Aspects of cognitive activity in schizophrenia

The application of Piaget's genetic psychology tests to schizophrenic patients yielded the following findings. The intelligence quotient of schizophrenics, although within the normal range, is slightly lower than that of a control population of similar age. This is due not to a loss of the operations of the intellect, but to a difficulty experienced by the patients in actualizing the operations. The difficulty is seen particularly in operations dealing with specific objects which require a constant maintenance of the equilibrium between assimilation and accommodation. The thought processes of hebephrenic patients oscillate between excessive assimilation, resulting in a distortion of observable data, and excessive accommodation which by adhering to the observable data distorts the reasoning process. The thought processes of paranoid schizophrenics are dominated by excessive assimilation. This predominance explains their tendency to distort observable data and their difficulty in the generalization of reasoning; it also has an impact on the assimilation/accommodation equilibrium of their logical operations, leading to (a) difficulties in delimiting reflecting abstractions, and therefore the comprehension and extension of concepts, and (b) loss of proof based on logico-mathematical reasoning and, as a result, a propensity to resort to magical thinking and subjective explanation

Role of Health Professionals Regarding the Impact of Climate Change on Health-An Exploratory Review.

Health professionals are increasingly urged to act to protect individuals and populations against the negative effects of climate and environment change on health. However, the amount of evidence supporting initiatives to that end is unknown. We explored the literature examining the awareness, preparedness, and role of healthcare professionals to inform about the impact of climate change on health on the one hand, and literature about the effectiveness of interventions mediated by health professionals aiming at reducing the environmental impact of human activities on the other hand. We included 137 articles published between 2000 and 2020, mostly in general medical and nursing journals. The typical article was a perspective, commentary, or other special article aimed at alerting readers about the impact of climate and environment change on health. We identified 22 studies, of which only two reported interventions. Despite increasing efforts of health professionals to address climate and environment change and related health risks, health literature supporting such efforts remains scarce, and studies assessing the effectiveness of interventions are lacking. We need appropriate evidence to indicate which interventions should be prioritized, considering that the association of health issues with climate and environment change could constitute an effective lever for change

Inventory and perspectives of chronic disease management programs in Switzerland: an exploratory survey

Objective: To describe chronic disease management programs active in Switzerland in 2007, using an exploratory survey. <br><br> Methods: We searched the internet (Swiss official websites and Swiss web-pages, using Google), a medical electronic database (Medline), reference lists of pertinent articles, and contacted key informants. Programs met our operational definition of chronic disease management if their interventions targeted a chronic disease, included a multidisciplinary team (≥2 healthcare professionals), lasted at least six months, and had already been implemented and were active in December 2007. We developed an extraction grid and collected data pertaining to eight domains (patient population, intervention recipient, intervention content, delivery personnel, method of communication, intensity and complexity, environment, clinical outcomes). <br><br> Results: We identified seven programs fulfilling our operational definition of chronic disease management. Programs targeted patients with diabetes, hypertension, heart failure, obesity, psychosis and breast cancer. Interventions were multifaceted; all included education and half considered planned follow-ups. The recipients of the interventions were patients, and healthcare professionals involved were physicians, nurses, social workers, psychologists and case managers of various backgrounds. <br><br> Conclusions: In Switzerland, a country with universal healthcare insurance coverage and little incentive to develop new healthcare strategies, chronic disease management programs are scarce. For future developments, appropriate evaluations of existing programs, involvement of all healthcare stakeholders, strong leadership and political will are, at least, desirable

Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: the AGREE project

BACKGROUND: International interest in clinical practice guidelines has never been greater but many published guidelines do not meet the basic quality requirements. There have been renewed calls for validated criteria to assess the quality of guidelines. OBJECTIVE: To develop and validate an international instrument for assessing the quality of the process and reporting of clinical practice guideline development. METHODS: The instrument was developed through a multi-staged process of item generation, selection and scaling, field testing, and refinement procedures. 100 guidelines selected from 11 participating countries were evaluated independently by 194 appraisers with the instrument. Following refinement the instrument was further field tested on three guidelines per country by a new set of 70 appraisers. RESULTS: The final version of the instrument contained 23 items grouped into six quality domains with a 4 point Likert scale to score each item (scope and purpose, stakeholder involvement, rigour of development, clarity and presentation, applicability, editorial independence). 95% of appraisers found the instrument useful for assessing guidelines. Reliability was acceptable for most domains (Cronbach's alpha 0.64-0.88). Guidelines produced as part of an established guideline programme had significantly higher scores on editorial independence and, after the publication of a national policy, had significantly higher quality scores on rigour of development (p&lt;0.005). Guidelines with technical documentation had higher scores on that domain (p&lt;0.0001). CONCLUSIONS: This is the first time an appraisal instrument for clinical practice guidelines has been developed and tested internationally. The instrument is sensitive to differences in important aspects of guidelines and can be used consistently and easily by a wide range of professionals from different backgrounds. The adoption of common standards should improve the consistency and quality of the reporting of guideline development worldwide and provide a framework to encourage international comparison of clinical practice guidelines. [authors]]]> oai:serval.unil.ch:BIB_4919CAD59633 2022-05-07T01:17:13Z <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_4919CAD59633 Neuronal death during development in the isthmo-optic nucleus of the chick: sustaining role of afferents from the tectum. info:doi:10.1002/cne.902340307 info:eu-repo/semantics/altIdentifier/doi/10.1002/cne.902340307 info:eu-repo/semantics/altIdentifier/pmid/3988990 Clarke, P.G.H. info:eu-repo/semantics/article article 1985 Journal of Comparative Neurology, vol. 234, no. 3, pp. 365-379 info:eu-repo/semantics/altIdentifier/pissn/0021-9967[print], 0021-9967[linking] <![CDATA[Neurons have been counted in the isthmo-optic nucleus following lesions of the optic tectum, its main source of afferents. Late lesions, made at 10.8-12.2 days of incubation, were employed as they cause the fewest non-specific side effects. The lesions spared the isthmo-optic tract, and although they caused many retinal ganglion cells to die, the degeneration did not spread to the inner nuclear layer, which contains the target cells of the isthmo-optic fibers. Hence the effects on the isthmo-optic nucleus were due to its being deprived of afferents. Even in unoperated embryos, 60% of the isthmo-optic neurons are known to die between embryonic days 12 and 17. The tectal lesions greatly increased the cell loss ipsilaterally; this was due to cell death, since other explanations such as migration away or differential cellular shrinkage have been ruled out. The fact that additional neuronal death occurred mainly during the latter half of the period of natural cell death implies that the tectal afferents are important for the survival of the isthmo-optic neurons during this latter half, but not before

Analyse économique du traitement de l'ostéoporose post-ménopausique par hormonothérapie substitutive chez la femme

[Table des matières] 1.1. Présente étude. 1.2. Littérature relative aux études économiques d'une hormonothérapie de substitution (HTS). 1.3. Etat des connaissances relatives aux effets cliniques d'une HTS. 2. Méthode. 2.1. Représentation de l'arbre de décision. 2.2. Réalisation du modèle. 3. Matériel. 3. 1. Incidences des événements considérés : fractures du fémur proximal, cancers du sein et de l'endomètre, infarctus du myocarde. 3.2. Survie/mortalité suite aux événements considérés : fractures de la hanche, cancers du sein, cancers de l'endomètre, infarctus du myocarde, autres. 3.3. Valeurs des risques relatifs des événements considérés lors de l'application d'une HTS : fracture du fémur proximal, cancer du sein et de l'endomètre, accident cardiovasculaire. 3.4. Observance à une HTS. 3.5. Prévalence des hystérectomies à 50 ans. 3.6. Coûts : programme de prévention, HTS, du suivi, liés à l'hospitalisation primaire pour infarctus du myocarde et cancer du sein. 3.7. Hypothèses de base. 4. Résultats. 4.1. Sous les hypothèses de base : nombre et pourcentage d'événements prévenus et induits par rapport à une situation sans HTS, coûts de l'HTS et de la surveillance médicale, coûts nets des événements, coûts totaux, coûts par fracture de la hanche évitée. 4.2. Analyse de sensibilité : taux d'escompte, HTS et surveillance médicale, taux d'incidence et de survie, modulation de l'efficacité du traitement hormonal sur la prévention des infarctus du myocarde, induction plus élevée de cas de cancers du sein, observance, traitement sélectif de la population à risque de fractures. 5. Importance de l'étude considérée