Female adolescents' views on a youth-friendly clinic

Rapport de synthèse : La satisfaction des patients concernant leur prise en charge fait maintenant partie intégrante de la qualité des soins. Elle a été évaluée à maintes reprises chez des patients adultes ou pédiatriques, mais rarement chez des patients adolescents. Les attentes des adolescents par rapport aux services de soins ont par contre été souvent étudiées et certains facteurs semblent particulièrement importants. Parmi ceux-ci, citons la confidentialité, le respect, l'honnêteté, l'écoute, l'accès aux soins ou le fait d'avoir des informations compréhensibles. L'Organisation Mondiale de la Santé a développé le concept de 'Youth-friendly health services' pour répondre aux besoins et attentes particuliers des adolescents. Il est basé sur sept principes : l'accessibilité, l'équité, l'efficience, l'efficacité, le fait d'être approprié et compréhensible. Notre objectif était d'évaluer la satisfaction des adolescentes consultant dans une clinique multidisciplinaire pour adolescents basée sur le modèle 'Youth-friendly health services' et de déterminer les facteurs qui y sont associés. Nous avons fait une enquête transversale dans une clinique pour adolescents à Lausanne entre mars et mai 2008 moyennant un questionnaire anonyme auto-administré. Tous les patients qui avaient consulté au moins une fois auparavant étaient éligibles. Nous avons ensuite éliminé les garçons, en très petit nombre et donc de faible valeur statistique. Trois cents onze patientes âgées de 12 à 22 ans ont été inclues dans l'étude. Nous avons effectué des analyses bivariées pour comparer les patientes satisfaites et non satisfaites puis avons construit un modèle log- linéaire afin de déterminer les facteurs directement ou indirectement liés à la satisfaction des patientes. Nonante-quatre pourcent des patientes étaient satisfaites. Les facteurs significativement associés à la satisfaction des adolescentes étaient les suivants : Les jeunes filles se sentaient plus écoutées en ce qui concerne leurs plaintes, et avaient plus l'impression que le soignant les comprenait. Elles avaient aussi moins changé de soignant durant le suivi, avaient plus l'impression d'avoir bénéficié du traitement adéquat et pensaient avoir plus suivi les conseils du soignant. Le modèle log-linéaire que nous avons effectué a mis en avant quatre facteurs directement liés à la satisfaction des patientes, qui sont la continuité des soins, le résultat de la prise en charge, l'adhérence au traitement et le sentiment d'être comprise par le soignant. Ces résultats mettent en avant l'importance de la relation interpersonnelle entre le soignant et le patient, mais rendent aussi attentif à des aspects qui pourraient être améliorés, en ce qui concerne par exemple la continuité des soins. En effet, une clinique comme la nôtre fait partie d'un hôpital de formation et le tournus fréquent des soignants est inévitable. Les changements de médecins et autres soignants devraient alors être préparés et expliqués aux patients avec la plus grande attention. L'adhérence au traitement semble être fortement liée à la satisfaction des patients, mais la nature de notre étude ne permet pas de conclure à une relation de cause à effet. Nous pouvons tout de même supposer qu'elle est une conséquence de la satisfaction des patients. Enfin, la confidentialité et l'accès aux soins souvent cités comme essentiels à la satisfaction des patients dans la littérature étaient secondaires dans notre étude. En conclusion, la satisfaction des adolescentes était principalement basée sur une relation de confiance de longue durée avec leurs soignants. Les pédiatres occupent une place privilégiée pour répondre à ces besoins parce qu'ils connaissent leurs patients depuis l'enfance. Ils devraient cependant garder à l'esprit que la relation avec le patient change au moment de l'adolescence et que les jeunes sont très sensibles à la relation de confiance interpersonnelle qu'ils ont avec leur médecin.

Embodied pollution in Spanish household consumption: a disaggregate analysis

[spa] En este artículo aplicamos un modelo input-output ampliado medioambientalmente para analizar un aspecto específico de la hipótesis de la curva de Kuznets ambiental. El propósito del estudio es analizar si las estructuras de consumo de los hogares con una mejor ‘posición económica’ pueden tener un efecto positivo para reducir las presiones medioambientales. Para ello combinamos información de diferentes bases de datos para analizar el impacto de la contaminación atmosférica del consumo de diferentes hogares españoles en el año 2000. Consideramos nueve gases, i.e. los seis gases de efecto invernadero (CO2, CH4, N2O, SF6, HFCs, y PFCs) y otros tres gases (SO2, NOx, y NH3). Clasificamos los hogares en quintiles de gasto per capita y quintiles de gasto equivalente. Los resultados obtenidos muestran que hay una relación positiva y elevada entre el nivel de gasto y las emisiones directas e indirectas generadas por el consumo de los hogares; sin embargo, las intensidades de emisión tienden a disminuir con el nivel de gasto para los diferentes gases, con la excepción de SF6, HFCs, y PFCs.

