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Baggio S, Nsingi N, Iglesias K, Sapin M. Validation of a 9-item Perceived Suicide Awareness Scale (PSAS-9) for adolescents. J Affect Disord 2024; 352:306-311. [PMID: 38387669 DOI: 10.1016/j.jad.2024.02.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 02/02/2024] [Accepted: 02/16/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Robust empirical data on suicide awareness are needed, to better plan and evaluate suicide prevention interventions. However, there is a lack of validated measures of suicide awareness. This is especially true for perceived suicide awareness, which focuses on perceived knowledge about suicide, willingness, and confidence to talk about suicide and get help. Using the theoretical framework of Social Cognitive Theory, this study aimed to validate a measure of perceived suicide awareness. METHODS We re-used data from a suicide prevention trial conducted in Swiss secondary schools (n = 366). Baseline and one-month follow-up data were used to validate the scale. The main measure was an initial 14-item Perceived Suicide Awareness Scale (PSAS). Perceived knowledge of help-seeking resources, suicide-related knowledge, and support networks were used to assess convergent validity. RESULTS A nine-item version, the PSAS-9, showed satisfactory psychometric properties, including high internal consistency (α = 0.78), acceptable test-retest (r = 0.68), and a one-factor structure explaining 95 % of the variance. The convergent validity was acceptable (0.19 ≤ r ≤ 0.40). The PSAS-9 was not correlated with suicide-related knowledge (r = 0.02). LIMITATIONS The study missed a similar construct to properly assess convergent validity and had a modest sample size. In addition, it only included secondary school adolescents, so further research in other samples of youths is needed to robustly validate the PSAS-9. CONCLUSIONS This study was an important step towards validating a perceived suicide awareness scale, which appears as a new dimension of suicidality, distinct from suicide-related knowledge. The PSAS-9 could be used to develop, evaluate, and improve suicide prevention efforts.
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Affiliation(s)
- Stéphanie Baggio
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland; Laboratory of Population Health (#PopHealthLab), University of Fribourg, Fribourg, Switzerland.
| | - Neslie Nsingi
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Katia Iglesias
- School of Health Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Switzerland.
| | - Marlène Sapin
- Swiss Center of Expertise in Social Sciences (FORS), University of Lausanne, Lausanne, Switzerland.
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2
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Baggio S, Billieux J, Dirkzwager A, Iglesias K, Moschetti K, Perroud N, Schneider M, Vernaz N, Wolff H, Heller P. Protocol of a monocentric, double-blind, randomized, superiority, controlled trial evaluating the effect of in-prison OROS-methylphenidate vs. placebo treatment in detained people with attention-deficit hyperactivity disorder (BATIR). Trials 2024; 25:23. [PMID: 38178233 PMCID: PMC10765778 DOI: 10.1186/s13063-023-07827-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/23/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Attention-deficit hyperactivity disorder (ADHD) is characterized by difficulty paying attention, poor impulse control, and hyperactive behavior. It is associated with several adverse health and social outcomes and leads to an increased risk of criminality and recidivism. Worldwide, ADHD is thus highly prevalent in prisons. However, ADHD treatment has been neglected in such environments. Stimulant medications such as osmotic-release oral system methylphenidate (OROS-MPH) are first-line treatments in the general population, but they are under-prescribed in prisons due to concerns about abuse, even though such claims are not empirically supported. This project aims to compare the efficacy of a 3-month in-prison OROS-MPH vs. placebo treatment on the severity of core ADHD symptoms and relevant in- and post-prison outcomes. METHODS This study is a phase III, double-blinded, randomized, superiority, controlled trial of OROS-MPH vs. placebo. After randomization, the participants will receive 3 months of treatment with OROS-MPH or placebo (1:1 ratio) while incarcerated. Upon release, all participants will be offered the treatment (OROS-MPH) for 1 year but will remain blinded to their initial study group. The study will be conducted at the Division of Prison Health, Geneva, Switzerland, among incarcerated men (n = 150). Measures will include (1) investigator-rated ADHD symptoms, (2) acute events collected by the medical and prison teams, (3) assessment of the risk of recidivism, (4) medication side effects, (5) medication adherence, (6) study retention, (7) health care/prison costs, and (8) 1-year recidivism. Analyses will include bivariable and multivariable modeling (e.g., regression models, mixed-effects models, survival analyses) and an economic evaluation (cost-benefit analysis). DISCUSSION We expect that early identification and treatment of ADHD in prison will be an important public health opportunity and a cost-effective approach that is likely to reduce the vulnerability of incarcerated individuals and promote pathways out of criminal involvement. The study will also promote standards of care for people with ADHD in prison and provide recommendations for continuity of care after release. TRIAL REGISTRATION ClinicalTrials.gov NCT05842330 . Registered on June 5, 2023. Kofam.ch SNCTP000005388. Registered on July 17, 2023.
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Affiliation(s)
- Stéphanie Baggio
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
- Laboratory of Population Health (#PopHealthLab), University of Fribourg, Fribourg, Switzerland.
- Division of Prison Health, Geneva University Hospitals, Geneva, Switzerland.
| | - Joël Billieux
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
- Center for Excessive Gambling, Addiction Medicine, Lausanne University Hospitals (CHUV), Lausanne, Switzerland
| | - Anja Dirkzwager
- Netherlands Institute for the Study of Crime and Law Enforcement, Amsterdam, The Netherlands
| | - Katia Iglesias
- School of Health Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Fribourg, Switzerland
| | - Karine Moschetti
- Health Technology Assessment Unit, University Hospital of Lausanne, Lausanne, Switzerland
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Nader Perroud
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Psychiatric Specialties, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Marie Schneider
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland
- Medication adherence and Interprofessionality lab, School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
| | - Nathalie Vernaz
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Hans Wolff
- Division of Prison Health, Geneva University Hospitals, Geneva, Switzerland
| | - Patrick Heller
- Division of Prison Health, Geneva University Hospitals, Geneva, Switzerland
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
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Sandoz M, Iglesias K, Achim AM, Fossard M. The contribution of discursive and cognitive factors in referential choices made by elderly people during a narrative task. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2024; 31:301-322. [PMID: 36602178 DOI: 10.1080/13825585.2022.2150141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 11/16/2022] [Indexed: 01/06/2023]
Abstract
The present study focuses on referential choices made by healthy aged adults during narrative discourse, and their relationship with cognitive and socio-cognitive abilities. Previously, some studies have shown that, compared to young adults, older adults produce more pronouns when referring to various entities during discourse, regardless of the accessibility level of the referent for the addressee. This referential behavior has been interpreted in relation to the decrease of cognitive abilities, such as working memory abilities. There is, as of yet, little empirical evidence highlighting which cognitive competences preferentially support referential choices during discourse production. Here, we focus on three categories of referential markers (indefinite, definite markers and pronouns) produced by 78 participants from 60 to 91 years old. We used a storytelling task enabling us to examine the referential choices made at three discourse stages (introduction, maintaining or shift of the referent in focus) and in increasing levels of referential complexity (one vs two characters, and different vs same gender). In addition to specifically assessing how increasing age influences referential choices, we also examine the contribution of various cognitive and socio-cognitive skills that are presumed to play a specific role in referential choices. We found that both age and specific cognitive abilities (planification, inhibition, and verbal episodic memory) had an effect on referential choices, but that these effects depended on when (at which discourse stage) the referential markers were produced. Overall, our study highlights the complex interplay between discursive and cognitive factors in referential choices made by healthy older speakers.
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Affiliation(s)
- Mélanie Sandoz
- Faculté des Lettres et Sciences Humaines, Institut des Sciences Logopédiques, University of Neuchâtel, Neuchâtel,Switzerland
| | - Katia Iglesias
- School of Health Sciences (HEdS-FR), HES-SO University of Applied Sciences and Arts Western Switzerland, Fribourg, Switzerland
| | - Amélie M Achim
- Département de Psychiatrie et Neurosciences, Centre de Recherche CERVO and Centre de Recherche VITAM, Université Laval,Québec, QC, Canada
| | - Marion Fossard
- Faculté des Lettres et Sciences Humaines, Institut des Sciences Logopédiques, University of Neuchâtel, Neuchâtel,Switzerland
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Rousson V, Trächsel B, Iglesias K, Baggio S. Evaluating the cost of simplicity in score building: An example from alcohol research. PLoS One 2023; 18:e0294671. [PMID: 38011173 PMCID: PMC10681198 DOI: 10.1371/journal.pone.0294671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 10/20/2023] [Indexed: 11/29/2023] Open
Abstract
Building a score from a questionnaire to predict a binary gold standard is a common research question in psychology and health sciences. When building this score, researchers may have to choose between statistical performance and simplicity. A practical question is to what extent it is worth sacrificing the former to improve the latter. We investigated this research question using real data, in which the aim was to predict an alcohol use disorder (AUD) diagnosis from 20 self-reported binary questions in young Swiss men (n = 233, mean age = 26). We compared the statistical performance using the area under the ROC curve (AUC) of (a) a "refined score" obtained by logistic regression and several simplified versions of it ("simple scores"): with (b) 3, (c) 2, and (d) 1 digit(s), and (e) a "sum score" that did not allow negative coefficients. We used four estimation methods: (a) maximum likelihood, (b) backward selection, (c) LASSO, and (d) ridge penalty. We also used bootstrap procedures to correct for optimism. Simple scores, especially sum scores, performed almost identically or even slightly better than the refined score (respective ranges of corrected AUCs for refined and sum scores: 0.828-0.848, 0.835-0.850), with the best performance been achieved by LASSO. Our example data demonstrated that simplifying a score to predict a binary outcome does not necessarily imply a major loss in statistical performance, while it may improve its implementation, interpretation, and acceptability. Our study thus provides further empirical evidence of the potential benefits of using sum scores in psychology and health sciences.
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Affiliation(s)
- Valentin Rousson
- Division of Biostatistics, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Bastien Trächsel
- Division of Biostatistics, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Katia Iglesias
- School of Health Sciences Fribourg (HEdS-FR), HES-SO University of Applied Sciences and Arts of Western Switzerland, Fribourg, Switzerland
| | - Stéphanie Baggio
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Laboratory of Population Health (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
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Schmutz T, Le Terrier C, Ribordy V, Iglesias K, Guechi Y. The Effect of Positive Therapeutic Communication on Pain (POPAIN) and Anxiety During Arterial Blood Gas Standardized Procedures in the Emergency Department Compared to Traditional Communication: Protocol for a Monocentric Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e42043. [PMID: 37310776 DOI: 10.2196/42043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND In the emergency department (ED), medical procedures, such as arterial blood gas (ABG) testing, can cause pain and high stress levels. However, ABG testing is a routine procedure assessing the severity of the patient's condition. To reduce the pain of ABG, several methods have been investigated without significant difference in pain perception. Communication, a key element of care, has shown a significant effect on pain perception. A positive communication strategy, including positive, kind, or reassuring words, can reduce pain perception, while negative words can raise this perception, causing discomfort, known as the "nocebo effect." Although some studies have compared the impact of verbal attitudes, particularly in anesthesia and mainly with staff already trained in hypnosis, to the best of our knowledge, none have investigated the effect of communication in the emergency setting, where patients may be more suggestible to the words used. OBJECTIVE In this study, we will investigate the effect of positive therapeutic communication on pain, anxiety, discomfort, and global satisfaction in patients requiring ABG compared to nocebo and neutral communication. METHODS A single-center, double-blind randomized controlled trial (RCT) with 3 parallel arms will be conducted with 249 patients requiring ABG during their ED visit. Patients will be randomly assigned to 1 of 3 groups before receiving ABG: positive communication group, negative communication (nocebo) group, or neutral communication (neutral) group. The communication and the words used by the physicians during hygiene preparation, artery location, and puncture will be imposed in each group. The study will be proposed to each patient corresponding to the inclusion criteria. The physicians will not be trained in hypnosis or in positive therapeutic communication. The procedure will be recorded with audio recorders to test its quality. Intention-to-treat analysis will be performed. The primary endpoint is the onset of pain. The secondary outcomes are patient comfort, patient anxiety, and global satisfaction of the patient with the communication strategy used. RESULTS On average, 2000 ABG procedures are performed each year in the EDs of hospitals. In this study, 249 patients are expected to be included. With a projected positive response rate of 80%, we intend to include 25 (10%) patients per month. The inclusion period began in April 2023 and will run until July 2024. We hope to publish the results of the study during the fall of 2024. CONCLUSIONS To the best of our knowledge, this study is the first RCT assessing the use of positive communication on pain and anxiety in patients undergoing the ABG procedure in the ED. A reduction in pain, discomfort, and anxiety is expected when using positive communication. If the results are positive, this could be useful to the medical community and encourage clinicians to monitor their communication during care. TRIAL REGISTRATION ClinicalTrials.gov NCT05434169; https://clinicaltrials.gov/ct2/show/NCT05434169. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/42043.
