Rhumatologie. Anti-TNF alpha: quels risques infectieux? Recommandations pratiques [Rheumatology. TNF alpha-inhibitors: infection risks? Practical recommendations].

Anti-TNF alpha are immunomodulatory treatments prescribed for some rheumatologic inflammatory diseases (ex: spondylarthropathy, rheumatoid polyarthritis). The randomised studies suggested that anti-TNF alpha therapy is associated with an overall risk of infectious diseases. The results of the observational studies are more reassuring. In this article, we will describe some results of theses studies and propose some practical recommendations in use of the anti-TNF alpha therapy.

Presència de Rousseau a Catalunya: entre el mite i la realitat

En aquest article s’ofereix un perfil del pensament de Rousseau a partir de la seva relació amb la filosofia estoica i la seva dependència respecte de les idees de Montaigne, alhora que es remarca —atenint-se a la Professió de fe del vicari savoià— la dimensió religiosa i espiritual de la seva cosmovisió. Sobre la base d’aquests supòsits es revisa l’impacte de les idees de Rousseau en el Romanticisme del segle xix, sense perdre de vista les crítiques que la seva pedagogia va merèixer dels ideòlegs del Noucentisme (Eugeni d’Ors, Joaquim Xirau). Finalment, es conclou que la presència de la pedagogia de Rousseau en el Moviment de Renovació Pedagògica, viscut durant les primeres dècades del segle xx a Catalunya, constitueix més un horitzó que no pas una realitat bastida sistemàticament i sòlidament.

Assistance au suicide en hôpital de soins aigus: sommes-nous prêts [Physician-assisted suicide in university hospital: are we ready?]

Assisting people to commit suicide has generated a passionate public debate. In exceptional situations, access to this support can be granted to the demanders in a hospital environment. So did the CHUV and the academic hospitals of Geneva draw up a procedure permitting, in principle, the access to an assistance to commit suicide. Two recent clinical situations experienced in the CHUV's Service of internal medicine have created a lot of discussions, doubts and revealed, sometimes, divergent positions. By the light of this clinical cases, we wished to share the perspective of the internist in charge of the ethician, of the chaplain, of the medical director, of the psychiatrist and of the palliative care responsible. Theses complex situations illustrate the deep ambivalence felt by the clinicians confronted to situations which require a multidisciplinary approach.

Occupational research : selected bibliography of Iowa research in vocational-technical education and related areas -- 1960-1967

The Iowa RCU has developed this selected bibliography of Iowa research in Vocational-Technical Education and related areas. Contract research as well as abstracts of masters theses and doctoral dissertations are included. For the most part, these abstracts have been gleaned from research at the three state universities and Drake University.

Occupational research supplement no. 1 : selected bibliography of Iowa research in vocational-technical education and related areas -- 1963-1968

This is a supplement to the selected bibliography of Iowa research in Vocational-Technical Education and related areas that the Iowa RCU developed. Contract research as well as abstracts of masters theses and doctoral dissertations are included.

Occupational research supplement no. 2 : selected bibliography of Iowa research in vocational-technical education and related areas -- 1966-1968

This is supplement no. 2 to the selected bibliography of Iowa research in Vocational-Technical Education and related areas that the Iowa RCU developed. Contract research as well as abstracts of masters theses and doctoral dissertations are included.

Anévrismes complexes de l'aorte abdominale: la chirurgie ouverte est-elle obsolète [The complex aortic abdominal aneurysm: is open surgery old fashion?].

Open surgery is still the main treatment of complex abdominal aortic aneurysm. Nevertheless, this approach is associated with major complications and high mortality rate. Therefore the fenestrated endograft has been used to treat the juxtarenal aneurysms. Unfortunately, no randomised controlled study is available to assess the efficacy of such devices. Moreover, the costs are still prohibitive to generalise this approach. Alternative treatments such as chimney or sandwich technique are being evaluated in order to avoid theses disadvantages. The aim of this paper is to present the endovascular approach to treat juxtarenal aneurysm and to emphasize that this option should be used only by highly specialized vascular centres.

The effect of workplace smoking bans on heart rate variability and pulse wave velocity of non-smoking hospitality workers

OBJECTIVES: To investigate the effect of a change in second-hand smoke (SHS) exposure on heart rate variability (HRV) and pulse wave velocity (PWV), this study utilized a quasi-experimental setting when a smoking ban was introduced. METHODS: HRV, a quantitative marker of autonomic activity of the nervous system, and PWV, a marker of arterial stiffness, were measured in 55 non-smoking hospitality workers before and 3-12 months after a smoking ban and compared to a control group that did not experience an exposure change. SHS exposure was determined with a nicotine-specific badge and expressed as inhaled cigarette equivalents per day (CE/d). RESULTS: PWV and HRV parameters significantly changed in a dose-dependent manner in the intervention group as compared to the control group. A one CE/d decrease was associated with a 2.3 % (95 % CI 0.2-4.4; p = 0.031) higher root mean square of successive differences (RMSSD), a 5.7 % (95 % CI 0.9-10.2; p = 0.02) higher high-frequency component and a 0.72 % (95 % CI 0.40-1.05; p < 0.001) lower PWV. CONCLUSIONS: PWV and HRV significantly improved after introducing smoke-free workplaces indicating a decreased cardiovascular risk.

