Niveau de connaissance, de confiance et d'acceptation des patients en ce qui concerne le rôle des résidents dans une clinique universitaire de médecine familiale

Background: Although participation of patients is essential for completing the training of medical residents, little is known about the relationships among patients’ level of knowledge about the role and responsibilities of medical residents, their confidence in residents’ abilities, and their acceptance toward receiving care from residents. The study sought to clarify if and how these three patient-resident relationship components are interrelated. Methods: This is a cross-sectional study using a self-administered questionnaire distributed in 2016 to a convenience sample of adult patients (≥ 18 years old) visiting a family medicine teaching clinic. Proportions and chi-square statistics were used to describe and compare groups, respectively. Results: Of the 471 patients who answered the questionnaire, only 28% were found to be knowledgeable about the role of family medicine residents. Between 54% and 83% of patients reported being highly confident in the ability of residents to perform five routine tasks. Of the patients surveyed, 69% agreed to see a resident during their next appointments. Patients with a high level of confidence in residents’ abilities were more likely to agree to see a resident during future appointments (p <0.0001). There was no significant association between level of knowledge and either confidence or acceptance. Conclusions: Although the majority of patients had poor knowledge about the role of residents, this was not related to their acceptance of being cared for by residents. A higher level of confidence in residents’ ability to perform certain tasks was associated with greater acceptance toward seeing a resident during future appointments.Contexte : Tandis que la participation des patients est essentielle pour la formation de résidents en médecine, on en sait peu sur le rapport entre le niveau de connaissance qu'ont les patients du rôle et des responsabilités des résidents, leur confiance dans les compétences des résidents et leur acceptation de recevoir des soins de leur part. La présente étude visait à clarifier si et de quelle manière ces trois composantes du rapport patient-résident sont interreliées. Méthodes : Il s'agit d'une étude transversale réalisée au moyen d'un questionnaire auto-administré distribué en 2016 à un échantillon de convenance de patients adultes (≥ 18 ans) ayant fréquenté une clinique universitaire de médecine familiale. La proportion et le test du khi carré ont été utilisés respectivement pour décrire et pour comparer les groupes. Résultats : Parmi les 471 patients qui ont répondu au questionnaire, à peine 28 % connaissaient bien le rôle des résidents en médecine familiale. Entre 54 % et 83 % des patients ont déclaré avoir une grande confiance dans la capacité des résidents à effectuer cinq tâches de routine. Parmi les patients interrogés, 69 % ont accepté de voir un résident lors de leurs prochains rendez-vous. Les patients ayant un niveau de confiance élevé dans les capacités des résidents étaient plus susceptibles d'accepter de voir un résident lors de leurs prochains rendez-vous (p <0,0001). Il n'y avait pas d'association significative entre le niveau de connaissance des patients et leur confiance dans les résidents ou leur acceptation d'être traités par ces derniers. Conclusions : Bien que la majorité des patients aient une mauvaise connaissance du rôle des résidents, celle-ci n'a pas d'incidence sur leur acceptation d'être soignés par de résidents. Un niveau de confiance plus élevé dans la capacité des résidents à effectuer certaines tâches était associé à une plus grande acceptation de voir un résident à l'avenir

Le traitement auprès des personnes incarcérées pour une courte période et auprès des contrevenants en probation : recension des écrits

Après avoir été critiquée et remise en question, la réhabilitation reprend la place parmi les finalités pénales les plus recherchées. Elle s’adresse en particulier aux délinquants sexuels, toxicomanes, conjoints violents et personnes souffrant dans leur santé mentale. Le présent texte résulte d’une recension des écrits des programmes offerts à des contrevenants peu étudiés: les personnes condamnées à une courte peine d’emprisonnement (trois mois et moins). Il couvre les résultats de recherche des 10 dernières années, discute des objectifs des programmes, des principales modalités de traitement et de l’impact de ces programmes, notamment aux niveaux de l’attrition et de la récidive. Les résultats démontrent que la majorité des programmes ont un certain effet positif. Suite à ce constat général, certaines précisions sont apportées sur la nature et l’ampleur des résultats. Le suivi postdétention en communauté constitue un élément crucial de l’efficacité des programmes. Les auteurs concluent par des réflexions d’ordre méthodologique et sur le problème de l’attrition.Conseil québécois de la recherche social

