Etes-vous serein face à votre placement? Une étude pilote

Introduction: Des unités d'attente de placement ont vu le jour pour¦répondre à la pénurie de lits d'hébergement de long séjour dans le¦Canton de Vaud et désengorger les hôpitaux aigus. Pour les patients¦qui y sont admis, la décision de placement intervient au sortir d'une¦hospitalisation aiguë, laissant peu de temps à la personne pour¦cheminer face à cette décision. Cette étude pilote vise à investiguer¦le degré de sérénité de ces patients face à l'hébergement de longue¦durée et déterminer s'il existe une relation avec la durée d'attente ou¦le décès en unité d'attente.¦Population et méthode: Personnes âgées (N = 78) admises dans¦une structure d'attente et préparation à l'hébergement de longue¦durée après un séjour hospitalier aigu. Des données démographiques,¦fonctionnelles, cognitives et affectives ont été récoltées dans les 4¦semaines après l'admission. La sérénité ressentie face à l'hébergement¦longue durée a été évaluée à l'aide d'une échelle de type Likert à¦quatre niveaux (pas du tout/plutôt pas/plutôt/tout à fait serein).¦Résultats: Les patients étaient âgés de 85.6 ans en moyenne, 74%¦(58/78) étaient des femmes, 47% (37/78) avaient des troubles cognitifs¦et 35% (27/78) des troubles dépressifs. Globalement 24% (19/78)¦des patients se déclaraient peu ou pas du tout sereins face au¦placement. Comparés aux patients sereins, ces 19 patients étaient¦significativement (p <.05) moins âgés (83.2 ± 1.0 vs 86.8 ± 6.5 ans),¦plus dépendants dans les activités de la vie quotidienne (BAVQ 2.5 ±¦1.7 vs 3.5 ± 1.6), plus déprimés (GDS 15-items 7.0 ± 3.5 vs 4.4 ± 3.0),¦et avaient plus souvent des antécédents de chutes (95% vs 75%). En¦analyse multivariée, le manque de sérénité restait significativement¦associé à une dépendance plus élevée dans les BAVQ, à un score¦GDS plus élevé ainsi qu'aux antécédents de chute. Il n'y avait pas de¦différence significative en termes de durée moyenne de séjour avant le¦placement (90.0 ± 57.3j vs 87.8 ± 73.2, médianes 85 vs 57, P = .45), ni¦de mortalité dans l'unité d'attente (5% vs 5%) entre les deux groupes¦de patients.¦Conclusion: Près d'un quart des patients en unité d'attente se¦déclarent peu sereins face à la perspective du placement. Ces patients¦sont plus dépendants, ont des antécédents de chutes et sont plus¦déprimés, ce qui souligne l'importance d'une identification précoce de¦ces patients afin de leur offrir un soutien dans cette période difficile de¦transition dans leur parcours de vie.

La réhabilitation psychosociale a l'aube du XXIème siècle. I: Principes, population cible et pathologie en cause

The relatively recent development of the psychosocial rehabilitation has its origins mainly in the progress of modern psychopharmacology, the assertion of the rights of the patients and the result of the studies showing that the evolution of persons suffering from severe and persistent mental illnesses can prove to be positive in many cases. In spite of the heterogeneity of the experiences and of the theoretical references, the core principles of the psychosocial rehabilitation imposed themselves. These principles can be classified according to three levels, that of relational ethics, that of the method of intervention and that of the institutional device. A recent study showed that 2.4@1000 of the general adult population of the Canton of Vaud live in sociotherapeutic and rehabilitation accommodations. In this sample, there is a important percentage of relatively young persons (55.3% are under 40). In institutional accommodation there is a majority of patients suffering from major personality disorders and addiction (40.6%), followed by psychotic disorders (37.2%), persistent mood disorders (12.3%), neurotic disorders (6.6%) and psycho-organic disorders (3.3%). In home based rehabilitation, the ratio of patients with psychotic disorders is more important (53.1%). This difference would indicate that people with schizophrenia would have a better social outcome than personality disorders with addiction

Inflammatory markers and incident heart failure risk in older adults: the Health ABC (Health, Aging, and Body Composition) study.