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Affiliation(s)
- Thomas Schmutz
- Department of Emergency Medicine, Fribourg Hospital, Fribourg Faculty of Medicine, Fribourg University, Fribourg, Switzerland
| | - Christophe Le Terrier
- Department of Emergency Medicine, Fribourg Hospital, Fribourg Faculty of Medicine, Fribourg University, Fribourg, Switzerland
- Division of Intensive Care, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Vincent Ribordy
- Department of Emergency Medicine, Fribourg Hospital, Fribourg Faculty of Medicine, Fribourg University, Fribourg, Switzerland
| | - Katia Iglesias
- School of Health Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Fribourg, Switzerland
| | - Youcef Guechi
- Department of Emergency Medicine, Fribourg Hospital, Fribourg Faculty of Medicine, Fribourg University, Fribourg, Switzerland
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6
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Boecker M, Iglesias K, Peytremann-Bridevaux I. Psychometric evaluation of the Patient Assessment of Chronic Illness Care instrument using Item analysis according to the Rasch model. J Eval Clin Pract 2022; 28:670-679. [PMID: 35195939 DOI: 10.1111/jep.13662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 01/05/2022] [Accepted: 01/10/2022] [Indexed: 11/27/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES The Patient Assessment of Chronic Illness Care (PACIC) instrument assesses patient care in alignment with the chronic care model. The aim of the study was to comprehensively validate the PACIC using the Rasch model. A special focus was placed on the investigation of local dependence (LD), differential item functioning (DIF) and targeting. METHOD This secondary analysis utilized data of 760 patients with a diagnosis of diabetes who had participated in the Swiss CoDiab-VD cohort study. The psychometric properties of the French PACIC-version were evaluated using the Rasch model. DIF was investigated in relation to age, gender, education, year of recruitment into the CoDiab-VD cohort study, type of diabetes and whether patients got an injectable antidiabetic drug or not. RESULTS The initial analysis of the PACIC revealed poor fit to the Rasch model (χ2 -p < 0.001) with response dependency being the most prominent problem. After combining the items into two testlets (testlet 1: Items 1-11; testlet 2: Items 12-20), good overall model fit was found (χ2 -p = 0.77) as well as good reliability (Person Separation Index = 0.85) and targeting. DIF with regard to whether patients got an injectable antidiabetic drug or not was found for testlet 2. However, the size of this DIF was regarded as not being substantial. CONCLUSION The PACIC is a well-targeted, reliable unidimensional instrument to assess patient care in alignment with the chronic care model in patients with diabetes. It is free of substantial DIF. The PACIC-20 sum score can hence be used in clinical practice for individual diagnostic. For evaluation purposes like assessment of change or group evaluations, the usage of the interval-scale level person parameters is recommended as it permits using parametric statistical analyses and provides a more accurate picture about the actual amount of change.
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Affiliation(s)
- Maren Boecker
- Institute of Medical Psychology and Medical Sociology, University Hospital of RWTH Aachen University, Aachen, Germany
| | - Katia Iglesias
- School of Health Sciences (HEdS-FR), HES-SO University of Applied Sciences and Arts of Western Switzerland, Fribourg, Switzerland
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7
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Baggio S, Iglesias K, Duarte M, Nicastro R, Hasler R, Euler S, Debbané M, Starcevic V, Perroud N. Validation of self-report measures of narcissism against a diagnostic interview. PLoS One 2022; 17:e0266540. [PMID: 35385531 PMCID: PMC8986001 DOI: 10.1371/journal.pone.0266540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/22/2022] [Indexed: 11/18/2022] Open
Abstract
The Pathological Narcissism Inventory (PNI) and the Narcissistic Personality Inventory (NPI) are often used to screen for pathological narcissism but have rarely been validated against a clinician-administered diagnostic interview. Our study evaluated the convergent validity of the PNI and NPI against a diagnostic interview for narcissistic personality disorder (NPD) in a clinical population. We used data from a psychiatric outpatient center located in Switzerland (n = 123). Correlations between PNI/NPI and NPD ranged between .299 and .498 (common variance 9.0–24.8%). The PNI and NPI should be used carefully to screen for NPD. We highlight a need to increase the compatibility between the conceptual underpinnings of the PNI, NPI and NPD.
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Affiliation(s)
- Stéphanie Baggio
- Division of Prison Health, Geneva University Hospitals, Geneva, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- * E-mail:
| | - Katia Iglesias
- School of Health Sciences (HEdS-FR), HES-SO University of Applied Sciences and Arts of Western Switzerland, Fribourg, Switzerland
| | - Miguel Duarte
- Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Rosetta Nicastro
- Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Roland Hasler
- Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
- Department of Psychiatry, University of Geneva, Geneva, Switzerland
- NCCR Synapsy, Campus Biotech, Geneva, Switzerland
| | - Sebastian Euler
- Department of Consultation Psychiatry and Psychosomatics, University Hospital Zurich, Zurich, Switzerland
| | - Martin Debbané
- Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
- Developmental Imaging and Psychopathology Lab, Department of Psychiatry, University of Geneva, Geneva, Switzerland
- Research Department of Clinical, Educational, and Health Psychology, University College London, London, United Kingdom
| | - Vladan Starcevic
- University of Sydney, Faculty of Medicine and Health, Sydney Medical School, Nepean Clinical School, Sydney, NSW, Australia
| | - Nader Perroud
- Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
- Department of Psychiatry, University of Geneva, Geneva, Switzerland
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
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Heesen R, Zuberbühler K, Bangerter A, Iglesias K, Rossano F, Pajot A, Guéry JP, Genty E. Evidence of joint commitment in great apes' natural joint actions. R Soc Open Sci 2021; 8:211121. [PMID: 34909217 PMCID: PMC8652280 DOI: 10.1098/rsos.211121] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/08/2021] [Indexed: 05/20/2023]
Abstract
Human joint action seems special, as it is grounded in joint commitment-a sense of mutual obligation participants feel towards each other. Comparative research with humans and non-human great apes has typically investigated joint commitment by experimentally interrupting joint actions to study subjects' resumption strategies. However, such experimental interruptions are human-induced, and thus the question remains of how great apes naturally handle interruptions. Here, we focus on naturally occurring interruptions of joint actions, grooming and play, in bonobos and chimpanzees. Similar to humans, both species frequently resumed interrupted joint actions (and the previous behaviours, like grooming the same body part region or playing the same play type) with their previous partners and at the previous location. Yet, the probability of resumption attempts was unaffected by social bonds or rank. Our data suggest that great apes experience something akin to joint commitment, for which we discuss possible evolutionary origins.
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Affiliation(s)
- Raphaela Heesen
- Institute of Work and Organizational Psychology, University of Neuchâtel, Switzerland
- Department of Psychology, Durham University, UK
| | - Klaus Zuberbühler
- Institute of Biology, University of Neuchâtel, Switzerland
- School of Psychology and Neuroscience, University of St Andrews, Scotland
| | - Adrian Bangerter
- Institute of Work and Organizational Psychology, University of Neuchâtel, Switzerland
| | - Katia Iglesias
- School of Health Sciences (HEdS-FR), HES-SO University of Applied Sciences and Arts of WesternSwitzerland
| | - Federico Rossano
- Department of Cognitive Science, University of California, San Diego, CA, USA
| | - Aude Pajot
- Institute of Work and Organizational Psychology, University of Neuchâtel, Switzerland
| | | | - Emilie Genty
- Institute of Work and Organizational Psychology, University of Neuchâtel, Switzerland
- Institute of Biology, University of Neuchâtel, Switzerland
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9
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Heesen R, Bangerter A, Zuberbühler K, Iglesias K, Neumann C, Pajot A, Perrenoud L, Guéry JP, Rossano F, Genty E. Assessing joint commitment as a process in great apes. iScience 2021; 24:102872. [PMID: 34471860 PMCID: PMC8390869 DOI: 10.1016/j.isci.2021.102872] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/12/2021] [Accepted: 07/14/2021] [Indexed: 11/23/2022] Open
Abstract
Many social animals interact jointly, but only humans experience a specific sense of obligation toward their co-participants, a joint commitment. However, joint commitment is not only a mental state but also a process that reveals itself in the coordination efforts deployed during entry and exit phases of joint action. Here, we investigated the presence and duration of such phases in N = 1,242 natural play and grooming interactions of captive chimpanzees and bonobos. The apes frequently exchanged mutual gaze and communicative signals prior to and after engaging in joint activities with conspecifics, demonstrating entry and exit phases comparable to those of human joint activities. Although rank effects were less clear, phases in bonobos were more moderated by friendship compared to phases in chimpanzees, suggesting bonobos were more likely to reflect patterns analogous to human “face management”. This suggests that joint commitment as process was already present in our last common ancestor with Pan. Great apes exchange signals and gaze before entering and exiting joint actions Joint action structure of both ape species resembles that of humans Coordinated joint action phases indicate an underlying joint commitment Social bonds affect joint action structure more in bonobos than in chimpanzees
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Affiliation(s)
- Raphaela Heesen
- Institute of Work and Organizational Psychology, University of Neuchâtel, Switzerland.,Department of Psychology, Durham University, UK
| | - Adrian Bangerter
- Institute of Work and Organizational Psychology, University of Neuchâtel, Switzerland
| | - Klaus Zuberbühler
- School of Psychology and Neuroscience, University of St Andrews, Scotland, UK.,Institute of Biology, University of Neuchatel, Switzerland
| | - Katia Iglesias
- School of Health Sciences (HEdS-FR), HES-SO University of Applied Sciences and Arts of Western Switzerland, Fribourg, Switzerland
| | - Christof Neumann
- Institute of Work and Organizational Psychology, University of Neuchâtel, Switzerland.,German Primate Center (DPZ), Leibniz Institute for Primate Research, Göttingen, Germany
| | - Aude Pajot
- Institute of Work and Organizational Psychology, University of Neuchâtel, Switzerland
| | - Laura Perrenoud
- Institute of Work and Organizational Psychology, University of Neuchâtel, Switzerland
| | | | - Federico Rossano
- Department of Cognitive Science, University of California San Diego, USA
| | - Emilie Genty
- Institute of Work and Organizational Psychology, University of Neuchâtel, Switzerland
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Iglesias K, Lannoy S, Sporkert F, Daeppen JB, Gmel G, Baggio S. Performance of self-reported measures of alcohol use and of harmful drinking patterns against ethyl glucuronide hair testing among young Swiss men. PLoS One 2020; 15:e0244336. [PMID: 33362226 PMCID: PMC7757898 DOI: 10.1371/journal.pone.0244336] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 12/07/2020] [Indexed: 12/21/2022] Open
Abstract
Background There is a need for empirical studies assessing the psychometric properties of self-reported alcohol use as measures of excessive chronic drinking (ECD) compared to those of objective measures, such as ethyl glucuronide (EtG). Objectives To test the quality of self-reported measures of alcohol use and of risky single-occasion drinking (RSOD) to detect ECD assessed by EtG. Methods A total of 227 samples of hair from young Swiss men were used for the determination of EtG. Self-reported measures of alcohol use (previous twelve-month and previous-week alcohol use) and RSOD were assessed. Using EtG (<30 pg/mg) as the gold standard of ECD assessment, the sensitivity and specificity were computed, and the AUROC were compared for alcohol use measures and RSOD. Logistic regressions were used to test the contribution of RSOD to the understanding of ECD after controlling for alcohol use. Results A total of 23.3% of participants presented with ECD. Previous twelve-month alcohol use with a cut-off of >15 drinks per week (sensitivity = 75.5%, specificity = 78.7%) and weekly RSOD (sensitivity = 75.5%, specificity = 70.1%) yielded acceptable psychometric properties. No cut-off for previous-week alcohol use gave acceptable results. In the multivariate logistic regression, after controlling for the previous twelve months of alcohol use, RSOD was still significantly associated with EtG (p = .016). Conclusion Self-reported measures of the previous twelve months of alcohol use and RSOD were acceptable measures of ECD for population-based screening. Self-reported RSOD appeared to be an interesting screening measure, in addition to the previous twelve months of alcohol use, to understand ECD among young people.
