Bulletin de la Societe des sciences medicales du Grand-Duche de Luxembourg最新文献

"Change", "transformation" and "evolution" are terms not at all interchangeable. They point at realities and deeply apply to mechanisms which partially intertwine each other without ever being overlapped or confused. We would like to distinguish and investigate their diffusion in former and current psychological approaches, especially when dealing with the analysis and follow-up of a moving process. We will present some illustrations, in the field of the phenomeno-structural method, which, after having dedicated an important part of its works to the enlightment of the organization of the mental structure, from 1920 to 1950, felt the need, from the 50's onwards, to follow its evolution through a set of psychological modifications pointing in a main direction: during normal and pathological development throughout childhood or at the critical moment of the adolescence period, in psychosurgery or psychobiological practices, then in cases of appearing and disappearing of delusional processes, in the follow-up of determining transformation phases during alcoholic detoxification, or, more recently, in the appreciation of the psychotherapeutic practices (directed daydream, relaxation). We will show how this perspective, standing apart and suspicious to the restrictive current tendency towards evaluation, takes part in a much wider theoretical and methodological frame with a constant concern to consider the sustainable effects and the limits of various events, circumstances or procedures on the structure of personality, through a vast and coherent understanding of the underlying psychological mechanisms which steer them by giving them sense.

Standard cluster analysis creates clusters based on the criterion that their members be closer to each other than to members of other clusters. In this article, it is proposed to examine empirical clusters that result from standard clustering, with the goal of assessing whether they contradict distributional assumptions. Four models are proposed. The models consider two data generation processes, the Poisson and the multinormal, as well as two convex shapes of cluster hulls, the spherical and the ellipsoidal. Based on the model, the probability of being in a cluster of a given location, size, and shape is estimated. This probability is compared with the observed proportion of cases. The observed proportion can turn out to be larger, as large, or smaller than expected. Examples are given using simulated and empirical data. The simulation showed that the size of a cluster, the data generation process, and the true distribution of data have the strongest effect on the results obtained with the proposed method. The empirical examples discuss distributional characteristics of cross-sectional and longitudinal clusters of aggressive behavior in adolescents. The examples show that clustering methods do not always yield clusters that contradict distributional assumptions. Some clusters contain even fewer cases than expected.

Childrens' externalizing behaviors such as aggression, delinquency and impulsivity are serious problems in many societies. In previous person-oriented analyses we found two types of externalizing problems in boys. One pattern contained externalizing problems only, whereas the other type showed both externalizing and internalizing problems (anxiety, depression etc.). The present study addressed these two groups in a prospective longitudinal design. It was investigated whether the previous descriptive findings remained stable over time and, in particular, whether the two types differed in important risk factors for antisocial behavior. The sample consisted of 198 boys from the Erlangen-Nuremberg Development and Prevention Study. The first assessment took place in kindergarten and the second 3.4 years later in elementary school. The behavior problems were assessed by ratings of kindergarten teachers and elementary school teachers using the Social Behavior Questionnaire (SBQ). The risk factors were low socio-economic status of the family, birth complications, physical punishment in parenting behavior, difficult temperament, low intelligence, and aggression-prone social information processing of the child. Approximately 15% of the boys revealed externalizing behavior problems. A variable-oriented analysis showed significant stability over time. In a person-oriented Configural Frequency Analysis the 'externalizing only' and the 'combined externalizing and internalizing' pattern could be replicated. For five of the six risk factors we found significant differences between the boys with behavior problems and a non-deviant group. However, the two different patterns of externalizing problems differed only in intelligence (lower for the group with combined problems). The results confirm models of cumulative biological, psychological and social risks for antisocial behavior over time. Furthermore, specified analyses of the two types and their relation to proactive and reactive aggression are recommended.

Retrospective study on a nine year ART practice focusing on pregnancy outcomes and multiple pregnancies, their complications, the gestational duration, delivery options, the new born weights and health statements til the age of two. Post ART pregnancies seem to have an increased complication rate; multiple births are more frequent than with spontaneous conception. The first chapter deals with the entire group. The second chapter analyses several sub-groups according to the ART method employed. The results are compared to publications in PubMed and Medline.

