Le système de prise en charge des personnes âgées dépendantes : le Japon un modèle pour la France ?

This thesis focuses on the long term home care policies conducted in Japan, in order to draw lessons for France. Our analysis is developped through three topics : i) the analysis of the differences between the Japanese and the French systems in the public care organisation and in the care received by the elderly, ii) the examination of potential barriers to access to public elderly care in Japan; iii) the study of the impact of informal care on the labor participation of Japanese middle-aged women. In this regard, we carried two qualitatives studies comparing Japanese and French policies, and two microeconometrics studies of individual and family behaviour of caring in Japan. This study outlines the specificities of the policies conducted in both countries, and highlights the strenghts and weakness of the Japanese model.Cette thèse étudie les politiques d’aide aux personnes âgées dépendantes à domicile menées au Japon, afin d’en tirer des enseignements pour la France. Nous développons notre étude à travers trois axes : i) l’analyse des différences entre le systèmes japonais et français dans l’organisation de l’aide publique et dans l’aide réellement perçue par les personnes en perte d’autonomie, ii) l’examen des barrières potentielles à l’accès aux aides publiques au Japon, iii) l’étude des conséquences de l’aide informelle sur l’emploi des femmes seniors au Japon. Dans cette perspective, nous avons effectué deux études qualitatives comparant les politiques japonaises et françaises, puis deux études micro-économétriques des comportements individuels et familiaux de prise en charge dans le contexte japonais. Ce travail met ainsi en exergue les spécificités des politiques menées dans les deux pays, et souligne les avantages et les faiblesses du modèle japonais

Newtoning financial development with heterogeneous firms

Abstract: This article theoretically and empirically tests the link between financial constraints and the extensive (proportion of exporters) and intensive (volume of exports) margins of international trade. The article's main contribution is its macroeconomic analysis of this relationship, which is further reaching than the sector-based focus found in the current literature. It also presents new information on firm behavior under financial constraints. The paper develops a trade model with heterogeneous firms and shows that countries with a high level of financial development have a lower productivity cut-off above which firms export and a higher proportion of exporting firms. Nevertheless, financial development is not correlated with firms' export volumes once they become exporters. An empirical analysis is developed on the basis of an international trade database on 135 countries between 1994 and 2007. The empirical analysis estimates a two-step gravity equation using panel data and confirms the first theoretical proposition that finance has a positive impact on the extensive margin. However, the intensive margin results are striking. They find a negative relationship between financial development and trade flows, confirmed by all the sensitivity tests. Despite the positive effect of financial development found by the literature in some economic sectors, the macroeconomic impact on overall exports was negative during the analyzed period

Inflammatory Monocytes and Neutrophils Are Licensed to Kill during Memory Responses In Vivo

Immunological memory is a hallmark of B and T lymphocytes that have undergone a previous encounter with a given antigen. It is assumed that memory cells mediate better protection of the host upon re-infection because of improved effector functions such as antibody production, cytotoxic activity and cytokine secretion. In contrast to cells of the adaptive immune system, innate immune cells are believed to exhibit a comparable functional effector response each time the same pathogen is encountered. Here, using mice infected by the intracellular bacterium Listeria monocytogenes, we show that during a recall bacterial infection, the chemokine CCL3 secreted by memory CD8+ T cells drives drastic modifications of the functional properties of several populations of phagocytes. We found that inflammatory ly6C+ monocytes and neutrophils largely mediated memory CD8+ T cell bacteriocidal activity by producing increased levels of reactive oxygen species (ROS), augmenting the pH of their phagosomes and inducing antimicrobial autophagy. These events allowed an extremely rapid control of bacterial growth in vivo and accounted for protective immunity. Therefore, our results provide evidence that cytotoxic memory CD8+ T cells can license distinct antimicrobial effector mechanisms of innate cells to efficiently clear pathogens

