Elaboração de instrumento para a investigação das falsas memórias.

International audienc

Accompagnement à la parentalité en Protection maternelle et infantile : co-construction de la logique d’intervention PERL

Introduction : En région Grand Est (France), une intervention de prévention primaire en périnatalité a montré des résultats encourageants sur le développement de l’enfant. Afin de rendre cette intervention transférable et pérenne hors d’un contexte de recherche, elle a été adaptée dans une politique de santé familiale universelle et évaluée par la recherche « Petite enfance, recherche-action en Lorraine » (PERL).Méthode : L’objectif de l’article est d’exposer la logique d’intervention de PERL, explicitée par l’évaluation des processus et mécanismes (2018-2019). Ancrée dans une démarche de co-construction, la méthode s’est structurée autour de 18 entretiens suivis d’un processus de concertation auprès des acteurs–chercheurs–décideurs impliqués.Résultats : Porté par les services de protections maternelle et infantile (PMI), PERL s’articule autour de visites au domicile de puéricultrices, d’analyses des pratiques et de supervisions. À l’inverse d’une tendance à la normalisation, l’approche reconnaît le parent comme expert de son enfant et propose un accompagnement le soutenant dans son rôle. L’importance des supervisions, pour soutenir les puéricultrices confrontées à des situations complexes, constitue une des pierres angulaires du dispositif.Discussion : PERL est un programme structuré et non standardisé d’accompagnement à la parentalité, impliquant des concepts forts de « promotion de la santé ». Cette évaluation met en avant l’importance de bénéficier d’une vision partagée de la logique d’une intervention ainsi que les défis sous-jacents. Dans la perspective du déploiement et du transfert de PERL il sera nécessaire d’adapter le dispositif aux contextes et aux territoires. Pour cela, un guide de mise en œuvre a été réalisé.Introduction: In the Greater Eastern region of France, a primary prevention intervention in perinatal care has shown promising results on child development. In order to make this intervention transferable and sustainable outside a research context, it was adapted into a universal family health program. The PERL (Petite Enfance Recherche-action en Lorraine: early childhood research-action in Lorraine) research-action aimed to evaluate the effects of this new intervention. Method: The objective of the article was to present the intervention logic of the PERL program, based on the evaluation of processes and mechanisms (2018-2019). The method was based on 18 semi-structured interviews with actors involved in the construction and implementation of PERL, and a consultation process. Results: Supported by the Maternal and Child Protection services (PMI), PERL is a program based on home visits by nurses, analysis of practices and supervision. In contrast to a standardized or an injunctive perspective, the approach recognizes and supports the parent as an expert of his or her own child. The importance of supervision in facilitating the adoption of an unconditional benevolent posture and the professional development of nurses confronted with complex situations is one of the cornerstones of the system. Conclusions: PERL is a structured and non-standardized parenting support program, based on strong health promotion concepts. This evaluation underlines the importance and challenges of having a shared vision of the intervention logic. In the perspective of the deployment and transfer of PERL, it will be necessary to adapt the system to the contexts and territories. In this perspective, an implementation guide has been produced

Pilot clinical trial of dehydroepiandrosterone (DHEA) versus placebo for Sjögren's syndrome

