Language difficulties in an Outpatient Clinic in Switzerland

This small-scale study attempts to examine the languages spoken in medical consultations during a one-month period in an outpatient clinic in Geneva and the ways health professionals use to communicate with their allophone patients, in particular by using interpreters. Patients of foreign origin accounted for 58% of all the consultations during the survey. Of these, 37% were Non-French-speakers (NFS). The four major language groups of NFS were Albanian, Somali, Tamil and Serbo-croat. Qualified interpreters were used in 24% of the consultations, relatives acting as interpreters in 17%, and in the other consultations without anyone interpreting (59%), a common language had to be negotiated: French, English, Italian, Spanish or German. In only 14% of the consultations without interpreters, both patient's and doctors ability to speak a common language was rated as good. Our data suggest that there has been an increasing awareness of the possible language barriers in the medical outpatient clinic. Even if proxy solutions (informal interpreters or the use of a common language) still play an important role, access to an interpreter service has been widely used. This calls for systematic and regular interpreter use, planning the interpreting needs in a timely manner. In the future, training in working with interpreters should become an integral part to the introductory sessions for the junior physicians assigned to the outpatient clinic.     

Physical fitness and sport activity of children and adolescents: Methodological aspects of a regional survey

Summary Measurement of physical fitness and physical activity in children and adolescents raise a lot of methodological issues, explaining the scarcity of surveys in European countries and in Switzerland. This article exposes the design and the methods used in a survey on physical fitness, physical activity and health conducted in a region of Switzerland, and discuss the choice of the instruments and the quality control procedure selected to measure physical activity and physical fitness. The survey was conducted in a sample of 3540 students 9–19 years-old and included a battery of physical fitness tests, anthropometrics measurements and a self-report questionnaire on physical activity, sports activity and life styles. An ancillary study in a sub sample assessed daily physical activity with a pedometer, dietary intake with a 3-day dietary record, serum lipids and nutritional status. Some results are displayed as example. Quality control techniques are exposed and the choice of the instrument to assess physical fitness, physical activity, sports, and dietary intake are discussed. Local reference tables are now available for fitness tests and the practicability of fitness testing has been demonstrated in physical education. The research process has induced the sensitisation of schools toward health promotion through physical activity.

---

Zusammenfassung Das Messen der physischen Kondition und der physischen Aktivität von Kindern und Adoleszenten wirft eine Vielzahl methodologischer Fragen auf, weshalb wohl in europäischen Ländern und in der Schweiz bisher nur wenige solche Untersuchungen durchgeführt wurden. Es sollen in dieser Studie, welche in einer Region der Schweiz zum Thema physische Kondition, körperliche Betätigung und Gesundheit durchgeführt wurde, die zur Anwendung gekommenen Untersuchungsmethoden dargestellt und das eigentliche Vorgehen beschrieben werden. Ebenfalls werden die instrumentenwahl sowie die für diese Studie ausgearbeiteten Verfahren zur Qualitätssicherung der Messungen der physischen Kondition und der physischen Aktivität diskutiert. Die Untersuchung wurde mit einer Auswahl von 3540 neun-bis neunzehnjährigen Schülern durchgeführt und beinhaltet die Messung der physischen Kondition mit Hilfe einer Testserie, anthropometrische Messungen und einen Fragebogen zur physischen Aktivität, sportlichen Betätigung und zum Lebensstil. Eine Zusatzstudie wurde in einem Teilkollektiv durchgeführt. Dabei wurden die tägliche physische Aktivität mit Hilfe eines Pedometers gemessen, während drei Tagen ein Tagebuch über die Nahrungsaufnahme geführt und die Lipidwerte im Blut sowie der Ernährungszustand analysiert. Einige Ergebnisse werden als Beispiel aufgeführt. Die zur Qualitätsgarantie der erfassten Daten eingesetzten Massnahmen, sowie die Wahl der für die Messungen der physischen Kondition, der körperlichen Aktivität, der sportlichen Betätigung und der Ernährung verwandten Instrumente werden diskutiert. Das Erstellen von lokalen Referenztabellen zur physischen Kondition von Jugendlichen erlaubte es, die Konditionstests in den Sportunterricht einzuführen und schulnahe Kreise dafür zu sensibilisieren, dass die körperliche Betätigung für eine Strategie der Gesundheitsförderung eine wichtige Rolle spielt.