Impact of the Spanish smoking law on exponsure to secondhand smoke in offices and hospitality venues: before-and-after study

BACKGROUND/OBJECTIVES: A smoking law was passed by the Spanish Parliament in December 2005 and was enforced by 1 January 2006. The law bans smoking in all indoor workplaces but only in some hospitality venues, because owners are allowed to establish a smoking zone (venues>100 m2) or to allow smoking without restrictions (venues<100 m2). The objective of the study is to assess the impact of the Spanish smoking law on exposure to secondhand smoke (SHS) in enclosed workplaces, including hospitality venues. MATERIALS AND METHODS: The study design is a before-and-after evaluation. We studied workplaces and hospitality venues from eight different regions of Spain. We took repeated samples of vapor-phase nicotine concentration in 398 premises, including private offices (162), public administration offices (90), university premises (43), bars and restaurants (79), and discotheques and pubs (24). RESULTS: In the follow-up period, SHS levels were markedly reduced in indoor offices. The median decrease in nicotine concentration ranged from 60.0% in public premises to 97.4% in private areas. Nicotine concentrations were also markedly reduced in bars and restaurants that became smoke-free (96.7%) and in the no-smoking zones of venues with separate spaces for smokers (88.9%). We found no significant changes in smoking zones or in premises allowing smoking, including discotheques and pubs. CONCLUSIONS: Overall, this study shows the positive impact of the law on reducing SHS in indoor workplaces. However, SHS was substantially reduced only in bars and restaurants that became smoke-free. Most hospitality workers continue to be exposed to very high levels of SHS. Therefore, a 100% smoke-free policy for all hospitality venues is required.

Treating tobacco use and dependence in clinical practice.

Physicians are in a unique position to advise smokers to quit by the ability to integrate the various aspects of nicotine dependence. This review provides an overview of the intervention strategies for smokers presented in a primary care setting. The strategies that are used for smoking cessation counselling differ according to the patient's readiness to quit. For smokers who do not intend to give up smoking, physicians should inform about tobacco use and the benefits of cessation. For smokers who are dissonant, physicians should use motivational strategies, such as discussing the barriers to successful cessation and their solutions. For smokers who are ready to quit, the physician should show strong support, help set a date to quit, prescribe pharmaceutical therapies for nicotine dependence, such as nicotine replacement therapy (i.e., gum, transdermal patch, nasal spray, mouth inhaler, lozenges, and micro and sublingual tablets) and/or bupropion (an atypical antidepressant thought to work by blocking the neural re-uptake of dopamine and/or noradrenaline), with instructions for use, and suggest behavioural strategies to prevent relapse. The efficacy of all of these pharmacotherapies is comparable, roughly doubling the cessation rates over control conditions.

Cannabis and tobacco co-consumptions: can cannabis consumers quit cigarette smoking?

Purpose: To assess the relation between cannabis and tobacco consumption among adolescents in Switzerland and whether cannabis and tobacco co-users can quit cigarette smoking. Methods: Based on individual interviews and focus groups, 22 youths aged 15-20 discussed cannabis consumption behaviours. Twenty (14 males) were cannabis consumers - of which 18 also smoked tobacco and 2 quit tobacco smoking - and 2 were former cannabis consumers (both females and daily smokers). Data were transcribed verbatim and analyzed using Atlas.ti qualitative analysis software. Results: Among the co-consumers, 9 started with tobacco, 7 with cannabis, and 2 with both. The main consumption mode among all cannabis consumers is joints, while other ways of consuming such as food preparations and water pipes are rare and experimental. Joints always mix cannabis with tobacco for 3 reasons: to burn correctly, pure cannabis is too strong, and smoking cannabis alone is too expensive. Two cannabis consumers - one former tobacco smoker and one occasional tobacco smoker - consider rolling tobacco less addictive than cigarette tobacco alone, and hence use it in their joints. Overall cannabis is considered 'natural' and less harmful to health than tobacco. Thus, many users describe their wish, in the longer term, to quit tobacco consumption without excluding occasional cannabis consumption. Nonetheless, all coconsumers declare that they smoke cigarettes as a substitute for cannabis: For example, "If I don't have a joint, I need fags; if I don't have fags, I need joints; and if I don't have anything, I go crazy!" or "About 20 minutes after smoking a joint we feel like smoking something again, because in the joint there is pure tobacco without a filter as in cigarettes, and that creates a crazy dependency!". Finally, all co-consumers state that the consumption of one of the substances increases when trying to diminish the other: "A few months ago I stopped smoking joints for a month. Well I was smoking more than a pack [of cigarettes] a day." Similarly, the 2 former cannabis consumers increased their cigarette use since quitting cannabis. Conclusions: The majority of cannabis users co-consume tobacco as a way of compensating for one substance or the other. Using tobacco within joints implies that there is a risk that even occasional joints can revive nicotine addiction. Consequently, health professionals wishing to help adolescents in substance use cessation and prevention efforts should consider both substances in a global perspective. Sources of Support: Dept. of Public Health of the canton of Vaud.

