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Contexte: La cirrhose est une maladie fréquente responsable d'une morbidité et mortalité importantes. De nombreuses études suggèrent une association entre cirrhose, résistance à l'insuline et diabète. Les mécanismes expliquant cette association sont néanmoins peu évidents. Objectifs: Nous avons débuté notre travail en révisant l'état des connaissances sur l'association entre cirrhose et altérations de l'homéostasie glucidique. Nous avons poursuivi par une étude prospective pour répondre aux questions suivantes : la cirrhose est-elle associée a de l'insulinorésistance et du diabète; l'insulinorésistance, indépendamment du diabète, est-elle associée à la sévérité de la cirrhose ;différentes étiologies de cirrhose sont-elles associées à des niveaux différents d'IR; les altérations du métabolisme glucidique sont-elles corrélées à une élévation de la morbidité et mortalité ; et enfin, quels sont les mécanismes physiopathologiques potentiels de cette association ? Patients et méthodes: La première partie du travail concerne la présentation et la discussion des recherches effectuées sur le sujet sur Pubmed. Pour la partie prospective, les patients de l'unité d'hépatologie ont été inclus durant la période s'étendant de février 2016 à septembre 2017. A l'inclusion, une étude de l'homéostasie glucidique était réalisée à sur une prise de sang veineuse à jeun, afin de calculer l'index de HOMA (homeostasis model assessment of insulin resistance). Les patients ont été séparés en plusieurs groupes, selon la présence ou l'absence de cirrhose (cirrhose vs contrôles) et selon l'absence ou présence d'altérations du métabolisme glucidique : diabétiques définis par la prescription d'un traitement ciblé et insulinorésistants (définis par un HOMA>2.5).Durant la période d'observation, nous avons enregistré l'étiologie de la maladie hépatique sous­ jacente, reporté les décès et hospitalisations pour complications de la cirrhose. Résultats: Notre revue de littérature montre que l'insulinorésistance chez les cirrhotiques est liée à une diminution de la sensibilité périphérique à l'insuline plutôt qu'à une production accrue de glucose par le foie. Les mécanismes expliquant cette insulinorésistance restent néanmoins mal expliqués. Durant la période d'étude, 107 patients et 20 contrôles ont accepté de participer à l'étude. 43% de patients cirrhotiques présentaient un diabète ainsi que 25% de contrôles (p=0.13). Chez les patients sans diabète, l'IR était plus prononcée que chez les contrôles (5.93±4.68 vs 2.79±2.24, p=0.004). Nous avons observé une corrélation entre la sévérité de la cirrhose (mesurée grâce au score de MELD) et importance de l'insulinorésistance chez les cirrhotiques (r=0.54, p<0.001), avec des différences significatives d'HOMA selon les étiologies de cirrhose ( p=0.001). Nous avons également montré que le diabète et l'IR sont associées à une morbi mortalité accrue (p=0.005), sans toutefois de différence significative entre patients insulinorésistants et non-insulinorésistants (p=0,16). Enfin, une corrélation entre le gradient hépato-veineux et l'HOMA existe (r=0.43, p=0.02), évoquant que la réduction de la clearance hépatique de l'insuline pourrait jouer un rôle dans l'élévation du score HOMA. Conclusion: L'IR est plus fréquente chez les patients cirrhotiques. L'importance de l'IR est corrélée à la sévérité de la cirrhose et est associée à un taux de complications et de mortalité plus important dans le groupe des patients cirrhotiques. La question d'un dépistage précoce et d'un traitement adapté pour réduire les complications reste à définir. Nous travaillons actuellement sur la caractérisation du tissu hépatique et des échantillons de sang chez cette population afin d'identifier les facteurs pouvant expliquer cette association. Background: Cirrhosis is a frequent disease inducing high morbidity and mortality. It has been suggested that cirrhosis could be associated with insulin resistance (IR) and diabetes mellitus (DM).The mechanisms underlying this process remains under debate .Objective: We first wanted to discuss the current knowledge on cirrhosis and glucose homeostasis alterations. Secondly we performed a prospective study to answer the following questions: is cirrhosis associated with IR and DM; is IR, independently from diabetes, associated with cirrhosis severity; are the different etiologies of cirrhosis associated with different levels of IR; does glucose homeostasis alterations correlate with higher morbidity and mortality and finally, could we explore some potential pathophysiological mechanisms underlying the association? Patients and methods: A Pubmed search on the subject is first presented and discussed. From February 2016 to September 2017, patients seen at the hepatology clinic were prospectively enrolled in this study. At inclusion, a complete assessment of glucose homeostasis was performed on fasted venous blood to calculate the homeostasis model assessment of insulin resistance (HOMA). Patients were separated in several cohorts, based on the presence or absence of cirrhosis (cirrhosis versus controls) absence or presence of DM (patients treated with glucose modulating agents) and IR (HOMA >2.5). We recorded the cause of the underlying liver disease and the number of hospitalization due to cirrhosis complication and death. Results: Our review reveals that insulin resistance in cirrhosis is linked to decreased glucose peripheral uptake rather than to increased liver glucose production and that the mechanism underlying this process remains ill-defined. Between our study period, 107 patients with cirrhosis and 20 controls accepted to participate in this study. There were 43% of patients with DM within the cirrhotic group compared with 25% of patients within the control group, meaning that diabetes was more frequent in cirrhotic patient although it didn't reach statistical significance (p=0.13) and in cirrhotic patients without DM, IR was more pronounced than in control patients (5.93±4.68 vs 2.79±2.24, p=0.004). We also found that IR was correlated with the severity of cirrhosis based on the MELD score (r=0.54, p<0.001). Different etiologies of cirrhosis were shown to exhibit different levels of IR (p=0.001). IR and DM were also associated with an elevated morbidity and mortality (p=0.005) although the difference between IR and non IR patients was not statistically significant (p=0.16). A positive correlation between hepatovenous pressure gradient and HOMA (r=0.43, p=0.02) was evidenced, meaning that the reduction of liver clearance of insulin could play a role in the increased HOMA results. Conclusion: IR is more frequent in cirrhotic patients. The level of IR is correlated with cirrhosis severity and is associated with a higher rate of complications and a lower survival within the cirrhotic group. Whether an early diagnosis of IR in this population and an appropriate treatment will reduce such complications remains to be defined. We are now working on the characterization of the liver tissue and blood samples in this population to identify potential factors explaining this situation.

