across species, and this relationship was maintained after accounting for phylogenetic nonindependence. In contrast to long-standing theoretical predictions, we found no evidence for a trade-off between constitutive and induced cardenolides; indeed the two were positively correlated across species in both roots and shoots. Finally, specialist root and shoot herbivores of common milkweed (A. syriaca) had opposing effects on latex production, and these effects had consequences for caterpillar growth consistent with latex providing resistance. Although cardenolides were not affected by our treatments, A. syriaca allocated 40% more cardenolides to shoots over roots. We conclude that constitutive and inducible defenses are not trading off across plant species, and shoots of Asclepias are more inducible than roots. Phylogenetic conservatism cannot explain the observed patterns of cardenolide levels across species, but inducibility per se was conserved in a tropical clade. Finally, given that above- and belowground herbivores can systemically alter the defensive phenotype of plants, we concur with recent calls for a whole-plant perspective in testing models of plant defense allocation.

Análise faunística dos helmintos de pardais (Passer domesticus L., 1758) capturados em Campo Grande, Rio de Janeiro, RJ

Sparrows captured in Campo Grande, Rio de Janeiro, RJ, were examined through necropsy and the helmints found were identified. The prevalence, intensity of infection and the habitat of each helminth species found are showed. An analysis of the helminth fauna using the importance value of the species collected indicated that in the sparrow the dominant species are: Leucochloridium parcum, Tanaisia inopina, Choanotaenia passerina, Dispharynx nasuta and Tetrameres minima; and the co-dominant species are: Echinostoma revolutum, Eumegacetes mediximus and Mediorhynchus papillosus. According to the host specificity were classified as specialist species: L. parcum, T. inopina, C. passerina and T. minima; and as generalist species: E. revolutum, E. medioximus, D. nasuta and M. papillosus. Echinostoma revolutum was found for the first time in P. domesticus. The species E. medioximus , T. minima and D. nasuta were found for the first time in the sparrow in Brazil. The species C. passerina and M. papillosus were found for the first time in Brazil, expanding their distribution to the Neotropical region.

The Perception of the Elements in the Hindu Traditions

The essays in this volume, contributions to an international symposium at the University of Lausanne in June 1998, represent the perception of the elements as a framework for the history of religions (Maya Burger), exemplified by the Hindu traditions. Each element is treated by a specialist in a different academic field in order to bring out a variety of approaches important to the discipline of the history of religion. Ether (akasa) was assigned to philosophy (Wilhelm Halbfass), wind to the history of religion (Bettina Bäumer), fire to classical philology (Peter Schreiner), water to a specialist on Indian medicine (Arion Rosu) and earth to anthropology (Gabriella Eichinger Ferro-Luzzi, specializing on Tamil literature). Les articles du présent volume, issus d'un symposium international ayant eu lieu à l'Université de Lausanne en juin 1998, présentent la perception des éléments comme base de recherche de l'étude des religions (Maya Burger), exemplifiée à l'aide des traditions hindoues. Chaque élément est traité par un spécialiste d'une discipline académique particulière dans le but de souligner la variété des approches nécessaire à la discipline d'histoire des religions. L'éther (akasa) a été considéré sous l'angle de la philosophie (Wilhelm Halbfass), le vent sous celui de l'histoire des religions (Bettina Bäumer), le feu sous celui de la philologie classique (Peter Schreiner), l'eau par un spécialiste de la médecine indienne (Arion Rosu) et la terre sous l'angle de l'anthropologie (Gabriella Eichinger Ferro-Luzzi, se concentrant sur la littérature tamoule).

The impact of past direct-personal traumatic events on 12-month outcome in first episode psychotic mania: trauma and early psychotic mania.

