Enseignement de recommandations pour la pratique: la prévention et le dépistage [Teaching practice recommendations: prevention and screening].

The aim of this article is to provide guidance to family doctors on how to tutor students about effective screening and primary prevention. Family doctors know their patients and adapt national and international guidelines to their specific context, risk profile, sex and age as well as to the prevalence of the disorders under consideration. Three cases are presented to illustrate guideline use according to the level of evidence (for a 19-year-old man, a 60-year-old woman, and an 80-year-old man). A particular strength of family medicine is that doctors see their patients over the years. Thus they can progressively go through the various prevention strategies, screening, counselling and immunisation, accompanying their patients with precious advice for their health throughout their lifetime.

Insects associated with tropical foliage produced in the coffee growing region of Colombia

We conducted a survey of insects and pest management practices on 34 farms growing ornamental tropical foliage plants in the central coffee region of Colombia over two years. Tropical foliage provided habitat for a diverse range of insects. In total, phytophagous or detritivorous insects from six orders, 40 families and 62 genera were collected. The most common were Hemiptera (29 genera from 16 families), followed by Coleoptera (17 genera from 4 families), Diptera (5 genera from 5 families), Lepidoptera (5 genera from 4 families), Hymenoptera (3 genera from 2 families) and Orthoptera (2 genera from 2 families). The most common phytophagous species were leaf cutting ants (Atta and Acromyrmex spp.), leaf beetles (Chrysomelidae), leafhoppers (Cicadellidae), stinkbugs (Pentatomidae), squash bugs (Coreidae), tree hoppers (Membracidae) and plant hoppers (Fulgoridae). Beneficial insects identified from tropical foliage included predators and parasitoids amongst 5 orders, 12 families and 22 genera. The most abundant were predators among the Coccinellidae, Chrysopidae, Reduviidae, Lycidae and Formicidae but only low numbers of parasitoids (Ichneumonidae, Braconidae and Tachinidae) were collected. A pest management questionnaire given to growers revealed a preponderance of reliance on broad spectrum insecticides with a smaller number of growers (approximately one third) also using some biological control methods. Our survey contributes basic information regarding diversity of Neotropical insects associated with ornamental foliage plants.

Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne): implementation of an early intervention programme for psychosis in Switzerland.

AIM: In a survey conducted in the Lausanne catchment area in 2000, we could estimate on the basis of file assessment that first-episode psychosis (FEP) patients had psychotic symptoms for more than 2 years before treatment and that 50% did not attend any outpatient appointment after discharge from hospital. In this paper, we describe the implementation of a specialized programme aimed at improving engagement and quality of treatment for early psychosis patients in the Lausanne catchment area in Switzerland. METHOD: The Treatment and Early Intervention in Psychosis Program-Lausanne is a comprehensive 3-year programme composed of (i) an outpatient clinic based on assertive case management; (ii) a specialized inpatient unit; and (iii) an intensive mobile team, connected for research to the Center for Psychiatric Neuroscience. RESULTS: Eight years after implementation, the programme has included 350 patients with a disengagement rate of 9% over 3 years of treatment. All patients have been assessed prospectively and 90 participated in neurobiological research. Based on this experience, the Health Department funded the implementation of similar programmes in other parts of the state, covering a total population of 540 000 people. CONCLUSION: Programmes for early intervention in psychosis have a major impact on patients' engagement into treatment. While development of mobile teams and assertive case management with specific training are crucial, they do not necessitate massive financial support to be started. Inclusion of a research component is important as well, in terms of service planning and improvement of both quality of care and impact of early intervention strategies.

Extracção de areia na praia de Calhetona (Ilha de Santiago, Cabo Verde): causas, processos e consequências