OBJECTIVES: The purpose of this study was to evaluate the association between inflammation and heart failure (HF) risk in older adults. BACKGROUND: Inflammation is associated with HF risk factors and also directly affects myocardial function. METHODS: The association of baseline serum concentrations of interleukin (IL)-6, tumor necrosis factor-alpha, and C-reactive protein (CRP) with incident HF was assessed with Cox models among 2,610 older persons without prevalent HF enrolled in the Health ABC (Health, Aging, and Body Composition) study (age 73.6 +/- 2.9 years; 48.3% men; 59.6% white). RESULTS: During follow-up (median 9.4 years), HF developed in 311 (11.9%) participants. In models controlling for clinical characteristics, ankle-arm index, and incident coronary heart disease, doubling of IL-6, tumor necrosis factor-alpha, and CRP concentrations was associated with 29% (95% confidence interval: 13% to 47%; p < 0.001), 46% (95% confidence interval: 17% to 84%; p = 0.001), and 9% (95% confidence interval: -1% to 24%; p = 0.087) increase in HF risk, respectively. In models including all 3 markers, IL-6, and tumor necrosis factor-alpha, but not CRP, remained significant. These associations were similar across sex and race and persisted in models accounting for death as a competing event. Post-HF ejection fraction was available in 239 (76.8%) cases; inflammatory markers had stronger association with HF with preserved ejection fraction. Repeat IL-6 and CRP determinations at 1-year follow-up did not provide incremental information. Addition of IL-6 to the clinical Health ABC HF model improved model discrimination (C index from 0.717 to 0.734; p = 0.001) and fit (decreased Bayes information criterion by 17.8; p < 0.001). CONCLUSIONS: Inflammatory markers are associated with HF risk among older adults and may improve HF risk stratification.

Incidents and complications of totally implanted vascular access devices in children: a prospective study.

BACKGROUND: Totally implanted vascular access devices are frequently used in children for repeated blood samples or intravenous treatments. This prospective study aims at identifying the risk factors associated with infections, obstructions and surgical complications of these devices in pediatric patients. METHODS: From January 2006 to January 2008, all children older than one year of age with a diagnosis of solid or blood cell malignancy were included in the study. Insertion was performed by the surgeon according to a standardized protocol after landmark-guided puncture of the subclavian or internal jugular vein by a senior anesthesiologist. Dressing and post-operative care were standardized. Every manipulation was prospectively recorded by specialized dedicated nurses, and all patients were screened for complications one month post-surgery. RESULTS: 45 consecutive patients 1 to 16 years old were enrolled in the study. Mean age at the time of procedure was 8.5 years (range 1.3-15.6; SD +/- 4.88). There were 12 peroperative adverse events in 45 procedures (27%), detailed as follows: 3 pneumothoraces (7%), 3 hematomas (7%), 6 arterial punctures (13%). Among these events, intervention was necessary for two pneumothorax and one arterial puncture. There was no air embolism. At one month, we recorded 5 post-operative complications (11%): 2 thrombotic obstructions, one unsightly scar, and one scapular pain of unknown etiology. One patient needed repositioning of the catheter. There was no catheter-related infection. CONCLUSION: Prospective recording of TIVA insertion in children reveals a significant number of early incidents and complications, mainly associated with the percutaneous puncture technique. We found no infection in this series. Results of a longer follow-up in the same population are pending.

Abnormal Lung Function and Risk for Heart Failure in the Elderly: The Health, Aging, and Body Composition Study

Background: Chronic obstructive pulmonary disease (COPD) has been associated with increased risk for heart failure (HF). The impact of subclinical abnormal spirometric findings on HF risk among older adults without history of COPD is not well elucidated. Methods: We evaluated 2125 participants (age 73.6±2.9 years; 50.5% men; 62.3% white; 45.6/9.4% past/current smokers; body mass index [BMI] 27.2±4.6 kg/m2) without prevalent COPD or HF who underwent baseline spirometry in the Health ABC Study. Abnormal lung function was defined either as forced vital capacity (FVC) below lower limit of normal (LLN) or forced expiratory volume in 1st sec (FEV1) to FVC ratio below LLN. Results: On follow-up (median, 9.4 years), 68 of 350 (19.4%) participants with abnormal lung function developed HF, as compared to 172 of 1775 (9.7%) participants with normal lung function (hazard ratio [HR], 2.31; 95% confidence interval [CI], 1.74 -3.06; P<.001). This increased risk persisted after adjusting for all other independent predictors of HF in the Health ABC Study, BMI, incident coronary events, and several inflammatory markers (HR, 1.82; 95% CI, 1.30 -2.54; P<.001), and remained constant over time. Baseline FVC and FEV1 had a linear association with HF risk (Figure). In adjusted models, HF risk increased by 21% (95% CI, 10 -36%) per 10% decrease in FVC and 18% (95% CI, 10 -28%) per 10% decrease in FEV1 (both P<.001); this association persisted among participants with normal lung function at baseline. Findings were consistent across sex, race, and smoking status. Conclusions: Subclinical abnormal spirometric findings are prevalent among older adults and are independently associated with risk for incident HF.

