Evaluation des activités de prévention du VIH/sida dans le canton de Genève, période 2006

Les principaux objets abordés au cours de l'évaluation en 2006 sont : 1. Le suivi de l'évolution des nouveaux cas de VIH et des comportements dans un des groupes spécifiques, à savoir les consommateurs de drogues par injection (comparaison 2000-2002-2006); 2. La poursuite du monitoring des activités des associations institué en 2005 et le suivi des recommandations émises dans le rapport 2005; 3. La révision des indicateurs proposés dans les contrats de partenariat et la définition des indicateurs de processus et des objectifs visés à moyen terme; 4. L'appréciation des synergies et des complémentarités du dispositif, en particulier des activités de prévention, dans le domaine des migrants, après les recommandations émises en 2005; 5. L'exploration des possibilités de comparer les clientèles et la demande de test dans les centres de test anonyme de Checkpoint et des HUG. Dans ce rapport figure en premier lieu le bilan épidémiologique et la présentation de l'évolution des comportements dans deux groupes cible à savoir les personnes séropositives et les consommateurs de drogues par injection. Les résultats des monitorings des activités des associations sont ensuite présentés en regard des recommandations émises dans le précédent rapport d'évaluation. La collaboration dans le travail effectué auprès des migrants fait l'objet d'un chapitre en soi alors que pour les objectifs 3 et 5 un bref résumé présente le travail effectué. [Extrait Introduction p. 5]

Evaluation d'un Espace de Prévention dans le cadre du Festival de Jazz de Montreux 2001: la Scène Bleue

L'initiative Scène Bleue (SB) se veut un espace, lieu de rencontre de jeunes adolescents âgés de 10 à 18 ans, dans le cadre de l'édition 2001 du Festival de Jazz de Montreux. Il s'agit de proposer une série d'animations permettant de faire la fête sans consommation de substances (légales et/ou illégales). Ce document fait l'historique du projet et de l'évaluation conduite par l'IUMSP. Cette évaluation comprend trois volets, correspondant à des temps différents : 1. Avant - documenter la perception des objectifs et les attentes des jeunes et des animateurs, avant le démarrage du projet SB. 2. Pendant - analyser la réalisation du projet in situ et recueillir informations et réactions auprès de la clientèle de la SB. 3. Après - examiner l'évolution des perceptions des différents acteurs, après le festival. Les résultats peuvent être résumés comme suit : la SB a rencontré un vif succès. La démonstration a été faite que le public concerné pouvait être attiré par un lieu avec des interdits relatifs à la consommation de substances : ainsi l'objectif de prévention primaire ciblant des jeunes âgés de 13 ans en moyenne a été atteint. Les visiteurs plus âgés, moins impliqués, ont malgré tout pu réaliser que faire la fête sans alcool ni drogues était possible. Le projet peut à l'avenir être consolidé en définissant des objectifs et des stratégies de prévention explicites. La participation des jeunes à cette entreprise collective partagée avec les animateurs et les reponsables peut être sollicitée davantage, notamment pour ce qui est de l'organisation et des choix concrets relatifs aux diverses animations. [Résumé]

The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement.

Routinely collected health data, obtained for administrative and clinical purposes without specific a priori research goals, are increasingly used for research. The rapid evolution and availability of these data have revealed issues not addressed by existing reporting guidelines, such as Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). The REporting of studies Conducted using Observational Routinely collected health Data (RECORD) statement was created to fill these gaps. RECORD was created as an extension to the STROBE statement to address reporting items specific to observational studies using routinely collected health data. RECORD consists of a checklist of 13 items related to the title, abstract, introduction, methods, results, and discussion section of articles, and other information required for inclusion in such research reports. This document contains the checklist and explanatory and elaboration information to enhance the use of the checklist. Examples of good reporting for each RECORD checklist item are also included herein. This document, as well as the accompanying website and message board (http://www.record-statement.org), will enhance the implementation and understanding of RECORD. Through implementation of RECORD, authors, journals editors, and peer reviewers can encourage transparency of research reporting.

