Approche anthropologique des déterminants de l'observance dans le traitement de l'hypertension artérielle

La revue Pratiques et organisation des soins (en ligne) porte le numéro ISSN : 1961 - 9391Revue en ligne et en libre accès : http://www.ameli.fr/l-assurance-maladie/statistiques-et-publications/la-revue-pratiques-et-organisation-des-soins/Article disponible en ligne sur le site de la revue : http://www.ameli.fr/fileadmin/user_upload/documents/Observance_du_traitement_de_l_hypertension_01.pdfAim: Uncontrolled hight blood pressure leads clinicians to wonder about adherence degree amongst hypertensive patients. In this context, our study aims to describe and analyse patients experience of antihypertensive drugs, in order to shed light on the multiple social and symbolic logics, forming part of the cultural factors shaping personal medication practices.Methods: The inductive and comprehensive anthropological approach implemented is based on an ethnographical survey (observations of medical consultations and interviews). Semi-structured interviews were conducted with 68 hypertensive patients (39 women and 29 men, between the ages of 40 and 95, of whom 52 were over 60) who had been receiving treatment for over a year.Results: Antihypertensive drug is reinterpreted using popular representations of pathophysiology (the body as a machine). This symbolic dimension eases acceptance of therapy, but leads to a hierarchy forming of other prescribed medicines and of certain therapeutic classes (such as diuretics). Prescription compliance does not solely depend on the patient's perception of cardiovascular risk, but also on how the patient appropriates the treatment and integrates it into his/her daily life, requiring identification with the product, building commitment and self-control of the treatment (experimentation; command of treatment; control of side effects, of intake, continuity of treatment).A relationship based on trust between the physician and patient is necessary for a prescription to be followed. We have identified three types of relationship: reasoned trust, emotional trust, conceded trust.Conclusion: Consideration and understanding of these pragmatic, symbolic issues by physicians should help practitioners support and advise patients with high blood pressure.Objectif : Les hypertensions artérielles non contrôlées conduisent les cliniciens à s'interroger sur les niveaux d'observance des hypertendus traités. Dans ce contexte, notre étude visait à décrire et à analyser l'expérience des hypotenseurs par les hypertendus, afin de mettre à jour les logiques plurielles, sociales et symboliques, permettant de comprendre ce qui construit culturellement les pratiques médicamenteuses des individus.Méthodes : La démarche anthropologique, inductive et compréhensive, mise en oeuvre reposait sur une enquête ethnographique (observations de consultations et entretiens). Nous avons interviewé 68 hypertendus (39 femmes et 29 hommes, âgés de 40 à 95 ans, 52 d'entre eux ayant plus de 60 ans) traités depuis plus d'un an.Résultats : Le médicament hypotenseur était réinterprété au travers du filtre des représentations populaires de la physiopathologie (corps machine). Cette dimension symbolique facilitait l'adhésion thérapeutique,mais conduisait à une hiérarchisation des autres médicaments prescrits, et de certaines classes thérapeutiques (diurétiques). Le suivi de l'ordonnance était conditionné par la perception du risque cardiovasculaire,mais également par l'appropriation du traitement et son intégration dans la vie quotidienne nécessitant une identification au produit, une fidélisation, et une auto-régulation du traitement (expérimentation ; maîtrise du traitement ; contrôle des effets indésirables, de l'ingestion, de la continuité du traitement). Le suivi de l'ordonnance requiert une relation de confiance entre le médecin et le patient dont nous avons relevé trois formes : la confiance raisonnée, la confiance affective, la confiance concédée.Conclusion : La prise en compte et la compréhension de ces différentes logiques pragmatiques et symboliques par le médecin traitant devraient pouvoir aider les praticiens dans leur fonction d'éducation thérapeutique des personnes hypertendues

Eukaryotic Initiation Factor 2B (eIF2B) GEF Activity as a Diagnostic Tool for EIF2B-Related Disorders

