Renforcer la prévention des maladies et la promotion de la santé dans l'entreprise: évaluation des besoins et de l'intérêt des collaborateurs pour le renforcement de la politique sanitaire développée par l'entreprise Nestlé sur son site de Vevey-Bergère

L'IUMSP a été chargé de mesurer l'état de santé subjectif et les modes de vie des employées de l'entreprise Nestlé, d'estimer la fréquence à laquelle ils sont exposés à certains facteurs de risque dans le contexte de leur activité professionnelle et de leur vie privée, de mettre en évidence l'existence de facteurs protecteurs, d'évaluer leurs pratiques en matière de consultation médicale et de déterminer leur volonté de participer à des actions de prévention. Notamment comparées aux informations fournies par l'Enquête suisse sur la santé, les données rassemblées pourront servir à construire des actions de prévention des maladies chroniques et dégénératives ou de promotion de la santé. Un questionnaire "Etat de santé, modes de vie" figure en annexe de ce document (en français & anglais). [Table des matières] 1. Méthodes. 1.1. Faisabilité de l'étude et élaboration du questionnaire. 1.2. Récolte des données. 1.3. Comparaison avec la population suisse. 2. Résultats : population, état de santé, état de santé subjectif, bien-être psychique, plaintes, malaises plus ou moins diffus (maux de tête, de dos, problèmes intestinaux), sommeil, état de santé "objectif", taille, poids, indice de masse corporelle, troubles visuels, troubles auditifs, cholestérol, hypertension, consommation de médicaments, maladies diagnostiquées et traitées, maladies et accidents professionnels, suivi médical et prévention, prise en charge par un médecin traitant - date et motif de la dernière consultation, prise en charge par un gynécologue - date de la dernière consultation, examens de dépistage, modes de vie, exercice physique, alimentation, alcool, tabac, produits stupéfiants, comportement sexuel, environnement professionnel, satisfaction au travail, motifs d'insatisfaction, nuisances perçues, impact des déplacements professionnels, pression (stress), prévention, dépistage et éducation à la santé dans le contexte de l'entreprise. 3. Recommandations. 4. Questionnaire. 5. Construction de l'indice de bien-être psychique

Tobacco use and attitudes towards a smoke-free policy : survey in the World Health Organization in Geneva

