bluuebunny/crossref_metadata_2025 huggingface dataset:
OCORRÊNCIA DE DIABETES MELLITUS GESTACIONAL EM UMA UNIDADE BÁSICA DE SAÚDE DE CAJAZEIRAS-PB NO ANO DE 2015
Authors: Vieira Lins Campos Bruna , Luana de Figueirêdo Pimenta Wigna , Vieira da Silva Valdez , Maria de Souza Albuquerque Vládia , Rodrigues Pereira da Silva Murilo , Algeni Tavares Landim Maria
Published: June 2019

Objetivo: Verificar a ocorrência de Diabetes Mellitus Gestacional em uma unidade básica de saúde de Cajazeiras-PB. Metodologia: Trata-se de uma pesquisa de campo, tipo descritiva, com uma abordagem quali-quantitativa. A população estudada foi composta por gestantes que fizeram o pré-natal em uma unidade básica de saúde de Cajazeiras-PB, no ano de 2015. Foram avaliados prontuários de 100 gestantes que realizaram o pré-natal nesta unidade. Resultados: Dos prontuários avaliados, apenas 2 mostraram diagnóstico de Diabetes Mllitus Gestacional (DMG) com valores superiores à 126 mg/dL de Glicemia de Jejum, e os 98 restantes apresentaram valores inferiores à 92 mg/dL. De acordo com os dados coletados, observou-se que a prevalência do DMG na Unidades Básica de Saúde de cajazeiras-PB apresentou uma frequência de 2 casos apenas e em nenhum momento as gestantes tiveram acompanhamento nutricional. O nutricionista tem papel fundamental na prevenção e tratamento do DMG, juntamente com outros profissionais da área da saúde, com o objetivo de controlar a glicemia e evitar problemas futuros tanto para a mãe como para o bebê. Conclusão: Os resultados encontrados apontam que os perfis glicêmicos da maioria das gestantes das unidades básicas de saúde Cajazeiras-PB, encontram-se dentro dos valores de normalidade. Esse resultado mostra que as gestantes estão fazendo a prevenção, se alimentando da forma adequada. A presente pesquisa é relevante, pois se trata de uma patologia que coloca em risco a saúde da gestante e do feto. Determinar a ocorrência de DMG irá evidenciar a necessidade do controle e da prevenção à população sobre essa doença, buscando assim uma melhor qualidade de vida para as futuras mães e seus filhos. Palavras chave: Diabetes mellitus gestacional. Prevalência. Diagnóstico.
ASSOCIAÇÃO DA FORÇA MUSCULAR RESPIRATÓRIA E O ESTADO NUTRICIONAL DE PACIENTES NEUROLÓGICOS
Authors: Rodrigues da Nóbrega Liliane , de Andrade Isidório Ubiraídys , Ligia Vieira Melo Marta , Engrácia Valenti Vitor , Vilar de Assis Elisangela
Published: June 2019

OBJETIVO: Avaliar a associação entre a força muscular respiratória e o estado nutricional de pacientes neurológicos. MÉTODO: Pesquisa transversal analítica quantitativa. A pesquisa foi realizada na Clínica Escola Integrada da Faculdade Santa Maria- FSM, Cajazeiras, Paraíba, durante o período de abril a maio de 2018. Foram incluídos na pesquisa indivíduos com comprometimento neurofuncional, de ambos os sexos e qualquer idade. Foram excluídos os que possuíam alteração do estado cognitivo e os impossibilitados de realizar a antropometria e a manovacuometria. RESULTADOS: Foram avaliados 12 pacientes de ambos os sexos, onde a maioria se autodeclararam pardas, casadas, com diagnóstico clínico de AVE e sem antecedentes pessoais para doenças cardiovasculares. Observou-se que quando as variáveis da PImáx e PEmáx foram correlacionadas, foi encontrada uma correlação positiva com a circunferência da cintura e a circunferência abdominal no sexo feminino. Enquanto que, essas pressões se correlacionaram negativamente com a prega cutânea subescapular, circunferência abdominal e circunferência da cintura nos homens. Essa relação negativa ainda foi observada com a prega cutânea subescapular, bicipital e a pressão arterial diastólica nas mulheres. CONCLUSÃO: Conclui-se que nos participantes avaliados do sexo feminino, houve uma correlação positiva, entre a força muscular respiratória e os parâmetros antropométricos, circunferência da cintura e abdominal. Palavras chave: Doenças do Sistema Nervoso. Estado Nutricional. Força Muscular Respiratória.
OLHANDO A SAÚDE DO HOMEM
Authors: Karina Soares de Oliveira Cindy , de Abrantes Silva Arthur , do Nascimento Andrade Feitosa Ankilma , Silva Oliveira Geane , Lívia Silva Fonsêca Moreira Renata
Published: June 2019

Tem por objetivo analisar através da literatura o conhecimento da população masculina sobre a Política Nacional de Atenção Integral à Saúde do Homem (PNAISH). O estudo trata-se de uma revisão integrativa, realizada nos meses de fevereiro a abril de 2019 e que tem como pergunta norteadora: Qual o conhecimento do público masculino acerca da Política Nacional de Atenção Integral à Saúde do Homem (PNAISH)? O levantamento bibliográfico foi realizado pela Internet, por meio das bases de dados LILACS (Literatura Latino-Americana em Ciências de Saúde) e SciELO (Scientific Electronic Library Online). Para a busca dos artigos, foi feito o cruzamento dos seguintes descritores: “Saúde do Homem”, “Política Pública” e “Conhecimento”. Após a pesquisa e aplicação dos filtros, restaram seis artigos para compor a pesquisa. Percebe-se que, embora exista a Política Nacional de Atenção Integral à Saúde do Homem (PNAISH) há 10 anos, ainda existe a resistência do público masculino e a ausência de estratégias para tornar a política conhecida executada nos serviços de saúdes, especialmente na atenção básica. Observa-se o desconhecimento do público masculino acerca da sua política e a urgência em conscientizar os homens da importância do cuidado com a sua saúde, tendo em vista o aumento da morbimortalidade da sua classe.

