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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.

This four-wave longitudinal study aimed to examine the associations between retrospectively perceived parenting profiles in adolescence and the development of alcohol use disorder (AUD) throughout emerging adulthood. The cohort consisted of 190 young Swiss men who completed retrospective reports of parenting at baseline and a short AUD self-report screening tool at four measurement times (mean age at baseline = 20.18; Time 1: 21.52; Time 2: 25.61; Time 3: 26.99). Latent profile analysis revealed three parenting profiles in adolescence based on retrospective measures of parenting styles and practices: Optimal (the highest levels of involvement, structure and knowledge; 69%), Uninformed (high levels of involvement, moderate levels of structure and the lowest levels of knowledge; 17%), Low Support (the lowest levels of involvement, moderate levels of structure and knowledge; 14%). Using latent growth curve analysis, we found that young men in the Low Support profile experienced a greater increase in AUD severity compared with those in the Uninformed and Optimal profiles. Young men in the Uninformed profile reported higher levels of AUD severity at baseline than those in the Optimal profile. These findings highlight the associations between retrospectively perceived parenting profiles during adolescence and the development of AUD during emerging adulthood.

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.

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. 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. The initial analysis of the PACIC revealed poor fit to the Rasch model (χ 2 -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 (χ 2 -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. 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.

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 through 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 twelve 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 (AUD) nor heavy alcohol use appear to be adequate to screen for AUD among young men from the Swiss population. The best screening alternative for AUD among young Swiss men appears to be a combination of eight symptoms of AUD and four alcohol-related consequences.

Funding: Research was funded by the Swiss National Science Foundation (grant no. CR31I3_166331 awarded to A.B. and K.Z.). 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. Publisher PDF

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 ( 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.

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.

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.

Family relationships account for much of the support available to individuals with mental illness. Although some studies have acknowledged the importance of family support, and while others have underlined the harmful effects of negative relationships, research has seldom empirically considered the complex web of positive and negative relationships in family networks. This research hypothesised that social capital has distinct consequences for psychological health depending on the presence or absence of negative family relationships. Through a five-wave follow-up of 60 individuals undergoing psychotherapy in a private practice, the study explored the structural features of positive and negative relationships, considered jointly, in the family networks of adults with mental illness. Four patterns of relationships were found: bonding social capital, bridging social capital, overload and ego-centred conflict. Compared to individuals within a bonding or bridging social capital pattern, those experiencing overload and ego-centred conflict patterns showed higher levels of psychological distress. These results highlight the importance of considering the structural dimensions of positive and negative relationships together to understand the lasting connection between family networks and the psychological health of individuals with mental illness.

Well-being is increasingly conceptualized and measured from a multidimensional perspective in order to provide policy makers and the general public with the necessary tools for monitoring social change. Synthetic measures of multidimensional concepts such as well-being are, therefore, needed. This paper provides a systematic comparison of three methodological approaches applicable in a top-down perspective to construct a synthetic multidimensional measure of well-being using the same theoretical framework and the same data. The three methodologies used are the confirmatory factor analysis, the Alkire and Foster counting approach and the posetic approach. The first two methodologies belong to the family of composite indicators, the most common way to synthetize multidimensional information. The third was developed in order to deal with the construction of composite indicators’ two major issues, namely weighting and aggregating. The main contribution of this paper is methodological; it aims at discussing the advantages and drawbacks of the three methodologies, and at identifying their similarities and specificities.

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 OsteoLaus study. We found that uniform kappa and instruction reading with the ISCD/IOF VFA reading course both increased the accuracy of the reproducibility. 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. 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 OsteoLaus study. 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. 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.

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.

