Dominique Peljak, « L’éducation thérapeutique du patient : la nécessité d’une approche globale, coordonnée et pérenne. »

À la vue du titre de l’article de Dominique Peljak paru dans la revue « Santé Publique », on peut comprendre sans l’avoir parcouru que l’auteur nous parlera de l’éducation thérapeutique du patient (ETP), qu’il prônera certainement les avantages d’une éducation du patient par le corps médical à la fois pérenne et coordonnée. Le terme d’« approche globale » peut laisser penser qu’il réduira le dispositif aux mêmes critères et ceci quelle que soit la pathologie dont les patients sont atteints. O..

Dominique Peljak, « L’éducation thérapeutique du patient : la nécessité d’une approche globale, coordonnée et pérenne. »

À la vue du titre de l’article de Dominique Peljak paru dans la revue « Santé Publique », on peut comprendre sans l’avoir parcouru que l’auteur nous parlera de l’éducation thérapeutique du patient (ETP), qu’il prônera certainement les avantages d’une éducation du patient par le corps médical à la fois pérenne et coordonnée. Le terme d’« approche globale » peut laisser penser qu’il réduira le dispositif aux mêmes critères et ceci quelle que soit la pathologie dont les patients sont atteints. O..

Pour une approche holistique des conditions de vie des populations du passé

International audienceDivers facteurs d’inégalité, tels que le genre, la position sociale, la profession, ou l'origine géographique, interagissent et influencent sur les conditions de vie des populations (approche intersectionnelle). S’y ajoutent des facteurs environnementaux, comme les famines, les guerres ou des problèmes climatiques, qui aggravent les inégalités sociales. La plupart des études comparatives portant sur l’état sanitaire se font à partir des groupes déjà constitués (femme/homme, classe d’âge, site, période ou composition du mobilier funéraire) (Polet, 2016 ; Scott & Hoppa, 2018 ; Ubelaker & Pap, 2009 ; Vercellotti et al., 2011). Elles supposent par là-même que ces groupes sont homogènes, alors qu’ils sont composés d’individus ayant vécu des expériences différentes.Pour contourner ce biais, nous proposons d’utiliser des méthodes statistiques qui permettent d’agréger les individus présentant des conditions de vie similaires (clustering). Pour cette analyse, nous considérons les variables suivantes : cribra orbitalia, hyperostose poreuse de la voûte crânienne, hypoplasie linéaire de l'email dentaire et petite stature. La collection objet de cette analyse, les Capucins de Ferrières (Martigues, Bouches-du-Rhône, 1720-21), présente quelques avantages : elle est composée exclusivement des victimes de l’épidémie de peste dite « de Marseille », leur décès est survenu dans un temps très bref (quelques mois), et tous ces individus ont vécu ensemble, selon les mêmes normes sociales et les mêmes contraintes environnementales.Les résultats obtenus montrent que les différences des conditions de vie sont moins en fonction du sexe ou de l’âge, que des facteurs socio-environnementaux et des caractéristiques socio-biologiques des individus qui leur confèrent une vulnérabilité (frailty) plus ou moins grande.Cette étude démontre qu’une approche genrée des conditions de vie doit prendre en compte la diversité des comportements et des vécus des individus, et qu’une analyse binaire (hommes versus femmes) rend impossible l’observation de toutes ces nuances

Stress et résilience : état sanitaire des enfants victimes de la peste de 1720 (Martigues, Bouches-du-Rhône)

Les règles sociales et les contraintes vécues ont une influence sur l’état de santé des populations. Dans cette note, nous évaluons l’impact d’une succession de crises sur l’état sanitaire d’un échantillon de squelettes d’individus immatures (n=66), victimes de la peste de 1720 (Martigues, Bouches-du-Rhône), à partir de l’observation de marqueurs de stress physiologiques (hypoplasie linéaire de l’émail dentaire, cribra orbitalia et hyperostose poreuse de la voûte crânienne). Notre but est de vérifier si les différentes classes d’âges ont été affectés de manière similaire par les stress, et d’établir un lien entre le stress vécu et les crises décrites dans les documents historiques. En effet, avant l’épidémie de peste de 1720, la Provence a connu plusieurs crises historiquement bien attestées : des événements climatiques extrêmes, des famines, des épidémies. Nous observons que 69,7% des individus sont touchés par au moins un marqueur de stress, 59% présentent des hypoplasies linéaires de l’émail dentaire, 50% des cribra orbitalia et 29% de l’hyperostose de la voûte crânienne. Nous avons observé un lien entre la prévalence des marqueurs de stress et les crises connues, notamment pour les enfants âgés de 10 ans (±30 mois) et de 15 ans (±36 mois). Ces squelettes témoignent des mauvaises conditions de vie qui prévalaient à Martigues à la veille de la peste.Any population’s living conditions are influenced by social rules and difficulties experienced. This being so, our paper assesses the impact of a succession of crises on the living conditions of a sample (n=66) of immature skeletons of victims of the Marseille plague (Martigues, Bouches-du-Rhône; 1720-1721), through observations of the presence of physiological stress markers (linear enamel hypoplasia, cribra orbitalia and porotic hyperostosis of the cranial vault). The aim is to verify whether different age categories were similarly affected by the stresses they experienced, and to establish a link between the stresses and crises described in historical documents. The Provence region had experienced several crises before this plague epidemic, including extreme climatic events, famines and other epidemics. We observed that at least one stress marker is present in 69.7% of the individuals, with 59% presenting linear enamel hypoplasia, 50% presenting cribra orbitalia and 29% porotic hyperostosis of the cranial vault. We observed a link between the prevalence of stress markers and historically known crises, particularly in the 10 year-old (±30 months) and 15 year-old (±36 months) age groups. These skeletons reflect the poor living conditions that prevailed in Martigues shortly before the plague

Getting to the point: An experimental approach to improving the identification of penetrating projectile trauma to bone caused by medieval arrows.