DESCRITORES: Saúde do Homem; Política Pública; Conhecimento.
SAÚDE NO PRESÍDIO: ANÁLISE DA SAÚDE DOS PRIVADOS DE LIBERDADE
Authors: de Abrantes Silva Arthur , do Nascimento Andrade Feitosa Ankilma , Karina Soares de Oliveira Cindy , Silva Oliveira Geane , Lívia Silva Fonseca Moreira Renata
Published: June 2019

OBJETIVO: Conhecer a situação de saúde dos indivíduos em cumprimento de pena no Brasil. METODOLOGIA: Tratou-se de uma revisão integrativa de literatura. Para seleção da amostragem, foi realizada uma pesquisa pela base de dados BVSalud, com acesso ao BDENF, LILACS e SciELO, além do Google Acadêmico, utilizando os unitermos População Privada de liberdade, detentos e saúde, somando uma população de 354 artigos na primeira plataforma e 143 na segunda. Como critérios de inclusão, têm-se: Artigos que apresentam a temática do estudo, em português, disponibilizados em texto completo, de acesso gratuito, publicados e indexados em periódicos nacionais nos referidos bancos de dados após o ano de 2015. Foram excluídos teses, dissertações, monografias, revistas literárias, artigos que divergiam com a temática após leitura dos seus resumos, artigos que não com resumo indisponível e publicações que se repetiram nas bases de dados. Após utilização desses critérios, 27 artigos do BVSalud e 12 do Google Acadêmico foram lidos seletiva e analiticamente, de onde restaram seis e três artigos, respectivamente. RESULTADOS E DISCUSSÕES: Percebe-se um sucateamento nos presídios com superlotação e deficiência em recursos humanos e materiais que possam garantir a oferta de serviços de saúde eficazes. As políticas e planos, embora existam, não possuem resolutividade pelas péssimas condições a que os presos são expostos. Os profissionais afirmam deficiência no conhecimento das ações destinadas à promoção de saúde. CONCLUSÃO: Observa-se a necessidade de investimento em estrutura física, recursos humanos e materiais, além de capacitação para que se possa oferecer saúde em termos de promoção, proteção e recuperação.

Descritores: População Privada de liberdade, detentos, saúde.
EXTENSÃO UNIVERSITÁRIA, GÊNERO E ECONOMIA SOLIDÁRIA: INTERAÇÃO DE SABERES E CONSTRUÇÃO DA CIDADANIA
Authors: Dias Pessoa Lindovon , Dantas Moraes Sharlene , Josefa da Silva Maria , Maria Alves Cavalcante Ligia , G. R. Nobrega Joanacele , Alves Cruz Lindalva
Published: June 2019

Este trabalho ressalta a experiência inovadora da extensão universitária no sertão da Paraíba, em especial, na Faculdade Santa Maria, PB. Nosso objetivo é apresentar, embora com resultados tímidos e parciais, o crescimento dos investimentos nas ações coletivas das mulheres e indicadores de empoderamento delas decorrente da interação dos saberes acadêmicos e populares. A construção envolve os estudantes, os professores, os colaboradores e os parceiros do projeto com as gestoras de economia solidária no campo e na periferia urbana. A metodologia a que recorremos foi a qualitativa, no sentido de apreender os resultados da observação participante, os depoimentos das destinatárias do projeto, dentre outros. Usamos como referencial teórico o entendimento de Paulo Freire sobre extensão universitária; de Paul Singer sobre economia solidária, além do entendimento da igualdade de gênero, para jogar luzes sobre as ações direcionadas a estimular empreendimentos de economia solidária autogestados, principalmente, por mulheres no município de Cajazeiras (PB). A proposta, em andamento, consiste de um projeto de extensão intitulado Produção e comercialização nos empreendimentos de economia solidária, o qual faz abordagem de gênero, agroecológica e técnico-operativa e é desenvolvido pelo grupo de estudo, pesquisa e extensão em gênero e economia solidária e cidadania (GEPEGESC) em parceria com o Instituto Maria José Batista Lacerda (IMJOB). O referido projeto apoia as mulheres nos processos de produção e comercialização. Para tanto, entre outras atividades, desenvolve cursos de formação nas áreas de gênero e economia solidária, gestão de pequenos negócios e empreendedorismo; auxilia no esforço por fomento para o crescimento da produção; viabiliza a integração dos saberes entre academia e comunidade. O propósito é qualificá-las no combate à pobreza e à desigualdade de gênero. As partes envolvidas com as atividades de extensão constroem a prática de cunho político-pedagógico e estão imbuídas do objetivo da autogestão.

PALAVRAS CHAVE: extensão universitária; economia solidária; gênero e cidadania.
FATORES DE RISCO ASSOCIADOS AO INFARTO AGUDO DO MIOCÁRDIO
Authors: Stefânya Pereira da Silva Maria , Isabel Vieira de Brito Dara , Emanoel de Abreu Oliveira Pierri , Silva Oliveira Geane , Iranilda Silva Magalhães Maria , Alciene Saraiva de Souza Maria
Published: June 2019

OBJETIVO: Descrever os fatores de riscos associados ao infarto agudo do miocárdio. MÉTODO: Trata-se de uma revisão integrativa da literatura, com base na pergunta norteadora: quais os fatores de riscos associados ao Infarto Agudo do Miocárdio (IAM)? Em sequência foram realizadas uma seleção de artigos publicados nas bases de dados SCIELO que foram encontrados 2.383 artigos e LILACS, onde foram descobertos 3.873 artigos, na qual as buscas dessas bases de dados ocorreram no período de fevereiro a dezembro de 2017. Utilizando os seguintes descritores: “infarto”, AND “sinais e sintomas”, AND “fatores de riscos”. Foram usados como critérios de inclusão: artigos publicados em português, texto completo, disponível e que alcançaram os objetivos propostos, indexados nos referidos bancos de dados nos últimos cinco anos. RESULTADOS: Dos dez artigos selecionados, 20% (02) são do ano de 2012, 20% (02) são do ano de 2014, 10% (01) do ano de 2015, 40% (04) são do ano de 2016 e 10% (01) são do ano de 2017. Com base na análise dos artigos utilizados na revisão integrativa, foi verificado que os fatores de riscos associados ao IAM são: HAS, DM, Tabagismo, Sedentarismo, Obesidade, Consumo de Álcool Excessivo. CONCLUSÃO: Este estudo mostra os principais fatores que desencadeiam o IAM evidenciando o grau elevado de morbimortalidade, mostrando que a população precisa ter a consciência de hábitos saudáveis, tendo também o conhecimento sobre todos os fatores para que haja uma prevenção precoce, evitando assim, essa enfermidade.

