Search

BackgroundThe mechanism underlying the health care cost trajectories among asylum seekers is not well understood. In the canton of Vaud in Switzerland, a nurse-led health care and medical Network for Migrant Health (“Réseau santé et migration” RESAMI) has established a health care model focusing on the first year after arrival of asylum seekers, called the “community health phase”. This model aims to provide tailored care and facilitate integration into the Swiss health care system. The aim of this study is to explore different health care cost trajectories among asylum seekers during this phase and identify the associated factors.MethodsWe detected different patterns of health care cost trajectories using time-series clustering of longitudinal data of asylum seekers in the canton of Vaud in Switzerland. These data included all adult asylum seekers and recipients of emergency aid who entered the canton between 2012 and 2015 and were followed until 2018. The different clusters of health care cost trajectories were then described using a multinomial logistic regression model.ResultsWe identified a concave, an upward trending, and a downward trending cluster of health care cost trajectories with different characteristics being associated with each cluster. The likelihood of being in the concave cluster is positively associated with coming from the Eastern Mediterranean region or Africa rather than Europe and with a higher share of consultations with an interpreter. The likelihood of being in the upward trending cluster, which accrued the highest costs, is positively associated with 20–24-year-olds rather than older individuals, coming from Europe than any other region and having a mental disorder. In contrast to the other two clusters, the likelihood of being in the downward trending cluster is positively associated with having contacted the RESAMI network within the first month after arrival, which might indicate the potential of early intervention. It is also positively associated with older age and living in a group lodge.ConclusionsAsylum seekers are heterogeneous in terms of health care cost trajectories. Exploring these differences can help point to possible ways to improve the care and supporting services provided to asylum seekers. Our findings could indicate that early and patient-centered interventions might be well-suited to this aim.

A Pseudomonas aeruginosa (isolate 416) from a patient with pneumonia, was initially susceptible to imipenem (MIC: 2 mg/l) but became resistant to this antibiotic (isolate 470, MIC: 32 mg/l) during imipenem therapy. Treatment failed. No parallel increases in MIC were observed for other antimicrobials tested. Isolates 416 and 470 shared the same pyocin type and serotype, produced small amounts of an inducible β-lactamase, and had similar lipopolysaccharide compositions. On electrophoresis of outer membrane proteins, the porin F, identified by the monoclonal antibody MA4-4, was expressed similarly by the two isolates but the production of one band (apparent molecular weight 47,000) was diminished in isolate 470. [14C]-Imipenem labelling of intact cells proceeded more slowly in 470 than in 416, especially when bacterial cells were treated by antibody MA4-4 to block the porin F channel. [14C]-Imipenem labelling of penicillin binding proteins (PBP) showed that the band identified as PBP-4 bound markedly less radioactivity in isolate 470 than in 416. After isolate 470 was passaged several times in antibiotic-free broth, the imipenem MIC was decreased from 32 to 8 mg/l, and the [14C]-imipenem PBP pattern recovered the initial profile as exhibited by isolate 416. Two resistance mechanisms, affecting imipenem electively, could have combined their effect in the post-therapy isolate, altered target protein and reduced permeability

Little is known about how many bacteria are present at an infectious focus at the onset of antibiotic therapy. The number of cfu was determined in pus and infected peritoneal fluids obtained from 41 patients. Pathogens were detected in 71% of specimens. There were high concentrations of bacteria in culture-positive samples, in both soft-tissue and peritoneal infections, averaging 2 x 10(8) cfu/mL. These concentrations were much higher than the standard inoculum size used in in-vitro susceptibility tests, 5 x 10(5) cfu/mL. The impact of this discrepancy on antibacterial efficacy was studied with amikacin, ciprofloxacin, imipenem and piperacillin against Escherichia coli and Staphylococcus aureus. The inhibitory and bactericidal activities of amikacin and ciprofloxacin determined with high inocula were two to four times lower than with standard inocula, whereas the activity of piperacillin was diminished at least 128-fold. Similar activity was observed with these drugs in Mueller-Hinton broth and peritoneal fluid. The bactericidal activity of imipenem was reduced in peritoneal fluid. Thus, conditions prevailing at the infection site may compromise antibiotic activity determined in vitro

Einleitung: In Deutschland werden Kinder mit akuter Appendizitis sowohl durch Allgemeinchirurgen (ACH) und Kinderchirurgen (KCH) in offen chirurgischer als auch laparoskopischer Technik operiert. Als Ursache für chirurgische Komplikationen werden verschiedene Faktoren diskutiert. Ziel dieser Studie[for full text, please go to the a.m. URL], 132. Kongress der Deutschen Gesellschaft für Chirurgie

Deux logiciels de dictée en langue allemande ont été étudiés dans une division de médecine interne. L'acuité de reconnaissance a pu être améliorée de 92–94% par des optimalisations successives durant un mois, de 97% pour des lettres courtes standardisées et des textes qui se répètent. Le temps de production pour les médecins pour les lettres de sortie complètes est resté inchangé par opposition aux lettres courtes. Cependant, toutes les lettres étaient plus rapidement disponibles. Les expériences de cet essai-pilote ont permis de documenter des difficultés d'ordre pratique qui limitent à l'heure actuelle l'utilisation à grande échelle de cette technologie à l'hôpital. Les conditions principales sont, en plus d'un logiciel adéquat, un choix judicieux des domaines d'application, un environnement calme et un utilisateur motivé.

Steffen M. Zeisbergera,b, Max Durstelerc, Rainer Warthd, Peter Schramle, Daniel Simeon-Dubachd, Simon P. Hoerstrupa,b, Jurg Blaserf a Zentrum Regenerative Medizin (ZRM), UniversitatsSpital Zurich (USZ) und Universitat Zurich (UZH), b Forschung Chirurgie, Herzchirurgie, Univer sitatsSpital Zurich (USZ) c Direktion ICT, UniversitatsSpital Zurich (USZ) d biobank-suisse (BBS), Bern e Institut Klinische Pathologie, UniversitatsSpital Zurich (USZ) f Forschungszentrum Medizininformatik Direktion F&L, UniversitatsSpital Zurich (USZ)