Maladies vasculaires: quels dépistages au cabinet du praticien [Vascular diseases: what screening could be done in the office?]

The screening of vascular pathologies in physician offices starts with precise medical history and clinical exam. Tools like the Edinburgh Claudication Questionnaire for the peripheral artery disease or the Wells score for the probability of a thromboembolic event are useful. The measure of the ankle brachial index, the D-dimers or any other biological screening are complementary. In the presence of pathological features, it is recommended to organise a specialised consultation in order to precise diagnosis, treatment and follow-up. The screening of a vascular disease is interesting not only for the management of local symptoms, but also for the associated systemic pathologies to provide a preventive medicine of good quality.

Ecological correlations between food availability and mortality: more than you can eat?

Introduction: There is little information regarding the impact of diet on disease incidence and mortality in Switzerland. Objectives: We aimed at assessing the associations between food availability and disease using ecological correlations. Methods: Time-trend ecologic study for period 1970 to 2009. Food availability was measured through the FAO food balance sheets. Standardized mortality rates (SMRs) were obtained from the Swiss Federal Office of Statistics. Cancer incidence data was obtained from the WHO Health for all database and the Vaud cancer registry. Association between food availability and mortality/incidence was assessed at lags 0, 5, 10 and 15 years by Spearman correlation. Results: Alcoholic beverages and fruit availability were positively associated with SMRs from all types of cardiovascular disease, while fish availability was negatively associated. Animal products, meat and animal fats were positively associated with SMR from ischemic heart disease only. For cancers, opposite results were found whether the association used SMRs or incidence rates. For all cancers, alcoholic beverages and fruits were positively associated with SMRs but negatively associated with incidence rates. Similar findings were obtained for all other foods, with the exception of vegetables, which were weakly and negatively associated with SMRs and incidence rates. Finally, a 15 years lag time reversed the association for animal and vegetal products, weakened the association for alcohol and fruits and strengthened the association for fish. Conclusion: Ecologic associations between food availability and disease vary considerably whether mortality or incidence rates are used. Great care should be taken when interpreting the results.

Análise do sistema eletrônico de compras do governo federal brasileiro sob a perspectiva da criação de valor público

O sistema de compras públicas do Governo Federal tem como um de seus objetivos a busca da eficiência. Esse conceito, contudo, amplia-se na medida em que são discutidos na Administração Pública aspectos complexos da criação de valor público, como expressão mais próxima do interesse do cidadão. Buscou-se na literatura identificar categorias que expressam o valor público para, então, analisar o sistema eletrônico de compras do Governo Federal brasileiro. As categorias encontradas foram: eficiência, transparência, accountability e interesse público. Na estratégia de pesquisa adotada, foram empregados os conceitos do pensamento sistêmico-complexo na elaboração de um instrumento de diagnóstico que permite a consideração de inter-relações entre categorias de análise, já aplicado no Ministério do Planejamento, Orçamento e Gestão (MPOG), órgão responsável pela gestão do sistema eletrônico de compras no Governo Federal brasileiro. Os resultados demonstraram que a categoria eficiência destaca-se das demais. Contudo, existem perspectivas para o desenvolvimento das demais categorias. O uso do instrumento de diagnóstico permitiu a percepção de novas possibilidades que podem contribuir para o sistema alcançar objetivos mais amplos no âmbito das compras do Governo Federal, dentre eles a criação de valor público.

Exposition au VIH, à l'hépatite B et C au cabinet médical et à l'hôpital. Prévention et prophylaxie postexpositionnelle [Exposure to HIV, hepatitis B and C in office practice and hospital. Prevention and post-exposure prophylaxis]