Hemorrhagic Fever, Ebola --- Ebolavirus --- Principle-Based Ethics --- Surge Capacity

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The past five years has seen CBR stakeholders work collaboratively to produce these CBR Guidelines which build upon key recommendations made in 2003 at the International Consultation to Review Community-based Rehabilitation in Helsinki and in 2004 in the ILO UNESCO WHO joint position paper on CBR. The guidelines promote CBR as a strategy which can contribute to implementation of the Convention on the Rights of Persons with Disabilities and of disability inclusive national legislation and which can support community-based inclusive development. The guidelines provide CBR managers among others w

Community Health Services. --- Disabled Persons -- rehabilitation. --- People with disabilities -- Rehabilitation. --- Rehabilitation. --- People with disabilities --- Community health services --- Principle-Based Ethics --- Human Rights --- Physical Medicine --- Health Services --- Persons --- Therapeutics --- Health Care Facilities, Manpower, and Services --- Social Control, Formal --- Ethics --- Analytical, Diagnostic and Therapeutic Techniques and Equipment --- Named Groups --- Medicine --- Philosophy --- Health Care Economics and Organizations --- Health Occupations --- Health Care --- Humanities --- Sociology --- Social Sciences --- Disciplines and Occupations --- Anthropology, Education, Sociology and Social Phenomena --- Rehabilitation --- Social Justice --- Disabled Persons --- Community Health Services --- Health & Biological Sciences --- Occupational Therapy & Rehabilitation --- Social Justice. --- methods. --- rehabilitation.