La consommation de tabac est la première cause de mortalité dans les pays occidentaux. Plusieurs études scientifiques ont également montré l'impact du tabagisme passif sur la santé. L'Organisation mondiale de la santé (OMS) a récemment identifié le contrôle du tabagisme (actif et passif) comme l'une de ses priorités pour les prochaines décennies. Ce contrôle peut être réalisé dans le cadre d'environnements professionnels sans fumée et de l'aide aux fumeurs souhaitant arrêter de fumer. Le lieu de travail devrait donc être aménagé afin de protéger les non-fumeurs de la fumée d'autrui. Une telle stratégie permet de réduire la consommation de cigarettes et fait progresser les fumeurs dans leur désaccoutumance au tabac. En 1999, le groupe "Tobacco free initiative" de l'OMS a mandaté l'Unité de prévention, (unité commune à l'Institut universitaire de médecine sociale et préventive et à la Policlinique médicale universitaire de Lausanne) de réaliser une enquête chez les employés de l'OMS. Les objectifs de cette enquête étaient les suivants : décrire la perception des employés et leurs connaissances en termes de contrôle du tabagisme ; déterminer leur exposition au tabagisme passif; connaître leur attitude envers une organisation totalement "smoke free" ; évaluer l'intérêt des fumeurs à bénéficier d'une aide à la désaccoutumance dans le cadre de leur activité professionnelle. [P. 4]]]> Health Policy ; Health Promotion ; Smoking ; Tobacco Smoke Pollution ; World Health Organization eng https://serval.unil.ch/resource/serval:BIB_D5D9E0FEA957.P001/REF.pdf http://nbn-resolving.org/urn/resolver.pl?urn=urn:nbn:ch:serval-BIB_D5D9E0FEA9577 info:eu-repo/semantics/altIdentifier/urn/urn:nbn:ch:serval-BIB_D5D9E0FEA9577 info:eu-repo/semantics/submittedVersion info:eu-repo/semantics/openAccess Copying allowed only for non-profit organizations https://serval.unil.ch/disclaimer application/pdf oai:serval.unil.ch:BIB_D5D9FE1D5924 2022-05-07T01:27:53Z openaire documents <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_D5D9FE1D5924 Firewalls Prevent Systemic Dissemination of Vectors Derived from Human Adenovirus Type 5 and Suppress Production of Transgene-Encoded Antigen in a Murine Model of Oral Vaccination. info:doi:10.3389/fcimb.2018.00006 info:eu-repo/semantics/altIdentifier/doi/10.3389/fcimb.2018.00006 info:eu-repo/semantics/altIdentifier/pmid/29423380 Revaud, J. Unterfinger, Y. Rol, N. Suleman, M. Shaw, J. Galea, S. Gavard, F. Lacour, S.A. Coulpier, M. Versillé, N. Havenga, M. Klonjkowski, B. Zanella, G. Biacchesi, S. Cordonnier, N. Corthésy, B. Ben Arous, J. Richardson, J.P. info:eu-repo/semantics/article article 2018 Frontiers in cellular and infection microbiology, vol. 8, pp. 6 info:eu-repo/semantics/altIdentifier/eissn/2235-2988 urn:issn:2235-2988 <![CDATA[To define the bottlenecks that restrict antigen expression after oral administration of viral-vectored vaccines, we tracked vectors derived from the human adenovirus type 5 at whole body, tissue, and cellular scales throughout the digestive tract in a murine model of oral delivery. After intragastric administration of vectors encoding firefly luciferase or a model antigen, detectable levels of transgene-encoded protein or mRNA were confined to the intestine, and restricted to delimited anatomical zones. Expression of luciferase in the form of multiple small bioluminescent foci in the distal ileum, cecum, and proximal colon suggested multiple crossing points. Many foci were unassociated with visible Peyer's patches, implying that transduced cells lay in proximity to villous rather than follicle-associated epithelium, as supported by detection of transgene-encoded antigen in villous epithelial cells. Transgene-encoded mRNA but not protein was readily detected in Peyer's patches, suggesting that post-transcriptional regulation of viral gene expression might limit expression of transgene-encoded antigen in this tissue. To characterize the pathways by which the vector crossed the intestinal epithelium and encountered sentinel cells, a fluorescent-labeled vector was administered to mice by the intragastric route or inoculated into ligated intestinal loops comprising a Peyer's patch. The vector adhered selectively to microfold cells in the follicle-associated epithelium, and, after translocation to the subepithelial dome region, was captured by phagocytes that expressed CD11c and lysozyme. In conclusion, although a large number of crossing events took place throughout the intestine within and without Peyer's patches, multiple firewalls prevented systemic dissemination of vector and suppressed production of transgene-encoded protein in Peyer's patches

The effect of non-medical factors on variations in the performance of colonoscopy among different health care settings

Background: Previous studies in the literature have shown significant variations in colonoscopy performance, even when medical factors are taken into account. This study aimed to examine the role of non-medical factors (i.e. embodied in health care system design) as possible contributors to variations in colonoscopy performance. Methods: We used patient data from a multicenter observational study conducted between 2000 and 2002 in 21 centers across 11 western countries. Variability was captured through two performance outcomes (diagnostic yield and colonoscopy withdrawal time), jointly studied as dependent variables using a multilevel two-equation system. Results: Results showed that open-access systems and high-volume colonoscopy centers were independently associated with a higher likelihood of detecting significant lesions and higher withdrawal durations. Fee for service (FFS) payment was associated with shorter withdrawal durations, and had an indirect negative impact on the diagnostic yield. Teaching centers exhibited lower detection rates and higher withdrawal times. Conclusions: Our results suggest that gate-keeping colonoscopy is likely to miss patients with significant lesions and that developing specialized colonoscopy units is important to improve performance. Results also suggest that FFS may result in a lower quality of care in colonoscopy practice and highlight that longer withdrawal times do not necessarily mean higher quality in teaching-centers.Medical Practice Variation (MPV), performance, non-medical factors, panel two-equation linear-probit model, colonoscopy