This study investigated co-morbidity of problem gambling and problematic Internet use (PIU) among adolescent Internet and land-based gamblers, with the classic approach using sum-scores of symptoms and a promising new method, namely the network perspective. This perspective allows testing for how multiple disorders are associated, showing symptoms overlap and centralities. We used cross-sectional data from two population-based samples of adolescents aged 17 years in France (n = 2,240) and Switzerland (n = 944). Measures included Internet gambling, problem gambling and PIU. The classic approach showed that Internet gambling was associated with increased levels of disordered gambling and PIU, but that correlations between disorders were weak (R2 min = 3.2%, R2 max = 17.6%). The network perspective showed that the co-morbid network of Internet gamblers was more connected in comparison with land-based gamblers. Problem gambling and PIU appeared as separate disorders, but their relationship was increased among Internet gamblers in comparison with land-based gamblers. The network perspective appeared as a promising avenue for a better understanding of addictive disorders, but it should not replace the classic approach, which showed increased levels of addictive behaviours among Internet gamblers.

Background: The measurement of Internet use is an under-documented topic despite the worldwide growth of problematic Internet use and the recent debate in addiction research suggesting that heavy use over time should be suitable for population-based assessment. This study compared different measures of Internet use to identify the most relevant one, and tested whether Internet use was a good proxy of self-reported Internet addiction.Methods: Data were collected in the ado@internet.ch study among 3054 Swiss 8th grade adolescents. Different assessments of Internet use (frequency, number of hours spent on Internet, quantity-frequency measure, latent score) were compared using rank invariance across instruments. We also examined associations of Internet use with health outcomes (Internet addiction, wellbeing, somatic health problems, and quantity of sleeping). Additionally, associations of Internet addiction with health outcomes were investigated.Results: Quantity-frequency captured 82% of the variabi...

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.

A mixed-design pilot study was undertaken to examine the feasibility, acceptability, and preliminary effects of an educational intervention based on the theory of human caring delivered to hemodialysis (HD) nurses in Switzerland. Participants were 9 nurses and 22 patients undergoing HD. Results showed that the proposed intervention had a high level of feasibility and acceptability. Following the intervention, participating nurses consolidated their caring attitudes/behaviours toward patients undergoing HD. The patients, for their part, perceived significant changes in the nurses' caring attitudes/behaviours following the intervention. Further research is needed to examine its effects on a larger population of nurses and patients.

IntroductionDiscussing 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 analysisA 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 disseminationThe 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 numberNCT04065685.

IntroductionShort 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 analysisBased 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 disseminationThe 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.

The aim of this study was to investigate the presence and concentrations of procalcitonin and C-reactive protein in pericardial fluid and compare these levels to those found in the postmortem serum obtained from the femoral blood. Two groups were formed, a sepsis-related fatalities group and a control group. Postmortem native CT scans, autopsies, histology, neuropathology and toxicology as well as other postmortem biochemistry investigations were performed in all cases. Pericardial fluid procalcitonin levels were significantly different between the cases of sepsis-related fatalities and those of the control group. Postmortem serum procalcitonin levels below the detection limit were also reflected in undetectable pericardial fluid levels. Similarly, a large increase in postmortem serum procalcitonin levels was reflected in a large increase of procalcitonin pericardial fluid levels. Based on these findings, pericardial fluid could be an alternative to postmortem serum for the determination of procalcitonin levels in cases where postmortem serum is not available and measurements of procalcitonin are required to circumstantiate the pathogenesis of death.

Background Estimated glomerular filtration rate (eGFR) is an important diagnostic instrument in clinical practice. The National Kidney Foundation-Kidney Disease Quality Initiative (NKF–KDOQI) guidelines do not recommend using formulas developed for adults to estimate GFR in children; however, studies confirming these recommendations are scarce. The aim of our study was to evaluate the accuracy of the new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula, the Modification of Diet in Renal Disease (MDRD) formula, and the Cockcroft–Gault formula in children with various stages of chronic kidney disease (CKD). Methods A total of 550 inulin clearance (iGFR) measurements for 391 children were analyzed. The cohort was divided into three groups: group 1, with iGFR >90 ml/min/1.73 m2; group 2, with iGFR between 60 and 90 ml/min/1.73 m2; group 3, with iGFR of 2. Results All formulas overestimate iGFR with a significant bias (p Conclusion Based on our results, the performances of all of these formulas are unreliable for eGFR in children across all CKD stages and cannot therefore be applied in the pediatric population group.