PALAVRAS CHAVE: Fatores de Riscos. Infarto. Sinais e Sintomas.
Excessive body weight, body fat, and eating habits of students from public and private elementary education
Authors: Ferrari Carlos
Published: June 2019

Aims: The objective of this study was to
evaluate the prevalence of excessive body weight and eating
habits among students of 3th and 4th periods of elementary
school. Methods: 202 children (87 girls and 115 boys) in
four schools (two publics, n=104 and two privates, n=98)
from Barra do Garças (MT), Brazil were evaluated. A food
frequency and physical activity questionnaire was applied.
After measurement of height, weight and body mass index,
the body fat (%) was estimated using a bioimpedance scale.
The estimation of frequencies and the statistical analysis
were performed by the epitools® program. Results:
Prevalence of both overweight and obesity were higher in
private schools compared to the public ones. The prevalence
of overweight ranged from 18.92% to 32.43%, whereas the
obesity prevalence varied from 18.2% to 36.4%. Body fat
distribution was highest among girls than boys. The daily
dietary intake of vegetables, legumes and fruits reached only
57.4%, 50% and 43.6%, respectively. 36.6% of the students
did not drink or eat milk and its derivatives. The dietary
intake of fatty foods and soft drinks 5 to 7 days per week
were high, reaching 24.26% and 27.23%, respectively. The
weekly consumption of sweeties and candies was excessive,
reaching 39.11% for 5 to7 days. Conclusions: obesity was
higher among students from private schools and dietary
intake of vegetable foods was inadequate, wherea
The Knowledge and Attitudes about the Benefits, Risks and Use of Medicine in Aged Primary Students in Indonesia
Authors: Syofyan Syofyan , Dachriyanus Dachriyanus , Masrul Masrul , Rasyid Rosfita
Published: June 2019

BACKGROUND: Medication always has a ratio of benefits and risks to become a safety measure. Therefore, its use must be careful, especially for children, because it can potentially occur drug incidents in children. As drug users, children are required to be active in using it, but children's knowledge and attitudes about benefits, risks (dangers) and use of medicine are still very shallow and fragmented.AIM: This study aims to look at the description of children's knowledge and attitudes about medicine from the perspective of the benefits, risks or dangers and use of medicine and the factors that influence them.MATERIAL AND METHODS: The study was conducted by the analytic method with a cross-sectional approach using a questionnaire instrument in grade V elementary school-age children in Padang City, Indonesia. The total sample size obtained was 503 students.RESULTS: The results showed that children's knowledge of medicine was generally categorised as low, with an average score of 4.70 (SD 1.82) from a scale of 9. Knowledge of drug use was much lower, namely the average score of 1.21 (0.74), followed by knowledge of drug hazards an average score of 1.69 (1.03) and drug benefits an average score of 1.80 (0.69). Age variables, address of residence, family income, the existence of families working as health workers and sources of drug information significantly influence students knowledge (P < 0.05). Whereas students attitudes towards medicine tend to be more positive with an average score of 7.18 (1.77), where the average score of attitudes towards benefits, risks (hazards) and drug use are 1.79 (0.46), respectively, 1.10 (0.58) and 4.29 (1.37). Address of residence, companion during illness, achievement in school and experience in hospital care have a significant effect on student attitudes (P < 0.05).CONCLUSION: This study concluded that indicate that students knowledge of benefits, risks and use of medicine is still low and very limited. While related to student attitudes, in general, it tends to be more positive, except about the dangers of medicine that show a negative attitude. The low level of knowledge and limited attitudes of children are the reason for the need for drug education given to children, especially in schools as an integral part of health education.
Requirement Prediction for Toluene Detox with Foods Intake Rich in CYP2E1 Enzyme and Glycine to Prevent Nerve and Kidney Damage at Shoe Home Industry Workers in Romokalisari Surabaya
Authors: Tualeka Abdul Rohim , Rahmawati Pudji , Ahsan Ahsan , Pathak Yashwant , Russeng Syamsiar S. , Sukarmin Sukarmin , Wahyu Atjo
Published: June 2019

BACKGROUND: Toluene was an organic compound used in chemical and drug industries, the main source of toluene emissions from fires. To reduce and even eliminate toluene toxins in chemical component could be using detoxification by foods. AIM: This research aimed to calculate the intake of foods rich in CYP2E1 enzyme and glycine to improve toluene detoxification.METHODS: The type of research was a descriptive study. The subject of the study was 51 workers in Romokalisari Surabaya who had worked for more than or equal to 10 years. Variables were body weight, duration of working (years), working time per week (days), and working time per day (hours). The breathing rate, intake of non-carcinogen per respondent, can be calculated by variables before. Then, the effective dose of food rich in CYP2E1 enzyme and glycine will be obtained.RESULTS: Majority respondents had toluene concentrations below the threshold limit value (TLV). The highest effective dose of foods rich in CYP2E1 enzymes such as beef liver, beef brain, and salmon was 239.61 g, 745.45 g, and 203.3 g. Also, foods rich in glycines such as seaweed, tuna, and spinach were 432.98 mg, 934.41 mg, and 2070.71 mg. CONCLUSION: The level of adequacy of the CYP2E1 enzyme and glycine of each person was different and varied. The effective dose required by each respondent depending on weight, length of work, and concentration of benzene in the workplace. The greater the toluene concentration, the greater the needs for foods rich in CYP2E1 enzymes and glycine. Body weight can also be another factor in differences in individual intake. Weight, length of working, and toluene concentration can affect the intake of non-carcinogen in each which can affect the effective dose of foods.
Assessment of Hyaluronic Acid Gel Injection in the Reconstruction of Interdental Papilla: A Randomized Clinical Trial
Authors: Abdelraouf Sara Amr , Dahab Omnia Aboul , Elbarbary Ahmed , El-Din Amany Mohy , Zaki Basma Mostafa
Published: June 2019