BACKGROUND:In recent years, the phenotypes of leukodystrophies linked to mutations in the eukaryotic initiation factor 2B genes have been extended, classically called CACH/VWM (Childhood ataxia with cntral hypomyélination/vanishing white matter disorder). The large clinical spectrum observed from the more severe antenatal forms responsible for fetal death to milder adult forms with an onset after 16 years old and restricted to slow cognitive impairment have lead to the concept of eIF2B-related disorders. The typical MRI pattern with a diffuse CSF-like aspect of the cerebral white matter can lack particularly in the adult forms whereas an increasing number of patients with clinical and MRI criteria for CACH/VWM disease but without eIF2B mutations are found. Then we propose the use of biochemical markers to help in this difficult diagnosis. The biochemical diagnosis of eIF2B-related disorder is difficult as no marker, except the recently described asialotransferrin/transferrin ratio measured in cerebrospinal fluid, has been proposed and validated until now. Decreased eIF2B GEF activity has been previously reported in lymphoblastoid cell lines from 30 eIF2B-mutated patients. Our objective was to evaluate further the utility of this marker and to validate eIF2B GEF activity in a larger cohort as a specific diagnostic test for eIF2B-related disorders. METHODOLOGY/PRINCIPAL FINDINGS:We performed eIF2B GEF activity assays in cells from 63 patients presenting with different clinical forms and eIF2B mutations in comparison to controls but also to patients with defined leukodystrophies or CACH/VWM-like diseases without eIF2B mutations. We found a significant decrease of GEF activity in cells from eIF2B-mutated patients with 100% specificity and 89% sensitivity when the activity threshold was set at < or =77.5%. CONCLUSION:These results validate the measurement of eIF2B GEF activity in patients' transformed-lymphocytes as an important tool for the diagnosis of eIF2B-related disorders

A motif within the N-terminal domain of TSP-1 specifically promotes the proangiogenic activity of endothelial colony-forming cells

Thrombospondin-1 (TSP-1) gives rise to fragments that have both pro- and anti-angiogenic effects in vitro and in vivo. the TSP-HepI peptide (2.3 kDa), located in the N-terminal domain of TSP-1, has proangiogenic effects on endothelial cells. We have previously shown that TSP-1 itself exhibits a dual effect on endothelial colony-forming cells (ECFC) by enhancing their adhesion through its TSP-HepI fragment while reducing their proliferation and differentiation into vascular tubes (tubulogenesis) in vitro. This effect is likely mediated through CD47 binding to the TSP-1 C-terminal domain. Here we investigated the effect of TSP-HepI peptide on the angiogenic properties of ECFC in vitro and in vivo. TSP-HepI peptide potentiated FGF-2-induced neovascularisation by enhancing ECFC chemotaxis and tubulogenesis in a Matrigel plug assay. ECFC exposure to 20 mu g/mL of TSP-HepI peptide for 18 h enhanced cell migration (p < 0.001 versus VEGF exposure), upregulated alpha 6-integrin expression, and enhanced their cell adhesion to activated endothelium under physiological shear stress conditions at levels comparable to those of SDF-1 alpha. the adhesion enhancement appeared to be mediated by the heparan sulfate proteoglycan (HSPG) syndecan-4, as ECFC adhesion was significantly reduced by a syndecan-4-neutralising antibody. ECFC migration and tubulogenesis were stimulated neither by a TSP-HepI peptide with a modified heparin-binding site (S/TSP-HepI) nor when the glycosaminoglycans (GAGS) moieties were removed from the ECFC surface by enzymatic treatment. Ex vivo TSP-HepI priming could potentially serve to enhance the effectiveness of therapeutic neovascularisation with ECFC. (C) 2012 Elsevier Inc. All rights reserved.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Groupe d'Etude et de Recherches sur l'Hemostase (GEHT)Region Ile-de-France (CORDDIM)Leducq TransAtlantic Network of ExcellenceUniv Estado Rio de Janeiro, Dept Biol Celular, Lab Biol Celula Endotelial & Angiogenese LabAngio, Inst Biol Roberto Alcantara Gomes, BR-20550011 Rio de Janeiro, RJ, BrazilINSERM, U765, Paris, FranceUniv Paris 05, Paris, FranceUniversidade Federal de São Paulo, Escola Paulista Med, Dept Biofis, São Paulo, BrazilUniv Fed Rio de Janeiro, Inst Ciencias Biomed, Rio de Janeiro, RJ, BrazilHop Europeen Georges Pompidou, AP HP, Dept Haematol, Paris, FranceINSERM, Paris Cardiovasc Res Ctr, U970, Paris, FranceUniversidade Federal de São Paulo, Escola Paulista Med, Dept Biofis, São Paulo, BrazilLeducq TransAtlantic Network of Excellence: 04CVD01-LENALeducq TransAtlantic Network of Excellence: 04CVD02 -LINATCNPq: E-26/110.780/2010CAPES: 629/09Web of Scienc

