Analyse du vécu et des stratégies mises en place par les médecins généralistes et les pédiatres suite à l interdiction des antitussifs chez les enfants de moins de deux ans

Les antitussifs étaient souvent prescrits chez les nourrissons lors d affections respiratoires bénignes. Leur interdiction chez les enfants de moins de deux ans, en 2010, a entrainé un changement dans les habitudes de prescription des médecins. Les objectifs de cette étude sont d analyser le vécu par les médecins de cette interdiction et d étudier les stratégies et les mesures alternatives mises en place à la suite de celle-ci. Il a été mené une enquête qualitative par entretiens téléphoniques auprès de médecins généralistes et pédiatres libéraux métropolitains. L interdiction est suivie et acceptée mais des critiques existent. La diffusion des recommandations et l éducation des parents sont les moteurs de ce changement. Des stratégies ont été élaborées pour faire face à la pression des parents. Un report de prescription est constaté. Il existe des freins à la désobstruction rhinopharyngée (DRP). Des obstacles à l adaptation des médecins et à l acceptation des recommandations persistent. Rassurer, informer les parents et structurer la prise en charge sont à la base des stratégies employées par les médecins. L origine du report de prescription s explique, en partie, par la propension des médecins à prescrire. Les mesures non-médicamenteuses peuvent favoriser l acceptation de la non-prescription d antitussifs. Réaliser une démonstration de la DRP est à promouvoir auprès des médecins généralistes. L éducation des parents à un rôle primordial pour faire accepter la non-prescription des antitussifs. Des éléments de réflexion sur les obstacles à l adaptation des médecins, le rôle des thérapeutiques non-médicamenteuses et sur les moyens de promouvoir la DRP sont apportés.Cough syrups were often prescribed to infants with minor breathing illnesses. Their ban for children below two years old, in 2010, lead to a change in physicians prescription habits. The objectives of this study are to analyze how this ban was experienced by the physicians, and to study the strategies and alternate measures they implemented following this cough medicines ban. A qualitative study was conducted thanks to semi guided phone interviews with fourteen general practitioners and private paediatricians in France. The ban was accepted even though criticism remains. A diffusion of recommendations and the information of the parents are the drivers of this change. Strategies have been developed to cope with the parents pressure. Recommendations are enforced although prescription of non recommended medicines was observed. Nasopharyngeal deobstructive treatments are often preferred but obstacles remain. Obstacles to the acceptance of recommendations and the physicians adaptation remain. Strategies developed by physicians are based on reassuring and informing the parents as well as organizing nursing. Prescription replacement by other medicines can be explained by the physicians tendency to prescribe. Non-medicinal measures can favor the acceptance of the cough medicines non-prescription and a demonstration of nasopharyngeal deobstructive treatments should be promoted. This study emphasizes the essential role of the parents information in the acceptance of antitussive non-prescription. This work also opens up on the obstacles for the physicians adaptation, the role of non-medicinal therapies and on means to promote nasopharyngeal deobstructive treatments.GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF

Une intervention en centres d’hébergement et de soins de longue durée visant à réduire les problèmes de santé mentale liés au travail

Une intervention visant la diminution des contraintes de l’environnement psychosocial du travail et de leurs effets sur la santé mentale a été mise en place à l’hiver 2002. Cette intervention se résume en cinq étapes : l’engagement du milieu et la constitution d’une équipe d’intervention, l’identification des contraintes, l’élaboration des plans d’action, l’actualisation des plans d’action et l’évaluation de l’intervention. La recherche se déroule dans douze centres d’hébergement et de soins de longue durée (CHSLD) et inclut l’ensemble du personnel soignant en contact direct avec la clientèle (N = 493). Un devis quasi-expérimental avec quatre groupes expérimentaux, huit groupes témoins et des mesures avant et après l’intervention a été utilisé.La description des phases de développement et d’implantation de la démarche d’intervention est présentée ainsi que l’évaluation à 12 mois des effets de l’intervention sur la prévalence des contraintes psychosociales au travail et des problèmes de santé mentale.An intervention aimed at reducing adverse occupational psychosocial factors and their mental health effects was begun during the winter of 2002. This intervention can be summarized in five steps: commitment of stakeholders and setting up of an intervention team, identification of adverse occupational psychosocial factors, development of an action plan, implementation of the action plans, and evaluation of the intervention. The study was conducted in twelve residential and extended care centres (CHSLD) and included all care-giving staff in direct contact with patients (N= 493). A quasi-experimental design was used with four experimental groups and eight control groups, and with pre- and post-intervention measurements.The description of the intervention’s development and implementation phases and the evaluation at 12 months of the effects of the intervention on the prevalence of occupational psychosocial factors and mental health problems are presented.En el invierno 2002 se ha establecido una intervención con objetivo de disminuir las coacciones del ambiente psicosocial del trabajo y de sus efectos sobre la salud mental. Esta intervención se resume en cinco etapas : la compromisión del medio y la constitución de un equipo de intervención, la identificación de las coacciones, la elaboración de los planes de acción, la actualización de los planes de acción y la evaluación de la intervención. La investigación se desarolla en doce centros de alojamiento y de cuidados a largo plazo (CHSLD) e incluye el conjunto del personal sanitario en contacto directo con la clientela (N= 493). Un presupuesto casi experimental de cuatro grupos experimentales, ocho grupos de control y medidas pre and post-intervención fueron utilizados.La descripción de las fases de desarrollo y de implantación de los trámites de intervención están presentados así como la evaluación después de 12 meses de los efectos de la intervención sobre la prevalencia de las coacciones psicosociales en el trabajo y de los problemas de salud mental

