L'autogestion de l'anticoagulation orale: un avantage pour certains patients: revue Cochrane pour le praticien

Cet article présente les résultats de la revue systématique: Garcia-Alamino JM, Ward AM, Alonso-Coello P, et al. Self-monitoring and self-management of oral anticoagulation. Cochrane Database of Systematic Reviews 2010, Issue 4. Art. No. : CD003839. DOI: 10.1002/14651858.CD003839.pub2.. PMID: 20393937.

Kann telemedizinische Überwachung die Behandlung von Patienten mit Herzinsuffizienz verbessern?: mini-review Cochrane für die Praxis

Cet article présente les résultats de la revue systématique: Inglis SC, Clark RA, McAlister FA, et al. Structured telephone support or telemonitoring programmes for patients with chronic heart failure. Cochrane Database Systematic Reviews 2010, Issue 8. Art. No.:CD007228. DOI:10.1002/14651858.CD007228.pub2. PMID: 20687083.

Evaluation des risques sanitaires liés à l'utilisation professionnelle des produits bitumeux et de leurs additifs

L'ANSES vient de publier un rapport formulant un certain nombre de recommandations pour prévenir les divers risques affectant la santé des travailleurs exposés aux bitumes. Au-delà du potentiel cancérogène des produits bitumineux et de leurs émissions, les experts de l'ANSES ont mis en évidence dans leur expertise l'existence d'effets respiratoires et suspectent également des effets cardiovasculaires et immunotoxiques. Selon les postes de travail, les niveaux d'exposition sont plus ou moins importants. La température est également un facteur de variation de l'émission de fumée, et par conséquent de l'exposition des travailleurs au risque chimique par voie d'inhalation. Le rapport souligne également la question du risque d'exposition par voie cutanée, à l'heure actuelle encore peu considéré. Enfin, les activités de rabotage et de recyclage de plus en plus pratiquées doivent faire l'objet d'une attention particulière en raison des matériaux précédemment utilisés qui peuvent contenir de l'amiante, des silices, d'anciens bitumes soufrés...

Statines et insuffisance rénale chronique: un bon ménage? : revue Cochrane pour le praticien

Cet article présente les résultats de la revue systématique: Navaneethan SD, Pansini F, Perkovic V, Manno C, Pellegrini F, Johnson DW, Craig JC, Strippoli GF. HMG CoA reductase inhibitors (statins) for people with chronic kidney disease not requiring dialysis. Cochrane Database Syst Rev. 2009 Apr 15;(2):CD007784. PMID: 19370693

Estratégias de prevenção para câncer de testículo e pênis: revisão integrativa

Cânceres de testículo e pênis são doenças que acometem pequena parcela da população, mas geralmente são agressivas principalmente pelo impacto psicológico que exercem sobre os pacientes. Este estudo buscou identificar evidências de estratégias preventivas para tais cânceres. Foi realizada revisão integrativa de literatura, nas bases de dados Biblioteca COCHRANE, PubMed/MEDLINE, LILACS, BDENF e CINAHL, utilizando os descritores controlados: promoção da saúde, fatores de risco, prevenção primária e neoplasias urogenitais; e os não controlados: prevenção, câncer de pênis, câncer de testículo. Os estudos foram unânimes ao identificar, para o câncer de testículo, o autoexame do órgão; para o câncer de pênis, evidenciou-se a circuncisão como fator protetor, a prevenção de infecção sexualmente transmissível e a adequada higiene íntima. Os enfermeiros devem assumir a função de promotor da saúde, tendo em vista a importância dessa atitude frente à prevenção de doenças.

Le zinc viendra-t-il à bout du rhume?: revue Cochrane pour le praticien.

Cet article présente les résultats de la revue systématique: Singh M, Das RR. Zinc for the common cold. Cochrane Database of Systematic Reviews 2011, Issue 2, Art. No.: CD001364. DOI: 10.1002/14651858.CD001364.pub3. PMID: 21328251.

Do pornographic websites influence boys' sexual behavior?

Purpose: To compare the sexual behavior of adolescent males who do and do not watch pornographic websites. Methods: This study was presented as a school survey. Data were drawn from the 2002 Swiss Multicenter Adolescent Survey on Health (SMASH02) database, a survey including 7,548 adolescents age 16-20. The setting was post-mandatory schools in Switzerland. A total of 2,891 male students who connected to the internet in the last 30 days were enrolled and distributed into two groups: boys who deliberately watched pornographic websites in the last 30 days (n ¼ 942; 33%) and boys who did not (n ¼ 1,949; 67%). Socio-demographic characteristics; frequency of connection to the internet; sexual behavior parameters (having a girlfriend and if yes, for more or less than 6 months; having had sexual intercourse; age at first sexual intercourse; use of a condom at last sexual intercourse; number of sexual partners; having made a partner pregnant). Results: A logistic regression was performed using STATA 9.2. The only significant socio-demographic variable was having a low socioeconomic status (adjusted odds ratio [AOR] 1.66); no difference was found for age and academic track between the two groups. Boys who watch pornographic websites were also significantly more likely to connect frequently to the internet (one day a week: AOR 1.75; several days a week: AOR 2.36; every day: AOR 3.11), to have had sexual intercourse (AOR 2.06), and to have had their first sexual intercourse before age 15 (AOR 1.48). The stability of the relationship with their girlfriend did not appear to have any influence on the search for pornography on the internet. Conclusions: About one third of boys in our sample report having accessed pornographic websites in the last 30 days, a proportion similar to other studies. Watching such websites increases with the frequency of connection to the internet and seems to be correlated with an earlier sexual activity debut among adolescent males. However, having had first sexual intercourse before age 15 is the only sexual risk behavior that seems to be increased when watching pornographic websites among boys. Further studies should address the causality of this correlation and the factors influencing the search for pornography on the web among boys, in order to explore some new ways of prevention about sexual risk behaviors. Sources of Support: The SMASH02 survey was carried out with the financial support of the Swiss Federal Office of Public Health and the participating cantons.