---

Résumé La mesure de la condition physique et de l'activité physique des enfants et des adolescents pose des problèmes méthodologiques particuliers, qui expliquent sans doute le petit nombre d'études de ce type dans les pays européens et en Suisse. Cet article présente la procédure et les méthodes utilisées dans une enquête sur la condition physique, l'activité physique et la santé, réalisée dans un canton de Suisse et discute le choix des instruments et des procédures mises en uvre pour assurer la qualité des mesures de la condition physique et d'activité physique. L'enquête a été conduite dans un échantillon de 3'540 élèves de 9 à 19 ans et comprenait des mesures de la condition physique grâce à une batterie de tests, des mesures anthropométriques et un questionnaire sur l'activité physique, la pratique sportive et les habitudes de vie. Dans un souséchantillon, on a utilisé un pédomètre mesurant l'activité physique quotidienne, un journal alimentaire de trois jours et un dosage sanguin des lipides et du status nutritionnel. Quelques résultats sont donnés à titre d'exemple. Les mesures mises en place pour assurer la qualité des données recueillies sont discutées, ainsi que le choix des instruments de mesure de la condition physique, de l'activité physique, de la pratique sportive et de l'alimentation. La réalisation de tables de référence locales pour les tests de condition physique a permis d'introduire l'utilisation des tests de condition physique dans l'enseignement de l'éducation physique, et de sensibiliser le milieu scolaire à l'importance de l'activité physique dans une stratégie de promotion de la santé.

     

The diluting effect of medical work groups on feedback efficacy in changing physician's practice

Feedback intervention has been advocated as a successful method to modify the way that physicians practice medicine. However, most studies concerned with modifying physician profiles have focused on interns and residents. The results presented here concern regular staff and therefore provide a better basis for generalization. Over a 2.5-year period, we analyzed the use of clinical resoucces by physicians practicing in four medical specialties in two hospitals. Hierarchical multiple regression models were used to control case mix in order to identify the specific effects attributable to feedback. The information failed to modify the physicians' practice profiles. Our results suggest that this failure is related to the organization of inpatient medical practice as a group effort. This mode of practice has a negative effect on feedback efficacy. First, it weakens one of the main feedback mechanisms, that is personal identification with the data. Second, it probably generates mutual adjustment among physicians, thus eliminating practice variations at the source.     

Treatment of post-operative nausea and vomiting: comparison of propofol,droperidol and metoclopramide

Purpose  

To compare the efficacy of propofol in a subhypnotic dose (10 mg iv), droperidol (1.25 mg iv), or metoclopramide (10 mg iv) in the treatment of PONV in the post anaesthesia care unit (PACU).     

Role of CD18-dependent and CD18-independent mechanisms in the increased leukocyte adhesiveness and in the variations of circulating white blood cell populations induced by anti-CD3 monoclonal antibodies

Anti-CD3 antibodies induce a quick and profound depletion of peripheral blood mononuclear cells (PBMCs) that is not well understood. We studied the effect of OKT3, a mouse monoclonal antibody againts the human CD3 complex, on the in vitro adhesion of human PBMCs to monolayers of fresh and fixed human umbilical vein endothelial cells (HUVECs). OKT3 induced an increased adhesiveness of PBMCs. This phenomenon was blocked with anti-CD18 antibodies, indicating the participation of 2 integrins. As this increased adhesiveness could explain the lymphopenia by adhesion of PBMCs to endothelial cells and their sequestration in some peripheral vascular beds, we studied the effect of anti-CD18 antibodies in vivo on mice injected with 145/2C11, a hamster monoclonal antibody against murine CD3. Mice treated with 145/2C11 presented with a transient granulocytopenia and a sustained reduction in PBMCs. A monoclonal anti-CD18 antibody prevented the granulocytopenia but had no effect the drop in PBMCs. Consequently, the in vivo depletion of PBMCs after administration of an anti-CD3 monoclonal antibody involves CD18-independent mechanisms, while the transient drop in polymorphonuclear cells appears to be CD18-dependent.     