Economic evaluation of prevention of mother – to – child – transmission of HIV/AIDS interventions in developing countries : a systematic review

Les gouvernements mondiaux et les organismes internationaux ont placé une haute priorité dans la prévention de la transmission mère-enfant du VIH. Cependant, bien qu'il y ait eu des progrès énormes rapportés dans des nations industrialisées, la situation dans les pays en voie de développement est encore déplorable; on y constate un grand écart entre l’engagement international pour réduire cette voie de transmission et l'accès aux interventions. Ceci peut être attribué à la situation économique déplorable dans plusieurs pays en voie de développement. Des interventions prioritaires en santé doivent donc être soigneusement sélectionnées afin de maximiser l'utilisation efficace des ressources limitées. L’évaluation économique est un outil efficace qui peut aider des décideurs à identifier quelles stratégies choisir. L'objectif de cette revue systématique est de recenser toutes les études d'évaluation économique existantes qui ont été effectuées dans les pays en voie de développement sur la prévention de la transmission mère-enfant du VIH. Notre revue a retenu 16 articles qui ont répondu aux critères d'inclusion. Nous avons conçu un formulaire pour l’extraction de données, puis nous avons soumis les articles à un contrôle rigoureux de qualité. Nos résultats ont exposé un certain nombre de défauts dans la qualité des études choisies. Nous avons également noté une forte hétérogénéité dans les estimations des paramètres de coût et d'efficacité de base, dans la méthodologie appliquée, ainsi que dans les écarts utilisés dans les analyses de sensibilité. Quelques interventions comportant la thérapie à la zidovudine ou à la nevirapine à court terme se sont avérées rentables, et ont enregistré des valeurs acceptables de coût-utilité. Les résultats des évaluations économiques analysées dans cette revue ont varié sur la base des facteurs suivants : la prévalence du VIH, la classification du pays selon le revenu, les infrastructures disponible, les coûts du personnel, et finalement les coûts des interventions, particulièrement les prix des médicaments.

Comprehensive evaluation of the WaterGAP3 model across climatic, physiographic, and anthropogenic gradients

