[Roma populations and health]. / Populations Roms et santé.

The health status of the so-called "Roma" is usually much poorer than that of neighbouring non-Roma populations with a life expectancy gap of 5-15 years. This results from prolonged exposure to adverse determinants of health and to persistent exclusion from social and political arenas. Scientific and social research has only poorly addressed the health issues of Roma and evidences are scarce. Insufficient access to public services, including to health care and non optimal clinical practices are modifiable factors. If correctly addressed, this could contribute to reduce health disparities, including in Switzerland.

Cutaneous squamous cell carcinoma in two pediatric lung transplant patients on prolonged voriconazole treatment.

Oral voriconazole is commonly used for treatment and prophylaxis of invasive fungal disease post-LTx. Development of cutaneous SCC has been described in adult LTx recipients, although it is extremely rare in children. We describe two Caucasian children who developed cutaneous SCC beyond three yr post-LTx. Both developed severe photosensitivity, actinic keratosis and required curative surgical excision of the cutaneous SCC lesions. Neither patient developed metastatic lesions nor had allograft dysfunction as a result of the SCC or the change in medical treatments. The effect of voriconazole on the development of malignant skin lesions is discussed and a recommendation on dermatologic surveillance, preventive measures against phototoxicity and early treatment of SCC are provided.

[Emerging parasitic diseases]. / Maladies parasitaires émergentes.

Travels, migration and circulation of goods facilitate the emergence of new infectious diseases often unrecognized outside endemic areas. Most of emerging infections are of viral origin. Muscular Sarcocystis infection, an acute illness acquired during short trips to Malaysia, and Chagas disease, a chronic illness with long incubation period found among Latin American migrants, are two very different examples of emerging parasitic diseases. The former requires a preventive approach for travelers going to Malaysia and must be brought forth when they return with fever, myalgia and eosinophilia, while the latter requires a proactive attitude to screen Latin American migrant populations that may face difficulties in accessing care.

An encyclopedia of mouse genes.

The laboratory mouse is the premier model system for studies of mammalian development due to the powerful classical genetic analysis possible (see also the Jackson Laboratory web site, http://www.jax.org/) and the ever-expanding collection of molecular tools. To enhance the utility of the mouse system, we initiated a program to generate a large database of expressed sequence tags (ESTs) that can provide rapid access to genes. Of particular significance was the possibility that cDNA libraries could be prepared from very early stages of development, a situation unrealized in human EST projects. We report here the development of a comprehensive database of ESTs for the mouse. The project, initiated in March 1996, has focused on 5' end sequences from directionally cloned, oligo-dT primed cDNA libraries. As of 23 October 1998, 352,040 sequences had been generated, annotated and deposited in dbEST, where they comprised 93% of the total ESTs available for mouse. EST data are versatile and have been applied to gene identification, comparative sequence analysis, comparative gene mapping and candidate disease gene identification, genome sequence annotation, microarray development and the development of gene-based map resources.

An assessment of the predictive value of low risk criteria for children with intermittent asthma.

BACKGROUND: Current asthma guidelines recommend short acting beta agonist medication (SABA) be used in combination with an inhaled corticosteroid to reduce risk for severe asthma exacerbations. This may not be appropriate for patients at low risk for severe exacerbations. METHODS: This study is a cohort study using computerized claims data from Texas Children's Health Plan. Inclusion criteria were members 1 to <18 years with a diagnosis of asthma in a baseline year between 2016 and 2018 and who had ≤2 SABA canisters or equivalent dispensed, no oral corticosteroid or inhaled corticosteroid dispensing, no asthma hospitalizations, and no asthma emergency department visits in the baseline year. Follow up year outcomes of asthma hospitalizations and emergency department visits were determined for the year following the baseline year. FINDINGS: Forty-five thousand two hundred and thiry health plan members 1 to <18 years met inclusion criteria. The rate of follow up year asthma hospitalization was 1.1 per thousand for those with no baseline SABA dispensing and 1.5 per thousand for those with >0 and ≤2 SABA canister dispensings (p = 0.3). Follow up year Emergency Department visits rates were 14 per thousand and 17 per thousand, respectively (p = 0.08). In analyses adjusted for age group, the follow up year asthma hospitalization rate was not different comparing the 0 SABA to the >0 and ≤2 SABA canister dispensings group (odds ratio: 0.99, 95% confidence interval: 0.54-1.81). INTERPRETATION: Asthma patients at low risk for severe exacerbations can be identified. This information can be useful to guide treatment decisions.

Assaying Spontaneous Network Activity and Cellular Viability Using Multi-Well Microelectrode Arrays.

Microelectrode array (MEA) technology is a neurophysiological method that allows for the measurement of spontaneous or evoked neural activity to determine chemical effects thereon. Following assessment of compound effects on multiple endpoints that evaluate network function, a cell viability endpoint in the same well is determined using a multiplexed approach. Recently, it has become possible to measure electrical impedance of cells attached to the electrodes, where greater impedance indicates greater number of cells attached. This would allow rapid and repeated assessments of cell health as the neural network develops in longer exposure assays without impacting cell health. Typically, the lactate dehydrogenase (LDH) assay for cytotoxity and CellTiter-Blue® (CTB) assay for cell viability are only performed at the end of the chemical exposure period because these assays involve lysing of the cells. Procedures describing the multiplexed methods in acute and network formation screening are included in this chapter.