A extracção clandestina de areia, nas faixas costeiras e nos leitos das ribeiras, tem sido prática de muitos agregados familiares cabo-verdianos. Nas últimas décadas, a praia de Calhetona (Ilha de Santiago) foi um dos muitos locais que sofreram degradação ambiental significativa, devido à realização desta actividade sem quaisquer planos de extracção e de posterior recuperação das áreas degradadas. Este trabalho, através da conjugação de recolha de dados por inquérito, observação directa e pesquisa documental e bibliográfica, teve como objectivos a caracterização da comunidade (que habita no bairro de Ponta Calhetona) que se dedica à extracção de areia na praia de Calhetona, a descrição da dinâmica da actividade extractiva, a avaliação da percepção que a comunidade tem relativamente às consequências da sua actividade e a descrição do impacte ambiental resultante da extracção de areia. Da análise dos inquéritos, efectuados em Fevereiro de 2012, a 25 chefes de agregados familiares que efectuam a extracção de areia na praia de Calhetona, constata-se que estes são maioritariamente mulheres, predominantemente com idade compreendida entre os 40 e os 59 anos, domésticas, com baixa escolaridade, com famílias numerosas e/ou alargadas a seu cargo e dedicando-se à extração de areia à mais de 10 anos. Os inquiridos, face à situação de vulnerabilidade económica, à falta de emprego e à grande procura de areia para a construção civil, vêem nesta actividade uma fonte de rendimento. Contudo, o proveito obtido desta actividade difícil e potencialmente perigosa é reduzido. Quem efectivamente beneficia são os camionistas que compram a areia a quem procede à extracção e a vendem ao consumidor final pelo dobro do preço. Os inquiridos demonstram uma consciência generalizada dos diversos impactes ambientais negativos resultantes da sua actividade, mas alegam que a extracção de areia é uma das poucas alternativas existentes para providenciar o sustento dos seus agregados familiares. Com base na comparação do estado actual da praia de Calhetona com relatos de habitantes locais, relativos às características da mesma no passado, verifica-se que nos últimos 40-50 anos, desde que se iniciou a intensa extracção de areia nesta praia, o seu aspecto físico se degradou claramente. Essa degradação caracteriza-se principalmente pelo recuo da linha de costa, pela quase ausência de areia e pela salinização dos solos localizados nas proximidades da praia, para além dos consequentes impactes negativos sobre a desova das tartarugas e o turismo balnear.

Reconstruction fronto-orbitaire complexe avec prothèse en PEEK et expansion cutanée : à propos d'un cas [Complex fronto-orbital reconstruction with a PEEK prosthesis and skin expansion: about a case].

INTRODUCTION: Reconstructions of the fronto-orbital area remain a challenge to the reconstructive surgeon, due to the functional and esthetic impact. OBSERVATION: The authors present a case of a complex fronto-orbital reconstruction with a PEEK (PolyEtherEtherKetone) implant, associated with a skin expansion. DISCUSSION: With a follow-up of over three years, the cosmetic result is excellent. The authors believe that this technique is reliable, fast with long-term good results.

Temperature-induced sex reversal is not responsible for sex-ratio distortions in grayling Thymallus thymallus or brown trout Salmo trutta.

On the basis of the experiments carried out over various years, it was concluded that (1) grayling Thymallus thymallus and brown trout Salmo trutta are resistant to temperature-induced sex reversal at ecologically relevant temperatures, (2) environmental sex reversal is unlikely to cause the persistent sex ratio distortion observed in at least one of the study populations and (3) sex-specific tolerance of temperature-related stress may be the cause of distorted sex ratios in populations of T. thymallus or S. trutta.

Gene-Age Interactions in Blood Pressure Regulation: A Large-Scale Investigation with the CHARGE, Global BPgen, and ICBP Consortia.

Although age-dependent effects on blood pressure (BP) have been reported, they have not been systematically investigated in large-scale genome-wide association studies (GWASs). We leveraged the infrastructure of three well-established consortia (CHARGE, GBPgen, and ICBP) and a nonstandard approach (age stratification and metaregression) to conduct a genome-wide search of common variants with age-dependent effects on systolic (SBP), diastolic (DBP), mean arterial (MAP), and pulse (PP) pressure. In a two-staged design using 99,241 individuals of European ancestry, we identified 20 genome-wide significant (p ≤ 5 × 10(-8)) loci by using joint tests of the SNP main effect and SNP-age interaction. Nine of the significant loci demonstrated nominal evidence of age-dependent effects on BP by tests of the interactions alone. Index SNPs in the EHBP1L1 (DBP and MAP), CASZ1 (SBP and MAP), and GOSR2 (PP) loci exhibited the largest age interactions, with opposite directions of effect in the young versus the old. The changes in the genetic effects over time were small but nonnegligible (up to 1.58 mm Hg over 60 years). The EHBP1L1 locus was discovered through gene-age interactions only in whites but had DBP main effects replicated (p = 8.3 × 10(-4)) in 8,682 Asians from Singapore, indicating potential interethnic heterogeneity. A secondary analysis revealed 22 loci with evidence of age-specific effects (e.g., only in 20 to 29-year-olds). Age can be used to select samples with larger genetic effect sizes and more homogenous phenotypes, which may increase statistical power. Age-dependent effects identified through novel statistical approaches can provide insight into the biology and temporal regulation underlying BP associations.

