Principaux résultats de l'étude suisse sur les DRG (étude Casemix). [Main results of the Swiss study on DRGs (Casemix Study)].

Sponsored by the Health Administrations of nine cantons, this study was conducted by the University Institute of Social and Preventive Medicine in Lausanne in order to assess how DRGs could be used within the Swiss context. A data base mainly provided by the Swiss VESKA statistics was used. The first step provided the transformation of Swiss diagnostic and intervention codes into US codes, allowing direct use of the Yale Grouper for DRG. The second step showed that the overall performance of DRG in terms of variability reduction of the length of stay was similar to the one observed in US; there are, however, problems when the homogeneity of medicotechnical procedures for DRG is considered. The third steps showed how DRG could be used as an account unit in hospital, and how costs per DRG could be estimated. Other examples of applications of DRG were examined, for example comparison of Casemix or length of stay between hospitals.

Use of Two-Part Regression Calibration Model to Correct for Measurement Error in Episodically Consumed Foods in a Single-Replicate Study Design: EPIC Case Study.

In epidemiologic studies, measurement error in dietary variables often attenuates association between dietary intake and disease occurrence. To adjust for the attenuation caused by error in dietary intake, regression calibration is commonly used. To apply regression calibration, unbiased reference measurements are required. Short-term reference measurements for foods that are not consumed daily contain excess zeroes that pose challenges in the calibration model. We adapted two-part regression calibration model, initially developed for multiple replicates of reference measurements per individual to a single-replicate setting. We showed how to handle excess zero reference measurements by two-step modeling approach, how to explore heteroscedasticity in the consumed amount with variance-mean graph, how to explore nonlinearity with the generalized additive modeling (GAM) and the empirical logit approaches, and how to select covariates in the calibration model. The performance of two-part calibration model was compared with the one-part counterpart. We used vegetable intake and mortality data from European Prospective Investigation on Cancer and Nutrition (EPIC) study. In the EPIC, reference measurements were taken with 24-hour recalls. For each of the three vegetable subgroups assessed separately, correcting for error with an appropriately specified two-part calibration model resulted in about three fold increase in the strength of association with all-cause mortality, as measured by the log hazard ratio. Further found is that the standard way of including covariates in the calibration model can lead to over fitting the two-part calibration model. Moreover, the extent of adjusting for error is influenced by the number and forms of covariates in the calibration model. For episodically consumed foods, we advise researchers to pay special attention to response distribution, nonlinearity, and covariate inclusion in specifying the calibration model.

Public health impact of statin prescribing strategies based on jupiter

Texte intégral: http://www.springerlink.com/content/3q68180337551r47/fulltext.pdf

Gesundheitszustand der Walliser Bevölkerung 2010

Im Auftrag der Dienststelle für Gesundheitswesen hat das Walliser Gesundheitsobservatorium (WGO) den vierten Bericht über den Gesundheitszustand der Walliser Bevölkerung veröffentlicht. Der Bericht zeigt einen guten Gesundheitszustand der Walliserinnen und Walliser. Herz- Kreislauf- Krankheiten. Krebserkrankungen und Lungenerkrankungen bleiben weiterhin für rund zwei Drittel der Todesfälle verantwortlich. Um das Ausmass dieser Krankheiten zu reduzieren wird eine aktive und gezielte Gesundheitsförderungs- und Präventionspolitik verfolgt. Der Staatsrat hat ein entsprechendes Rahmenprogramm angenommen. Der Bericht über den Gesundheitszustand der Walliser Bevölkerung wurde vom Walliser Gesundheitsobservatorium in Zusammenarbeit mit dem Institut für Sozial- und Präventivmedizin der Universität Lausanne (IUMSP) erarbeitet. Der Bericht dient der Regierung als Referenzdokument, um die Stossrichtung ihrer Präventions- und Gesundheitsförderungspolitik 2011-2014 vorzugeben.

