Prévention du sida chez les toxicomanes en Suisse: une évolution encourageante. [Prevention of AIDS in drug addicts in Switzerland: an encouraging development].

Switzerland has adopted a prevention strategy including the promotion of non-sharing injection material and use of condoms. The access to sterile equipment has been made easier, but regional differences still exist. Studies conducted between 1989 and 1992 among drug users in different Swiss regions are reviewed in order to examine if progress in prevention occurred. Syringe sharing diminished everywhere, but rather high sharing rates persist where sterile material is less accessible. Condom use increased, but the situation is still unsatisfactory considering the high HIV prevalence among i.v. drug users. Where several surveys have been conducted consecutively, a stabilization of HIV prevalence was observed. This suggests a slowing down of the progression of the epidemic among drug users. These results, obtained in few years, are encouraging in the light of the pessimism which prevailed at the beginning of the epidemic about the ability of drug users to adopt preventive behaviour.

Hospital antibiotic consumption in Switzerland: comparison of a multicultural country with Europe.

The consumption of antibiotics in the inpatient setting of Switzerland was assessed to determine possible differences between linguistic regions, and to compare these results with European results. Data on antibiotic consumption were obtained from a sentinel network representing 54% of the national acute care hospitals, and from a private drug market monitoring company. Aggregated data were converted into defined daily doses (DDD). The total consumption density in Switzerland was close to the median consumption reported in European surveys. Between 2004 and 2008, the total consumption of systemic antibiotics rose from 46.1 to 54.0 DDD per 100 occupied bed-days in the entire hospitals, and from 101.6 to 114.3 DDD per 100 occupied bed-days in the intensive care units. Regional differences were observed for total consumption and among antibiotic classes. Hospitals in the Italian-speaking region showed a significantly higher consumption density, followed by the French- and German-speaking regions. Hospitals in the Italian-speaking region also had a higher consumption of fluoroquinolones, in line with the reported differences between Italy, Germany and France. Antibiotic consumption in acute care hospitals in Switzerland is close to the European median with a relatively low consumption in intensive care units. Some of the patterns of variation in consumption levels noticed among European countries are also observed among the cultural regions of Switzerland.

In vivo brain macromolecule signals in healthy and glioblastoma mouse models: (1) H magnetic resonance spectroscopy, post-processing and metabolite quantification at 14.1 T.

In (1) H magnetic resonance spectroscopy, macromolecule signals underlay metabolite signals, and knowing their contribution is necessary for reliable metabolite quantification. When macromolecule signals are measured using an inversion-recovery pulse sequence, special care needs to be taken to correctly remove residual metabolite signals to obtain a pure macromolecule spectrum. Furthermore, since a single spectrum is commonly used for quantification in multiple experiments, the impact of potential macromolecule signal variability, because of regional differences or pathologies, on metabolite quantification has to be assessed. In this study, we introduced a novel method to post-process measured macromolecule signals that offers a flexible and robust way of removing residual metabolite signals. This method was applied to investigate regional differences in the mouse brain macromolecule signals that may affect metabolite quantification when not taken into account. However, since no significant differences in metabolite quantification were detected, it was concluded that a single macromolecule spectrum can be generally used for the quantification of healthy mouse brain spectra. Alternatively, the study of a mouse model of human glioma showed several alterations of the macromolecule spectrum, including, but not limited to, increased mobile lipid signals, which had to be taken into account to avoid significant metabolite quantification errors.

Congenital hydronephrosis: prenatal diagnosis and epidemiology in Europe.

OBJECTIVE: To describe prevalence, prenatal diagnosis and epidemiology of congenital hydronephrosis (CH) in Europe. MATERIAL AND METHOD: Data from a large European database for surveillance of congenital malformations (EUROCAT). The 20 participating registries are all based on multiple sources of information and include information about livebirths, fetal deaths with gestational age >or=20 weeks and terminations of pregnancy after prenatal diagnosis of malformations. Included were all cases with CH and born 1995-2004. RESULTS: There were 3648 cases with CH giving an overall prevalence of 11.5 cases per 10,000 births. The large majority of cases were livebirths (3506, 96% of total) and only 17 cases were fetal deaths and 120 were terminations of pregnancy. Almost all livebirths were alive 1 week after birth. Boys accounted for 72% of all cases. A high proportion of the cases (86%) had an isolated renal malformation. There were large regional differences in prevalence of CH ranging from 2 to 29 per 10,000 births. There was little regional variation in the prevalence of postnatally diagnosed cases while there were large regional differences in prevalence of prenatally diagnosed cases. CONCLUSION: Cases with CH are mainly livebirths, boys and survive the first week after birth. The large difference in prevalence seems to be related to the availability of prenatal screening in the region. The impact of over-diagnosis and potential over-treatment in regions with high prevalence or under-diagnosis with implications for renal function later in life in regions with low prevalence needs further investigation.