Que promettent les styles d'interactions? Une approche sociologique de l'intimité conjugale

This article intends to grasp the stabilization process, deterioration or improvement of the conjugal intimacy over five years, based on a representative sample of couples living in Switzerland. The dynamics develop in different ways depending on the degree of autonomy of the partners, the gendering of household tasks, conjugal openess and the coping strategies of the couples.

Cavernomas and brain cysts as treatment-related sequelae in survivors of pediatric brain tumors

Cavernomas after radiotherapy, developing in irradiated children treated for malignant brain tumors, are capillary malformations that are frquently asymptomatic and benign in their evolution. However, in some children this can lead to haemorrhage, which can cause symptoms and need a surgical intervention. Although there is increasing evidence of cavernoma as a possible long term sequelae after radiotherapy, there is still information needed concerning very long follow-up. Different groups studied this problem focusing on incidence and the lag time radiotherapy and the appearance of cavernomas. Results showed that the period can last a long time and the cumulative incidence increases over the years, but the numbers vary between the different publications. More recently researchers tried to compare several predictive factors with the incidence of cavernomas, such as age at radiotherapy, gender, kind of cancer and chemotherapy. No relation has been recorded except a growing incidence when the radiotherapy was started before the age of ten. Reason of the study : The observations reported until now comprised a very heterogenous cohort of patients. No study has ever been made with patients affected only by malignant brain tumors which are typical in a children. As for the studied predictive factors, no publication described the technical aspect of radiotherapy. Objectives: To study a population of pediatric patients children with only malignant brain tumors in order tp calculate the incidence of cavernomas after radiotherapy and their evolution over a longer period compared to so far published researches. To analyse known predictive factors such as age of children at the moment of the radiotherapy, gender, and kind of cancer. To study extensively the role technical aspects of radiotherapy in the occurrence of cavernomas. Methodology: Retrospective study of a group of 62 children irradiated at the CHUV (Lausanne, Switzerland) between 1975 and 2010 due to the following malignant brain cancers: medulloblastoma, ependymoma, PNET. The images of IRM post radiotherapy will be analysed by a neuroradiologist and a radiotherapist will interpret the radiotherapy data. Expected results: We expect to find relations between the incidence of cavernomas post radiotherapy and the predictive factors including different techniques of radiotherapy and consequently to define the best long-term follow up of the children at risk.

Quantitative analysis of crystal/grain sizes and their distributions in 2D and 3D

We review methods to estimate the average crystal (grain) size and the crystal (grain) size distribution in solid rocks. Average grain sizes often provide the base for stress estimates or rheological calculations requiring the quantification of grain sizes in a rock's microstructure. The primary data for grain size data are either 1D (i.e. line intercept methods), 2D (area analysis) or 3D (e.g., computed tomography, serial sectioning). These data have been used for different data treatments over the years, whereas several studies assume a certain probability function (e.g., logarithm, square root) to calculate statistical parameters as the mean, median, mode or the skewness of a crystal size distribution. The finally calculated average grain sizes have to be compatible between the different grain size estimation approaches in order to be properly applied, for example, in paleo-piezometers or grain size sensitive flow laws. Such compatibility is tested for different data treatments using one- and two-dimensional measurements. We propose an empirical conversion matrix for different datasets. These conversion factors provide the option to make different datasets compatible with each other, although the primary calculations were obtained in different ways. In order to present an average grain size, we propose to use the area-weighted and volume-weighted mean in the case of unimodal grain size distributions, respectively, for 2D and 3D measurements. The shape of the crystal size distribution is important for studies of nucleation and growth of minerals. The shape of the crystal size distribution of garnet populations is compared between different 2D and 3D measurements, which are serial sectioning and computed tomography. The comparison of different direct measured 3D data; stereological data and direct presented 20 data show the problems of the quality of the smallest grain sizes and the overestimation of small grain sizes in stereological tools, depending on the type of CSD. (C) 2011 Published by Elsevier Ltd.

