Prévention des adhérences péricardiques avec une membrane biorésorbable [Prevention of pericardial adhesions with a bioresorbable membrane]

A bioresorbable membrane made of sodium hyaluronate and carboxymethycellulose, has been reported to prevent peritoneal adhesion. This study was designed to test its efficiency in the prevention of pericardial adhesions. Two groups of six pigs (mean weight 72 +/- 8 kg) were chosen for the experiment. The heart was exposed through a left thoracotomy and a wide patch of pericardium was excised. In the test group (n = 6), the left ventricular area without pericardium was divided into two areas: area A where six stitches of Prolene were performed, and area B which was left intact. The membrane was applied on the both areas as well as on the adjacent area covered with pericardium (area C). In the control group (n = 6), the same protocol was performed except for the membrane application. The animals were sacrificed one month later. The adhesion status as well as the visibility of the coronary anatomy was assessed according to severity scores ranging from 0 to 3 for the adhesions and from 0 to 2 for the visibility. The difference between groups was considered significant when p < 0.05. The adhesion score of the area A was 1.7 +/- 0.5 in the test group versus 2.5 +/- 0.5 in the control group (p = 0.02) and the visibility score was 1.3 +/- 0.8 and 2 +/- 0 respectively (p = 0.07). In the area B, the adhesion score was 1 +/- 0 in the test group versus 2 +/- 0.6 in the control group (p = 0.03) and the visibility score was 0.7 +/- 0.5 and 2 +/- 0 respectively (p = 0.001). Lastly, in the area C, the adhesion score was 1 +/- 0 in both groups (n.s.) and the visibility score was 0.7 +/- 0.4 in the test group versus 0.5 +/- 0.5 in the control group (n.s.). In this animal model, the role of the bioresorbable membrane in the prevention of pericardial adhesions is limited to the areas without pericardial cover and without foreign material. The presence of foreign material neutralizes its effect.

Prophylaxis of experimental endocarditis with antiplatelet and antithrombin agents : a role for long-term prevention of infective endocarditis in humans?

BACKGROUND: Infective endocarditis (IE) mostly occurs after spontaneous low-grade bacteremia. Thus, IE cannot be prevented by circumstantial antibiotic prophylaxis. Platelet activation following bacterial-fibrinogen interaction or thrombin-mediated fibrinogen-fibrin polymerization is a critical step in vegetation formation. We tested the efficacy of antiplatelet and antithrombin to prevent experimental IE. METHODS: A rat model of experimental IE following prolonged low-grade bacteremia mimicking smoldering bacteremia in humans was used. Prophylaxis with antiplatelets (aspirin, ticlopidine [alone or in combination], eptifibatide, or abciximab) or anticoagulants (antithrombin dabigatran etexilate or anti-vitamin K acenocoumarol) was started 2 days before inoculation with Streptococcus gordonii or Staphylococcus aureus. Valve infection was assessed 24 hours later. RESULTS: Aspirin plus ticlopidine, as well as abciximab, protected 45%-88% of animals against S. gordonii and S. aureus IE (P < .05). Dabigatran etexilate protected 75% of rats against IE due to S. aureus (P < .005) but failed to protect against S. gordonii (<30% protection). Acenocoumarol was ineffective. CONCLUSIONS: Antiplatelet and direct antithrombin agents may be useful in the prophylaxis of IE in humans. In particular, the potential dual benefit of dabigatran etexilate might be reconsidered for patients with prosthetic valves, who require life-long anticoagulation and in whom S. aureus IE is associated with high mortality.

