[Desire disorders in the couple: accident, dream, sexuality]. / Troubles du désir dans le couple; accident, rêve et sexualité.

Eros, as few only would doubt about it, takes part in the deepest and most intimate area of the human being. Our contemporaries attach great importance to sexuality, but feed the illusion that mastering it could lead to miracles in the couple. We suggest that giving up control and committing himself to fully listening to the patient, the physician will be able to orient him in the blind rules of desire and to accept fortuity. Unexpected (?) accident, dream, hypnosis, often powerfully catalyze changes. Some clinical situations are described in this article with their evolution as consultations develop, without foreseeing their interpretation.

[Onirism, a renewal of sexual identity]. / Onirisme et renouvellement de l'identité sexuelle.

Unity in complementarities of genders represents an almost universal sexual fantasy between man and woman, hardly ever object of scientific discussion. In line with tradition, medical education loses indeed insight into the evolutionary nature of sexuality. Sexologists do actually stress the importance of the struggle for pleasure in the healing processes, but too often neglect the nocturnal and the subconscious mind. An "avant-garde" medical approach, based on medical onirologie, could develop a critical approach to overidealization and promote multiple "erotic mind-body experiences", i.e., sources of renewed identities.

[Horses in Switzerland: results of a representative survey of population, housing and use in 2004]. / Pferde in der Schweiz: Ergebnisse einer repräsentativen Befragung zu Populationszusammensetzung, Haltung und Nutzung im Jahr 2004.

A survey of 2559 stables, representative for Switzerland, was conducted in the year 2004, with questions related to age, sex, breed, housing conditions, social contact, use, feeding, ability to move freely on the one hand, and health prophylaxis and health disorders in the past 12 months on the other. With a respond rate of 30.9% to the questionnaire, data for 2912 horses and ponies were recorded. The data were compared to a previous survey of 1997 (Bachmann & Stauffacher, 2002). In this study, data on population, housing and use were analysed. The proportion of horses kept individually, especially in tie-stalls, had substantially decreased since 1997, whereas the proportion of horses living in group housing systems had increased. In 2004, Warmblood and Thoroughbred were kept more often individually than in groups in comparison to other breeds. Swiss Franches-Montagnes horses were kept more often tied up than horses of all other breeds. Access to pasture or paddock was available more often in horses kept in structured group housing systems, but in general more restricted in the winter season. A correlation between use or intensity of use and frequency of pasture/paddock access was not evident. Even though horses older than 20 years were more rarely used or intensively used, they were not stabled differently from younger horses.

[Frequency of diseases and injuries in the Swiss horse population]. / Häufigkeiten von Erkrankungen und Verletzungen in der Schweizer Pferdepopulation.

Through a written questionnaire, which was sent to a representatively distributed and randomly selected sample of Swiss horse owners, data of 2912 horses and ponies were acquired to extrapolate prevalence data of health disorders. General questions about the horse and associated factors of housing and use, as well as questions about the current health status and the occurrence of diseases and injuries had been asked. 718 horses (24.7% of the sample) had been examined by a veterinarian within the 12 months prior to the survey. Orthopaedic and traumatic disorders (41.5%) had the largest proportion, followed by gastrointestinal--(27.1%) and respiratory (14.0%) diseases. Half of the lameness cases occurred as a direct consequence of a injury. The injuries were associated with pasture/paddock (38.1%), kicking and biting (21.6%), boxstall (7.8%), terrain and hacking (13.4%), training (3.5%), competition (3.5%), transportation (3.0%) or other circumstances (9.1%). A change in feeding management up to 4 weeks before development of a colic episode occurred in 26.5% of all colic cases. In 13.8% of all respiratory cases the same disease was diagnosed in other horses in the same barn. 8.1% of all cases had to be treated surgically, 6.7% required hospitalization for several days. Information about diagnostic or therapeutic procedures was related to specific disease categories. In 25.6% of all cases diagnosed by a veterinarian alternative therapeutic methods were used either in addition to traditional medicine or exclusively.

Bite and kick injuries in horses: prevalence, risk factors and prevention.

