Évaluation médico-économique de l'intervention "Un Chez Soi d'Abord" Application du modèle de Markov pour une évaluation à long terme

Thèse présentée sous la forme d'une "Thèse Article"Contexte : Compte tenu du nombre croissant de sans-abri dans les pays occidentaux et de la prévalence des troubles mentaux sévères dans cette population, des programmes de logement accompagné ont été expérimentés depuis le début des années 2000. Les programmes de type Housing First (HF), qui combinent la gestion de cas et l'accès à un logement permanent et indépendant sans aucune condition, peuvent représenter un obstacle financier à l'élaboration d'une politique publique européenne plus saine. Notre objectif était de réaliser l’analyse coût-efficacité de ce programme en France, appelé Un Chez Soi d’Abord.Méthodes : Entre 2011 et 2014, 703 sans-abri atteints de maladies mentales sévères de 4 villes françaises ont été randomisés dans le groupe HF (n=353) ou dans le groupe traitement habituel (Treatment as usual = TAU) (n=350) et suivis sur 24 mois. La stabilité résidentielle a été évaluée. Les coûts engagés par l’accès aux services de santé (passages aux urgences, admissions à l'hôpital, consultations médicales), aux services judiciaires (comparutions devant les tribunaux, centres de détention et pénitenciers), aux structures résidentielles (refuges d'urgence, refuges à long terme et logements accompagnés) et aux prestations d'aide sociale ont été évalués pendant 24 mois. Une modélisation de Markov a été réalisée afin de comparer sur vie entière le ratio coût-efficacité incrémental entre les deux stratégies comparées.Résultats : Les individus du groupe HF ont passé 2685 nuits sur vie entière dans un logement indépendant et seulement 775 nuits pour les individus TAU. Chaque participant du groupe HF a coûté 10 163 € de plus qu'un participant du groupe TAU, soit un coût de 5,3 € par nuit supplémentaire passée dans un logement indépendant. La courbe d'acceptabilité a montré que dans 27% des itérations, la stratégie HF était dominante.Conclusion : Le modèle HF semble être un modèle efficient de prise en charge des personnes sans domicile souffrant de troubles mentaux sévères. Ces résultats, attendus par les décideurs publics, vont participer à la définition des conditions de mise en œuvre et de diffusion de ce modèle en France

The representation of shopping in children’s books

International audiencePurpose The purpose of this paper is to identify the representations, figures and processes of shopping/commerce in books published in France that are aimed at three to seven-year-olds. Design/methodology/approach A semiotic analysis of nearly 50 books published over the past 60 years. Findings These books reveal a broad diversity in the images of shops given to children (ranging from the traditional shop, a source of pleasure and creator of social ties, to the hypermarket/megastore, a symbol of stress and overconsumption) and the wealth of information that is given to children to help them assimilate the process of a shopping transaction. Originality/value The originality and richness of this research lies in its methodological approach. Indeed, it is perfectly aligned with a recent academic trend that calls on researchers to mobilise and compare new data collection tools to apprehend current and future consumer behaviour. Consequently this research is based on an immersion in children’s books that depict the world of commerce in one way or another

The Representation of Shopping in Children’s Books

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Aspects logistiques de la transfusion de concentrés érythrocytaires en milieu préhospitalier

Pre-hospital red blood cell transfusion is already used in many countries, both in military and civilian settings, and provides a better chance of survival for patients suffering from massive bleeding. However, this is not a current practice in Switzerland. This article aims to study Swiss specificities and provide a turnkey concept for the implementation of red blood cell transfusion in an emergency pre-hospital setting, by road or by air. The transfusion benefits and risks, the logistical aspect and the costs are discussed.La transfusion de concentrés érythrocytaires (CE) en milieu préhospitalier est déjà réalisée dans de nombreux pays tant dans un contexte militaire que civil et permet d’augmenter les chances de survie des patients souffrant d’hémorragie massive. En Suisse, cette pratique n’est pas courante. Cet article a pour but d’étudier les spécificités suisses et de proposer un concept clé en main pour l’implémentation de la transfusion de CE dans un service de sauvetage médicalisé terrestre ou héliporté. Les bénéfices et les risques de la transfusion, les modalités logistiques et les coûts y sont abordés

How to increase first‐time donors' returns? The postdonation letter's content can make a difference

