Usage et utilité clinique de la CRP dans le diagnostic, le pronostic et le suivi de patients hospitalisés pour une pneumonie acquise dans la communauté. Enquête auprès des médecins du CHUV

Introduction: L'utilisation de marqueurs de l'inflammation comme la CRP pour le diagnostic, le pronostic et le suivi lors de pneumonie acquise dans la communauté (PAC) est une méthode rapide et bon marché. Cependant son utilité reste controversée etles avis d'expert divergent. Au CHUV, la CRP est dosée systématiquement chez les patients hospitalisés avec une PAC. L'objectif de ce travail est double: 1) effectuer une revue systématique de la littérature; 2) mieux comprendre l'usage et la perception de l'utilité clinique de la CRP en analysant la pratique des médecins du CHUV. Méthode: Nous avons envoyé un questionnaire par email à 2 reprises à tous les médecins assistants et chefs de clinique du service de médecine interne (SMI) et du centre interdisciplinaire des urgences (CIU) du CHUV. Les questions portaient sur la pratique clinique et sur la perception de l'utilité de la CRP dans le diagnostic, le pronostic et le suivi de patients hospitalisés pour une PAC. Résultats: Les résultats de la revue systématique sont présentés et analysés en intégrant les réponses issues du questionnaire. Nous avons reçu 53 réponses sur les 125 questionnaires envoyés. 62% des médecins interrogés demandent un dosage de la CRP dans >90% des cas lors d'une suspicion de PAC basée sur la clinique contre 45% si en plus la radiologie parle en faveur d'une PAC. 75% des médecins répètent ce dosage 1 à 4 fois durant le suivi. La raison principale évoquée est la suspicion d'une évolution défavorable et, plus rarement, la présence de comorbidités. Quand on questionne les médecins sur l'utilité de la CRP,on observe que seulement 30% pensent que la CRP est utile pour le diagnostic de PAC et 28% pour exclure une PAC lors de suspicion clinique. De même, 25% des médecins pensent qu'elle est utile dans le suivi des patients et 9% pour évaluer le pronostic de la PAC. On ne trouve pas d'association entre le niveau de formation et l'usage ou l'appréciation de l'utilité de la CRP. Conclusion: Les médecins assistants et les chefs de clinique du SMI et du CIU du CHUV dosent très souvent la CRP chez les patients hospitalisés pour une PAC. Leur motivation n'est ni liée à l'éventuelle valeur diagnostique de cet examen biologique,ni à son hypothétique valeur pour le pronostic et le suivi.

Does unemployment hurt less if there is more of it around? A panel analysis of life satisfaction in Germany and Switzerland

This article examines the existence of a habituation effect to unemployment: Does the subjective well-being of unemployed people decline less if unemployment is more widespread? The underlying idea is that unemployment hysteresis may operate through a sociological channel: if many people in the community lose their job and remain unemployed over an extended period, the psychological cost of being unemployed diminishes and the pressure to accept a new job declines. We analyze this question with individual-level data from the German Socio-Economic Panel (1984-2010) and the Swiss Household Panel (2000-2010). Our fixed-effects estimates show no evidence for a mitigating effect of high surrounding unemployment on the subjective well-being of the unemployed. Becoming unemployed hurts as much when regional unemployment is high as when it is low. Likewise, the strongly harmful impact of being unemployed on well-being does not wear off over time, nor do repeated episodes of unemployment make it any better. It thus appears doubtful that an unemployment shock becomes persistent because the unemployed become used to, and hence reasonably content with, being without a job.

Ready or not? Let's leave it 'til later

This leaflet details 10 things to think about before having sex.

Passive smoking: there's nothing passive about it

This leaflet highlights the health risks of passive smoking to adults and children, and suggests way of minimising your exposure to second-hand smoke.

Clean hands? It's OK to ask

This poster is part of an extension of the cleanyourhands campaign, aimed at preventing the spread of healthcare associated infections (HCAIs) in community healthcare settings including primary care and dental services, residential and nursing homes (including independent sector homes), hospices and independent clinics/hospitals. It is designed to heighten awareness in patient/relative waiting areas of how healthcare staff can help protect patients from avoidable infections by cleaning their hands. Due to licensing restrictions, this poster is not available for download. Limited numbers are available from local HSC Trusts (Belfast HSCT and South Eastern HSCT on 028 9056 5862; Southern HSCT on 028 3741 2887; Northern HSCT on 028 2563 5575; Western HSCT on 028 7186 5127).