Depressed mood in a cohort of elderly medical inpatients: Prevalence, clinical correlates and recognition rate

The objectives of this prospective cohort study were to 1) determine the prevalence of depressed mood, 2) identify the characteristics associated with it, and 3) evaluate the recognition rate of depressed mood by clinicians. The study population was a cohort of 401 elderly patients, aged 75 years and older, admitted to the internal medicine service of a tertiary care academic medical center in Western Switzerland over six months. We excluded patients with severe cognitive impairment, terminal disease or those living in a nursing home. Data on demographics, medical, physical, social and mental status were collected upon admission. Presence of depressed mood was defined as a score ≥ 6 on the Geriatric Depression Scale (GDS), short form (15-item). An independent re-viewer performed a discharge summary abstraction to assess recognition rate. Subjects' mean age was 82.4 years, 60.9% were women. Overall, 90 patients (22.4%) had an abnormal GDS score (≥6). Compared to those without a depressed mood, these subjects were (all p<0.05) older (83.5 vs 82.0 years), more frequently living alone (66.7 vs 55.0%), dependent in both basic activities of daily living (BADL) and instrumental ADL (48.9 vs 36.0%, and 91.1 vs 84.9%, respectively), and cognitively impaired (47.8 vs 27.7% with MMSE score<24). In addition, they had more comorbidities (Charlson index 1.6 vs 1.2). In multivariate analysis, an independent association remains for subjects living alone (OR 1.8, 95%CI 1.1-3.0), with cognitive impairment (OR 1.9, 95%CI 1.1-3.2), and comorbidities (OR 1.3 per point, 95%CI 1.1-1.5). Detection rate during the index hospitalization was only 16.7% (15/90). In conclusion, depressed mood was frequent but rarely detected in this population. These findings emphasize the need to improve screening efforts, and to develop additional strategies such as using a pre-screening question to enhance clinical recognitio

Characteristics associated with inappropriate hospital use in elderly patients admitted to a general internal medicine service

Our objective was to identify patient characteristics associated with inappropriate hospital days in a cohort of elderly medical inpatients. This prospective cohort study included a total of 196 patients aged 75 years and older, who were consecutively admitted over eight months to the internal medicine service of a regional, non-academic public hospital located in a rural area of Western Switzerland. Patients with severe cognitive impairment, terminal disease, or previously living in a nursing home were excluded. Data on demographics, medical, physical, social and mental status were collected at admission. A blinded hospitalization review was performed concurrently using a modified version of the Appropriateness Evaluation Protocol (AEP). Subjects' mean age was 82.4 years; 63.3% were women. Median length of stay was 8 days. Overall, 68 patients (34.7%) had at least one inappropriate day during their stay, including 18 patients (9.2%) whose hospital admission and entire stay were considered inappropriate. Most inappropriate days were due to discharge delays (87.1%), primarily to nursing homes (59.3%). Univariate analysis showed that subjects with inappropriate days were more likely to be living alone (69.1 vs 48.4%, p=0.006), and receiving formal in-home help (48.5 vs 32.8%, p=0.031). In addition, they were more impaired in basic and instrumental activities of daily living BADLs, and IADLs, p<0.001 and p=0.015, respectively), and more frequently had a depressed mood [29.4 vs 10.9%, p=0.001 with a score ≥ 6 at the Geriatric Depression Scale (GDS), short form]. Using multivariate analysis, independent associations remained for patients living alone (OR 2.6, 95%CI 1.2-5.8, p=0.016), those with a depressed mood (OR 2.8, 95%CI 1.1-7.3, p=0.032), with BADL dependencies (OR 1.5, 95%CI 1.2-1.8, p=0.001), and IADL dependencies (OR 1.3, 95%CI 1.0-1.6, p=0.032). Cardiovascular (OR 0.2, 95%CI 0.1-0.7, p=0.008) and pulmonary admission diagnoses (OR 0.1, 95%CI 0.0-0.7, p=0.022) were inversely associated with inappropriate hospital days. In conclusion, patients living alone, functionally impaired and showing depressive symptoms were at increased risk for inappropriate hospital days. These characteristics might permit better targeting for early discharge planning in these at-risk subjects, and contribute to avoiding premature discharge of other vulnerable elderly patients. Whether these interventions for at-risk patients will also result in prevention of hospitalization hazards, such as deconditioning and related functional decline, will require further stud