Extended access cocaine self-administration differentially activates dorsal raphe and amygdala corticotropin-releasing factor systems in rats.

Cocaine-induced neuroadaptation of stress-related circuitry and increased access to cocaine each putatively contribute to the transition from cocaine use to cocaine dependence. The present study tested the hypothesis that rats receiving extended versus brief daily access to cocaine would exhibit regional differences in levels of the stress-regulatory neuropeptide corticotropin-releasing factor (CRF). A secondary goal was to explore how CRF levels change in relation to the time since cocaine self-administration. Male Wistar rats acquired operant self-administration of cocaine and were assigned to receive daily long access (6 hours/day, LgA, n = 20) or short access (1 hour/day, ShA, n = 18) to intravenous cocaine self-administration (fixed ratio 1, ∼0.50 mg/kg/infusion). After at least 3 weeks, tissue CRF immunoreactivity was measured at one of three timepoints: pre-session, post-session or 3 hours post-session. LgA, but not ShA, rats showed increased total session and first-hour cocaine intake. CRF immunoreactivity increased within the dorsal raphe (DR) and basolateral, but not central, nucleus of the amygdala (BLA, CeA) of ShA rats from pre-session to 3 hours post-session. In LgA rats, CRF immunoreactivity increased from pre-session to 3 hours post-session within the CeA and DR but tended to decrease in the BLA. LgA rats showed higher CRF levels than ShA rats in the DR and, pre-session, in the BLA. Thus, voluntary cocaine intake engages stress-regulatory CRF systems of the DR and amygdala. Increased availability of cocaine promotes greater tissue CRF levels in these extrahypothalamic brain regions, changes associated here with a model of cocaine dependence.

Attitudes and beliefs of palliative care physicians regarding communication with terminally ill cancer patients.

The subject of communication between palliative care physicians and their patients regarding their diagnosis and prognosis has not been extensively researched. The purpose of this survey was to compare the attitudes and beliefs of palliative care specialists regarding communication with the terminally ill in Europe, South America, and Canada. A sample of palliative care physicians from South America (Argentina and Brazil), French-speaking Europe, and Canada were identified, and posted a questionnaire. Physicians who stated that they practised palliative care at least 30% of their time were considered evaluable as palliative care specialists. Of a total of 272 questionnaires, 228 were returned (84%); and 182/228 (81%) respondents were considered to be palliative care specialists. Palliative care physicians in all three regions believed that cancer patients should be informed of their diagnosis and the terminal nature of their illness. Physicians reported that at least 60% of their patients knew their diagnosis and the terminal stage of their illness in 52% and 24% of cases in South America, and 69% and 38% of cases in Europe, respectively. All physicians agreed that 'do not resuscitate' orders should be present, and should be discussed with the patient in all cases. While 93% of Canadian physicians stated that at least 60% of their patients wanted to know about the terminal stage of their illness, only 18% of South American, and 26% of European physicians said this (P < 0.001). Similar results were found when the physicians were asked the percentage of families who want patients to know the terminal stage of their illness. However, almost all of the physicians agreed that if they had terminal cancer they would like to know. There was a significant association between patient based decision-making and female sex (P = 0.007), older age (P = 0.04), and physicians from Canada and South America (P < 0.001). Finally, in their daily decision making, South American physicians were significantly more likely to support beneficence and justice as compared with autonomy. Canadian physicians were more likely to support autonomy as compared with beneficence. In summary, our findings suggest that there are major regional differences in the attitudes and beliefs of physicians regarding communication at the end of life. More research is badly needed on the attitudes and beliefs of patients, families, and health care professionals in different regions of the world.

