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

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

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

Separation of small metabolites and lipids in spectra from biopsies by diffusion-weighted HR-MAS NMR: a feasibility study.

High Resolution Magic Angle Spinning (HR-MAS) NMR allows metabolic characterization of biopsies. HR-MAS spectra from tissues of most organs show strong lipid contributions that are overlapping metabolite regions, which hamper metabolite estimation. Metabolite quantification and analysis would benefit from a separation of lipids and small metabolites. Generally, a relaxation filter is used to reduce lipid contributions. However, the strong relaxation filter required to eliminate most of the lipids also reduces the signals for small metabolites. The aim of our study was therefore to investigate different diffusion editing techniques in order to employ diffusion differences for separating lipid and small metabolite contributions in the spectra from different organs for unbiased metabonomic analysis. Thus, 1D and 2D diffusion measurements were performed, and pure lipid spectra that were obtained at strong diffusion weighting (DW) were subtracted from those obtained at low DW, which include both small metabolites and lipids. This subtraction yielded almost lipid free small metabolite spectra from muscle tissue. Further improved separation was obtained by combining a 1D diffusion sequence with a T2-filter, with the subtraction method eliminating residual lipids from the spectra. Similar results obtained for biopsies of different organs suggest that this method is applicable in various tissue types. The elimination of lipids from HR-MAS spectra and the resulting less biased assessment of small metabolites have potential to remove ambiguities in the interpretation of metabonomic results. This is demonstrated in a reproducibility study on biopsies from human muscle

Thrombospondin-1 is downregulated by anoxia and suppresses tumorigenicity of human glioblastoma cells.

Angiogenesis, the sprouting of new capillaries from preexisting blood vessels, results from a disruption of the balance between stimulatory and inhibitory factors. Here, we show that anoxia reduces expression of thrombospondin-1 (TSP-1), a natural inhibitor of angiogenesis, in glioblastoma cells. This suggests that reduced oxygen tension can promote angiogenesis not only by stimulating the production of inducers, such as vascular endothelial growth factor, but also by reducing the production of inhibitors. This downregulation may significantly contribute to glioblastoma development, since we show that an increase in TSP-1 expression is sufficient to strongly suppress glioblastoma cell tumorigenicity in vivo

Sympathetic activity and early mobilization in patients in intensive and intermediate care with severe brain injuries: a preliminary prospective randomized study.

Patients who experience severe brain injuries are at risk of secondary brain damage, because of delayed vasospasm and edema. Traditionally, many of these patients are kept on prolonged bed rest in order to maintain adequate cerebral blood flow, especially in the case of subarachnoid hemorrhage. On the other hand, prolonged bed rest carries important morbidity. There may be a clinical benefit in early mobilization and our hypothesis is that early gradual mobilization is safe in these patients. The aim of this study was to observe and quantify the changes in sympathetic activity, mainly related to stress, and blood pressure in gradual postural changes by the verticalization robot (Erigo®) and after training by a lower body ergometer (MOTOmed-letto®), after prolonged bed rest of minimum 7 days. Thirty patients with severe neurological injuries were randomized into 3 groups with different protocols of mobilization: Standard, MOTOmed-letto® or Erigo® protocol. We measured plasma catecholamines, metanephrines and blood pressure before, during and after mobilization. Blood pressure does not show any significant difference between the 3 groups. The analysis of the catecholamines suggests a significant increase in catecholamine production during Standard mobilization with physiotherapists and with MOTOmed-letto® and no changes with Erigo®. This preliminary prospective randomized study shows that the mobilization of patients with severe brain injuries by means of Erigo® does not increase the production of catecholamines. It means that Erigo® is a well-tolerated method of mobilization and can be considered a safe system of early mobilization of these patients. Further studies are required to validate our conclusions. The study was registered in the ISRCTN registry with the trial registration number ISRCTN56402432 . Date of registration: 08.03.2016. Retrospectively registered

Salute e stile di vita degli adolescenti dai 16 ai 20 anni in Svizzera (2002) : SMASH 2002 : Swiss multicenter adolescent survey on health 2002

