Expert opinion on the cough hypersensitivity syndrome in respiratory medicine

In 2011, a European Respiratory Society Task Force embarked on a process to determine the position and clinical relevance of the cough hypersensitivity syndrome, a disorder characterised by troublesome coughing often triggered by low levels of thermal, mechanical or chemical exposure, in the management of patients with chronic cough. A 21-component questionnaire was developed by an iterative process supported by a literature review. 44 key opinion leaders in respiratory medicine were selected and interviewed as to their opinions. There was a high degree of unanimity in the responses obtained, with all opinion leaders supporting the concept of cough hypersensitivity as a clinically useful paradigm. The classic stratification of cough into asthmatic, rhinitic and reflux-related phenotypes was supported. Significant disparity of opinion was seen in the response to two questions concerning the therapy of chronic cough. First, the role of acid suppression in reflux cough was questioned. Secondly, the opinion leaders were split as to whether a trial of oral steroids was indicated to establish a diagnosis of eosinophilic cough. The cough hypersensitivity syndrome was clearly endorsed by the opinion leaders as a valid and useful concept. They considered that support of patients with chronic cough was inadequate and the Task Force recommends that further work is urgently required in this neglected area.

Global Production, CSR and Human Rights: The Courts of Public Opinion and the Social License to Operate

This paper takes at its starting point the responsibility placed upon corporations by the United Nations’ Protect, Respect and Remedy Framework as elaborated upon by the Guiding Principles on Business and Human Rights to respect human rights. The overt pragmatism and knowledge of the complex business relationships that are embedded in global production led John Ruggie, the author of the Framework, to adopt a structure for the relationship between human rights and business that built on the existing practices of Corporate Social Responsibility (CSR). His intention was that these practices should be developed to embrace respect for human rights by exhorting corporations to move from “the era of declaratory CSR” to showing a demonstrable policy commitment to respect for human rights. The prime motivation for corporations to do this was, according to Ruggie, because the responsibility to respect was one that would be guarded and judged by the “courts of public opinion” as part of the social expectations imposed upon corporations or to put it another way as a condition of a corporation’s social license to operate.
This article sets out the background context to the Framework and examines the structures that it puts forward. In its third and final section the article looks at how the Framework requires a corporation’s social license to be assembled and how and by whom that social license will be judged. The success or failure of the Framework in persuading corporations to respect human rights is tied to whether “the courts of public opinion” can use their “naming and shaming power” effectively.

La rhétorique professionnelle des conseillers d'orientation pour l'accès à la pratique de la médiation familiale une image publique floue

Depuis le 1er septembre 1997, cinq professionnels ont accès à la pratique de la médiation familiale. Les conseillers d'orientation sont de ce nombre et ils sont les professionnels les moins bien représentés en médiation familiale et ce, à plusieurs points de vue. Ce mémoire pose l'hypothèse que les conseillers d'orientation ont de la difficulté à s'imposer dans cette pratique parce qu'ils ont un problème d'identité professionnelle qui les empêche de convaincre de leur pertinence en tant qu'intervenants. Balisé par un contexte théorique à caractère sociologique reposant sur les concepts de rhétorique professionnelle (Paradeise, 1985) et d'espace professionnel (Bourdon, 1994), les transcriptions des débats tenus en commission parlementaire sur la médiation familiale ont été analysés à l'aide d'une méthodologie qualitative. Il appert que les conseillers d'orientation n'ont su utiliser correctement les éléments de rhétorique professionnelle, et par surcroît, ils ont été les grandes victimes des tactiques utilisées par les autres acteurs.

The role of implicit theories in the formation of expert opinion in portuguese criminal law

Tese de doutoramento, Ciências e Tecnologias da Saúde (Medicina Legal e Ciências Forenses), Universidade de Lisboa, Faculdade de Medicina, 2014

Le sport, un enjeu de santé publique ?

Les bénéfices pour la santé d'une activité physique régulière sont de mieux en mieux établis et s'appliquent notamment à des pathologies aussi diverses que l'infarctus du myocarde ou certains cancers. Or, deux tiers de la population suisse rapportent une pratique en activité physique inférieure aux recommandations minimales pour la santé. On estime en Suisse que la sédentarité est annuellement responsable de 2,1 millions de cas de maladie, de 2900 décès et de 2,4 milliards de francs de coûts liés aux traitements.

Development and current use of parenteral nutrition in critical care - an opinion paper.