Political centralization and government accountability

This paper studies fiscal federalism when regions differ in voters' ability to monitor publicofficials. We develop a model of political agency in which rent-seeking politicians providepublic goods to win support from heterogeneously informed voters. In equilibrium, voterinformation increases government accountability but displays decreasing returns. Therefore,political centralization reduces aggregate rent extraction when voter information varies acrossregions. It increases welfare as long as the central government is required to provide publicgoods uniformly across regions. The need for uniformity implies an endogenous trade off between reducing rents through centralization and matching idiosyncratic preferences throughdecentralization. We find that a federal structure with overlapping levels of government canbe optimal only if regional differences in accountability are sufficiently large. The modelpredicts that less informed regions should reap greater benefits when the central governmentsets a uniform policy. Consistent with our theory, we present empirical evidence that lessinformed states enjoyed faster declines in pollution after the 1970 Clean Air Act centralizedenvironmental policy at the federal level.

Cross-scale analysis of the region effect on vascular plant species diversity in southern and northern European mountain ranges.

Background: The divergent glacial histories of southern and northern Europe affect present-day species diversity at coarse-grained scales in these two regions, but do these effects also penetrate to the more fine-grained scales of local communities?Methodology/Principal Findings: We carried out a cross-scale analysis to address this question for vascular plants in two mountain regions, the Alps in southern Europe and the Scandes in northern Europe, using environmentally paired vegetation plots in the two regions (n = 403 in each region) to quantify four diversity components: (i) total number of species occurring in a region (total gamma-diversity), (ii) number of species that could occur in a target plot after environmental filtering (habitat-specific gamma-diversity), (iii) pair-wise species compositional turnover between plots (plot-to-plot beta-diversity) and (iv) number of species present per plot (plot gamma-diversity). We found strong region effects on total gamma-diversity, habitat-specific gamma-diversity and plot-to-plot beta-diversity, with a greater diversity in the Alps even towards distances smaller than 50 m between plots. In contrast, there was a slightly greater plot alpha-diversity in the Scandes, but with a tendency towards contrasting region effects on high and low soil-acidity plots.Conclusions/Significance: We conclude that there are strong regional differences between coarse-grained (landscape- to regional-scale) diversity components of the flora in the Alps and the Scandes mountain ranges,but that these differences do not necessarily penetrate to the finest-grained (plot-scale) diversity component, at least not on acidic soils. Because different processes can lead to a similar pattern, we discuss the consistency of our results with Quaternary history and other divergent features between the two regions such as habitat connectivity, selection for vagility and environmental differences not accounted for in our analyses

Meckel-Gruber Syndrome: a population-based study on prevalence, prenatal diagnosis, clinical features, and survival in Europe.

Meckel-Gruber Syndrome is a rare autosomal recessive lethal ciliopathy characterized by the triad of cystic renal dysplasia, occipital encephalocele and postaxial polydactyly. We present the largest population-based epidemiological study to date using data provided by the European Surveillance of Congenital Anomalies (EUROCAT) network. The study population consisted of 191 cases of MKS identified between January 1990 and December 2011 in 34 European registries. The mean prevalence was 2.6 per 100 000 births in a subset of registries with good ascertainment. The prevalence was stable over time, but regional differences were observed. There were 145 (75.9%) terminations of pregnancy after prenatal diagnosis, 13 (6.8%) fetal deaths, 33 (17.3%) live births. In addition to cystic kidneys (97.7%), encephalocele (83.8%) and polydactyly (87.3%), frequent features include other central nervous system anomalies (51.4%), fibrotic/cystic changes of the liver (65.5% of cases with post mortem examination) and orofacial clefts (31.8%). Various other anomalies were present in 64 (37%) patients. As nowadays most patients are detected very early in pregnancy when liver or kidney changes may not yet be developed or may be difficult to assess, none of the anomalies should be considered obligatory for the diagnosis. Most cases (90.2%) are diagnosed prenatally at 14.3±2.6 (range 11-36) gestational weeks and pregnancies are mainly terminated, reducing the number of LB to one-fifth of the total prevalence rate. Early diagnosis is important for timely counseling of affected couples regarding the option of pregnancy termination and prenatal genetic testing in future pregnancies.