Automatització d'una planta de processos químics

Resum L’any 1969 es van començar a comercialitzar els sistemes digitals programables coneguts com autòmats programables o PLC’s, utilitzats per controlar qualsevol tipus de procés industrial. Al llarg de tots aquests anys, aquests sistemes i tota la tecnologia en general han evolucionat molt, i només és qüestió de temps que la tecnologia que utilitzem avui en dia quedi obsoleta i substituïda per una de millors característiques i amb més avantatges. Aquest és el motiu de l’elaboració d’aquest treball, que com a objectiu pretén modernitzar un procés de fabricació d’una industria química que ha quedat molt limitat a causa de l’antiguitat de la instal•lació. Per dur a terme aquesta modernització, s’introdueixen sistemes de control amb majors prestacions, s’utilitzen xarxes de comunicacions per facilitar el muntatge elèctric de la instal•lació i un sistema de supervisió i adquisició de dades per poder obtenir un control més estricte del procés de fabricació i de tots els factors que intervenen. El funcionament del procés de fabricació és que a partir d’unes matèries primeres líquides emmagatzemades en dipòsits, es dosifiquin aquestes matèries en l’ordre i la quantitat desitjada dins un o diversos recipients per barrejar-les i aplicar els tractaments que siguin necessaris. Tot aquest procés està controlat per un autòmat programable, i disposa de diferents terminals operadors per poder interactuar amb el sistema. També té implementat un sistema SCADA en diversos ordinadors per aportar una visió general de la planta en temps real, un registre de dades dels paràmetres que es controlen i alhora serveix per enllaçar amb la xarxa d’ordinadors existent. Com annex d’aquest treball, es presenten els esquemes elèctrics i el programa de l’autòmat programable per veure totes les característiques elèctriques dels dispositius i el mètode de funcionament del procés. S’ha aconseguit donar un salt tecnològic i poder gaudir de tots els avantatges que ofereixen les noves tecnologies, que com a resultat s’ha optimitzat i millorat el procés de fabricació. De totes les conclusions, la més destacada és la d’haver dissenyat un sistema de control basat en una estructura descentralitzada molt flexible, que es pot expandir i adaptar fàcilment als possibles canvis.

Estudi i implantació de programari lliure

RESUM Actualment la majoria de nosaltres sabem de l’existència de molts programes lliures, però hem tenir clar que lliure no vol dir sempre programa gratuït. Tot i que a vegades sí que pot ser-ho, es té en compte molt més que això: és una manera de pensar i entendre el programari i al llarg dels anys ha generat tot un moviment social. Considerem que un programa lliure és aquell que garanteix als usuaris la llibertat per executar, copiar, distribuir, estudiar, canviar i millorar el codi programat, com molt bé defineixen les seves llibertats bàsiques. El programari lliure el podem trobar funcionant en ordinadors personals, escoles, empreses diverses, administracions, etc. ja que la majoria de programes que utilitzen actualment, com hem vist, tenen el seu equivalent en lliure. El fet de si és viable que una empresa es passi a programari lliure, depèn ben bé del seu entorn, ja que en funció d’aquest li serà més o menys fàcil la migració. La finalitat d’aquest projecte és, primer de tot, fer un ampli estudi del món del programari lliure i del seu moviment social. S’ha fet una recerca de diferents aspectes dins del programari lliure per conèixer-lo a fons i després s’ha proposat una possible implantació d’aquest en un usuari domèstic i en una administració pública, tenint en compte tots els aspectes vistos en l’estudi, valorant si totes les idees que defensa i els beneficis que aporta són aplicables i viables en qualsevol persona i àmbit i el perquè. Com a conclusió principal en destacaria que tot i que el programa lliure disposa d’una ideologia que agrada i té uns programes tècnicament perfectes (sense que això sigui el seu objectiu principal), penso que encara hi ha molt camí per recórrer quant a una migració en grans entorns, ja que per exemple en un ajuntament una migració total és encara difícil (tot i que no impossible perquè n’hi ha que s’hi han migrat). A l’apartat d’annexos s’hi inclou un glossari amb un seguit de terminologies amb paraules que no tothom pot saber i s’ha cregut oportú incloure-les en aquest apartat. La primera vegada que apareix alguna d’aquestes paraules la podem trobar senyalitzada amb un *.