[Urban health: the irremediable urbanization of life and medicine]. / Urban health: l'irrémédiable urbanisation de la vie et de la médecine.

Since 2007, the number of people living in cities exceeds that of rural areas. Thus, cities and their organizations have a major influence on all spheres of human life, especially health. This influence may generate inequality, suffering and disease, but also represent an opportunity for health and well-being. This paper introduces the concept of urban health, particularly in terms of primary care medicine and presents solutions that encompass a wide field (politics, urban planning, social inequality, education). Improving urban health requires collaboration of medical with non-medical actors, in order to become of development (re-) urban structure and promotes the health of all.

[What was new in ambulatory general internal medicine in 2011?]. / Nouveautés 2011 en médecine interne générale ambulatoire.

This review of articles published in 2011 covers a large spectrum of topics that are of interest for the practice of general internal medicine and of primary care. Authors discuss public health issues, such as sleep disorders and their relationship with subsequent weight disorders, and the benefits of commercial weight reduction programs. Clinical topics, such as the management of victims of sexual violence and screening strategies for lung cancer, streptococcal pharyngitis, functional bowel disorders and hypertension in ambulatory settings are also reviewed. Besides, authors cover therapeutic issues, such as the treatment of hand arthritis with chondroitin sulfate and the management of plantar warts with salicylic acids and cryotherapy.

Chagas disease in Switzerland: history and challenges.

Chagas disease, endemic in Latin America, is an emerging health problem in Europe affecting an estimated 80,000 persons. Around 60,000 Latin American migrants live in Switzerland, and cases of Chagas disease have been reported since 1979. As of June 2011, 258 cases have been diagnosed, mostly adults in the indeterminate phase of the chronic stage of the disease. Vertical transmission has been identified and there is a high potential for blood- and organ-borne transmission in the absence of systematic screening. Major challenges include (i) raising awareness among migrants and healthcare professionals, (ii) developing national protocols for screening and treatment targeting high-risk groups such as pregnant woman, newborns, migrants from highly endemic areas (e.g. Bolivia), and immunocompromised migrants, (iii) preventing blood- and organ-borne transmission by appropriate screening strategies, (iv) taking into account the social vulnerability of individuals at risk in the design and implementation of public health programmes, and (v) facilitating contacts with the communities at risk through outreach programmes, for example in churches and cultural groups.

EuroTravNet: imported Chagas disease in nine European countries, 2008 to 2009.

In recent years, Chagas disease has emerged as a disease of importance outside of endemic areas, largely as a result of migration. In Europe, clinicians may have to treat infected migrants from endemic areas as well as people with acute infections transmitted congenitally,through organ donation or blood transfusion.We describe here the characteristics of patients diagnosed with chronic Chagas disease at the core clinical sites of the EuroTravNet network during 2008 and 2009. Of the 13,349 people who attended the sites, 124 had chronic Chagas disease. Most (96%) were born in Bolivia and the median number of months in the country of residence before visiting a EuroTravNet core site was 38 months (quartile (Q1)­Q3: 26­55). The median age of the patients was 35 years (Q1­Q3: 29­45) and 65% were female. All but one were seen as outpatients and the most frequent reason for consultation was routine screening. Considering that Chagas disease can be transmitted outside endemic regions and that there is effective treatment for some stages of the infection, all migrants from Latin America (excluding the Caribbean) should be questioned about past exposure to the parasite and should undergo serological testing if infection is suspected.

Chagas disease in European countries: the challenge of a surveillance system.

A study of aggregate data collected from the literature and official sources was undertaken to estimate expected and observed prevalence of Trypanosoma cruzi infection, annual incidence of congenital transmission and rate of underdiagnosis of Chagas disease among Latin American migrants in the nine European countries with the highest prevalence of Chagas disease. Formal and informal data sources were used to estimate the population from endemic countries resident in Europe in 2009, diagnosed cases of Chagas disease and births from mothers originating from endemic countries. By 2009, 4,290 cases had been diagnosed in Europe, compared with an estimated 68,000 to 122,000 expected cases. The expected prevalence was very high in undocumented migrants (on average 45% of total expected cases) while the observed prevalence rate was 1.3 cases per 1,000 resident migrants from endemic countries. An estimated 20 to 183 babies with congenital Chagas disease are born annually in the study countries. The annual incidence rate of congenital transmission per 1,000 pregnancies in women from endemic countries was between none and three cases. The index of under diagnosis of T. cruzi infection was between 94% and 96%. Chagas disease is a public health challenge in the studied European countries. Urgent measures need to be taken to detect new cases of congenital transmission and take care of the existing cases with a focus on migrants without legal residency permit and potential difficulty accessing care.

Functional disability in paediatric patients with recurrent abdominal pain.