Unification of Emission Measurements in Paper and Pulp Mills

Tässä diplomityössä tavoitteena on selvittää käytännöt ja menetelmät, joilla UPM-Kymmenen sellu-, paperi- ja vaneritehtaat ympäri maailman mittaavat ja laskevat ilmapäästönsä. Tämä tehdään kyselylomakkeella, joka lähetetään tehtaiden ympäristöpäälliköille. Kaikki tärkeimmät seikat ilmapäästöihin liittyen, kuten vaaditut jatkuvatoimiset mittaukset, jaksottaiset mittaukset, raportointikäytäntö, kalibrointi jne. kysytään lomakkeessa. Kyselylomakkeessa painotetaan mittauskäytäntöä sellutehtaissa sekä energiantuotannossa. Saatujen tulosten perusteella annetaan ehdotuksia sekä ohjeita tulevaisuutta varten, jotta mittaustulosten kokoaminen helpottuisi ja vertailukelpoisuus paranisi. Työn kirjallisuusosuudessa selvitetään yleisimmät päästölähteet sekä päästökomponentit paperi –ja selluteollisuudessa. Näiden ei toivottujen yhdisteiden syntymekanismit sekä menetelmät niiden poistamiseksi savukaasuista on myös lyhyesti kuvailtu. Myös erilaiset analysointi- ja näytteenottomenetelmät on kerrottu. Erot tehtaiden ympäristöluvissa käydään läpi, jakaen tehtaat kolmeen maantieteelliseen ryhmään. Lupakäytäntöjen osalta Suomen osuutta on painotettu, sillä UPM-Kymmene on varsin Suomikeskeinen yhtiö tehtaiden lukumääriin ja sijainteihin katsottuna. Viranomaismääräykset sekä päästörajat muutamista tehtaista on esitetty havainnollistaakseen alueellisia eroja.

Sanomalehtipaperikoneiden kustannusrakenteiden vertailu

Uudella vuosituhannella metsäteollisuusyrityksien kustannustehokkuuden merkitys tulee korostumaan. Meneillään olevassa koko toimialaa koskevassa rakennemuutoksessa kustannuskilpailukyvyn säilyttäminen on elintärkeää liiketoiminnassa menestymiseen.Tässä työssä kerätään ja analysoidaan erään metsäteollisuusyhtiön sanomalehtipaperikoneiden kustannusrakennetiedot. Tärkeimpänä tavoitteena on lisätä tietoisuutta hintaeroista kustannuskomponenttien välillä sekä tehokkuuseroista eri toimintojen välillä. Tutkimusta voidaan hyödyntää etsittäessä parhaita toimintatapoja sekä käyttää tukemaan erilaisia päätöksentekotilanteita. Tutkimus osoitti konkreettisesti erot kustannuskomponenttien välillä. Alueelliset erot olivat merkittäviä. Kierrätyspaperista tehty sanomalehti-paperi osoittautui analyyseissä selvästi kustannuskilpailukykyisimmäksi. Tutkimuksen perusteella tuotannon painopistettä on siirrettävä tulevaisuudessa entistä enemmän niille alueille, missä paperin valmistuksen edellytykset ovat parhaimmat. Tulevaisuudessa uskotaan laajasti hintaerojen tasoittumiseen eri alueiden välillä, joten mielenkiintoisia muutoksia kustannusrakenteisiin on ainakin näiltä osin tiedossa.

Organisaation osaamisen ja uudistumiskyvyn kehittäminen strategialähtöisesti, case: Puumerkki Oy