Objectives: Frequent Emergency Department (ED) users have an elevated mortality, yet little is known about risk factors. Our aim was to characterize deceased frequent ED users and determine predictors of mortality. Methods: This is a post-hoc analysis of all-cause mortality among frequent ED users participating in a randomized clinical trial on case management at the Lausanne University Hospital (Switzerland). We enrolled 250 frequent ED users (5+ visits/past year) in a 12-month randomized clinical trial; those with an estimated survival of fewer than 18 months were excluded. The primary outcome was 12-month all-cause mortality. We performed descriptive statistics to compare the baseline characteristics of living and deceased participants, and examined predictors of all-cause mortality using logistic regressions, including age adjustment. Results: Twenty of the 250 (8%) frequent users died during the 12-month follow-up. Seven (35%) deaths were because of cardiac causes and six (30%) were because of cancer. The median age at death was 71 years. Deceased participants were older and more likely to report any somatic determinant, chronic illness, and medical comorbidity. Age (odds ratio 1.07, 95% confidence interval 1.04-1.11) and medical comorbidity (odds ratio 4.76, 95% confidence interval 1.86-12.15) were statistically significant predictors of mortality. Conclusion: Despite excluding those with an estimated survival of fewer than 18 months, 8% of frequent ED users died during the study. Age and medical comorbidity were significant predictors of mortality. Interventions, such as case management, should target older frequent ED users and those with multiple medical conditions, and future research should explore their potential impact on mortality.

In contemporary societies, attaining a decent standard of living which allows people to lead a socially integrated life is a key issue for human rights and social policy. In a context in which social structures are more porous yet still quite powerful, the risk of poverty is influenced both by the inertia of these structural determinants and by uncertain life events.

Objective There is a need of empirical evidence of the relationship between heavy alcohol use and alcohol markers. More precisely, associations of these markers with patterns of alcohol use, such as risky single occasion drinking (i.e., drinking 6 drinks or more on a single occasion) have been scarcely investigated. This study aimed to derive psychometric properties of alcohol markers in comparison with different measures of alcohol use and to test whether it allows detecting excessive alcohol use. Methods Participants (n = 233, male, around 20 years old) were recruited based on a stratified random selection of the Swiss Cohort Study on Substance Use and Risk Factors. Inclusion criterion was an Audit score ≥ 13. Assessments included a clinical interview based on the Diagnostic Interview for Genetic Studies (DIGS) and self-reported alcohol measures [1] . Hair (n = 230) and capillary blood (n = 233) on Hemaxis® DBS device were collected for ethyl glucuronide (EtG) and phosphatidylethanol (PEth) determination, respectively. EtG was extracted from washed hair by micropulverized extraction and SPE purification. The extracts were submitted to LC-MS/MS analysis (6500 Qtrap Sciex). Chromatographic separation was achieved using a Merck Chromolith® RP-C18e column (150 × 3 mm). The PEth homologs 16:0/18:1 and 16:0/18:2 concentrations were determined by LC-MS/MS (5000 Qtrap Sciex) according to a validated method [2] . For the interpretation, only the PEth homolog 16:0/18:1 were used. Statistical data treatment (ROC-analysis) was carried out using R software. Results EtG could be detected in 151 of 230 samples with concentrations ≥ 4.0 pg/mg (LOQ). The maximum measured concentration was 690 pg/mg. Twenty-five percent, 50% (median) and 75% percentiles were 6.8, 15, and 34 pg/mg, respectively. In 53 cases, EtG concentrations were ≥ 30 pg/mg, suggesting excessive alcohol consumption. The area under the ROC curve for EtG ≥ 30 pg/mg vs. PEth was 0.8322. In cases where PEth ≥ 210 ng/mL, more than 75% presented also EtG ≥ 30 pg/mg. PEth 16:0/18:1 detected in 218 of 233 samples with concentrations ≥ 10 ng/mL (LOQ). The maximum measured concentration was 1990 ng/mL. Twenty-five percent, 50% (median) and 75% percentiles were 71, 182, and 360 ng/ml, respectively. In 99 cases, PEth 16:0/18:1 concentrations ≥ 210 ng/mL, suggesting excessive alcohol consumption, were found. Compared to self-reported data (last week total alcohol intake diary), area under the ROC curve for PEth ≥ 210 ng/mL were 0.8174. For detecting a risky single occasion drinking (≥ 5 drinks at one occasion), the area under the ROC curve for PEth were 0.7955. Conclusion EtG and PEth measurement allowed detecting excessive alcohol consumption with high specificity and sensitivity. Both marker are complementary and do not necessarily provide the same information because of their different detection window and change of consumption during the evaluation period. The results support the statement in the SoHT consensus for the use of alcohol markers: “It is not advisable to use the results of hair testing for alcohol markers in isolation” [3] .