In den letzten Jahrzehnten haben sich makroskalige hydrologische Modelle als wichtige Werkzeuge etabliert um den Zustand der globalen erneuerbaren Süßwasserressourcen flächendeckend bewerten können. Sie werden heutzutage eingesetzt um eine große Bandbreite wissenschaftlicher Fragestellungen zu beantworten, insbesondere hinsichtlich der Auswirkungen anthropogener Einflüsse auf das natürliche Abflussregime oder der Auswirkungen des globalen Wandels und Klimawandels auf die Ressource Wasser. Diese Auswirkungen lassen sich durch verschiedenste wasserbezogene Kenngrößen abschätzen, wie z.B. erneuerbare (Grund-)Wasserressourcen, Hochwasserrisiko, Dürren, Wasserstress und Wasserknappheit. Die Weiterentwicklung makroskaliger hydrologischer Modelle wurde insbesondere durch stetig steigende Rechenkapazitäten begünstigt, aber auch durch die zunehmende Verfügbarkeit von Fernerkundungsdaten und abgeleiteten Datenprodukten, die genutzt werden können, um die Modelle anzutreiben und zu verbessern. Wie alle makro- bis globalskaligen Modellierungsansätze unterliegen makroskalige hydrologische Simulationen erheblichen Unsicherheiten, die (i) auf räumliche Eingabedatensätze, wie z.B. meteorologische Größen oder Landoberflächenparameter, und (ii) im Besonderen auf die (oftmals) vereinfachte Abbildung physikalischer Prozesse im Modell zurückzuführen sind. Angesichts dieser Unsicherheiten ist es unabdingbar, die tatsächliche Anwendbarkeit und Prognosefähigkeit der Modelle unter diversen klimatischen und physiographischen Bedingungen zu überprüfen. Bisher wurden die meisten Evaluierungsstudien jedoch lediglich in wenigen, großen Flusseinzugsgebieten durchgeführt oder fokussierten auf kontinentalen Wasserflüssen. Dies steht im Kontrast zu vielen Anwendungsstudien, deren Analysen und Aussagen auf simulierten Zustandsgrößen und Flüssen in deutlich feinerer räumlicher Auflösung (Gridzelle) basieren. Den Kern der Dissertation bildet eine umfangreiche Evaluierung der generellen Anwendbarkeit des globalen hydrologischen Modells WaterGAP3 für die Simulation von monatlichen Abflussregimen und Niedrig- und Hochwasserabflüssen auf Basis von mehr als 2400 Durchflussmessreihen für den Zeitraum 1958-2010. Die betrachteten Flusseinzugsgebiete repräsentieren ein breites Spektrum klimatischer und physiographischer Bedingungen, die Einzugsgebietsgröße reicht von 3000 bis zu mehreren Millionen Quadratkilometern. Die Modellevaluierung hat dabei zwei Zielsetzungen: Erstens soll die erzielte Modellgüte als Bezugswert dienen gegen den jegliche weiteren Modellverbesserungen verglichen werden können. Zweitens soll eine Methode zur diagnostischen Modellevaluierung entwickelt und getestet werden, die eindeutige Ansatzpunkte zur Modellverbesserung aufzeigen soll, falls die Modellgüte unzureichend ist. Hierzu werden komplementäre Modellgütemaße mit neun Gebietsparametern verknüpft, welche die klimatischen und physiographischen Bedingungen sowie den Grad anthropogener Beeinflussung in den einzelnen Einzugsgebieten quantifizieren. WaterGAP3 erzielt eine mittlere bis hohe Modellgüte für die Simulation von sowohl monatlichen Abflussregimen als auch Niedrig- und Hochwasserabflüssen, jedoch sind für alle betrachteten Modellgütemaße deutliche räumliche Muster erkennbar. Von den neun betrachteten Gebietseigenschaften weisen insbesondere der Ariditätsgrad und die mittlere Gebietsneigung einen starken Einfluss auf die Modellgüte auf. Das Modell tendiert zur Überschätzung des jährlichen Abflussvolumens mit steigender Aridität. Dieses Verhalten ist charakteristisch für makroskalige hydrologische Modelle und ist auf die unzureichende Abbildung von Prozessen der Abflussbildung und –konzentration in wasserlimitierten Gebieten zurückzuführen. In steilen Einzugsgebieten wird eine geringe Modellgüte hinsichtlich der Abbildung von monatlicher Abflussvariabilität und zeitlicher Dynamik festgestellt, die sich auch in der Güte der Niedrig- und Hochwassersimulation widerspiegelt. Diese Beobachtung weist auf notwendige Modellverbesserungen in Bezug auf (i) die Aufteilung des Gesamtabflusses in schnelle und verzögerte Abflusskomponente und (ii) die Berechnung der Fließgeschwindigkeit im Gerinne hin. Die im Rahmen der Dissertation entwickelte Methode zur diagnostischen Modellevaluierung durch Verknüpfung von komplementären Modellgütemaßen und Einzugsgebietseigenschaften wurde exemplarisch am Beispiel des WaterGAP3 Modells erprobt. Die Methode hat sich als effizientes Werkzeug erwiesen, um räumliche Muster in der Modellgüte zu erklären und Defizite in der Modellstruktur zu identifizieren. Die entwickelte Methode ist generell für jedes hydrologische Modell anwendbar. Sie ist jedoch insbesondere für makroskalige Modelle und multi-basin Studien relevant, da sie das Fehlen von feldspezifischen Kenntnissen und gezielten Messkampagnen, auf die üblicherweise in der Einzugsgebietsmodellierung zurückgegriffen wird, teilweise ausgleichen kann.