REASON FOR PERFORMING STUDY: Studies on the prevalence and predisposing factors of bite and kick injuries in horses have not been reported in a population-based data sample. OBJECTIVES: To investigate the prevalence of bite and kick injuries in horses and associated risk factors in a representative sample of horses in Switzerland. METHODS: A questionnaire on the incidence of disease and injury, which included the frequency of bite and kick injuries and their association with breed, housing, use and feeding regime, was sent to 2559 horse owners randomly selected throughout Switzerland. RESULTS: The data of 2912 horses with 897 disorders diagnosed by a veterinarian were analysed. There were 231 injuries, 50 (21.6%) caused by a bite or kick from another horse; this number corresponded to 5.6% of all diseases and injuries and concerned only 1.7% of all the horses evaluated. Warmblood, Thoroughbred and Arabian horses had a 4.3 times higher risk of bite or kick injuries than horses of other breeds. Eighteen per cent of injuries were associated with a change in housing management and occurred regardless of whether horses were kept in groups permanently or sporadically. CONCLUSIONS AND POTENTIAL RELEVANCE: A stable group hierarchy and a housing system that provides adequate space and is adapted to horse-specific behaviour are important factors in prevention and kick and bite injuries.

[Castration of calves: a survey among Swiss suckler beef farmers]. / Kälberkastration: Eine Befragung von Schweizer Mutterkuhhaltern.

In fall 2004, a survey of a representative sample of 1185 Swiss suckler beef farmers was carried out by questionnaire (return rate 51.9%). 32.7% of the respondents castrated their calves without the help of a veterinarian, 37.8% mandated a veterinarian to carry out the castrations and 29.4% did not castrate their bull calves at all. On average, 8 calves were castrated per farm and year at an average age of 7 days when the castration was carried out by a farmer or 34 days when the castration was carried out by a veterinarian. Almost all farmers castrated their calves with the rubber ring, and a majority considered no other method as feasible. 73.9% of the veterinarians used the Burdizzo technique, 14.9% applied rubber rings, and 11.2% performed a surgical procedure. 22.6% of the farmers and 85.4% of the veterinarians used sedation; local anaesthesia was performed in 32.1% of the castrations carried out by farmers and in 84.5% of the castrations carried out by veterinarians. 65.7% of the farmers were concerned by the change of the Swiss Animal Protection Ordinance (2001), when pain relief became mandatory. 47.6% of these farmers changed their castration routine: 53.1% now mandated a veterinarian, 33.0% used sedation or local anaesthesia and 8.9% abandoned castration of their calves. 59.8% of the farmers intended to participate in a future course for laymen, to study and train the technique of local anaesthesia for castration. Castration of their calves is for many suckler beef farmers an inevitable husbandry procedure. The political goal, that all calves shall be castrated with local anaesthesia can only be reached when livestock owners are informed about the distress caused by the castration and convinced of the benefit of the local anaesthesia. Veterinarians are important information carriers in this process. The implementation also produces work, be it the more complex castration procedure or the education of the farmers who want to carry out the local anaesthesia themselves.

The association between heart rate, heart rate variability, endocrine and behavioural pain measures in horses suffering from laminitis.

The objective of this study was to compare the stress response of horses suffering from laminitis after short- and long-term treatment with the intent to evaluate power spectral analysis of heart rate variability (HRV) for pain monitoring. Data were collected from 19 horses with acute or chronic exacerbating laminitis without known primary disease before and after treatment with non-steroidal anti-inflammatory drugs (NSAID). Recordings were carried out the day after admission to the equine hospital. Measurements were repeated on day 7 of the treatment. The recorded parameters included a clinical orthopaedic index (OLPI: Obel-grade plus hoof tester score), frequency of weight-shifting between contralateral limbs, mean beat-to-beat interval (R-R) duration, standard deviation of continuous R-R intervals, low- (LF) and high-frequency (HF) components of HRV, sympatho-vagal balance (LF/HF), and plasma concentration of cortisol, adrenalin and noradrenalin. The LF represents mainly sympathetic influences on the heart whereas HF is mediated by the parasympathetic tone. Weight-shifting and OLPI decreased significantly with treatment. The LF normalized units (n.u.) decreased after NSAID from 60.41 +/- 21.42 to 51.12 +/- 19.81 and was 49.33 +/- 22.64 on day 7, whereas HF n.u. increased from 35.07 +/- 20.02 to 43.14 +/- 18.30 and was 45.98 +/- 23.00 on day 7. Hormone levels showed no tendency to change with treatment. The OLPI was only correlated with LF/HF, LF and HF (R = 0.57, 0.55 and -0.54 respectively). Significant negative correlations existed between HFn.u. and weight-shifting frequency (R = -0.37), HFn.u. and adrenalin (R = -0.47), and HFn.u. and noradrenalin (R = 0.33). The LFn.u. only correlated positively with adrenalin. Cortisol levels were poorly associated with the other parameters. Determination of the sympatho-vagal influences on cardiac function may offer complementary information for reliable assessment of pain and may represent a valuable alternative method to catecholamine measurements.

