Suizidprävention: Vorgehensweisen und Wirksamkeit

According to official statistics every year 11,000 persons in Germany die from suicide. 20 years ago nearly 19,000 suicides were registered. What are the causes for this decrease? Do suicide preventive measures contribute to the reduction of suicide rates? Different universal prevention strategies ( e. g. restriction of access to means) and selective approaches ( programs for special high-risk groups; e. g. patients after attempted suicide) are presented and discussed regarding their preventive value. In most cases it is hardly possible to scientifically prove the efficacy of suicide prevention strategies. Neither the role of psychosocial interventions nor the impact of psychotropic agents can be sufficiently quantified. Due to various methodological reasons ( e. g. small sample sizes and the lack of randomization), interpretation of the data is difficult. In terms of a comprehensive approach of suicide prevention a combination of different activities should be most adequate in the long run

Rapport III.4. Développement des équipements hydroagricoles et estimation prévisionnelle des besoins en eau d’irrigation dans le Bassin de la Garonne

A set of general investigations on hydroagricultural development in the main valleys of the Garonne river basin have been carried out for the French Ministry of Agriculture during the last few years. In this paper, factors in these investigations connected with the forecasting of irrigation water requirements are discussed, with particular emphasis on the methods applied. The paper is in three parts, as follows : 1. A general evaluation of potential requirements. 2. Particulars of flows required. 3. An attempt to forecast the trend of future demand. The general evaluation of potential requirements is based on a soil and climate study and allows for the probable frequency at which the requirements will arise. The particulars of the flows required to meet this demand emerge in a study of development schemes for potentially irrigable areas. The trend of future demand is uncertain and difficult to predict, depending as it does on a complex set of decisions, but generally speaking it can be linked with the socio-economic development of farming as a whole. An attempt has been made to establish a means of forecasting the latter development, so as to facilitate further progress in evaluating future demand and programming investment.Au cours des dernières années, le Ministère de l’Agriculture a fait procéder, dans le Bassin de la Garonne, à un ensemble d’études générales relatives aux aménagements hydroagricoles des vallées principales. La communication ci-dessous expose, en insistant sur les méthodes utilisées, ce qui, dans ces études, se rapporte à l’estimation prévisionnelle des besoins en eau d’irrigation. Elle est divisée en trois parties : — évaluation générale des besoins potentiels ; — caractéristiques des prélèvements ; — essai de prévision d’une évolution des besoins dans le temps. L’évaluation générale des besoins potentiels est basée sur l’étude des sols et du climat. Elle tient compte de la fréquence probable d’apparition de ces besoins. Les caractéristiques des prélèvements correspondant à ces besoins apparaissent lors de l’étude des schémas d’aménagement des zones dont l’irrigation peut être envisagée. L’évolution des besoins dans le temps, qui est liée à un ensemble complexe de décisions, est incertaine et reste difficile à prévoir. Elle peut être rattachée, d’une manière globale, au développement socio-économique de l’agriculture. Une tentative a été faite pour mettre sur pied un instrument de prévision de ce développement, qui puisse aider au progrès de l’évaluation des besoins, et de la programmation des investissements.Kreitmann H., Jaminet P., Boissezon J. de. Rapport III.4. Développement des équipements hydroagricoles et estimation prévisionnelle des besoins en eau d’irrigation dans le Bassin de la Garonne. In: Utilisation des ressources en eau d'un bassin dans le cadre de l'aménagement du territoire. Compte rendu des onzièmes journées de l'hydraulique; Paris, 22-24 septembre 1970. Tome 1, 1971

Lung and chest wall mechanics in patients with acute respiratory distress syndrome, expiratory flow limitation, and airway closure

Tidal expiratory flow limitation (EFL), which may herald airway closure (AC), is a mechanism of loss of aeration in ARDS. In this prospective, short-term, two-center study, we measured static and dynamic chest wall (Est,cw and Edyn,cw) and lung (Est,L and Edyn,L) elastance with esophageal pressure, EFL, and AC at 5 cmH(2)O positive end-expiratory pressure (PEEP) in intubated, sedated, and paralyzed ARDS patients. For EFL determination, we used the atmospheric method and a new device allowing comparison of tidal flow during expiration to PEEP and to atmosphere. AC was validated when airway opening pressure (AOP) assessed from volume-pressure curve was found greater than PEEP by at least 1 cmH(2)O. EFL was defined whenever flow did not increase between exhalation to PEEP and to atmosphere over all or part of expiration. Elastance values were expressed as percentage of normal predicted values (%N). Among the 25 patients included, eight had EFL (32%) and 13 AOP (52%). Between patients with and without EFL Edyn,cw [median (1st to 3rd quartiles)] was 70 (16-127) and 102 (70-142) %N (P = 0.32) and Edyn,L338 (332-763) and 224 (160-275) %N (P \textless 0.001). The corresponding values for Est,cw and Est,L were 70 (56-88) and 85 (64-103) %N (P = 0.35) and 248 (206-348) and 170 (144-195) (P = 0.02), respectively. Dynamic E(L) had an area receiver operating characteristic curve of 0.88 [95% confidence intervals 0.83-0.92] for EFL and 0.74[0.68-0.79] for AOP. Higher Edyn,L was accurate to predict EFL in ARDS patients; AC can occur independently of EFL, and both should be assessed concurrently in ARDS patients.NEW & NOTEWORTHY Expiratory flow limitation (EFL) and airway closure (AC) were observed in 32% and 52%, respectively, of 25 patients with ARDS investigated during mechanical ventilation in supine position with a positive end-expiratory pressure of 5 cmH(2)O. The performance of dynamic lung elastance to detect expiratory flow limitation was good and better than that to detect airway closure. The vast majority of patients with EFL also had AC; however, AC can occur in the absence of EFL

Quality of Life of Children with Congenital Heart Diseases: A Multicenter Controlled Cross-Sectional Study

International audienceTo assess the health-related quality of life (QoL) in children with congenital heart diseases (CHD) with a validated questionnaire in comparison with control children. We prospectively recruited 282 children with CHD aged from 8 to 18 years in two tertiary care centers (France and Belgium) and 180 same-age controls in randomly selected French schools. Children's QoL was self-reported with the KIDSCREEN-52 questionnaire and reported by parents with the KIDSCREEN-27. QoL scores of each dimension were compared between CHD and controls and between the classes of disease severity. Both centers were comparable for most demographic and clinical data. Age- and gender-adjusted self-reported QoL scores were lower in CHD children than in controls for physical well-being (mean ± SEM 45.97 ± 0.57 vs 50.16 ± 0.71, p < 0.0001), financial resources (45.72 ± 0.70 vs 48.85 ± 0.87, p = 0.01), peers/social support (48.01 ± 0.72 vs 51.02 ± 0.88, p = 0.01), and autonomy in the multivariate analysis (47.63 ± 0.69 vs 49.28 ± 0.85, p = 0.04). Parents-reported scores were lower in CHD children for physical (p < 0.0001), psychological well-being (p = 0.04), peers/social support (p < 0.0001), and school environment (p < 0.0001) dimensions. Similarly, the disease severity had an impact on physical well-being (p < 0.001), financial resources (p = 0.05), and peers/social support (p = 0.01) for self-reported dimensions, and on physical well-being (p < 0.001), psychological well-being (p < 0.01), peers/social support (p < 0.001), and school environment (p < 0.001) for parents-reported dimensions. However, in multivariate analysis on self-reported QoL, disease severity was significantly associated with the self-perception dimension only. Self-reported QoL of CHD children was similar to that of same-age healthy children in seven of 10 dimensions, but parents-reported QoL was impaired in four of five dimensions