Good practice in reviewing and publishing studies on herbal medicine, with special emphasis on traditional Chinese medicine and Chinese materia medica

Ethnopharmacological relevance: Studies on traditional Chinese medicine (TCM), like those of other systems of traditional medicine (TM), are very variable in their quality, content and focus, resulting in issues around their acceptability to the global scientific community. In an attempt to address these issues, an European Union funded FP7 consortium, composed of both Chinese and European scientists and named “Good practice in traditional Chinese medicine” (GP-TCM), has devised a series of guidelines and technical notes to facilitate good practice in collecting, assessing and publishing TCM literature as well as highlighting the scope of information that should be in future publications on TMs. This paper summarises these guidelines, together with what has been learned through GP-TCM collaborations, focusing on some common problems and proposing solutions. The recommendations also provide a template for the evaluation of other types of traditional medicine such as Ayurveda, Kampo and Unani. Materials and methods: GP-TCM provided a means by which experts in different areas relating to TCM were able to collaborate in forming a literature review good practice panel which operated through e-mail exchanges, teleconferences and focused discussions at annual meetings. The panel involved coordinators and representatives of each GP-TCM work package (WP) with the latter managing the testing and refining of such guidelines within the context of their respective WPs and providing feedback. Results: A Good Practice Handbook for Scientific Publications on TCM was drafted during the three years of the consortium, showing the value of such networks. A “deliverable – central questions – labour division” model had been established to guide the literature evaluation studies of each WP. The model investigated various scoring systems and their ability to provide consistent and reliable semi-quantitative assessments of the literature, notably in respect of the botanical ingredients involved and the scientific quality of the work described. This resulted in the compilation of (i) a robust scoring system and (ii) a set of minimum standards for publishing in the herbal medicines field, based on an analysis of the main problems identified in published TCM literature.

Post-occupancy studies of an office environment: Energy performance and occupants’ satisfaction

It is generally accepted that the physical workplace environment affects employees’ satisfaction and, consequently, their perceived productivity and well-being. This study investigated whether employee “satisfaction” variables can predict perceived productivity, well-being and enjoyment at work, and if so, to what extent. The study also explored whether limiting employees’ control over their environment could save energy without compromising employees’ satisfaction and perceived productivity. Preoccupancy and post-occupancy evaluation studies were conducted, in terms of both energy consumption and employee perceptions, to make comparisons between a company’s old and current headquarters buildings, both located in the same area of London. The results showed that employees were more satisfied with their work environment at their new HQ, in general, than with that of their previous office. Also, employees’ self-reported productivity, well-being and enjoyment at work improved after the move. It was revealed that the combination of employees’ level of satisfaction with “interior use of space” and “physical conditions” was the best predictor of their perceived productivity, while satisfaction with “indoor facilities” was not a good predictor. In terms of energy performance, although the new HQ’s energy consumption per m2 was significantly less than that of the previous building, there was still a gap between the refurbishment design target and the actual performance of the building. The findings suggest that this gap could be due to a number of factors, including an ineffective use of interior space, and occupants’ behaviour.

Morphological and functional evaluation of distal esophagus of rabbits submitted to esophageal infusion with caustic soda

A ingestão de substâncias cáusticas constitui importante situação de emergência, tendo em vista a gravidade de suas seqüelas. OBJETIVO: Estudar as alterações morfológicas e funcionais do esôfago de coelhos submetidos à infusão esofágica com soda cáustica (NaOH). MÉTODOS: 88 coelhos foram divididos em 4 grupos: G1 (n=22) foi submetido à infusão esofágica com água destilada; G2, G3 e G4 foram submetidos a infusão esofágica com NaOH a 2%, 4% e 6%, respectivamente. Alterações morfológicas foram estudadas em 12 animais de cada grupo e as alterações manométricas, nos 10 animais restantes. Foram feitas análises do esfíncter inferior do esôfago (EIE), número e amplitude das contrações no terço distal do esôfago. Estes estudos foram realizados antes (momento 1 - M1) e aos 30 minutos, 6 horas e 24 horas após a infusão esofágica (momentos M2, M3 e M4, respectivamente). RESULTADOS: Avaliação macroscópica: G1 - sem alterações; G2 - edema, hiperemia e descamação; G3 - aumento do calibre do esôfago, úlceras, descamação da mucosa; G4 - lesões semelhantes as do G3, porém mais intensas, áreas de extensa hemorragia. Avaliação funcional: a pressão no EIE foi mais elevada em M2 no grupo 2; o número das contrações no terço distal do esôfago foi menor em G3 e G4, e a amplitude das contrações foi menor em G4. CONCLUSÕES: 1) a infusão esofágica com NaOH constitui excelente modelo experimental de esofagite cáustica no coelho; 2) a infusão esofágica com NaOH causa lesões na parede do esôfago, com gravidade proporcional a concentração da solução; 3) a infusão causou espasmo do EIE em M2 e redução do número e amplitude das contrações no terço distal do esôfago.

