Pourquoi les internes en médecine de France métropolitaine pratiquent l automédication et l autoprescription ? (étude qualitative)

L automédication est une pratique courante en France et en constante progression. Il est avéré qu un grand nombre d internes en médecine y ont également recours. Cette pratique, bien que légale, ne semble pas toujours raisonnable et adaptée et nous avons cherché à en comprendre les motifs. Nous avons réalisé une étude qualitative par entretiens semi-dirigés auprès de 15 internes de France métropolitaine. Puis une analyse thématique des verbatim par triangulation des chercheurs a été conduite après retranscription intégrale des entretiens. Si les premiers arguments avancés sont généralement d ordre pratique : manque de temps pour consulter, accessibilité évidente aux médicaments et aux ordonnances et aisance diagnostique, notre étude a également révélé d autres éléments plus subjectifs. En effet, les internes ont exprimé certaines craintes (jugement par un confrère et manque de confidentialité) ainsi que des sentiments d invulnérabilité et de toute puissance qui favorisent leur recours à l automédication. Notre travail a mis en évidence qu il semble plus facile pour un interne en médecine de s automédiquer que de consulter. En effet, accepter l état de patient s apparenterait pour eux à perdre leur identité sociale. L automédication n est pas uniquement un moyen d accéder facilement aux médicaments, elle permet également aux internes d éviter une confrontation personnelle à la maladie.Self-medication is a common practice in France which has been growing steadily over the years. In fact, lots of medical interns self-medicate. This practice, even though legal, is not always the reasonable and appropriate course of action. Thus, we aimed to understand the reasons that push medical interns to self-medicate. We conducted a qualitative study using semi-structured interviews with a sample of 15 interns leaving in Metropolitan France. Following a full transcription of the interviews, the researchers used a consensus approach to identify major themes from the data. Although the first reasons for self-medication mentioned by interns are usually of practical order (e.g., lack of time to go see a doctor, ease of access to medications and prescriptions, simplicity of diagnostic), our study also revealed more subjective reasoning. As a matter of fact, the interns expressed some concerns (e.g., judgment from a peer, lack of confidentiality) as well as feelings of invulnerability and almightiness, all promoting their use of self-medication. Our work suggests that it seems easier for a medical intern to self-medicate than to go see a doctor. In fact, accepting the status of being a patient might cause the interns to lose their social identity. Self-medication for interns is not only a way to easily access medications. This practice also prevents interns from directly facing the illness.GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF

The genomic basis of color pattern polymorphism in the Harlequin ladybird

© 2018 The Authors Many animal species comprise discrete phenotypic forms. A common example in natural populations of insects is the occurrence of different color patterns, which has motivated a rich body of ecological and genetic research [1–6]. The occurrence of dark, i.e., melanic, forms displaying discrete color patterns is found across multiple taxa, but the underlying genomic basis remains poorly characterized. In numerous ladybird species (Coccinellidae), the spatial arrangement of black and red patches on adult elytra varies wildly within species, forming strikingly different complex color patterns [7, 8]. In the harlequin ladybird, Harmonia axyridis, more than 200 distinct color forms have been described, which classic genetic studies suggest result from allelic variation at a single, unknown, locus [9, 10]. Here, we combined whole-genome sequencing, population-based genome-wide association studies, gene expression, and functional analyses to establish that the transcription factor Pannier controls melanic pattern polymorphism in H. axyridis. We show that pannier is necessary for the formation of melanic elements on the elytra. Allelic variation in pannier leads to protein expression in distinct domains on the elytra and thus determines the distinct color patterns in H. axyridis. Recombination between pannier alleles may be reduced by a highly divergent sequence of ∼170 kb in the cis-regulatory regions of pannier, with a 50 kb inversion between color forms. This most likely helps maintain the distinct alleles found in natural populations. Thus, we propose that highly variable discrete color forms can arise in natural populations through cis-regulatory allelic variation of a single gene. More than 200 distinct color forms have been described in natural populations of the harlequin ladybird, Harmonia axyridis. Gautier et al. show that this variation is controlled by the transcription factor Pannier. Pannier is necessary to produce black pigment, and its expression pattern prefigures the coloration pattern in each color form

Le Développement Professionnel Continu : un outil d'amélioration des pratiques des professionnels de santé : étude de cas au Centre Hospitalier Universitaire de Grenoble