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.

Healthcare renunciation has been a recent focus of the public health debate, but large-scale investigations of healthcare renunciation are scarce. The goal of this study was to examine healthcare renunciation among young adults at French universities. It investigated prevalence of and reasons for healthcare renunciation and identified subgroups of vulnerable youths. Data were collected in the 2013 triennial study conducted by the French National Observatory of Student Life. That study had a sample of 35,810 18- to 25-year-old participants. Measures included healthcare renunciation, reasons for healthcare renunciation, demographics, cultural and socioeconomic background, health and social outcomes, healthcare system-related variables, and markers of adulthood. The results showed that the prevalence of healthcare renunciation was 27.2%. The most common reasons for healthcare renunciation were refusal renunciation (self-care, 12.7%; wait for improvement, 15.5%) and barrier renunciation (financial reasons, 12.1%; lack of time, 10.2%). Therefore, healthcare renunciation is linked not only to financial constraints but also to individuals' subjective needs and ways of facing illness. Overall, disadvantaged youths and youths transitioning to adulthood were likelier to renounce care, especially for financial reasons. To conclude, there are social inequalities in the use of healthcare by emerging adults in higher education in France. Emerging adulthood appears to be a risky period in which people are likely to renounce healthcare for multiple reasons. Support should be provided for vulnerable youths to prevent them from becoming increasingly vulnerable.

Switzerland reached the top five countries which have the highest rate of subjective well-being (SWB), which converges with the economic prosperity and high quality of life in this country. Based on transversal data (European Social Survey), SWB measured through a global question remained globally constant over the last decades. However, SWB declined between 2000 and 2015 when measured with longitudinal data (Swiss Household Panel, SHP). In this context, the aim of this contribution is to examine to what extent the decline in SWB in longitudinal data is a robust result showing an actual decrease or reflect some specific methodological artifacts of these data. We identified more precisely four possible methodological issues: non-random attrition (NRA), panel conditioning (PC), refreshment sample, and aging of participants. Because of its structure, SHP data are particularly appropriate to challenge these issues, with a special attention to panel conditioning on several measures of SWB (i.e., global question vs. questions by life domains). SHP has been administered annually since 1999. A first sample was randomly selected in 1999, a second sample in 2004, and a third sample in 2013. First, we found that attrition was selective in the predictors of SWB all along the waves and that the respondents leaving the panel were more frequently represented in modalities of predictors associated with lower SWB. Second, panel conditioning was found to affect SWB measure in the first five waves for the global question and no specific patterns for questions by life domains were found. Third, we found higher SWB mean score in new samples than in old ones. And fourth, we found that aging modified the characteristics of the sample—for example, an increase of inactive persons or a decrease of persons with a low education affected the levels of SWB. Thus, SWB and its determinants were affected by NRA, PC, refreshment, and aging. Moreover, it has to be noted that it was difficult or impossible to distinguish these methodological issues from one another—aging from PC or refreshment from PC for example—as well as to propose methodological “remedies” to them. Finally, it resulted from our research that once these methodological issues have been neutralized, SWB did not decline anymore over the last fifteen years in Switzerland.

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.