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Continuing the debate over whether consciousness causes behaviour or plays no functional role in it, leading scholars discuss the question in terms of neuroscience, philosophy, law and public policy.

Cognitive psychology --- Philosophical anthropology --- Neuropsychology --- Consciousness. --- Personal Autonomy. --- Philosophy. --- Neuropsychology. --- Mind and body. --- Intention. --- Liberty --- Human behavior --- Conscience --- Neuropsychologie --- Esprit et corps --- Intention --- Liberté --- Comportement humain --- methods. --- Philosophy --- Philosophie --- Consciousness --- Mind and body --- Humanities --- Psychophysiology --- Freedom --- Principle-Based Ethics --- Psychological Phenomena and Processes --- Investigative Techniques --- Cognition --- Mental Processes --- Ethics --- Physiology --- Behavioral Sciences --- Psychiatry and Psychology --- Human Rights --- Analytical, Diagnostic and Therapeutic Techniques and Equipment --- Biological Science Disciplines --- Social Control, Formal --- Behavioral Disciplines and Activities --- Health Care Economics and Organizations --- Sociology --- Natural Science Disciplines --- Disciplines and Occupations --- Health Care --- Social Sciences --- Anthropology, Education, Sociology and Social Phenomena --- Personal Autonomy --- Methods --- Human Anatomy & Physiology --- Health & Biological Sciences --- Neuroscience --- Liberté --- Body and mind --- Body and soul (Philosophy) --- Human body --- Mind --- Mind-body connection --- Mind-body relations --- Mind-cure --- Somatopsychics --- Psychological aspects --- Brain --- Dualism --- Holistic medicine --- Mental healing --- Parousia (Philosophy) --- Phrenology --- Self --- Neurophysiology --- Attitude (Psychology) --- Apperception --- Perception --- Psychology --- Spirit --- NEUROSCIENCE/General --- COGNITIVE SCIENCES/Psychology/Cognitive Psychology

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In most developed countries, the epidemiological disease profile has changed from infectious to degenerative, causing major alterations in epidemiological thinking and public health policies. Less developed nations have to deal with a more complex situation, because social disparities create highly unequal health conditions, the affluent being afflicted by degenerative conditions, whereas the poorer social segments continue to suffer infectious diseases, but also begin to feel the effects of chronic illness. At the turn of the 21st century, equity in health care is not being served, and social justice has lost credibility as a conceptual driving force of public health policies. Rampant injustice confirms that theories, reality and suggested practices of just social orders are flawed, leaving the needy without help or hope in a world of flagrant ethical inadequacy. And yet, mainstream bioethics loses meaning and relevance as it clings to the principle of justice and hails such concepts as global justice and universal health-care equity, misleadingly focusing on justice as a desideratum. This book pleads for an urgent turn towards directly addressing injustice as a reality that requires pressingly needed arguments and proposals to inspire realistic public health policies and programs based on an ethics of protection. Ever since Hobbes, all shades of political philosophy accept that the basic obligation of the ruling power is to protect its subjects. The ethics of protection emphasizes aiding the needy and the disempowered in obtaining access to basic goods and services related to health-care. Public health is called upon to fulfill protective obligations to guarantee disease prevention and medical services to the population, taking special care to safeguard those unable to cover their health-care needs in market-oriented medical services and institutions. The bioethics of protection developed in this text presents specific and explicit guide-lines to assure that protective public health actions be efficacious (problem-solving), efficient (sustainable cost/benefit relation) and ethically sound (respecting human rights and the common weal). These guide-lines are designed to give ethical support and justification to public health policies even when they require some unavoidable limitations of individual autonomy to promote social health benefits.

