Pratique du scanner en Suisse: fréquence et évolution temporelle [CT utilisation in Switzerland: frequency and secular trends]

PURPOSE: This study analyzes CT examinations in Switzerland. MATERIALS AND METHODS: Using different sources (administrative data on the equipment, a 1998 nationwide inquiry into practices, and data provided by the Swiss University Hospitals of Basel, Zurich, and Lausanne), we determined the frequency of CT examinations (hospitals and private radiologists) in 1998 according to different descriptive variables and studied the progression in CT use over time. RESULTS: CT scanners increased by 7% between 1998 and 2004. The average annual number of CT examinations in 1998 was 46.3/1000 population, 3.4% of all radiological examinations in Switzerland in 1997-1998. The most frequent examination was CT of the skull (24%), while private radiology institutes perform more CTs of the spine. More CT examinations were performed for men than for women (sex ratio M/F=1.17). The average annual increase in CT in Swiss hospitals varied from 8% for Basel to 18% for Lausanne. Finally, the proportion of pediatric examinations was 5%; their numbers appear to be stabilizing. CONCLUSION: There is a significant increase in CT examinations. It is hoped that our study will heighten awareness among doctors of CT examinations in order to optimize their use.

Secular changes of spinal canal dimensions in Western Switzerland: a narrowing epidemic?

STUDY DESIGN: Computed tomography-based anatomical study. OBJECTIVE: To study the secular changes in lumbar spinal canal dimensions. SUMMARY OF BACKGROUND DATA: Development of symptomatic lumbar spinal stenosis, among other factors, is related to the dimensions of the bony canal. The canal reaches its adult size early on in life. Several factors, including protein intake, may influence its final dimensions. As with increases in human stature from improvements of socioeconomic conditions, we hypothesized that adult bony canal size has also grown larger in recent generations. METHODS: This study analyzes computed tomographic reconstructions from 184 subjects performed for either trauma (n = 81) or abdominal pathologies (n = 103) and born either between 1940 and 1949 (n = 88) or 1970 and 1979 (n = 96). The cross-sectional area of the bony canal was digitally measured at the level of the pedicle (i.e., at a level not influenced by degenerative changes) for each lumbar vertebra. Intra- and interobserver reliability was assessed. RESULTS: Intra- and interobserver measurement reliability were excellent (interclass correlation coefficient = 0.87) and good (interclass correlation coefficient = 0.61), respectively. Contrary to our hypothesis, the 1940-1949 generation patient group exhibited larger lumbar canals at all levels as compared with the 1970-1979 group. Statistically this difference was highly significant (P < 0.001) and particularly pronounced in the trauma subgroup. CONCLUSION: Given that human stature evolution has stabilized and adult height is established during the first 2 years of long bone growth, it is possible that antenatal factors are responsible for this surprising finding. Maternal smoking and age may be possible explanations. This finding may have significant implications. An increasing number of patients may emerge with lumbar spinal stenosis as degenerative changes develop, putting a strain on health resources. Further studies in different population groups and countries will be important to further confirm this trend. LEVEL OF EVIDENCE: 3.

Discordant secular trends in elevated blood pressure and obesity in children and adolescents in a rapidly developing country

BACKGROUND: The effect of the increasing prevalence of obesity on blood pressure (BP) secular trends is unclear. We analyzed BP and body mass index secular trends between 1998 and 2006 in children and adolescents of the Seychelles, a rapidly developing island state in the African region. METHODS AND RESULTS: School-based surveys were conducted annually between 1998 and 2006 among all students in 4 school grades (kindergarten and 4th, 7th, and 10th years of compulsory school). We used the Centers for Disease Control and Prevention criteria to define obesity and elevated BP. The same methods and instruments were used in all surveys. Some 25 586 children and adolescents 4 to 18 years of age contributed 43 867 observations. Although the prevalence of obesity in boys and girls increased from 5.1% and 6.0%, respectively, in 1998 to 2000 to 8.0% and 8.7% in 2004 to 2006, the prevalence of elevated BP decreased from 8.4% and 9.8% to 6.9% and 7.8%. During the interval, mean age-adjusted body mass index increased by 0.57 kg/m(2) in boys and 0.58 kg/m(2) in girls. Mean age- and height-adjusted systolic BP decreased by -3.0 mm Hg in boys and -2.8 mm Hg in girls, whereas mean diastolic BP did not change substantially in boys (-0.2 mm Hg) and increased slightly in girls (0.4 mm Hg). CONCLUSIONS: At a population level, the marked increase in the prevalence of obesity in children and adolescents in the Seychelles was not associated with a commensurate secular rise in mean BP.

A set of indicators for decomposing the secular increase of life expectancy.

