Die Epidemiologie der Risikofaktoren für kardiovaskuläre Krankheiten in der Schweiz = Epidémiologie des facteurs de risque des maladies cardio-vasculaires en Suisse

[Contient] Introduction = Einführung - Programme national suisse de recherche sur la prévention des maladies cardio-vasculaires: l'examen de santé initial / B. Junod, F. Gutzwiller - Rauchgewohnheiten in vier Schweizer Städten / C. Schucan, T. Abelin - Distribution du chlolestérol plasmatique dans quatre villes suisses / H. Micheli - Ernährungsverhalten, Verzehrsgewohnheiten und Massenindex in vier Schweizer Städten / G. Ritzel - Epidemiologie des Blutdrucks in vier Schweizer Städten / F. Gutzwiller - Körperliche Aktivität und Leistungsfähigkeit in vier Schweizer Städten / H. Howald - Prévalence de l'exposition aux facteurs de risque des maladies cardio-vasculaires dans quatre villes suisses (Nyon, Vevey, Aarau, Soleure) / J. Alexander, B. Junod

Specific heat of MgB_2 after irradiation

We studied the effect of disorder on the superconducting properties of polycrystalline MgB_2 by specific-heat measurements. In the pristine state, these measurements give a bulk confirmation of the presence of two superconducting gaps with 2 Delta 0 / k_B T_c = 1.3 and 3.9 with nearly equal weights. The scattering introduced by irradiation suppresses T_c and tends to average the two gaps although less than predicted by theory. We also found that by a suitable irradiation process by fast neutrons, a substantial bulk increase of dH_{c2}/dT at T_c can be obtained without sacrificing more than a few degrees in T_c. The upper critical field of the sample after irradiation exceeds 28 T at T goes to 0 K.Comment: 11 pages text, 6 figures, accepted by Journal of Physics: Condensed Matte

Patient expectations at a multicultural out-patient clinic in Switzerland

Background. Recognizing patient expectation is considered as an important objective for primary care physicians. A number of studies suggest that failure to identify patient expectations can lead to patient dissatisfaction with care, lack of compliance and inappropriate use of medical resources. It has been suggested that identifying patient expectations in multicultural contexts can be especially challenging. Objectives. The aim of the study was to compare health care expectations of Swiss and immigrant patients attending the out-patient clinic of a Swiss university hospital and to assess physicians' ability to identify their patients' expectations. Methods. Over a 3-month period, all patients attending the out-patient clinic at a Swiss university hospital were requested to complete pre-consultation surveys. Their physicians were requested to complete post-consultation surveys. Outcome measures were patients' self-rated health, resort to prior home treatment, patients' expectations of the consultation, physicians' perception of their patients' expectations and agreement between patients and physicians. Results. We analysed 343 questionnaires completed by patients prior to their consultation (> 50% immigrants) and 333 questionnaires completed by their physicians after the consultation. Most expectations were shared by all patients. Physicians had inaccurate perceptions of their patients' expectations, regardless of patients' origin. Conclusions. Our study found no evidence that immigrant patients' expectations differed from those of Swiss patients, nor that physicians had more difficulty identifying expectations of immigrant patients. However, physicians in our study were generally poor at identifying patients' expectations, and therefore inter-group differences may be difficult to detect. Our results point to the need to strengthen physicians' general communication skills which should then serve as a foundation for more specific, cross-cultural communication trainin

Direct Observation and Anisotropy of the Contribution of Gap nodes in the Low Temperature Specific Heat of YBa_2Cu_3O_7

The specific heat due to line nodes in the superconducting gap of YBa2Cu3O7 has been obscured up to now by magnetic terms of extrinsic origin, even for high quality crystals. We report the specific heat of a new single crystal grown in a non-corrosive BaZrO3 crucible, for which paramagnetic terms are reduced to less than one spin-1/2 center for 20'000 Cu atoms. The contribution of line nodes shows up directly in the difference C(B,T) - C(0,T) at fixed temperatures (T < 5 K) as a function of the magnetic field parallel to the c-axis (B<=14 T). These data illustrate the smooth crossover from C propotional to T^2 at low fields to C propotional to TB^1/2 at high fields, and provide new values for gap parameters which are quantitatively consistent with tunneling spectroscopy and thermal conductivity in the framework of dx^2-y^2 pairing symmetry. Data for B along the nodal and antinodal directions in the ab-plane are also provided. The in-plane anisotropy predicted in the clean limit is not observed.Comment: 29 pages(using Revtex style), 14 postscript figures, submitted to Phys. Rev. B Content of the file changed after replacin

Predictive ability of an early diagnostic guess in patients presenting with chest pain; a longitudinal descriptive study