Maintaining Dependent Elderly People at Home in France and Japan

Avec le vieillissement de la population, les pouvoirs publics des pays industrialisés sont confrontés à la question de la prise en charge des personnes âgées dépendantes. En 1997, la France a mis en place une prestation spécifique dépendance (PSD), tandis que le Japon adoptait une assurance dépendance obligatoire qui est appliquée depuis avril 2000. Cet article met en exergue les similitudes et les divergences de la prise en charge des personnes âgées dépendantes à domicile dans ces deux pays en se plaçant du point de vue de l’usager. Le travail comparatif s’appuie d’une part sur des entretiens semi-directifs menés auprès de professionnels de la santé et du social et d’autre part sur un projet des cas-types. L’étude montre un système de prise en charge japonais particulièrement standardisé, aussi bien dans le processus d’évaluation que dans la composition des aides. Le système français, moins standardisé, semble accorder une plus grande importance aux inégalités de ressources.As the populations of the industrialised nations age, governments are having to face the issue of how best to look after dependent elderly people. France implemented specific benefits for dependent people in 1997, while Japan has had mandatory long term care insurance since April 2000. The article focuses on the similarities and differences in how dependent elderly people are maintained in their homes in each country, taking the viewpoint of service users. The comparative study draws on semi-structured interviews with health and social care professionals and on a project looking at typical case studies. It shows that the Japanese system is particularly standardised, both in evaluating need and in the assistance it offers. The French system is less standardised and seems to place greater emphasis on inequality of income

Long term care system : Japan, a model for France?

Cette thèse étudie les politiques d’aide aux personnes âgées dépendantes à domicile menées au Japon, afin d’en tirer des enseignements pour la France. Nous développons notre étude à travers trois axes : i) l’analyse des différences entre le systèmes japonais et français dans l’organisation de l’aide publique et dans l’aide réellement perçue par les personnes en perte d’autonomie, ii) l’examen des barrières potentielles à l’accès aux aides publiques au Japon, iii) l’étude des conséquences de l’aide informelle sur l’emploi des femmes seniors au Japon. Dans cette perspective, nous avons effectué deux études qualitatives comparant les politiques japonaises et françaises, puis deux études micro-économétriques des comportements individuels et familiaux de prise en charge dans le contexte japonais. Ce travail met ainsi en exergue les spécificités des politiques menées dans les deux pays, et souligne les avantages et les faiblesses du modèle japonais.This thesis focuses on the long term home care policies conducted in Japan, in order to draw lessons for France. Our analysis is developped through three topics : i) the analysis of the differences between the Japanese and the French systems in the public care organisation and in the care received by the elderly, ii) the examination of potential barriers to access to public elderly care in Japan; iii) the study of the impact of informal care on the labor participation of Japanese middle-aged women. In this regard, we carried two qualitatives studies comparing Japanese and French policies, and two microeconometrics studies of individual and family behaviour of caring in Japan. This study outlines the specificities of the policies conducted in both countries, and highlights the strenghts and weakness of the Japanese model

Effect of Arabinogalactan Proteins from the Root Caps of Pea and Brassica napus on Aphanomyces euteiches Zoospore Chemotaxis and Germination

International audienceRoot tips of many plant species release a number of border, or border-like, cells that are thought to play a major role in theprotection of root meristem. However, little is currently known on the structure and function of the cell wall components of suchroot cells. Here, we investigate the sugar composition of the cell wall of the root cap in two species: pea (Pisum sativum), whichmakes border cells, and Brassica napus, which makes border-like cells. We find that the cell walls are highly enriched in arabinoseand galactose, two major residues of arabinogalactan proteins. We confirm the presence of arabinogalactan protein epitopes onroot cap cell walls using immunofluorescence microscopy. We then focused on these proteoglycans by analyzing theircarbohydrate moieties, linkages, and electrophoretic characteristics. The data reveal (1) significant structural differencesbetween B. napus and pea root cap arabinogalactan proteins and (2) a cross-link between these proteoglycans and pecticpolysaccharides. Finally, we assessed the impact of root cap arabinogalactan proteins on the behavior of zoospores ofAphanomyces euteiches, an oomycetous pathogen of pea roots. We find that although the arabinogalactan proteins of bothspecies induce encystment and prevent germination, the effects of both species are similar. However, the arabinogalactanprotein fraction from pea attracts zoospores far more effectively than that from B. napus. This suggests that root arabinogalactanproteins are involved in the control of early infection of roots and highlights a novel role for these proteoglycans in root-microbeinteractions

IL-4 directs both CD4 and CD8 T cells to produce Th2 cytokines in vitro, but only CD4 T cells produce these cytokines in response to alum-precipitated protein in vivo.

