Role of hepatitis C virus genotype 3 in liver fibrosis progression : a systematic review and meta-analysis ; et, Impact of nurse vaccination program on hepatitis B immunity in a Swiss HIV clinic

Rôle du génotype 3 du virus de l'hépatite C dans la progression de la fibrose hépatique, une revue systématique avec méta-analyse. On estime à 170 millions le nombre de personnes atteintes d'hépatite C chronique dans le monde. La principale conséquence de cette maladie est la fibrose du foie, qui évolue plus ou moins rapidement, pour aboutir au développement d'une cirrhose et/ou d'un hépatocarcinome. Certains des facteurs accélérateurs de la fibrose, comme l'âge avancé au moment de l'infection, le sexe masculin, la consommation d'alcool, sont bien connus. On a longtemps considéré que les six différents génotypes viraux n'influençaient pas la progression de la fibrose. Des études récentes ont cependant suggéré que certains génotypes, en particulier ie génotype 3, pouvaient entraîner une fibrose plus rapide. Le but de ce travail de thèse était de déterminer à l'aide d'une méta-analyse le rôle du génotype viral dans la progression de la fibrose dans l'infection chronique au virus de l'hépatite C. Les études ont été sélectionnées dans la littérature médicale à partir d'une série de mots-clés. Le degré de fibrose a été estimé par biopsie, en utilisant le score Metavir. Deux types d'études ont décrits de manière différente la durée d'infection. Les premières ont calculé la progression de la fibrose depuis le moment estimée de l'infection (« études avec une biopsie »), les secondes ont exprimés cette durée comme étant l'intervalle entre deux biopsies (« études avec deux biopsies »). L'analyse a permis d'identifier 8 études avec une biopsie pour un collectif total de 3182 patients ainsi que 8 études avec deux biopsies pour un collectif de 896 patients. Dans une méta-analyse de type « random effect », le rapport de cote pour l'association du génotype 3 avec une fibrose accélérée est de 1.52 (95% IC 1.12-2.07, p=0.007) pour les études à une biopsie. Pour les études à deux biopsies, le rapport de cote pour cette association est de 1.37 (95% IC 0.87-2.17, P=0.17). Cette étude montre que les patients avec une hépatite C chronique due au génotype 3 ont une progression de fibrose plus rapide que ceux qui sont infectés par les autres génotypes. Alors que la méta-analyse des études avec une biopsie est clairement significative, celle des études avec deux biopsies est au-dessous du seuil de significativité. Les études à deux biopsies peuvent être limitées par plusieurs facteurs, comprenant un « biais d'indication » (seuls les patients évoluant rapidement vers la cirrhose ont plus de risque d'avoir une deuxième biopsie), une durée d'observation très courte (5 années comparée à 13 années pour les études à 2 biopsies), et un nombre de patient limité (896 pour le études à 2 biopsies comparé à 3182 pour les études à 1 biopsie). Impact d'un programme de vaccination sur l'immunité contre l'hépatite Β dans une clinique suisse du VIH Le virus de l'hépatite Β cause une infection aigûe dont la symptomatologie varie d'une présentation subclinique à une progression fulminante. Dans une minorité de cas, l'infection aigiie est suivie d'une infection chronique pouvant évoluer vers une cirrhose hépatique et/ou un hépatocarcinome. La prévalence de l'hépatite Β aiguë et chronique chez les personnes vivant avec le virus d'immunodéficience humaine (VIH) est supérieure à celle de la population générale. Par ailleurs la co-infection avec le virus du VIH entraine une progression plus rapide de l'hépatite B. Dès lors, l'immunité pour le virus de l'hépatite Β représente un facteur primordial de prévention dans la population infectée par le virus de l'HIV. Bien que l'administration d'un vaccin contre l'hépatite Β soit particulièrement recommandée chez tous les individus infectés par le VIH, la couverture vaccinale dans cette population est souvent insuffisante. Le but de cette étude était de déterminer l'état d'immunisation contre le virus de l'hépatite Β dans la population infectée par le VIH de la cohorte Suisse HIV et d'analyser l'efficacité d'un programme de vaccination administré par le personnel soignant. L'immunité avant et après intervention dans notre centre a été comparée aux autres centres de la cohorte HIV en Suisse. L'immunité pour le centre d'intervention a passé de 32% avant intervention à 76% après intervention alors que pour les autres centres, l'immunité n'a progressé que de 33% à 39% dans le même laps de temps (n=2712, P=0.001). Cette étude montre qu'un contrôle systématique de l'immunité par du personnel soignant augmente de manière significative l'immunité pour le vaccin de l'hépatite Β dans la population HIV.

Parental monitoring: a way to decrease substance use among Swiss adolescents?