OBJECTIVE: Past traumatic events have been associated with poorer clinical outcomes in people with bipolar disorder. However, the impact of these events in the early stages of the illness remains unclear. The aim of this study was to investigate whether prior traumatic events were related to poorer outcomes 12 months following a first episode of psychotic mania. METHODS: Traumatic events were retrospectively evaluated from patient files in a sample of 65 participants who had experienced first episode psychotic mania. Participants were aged between 15 and 28 years and were treated at a specialised early psychosis service. Clinical outcomes were measured by a variety of symptomatic and functioning scales at the 12-month time-point. RESULTS: Direct-personal traumatic experiences prior to the onset of psychotic mania were reported by 48% of the sample. Participants with past direct-personal trauma had significantly higher symptoms of mania (p=0.02), depression (p=0.03) and psychopathology (p=0.01) 12 months following their first episode compared to participants without past direct-personal trauma, with medium to large effects observed. After adjusting for baseline scores, differences in global functioning (as measured by the Global Assessment of Functioning scale) were non-significant (p=0.05); however, participants with past direct-personal trauma had significantly poorer social and occupational functioning (p=0.04) at the 12-month assessment with medium effect. CONCLUSIONS: Past direct-personal trauma may predict poorer symptomatic and functional outcomes after first episode psychotic mania. Limitations include that the findings represent individuals treated at a specialist early intervention centre for youth and the retrospective assessment of traumatic events may have been underestimated.

21

Induction chemotherapy, as part of an integrated plan of management for locally advanced cancers, is being practised throughout the world in independent, isolated departments in universities, teaching hospitals, and clinical schools. Frequently, however, teams are relatively unaware of the work being undertaken in other institutions, and this situation may slow further progress. This book aims to present the full range of management techniques and practices used in induction chemotherapy within one accessible volume. It provides up-to-date information on the pioneering and cutting edge practices employed in different institutions and documents the advantages of integrated treatment schedules. Patient selection is discussed, and each of the cancer types for which induction therapy has proved important is considered in detail. All who are responsible for the treatment of patients with locally advanced cancers will find this book to be an invaluable source of information. It will be particularly interesting for specialist oncologists aiming to set up and develop fully comprehensive cancer centres and for health administrators wishing to learn about the benefits of establishing such centres in strategic locations.

Cultural competency of health-care providers in a Swiss University Hospital: self-assessed cross-cultural skillfulness in a cross-sectional study.

BACKGROUND: As the diversity of the European population evolves, measuring providers' skillfulness in cross-cultural care and understanding what contextual factors may influence this is increasingly necessary. Given limited information about differences in cultural competency by provider role, we compared cross-cultural skillfulness between physicians and nurses working at a Swiss university hospital. METHODS: A survey on cross-cultural care was mailed in November 2010 to front-line providers in Lausanne, Switzerland. This questionnaire included some questions from the previously validated Cross-Cultural Care Survey. We compared physicians' and nurses' mean composite scores and proportion of "3-good/4-very good" responses, for nine perceived skillfulness items (4-point Likert-scale) using the validated tool. We used linear regression to examine how provider role (physician vs. nurse) was associated with composite skillfulness scores, adjusting for demographics (gender, non-French dominant language), workplace (time at institution, work-unit "sensitized" to cultural-care), reported cultural-competence training, and cross-cultural care problem-awareness. RESULTS: Of 885 questionnaires, 368 (41.2%) returned the survey: 124 (33.6%) physicians and 244 (66.4%) nurses, reflecting institutional distribution of providers. Physicians had better mean composite scores for perceived skillfulness than nurses (2.7 vs. 2.5, p < 0.005), and significantly higher proportion of "good/very good" responses for 4/9 items. After adjusting for explanatory variables, physicians remained more likely to have higher skillfulness (β = 0.13, p = 0.05). Among all, higher skillfulness was associated with perception/awareness of problems in the following areas: inadequate cross-cultural training (β = 0.14, p = 0.01) and lack of practical experience caring for diverse populations (β = 0.11, p = 0.04). In stratified analyses among physicians alone, having French as a dominant language (β = -0.34, p < 0.005) was negatively correlated with skillfulness. CONCLUSIONS: Overall, there is much room for cultural competency improvement among providers. These results support the need for cross-cultural skills training with an inter-professional focus on nurses, education that attunes provider awareness to the local issues in cross-cultural care, and increased diversity efforts in the work force, particularly among physicians.

