Santé au travail, burnout, troubles musculosquelettiques: quelle place pour le médecin de premier recours ?

Les médecins de premiers recours (MPR) sont parmi les spécialistes les plus souvent confrontés aux problèmes de santé liés au travail. Les atteintes de l'appareil locomoteur (rachis ou extrémités) et les problèmes psychiques sont les principales pathologies liées au travail rencontrées par leur patient. Dans ce contexte, il est essentiel pour le MPR de pouvoir identifier le lien entre l'atteinte à la santé et le contexte professionnel afin de conduire une prise en charge adaptée. Cet article aborde, par deux vignettes cliniques, les aspects sémiologiques et thérapeutiques du syndrome d'épuisement professionnel (burnout) et des troubles musculosquelettiques du membre supérieur. Il propose des repères au MPR pour orienter sa pratique dans une approche multidimensionnelle tournée aussi bien vers le patient que sur son environnement professionnel.

Maladaptive exploratory behavior and neuropathology of the PS-1 P117L Alzheimer transgenic mice.

Patients with the early-onset Alzheimer's disease P117L mutation in the presenilin-1 gene (PS-1) present pathological hallmarks in the hippocampus, the frontal cortex and the basal ganglia. In the present work we determined by immunohistochemistry which brain regions were injured in the transgenic PS-1 P117L mice, in comparison to their littermates, the B6D2 mice. Furthermore, as these regions are involved in novelty detection, we investigated the behavior of these mice in tests for object and place novelty recognition. Limited numbers of senile plaques and neurofibrillary tangles were detected in aged PS-1 P117L mice in the CA1 only, indicating that the disease is restrained to an initial neuropathological stage. Western blots showed a change in PSD-95 expression (p=0.03), not in NR2A subunit, NR2B subunit and synaptophysin expressions in the frontal cortex, suggesting specific synaptic alterations. The behavioral tests repeatedly revealed, despite a non-significant preference for object or place novelty, maladaptive exploratory behavior of the PS-1 P117L mice in novel environmental conditions, not due to locomotor problems. These mice, unlike the B6D2 mice, were less inhibited to visit the center of the cages (p=0.01) and they continued to move excessively in the presence of a displaced object (p=0.021). Overall, the PS-1 P117L mice appear to be in an initial Alzheimer's disease-like neuropathological stage, and they showed a lack of reaction toward novel environmental conditions.

Identity and combinations of arbuscular mycorrhizal fungal isolates influence plant resistance and insect preference

1. Accumulating evidence indicates that plant resistance against above-ground herbivores can be affected by the presence of arbuscular mycorrhizal fungi (AMF) in association with the host plant. Little is known, however, about how AMF composition can influence herbivore choice to feed on a particular plant. 2. Unravelling the preference-performance hypothesis in a multitrophic context is needed to expand our knowledge of complex multitrophic interactions in natural systems. If given mycorrhizal fungal genotypes increase attractiveness for a herbivore (reduced plant resistance), then the benefits of increased unpalatability provided by the mycorrhizal fungi (increased plant resistance) might be outweighed by the increased herbivore recruitment. 3. This was addressed by designing three experiments to test the effects of different AMF genotypes, inoculated either alone or in combination, to measure intraspecific AMF effects on plant resistance and insect herbivore preference. Using strawberry (Fragaria vesca L.) plants that were colonised by eight different combinations of Rhizophagus irregularis isolates, we measured effects on plant growth, insect growth and survival, as well as feeding preferences of a generalist herbivore caterpillar (Spodoptera littoralis Boisduval). 4. Overall, it was found that: (i) AMF influenced plant resistance in an AMF genotype-specific manner; (ii) some AMF inoculations decreased insect performance; (iii) insects preferentially chose to feed more on leaves originating from non-mycorrhizal plants; but also that (iv) in a whole plant bioassay, insects preferentially chose the biggest plant, regardless of their mycorrhizal status. 5. Therefore, AMF-mediated trade-offs between growth and resistance against herbivores have been shown. Such trade-offs, particularly driven by plant attractiveness to herbivores, buffer the positive effects of the mycorrhizal symbiosis on enhanced plant growth.

Place du frottis cytologique à l'adolescence [Role of the PAP smear in adolescence]

The publication of the 2006 directives concerning the management of PAP smears has incited us to update our internal protocols at the CHUV, which are described in this article. A new addition to these directives is the specific management of adolescent PAP smears, who present both a high HPV carriage rate and increased incidence of cytological abnormalities with a favorable outcome in most cases. Our goal is to avoid over-treating dysplasias in this type of patient in order to avoid long-term complications. Emphasis is placed on the first gynecological consultation where a listening ear and clear and targeted information remain essential in the proper management of a young patient.

