Souffrance au travail en milieu carcéral: les épreuves de l'exercice professionnel au parloir pénitentiaire

Cet article analyse, à partir d'un modèle intégratif et dynamique, la souffrance au travail et les manifestations de celle-ci, chez les agents pénitentiaires en milieu carcéral dans un espace particulier qui est celui du « parloir pénitentiaire ». Si les questions des facteurs de risques, notamment du stress ou du burnout ont été abondamment traitées dans la littérature, selon des approches factorielles, rares sont les modèles multidimensionnels existants qui permettent de comprendre la complexité et la spécificité des processus en jeu en milieu carcéral. La méthode de recherche relève d'une analyse comparative des espaces professionnels. Soixante douze entretiens semi-directifs de recherche ont été conduits auprès des surveillants occupant chacun des espaces, dans trois établissements pénitentiaires français. À partir de différents indicateurs, le modèle permet de saisir les processus et étapes qui conduisent à la manifestation de souffrances au travail. Il offre à la fois des perspectives d'intervention et de prévention pour les cadres et psychologues chargés du soutien aux personnels.

Hypothermie thérapeutique après arrêt cardio-respiratoire: bénéfices d'une prophylaxie antibiotique précoce

Contexte: Plusieurs études randomisées ont démontré que l'hypothermie thérapeutique modérée (33 à 34°C pendant 12 à 24H) diminue la mortalité intra-hospitalière et améliore le pronostic neurologique chez les patients comateux suite à un arrêt cardio-respiratoire (ACR). Néanmoins cette technique n'est pas dénuée d'effets secondaires au premier rang desquels on trouve les perturbations infectieuses, cardiovasculaires et hydroélectriques. L'introduction d'une prophylaxie antibiotique susceptible de diminuer l'incidence des complications infectieuses chez ces patients est préconisée par certains experts. Objectif: Evaluer si une prophylaxie antibiotique d'Augmentin® pendant 5 à 7 jours peut réduire l'incidence de pneumonies acquises sous ventilateur (VAP) au sein d'une cohorte de patients comateux hospitalisés à la suite d'un arrêt cardio-respiratoire et traités par hypothermie thérapeutique. Méthodologie: Analyse d'une base de données prospective comprenant des patients admis aux SI du Centre hospitalier universitaire vaudois (CHUV) entre juin 2007 et juillet 2011 en raison d'un ACR et traités par hypothermie thérapeutique, selon notre protocole standard de prise en charge. Pour définir si une infection était présente, nous avons analysé rétrospectivement le dossier informatique de chaque patient à la recherche des données nécessaires (radiographies du thorax, microbiologie, etc.). Nous avons également calculé le score CPIS (Clinical Pulmonary Infection Score) quotidien de chaque patient lorsque cela était possible. Le score CPIS a été validé comme outil visant à faciliter le diagnostic de VAP. Il est calculé sur la base de points attribués pour différents signes et symptômes de pneumonie. Résultats: 147 patients (âge moyen 62 ans, durée moyenne de l'arrêt circulatoire 26 min) ont été étudiés. 33% ont développé une infection (dont 30,5% de VAP) parmi lesquels 32/71 (45%) des patients qui n'ont pas reçu de prophylaxie et 17/76 (22%) de ceux qui en ont reçu une (P=0.0035). Il y a avait significativement plus de patients avec un CPIS >6 dans le groupe sans prophylaxie au jour 3 (36/65 [55%] vs. 17/69 [25%], P=0.003) et au jour 5 (24/42 [57%] vs. 17/51 [33%], P=0.02) après admission. Le CPIS médian était aussi plus bas chez les patients avec prophylaxie aux 5ème et 7ème jours (6 [range 0-10] vs. 4.5 [range 0-11], P=0.03 et 7 [range 0-10] vs. 4 [range 0-19], P=0.02, respectivement). La mortalité hospitalière était comparable entre les deux groupes (36/71 [51%] vs. 35/76 [46%], P=0.58). Conclusions: Une prophylaxie antibiotique est une mesure efficace pour réduire la survenue de VAP chez les patients avec ACR et hypothermie thérapeutique. Ce résultat devrait encourager des études à plus large échelle afin de démontrer si une antiobioprophylaxie peut également diminuer la mortalité hospitalière. Le score CPIS est un outil valide et utile dans ce contexte pour faciliter le diagnostic de pneumonie liée au ventilateur.

The role of interval nodes in sentinel lymph node mapping and dissection for melanoma patients.