Introduction : Le monitoring de la tension arterielle a domicile est recommande par plusieurs guidelines et a ete montre etre faisable chez la personne âgee. Les manometres au poignet ont recemment ete proposes pour la mesure de la tension arterielle a domicile, mais leur precision n'a pas ete au prealable evaluee chez les patients âges. Methode : Quarante-huit participants (33 femmes et 15 hommes, moyenne d'âge 81.3±8.0 ans) ont leur tension arterielle mesuree avec un appareil au poignet avec capteur de position et un appareil au bras dans un ordre aleatoire et dans une position assise. Resultats : Les moyennes de mesures de tension arterielle etaient systematiquement plus basses avec l'appareil au poignet par rapport a celui du bras pour la pression systolique (120.1±2.2 vs. 130.5±2.2 mmHg, P < 0.001, moyenneideviation standard) et pour la pression diastolique (66.011.3 vs. 69.7±1.3 mmHg, P < 0.001). De plus, une difference de lOmmHg ou plus grande entre l'appareil au bras et au poignet etait observee dans 54.2 et 18,8% des mesures systoliques et diastoliques respectivement. Conclusion : Compare a l'appareil au bras, l'appareil au poignet avec capteur de position sous-estimait systematiquement aussi bien la tension arterielle systolique que diastolique. L'ampleur de la difference est cliniquement significative et met en doute l'utilisation de l'appareil au poignet pour monitorer la tension arterielle chez la personne âgee. Cette etude indique le besoin de valider les appareils de mesures de la tension arterielle dans tous les groupes d'âge, y compris les personnes âgees.

The aim of this study was to investigate the usefulness of postmortem biochemical investigations in the diagnosis of fatal hypothermia. 10 cases of fatal hypothermia and 30 control cases were selected. A series of biochemical parameters, such as glucose, acetone, 3-beta-hydroxybutyrate, isopropyl alcohol, free fatty acids, adrenaline, growth hormone, adrenocorticotropic hormone, thyroid-stimulating hormone, cortisol, calcium, magnesium, C-reactive protein, procalcitonin as well as markers of renal and cardiac functions were measured in blood, postmortem serum from femoral blood, urine, vitreous and pericardial fluid. The results suggested that deaths due to hypothermia, especially in free-ethanol cases, are characterized by increased ketone levels in blood and other biological fluids, increased adrenaline concentrations in urine, increased cortisol levels in postmortem serum from femoral blood and increased free cortisol values in urine. Increased or decreased levels of other biological parameters are either the result of terminal metabolic changes or the expression of preexisting diseases and may provide information to elucidate the death process on a case-by-case basis.

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 Alzheimer9s 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.

This article investigates whether immigrant self-employment is related more to segregation in the labour market than work as an employee (making it justifiable to speak of ethnic business) or whether, on the contrary, it reflects equality with the self-employment by the Swiss. The distinctive features of this research design are the comparison of ethnic segregation in the labour market with gender-specific segregation and the fact that, apart from migrants of the first generation, members of the second generation are also taken into consideration. The analyses show, firstly, that large differences exist between the various groups of migrants and that three patterns in immigrant self-employment become apparent. While for one person self-employment brings greater adjustment to the Swiss in comparison with working as an employee, for another it is associated with greater segregation. The third pattern reveals that self-employment can be an expression of “superstratification” (Überschichtung). Secondly, the analyses indicate that, for the self-employed, gender-specific horizontal and vertical segregation tends to be smaller than for employees. However, in the upper positions of the social space, greater gender-specific inequalities can be observed than in the lower positions, thus making “class” and “gender” intersect as structural categories of social inequality.