How farmers in Switzerland perceive fertilizers from recycled anthropogenic nutrients (urine).

We studied acceptance of a urine-based fertilizer product using a mail survey of 467 Swiss farmers. We distinguished among four production types: organic or IP farming, and with or without vegetable production. Considering that the idea of urine-based fertilizers is new, acceptance among the answering farmers was surprisingly high, with 57% explicitly stating that they thought it was a good or very good idea, and 42% willing to purchase such a product. The farmers of different production types did not differ strongly in their attitude towards urine-based fertilizers. Especially IP and vegetable farmers, who purchased additional fertilizers anyway, seem willing to accept urine-based fertilizers, hereby preferring a grainy, odorless ammonium nitrate fertilizer. Absolutely essential is a hazard-free product: 30% of all farmers had concerns regarding micropollutants. Based on fertilizer data, we demonstrate an existing demand for the nutrients N, P, and K in Switzerland, which could be partially substituted by a recycled urine product. Finally, we discuss methodological requirements of social science surveys. To obtain representative data on an entire population in a mail survey, multiple contacts with respondents are necessary. We argue that information and participation of stakeholders at an early stage is essential for successful technology transfer.

Risk factors associated with behavioural disorders of crib-biting, weaving and box-walking in Swiss horses.

REASONS FOR PERFORMING STUDY: Studies on the prevalence of behavioural disorders in horses and on associated risk factors have revealed inconsistent results. There are many studies on the neuropharmacological, surgical or mechanical therapy of stereotypies, but little is known about their causation. OBJECTIVES: To explore risk factors associated with the occurrence of behavioural disorders in horses. METHODS: A sample of horse owners, selected randomly and representative for Switzerland, was contacted in a postal survey. Answers were provided for 622 stables (response rate 35.2%). Individual data of 2,341 horses were examined with path analysis (multivariable linear and logistic regression), and adjustment made for possible confounding effects due to age and breed. RESULTS: Out of 60 possible risk factors, 11 were associated with the outcome at the univariable level (null-hypothesis path model) and 3 factors remained after the backward logistic regression procedure. Mature Warmbloods and Thoroughbreds, assessed by the owners to be reactive, fed 4 times a day and without daily pasture, had increased odds of displaying crib-biting, weaving and box-walking. Furthermore, indirect associations of 5 factors with the outcome were identified. CONCLUSIONS: The final logistic regression model of risk factors leads to the hypotheses that causal prevention of stereotypic behaviours should be based upon housing and management conditions which allow tactile contact with other horses (e.g. mutual grooming), daily free movement (paddock or pasture), as well as the provision of high amounts of roughage but of little or no concentrates. POTENTIAL CLINICAL RELEVANCE: It is one of the aims of population medicine to prevent the development of behavioural disorders. Further research is needed to test the concluding hypotheses in experimental studies or to verify them in the context of similar observational studies.

[Housing and use of horses in Switzerland: a representative analysis of the status quo]. / Haltung und Nutzung von Pferden in der Schweiz: Eine repräsentative Erfassung des Status quo.

Out of a representative sample of 1861 Swiss horse yards, 622 horse keepers (35.2%) with 2536 horses, ponies and donkeys sent back a questionnaire about general farm characteristics, their horse-specific training, horse stock, housing conditions, intraspecific social contacts, feeding, ability to move freely, use of the horses and management. 83.5% of horses were kept individually (thereof 18.3% tethered, 32.3% in a loose box indoors, 28.4% in a loose box outdoors, and 4.5% in a loose box with permanent access to a paddock or an individual pasture), and 16.5% lived in group housing systems. 36% of the horses had daily access to a pasture, 62.8% depending on the weather, and 1.2% never at all. Individually housed horses pastured significantly less than horses kept in groups. The mean use per week was 4.5 hours, depending on breed, type of use and housing system. Only 50% of the horse keepers were trained with respect to horses or farm animals (e.g. professional training graduation, license, military service, veterinarian, farmer). In Switzerland, horses are still housed and fed in a traditional way, despite considerable recent changes in the amount and type of use (65.1% leisure horses, 34.9% sport and working horses); this may result in health and behavioural problems. Therefore, information and education of horsewomen and horsemen should be emphasized in the future. For the transfer of knowledge, veterinarians are of high importance.

[Prevalence of behavioral disorders in the Swiss horse population]. / Prävalenz von Verhaltensstörungen in der Schweizer Pferdepopulation.