In sentinel node (SN) biopsy, an interval SN is defined as a lymph node or group of lymph nodes located between the primary melanoma and an anatomically well-defined lymph node group directly draining the skin. As shown in previous reports, these interval SNs seem to be at the same metastatic risk as are SNs in the usual, classic areas. This study aimed to review the incidence, lymphatic anatomy, and metastatic risk of interval SNs. METHODS: SN biopsy was performed at a tertiary center by a single surgical team on a cohort of 402 consecutive patients with primary melanoma. The triple technique of localization was used-that is, lymphoscintigraphy, blue dye, and gamma-probe. Otolaryngologic melanoma and mucosal melanoma were excluded from this analysis. SNs were examined by serial sectioning and immunohistochemistry. All patients with metastatic SNs were recommended to undergo a radical selective lymph node dissection. RESULTS: The primary locations of the melanomas included the trunk (188), an upper limb (67), or a lower limb (147). Overall, 97 (24.1%) of the 402 SNs were metastatic. Interval SNs were observed in 18 patients, in all but 2 of whom classic SNs were also found. The location of the primary was truncal in 11 (61%) of the 18, upper limb in 5, and lower limb in 2. One patient with a dorsal melanoma had drainage exclusively in a cervicoscapular area that was shown on removal to contain not lymph node tissue but only a blue lymph channel without tumor cells. Apart from the interval SN, 13 patients had 1 classic SN area and 3 patients 2 classic SN areas. Of the 18 patients, 2 had at least 1 metastatic interval SN and 2 had a classic SN that was metastatic; overall, 4 (22.2%) of 18 patients were node-positive. CONCLUSION: We found that 2 of 18 interval SNs were metastatic: This study showed that preoperative lymphoscintigraphy must review all known lymphatic areas in order to exclude an interval SN.

Differential gene expression in the pathogenic dermatophyte Arthroderma benhamiae in vitro versus during infection.

Although dermatophytes are the most common agents of superficial mycoses in humans and animals, the molecular basis of the pathogenicity of these fungi is largely unknown. In vitro digestion of keratin by dermatophytes is associated with the secretion of multiple proteases, which are assumed to be responsible for their particular specialization to colonize and degrade keratinized host structures during infection. To investigate the role of individual secreted proteases in dermatophytosis, a guinea pig infection model was established for the zoophilic dermatophyte Arthroderma benhamiae, which causes highly inflammatory cutaneous infections in humans and rodents. By use of a cDNA microarray covering approximately 20-25 % of the A. benhamiae genome and containing sequences of at least 23 protease genes, we revealed a distinct in vivo protease gene expression profile in the fungal cells, which was surprisingly different from the pattern elicited during in vitro growth on keratin. Instead of the major in vitro -expressed proteases, others were activated specifically during infection. These enzymes are therefore suggested to fulfil important functions that are not exclusively associated with the degradation of keratin. Most notably, the gene encoding the serine protease subtilisin 6, which is a known major allergen in the related dermatophyte Trichophyton rubrum and putatively linked to host inflammation, was found to be the most strongly upregulated gene during infection. In addition, our approach identified other candidate pathogenicity-related factors in A. benhamiae, such as genes encoding key enzymes of the glyoxylate cycle and an opsin-related protein. Our work provides what we believe to be the first broad-scale gene expression profile in human pathogenic dermatophytes during infection, and points to putative virulence-associated mechanisms that make these micro-organisms the most successful aetiological agents of superficial mycoses.

The Spatial Effects of Trade Openness: A Survey

This paper surveys the literature on the implications of trade liberalisation for intra-national economic geographies. Three results stand out. First, neither urban systems models nor new economic geography models imply a robust prediction for the impact of trade openness on spatial concentration. Whether trade promotes concentration or dispersion depends on subtle modelling choices among which it is impossible to adjudicate a priori. Second, empirical evidence mirrors the theoretical indeterminacy: a majority of cross-country studies find no significant effect of openness on urban concentration or regional inequality. Third, the available models predict that, other things equal, regions with inherently less costly access to foreign markets, such as border or port regions, stand to reap the largest gains from trade liberalisation. This prediction is confirmed by the available evidence. Whether trade liberalisation raises or lowers regional inequality therefore depends on each country's specific geography.

SIRT1 Activates MAO-A in the Brain to Mediate Anxiety and Exploratory Drive.

