Diff��renciation des trajectoires professionnelles li��e �� la transition �� la parentalit�� en Suisse

Les travaux qui se sont int��ress��s �� l'hypoth��se des avantages et d��savantages cumulatifs (ADC) dans la perspective du parcours de vie montrent comment, au sein d'une m��me cohorte, des diff��rences initiales pour une caract��ristique d��termin��e (sexe, statut social, sant��) contribuent �� structurer des trajectoires de vie diff��renci��es. La plupart de ces ��tudes se concentrent sur l'empan de vie sans mesurer l'effet que des transitions particuli��res jouent dans ce processus. Dans cet article nous nous centrons sur la transition �� la parentalit�� pour montrer que le type d'insertion professionnelle des partenaires avant cette transition explique la diff��renciation subs��quente de leurs trajectoires professionnelles. Abstract Life course studies focusing on the cumulated advantages and disadvantages (CAD) hypothesis indicate that initial differences in a specific characteristic (sex, social status, or health) have an impact on intracohort differentiation. Most of these studies consider an entire life course and do not focus on specific transitions as a key moment for differentiation. In this article, the researchers focus on the transition to parenthood, showing that variations in occupational participation of both partners before the birth of a first child explain how professional trajectories differentiate after the birth of the child. Zusammenfassung Die Arbeiten, die sich f��r die Hypothese der kumulierten Vor- und Nachteile in einer Lebenslaufperspektive interessiert haben, zeigen, wie anf��ngliche Unterschiede bez��glich bestimmter Charakteristiken (Geschlecht, sozialer Status, Gesundheit) innerhalb einer Kohorte zur Strukturierung unterschiedlicher Lebensl��ufe beitragen. Die meisten dieser Studien konzentrieren sich auf den Gesamtlebenslauf, ohne die Effekte spezifischer biographischer ��berg��nge zu messen. In diesem Artikel beschr��nken wir uns auf den biographischen ��bergang zur Elternschaft. Wir zeigen auf, wie die Erwerbssituation der Partner vor diesem ��bergang die nachfolgende Differenzierung ihrer Berufsverl��ufe beeinflusst.

Higher Risk of Incident Hepatitis C Virus Coinfection Among Men Who Have Sex With Men, in Whom the HIV Genetic Bottleneck at Transmission Was Wide.

BACKGROUND: High-risk sexual behaviors have been suggested as drivers of the recent dramatic increase of sexually transmitted hepatitis C virus (HCV) among human immunodeficiency virus (HIV)-infected men who have sex with men (MSM). METHODS: We assessed the association between the genetic bottleneck of HIV at transmission and the prevalence and incidence of HCV coinfection in HIV-infected MSM from the Swiss HIV Cohort Study (SHCS). As a proxy for the width of the transmission bottleneck, we used the fraction of ambiguous nucleotides detected by genotypic resistance tests sampled during early HIV infection. We defined a broad bottleneck as a fraction of ambiguous nucleotides exceeding a previously established threshold (0.5%). RESULTS: From the SHCS, we identified 671 MSM with available results of HCV serologic tests and with an HIV genotypic resistance test performed during early HIV infection. Of those, 161 (24.0%) exhibited a broad HIV transmission bottleneck, 38 (5.7%) had at least 1 positive HCV test result, and 26 (3.9%) had an incident HCV infection. Individuals with broad HIV transmission bottlenecks exhibited a 2-fold higher odds of having ever experienced an HCV coinfection (odds ratio, 2.2 [95% confidence interval {CI}, 1.1-4.3]) and a 3-fold higher hazard of having an incident HCV infection (hazard ratio, 3.0 [95% CI, 1.4-6.6]) than individuals with narrow HIV transmission bottlenecks. CONCLUSIONS: Our results indicate that the currently occurring sexual spread of HCV is focused on MSM who are prone to exhibit broad HIV transmission bottlenecks. This is consistent with an important role of high-risk behavior and mucosal barrier impairment in the transmission of HCV among MSM.

Arthrogryposis multiplexa congenita: an epidemiologic study of nearly 9 million births in 24 EUROCAT registers.