Edad, crecimiento y algunos aspectos reproductivos y alimentarios de la caballa (Scomber japonicus peruanus)

El presente trabajo comprende el estudio de algunos aspectos de la biología de la caballa (Scomber japonicus peruanus)referidos a la reproducción, alimentación y crecimiento con material procedente de los laboratorios regionales del Instituto del Mar del Perú (IMARPE) en Chimbote y Callao para los años 1976-1978. Se determinó que el desove de la caballa desembarcada en ambos puertos ocurre con mayor intensidad a fines de primavera y durante el verano; sin embargo, se encontraron individuos maduros o en desove durante todo el año. Las longitudes medias de madurez sexual oscilaron en los años 1977-78 entre 33.4 y 34.2 cm en el material de Chimbote, y entre 32.3 y 33.6 en el del Callao. La dieta alimentaria de esta especie está compuesta principalmente por zooplancton, peces y fitoplancton. En el año 1976 se observa en el Contenido estomacal una mayor incidencia de peces ( en su mayoría anchoveta Engraulis ringens) que en los años 1977 y 1978, ligada a una mayor disponibilidad de esta especie. El "coeficiente alimentario" calculado presenta variaciones mensuales relacionado posiblemente con el desove y la disponibilidad de alimento. La determinación de la edad se llevó a cabo en base a lectura de otolitos de individuos procedentes de la zona de Callao en el año 1978. Se constató la formación de un anillo hialino en invierno y otro en verano ligados posiblemente a la disponibilidad de alimento y al desove respectivamente.

In vivo characterization of sunitinib eluting beads

Purpose: To study the pharmacokinetics and potential toxicity of sunitinib eluting beads in an animal modelMaterials: Healthy New-Zealand white rabbits were used. 8 animals received 0.2ml of DC Beads loaded with 6mg of sunitinb intra arterially in the hepatic artery (group 1) and 4 animals received 6mg of sunitinib administered orally (group 2). In group 1, animals were sacrificed 6 hours (n=4) and 24 hours (n=4) after embolization. In group 2, animals were sacrificed 6 hours (n=2) and 24 hours (n=2) after oral administration of sunitinib. Liver enzymes were measured at 0, 6 and 24 hours in both groups. Plasmatic sunitinib concentration was measured by LC MS/MS tandem mass spectroscopy at 0, 1, 2, 3, 4, 5, 6 and 24 hours. At sacrifice, the livers were harvested and sunitinib concentration in liver tissue was assessed by LC MS/MS tandem mass spectroscopy.Results: After embolization we observed an expected elevation of AST and ALT. Serial plasmatic measurments after embolization showed a very low sunitinib concentration (<50ng/ml). Measurment of sunitinib in the embolized liver tissue showed a very high concentration at 6 hours (3870ng/ml) and 24 hours (4741.7ng/ml).Conclusions: Sunitinib eluting beads are well tolerated by rabbits when administered intra-arterially in the hepatic artery. No unexpected toxicity was observed. Very high drug concentration canbe obtained at the site of embolization with minimal systemic passage.

Who is at low risk for cardiovascular disease? An assessment of different definitions

Purpose: To assess the prevalence and trends of low cardiovascular risk factor (RF) profile in the Swiss population according to different definitions. Methods: Population-based cross-sectional study of 6170 subjects (3241 women) aged 35-75 years living in Lausanne, Switzerland. Trends were assessed using data from the Swiss MONICA population surveys conducted in 1984-6 (N=3300), 1988-9 (N=3331) and 1992-3 (N=3133) and restricted to the same age group. Seven different definitions of low RF profile were used. Results: Prevalence of low RF profile varied between 6.5% (95% confidence interval: 5.9-7.1) and 9.7% (9.0-10.5) depending on the definition used. The prevalence was inversely related to the number of criteria used and higher than in other countries. Irrespective of the definition used, the prevalence of low RF profile was higher in women and in physically active participants, and decreased with increasing age or in the presence of a family history of cardiovascular disease (table). The prevalence of low RF profile increased from 3.8% (3.1-4.5) in 1984-6 to 6.7% (6.1-7.3) in 2003-6; using another definition, the results were 5.9% (5.1-6.8) and 9.7% (9.0-10.5), respectively. Conclusion: The prevalence of low RF profile varies according to the criteria used; this prevalence is relatively high and increasing in the Swiss population, which might partly explain the low and decreasing trend in cardiovascular mortality rates.