Managing diabetes in Switzerland : a systemic approach

Executive summaryThe increasing prevalence of chronic diseases is one of the major causes of rising health expenditure, as stated by the WHO. Not only chronic diseases are very costly, but they are by far the leading cause of mortality in the world, representing 60% of all deaths. Diabetes in particular is becoming a major burden of disease. In Switzerland around 5% of the population suffer of type 2 diabetes and 5 to 10% of the annual health care budget is attributable to diabetes. If the predictions of WHO do realise, the prevalence of diabetes will double until 2030 and so is expected the attributable health expenditure.The objective of this thesis is to provide policy recommendations as to slow down the disease progression and its costly complication. We study the factors that influence diabetes dynamics and the interventions that improve health outcomes while decreasing costs according to different time horizon and use systems thinking and system dynamic.Our results show that managing diabetes requires using integrated care interventions that are effective on three fronts: (1) delaying the onset of complications, (2) slowing down the disease progression and (3) accelerating the time to diagnosis of diabetes and its complications. We recommend firstly the implementation of those interventions targeted at changing patients' behaviour which are also less expensive, but require a change in the delivery of care and medical practices. Then policies targeted at an earlier diagnosis of diabetes, its prevention and the diagnosis of complications are to be considered. This sequence of interventions allows saving money, as total costs decrease, even including the costs of interventions and result in longer life expectancy of diabetics in the long term.In diabetes management there is therefore a trade-off between medical costs and patients' benefits on the one hand and between the objectives of obtaining results in the short or long term on the other hand. Decision makers need to deliver acceptable outcomes in the short term. Considering this criterion, the preferred policy may be to focus only on diagnosed diabetics, thus attempting to slow down the progression of their disease, compared to an integrated care approach addressing all the aspects of the disease. Such a policy also yields desirable results in terms of costs and patients' benefits.

Social Policy Preferences and Party Choice in the 2011 Swiss Elections

To what extent do social policy preferences explain party choice? This question has received little attention over the past years, because the bulk of the literature has argued that electoral choice is increasingly shaped by identity-based attitudes, rather than by preferences for economic-distributive social policies. We argue that in the wake of this debate, the significance of social policy preferences for electoral choice has been underestimated, because most contributions neglect social policy debates that are specific to post-industrial societies. In particular, they merely focus on income redistribution, while neglecting distributive conflicts around social investment. The Selects 2011 data allows investigating this crucial distinction for Switzerland. Our empirical analyses confirm that it is pivotal to take the pluridimensionality of distributive conflicts seriously: when looking at preferences for social investment rather than income redistribution, we find that social policy preferences are significant explanatory factors for the choice of the five major Swiss political parties.

Report of Recommendations to the Governor's Office of Drug Control Policy, June 30, 2002

State Agency Audit Report

Influencia social y uso del preservativo en la prevención de la transmisión heterosexual del VIH = Social influence and condom use for VIH heterosexual transmission prevention

Se revisan diferentes formas en que la influencia social puede incidir sobre los comportamientosheterosexuales de prevención de la transmisión del VIH de los jóvenes y se presentanlos resultados de algunos trabajos de las autoras, así como de otros investigadores, en que seanalizan dichas relaciones. Se concluye resaltando: 1) la utilidad clínica de la evaluación de lasexpectativas de autoeficacia para poder intervenir específicamente en aquellas áreas en que losjóvenes se perciban con menores capacidades para ser preventivos, 2) la relación observadaentre el uso de preservativo autoinformado y la creencia en su aceptación por parte de los referentessociales más cercanos y 3) la conveniencia de que los jóvenes posean suficientes habilidadesde comunicación que les permitan negociar con éxito el uso del preservativo y les ayudena compensar posibles influencias sociales en contra de su empleo

Infections nosocomiales en médecine ambulatoire: importance et prévention [Importance and prevention of nosocomial infections in the outpatient setting]

The concept of nosocomial infections (or healthcare-related infections) applies to the outpatients clinics. However, data are scarce and imprecise in this setting compared with hospitals. The choice of preventive measures is therefore difficult. A lower risk in the outpatient facilities does not justify the complete implementation of hospital precautions. The latter can nevertheless be adapted since infection may be acquired during an ambulatory consultation through the same mechanisms as in hospitals. We propose a preventive strategy derived from standard precautions to be applied in every case, transmission-based precautions that are more rarely needed, and asepsis in case of invasive procedure.

A low number of Swiss companies uses nanoparticles

Nanoparticles <100 nanometres are being introduced into industrial processes, but they are suspected to cause similar negative health effects to ambient particles. Poor knowledge about the scale of introduction has not allowed global risk analysis until now. In 2006 a targeted telephone survey among Swiss companies (1) showed the usage of nanoparticles in a few selected companies but did not provide data to extrapolate to the full Swiss workforce. The purpose of the study presented here was to provide a quantitative estimate of the potential occupational exposure to nanoparticles in Swiss industry. Method: A layered representative questionnaire survey among 1626 Swiss companies of the production sector was conducted in 2007. The survey was a written questionnaire, collecting data about the used nanoparticles, the number of potentially exposed persons in the companies and their protection strategy. Results: The response rate of the study was 58.3%. The number of companies estimated to be using nanoparticles in Switzerland was 586 (95% Confidence Interval 145 to 1027). It is estimated that 1309 workers (95% CI 1073 to 1545) do their job in the same room as a nanoparticle application. Personal protection was shown to be the predominant protection means. Such information is valuable for risk evaluation. The low number of companies dealing with nanoparticles in Switzerland suggests that policy makers as well as health, safety and environmental officers within companies can focus their efforts on a relatively small number of companies or workers. The collected data about types of particles and applications may be used for research on prevention strategies and adapted protection means. However, to reflect the most recent trends, the information presented here has to be continuously updated, and a large-scale inventory of the usage should be considered.