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Affiliation(s)
- Katia Iglesias
- School of Health Sciences (HEdS-FR), HES-SO University of Applied Sciences and Arts of Western Switzerland, Fribourg, Fribourg, Switzerland
- * E-mail:
| | - Séverine Lannoy
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, United States of America
- Laboratory for Experimental Psychopathology, Psychological Sciences Research Institute, Université Catholique de Louvain, Louvain-la-Neuve, Brabant Wallon, Belgium
| | - Frank Sporkert
- Center of Legal Medicine, Forensic Toxicology and Chemistry Unit, Lausanne and Geneva Universities, Lausanne, Vaud, Switzerland
| | - Jean-Bernard Daeppen
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Gerhard Gmel
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital, Lausanne, Vaud, Switzerland
- Addiction Switzerland, Lausanne, Vaud, Switzerland
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of the West of England, Bristol, United Kingdom
| | - Stéphanie Baggio
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Thônex, Geneva, Switzerland
- Office of Corrections, Department of Justice and Home Affairs of the Canton of Zurich, Zurich, Switzerland
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Heesen R, Bangerter A, Zuberbühler K, Rossano F, Iglesias K, Guéry JP, Genty E. Bonobos engage in joint commitment. Sci Adv 2020; 6:6/51/eabd1306. [PMID: 33355132 DOI: 10.1126/sciadv.abd1306] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/06/2020] [Indexed: 06/12/2023]
Abstract
Joint action is central to human nature, enabling collectives to achieve goals otherwise unreachable by individuals. It is enabled by humans' capacity to understand and engage in joint commitments. Joint commitments are evidenced when partners in interrupted joint actions reengage one another. To date, there is no clear evidence whether nonhuman animals understand joint commitment, suggesting that only humans experience it. Here, we revisit this claim by interrupting bonobos engaged in social activities. Bonobos reliably resumed the activity, and the likelihood of resumption was higher for social compared to solitary activities. Furthermore, communicative efforts deployed to suspend and resume social activities varied depending on partners' social relationships and interactive roles. Our results suggest that bonobos, like humans, engage in joint commitment and have some awareness of the social consequences of breaking it.
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Affiliation(s)
- Raphaela Heesen
- Institute of Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland.
| | - Adrian Bangerter
- Institute of Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Klaus Zuberbühler
- School of Psychology and Neuroscience, University of St. Andrews, Scotland, UK
- Institute of Biology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Federico Rossano
- Cognitive Science Department, University of California, San Diego, San Diego, CA, USA
| | - Katia Iglesias
- School of Health Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Fribourg, Switzerland
| | | | - Emilie Genty
- Institute of Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
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12
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Iglesias K, Busnel C, Dufour F, Pautex S, Séchaud L. Nurse-led patient-centred intervention to increase written advance directives for outpatients in early-stage palliative care: study protocol for a randomised controlled trial with an embedded explanatory qualitative study. BMJ Open 2020; 10:e037144. [PMID: 32958487 PMCID: PMC7511622 DOI: 10.1136/bmjopen-2020-037144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Discussing the evolution of life-threatening diseases and end-of-life issues remains difficult for patients, relatives and professionals. Helping people discuss and formalise their preferences in end-of-life care, as planned in the Go Wish intervention, could reduce health-related anxiety in the advance care planning (ACP) and advance directive (AD) process. The aims of this study are (1) to test the effectiveness of the Go Wish intervention among outpatients in early-stage palliative care and (2) to understand the role of defence mechanisms in end-of-life discussions among nurses, patients and relatives. METHODS AND ANALYSIS A mixed-methods study will be performed. A cluster randomised controlled trials with three parallel arms will be conducted with 45 patients with chronic progressive diseases impacting life expectancy in each group: (1) Group A, Go Wish intervention for patients and their relatives; (2) Group A, Go Wish intervention for patients alone and (3) Group B, for patients (with a waiting list), who will receive the standardised information on ADs (usual care). Randomisation will be at the nurse level as each patient is referred to one of the 20 participating nurses (convenience sample of 20 nurses). A qualitative study will be conducted to understand the cognitive and emotional processes and experiences of nurses, patients and relatives confronted with end-of-life discussions. The outcome measurements include the completion of ADs (yes/no), anxiety, quality of communication about end-of-life care, empowerment, quality of life and attitudes towards ADs. ETHICS AND DISSEMINATION The study protocol has been approved by the Human Research Ethics Committee of the Canton of Geneva, Switzerland (no. 2019-00922). The findings will be disseminated to practice (nurses, patients and relatives), to national and international scientific conferences, and peer-reviewed journals covering nursing science, psychology and medicine. TRIAL REGISTRATION NUMBER NCT04065685.
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Affiliation(s)
- Katia Iglesias
- School of Health Sciences (HEdS-FR), HES-SO University of Applied Sciences and Arts Western Switzerland, Friourg, Switzerland
| | - Catherine Busnel
- Geneva Institution for Homecare and Assistance (imad), Geneva, Switzerland
| | - Florian Dufour
- School of Management and Engineering Vaud (HEIG-VD), HES-SO University of Applied Sciences and Arts Western Switzerland, Yverdon, Switzerland
| | - Sophie Pautex
- Division of Palliative Medicine, Department of rehabilitation and geriatrics, University Hospitals Geneva, Geneva, Switzerland
| | - Laurence Séchaud
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
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13
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Sandoz M, Iglesias K, Achim AM, Démonet JF, Fossard M. Referential adjustment during discourse production in Alzheimer's disease. J Clin Exp Neuropsychol 2020; 42:710-724. [PMID: 32777976 DOI: 10.1080/13803395.2020.1798883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Several studies have shown that people with Alzheimer's disease (AD) tend to use more pronouns than healthy aged adults when referring to entities during discourse. This referential behavior has been associated with the decrease of cognitive abilities, such as lexical retrieval difficulties or reduced abilities in working memory. However, the influence of certain important discourse factors on the referential choices made by people with AD has yet to be established. This study examines referential choices made at three discourse stages during narrative discourse (the introduction of a referent, the maintaining of the referent in focus, and the shift from one referent in focus to another). These referential choices are examined in increasingly complex referential contexts. In addition, this study investigates the relationships between referential choices and various cognitive abilities. To do so, the narrative discourses of 21 people with AD and 21 healthy adults were elicited using a newly developed storytelling in sequence task. The analyses focused on the production of three major referential expressions (indefinite expressions, definite expressions and pronouns) which are expected to vary according to discourse stage and the referential complexity of the stories. The results show that AD participants produce significantly fewer of the referential expressions expected at the introduction and shift stages than healthy aged adults produce. Nevertheless, the variation in the categories of referential expressions produced by the AD participants between the discourse stages is similar to that produced by the healthy aged adults, suggesting a preserved sensitivity to the factors manipulated in the task (i.e., discourse stages and referential complexity). This study also highlights the fact that different cognitive competences, especially executive abilities, are greatly involved in referential choices. The results add further evidence that referential choices rely on a variety of cognitive skills, depending on the discourse context in which they are made.
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Affiliation(s)
- Mélanie Sandoz
- Institut des Sciences Logopédiques, Université de Neuchâtel , Neuchâtel, Switzerland
| | - Katia Iglesias
- Haute Ecole de Santé, HES-SO Haute Ecole Spécialisée de Suisse Occidentale , Fribourg, Switzerland
| | - Amélie M Achim
- Département de Psychiatrie et Neurosciences, Université Laval, Québec, Canada, Centre de Recherche CERVO , Québec, Canada
| | - Jean-François Démonet
- Centre Leenaards de la Mémoire, Département des Neurosciences Cliniques, Centre Hospitalier Universitaire Vaudois , Lausanne, Switzerland
| | - Marion Fossard
- Institut des Sciences Logopédiques, Université de Neuchâtel , Neuchâtel, Switzerland
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Baggio S, Baudat S, Daeppen JB, Gmel G, Heller P, Perroud N, Rothen S, Sporkert F, Studer J, Wolff H, Iglesias K. Screening for alcohol use disorder among individuals with comorbid psychiatric disorders: Diagnostic accuracy in a sample of young Swiss men. Addict Behav 2020; 106:106354. [PMID: 32135396 DOI: 10.1016/j.addbeh.2020.106354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/27/2020] [Accepted: 02/11/2020] [Indexed: 12/27/2022]
Abstract
Alcohol use disorder (AUD) is frequently comorbid with other psychiatric disorders. However, few studies investigated the psychometric properties of AUD screening tools in presence of co-occurring disorders. This study examined the diagnostic accuracy of a short AUD screening tool among young adults, in the presence of high vs. low or moderate symptomatology of other common psychiatric disorders. Data were collected among young Swiss men (n = 233) between 2016 and 2018. Measures included a diagnostic interview for AUD and screening tools for AUD and other psychiatric disorders (attention deficit hyperactivity disorder, antisocial personality disorder, bipolar disorder, borderline personality disorder, major depressive disorder, and social anxiety disorder). We computed receiver operating characteristic curves to test whether the AUD screening tool was an accurate indicator of AUD for groups with high vs. low or moderate symptomatology of each psychiatric disorder. The results showed that the optimal cut-off score was ≥3 (the original cut-off of the scale) for participants with a low or moderate symptomatology and ≥4 for participants with a high symptomatology. Our findings highlighted the urgent need for an integrated approach to screening. Psychiatric comorbidities should be included in the screen for AUD to obtain accurate results.
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Iglesias K, De Geest S, Berben L, Dobbels F, Denhaerynk K, Russell LC, Helmy R, Peytremann-Bridevaux I. Validation of the patient assessment of chronic illness care (PACIC) short form scale in heart transplant recipients: the international cross-sectional bright study. BMC Health Serv Res 2020; 20:160. [PMID: 32126998 PMCID: PMC7055084 DOI: 10.1186/s12913-020-5003-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 02/14/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Transplant recipients are chronically ill patients, who require lifelong follow-up to manage co-morbidities and prevent graft loss. This necessitates a system of care that is congruent with the Chronic Care Model. The eleven-item self-report Patient Assessment of Chronic Illness Care (PACIC) scale assesses whether chronic care is congruent with the Chronic Care Model, yet its validity for heart transplant patients has not been tested. METHODS We tested the validity of the English version of the PACIC, and compared the similarity of the internal structure of the PACIC across English-speaking countries (USA, Canada, Australia and United Kingdom) and across six languages (French, German, Dutch, Spanish, Italian and Portuguese). This was done using data from the cross-sectional international BRIGHT study that included 1378 heart transplant patients from eleven countries across 4 continents. To test the validity of the instrument, confirmatory factor analyses to check the expected unidimensional internal structure, and relations to other variables, were performed. RESULTS Main analyses confirmed the validity of the English PACIC version for heart transplant patients. Exploratory analyses across English-speaking countries and languages also confirmed the single factorial dimension, except in Italian and Spanish. CONCLUSION This scale could help healthcare providers monitor level of chronic illness management and improve transplantation care. TRIAL REGISTRATION Clinicaltrials.gov ID: NCT01608477, first patient enrolled in March 2012, registered retrospectively: May 30, 2012.
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Affiliation(s)
- Katia Iglesias
- School of Health Sciences (HEdS-FR), University of Applied Sciences and Arts of Western Switzerland (HES-SO), Route des Arsenaux 16a, 1700 Fribourg, Switzerland
| | - Sabina De Geest
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, CH Switzerland
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35 blok d-box 7001, 3000 Leuven, Belgium
| | - Lut Berben
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, CH Switzerland
| | - Fabienne Dobbels
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, CH Switzerland
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35 blok d-box 7001, 3000 Leuven, Belgium
| | - Kris Denhaerynk
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, CH Switzerland
| | - L. Cynthia Russell
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, MO USA
| | - Remon Helmy
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, CH Switzerland
| | - Isabelle Peytremann-Bridevaux
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, CH Switzerland
- Department of epidemiology and health systems (DESS), Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 10, 1010 Lausanne, Switzerland
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Baggio S, Trächsel B, Rousson V, Rothen S, Studer J, Marmet S, Heller P, Sporkert F, Daeppen JB, Gmel G, Iglesias K. Identifying an accurate self-reported screening tool for alcohol use disorder: evidence from a Swiss, male population-based assessment. Addiction 2020; 115:426-436. [PMID: 31656049 DOI: 10.1111/add.14864] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/21/2019] [Accepted: 10/14/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIMS Short screenings for alcohol use disorder (AUD) are crucial for public health purposes, but current self-reported measures have several pitfalls and may be unreliable. The main aim of our study was to provide empirical evidence on the psychometric performance of self-reports currently used. Our research questions were: compared with a gold standard clinical interview, how accurate are (1) self-reported AUD, (2) self-reported alcohol use over time and (3) biomarkers of alcohol use among Swiss men? Finally, we aimed to identify an alternative screening tool. DESIGN A single-center study with a cross-sectional design and a stratified sample selection. SETTING Lausanne University Hospital (Switzerland) from October 2017 to June 2018. PARTICIPANTS We selected participants from the French-speaking participants of the ongoing Cohort Study on Substance Use and Risk Factors (n = 233). The sample included young men aged on average 27.0 years. MEASUREMENTS We used the Diagnostic Interview for Genetic Studies as the gold standard for DSM-5 AUD. The self-reported measures included 11 criteria for AUD, nine alcohol-related consequences, and previous 12 months' alcohol use. We also assessed biomarkers of chronic excessive drinking (ethyl glucuronide and phosphatidylethanol). FINDINGS None of the self-reported measures/biomarkers taken alone displayed both sensitivity and specificity close to 100% with respect to the gold standard (e.g. self-reported AUD: sensitivity = 92.3%, specificity = 45.8%). The best model combined eight self-reported criteria of AUD and four alcohol-related consequences. Using a cut-off of three, this screening tool yielded acceptable sensitivity (83.3%) and specificity (78.7%). CONCLUSIONS Neither self-reported alcohol use disorder nor heavy alcohol use appear to be adequate to screen for alcohol use disorder among young men from the Swiss population. The best screening alternative for alcohol use disorder among young Swiss men appears to be a combination of eight symptoms of alcohol use disorder and four alcohol-related consequences.