In the Swiss horse population, the prevalence of conspicuous behaviours (behavioural disorders and stable vices) was recorded with a written questionnaire in a representative survey among 1861 horse yards, and the occurrence of the stereotypic behavioural disorders crib-biting, weaving and boxwalking was analysed with emphasis on their association with horse specific (breed, age, sex) and environmental factors (e.g. housing system, nutrition, management and utilisation). 622 horse yards with a total number of 2536 horses answered to the questionnaire, and conspicuous behaviours were described for 418 horses (16.5%). Thereof, the most common stereotypic behavioural disorders with a potential negative impact on animal welfare, crib-biting, weaving, and/or boxwalking were named for 89 horses (3.5%). Stable vices (e.g. shying, bucking, aggressivity against humans) were noted for 47 horses (1.9%). For 281 horses (11.1%) conspicuous behaviours such as pawing, lip-liking, head shacking, kicking stall were given; these can be categorised as behavioural disorders or as stable vices depending on their intensity and causation. Data analysis data revealed a number of statistically significant associations between genetic factors (breed), housing, management practices, utilisation and the three stereotypies. The strongest influence on the degree of behavioural disorders had the breed as well as the extent of direct social contact with other horses, free movement on pasture, feeding pattern and regular utilisation.

Randomized clinical trial of a quality improvement intervention in nursing homes.

PURPOSE: The purpose of the study was to determine if simply providing nursing facilities with comparative quality performance information and education about quality improvement would improve clinical practices and subsequently improve resident outcomes, or if a stronger intervention, expert clinical consultation with nursing facility staff, is needed. DESIGN AND METHODS: Nursing facilities (n = 113) were randomly assigned to one of three groups: workshop and feedback reports only, workshop and feedback reports with clinical consultation, and control. Minimum Data Set (MDS) Quality Indicator (QI) feedback reports were prepared and sent quarterly to each facility in intervention groups for a year. Clinical consultation by a gerontological clinical nurse specialist (GCNS) was offered to those in the second group. RESULTS: With the exception of MDS QI 27 (little or no activity), no significant differences in resident assessment measures were detected between the groups of facilities. However, outcomes of residents in nursing homes that actually took advantage of the clinical consultation of the GCNS demonstrated trends in improvements in QIs measuring falls, behavioral symptoms, little or no activity, and pressure ulcers (overall and for low-risk residents). IMPLICATIONS: Simply providing comparative performance feedback is not enough to improve resident outcomes. It appears that only those nursing homes that sought the additional intensive support of the GCNS were able to effect enough change in clinical practice to improve resident outcomes significantly.

Enrichment-dependent differences in novelty exploration in rats can be explained by habituation.

In rats, exploratory activity and emotional reactivity towards novel stimuli reflect independent biological functions that are modulated differently by rearing experiences. Environmental enrichment is known to improve performance in exploratory tasks, while having inconsistent effects on emotionality. This study examined the effect of environmental enrichment on the behaviour of rats in two exploratory tasks. Male rats were reared under one of four conditions, differing in social and non-social complexity. At 9 weeks of age, exploration of a novel open field, and exploration of novel objects in the same open field following 24 h habituation, was assessed. Differences in social and non-social complexity of the rearing environment had inconsistent effects on exploration in the novel open field. In contrast, when rats were faced with novel objects in an otherwise familiar environment, exploration habituated faster with increasing stimulus complexity of the non-social environment. The social environment had no effect on this latter test. These findings indicate that environmental enrichment affects exploratory activity primarily through its effect on habituation to novelty. This effect depends on relative stimulus complexity of the rearing environment, but is independent of social factors. The present results further suggest that aversive tasks can obscure the expression of enrichment-dependent differences in habituation to novelty.

Development of health care delivery systems that are sensitive to the needs of stroke survivors and their caregivers.

The life-altering event of a stroke has long-term effects not only on stroke survivors but also on their caregivers, health care professionals, and health care delivery systems. The nurse administrator is faced with an obvious challenge to organize nursing systems to meet the multiple needs of the stroke survivor. The article presents data on the perceived needs of stroke survivors and their caregivers that provide direction and assistance to nursing administrators in organizing nursing services to address these perceived needs.

Initial field testing of an instrument to measure: observable indicators of nursing home care quality.