OBJECTIVE: To examine the occurrence of arthrogryposis multiplex congenita (AMC) in Europe and to identify possible risk factors. STUDY DESIGN: Retrospective population-based epidemiological study using EUROCAT congenital anomaly registries. The study population included all cases of AMC (based on WHO ICD-9 or ICD-10 codes) that were livebirths (LB), fetal deaths (FD) from 20 weeks gestation and underwent termination of pregnancy for fetal anomaly (TOPFA), 1980-2006. RESULTS: Among 8.9 million births covered by 24 EUROCAT congenital anomaly registries, 757 AMC cases were reported. This gives a prevalence of 8.5 per 100,000. Five hundred and four (67%) AMC cases were LB, 199 (26%) cases were TOPFA, and FD occurred in 54 (7%) cases. First week survival status was known for 381 of the 504 LB (76%), of whom 87 (23%) died within the first week of life. Perinatal mortality associated with AMC was 32%. Two hundred and eighty-two (37%) cases had isolated AMC, 90 (12%) had additional syndrome or chromosomal anomalies and 385 (51%) had other major malformations. The same or similar anomaly was reported in 13% of siblings and in 12% of the mother's own family background. Information on prenatal testing was available for 521 cases of which 360 tested positive for a congenital anomaly, representing a sensitivity of 69%. Information on maternal illness before and during pregnancy and medication use in the first trimester was available for approximately a third of the mothers, of whom the vast majority reported no maternal illness or medication use. CONCLUSION: AMC is a rare occurrence, with a reported prevalence of 1:12,000. In this study, while information on potential risk factors such as maternal disease or maternal use of drugs was limited, they did not appear to be associated with the occurrence of AMC. AMC was lethal in a third of cases, either in utero or during the first week of life, although this may not be solely attributed to AMC as most cases had additional malformations.

Dental service utilization by Europeans aged 50 plus.

OBJECTIVES: To describe variations in the utilization of dental services by persons aged 50+ from 14 European countries and to identify the extent to which such variations are attributable to differences in oral health need and in accessibility of dental care. METHODS: We use data from the Survey of Health, Ageing, and Retirement in Europe (SHARE Waves 2 and 3) and estimate a series of multivariate logistic regression models to analyze variations in dental service utilization (overall dental attendance, preventive treatment and/or operative treatment, dental attendance in early life years) RESULTS: Overall dental attendance and incidence of solely preventive treatment are comparatively high in the Netherlands, Sweden, Denmark, Germany, and Switzerland. In contrast, overall dental attendance is relatively low in Spain, Italy, France, Greece, Poland, and Ireland. Moreover, a high incidence of solely operative treatment is observed in Austria, Italy, and France, whereas in the Netherlands, Sweden, Denmark, Switzerland, and Ireland, the incidence of solely operative treatment is comparably low. By and large, these variations persist even when controlling for cross-country differences in oral health need and in accessibility of dental care. CONCLUSIONS: In comparison with other European regions, there is a tendency toward more frequent and preventive dental treatment of the elderly populations residing in Scandinavia and Western Europe. Such utilization patterns appear only partially attributable to differences in need for and accessibility of dental care.

High prevalence of anorectal chlamydial infection in HIV-infected men who have sex with men in Switzerland.

Human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) were enrolled in an anorectal Chlamydia trachomatis screening study. Anorectal Chlamydia DNA was detected in 16 (10.9%) of 147 men, mainly among asymptomatic patients and patients having >20 sexual partners. These results support routine anorectal Chlamydia screening in HIV-infected MSM who report unprotected anal intercourse.

Increased risks of early sexual initiators: time makes a difference

BACKGROUND: Years since onset of sexual intercourse (YSSI) is a rarely used variable when studying adolescents- sexual outcomes. The aim of this study is to evaluate the influence of YSSI on the adverse sexual outcomes of early sexual initiators. METHODS: Data were drawn from the 2002 Swiss Multicenter Adolescent Survey on Health database, a nationally representative cross-sectional survey including 7429 adolescents in post mandatory school aged 16-20 years. Only adolescents reporting sexual intercourse (SI) were included (N=4388; 45% females) and divided by age of onset of SI (early initiators, age<16: N=1469, 44% females; and late initiators, age&#8805;16: N=2919, 46% females). Analyses were done separately by gender. Groups were compared for personal characteristics at the bivariate level. We analyzed three sexual outcomes (&#8805;4 sexual partners, pregnancy and non-use of condom at last SI) controlling for all significant personal variables with two logistic regressions first using age, then YSSI as one of the confounding variables. Results are given as adjusted odds ratios (aOR) using lSI as the reference category. RESULTS: After adjusting for YSSI instead of age, negative sexual outcomes among early initiators were no longer significant, except for multiple sexual partners among females, although at a much lower level. Early initiators were less likely to report non-use of condom at last SI when adjusting for YSSI (females: aOR=0.59 [0.44-0.79]; p<0.001; males aOR=0.71 [0.50-1.00]; p=0.053). CONCLUSION: YSSI is an important explanatory variable when studying adolescents- sexuality and needs to be included in future research on adolescents- sexual health.