Background: Retention of first-time donors is pivotal for blood collection centers. The present study built on research showing the importance of donor identity among regular donors and sought to compare the effectiveness of various communication strategies on return rate.Study design and methods: Postal letters were sent to a large sample of first-time whole blood donors (N = 1219) a few weeks following their first donation. Four versions of this letter were differently constructed in a way to boost the acquisition of donor identity (i.e., by including information about their ABO and Rh(D) blood group, emphasizing the salience of donor identity, offering a keyring with personalized information, or specifying the percentage of those sharing the same ABO and Rh(D) blood group). One version with no identity-related information served as a control condition. Participants' subsequent blood donations were tracked for 5-22 months after receiving the letter.Results: Survival analysis showed that the return rate was significantly higher among those who had received information about the percentage of the country's population with the same ABO and Rh(D) blood group (in comparison with the four other versions). There was no significant effect on the blood type rarity.Conclusion: Blood collection centers could orient the strategy employed to communicate with first-time donors to improve donors' retention. Arousing a sense of social identification with others with the same blood type may reveal a promising avenue.</p

Comparison of epicardial vs. endocardial reimplantation in pacemaker-dependent patients with device infection

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C-Reactive Protein on Postoperative Day 1 Is a Reliable Predictor of Pancreas-Specific Complications After Pancreaticoduodenectomy

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Seasonal variations in cardiac implantable electronic device infections

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Feasibility and Impact of Adapted Physical Activity (APA) in Cancer Outpatients Beginning Medical Anti-Tumoral Treatment: The UMA-CHAPA Study

Adapted physical activity (APA) improves quality of life and cancer outcomes. The aim of this study was to assess the feasibility of an APA program in outpatients beginning medical anticancer treatment. The secondary objective was to assess the impact of APA on fatigue, anxiety, depression, and handgrip strength (HGS). This prospective study was conducted between January and July 2017. Among 226 patients beginning treatment in the unit for a digestive, lung, hematological, or dermatological cancer, 163 were included. Adherence to the APA program was defined as more than or equal to one one-hour session per week for 3 months. The first evaluation was conducted at 3 months (M3), and the second evaluation at 6 months (M6). A total of 163 patients were included (mean age 62.5 ± 14.3); 139 (85.3%) agreed to follow the APA program. At M3, 106 of them were evaluated, of which 86 (81.1%) declared that they had followed the program. Improvement in anxiety was observed at M3 (−1.0 ± 3.2; p = 0.002) but there was no significant change in fatigue or depression. HGS decreased significantly (−1.2 ± 5.5; p = 0.04). The APA program was feasible in cancer outpatients beginning medical anticancer treatment. APA should be part of standard support care

Comparative performance of ISAGA IgM and ELISA assays for the diagnosis of maternal and congenital Toxoplasma infections: which technique could replace ISAGA IgM?

International audienceThe ISAGA immunocapture test for the detection of anti-Toxoplasma immunoglobulin M is a manual technique known for its excellent sensitivity and specificity. The purpose of this retrospective, multicenter study was to compare the performances and agreement between ISAGA and other IgM detection techniques before cessation of ISAGA production. The analytic performance of the different tests was evaluated using 1,341 serum samples from adults with positive IgM and negative IgG to Toxoplasma gondii, and 1,206 sera from neonates born to mothers with seroconversion. The agreement between the tests was evaluated on 13,506 adult and 5,795 child serum samples. The sensitivity of Toxo-ISAGA IgM® (adults 98.7%, neonates 63.1%) was similar to that of Platelia Toxo IgM® (adults 94.4%, neonates 64.6%), and significantly higher than Liaison Toxo IgM® (adults 90.6%), Architect/Alinity Toxo IgM® (adults 95.7%, neonates 48.6%), and Vidas Toxo IgM® (adults 81.8%, neonates 17.5%). However, the specificities varied between 24.4% (Platelia Toxo IgM®) and 95.2% (Liaison Toxo IgM®) in adults and were >95% for all tests in neonates. An analysis of the kappa coefficients showed better agreement between ISAGA IgM® and the other tests in children (0.75–0.83%) than in adults (0.11–0.53%). We conclude that, in the absence of Toxo-ISAGA IgM®, the association of a very sensitive technique (Platelia Toxo IgM® or Architect/Alinity Toxo IgM®) and a very specific technique (Vidas Toxo IgM® or Liaison Toxo IgM®) is recommended for IgM detection in adult sera. For neonates, Platelia Toxo IgM® appeared to be the best alternative to replace Toxo-ISAGA IgM®