Does Provision of an Evidence-Based Information Change Public Willingness to Accept a Screening Test ?

The basic requirement for patient decision making is the provision by the physician of an essential relevant and understandable information (Evidence Based) allowing him to decide whether he wish or not to receive the proposed treatment. This analysis shows that the willingness to undergo a doubtful screening test (about 70 % false positive responses) for a rare cancer by the general population change dramatically (60% versus 13,5%) according to the quality of information provided. This result, facing the impressive increase of diagnostic and screening procedures, could have important economical, ethical, clinical, public health and legal implications.health care markets; information; decision making; doctor-patient relationship; screening; diagnostic procedures; evidence based medicine; public health

Health Effects of Job Insecurity among Employees in Swiss General Population

Objectives. To investigate at national level the association between health and the social distress in which the whole employed population is plunged as a consequence of job insecurity. Design. Cross-sectional study. Setting. Switzerland. Subjects. Individuals working full or part time as employees drawn from a random sample (N=2024) of the Swiss general population interviewed by phone. Main outcome measures. Prevalence rates of ten self reported health and health related behaviour indicators according to three levels of perceived job insecurity (low, middle, high). Odds ratios estimated with logistic regression adjusted for relevant respondents characteristics (sex, age, education, having a chronic disease, working full or part-time and in public or private field). Results. One employee out of 10 experienced a high level of job insecurity, out of five a middle level while about 2/3 have no or a very low perception of job insecurity. The results clearly show that psychosocial stress induced in general employed population by fear of unemployment has a negative impact on the individual health and related health behaviour. A positive "dose-response" gradient was found between rise in job insecurity level's and the indicators investigated, suggesting a linear deterioration of health. In particular, employees in high insecurity group, compared to those in low one, have significantly higher odds ratios for seven indicators out of ten [not being in good health OR 1.6 (CI 1.0-2.7); high level of subjective stress OR 1.6 (CI 1.1-2.3); low self-esteem OR 2.9 (CI 1.5-5.7); daily or weekly consumption of tranquillisers OR 2.1 (CI 1.0-4.3); regular low-back pain OR 2.0 (CI 1.3-3.2); regular smoking OR 1.6 (CI 1.0-2.4); avoiding medical consultation or caring for themselves for fear of missing work OR 3.4 (CI 1.9-5.9)]. Employees with higher educational status seem to have more difficulties than less educated in coping with job insecurity. Conclusions. There is a positive association between health status and health related behaviour and social distress due to perception of job insecurity. Fear of unemployment seems to have stronger unfavourable effect in high educated employees than in less educated, probably because investment in career and in personal expectations are, in that group, generally higher. Although this cross-sectional study carried out at national level do not reach the "gold standard" represented by longitudinal ones, the results are fully consistent with those of few analysis on job insecurity carried out prospectively at firm level. Recommendations. In terms of concrete actions the main recommendations stemming from this study could be [i] to break the wall of silence generally erected around studies showing the positive relationship between job insecurity and deterioration of health, in order to promote a public and political consciousness in favour of less excluding and more solidary social and economic choices and [ii] to promote a systematic measure of health impact of policies and legislations with particular emphasis on those affecting labour market and work environment.economic development; labour market; unemployment; job insecurity; deprivation; health; public health; health impact assessment

"Les médecins exercent l'un des métiers les plus durs qui soient" : interview de Gianfranco Domenighetti, économiste de la santé et ancien directeur du Service cantonal de la santé publique du Tessin

