Patients' understanding of blood tests and attitudes to HIV screening in the emergency department of a Swiss teaching hospital: a cross-sectional observational study.

BACKGROUND: In Switzerland, patients may undergo "blood tests" without being informed what these are screening for. Inadequate doctor-patient communication may result in patient misunderstanding. We examined what patients in the emergency department (ED) believed they had been screened for and explored their attitudes to routine (non-targeted) human immunodeficiency virus (HIV) screening. METHODS: Between 1st October 2012 and 28th February 2013, a questionnaire-based survey was conducted among patients aged 16-70 years old presenting to the ED of Lausanne University Hospital. Patients were asked: (1) if they believed they had been screened for HIV; (2) if they agreed in principle to routine HIV screening and (3) if they agreed to be HIV tested during their current ED visit. RESULTS: Of 466 eligible patients, 411 (88%) agreed to participate. Mean age was 46 ± 16 years; 192 patients (47%) were women; 366 (89%) were Swiss or European; 113 (27%) believed they had been screened for HIV, the proportion increasing with age (p ≤0.01), 297 (72%) agreed in principle with routine HIV testing in the ED, and 138 patients (34%) agreed to be HIV tested during their current ED visit. CONCLUSION: In this ED population, 27% believed incorrectly they had been screened for HIV. Over 70% agreed in principle with routine HIV testing and 34% agreed to be tested during their current visit. These results demonstrate willingness among patients concerning routine HIV testing in the ED and highlight a need for improved doctor-patient communication about what a blood test specifically screens for.

Trends and characteristics of attendance at the emergency department of a Swiss university hospital: 2002-2012.

BACKGROUND: The numbers of people attending emergency departments (EDs) at hospitals are increasing. We aimed to analyse trends in ED attendance at a Swiss university hospital between 2002 and 2012, focussing on age-related differences and hospital admission criteria. METHODS: We used hospital administrative data for all patients aged ≥16 years who attended the ED (n = 298,306) at this university hospital between 1 January 2002, and 31 December 2012. We descriptively analysed the numbers of ED visits according to the admission year and stratified by age (≥65 vs <65 years). RESULTS: People attending the ED were on average 46.6 years old (standard deviation 20 years, maximum range 16‒99 years). The annual number of ED attendances grew by n = 6,639 (27.6%) from 24,080 in 2002 to 30,719 in 2012. In the subgroup of patients aged ≥65 the relative increase was 42.3%, which is significantly higher (Pearson's χ2 = 350.046, df = 10; p = 0.000) than the relative increase of 23.4% among patients <65 years. The subgroup of patients ≥65 years attended the ED more often because of diseases (n = 56,307; 85%) than accidents (n = 9,844; 14.9%). This subgroup (patients ≥65 years) was also more often admitted to hospital (Pearson's χ2 = 23,377.190; df = 1; p = 0.000) than patients <65 years. CONCLUSIONS: ED attendance of patients ≥65 years increased in absolute and relative terms. The study findings suggest that staff of this ED may want to assess the needs of patients ≥65 years and, if necessary, adjust the services (e.g., adapted triage scales, adapted geriatric screenings, and adapted hospital admission criteria).

Variation in treatment strategies of Swiss general practitioners for subclinical hypothyroidism in older adults.

QUESTIONS UNDER STUDY: As the best management of subclinical hypothyroidism is controversial, we aimed to assess variations in treatment strategies depending on different Swiss regions, physician and patient characteristics. METHODS: We performed a case-based survey among general practitioners (GPs) in different Swiss regions, which consisted of eight hypothetical cases presenting a female patient with subclinical hypothyroidism and nonspecific complaints differing by age, vitality status and thyroid-stimulating hormone (TSH) concentration. RESULTS: A total of 262 GPs participated in the survey. There was considerable variation in the levothyroxine starting dose chosen by GPs, ranging from 25 µg to 100 µg. Across the Swiss regions, GPs in the Bern region were significantly more inclined to treat, with a higher probability of initiating treatment (60%, p = 0.01) and higher mean starting doses (45 µg, p <0.01) compared with the French-speaking region (44%, 36 µg); the Zurich region had intermediate values (52%, 39 µg). We found no association between treatment rate and other physician characteristics. GPs were more reluctant to initiate treatment in 85-year-old than in 70-year-old women (odds ratio [OR] 0.77, 95% confidence interval [CI] 0.63-0.94), and more likely to treat women with a TSH of 15 mU/l than those with a TSH of 6mU/l (OR 8.71, 95% CI 6.21-12.20). CONCLUSIONS: There are strong variations in treatment strategies for elderly patients with subclinical hypothyroidism across different Swiss regions, including use of higher starting doses than the recommended 25 µg in the Swiss guidelines, which recommend a starting dose of 25 µg. These variations likely reflect the current uncertainty about the benefits of treatment, which arise from the current lack of evidence from adequately powered clinical trials.