Normal weight obesity: relationship with lipids, glycaemic status, liver enzymes and inflammation

BACKGROUND AND AIMS: Normal weight obesity (NWO) is defined as an excessive body fat associated with a normal body mass index (BMI) and has been associated with early inflammation, but its relationship with cardiovascular risk factors await investigation. METHODS AND RESULTS: Cross-sectional study including 3213 women and 2912 men aged 35-75 years to assess the clinical characteristics of NWO in Lausanne, Switzerland. Body fat was assessed by bioimpedance. NWO was defined as a BMI<25 kg/m(2) and a % body fat ≥66(th) gender-specific percentiles. The prevalence of NWO was 5.4% in women and less than 3% in men, so the analysis was restricted to women. NWO women had a higher % of body fat than overweight women. After adjusting for age, smoking, educational level, physical activity and alcohol consumption, NWO women had higher blood pressure and lipid levels and a higher prevalence of dyslipidaemia (odds-ratio=1.90 [1.34-2.68]) and fasting hyperglycaemia (odds-ratio=1.63 [1.10-2.42]) than lean women, whereas no differences were found between NWO and overweight women. Conversely, no differences were found between NWO and lean women regarding levels of CRP, adiponectin and liver markers (alanine aminotransferase, aspartate aminotransferase and gamma glutamyl transferase). Using other definitions of NWO led to similar conclusions, albeit some differences were no longer significant. CONCLUSION: NWO is almost nonexistent in men. Women with NWO present with higher cardiovascular risk factors than lean women, while no differences were found for liver or inflammatory markers. Specific screening of NWO might be necessary in order to implement cardiovascular prevention.

Declining stroke and myocardial infarction mortality between 1989 and 2010 in a country of the African region.

BACKGROUND AND PURPOSE: In low- and middle-income countries, the total burden of cardiovascular diseases is expected to increase due to demographic and epidemiological transitions. However, data on cause-specific mortality are lacking in sub-Saharan Africa. Seychelles is one of the few countries in the region where all deaths are registered and medically certified. In this study, we examine trends in mortality for stroke and myocardial infarction (MI) between 1989 and 2010. METHODS: Based on vital statistics, we ascertained stroke and MI as the cause of death if appearing in any of the 4 fields for immediate, intermediate, underlying, and contributory causes in death certificates. RESULTS: Mortality rates (per 100 000, age-standardized to World Health Organization standard population) decreased from 1669/710 (men/women) in 1989 to 1991 to 1113/535 in 2008-10 for all causes, from 250/140 to 141/86 for stroke, and from 117/51 to 59/24 for MI, corresponding to proportionate decreases of 33%/25% for all-cause mortality, 44%/39% for stroke, and 50%/53% for MI over 22 years. The absolute number of stroke and MI deaths did not increase over time. In 2008 to 2010, the median age of death was 65/78 years (men/women) for all causes, 68/78 for stroke, and 66/73 for MI. CONCLUSIONS: Between 1989 and 2010, age-standardized stroke and MI mortality decreased markedly and more rapidly than all-cause mortality. The absolute number of cardiovascular disease deaths did not increase over time because the impact of population aging was fully compensated by the decline in cardiovascular disease mortality. Stroke mortality remained high, emphasizing the need to strengthen cardiovascular disease prevention and control.

Sistema de apoyo al programa de diversificación curricular en un IES

En este proyecto se incluyen las etapas de análisis previo, análisis de requerimientos y diseño técnico de un sistema de apoyo a la diversificación en un IES, siguiendo los métodos y técnicas descritos en el ciclo de vida en cascada o ciclo de vida clásico del software. Puesto que se llegará hasta la especificación del diseño de la aplicación, esta documentación servirá de base al programador del software para implementar la aplicación, según las indicaciones y necesidades especificadas.