Increases in condomless sex in the Swiss HIV Cohort Study.

Condomless sex is a key driver of sexually transmitted diseases. In this study, we assess the long-term changes (2000-2013) of the occurrence of condomless sex among human immunodeficiency virus (HIV)-infected individuals enrolled in the Swiss HIV Cohort study. The frequencies with which HIV-infected individuals reported condomless sex were either stable or only weakly increasing for 2000-2008. For 2008-2013, these rates increased significantly for stable relationships among heterosexuals and men who have sex with men (MSM) and for occasional relationships among MSM. Our results highlight the increasing public health challenge posed by condomless sex and show that condomless sex has been increasing even in the most recent years.

Diversity of the Quality Criteria in Qualitative Research in the Health Sciences: Lessons from a Lexicometric Analysis Composed of 133 Guidelines

A review of health sciences literature shows a substantial increase in qualitative publications. This work incorporates a certain number of research quality guidelines. We present the results of the Alceste�� lexicometric analysis, which includes 133 quality grids for qualitative research covering five disciplinary fields of the health sciences: medicine and epidemiology, public health and health education, nursing, health sociology and anthropology, psychiatry and psychology. This analysis helped to cross-check the disciplinary fields with the various objectives assigned to the different criteria in the grids examined. The results obtained with Alceste�� show the variability of the objectives sought by the authors of the guidelines. These discrepancies are not directly associated to disciplinary fields, and appear to be more closely linked to different qualitative research conceptualizations within the disciplines, and with essential qualitative research validation criteria. These conceptualizations must be clarified to help users better understand the objectives targeted by the grids, and promote more appreciation for qualitative research in the health sciences.

Hepatitis C Virus Awareness Among Men Who Have Sex With Men in Southwest Switzerland.

BACKGROUND: In Switzerland, the incidence of hepatitis C virus (HCV) infection in HIV-positive men who have sex with men (MSM) rose 18-fold between 1998 and 2011. We aimed to evaluate transmission risk factors, awareness, and seroprevalence of HCV among MSM in southwest Switzerland. METHODS: From 1st June 2011 to 31st August 2012, trained health care professionals invited individuals attending (1) MSM screening clinics and (2) indoor and outdoor meeting areas to complete an anonymous questionnaire. Consenting participants were rapid tested for HCV (OraQuick HCV Rapid Antibody Test). RESULTS: Of 918 MSM approached, 654 agreed to participate, most of whom (536, 82%) were enrolled via MSM screening clinics. Of 654 participants, 21 (3.2%) disclosed being HIV positive; 140 (21%) had unknown HIV status. In the preceding 12 months, 357 (55%) of 654 participants reported unprotected anal intercourse (UAI) and 321 (49%) of 654 participants reported UAI with partners of different/unknown HIV status. Not HIV serosorting was reported more frequently among HIV-positive individuals (76%, P &lt; 0.001). Three hundred two participants (46%) were aware of HCV, awareness being higher among clinic than meeting area participants (49% vs. 33%, P = 0.04). One individual (of 654; 0.2%), with a negative HIV test result 18 months previously was newly diagnosed as being HCV positive on rapid testing. CONCLUSIONS: In this sample of predominantly HIV-negative MSM, half the participants were aware of HCV and HCV seroprevalence was low. However, high rates of UAI and of UAI without HIV serosorting were reported. Given the increasing incidence of HCV among HIV-positive men, we propose that HCV counseling should be offered to MSM regardless of HIV status, with testing offered to those at high risk.

DOHaD et information ��pig��n��tique - Enjeux soci��taux [DOhaD and epigenetic information: societal challenges].

