La santé en Suisse : le point sur les maladies chroniques : rapport national sur la santé 2015

Le vieillissement de la population va de pair avec une progression constante des maladies chroniques dans notre société. Les modes de vie modernes favorisent l'apparition de ces maladies, notamment par le tabagisme, par le manque d'activité physique et par une alimentation déséquilibrée. Les maladies chroniques somatiques sont aujourd'hui dans la ligne de mire des responsables de la politique de la santé. Elles constituent, avec les maladies chroniques psychiques, dont les conséquences sont multiples, un défi de taille pour notre système de santé et un problème majeur de santé publique. La prise en charge des maladies chroniques requiert une bonne coordination du système de santé. La Confédération et les cantons y travaillent activement en s'engageant par exemple dans le domaine du personnel de santé et de l'organisation des structures de soins. Confédération et cantons contribuent à faire en sorte que les maladies chroniques psychiques ou somatiques deviennent moins fréquentes ou soient traitées suffisamment tôt. Tels sont les objectifs des politiques de promotion de la santé et de prévention des maladies, dont l'importance ira croissant à l'avenir. Le présent rapport national sur la santé donne une vue d'ensemble de la santé dans la population suisse; il met en lumière certains aspects importants des maladies chroniques dans notre pays. Puisse-t-il donner des impulsions nouvelles et aider les acteurs du système suisse de santé à maîtriser ensemble les défis liés à ces maladies.

Characterization of volatile organic gunshot residues in fired handgun cartridges by headspace sorptive extraction

In forensic investigation of firearm-related cases, determination of the residual amount of volatile compounds remaining inside a cartridge could be useful in estimating the time since its discharge. Published approaches are based on following the decrease of selected target compounds as a function of time by using solid phase micro-extraction (SPME). Naphthalene, as well as an unidentified decomposition product of nitrocellulose (referred to as "TEA2"), are usually employed for this purpose. However, reliability can be brought into question given their high volatility and the low reproducibility of their extracted quantities. In order to identify alternatives and therefore develop improved dating methods, an extensive study on the composition and variability of volatile residues in nine different types of cartridges was carried out. Analysis was performed using headspace sorptive extraction (HSSE), which is a more exhaustive technique compared to SPME. 166 compounds were identified (several of which for the first time), and it was observed that the final compositional characteristics of each residue were strongly dependent on its source. Variability of single identified compounds within and between different types of cartridge, as well as their evolution over time, was also studied. Many explosion products containing up to 4 aromatic rings were found to be globally present in high proportions amongst residues. 27 of them (excluding naphthalene) also presented detectable decreases during the first 24 h. Therefore, they could be used as complementary target analytes in future dating methods.

COMPARISON OF RNA EXTRACTION METHODS FOR Passiflora edulis SIMS LEAVES

ABSTRACT Functional genomic analyses require intact RNA; however, Passiflora edulis leaves are rich in secondary metabolites that interfere with RNA extraction primarily by promoting oxidative processes and by precipitating with nucleic acids. This study aimed to analyse three RNA extraction methods, Concert™ Plant RNA Reagent (Invitrogen, Carlsbad, CA, USA), TRIzol® Reagent (Invitrogen) and TRIzol® Reagent (Invitrogen)/ice -commercial products specifically designed to extract RNA, and to determine which method is the most effective for extracting RNA from the leaves of passion fruit plants. In contrast to the RNA extracted using the other 2 methods, the RNA extracted using TRIzol® Reagent (Invitrogen) did not have acceptable A260/A280 and A260/A230 ratios and did not have ideal concentrations. Agarose gel electrophoresis showed a strong DNA band for all of the Concert™ method extractions but not for the TRIzol® and TRIzol®/ice methods. The TRIzol® method resulted in smears during electrophoresis. Due to its low levels of DNA contamination, ideal A260/A280 and A260/A230 ratios and superior sample integrity, RNA from the TRIzol®/ice method was used for reverse transcription-polymerase chain reaction (RT-PCR), and the resulting amplicons were highly similar. We conclude that TRIzol®/ice is the preferred method for RNA extraction for P. edulis leaves.