The Perception of the Elements in the Hindu Traditions

The essays in this volume, contributions to an international symposium at the University of Lausanne in June 1998, represent the perception of the elements as a framework for the history of religions (Maya Burger), exemplified by the Hindu traditions. Each element is treated by a specialist in a different academic field in order to bring out a variety of approaches important to the discipline of the history of religion. Ether (akasa) was assigned to philosophy (Wilhelm Halbfass), wind to the history of religion (Bettina Bäumer), fire to classical philology (Peter Schreiner), water to a specialist on Indian medicine (Arion Rosu) and earth to anthropology (Gabriella Eichinger Ferro-Luzzi, specializing on Tamil literature). Les articles du présent volume, issus d'un symposium international ayant eu lieu à l'Université de Lausanne en juin 1998, présentent la perception des éléments comme base de recherche de l'étude des religions (Maya Burger), exemplifiée à l'aide des traditions hindoues. Chaque élément est traité par un spécialiste d'une discipline académique particulière dans le but de souligner la variété des approches nécessaire à la discipline d'histoire des religions. L'éther (akasa) a été considéré sous l'angle de la philosophie (Wilhelm Halbfass), le vent sous celui de l'histoire des religions (Bettina Bäumer), le feu sous celui de la philologie classique (Peter Schreiner), l'eau par un spécialiste de la médecine indienne (Arion Rosu) et la terre sous l'angle de l'anthropologie (Gabriella Eichinger Ferro-Luzzi, se concentrant sur la littérature tamoule).

Validació i adaptació de l'EuropASI a la població penitenciària catalana (Índex europeu de la severitat de l'addicció)

Aquest treball d'investigació fa una anàlisi de les possibilitats de l’escala EuropASI. Aquest instrument, adaptació europea de l'Addiction Severity Index (ASI), ha demostrat la seva utilitat com a instrument que permet avaluar diferents àrees, assignar als usuaris un tractament i avaluar els canvis produïts per un tractament. També s'han administrat altres proves, com ara la CMR-versió presó i la TECVASP, i s'han recollit diferents variables penitenciàries. En aquesta investigació s'ha fet una revisió dels principals treballs relacionats amb aquest instrument i s'ha utilitzat una mostra de 49 interns dels DAE del Centre Penitenciari Quatre Camins i del Centre Penitenciari Brians 2. Després d'analitzar les dades obtingudes, s'han observat algunes diferències significatives entre els interns del dos DAE que l'EuropASI és capaç de detectar. Les correlacions entre les escales de l'EuropASI indiquen una coherència interna en relació amb les mostres observades. Algunes escales, com ara les d'estat psiquiàtric, relacions familiars i socials i consum d'alcohol i drogues són les que aporten major informació en el global de l'escala. La inclusió de l'escala de l'ASI Criminalitat aporta informació especifica que complementa la resta de les escales. Al treball també s'emfatitzen alguns aspectes relacionats amb l'aplicació i amb la recomanació que les persones que utilitzin aquest instrument tinguin algun tipus de formació, així com algunes propostes relacionades amb l'escala.

Frailty and use of health and community services by community-dwelling older men: the Concord Health and Ageing in Men Project.

BACKGROUND: frailty is a concept used to describe older people at high risk of adverse outcomes, including falls, functional decline, hospital or nursing home admission and death. The associations between frailty and use of specific health and community services have not been investigated. METHODS: the cross-sectional relationship between frailty and use of several health and community services in the last 12 months was investigated in 1,674 community-dwelling men aged 70 or older in the Concord Health and Ageing in Men study, a population-based study conducted in Sydney, Australia. Frailty was assessed using a modified version of the Cardiovascular Health Study criteria. RESULTS: overall, 158 (9.4%) subjects were frail, 679 (40.6%) were intermediate (pre-frail) and 837 (50.0%) were robust. Frailty was associated with use of health and community services in the last 12 months, including consulting a doctor, visiting or being visited by a nurse or a physiotherapist, using help with meals or household duties and spending at least one night in a hospital or nursing home. Frail men without disability in activities of daily living were twice more likely to have seen a doctor in the previous 2 weeks than robust men (adjusted odds ratio 2.04, 95% confidence interval 1.21-3.44), independent of age, comorbidity and socio-economic status. CONCLUSION: frailty is strongly associated with use of health and community services in community-dwelling older men. The high level of use of medical services suggests that doctors and nurses could play a key role in implementation of preventive interventions.