Mechanism of reduction of virus release and cell-cell fusion in persistent canine distemper virus infection.

Canine distemper virus (CDV), a mobillivirus related to measles virus causes a chronic progressive demyelinating disease, associated with persistence of the virus in the central nervous system (CNS). CNS persistence of morbilliviruses has been associated with cell-to-cell spread, thereby limiting immune detection. The mechanism of cell-to-cell spread remains uncertain. In the present study we studied viral spread comparing a cytolytic (non-persistent) and a persistent CDV strain in cell cultures. Cytolytic CDV spread in a compact concentric manner with extensive cell fusion and destruction of the monolayer. Persistent CDV exhibited a heterogeneous cell-to-cell pattern of spread without cell fusion and 100-fold reduction of infectious viral titers in supernatants as compared to the cytolytic strain. Ultrastructurally, low infectious titers correlated with limited budding of persistent CDV as compared to the cytolytic strain, which shed large numbers of viral particles. The pattern of heterogeneous cell-to-cell viral spread can be explained by low production of infectious viral particles in only few areas of the cell membrane. In this way persistent CDV only spreads to a small proportion of the cells surrounding an infected one. Our studies suggest that both cell-to-cell spread and limited production of infectious virus are related to reduced expression of fusogenic complexes in the cell membrane. Such complexes consist of a synergistic configuration of the attachment (H) and fusion (F) proteins on the cell surface. F und H proteins exhibited a marked degree of colocalization in cytolytic CDV infection but not in persistent CDV as seen by confocal laser microscopy. In addition, analysis of CDV F protein expression using vaccinia constructs of both strains revealed an additional large fraction of uncleaved fusion protein in the persistent strain. This suggests that the paucity of active fusion complexes is due to restricted intracellular processing of the viral fusion protein.

MDCT arthrography of the hip: value of the adaptive statistical iterative reconstruction technique and potential for radiation dose reduction.

OBJECTIVE: The purpose of this article is to assess the effect of the adaptive statistical iterative reconstruction (ASIR) technique on image quality in hip MDCT arthrography and to evaluate its potential for reducing radiation dose. SUBJECTS AND METHODS: Thirty-seven patients examined with hip MDCT arthrography were prospectively randomized into three different protocols: one with a regular dose (volume CT dose index [CTDIvol], 38.4 mGy) and two with a reduced dose (CTDIvol, 24.6 or 15.4 mGy). Images were reconstructed using filtered back projection (FBP) and four increasing percentages of ASIR (30%, 50%, 70%, and 90%). Image noise and contrast-to-noise ratio (CNR) were measured. Two musculoskeletal radiologists independently evaluated several anatomic structures and image quality parameters using a 4-point scale. They also jointly assessed acetabular labrum tears and articular cartilage lesions. RESULTS: With decreasing radiation dose level, image noise statistically significantly increased (p=0.0009) and CNR statistically significantly decreased (p=0.001). We also found a statistically significant reduction in noise (p=0.0001) and increase in CNR (p≤0.003) with increasing percentage of ASIR; in addition, we noted statistically significant increases in image quality scores for the labrum and cartilage, subchondral bone, overall diagnostic quality (up to 50% ASIR), and subjective noise (p≤0.04), and statistically significant reductions for the trabecular bone and muscles (p≤0.03). Regardless of the radiation dose level, there were no statistically significant differences in the detection and characterization of labral tears (n=24; p=1) and cartilage lesions (n=40; p≥0.89) depending on the ASIR percentage. CONCLUSION: The use of up to 50% ASIR in hip MDCT arthrography helps to reduce radiation dose by approximately 35-60%, while maintaining diagnostic image quality comparable to that of a regular-dose protocol using FBP.

Interleukin-17 is a critical mediator of vaccine-induced reduction of Helicobacter infection in the mouse model.

