A Subjetividade do Bem-Estar em Saúde

In this paper we will illustrate the accessibility to a subjective state of well-being from two clinical situations. We will observe how these two patients, one suffered a stroke and one displaying a neurodegenerative disease, were able to overcome their handicap and deploy their creative potential, past the psychometric assessment phase.Dans cet article nous illustrerons l’accessibilité à un état subjectif à partir de deux situations cliniques. Nous observerons comment ces deux patients, l’un présentant accident cérébral vasculaire et l’autre, une pathologie neurodégénérative ont pu surpasser leur handicap et déployer leur potentiel créatif, passée la phase d’évaluation psychométrique.Neste artigo, ilustraremos o acesso a um estado subjetivo de bem-estar, a partir de dois casos clínicos. Observaremos como esses dois pacientes, um que sofreu um derrame e outro que apresentava uma doença neurodegenerativa, foram capazes de superar sua deficiência e implementar seu potencial criativo, passada a fase de avaliação psicométrica

Voyage au Liban

Les relations historiques entretenues par l’ABF-Paca avec les bibliothécaires libanais ont débouché sur un voyage exceptionnel d’une semaine de 15 professionnels de la région au pays du cèdre. Ce riche tour d’horizon englobe les bibliothèques de lecture publique, les bibliothèques universitaires et passe par la Bibliothèque nationale avant de saluer les efforts de toute la chaîne du livre en direction du jeune public

Contribution of Each Leg to the Control of Unperturbed Bipedal Stance in Lower Limb Amputees: New Insights Using Entropy

The present study was designed to assess the relative contribution of each leg to unperturbed bipedal posture in lower limb amputees. To achieve this goal, eight unilateral traumatic trans-femoral amputees (TFA) were asked to stand as still as possible on a plantar pressure data acquisition system with their eyes closed. Four dependent variables were computed to describe the subject's postural behavior: (1) body weight distribution, (2) amplitude, (3) velocity and (4) regularity of centre of foot pressure (CoP) trajectories under the amputated (A) leg and the non-amputated (NA) leg. Results showed a larger body weight distribution applied to the NA leg than to the A leg and a more regular CoP profiles (lower sample entropy values) with greater amplitude and velocity under the NA leg than under the A leg. Taken together, these findings suggest that the NA leg and the A leg do not equally contribute to the control of unperturbed bipedal posture in TFA. The observation that TFA do actively control unperturbed bipedal posture with their NA leg could be viewed as an adaptive process to the loss of the lower leg afferents and efferents because of the unilateral lower-limb amputation. From a methodological point of view, these results demonstrate the suitability of computing bilateral CoP trajectories regularity for the assessment of lateralized postural control under pathological conditions

Excessive Food Intake, Obesity and Inflammation Process in Zucker fa/fa Rat Pancreatic Islets

Inappropriate food intake-related obesity and more importantly, visceral adiposity, are major risk factors for the onset of type 2 diabetes. Evidence is emerging that nutriment-induced β-cell dysfunction could be related to indirect induction of a state of low grade inflammation. Our aim was to study whether hyperphagia associated obesity could promote an inflammatory response in pancreatic islets leading to ß-cell dysfunction. In the hyperphagic obese insulin resistant male Zucker rat, we measured the level of circulating pro-inflammatory cytokines and estimated their production as well as the expression of their receptors in pancreatic tissue and β-cells. Our main findings concern intra-islet pro-inflammatory cytokines from fa/fa rats: IL-1β, IL-6 and TNFα expressions were increased; IL-1R1 was also over-expressed with a cellular redistribution also observed for IL-6R. To get insight into the mechanisms involved in phenotypic alterations, abArrays were used to determine the expression profile of proteins implicated in different membrane receptors signaling, apoptosis and cell cycle pathways. Despite JNK overexpression, cell viability was unaffected probably because of decreases in cleaved caspase3 as well as in SMAC/DIABLO and APP, involved in the induction and amplification of apoptosis. Concerning β-cell proliferation, decreases in important cell cycle regulators (Cyclin D1, p35) and increased expression of SMAD4 probably contribute to counteract and restrain hyperplasia in fa/fa rat islets. Finally and probably as a result of IL-1β and IL-1R1 increased expressions with sub-cellular redistribution of the receptor, islets from fa/fa rats were found more sensitive to both stimulating and inhibitory concentrations of the cytokine; this confers some physiopathological relevance to a possible autocrine regulation of β-cell function by IL-1β. These results support the hypothesis that pancreatic islets from prediabetic fa/fa rats undergo an inflammatory process. That the latter could contribute to β-cell hyperactivity/proliferation and possibly lead to progressive β-cell failure in these animals, deserves further investigations

Quality indicators for responsible antibiotic use in the inpatient setting: a systematic review followed by an international multidisciplinary consensus procedure

