Exposition aux immunosuppresseurs in utero [Exposure in utero to immunosuppressives]

The number of pregnant women receiving immunosuppressive therapy is increasing. Use of immunosuppressants during pregnancy is indicated for anti-rejection therapy in transplantation patients and treatment of autoimmune diseases. Despite the maternal and fetal risks of these pregnancies, the proportion of surviving infants is improving and the possibility that a pregnancy could occur in these women during their childbearing years should be considered. All immunosuppressant drugs and their metabolites cross the placenta, raising questions about the long-term outcome of the children exposed to these agents in utera. There is no increased risk of congenital anomalies. However, there is an elevated incidence of prematurity, intrauterine growth retardation (IUGR) and therefore low birthweight, as well as maternal hypertension and preeclampsia. The most frequent neonatal complications are those associated with prematurity and IUGR, as well as adrenal insufficiency with corticosteroids, immunological disturbances with azathioprine and cyclosporin, and hyperkalemia with tacrolimus. The long-term follow-up of infants exposed to immunosuppressants in utero is still limited and experimental studies raise the question whether there could be an increased incidence at adult age of some pathologies including renal insufficiency, hypertension and diabetes. The follow-up of these infants should be carefully organized and multidisciplinary, taking the perinatal context into account.

Sécurité routière: moins de morts et de blessés grâce aux radars?

[Introduction (extrait)] Si l'on connaît généralement les revues systématiques dans le domaine médical ou des soins, l'évaluation de l'efficacité d'une intervention technique ou structurelle en dehors de ces domaines est moins connue. Le but est cependant similaire : quelles preuves a-t-on qu'une intervention soit efficace pour améliorer la santé de la population ou d'une personne ? L'article ci-dessous présente une revue systématique en prévention et santé publique

Croire aux esprits? Plutôt les percevoir, ou comment l'anthropologue apprend sensiblement le monde de ses hôtes

Alors que dans notre culture francophone et occidentale les relations avec les "esprits" sont presque invariablement qualifiées dans les termes de la croyance, à Zanzibar elles sont déclinées selon des modalités fort différentes. "Croire aux esprits" se révèle donc inadéquat, voire même insensé, dans la pratique de l'uganga, les rituels d'incorporation des "esprits". C'est pourquoi je propose dans cet article un déplacement : remplacer "croire" par "percevoir". Cela ouvre un vaste champ d'investigation quant à la part expérientielle de notre rapport aux esprits et aux manières dont nous percevons le monde que nous habitons.

Accès aux soins et maintien dans la communauté des personnes difficiles à engager dans un traitement psychiatrique [Access to care and maintenance in the community of persons who are difficult to engage in psychiatric treatment]

Psychotic patients to not access easily to psychiatric care. First, psychotic disorders are difficult to identify among a great number of non psychotic depressive and anxious disorders. Second, inpatient care has shortened and now focus on acute care rather than long stay. For some psychotic patients, desinstitutionalization means exclusion and marginalization. Intensive case management can answer these needs in collaboration with relatives and professionals of patient's social network. Results and care's steps of intensive case management as practiced in Lausanne are described and illustrated with cases vignettes.