The role of spatial frequencies for facial pain categorization

Studies on low-level visual information underlying pain categorization have led to inconsistent findings. Some show an advantage for low spatial frequency information (SFs) and others a preponderance of mid SFs. This study aims to clarify this gap in knowledge since these results have different theoretical and practical implications, such as how far away an observer can be in order to categorize pain. This study addresses this question by using two complementary methods: a data-driven method without a priori expectations about the most useful SFs for pain recognition and a more ecological method that simulates the distance of stimuli presentation. We reveal a broad range of important SFs for pain recognition starting from low to relatively high SFs and showed that performance is optimal in a short to medium distance (1.2–4.8 m) but declines significantly when mid SFs are no longer available. This study reconciles previous results that show an advantage of LSFs over HSFs when using arbitrary cutoffs, but above all reveal the prominent role of mid-SFs for pain recognition across two complementary experimental tasks

Nouveaux cahiers d'Ethos (2)

1ère partie - Quelques enjeux éthiques associés à la pandémie de COVID-19 : La vaccination obligatoire des travailleurs de la santé contre la COVID-19 -- Les éthiques de la vulnérabilité et du care pour aborder la situation des travailleur.euse.s essentiel.le.s en temps de COVID-19 -- Prendre soin de l'itinérance en temps de pandémie. Réflexion éthique sur l'impact des directives sanitaires auprès des personnes vivant en situation d'itinérance -- Le service public en contexte de pandémie : le dilemme de Jeanne, infirmière -- Hold-up : les enjeux éthiques du financement participatif à l'épreuve du contexte de la pandémie de COVID-19 -- 2e partie - Varia : Angles morts écologiques, maîtrise et déni de vulnérabilité -- Du processus d'insertion sociale à l'inclusion sociale ou de la vulnérabilité à la résilience-reliance -- Portrait éthique et identité du professionnel dans l'environnement de recherche publique fédérale

Associations between Nitric Oxide Synthase Genes and Exhaled NO-Related Phenotypes according to Asthma Status

International audienceBACKGROUND: The nitric oxide (NO) pathway is involved in asthma, and eosinophils participate in the regulation of the NO pool in pulmonary tissues. We investigated associations between single nucleotide polymorphisms (SNPs) of NO synthase genes (NOS) and biological NO-related phenotypes measured in two compartments (exhaled breath condensate and plasma) and blood eosinophil counts. METHODOLOGY: SNPs (N = 121) belonging to NOS1, NOS2 and NOS3 genes were genotyped in 1277 adults from the French Epidemiological study on the Genetics and Environment of Asthma (EGEA). Association analyses were conducted on four quantitative phenotypes: the exhaled fraction of NO (Fe(NO)), plasma and exhaled breath condensate (EBC) nitrite-nitrate levels (NO2-NO3) and blood eosinophils in asthmatics and non-asthmatics separately. Genetic heterogeneity of these phenotypes between asthmatics and non-asthmatics was also investigated. PRINCIPAL FINDINGS: In non-asthmatics, after correction for multiple comparisons, we found significant associations of Fe(NO) levels with three SNPs in NOS3 and NOS2 (P ≤ 0.002), and of EBC NO2-NO3 level with NOS2 (P = 0.002). In asthmatics, a single significant association was detected between Fe(NO) levels and one SNP in NOS3 (P = 0.004). Moreover, there was significant heterogeneity of NOS3 SNP effect on Fe(NO) between asthmatics and non-asthmatics (P = 0.0002 to 0.005). No significant association was found between any SNP and NO2-NO3 plasma levels or blood eosinophil counts. CONCLUSIONS: Variants in NO synthase genes influence Fe(NO) and EBC NO2-NO3 levels in adults. These genetic determinants differ according to asthma status. Significant associations were only detected for exhaled phenotypes, highlighting the critical relevance to have access to specific phenotypes measured in relevant biological fluid

Fifteen years of research on oral–facial–digital syndromes: from 1 to 16 causal genes

Oral–facial–digital syndromes (OFDS) gather rare genetic disorders characterised by facial, oral and digital abnormalities associated with a wide range of additional features (polycystic kidney disease, cerebral malformations and several others) to delineate a growing list of OFDS subtypes. The most frequent, OFD type I, is caused by a heterozygous mutation in the OFD1 gene encoding a centrosomal protein. The wide clinical heterogeneity of OFDS suggests the involvement of other ciliary genes. For 15 years, we have aimed to identify the molecular bases of OFDS. This effort has been greatly helped by the recent development of whole-exome sequencing (WES). Here, we present all our published and unpublished results for WES in 24 cases with OFDS. We identified causal variants in five new genes (C2CD3, TMEM107, INTU, KIAA0753 and IFT57) and related the clinical spectrum of four genes in other ciliopathies (C5orf42, TMEM138, TMEM231 and WDPCP) to OFDS. Mutations were also detected in two genes previously implicated in OFDS. Functional studies revealed the involvement of centriole elongation, transition zone and intraflagellar transport defects in OFDS, thus characterising three ciliary protein modules: the complex KIAA0753-FOPNL-OFD1, a regulator of centriole elongation; the Meckel-Gruber syndrome module, a major component of the transition zone; and the CPLANE complex necessary for IFT-A assembly. OFDS now appear to be a distinct subgroup of ciliopathies with wide heterogeneity, which makes the initial classification obsolete. A clinical classification restricted to the three frequent/well-delineated subtypes could be proposed, and for patients who do not fit one of these three main subtypes, a further classification could be based on the genotype