ABSTRACT: BACKGROUND: The ongoing increase in life expectancy in developed countries is associated with changes in the shape of the survival curve. These changes can be characterized by two main, distinct components: (i) the decline in premature mortality, i.e., the concentration of deaths around some high value of the mean age at death, also termed rectangularization of the survival curve; and (ii) the increase of this mean age at death, i.e., longevity, which directly reflects the reduction of mortality at advanced ages. Several recent observations suggest that both mechanisms are simultaneously taking place. METHODS: We propose a set of indicators aiming to quantify, disentangle, and compare the respective contribution of rectangularization and longevity increase to the secular increase of life expectancy. These indicators, based on a nonparametric approach, are easy to implement. RESULTS: We illustrate the method with the evolution of the Swiss mortality data between 1876 and 2006. Using our approach, we are able to say that the increase in longevity and rectangularization explain each about 50% of the secular increase of life expectancy. CONCLUSION: Our method may provide a useful tool to assess whether the contribution of rectangularization to the secular increase of life expectancy will remain around 50% or whether it will be increasing in the next few years, and thus whether concentration of mortality will eventually take place against some ultimate biological limit.

Secular trends in height and weight among children and adolescents of the Seychelles, 1956-2006.

BACKGROUND: Height of individuals has long been considered as a significant index of nutrition and health of a population; still, there is little information regarding the trends of height and weight among developing or transitional countries. We assessed the secular trends in height and weight in children of the Seychelles, a rapidly developing island state in the Indian Ocean (African region). METHODS: Height and weight were measured in all students of all schools in four selected school grades (kindergarten, 4th, 7th and 10th grades) for the periods 1998-9 (6391 children) and 2005-6 (8582 children). Data for 1956-7 was extracted from a previously published report. RESULTS: At age 15.5 years, boys/girls were on average 10/13 cm taller and 15/9 kg heavier in 2005-6 than in 1956-7. Height increased in boys/girls by 1.62/0.93 cm/decade between 1956-7 and 1998-9 and by 1.14/1.82 cm/decade between 1998-9 and 2005-6. For weight, the linear increase in boys/girls was 1.38/1.10 kg/decade between 1956-7 and 1998-9 and 2.21/2.50 kg/decade between 1998-9 and 2005-6. Overall, the relative increase in weight between 1956-7 and 2005-6 was 5-fold higher than the relative increase in height. CONCLUSION: Height and weight increased markedly over time in children aged <16 years in the Seychelles, consistent with large changes in socio-economic and nutritional indicators in the considered 50-year interval. The markedly steeper increase in weight than height over time is consistent with an epidemic of overweight and obesity.

Variabilidade interdecadal na série secular de temperatura do ar em Santa Maria, RS

O objetivo deste trabalho foi verificar possíveis associações entre a variabilidade interdecadal das temperaturas mínima (Tmín) e máxima (Tmáx) diárias do ar e da amplitude térmica diária (ATD) em Santa Maria, RS, com a Oscilação Decadal do Pacífico (ODP). Foram usados os valores diários de Tmín e Tmáx de janeiro de 1912 a dezembro de 2009, e os valores mensais do índice da ODP do mesmo período. Há associação entre a variabilidade interdecadal da Tmín e Tmáx e da ATD com a ODP nesse local. Na fase fria da ODP, de 1947-1976, houve decréscimo nas Tmín e Tmáx. Nas duas fases quentes da ODP, 1925-1946 e de 1977-1998, houve aumento na Tmín no primeiro período e na Tmáx no segundo período. Durante a fase fria da ODP, de 1947-1976, houve redução da ATD, pela diminuição da Tmáx média e máxima. Houve aumento na ATD, no primeiro semestre na fase fria atual (1999-2009), em razão da diminuição na média da Tmín. Esses ciclos de aquecimento e resfriamento, na escala decadal, podem nortear estratégias de adaptação e mitigação na agricultura, por meio do melhoramento genético e desenvolvimento de cultivares tolerantes a tais oscilações de temperatura.

Soins aux mineurs non accompagnés (MNA): l'expérience lausannoise [Caring for unaccompanied minors: an experience from Lausanne].

La prise en charge médicale du mineur non accompagné est complexe et nécessite la mise en place d'un réseau biopsychosocial. A Lausanne, l'Unité multidisciplinaire de santé des adolescents (UMSA) joue un rôle préventif et curatif pour cette population extrêmement vulnérable. Une prise en charge psychologique rapide est souvent nécessaire en raison des événements de vie dramatiques auxquels la plupart de ces adolescents ont été confrontés. L'absence de projet d'avenir pour la majorité de ces adolescents reste une entrave majeure à leur développement et à leur santé mentale et physique. Medical treatment of an unaccompanied minor is made more complicated firstly by its connections with the politics of immigration and secondly by the difficulty in gaining recognition of the priority of the minor's interests. Enabling healthcare teams to travel and meet these particularly vulnerable youths makes medical care more accessible to them and facilitates an optimal bio-psycho-social treatment. For most of these adolescents it is their lack of plans for the future which remains the major obstacle to their development and mental and physical health.

