La réhabilitation psychosociale a l'aube du XXIème siècle. I: Principes, population cible et pathologie en cause

The relatively recent development of the psychosocial rehabilitation has its origins mainly in the progress of modern psychopharmacology, the assertion of the rights of the patients and the result of the studies showing that the evolution of persons suffering from severe and persistent mental illnesses can prove to be positive in many cases. In spite of the heterogeneity of the experiences and of the theoretical references, the core principles of the psychosocial rehabilitation imposed themselves. These principles can be classified according to three levels, that of relational ethics, that of the method of intervention and that of the institutional device. A recent study showed that 2.4@1000 of the general adult population of the Canton of Vaud live in sociotherapeutic and rehabilitation accommodations. In this sample, there is a important percentage of relatively young persons (55.3% are under 40). In institutional accommodation there is a majority of patients suffering from major personality disorders and addiction (40.6%), followed by psychotic disorders (37.2%), persistent mood disorders (12.3%), neurotic disorders (6.6%) and psycho-organic disorders (3.3%). In home based rehabilitation, the ratio of patients with psychotic disorders is more important (53.1%). This difference would indicate that people with schizophrenia would have a better social outcome than personality disorders with addiction

Major bleeding risk in anticoagulated patients receiving concomitant antiplatelet therapy: A prospective study.

INTRODUCTION: Current literature suggesting a higher bleeding risk during combination therapy compared to oral anticoagulation alone is primarily based on retrospective studies or specific populations. We aimed to prospectively evaluate whether unselected medical patients on oral anticoagulation have an increased risk of bleeding when on concomitant antiplatelet therapy. MATERIAL AND METHODS: We prospectively studied consecutive adult medical patients who were discharged on oral anticoagulants between 01/2008 and 03/2009 from a Swiss university hospital. The primary outcome was the time to a first major bleed on oral anticoagulation within 12months, adjusted for age, international normalized ratio target, number of medications, and history of myocardial infarction and major bleeding. RESULTS: Among the 515 included anticoagulated patients, the incidence rate of a first major bleed was 8.2 per 100 patient-years. Overall, 161 patients (31.3%) were on both anticoagulant and antiplatelet therapy, and these patients had a similar incidence rate of major bleeding compared to patients on oral anticoagulation alone (7.6 vs. 8.4 per 100 patient-years, P=0.81). In a multivariate analysis, the association of concomitant antiplatelet therapy with the risk of major bleeding was not statistically significant (hazard ratio 0.89, 95% confidence interval, 0.37-2.10). CONCLUSIONS: The risk of bleeding in patients receiving oral anticoagulants combined with antiplatelet therapy was similar to patients receiving oral anticoagulants alone, suggesting that the incremental bleeding risk of combination therapy might not be clinically significant.

Can the trabecular bone score (TBS) be considered as a major clinical risk factor (CRF) of osteoporotic fractures? A meta-like analysis

Abstract: To have an added value over BMD, a CRF of osteoporotic fracture must be predictable of the fracture, independent of BMD, reversible and quantifiable. Many major recognized CRF exist.Out of these factorsmany of themare indirect factor of bone quality. TBS predicts fracture independently of BMD as demonstrated from previous studies. The aim of the study is to verify if TBS can be considered as a major CRF of osteoporotic fracture. Existing validated datasets of Caucasian women were analyzed. These datasets stem from different studies performed by the authors of this report or provided to our group. However, the level of evidence of these studies will vary. Thus, the different datasets were weighted differently according to their design. This meta-like analysis involves more than 32000 women (≥50 years) with 2000 osteoporotic fractures from two prospective studies (OFELY&MANITOBA) and 7 crosssectional studies. Weighted relative risk (RR) for TBS was expressed for each decrease of one standard deviation as well as per tertile difference (TBS=1.300 and 1.200) and compared with those obtained for the major CRF included in FRAX®. Overall TBS RR obtained (adjusted for age) was 1.79 [95%CI-1.37-2.37]. For all women combined, RR for fracture for the lowest comparedwith themiddle TBS tertilewas 1.55[1.46- 1.68] and for the lowest compared with the highest TBS tertile was 2.8[2.70-3.00]. TBS is comparable to most of the major CRF (Fig 1) and thus could be used as one of them. Further studies have to be conducted to confirm these first findings.

Volatilização de N-NH3 na cultura de milho:: II. avaliação de fontes sólidas e fluidas em sistema de plantio direto e convencional

Foram desenvolvidos dois experimentos em campo, em sistema de plantio direto (SPD) sobre cobertura de aveia-preta, em latossolo vermelho-escuro, distrófico, argiloso, e em sistema de plantio convencional (SPC), após cultivo de soja, em latossolo vermelho-amarelo distrófico arenoso, no Centro de Pesquisa Novartis-Seeds e na Fazenda Stª. Teresinha, Uberlândia (MG) respectivamente. O estudo objetivou avaliar as perdas por volatilização de N-NH3 da cobertura nitrogenada na cultura de milho com cerca de 100 kg ha-1 de N, de cinco fontes nitrogenadas em ambos os sistemas de plantio. As fontes nitrogenadas - sulfato de amônio, nitrato de amônio, uréia e duas soluções nitrogenadas constituídas de uréia + nitrato de amônio (uran) e uréia + nitrato de amônio + sulfato de amônio (sulfuran) - foram aplicadas na superfície e incorporadas no meio da entrelinha. Após a aplicação da cobertura, instalaram-se, ao acaso, três coletores do tipo semi-aberto estático, por tratamento, sendo efetuadas seis amostragens de N-NH3 volatilizado, em intervalos de quatro a cinco dias. No SPD, as perdas acumuladas de N-NH3 provenientes das fontes uréia, uran e sulfuran aplicadas na superfície foram, respectivamente, de 78,0; 37,2 e 26,9% do N aplicado. No SPC, as perdas mais significativas foram de uréia (30,7%) e uran (9,7%). O nitrato de amônio e o sulfato de amônio apresentaram perdas inferiores a 15,0% do N aplicado à superfície. A correlação das perdas por volatilizacão de N-NH3 e a produtividade dos dois experimentos mostraram um ajuste linear negativo, de tal forma que no SPD houve uma queda de produção de 13,3 kg de grãos e no SPC, de 11,8 kg de grãos para cada quilograma de N volatilizado.

[Albano. Palazzolo]

Référence bibliographique : Weigert, 308

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