La "satisfaction" du m��decin lors d'une premi��re consultation diff��re-t-elle selon l'origine du patient? Une ��tude prospective. [Does physician's satisfaction with an initial consultation differ according to the patient's origin? A prospective study].

Difficulties in the doctor-patient relationship may arise because of differences in socio-cultural background. The aim of this study was to evaluate the doctors' satisfaction in an ambulatory care setting when confronted with 3 different cultural groups (Swiss, foreign residents, refugees) and to review some preconceived ideas. Actually, the foreign population did not consult more often in emergencies than the Swiss population, nor did it present more frequently with somatizations in first interview. However, the doctors felt globally less satisfied with the refugees than with the other patients, mainly because of communication difficulties and therefore a less satisfying doctor-patient relationship. Nevertheless, the doctors felt they had the same diagnostic accuracy in the 3 groups. Studies on the satisfaction of primary care doctors are important, because the quality of the doctor-patient relationship directly influences the quality of medical care.

Patterns of alcohol consumption in the Seychelles Islands (Indian Ocean).

Self-reported drinking habits were examined in a random sample of 1067 persons aged 25-64 years in the Seychelles, a country in epidemiological transition where consumption of home-brewed, mostly unregistered beverages has been traditionally high. Alcohol consumption was calculated from respondents reporting at least one drink per week ('regular drinkers'). Among men, 51.1% were regular drinkers and had average intake of 112.1 ml alcohol a day. Among women, 5.9% were regular drinkers and had 49.7 ml alcohol a day. Frequency of drinking, but not amount per drinker, was slightly less in the 25-34-year than older-age categories. Home-brews (mostly palm toddy and fermented sugar cane juice) were consumed by 52% of regular drinkers and accounted for 54% of the total alcohol intake reported by all regular drinkers. Based on the reported consumption by regular drinkers only, the average annual alcohol consumption amounted respectively to 20.7 litres and 1.2 litres per man and woman aged 25-64 years, or, using extrapolation, 13.2 litres and 0.8 litres per man and woman respectively of the total population. These values may underestimate the true figures by half, since reported beer consumption accounted for 53% of beer sales. Socio-economic status was associated strongly and inversely with home-brew consumption, but slightly and positively with consumption of commercially marketed beverages. Alcohol intake was associated with smoking, high-density lipoprotein cholesterol, carbohydrate-deficient transferrin and blood pressure, but not with age and body mass index. In conclusion, these data show high alcohol consumption in the Seychelles with an important gender difference, a large proportion of alcohol derived from home-brews, and opposite tendencies for the relationships between socio-economic status and home-made or commercially marketed beverages.

Decomposing Cross-Country Gaps in Obesity and Overweight: Does the Social Environment Matter?

[cat] Una q��esti�� clau sobre la producci�� de salut relativament poc explorada es refereix a la influ��ncia dels factors socioecon��mics i mediambientals sobre el pes i l���obesitat. Aquesta problem��tica adquireix particular rellev��ncia quan es comparen dos pa��sos Mediterranis com It��lia i Espanya. ��s interessant adonar-se que l���obesitat a Espanya ��s 5 punts percentual m��s elevada al 2003 mentre que a l���any 1990 era aproximadament la mateixa en ambd��s pa��sos. Aquesta article presenta una descomposici�� no lineal dels gaps o diferencials en taxes de sobrep��s (��ndex de massa corporal ��� IMC- entre 25 i 29.9 9 kg/m2), obesitat classe 1 (IMC���30 kg/m2) i classe 2 (IMC���35 kg/m2) entre Espanya i It��lia per g��nere i grups d���edat. En explicar aquests gaps entre pa��sos a��llem les influ��ncies dels estils de vida, els efectes socioecon��mics i els mediambientals. Els nostres resultats indiquen que quan no es controla pels efectes mediambientals (efectes de grup o ���peer effects���) els h��bits alimentaris i el nivell educatiu s��n els principals predictors del gaps totals entre pa��sos (36-52%), si b�� aquests dos factors exerceixen un impacte diferenciat segons g��nere i edat. Un tant paradoxalment, quan controlem pels efectes de grup aquests predictors perden la seva capacitat explicativa i els efectes de grup passen a explicar entre el 46-76% dels gaps en sobrep��s i obesitat i mostren un patr�� creixent amb l���edat.