Background This study was conducted as part of the Driving Reinvestment in Research and Development and Responsible Antibiotic Use (DRIVE-AB) project and aimed to develop generic quality indicators (QIs) for responsible antibiotic use in the inpatient setting. Methods A RAND-modified Delphi method was applied. First, QIs were identified by a systematic review. A complementary search was performed on web sites of relevant organizations. Duplicates were removed and disease and patient-specific QIs were combined into generic indicators. The relevance of these QIs was appraised by a multidisciplinary international stakeholder panel through two questionnaires and an in-between consensus meeting. Results The systematic review retrieved 70 potential generic QIs. The QIs were appraised by 25 international stakeholders with diverse backgrounds (medical community, public health, patients, antibiotic research and development, regulators, governments). Ultimately, 51 QIs were selected in consensus. QIs with the highest relevance score included: (i) an antibiotic plan should be documented in the medical record at the start of the antibiotic treatment; (ii) the results of bacteriological susceptibility testing should be documented in the medical record; (iii) the local guidelines should correspond to the national guidelines but should be adapted based on local resistance patterns; (iv) an antibiotic stewardship programme should be in place at the healthcare facility; and (v) allergy status should be taken into account when antibiotics are prescribed. Conclusions This systematic and stepwise method combining evidence from literature and stakeholder opinion led to multidisciplinary international consensus on generic inpatient QIs that can be used globally to assess the quality of antibiotic use

Inhibition sélective de l'information non pertinente chez des sujets induits dans un état anxieux

Le biais attentionnel observé dans l'anxiété pourrait être le résultat d'un déficit au niveau de l'inhibition des distracteurs négatifs. Une façon d'analyser ce déficit a consisté, dans les trois premières expériences à dissocier dans le temps les composantes sémantique et chromatique de la tâche de Stroop. Les résultats observés dans ces expériences ont principalement montré que les sujets induits dans un état anxieux se différenciaient des sujets contrôles au niveau du décours temporel de l'interférence mot/couleur et que le biais attentionnel associé à l'anxiété était le reflet d'un dysfonctionnement attentionnel général à l'égard de l'information distractrice et pas seulement d'un déficit au niveau de l'inhibition sélective. Une quatrième expérience, dans laquelle nous avons utilisé un paradigme d'amorçage négatif ne confirme pas l'existence d'un déficit des mécanismes inhibiteurs chez les personnes anxieuses. En référence aux travaux de Fox (1994) qui laissent supposer que les personnes anxieuses auraient des difficultés à inhiber l'information négative, lorsqu'un processus de recherche visuelle est engagé, nous avons conçu trois autres expériences, impliquant un traitement spatial. Les expériences 5 et 6 n'ont montré aucun biais attentionnel associé à la valence des mots chez les personnes induites dans un état émotionnel. Cet échec pourrait s'interpréter par le fait que le traitement émotionnel ne fait pas l'objet d'une interférence mesurable dans ces expériences car d'autres types de traitement interviendraient et neutraliseraient l'activation de cette information. Nous avons donc mis en place une autre expérience, qui prendrait plus en compte le traitement émotionnel de l'information. Les résultats vont dans le sens d'une difficulté à inhiber l'information distractrice de valence négative chez les personnes induites dans un état anxieux, lorsqu'une recherche visuo-spatiale est impliquée.LYON2/BRON-BU (690292101) / SudocSudocFranceF

Decision-Making in Alzheimer’s Disease: The Role of Working Memory and Executive Functions in the Iowa Gambling Task and in Tasks Inspired by Everyday Situations

International audienceBackground: Alzheimer’s disease (AD) negatively impacts patients’ ability to make advantageous decisions, i.e., a core ability contributing to the preservation of autonomy. Objective: The present study aims to analyze the changes that occur in the decision-making competence (DMC) in AD patients and to determine if these changes are related to the deterioration of executive functions and working memory. Method: To this end, 20 patients with AD and 20 elderly control adults were assessed using executive, working memory, and DMC tasks. The latter comprised the Iowa Gambling Task (IGT) and a scenarios task based on situations inspired by everyday life and performed under conditions of risk and ambiguity. Results: Results revealed lower performances in AD patients than in elderly control adults for all the tasks assessing cognitive functions. The AD patients also made more strategy changes during the IGT. In the scenarios tasks, the two groups took as many ambiguous or risky decisions, but AD patients tended to take more risks in the context of gain than elderly control adults did. Switching and updating ability, as well as working memory, appeared to be involved in decisions in tasks inspired by everyday life, while inhibition was more related to the IGT performances. Conclusion: Working memory and executive functions seem to be involved in decision-making, but in different ways in gambling and daily-life situations

Decision-Making in Alzheimer’s Disease: The Role of Working Memory and Executive Functions in the Iowa Gambling Task and in Tasks Inspired by Everyday Situations

International audienceBackground: Alzheimer’s disease (AD) negatively impacts patients’ ability to make advantageous decisions, i.e., a core ability contributing to the preservation of autonomy. Objective: The present study aims to analyze the changes that occur in the decision-making competence (DMC) in AD patients and to determine if these changes are related to the deterioration of executive functions and working memory. Method: To this end, 20 patients with AD and 20 elderly control adults were assessed using executive, working memory, and DMC tasks. The latter comprised the Iowa Gambling Task (IGT) and a scenarios task based on situations inspired by everyday life and performed under conditions of risk and ambiguity. Results: Results revealed lower performances in AD patients than in elderly control adults for all the tasks assessing cognitive functions. The AD patients also made more strategy changes during the IGT. In the scenarios tasks, the two groups took as many ambiguous or risky decisions, but AD patients tended to take more risks in the context of gain than elderly control adults did. Switching and updating ability, as well as working memory, appeared to be involved in decisions in tasks inspired by everyday life, while inhibition was more related to the IGT performances. Conclusion: Working memory and executive functions seem to be involved in decision-making, but in different ways in gambling and daily-life situations