Fin janvier 2007, Gianfranco Domenighetti, l'une des personnalités les plus marquantes du système de santé suisse, a pris sa retraite de directeur du Service cantonal de la santé publique du Canton du Tessin. Cet économiste de la santé, toujours très actif, jette un regard rétrospectif sur ses 40 années de carrière. [Auteurs]]]> Delivery of Health Care ; Health Promotion fre oai:serval.unil.ch:BIB_01C6C5BA6D93 2022-05-07T01:09:04Z phdthesis urnserval <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_01C6C5BA6D93 Accidents vasculaires cérébraux et défects du septum interauriculaire Garazi, Sylvain Université de Lausanne, Faculté de médecine info:eu-repo/semantics/doctoralThesis phdthesis 1996 fre https://serval.unil.ch/resource/serval:BIB_01C6C5BA6D93.P001/REF.pdf http://nbn-resolving.org/urn/resolver.pl?urn=urn:nbn:ch:serval-BIB_01C6C5BA6D939 info:eu-repo/semantics/altIdentifier/urn/urn:nbn:ch:serval-BIB_01C6C5BA6D939 info:eu-repo/semantics/restrictedAccess Restricted: indefinite embargo Copying allowed only for non-profit organizations https://serval.unil.ch/disclaimer application/pdf oai:serval.unil.ch:BIB_01C6DAF1F20C 2022-05-07T01:09:04Z <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_01C6DAF1F20C Keith P. Luria : Sacred Boundaries. Religious Coexistence and Conflict in Early Modern France Grosse, C. info:eu-repo/semantics/article article 2006 Archiv für Reformationsgeschichte, vol. 35, pp. 176-177 fre oai:serval.unil.ch:BIB_01C7B253DB80 2022-05-07T01:09:04Z openaire documents urnserval <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_01C7B253DB80 Segmentation and Clustering of Textual Sequences: a Typological Approach http://www.aclweb.org/anthology-new/R/R11/R11-1059.pdf Cocco, C. Pittier, R. Bavaud, F. Xanthos, A. info:eu-repo/semantics/conferenceObject inproceedings 2011 Recent Advances in Natural Language Processing. International Conference (RANLP 8 : Hissar : 2011). Proceedings, pp. 427-433 Angelova, G. (ed.) Bontcheva, K. (ed.) Mitkov, R. (ed.) Nikolov, N. (ed.) info:eu-repo/semantics/altIdentifier/isbn/1313-8502 <![CDATA[The long term goal of this research is to develop a program able to produce an automatic segmentation and categorization of textual sequences into discourse types. In this preliminary contribution, we present the construction of an algorithm which takes a segmented text as input and attempts to produce a categorization of sequences, such as narrative, argumentative, descriptive and so on. Also, this work aims at investigating a possible convergence between the typological approach developed in particular in the field of text and discourse analysis in French by Adam (2008) and Bronckart (1997) and unsupervised statistical learning

Définition des priorités sanitaires et rationnement. L'opinion des Suisses, des Administrateurs hospitaliers et des Départements sanitaires des Cantons.

Objectifs. Le but de cette analyse est,[i] de présenter l'opinion actuelle de la population suisse sur des thèmes liés à la limitation des ressources, à la définition des priorités et au rationnement dans le secteur sanitaire, [ii] de comparer cette opinion avec celle d'autres groupes professionnellement engagés dans le secteur (administrateurs des hôpitaux et directions des Départements sanitaires des cantons) et [iii] de contribuer ainsi au démarrage d'un processus dynamique de confrontation sur les opinions afin qu'un consensus social sur les priorités puisse être mieux atteint à moyen terme. Méthodologie. Sondages par questionnaire auprès de deux échantillons représentatifs respectivement de la population suisse (N= 1000, taux de réponse 87%) et des administrateurs hospitaliers (N=250, t.r. 61%) et auprès de toutes les directions sanitaires des cantons suisses (N= 26, t.r. 85% - 69% voir page 8). Analyses. Les questions et les "études de cas" soumis touchaient aux thèmes suivant: - financement du secteur; - entités qui doivent décider les priorités; - rationnement implicite ou explicite; - choix de priorités parmi différentes prestations et services médico-sanitaires; - adhésion à quelques critères généralement retenus pour la définition de priorités de prise en charge sanitaire (âge; comportement individuel à risque; qualité de vie future; soins dont l'éfficacité est scientifiquement démontrée -EBM-; efficience, efficacité versus équité; utilité individuelle versus utilité sociale). Une comparaison des résultats suisses avec ceux observés dans d'autres pays (Grande-Bretagne et Etats-Unis) est aussi présentée. Résultats. Les divergences plus marquantes entre la population et les groupes professionnellement engagés dans le secteur concernent, notamment, la nécessité de limiter les ressources, le rôle de la politique dans la définition des priorités, l'importance relative différente attribuée à quelques prestations sanitaires (notamment: transplantations, mammographie, soins aux schizophrènes et à domicile aux personnes âgées), à l'âge comme critère de rationnement et à l'importance attribuable à l'utilité individuelle versus l'utilité sociale. L'analyse montre aussi un consensus entre les groupes pour des choix de rationnement transparents et explicites ainsi qu'une préférence claire pour l'équité lorsqu'elle concurrence l'efficience et l'efficacité. Un consensus disentable envers la pénalisation de la responsabilité causale individuelle dans la maladie est aussi mis en évidence. Conclusions. Les opinions de la population, des administrateurs et des directions politiques des cantons ne sont pas toujours consensuelles et ces trois entités ne donnent pas souvent la même importance aux divers choix et critères sous-jacents à la définition de priorités. L'avis de la population, incontournable en Suisse avec sa démocratie directe, a été probablement exprimé sans que les opinions se soient formées à travers des confrontations caractérisées par des échanges de points de vue et par des délibérations. Le processus de formation de l'opinion est un processus dynamique et évolutif. On peut donc conclure que les avis des groupes, recueillis lors de ce sondage peuvent être sensiblement modifiés par l'information et la discussion publique de la problématique du rationnement et de la définition des priorités sanitaires qui devrait avoir lieu afin d'anticiper les conséquences incontournables de la croissance de la dépense sanitaire socialisée face à la limitation des ressources.Health care utilization; priority setting; rationing; population, administrators, politicians; surveys; Switzerland