Mise en place percutanée de filtres dans la veine cave inférieure en prévention de l'embolie pulmonaire : recommandations

Recommandations conçues dans le cadre d'un Groupe de travail coordonée par Lucia Mazzolai du Service d'angiologie. Membres du Groupe de travail: Angelillo-Scherrer Anne (Service d'hématologie), Burnier Michel ( Service de néphrologie), Demartines Nicolas (Service de chirurgie viscérale), Duchosal Michel (Service d'hématologie), Farron Alain (Service d'orthopédie), Hohlfeld Patrick (Département de gynéco-obstétrique), Hugli Olivier (Service des urgences), Jichlinski Patrice (Service d'urologie), Jolliet Philippe (Service de médecine intensive), Kern Christian (Service d'anesthésiologie), Levivier Marc (Service de neurochirurgie), Leyvraz Serge (Service d'oncologie), Meuli Reto (Service de radiodiagnostic et radiologie interventionnelle), Nicod Laurent (Service de pneumologie), Qanadli Salah (Service de radiodiagnostic et radiologie interventionnelle), Ris Hans-Beat (Service de chirurgie thoracique et vasculaire), Ruchat Patrick (Service de chirurgie cardiovasculaire), Vial Yvan (Service de gynécologie obstétrique), Vogt Pierre (Service de cardiologie), Von Segesser Ludwig (Service de chirurgie cardiovasculaire), Waeber Gerard (Service de médecine interne), Yersin Bertrand (Service des urgences)

Place branding : a conceptual and theoretical framework

Within the context of rising competition between territories, identity has become the most important element of recognition, differentiation and commodification in the communicative process within which cities, regions and countries position themselves. Geographical spaces thus compete in terms of this identity, which is then subjected to fierce comparison and competition (Nogué, 1999; Anholt, 2007a). The territorial brand thus entails the reinvention of places through a process of brand construction (branding) based on the promotion of the individual and collective identities of geographical spaces; these identities, in turn, are imbued with the intangible factors associated with their respective territorial identities.

La place des registres dans la surveillance des maladies transmissibles. [The role of registries in the surveillance of transmissible diseases].

Registries are among the oldest methods used in public health for epidemiological surveillance and decision making in the area of communicable diseases. Although other sources of data are now available in many developed countries, registries still provide important information. This article reviews the main aims and characteristics of modern registries, providing several examples of current epidemiological problems. Practical advantages and disadvantages of registries are also discussed, as well as some developmental perspectives in this area.

1980 Census of population & housing: Iowa by place. Report 1A, Population characteristics, 1982

As with the 1970 Census, the U.S. Department of labor's Employment and Training Administration (ETA) has compiled a series of special reports for the use of program managers and other social scientists concerned with human resources. These reports. which were designed cooperatively by federal, state and local government research staff, include much unpublished data from the 1980 Census Summary Tape Files. The reports in this series cover not only all of the major government and census designated geographic areas in the United States, but also the unique administrative areas that concern program managers.

Automatització d'un sistema de neteja Cleaning In Place

El projecte es realitza en una empresa embotelladora d'aigua, on el procés d'embotellat estàautomatitzat. En canvi les tasques de sanitització de les línies es realitzen de maneramanual.Actualment, l'empresa es troba en fase de llançament de nous productes (refrescos) i pertant serà necessària una nova línia de producció. Es vol que la tasca de neteja dels equipsinstal•lats per a la realització dels nous productes sigui totalment automatitzada.El sistema de neteja automatitzat escollit és del tipus Cleaning In Place (CIP), que consisteixa netejar sense haver de desmuntar cap part del procés, garantint la correcta sanitització detotes les parts que estan en contacte amb el producte durant el procés de producció. Esdissenya el mòdul mesclador on es faran els xarops que formen part de les noves begudes.El disseny s'ha d'adaptar a les necessitats productives i a les exigències pròpies d'unasanitització.Es realitza la selecció dels actuadors, pre-actuadors i sensors necessaris per al'automatització del procés de neteja i preparació de xarops. Aquests elements esgovernaran a través d'un autòmat, on es carregaran els programes de neteja i preparació dexarops amb llenguatge de programació grafcet. Finalment, també es crea l'SCADA devisualització i control dels processos a través d'un panell tàctil