The concept of the developmental origins of health and disease (DOHaD) alters our understanding of what constitutes "health" or "disease" intended as chronic, non-communicable diseases, which develop over the life course in high income and emerging countries. It implies a change in paradigm forming a basis for prevention policies across the globe. It also impacts psychological, social, economic, ethical and legal sciences. In line with the unanticipated underpinning epigenetic mechanisms are also the social issues (including public policies) that could be produced by the knowledge related to DOHaD that opens a wide field of inquiry. The information unveiled by epigenetics coupled with information on lifestyle including during the development phase, is of unforeseen nature, raising issues of different nature. Therefore it requires specific attention and research, and a specific support by a pluridisciplinary reflection since the very beginning of its production, to anticipate the questions that might be raised in the future.

���Kyll��h��n nyt pit��s olla jo semmonen aika, ett�� p����sis niin k�� keskustelemhan n��ist�� asioista.��� Tutkimus lappilaisten sotavankien, partisaanien uhrien ja huutolaisten el��m��nkulusta, voimavaroista, terveydest�� ja sairauksista

<b>Research into the course of life, mental stamina and health status of wartime prisoners, victims of Soviet partisan attacks, and paupers in Finnish Lapland</b> The basis of this research comprised the issues raised during the interviews conducted in my work as a general practitioner in Lapland, regarding factors that have possibly affected the life stories and health conditions of Lappish people who had lived through the war as war prisoners, victims of partisan attacks, or paupers. The purpose of the study was to describe how the different life phases and experiences emerged from the interviewees��� stories and to identify their mental stamina. Another goal was to make observations on their health status, in which the main emphasis became to address mental symptoms. The cohort consisted of elderly Finns who lived in Lapland during the war and experienced war imprisonment, pauperism, or became victims of partisan attacks. All three groups consisted of 12 interviewees. The interview transcripts were read several times and then investigated using the content analysis methods applicable to the material. The research methodology was based on building awareness and understanding. Thematic tagging and data coding were used as structured analysis tools. In all three groups most of the interviewees clearly identified their mental stamina, the most fundamental of which were home, family and work. The war prisoners��� injuries and nervous sensibility symptoms had been shown in earlier studies on war prisoners, and on this basis they had been granted disability pensions. However, many of them had suppressed their traumatic experiences and mental difficulties, and they could not talk about these issues until at the time of these interviews held at old age. Four of them still suffered from a post-traumatic stress disorder. The victims of Soviet partisans had had to carry their mental load alone for decades before the cruel ravages on civilians in remote areas of Lapland became publicly known. Most of them still had disturbing nervous sensibility symptoms. Four interviewees had a post-traumatic stress disorder, and in addition to these, the mental symptoms of one had developed into a post-traumatic stress disorder during old age. Many of the interviewees who had been left paupers remembered their childhood as filled with grief and feelings of inferiority, and had nightmares relating to their wartime experiences. Yet none of them suffered from post-traumatic stress disorder. The results showed that the exceptional suffering caused by the war, the wartime imprisonment and the devastating attacks by Soviet partisans had led especially to mental difficulties. These were left almost completely unnoticed in the post-war conditions, and the war victims were unable to seek help on their own. Based on the results, our health care for the elderly should focus on familiarization with the individual experiences and life stories of each elderly person. This can facilitate geriatric diagnostics and individual therapy planning. Empathic familiarization with the life experiences of the elderly may strengthen their mental stamina and improve the quality of successful aging.

Supporting older people���s independent living at home through social and health care collaboration