Hold your drink, don't give anyone the chance to spike it

This poster warns of the dangers of leaving your drink unattended.

It's me

This poster highlights the fact that mental health problems are more common than most people think and encourages anyone who may be feeling down or unable to cope to talk to a friend, family member or doctor.

Cervical cancer: it's best to take the test

From January 2011, the Northern Ireland cervical screening programme no longer invited women aged under 25 to attend for screening. In addition, the screening interval for women aged 25-49 was reduced to every three years. This leaflet is one of a series of new information materials that was developed to reflect the policy changes and to give information to increase the uptake of information and interventions offered to protect and maintain the health of women in the target group. It gives information about cervical screening in Northern Ireland and helps women to understand why it is important to be screened.

Cook it! An evaluation of a community nutrition education programme in Northern Ireland

Cook it! was originally introduced to Northern Ireland in 1995 by the Health Promotion Agency for Northern Ireland (HPA) in a collaborative project with the Eastern Health and Social Services Board, the Northern Health and Social Services Board and the North and West Belfast Health and Social Services Trust. Having run for five years, this initial phase of the programme was evaluated in 2000. Cook it! was found to be a valuable approach to community based nutrition education. However, a number of recommendations were made as to how it could be improved. In conjunction with a number of community dietitians the HPA therefore revised and updated the programme, which included a redesigned resource manual with improved session outlines and recipe sheets. The Public Health Agency was established in 2009 under a major reform ofhealth structuresin Northern Ireland. The four key functions of the PHA are: health and social wellbeing improvement; health protection; public health support to commissioning and policy development; HSC research and development.

Rabies - it can be a fatal bite

Rabies is a preventable disease, but it kills up to 55,000 people each year. Therefore on World Rabies Day, 28 September 2011, the Public Health Agency wants to raise awareness and understanding about the importance of seeking medical advice on whether the country or countries people are visiting require vaccination against this serious disease.Rabies is transmitted to humans mainly by the bite of an infected animal (commonly a dog, but can be spread by other mammals including cats and monkeys). It can also be spread through a scratch, or by the animal licking a cut or a wound and saliva from the infected animal getting into the eyes, mouth or nose. It is impossible to tell just by looking at an animal if they are infected, therefore while visiting other countries it is best to avoid touching animals, especially strays.Dr Michael Devine, Consultant in Health Protection, PHA, said: "Rabies is an acute viral infection which is almost certainly fatal. The infection causes inflammation of the brain and symptoms usually start 2-8 weeks after exposure. Early symptoms include headache, fever and anxiety; progressing to acute pain, violent uncontrolled movements, spasms of the swallowing muscles making it impossible to drink and respiratory failure."People may be used to thinking about rabies when they go to more exotic locations like Asia and Africa, but it can also be present closer to home, such as in some eastern European countries. So it is always best to play it safe and avoid animals, especially strays."Dr Devine continued: "If you are bitten by an animal while abroad it is important to clean the wound thoroughly with soap and water and seek medical attention immediately, even if you have been previously immunised, as treatment must be given to attempt to reduce the risk of developing the disease - treatment works best if initiated as soon as possible. Rabies vaccination is very effective - almost 100%. Booster doses may be required after one year and then every 2-5 years for those at continued risk."

Cook it! Fun, fast food for less: community nutrition education programme

This training manual was produced to support the Cook it! programme, which was specially developed for use in Northern Ireland. The Cook it! programme is delivered in the community by trained facilitators and can be used with a wide range of groups, including young/single parents, young people leaving residential care, offenders during rehabilitation programmes, older people in sheltered accomodation etc.The manual contains all the information needed to deliver Cook it! programmes in the community, including background information on healthy eating, information about dealing with special dietary requirements, sessions outlines, photocopiable resources and 75 recipes for snacks and meals.This updated version replaces the March 2007 edition.For information on training as a Cook it! facilitator, contact the health promotion service in your local Health and Social Care Trust.