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Objectives: Assertive Community Treatment (ACT) is known to have a positive impact on the number and length of inpatient stays. Yet, research is needed in order to help understand how ACT programs may ease off families' burden, e.g. in terms of economic expenditures. Indeed, many families with siblings suffering from chronic mental illness, who disengaged from psychiatric services, report needs related to ACT. This paper aims to describe the impact of a new ACT program in Geneva on patients and their families' burden., Methods: Out of 91 patients consecutively treated by the ACT program for at least 3 months, 55 consented to participate in the research. Twenty-one allowed us to contact their families (out of 37 who had relatives in the area). Data were gathered on patients and families before and after a 6-month-follow-up., Results: For the patients, after adjustment for the time spent during follow-up, most of the studied variables evolved favorably, particularly for their symptoms. At baseline, most of the family members felt overburdened by the financial cost (59.1%) related to their relatives with severe mental disorder and experienced inconvenience at having to give them assistance in daily life (68.2%) and to supervise them in daily activities (54.5%). Several variables evolved favorably during follow-up. Notably the best changes were observed for the inconvenience relating to assistance in daily life and relatives' emotional distress. Families of patients with delusional disorder featured less or no improvement during the ACT follow-up. The best correlate of improvement in familial burdens was improvement in patient's positives symptoms. Among those patients, being a female and suffering from a schizo-affective disorder was known to have had a higher impact on the number of interventions provided by families., Discussion: ACT should be recommended for patients who feature a poor outcome when treated in other settings. In addition, our results suggest that their families can also improve considerably, particularly those confronted with patients with persistent and enduring disturbing behaviors related to positive symptoms which do not, however, warrant hospitalization. Clinicians should pay particular attention to patients suffering from delusional disorder and their families, as this disorder does not appear to be associated with improvement in family burdens. These data do not allow definitely disentangling whether the improvement of families' burden is directly related to ACT interventions with them, to the implementation of support by other structures (such as peer support groups) or to an indirect effect related to patients' improvement. To our knowledge no similar study on the effect of ACT on family burden exists. Hence, such research needs to be replicated in other areas with different clinical and cultural backgrounds., (Copyright © 2011 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Background: Public health stakeholders are concerned about program sustainability. However, they usually conceive sustainability in accordance with financial criteria for at least one reason. No simple frameworks are operationally and theoretically sound enough to globally evaluate program sustainability. The present paper aims to describe an application of one framework assessment tool used to evaluate the sustainability level and process of a Nutritional Care Unit managed by a Swiss humanitarian agency to fight against severe child malnutrition in a Haitian area. The managing agency is committed to put this Unit back into the structure of a local public hospital., Methods: The evaluation was performed within the sustainability framework proposed in a former article. Data were collected with a combination of tools, semi-structured interviews (n=33, medical and support staff from the agency and the hospital), participatory observation and document review. Data concerned the four characteristics of organizational routines (memory, adaptation, values and rules) enabling assess to the level of sustainability. In addition, data were related to three types of events distinguishing routinization processes from implementation processes: specific events of routinization, routinization-implementation joint events, and specific events of implementation. Data analysis was thematic and results were validated by actors through a feed-back session and written comments., Results: The current level of sustainability of the Nutritional Care Unit within the Hospital is weak: weak memory, high adaptation, weak sharing of values and rules. This may be explained by the sustainability process, and the absence of specific routinization events. The relevance of such processes is reasonable, while it has been strongly challenged in the troublesome Haitian context. Riots have been widespread over the last years, creating difficulties for the Hospital., Conclusion: This experience suggests the proposed framework and sustainability assessment tools are useful when the context permits scrutinization of program sustainability.

Background: The objectives of the present study were to evaluate Aids prevention in drug users attending low threshold centres providing sterile injection equipment in Switzerland, to identify the characteristics of these users, and to monitor the progress of indicators of drug-related harm., Methods: This paper presents results from a cross-sectional survey carried out in 1994., Results: The mean age of attenders was 28 years, and women represented 27% of the sample. 75% of attenders used a combination of hard drugs (heroin and cocaine). Mean duration of heroin consumption was 8 years, and of cocaine 7 years; 76% of attenders had a fixed abode, but only 34% had stable employment; 45% were being treated with methadone; 9% had shared their injection material in the last 6 months; 24% always used condoms in the case of a stable relationship, and 71% in casual relationships. In a cluster analysis constructed on the basis of multiple correspondence analysis, two distinct profiles of users emerge: highly marginalised users with a high level of consumption (21%); irregular users, better integrated socially, of which the majority are under methadone treatment (79%)., Conclusion: Theses centres play a major role in Aids prevention. Nevertheless, efforts to improve the hygiene conditions of drug injection in Switzerland should be pursued and extended. At the same time, prevention of HIV sexual transmissions should be reinforced.