IFT81, encoding an IFT-B core protein, as a very rare cause of a ciliopathy phenotype

Background: Bidirectional intraflagellar transport (IFT) consists of two major protein complexes, IFT-A and IFT-B. In contrast to the IFT-B complex, all components of IFT-A have recently been linked to human ciliopathies when defective. We therefore hypothesised that mutations in additional IFT-B encoding genes can be found in patients with multisystemic ciliopathies. Methods: We screened 1628 individuals with reno-ocular ciliopathies by targeted next-generation sequencing of ciliary candidate genes, including all IFT-B encoding genes. Results: Consequently, we identified a homozygous mutation in IFT81 affecting an obligatory donor splice site in an individual with nephronophthisis and polydactyly. Further, we detected a loss-of-stop mutation with extension of the deduced protein by 10 amino acids in an individual with neuronal ceroid lipofuscinosis-1. This proband presented with retinal dystrophy and brain lesions including cerebellar atrophy, a phenotype to which the IFT81 variant might contribute. Cultured fibroblasts of this latter affected individual showed a significant decrease in ciliated cell abundance compared with controls and increased expression of the transcription factor GLI2 suggesting deranged sonic hedgehog signalling. Conclusions: This work describes identification of mutations of IFT81 in individuals with symptoms consistent with the clinical spectrum of ciliopathies. It might represent the rare case of a core IFT-B complex protein found associated with human disease. Our data further suggest that defects in the IFT-B core are an exceedingly rare finding, probably due to its indispensable role for ciliary assembly in development

Search for dark matter produced in association with bottom or top quarks in √s = 13 TeV pp collisions with the ATLAS detector

A search for weakly interacting massive particle dark matter produced in association with bottom or top quarks is presented. Final states containing third-generation quarks and miss- ing transverse momentum are considered. The analysis uses 36.1 fb−1 of proton–proton collision data recorded by the ATLAS experiment at √s = 13 TeV in 2015 and 2016. No significant excess of events above the estimated backgrounds is observed. The results are in- terpreted in the framework of simplified models of spin-0 dark-matter mediators. For colour- neutral spin-0 mediators produced in association with top quarks and decaying into a pair of dark-matter particles, mediator masses below 50 GeV are excluded assuming a dark-matter candidate mass of 1 GeV and unitary couplings. For scalar and pseudoscalar mediators produced in association with bottom quarks, the search sets limits on the production cross- section of 300 times the predicted rate for mediators with masses between 10 and 50 GeV and assuming a dark-matter mass of 1 GeV and unitary coupling. Constraints on colour- charged scalar simplified models are also presented. Assuming a dark-matter particle mass of 35 GeV, mediator particles with mass below 1.1 TeV are excluded for couplings yielding a dark-matter relic density consistent with measurements

Search for new particles in events with energetic jets and large missing transverse momentum in proton-proton collisions at root s=13 TeV

A search is presented for new particles produced at the LHC in proton-proton collisions at root s = 13 TeV, using events with energetic jets and large missing transverse momentum. The analysis is based on a data sample corresponding to an integrated luminosity of 101 fb(-1), collected in 2017-2018 with the CMS detector. Machine learning techniques are used to define separate categories for events with narrow jets from initial-state radiation and events with large-radius jets consistent with a hadronic decay of a W or Z boson. A statistical combination is made with an earlier search based on a data sample of 36 fb(-1), collected in 2016. No significant excess of events is observed with respect to the standard model background expectation determined from control samples in data. The results are interpreted in terms of limits on the branching fraction of an invisible decay of the Higgs boson, as well as constraints on simplified models of dark matter, on first-generation scalar leptoquarks decaying to quarks and neutrinos, and on models with large extra dimensions. Several of the new limits, specifically for spin-1 dark matter mediators, pseudoscalar mediators, colored mediators, and leptoquarks, are the most restrictive to date.Peer reviewe