BACKGROUND: Various techniques have been implemented to reconstruct the deficient interdental papilla.AIM: The present trial was conducted to assess the effect of injection of hyaluronic acid gel for the reconstruction of deficient interdental papilla.MATERIAL AND METHODS: Thirty-six deficient interdental papilla sites in ten patients were randomly allocated into two equal groups; intervention group who received the injection of hyaluronic acid (HA) gel and control group who received the injection of saline solution as a placebo. Each deficient papilla received three injections. The first injection was given one week following the re-evaluation period (four weeks after performing full mouth supra-gingival scaling and sub-gingival debridement). The second and third injections were given after three and six weeks, respectively. The height and surface area of black triangles were recorded at baseline before the injection procedures. The participants were recalled after three and six months from the first injection for re-measuring the recorded parameters. At 6 months, patients' satisfaction was also assessed.RESULTS: After three and six months from baseline, the results revealed a statistically significant higher mean decrease in height and surface area of black triangles in favour of the HA group. From three to six months, there was no statistically significant difference between the two groups in both parameters. At 6 months, the HA group showed a statistically significant higher mean satisfaction score than the saline group.CONCLUSION: The use of hyaluronic acid gel for the reconstruction of interdental papillary deficiency was effective with promising levels of patients' satisfaction.
Isolated Bilateral Pinna Swelling: A Rare Initial Presentation of Leprosy
Authors: Mohd Yusuf Salma , Ismail Ilham Ameera , Abdul Hamid Rumihati , Jamil Nur Adliah , Md Yasin Mazapuspavina
Published: June 2019

BACKGROUND: Leprosy or Hansen disease is a chronic infectious disease that causes social stigma due to its deforming bodily appearance and physical disability. It has a wide spectrum of presentation affecting diagnosis.CASE REPORT: A 21-year-old man who presented with chronic isolated bilateral pinna swelling as a result of leprosy is reported. The bilateral pinna swelling started as multiple shiny papules with an erythematous background and progressively became hyperpigmented and lobular over two years. This rare presentation of leprosy poses initial diagnostic difficulties, leading to misdiagnoses by various health care professionals. Diagnoses ascribed include eczema, insect bite and perichondritis. A suspicion of leprosy was raised when hyperaesthetic hypopigmentation of skin started to appear on the body after two years, with worsening of the pinna swellings. This was confirmed by identification of Mycobacterium leprae in slit skin smear test and skin biopsy.CONCLUSION: Isolated involvement of pinna in a patient without lesions in other body parts is an unusual initial presentation of leprosy. However, leprosy should be kept as a rare differential diagnosis of isolated lesions on the ear in patients not responding to conventional treatment.
Prevalence and Anti-Microbial Susceptibility of Hospital Acquired Infections in Two Pediatric Intensive Care Units in Egypt
Authors: El-Sahrigy Sally , Shouman Mohamed G. , Ibrahim Hanan , Rahman Azza Abdel , Habib Sonia Adolf , Khattab Aser A. , Gomaa Howayda A. , Helmy Naiven
Published: June 2019

BACKGROUND: Hospital-acquired (nosocomial) infection is a common serious health problem worldwide, especially in pediatric intensive care units and is associated with high mortality and morbidity, prolonged hospital stays and high cost.AIM: To determine the types of organisms involved in hospital-acquired an infection in two pediatric intensive care units during the one-year study and its anti-microbial susceptibility.MATERIAL AND METHODS: This study was carried out in the pediatric intensive care units (PICU) of Ain Shams & Cairo Universities, where 86 pediatric patients were recruited. Their age ranged from 1 month to 156 months with mean 20.7 ± 25.8 months. Male to female ratio was 37:29. Four samples were collected from each child for culture and sensitivity: blood, endotracheal aspirate, urine and skin swab.RESULTS: The most common microorganism was staphylococcus while Gram-negative bacteria were the commonest group. Amikacin and imipenem are the most sensitive antibiotics. Risk estimate for different risk factors among studied patients revealed no significance.CONCLUSION: Staphylococcus was the commonest micro-organism while Gram-negative infections were the commonest group among PICU with a predominance of Acinetobacter and Klebsiella. Respiratory infections were the most common, followed by blood-borne infection. Risk factors for mortality were not significant.
Mortality Rate Due to Circulatory and Alcohol-Dependent Diseases in Different Climatic Zones of Russia
Authors: Yakovleva Tatiana P. , Nikitina Natalia I. , Gardanova Zhanna R. , Mikhailova Natalia S. , Gaponenko Albina V. , Koverkina Elena V.
Published: June 2019