To screen for potential efficacy and assess feasibility and safety of dehydroepiandrosterone (DHEA) as a treatment for Sjögren's syndrome (SS). A 24-week randomized, double-blinded, pilot trial of oral DHEA (200 mg/day) versus placebo was conducted. The primary comparison was to a hypothesized 20% placebo response rate. If 14 consecutive subjects on DHEA did not respond, a Phase III trial would be considered futile. A placebo group of 14 subjects was planned to verify placebo response rate and estimate sample size required for a definitive trial. Response criteria required 20% improvement in at least 2 of 3 domains. Analysis of covariance was used to adjust for baseline differences and for stratified randomization. Outcome measures included visual analog scale questionnaires for dry eye and dry mouth symptoms, lissamine green ocular dye staining and Schirmer I tests, stimulated salivary flow, IgG, and erythrocyte sedimentation rate (ESR). Randomization resulted in 14 DHEA and 14 placebo group subjects. At baseline, mean +/- SD for DHEA versus placebo groups were Schirmer I tests 4.5 +/- 4.5 versus 5.4 +/- 6.1 mm/5 minutes; Van Bijsterveld score 5.3 +/- 2.1 versus 5.5 +/- 2.2; unstimulated saliva 0.03 +/- 0.05 versus 0.04 +/- 0.10 ml/minute; IgG 1,699 +/- 749 versus 1,712 +/- 621 g/dl; and ESR 40 +/- 31 versus 44 +/- 28 mm/hour. Apart from changes over the trial in dry mouth symptoms, no significant differences were noted between the DHEA and placebo groups for dry eye symptoms, objective measures of ocular dryness, stimulated salivary flow; IgG, or ESR. Four DHEA and one placebo group patient dropped out because of adverse effects. Although 7 subjects met response criteria in the DHEA group, 5 met the criteria in the placebo group, and there was no significant difference between groups. DHEA showed no evidence of efficacy in SS. Without evidence for efficacy, patients with SS should avoid using unregulated DHEA supplements, since long-term adverse consequences of exposure to this hormone are unknow

Development of a model to predict the 10-year cumulative risk of second primary cancer among cancer survivors

International audienceBackgroundTo develop a prediction model to quantify the cumulative risk of Second Primary Cancer (SPC) among cancer patients given that they survive their disease.MethodsA cohort of 293,435 patients based on data from twelve French cancer registries was analyzed. For five first cancer sites, SPC incidence rates were estimated using Poisson regression models. The cumulative risks of SPC were computed for different follow-up times. For comparison purpose, the same method was used to estimate the probability of cancer in the general population.ResultsIn this population-based cohort, 27,320 patients presented with a SPC. The cumulative risk of SPC varied depending on first cancer site, with a 10-year cumulative probability of SPC ranging from 6.2% for women with breast cancer to 44.0% for men with head and neck cancer. Compared with the general population, the 10-year cumulative risk of SPC was dramatically elevated for tobacco-related first cancers, with an increase of +7.3% for men aged 55 to 64 with a first lung cancer and +35.6% for men aged 45 to 54 with a first head and neck cancer. Lower differences were observed among patients diagnosed with a first prostate cancer (+5.5% among men aged 55 to 64), colorectal (+4.1% for women aged 55 to 64 and +6.3% for men aged 55 to 64), and breast (+2.0% among females aged 75 and older) cancers.ConclusionThis study provides physicians with a practical estimate to assess the risk of SPC of their patients more accurately

Ovarian cancer in France: Trends in incidence, mortality and survival, 1980–2012

International audienc

Use of a case-mix approach to study the trends in the incidence of second primary cancers

International audiencePURPOSE:To analyze trends in second primary cancer (SPC) incidence by using a case-mix approach to standardize on first cancer site distribution.METHODS:Cases registered by 13 French cancer registries between 1989 and 2010 and followed-up until June 2013 were included. The person-year approach was used to compute standardized incidence ratios (SIRs) of metachronous SPC. Usual SIRs and cancer site-specific weighted SIRs called "case-mix SIRs" (cmSIRs) were estimated by sex and calendar period of first cancer diagnosis. Calendar trends in SIRs and cmSIRs were compared.RESULTS:More than 2.9 million person-years at risk were included. Among males, SIRs dropped from 1.49 to 1.23 between 1989-1994 and 2005-2010, while cmSIRs decreased from 1.40 to 1.27. This difference seems mainly related to a stronger representation of prostate cancers (at lower risk of SPC) and a weaker contribution of bladder and head and neck cancers (at higher risk of SPC) in recent periods of diagnosis. Among females, both SIRs and cmSIRs have remained stable at around 1.22 and 1.21, respectively.CONCLUSIONS:The cmSIR is an indicator that is not influenced by changes in first cancer site distribution. Its use should be encouraged to assess second cancer incidence control