Île-de-France

À la fois centre d’activités économiques, pôle culturel et destination de la grande majorité des exilés et réfugiés, l’Île-de-France, devenue une “région monde”, est un observatoire privilégié et singulier du phénomène migratoire, qui a contribué à son expansion territoriale et participé à son dynamisme économique. L’histoire de l’immigration postcoloniale en région continue, elle, à s’écrire au quotidien, et d’autres, comme celle des mouvements de sans-papiers et de mal-logés, y sont en deveni

Study of Xenon Mobility in the Two Forms of MIL-53(Al) Using Solid-State NMR Spectroscopy

The Al-based metal–organic framework (MOF) MIL-53­(Al) exhibits a structural transition between a large-pore (<i>lp</i>) form and a narrow-pore (<i>np</i>) one. Such change is induced by temperature, external pressure, or the adsorption of guest molecules. ¹²⁹Xe solid-state NMR experiments under static and magic-angle spinning (MAS) conditions have been used to study the <i>lp</i>–<i>np</i> transition in MIL-53­(Al) initially loaded with xenon gas under a pressure of 5 × 10⁴ Pa (at room temperature). The conversion of the <i>lp</i> form into the <i>np</i> one when the temperature decreases from 327 to 237 K and the reopening of the pores below 230 K are then observed. Furthermore, ¹H → ¹²⁹Xe cross-polarization under MAS (CPMAS) experiments demonstrate the possibility to observe the <i>np</i> phase at <i>T</i> ≤ 230 K, while the <i>lp</i> one is unseen because the xenon residence time is too short for successful cross-polarization transfer. Moreover, even for the <i>np</i> phase at 199 K, the xenon atoms still exhibit significant motion on time scale faster than a few milliseconds. We prove the exchange of Xe atoms between the <i>lp</i> and <i>np</i> forms at room temperature with the two-dimensional (2D) ¹²⁹Xe EXchange SpectroscopY (EXSY) NMR method. Using ¹²⁹Xe selective inversion recovery (SIR) experiments, the rate for this exchange has been measured at 43 ± 6 s^–1

Impact Assessment Modeling of Low-Water Management Policy

International audienceWe briefly present the main steps involved in designing and developing a platform for the numerical simulation of environmental and social impacts of the implementation of new environmental norms related to low-water management in France (MAELIA Project: multi-agents for environmental norms impact assessment). Some results are highlighted concerning in particular the structure of the underlying low-water management model and the process and agents' activity modeling

Centre d’anthropologie sociale – CAS

Jean-Pierre Albert, directeur d’étudesAnne Bouchy, directrice d’études à l’EFEO La mort et les religions. Études comparatives Avec Marlène Albert-Llorca, Alain Ballabriga, Anny Bloch-Raymond, Marine Carrin, Patrizia Ciambelli, Jean-Louis Ormières, Valérle Robin, Guillaume Rozenberg, Harald Tambs-Lyche, Sébastien Tank-Storper, Claudine Vassas. Les séances ont été centrées sur le thème « Mort, religion et politique », avec deux orientations principales : Les enjeux des rites funéraires et de la..