Ostéopathie et pédiatrie : deux mondes reliés par l'enfant et ses parents

Objectif : le but de cette étude est d'évaluer la connaissance des pédiatres du canton de Vaud quant à la prise en charge ostéopathique de leurs patients, analyser et quantifier la communication entre pédiatres et ostéopathes de ce même canton et les perspectives futures de cette collaboration, de comparer les propositions de prise en charge face aux principaux motifs de consultations des nourrissons chez l'ostéopathes, et finalement d'évaluer les raisons poussant les parents à consulter un ostéopathe pour leur enfant durant son premier mois de vie, ceci toujours à travers l'avis des pédiatres et ostéopathes du canton de Vaud. Méthode : une étude prospective réalisée dans un premier temps par des entretiens semi-structurés auprès de pédiatres hospitaliers, d'ostéopathes et de pédiatres installés, complétée dans un deuxième temps par un questionnaire en ligne transmis aux pédiatres et ostéopathes du canton de Vaud. Résultats : 77.8% des pédiatres ayant répondu au questionnaire déclarent qu'ils ont connaissance de la prise en charge ostéopathique de moins de trente pourcents de leurs patients et 53.6% des ostéopathes savent que moins de trente pourcents des pédiatres de leurs clients en âge pédiatriques savent qu'ils sont suivi par un ostéopathe. L'intermédiaire presque exclusif entre les deux professions est le parent (plus de quatre-vingts pourcents pour 57.8% des pédiatres, idem pour les ostéopathes). La communication entre pédiatres et ostéopathes est faible (selon 67.6% des ostéopathes) à inexistante (selon 60% des pédiatres). 89.7% de l'ensemble du panel souhaite une amélioration de cette situation. La considération que se portent les deux professions est opposée avec des valeurs de coefficients de corrélations négatifs (κ2=(-0.642), ICC=(-0.494), r=(-0.691)). 31.1% des pédiatres ne conseil en aucun cas une prise en charge ostéopathique à leurs patients alors que 62.2% le font en cas de plagiocéphalie. Les prises en charges proposées par les deux corps de métiers pour les coliques du nourrisson et suite à un accouchement difficile sont très peu corrélées (respectivement κ2=0.091 et 0.021, ICC=0.169 et (-0.076), r=0.232 et 0.120). Les sages-femmes conseillant la visite chez l'ostéopathe ont été désignées comme principale cause de la visite ostéopathique durant le premier mois de vie des enfants par les ostéopathes (90.1%) et seconde cause par les pédiatres (82.2%), y voyant premièrement l'effet d'une mode ou tendance de notre époque (88.9%). Conclusion : Les pédiatres n'ont connaissance de la prise en charge ostéopathique que d'une partie de leur patientèle ayant cette prise en charge parallèle et l'information de cette prise en charge repose presque exclusivement sur les épaules des parents. La communication entre pédiatres et ostéopathes est très faible mais une amélioration de cette situation est souhaitée et des pistes pour réaliser cette communication sont proposées. L'estime que se portent pédiatres et ostéopathes quant à leurs prises en charges s'oppose ce qui fait que plus de trente pourcents des pédiatres ne conseillent pour aucune indication la prise en charge ostéopathique. Cela s'explique également par le fait que leurs propositions de prise en charge ne se corrèlent pas. La première cause poussant la consultation ostéopathique des nourrissons dans le premier mois de vie a été désignée comme étant les sages femmes

PCN21 FIRST-LINE BEVACIZUMAB-BASED THERAPY VERSUS PEMETREXED + CISPLATIN FOR THE TREATMENT OF ADVANCED ADENOCARCINOMA NONSQUAMOUS NON-SMALL CELL LUNG CANCER: INDIRECT COMPARISON APPLYING REAL-LIFE OUTCOMES

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Societal savings in patients with advanced non-squamous non-small-cell lung cancer receiving bevacizumab-based versus non-bevacizumab-based treatments in France, Germany, Italy, and Spain

BACKGROUND: The purpose of this study was to investigate the savings accrued using bevacizumab-based treatment for non-small-cell lung cancer from the societal perspective, taking only public costs into account, in France, Germany, Italy, and Spain. METHODS: Societal costs were estimated by collecting and analyzing labor costs, carer costs, sickness benefits, disability benefits, and home care benefits. Cost inputs were derived from publicly available databases or from the published literature. Expert opinion was only used if no other source was available. Efficacy data from two randomized clinical trials were used. The time horizon in the health economic model was lifetime. Efficacy and costs were discounted by 3.5%. All main model parameters were tested in deterministic and probabilistic sensitivity analyses. RESULTS: Mean incremental savings to society per patient ranged from €2277 in Italy to €4461 in Germany. The results were most sensitive to the change in proportion of patients working fulltime and the proportion of patients who were able to return to work. CONCLUSION: This analysis shows that bevacizumab-based treatment in non-small-cell lung cancer is associated with more savings to society compared to standard chemotherapy in terms of increased productivity and decreased social benefits paid to patients who are able to work in France, Germany, Italy, and Spain

Costs of managing adverse events in the treatment of first-line metastatic renal cell carcinoma: Bevacizumab in combination with interferon-α2a compared with sunitinib