Revisiting the Most Informed Consumer of Surgical Services: The Physician-Patient

Little is known about the consumption of medical and surgical services by the most informed consumer in the health care market: the physician-patient. Such knowledge should be important for the understanding of the role of information on consumption, supplier-induced demand, the doctor-patient relationship, unnecessary medical services, and the adequacy of professional practices to the real health needs of the "ordinary patient.” We measured by questionnaire the standardized consumption of seven common surgical procedures. Except for appendectomy, the age- and sex-standardized consumption for each of the common surgical procedures was always significantly higher in the general population than for the "gold standard” of physician-patients. The data suggest that (a) contrary to prior research, doctors have much lower rates of surgery than does the general population; and (b) in a fee-for-services health care market without financial barriers to medical care, less-informed patients are greater consumers of common surgical procedure

Ability to pay and equity in access to Italian and British National Health Services

Background: Equity in delivery and distribution of health care is an important determinant of health and a cornerstone in the long way to social justice. We performed a comparative analysis of the prevalence of Italian and British residents who have fully paid out-of-pocket for health services which they could have obtained free of charge or at a lower cost from their respective National Health Services. Methods: Cross-sectional study based on a standardized questionnaire survey carried out in autumn 2006 among two representative samples (n = 1000) of the general population aged 20-74 years in each of the two countries. Results: 78% (OR 19.9; 95% CI 15.5-25.6) of Italian residents have fully paid out-of-pocket for at least one access to health services in their lives, and 45% (OR 18.1; 95% CI 12.9-25.5) for more than five accesses. Considering only the last 2 years, 61% (OR 16.5; 95% CI 12.6-21.5) of Italians have fully paid out-of-pocket for at least one access. The corresponding pattern for British residents is 20 and 4% for lifelong prevalence, and 10% for the last 2 years. Conclusions: Opening the public health facilities to a privileged private access to all hospital physicians based on patient's ability to pay, as Italy does, could be a source of social inequality in access to care and could probably represent a major obstacle to decreasing waiting times for patients in the standard formal ‘free of charge' way of acces

Systemic treatments for women with breast cancer: outcome with relation to screening for the disease

Early detection and proper care of breast cancer are currently the best available approaches to the treatment of patients with the disease. In countries with a breast cancer screening programme, there has been a demonstrated reduction in breast cancer-related mortality. Such reduction has also been observed in Switzerland, a country in which no national programme of screening is available. Although there is no doubt that early diagnosis might have had a major role in reducing breast cancer mortality the magnitude of this effect is unknown. Research with tailored approaches on alternative imaging for early detection of breast cancer in high-risk women and on treatments offered according to proper criteria of responsiveness to therapies is warrante

Evolution of Level I Fieldwork during an International Pandemic: Students’ Perceptions of the Effectiveness of Virtual Simulation-based Level I Fieldwork

Fieldwork education is an essential component of occupational therapy (OT) curriculum; yet national shortages and the COVID-19 pandemic have affected fieldwork availability. To combat the shortage, some academic programs implemented simulation-based Level I fieldwork experiences. The objective of this research study was to compare the perceived knowledge, confidence, and attitude of OT students that completed a virtual simulation-based Level I fieldwork to those that completed a traditional Level I fieldwork. This study involved a sample of 26 doctorate of OT students that completed a traditional or virtual simulation-based Level I fieldwork. Students completed pre-and-post fieldwork surveys regarding their perceived knowledge, confidence, and attitude. Mann Whitney and Wilcoxin signed rank tests were used for comparative analysis. There was no statistically significant difference in knowledge or confidence between the two groups (p = .734, p = .303). Students that completed a virtual simulation-based fieldwork experienced increased attitude (p = .021) and both groups experienced an increase in perceived knowledge (p = .012, p = .003) following their fieldwork experience. This study adds to the growing body of knowledge regarding the utilization of simulations in OT curricula and proposes an alternative Level I fieldwork model to assist with the national shortage of fieldwork availability