Pressure evaluation of the antireflux ability of the rat ureterovesical junction

The bladder pressure necessary to cause vesicoureteral reflux (VUR) was measured in 16 female rats. Under general anesthesia, the ureters were exposed via an abdominal incission and a pressure catheter was placed near the uterovesical junction. Values of bladder distension and bladder pressure increase to cause VUR were obtained by injecting isotonic saline in one ureter until VUR in the opposite ureter was detected as a sudden pressure increase. After 5 min the same procedure was done on the contralateral side. This procedure was repeated eight times in each rat with a 15-min intermission. The bladder pressure at which VUR occurred was measured through a uretral catheter. Two groups were studied: G1, control, and G2, administration of intravenous metoclopramide (0.007 mg/100 g body weight) four times.

Psychological evaluation of patients scheduled for orthognathic surgery.

Using a questionnaire, 41 patients scheduled for orthognathic surgery were evaluated pre- and postoperatively to determine some of their psychological characteristics and treatment outcome from the patient's standpoint. Among other conclusions, the results showed that some patients may not fully understand the details of their deformity, despite a full explanation by the orthodontist and surgeon. Expectations regarding treatment outcome may be unrealistic even in patients with valid self-motivation for surgery. Social adjustment usually improves after treatment. Functional changes were noticed by over 80% of the patients and esthetic changes in over 90%.

Validity of the 'protocol of oro-facial myofunctional evaluation with scores' for young and adult subjects

The aims of this study were to analyse the validity, sensitivity and specificity of the protocol of oro-facial myofunctional evaluation with scores (OMES) for oro-facial myofunctional disorder (OMD) diagnosis in young and adult subjects. Eighty subjects were examined. The OMES was validated against the Nordic Orofacial Test-Screening (NOT-S) protocol (criterion validity) (Spearman correlation test). The construct validity was tested by analysis of the ability of the OMES (i) to differentiate healthy subjects (n = 22) from temporomandibular disorder (TMD) patients (n = 22), which frequently have OMD (MannWhitney test) and (ii) to measure the changes that occurred in a subgroup with TMD between the period before and after oro-facial myofunctional therapy (T group, n = 15) (Wilcoxon test). Two speech therapists trained with the OMES participated as examiners (E). There was a statistically significant correlation between the OMES and NOT-S protocols, which was negative because the two scales are inverse (r = -0.86, P < 0.01). There was a significant difference between the healthy and TMD subjects regarding the oro-facial myofunctional status (OMES total score, P = 0.003). After therapy, the T group showed improvement in the oro-facial myofunctional status (OMES total score, P = 0.001). Inter- and intra-examiner agreement was moderate, and the reliability coefficients ranged from good to excellent. The OMES protocol presented mean sensitivity and specificity = 0.80, positive predictive value = 0.76 and negative predictive value = 0.84. Conclusion: The OMES protocol is valid and reliable for clinical evaluation of young and adult subjects, among them patients with TMD.

Renal function evaluation in patients with American Cutaneous Leishmaniasis after specific treatment with pentavalent antimonial