Série histórica secular de brilho solar e suas relações com os modos de variabilidade ENOS e ODP em Santa Maria-RS

Os objetivos neste trabalho foram testar a homogeneidade, recalcular a média climatológica e determinar possíveis tendências e variabilidade interanual e interdecadal na série histórica secular mensal e sazonal de brilho solar, em Santa Maria - RS. Os dados de brilho solar foram obtidos na Estação Climatológica Principal (ECP) do Instituto Nacional de Meteorologia (8o DISME), no período de 1912 a 2011. Foram usados os testes de Sequência, de Mann-Kendall e Pettitt para análise de homogeneidade e tendência, respectivamente. As séries históricas na escala mensal e sazonal são estacionárias e homogêneas, exceto para o mês de dezembro e para a estação de outono. Há variabilidade interanual e interdecadal nas séries, devido aos fenômenos El Niño-Oscilação Sul (ENOS) e da Oscilação Decadal do Pacífico (ODP), com sinal marcante da fase fria de ambos os fenômenos, que aumentam o brilho solar, principalmente nos meses de outubro e novembro (primavera).

Cartilha de alfabetização e cultura escolar: um pacto secular

No Brasil, a partir da última década do século XIX, com a organização republicana da instrução pública, observa-se o início de um movimento de escolarização das práticas de leitura e escrita e de identificação entre o processo de ensino inicial dessas práticas e a questão dos métodos. A partir de então, a cartilha vai-se consolidando como um imprescindível instrumento de concretização dos métodos propostos e, em decorrência, de configuração de determinado conteúdo de ensino, assim como de certas silenciosas, mas operantes, concepções de alfabetização, leitura, escrita e texto, cuja finalidade e utilidade se encerram nos limites da própria escola e cuja permanência se pode observar até os dias atuais. O objetivo deste artigo é, mediante análise dessas questões, problematizar a relação entre cartilha de alfabetização e cultura escolar e seus desdobramentos na história da educação e da alfabetização em nosso país.

Secular Possession: Cinematic Iconography of Addiction

Addiction, and the experience of being addicted, is notoriously difficult to describe verbally and explain rationally. Would multifaceted and multisensory cinematic images work better in making addiction understandable? This study enquires how cinematic expression can render visible the experience of being addicted which is invisible as such. The basic data consists of circa 50 mainly North American and European fiction films from the early 1900s to the early 2000s that deal with addictive disorders as defined in the psychiatric DSM-V classification (substance dependence- and gambling disorders). The study develops an approach for analyzing and interpreting a large volume of digital film data: digital cinematic iconography is a framework to study the multifaceted cinematic images by processing and viewing them in the “digital image-laboratory” of the computer. Images are cut and classified by editing software and algorithmic sorting. The approach draws on early 1900s German art historian Aby Waburg’s image research and media archaeology, that are connected to film studies inspired by the phenomenology of the body and Gilles Deleuze’s film-philosophy. The first main chapter, “Montage”, analyses montage, gestural and postural images, and colors in addiction films. The second main chapter, “Thingness”, focuses on the close-ups of material objects and faces, and their relation to the theme of spirituality in cinema and art history, The study argues that the cinema engages the spectator to "feel" what addiction is through everyday experience and art historical imagery. There is a particular, historically transmitted cinematic iconography of addiction that is profane, material, thing-centered, abject, and repetitive. The experience of being addicted is visualized through montages of images characterized by dark and earthy colors, horizontal compositions and downward- directed movements. This is very profane and secular imagery that, however, circulates image-historical traces of Christian iconography, such as that of being in the grip of an unknown power.

Unaccompanied minors in Canada: How social and legal services affect their lives in Ontario

This qualitative research examines how service provisions affect lives of unaccompanied minors in Canada. In this study I utilized a semi-structured individual interview method. Among thirteen participants in my study, five came to Canada as unaccompanied minors and eight are professionals involved with service providing organizations in the Niagara region. The unaccompanied children that I interviewed had mixed experiences. Social and legal supports were made available to some of them while one was deported. This paper employs Bhabha’s postcolonial perspective and Foucault’s governmentality to illustrate unaccompanied minors’ post-arrival situation in Canada. This paper also attempts to look at children’s rights from Hanson and Nieuwenhuys’s (2013) perspective of living rights, social justice and translations. This paper explores how the change in recent immigration law affects the lives of unaccompanied minors. Findings of this study suggest that it is important to have a consensus on the definition of an unaccompanied minor; improved data collection and record-keeping on the number of unaccompanied minors; and, having a government-approved follow up mechanism. The study recommends policy makers, service providers and scholars pay increased attention to the experiences of unaccompanied minors to ensure that adequate social and legal services are offered to an unaccompanied minor in Canada.