The "Observable Indicators of Nursing Home Care Quality" instrument was developed as a new measure of nursing home care quality. The instrument is based on a theoretical model of quality nursing home care grounded in data from provider and consumer focus groups. The instrument was piloted in 10 Missouri nursing homes. Subsequent versions were tested in 109 Missouri and 11 Icelandic nursing homes. Content validity was established using experts. Concurrent and known groups validity was evaluated using Minimum Data Set quality indicators, survey citations, and a process of care measure. Interrater and test-retest reliabilities were calculated as well as coefficient alpha. The "Observable Indicators of Nursing Home Care Quality" instrument is a new measure that can be used by researchers, and potentially by regulators, consumers, or providers, to observe and score specific indicators of quality care following a 20- to 30-minute inspection of a nursing home.

Setting thresholds for quality indicators derived from MDS data for nursing home quality improvement reports: an update.

BACKGROUND: Determining meaningful thresholds to reinforce excellent performance and flag potential problem areas in nursing home care is critical for preparing reports for nursing homes to use in their quality improvement programs. This article builds on the work of an earlier panel of experts that set thresholds for quality indicators (QIs) derived from Minimum Data Set (MDS) assessment data. Thresholds were now set for the revised MDS 2.0 two-page quarterly form and Resource Utilization Groups III (RUGS III) quarterly instrument. SETTING THRESHOLDS: In a day-long session in October 1998, panel members individually determined lower (good) and upper (poor) threshold scores for each QI, reviewed statewide distributions of MDS QIs, and completed a follow-up Delphi of the final results. REPORTING MDS QIS FOR QUALITY IMPROVEMENT: The QI reports compiled longitudinal data for all residents in the nursing home during each quarter and cumulatively displayed data for five quarters for each QI. A resident roster was provided to the nursing home so that the quality improvement team could identify the specific residents who developed the problems defined by each QI during the last quarter. Quality improvement teams found the reports helpful and easy to interpret. SUMMARY AND CONCLUSIONS: As promised in an earlier report, to ensure that thresholds reflect current practice, research using experts in a panel to set thresholds was repeated as needed. As the MDS instrument or recommended calculations for the MDS QIs change, thresholds will be reestablished to ensure a fit with the instrument and data.

The future of long-term care for the chronically ill.

Consumers want a range of services and care available for them if and when they may need them. They want long-term care that addresses six areas of concern: community-based services, continuity, coordination, caring, convenience, and cost. To develop new perspectives and new ways of providing the needed long-term services, it is time for health care leaders to work cooperatively with consumers to redesign long-term care, both community-based and institutional. Consumers and consumer advocates, working cooperatively with health care leaders, could reinvent home health care, nursing home care, and other long-term services such as "aging in place" for older people.

Minimum Data Set and Resident Assessment Instrument. Can using standardized assessment improve clinical practice and outcomes of care?

Regulating and standardizing the assessment of residents was envisioned by the 1986 Committee on Nursing Home Reform to have many advantages for facility management, government regulatory agencies, and clinical staff to evaluate changes in resident status and adjust the care plans accordingly. Standardized assessment data was viewed as a source of management information to be used to track case mix (i.e., acuity) of residents, allocate resources such as staff, and evaluate care quality. The Resident Assessment Instrument is a clinically relevant assessment process that can facilitate effective care planning, interventions, and quality improvement. It is a clinically complex process requiring care delivery systems developed by RNs to support the implementation of individualized care.

Nursing home care quality: a multidimensional theoretical model integrating the views of consumers and providers.

This exploratory study was undertaken to discover the defining dimensions of nursing home care quality from the viewpoint of consumers of nursing home care. Eleven focus groups were conducted in five Missouri communities. The seven dimensions of the consumer multidimensional model of nursing home care quality are: staff, care, family involvement, communication, environment, home, and cost. The views of consumers and families are compared with the results of a previous study of providers of nursing home services. An integrated, multidimensional theoretical model is presented for testing and evaluation. An instrument based on the model is being tested to observe and score the dimensions of nursing home care quality.

The Pompidou Group treatment demand protocol: the first pan-European standard in the field.

There have been many efforts to collect drug treatment demand data in the last decades, but only few organisations worked on international comparable instruments. This paper describes such an attempt organised under the auspices of the Council of Europe in the late 80s, beginning of the 90s. Both the developed protocol as well as its implementation in various European cities are presented. Between 1993 and 1999, a comparative research project to annually compile data and trends on European level was carried out. Data quality issues and methodological problems are highlighted. The paper notes the value and success of the treatment demand indicator, but claims for further improvements and a combined use with other indicators and qualitative information. Some spin-off and follow-up projects are summarised.