Subcellular localization of 14-3-3 proteins in Toxoplasma gondii tachyzoites and evidence for a lipid raft-associated form. in « Fems

Abstract A polyclonal antibody was raised against a Toxoplasma gondii 14-3-3^gluthatione S-transferase fusion protein obtained by cloning a 14-3-3 cDNA sequence determined from the T. gondii database. This antibody specifically recognized T. gondii 14-3-3 without any crossreaction with mammalian proteins. Immunofluorescence microscopy studies of the tachyzoites or the T. gondii-infected cells suggested cytosolic and membranous localizations of 14-3-3 protein. Different subcellular fractions were prepared for electrophoresis analysis and immunodetection. 14-3-3 proteins were found in the cytosol, the membrane fraction and Triton X-100-resistant membranes. Two 14-3-3 isoforms were detected. The major one was mainly cytoplasmic and to a lesser extent membrane-associated, whereas the minor isoform was associated with the detergent-resistant lipid rafts.

A collaborative model to implement flexible, accessible and efficient oncogenetic services for hereditary breast and ovarian cancer : the C-MOnGene study

Medical genetic services are facing an unprecedented demand for counseling and testing for hereditary breast and ovarian cancer (HBOC) in a context of limited resources. To help resolve this issue, a collaborative oncogenetic model was recently developed and implemented at the CHU de Québec-Université Laval; Quebec; Canada. Here, we present the protocol of the C-MOnGene (Collaborative Model in OncoGenetics) study, funded to examine the context in which the model was implemented and document the lessons that can be learned to optimize the delivery of oncogenetic services. Within three years of implementation, the model allowed researchers to double the annual number of patients seen in genetic counseling. The average number of days between genetic counseling and disclosure of test results significantly decreased. Group counseling sessions improved participants' understanding of breast cancer risk and increased knowledge of breast cancer and genetics and a large majority of them reported to be overwhelmingly satisfied with the process. These quality and performance indicators suggest this oncogenetic model offers a flexible, patient-centered and efficient genetic counseling and testing for HBOC. By identifying the critical facilitating factors and barriers, our study will provide an evidence base for organizations interested in transitioning to an oncogenetic model integrated into oncology care; including teams that are not specialized but are trained in genetics

Statistical Analysis of Large Simulated Yield Datasets for Studying Climate Effects

Many studies have been carried out during the last decade to study the effect of climate change on crop yields and other key crop characteristics. In these studies, one or several crop models were used to simulate crop growth and development for different climate scenarios that correspond to different projections of atmospheric CO2 concentration, temperature, and rainfall changes (Semenov et al., 1996; Tubiello and Ewert, 2002; White et al., 2011). The Agricultural Model Intercomparison and Improvement Project (AgMIP; Rosenzweig et al., 2013) builds on these studies with the goal of using an ensemble of multiple crop models in order to assess effects of climate change scenarios for several crops in contrasting environments. These studies generate large datasets, including thousands of simulated crop yield data. They include series of yield values obtained by combining several crop models with different climate scenarios that are defined by several climatic variables (temperature, CO2, rainfall, etc.). Such datasets potentially provide useful information on the possible effects of different climate change scenarios on crop yields. However, it is sometimes difficult to analyze these datasets and to summarize them in a useful way due to their structural complexity; simulated yield data can differ among contrasting climate scenarios, sites, and crop models. Another issue is that it is not straightforward to extrapolate the results obtained for the scenarios to alternative climate change scenarios not initially included in the simulation protocols. Additional dynamic crop model simulations for new climate change scenarios are an option but this approach is costly, especially when a large number of crop models are used to generate the simulated data, as in AgMIP. Statistical models have been used to analyze responses of measured yield data to climate variables in past studies (Lobell et al., 2011), but the use of a statistical model to analyze yields simulated by complex process-based crop models is a rather new idea. We demonstrate herewith that statistical methods can play an important role in analyzing simulated yield data sets obtained from the ensembles of process-based crop models. Formal statistical analysis is helpful to estimate the effects of different climatic variables on yield, and to describe the between-model variability of these effects

Low loss coatings for the VIRGO large mirrors

présentée par L. PinardThe goal of the VIRGO program is to build a giant Michelson type interferometer (3 kilometer long arms) to detect gravitational waves. Large optical components (350 mm in diameter), having extremely low loss at 1064 nm, are needed. Today, the Ion beam Sputtering is the only deposition technique able to produce optical components with such performances. Consequently, a large ion beam sputtering deposition system was built to coat large optics up to 700 mm in diameter. The performances of this coater are described in term of layer uniformity on large scale and optical losses (absorption and scattering characterization). The VIRGO interferometer needs six main mirrors. The first set was ready in June 2002 and its installation is in progress on the VIRGO site (Italy). The optical performances of this first set are discussed. The requirements at 1064 nm are all satisfied. Indeed, the absorption level is close to 1 ppm (part per million), the scattering is lower than 5 ppm and the R.M.S. wavefront of these optics is lower than 8 nm on 150 mm in diameter. Finally, some solutions are proposed to further improve these performances, especially the absorption level (lower than 0.1 ppm) and the mechanical quality factor Q of the mirrors (thermal noise reduction)

Une migration intellectuelle post-coloniale et son impact scientifique (les intellectuels arabes en France face à la redéfinition des savoirs sur le monde arabe (milieu des années 1950 - fin des années 1970) )

ST QUENTIN EN YVELINES-BU (782972101) / SudocSudocFranceF

Establishment of quinoa (Chenopodium quinoa Willd.) and simulation of its cultivation with the STICS crop model

International audienc

Utilisation du modèle de culture STICS comme outil pour renseigner les zonages viticoles

National audienc