SIDA: l'information comme outil de prévention. [AIDS: information as a means to prevention].

Objective information for the groups exposed to the disease and the public in general is the only step that is currently possible in the prevention of AIDS. A certain number of information and support actions have been developed as a consequence of the appearance of AIDS in Switzerland. The AIDS information hot-line at the CHUV is one of these actions with the aim of orienting the information according to demand and examining the utility of this means, we made a prospective evaluation of the calls (between 23 October 1985-inception of the line and 31 March 1986). Out of a total of 535 calls, 317 requests for appointments (tests, consultation) or written documentation, and 218 (41%) were transferred to the doctor; 39% of the calls came from people who were directly concerned (ill, with a positive test, exposed groups), 11% from health professionals, and 47% from the general public. 56% of the calls were concerned with transmission of the disease (sexual, blood, indirect), 22% with the meaning of the detection test, 22% referred to the symptoms of the disease. According to the doctor's estimate, although the standard of knowledge is satisfactory in 55% of the cases, a considerable number of false ideas, that generate irrational fear, still persist. This hot-line thus provides a sympathetic ear and individual support, particularly for the exposed groups, rather than information about the disease. The existence of this action, therefore, appears justified, but must be integrated into a global strategy of information promotion.

La contraception d'urgence chez les adolescents en Suisse: une étude sur la sexualité des 16-20 ans

Objectifs: Faire le point sur les connaissances concernant la contraception post-coïtale (CPC) et son utilisation par les adolescentes, et réunir les recommandations utiles aux médecins prescripteurs. Matériel et méthodes: La revue de littérature concernant la CPC et les résultats d'une enquête concernant les comportements sexuels des adolescents de 16-20 ans en Suisse sont utilisés. Résultats: Plusieurs méthodes peuvent être utilisées incluant les oestroprogestatifs et les progestatifs seuls. C'est surtout à l'occasion de rupture de préservatif, d'oubli de pilule ou d'absence de contraception que la CPC peut être utile. Les adolescents sexuellement actifs semblent connaître l'existence de la CPC et 20% des jeunes filles y ont eu recours en Suisse. Mais les obstacles qui limitent l'accès à la CPC sont nombreux au niveau de l'information et de la qualité des services dans cette situation d'urgence. Discussion et conclusion: La sensibilisation des adolescents et des jeunes aux conditions d'utilisation de la CPC est nécessaire, et doit être associée à un effort de formation des professionnels et de qualité des services pour faciliter l'accès à la CPC. Mots-clefs: contraception d?urgence, contraception post-coïtale, pilule du lendemain, adolescents.<br/><br/>Purpose: To describe and analyze emergency contraception (EC) awareness and use among sexually active Swiss teenagers. Methods: Anonymous computerized questionnaires were distributed to a national representative sample of 4283 in-school adolescents (aged 16 to 20 years) in high schools and professional centers. Young people who were sexually active (51.5% of the sample: 1058 girls and 1073 boys) responded to questions on EC awareness and use and on sexual perception, attitude and behaviors. Univariate analyses and multiple regression analyses were used to describe EC awareness and use and their correlates. Results: Most of the sexually active girls (89.3%) and boys (75.2%) knew of the existence of EC. Of girls, 20% reported having used EC, and the majority of them used it only once (64.1%) or twice (18.5%). EC awareness was positively associated with the father's level of education (girls: odds ratio:5.18), and the scholastic curriculum of the respondent. Gender differences in the correlates of EC awareness demonstrate that girls who had a confidant, or a group of friends or boys of Swiss nationality and those who have had the opportunity to discuss the issue of contraception declare greater awareness of EC. EC use was higher among girls who lived in urban areas (odds ratio: 1.91) and occasionally had unprotected intercourse. We did not find any significant difference in the profile of multiple vs. one-time users. Conclusion: EC awareness and use should be improved through better information and accessibility, especially among teenagers who place themselves in at-risk situations. Keywords: Adolescents, Emergency contraception, Gender differences, Teenage pregnancy prevention, Switzerland.

