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1) To describe the community health nursing workforce in Canada; 2) To compare, across political jurisdictions and community health sectors, what helps and hinders community nurses to work effectively; 3) To identify organizational attributes that support one community subsector--public health nurses--to practise the full scope of their competencies.Our study included an analysis of the Canadian Institute for Health Information nursing databases (1996-2007), a survey of over 13,000 community health nurses across Canada and 23 focus groups of public health policy-makers and front-line public health nurses.Over 53,000 registered and licensed practical nurses worked in community health in Canada in 2007, about 16% of the nursing workforce. Community nurses were older on average than the rest of their profession. Typical practice settings for community nurses included community health centres, home care and public health units/departments. To practise effectively, community nurses need professional confidence, good team relationships, supportive workplaces and community support. Most community nurses felt confident in their practice and relationships with other nurses and professionals, though less often with physicians. Their feelings about salary and job security were mixed, and most community nurses would like more learning opportunities, policy and practice information and chances to debrief about work. They needed their communities to do more to address social determinants of health and provide good quality resources. Public health nursing needs a combination of factors to succeed: sound government policy, supportive organizational culture and good management practices. Organizational attributes identified as supports for optimal practice include: flexibility in funding, program design and job descriptions; clear organizational vision driven by shared values and community needs; coordinated public health planning across jurisdictions; and strong leadership that openly promotes public health, values their staff's work and invests in education and training.The interchangeable and inconsistent use of titles used by community nurses and their employers makes it difficult to discern differences within this sector such as home care, public health, etc. Our studies also revealed that community nurses: thrive in workplaces where they share the vision and goals of their organization and work collaboratively in an atmosphere that supports creative, autonomous practice; work well together, but need time, flexible funding and management support to develop relationships with the community and their clients, and to build teams with other professionals; could sustain their competencies and confidence in their professional abilities with more access to continuing education, policies, evidence and debriefing sessions.

We report a prospective and descriptive study in 12 patients who had pacemaker implantation from may. 1996 and dec. 1997. Our patients benefited from complete clinical examination, ECG (12 derivations), standard laboratory tests, chest X ray. Pulsed-Doppler, two dimensional and TM echocardiography have been performed. Stimulation was achieved using endocardial lead introduced percutaneously. During the study, 12 patients over 22, representing 55% of the subjects with symptomatic conduction defects, had definitive pacemaker implantation. Mean age was 53.8 years +/- 18. Most of the patients lived in Dakar. Sex-ratio was 0.58 (7 males/5 females). Most of the patients (83%) had low socio-economical status. Before implantation mean heart rate was 47 bpm +/- 20.8. Mean blood pressure was 155 mmHg +/- 26.7 (systolic) and 71.6 +/- 20.8 mmHg (diastolic). Heart failure was present in 5 patients/12. Others symptoms were mainly syncope (83%). Mean cardiothoracic ratio was 0.56 +/- 0.09. Over a 14 months period we have implanted 7 double chamber stimulators (DDD) and 5 monochamber (VVI). Over a 210 days follow-up, main problems are infection of the pocket in 2 patients. In one of them culture was positive. In Senegal, it is necessary to develop cardiac stimulation. Pacemakers should be available for all patients with symptomatic conduction defects. A national center for electrophysiologic studies and pacemaker implantation is a priority.

We investigated the cellular mechanisms responsible for growth hormone (GH) resistance in diabetes and malnutrition in the rat. In insulin-dependent diabetes, a post-receptor defect participates in GH resistance. During fasting, there is a loss of liver GH binding sites. Dietary protein restriction causes a post-receptor defect. This defect can be attributed to the combined effects of decreased liver IGF-I mRNA content and impaired message translation.

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Nous distinguons d'abord l'approche traditionnelle en enseignement des mathématiques, typique des classes dont le fonctionnement s'appuie sur l'utilisation de manuels, et l'approche « investigative » mise en oeuvre dans des classes dont le fonctionnement est compatible avec la perspective constructiviste. Nous mettons ensuite l'accent sur cette approche « investigative » et analysons les tensions théoriques et pragmatiques qu'elle suscite en relation avec une conception de l'apprentissage des mathématiques conçu à la fois comme processus actif de construction individuelle et un processus d'acculturation. Une attention particulière est accordée aux façons dont le constructivisme et les théories socioculturelles abordent cet aspect. Nous traitons enfin du développement de certaines activités pédagogiques mises en oeuvre dans des classes de mathématiques à fonctionnement « investigatif »., We first distinguish between the school mathematics tradition typically established in textbook-based classrooms and the inquiry mathematics tradition established in classrooms where instruction is compatible with constructivism. We then focus on the inquiry mathematics tradition and consider the theoretical and pragmatic tensions inherent in the view that mathematical learning is both a process of active individual construction and a process of acculturation. Particular attention is given to the ways in which both constructivist and sociocultural theorists address this issue. Finally, we discuss the development of instructional activities for inquiry mathematics classrooms., Primero distinguimos el enfoque tradicional de las matematicas tipicas de las clases, cuyo funcionamiento se apoya en la utilization de manuales, del enfoque "investigativo" utilizado en las clases, cuyo funcionamiento es compatible con la perspectiva construccionista. Luego acentuamos este enfoque "investigativo" y analizamos las tensiones teóricas y pragmaticas que surgen al mirar la conception del aprendizaje de las matematicas que la apoya, tratandose a la vez de un proceso activo de construction individual y de un proceso de aculturacion. Se acuerda una atencion especial a las formas en que el construccionismo y las teorias socioculturales abordan este aspecto. Finalmente tratamos el desarrollo de ciertas actividades pedagogicas utilizadas en clases de matematicas de funcionamiento "investigativo"., Zunächst unterscheiden wir die traditionelle Méthode der Mathematik, die fiir die Klassen typisch ist, die sich auf die Verwendung von Fachbiichern stiitzen, und die "investigative" Méthode, die von den Klassen angewandt wird, deren Vorgehen mit der konstruktivistischen Ausrichtung zu vereinbaren ist. Dann gehen wir auf dièse "investigative" Méthode ein und analysieren die theoretischen und tatsâchlichen Spannungen, die sie beziiglich des zugrundeliegenden Begriffs des Erlernens der Mathematik hervorruft, nàmlich dass es sich zugleich um einen aktiven Vorgang individuellen Konstruierens und um einen kulturell beeinflussten Prozess handle. Besondere Beachtung wird der Art und Weise geschenkt, mit der Konstruktivismus und die soziokulturellen Théo rien an diesen Aspekt herangehen. Schliesslich behandeln wir die Entwicklung gewisser pädagogischer Aktivitâten, die in den Klassen mit "investigativem" Vorgehen angewandt werden.