Medical ethics. --- Public health -- Moral and ethical aspects. --- Public health --- Medical policy --- Medical ethics --- Ethics, Clinical --- Principle-Based Ethics --- Environment and Public Health --- Medicine --- Morals --- Health --- Human Rights --- Psychology, Social --- Humanities --- Social Control, Formal --- Population Characteristics --- Health Care --- Ethics, Professional --- Health Occupations --- Behavior and Behavior Mechanisms --- Sociology --- Philosophy --- Disciplines and Occupations --- Health Care Economics and Organizations --- Health Care Quality, Access, and Evaluation --- Social Sciences --- Psychiatry and Psychology --- Anthropology, Education, Sociology and Social Phenomena --- Ethics, Medical --- Bioethical Issues --- Public Health --- Social Justice --- Ethics --- Health & Biological Sciences --- Public Health - General --- Moral and ethical aspects --- Bioethics. --- Moral and ethical aspects. --- Biology --- Biomedical ethics --- Life sciences --- Life sciences ethics --- Medicine. --- Public health. --- Medicine & Public Health. --- Public Health. --- Theory of Medicine/Bioethics. --- Science --- Clinical ethics --- Health care ethics --- Medical care --- Bioethics --- Professional ethics --- Nursing ethics --- Social medicine --- Community health --- Health services --- Hygiene, Public --- Hygiene, Social --- Public health services --- Public hygiene --- Social hygiene --- Human services --- Biosecurity --- Health literacy --- Medicine, Preventive --- National health services --- Sanitation

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K. Danner Clouser is one of the most important figures in establishing and shaping the fields of medical ethics, bioethics, and the philosophy of education in the second half of the twentieth century. Clouser challenged many established approaches to moral theory and offered innovative strategies for integrating the humanities into professional education, especially that of physicians and nurses. The contributions published in Building Bioethics: Conversations with Clouser and Friends on Medical Ethics are unique both in their devotion to a critical review of his contributions, and in bringing together internationally known figures in bioethics, medical ethics, and philosophy of medicine to comment upon Clouser's work. These leaders of the field include Tom Beauchamp, Daniel Callahan, James Childress, Nancy Dubler, H. Tristram Engelhardt, Al Jonsen, Loretta Kopelman, Larry McCullough, John Moskop, and Robert Veatch. This book merits special attention from those interested in bioethics, philosophy of medicine, medical ethics, philosophy, medical education, religious studies, and nursing education.

Bioethics -- Miscellanea. --- Clouser, K. Danner. --- Medical ethics -- Miscellanea. --- Medical ethics --- Bioethics --- Ethical Theory --- Morals --- Principle-Based Ethics --- Philosophy --- Education, Medical --- Ethics, Medical --- Ethics --- Psychology, Social --- Ethics, Clinical --- Education, Professional --- Humanities --- Education --- Ethics, Professional --- Health Care Quality, Access, and Evaluation --- Behavior and Behavior Mechanisms --- Psychiatry and Psychology --- Anthropology, Education, Sociology and Social Phenomena --- Health Care --- Medical Ethics & Philosophy --- Medicine --- Health & Biological Sciences --- Philosophy & Religion --- principebenadering (principalisme, autonomie, weldadigheid, weldoen, non maleficence, rechtvaardigheid) --- Biomedical ethics --- Clinical ethics --- Health care ethics --- Medical care --- Professional ethics --- Nursing ethics --- Social medicine --- Biology --- Life sciences --- Life sciences ethics --- Science --- principlisme (principisme, principe éthique, autonomie, bienfaisance, non-malfaisance, non-nuisance, justice) --- Moral and ethical aspects --- Festschrift - Libri Amicorum --- Bioethics. --- Ethics, Medical. --- Morals. --- Ethique médicale --- Bioéthique --- Miscellanea --- Miscellanées --- EPUB-LIV-FT SPRINGER-B --- Conduct of life --- Ethics. --- Medical ethics. --- Philosophy (General). --- Medicine-Philosophy. --- Theory of Medicine/Bioethics. --- Philosophy, general. --- Philosophy of Medicine. --- Philosophy. --- Medicine—Philosophy. --- Mental philosophy --- Deontology --- Ethics, Primitive --- Ethology --- Moral philosophy --- Morality --- Philosophy, Moral --- Science, Moral --- Values