Fouling, prevention of fouling, and clearing in filtration

In this thesis fouling of conventional filter fabrics and membranes was studied. In the beginning of the thesis fouling and how it can be measured and predicted is reviewed. Information on different methods on how fouling canbe decreased or cleaned away is also given. The experimental part is divided into two sections; fabric filtration and membrane filtration. Fouling of the filter fabrics was studied with silica or cupper slurries and fouling of the membranes was studied with pulp and paper mill waters. The fouled filter materials were characterised according to many different methods. The most useful way to observe fouling is to measure the changes in the permeate flux. Fouling can also be seen visually e.g. with scanning electron microscopy. Consequently, also the reason for the fouling in question might be found. Different filtration characteristics affect fouling e.g. as the filtration pressure was increased it did not have much influence on the permeate flux, but the pressure caused the membrane to get fouled faster. Also, an increase of shear rate on the membrane surface decreased fouling. Different pretreatment methods for the effluent were tested in membrane filtration to decrease fouling. The tested methods; biological treatment, ozonation, enzymatic treatment and flocculation, did not have a clear influence on the fouling of the membrane, but e.g. a biological treatment combined with ultrafiltration made the tested groundwood mill circulation water purer than ultrafiltration alone.

Emergency hospital services utilization in Lleida (Spain): a cross-sectional study of immigrant and Spanish-born populations

Background: The use of emergency hospital services (EHS) has increased steadily in Spain in the last decade while the number of immigrants has increased dramatically. Studies show that immigrants use EHS differently than native-born individuals, and this work investigates demographics, diagnoses and utilization rates of EHS in Lleida (Spain). Methods: Cross-sectional study of all the 96,916 EHS visits by patients 15 to 64 years old, attended during the years 2004 and 2005 in a public teaching hospital. Demographic data, diagnoses of the EHS visits, frequency of hospital admissions, mortality and diagnoses at hospital discharge were obtained. Utilization rates were estimated by group of origin. Poisson regression was used to estimate the rate ratios of being visited in the EHS with respect to the Spanish-born population. Results: Immigrants from low-income countries use EHS services more than the Spanish-born population. Differences in utilization patterns are particularly marked for Maghrebi men and women and sub-Saharan women. Immigrant males are at lower risk of being admitted to the hospital, as compared with Spanish-born males. On the other hand, immigrant women are at higher risk of being admitted. After excluding the visits with gynecologic and obstetric diagnoses, women from sub-Saharan Africa and the Maghreb are still at a higher risk of being admitted than their Spanish-born counterparts. Conclusion: In Lleida (Spain), immigrants use more EHS than the Spanish born population. Future research should indicate whether the same pattern is found in other areas of Spain and whether EHS use is attributable to health needs, barriers to access to the primary care services or similarities in the way immigrants access health care in their countries of origin.

Increasing prehospital emergency medical service interventions for nursing home residents.

QUESTION: In the ageing European population, the proportion of interventions by the emergency medical services (EMS) for elderly patients is increasing, but little is known about the recent trend of EMS interventions in nursing homes. The aim of this analysis was to describe the evolution of the incidence of requests for prehospital EMS interventions for nursing home residents aged 65 years and over between 2004 and 2013. METHODS: A prospective population-based register of routinely collected data for each EMS intervention in the Canton of Vaud. Linear time trends of incidence of requests to the EMS in nursing homes were calculated and stratified by age categories. RESULTS: The number of ambulance interventions in nursing homes for people aged 65 years and over (65+) increased by 68.9% (1124‒1898) between 2004 and 2013. A significant linear increase of the annual incidence of requests to EMS per 1,000 nursing home residents was found for people aged 65-79 (10.2, 95% confidence interval [CI] 6.2-14.2), 80-89 (16.5, 95% CI 14.0-19.0) and over 90 (12.1, 95% CI 5.8-18.4). EMS interventions in nursing home residents who required an emergency physician increased during the same period by 205.6% (from 106 to 324), representing an increase from 2% to 7% of all emergency physician interventions in the Canton. CONCLUSIONS: Our results confirmed an important increase in the incidence of EMS interventions in nursing homes during the last decade, far exceeding the actual increase of the nursing home population during the same period. This evolution represents an important opportunity to reconsider the EMS missions in the context of an ageing society.

An alternative approach to the prevention of doping in cycling

The article proposes an alternative approach to policies for preventing doping in cycling, based on in-depth analysis of the functioning of nine of the 40 world professional teams and the careers of the 2,351 riders who were or have been professionals since 2005. The first part shows that the instruments of prevention have been based on a questionable understanding of doping as an individual moral fault, and have not produced the expected results. The second part proposes to analyse the ways in which teams and riders produce their achievments, so as to put forward an alternative to the anti-doping policies used hitherto, which have little impact on riders. The study shows that it is more pertinent to examine the forms of employment and the business models, because these have important effects on cycling professionals' conditions of work. It makes it possible to identify three dimensions of the risk of doping on which organisations can act in their antidoping policies: team organisation, riders' preparation and workload, and the precarity of employment.