Usage personnel de pratiques relevant des médecines douces ou alternatives parmi les médecins suisses

L'importance de l'utilisation pour des besoins personnels de pratiques relevant des médecines douces ou alternatives parmi les médecins est très mal connue. Elle pourrait avoir plusieurs implications notamment par rapport à l'effort actuel de promotion de pratiques médicales fondées sur des preuves d'efficacité (Evidence-based medicine, EBM). [Auteurs]]]> fre oai:serval.unil.ch:BIB_F32E44E67757 2022-05-07T01:30:01Z openaire documents urnserval <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_F32E44E67757 PAX5 activates the transcription of the human telomerase reverse transcriptase gene in B cells. info:doi:10.1002/path.2620 info:eu-repo/semantics/altIdentifier/doi/10.1002/path.2620 info:eu-repo/semantics/altIdentifier/pmid/19806612 Bougel, Stephanie Renaud, Stephanie Braunschweig, Richard Loukinov, Dmitri Morse Herbert C. III, Bosman Fred, T. Lobanenkov, Victor Benhattar, Jean info:eu-repo/semantics/article article 2010 Journal of Pathology, vol. 220, no. 1, pp. 87-96 info:eu-repo/semantics/altIdentifier/pissn/1096-9896[electronic] <![CDATA[Telomerase is an RNA-dependent DNA polymerase that synthesizes telomeric DNA. Its activity is not detectable in most somatic cells but it is reactivated during tumorigenesis. In most cancers, the combination of hTERT hypermethylation and hypomethylation of a short promoter region is permissive for low-level hTERT transcription. Activated and malignant lymphocytes express high telomerase activity, through a mechanism that seems methylation-independent. The aim of this study was to determine which mechanism is involved in the enhanced expression of hTERT in lymphoid cells. Our data confirm that in B cells, some T cell lymphomas and non-neoplastic lymph nodes, the hTERT promoter is unmethylated. Binding sites for the B cell-specific transcription factor PAX5 were identified downstream of the ATG translational start site through EMSA and ChIP experiments. ChIP assays indicated that the transcriptional activation of hTERT by PAX5 does not involve repression of CTCF binding. In a B cell lymphoma cell line, siRNA-induced knockdown of PAX5 expression repressed hTERT transcription. Moreover, ectopic expression of PAX5 in a telomerase-negative normal fibroblast cell line was found to be sufficient to activate hTERT expression. These data show that activation of hTERT in telomerase-positive B cells is due to a methylation-independent mechanism in which PAX5 plays an important role

Tropomodulin 1 directly controls thin filament length in both wild-type and tropomodulin 4-deficient skeletal muscle

The sarcomeric tropomodulin (Tmod) isoforms Tmod1 and Tmod4 cap thin filament pointed ends and functionally interact with the leiomodin (Lmod) isoforms Lmod2 and Lmod3 to control myofibril organization, thin filament lengths, and actomyosin crossbridge formation in skeletal muscle fibers. Here, we show that Tmod4 is more abundant than Tmod1 at both the transcript and protein level in a variety of muscle types, but the relative abundances of sarcomeric Tmods are muscle specific. We then generate Tmod4(−/−) mice, which exhibit normal thin filament lengths, myofibril organization, and skeletal muscle contractile function owing to compensatory upregulation of Tmod1, together with an Lmod isoform switch wherein Lmod3 is downregulated and Lmod2 is upregulated. However, RNAi depletion of Tmod1 from either wild-type or Tmod4(−/−) muscle fibers leads to thin filament elongation by ∼15%. Thus, Tmod1 per se, rather than total sarcomeric Tmod levels, controls thin filament lengths in mouse skeletal muscle, whereas Tmod4 appears to be dispensable for thin filament length regulation. These findings identify Tmod1 as the key direct regulator of thin filament length in skeletal muscle, in both adult muscle homeostasis and in developmentally compensated contexts