The objective of this research was to determine whether the level of parental monitoring is associated with substance use among adolescents in Switzerland, and to assess whether this effect remains when these adolescents have consuming peers. For this purpose, we used a nationally representative sample from the Swiss participation in the 2007 European School Project on Alcohol and Other Drugs survey, which included 7,611 adolescents in public schools (8th-10th grades). Four levels of parental control were created and four substances (tobacco, alcohol, cannabis, and ecstasy) were analyzed. All significant variables at the bivariate level were included in the multivariate analysis. Most adolescents had a high level of parental monitoring and that was associated with younger age, females, high socioeconomic status, intact family structure, and satisfactory relationships with mother, father, and peers. Overall, substance use decreased as parental monitoring increased and high parental monitoring decreased as having consuming peers increased. Results remained essentially the same when the variable "having consuming peers" was added to the analysis. Conclusion: parental monitoring is associated to positive effects on adolescent substance use with a reduction of consumption and a lower probability of having consuming peers, which seems to protect adolescents against potentially negative peer influence. Encouraging parents to monitor their adolescents' activities and friendships by establishing rules about what is allowed or not is a way to limit the negative influence of consuming peers on adolescent substance use.

Association between nonmedical prescription drug use and health status among young swiss men.

PURPOSE: To examine the relationship between the nonmedical prescription drug use (NMPDU) of six drug classes and health. METHODS: Data on young adults males (mean age, 19.96 years) from the baseline and follow-up of the Cohort Study on Substance Use Risk Factors (C-SURF) were used (n = 4,958). Two sets of logistic regression models were fitted to examine the associations between NMPDU of opioid analgesics, sedatives or sleeping pills, anxiolytics, antidepressants, beta blockers and stimulants, and health status (assessed using the Medical Outcomes Study 12-Item Short Form Survey Instrument [SF-12 v2]). We first computed odds ratios between NMPDU at baseline and poor mental and physical health at follow-up, adjusting for poor mental or physical health at baseline. We then computed odds ratios between poor mental and physical health at baseline and NMPDU at follow-up, adjusting for NMPDU at baseline. RESULTS: Three key findings regarding mental health were (1) there was a reciprocal risk between poor mental health and sedatives and anxiolytics; (2) poor mental health increased NMPDU of opioid analgesics and antidepressants but not vice versa; and (3) there were no associations with stimulants. Three key findings regarding physical health were (1) poor physical health increased the risk of NMPDU of anxiolytics; (2) the only reciprocal risk was between physical health and NMPDU of opioid analgesics; and (3) there were no associations with stimulants. CONCLUSION: These results, among the first ever on reciprocal effects between NMPDU and mental and physical health status, give unique information concerning the adverse effects of NMPDU on health and vice versa. The study shows that NMPDU is not only a sign of self-medication but may induce health problems.

Etude clinique et analyse de liaison au locus 3q28 de deux familles suisses avec atrophie optique dominante de Kjer (OPA1) [Clinical study and genetic 3q28 locus linkage in 2 Swiss families with Kjer dominant optic atrophy (OPA1)]

METHODS: We examined 20 patients from 2 unrelated Swiss families to describe their clinical phenotype. In addition, a linkage analysis was performed in an attempt to confirm the reported genetic homogeneity of this condition as well as to refine its genomic localization. RESULTS: Two point analysis provided a cumulative LOD-score of 3.03 with marker D3S 2305. The absence of recombination precluded further refinement of the disease interval. CONCLUSIONS: Our data confirm the genetic homogeneity and the extreme variability of expression, occasionally mimicking low tension glaucoma.

The Football Stadium - A Place Where Right-Wing Extremists Recruit ? Case Studies of Three Swiss Clubs

Der Sammelband ,,Right-wing extremism" hat ein doppeltes Ziel. Zum einen soll er das Nationale Forschungsprogramm 40plus und seine Projekte präsentieren (die alle mit Beiträgen präsent sind), zum anderen sollen diese nationalen Beiträge in eine internationale Perspektive gestellt werden, sodass in der Übersicht und Umschau eine Verortung der schweizerischen Forschung (und damit auch des NFP40plus selbst) und ihrer Resultate möglich wird. Eingeladen wurden dazu führende europäische Forscher auf dem Gebiet des Rechtsextremismus.

Compliance with the Swiss Society for Nutrition's dietary recommendations in the population of Geneva, Switzerland: a 10-year trend study (1999-2009).

The trends in compliance with the dietary recommendations of the Swiss Society for Nutrition in the Geneva population were assessed for the period from 1999 to 2009 using 10 cross-sectional, population-based surveys (Bus Santé study) with a total of 9,320 participants aged 35 to 75 years (50% women). Dietary intake was assessed using a self-administered, validated, semi-quantitative food frequency questionnaire. Trends were assessed by logistic regression adjusting for age, smoking status, education, and nationality using survey year as the independent variable. After excluding participants with extreme intakes, the percentage of participants with a cholesterol intake of <300 mg/day increased from 40.8% in 1999 to 43.6% in 2009 for men (multivariate-adjusted P for trend=0.04) and from 57.8% to 61.4% in women (multivariate-adjusted P for trend=0.06). Calcium intake >1 g/day decreased from 53.3% to 46% in men and from 47.6% to 40.7% in women (multivariate-adjusted P for trend<0.001). Adequate iron intake decreased from 68.3% to 65.3% in men and from 13.3% to 8.4% in women (multivariate-adjusted P for trend<0.001). Conversely, no significant changes were observed for carbohydrates, protein, total fat (including saturated, monounsaturated, and polyunsaturated fatty acids), fiber, and vitamins D and A. We conclude that the quality of the Swiss diet did not improve between 1999 and 2009 and that intakes deviate substantially from expert recommendations for health promotion and chronic disease risk reduction.