Emergency department visits for non-life-threatening conditions : evolution over 13 years in a Swiss urban teaching hospital

INTRODUCTION: A large proportion of visits to our Emergency Department (ED) are for non-life-threatening conditions. We investigated whether patients' characteristics and reasons for consultation had changed over 13 years. METHODS: Consecutive adult patients with non-life-threatening conditions at triage were included in the spring of 2000 and in the summer of 2013. In both years patients completed a similar questionnaire, which addressed their reasons for consultation and any previous consultation with a general practitioner (GP). RESULTS: We included 581 patients in 2013 vs 516 in 2000, with a mean age of 44.5 years vs 46.4 years (p=0.128). Of these patients, 54.0% vs 57.0% were male (p=0.329), 55.5% vs 58.7% were Swiss (p=0.282), 76.4% were registered with a GP in both periods, but self-referral increased from 52.0% to 68.8% (p<0.001); 57.7% vs., 58.3% consulted during out-of- hours (p=0.821). Trauma-related visits decreased from 34.2% to 23.7% (p<0.001). Consultations within 12 hours of onset of symptoms dropped from 54.5% to 30.9%, and delays of ≥1 week increased from 14.3% to 26.9% (p<0.001). The primary motive for self-referral remained unawareness of an alternative, followed in 2013 by dissatisfaction with the GP's treatment or appointment. Patients who believed that their health problem would not require hospitalisation increased from 52.8% to 74.2% and those who were actually hospitalised decreased from 24.9% to 13.9% (all p<0.001). CONCLUSION: The number of visits for non-life-threatening consultations continue to increase. Our ED is used by a large proportion of patients as a convenient alternative source of primary care.

Ist die «Polypille» in der kardiovaskulären Prävention eine Option [Is the "polypill" in cardiovascular prevention an option]

Fallvignette: Ein 58-jähriger Mann hatte vor einem Jahr einen Herzinfarkt, der mit einem beschichteten Stent versorgt wurde. Im Beruf hat er eine verantwortungsvolle Position und ist häufig geschäftlich unterwegs. Er gibt an, dass er Mühe mit der Einnahme seiner fünf Medikamente (Statin, β-Blocker, ACE-Hemmer, Clopidogrel, Acetylsalizylsäure) hat und dass er ab und zu vergisst, eines zu nehmen. Frage: Könnte ihm ein Kombinationspräparat (Polypille) helfen, seine Medikamente regelmässig einzunehmen? Hintergrund: Weltweit sind Herz-Kreislauf-Erkrankungen die führende Ursache für Tod und Behinderung. Um diese Krankheitslast zu vermindern, ist eine bevölkerungsbezogene Prävention entscheidend, bei der bekannte kardiovaskuläre Risikofaktoren kontrolliert werden. Das Konzept der Polypille mit einer fixen Kombination von mindestens einem Antihypertensivum und einem Statin wurde vor allem in Hinblick auf Entwicklungs- und Schwellenländer entwickelt. Die Primärprävention ist in diesen Ländern schwierig durch führbar; eine einzige Tablette wäre dort eine kostengünstige Variante. Aber auch in reichen Ländern könnte die Polypille sinnvoll sein, um z.B. die Compliance bei multimorbiden Patienten zu verbessern. Als Polypille werden verschiedene Kombinationen von Medikamenten angeboten, ihre Wirksamkeit und möglichen Nebenwirkungen sind jedoch unklar. Ziel dieses Reviews war, ihre Wirksamkeit in der primären und sekundären Prävention bezüglich Mortalität, nicht-tödliche kardiovaskuläre Ereignisse und Blutdruck-bzw. Lipidsenkung zu überprüfen.