While IL-4 directs CD4 T cells to produce Th2 cytokines (including IL-4, IL-13, IL-5) in vitro it has been shown that production of these cytokines can be induced in vivo in the absence of IL-4/IL-13/STAT-6 signaling. The present report shows that CD8 as well as CD4 T cells activated through their TCR, in vitro upregulate the Th2-features – IL-4, IL-13, IL-5, and GATA-3. However, in vivo while alum-precipitated antigen strongly and selectively induces these Th2-features in CD4 T cells, CD8 T cells mount a markedly different response to this antigen. This CD8 response is associated with strong proliferation and production of IFN-γ, but no Th2-features are induced. Alum-protein formulations are widely used in human vaccines and typically induce strong antibody responses characterized by the differentiation of IL-4-producing CD4 T cells and immunoglobulin class switching to IgG1. Nevertheless, the mechanism responsible for CD4 Th2 and follicular helper T cell commitment triggered by these alum-protein vaccines is still poorly understood. Analysis of the in vivo response to alum-precipitated protein shows that while subsets of CD4 T cells strongly upregulate Th2 and follicular helper T cell features including the surface markers OX40, CXCR5, PD-1, IL-17RB and the transcription factor c-Maf, CD8 T cells do not. These discrete differences between responding CD4 and CD8 T cells provide further insight into the differences between Th2 polarization of CD4 T cells directed by IL-4 in vitro and the induction of IL-4 production by CD4 T cells in vivo in response to alum-precipitated protein

Prenatal pharmacotherapy rescues brain development in a Down's syndrome mouse model

Intellectual impairment is a strongly disabling feature of Down's syndrome, a genetic disorder of high prevalence (1 in 700-1000 live births) caused by trisomy of chromosome 21. Accumulating evidence shows that widespread neurogenesis impairment is a major determinant of abnormal brain development and, hence, of intellectual disability in Down's syndrome. This defect is worsened by dendritic hypotrophy and connectivity alterations. Most of the pharmacotherapies designed to improve cognitive performance in Down's syndrome have been attempted in Down's syndrome mouse models during adult life stages. Yet, as neurogenesis is mainly a prenatal event, treatments aimed at correcting neurogenesis failure in Down's syndrome should be administered during pregnancy. Correction of neurogenesis during the very first stages of brain formation may, in turn, rescue improper brain wiring. The aim of our study was to establish whether it is possible to rescue the neurodevelopmental alterations that characterize the trisomic brain with a prenatal pharmacotherapy with fluoxetine, a drug that is able to restore post-natal hippocampal neurogenesis in the Ts65Dn mouse model of Down's syndrome. Pregnant Ts65Dn females were treated with fluoxetine from embryonic Day 10 until delivery. On post-natal Day 2 the pups received an injection of 5-bromo-2-deoxyuridine and were sacrificed after either 2 h or after 43 days (at the age of 45 days). Untreated 2-day-old Ts65Dn mice exhibited a severe neurogenesis reduction and hypocellularity throughout the forebrain (subventricular zone, subgranular zone, neocortex, striatum, thalamus and hypothalamus), midbrain (mesencephalon) and hindbrain (cerebellum and pons). In embryonically treated 2-day-old Ts65Dn mice, precursor proliferation and cellularity were fully restored throughout all brain regions. The recovery of proliferation potency and cellularity was still present in treated Ts65Dn 45-day-old mice. Moreover, embryonic treatment restored dendritic development, cortical and hippocampal synapse development and brain volume. Importantly, these effects were accompanied by recovery of behavioural performance. The cognitive deficits caused by Down's syndrome have long been considered irreversible. The current study provides novel evidence that a pharmacotherapy with fluoxetine during embryonic development is able to fully rescue the abnormal brain development and behavioural deficits that are typical of Down's syndrome. If the positive effects of fluoxetine on the brain of a mouse model are replicated in foetuses with Down's syndrome, fluoxetine, a drug usable in humans, may represent a breakthrough for the therapy of intellectual disability in Down's syndrome