Comparison of two osteoporotic fracture management pathways: experience at 1 year

Introduction: Osteoporosis presenting as low-impact fractures to traumatology units is often undiagnosed and under-treated. Results from the Osteocare study in Lausanne (a nurse based intervention, passive pathway) showed that only 19% of patients received management for osteoporosis, and in the literature [1], the rate is between 10-25%. We have evaluated a different management concept, based on the systematic assessment of patients with osteoporotic fractures during and after hospitalization (active pathway). Methods: Inpatients admitted to the Department of Musculoskeletal Medicine for a fragility fracture were identified by a nurse according to a predefined questionnaire and were then clinically evaluated by a doctor. Based on the results, a management plan was proposed to the patients. Patients could choose between follow up either by their GP or by the Centre of Bone Disease of the CHUV. For patients who chose follow-up in our Centre, we assessed their adherence to medical follow-up 1 year inclusion. The results of patients who had been evaluated in our cohort between the 1 November 2008 and the 1 December 2009 were analysed. Results: 573 inpatients received specific management of their osteoporotic fracture over 18 months. The mean age was 77 y (31-99), 81% were women (203 hip fractures, 40 pelvis fractures, 101 arm fractures, 57 vertebral fractures, 63 ankle fractures, and 25 others sites). During the study period, 303 patients received a proposition of a specific treatment. 39 (13%) chose a follow up with the GP, 19 (6%) dead and 245 (81%) preferred a follow up in our Centre. After 1 year, 166 (67%) patients are under follow up in our outpatient clinic. Conclusion: With an active clinical pathway that starts during the hospitalization, consisting on a nursing evaluation followed by a medical consultation by an expert in osteoporosis, the adherence increased from 19% to 67% in terms of follow up. These results lead us to propose a consultation with a doctor experienced in osteoporosis after all osteoporotic fractures.

High prevalence of hypovitaminosis D in a Swiss rheumatology outpatient population.

Vitamin D is important for bone metabolism and neuromuscular function. While a routine dosage is often proposed in osteoporotic patients, it is not so evident in rheumatology outpatients where it has been shown that the prevalence of hypovitaminosis D is high. The aim of the current study was to systematically evaluate the vitamin D status in our outpatient rheumatology population to define the severity of the problem according to rheumatologic diseases. During November 2009, all patients were offered a screening test for 25-OH vitamin D levels and categorised as deficient (<10 µg/l [ng/ml] [25 nmol/l]), insufficient (10 µg/l to 30 µg/l [25 to 75 nmol/l]) or normal (>30 µg/l [75 nmol/l]). A total of 272 patients were included. The mean 25-OH vitamin D level was 21 µg/l (range 1.5 to 45.9). A total of 20 patients had vitamin D deficiency, 215 patients had an insufficiency and 37 patients had normal results. In the group of patients with osteoporosis mean level of 25-OH vitamin D was 25 µg/l and 31% had normal results. In patients with inflammatory rheumatic diseases (N = 219), the mean level of 25-OH vitamin D was 20.5 µg/l, and only 12% had normal 25-OH vitamin D levels. In the small group of patients with degenerative disease (N = 33), the mean level of 25-OH vitamin D was 21.8 µg/l, and 21% had normal results. Insufficiency and deficiency were even seen in 38% of the patients who were taking supplements. These results confirm that hypovitaminosis D is highly prevalent in an outpatient population of rheumatology patients, affecting 86% of subjects. Despite oral supplementation (taken in 38% of our population), only a quarter of those on oral supplementation attained normal values of 25-OH vitamin D.

Changing the awareness of low vitamin D status in a rheumatology population: a pre/post-study.

INTRODUCTION: In 2009 hypovitaminosis D was highly prevalent in a population of Swiss rheumatology patients (86%). We aimed to evaluate the evolution of vitamin D status in the same population two years later, after the results of the first study were disseminated to local physicians and patients, in order to determine the evolution of the problem and the impact of physician information. METHOD: Patients in our rheumatology clinic were screened for 25-OH vitamin D. Results were categorised as: deficient (<10 ng/ml or <25 nmol/l), insufficient (10 to 30 ng/ml or 25 to 75 nmol/l) or normal (>30 ng/ml or >75 nmol/l). We also used another cut-off of 20 ng/ml (50 nmol/l). We evaluated the evolution of 25-OH vitamin D dosages and vitamin D3 prescriptions between 2008 and 2011 in our institution and the number of publications on vitamin D in three important medical journals of the French speaking part of Switzerland. RESULTS: Compared with 2009, significantly more patients had normal results in 2011. Fifty-two percent of patients had levels >20 ng/ml in 2009 and 66% in 2011, difference statistically significant (p = 0.001). During the years separating the two study periods the number of 25-OH vitamin D dosages and the prescription of high doses of vitamin D3 increased in our hospital. In addition the number of publications on vitamin D increased between 2008 and 2011. CONCLUSION: We concluded that lower prevalence in hypovitaminosis D is certainly related to better adherence to daily supplements, and to better information and awareness of the physicians about hypovitaminosis D.

The Swiss Systemic lupus erythematosus Cohort Study (SSCS) - cross-sectional analysis of clinical characteristics and treatments across different medical disciplines in Switzerland.