Profit repatriation of a Polish subsidiary from tax planning point of view of an international corporation

The main purpose of this study was to examine and compare the possibilities of profit repatriation from the point of view of tax planning of an international corporation, in such a case that a Finnish parent company has a subsidiary in Poland. The main research problem was divided into two sub research problems: 1) to examine concepts and principles of international taxation and tax planning from the point of view of international corporations and 2) to discuss the main features of Polish Companies-, Accounting- and Tax Act from the point of view a Finnish parent company. The research method of this study is mainly decision making, comparative analysis. In this study have been discussed the possibilities of international profit repatriation for supporting the decision making of the management of a Finnish parent company. In addition different repatriation possibilities have been compared. In this study has been noticed that a Finnish parent company can repatriate profit of its Polish subsidiary either directly as dividends or by using indirect methods such as interests, royalties, management fees and transfer pricing of goods. The total tax burden of dividends is heavier than the tax burden of indirect methods. It was also concluded that during the last years the Polish legislation has been renewed in order to prevent hidden dividend distribution. This has been done by implementing new rules of transfer pricing and thin capitalization.

Gamma-ray emission from massive young stellar objects

Context.Massive stars form in dense and massive molecular cores. The exact formation mechanism is unclear, but it is possible that some massive stars are formed by processes similar to those that produce the low-mass stars, with accretion/ejection phenomena occurring at some point of the evolution of the protostar. This picture seems to be supported by the detection of a collimated stellar wind emanating from the massive protostar IRAS 16547-4247. A triple radio source is associated with the protostar: a compact core and two radio lobes. The emission of the southern lobe is clearly non-thermal. Such emission is interpreted as synchrotron radiation produced by relativistic electrons locally accelerated at the termination point of a thermal jet. Since the ambient medium is determined by the properties of the molecular cloud in which the whole system is embedded, we can expect high densities of particles and infrared photons. Because of the confirmed presence of relativistic electrons, inverse Compton and relativistic Bremsstrahlung interactions are unavoidable. Aims.We aim to make quantitative predictions of the spectral energy distribution of the non-thermal spots generated by massive young stellar objects, with emphasis on the particular case of IRAS 16547-4247. Methods.We study the high-energy emission generated by the relativistic electrons which produce the non-thermal radio source in IRAS 16547-4247. We also study the result of proton acceleration at the terminal shock of the thermal jet and make estimates of the secondary gamma rays and electron-positron pairs produced by pion decay. Results.We present spectral energy distributions for the southern lobe of IRAS 16547-4247, for a variety of conditions. We show that high-energy emission might be detectable from this object in the gamma-ray domain. The source may also be detectable in X-rays through long exposures with current X-ray instruments. Conclusions.Gamma-ray telescopes such as GLAST, and even ground-based Cherenkov arrays of new generation can be used to study non-thermal processes occurring during the formation of massive stars.

Older persons' perceptions of general practitioner or specialist primary care physicians : same point of view? : older persons' primary care perception