SIRT1 is a NAD(+)-dependent deacetylase that governs a number of genetic programs to cope with changes in the nutritional status of cells and organisms. Behavioral responses to food abundance are important for the survival of higher animals. Here we used mice with increased or decreased brain SIRT1 to show that this sirtuin regulates anxiety and exploratory drive by activating transcription of the gene encoding the monoamine oxidase A (MAO-A) to reduce serotonin levels in the brain. Indeed, treating animals with MAO-A inhibitors or selective serotonin reuptake inhibitors (SSRIs) normalized anxiety differences between wild-type and mutant animals. SIRT1 deacetylates the brain-specific helix-loop-helix transcription factor NHLH2 on lysine 49 to increase its activation of the MAO-A promoter. Both common and rare variations in the SIRT1 gene were shown to be associated with risk of anxiety in human population samples. Together these data indicate that SIRT1 mediates levels of anxiety, and this regulation may be adaptive in a changing environment of food availability.

Differences between first episode schizophrenia and schizoaffective disorder.

BACKGROUND: The diagnostic and clinical overlap between schizophrenia and schizoaffective disorder is an important nosological issue in psychiatry that is yet to be resolved. The aim of this study was to compare the clinical and functional characteristics of an epidemiological treated cohort of first episode patients with an 18-month discharge diagnosis of schizophrenia (FES) or schizoaffective disorder (FESA). METHODS: This study was part of the larger First Episode Psychosis Outcome Study (FEPOS) which involved a medical file audit study of all 786 patients treated at the Early Psychosis Prevention and Intervention Centre between 1998 and 2000. Of this cohort, 283 patients had an 18-month discharge diagnosis of FES and 64 had a diagnosis of FESA. DSM-IV diagnoses and clinical and functional ratings were derived and validated by two consultant psychiatrists. RESULTS: Compared to FES patients, those with FESA were significantly more likely to have a later age of onset (p=.004), longer prodrome (p=.020), and a longer duration of untreated psychosis (p<.001). At service entry, FESA patients presented with a higher illness severity (p=.020), largely due to the presence of more severe manic symptoms (p<.001). FESA patients also had a greater number of subsequent inpatient admissions (p=.017), had more severe depressive symptoms (p=.011), and higher levels of functioning at discharge. DISCUSSION: The findings support the notion that these might be considered two discernable disorders; however, further research is required to ascertain the ways and extent to which these disorders are discriminable at presentation and over time.

Exploratory survey about dietary supplement use: a hazardous and erratic way to improve one's health?

INTRODUCTION: Dietary supplement (DS) use increased rapidly in recent years. However, evidence of benefits of many DSs for healthy users is scarce and may not equate with known risks of overdose, drug interaction and recently discovered negative long-term effects. This exploratory study aimed to investigate the perceptions and motivations of DS users in Lausanne, Switzerland. METHOD: A convenience sample (n = 147) was recruited at the entrances of local sales points. Data were collected in on-site semistructured interviews that assessed dietary supplementation habits. RESULTS: The majority of DSs were all-in-one products, containing a mixture of minerals and vitamins, or products containing only minerals. Among the 147 users, 72 (49%) used one all-in-one product and 3 (2%) used two all-in-one products. Thirty-one (21%) consumers did not know for at least one product what the purpose of their DS use was. Seventy-five percent of participants thought that DS use presents no risk or nearly no risk. Only 49% of participants stated that their physicians were informed about their consumption. Although men searched more often for potential risks (p <0.001), they turned less frequently to health professionals to get this information (p = 0.007). DISCUSSION: As in other surveys performed elsewhere, our study shows that, in Lausanne (Switzerland), DSs are commonly used as mixed products. Risk perception seems generally low among DS users. Physicians should be trained to evaluate patients' perceived needs and DS consumption in order to provide good evidence-based information or to propose alternatives to DS use.

High-precision dating and origin of synsedimentary volcanism in the Late Carboniferous Salvan-Dorenaz basin (Aiguilles-Rouges Massif, Western Alps)