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Affiliation(s)
- Stéphanie Baggio
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Thônex, Switzerland.,Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland
| | - Bastien Trächsel
- Division of Biostatistics, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Valentin Rousson
- Division of Biostatistics, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Stéphane Rothen
- Addiction Division, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Joseph Studer
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Simon Marmet
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Patrick Heller
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Thônex, Switzerland.,Adult Psychiatry Division, Department of Mental Health and Psychiatry, Geneva University Hospitals, Thônex, Switzerland
| | - Frank Sporkert
- Centre of Legal Medicine, Forensic Toxicology and Chemistry Unit, Lausanne and Geneva Universities, Lausanne, Switzerland
| | - Jean-Bernard Daeppen
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Gerhard Gmel
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland.,Addiction Switzerland, Lausanne, Switzerland.,Centre for Addiction and Mental Health, Toronto,, ON, Canada.,University of the West of England, Bristol, UK
| | - Katia Iglesias
- School of Health Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Fribourg, Switzerland
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Baggio S, Iglesias K. Commentary on : Caution is needed when using self-reported alcohol use disorder screening tools. Addict Behav 2020; 100:106115. [PMID: 31494525 DOI: 10.1016/j.addbeh.2019.106115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/30/2019] [Accepted: 08/30/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Stéphanie Baggio
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Chemin du Petit Bel Air 2, 1226 Thônex, Switzerland; Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Falkenplatz 16, 3012 Bern, Switzerland.
| | - Katia Iglesias
- School of Health Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Route des Arsenaux 16a, 1700 Fribourg, Switzerland.
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Baggio S, Iglesias K. On the limitations of the Alcohol Use Disorders Identification Test (AUDIT). Drug Alcohol Depend 2020; 206:107662. [PMID: 31699491 DOI: 10.1016/j.drugalcdep.2019.107662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 10/04/2019] [Accepted: 10/20/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Stéphanie Baggio
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Chemin du Petit Bel Air 2, 1226, Thônex, Switzerland; Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Falkenplatz 16, 3012, Bern, Switzerland.
| | - Katia Iglesias
- School of Health Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Route des Arsenaux 16a, 1700, Fribourg, Switzerland.
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Arditi C, Iglesias K, Peytremann-Bridevaux I. The use of the Patient Assessment of Chronic Illness Care (PACIC) instrument in diabetes care: a systematic review and meta-analysis. Int J Qual Health Care 2019; 30:743-750. [PMID: 29733366 DOI: 10.1093/intqhc/mzy091] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 04/13/2018] [Indexed: 02/05/2023] Open
Abstract
Purpose The Patient Assessment of Chronic Illness Care (PACIC) was created to assess whether provided care is congruent with the Chronic Care Model, according to patients. We aimed to identify all studies using the PACIC in diabetic patients to explore (i) how overall PACIC scores varied across studies and (ii) whether scores varied according to healthcare delivery, patient and instrument characteristics. Data sources MEDLINE, Embase, PsycINFO, CINAHL and PubMed Central (PMC), from 2005 to 2016. Study selection Studies of any design using the PACIC in diabetic patients. Data extraction and synthesis We extracted data on healthcare delivery, patient, and instrument characteristics, and overall PACIC score and standard deviation. We performed random-effects meta-analyses and meta-regressions. Results We identified 34 studies including 25 942 patients from 13 countries, mostly in North America and Europe, using different versions of the PACIC in 11 languages. The overall PACIC score fluctuated between 1.7 and 4.2, with a pooled score of 3.0 (95% confidence interval 2.8-3.2, 95% predictive interval 1.9-4.2), with very high heterogeneity (I2 = 99%). The PACIC variance was not explained by healthcare delivery or patient characteristics, but by the number of points on the response scale (5 vs. 11) and the continent (Asia vs. others). Conclusion The PACIC is a widely used instrument, but the direct comparison of PACIC scores between studies should be performed with caution as studies may employ different versions and the influence of cultural norms and language on the PACIC score remains unknown.
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Affiliation(s)
- Chantal Arditi
- Health Care Evaluation Unit (UES), Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Biopôle 2, Lausanne, Switzerland
| | - Katia Iglesias
- Applied Research and Development Unit, School of Health Sciences Fribourg (HEdS‑FR), University of Applied Sciences and Arts Westrn Switzerland (HES-SO), Route des Cliniques 15, Fribourg, Switzerland.,Center for the Understanding of Social Processes University of Neuchâtel, Breguet 1, Neuchâtel, Switzerland
| | - Isabelle Peytremann-Bridevaux
- Health Care Evaluation Unit (UES), Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Biopôle 2, Lausanne, Switzerland
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Sporkert F, Iglesias K, Jacot S, Deglon J, Baggio S. Assessment of heavy alcohol drinking among young Swiss men. Toxicologie Analytique et Clinique 2019. [DOI: 10.1016/j.toxac.2019.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Moschetti K, Iglesias K, Baggio S, Velonaki V, Hugli O, Burnand B, Daeppen JB, Wasserfallen JB, Bodenmann P. Health care costs of case management for frequent users of the emergency department: Hospital and insurance perspectives. PLoS One 2018; 13:e0199691. [PMID: 30248102 PMCID: PMC6152853 DOI: 10.1371/journal.pone.0199691] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 06/08/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In most emergency departments (EDs), few patients account for a relatively high number of ED visits. To improve the management of these patients, the university hospital of Lausanne, Switzerland, implemented an interdisciplinary case management (CM) intervention. This study examined whether the CM intervention-compared with standard care (SC) in the ED-reduced costs generated by frequent ED users, not only from the hospital perspective, but also from the third-party payer perspective, that is, from a broader perspective that takes into account the costs of health care services used outside the hospital offering the intervention. METHODS In this randomized controlled trial, 250 frequent ED users (>5 visits during the previous 12 months) were allocated to either the CM or the SC group and followed up for 12 months. Cost data were obtained from the hospital's analytical accounting system for the entire sample and from health insurance companies for a subgroup (n = 140). Descriptive statistics and multivariate regressions were used to make comparisons between groups and assess the contribution of patient characteristics to the main cost components. RESULTS At the end of the 12-month follow-up, 115 patients were in the CM group and 115 in the SC group (20 had died). Despite differences in economic costs between patients in the CM intervention and the SC groups, our results do not show any statistically significant reduction in costs associated with the intervention, either for the hospital that housed the intervention or for the third-party payer. Frequent ED users were big users of health services provided by both the hospital and community-based services, with 40% of costs generated outside the hospital that housed the intervention. Higher age, Swiss citizenship, and having social difficulty increased costs significantly. CONCLUSIONS As the role of the CM team is to guide patients through the entire care process, the intervention location is not limited to the hospital but often extends into the community.
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Affiliation(s)
- Karine Moschetti
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
- Technology Assessment Unit, Lausanne University Hospital, Lausanne, Switzerland
- IEMS Plateforme interfacultaire en économie et management de la santé, University of Lausanne, Lausanne Switzerland
| | - Katia Iglesias
- School of Health Sciences (HEdS-FR), University of Applied Sciences Western Switzerland (HES-SO), Fribourg, Switzerland
| | - Stéphanie Baggio
- Life Course and Social Inequality Research Center, University of Lausanne, Lausanne, Switzerland
| | - Venetia Velonaki
- Department of Community Medicine and Public Health, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Hugli
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Bernard Burnand
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | | | | | - Patrick Bodenmann
- Vulnerable Population Center, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
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Iglesias K, Sporkert F, Daeppen JB, Gmel G, Baggio S. Comparison of self-reported measures of alcohol-related dependence among young Swiss men: a study protocol for a cross-sectional controlled sample. BMJ Open 2018; 8:e023632. [PMID: 30012797 PMCID: PMC6082486 DOI: 10.1136/bmjopen-2018-023632] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Short screenings of alcohol-related dependence are needed for population-based assessments. A clinical interview constitutes a reliable diagnosis often seen as gold standard, but it is costly and time consuming and as such, not suitable for population-based assessments. Therefore, self-reported questionnaires are needed (eg, alcohol use disorder (AUD) as in the Diagnostic and Statistic Manual of Mental Disorders (DSM) 5), but their reliability is questionable. Recent studies called for more evidence-based measurements for population-based screening (eg, heavy alcohol use over time (HAU)). This study aims to test the reliability of different self-reported measures of alcohol use. METHODS AND ANALYSIS Based on stratified random selection, 280 participants will be recruited from the French-speaking subgroup of the Swiss National Science Foundation-supported Cohort Study on Substance Use and Risk Factors (C-SURF). This cohort is a population-based sample of young Swiss men in their mid-20s (n=2668). The sample size calculation is based on a proportion non-inferiority test (alpha=5%, power=80%, margin of equivalence=10%, difference in sensitivity between self-reported AUD and HAU=5%, correlation between AUD and HAU=0.35, and drop-outs=15%). Assessment will include a clinical interview as the gold standard of alcohol-related dependence, self-reported alcohol measures (HAU, AUD and drinking patterns), biomarkers as gold standards of chronic excessive drinking, and health outcomes. To assess the validity of the self-reported alcohol measures, sensitivity analyses will be run. The associations between alcohol-related measures and health outcomes will be tested. A non-response analysis will be run using the previous waves of the C-SURF study using logistic regressions. ETHICS AND DISSEMINATION The study protocol has been approved by the Human Research Ethics Committee of the Canton of Vaud, Switzerland (no. 2017-00776). The results will be submitted for publication in peer-reviewed journals and presented at national and international conferences.
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Affiliation(s)
- Katia Iglesias
- School of Health Sciences (HEdS-FR), HES-SO University of Applied Sciences and Arts of Western Switzerland, Fribourg, Switzerland
- Center for the Understanding of Social Processes, University of Neuchâtel, Neuchâtel, Switzerland
| | - Frank Sporkert
- Forensic Toxicology and Chemistry Unit, Lausanne and Geneva Universities, Centre of Legal Medicine, Lausanne, Switzerland
| | | | - Gerhard Gmel
- Alcohol Treatment Centre, Lausanne University Hospital, Lausanne, Switzerland
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of the West of England, Bristol, UK
| | - Stephanie Baggio
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- Life Course and Social Inequality Research Center, University of Lausanne, Lausanne, Switzerland
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23
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Baggio S, Iglesias K, Rousson V. Modeling count data in the addiction field: Some simple recommendations. Int J Methods Psychiatr Res 2018; 27:e1585. [PMID: 29027305 PMCID: PMC6877188 DOI: 10.1002/mpr.1585] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 08/02/2017] [Accepted: 08/03/2017] [Indexed: 11/09/2022] Open
Abstract
Analyzing count data is frequent in addiction studies but may be cumbersome, time-consuming, and cause misleading inference if models are not correctly specified. We compared different statistical models in a simulation study to provide simple, yet valid, recommendations when analyzing count data.We used 2 simulation studies to test the performance of 7 statistical models (classical or quasi-Poisson regression, classical or zero-inflated negative binomial regression, classical or heteroskedasticity-consistent linear regression, and Mann-Whitney test) for predicting the differences between population means for 9 different population distributions (Poisson, negative binomial, zero- and one-inflated Poisson and negative binomial, uniform, left-skewed, and bimodal). We considered a large number of scenarios likely to occur in addiction research: presence of outliers, unbalanced design, and the presence of confounding factors. In unadjusted models, the Mann-Whitney test was the best model, followed closely by the heteroskedasticity-consistent linear regression and quasi-Poisson regression. Poisson regression was by far the worst model. In adjusted models, quasi-Poisson regression was the best model. If the goal is to compare 2 groups with respect to count data, a simple recommendation would be to use quasi-Poisson regression, which was the most generally valid model in our extensive simulations.