BACKGROUND: Recurrent abdominal pain (RAP) is common in childhood, affecting approximately 12% of children and adolescents. Children with RAP tend to experience impairments in functioning, such as increased school absences, anxiety and depression. METHODS: The current study investigated the potential influences on the relation between functional disability and RAP in 100 school-aged children. A series of hierarchical regression analyses were conducted to test two models: main effects and moderation of the relation between abdominal pain symptoms, child anxiety, child depression, maternal emotional distress, maternal encouragement of child illness behaviour and functional disability. RESULTS: The results indicated support for abdominal pain symptoms and child depression in predicting functional disability. The results also indicated that child anxiety and child depression each moderated the relation between pain symptoms and functional disability. CONCLUSIONS: Implications of the findings are discussed in terms of potential influences on the development of functional disability in youth.

[Management of Chagas disease in Europe. Experiences and challenges in Spain, Switzerland and Italy]. / Prise en charge de la maladie de Chagas en Europe. Expériences et défis en Espagne, Suisse et Italie.

The intention of this article is not to describe the illness or evaluate the number of cases diagnosed in Spain, Switzerland and Italy, nor to analyse the protocols followed in various centres. The authors rather seek to examine the main technical, local and national challenges involved in the care of patients with Chagas disease. To this end, they review concisely a number of themes which are common to the three countries. These are: the detection of disease; confirmation of the diagnosis; treatment; response to treatment; follow-up; the risk of transmission by transfusion, by organ donation and from mother to child; the psychosocial and socio-economic aspects of Chagas disease outside endemic areas; and what progress needs to be made in improving information about the condition.

[International migration: global issue, local impact: the example of two parasites]. / Migration internationale: phénomène global, impact local, l'exemple de deux parasites.

International migration profoundly affects the world's economy and social situation. This global phenomenon modifies the epidemiology of numerous diseases and exposes countries to new challenges in public health. Migrants may export pathologies specific of their country of origin but also develop health problems typical of the country of residence. This article presents some key figures on international migration and explores some of its consequences concerning Chagas disease and malaria epidemiology in Switzerland.

[Congenital Chagas disease in Geneva: diagnostic and clinical aspects]. / Dépistage et prise en charge de la maladie de Chagas congénitale à Genève.

Chagas disease, a parasitic infection with Trypanosoma cruzi, recently emerged in Europe and in Switzerland. Mother-to-child infection represents a major mode of transmission in non endemic areas. In 2008, 305 Latin American pregnant women consulting at the Geneva University Hospitals were screened by serology. Overall prevalence was 2% and 8.8% in Bolivian women. All infected women were in the indeterminate form of the chronic phase. Two newborns were congenitally infected. Considering the potential for vertical transmission and the risk of long-term complications, screening programs for persons at risk need to be implemented.

Lung transplantation and survival in children with cystic fibrosis: solid statistics--flawed interpretation.

In their provocative paper, "Lung transplantation and survival in children with cystic fibrosis," Liou and colleagues state that "Prolongation of life by means of lung transplantation should not be expected in children with cystic fibrosis. A prospective, randomized trial is needed to clarify whether and when patients derive a survival and quality of life benefit from lung transplantation." Unfortunately, that conclusion is not supportable. Liou's dataset introduced bias against transplantation by using covariates obtained well before the time of transplant (when predicted survival was good) and having a cohort with lower than expected post-transplant survival than reported elsewhere. The calculated hazard ratios are based on factors that may have changed between listing and transplant, and do not reflect true benefit on a patient by patient basis. The findings of the study are contrary to other studies using similar methods. Finally, recent changes in US lung transplant allocation policy may have made the study findings moot. In contrast to Liou's suggestion to perform an ethically and logistically challenging randomized trial to verify the benefit of lung transplantation, a research agenda is recommended for pediatric lung transplantation for cystic fibrosis that focuses on developing strategies to continually reassess and maximize quality of life and survival benefit.

[Security and travel]. / Sécurité et voyages.

Hijacking, crime, aggression and theaft when people travel abroad are regularly reported by the media. This increases travellers' fears. As there is little research that quantifies risks, subjectivity and preconceived ideas prevail. A survey done among travellers in Geneva, Lausanne and Lyon showed that the risk of incidents was lower in countries located outside of Europe, usually in cities. Most frequently it was baggage stealing, or stealing in the street, during the day. In Europe, stealing by breaking into cars was most frequent. Without becoming paranoid about aggression and burglary, some simple rules can be followed. Keep constant situational awareness, be respectful of the people in countries visited, avoid provocative attitudes and avoid insecure areas.

[Japanese encephalitis]. / L'encéphalite japonaise.

Japanese encephalitis is the primary cause of viral encephalitis in Asia where it is annually responsible for the death of around 20,000 people. The virus is transmitted by night-biting mosquitoes in wet rural areas. The classical clinical presentation includes fever, paresis, decreased level of consciousness and convulsions. There is no efficient anti-viral treatment available. Avoidance of mosquito bites and vaccination are the only effective measures to prevent the disease. Vaccination is recommended for travellers and expatriates who will stay in rural endemic areas for at least one month during the rainy season. The vaccine is contra-indicated in individuals with a previous history of severe allergic reaction.