POURSUITE DE LA CONTRACEPTION CHEZ LES ADOLESCENTES

En Suisse, les chiffres et les données manquent concernant les habitudes en matière de contraception dans la population adolescente. Alors que le risque de grossesse non désirée augmente au moment des changements contraceptifs, nous désirions connaître le taux de poursuite d’une méthode contraceptive prescrite à une adolescente suisse au bout d’un an d’utilisation. Pour cela, nous avons mis sur pied une étude de cohorte prospective observationnelle. Nous avons recruté des patientes entre 12 et 19 ans qui commençaient une contraception. Les lieux de recrutement étaient les différents centres PROFA du canton de Vaud, l’unité de médecine des adolescents du Centre Hospitalier Universitaire Vaudois (CHUV) ainsi que la consultation d’un médecin associé au CHUV. Nous avons recontacté les jeunes filles un an après le début de la prescription pour leur soumettre un questionnaire à propos de l’utilisation de la méthode en question, la satisfaction, les effets indésirables et les raisons d’un éventuel changement de type de contraception. Nous avons également récolté des données épidémiologiques au moment du recrutement ainsi qu’au moment du questionnaire. 204 patientes ont été inclues. 85,8% avaient choisi une pilule oestroprogestative. Le taux de réponse à un an était élevé à 71%. Parmi les répondantes, le taux de poursuite de la méthode contraceptive initiale était de 73,1%. Nos résultats montrent que le seul facteur prédictif de la poursuite contraceptive est la méthode choisie. L’activité sexuelle ainsi que le lieu de résidence un an après affecte également de manière statistique la poursuite. Cependant, le tabagisme, l’âge, la nationalité, le type d’activité ou même l’information du représentant légal concernant la prise contraceptive n’ont pas eu d’impact statistique sur la poursuite. Les méthodes contraceptives peuvent donc se classer par ordre croissant de fréquence de poursuite : patch et anneau, pilule progestative, injection, pilule oestro-progestative, et enfin méthodes dites LARC (Long Acting Reversible Contraception) comprenant les stérilets et implants. Les faiblesses de notre étude sont le faible nombre de patientes utilisant d’autres méthodes que la pilule oestro-progestative, un possible biais concernant la population étrangère qui est sous représentée dans les répondantes, et l’utilisation uniquement des déclarations des patientes pour juger de la poursuite ou non de la méthode contraceptive. Néanmoins, cette étude est la première étude prospective sur le sujet en Suisse. L’absence d’intervention et de subvention permet d’en tirer des données très proches de la réalité pratique et clinique. Nous concluons à un taux élevé de poursuite de contraception parmi les adolescentes du canton de Vaud. La méthode contraceptive prescrite le plus fréquemment reste la pilule oestro-progestative. La confidentialité vis-à-vis des parents n’affecte pas la poursuite sur le long terme. L’impact significatif de la méthode contraceptive prescrite souligne l’importance du conseil individualisé lors de la prescription

Mining the Qualitative from the Quantitative: Re-Evaluating Cemetery Survey for the Field of Historic Preservation

This thesis proposes to critique the process of the survey of historic cemeteries and the data and information that can be generated through them through the eyes of a historic preservationist, focusing on the data collection over the past 30 years at St. Louis Number Two Cemetery in New Orleans, Louisiana. Through this research, the process of cemetery survey is described from beginning to end, including what brings it about, what types of data are collected by what types of groups, and finally, a brief glimpse into the types of data analysis and measurement that can be done using this data. The conclusions of this research generate further questions on how to better collect, manage, and mine this data to make important contributions to the field of historic preservation

Disability through COVID-19 pandemic: neurorehabilitation cannot wait.