Suite à un accident exposant à du sang (piqûre; coupure), provenant d'un patient infecté, le risque d'infection par VIH est d'environ 0,3% et par le virus de l'hépatite C (VHC) d'environ 0,5%. Chez les personnes vaccinées avec une réponse immunitaire adéquate (titre d'anticorps HBs >100 mUI/ml), aucune infection professionnelle par hépatite B n'a été reconnue en Suisse. La plupart des infections par VIH et VHB peuvent être prévenues par un traitement d'urgence et une prophylaxie postexpositionnelle (PEP). Il n'y a actuellement aucune prophylaxie postexpositionnelle pour le VHC. En cas de transmission de VHC, un traitement rapide par peginterféron et ribavirine est à envisager. Chaque hôpital et cabinet médical doivent mettre sur pied un système pour assurer une prise en charge optimale et en urgence des blessures par piqûres ou coupures. Lors de blessures accidentelles avec du sang de patients séropositifs pour le VIH et dans des situations complexes, il est recommandé de consulter un médecin du personnel ou un infectiologue expérimenté. The risk of infection after an occupational needle stick injury with blood from an infected source patient is approximately 0.3% for HIV and 0.5% for hepatitis C virus (HCV). In Switzerland no cases of occupational HBV infection have been recorded in fully vaccinated persons with a documented adequate vaccine response (HBsantibody titer >100 mIU/mL). Most occupational HIV und HBV infections can be prevented by appropriate emergency measures and post-exposure prophylaxis (PEP). No HCV-PEP is currently available. Early therapy with peginterferon and ribavirin should be considered in cases of occupational HCV seroconversion. Every hospital and office practice should establish a system for 24 h/24 h emergency management of occupational needle stick injuries. In the setting of an HIV-seropositive source patient and in complex situations, early consultation with a specialist in occupational medicine or infectious diseases should be considered.

Evolução da demanda ao Curso de Graduação em Enfermagem da Universidade Federal de São Carlos

O estudo analisa a evolução da procura pelo Curso de Graduação em Enfermagem da Universidade Federal de São Carlos (UFSCar), desde o 1º vestibular em 1977 até 1996. Nessa análise serão utilizados comparativamente os dados dos Cursos da Universidade de São Paulo (USP) e da Escola Paulista de Medicina, atualmente denominada Uiversidade Federal de São Paulo (UNIFESP). A crise econômica e do setor da saúde influíram significativamente na queda súbita da procura pelos Cursos na década de 80. Em 1990 o vestibular da UFSCar passou a ser realizado pela Fundação Universitária para o Vestibular (FUVEST). Nesse ano a relação candidato/ vaga atingiu seu nível mais baixo, desde 1977. A partir de 1991, a tendência de retomada do crescimento econômico, e a implantação do Sistema Único de Saúde (SUS) determinaram o crescimento da demanda. Dos três cursos da carreira da Enfermagem na FUVEST, o da UFSCar que é o único do interior do Estado, ainda é o mais procurado em 3ª opção, apesar da procura em 1ª opção ter passado de 2,0 em 1990 para 6,0 em 1995, caindo para 4,6 em 1996. A pouca procura em 1990; os critérios de corte e o procedimento de chamada dos candidatos classificados concorreram para que das 30 vagas oferecidas fossem repreenchidas apenas 15, mesmo com dois vestibulares.

Office of Drug Control Policy, Agency Performance Plan

Annual Report, Agency Performance Plan

(Re)constituer un espace public et promouvoir le débat sans prendre position

This paper presents the analysis of a website created in 2011 by the Federal Office of Public Health (FOPH) to support an information campaign about the organ donation. Observing how a Swiss institution publicly communicates about an issue belonging to the private sphere, this paper describes how the semiotic and discursive resources are mobilised to meet specific goals: promoting discussion and decision about the organ donation while maintaining complete neutrality about the topic. In order to do this, we first discuss the issue of publicising organ donation in Switzerland; then we conduct a detailed analysis of the website to understand the role of the linguistic forms and structures in the communication strategy of the FOPH. This strategy relies on the representation of a public sphere in which ordinary people express conflicting positions about organ donation.

Iowa Problem Indentification for Federal 402 State and Community Highway Safety Programs, Iowa Department of Public Safety, January, 2002

The major objective of this problem identification document is the determination of the relative severity of traffic safety problems in each of the 99 counties. The National Highway Traffic Safety Administration and the Iowa Governor's Traffic Safety Bureau are committed to the reduction of death and injury on the nation's roads. As part of its duty in administering federal traffic safety funds in the State of Iowa, the Governor's Traffic Safety Bureau conducts a comprehensive Problem Identification update each year.

Iowa Department of Transportation Office of Contracts Letting Summary, July 1, 2002 - June 30, 2003

Summary of contracts let by Iowa DOT Office of Contracts in 12 regular and three emergency/special lettings during FY 2003 for construction and maintenance work. It also contains a comparison of quantities and unit contract prices for various items of highway construction work for projects let in fiscal years 2000, 2001, 2002 and 2003.