Soll bei einer Pneumonie Atemphysiotherapie verordnet werden?: Mini-Review Cochrane für die Praxis

Cet article présente les résultats de la revue systématique: Yang M, Yan Y, Yin X, et al. Chest physiotherapy for pneumonia in adults. Cochrane Database of Systematic Reviews 2010, Issue 2. Art. No.: CD006338. DOI: 10.1002/14651858.CD006338.pub2. PMID: 20166082.

Quality of life transformations before and after kidney transplantation: A prospective qualitative study.

The aim of this IRB-approved study was to analyze prospectively quality of life (QOL) and psychological changes in 30 ESRD patients before and after kidney transplantation (KT). Semi-structured interviews were conducted after inclusion on the waiting list (A). Follow-up interviews were performed 6 months later with patients still awaiting KT (B6, n= 15), and with transplant recipients 6, 12 and 24 months after KT (C6, n=15; C12, n=15; C24, n=14). Qualitative thematic analysis was performed. A: All patients reported loss of freedom, 87% tried to maintain normality; 57% modified medical directives. All mentioned emotional fragility, negative thoughts (43%), and suicidal thoughts (20%) related to loss of QOL from dialysis (D), and professional tension (26%). B6: 40% reported no change compared to baseline, while 60% mentioned increase of illness intrusiveness, 46% D side effects, 40% communication problems, and 33% concerns about the waiting list handling. Fear of emotional breakdown (40%), couple problems (47%), and worsened professional difficulties (20%) were reported. C6: All patients reported recovery of QOL and concerns about acute rejection. 73% were anxious about laboratory results. 93% felt dependent on immunosuppressants (IS), 47% reported difficulties coping with their regimen, and 47% were concerned about side effects; 67% had resumed work, but medical constraints led 40% to professional stigmatization. C12: All enjoyed good QOL. Adherence to IS was mandatory (100%). All were aware of the limited long-term graft survival and 47% anxious about a possible return to D. 60% underlined positive life value; 47% resumed a full time job; 40% were on social security. C24: Good QOL was underlined (86%). Patients stated they would prefer re-TX to resuming D (71%). Post-TX health problems were mentioned (64%); increase of creatinine levels induced fear (36%). 79% complained about side effects. 64% reported changes in life values. This study reveals positive QOL and psychological transformations after KT, which are associated with positive changes related to graft survival and freedom from D. Psychological follow-up should be offered to patients who face relapsing ESRD or post-TX co-morbidities.

Appropriateness of colonoscopy in Europe (EPAGE II): presentation of methodology, general results, and analysis of complications.

BACKGROUND AND STUDY AIMS: Appropriate use of colonoscopy is a key component of quality management in gastrointestinal endoscopy. In an update of a 1998 publication, the 2008 European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE II) defined appropriateness criteria for various colonoscopy indications. This introductory paper therefore deals with methodology, general appropriateness, and a review of colonoscopy complications. METHODS:The RAND/UCLA Appropriateness Method was used to evaluate the appropriateness of various diagnostic colonoscopy indications, with 14 multidisciplinary experts using a scale from 1 (extremely inappropriate) to 9 (extremely appropriate). Evidence reported in a comprehensive updated literature review was used for these decisions. Consolidation of the ratings into three appropriateness categories (appropriate, uncertain, inappropriate) was based on the median and the heterogeneity of the votes. The experts then met to discuss areas of disagreement in the light of existing evidence, followed by a second rating round, with a subsequent third voting round on necessity criteria, using much more stringent criteria (i. e. colonoscopy is deemed mandatory). RESULTS: Overall, 463 indications were rated, with 55 %, 16 % and 29 % of them being judged appropriate, uncertain and inappropriate, respectively. Perforation and hemorrhage rates, as reported in 39 studies, were in general < 0.1 % and < 0.3 %, respectively CONCLUSIONS: The updated EPAGE II criteria constitute an aid to clinical decision-making but should in no way replace individual judgment. Detailed panel results are freely available on the internet (www.epage.ch) and will thus constitute a reference source of information for clinicians.

Las Puertas de la noche, roman policier D'Amir Valle: traduction et commentaire

Traduction française des trois premiers chapitres de Las puertas de la noche (Plaza Mayor, San Juan de Puerto Rico, 2002), roman policier de l’écrivain cubain Amir Valle, dont le style se caractérise par la culture qu’il véhicule, son registre familier, sa syntaxe complexe et ses figures de style.

Un tango de neutres sur fond de guerre : les relations économiques entre la Suisse et l'Argentine (1938-945)

Cet article porte sur les relations économiques entre deux pays restés neutres durant la guerre. Fondé sur des documents d'archives encore inexploités, il vise à comprendre comment la Suisse et l'Argentine sont parvenues à maintenir, et même à renforcer, leurs échanges malgré les obstacles liés au conflit. La guerre offre à la Suisse l'opportunité de gagner des parts importantes du marché argentin pour les produits phares de son industrie d'exportation. Au-delà des circonstances de la guerre, ce sont aussi les stratégies volontaristes mises en oeuvre par les milieux dirigeants helvétiques qui permettent ce résultat. Parmi ces stratégies, un crédit de 40 millions de francs suisses octroyés par les milieux financiers au Gouvernement argentin est au coeur de l'analyse.