AIM: Evaluation of the impact of climatic factors on the formation of mortality due to circulatory diseases and a group of diseases related to alcohol consumption identified as alcohol-dependent. METHODS: The study subject was the adult population residing in different climatic zones of Russia: in the second, third and fourth zones, with different conditions: average annual temperature (5.2°C; 1-2°C; -2.0°C), snow cover duration (≤ 150 days, ≤ 180 days, ≈ 220 days) sunshine duration and the presence of polar night and polar day in the territory of the fourth climatic zone. The assessment “impact-case of death” was carried out by calculating the standardized incidence ratio (SIR) with 95% confidence intervals (CI) for circulatory system diseases (CSD) and alcohol-dependent diseases (ADD) in accordance with the international classification of diseases (ICD-X). RESULTS: The SIR of death from alcohol-dependent diseases for the female population in the 4th climatic zone (Murmansk Region) was the highest: the SIR of death from ADD 1.87; 95% CI (1.5-2.7), the SIR of death from CSD 1.3; 95% CI (1.2-2.3). For the female population in the 3rd climatic zone (Novosibirsk Region), the SIR of death has amounted to: SIRADD 1.52; 95% CI (1.2-1.87), SIRCSD 1.14; 95 CI (1.01-1.3). Living in the 3rd climatic zone was not so important for the health of the male population: the SIR of death from CSD 1.1; 95% CI (1.05-1.13); the SIR of death from ADD 0.8; 95% CI (0.65-0.98). However, living in the 4th climatic zone (Murmansk Region) poses a higher risk of death for the male population: SIRCSD 1.22 (22.0%); 95% CI (1.02-3.95); SIRADD 1.45 (45.0%); 95% CI (0.98-2.1). CONCLUSION: Living in high northern latitudes contributes to higher levels of mortality, both female and male, from circulatory and alcohol-dependent diseases.
Encounters with Rheumatologists in a Publicly Funded Canadian Healthcare System: A Population-based Study
Authors: Widdifield Jessica , Bernatsky Sasha , Pope Janet E. , Ahluwalia Vandana , Barber Claire E.H. , Eder Lihi , Kuriya Bindee , Ling Vicki , Paterson J. Michael , Thorne J. Carter
Published: June 2019

Objective.

To quantify population-level and practice-level encounters with rheumatologists over time.

Methods.

We conducted a population-based study from 2000 to 2015 in Ontario, Canada, where all residents are covered by a single-payer healthcare system. Annual total number of unique patients seen by rheumatologists, the number of new patients seen, and total number of encounters with rheumatologists were identified.

Results.

From 2000 to 2015, the percentage of the population seen by rheumatologists was constant over time (2.7%). During this time, Ontario had a stable supply of rheumatologists (0.8 full-time equivalents/75,000). From 2000 to 2015, the number of annual rheumatology encounters increased from 561,452 to 786,061, but the adjusted encounter rates remained stable over time (at 62 encounters per 1000 population). New patient assessment rates declined over time from 10 new outpatient assessments per 1000 in 2000 to 6 per 1000 in 2015. The crude volume of new patients seen annually decreased and an increasing proportion of rheumatology encounters were with established patients. We observed a shift in patient case mix over time, with more assessments for systemic inflammatory conditions. Rheumatologists’ practice volumes, practice sizes, and the annual number of days providing clinical care decreased over time.

Conclusion.

Over a 15-year period, the annual percentage of the population seen by a rheumatologist remained constant and the volume of new patients decreased, while followup patient encounters increased. Patient encounters per rheumatologist decreased over time. Our findings provide novel information for rheumatology workforce planning. Factors affecting clinical activity warrant further research.
Prevalence and Risk Factors for Major Infections in Patients with Antineutrophil Cytoplasmic Antibody–associated Vasculitis: Influence on the Disease Outcome
Authors: Garcia-Vives Eloi , Segarra-Medrano Alfons , Martinez-Valle Ferran , Agraz Irene , Solans-Laque Roser
Published: June 2019

Objective.

To analyze the role that infections play on the antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) outcome.

Methods.

A retrospective study of adult patients with AAV diagnosed in a tertiary center. Clinical features, laboratory findings, treatment, relapses, major infections, and outcome were evaluated.

Results.

Included were 132 patients [51 microscopic polyangiitis (MPA), 52 granulomatosis with polyangiitis (GPA), 29 eosinophilic GPA (EGPA)] with a mean followup of 140 (96–228) months. ANCA were positive in 85% of cases. A total of 300 major infections, mainly bacterial (85%), occurred in 60% patients during the followup. Lower respiratory tract (64%) and urinary tract infections (11%) were the most frequent, followed by bacteremia (10%). A total of 7.3% opportunistic infections were observed, most due to systemic mycosis. Up to 46% of all opportunistic infections took place in the first year of diagnosis, and 55% of them under cyclophosphamide (CYC) treatment. Bacterial infections were associated with Birmingham Vasculitis Activity Score (version 3) > 15 at the disease onset, a total cumulative CYC dose > 8.65 g, dialysis, and development of leukopenia during the followup. Leukopenia was the only factor independently related to opportunistic infections. Forty-four patients died, half from infection. Patients who had major infections had an increased mortality from any cause.

Conclusion.

Our results confirm that major infections are the main cause of death in patients with AAV.
Renal Parenchymal Thickness in Patients with Systemic Sclerosis Is Related to Intrarenal Hemodynamic Variables and Raynaud Renal Phenomenon
Authors: Gigante Antonietta , Barbano Biagio , Gasperini Maria Ludovica , Zingaretti Viviana , Cianci Rosario , Rosato Edoardo
Published: June 2019

Objective.

Renal involvement in systemic sclerosis (SSc) ranges from urinary abnormalities, reduction of glomerular filtration rate, and high renal resistive index, to scleroderma renal crisis. Intrarenal resistance indices are considered markers of renal SSc-associated vasculopathy. The aim of this study is to evaluate renal morphological variables, such as renal length, parenchymal thickness, atrophy index, and renal sinus in patients with SSc and to correlate it with renal function and hemodynamic variables.

Methods.

There were 92 patients with SSc and 40 healthy controls (HC) enrolled in this study. Doppler and renal ultrasound (US) including renal length, parenchymal thickness, atrophy index, renal sinus, and intrarenal resistive index were measured in patients with SSc and HC.

Results.