Potential health-care service utilization substitution effects induced by case management for emergency department frequent users

BACKGROUND: In most of the emergency departments (ED) in developed countries, a subset of patients visits the ED frequently. Despite their small numbers, these patients are the source of a disproportionally high number of all ED visits, and use a significant proportion of healthcare resources. They place a heavy economic burden on hospital and healthcare systems budgets overall. Several interventions have been carried out to improve the management of these ED frequent users. Case management has been shown in some North American studies to reduce ED utilization and costs. In these studies, cost analyses have been carried out from the hospital perspective without examining the costs induced by healthcare consumed in the community. However, case management might reduce ED visits and costs from the hospital's perspective, but induce substitution effects, and increase health service utilization outside the hospital. This study examined if an interdisciplinary case-management intervention-compared to standard ED care -reduced costs generated by frequent ED users not only from the hospital perspective, but also from the healthcare system perspective-that is, from a broader perspective taking into account the costs of healthcare services used outside the hospital. METHODS: In this randomized controlled trial, 250 adult frequent emergency department users (5 or more visits during the previous 12 months) who visited the ED of the University Hospital of Lausanne, Switzerland, between May 2012 and July 2013 were allocated to one of two groups: case management intervention (CM) or standard ED care (SC), and followed up for 12 months. Depending on the perspective of the analysis, costs were evaluated differently. For the analysis from the hospital's perspective, the true value of resources used to provide services was used as a cost estimate. These data were obtained from the hospital's analytical accounting system. For the analysis from the health-care system perspective, all health-care services consumed by users and charged were used as an estimate of costs. These data were obtained from health insurance providers for a subsample of participants. To allow comparisons in a same time period, individual monthly average costs were calculated. Multivariate linear models including a fixed effect "group" were run using socio-demographic characteristics and health-related variables as controlling variables (age, gender, educational level, citizenship, marital status, somatic and mental health problems, and risk behaviors).

Frequent users of the emergency department in a universal health coverage system : a randomized controlled trial of a case-management intervention

BACKGROUND: Frequent emergency department users represent a small number of patients but account for a large number of emergency department visits. They should be a focus because they are often vulnerable patients with many risk factors affecting their quality of life (QoL). Case management interventions have resulted in a significant decrease in emergency department visits, but association with QoL has not been assessed. One aim of our study was to examine to what extent an interdisciplinary case management intervention, compared to standard emergency care, improved frequent emergency department users' QoL. METHODS: Data are part of a randomized, controlled trial designed to improve frequent emergency department users' QoL and use of health-care resources at the Lausanne University Hospital, Switzerland. In total, 250 frequent emergency department users (≥5 attendances during the previous 12 months; ≥ 18 years of age) were interviewed between May 2012 and July 2013. Following an assessment focused on social characteristics; social, mental, and somatic determinants of health; risk behaviors; health care use; and QoL, participants were randomly assigned to the control or the intervention group (n=125 in each group). The final sample included 194 participants (20 deaths, 36 dropouts, n=96 in the intervention group, n=99 in the control group). Participants in the intervention group received a case management intervention by an interdisciplinary, mobile team in addition to standard emergency care. The case management intervention involved four nurses and a physician who provided counseling and assistance concerning social determinants of health, substance-use disorders, and access to the health-care system. The participants' QoL was evaluated by a study nurse using the WHOQOL-BREF five times during the study (at baseline, and at 2, 5.5, 9, and 12 months). Four of the six WHOQOL dimensions of QoL were retained here: physical health, psychological health, social relationship, and environment, with scores ranging from 0 (low QoL) to 100 (high QoL). A linear, mixed-effects model with participants as a random effect was run to analyze the change in QoL over time. The effects of time, participants' group, and the interaction between time and group were tested. These effects were controlled for sociodemographic characteristics and health-related variables (i.e., age, gender, education, citizenship, marital status, type of financial resources, proficiency in French, somatic and mental health problems, and behaviors at risk).

Lipid peroxidation and seed emergency in progenies of the yellow passion fruit plant

The objective was to evaluate the percentage of emergency plantlets and lipid peroxidation in seeds of 29 half-sib progenies of yellow passion fruit (Passiflora edulis Sims.) after 24 months under storage. The experimental design was completely randomized, with four replications of 50 seeds each, from which the treatments were the progenies (1-29). The evaluation of the percent plantlet emergency was accomplished at 14 and 28 days after sowing. The lipid peroxidation of the seeds was expressed as malondialdehyde (MDA) content that was determined by the TBARS method. Approximately 21% of those half-sib progenies maintained the viability of their seeds for twenty-four months under storage. The results point out a remarkable genetic variability for vigor and emergency of the yellow passion fruit plantlets, with occurrence of individuals with high and other ones with low capacity to maintaining the physiologic quality of their seeds after storage.