Coronavirus disease 2019 (CoViD-19) pandemic is strongly impacting all domains of our healthcare systems, including rehabilitation. In Italy, the first hit European country, medical activities were postponed to allow shifting of staff and facilities to intensive care, with neurorehabilitation limited to time-dependent diseases, <sup>1</sup> including CoViD-19 complications. <sup>2,3</sup> Hospital access to people with chronic neurodegenerative conditions such as multiple sclerosis, movement disorders or dementia, more at risks of serious consequences from the infection, <sup>4</sup> has been postponed. Patients also seek less for hospital care, with over 50% reduced stroke admissions as from an Italian survey, <sup>5</sup> possibly in fear of being infected or denied to see their families after being hospitalized. This situation can be bearable only for a short time, as any initial freezing reaction to a danger

Inverse problems in tumor modelling

In this project, we deepen the analysis of a tumour growth model, recently proposed by Garcke et al. in [1]. This model describes tumour and healthy cells evolution as well as tumour cells’ nutrients, mixture velocity and pressure in the domain. Furthermore, it takes into account chemotaxis and apoptosis death of tumour cells, through a system of parabolic nonlinear PDE, that is a Cahn-Hilliard Darcy model, together with an advection-diffusion-reaction equation describing the evolution of nutrients. We perform a dimensional analysis and we build a numerical solver by use of the finite element method in space, a Backward Euler in time and a Newton method to tackle the nonlinearity. We perform several numerical simulations in order to recover results obtained in the article and to catch a general growth of the tumour depending on parameters of interest. Finally, a PDE-constrained optimization problem is formulated and solved, aiming at determining the shape of the tumur after a fixed time from an initial guess of its location. From the numerical simulations we obtained for the nutrients, we notice that the concentration of nutrients in an observable zone around the tumor region could possibly bring enough information to achieve this goal. Therefore, a previous numerical simulation of nutrients will be taken as a target, in order to recover the controlled tumor function, previously simulated numerically. In this respect, preliminary numerical results show that, to some extents, it is possible to identify the general shape of the tumor, even if the exact result of the numerical simulation could not be recovered

Adolescents' contraception continuation in Switzerland: a prospective observational study.

Securing the adherence over time to contraception by adolescent girls is a challenge. Until now little was known about this topic in Switzerland. The aim of our study was to determine contraceptive continuation rates among adolescents in this country and assess possible predictive factors for discontinuation. A prospective observational cohort study of 12- to 19-year-old girls starting contraception was performed. Patients were interviewed again after 1 year by phone, email or postal mail. A total of 204 patients were included, of whom 85.8% chose a combined oestrogen-progestogen pill. The answer rate 1 year later was 71%. Among these, continuation of the initially prescribed contraceptive method was observed in 73.1%. Factors statistically affecting the continuation rate were the initial contraceptive method, the place of residence and sexual activity after 1 year. Classification of contraceptive methods in decreasing order of continuation rate was the following: long acting reversible contraception (LARC) methods, oestrogen-progestogen pills, injections, progestogen pills, patches and rings. Major reasons reported for stopping the prescribed contraceptive method were ending sexual relations (54.3%), developing side effects (34.3%) or changing to another contraceptive method (22.9%). Neither age, nationality, smoking, occupation, nor the legal representative's knowledge of the contraception influenced adherence. Contraceptive continuation rate was high among the adolescent population studied. The only predictive factor of discontinuation was the contraceptive method. Our study also reveals that respecting teenagers' confidentiality is essential as it does not negatively impact the continuation rate. The significant impact of the type of contraception on continuation rates stresses the importance of individualised counselling

Recovery in cognitive motor dissociation after severe brain injury: A cohort study.