Food's visually perceived fat content affects discrimination speed in an orthogonal spatial task.

Choosing what to eat is a complex activity for humans. Determining a food's pleasantness requires us to combine information about what is available at a given time with knowledge of the food's palatability, texture, fat content, and other nutritional information. It has been suggested that humans may have an implicit knowledge of a food's fat content based on its appearance; Toepel et al. (Neuroimage 44:967-974, 2009) reported visual-evoked potential modulations after participants viewed images of high-energy, high-fat food (HF), as compared to viewing low-fat food (LF). In the present study, we investigated whether there are any immediate behavioural consequences of these modulations for human performance. HF, LF, or non-food (NF) images were used to exogenously direct participants' attention to either the left or the right. Next, participants made speeded elevation discrimination responses (up vs. down) to visual targets presented either above or below the midline (and at one of three stimulus onset asynchronies: 150, 300, or 450 ms). Participants responded significantly more rapidly following the presentation of a HF image than following the presentation of either LF or NF images, despite the fact that the identity of the images was entirely task-irrelevant. Similar results were found when comparing response speeds following images of high-carbohydrate (HC) food items to low-carbohydrate (LC) food items. These results support the view that people rapidly process (i.e. within a few hundred milliseconds) the fat/carbohydrate/energy value or, perhaps more generally, the pleasantness of food. Potentially as a result of HF/HC food items being more pleasant and thus having a higher incentive value, it seems as though seeing these foods results in a response readiness, or an overall alerting effect, in the human brain.

Interaction between Musca domestica L. and its predator Muscina stabulans (Fallén) (Diptera, Muscidae): effects of prey density and food source abundance

Interaction between Musca domestica L. and its predator Muscina stabulans (Fallén) (Diptera, Muscidae): Effects of prey density and food source abundance. The objective of this work was to evaluate the influence of prey density and food source abundance on the predatory behavior of Muscina stabulans over M. domestica. Three predator/prey proportions were evaluated (1:1, 1:3 and 1:6), using 100 third instar predator larvae against second instar prey larvae. Each proportion was maintained using three different levels of food substrate (25, 50 and 100 g). The experiments were carried out in triplicate in BOD incubators (25ºC, UR 70% ± 10% and 12 h photoperiod). The mortality of the M. domestica larvae was 100% under all conditions, except in the 1:6 predator/prey proportion, at the 50g and 100g food substrate levels, where it was 99.99% and 99.22%, respectively. There was a significant increase in the development period of M. stabulans in relation to the increase in prey density and decrease in quantity of food substrate. An increase in the proportion of individuals and a reduction in the amount of resource slowed down larval development. Muscina stabulans pupal weight was proportional to the increase in prey density and the amount of food substrate. The proportion or the density influenced the survival of M. stabulans, with no difference in relation to the amount of food source and consequently in the interaction of the factors. There was no difference between the 1:1 and 1:3 predator-prey densities, with both differing from the 1:6 density.

Weight status and gender-related differences in motor skills and in child care - based physical activity in young children.

Over the last decades, a decline in motor skills and in physical activity and an increase in obesity has been observed in children. However, there is a lack of data in young children. We tested if differences in motor skills and in physical activity according to weight or gender were already present in 2- to 4-year-old children. Fifty-eight child care centers in the French part of Switzerland were randomly selected for the Youp'là bouge study. Motor skills were assessed by an obstacle course including 5 motor skills, derived from the Zurich Neuromotor Assessment test. Physical activity was measured with accelerometers (GT1M, Actigraph, Florida, USA) using age-adapted cut-offs. Weight status was assessed using the International Obesity Task Force criteria (healthy weight vs overweight) for body mass index (BMI). Of the 529 children (49% girls, 3.4 ± 0.6 years, BMI 16.2 ± 1.2 kg/m2), 13% were overweight. There were no significant weight status-related differences in the single skills of the obstacle course, but there was a trend (p = 0.059) for a lower performance of overweight children in the overall motor skills score. No significant weight status-related differences in child care-based physical activity were observed. No gender-related differences were found in the overall motor skills score, but boys performed better than girls in 2 of the 5 motor skills (p ≤ 0.04). Total physical activity as well as time spent in moderate-vigorous and in vigorous activity during child care were 12-25% higher and sedentary activity 5% lower in boys compared to girls (all p < 0.01). At this early age, there were no significant weight status- or gender-related differences in global motor skills. However, in accordance to data in older children, child care-based physical activity was higher in boys compared to girls. These results are important to consider when establishing physical activity recommendations or targeting health promotion interventions in young children.