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Affiliation(s)
- Stéphanie Baggio
- Life Course and Inequality Research CentreUniversity of LausanneLausanneSwitzerland
| | - Katia Iglesias
- Centre for the Understanding of Social ProcessesUniversity of NeuchâtelNeuchâtelSwitzerland
| | - Valentin Rousson
- Institute for Social and Preventive MedicineUniversity Hospital LausanneLausanneSwitzerland
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24
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Tort LFL, Iglesias K, Bueno C, Lizasoain A, Salvo M, Cristina J, Kandratavicius N, Pérez L, Figueira R, Bícego MC, Taniguchi S, Venturini N, Brugnoli E, Colina R, Victoria M. Wastewater contamination in Antarctic melt-water streams evidenced by virological and organic molecular markers. Sci Total Environ 2017; 609:225-231. [PMID: 28743008 DOI: 10.1016/j.scitotenv.2017.07.127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/13/2017] [Accepted: 07/14/2017] [Indexed: 06/07/2023]
Abstract
Human activities in the Antarctica including tourism and scientific research have been raised substantially in the last century with the concomitant impact on the Antarctic ecosystems through the release of wastewater mainly from different scientific stations activities. The aim of this study was to assess the wastewater contamination of surface waters and sediments of three melt-water streams (11 sites) by leaking septic tanks located in the vicinity of the Uruguayan Scientific Station in the Fildes Peninsula, King George Island, Antarctica, during summer 2015. For this purpose, we combined the analysis of fecal steroids in sediments by using gas chromatography and six enteric viruses in surface waters by quantitative and qualitative PCR. Coprostanol concentrations (from 0.03 to 3.31μgg-1) and fecal steroids diagnostic ratios indicated that stations C7 and C8 located in the kitchen stream presented sewage contamination. Rotavirus was the only enteric virus detected in five sites with concentration ranging from 1.2×105gcL-1 to 5.1×105gcL-1 being three of them located downstream from the leaking AINA and Kitchen septic tanks. This study shows for the first time the presence of both virological and molecular biomarkers of wastewater pollution in surface waters and sediments of three melt-water streams in the vicinity of a scientific station in the Antarctica. These results highlight the importance of the complementation of these biomarkers in two different matrices (surface waters and sediments) to assess wastewater pollution in an Antarctic environment related to anthropogenic activities in the area.
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Affiliation(s)
- L F L Tort
- Laboratorio de Virología Molecular, Sede Salto del CENUR Litoral Norte, Universidad de la República, Rivera 1350, Salto 50000, Uruguay
| | - K Iglesias
- Laboratorio de Biogeoquímica Marina, IECA, Facultad de Ciencias, Universidad de la República, Iguá 4225, Montevideo 11400, Uruguay
| | - C Bueno
- Oceanografía y Ecología Marina, IECA, Facultad de Ciencias, Universidad de la República, Iguá 4225, Montevideo 11400, Uruguay
| | - A Lizasoain
- Laboratorio de Virología Molecular, Sede Salto del CENUR Litoral Norte, Universidad de la República, Rivera 1350, Salto 50000, Uruguay
| | - M Salvo
- Laboratorio de Virología Molecular, Sede Salto del CENUR Litoral Norte, Universidad de la República, Rivera 1350, Salto 50000, Uruguay
| | - J Cristina
- Laboratorio de Virología Molecular, Centro de Investigaciones Nucleares, Facultad de Ciencias, Universidad de la República, Mataojo 2055, Montevideo (11400) Uruguay
| | - N Kandratavicius
- Oceanografía y Ecología Marina, IECA, Facultad de Ciencias, Universidad de la República, Iguá 4225, Montevideo 11400, Uruguay
| | - L Pérez
- Centro Universitario de la Regional Este, Universidad de la República, Ruta 9 y Ruta 15, Rocha, Uruguay
| | - R Figueira
- Instituto Oceanográfico da Universidade de São Paulo, Praça do Oceanográfico 191, Cidade Universitária (05508-120), São Paulo, SP, Brazil
| | - M C Bícego
- Instituto Oceanográfico da Universidade de São Paulo, Praça do Oceanográfico 191, Cidade Universitária (05508-120), São Paulo, SP, Brazil
| | - S Taniguchi
- Instituto Oceanográfico da Universidade de São Paulo, Praça do Oceanográfico 191, Cidade Universitária (05508-120), São Paulo, SP, Brazil
| | - N Venturini
- Laboratorio de Biogeoquímica Marina, IECA, Facultad de Ciencias, Universidad de la República, Iguá 4225, Montevideo 11400, Uruguay
| | - E Brugnoli
- Oceanografía y Ecología Marina, IECA, Facultad de Ciencias, Universidad de la República, Iguá 4225, Montevideo 11400, Uruguay
| | - R Colina
- Laboratorio de Virología Molecular, Sede Salto del CENUR Litoral Norte, Universidad de la República, Rivera 1350, Salto 50000, Uruguay
| | - M Victoria
- Laboratorio de Virología Molecular, Sede Salto del CENUR Litoral Norte, Universidad de la República, Rivera 1350, Salto 50000, Uruguay.
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Iglesias K, Baggio S, Moschetti K, Wasserfallen JB, Hugli O, Daeppen JB, Burnand B, Bodenmann P. Using case management in a universal health coverage system to improve quality of life of frequent Emergency Department users: a randomized controlled trial. Qual Life Res 2017; 27:503-513. [PMID: 29188481 PMCID: PMC5846993 DOI: 10.1007/s11136-017-1739-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2017] [Indexed: 11/30/2022]
Abstract
Purpose Frequent Emergency Department users are likely to experience poor quality of life (QOL). Case management interventions are efficient in responding to the complex needs of this population, but their effects on QOL have not been tested yet. Therefore, the aim of our study was to examine to what extent a case management intervention improved frequent Emergency Department users’ QOL in a universal health coverage system. Methods Data were part of a randomized controlled trial designed to improve frequent Emergency Department users’ QOL at the Lausanne University Hospital, Switzerland. A total of 250 frequent Emergency Department users (≥ 5 attendances during the previous 12 months) were randomly assigned to the control (n = 125) or the intervention group (n = 125). The latter benefited from case management intervention. QOL was evaluated using the WHOQOL-BREF at baseline, two, five and a half, nine, and twelve months later. It included four dimensions: physical health, psychological health, social relationship, and environment. Linear mixed-effects models were used to analyze the change in the patients’ QOL over time. Results Patients’ QOL improved significantly (p < 0.001) in both groups for all dimensions after two months. However, environment QOL dimension improved significantly more in the intervention group after 12 months. Conclusions Environment QOL dimension was the most responsive dimension for short-term interventions. This may have been due to case management’s assistance in obtaining income entitlements, health insurance coverage, stable housing, or finding general health care practitioners. Case management in general should be developed to enhance frequent users’ QOL. Trial registration: http://www.clinicaltrials.gov, Unique identifier: NCT01934322
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Affiliation(s)
- Katia Iglesias
- School of Health Sciences (HEdS-FR), University of Applied Sciences Western Switzerland (HES-SO), Route des Cliniques 15, 1700, Fribourg, Switzerland. .,Center for the Understanding of Social Processes, University of Neuchâtel, Neuchâtel, Switzerland.
| | - Stéphanie Baggio
- Life Course and Social Inequality Research Center, University of Lausanne, Lausanne, Switzerland
| | - Karine Moschetti
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland.,Health Technology Assessment Unit, Lausanne University Hospital, Lausanne, Switzerland.,IEMS Plateforme interfacultaire en économie et management de la santé, University of Lausanne, Lausanne, Switzerland
| | | | - Olivier Hugli
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Bernard Burnand
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Patrick Bodenmann
- Vulnerable Population Unit, Department of Ambulatory Care and Community Medicine, Lausanne University Hospital, Lausanne, Switzerland
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26
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Grandjean A, Iglesias K, Dubuis C, Déglise S, Corpataux JM, Saucy F. Surgical and endovascular hybrid approach in peripheral arterial disease of the lower limbs. VASA 2017; 45:417-22. [PMID: 27594393 DOI: 10.1024/0301-1526/a000561] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Multilevel peripheral arterial disease is frequently observed in patients with intermittent claudication or critical limb ischemia. This report evaluates the efficacy of one-stage hybrid revascularization in patients with multilevel arterial peripheral disease. PATIENTS AND METHODS A retrospective analysis of a prospective database included all consecutive patients treated by a hybrid approach for a multilevel arterial peripheral disease. The primary outcome was the patency rate at 6 months and 1 year. Secondary outcomes were early and midterm complication rate, limb salvage and mortality rate. Statistical analysis, including a Kaplan-Meier estimate and univariate and multivariate Cox regression analyses were carried out with the primary, primary assisted and secondary patency, comparing the impact of various risk factors in pre- and post-operative treatments. RESULTS 64 patients were included in the study, with a mean follow-up time of 428 days (range: 4 - 1140). The technical success rate was 100 %. The primary, primary assisted and secondary patency rates at 1 year were 39 %, 66 % and 81 %, respectively. The limb-salvage rate was 94 %. The early mortality rate was 3.1 %. Early and midterm complication rates were 15.4 % and 6.4 %, respectively. The early mortality rate was 3.1 %. CONCLUSIONS The hybrid approach is a major alternative in the treatment of peripheral arterial disease in multilevel disease and comorbid patients, with low complication and mortality rates and a high limb-salvage rate.
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Affiliation(s)
- Anouk Grandjean
- 1 Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Katia Iglesias
- 1 Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Céline Dubuis
- 1 Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | | | - François Saucy
- 1 Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Bodenmann P, Velonaki VS, Griffin JL, Baggio S, Iglesias K, Moschetti K, Ruggeri O, Burnand B, Wasserfallen JB, Vu F, Schupbach J, Hugli O, Daeppen JB. Case Management may Reduce Emergency Department Frequent use in a Universal Health Coverage System: a Randomized Controlled Trial. J Gen Intern Med 2017; 32:508-515. [PMID: 27400922 PMCID: PMC5400747 DOI: 10.1007/s11606-016-3789-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 05/04/2016] [Accepted: 06/21/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Frequent emergency department (ED) users account for a disproportionately high number of ED visits. Studies on case management (CM) interventions to reduce frequent ED use have shown mixed results, and few studies have been conducted within a universal health coverage system. OBJECTIVE To determine whether a CM intervention-compared to standard emergency care-reduces ED attendance. DESIGN Randomized controlled trial. PARTICIPANTS Two hundred fifty frequent ED users (5 or more visits in the prior 12 months) who visited a public urban ED at the Lausanne University Hospital between May 2012 and July 2013 were allocated to either an intervention (n = 125) or control (n = 125) group, and monitored for 12 months. INTERVENTIONS An individualized CM intervention consisting of concrete assistance in obtaining income entitlements, referral to primary or specialty medical care, access to mental health care or substance abuse treatment, and counseling on at-risk behaviors and health care utilization (in addition to standard care) at baseline and 1, 3, and 5 months. MAIN MEASURES We used a generalized linear model for count data (negative binomial distribution) to compare the number of ED visits during the 12-month follow-up between CM and usual care, from an intention-to-treat perspective. KEY RESULTS At 12 months, there were 2.71 (±0.23) ED visits in the intervention group versus 3.35 (±0.32) visits among controls (ratio = 0.81, 95 % CI = 0.63; 1.02). In the multivariate model, the effect of the CM intervention on the number of ED visits approached statistical significance (b = -0.219, p = 0.075). The presence of poor social determinants of health was a significant predictor of ED use in the multivariate model (b = 0.280, p = 0.048). CONCLUSIONS CM may reduce ED use by frequent users through an improved orientation to the health care system. Poor social determinants of health significantly increase use of the ED by frequent users.