BACKGROUND & AIMS: Despite the proven ability of immunization to reduce Helicobacter infection in mouse models, the precise mechanism of protection has remained elusive. This study explores the possibility that interleukin (IL)-17 plays a role in the reduction of Helicobacter infection following vaccination of wild-type animals or in spontaneous reduction of bacterial infection in IL-10-deficient mice. METHODS: In mice, reducing Helicobacter infection, the levels and source of IL-17 were determined and the role of IL-17 in reduction of Helicobacter infection was probed by neutralizing antibodies. RESULTS: Gastric IL-17 levels were strongly increased in mice mucosally immunized with urease plus cholera toxin and challenged with Helicobacter felis as compared with controls (654 +/- 455 and 34 +/- 84 relative units for IL-17 messenger RNA expression [P < .01] and 6.9 +/- 8.4 and 0.02 +/- 0.04 pg for IL-17 protein concentration [P < .01], respectively). Flow cytometry analysis showed that a peak of CD4(+)IL-17(+) T cells infiltrating the gastric mucosa occurred in immunized mice in contrast to control mice (4.7% +/- 0.3% and 1.4% +/- 0.3% [P < .01], respectively). Gastric mucosa-infiltrating CD4(+)IL-17(+) T cells were also observed in IL-10-deficient mice that spontaneously reduced H felis infection (4.3% +/- 2.3% and 2% +/- 0.6% [P < .01], for infected and noninfected IL-10-deficient mice, respectively). In wild-type immunized mice, intraperitoneal injection of anti-IL-17 antibodies significantly inhibited inflammation and the reduction of Helicobacter infection in comparison with control antibodies (1 of 12 mice vs 9 of 12 mice reduced Helicobacter infection [P < .01], respectively). CONCLUSIONS: IL-17 plays a critical role in the immunization-induced reduction of Helicobacter infection from the gastric mucosa.

Influence of scatter reduction method and monochromatic beams on image quality and dose in mammography.

In mammography, the image contrast and dose delivered to the patient are determined by the x-ray spectrum and the scatter to primary ratio S/P. Thus the quality of the mammographic procedure is highly dependent on the choice of anode and filter material and on the method used to reduce the amount of scattered radiation reaching the detector. Synchrotron radiation is a useful tool to study the effect of beam energy on the optimization of the mammographic process because it delivers a high flux of monochromatic photons. Moreover, because the beam is naturally flat collimated in one direction, a slot can be used instead of a grid for scatter reduction. We have measured the ratio S/P and the transmission factors for grids and slots for monoenergetic synchrotron radiation. In this way the effect of beam energy and scatter rejection method were separated, and their respective importance for image quality and dose analyzed. Our results show that conventional mammographic spectra are not far from optimum and that the use of a slot instead of a grid has an important effect on the optimization of the mammographic process. We propose a simple numerical model to quantify this effect.

Reduction of Concrete Deterioration by Ettringite Using Crystal Growth Inhibition Techniques, TR-431, 2001

Many researchers have concluded that secondary or delayed ettringite is responsible for serious premature deterioration of concrete highways. In some poorly performing Iowa concretes, ettringite is the most common secondary mineral but its role in premature deterioration is uncertain since some researchers still maintain that secondary ettringite does not itself cause deterioration. The current research project was designed to determine experimentally if it is possible to reduce secondary ettringite formation in concrete by treating the concrete with commercial crystallization inhibitor chemicals. The hypothesis is such that if the amount of ettringite is reduced, there will also be a concomitant reduction of concrete expansion and cracking. If both ettringite formation and deterioration are simultaneously reduced, then the case for ettringite induced expansion/cracking is strengthened. The experiment used four commercial inhibitors - two phosphonates, a polyacrylic acid, and a phosphate ester. Concrete blocks were subjected to continuous immersion, wet/dry and freeze/thaw cycling in sodium sulfate solutions and in sulfate solutions containing an inhibitor. The two phosphonate inhibitors, Dequest 2060 and Dequest 2010, manufactured by Monsanto Co., were effective in reducing ettringite nucleation and growth in concrete. Two other inhibitors, Good-rite K752 and Wayhib S were somewhat effective, but less so than the two phosphonates. Rapid experiments with solution growth inhibition of ettringite without the presence of concrete phases were used to explore the mechanisms of inhibition of this mineral. Reduction of new ettringite formation in concrete blocks also reduced expansion and cracking of the blocks. This relationship clearly links concrete expansion with this mineral - a conclusion that some research workers have disputed despite theoretical arguments for such a relationship and despite numerous observations of ettringite mineralization in prematurely deteriorated concrete highways. Secondary ettringite nucleation and growth must cause concrete expansion because the only known effect of the inhibitor chemicals is to reduce crystal nucleation and growth, and the inhibitors cannot in any other way be responsible for the reduction in expansion. The mechanism of operation of the inhibitors on ettringite reduction is not entirely clear but the solution growth experiments show that they prevent crystallization of a soluble ettringite precursor gel. The present study shows that ettringite growth alone is not responsible for expansion cracking because the experiments showed that most expansion occurs under wet/dry cycling, less under freeze/thaw cycling, and least under continuous soaking conditions. It was concluded from the different amounts of damage that water absorption by newly-formed, minute ettringite crystals is responsible for part of the observed expansion under wet/dry conditions, and that reduction of freeze resistance by ettringite filling of air-entrainment voids is also important in freeze/thaw environments.