Relevance of platelet serotonin and plasma tryptophan concentration in normal pregnant women and newborns to early child psychiatry

Dysfunctions of the serotonergic system are implicated in psychiatric disorders, and there is evidence that a familial element may be significant in childhood autism. The concentrations of platelet 5-HT and free and total plasma tryptophan were determined in healthy pregnant women at each month of pregnancy and, at delivery, in both maternal and umbilical cord blood. A significant rise in the level of platelet 5-HT occured during month 3 and 4 followed by a retum to normal from month 5 until the delivery. The level of total plasma tryptophan remained equal to that in normal healthy non pregnant women until the 6th month. By month 7, it had decreased significantly and remained low until the month 9. At delivery the level fell significantly by –41%. The concentration of free tryptophan varied widely from one month to another but there was a trend towards a progressive increase from month 1 to 9, and at delivery the level returned to basal values. The concentration of 5-HT in the umbilical cord blood was about half that of the maternal blood. Inversely the concentrations of both free and total plasma tryptophan in the umbilical cord blood were nearly twice that of the maternal blood.

---

Zusammenfassung Dysfunktionen des serotoninergen Systems werden bei verschiedenen psychiatrischen Störungen angenommen, wobei es Hinweise für eine familiäre Komponente im Rahmen des kindlichen Autismus gibt. Die Konzentrationen der 5-Hydroxyindolessigsäure in Blutplättchen und des Tryptophans (freie und Gesamtplasmakonzentrationen) wurden in gesunden schwangeren Frauen sowohl im mütterlichen Blut als auch im Nabelschnurblut in jedem Schwangerschaftsmonat und bei der Geburt bestimmt. Ein signifikanter Anstieg der Konzentration der 5-Hydroxyindolessigsäure in Blutplättchen ereignete sich zwischen Mens III und IV, und von Mens V ab an bis zur Geburt normalisierte sich die Konzentration. Der Gesamtplasmaspiegel von Tryptophan glich dem in gesunden nicht-schwangeren Frauen bis zu Mens VI, in Mens VII war er signifikant abgefallen und blieb bis zur Mens IX niedrig. Zum Geburtstermin fiel der Spiegel signifikant um 41%. Die Konzentration des freien Tryptophans zeigte von Monat zu Monat deutliche Schwankungen, wobei es einen Trend in Richtung eines kontinuierlichen Anstiegs von Mens I–IX gab. Zum Termin fiel der Spiegel auf die basalen Werte ab. Die Konzentration der 5-Hydroxyindolessigsäure im Nabelschnurblut betrug ca. die Hälfte derer im maternalen Blut. Umgekehrt waren die Konzentrationen sowohl des freien als auch Gesamtplasmatryptophans im Nabelschnurblut ca. doppelt so hoch wie im maternalen Blut.

---

Résumé Le système sérotonergique semble impliqué dans les psychoses infantiles précoces, et, dans la mesure où une prévalence familiale existe pour ces affections, il nous a paru intéressant de déterminer un profil normal de la sérotonine (5-HT) plaquettaire et du tryptophane au cours de la gestation. Ceci dans le but de puvoir interpréter des résultats trouvés pendant la grossesse de femmes déjà mères d'un enfant psychotique. Nous avons déterminé les concentrations en 5-HT plaquettaire et en tryptophane plasmatique total et libre chez des femmes enceintes témoins à chaque mois de grossesse et, à l'accouchement, dans le sang maternel et dans le sang du cordon. La concentration en 5-HT plaquettaire augmente significativement aux 3ème et 4ème mois puis revient à la normale à partir du 5ème mois jusqu'à l'accouchement. Le tryptophane total est normal jusqu'au 6ème mois, il diminue significativement au 7ème mois et reste bas jusqu'au 9ème mois. A l'accouchement, il s'effondre (–41%). Le tryptophane libre varie beaucoup d'un mois à l'autre, il augmente progressivement du début à la fin de la grossesse, à l'accouchement par contre, il est normal. Dans le sang du cordon, la concentration en 5-HT est environ la moitié de celle du sang maternel, le tryptophane total et le tryptophane libre environ deux fois plus élevés.