Questo studio si basa su due approcci complementari inerenti alla salute : il primo mette l'accento sugli aspetti sociologici dei comportainenti riguardanti la salute e cerca di evidenziare il determinismo psicosociale e la percezione dei modi di comportarsi ("lifestyle"). I1 secondo, di natura epidemiologica, mette l'accento sulla prevalenza dei comportamenti e procede &amp;'analisi nei diversi sottogruppi o nel tempo. Le scelte che sono fatte in questa inchiesta si riferiscono alla concezione della salute vista come uno stato d'equilibrio, un processo dinamico costantemente influenzato da elementi e comportamenti personali come pure da variabili ambientali di prossimità (livello socioeconomico) e distali (il clima, i mezzi di trasporto, ecc.). Lo studio SMASH 2002 fornisce una panoramica della situazione degli adolescenti e del loro stato di salute : bisogni e comportamenti legati alla salute, fattori associati e una valutazione dei grandi cambiamenti insorti da una decina d'anni. Questi dati dovrebbero permettere una riflessione sulla pianificazione ottimale dei servizi di cure e dei programmi di prevenzione e di promozione della salute rivolti agli adolescenti. [P. 6]]]> Health Surveys ; Adolescent ; Health Status ; Life Style ; Sexual Behavior ; Substance-Related Disorders ; Health Behavior ; Mental Health ; Adolescent Health Services ; Violence ; Questionnaires ; Switzerland ita https://serval.unil.ch/resource/serval:BIB_6A9892B282F8.P001/REF.pdf http://nbn-resolving.org/urn/resolver.pl?urn=urn:nbn:ch:serval-BIB_6A9892B282F82 info:eu-repo/semantics/altIdentifier/urn/urn:nbn:ch:serval-BIB_6A9892B282F82 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_6A99073857AE 2022-05-07T01:19:47Z 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_6A99073857AE Ceftazidime in severe infections: a Swiss multicentre study. info:doi:10.1093/jac/12.suppl_A.139 info:eu-repo/semantics/altIdentifier/doi/10.1093/jac/12.suppl_A.139 info:eu-repo/semantics/altIdentifier/pmid/6225761 Francioli, P. Clément, M. Geroulanos, S. von Graevenitz, A. Luthy, R. Regamey, C. Stalder, H. Vogt, M. Waldvogel, F.A. info:eu-repo/semantics/article article 1983-07 The Journal of Antimicrobial Chemotherapy, vol. 12 Suppl A, pp. 139-146 info:eu-repo/semantics/altIdentifier/pissn/0305-7453 <![CDATA[A total of 105 patients (mean age 57, range 15 to 90) with serious infections were treated with intravenous ceftazidime, usually 2 g 8-hourly. Most patients had complicating factors such as major surgery, cancer, chronic obstructive lung disease, catheters or anatomical abnormalities. Eighty-seven infectious episodes in 77 patients could be assessed for efficacy. Bacteraemia was diagnosed in 26% of these episodes. Seventy-five per cent of infections were due to Gram-negative bacteria, Pseudomonas aeruginosa being the most frequent. The major sites of infections were the lower respiratory tract (30), the urinary tract (28), the soft tissues (9), the biliary tract (4), bones (4) and the ears (4). Overall, 67% of the patients were cured, 20% improved, 7% relapsed and 6% failed to respond. Among the 27 infections due to Ps aeruginosa, only two failures (in the same patient) and four relapses were recorded. However, in the two failures and in three other cases with persistent Ps. aeruginosa colonisation, the organism had become resistant to ceftazidime. Three failures were recorded in the seven Staphylococcus aureus infections included in this study. Superinfection occurred in four patients. Adverse events included rash (6), Clostridium difficile toxin-induced diarrhoea (3), transaminase elevation (3), weakly positive Coombs test (10). Ceftazidime appears to be safe and effective for the treatment of severe Gram-negative infections, including those caused by Ps. aeruginosa

Outcome Prediction of Consciousness Disorders in the Acute Stage Based on a Complementary Motor Behavioural Tool.

Attaining an accurate diagnosis in the acute phase for severely brain-damaged patients presenting Disorders of Consciousness (DOC) is crucial for prognostic validity; such a diagnosis determines further medical management, in terms of therapeutic choices and end-of-life decisions. However, DOC evaluation based on validated scales, such as the Revised Coma Recovery Scale (CRS-R), can lead to an underestimation of consciousness and to frequent misdiagnoses particularly in cases of cognitive motor dissociation due to other aetiologies. The purpose of this study is to determine the clinical signs that lead to a more accurate consciousness assessment allowing more reliable outcome prediction. From the Unit of Acute Neurorehabilitation (University Hospital, Lausanne, Switzerland) between 2011 and 2014, we enrolled 33 DOC patients with a DOC diagnosis according to the CRS-R that had been established within 28 days of brain damage. The first CRS-R assessment established the initial diagnosis of Unresponsive Wakefulness Syndrome (UWS) in 20 patients and a Minimally Consciousness State (MCS) in the remaining13 patients. We clinically evaluated the patients over time using the CRS-R scale and concurrently from the beginning with complementary clinical items of a new observational Motor Behaviour Tool (MBT). Primary endpoint was outcome at unit discharge distinguishing two main classes of patients (DOC patients having emerged from DOC and those remaining in DOC) and 6 subclasses detailing the outcome of UWS and MCS patients, respectively. Based on CRS-R and MBT scores assessed separately and jointly, statistical testing was performed in the acute phase using a non-parametric Mann-Whitney U test; longitudinal CRS-R data were modelled with a Generalized Linear Model. Fifty-five per cent of the UWS patients and 77% of the MCS patients had emerged from DOC. First, statistical prediction of the first CRS-R scores did not permit outcome differentiation between classes; longitudinal regression modelling of the CRS-R data identified distinct outcome evolution, but not earlier than 19 days. Second, the MBT yielded a significant outcome predictability in the acute phase (p&lt;0.02, sensitivity&gt;0.81). Third, a statistical comparison of the CRS-R subscales weighted by MBT became significantly predictive for DOC outcome (p&lt;0.02). The association of MBT and CRS-R scoring improves significantly the evaluation of consciousness and the predictability of outcome in the acute phase. Subtle motor behaviour assessment provides accurate insight into the amount and the content of consciousness even in the case of cognitive motor dissociation