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Affiliation(s)
- Patrick Bodenmann
- Vulnerable Populations Center, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.
| | - Venetia-Sofia Velonaki
- Institute of Higher Education and Research in Healthcare, Department of Community Medicine and Public Health, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Judith L Griffin
- Vulnerable Populations Center, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Stéphanie Baggio
- Life Course and Social Inequality Research Center, Faculty of Social and Political Sciences, University of Lausanne, Lausanne, Switzerland
| | - Katia Iglesias
- Center for the Understanding of Social Processes, University of Neuchâtel, Neuchâtel, Switzerland.,Institute of social and preventive medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Karine Moschetti
- Institute of social and preventive medicine, Lausanne University Hospital, Lausanne, Switzerland.,Technology Assessment Unit, Lausanne University Hospital, Lausanne, Switzerland.,IEMS - Plateforme interfacultaire en économie et management de la santé, University of Lausanne, Lausanne, Switzerland
| | - Ornella Ruggeri
- Department of Community Medicine and Public Health, Lausanne University Hospital, Lausanne, Switzerland
| | - Bernard Burnand
- Institute of social and preventive medicine, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Francis Vu
- Vulnerable Populations Center, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Joelle Schupbach
- Vulnerable Populations Center, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Olivier Hugli
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland
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Aubry-Rozier B, Fabreguet I, Iglesias K, Lamy O, Hans D. Impact of level of expertise versus the statistical tool on vertebral fracture assessment (VFA) readings in cohort studies. Osteoporos Int 2017; 28:523-527. [PMID: 27589975 DOI: 10.1007/s00198-016-3757-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 08/23/2016] [Indexed: 11/30/2022]
Abstract
UNLABELLED The present study tested if the accuracy of the VFA reading reproducibility is more affected by the statistical tool used or by the reader's level of expertise in 50 VFA from a population-based cohort, the OstéoLaus study. We found that uniform kappa and instruction reading with the ISCD/IOF VFA reading course both increased the accuracy of the reproducibility. INTRODUCTION Vertebral fractures (VF) due to osteoporosis are under diagnosed. Screening osteoporosis in the general population allows improving management of fragility fracture. It consists to perform a dual X-ray absorptiometry and a spine X-ray to look at a VF. To reduce the dosage of radiation, prevalent or incident VF could be detected by DXA image. The aim of the present study was to test the reproducibility of vertebral fracture assessment (VFA) readings in a population-based cohort and to explore if the accuracy of the reproducibility is more affected by the statistical tool used or by the reader's level of expertise. METHODS We calculated the reproducibility of VFA reading by uniform and Cohen's kappa, comparing one expert and one non-expert, before and after an instructional on-line International Society of Clinical Densitometry (ISCD) /International Osteoporosis Foundation (IOF) course on VFA reading. We performed the analysis on 50 VFA from a population-based cohort, the OstéoLaus study. RESULTS Before the VFA reading course, reproducibility with Cohen's kappa was moderate to poor (0 to 0.520), good with the uniform kappa (0.796 to 0.958). After the course, both Cohen's kappa and uniform kappa statistically increased, ranging from 0.524 to 1.000. CONCLUSIONS For female population-based cohort studies, we recommend using the uniform kappa and instructing a non-expert reader using the ISCD/IOF VFA reading course to correctly read and evaluate the reproducibility of the VFA reading.
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Affiliation(s)
- B Aubry-Rozier
- Centre for Bone Diseases, Lausanne University Hospital, Avenue Pierre Decker 4, 1011, Lausanne, Switzerland.
| | - I Fabreguet
- Centre for Bone Diseases, Lausanne University Hospital, Avenue Pierre Decker 4, 1011, Lausanne, Switzerland
| | - K Iglesias
- Département de médecine sociale et préventive, Lausanne University Hospital, Bugnon 21, 1011, Lausanne, Switzerland
| | - O Lamy
- Centre for Bone Diseases, Lausanne University Hospital, Avenue Pierre Decker 4, 1011, Lausanne, Switzerland
| | - D Hans
- Centre for Bone Diseases, Lausanne University Hospital, Avenue Pierre Decker 4, 1011, Lausanne, Switzerland
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Baggio S, Gainsbury SM, Berchtold A, Iglesias K. Co-morbidity of gambling and Internet use among Internet and land-based gamblers: classic and network approaches. International Gambling Studies 2016. [DOI: 10.1080/14459795.2016.1242148] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
The principal aim of this study was to investigate the psychosocial well-being of emerging adults using psychological states associated with this transitional phase and classic measures of emerging adulthood. We expected psychological states to be more closely associated with psychological well-being than classic markers of achieved adulthood. Data were collected in the Cohort Study on Substance Use Risk Factors from 4,991 Swiss men aged 18–25 years. The assessment included the Short Form of the Inventory of Dimensions of Emerging Adulthood (IDEA-8), classic markers of achieved adulthood (e.g., financial independence, stable relationship), and psychosocial well-being. Structural equation models (SEMs) were conducted to test the association between measures of emerging adulthood and psychosocial well-being. Overall, the results highlighted contrasting associations of measures of emerging adulthood and psychosocial well-being. Youths facing negative psychological states (dimension “negativity”) and exploring life without knowing how to define themselves (dimension “identity exploration”) had a decreased psychosocial well-being. On the contrary, youths exploring many opportunities with an optimistic perspective (dimension “experimentation”) had an increased psychosocial well-being. By contrast, classic markers of adulthood were less related to psychosocial well-being. The IDEA-8 Scale appeared to be a useful screening tool for identifying vulnerable youths, and emerging adulthood should be measured with a focus on the psychological states associated with this period. This information may be valuable for mental health systems that have not yet adapted to emerging adults’ needs.
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Affiliation(s)
- Stéphanie Baggio
- Life Course and Social Inequality Research Centre, University of Lausanne, Lausanne, Switzerland
| | - Joseph Studer
- Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Katia Iglesias
- Centre for the Understanding of Social Processes, University of Neuchâtel, Neuchâtel, Switzerland
| | - Jean-Bernard Daeppen
- Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Gerhard Gmel
- Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne, Switzerland
- Addiction Switzerland, Lausanne, Switzerland
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of the West of England, Bristol, UK
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Baggio S, Spilka S, Studer J, Iglesias K, Gmel G. Trajectories of drug use among French young people: Prototypical stages of involvement in illicit drug use. Journal of Substance Use 2016. [DOI: 10.3109/14659891.2015.1063720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bodenmann P, Baggio S, Iglesias K, Althaus F, Velonaki VS, Stucki S, Ansermet C, Paroz S, Trueb L, Hugli O, Griffin JL, Daeppen JB. Characterizing the vulnerability of frequent emergency department users by applying a conceptual framework: a controlled, cross-sectional study. Int J Equity Health 2015; 14:146. [PMID: 26645272 PMCID: PMC4673736 DOI: 10.1186/s12939-015-0277-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 12/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Frequent emergency department (ED) users meet several of the criteria of vulnerability, but this needs to be further examined taking into consideration all vulnerability's different dimensions. This study aimed to characterize frequent ED users and to define risk factors of frequent ED use within a universal health care coverage system, applying a conceptual framework of vulnerability. METHODS A controlled, cross-sectional study comparing frequent ED users to a control group of non-frequent users was conducted at the Lausanne University Hospital, Switzerland. Frequent users were defined as patients with five or more visits to the ED in the previous 12 months. The two groups were compared using validated scales for each one of the five dimensions of an innovative conceptual framework: socio-demographic characteristics; somatic, mental, and risk-behavior indicators; and use of health care services. Independent t-tests, Wilcoxon rank-sum tests, Pearson's Chi-squared test and Fisher's exact test were used for the comparison. To examine the -related to vulnerability- risk factors for being a frequent ED user, univariate and multivariate logistic regression models were used. RESULTS We compared 226 frequent users and 173 controls. Frequent users had more vulnerabilities in all five dimensions of the conceptual framework. They were younger, and more often immigrants from low/middle-income countries or unemployed, had more somatic and psychiatric comorbidities, were more often tobacco users, and had more primary care physician (PCP) visits. The most significant frequent ED use risk factors were a history of more than three hospital admissions in the previous 12 months (adj OR:23.2, 95%CI = 9.1-59.2), the absence of a PCP (adj OR:8.4, 95%CI = 2.1-32.7), living less than 5 km from an ED (adj OR:4.4, 95%CI = 2.1-9.0), and household income lower than USD 2,800/month (adj OR:4.3, 95%CI = 2.0-9.2). CONCLUSIONS Frequent ED users within a universal health coverage system form a highly vulnerable population, when taking into account all five dimensions of a conceptual framework of vulnerability. The predictive factors identified could be useful in the early detection of future frequent users, in order to address their specific needs and decrease vulnerability, a key priority for health care policy makers. Application of the conceptual framework in future research is warranted.
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Affiliation(s)
- Patrick Bodenmann
- Vulnerable Populations Center, Department of Ambulatory Care and Community Medicine, University of Lausanne & Lausanne University Hospital, Lausanne, CH-1015, Switzerland.
| | - Stéphanie Baggio
- Life Course and Inequality Research Center, Faculty of Social and Political Sciences, University of Lausanne, Lausanne, CH-1015, Switzerland.
| | - Katia Iglesias
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, CH-1011, Switzerland.
| | - Fabrice Althaus
- Vulnerable Populations Center, Department of Ambulatory Care and Community Medicine, University of Lausanne & Lausanne University Hospital, Lausanne, CH-1015, Switzerland.
| | - Venetia-Sofia Velonaki
- Institute of Higher Education and Research in Healthcare, Lausanne University Hospital, Lausanne, CH-1010, Switzerland.
| | - Stephanie Stucki
- Addiction Switzerland, Research Institute, Lausanne, CH-1001, Switzerland.
| | - Corine Ansermet
- Department of Community Medicine and Public Health, Lausanne University Hospital, Lausanne, CH-1011, Switzerland.
| | - Sophie Paroz
- Department of Community Medicine and Public Health, Lausanne University Hospital, Lausanne, CH-1011, Switzerland.
| | - Lionel Trueb
- Emergency Department, Lausanne University Hospital, Lausanne, CH-1011, Switzerland.
| | - Olivier Hugli
- Emergency Department, Lausanne University Hospital, Lausanne, CH-1011, Switzerland.
| | - Judith L Griffin
- Vulnerable Populations Center, Department of Ambulatory Care and Community Medicine, University of Lausanne & Lausanne University Hospital, Lausanne, CH-1015, Switzerland.
| | - Jean-Bernard Daeppen
- Alcohol Treatment Service, Lausanne University Hospital, Lausanne, CH-1011, Switzerland.
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Vu F, Daeppen JB, Hugli O, Iglesias K, Stucki S, Paroz S, Canepa Allen M, Bodenmann P. Screening of mental health and substance users in frequent users of a general Swiss emergency department. BMC Emerg Med 2015; 15:27. [PMID: 26452550 PMCID: PMC4600290 DOI: 10.1186/s12873-015-0053-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 09/30/2015] [Indexed: 11/25/2022] Open
Abstract
Background The objectives of this study were to determine the proportions of psychiatric and substance use disorders suffered by emergency departments’ (EDs’) frequent users compared to the mainstream ED population, to evaluate how effectively these disorders were diagnosed in both groups of patients by ED physicians, and to determine if these disorders were predictive of a frequent use of ED services. Methods This study is a cross-sectional study with concurrent and retrospective data collection. Between November 2009 and June 2010, patients’ mental health and substance use disorders were identified prospectively in face-to-face research interviews using a screening questionnaire (i.e. researcher screening). These data were compared to the data obtained from a retrospective medical chart review performed in August 2011, searching for mental health and substance use disorders diagnosed by ED physicians and recorded in the patients’ ED medical files (i.e. ED physician diagnosis). The sample consisted of 399 eligible adult patients (≥18 years old) admitted to the urban, general ED of a University Hospital. Among them, 389 patients completed the researcher screening. Two hundred and twenty frequent users defined by >4 ED visits in the previous twelve months were included and compared to 169 patients with ≤4 ED visits in the same period (control group). Results Researcher screening showed that ED frequent users were more likely than members of the control group to have an anxiety, depressive disorder, post-traumatic stress disorder (PTSD), or suffer from alcohol, illicit drug abuse/addiction. Reviewing the ED physician diagnosis, we found that the proportions of mental health and substance use disorders diagnosed by ED physicians were low both among ED frequent users and in the control group. Using multiple logistic regression analyses to predict frequent ED use, we found that ED patients who screened positive for psychiatric disorders only and those who screened positive for both psychiatric and substance use disorders were more likely to be ED frequent users compared to ED patients with no disorder. Conclusions This study found high proportions of screened mental health and/or substance use disorders in ED frequent users, but it showed low rates of detection of such disorders in day-to-day ED activities which can be a cause for concern. Active screening for these disorders in this population, followed by an intervention and/or a referral for treatment by a case-management team may constitute a relevant intervention for integration into a general ED setting.
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Affiliation(s)
- Francis Vu
- Vulnerable Population Centre, Department of Ambulatory Care and Community Medicine, University of Lausanne & Lausanne University Hospital (CHUV), Rue du Bugnon 44, 1011, Lausanne, Switzerland.
| | - Jean-Bernard Daeppen
- Alcohol Treatment Centre, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
| | - Olivier Hugli
- Emergency Service, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
| | - Katia Iglesias
- Institute of Social and Preventive Medicine (IUMSP) and Clinical Research Centre, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
| | - Stephanie Stucki
- Research Department, Addiction Switzerland, Lausanne, Switzerland.
| | - Sophie Paroz
- Department of Community Medicine and Public Health (DUMSC), Lausanne University Hospital (CHUV), Lausanne, Switzerland.
| | - Marina Canepa Allen
- Department of Community Medicine and Public Health (DUMSC), Lausanne University Hospital (CHUV), Lausanne, Switzerland.
| | - Patrick Bodenmann
- Vulnerable Population Centre, Department of Ambulatory Care and Community Medicine, University of Lausanne & Lausanne University Hospital (CHUV), Rue du Bugnon 44, 1011, Lausanne, Switzerland.
