Úlcera por pressão em pacientes submetidos à cirurgia: incidência e fatores associados

As úlceras por pressão constituem um dos principais indicadores da qualidade do cuidado na assistência perioperatória. Este é um estudo longitudinal, do tipo série de casos, com o objetivo de estimar a incidência de úlceras por pressão em pacientes submetidos a cirurgias de médio e grande portes; classificá-las segundo estágio e localização, verificar a associação das variáveis sexo, idade, índice de massa corpórea, comorbidades, posição cirúrgica, tempo cirúrgico, anestesia e uso de dispositivos de posicionamento com a presença ou ausência de úlceras por pressão. Os dados foram coletados em 2007, em São Paulo, com 199 pacientes, dos quais 20,6% apresentaram úlceras por pressão, 98,6% nos estágios I e II, com localização predominante no tronco frontal (35,1%). As variáveis: posição, tempo cirúrgico, anestesia geral e uso de dispositivos apresentaram associação estatística significativa. Concluiu-se que a incidência de úlceras por pressão em pacientes cirúrgicos é elevada, demandando ações que visem à redução desse tipo de lesão.

Medical and legal professionals' attitudes towards confidentiality and disclosure of clinical information in forensic settings: a survey using case vignettes.

OBJECTIVE: When potentially dangerous patients reveal criminal fantasies to their therapists, the latter must decide whether this information has to be transmitted to a third person in order to protect potential victims. We were interested in how medical and legal professionals handle such situations in the context of prison medicine and forensic evaluations. We aimed to explore the motives behind their actions and to compare these professional groups. METHOD: A mail survey was conducted among medical and legal professionals using five fictitious case vignettes. For each vignette, participants were asked to answer questions exploring what the professional should do in the situation and to explain their justification for the chosen response. RESULTS: A total of 147 questionnaires were analysed. Agreement between participants varied from one scenario to another. Overall, legal professionals tended to disclose information to a third party more easily than medical professionals, the latter tending to privilege confidentiality and patient autonomy over security. Perception of potential danger in a given situation was not consistently associated with actions. CONCLUSION: Professionals' opinions and attitudes regarding the confidentiality of potentially dangerous patients differ widely and appear to be subjectively determined. Shared discussions about clinical situations could enhance knowledge and competencies and reduce differences between professional groups.

La huella del futuro. El cine y el pensamiento y la imagen y el fantasma

Se tratará en este trabajo, primero, de caracterizar un tipo de imagen capaz deromper con los yugos con los que la contemporaneidad somete la imaginación a partir de la obra de cineastas particularmente sensibles a este problema, como Werner Herzog y Wim Wenders. Una vez hecho esto, analizaremos la fuente de dicha imagen para así poder invocarla, como si de verdaderas hechicerías o chamanismos se tratase, teniendo en cuenta las nuevas tecnologías y atendiendo a algunos de quienes han sabido extraer de ellas sus poderes más ocultos, sobre todo Jean-Luc Godard y David Lynch. Por último, será a través del cine de Claire Denis y de una cierta idea del cuerpo como ahondaremos en el acontecimiento de la nueva imagen capaz de sacar al sistema de sus goznes y relanzar al cine y al pensamiento hacia un futuro incierto; incierto como es todo auténtico futuro.

Marseille. Collection de copies et de documents originaux concernant l'histoire de Marseille. Collection Mortreuil sur Marseille vol. 12 : Corps religieux (Préfecture des Bouches du Rhône. Archives de l’église d’Arcoules, du monastère de Saint Sauveur et des Grands Trinitaires de Marseille. Actes antérieurs au XIV e siècle. A.M. 1855.)

Copie manuscrite de documents d’archives : F. 1-91. Archives de l’Eglise d’Arcoules de Marseille. F. 92-104. Augustins. F. 105-149. Archives des Dominicains (precheurs) de Marseille. F. 150-153. Abbaye de l’Huveaune, prémontrés. F. 154-178. Frères Mineurs. F. 179-180. La Major. F. 181 -184. St Carmat. F. 185-186. St Etienne des îles Ratoneau. F. 187-191. St Jacques de Corrégie. F. 192-193. St Laurent. F. 194-195. Prieuré de St Lazare. F. 196-199. St Martin F. 200-206. St Michel et St Etienne du Plan. F. 207 -379. Archives du monastère de Saint Sauveur de Marseille. F. 381-387. Sainte Claire. F. 388-391. N.D. de Syon. F. 392 459. Archives des Grands Trinitaires de Marseille.

The pattern of health care use of older prisoners in Switzerland.

Introduction: Population ageing is a worldwide phenomenon that forces us to make radical changes on multiple levels of society. So far, studies have concluded that the health, both physical and mental, of prisoners in general and older prisoners in particular is worse than that of the general population. Prisoners are reported to age faster as compared to adults in the community. However, to date, very little is known about the actual healthcare conditions of older prisoners and almost no substantial knowledge is available concerning their patterns of healthcare use. Method: A quantitative study was conducted in four prisons for male prisoners in Switzerland, including two open and two closed prisons situated in different cantons. In this study, medical records of older prisoners (50+) were obtained from the respective authority upon consent and total anonymity was ensured. Data gathered from all available medical records included basic demographic information, education and prison sentencing. Healthcare data obtained were extensive in nature encompassing data related to illness types, number of visits to different health care providers and hospitals. The corresponding reasons for visits and outcomes of these visits were extracted. All data are analysed using statistical software SPSS 20.0. Results: Data were extracted for a total of 50 older prisoners living in Switzerland. The chosen prisons are located in German-speaking cantons. Preliminary results show that the age average was 56 years. For more than half, this was their first imprisonment. Nevertheless, a third of them were sentenced to measures (Art. 64 Swiss Criminal Code) which means that the length of the detention is indefinite and while release is possible it is in most cases not very likely. This entails that these prisoners will grow old in prison and some will even spend their remaining years there. Concerning their health, a third of the sample reported respiratory and cardiovascular illnesses and half reported suffering from some form of musculoskeletal related pain. Older prisoners were prescribed on average only 3.5 medications, which is significantly fewer than the number of medication prescribed to younger prisoners, whose data were also sampled. Conclusion: Access to healthcare is a right given to all prisoners through the principle of equivalence which is generally exercised in Switzerland. Prisoners growing old in prison will represent a challenge for prison health care services.