Late Variscan volcanic activity is documented in the Late Carboniferous Salvan-Dorenaz sedimentary basin and in the neighboring basement units of the Aiguilles-Rouges and Mont-Blanc crystalline massifs (Western Alps). Precise U/Pb isotopic dating, zircon morphology and geochemical analyses indicate that volcanism occurred during short-lived pulses and that coexisting crustal and mantle sources were involved in the production of melts. Volcanic and subvolcanic products were emplaced along major N-S to NNE-SSW transtensional fracture zones, similar to the ones that governed intense basement exhumation and that favored the formation and filling of the Late Carboniferous Salvan-Dorenaz continental basin. In the Aiguilles-Rouges massif, dacitic flows outcropping at the base of the Salvan-Dorenaz basin erupted at 308 +/- 3 Ma; they represent the surface equivalent of the nearby Vallorcine peraluminous granite and associated rhyolitic dykes (311 +/- 17 Ma). In the Mont Blanc massif, calc-alkaline rhyolitic dykes were emplaced simultaneously (307 +/- 2 Ma) at shallow crustal levels, but they derive from deeper magma sources denoting enhanced mantellic activity. Recently identified tuffs and volcaniclastic layers embedded at different levels of the Salvan-Dorenaz stratigraphic record testify a 295 +3/-4 Ma old episode of highly explosive volcanism from distant volcanic centers, possibly located in the Aar-Gotthard massifs (Central Alps). Their zircon typology is highly heterogeneous. documenting wall-rock contamination of the melts and/or admixture of crustal sediments, whereas consistent subpopulations point to high-temperature magmas of deep-seated origin and alkaline affinity. The dated volcanic layers from the Salvan-Dorenaz basin set the beginning of the detrital sedimentation at 308 +/- 3 Ma and constrain the deposition of 1.5-1.7 km thick of elastic sediments within a time span of 10-15 Ma. These results infer minimum, long-term subsidence rates during basin evolution in the order of >0.1 mm/a, while in the surrounding basement units estimated exhumation rates are in the range of 1 mm/a. All dated rocks contain inherited zircon populations about 350, 450 or 600 Ma old.

High prevalence of anorectal chlamydial infection in HIV-infected men who have sex with men in Switzerland.

Human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) were enrolled in an anorectal Chlamydia trachomatis screening study. Anorectal Chlamydia DNA was detected in 16 (10.9%) of 147 men, mainly among asymptomatic patients and patients having >20 sexual partners. These results support routine anorectal Chlamydia screening in HIV-infected MSM who report unprotected anal intercourse.

The diet of the Alpine mouse Apodemus alpicola in the Swiss Alps

In this study, we used faecal analysis to determine the diet of the alpine mouse Apodemus alpicola in the field for the first time. This species consumes mainly insects in spring and fruits and seeds of small herbaceous dicotyledons in summer and autumn. Compared to the two congeneric species A. flavicollis and A. sylvaticus, which also occur in the Alps, the diet of A. alpicola is rich in contrasts, with a very pronounced difference between spring and summer. The absence of tree seeds also suggests a mostly terrestrial behaviour. We explain these facts by the specificity of the habitat of A. alpicola: the extreme weather conditions produce great seasonal changes in the vegetation, and the rocky ground favours the adaptation to rock climbing rather than to arboreal Living. (c) 2005 Elsevier GmbH. All rights reserved.

Variability of the nucleolar organizer activity in human lymphocytes via Ag-staining.

Chromosomes with Ag staining that varies from one metaphase to the other can be distinguished from those with an Ag-staining that is the same in all metaphases. The intercellular variation of an Ag-NOR can be attributed to many different factors. Whatever the importance of technical factors, they do not seem to account for the large variations in Ag-staining which were observed for each ac. This suggests the existence of a natural intercellular variability of the NOR's activity. The variation of the Ag-stainability of a given NOR, the diversity of Ag-stainings observed on the ten ac of one individual and the differences that exist between individuals raise the question of the existence of a compensation of activity between nucleolar organizers. The study, for each individual, of the mean sum of staining per metaphase reveals that this value is not absolutely constant from one individual to another; in the carriers of Robertsonian fusions it is smaller than in chromosomally normal individuals. The analysis of the transmission shows that inactive NORs remain inactive and that active NORs present a variation in the activity from one generation to the next.

The Lin28/let-7 axis regulates glucose metabolism.

The let-7 tumor suppressor microRNAs are known for their regulation of oncogenes, while the RNA-binding proteins Lin28a/b promote malignancy by inhibiting let-7 biogenesis. We have uncovered unexpected roles for the Lin28/let-7 pathway in regulating metabolism. When overexpressed in mice, both Lin28a and LIN28B promote an insulin-sensitized state that resists high-fat-diet induced diabetes. Conversely, muscle-specific loss of Lin28a or overexpression of let-7 results in insulin resistance and impaired glucose tolerance. These phenomena occur, in part, through the let-7-mediated repression of multiple components of the insulin-PI3K-mTOR pathway, including IGF1R, INSR, and IRS2. In addition, the mTOR inhibitor, rapamycin, abrogates Lin28a-mediated insulin sensitivity and enhanced glucose uptake. Moreover, let-7 targets are enriched for genes containing SNPs associated with type 2 diabetes and control of fasting glucose in human genome-wide association studies. These data establish the Lin28/let-7 pathway as a central regulator of mammalian glucose metabolism.