T��ss�� tutkimuksessa tarkasteltiin ik��ihmisten kotona asumista sosiaali- ja terveydenhuollon yhteisty��n n��k��kulmasta. Tutkimuksen tarkoituksena oli lis��t�� ymm��rryst�� i��kk��iden kotihoidon asiakkaiden voimavaroista arjesta selviytymisen n��k��kulmasta, ja tutkia miten asiakkaiden hoito sosiaali- ja terveydenhuollon yhteisty��n�� toteutuu. Tutkimus oli poikkileikkaustutkimus, jossa sovellettiin kuvailevaa ja vertailevaa tutkimusasetelmaa. Tutkimusaineisto ker��ttiin yhden l��nsisuomalaisen kunnan kotihoidon asiakkailta (���65 v.) ja heit�� hoitavilta ammattihenkil��ilt��. Kotihoidon 21 i��k��st�� asiakasta kuvasivat omia voimavarojaan arjesta selviytymisen n��k��kulmasta sek�� kokemuksiaan hoidon toteutumisesta ammattihenkil��iden yhteisty��n��. Aineisto ker��ttiin avoimella haastattelulla ja analysoitiin sis��ll��n analyysill��. Lis��ksi 25 kotihoidon ammattihenkil����: 13 kotipalvelun ty��ntekij����, 11 kotisairaanhoitajaa ja l����k��ri kuvasivat kokemuksiaan i��kk����n asiakkaan hoidon toteutumisesta ammattihenkil��iden yhteisty��n��. Aineisto ker��ttiin fokusryhm��haastattelulla ja analysoitiin sis��ll��n analyysill��. N��iden tulosten sek�� aikaisemman kirjallisuuden perusteella laadittiin strukturoitu kyselylomake, jolla analysoitiin ja vertailtiin asiakkaiden ja ammattihenkil��iden n��kemyksi�� siit��, miten asiakkaiden hoito sosiaali- ja terveydenhuollon yhteisty��n�� toteutui. Esitestausten j��lkeen kyselylomake l��hetettiin 200 kotihoidon asiakkaalle ja 570 heit�� hoitavalle kotihoidon ty��ntekij��lle: 485 kotipalvelun ty��ntekij��lle, 81 kotisairaanhoitajalle ja 4 l����k��rille. Kyselyyn vastasi 120 asiakasta (60 %) ja 370 ammattihenkil���� (65 %). Ryhmien v��listen erojen tarkastelussa k��ytettiin ristiintaulukointia, Pearsonin khin neli��testi�� ja Fisherin tarkan todenn��k��isyyden testi��. I��kk��iden asiakkaiden kuvauksissa voimavarat muodostuivat el��m��nhallinnan tunteesta ja toimintatahdon s��ilymisest��. Asiakkaat ammensivat arkeen voimaa harrastuksista ja sosiaalisesta verkostosta, mutta ulkopuolisten asettamat el��misen ehdot, terveydentilan heikkeneminen sek�� yksin��isyys asettivat ik��ihmisen ja h��nen voimavaransa suurten haasteiden eteen. Tulokset osoittivat, ett�� ammattihenkil��iden toiminta oli osittain ristiriidassa ik��ihmisten omien odotusten kanssa, eik�� se kaikilta osin tukenut asiakkaiden omia voimavaroja. Ammattihenkil��t tekiv��t hoitoon liittyvi�� p����t��ksi�� ja toimintoja asiakkaiden puolesta, vaikka asiakkaille itselleen oli t��rke���� el��m��nhallinnan tunne ja toimintatahdon s��ilyminen. Asiakkaiden voimavarojen tukemista moniammatillisena yhteisty��n�� vaikeuttivat ammattihenkil��iden vaikeus tunnistaa asiakkaiden omia voimavaroja sek�� niit�� uhkaavia tekij��it��, tiedon kulun ongelmat, tavoitteeton ja ep��yhten��inen tapa toimia sek�� ammattihenkil��iden vastakkain asettuvat n��kemyserot ja toimintatavat. Asiakkaiden ja ammattihenkil��iden n��kemykset toteutetusta hoidosta erosivat toisistaan tilastollisesti merkitsev��sti (p<0.05). Asiakkaat arvioivat sek�� itsen��iseen toimintaan tukemisen ett�� fyysisen, psyykkisen ja sosiaalisen tuen toteutuneen ty��ntekij��it�� huonommin. Yhteisty��n kehitt��mishaasteita kotihoidossa ovat asiakkaan oman el��m��ns�� asiantuntijuuden vahvistaminen, toimintakulttuurin muuttaminen asiakasl��ht��iseksi tavoitteelliseksi toiminnaksi, ammattihenkil��iden roolien ja vastuun selkiytt��minen sek�� tiedon kulun menetelmien kehitt��minen. Tutkimus vahvistaa gerontologisen hoitotieteen tietoperustaa ja tuottaa uutta tietoa, jota voidaan soveltaa sosiaali- ja terveysalan koulutuksessa ja johtamisessa