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Baggio S, Dupuis M, Iglesias K, Daeppen JB. Independent and combined associations of risky single-occasion drinking and drinking volume with alcohol use disorder: Evidence from a sample of young Swiss men. Drug Alcohol Depend 2015. [PMID: 26210735 DOI: 10.1016/j.drugalcdep.2015.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Risky single-occasion drinking (RSOD) is a prevalent and potentially harmful alcohol use pattern associated with increased alcohol use disorder (AUD). However, RSOD is commonly associated with a higher level of alcohol intake, and most studies have not controlled for drinking volume (DV). Thus, it is unclear whether the findings provide information about RSOD or DV. This study sought to investigate the independent and combined effects of RSOD and DV on AUD. METHODS Data were collected in the longitudinal Cohort Study on Substance Use Risk Factors (C-SURF) among 5598 young Swiss male alcohol users in their early twenties. Assessment included DV, RSOD, and AUD at two time points. Generalized linear models for binomial distributions provided evidence regarding associations of DV, RSOD, and their interaction. RESULTS DV, RSOD, and their interaction were significantly related to the number of AUD criteria. The slope of the interaction was steeper for non/rare RSOD than for frequent RSOD. CONCLUSIONS RSOD appears to be a harmful pattern of drinking, associated with increased AUD and it moderated the relationship between DV and AUD. This study highlighted the importance of taking drinking patterns into account, for both research and public health planning, since RSO drinkers constitute a vulnerable subgroup for AUD.
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Affiliation(s)
- Stéphanie Baggio
- Life Course and Social Inequality Research Centre, University of Lausanne, Geopolis Building, CH-1015 Lausanne, Switzerland.
| | - Marc Dupuis
- Institute of Psychology, University of Lausanne, Geopolis Building, CH-1015 Lausanne, Switzerland.
| | - Katia Iglesias
- Centre for the Understanding of Social Processes, University of Neuchâtel, Faubourg de l'Hôpital 27, CH-2000 Neuchâtel, Switzerland.
| | - Jean-Bernard Daeppen
- Alcohol Treatment Centre, Lausanne University Hospital CHUV, Av. Beaumont 21 bis, Pavillon 2, CH-1011 Lausanne, Switzerland.
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Aubry-Rozier B, Chapurlat R, Duboeuf F, Iglesias K, Krieg MA, Lamy O, Burnand B, Hans D. Reproducibility of Vertebral Fracture Assessment Readings From Dual-energy X-ray Absorptiometry in Both a Population-based and Clinical Cohort: Cohen's and Uniform Kappa. J Clin Densitom 2015; 18:233-8. [PMID: 25439454 DOI: 10.1016/j.jocd.2014.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/01/2014] [Accepted: 09/03/2014] [Indexed: 10/24/2022]
Abstract
Vertebral fracture assessments (VFAs) using dual-energy X-ray absorptiometry increase vertebral fracture detection in clinical practice and are highly reproducible. Measures of reproducibility are dependent on the frequency and distribution of the event. The aim of this study was to compare 2 reproducibility measures, reliability and agreement, in VFA readings in both a population-based and a clinical cohort. We measured agreement and reliability by uniform kappa and Cohen's kappa for vertebral reading and fracture identification: 360 VFAs from a population-based cohort and 85 from a clinical cohort. In the population-based cohort, 12% of vertebrae were unreadable. Vertebral fracture prevalence ranged from 3% to 4%. Inter-reader and intrareader reliability with Cohen's kappa was fair to good (0.35-0.71 and 0.36-0.74, respectively), with good inter-reader and intrareader agreement by uniform kappa (0.74-0.98 and 0.76-0.99, respectively). In the clinical cohort, 15% of vertebrae were unreadable, and vertebral fracture prevalence ranged from 7.6% to 8.1%. Inter-reader reliability was moderate to good (0.43-0.71), and the agreement was good (0.68-0.91). In clinical situations, the levels of reproducibility measured by the 2 kappa statistics are concordant, so that either could be used to measure agreement and reliability. However, if events are rare, as in a population-based cohort, we recommend evaluating reproducibility using the uniform kappa, as Cohen's kappa may be less accurate.
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Affiliation(s)
| | | | | | - Katia Iglesias
- Département de Médecine Sociale et Préventive, Lausanne University Hospital, Lausanne, Switzerland
| | - Marc-Antoine Krieg
- Centre for Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Lamy
- Centre for Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland
| | - Bernard Burnand
- Département de Médecine Sociale et Préventive, Lausanne University Hospital, Lausanne, Switzerland
| | - Didier Hans
- Centre for Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland
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Durrleman S, Hippolyte L, Zufferey S, Iglesias K, Hadjikhani N. Complex syntax in autism spectrum disorders: a study of relative clauses. Int J Lang Commun Disord 2015; 50:260-267. [PMID: 25244532 DOI: 10.1111/1460-6984.12130] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 07/16/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND The few studies that have evaluated syntax in autism spectrum disorder (ASD) have yielded conflicting findings: some suggest that once matched on mental age, ASD and typically developing controls do not differ for grammar, while others report that morphosyntactic deficits are independent of cognitive skills in ASD. There is a need for a better understanding of syntax in ASD and its relation to, or dissociation from, nonverbal abilities. AIMS Syntax in ASD was assessed by evaluating subject and object relative clause comprehension in adolescents and adults diagnosed with ASD with a performance IQ within the normal range, and with or without a history of language delay. METHODS & PROCEDURES Twenty-eight participants with ASD (mean age 21.8) and 28 age-matched controls (mean age 22.07) were required to point to a character designated by relative clauses that varied in syntactic complexity. OUTCOMES & RESULTS Scores indicate that participants with ASD regardless of the language development history perform significantly worse than age-matched controls with object relative clauses. In addition, participants with ASD with a history of language delay (diagnosed with high-functioning autism in the DSM-IV-TR) perform worse on subject relatives than ASD participants without language delay (diagnosed with Asperger syndrome in the DSM-IV-TR), suggesting that these two groups do not have equivalent linguistic abilities. Performance IQ has a positive impact on the success of the task for the population with ASD. CONCLUSIONS & IMPLICATIONS This study reveals subtle grammatical difficulties remaining in adult individuals with ASD within normal IQ range as compared with age-matched peers. Even in the absence of a history of language delay in childhood, the results suggest that a slight deficit may nevertheless be present and go undetected by standardized language assessments. Both groups with and without language delay have a similar global performance on relative clause comprehension; however, the study also indicates that the participants with reported language delay show more difficulty with subject relatives than the participants without language delay, suggesting the presence of differences in linguistic abilities between these subgroups of ASD.
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Affiliation(s)
- Stephanie Durrleman
- Institute of Cognitive Science, CNRS, Lyon, France; Department of Linguistics, University of Geneva, Geneva, Switzerland
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Casillas A, Iglesias K, Flatz A, Burnand B, Peytremann-Bridevaux I. No consistent association between processes-of-care and health-related quality of life among patients with diabetes: a missing link? BMJ Open Diabetes Res Care 2015; 3:e000042. [PMID: 25621176 PMCID: PMC4298028 DOI: 10.1136/bmjdrc-2014-000042] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 09/24/2014] [Accepted: 11/04/2014] [Indexed: 11/05/2022] Open
Abstract
PURPOSE Health-related quality of life (HRQoL) is considered a representative outcome in the evaluation of chronic disease management initiatives emphasizing patient-centered care. We evaluated the association between receipt of processes-of-care (PoC) for diabetes and HRQoL. METHODS This cross-sectional study used self-reported data from non-institutionalized adults with diabetes in a Swiss canton. Outcomes were the physical/mental composites of the short form health survey 12 (SF-12) physical composite score, mental composite score (PCS, MCS) and the Audit of Diabetes-Dependent Quality of Life (ADDQoL). Main exposure variables were receipt of six PoC for diabetes in the past 12 months, and the Patient Assessment of Chronic Illness Care (PACIC) score. We performed linear regressions to examine the association between PoC, PACIC and the three composites of HRQoL. RESULTS Mean age of the 519 patients was 64.5 years (SD 11.3); 60% were male, 87% reported type 2 or undetermined diabetes and 48% had diabetes for over 10 years. Mean HRQoL scores were SF-12 PCS: 43.4 (SD 10.5), SF-12 MCS: 47.0 (SD 11.2) and ADDQoL: -1.6 (SD 1.6). In adjusted models including all six PoC simultaneously, receipt of influenza vaccine was associated with lower ADDQoL (β=-0.4, p≤0.01) and foot examination was negatively associated with SF-12 PCS (β=-1.8, p≤0.05). There was no association or trend towards a negative association when these PoC were reported as combined measures. PACIC score was associated only with the SF-12 MCS (β=1.6, p≤0.05). CONCLUSIONS PoC for diabetes did not show a consistent association with HRQoL in a cross-sectional analysis. This may represent an effect lag time between time of process received and health-related quality of life. Further research is needed to study this complex phenomenon.
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Affiliation(s)
- Alejandra Casillas
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital , Lausanne, Vaud , Switzerland
| | - Katia Iglesias
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital , Lausanne, Vaud , Switzerland
| | - Aline Flatz
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital , Lausanne, Vaud , Switzerland
| | - Bernard Burnand
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital , Lausanne, Vaud , Switzerland
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Baggio S, Iglesias K, Studer J, Dupuis M, Daeppen JB, Gmel G. Is the Relationship Between Major Depressive Disorder and Self-Reported Alcohol Use Disorder an Artificial One? Alcohol Alcohol 2014; 50:195-9. [DOI: 10.1093/alcalc/agu103] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Valerio M, Cerantola Y, Fritschi U, Hubner M, Iglesias K, Legris AS, Lucca I, Vlamopoulos Y, Vaucher L, Jichlinski P. Comorbidity and nutritional indices as predictors of morbidity after transurethral procedures: A prospective cohort study. Can Urol Assoc J 2014; 8:E600-4. [PMID: 25295129 DOI: 10.5489/cuaj.1848] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Preoperative scores are widely used predictors of complications after major surgery. These scores, however, are not widely used in transurethral procedures. The aim of this study was to assess the value of the Charlson Comorbidity Index (CCI), the age-adjusted CCI, the American Society of Anesthesiologist score (ASA) and the Nutritional Risk Score (NRS) in predicting early morbidity after transurethral urological procedures. METHODS Consecutive patients undergoing transurethral resection of the bladder or the prostate were prospectively enrolled. The scores were calculated preoperatively; 30-day complications were prospectively recorded according to the Dindo-Clavien classification. Univariate logistic regression was performed to investigate the value of each score and of other factors (i.e., age, sex, body mass index, anemia, smoking habit, type of operation and anaesthesia) as predictors of complications. A multivariate model was then calculated using these predictors. RESULTS Overall, 197 patients were included. The mean age was 72 (standard deviation ± 10). In total, 26.9% patients had at least 1 complication. Using univariate analysis, we found that each score significantly predicted complications. In multivariate analysis, only the ASA (odds ration [OR] 2.11; 95% confidence interval [CI] 1.01-4.43) and the NRS (OR 2.42; 95% CI 1.56-3.74) remained independent predictors. The best model incorporated ASA, NRS and gender, and predicted morbidity with an area under the curve of 76%. Our study's main limitations are population heterogeneity and limited sample size. CONCLUSION The ASA and the NRS are important and independent determinants of early morbidity after transurethral procedures. The use of these indices may assist clinicians in the decision-making process to balance the possible benefits of transurethral procedures with the potential risks.
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Affiliation(s)
- Massimo Valerio
- Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Yannick Cerantola
- Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Urs Fritschi
- Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Martin Hubner
- Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Katia Iglesias
- Clinical Research Center, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Anne-Sophie Legris
- Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Ilaria Lucca
- Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Yannis Vlamopoulos
- Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Laurent Vaucher
- Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Patrice Jichlinski
- Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Iglesias K, Burnand B, Peytremann-Bridevaux I. PACIC Instrument: disentangling dimensions using published validation models. Int J Qual Health Care 2014. [DOI: 10.1093/intqhc/mzu075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Baggio S, Iglesias K, Studer J, Gmel G. An 8-Item Short Form of the Inventory of Dimensions of Emerging Adulthood (IDEA) Among Young Swiss Men. Eval Health Prof 2014; 38:246-54. [PMID: 24973242 DOI: 10.1177/0163278714540681] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Emerging adulthood is a period of life transition, in which youths are no longer adolescents but have not yet reached full adulthood. Measuring emerging adulthood is crucial because of its association with psychopathology and risky behaviors such as substance use. Unfortunately, the only validated scale for such measurement has a long format (Inventory of Dimensions of Emerging Adulthood [IDEA]—31 items). This study aimed to test whether a shorter form yields satisfactory results without substantial loss of information among a sample of young Swiss men. Data from the longitudinal Cohort Study on Substance Use Risk Factors were used ( N = 5,049). IDEA, adulthood markers (e.g., parenthood or financial independence), and risk factors (i.e., substance use and mental health issues) were assessed. The results showed that an 8-item, short-form scale (IDEA-8) with four factors (experimentation, negativity, identity exploration, and feeling in between) returned satisfactory results, including good psychometric properties, high convergence with the initial scale, and strong empirical validity. This study was a step toward downsizing a measure of emerging adulthood. Indeed, this 8-item short form is a good alternative to the 31-item long form and could be more convenient for surveys with constraints on questionnaire length. Moreover, it should help health care practitioners in identifying at-risk populations to prevent and treat risky behaviors.
