Prevalence and management of cardiovascular risk factors in Portuguese residents and Portuguese who migrated to Switzerland

Background: there is little information regarding the health status of migrants compared to subjects who remained in their country of origin. The aim was to compare Portuguese living in Porto (Portugal) with Portuguese migrants living in Lausanne (Switzerland). Design: cross-sectional studies conducted in Porto (EpiPorto, n=1150) and Lausanne (CoLaus, n=388) among Portuguese subjects aged between 35 and 65 years. Methods: body mass index, blood pressure, cholesterol and glucose levels were assessed using standardized procedures. Educational level, antihypertensive, hypocholesterolemic and antidiabetic treatments were collected using questionnaires. Results: Portuguese living in Lausanne were younger, more frequently male and had a lower education than Portuguese living in Porto. After multivariate adjustment, Portuguese living in Porto had a higher likelihood of being obese [Odds ratio and 95% confidence interval: 1.40 (1.01-1.94)] or abdominal obese [OR: 1.40 (1.02-1.93)] than Portuguese living in Lausanne. Portuguese living in Porto had a higher likelihood of being hypertensive than Portuguese living in Lausanne [OR: 1.38 (1.01-1.90)], while no differences were found regarding hypertension management and control. Portuguese living in Porto had a higher likelihood of being hypercholesterolemic [OR: 1.40 (1.06-1.85)] and were less likely to be treated [OR: 0.47 (0.27-0.83)] and controlled [OR: 0.47 (0.27-0.83)] than Portuguese living in Lausanne. Finally, no differences were found regarding smoking, prevalence and management of diabetes. Conclusion: Portuguese living in Lausanne, Switzerland, present a better cardiovascular risk profile and tend to be better managed regarding their cardiovascular risk factors than Portuguese living in Porto, Portugal.

Duodénopancréatectomie céphalique: indications, résultats et prise en charge des complications [Pancreaticoduodenectomy: indications, results and management of complications]

Pancreaticoduodenectomy is a major procedure in visceral surgery. Post-operative mortality is around 5% in high-volume hospitals, thanks to improvement in global patients care. Morbidity remains high though. The treatment of complications most often require a multidisciplinary approach. Delayed gastric emptying, intraabdominal abscesses and pancreatic fistulas are the most frequent complications. Post-pancreatectomy hemorrhage, although more rare, is a severe and dreadful event. Despite its morbidity, duodenopancreatectomy significantly improves survival of patients with biliopancreatic cancer. Early recognition of these complications and a prompt treatment increase the safety of this procedure.

Water tanks as ecosystems. Local ecosystemic perception for integral management of water tanks in Tamil Nadu, South India

Water tanks offer from many centuries ago solutions in South India for several problems related with water scarcity. They are a traditional water harvesting system wide spread in this territory, allowing a potential decentralized and participatory management of the local population on their own resources. Although water tanks¿ main function is irrigation, they have many other uses, functions and natural resources associated, involving stakeholders in the villages apart from those farmers making use of the irrigation. Water tanks provide a variety of landscapes and biodiversity that creates a valuable heterogeneous territory. The complexity of such an ecosystem should be managed with an integral perspective, considering all the elements involved and their relations, and understanding that water tanks are not just water deposits. This multidisciplinary study tries to demonstrate the idea of water tanks as ecosystems, describing and analyzing deeply and in an unprecedentedly way the functions, uses, natural resources and stakeholders. The research also focuses in the assessment of the ecosystemic perception of the local population of some villages in Tamil Nadu, employing diverse anthropological methodology.

Audit report of the Iowa Department of Cultural Affairs for the year ended June 30, 2011

Audit report of the Iowa Department of Cultural Affairs for the year ended June 30, 2011

[Hematological malignancy: management of anemia and leukopenia by primary care physicians]

In hematological malignancies, the occurrence of anemia is very common and can have significant consequences on daily life. Treatment includes essentially red blood cell transfusions. The prescription of erythropoietic agents and/or iron is exceptionnal and often not registered in Switzerland. The onset of neutropenia is also frequently encountered and in some situations may require the prescription of myeloid growth factors. The purpose of this article is to focus on the current recommendations of these two issues for practitioners.

Artificial-Intelligence-Based Optimization of the Management of Snow Removal Assets and Resources Final Report, October 2002

Geographic information systems (GIS) and artificial intelligence (AI) techniques were used to develop an intelligent snow removal asset management system (SRAMS). The system has been evaluated through a case study examining snow removal from the roads in Black Hawk County, Iowa, for which the Iowa Department of Transportation (Iowa DOT) is responsible. The SRAMS is comprised of an expert system that contains the logical rules and expertise of the Iowa DOT’s snow removal experts in Black Hawk County, and a geographic information system to access and manage road data. The system is implemented on a mid-range PC by integrating MapObjects 2.1 (a GIS package), Visual Rule Studio 2.2 (an AI shell), and Visual Basic 6.0 (a programming tool). The system could efficiently be used to generate prioritized snowplowing routes in visual format, to optimize the allocation of assets for plowing, and to track materials (e.g., salt and sand). A test of the system reveals an improvement in snowplowing time by 1.9 percent for moderate snowfall and 9.7 percent for snowstorm conditions over the current manual system.