Verrucous Carcinoma of the Vulva: A Case Report and Review of the Literature.

Verrucous carcinoma of the vulva is a rare lesion (1). Affecting essentially postmenopausal women, this lesion is a distinct and particular entity in vulval carcinoma classification and its scalability is uncertain and unpredictable. Here, we present a case concerning a 48-year-old patient, without follow-up after a condyloma acuminate of the vulva (large left lip). The origin of this case will be discussed in this article. The treatment decided was only surgical. A review of literature shows the rarity of this lesion of the female genital tract.

Sociodemographic, behavioral and genetic determinants of allostatic load in a Swiss population-based study.

Allostatic load (AL) is a marker of physiological dysregulation which reflects exposure to chronic stress. High AL has been related to poorer health outcomes including mortality. We examine here the association of socioeconomic and lifestyle factors with AL. Additionally, we investigate the extent to which AL is genetically determined. We included 803 participants (52% women, mean age 48±16years) from a population and family-based Swiss study. We computed an AL index aggregating 14 markers from cardiovascular, metabolic, lipidic, oxidative, hypothalamus-pituitary-adrenal and inflammatory homeostatic axes. Education and occupational position were used as indicators of socioeconomic status. Marital status, stress, alcohol intake, smoking, dietary patterns and physical activity were considered as lifestyle factors. Heritability of AL was estimated by maximum likelihood. Women with a low occupational position had higher AL (low vs. high OR=3.99, 95%CI [1.22;13.05]), while the opposite was observed for men (middle vs. high OR=0.48, 95%CI [0.23;0.99]). Education tended to be inversely associated with AL in both sexes(low vs. high OR=3.54, 95%CI [1.69;7.4]/OR=1.59, 95%CI [0.88;2.90] in women/men). Heavy drinking men as well as women abstaining from alcohol had higher AL than moderate drinkers. Physical activity was protective against AL while high salt intake was related to increased AL risk. The heritability of AL was estimated to be 29.5% ±7.9%. Our results suggest that generalized physiological dysregulation, as measured by AL, is determined by both environmental and genetic factors. The genetic contribution to AL remains modest when compared to the environmental component, which explains approximately 70% of the phenotypic variance.

The updated Swiss guidelines 2016 for the treatment and follow-up of cutaneous melanoma.

Cutaneous melanoma is the most deadly cutaneous neoplasm. In order to guide treatment decisions and follow-up of melanoma patients, guidelines for the management of melanoma in Switzerland were inaugurated in 2001 and revised in 2006 and 2016. Recent data on surgical and medical treatments from randomised trials necessitated modification of the treatment and follow-up recommendations.

Memory mixed with desire : a preliminary study of philosophy and literature in the works of Friedrich Nietzsche and Milan Kundera

Memory Mixed with Desire: A preliminary study of Philosophy and Literature in the works of Friedrich Nietzsche and Milan Kundera Robert Spinelli Brock University, Department of Philosophy This thesis studies intertextuality in the works of Friedrich Nietzsche and Milan Kundera through the primary themes of memory and forgetting. The thesis starts with two introductory chapters that delineate memory according to Nietzsche and Kundera respectively. From here, I move into a discussion of Nietzsche's Ubermensch as an example of the type of forgetting that Nietzsche sees as a cure for the overabundance of memory that has led to Christian morality. Next, I explore the Kunderan concept of kitsch as the polar opposite of what Nietzsche has sought in his philosophy, finishing the chapter by tying the two thinkers together in a Kunderan critique of Nietzsche. The thesis ends with a chapter devoted to the Eternal Return beginning with an exegesis of Nietzsche's idea and ending with a similar exegesis of Kundera's treatment of this thought. What I suggest in this chapter is that the Eternal Return might itself be a form of kitsch even in its attempt to revalue existence.

Emptying the bell jar: an exploration of adolescent responses to a women's literature unit /

This study examines adolescent student responses to a women's literature unit taught within a grade 12 Writer's Craft course. Current research (Gilligan, 1989, Pipher, 1994 & Slack, 1999) suggests that there is a great under-representation of female authors in the high school literature curriculum. The use of women's literature may draw attention to important literary figures who are historically overlooked within the curriculum. It gives voice to a marginalized group and presents students with alternative subjects and heroes. It encourages students to develop a critical perspective and reevaluate assumptions about institutions, ideologies, language and culture. It also allows me, as a teacher, to reflect on my own teaching practices and explore alternate feminist pedagogical principles and teaching styles encouraging multiplicity of voices, deconstruction of power relations, and alternative assessment tools within the classroom. As an educator, it is important for me to teach curriculum that is relevant and meaningful to students and help them become critical, self-reflective thinkers. It is also important for me to assist students in their exploration of self and encourage them to expand their awareness of historical, social and global issues. Sylvia Plath's (1963) The belljar is used as the primary text taught within this unit. In this novel, the bell jar is a central image that signifies entrapment and isolation. "To the person in the bell jar, blank and stopped as a dead body, the world itself is the bad dream"(p.l 54). As a metaphor, the bell jar resonates with young readers in a variety of ways.