The bow and arrow were an important part of medieval warfare, and the study of projectile injuries in skeletal assemblages has the potential to give valuable insight into the nature of conflict in this period. Projectile injuries are often overlooked in favour of sharp force trauma, and as of yet there have been no experiments looking at skeletal trauma caused by different types of medieval arrows, although several studies have examined prehistoric impact marks. The current study addresses this deficiency by examining the lesions left by three kinds of medieval arrowheads: leaf-shaped broadheads, armour-piercing bodkins, and barbed hunting broadheads, when fired from a longbow into cattle scapulae. The results show that the vast majority of impacts are puncture lesions with shapes that roughly conform to the cross-section of the heads used, and many of the defects perforate the bone entirely and have internal bevelling. Based mostly on wound shape, it is relatively straightforward to distinguish between bodkin and broadhead punctures, while the different types of broadheads leave more similar, yet distinctive, marks. Further experiments are required in order to assess the extent to which it is possible to distinguish between projectile trauma and penetrating trauma made by other types of medieval weapons

Nose profile morphology and accuracy study of nose profile estimation method in Scottish subadult and Indonesian adult populations

This study investigated nose profile morphology and its relationship to the skull in Scottish subadult and Indonesian adult populations, with the aim of improving the accuracy of forensic craniofacial reconstruction. Samples of 86 lateral head cephalograms from Dundee Dental School (mean age, 11.8 years) and 335 lateral head cephalograms from the Universitas Padjadjaran Dental Hospital, Bandung, Indonesia (mean age 24.2 years), were measured. The method of nose profile estimation based on skull morphology previously proposed by Rynn and colleagues in 2010 (FSMP 6:20–34) was tested in this study. Following this method, three nasal aperture-related craniometrics and six nose profile dimensions were measured from the cephalograms. To assess the accuracy of the method, six nose profile dimensions were estimated from the three craniometric parameters using the published method and then compared to the actual nose profile dimensions. In the Scottish subadult population, no sexual dimorphism was evident in the measured dimensions. In contrast, sexual dimorphism of the Indonesian adult population was evident in all craniometric and nose profile dimensions; notably, males exhibited statistically significant larger values than females. The published method by Rynn and colleagues (FSMP 6:20–34, 2010) performed better in the Scottish subadult population (mean difference of maximum, 2.35 mm) compared to the Indonesian adult population (mean difference of maximum, 5.42 mm in males and 4.89 mm in females). In addition, regression formulae were derived to estimate nose profile dimensions based on the craniometric measurements for the Indonesian adult population. The published method is not sufficiently accurate for use on the Indonesian population, so the derived method should be used. The accuracy of the published method by Rynn and colleagues (FSMP 6:20–34, 2010) was sufficiently reliable to be applied in Scottish subadult population

A Fully Three-Dimensional Method for Facial Reconstruction Based on Deformable Models

International audienceTwo facial models corresponding to two deceased subjects have been manually created and the two corresponding skulls have been dissected and skeletonized. These pairs of skull/ facial data have been scanned with a CT scanner, and the computed geometric three-dimensional models of both skulls and facial tissue have been built. One set of skull/facial data will be used as a reference set whereas the second set is used as ground truth for validating our method. After a semi-automatic face-skull registration, we apply an original computing global parametric transformation T that turns the reference skull into the skull to be reconstructed. This algorithm is based upon salient lines of the skull called crest lines: more precisely the crest lines of the first skull are matched to the crest lines of the second skull by an iterative closest point algorithm. Then we apply this algorithm to the reference face to obtain the "unknown" face to be reconstructed. The reliability and difficulties of this original technique are then discussed

Research potential and limitations of trace analyses of cremated remains

Human cremation is a common funeral practice all over the world and willpresumably become an even more popular choice for interment in thefuture. Mainly for purposes of identification, there is presently agrowing need to perform trace analyses such as DNA or stable isotopeanalyses on human remains after cremation in order to clarify pendingquestions in civil or criminal court cases. The aim of this study was toexperimentally test the potential and limitations of DNA and stableisotope analyses when conducted on cremated remains.For this purpose, tibiae from modern cattle were experimentally crematedby incinerating the bones in increments of 100 degrees C until a maximumof 1000 degrees C was reached. In addition, cremated human remains werecollected from a modern crematory. The samples were investigated todetermine level of DNA preservation and stable isotope values (C and Nin collagen, C and O in the structural carbonate, and Sr in apatite).Furthermore, we assessed the integrity of microstructural organization,appearance under UV-light, collagen content, as well as the mineral andcrystalline organization. This was conducted in order to provide ageneral background with which to explain observed changes in the traceanalyses data sets. The goal is to develop an efficacious screeningmethod for determining at which degree of burning bone still retains itsoriginal biological signals. We found that stable isotope analysis ofthe tested light elements in bone is only possible up to a heat exposureof 300 degrees C while the isotopic signal from strontium remainsunaltered even in bones exposed to very high temperatures. DNA-analysesseem theoretically possible up to a heat exposure of 600 degrees C butcan not be advised in every case because of the increased risk ofcontamination. While the macroscopic colour and UV-fluorescence ofcremated bone give hints to temperature exposure of the bone’s outersurface, its histological appearance can be used as a reliable indicatorfor the assessment of the overall degree of burning