Actores periodísticos y políticos en momentos de crisis: un estudio de caso

Este artículo pretende estudiar la relación entre periodistas y políticos en situacionescríticas. Los autores han analizado la información emitida por las cadenas de televisión:Televisión Española, Antena 3 y Tele 5 en los días 11, 12 y 13 de marzo de 2004, coincidiendocon el atentado de Madrid. De esta investigación, se concluye que los periodistasactuaron con poca capacidad crítica, en connivencia con los políticos, en la propagaciónde determinadas tesis poco o nada argumentadas y de ciertos tópicos y expresionesgratuitas.

Prévalence et facteurs associés à la consommation de tabac non fumé chez les jeunes hommes suisses

Introduction Le tabac non fumé (smokeless tobacco) comprend les formes de tabac qui ne sont pas consommées par combustion. Les deux principaux types de consommation sont le snus, par application sur la muqueuse orale, et le tabac à sniffer. Le premier se consomme surtout en Suède et les pays scandinaves ; la consommation du second a récemment fait son apparition en Suisse malgré son interdiction. Méthodes Nous avons utilisé la base de données de la Cohort on substance use risk factors (C-surf), une cohorte de jeunes hommes suisses se présentant à 3 centres de recrutement de l'Armée Suisse (Lausanne, Windisch et Mels). Un total de 13 245 jeunes hommes ont été invités à participer à cette enquête sur la consommation de substances. Le taux de réponses a été de 45.2%. Nous avons inclu 5720 participants pour cette analyse et utilisé une approche statistique par régression logistique pour identifier les déterminants de consommation de tabac non fumé. Résultats L'âge moyen des participants était de 19.5 ans. 8% des participants ont déclaré consommer régulièrement du tabac à sniffer et 3% consommer du snus au moins une fois par mois. La consommation de tabac à sniffer était associée à la consommation non quotidienne de cigarettes [odds ratio (OR) 2.41, 95% confidence interval (Cl) 1.90-3.05], ainsi qu'à celle d'alcool à risque (OR 3.93, 95% Cl 1.86-8.32) etépisodique (OR 7.41, 95% Cl 4.11-13.38). Un BMI élevé, un revenu familial au-dessus de la moyenne et un faible niveau de formation étaient également associés à la consommation de tabac à sniffer, alors que la consommation occasionnelle de cannabis l'était négativement. Les facteurs associés à la consommation de snus étaient similaires à ceux du tabac à sniffer. Conclusions Un jeune homme suisse sur 12 consomme du tabac à sniffer et 3% consomment du snus. La consommation de tabac non fumé est associée à d'autres comportements à risque, en particulier la consommation d'alcool à risque. Les résultats de la régression logistique multivariée montrent une association de la consommation de tabac non fumé à la consommation d'alcool à risque. Le rôle du tabac non fumé dans l'induction de la dépendance à la nicotine et dans l'initiation à d'autres comportements à risque, ainsi que ses effets sur la santé devront être analysés sur la base d'études longitudinales.

City Energy Management Program A Regional Energy Manager Approach, May 2014

Through the City Energy Management Program, energy managers will directly work with up to 20 municipalities in Iowa to help identify opportunities to reduce energy costs in city-owned buildings, exterior lighting, and water/wastewater facilities. This assistance will be provided to the selected municipalities who will provide an in-kind match to achieve energy efficiency within their community. Power Point of theses resources.

Protracted treatment with MDMA induces heteromeric nicotinic receptor up-regulation in rat brain: an autoradiography study.

Previous studies indicate that 3,4-methylenedioxy-methamphetamine (MDMA, ecstasy) can induce heteromeric nicotinic acetylcholine receptor (nAChR, mainly of α4β2 subtype) up-regulation. In this study we treated Sprague-Dawley rats twice-daily for 10 days with either saline or MDMA (7 mg/kg) and killed them on day 11 to perform [125I]epibatidine binding autoradiograms on serial coronal slices. Results showed significant increases in nAChR density in the substantia nigra, ventral tegmental area, nucleus accumbens, olfactory tubercle, anterior caudate-putamen, somatosensory cortex, motor cortex, auditory cortex, retrosplenial cortex, laterodorsal thalamus nuclei, amygdala, postsubiculum and pontine nuclei. These increases ranged from 3% (retrosplenial cortex) to 30 and 33% (amygdala and substantia nigra). No increased α4 subunit immunoreactivity was found in up-regulated areas compared with saline-treated rats, suggesting a post-translational mechanism as occurs with nicotine. The percentage of up-regulation correlated positively with the density of serotonin transporters, according to the serotonergic profile of MDMA. The heteromeric nAChR increase in concrete areas could account, at least in part, for the reinforcing, sensitizing and psychiatric disorders observed after long-term treatment with MDMA.