A conceptual analysis of research literature on teachers' ideology and literacy practices: extending the dialogue through a secondary analysis of high school English as an additional language contexts /

This thesis provides a conceptual analysis of research literature on teachers' ideology and literacy practices as well as a secondary analysis of three empirical studies and the ways in which the ideologies of the English as an Additional Language (EAL) (Street, 2005) teachers in these contexts impact the teaching of literacy in empowering/disabling ways. Several major theoretical components of Cummins (1996, 2000), Gee (1996, 2004) and Street (1995, 2001) are examined and integrated into a conceptual triad consisting of three main areas: power and ideology, validation of students ' cultural and linguistic backgrounds, and teaching that empowers. This triad provides the framework for the secondary analysis of three empirical studies on the ideologies of secondary EAL teachers. Implications of the findings from the conceptual and secondary analyses are examined in light of the research community and secondary school teachers of EAL.

The impact of a digital children's literature program on primary students' reading motivation

This qualitative study stemmed from a concern of the perceived decline in students' reading motivation after the early years of schooling, which has been attributed to the disconnect between the media students are accustomed to using outside the classroom and the media they predominantly use within the classroom. This research documented the effectiveness of a digital children's literature program and a postreading multimedia program on eight grade 1 students' reading motivation, word recognition, and comprehension abilities. Eight students were given ten 25-minute sessions with the software program over 15 weeks. Preprogram, interim-program, and postprogram qualitative data were collected from students, teachers, and parents through questionnaires, interviews, standardized reading assessment tools, classroom observations, field notes, and student behaviour observation checklists. Findings are summarized into 3 themes. The motivational aspects and constructivist styles of instruction in the digital reading programs may have contributed to 5 student participants' increased participation in online storybook reading at home. Qualitative data revealed that the digital children's literature program and multimedia postreading activities seemed to have a positive influence on the majority of grade 1 student participants' reading motivation, word recognition, and listening comprehension skills. These findings suggest the promise of multimedia and Internet-based reading software programs in supporting students with reading andlor behavioural difficulties. In keeping with current educational initiatives and efforts, increased use of media literacy practices in the grade 1 curriculum is suggested.

In danger of jammed minds: A deconstructive discourse analysis of the criteria for early onset schizophrenia and imagination in children's literature

The purpose of this research is to expose and complicate those discourses of childhood imagination as demonstrated in the diagnostic criteria for early onset schizophrenia by using an antipsychiatry perspective. This will be done by evaluating those discourses alongside those found in popular children’s literature, specifically, Harry Potter and The Philosopher’s Stone, Bridge to Terabithia, and A Wrinkle in Time. Once uncovered, the underlying power discourses were then exposed. This research will then employ a minor reading as provided by Deleuze and Guattari’s (1987) approach to minor literature to demonstrate the ways in which the child can subvert those dominant discourses. The potential of literature is evaluated for its ability to provide alternative modes of experience and lines of flight for the child subjected to the diagnostic criteria of schizophrenia.

Using First Nations Children's Literature in the Classroom: Portfolio of Learning

A portfolio was developed to encourage teachers of Aboriginal children to include First Nations mentor texts into their daily teaching practices. The artifacts within the portfolio have been produced in accordance with guiding beliefs about how students, specifically First Nations students, learn. The portfolio supports the notion that Aboriginal children need to encounter representations of their own culture, histories and beliefs within the literature in order to be successful in school. The use of First Nations children’s literature in the classroom was explored with an emphasis on how using this literature will assist in improving literacy levels and the self-esteem of First Nations students.

"They're trying to trick us!": Making sense of anti-oppressive children's literature in the elementary school classroom

This study examines how children make sense of “anti-oppressive” children’s literature in the classroom, specifically, books that integrate and promote positive portrayals of gender non-conformity and sexual diversity. Through a feminist poststructural lens, I conducted ethnographic observations and reading groups with twenty students in a grade one/two classroom to explore how children engage with these storybooks. I further explored how the use of these books in the classroom might help to mediate and negotiate existing gendered and heteronormative beliefs and practices within educational settings. The books used in this study challenge oppressive gender and sexuality regimes within mainstream children’s literature that have traditionally served to marginalize and silence gender non-conforming and LGBTQ individuals. Responses from participants in this study aid in questioning how dominant discourses of gender and sexuality are produced and reinforced, as well as where we may find opportunities for change and reform within the elementary school classroom.

History of Spanish literature by George Ticknor

UANL

Face to face with the mexicans : the domestic life, educational, social, and bussines ways statesmanship and literature, legendary and general history of the mexicana people.

UANL