Training needs in adolescent medicine of practising doctors: a Swiss national survey of six disciplines.

OBJECTIVE: To assess and compare the training needs in adolescent medicine of doctors within 6 specialties as a basis for the development of pre/postgraduate and continuing medical education (CME) training curricula. DESIGN: Cross-sectional postal survey. SETTING: Switzerland. PARTICIPANTS: National, representative, random sample of 1857 practising doctors in 6 disciplines (general practitioners, paediatricians, gynaecologists, internists, psychiatrists, child psychiatrists) registered with the Swiss Medical Association. MAIN OUTCOME MEASURES: Perceived importance of and training interest in 35 topics related to adolescent medicine listed in a self-administered, anonymous questionnaire. RESULTS: A total of 1367 questionnaires were returned, representing a response rate of 73.9%. Clear interest in adolescent medicine was reported by 62.1% of respondents. Topics perceived to be the most important in everyday practice were functional symptoms (71.4%), acne (67.1%), obesity (64.6%), depression-anxiety (68.1%) and communication with adolescents (61.7%). Differences between disciplines were especially marked for gynaecologists, who expressed interest almost exclusively in medical topics specific to their field. In contrast, other disciplines commonly reported a keen interest in psychosocial problems. Accordingly, interest in further training was expressed mostly for functional symptoms (62.4%), eating disorders (56.3%), depression-anxiety (53.7%) and obesity (52.6%). Issues related to injury prevention, chronic disease and confidentiality were rated as low priorities. CONCLUSIONS: Regardless of discipline, Swiss primary care doctors expressed a strong interest in adolescent medicine. Continuing medical education courses should include both interdisciplinary courses and discipline-specific sessions. Further training should address epidemiological and legal/ethical issues (e.g. injury prevention, confidentiality, impact of chronic conditions).

Suomen öljytaseen laskenta kansainvälisessä raportoinnissa ja kansallisessa tilastoinnissa

Työn kohteena olivat Suomen öljytaseeseen liittyvät kansainväliset vuosikyselyt, joiden raportoinnista Suomessa vastaa Tilastokeskus. Samalla tarkasteltiin Tilastokeskuksen laatimia kansallisia energiatilastoja, jotka liittyvät öljyn hankintaan, jalostukseen ja käyttöön. Työn pääpaino oli kuitenkin kansainvälisissä raportoinneissa. Työn tavoitteena oli kehittää Eurostatin, IEA:n ja YK:n vuosittaisen öljykyselyn sekä YK:n ilmastosopimukselle laadittavaan kasvihuonekaasuinventaarioon liittyvän Reference Approach -laskennan raportointia. Selvitysten toivottiin pienentävän öljynhankinnan ja kulutuksen välisistä tase-eroista johtuvia tilastovirheitä. Kansainvälisten raportointien tutkimuksesta odotettiin myös löytyvän kehittämisehdotuksia kansallisiin energiatilastoihin. Vuosittaisten energiakyselyiden pohjalta syntyvät merkittävimmät kansainväliset energiatilastotietokannat. Tietoja käytetään useisiin tarkoituksiin muun muassa energian riittävyyden jakulutuksen analysointiin globaalisti. Reference Approach on taas vaihtoehtoinenlaskentatapa energiakäytöstä ja -tuotannosta aiheutuville hiilidioksidipäästöille. Reference Approach raportoidaan vuosittain YK:n ilmastosopimukselle. Työ toteutettiin tarkastelemalla kansainvälisen öljykyselyn rakennetta ja useista eri lähteistä saatuja öljytuotteiden lähtötietoja. Vuoden 2004 öljykyselyä täydennettiin ja tietoja verrattiin alkuperäiseen raporttiin. Reference Approach -laskennan tutkiminen toteutettiin tarkistamalla öljytuotteiden lähtötiedot ja loppukäytön jakaantuminen energiakäytön ja raaka-ainekäytön välillä. Tutkimuksien pohjalta Reference Approach -aikasarja laskettiin uudelleen ja tuloksia verrattiin alkuperäiseen aikasarjaan. Työn tuloksena saatiin sekä kansainvälistä öljykyselyä että Reference Approach -laskentaa tarkennettua huomattavasti. Samalla tilastovirheet pienenivät merkittävästi. Työssä tehtyjä havaintoja ja tuloksia tullaan hyödyntämään jatkossa sekä Suomen kasvihuonekaasupäästöjen laskennassa että kansainvälisen öljykyselyn raportoinnissa.

External validation of the ASTRAL score to predict 3- and 12-month functional outcome in the China National Stroke Registry.