La permacultura en la gestión del agua: el caso de Can Valldaura

El presente trabajo se centra en el análisis del ciclo del Agua en la finca de Can Valldaura, en el municipio de Cerdanyola, dentro del Parc de Collserola. El IAAC (Instituto de Arquitectura Avanzada de Cataluña), organismo gestor, pretende estudiar e investigar sobre el término de la autosuficiencia, volviendo a dinamizar entre otros aspectos las funciones agrícolas y ganaderas de la finca. El objetivo principal de este estudio es hacer propuestas en la gestión del agua bajo los principios de la Permacultura en la finca de Can Valldaura, queriendo analizar si es posible alcanzar la autosuficiencia a nivel hídrico realizando el proyecto silvoagroforestal planeado por el IAAC. Una vez calculadas las necesidades hídricas del proyecto de Can Valldaura, y analizadas las entradas y salidas hídricas del sistema, los resultados muestran que las infraestructuras actuales son insuficientes para llevar a cabo el proyecto silvoagroforestal si la autosuficiencia es un objetivo prioritario. En este sentido se proponen distintas medidas de gestión: la restauración del antiguo sistema de drenaje, la construcción de una nueva balsa, y el aprovechamiento de las aguas recogidas por los caminos. Además se proponen sistemas de cultivo que mejorarían la estructura del suelo aumentando la infiltración del agua de la lluvia y su retención. Los datos analizados indican que con las medias de gestión y sistemas de cultivo propuestos el proyecto silvoagroforestal podría llevarse a cabo de forma autosufiente.

Projecte d’una granja d’engreix porcí de 1.200 caps al terme municipal de Bellcaire d’Empordà (Baix Empordà)

El projecte té com a objectiu la construcció d’una nau per a ús ramader, concretament per a l’engreix de porcs, així com de les instal•lacions necessàries per a fer-la viable. Aquesta granja d’engreix serà un complement per a l’activitat actual de la finca. L’edificació disposarà, a més de la zona d’estabulació, d'un vestidor amb lavabos i un petit magatzem. Serà necessari disposar de sitges per al pinso, dipòsits d'aigua i bassa de purins. Pel que fa a l'apartat productiu, l'objectiu de l’explotació és l’obtenció d’una producció de 1.000 porcs d’engreix per cicle productiu. Cada any hi haurà 2,5 engreixades, el que representa 2.500 porcs teòrics/any

Impact of genomic methylation on radiation sensitivity of colorectal carcinoma.

PURPOSE: To investigate the influence of demethylation with 5-aza-cytidine (AZA) on radiation sensitivity and to define the intrinsic radiation sensitivity of methylation deficient colorectal carcinoma cells. METHODS AND MATERIALS: Radiation sensitizing effects of AZA were investigated in four colorectal carcinoma cell lines (HCT116, SW480, L174 T, Co115), defining influence of AZA on proliferation, clonogenic survival, and cell cycling with or without ionizing radiation. The methylation status for cancer or DNA damage response-related genes silenced by promoter methylation was determined. The effect of deletion of the potential target genes (DNMT1, DNMT3b, and double mutants) on radiation sensitivity was analyzed. RESULTS: AZA showed radiation sensitizing properties at >or=1 micromol/l, a concentration that does not interfere with the cell cycle by itself, in all four tested cell lines with a sensitivity-enhancing ratio (SER) of 1.6 to 2.1 (confidence interval [CI] 0.9-3.3). AZA successfully demethylated promoters of p16 and hMLH1, genes associated with ionizing radiation response. Prolonged exposure to low-dose AZA resulted in sustained radiosensitivity if associated with persistent genomic hypomethylation after recovery from AZA. Compared with maternal HCT116 cells, DNMT3b-defcient deficient cells were more sensitive to radiation with a SER of 2.0 (CI 0.9-2.1; p = 0.03), and DNMT3b/DNMT1-/- double-deficient cells showed a SER of 1.6 (CI 0.5-2.7; p = 0.09). CONCLUSIONS: AZA-induced genomic hypomethylation results in enhanced radiation sensitivity in colorectal carcinoma. The mediators leading to sensitization remain unknown. Defining the specific factors associated with radiation sensitization after genomic demethylation may open the way to better targeting for the purpose of radiation sensitization.

Diabetes in Africa: the situation in the Seychelles

Comment on: Levitt NS. Diabetes in Africa: epidemiology, management and healthcare challenges. Heart 2008; 94: 1376-1382. doi: 10.1136/hrt.2008.147306. PMID: 18519551.

Disseny i implementació d'una base de dades relacional per a un concessionari de vehicles

TFC de l'àrea de Base de dades del segon cicle d'Enginyeria Informàtica basat en el disseny i la implementació d'una base de dades relacional per a un concessionari de vehicles.