El��m��nkokemukset ja koherenssin tunne ��� typologinen tutkimus grounded theory -metodologiaa soveltaen

Tutkimuksen tarkoituksena on laadullisin menetelmin syvent���� tietoa ty��ik��isten (28���60-vuotiaiden) suomalaisten kvantitatiivisesti mitatun koherenssin tunteen takana olevista tekij��ist��. Tutkimuksella halutaan tuottaa aineistol��ht��isesti tietoa siit��, mitk�� k��sitteet kuvaavat tutkittavien kerrottujen el��m��nkokemusten kautta selvitetty�� koherenssin tunnetta ja samalla lis����m����n ymm��rryst�� Antonovskyn salutogeenisesta teoreettisesta mallista. Tutkimukseen osallistuneet olivat Health and Social Support tutkimukseen vuosina 1998 ja 2003 osallistuneita. Koko kyseinen tutkimusotos edusti vuonna 1998 20���24, 30���34, 40���44 ja 50���54 -vuotiasta Suomen v��est����. Tutkimuksen metodina k��ytettiin glaserilaista grounded theory -metodologiaa. Tutkimuksen aineistonkeruu toteutettiin kolmessa eri vaiheessa. Ensimm��isess�� vaiheessa haastateltiin 27 tutkittavaa. Toisessa vaiheessa haastateltavilta ker��ttiin lis��aineistoa kirjallisesti. Kahdeksan vastasi t��h��n pyynt����n. Kolmannessa vaiheessa haastateltiin seitsem����. Haastattelujen yhteydess�� haastateltavat t��yttiv��t koherenssin tunteen mittarin (13-osainen). Aineisto analysoitiin koherenssipisteiden mukaisesti kolmena eri aineistona. Tulokseksi saatiin substantiivinen teoria. Tutkimuksen tuloksena kuvattiin sosiaalinen perusprosessi, joka nimitettiin El��m��n kokonaisuudeksi t��ss�� hetkess��. Sosiaalisen perusprosessin sis��ll�� on typologia. Jokaisesta koherenssipisteryhm��st�� muodostettiin oma typologia. Kukin typologia sis��lsi nelj�� tyyppi��. Sosiaalisen perusprosessin vaiheet olivat: ehdot t��m��n hetken taustalla, el��minen ehtojen varassa ja uusia luoden (tietynlainen ihminen, el��minen t��ss�� hetkess��, kokonaisn��kemys el��m��st��) sek�� jatkaminen ehtojen varassa ja uusia luoden. Typologiat ovat nimelt����n ehe��t, p��rj����v��t ja sinnittelij��t. Haastateltavien kokemuksia ei analyysivaiheessa pyritty liitt��m����n tiettyyn kontekstiin, vaan ne liittyiv��t toimintaan ja k��ytt��ytymiseen. Tulosten tarkasteluvaiheessa tehtiin kuitenkin lyhyt kuvaus el��m��nkulkututkimuksesta sek�� sosiaalisesta ja kulttuurisesta ymp��rist��st��. Tutkimustulokset ovat kuvailevia ja niiden perusteella saadaan viitteit�� siit��, millaiset asiat ovat yhteydess�� koherenssin tunteeseen ja mill�� tavalla yhteys rakentuu. Saatu substantiivinen teoria on p��tev�� t��ss�� aineistossa. Tulokset noudattelevat Antonovskyn salutogeenista teoreettista mallia silt�� osin, ett�� mit�� korkeammat koherenssipisteet olivat, sit�� enemm��n typologiassa oli eheytt�� lis����vi�� tekij��it��. Eheys tuo el��m����n henkist�� liikkumavaraa, jota typologian tyypit (rakentava, ilmavasti el��v��, el��m��nmy��nteinen, juureva realisti) ilment��v��t. Typologioiden kuvauksista voidaan lukea, ett�� kaikissa tyypeiss�� kuvataan vaikeita el��m��nkokemuksia. Olennaista on se, miten n��ihin vaikeuksiin suhtaudutaan. Eheill�� on parhaat edellytykset k��sitell�� el��m��n haasteita. Voidaan kuitenkin todeta, ett�� kaikki t��h��n tutkimukseen osallistuneet olivat selviytyji��.