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Affiliation(s)
- Stéphanie Baggio
- Life Course and Social Inequality Research Centre, University of Lausanne, Lausanne, Switzerland
- Alcohol Treatment Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Katia Iglesias
- Services and Center for Clinical Research, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Joseph Studer
- Alcohol Treatment Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Gerhard Gmel
- Alcohol Treatment Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Addiction Switzerland, Lausanne, Switzerland
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of the West of England, Bristol, UK
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Bodenmann P, Velonaki VS, Ruggeri O, Hugli O, Burnand B, Wasserfallen JB, Moschetti K, Iglesias K, Baggio S, Daeppen JB. Case management for frequent users of the emergency department: study protocol of a randomised controlled trial. BMC Health Serv Res 2014; 14:264. [PMID: 24938769 PMCID: PMC4071797 DOI: 10.1186/1472-6963-14-264] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 06/11/2014] [Indexed: 12/04/2022] Open
Abstract
Background We devised a randomised controlled trial to evaluate the effectiveness and efficiency of an intervention based on case management care for frequent emergency department users. The aim of the intervention is to reduce such patients’ emergency department use, to improve their quality of life, and to reduce costs consequent on frequent use. The intervention consists of a combination of comprehensive case management care and standard emergency care. It uses a clinical case management model that is patient-identified, patient-directed, and developed to provide high intensity services. It provides a continuum of hospital- and community-based patient services, which include clinical assessment, outreach referral, and coordination and communication with other service providers. Methods/Design We aim to recruit, during the first year of the study, 250 patients who visit the emergency department of the University Hospital of Lausanne, Switzerland. Eligible patients will have visited the emergency department 5 or more times during the previous 12 months. Randomisation of the participants to the intervention or control groups will be computer generated and concealed. The statistician and each patient will be blinded to the patient’s allocation. Participants in the intervention group (N = 125), additionally to standard emergency care, will receive case management from a team, 1 (ambulatory care) to 3 (hospitalization) times during their stay and after 1, 3, and 5 months, at their residence, in the hospital or in the ambulatory care setting. In between the consultations provided, the patients will have the opportunity to contact, at any moment, the case management team. Participants in the control group (N = 125) will receive standard emergency care only. Data will be collected at baseline and 2, 5.5, 9, and 12 months later, including: number of emergency department visits, quality of life (EuroQOL and WHOQOL), health services use, and relevant costs. Data on feelings of discrimination and patient’s satisfaction will also be collected at the baseline and 12 months later. Discussion Our study will help to clarify knowledge gaps regarding the positive outcomes (emergency department visits, quality of life, efficiency, and cost-utility) of an intervention based on case management care. Trial registration ClinicalTrials.gov Identifier: NCT01934322.
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Affiliation(s)
- Patrick Bodenmann
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne CH-1015, Switzerland.
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Iglesias K, Burnand B, Peytremann-Bridevaux I. PACIC Instrument: disentangling dimensions using published validation models. Int J Qual Health Care 2014; 26:250-60. [DOI: 10.1093/intqhc/mzu042] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Simioni S, Cavassini M, Annoni JM, Métral M, Iglesias K, Rimbault Abraham A, Jilek S, Calmy A, Müller H, Fayet-Mello A, Giacobini E, Hirschel B, Du Pasquier RA. Rivastigmine for HIV-associated neurocognitive disorders: a randomized crossover pilot study. Neurology 2013; 80:553-60. [PMID: 23345635 DOI: 10.1212/wnl.0b013e3182815497] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the efficacy and safety of rivastigmine for the treatment of HIV-associated neurocognitive disorders (HAND) in a cohort of long-lasting aviremic HIV+ patients. METHODS Seventeen aviremic HIV+ patients with HAND were enrolled in a randomized, double-blind, placebo-controlled, crossover study to receive either oral rivastigmine (up to 12 mg/day for 20 weeks) followed by placebo (20 weeks) or placebo followed by rivastigmine. Efficacy endpoints were improvement on rivastigmine in the Alzheimer's disease assessment scale-cognitive subscale (ADAS-Cog) and individual neuropsychological scores of information processing speed, attention/working memory, executive functioning, and motor skills. Measures of safety included frequency and nature of adverse events and abnormalities on laboratory tests and on plasma concentrations of antiretroviral drugs. Analyses of variance with repeated measures were computed to look for treatment effects. RESULTS There was no change on the primary outcome ADAS-Cog on drug. For secondary outcomes, processing speed improved on rivastigmine (trail making test A: F(1,13) = 5.57, p = 0.03). One measure of executive functioning just failed to reach significance (CANTAB spatial working memory [strategy]: F(1,13) = 3.94, p = 0.069). No other change was observed. Adverse events were frequent, but not different from those observed in other populations treated with rivastigmine. No safety issues were recorded. CONCLUSIONS Rivastigmine in aviremic HIV+ patients with HAND seemed to improve psychomotor speed. A larger trial with the better tolerated transdermal form of rivastigmine is warranted. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that rivastigmine is ineffective for improving ADAS-Cog scores, but is effective in improving some secondary outcome measures in aviremic HIV+ patients with HAND.
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Augsburger M, Iglesias K, Bardy D, Mangin P, Palmiere C. Diagnostic value of lipopolysaccharide-binding protein and procalcitonin for sepsis diagnosis in forensic pathology. Int J Legal Med 2012; 127:427-35. [DOI: 10.1007/s00414-012-0780-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 10/04/2012] [Indexed: 01/07/2023]
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Mantel I, Deli A, Iglesias K, Ambresin A. Prospective study evaluating the predictability of need for retreatment with intravitreal ranibizumab for age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2012; 251:697-704. [DOI: 10.1007/s00417-012-2090-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 06/07/2012] [Accepted: 06/11/2012] [Indexed: 10/28/2022] Open
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Grabherr S, Widmer C, Iglesias K, Sporkert F, Augsburger M, Mangin P, Palmiere C. Postmortem biochemistry performed on vitreous humor after postmortem CT-angiography. Leg Med (Tokyo) 2012; 14:297-303. [PMID: 22703847 DOI: 10.1016/j.legalmed.2012.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Revised: 04/08/2012] [Accepted: 04/25/2012] [Indexed: 01/08/2023]
Abstract
Postmortem angiography is becoming increasingly essential in forensic pathology as an adjunct to conventional autopsy. Despite the numerous advantages of this technique, some questions have been raised regarding the influence of the contrast agent injected on the results of toxicological and biochemical analyses. The aim of this study was to investigate the effect of the injection of the contrast agent Angiofil®, mixed with paraffin oil, on the results of postmortem biochemical investigations performed on vitreous humor. Postmortem biochemical investigations were performed on vitreous samples collected from bodies that had undergone postmortem angiography (n=50) and from a control group (n=50). Two vitreous samples were analyzed for each group and the results compared. Glucose, urea, creatinine, 3-β-hydroxybutyrate, sodium and chloride were tested. Different values were observed between the first and second samples in each group. However, these differences were not clinically relevant, suggesting that the injection of this contrast agent mixture does not modify the concentration of the analyzed substances in the vitreous humor.
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Affiliation(s)
- Silke Grabherr
- University Center of Legal Medicine, Lausanne-Geneva, Rue du Bugnon 21, 1011 Lausanne, Switzerland
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Simonin J, Gerber-Lemaire S, Centeno C, Seghezzi C, Iglesias K, Abid K, Grouzmann E. Synthetic calibrators for the analysis of total metanephrines in urine: Revisiting the conditions of hydrolysis. Clin Chim Acta 2012; 413:998-1003. [DOI: 10.1016/j.cca.2012.02.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 02/09/2012] [Accepted: 02/21/2012] [Indexed: 11/24/2022]
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Muller ME, Bochud M, Pruijm M, Iglesias K, Burnier M, Wuerzner G. [Effects of nighttime and daytime interval definition on blood pressure and dipping in patients referred for ambulatory blood pressure measurement]. Ann Cardiol Angeiol (Paris) 2012; 61:193-197. [PMID: 22683138 DOI: 10.1016/j.ancard.2012.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 04/22/2012] [Indexed: 06/01/2023]
Abstract
UNLABELLED Ambulatory blood pressure monitoring (ABPM) has become indispensable for the diagnosis and control of hypertension. However, no consensus exists on how daytime and nighttime periods should be defined. OBJECTIVE To compare daytime and nighttime blood pressure (BP) defined by an actigraph and by body position with BP resulting from arbitrary daytime and nighttime periods. PATIENTS AND METHOD ABPM, sleeping periods and body position were recorded simultaneously using an actigraph (SenseWear Armband(®)) in patients referred for ABPM. BP results obtained with the actigraph (sleep and position) were compared to the results obtained with fixed daytime (7a.m.-10p.m.) and nighttime (10p.m.-7a.m.) periods. RESULTS Data from 103 participants were available. More than half of them were taking antihypertensive drugs. Nocturnal BP was lower (systolic BP: 2.08±4.50mmHg; diastolic BP: 1.84±2.99mmHg, P<0.05) and dipping was more marked (systolic BP: 1.54±3.76%; diastolic BP: 2.27±3.48%, P<0.05) when nighttime was defined with the actigraph. Standing BP was higher (systolic BP 1.07±2.81mmHg; diastolic BP: 1.34±2.50mmHg) than daytime BP defined by a fixed period. CONCLUSION Diurnal BP, nocturnal BP and dipping are influenced by the definition of daytime and nighttime periods. Studies evaluating the prognostic value of each method are needed to clarify which definition should be used.
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Affiliation(s)
- M-E Muller
- Service de néphrologie et d'hypertension, CHU Vaudois, rue du Bugnon 17, 1011 Lausanne, Suisse
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50
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Oddo M, Levine JM, Kumar M, Iglesias K, Frangos S, Maloney-Wilensky E, Le Roux PD. Anemia and brain oxygen after severe traumatic brain injury. Intensive Care Med 2012; 38:1497-504. [PMID: 22584800 DOI: 10.1007/s00134-012-2593-1] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 04/23/2012] [Indexed: 01/25/2023]
Abstract
PURPOSE To investigate the relationship between hemoglobin (Hgb) and brain tissue oxygen tension (PbtO(2)) after severe traumatic brain injury (TBI) and to examine its impact on outcome. METHODS This was a retrospective analysis of a prospective cohort of severe TBI patients whose PbtO(2) was monitored. The relationship between Hgb-categorized into four quartiles (≤9; 9-10; 10.1-11; >11 g/dl)-and PbtO(2) was analyzed using mixed-effects models. Anemia with compromised PbtO(2) was defined as episodes of Hgb ≤ 9 g/dl with simultaneous PbtO(2) < 20 mmHg. Outcome was assessed at 30 days using the Glasgow outcome score (GOS), dichotomized as favorable (GOS 4-5) vs. unfavorable (GOS 1-3). RESULTS We analyzed 474 simultaneous Hgb and PbtO(2) samples from 80 patients (mean age 44 ± 20 years, median GCS 4 (3-7)). Using Hgb > 11 g/dl as the reference level, and controlling for important physiologic covariates (CPP, PaO(2), PaCO(2)), Hgb ≤ 9 g/dl was the only Hgb level that was associated with lower PbtO(2) (coefficient -6.53 (95 % CI -9.13; -3.94), p < 0.001). Anemia with simultaneous PbtO(2) < 20 mmHg, but not anemia alone, increased the risk of unfavorable outcome (odds ratio 6.24 (95 % CI 1.61; 24.22), p = 0.008), controlling for age, GCS, Marshall CT grade, and APACHE II score. CONCLUSIONS In this cohort of severe TBI patients whose PbtO(2) was monitored, a Hgb level no greater than 9 g/dl was associated with compromised PbtO(2). Anemia with simultaneous compromised PbtO(2), but not anemia alone, was a risk factor for unfavorable outcome, irrespective of injury severity.
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Affiliation(s)
- Mauro Oddo
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA.
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