More and more clinicians are facing young girls suffering from anorexia or bulimia, but the question as to whether these diseases are really increasing remains open. This paper reviews the epidemiological literature published over the last 30-40 years. Until 1980, the authors of retrospective studies claim that the incidence of anorexia has increased. From 1990 on more strictly defined retrospective researches conclude that the incidence and prevalence of anorexia remains steady, although atypical anorectical disorders--often self limited--are increasing. Thus, the incidence of anorexia--strictly defined--is evaluated at 1/100,000 inhabitants within the general population and at 20 to 30/100,000 inhabitants among 15 to 45 year-old females. Moreover, from 1980 on, using new diagnostic tools such as the EAT (Eating Attitude Test), authors describe new nutritional disorders such as bulimia, the incidence of which is calculated at 2 to 5% among 15-45 year-old females. The variability of the results--i.e. the rates--is probably explained by the heterogeneity of the epidemiological approaches, as well as a tendency to denial from the subjects suffering from severe diseases. In the future, one will have to remain cautious in the interpretation of such data: self-administered questionnaires can more easily detect minor eating disorders, and the diagnosis of true anorexia or severe bulimia should be assessed through clinical interviews.

During February and March 1987, 313 private practitioners and 35 outpatients clinics in the cantons of Vaud et Fribourg participated in the study "Ambulatory medical practice". A representative sample of more than 17,800 records was collected and analysed from the 110,000 weekly consultations. In this paper we discuss the patient flow in ambulatory medical care. Overall, patient flows appear to be influenced more by practitioner and patient characteristics than by contextual factors such as medical density. In private practice the proportion of patients who are appointed and indeed attend the consultation is 50%; in outpatient clinics only 30%. The patient's compliance (probability of keeping an appointment) depends on one hand of the physicians' specialty and, on the other hand, it decreases when the appointment rate increases.

In 1970/72, a random sample of 1392 adolescents of the population irrespective of nationality and sex has been drawn, using computer equipment, from the Geneva (Switzerland) resident population, ages 16 to 20 years. The sampling fraction was 13%. These adolescents were interviewed for case history, and then underwent clinical, radiological and photographic examination by a medically trained team including a dentist and a dental hygienist. The sampling had been designed so as to avoid selection regarding the adolescents' sex and occupation (student/apprentice/young labourer) or the parents' socio-professional category. Comprehensive epidemiological data concerning the main dental and periodontal diseases are thus recorded to allow estimation of the individual cost for a complete functional restoration of the dentition and the periodontium (orthodontic treatments not included). The estimating arithmetic is performed on the computer by means of an original program worked out especially for cost estimation referring to an approved list of fees for medico-dental treatments. The first part of the article, as published below, reports the relative frequency distributions of estimated cost depending on age, sex and occupation separately as well as jointly. Moreover, these distributions are summarized by their basic descriptive statistics (medians, quartiles, ranges, extreme values, etc.). At first sight, it seems that by and large the median cost is higher for boys than for girls, and that there is evidence for an increasing trend with respect to age; young labourers rank somehow between students and apprentices. The data seem to exhibit a decreasing trend of median cost as regards ascending socio-professional category. Besides this trend is maintained when duration of caries prophylaxy by means of fluorine tablets intake is accounted for. Average number of daily tooth brushings also positively correlates with median cost, whereas the latter does not seem to depend very closely on time elapsed since the latest appointment with the adolescent's dentist. In another connection, the present paper indicates the overall cost (as well as cost for certain treatment subgroups) estimated for the sample on the one hand, for the whole population on the other hand.

This paper presents the variation in dietary intake, according to sex and age, observed among a representative sample of the over-19-years old residents of Canton Geneva (Switzerland). 576 men and 384 women have been interviewed by 2 specially trained dietitians using a dietary history questionnaire (7.9% of the total population). Differences between sexes are essentially a matter of quantities: in grams or kilocalories, men eat more of all nutriments than women. The energetic intake of the males exceeds by 600 kcal the one of the females. This difference is partly due to a mean alcoholic intake of 44 g for the men and 13.7 g for the women. But the percent of each nutriment in the energetic intake, without alcohol, is the same in both sexes, i.e. 15 +/- 2% of proteins, 40 +/- 6% of lipids and 45 +/- 7% of glucids. The same phenomenon can be seen in Oriental Flandras, in Liège or in Calvados. Age is an important factor influencing all types of nutrient intakes. Our data show that when men or women get older, the percentage of lipids and protids in the energetic intake tends to decrease while the percentage of glucids increases. The total lipid intake decreases with age but the polyunsaturated/saturated fatty acid ration remains constant with age. This observation could be associated with a change in dietary habits of the elderly, a difference of diet from one generation to the other, or the result of a mortality excess among individuals that had an hyperlipidic diet.