BACKGROUND AND PURPOSE: The ASTRAL score was recently introduced as a prognostic tool for acute ischemic stroke. It predicts 3-month outcome reliably in both the derivation and the validation European cohorts. We aimed to validate the ASTRAL score in a Chinese stroke population and moreover to explore its prognostic value to predict 12-month outcome. METHODS: We applied the ASTRAL score to acute ischemic stroke patients admitted to 132 study sites of the China National Stroke Registry. Unfavorable outcome was assessed as a modified Rankin Scale score >2 at 3 and 12 months. Areas under the curve were calculated to quantify the prognostic value. Calibration was assessed by comparing predicted and observed probability of unfavorable outcome using Pearson correlation coefficient. RESULTS: Among 3755 patients, 1473 (39.7%) had 3-month unfavorable outcome. Areas under the curve for 3 and 12 months were 0.82 and 0.81, respectively. There was high correlation between observed and expected probability of unfavorable 3- and 12-month outcome (Pearson correlation coefficient: 0.964 and 0.963, respectively). CONCLUSIONS: ASTRAL score is a reliable tool to predict unfavorable outcome at 3 and 12 months after acute ischemic stroke in the Chinese population. It is a useful tool that can be readily applied in clinical practice to risk-stratify acute stroke patients.

Assessment of glenoid inclination on routine clinical radiographs and computed tomography examinations of the shoulder.

BACKGROUND: Accurate assessment of glenoid inclination is of interest for a variety of conditions and procedures. The purpose of this study was to develop an accurate and reproducible measurement for glenoid inclination on standardized anterior-posterior (AP) radiographs and on computed tomography (CT) images. MATERIALS AND METHODS: Three consistently identifiable angles were defined: Angle α by line AB connecting the superior and inferior glenoid tubercle (glenoid fossa) and the line identifying the scapular spine; angle β by line AB and the floor of the supraspinatus fossa; angle γ by line AB and the lateral margin of the scapula. Experimental study: these 3 angles were measured in function of the scapular position to test their resistance to rotation. Conventional AP radiographs and CT scans were acquired in extension/flexion and internal/external rotation in a range up to ±40°. Clinical study: the inter-rater reliability of all angles was assessed on AP radiographs and CT scans of 60 patients (30 with proximal humeral fractures, 30 with osteoarthritis) by 2 independent observers. RESULTS: The experimental study showed that angle α and β have a resistance to rotation of up to ±20°. The deviation from neutral position was not more than ±10°. The results for the inter-rater reliability analyzed by Bland-Altman plots for the angle β fracture group were (mean ± standard deviation) -0.1 ± 4.2 for radiographs and -0.3 ± 3.3 for CT scans; and for the osteoarthritis group were -1.2 ± 3.8 for radiographs and -3.0 ± 3.6 for CT scans. CONCLUSION: Angle β is the most reproducible measurement for glenoid inclination on conventional AP radiographs, providing a resistance to positional variability of the scapula and a good inter-rater reliability.

Les Comptes régionaux des branches industrielles en 1978 / Institut national de la statistique et des études économiques ; [par] Laurent Bisault

Collection : Les Collections de l'INSEE ; 426, 51

Les Comptes régionaux des branches industrielles en 1979 et 1980 / Institut national de la statistique et des études économiques ; [par] Laurent Bisault et Jean-Paul Blandinières

Collection : Les Collections de L'INSEE ; 454, 54

Comptes régionaux des branches industrielles de 1981 à 1983 / Ministère de l'économie, des finances et de la privatisation, Institut national de la statistique et des études économiques ; [réd. par] J.-C. Donnellier, J. Maliverney et E. Montlouis

Collection : Les Collections de l'INSEE ; 539, 63

L'Appareil productif régional de 1975 à 1984 : une analyse des valeurs ajoutées / Ministère de l'économie, des finances et de la privatisation, Institut national de la statistique et des études économiques ; [réd. par] Jean-Christophe Donnellier, Jacques Maliverney et Elisabeth Montlouis

Collection : Les Collections de l'INSEE ; 561, 64

Les Comptes régionaux des ménages 1981-1984 ; Les comptes régionaux des administrations publiques locales en 1982 / Institut national de la statistique et des études économiques ; [par] Jean-Christophe Donnellier [et] Patrick Blanc

Collection : Les Collections de l'INSEE ; 575, 67

Les Comptes régionaux des collectivités locales de 1962 à 1967 / Institut national de la statistique et des études économiques ; [rédigé] par Monique Gombert, Gérard Lattès et Jean-Claude Prager

Collection : Les Collections de l'Insee ; 80, 10

Les Comptes régionaux de l'agriculture : de 1962 à 1967 / Institut national de la statistique et des études économiques ; [rédigé] par Jean Ousset

Collection : Les Collections de l'Insee ; 104, 13

L'Adéquation entre la formation et l'emploi dans les régions / Ministère de l'économie et des finances, Institut national de la statistique et des études économiques ; [rédigé par] Jean-Marie Chanut

Collection : Les Collections de l'Insee ; 236, 26