Centres diürns d'atenció a la gent gran: grau de satisfacció dels usuaris i familiars

Estudi descriptiu sobre els centres de dia i centres de serveis per a la gent gran, dos recursos que ofereixen atenció diürna, i sobre la satisfacció que comporta assistir a un o a l’altre. OBJECTIUS. Descriure i comparar dos models d’atenció diürna per a la gent gran, i els graus de satisfacció d’aquells que els utilitzen. MÈTODES. Estudi multicèntric descriptiu, de disseny és transversal. Portat a terme entre els mesos d’abril i juny de 2011, en set centres de serveis i un centre de dia, ha inclòs un total de 296 persones. S’ha fet una valoració del grau de satisfacció d’usuaris i familiars mitjançant una enquesta de disseny propi. RESULTATS. Els centres de dia, que es troben situats en zones urbanes, ofereixen un únic servei (servei d’estada), on el 41,94% de les persones tenen una elevada dependència. Els centres de serveis, que estan situats en zones rurals, ofereixen serveis d’estada, ambulatoris, tallers i atenció a domicili, i el 25,58% de les persones mostra una dependència elevada. El grau de satisfacció en els dos tipus de centres és elevada tant en famílies 87,63%, com en usuaris 96.5% . CONCLUSIÓ. Són dos models que tenen similituds, però ofereixen diferents tipus de serveis. Creats amb més de 15 anys de diferència, és possible que el centre de serveis acabi sent l’evolució natural del centre de dia.

Medical demography and intergenerational inequalities in general practitioners' earnings

This article examines the link between restrictions on the number of physicians and general practitioners' (GPs) earnings. Using a representative panel of 6016 French self-employed GPs over the years 1983-2004, we estimate an earnings function to identify experience, time and cohort effects. The estimated gap in earnings between 'good' and 'bad' cohorts can be as large as 25%. GPs who began their practices during the eighties have the lowest permanent earnings: they belong to the large cohorts of the baby-boom and face the consequences of an unlimited number of places in medical schools. Conversely, the decrease in the number of places in medical schools led to an increase in permanent earnings of GPs who began their practices in the mid-nineties. A stochastic dominance analysis shows that unobserved heterogeneity does not compensate for average differences in earnings between cohorts. These findings suggest that the first years of practice are decisive for a GP. If competition between physicians is too intense at the beginning of their careers, they will suffer from permanently lower earnings. To conclude, our results show that the policies aimed at reducing the number of medical students succeeded in buoying up physicians' permanent earnings. [Ed.]

Effects of zoledronate versus placebo on spine bone mineral density and microarchitecture assessed by the trabecular bone score in postmenopausal women with osteoporosis: A three-year study.

The trabecular bone score (TBS) is an index of bone microarchitectural texture calculated from anteroposterior dual-energy X-ray absorptiometry (DXA) scans of the lumbar spine (LS) that predicts fracture risk, independent of bone mineral density (BMD). The aim of this study was to compare the effects of yearly intravenous zoledronate (ZOL) versus placebo (PLB) on LS BMD and TBS in postmenopausal women with osteoporosis. Changes in TBS were assessed in the subset of 107 patients recruited at the Department of Osteoporosis of the University Hospital of Berne, Switzerland, who were included in the HORIZON trial. All subjects received adequate calcium and vitamin D3. In these patients randomly assigned to either ZOL (n = 54) or PLB (n = 53) for 3 years, BMD was measured by DXA and TBS assessed by TBS iNsight (v1.9) at baseline and 6, 12, 24, and 36 months after treatment initiation. Baseline characteristics (mean ± SD) were similar between groups in terms of age, 76.8 ± 5.0 years; body mass index (BMI), 24.5 ± 3.6 kg/m(2) ; TBS, 1.178 ± 0.1 but for LS T-score (ZOL-2.9 ± 1.5 versus PLB-2.1 ± 1.5). Changes in LS BMD were significantly greater with ZOL than with PLB at all time points (p < 0.0001 for all), reaching +9.58% versus +1.38% at month 36. Change in TBS was significantly greater with ZOL than with PLB as of month 24, reaching +1.41 versus-0.49% at month 36; p = 0.031, respectively. LS BMD and TBS were weakly correlated (r = 0.20) and there were no correlations between changes in BMD and TBS from baseline at any visit. In postmenopausal women with osteoporosis, once-yearly intravenous ZOL therapy significantly increased LS BMD relative to PLB over 3 years and TBS as of 2 years. © 2013 American Society for Bone and Mineral Research.