Renal US showed significant differences between HC and patients with SSc. The renal length (mm; 106.7 ± 5.1 vs 102.3 ± 8.4) and renal sinus (70.7 ± 7.9 vs 65.3 ± 7.7 mm) were significantly (p = 0.001) higher in HC than patients with SSc. The parenchymal thickness was significantly (p = 0.004) higher in HC than patients with SSc (18 ± 3.1 vs 16.3 ± 2.5 mm). Pulsatility index, resistive index, and systolic/diastolic ratio were significantly (p < 0.0001) lower in HC than patients with SSc. The renal length was significantly (p = 0.004) higher in diffuse cutaneous SSc (105 ± 8.4) than in limited cutaneous SSc (99.5 ± 7.5).

Conclusion.

In SSc, kidney involvement is subclinical and is related to vascular injury, Raynaud phenomenon, and chronic hypoxia that can modify renal morphology. Serum creatinine is a poor marker of renal damage, and renal US could be a useful tool — together with Doppler — to evaluate renal involvement in a systemic and chronic disease such as SSc.
Fragmentation territoriale de la formalisation des récupérateurs à Lima
Authors: Rateau Mélanie
Published: June 2019

Résumé Face aux enjeux sanitaires liés à la gestion des déchets, les politiques publiques d’intégration du secteur informel de la récupération sont longtemps restées minoritaires. Au Pérou, depuis la Loi du recycleur de 2009, les municipalités districales doivent mettre en place un service de collecte sélective par l’intégration des récupérateurs informels. En mobilisant les concepts de modèle de formalisation et de gestion partagée, l’objectif de cet article est de comprendre les modalités d’application de cette nouvelle législation à Lima, capitale péruvienne marquée par la fragmentation territoriale. La recherche empirique menée sur trois districts liméniens souligne que le potentiel de la gestion partagée est sous-exploité et que la seule Loi du recycleur ne peut mettre fin au secteur informel de la gestion des déchets.
L’entrée de nouveaux acteurs sur la scène des projets de développement sanitaires : altération ou maintien du concept de santé publique ? L’exemple de la responsabilité sociale des entreprises pétrolières en Angola
Authors: Tallio Virginie
Published: June 2019

Résumé La fin de la guerre en 2002 a permis à l’Angola de recueillir les dividendes de la paix. Pour autant, les indicateurs de développement humain restent alarmants. Par ailleurs, alors qu’on pourrait s’attendre à une forte présence des ONG de développement dans le pays, elles en sont absentes tandis que, parallèlement, les départements de responsabilité sociale des entreprises pétrolières financent ou mettent en place de nombreux projets de développement. Nous nous focaliserons sur le domaine sanitaire. Nous ébaucherons une classification des projets de responsabilité sociale des entreprises et montrerons en quoi ils diffèrent des projets menés par les ONG. Nous verrons ensuite comment ces nouveaux acteurs influencent le modèle de santé publique mis en place.
Mettre en œuvre un processus de transformation au sein des organisations. Cinq tableaux pour caractériser une approche énantiologique
Authors: Bonnet Daniel
Published: June 2019

Cet article met en perspective le concept de l’énantiologie. Nos travaux de recherches conduisent à proposer cette conceptualisation comme principe et domaine des connaissances relatives à l’étude des transformations. La transformation organisationnelle et stratégique comporte de mieux connaître le processus opératoire des opérations de la transformation et ses constructions afin de conduire plus efficacement le changement. La recherche contribue à l’expérimentation d’une clinique de l’intervention pour des missions de conduite du changement impliquant une transformation des structures mentales du fonctionnement et du management de l’organisation.
Exploration de la dynamique incestuelle au sein de la famille d’un adolescent auteur d’agression sexuelle : le suivi de Thomas
Authors: Corré Sonia , Mazoyer Anne-Valérie
Published: June 2019

Dans une perspective psychanalytique, nous avons tenté de comprendre les enjeux psychiques d’une agression sexuelle intrafamiliale commise par un adolescent. À partir d’une situation clinique suivie cliniquement et éducativement pendant plusieurs années, nous avons dégagé les différents enchaînements qui conduisent au passage à l’acte : la dimension incestuelle dans la famille derrière une pseudo-normalité, la transmission brute de faits traumatiques restés en panne d’élaboration, la fonction de l’agir comme régulateur des excitations pulsionnelles difficilement canalisables, l’amplification des angoisses dépressives de séparation, l’attaque du frère rival dans une visée restauratrice narcissique. La perspective de cet article est également de proposer des modalités thérapeutiques à proposer à l’adolescent comme à la famille pour travailler la dimension intrapsychique et l’intersubjectivité.
La technique analytique face à la pathologie par clivage
Authors: Jiménez Avello José , Landa Eva
Published: June 2019

En approfondissant et en systématisant l’œuvre des dernières années de Ferenczi – ce qu’il n’a pu réaliser lui-même du fait de sa mort prématurée –, on y rencontre une conception bien personnelle de la métapsychologie et de la technique psychanalytique. La métapsychologie semble d’un abord relativement difficile, mais on y adhère sans difficulté ni objections si on l’examine en profondeur. En revanche, ses propositions techniques, bien que plus faciles d’accès, semblent plus discutables à notre époque, et il nous faut choisir entre les abandonner ou les remettre à jour. Opter pour leur mise à jour implique de dépasser la « primitivité » de la logique dont elles souffrent (tout comme les propositions techniques de Freud). Et cela nous amène à réfléchir aux « principes », et non aux « règles », sous-jacents aux innovations de l’auteur, en particulier ceux énoncées à partir de 1928. Ceux-ci conviennent au traitement de certaines pathologies, notamment celles qui s’originent dans les défenses par clivage ; des pathologies relativement étrangères à Freud dont la technique convient plutôt aux troubles névrotiques liés au refoulement. Les troubles relevant du clivage résistent aux techniques classiques qu’il faut alors radicalement modifier. La « capacité d'empathie », la « sympathie », sont les points fondamentaux développés dans cet exposé, ainsi que l’« humilité », la « reconnaissance des erreurs » et, plus généralement, la « sincérité professionnelle » qui y sont inévitablement associées. En conclusion, il sera question d’une situation concrète et extrême en clinique : comment agir s’il y a érotisation du contre-transfert.
Terreur de la souffrance, tourment de la douleur
Authors: Eekhoff Judy K. , Adam Elena , Frey Nicole
Published: June 2019