Background: Bevacizumab plus interferon-α2a (IFN) prolongs progression-free survival to>10 months, which is comparable with sunitinib as first-line treatment of metastatic renal cell carcinoma (RCC). The two regimens have different tolerability profiles; therefore, costs for managing adverse events may be an important factor in selecting therapy.Methods: Costs of managing adverse events affecting patients with metastatic RCC eligible for treatment with bevacizumab plus IFN or sunitinib were evaluated using a linear decision analytical model. Management costs were calculated from the published incidence of adverse events and health-care costs for treating adverse events in the United Kingdom, Germany, France and Italy.Results: Adverse event management costs were higher for sunitinib than for bevacizumab plus IFN. The average cost per patient for the management of grade 3-4 adverse events was markedly lower with bevacizumab plus IFN compared with sunitinib in the United Kingdom (\[euro]1475 vs \[euro]804), Germany (\[euro]1785 vs \[euro]1367), France (\[euro]2590 vs \[euro]1618) and Italy (\[euro]891 vs \[euro]402). The main cost drivers were lymphopaenia, neutropaenia, thrombocytopaenia, leucopaenia and fatigue/asthaenia for sunitinib; and proteinuria, fatigue/asthaenia, bleeding, anaemia and gastrointestinal perforation for bevacizumab plus IFN.Conclusion: The costs of managing adverse events are lower for bevacizumab plus IFN than for sunitinib. The potential for cost savings should be considered when selecting treatments for RCC

Energy Modelling on the Alpine Bow

The Alpine bow has a great potential for renewable energy (RE) development. At the same time, wildlife in Alpine areas is at risk and has to be protected. More of 40% of the Alpine area is covered by protected areas. They vary in definition and level of protection regarding their category, region, and country. Therefore, some of those protected areas may be suited for the development of bioenergy whereas others may be more suited for the development of hydropower. Using a precise classification of those protected areas, and assuming the correct protection level the techno-economic model, spatial explicit, BeWhere, will identify the potential from hydropower, bioenergy, wind and solar power while balancing the ecosystems services in the Alps. The model is based on the minimization of the whole supply chain, starting from the collection of the feedstock to the delivery of the final product to the consumers in the Alps and in the major cities outside the Alps. Access to the site is a determinant issue to build a new power plant in the Alps, therefore the model uses a detailed road network for the transport of the feedstock and accessibility, as well as a map of the high voltage power line. The future RE production plants will be installed if the production cost is competitive enough against fossil fuel based power and heat. The model will then provide the optimal locations, numbers, technologies, and capacities for hydropower stations, bioenergy production plants, solar PV fields and wind parks, together with their corresponding costs and emissions. A series of scenarios will be carried out varying the fossil fuel price, the carbon cost and the level of protection of the environment. For each of the scenarios, the RE potential, production cost, and emission reductions will be assessed. The results will provide key indications to the stakeholders and the policymakers on the consequences of protecting the environment and the development of RE production

Global citizenship as the completion of cosmopolitanism

A conception of global citizenship should not be viewed as separate from, or synonymous with, the cosmopolitan moral orientation, but as a primary component of it. Global citizenship is fundamentally concerned with individual moral requirements in the global frame. Such requirements, framed here as belonging to the category of individual cosmopolitanism, offer guidelines on right action in the context of global human community. They are complementary to the principles of moral cosmopolitanism – those to be used in assessing the justice of global institutions and practices – that have been emphasised by cosmopolitan political theorists. Considering principles of individual and moral cosmopolitanism together can help to provide greater clarity concerning individual duties in the absence of fully global institutions, as well as clarity on individual obligations of justice in relation to emerging and still-developing trans-state institutions

Schools and civil society : corporate or community governance

School improvement depends upon mediating the cultural conditions of learning as young people journey between their parochial worlds and the public world of cosmopolitan society. Governing bodies have a crucial role in including or diminishing the representation of different cultural traditions and in enabling or frustrating the expression of voice and deliberation of differences whose resolution is central to the mediation of and responsiveness to learning needs. A recent study of governing bodies in England and Wales argues that the trend to corporatising school governance will diminish the capacity of schools to learn how they can understand cultural traditions and accommodate them in their curricula and teaching strategies. A democratic, stakeholder model remains crucial to the effective practice of governing schools. By deliberating and reconciling social and cultural differences, governance constitutes the practices for mediating particular and cosmopolitan worlds and thus the conditions for engaging young people in their learning, as well as in the preparation for citizenship in civil society

Integrity in democratic politics

The complaint that many professional politicians lack integrity is common. However, it is unclear what such a judgement amounts to. Taking various codes of political ethics in the United Kingdom as my starting point, I examine the extent to which we can understand political integrity as a matter of politicians adhering to the obligations that official codes of ethics prescribe and, in a more general sense, the public-service ethos that underpins these codes. I argue that although this way of approaching the issue usefully draws our attention to an important class of positional duties that apply to politicians, commitment to principled political causes plays a further, indispensable role in coherent assessments of political integrity. In consequence, I claim that politicians of integrity succeed in furthering their deepest political commitments while avoiding malfeasance or misconduct. As such, the ascription of political integrity can often only be made when assessing a long train of action