2D-shape analysis of biological objects is described first in 2007 with MRI-data (magnetic resonance imaging) of renal tumours of infancy. For shape analysis the evaluation of landmarks is necessary (n >2). In this study 24 landmarks are selected. Every object is described by these landmarks. The shape is the standardised and centred object. The procedure is applied on transversal as well as on frontal images. The results for frontal and transversal images are compared. Tumours of different origin, topography and size can be analysed. The differentiation of relevant landmarks is important for statistical and medical reason. In this study, evaluation of landmarks and their possibility for tumour differentiation is demonstrated.

Nowadays, as a result of the global competition encountered, numerous companies come up against financial distresses. To predict and take proactive approaches for those problems is quite important. Thus, the prediction of crisis and financial distress is essential in terms of revealing the financial condition of companies. In this study, financial ratios relating to 156 industrial firms that are quoted in the Istanbul Stock Exchange are used and probabilities of financial distress are predicted by means of an ordered logit regression model. By means of Altman's Z Score, the dependent variable is composed by scaling the level of risk. Thus, a model that can compose an early warning system and predict financial distress is proposed.

Aims: The objective of this study was to assess the adherence to national guidelines on cardiovascular prevention and target attainment for patients with type 2 diabetes mellitus followed-up in general practice.

Methods: Non-interventional, cross-sectional survey.

Results: 606 patients have been considered in this analysis. Type 2 diabetes patients remain undertreated with statins (63% treated), even so those with a cardiovascular history (80% treated). Although more patients received antihypertensive treatment (82%) compared to hypolipidemic medication (69%), the proportion of patients attaining targets for total (35%), HDL (65%), and LDL-cholesterol (42%) exceeded far those attaining blood pressure control (13%). The primary endpoint of reaching the goal for LDL-cholesterol (<100 mg/dL) was attained by 42% of patients, of which only 13% reached the more stringent target of LDL-C <70 mg/dL. About half of the patients attained glycemic control (HbA1c <7%, 49%) and had triglycerides <150 mg/dL (55%).

Conclusions: The majority of type 2 diabetes patients are treated for hypercholesterolemia and hypertension, although, there is still undertreatment with statins, especially in patients with CV disease. Only 42% of patients were on target for LDL-cholesterol and 13% for blood pressure. Therefore, wider implementation of process and outcome indicators, which proved to be related, and continuous evaluation of their result, is needed.

Unlabelled: In Luxemburg, the national breast cancer mammography screening programme has been running for 18 years. The Coordinating Centre treats approximately 17,000 files a year. The Health Directorate, as promoter of the "Programme Mammographie", is obliged to provide itself with a maximum of guarantees; within the framework of its legal missions, it has to implement all the possible means in order that the whole approach assures minimal adverse effects. The technical quality of the 9 centres is at the level required by the European Guidelines for Quality Assurance in Mammography Screening and Diagnosis, 4th edition. The quality of the readings was already the subject of 2 evaluations of the performance of the readers: the mean accuracy of the first readers to detect cancers is 87%, of the second readers 97%. The mean recall rate for assessment is about 6%. The double reading assures the detection of between 15 and 21% additional cancers, depending on the years. The imaging of diagnostic assessment has been the subject of a retrospective study. Out of 392 cancers, time from assessment to diagnosis was longer then 24 months for 17 women (4%). Examples are described and reasons for negative assessment are listed. The main cause is the multiplicity of the doctors acting in the assessment process, resulting in a default of the examination synthesis and a certain lack of communication and multidisciplinary approach. More convergence in diagnostic breast assessment and a shortening of delays between screening and diagnosis, are desirable.

In conclusion: The evolution towards Specialist Centres for breast cancer care answers an ethical obligation which the initiators of a public health programme have to assume, such as the organization of a high quality breast cancer screening programme.