Tutkielman tavoitteena oli selvittää organisaation osaamisen ja uudistumiskyvyn strategiset vahvuudet, heikkoudet ja kehittämiskohteet case-organisaatio Puumerkki Oy:ssä. Mittausten avulla haluttiin selvittää uuden organisaation toimivuus, organisaation osaamisen nykytila sekä toiminnan nykytilanne suhteessa strategiaan ja muihin yrityksiin. Tutkielmassa käytettiin sekä kvantitatiivista että kvalitatiivista tutkimusotetta. Olemassa olevalla mittarilla (KM-factor -organisaation uudistumiskyvyn mittari) mitattiin case-yritys, Puumerkki Oy. Mittauksia tehtiin kaksi: kesäkuussa 2003 ja tammikuussa 2004. Näin saatiin selville muutoksen ja kehityksen suunta sekä edistyminen. Mittausten kohteena olivat kaikki Puumerkki Oy:n työntekijät. Tutkimuksen luotettavuuden takaamiseksi ja tarkistamiseksi haastateltiin teemahaastatteluin lokakuussa 2003 Puumerkin henkilöstöstä kymmentä (10) satunnaisesti valittua henkilöä, ensimmäisen mittauksen (06/2003) alueellista vastausjakaumaa mukaillen. KM-factor mittausten tulosraportit analysoitiin ja purettiin sanalliseen muotoon sekä tuloksista tiivistettiin lyhyt esitys organisaation henkilöstölle raportointia varten. Haastatteluaineisto analysoitiin purkamalla haastattelut sanallisiksi teema-alueiden mukaisiin kokonaisuuksiin ja vertaamalla niitä mittauksien tuloksiin. Mittausten avulla kerättiin tietoa organisaation osaamisen, tiedonkulun, suhteiden ja johtamisen nykyisestä toiminnasta ja niiden tavoitetilasta eri tietoympäristöissä. Mittauksen mukaan Puumerkki Oy:n uudistumiskyky oli parempi kuin vertailuryhmällä ja toiminnan suunta oli oikea, strategian mukainen. Puumerkki Oy:n vahvuuksia olivat keskinäinen sitoutuminen tavoitteisiin, haasteellinen tavoitetaso, tilanneherkkyys ja yksimielisyys muutostarpeista. Mitään erityisen heikkoa aluetta ei mittauksessa löytynyt. Toiminnasta löytyi kuitenkin muutamia yleisiä kehityskohteita: liian autoritäärinen johtaminen, heikko innovaatiopotentiaali eli yrityksen jatkuva kehittämiskyky ja suuret yksikkökohtaiset (alueelliset) erot. Yrityksen kulttuurin, infrastruktuurin, viestinnän ja tietoteknisten työkalujen tulisi tukea aktiivista tiedonvaihtoa ja uuden tiedon hyödyntämistä.

The effect of the birth hospital and the time of birth on the outcome of Finnish very preterm infants

The purpose of this study was to evaluate the effect of the birth hospital and the time of birth on mortality and the long-term outcome of Finnish very low birth weight (VLBW) or very low gestational age (VLGA) infants. This study included all Finnish VLBW/VLGA infants born at <32 gestational weeks or with a birth weight of ≤1500g, and controls born full-term and healthy. In the first part of the study, the mortality of VLBW/VLGA infants born in 2000–2003 was studied. The second part of the study consisted of a five-year follow-up of VLBW/VLGA infants born in 2001–2002. The study was performed using data from parental questionnaires and several registers. The one-year mortality rate was 11% for live-born VLBW/VLGA infants, 22% for live-born and stillborn VLBW/VLGA infants, and 0% for the controls. In live-born and in all (including stillbirths) VLBW/VLGA infants, the adjusted mortality was lower among those born in level III hospitals compared with level II hospitals. Mortality rates of live-born VLBW/VLGA infants differed according to the university hospital district where the birth hospital was located, but there were no differences in mortality between the districts when stillborn infants were included. There was a trend towards lower mortality rates in VLBW/VLGA infants born during office hours compared with those born outside office hours (night time, weekends, and public holidays). When stillborn infants were included, this difference according to the time of birth was significant. Among five-year-old VLBW/VLGA children, morbidity, use of health care resources, and problems in behaviour and development were more common in comparison with the controls. The health-related quality of life of the surviving VLBW/VLGA children was good but, statistically, it was significantly lower than among the controls. The median and the mean number of quality-adjusted life-years were 4.6 and 3.6 out of a maximum five years for all VLBW/VLGA children. For the controls, the median was 4.8 and the mean was 4.9. Morbidity rates, the use of health care resources, and the mean quality-adjusted life-years differed for VLBW/VLGA children according to the university hospital district of birth. However, the time of birth, the birth hospital level or university hospital district were not associated with the health-related quality of life, nor with behavioural and developmental scores of the survivors at the age of five years. In conclusion, the decreased mortality in level III hospitals was not gained at the expense of long-term problems. The results indicate that VLBW/VLGA deliveries should be centralized to level III hospitals and the regional differences in the treatment practices should further be clarified. A long-term follow-up on the outcome of VLBW/VLGA infants is important in order to recognize the critical periods of care and to optimise the care. In the future, quality-adjusted life-years can be used as a uniform measure for comparing the effectiveness of care between VLBW/VLGA infants and different patient groups