Recommandations suisses pour le traitement de l'herpès génital et de l'herpès du nouveau-né [Swiss recommendations for the management of gential herpers and herpes simplex virus infection of the neonate]

Genital herpes is being recognised as a medical problem of increasing importance. Diagnosis and management are complex. The present recommendations have been established by a multidisciplinary panel of specialists and endorsed by all Swiss medical societies involved in the medical care of such patients. The aim is to improve the care of affected patients, to reduce horizontal and vertical transmission and to diminish the psychosocial burden.

EULAR recommendations for the management of large-vessel vasculitis.

Objectives: To develop European League Against Rheumatism (EULAR) recommendations for the management of large vessel vasculitis. Methods: An expert group (10 rheumatologists, 3 nephrologists, 2 immunolgists, 2 internists representing 8 European countries and the USA, a clinical epidemiologist and a representative from a drug regulatory agency) identified 10 topics for a systematic literature search through a modified Delphi technique. In accordance with standardised EULAR operating procedures, recommendations were derived for the management of large vessel vasculitis. In the absence of evidence, recommendations were formulated on the basis of a consensus opinion. Results: Seven recommendations were made relating to the assessment, investigation and treatment of patients with large vessel vasculitis. The strength of recommendations was restricted by the low level of evidence and EULAR standardised operating procedures. Conclusions: On the basis of evidence and expert consensus, management recommendations for large vessel vasculitis have been formulated and are commended for use in everyday clinical practice.

EULAR recommendations for the management of primary small and medium vessel vasculitis.

Objectives: To develop European League Against Rheumatism (EULAR) recommendations for the management of small and medium vessel vasculitis. Methods: An expert group (consisting of 10 rheumatologists, 3 nephrologists, 2 immunologists, 2 internists representing 8 European countries and the USA, a clinical epidemiologist and a representative from a drug regulatory agency) identified 10 topics for a systematic literature search using a modified Delphi technique. In accordance with standardised EULAR operating procedures, recommendations were derived for the management of small and medium vessel vasculitis. In the absence of evidence, recommendations were formulated on the basis of a consensus opinion. Results: In all, 15 recommendations were made for the management of small and medium vessel vasculitis. The strength of recommendations was restricted by low quality of evidence and by EULAR standardised operating procedures. Conclusions: On the basis of evidence and expert consensus, recommendations have been made for the evaluation, investigation, treatment and monitoring of patients with small and medium vessel vasculitis for use in everyday clinical practice.

Pro-adrenomedullin usefulness in the management of children with community-acquired pneumonia, a preliminary prospective observational study

BackgroundIn adult population with community acquired pneumonia high levels of pro-adrenomedullin (pro-ADM) have been shown to be predictors of worse prognosis. The role of this biomarker in pediatric patients had not been analyzed to date. The objective of this study is to know the levels of pro-ADM in children with community acquired pneumonia (CAP) and analyze the relation between these levels and the patients¿ prognosis.FindingsProspective observational study including patients attended in the emergency service (January to October 2009) admitted to hospital with CAP and no complications at admission. The values for pro-ADM were analyzed in relation to: need for oxygen therapy, duration of oxygen therapy, fever and antibiotic therapy, complications, admission to the intensive care unit, and length of hospital stay. Fifty patients were included. Ten presented complications (7 pleural effusion). The median level of pro-ADM was 1.0065¿nmol/L (range 0.3715 to 7.2840¿nmol/L). The patients presenting complications had higher levels of pro-ADM (2.3190 vs. 1.1758¿nmol/L, p¿=¿0.013). Specifically, the presence of pleural effusion was associated with higher levels of pro-ADM (2.9440 vs. 1.1373¿nmol/L, p¿<¿0.001).ConclusionsIn our sample of patients admitted to hospital with CAP, pro-ADM levels are related to the development of complications during hospitalization.

Prise en charge des patients avec des problèmes d'alcool: quelle efficacité? Quelques éléments de réponse à partir d'une revue de la littérature [Management of patients with alcohol problems: how effective? Several response factors based on a review of the literature]

What do we know about the effectiveness of various treatments of alcoholism? This review of literature shows that lack--or weaknesses--of published studies make it impossible to draw definite conclusions. Rigorous controlled studies show high rates of spontaneous remission and important uncertainties about specialised treatments of alcoholism. However, except for severe dependence that may well require a different approach, brief interventions conducted by non-specialists have proved highly effective for at-risk alcohol drinkers: based on minimal medical advice, they increase the chances of lowering alcohol consumption. General practitioners may thus represent on important link in the therapeutic chain.