La manière dont Ferenczi a compris les défenses primaires nécessaires pour faire face au trauma, telles l’introjection, l’identification à l’agresseur, l’atomisation et le « calcul », vient étayer les observations cliniques de l’auteur à propos de patients ayant introjecté une mère-douleur . L’introjection d’une mère en souffrance maintient le terrorisme de l’événement externe premier par la persistance de la douleur interne, avec pour résultat d’être soumis au tourment de la souffrance. Une telle introjection crée des difficultés techniques pour l’analyste. Un cas clinique est présenté ici pour en témoigner.
La grande adaptation
Authors: Le Dévédec Nicolas
Published: June 2019

Résumé Le transhumanisme ne se réduit pas à un projet technoscientifique. Il engage un rapport au monde, à la collectivité, à la cité (polis), qu’il est nécessaire d’interroger, au-delà des enjeux éthiques et utilitaristes qui tendent aujourd’hui à prédominer dans les débats. C’est la nature et le sens de ce « rapport au monde » promu par le mouvement que cet article entend mettre en lumière dans une perspective théorique critique. Son objectif est de montrer que le transhumanisme, y compris quant à la branche dite sociale et progressiste du mouvement, promeut et diffuse un rapport au monde qui se caractérise fondamentalement par l’élusion du politique, au sens philosophique et fondamental du terme. Sur des sujets aussi divers que la prise en charge des risques globaux planétaires, la question des problèmes de santé publique, le bien-être conjugal ou encore les questions écologiques, les transhumanistes avancent des explications de type « psycho-bio-évolutionnistes » qui exonèrent les sociétés capitalistes de toute responsabilité et conduisent à privilégier des solutions technoscientifiques centrées sur l’adaptation humaine.
La « liberté morphologique » transhumaniste, un nouvel esprit anti-cosmopolitique
Authors: Bourcier Benjamin
Published: June 2019

Résumé Dans cet article, il s’agit, à partir d’une analyse des arguments expliquant le sens de la liberté morphologique défendue par les transhumanistes, de mettre en question l’idéologie politique portée par le transhumanisme. Nous proposons de montrer que le transhumanisme est un anti-cosmopolitisme en explicitant les enjeux de cette opposition radicale en s’appuyant sur des approches différentes du cosmopolitisme contemporain.
Urbanisation et inégalités en Afrique : une étude à partir des indices désagrégés
Authors: Ongo Nkoa Bruno Emmanuel , Song Jacques Simon
Published: June 2019

Dans cet article, nous évaluons l’effet de l’urbanisation sur les inégalités en Afrique au cours de la période 1980-2016. En effet, l’urbanisation croissante de l’Afrique depuis le début des années 1980, s’est accompagnée d’un approfondissement des inégalités. À partir d’un échantillon de 48 pays africains, nous estimons un modèle en données de panel dynamique par la Méthode des Moments Généralisés ( Mmg ) en Système. Nos résultats montrent que, l’urbanisation accroît les inégalités de revenus, environnementales et d’habitats. Ces résultats demeurent robustes avec l’utilisation des modèles Pstr (Panel Smooth Transition Regression Model) et Ptr (Panel Transition Regression Model). Nous suggérons la prise en compte des disparités identifiées dans les politiques d’urbanisation inclusives des villes africaines. Classification JEL  : D63, F18, L16, L52
Le caractère territorial des attractions touristiques liées aux pêches maritimes : une illustration par le modèle du panier de biens
Authors: Pocheau Chloé , Alban Frédérique , Le Floc’h Pascal , Legouvello Raphaela
Published: June 2019

La question abordée dans cet article porte sur le caractère territorial des attractions touristiques autour d’un port de pêche à forte identité. Face à l’épuisement des ressources, les territoires dépendants de l’exploitation des ressources marines vivantes tentent au cours des années 1990 des diversifications d’activité, notamment vers le tourisme. L’article retient le cas d’étude du port de pêche du Guilvinec sur lequel est implanté depuis 2000 un centre de découverte destiné à attirer une clientèle touristique. La méthodologie d’enquête est mobilisée pour délimiter le territoire sur lequel s’exerce une attractivité des activités de pêche et du centre de découverte. Une estimation des dépenses engagées par les visiteurs sur ce même territoire est proposée. Le modèle du panier de biens est adapté dans l’étude du comportement de la clientèle touristique. En effet, le centre de découverte offre une combinaison de biens au choix des visiteurs, avec un fort ancrage territorial. Classification JEL  : 018, Q22, R11, L83
De père en fille
Authors: Deutsch Catherine
Published: June 2019

Cet article propose une traduction française des extraits relatifs à la musique du Raisonnement à dame Lavinia d’Annibale Guasco, avec le texte original italien en regard. L’ouvrage, publié à Turin en 1586 à l’initiative de Lavinia, la fille de l’auteur, est écrit dans un ton extrêmement intime et spontané qui contraste avec les nombreux traités contemporains sur l’éducation féminine. Le texte témoigne de façon exceptionnelle des nombreux enjeux liés aux pratiques musicales féminines dans l’Italie de la fin de la Renaissance, et offre une perspective originale sur la relation nouée entre un père et une fille autour de la musique. S’il s’agit, pour Annibale Guasco, d’exercer son autorité paternelle sur sa fille en l’incitant à cultiver ses talents, pour Lavinia, la virtuosité musicale n’est pas qu’une simple vertu : elle est garante de son succès à la cour, et par ricochet, de la réputation de son père et de la prospérité de sa famille.
Sabina Pasqual, comédienne-chanteuse à Madrid (1688-1727) : mère, épouse et fille de musiciens, du « duo » à la carrière soliste
Authors: Bec Caroline
Published: June 2019