Tilirahan arvostaminen, korkoriskin hallinta ja Suomen talletusmarkkinat

Tilirahalla tarkoitetaan matalan koron tilejä, joihin liittyy tallettajan optio nostaa talletus haluamanaan ajankohtana. Tästä huolimatta tilirahan on havaittu olevan pankille kohtalaisen pysyvää rahoitusta. Pitkä keskimääräinen elinikä yhdistettynä matalaan kustannukseen tekee tilirahasta yhden pankin merkittävimmistä tulonlähteistä. Suuri korkomarginaali ja talletuskoron jäykkyys suhteessa markkinakorkotasoon aiheuttavat puolestaan pankille suuren korkoriskin. Tutkielma vastaa kysymykseen mitä tekijöitä tulee ottaa huomioon tilirahan arvostamisessa ja korkoriskin hallinnassa Suomen talletusmarkkinoilla. Kirjallisuuskatsauksessa esitettyjä tietoja ja niiden soveltuvuutta suomalaisten kotitalouksien tilirahavolyymien kehityksen ennustamisessa arvioidaan lopuksi Suomen Pankista, Eurostatista ja Tilastokeskuksesta saatavien lukujen pohjilta. Virallisista tilastoista johdettujen arvioiden havaittiin osin poikkeavan kirjallisuuskatsauksessa esitetystä. Syynä tähän nähdään eri maiden väliset erot kotitalouksien säästämiskäyttäytymisessä. Suomessa kotitalouksien käyttäytymistä ei näytä ensisijaisesti ohjaavan taloudelliset vaan ei-taloudelliset tekijät kuten parempi likviditeetti. Lisäksi bruttokansantuotteen ja tilirahavolyymin kehityksen välillä havaittiin Suomessa todennäköinen korrelaatio. Alueelliset erot tuleekin huomioida aikaisempia tutkimustuloksia hyödynnettäessä.

Dispersal and metacommunity dynamics in a soft-sediment benthic system : how well is the seafloor connected?

Connectivity depends on rates of dispersal between communities. For marine soft-sediment communities continued small-scale dispersal as post-larvae and as adults can be equally important in maintaining community composition, as initial recruitment of substrate by pelagic larvae. In this thesis post-larval dispersal strategies of benthic invertebrates, as well as mechanisms by which communities are connected were investigated. Such knowledge on dispersal is scarce, due to the difficulties in actually measuring dispersal directly in nature, and dispersal has not previously been quantified in the Baltic Sea. Different trap-types were used underwater to capture dispersing invertebrates at different sites, while in parallel measuring waves and currents. Local community composition was found to change predictably under varying rates of dispersal and physical connectivity (waves and currents). This response was, however, dependent on dispersal-related traits of taxa. Actively dispersing taxa will be relatively better at maintaining their position, as they are not as dependent on hydrodynamic conditions for dispersal and will be less prone to be passively transported by currents. Taxa also dispersed in relative proportions that were distinctly different from resident community composition and a significant proportion (40 %) of taxa were found to lack a planktonic larval life-stage. Community assembly was re-started in a large-scale manipulative field experiment over one year across several sites, which revealed how patterns of community composition (α-, β- and λ-diversity) change depending on rates of dispersal. Results also demonstrated that in response to small-scale disturbance, initial recruitment was by nearby-dominant species after which other species arrived from successively further away. At later assembly time, the number of coexisting species increased beyond what was expected purely by local niche requirements (species sorting), transferring regional differences in community composition (β-diversity) to the local scale (α-diversity, mass effect). Findings of this thesis complement more theoretical studies in metacommunity ecology by demonstrating that understanding how and when individuals disperse relative to underlying environmental heterogeneity is key to interpreting how patterns of diversity change across different spatial scales. Such information from nature is critical when predicting responses to, for example, different types of disturbances or management actions in conservation.