Background: Renal evaluation studies are rare in American Cutaneous Leishmaniasis (ACL). The aim of this study is to investigate whether specific treatment reverts ACL-associated renal dysfunction. Methods: A prospective study was conducted with 37 patients with ACL. Urinary concentrating and acidification ability was assessed before and after treatment with pentavalent antimonial. Results: The patients mean age was 35.6 +/- 12 years and 19 were male. Before treatment, urinary concentrating defect (U/P-osm < 2.8) was identified in 27 patients (77%) and urinary acidification defect in 17 patients (46%). No significant glomerular dysfunction was observed before and after specific ACL treatment. There was no reversion of urinary concentrating defects, being observed in 77% of the patients before and in 88% after treatment (p = 0.344). Urinary acidification defect was corrected in 9 patients after treatment, reducing its prevalence from 40% before to only 16% after treament, (p = 0.012). Microalbuminuria higher than 30 mg/g was found in 35% of patients before treatment and in only 8% after treatment. Regarding fractional excretion of sodium, potassium, calcium, phosphorus and magnesium, there was no significant difference between pre and post-treatment period. Conclusion: As previously described, urinary concentrating and acidification defects were found in an important number of patients with ACL. Present results demonstrate that only some patients recover urinary acidification capacity, while no one returned to normal urinary concentration capacity.

Renal function evaluation in patients with American Cutaneous Leishmaniasis after specific treatment with pentavalent antimonial

Background Renal evaluation studies are rare in American Cutaneous Leishmaniasis (ACL). The aim of this study is to investigate whether specific treatment reverts ACL-associated renal dysfunction. Methods A prospective study was conducted with 37 patients with ACL. Urinary concentrating and acidification ability was assessed before and after treatment with pentavalent antimonial. Results The patients mean age was 35.6 ± 12 years and 19 were male. Before treatment, urinary concentrating defect (U/Posm <2.8) was identified in 27 patients (77%) and urinary acidification defect in 17 patients (46%). No significant glomerular dysfunction was observed before and after specific ACL treatment. There was no reversion of urinary concentrating defects, being observed in 77% of the patients before and in 88% after treatment (p = 0.344). Urinary acidification defect was corrected in 9 patients after treatment, reducing its prevalence from 40% before to only 16% after treament, (p = 0.012). Microalbuminuria higher than 30 mg/g was found in 35% of patients before treatment and in only 8% after treatment. Regarding fractional excretion of sodium, potassium, calcium, phosphorus and magnesium, there was no significant difference between pre and post-treatment period. Conclusion As previously described, urinary concentrating and acidification defects were found in an important number of patients with ACL. Present results demonstrate that only some patients recover urinary acidification capacity, while no one returned to normal urinary concentration capacity.

[Effectiveness of Integrated Psychological Therapy for schizophrenia patients : A meta-analysis including 28 independent studies.]

Over the past 24 years, research groups in eight different countries have conducted 28 independent evaluation studies on Integrated Psychological Therapy (IPT) including 1,329 schizophrenia patients. The present study examines the effectiveness of IPT under different treatment conditions by means of a meta-analytic review. The most salient results indicate favourable mean effect sizes for IPT in comparison to control groups (placebo-attention conditions, standard care). Moreover, the superiority of IPT continues to increase during an average catamnestic phase of 8.1 months. The method obtains similarly favourable effects in different functional areas (neurocognition, social behaviour, psychopathology) and different assessment formats (expert ratings, self-reports, psychological tests). The comparison of different settings of IPT and control groups shows the superiority of IPT in any given therapy or site condition. The analysis of subsamples of inpatients, outpatients, and patients in varying rehabilitation phases reveals similarly favourable effects. Comparing only high-quality studies yields comparable results. In summary, the present meta-analysis corroborates evidence that IPT is an 'empirically validated treatment' according to American Psychiatric Association guidelines.

UTILIZATION OF EVALUATION RESULTS

The issue over utilization of evaluation results has been receiving increasing attention lately. However, a continuing problem has been the lack of knowledge of the specific determinants of the utilization of evaluation results, the extent that these results are used, and the absence in the literature of empirical investigations of those determinants. The purposes of the current study were to examine the patterns of utilization of the recommendations made to an organization following an extensive evaluation, and to quantitatively examine some determinants of that utilization. During the course of the ten-month study, a number of important points regarding evaluation studies, and the utilization of their results were identified. Primary among these was the fact that a definition of utilization that requires adoption of recommendations is limited. Tremendous amounts of organizational activity may accrue from the results of an evaluation regardless of whether the results are adopted. In addition, none of the characteristics of the recommendations that were examined proved to be significant predictors of the extent of their utilization other than whether adoption was considered an authority decision or the results of staff concensus. ^