Anterior subluxation after reduction of a posterior traumatic sterno-clavicular dislocation: a case report and a review of the literature.

Sternoclavicular dislocations represent a rare injury. Based on our clinical experience with a patient showing an anterior subluxation after reduction of a posterior traumatic dislocation, we review the literature. The emergent reduction of the dislocation is mandatory, always keeping in mind the potentially devastating neurovascular complications. If the treatment of a residual anterior instability remains controversial, a residual posterior instability should be treated by a surgical procedure. The optimal treatment depends mainly on each surgeon's choice and practice.

Bentonite Treatment for Economical Dust Reduction on Limestone Surfaced Secondary Roads, HR-351, 1995

This research project was directed at laboratory and field evaluation of sodium montmorillonite clay (Bentonite) as a dust palliative for limestone surfaced secondary roads. It was postulated that the electrically charged surfaces (negative) of the clay particles could interact with the charged surfaces (positive) of the limestone and act as a bonding agent to agglomerate fine (-#200) particulates, and also to bond the fine particulates to larger (+#200) limestone particles. One mile test roads were constructed in Tama, Appanoose, and Hancock counties in Iowa using Bentonite treatment levels (by weight of aggregate) ranging from 3.0 to 12.0%. Construction was accomplished by adding dry Bentonite to the surfacing material and then dry road mixing. The soda ash/water solution (dispersing agent) was spray applied and the treated surfacing material wet mixed by motor graders to a consistency of 2 to 3 inch slump concrete. Two motor graders working in tandem provided rapid mixing. Following wet mixing the material was surface spread and compacted by local traffic. Quantitative and qualitative periodic evaluations and testing of the test roads was conducted with respect to dust generation, crust development, roughness, and braking characteristics. As the Bentonite treatment level increased dust generation decreased. From a cost/benefit standpoint, an optimum level of treatment is about 8% (by weight of aggregate). For roads with light traffic, one application at this treatment level resulted in a 60-70% average dust reduction in the first season, 40-50% in the second season, and 20-30% in the third season. Crust development was rated at two times better than untreated control sections. No discernible trend was evident with respect to roughness. There was no evident difference in any of the test sections with respect to braking distance and braking handling characteristics, under wet surface conditions compared to the control sections. Chloride treatments are more effective in dust reduction in the short term (3-4 months). Bentonite treatment is capable of dust reduction over the long term (2-3 seasons). Normal maintenance blading operations can be used on Bentonite treated areas. Soda ash dispersed Bentonite treatment is estimated to be more than twice as cost effective per percent dust reduction than conventional chloride treatments, with respect to time. However, the disadvantage is that there is not the initial dramatic reduction in dust generation as with the chloride treatment. Although dust is reduced significantly after treatment there is still dust being generated. Video evidence indicates that the dust cloud in the Bentonite treated sections does not rise as high, or spread as wide as the cloud in the untreated section. It also settles faster than the cloud in the untreated section. This is considered important for driving safety of following traffic, and for nuisance dust invasion of residences and residential areas. The Bentonite appears to be functioning as a bonding agent.

ProScan Automated Profilogram Reduction System, MLR-94-7, 1994

Kansas State University, with funding from the Kansas Department of Transportation (KDOT), has developed a computerized reduction system for profilograms produced by mechanical profilographs. The commercial version of the system (ProScan (trademark)) is marketed by Devore Systems, Inc. The system consists of an IBM Compatible PC 486SX33 computer or better, Epson LQ-570 printer, a Logitech Scanman 32 hand scanner system, a paper transport unit, and the ProScan software. The Scanner is not adaptable to IBM computers with the micro channel architecture. The Iowa DOT Transportation Centers could realize the following advantages by using ProScan: (1) Save about 5 to 8 staff hours of reduction and reporting time per Transportation Center per week for a Materials Technician 3 or 4 (the time savings would come during the busiest part of the season); (2) Reduce errors in reduction, transfer, and typing of profile values; (3) Increase the accuracy of the monitor results; and (4) Allow rapid evaluation of contractor traces when tolerance limits between monitor and certified results are exceeded.