Evaluation of the impact of a therapeutic drug monitoring program in a Swiss University Hospital

Background and objective: Therapeutic Drug Monitoring (TDM) has been introduced early 1970 in our hospital (CHUV). It represents nowadays an important routine activity of the Division of Clinical Pharmacology and Toxicology (PCL), and its impact and utility for clinicians required assessment. This study thus evaluated the impact of TDM recommendations in terms of dosage regimen adaptation. Design: A prospective observational study was conducted over 5 weeks. The primary objective was to evaluate the application of our TDM recommendations and to identify potential factors associated to variations in their implementation. The secondary objective was to identify pre-analytical problems linked to the collection and processing of blood samples. Setting: Four representative clinical units at CHUV. Main outcome measure: Clinical data, drug related data (intake, collection and processing) and all information regarding the implementation of clinical recommendations were collected and analyzed by descriptive statistics. Results: A total of 241 blood measurement requests were collected, among which 105 triggered a recommendation. 37% of the recommendations delivered were applied, 25 % partially applied and 34% not applied. In 4% it was not applicable. The factors determinant for implementation were the clinical unit and the mode of transmission of the recommendation (written vs oral). No clear difference between types of drugs could be detected. Pre-analytical problems were not uncommon, mostly related to completion of request forms and delays in blood sampling (equilibration or steady-state not reached). We have identified 6% of inappropriate and unusable drug level measurements that could cause a substantial cost for the hospital. Conclusion: This survey highlighted a better implementation of TDM recommendations in clinical units where this routine is well integrated and understood by the medical staff. Our results emphasize the importance of communication with the nurse or the physician in charge, either to transmit clinical recommendations or to establish consensual therapeutic targets in specific conditions. Development of strong partnerships between clinical pharmacists or pharmacologists and clinical units would be beneficial to improve the impact of this clinical activity.

Programa de suport per a la millora de les competències musicals

El projecte desenvolupat ha assolit l'objectiu principal d'elaborar materials multimèdia per a la millora de les competències auditives dels estudiants de la Titulació de Mestre de Primària-Especialitat d'Educació Musical (Facultat de Ciències de l'Educació; Universitat Autònoma de Barcelona - UAB). Aquest material està a la lliure disposició de tot l'alumnat d'aquesta titulació, en els webs indicats en l'apartat 2.3. El seu ús està especialment recomanat per a aquells que tenen més dificultats en alguna de les diferents competències que s'han determinat com a essencials per a un mestre de música. Els materials inclouen: la lectura de ritmes (a una i a dues veus) i el reconeixement d'intervals, acords i tonalitats. El programari que s'ha creat permet l'autocorrecció i la repetició dels exercicis. Cada estudiant pot seguir el seu propi ritme d'aprenentatge segons les seves possibilitats de dedicació i d'exigència personal. Es pot escollir el nivell de dificultat i obtenir unes estadístiques per tal que professor i alumne en puguin fer un seguiment. Així mateix, i tal com s'havia previst en els objectius del projecte, s'ha dut a terme una anàlisi del perfil de l'alumnat que ha accedit a la titulació durant els cursos 2004-05, 05-06 i 06-07, fent especial incidència en aquells factors susceptibles de tenir alguna relació amb l'alta taxa d'abandonaments, la més alta de totes les titulacions de mestre de la UAB. S'ha pogut establir que la manca de formació musical està directament relacionada amb aquest fet. També és significativa l'opció amb què s'ha triat la titulació en el procés de preinscripció universitària. També s'ha elaborat un referencial de competències musicals a partir de la consulta de bibliografia i del contrast del criteri de cinc experts externs i del professorat de les assignatures on es fa més evident la manca de coneixements musicals previs.