First consumption ever of multiple substances: applying an expert-based taxonomy to a Swiss national sample of adolescents.

The use of multiple legal and illegal substances by adolescents is a growing concern in all countries, but since no consensus about a taxonomy did emerge yet, it is difficult to understand the different patterns of consumption and to implement tailored prevention and treatment programs directed towards specific subgroups of the adolescent population. Using data from a Swiss survey on adolescent health, we analyzed the age at which ten legal and illegal substances were consumed for the first time ever by applying a method combining the strength of both automatic clustering and use of substance experts. Results were then compared to 30 socio-economic factors to establish the usefulness of and to validate our taxonomy. We also analyzed the succession of substance first use for each group. The final taxonomy consists of eight groups ranging from non-consumers to heavy drug addicts. All but four socio-economic factors were significantly associated with the taxonomy, the strongest associations being observed with health, behavior, and sexuality factors. Numerous factors influence adolescents in their decision to first try substances or to use them on a regular basis, and no factor alone can be considered as an absolute marker of problematic behavior regarding substance use. Different processes of experimentation with substances are associated with different behaviors, therefore focusing on only one substance or only one factor is not efficient. Prevention and treatment programs can then be tailored to address specific issues related to different youth subgroups.

Iowa Wetland Management District: Environmental Assessment and Draft Comprehensive Conservation Plan

This Environmental Assessment documents the National Environmental Policy Act (NEPA) process for developing a Comprehensive Conservation Plan (CCP) for the Iowa Wetland Management District (WMD, district). In general, scoping reveals issues that drive alternative ways of managing the district. Implementation of each of those alternative management styles (including the No Action Alternative) may have different effects on the physical, biological, and socio-economic environment. Analysis of these effects reveals the ���preferred��� alternative, which constitutes the CCP. The CCP includes goals, objectives, and strategies for the district to guide overall management for the next 15 years. The Iowa WMD consists of scattered tracts of habitat (both wetland and upland grassland) known as Waterfowl Production Areas (WPAs). As of 2011, there are 75 WPAs in 18 counties in north-central Iowa totaling 24,712 acres in fee title primarily managed by the Iowa Department of Natural Resources (DNR). Even though district acquisition has only occurred in 18 counties to date, a larger 35-county boundary is approved. This boundary follows the historic range of the poorly drained Prairie Pothole Region (PPR) in Iowa, an area known for its waterfowl production. The district also includes 575 WPA acres and approximately 434 Farm Service Agency acres in conservation easements on private land. This plan was prepared with the intent that the strong partnership with the Iowa DNR will continue over the next 15 years.

Algies apr��s cure de hernie inguinale: que faire [Pain after inguinal hernia repair: what to do?]

Hernia repair one of the most frequently performed operations in general surgery. With the introduction of tension-free mesh repair, recurrence rates dropped well below 5% for open and laparoscopic procedures. However, chronic postoperative pain remains a widely neglected complication with a high socio-economic impact. It occurs in about 10-20% of patients after hernia repair. We review the different types of post-herniorrhaphy pain with the typical diagnostic features and we conclude with a pragmatic algorithm based on our clinical experience.

Heterogeneity, selection and labor market disparities

We study the incentives to acquire skill in a model where heterogeneous firmsand workers interact in a labor market characterized by matching frictions and costlyscreening. When effort in acquiring skill raises both the mean and the variance of theresulting ability distribution, multiple equilibria may arise. In the high-effort equilibrium, heterogeneity in ability is sufficiently large to induce firms to select the bestworkers, thereby confirming the belief that effort is important for finding good jobs.In the low-effort equilibrium, ability is not sufficiently dispersed to justify screening,thereby confirming the belief that effort is not so important. The model has implications for wage inequality, the distribution of firm characteristics, sorting patternsbetween firms and workers, and unemployment rates that can help explaining observedcross-country variation in socio-economic and labor market outcomes.