The intuitive early diagnostic guess could play an important role in reaching a final diagnosis. However, no study to date has attempted to quantify the importance of general practitioners' (GPs) ability to correctly appraise the origin of chest pain within the first minutes of an encounter. The validation study was nested in a multicentre cohort study with a one year follow-up and included 626 successive patients who presented with chest pain and were attended by 58 GPs in Western Switzerland. The early diagnostic guess was assessed prior to a patient's history being taken by a GP and was then compared to a diagnosis of chest pain observed over the next year. Using summary measures clustered at the GP's level, the early diagnostic guess was confirmed by further investigation in 51.0% (CI 95%; 49.4% to 52.5%) of patients presenting with chest pain. The early diagnostic guess was more accurate in patients with a life threatening illness (65.4%; CI 95% 64.5% to 66.3%) and in patients who did not feel anxious (62.9%; CI 95% 62.5% to 63.3%). The predictive abilities of an early diagnostic guess were consistent among GPs. The GPs early diagnostic guess was correct in one out of two patients presenting with chest pain. The probability of a correct guess was higher in patients with a life-threatening illness and in patients not feeling anxious about their pain

Alexander I of Molossia and the creation of Apeiros

Epeiros, sometimes ‹Apeiros› in the sources, was a region in the northwest of the ancient Balkan peninsula. It ran roughly from the Gulf of Ambrakia in the south to Apollonia in the north, and as far inland as the Pindos mountain range. Epeiros was a region of substantial political and ethnic variety. For instance, Thucydides (2. 80. 5–6), when relating the local forces campaigning with the Spartan admiral Knemos in Akarnania in the summer of 429, describes a variety of ‹barbarian› contingents from Epeiros, some coming from communities with kings (Molossians, Atintanians, Parauaians, Orestians) and others kingless (Chaonians, Thesprotians). Three of these ethne came to dominate the region in the fourth, third, and second centuries: the Molossians, the Thesprotians, and the Chaonians. The Molossians and their ruling house, the Aiakids, appear most frequently in our standard narratives: Olympias, mother of Alexander the Great, and Pyrrhos, enemy of Rome, were both Aiakids

Chest wall syndrome among primary care patients: a cohort study

BACKGROUND: The epidemiology of chest pain differs strongly between outpatient and emergency settings. In general practice, the most frequent cause is the chest wall pain. However, there is a lack of information about the characteristics of this syndrome. The aims of the study are to describe the clinical aspects of chest wall syndrome (CWS). METHODS: Prospective, observational, cohort study of patients attending 58 private practices over a five-week period from March to May 2001 with undifferentiated chest pain. During a one-year follow-up, questionnaires including detailed history and physical exam, were filled out at initial consultation, 3 and 12 months. The outcomes were: clinical characteristics associated with the CWS diagnosis and clinical evolution of the syndrome. RESULTS: Among 24 620 consultations, we observed 672 cases of chest pain and 300 (44.6%) patients had a diagnosis of chest wall syndrome. It affected all ages with a sex ratio of 1:1. History and sensibility to palpation were the keys for diagnosis. Pain was generally moderate, well localised, continuous or intermittent over a number of hours to days or weeks, and amplified by position or movement. The pain however, may be acute. Eighty-eight patients were affected at several painful sites, and 210 patients at a single site, most frequently in the midline or a left-sided site. Pain was a cause of anxiety and cardiac concern, especially when acute. CWS coexisted with coronary disease in 19 and neoplasm in 6. Outcome at one year was favourable even though CWS recurred in half of patients. CONCLUSION: CWS is common and benign, but leads to anxiety and recurred frequently. Because the majority of chest wall pain is left-sided, the possibility of coexistence with coronary disease needs careful consideration

An investigation of the apparent breast cancer epidemic in France: screening and incidence trends in birth cohorts

<p>Abstract</p> <p>Background</p> <p>Official descriptive data from France showed a strong increase in breast-cancer incidence between 1980 to 2005 without a corresponding change in breast-cancer mortality. This study quantifies the part of incidence increase due to secular changes in risk factor exposure and in overdiagnosis due to organised or opportunistic screening. Overdiagnosis was defined as non progressive tumours diagnosed as cancer at histology or progressive cancer that would remain asymptomatic until time of death for another cause.</p> <p>Methods</p> <p>Comparison between age-matched cohorts from 1980 to 2005. All women residing in France and born 1911-1915, 1926-1930 and 1941-1945 are included. Sources are official data sets and published French reports on screening by mammography, age and time specific breast-cancer incidence and mortality, hormone replacement therapy, alcohol and obesity. Outcome measures include breast-cancer incidence differences adjusted for changes in risk factor distributions between pairs of age-matched cohorts who had experienced different levels of screening intensity.</p> <p>Results</p> <p>There was an 8-fold increase in the number of mammography machines operating in France between 1980 and 2000. Opportunistic and organised screening increased over time. In comparison to age-matched cohorts born 15 years earlier, recent cohorts had adjusted incidence proportion over 11 years that were 76% higher [95% confidence limits (CL) 67%, 85%] for women aged 50 to 64 years and 23% higher [95% CL 15%, 31%] for women aged 65 to 79 years. Given that mortality did not change correspondingly, this increase in adjusted 11 year incidence proportion was considered as an estimate of overdiagnosis.</p> <p>Conclusions</p> <p>Breast cancer may be overdiagnosed because screening increases diagnosis of slowly progressing non-life threatening cancer and increases misdiagnosis among women without progressive cancer. We suggest that these effects could largely explain the reported "epidemic" of breast cancer in France. Better predictive classification of tumours is needed in order to avoid unnecessary cancer diagnoses and subsequent procedures.</p