La perception du patient vis-à-vis de son médecin traitant (MT) a suscité beaucoup de recherches et d'interet, notamment à cause de l'importance de la relation médecin-patient nécessaire à la qualité des soins. En Suisse, dans un contexte de libre choix du médecin, le rôle de MT peut être assumé par un generalise mais aussi, théoriquement, par un spécialiste. La fréquence de cette situation est cependant inconnue de même que son impact sur l'expérience des patients. L'objectif principal de cette etude était de décrire l'expérience des personnes âgées du canton de Vaud auprès de leur medecin traitant et de tester l'hypothèse selon laquelle cette expérience serait différente lorsque le MT est décrit comme « Généraliste » (MT Gén) ou comme « Spécialiste » (MT Spéc). Méthode : La recherche a été effectuée sur la base des données d'une enquête par questionnaire, envoyé à la population lausannoise participant à l'étude Lc65+ et à un échantillon supplémentaire de personnes agees de 68 ans ou plus sélectionnées aléatoirement dans le canton de Vaud. L'analyse a porté sur 17 items relatifs à la perception qu'ont les patients de leur MT, regroupés en 4 thèmes ? Access,bihte/Disponibilité, Relation Médecin-Patient, Information et Continuité des soins Nous ayons également analysé le recours déclaré aux soins ambulatoires, aux consultations de services d urgence, ainsi qu'aux actes de prévention. Les différences de perception et de recours selon le type de MT (Gen vs Spéc) ont été analysées par des modèles multivariés tenant compte de l'âge du sexe de I education, de la morbidité, de la présence de symptômes dépressifs et de la durée de la relation medecin-patient. Résultats : Les participants ont exprimé une perception favorable de leur MT à des taux excédant 75% pour la plupart des 17 items. Cependant, seulement 38 à 51% des participants ont répondu positivement aux questions relatives à la disponibilité en dehors des heures d'ouvertures, à l'accès au MT le soir ou en tin de semaine, à la possibilité de visites à domicile, à la probabilité de se voir prescrire des medicaments coûteux en cas de besoin, ou à la connaissance du médecin des médicaments en vente libre que le patient consomme. Les analyses bivariées et multivariées n'ont pas montré de différence entre les groupes MT Gén et MT Spec quant à la perception qu'ont les patients de leur MT, au recours aux actes de prévention ou aux services de santé. Conclusion : L'expérience des personnes interrogées était globalement positive, à part quelques questions concernant principalement le thème de l'Accessibilité/Disponibilité du MT. Nous n'avons pas mis en evidence de différence de perception ou de recours aux soins entre les deux groupes que nous avons analyses pour tester notre hypothèse. Perspective : Cette étude connaît des limites (données rapportées par les participants, groupe des MT Spéc de taille restreinte, absence de données sur les non-répondants, possible conflit de loyauté vis-à-vis du MT pour certaines questions) mais repose sur un large échantillon lui conférant une puissance suffisante, aléatoirement sélectionné dans une population géographiquement définie. Bien que ces résultats ne soient généralisables qu'au canton de Vaud, elle montre d'abord que les spécialistes reconnus comme MT s'inscrivent généralement dans des disciplines impliquant une formation en medec.ne interne. Dans cette circonstance, elle ne met en évidence aucune différence de résultats entre les personnes âgées traitées par un MT généraliste ou spécialiste.

Biomarkers of Host Response Predict Primary End-Point Radiological Pneumonia in Tanzanian Children with Clinical Pneumonia: A Prospective Cohort Study.

BACKGROUND: Diagnosing pediatric pneumonia is challenging in low-resource settings. The World Health Organization (WHO) has defined primary end-point radiological pneumonia for use in epidemiological and vaccine studies. However, radiography requires expertise and is often inaccessible. We hypothesized that plasma biomarkers of inflammation and endothelial activation may be useful surrogates for end-point pneumonia, and may provide insight into its biological significance. METHODS: We studied children with WHO-defined clinical pneumonia (n = 155) within a prospective cohort of 1,005 consecutive febrile children presenting to Tanzanian outpatient clinics. Based on x-ray findings, participants were categorized as primary end-point pneumonia (n = 30), other infiltrates (n = 31), or normal chest x-ray (n = 94). Plasma levels of 7 host response biomarkers at presentation were measured by ELISA. Associations between biomarker levels and radiological findings were assessed by Kruskal-Wallis test and multivariable logistic regression. Biomarker ability to predict radiological findings was evaluated using receiver operating characteristic curve analysis and Classification and Regression Tree analysis. RESULTS: Compared to children with normal x-ray, children with end-point pneumonia had significantly higher C-reactive protein, procalcitonin and Chitinase 3-like-1, while those with other infiltrates had elevated procalcitonin and von Willebrand Factor and decreased soluble Tie-2 and endoglin. Clinical variables were not predictive of radiological findings. Classification and Regression Tree analysis generated multi-marker models with improved performance over single markers for discriminating between groups. A model based on C-reactive protein and Chitinase 3-like-1 discriminated between end-point pneumonia and non-end-point pneumonia with 93.3% sensitivity (95% confidence interval 76.5-98.8), 80.8% specificity (72.6-87.1), positive likelihood ratio 4.9 (3.4-7.1), negative likelihood ratio 0.083 (0.022-0.32), and misclassification rate 0.20 (standard error 0.038). CONCLUSIONS: In Tanzanian children with WHO-defined clinical pneumonia, combinations of host biomarkers distinguished between end-point pneumonia, other infiltrates, and normal chest x-ray, whereas clinical variables did not. These findings generate pathophysiological hypotheses and may have potential research and clinical utility.