La mesure ambulatoire de la pression artérielle (MAPA) est devenue un outil indispensable dans le diagnostic et le contrôle de la pression artérielle (PA). Il n’existe cependant aucun consensus concernant la définition des périodes diurnes ou nocturnes lors des MAPA. But de l’étude Comparer les valeurs de PA diurnes et nocturnes et la baisse nocturne de la PA (dipping) définies par un actigraphe et par la position du corps aux valeurs calculées sur des périodes fixées arbitrairement. Patients et méthodes Enregistrement simultané de la MAPA, des périodes de sommeil et de la position du corps (débout/allongé) par un actigraphe (SenseWear Armband®) chez des patients référés pour une MAPA. Les résultats obtenus par l’actigraphe (sommeil et position) étaient comparés aux résultats obtenus par une période de jour (07 h 00–22 h 00) et de nuit (22 h 00–07 h 00) fixées arbitrairement. Resultats Les données de 103 patients, dont plus de la moitié étaient traités pour une hypertension, ont été analysées. Par rapport aux périodes fixées arbitrairement, les PA nocturnes étaient plus basses (PA systolique : 2,08 ± 4,50 mmHg ; PA diastolique : 1,84 ± 2,99 mmHg, p < 0,05) et le dipping était plus marqué (PA systolique : 1,54 ± 3,76 % ; PA diastolique : 2,27 ± 3,48 %, p < 0,05) lorsque la période nocturne était définie par l’actigraphe. Les valeurs en position debout étaient supérieures (PA systolique : 1,07 ± 2,81 mmHg ; PA diastolique : 1,34 ± 2,50 mmHg) aux valeurs diurnes de la période diurne fixée. Conclusion La PA diurne et nocturne ainsi que le dipping sont influencés par la méthode utilisée pour définir l’intervalle nocturne. Le choix d’une méthode par rapport à une autre dépendra de la valeur pronostique de chaque méthode sur des évènements cardiovasculaires. 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 (7 a.m.–10 p.m.) and nighttime (10 p.m.–7 a.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 ± 4.50 mmHg; diastolic BP: 1.84 ± 2.99 mmHg, 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 ± 2.81 mmHg; diastolic BP: 1.34 ± 2.50 mmHg) 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.

Background The quantification of total (free + sulfated) metanephrines in urine is recommended to diagnose pheochromocytoma. Urinary metanephrines include metanephrine itself, normetanephrine and methoxytyramine, mainly in the form of sulfate conjugates (60–80%). Their determination requires the hydrolysis of the sulfate ester moiety to allow electrochemical oxidation of the phenolic group. Commercially available urine calibrators and controls contain essentially free, unhydrolysable metanephrines which are not representative of native urines. The lack of appropriate calibrators may lead to uncertainty regarding the completion of the hydrolysis of sulfated metanephrines, resulting in incorrect quantification. Methods We used chemically synthesized sulfated metanephrines to establish whether the procedure most frequently recommended for commercial kits (pH 1.0 for 30 min over a boiling water bath) ensures their complete hydrolysis. Results We found that sulfated metanephrines differ in their optimum pH to obtain complete hydrolysis. Highest yields and minimal variance were established for incubation at pH 0.7–0.9 during 20 min. Conclusion Urinary pH should be carefully controlled to ensure an efficient and reproducible hydrolysis of sulfated metanephrines. Synthetic sulfated metanephrines represent the optimal material for calibrators and proficiency testing to improve inter-laboratory accuracy.

Objective : Frequent Emergency Department (ED) users are vulnerable individuals and discrimination is usually associated with increased vulnerability. The aim of this study was to investigate frequent ED users' perceptions of discrimination and to test whether they were associated with increased vulnerability. Methods : In total, 250 adult frequent ED users were interviewed in Lausanne University Hospital. From a previously published questionnaire, we assessed 15 dichotomous sources of perceived discrimination. Vulnerability was assessed using health status: objective health status (evaluation by a healthcare practitioner including somatic, mental health, behavioral, and social issues - dichotomous variables) and subjective health status [self-evaluation including health-related quality of life (WHOQOL) and quality of life (EUROQOL) - mean-scores]. We computed the prevalence rates of perceived discrimination and tested associations between perceived discrimination and health status (Fischer's exact tests, Mann-Whitney U-tests). Results : A total of 35.2% of the frequent ED users surveyed reported at least one source of perceived discrimination. Objective health status was not significantly related to perceived discrimination. In contrast, experiencing perceived discrimination was associated with worse subjective health status (P Conclusion : Frequent ED users are highly likely to report perceived discrimination during ED use, and this was linked to a decrease in their own rating of their health. Hence, discrimination should be taken into account when providing care to such users as it may constitute an additional risk factor for this vulnerable population. Perceived discrimination may also be of concern to professionals seeking to improve practices and provide optimal care to frequent ED users.