Cohort profile: the Swiss HIV Cohort study.

The substantial recurrence rate of colorectal cancer following potentially curative resection has fuelled the search for effective adjuvant therapy. Previous trials using 5-fluorouracil (5-FU) as a single agent or in combination chemotherapy regimens have not demonstrated meaningful benefits, an impression reflected in the results of a meta-analysis encompassing large patient numbers. Newer developments utilizing intraportal chemotherapy and the combination of 5-FU and levamisole have resulted in lower recurrence rates and improved survival in patients with colon cancer. In advanced disease, the biochemical modulation of 5-FU by Leucovorin has been shown to prolong survival in some studies. Combined chemotherapy and radiotherapy or chemotherapy alone have showed promising results in rectal cancer. These developments have now been incorporated into ongoing trials.

Antiretroviral therapy during pregnancy and premature birth: analysis of Swiss data.

BACKGROUND: There is an ongoing debate as to whether combined antiretroviral treatment (cART) during pregnancy is an independent risk factor for prematurity in HIV-1-infected women. OBJECTIVE: The aim of the study was to examine (1) crude effects of different ART regimens on prematurity, (2) the association between duration of cART and duration of pregnancy, and (3) the role of possibly confounding risk factors for prematurity. METHOD: We analysed data from 1180 pregnancies prospectively collected by the Swiss Mother and Child HIV Cohort Study (MoCHiV) and the Swiss HIV Cohort Study (SHCS). RESULTS: Odds ratios for prematurity in women receiving mono/dual therapy and cART were 1.8 [95% confidence interval (CI) 0.85-3.6] and 2.5 (95% CI 1.4-4.3) compared with women not receiving ART during pregnancy (P=0.004). In a subgroup of 365 pregnancies with comprehensive information on maternal clinical, demographic and lifestyle characteristics, there was no indication that maternal viral load, age, ethnicity or history of injecting drug use affected prematurity rates associated with the use of cART. Duration of cART before delivery was also not associated with duration of pregnancy. CONCLUSION: Our study indicates that confounding by maternal risk factors or duration of cART exposure is not a likely explanation for the effects of ART on prematurity in HIV-1-infected women.

Unlicensed and off-label drug use in a Swiss paediatric university hospital.

BACKGROUND: Many medicines used in newborns, infants, children and adolescents are not licensed ("unlicensed") or are prescribed outside the terms of the marketing authorization ("off-label"). Several studies have shown that this is a common practice in various healthcare settings in the USA, Europe and Australia, but data are scarce in Switzerland. OBJECTIVES: The aim of our prospective study was to determine the proportion of unlicensed or off-label prescriptions in paediatric patients. METHODS: This pilot study was conducted prospectively over a six month period in the department of paediatrics of a university hospital. RESULTS: Sixty patients aged from three days to 14 years were included in the study. A total of 483 prescriptions were written for the patients. More than half of all prescriptions (247; 51%) followed the terms of the marketing authorization. 114 (24%) were unlicensed and 122 (25%) off-label. All patients received at least one unlicensed or offlabel medicine. CONCLUSION: The use of unlicensed or off-label medicines to treat children was found to be common. Co-operation between the pharmaceutical industry, national regulatory authorities, clinical researchers, healthcare professionals and parents is required in order to ensure that children do not remain "therapeutic orphans".

Multifractal portrayal of the distribution of the Swiss population

The present research studies the spatial patterns of the distribution of the Swiss population (DSP). This description is carried out using a wide variety of global spatial structural analysis tools such as topological, statistical and fractal measures, which enable the estimation of the spatial degree of clustering of a point pattern. A particular attention is given to the analysis of the multifractality to characterize the spatial structure of the DSP at different scales. This will be achieved by measuring the generalized q-dimensions and the singularity spectrum. This research is based on high quality data of the Swiss Population Census of the Year 2000 at a hectometric resolution (grid 100 x 100 m) issued by the Swiss Federal Statistical Office (FSO).

Enseignement prégradué de la médecine ambulatoire a la PMU: quelques repères [Pregraduate training in ambulatory care: a Swiss perspective].

The current lack of general practitioners in Switzerland is the result of health care policy which aimed in the past years to reduce the number of medical students and physicians in private practice. Furthermore, during the past decades, the Swiss Medical Schools emphasized on the transmission of medical care by specialists and neglected primary care medicine. The Faculty of medicine at the University of Lausanne recently decided to renew the curriculum. The Department of ambulatory care and community medicine (Policlinique Médicale Universitaire) of Lausanne is committed to the elaboration of this move. The biomedical model, essential to the acquisition of clinical competence, is still taught to the students. Nevertheless, from the beginning to the end of the curriculum, an emphasis is now put on the clinical skills and the clinical reasoning.