     

A case-control study of persons with elevated blood levels of dieldrin

Twenty-seven pesticide workers with elevated blood levels of dieldrin (15 ppb) were involved in a case-control study which included history and physical examination, comprehensive neurological evaluation, laboratory tests, and psychological and psychomotor testing. No clinically important differences were found on history, physical, specialized neurological tests, or laboratory examination. The exposed group showed a statistically significant difference in five out of 58 psychological (P) and psychomotor (PM) tests—at least three would be expected by chance (p .05). In only one of these tests was there any significant correlation with dieldrin levels. Even though the exposed group had worse scores than the control group in 47 of 58 P-PM tests, such scores were, with a few exceptions, in the normal range of values. Elevated blood levels of dieldrin encountered in this study do not appear to have any chronic deleterious effects on health, as measured by conventional medical work-up and extensive central nervous system testing.     

Rectal Mucosa Damage in Rabbits After Subchronical Application of Suppository Bases

The effect of suppository bases on rabbit rectal mucosa was investigated using six triglyceride bases, polyethylene glycol, and a triglyceride base combined with monoglycerides or fatty acids and methyl esters of those acids. Rectal irritation was evaluated and scored according to defined pathological features. Pure triglycerides and a triglyceride to which a nonionic surfactant was added caused severe mucosal damage with ulceration and inflammation. Hyperemia was characteristic for irritation by polyethylene glycol suppositories. Mucosal damage by a pure triglyceride combined with monoglycerides or fatty acids and methyl esters of those acids was similar but statistically less pronounced than with all other bases.     

Residual curarization in the neonate after Caesarean section

The transplacental transfer and the neonatal effects of atracurium 0.3 mg.kg-1 (ED95) were compared with those of d-tubocurarine at the usual clinical dose of 0.3 mg.kg-1 (ED90) in 46 patients undergoing elective Caesarean section. The atracurium group (25 patients) was similar to the d-tubocurarine group (21 patients) as far as age, parity and time intervals between precurarization, induction, skin incision, muscle relaxant administration, hysterotomy and birth. The transplacental transfer of atracurium was lower than that of d-tubocurarine, with a feto-maternal ratio of 9 +/- 3% for atracurium and 12 +/- 5% for d-tubocurarine (P less than 0.05). The transplacental transfer of laudanosine was low at 14 +/- 5%, with blood levels of 0.101 +/- 0.032 microM.L-1 in the umbilical vein. Newborns in the two groups were comparable in terms of Apgar scores at one, five and ten minutes, as well as for NACS scores (neurological and adaptive capacity scoring test) at two and 24 hours after birth. However, at 15 min after birth, only 55% of newborns in whom the mothers received atracurium had a normal NACS score (greater than or equal to 35/40) compared with 83% of newborns in whom the mothers received d-tubocurarine (P less than 0.05). Further analysis of the five variables related to active muscle tone revealed that the modal score for active extension of the neck of newborns from the atracurium group was lower than for newborns from the d-tubocurarine group (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)     

Outcome of treatment in adults with acute lymphoblastic leukemia: analysis of the LALA-94 trial.

PURPOSE: We analyzed the benefits of a risk-adapted postremission strategy in adult lymphoblastic leukemia (ALL), and re-evaluated stem-cell transplantation (SCT) for high-risk ALL. PATIENTS AND METHODS: A total of 922 adult patients entered onto the trial according to risk groups: standard-risk ALL (group 1), high-risk ALL (group 2), Philadelphia chromosome-positive ALL (group 3), and CNS-positive ALL (group 4). All received a standard four-drug/4-week induction course. Patients from group 1 who achieved a complete remission (CR) after one course of induction therapy were randomly assigned between intensive and less intensive postremission chemotherapy, whereas those who achieved CR after salvage therapy were then included in group 2. Patients in groups 2, 3, and 4 with an HLA-identical sibling were assigned to allogeneic SCT. In groups 3 and 4, autologous SCT was offered to all other patients, whereas in group 2 they were randomly assigned between chemotherapy and autologous SCT. RESULTS: Overall, 771 patients achieved CR (84%). Median disease-free survival (DFS) was 17.5 months, with 3-year DFS at 37%. In group 1, the 3-year DFS rate was 41%, with no difference between arms of postremission randomization. In groups 2 and 4, the 3-year DFS rates were 38% and 44%, respectively. In group 2, autologous SCT and chemotherapy resulted in comparable median DFS. Patients with an HLA-matched sibling (groups 2 and 4) had improved DFS. Three-year DFS was 24% in group 3. CONCLUSION: Allogeneic SCT improved DFS in high-risk ALL in the first CR. Autologous SCT did not confer a significant benefit over chemotherapy for high-risk ALL.