Statins for cardiovascular prevention according to different strategies: a cost analysis.

Background: Several studies have shown that treatment with HMG-CoA reductase inhibitors (statins) can reduce coronary heart disease (CHD) rates. However, the cost effectiveness of statin treatment in the primary prevention of CHD has not been fully established. Objective: To estimate the costs of CHD prevention using statins in Switzerland according to different guidelines, over a 10-year period. Methods: The overall 10-year costs, costs of one CHD death averted, and of 1 year without CHD were computed for the European Society of Cardiology (ESC), the International Atherosclerosis Society (IAS), and the US Adult Treatment Panel III (ATP-III) guidelines. Sensitivity analysis was performed by varying number of CHD events prevented and costs of treatment. Results: Using an inflation rate of medical costs of 3%, a single yearly consultation, a single total cholesterol measurement per year, and a generic statin, the overall 10-year costs of the ESC, IAS, and ATP-III strategies were 2.2, 3.4, and 4.1 billion Swiss francs (SwF [SwF1 = $US0.97]). In this scenario, the average cost for 1 year of life gained was SwF352, SwF421, and SwF485 thousand, respectively, and it was always higher in women than in men. In men, the average cost for 1 year of life without CHD was SwF30.7, SwF42.5, and SwF51.9 thousand for the ESC, IAS, and ATP-III strategies, respectively, and decreased with age. Statin drug costs represented between 45% and 68% of the overall preventive cost. Changing the cost of statins, inflation rates, or number of fatal and non-fatal cases of CHD averted showed ESC guidelines to be the most cost effective. Conclusion: The cost of CHD prevention using statins depends on the guidelines used. The ESC guidelines appear to yield the lowest costs per year of life gained free of CHD.

Dépistage et prévention chez les aînés: quelles interventions proposer, à qui, et jusqu'à quel âge [Screening and prevention in the elderly: which interventions should be proposed, to whom, and up to what age?].

Recommendations on preventive services rarely mention how to apply them to older people. Even though general criteria (prevalence of disease, quality of screening tests) that influence screening's efficacy remain important, appropriateness of screening in older persons depends much more on individual criteria, such as comorbidity, functional status, and life expectancy. More than with any other age group, patients preferences regarding future investigation and treatment guide the clinical decision. This article focuses on primary and secondary prevention, and discusses specific criteria to consider in each patient. A table summarizes the appropriate recommendations.

Prevention of Caval Collapse During Venous Drainage for CPB.

A new plastic self-expanding Smartcanula (Smartcanula LLC, Lausanne, Switzerland) is designed for central insertion and prevention of caval collapse. The objective of our work is to assess the influence of the new design on atrial chatter. Caval collapse over the entire caval axis, right atrial, hepatic, renal vein, and iliac vein is realized in drainage tubes with holes at 5 cm distance intervals. Smartcanulas with various lengths (26 cm [= right atrial], 34 cm [= hepatic], 43 cm [= renal], and 53 cm [= iliac]) versus two-stage cannulas are compared. Pressure drop (ΔP) is measured using Millar pressure-transducers. Flow rate (Q) is measured using an ultrasonic flow meter. Cannula resistance is defined as the ΔP/Q ratio. Data display and recording are controlled using LabView virtual instruments. At an 88 cm height differential, Q values are 8.69 and 6.8 l/min, and ΔP/Q ratios are 0.63 and 1.28 for the 26-cm Smartcanula and the reference cannula, respectively. The 34-cm Smartcanula showed 8.89 l/min and 0.6 ΔP/Q ratio vs. 7.59 l/min and 0.9 for the control cannula (P < 0.05). The 43-cm and 53-cm Smartcanulas showed Q values of 9.04 and 8.81 l/min, respectively, and ΔP/Q2 ratio of 0.6. The Smartcanula outperforms the two-stage cannula, and direct cannula insertion without guide wire is effective.