直肠间质瘤致下消化道大出血1例报告

胃肠道间质瘤是一种发生于消化道的少见的间叶肿瘤,直肠间质瘤更为罕见,在直肠肿瘤中的发生率0．1％以下。直肠问质瘤的临床表现无特异性,与其他直肠肿瘤相似,随肿瘤逐渐增大可表现为排便习惯改变、便血、排便困难等。临床确定诊断困难。手术治疗是能够治愈直肠问质瘤的唯一方法。格列卫作为一线化疗药物对术前降期及改善预后都有良好疗效。本例患者因下消化道大出血入院,肿瘤近肛缘,术中病理考虑为直肠闻质瘤,完整切除肿瘤后行保肛术。术后应用格列卫,随诊3个月无复发、转移。     

根据血压昼夜节律选择服药时间控制血压晨峰

根据血压昼夜节律,观察给药时间对血压晨峰的影响。256例原发性高血压患者,经24h动态血压监测分为超杓型（n＝49）、杓型（n＝127）和非杓型（n＝80）3组;各组再分为清晨服药组和晚上服药组。用药6周,比较用药前后血压昼夜节律及血压晨峰的变化,发现在改变血压昼夜节律及降低血压晨峰方面,超杓型组清晨服药优于晚上服药,非杓型组晚上服药优于清晨服药;杓型组清晨服药与晚上服药均能降低晨峰值,提示根据个体血压昼夜节律选择服药时间能更好地控制血压晨峰。     

Travailler dans un réseau de santé : effets sur la santé psychique au travail

The new needs as regards care taking charge of patients have contributed to the creation of health networks. As they are growing fast, they are an integral part of the French sanitation system. The impact, on the health professionals, of networking is, today, the object of contrasted research and results, but has little been studied as far as Social Psychology, Work and Organizations are concerned. This article follows a research project which had the objective, on the one hand, to describe the effects of the participation to a health network mental health at work and, on the other hand, to examine the variables and process accounting for the variability of these effects. This research privileges an approach to the health network as a place of socialization and personalization (Malrieu, 1979). The research on the ground is carried out in collaboration with the health network town-hospital Prevention and Taking charge of Pediatric Obesity Network (RéPPOP) Midi-Pyrénées. We have carried out semi-guided interviews with 20 private professionals (8 doctors, 8 dieticians, 3 psychologists, 1 physiotherapist) members of the RePPOP Midi-Pyrénées network. The main results show that the perception of positive and/or negative effects of networking on mental health varies according to the age of membership of the network and the processes of transfer of experience (from professional practice within the network to professional practice off-network and vice versa). Proposals are deduced in terms of continuing education within the network.     

Secret médical en santé au travail

The occupational physicians are obliged, like any doctor, to respect the ethical obligations imposed on their profession, including in the exercise of the missions specific to occupational medicine and contained in the Labor Code. The occupational physician is not isolated and works in a multidisciplinary team of a health service at work. He must communicate with other health professionals, but also with employers, representative bodies of staff. Medical confidentiality holds a special place in the triangular relationship between the occupational physician, the employee and the employer. The medical practice in the field of occupational health requires that many provisions of the Labor Code be followed, including the respect of the secret of manufacture and the position of advising employers and employees. The occupational physician must communicate with the employer in order to best achieve his mission, but in practice, it may be difficult for the occupational doctor to make his recommendations heard to improve the working conditions of employees without power, when he cannot argue his opinions on medical information.     

Lower back pain in nurses working in home care: linked to work–family conflict,emotional dissonance,and appreciation?

In industrial countries home care services for elderly people living in the community are growing rapidly. Home care nursing is intensive and the nurses often suffer from musculoskeletal pain. Time pressure and job control are job-related factors linked to the risk of experiencing lower back pain (LBP) and LBP-related work impairment. This survey investigated whether work-family conflict (WFC), emotional dissonance and being appreciated at work have incremental predictive value. Responses were obtained from 125 home care nurses (63% response rate). Multiple linear regression showed that emotional dissonance and being appreciated at work predicted LBP intensity and LBP-related disability independently of time pressure and job control. WFC was not a predictor of LBP-related disability in multiple regression analyses despite a zero-order correlation with it. Redesigning the working pattern of home care nurses to reduce the emotional demands and improve appreciation of their work might reduce the incidence of LBP in this group.     

Pedestrians’ road crossing decisions and body parts’ movements

This study aims to examine pedestrians' crossing decision, body parts' movement and full body movement, just before and during road crossing in a simulated setup. To accomplish this, a novel experimental setup for analyzing pedestrians’ crossing behavior and motion was developed where the simulated display was synchronized with a 3D motion capturing system. Twenty participants, divided into control and an experimental time pressure group, observed sixteen short (less than 30 s) and long road (70 s or more) crossing scenarios with varying crossing opportunities. Based on the crossing opportunities they were asked to cross a 3.6 m wide one-lane one way urban road. It was found that the crossing initiation process consists of four incremental movements of body parts: the head and the shoulder first; the hip, wrist and elbow second; the knee as a separate joint, and finally the ankle. Results showed that pedestrians’ decision to cross and body parts movement are influenced by time pressure and wait time for a safe crossing opportunity. Specifically, pedestrians prepare their body parts earlier, initiate their crossing earlier, and adjust their speed to compensate for the risk taken in less safe or non-safe crossing opportunities. Within the control group, women tended to be more risk avoiding than men, however those differences disappeared in the time pressure group. Most importantly, the findings provide initial evidence that this novel simulation configuration can be used to gain precise knowledge of pedestrians’ decision-making and movement processes.     

Making Time Protestant in Early-Modern Glasgow

This article, drawn largely from the under-utilized Kirk session records from late-sixteenth-century Glasgow, by way of example, demonstrates how changing dispositions towards time were at the heart of the Reformation change of religion in Scotland. From the expansion of time obligations of Christians, the alteration of holy days, and the re-definition of basic units of time, alternative understandings of time were among the most tangible effects of the establishment of Protestantism in Scotland. In introducing time as a new way to examine the broad influence of the Reformation on the lives of the Scottish people, the article builds on recent research on the European Reformations while also introducing new perspectives on the uniqueness of the Scottish case.