How the West "invented" fertility restriction

We analyze the rise of the first socio-economic institution in history that limited fertility ? long before theDemographic Transition. The "European Marriage Pattern" (EMP) raised the marriage age of women andensured that many remained celibate, thereby reducing childbirths by up to one third between the 14thand 18th century. To explain the rise of EMP we build a two-sector model of agricultural production ?grain and livestock. Women have a comparative advantage in the latter because plow agriculture requiresphysical strength. After the Black Death in 1348-50, land abundance triggered a shift towards the landintensivepastoral sector, improving female employment prospects. Because women working in animalhusbandry had to remain unmarried, more farm service spelled later marriages. The resulting reductionin fertility led to a new Malthusian steady state with lower population pressure and higher wages. Themodel can thus help to explain the divergence in income per capita between Europe and Asia long beforethe Industrial Revolution. Using detailed data from England after 1290, we provide strong evidence forour mechanism. Where pastoral agriculture dominated, more women worked as servants, and marriageoccurred markedly later. Overall, we estimate that pastoral farming raised female ages at first marriage bymore than 4 years.

Disentangling the link between health and social capital: A comparison of immigrant and native-born populations in Spain

An increasing body of research has pointed to the relevance of social capital in studying a great variety of socio-economic phenomena, ranging from economics growth and development to educational attainment and public health. Conceptually, our paper is framed within the debates about the possible links between health and social capital, on one hand, and within the hypotheses regarding the importance of social and community networks in all stages of the dynamics of international migration, on the other hand. Our primary objective is to explore the ways social relations contribute to health differences between the immigrants and the native-born population of Spain. We also try to reveal differences in the nature of the social networks of foreign-born, as compared to that of the native-born persons. The empirical analysis is based on an individual-level data coming from the 2006 Spanish Health Survey, which contains a representative sample of the immigrant population. To assess the relationship between various health indicators (self-assessed health, chronic conditions and long-term illness) and social capital, controlling for other covariates, we estimate multilevel models separately for the two population groups of interest. In the estimates we distinguish between individual and community-level social capital. While the Health Survey contains information that allows us to define individual social capital measures, the collective indicators come from other official sources. In particular, for the subsample of immigrants, we proxy community-level networks and relationships by variables contained in the Spanish National Survey of Immigrants 2007. The results obtained so far point to the relevance of social capital as a covariate in the health equation, although, the significance varies according to the specific health indicator used. Additionally, and contrary to what is expected, immigrants��� social networks seem to be inferior to those of the native-born population in many aspects; and they also affect immigrant���s health to a lesser extent. Policy implications of the findings are discussed. Keywords: health status, social capital, immigration, Spain

Estudi de les aig��es salines a la conca del riu Llobregat i Cardener : implicacions ambientals

L���increment de la salinitat a les aig��es subterr��nies a prop de la zones de les explotacions mineres salines representa un problema ambiental amb moltes implicacions socio-econ��miques. La part mitja de la conca del riu Llobregat i Cardener ��s un clar exemple d���aquesta problem��tica. En molts casos l���origen de la salinitat ��s dubt��s, ja que pot provenir del contacte de l���aigua de l���aq����fer amb formacions geol��giques salines naturals o per l���afectaci�� de les escombreres produ��des per l���explotaci�� minera de potasses que es troba en aquesta regi��. L���objectiu d���aquest treball ��s demostrar que el Ra pot ser un bon tra��ador per determinar l���origen de la salinitat de les aig��es i complementar les anal��tiques qu��miques elementals i dels is��tops del sofre i de l���oxigen del sulfat (��34SSO4 i ��18OSO4). La pres��ncia dels diversos is��tops del Ra en les aig��es subterr��nies dependr�� de la geologia i del temps de resid��ncia de l���aigua dins l���aq����fer. L���an��lisi de 12 mostres de la comarca indica que el 226Ra ��s el millor dels is��tops del Ra que permet diferenciar l���origen de les aig��es subterr��nies.

Does unemployment hurt less if there is more of it around? A panel analysis of life satisfaction in Germany and Switzerland

This paper examines the existence of a habituation effect to unemployment: Do theunemployed suffer less from job loss if unemployment is more widespread, if their ownunemployment lasts longer and if unemployment is a recurrent experience? Theunderlying idea is that unemployment hysteresis may operate through a sociologicalchannel: if many people in the community lose their job and remain unemployed over anextended period, the psychological cost of being unemployed diminishes and the pressureto accept a new job declines. We analyze this question with individual-level data from theGerman Socio-Economic Panel (1984-2009) and the Swiss Household Panel (2000-2009). We find no evidence for a mitigating effect of high surrounding unemployment onunemployed individuals' subjective well-being: Becoming unemployed hurts as muchwhen regional unemployment is high as when it is low. Likewise, the strongly harmfulimpact of being unemployed on well-being does not wear off over time, nor do repeatedepisodes of unemployment make it any better. It thus appears doubtful that anunemployment shock becomes persistent because the unemployed become used to, andhence reasonably content with, being without a job.