Les professionnels du corps médical et paramédical détiennent depuis longtemps une obligation déontologique de maintien des connaissances et de la pratique. Le 21 juillet 2009, l'article 59 de la loi HPST a refondu le système de formation continue pour en faire une obligation légale à l'usage de tous les professionnels de santé : le Développement Professionnel Continu (DPC). Cette mesure confronte opportunités et contraintes à l'échelle individuelle et institutionnelle. L'analyse d'entretiens avec des professionnels de santé responsables de l'implémentation du DPC dans une institution publique hospitalière de la région Rhône-Alpes nous montre clairement les enjeux du dispositif mais aussi les limites de sa mise en œuvre. Même si le DPC semble encourager la coopération, la transversalité et le décloisonnement entre les différents professionnels de santé, la contrainte et la difficulté de l'implémentation du dispositif, dans un contexte de pénurie de personnels et de réduction des dépenses globales de santé, rend son appropriation difficile et remet en cause la pertinence de ce système au sein d'un CHU. Il est, à ce jour, difficile de mesurer la pertinence de cette réforme au niveau institutionnel et national compte-tenu des premiers balbutiements. Malgré une mise en œuvre lente et peu probante, des pistes d'améliorations voient pourtant le jour

Vie de la Société

Prud'homme Paule, Higel Anne-Marie. Vie de la Société. In: Le Fablier. Revue des Amis de Jean de La Fontaine, n°11, 1999. Avec La Fontaine chez Fouquet : André Félibien à Vaux-le-Vicomte (1660-1661) p. 85

Plant-availability of phosphorus recycled from pig manures and dairy effluents as assessed by isotopic labeling techniques

International audienceDeposits of phosphate rocks are non-renewable and the only fossil resource for the production of phosphate fertilizers. The presence of phosphorus (P) in animal and domestic wastes provides an alternative opportunity to recycle P for use as P fertilizer. Hence, the objective of the present study was to assess the plant availability of recycled P products derived from dairy effluents (one product, hereafter named as “RPDE”) and pig manures (four products, “RPPM”), through bio- and chemical precipitation processes, respectively. The RPDE product is composed of Ca–P (partly as hydroxyapatite, HA) and RPPM products contain recovered struvite (ST) and Ca–P. Plant-availability of recycled P was compared to that of commercial triple superphosphate (TSP), reference HA, and reference ST. To this end, pot and soil incubation experiments were used. A pot experiment with a mixture of ryegrass and fescue was carried out using a P-deficient and slightly acidic (pH = 6.49) soil, at 50 mg P kg− 1 application rates of the different products. The 32P-labeling of soil P was used to determine the L-value (i.e. plant-available soil P) and to accurately quantify the P taken up by plants from the different P sources. Shoot and root biomass productions, plant P nutrition and L-value increased owing to application of P products. There were no significant differences between RPDE and RPPM products with regard to plant P nutrition. All recycled products were as effective as TSP and reference ST. By contrast, the P-equivalence of HA was only 22% of TSP in the slightly acidic soil. Thus, plant availability of P in RPDE product was higher than that of well-crystallized HA (synthetic product). Product application to incubated soils induced an increase in the amounts of phosphate ions in soil solution and isotopically exchangeable P (E-values), which were overall correlated to the L-values and plant P uptake. Plant-availability of recycled P may thus be inferred appropriately from simple soil incubations. In conclusion, this study shows that it is possible to substitute commercial fertilizers (such as TSP) by P recycled from pig manures and dairy effluents

Grazing intensity modulates carbohydrate storage pattern in five grass species from temperate grasslands

Regrowth after defoliation is an essential mechanism of plant tolerance to grazing. In grasses, non-structural carbohydrates (NSC) contained in tiller bases constitute a major substrate for regrowth after defoliation. Using a multi-specific approach, the present study aimed at testing the effect of grazing intensity on NSC concentration in tiller bases. We selected five grazing-tolerant grass species (Agrostis stolonifera, Cynosurus cristatus, Hordeum secalinum, Lolium perenne and Poa trivialis) and collected plants in a grassland subjected to two cattle grazing intensities (intensive versus moderate) for years. We measured NSC concentrations (starch, fructans, sucrose, glucose and fructose) in tiller bases. We found that fructan and sucrose concentrations before the grazing season (April) were higher under intensive than moderate grazing. By contrast, no significant effect of the grazing intensity on these NSC concentrations in tiller bases remained at the end of the grazing season (October). These results suggest that the level of reserves available before the onset of disturbance caused by grazing as well as the reserve replenishment capacity during the grazing season are modified by the intensity of grazing

Conformité, microstructure et purété de films d'aluminium déposés sur substrats de Si patternés. Etude comparative selon le procédé de dépôt : pulvérisation plasma, ablation laser, dépôt chimique en phase vapeur

National audienc