Critically ill patients depend on artificial nutrition for the maintenance of their metabolic functions and lean body mass, as well as for limiting underfeeding-related complications. Current guidelines recommend enteral nutrition (EN), possibly within the first 48 hours, as the best way to provide the nutrients and prevent infections. EN may be difficult to realize or may be contraindicated in some patients, such as those presenting anatomic intestinal continuity problems or splanchnic ischemia. A series of contradictory trials regarding the best route and timing for feeding have left the medical community with great uncertainty regarding the place of parenteral nutrition (PN) in critically ill patients. Many of the deleterious effects attributed to PN result from inadequate indications, or from overfeeding. The latter is due firstly to the easier delivery of nutrients by PN compared with EN increasing the risk of overfeeding, and secondly to the use of approximate energy targets, generally based on predictive equations: these equations are static and inaccurate in about 70% of patients. Such high uncertainty about requirements compromises attempts at conducting nutrition trials without indirect calorimetry support because the results cannot be trusted; indeed, both underfeeding and overfeeding are equally deleterious. An individualized therapy is required. A pragmatic approach to feeding is proposed: at first to attempt EN whenever and as early as possible, then to use indirect calorimetry if available, and to monitor delivery and response to feeding, and finally to consider the option of combining EN with PN in case of insufficient EN from day 4 onwards.

L'action publique locale dans tous ses états. Différenciation et standardisation

Les espaces politiques infranationaux définissent et prennent en charge un nombre croissant de problèmes publics. Quelle est la capacité des acteurs et institutions locales à faire émerger une action publique autonome ? Assiste-t-on à la fin d'un cycle ou à une nouvelle transformation des relations entre l'Etat et le local ? Quelles sont les limites de la capacité du politique à organiser les territoires ? Les collectivités locales favorisent-elles de nouvelles impulsions démocratiques ? Cette volonté de croiser les regards - disciplinaires, géographiques et générationnels - permet aux auteurs de souligner l'étendue du travail de construction de la comparabilité en sciences sociales. L'enjeu scientifique n'est plus de trancher entre centralisation et décentralisation mais bien de développer des outils et des cadres d'analyse heuristiques pour penser les effets des nouvelles interdépendances. L'ouvrage nous invite aussi à poser différemment la question sensible du rapport des individus à l'Etat et au pouvoir politique dans chaque contexte local , à questionner les ressorts démocratiques de l'action publique au coeur de chaque métropole et de chaque région.

Structure du temps de travail des infirmières de santé publique: effets de l'âge des patients, de la nature des prestations fournies et du lieu du contact. [Structure of work times of public health nurses: effect of the age of patients, nature of care given and location of contact].

In the framework of health services research sponsored by the Swiss National Science Foundation, a research was undertaken of the activity of the large majority of the public health nurses working in the Swiss cantons of Vaud and Fribourg (total population 700,000). During one week, 130 nurses gathered, with a specially devised instrument, data on 4165 patient visits. Studying the duration of the contacts, one has distinguished contact duration per se (DC), duration of the travel time preceding the contact (DD), and total duration in relation with the contact (DTC-addition of the first two). It was noted that the three durations increased significantly with patient age (as regard travel time, this is explained by the higher proportion of home visits in higher age groups, as compared with visits at a health center). Examined according to location of the visit, contact duration per se (without travel) is higher for visits at home and in nursing homes than for those taking place at a health center. Looked at in respect to the care given (technical care, or basic nursing care, or both simultaneously), our data show that the provision of basic nursing care (alone or with technical care) doubles contact duration (from 20 to 42-45'). The analyses according to patient age shows that, at an advanced age (beyond 80 years particularly), there is an important increase of the visits where both types of care are given. However, contact duration per se shows a significant raise with age only for the group "technical care only"; it can be demonstrated that this is due to the fact that older patients require more complex technical acts (e.g., bladder care, as compared with simpler acts such as injection). A model of the relationships between patient age and contact duration is proposed: it is because of the increase in the proportions of home visits, of visits including basic nursing care, and of more complex technical acts that older persons require more of the working time of public health nurses.

Publicité pour les médicaments: la santé publique l'emporte sur la liberté d'expression

Die Werbung für Medikamente unterliegt sowohl nach europäischem ais auch nach schweizerischem Recht verschiedenen Verboten. Die se Einschränkungen betreffen sowohl Unternehmen ais auch Einzelpersonen. lm Urteil Damgaard aus dem Jahre 2009 hat der Gerichtshof der Europäischen Union bestätigt, dass eine Privatperson, vorliegend ein Journalist, für die Verletzung eines solchen Verbotes strafrechtlich zur Verantwortung gezogen werden kann, auch wenn er keine Verbindung mit dem Unternehmen unterhält, welches die Medikamente verkauft. Für den Gerichtshof wurde die Meinungsfreiheit des Journalisten in Anbetracht der kommerziellen Natur seiner Veröffentlichung nicht verletzt, da die Rechtsnorm einem öffentlichen Interesse entspreche und verhältnismässig sei. Die se strenge Haltung ist nur schwer vereinbar mit dern aktuellen Trend, dem Patienten - besonders im Bereich Internet-mehr Verantwortung zu übertragen. Der vorliegende Artikel analysiert diese Rechtsprechung und zieht Parallelen zum Schweizer Recht.

Réunion des sociétés savantes des départements à la Sorbonne.... Section des beaux-arts / Ministère de l'instruction publique...

1905 (SESSION29).