Exercici terap��utic cognitiu en lesions cerebrals

Estudi experimental basat amb el m��tode Perfetti realitzat per avaluar l���efic��cia i l���efici��ncia del tractament envers a les diferents afectacions cerebrals que pot tenir un pacient quan ha patit un AVC (Accident Vascular Cerebral). Farem un estudi quantitatiu, tenint en compte unes variables espec��fiques que ens indicaran d���una forma molt m��s acurada l���evoluci�� del pacient des de l��� inici fins a la fi del tractament. Hem de tenir en compte que al ser un estudi experimental ens podem trobar amb certes limitacions, impl��cites com trobar la idone��tat de la mostra de pacients o que totes les afectacions cerebrals d���estudi siguin compatibles. Sempre tindrem en compte que no es seguir�� un protocol sin�� que ��s un tractament individualitzat i totalment personalitzat. La poblaci�� en el nostre pa��s cada cop envelleix m��s, per aix�� millorar la qualitat de vida ��s imprescindible. El que volem ��s intentar que el pacient millori la seva qualitat de vida minvant la seva depend��ncia i/o discapacitat, despr��s de l���AVC. En conseq����ncia i ja que l���actual situaci�� socioecon��mica no ��s favorable podrem afavorir la reducci�� de l���actual despesa sanit��ria,en aquest tipus de patologies en el nostre pa��s.

Estrat��gies educatives a trav��s de l'expressi�� corporal per a la inclusi�� de l'alumnat amb risc d'exclusi�� social

Aquest document ens explica com afecta la crisi socioecon��mica del nostre pa��s als infants que es troben en situaci�� de risc social. En concret, la recerca es va centrar en una escola p��blica de Torell�� on hi ha un predomini d���infants immigrants. La majoria d���aquests infants es troben en una situaci�� prec��ria i, a m��s, tenen dificultats per entendre la llengua del centre i per comunicar-se amb la mestra tutora de l���aula. Per concloure l���estudi es va elaborar un pla d���acci�� on es mostra que si es porten a terme estrat��gies educatives inclusives, com pot ser l���expressi�� corporal, dins l���aula ordin��ria els infants amb major risc social poden aprendre m��s amb la interacci��.

Sosioekonomisten tekij��iden yhteys terveyteen 75- ja 80-vuotiailla jyv��skyl��l��isill�� miehill�� ja naisilla

Summary: Socio-economic factors and health among 75- and 80-year-old men and women

A case study of landslides and coping strategies in two villages of central-eastern Nepal

Landslides are an increasing problem in Nepal's Middle Hills due to both natural and human phenomena: mainly increasingly intense monsoon rains and a boom in rural road construction. This problem has largely been neglected due to underreporting of losses and the dispersed nature of landslides. Understanding how populations cope with landslides is a first step toward developing more effective landslide risk management programs. The present research focuses on two villages in Central-Eastern Nepal, both affected by active landslides but with different coping strategies. Research methods are interdisciplinary, based on a geological assessment of landslide risk and a socio-economic study of the villages using household questionnaires, focus group discussions and transect walks. Community risk maps are compared with geological landslide risk maps to better understand and communicate community risk perceptions, priorities and coping strategies. A modified typology of coping strategies is presented, based on previous work by Burton, Kates, and White (1993) that is useful for decision-makers for designing more effective programs for landslide mitigation. Main findings underscore that coping strategies, mainly seeking external assistance and outmigration, are closely linked to access to resources, ethnicity/social status and levels of community organization. Conclusions include the importance of investing in organizational skills, while building on local knowledge about landslide mitigation for reducing landslide risk. There is great potential to increase coping strategies by incorporating skills training on landslide mitigation in existing agricultural outreach and community forest user group training.