Le parcours de la comédienne-chanteuse espagnole Sabina Pasqual à Madrid, entre 1688 et 1727, inaugure la valorisation des voix féminines dans le drame lyrique espagnol, alors en plein essor, suivant l’héritage théâtral du Siècle d’Or mais aussi l’influence de l’opéra italien.Si Sabina Pasqual a bénéficié d’un savoir-faire musical familial essentiellement masculin lors de ses années de formation « en duo » avec son père, Félix Pasqual, guitariste et harpiste, puis auprès de son mari, le musicien et compositeur Ramón de Villaflor, cette artiste a été l’une des premières à connaître une carrière soliste florissante et une indépendance de plus en plus grande dans ses activités professionnelles comme dans sa vie privée.Cette chanteuse a ainsi contribué à la création du statut d’artiste lyrique féminine espagnole au XVIIIe siècle et plus largement à la redéfinition du rôle de la femme dans la société madrilène de l’époque.
Vítĕzslava Kaprálová et Bohuslav Martinů : entre émulation et complémentarité (1937-1940)
Authors: Derny Nicolas
Published: June 2019

Fille de musiciens, Vítĕzslava Kaprálová effectue, contre l’avis paternel, un cursus complet au Conservatoire de Brno. Elle se perfectionne ensuite à Prague, auprès de Vitĕzslav Novák (composition) et de Václav Talich (direction d’orchestre). En 1937, elle rencontre Bohuslav Martinů, alors en pleins préparatifs pour la création de Juliette ou la clé des songes qui doit se tenir au Národní divadlo l’année suivante. Celui-ci s’éprend de la jeune femme, qu’il convainc de venir étudier à Paris, où il est établi depuis 1923. Rapidement, il identifie Kaprálová à l’héroïne de son opéra, avatar de l’Éternel féminin. Leur relation de maître à élève tourne à la romance dont il est possible de suivre les rebondissements dans certaines de leurs œuvres respectives. L’étude montre comment, dans ce contexte, chacun devient l’égal et la muse de l’autre, pour parvenir à former un véritable « duo ».
Élisabeth Jacquet de La Guerre en duo avec sa famille, son milieu et son roi
Authors: Cessac Catherine
Published: June 2019

Élisabeth Jacquet de La Guerre (1665-1729) est connue et reconnue de nos jours comme l’une des grandes figures de la musique baroque française. Née dans une famille de musiciens, elle bénéficie d’un contexte favorable pour développer sa carrière de claveciniste et de compositrice. Sa destinée exceptionnelle à la cour, puis à la ville, tient aussi en son talent et dans l’appui indéfectible qu’elle a trouvé en la personne de Louis XIV qui va lui offrir les moyens notamment de publier son œuvre. Tout en décrivant l’entourage familial et amical bienveillant de la musicienne, cet article tend à montrer la relation privilégiée qu’elle entretient avec son roi sous la forme d’un véritable duo fondé sur l’affection, l’admiration et la confiance.
En solo plus souvent qu’en duo : les femmes organistes de 1790
Authors: Granger Sylvie
Published: June 2019

L’enquête prosopographique MUSÉFREM a fait émerger un corpus de 155 femmes organistes exerçant dans les provinces à la veille de la Révolution, antérieurement plus inconnues encore que leurs collègues masculins. Derrière 70 % de celles dont on connaît les origines familiales, on entrevoit un père musicien, le plus souvent organiste lui-même, parfois une mère, qui ont eu un rôle déterminant dans l’acquisition du savoir musical. Dans l’ombre, les filles suppléent leur père malade, vieillissant ou titulaire de trop de tribunes. Mais l’orgue permet aussi une amorce de professionnalisation et près de 70 % des femmes organistes de 1790 sont célibataires. Les autres, à un âge un peu plus élevé que la moyenne, ont épousé majoritairement un musicien. Comment fonctionnaient ces couples endogames ? Quelques exemples, à Dijon, Bordeaux, Rouen ou Dreux, permettent d’approcher les réalités concrètes de leurs vies (répartition des postes, contrats, rémunérations, invisibilité féminine persistante).
Révoltes suggérées et annonce de la Révolution française : Que la fête commence de Bertrand Tavernier
Authors: Duprat Annie
Published: June 2019

À sa sortie, le film Que la fête commence a été critiqué sur plusieurs choix du réalisateur. D’une part, la période de la Régence aurait été dépeinte de façon à la fois trop libertine et trop sombre, induisant de ce fait l’idée de la fin prochaine d’un monde vermoulu. La scène finale, qui voit des paysans brûler le carrosse a été considérée comme artificielle et fausse. Elle évoque irrésistiblement les violences de l’été 1789, la « Grande Peur » alors que le film se déroule au début des années 1720. Y aurait-il intentionnalité de Tavernier dans ce choix ?
Les sirènes de Myrina
Authors: Mathieux Néguine
Published: June 2019

Parmi les très nombreuses figurines recueillies à Myrina en Asie Mineure, le type de la sirène se détache par la singularité de son iconographie, la fréquence de son apparition sur le site et son caractère fortement local. Ces sirènes représentent une série pertinente pour l’étude des pratiques artisanales, du fait du nombre important d’exemplaires provenant d’un même contexte archéologique. La caractérisation de séries, de générations, de versions et de variantes à l’intérieur de cet ensemble homogène pose la question de l’évolution du type iconographique, celle-ci pouvant s’expliquer par des différences chronologiques ou par une pluralité d’ateliers. L’examen stylistique suggère cependant une grande unité liée à une représentation volontairement stéréotypée, statique et frontale, qui s’expliquerait par le rapport étroit entre le choix de la forme plastique et l’iconographie. L’identité mythologique de la sirène comme héraut funéraire, confirmée par la comparaison avec des stèles, impose une représentation spécifique qui se distingue nettement des autres figurines qui ont été retrouvées, à leurs côtés, dans les tombeaux. Cette codification attachée à la fonction des sirènes empêche d’y retrouver des indices de datation précis.