Combining molecular evolution and environmental genomics to unravel adaptive processes of MHC class IIB diversity in European minnows (Phoxinus phoxinus)

Host-pathogen interactions are a major evolutionary force promoting local adaptation. Genes of the major histocompatibility complex (MHC) represent unique candidates to investigate evolutionary processes driving local adaptation to parasite communities. The present study aimed at identifying the relative roles of neutral and adaptive processes driving the evolution of MHC class IIB (MHCIIB) genes in natural populations of European minnows (Phoxinus phoxinus). To this end, we isolated and genotyped exon 2 of two MHCIIB gene duplicates (DAB1 and DAB3) and 1665 amplified fragment length polymorphism (AFLP) markers in nine populations, and characterized local bacterial communities by 16S rDNA barcoding using 454 amplicon sequencing. Both MHCIIB loci exhibited signs of historical balancing selection. Whereas genetic differentiation exceeded that of neutral markers at both loci, the populations' genetic diversities were positively correlated with local pathogen diversities only at DAB3. Overall, our results suggest pathogen-mediated local adaptation in European minnows at both MHCIIB loci. While at DAB1 selection appears to favor different alleles among populations, this is only partially the case in DAB3, which appears to be locally adapted to pathogen communities in terms of genetic diversity. These results provide new insights into the importance of host-pathogen interactions in driving local adaptation in the European minnow, and highlight that the importance of adaptive processes driving MHCIIB gene evolution may differ among duplicates within species, presumably as a consequence of alternative selective regimes or different genomic context.

VOLUMES RELIES du Cabinet des titres : recherches de noblesse, armoriaux, preuves, histoires généalogiques. Preuves de noblesse diverses et généalogie de la maison de Noailles.

Preuves de noblesse de Charles de Montsaunin (1), — et de dom François de Calvo (4 et 6), pour les Ordres du roi ; — de Marie-Jeanne-Françoise d'Alesso d'Eragni (8), — des demoiselles Marie et Louise Lois de Boussens (10), — d'Anne Raimond de Villogon (12), — Marie-Françoise de Saint-Martin (16), — Barbe de Limosin d'Alheim (18), — Marie-Louise de Houlei (20), pour Saint-Cyr ; — de Charles Acary de La Suze (22), — Pierre de Brie (24), — Joseph-Emmanuel d'Orillac (27), — François-Jacques Petit de La Borde (29). — Jean-Joseph de Rastel de Rocheblave (33), — Charles de Fautereau (39), — Pierre de Baud du Castelet (41), pour l'École militaire. — Parchemin. — Blasons peints. Épreuves de gravure des « Statuts de l'Ordre du St-Esprit. De l'Imprimerie royale, 1703 » (fol. 43). « Généalogie de la maison de Noailles » (fol. 56), avec nombreux dessins, blasons et encadrements, au crayon.

Quelle position professionnelle adopter face à la diversité des problèmes posés par l'évaluation des dangerosités ?

Cet article aborde divers problèmes posés par la notion de dangerosité. Malgré son abandon au profit de la notion d'évaluation du risque dans de nombreux pays après les années 1980, la demande d'évaluation de la dangerosité fait un retour marqué dans la législation française et dans les pratiques expertales. Dans cet article, la notion de dangerosité est interrogée sur le plan pénal, théorique, empirique et clinique afin de rendre intelligibles les débats et positionnements contrastés qu'elle provoque en France et afin de tenter de définir une position professionnelle face à l'insistante demande d'évaluation.

Quelques conséquences de l'application du nouveau code pénal suisse sur la psychiatrie légale [Some consequences of the application of the new Swiss penal code on legal psychiatry]

The new text of the Swiss penal code, which entered into effect at the beginning of 2007, has many incidences on the practice of the psychiatrists realizing expertises in the penal field or engaged in the application of legal measures imposing a treatment. The most notable consequences of this text are, on the one hand, a new definition of the concept of penal irresponsibility which is not necessarily any more related to a psychiatric diagnosis and, on the other hand, a new definition of legal constraints that justice can take to prevent new punishable acts and which appreciably modifies the place of the psychiatrists in the questions binding psychiatric care and social control.

Symptômes dépressifs et douleurs diffuses chez un détenu : penser au déficit en vitamine D [Depressive symptoms and widespread pains in a prisoner. Think on vitamin D deficiency].

The confinement can lead to an important limitation of sun exposure of the prisoners. This limitation can lead to a deficit in vitamin D, source of diverse disorders. Diffuse pains of members and of joints are the most classics troubles. The association of vitamin D deficiency and psychiatric disorders is frequent but badly known. Even if there is still no evidence indicating a cause and effect relationship between vitamin D deficiency and depressive episodes, the contribution of vitamin D deficiency in the arisen of a depression has to be considered. The treatment of vitamin D deficiency cannot, in itself, constitute a treatment of the depressive disorder but contributes to the improvement of the whole status The psychiatric follow-up remains indispensable, in particular because of the suicidal risk, particularly present in prison.