OBJECTIVES: To describe disease characteristics and treatment modalities in a multidisciplinary cohort of systemic lupus erythematosus (SLE) patients in Switzerland. METHODS: Cross-sectional analysis of 255 patients included in the Swiss SLE Cohort and coming from centres specialised in Clinical Immunology, Internal Medicine, Nephrology and Rheumatology. Clinical data were collected with a standardised form. Disease activity was assessed using the Safety of Estrogens in Lupus Erythematosus National Assessment-SLE Disease Activity Index (SELENA-SLEDAI), an integer physician's global assessment score (PGA) ranging from 0 (inactive) to 3 (very active disease) and the erythrocyte sedimentation rate (ESR). The relationship between SLE treatment and activity was assessed by propensity score methods using a mixed-effect logistic regression with a random effect on the contributing centre. RESULTS: Of the 255 patients, 82% were women and 82% were of European ancestry. The mean age at enrolment was 44.8 years and the median SLE duration was 5.2 years. Patients from Rheumatology had a significantly later disease onset. Renal disease was reported in 44% of patients. PGA showed active disease in 49% of patients, median SLEDAI was 4 and median ESR was 14 millimetre/first hour. Prescription rates of anti-malarial drugs ranged from 3% by nephrologists to 76% by rheumatologists. Patients regularly using anti-malarial drugs had significantly lower SELENA-SLEDAI scores and ESR values. CONCLUSION: In our cohort, patients in Rheumatology had a significantly later SLE onset than those in Nephrology. Anti-malarial drugs were mostly prescribed by rheumatologists and internists and less frequently by nephrologists, and appeared to be associated with less active SLE.

Evaluación de las artes y métodos de pesca empleados en el río Mazan

El informe detalla los trabajos desarrollados por el personal del área de Artes y métodos de pesca en aguas continentales de la Dirección de investigaciones y extracción, con la ayuda material proporcionada durante las labores de campo por el Comité de pescadores del río Mazán y el personal de la oficina regional de pesquería de Iquitos, específicamente por el encargado de la zona reservada del río Mazán.

Artes y métodos de pesca en las riveras del lago Titicaca

Expone el nivel técnico que han alcanzado los pescadores que habitan las riveras del lago Titicaca, así como sus artes y métodos de pesca más empleados por ellos. Los resultados presentados durante las labores de campo demuestran que la extracción pesquera del lago, se centra fundamentalmente en la captura del carachi, debido a que es la especie más abundante y de más fácil captura por su costumbre de vivir en lugares cercanos a la playa.

Captura y acondicionamiento en cautiverio de la anchoveta peruana Engraulis ringens

Se describe la metodología de captura de ejemplares vivos de anchoveta peruana, mediante un sistema de red izada.

Características hidrográficas y sedimentológicas de la bahía de Sechura

En la zona central de la bahía de Sechura afloran principalmente Aguas Costeras Frías. En superficie y en condiciones normales la temperatura fluctúa de 15 a 24 °C, salinidad de 34,8 a 35,3 ups, oxígeno disuelto de 2 a 5,5 mL/L. La capa subsuperficial con valores menores a los de superficie, varían ante eventos El Niño y en menor escala en La Niña. Los sedimentos superficiales predominantes cerca a la costa son textura arenosa con bajo contenido orgánico que se extiende a mayor profundidad hacia el norte de Punta Aguja; textura areno limosa adyacentes a los de arena, ocupan gran extensión de la bahía, asociados con altos contenidos de materia orgánica, pequeñas extensiones de arena arcillosa y limo arenoso frente a la Bocana, Bayovar y Punta Tric Trac. Contenidos de carbonato más altos (70%) de origen biogénico frente a San Pablo, asociados a texturas de arena y arena limosa.

Mélanges sur l'histoire d'Espagne.

Contient : Extraits des archives de Pampelune ; Extraits de l'Antiguedad de Espana y confermacion de la nobleza de Cantabria, par Pablo Gottardo (Milan, 1586) ; Confirmation des privilèges des marchands descendant dans la vallée de Roncal (1628) ; « Capitulos de la Hermandad » de Tudela ; Privilèges de Roncal ; Capitulation de la cité de Pampelune entre les mains du duc d'Albe ; Instructions données par le roi d'Espagne à M. de Salinas, pour s'enquérir au sujet du roi de France et du seigneur d'Albret ; Cession du Guipuzcoa à Charles [le Mauvais], roi de Navarre, par Pierre [le Cruel], roi de Castille ; Confirmation par Catherine, reine de Navarre, des privilèges accordés en 884 par Eneco à l'abbaye de Leyre ; Mémoire sur les privilèges accordés par les rois à diverses villes d'Espagne ; Chartes de Notre-Dame d'Oliva, en Navarre ; Fondation et privilèges de Notre-Dame de Fitero ; Pièces relatives à Louis de Beaumont, connétable de Castille ; Monitoire du Saint-Office contre Jeanne d'Albret ; Bref de Pie V, réglant les mesures à prendre dans les provinces basques par l'évêque de Bayonne, au sujet des affaires du for ecclésiastique ; Mémoire, en espagnol, sur la maison de Beaumont ; Donation par Jean V, roi d'Aragon, à Jean de Atondo, d'une rente de 120 florins d'or ; Notice généalogique sur la famille Enriquez de la Carra y Navarra

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