To investigate the functional and cognitive outcomes during early intensive neurorehabilitation and to compare the recovery patterns of patients presenting with cognitive motor dissociation (CMD), disorders of consciousness (DOC) and non-DOC. We conducted a single center observational cohort study of 141 patients with severe acquired brain injury, consecutively admitted to an acute neurorehabilitation unit. We divided patients into three groups according to initial neurobehavioral diagnosis at admission using the Coma Recovery Scale-Revised (CRS-R) and the Motor Behavior Tool (MBT): potential clinical CMD, [N = 105]; DOC [N = 19]; non-DOC [N = 17]). Functional and cognitive outcomes were assessed at admission and discharge using the Glasgow Outcome Scale, the Early Rehabilitation Barthel Index, the Disability Rating Scale, the Rancho Los Amigos Levels of Cognitive Functioning, the Functional Ambulation Classification Scale and the modified Rankin Scale. Confirmed recovery of conscious awareness was based on CRS-R criteria. CMD patients were significantly associated with better functional outcomes and potential for improvement than DOC. Furthermore, outcomes of CMD patients did not differ significantly from those of non-DOC. Using the CRS-R scale only; approximatively 30% of CMD patients did not recover consciousness at discharge. Our findings support the fact that patients presenting with CMD condition constitute a separate category, with different potential for improvement and functional outcomes than patients suffering from DOC. This reinforces the need for CMD to be urgently recognized, as it may directly affect patient care, influencing life-or-death decisions

Emergency department visits for non-life-threatening conditions : evolution over 13 years in a Swiss urban teaching hospital

INTRODUCTION: A large proportion of visits to our Emergency Department (ED) are for non-life-threatening conditions. We investigated whether patients' characteristics and reasons for consultation had changed over 13 years. METHODS: Consecutive adult patients with non-life-threatening conditions at triage were included in the spring of 2000 and in the summer of 2013. In both years patients completed a similar questionnaire, which addressed their reasons for consultation and any previous consultation with a general practitioner (GP). RESULTS: We included 581 patients in 2013 vs 516 in 2000, with a mean age of 44.5 years vs 46.4 years (p=0.128). Of these patients, 54.0% vs 57.0% were male (p=0.329), 55.5% vs 58.7% were Swiss (p=0.282), 76.4% were registered with a GP in both periods, but self-referral increased from 52.0% to 68.8% (p<0.001); 57.7% vs., 58.3% consulted during out-of- hours (p=0.821). Trauma-related visits decreased from 34.2% to 23.7% (p<0.001). Consultations within 12 hours of onset of symptoms dropped from 54.5% to 30.9%, and delays of ≥1 week increased from 14.3% to 26.9% (p<0.001). The primary motive for self-referral remained unawareness of an alternative, followed in 2013 by dissatisfaction with the GP's treatment or appointment. Patients who believed that their health problem would not require hospitalisation increased from 52.8% to 74.2% and those who were actually hospitalised decreased from 24.9% to 13.9% (all p<0.001). CONCLUSION: The number of visits for non-life-threatening consultations continue to increase. Our ED is used by a large proportion of patients as a convenient alternative source of primary care

Intensive Care Admission and Early Neuro-Rehabilitation. Lessons for COVID-19?

Coronavirus disease 2019 (COVID-19) requires admission to intensive care (ICU) for the management of acute respiratory distress syndrome in about 5% of cases. Although our understanding of COVID-19 is still incomplete, a growing body of evidence is indicating potential direct deleterious effects on the central and peripheral nervous systems. Indeed, complex and long-lasting physical, cognitive, and functional impairments have often been observed after COVID-19. Early (defined as during and immediately after ICU discharge) rehabilitative interventions are fundamental for reducing the neurological burden of a disease that already heavily affects lung function with pulmonary fibrosis as a possible long-term consequence. In addition, ameliorating neuromuscular weakness with early rehabilitation would improve the efficiency of respiratory function as respiratory muscle atrophy worsens lung capacity. This review briefly summarizes the polymorphic burden of COVID-19 and addresses possible early interventions that could minimize the neurological and systemic impact. In fact, the benefits of early multidisciplinary rehabilitation after an ICU stay have been shown to be advantageous in several clinical conditions making an early rehabilitative approach generalizable and desirable to physicians from a wide range of different specialties