Comparison of Serum Lipoprotein(a) Distribution and its Correlates among Black and White Populations

Bovet P (Clinical Epidemiology Unit, Institute of Social and Preventive Medicine, University of Lausanne, Bugnon 17, CH-1005 Lausanne, Switzerland), Rickenbach M, Wietlisbach V, Riesen W, Shamlaye C, Darioli R and Burnand B. Comparison of lipoprotein(a) distribution and its correlates among black and white populations. International Journal of Epidemiology 1994; 23: 20-27. Background Epidemiological data on serum lipoprotein(a) (Lp(a)), a presumably strong risk factor for coronary artery disease in White populations, has mostly been derived, in Black populations, from small samples. This study compares the distribution and the determinants of serum Lp(a) in Blacks and in Whites using large representative samples and the same methods in both populations. Methods The distribution and the correlates of serum Lp(a) were investigated in population-based samples of 701 Blacks in the Seychelles and 634 Whites in Switzerland, aged 25-64 years. Serum Lp(a) was quantified using a commercial immunoradiometric assay. Results The distribution of serum Lp(a) was similarly skewed in both ethnic groups, but median Lp(a) concentration was about two fold higher in Blacks (210 mg/l) compared to Whites (100 mg/l). The proportions of individuals with elevated serum Lp(a) >300 mg/l) was about 50% higher in Blacks (37.5%) than in Whites (25.2%). In both ethnic groups, serum Lp(a) was found to correlate with total cholesterol, LDL-cholesterol and apoprotein B but not with HDL-cholesterol, alcohol intake, smoking, and body mass index. The variance in serum Lp(a) concentration explained by any combination of these factors was smaller than 5.3% in the two populations. Conclusions The measured factors did not explain the higher levels of serum Lp(a) found in Blacks compared to Whites. These findings are consistent with the hypothesis that genetic factors account for much of the variation of serum Lp(a) in both population

Patient use of the Internet for health care information in Switzerland.

The aim of this study was to examine for the first time the frequency of Internet use for medical purposes by patients in Switzerland. In 2001 over a period of one month, 1604 patients at 8 medical practices in Switzerland completed a self-administered questionnaire on their access to the Internet and any search for medical information using this media. The attending physician supplied the patient's diagnosis and information on the severity of the disorder motivating the visit using a separate questionnaire. 46% of the patients included in the study had a personal computer, 33% had an Internet connection and 10% used the Internet to find medical information. Age was inversely associated with the probability of having an Internet access, whereas educational level and command of the English language were factors directly associated with this. Among those patients with access to the Internet, young adults (25 to 44 years) and those with knowledge of the English language searched for medical information significantly more frequently. Furthermore, patients attending urban medical practices and those with a more severe level of disease more often sought health care information on the Internet. The proportion of patients in Switzerland who search for medical information on the Internet is similar to the rates observed in European English-speaking countries. The Internet allows patients to actively search for information concerning their own health problems but is not currently the most common source of information used by patients. Since health professionals generate, directly or indirectly, most of the medical information published on the Internet, additional research is needed to better understand patients' needs and expectations concerning medical information using this media